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Zhang M, Chen Y, Liu J, Luo C, Chen Z, Xu T. Patterns of neurogenic lower urinary tract dysfunction management and associated factors among Chinese community-dwelling individuals with spinal cord injury. Sci Rep 2024; 14:13224. [PMID: 38851783 PMCID: PMC11162410 DOI: 10.1038/s41598-024-64081-w] [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: 10/16/2023] [Accepted: 06/05/2024] [Indexed: 06/10/2024] Open
Abstract
To identify different patterns of neurogenic lower urinary tract dysfunction management among Chinese community-dwelling individuals with spinal cord injury and explore the factors associated with latent classes. This was a cross-sectional study conducted in communities throughout China Mainland. Participants were recruited through the China Association of Persons with Physical Disability and a total of 2582 participants was included in the analysis. The data were collected by a questionnaire consisting of socio-demographic factors, disease-related factors, and a list of 8 bladder management methods. Latent class analysis was used to identify different latent classes of neurogenic lower urinary tract dysfunction management. Then the multinomial logistic regression was applied to analyze the relationship between neurogenic lower urinary tract dysfunction management patterns and socio-demographic and disease-related factors. Neurogenic lower urinary tract dysfunction management pattern among community-dwelling individuals with spinal cord injury was divided into four latent classes: "urinal collecting apparatus dominated pattern" (40.3%), "bladder compression dominated pattern" (30.7%), "intermittent catheterization dominated pattern" (19.3%) and "urethral indwelling catheterization dominated pattern" (9.6%). Multinomial logistic regression analysis found that the employment status, residential region, nursing need, payment method for catheterization products, hand function, time since spinal cord injury, urinary incontinence and concerns about social interaction affected by urination problems were significantly associated with latent classes. Only 19.3% of people used the intermittent catheterization as their main neurogenic lower urinary tract dysfunction management method. More attention needs to be paid to the promotion of the standardization process of intermittent catheterization in community-dwelling individuals with spinal cord injury. The associated factors of the four classes can be used for tailored and targeted interventions to increase the use of intermittent catheterization.
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Affiliation(s)
- Mengyang Zhang
- Department of Rehabilitation, Tongji Hospital Affiliated to Tongji Medical College of Huazhong University of Science and Technology, Wuhan, 430030, Hubei, China
| | - Ye Chen
- Department of Nursing, Tongji Hospital Affiliated to Tongji Medical College of Huazhong University of Science and Technology, Wuhan, 430030, Hubei, China
| | - Jiawei Liu
- Department of Rehabilitation, Tongji Hospital Affiliated to Tongji Medical College of Huazhong University of Science and Technology, Wuhan, 430030, Hubei, China
| | - Can Luo
- Department of Rehabilitation, Tongji Hospital Affiliated to Tongji Medical College of Huazhong University of Science and Technology, Wuhan, 430030, Hubei, China
| | - Zhong Chen
- Department of Urology, Tongji Hospital Affiliated to Tongji Medical College of Huazhong University of Science and Technology, Wuhan, 430030, Hubei, China
| | - Tao Xu
- Department of Rehabilitation, Tongji Hospital Affiliated to Tongji Medical College of Huazhong University of Science and Technology, Wuhan, 430030, Hubei, China.
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Sartori AM, Kessler TM, Castro-Díaz DM, de Keijzer P, Del Popolo G, Ecclestone H, Frings D, Groen J, Hamid R, Karsenty G, Musco S, Padilla-Fernández B, Pannek J, Schouten N, van der Vorm A, Blok BFM. Summary of the 2024 Update of the European Association of Urology Guidelines on Neurourology. Eur Urol 2024; 85:543-555. [PMID: 38594103 DOI: 10.1016/j.eururo.2024.03.026] [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: 03/03/2024] [Revised: 03/14/2024] [Accepted: 03/25/2024] [Indexed: 04/11/2024]
Abstract
BACKGROUND AND OBJECTIVE Most patients with neurourological disorders require lifelong medical care. The European Association of Urology (EAU) regularly updates guidelines for diagnosis and treatment of these patients. The objective of this review is to provide a summary of the 2024 updated EAU guidelines on neurourology. METHODS A structured literature review covering the timeframe 2021-2023 was conducted for the guideline update. A level of evidence and a strength rating were assigned for each recommendation on the basis of the literature data. KEY FINDINGS AND LIMITATIONS Neurological conditions significantly affect urinary, sexual, and bowel function, and lifelong management is required for neurourological patients to maintain their quality of life and prevent urinary tract deterioration. Early diagnosis and effective treatment are key, and comprehensive clinical assessments, including urodynamics, are crucial. Management should be customised to individual needs and should involve a multidisciplinary approach and address sexuality and fertility. Lifelong monitoring and follow-up highlight the importance of continuous care for neurourological patients. CONCLUSIONS AND CLINICAL IMPLICATIONS The 2024 EAU guidelines on neurourology provide an up-to-date overview of available evidence on diagnosis, treatment, and follow-up for neurourological patients. PATIENT SUMMARY Neurological disorders very frequently affect the lower urinary tract and sexual and bowel function and patients need lifelong management. We summarise the updated European Association of Urology guidelines on neurourology to provide patients and caregivers with the latest insights for optimal health care support.
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Affiliation(s)
- Andrea M Sartori
- Department of Neuro-Urology, Balgrist University Hospital, University of Zürich, Zürich, Switzerland; Harvard Medical School, Boston, MA, USA; Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA.
| | - Thomas M Kessler
- Department of Neuro-Urology, Balgrist University Hospital, University of Zürich, Zürich, Switzerland
| | - David M Castro-Díaz
- Department of Urology, Complejo Hospitalario Universitario de Canarias, Universidad de La Laguna, Tenerife, Spain
| | - Peter de Keijzer
- European Association of Urology Guidelines Office, Arnhem, The Netherlands
| | - Giulio Del Popolo
- Department of Neuro-urology, Careggi University Hospital, Florence, Italy
| | | | - Dennis Frings
- Department of Urology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Jan Groen
- Department of Urology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Rizwan Hamid
- Department of Neuro-Urology, London Spinal Injuries Centre, Stanmore, UK
| | - Gilles Karsenty
- Department of Urology, Aix Marseille University, Marseille, France
| | - Stefania Musco
- Department of Neuro-urology, Careggi University Hospital, Florence, Italy
| | - Bárbara Padilla-Fernández
- Department of Urology, Complejo Hospitalario Universitario de Canarias, Universidad de La Laguna, Tenerife, Spain
| | - Jürgen Pannek
- Neuro-Urology Department, Swiss Paraplegic Center, Nottwil, Switzerland; Department of Urology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Natasha Schouten
- European Association of Urology Guidelines Office, Arnhem, The Netherlands
| | | | - Bertil F M Blok
- Department of Urology, Erasmus Medical Center, Rotterdam, The Netherlands
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Jiang Y, Li X, Guo S, Wei Z, Xu S, Qin H, Xu J. Transcutaneous Electrical Stimulation for Neurogenic Bladder After Spinal Cord Injury: A Systematic Review and Meta-Analysis. Neuromodulation 2024; 27:604-613. [PMID: 37642626 DOI: 10.1016/j.neurom.2023.06.002] [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: 03/21/2023] [Revised: 05/04/2023] [Accepted: 06/05/2023] [Indexed: 08/31/2023]
Abstract
OBJECTIVES This review aims to assess the efficacy of transcutaneous electrical nerve stimulation (TENS) for neurogenic bladder after spinal cord injury (SCI). MATERIALS AND METHODS A systematic search was conducted of seven electronic data bases from inception to Dec 31, 2022, to identify randomized controlled trials that studied TENS for neurogenic bladder after SCI. The primary outcomes were maximum cystometric capacity (MCC) and residual urine volume (RUV). Secondary outcomes included maximum detrusor pressure, flow rate, and bladder diary. Random effects models were used in all analyses. RESULTS Eleven trials involving 881 participants were included. Meta-analysis showed that TENS in addition to conventional treatment had larger MCC (mean difference [MD] 50.55 ml, 95% CI 27.81-73.29, p<0.0001) and lower RUV (MD -22.96 ml, 95% CI -33.45 to -12.47, p<0.0001) than did conventional treatment only. Compared with magnetic stimulation, no differences were observed with TENS for MCC (MD -14.49 ml, 95% CI -48.97 to 19.98, p = 0.41) and RUV (MD 25 ml, 95% CI -61.79 to 111.79, p = 0.57). There also were no differences in MCC (MD -7.2 ml, 95% CI -14.56 to 0.16, p= 0.06) and (MD -5.2 ml, 95% CI -60.00 to 49.60, p = 0.851) when compared with solifenacin succinate and pelvic floor biofeedback, respectively. CONCLUSIONS TENS may be an effective treatment option for neurogenic bladder after SCI.
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Affiliation(s)
- Yangyang Jiang
- The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China
| | - Xiang Li
- The Fourth Affiliated Hospital of Guangxi Medical University, Liuzhou, Guangxi, China
| | - Suhui Guo
- The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China
| | - Zhengshu Wei
- The Fourth Affiliated Hospital of Guangxi Medical University, Liuzhou, Guangxi, China
| | - Senming Xu
- The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China; Affiliated Hospital of You Jiang Medical University for Nationalities, Baise, Guangxi, China
| | - Huiqing Qin
- The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China
| | - Jianwen Xu
- The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China.
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Zhao Q, Feng P, Zhu J, Wang Y, Zhou X, Xia Z, Wang D, He Y, Wang P, Li X. A novel score for early prediction of urinary tract infection risk in patients with acute ischemic stroke: a nomogram-based retrospective cohort study. Sci Rep 2024; 14:10707. [PMID: 38730021 PMCID: PMC11087532 DOI: 10.1038/s41598-024-61623-0] [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: 04/17/2024] [Accepted: 05/07/2024] [Indexed: 05/12/2024] Open
Abstract
This study aimed to construct and externally validate a user-friendly nomogram-based scoring model for predicting the risk of urinary tract infections (UTIs) in patients with acute ischemic stroke (AIS). A retrospective real-world cohort study was conducted on 1748 consecutive hospitalized patients with AIS. Out of these patients, a total of 1132 participants were ultimately included in the final analysis, with 817 used for model construction and 315 utilized for external validation. Multivariate regression analysis was applied to develop the model. The discriminative capacity, calibration ability, and clinical effectiveness of the model were evaluated. The overall incidence of UTIs was 8.13% (92/1132), with Escherichia coli being the most prevalent causative pathogen in patients with AIS. After multivariable analysis, advanced age, female gender, National Institute of Health Stroke Scale (NIHSS) score ≥ 5, and use of urinary catheters were identified as independent risk factors for UTIs. A nomogram-based SUNA model was constructed using these four factors (Area under the receiver operating characteristic curve (AUC) = 0.810), which showed good discrimination (AUC = 0.788), calibration, and clinical utility in the external validation cohort. Based on four simple and readily available factors, we derived and externally validated a novel and user-friendly nomogram-based scoring model (SUNA score) to predict the risk of UTIs in patients with AIS. The model has a good predictive value and provides valuable information for timely intervention in patients with AIS to reduce the occurrence of UTIs.
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Affiliation(s)
- Qinqin Zhao
- Department of Pharmacy, Tongde Hospital of Zhejiang Province, No. 234 Gucui Road, Xihu District, Hangzhou City, 310012, Zhejiang Province, China
| | - Pinpin Feng
- Department of Pharmacy, Tongde Hospital of Zhejiang Province, No. 234 Gucui Road, Xihu District, Hangzhou City, 310012, Zhejiang Province, China
| | - Jun Zhu
- Department of Pharmacy, Tongde Hospital of Zhejiang Province, No. 234 Gucui Road, Xihu District, Hangzhou City, 310012, Zhejiang Province, China
| | - Yunling Wang
- Department of Neurology, Tongde Hospital of Zhejiang Province, Hangzhou, 310012, China
| | - Xiaojuan Zhou
- Department of Pharmacy, Tongde Hospital of Zhejiang Province, No. 234 Gucui Road, Xihu District, Hangzhou City, 310012, Zhejiang Province, China
| | - Zhongni Xia
- Department of Pharmacy, Tongde Hospital of Zhejiang Province, No. 234 Gucui Road, Xihu District, Hangzhou City, 310012, Zhejiang Province, China
| | - Danqing Wang
- School of Pharmaceutical Sciences, Hangzhou Medical College, Hangzhou, 311399, China
| | - Yueyue He
- School of Pharmaceutical Sciences, Hangzhou Medical College, Hangzhou, 311399, China
| | - Pei Wang
- Department of Pharmacy, Tongde Hospital of Zhejiang Province, No. 234 Gucui Road, Xihu District, Hangzhou City, 310012, Zhejiang Province, China.
| | - Xiang Li
- School of Basic Medical Sciences & Forensic Medicine, Hangzhou Medical College, No. 8 Yikang Street, Lin'an District, Hangzhou City, 311399, Zhejiang Province, China.
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Elkhashab MM, Alqahtani AM, Kim MH, Kim J, Kim JH, Jung JH. Safety and efficacy of beta-3 adrenergic agonists in treating neurogenic lower urinary tract dysfunction: A systematic review and meta-analysis. Investig Clin Urol 2024; 65:217-229. [PMID: 38714512 PMCID: PMC11076796 DOI: 10.4111/icu.20230271] [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: 08/15/2023] [Revised: 10/01/2023] [Accepted: 01/22/2024] [Indexed: 05/10/2024] Open
Abstract
PURPOSE To evaluate efficacy and safety of beta-3 adrenergic agonists in adults with neurogenic lower urinary tract dysfunction. MATERIALS AND METHODS According to a protocol (CRD42022350079), we searched multiple data sources for published and unpublished randomized controlled trials (RCTs) up to 2nd August 2022. Two review authors independently screened studies and abstracted data from the included studies. We performed statistical analyses by using a random-effects model and interpreted them according to the Cochrane Handbook for Systematic Reviews of Interventions. We used GRADE guidance to rate the certainty of evidence (CoE). RESULTS We found data to inform two comparisons: beta-3 adrenergic agonists versus placebo (4 RCTs) and anticholinergics (2 RCTs). Only mirabegron was used for intervention in all included studies. Compared to placebo, beta-3 adrenergic agonists may have a clinically unimportant effect on urinary symptoms score (mean difference [MD] -2.50, 95% confidence interval [CI] -4.78 to -0.22; I²=92%; 2 RCTs; 192 participants; low CoE) based on minimal clinically important difference of 3. We are very uncertain of the effects of beta-3 adrenergic agonists on quality of life (MD 10.86, 95% CI 1.21 to 20.50; I²=41%; 2 RCTs; 98 participants; very low CoE). Beta-3 adrenergic agonists may result in little to no difference in major adverse events (cardiovascular adverse events) (risk ratio 0.57, 95% CI 0.14 to 2.37; I²=0%; 4 RCTs; 310 participants; low CoE). Compared to anticholinergics, no study reported urinary symptom scores and quality of life. There were no major adverse events (cardiovascular adverse events) in either study group (1 study; 60 participants; very low CoE). CONCLUSIONS Compared to placebo, beta-3 adrenergic agonists may have similar effects on urinary symptom scores and major adverse events. There were uncertainties about their effects on quality of life. Compared to anticholinergics, we are either very uncertain or have no evidence about urinary symptom scores, quality of life, and major adverse events.
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Affiliation(s)
- Mohamed Medhat Elkhashab
- Department of Urology & Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea
- Department of Urology, Tanta University, Faculty of Medicine, Tanta, Egypt
| | - Abdullah Mari Alqahtani
- Department of Urology & Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea
- Department of Urology, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
| | - Myung Ha Kim
- Yonsei Wonju Medical Library, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Jinu Kim
- Department of Urology & Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Jang Hwan Kim
- Department of Urology & Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Jae Hung Jung
- Department of Precision Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea
- Department of Urology, Yonsei University Wonju College of Medicine, Wonju, Korea
- Center of Evidence Based Medicine, Institute of Convergence Science, Yonsei University, Seoul, Korea.
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Hogue LL, Kennelly M. The Ideal Neurogenic Bladder Management Team. Urol Clin North Am 2024; 51:297-303. [PMID: 38609201 DOI: 10.1016/j.ucl.2024.02.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/14/2024]
Abstract
This article discusses the ideal neurogenic bladder management team for patients who have neurogenic lower urinary tract dysfunction (NLUTD). It emphasizes the importance of a diverse team, including urologists, physiatrists, neurologist and others, working collaboratively to prevent complications and enhance patient outcomes. Owing to the unique nuances of the various neurologic conditions and patterns of NLUTD dysfunction, the roles of different specialists in the interdisciplinary team are outlined. This article describes 3 team models: multidisciplinary, interdisciplinary, and transdisciplinary, highlighting the benefits of collaborative approaches.
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Affiliation(s)
- LaTanya Lofton Hogue
- Department of Orthopedic Surgery, Wake Forest School of Medicine, Atrium Health, Carolinas Rehabilitation, 1100 Blythe Boulevard, Charlotte, NC 28203, USA
| | - Michael Kennelly
- Department of Urology, Wake Forest School of Medicine, Atrium Health, Carolinas Rehabilitation, 1100 Blythe Boulevard, Charlotte, NC 28203, USA.
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7
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Ingram CF, Lincoln JA, Khavari R. Voiding Phase Dysfunction in Multiple Sclerosis: Contemporary Review of Terminology, Diagnosis, Management, and Future Directions. Urol Clin North Am 2024; 51:177-185. [PMID: 38609190 DOI: 10.1016/j.ucl.2024.01.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/14/2024]
Abstract
Lower urinary tract symptoms (LUTS) are highly prevalent in individuals with multiple sclerosis (MS). However, assessment of these symptoms is often hindered by vague definitions or absence of screening in asymptomatic patients. It is crucial to exercise caution when applying the non-neurogenic definition of urinary retention in this population. For men with MS experiencing persistent and treatment-resistant LUTS, urodynamic studies should be used to identify the underlying causes of symptoms. Although numerous therapies are presently accessible for managing LUTS in MS, there is a need for further investigation into emerging treatments such as percutaneous tibial nerve, and noninvasive brain stimulation.
