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Ramel S, Gueganton L, Nowak E, Bihan JL, Arnouat B, Belleguic C, Danner-Boucher I, Mankikian J, Payet A, Urban T, Buyse M, Hubeaux K. Sexual dysfunction in cystic fibrosis. J Cyst Fibros 2024:S1569-1993(24)00056-0. [PMID: 38688746 DOI: 10.1016/j.jcf.2024.04.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 12/22/2023] [Revised: 04/15/2024] [Accepted: 04/20/2024] [Indexed: 05/02/2024]
Abstract
BACKGROUND Sexual dysfunction (erectile dysfunction in males, sexual dissatisfaction, sexual interest/arousal disorders, and dyspareunia in females) has not been the subject of indepth research in people with cystic fibrosis (CF). This study aimed to determine the prevalence of sexual dysfunction in adults with CF, factors associated with sexual dysfunction, and the impact of sexual dysfunction on quality of life. METHOD We conducted a multicentre study in adults with cystic fibrosis followed in specialist centres in Western France. We assessed erectile dysfunction and its severity using the IIEF5 self-questionnaire (International Index of Erectile Function); the FSFI (Female Sexual Function Index) was used to assess sexual function in females, and we evaluated quality of life in both sexes using the CFQ-R14+ questionnaire. RESULTS In total, 77 males and 74 females completed the sexual function questionnaire (mean age 32+/- 10 and 25+/- 8,5 years respectively). Among them, 21 % of males and 30 % of females reported sexual dysfunction. CFQ-R14+ score was significantly lower in males with erectile dysfunction than those without (p < 0.001). Faecal incontinence was associated with more frequent sexual dysfunction in females and higher severity of erectile dysfunction in males. CONCLUSION The prevalence of sexual disorders is relatively high in males and females with cystic fibrosis. Therefore, it seems important to train specialist teams to address the issue of sexuality without embarrassment, and to encourage them to seek out and treat faecal incontinence, which is associated with greater severity or frequency of these symptoms.
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Affiliation(s)
- Sophie Ramel
- CRCM (Centre de Ressources et de Compétences de la Mucoviscidose), Fondation Ildys, Roscoff, France.
| | - Laetitia Gueganton
- CRCM (Centre de Ressources et de Compétences de la Mucoviscidose), Fondation Ildys, Roscoff, France
| | - Emmanuel Nowak
- Direction de la Recherche Clinique et de l'Innovation (DRCI), CHU de Brest, Brest, France & Centre d'Investigation Clinique, INSERM CIC 1412, CHU de Brest, Brest, France
| | - Jean Le Bihan
- CRCM (Centre de Ressources et de Compétences de la Mucoviscidose), Fondation Ildys, Roscoff, France
| | - Baptiste Arnouat
- Dept of Respiratory Medicine, Centre Hospitalier Bretagne Atlantique, Vannes, France
| | - Chantal Belleguic
- Univ Rennes, CHU Rennes, Department of Respiratory Medicine, F-35033, Rennes, France
| | - Isabelle Danner-Boucher
- Service de Pneumologie, L'Institut Du Thorax, Centre Hospitalier Universitaire de Nantes, Nantes, France
| | - Julie Mankikian
- Service de pneumologie et d'explorations fonctionnelles respiratoires, CHU, hôpital Bretonneau, Tours, France
| | - Annabelle Payet
- Service de Pneumologie, CHU La Réunion Site Sud Réunion, Saint Pierre, Réunion, France
| | - Thierry Urban
- Département de Pneumologie, CHU d'Angers, Angers, France
| | - Marion Buyse
- CRCM (Centre de Ressources et de Compétences de la Mucoviscidose), Fondation Ildys, Roscoff, France
| | - Katelyne Hubeaux
- CRCM (Centre de Ressources et de Compétences de la Mucoviscidose), Fondation Ildys, Roscoff, France; Service d'explorations fonctionnelles, Fondation Ildys, Roscoff, France
