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Yamasaki N, Mizumoto J, Shimizu T. Spinal Deformity Manifested by Urinary Tract Infection: A Case of Acute-on-Chronic Mobility Dysfunction. Cureus 2024; 16:e55475. [PMID: 38571861 PMCID: PMC10989209 DOI: 10.7759/cureus.55475] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/04/2024] [Indexed: 04/05/2024] Open
Abstract
A 53-year-old man with diabetes mellitus presented to the emergency department with a fever and impaired mobility. A preliminary diagnosis of urinary tract infection was made based on dysuria and pyuria. History-taking revealed a history of gait disturbance and difficult urination. A thorough physical examination suggested a spinal abnormality. MRI scan revealed a narrow spinal canal due to ossification of the posterior longitudinal ligament and diffuse idiopathic skeletal hyperostosis. Throughout the diagnostic process, we employed both vertical tracing to investigate the causes of urinary tract infection and horizontal tracing to explore comorbidities such as diabetes. Additionally, we introduced appropriate social security and support systems under the name of diagnostic excellence.
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Affiliation(s)
- Noriko Yamasaki
- Center for Medical Training, Ehime Seikyo Hospital, Matsuyama, JPN
| | - Junki Mizumoto
- Department of Medical Education Studies, International Research Center for Medical Education, Graduate School of Medicine, The University of Tokyo, Tokyo, JPN
| | - Taro Shimizu
- Department of Diagnostic and Generalist Medicine, Dokkyo Medical University Hospital, Mibu, JPN
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2
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Salyukov RV, Kamalov AA, Okhobotov DA, Chalyi ME, Frolova MV. [Efficacy of fesoterodine for prevention of autonomic dysreflexia in patients with neurogenic dysfunction of the bladder after spinal cord injury]. Urologiia 2023:47-51. [PMID: 37417411] [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] [Subscribe] [Scholar Register] [Indexed: 07/08/2023]
Abstract
AIM to evaluate the effectiveness of fesoterodine for the prevention of autonomic dysreflexia (AD) in patients with neurogenic bladder dysfunction (NBD) after spinal cord injury (SCI). MATERIALS AND METHODS a total of 53 patients with AD were included in the study. In the main group (n=33) patients received fesoterodine 4 mg per day for 12 weeks as a treatment for neurogenic bladder dysfunction and prevention of AD. In the control group (n=20), patients were monitored for 12 weeks without specific treatment. The assessment was based on the results of ADFSCI and NBSS questionnaires, daily blood pressure monitoring with the completion of a self-observation diary, cystometry with simultaneous monitoring of blood pressure and heart rate. RESULTS In the main group there was a significant decrease in episodes and severity of AD according to ADFSCI questionnaire and an improvement in the quality of life according to NBSS questionnaire compared to the control group (p<0.001). Also, in the main group, the number of episodes of AD and systolic blood pressure decreased. The maximum bladder capacity and bladder compliance increased (p<0.001), and the maximum detrusor pressure and systolic blood pressure when the cystometric capacity was reached, decreased significantly (p<0.001) in the main group compared in comparison with the control group. CONCLUSION Fesoterodine at a dosage of 4 mg for 12 weeks reduced the severity of symptoms of AD in patients with SCI and NBD, which was manifested by the stabilization of blood pressure and a decrease in the number of episodes of AD, which significantly improved the quality of life. Also, the drug led to a significant improvement in urodynamic parameters during cystometry, in the form of a decrease in detrusor pressure and an increase in cystometric capacity. We can conclude that fesoterodine is effective in the prevention of AD in patients with NBD after SCI.