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Affiliation(s)
| | - John A Lincoln
- Department of Neurology, McGovern Medical School, UT Health Neurosciences Neurology, 6431 Fannin Street, MSB 7.222, 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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Decombe O, Germain T, Lenfant L, Denormandie A, Felber M, Robain G, Denys P, Chartier-Kastler E. Isolated continent cystostomy on neurologic native bladder: Functional results. THE FRENCH JOURNAL OF UROLOGY 2024; 34:102642. [PMID: 38701949 DOI: 10.1016/j.fjurol.2024.102642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Revised: 04/14/2024] [Accepted: 04/28/2024] [Indexed: 05/06/2024]
Abstract
INTRODUCTION Continent cutaneous urinary diversion (CCUD) is proposed to patients suffering from chronic neurologic retention and undergoing intermittent self-catheterization (ISC). In case of neurogenic detrusor overactivity (NDO), augmentation enterocystoplasty is often required. The aim was to identify the prevalence of urinary stomal and/or urethral leakage in patients who had not undergone enlargement. METHODS Monocentric, retrospective study of patients who underwent CCUD surgery in a neuro-urological context. Mitrofanoff's, Monti's or Casale's channels were performed. Patients selected had an underactive, stable, or stabilized bladder under adjuvant therapy with proper cystomanometric capacity. Prior or concomitant enterocystoplasty were excluded. Failure was defined as the occurrence of clinical leakage whatever it is through urinary stomal, or urethral. Urodynamic parameters were also reported. RESULTS Thirty-one patients underwent surgery. Nine women had a concomitant bladder neck sling and 1 urethral closure. The mean follow-up was 7 years. 8/31 (26%) had stomal leakage and 9 urethral leakage (29%). Five spinal cord injured patients (n=14) had stomal leakage (36%) and 6 urethral leakage (43%). Of the 25 postoperative urodynamic parameters, cystomanometric bladder capacity was 419mL (vs. 514mL) and 2 additional patients had de novo NDO (9 vs. 7). DISCUSSION The morbidity of augmentation enterocystoplasty is weighed against the presence of a well-controlled bladder preoperatively. Our study shows the appearance of leakage in some patients despite a well-balanced bladder, a decrease in mean cystomanometric capacity and an increase in the rate of NDO postoperatively. Good selection criteria for an isolated CCUD should be carefully revised and defined. LEVEL OF EVIDENCE Grade C - retrospective study.
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Affiliation(s)
- O Decombe
- Department of Urology, Sorbonne université, Pitié-Salpêtrière Academic Hospital, AP-HP, Paris, France.
| | - T Germain
- Department of Urology, Sorbonne université, Pitié-Salpêtrière Academic Hospital, AP-HP, Paris, France
| | - L Lenfant
- Department of Urology, Sorbonne université, Pitié-Salpêtrière Academic Hospital, AP-HP, Paris, France
| | - A Denormandie
- Department of Urology, Sorbonne université, Pitié-Salpêtrière Academic Hospital, AP-HP, Paris, France
| | - M Felber
- Department of Urology, Sorbonne université, Pitié-Salpêtrière Academic Hospital, AP-HP, Paris, France
| | - G Robain
- Department of rehabilitation, Sorbonne université, Rothschild Hospital, AP-HP, Paris, France
| | - P Denys
- Department of rehabilitation, Paris-Saclay University, Raymond-Poincaré Hospital, AP-HP, Paris, France
| | - E Chartier-Kastler
- Department of Urology, Sorbonne université, Pitié-Salpêtrière Academic Hospital, AP-HP, Paris, France
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9
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Baboudjian M, Hashim H, Bhatt N, Creta M, De Nunzio C, Gacci M, Herrmann T, Karavitakis M, Malde S, Moris L, Netsch C, Rieken M, Sakalis V, Schouten N, Tutolo M, Cornu JN. Summary Paper on Underactive Bladder from the European Association of Urology Guidelines on Non-neurogenic Male Lower Urinary Tract Symptoms. Eur Urol 2024:S0302-2838(24)02273-5. [PMID: 38644139 DOI: 10.1016/j.eururo.2024.04.004] [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: 02/27/2024] [Revised: 02/29/2024] [Accepted: 04/02/2024] [Indexed: 04/23/2024]
Abstract
BACKGROUND AND OBJECTIVE The European Association of Urology (EAU) Guidelines Panel on non-neurogenic male lower urinary tract symptoms (LUTS) aimed to develop a new subchapter on underactive bladder (UAB) in non-neurogenic men to inform health care providers of current best evidence and practice. Here, we present a summary of the UAB subchapter that is incorporated into the 2024 version of the EAU guidelines on non-neurogenic male LUTS. METHODS A systematic literature search was conducted from 2002 to 2022, and articles with the highest certainty evidence were selected. A strength rating has been provided for each recommendation according to the EAU Guideline Office methodology. KEY FINDINGS AND LIMITATIONS Detrusor underactivity (DU) is a urodynamic diagnosis defined as a contraction of reduced strength and/or duration, resulting in prolonged bladder emptying and/or failure to achieve complete bladder emptying within a normal time span. UAB is a terminology that should be reserved for describing symptoms and clinical features related to DU. Invasive urodynamics is the only widely accepted method for diagnosing DU. In patients with persistently elevated postvoid residual (ie, >300 ml), intermittent catheterization is indicated and preferred to indwelling catheters. Alpha-adrenergic blockers are recommended before more invasive techniques, but the level of evidence is low. In men with DU and concomitant benign prostatic obstruction (BPO), benign prostatic surgery should be considered only after appropriate counseling. In men with DU and no BPO, a test phase of sacral neuromodulation may be considered. CONCLUSIONS AND CLINICAL IMPLICATIONS The current text represents a summary of the new subchapter on UAB. For more detailed information, refer to the full-text version available on the EAU website (https://uroweb.org/guidelines/management-of-non-neurogenic-male-luts). PATIENT SUMMARY The European Association of Urology guidelines on underactive bladder in non-neurogenic adult men are presented here. Patients must be fully informed of all relevant options and, together with their treating physicians, decide on the most optimal management for them.
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Affiliation(s)
- Michael Baboudjian
- Department of Urology, APHM, North Academic Hospital, Marseille, France; Department of Urology, APHM, La Conception Hospital, Marseille, France; Department of Urology, Fundació Puigvert, Autonoma University of Barcelona, Barcelona, Spain; Department of Urology, La Croix, Quint Fonsegrives, France.
| | | | - Nikita Bhatt
- Department of Urology, East of England Deanery, Cambridge, UK
| | | | - Cosimo De Nunzio
- Department of Urology, Sapienza University, Ospedale Sant'Andrea, Rome, Italy
| | - Mauro Gacci
- Unit of Urological Robotic Surgery and Renal Transplantation, University of Florence, Careggi Hospital, Florence, Italy; Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Thomas Herrmann
- Department of Urology, Kantonsspital Frauenfeld, Frauenfeld, Switzerland
| | - Markos Karavitakis
- Department of Urology, University General Hospital of Heraklion, University of Crete Medical School, Heraklion, Crete, Greece
| | - Sachin Malde
- Department of Urology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Lisa Moris
- Department of Urology, University Hospitals Leuven, Leuven, Belgium; Laboratory of Molecular Endocrinology, KU Leuven, Leuven, Belgium
| | | | | | - Vasileios Sakalis
- Department of Urology, Hippokrateion General Hospital, Thessaloniki, Greece
| | - Natasha Schouten
- European Association of Urology Guidelines Office, Arnhem, The Netherlands
| | - Manuela Tutolo
- Department of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Jean-Nicolas Cornu
- Department of Urology, CHU Hôpitaux de Rouen - Hôpital Charles Nicolle, Rouen, France
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10
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Chen SF, Kuo HC. Management of spinal cord injury patients with neurogenic lower urinary tract dysfunction using minimally invasive and surgical therapies in Taiwan. Int Urol Nephrol 2024; 56:1205-1216. [PMID: 38036803 DOI: 10.1007/s11255-023-03884-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Accepted: 11/06/2023] [Indexed: 12/02/2023]
Abstract
The main problems of neurogenic lower urinary tract dysfunction (NLUTD) in patients with spinal cord injury (SCI) consist of impaired urine storage, impaired bladder emptying, or both. The priorities in the management of SCI-NLUTD should be preservation of renal function, followed by freedom from urinary tract infections and improvement of quality of life. Management of NLUTD in patients with SCI must be based on urodynamic findings rather than clinical evaluations. In the hospital without urodynamic equipment, careful measurement of intravesical pressure and safety functional bladder capacity in conjunction with clinical assessment are also feasible. Identification of high-risk patients is important for preventing urological complications in patients with chronic SCI. The management of NLUTD should start with conservative bladder management and medical treatment. Patients with SCI should be regularly followed up, and any NLUTDs and urological complications should be adequately treated. When surgical intervention is necessary, less invasive and reversible procedures should be considered first, and any unnecessary surgery should be avoided. This article reports the current evidence and expert opinions on the patient-centered bladder management of NLUTD in chronic SCI patients in Taiwan. To avoid renal function deterioration and urological complications, annual active surveillance of bladder and renal function is mandatory, especially for high-risk SCI patients.
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Affiliation(s)
- Sheng-Fu Chen
- Department of Urology, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, and Tzu Chi University 707, Section 3, Chung-Yang Road, Hualien, Taiwan.
| | - Hann-Chorng Kuo
- Department of Urology, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, and Tzu Chi University 707, Section 3, Chung-Yang Road, Hualien, Taiwan.
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11
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Welk B, Krhut J, Sýkora R. An individual participant meta-analysis of mirabegron in multiple sclerosis and spinal cord injury. Neurourol Urodyn 2024; 43:803-810. [PMID: 38477368 DOI: 10.1002/nau.25439] [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: 08/31/2023] [Revised: 01/03/2024] [Accepted: 02/27/2024] [Indexed: 03/14/2024]
Abstract
INTRODUCTION Our objective was to conduct an individual patient data meta-analysis (IPDMA) of the two published randomized placebo-controlled trials of mirabegron in people with neurogenic lower urinary tract dysfunction (NLUTD) due to spinal cord injury (SCI) or multiple sclerosis (MS). METHODS We identified two randomized, placebo-controlled trials. We extracted individual patient data from the trials and evaluated two primary outcomes: change in maximum cystometric capacity and change in the patient perception of bladder condition (PPBC). We also evaluated several secondary outcomes related to urodynamic function and quality of life. We conducted three exploratory analyses to test hypotheses based on our clinical experiences with mirabegron in NLUTD. Analysis of covariance with adjustment for baseline values was used for the statistical analysis. RESULTS Our IPDMA included 98 patients from the two trials. The results showed that mirabegron was associated with a significant improvement in maximum cystometric capacity (+41 mL, p = 0.04) and in the PPBC (-0.8, p < 0.01) compared to placebo. Secondary outcomes including peak neurogenic detrusor overactivity pressure (-20 cm H2O, p < 0.01), incontinence-QOL score (+12, p < 0.01), and 24 h pad weights (-79 g, p = 0.04) also improved significantly compared to placebo. Exploratory analyses found similar improvements in people with MS and SCI; some outcomes improved to a greater degree among people with incomplete SCI, or SCIs that were below T7. CONCLUSIONS Our IPDMA provides evidence supporting the use of mirabegron in patients with NLUTD due to SCI or MS. Further work evaluating differential responses in people with different SCI lesion characteristics may be warranted.
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Affiliation(s)
- Blayne Welk
- Department of Surgery and Epidemiology and Biostatistics, Western University, London, Ontario, Canada
| | - Jan Krhut
- Department of Urology, University Hospital, Ostrava, Czech Republic
- Department of Surgical Studies, Ostrava University, Ostrava, Czech Republic
| | - Radek Sýkora
- Department of Urology, University Hospital, Ostrava, Czech Republic
- Department of Surgical Studies, Ostrava University, Ostrava, Czech Republic
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12
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Calderón-Juárez M, Samejima S, Rempel L, Sachdeva R, Krassioukov A. Autonomic dysreflexia in urological practice: pathophysiology, prevention and treatment considerations. World J Urol 2024; 42:80. [PMID: 38358540 DOI: 10.1007/s00345-024-04781-0] [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: 10/13/2023] [Accepted: 01/09/2024] [Indexed: 02/16/2024] Open
Abstract
PURPOSE Spinal cord injury (SCI) leads to sensorimotor impairments; however, it can also be complicated by significant autonomic dysfunction, including cardiovascular and lower urinary tract (LUT) dysfunctions. Autonomic dysreflexia (AD) is a dangerous cardiovascular complication of SCI often overlooked by healthcare professionals. AD is characterized by a sudden increase in blood pressure (BP) that can result in severe cardiovascular and cerebrovascular complications. In this review, we provide an overview on the clinical manifestations, risk factors, underlying mechanisms, and current approaches in prevention and management of AD. METHODS After conducting a literature research, we summarized relevant information regarding the clinical and pathophysiological aspects in the context of urological clinical practice CONCLUSIONS: The most common triggers of AD are those arising from LUT, such as bladder distention and urinary tract infections. Furthermore, AD is commonly observed in individuals with SCI during urological procedures, including catheterization, cystoscopy and urodynamics. Although significant progress in the clinical assessment of AD has been made in recent decades, effective approaches for its prevention and treatment are currently lacking.
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Affiliation(s)
- Martín Calderón-Juárez
- International Collaboration On Repair Discoveries, Faculty of Medicine, The University of British Columbia, 818 West 10th Avenue, Vancouver, BC, V5Z 1M9, Canada
- Division of Physical Medicine and Rehabilitation, Department of Medicine, The University of British Columbia, Vancouver, Canada
| | - Soshi Samejima
- International Collaboration On Repair Discoveries, Faculty of Medicine, The University of British Columbia, 818 West 10th Avenue, Vancouver, BC, V5Z 1M9, Canada
- Division of Physical Medicine and Rehabilitation, Department of Medicine, The University of British Columbia, Vancouver, Canada
| | - Lucas Rempel
- International Collaboration On Repair Discoveries, Faculty of Medicine, The University of British Columbia, 818 West 10th Avenue, Vancouver, BC, V5Z 1M9, Canada
- Faculty of Medicine, The University of British Columbia, Vancouver, Canada
| | - Rahul Sachdeva
- International Collaboration On Repair Discoveries, Faculty of Medicine, The University of British Columbia, 818 West 10th Avenue, Vancouver, BC, V5Z 1M9, Canada
- Division of Physical Medicine and Rehabilitation, Department of Medicine, The University of British Columbia, Vancouver, Canada
| | - Andrei Krassioukov
- International Collaboration On Repair Discoveries, Faculty of Medicine, The University of British Columbia, 818 West 10th Avenue, Vancouver, BC, V5Z 1M9, Canada.
- Division of Physical Medicine and Rehabilitation, Department of Medicine, The University of British Columbia, Vancouver, Canada.
- GF Strong Rehabilitation Centre, Vancouver Coastal Health, Vancouver, BC, Canada.
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Liu J, Hao X, Shang X, Chi R, Xu T. Incidence and risk factors of urinary tract infection in hospitalized patients with spinal cord injury in a hospital of China. Sci Rep 2024; 14:3579. [PMID: 38347072 PMCID: PMC10861502 DOI: 10.1038/s41598-024-54234-2] [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: 11/01/2023] [Accepted: 02/10/2024] [Indexed: 02/15/2024] Open
Abstract
Urinary tract infection (UTI) caused by spinal cord injury (SCI) can have significant morbidity. There is currently a lack of relevant data in China. This study explores incidence and risk factors of UTI in hospitalized patients with SCI in China, and will help healthcare professionals to make informed clinical decisions to reduce the incidence of UTI. This retrospective study analyzed the medical records of patients with SCI who were hospitalized at three campuses of a hospital in central China between August 2014 and August 2023. The files of patients with SCI were reviewed for demographics and clinical characteristics. Logistic regression analysis was performed to identify risk factors associated with UTI. A total of 538 patients were included in this study. The incidence of UTI was 49.8%. Sex, hypoproteinemia, urinary incontinence, bladder irrigation, timing of rehabilitation, duration of indwelling urinary catheter were risk factors of UTI. The implementation of specific preventive measures is anticipated to result in a decrease in the occurrence of UTI among individuals with SCI, consequently enhancing their overall quality of life and prognosis.
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Affiliation(s)
- Jiawei Liu
- Department of Rehabilitation, Tongji Hospital of Tongji Medical College of Huazhong University of Science and Technology, Jiefang Avenue, No. 1095, Wuhan, 430030, Hubei, China
| | - Xiaoxia Hao
- Department of Rehabilitation, Tongji Hospital of Tongji Medical College of Huazhong University of Science and Technology, Jiefang Avenue, No. 1095, Wuhan, 430030, Hubei, China
| | - Xingru Shang
- Department of Rehabilitation, Tongji Hospital of Tongji Medical College of Huazhong University of Science and Technology, Jiefang Avenue, No. 1095, Wuhan, 430030, Hubei, China
| | - Ruimin Chi
- Department of Rehabilitation, Tongji Hospital of Tongji Medical College of Huazhong University of Science and Technology, Jiefang Avenue, No. 1095, Wuhan, 430030, Hubei, China
| | - Tao Xu
- Department of Rehabilitation, Tongji Hospital of Tongji Medical College of Huazhong University of Science and Technology, Jiefang Avenue, No. 1095, Wuhan, 430030, Hubei, China.
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14
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Khadour YA, Zheng M, Khadour FA. Arabic version of the SF-Qualiveen: cross-cultural adaptation, translation, and validation of urinary disorder-specific instruments in patients with multiple sclerosis. BMC Urol 2024; 24:37. [PMID: 38347524 PMCID: PMC10863290 DOI: 10.1186/s12894-024-01429-4] [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: 05/22/2023] [Accepted: 02/07/2024] [Indexed: 02/15/2024] Open
Abstract
BACKGROUND The Short Form Qualiveen (SF-Qualiveen) questionnaire assesses the effect of bladder and urinary symptoms on patients' quality of life (QoL) with urological impairment caused by neurological diseases. There is no validated SF-Qualiveen questionnaire in Arabic, so this study aims to provide a translated and validated version of the SF-Qualiveen questionnaire among Arabic-speaking patients with multiple sclerosis (MS). METHODS The English version of the SF-Qualiveen was translated into Arabic using an algorithm for linguistic and cultural adaptation. MS patients completed the SF-Qualiveen, and the Neurogenic Bladder Symptom Score(NBSS) questionnaire. Psychometric features such as content and construct validity, test-retest reliability, and internal consistency were analyzed. Construct validity was evaluated by contrasting the SF-Qualiveen with the NBSS questionnaire. Internal consistency was measured using Cronbach's alpha, whereas the intraclass correlation coefficient (ICC) was employed to assess the test-retest reliability. RESULTS One hundred and two patients with MS were included in this study. The internal consistency of the total SF-Qualiveen, and the domains "Bother with limitations," "Fear," "Feeling," and "Frequency of limitations" showed good internal consistency (Cronbach's alpha of > 0.7). ICC was 0.91 for the total score 0.85 for the Bother with limitations, 0.81 for Fears, 0.86 for Feeling, and 0.81 for Frequency of limitations. The correlation analysis revealed a positive association between the total scores on the NBSS and the domains of the SF-Qualiveen, comprising bother with limitations (r = 0.473, p = 0.027), fears (r = 0.611, p = 0.031), feelings (r = 0.572, p = 0.04), and frequency of limitations (r = 0.514, p = 0.013). CONCLUSIONS The findings of this validation study revealed that the SF-Qualiveen is a reliable and valid instrument appropriate for Arabic-speaking patients with MS in both research and clinical practice.
