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Drake MJ, Clavica F, Murphy C, Fader MJ. Innovating Indwelling Catheter Design to Counteract Urinary Tract Infection. Eur Urol Focus 2024:S2405-4569(24)00184-6. [PMID: 39341718 DOI: 10.1016/j.euf.2024.09.015] [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: 07/10/2024] [Revised: 09/08/2024] [Accepted: 09/20/2024] [Indexed: 10/01/2024]
Abstract
BACKGROUND AND OBJECTIVE Bacteriuria is anticipated in long-term indwelling catheter (IDC) use, and urinary tract infections (UTIs) and related issues are common. Defence mechanisms against infection are undermined by the presence of a Foley catheter, and adjustments to design could influence UTI risk. METHODS We reviewed the various aspects of IDCs and ureteric stent designs to discuss potential impact on UTI risk. KEY FINDINGS AND LIMITATIONS Design adaptations have focussed on reducing the sump of undrained urine, potential urinary tract trauma, and bacterial adherence. Experimental and computational studies on ureteral stents found an interplay between urine flow, bacterial microcolony formation, and accumulation of encrusting particles. The most critical regions for biofilm and crystal accumulation are associated with low shear stress. The full drainage system is the functioning unit, not just the IDC in isolation. This means reliably keeping the drainage system closed and considering whether a valve is preferred to a collection bag. Other developments may include one-way valves, obstacles to "bacterial swimming", and ultrasound techniques. Preventing or clearing IDC blockage can exploit access via the lumen or retaining balloon. Progress in computational fluid dynamics, energy delivery, and soft robotics may increase future options. Clinical data on the effectiveness of IDC design features are lacking, which is partly due to reliance on proxy measures and the challenges of undertaking trials. CONCLUSIONS AND CLINICAL IMPLICATIONS Design changes are legitimate lines of development, but are only indirect for UTI prevention. Modifications may be advantageous, but might potentially bring problems in other ways. Education of health care professionals can improve UTIs and should be prioritised. PATIENT SUMMARY Catheters used to help bladder drainage can cause urinary infections, and improvements in design might reduce the risk. Several approaches are described in this review. However, proving that these approaches work is a challenge. Training professionals in the key aspects of catheter care is important.
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Affiliation(s)
- Marcus J Drake
- Department of Surgery and Cancer, Imperial College, London, UK; Department of Urology, Charing Cross Hospital, London, UK.
| | - Francesco Clavica
- ARTORG Center for Biomedical Engineering Research, University of Bern, Bern, Switzerland; Department of Urology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Cathy Murphy
- School of Health Sciences, University of Southampton, Southampton, UK
| | - Mandy J Fader
- School of Health Sciences, University of Southampton, Southampton, UK
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Françot M, Lefevre C, Reiss B, Lefort M, Karam G, Rigaud J, Le Normand L, Ruffion A, Perrouin‐Verbe B, Perrouin‐Verbe M. Indications and added value of videourodynamics in men with spinal cord injury. BJUI COMPASS 2024; 5:761-769. [PMID: 39157163 PMCID: PMC11327492 DOI: 10.1002/bco2.370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2023] [Revised: 04/07/2024] [Accepted: 04/10/2024] [Indexed: 08/20/2024] Open
Abstract
Purpose The primary aim of this study was to evaluate the indications and additional information provided by videourodynamic study (VUDS) over urodynamic studies (UDS) in men with spinal cord injury (SCI) and neurogenic lower urinary tract dysfunction (NLUTD). The secondary aim was to determine the added value of VUDS and its impact on bladder management. Materials and Methods Single-centre retrospective study of all men with SCI who underwent VUDS between 2011 and 2021. Participant characteristics, clinical data and indications for UDS and VUDS as well as bladder management were recorded. The added value of VUDS was defined as additional information not provided by standard UDS that impacted on bladder management (choice of voiding mode, surgical indication or type of surgery). Results Eighty-eight men with a median age of 52 years were included. In 20 men who were unable to perform self-catheterisation, the VUDS clarified the nature and extent of the obstruction and enabled targeted surgery to achieve reflex bladder emptying in all of them. VUDS also clarified the type and level of obstruction in 28 patients, enabling targeted surgery in 24. In 11 men, VUDS was performed as part of the preoperative assessment for a Brindley procedure or after this operation if a complication occurred during follow-up to confirm the need for further surgery or to target surgical revision. Overall, VUDS had added value in 59 patients (67%). Conclusions VUDS had added value over UDS in specific situations; the additional information provided impacted on bladder management in men with SCI and NLUTD.
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Affiliation(s)
- Marc Françot
- Department of UrologyNantes University HospitalNantesFrance
| | - Chloé Lefevre
- Department of Physical Medicine and RehabilitationNantes University HospitalNantesFrance
| | - Bénédicte Reiss
- Department of Physical Medicine and RehabilitationNantes University HospitalNantesFrance
| | - Marc Lefort
- Department of Physical Medicine and RehabilitationNantes University HospitalNantesFrance
| | - Georges Karam
- Department of UrologyNantes University HospitalNantesFrance
| | - Jerome Rigaud
- Department of UrologyNantes University HospitalNantesFrance
| | | | - Alain Ruffion
- Urology Department, Lyon Sud Hospital, Hospices Civils de Lyon, Lyon Cancer Innovation Center (EA 3738 CICLY)Lyon Sud Medical School, University of Lyon 1LyonFrance
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Neves Videira LG, Corbo LN, de Avila MAG, Martins GP, Schoeller SD, Kappler C, Faleiros F. Analysis of Urinary Incontinence in the Neurogenic Bladder and Its Relationship with the Satisfaction and Lifestyle of People with SCI. Healthcare (Basel) 2024; 12:1501. [PMID: 39120204 PMCID: PMC11311287 DOI: 10.3390/healthcare12151501] [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: 05/16/2024] [Revised: 07/22/2024] [Accepted: 07/23/2024] [Indexed: 08/10/2024] Open
Abstract
One of the most common complications of neurogenic bladder secondary to spinal cord injury (SCI) is urinary incontinence, which is possibly related to bladder-emptying methods and changes in quality of life. This study aimed to identify the occurrence of this complication in adults with SCI and analyze its relationship with bladder-emptying methods, satisfaction, and lifestyle. This is a quantitative, exploratory, and cross-sectional study. The variables were collected using the Bowel and Bladder Treatment Index during a telephone interview with 290 participants from February to November 2021. According to the results, 70% of the participants were male and 74.1% performed clean intermediate catheterization (CIC) as the main bladder-emptying method. Moreover, 55.6% were considered incontinent in the last year. Emptying by normal urination and bladder reflex triggering had a statistically significant relationship with urinary incontinence. A statistical association was observed between all the variables of satisfaction and lifestyle with urinary incontinence. Although CIC reduced urine leakage, a considerable number of participants still presented with frequent urine leakage. Urinary incontinence had a negative impact on satisfaction with the bladder-emptying method, effectiveness of bladder management, quality of life, and personal and social relationships.
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Affiliation(s)
- Lorena Gomes Neves Videira
- Ribeirão Preto College of Nursing, University of São Paulo, Ribeirao Preto 14040-902, Brazil; (L.G.N.V.); (L.N.C.); (G.P.M.)
| | - Letícia Noelle Corbo
- Ribeirão Preto College of Nursing, University of São Paulo, Ribeirao Preto 14040-902, Brazil; (L.G.N.V.); (L.N.C.); (G.P.M.)
| | | | - Giovana Pelosi Martins
- Ribeirão Preto College of Nursing, University of São Paulo, Ribeirao Preto 14040-902, Brazil; (L.G.N.V.); (L.N.C.); (G.P.M.)
| | | | - Christoph Kappler
- Faculty of Rehabilitation Sciences, University of Dortmund, 44227 Dortmund, Germany;
| | - Fabiana Faleiros
- Ribeirão Preto College of Nursing, University of São Paulo, Ribeirao Preto 14040-902, Brazil; (L.G.N.V.); (L.N.C.); (G.P.M.)
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Wang Q, Hou G, Wen M, Ren Z, Duan W, Lei X, Yao Z, Zhao S, Ye B, Tu Z, Huang P, Xie F, Gao B, Hu X, Luo Z. How to assess the long-term recovery outcomes of patients with cauda equina syndrome before surgery: a retrospective cohort study. Int J Surg 2024; 110:4197-4207. [PMID: 38502853 PMCID: PMC11254269 DOI: 10.1097/js9.0000000000001336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Accepted: 03/03/2024] [Indexed: 03/21/2024]
Abstract
BACKGROUND Factors influencing recovery after decompression surgery for cauda equina syndrome (CES) are not completely identified. The authors aimed to investigate the most valuable predictors (MVPs) of poor postoperative recovery (PPR) in patients with CES and construct a nomogram for discerning those who will experience PPR. METHODS Three hundred fifty-six patients with CES secondary to lumbar degenerative diseases treated at Xijing Hospital were randomly divided into training ( N =238) and validation ( N =118) cohorts at a 2:1 ratio. Moreover, 92 patients from the 970 th Hospital composed the testing cohort. Least Absolute Shrinkage and Selection Operator regression (LASSO) was used for selecting MVPs. The nomogram was developed by integrating coefficients of MVPs in the logistic regression, and its discrimination, calibration, and clinical utility were validated in all three cohorts. RESULTS After 3 to 5 years of follow-up, the residual rates of bladder dysfunction, bowel dysfunction, sexual dysfunction, and saddle anesthesia were 41.9, 44.1, 63.7, and 29.0%, respectively. MVPs included stress urinary incontinence, overactive bladder, low stream, difficult defecation, fecal incontinence, and saddle anesthesia in order. The discriminatory ability of the nomogram was up to 0.896, 0.919, and 0.848 in the training, validation, and testing cohorts, respectively. Besides, the nomogram showed good calibration and clinical utility in all cohorts. Furthermore, the optimal cutoff value of the nomogram score for distinguishing those who will experience PPR was 148.02, above which postoperative outcomes tend to be poor. CONCLUSION The first pretreatment nomogram for discerning CES patients who will experience PPR was developed and validated, which will aid clinicians in clinical decision-making.
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Affiliation(s)
- Qiushi Wang
- Department of Orthopaedic, Xijing Hospital, Air Force Medical University
- Department of Orthopaedic, No. 970th Hospital of Joint Logistic Support Force of PLA, Yantai
| | - Guangdong Hou
- Department of Urology, Xijing Hospital, Air Force Medical University, Xi’an
| | - Mengyuan Wen
- Department of Orthopaedic, Xijing Hospital, Air Force Medical University
- School of Nursing, Shaanxi University of Traditional Chinese Medicine, Xianyang, Shaanxi, People’s Republic of China
| | - Zhongwu Ren
- Department of Orthopaedic, No. 970th Hospital of Joint Logistic Support Force of PLA, Yantai
| | - Wei Duan
- Department of Orthopaedic, Xijing Hospital, Air Force Medical University
| | - Xin Lei
- Department of Orthopaedic, Xijing Hospital, Air Force Medical University
| | - Zhou Yao
- Department of Orthopaedic, Xijing Hospital, Air Force Medical University
| | - Shixian Zhao
- Department of Orthopaedic, Xijing Hospital, Air Force Medical University
| | - Bin Ye
- Department of Orthopaedic, Xijing Hospital, Air Force Medical University
| | - Zhipeng Tu
- Department of Orthopaedic, Xijing Hospital, Air Force Medical University
| | - Peipei Huang
- Department of Orthopaedic, Xijing Hospital, Air Force Medical University
| | - Fang Xie
- Department of Orthopaedic, Xijing Hospital, Air Force Medical University
| | - Bo Gao
- Department of Orthopaedic, Xijing Hospital, Air Force Medical University
| | - Xueyu Hu
- Department of Orthopaedic, Xijing Hospital, Air Force Medical University
| | - Zhuojing Luo
- Department of Orthopaedic, Xijing Hospital, Air Force Medical University
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Jin X, Tang H, Yuan H, Chen G. Case report: Sacral neuromodulation for neurogenic lower urinary tract dysfunction in patient with neuronal intranuclear inclusion disease. Heliyon 2024; 10:e32374. [PMID: 39183860 PMCID: PMC11341320 DOI: 10.1016/j.heliyon.2024.e32374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2023] [Revised: 06/01/2024] [Accepted: 06/03/2024] [Indexed: 08/27/2024] Open
Abstract
Neuronal intranuclear inclusion disease is an uncommon neurodegenerative disorder. The diagnosis of this condition has become more definitive based on current research. However, treatment options remain limited. Neurogenic lower urinary tract dysfunction is one of the prevalent and significant complications, which is the result of its multi-system effects. Here, we present the case of a 48-year-old man diagnosed with neuronal intranuclear inclusion disease based on existing evidence and was complicated by neurogenic lower urinary tract dysfunction. Despite undergoing some medical treatments, his lower urinary tract symptoms, including urinary incontinence, incomplete or intermittent voiding, etc, continued to worsen while upper urinary tract injury developed. Based on careful consideration of the patient's condition and the available findings, we performed an unprecedented sacral neuromodulation on him. Implementation of sacral neuromodulation led to significant improvement in his urination function and alleviate kidney function damage. Our case suggests a potential therapeutic role for sacral neuromodulation in the treatment of neurogenic lower urinary tract dysfunction associated with neuronal intranuclear inclusion disease. Additional research is required to determine the effectiveness of sacral neuromodulation in managing neurogenic lower urinary tract dysfunction caused by various etiologies.
