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Chen SF, Kuo HC. Interventional management and surgery of neurogenic lower urinary tract dysfunction in patients with chronic spinal cord injury: A urologist's perspective. Low Urin Tract Symptoms 2022; 14:132-139. [PMID: 35233967 DOI: 10.1111/luts.12434] [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: 12/12/2021] [Revised: 02/10/2022] [Accepted: 02/13/2022] [Indexed: 11/30/2022]
Abstract
Neurogenic lower urinary tract dysfunction (NLUTD) caused by spinal cord injury (SCI) is challenging for urologists. NLUTD not only affects the quality of life but also endangers the upper urinary tract of patients with chronic SCI. Considering that the bladder and urethral function change with time, regular follow-up of NLUTD is necessary, and any complication should be adequately treated. The first priority of bladder management in patients with chronic SCI manifesting NLUTD should be renal function preservation, followed by the normalization of lower urinary tract function. The quality of life should also be assessed. Patients who have a high risk for impaired renal function should be more frequently identified and investigated. Conservative treatment and pharmacological therapy should be started as early as possible. Intravesical or urethral injections of botulinum toxin A is an alternative treatment for refractory NLUTD. When surgical intervention is necessary, less invasive and reversible procedures should be considered first. Improving patients' quality of life and willingness to undergo bladder management is the most important aspect of treatment.
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Affiliation(s)
- Sheng-Fu Chen
- Department of Urology, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation and Tzu Chi University, Hualien, Taiwan
| | - Hann-Chorng Kuo
- Department of Urology, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation and Tzu Chi University, Hualien, Taiwan
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Jang TM, Lee JH, Zhou H, Joo J, Lim BH, Cheng H, Kim SH, Kang IS, Lee KS, Park E, Hwang SW. Expandable and implantable bioelectronic complex for analyzing and regulating real-time activity of the urinary bladder. SCIENCE ADVANCES 2020; 6:6/46/eabc9675. [PMID: 33177091 PMCID: PMC7673729 DOI: 10.1126/sciadv.abc9675] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/24/2020] [Accepted: 09/23/2020] [Indexed: 05/06/2023]
Abstract
Underactive bladder or detrusor underactivity (DUA), that is, not being able to micturate, has received less attention with little research and remains unknown or limited on pathological causes and treatments as opposed to overactive bladder, although the syndrome may pose a risk of urinary infections or life-threatening kidney damage. Here, we present an integrated expandable electronic and optoelectronic complex that behaves as a single body with the elastic, time-dynamic urinary bladder with substantial volume changes up to ~300%. The system configuration of the electronics validated by the theoretical model allows conformal, seamless integration onto the urinary bladder without a glue or suture, enabling precise monitoring with various electrical components for real-time status and efficient optogenetic manipulation for urination at the desired time. In vivo experiments using diabetic DUA models demonstrate the possibility for practical uses of high-fidelity electronics in clinical trials associated with the bladder and other elastic organs.
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Affiliation(s)
- Tae-Min Jang
- KU-KIST Graduate School of Converging Science and Technology, Korea University, Seoul, Republic of Korea
| | - Joong Hoon Lee
- KU-KIST Graduate School of Converging Science and Technology, Korea University, Seoul, Republic of Korea
| | - Honglei Zhou
- Department of Engineering Science and Mechanics, Penn State University, University Park, PA, USA
- Department of Engineering Mechanics, School of Mechanics, Civil Engineering and Architecture, Northwestern Polytechnical University, Xi'an, P.R. China
| | - Jaesun Joo
- Biomedical Engineering Research Center, Smart Healthcare Research Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Bong Hee Lim
- Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Huanyu Cheng
- Department of Engineering Science and Mechanics, Penn State University, University Park, PA, USA
| | - Soo Hyun Kim
- KU-KIST Graduate School of Converging Science and Technology, Korea University, Seoul, Republic of Korea
- Center for Biomaterials, Biomedical Research Institute, Korea Institute of Science and Technology, Seoul, Republic of Korea
| | - Il-Suk Kang
- National NanoFab Center, Korea Advanced Institute of Science and Technology, Daejeon, Republic of Korea
| | - Kyu-Sung Lee
- Biomedical Engineering Research Center, Smart Healthcare Research Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
- Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
- Department of Medical Device Management and Research, SAIHST, Sungkyunkwan University, Seoul, Republic of Korea
| | - Eunkyoung Park
- Biomedical Engineering Research Center, Smart Healthcare Research Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
- Department of Medical Device Management and Research, SAIHST, Sungkyunkwan University, Seoul, Republic of Korea
| | - Suk-Won Hwang
- KU-KIST Graduate School of Converging Science and Technology, Korea University, Seoul, Republic of Korea.