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Affiliation(s)
- Younes A Khadour
- Department of Physical Therapy, Cairo University, Cairo, 11835, Egypt
- Department of Rehabilitation, Faculty of Medicine, Al Baath University, Homs, Syria
| | - Meng Zheng
- Department of Orthopaedic Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Fater A Khadour
- Department of Rehabilitation, Faculty of Medicine, Al Baath University, Homs, Syria.
- Department of Physical Therapy, Health Science Faculty, Al-Baath University, Homs, Syria.
- Department of Rehabilitation, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095#, Jie-Fang Avenue, Qiaokou District, Wuhan, 430030, Hubei, China.
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Vrijens D, Kendall H, Hervé F. Neurological sphincter deficiency: is there a place for artificial urinary sphincter? World J Urol 2024; 42:69. [PMID: 38308692 PMCID: PMC10838219 DOI: 10.1007/s00345-023-04716-1] [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: 06/02/2023] [Accepted: 09/26/2023] [Indexed: 02/05/2024] Open
Abstract
PURPOSE Neurogenic stress urinary incontinence (N-SUI) is a condition with serious impact on the quality of life. There are several treatment modalities of which the artificial urinary sphincter (AUS) stands out as the most suitable technique for addressing sphincter insufficiency. In this article, the purpose is to describe practical considerations, outcomes, and complications of the artificial urinary sphincter in neurological sphincter deficiency in both males and females. METHODS A narrative review of the current literature. RESULTS The outcomes of AUS are reasonably good in patients with NLUTD, the surgical technique is discussed as well as the limitations and special considerations in this complex and heterogeneous patient population. CONCLUSION The available evidence suggests that its efficacy and functional durability may be lower in patients with neurogenic lower urinary tract dysfunction (NLUTD) compared to those without neurological deficits. However, studies have shown that AUS can still provide effective and safe continence outcomes in both male and female patients, with long-term device survival rates ranging from several years to over a decade.
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Affiliation(s)
- Desiree Vrijens
- Departement of Urology, Maastricht University Medical Centre, Maastricht, Netherlands.
| | - Harry Kendall
- Departement of Urology, Maastricht University Medical Centre, Maastricht, Netherlands
| | - François Hervé
- Departement of Urology, University Hospital of Ghent, Ghent, Belgium
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Lambert E, Chartier-Kastler E, Vaessen C, Beaugerie A, Cotte J, Roupret M, Mozer P, Parra J, Seisen T, Lenfant L. Robot-assisted Periprostatic Artificial Urinary Sphincter Implantation in Men with Neurogenic Stress Urinary Incontinence: Description of the Surgical Technique and Comparison of Long-term Functional Outcomes with the Open Approach. Eur Urol 2024; 85:139-145. [PMID: 37914580 DOI: 10.1016/j.eururo.2023.09.025] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Revised: 09/02/2023] [Accepted: 09/28/2023] [Indexed: 11/03/2023]
Abstract
BACKGROUND Periprostatic artificial urinary sphincter implantation (pAUSi) is a rare yet relevant indication for male neurogenic stress urinary incontinence (SUI). OBJECTIVE To describe the surgical technique of robot-assisted pAUSi (RApAUSi) and compare the long-term functional results with the open pAUSi (OpAUSi). DESIGN, SETTING, AND PARTICIPANTS Data of 65 consecutive men with neurogenic SUI undergoing pAUSi between 2000 and 2022 in a tertiary centre were collected retrospectively. SURGICAL PROCEDURE Thirty-three patients underwent OpAUSi and 32 underwent RApAUSi. OpAUSi cases were performed by a single surgeon, experienced in functional urology and prosthetic surgery. RApAUSi cases were performed by the same surgeon together with a second surgeon, experienced in robotic surgery. MEASUREMENTS Outcome measures were achievement of complete urinary continence, intra- and postoperative complications, and surgical revision-free survival (SRFS). RESULTS AND LIMITATIONS RApAUSi showed superior results to OpAUSi in terms of median (interquartile range) operative time (RApAUSi: 170 [150-210] min vs OpAUSi: 245 [228-300] min; p < 0.001), estimated blood loss (RApAUSi: 20 [0-50] ml vs OpAUSi: 500 [350-700] ml; p < 0.001), and median length of hospital stay (LOS; RApAUSi: 5 [4-6] d vs OpAUSi: 11 [10-14] d; p < 0.001). Clavien-Dindo grade ≥3a complications occurred more frequently after OpAUSi (RApAUSi: 1/32 [3%] vs OpAUSi: 10/33 [30%]; p = 0.014). Achievement of complete urinary continence (zero pads) was comparable between the groups (RApAUSi: 24/32 [75%] vs OpAUSi: 24/33 [73%]; p = 0.500). The median follow-up periods were 118 (50-183) and 56 (25-84) mo for OpAUSi and RApAUSi, respectively (p < 0.001). A tendency towards longer SRFS was observed in the RApAUSi group (p = 0.076). The main study limitation was its retrospective nature. CONCLUSIONS RApAUSi is an efficient alternative to OpAUSi, resulting in shorter operative times, less blood loss, fewer severe complications, and a shorter LOS with similar functional results and need for revision surgery. PATIENT SUMMARY Compared with open periprostatic artificial urinary sphincter implantation (pAUSi), robot-assisted pAUSi leads to faster recovery and similar functional results, with fewer postoperative complications.
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Affiliation(s)
- Edward Lambert
- Department of Urology, University Hospital Pitié-Salpêtrière, Paris, France; J-ERUS/YAU Academic Urologists Working Group on Robot-Assisted Surgery, Paris, France.
| | - Emmanuel Chartier-Kastler
- Department of Urology, University Hospital Pitié-Salpêtrière, Paris, France; Faculty of Medicine Sorbonne University, Paris, France
| | - Christophe Vaessen
- Department of Urology, University Hospital Pitié-Salpêtrière, Paris, France
| | - Aurélien Beaugerie
- Department of Urology, University Hospital Pitié-Salpêtrière, Paris, France; Faculty of Medicine Sorbonne University, Paris, France
| | - Juliette Cotte
- Department of Urology, University Hospital Pitié-Salpêtrière, Paris, France; Faculty of Medicine Sorbonne University, Paris, France
| | - Morgan Roupret
- Department of Urology, University Hospital Pitié-Salpêtrière, Paris, France; Faculty of Medicine Sorbonne University, Paris, France
| | - Pierre Mozer
- Department of Urology, University Hospital Pitié-Salpêtrière, Paris, France; Faculty of Medicine Sorbonne University, Paris, France
| | - Jérôme Parra
- Department of Urology, University Hospital Pitié-Salpêtrière, Paris, France
| | - Thomas Seisen
- Department of Urology, University Hospital Pitié-Salpêtrière, Paris, France; Faculty of Medicine Sorbonne University, Paris, France
| | - Louis Lenfant
- Department of Urology, University Hospital Pitié-Salpêtrière, Paris, France; Faculty of Medicine Sorbonne University, Paris, France
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Sacco R, Maino P, Koetsier E, Disanto G, Renard J, Digesu A, Gobbi C, Zecca C. Efficacy and safety of the implantable, magnetic resonance imaging-compatible StimRouter neuromodulation system in the treatment of refractory lower urinary tract symptoms in multiple sclerosis patients. Eur J Neurol 2024; 31:e16146. [PMID: 37975785 DOI: 10.1111/ene.16146] [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: 06/15/2023] [Revised: 09/29/2023] [Accepted: 10/26/2023] [Indexed: 11/19/2023]
Abstract
BACKGROUND AND PURPOSE Lower urinary tract symptoms (LUTS) significantly affect quality of life (QoL) of multiple sclerosis (MS) patients, and pharmacotherapy has limited efficacy. We investigated efficacy and safety of the implantable StimRouter neuromodulation system for treating refractory LUTS in MS. METHODS This prospective, single-center, clinical trial was conducted at the Multiple Sclerosis Center of Lugano, Switzerland, involving MS patients treated with self-administered percutaneous tibial nerve stimulation delivered by StimRouter over 24 weeks. Changes in video-urodynamic parameters as well as LUTS severity were measured by Overactive Bladder Questionnaire (OAB-q), QoL using the Multiple Sclerosis Quality of Life (MSQoL-54), and treatment satisfaction using a 1-10 visual analogue scale. Adverse events were also recorded. RESULTS Of 23 MS patients recruited, six had neurogenic detrusor overactivity (NDO), five had detrusor sphincter dyssynergia (DSD), and 12 had both NDO and DSD. Of patients with NDO, median bladder volume at first uninhibited contraction significantly increased from baseline to week 24 (median = 136 mL, interquartile range [IQR] = 101-244 mL vs. 343 mL, IQR = 237-391 mL; β = 138.2, p = 0.001). No significant changes of urodynamic parameters were found in patients with DSD. OAB-q symptom scores progressively decreased, and OAB-q quality of life scores increased (β = -0.50, p < 0.001 and β = 0.47, p < 0.001, respectively), whereas MSQoL-54 scores did not significantly change (β = 0.24, p = 0.084) in the overall population. Treatment satisfaction was overall high (median = 8, IQR = 6-9). No serious adverse events were recorded. CONCLUSIONS StimRouter represents a minimally invasive, magnetic resonance imaging-compatible, self-administered neuromodulation device leading to objective and subjective improvements of OAB symptoms and related QoL in MS patients with refractory LUTS.
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Affiliation(s)
- Rosaria Sacco
- Department of Neurology, Multiple Sclerosis Center, Neurocenter of Southern Switzerland, Regional Hospital (EOC) of Lugano, Lugano, Switzerland
| | - Paolo Maino
- Anestesiologia, Neurocenter of Southern Switzerland, Regional Hospital (EOC) of Lugano, Lugano, Switzerland
- Faculty of Biomedical Sciences, Università della Svizzera Italiana (USI), Lugano, Switzerland
| | - Eva Koetsier
- Anestesiologia, Neurocenter of Southern Switzerland, Regional Hospital (EOC) of Lugano, Lugano, Switzerland
| | - Giulio Disanto
- Department of Neurology, Multiple Sclerosis Center, Neurocenter of Southern Switzerland, Regional Hospital (EOC) of Lugano, Lugano, Switzerland
| | - Julien Renard
- Urology Service, Ospedale Regionale di Bellinzona e Valli (EOC), Bellinzona, Switzerland
| | - Alex Digesu
- Department of Urogynaecology, Imperial College Healthcare NHS Trust, London, UK
| | - Claudio Gobbi
- Department of Neurology, Multiple Sclerosis Center, Neurocenter of Southern Switzerland, Regional Hospital (EOC) of Lugano, Lugano, Switzerland
- Faculty of Biomedical Sciences, Università della Svizzera Italiana (USI), Lugano, Switzerland
| | - Chiara Zecca
- Department of Neurology, Multiple Sclerosis Center, Neurocenter of Southern Switzerland, Regional Hospital (EOC) of Lugano, Lugano, Switzerland
- Faculty of Biomedical Sciences, Università della Svizzera Italiana (USI), Lugano, Switzerland
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Khadour YA, Ebrahem B, Khadour FA. Arabic version of the SF-Qualiveen: cross-cultural adaptation, translation, and validation of urinary disorder-specific instruments in patients with spinal cord injury. J Orthop Surg Res 2024; 19:56. [PMID: 38217026 PMCID: PMC10785342 DOI: 10.1186/s13018-023-04411-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Accepted: 11/26/2023] [Indexed: 01/14/2024] Open
Abstract
BACKGROUND The Short-Form Qualiveen (SF-Qualiveen) questionnaire assesses the effect of bladder and urinary symptoms on patients' quality of life (QoL) with urological impairment caused by neurological diseases. There is no validated SF-Qualiveen questionnaire in Arabic, so this study aims to provide a translated and validated version of the SF-Qualiveen questionnaire among Arabic patients experiencing spinal cord injury (SCI). METHODS Psychometric features such as content and construct validity, test-retest reliability, and internal consistency were analyzed. Construct validity was evaluated by contrasting the SF-Qualiveen with the Neurogenic Bladder Symptom Score Short-Form (NBSS-SF) questionnaire. Internal consistency was measured using Cronbach's alpha, whereas the intraclass correlation coefficient (ICC) was employed to assess the test-retest reliability. Factorial validity was established by principal component analysis (PCA). RESULTS The internal consistency of the total SF-Qualiveen and the domains "Bother with limitations," "Fear," "Feeling," and "Frequency of limitations" showed good internal consistency (Cronbach's alpha of > 0.7). ICC was 0.90 for the total score, 0.83 for the bother with limitations, 0.80 for fears, 0.84 for feeling, and 0.81 for frequency of limitations. The correlation analysis revealed a positive association between the total scores on the NBSS-SF and the domains of the SF-Qualiveen, comprising bother with limitations (r = 0.53, p = 0.02), fears (r = 0.44, p = 0.03), feelings (r = 0.49, p = 0.04), and frequency of limitations (r = 0.46, p = 0.02). The best-fit four-factor model for confirming overall item communalities ranged from 0.552 to 0.814, which indicates moderate to high communalities, and confirms the homogeneity of the SF-Qualiveen using PCA. CONCLUSIONS The findings of this validation study revealed that the SF-Qualiveen is a reliable and valid instrument appropriate for Arabic-speaking patients with SCI in both research and clinical practices.
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Affiliation(s)
- Younes A Khadour
- Department of Physical Therapy, Cairo University, Cairo, 11835, Egypt
- Department of Rehabilitation, Faculty of Medicine, Al Baath University, Homs, Syria
| | - Bashar Ebrahem
- Department of Physical Therapy, Health Science Faculty, Al-Baath University, Homs, Syria
| | - Fater A Khadour
- Department of Rehabilitation, Faculty of Medicine, Al Baath University, Homs, Syria.
- Department of Physical Therapy, Health Science Faculty, Al-Baath University, Homs, Syria.
- Department of Rehabilitation, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095#, Jie-Fang Avenue, Qiaokou District, Wuhan, 430030, Hubei, China.
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19
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Marcou M, Galiano M, Tzschoppe A, Sauerstein K, Wach S, Taubert H, Wullich B, Hirsch-Koch K, Apel H. Clean Intermittent Catheterization in Children under 12 Years Does Not Have a Negative Impact on Long-Term Graft Survival following Pediatric Kidney Transplantation. J Clin Med 2023; 13:33. [PMID: 38202040 PMCID: PMC10779672 DOI: 10.3390/jcm13010033] [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: 11/30/2023] [Revised: 12/16/2023] [Accepted: 12/17/2023] [Indexed: 01/12/2024] Open
Abstract
BACKGROUND Congenital anomalies of the kidneys and urinary tract (CAKUTs) are one of the most prevalent primary causes of end-stage renal disease (ESRD) in young children, and approximately one-third of these children present with lower urinary tract dysfunction (LUTD). Many children with LUTD require therapy with clean intermittent catheterization (CIC). CIC commonly leads to bacteriuria, and considerations have arisen regarding whether CIC in immunosuppressed children is safe or whether repeated febrile urinary tract infections (UTIs) may lead to the deterioration of kidney graft function. MATERIAL AND METHODS We retrospectively reviewed all cases of primary kidney transplantation performed in our center between 2001 and 2020 in recipients aged less than twelve years. The number of episodes of febrile UTIs as well as the long-term kidney graft survival of children undergoing CIC were compared to those of children with urological causes of ESRD not undergoing CIC, as well as to those of children with nonurological causes of ESRD. RESULTS Following successful kidney transplantation in 41 children, CIC was needed in 8 of these patients. These 8 children undergoing CIC had significantly more episodes of febrile UTIs than did the 18 children with a nonurological cause of ESRD (p = 0.04) but not the 15 children with a urological cause of ESRD who did not need to undergo CIC (p = 0.19). Despite being associated with a higher rate of febrile UTIs, CIC was not identified as a risk factor for long-term kidney graft survival, and long-term graft survival did not significantly differ between the three groups at a median follow-up of 124 months. CONCLUSIONS Our study demonstrates that, under regular medical care, CIC following pediatric transplantation is safe and is not associated with a higher rate of long-term graft loss.
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Affiliation(s)
- Marios Marcou
- Clinic of Urology and Pediatric Urology, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, 91054 Erlangen, Germany; (S.W.); (H.T.); (B.W.); (K.H.-K.); (H.A.)
- Transplantation Center Erlangen-Nürnberg, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, 91054 Erlangen, Germany
| | - Matthias Galiano
- Clinic of Pediatrics and Adolescent Medicine, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, 91054 Erlangen, Germany; (M.G.); (A.T.); (K.S.)
- Transplantation Center Erlangen-Nürnberg, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, 91054 Erlangen, Germany
| | - Anja Tzschoppe
- Clinic of Pediatrics and Adolescent Medicine, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, 91054 Erlangen, Germany; (M.G.); (A.T.); (K.S.)
- Transplantation Center Erlangen-Nürnberg, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, 91054 Erlangen, Germany
| | - Katja Sauerstein
- Clinic of Pediatrics and Adolescent Medicine, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, 91054 Erlangen, Germany; (M.G.); (A.T.); (K.S.)
- Transplantation Center Erlangen-Nürnberg, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, 91054 Erlangen, Germany
| | - Sven Wach
- Clinic of Urology and Pediatric Urology, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, 91054 Erlangen, Germany; (S.W.); (H.T.); (B.W.); (K.H.-K.); (H.A.)
