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Kammuang-Lue P, Pattanakuhar S, Sermsuk M, Angkurawaranon C. Duration of detrusor overactivity as an independent predictive factor of upper urinary tract deterioration in patients with traumatic spinal cord injury: results of a retrospective cohort study. Spinal Cord 2024; 62:328-335. [PMID: 38575739 DOI: 10.1038/s41393-024-00988-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Revised: 03/26/2024] [Accepted: 03/27/2024] [Indexed: 04/06/2024]
Abstract
OBJECTIVE To determine whether duration of detrusor overactivity (DO) during a cystometric study is an independent predictive factor of upper urinary tract deterioration (UUTD) in patients with traumatic spinal cord injury (TSCI). STUDY DESIGN Retrospective cohort study. SETTING A rehabilitation facility in Chiang Mai, Thailand. METHODS Data were obtained from medical records of patients who underwent cystometric evaluation at 6-12 months after TSCI. The independent predictor of interest is the duration of DO, which was evaluated by the DO/cystometry ratio (DOratio). Other conventional urodynamic parameters (maximum detrusor pressure, cystometric capacity, bladder compliance, and detrusor-sphincter dyssynergia) and clinical parameters (age, sex, level and severity of injury, comorbidities, bladder emptying method, and history of urinary tract infection) were determined. The outcome was UUTD, which is indicated by chronic kidney disease (GFR < 60 ml/min/1.73 m2), hydronephrosis, and/or vesicoureteral reflux. Multivariable Cox regression analysis was used to determine the independent associations between DOratio and UUTD by adjusting with all other parameters. RESULTS Medical records of 194 patients with TSCI were included in the study. During a combined total of 1260 follow-up years of those patients, 34 UUTD events were identified, indicating an incidence rate of 27.0 cases per 1000 person-years. After adjusting for all other parameters, a high DOratio (≥0.33) was significantly associated with UUTD (hazard ratio = 3.00 [95% CI: 1.12-7.99], p = 0.025). CONCLUSION DOratio may be an independent cystometric predictor of UUTD in patients with TSCI. However, further prospective study is needed prior to applying DOratio as a predictor of UUTD in clinical settings. CLINICAL TRIAL REGISTRATION There was no clinical trial registration since this study is not a clinical trial.
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Affiliation(s)
- Pratchayapon Kammuang-Lue
- Department of Rehabilitation Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Sintip Pattanakuhar
- Department of Rehabilitation Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand.
- Health Services and Clinical Care Unit, Swiss Paraplegic Research, Nottwil, Switzerland.
| | - Maysa Sermsuk
- Department of Rehabilitation Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Chaisiri Angkurawaranon
- Department of Family Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
- Global Health and Chronic Conditions Research Group, Chiang Mai University, Chiang Mai, Thailand
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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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Geretto P, Lombardo R, Albisinni S, Turchi B, Campi R, DE Cillis S, Vacca L, Pelizzari L, Gallo ML, Sampogna G, Giammo A, Li Marzi V, DE Nunzio C. Quality of information and appropriateness of ChatGPT outputs for neuro-urology. Minerva Urol Nephrol 2024; 76:138-140. [PMID: 38742548 DOI: 10.23736/s2724-6051.24.05807-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/16/2024]
Affiliation(s)
- Paolo Geretto
- Unit of Neuro-Urology, Città della Salute e della Scienza University Hospital, University of Turin, Turin, Italy -
| | - Riccardo Lombardo
- Unit of Urology, Sant'Andrea Hospital, Sapienza University, Rome, Italy
| | - Simone Albisinni
- Unit of Urology, Department of Surgical Sciences, Tor Vergata University Hospital, Tor Vergata University of Rome, Rome, Italy
| | - Beatrice Turchi
- Unit of Urology, Sant'Andrea Hospital, Sapienza University, Rome, Italy
| | - Riccardo Campi
- Department of Minimally Invasive and Robotic Urologic Surgery, Careggi University Hospital, University of Florence, Florence, Italy
| | - Sabrina DE Cillis
- Division of Urology, Department of Oncology, San Luigi Gonzaga Hospital, University of Turin, Orbassano, Turin, Italy
| | - Lorenzo Vacca
- Unit of Precision Gynecological Surgery, Dipartimento Centro di Eccellenza Donna e Bambino Nascente, Fatebenefratelli Gemelli Isola Tiberina, Rome, Italy
| | - Laura Pelizzari
- Department of Rehabilitative Medicine, AUSL Piacenza, Fiorenzuola d'Arda, Piacenza, Italy
| | - Maria L Gallo
- Department of Minimally Invasive and Robotic Urologic Surgery, Careggi University Hospital, University of Florence, Florence, Italy
| | - Gianluca Sampogna
- Unit of Urology, Niguarda Hospital, University of Milan, Milan, Italy
| | - Alessandro Giammo
- Unit of Neuro-Urology, Città della Salute e della Scienza University Hospital, University of Turin, Turin, Italy
| | - Vincenzo Li Marzi
- Department of Minimally Invasive and Robotic Urologic Surgery, Careggi University Hospital, University of Florence, Florence, Italy
| | - Cosimo DE Nunzio
- Unit of Urology, Sant'Andrea Hospital, Sapienza University, Rome, Italy
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Singh GK, Deshpande AV, Schlegel G, Starkey MR, Taghavi K. The rationale for bladder washouts in children with neurogenic bladder. Neurourol Urodyn 2024; 43:1019-1024. [PMID: 38516982 DOI: 10.1002/nau.25450] [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: 01/22/2024] [Accepted: 03/11/2024] [Indexed: 03/23/2024]
Abstract
Children with a neurogenic bladder are at risk of developing recurrent urinary tract infections and long-term kidney failure. Due to an altered lower urinary tract, children may be overtreated for simple bacteriuria or undertreated for a potentially severe urinary tract infection. This group of patients represent high users of healthcare, and are at risk of colonization and development of antibiotic resistance. Bladder washouts with non-antibiotic electrochemically activated solutions are a potential new prophylactic option for patients with bladder dysfunction when clean intermittent catheterization has resulted in chronic bacteriuria.
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Affiliation(s)
- Gopal-Krsna Singh
- Department of Paediatrics, School of Clinical Sciences at Monash Health, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
| | - Aniruddh V Deshpande
- Department of Urology, Children's Hospital at Westmead, Westmead, New South Wales, Australia
- Center for Kidney Research, Children's Hospital at Westmead, Westmead, New South Wales, Australia
- School of Public Health, Westmead, New South Wales, Australia
- Bladder and Kidney Health Discovery Program, Department of Immunology, School of Translational Medicine, Monash University, Melbourne, Victoria, Australia
| | - Gemma Schlegel
- Bladder and Kidney Health Discovery Program, Department of Immunology, School of Translational Medicine, Monash University, Melbourne, Victoria, Australia
| | - Malcolm Ronald Starkey
- Bladder and Kidney Health Discovery Program, Department of Immunology, School of Translational Medicine, Monash University, Melbourne, Victoria, Australia
| | - Kiarash Taghavi
- Department of Paediatrics, School of Clinical Sciences at Monash Health, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
- Department of Paediatric Urology, Monash Children's Hospital, Monash Health, Melbourne, Victoria, Australia
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Gubbiotti M, Balzarro M, Zoccante L, Di Gennaro G, Marchiafava M, Bedetti C, Rubilotta E. National Survey on bladder and bowel dysfunctions in Autism Spectrum Disorder population. Front Psychiatry 2024; 15:1140113. [PMID: 38528973 PMCID: PMC10961907 DOI: 10.3389/fpsyt.2024.1140113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2023] [Accepted: 02/06/2024] [Indexed: 03/27/2024] Open
Abstract
Introduction To evaluate lower urinary tract symptoms (LUTS) and bowel disorders in a population of young subjects with autism spectrum disorder (ADS) by a national survey and to assess the relationship between the occurrence, frequency, and type of LUTS and the severity of behavioral and neuropsychiatric characteristics. Materials and methods A survey on LUTS and bowel disorders in the ASD population was sent by mail and social media through the main Italian Associations of ASD between February and September 2022. The correlation between LUTS and ASD severity was also assessed. Results The survey was completed by 502 subjects with a mean age of 16.6 years ± 10 years: male participants were 413 (mean age: 16.5 years ± 9.8 years), while female participants 89 (mean age: 17.2 years ± 10.9 years). ADS severity was found low in 29.9%, moderate in 27.1%, and severe in 43%. LUTS were reported by 77.1%, storage symptoms in 51.4%, and voiding symptoms in 60.6%. Urinary incontinence was reported by 12.5%. Enuresis was reported by 14.3% (72/502) of the respondents: primary enuresis in 70.8% (51/72), secondary in the remaining. Pads were used by 40 subjects with a median of 2.9 pads/day (range, 0-8). A toilet training program was performed by 61 of the respondents, with satisfactory results in 40/61 (65.6%). A significant correlation was found between greater ASD severity and higher LUTS rates. The mean VAS score on the impact of LUTS on family relationships was 2 ± 2.9. Regular bowel function was reported by 57.4% (288/502) of the respondents, while increased daily defecations were present in 11.2% (56/502), constipation in 31.5% (158/502), and fecal incontinence in 7.9% (40/502). Conclusion This survey demonstrated that LUTS are very common in the young ASD population and that the prevalence of urinary symptoms is related to higher severity of the ASD condition. Bowel disorders are often associated with urinary symptoms and dysfunctions. Urologists should be aware of the frequent occurrence of urological disorders and symptoms in individuals with ASD and should be involved in their clinical management in a multidisciplinary team that cares for these people.
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Affiliation(s)
| | - Matteo Balzarro
- Department of Urology, A.O.U.I. Verona University, Verona, Italy
| | - Leonardo Zoccante
- Department of Child Neuropsychiatry, A.O.U.I. Verona University, Verona, Italy
| | - Gianfranco Di Gennaro
- Department of Health Sciences, “Magna Graecia” University of Catanzaro, Catanzaro, Italy
| | - Moreno Marchiafava
- Department of Mental Health and Pathological Addictions, ASL Roma 5, Roma, Italy
| | - Chiara Bedetti
- Stroke Unite/Neurology, Città di Castello Hospital, Perugia, Italy
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Ramallo‐Fariña Y, Chávarri AT, Robayna AA, Vidal MM, Valcárcel‐Nazco C, Armas Moreno C, Perestelo‐Pérez L, Serrano Muñoz M, Luque González M, García‐Pérez L, García‐Bello MÁ, Serrano‐Aguilar P, Castellano Santana PR, Vera Álamo L. Effectiveness of the T-Control catheter: A study protocol. BJUI COMPASS 2024; 5:178-188. [PMID: 38371205 PMCID: PMC10869656 DOI: 10.1002/bco2.285] [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: 05/23/2023] [Revised: 08/04/2023] [Accepted: 08/04/2023] [Indexed: 02/20/2024] Open
Abstract
Background Foley catheters have been subject to limited development in the last few decades. They fulfil their basic function of draining urine from the bladder but cause other associated problems. T-Control is a new silicone Foley catheter with an integrated fluid control valve whose design aims to reduce the risks associated with bladder catheterisation by a multifactorial approach. The general purpose of this study is to evaluate the effectiveness and cost-effectiveness of the T-Control catheter versus the Foley-type catheter in patients with Acute Urine Retention (AUR). Study design This is a pragmatic, open, multicentre, controlled clinical trial with random allocation to the T-Control catheter or a conventional Foley-type catheter in patients with AUR. Endpoints The magnitude of infections will be analysed as a primary endpoint. While as secondary endpoint, the following will be analysed: rate of symptomatic and asymptomatic infections; days free of infection; quality of life-related to self-perceived health; indication of associated antibiotic treatments; determination of biofilm; number of catheter-related adverse events; use of each type of catheterisation's healthcare resources; level of satisfaction and workload of health professionals and acceptability of the T-Control device as well as the patient experience. Patients and methods Eligible patients are male adults aged ≥50 years, with AUR and with an indication of bladder catheterisation for at least 2 weeks. The estimated sample size is 50 patients. Patient follow-up includes both the time of catheter insertion and its removal or change 2 weeks later, plus 2 weeks after this time when the patient will be called for an in-depth interview.