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Colaco M, Osman NI, Karakeçi A, Artibani W, Andersson KE, Badlani GH. Current concepts of the acontractile bladder. BJU Int 2018; 122:195-202. [PMID: 29633516 DOI: 10.1111/bju.14236] [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] [Indexed: 01/11/2023]
Abstract
The acontractile bladder (AcB) is a urodynamic-based diagnosis wherein the bladder is unable to demonstrate any contraction during a pressure flow study. Although it is often grouped with underactive bladder, it is a unique phenomenon and should be investigated independently. The purpose of the present review was to examine the current literature on AcB regarding its pathology, diagnosis, current management guidelines, and future developments. We performed a review of the PubMed database, classifying the evidence for AcB pathology, diagnosis, treatment, and potential future treatments. Over the 67 years covered in our review period, 42 studies were identified that met our criteria. Studies were largely poor quality and mainly consisted of retrospective review or animal models. The underlying pathology of AcB is variable with both neurological and myogenic aetiologies. Treatment is largely tailored for renal preservation and reduction of infection. Although future developments may allow more functional restorative treatments, current treatments mainly focus on bladder drainage. AcB is a unique and understudied bladder phenomenon. Treatment is largely based on symptoms and presentation. While cellular therapy and neuromodulation may hold promise, further research is needed into the underlying neuro-urological pathophysiology of this disease so that we may better develop future treatments.
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Affiliation(s)
- Marc Colaco
- Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Nadir I Osman
- Academic Urology Unit, Royal Hallamshire Hospital, Sheffield, UK
| | | | - Walter Artibani
- Urologic Clinic, University Hospital, Ospedale Policlinico, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
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Kim DK. Current pharmacological and surgical treatment of underactive bladder. Investig Clin Urol 2017; 58:S90-S98. [PMID: 29279881 PMCID: PMC5740035 DOI: 10.4111/icu.2017.58.s2.s90] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2017] [Accepted: 10/18/2017] [Indexed: 11/18/2022] Open
Abstract
Generally accepted guidelines are not yet available on the management of underactive bladder (UAB). Although the natural history of UAB is still not fully understood, observation may be an acceptable management option in patients with tolerable lower urinary tract symptoms and little risk of upper urinary tract damage. If needed, scheduled and double voiding may be recommended as an effective and safe add-on therapy. Parasympathomimetics have been widely used for the management of UAB, but the evidence does not support clinical benefit. The efficacy of alpha-blockers has also not yet been clearly demonstrated. However, selective alpha-blockers may help to enhance voiding efficiency and to decrease possible upper tract damage. Sacral neuromodulation is a surgical option for nonobstructive UAB approved by the Food and Drug Administration. However, the response rate of test stimulation is not high and the efficacy of permanent implants does not always coincide with that of test stimulation. Although surgery to reduce outlet resistance may be a viable option in UAB with presumed obstruction, surgery seems to have little role in those without obstruction. Latissimus dorsi detrusor myoplasty has shown promising results in restoring voluntary voiding in selected patients. The procedure requires a multidisciplinary team approach of urologists and plastic reconstructive experts. In summary, current treatments of UAB remain unsatisfactory. The multifactorial nature of UAB pathogenesis complicates the appropriate management for each patient. Future research to establish a more clinically relevant definition of UAB will be required to open new era of UAB management.