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Affiliation(s)
- Xiaosong Jin
- Department of Urology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Haibin Tang
- Department of Urology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Heng Yuan
- Department of Urology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Gang Chen
- Department of Urology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
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Frainey BT, Clayton DB. OnabotulinumtoxinA is now an important tool for managing pediatric neurogenic lower urinary tract dysfunction. Front Pediatr 2024; 12:1407009. [PMID: 38887561 PMCID: PMC11180881 DOI: 10.3389/fped.2024.1407009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2024] [Accepted: 05/09/2024] [Indexed: 06/20/2024] Open
Abstract
Initial urologic management of pediatric neurogenic lower urinary tract dysfunction (NLUTD) includes clean intermittent catheterization (CIC) regimen and use of anticholinergic or beta3 agonist medications. Historically, NLUTD that did not respond to these initial management strategies received open surgical procedures such as augmentation cystoplasty (AC) to increase bladder capacity and create a lower-pressure reservoir. Since its first reported use in 2002, intradetrusor onabotulinumtoxinA (BTX-A) injections has developed an emerging role in management of pediatric NLUTD, culminating in its recent FDA-approval in 2021. In this review, the current evidence regarding the safety, tolerability, and efficacy of BTX-A use in pediatric NLUTD will be summarized. Additionally, we will attempt to define the current role of BTX-A in the management of patients with NLUTD, discuss limitations to the current body of literature, and suggest future avenues of study.
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Affiliation(s)
- Brendan T. Frainey
- Department of Urology, Division of Pediatric Urology, Monroe Carell Jr. Children’s Hospital at Vanderbilt, Vanderbilt University Medical Center, Nashville, TN, United States
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Kammuang-Lue P, Pattanakuhar S, Sermsuk M, Angkurawaranon C. Duration of detrusor overactivity as an independent predictive factor of upper urinary tract deterioration in patients with traumatic spinal cord injury: results of a retrospective cohort study. Spinal Cord 2024; 62:328-335. [PMID: 38575739 DOI: 10.1038/s41393-024-00988-5] [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: 07/20/2023] [Revised: 03/26/2024] [Accepted: 03/27/2024] [Indexed: 04/06/2024]
Abstract
OBJECTIVE To determine whether duration of detrusor overactivity (DO) during a cystometric study is an independent predictive factor of upper urinary tract deterioration (UUTD) in patients with traumatic spinal cord injury (TSCI). STUDY DESIGN Retrospective cohort study. SETTING A rehabilitation facility in Chiang Mai, Thailand. METHODS Data were obtained from medical records of patients who underwent cystometric evaluation at 6-12 months after TSCI. The independent predictor of interest is the duration of DO, which was evaluated by the DO/cystometry ratio (DOratio). Other conventional urodynamic parameters (maximum detrusor pressure, cystometric capacity, bladder compliance, and detrusor-sphincter dyssynergia) and clinical parameters (age, sex, level and severity of injury, comorbidities, bladder emptying method, and history of urinary tract infection) were determined. The outcome was UUTD, which is indicated by chronic kidney disease (GFR < 60 ml/min/1.73 m2), hydronephrosis, and/or vesicoureteral reflux. Multivariable Cox regression analysis was used to determine the independent associations between DOratio and UUTD by adjusting with all other parameters. RESULTS Medical records of 194 patients with TSCI were included in the study. During a combined total of 1260 follow-up years of those patients, 34 UUTD events were identified, indicating an incidence rate of 27.0 cases per 1000 person-years. After adjusting for all other parameters, a high DOratio (≥0.33) was significantly associated with UUTD (hazard ratio = 3.00 [95% CI: 1.12-7.99], p = 0.025). CONCLUSION DOratio may be an independent cystometric predictor of UUTD in patients with TSCI. However, further prospective study is needed prior to applying DOratio as a predictor of UUTD in clinical settings. CLINICAL TRIAL REGISTRATION There was no clinical trial registration since this study is not a clinical trial.
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Affiliation(s)
- Pratchayapon Kammuang-Lue
- Department of Rehabilitation Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Sintip Pattanakuhar
- Department of Rehabilitation Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand.
- Health Services and Clinical Care Unit, Swiss Paraplegic Research, Nottwil, Switzerland.
| | - Maysa Sermsuk
- Department of Rehabilitation Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Chaisiri Angkurawaranon
- Department of Family Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
- Global Health and Chronic Conditions Research Group, Chiang Mai University, Chiang Mai, Thailand
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Xing H, Dai H, Li B, Yuan X, Liu X, Cui G, Liu N, Biering-Sørensen F. Factors associated with urinary tract infection in the early phase after performing intermittent catheterization in individuals with spinal cord injury: a retrospective study. Front Med (Lausanne) 2023; 10:1257523. [PMID: 38046407 PMCID: PMC10691259 DOI: 10.3389/fmed.2023.1257523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Accepted: 10/23/2023] [Indexed: 12/05/2023] Open
Abstract
Objectives To investigate the occurrence rate of urinary tract infections (UTIs) in the early phase after performing intermittent catheterization (IC) and to explore the possible factors associated with UTIs after performing IC among people with spinal cord injury (SCI). Setting An inpatient rehabilitation department of a teaching hospital in China. Design Retrospective chart review. Methods A retrospective chart review was carried out for traumatic and non-traumatic SCI patients after performing IC during their inpatient stay. Demographic information, comorbidity of diabetes, urine analysis results before IC, method of IC (sterile or clean), use of bladder irrigation, cessation of IC and its reasons, and UTI events were collected. Results A total of 183 adult individuals were included, of which 60 (32.8%) of them were women. The median age was 49.0 years. The median time post-injury was 2 months. The overall occurrence rate of UTI after performing IC was 1.31 (95% confidence intervals: 0.96-1.77) events per 100 days. Sixty-nine (37.7%) patients discontinued IC during hospitalization, and UTIs were the leading reason for cessation (50.7%). Female sex, use of antibiotics for infections other than UTI, and use of bladder irrigation were found to be associated with a lower occurrence rate of UTI in the early phase after performing IC, with an odds ratio of 0.38 (p = 0.019), 0.20 (p = 0.022), and 0.24 (p < 0.001), respectively. Conclusion UTI after performing IC is prevalent among people with SCI. The study indicated that antibiotic prophylaxis and routine bladder irrigation might be associated with the reduction in UTI in the early phase after performing IC. Further research is needed to provide more evidence.
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Affiliation(s)
- Huayi Xing
- Department of Rehabilitation Medicine, Peking University Third Hospital, Beijing, China
| | - Hongyue Dai
- Department of Rehabilitation Medicine, Peking University Third Hospital, Beijing, China
| | - Baohua Li
- Department of Nursing, Peking University Third Hospital, Beijing, China
| | - Xiaoning Yuan
- Department of Hospital-Acquired Infection Control, Peking University Third Hospital, Beijing, China
| | - Xiaoxuan Liu
- Department of Rehabilitation Medicine, Peking University Third Hospital, Beijing, China
| | - Guoqing Cui
- Department of Rehabilitation Medicine, Peking University Third Hospital, Beijing, China
| | - Nan Liu
- Department of Rehabilitation Medicine, Peking University Third Hospital, Beijing, China
| | - Fin Biering-Sørensen
- Clinic for Spinal Cord Injuries, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
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Takahashi R, Sekido N, Matsuoka M, Sengoku A, Nomi M, Matsuyama F, Murata T, Kitta T, Mitsui T. Hygiene management of intermittent self-catheterization using reusable silicone catheters in people with spinal cord lesions: A cross-sectional Internet survey in Japan. Low Urin Tract Symptoms 2023; 15:165-172. [PMID: 37300392 DOI: 10.1111/luts.12490] [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: 04/23/2023] [Revised: 05/15/2023] [Accepted: 05/21/2023] [Indexed: 06/12/2023]
Abstract
OBJECTIVES To investigate hygiene management and catheter maintenance of reusable silicone catheters for intermittent self-catheterization (ISC) in Japan and examine their relationship with symptomatic urinary tract infection (sUTI). METHODS We conducted a cross-sectional Internet survey of people performing ISC using reusable silicone catheters owing to spinal cord lesions in Japan. Hygiene management and catheter maintenance of reusable silicone catheters and the incidence and frequency of sUTI were evaluated. We also examined the significant risk factors for sUTI. RESULTS Of 136 respondents, 62 (46%), 41 (30%), and 58 (43%) washed hands with water, washed hands with soap, and cleaned or disinfected the urethral meatus every time or most of the time before ISC, respectively. No significant difference was observed in the incidence and frequency of sUTI between respondents who adhered to these procedures and those who did not. There were no significant differences in the incidence and frequency of sUTI in respondents who changed their catheters every month and in those who changed their preservation solution within 2 days compared with those who did not. In multivariate analysis, pain during ISC, inconvenience of indoor mobility, bowel management problems, and participants' feeling of never having received instruction on catheter replacement were significant risk factors for sUTI. CONCLUSIONS There are individual differences in hygiene management and catheter maintenance of reusable silicone catheters, but the influence of these differences on the incidence and frequency of sUTI is not clear. Pain during ISC, bowel management problems, and inadequate instruction on catheter maintenance procedures are factors associated with sUTI.
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Affiliation(s)
| | - Noritoshi Sekido
- Department of Urology, Toho University Ohashi Medical Center, Tokyo, Japan
| | - Mihoko Matsuoka
- Department of Rehabilitation Medicine, Aijinkai Rehabilitation Hospital, Osaka, Japan
| | - Atsushi Sengoku
- Department of Urology, Hyogo Prefectural Central Rehabilitation Hospital, Hyogo, Japan
| | - Masashi Nomi
- Department of Urology, Hyogo Prefectural Central Rehabilitation Hospital, Hyogo, Japan
| | | | | | - Takeya Kitta
- Department of Renal and Urologic Surgery, Asahikawa Medical University, Hokkaido, Japan
| | - Takahiko Mitsui
- Department of Urology, University of Yamanashi Graduate School of Medical Sciences, Yamanashi, Japan
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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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KÜTÜKOĞLU U, ALTUNTAŞ T, ŞAHİN B, ONUR R. Sacral neuromodulation treatment for urinary voiding dysfunctions: results of treatment with the largest single-center series in a tertiary referral center in Turkey. Turk J Med Sci 2023; 53:206-210. [PMID: 36945940 PMCID: PMC10387836 DOI: 10.55730/1300-0144.5575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Revised: 02/22/2023] [Accepted: 03/19/2022] [Indexed: 02/26/2023] Open
Abstract
BACKGROUND Sacral neuromodulation (SNM) is a minimally invasive treatment that modulates spinal reflexes to regulate bladder, urinary sphincter, and pelvic floor and has successfully been used in the treatment of refractory voiding dysfunctions. The aim of this study was to present our experience with SNM in a tertiary referral center with the largest number of patients and review the safety and efficacy of the procedure. METHODS A total of 42 patients with refractory lower urinary tract symptoms were included into the study. After an initial test period, patients who showed more than 50% improvement in their symptoms underwent the second stage of SNM. Twelve patients had overactive bladder (OAB), bladder pain syndrome/interstitial cystitis (BPS/IC) and 17 had urinary retention. The clinical success was examined during follow-up by voiding diary, urodynamics, and global response assessment. RESULTS Between February 2015 and December 2020, a total of 29 patients underwent stages I&II SNM procedures. The mean ages of patients in OAB/BPS group and retention group were 40 (37-57 years) and 35 (27-44 years), respectively. Mean follow-up time was at least 1 year. Overall, 58.5% success rate was observed in OAB, BPS/IC, and urinary retention groups. Global response assessment score in both groups increased significantly (p = 0.001). No statistically significant difference was found between success or failure rates when sex and age were variable parameters (p > 0.05). DISCUSSION SNM appears to be an effective and safe treatment option in restoring voiding dysfunctions in patients with refractory idiopathic and neurogenic voiding dysfunctions. Our initial series revealed favorable results; however, further studies with larger series and longer follow-up are needed.
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Affiliation(s)
- Umut KÜTÜKOĞLU
- Department of Urology, Faculty of Medicine, Marmara University, İstanbul,
Turkey
| | - Türker ALTUNTAŞ
- Department of Urology, Faculty of Medicine, Marmara University, İstanbul,
Turkey
| | - Bahadır ŞAHİN
- Department of Urology, Faculty of Medicine, Marmara University, İstanbul,
Turkey
| | - Rahmi ONUR
- Department of Urology, Faculty of Medicine, Marmara University, İstanbul,
Turkey
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12
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Filip SS, Slyvka RM, Batchynsky AI. HYPERACTIVE BLADDER SYNDROME SECONDARY TO BAROTRAUMA AND CHRONIC STRESS. WIADOMOSCI LEKARSKIE (WARSAW, POLAND : 1960) 2023; 76:2401-2405. [PMID: 38112356 DOI: 10.36740/wlek202311110] [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: 12/21/2023]
Abstract
OBJECTIVE The aim: To improve the results of treatment of hyperactive bladder syndrome in men of working age on the background of barotrauma and stress, as a consequence of combat trauma. PATIENTS AND METHODS Materials and methods: An analysis of the questionnaire and the results of the clinical examination of 32 patients, injured servicemen and people who were injured in combat zones was carried out. The drug solifenacin succinate was used in the treatment complex, which is a specific antagonist of M3 subtype cholinergic receptors. Its influence allows you to achieve relaxation of the bladder detrusor and reduce the contractility of hyperactive bladder. RESULTS Results: The main criterion for the effectiveness of the treatment was a decrease in the number of urgent cases, the frequency of urination and manifestations of nocturia by 50% or more, which was considered a positive effect. At the same time, the positive effect was differentiated as follows : an improvement of these parameters by 75% or more from the initial value which is a good result; reduction of symptoms in the range of 50-75% is satisfactory; less than 50% is an unsatisfactory result. A positive effect from the treatment after 8 weeks was observed in 88% of patients, of which 52% had a good result and 36% had a satisfactory result. CONCLUSION Conclusions: The proposed complex of treatment of hyperactive bladder syndrome as a result of combat trauma against the background of barotrauma with neurological consequences and chronic stress allows to achieve a pronounced clinical effect in the vast majority of male patients of working age. And the diagnostic complex allows you to emphasize aspects of clinical vigilance, both for doctors of a specialized branch and of doctors of a general direction.