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Hubeaux K, Gueganton L, Nowak E, Arnouat B, Belleguic C, Danner-Boucher I, Mankikian J, Payet A, Urban T, Buyse M, Ramel S. Prevalence and severity of functional urinary and anorectal disorders and their impact on quality of life in cystic fibrosis. J Cyst Fibros 2023:S1569-1993(23)01659-4. [PMID: 37907384 DOI: 10.1016/j.jcf.2023.10.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 06/29/2023] [Revised: 09/08/2023] [Accepted: 10/14/2023] [Indexed: 11/02/2023]
Abstract
BACKGROUND In cystic fibrosis (CF), coughing is associated with a risk of pelvic floor dysfunction. However, data on the prevalence of symptoms (stress urinary incontinence, bladder overactivity, dysuria, and faecal incontinence) are lacking in males and females with CF. The impact of incontinence on adherence to respiratory care has not been studied. METHODS We conducted a multicentre study in adults with CF followed in the North-West French CF network. Urinary disorders and their severity were assessed using the Urinary Symptom Profile (USP) self-report questionnaire; the impact of urinary disorders on general quality of life was measured using the SF-Qualiveen questionnaire; faecal incontinence was assessed using the Wexner self-report questionnaire; and the CFQ-R14+ questionnaire was used to assess quality of life. A self-administered questionnaire developed for the study assessed the impact of symptoms on respiratory care. RESULTS Of the 178 people with CF included, 34 % reported stress urinary incontinence, with a large female predominance (63.5 % of females vs. 7.5 % of males), 65 % bladder overactivity (including 16 % urge incontinence) and 50 % faecal incontinence, also with a female predominance. Neither urinary nor faecal incontinence were related to the severity of the respiratory impairment (FEV1). Quality of life was particularly affected in women. Stress urinary Incontinence symptoms affected respiratory care in both sexes. CONCLUSION The prevalence of functional urinary and faecal disorders was high in adults with CF and impacted on quality of life and respiratory care. Therefore, multidisciplinary teams must have knowledge of symptoms, the diagnostic tools and management strategies to provide specific treatment.
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Affiliation(s)
- Katelyne Hubeaux
- CRCM (Centre de Ressources et de Compétences de la Mucoviscidose), Fondation Ildys, Roscoff, France
| | - Laetitia Gueganton
- CRCM (Centre de Ressources et de Compétences de la Mucoviscidose), Fondation Ildys, Roscoff, France
| | - Emmanuel Nowak
- Direction de la Recherche Clinique et de l'Innovation (DRCI), CHU de Brest, Brest, France & Centre d'Investigation Clinique, INSERM CIC 1412, CHU de Brest, Brest, France
| | - Baptiste Arnouat
- Dept of Respiratory Medicine, Centre Hospitalier Bretagne Atlantique, Vannes, France
| | - Chantal Belleguic
- Univ Rennes, CHU Rennes, Department of Respiratory Medicine, Rennes F-35033, France
| | - Isabelle Danner-Boucher
- Service de Pneumologie, L'Institut Du Thorax, Centre Hospitalier Universitaire de Nantes, Nantes, France
| | - Julie Mankikian
- Service de pneumologie et d'explorations fonctionnelles respiratoires, CHU, hôpital Bretonneau, Tours, France
| | - Annabelle Payet
- Service de Pneumologie, CHU La Réunion Site Sud Réunion, Saint Pierre, Réunion, France
| | - Thierry Urban
- Département de Pneumologie, CHU d'Angers, Angers, France
| | - Marion Buyse
- CRCM (Centre de Ressources et de Compétences de la Mucoviscidose), Fondation Ildys, Roscoff, France
| | - Sophie Ramel
- CRCM (Centre de Ressources et de Compétences de la Mucoviscidose), Fondation Ildys, Roscoff, France.