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Affiliation(s)
- Dae Kyung Kim
- Department of Urology, Eulji University Hospital, Eulji University College of Medicine, Daejeon, Korea
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Abstract
Underactive bladder (UAB) is a very common condition leading to disabling lower urinary tract symptoms. There has been an increasing interest in this condition as there is no effective treatment currently available. UAB has been described in many ways, but there is no agreed upon consensus on its terminology. The prevalence of UAB may be underestimated. This review focuses on the terminology, pathophysiology, common causes, its treatment, and future areas of research.
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Affiliation(s)
- Himanshu Aggarwal
- Department of Urology, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, J8 122, Dallas, TX, 75390-9110, USA
| | - Philippe E Zimmern
- Department of Urology, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, J8 122, Dallas, TX, 75390-9110, USA.
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Schurch B, Tawadros C, Carda S. Dysfunction of lower urinary tract in patients with spinal cord injury. HANDBOOK OF CLINICAL NEUROLOGY 2015; 130:247-67. [PMID: 26003248 DOI: 10.1016/b978-0-444-63247-0.00014-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Over the past 50 years, the mortality for urorenal cause in patients with spinal cord injuries (SCI) has decreased from over 75% to 2.3%, as a result of dramatic improvements in the diagnosis and management of lower urinary tract dysfunction (LUTD). The aims of this chapter are to assess the physiopathology of upper and lower motor neuron lesion on bladder and sphincter function after SCI, to give an overview of required clinical and instrumental examination and to discuss treatment modalities. Videourodynamic examination plays a key role in the assessment and follow-up of LUTD in SCI patients, in conjunction with neurophysiological and radiological examinations. The cornerstone of bladder management in SCI is clean intermittent self-catheterization, but often other treatments are needed to achieve full continence, to reduce infections and stone formation, to protect the upper urinary tract from excessive bladder pressure, and to prevent chronic renal failure. Treatments may be pharmacologic (i.e., anticholinergic drugs and botulinum toxin) or surgical (by enterocystoplasty or urinary diversion). In selected cases, neuromodulation and sacral root stimulation can be used to reduce detrusor overactivity and empty the bladder. Management of LUTD in SCI patients requires a deep knowledge of spinal cord medicine and functioning of patients with neurologic disability.
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Affiliation(s)
- Brigitte Schurch
- Neuropsychology and Neurorehabilitation Service, Department of Clinical Neuroscience, Lausanne University Hospital, Lausanne, Switzerland.
| | - Cécile Tawadros
- Urology Service, Lausanne University Hospital, Lausanne, Switzerland
| | - Stefano Carda
- Neuropsychology and Neurorehabilitation Service, Department of Clinical Neuroscience, Lausanne University Hospital, Lausanne, Switzerland
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Drake MJ, Williams J, Bijos DA. Voiding dysfunction due to detrusor underactivity: an overview. Nat Rev Urol 2014; 11:454-64. [PMID: 25002201 DOI: 10.1038/nrurol.2014.156] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Detrusor underactivity (DUA) is defined as a voiding contraction of reduced strength and/or duration, which prolongs urination and/or prevents complete emptying of the bladder within a 'normal' period of time. This issue is associated with voiding and postmicturition urinary symptoms, and can predispose to urinary infections and acute urinary retention. The aetiology of DUA is influenced by multiple factors, including ageing, bladder outlet obstruction, neurological disease, and autonomic denervation. The true prevalence of this condition remains unknown, as most data come from referral populations. Urodynamic testing is used to diagnose the condition, either by assessing the relationship between bladder pressures and urinary flow, or by interrupting voiding to measure detrusor pressure change under isovolumetric conditions. Current treatments for DUA have poor efficacy and tolerability, and often fail to improve quality of life; muscarinic receptor agonists, in particular, have limited efficacy and frequent adverse effects. Bladder emptying might be achieved through Valsalva straining, and intermittent or indwelling catheterization, although sacral nerve stimulation can reduce dependency on catheterization. Novel stem-cell-based therapies have been attempted; however, new drugs that increase contractility are currently largely conceptual, and the complex pathophysiology of DUA, difficulty achieving organ specificity of treatment, the limited availability of animal models, and the subjective nature of current outcome measures must be addressed to facilitate the development of such agents.