- Transplantation Center Erlangen-Nürnberg, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, 91054 Erlangen, Germany
| | - Helge Taubert
- Clinic of Urology and Pediatric Urology, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, 91054 Erlangen, Germany; (S.W.); (H.T.); (B.W.); (K.H.-K.); (H.A.)
- Transplantation Center Erlangen-Nürnberg, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, 91054 Erlangen, Germany
| | - Bernd Wullich
- Clinic of Urology and Pediatric Urology, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, 91054 Erlangen, Germany; (S.W.); (H.T.); (B.W.); (K.H.-K.); (H.A.)
- Transplantation Center Erlangen-Nürnberg, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, 91054 Erlangen, Germany
| | - Karin Hirsch-Koch
- Clinic of Urology and Pediatric Urology, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, 91054 Erlangen, Germany; (S.W.); (H.T.); (B.W.); (K.H.-K.); (H.A.)
- Transplantation Center Erlangen-Nürnberg, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, 91054 Erlangen, Germany
| | - Hendrik Apel
- Clinic of Urology and Pediatric Urology, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, 91054 Erlangen, Germany; (S.W.); (H.T.); (B.W.); (K.H.-K.); (H.A.)
- Transplantation Center Erlangen-Nürnberg, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, 91054 Erlangen, Germany
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20
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DE Palma L, Balsamo R, Cicalese A, Frasca G, Granile A, Dell'olio L, Ladisa I, Falcone F, Ranieri M, Megna M. Intermittent self-catheterization training and effects on treatment adherence and infection. Eur J Phys Rehabil Med 2023; 59:782-788. [PMID: 37750862 DOI: 10.23736/s1973-9087.23.08008-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/27/2023]
Abstract
BACKGROUND Intermittent self-catheterization (CISC) is the preferred treatment for patients with bladder dysfunction due to spinal cord injuries or multiple sclerosis (MS). However, the learning phase plays a crucial role in the still frequent drop-out. AIM To examine whether the timing of training affects the treatment compliance and the prevalence of urinary tract infections in patients with neurogenic urinary retention. DESIGN This is a non-randomized observational study. SETTING The study was carried out from January 2017 to December 2019 in outpatient settings at the Bari Polyclinic Unipolar Spinal Unit (Bari, Italy). POPULATION The study included adults with a CISC prescription for neurogenic urinary retention and learning the technique for the first time. METHODS One hundred patients were enrolled, 75 trained immediately after diagnosis and physician prescription, while 25 in the contest of a separate training visit, one or two days after physician prescription. After the training (T0), patient's data and number of prescribed daily catheterizations were recorded and compared with those collected after 6 and 12 months. Accuracy of the procedure and episodes of infections were assessed as well. RESULTS Adherence to prescribed CISC frequency and complications were not affected by the timing of training. However, patients adherent to the prescribe frequency of catheterization had less risk of infection than those who were not. Further post-hoc analysis confirmed that urodynamic findings and the pathology did not impact the overall occurrence of complications, but infections occurred more frequently in patients with MS (P<0.03). CONCLUSIONS The timing of CISC education does not affect treatment adherence or the occurrence of complications. However, the adherence to the CISC prescription seems to reduce the risk of infection. CLINICAL REHABILITATION IMPACT Patient training can be scheduled according to the organization of the centers, as patient compliance and the occurrence of complications are not affected.
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Affiliation(s)
- Luisa DE Palma
- Unit of Physical, Rehabilitation Medicine and Spinal Cord, Polyclinic of Bari, Bari, Italy -
| | - Raffaele Balsamo
- Department of Urology, Monaldi Hospital, Naples, Italy
- AORN dei Colli, Naples, Italy
| | - Annarita Cicalese
- Department of Urology, San Giuseppe Moscati Hospital, Avellino, Italy
| | - Giuseppina Frasca
- Unit of Physical, Rehabilitation Medicine and Spinal Cord, Polyclinic of Bari, Bari, Italy
| | - Adriana Granile
- Unit of Physical, Rehabilitation Medicine and Spinal Cord, Polyclinic of Bari, Bari, Italy
| | - Lucrezia Dell'olio
- Unit of Physical, Rehabilitation Medicine and Spinal Cord, Polyclinic of Bari, Bari, Italy
| | - Ilaria Ladisa
- Unit of Physical, Rehabilitation Medicine and Spinal Cord, Polyclinic of Bari, Bari, Italy
| | - Francesca Falcone
- Unit of Physical, Rehabilitation Medicine and Spinal Cord, Polyclinic of Bari, Bari, Italy
| | - Maurizio Ranieri
- Department of Translational Biomedicine and Neuroscience (DiBrain), University of Bari Aldo Moro, Bari, Italy
| | - Marisa Megna
- Department of Translational Biomedicine and Neuroscience (DiBrain), University of Bari Aldo Moro, Bari, Italy
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21
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Dequirez PL, Pues M, Queval L, Vercleyen S, Carpentier A, Lebuffe G, Seguy D, Blanchard A, Vermersch P, Biardeau X. Standardized one-day evaluation before urinary reconstructive surgery for neurogenic lower urinary tract dysfunction: Feasibility and impact on surgical strategy and care pathway. Prog Urol 2023; 33:1014-1025. [PMID: 37858377 DOI: 10.1016/j.purol.2023.09.032] [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: 07/13/2023] [Revised: 09/16/2023] [Accepted: 09/26/2023] [Indexed: 10/21/2023]
Abstract
OBJECTIVES To describe a concept of standardized preoperative one-day evaluation before urinary reconstructive or diversion surgery for the treatment of neurogenic lower urinary tract (LUT) dysfunction, and to evaluate its feasibility and its impact on the care pathway. MATERIALS AND METHODS All patients who underwent a one-day standardized evaluation before a urinary reconstructive or derivation surgery for the treatment of neurogenic LUT dysfunction between January 2017 and December 2021 in our institution were included. Data were collected retrospectively from standardized reports. The main outcome was the rate of completion of the tests and consultations planned during this evaluation. Secondary outcomes included the findings from the one-day evaluation and changes in the urological surgical strategy at different time points within one year. RESULTS One hundred and thirty-one patients benefited from this one-day standardized evaluation. The overall completeness rate of the data collected was 77.5%, increasing from 62.3% in 2017 to 89.3% in 2021. The urological surgical plan was modified for 19.1% of patients following this preoperative evaluation. The indication was then confirmed for 114 patients (87.0%) by the multidisciplinary meeting and was carried out unchanged during the following year for 89 patients (67.9%). An associated colostomy procedure was proposed for 18.3% of patients and was finally performed in 11.5%. CONCLUSION A standardized multidisciplinary preoperative one-day evaluation before performing reconstructive or diversion surgery for the treatment of neurogenic LUT dysfunction seems feasible and makes it possible to optimize the surgical plan and adapt the course of care. LEVEL OF EVIDENCE: 4
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Affiliation(s)
- P-L Dequirez
- Department of Urology, CHU de Lille, université de Lille, 59000 Lille, France.
| | - M Pues
- Department of Urology, CHU de Lille, université de Lille, 59000 Lille, France
| | - L Queval
- Department of Urology, CHU de Lille, université de Lille, 59000 Lille, France
| | - S Vercleyen
- Department of Urology, CHU de Lille, université de Lille, 59000 Lille, France
| | - A Carpentier
- Department of Urology, CHU de Lille, université de Lille, 59000 Lille, France
| | - G Lebuffe
- Department of Anesthesiology and Critical Care Anesthesiology, CHU de Lille, université de Lille, 59000 Lille, France
| | - D Seguy
- Department of Nutrition, CHU de Lille, université de Lille, 59000 Lille, France
| | - A Blanchard
- Department of Physical and Rehabilitation Medicine, CHU de Lille, université de Lille, 59000 Lille, France
| | - P Vermersch
- UMR-S1172 LilNCog, Lille Neuroscience and Cognition, CHU de Lille, Inserm, université de Lille, 59000 Lille, France
| | - X Biardeau
- Department of Urology, CHU de Lille, université de Lille, 59000 Lille, France; UMR-S1172 LilNCog, Lille Neuroscience and Cognition, CHU de Lille, Inserm, université de Lille, 59000 Lille, France
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22
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Pang H, Yin Y, Xue J, Chen X, Pang J, Zhang J, Sun Y. Associations between visceral adipose index and stress urinary incontinence among US adult women: a cross-sectional study. World J Urol 2023; 41:3671-3678. [PMID: 37921934 PMCID: PMC10693499 DOI: 10.1007/s00345-023-04667-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2023] [Accepted: 09/26/2023] [Indexed: 11/05/2023] Open
Abstract
OBJECTIVE Visceral adipose index (VAI) is a novel parameter for the evaluation of visceral obesity. The present study aimed to investigate the association between VAI levels and stress urinary incontinence (SUI) in a nationally representative population. MATERIALS AND METHODS The National Health and Nutrition Examination Survey (NHANES) women population aged > 20 years were analyzed from 2001 to 2018. SUI was determined by self-reported questions. VAI was calculated using physical examination data and laboratory tests. Survey-weighted logistic regression models were used to analyze the correlation between SUI and VAI. RESULTS The final analysis included 9709 women. Among them, 4032 (41.53%) were any SUI, 1130 (11.64%) were at least weekly SUI, and 506 (5.21%) were at least daily SUI. In multivariate analysis, the odds ratio (OR) for overall SUI increased slightly after full adjustment (OR 1.06, 95% CI 1.03-1.10, P = 0.001). Similar results were observed in weekly (OR 1.04, 95% CI 1.00-1.08, P = 0.0327) and daily (OR 1.04, 95% CI 1.00-1.09, P = 0.0702) SUI. The analysis of VAI categorized showed an increased OR of any, weekly, and daily SUI in the highest compared to the lowest tertile (OR 1.44, 95% CI 1.26-1.65, P < 0.0001 for trend, OR 1.38, 95% CI 1.07-1.78, P = 0.0153 for trend, OR 1.33, 95% CI 0.94-1.87, P = 0.094 for trend). CONCLUSION This study revealed a significant association between SUI and VAI among US adult women. VAI is an easily applicable index for the evaluation of visceral fat dysfunction, which might be useful for the calculation of SUI risk.
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Affiliation(s)
- Haigang Pang
- Department of Urology, No.971 Hospital of the PLA Navy, Qingdao, 266071, China
| | - Yuxin Yin
- Department of Urology, No.971 Hospital of the PLA Navy, Qingdao, 266071, China
| | - Juan Xue
- Department of Nursing, No.971 Hospital of the PLA Navy, Qingdao, 266071, China
| | - Xi Chen
- Department of Urology, No.971 Hospital of the PLA Navy, Qingdao, 266071, China
| | - Jian Pang
- Department of Urology, No.971 Hospital of the PLA Navy, Qingdao, 266071, China
| | - Jinping Zhang
- Department of Urology, No.971 Hospital of the PLA Navy, Qingdao, 266071, China.
| | - Yi Sun
- Department of Urology, No.971 Hospital of the PLA Navy, Qingdao, 266071, China.
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23
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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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24
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Liu J, Luo C, Xiao W, Xu T. Urinary tract infections and intermittent catheterization among patients with spinal cord injury in Chinese community. Sci Rep 2023; 13:17683. [PMID: 37848530 PMCID: PMC10582103 DOI: 10.1038/s41598-023-44697-0] [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: 08/10/2023] [Accepted: 10/11/2023] [Indexed: 10/19/2023] Open
Abstract
We conducted a cross-sectional study using an online questionnaire to investigate the current status of urinary tract infections (UTIs) and the use of clean intermittent catheterization (CIC) in Chinese community-based SCI patients and to explore the risk factors for UTIs in patients using CIC. Our findings suggest that the prevalence of UTIS is higher in Chinese community-based SCI patients compared with patients in medically developed countries. In addition, we found that CIC had the lower incidence of UTIs than urinary indwelling catheter (UIC) and suprapubic catheter (SPC), and that SCI patients with CIC had low rates of use and poor compliance. Further analysis indicated that most of the risk factors for UTIs in CIC patients were associated with irregular use of CIC. Therefore, we call for not only the need to provide stronger caregiver support and financial assistance to improve CIC adherence in Chinese community SCI patients, but also the establishment of a database of Chinese SCI patients in order to enhance the management of bladder emptying methods and further standardize the CIC operation in such patients, thus reducing the risk of UTIs in Chinese community SCI patients.
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Affiliation(s)
- Jiawei Liu
- Department of Rehabilitation, Tongji Hospital affiliated to Tongji Medical College of Huazhong University of Science & Technology, Wuhan, 430030, Hubei, China
| | - Can Luo
- Department of Rehabilitation, Tongji Hospital affiliated to Tongji Medical College of Huazhong University of Science & Technology, Wuhan, 430030, Hubei, China
| | - Weichu Xiao
- Department of Rehabilitation, Tongji Hospital affiliated to Tongji Medical College of Huazhong University of Science & Technology, Wuhan, 430030, Hubei, China
| | - Tao Xu
- Department of Rehabilitation, Tongji Hospital affiliated to Tongji Medical College of Huazhong University of Science & Technology, Wuhan, 430030, Hubei, China.
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25
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Ruan J, Cui X, Yan H, Jia C, Ou T, Shang Z. Expression profiles of circular RNAs and interaction networks of competing endogenous RNAs in neurogenic bladder of rats following suprasacral spinal cord injury. PeerJ 2023; 11:e16042. [PMID: 37744239 PMCID: PMC10512963 DOI: 10.7717/peerj.16042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Accepted: 08/15/2023] [Indexed: 09/26/2023] Open
Abstract
Background Neurogenic bladder (NB) following suprasacral spinal cord injury (SSCI) is an interstitial disease with the structural remodeling of bladder tissue and matrix over-deposition. Circular RNAs (circRNAs) are involved in fibrotic disease development through their post-transcriptional regulatory functions. This study aimed to use transcriptome high-throughput sequencing to investigate the process of NB and bladder fibrosis after SSCI. Methods Spinal cord transection at the T10-T11 level was used to construct the SSCI model in rats (10-week-old female Wistar rats, weighing 200 ± 20 g). The bladders were collected without (sham group) and with (SSCI 1-3 groups) NB status. Morphological examination was conducted to assess the extent of bladder fibrosis. Additionally, RNA sequencing was utilized to determine mRNAs and circRNAs expression patterns. The dynamic changes of differentially expressed mRNAs (DEMs) and circRNAs (DECs) in different periods of SSCI were further analyzed. Results Bladder weight, smooth muscle cell hypertrophy, and extracellular matrix gradually increased after SSCI. Compared with the sham group, 3,255 DEMs and 1,339 DECs, 3,449 DEMs and 1,324 DECs, 884 DEMs, and 1,151 DECs were detected in the SSCI 1-3 groups, respectively. Specifically, circRNA3621, circRNA0617, circRNA0586, and circRNA4426 were significant DECs common to SSCI 1-3 groups compared with the sham group. Moreover, Gene Ontology (GO) enrichment suggested that inflammatory and chronic inflammatory responses were the key events in NB progression following SSCI. Kyoto Encyclopedia of Genes and Genomes (KEGG) pathways enrichment associated with the "Chemokine signaling pathway", the "IL-17 signaling pathway", and the "TGF-beta signaling pathway" suggests their potential involvement in regulating biological processes. The circRNA-miRNA-mRNA interaction networks of DECs revealed rno-circ-2239 (micu2) as the largest node, indicating that the rno-circ-2239-miRNA-mRNA-mediated network may play a critical role in the pathogenesis of SSCI-induced NB. Conclusions This study offers a comprehensive outlook on the possible roles of DEMs and DECs in bladder fibrosis and NB progression following SSCI. These findings have the potential to serve as novel biomarkers and therapeutic targets.
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Affiliation(s)
- Jimeng Ruan
- Department of Urology, Xuanwu Hospital Capital Medical University, Beijing, China
| | - Xin Cui
- Department of Urology, Xuanwu Hospital Capital Medical University, Beijing, China
| | - Hao Yan
- Department of Urology, Xuanwu Hospital Capital Medical University, Beijing, China
| | - Chunsong Jia
- Department of Urology, Xuanwu Hospital Capital Medical University, Beijing, China
| | - Tongwen Ou
- Department of Urology, Xuanwu Hospital Capital Medical University, Beijing, China
| | - Zhenhua Shang
- Department of Urology, Xuanwu Hospital Capital Medical University, Beijing, China
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26
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Zhao Y, Chen C, Huang Z, Wang H, Tie X, Yang J, Cui W, Xu J. Prediction of upcoming urinary tract infection after intracerebral hemorrhage: a machine learning approach based on statistics collected at multiple time points. Front Neurol 2023; 14:1223680. [PMID: 37780719 PMCID: PMC10538571 DOI: 10.3389/fneur.2023.1223680] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Accepted: 08/18/2023] [Indexed: 10/03/2023] Open
Abstract
Purpose Accurate prediction of urinary tract infection (UTI) following intracerebral hemorrhage (ICH) can significantly facilitate both timely medical interventions and therapeutic decisions in neurocritical care. Our study aimed to propose a machine learning method to predict an upcoming UTI by using multi-time-point statistics. Methods A total of 110 patients were identified from a neuro-intensive care unit in this research. Laboratory test results at two time points were chosen: Lab 1 collected at the time of admission and Lab 2 collected at the time of 48 h after admission. Univariate analysis was performed to investigate if there were statistical differences between the UTI group and the non-UTI group. Machine learning models were built with various combinations of selected features and evaluated with accuracy (ACC), sensitivity, specificity, and area under the curve (AUC) values. Results Corticosteroid usage (p < 0.001) and daily urinary volume (p < 0.001) were statistically significant risk factors for UTI. Moreover, there were statistical differences in laboratory test results between the UTI group and the non-UTI group at the two time points, as suggested by the univariate analysis. Among the machine learning models, the one incorporating clinical information and the rate of change in laboratory parameters outperformed the others. This model achieved ACC = 0.773, sensitivity = 0.785, specificity = 0.762, and AUC = 0.868 during training and 0.682, 0.685, 0.673, and 0.751 in the model test, respectively. Conclusion The combination of clinical information and multi-time-point laboratory data can effectively predict upcoming UTIs after ICH in neurocritical care.
