1
|
Türker A, Özkeskin M. Investigation of urinary disorders, functional independence, and quality of life in children with cerebral palsy. Neurourol Urodyn 2023; 42:597-606. [PMID: 36710569 DOI: 10.1002/nau.25135] [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: 10/20/2022] [Revised: 12/10/2022] [Accepted: 01/16/2023] [Indexed: 01/31/2023]
Abstract
PURPOSE The study aimed to investigate the relationship between voiding disorders, functional independence, and quality of life, according to the gross motor function classification system, in children with cerebral palsy (CP) aged 8-17. METHODS A total of 102 individuals (aged 8-17) with CP were included in the study. The Gross Motor Function Classification System (GMFCS), Dysfunctional Voiding and Incontinence Scoring System (DVISS), Wee Functional Independence Measure for Children (WeeFIM), and Pediatric Quality of Life Inventory (PedsQL) were used to evaluate the clinical parameters. RESULTS There is a statistically significant difference in DVISS (p = 0.010), WeeFIM (p = 0.001), and PedsQL (p = 0.001) scores of individuals with CP regarding GMFCS. According to the CP classification, there is a statistically significant difference between WeeFIM (p = 0.001) and PedsQL (p = 0.020) scores. Besides, there is a significant difference between DVISS (p = 0.048), WeeFIM (p = 0.001) and PedsQL (p = 0.001) according to the ambulation status of individuals with CP. On the other hand, there is a positive moderate, statistically significant correlation between WeeFIM and PedsQL scores (ρ = 0.306, r = 0.002). A moderately negative statistically significant relationship exists between PedsQL and DVISS (ρ = -0.266, r = 0.007). A negative, moderate, statistically significant correlation was shown between DVISS and WeeFIM scores (ρ = -0.323, r = 0.001). CONCLUSIONS As the gross motor functional level of individuals with CP increased, voiding dysfunction increased; on the other hand, functional independence and quality of life decreased.
Collapse
Affiliation(s)
- Arda Türker
- Department of Physiotherapy and Rehabilitation, Institute of Health Sciences, Istanbul Okan University, Istanbul, Turkey
| | - Mehmet Özkeskin
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Ege University, Izmir, Turkey
| |
Collapse
|
2
|
Akkoc Y. Efficacy and safety of mirabegron for treatment of neurogenic detrusor overactivity in adults with spinal cord injury or multiple sclerosis: a systematic review. Spinal Cord 2022; 60:854-861. [PMID: 36085413 DOI: 10.1038/s41393-022-00853-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Revised: 08/26/2022] [Accepted: 08/29/2022] [Indexed: 12/24/2022]
Abstract
STUDY DESIGN Systematic review. OBJECTIVE To evaluate the efficacy and safety of mirabegron in patients with neurogenic detrusor overactivity due to SCI or MS. METHODS A comprehensive search of the Pubmed, Cochrane, Scopus, and Embase databases was performed. Studies evaluating adult patients with neurogenic detrusor overactivity due to SCI or MS were analyzed according to clinical and urodynamic outcome parameters. RESULTS A total of 488 patients were included in 11 studies, with sample sizes ranging from 15 to 91. The duration of the treatments varied from 4 weeks to 12 months. Mirabegron was used as a secondline treatment after anticholinergics in most of the studies. While clinical outcome parameters are used in studies involving only MS patients, urodynamic outcome parameters are also used in studies involving patients with SCI. The efficacy of mirabegron was found not to be different than anticholinergics when compared in MS patients. Comprehensive urodynamic evaluation was performed in 2 randomized, double-blind, placebo-controlled studies and no satisfactory results were obtained compared to placebo. In retrospective studies there were some significant improvements in Pdet(max), MCC and compliance. The major safety concern with mirabegron is cardiovascular safety. In one study, tachyarrhythmia and palpitations reported in a patient with SCI at C6 level, in another study tachycardia reported in one patient with MS. CONCLUSIONS Although mirabegron demonstrates similar clinical efficacy to anticholinergics in MS patients, its effect on urodynamic parameters in patients with SCI cannot be considered satisfactory. It has a good safety profile with mild cardiovascular side effects.
Collapse
Affiliation(s)
- Yesim Akkoc
- Department of Physical Medicine and Rehabilitation, Ege University Medical Faculty, Izmir, Turkey.