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Affiliation(s)
- Yolanda Ramallo‐Fariña
- Evaluation Unit (SESCS), Canary Island Health ServiceCanary Islands Health Research Institute Foundation (FIISC)TenerifeSpain
- Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS)TenerifeSpain
| | - Ana Toledo Chávarri
- Evaluation Unit (SESCS), Canary Island Health ServiceCanary Islands Health Research Institute Foundation (FIISC)TenerifeSpain
- Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS)TenerifeSpain
| | - Adrián Amador Robayna
- Department of UrologyUniversity Hospital of Nuestra Señora de CandelariaTenerifeSpain
| | | | - Cristina Valcárcel‐Nazco
- Evaluation Unit (SESCS), Canary Island Health ServiceCanary Islands Health Research Institute Foundation (FIISC)TenerifeSpain
- Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS)TenerifeSpain
| | | | - Lilisbeth Perestelo‐Pérez
- Evaluation Unit (SESCS), Canary Island Health ServiceCanary Islands Health Research Institute Foundation (FIISC)TenerifeSpain
- Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS)TenerifeSpain
| | | | | | - Lidia García‐Pérez
- Evaluation Unit (SESCS), Canary Island Health ServiceCanary Islands Health Research Institute Foundation (FIISC)TenerifeSpain
- Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS)TenerifeSpain
| | - Miguel Ángel García‐Bello
- Evaluation Unit (SESCS), Canary Island Health ServiceCanary Islands Health Research Institute Foundation (FIISC)TenerifeSpain
- Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS)TenerifeSpain
- University of La Laguna (ULL)TenerifeSpain
| | - Pedro Serrano‐Aguilar
- Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS)TenerifeSpain
| | | | - Laura Vera Álamo
- Department of UrologyInsular University Hospital of Gran CanariaGran CanariaSpain
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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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Leboutte F, Engesser C, Zahiti L, Rentsch CA, Seifert H, Anding R, Hund-Georgiadis M, Möhr S, Walter M. Prevalence of Unfavorable Video-Urodynamic Findings and Clinical Implications in Patients with Minimally Conscious State/Unresponsive Wakefulness Syndrome: A Retrospective Descriptive Analysis. Biomedicines 2023; 11:2432. [PMID: 37760873 PMCID: PMC10525630 DOI: 10.3390/biomedicines11092432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Revised: 08/25/2023] [Accepted: 08/28/2023] [Indexed: 09/29/2023] Open
Abstract
The aim of this retrospective exploratory study was to investigate the prevalence of unfavorable findings during video-urodynamic studies (VUDS) in patients with minimally conscious state (MCS)/unresponsive wakefulness syndrome (UWS) and whether management of the lower urinary tract (LUT) was adjusted accordingly. A retrospective chart review was conducted to screen for patients diagnosed with MCS/UWS at our rehabilitation center between 2011 and 2020. Patients 18 years or older were included and underwent baseline VUDS after being diagnosed with MCS/UWS. We analyzed urodynamic parameters and subsequent changes in LUT management in this cohort. In total, 32 patients (7 females, 25 males, median age 37 years) with MCS/UWS were included for analysis. While at least one unfavorable VUDS finding (i.e., neurogenic detrusor overactivity [NDO], detrusor sphincter dyssynergia {DSD, high maximum detrusor pressure during storage phase [>40 cmH2O], low-compliance bladder [<20 mL/cmH2O], and vesico-uretero-renal reflux [VUR]) was found in each patient, NDO (78.1%, 25/32) and DSD (68.8%, 22/32) were the two most frequent unfavorable VUDS findings. Following baseline VUDS, new LUT treatment options were established in 56.3% (18/32) of all patients. In addition, bladder-emptying methods were changed in 46.9% (15/32) of all patients, resulting in fewer patients relying on indwelling catheters. Our retrospective exploratory study revealed a high prevalence of NDO and DSD in patients with MCS/UWS, illustrating the importance of VUDS to adapt LUT management in this cohort accordingly.
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Affiliation(s)
- Francois Leboutte
- Department of Urology, University Hospital Basel, University of Basel, 4031 Basel, Switzerland; (F.L.); (C.E.); (L.Z.); (C.A.R.); (H.S.)
| | - Christian Engesser
- Department of Urology, University Hospital Basel, University of Basel, 4031 Basel, Switzerland; (F.L.); (C.E.); (L.Z.); (C.A.R.); (H.S.)
| | - Leutrim Zahiti
- Department of Urology, University Hospital Basel, University of Basel, 4031 Basel, Switzerland; (F.L.); (C.E.); (L.Z.); (C.A.R.); (H.S.)
| | - Cyrill A. Rentsch
- Department of Urology, University Hospital Basel, University of Basel, 4031 Basel, Switzerland; (F.L.); (C.E.); (L.Z.); (C.A.R.); (H.S.)
| | - Helge Seifert
- Department of Urology, University Hospital Basel, University of Basel, 4031 Basel, Switzerland; (F.L.); (C.E.); (L.Z.); (C.A.R.); (H.S.)
| | - Ralf Anding
- Department of Urology, University Hospital Basel, University of Basel, 4031 Basel, Switzerland; (F.L.); (C.E.); (L.Z.); (C.A.R.); (H.S.)
| | | | - Sandra Möhr
- Neuro-Urology, REHAB Basel, 4055 Basel, Switzerland
| | - Matthias Walter
- Department of Urology, University Hospital Basel, University of Basel, 4031 Basel, Switzerland; (F.L.); (C.E.); (L.Z.); (C.A.R.); (H.S.)
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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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Jia Y, Gao J. Spontaneous perirenal hemorrhage (Wunderlich syndrome) in the fetus: a case report. J Med Case Rep 2023; 17:204. [PMID: 37147736 PMCID: PMC10163762 DOI: 10.1186/s13256-023-03867-4] [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: 12/19/2022] [Accepted: 02/28/2023] [Indexed: 05/07/2023] Open
Abstract
BACKGROUND Spontaneous perirenal hemorrhage (Wunderlich syndrome) in the fetus is a rare urinary system disease. Prenatal ultrasound diagnosis presents challenges due to the lack of specific clinical features. CASE PRESENTATION A 27-year-old Chinese woman gravida 2 para 0 found her fetus with the left Wunderlich syndrome accompanying bilateral hydronephroses and bladder dysfunction with an early diagnosis through prenatal ultrasound and postnatal magnetic resonance imaging. After a timely emergency cesarean section, the infant was administrated antimicrobial prophylaxis and an indwelling catheter treatment. Ultrasound follow-up showed his urinary system gradually developed normally. CONCLUSION A fetus with bilateral hydronephroses accompanying bladder dysfunction should be observed because of the risk of spontaneous renal rupture with hemorrhage formation. Ultrasound and magnetic resonance imaging play a vital role in the diagnosis and follow-up of Wunderlich syndrome. Early diagnosis facilitates better pregnancy planning and appropriate care of newborns.
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Affiliation(s)
- Yongmei Jia
- Xiangyang Central Hospital, Hubei University of Arts and Science, Xiangyang, 441021, China
| | - Junxia Gao
- Xiangyang Central Hospital, Hubei University of Arts and Science, Xiangyang, 441021, China.
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11
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Wu SY, Jhang JF, Liu HH, Chen JT, Li JR, Chiu B, Chen SL, Kuo HC. Long-Term Surveillance and Management of Urological Complications in Chronic Spinal Cord-Injured Patients. J Clin Med 2022; 11:7307. [PMID: 36555924 PMCID: PMC9785560 DOI: 10.3390/jcm11247307] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2022] [Revised: 12/02/2022] [Accepted: 12/07/2022] [Indexed: 12/13/2022] Open
Abstract
Bladder dysfunction is a common complication after chronic spinal cord injury (SCI). Patients may experience renal function loss, urinary tract infection (UTI), urolithiasis, bladder cancer, and even life-threatening events such as severe sepsis or renal failure. Suitable patient care may prevent UTI and urinary incontinence, decrease medication use, and preserve renal function. As the primary goal is to preserve renal function, management should be focused on facilitating bladder drainage, the avoidance of UTI, and the maintenance of a low intravesical pressure for continence and complete bladder emptying. Currently, several bladder management options are available to SCI patients: (1) reflex voiding; (2) clean intermittent catheterization; (3) indwelling catheterization. The target organ may be the bladder or the bladder outlet. The purposes of intervention include the following: (1) increasing bladder capacity and/or decreasing intravesical pressure; (2) increasing bladder outlet resistance; (3) decreasing bladder outlet resistance; (4) producing detrusor contractility; (5) urinary diversion. Different bladder management methods and interventions may have different results depending on the patient's lower urinary tract dysfunction. This review aims to report the current management options for long-term bladder dysfunction in chronic SCI patients. Furthermore, we summarize the most suitable care plans for improving the clinical outcome of SCI patients.
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Affiliation(s)
- Shu-Yu Wu
- Department of Urology, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei City 23142, Taiwan
- Department of Urology, School of Medicine, Tzu Chi University, Hualien 97004, Taiwan
| | - Jia-Fong Jhang
- Department of Urology, School of Medicine, Tzu Chi University, Hualien 97004, Taiwan
- Department of Urology, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien 97002, Taiwan
| | - Hsin-Ho Liu
- Department of Urology, Taichung Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Taichung 42743, Taiwan
| | - Jian-Ting Chen
- Division of Urology, Department of Surgery, Yuanlin Christian Hospital, Changhua 51053, Taiwan
| | - Jian-Ri Li
- Department of Urology, Taichung Veterans General Hospital, Taichung 40705, Taiwan
| | - Bin Chiu
- Department of Urology, Far Eastern Memorial Hospital, New Taipei City 22000, Taiwan
| | - Sung-Lang Chen
- Department of Urology, Chung Shan Medical University Hospital, Taichung 40201, Taiwan
- Department of Urology, School of Medicine, Chung Shan Medical University, Taichung 40201, Taiwan
| | - Hann-Chorng Kuo
- Department of Urology, School of Medicine, Tzu Chi University, Hualien 97004, Taiwan
- Department of Urology, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien 97002, Taiwan
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12
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Sadeghmousavi S, Soltani Khaboushan A, Jafarnezhad-Ansariha F, Nejad-Gashti R, Farsi M, Esmaeil-Pour R, Alijani M, Majidi Zolbin M, Niknejad H, Kajbafzadeh AM. The role of spinal cord tractography in detecting lesions following selective bladder afferent and efferent fibers: A novel method for induction of neurogenic lower urinary tract dysfunction in rabbit. Neurourol Urodyn 2022; 41:1539-1552. [PMID: 35842827 DOI: 10.1002/nau.25009] [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: 03/21/2022] [Revised: 06/07/2022] [Accepted: 06/19/2022] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Neurogenic lower urinary tract dysfunction (NLUTD), a challenging disorder, is defined by lack of bladder control due to the abnormalities in neural pathways and can be classified based on the location of lesions within the nervous system, thus investigating the neural pathways can help us to know the site of the lesion and specify the class of the NLUTD. Diffusion Tensor Imaging (DTI) tractography, a noninvasive advanced imaging method, is capable of detecting central nervous system pathologies, even if routine magnetic resonance imaging shows no abnormality. Accordingly, tractography is an ideal technique to evaluate patients with NLUTD and visualize the pathology site within the spine. This study aimed to introduce a novel method of spinal cord injury (SCI) to establish NLUTD in the rabbit and to investigate the potential of tractography in tracing neural tracts of the spinal cord in an induced NLUTD animal model. MATERIALS AND METHODS An animal model of NLUTD was induced through cauterization of the spinal cord at the level T12-L1 in 12 rabbits. Then rabbits were assessed via DTI, urodynamic studies (UDS), voiding cystourethrogram (VCUG), and pathology assessments using antineurofilament 200 (NF200) antibody, anti-S100, anti-Smooth Muscle Actin, anti-Myogenin, and anti-MyoD1. RESULTS The tractography visualized lesions within spinal cord fibers. DTI parameters including fractional anisotropy (FA) value and tract density were significantly decreased (FA: p-value = 0.01, Tract density: p-value = 0.05) after injury. The mean diffusivity (MD) was insignificantly increased compared to before the injury. Also, the results of UDS and pathology assessments corroborated that applying SCI and the establishment of the NLUTD model was completely successful. CONCLUSION In the present study, we investigated the auxiliary role of tractography in detecting the spinal cord lesions in the novel established rabbit model of NLUTD. The introduced method of NLUTD induction was without the leg's neurological deficit, easily applicable, low-cost, and was accompanied by minimal surgical preparation and a satisfactory survival rate in comparison with other SCI animal models.
