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Milicevic S, Sekulic A, Nikolic D, Tomasevic-Todorovic S, Lazarevic K, Pelemis S, Petrovic M, Mitrovic SZ. Urinary Tract Infections in Relation to Bladder Emptying in Patients with Spinal Cord Injury. J Clin Med 2024; 13:3898. [PMID: 38999463 PMCID: PMC11242679 DOI: 10.3390/jcm13133898] [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: 05/27/2024] [Revised: 06/22/2024] [Accepted: 06/28/2024] [Indexed: 07/14/2024] Open
Abstract
Background/Objectives: Spinal cord injuries are debilitating conditions with significant impacts on physical function and patient quality of life. The high incidence of urinary tract infections in these patients can be attributed to neurogenic bladder-a major complication of spinal cord injuries. The aim of this study is to investigate the incidence of urinary tract infections in patients with spinal cord injuries and their relation to the method of bladder emptying. Methods: A retrospective analysis on 560 patients admitted for rehabilitation at the Clinic for Rehabilitation "Dr Miroslav Zotovic" from December 2009 to January 2023 was conducted. Patients over 18 years old who were inpatients for longer than 30 days without any symptoms of urinary tract infection on admission were included. Patient demographics, injury details, and bladder emptying methods were recorded. Results: In our study, 402 (71.8%) participants developed a urinary tract infection during their rehabilitation. Urinary tract infections were significantly more common in patients with traumatic spinal cord injuries, lower ASIA scores, and thoracic-level injuries. The highest incidence of urinary tract infections was observed in intermittent self-catheterization patients (62.7%), with Escherichia coli and Proteus mirabilis being the most frequently isolated pathogens. Conclusions: The method of bladder emptying significantly impacted the incidence of urinary tract infection in patients with spinal cord injuries. Despite guidelines favoring intermittent catheterization, this study found it to be associated with the highest infection rates. These findings suggest a need for personalized bladder management strategies to reduce the risk of urinary tract infections and improve outcomes for spinal cord injury patients.
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Affiliation(s)
- Sasa Milicevic
- Faculty of Medicine, University of Pristina, 38220 Kosovska Mitrovica, Serbia
| | | | - Dejan Nikolic
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia
- Department of Physical Medicine and Rehabilitation, University Children’s Hospital, 11000 Belgrade, Serbia
| | - Snezana Tomasevic-Todorovic
- Faculty of Medicine, University of Novi Sad, 21000 Novi Sad, Serbia
- Clinic for Medical Rehabilitation, Clinical Center of Vojvodina, 21000 Novi Sad, Serbia
| | - Konstansa Lazarevic
- Department for Biomedical Science, State University of Novi Pazar, 36300 Novi Pazar, Serbia
| | - Svetislav Pelemis
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia
- Clinic for Otorhinolaryngology and Maxillofacial Surgery, Clinical Center of Serbia, 11000 Belgrade, Serbia
| | - Masa Petrovic
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia
- Institute for Cardiovascular Diseases “Dedinje”, 11000 Belgrade, Serbia
| | - Sindi Z. Mitrovic
- Clinic for Rehabilitation “Dr Miroslav Zotovic”, 11000 Belgrade, Serbia
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia
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2
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Liu Q, Qu QR, Xu M, Liu JS, Qi F, Yi XQ, Zhang H, Zhou L, Ai K. The protein kinase A signaling pathway mediates the effect of electroacupuncture on excessive contraction of the bladder detrusor in a rat model of neurogenic bladder. Acupunct Med 2024; 42:32-38. [PMID: 37899603 DOI: 10.1177/09645284231206154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2023]
Abstract
BACKGROUND Neurogenic bladder (NB) is a form of neurological bladder dysfunction characterized by excessive contraction of the bladder detrusor. Protein kinase A (PKA) signaling is involved in the contraction of the detrusor muscle. AIMS To investigate whether PKA signaling mediates the effect of electroacupuncture (EA) on the excessive contraction of the bladder detrusor in NB. METHODS Sixty rats were randomly divided into control, sham, NB, NB + EA, and NB + EA + H89 (a PKA receptor antagonist) groups. The modified Hassan Shaker spinal cord transection method was used to generate a NB model. After EA intervention for one week, urodynamic tests were used to evaluate bladder function, hematoxylin and eosin staining was conducted to assess morphological changes, enzyme-linked immunosorbent assay (ELISA) was performed to measure the concentration of PKA, and Western blotting was conducted to measure the protein levels of phosphorylated myosin light chain kinase (p-MLCK)/p-MLC. RESULTS The results showed that NB resulted in morphological disruption, impairment of urodynamics, and decreases in the concentration of PKA and the protein levels of p-MLCK/p-MLC. EA reversed the changes induced by NB dysfunction. However, the improvement in urodynamics and the increases in the concentration of PKA and the protein levels of p-MLCK/p-MLC were inhibited by H89. CONCLUSION Our findings indicate that the PKA signaling pathway mediates the beneficial effect of EA on excessive contraction of the bladder detrusor in a rat model of NB.