| |
Collapse
|
3
|
Zhang F, Wang F, Li CH, Wang JW, Han CL, Fan SY, Gao DM, Xing YJ, Yang C, Zhang JG, Meng FG. Subthalamic nucleus-deep brain stimulation improves autonomic dysfunctions in Parkinson's disease. BMC Neurol 2022; 22:124. [PMID: 35361123 PMCID: PMC8969348 DOI: 10.1186/s12883-022-02651-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Accepted: 03/23/2022] [Indexed: 11/21/2022] Open
Abstract
Background To study the effects of subthalamic nucleus-deep brain stimulation (STN-DBS) on autonomic dysfunctions in Parkinson’s disease (PD) patients. Methods A total of 57 PD patients who underwent bilateral STN-DBS from March to December 2018, were retrospectively analyzed. Preplanned assessments at baseline and postoperatively at 1, 3, and 6 months also included the Scales for Outcomes in Parkinson’s Disease-Autonomic questionnaire (SCOPA-Aut), the Unified Parkinson’s Disease Rating Scale (UPDRS) III score, levodopa equivalent day dose (LEDD), Parkinson’s Disease Quality of Life Scale (PDQ-39), the Hamilton Anxiety Rating Scale (HAMA), and the Hamilton Depression Rating Scale (HAMD). Results The SCOPA-Aut scores improved significantly [14.59% (18.32%), 24.00% (27.05%), 22.16% (27.07%), all P < 0.001] at 1 month, 3 months, and 6 months of STN-DBS, respectively. Analysis of the SCOPA-Aut sub-items showed significant improvements only in urine and thermoregulation sub-items at 6 months after surgery (P < 0.001). There was no significant correlation between improvements of SCOPA-Aut scores and improvements of PDQ-39 scores (P > 0.05) at 6 months after surgery. SCOPA-Aut scores were positively correlated with age (r = 0.428, P = 0.001); the improvements of SCCOPA-Aut scores were positively correlated with improvements of HAMA and HAMD scores (HAMA: r = 0.325, P = 0.015; HAMD: r = 0.265, P = 0.049) at 6 months after surgery. Conclusion STN-DBS improved autonomic dysfunction symptoms of PD patients, and urinary and thermoregulatory sub-items of autonomic dysfunction were improved in the short-term after surgery. There was a close relationship between improved autonomic symptoms and improved anxiety and depression 6 months after surgery. We should therefore direct more attention to autonomic dysfunctions in PD involving detailed preoperative evaluations and postoperative follow-ups, to improve the quality of life of patients.
Collapse
Affiliation(s)
- Feng Zhang
- Department of Neurosurgery, the First Hospital of Hebei Medical University, Shijiazhuang, 050031, Hebei, China
| | - Feng Wang
- Departments of Neurosurgery, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310000, Zhejiang, China.,Departments of Neurosurgery, General Hospital of Ningxia Medical University, Yinchuan, 750004, Ningxia, China
| | - Cong-Hui Li
- Department of Neurosurgery, the First Hospital of Hebei Medical University, Shijiazhuang, 050031, Hebei, China
| | - Ji-Wei Wang
- Department of Neurosurgery, the First Hospital of Hebei Medical University, Shijiazhuang, 050031, Hebei, China
| | - Chun-Lei Han
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100070, China
| | - Shi-Ying Fan
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100070, China
| | - Dong-Mei Gao
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100070, China
| | - Yu-Jing Xing
- Department of Neurosurgery, the First Hospital of Hebei Medical University, Shijiazhuang, 050031, Hebei, China
| | - Chen Yang
- Department of Neurosurgery, the First Hospital of Hebei Medical University, Shijiazhuang, 050031, Hebei, China
| | - Jian-Guo Zhang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100070, China
| | - Fan-Gang Meng
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100070, China. .,Beijing Neurosurgical Institute, Capital Medical University, Beijing, 100070, China. .,Beijing Key Laboratory of Neurostimulation, Beijing, 100070, China. .,Chinese Institute for Brain Research, Beijing, 102206, China.
| |
Collapse
|
4
|
Duncan D. Role of the community nurse in Parkinson's disease and lower urinary disorders. Br J Community Nurs 2021; 26:251-254. [PMID: 33939461 DOI: 10.12968/bjcn.2021.26.5.251] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Parkinson's disease (PD) is an incurable and progressive neurodegenerative disorder. People with PD also have increased muscle weakness and the typical symptoms of tremor, stiffness, slowness, balance problems and/or gait disorders. Other symptoms may include an overactive bladder, urgency and nocturia which can often lead to incontinence. Treatment options vary are dependent on the cause of the incontinence and should focus on improving Quality of life with a multi-pronged diagnosis-specific approach that takes into consideration a patient's ability to comply with treatment. The article looks at the role of the community nurse in caring for patients with PD and lower urinary disorders. They have a key role in assessment of patients and supporting families with tailor made bladder training such as establish a regular toilet routine, education about pelvic floor exercises or supply of incontinence products.