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13
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Andretta E, Pagliacci MC, Zuliani C, Filocamo MT, Losavio E, Krassioukov A. A survey of clinical practice concerning long-term follow-up of neurogenic lower urinary tract dysfunction due to spinal cord injury in Italy. J Spinal Cord Med 2022; 45:907-915. [PMID: 33848215 PMCID: PMC9662064 DOI: 10.1080/10790268.2020.1863899] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
CONTEXT/OBJECTIVE This study aimed to assess the clinical practice for long-term follow-up (FU) of neurogenic lower urinary tract dysfunction (NLUTD) due to spinal cord injury (SCI) in Italy and compare this practice with the clinical practice in other countries and with the international guidelines. DESIGN Data concerning the long-term urological FU of individuals with SCI were collected using a questionnaire and analyzed by means of descriptive and inferential statistics. SETTING Twenty-one Italian centers following SCI patients. PARTICIPANTS One physician at each center (either a permanent staff member or chief). OUTCOME MEASURES Questions addressed the treatment of urinary tract infections (UTI), frequency of visits, urinary tract imaging examinations and urodynamic tests (UD), distinguishing between suprasacral and sacral SCI. RESULTS Nineteen out of 21 centers completed the survey. In most centers, patients were recommended to undergo a visit and an ultrasound examination of urinary tract (UT) at least once a year. While the median interval between FU visits was identical (12 months) for individuals with suprasacral and sacral SCI, the two interval distributions were significantly different (suprasacral SCI: min-max 4-18, IQR = 6; sacral SCI: min-max 6-24; IQR = 8.5; P = 0.02), showing people with suprasacral SCI are followed up more often. Approximately 80% of the surveyed centers performed scheduled UD, with a yearly median frequency of 12 months (range 6-36) for patients with suprasacral SCI, as compared to a median frequency of 18 months for sacral SCI (range 0-36, P = 0.04). VideoUD and antibiotic prophylaxis for recurrent UTIs are carried out only by urologists in 63% and 47.4% of the centers, respectively. Overall, Italian centers share common strategies that compare to standards, including yearly visits, yearly UT examinations and stricter follow-up of people with suprasacral SCI, but may not have standard protocols for antibiotic prophylaxis of UTI, and in few cases control visits and UD are carried out too often. CONCLUSIONS Even though most Italian centers follow up patients with NLUTD secondary to SCI according to international guidelines, heterogeneity in frequency of FU examinations still exists. A tailored approach to the SCI patient that minimizes unnecessary examinations and groups different tests in a single access could improve patients' compliance with FU and reduce costs for the Health system.
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Affiliation(s)
- Elena Andretta
- Urology Department, Dolo General Hospital, Venice, Italy,Correspondence to: Elena Andretta, Urology Department, Dolo General Hospital, Riviera XXIX Aprile, 2, 30031, Dolo, Venice, Italy; Phone: +39 041 5133652; +39 041 5133481.
| | | | | | | | | | - Andrei Krassioukov
- International Collaboration on Repair Discoveries, Vancouver, BC, Canada,Spinal Cord Program, GF Strong Rehabilitation Centre, University of British Columbia, Vancouver, BC, Canada,Department of Physical Medicine and Rehabilitation, University of Western Ontario, London, ON, Canada
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14
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Kovacic J, Dhar A, Shepherd A, Chung A. A rude awakening: management of nocturia in men. TRENDS IN UROLOGY & MEN'S HEALTH 2022. [DOI: 10.1002/tre.886] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- James Kovacic
- Royal North Shore Hospital Sydney Australia
- North Shore Urology Research Group Sydney Australia
| | - Ankur Dhar
- Royal North Shore Hospital Sydney Australia
- North Shore Urology Research Group Sydney Australia
| | - Andrew Shepherd
- Royal North Shore Hospital Sydney Australia
- Adelaide Medical School University of Adelaide Australia
| | - Amanda Chung
- Royal North Shore Hospital Sydney Australia
- North Shore Urology Research Group Sydney Australia
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15
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van Merode NAM, Dawson S, Coulthard E, Henderson EJ, Rice CM, Rees J, Smith M, Strong E, Cotterill N, Huntley AL, Drake MJ. Assessment and Treatment of Nocturia in Neurological Disease in a Primary Care Setting: Systematic Review and Nominal Group Technique Consensus. Eur Urol Focus 2022; 8:33-41. [PMID: 35031351 DOI: 10.1016/j.euf.2021.12.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Accepted: 12/28/2021] [Indexed: 12/16/2022]
Abstract
CONTEXT Neurological disease can affect the rate of urine production and bladder storage function, increasing nocturia severity, with additional risks if mobility or cognition is impaired. OBJECTIVE To conduct a systematic review (SR) of nocturia in neurological diseases and achieve expert consensus for management in clinics without neurologist input. EVIDENCE ACQUISITION Four databases were searched from January 2000 to April 2020. A total of 6262 titles and abstracts were screened and 43 studies were included for full-text screening. Eleven of these met the inclusion criteria and two studies were identified through other sources. The nominal group technique (NGT) was used to develop consensus in panel comprising experts and public representation. EVIDENCE SYNTHESIS Thirteen studies (seven in Parkinson's disease, five in multiple sclerosis) were included, all undertaken in secondary care. Neurological disease severity was incompletely described, and nocturia severity was generally measured subjectively. NGT consensus supported basic neurological assessment, and the use of bladder diaries where neurological impairment permits. Treatments include pelvic-floor muscle training, review of medications, risk mitigation, improving bowel function, therapy for overactive bladder syndrome (if urgency is reported in association with nocturia episodes), treatment of postvoid residual and desmopressin according to licence. Measures to improve mobility and mitigate risk when using the toilet overnight should be considered. Multifactorial issues such as obstructive sleep apnoea and hypoventilation must be considered. CONCLUSIONS Nocturia in neurological disease is complex and lacks a robust evidence base, with very little research done in the primary care context. Guidance should be pragmatic, with reduction of risk a key requirement, until a multidisciplinary evidence base can be developed. PATIENT SUMMARY People with a neurological disease can suffer severe sleep disturbance because of the need to pass urine several times overnight (called nocturia). We looked at published research and found very little information to help general practitioners in managing this condition. We assembled a group of experts to develop practical approaches for assessing and treating nocturia in neurological disease.
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Affiliation(s)
| | - Shoba Dawson
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Elizabeth Coulthard
- Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Emily J Henderson
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK; Older Person's Unit, Royal United Hospital NHS Foundation Trust Bath, Combe Park, Bath, UK
| | - Claire M Rice
- Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | | | - Matthew Smith
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Edward Strong
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Nikki Cotterill
- School of Health and Social Wellbeing, University of the West of England, Bristol, Bristol, UK; Bristol Urological Institute, North Bristol NHS Trust, Bristol, UK
| | - Alyson L Huntley
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Marcus J Drake
- Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK; Bristol Urological Institute, North Bristol NHS Trust, Bristol, UK.
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Herschorn S, Locke J, Vigil H. Hemi-Kock Continent Stoma With Augmentation Cystoplasty: Modifications and Outcomes. Urology 2021; 160:217-222. [PMID: 34910923 DOI: 10.1016/j.urology.2021.10.004] [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: 08/16/2021] [Revised: 09/28/2021] [Accepted: 10/04/2021] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To evaluate the long-term outcomes and impact of surgical modifications on the need for secondary surgery of the Hemi-Kock continent catheterizable stoma, comprising a detubularized ileal segment with an attached stapled ileoileal intussusception of the catheterizable channel, in patients with complex lower urinary tract disorders. The technique may be used for augmentation in patients with reduced bladder capacity who require a continent catheterizable channel. Compared to the flap and ileocecal valve procedures, the hemi-Kock technique has not been widely adopted. MATERIALS AND METHODS This is a retrospective case series including all patients who underwent a hemi-Kock catheterizable channel with cystoplasty from a single institution. Surgical technique and modifications in valve construction and tapering of the catheterizable limb are described. RESULTS A total of 109 patients, with a median age of 38 years (range 18-72), underwent the procedure. At a mean of 10.4 years, 98 patients (90%) reported that they were managing with clean intermittent catheterization ± pads; 11 (10%) were failures. A total of 70 (64.2%) patients underwent secondary interventions with >60% performed endoscopically or under local anesthesia, mainly for bladder stones. Fourteen patients (12.8%) required valve revisions. However, the rate decreased from 18.2% (8/44) to 9.3% (6/65) following incorporation of the surgical modifications. CONCLUSION We present the largest cohort to date of patients managed with a Hemi-Kock catheterizable channel and cystoplasty. Valve revision rate improved with surgical modifications. We demonstrate long-term durability and maintenance of stomal catheterization in the vast majority of patients.
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Affiliation(s)
- Sender Herschorn
- Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada.
| | - Jennifer Locke
- Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Humberto Vigil
- Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
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17
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Demeestere A, de Guerry ML, Bergot C, de Hauteclocque A, Hascoet J, Gamé X, Bajeot AS, Peyronnet B, Capon G, Perrouin-Verbe MA, Biardeau X. Adjustable continence therapy (ACT®) balloons to treat neurogenic and non-neurogenic female urinary incontinence. Neurourol Urodyn 2021; 41:313-322. [PMID: 34633672 DOI: 10.1002/nau.24822] [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: 07/25/2021] [Revised: 08/31/2021] [Accepted: 09/07/2021] [Indexed: 11/07/2022]
Abstract
AIMS To compare efficacy and safety between neurogenic and non-neurogenic women after adjustable continence therapy (ACT®) balloons implantation to treat stress urinary incontinence (SUI) due to intrinsic sphincter deficiency. METHODS In the present retrospective multicentric study, all neurogenic and non-neurogenic women implanted with ACT® balloons between 2000 and 2018 were considered for inclusion. Efficacy was compared 1 year after implantation, and women were allocated in three different groups as follows. Success: maximum 1 pad per day and patient's impression of improvement assessed using a numeral rating scale (NRS) ≥8/10. Improvement: decrease of daily pad use and/or NRS ≥5/10. Failure: increase or stability of daily pad use or NRS <5/10. Overall surgical complications and explantations were compared 1 year after implantation. RESULTS Among the 277 included women, 51 presented with a neurologic underlying disease. Mean age at implantation was 68.5 years. There was no significant difference in efficacy between neurogenic and non-neurogenic women with a success rate of 39.2% and 36.3%, respectively (p = 0.69). Similarly, improvement rate was reported to be 31.4% and 33.6%, in neurogenic and non-neurogenic women, respectively (p = 0.92). The overall surgical complications rate (24% vs. 34.5%, p = 0.15) and the explantation rate (19.6% vs. 28.8%, p = 0.18) were not significantly different. CONCLUSION ACT balloons may be proposed to treat mixed or SUI in females with ISD. Efficacy and safety profiles appear to be similar in both neurogenic and non-neurogenic patients.
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Affiliation(s)
- Amélie Demeestere
- Department of Urology, Claude Huriez Hospital, CHU Lille, Univ. Lille, Lille, France
| | | | | | | | - Juliette Hascoet
- Department of Urology, Rennes University Hospital, Rennes, France
| | - Xavier Gamé
- Department of Urology, University Hospital Paul Sabatier Toulouse III, Toulouse, France
| | | | - Benoit Peyronnet
- Department of Urology, Rennes University Hospital, Rennes, France
| | - Grégoire Capon
- Department of Urology, Bordeaux University Hospital, Bordeaux, France
| | | | - Xavier Biardeau
- Department of Urology, Claude Huriez Hospital, CHU Lille, Univ. Lille, Lille, France
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18
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Honda M, Yokoyama O, Takahashi R, Matsuda T, Nakayama T, Mogi T. Botulinum toxin injections for Japanese patients with urinary incontinence caused by neurogenic detrusor overactivity: Clinical evaluation of onabotulinumtoxinA in a randomized, placebo-controlled, double-blind trial with an open-label extension. Int J Urol 2021; 28:906-912. [PMID: 34075630 PMCID: PMC8453759 DOI: 10.1111/iju.14602] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Accepted: 04/25/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To assess the efficacy and safety of botulinum toxin treatment (onabotulinumtoxinA 200 units) for Japanese patients with neurogenic detrusor overactivity caused by spinal cord injury or multiple sclerosis. METHODS Patients with urinary incontinence refractory to pharmacological treatment were enrolled and randomized in a phase III trial. A single dose of onabotulinumtoxinA (n = 11) or placebo (n = 10) was given in the double-blind phase, and repeat injections of onabotulinumtoxinA were given in the subsequent open-label phase. Outcomes included urinary incontinence episodes, urodynamics, patient-reported outcomes and adverse events. RESULTS The onabotulinumtoxinA group showed a numerically greater reduction in the number of urinary incontinence episodes per day than the placebo group, with the difference between the groups at week 6 of -3.02 (95% confidence interval -5.85 to -0.19). The onabotulinumtoxinA group also showed greater improvements in urodynamic assessments. Adverse events related to onabotulinumtoxinA injections were hematuria, urinary retention, urinary bladder hemorrhage, autonomic dysreflexia and epididymitis. Most events were deemed mild or moderate. CONCLUSIONS Intradetrusor injections of onabotulinumtoxinA are efficacious and tolerable for Japanese patients with neurogenic detrusor overactivity-related symptoms that are difficult to manage with anticholinergics and/or β3 -adrenergic receptor agonists.