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Affiliation(s)
- Qiong Liu
- School of Acupuncture-moxibustion, Tuina and Rehabilitation, Hunan University of Chinese Medicine, Changsha, China
| | - Qi-Rui Qu
- School of Acupuncture-moxibustion, Tuina and Rehabilitation, Hunan University of Chinese Medicine, Changsha, China
| | - Ming Xu
- School of Acupuncture-moxibustion, Tuina and Rehabilitation, Hunan University of Chinese Medicine, Changsha, China
| | - Ji-Sheng Liu
- School of Acupuncture-moxibustion, Tuina and Rehabilitation, Hunan University of Chinese Medicine, Changsha, China
| | - Fang Qi
- School of Acupuncture-moxibustion, Tuina and Rehabilitation, Hunan University of Chinese Medicine, Changsha, China
| | - Xi-Qin Yi
- School of Acupuncture-moxibustion, Tuina and Rehabilitation, Hunan University of Chinese Medicine, Changsha, China
| | - Hong Zhang
- School of Acupuncture-moxibustion, Tuina and Rehabilitation, Hunan University of Chinese Medicine, Changsha, China
| | - Lu Zhou
- Department of Rehabilitation Medicine, West Hospital of Chenzhou First People's Hospital, Chenzhou, China
| | - Kun Ai
- School of Acupuncture-moxibustion, Tuina and Rehabilitation, Hunan University of Chinese Medicine, Changsha, China
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3
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Han X, Xiong D, Ren R. Sacral neuromodulation for urinary incontinence in patients with pelvic floor injury. Asian J Surg 2023; 46:3908-3909. [PMID: 37080812 DOI: 10.1016/j.asjsur.2023.03.169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2023] [Accepted: 03/30/2023] [Indexed: 04/22/2023] Open
Affiliation(s)
- Xiaolei Han
- Department of Urology Surgery, Chengdu Second People's Hospital, Chengdu, Sichuan, 610017, China.
| | - Dan Xiong
- Department of Cardio-Thoracic Surgery, Chengdu Second People's Hospital, Chengdu, Sichuan, 610017, China.
| | - Rui Ren
- Department of Urology Surgery, Chengdu Second People's Hospital, Chengdu, Sichuan, 610017, China.
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4
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Rosen DP, Husmann DA, Mynderse LA, Kelly TF, Alizad A, Fatemi M. Detrusor overactivity assessment using ultrasound bladder vibrometry. Physiol Meas 2021; 42:10.1088/1361-6579/ac2c5c. [PMID: 34598174 PMCID: PMC8609921 DOI: 10.1088/1361-6579/ac2c5c] [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: 05/14/2021] [Accepted: 10/01/2021] [Indexed: 11/12/2022]
Abstract
Objective. Detrusor overactivity (DO) is a urodynamic observation characterized by fluctuations in detrusor pressure (Pdet) of the bladder. Although detecting DO is important for the management of bladder symptoms, the invasive nature of urodynamic studies (UDS) makes it a source of discomfort and morbidity for patients. Ultrasound bladder vibrometry (UBV) could provide a direct and noninvasive means of detecting DO, due to its sensitivity to changes in elasticity and load in the bladder wall. In this study, we investigated the feasibility and applying UBV toward detecting DO.Approach. UBV and urodynamic study (UDS) measurements were collected in 76 neurogenic bladder patients (23 with DO). Timestamped group velocity squared (cg2) data series were collected from UBV measurements. ConcurrentPdetdata series were identically analyzed for comparison and validation. A processing approach is developed to separate transient fluctuations in the data series from the larger trend of the data and a DO index is proposed for characterizing the transient peaks observed in the data.Main Results.Applying the DO index as a classifier for DO produced sensitivities and specificities of 0.70 and 0.75 forcg2data series and 0.70 and 0.83 forPdetdata series respectively.Significance. It was found that DO can be feasibly detected from data series of timestamped UBV measurements. Collectively, these initial results are promising, and further refinement to the UBV measurement process is likely to improve and clarify its capabilities for noninvasive detection of DO.
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Affiliation(s)
- David P. Rosen
- Department of Physiology and Biomedical Engineering, Mayo
Clinic College of Medicine & Science, Rochester, MN, USA
| | - Douglas A. Husmann
- Department of Urology, Mayo Clinic College of Medicine
& Science, Rochester, MN, USA
| | - Lance A. Mynderse
- Department of Urology, Mayo Clinic College of Medicine
& Science, Rochester, MN, USA
| | - Troy F. Kelly
- Department of Physiology and Biomedical Engineering, Mayo
Clinic College of Medicine & Science, Rochester, MN, USA
| | - Azra Alizad
- Department of Physiology and Biomedical Engineering, Mayo
Clinic College of Medicine & Science, Rochester, MN, USA
- Department of Radiology, Mayo Clinic College of Medicine
& Science, Rochester, MN, USA
| | - Mostafa Fatemi
- Department of Physiology and Biomedical Engineering, Mayo
Clinic College of Medicine & Science, Rochester, MN, USA
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5
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Yoon JY, Kim DS, Kim GW, Won YH, Park SH, Ko MH, Seo JH. Disruption of sensation-dependent bladder emptying due to bladder overdistension in a complete spinal cord injury: A case report. World J Clin Cases 2021; 9:8946-8952. [PMID: 34734079 PMCID: PMC8546819 DOI: 10.12998/wjcc.v9.i29.8946] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2021] [Revised: 07/27/2021] [Accepted: 08/18/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Autonomic dysreflexia (AD) can be a life-threatening condition in patients with spinal cord injury. It is important to prevent bladder overdistension in these patients as it may trigger AD. Sensation-dependent bladder emptying (SDBE), as a method of bladder management, improves the quality of life and allows physiologic voiding. In this study, we report disruption of the SDBE habit after bladder overdistension leading to AD with chest pain.
CASE SUMMARY A 47-year-old male with a diagnosis of C4 American Spinal Cord Injury Association impairment scale A had been emptying his bladder using the clean intermittent catheterization method with an itchy sensation in the nose as a sensory indication for a full bladder for 23 years, and the usual urine volume was about 300-400 mL. At the time of this study, the patient had delayed catheterization for approximately five hours. He developed severe abdominal pain and headache and had to visit the emergency room for bladder overdistension (800 mL) and a high systolic blood pressure (205 mmHg). After control of AD, a hypersensitive bladder was observed despite using anticholinergic agents. The sensation indicating bladder fullness changed from nose itching to pain in the abdomen and precordial area. Moreover, the volume of the painful bladder filling sensation became highly variable and was noted when the bladder urine volume exceeded only 100 mL. The patient refused intermittent clean catheterization. Finally, a cystostomy was performed, which relieved the symptoms.