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Affiliation(s)
- R V Salyukov
- Medical Scientific and Educational Center of Lomonosov Moscow State University, Moscow, Russia
- Department of Urology and Andrology, Faculty of Fundamental Medicine of Moscow State University by Lomonosov, Moscow, Russia
- Russian X-radiology Research Center of the Ministry of Healthcare of the Russian Federation, Moscow, Russia
- Department of Medical Rehabilitation of Pirogov Russian National Research Medical University, Moscow, Russia
| | - A A Kamalov
- Medical Scientific and Educational Center of Lomonosov Moscow State University, Moscow, Russia
- Department of Urology and Andrology, Faculty of Fundamental Medicine of Moscow State University by Lomonosov, Moscow, Russia
- Russian X-radiology Research Center of the Ministry of Healthcare of the Russian Federation, Moscow, Russia
- Department of Medical Rehabilitation of Pirogov Russian National Research Medical University, Moscow, Russia
| | - D A Okhobotov
- Medical Scientific and Educational Center of Lomonosov Moscow State University, Moscow, Russia
- Department of Urology and Andrology, Faculty of Fundamental Medicine of Moscow State University by Lomonosov, Moscow, Russia
- Russian X-radiology Research Center of the Ministry of Healthcare of the Russian Federation, Moscow, Russia
- Department of Medical Rehabilitation of Pirogov Russian National Research Medical University, Moscow, Russia
| | - M E Chalyi
- Medical Scientific and Educational Center of Lomonosov Moscow State University, Moscow, Russia
- Department of Urology and Andrology, Faculty of Fundamental Medicine of Moscow State University by Lomonosov, Moscow, Russia
- Russian X-radiology Research Center of the Ministry of Healthcare of the Russian Federation, Moscow, Russia
- Department of Medical Rehabilitation of Pirogov Russian National Research Medical University, Moscow, Russia
| | - M V Frolova
- Medical Scientific and Educational Center of Lomonosov Moscow State University, Moscow, Russia
- Department of Urology and Andrology, Faculty of Fundamental Medicine of Moscow State University by Lomonosov, Moscow, Russia
- Russian X-radiology Research Center of the Ministry of Healthcare of the Russian Federation, Moscow, Russia
- Department of Medical Rehabilitation of Pirogov Russian National Research Medical University, Moscow, Russia
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Khan MA, Lyan NA, Vakhova EL, Lvova AV, Mikhlin SB, Illarionov VE. [The high-intensity pulsed magnetic therapy in the medical rehabilitation of children. (Literature review)]. Vopr Kurortol Fizioter Lech Fiz Kult 2023; 100:99-102. [PMID: 38289311 DOI: 10.17116/kurort202310006199] [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] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/01/2024]
Abstract
In recent decades, a promising area of physiotherapy has been intensively developed In Russia and abroad - magnetic therapy, based on the use of various types of magnetic fields for preventive, curative and rehabilitative purposes. The use of high-intensity pulsed magnetotherapy is promising. The effectiveness of the method in a number of diseases of childhood, which has an active stimulating effect on the state of the neuromuscular apparatus, has been proven.