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Affiliation(s)
- Shaghayegh Sadeghmousavi
- Pediatric Urology and Regenerative Medicine Research Center, Section of Tissue Engineering and Stem Cells Therapy, Children's Hospital Medical Center, Pediatrics' Center of Excellence, Tehran University of Medical Sciences, Tehran, Iran.,School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Alireza Soltani Khaboushan
- Pediatric Urology and Regenerative Medicine Research Center, Section of Tissue Engineering and Stem Cells Therapy, Children's Hospital Medical Center, Pediatrics' Center of Excellence, Tehran University of Medical Sciences, Tehran, Iran.,Students' Scientific Research Center, Tehran University of Medical Science, Tehran, Iran
| | - Fahimeh Jafarnezhad-Ansariha
- Pediatric Urology and Regenerative Medicine Research Center, Section of Tissue Engineering and Stem Cells Therapy, Children's Hospital Medical Center, Pediatrics' Center of Excellence, Tehran University of Medical Sciences, Tehran, Iran
| | - Reza Nejad-Gashti
- Pediatric Urology and Regenerative Medicine Research Center, Section of Tissue Engineering and Stem Cells Therapy, Children's Hospital Medical Center, Pediatrics' Center of Excellence, Tehran University of Medical Sciences, Tehran, Iran
| | - Maryam Farsi
- Pediatric Urology and Regenerative Medicine Research Center, Section of Tissue Engineering and Stem Cells Therapy, Children's Hospital Medical Center, Pediatrics' Center of Excellence, Tehran University of Medical Sciences, Tehran, Iran
| | - Reza Esmaeil-Pour
- Pediatric Urology and Regenerative Medicine Research Center, Section of Tissue Engineering and Stem Cells Therapy, Children's Hospital Medical Center, Pediatrics' Center of Excellence, Tehran University of Medical Sciences, Tehran, Iran
| | - Maryam Alijani
- Pediatric Urology and Regenerative Medicine Research Center, Section of Tissue Engineering and Stem Cells Therapy, Children's Hospital Medical Center, Pediatrics' Center of Excellence, Tehran University of Medical Sciences, Tehran, Iran
| | - Masoumeh Majidi Zolbin
- Pediatric Urology and Regenerative Medicine Research Center, Section of Tissue Engineering and Stem Cells Therapy, Children's Hospital Medical Center, Pediatrics' Center of Excellence, Tehran University of Medical Sciences, Tehran, Iran
| | - Hassan Niknejad
- Department of Pharmacology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Abdol-Mohammad Kajbafzadeh
- Pediatric Urology and Regenerative Medicine Research Center, Section of Tissue Engineering and Stem Cells Therapy, Children's Hospital Medical Center, Pediatrics' Center of Excellence, Tehran University of Medical Sciences, Tehran, Iran.,Pediatric Urology and Regenerative Medicine Research Center, Gene, Cell and Tissue Research Institute, Childern's Medical Center, Tehran University of Medical Sciences, Tehran, Iran
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13
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Balanca A, Even A, Malot C, Chartier-Kastler E, Denys P, Joussain C. Long-term clinical and urodynamic effectiveness of augmentation ileocystoplasty with supra-trigonal cystectomy in individuals with spinal cord injury. World J Urol 2022; 40:2121-2127. [PMID: 35680652 DOI: 10.1007/s00345-022-04028-w] [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: 02/26/2022] [Accepted: 04/23/2022] [Indexed: 11/28/2022] Open
Abstract
PURPOSE This study aimed to determine the long-term effectiveness of augmentation ileocystoplasty (AI) associated with supra-trigonal cystectomy on clinical and urodynamic variables, and the safety of the intervention in individuals with spinal cord injury (SCI). MATERIALS AND METHODS Single-center, retrospective study of all patients with SCI who underwent AI with supra-trigonal cystectomy from January 1994, with a follow-up of more than 8 years. The primary outcome was the sustained long-term effectiveness of AI with supra-trigonal cystectomy on clinical and urodynamic variables. The secondary outcome was the long-term safety of this procedure. RESULTS We included 77 patients: 57% were female, mean (SD) age was 52.0 (13.0) years, 77% had paraplegia, and median time since onset was 25.0 [19; 30] years. Long-term success rate (evaluated 13 [10; 15] years post AI) was 93.5% for urodynamic parameters and 76.6% for urinary incontinence. Results of the short- and long-term post-AI assessments did not differ for any urodynamic or clinical variables. Bladder lithiasis occurred in 20.5% of cases and ≥ 1 febrile urinary tract infection occurred in 55.8%, mostly within the first 2 years of follow-up. No cases of bladder cancer were diagnosed. CONCLUSION AI associated with supra-trigonal cystectomy in patients with SCI is safe and effective in both the short term and long term. Regular urodynamic assessment is not necessary in clinically stable patients with low bladder risk; however, close monitoring is important because of the risk of urological complications.
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Affiliation(s)
- A Balanca
- Neuro-Uro-Andrology Hospital Universitaire R.Poincare, AP-HP, 104 bvd R. Poincare, 92380, Garches, France
| | - A Even
- Neuro-Uro-Andrology Hospital Universitaire R.Poincare, AP-HP, 104 bvd R. Poincare, 92380, Garches, France
| | - C Malot
- Department of Sport Medicine and Readaptation, Hôpital Foch, 92150, Suresnes, France
| | - E Chartier-Kastler
- Neuro-Uro-Andrology Hospital Universitaire R.Poincare, AP-HP, 104 bvd R. Poincare, 92380, Garches, France.,Department of Urology, APHP-Pitié-Salpétrière Hospital, Sorbonne Université, Paris, France.,Inserm U1179, UFR Des Sciences de la Santé, University of Versailles Saint-Quentin, Montigny-le-Bretonneux, France
| | - P Denys
- Neuro-Uro-Andrology Hospital Universitaire R.Poincare, AP-HP, 104 bvd R. Poincare, 92380, Garches, France.,Inserm U1179, UFR Des Sciences de la Santé, University of Versailles Saint-Quentin, Montigny-le-Bretonneux, France
| | - C Joussain
- Neuro-Uro-Andrology Hospital Universitaire R.Poincare, AP-HP, 104 bvd R. Poincare, 92380, Garches, France. .,Inserm U1179, UFR Des Sciences de la Santé, University of Versailles Saint-Quentin, Montigny-le-Bretonneux, France.
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14
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Swatesutipun V, Tangpaitoon T. The safety cutoff storage pressure for preventing upper urinary tract damage in neurogenic bladder from spinal cord pathology and risk factor analysis. Neurourol Urodyn 2022; 41:991-1001. [PMID: 35320589 DOI: 10.1002/nau.24911] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Revised: 02/25/2022] [Accepted: 02/27/2022] [Indexed: 11/12/2022]
Abstract
INTRODUCTION Low-compliance bladder or high bladder pressure undoubtedly leads to hydronephrosis and renal impairment. As four decades have elapsed since a previous study found a detrusor leak-point pressure (DLPP) >40 cm H2 O to result in hydronephrosis, we suspected the possibility of hydronephrosis or vesicoureteral reflux occurring at any point below the 40 cm H2 O DLPP reference. Therefore, this study aimed to determine the storage detrusor pressure value and risk factors related to upper urinary tract damage (UUTD). MATERIALS AND METHODS This study retrospectively reviewed the hospital records of 110 patients who visited the Neurogenic Bladder TU Service of Excellence Unit, Thammasat University Hospital, Pathum Thani, Thailand, and were diagnosed with neurogenic bladder between 2016 and 2020. The inclusion criteria were as follows: patients who were diagnosed with neurogenic bladder from spinal cord problems (spinal dysraphism, spinal cord disease [tumor, degenerative, arteriovenous malformation, etc.], or traumatic spinal cord injury) and underwent a complete examination, including urodynamic study and renal ultrasound. The exclusion criteria were as follows: patients who had previous pelvic irradiation, other concomitant neurological disease (stroke, Parkinson's disease, etc.), or other urological diseases (stone, tumor, etc.), and those who had an indwelling suprapubic or urethral catheter. We identified the cutoff point for storage pressure related to UUTD using receiver operating characteristic (ROC) curve analysis to identify the value that produced maximum sensitivity and specificity. To identify risk factors for developing UUTD, we included seven risk factors: intravesical pressure, poor compliance, detrusor overactivity (DO), detrusor sphincter dyssynergia (DSD), level of the spinal cord pathology, male sex, and spontaneous voiding in univariable and multivariable regression analyses. RESULTS Of the 110 patients who met the inclusion criteria, 22 were excluded from the study. Fifty-nine patients had a normal upper urinary tract, and 29 had UUTD. The mean age, sex, voiding pattern, type of spinal cord pathology, and level of spinal cord lesions were not different between the two groups. After performing ROC curve analysis, a cutoff value for daily storage pressure ≥15 cm H2 O provided 79.31% sensitivity and 67.80% specificity (area under the ROC curve: 0.73) for UUTD development. From univariable analysis, low compliance (cutoff values at <12.5 and <20 ml/cm H2 O) and a storage pressure ≥15 cm H2 O was related to UUTD with statistical significance (risk ratio [RR]: 3.16, 2.3, and 3.6, respectively [p < 0.05]). After performing multivariable analysis, a storage pressure ≥15 cm H2 O and both cutoff values for low compliance were related to UUTD with statistical significance (RR: 3.9, 2.4, and 3.2, respectively [p < 0.05]). However, other factors, including male sex, spontaneous voiding, suprasacral lesion, DSD, and DO, were not related to UUTD. CONCLUSION Our results demonstrated that low compliance and a storage pressure ≥15 cm H2 O were significantly associated with UUTD. Various bladder-management strategies have been developed to prevent UUTDs. However, the main concept continues to be the maintenance of a low storage pressure.
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Affiliation(s)
- Valeerat Swatesutipun
- Department of Surgery, Division of Urology, Thammasat University Hospital, Pathum Thani, Thailand
| | - Teerayut Tangpaitoon
- Department of Surgery, Division of Urology, Thammasat University Hospital, Pathum Thani, Thailand
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15
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Tuttle TG, Lujan HL, Tykocki NR, DiCarlo SE, Roccabianca S. Remodeling of extracellular matrix in the urinary bladder of paraplegic rats results in increased compliance and delayed fiber recruitment 16 weeks after spinal cord injury. Acta Biomater 2022; 141:280-289. [PMID: 35032719 PMCID: PMC8898290 DOI: 10.1016/j.actbio.2022.01.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Revised: 12/17/2021] [Accepted: 01/07/2022] [Indexed: 01/21/2023]
Abstract
The ability of the urinary bladder to maintain low intravesical pressures while storing urine is key in ensuring proper organ function and highlights the key role that tissue mechanics plays in the lower urinary tract. Loss of supraspinal neuronal connections to the bladder after spinal cord injury can lead to remodeling of the structure of the bladder wall, which may alter its mechanical characteristics. In this study, we investigate if the morphology and mechanical properties of the bladder extracellular matrix are altered in rats 16 weeks after spinal cord injury as compared to animals who underwent sham surgery. We measured and quantified the changes in bladder geometry and mechanical behavior using histological analysis, tensile testing, and constitutive modeling. Our results suggest bladder compliance is increased in paraplegic animals 16 weeks post-injury. Furthermore, constitutive modeling showed that increased distensibility was driven by an increase in collagen fiber waviness, which altered the distribution of fiber recruitment during loading. STATEMENT OF SIGNIFICANCE: The ability of the urinary bladder to store urine under low pressure is key in ensuring proper organ function. This highlights the important role that mechanics plays in the lower urinary tract. Loss of control of neurologic connection to the bladder from spinal cord injury can lead to changes of the structure of the bladder wall, resulting in altered mechanical characteristics. We found that the bladder wall's microstructure in rats 16 weeks after spinal cord injury is more compliant than in healthy animals. This is significant since it is the longest time post-injury analyzed, to date. Understanding the extreme remodeling capabilities of the bladder in pathological conditions is key to inform new possible therapies.
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Affiliation(s)
- Tyler G Tuttle
- Michigan State University, Department of Mechanical Engineering, 428 S. Shaw Lane, Rm 2555, East Lansing, MI 48824, United States
| | - Heidi L Lujan
- Michigan State University, Department of Physiology, 567 Wilson Rd., Rm 2201, East Lansing, MI 48824, United States
| | - Nathan R Tykocki
- Michigan State University, Department of Pharmacology and Toxicology, 1355 Bogue St., B436 Life Science Building, East Lansing, MI 48824, United States
| | - Stephen E DiCarlo
- Michigan State University, Department of Physiology, 567 Wilson Rd., Rm 2201, East Lansing, MI 48824, United States
| | - Sara Roccabianca
- Michigan State University, Department of Mechanical Engineering, 428 S. Shaw Lane, Rm 2555, East Lansing, MI 48824, United States.
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16
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Wu SY, Jiang YH, Jhang JF, Hsu YH, Ho HC, Kuo HC. Inflammation and Barrier Function Deficits in the Bladder Urothelium of Patients with Chronic Spinal Cord Injury and Recurrent Urinary Tract Infections. Biomedicines 2022; 10:biomedicines10020220. [PMID: 35203430 PMCID: PMC8868780 DOI: 10.3390/biomedicines10020220] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Revised: 01/15/2022] [Accepted: 01/18/2022] [Indexed: 12/16/2022] Open
Abstract
Patients with spinal cord injury (SCI) commonly experience neurogenic voiding dysfunctions and urinary tract complications, including recurrent urinary tract infections (rUTI). The bladder mucosa barrier function contributes to UTI prevention. This study investigated changes in bladder urothelium protein expression in patients with SCI and rUTI. From June 2011 to November 2017, 23 patients (19 men and 4 women) with chronic SCI were enrolled (mean age: 43 years. Bladder tissues from 6 healthy adults served as the normal control group. Biopsy samples (9 partial cystectomies and 14 bladder biopsies) were analyzed for functional biomarkers using western blot and immunohistochemistry analysis. The barrier function proteins E-cadherin, zonula occludens 1 (ZO-1) and uroplakin III (UPK-3) were significantly reduced, whereas tumor protein p63 (TP63) was significantly increased in SCI patients compared with controls. No significant differences in basal cell progenitor proteins were observed between groups. The proliferation marker Ki-67, the proapoptotic marker BCL-2-associated X protein (BAX), and proinflammatory proteins were increased in patients with SCI compared with controls. No significant differences were observed between SCI patients with and without recently rUTI. These results suggest that SCI patients experience chronic bladder inflammation, increased apoptosis, and reduced barrier function, contributing to rUTI.