Collapse
Affiliation(s)
- Debbie Duncan
- Lecturer (Education), School of Nursing and Midwifery, Queen's University, Belfast
| |
Collapse
|
5
|
Vasudeva P, Prasad V, Yadav S, Kumar N, Saurav K, Prashanth YM, Tyagi V. Efficacy and safety of mirabegron for the treatment of neurogenic detrusor overactivity resulting from traumatic spinal cord injury: A prospective study. Neurourol Urodyn 2021; 40:666-671. [PMID: 33410559 DOI: 10.1002/nau.24604] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Revised: 12/18/2020] [Accepted: 12/21/2020] [Indexed: 11/08/2022]
Abstract
OBJECTIVE To assess the clinical, urodynamic efficacy, and safety of mirabegron in patients with neurogenic detrusor overactivity (NDO) consequent to traumatic spinal cord injury (SCI). METHODS This prospective cohort study was performed between January 2018 and July 2019 and included adult patients with stable traumatic suprasacral SCI, performing clean intermittent catheterization (CIC), and demonstrating NDO on urodynamic study (UDS). A 3-day bladder diary was made at the baseline after which all patients were started on Mirabegron 50 mg. They were followed up at 6 weeks with a repeat bladder diary and UDS which were compared with those at the baseline. RESULTS A total of 30 patients (4 females, 26 males, mean age: 30.07 years) were included. After 6 weeks of treatment, 5 out of the 29 incontinent patients became completely dry. The mean frequency of CIC decreased from 6.63 at the baseline to 5.37 at 6 weeks (p = .002), the mean CIC volume increased from 275 ml to 341 ml (p = .0002), the mean number of incontinence episodes in between CIC reduced from 3.97 to 2.27 (p < .0001) and time from CIC to leakage increased from 1.73 h to 2.75 h (p < .0001). The mean cystometric capacity increased from 348 ml to 406 ml (p = .008) and the maximum amplitude of NDO decreased from 54 cm H2 O to 41 cm H2 O (p = .005) at 6 weeks. Only two patients reported new onset dry mouth. No major adverse events were noted and none discontinued treatment. CONCLUSION Mirabegron is efficacious and safe in patients with NDO consequent to traumatic SCI.
Collapse
Affiliation(s)
- Pawan Vasudeva
- Department of Urology & Renal transplant, V.M. Medical College and Safdarjang Hospital, New Delhi, India
| | - Vishnu Prasad
- Department of Urology & Renal transplant, V.M. Medical College and Safdarjang Hospital, New Delhi, India
| | - Siddharth Yadav
- Department of Urology & Renal transplant, V.M. Medical College and Safdarjang Hospital, New Delhi, India
| | - Niraj Kumar
- Department of Urology & Renal transplant, V.M. Medical College and Safdarjang Hospital, New Delhi, India
| | - Kumar Saurav
- Department of Urology & Renal transplant, V.M. Medical College and Safdarjang Hospital, New Delhi, India
| | - Y M Prashanth
- Department of Urology & Renal transplant, V.M. Medical College and Safdarjang Hospital, New Delhi, India
| | - Vijay Tyagi
- Department of Urology & Renal transplant, V.M. Medical College and Safdarjang Hospital, New Delhi, India
| |
Collapse
|
6
|
Ding X, Zhou L, Jiang X, Liu H, Yao J, Zhang R, Liang D, Wang F, Ma M, Tang B, Wu E, Teng J, Wang X. Propagation of Pathological α-Synuclein from the Urogenital Tract to the Brain Initiates MSA-like Syndrome. iScience 2020; 23:101166. [PMID: 32470898 PMCID: PMC7260590 DOI: 10.1016/j.isci.2020.101166] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Revised: 12/29/2019] [Accepted: 05/08/2020] [Indexed: 01/10/2023] Open
Abstract
The neuropathological feature of multiple system atrophy (MSA), a fatal adult-onset disorder without effective therapy, is the accumulation of pathological α-synuclein (α-Syn) in the central nervous system (CNS). Here we show that pathological α-Syn exists in nerve terminals in detrusor and external urethral sphincter (EUS) of patients with MSA. Furthermore, α-Syn-preformed fibrils (PFFs) injected in the EUS or detrusor in TgM83+/− mice initiated the transmission of pathological α-Syn from the urogenital tract to brain via micturition reflex pathways, and these mice developed widespread phosphorylated α-Syn inclusion pathology together with phenotypes. In addition, urinary dysfunction and denervation-reinnervation of external anal sphincter were detected earlier in the mouse models with α-Syn PFFs inoculation before the behavioral manifestations. These results suggest that pathological α-Syn spreading through the micturition reflex pathways retrogradely from the urogenital tract to CNS may lead to urinary dysfunction in patients with MSA, which is different from the etiology of idiopathic Parkinson disease. Pathological α-Syn exhibits in nerve terminals in DET and EUS of patients with MSA Propagation of pathological α-Syn from urinary tract to CNS causes MSA-like syndrome The mouse models show urinary dysfunction and abnormal EAS EMG before motor deficits Lower urinary tract injection of α-Syn PFFs induces autonomic and motor dysfunctions
Collapse
Affiliation(s)
- Xuebing Ding
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan 450052, China; Institute of Parkinson and Movement Disorder, Zhengzhou University, Zhengzhou, Henan 450052, China.
| | - Lebo Zhou
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan 450052, China; Institute of Parkinson and Movement Disorder, Zhengzhou University, Zhengzhou, Henan 450052, China
| | - Xiaoyi Jiang
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan 450052, China; Institute of Parkinson and Movement Disorder, Zhengzhou University, Zhengzhou, Henan 450052, China
| | - Han Liu
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan 450052, China; Institute of Parkinson and Movement Disorder, Zhengzhou University, Zhengzhou, Henan 450052, China
| | - Jing Yao
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan 450052, China; Institute of Parkinson and Movement Disorder, Zhengzhou University, Zhengzhou, Henan 450052, China
| | - Rui Zhang
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan 450052, China; Institute of Parkinson and Movement Disorder, Zhengzhou University, Zhengzhou, Henan 450052, China
| | - Dongxiao Liang
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan 450052, China; Institute of Parkinson and Movement Disorder, Zhengzhou University, Zhengzhou, Henan 450052, China
| | - Fengfei Wang
- Neuroscience Institute and Department of Neurosurgery, Baylor Scott & White Health, Temple, TX 76508, USA; College of Medicine, Texas A&M Health Science Center, College Station, TX 77843, USA
| | - Mingming Ma
- Department of Neurology, Affiliated People's Hospital of Zhengzhou University, Henan Provincial People's Hospital, Zhengzhou, Henan 450003, China.