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Affiliation(s)
- M A Khan
- Moscow Scientific and Practical Center of Medical Rehabilitation, Restorative and Sports Medicine, Moscow, Russia
- Filatov Children's City Hospital, Moscow, Russia
| | - N A Lyan
- Moscow Scientific and Practical Center of Medical Rehabilitation, Restorative and Sports Medicine, Moscow, Russia
- Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
| | - E L Vakhova
- Moscow Scientific and Practical Center of Medical Rehabilitation, Restorative and Sports Medicine, Moscow, Russia
- Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
| | - A V Lvova
- Moscow Scientific and Practical Center of Medical Rehabilitation, Restorative and Sports Medicine, Moscow, Russia
| | - S B Mikhlin
- Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
| | - V E Illarionov
- Petrovsky National Research Centre of Surgery, Moscow, Russia
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Aoki K, Momose H, Gotoh D, Morizawa Y, Hori S, Nakai Y, Miyake M, Anai S, Torimoto K, Tanaka N, Yoneda T, Matsumoto Y, Fujimoto K. Video-urodynamic effects of vibegron, a new selective β3-adrenoceptor agonist, on antimuscarinic-resistant neurogenic bladder dysfunction in patients with spina bifida. Int J Urol 2021; 29:76-81. [PMID: 34608669 DOI: 10.1111/iju.14720] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [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: 07/01/2021] [Accepted: 09/16/2021] [Indexed: 01/22/2023]
Abstract
OBJECTIVES To evaluate the efficacy, safety and tolerability of vibegron for the treatment of antimuscarinic-resistant neurogenic bladder dysfunction in patients with spina bifida. METHODS In this retrospective study, 15 patients with antimuscarinic-resistant neurogenic bladder dysfunction due to spina bifida underwent a video-urodynamic study before and during the administration of vibegron 50 mg once daily instead of antimuscarinic agents from February 2019 through April 2021. The video-urodynamic study was carried out to evaluate bladder compliance, maximum cystometric bladder capacity, detrusor overactivity, detrusor leak point pressure and vesicoureteral reflux before and >3 months after the beginning of vibegron administration. RESULTS Treatment with vibegron significantly improved bladder compliance and maximum cystometric bladder capacity compared with antimuscarinic agents, respectively (7.4 ± 4.2 vs 30.4 ± 48.2 mL/cmH2 O, P = 0.0001; 231.4 ± 81.2 vs 325.2 ± 106.5 mL, P = 0.0005). Detrusor overactivity did not change after the administration of vibegron. Bladder deformity, which was confirmed in 12 patients, improved in half of the patients after taking vibegron. Vesicoureteral reflux, which was confirmed in two patients, was extinguished after taking vibegron. Newly occurring adverse events were not observed, and all patients continued to take vibegron during the treatment period. CONCLUSIONS Favorable efficacy of vibegron for antimuscarinic-resistant neurogenic bladder dysfunction due to spina bifida was shown video-urodynamically without apparent adverse events. Vibegron is a favorable option for the treatment of antimuscarinic-resistant neurogenic bladder dysfunction in patients with spina bifida.
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Affiliation(s)
- Katsuya Aoki
- Department of Urology, Nara Medical University, Japan
| | - Hitoshi Momose
- Department of Urology, Hirao Hospital, Kashihara, Nara, Japan
| | - Daisuke Gotoh
- Department of Urology, Nara Medical University, Japan
| | | | - Shunta Hori
- Department of Urology, Nara Medical University, Japan
| | - Yasushi Nakai
- Department of Urology, Nara Medical University, Japan
| | - Makito Miyake
- Department of Urology, Nara Medical University, Japan
| | - Satoshi Anai
- Department of Urology, Nara Medical University, Japan
| | | | | | - Tatsuo Yoneda
- Department of Urology, Nara Medical University, Japan
| | - Yoshihiro Matsumoto
- Department of Urology, Japan Community Health Care Organization Hoshigaoka Medical Center, Hirakata, Osaka, Japan
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Silva T, T Horliana ACR, Malavazzi TCS, Santos EM, Gonçalves MLL, Fernandes KPS, Mesquita-Ferrari RA, Martimbianco ALC, Bussadori SK. Efficacy and safety of electrical stimulation in the treatment of neurogenic bladder dysfunction in myelomeningocele-Systematic review of randomized clinical trials. Neurourol Urodyn 2021; 41:91-101. [PMID: 34524699 DOI: 10.1002/nau.24792] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 06/24/2021] [Revised: 08/23/2021] [Accepted: 08/31/2021] [Indexed: 11/05/2022]
Abstract
AIMS The purpose of this systematic review was to investigate and synthesize the effects (benefits and harms) of electrical stimulation (EE), alone or in association with other interventions, compared with sham and other interventions, for the treatment of neurogenic bladder dysfunction in myelomeningocele. METHODS This systematic review was conducted following the methodological recommendations of the Cochrane Handbook for Systematic Reviews of Interventions and registered at PROSPERO (CRD42020200425). A search was performed in the following electronic databases: MEDLINE, Cochrane Central Register of Controlled Trials, EMBASE, LILACS, and PEDro. Randomized clinical trials (RCTs) that assessed any EE in children diagnosed with myelomeningocele and neurogenic bladder and/or urinary incontinence were included and reported. RESULTS When comparing EE versus sham groups, some estimated effects showed a wide confidence interval, probably due to the small sample size of the included studies. This indicates an imprecision in these findings. Regarding the safety of this intervention and safety of the lower urinary tract, no adverse events resulting from EE were reported. All the included studies have evaluated the efficacy of EE compared with sham, but different EE parameters and electrode positions among studies make it impossible to perform a meta-analysis. CONCLUSIONS Based on very low certainty evidence, the findings of this systematic review suggested no difference between EE and sham to improve urinary incontinence in children with myelomeningocele. However, the small sample size and the imprecision arising from the wide confidence intervals must be considered. Future RCTs following a rigorous methodology, as recommended by the CONSORT statement, should be conducted to support the use of this intervention in clinical practice.
