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Kerensky MJ, Paul A, Routkevitch D, Hersh AM, Kempski Leadingham KM, Davidar AD, Judy BF, Punnoose J, Williams A, Kumar A, Lehner K, Smith B, Son JK, Azadi JR, Shekhar H, Mercado-Shekhar KP, Thakor NV, Theodore N, Manbachi A. Tethered spinal cord tension assessed via ultrasound elastography in computational and intraoperative human studies. COMMUNICATIONS MEDICINE 2024; 4:4. [PMID: 38182729 PMCID: PMC10770351 DOI: 10.1038/s43856-023-00430-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Accepted: 12/19/2023] [Indexed: 01/07/2024] Open
Abstract
BACKGROUND Tension in the spinal cord is a trademark of tethered cord syndrome. Unfortunately, existing tests cannot quantify tension across the bulk of the cord, making the diagnostic evaluation of stretch ambiguous. A potential non-destructive metric for spinal cord tension is ultrasound-derived shear wave velocity (SWV). The velocity is sensitive to tissue elasticity and boundary conditions including strain. We use the term Ultrasound Tensography to describe the acoustic evaluation of tension with SWV. METHODS Our solution Tethered cord Assessment with Ultrasound Tensography (TAUT) was utilized in three sub-studies: finite element simulations, a cadaveric benchtop validation, and a neurosurgical case series. The simulation computed SWV for given tensile forces. The cadaveric model with induced tension validated the SWV-tension relationship. Lastly, SWV was measured intraoperatively in patients diagnosed with tethered cords who underwent treatment (spinal column shortening). The surgery alleviates tension by decreasing the vertebral column length. RESULTS Here we observe a strong linear relationship between tension and squared SWV across the preclinical sub-studies. Higher tension induces faster shear waves in the simulation (R2 = 0.984) and cadaveric (R2 = 0.951) models. The SWV decreases in all neurosurgical procedures (p < 0.001). Moreover, TAUT has a c-statistic of 0.962 (0.92-1.00), detecting all tethered cords. CONCLUSIONS This study presents a physical, clinical metric of spinal cord tension. Strong agreement among computational, cadaveric, and clinical studies demonstrates the utility of ultrasound-induced SWV for quantitative intraoperative feedback. This technology is positioned to enhance tethered cord diagnosis, treatment, and postoperative monitoring as it differentiates stretched from healthy cords.
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Affiliation(s)
- Max J Kerensky
- Department of Biomedical Engineering, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- HEPIUS Innovation Laboratory, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Abhijit Paul
- Discipline of Biological Engineering, Indian Institute of Technology Gandhinagar, Gujarat, India
| | - Denis Routkevitch
- Department of Biomedical Engineering, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- HEPIUS Innovation Laboratory, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Andrew M Hersh
- HEPIUS Innovation Laboratory, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Kelley M Kempski Leadingham
- HEPIUS Innovation Laboratory, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - A Daniel Davidar
- HEPIUS Innovation Laboratory, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Brendan F Judy
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Joshua Punnoose
- HEPIUS Innovation Laboratory, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Autumn Williams
- Department of Biomedical Engineering, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Avisha Kumar
- HEPIUS Innovation Laboratory, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Department of Electrical and Computer Engineering, Johns Hopkins University, Baltimore, MD, USA
| | - Kurt Lehner
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Beth Smith
- HEPIUS Innovation Laboratory, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Jennifer K Son
- HEPIUS Innovation Laboratory, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Javad R Azadi
- HEPIUS Innovation Laboratory, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Himanshu Shekhar
- Discipline of Electrical Engineering, Indian Institute of Technology Gandhinagar, Gujarat, India
| | - Karla P Mercado-Shekhar
- Discipline of Biological Engineering, Indian Institute of Technology Gandhinagar, Gujarat, India
| | - Nitish V Thakor
- Department of Biomedical Engineering, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- HEPIUS Innovation Laboratory, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Department of Electrical and Computer Engineering, Johns Hopkins University, Baltimore, MD, USA
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Nicholas Theodore
- Department of Biomedical Engineering, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- HEPIUS Innovation Laboratory, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Department of Orthopaedic Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Amir Manbachi
- Department of Biomedical Engineering, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
- HEPIUS Innovation Laboratory, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
- Department of Electrical and Computer Engineering, Johns Hopkins University, Baltimore, MD, USA.
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
- Department of Mechanical Engineering, Johns Hopkins University, Baltimore, MD, USA.
