[Management of neurogenic bladder patients in France: a survey carried out by the French-speaking neurourology study group (GENULF)]

Adherence to long-term medical follow-up: A qualitative, experience-focused study of people with spinal cord injury

BACKGROUND

Scientific evidence indicates the presence of secondary conditions (such as pressure injuries) after spinal cord injury (SCI). Treatment methods focusing on the management of paraplegia and tetraplegia include systematic preventive follow-up. These advances have significantly improved the functional and vital prognosis of people with SCI, but some people may not have access to these specialized organizations or may not adhere closely to this medicalized vision. We used a narrative approach to explore the perceptions of people with SCI to better understand their adherence to follow-up.

OBJECTIVES

We aimed to determine the "common denominators" that lead to adherence or non-adherence to long-term follow-up after SCI.

METHODS

People with SCI who had completed their first rehabilitation period for > 1 year were included with regard to 2 variables: 1) an actual medical follow-up or not and 2) a history of pressure injury or not. A review of the literature was used as preparation for semi-directive interviews, which were prospectively analysed by using qualitative analysis software. Thematic saturation was reached at 28 interviews, and 32 interviews were ultimately completed.

RESULT

Three main areas concerning participants' perceptions emerged: people's readiness, appropriation and modulation of the systematic follow-up. We developed a broad conceptual framework representing follow-up and the promotion of the long-term health of people with SCI from their perspectives.

CONCLUSIONS

The medical environment should ensure that people with SCI are ready to actively consider the implementation of prevention strategies and should take into account their ability to establish their own truth, to integrate various life stages after SCI and to negotiate systematic follow-up. The implementation of data about functioning should be conducted using the concept of the Learning Health System.

Evaluation and management of neurogenic bladder after spinal cord injury: Current practice among physical medicine and rehabilitation specialists in Turkey

Objectives

This study aims to determine the current trends in evaluation and management of neurogenic bladder secondary to spinal cord injury (SCI) among Physical Medicine and Rehabilitation (PMR) specialists in Turkey.

Materials and methods

Between September 2013 and November 2013, a total of 100 PMR specialists from 18 different provinces of Turkey were included in the study. A 23-item questionnaire was developed to evaluate the current practice on assessment and follow-up of upper and lower urinary tract dysfunction. The questionnaire was delivered via e-mail to the participants routinely providing care for patients with SCI and all responses were obtained electronically.

Results

For surveillance of the upper urinary tract dysfunction, 93% of the participants preferred ultrasonography. A total of 59% of the participants favored an annual assessment and 36% preferred six-month intervals. Multichannel urodynamics, voiding cystourethrography combined with urodynamics, and video-urodynamics were preferred by 62%, 25%, and 10% of the participants, respectively for surveillance of the lower urinary tract. Urodynamic evaluation was performed annually by 51% of the participants. In patients with detrusor overactivity unresponsive to the combination of intermittent catheterization (IC) and anticholinergic agents, 66% preferred to increase the dose and 22% preferred to switch to another medication. For treatment of areflexic bladder, 78% preferred IC and 12% preferred the Credé' or Valsalva maneuvers. Treatment of asymptomatic bacteriuria was not favored in patients on IC and indwelling urethral catheter by 33% and 44% of the participants respectively. Totally, 84% participants preferred to administer antibiotics for 10 to 14 days for the treatment of symptomatic urinary tract infection.

Conclusion

Our study results indicate that there are some differences in the current practice of PMR specialists for surveillance and management of SCI patients with neurogenic bladder. These results also emphasize the need for development of guidelines and implementation of continuous medical education activities in this field.

[Antibioprophylaxy and urological management of women with spinal cord injury during pregnancy]

OBJECTIVE

More and more women with spinal cord injury (SCI) can have a pregnancy. Few data have been published on these pregnancies and their urological impact. We report a series of these cases illustrating the urological experience of specialized centers.

METHODS

This is a retrospective study that identified pregnancies in women with SCI followed-up between 2000 and 2014. Data covering all urological and obstetric events during pregnancies, before and after implementation of weekly oral cyclic antibiotics (WOCA) program, were collected from medical records.

RESULTS

Fifteen women with SCI who gave birth to 20 children were included. Three of them were quadriplegics and 12 were paraplegics. All of them performed themselves intermittent catheterization: 11 by urethral way and 4 by high way because carrying a continent cystostomy. Mean follow-up period before pregnancy was 14.6 years [3-27 years IC 95%] and the mean follow-up for the study was 8.5 months [6.5-9 IC 95%]. We observed a reduction of symptomatic urinary tract infections after WOCA onset (13/13 before vs. 0/7 after, P=0.001), a reduction of recurrent urinary infections (6/13 vs. 0/7, P=0.03), a reduction of threats to premature births (8/13 vs. 0/7, P=0.001). Multi-resistant bacteria appeared to increase (0/13 vs. 3/7, P=0.01). We also observed a trend to significant reduction of premature births number (4/13 vs. 0/13, P=0.1) and that of low birth weight (3/13 versus 0/7, P=0.1). The overall neonatal survival rate was 100%.

CONCLUSION

Our study before/after introduction of a weekly oral cycle antibiotic prophylaxis during pregnancy for women with spinal cord injury showed a significant reduction in symptomatic urinary tract infections and a tendency to improve pregnancy outcomes.

LEVEL OF EVIDENCE

4.

[Lower urinary tract dysfunctions in parkinsonian syndromes: a review by the Neuro-Urology Comittee of the French Association of Urology]

INTRODUCTION

Lower urinary tract disorders (LUTD) are common in Parkinson's disease (PD) and other parkinsonian syndromes (PS). They are responsible for a significant morbidity and mortality and impair patients' quality of life. The therapeutic management of these LUTD requires to know how to distinguish the PD from other PS and their epidemiology and pathophysiology.

OBJECTIVE

To provide a diagnostic and therapeutic management of LUTD in patients with PS.

METHOD

A review of litterature using PubMed library was performed using the following keywords: Parkinson's disease, multiple system atrophy, lower urinary tract disorders, neurogenic bladder, overactive bladder, obstruction, anticholinergics, dopamine, prostate surgery.

RESULTS

Sometimes revealing the neurological disease, LUTD in PS raise a diagnostic problem because they occur at an age when various urogynecological disorders can be intricated with neurogenic bladder dysfunction. The differential diagnosis between PD and multiple system atrophy is important to know by the urologist. The distinction is based on the semiological analysis, the clinical response to dopaminergic therapy and the clinical outcome but also on data from urodynamic explorations. The therapeutic management of these LUTD cannot be easy due to the difficulty of use of some pharmacological treatments and the risk of deterioration after inappropriate surgery. The different treatments include the careful use of anticholinergics, posterior tibial nerve stimulation, deep thalamic stimulation and low-dose intradetrusor injections of botulinum toxin without approval. The decision to perform prostate surgery will be taken with caution after proving the bladder obstruction.

CONCLUSION

When analysing LUTD in PS, the urologist must know to question the initial diagnosis of PD. Treatments in order to reduce morbidity and mortality of these LUTD and to improve the quality of life of patients suffering from these degenerative diseases, will be proposed after multidisciplinary neuro-urologic concertation. The decision to perform prostate surgery must be taken with caution after proving sub-vesical obstruction.