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Affiliation(s)
- Tamiris Silva
- Postgraduate Program in Rehabilitation Sciences, Universidade Nove de Julho (UNINOVE), São Paulo, Brazil
| | - Anna C R T Horliana
- Postgraduate Program in Biophotonics Applied to the Health Sciences, UNINOVE, São Paulo, Brazil
| | - Tainá C S Malavazzi
- Postgraduate Program in Biophotonics Applied to the Health Sciences, UNINOVE, São Paulo, Brazil
| | - Elaine M Santos
- Pro-rectory for Academic Affairs, UNIMES, Santos, Brazil.,Postgraduate Program in Health and Environment, Universidade Metropolitana de Santos (UNIMES), Santos, Brazil
| | - Marcela L L Gonçalves
- Postgraduate Program in Biophotonics Applied to the Health Sciences, UNINOVE, São Paulo, Brazil.,Postgraduate Program in Health and Environment, Universidade Metropolitana de Santos (UNIMES), Santos, Brazil
| | | | - Raquel A Mesquita-Ferrari
- Postgraduate Program in Rehabilitation Sciences, Universidade Nove de Julho (UNINOVE), São Paulo, Brazil.,Postgraduate Program in Biophotonics Applied to the Health Sciences, UNINOVE, São Paulo, Brazil
| | - Ana Luiza C Martimbianco
- Postgraduate Program in Health and Environment, Universidade Metropolitana de Santos (UNIMES), Santos, Brazil.,Center of Health Technology Assessment, Hospital Sírio-Libanês, São Paulo, Brazil
| | - Sandra K Bussadori
- Postgraduate Program in Rehabilitation Sciences, Universidade Nove de Julho (UNINOVE), São Paulo, Brazil.,Postgraduate Program in Biophotonics Applied to the Health Sciences, UNINOVE, São Paulo, Brazil
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Gong D, Wang Y, Zhong L, Jia M, Liu T, Li K. Excretory dysfunction and quality of life after a spinal cord injury: A cross-sectional study. J Clin Nurs 2021; 30:1394-1402. [PMID: 33528879 DOI: 10.1111/jocn.15689] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [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: 10/05/2020] [Revised: 12/14/2020] [Accepted: 01/22/2021] [Indexed: 11/28/2022]
Abstract
AIMS AND OBJECTIVES To determine the aspects of excretory dysfunction most influential in determining the quality of life of survivors of spinal cord injury. BACKGROUND Excretory dysfunction is one of the most common and troublesome sequelae of spinal cord injury. Previous studies have shown that it can restrict social participation restriction, cause readmission and generally influence quality of life substantially. DESIGN A cross-sectional survey of hospital inpatients following STOBE guidelines. METHODS A convenience sample of 101 patients with traumatic or non-traumatic spinal cord injury were asked about their experiences of excretory dysfunction, and management and their self-perceived quality of life. Univariate analysis and multiple linear regression were performed to isolate the most important relationships. RESULTS Only 2 of the 101 subjects professed to be unaffected by excretion dysfunction. Bladder-related dysfunction was the most frequently mentioned type of problem. Quality of life impairment was found to be most often associated with bladder accidents, bowel accidents and having more than one bladder complications. CONCLUSIONS Excretory dysfunction substantially impacts quality of life after a spinal cord injury. Bladder accidents, bowel accidents and more than one bladder complication are factors independently influencing the quality of life of spinal cord injury survivors. RELEVANCE TO CLINICAL PRACTICE To improve excretion-related QOL, patients' bladder and bowel self-management training should be strengthened seeking to prevent complications and reduce the risk of bladder and bowel accidents.