| | - Beisha Tang
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, Hunan 410008, China; National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Changsha, Hunan 410008, China.
| | - Erxi Wu
- Neuroscience Institute and Department of Neurosurgery, Baylor Scott & White Health, Temple, TX 76508, USA; College of Medicine, Texas A&M Health Science Center, College Station, TX 77843, USA; College of Pharmacy, Texas A&M Health Science Center, College Station, TX 77843, USA; LIVESTRONG Cancer Institutes, Dell Medical School, the University of Texas at Austin, Austin, TX 78712, USA.
| | - Junfang Teng
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan 450052, China; Institute of Parkinson and Movement Disorder, Zhengzhou University, Zhengzhou, Henan 450052, China.
| | - Xuejing Wang
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan 450052, China; Institute of Parkinson and Movement Disorder, Zhengzhou University, Zhengzhou, Henan 450052, China.
| |
Collapse
|
7
|
Lucke-Wold B. Managing Acute Urinary Dysfunction for Neurologic Injury Patients. JOURNAL OF EXPERIMENTAL NEUROLOGY 2020; 1:40-42. [PMID: 32661516 PMCID: PMC7357962 DOI: pmid/32661516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Grants] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
|
8
|
Vaughan CP, Fitzgerald CM, Markland AD. Management of Urinary Incontinence in Older Adults in Rehabilitation Care Settings. CURRENT PHYSICAL MEDICINE AND REHABILITATION REPORTS 2019. [DOI: 10.1007/s40141-019-00221-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
9
|
Lima DX, Pires CR, Santos ACRD, Mendes RG, Fonseca CEC, Zocratto OB. Quality of life evaluation of patients with neurogenic bladder submitted to reconstructive urological surgeries preserving the bladder. Int Braz J Urol 2015. [PMID: 26200548 PMCID: PMC4752148 DOI: 10.1590/s1677-5538.ibju.2014.0150] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Treatment of neurogenic bladder (BN) aims to upper urinary tract protection. When the conservative clinical measures are insufficient, surgical treatment is indicated. Though admittedly important, the quality of life (QoL) has been little studied in these patients, there are even contradictory results. The aim of this study was to evaluate QoL before and after bladder augmentation in patients with BN refractory to medical treatment. We analyzed, prospectively, the data of 67 patients who underwent surgical treatment for BN by questionnaire SF-36® and Qualiveen® QoL before and after six months of operation. Comparisons using paired t-tests and Wilcoxon and the assumption of normality was assessed using the Shapiro-Wilk test were made. According to the analysis of the SF-36® questionnaire, the patients had higher QoL indices in the postoperative period in the areas functional capacity, general state of health, vitality, social aspects, emotional aspects and mental health (n = 67; p <0.05). The questionnaire also revealed Qualiveen® best result in quality of life index in the postoperative period, and show lower specific negative impact by urinary problems (n = 36; p <0.05). The results show that, despite not being the main objective, the bladder augmentation results in significant improvement in QoL, probably related to the perception of better health and the resolution of urinary incontinence. Thus, the bladder augmentation associated with other urologic reconstruction techniques allows the upper urinary tract protection, and contribute to a better quality of life of patients with BN.
Collapse
Affiliation(s)
- Daniel Xavier Lima
- Hospital of the Medical School of the Federal University of Minas Gerais
| | | | | | | | | | | |
Collapse
|
10
|
Initial experience with the treatment of neurogenic detrusor overactivity with a new β-3 agonist (mirabegron) in patients with spinal cord injury. Spinal Cord 2015; 54:78-82. [PMID: 26503222 DOI: 10.1038/sc.2015.195] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2015] [Revised: 09/18/2015] [Accepted: 10/01/2015] [Indexed: 11/09/2022]
Abstract
STUDY DESIGN It is a retrospective chart analysis. OBJECTIVES In patients with neurogenic lower urinary tract dysfunction (NLUTD) due to spinal cord injury (SCI), neurogenic detrusor overactivity (NDO) can cause both deterioration of the upper urinary tract and urinary incontinence. Antimuscarinic treatment is frequently discontinued due to side effects or lack of efficacy, whereas injection of onabotulinumtoxin into the detrusor is a minimally invasive procedure with risks of urinary retention, infection and haematuria. Mirabegron, a new β-3 agonist, is a potential new agent for treatment of NDO. Aim of the study was to evaluate the efficacy of mirabegron in SCI patients with NLUTD. SETTING Swiss Paraplegic Center, Nottwil, Switzerland. METHODS A retrospective chart analysis of SCI patient treated with mirabegron. RESULTS Fifteen patients with NDO were treated with mirabegron for a period of at least 6 weeks. Significant reduction of the frequency of bladder evacuation per 24 h (8.1 vs 6.4, P=0.003), and of incontinence episodes per 24 h (2.9 vs 1.3, P=0.027) was observed. Furthermore, we observed improvements in bladder capacity (from 365 to 419 ml), compliance (from 28 to 45 ml cm(-1) H(2)0) and detrusor pressure during storage phase (45.8 vs 30 cm H(2)0). At follow-up, 9/15 patients were satisfied with the therapy, 4/15 reported side effects (3 × aggravation of urinary incontinence, 1 × constipation). CONCLUSIONS Mirabegron may evolve as an alternative in the treatment of NDO. We observed improvements in urodynamic and clinical parameters. Due to the limited number of patients and the retrospective nature of the study, prospective, placebo-controlled studies are necessary.