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Sacral Spina Bifida Occulta: A Frequency Analysis of Secular Change. ANTHROPOLOGICAL REVIEW 2022. [DOI: 10.18778/1898-6773.85.2.02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Substantial relaxation of natural selection beginning around 1900 changed the mutation/selection balance of modern genetic material, producing an increase in variable anatomical structures. While multiple structures have been affected, the temporal increase in variations of the sacrum, specifically, ‘Sacral Spina Bifida Occulta,’ have been reliably demonstrated on a localised scale. Calculation of largescale frequency has been hindered by the localised nature of these publications, the morphological variability of this variation, and potential pathological associations, which have produced divergent classifications, and conflicting reported rates of occurrence. A systematic review of the reported literature was conducted to provide an objective analysis of Sacral Spina Bifida Occulta frequency from 2500 BCE to the present. This review was designed to compensate for observed inconsistencies in reporting and to ascertain, for the first time, the temporal trajectory of this secular trend. A systematic review of Sacral Spina Bifida Occulta literature was conducted through the strict use of clinical meta-analysis criteria. Publications were retrieved from four databases: PubMed, Embase, the Adelaide University Library database, and Google Scholar. Data were separated into three historical groups, (1 = <1900, 2 = 1900 to 1980 and 3 = >1980), and frequency outcomes compared, to determine temporal rates of occurrence.
A total of 39/409 publications were included in the final analysis, representing data for 16,167 sacra, spanning a period of 4,500 years. Statistically significant results were obtained, with total open S1 frequency increasing from 2.34%, (79 to 1900CE), to 4.80%, (1900 to 1980CE) and to 5.43% (>1980CE). These increases were significant at p<0.0001, with Chi-squared analysis. A clear secular increase in the global frequency of Sacral Spina Bifida Occulta has been demonstrated from 1900 to the present. This research provides a novel and adaptable framework for the future assessment of variation distribution, with important implications for the fields of biological anthropology and bioarchaeology.
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Moussa M, Papatsoris AG, Chakra MA, Fares Y, Dabboucy B, Dellis A. Perspectives on urological care in spina bifida patients. Intractable Rare Dis Res 2021; 10:1-10. [PMID: 33614369 PMCID: PMC7882087 DOI: 10.5582/irdr.2020.03077] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Revised: 10/04/2020] [Accepted: 12/12/2020] [Indexed: 02/05/2023] Open
Abstract
Spina bifida (SB) is a neurogenetic disorder with a complex etiology that involves genetic and environmental factors. SB can occur in two major forms of open SB or SB aperta and closed SB or SB occulta. Myelomeningocele (MMC), the most common neural tube defects (NTDs), occurs in approximately 1 in 1,000 births. Considering non-genetic factors, diminished folate status is the best-known factor influencing NTD risk. The methylenetetrahydrofolate reductase (MTHFR) gene has been implicated as a risk factor for NTDs. The primary disorder in the pathogenesis of MMC is failed neural tube closure in the embryonic spinal region. The clinical manifestation of SB depends on clinical type and severity. SB can be detected in the second trimester using ultrasound which will reveal specific cranial signs. The management of MMC traditionally involves surgery within 48 h of birth. Prenatal repair of MMC is recommended for fetuses who meet maternal and fetal Management of Myelomeningocele Study (MOMS) specified criteria. Urological manifestations of SB include urinary incontinence, urolithiasis, sexual dysfunction, renal dysfunction, and urinary tract infection. Renal failure is among the most severe complications of SB. The most important role of the urologist is the management of neurogenic bladder. Medical management with clean intermittent catheterization and anticholinergic treatment is generally considered the gold standard of therapy. However, when this therapy fails surgical reconstruction become the only remaining option. This review will summarize the pathogenesis, risk factors, genetic contribution, diagnostic test, and management of SB. Lastly, the urologic outcomes and therapies are reviewed.