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Affiliation(s)
- Yanjie Zhao
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, China
- Department of Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, China
| | - Chaoyue Chen
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, China
- Department of Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, China
| | - Zhouyang Huang
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, China
| | - Haoxiang Wang
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, China
| | - Xin Tie
- Department of Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, China
| | - Jinhao Yang
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, China
| | - Wenyao Cui
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, China
- Department of Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, China
| | - Jianguo Xu
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, China
- Department of Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, China
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27
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Le Roy C, Lefèvre C, Lepoittevin L, Reiss B, Le Fort M, Rigaud J, Perrouin-Verbe B, Perrouin-Verbe MA. Switching from onabotulinum toxin A to abobotulinum toxin A for treating detrusor overactivity in spinal cord injured patient, does it really work? Prog Urol 2023; 33:503-508. [PMID: 37550178 DOI: 10.1016/j.purol.2023.07.007] [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: 04/28/2023] [Accepted: 07/10/2023] [Indexed: 08/09/2023]
Abstract
AIM To assess the efficacy of switching to Abobotulinumtoxin A (ATA) intradetrusor injections (IDI) after failure of Onabotulinumtoxin A (OTA) IDI for the treatment of neurogenic detrusor overactivity in patients with spinal cord injury (SCI). MATERIALS AND METHODS A single-centre retrospective chart review study. All SCI patients who started OTA IDI after 2011 and had an ATA IDI switch were included. The primary outcome was the clinical and urodynamic efficacy of the switch to ATA IIDs at the last follow-up. Secondary outcomes were initial efficacy, duration of ATA treatment, and patient outcome including the occurrence of augmentation enterocystoplasty at last follow-up. RESULTS Sixty-two patients were included. Eighteen patients (28.9%) were initially responders to ATA IDI. Nine patients (14.5%) remained responders at last follow-up after a median of 17 months (AE 8.8-29). Thirty-two patients (51.6%) had had or were awaiting augmentation enterocystoplasty with a follow-up time of 18.5 months (IQR 8-27). Eleven patients (17.7%) were on ATA IDI with low efficacy. Seven patients (11.3%) were switched back to OTA and 3 patients (4.8%) changed their voiding pattern. CONCLUSION Switching from OTA to ATA toxin for IDI in the treatment of detrusor overactivity after spinal cord injury have long-term efficacy for a limited number of patients but may delay the need for surgery. LEVEL OF EVIDENCE: 4
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Affiliation(s)
- C Le Roy
- Department of Physical Medicine and Rehabilitation, University Hospital of Nantes, Nantes, France.
| | - C Lefèvre
- Department of Physical Medicine and Rehabilitation, University Hospital of Nantes, Nantes, France
| | - L Lepoittevin
- Department of Physical Medicine and Rehabilitation, University Hospital of Nantes, Nantes, France
| | - B Reiss
- Department of Physical Medicine and Rehabilitation, University Hospital of Nantes, Nantes, France
| | - M Le Fort
- Department of Physical Medicine and Rehabilitation, University Hospital of Nantes, Nantes, France
| | - J Rigaud
- Department of Urology, University Hospital of Nantes, Nantes, France
| | - B Perrouin-Verbe
- Department of Physical Medicine and Rehabilitation, University Hospital of Nantes, Nantes, France
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28
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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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Neumeier V, Stangl FP, Borer J, Anderson CE, Birkhäuser V, Chemych O, Gross O, Koschorke M, Marschall J, McCallin S, Mehnert U, Sadri H, Stächele L, Kessler TM, Leitner L. Indwelling catheter vs intermittent catheterization: is there a difference in UTI susceptibility? BMC Infect Dis 2023; 23:507. [PMID: 37533010 PMCID: PMC10398982 DOI: 10.1186/s12879-023-08475-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Accepted: 07/20/2023] [Indexed: 08/04/2023] Open
Abstract
BACKGROUND Patients with neurogenic lower urinary tract dysfunction (NLUTD) often rely on some type of catheterization for bladder emptying. Intermittent catheterization (IC) is considered the gold standard and is preferred over continuous catheterization, since it is considered to cause fewer urinary tract infections (UTIs) than indwelling catheterization. The main objective of our study was to describe UTI prevalence (at visit) and incidence (within the last 12 months) and urine culture characteristics between patients using an indwelling catheter versus (vs) those performing IC. METHODS In this cross-sectional study, we prospectively evaluated from 02/2020 to 01/2021 patients with NLUTD undergoing urine cultures for prophylactic reasons or due to UTI symptoms. At visit, all patients underwent a standardized interview on current UTI symptoms as well as UTI history and antibiotic consumption within the past year. Patients using an indwelling catheter (n = 206) or IC (n = 299) were included in the analysis. The main outcome was between-group differences regarding UTI characteristics. RESULTS Patients using an indwelling catheter were older (indwelling catheter vs IC: median 66 (Q1-Q3: 55-77) vs 55 (42-67) years of age) and showed a higher Charlson comorbidity index (indwelling catheter vs IC: median 4 (Q1-Q3: 2-6) vs 2 (1-4) (both p < 0·001). A total of 40 patients from both groups were diagnosed with a UTI at visit (indwelling catheters vs IC: 8% (16/206) vs 8% (24/299); p = 0·782), and the number of UTIs within the past 12 months was not significantly different between groups. Overall, Escherichia coli (21%), Enterococcus faecalis (17%), and Klebsiella spp. (12%) were the most frequently detected bacteria. CONCLUSIONS In this cohort of patients with NLUTD, we did not find relevant differences in UTI frequency between groups. These results suggest that UTI-related concerns should not be given undue emphasis when counseling patients for catheter-related bladder emptying methods.
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Affiliation(s)
- Vera Neumeier
- Department of Neuro-Urology, Balgrist University Hospital, University of Zürich, Forchstrasse 340, 8008, Zürich, Switzerland
| | - Fabian P Stangl
- Department of Urology, Inselspital, University Hospital Bern, Bern, Switzerland
| | - Joëlle Borer
- Department of Neuro-Urology, Balgrist University Hospital, University of Zürich, Forchstrasse 340, 8008, Zürich, Switzerland
- Department of Urology, University Hospital Zürich, University of Zürich, Zürich, Switzerland
| | - Collene E Anderson
- Department of Neuro-Urology, Balgrist University Hospital, University of Zürich, Forchstrasse 340, 8008, Zürich, Switzerland
- Swiss Paraplegic Research, Nottwil, Switzerland
- Department of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland
| | - Veronika Birkhäuser
- Department of Neuro-Urology, Balgrist University Hospital, University of Zürich, Forchstrasse 340, 8008, Zürich, Switzerland
| | - Oksana Chemych
- Department of Neuro-Urology, Balgrist University Hospital, University of Zürich, Forchstrasse 340, 8008, Zürich, Switzerland
| | - Oliver Gross
- Department of Neuro-Urology, Balgrist University Hospital, University of Zürich, Forchstrasse 340, 8008, Zürich, Switzerland
| | - Miriam Koschorke
- Department of Neuro-Urology, Balgrist University Hospital, University of Zürich, Forchstrasse 340, 8008, Zürich, Switzerland
| | - Jonas Marschall
- Division of Infectious Diseases, Washington University School of Medicine, St. Louis Missouri, USA
| | - Shawna McCallin
- Department of Neuro-Urology, Balgrist University Hospital, University of Zürich, Forchstrasse 340, 8008, Zürich, Switzerland
| | - Ulrich Mehnert
- Department of Neuro-Urology, Balgrist University Hospital, University of Zürich, Forchstrasse 340, 8008, Zürich, Switzerland
| | - Helen Sadri
- Department of Neuro-Urology, Balgrist University Hospital, University of Zürich, Forchstrasse 340, 8008, Zürich, Switzerland
| | - Lara Stächele
- Department of Neuro-Urology, Balgrist University Hospital, University of Zürich, Forchstrasse 340, 8008, Zürich, Switzerland
| | - Thomas M Kessler
- Department of Neuro-Urology, Balgrist University Hospital, University of Zürich, Forchstrasse 340, 8008, Zürich, Switzerland
| | - Lorenz Leitner
- Department of Neuro-Urology, Balgrist University Hospital, University of Zürich, Forchstrasse 340, 8008, Zürich, Switzerland.
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Ou YC, Huang CC, Kao YL, Ho PC, Tsai KJ. Stem Cell Therapy in Spinal Cord Injury-Induced Neurogenic Lower Urinary Tract Dysfunction. Stem Cell Rev Rep 2023; 19:1691-1708. [PMID: 37115409 DOI: 10.1007/s12015-023-10547-9] [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] [Accepted: 04/14/2023] [Indexed: 04/29/2023]
Abstract
Spinal cord injury (SCI) is a devastating condition that enormously affects an individual's health and quality of life. Neurogenic lower urinary tract dysfunction (NLUTD) is one of the most important sequelae induced by SCI, causing complications including urinary tract infection, renal function deterioration, urinary incontinence, and voiding dysfunction. Current therapeutic methods for SCI-induced NLUTD mainly target on the urinary bladder, but the outcomes are still far from satisfactory. Stem cell therapy has gained increasing attention for years for its ability to rescue the injured spinal cord directly. Stem cell differentiation and their paracrine effects, including exosomes, are the proposed mechanisms to enhance the recovery from SCI. Several animal studies have demonstrated improvement in bladder function using mesenchymal stem cells (MSCs) and neural stem cells (NSCs). Human clinical trials also provide promising results in urodynamic parameters after MSC therapy. However, there is still uncertainty about the ideal treatment window and application protocol for stem cell therapy. Besides, data on the therapeutic effects regarding NSCs and stem cell-derived exosomes in SCI-related NLUTD are scarce. Therefore, there is a pressing need for further well-designed human clinical trials to translate the stem cell therapy into a formal therapeutic option for SCI-induced NLUTD.
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Affiliation(s)
- Yin-Chien Ou
- Institute of Clinical Medicine, College of Medicine, National Cheng Kung University, No. 1, University Road, Tainan, 701, Taiwan
- Department of Urology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Chi-Chen Huang
- Institute of Clinical Medicine, College of Medicine, National Cheng Kung University, No. 1, University Road, Tainan, 701, Taiwan
- Section of Neurosurgery, Department of Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Yao-Lin Kao
- Department of Urology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Pei-Chuan Ho
- Institute of Clinical Medicine, College of Medicine, National Cheng Kung University, No. 1, University Road, Tainan, 701, Taiwan
| | - Kuen-Jer Tsai
- Institute of Clinical Medicine, College of Medicine, National Cheng Kung University, No. 1, University Road, Tainan, 701, Taiwan.
- Research Center of Clinical Medicine, National Cheng Kung University Hospital , College of Medicine, National Cheng Kung University, Tainan, Taiwan.
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Miller T, Roik LJ, Kalimullina T, Samejima S, Shackleton C, Malik RN, Sachdeva R, Krassioukov AV. The temporal burden of preparing catheters for re-use in adults with spinal cord injury: a cross-sectional study. Spinal Cord Ser Cases 2023; 9:39. [PMID: 37528074 PMCID: PMC10393987 DOI: 10.1038/s41394-023-00596-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Revised: 07/11/2023] [Accepted: 07/20/2023] [Indexed: 08/03/2023] Open
Abstract
STUDY DESIGN Cross-sectional OBJECTIVES: Neurogenic lower urinary tract dysfunction is common among people with spinal cord injury (SCI). Although single-use clean intermittent catheterization is recommended to facilitate routine bladder emptying, catheter re-use is common. Barriers associated with the preparation (i.e., cleaning) of catheters for re-use are unknown. This study examined barriers to catheter re-use in adult individuals with SCI by assessing (1) the time needed to clean a catheter, and (2) the perceived difficulty of the catheter cleaning routine. SETTING Laboratory METHODS: Twenty individuals with chronic SCI ( ≥ 1 year since injury; Group 1 = 10 with tetraplegia; Group 2 = 10 with paraplegia) completed the study. Using a standardized cleaning procedure (i.e., Milton method), catheter cleaning was timed for each participant. Perceived difficulty was assessed using a 5-point Likert scale. Functional impairment was assessed with the Upper Extremity Motor Score (UEMS). RESULTS Significant between-group differences were observed for total cleaning time (Group 1 = 1584.1 ± 179.8 s; Group 2 = 1321.0 ± 93.8 s, p = 0.004) and perceived difficulty [Group 1 = 2.6 (2, 3); Group 2 = 2 (1.7, 2.3), p = 0.028]. Total cleaning time was significantly correlated with UEMS (ρ = -0.709, p ≤ 0.001) and perceived difficulty (ρ = 0.468, p = 0.037). UEMS emerged as an independent predictor of total cleaning time (R2 = 0.745, β = -0.833, p ≤ 0.001). CONCLUSIONS Preparing catheters for re-use is time-intensive and difficult for people with higher SCI level, severity and more pronounced upper limb motor impairment, which was independently associated with total cleaning time. Performing this routine on a consistent basis would require a substantial time commitment and would have a profoundly negative impact on overall quality of life.
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Affiliation(s)
- T Miller
- International Collaboration on Repair Discoveries, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
- Division of Physical Medicine and Rehabilitation, Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - L J Roik
- International Collaboration on Repair Discoveries, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - T Kalimullina
- International Collaboration on Repair Discoveries, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - S Samejima
- International Collaboration on Repair Discoveries, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
- Division of Physical Medicine and Rehabilitation, Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - C Shackleton
- International Collaboration on Repair Discoveries, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
- Division of Physical Medicine and Rehabilitation, Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - R N Malik
- International Collaboration on Repair Discoveries, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
- Division of Physical Medicine and Rehabilitation, Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - R Sachdeva
- International Collaboration on Repair Discoveries, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
- Division of Physical Medicine and Rehabilitation, Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - A V Krassioukov
- International Collaboration on Repair Discoveries, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada.
- Division of Physical Medicine and Rehabilitation, Department of Medicine, University of British Columbia, Vancouver, BC, Canada.
- Spinal Cord Program, GF Strong Rehabilitation Centre, Vancouver Coastal Health, Vancouver, BC, Canada.
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Yang M, Gao S, Yao H, He X, Fang J, Chen Y, Liu Z. Effects of electroacupuncture on pediatric chronic urinary retention: a case-series study. Front Pediatr 2023; 11:1194651. [PMID: 37547105 PMCID: PMC10401264 DOI: 10.3389/fped.2023.1194651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Accepted: 07/05/2023] [Indexed: 08/08/2023] Open
Abstract
Objectives This study aims to preliminarily evaluate the effect and safety of electroacupuncture (EA) in treating pediatric chronic urinary retention (CUR) following lumbosacral surgeries, with treatment duration evaluated. Methods This prospective case-series study was performed from August 5, 2017, to July 31, 2022. Pediatric patients diagnosed with CUR following lumbosacral surgeries were included and treated by EA for 2-16 weeks. Responders were defined as participants achieving a reduction of 50% or more in post void residuals (PVR) from baseline. Time-to-event analysis was applied to explore the association between EA treatment duration and response rate. Adverse event was recorded. Results Totally 14 participants (mean [SD] age, 12 [4] years) completed EA treatment. Response rate was 71% (10/14) at the 12th week. 50% (7/14) of participants removed catheters at the 12th week, and none of them experienced re-catheterization in the 24-week follow-up. No serious adverse event was reported. Time-to-event analysis estimated that over 50% patients could respond to EA of more than 8 weeks. Subgroup analysis showed that participants with baseline PVR ≥300 ml and CUR duration ≥12 months experienced longer EA duration to reach the response rate of 50%, compared with those whose PVR <300 ml and CUR duration <12 months (median value: 12 weeks vs. 8 weeks, 12 weeks vs. 4 weeks, respectively). Conclusions EA could reduce PVR for pediatric patients suffering from CUR following lumbosacral surgeries, with long-term efficacy and safety. EA treatment of more than 8 weeks was reasonable. Further study of a larger sample and controlling is needed. Clinical Trial Registration www.chictr.org.cn, identifier, ChiCTR1800020222.
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Affiliation(s)
- Min Yang
- Department of Acupuncture, Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Shuai Gao
- Department of Acupuncture, Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Hao Yao
- Department of Acupuncture, Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
- Graduate School, Beijing University of Chinese Medicine, Beijing, China
| | - Xin He
- Department of Acupuncture, Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
- Graduate School, Beijing University of Chinese Medicine, Beijing, China
| | - Jiufei Fang
- Department of Acupuncture, Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Yu Chen
- Beijing Houpo Chinese Medicine Institute, Beijing, China
| | - Zhishun Liu
- Department of Acupuncture, Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
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Miller T, Lange D, Kizhakkedathu JN, Yu K, Felix D, Samejima S, Shackleton C, Malik RN, Sachdeva R, Walter M, Krassioukov AV. The Microbiological Burden of Short-Term Catheter Reuse in Individuals with Spinal Cord Injury: A Prospective Study. Biomedicines 2023; 11:1929. [PMID: 37509568 PMCID: PMC10377649 DOI: 10.3390/biomedicines11071929] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Revised: 07/04/2023] [Accepted: 07/05/2023] [Indexed: 07/30/2023] Open
Abstract
Despite the risk of developing catheter-associated urinary tract infections (CAUTI), catheter reuse is common among people with spinal cord injury (SCI). This study examined the microbiological burden and catheter surface changes associated with short-term reuse. Ten individuals with chronic SCI reused their catheters over 3 days. Urine and catheter swab cultures were collected daily for analysis. Scanning electron microscopy (SEM) and X-ray photoelectron spectroscopy (XPS) analyses were used to assess catheter surface changes. Catheter swab cultures showed no growth after 48 h (47.8%), skin flora (28.9%), mixed flora (17.8%), or bacterial growth (5.5%). Asymptomatic bacteriuria was found for most participants at baseline (n = 9) and all at follow-up (n = 10). Urine samples contained Escherichia coli (58%), Klebsiella pneumoniae (30%), Enterococcus faecalis (26%), Acinetobacter calcoaceticus-baumannii (10%), Pseudomonas aeruginosa (6%) or Proteus vulgaris (2%). Most urine cultures showed resistance to one or more antibiotics (62%). SEM images demonstrated structural damage, biofilm and/or bacteria on all reused catheter surfaces. XPS analyses also confirmed the deposition of bacterial biofilm on reused catheters. Catheter surface changes and the presence of antibiotic-resistant bacteria were evident following short-term reuse, which may increase susceptibility to CAUTI in individuals with SCI despite asymptomatic bacteriuria.