CONCLUSION Patients using physiologic feedback, such as SDBE, for bladder management are recommended to avoid bladder overdistension.
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Affiliation(s)
- Ju-Yul Yoon
- Department of Physical Medicine and Rehabilitation, Jeonbuk National University Medical School, Jeonju 54097, Jeonbuk, South Korea
| | - Da-Sol Kim
- Department of Physical Medicine and Rehabilitation, Jeonbuk National University Medical School, Korea Research Institute of Clinical Medicine of Jeonbuk National University − Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju 54097, Jeonbuk, South Korea
| | - Gi-Wook Kim
- Department of Physical Medicine and Rehabilitation, Jeonbuk National University Medical School, Korea Research Institute of Clinical Medicine of Jeonbuk National University − Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju 54097, Jeonbuk, South Korea
| | - Yu Hui Won
- Department of Physical Medicine and Rehabilitation, Jeonbuk National University Medical School, Korea Research Institute of Clinical Medicine of Jeonbuk National University − Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju 54097, Jeonbuk, South Korea
| | - Sung-Hee Park
- Department of Physical Medicine and Rehabilitation, Jeonbuk National University Medical School, Korea Research Institute of Clinical Medicine of Jeonbuk National University − Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju 54097, Jeonbuk, South Korea
| | - Myoung-Hwan Ko
- Department of Physical Medicine and Rehabilitation, Jeonbuk National University Medical School, Korea Research Institute of Clinical Medicine of Jeonbuk National University − Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju 54097, Jeonbuk, South Korea
| | - Jeong-Hwan Seo
- Department of Physical Medicine and Rehabilitation, Jeonbuk National University Medical School, Korea Research Institute of Clinical Medicine of Jeonbuk National University − Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju 54097, Jeonbuk, South Korea
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6
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Maltagliati M, Sampogna G, Secco S, Galfano A, Montanari E, Micali S, Rocco B, Spinelli M. Case report of life-threatening complications following cystectomy in a woman with neurogenic lower urinary tract dysfunction treated with indwelling bladder catheter for about 30 years. ACTA BIO-MEDICA : ATENEI PARMENSIS 2021; 92:e2021086. [PMID: 33944853 PMCID: PMC8142763 DOI: 10.23750/abm.v92is1.8615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/22/2019] [Accepted: 07/21/2019] [Indexed: 11/23/2022]
Abstract
Patients with neurogenic lower urinary tract dysfunction (NLUTD), specially with indwelling bladder catheter (iBC), have an increased risk of developing bladder stones, incomplete bladder emptying, recurrent urinary tract infections, sepsis, urethral trauma and bladder cancer. We present the case of a patient with a large bladder stone in iatrogenic NLUTD treated with iBC for about 30 years, who underwent a cystectomy followed by several life-threatening complications.
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Affiliation(s)
- Matteo Maltagliati
- Urology Unit, Ospedale Policlinico e Nuovo Ospedale Civile S. Agostino Estense, University of Modena and Reggio Emilia, Modena, Italy.
| | - Gianluca Sampogna
- Urology Unit, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, University of Milan, Milan, Italy.
| | - Silvia Secco
- Urology Unit, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy.
| | - Antonio Galfano
- Urology Unit, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy.
| | - Emanuele Montanari
- Urology Unit, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, University of Milan, Milan, Italy.
| | - Salvatore Micali
- Urology Unit, Ospedale Policlinico e Nuovo Ospedale Civile S. Agostino Estense, University of Modena and Reggio Emilia, Modena, Italy.
| | - Bernardo Rocco
- Urology Unit, Ospedale Policlinico e Nuovo Ospedale Civile S. Agostino Estense, University of Modena and Reggio Emilia, Modena, Italy.
| | - Michele Spinelli
- Neuro-urology Unit, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy.
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7
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Ma Y, Chen Y, Zheng Y, Wen Y, Li Y, Feng J, He Y, Wen J. SCF/c-kit signaling pathway participates in ICC damage in neurogenic bladder. Cell Cycle 2020; 19:2074-2080. [PMID: 32658594 DOI: 10.1080/15384101.2020.1793059] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
Neurogenic bladder (NB) is a type of double renal dysfunction caused by nerve lesions. The interstitial cells of Cajal (ICC) damage are involved in bladder dysfunction. The aim of this study is to investigate the effect of stem cell factor (SCF)/c-kit signaling pathway on ICC damage in NB model rats. Maximum cystometric capacity (MCC), bladder leak point pressures (BLPP), and bladder compliance (BC) were measured in sham-operated and NB model rats. Immunofluorescent staining for c-kit was performed to determine ICC count in rat bladder trigone. The morphology and ultrastructure changes of ICCs were observed under an electron microscope. The mRNA levels of c-kit and SCF in bladder tissues were determined by reverse transcription-quantitative polymerase chain reaction (RT-qPCR). The protein levels of c-kit, SCF, p-JAK, p-STAT1, and p-STAT3 in bladder tissues were determined by western blot. ICC proliferation was detected by CCK-8 assay. NB resulted in changes in ultrastructure changes of ICCs and a decrease in the number of ICCs and in expression of c-kit, SCF, p-JAK, p-STAT1, and p-STAT3 in NB tissues. Inhibition of SCF/c-kit signaling pathway suppressed ICC proliferation by inhibiting JAK/STAT3 pathway. Moreover, inhibition of SCF/c-kit signaling pathway impaired the SCF-induced attenuation of ICC damage in NB model rats. Collectively, our data indicate that SCF/c-kit signaling pathway participates in ICC damage in NB.