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Affiliation(s)
- Masashi Honda
- Department of UrologyTottori University Faculty of MedicineYonagoJapan
| | - Osamu Yokoyama
- Department of UrologyFaculty of Medical ScienceUniversity of FukuiFukuiJapan
| | | | - Tatsuma Matsuda
- Clinical Development (Oncology)Japan Medical and DevelopmentGlaxoSmithKline K.K.TokyoJapan
| | - Takashi Nakayama
- BiostatisticsJapan Medical and DevelopmentGlaxoSmithKline K.K.TokyoJapan
| | - Takao Mogi
- Clinical Development (Specialty)Japan Medical and DevelopmentGlaxoSmithKline K.K.TokyoJapan
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19
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Cracchiolo M, Ottaviani MM, Panarese A, Strauss I, Vallone F, Mazzoni A, Micera S. Bioelectronic medicine for the autonomic nervous system: clinical applications and perspectives. J Neural Eng 2021; 18. [PMID: 33592597 DOI: 10.1088/1741-2552/abe6b9] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Accepted: 02/16/2021] [Indexed: 12/11/2022]
Abstract
Bioelectronic medicine (BM) is an emerging new approach for developing novel neuromodulation therapies for pathologies that have been previously treated with pharmacological approaches. In this review, we will focus on the neuromodulation of autonomic nervous system (ANS) activity with implantable devices, a field of BM that has already demonstrated the ability to treat a variety of conditions, from inflammation to metabolic and cognitive disorders. Recent discoveries about immune responses to ANS stimulation are the laying foundation for a new field holding great potential for medical advancement and therapies and involving an increasing number of research groups around the world, with funding from international public agencies and private investors. Here, we summarize the current achievements and future perspectives for clinical applications of neural decoding and stimulation of the ANS. First, we present the main clinical results achieved so far by different BM approaches and discuss the challenges encountered in fully exploiting the potential of neuromodulatory strategies. Then, we present current preclinical studies aimed at overcoming the present limitations by looking for optimal anatomical targets, developing novel neural interface technology, and conceiving more efficient signal processing strategies. Finally, we explore the prospects for translating these advancements into clinical practice.
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Affiliation(s)
- Marina Cracchiolo
- The BioRobotics Institute and Department of Excellence in Robotics & AI, The BioRobotics Institute, Scuola Superiore Sant'Anna, Pisa, Italy
| | - Matteo Maria Ottaviani
- The BioRobotics Institute and Department of Excellence in Robotics & AI, The BioRobotics Institute, Scuola Superiore Sant'Anna, Pisa, Italy
| | - Alessandro Panarese
- The BioRobotics Institute and Department of Excellence in Robotics & AI, The BioRobotics Institute, Scuola Superiore Sant'Anna, Pisa, Italy
| | - Ivo Strauss
- The BioRobotics Institute and Department of Excellence in Robotics & AI, The BioRobotics Institute, Scuola Superiore Sant'Anna, Pisa, Italy
| | - Fabio Vallone
- The BioRobotics Institute and Department of Excellence in Robotics & AI, The BioRobotics Institute, Scuola Superiore Sant'Anna, Pisa, Italy
| | - Alberto Mazzoni
- The BioRobotics Institute and Department of Excellence in Robotics & AI, The BioRobotics Institute, Scuola Superiore Sant'Anna, Pisa, Italy
| | - Silvestro Micera
- The BioRobotics Institute and Department of Excellence in Robotics & AI, The BioRobotics Institute, Scuola Superiore Sant'Anna, Pisa, Italy.,Bertarelli Foundation Chair in Translational NeuroEngineering, Centre for Neuroprosthetics and Institute of Bioengineering, École Polytechnique Fédérale de Lausanne (EPFL), Lausanne, Switzerland
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20
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Mazouin C, Hubert J, Tricard T, Lecoanet P, Haudebert C, Bentellis I, Baron P, Hascoet J, Castes C, Verhoest G, Tibi B, Pradere B, Bruyere F, Capon G, Manunta A, Saussine C, Peyronnet B. Robot-Assisted Cystectomy and Ileal Conduit for Neurogenic Bladder: Comparison of Extracorporeal vs Intracorporeal Urinary Diversion. J Endourol 2021; 35:1350-1356. [PMID: 33499755 DOI: 10.1089/end.2020.0921] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Objectives: The aim of the present study was to compare the perioperative outcomes of extracorporeal (EXTRA) vs intracorporeal (INTRA) urinary diversion in patients undergoing robotic cystectomy and ileal conduit for neurogenic bladder. Methods: All consecutive patients who underwent robot-assisted cystectomy and ileal conduit for neurogenic bladder in six centers between 2011 and 2020 were included in a retrospective study. Four centers performed exclusively INTRA urinary diversion all over the study period, one center performed exclusively EXTRA urinary diversion, and the last center performed EXTRA urinary diversion during a first period and INTRA during the subsequent period. Results: Ninety-seven patients were included: 66 in the EXTRA group and 31 in the INTRA group. There were 11 major (Clavien grade ≥3) postoperative complications in the overall population (11.3%) with no statistically significant difference between both groups (EXTRA = 12.1% vs INTRA = 9.7%; p = 0.99). The mean length of stay did not differ significantly between INTRA and EXTRA (13.1 vs 14.1 days; p = 0.44). The mean times to oral feeding and to return of bowel function were similar in the two groups (3.9 vs 3.5 days; p = 0.28 and 4.1 vs 4.1 days; p = 0.51, respectively). There was no incisional hernia in the INTRA group vs five in the EXTRA group (0% vs 7.6%; p = 0.17). Conclusion: The perioperative morbidity of robotic cystectomy and ileal conduit for neurogenic bladder appears to be relatively limited compared with the historical open series. Possibly due to the relatively small sample size, no difference was found between INTRA and EXTRA urinary diversion in terms of perioperative outcomes.
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Affiliation(s)
| | - Jacques Hubert
- Department of Urology, University of Nancy, Nancy, France
| | - Thibault Tricard
- Department of Urology, University of Strasbourg, Strasbourg, France
| | | | | | | | - Pierre Baron
- Department of Urology, University of Tours, Tours, France
| | | | - Camille Castes
- Department of Urology, University of Bordeaux, Bordeaux, France
| | | | - Branwell Tibi
- Department of Urology, University of Nice, Nice, France
| | | | - Franck Bruyere
- Department of Urology, University of Tours, Tours, France
| | - Grégoire Capon
- Department of Urology, University of Bordeaux, Bordeaux, France
| | - Andréa Manunta
- Department of Urology, University of Rennes, Rennes, France
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Wang S, Wang R, Wen H, Gao Y, Lv Q, Li H, Wang S, Wang Y, Liu Q, Han J, Wang H, Li Y, Wang Q, Cao T, Wang S, Sun H, Wang Z, Sun X, Wang J. Association of pelvic floor function with postoperative urinary incontinence in cervical cancer patients after the radical hysterectomy. Neurourol Urodyn 2021; 40:483-492. [PMID: 33305849 DOI: 10.1002/nau.24587] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Revised: 11/10/2020] [Accepted: 11/14/2020] [Indexed: 12/21/2022]
Abstract
AIMS To assess the pelvic floor function in cervical cancer patients after radical hysterectomy and its relationship with urinary incontinence (UI). METHODS Cervical cancer patients who underwent radical hysterectomy were recruited from 18 hospitals in China from January 2012 to March 2015. Pelvic floor examinations were conducted by measuring the pelvic floor muscle strength, fatigue of pelvic floor muscle fatigue, dynamic pressure of vaginal, nerve injury, A3 feedback, muscle potential, static tension, and dynamic tension. Postoperative urinary incontinence (UI) was identified using the International Consultation on Incontinence Questionnaire. Multivariable logistic regression analysis was used to assess the association of pelvic floor function examination results with postoperative UI. RESULTS Totally 169 patients were included in this study. The prevalence of UI was 39.6% (67/169). The proportion of abnormal fatigue of Type I muscle (64% vs. 36%, p = .04) and abnormal A3 feedback (53.9% vs. 46.1%, p = .03) were higher among patients with postoperative UI compared to those without UI. In the multivariable analysis, abnormal fatigue of Type I muscle (odds ratio [OR] = 3.73, 95% confidence interval [CI]: 1.42-9.84), abnormal A3 feedback (OR = 2.40, 95% CI: 1.04-5.51), and length of resected vagina > 3 cm (OR = 3.44, 95% CI: 1.27-9.31) were associated with postoperative UI. Compared to laparoscopy, laparotomy was less likely to cause postoperative UI (OR = 0.12, 95% CI:0.04-0.33). CONCLUSIONS The abnormal function of the pelvic floor muscle is related to postoperative UI. Early assessment among these patients is needed to prevent the development of pelvic floor disorder postoperatively.
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Affiliation(s)
- Shiyan Wang
- Department of Obstetrics and Gynecology, Peking University People's Hospital, Beijing, China
- Beijing Key Laboratory of Female Pelvic Floor Disorders, Beijing, China
| | - Runzhi Wang
- Department of Gynecology and Obstetrics, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Hongwu Wen
- Department of Obstetrics and Gynecology, Peking University First Hospital, Beijing, China
| | - Yunong Gao
- Department of Gynecology, Peking University Cancer Hospital and Institute, Beijing, China
| | - Qiubo Lv
- Department of Obstetrics and Gynecology, Beijing Hospital, Beijing, China
| | - Hongyu Li
- Department of Obstetrics and Gynecology, Zhengzhou University Third Hospital, Zhengzhou, China
| | - Sumei Wang
- Department of Obstetrics and Gynecology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Yanlong Wang
- Department of Obstetrics and Gynecology, Women and Children Health Hospital of Xiamen, Xiamen, China
| | - Qing Liu
- Department of Obstetrics and Gynecology, Women and Children Health Hospital of Gansu, Lanzhou, China
| | - Jinsong Han
- Department of Obstetrics and Gynecology, Peking University Third Hospital, Beijing, China
| | - Haibo Wang
- Peking University Clinical Research Institute, Peking University Medical Department, Beijing, China
| | - Yi Li
- Medical Informatics Center, Peking University Medical Department, Beijing, China
| | - Qing Wang
- Department of Obstetrics and Gynecology, Peking University People's Hospital, Beijing, China
- Beijing Key Laboratory of Female Pelvic Floor Disorders, Beijing, China
| | - Tingting Cao
- Department of Obstetrics and Gynecology, Peking University People's Hospital, Beijing, China
- Beijing Key Laboratory of Female Pelvic Floor Disorders, Beijing, China
| | - Sha Wang
- Department of Obstetrics and Gynecology, Peking University People's Hospital, Beijing, China
- Beijing Key Laboratory of Female Pelvic Floor Disorders, Beijing, China
| | - Huaxin Sun
- Department of Obstetrics and Gynecology, Peking University People's Hospital, Beijing, China
- Beijing Key Laboratory of Female Pelvic Floor Disorders, Beijing, China
| | - Zhiqi Wang
- Department of Obstetrics and Gynecology, Peking University People's Hospital, Beijing, China
- Beijing Key Laboratory of Female Pelvic Floor Disorders, Beijing, China
| | - Xiuli Sun
- Department of Obstetrics and Gynecology, Peking University People's Hospital, Beijing, China
- Beijing Key Laboratory of Female Pelvic Floor Disorders, Beijing, China
| | - Jianliu Wang
- Department of Obstetrics and Gynecology, Peking University People's Hospital, Beijing, China
- Beijing Key Laboratory of Female Pelvic Floor Disorders, Beijing, China
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22
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Review of Current Neurogenic Bladder Best Practices and International Guidelines. CURRENT BLADDER DYSFUNCTION REPORTS 2020. [DOI: 10.1007/s11884-020-00622-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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Burholt V, Davies J, Boyd M, Mullins JM, Shoemark EZ. A research agenda for promoting continence for people living with dementia in the community: Recommendations based on a critical review and expert-by-experience opinion. J Clin Nurs 2020; 31:1933-1946. [PMID: 33091190 PMCID: PMC9292568 DOI: 10.1111/jocn.15537] [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: 07/20/2020] [Revised: 10/07/2020] [Accepted: 10/08/2020] [Indexed: 12/03/2022]
Abstract
Aims and objectives To identify research undertaken in the last decade addressing continence for people living with dementia (PLWD) in the community. To highlight gaps and develop recommendations for future research, taking into account the experiences and priorities of PLWD, caregivers and healthcare professionals. Methods A critical review with an Expert Review Group (ERG) comprising researchers, PLWD and facing continence issues, caregivers and other professional stakeholders. Findings are reported in line with the COREQ and Preferred Reporting Items for Systematic reviews and Meta‐Analyses extension for Scoping Reviews checklists. Background Caregivers rate the independent use of the toilet as the most important activity for PLWD to retain. However, in 2009 a review identified shortfalls in knowledge and praxis around promoting continence and managing incontinence for PLWD in the community. As absolute numbers of people with dementia are predicted to increase, it is imperative to examine whether these deficits have been addressed. Results Of 3,563 records identified, 57 full‐text articles were reviewed. The ERG developed a conceptual model to summarise research evidence according to the extent of the challenge (neuropathology and clinicopathology, prevalence and incidence), gateways to continence services, effectiveness of interventions, outcomes and the potential influences of personal resources, socio‐cultural factors and environmental contexts. Conclusions Research on (in)continence for PLWD in the community is under‐developed and has not increased substantially over the last decade. ERG recommendations for future research included user involvement to identify appropriate quality indicators to assess the effectiveness of interventions. Relevance to clinical practice There is insufficient evidence on which to base decisions on continence care for PLWD in the community. Omission from continence care guidelines has the effect of marginalising and silencing this population. User involvement in clinical research and developing practice guidelines has the potential for positive systems change.