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Affiliation(s)
- Shu-Yu Wu
- Department of Urology, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei City 23142, Taiwan;
- Department of Urology, School of Medicine, Tzu Chi University, Hualien 97004, Taiwan; (Y.-H.J.); (J.-F.J.)
| | - Yuan-Hong Jiang
- Department of Urology, School of Medicine, Tzu Chi University, Hualien 97004, Taiwan; (Y.-H.J.); (J.-F.J.)
- Department of Urology, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien 97004, Taiwan
| | - Jia-Fong Jhang
- Department of Urology, School of Medicine, Tzu Chi University, Hualien 97004, Taiwan; (Y.-H.J.); (J.-F.J.)
- Department of Urology, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien 97004, Taiwan
| | - Yung-Hsiang Hsu
- Department of Pathology, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien 97004, Taiwan;
- Department of Pathology, School of Medicine, Tzu Chi University, Hualien 97004, Taiwan
| | - Han-Chen Ho
- Department of Anatomy, School of Medicine, Tzu Chi University, Hualien 97004, Taiwan;
| | - Hann-Chorng Kuo
- Department of Urology, School of Medicine, Tzu Chi University, Hualien 97004, Taiwan; (Y.-H.J.); (J.-F.J.)
- Department of Urology, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien 97004, Taiwan
- Correspondence: ; Tel.: +886-3856-1825 (ext. 2113)
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17
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Jiang M, Deng J, Zhou G, Li S, Liu G. Risk factors for recurrent urinary tract infection in children with neurogenic bladder following clean intermittent catheterization. Urology 2022; 164:224-229. [PMID: 35026189 DOI: 10.1016/j.urology.2021.12.027] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Revised: 12/23/2021] [Accepted: 12/28/2021] [Indexed: 10/19/2022]
Abstract
OBJECTIVE To investigate the risk factors for recurrent urinary tract infection (UTI) in children with a neurogenic bladder (NB) managed by clean intermittent catheterization (CIC). METHODS Over a 5-year period, we retrospectively assessed the risk factors for recurrent UTIs in children (age 9-151 months) who had CIC. All patients were followed up for more than 12 months and had at least two clinic visits during the study period. Demographic, clinical, and urodynamic parameters were assessed. All data were compared between the recurrent UTI (>1.0 UTI/study-year) and episodic UTI (≤1.0 UTI/study-year) groups. RESULTS Of 327 patients, 79 (24.2%) had recurrent UTIs and 248 (75.8%) had episodic UTIs. Univariate and multivariate analyses showed that older age, lumbar level lesions, long duration of NB, presence of vesicoureteral reflux (VUR), increased bladder wall thickness (BWT), and low bladder compliance were the significant factors for recurrent UTIs. Bladder trabeculation was associated with recurrent UTIs on univariate analysis, but not on multivariate analysis. During the follow-up period, chronic renal insufficiency was diagnosed in 31 (39.2%) and 29 patients (11.7%) in the recurrent and episodic UTI groups (p<0.05), respectively. CONCLUSIONS These results suggest that older age, high level of spinal cord lesions, long duration of NB, VUR, increased BWT, and low bladder compliance may be directly associated with recurrent UTIs in children with NB. Children with NB might have higher susceptibility to chronic renal insufficiency after recurrent UTIs.
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Affiliation(s)
- Man Jiang
- Key Laboratory of Major Diseases in Children, Ministry of Education, Department of Infectious Diseases, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, No.56 Nanlishi Road, Xicheng District, Beijing, China 100045; Department of Infectious Disease, Shenzhen Children's Hospital, Futian District, Shenzhen, Guangdong, China 518000
| | - Jikui Deng
- Department of Infectious Disease, Shenzhen Children's Hospital, Futian District, Shenzhen, Guangdong, China 518000
| | - Guanglun Zhou
- Department of Urology and Laboratory of Pelvic Floor Muscle Function, Shenzhen Children's Hospital, Futian District, Shenzhen, Guangdong, China 518000
| | - Shoulin Li
- Department of Urology and Laboratory of Pelvic Floor Muscle Function, Shenzhen Children's Hospital, Futian District, Shenzhen, Guangdong, China 518000
| | - Gang Liu
- Key Laboratory of Major Diseases in Children, Ministry of Education, Department of Infectious Diseases, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, No.56 Nanlishi Road, Xicheng District, Beijing, China 100045.
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18
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Saini M, Kataruka M, Gogoi B, Sharma V, Madan GS, Sood C. Incidence of Renal Tract Abnormalities on Ultrasonography in Patients with Spinal Cord Injury: A Retrospective Pilot Study of a Military Cohort Undergoing Long-Term Institutional Rehabilitation. Asian Spine J 2021; 16:204-211. [PMID: 34000800 PMCID: PMC9066262 DOI: 10.31616/asj.2020.0471] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Accepted: 03/11/2021] [Indexed: 11/24/2022] Open
Abstract
Study Design Retrospective pilot study. Purpose To assess the incidence of renal tract abnormalities using ultrasonography (US) in a military cohort with traumatic spinal cord injury (TSCI) at a tertiary level spinal cord injury center. Overview of Literature Neurogenic bladder in TSCI patients results in significant urological morbidity. There is lack of data for these patients during the first 18 months of long-term rehabilitation in an institutional setting. Methods We retrospectively reviewed patient records to collect data on demographic characteristics, injury level, injury severity, time since injury, bladder management methods (such as an indwelling catheter [IC], clean intermittent catheterization [CIC], or self-voiding [S]); we correlated these data with the findings of the renal tract US. Results The study included 73 out of 81 male participants. The mean patient age was 29.99 years; the study group included 34.2% tetraplegics and 65.8% people with paraplegia. The time since injury was 6–12 months for 42.5% of the subjects and 12–18 months for 57.5% of the subjects. A normal US scan was recorded in 65.7% patients, and bladder trabeculation was the commonest finding in 15.1% of the subjects, followed by hydronephrosis (HDN) in 12.3%, and renal calculus and atrophy in 1.3% participants each. We found 22.22% of the IC group participants had higher US abnormalities than those in the reflex voiding group (statistically non-significant difference, p=0.7). Trabeculations (21.4%) and HDN (19%) were more common in those who had sustained the injury 12–18 months previously as compared to that in those who had injured themselves 6–12 months previously (p=0.04). The proportion of patients who had a normal US scan was higher in the group who sustained the injury 6–12 months previously versus those who had sustained the injury 12–18 months previously; the difference was statistically significant (p=0.02). There was no significant (p=0.72) correlation in the bladder management method, injury level, and renal tract abnormalities between the groups. Conclusions This retrospective study shows that 65% of TSCI participants had no renal tract abnormality on US scan and bladder trabeculation ruled out as the most common finding. Long-term supervised rehabilitation may help achieve good renal quality of life; however, further prospective trials are required on this subject.
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Affiliation(s)
- Mandeep Saini
- Department of Radiodiagnosis and Imaging, Military Hospital Kirkee, Pune, India
| | - Mohit Kataruka
- Department of PMR, Spinal Cord Injury Centre, Military Hospital Kirkee, Pune, India
| | - Biraj Gogoi
- Department of Orthopaedics and Spine Surgery, Spinal Cord Injury Centre, Military Hospital Kirkee, Pune, India
| | - Vyom Sharma
- Department of Orthopaedics and Spine Surgery, Spinal Cord Injury Centre, Military Hospital Kirkee, Pune, India
| | | | - Chetan Sood
- Department of Orthopaedics and Spine Surgery, Spinal Cord Injury Centre, Military Hospital Kirkee, Pune, India
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Austin PF, Franco I, Dobremez E, Kroll P, Titanji W, Geib T, Jenkins B, Hoebeke PB. OnabotulinumtoxinA for the treatment of neurogenic detrusor overactivity in children. Neurourol Urodyn 2020; 40:493-501. [PMID: 33305474 PMCID: PMC7839517 DOI: 10.1002/nau.24588] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Revised: 10/29/2020] [Accepted: 11/16/2020] [Indexed: 02/06/2023]
Abstract
AIMS This study evaluated whether one (or more) of three doses of onabotulinumtoxinA were safe and effective to treat neurogenic detrusor overactivity (NDO) in children. METHODS This was a 48-week prospective, multicenter, randomized, double-blind study in children (aged 5-17 years) with NDO and urinary incontinence (UI) receiving one onabotulinumtoxinA treatment (50, 100, or 200 U; not to exceed 6 U/kg). Primary endpoint: change from baseline in daytime UI episodes. Secondary endpoints: change from baseline in urine volume at first morning catheterization, urodynamic measures, and positive response on the treatment benefit scale. Safety was also assessed. RESULTS There was a similar reduction in urinary incontinence from baseline to Week 6 for all doses (-1.3 episodes/day). Most patients reported positive responses on the treatment benefit scale (75.0%-80.5%). From baseline to Week 6, increases were observed in urine volume at first morning clean intermittent catheterization (50 U, 21.9 ml; 100 U, 34.9 ml; 200 U, 87.5 ml; p = 0.0055, 200 U vs. 50 U) and in maximum cystometric capacity (range 48.6-63.6 ml) and decreases in maximum detrusor pressure during the storage phase (50 U, -12.9; 100 U, -20.1; 200 U, -27.3 cmH2 O; p = 0.0157, 200 U vs. 50 U). The proportion of patients experiencing involuntary detrusor contractions dropped from baseline (50 U, 94.4%; 100 U, 88.1%; 200 U, 92.6%) to Week 6 (50 U, 61.8%; 100 U, 44.7%; 200 U, 46.4%). Safety was similar across doses; urinary tract infection was most frequent. CONCLUSIONS OnabotulinumtoxinA was well tolerated and effective for the treatment of NDO in children; 200 U showed greater efficacy in reducing bladder pressure and increasing bladder capacity.
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Affiliation(s)
- Paul F Austin
- Texas Children's Hospital, Baylor College of Medicine, Houston, Texas, USA
| | - Israel Franco
- Yale New Haven Children's Hospital, New Haven, Connecticut, USA
| | | | - Pawel Kroll
- Neuro-urology Unit, Paediatric Urology Clinic, Poznań, Poland
| | | | - Till Geib
- Allergan, an AbbVie company, Irvine, California, USA
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Sturm RM, Cantrell AB, Durbin-Johnson B, Kurzrock EA. Use of a Closed Diurnal Indwelling Catheter for Patients With Spinal Cord Disorders: A Pilot Study. Urology 2020; 142:237-242. [DOI: 10.1016/j.urology.2020.04.033] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2019] [Revised: 03/12/2020] [Accepted: 04/02/2020] [Indexed: 10/24/2022]
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Gaubert V, Gidik H, Koncar V. Proposal of a Lab Bench for the Unobtrusive Monitoring of the Bladder Fullness with Bioimpedance Measurements. SENSORS (BASEL, SWITZERLAND) 2020; 20:E3980. [PMID: 32709078 PMCID: PMC7412207 DOI: 10.3390/s20143980] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Revised: 07/08/2020] [Accepted: 07/15/2020] [Indexed: 11/16/2022]
Abstract
(1) Background: millions of people, from children to the elderly, suffer from bladder dysfunctions all over the world. Monitoring bladder fullness with appropriate miniaturized textile devices can improve, significantly, their daily life quality, or even cure them. Amongst the existing bladder sensing technologies, bioimpedance spectroscopy seems to be the most appropriate one to be integrated into textiles. (2) Methods: to assess the feasibility of monitoring the bladder fullness with textile-based bioimpedance spectroscopy; an innovative lab-bench has been designed and fabricated. As a step towards obtaining a more realistic pelvic phantom, ex vivo pig's bladder and skin were used. The electrical properties of the fabricated pelvic phantom have been compared to those of two individuals with tetrapolar impedance measurements. The measurements' reproducibility on the lab bench has been evaluated and discussed. Moreover, its suitability for the continuous monitoring of the bladder filling has been investigated. (3) Results: although the pelvic phantom failed in reproducing the frequency-dependent electrical properties of human tissues, it was found to be suitable at 5 kHz to record bladder volume change. The resistance variations recorded are proportional to the conductivity of the liquid filling the bladder. A 350 mL filling with artificial urine corresponds to a decrease in resistance of 7.2%, which was found to be in the same range as in humans. (4) Conclusions: based on that resistance variation; the instantaneous bladder fullness can be extrapolated. The presented lab-bench will be used to evaluate the ability of textiles electrodes to unobtrusively monitor the bladder volume.