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Affiliation(s)
- De Gong
- School of Nursing, Sun Yat-sen University, Guangzhou, China
| | - Yingmin Wang
- Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Lirong Zhong
- Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Mengmeng Jia
- School of Nursing, Sun Yat-sen University, Guangzhou, China
| | - Ting Liu
- School of Nursing, Sun Yat-sen University, Guangzhou, China
| | - Kun Li
- School of Nursing, Sun Yat-sen University, Guangzhou, China
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7
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Alatas I, Ozel K, Kara N, Canaz H. Urodynamic Study Findings Prior to Myelomeningocele Repair in Neonates. J Pediatr Neurosci 2020; 15:220-223. [PMID: 33531935 PMCID: PMC7847111 DOI: 10.4103/jpn.jpn_91_19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Accepted: 11/18/2019] [Indexed: 11/04/2022] Open
Abstract
Introduction Myelomeningocele (MMC) is the most common cause of neurogenic bladder dysfunction in children. Neurogenic bladder dysfunction is developed before birth due to autonomous nervous system affected prenatally in patients with MMC. The aim of this study was to share urodynamic study findings before MMC repair and to discuss the correlation with neurological evaluation. Materials and Methods We prospectively studied 37 patients who underwent surgery for MMC repair in our institution in the first 20 h of their lives between 2013 and 2016. All patients were evaluated by a neurosurgeon, neonatologist, and pediatric surgeon. Urodynamic study was performed in first 18h of life before MMC repair in all patients. Lesion level, occurrence of hydrocephalus, neurological functions, spinal deformities, and urodynamic study results were analyzed. Results The study included 18 female and 19 male patients. Overactive detrusor was detected in 22 patients, and hypoactive detrusor was detected in 5 patients. Overactive sphincter muscle was detected in 32 patients, and hypoactive sphincter was detected in 2 patients. Detrusor-sphincter dyssynergia was present in 34 patients. Conclusion Detailed analysis of urodynamic study findings in larger patient groups may be important to understand the physiopathology of prenatal damage in patients with MMC.
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Affiliation(s)
- Ibrahim Alatas
- Department of Neurosurgery, Florence Nightingale Hospital, Demiroglu Bilim University, Istanbul, Turkey
| | - Kerem Ozel
- Department of Pediatric Surgery, Medeniyet University, Istanbul, Turkey
| | - Nursu Kara
- Department of Neonatology, Istanbul Training and Education Hospital, Istanbul, Turkey
| | - Huseyin Canaz
- Department of Neurosurgery, Florence Nightingale Hospital, Demiroglu Bilim University, Istanbul, Turkey
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Ehrén I, Lindbo L, Gabrielsson H, Bendt M, Seiger Å. Voiding conditions, renal and bowel function in a cohort of adults with spina bifida. Neurourol Urodyn 2020; 39:1796-1802. [PMID: 32531078 DOI: 10.1002/nau.24422] [Citation(s) in RCA: 2] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Accepted: 05/26/2020] [Indexed: 11/09/2022]
Abstract
AIM To map voiding patterns, degree of continence, use of drugs for voiding disorders, kidney function and surgical interventions but also the bowel function in a near-total regional cohort of adults with spina bifida aged more than or equal to 18 years. METHODS All individuals more than or equal to 18 years of age with spina bifida registered at a regional outpatient clinic (n = 219) were invited to participate, of which 196 persons were included. Bladder and bowel function were assessed according to questions used by the Nordic Spinal Cord Injury Registry by structured interviews and questionnaires in combination with review of patient charts including kidney function. RESULTS Twenty percent of the patients voided spontaneously. Fifty-four percent used clean intermittent catherization (CIC) and of these, 14% had also undergone augmentation of the bladder and/or implantation of an artificial sphincter or sling, 23% had undergone major urological surgery, and 3% had an indwelling catheter. Seventeen percent of patients voiding spontaneously or using CIC reported total continence but as many as 36% reported daily leakage. Anticholinergics was the most common drug, used by 21% in the total cohort. About 13% of the patients had a reduced kidney function but only 1.5% had end stage renal failure. Seventy-three percent had problems emptying the bowel and 18% experienced fecal leakage weekly or even daily. CONCLUSION We found a large variation in problems with bladder and bowel function in this adult group of persons with spina bifida. A structured customized program for follow-up seems necessary to optimize their health status in these areas.