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Affiliation(s)
- Tiev Miller
- International Collaboration on Repair Discoveries (ICORD), Faculty of Medicine, University of British Columbia (UBC), Vancouver, BC V6T 1Z3, Canada
- Division of Physical Medicine and Rehabilitation, Faculty of Medicine, University of British Columbia (UBC), Vancouver, BC V6T 1Z3, Canada
| | - Dirk Lange
- Department of Urologic Sciences, Faculty of Medicine, University of British Columbia (UBC), Vancouver, BC V6T 1Z3, Canada
- The Stone Centre at Vancouver General Hospital, Vancouver, BC V5Z 1M9, Canada
| | - Jayachandran N Kizhakkedathu
- Department of Pathology and Laboratory Medicine, Faculty of Medicine, University of British Columbia (UBC), Vancouver, BC V6T 1Z3, Canada
- Centre for Blood Research, Life Science Institute, Faculty of Medicine, University of British Columbia (UBC), Vancouver, BC V6T 1Z3, Canada
- The School of Biomedical Engineering, Faculty of Medicine, University of British Columbia (UBC), Vancouver, BC V6T 1Z3, Canada
| | - Kai Yu
- Department of Pathology and Laboratory Medicine, Faculty of Medicine, University of British Columbia (UBC), Vancouver, BC V6T 1Z3, Canada
- Centre for Blood Research, Life Science Institute, Faculty of Medicine, University of British Columbia (UBC), Vancouver, BC V6T 1Z3, Canada
| | - Demian Felix
- Department of Urologic Sciences, Faculty of Medicine, University of British Columbia (UBC), Vancouver, BC V6T 1Z3, Canada
- The Stone Centre at Vancouver General Hospital, Vancouver, BC V5Z 1M9, Canada
| | - Soshi Samejima
- International Collaboration on Repair Discoveries (ICORD), Faculty of Medicine, University of British Columbia (UBC), Vancouver, BC V6T 1Z3, Canada
- Division of Physical Medicine and Rehabilitation, Faculty of Medicine, University of British Columbia (UBC), Vancouver, BC V6T 1Z3, Canada
| | - Claire Shackleton
- International Collaboration on Repair Discoveries (ICORD), Faculty of Medicine, University of British Columbia (UBC), Vancouver, BC V6T 1Z3, Canada
- Division of Physical Medicine and Rehabilitation, Faculty of Medicine, University of British Columbia (UBC), Vancouver, BC V6T 1Z3, Canada
| | - Raza N Malik
- International Collaboration on Repair Discoveries (ICORD), Faculty of Medicine, University of British Columbia (UBC), Vancouver, BC V6T 1Z3, Canada
- Division of Physical Medicine and Rehabilitation, Faculty of Medicine, University of British Columbia (UBC), Vancouver, BC V6T 1Z3, Canada
| | - Rahul Sachdeva
- International Collaboration on Repair Discoveries (ICORD), Faculty of Medicine, University of British Columbia (UBC), Vancouver, BC V6T 1Z3, Canada
- Division of Physical Medicine and Rehabilitation, Faculty of Medicine, University of British Columbia (UBC), Vancouver, BC V6T 1Z3, Canada
| | - Matthias Walter
- International Collaboration on Repair Discoveries (ICORD), Faculty of Medicine, University of British Columbia (UBC), Vancouver, BC V6T 1Z3, Canada
- Department of Urology, University Hospital Basel, University of Basel, 4031 Basel, Switzerland
| | - Andrei V Krassioukov
- International Collaboration on Repair Discoveries (ICORD), Faculty of Medicine, University of British Columbia (UBC), Vancouver, BC V6T 1Z3, Canada
- Division of Physical Medicine and Rehabilitation, Faculty of Medicine, University of British Columbia (UBC), Vancouver, BC V6T 1Z3, Canada
- GF Strong Rehabilitation Centre, Vancouver Coastal Health, Vancouver, BC V5Z 2G9, Canada
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34
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Birkhäuser V, Anderson CE, Kozomara M, Bywater M, Gross O, Kiss S, Knüpfer SC, Koschorke M, Leitner L, Mehnert U, Sadri H, Sammer U, Stächele L, Tornic J, Liechti MD, Brinkhof MWG, Kessler TM. Urodynamics Are Essential to Predict the Risk for Upper Urinary Tract Damage after Acute Spinal Cord Injury. Biomedicines 2023; 11:1748. [PMID: 37371843 DOI: 10.3390/biomedicines11061748] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Revised: 06/12/2023] [Accepted: 06/15/2023] [Indexed: 06/29/2023] Open
Abstract
We used clinical parameters to develop a prediction model for the occurrence of urodynamic risk factors for upper urinary tract (UUT) damage during the first year after acute spinal cord injury (SCI). A total of 97 patients underwent urodynamic investigation at 1, 3, 6, and 12 months after acute SCI, within the framework of a population-based longitudinal study at a single university SCI center. Candidate predictors included demographic characteristics and neurological and functional statuses 1 month after SCI. Outcomes included urodynamic risk factors for UUT damage: detrusor overactivity combined with detrusor sphincter dyssynergia, maximum storage detrusor pressure (pDetmax) ≥ 40 cmH2O, bladder compliance < 20 mL/cmH2O, and vesicoureteral reflux. Multivariable logistic regression was used for the prediction model development and internal validation, using the area under the receiver operating curve (aROC) to assess model discrimination. Two models showed fair discrimination for pDetmax ≥ 40 cmH2O: (i) upper extremity motor score and sex, aROC 0.79 (95% CI: 0.69-0.89), C-statistic 0.78 (95% CI: 0.69-0.87), and (ii) neurological level, American Spinal Injury Association Impairment Scale grade, and sex, aROC 0.78 (95% CI: 0.68-0.89), C-statistic 0.76 (95% CI: 0.68-0.85). We identified two models that provided fair predictive values for urodynamic risk factors of UUT damage during the first year after SCI. Pending external validation, these models may be useful for clinical trial planning, although less so for individual-level patient management. Therefore, urodynamics remains essential for reliably identifying patients at risk of UUT damage.
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Affiliation(s)
- Veronika Birkhäuser
- Department of Neuro-Urology, Balgrist University Hospital, University of Zürich, 8008 Zürich, Switzerland
| | - Collene E Anderson
- Department of Neuro-Urology, Balgrist University Hospital, University of Zürich, 8008 Zürich, Switzerland
- Swiss Paraplegic Research, 6207 Nottwil, Switzerland
- Department of Health Sciences and Medicine, University of Lucerne, 6002 Lucerne, Switzerland
| | - Marko Kozomara
- Department of Neuro-Urology, Balgrist University Hospital, University of Zürich, 8008 Zürich, Switzerland
- Department of Urology, Cantonal Hospital Lucerne, 6000 Lucerne, Switzerland
| | - Mirjam Bywater
- Department of Neuro-Urology, Balgrist University Hospital, University of Zürich, 8008 Zürich, Switzerland
- Department of Urology, Cantonal Hospital Aarau, 5001 Aarau, Switzerland
| | - Oliver Gross
- Department of Neuro-Urology, Balgrist University Hospital, University of Zürich, 8008 Zürich, Switzerland
| | - Stephan Kiss
- Department of Neuro-Urology, Balgrist University Hospital, University of Zürich, 8008 Zürich, Switzerland
- Department of Urology, Cantonal Hospital Aarau, 5001 Aarau, Switzerland
| | - Stephanie C Knüpfer
- Department of Neuro-Urology, Balgrist University Hospital, University of Zürich, 8008 Zürich, Switzerland
- Department of Neuro-Urology, Clinic for Urology, University Hospital Bonn, 53127 Bonn, Germany
| | - Miriam Koschorke
- Department of Neuro-Urology, Balgrist University Hospital, University of Zürich, 8008 Zürich, Switzerland
- Department of Urology, Cantonal Hospital Aarau, 5001 Aarau, Switzerland
| | - Lorenz Leitner
- Department of Neuro-Urology, Balgrist University Hospital, University of Zürich, 8008 Zürich, Switzerland
| | - Ulrich Mehnert
- Department of Neuro-Urology, Balgrist University Hospital, University of Zürich, 8008 Zürich, Switzerland
| | - Helen Sadri
- Department of Neuro-Urology, Balgrist University Hospital, University of Zürich, 8008 Zürich, Switzerland
| | - Ulla Sammer
- Department of Neuro-Urology, Balgrist University Hospital, University of Zürich, 8008 Zürich, Switzerland
| | - Lara Stächele
- Department of Neuro-Urology, Balgrist University Hospital, University of Zürich, 8008 Zürich, Switzerland
| | - Jure Tornic
- Department of Neuro-Urology, Balgrist University Hospital, University of Zürich, 8008 Zürich, Switzerland
- Department of Urology, Winterthur Cantonal Hospital, 8400 Winterthur, Switzerland
| | - Martina D Liechti
- Department of Neuro-Urology, Balgrist University Hospital, University of Zürich, 8008 Zürich, Switzerland
| | - Martin W G Brinkhof
- Swiss Paraplegic Research, 6207 Nottwil, Switzerland
- Department of Health Sciences and Medicine, University of Lucerne, 6002 Lucerne, Switzerland
| | - Thomas M Kessler
- Department of Neuro-Urology, Balgrist University Hospital, University of Zürich, 8008 Zürich, Switzerland
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Pavese C, Kessler TM. Prediction of Lower Urinary Tract, Sexual, and Bowel Function, and Autonomic Dysreflexia after Spinal Cord Injury. Biomedicines 2023; 11:1644. [PMID: 37371739 DOI: 10.3390/biomedicines11061644] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Revised: 06/02/2023] [Accepted: 06/04/2023] [Indexed: 06/29/2023] Open
Abstract
Spinal cord injury (SCI) produces damage to the somatic and autonomic pathways that regulate lower urinary tract, sexual, and bowel function, and increases the risk of autonomic dysreflexia. The recovery of these functions has a high impact on health, functioning, and quality of life and is set as the utmost priority by patients. The application of reliable models to predict lower urinary tract, sexual, and bowel function, and autonomic dysreflexia is important for guiding counseling, rehabilitation, and social reintegration. Moreover, a reliable prediction is essential for designing future clinical trials to optimize patients' allocation to different treatment groups. To date, reliable and simple algorithms are available to predict lower urinary tract and bowel outcomes after traumatic and ischemic SCI. Previous studies identified a few risk factors to develop autonomic dysreflexia, albeit a model for prediction still lacks. On the other hand, there is an urgent need for a model to predict the evolution of sexual function. The aim of this review is to examine the available knowledge and models for the prediction of lower urinary tract, sexual, and bowel function, and autonomic dysreflexia after SCI, and critically discuss the research priorities in these fields.
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Affiliation(s)
- Chiara Pavese
- Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia, 27100 Pavia, Italy
- Istituti Clinici Scientifici Maugeri IRCCS, Neurorehabilitation and Spinal Unit of Pavia Institute, 27100 Pavia, Italy
| | - Thomas M Kessler
- Department of Neuro-Urology, Balgrist University Hospital, University of Zürich, 8008 Zürich, Switzerland
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36
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Doelman AW, Streijger F, Majerus SJA, Damaser MS, Kwon BK. Assessing Neurogenic Lower Urinary Tract Dysfunction after Spinal Cord Injury: Animal Models in Preclinical Neuro-Urology Research. Biomedicines 2023; 11:1539. [PMID: 37371634 DOI: 10.3390/biomedicines11061539] [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: 05/04/2023] [Revised: 05/20/2023] [Accepted: 05/21/2023] [Indexed: 06/29/2023] Open
Abstract
Neurogenic bladder dysfunction is a condition that affects both bladder storage and voiding function and remains one of the leading causes of morbidity after spinal cord injury (SCI). The vast majority of individuals with severe SCI develop neurogenic lower urinary tract dysfunction (NLUTD), with symptoms ranging from neurogenic detrusor overactivity, detrusor sphincter dyssynergia, or sphincter underactivity depending on the location and extent of the spinal lesion. Animal models are critical to our fundamental understanding of lower urinary tract function and its dysfunction after SCI, in addition to providing a platform for the assessment of potential therapies. Given the need to develop and evaluate novel assessment tools, as well as therapeutic approaches in animal models of SCI prior to human translation, urodynamics assessment techniques have been implemented to measure NLUTD function in a variety of animals, including rats, mice, cats, dogs and pigs. In this narrative review, we summarize the literature on the use of animal models for cystometry testing in the assessment of SCI-related NLUTD. We also discuss the advantages and disadvantages of various animal models, and opportunities for future research.
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Affiliation(s)
- Adam W Doelman
- International Collaboration on Repair Discoveries, University of British Columbia, Vancouver, BC V5Z 1M9, Canada
| | - Femke Streijger
- International Collaboration on Repair Discoveries, University of British Columbia, Vancouver, BC V5Z 1M9, Canada
| | - Steve J A Majerus
- Department of Electrical, Computer and Systems Engineering, Case Western Reserve University, Cleveland, OH 44106, USA
- Advanced Platform Technology Center, Louis Stokes Cleveland VA Medical Center, Cleveland, OH 44106, USA
| | - Margot S Damaser
- Advanced Platform Technology Center, Louis Stokes Cleveland VA Medical Center, Cleveland, OH 44106, USA
- Department of Biomedical Engineering, Lerner Research Institute, Cleveland Clinic, Cleveland, OH 44195, USA
| | - Brian K Kwon
- International Collaboration on Repair Discoveries, University of British Columbia, Vancouver, BC V5Z 1M9, Canada
- Department of Orthopaedics, Vancouver Spine Surgery Institute, University of British Columbia, Vancouver, BC V5Z 1M9, Canada
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Chen Y, Peng L, Zhang C, Chen J, Chen J, Shen H, Luo D. The effectiveness and safety of oral medications, onabotulinumtoxinA (three doses) and transcutaneous tibial nerve stimulation as non or minimally invasive treatment for the management of neurogenic detrusor overactivity in adults: a systematic review and network meta-analysis. Int J Surg 2023; 109:1430-1438. [PMID: 36974676 PMCID: PMC10389548 DOI: 10.1097/js9.0000000000000338] [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: 01/12/2023] [Accepted: 03/08/2023] [Indexed: 03/29/2023]
Abstract
BACKGROUND Oral medications, onabotulinumtoxinA injections, and transcutaneous tibial nerve stimulation (TTNS) are recommended by the American Urological Association/Society of Urodynamics, Female Pelvic Medicine and Urogenital Reconstruction guidelines as non or minimally invasive treatments for patients with neurogenic detrusor overactivity (NDO) without treatment hierarchy. OBJECTIVE The objective was to compare and rank the effectiveness and safety of oral medications, three doses of onabotulinumtoxinA, and TTNS on improving urodynamic outcomes in patient-reported outcomes and safety outcomes in patients with NDO. METHODS The authors searched PubMed, EMBASE, MEDLINE, Cochrane Library, Medicine, and clinicaltrials.gov, from their inception to October 2022 and included randomized controlled studies on the drug, onabotulinumtoxinA, and TTNS for the treatment of patients with NDO. Outcomes included urodynamic parameters, voiding diary, quality of life changes, adverse event rate and postvoid residual. RESULTS A total of 26 articles and 2938 patients were included in the statistics. Regarding effectiveness, all interventions except TTNS and α-blockers were statistically different for the placebo group. The urodynamic outcome and patient-reported outcome suggested that onabotulinumtoxinA injection (urodynamic outcome: onabotulinumtoxinA 200 U, the mean surface under the cumulative ranking curve (SUCRA): 87.4; patient-reported outcome: onabotulinumtoxinA 100 U, mean SUCRA: 89.8) was the most effective treatment, and the safety outcome suggested that TTNS (SUCRA: 83.3) was the safest. Cluster analysis found that antimuscarinics and β3-adrenoceptor-agonists possessed good effectiveness and safety. CONCLUSION OnabotulinumtoxinA injection is probably the most effective way to treat patients with NDO, with increasing effectiveness but decreasing safety as the dose rises. The effectiveness of α-blockers and TTNS was not statistically different from the placebo group. Antimuscarinics and β3-adrenoceptor-agonists have good effectiveness and safety.
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Affiliation(s)
| | | | | | | | | | | | - Deyi Luo
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, Sichuan, People’s Republic of China
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Wang X, Zhou Z, Zhang F, Li X, Liao L. Augmentation Uretero-enterocystoplasty Is an Effective Procedure in Protecting the Upper Urinary Tract Without Accelerating Deterioration of Renal Function. EUR UROL SUPPL 2023; 51:62-69. [PMID: 37187718 PMCID: PMC10175731 DOI: 10.1016/j.euros.2023.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/13/2023] [Indexed: 04/03/2023] Open
Abstract
Background Augmentation uretero-enterocystoplasty (AUEC) provides a low-pressure urinary storage capsule that can preserve renal function in patients with lower urinary tract dysfunction for whom conservative treatments have failed. Objective To summarize the effectiveness and safety of augmentation uretero-enterocystoplasty (AUEC) and evaluate whether it aggravates renal function deterioration in patients with renal insufficiency. Design setting and participants This was a retrospective cohort study of patients who underwent AUEC from 2006 to 2021. Patients were grouped according to whether they had normal renal function (NRF) or renal dysfunction (serum creatinine >1.5 mg/dl). Outcome measurements and statistical analysis Follow-up of upper and lower urinary tract function was assessed via review of clinical records, urodynamic data, and laboratory results. Results and limitations We included 156 patients in the NRF group and 68 in the renal dysfunction group. We confirmed that urodynamic parameters and upper urinary tract dilation were significantly improved for patients after AUEC. Serum creatinine declined during the first 10 mo in both groups and remained stable thereafter. The reduction in serum creatine was significantly greater in the renal dysfunction group than in the NRF group in the first 10 mo (difference in reduction 4.19 units; p < 0.05). A multivariable regression model showed that baseline renal dysfunction was not a significant risk factor for deterioration of renal function in patients who had undergone AUEC (odds ratio 2.15; p = 0.11). The main limitations are selection bias because of the retrospective design, loss to follow-up, and missing data. Conclusions AUEC is a safe and effective procedure to protect the upper urinary tract and will not hasten deterioration of renal function in patients with lower urinary tract dysfunction. In addition, AUEC improved and stabilized residual renal function in patients with renal insufficiency, which is important in preparation for renal transplantation. Patient summary Bladder dysfunction is usually treated with medication or Botox injections. If these treatments fail, surgery to increase the bladder size using a portion of the patient's intestine is a possible option. Our study shows that this procedure was safe and feasible and improved bladder function. It did not lead to a further decrease in function in patients who already had impaired kidney function.