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Affiliation(s)
- Valentin Gaubert
- GEnie et Matériaux TEXtiles (GEMTEX) Laboratory, École Nationale Supérieure des Arts et Industries Textiles (ENSAIT), F-59100 Roubaix, France; (H.G.); (V.K.)
- Hautes Etudes Ingénieur (HEI)—YNCREA, University of Lille, F-59650 Villeneuve d’Ascq, France
| | - Hayriye Gidik
- GEnie et Matériaux TEXtiles (GEMTEX) Laboratory, École Nationale Supérieure des Arts et Industries Textiles (ENSAIT), F-59100 Roubaix, France; (H.G.); (V.K.)
- Hautes Etudes Ingénieur (HEI)—YNCREA, University of Lille, F-59650 Villeneuve d’Ascq, France
| | - Vladan Koncar
- GEnie et Matériaux TEXtiles (GEMTEX) Laboratory, École Nationale Supérieure des Arts et Industries Textiles (ENSAIT), F-59100 Roubaix, France; (H.G.); (V.K.)
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Maltagliati M, Sampogna G, Citeri M, Guerrer CS, Zanollo LG, Rizzato L, Montanari E, Micali S, Rocco B, Spinelli M. A consecutive series of patients undergoing trans-urethral cystolithotripsy with ballistic lithotripsy by a tertiary referral center for neurogenic bladder. ACTA BIO-MEDICA : ATENEI PARMENSIS 2020; 91:e2020112. [PMID: 33525264 PMCID: PMC7927523 DOI: 10.23750/abm.v91i4.9132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/27/2019] [Accepted: 01/24/2020] [Indexed: 11/23/2022]
Abstract
Background and aim of the work Patients with neurogenic bladder (NB) have an increased risk of developing bladder stones due to bladder catheter, incomplete bladder emptying, recurrent urinary tract infections, and immobilization. In these patients, minimally invasive treatments are usually adopted, as noninvasive extracorporeal shockwave lithotripsy is limited by the risk of not clearing all stone fragments, and open surgery is usually discouraged. The aim of our study was to present our experience with trans-urethral cystolithotripsy (TUCL) in patients treated by a tertiary referral center for NB. Methods We retrospectively collected pre-, intra- and post-operative data from our patients, who underwent TUCL from October 2013 to October 2019. The procedure was performed with a 24 Fr cystoscope and a ballistic lithotripter. Lapaxy was performed with Ellik bladder evacuator. All procedures were performed by two expert surgeons. Stone-free rate (SFR) was defined as the percentage of patients with absence of residual fragments > 2 mm in diameter. Results We performed consecutively 90 TUCLs in 75 patients during the selected period. SFR was 94.1%. Intra- and post-operative complications occurred in one (1.1%) patient. Our statistical analysis outlined the SFR was affected in a statistically significant way by sex, NB etiology, stone cumulative diameter, and operative time. Conclusion Our series proved the safety and efficacy of TUCL with ballistic lithotripsy in NB patients. Further multicenter randomized controlled trials are mandatory to validate definitively TUCL as the gold standard therapy for bladder urolithiasis in NB patients, and to identify risk factors limiting the SFR.
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Affiliation(s)
- Matteo Maltagliati
- Urology Unit, Ospedale Policlinico e Nuovo Ospedale Civile S. Agostino Estense, University of Modena and Reggio Emilia, Modena, Italy .
| | - Gianluca Sampogna
- Urology Unit, Fondazione IRCCS Ca' Granda - Ospedale Maggiore Policlinico, University of Milan, Milan, Italy.
| | - Marco Citeri
- Neuro-urology Unit, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy.
| | | | | | - Luigi Rizzato
- Neuro-urology Unit, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy.
| | - Emanuele Montanari
- Urology Unit, Fondazione IRCCS Ca' Granda - Ospedale Maggiore Policlinico, University of Milan, Milan, Italy.
| | - Salvatore Micali
- Urology Unit, Ospedale Policlinico e Nuovo Ospedale Civile S. Agostino Estense, University of Modena and Reggio Emilia, Modena, Italy .
| | - Bernardo Rocco
- Urology Unit, Ospedale Policlinico e Nuovo Ospedale Civile S. Agostino Estense, University of Modena and Reggio Emilia, Modena, Italy .
| | - Michele Spinelli
- Neuro-urology Unit, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy.
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Kovacevic N, Lopes NN, Raffee S, Atiemo HO. Predicting Upper Urinary Tract Risk in the Neurogenic Bladder Patient. CURRENT BLADDER DYSFUNCTION REPORTS 2020. [DOI: 10.1007/s11884-020-00578-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Abolhasanpour N, Hajebrahimi S, Ebrahimi-Kalan A, Mehdipour A, Salehi-Pourmehr H. Urodynamic Parameters in Spinal Cord Injury-Induced Neurogenic Bladder Rats after Stem Cell Transplantation: A Narrative Review. IRANIAN JOURNAL OF MEDICAL SCIENCES 2020; 45:2-15. [PMID: 32038054 PMCID: PMC6983271 DOI: 10.30476/ijms.2019.45318] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Neurogenic bladder (NGB) secondary to spinal cord injury (SCI) is accompanied with several complications such as urinary tract deterioration, urinary incontinence, and consequently lower quality of life (QoL),
significant morbidities, and occasionally death. Current therapeutic methods have some side effects and there is no treatment for the upper urinary tract injuries. Stem cell therapy is a promising method for
treating this condition. However, the best timing and the best route of its transplantation have not yet been determined. Animal models of SCI, especially in rats, are the most commonly used method for evaluating
the efficacy of cell therapy in NGB improvement, and the most common assessment method is the urodynamic studies (UDS). However, there are variations in the range of UDS parameters among the published studies.
The current review aimed to discuss the effect of stem cell transplantation on bladder dysfunction recovery based on urodynamic parameters after SCI in rats. For this purpose, the cell source, doses, the route
of administration, and the complete UDS equipment and its parameters were summarized in SCI models in rats. In some urodynamic test results, to some extent, an improvement in the lower urinary system function
was observed in each treatment group. However, this improvement was far from full functional recovery. The average cell dose was about 1 million cells in every injected site. In most studies, the stem cells (SCs)
were transplanted 9 days after the injury using PE-50 and PE-60. Many researchers have recommended further experimental and clinical studies to confirm this treatment modality.
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Affiliation(s)
- Nasrin Abolhasanpour
- Department of Biology, Science and Research Branch, Islamic Azad University, Tehran, Iran
| | - Sakineh Hajebrahimi
- Research Center for Evidence Based-Medicine, Iranian EBM Centre: A Joanna Briggs Institute Affiliated Group, Tabriz University of Medical Sciences, Tabriz, Iran.,Department of Urology, Imam Reza Teaching Hospital, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Abbas Ebrahimi-Kalan
- Department of Neurosciences and Cognitive, School of Advanced Medical Sciences, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Ahmad Mehdipour
- Department of Tissue Engineering, School of Advanced Medical Sciences, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Hanieh Salehi-Pourmehr
- Research Center for Evidence Based-Medicine, Iranian EBM Centre: A Joanna Briggs Institute Affiliated Group, Tabriz University of Medical Sciences, Tabriz, Iran.,Neurosciences Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
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Long term continuation with repeated Botulinum toxin A injections in people with neurogenic detrusor overactivity after spinal cord injury. Spinal Cord 2020; 58:675-681. [PMID: 31913344 DOI: 10.1038/s41393-019-0411-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Revised: 12/20/2019] [Accepted: 12/20/2019] [Indexed: 11/09/2022]
Abstract
STUDY DESIGN Retrospective chart study. OBJECTIVES The aim was to examine continuation of treatment of individuals with spinal cord injury including myelomeningocele and neurogenic detrusor overactivity, treated with repeated intra-detrusor Botulinum toxin A injections, and to investigate factors associated with discontinuation of treatment. SETTING Rigshospitalet, Denmark METHODS: This study included 128 individuals with spinal cord injury and neurogenic detrusor overactivity, who were offered repeated Botulinum toxin A injections between 2001 and 2018. Continuation rates of the treatment were estimated using Kaplan Meier analysis. A Cox proportional hazard analysis was used to investigate factors predictive of discontinuation. RESULTS A total of 1156 treatments were performed. The median number of treatments was six (IQR 9, range 1-51), and median follow-up was 10.6 years (IQR 8.5, range 0-16.9). All urodynamic parameters changed significantly after the first treatment (p < 0.001). The continuation group had significantly higher mean maximum bladder capacity after the first injections compared with the discontinuation group, with a mean difference between the groups of 84.5 mL (95% CI 4.7-164.2) (p = 0.038). The probability of continuing treatments after 5 years was 59% (95% CI 50.0-67.8) and 50% (95% CI 40.1-59.3) after 10 years. Individuals aged 31-50 years were more likely to continue treatment compared with those aged >50 years (95% CI 0.21‒0.79) (p = 0.008). No other factors predicted discontinuation. CONCLUSIONS This long-term follow-up study showed that 50% of people with spinal cord injury starting intra-detrusor Botulinum toxin A for neurogenic detrusor overactivity are still receiving injections after 10 years.
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Wang W, Fang H, Xie P, Cao Q, He L, Cai W. Create a predictive model for neurogenic bladder patients: upper urinary tract damage predictive nomogram. Int J Neurosci 2019; 129:1240-1246. [PMID: 31401918 DOI: 10.1080/00207454.2019.1655016] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Objective: To create a nomogram to evaluate the risk of upper urinary tract damage (UUTD) in patients with neurogenic bladder (NGB) Methods: A retrospective analysis was conducted on 301 patients with NGB who were admitted to certain hospitals. Data collected included clinical symptoms, patients' characteristics, laboratory parameters, imaging findings, and urodynamic parameters. The least absolute shrinkage and selection operator(LASSO)regression model was used to optimise the selection of predictors. Multivariate logistic regression analysis was performed to develop a UUTD risk predictive model. Validation was performed by bootstrap. Results: The predictors included in the nomogram included sex, duration of disease, history of UTI, bladder compliance, and fecal incontinence. The model presented good discrimination with a C-index value of 0.796 (95% confidence interval: 0.74896-0.84304) and good calibration. The C-index value of the interval validation was 0.7872112. The results of decision curve analysis (DCA) demonstrated that the UUTD-risk predictive nomogram was clinically useful. Conclusion: The nomogram incorporating the sex, duration of disease, history of UTI, bladder compliance, and fecal incontinence could be an important tool of UUTD risk prediction in NGB patients.
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Affiliation(s)
- Wenqiang Wang
- Department of Nursing, Shenzhen Hospital, Southern Medical University , Shenzhen , China
| | - Hengying Fang
- Department of Nursing, The Third Affiliated Hospital of Sun Yat-Sen University , Guangzhou , China
| | - Peng Xie
- Department of Critical Care Medicine, Nanchong Central Hospital, the Second Clinical Medical College of North Sichuan Medical College , Nanchong , China
| | - Qunduo Cao
- Department of Urology, Peking University Shenzhen Hospital , Shenzhen , China
| | - Ling He
- Department of Radiation Oncology Department, Nanfang Hospital, Southern Medical University, Guangzhou , China
| | - Wenzhi Cai
- Department of Nursing, Shenzhen Hospital, Southern Medical University , Shenzhen , China
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Kavanagh A, Baverstock R, Campeau L, Carlson K, Cox A, Hickling D, Nadeau G, Stothers L, Welk B. Canadian Urological Association guideline: Diagnosis, management, and surveillance of neurogenic lower urinary tract dysfunction - Full text. Can Urol Assoc J 2019; 13:E157-E176. [PMID: 30763235 DOI: 10.5489/cuaj.5912] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
- Alex Kavanagh
- Department of Urologic Sciences, University of British Columbia, Vancouver, BC, Canada
| | - Richard Baverstock
- vesia [Alberta Bladder Centre]; Division of Urology, Department of Surgery, University of Calgary, Calgary, AB, Canada
| | - Lysanne Campeau
- Department of Urology, Jewish General Hospital, McGill University, Montreal, QC, Canada
| | - Kevin Carlson
- vesia [Alberta Bladder Centre]; Division of Urology, Department of Surgery, University of Calgary, Calgary, AB, Canada
| | - Ashley Cox
- Department of Urology, Dalhousie University, Halifax, NS, Canada
| | - Duane Hickling
- Division of Urology, Department of Surgery, The Ottawa Hospital, Ottawa, ON, Canada
| | - Genviève Nadeau
- Division of Urology, CIUSSS-Capitale Nationale Université Laval, Quebec City, QC, Canada
| | - Lynn Stothers
- Department of Urologic Sciences, University of British Columbia, Vancouver, BC, Canada
| | - Blayne Welk
- University of Western Ontario, London, ON, Canada
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Dutton RA. Medical and Musculoskeletal Concerns for the Wheelchair Athlete: A Review of Preventative Strategies. Curr Sports Med Rep 2019; 18:9-16. [PMID: 30624329 DOI: 10.1249/jsr.0000000000000560] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Adaptive sports refers to organized sporting activities that are practiced by individuals with disabilities and are worthwhile to maintain physical and psychological health. As adaptive sports participation continues to rise, health care providers must have an enhanced understanding of injury and illness patterns specific to the adaptive athlete. Early recognition and prevention are important to ensure safe and successful participation in sport. The present review aims to provide a framework for diagnosis and prevention of common conditions specific to the wheelchair athlete. In particular, autonomic dysreflexia, impaired thermoregulation, urinary tract infection, and pressure injuries, as well as shoulder pain, upper-extremity entrapment neuropathies, and osteoporotic fractures will be discussed.