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Affiliation(s)
- Mohamad Moussa
- Urology Department, Zahraa Hospital, University Medical Center, Lebanese University, Beirut, Lebanon
| | - Athanasios G. Papatsoris
- 2nd Department of Urology, School of Medicine, Sismanoglio Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Mohamad Abou Chakra
- Department of Urology, Faculty of Medicine, Lebanese University, Beirut, Lebanon
| | - Youssef Fares
- Department of Neurosurgery, Neuroscience Research Center, Faculty of Medical Sciences, Lebanese University, Beirut, Lebanon
| | - Baraa Dabboucy
- Department of Neurosurgery, Faculty of Medicine, Lebanese University, Beirut, Lebanon
| | - Athanasios Dellis
- Department of Urology/General Surgery, Areteion Hospital, Athens, Greece
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Peyronnet B, Gao F, Brochard C, Oger E, Scailteux LM, Balusson F, Hascoet J, Alimi Q, Khene ZE, Bayat S, Jezequel M, Olivari C, Voiry C, Kerdraon J, Bouguen G, Game X, Siproudhis L, Manunta A. Urologic Disorders are Still the Leading Cause of In-hospital Death in Patients With Spina Bifida. Urology 2020; 137:200-204. [DOI: 10.1016/j.urology.2019.11.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2019] [Revised: 11/06/2019] [Accepted: 11/07/2019] [Indexed: 01/04/2023]
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Peyronnet B, Brochard C, Jezequel M, Hascoet J, Alimi Q, Senal N, Carsin-Nicole B, Riffaud L, Le Reste PJ, Bonan I, Olivari-Philiponnet C, Siproudhis L, Kerdraon J, Game X, Manunta A. Comparison of neurogenic lower urinary tract dysfunctions in open versus closed spinal dysraphism: A prospective cross-sectional study of 318 patients. Neurourol Urodyn 2018; 37:2818-2826. [DOI: 10.1002/nau.23782] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2018] [Accepted: 07/09/2018] [Indexed: 12/16/2022]
Affiliation(s)
- Benoit Peyronnet
- Service d'urologie; CHU Rennes; Rennes France
- Centre de référence spina bifida; CHU Rennes; Rennes France
- Equipe thématique INPHY CIC 1414 et INSERM UMR 991; CHU Rennes; Rennes France
| | - Charlène Brochard
- Centre de référence spina bifida; CHU Rennes; Rennes France
- Equipe thématique INPHY CIC 1414 et INSERM UMR 991; CHU Rennes; Rennes France
- Service de Gastro-Entérologie; CHU Rennes; Rennes France
| | | | - Juliette Hascoet
- Service d'urologie; CHU Rennes; Rennes France
- Centre de référence spina bifida; CHU Rennes; Rennes France
- Equipe thématique INPHY CIC 1414 et INSERM UMR 991; CHU Rennes; Rennes France
| | - Quentin Alimi
- Service d'urologie; CHU Rennes; Rennes France
- Centre de référence spina bifida; CHU Rennes; Rennes France
- Equipe thématique INPHY CIC 1414 et INSERM UMR 991; CHU Rennes; Rennes France
| | - Nelly Senal
- Centre de référence spina bifida; CHU Rennes; Rennes France
- Service de Médecine Physique et Réadaptation; CHU Rennes; Rennes France
| | - Béatrice Carsin-Nicole
- Centre de référence spina bifida; CHU Rennes; Rennes France
- Service de Neuro-Radiologie; CHU Rennes; Rennes France
| | - Laurent Riffaud
- Centre de référence spina bifida; CHU Rennes; Rennes France
- Service de Neurochirurgie; CHU Rennes; Rennes France
| | - Pierre-Jean Le Reste
- Centre de référence spina bifida; CHU Rennes; Rennes France
- Service de Neurochirurgie; CHU Rennes; Rennes France
| | - Isabelle Bonan
- Centre de référence spina bifida; CHU Rennes; Rennes France
- Service de Médecine Physique et Réadaptation; CHU Rennes; Rennes France
| | - Camille Olivari-Philiponnet
- Centre de référence spina bifida; CHU Rennes; Rennes France
- Service de Médecine Physique et Réadaptation; CHU Rennes; Rennes France
| | - Laurent Siproudhis
- Centre de référence spina bifida; CHU Rennes; Rennes France
- Equipe thématique INPHY CIC 1414 et INSERM UMR 991; CHU Rennes; Rennes France
- Service de Gastro-Entérologie; CHU Rennes; Rennes France
| | - Jacques Kerdraon
- Centre de référence spina bifida; CHU Rennes; Rennes France
- Centre de rééducation de Kerpape; Ploemeur France
| | - Xavier Game
- Département d'Urologie; Transplantation Rénale et Andrologie; CHU Rangueil; Toulouse France
| | - Andrea Manunta
- Service d'urologie; CHU Rennes; Rennes France
- Centre de référence spina bifida; CHU Rennes; Rennes France
- Equipe thématique INPHY CIC 1414 et INSERM UMR 991; CHU Rennes; Rennes France
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Chrzan R. Refractory Urinary Incontinence in Girls: The Role of the Bladder Neck. Front Pediatr 2017; 5:74. [PMID: 28443271 PMCID: PMC5385460 DOI: 10.3389/fped.2017.00074] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2016] [Accepted: 03/24/2017] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Prevalence of lower urinary tract dysfunction (LUTD) in children is between 6 and 9% with urinary incontinence (UI) being one of the most common symptom. VARIOUS ASPECTS OF LOWER URINARY TRACT SYMPTOMS LUTS Anatomical anomalies of the urinary tract as well as neurogenic underlying pathology can results in LUTS. Comorbidities and long-term consequences of the LUTD for the female patients as well as genetic issues are also briefly discussed. THE ROLE OF THE BLADDER NECK Thanks to urodynamics, we have learnt a lot about the lower urinary tract function, but the role of the bladder neck in the pathophysiology of LUTS in children is not clear. Secondary bladder neck hypertrophy is a well-described pathology, but there is no standardized treatment for this phenomenon. Primary bladder neck dysfunction has already been defined by the International Children's Continence Society. REFRACTORY UI IN GIRLS Uniform diagnostic protocols are used in these girls with UI. Treatment consists of standard urotherapy, additional interventions, and pharmacotherapy in selected cases. Those with refractory UI require careful reassessment to look for the unrecognized disorders. Invasive urodynamics should be done in those patients. Ultrasound of the bladder neck region and the pelvic floor can be helpful, but its interpretation is very subjective. In a small group bladder neck insufficiency can be found and those might benefit from a surgical intervention. FUTURE PERSPECTIVE Strict criteria of the bladder neck insufficiency in children must be defined. Early surgical intervention in girls with bladder neck insufficiency might reduce the long period of intensive conservative treatment.