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Jacq C, Hubeaux K, Ramanantsitonta J. [Multiple sclerosis and intermittent self-catheterization]. Prog Urol 2020; 31:195-203. [PMID: 33277166 DOI: 10.1016/j.purol.2020.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 07/25/2020] [Revised: 10/24/2020] [Accepted: 11/02/2020] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Lower urinary tract dysfunctions are frequent in patients with multiple sclerosis (MS). These disorders impair quality of life and can cause urological complications. In cases of urinary retention or incomplete bladder emptying, clean intermittent self-catheterization is the preferred option where possible. OBJECTIVE To identify data concerning the use of intermittent self-catheterization by patients with MS. BIBLIOGRAPHIC SOURCE A review was done using Medline/Pubmed with selection of articles in either English or French. The key words were: « multiple sclerosis and intermittent catheterization, self-catheterization, neuro-urology/urinary guidelines, continent stoma, continent vesicostomy». STUDY SELECTION Studies were selected if they concerned either multiple sclerosis exclusively or with a majority of cases concerning MS. RESULTS Intermittent self-catheterization is recommended and commonly used in patients with MS. Studies are rare in this specific population. Questions still remain about indications and practicalities in this disease. Indications must be individually evaluated according to symptoms and complications. The use of self-catheterization can improve symptomatology or quality of life, however, global urinary management is necessary. Urinary infection is the most frequently reported side effect. The teaching of self-catheterization should take into account physical and cognitive impairment. Due to the developing nature of the pathology, indications and the patients' ability to carry out self-catheterization should be regularly assessed. LIMITATIONS The search was limited to a single bibliographic source and studies are rare. CONCLUSION Further studies are necessary to increase knowledge of self-catheterization specificities in MS patients compared to other neurogenic patients.
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Affiliation(s)
- C Jacq
- Service de MPR, site d'Auray, Centre hospitalier Bretagne Atlantique, 20, boulevard du Général-Maurice-Guillaudot, BP 70555, 56017 Vannes cedex, France.
| | - K Hubeaux
- Service d'explorations fonctionnelles, site de Perharidy, Fondation Ildys, route de Perharidy, 29680 Roscoff, France
| | - J Ramanantsitonta
- Service de MPR, site d'Auray, Centre hospitalier Bretagne Atlantique, 20, boulevard du Général-Maurice-Guillaudot, BP 70555, 56017 Vannes cedex, France
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Ramel S, Gueganton L, Troussier F, Markov M, Danner I, Loppinet V, Belleguic C, Berhault I, Huge S, Fretay R, Mankikian J, Payet A, Maillot A, Le Bihan J, Hubeaux K. WS13.5 Assessment of the prevalence and severity of urinary and ano-rectal functional disorders and their impact on quality of life and sexuality in adult with cystic fibrosis in the French North-West Cystic Fibrosis Network. J Cyst Fibros 2018. [DOI: 10.1016/s1569-1993(18)30194-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Jourdan C, Brugel D, Hubeaux K, Touré H, Laurent-Vannier A, Chevignard M. Early weight gain after childhood traumatic brain injury. Ann Phys Rehabil Med 2014. [DOI: 10.1016/j.rehab.2014.03.1248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Amarenco G, Raibaut P, Hubeaux K, Jousse M, Sheikh Ismaël S, Lapeyre E. [Autonomic nervous system alteration in multiple sclerosis patients with urinary symptoms. Clinical, urodynamic and cardiovascular study]. Prog Urol 2013; 23:1505-10. [PMID: 24286553 DOI: 10.1016/j.purol.2013.06.010] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [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: 03/15/2013] [Revised: 06/18/2013] [Accepted: 06/19/2013] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To assess symptoms related to autonomic nervous system alteration in a population of patients suffering from multiple sclerosis (MS) and presenting with urinary symptoms. PATIENTS AND METHODS We investigated 65 patients (mean age 47.5 years) suffering from MS, and presenting with urological dysfunction by means of symptom scores, urodynamic investigation, cardiovascular autonomic function tests (orthostatic hypotension testing, Valsalva test, deep breath test, cold pressor test) and sympathetic skin responses. RESULTS Forty-five (69%) patients suffered from overactive bladder, 48 (73%) from voiding dysfunction, 14 (21%) from urinary retention and 13 (20%) from fecal incontinence. Urodynamic investigation demonstrated overactive detrusor in 46 (70%) cases, and underactive detrusor in four (6%) cases. Twenty-five (38%) patients had dysautonomia without correlation neither with clinical or urodynamic data, nor gravity of multiple sclerosis (EDSS). CONCLUSION In this series, the prevalence of dysautonomia was high in patients suffering from MS and presenting with urinary disorders.