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Affiliation(s)
- Ingrid Ehrén
- Rehab Station Stockholm, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden.,Department of Urology, Karolinska University Hospital, Stockholm, Sweden.,Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Lena Lindbo
- Rehab Station Stockholm, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
| | - Hanna Gabrielsson
- Rehab Station Stockholm, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden.,Faculty of Medicine and Health, School of Health Sciences, Örebro University, Örebro, Sweden.,Ersta Sköndal Bräcke University College, Stockholm, Sweden
| | - Martina Bendt
- Rehab Station Stockholm, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden.,Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
| | - Åke Seiger
- Rehab Station Stockholm, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden.,Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
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Gupta A, Sivaram A, Krishnan R, Khanna M. Urinary Symptoms and Bladder Dysfunction in Patients with Neuromyelitis Optica Spectrum Disorders: Evaluation with Urodynamics and Management. J Neurosci Rural Pract 2020; 11:245-249. [PMID: 32367978 PMCID: PMC7195965 DOI: 10.1055/s-0040-1701557] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Objective
To assess lower urinary tract symptoms (LUTSs) in patients with neuromyelitis optica spectrum disorders (NMOSDs) and bladder dysfunction through urodynamics (filling and voiding phase of cystometrography) and management based on findings.
Patients and Methods
The study included 42 (34 females) patients admitted to the rehabilitation department. Neurologic evaluation was performed and severity of myelitis was assessed using the American Spinal Injury Association Impairment Scale. All patients underwent urodynamics, and management was based on the findings.
Results
Mean age was 34.5 years (range: 11–64 years; standard deviation: 13.1). Twenty-three (54.8%) patients had a first episode of myelitis, whereas 19 patients had relapses (number of episodes varying from 2 to 7). Eleven (26%) patients had increased frequency, 16 (37%) had urgency, 12 (28%) had urge incontinence, 8 (18.6%) had stress incontinence, 22 (52.4%) had nocturia, 31 (72%) had retention of urine, 22 (52.4%) had incomplete evacuation, and 14 (33.3%) patients had mixed urinary complaints. The common urodynamic findings were neurogenic detrusor overactivity (NDO) with detrusor-sphincter dyssynergia (DSD) in 14 (33.3%) patients, NDO without DSD in 8 (19%), and acontractile detrusor in 20 (47.6%). Pharmacotherapy was advised to 22 (52.4%) patients, whereas clean intermittent catheterization (CIC)/self-catheterization was advised to 39 (92.9%) patients.
Conclusions
Urinary retention was observed to be the most common urinary complaint in patients with NMOSD followed by NDO with or without sphincter dyssynergia. Urodynamics should be performed in all patients with LUTSs for best management. CIC remains the gold standard for the management of neurogenic bladder dysfunction.