Collapse
|
11
|
Abstract
To critically review recent literature on lower urinary tract symptoms (LUTS) in patients with Parkinson's Disease.A literature search was conducted using the keywords LUTS, urinary symptoms, non-motor, and Parkinson's disease (PD) via the PubMed/Medline search engine. In the literature, we critically examined lower urinary symptoms in Parkinson's patients by analyzing prevalence, pathogenesis, urinary manifestations, pharmacologic trials and interventions, and prior review articles. The data collected ranged from 1986 to the present with an emphasis placed on recent publications.The literature regards LUTS in PD as a major comorbidity, especially with respect to a patient's quality of life. Parkinson's patients experience both storage and voiding difficulties. Storage symptoms, specifically overactive bladder, are markedly worse in patients with PD than in the general population. Surgical management of prostatic obstruction in PD can improve urinary symptoms. Multiple management options exist to alleviate storage LUTS in patients with PD, ranging from behavioral modification to surgery, and vary in efficacy.Lower urinary tract dysfunction in PD may be debilitating. Quality of life can be improved with a multi-pronged diagnosis-specific approach to treatment that takes into consideration a patient's ability to comply with treatment. A stepwise algorithm is presented and may be utilized by clinicians in managing LUTS in Parkinson's patients.
Collapse
|
12
|
Sakakibara R, Panicker J, Finazzi-Agro E, Iacovelli V, Bruschini H. A guideline for the management of bladder dysfunction in Parkinson's disease and other gait disorders. Neurourol Urodyn 2015; 35:551-63. [PMID: 25810035 DOI: 10.1002/nau.22764] [Citation(s) in RCA: 81] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2014] [Accepted: 02/19/2015] [Indexed: 12/19/2022]
Abstract
Parkinson's disease (PD) is a common neurodegenerative disorder, and lower urinary tract (LUT) dysfunction is one of the most common autonomic disorders with an estimated incidence rate of 27-80%. Studies have shown that bladder dysfunction significantly influences quality-of-life (QOL) measures, early institutionalisation, and health economics. We review the pathophysiology of bladder dysfunction in PD, lower urinary tract symptoms (LUTS), objective assessment, and treatment options. In patients with PD, disruption of the dopamine D1-GABAergic direct pathway may lead to LUTS. Overactive bladder (OAB) is the most common LUT symptom in PD patients, and an objective assessment using urodynamics commonly shows detrusor overactivity (DO) in these patients. The post-void residual (PVR) volume is minimal in PD, which differs significantly from multiple system atrophy (MSA) patients who have a more progressive disease that leads to urinary retention. However, subclinical detrusor weakness during voiding may also occur in PD. Regarding bladder management, there are no large, double-blind, prospective studies in this area. It is well recognised that dopaminergic drugs can improve or worsen LUTS in PD patients. Therefore, an add-on therapy with anticholinergics is required. Beta-3 adrenergic agonists are a potential treatment option because there are little to no central cognitive events. Newer interventions, such as deep brain stimulation (DBS), are expected to improve bladder dysfunction in PD. Botulinum toxin injections can be used to treat intractable urinary incontinence in PD. Transurethral resection of the prostate gland (TURP) for comorbid BPH in PD is now recognised to be not contraindicated if MSA is excluded. Collaboration of urologists with neurologists is highly recommended to maximise a patients' bladder-associated QOL. Neurourol. Urodynam. 35:551-563, 2016. © 2015 Wiley Periodicals, Inc.
