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Roy HA, Nettleton J, Blain C, Dalton C, Farhan B, Fernandes A, Georgopoulos P, Klepsch S, Lavelle J, Martinelli E, Panicker JN, Radoja I, Rapidi CA, Pereira E Silva R, Tudor K, Wagg AS, Drake MJ. Assessment of patients with lower urinary tract symptoms where an undiagnosed neurological disease is suspected: A report from an International Continence Society consensus working group. Neurourol Urodyn 2020; 39:2535-2543. [PMID: 32754994 DOI: 10.1002/nau.24469] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Accepted: 07/16/2020] [Indexed: 11/10/2022]
Abstract
AIM Lower urinary tract symptoms (LUTS) are a common urological referral, which sometimes can have a neurological basis in a patient with no formally diagnosed neurological disease ("occult neurology"). Early identification and specialist input is needed to avoid bad LUTS outcomes, and to initiate suitable neurological management. METHODS The International Continence Society established a neurological working group to consider: Which neurological conditions may include LUTS as an early feature? What diagnostic evaluations should be undertaken in the LUTS clinic? A shortlist of conditions was drawn up by expert consensus and discussed at the annual congress of the International Neurourology Society. A multidisciplinary working group then generated recommendations for identifying clinical features and management. RESULTS The relevant conditions are multiple sclerosis, multiple system atrophy, normal pressure hydrocephalus, early dementia, Parkinsonian syndromes (including early Parkinson's Disease and Multiple System Atrophy) and spinal cord disorders (including spina bifida occulta with tethered cord, and spinal stenosis). In LUTS clinics, the need is to identify additional atypical features; new onset severe LUTS (excluding infection), unusual aspects (eg, enuresis without chronic retention) or "suspicious" symptoms (eg, numbness, weakness, speech disturbance, gait disturbance, memory loss/cognitive impairment, and autonomic symptoms). Where occult neurology is suspected, healthcare professionals need to undertake early appropriate referral; central nervous system imaging booked from LUTS clinic is not recommended. CONCLUSIONS Occult neurology is an uncommon underlying cause of LUTS, but it is essential to intervene promptly if suspected, and to establish suitable management pathways.
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Affiliation(s)
- Holly A Roy
- Neurosurgery Department, Derriford Hospital, University Hospitals Plymouth NHS Trust, Plymouth, UK
| | - Jeremy Nettleton
- Department of Urology, Cheltenham General Hospital, Gloucestershire Hospitals NHS Foundation Trust, Cheltenham, UK
| | - Camilla Blain
- Atkinson Morley Regional Neurosciences Centre, St George's University Hospitals NHS Foundation Trust, London, UK
| | - Catherine Dalton
- Atkinson Morley Regional Neurosciences Centre, St George's University Hospitals NHS Foundation Trust, London, UK
| | - Bilal Farhan
- UTMB Health Division of Urology, Galveston, Texas
| | - Ailton Fernandes
- Department of Urology, State University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Petros Georgopoulos
- Department of Urology and Pelvic Floor Unit, Aarhus University Hospital, Aarhus, Denmark
| | - Sabine Klepsch
- Neurology Department, Southmead Hospital, North Bristol NHS Trust, Bristol, UK
| | - John Lavelle
- Veteran Affairs Palo Alto Health Care System, Palo Alto, California
| | | | - Jalesh N Panicker
- Department of Uro-Neurology, The National Hospital for Neurology and Neurosurgery, UCL Queen Square Institute of Neurology, Faculty of Brain Sciences, University College London, London, UK
| | - Ivan Radoja
- Department of Urology, University Hospital Centre Osijek, Faculty of Medicine, The J. J. Strossmayer University of Osijek, Osijek, Croatia
| | | | - Ricardo Pereira E Silva
- Department of Urology, Centro Hospitalar Universitário Lisboa Norte, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
| | - Katarina Tudor
- Department of Neurology, Unit for Headaches, Neurogenic Pain and Spinal Disorders, School of Medicine, University Hospital Centre Zagreb, University of Zagreb, Zagreb, Croatia
| | - Adrian S Wagg
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Marcus J Drake
- Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol Urological Institute, Bristol, UK