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Affiliation(s)
- Anupam Gupta
- Department of Neurological Rehabilitation, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Alisseril Sivaram
- Department of Neurological Rehabilitation, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Rashmi Krishnan
- Department of Neurological Rehabilitation, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Meeka Khanna
- Department of Neurological Rehabilitation, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
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Lei H, Fu Y, Xu G, Yin Z, Zhao L, Liang F. Different types of acupuncture and moxibustion therapy for neurogenic bladder after spinal cord injury: A systematic review and network meta-analysis study protocol. Medicine (Baltimore) 2020; 99:e18558. [PMID: 31895798 PMCID: PMC6946264 DOI: 10.1097/md.0000000000018558] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Accepted: 12/03/2019] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND The invasive surgical intervention for neurogenic bladder dysfunction (NBD) following spinal cord injury (SCI) involves permanently altering one's body system and carries many surgical related risks and medication side effects are often seen in long term usage of pharmaceutical medications. Therefore, acupuncture and moxibustion therapies have been recommended due to their efficacy, simplicity of operation, cost effectiveness and safety. This protocol is designed for systematic review and network meta-analysis, which will perform comparisons or rankings of efficacy among the currently available acupuncture and moxibustion techniques and provide evidence to guide the best practice in acupuncture and moxibustion treatments of NBD due to SCI. METHODS/DESIGN The Cochrane Library, EMBASE, PubMed, Web of Science, CENTRAL, CNKI, The VIP Database, The Wanfang database, CDFD, CMFD will be searched from inception to November 1, 2019. All randomized controlled trials containing eligible interventions(s) and outcome(s) will be included. The quality of included trials will be assessed using the "Risk of bias" tool from the Cochrane Handbook (V.5.1.0). Data analysis will be conducted by using STATA software (Version 13.0). Continuous outcome will be indicated as mean difference (MD) or standard mean difference (SMD), and enumeration data will be presented with odds risk (OR) or relative risk (RR). RESULTS This systematic review and network meta-analysis study aims to determine the most effective and safe approach in relieving urinary symptoms, and whether it produces better results in urodynamic examination. And a high-quality ranking of the therapeutic classes will be presented. The report will follow the PRISMA checklist for network meta-analysis. Results of the search strategy and the study selection will be presented in a PRISMA compliant flow chart. CONCLUSION This study aims to propose a standard clinical decision-making guideline for acupuncture and moxibustion treatment of NBD after SCI.
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Abstract
Objective This study aimed to evaluate the effect of continuous care intervention on the quality of life (QoL) of patients with neurogenic bladder. Methods Eighty-two patients with neurogenic bladder dysfunction caused by spinal cord injury were included into the study. All of the patients had continuous care intervention (for 3 months), including clean intermittent self-catheterization, drinking guidance, and bladder training guidance. A health record was established for each patient before discharge and was used to record changes in the patients when followed up. Scores of QoL, which were based on the World Health Organization Quality of Life-BREF, occurrence of complications, and compliance of all patients were recorded. Results After 3-month care intervention, there were significantly fewer complications than before the intervention. Patients’ compliance and QoL were significantly higher after 3 months of care intervention than before the intervention. Conclusion Continuous care intervention can improve patients’ compliance and reduce urinary complications.