Collapse
Affiliation(s)
- Ryuji Sakakibara
- Neurology, Internal Medicine, Sakura Medical Center, Toho University, Sakura, Japan
| | - Jalesh Panicker
- Neurology, National Hospital for Neurology & Neurosurgery, London, United Kingdom
| | - Enrico Finazzi-Agro
- Department of Experimental Medicine and Surgery, Tor Vergata University and Unit for Functional Urology, Policlinico Tor Vergata University Hospital, Rome, Italy
| | - Valerio Iacovelli
- School of Specialization in Urology, Tor Vergata University Unit for Functional Urology, Policlinico Tor Vergata University Hospital, Rome, Italy
| | | | | |
Collapse
|
13
|
Michels L, Blok BFM, Gregorini F, Kurz M, Schurch B, Kessler TM, Kollias S, Mehnert U. Supraspinal Control of Urine Storage and Micturition in Men--An fMRI Study. Cereb Cortex 2014; 25:3369-80. [PMID: 24969474 PMCID: PMC4585491 DOI: 10.1093/cercor/bhu140] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
Despite the crucial role of the brain in the control of the human lower urinary tract, little is known about the supraspinal mechanisms regulating micturition. To investigate the central regulatory mechanisms activated during micturition initiation and actual micturition, we used an alternating sequence of micturition imitation/imagination, micturition initiation, and actual micturition in 22 healthy males undergoing functional magnetic resonance imaging. Subjects able to micturate (voiders) showed the most prominent supraspinal activity during the final phase of micturition initiation whereas actual micturition was associated with significantly less such activity. Initiation of micturition in voiders induced significant activity in the brainstem (periaqueductal gray, pons), insula, thalamus, prefrontal cortex, parietal operculum and cingulate cortex with significant functional connectivity between the forebrain and parietal operculum. Subjects unable to micturate (nonvoiders) showed less robust activation during initiation of micturition, with activity in the forebrain and brainstem particularly lacking. Our findings suggest that micturition is controlled by a specific supraspinal network which is essential for the voluntary initiation of micturition. Once this network triggers the bulbospinal micturition reflex via brainstem centers, micturition continues automatically without further supraspinal input. Unsuccessful micturition is characterized by a failure to activate the periaqueductal gray and pons during initiation.
Collapse
Affiliation(s)
- Lars Michels
- Institute of Neuroradiology, University Hospital Zurich, 8091 Zurich, Switzerland
| | - Bertil F M Blok
- Department of Urology, Erasmus Medical Center, Erasmus University, Rotterdam, The Netherlands
| | - Flavia Gregorini
- Neuro-Urology, Spinal Cord Injury Center & Research, University of Zurich, Balgrist University Hospital, 8008 Zurich, Switzerland
| | - Michael Kurz
- Department of Urology, University Hospital Zurich, 8091 Zurich, Switzerland
| | - Brigitte Schurch
- Neuro-Urology, Department of Clinical Neurosciences, University Hospital Centre (CHUV), University of Lausanne, 1011 Lausanne, Switzerland
| | - Thomas M Kessler
- Neuro-Urology, Spinal Cord Injury Center & Research, University of Zurich, Balgrist University Hospital, 8008 Zurich, Switzerland
| | - Spyros Kollias
- Institute of Neuroradiology, University Hospital Zurich, 8091 Zurich, Switzerland
| | - Ulrich Mehnert
- Neuro-Urology, Spinal Cord Injury Center & Research, University of Zurich, Balgrist University Hospital, 8008 Zurich, Switzerland
| |
Collapse
|
14
|
Sand PK, Sand RI. The diagnosis and management of lower urinary tract symptoms in multiple sclerosis patients. Dis Mon 2013; 59:261-8. [PMID: 23786660 DOI: 10.1016/j.disamonth.2013.03.013] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Sixty-five percent of multiple sclerosis patients have moderate to severe urinary symptoms and up to 14% initially present with urinary symptomatology. Urinary retention, neurogenic detrusor overactivity, and detrusor sphincter dyssynergia, all increase the risk for urinary tract infections in patients with multiple sclerosis, and these infections may exacerbate their immune response, leading to symptom progression. Fewer than half of the patients with urinary symptoms have seen a specialist and only half have been treated for their neurogenic detrusor overactivity. Several treatments including pelvic floor muscle therapy, pelvic floor electrical stimulation, anticholinergics, desmopressin, sacral nerve neuromodulation, posterior tibial nerve stimulation, cannabinoids, and intravesical therapy with vanniloids, as well as botulinum toxin, have all been shown to be effective in treating urinary symptoms in those with multiple sclerosis. Clean intermittent catheterization is invaluable in patients with persistent urinary retention to avoid infection and upper tract dysfunction. Indwelling transurethral catheterization should be avoided because of the high risk of infection. Identification and successful treatment of these urinary conditions will improve the health and quality of life for these men and women.
Collapse
|
15
|
Nardos R, Gregory WT, Krisky C, Newell A, Nardos B, Schlaggar B, Fair DA. Examining mechanisms of brain control of bladder function with resting state functional connectivity MRI. Neurourol Urodyn 2013; 33:493-501. [PMID: 23908139 DOI: 10.1002/nau.22458] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2013] [Accepted: 06/07/2013] [Indexed: 11/09/2022]
Abstract
AIMS This aim of this study is to identify the brain mechanisms involved in bladder control. METHODS We used fMRI to identify brain regions that are activated during bladder filling. We then used resting state connectivity fMRI (rs-fcMRI) to assess functional connectivity of regions identified by fMRI with the rest of the brain as the bladder is filled to capacity. RESULTS Female participants (n = 20) were between ages 40 and 64 with no significant history of symptomatic urinary incontinence. Main effect of time (MET) fMRI analysis resulted in 20 regions of interest (ROIs) that have significant change in BOLD signal (z = 3.25, P <0.05) over the course of subtle bladder filling and emptying regardless of full versus empty bladder state. Bladder-state by time (BST) fMRI analysis resulted in three ROIs that have significant change in BOLD signal (z = 3.25, P <0.05) over the course of bladder runs comparing full versus empty bladder state. Rs-fcMRI fixed effects analysis identified significant changes in connectivity between full and empty bladder states in seven brain regions (z = 4.0) using the three BST ROIs and sixteen brain regions (z = 7) using the twenty MET ROIs. Regions identified include medial frontal gyrus, posterior cingulate (PCC), inferiolateral temporal and post-central gyrus, amygdale, the caudate, inferior parietal lobe as well as anterior and middle cingulate gyrus. CONCLUSIONS There is significant and vast changes in the brain's functional connectivity when bladder is filled suggesting that the central process responsible for the increased control during the full bladder state appears to largely rely on the how distributed brain systems are functionally integrated.