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Radoja I, Degmečić D. Quality of Life and Female Sexual Dysfunction in Croatian Women with Stress-, Urgency- and Mixed Urinary Incontinence: Results of a Cross-Sectional Study. ACTA ACUST UNITED AC 2019; 55:medicina55060240. [PMID: 31163685 PMCID: PMC6631052 DOI: 10.3390/medicina55060240] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Revised: 03/03/2019] [Accepted: 05/29/2019] [Indexed: 11/16/2022]
Abstract
Background and objectives: Urinary incontinence is defined as the involuntary leakage of urine. Studies have reported that the severity of urinary incontinence symptoms can cause decreased quality of life and female sexual dysfunction in women, but the association between the duration of the incontinence and the aforementioned disturbances has not been evaluated. The objective of this study was to evaluate the differences in the occurrence of decreased quality of life and female sexual dysfunction in Croatian women with urinary incontinence, with regard to the duration and subtype of urinary incontinence. Materials and Methods: We conducted a cross-sectional study from March 2017 to July 2018 at our neurourology and urodynamics outpatient clinic, among 120 women with urinary incontinence symptoms. Based on medical history, physical exam and urodynamic assessment, participants were divided into groups with stress-, urgency- and mixed urinary incontinence. Several quality of life and female sexual dysfunction questionnaires were used for evaluation. The differences between the three UI groups were tested by the Kruskal-Wallis test. All p values were two-sided. The level of significance was set to Alpha = 0.05. Results: The mixed urinary incontinence group had a significantly inferior quality of life (p = 0.003) and lower scores on the female sexual dysfunction questionnaires (p = 0.02). The longer the duration of incontinence King's Health Questionnaire total score was worse (p = 0.003) and Female Sexual Function Index total score was worse (p < 0.001). Conclusions: Our results showed that there was a statistically significant difference in the occurrence of decreased quality of life and female sexual dysfunction considering the duration and subtype of incontinence in Croatian women.
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Affiliation(s)
- Ivan Radoja
- Department of Urology, University Hospital Centre Osijek, Faculty of medicine, The J. J. Strossmayer University of Osijek, 31000 Osijek, Croatia.
| | - Dunja Degmečić
- Faculty of medicine, The J. J. Strossmayer University of Osijek, Psychiatric Clinic, University Hospital Centre Osijek, 31000 Osijek, Croatia.
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Sudarević B, Radoja I, Šimunović D, Kuveždić H. Trends in testicular germ cell cancer incidence in Eastern Croatia. Med Glas (Zenica) 2014; 11:152-158. [PMID: 24496357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Received: 09/16/2013] [Accepted: 11/19/2013] [Indexed: 06/03/2023]
Abstract
AIM To investigate a possible association between radioactive and toxic elements contamination, mainly depleted uranium (DU) from the Chernobyl accident, Croatian War of Independence and Bosnian War and the increasing incidence of testicular germ cell cancers (TGCC) in the population of Eastern Croatia. METHODS From 1969 to 2012, 258 testicular cancer (TC) patients were treated at the Department of Urology, University Hospital Centre Osijek. Incomplete data were found in 32 patients who were excluded from the analysis and 10 patients had non-TGCC TC. Seminoma and non-seminoma groups were included out of 216 TGCC patients. The patients were assigned to one of the time periods: 1969-1995 (distant prewar and war period) and 1996- 2012 (postwar period). RESULTS In the postwar period 3.5 times higher incidence rate for non-seminomas (4.5 patients yearly vs. 1.3), seminomas (4.2 vs. 1.2) and TGCC overall (8.7 vs. 2.5) was found compared to the prewar period, with non-seminoma presenting in more advanced stage III (35.5% vs. 13.9%, p=0.013). CONCLUSION Usage of depleted uranium in armed conflicts could lead to the development of TGCC after unknown time of latency. Exposure assessment is mandatory to determine a possible causative correlation between the depleted uranium exposure and testicular germ cell cancer.
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Affiliation(s)
- Bojan Sudarević
- Department of Urology, University Hospital Centre Osijek, Osijek, Croatia
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