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Liao Y, Wang M, Liu Y, Zhou W, Liu J, Yu H. Magnetically controlled artificial urinary sphincter: An overview from existing devices to future developments. Artif Organs 2023. [PMID: 37114754 DOI: 10.1111/aor.14535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Revised: 04/04/2023] [Accepted: 04/06/2023] [Indexed: 04/29/2023]
Abstract
BACKGROUND Urinary incontinence is a common clinical problem in the world today. Artificial urinary sphincter is a good treatment approach for severe urinary incontinence, which is designed to mimic the action of the human urinary sphincter and assist patients to regain urinary function. METHODS There are many control methods based on artificial urinary sphincter, such as hydraulic control, electromechanical control, magnetic control, and shape memory alloy control. In this paper, the literature was first searched and documented based on PRISMA search strategy for selected specific subject terms. Then, a comparison of artificial urethral sphincters based on different control methods was conducted, and the research progress of magnetically controlled artificial urethral sphincters was reviewed, and their advantages and disadvantages were summarized. Finally, the design factors for the clinical application of magnetically controlled artificial urinary sphincter are discussed. RESULTS As magnetic control allows for non-contact force transfer and does not generate heat, it is proposed that magnetic control may be one of the more promising control methods. The design of future magnetically controlled artificial urinary sphincters will need a variety of considerations, including the structural design of the device, manufacturing materials, manufacturing costs, and convenience. In addition, validation of the safety and effectiveness of the device and device management are equally important. CONCLUSIONS The design of an ideal magnetically controlled artificial urinary sphincter is of great importance to enhance patient treatment outcomes. However, there are still great challenges to be faced for the clinical application of such devices.
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Affiliation(s)
- Yucheng Liao
- Institute of Rehabilitation Engineering and Technology, School of Intelligent Rehabilitation Engineering, University of Shanghai for Science and Technology, Shanghai, China
- Shanghai Engineering Research Center of Assistive Devices, Shanghai, China
| | - Minghui Wang
- Institute of Rehabilitation Engineering and Technology, School of Intelligent Rehabilitation Engineering, University of Shanghai for Science and Technology, Shanghai, China
- Shanghai Engineering Research Center of Assistive Devices, Shanghai, China
| | - Yunlong Liu
- Institute of Rehabilitation Engineering and Technology, School of Intelligent Rehabilitation Engineering, University of Shanghai for Science and Technology, Shanghai, China
- Shanghai Engineering Research Center of Assistive Devices, Shanghai, China
| | - Wei Zhou
- Institute of Rehabilitation Engineering and Technology, School of Intelligent Rehabilitation Engineering, University of Shanghai for Science and Technology, Shanghai, China
- Shanghai Engineering Research Center of Assistive Devices, Shanghai, China
| | - Ji Liu
- Institute of Rehabilitation Engineering and Technology, School of Intelligent Rehabilitation Engineering, University of Shanghai for Science and Technology, Shanghai, China
- Shanghai Engineering Research Center of Assistive Devices, Shanghai, China
| | - Hongliu Yu
- Institute of Rehabilitation Engineering and Technology, School of Intelligent Rehabilitation Engineering, University of Shanghai for Science and Technology, Shanghai, China
- Shanghai Engineering Research Center of Assistive Devices, Shanghai, China
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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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Anderson CE, Kozomara M, Birkhäuser V, Bywater M, Gross O, Kiss S, Knüpfer SC, Koschorke M, Leitner L, Mehnert U, Sadri H, Sammer U, Stächele L, Tornic J, Liechti MD, Brinkhof MWG, Kessler TM. Temporal development of unfavourable urodynamic parameters during the first year after spinal cord injury. BJU Int 2023; 131:503-512. [PMID: 36221991 DOI: 10.1111/bju.15918] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To describe the temporal development of and risk factors for the occurrence of unfavourable urodynamic parameters during the first year after spinal cord injury (SCI). PATIENTS AND METHODS This population-based longitudinal study used data from 97 adult patients with a single-event traumatic or ischaemic SCI who underwent video-urodynamic investigation (UDI) at a university SCI centre. The first occurrences of unfavourable urodynamic parameters (detrusor overactivity combined with detrusor sphincter dyssynergia [DO-DSD], maximum storage detrusor pressure ≥40 cmH2 O, bladder compliance <20 mL/cmH2 O, vesico-ureteric reflux [VUR] and any unfavourable parameter [composite outcome]) were evaluated using time-to-event analysis. RESULTS The majority of the population (87/97 [90%]) had at least one unfavourable urodynamic parameter. Most unfavourable urodynamic parameters were initially identified during the 1- or 3-month UDI, including 92% of the DO-DSD (78/85), 82% of the maximum storage pressure ≥40 cmH2 O (31/38), and 100% of the VUR (seven of seven) observations. No low bladder compliance was observed. The risk of DO-DSD was elevated in patients with thoracic SCI compared to those with lumbar SCI (adjusted hazard ratio [aHR] 2.38, 95% confidence interval [CI] 1.16-4.89). Risk of maximum storage detrusor pressure ≥40 cmH2 O was higher in males than females (aHR 8.33, 95% CI 2.51-27.66), in patients with a cervical SCI compared to those with lumbar SCI (aHR 14.89, 95% CI 3.28-67.55), and in patients with AIS Grade B or C compared to AIS Grade D SCI (aHR 6.17, 95% CI 1.78-21.39). No risk factors were identified for the composite outcome of any unfavourable urodynamic parameter. CONCLUSIONS The first UDI should take place within 3 months after SCI as to facilitate early diagnosis of unfavourable urodynamic parameters and timely treatment. Neuro-urological guidelines and individualised management strategies for patients with SCI may be strengthened by considering sex and SCI characteristics in the scheduling of UDIs.
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Affiliation(s)
- Collene E Anderson
- Swiss Paraplegic Research, Nottwil, Switzerland
- Department of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland
- Department of Neuro-Urology, Balgrist University Hospital, University of Zürich, Zürich, Switzerland
| | - Marko Kozomara
- Department of Neuro-Urology, Balgrist University Hospital, University of Zürich, Zürich, Switzerland
- Department of Urology, University Hospital Zürich, University of Zürich, Zürich, Switzerland
| | - Veronika Birkhäuser
- Department of Neuro-Urology, Balgrist University Hospital, University of Zürich, Zürich, Switzerland
| | - Mirjam Bywater
- Department of Neuro-Urology, Balgrist University Hospital, University of Zürich, Zürich, Switzerland
- Department of Urology, Cantonal Hospital Aarau, Aarau, Switzerland
| | - Oliver Gross
- Department of Neuro-Urology, Balgrist University Hospital, University of Zürich, Zürich, Switzerland
| | - Stephan Kiss
- Department of Neuro-Urology, Balgrist University Hospital, University of Zürich, Zürich, Switzerland
- Department of Urology, Cantonal Hospital Aarau, Aarau, Switzerland
| | - Stephanie C Knüpfer
- Department of Neuro-Urology, Balgrist University Hospital, University of Zürich, Zürich, Switzerland
- Department of Urology, Clinic for Urology, University Hospital Bonn, Bonn, Germany
| | - Miriam Koschorke
- Department of Neuro-Urology, Balgrist University Hospital, University of Zürich, Zürich, Switzerland
| | - Lorenz Leitner
- Department of Neuro-Urology, Balgrist University Hospital, University of Zürich, Zürich, Switzerland
| | - Ulrich Mehnert
- Department of Neuro-Urology, Balgrist University Hospital, University of Zürich, Zürich, Switzerland
| | - Helen Sadri
- Department of Neuro-Urology, Balgrist University Hospital, University of Zürich, Zürich, Switzerland
| | - Ulla Sammer
- Department of Neuro-Urology, Balgrist University Hospital, University of Zürich, Zürich, Switzerland
| | - Lara Stächele
- Department of Neuro-Urology, Balgrist University Hospital, University of Zürich, Zürich, Switzerland
| | - Jure Tornic
- Department of Neuro-Urology, Balgrist University Hospital, University of Zürich, Zürich, Switzerland
- Department of Urology, Winterthur Cantonal Hospital, Winterthur, Switzerland
| | - Martina D Liechti
- Department of Neuro-Urology, Balgrist University Hospital, University of Zürich, Zürich, Switzerland
| | - Martin W G Brinkhof
- Swiss Paraplegic Research, Nottwil, Switzerland
- Department of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland
| | - Thomas M Kessler
- Department of Neuro-Urology, Balgrist University Hospital, University of Zürich, Zürich, Switzerland
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Aldridge JHR. Botulinum neurotoxin: A therapeutic powerhouse with broad clinical implications. JAAPA 2023; 36:39-41. [PMID: 36976032 DOI: 10.1097/01.jaa.0000921280.56648.da] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/29/2023]
Abstract
ABSTRACT Clostridium botulinum is a Gram-positive bacterium that produces one of the most deadly chemodenervating toxins in the world. To date, six distinct neurotoxins are available for prescription use in the United States. Decades of data across aesthetic therapeutic areas and therapeutic disease states support the safety and efficacy of C. botulinum, providing good symptom management and improved quality of life in appropriately chosen patients. Unfortunately, many clinicians are slow to progress patients to toxin therapy from more conservative measures, and others wrongly interchange the products despite characteristics unique to each. Commensurate with an improved understanding of the complex pharmacology and clinical implications of botulinum neurotoxins is the importance for clinicians to appropriately identify, educate, refer, and/or treat candidate patients. This article provides an overview of the history, mechanism of action, differentiation, indications, and uses for botulinum neurotoxins.
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Affiliation(s)
- Jamie H R Aldridge
- Jamie H. R. Aldridge is a medical science liaison for argenx USA, Inc., in Boston, Mass., and practices at Moses H. Cone Memorial Hospital in Greensboro, N.C. The author has disclosed no potential conflicts of interest, financial or otherwise
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Li J, Wang J, Hu Y, Jian R, Zhao Y, Li D, Wan T, Jike W, Xu F, Huang M. Effects of repetitive functional magnetic stimulation in the sacral nerve in patients with neurogenic detrusor overactivity after suprasacral spinal cord injury: a study protocol for a randomized controlled trial. Trials 2023; 24:199. [PMID: 36932375 PMCID: PMC10022156 DOI: 10.1186/s13063-023-07207-1] [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: 10/26/2022] [Accepted: 02/28/2023] [Indexed: 03/19/2023] Open
Abstract
BACKGROUND Neurogenic detrusor overactivity (NDO) is a serious and common complication after spinal cord injury, affecting patients' quality of life seriously. Therefore, we developed this research protocol to evaluate the efficacy of repetitive functional magnetic stimulation (rFMS) in the sacral nerve in patients with neurogenic detrusor overactivity (NDO) after suprasacral spinal cord injury (SCI) and provide more options for rFMS in treating NDO after suprasacral SCI. METHODS This study is a single-center, randomized, parallel-group clinical trial. We will recruit the patients with NDO after suprasacral SCI in the Rehabilitation Department of the Affiliated Hospital of Southwest Medical University from September 2022 to August 2023. They will be assigned to the rFMS group and the sham stimulation group randomly. The sample size is 66, with 33 patients in each group. The rFMS group will receive real rFMS treatment of the sacral nerve (100% stimulation intensity, 5 Hz, 20 min each time, five times a week), and the sham group will receive sham stimulation. Both groups will receive similar treatment strategies, including medication, standard urine management, acupuncture treatment, and health education. The bladder compliance (bladder capacity/detrusor pressure) and pudendal nerve electromyography will be evaluated at baseline, 8th week of treatment. The residual volume of the bladder and bladder diary will be recorded once a week during 8 weeks of treatments. SCI-QOL and NBSS will be evaluated at baseline, the 4th and 8th week of treatment. In addition, the above assessments will be followed up at 8 weeks after the end of treatment. DISCUSSION It is expected that the bladder function, symptoms, and quality of life might be significantly improved after rFMS of the sacral nerve. TRIAL REGISTRATION The China Clinical Trials Registry has approved this study, registration number: ChiCTR2100045148. Registered on April 7, 2021.
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Affiliation(s)
- Jiyang Li
- grid.488387.8Rehabilitation Medicine Department, The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan People’s Republic of China
| | - Jianxiong Wang
- grid.488387.8Rehabilitation Medicine Department, The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan People’s Republic of China
| | - Yue Hu
- grid.488387.8Rehabilitation Medicine Department, The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan People’s Republic of China
| | - Rui Jian
- grid.488387.8Rehabilitation Medicine Department, The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan People’s Republic of China
| | - Yulu Zhao
- grid.488387.8Rehabilitation Medicine Department, The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan People’s Republic of China
| | - Dan Li
- grid.488387.8Rehabilitation Medicine Department, The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan People’s Republic of China
| | - Tenggang Wan
- grid.488387.8Rehabilitation Medicine Department, The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan People’s Republic of China
| | - Wuga Jike
- grid.488387.8Rehabilitation Medicine Department, The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan People’s Republic of China
| | - Fangyuan Xu
- grid.488387.8Rehabilitation Medicine Department, The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan People’s Republic of China
| | - Maomao Huang
- grid.488387.8Rehabilitation Medicine Department, The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan People’s Republic of China
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A cost-effectiveness analysis of bladder management strategies in neurogenic lower urinary tract dysfunction after spinal cord injury: A publicly funded health care perspective. Spinal Cord 2023; 61:269-275. [PMID: 36894764 DOI: 10.1038/s41393-023-00883-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Revised: 01/22/2023] [Accepted: 02/23/2023] [Indexed: 03/11/2023]
Abstract
STUDY DESIGN Economic evaluation study. OBJECTIVES To investigate the long-term cost-effectiveness of clean intermittent catheterization (CIC) compared with suprapubic catheters (SPC) and indwelling urethral catheters (UC) among individuals with neurogenic lower urinary tract dysfunction (NLUTD) related to spinal cord injury (SCI) from a public healthcare perspective. SETTING University affiliated hospital in Montreal, Canada. METHODS A Markov model with Monte Carlo simulation was developed with a cycle length of 1 year and lifetime horizon to estimate the incremental cost per quality-adjusted life years (QALYs). Participants were assigned to treatment with either CIC or SPC or UC. Transition probabilities, efficacy data, and utility values were derived from literature and expert opinion. Costs were obtained from provincial health system and hospital data in Canadian Dollars. The primary outcome was cost per QALY. Probabilistic and one-way deterministic sensitivity analyses were performed. RESULTS CIC had a lifetime mean total cost of $ 29,161 for 20.91 QALYs. The model predicted that a 40-year-old person with SCI would gain an additional 1.77 QALYs and 1.72 discounted life-years gained if CIC were utilized instead of SPC at an incremental cost savings of $330. CIC confer 1.96 QALYs and 3 discounted life-years gained compared to UC with an incremental cost savings of $2496. A limitation of our analysis is the lack of direct long-term comparisons between different catheter modalities. CONCLUSIONS CIC appears to be a dominant and more economically attractive bladder management strategy for NLUTD compared with SPC and/or UC from the public payer perspective over a lifetime horizon.
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Ong HL, Chiang IN, Hsu LN, Chin CW, Shao IH, Jang MY, Juan YS, Wang CC, Kuo HC. Conservative Bladder Management and Medical Treatment in Chronic Spinal Cord Injury Patients. J Clin Med 2023; 12:jcm12052021. [PMID: 36902808 PMCID: PMC10003947 DOI: 10.3390/jcm12052021] [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: 02/19/2023] [Revised: 02/28/2023] [Accepted: 03/02/2023] [Indexed: 03/08/2023] Open
Abstract
To review the available data on non-surgical management for neurogenic lower urinary tract dysfunction (NLUTD) in patients with chronic spinal cord injury (SCI) and provide the most updated knowledge for readers. We categorized the bladder management approaches into storage and voiding dysfunction separately; both are minimally invasive, safe, and efficacious procedures. The main goals for NLUTD management are to achieve urinary continence; improve quality of life; prevent urinary tract infections and, last but not least, preserve upper urinary tract function. Annual renal sonography workups and regular video urodynamics examinations are crucial for early detection and further urological management. Despite the extensive data on NLUTD, there are still relatively few novel publications and there is a lack of high-quality evidence. There is a paucity of new minimally invasive and prolonged efficacy treatments for NLUTD, and a partnership between urologists, nephrologists and physiatrists is required to promote and ensure the health of SCI patients in the future.
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Affiliation(s)
- Hueih Ling Ong
- Department of Urology, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chia-Yi 622, Taiwan
| | - I-Ni Chiang
- Department of Urology, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei 110, Taiwan
| | - Lin-Nei Hsu
- Department of Urology, An Nan Hospital, China Medical University, Tainan City 833, Taiwan
| | - Cheih-Wen Chin
- Feng Shan Lee Chia Wen Urologic Clinic, Kaohsiung 800, Taiwan
| | - I-Hung Shao
- Division of Urology, Department of Surgery, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan 333, Taiwan
| | - Mei-Yu Jang
- Department of Urology, Kaohsiung Municipal Siaogang Hospital, Kaohsiung 812, Taiwan
| | - Yung-Shun Juan
- Department of Urology, College of Medicine, Kaohsiung Medical University, Kaohsiung 807, Taiwan
- Department of Urology, Kaohsiung Medical University Hospital, Kaohsiung 813031, Taiwan
- Graduate Institute of Clinical Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 807, Taiwan
| | - Chung-Cheng Wang
- Department of Urology, En Chu Kong Hospital, New Taipei City 237, Taiwan
- Department of Biomedical Engineering, Chung Yuan Christian University, Chungli 320, Taiwan
| | - Hann-Chorng Kuo
- Department of Urology, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Buddhist Tzu Chi University, Hualien 970, Taiwan
- Correspondence: ; Tel.: +886-3-8561825 (ext. 2117); Fax: +886-3-8560794
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Calën L, Mesnard B, Hedhli O, Broudeur L, Reiss B, Loubersac T, Branchereau J, Baron M, Rigaud J, Le Fort M, Perrouin-Verbe B, Le Normand L, Lefevre C, Perrouin-Verbe MA. Robot-assisted laparoscopic cystectomy with non-continent urinary diversion for neurogenic lower urinary tract dysfunction: Midterm outcomes. Neurourol Urodyn 2023; 42:586-596. [PMID: 36695768 DOI: 10.1002/nau.25134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Revised: 12/21/2022] [Accepted: 01/16/2023] [Indexed: 01/26/2023]
Abstract
OBJECTIVES The aim of this study was to assess midterm functional outcomes and complications of robot-assisted laparoscopic cystectomy with non-continent urinary diversion in patients with neurogenic lower urinary tract dysfunction. MATERIALS AND METHODS We performed a retrospective single center study including all patients who underwent robot-assisted laparoscopic cystectomy with non-continent urinary diversion between January 2008 and December 2018 for neurogenic lower urinary tract dysfunction. Perioperative data, early and late complications, reoperation rate, renal function, and patient satisfaction (PGI-I) were evaluated. RESULTS One hundred and forty patients were included (70 multiple sclerosis, 37 spinal cord injuries, 33 others) with a median follow-up of 29 months (12-49). The main indication for surgery was an inability to perform intermittent self-catheterization (n = 125, 89%). The early complication rate (<30 days) was 41% (n = 58), including 72% (n = 45) minor complications (Clavien I-II) and 29% (n = 17) major complications (Clavien III-V). Three patients died in the early postoperative period. Late complications appear in 41% (n = 57), with 9% (n = 13) being ureteroileal anastomotic stricture. The overall reintervention rate was 19% (n = 27), mainly for lithiasis surgery. Pre- and postoperative renal function were comparable. Most of patients reported an improvement in their quality of life following their surgery (PGI-I 1-2). CONCLUSION Robot-assisted laparoscopic cystectomy with non-continent urinary diversion may be of particular interest in patients with neurogenic lower urinary tract dysfunction who are unable to benefit from conservative treatment, as it provides midterm protection of the upper urinary tract and an improvement in quality of life.