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Affiliation(s)
- Rafal Chrzan
- Pediatric Urology, Jagiellonian University Medical College, Krakow, Poland
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7
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Tudor KI, Sakakibara R, Panicker JN. Neurogenic lower urinary tract dysfunction: evaluation and management. J Neurol 2016; 263:2555-2564. [DOI: 10.1007/s00415-016-8212-2] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2016] [Accepted: 06/18/2016] [Indexed: 12/20/2022]
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8
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Hascoet J, Manunta A, Brochard C, Arnaud A, Damphousse M, Menard H, Kerdraon J, Journel H, Bonan I, Odent S, Fremond B, Siproudhis L, Gamé X, Peyronnet B. Outcomes of intra-detrusor injections of botulinum toxin in patients with spina bifida: A systematic review. Neurourol Urodyn 2016; 36:557-564. [PMID: 27187872 DOI: 10.1002/nau.23025] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2016] [Accepted: 03/30/2016] [Indexed: 12/11/2022]
Abstract
CONTEXT Bladder management in spina bifida patients relies on clean intermittent catheterization and oral antimuscarinics with a significant failure rate. The efficacy of intradetrusor injections of botulinum toxin has been confirmed in patients with spinal cord injury or multiple sclerosis but not in patients with myelomeningocele. OBJECTIVE To conduct a systematic review of current evidence regarding the efficacy of intra-detrusor injections of Botulinum Toxin A (BTX-A) in spina bifida patients with neurogenic detrusor overactivity (NDO) refractory to antimuscarinics. METHODS A research has been conducted on Medline and Embase using the keywords: ("spina bifida" OR "myelomeningocele" OR "dysraphism") AND "toxin." The search strategy and studies selection were performed using the PICOS method according to the PRISMA statement. RESULT Twelve published series were included (n = 293 patients). All patients were <18 years old. There was no randomized study comparing BTX-A versus placebo and most studies had no control group. Most studies reported a clinical and urodynamic improvement with resolution of incontinence in 32-100% of patients, a decrease in maximum detrusor pressure from 32 to 54%, an increase of maximum cystometric capacity from 27 to 162%, and an improvement in bladder compliance of 28-176%. Two studies suggested lower efficacy in patients with low compliance bladder compared to those with isolated detrusor overactivity. CONCLUSION Intradetrusor injections of BTX-A could be effective in children with spina bifida but this assumption is not supported by high level of evidence studies. There is no data available in adult patients. Neurourol. Urodynam. 36:557-564, 2017. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
| | - Andrea Manunta
- Service d'urologie, CHU Rennes, Rennes, France.,Centre de référence spina bifida, CHU Rennes, Rennes, France
| | - Charlène Brochard
- Centre de référence spina bifida, CHU Rennes, Rennes, France.,Service de Gastro-Entérologie, CHU Rennes, Rennes, France.,Equipe thématique INPHY CIC 1414 et INSERM UMR 991, CHU Rennes, Rennes, France
| | - Alexis Arnaud
- Service de chirurgie pédiatrique, CHU Rennes, Rennes, France
| | - Mireille Damphousse
- Centre de référence spina bifida, CHU Rennes, Rennes, France.,Service de médecine physique et réadaptation, CHU Rennes, Rennes, France
| | - Hélène Menard
- Centre de référence spina bifida, CHU Rennes, Rennes, France
| | - Jacques Kerdraon
- Centre de référence spina bifida, CHU Rennes, Rennes, France.,Centre de rééducation de Kerpape, Ploemeur, France
| | - Hubert Journel
- Centre de référence spina bifida, CHU Rennes, Rennes, France
| | - Isabelle Bonan
- Centre de référence spina bifida, CHU Rennes, Rennes, France.,Service de médecine physique et réadaptation, CHU Rennes, Rennes, France
| | - Sylvie Odent
- Centre de référence spina bifida, CHU Rennes, Rennes, France.,Service de génétique, CHU Rennes, Rennes, France
| | - Benjamin Fremond
- Service de chirurgie pédiatrique, CHU Rennes, Rennes, France.,Centre de référence spina bifida, CHU Rennes, Rennes, France
| | - Laurent Siproudhis