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Affiliation(s)
- Vanessa Burholt
- Faculty of Medical and Health Sciences, School of Nursing, University of Auckland, Auckland, New Zealand.,Centre for Innovative Ageing, College of Human and Health Sciences, Swansea University, Swansea, UK
| | - Johanna Davies
- Centre for Innovative Ageing, College of Human and Health Sciences, Swansea University, Swansea, UK
| | - Michal Boyd
- School of Nursing and Freemasons' Department of Geriatric Medicine, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Jane M Mullins
- Centre for Innovative Ageing, College of Human and Health Sciences, Swansea University, Swansea, UK
| | - E Zoe Shoemark
- Centre for Innovative Ageing, College of Human and Health Sciences, Swansea University, Swansea, UK
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Roy HA, Nettleton J, Blain C, Dalton C, Farhan B, Fernandes A, Georgopoulos P, Klepsch S, Lavelle J, Martinelli E, Panicker JN, Radoja I, Rapidi CA, Pereira E Silva R, Tudor K, Wagg AS, Drake MJ. Assessment of patients with lower urinary tract symptoms where an undiagnosed neurological disease is suspected: A report from an International Continence Society consensus working group. Neurourol Urodyn 2020; 39:2535-2543. [PMID: 32754994 DOI: 10.1002/nau.24469] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Accepted: 07/16/2020] [Indexed: 11/10/2022]
Abstract
AIM Lower urinary tract symptoms (LUTS) are a common urological referral, which sometimes can have a neurological basis in a patient with no formally diagnosed neurological disease ("occult neurology"). Early identification and specialist input is needed to avoid bad LUTS outcomes, and to initiate suitable neurological management. METHODS The International Continence Society established a neurological working group to consider: Which neurological conditions may include LUTS as an early feature? What diagnostic evaluations should be undertaken in the LUTS clinic? A shortlist of conditions was drawn up by expert consensus and discussed at the annual congress of the International Neurourology Society. A multidisciplinary working group then generated recommendations for identifying clinical features and management. RESULTS The relevant conditions are multiple sclerosis, multiple system atrophy, normal pressure hydrocephalus, early dementia, Parkinsonian syndromes (including early Parkinson's Disease and Multiple System Atrophy) and spinal cord disorders (including spina bifida occulta with tethered cord, and spinal stenosis). In LUTS clinics, the need is to identify additional atypical features; new onset severe LUTS (excluding infection), unusual aspects (eg, enuresis without chronic retention) or "suspicious" symptoms (eg, numbness, weakness, speech disturbance, gait disturbance, memory loss/cognitive impairment, and autonomic symptoms). Where occult neurology is suspected, healthcare professionals need to undertake early appropriate referral; central nervous system imaging booked from LUTS clinic is not recommended. CONCLUSIONS Occult neurology is an uncommon underlying cause of LUTS, but it is essential to intervene promptly if suspected, and to establish suitable management pathways.
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Affiliation(s)
- Holly A Roy
- Neurosurgery Department, Derriford Hospital, University Hospitals Plymouth NHS Trust, Plymouth, UK
| | - Jeremy Nettleton
- Department of Urology, Cheltenham General Hospital, Gloucestershire Hospitals NHS Foundation Trust, Cheltenham, UK
| | - Camilla Blain
- Atkinson Morley Regional Neurosciences Centre, St George's University Hospitals NHS Foundation Trust, London, UK
| | - Catherine Dalton
- Atkinson Morley Regional Neurosciences Centre, St George's University Hospitals NHS Foundation Trust, London, UK
| | - Bilal Farhan
- UTMB Health Division of Urology, Galveston, Texas
| | - Ailton Fernandes
- Department of Urology, State University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Petros Georgopoulos
- Department of Urology and Pelvic Floor Unit, Aarhus University Hospital, Aarhus, Denmark
| | - Sabine Klepsch
- Neurology Department, Southmead Hospital, North Bristol NHS Trust, Bristol, UK
| | - John Lavelle
- Veteran Affairs Palo Alto Health Care System, Palo Alto, California
| | | | - Jalesh N Panicker
- Department of Uro-Neurology, The National Hospital for Neurology and Neurosurgery, UCL Queen Square Institute of Neurology, Faculty of Brain Sciences, University College London, London, UK
| | - Ivan Radoja
- Department of Urology, University Hospital Centre Osijek, Faculty of Medicine, The J. J. Strossmayer University of Osijek, Osijek, Croatia
| | | | - Ricardo Pereira E Silva
- Department of Urology, Centro Hospitalar Universitário Lisboa Norte, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
| | - Katarina Tudor
- Department of Neurology, Unit for Headaches, Neurogenic Pain and Spinal Disorders, School of Medicine, University Hospital Centre Zagreb, University of Zagreb, Zagreb, Croatia
| | - Adrian S Wagg
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Marcus J Drake
- Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol Urological Institute, Bristol, UK
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25
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Mostafaei H, Shariat SF, Salehi-Pourmehr H, Janisch F, Mori K, Quhal F, Hajebrahimi S. The clinical pharmacology of the medical treatment for overactive bladder in adults. Expert Rev Clin Pharmacol 2020; 13:707-720. [PMID: 32500759 DOI: 10.1080/17512433.2020.1779056] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
INTRODUCTION Overactive bladder is a prevalent symptom complex that affects the patient's quality of life. Any disruption between the neuronal micturition pathway can lead to bladder overactivity. Neurogenic causes, myogenic causes, aging, bladder outlet obstruction, sex, and psychological factors are some of the factors contributing to bladder overactivity. The complaint of any symptoms of OAB, which is highly prevalent and affects overall QOL, often needs therapeutic interventions. When conservative therapy methods fail, the addition of medications is recommended. The most commonly used agents for the treatment of OAB are antimuscarinic drugs. New classes of drugs, such as beta-3 agonists, have enriched our pharmacologic armamentarium. AREAS COVERED In this review, with a special focus on oral pharmacological treatments, we discussed the definition, etiology, symptoms, diagnosis, and management of OAB. EXPERT OPINION OAB is a multifactorial condition with every patient presenting with a different collection of symptoms and signs. Medical therapies should be given in conjunction with behavioral therapies. Using high or low doses, flexible doses, and stopping or changing the medications are interchangeable strategies based on the level of treatment efficacy and patient satisfaction.
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Affiliation(s)
- Hadi Mostafaei
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna , Vienna, Austria.,Research Center for Evidence Based Medicine, Tabriz University of Medical Sciences , Tabriz, Iran
| | - Shahrokh F Shariat
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna , Vienna, Austria.,Institute for Urology and Reproductive Health, I.M. Sechenov First Moscow State Medical University , Moscow, Russia.,Department of Urology, University of Texas Southwestern Medical Center , Dallas, TX, USA.,Department of Urology, Second Faculty of Medicine, Charles University , Prague, Czech Republic.,Department of Urology, Weill Cornell Medical College , New York, NY, USA.,Karl Landsteiner Institute of Urology and Andrology , Vienna, Austria.,Department of Urology, University of Jordan , Amman, Jordan
| | - Hanieh Salehi-Pourmehr
- Research Center for Evidence Based Medicine, Tabriz University of Medical Sciences , Tabriz, Iran.,Student Research Committee, Tabriz University of Medical Sciences , Tabriz, Iran
| | - Florian Janisch
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna , Vienna, Austria.,Department of Urology, Medical University of Hamburg , Hamburg, Germany
| | - Keiichiro Mori
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna , Vienna, Austria.,Department of Urology, The Jikei University School of Medicine , Tokyo, Japan
| | - Fahad Quhal
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna , Vienna, Austria.,King Fahad Specialist Hospital-Dammam , Saudi Arabia
| | - Sakineh Hajebrahimi
- Research Center for Evidence Based Medicine, Tabriz University of Medical Sciences , Tabriz, Iran
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Doherty SP, Vanhoestenberghe A, Duffell LD, Hamid R, Knight SL. Ambulatory urodynamic monitoring assessment of dorsal genital nerve stimulation for suppression of involuntary detrusor contractions following spinal cord injury: a pilot study. Spinal Cord Ser Cases 2020; 6:30. [PMID: 32355163 PMCID: PMC7192939 DOI: 10.1038/s41394-020-0279-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Revised: 03/27/2020] [Accepted: 03/28/2020] [Indexed: 11/08/2022] Open
Abstract
STUDY DESIGN A prospective interventional pilot study using within-individual comparisons. OBJECTIVES To assess the effect of dorsal genital nerve stimulation (DGNS) on urine-storage parameters in participants with spinal cord injury (SCI) and neurogenic detrusor overactivity (NDO) during natural bladder filling. SETTING The London Spinal Cord Injuries Centre at the Royal National Orthopaedic Hospital, Stanmore, UK. METHODS Ambulatory urodynamic monitoring (AUM) was carried out with and without DGNS, before and after a week of using DGNS at home. DGNS was applied on-demand by four participants with bladder sensation, and both continuously and intermittently by one participant with absent sensation. A Wilcoxon sign-rank test was used to test paired results of changes within an AUM session. RESULTS Urodynamic outcomes were improved using DGNS. Bladder capacity was increased from 244 ± 59 to 346 ± 61 ml (p = 0.0078), a mean change of 46 ± 25%. Maximum detrusor pressure was decreased from 58 ± 18 to 47 ± 18 cmH2O (p = 0.0156), a change of 17 ± 13%, and average peak detrusor pressure was decreased from 56 ± 16 to 31 ± 128 cmH2O (p = 0.0156), a mean reduction of 50 ± 19%. There was an increase in the number of detrusor contractions from the first involuntary detrusor contraction to a strong desire, urgency or incontinence, from 1.5 ± 1.4 to 4.3 ± 1.7, and an increase in time of 23 ± 22 min. There were no changes in baseline outcomes following home use of DGNS. CONCLUSIONS DGNS may be applied on-demand, intermittently or continuously, to increase bladder capacity, decrease storage pressures and provide extra time. Improvements were made in addition to existing antimuscarinic medication regimes.
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Affiliation(s)
- Sean P Doherty
- Aspire Centre for Rehabilitation Engineering and Assistive Technology, University College London, London, UK.
- London Spinal Cord Injury Centre, Royal National Orthopaedic Hospital, London, UK.
| | - Anne Vanhoestenberghe
- Aspire Centre for Rehabilitation Engineering and Assistive Technology, University College London, London, UK
| | - Lynsey D Duffell
- Aspire Centre for Rehabilitation Engineering and Assistive Technology, University College London, London, UK
| | - Rizwan Hamid
- London Spinal Cord Injury Centre, Royal National Orthopaedic Hospital, London, UK
| | - Sarah L Knight
- London Spinal Cord Injury Centre, Royal National Orthopaedic Hospital, London, UK
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27
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Neves da Costa J, Oliveira Lopes MV, Baena de Moraes Lopes MH. Simultaneous Concept Analysis of Diagnoses Related to Urinary Incontinence. Int J Nurs Knowl 2020; 31:109-123. [DOI: 10.1111/2047-3095.12254] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2019] [Revised: 07/06/2019] [Accepted: 07/08/2019] [Indexed: 11/29/2022]
Affiliation(s)
- Juliana Neves da Costa
- School of Nursing (FEnf)Universidade Estadual de Campinas (Unicamp) Campinas São Paulo Brazil
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28
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Tiwari E, Salvadeo DM, Braverman AS, Frara NA, Hobson L, Cruz G, Brown JM, Mazzei M, Pontari MA, White AR, Barbe MF, Ruggieri MR. Nerve transfer for restoration of lower motor neuron-lesioned bladder and urethra function: establishment of a canine model and interim pilot study results. J Neurosurg Spine 2020; 32:258-268. [PMID: 31703192 PMCID: PMC7189959 DOI: 10.3171/2019.8.spine19265] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2019] [Accepted: 08/13/2019] [Indexed: 12/27/2022]
Abstract
OBJECTIVE Previous patient surveys have shown that patients with spinal cord or cauda equina injuries prioritize recovery of bladder function. The authors sought to determine if nerve transfer after long-term decentralization restores bladder and sphincter function in canines. METHODS Twenty-four female canines were included in this study. Transection of sacral roots and hypogastric nerves (S Dec) was performed in 6 animals, and 7 animals underwent this procedure with additional transection of the L7 dorsal roots (L7d+S Dec). Twelve months later, 3 L7d+S Dec animals underwent obturator-to-pelvic nerve and sciatic-to-pudendal nerve transfers (L7d+S Dec+Reinn). Eleven animals served as controls. Squat-and-void behaviors were tracked before and after decentralization, after reinnervation, and following awake bladder-filling procedures. Bladders were cystoscopically injected with Fluoro-Gold 3 weeks before euthanasia. Immediately before euthanasia, transferred nerves were stimulated to evaluate motor function. Dorsal root ganglia were assessed for retrogradely labeled neurons. RESULTS Transection of only sacral roots failed to reduce squat-and-void postures; L7 dorsal root transection was necessary for significant reduction. Three L7d+S Dec animals showing loss of squat-and-void postures post-decentralization were chosen for reinnervation and recovered these postures 4-6 months after reinnervation. Each showed obturator nerve stimulation-induced bladder contractions and sciatic nerve stimulation-induced anal sphincter contractions immediately prior to euthanasia. One showed sciatic nerve stimulation-induced external urethral sphincter contractions and voluntarily voided twice following nonanesthetized bladder filling. Reinnervation was confirmed by increased labeled cells in L2 and the L4-6 dorsal root ganglia (source of obturator nerve in canines) of L7d+S Dec+Reinn animals, compared with controls. CONCLUSIONS New neuronal pathways created by nerve transfer can restore bladder sensation and motor function in lower motor neuron-lesioned canines even 12 months after decentralization.