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Affiliation(s)
- Yuan Ma
- Institute of Clinical Medicine, Urodynamic Center and Department of Urology, The First Affiliated Hospital of Zhengzhou University , Zhengzhou, China
| | - Yan Chen
- Institute of Clinical Medicine, Urodynamic Center and Department of Urology, The First Affiliated Hospital of Zhengzhou University , Zhengzhou, China
| | - Yan Zheng
- Immunization Key Lab of Kidney Disease of Henan Province, People's Hospital of Henan Province, Zhengzhou University , Zhengzhou, China
| | - Yibo Wen
- Department of Urology, The First Affiliated Hospital of Zhengzhou University , Zhengzhou, China
| | - Yunlong Li
- Department of Urology, The First Affiliated Hospital of Zhengzhou University , Zhengzhou, China
| | - Jinjin Feng
- Department of Urology, The First Affiliated Hospital of Zhengzhou University , Zhengzhou, China
| | - Yulin He
- Department of Urology, The First Affiliated Hospital of Zhengzhou University , Zhengzhou, China
| | - Jianguo Wen
- Institute of Clinical Medicine, Urodynamic Center and Department of Urology, Institute of Clinical Medicine, Pediatric Urodynamic Center and Department of Urology, The First Affiliated Hospital of Zhengzhou University , Zhengzhou, China
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8
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Keller EE, Patras I, Hutu I, Roider K, Sievert KD, Aigner L, Janetschek G, Lusuardi L, Zimmermann R, Bauer S. Early sacral neuromodulation ameliorates urinary bladder function and structure in complete spinal cord injury minipigs. Neurourol Urodyn 2019; 39:586-593. [PMID: 31868966 PMCID: PMC7027870 DOI: 10.1002/nau.24257] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Accepted: 12/03/2019] [Indexed: 12/12/2022]
Abstract
Aims To determine the effects of early sacral neuromodulation (SNM) and pudendal neuromodulation (PNM) on lower urinary tract (LUT) function, minipigs with complete spinal cord injury (cSCI) were analyzed. SNM and PNM have been proposed as therapeutic approaches to improve bladder function, for example after cSCI. However, further evidence on efficacy is required before these methods can become clinical practice. Methods Eleven adults, female Göttingen minipigs with cSCI at vertebral level T11‐T12 were included: SNM (n = 4), PNM (n = 4), and SCI control (SCIC: n = 3). Tissue from six healthy minipigs was used for structural comparisons. Stimulation was started 1 week after cSCI. Awake urodynamics was performed on a weekly basis. After 16 weeks follow‐up, samples from the urinary bladder were taken for analyses. Results SNM improved bladder function with better capacities and lower detrusor pressures at voiding and avoided the emergence of detrusor sphincter dyssynergia (DSD). PNM and untreated SCI minipigs had less favorable outcomes with either DSD or constant urinary retention. Structural results revealed SCI‐typical fibrotic alterations in all cSCI minipigs. However, SNM showed a better‐balanced distribution of smooth muscle to connective tissue with a trend towards the reduced progression of bladder wall scarring. Conclusion Early SNM led to an avoidance of the emergence of DSD showing a more physiological bladder function during a 4 month follow‐up period after cSCI. This study might pave the way for the clinical continuation of early SNM for the treatment of neurogenic LUT dysfunction after SCI.
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Affiliation(s)
- Elena E Keller
- Department of Urology and Andrology, University Clinics Salzburg, Salzburg, Austria.,Spinal Cord Injury and Tissue Regeneration Center Salzburg, Paracelsus Medical University, Salzburg, Austria.,Institute of Molecular Regenerative Medicine, Paracelsus Medical University, Salzburg, Austria
| | - Irina Patras
- Banat University of Agricultural Science and Veterinary Medicine, Timișoara, Romania
| | - Ioan Hutu
- Banat University of Agricultural Science and Veterinary Medicine, Timișoara, Romania
| | - Karin Roider
- Department of Urology and Andrology, University Clinics Salzburg, Salzburg, Austria.,Spinal Cord Injury and Tissue Regeneration Center Salzburg, Paracelsus Medical University, Salzburg, Austria.,Institute of Molecular Regenerative Medicine, Paracelsus Medical University, Salzburg, Austria
| | - Karl-Dietrich Sievert
- Klinik für Urologie, Klinikum Lippe, Detmold, Germany.,Department of Urology, Comprehensive Cancer Center, Medical University Vienna, Vienna, Austria
| | - Ludwig Aigner
- Institute of Molecular Regenerative Medicine, Paracelsus Medical University, Salzburg, Austria.,Austrian Cluster of Tissue Regeneration, Vienna, Austria
| | - Günter Janetschek
- Spinal Cord Injury and Tissue Regeneration Center Salzburg, Paracelsus Medical University, Salzburg, Austria
| | - Lukas Lusuardi
- Department of Urology and Andrology, University Clinics Salzburg, Salzburg, Austria
| | | | - Sophina Bauer
- Department of Urology and Andrology, University Clinics Salzburg, Salzburg, Austria
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9
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Ozdemir Koken Z, Sezer RE, Tosun K. Nursing Care of the Patient With Neurogenic Bladder After Kidney Transplantation: A Case Report. Transplant Proc 2019; 51:2501-2502. [PMID: 31405733 DOI: 10.1016/j.transproceed.2019.01.187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2018] [Accepted: 01/03/2019] [Indexed: 10/26/2022]
Abstract
OBJECTIVE Urologic complications are among the most common complications after kidney transplantation. These complications are urinary retention, hematuria, hemorrhage, urinary leakage, vesicoureteral reflux, pyelonephritis, and nephrolithiasis. Although neurogenic bladder is one of the indications for kidney transplantation, it is not considered in the literature to be an expected complication after transplantation. In this case, we discuss the nursing care of a patient who underwent kidney transplantation from a living donor and developed neurogenic bladder. CASE REPORT A 60-year-old woman underwent kidney transplantation from a living donor, and neurogenic bladder developed in the patient 1 year after kidney transplantation. Clear intermittent catheterization treatment was administered for the kidney transplant recipient with neurogenic bladder. Clear intermittent catheterization treatment was stopped in the patient who had frequent urinary tract infections and, alternatively, sacral neuromodulation treatment was administered to the patient. CONCLUSIONS The nursing care of a patient with neurogenic bladder after kidney transplantation aims to prevent excessive bladder distension, infection, stone formation, vesicoureteral reflux, renal failure, urinary tract damage, and incontinence, and to ensure regular and complete discharge of the bladder. The most common treatment modalities for these objectives are permanent or intermittent catheterization, sacral neuromodulation, and medical therapy. In the care of the patient with neurogenic bladder after kidney transplantation, nurses should provide appropriate care related to treatment options and bladder training, plan urination schedules of the patient, and monitor for possible complications.