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Affiliation(s)
- G Amarenco
- GRC 01 UPMC GREEN groupe de recherche clinique en neuro-urologie, service de neuro-urologie et d'explorations périnéales, hôpital Tenon, AP-HP, 4, rue de la Chine, 75020 Paris, France.
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Hubeaux K, Deffieux X, Jousse M, Amarenco G. Correlation between voiding dysfunction symptoms and uroflowmetry in women suffering from stress urinary incontinence. Indian J Urol 2012. [PMID: 23204661 PMCID: PMC3507402 DOI: 10.4103/0970-1591.102710] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Objectives: To determine whether the completion of a voiding dysfunction (VD) questionnaire could have a good predictive value for uroflowmetry findings, in a population of stress urinary incontinence (SUI) women. Materials and Methods: From a urodynamic database of 415 SUI women, 93 with isolated SUI who underwent urodynamic investigations were eligible for this study. Patients with obvious etiologies of obstruction were excluded. VD symptoms were analyzed using the Bristol Female Lower Urinary Tract Symptoms Questionnaire. Bladder outlet obstruction (BOO) was defined as a maximal flow rate under 15 ml/s for a urine volume > 200 ml, or a post-void residual volume greater than 50 ml, or an abnormal pattern of the flow curve. The sensitivity, specificity, positive and negative predictive value of questioning VD were calculated. Statistical analysis was done using a Wilcoxon test for continuous data and Fisher exact test for categorical data, and multivariate analysis. Results: Reported VD had a poor specificity (41%) and positive predictive value (32%) of BOO on uroflowmetry. No statistical correlation was found between VD symptoms and BOO defined on uroflowmetry (P=0.64) in this specific SUI population showing no obvious etiologies of obstruction. Conclusions: No correlation was found between obstructive symptoms and BOO as defined on uroflowmetry, in a specific population of SUI women. Our results suggest that uroflowmetry may be necessary rather than multichannel urodynamics.
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Affiliation(s)
- Katelyne Hubeaux
- Department of Neurological Rehabilitation, Urodynamic and Neurophysiology Laboratory, Tenon Hospital, Paris, France ; ER6, Université Pierre et Marie Curie, Paris, France
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Abstract
AIM The aim of the study was to assess weight changes after traumatic brain injury (TBI) in children and the factors influencing them. METHOD We conducted a longitudinal observational study of children with TBI of mixed severity who were consecutively admitted to one rehabilitation department (39 children; 23 males, 16 females; median age 8y 7mo; 25th to 75th centiles 3y 7mo-11y 6mo). Weight and height before TBI were obtained from the children's records and were measured monthly for 1 year after TBI. Body mass index (BMI) and BMI z-scores were calculated, and pre-TBI values were compared with the final values using paired tests. Linear mixed-effect interaction models were used to assess the effect of various factors on z-score evolution. RESULTS Z-score curves revealed early weight loss followed by a rapid increase in weight. The mean BMI gain over the period under study was 0.9 kg/m² (p < 0.001) and the mean z-score gain was 0.4 (p = 0.006). Six children had become overweight by the time of final assessment. Factors associated with a greater rate of increase in the post-TBI z-score were mobility restriction, male sex, and older age. Global pre- to post-TBI weight gain was significantly higher in males (z-score 0.7). Pituitary hormonal testing was available for 17 children at 3 months and for 27 at 1 year. Growth hormone deficiency was detected in one child. INTERPRETATION Weight gain of children during the first year after TBI was rapid and excessive. Male sex was a risk factor for excessive weight gain.