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Affiliation(s)
- Ekta Tiwari
- Department of Computer and Electrical Engineering, College of Engineering,Temple University, Philadelphia, Pennsylvania
| | - Danielle M. Salvadeo
- Department of Anatomy and Cell Biology, Lewis Katz School of Medicine,Temple University, Philadelphia, Pennsylvania
| | - Alan S. Braverman
- Department of Anatomy and Cell Biology, Lewis Katz School of Medicine,Temple University, Philadelphia, Pennsylvania
| | - Nagat A. Frara
- Department of Anatomy and Cell Biology, Lewis Katz School of Medicine,Temple University, Philadelphia, Pennsylvania
| | - Lucas Hobson
- Department of Anatomy and Cell Biology, Lewis Katz School of Medicine,Temple University, Philadelphia, Pennsylvania
| | - Geneva Cruz
- Department of Anatomy and Cell Biology, Lewis Katz School of Medicine,Temple University, Philadelphia, Pennsylvania
| | - Justin M. Brown
- Department of Neurosurgery, Neurosurgery Paralysis Center, Massachusetts General Hospital, Boston, Massachusetts
| | - Michael Mazzei
- Department of Medicine, and Temple University, Philadelphia, Pennsylvania
| | - Michel A. Pontari
- Department of Urology, Temple University, Philadelphia, Pennsylvania
| | - Amanda R. White
- Department of Anatomy and Cell Biology, Lewis Katz School of Medicine,Temple University, Philadelphia, Pennsylvania
| | - Mary F. Barbe
- Department of Anatomy and Cell Biology, Lewis Katz School of Medicine,Temple University, Philadelphia, Pennsylvania
| | - Michael R. Ruggieri
- Department of Computer and Electrical Engineering, College of Engineering,Temple University, Philadelphia, Pennsylvania
- Department of Anatomy and Cell Biology, Lewis Katz School of Medicine,Temple University, Philadelphia, Pennsylvania
- The Shriners Hospital of Philadelphia, Pennsylvania
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29
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Wyndaele M, Rosier PFWM. Basics of videourodynamics for adult patients with lower urinary tract dysfunction. Neurourol Urodyn 2019; 37:S61-S66. [PMID: 30614055 DOI: 10.1002/nau.23778] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2018] [Accepted: 07/11/2018] [Indexed: 11/06/2022]
Abstract
AIMS Videourodynamics is the addition of imaging to invasive urodynamics and one of the methods to ensure objective diagnosis in persons with signs or symptoms of lower urinary tract dysfunction. This manuscript has the aim to outline the basics of the practice of videourodynamics and to elementary explain interpretation of the results. METHODS Literature sources and expert opinion were arranged to provide the reader with an introductory overview of current knowledge. RESULTS Videourodynamics was-like most diagnostics in health care-introduced on the basis of plausibility and expert conviction but has stood the test of time. Videourodynamics has, especially in patients with congenital or acquired neurogenic dysfunction of the lower urinary tract, undisputedly although not precisely quantifiable, added to (lower urinary tract) health care quality. CONCLUSION The manuscript summarizes the basic elements of indication, practice, and interpretation of videourodynamics.
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Affiliation(s)
- Michel Wyndaele
- Department of Urology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Peter F W M Rosier
- Department of Urology, University Medical Center Utrecht, Utrecht, The Netherlands
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30
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Patel DP, Herrick JS, Stoffel JT, Elliott SP, Lenherr SM, Presson AP, Welk B, Jha A, Myers JB. Reasons for cessation of clean intermittent catheterization after spinal cord injury: Results from the Neurogenic Bladder Research Group spinal cord injury registry. Neurourol Urodyn 2019; 39:211-219. [PMID: 31578784 DOI: 10.1002/nau.24172] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Accepted: 09/12/2019] [Indexed: 11/06/2022]
Abstract
INTRODUCTION Clean intermittent catheterization (CIC) is recommended for bladder management after spinal cord injury (SCI) since it has the lowest complication rate. However, transitions from CIC to other less optimal strategies, such as indwelling catheters (IDCs) are common. In individuals with SCI who stopped CIC, we sought to determine how individual characteristics affect the bladder-related quality of life (QoL) and the reasons for CIC cessation. METHODS The Neurogenic Bladder Research Group registry is an observational study, evaluating neurogenic bladder-related QoL after SCI. From 1479 participants, those using IDC or urinary conduit were asked if they had ever performed CIC, for how long, and why they stopped CIC. Multivariable regression, among participants discontinuing CIC, established associations between demographics, injury characteristics, and SCI complications with bladder-related QoL. RESULTS There were 176 participants who had discontinued CIC; 66 (38%) were paraplegic and 110 (63%) were male. The most common reasons for CIC cessation among all participants were inconvenience, urinary leakage, and too many urine infections. Paraplegic participants who discontinued CIC had higher mean age, better fine motor scores, and lower educational attainment and employment. Multivariable regression revealed years since SCI was associated with worse bladder symptoms (neurogenic bladder symptom score), ≥4 urinary tract infections (UTIs) in a year was associated with worse satisfaction and feelings about bladder symptoms (SCI-QoL difficulties), while tetraplegia was associated better satisfaction and feelings about bladder symptoms (SCI-QoL difficulties). CONCLUSIONS Tetraplegics who have discontinued CIC have an improved QoL compared with paraplegics. SCI individuals who have discontinued CIC and have recurrent UTIs have worse QoL.
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Affiliation(s)
- Darshan P Patel
- Division of Urology, Department of Surgery, University of Utah, Salt Lake City, Utah
| | - Jennifer S Herrick
- Division of Epidemiology and Biostatistics, Department of Internal Medicine, University of Utah, Salt Lake City, Utah
| | - John T Stoffel
- Department of Urology, University of Michigan, Ann Arbor, Michigan
| | - Sean P Elliott
- Department of Urology, University of Minnesota, Minneapolis, Minnesota
| | - Sara M Lenherr
- Division of Urology, Department of Surgery, University of Utah, Salt Lake City, Utah
| | - Angela P Presson
- Division of Epidemiology and Biostatistics, Department of Internal Medicine, University of Utah, Salt Lake City, Utah
| | - Blayne Welk
- Department of Surgery, University of Western Ontario, London, Ontario, Canada
| | - Amitabh Jha
- Department of Physical Medicine and Rehabilitation, University of Utah, Salt Lake City, Utah
| | - Jeremy B Myers
- Division of Urology, Department of Surgery, University of Utah, Salt Lake City, Utah
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31
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Kaiser R, Nasto LA, Venkatesan M, Waldauf P, Perez B, Stokes OM, Haddad S, Mehdian H, Tsegaye M. Time Factor and Disc Herniation Size: Are They Really Predictive for Outcome of Urinary Dysfunction in Patients With Cauda Equina Syndrome? Neurosurgery 2019; 83:1193-1200. [PMID: 29425362 DOI: 10.1093/neuros/nyx607] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2017] [Accepted: 12/04/2017] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Timing of surgery and the importance of the size of disc prolapse in cauda equina syndrome (CES) remain controversial. OBJECTIVE To investigate whether there is a relationship between postoperative urinary function, preoperative duration of neurogenic lower urinary tract dysfunction (NLUTD), and the level of canal compromise. METHODS Seventy-one patients operated for CES were prospectively identified between 2010 and 2013. Fifty-two cases with preoperative NLUTD were included. The "Prolapse: Canal ratio" (PCR) was calculated as a proportion of cross-sectional area of disc prolapse on total cross-sectional area of spinal canal. RESULTS Median of preoperative duration of NLUTD was 72 h (48; 132) and period from first assessment to surgery 10.5 h (7; 18.5). Urinary incontinence was seen in 46.2% of patients, 38.4% had painless retention and 15.4% had painful retention. In 38.5% of cases, urinary symptoms persisted for more than 20 mo postoperatively. There was no correlation between duration of preoperative NLUTD and urinary dysfunction persistence (P = .921). The outcome was not significantly influenced by having surgery more than the 48 h after presentation (P = .135). Preoperative incontinence persisted in 58% and painless retention in 30% of cases. The mean PCR was 0.6 ± 0.18. There was no correlation between PCR and outcome (P = .537) even after adjusting for duration of preoperative NLUTD (P = .7264). CONCLUSION No significant correlation was demonstrated between the preoperative duration of urinary dysfunction, the size of disc herniation relative to size of spinal canal, and postoperative urinary function in a large consecutive series of patients with CES.
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Affiliation(s)
- Radek Kaiser
- The Centre for Spinal Studies and Surgery, QMC, Nottingham University Hospitals NHS Trust, Nottingham, UK.,Department of Neurosurgery and Neurooncology, First Faculty of Medicine, Charles University and Military University Hospital, Prague, Czech Republic
| | - Luigi Aurelio Nasto
- The Centre for Spinal Studies and Surgery, QMC, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Murali Venkatesan
- The Centre for Spinal Studies and Surgery, QMC, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Petr Waldauf
- Department of Anesthesiology and Critical Care Medicine, Third Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Belen Perez
- The Centre for Spinal Studies and Surgery, QMC, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Oliver M Stokes
- Exeter Spine Unit, Princess Elizabeth Orthopaedic Centre, Royal Devon and Exeter NHS Foundation Trust, Exeter, UK
| | - Sleiman Haddad
- The Centre for Spinal Studies and Surgery, QMC, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Hossein Mehdian
- The Centre for Spinal Studies and Surgery, QMC, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Magnum Tsegaye
- The Centre for Spinal Studies and Surgery, QMC, Nottingham University Hospitals NHS Trust, Nottingham, UK
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32
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Bragge P, Guy S, Boulet M, Ghafoori E, Goodwin D, Wright B. A systematic review of the content and quality of clinical practice guidelines for management of the neurogenic bladder following spinal cord injury. Spinal Cord 2019; 57:540-549. [PMID: 30971756 DOI: 10.1038/s41393-019-0278-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Revised: 03/12/2019] [Accepted: 03/14/2019] [Indexed: 11/09/2022]
Abstract
INTRODUCTION Neurogenic bladder following acute spinal cord injury (SCI) increases urinary tract infection (UTI) risk and affects quality of life and health system costs. OBJECTIVES This study aimed to identify, describe and evaluate quality of clinical practice guidelines (CPGs) for managing neurogenic bladder following SCI. METHODS A comprehensive search covered six electronic databases (PubMed, Web of Science, Health Systems Evidence, Cochrane, CINAHL, Epistomonikos) and 12 CPG portals. Inclusion criteria were English language CPG; includes recommendations for managing neurogenic bladder in adults; all phases of care; published 2011 onwards in peer-reviewed journal/CPG portal. For eligible CPGs, key characteristics including years covered by CPG searching and number of neurogenic bladder recommendations were extracted. Quality appraisal used the AGREE II instrument. Appraiser agreement was assessed using the intraclass correlation coefficient. RESULTS Searching yielded 4028 citations and eight relevant CPGs. Collectively the CPGs contained 304 recommendations. Over half (160) pertained to assessment, surgery or education. Most surgery recommendations were from older CPGs; more recent CPGs emphasised conservative therapy. Methodological quality across CPGs was good in the domains of 'clarity of presentation' (84% mean domain score), 'scope and purpose' (72%) and 'editorial independence' (68%). There were shortcomings in the domains of 'rigor of development' (52%) 'stakeholder involvement' (42%) and 'applicability' (33%). CONCLUSION CPGs for the management of neurogenic bladder following SCI are generally robust in stating their scope and clearly presenting recommendations. Only three CPGs attained domain scores over 70% pertaining to methodological rigor. Future CPGs should also focus on providing implementation / audit resources and incorporating patient perspectives.
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Affiliation(s)
- Peter Bragge
- BehaviourWorks Australia, Monash Sustainable Development Institute, Monash University, Melbourne, Australia.
| | - Stacey Guy
- Lawson Health Research Institute, London, Ontario, Canada
| | - Mark Boulet
- BehaviourWorks Australia, Monash Sustainable Development Institute, Monash University, Melbourne, Australia
| | | | - Denise Goodwin
- BehaviourWorks Australia, Monash Sustainable Development Institute, Monash University, Melbourne, Australia
| | - Breanna Wright
- BehaviourWorks Australia, Monash Sustainable Development Institute, Monash University, Melbourne, Australia
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Jaggi A, Nazir J, Fatoye F, Siddiqui E, Choudhury N, Argoubi R, Ali M, de Ridder D, Drake MJ. Drug utilization patterns and healthcare resource use and costs in patients with neurogenic bladder in the United Kingdom: A retrospective primary care database study. Neurourol Urodyn 2019; 38:1278-1289. [PMID: 30924184 PMCID: PMC6850049 DOI: 10.1002/nau.23981] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Revised: 01/29/2019] [Accepted: 03/01/2019] [Indexed: 12/02/2022]
Abstract
Aim To characterize patients with neurogenic bladder (NGB), their treatment patterns, healthcare resource utilization, and associated costs based on records from a primary care database in the United Kingdom. Methods This was a retrospective, descriptive, observational study of anonymized data from the Clinical Practice Research Datalink and Hospital Episode Statistics databases (selection period, 1 January 2004 to 31 December 2016). Adults with a definitive or probable diagnosis of NGB and ≥1 referral to a urologist were included. Results The study cohort included 3913 patients with definitive (n = 363) or probable (n = 3550) NGB. Patients had a mean of 8.6 (standard deviation [SD], 7.6) comorbidities, and mean Anticholinergic Cognitive Burden Scale score of 6.6 (SD, 5.9). During 12 months’ follow‐up, urinary tract infection (UTI) and urinary incontinence were the most common complications. Most patients (92.2%) received ≥1 prescription for an antimuscarinic agent or mirabegron, and 53.9% of patients received prescriptions for UTI‐specific antibiotics. The mean number of visits to a general practitioner for any cause was 67.7 (SD, 42.6) per individual. Almost half (46.7%) of the study cohort visited a specialist during the 12‐month follow‐up period, and 11.0% had ≥1 hospital admission. Total mean per patient costs for healthcare resource utilization was £2395. Conclusions The burden of illness, healthcare resource needs, and associated costs among patients with NGB are considerable. Drug prescribing patterns are consistent with the symptoms and complications of NGB, although increased awareness of drugs with anticholinergic activity among prescribers may help to reduce the cumulative anticholinergic burden in this vulnerable population.