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Affiliation(s)
- Laura Calën
- Department of Urology, CHU Nantes, Nantes Université, Nantes, France
| | - Benoît Mesnard
- Department of Urology, CHU Nantes, Nantes Université, Nantes, France
| | - Oussama Hedhli
- Department of Urology, CHU Nantes, Nantes Université, Nantes, France
| | - Lucas Broudeur
- Department of Urology, CHU Nantes, Nantes Université, Nantes, France
| | - Bénédicte Reiss
- Department of Physical Medicine and Rehabilitation, CHU Nantes, Nantes Université, Nantes, France
| | - Thomas Loubersac
- Department of Urology, CHU Nantes, Nantes Université, Nantes, France
| | | | - Maximilien Baron
- Department of Urology, CHU Nantes, Nantes Université, Nantes, France
| | - Jérôme Rigaud
- Department of Urology, CHU Nantes, Nantes Université, Nantes, France
| | - Marc Le Fort
- Department of Physical Medicine and Rehabilitation, CHU Nantes, Nantes Université, Nantes, France
| | - Brigitte Perrouin-Verbe
- Department of Physical Medicine and Rehabilitation, CHU Nantes, Nantes Université, Nantes, France
| | - Loïc Le Normand
- Department of Urology, CHU Nantes, Nantes Université, Nantes, France
| | - Chloé Lefevre
- Department of Physical Medicine and Rehabilitation, CHU Nantes, Nantes Université, Nantes, France
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Manunta A, Peyronnet B, Olivari-Philiponnet C, Chartier-Kastler E, Saussine C, Phé V, Robain G, Denys P, Even A, Samson E, Grise P, Karsenty G, Hascoet J, Castel-Lacanal E, Charvier K, Guinet-Lacoste A, Chesnel C, Amarenco G, Haffner F, Haddad M, Le Normand L, Perrouin-Verbe MA, Perrouin-Verbe B, De Seze M, Ruffion A, Gamé X. [Guidelines on the urological management of the adult patient with spinal dysraphism (spina bifida)]. Prog Urol 2023; 33:178-197. [PMID: 36609138 DOI: 10.1016/j.purol.2022.12.006] [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: 12/03/2022] [Accepted: 12/10/2022] [Indexed: 01/06/2023]
Abstract
INTRODUCTION Improved life expectancy and prenatal screening have changed the demographics of spina bifida (spinal dysraphism) which has presently become a disease of adulthood. Urinary disorders affect almost all patients with spinal dysraphism and are still the leading cause of mortality in these patients. The aim of this work was to establish recommendations for urological management that take into account the specificities of the spina bifida population. MATERIALS AND METHODS National Diagnosis and Management Guidelines (PNDS) were drafted within the framework of the French Rare Diseases Plan at the initiative of the Centre de Référence Maladies Rares Spina Bifida - Dysraphismes of Rennes University Hospital. It is a collaborative work involving experts from different specialties, mainly urologists and rehabilitation physicians. We conducted a systematic search of the literature in French and English in the various fields covered by these recommendations in the MEDLINE database. In accordance with the methodology recommended by the authorities (Guide_methodologique_pnds.pdf, 2006), proposed recommendations were drafted on the basis of this literature review and then submitted to a review group until a consensus was reached. RESULTS Bladder dysfunctions induced by spinal dysraphism are multiple and varied and evolve over time. Management must be individually adapted and take into account all the patient's problems, and is therefore necessarily multi-disciplinary. Self-catheterisation is the appropriate micturition method for more than half of the patients and must sometimes be combined with treatments aimed at suppressing any neurogenic detrusor overactivity (NDO) or compliance alteration (anticholinergics, intra-detrusor botulinum toxin). Resort to surgery is sometimes necessary either after failure of non-invasive treatments (e.g. bladder augmentation in case of NDO resistant to pharmacological treatment), or as a first line treatment in the absence of other non-invasive alternatives (e.g. aponeurotic suburethral tape or artificial urinary sphincter for sphincter insufficiency; urinary diversion by ileal conduit if self-catheterisation is impossible). CONCLUSION Spinal dysraphism is a complex pathology with multiple neurological, orthopedic, gastrointestinal and urological involvement. The management of bladder and bowel dysfunctions must continue throughout the life of these patients and must be integrated into a multidisciplinary context.
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Affiliation(s)
- A Manunta
- Centre de référence Spina Bifida-Dysraphismes, CHU Pontchaillou, Rennes, France
| | - B Peyronnet
- Centre de référence Spina Bifida-Dysraphismes, CHU Pontchaillou, Rennes, France.
| | | | - E Chartier-Kastler
- Service d'Urologie, GH Pitié-Salpétrière, APHP, Paris, France; Sorbonne Université, Paris, France; Service de médecine physique et réadaptation, Hôpital Raymond-Poincaré, APHP, Garches, France
| | - C Saussine
- Service d'urologie, les hôpitaux universitaires de Strasbourg, Strasbourg, France
| | - V Phé
- Service d'urologie, Sorbonne Université, Assistance Publique-Hôpitaux de Paris, Hôpital Tenon, Paris, France
| | - G Robain
- Service de médecine physique et réadaptation, Hôpital Rotschild, APHP, Paris, France
| | - P Denys
- Service de médecine physique et réadaptation, Hôpital Raymond-Poincaré, APHP, Garches, France; Faculté de médecine Paris Ouest, Université de Versailles-Saint-Quentin-en-Yvelines, Garches, France
| | - A Even
- Service de médecine physique et réadaptation, Hôpital Raymond-Poincaré, APHP, Garches, France; Faculté de médecine Paris Ouest, Université de Versailles-Saint-Quentin-en-Yvelines, Garches, France
| | - E Samson
- Centre de référence Spina Bifida-Dysraphismes, CHU Pontchaillou, Rennes, France
| | - P Grise
- Service d'urologie, CHU Rouen, Rouen, France
| | - G Karsenty
- Aix-Marseille Université, urologie et transplantation rénale, Hôpital La Conception, AP-HM, Marseille, France
| | - J Hascoet
- Centre de référence Spina Bifida-Dysraphismes, CHU Pontchaillou, Rennes, France
| | - E Castel-Lacanal
- CHU Toulouse, service de médecine physique et de réadaptation et ToNIC, Toulouse NeuroImaging Center, Université de Toulouse, Inserm, UPS, Toulouse, France
| | - K Charvier
- Service de médecine physique et réadaptation, Hôpital Henry-Gabrielle, Hospices civils de Lyon, Saint-Genis-Laval, France
| | - A Guinet-Lacoste
- Sorbonne Université, GRC 001, GREEN Groupe de recherche clinique en neuro-urologie, AP-HP, Hôpital Tenon, 75020 Paris, France
| | - C Chesnel
- Sorbonne Université, GRC 001, GREEN Groupe de recherche clinique en neuro-urologie, AP-HP, Hôpital Tenon, 75020 Paris, France; Service de neuro-urologie et explorations périnéales, Hôpital Tenon, AP-HP, Paris, France
| | - G Amarenco
- Sorbonne Université, GRC 001, GREEN Groupe de recherche clinique en neuro-urologie, AP-HP, Hôpital Tenon, 75020 Paris, France; Service de neuro-urologie et explorations périnéales, Hôpital Tenon, AP-HP, Paris, France
| | - F Haffner
- ASBH, Association nationale Spina Bifida et Handicaps associés, 94420 Le Plessis Trevise, France
| | - M Haddad
- Service de chirurgie viscérale et urologie pédiatrique, AP-HM, Marseille, France
| | - L Le Normand
- Service d'urologie, CHU de Nantes, Nantes, France
| | | | - B Perrouin-Verbe
- Service de médecine physique et réadaptation, CHU de Nantes, Nantes, France
| | - M De Seze
- Spécialiste en médecine physique et de réadaptation, Clinique St.-Augustin, Bordeaux, France
| | - A Ruffion
- Service d'urologie, Hospices civils de Lyon, Lyon, France
| | - X Gamé
- Département d'urologie, transplantation rénale et andrologie, CHU Rangueil, Université Paul-Sabatier, Toulouse, France
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Zhao P, Zhang G, Shen Y, Wang Y, Shi L, Wang Z, Wei C, Zhai W, Sun L. Urinary dysfunction in patients with vascular cognitive impairment. Front Aging Neurosci 2023; 14:1017449. [PMID: 36742205 PMCID: PMC9889668 DOI: 10.3389/fnagi.2022.1017449] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Accepted: 12/28/2022] [Indexed: 01/20/2023] Open
Abstract
Vascular cognitive impairment (VCI) is caused by vascular pathologies, with the spectrum of cognitive disorders ranging from subjective cognitive dysfunction to dementia. Particularly among older adults, cognitive impairment is often complicated with urinary dysfunction (UD); some patients may present with UD before cognitive impairment owing to stroke or even when there are white matter hyperintensities on imaging studies. Patients with cognitive impairment often have both language and movement dysfunction, and thus, UD in patients with VCI can often be underdiagnosed and remain untreated. UD has an impact on the quality of life of patients and caregivers, often leading to poor outcomes. Medical history is an important aspect and should be taken from both patients and their caregivers. Clinical assessment including urinalysis, voiding diary, scales on UD and cognitive impairment, post-void residual volume measurement, uroflowmetry, and (video-) urodynamics should be performed according to indication. Although studies on UD with VCI are few, most of them show that an overactive bladder (OAB) is the most common UD type, and urinary incontinence is the most common symptom. Normal urine storage and micturition in a specific environment are complex processes that require a sophisticated neural network. Although there are many studies on the brain-urinary circuit, the specific circuit involving VCI and UD remains unclear. Currently, there is no disease-modifying pharmacological treatment for cognitive impairment, and anti-acetylcholine drugs, which are commonly used to treat OAB, may cause cognitive impairment, leading to a vicious circle. Therefore, it is important to understand the complex interaction between UD and VCI and formulate individualized treatment plans. This review provides an overview of research advances in clinical features, imaging and pathological characteristics, and treatment options of UD in patients with VCI to increase subject awareness, facilitate research, and improve diagnosis and treatment rates.
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van Veen FEE, Scheepe JR, Blok BFM. Regional variation in urinary catheter use in the Netherlands from 2012 to 2021: a population-based cohort. Ther Adv Urol 2023; 15:17562872231215181. [PMID: 38046940 PMCID: PMC10691317 DOI: 10.1177/17562872231215181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Accepted: 11/01/2023] [Indexed: 12/05/2023] Open
Abstract
Objectives Our aim was to evaluate trends and regional differences in the use of indwelling and intermittent urinary catheters in the community setting in the Netherlands from 2012 to 2021. Design and methods For this population-based cohort study, data on catheter use was collected from the Drug and Medical Devices Information System of the National Healthcare Institute of the Netherlands. This database contains information on the Dutch insured population, which was 100% of the total population in 2018. Users were divided into 12 provinces according to the Nomenclature of Territorial Units for Statistics codes. The number of catheter users was adjusted for the total population of the provinces by sex and age, and was expressed by users per 100,000 people. Negative binomial regression (NBR) was used to test for differences in clean intermittent catheter (CIC) and indwelling catheter (IDC) users across Dutch provinces. Results Between 2012 and 2021, IDC users increased by 44.6% from 41,619 to 60,172, and CIC users increased by 27.3% from 34,204 to 43,528. The greatest increases were mainly observed among IDC users over 85 years old and male CIC users over 65 years old. NBR showed significant differences for IDC and CIC users between the 12 provinces. CIC incidence was higher in Drenthe and Groningen (Northern Netherlands) compared to Zuid-Holland (Southern Netherlands). IDC incidence was higher in seven provinces dispersed throughout the Netherlands compared to Noord-Holland. Conclusion CIC and IDC users have continued to increase in recent years; this was especially observed among older men. In addition, there were regional differences in the number of CIC and IDC users; CIC was more prominent in the northern region of the Netherlands, and IDC varied between multiple provinces. Practice variation in urinary catheterization may result from patient population differences or healthcare provider preferences and their alignment with guidelines.
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Affiliation(s)
- Felice E. E. van Veen
- Department of Urology, Erasmus Medical Center, Room Na-1524, Dr. Molewaterplein 40, Rotterdam 3013 GD, The Netherlands
| | - Jeroen R. Scheepe
- Department of Urology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Bertil F. M. Blok
- Department of Urology, Erasmus Medical Center, Rotterdam, The Netherlands
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Hao F, Jia F, Hao P, Duan H, Wang Z, Fan Y, Zhao W, Gao Y, Fan OR, Xu F, Yang Z, Sun YE, Li X. Proper wiring of newborn neurons to control bladder function after complete spinal cord injury. Biomaterials 2023; 292:121919. [PMID: 36455486 DOI: 10.1016/j.biomaterials.2022.121919] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Revised: 10/14/2022] [Accepted: 11/18/2022] [Indexed: 11/26/2022]
Abstract
Activation of endogenous neurogenesis by bioactive materials enables restoration of sensory/motor function after complete spinal cord injury (SCI) via formation of new relay neural circuits. The underlying wiring logic of newborn neurons in adult central nervous system (CNS) is unknown. Here, we report neurotrophin3-loaded chitosan biomaterial substantially recovered bladder function after SCI. Multiple neuro-circuitry tracing technologies using pseudorabies virus (PRV), rabies virus (RV), and anterograde adeno-associated virus (AAV), demonstrated that newborn neurons were integrated into the micturition neural circuits and reconnected higher brain centers and lower spinal cord centers to control voiding, and participated in the restoration of the lower urinary tract function, even in the absence of long-distance axonal regeneration. Opto- and chemo-genetic studies further supported the notion that the supraspinal control of the lower urinary tract function was partially recovered. Our data demonstrated that regenerated relay neurons could be properly integrated into disrupted long-range neural circuits to restore function of adult CNS.
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Affiliation(s)
- Fei Hao
- Beijing Key Laboratory for Biomaterials and Neural Regeneration, School of Engineering Medicine, Beihang University, Beijing, 100191, China
| | - Fan Jia
- Guangdong Provincial Key Laboratory of Brain Connectome and Behavior, CAS Key Laboratory of Brain Connectome and Manipulation, The Brain Cognition and Brain Disease Institute (BCBDI), Translational Research Center for the Nervous System (TRCNS), Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences; Shenzhen-Hong Kong Institute of Brain Science-Shenzhen Fundamental Research Institutions, Shenzhen, 518055, China; University of Chinese Academy of Sciences, Beijing, 100049, China
| | - Peng Hao
- Department of Neurobiology, School of Basic Medical Sciences, Capital Medical University, Beijing, 100069, China
| | - Hongmei Duan
- Department of Neurobiology, School of Basic Medical Sciences, Capital Medical University, Beijing, 100069, China
| | - Zijue Wang
- Department of Neurobiology, School of Basic Medical Sciences, Capital Medical University, Beijing, 100069, China
| | - Yubo Fan
- Key Laboratory for Biomechanics and Mechanobiology of the Ministry of Education, Beijing Advanced Innovation Centre for Biomedical Engineering, School of Biological Science and Medical Engineering, Beihang University, Beijing, 100191, China; School of Engineering Medicine, Beihang University, Beijing, 100191, China
| | - Wen Zhao
- Department of Neurobiology, School of Basic Medical Sciences, Capital Medical University, Beijing, 100069, China
| | - Yudan Gao
- Department of Neurobiology, School of Basic Medical Sciences, Capital Medical University, Beijing, 100069, China
| | - Orion R Fan
- Department of Evolution and Ecology, University of California, Davis, CA, 90007, USA
| | - Fuqiang Xu
- Guangdong Provincial Key Laboratory of Brain Connectome and Behavior, CAS Key Laboratory of Brain Connectome and Manipulation, The Brain Cognition and Brain Disease Institute (BCBDI), Translational Research Center for the Nervous System (TRCNS), Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences; Shenzhen-Hong Kong Institute of Brain Science-Shenzhen Fundamental Research Institutions, Shenzhen, 518055, China; University of Chinese Academy of Sciences, Beijing, 100049, China; State Key Laboratory of Magnetic Resonance and Atomic and Molecular Physics, Key Laboratory of Magnetic Resonance in Biological Systems, Wuhan Center for Magnetic Resonance, Innovation Academy for Precision Measurement Science and Technology, Chinese Academy of Sciences, Wuhan, 430071, China.
| | - Zhaoyang Yang
- Department of Neurobiology, School of Basic Medical Sciences, Capital Medical University, Beijing, 100069, China.
| | - Yi E Sun
- Key Laboratory of Spine and Spinal Cord Injury Repair and Regeneration (Tongji University), Ministry of Education, Shanghai, 200065, China; Shanghai Institute of Stem Cell Research and Clinical Translation, Shanghai East Hospital, Tongji University, School of Medicine, Shanghai, 200120, China.
| | - Xiaoguang Li
- Beijing Key Laboratory for Biomaterials and Neural Regeneration, School of Engineering Medicine, Beihang University, Beijing, 100191, China; Department of Neurobiology, School of Basic Medical Sciences, Capital Medical University, Beijing, 100069, China.
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