Collapse
Affiliation(s)
- Rahel Nardos
- Oregon Health and Science University, Portland, Oregon; Kaiser Permanente, Clackamas, Oregon
| | | | | | | | | | | | | |
Collapse
|
16
|
Kapoor S, Bourdoumis A, Mambu L, Barua J. Effective management of lower urinary tract dysfunction in idiopathic Parkinson's disease. Int J Urol 2013; 20:79-84. [PMID: 23281786 DOI: 10.1111/j.1442-2042.2012.03220.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2012] [Accepted: 09/30/2012] [Indexed: 12/14/2022]
Abstract
Parkinson's disease, also known as paralysis agitans, is a progressive degenerative disorder of the central nervous system, with onset usually between the ages of 50 and 65 years, and is associated with loss of dopaminergic neurons in the subsantia nigra and the presence of Lewy bodies. It is characterized by the triad of resting tremor, muscular rigidity and bradykinesia. Often-accompanying abnormalities include disorders of equilibrium, posture and autonomic function, including micturition. Symptoms from the lower urinary tract add a significant comorbidity factor in these patients. The incidence and prevalence of lower urinary tract dysfunction rise with increasing progression of the underlying neurological disease. They present a troublesome and difficult to treat health issue with a profound impact on the patient's quality of life. Storage symptoms seem to predominate. In the long term, renal function might be compromised, mainly as a result of elevated intravesical pressure. Various conservative, minimally-invasive and surgical treatment options are available to prevent harmful sequelae, and to improve the quality of life of these patients. We present an overview of current and prospective treatment strategies.
Collapse
Affiliation(s)
- Sona Kapoor
- Urology Department, King George Hospital, Barking, Havering and Redbridge University Teaching Hospitals NHS Trust, Essex, UK.
| | | | | | | |
Collapse
|
17
|
Li WJ, Oh SJ. Management of lower urinary tract dysfunction in patients with neurological disorders. Korean J Urol 2012; 53:583-92. [PMID: 23060994 PMCID: PMC3459999 DOI: 10.4111/kju.2012.53.9.583] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2012] [Accepted: 07/18/2012] [Indexed: 01/29/2023] Open
Abstract
The proper performance of the lower urinary tract is dependent on an intact neural innervation of the individual structures involved. Therefore, any congenital neurological anomalies, diseases, or lesions of the central, peripheral, or autonomic nervous systems can result in lower urinary tract symptoms. Lower urinary tract dysfunction (LUTD) secondary to neurological disorders can significantly reduce quality of life (QoL) and may also give rise to serious complications and psychological and social sequelae. The goals of management of LUTD in patients with neurological disorders are to prevent serious complications and to improve the patient's QoL. Understanding the physiology and pathophysiology of micturition is critical to selecting appropriate treatment options. This article provides an overview of the clinical characteristics, diagnosis, and management of LUTD in patients with certain central and peripheral neuropathies and common lesions.
Collapse
Affiliation(s)
- Wen Ji Li
- Department of Urology, Seoul National University Hospital, Neuroscience Research Institute, Medical Research Center, Seoul National University College of Medicine, Seoul, Korea. ; Department of Urology and Andrology, Ninth People's Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | | |
Collapse
|
18
|
Hamill RW, Tompkins JD, Girard BM, Kershen RT, Parsons RL, Vizzard MA. Autonomic dysfunction and plasticity in micturition reflexes in human α-synuclein mice. Dev Neurobiol 2012; 72:918-36. [PMID: 21916020 PMCID: PMC4028626 DOI: 10.1002/dneu.20978] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Although often overshadowed by the motor dysfunction associated with Parkinson's disease (PD), autonomic dysfunction including urinary bladder and bowel dysfunctions are often associated with PD and may precede motoric changes; such autonomic dysfunction may permit early detection and intervention. Lower urinary tract symptoms are common in PD patients and result in significant morbidity. This studies focus on nonmotor symptoms in PD using a transgenic mouse model with overexpression of human α-synuclein (hSNCA), the peptide found in high concentrations in Lewy body neuronal inclusions, the histopathologic hallmark of PD. We examined changes in the physiological, molecular, chemical, and electrical properties of neuronal pathways controlling urinary bladder function in transgenic mice. The results of these studies reveal that autonomic dysfunction (i.e., urinary bladder) can precede motor dysfunction. In addition, mice with hSNCA overexpression in relevant neuronal populations is associated with alterations in expression of neurotransmitter/neuromodulatory molecules (PACAP, VIP, substance P, and neuronal NOS) within neuronal pathways regulating bladder function as well as with increased NGF expression in the urinary bladder. Changes in the electrical and synaptic properties of neurons in the major pelvic ganglia that provide postganglionic innervation to urogenital tissues were not changed as determined with intracellular recording. The urinary bladder dysfunction observed in transgenic mice likely reflects changes in peripheral (i.e., afferent) and/or central micturition pathways or changes in the urinary bladder. SYN-OE mice provide an opportunity to examine early events underlying the molecular and cellular plasticity of autonomic nervous system pathways underlying synucleinopathies.