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Affiliation(s)
- Marcus J Drake
- Urology Department, University of Bristol and Bristol Urological Institute, Southmead Hospital, Bristol, Avon BS10 5NB, UK
| | - Jonathan Williams
- Urology Department, University of Bristol and Bristol Urological Institute, Southmead Hospital, Bristol, Avon BS10 5NB, UK
| | - Dominika A Bijos
- Urology Department, University of Bristol and Bristol Urological Institute, Southmead Hospital, Bristol, Avon BS10 5NB, UK
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Rom M, Waldert M, Klingler HC, Klatte T. Bladder outlet obstruction in men with acute urinary retention: an urodynamic study. World J Urol 2013; 31:1045-50. [PMID: 23325166 DOI: 10.1007/s00345-013-1027-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2012] [Accepted: 01/08/2013] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE To identify clinical predictors of bladder outlet obstruction (BOO) in men with the first episode of spontaneous acute urinary retention (AUR), in order to facilitate patient selection for early de-obstructive prostate surgery. METHODS A multichannel urodynamic investigation was performed in 156 consecutive men ≥ 50 years five days following AUR. Clinical routine parameters were evaluated for their ability to predict BOO, which was defined as a BOO-index (BOOI) >40. Univariable and multivariable logistic regression models were fitted. A nomogram was constructed from significant variables of a reduced multivariable model. Discrimination and calibration of the nomogram were assessed. RESULTS The mean age of the 156 men was 71.6 years, and the mean drained volume was 953 mL. Seventy-two men (46.2 %) had severe AUR-associated pain. On urodynamic evaluation, 79 (50.6 %) were obstructed (BOOI > 40). In multivariable regression analysis, age (p = 0.014) drained volume (p = 0.044) and pain intensity (p < 0.001) were independently associated with BOO. These variables formed the basis of the nomogram, which predicted BOO with a bootstrap-corrected accuracy of 78.2 %. The positive predictive value, sensitivity, and specificity of a 70 % nomogram cutoff was 83, 51, and 90 %, respectively. Decision-curve analysis demonstrated a net benefit with use of the nomogram. CONCLUSIONS The routine clinical parameters age, drained volume, and pain intensity are independent predictors of BOO in men with AUR. According to our model, patients with a nomogram predicted BOO probability of >70 % might be candidates for early surgery. External validation of the nomogram is advocated.
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Affiliation(s)
- Maximilian Rom
- Department of Urology, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
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Abstract
Patients with congenital and acquired neurogenic bladder dysfunction due to central and peripheral nervous lesions are significantly limited in their daily lives. The neurogenic dysfunction of the bladder and lower urinary tract are often misinterpreted and later fed to a diagnosis. Without therapy severe complications, including renal damage, could be the consequence in the follow up. Therefore, dedicated diagnostics have to be done to recognize the different disorders and to determine the specific therapy. For these patients a lifelong bladder monitoring and neuro-urological management is necessary. This article describes techniques of neuro-urological testings and the interpretation in case of neurogenic disorders.
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Abstract
Muscarinic receptors comprise five cloned subtypes, encoded by five distinct genes, which correspond to pharmacologically defined receptors (M(1)-M(5)). They belong to the family of G-protein-coupled receptors and couple differentially to the G-proteins. Preferentially, the inhibitory muscarinic M(2) and M(4) receptors couple to G(i/o), whereas the excitatory muscarinic M(1), M(3), and M(5) receptors preferentially couple to G(q/11). In general, muscarinic M(1), M(3), and M(5) receptors increase intracellular calcium by mobilizing phosphoinositides that generate inositol 1,4,5-trisphosphate (InsP3) and 1,2-diacylglycerol (DAG), whereas M(2) and M(4) receptors are negatively coupled to adenylyl cyclase. Muscarinic receptors are distributed to all parts of the lower urinary tract. The clinical use of antimuscarinic drugs in the treatment of detrusor overactivity and the overactive bladder syndrome has focused interest on the muscarinic receptors not only of the detrusor, but also of other components of the bladder wall, and these have been widely studied. However, the muscarinic receptors in the urethra, prostate, and ureter, and the effects they mediate in the normal state and in different urinary tract pathologies, have so far not been well characterized. In this review, the expression of and the functional effects mediated by muscarinic receptors in the bladder, urethra, prostate, and ureters, under normal conditions and in different pathologies, are discussed.