- Centre de référence spina bifida, CHU Rennes, Rennes, France.,Service de Gastro-Entérologie, CHU Rennes, Rennes, France.,Equipe thématique INPHY CIC 1414 et INSERM UMR 991, CHU Rennes, Rennes, France
| | - Xavier Gamé
- Département d'Urologie, Transplantation Rénale et Andrologie, CHU Rangueil, Toulouse, France
| | - Benoit Peyronnet
- Service d'urologie, CHU Rennes, Rennes, France.,Centre de référence spina bifida, CHU Rennes, Rennes, France.,Equipe thématique INPHY CIC 1414 et INSERM UMR 991, CHU Rennes, Rennes, France
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Abstract
The population of patients with congenital genitourinary disorders has unique healthcare demands that require an additional interpersonal and medical skillset. Adults with congenital neurogenic bladder may have complex urinary anatomy, abnormal bladder function and atypical voiding mechanisms. While initial surgery and care of these patients is typically managed by a pediatric urologist, growth and development into adulthood necessitates transition of care to an adult care team. Failure of transition to adult care has been demonstrated to result in lower quality healthcare and increased risk of developing preventable complications.
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Affiliation(s)
- Christopher J Loftus
- 1 Cleveland Clinic Lerner College of Medicine, Cleveland Clinic, Cleveland, USA ; 2 Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, USA
| | - Hadley M Wood
- 1 Cleveland Clinic Lerner College of Medicine, Cleveland Clinic, Cleveland, USA ; 2 Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, USA
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Loftus C, Wood H. Emerging Concepts in Transitional Care of Congenital Genitourinary Reconstructions. CURRENT BLADDER DYSFUNCTION REPORTS 2015. [DOI: 10.1007/s11884-015-0326-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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11
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Panicker JN, Fowler CJ, Kessler TM. Lower urinary tract dysfunction in the neurological patient: clinical assessment and management. Lancet Neurol 2015; 14:720-32. [PMID: 26067125 DOI: 10.1016/s1474-4422(15)00070-8] [Citation(s) in RCA: 262] [Impact Index Per Article: 29.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2015] [Revised: 04/27/2015] [Accepted: 04/27/2015] [Indexed: 12/21/2022]
Abstract
Lower urinary tract (LUT) dysfunction is a common sequela of neurological disease, resulting in symptoms that have a pronounced effect on quality of life. The site and nature of the neurological lesion affect the pattern of dysfunction. The risk of developing upper urinary tract damage and renal failure is much lower in patients with slowly progressive non-traumatic neurological disorders than in those with spinal cord injury or spina bifida; this difference in morbidity is taken into account in the development of appropriate management algorithms. Clinical assessment might include tests such as uroflowmetry, post-void residual volume measurement, renal ultrasound, (video-)urodynamics, neurophysiology, and urethrocystoscopy, depending on the indication. Incomplete bladder emptying is most often managed by intermittent catheterisation, and storage dysfunction by antimuscarinic drugs. Intradetrusor injections of onabotulinumtoxinA have transformed the management of neurogenic detrusor overactivity. Neuromodulation offers promise for managing both storage and voiding dysfunction. An individualised, patient-tailored approach is required for the management of LUT dysfunction associated with neurological disorders.
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Affiliation(s)
- Jalesh N Panicker
- Department of Uro-Neurology, The National Hospital for Neurology and Neurosurgery and UCL Institute of Neurology, London, UK.
| | - Clare J Fowler
- Department of Uro-Neurology, The National Hospital for Neurology and Neurosurgery and UCL Institute of Neurology, London, UK
| | - Thomas M Kessler
- Neuro-Urology, Spinal Cord Injury Center, University of Zürich, Balgrist University Hospital, Zürich, Switzerland
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