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Affiliation(s)
- Zeliha Ozdemir Koken
- Surgical Nursing Department, Hacettepe University Faculty of Nursing, Ankara, Turkey.
| | - Rana Elcin Sezer
- Surgical Nursing Department, Hacettepe University Faculty of Nursing, Ankara, Turkey
| | - Kubra Tosun
- Department of Urology, Hacettepe University Adult Hospital, Ankara, Turkey
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10
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Han SH, Cho IK, Jung JH, Jang SH, Lee BS. Long-Term Efficacy of Mirabegron Add-On Therapy to Antimuscarinic Agents in Patients With Spinal Cord Injury. Ann Rehabil Med 2019; 43:54-61. [PMID: 30852871 PMCID: PMC6409660 DOI: 10.5535/arm.2019.43.1.54] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2018] [Accepted: 08/20/2018] [Indexed: 11/08/2022] Open
Abstract
Objective To evaluate the long-term efficacy of mirabegron add-on therapy in patients with spinal cord injury (SCI) based on an urodynamic study. Methods This retrospective study involved a chart audit of individuals with SCI who underwent two consecutive urodynamic studies between April 1, 2015 and April 1, 2018. After adding 50 mg of mirabegron once a day to the pre-existing antimuscarinic therapy for a period of, at least 6 months, the following variables were analyzed: change in cystometric capacity, change in bladder compliance, change in maximal detrusor pressure, change in reflex volume, and presence of significant leakage during filling cystometry. Results A total of 31 participants with a mean age of 41±15 years were included in the analysis. A significant increase in cystometric capacity (mean, 362 to 424 mL; p=0.03), reflex volume (mean, 251 to 329 mL; p=0.02), and bladder compliance (median, 12 to 18 mL/cmH2O; p=0.04) was observed. The presence of leakage during filling cystometry was significantly reduced (29% to 10%; p=0.03). Likewise, a non-significant decrease in the change in maximal detrusor pressure was observed (mean, 31 to 27 cmH2O; p=0.39). Conclusion Adding mirabegron to conventional antimuscarinics further improved urodynamic parameters in patients with chronic SCI, and sustained efficacy was observed in long-term use.
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Affiliation(s)
- Seok-Hee Han
- Department of Physical Medicine and Rehabilitation, National Rehabilitation Center, Seoul, Korea
| | - In Kyoung Cho
- Department of Physical Medicine and Rehabilitation, National Rehabilitation Center, Seoul, Korea
| | - Joo Hwan Jung
- Department of Physical Medicine and Rehabilitation, National Rehabilitation Center, Seoul, Korea
| | - Seong Ho Jang
- Department of Physical Medicine and Rehabilitation, Hanyang University College of Medicine, Seoul, Korea
| | - Bum-Suk Lee
- Department of Physical Medicine and Rehabilitation, National Rehabilitation Center, Seoul, Korea
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11
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Liu L, Zhao K, Chen F, Wu J, Yang Z, Chen M, Mao L, Han J. Testing of a New Portable Device for Dynamic Bladder Pressure Monitoring. Low Urin Tract Symptoms 2018; 10:193-197. [PMID: 29664238 DOI: 10.1111/luts.12146] [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: 02/24/2016] [Revised: 05/11/2016] [Accepted: 05/30/2016] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To develop a portable dynamic bladder pressure monitoring device for facilitating the monitoring of bladder detrusor pressure in patients with neurogenic bladder (NB) caused by spinal cord injury and further compared the effect with traditional urodynamics devices. METHODS Portable dynamic bladder pressure monitoring device was implemented by software and hardware. The hardware was mainly composed of seven parts, such as micro liquid pressure sensor, electric bridge amplifying circuit, clock module, SD card storage circuit, liquid crystal display circuit, touch circuit, controller circuit and so on. The main program of the software included system initialization, data acquisition, storage, display, alarm, etc. A total of 45 patients with neurogenic bladder caused by spinal cord injury were enrolled in the study. Detrusor pressure was measured with the portable device and traditional urodynamics device. RESULTS The test-retest reliability of the portable device was modest in two times test (intra-class correlation coefficient (ICC) = 0.852), no significant difference was found in the results of volume perfusion evaluation between our device and conventional urodynamic (each P > 0.05). CONCLUSION The portable dynamic bladder pressure monitoring device is conducive to the dynamic monitoring of bladder pressure in patients with neurogenic bladder caused by spinal cord injury.