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Affiliation(s)
- Ashley Jaggi
- Department of Health Professions, Manchester Metropolitan University, Manchester, United Kingdom.,Health Economics and Outcomes Research, Astellas Pharma Europe Ltd, Chertsey, United Kingdom
| | - Jameel Nazir
- Health Economics and Outcomes Research, Astellas Pharma Europe Ltd, Chertsey, United Kingdom
| | - Francis Fatoye
- Department of Health Professions, Manchester Metropolitan University, Manchester, United Kingdom
| | - Emad Siddiqui
- Health Economics and Outcomes Research, Astellas Pharma Europe Ltd, Chertsey, United Kingdom
| | - Nurul Choudhury
- Health Economics and Outcomes Research, Astellas Pharma Europe Ltd, Chertsey, United Kingdom
| | - Ramzi Argoubi
- Health Economics and Outcomes Research, Creativ-Ceutical SARL, Les Berges du lac, Tunisia
| | - Mahmood Ali
- Department of Health Professions, Manchester Metropolitan University, Manchester, United Kingdom.,Health Economics and Outcomes Research, Astellas Pharma Europe Ltd, Chertsey, United Kingdom
| | - Dirk de Ridder
- Department of Urology, Organ Systems, Development and Regeneration, University of Leuven, Leuven, Belgium
| | - Marcus J Drake
- School of Clinical Sciences, Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
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Teplitsky S, Murphy A, Shenot PJ. Knowledge Gaps in Urologic Care of Female Spinal Cord Injury Patients. Curr Urol Rep 2019; 20:21. [PMID: 30904966 DOI: 10.1007/s11934-019-0884-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
PURPOSE OF REVIEW We highlight the substantial gaps in knowledge on urologic care of female spinal cord injury (SCI) patients. RECENT FINDINGS Males account for approximately 80% of people living with SCI in developed nations. Although there is a robust body of literature in some aspects of urologic care of individuals with SCI, such as treatments for neurogenic detrusor overactivity, there are relatively few studies focusing specifically on females. There are also few studies focusing on other aspects of urologic care of women with SCI such as sexual dysfunction, pelvic organ prolapse, and bladder cancer. Established guidelines for bladder management exist, generally recommending intermittent catheterization, but the fact remains that a substantial number of women with SCI utilize indwelling catheters for bladder management. There remains a paucity of literature using patient-reported measures regarding both outcomes and experiences of urologic management in the SCI population. Bladder management is challenging for many women with SCI. There are few studies on other urologic concerns in women with SCI.
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Affiliation(s)
- Seth Teplitsky
- Department of Urology, Sidney Kimmel Medical College, Thomas Jefferson University, 1025 Walnut St, Ste 1100, Philadelphia, PA, 19107, USA
| | - Alana Murphy
- Department of Urology, Sidney Kimmel Medical College, Thomas Jefferson University, 1025 Walnut St, Ste 1100, Philadelphia, PA, 19107, USA
| | - Patrick J Shenot
- Department of Urology, Sidney Kimmel Medical College, Thomas Jefferson University, 1025 Walnut St, Ste 1100, Philadelphia, PA, 19107, USA.
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Ronzi Y, Le Normand L, Chartier-Kastler E, Game X, Grise P, Denys P, Perrouin-Verbe B. Neurogenic stress urinary incontinence: is there a place for Adjustable Continence Therapy (ACT™ and ProACT™, Uromedica, Plymouth, MN, USA)? A retrospective multicenter study. Spinal Cord 2019; 57:388-395. [DOI: 10.1038/s41393-018-0219-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2018] [Revised: 10/18/2018] [Accepted: 10/24/2018] [Indexed: 11/09/2022]
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Cotterill N, Sullivan A, Norton C, Wilkins A, Weir I, Kilonzo M, Drake MJ. Conservative interventions for urinary or faecal incontinence, or both, in adults with multiple sclerosis. Cochrane Database Syst Rev 2018. [DOI: 10.1002/14651858.cd013150] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Affiliation(s)
- Nikki Cotterill
- North Bristol NHS Trust; Bristol Urological Institute; Southmead Hospital Bristol UK BS10 5NB
- CLAHRC West; The National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care West (NIHR CLAHRC West) at University Hospitals Bristol NHS Foundation Trust, UK; 9th Floor, Whitefriars Lewins Mead Bristol UK BS1 2NT
- University of the West of England; Centre for Health and Clinical Research, Faculty of Health and Applied Sciences; Blackberry Hill Bristol UK BS16 1DD
| | - Amanda Sullivan
- North Bristol NHS Trust; Department of Physiotherapy; Southmead Hospital, Southmead Road Bristol UK BS10 5NB
| | - Christine Norton
- King's College London; Adult Nursing, Florence Nightingale Faculty of Nursing Midwifery and Palliative Care; 57 Waterloo Road London UK SE1 8WA
| | - Alastair Wilkins
- North Bristol NHS Trust; Bristol and Avon Multiple Sclerosis Unit/Clinical Neurosciences; Southmead Hospital, Southmead Road Bristol UK BS10 5NB
| | - Iain Weir
- University of West of England; Department of Engineering, Design and Mathematics; Coldharbour Lane Bristol UK BS16 1QY
| | - Mary Kilonzo
- University of Aberdeen; Health Economics Research Unit; Aberdeen UK AB25 2ZD
| | - Marcus J Drake
- University of Bristol; School of Clinical Sciences; Bristol UK BS10 5NB
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Chesnel C, Charlanes A, Declemy A, Le Breton F, Kerdraon J, Sheikh Ismael S, Amarenco G. Emptying cystometry: A feasibility and validation pilot study on female patients. Prog Urol 2018; 28:542-547. [PMID: 30017704 DOI: 10.1016/j.purol.2018.06.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2017] [Revised: 05/25/2018] [Accepted: 06/13/2018] [Indexed: 11/17/2022]
Abstract
INTRODUCTION To assess the feasibility and the accuracy of emptying cystometry in order to simplify the manometric follow-up of overactive detrusor in neurological patients under anticholinergic or botulinum toxin injections. MATERIAL Female patients with a stable detrusor underwent both a conventional cystometry and sequential measurements of bladder pressure during emptying (emptying cystometry). At the end of the standard cystometry, a CH12 urinary catheter was introduced in the bladder and was connected to a three-way stopcock. The second way of the stopcock permitted the emptying. The third way of the stopcock was connected to a vertical graduated tube to measure the bladder pressure each 50mL during the bladder emptying. RESULTS Eleven female patients were included (mean age: 59.4years). Nine patients (82%) had neurogenic bladder. Mean cystometric capacity was 439mL (SD: 35mL). During the emptying cystometry, 8 to 10 measures were taken (mean: 9.4). The mean detrusor pressure was 1.7cmH2O (SD 2.1) for the filling cystometry and 2.3cmH2O (SD: 2.7) for the emptying cystometry. The agreement between the detrusor pressure between the two cystometries was good with intra-class correlation coefficient at 0.66 [0.48-0.77] - and the correlation was high (r=0.7; P<0.000001). CONCLUSION In a small, selected sample of patients, emptying cystometry provides similar results of detrusor pressure to filling cystometry. This technique could constitute a home monitoring of bladder pressures in a selected population of patients with intermittent catheterization in whom a manometric follow-up of detrusor overactivity is required. LEVEL OF EVIDENCE 4.
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Affiliation(s)
- C Chesnel
- GREEN GRC-01 UPMC (Group of clinical Research in Neuro-urology), Sorbonne University, Paris, France; Department of Neuro-urology, Tenon Hospital, AP-HP, 4, rue de la Chine, 75020 Paris, France.
| | - A Charlanes
- GREEN GRC-01 UPMC (Group of clinical Research in Neuro-urology), Sorbonne University, Paris, France; Department of Neuro-urology, Tenon Hospital, AP-HP, 4, rue de la Chine, 75020 Paris, France.
| | - A Declemy
- GREEN GRC-01 UPMC (Group of clinical Research in Neuro-urology), Sorbonne University, Paris, France; Department of Neuro-urology, Tenon Hospital, AP-HP, 4, rue de la Chine, 75020 Paris, France.
| | - F Le Breton
- GREEN GRC-01 UPMC (Group of clinical Research in Neuro-urology), Sorbonne University, Paris, France; Department of Neuro-urology, Tenon Hospital, AP-HP, 4, rue de la Chine, 75020 Paris, France.
| | - J Kerdraon
- GREEN GRC-01 UPMC (Group of clinical Research in Neuro-urology), Sorbonne University, Paris, France; Department of Physical Medicine and Rehabilitation, Kerpape Ploemeur Hospital, Ploemeur, France.
| | - S Sheikh Ismael
- GREEN GRC-01 UPMC (Group of clinical Research in Neuro-urology), Sorbonne University, Paris, France; Department of Neuro-urology, Tenon Hospital, AP-HP, 4, rue de la Chine, 75020 Paris, France.
| | - G Amarenco
- GREEN GRC-01 UPMC (Group of clinical Research in Neuro-urology), Sorbonne University, Paris, France; Department of Neuro-urology, Tenon Hospital, AP-HP, 4, rue de la Chine, 75020 Paris, France.
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Abstract
PURPOSE OF REVIEW Multiple sclerosis (MS) is the most frequent neuroinflammatory disease of the central nervous system and is commonly associated with lower urinary tract (LUT) dysfunction. As a consequence, health-related quality of life is often impaired and the upper urinary tract might be at risk for damage. The aim of this review is to give an overview of current treatment options for LUT dysfunction in patients with MS. RECENT FINDINGS The treatment is tailored to the type of dysfunction-storage or voiding dysfunction-beginning with conservative treatment options and ending with invasive therapies and surgery. Additionally, alternative options, e.g., different intravesical therapies or cannabinoids, have been evaluated in recent years with promising results. Current available therapies offer different possible treatments for LUT dysfunction in patients with MS. They address either voiding or storage dysfunction and therefore ameliorate LUT symptoms improve quality of life and protect the upper urinary tract.
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Affiliation(s)
- Jure Tornic
- Department of Uro-Neurology, The National Hospital For Neurology and Neurosurgery and UCL Institute for Neurology, Queen Square, London, WC1N 3BG, UK.
| | - Jalesh N Panicker
- Department of Uro-Neurology, The National Hospital For Neurology and Neurosurgery and UCL Institute for Neurology, Queen Square, London, WC1N 3BG, UK
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Vaughan CP, Markland AD, Smith PP, Burgio KL, Kuchel GA. Report and Research Agenda of the American Geriatrics Society and National Institute on Aging Bedside-to-Bench Conference on Urinary Incontinence in Older Adults: A Translational Research Agenda for a Complex Geriatric Syndrome. J Am Geriatr Soc 2018; 66:773-782. [PMID: 29205261 PMCID: PMC5906179 DOI: 10.1111/jgs.15157] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
The American Geriatrics Society, with support from the National Institute on Aging and other funders, held its ninth Bedside-to-Bench research conference, entitled "Urinary Incontinence in the Older Adult: A Translational Research Agenda for a Complex Geriatric Syndrome," October 16 to 18, 2016, in Bethesda, Maryland. As part of a conference series addressing three common geriatric syndromes-delirium, sleep and circadian rhythm disturbance, and urinary incontinence-the series highlighted relationships and pertinent clinical and pathophysiological commonalities between these conditions. The conference provided a forum for discussing current epidemiology, basic science, and clinical and translational research on urinary incontinence in older adults; for identifying gaps in knowledge; and for developing a research agenda to inform future investigative efforts. The conference also promoted networking involving emerging researchers and thought leaders in the field of incontinence, aging, and other fields of research, as well as National Institutes of Health program personnel.
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Affiliation(s)
- Camille P Vaughan
- Geriatric Research, Education, and Clinical Center, Department of Veterans Affairs Birmingham/Atlanta, Atlanta, Georgia, Birmingham, Alabama
- Division of General Medicine and Geriatrics, Department of Medicine, Emory University, Atlanta, Georgia
| | - Alayne D Markland
- Geriatric Research, Education, and Clinical Center, Department of Veterans Affairs Birmingham/Atlanta, Atlanta, Georgia, Birmingham, Alabama
- Division of Gerontology, Geriatrics, and Palliative Care, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| | - Phillip P Smith
- Division of Urology, University of Connecticut Health Center, Farmington, Connecticut
- UConn Center on Aging, University of Connecticut Health Center, Farmington, Connecticut
| | - Kathryn L Burgio
- Geriatric Research, Education, and Clinical Center, Department of Veterans Affairs Birmingham/Atlanta, Atlanta, Georgia, Birmingham, Alabama
- Division of Gerontology, Geriatrics, and Palliative Care, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| | - George A Kuchel
- UConn Center on Aging, University of Connecticut Health Center, Farmington, Connecticut
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Lam Van Ba O, Soustelle L, Wagner L, Siegler N, Boukaram M, Naoum KB, Droupy S, Chevrot A, Costa P. Impact on quality of life and sexual satisfaction of continent cystostomy with enterocystoplasty in an adult neurologic population. Neurourol Urodyn 2018; 37:1405-1412. [PMID: 29464756 DOI: 10.1002/nau.23461] [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: 07/28/2017] [Revised: 10/31/2017] [Accepted: 11/04/2017] [Indexed: 01/14/2023]
Abstract
AIMS To evaluate long-term general and urinary quality of life (QOL) and sexual satisfaction in adult neurologic patients undergoing continent cystostomy surgery associated with a bladder enlargement to treat neurogenic lower urinary tract dysfunction. METHODS Monocentre, retrospective series of adult neurologic patients who underwent continent cystostomy with bladder enlargement and followed-up in the long-term. We assessed during follow-up, urinary and renal function and patients filled QOL questionnaires on general QOL, sexuality and urinary (short form Qualiveen) disability. RESULTS Fifty-three patients were included and followed-up 77 months on average. Rates of patients' satisfaction, stomal and urethral continences were respectively of 98.7% (n = 51), 94.1% (n = 48), and 80.4% (n = 41). Impact of surgery on general QOL and autonomy were strong and positive (respective mean scores of 4.8 and 4.7 on a scale ranging from 1 to 5). Mean overall urinary Qualiveen QOL score was 0.8 (0.09-2.67) indicating a low negative impact of urinary disability on QOL. In patients <45 years, 52.6% (n = 10) reported a moderate to important improvement of their sexuality after surgery. Renal function remained stable during follow-up. CONCLUSION In the long-term, continent cystostomy with bladder enlargement provides great satisfaction to almost most patients. It has a strong positive impact on general and specific urinary QOL, patients' autonomy and urinary continence. In young patients a positive impact on sexuality was also noticed. These encouraging data, that need to be confirmed, constitute interesting information to provide to neurologic patients to help them deciding whether they are willing to undergo continent cystostomy surgery.