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Affiliation(s)
- Rebecca A Dutton
- University of New Mexico, Department of Orthopaedics and Rehabilitation
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Akkoç Y, Bardak AN, Ersöz M, Yılmaz B, Yıldız N, Erhan B, Tunç H, Koklu K, Alemdaroğlu E, Dogan A, Ozisler Z, Koyuncu E, Şimşir Atalay N, Gündüz B, Işık R, Güler A, Sekizkardeş M, Demir Y, Yaşar E, Sasmaz E, Şatır Ö. Post-stroke lower urinary system dysfunction and its relation with functional and mental status: a multicenter cross-sectional study. Top Stroke Rehabil 2018; 26:136-141. [DOI: 10.1080/10749357.2018.1555389] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Affiliation(s)
- Yeşim Akkoç
- Department of Physical Medicine and Rehabilitation, Ege University Faculty of Medicine, Izmir, Turkey
| | - Ayşe Nur Bardak
- Department of Physical Medicine and Rehabilitation, Istanbul Physical Medicine and Rehabilitation Teaching and Research Hospital, Istanbul, Turkey
| | - Murat Ersöz
- Department of Physical Medicine and Rehabilitation, Yıldırım Beyazıt University Faculty of Medicine, Ankara, Turkey
- Department of Physical Medicine and Rehabilitation, Turkish Republic of Ministry of Health Sciences University Ankara PMR Training and Research Hospital, Ankara, Turkey
| | - Bilge Yılmaz
- Department of Physical Medicine and Rehabilitation, Gaziler Physical Medicine and Rehabilitation Education and Research Hospital, Ankara, Turkey
| | - Necmettin Yıldız
- Department of Physical Medicine and Rehabilitation, Pamukkale University Faculty of Medicine, Denizli, Turkey
| | - Belgin Erhan
- Department of Physical Medicine and Rehabilitation, Istanbul Physical Medicine and Rehabilitation Teaching and Research Hospital, Istanbul, Turkey
| | - Hakan Tunç
- Department of Physical Medicine and Rehabilitation, Turkish Republic of Ministry of Health Sciences University Ankara PMR Training and Research Hospital, Ankara, Turkey
| | - Kurtulus Koklu
- Department of Physical Medicine and Rehabilitation, Turkish Republic of Ministry of Health Sciences University Ankara PMR Training and Research Hospital, Ankara, Turkey
| | - Ebru Alemdaroğlu
- Department of Physical Medicine and Rehabilitation, Turkish Republic of Ministry of Health Sciences University Ankara PMR Training and Research Hospital, Ankara, Turkey
| | - Asuman Dogan
- Department of Physical Medicine and Rehabilitation, Ankara Yeni Vizyon Health Center, Ankara, Turkey
| | - Zuhal Ozisler
- Department of Physical Medicine and Rehabilitation, Turkish Republic of Ministry of Health Sciences University Ankara PMR Training and Research Hospital, Ankara, Turkey
| | - Engin Koyuncu
- Department of Physical Medicine and Rehabilitation, Turkish Republic of Ministry of Health Sciences University Ankara PMR Training and Research Hospital, Ankara, Turkey
| | - Nilgün Şimşir Atalay
- Department of Physical Medicine and Rehabilitation, Fizyorad Physical Therapy and Rehabilitation Medicine Center, Denizli, Turkey
| | - Berrin Gündüz
- Department of Physical Medicine and Rehabilitation, Istanbul Physical Medicine and Rehabilitation Teaching and Research Hospital, Istanbul, Turkey
| | - Rıdvan Işık
- Department of Physical Medicine and Rehabilitation, Ege University Faculty of Medicine, Izmir, Turkey
| | - Ayse Güler
- Department of Neurology, Ege University Faculty of Medicine, İzmir, Turkey
| | - Merve Sekizkardeş
- Department of Physical Medicine and Rehabilitation, Istanbul Physical Medicine and Rehabilitation Teaching and Research Hospital, Istanbul, Turkey
| | - Yasin Demir
- Department of Physical Medicine and Rehabilitation, Gaziler Physical Medicine and Rehabilitation Education and Research Hospital, Ankara, Turkey
| | - Evren Yaşar
- Department of Physical Medicine and Rehabilitation, Gaziler Physical Medicine and Rehabilitation Education and Research Hospital, Ankara, Turkey
| | - Ezgi Sasmaz
- Department of Physical Medicine and Rehabilitation, Pamukkale University Faculty of Medicine, Denizli, Turkey
| | - Özlem Şatır
- Department of Physical Medicine and Rehabilitation, Istanbul Physical Medicine and Rehabilitation Teaching and Research Hospital, Istanbul, Turkey
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Neyaz O, Srikumar V, Equebal A, Biswas A. Change in urodynamic pattern and incidence of urinary tract infection in patients with traumatic spinal cord injury practicing clean self-intermittent catheterization. J Spinal Cord Med 2018; 43:347-352. [PMID: 30277852 PMCID: PMC7241564 DOI: 10.1080/10790268.2018.1512729] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
Abstract
Objective: To observe changes in cystometric parameters in individuals with spinal cord injury (SCI) with neurogenic bladder practicing clean intermittent self-catheterization (CIC) and incidence of urinary tract infection (UTI) in such patients.Design: Prospective, observational study.Setting: Tertiary Urban Rehabilitation Hospital.Participants: Persons with neurogenic bladder caused by traumatic SCI and practicing CIC.Interventions: Clinical evaluation, complete urine analysis, urine culture and sensitivity, ultrasonography of the abdomen and urodynamic study were evaluated at baseline and at follow-up (6 months to 1 year).Outcome Measures: Detrusor pattern, cystometric capacity, detrusor compliance, detrusor leak point pressure, residual urine, incidence of UTI.Results: Thirty-one participants were included in the study. The baseline cystometric study showed that 15 had overactive detrusor and 16 had detrusor areflexia. The mean cystometric capacity decreased significantly between baseline and follow-up in both the groups but remained within the normal threshold limit, decline being more marked in the overactive detrusor group, who also had more marked decrease in compliance. Mean detrusor leak point pressure was below 40 cm H2O in all participants in both groups at baseline and follow-up. Mean residual urine improved at follow-up in both groups. Incidence of UTI was 2.29 episodes per patient per year, and more frequent in the overactive detrusor group. Escherichia coli was the causative agent in 45%.Conclusion: The cystometric capacity and compliance decreased significantly though patients were doing regular CIC and managed on antimuscarinics for detrusor overactivity (DO). UTI is more common in individuals with SCI with DO and E. coli is the most common cause of UTI.
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Affiliation(s)
- Osama Neyaz
- Department of Physical Medicine and Rehabilitation, All India Institute of Medical Sciences, New Delhi, India
| | - Venkataraman Srikumar
- Department of Physical Medicine and Rehabilitation, All India Institute of Medical Sciences, New Delhi, India,Correspondence to: Venkataraman Srikumar, Department of Physical Medicine and Rehabilitation, All India Institute of Medical Sciences, Ansari Nagar, New Delhi 110029, India; Ph: +91 011 26593232.
| | - Ameed Equebal
- National Institute for Locomotor Disabilities, Kolkata, India
| | - Abhishek Biswas
- National Institute for Locomotor Disabilities, Kolkata, India
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Dray E, Cameron AP, Clemens JQ, Qin Y, Covalschi D, Stoffel J. Does Post-Void Residual Volume Predict Worsening Urological Symptoms in Patients with Multiple Sclerosis? J Urol 2018; 200:868-874. [PMID: 29702098 DOI: 10.1016/j.juro.2018.04.068] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/15/2018] [Indexed: 10/17/2022]
Abstract
PURPOSE Our goal was to examine how post-void residual urine volume relates to urinary symptoms in patients with multiple sclerosis. MATERIALS AND METHODS We retrospectively reviewed the records of patients with multiple sclerosis who had lower urinary tract symptoms and presented to a tertiary neurourology clinic. Patients for whom post-void residual volume was recorded at the initial urological assessment were included in our analysis. Results of the AUA (American Urological Association) SI (Symptom Index) and the M-ISI (Michigan Incontinence Symptom Index) completed at this visit were analyzed to assess the severity of lower urinary tract symptoms and incontinence. A chart review was performed to obtain information on demographics and documented urinary tract infections. RESULTS Between 2014 and 2017, 110 patients diagnosed with multiple sclerosis underwent post-void residual volume measurement at our clinic. Average post-void residual volume was 123.4 cc (range 0 to 650 cc). The mean AUA symptom score was 19.1 with an average bother score of 4.1. Analysis of post-void residual volume as a continuous variable did not show an association between increasing post-void residual volume and an increasing AUA SI or bother score (p = 0.53 and 0.44, respectively). When evaluated by post-void residual volume tertile, no relationship was found between post-void residual volume, and the AUA SI and the M-ISI (p = 0.54 and 0.57, respectively). No correlation was also found between increasing post-void residual volume and a recent history of recurrent urinary tract infections (p = 0.27). CONCLUSIONS Post-void residual volume was not associated with worsening obstructive lower urinary tract symptoms as assessed by the AUA SI, worsening incontinence as measured by the M-ISI score or an increased risk of recurrent urinary tract infections in select patients with multiple sclerosis and lower urinary tract symptoms.
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Przydacz M, Chlosta P, Corcos J. Recommendations for urological follow-up of patients with neurogenic bladder secondary to spinal cord injury. Int Urol Nephrol 2018; 50:1005-1016. [PMID: 29569211 DOI: 10.1007/s11255-018-1852-7] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2018] [Accepted: 03/19/2018] [Indexed: 12/30/2022]
Abstract
PURPOSE To review currently available guidelines and recommendations regarding urological follow-up of patients after spinal cord injury (SCI) and present an evidence-based summary to support clinicians in their clinical practice. METHODS Maximum data were collected according to different methods, including searches with multiple and specific keywords, reference checks, gray literature searches (congress reports, working papers, statement documents), and browsing-related Web site access. Obtained data were analyzed with the modified version of the Oxford grading system for recommendations using levels of evidence (LE) and grades of recommendation (GR). RESULTS Different surveillance strategies exist, but there is no consensus among authors and organizations. As a result, practice patterns vary around the world. The present review indicates that proper urological follow-up of SCI patients should consist of medical history (LE 1-4, GR B-C), clinical examination (LE 4, GR C), renal laboratory tests (LE 1-3, GR B), imaging surveillance of the upper urinary tract (LE 1-3, GR A-B), urodynamic study (LE 2-4, GR B-C), and cystoscopy/cytology (LE 1-4, GR D). Clinicians agree that SCI patients should be followed up regularly with an individually tailored approach. A 1-year follow-up schedule seems reasonable in SCI patients without additional risk factors of renal deterioration (LE 3-4, GR C). In those who manifest risk factors, report changes in bladder behavior, or present with already developed complications of neurogenic bladder dysfunction, follow-up plans should be modified with more frequent checkups (LE 4, GR C). Urodynamic study should be repeated and considered as a routine monitoring strategy. CONCLUSION Individuals with neurogenic lower urinary tract dysfunction are at increased risk of multiple complications. Nevertheless, proper follow-up after SCI improves the prognosis for these patients and their quality of life.
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Affiliation(s)
- Mikolaj Przydacz
- Department of Urology, Jewish General Hospital, McGill University, Montreal, Canada
- Department of Urology, Jagiellonian University, Medical College, Kraków, Poland
| | - Piotr Chlosta
- Department of Urology, Jagiellonian University, Medical College, Kraków, Poland
| | - Jacques Corcos
- Department of Urology, Jewish General Hospital, McGill University, Montreal, Canada.