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Affiliation(s)
- Lingfeng Liu
- Department of Rehabilitation Medicine, Jingjiang People's Hospital, The Seventh Affiliated Hospital of Yangzhou University, Jingjiang, China
| | - Kang Zhao
- Physics Teaching and Research Section, School of Physics Science and Technology, Yangzhou University, Yangzhou, China
| | - Fan Chen
- Physics Teaching and Research Section, School of Physics Science and Technology, Yangzhou University, Yangzhou, China
| | - Jian Wu
- Department of Rehabilitation Medicine, Jingjiang People's Hospital, The Seventh Affiliated Hospital of Yangzhou University, Jingjiang, China
| | - Zhaofeng Yang
- Department of Rehabilitation Medicine, Jingjiang People's Hospital, The Seventh Affiliated Hospital of Yangzhou University, Jingjiang, China
| | - Ming Chen
- Department of Rehabilitation Medicine, Jingjiang People's Hospital, The Seventh Affiliated Hospital of Yangzhou University, Jingjiang, China
| | - Linbo Mao
- Department of Rehabilitation Medicine, Jingjiang People's Hospital, The Seventh Affiliated Hospital of Yangzhou University, Jingjiang, China
| | - Jiurong Han
- Physics Teaching and Research Section, School of Physics Science and Technology, Yangzhou University, Yangzhou, China
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12
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Przydacz M, Chlosta P, Corcos J. Recommendations for urological follow-up of patients with neurogenic bladder secondary to spinal cord injury. Int Urol Nephrol 2018; 50:1005-1016. [PMID: 29569211 DOI: 10.1007/s11255-018-1852-7] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2018] [Accepted: 03/19/2018] [Indexed: 12/30/2022]
Abstract
PURPOSE To review currently available guidelines and recommendations regarding urological follow-up of patients after spinal cord injury (SCI) and present an evidence-based summary to support clinicians in their clinical practice. METHODS Maximum data were collected according to different methods, including searches with multiple and specific keywords, reference checks, gray literature searches (congress reports, working papers, statement documents), and browsing-related Web site access. Obtained data were analyzed with the modified version of the Oxford grading system for recommendations using levels of evidence (LE) and grades of recommendation (GR). RESULTS Different surveillance strategies exist, but there is no consensus among authors and organizations. As a result, practice patterns vary around the world. The present review indicates that proper urological follow-up of SCI patients should consist of medical history (LE 1-4, GR B-C), clinical examination (LE 4, GR C), renal laboratory tests (LE 1-3, GR B), imaging surveillance of the upper urinary tract (LE 1-3, GR A-B), urodynamic study (LE 2-4, GR B-C), and cystoscopy/cytology (LE 1-4, GR D). Clinicians agree that SCI patients should be followed up regularly with an individually tailored approach. A 1-year follow-up schedule seems reasonable in SCI patients without additional risk factors of renal deterioration (LE 3-4, GR C). In those who manifest risk factors, report changes in bladder behavior, or present with already developed complications of neurogenic bladder dysfunction, follow-up plans should be modified with more frequent checkups (LE 4, GR C). Urodynamic study should be repeated and considered as a routine monitoring strategy. CONCLUSION Individuals with neurogenic lower urinary tract dysfunction are at increased risk of multiple complications. Nevertheless, proper follow-up after SCI improves the prognosis for these patients and their quality of life.
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Affiliation(s)
- Mikolaj Przydacz
- Department of Urology, Jewish General Hospital, McGill University, Montreal, Canada
- Department of Urology, Jagiellonian University, Medical College, Kraków, Poland
| | - Piotr Chlosta
- Department of Urology, Jagiellonian University, Medical College, Kraków, Poland
| | - Jacques Corcos
- Department of Urology, Jewish General Hospital, McGill University, Montreal, Canada.
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13
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Liu Q, Wu C, Huang S, Wu Q, Zhou T, Liu X, Liu X, Hu X, Li L. Decreased hyperpolarization-activated cyclic nucleotide-gated channels are involved in bladder dysfunction associated with spinal cord injury. Int J Mol Med 2018; 41:2609-2618. [PMID: 29436607 PMCID: PMC5846662 DOI: 10.3892/ijmm.2018.3489] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2016] [Accepted: 02/08/2018] [Indexed: 12/12/2022] Open
Abstract
Spinal cord injury (SCI) leads to bereft voluntary control of bladder, but the possible role of spontaneous excited system in bladder of SCI patients is poorly understood. Hyper polarization-activated cyclic nucleotide-gated (HCN) channels are deemed to regulate the spontaneous contraction of bladder, our study explored the functional role of HCN channels in SCI induced neurogenic bladder. Sixty female Sprague-Dawley rats were randomized into control, sham and SCI groups. Rat models subjected to SCI at S2 levels were successfully established and were assessed using hematoxylin and eosin staining and cystometry. In SCI rats, the mRNA and protein expression levels of HCN channels and the Ih density were significantly reduced, and expression levels of several bladder HCN1 channel regulatory proteins were also significantly changed. The effects of 50 µM forskolin and 50 µM 8-bromoadenosine 3′,5′-cyclic monophosphate on [Ca2+]i of isolated bladder interstitial cells of Cajal-like cells were significantly decreased in SCI rats. The spontaneous contractions in detrusor strips from SCI rats were significantly weakened. Furthermore, detrusor strips from SCI rats exhibited decreased tolerance to two doses of ZD7288 (10 and 50 µM). Taken together, our results indicate that the decreased bladder HCN channel expression and function induced by altered regulatory proteins are involved in the pathological process of SCI induced neurogenic bladder, which present HCN channels as valid therapeutic targets for treating this disease.
