Effects of acupuncture and pelvic floor muscle training on bladder dysfunction after spinal cord injury: A meta-analysis

The impact of anticholinergics on cognitive function in patients with neurogenic lower urinary tract dysfunction: A narrative review

This narrative review discusses the relationship between anticholinergic medications and cognitive change specifically in patients with neurogenic lower urinary tract dysfunction (NLUTD). NLUTD is prevalent in various conditions, including spinal cord injury (SCI), spina bifida (SB), multiple sclerosis (MS), Parkinson's, stroke, and dementia and often requires anticholinergic overactive bladder (OAB) medications. In the general population, and among those with OAB, several studies have found a significant association between this class of medications and cognitive side effects, mostly when used for > 90 days. These cognitive side effects may be particularly relevant to people with NLUTD due to their higher baseline risk of cognitive impairment. Two studies (one in people with SCI and another in MS) found evidence of cognitive impairment with the use of OAB anticholinergics (specifically oxybutynin and tolterodine). People with dementia commonly use OAB anticholinergics, and there is evidence that oxybutynin and tolterodine may impair cognition in this population. Two recent studies in children with SB studied 12 months of solifenacin and 6 months of fesoterodine/oxybutynin and found there was no significant change in neuropsychological testing. Clinical studies in people with Parkinson's disease and prior stroke have not shown that trospium, darifenacin, or fesoterodine have a significant impact on cognitive measures. In summary, oxybutynin and tolterodine may pose a higher risk of cognitive impairment than newer OAB anticholinergics in people with NLUTD; there is no evidence that children with SB experience cognitive impairment with OAB anticholinergics. Further study is necessary to confirm cognitive safety, particularly as the NLUTD population may have a high exposure to OAB anticholinergics. Advocating for potentially safer OAB medications is necessary if there is concern about cognitive risks.

Acupuncture treatment of acute urinary retention caused by varicella-zoster virus through by combining the mechanism of sacral neuromodulation: A rare case report

RATIONALE

Urinary dysfunction triggered by varicella-zoster virus (VZV) attacking the nervous system seriously affects the quality of life of patients and may even cause irreversible damage to the urinary system. This a 62-year-old man with acute urinary retention triggered by VZV, who was cured after acupuncture treatment. The rational application of acupuncture therapy to promote the recovery of bladder contraction function can effectively relieve the symptoms of dysuria, shorten the course of the disease.

PATIENT CONCERNS

Symptoms included dysuria and distension of the bladder area secondary to postherpetic herpes zoster, with significant pressure and pain in his lower abdomen, accompanied by cutaneous herpes distributed over the sacral region.

DIAGNOSES

The case was diagnosed as acute urinary retention (Neurogenic Bladder). Ancillary tests include urodynamic examination, Doppler ultrasound, urodynamic tests are the preferred diagnostic method and suggest: no contraction of the detrusor muscle is seen during voiding, and voiding occurs in an The absence of abdominal pressure-assisted micturition and repeated attempts to pass urine suggests detrusor weakness; residual urine suggests a severe bladder emptying disorder. Doppler ultrasound suggested overfilling of the bladder, and 1153 mL of residual urine was seen in the bladder after voiding.

INTERVENTIONS

The patient developed sacral herpes and dysuria and was treated with oral antiviral drugs on the 12th day of illness. But his urinary difficulty did not improve but gradually worsened, resulting in acute urinary retention, and he then turned to the acupuncture treatment, innovative approach combined the mechanism of action of sacral neuromodulation with traditional Chinese medicine theory.

OUTCOMES

The duration of acupuncture treatment totaled 12 weeks; he was able to urinate on her own and her symptoms completely disappeared. No other adverse and unintended events occurred during treatment.

LESSONS

This study demonstrates that acupuncture is safe and effective in the treatment of acute urinary retention caused by VZV, which is worth recommending as a conservative treatment. Moreover, we found that the early intervention and full-term treatment with acupuncture is particularly important, provided that the right key acupoints are selected.