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Affiliation(s)
- Claire Jourdan
- AP-HP, Hôpital Raymond Poincaré, Physical Medicine and Rehabilitation Department, Garches, France.
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Hubeaux K, Jousse M, Amarenco G. Hyperactivité vésicale idiopathique de la femme et système nerveux autonome. Prog Urol 2012; 22:199-206. [DOI: 10.1016/j.purol.2012.01.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2011] [Accepted: 12/22/2011] [Indexed: 10/28/2022]
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Hubeaux K, Deffieux X, Raibaut P, Le Breton F, Jousse M, Amarenco G. Evidence for autonomic nervous system dysfunction in females with idiopathic overactive bladder syndrome. Neurourol Urodyn 2011; 30:1467-72. [DOI: 10.1002/nau.21154] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2011] [Accepted: 04/26/2011] [Indexed: 02/02/2023]
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Damphousse M, Hubeaux K, Weil M, Raibaut P, Lebreton F, Amarenco G. Signes de lutte dans les vessies neurologiques des lésions de la queue de cheval et du cône terminal. Prog Urol 2010; 20:450-7. [DOI: 10.1016/j.purol.2010.01.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2009] [Revised: 12/03/2009] [Accepted: 01/09/2010] [Indexed: 11/29/2022]
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Deffieux X, Hubeaux K, Dick J, Ismael SS, Raibaut P, Amarenco G. Urine leakage related to physical fatigue in women with urinary stress incontinence. J Obstet Gynaecol Res 2009; 35:738-45. [DOI: 10.1111/j.1447-0756.2008.01000.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Deffieux X, Hubeaux K, Faivre E, Raibaut P, Ismael S, Fernandez H, Amarenco G. Sacral reflexes and urinary incontinence in women: New concepts. Ann Phys Rehabil Med 2009; 52:256-68. [DOI: 10.1016/j.rehab.2008.12.013] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Deffieux X, Hubeaux K, Amarenco G. Incontinence urinaire à l’effort de la femme : analyse des hypothèses physiopathologiques. ACTA ACUST UNITED AC 2008; 37:186-96. [DOI: 10.1016/j.jgyn.2007.11.029] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2007] [Revised: 10/23/2007] [Accepted: 11/26/2007] [Indexed: 10/22/2022]
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Hubeaux K, Deffieux X, Ismael SS, Raibaut P, Amarenco G. Autonomic Nervous System Activity During Bladder Filling Assessed by Heart Rate Variability Analysis in Women With Idiopathic Overactive Bladder Syndrome or Stress Urinary Incontinence. J Urol 2007; 178:2483-7. [DOI: 10.1016/j.juro.2007.08.036] [Citation(s) in RCA: 67] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2007] [Indexed: 11/24/2022]
Affiliation(s)
- Katelyne Hubeaux
- Université Pierre et Marie Curie-Paris 6, Faculté de Médecine, Unité Mixte de Recherche, Paris, France
- L’Assistance Publique-Hôpitaux de Paris, Groupe Hospitalier Universitaire Est, Hôpital Rothschild, Service de Rééducation Neurologique et d’Explorations Périnéales, Paris, France
- L’Institut National de la Santé et de la Recherche Médicale (INSERM Unit 731), Paris, France
| | - Xavier Deffieux
- Université Pierre et Marie Curie-Paris 6, Faculté de Médecine, Unité Mixte de Recherche, Paris, France
- L’Assistance Publique-Hôpitaux de Paris, Groupe Hospitalier Universitaire Est, Hôpital Rothschild, Service de Rééducation Neurologique et d’Explorations Périnéales, Paris, France