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Affiliation(s)
- Qian Liu
- Department of Urology, The Second Affiliated Hospital, The Third Military Medical University, Chongqing 400037, P.R. China
| | - Chao Wu
- Department of Urology, The Second Affiliated Hospital, The Third Military Medical University, Chongqing 400037, P.R. China
| | - Shengquan Huang
- Department of Urology, The Second Affiliated Hospital, The Third Military Medical University, Chongqing 400037, P.R. China
| | - Qingjian Wu
- Department of Urology, The Second Affiliated Hospital, The Third Military Medical University, Chongqing 400037, P.R. China
| | - Tao Zhou
- Department of Urology, The Second Affiliated Hospital, The Third Military Medical University, Chongqing 400037, P.R. China
| | - Xiaobing Liu
- Department of Urology, The Second Affiliated Hospital, The Third Military Medical University, Chongqing 400037, P.R. China
| | - Xin Liu
- Department of Urology, The Second Affiliated Hospital, The Third Military Medical University, Chongqing 400037, P.R. China
| | - Xiaoyan Hu
- Department of Urology, The Second Affiliated Hospital, The Third Military Medical University, Chongqing 400037, P.R. China
| | - Longkun Li
- Department of Urology, The Second Affiliated Hospital, The Third Military Medical University, Chongqing 400037, P.R. China
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14
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Chong JT, Simma-Chiang V. A historical perspective and evolution of the treatment of male urinary incontinence. Neurourol Urodyn 2017; 37:1169-1175. [PMID: 29053886 DOI: 10.1002/nau.23429] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2017] [Accepted: 09/15/2017] [Indexed: 12/17/2022]
Abstract
AIMS To describe the historical changes from antiquity until present in the presentation and treatment of male urinary incontinence. METHODS A literature review of PubMed articles in English pertaining to male incontinence was performed. RESULTS Male urinary incontinence was first mentioned in Egyptian manuscripts in 1500 B.C. In 1564, Ambroise Pare designed portable urinals for incontinent males. Wilhem Hildanus created the first condom catheter with pig bladder in the 1600s and was also credited with fashioning the first penile clamp. Lorenz Heister introduced a perineal bulbar urethral compression belt in 1747 which would provide the blueprint for air-inflated bulbar urethral compression devices such as the one designed by S.A. Vincent in 1960. Robert Gersuny performed the first periurethral paraffin injection bulking therapy in the late 19th century. In 1929, Frederic Foley introduced the modern catheter, and also credited with conception of the first artificial sphincter. From 1970 to 1973, Joseph Kaufman surgically created bulbar compression for post-prostatectomy incontinence, but not before designing the first male sling with John Berry in 1958. In 1973, F. Brantley Scott introduced the first multi-component artificial inflatable sphincter. Improvements upon periurethral bulking therapy occurred rapidly in the late 20th century with Teflon, collagen, autologous adipose, tissue and cross-linked silicone gels. Since 2007, stem cell injection therapy has emerged as a new therapeutic option for incontinence; however, results are mixed and remains experimental. CONCLUSION Treatment for male urinary incontinence has evolved from noninvasive devices to various surgical procedures. Artificial sphincters remain the gold-standard therapy for male urinary incontinence.
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Affiliation(s)
- Julio T Chong
- Department of Urology, Icahn School of Medicine at Mount Sinai Hospital, New York, New York
| | - Vannita Simma-Chiang
- Department of Urology, Icahn School of Medicine at Mount Sinai Hospital, New York, New York.,Department of Urology, Queens Health Network, New York, New York
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15
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Yang YD, Yu X, Wang XM, Mu XH, He F. Tanshinone IIA improves functional recovery in spinal cord injury-induced lower urinary tract dysfunction. Neural Regen Res 2017; 12:267-275. [PMID: 28400810 PMCID: PMC5361512 DOI: 10.4103/1673-5374.200810] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/27/2016] [Indexed: 01/14/2023] Open
Abstract
Tanshinone IIA, extracted from Salvia miltiorrhiza Bunge, exerts neuroprotective effects through its anti-inflammatory, anti-oxidative and anti-apoptotic properties. This study intravenously injected tanshinone IIA 20 mg/kg into rat models of spinal cord injury for 7 consecutive days. Results showed that tanshinone IIA could reduce the inflammation, edema as well as compensatory thickening of the bladder tissue, improve urodynamic parameters, attenuate secondary injury, and promote spinal cord regeneration. The number of hypertrophic and apoptotic dorsal root ganglion (L6-S1) cells was less after treatment with tanshinone IIA. The effects of tanshinone IIA were similar to intravenous injection of 30 mg/kg methylprednisolone. These findings suggested that tanshinone IIA improved functional recovery after spinal cord injury-induced lower urinary tract dysfunction by remodeling the spinal pathway involved in lower urinary tract control.