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Long-term Outcome of 1-step Kidney Transplantation and Bladder Augmentation Procedure in Pediatric Patients. Transplantation 2018; 102:1014-1022. [PMID: 29319624 DOI: 10.1097/tp.0000000000002050] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Guidelines for bladder augmentation (BA) in kidney transplantation (KT) recipients are not well-defined. In our center, simultaneous BA with KT (BA-KT) is performed. We assessed transplantation outcomes of this unique extensive procedure. METHODS A case-control single center retrospective study. Transplantation outcomes were compared with those of KT recipients who did not need BA. RESULTS Compared with 22 patients who underwent KT only, for 9 who underwent BA-KT, surgical complications and the need for revision in the early posttransplantation period were similar; early graft function was better: estimated glomerular filtration rate, 96.5 ± 17.1 versus 79.4 ± 16.6 mL/min at 0 to 6 months (P = 0.02); posttransplantation clean intermittent catheterization was more often needed: by 78% (7/9) versus 13% (3/22); and asymptomatic bacteriuria was more common: 100% versus 9% during the first 6 months (P < 0.001), 55% versus 9% (P = 0.02) and 66.6% versus 9% during the first and second years, respectively (P = 0.004). Urinary tract infection (UTI) incidence was also higher: 100% versus 23% during the first 6 months and 44% versus 9% during the second year posttransplantation. Graft function deteriorated significantly in the BA-KT group by the fifth posttransplantation year: estimated glomerular filtration rate was 47.7 ± 39.7 mL/min versus 69 ± 21.3 mL/min, with only 6 (66%) of 9 functioning grafts versus 100% in the KT only group. Causes of graft loss were noncompliance with drug therapy in 2 patients and recurrent UTIs in 2 patients. CONCLUSIONS Excellent short-term outcome for simultaneous BA-KT is threatened by graft loss due to a high prevalence of UTIs and patient noncompliance with the demanding complex posttransplantation therapy.
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Patel DP, Lenherr SM, Stoffel JT, Elliott SP, Welk B, Presson AP, Jha A, Rosenbluth J, Myers JB. Study protocol: patient reported outcomes for bladder management strategies in spinal cord injury. BMC Urol 2017; 17:95. [PMID: 29017505 PMCID: PMC5635498 DOI: 10.1186/s12894-017-0286-3] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2017] [Accepted: 10/02/2017] [Indexed: 12/20/2022] Open
Abstract
Background The majority of spinal cord injury (SCI) patients have urinary issues, such as incontinence, retention, and frequency. These problems place a significant burden on patients’ physical health and quality of life (QoL). There are a wide variety of bladder management strategies available to patients with no clear guidelines on appropriate selection. Inappropriate bladder management can cause hospitalizations and serious complications, such as urosepsis and renal failure. Patients believe that both independence and ability to carry out daily activities are just as important as physical health in selecting the right bladder-management strategy but little is known about patient’s QoL with different bladder managements. Our study’s aim is to assess patient reported QoL measures with various bladder managements after SCI. This manuscript describes the approach, study design and common data elements for our central study. Methods This is a multi-institutional prospective cohort study comparing three different bladder-management strategies (clean intermittent catheterization, indwelling catheters, and surgery). Information collected from participants includes demographics, past medical and surgical history, injury characteristics, current and past bladder management, and SCI /bladder-related complications. Patient reported outcomes and QoL questionnaires were administered at enrollment and every 3 months for 1 year. Aims of this study protocol are: (1) to assess baseline QoL differences between the three different bladder-management strategies; (2) determine QoL impact when those using either form of catheter management undergo a surgery over the 1 year of follow-up among patients eligible for surgery; (3) assess the effects of changes in bladder management and complications on QoL over a 1-year longitudinal follow-up. Discussion By providing information about patient-reported outcomes associated with different bladder management strategies after SCI, and the impact of bladder management changes and complications on QoL, this study will provide essential information for shared decision-making and guide future investigation. Trial registration Trial registration number: www.clinicaltrials.gov: Identifier: NCT0261608; U.S. National Library of Medicine, wwwcf.nlm.nih.gov: Identifier: HSRP20153564.
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Affiliation(s)
- Darshan P Patel
- Division of Urology, Department of Surgery, University of Utah Health Care, 30 North 1900 East, Room #3B420, Salt Lake City, UT, 84132, USA
| | - Sara M Lenherr
- Division of Urology, Department of Surgery, University of Utah Health Care, 30 North 1900 East, Room #3B420, Salt Lake City, UT, 84132, USA
| | - John T Stoffel
- Department of Urology, University of Michigan, Ann Arbor, Michigan, USA
| | - Sean P Elliott
- Department of Urology, University of Minnesota, Minneapolis, Minnesota, USA
| | - Blayne Welk
- Divsion of Urology, University of Western Ontario, London, Ontario, Canada
| | - Angela P Presson
- Divsion of Epidemiology, Department of Internal Medicine, University of Utah Health Care, Salt Lake City, Utah, USA
| | - Amitabh Jha
- Department of Physical Medicine and Rehabilitation, University of Utah Health Care, Salt Lake City, Utah, USA
| | - Jeffrey Rosenbluth
- Department of Physical Medicine and Rehabilitation, University of Utah Health Care, Salt Lake City, Utah, USA
| | - Jeremy B Myers
- Division of Urology, Department of Surgery, University of Utah Health Care, 30 North 1900 East, Room #3B420, Salt Lake City, UT, 84132, USA.
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Abstract
It is widely accepted that neurogenic lower urinary tract dysfunction, when left untreated, has a natural history that has a potential for causing deterioration of renal function over time. However, certain patient profiles are at risk for this and other complications. This can be linked to their underlying neurologic disease process. Identifying risk profiles allows the provider to determine what surveillance strategies might be adopted. Risk factors for upper urinary tract deterioration include loss of bladder compliance, repeated bouts of pyelonephritis, and chronic indwelling catheterization. Other long-term complications include nephrolithiasis, refractory urinary incontinence, and malignancy.
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Affiliation(s)
- Unwanaobong Nseyo
- Department of Urology, UC San Diego Health, University of California-San Diego, 200 West Arbor Drive, San Diego, CA 92103-8897, USA
| | - Yahir Santiago-Lastra
- Department of Urology, UC San Diego Health, University of California-San Diego, 200 West Arbor Drive, San Diego, CA 92103-8897, USA.
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Agrawal S, Agrawal RR, Wood HM. Establishing a Multidisciplinary Approach to the Management of Neurologic Disease Affecting the Urinary Tract. Urol Clin North Am 2017; 44:377-389. [PMID: 28716319 DOI: 10.1016/j.ucl.2017.04.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Neurologic diseases often affect the urinary tract and may be congential or acquired. The progressive nature of many neurologic diseases necessitates routine surveillance and treatment with a multidisciplinary approach. Urologic treatments may interact with pharmacologic or procedural interventions planned by other specialists, mandating close coordination of care and communication among providers. Primary care and nursing often can serve as the quarterbacks of the multidisciplinary team by identifying when a slowly progressive condition warrants further investigation and management by specialists.
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Affiliation(s)
- Shree Agrawal
- Case Western Reserve University School of Medicine, 2109 Adelbert Road, Cleveland, OH 44106, USA.
| | - Ravi R Agrawal
- Boston University, One Silber Way, Boston, MA 02215, USA
| | - Hadley M Wood
- Glickman Urological and Kidney Institute, Cleveland Clinic, 9500 Euclid Avenue, Q10-1, Cleveland, OH 44195, USA
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Böthig R, Domurath B, Kaufmann A, Bremer J, Vance W, Kurze I. [Neuro-urological diagnosis and therapy of lower urinary tract dysfunction in patients with spinal cord injury : S2k Guideline of the German-Speaking Medical Society of Paraplegia (DMGP), AWMF register no. 179/001]. Urologe A 2017; 56:785-792. [PMID: 28314966 DOI: 10.1007/s00120-017-0354-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND Most patients with spinal cord injury (SCI) suffer from neurogenic lower urinary tract dysfunction (NLUTD), bowel dysfunction and sexual dysfunction. If these remain untreated, severe medical complications and serious limitations (restrictions) in quality of life are imminent. OBJECTIVES In the long term, there are considerable differences in the treatment results of highly specialized centers versus other treatment facilities. MATERIALS AND METHODS Against this background, a consensus-based guideline, according to the AWMF (Association of the Scientific Medical Societies in Germany) criteria (S2k), was developed by the neuro-urology working group of the DMPG (German-Speaking Medical Society of Paraplegia). RESULTS The guideline defines the principles and objectives of the neuro-urological care of patients with SCI and discusses in detail the principles of diagnosis and therapy of NLUTD. The need for video-urodynamic studies as a basis for the classification of the NLUTD and as a foundation for the development of a treatment strategy is emphasized. Both conservative and surgical therapy options and their indications are explained in detail. Possible complications and their prevention in the long-term course of SCI are presented with a particular consideration of the specific features of urinary tract infections and autonomic dysreflexia. Finally, the principles of the provision of urological appliances are discussed. CONCLUSIONS The presented S2k guideline provides the current standards in the neuro-urological care of patients with NLUTD due to SCI. Their consistent implementation both in the acute and chronic phase as well as in the context of lifelong surveillance of SCI patients should prevent the impending complications of NLUTD.
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Affiliation(s)
- R Böthig
- Abt. Neuro-Urologie, Querschnittgelähmtenzentrum, BG-Klinikum Hamburg, Bergedorfer Str. 10, 21033, Hamburg, Deutschland.
| | - B Domurath
- Neurologische Rehabilitationsklinik, Neuro-Urologisches Zentrum, Kliniken Beelitz GmbH, Paracelsusring 6a, 14547, Beelitz-Heilstätten, Deutschland
| | - A Kaufmann
- Zentrum für Kontinenz und Neuro-Urologie, Kliniken Maria Hilf GmbH, Viersener Str. 450, 41063, Mönchengladbach, Deutschland
| | - J Bremer
- Zentrum für Neuro-Rehabilitation, Querschnittgelähmten-Zentrum, BDH-Klinik Greifswald gGmbH, Karl-Liebknecht-Ring 26a, 17491, Greifswald, Deutschland
| | - W Vance
- Neurologische Rehabilitationsklinik, Neuro-Urologisches Zentrum, Kliniken Beelitz GmbH, Paracelsusring 6a, 14547, Beelitz-Heilstätten, Deutschland
| | - I Kurze
- Querschnittgelähmten-Zentrum, Klinik für Paraplegiologie und Neuro-Urologie, Zentralklinik Bad Berka, Robert-Koch-Allee 9, 99437, Bad Berka, Deutschland
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Lopes MAL, Lima EDRDP. Continuous use of intermittent bladder catheterization--can social support contribute? Rev Lat Am Enfermagem 2016; 22:461-6. [PMID: 25029058 PMCID: PMC4292630 DOI: 10.1590/0104-1169.3268.2438] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2013] [Accepted: 03/11/2014] [Indexed: 12/02/2022] Open
Abstract
Objective to investigate the factors affecting the adequate continuous use of
intermittent catheterization and its relation with social support. Method sectional, descriptive and correlational study involving 49 patients with
neuropathic bladder caused by spinal cord injury. Results almost all (92%) participants continued the intermittent catheterization,
but 46.9% made some changes in the technique. The complications (28.6% of
the sample) were mainly infection and vesicolithiasis. There were high
scores for social support in relation to people that were part of the
patient's social support. Conclusion All of them noticed great support from the family, but not from the society
in general. The difficulties were related to the lack of equipment and
inadequate infrastructure, leading to changes that increased urologic
complications.
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Duncan D. Intermittent self-catheterisation for urolgical problems caused by FGM. BRITISH JOURNAL OF NURSING (MARK ALLEN PUBLISHING) 2016; 25:S26-S31. [PMID: 27734726 DOI: 10.12968/bjon.2016.25.18.s26] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
This is the fourth and final article in a series on female genital mutilation (FGM). It describes the complications of FGM, with a focus on the urinary ones. FGM refers to all procedures that involve partial or total removal of the external female genitalia and/or damage to other female genital organs for non-medical reasons. The World Health Organization (WHO) has classified FGM into four types (1-4). Women who have type 3 commonly experience long-term complications of their urological tract. The first-line treatment for type 3 FGM involves surgical defibulation, but this is not always successful and women can be left with neurogenic bladder dysfunction and urethral stricture disease. Intermittent self-catheterisation (ISC) enables these women to have control of their bladder function.
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Affiliation(s)
- Debbie Duncan
- Senior Nurse Lecturer, Buckinghamshire New University
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More Than 15 Years of Experience with Intradetrusor OnabotulinumtoxinA Injections for Treating Refractory Neurogenic Detrusor Overactivity: Lessons to Be Learned. Eur Urol 2016; 70:522-8. [DOI: 10.1016/j.eururo.2016.03.052] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2016] [Accepted: 03/31/2016] [Indexed: 01/23/2023]
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Can We Further Improve the Quality of Nephro-Urological Care in Children with Myelomeningocele? INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2016; 13:ijerph13090876. [PMID: 27598183 PMCID: PMC5036709 DOI: 10.3390/ijerph13090876] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/06/2016] [Revised: 08/11/2016] [Accepted: 08/26/2016] [Indexed: 11/17/2022]
Abstract
Myelomeningocele (MMC) results from a failure of normal neural tube fusion in early fetal development. Retrospective, observational study of medical data of 54 children treated in Pediatric Nephrology and Urology Clinics for five years was performed. The following data were analyzed: serum creatinine, eGFR, urine analysis, renal scintigraphy (RS), renal ultrasound, and urodynamics. Mean age of studied population: 12.3 years, median of eGFR at the beginning and at the end of survey was 110.25 and 116.5 mL/min/1.73 m2 accordingly. Median of frequency of urinary tract infections (fUTI): 1.2 episodes/year. In 24 children: low-pressure, in 30 children: high-pressure bladder was noted. Vesicouretral reflux (VUR) was noted in 23 children (42.6%). fUTI were more common in high-grade VUR group. High-grade VURs were more common in group of patients with severe renal damage. At the end of the survey 11.1% children were qualified to higher stages of chronic kidney disease. Renal parenchyma damage progression in RS was noted in 22.2% children. Positive VUR history, febrile recurrent UTIs, bladder wall trabeculation, and older age of the patients constitute risk factors of abnormal renal scans. More than 2.0 febrile, symptomatic UTIs annually increase by 5.6-fold the risk of severe renal parenchyma damage after five years.