Collapse
Affiliation(s)
- Robert W Hamill
- Department of Anatomy and Neurobiology, University of Vermont College of Medicine, Burlington, Vermont 05405, USA.
| | | | | | | | | | | |
Collapse
|
19
|
Mehnert U, Nehiba M. [Neuro-urological dysfunction of the lower urinary tract in CNS diseases: pathophysiology, epidemiology, and treatment options]. Urologe A 2012; 51:189-97. [PMID: 22331072 DOI: 10.1007/s00120-011-2796-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The lower urinary tract (LUT) is regulated by a complex neural network that is subject to supraspinal control. Neurological disorders, especially of the central nervous system (CNS), can rapidly lead to disruption of this control. Multiple sclerosis, Parkinson's disease, multiple system atrophy, and stroke are neurological disorders which quite frequently cause dysfunction of the LUT. With respect to the pathophysiology of bladder dysfunction in CNS diseases there are various hypotheses regarding the individual disorders: disturbances of neural communication between the frontal cortex and pontine micturition center, between the pontine micturition center and the lumbosacral parts of the spinal cord, and between the basal ganglia, thalamus, and anterior cingulate gyrus appear to play a pivotal role in the development of bladder dysfunction. The symptoms and urodynamic presentation of LUT dysfunction can vary considerably depending on the disease and disease progression and can change in the course of the disease. The incidence and prevalence of LUT dysfunctions rise with increasing progression of the underlying neurological disease.Various conservative, minimally invasive, and open surgical procedures are available to prevent harmful sequelae and to improve the quality of life of these patients. As yet, however, few data exist on most of the treatment options in cases of the above-mentioned CNS diseases. Intermittent self-catheterization and antimuscarinic medications are among the most important conservative treatment options. Injection of botulinum neurotoxin type A into the detrusor muscle and increasingly sacral or pudendal neuromodulation are among the most important minimally invasive treatment options. Surgical methods include reconstructive continent or incontinent urinary diversion.When planning therapy the patient's current needs and neurological limitations as well as possible disease progression must be taken into consideration. It is often advisable to consult with and enlist the cooperation of the attending neurologist when planning treatment.
Collapse
Affiliation(s)
- U Mehnert
- Urologische Klinik, Marienhospital Herne, Universitätsklinikum der Ruhr-Universität Bochum, Widumer Straße 8, 44627 Herne, Deutschland.
| | | |
Collapse
|
20
|
Edokpolo LU, Stavris KB, Foster HE. Intermittent catheterization and recurrent urinary tract infection in spinal cord injury. Top Spinal Cord Inj Rehabil 2012; 18:187-92. [PMID: 23459635 PMCID: PMC3584766 DOI: 10.1310/sci1802-187] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE To study the association of recurrent symptomatic urinary tract infections (UTIs) with the long-term use of clean intermittent catheterization (CIC) for the management of neurogenic bladder in patients with spinal cord injury (SCI). METHODS Retrospective study of 61 SCI patients with neurogenic bladder managed by CIC. Subjects were selected from 210 SCI patients seen at the Yale Urology Medical Group between 2000 and 2010. Medical UTI prophylaxis (PRx) with oral antimicrobials or methenamine/ascorbic acid was used to identify patients with recurrent UTI. The number of positive cultures (≥10(3) cfu/mL) within a year prior to starting PRx was used to confirm the recurrence of UTI. RESULTS Fifty-one male and 10 female subjects were managed with CIC. Forty-one (67%) subjects were placed on medical PRx for symptomatic recurrent UTI. Seventeen (28%) subjects had at least 3 positive cultures within the year prior to starting PRx. Fifteen of 20 (75%) subjects not on PRx had no complaints of UTI symptoms in the final year of follow-up. CONCLUSION Recurrent symptomatic UTIs remain a major complication of long-term CIC in SCI patients. Although CIC is believed to have the fewest number of complications, many SCI patients managed with long-term CIC are started on medical PRx early in the course of management. Future studies are needed to determine the efficacy of routine UTI PRx in these patients as well as determine what factors influence why many patients on CIC experience frequent infections and others do not.
Collapse
Affiliation(s)
- Leonard U Edokpolo
- Department of Urology, Yale University School of Medicine , New Haven , Connecticut
| | | | | |
Collapse
|
21
|
Vaughan CP, Goode PS, Burgio KL, Markland AD. Urinary Incontinence in Older Adults. ACTA ACUST UNITED AC 2011; 78:558-70. [DOI: 10.1002/msj.20276] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
|