- L’Institut National de la Santé et de la Recherche Médicale (INSERM Unit 731), Paris, France
| | - Samer Sheikh Ismael
- L’Assistance Publique-Hôpitaux de Paris, Groupe Hospitalier Universitaire Est, Hôpital Rothschild, Service de Rééducation Neurologique et d’Explorations Périnéales, Paris, France
| | - Patrick Raibaut
- L’Assistance Publique-Hôpitaux de Paris, Groupe Hospitalier Universitaire Est, Hôpital Rothschild, Service de Rééducation Neurologique et d’Explorations Périnéales, Paris, France
| | - Gérard Amarenco
- Université Pierre et Marie Curie-Paris 6, Faculté de Médecine, Unité Mixte de Recherche, Paris, France
- L’Assistance Publique-Hôpitaux de Paris, Groupe Hospitalier Universitaire Est, Hôpital Rothschild, Service de Rééducation Neurologique et d’Explorations Périnéales, Paris, France
- L’Institut National de la Santé et de la Recherche Médicale (INSERM Unit 731), Paris, France
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Rajab T, Kraemer B, Wallwiener C, Wallwiener M, Planck H, Wallwiener D, Hubeaux K. 235: Adhesion Prophylaxis After Laparoscopic Myomectomy using a Novel Resorbable Membrane Consisting of D,L-Polylactid (Supraseal). J Minim Invasive Gynecol 2007. [DOI: 10.1016/j.jmig.2007.08.177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Deffieux X, Hubeaux K, Porcher R, Ismael SS, Raibaut P, Amarenco G. Pelvic floor muscle activity during coughing: altered pattern in women with stress urinary incontinence. Urology 2007; 70:443-7; discussion 447-8. [PMID: 17905093 DOI: 10.1016/j.urology.2007.03.084] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2006] [Revised: 01/28/2007] [Accepted: 03/01/2007] [Indexed: 12/18/2022]
Abstract
OBJECTIVES To assess the relationship between bladder pressure (BP) and pelvic floor muscle activity during coughing in women with stress urinary incontinence (SUI). METHODS External anal sphincter integrated electromyographic activity (EAS-EMGi) was recorded in 21 women using pregelled surface electrodes. The relationship between BP and EAS-EMGi activity was assessed during four successive coughs at 0, 200, and 400 mL of filling. We also compared this relationship in 6 women presenting with SUI and 4 continent women. RESULTS Among the considered models, a sigmoid relationship between EAS-EMGi and BP best described the data: EMGi = exp[a x (BP - b)]/(1 + exp[a x (BP - b)]). This relationship between EAS-EMGi and BP was significantly altered in women presenting with SUI (P <0.0001). CONCLUSIONS Women with SUI exhibited an altered pattern of the pelvic floor muscle response during successive coughing efforts. The lack of this modulation of pelvic floor muscle response to stress might be one of the pathophysiologic factors of SUI.
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Affiliation(s)
- Xavier Deffieux
- Université Pierre et Marie Curie, Paris 6, Faculté de Médecine, Paris, France.
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Deffieux X, Hubeaux K, Porcher R, Ismael SS, Raibaut P, Amarenco G. Decrease in urethral pressure following repeated cough efforts: A new concept for pathophysiology of stress urinary incontinence. Int J Urol 2007; 14:1019-24. [PMID: 17956530 DOI: 10.1111/j.1442-2042.2007.01887.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Xavier Deffieux
- Pierre & Marie Curie University; Urodynamics Laboratory, Rothschild Hospital, AP-HOP, 33 boulevard de Picpus, Paris Cedex 12, France.