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Konstantinidis C, Kratiras Z, Samarinas M, Skriapas K. Optimal bladder diary duration for patients with suprapontine neurogenic lower urinary tract dysfunction. Int Braz J Urol 2016; 42:766-72. [PMID: 27564288 PMCID: PMC5006773 DOI: 10.1590/s1677-5538.ibju.2015.0292] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2015] [Accepted: 10/12/2015] [Indexed: 12/03/2022] Open
Abstract
Purpose: To identify the minimum bladder diary's length required to furnish reliable documentation of LUTS in a specific cohort of patients suffering from neurogenic urinary dysfunction secondary to suprapontine pathology. Materials and Methods: From January 2008 to January 2014, patients suffering from suprapontine pathology and LUTS were requested to prospectively complete a bladder diary form for 7 consecutive days. Micturitions per day, excreta per micturition, urgency and incontinence episodes and voided volume per day were evaluated from the completed diaries. We compared the averaged records of consecutive days (2-6 days) to the total 7 days records for each patient's diary, seeking the minimum diary's length that could provide records comparable to the 7 days average, the reference point in terms of reliability. Results: From 285 subjects, 94 male and 69 female patients enrolled in the study. The records of day 1 were significantly different from the average of the 7 days records in every parameter, showing relatively small correlation and providing insufficient documentation. Correlations gradually increased along the increase in diary's duration. According to our results a 3-day duration bladder diary is efficient and can provide results comparable to a 7 day length for four of our evaluated parameters. Regarding incontinence episodes, 3 days seems inadequate to furnish comparable results, showing a borderline difference. Conclusions: A 3-day diary can be used, as its reliability is efficient regarding number of micturition per day, excreta per micturition, episodes of urgency and voided volume per day.
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Affiliation(s)
| | - Zisis Kratiras
- Department of Urology, General Hospital of Larissa "Koutlibanio", Larissa, Greece
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Li Z, Hogan KA, Cai C, Rieth S. Human Health Effects of Biphenyl: Key Findings and Scientific Issues. ENVIRONMENTAL HEALTH PERSPECTIVES 2016; 124:703-12. [PMID: 26529796 PMCID: PMC4892917 DOI: 10.1289/ehp.1509730] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/16/2015] [Accepted: 10/23/2015] [Indexed: 05/04/2023]
Abstract
BACKGROUND In support of the Integrated Risk Information System (IRIS), the U.S. Environmental Protection Agency (EPA) has evaluated the human health hazards of biphenyl exposure. OBJECTIVES We review key findings and scientific issues regarding expected human health effects of biphenyl. METHODS Scientific literature from 1926 through September 2012 was critically evaluated to identify potential human health hazards associated with biphenyl exposure. Key issues related to the carcinogenicity and noncancer health hazards of biphenyl were examined based on evidence from experimental animal bioassays and mechanistic studies. DISCUSSION Systematic consideration of experimental animal studies of oral biphenyl exposure took into account the variety of study designs (e.g., study sizes, exposure levels, and exposure durations) to reconcile differing reported results. The available mechanistic and toxicokinetic evidence supports the hypothesis that male rat urinary bladder tumors arise through urinary bladder calculi formation but is insufficient to hypothesize a mode of action for liver tumors in female mice. Biphenyl and its metabolites may induce genetic damage, but a role for genotoxicity in biphenyl-induced carcinogenicity has not been established. CONCLUSIONS The available health effects data for biphenyl provides suggestive evidence for carcinogenicity in humans, based on increased incidences of male rat urinary bladder tumors at high exposure levels and on female mouse liver tumors. Kidney toxicity is also a potential human health hazard of biphenyl exposure. CITATION Li Z, Hogan KA, Cai C, Rieth S. 2016. Human health effects of biphenyl: key findings and scientific issues. Environ Health Perspect 124:703-712; http://dx.doi.org/10.1289/ehp.1509730.
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Affiliation(s)
- Zheng Li
- Address correspondence to Z. Li, National Center for Environmental Assessment–8601P, U.S. EPA, Two Potomac Yard (North Building), 2733 S. Crystal Dr., Arlington, VA 22202 USA. Telephone: (703) 347-8577. E-mail:
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Redder J, Leth R, Møller J. Analysing risk factors for urinary tract infection based on automated monitoring of hospital-acquired infection. J Hosp Infect 2016; 92:397-400. [DOI: 10.1016/j.jhin.2015.12.009] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2015] [Accepted: 12/08/2015] [Indexed: 11/29/2022]
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Wang L, Zhou Z, Gong MZ, Pan DL, Zhang XH, Li NC, Na YQ. A Large Bladder Tumor Covered With a Thick "Shell" of Necrotic Material: Misdiagnosis of a Patient With Spina Bifida. Medicine (Baltimore) 2016; 95:e3443. [PMID: 27100442 PMCID: PMC4845846 DOI: 10.1097/md.0000000000003443] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Bladder tumor arising in a spina bifida patient is rare and may be clinically latent. We report the case of a 61-year-old female patient with spina bifida, neurogenic bladder, and a history of recurrent urinary tract infections. A B-ultrasound and non-contrast computed tomography scan did not reveal any bladder mass, but an unexplained "well-filled" bladder was observed, which was confusing as the catheter was present and open. However, a subsequent cystoscopic evaluation revealed a large bladder mass measuring 9.5 × 9.0 × 6.5 cm³, which almost filled the entire bladder. The mass had coarse and flocculent surface and seemed to be free from each observed wall of the urinary bladder. It was diagnosed as an infectious necrotic mass based on its appearance. During transurethral resection of the mass, a bladder tumor was suspected as small blood vessels and bleeding appeared within the inner layer of the mass. Pathological examination revealed necrotic material, inflammatory cells, and urothelial carcinoma cells. Then, a radical cystectomy was performed, and the pathological results indicated stage pT3bN0M0 transitional cell carcinoma. In the gross specimen, the base of the tumor measured 3 × 3 cm² on the top of the back wall of the bladder. Bladder tumors may have atypical presentations in patients with spina bifida. Regular screening is helpful for earlier detection and improving outcomes of bladder tumors in such patients.
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Affiliation(s)
- Lei Wang
- From the Department of Urology, Peking University Shougang Hospital (LW, ZZ, D-LP, X-HZ, N-CL, Y-QN); Peking University Wu Jieping Urology Center (LW, ZZ, D-LP, X-HZ, N-CL, Y-QN); and Department of Pathology, Peking University Shougang Hospital, Peking University Health Science Center (MG), Beijing, China
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Andrade RCP, Neto JA, Andrade L, Oliveira TS, Santos DN, Oliveira CJV, Prado MJ, Carvalho EM. Effects of Physiotherapy in the Treatment of Neurogenic Bladder in Patients Infected With Human T-Lymphotropic Virus 1. Urology 2016; 89:33-8. [PMID: 26724409 PMCID: PMC4792685 DOI: 10.1016/j.urology.2015.09.036] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2015] [Revised: 09/04/2015] [Accepted: 09/17/2015] [Indexed: 12/14/2022]
Abstract
OBJECTIVE To evaluate the efficacy of physiotherapy for urinary manifestations in patients with human T-lymphotropic virus 1-associated lower urinary tract dysfunction. METHODS Open clinical trial was conducted with 21 patients attending the physiotherapy clinic of the Hospital Universitário, Bahia, Brazil. Combinations of behavioral therapy, perineal exercises, and intravaginal or intra-anal electrical stimulation were used. RESULTS The mean age was 54 ± 12 years and 67% were female. After treatment, there was an improvement in symptoms of urinary urgency, frequency, incontinence, nocturia, and in the sensation of incomplete emptying (P < .001). There was also a reduction in the overactive bladder symptom score from 10 ± 4 to 6 ± 3 (P < .001) and an increase in the perineal muscle strength (P <.001). The urodynamic parameters improved, with reduction in the frequency of patients with detrusor hyperactivity from 57.9% to 42.1%, detrusor-sphincter dyssynergia from 31.6% to 5.3%, detrusor hypocontractility from 15.8% to 0%, and detrusor areflexia from 10.5% to 0%, with positive repercussions in the quality of life in all patients. CONCLUSION Physiotherapy was effective in cases of human T-lymphotropic virus 1-associated neurogenic bladder, reducing symptoms, increasing perineal muscle strength, and improving urodynamic parameters and quality of life.
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Affiliation(s)
- Rosana C P Andrade
- Physiotherapy Department, Complexo Hospitalar Professor Edgard Santos, Universidade Federal da Bahia (UFBA), Salvador, Bahia, Brazil; Postgraduate Program in Health Sciences, Federal University of Bahia School of Medicine, Salvador, Bahia, Brazil
| | - José A Neto
- Immunology Service, Complexo Hospitalar Professor Edgard Santos, Universidade Federal da Bahia (UFBA), Salvador, Bahia, Brazil; Postgraduate Program in Health Sciences, Federal University of Bahia School of Medicine, Salvador, Bahia, Brazil
| | - Luciana Andrade
- Physiotherapy Department, Complexo Hospitalar Professor Edgard Santos, Universidade Federal da Bahia (UFBA), Salvador, Bahia, Brazil
| | - Tatiane S Oliveira
- Physiotherapy Department, Complexo Hospitalar Professor Edgard Santos, Universidade Federal da Bahia (UFBA), Salvador, Bahia, Brazil
| | - Dislene N Santos
- Physiotherapy Department, Complexo Hospitalar Professor Edgard Santos, Universidade Federal da Bahia (UFBA), Salvador, Bahia, Brazil
| | - Cassius J V Oliveira
- Immunology Service, Complexo Hospitalar Professor Edgard Santos, Universidade Federal da Bahia (UFBA), Salvador, Bahia, Brazil; Postgraduate Program in Health Sciences, Federal University of Bahia School of Medicine, Salvador, Bahia, Brazil
| | - Márcio J Prado
- Department of Gynecology, Complexo Hospitalar Professor Edgard Santos, Universidade Federal da Bahia (UFBA), Salvador, Bahia, Brazil
| | - Edgar M Carvalho
- Immunology Service, Complexo Hospitalar Professor Edgard Santos, Universidade Federal da Bahia (UFBA), Salvador, Bahia, Brazil; Gonçalo Moniz Research Center, Fiocruz, Salvador, Bahia, Brazil; National Institute of Science and Technology in Tropical Diseases (INCT-DT), MCT/CNPq, Universidade Federal da Bahia (UFBA), Salvador, Bahia, Brazil; Postgraduate Program in Health Sciences, Federal University of Bahia School of Medicine, Salvador, Bahia, Brazil.
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Literature Review: Long-Term Complications of the Neurogenic Bladder. CURRENT BLADDER DYSFUNCTION REPORTS 2015. [DOI: 10.1007/s11884-015-0337-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
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Ginsberg DA, Schneider LK, Watanabe TK. Improving Outcomes in Patients With Refractory Idiopathic and Neurogenic Detrusor Overactivity: Management Strategies. Arch Phys Med Rehabil 2015; 96:S341-57.e1. [PMID: 26318392 DOI: 10.1016/j.apmr.2015.05.016] [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: 02/12/2015] [Revised: 05/18/2015] [Accepted: 05/26/2015] [Indexed: 11/26/2022]
Abstract
Neurogenic detrusor overactivity (NDO) is a lower urinary tract dysfunction commonly seen in rehabilitation settings. The emotional, medical, and financial consequences of NDO can be substantial and management typically requires a multidisciplinary team approach. Physiatrists need to be able to identify patients who require referral to specialists for diagnostic testing or higher-tiered treatment and need to engender open lines of communication between their patients and all treating clinicians. This requires an understanding of the evaluation, diagnosis, and treatment of neurogenic lower urinary tract dysfunctions.
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Affiliation(s)
- David A Ginsberg
- Department of Urology, University of Southern California, Los Angeles, CA; Rancho Los Amigos National Rehabilitation Center, Downey, CA.
| | | | - Thomas K Watanabe
- Department of Physical Medicine and Rehabilitation, Temple University School of Medicine, Philadelphia, PA; Drucker Brain Injury Center, Moss Rehab at Elkins Park, Elkins Park, PA
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