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Affiliation(s)
| | | | - Laurent Wagner
- Department of Urology, Nîmes University Hospital, Nîmes, France
| | - Nicolas Siegler
- Department of Urology, Nîmes University Hospital, Nîmes, France
| | - Michel Boukaram
- Department of Urology, Nîmes University Hospital, Nîmes, France
| | - Kamel Ben Naoum
- Department of Urology, Nîmes University Hospital, Nîmes, France
| | - Stéphane Droupy
- Department of Urology, Nîmes University Hospital, Nîmes, France
| | - Armand Chevrot
- Department of Urology, Nîmes University Hospital, Nîmes, France
| | - Pierre Costa
- Department of Urology, Nîmes University Hospital, Nîmes, France
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Tahseen S. Role of sacral neuromodulation in modern urogynaecology practice: a review of recent literature. Int Urogynecol J 2018; 29:1081-1091. [PMID: 29302716 DOI: 10.1007/s00192-017-3546-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2017] [Accepted: 12/12/2017] [Indexed: 12/01/2022]
Abstract
Sacral neuromodulation (SNM) offers promise in the therapy of many pelvic floor disorders. This innovative treatment has slowly gained popularity. A review of recent literature is presented in relation to its efficacy and complications in various pelvic floor conditions: overactive bladder and urge urinary incontinence, chronic urinary retention, painful bladder syndrome, pelvic pain and double incontinence. It is a minimally invasive, completely reversible safe procedure with good long-term outcomes. However, the treatment is costly, the revision rate is high and patients require life-long follow-up. SNM should always be considered in suitable patients before offering bladder augmentation procedures or urinary diversion or permanent catheterization for bladder dysfunction. SNM should also be considered in patients with double incontinence, after discussion in a urogynaecology/colorectal multidisciplinary team.
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Ladi-Seyedian SS, Nabavizadeh B, Sharifi-Rad L, Kajbafzadeh AM. Pharmacological treatments available for the management of underactive bladder in neurological conditions. Expert Rev Clin Pharmacol 2017; 11:193-204. [DOI: 10.1080/17512433.2018.1411801] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Affiliation(s)
- Seyedeh-Sanam Ladi-Seyedian
- Pediatric Urology and Regenerative Medicine Research Center, Children’s Medical Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Behnam Nabavizadeh
- Pediatric Urology and Regenerative Medicine Research Center, Children’s Medical Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Lida Sharifi-Rad
- Pediatric Urology and Regenerative Medicine Research Center, Children’s Medical Center, Tehran University of Medical Sciences, Tehran, Iran
- Department of Physical Therapy, Children’s Medical Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Abdol-Mohammad Kajbafzadeh
- Pediatric Urology and Regenerative Medicine Research Center, Children’s Medical Center, Tehran University of Medical Sciences, Tehran, Iran
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Sinha S. Follow-up urodynamics in patients with neurogenic bladder. Indian J Urol 2017; 33:267-275. [PMID: 29021649 PMCID: PMC5635666 DOI: 10.4103/iju.iju_358_16] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2016] [Accepted: 02/24/2017] [Indexed: 11/21/2022] Open
Abstract
INTRODUCTION Neurogenic bladder patients are at long-term risk of secondary upper urinary tract damage. Symptoms are unreliable and follow-up urodynamics is the only method of ascertaining safety of bladder pressures. This review examines the recommendations, shortcomings and utilization of existing guidelines. The evidence with regard to follow-up urodynamics in different settings relevant to neurogenic bladder is evaluated and an algorithm is proposed. METHODS A pubmed search was conducted for studies on follow-up urodynamics in patients with neurogenic bladder. Additional search was made of secondary sources including reviews and guidelines. RESULTS The need for follow-up urodynamics should be considered in all patients undergoing an initial assessment and weighed against the risks. Existing guidelines, while unanimous in their recommendation of its utilization, give scant details regarding its incorporation in clinical management. Follow-up urodynamics can document efficacy and identify the need for escalation of therapy in patients on intermittent catheterization and antimuscarinics. Patients with spinal injury, spinal dysraphism and anorectal malformations are at higher risk for upper tract damage. Follow-up urodynamics can help identify patients suitable for intravesical botulinum and mark those destined for failure. Patients undergoing augmentation cystoplasty may be candidates for less aggressive urodynamic follow-up. CONCLUSIONS Neurogenic bladder is managed by a broad cross-section of physicians. Clear recommendations and a management algorithm are important for improving patient care. Follow-up urodynamics can identify patients at risk, prevent renal dysfunction and improve the quality of life. There is an urgent need for more evidence on this important subject.
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Affiliation(s)
- Sanjay Sinha
- Department of Urology, Apollo Hospital, Hyderabad, Telangana, India
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Kaviani A, Khavari R. Disease-Specific Outcomes of Botulinum Toxin Injections for Neurogenic Detrusor Overactivity. Urol Clin North Am 2017; 44:463-474. [PMID: 28716326 PMCID: PMC5604875 DOI: 10.1016/j.ucl.2017.04.012] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Intradetrusor injection of botulinum toxin A (BTX-A) is an effective option for managing patients with neurogenic detrusor overactivity (NDO) who do not respond to or tolerate oral pharmacologic agents. There is level I evidence that intradetrusor injection of onabotulinumtoxinA for refractory NDO in patients with multiple sclerosis and spinal cord injury is associated with a significantly greater achievement of goals and improved performance in urodynamic studies than placebo. Pilot studies or small case series support BTX-A for NDO in patients with Parkinson's disease and cerebrovascular accident. BTX-A seems to be effective in children with myelomeningocele. However, no adult data exists.
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Affiliation(s)
- Aaron Kaviani
- Department of Urology, Houston Methodist Hospital, 6560 Fannin Street, Suite 2100, Houston, TX 77030, USA
| | - Rose Khavari
- Department of Urology, Houston Methodist Hospital, 6560 Fannin Street, Suite 2100, Houston, TX 77030, USA.
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Janssen DA, Martens FM, de Wall LL, van Breda HM, Heesakkers JP. Clinical utility of neurostimulation devices in the treatment of overactive bladder: current perspectives. MEDICAL DEVICES-EVIDENCE AND RESEARCH 2017; 10:109-122. [PMID: 28615976 PMCID: PMC5460621 DOI: 10.2147/mder.s115678] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Objectives This review describes the evidence from established and experimental therapies that use electrical nerve stimulation to treat lower urinary tract dysfunction. Methods Clinical studies on established treatments such as percutaneous posterior tibial nerve stimulation (P-PTNS), transcutaneous electrical nerve stimulation (TENS), sacral nerve stimulation (SNS) and sacral anterior root stimulation (SARS) are evaluated. In addition, clinical evidence from experimental therapies such as dorsal genital nerve (DGN) stimulation, pudendal nerve stimulation, magnetic nerve stimulation and ankle implants for tibial nerve stimulation are evaluated. Results SNS and P-PTNS have been investigated with high-quality studies that have shown proven efficacy for the treatment for overactive bladder (OAB). SARS has proven evidence-based efficacy in spinal cord patients and increases the quality of life. TENS seems inferior to other OAB treatments such as SNS and P-PTNS but is noninvasive and applicable for ambulant therapy. Results from studies on experimental therapies such as pudendal nerve stimulation seem promising but need larger study cohorts to prove efficacy. Conclusion Neurostimulation therapies have proven efficacy for bladder dysfunction in patients who are refractory to other therapies. Significance Refinement of neurostimulation therapies is possible. The aim should be to make the treatments less invasive, more durable and more effective for the treatment of lower urinary tract dysfunction.
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Affiliation(s)
- Dick Aw Janssen
- Department of Urology, Radboud University Nijmegen Medical Center, Nijmegen
| | - Frank Mj Martens
- Department of Urology, Radboud University Nijmegen Medical Center, Nijmegen
| | - Liesbeth L de Wall
- Department of Urology, Radboud University Nijmegen Medical Center, Nijmegen
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McClurg D, Coyle J, Long A, Moore K, Cottenden A, May C, Fader M. A two phased study on health care professionals' perceptions of single or multi-use of intermittent catheters. Int J Nurs Stud 2017; 72:83-90. [PMID: 28505559 DOI: 10.1016/j.ijnurstu.2017.04.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2016] [Revised: 04/23/2017] [Accepted: 04/27/2017] [Indexed: 11/25/2022]
Abstract
AIMS This two phase study aimed to explore health care professionals' teaching and prescribing practice related to intermittent catheterisation and to identify their perceptions about the possible implementation of a mixed (single and multi-use) package for intermittent catheterization. INTRODUCTION Single-use intermittent catheters are the norm in the UK although multi-use is common in some other countries. A recent Cochrane review found no difference in complications, including urinary tract infection rates, between those using single or multi-use catheters. A flexible option of both multi-use and single use intermittent catheters could provide users with more flexible choices in self-care. However, understanding health care professionals' perspectives is one of the keys to developing a multi-use intervention. DESIGN A qualitative research framework using in-depth interviews to inform an on line survey. METHOD In-depth interviews were conducted with health care professionals based in the UK who prescribe catheters, teach intermittent catheterisation or manage an intermittent catheterisation service. The interviewees were selected to represent a range of clinical areas, experience and professions - continence advisors, urology, multiple sclerosis (MS) and spinal cord injury specialist nurses, and General Practitioners. Following framework analysis the themes and factors identified were used to develop an on-line survey which was disseminated through health care professional networks whose members saw patients who use intermittent catheters. RESULTS Nineteen health care professionals participated in the telephone interviews; 206 completed the survey. A wide range of professionals in terms of experience and specialty afforded rich information regarding the contextual issues around the teaching and prescribing of intermittent catheters. The primary finding was that health care professionals were concerned about 'minimising health risk' and maximising 'normalcy' for those using intermittent self-catheterisation. Health care professionals who worked in the acute setting or had no experience of re-use were most resistant to the re-use of catheters. Professionals requested evidence that a multi-use package would not increase the risk of developing a urinary tract infection or increase the burden of use to a patient before a mixed package would be considered. CONCLUSIONS For multi-use to be acceptable, evidence based guidelines must be available for healthcare professionals and cleaning methods must be acceptable and safe for intermittent catheter users. Further evidence may be required to establish that a mixed catheter package is equivalent to single use only, particularly for outcomes such as urinary tract infection, urethral injury and quality of life. RELEVANCE TO CLINICAL PRACTICE This paper highlights that if multi-use catheters are to be successfully introduced into clinical practice, the ease of use, safety and effectiveness of the cleaning technique will need to be convincingly demonstrated by a range of well-defined users.
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Affiliation(s)
- D McClurg
- NMAHP RU, Glasgow Caledonian University, Glasgow G4 0BA, UK.
| | - J Coyle
- NMAHP RU, Glasgow Caledonian University, Glasgow G4 0BA, UK.
| | - A Long
- Cx Products & Services, Sheffield, S6 5SQ, UK.
| | - K Moore
- University of Alberta, Faculty of Nursing, Edmonton, Canada.
| | - A Cottenden
- Dept. Medical Physics and Biomedical Engineering, First Floor Wolfson House, 2-10 Stephenson Way, University College London, London, WC1E 6BT, UK.
| | - C May
- Southampton University faculty of Health Sciences, Southampton University, SO16 6YD, UK.
| | - M Fader
- University of Southampton, Faculty of Health Sciences, Southampton General Hospital, Clinical Academic Facility,South Academic Block, Southampton, Hampshire, SO16 6YD, UK.
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Rognoni C, Tarricone R. Intermittent catheterisation with hydrophilic and non-hydrophilic urinary catheters: systematic literature review and meta-analyses. BMC Urol 2017; 17:4. [PMID: 28073354 PMCID: PMC5225586 DOI: 10.1186/s12894-016-0191-1] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2016] [Accepted: 12/07/2016] [Indexed: 11/10/2022] Open
Abstract
Background Intermittent catheterisation is the method of choice for the management of bladder dysfunctions. Different urinary catheters are available, but there is conflicting evidence on which type of catheter is best. The present study provides an objective evaluation of the clinical effectiveness of different subsets of urinary catheters. Methods A systematic literature review was performed for published RCTs regarding hydrophilic coated and PVC (standard) catheters for intermittent catheterisation. Separate meta-analyses were conducted to combine data on frequencies of urinary tract infections (UTIs) and haematuria. Two separate analyses were performed, including or excluding reused standard catheters. Results Seven studies were eligible for inclusion in the review. The meta-analyses exploring UTI frequencies showed a lower risk ratio associated with hydrophilic catheters in comparison to standard ones (RR = 0.84; 95% CI, 0.75–0.94; p = 0.003). Results for the “reuse” scenario were consistent with the ones related to “single-use” scenario in terms of frequency of UTIs. The meta-analyses exploring haematuria were not able to demonstrate any statistically significant difference between hydrophilic catheters in comparison to standard ones. Conclusions The findings confirm previously reported benefits of hydrophilic catheters but a broader evaluation that takes into account also patient preferences, compliance of therapy, quality of life and costs would be needed to assess the economic sustainability of these advanced devices. Electronic supplementary material The online version of this article (doi:10.1186/s12894-016-0191-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Carla Rognoni
- Centre for Research on Health and Social Care Management (CERGAS), Bocconi University, Via Roentgen 1, Milan, 20136, Italy.
| | - Rosanna Tarricone
- Centre for Research on Health and Social Care Management (CERGAS), Bocconi University, Via Roentgen 1, Milan, 20136, Italy.,Department of Policy Analysis and Public Management, Bocconi University, Via Roentgen 1, Milan, 20136, Italy
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