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Ahmad I, Krishna NS, Small DR, Conn IG. Aetiology and Management of Acute Female Urinary Retention. ACTA ACUST UNITED AC 2009. [DOI: 10.1016/j.bjmsu.2008.10.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Aims: Interest in female urinary retention has increased recently because of improved understanding in the pathophysiology as well as the availability of specialised treatments such as sacral neuromodulation. There is little in the literature regarding the incidence and aetiology of urinary retention in females. We therefore undertook a review of all female retention patients presenting to our urology unit over an 11 year period. Methods: 300 females presented with retention in 11 years January 1996 to January 2007 (7% of the male incidence). 81 presented more than once. Median age was 67. Aetiology included urethral stenosis ( n = 51), urinary tract infection ( n = 33), constipation ( n = 23), neurological causes ( n = 14), gynaecological causes ( n = 16), non urological post-operative patients ( n = 21), medications ( n = 7) and clot retention secondary to bladder cancer ( n = 12). Results: Ultrasound ( n = 240) was carried out in the majority, cystoscopy ( n = 140), and urodynamics in a minority ( n = 38). Urethral pressure profilometry ( n = 38) revealed significantly higher closure pressures as compared to a control group—median 90 vs. 57mmH20 ( p = 0.02). 245 had successful trials without catheter. Prior to this, treatments included cystoscopy and urethral dilatation ( n = 73), laxatives ( n = 25) or antibiotics ( n = 29). Initially 54 patients were taught intermittent self-catheterisation; 38 patients were unable to perform this, and left with a long-term catheter. Conclusions: The number of female retentions encountered in our practice is fairly high, with very few of these fitting the criteria for sacral nerve stimulation. In a third no aetiology was found. Approximately half of those who successfully voided did so with no treatment.
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Affiliation(s)
- Imran Ahmad
- Beatson Institute for Cancer Research, Garscube Estate, Switchback Road, Bearsden, Glasgow G61 1BD, Scotland, UK
| | | | - Douglas Ramsay Small
- Department of Urology, Southern General Hospital, 1345 Govan Road, Glasgow, Scotland, UK
| | - Ian Graeme Conn
- Department of Urology, Southern General Hospital, 1345 Govan Road, Glasgow, Scotland, UK
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Kalsi J, Harland SJ, Feneley MR. Electromotive drug administration with mitomycin C for intravesical treatment of non-muscle invasive transitional cell carcinoma. Expert Opin Drug Deliv 2007; 5:137-45. [DOI: 10.1517/17425247.5.1.137] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Kim JY, Hong JH, Lee KS. The Effect of Bethanechol Chloride with an α-adrenergic Blocker in Patients with Impaired Detrusor Contractility. Korean J Urol 2007. [DOI: 10.4111/kju.2007.48.10.1040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Affiliation(s)
- Ji Young Kim
- Department of Urology, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jeong Hee Hong
- Department of Urology, Dankook University College of Medicine, Cheonan, Korea
| | - Kyu-Sung Lee
- Department of Urology, Sungkyunkwan University School of Medicine, Seoul, Korea
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Semins MJ, Chancellor MB. Diagnosis and management of patients with overactive bladder syndrome and abnormal detrusor activity. ACTA ACUST UNITED AC 2006; 1:78-84; quiz 109. [PMID: 16474519 DOI: 10.1038/ncpuro0054] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2004] [Accepted: 10/29/2004] [Indexed: 11/09/2022]
Abstract
Overactive bladder syndrome (OABS) is a widely recognized syndrome with symptoms that can include urinary urgency, frequency, nocturia, and incontinence. Although there may be several causative factors for OABS, detrusor overactivity is the most common. In addition, urinary incontinence can also be due to a distinct but equally bothersome condition underactive bladder syndrome, or detrusor underactivity. The incomplete bladder emptying that characterizes detrusor underactivity often arises from impaired contractile function of the detrusor muscle. The variations in etiologies of the two syndromes necessitate patient evaluations tailored to individual symptom presentation. Increased awareness of the differences between the manifestations of OABS and underactive bladder syndrome call for specific approaches to the management of bladder dysfunction.