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Deffieux X, Hubeaux K, Porcher R, Ismael SS, Raibaut P, Amarenco G. Abnormal pelvic response to cough in women with stress urinary incontinence. Neurourol Urodyn 2007; 27:291-6. [PMID: 17803192 DOI: 10.1002/nau.20506] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
AIMS To assess how muscular fatigue deteriorates the modulation of pelvic contraction during increasing cough efforts. Furthermore, we investigated the correlation between the temporal course of pelvic floor activation during cough. METHODS Informed consent was obtained from 20 women presenting with SUI and 6 continent women (overactive bladder syndrome [OAB]). Bladder pressure (BP) and external anal sphincter electromyographic activity (EAS EMGi) were recorded concomitantly during increasing cough efforts. Modulation of pelvic contraction was assessed before and after two types of intense pelvic exercise (Exercise #1: 10 successive strong cough efforts; Exercise #2: 10 pelvic contractions followed by a maximal pelvic contraction) at 0, 200, and 400 ml of bladder filling. We have also recorded electromyographic activity of external intercostal (EIC) muscles. RESULTS Whereas the Exercise 1 had no effect on modulation, the Exercise 2 altered significantly the modulation of pelvic contraction during increasing cough efforts (P = 0.043) only in women presenting with SUI. The bladder filling volume seems to not significantly modify this modulation (P = 0.12). Median latency between the onset of the EAS EMGi and the onset of the EIC EMGi was -470 and -60 msec in OAB group and in SUI group, respectively (P = 0.012). There was a good correlation between mean latency (default of EAS EMGi pre-activation) and an altered modulation of pelvic contraction during increasing cough efforts (P = 0.040). CONCLUSIONS Some women with SUI exhibit an altered pattern of the PFM response during increasing coughing efforts. The lack of this modulation of PFM response to stress may be one of the pathophysiologic factors of SUI.
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Affiliation(s)
- Xavier Deffieux
- Université Pierre et Marie Curie-Paris 6, Faculté de Médecine, Paris, France.
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Deffieux X, Raibaut P, Hubeaux K, Ismael SS, Amarenco G. [Voiding dysfunction after surgical resection of deeply infiltrating endometriosis: pathophysiology and management]. Gynecol Obstet Fertil 2007; 35 Suppl 1:S8-13. [PMID: 17682230] [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] [Indexed: 05/16/2023]
Abstract
Autonomic nerve (sympathic and parasympathic) damage plays a crucial role in the aetiology of bladder dysfunction that occurs after resection of deeply infiltrating endometriosis (uterosacral ligaments, colorectal bowel, rectovaginal wall). This review presents an overview of the pathophysiology and management of voiding dysfunction that occur after this kind of surgery. The rate of significant post-voiding residual volume and/or hypoactive bladder after colorectal resection for endometriosis ranges from 15 to 20%. This rate seems to be higher (up to 30%) after proximal utero-sacral ligaments resection. This is explained by the location of the inferior hypogastric plexus at the proximal portion of the utero-sacral ligaments. Urodynamics investigations show non specific hypoactive bladder and altered uroflowmetry. Concerning treatment, further controlled studies are needed to assess the hypothetical usefulness of parasympathomimetic and prokinetic agents for hypoactive bladder occurring after pelvic autonomic denervation. Neuromodulation is a successful treatment for patients with refractory lower urinary tract dysfunction. However, there is no controlled study that focused on its efficacy in voiding dysfunction after radical pelvic surgery. Overall, the main objective of the treatment is to avoid the complications of post-voiding residue (such as infection) and of abdominal pushing effort (deterioration of perineal tissues). Therefore, self catheterization should be recommended when this postoperative complication occurs. An understanding of the location of the autonomic pelvic network should help prevent iatrogenic injury through the adoption of surgical techniques, such as nerve sparing, that reduce postoperative autonomic dysfunction.
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Affiliation(s)
- X Deffieux
- Laboratoire d'Urodynamique et d'Explorations Neurophysiologiques du Périnée, Service de Rééducation Neurologique, Hôpital Rothschild, AP-HP, Paris, France.