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Affiliation(s)
- Yong-dong Yang
- Department of Orthopedics, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
- School of Materials Science and Engineering, Tsinghua University, Beijing, China
| | - Xing Yu
- Department of Orthopedics, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Xiu-mei Wang
- School of Materials Science and Engineering, Tsinghua University, Beijing, China
| | - Xiao-hong Mu
- Department of Orthopedics, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Feng He
- Department of Orthopedics, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
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16
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Wada N, Shimizu T, Takai S, Shimizu N, Tyagi P, Kakizaki H, Yoshimura N. Combinational effects of muscarinic receptor inhibition and β3-adrenoceptor stimulation on neurogenic bladder dysfunction in rats with spinal cord injury. Neurourol Urodyn 2016; 36:1039-1045. [PMID: 27367752 DOI: 10.1002/nau.23066] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2016] [Accepted: 06/22/2016] [Indexed: 02/06/2023]
Abstract
AIMS To investigate the effects of combined therapy with an anticholinergic agent and a β3-adrenoceptor agonist on bladder dysfunction and proliferation-related molecule expression in rats with spinal cord injury (SCI). METHODS The spinal cord was transected at the level of T8-9 in female Sprague-Dawley rats, which were divided into four groups; A: Vehicle, B: 10 mg/kg/day of oxybutynin, C: 10 mg/kg/day of mirabegron, and D: combined administration of oxybutynin and mirabegron. Drugs were administered by oral gavage from 2 to 4 weeks after spinal cord transection. We evaluated urodynamic parameters and bladder tissue remodeling factors. RESULTS Non-voiding contractions (NVCs) during the storage phase of cystometrograms tended to be decreased in all three treated groups with a significant reduction in group D versus A. Bladder compliance was improved, and intercontraction intervals, voided volume and bladder capacity were increased in group D. In all three treated groups (B-D), the expression of HIF1-α and TGF-β1 was decreased compared to group A. The expression of collagen-III and bFGF was decreased in groups B and D. The total bladder elastin level was increased in group D. CONCLUSIONS The combination therapy of an anticholinergic agent and a β3-adrenoceptor agonist elevated the bladder elastin level, reduced NVCs, and increased bladder compliance more effectively than the monotherapy in SCI rats. Thus, the combination therapy could be effective for the treatment of neurogenic bladder dysfunction including bladder remodeling. Neurourol. Urodynam. 36:1039-1045, 2017. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Naoki Wada
- Department of Urology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania.,Department of Renal and Urologic Surgery, Asahikawa Medical University, Asahikawa, Japan
| | - Takahiro Shimizu
- Department of Urology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Shun Takai
- Department of Urology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Nobutaka Shimizu
- Department of Urology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Pradeep Tyagi
- Department of Urology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Hidehiro Kakizaki
- Department of Renal and Urologic Surgery, Asahikawa Medical University, Asahikawa, Japan
| | - Naoki Yoshimura
- Department of Urology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
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17
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Welk B, Liu K, Winick-Ng J, Shariff SZ. Urinary tract infections, urologic surgery, and renal dysfunction in a contemporary cohort of traumatic spinal cord injured patients. Neurourol Urodyn 2016; 36:640-647. [PMID: 26928899 DOI: 10.1002/nau.22981] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2015] [Accepted: 02/04/2016] [Indexed: 02/06/2023]
Abstract
AIMS The objective of this study was to measure the incidence of urinary tract infections (UTIs), urologic reconstruction/urinary diversion, and renal dysfunction after a traumatic spinal cord injury (TSCI). METHODS Retrospective cohort study using administrative data from Ontario, Canada. All incident adult TSCI patients (2002-2013) admitted to a rehabilitation center were included. The impact of lesion level on each outcome was assessed. The rate of outcomes was further compared to an age and sex matched sample from the general population. RESULTS A total of 2,023 incident TSCI patients were identified (median follow-up of 4.8 years). Most patients (73%) were male and median age was 50 years. Lesion level included cervical (39%), thoracolumbar (44%), and unknown (17%). The incidence of serious UTIs (requiring emergency room visit or hospital admission) was 40%. Thoracolumbar lesion TSCI patients had significantly greater risk of serious UTIs (HR 1.3, 95%CI 1.1-1.7, P < 0.01) compared to those with a cervical lesion. Urologic reconstruction/urinary diversion was carried out on 2.4% of patients. New onset renal dysfunction was identified in 4.2% (84) TSCI patients. The rate ratios for serious UTIs (10.59, 95%CI 8.71-12.89), urologic reconstruction/urinary diversion (6.48, 95%CI 3.07-13.68), and renal dysfunction (2.55, 95%CI 1.70-3.83) were significantly increased among TSCI patients compared to matched controls. CONCLUSIONS Urologic disease is still an important source of morbidity for contemporary TSCI patients, and is more common compared to the general population. Neurourol. Urodynam. 36:640-647, 2017. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Blayne Welk
- Department of Surgery and Epidemiology and Biostatistics, Western University, London, Ontario, Canada.,Institute for Clinical Evaluative Sciences-Western (ICES Western), London, Ontario, Canada
| | - Kuan Liu
- Institute for Clinical Evaluative Sciences-Western (ICES Western), London, Ontario, Canada
| | - Jennifer Winick-Ng
- Institute for Clinical Evaluative Sciences-Western (ICES Western), London, Ontario, Canada
| | - Salimah Z Shariff
- Institute for Clinical Evaluative Sciences-Western (ICES Western), London, Ontario, Canada
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Allio BA, Peterson AC. Urodynamic and physiologic patterns associated with the common causes of neurogenic bladder in adults. Transl Androl Urol 2016; 5:31-8. [PMID: 26904410 PMCID: PMC4739972 DOI: 10.3978/j.issn.2223-4683.2016.01.05] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
The clinical presentation of the neurogenic bladder can be as vast as the pathologic causes however urodynamics (UDS) can help guide clinical decision-making and help simplify a complex disease state. UDS may be considered as the gold standard in helping to break down complex and multifactorial voiding dysfunction into manageable goals; these include protecting the upper tracts, limiting urinary tract infections (UTI) via avoiding urinary stasis, and maintaining quality of life. Included within are examples of normal to pathologic tracings including normal filling and voiding, detrusor sphincteric coordination, changes in compliance, etc. Additionally we have provided expected UDS findings based on neurogenic disease process, including but not limited to, Parkinson’s, dementia, multiple sclerosis (MS) and spinal cord injury based on lesion location. Pattern recognition and understanding of UDS can help lead to quality of life improvements and optimal management for the patient with neurogenic bladder dysfunction.
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