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Abstract
Female voiding dysfunction is poorly understood; it lacks standard definitions, and there is no consensus on diagnostic criteria. In the majority of women who are neurologically intact the cause is idiopathic. It affects the sufferers' quality of life, but unfortunately there is a paucity of published literature on its management. This review examines the current knowledge on the management of this common problem. Diagnosis is aimed at identifying the underlying aetiological factors, which are discussed, as well as the importance of a detailed history and focused physical examination. Investigations essential to management are outlined. Developments in the medical treatment of voiding dysfunction have been disappointing. The role of surgery is even more limited except for those with postoperative voiding problems after new-generation sling procedures. Intermittent self-catheterisation, supervised and supported by a dedicated nursing specialist, remains the mainstay of management. A multidisciplinary approach is essential to success. Emerging treatment modalities such as sacral and peripheral neuromodulation and the use of alpha(1)-blockers are discussed. Botulinum toxin A injections have been useful in some cases. There are relatively few publications on the effectiveness of these interventions in clinical practice. These issues need to be addressed by quality research. Female voiding dysfunction presents a challenge to urogynaecologists and urologists alike.
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Affiliation(s)
- Lawrence O Olujide
- Department of Obstetrics and Gynaecology, Royal Bournemouth Hospital, Castle Lane East, Bournemouth, Dorset BH7 7DW, UK.
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DasGupta R, Fowler CJ. The management of female voiding dysfunction: Fowler's syndrome -- a contemporary update. Curr Opin Urol 2003; 13:293-9. [PMID: 12811293 DOI: 10.1097/00042307-200307000-00005] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW Several aspects of voiding dysfunction in women remain under investigation, including standardization of the diagnosis and management of bladder outflow obstruction. This article describes a specific cause of urinary retention in young women, associated with a failure of urethral sphincter relaxation, and a treatment option that can restore voiding in this group of patients - sacral nerve electrical stimulation therapy. Recently there have been advances in the stimulator implantation technique, as well as in our appreciation of its mechanism of action. RECENT FINDINGS Advances include the use of ancillary investigations such as urethral function tests as well as better understanding of the clinical profile of these patients. Improvements in the surgical technique include better methods of lead fixation and a less invasive surgical approach. Research suggests the action of neuromodulation is on the afferent pathway, though it remains to be shown whether this is at a spinal or supraspinal level. It is likely that sacral nerve stimulation has an indirect modulatory effect on detrusor contractility rather than a direct effect on the sphincter. SUMMARY Experience of sacral nerve stimulation has increased over the past few years, and its application is expanding to other clinical domains. This knowledge has helped improve the therapy, which is particularly effective in the treatment of women with urinary retention. Although how it works is still not fully understood, this is something that is being addressed by ongoing research.
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Affiliation(s)
- Ranan DasGupta
- Department of Uro-Neurology, National Hospital for Neurology & Neursurgery, London, UK.
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Abstract
Impaired detrusor contractility (IDC) is a poorly defined entity that represents a treatment challenge for the urologist. The etiology of IDC is variable and may include neurologic disorders, inflammatory conditions, and pharmacologic and psychogenic causes. The gold standard for the treatment of IDC is clean intermittent catheterization (CIC). Although well-established as efficacious and safe, CIC may be conceived as a major burden on a patient's quality of life and has been associated with urinary tract infections and urethral and/or bladder injury. Alternative treatment modalities for IDC can be divided into interventions at the nervous system supplying the bladder, the bladder itself, or the bladder outlet. We review and discuss novel and creative treatment options for patients with IDC that have been developed or tested over the past decade.
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Affiliation(s)
- Shahar Madjar
- The Northern Michigan Bladder Control Center, 100 Malton Road, Negaunee, MI 49866, USA.
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18
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Lackner TE. Pharmacotherapy of Urinary Incontinence. J Am Med Dir Assoc 2002. [DOI: 10.1016/s1525-8610(04)70254-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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