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Bonan IV, Hubeaux K, Gellez-Leman MC, Guichard JP, Vicaut E, Yelnik AP. Influence of subjective visual vertical misperception on balance recovery after stroke. J Neurol Neurosurg Psychiatry 2007; 78:49-55. [PMID: 17012343 PMCID: PMC2117806 DOI: 10.1136/jnnp.2006.087791] [Citation(s) in RCA: 68] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2006] [Revised: 09/11/2006] [Accepted: 09/16/2006] [Indexed: 11/04/2022]
Abstract
BACKGROUND Subjective visual vertical (SVV) perception can be perturbed after stroke, but its effect on balance recovery is not yet known. AIM To evaluate the influence of SVV perturbations on balance recovery after stroke. METHODS 28 patients (14 with a right hemisphere lesion (RHL) and 14 with a left hemisphere lesion (LHL)) were included, 5 were lost to follow-up. SVV perception was initially tested within 3 months after stroke, then at 6 months, using a luminous line, which the patients adjusted to the vertical position in a dark room. Mean deviation (V) and uncertainty (U), defined as the standard deviation of the SVV, were calculated for eight trials. Balance was initially assessed by the Postural Assessment Scale for Stroke (PASS), and at 6 months by the PASS (PASS6), a force platform (lateral and sagittal stability limits (LSL6 and SSL6)), the Rivermead Mobility Index (RMI6) and gait velocity (v6). Functional outcome was also assessed by the Functional Independence Measure at 6 months (FIM6). RESULTS The scores for balance and for FIM6 were related to the initial V value: PASS6 (p = 0.01, tau = -0.38); RMI6 (p = 0.002, tau = -0.48), LSL6 (p = 0.06, tau = -0.29), SSL6 (p = 0.004, tau = -0.43), v6 (p = 0.01, tau = -0.36) and FIM6 (p = 0.001, tau = -0.49), as well as to the initial U value: PASS6 (p = 0.03, tau = -0.32), RMI6 (p = 0.02, tau = -0.35), SSL6 (p = 0.005, tau = -0.43) and FIM6 (p = 0.01, tau = -0.38). CONCLUSIONS Initial misperception of verticality was related to a poor score for balance after stroke. This relationship seems to be independent of motricity and neglect. Rehabilitation programmes should take into account verticality misperceptions, which could be an important factors influencing balance recovery after stroke.
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Affiliation(s)
- I V Bonan
- Physical Medicine and Rehabilitation Department, GH Lariboisiere-F Widal, 200 Rue du Faubourg St Denis, Paris 75010, France.
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Deffieux X, Hubeaux K, Damphousse M, Raibaut P, Sheikh Ismael S, Thoumie P, Amarenco G, Lapeyre E, Jousse M. Fatigue neuromusculaire périnéale. ACTA ACUST UNITED AC 2006; 49:331-6, 413-7. [PMID: 16698109 DOI: 10.1016/j.annrmp.2006.03.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2006] [Accepted: 03/22/2006] [Indexed: 10/24/2022]
Abstract
AIM The physiology of urinary continence during stress is complex and the role of passive and active mechanisms remains unclear. Coughing leads to a contraction of urethral rhabdomyosphincter and pelvic floor muscles leading to a positive urethro-vesical gradient and continence. Neuromuscular fatigue can involve all striated muscles, including rhabdomyosphincter, peri-urethral and pelvic floor muscles. This article reviews results of studies assessing perineal muscular fatigue in urinary incontinence. MATERIALS AND METHODS A systematic review of the literature (Medline, Pascal and Embase) with use of the MESH keywords fatigue, stress, urinary incontinence, pelvic floor, urethra, urethral pressure, and muscle. RESULTS Animal models have shown that the pelvic muscles (iliococcygeus and pubococcygeous) exhibit more neuromuscular fatigue than classical skeletal striated muscles (i.e. soleus muscle). Although the human external urethral sphincter is considered to be a highly fatigue-resistant muscle with its high proportion of slow muscle fibers, repeated coughing seems to lead to decreased urethral pressure in numerous women affected with stress urinary incontinence. In this case, "urethral fatigue" might be a possibility. CONCLUSIONS Although few studies have focused on perineal muscular fatigue, such increased fatigue in pelvic floor muscles may play a role in the pathophysiologic features of stress urinary incontinence in women.
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Affiliation(s)
- X Deffieux
- Laboratoire d'Urodynamique et d'Explorations Neurophysiologiques du Périnée, Service de Rééducation Neurologique, Hôpital Rothschild, APHP, 75012 Paris, France.
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