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Affiliation(s)
- Fang Tang
- 1 Department of Orthopedic Surgery, Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital, Chengdu, China
| | - Zongyan Cheng
- 2 Department of Surgery, Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital, Chengdu, China
| | - Xianxiu Wen
- 3 Department of Nursing, Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital, Chengdu, China
| | - Jinying Guan
- 4 Department of Rehabilitation Medicine, Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital, Chengdu, China
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12
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Storme O, Tirán Saucedo J, Garcia-Mora A, Dehesa-Dávila M, Naber KG. Risk factors and predisposing conditions for urinary tract infection. Ther Adv Urol 2019; 11:1756287218814382. [PMID: 31105772 PMCID: PMC6502981 DOI: 10.1177/1756287218814382] [Citation(s) in RCA: 83] [Impact Index Per Article: 16.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2018] [Accepted: 10/27/2018] [Indexed: 12/16/2022] Open
Abstract
Understanding individual and population-specific risk factors associated with recurrent urinary tract infections (UTIs) can help physicians tailor prophylactic strategies. Frequent intercourse, vulvovaginal atrophy, change of the local bacterial flora, history of UTIs during premenopause or in childhood, family history, and a nonsecretor blood type are substantiated risk factors for recurrent uncomplicated UTIs. This is a narrative review based on relevant literature according to the experience and expertise of the authors. Asymptomatic bacteriuria is generally benign; however, during pregnancy it is more common and is associated with an increased likelihood of symptomatic infection, which may harm the mother or fetus. Screening of pregnant women and appropriate treatment with antimicrobials must be balanced with the potential for adverse treatment-related outcomes; appropriate prophylaxis should be considered where possible. High-quality data are currently lacking on risks related to asymptomatic bacteriuria in pregnancy and further data in this hard-to-study population should be a primary concern for researchers. Incomplete voiding represents the primary risk factor for UTIs associated with conditions such as urinary incontinence and prolapse. Correcting the presence of residual urine remains the most effective prophylaxis in these populations. Bladder function alters throughout life; however, changes in function may be particularly profound in clinical populations at high risk of UTIs. Patients with neurogenic bladder will also likely have other evolving medical issues which increase the risk of UTIs, such as repeated catheterization and increasing residual urine volume. More aggressive antimicrobial prophylactic strategies may be appropriate in these patients. Again, the paucity of data on prophylaxis in these high-risk patients requires the attention of the research community.
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Affiliation(s)
- Oscar Storme
- Padre Hurtado Hospital, Universidad del
Desarrollo, Calle Esperanza 2150, Paradero 28, Santa Rosa, San Ramón,
Chile
| | - José Tirán Saucedo
- Instituto Mexicano de Infectología, Ginecología
y Obstetrica, Universidad de Monterrey, Monterrey, Mexico
| | - Arturo Garcia-Mora
- Instituto Nacional de Ciencias Médicas y
Nutrición Salvador Zubirán, Mexico City, Mexico
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Rosier PFWM, Kuo HC, De Gennaro M, Gammie A, Finazzi Agro E, Kakizaki H, Hashim H, Toozs-Hobson P. International Consultation on Incontinence 2016; Executive summary: Urodynamic testing. Neurourol Urodyn 2018; 38:545-552. [PMID: 30576004 DOI: 10.1002/nau.23903] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [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: 06/11/2018] [Accepted: 07/01/2018] [Indexed: 11/10/2022]
Abstract
AIMS The International Consultation on Incontinence has published an update of the recommendations for the diagnosis and management of urine incontinence (ICI2016). This manuscript summarizes the consultations committee-recommendations with regard to urodynamic assessment. METHODS Expert consensus on the basis of structured evidence assessment has been the basis of the consultations publication and has been summarized by the committee for this manuscript. RESULTS Patients that are not satisfied with their initial management on the basis of their reported signs and symptoms of urinary incontinence, as well as all patients with neurological abnormalities that are potentially relevant for the function of the lower urinary tract, may very likely profit from objective diagnosis and staging and grading of their dysfunction, with urodynamic testing, regardless their age, vulnerability and/or comorbidities. The principles and technical innovations as well as the principal recommendations for the utilization of (invasive) urodynamic assessment for women, men, children, and vulnerable elderly, with or without neurogenic lower urinary tract dysfunction with urinary incontinence are provided in this abbreviated ICI recommendations-document. CONCLUSIONS The ICI2016 committee on urodynamics presents an executive summary of the most important reasons and recommendations for the use of urodynamic investigations for patients with urinary incontinence.
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Affiliation(s)
- Peter F W M Rosier
- Department of Urology, University Medical Center, Utrecht, The Netherlands
| | - Hann-Chorng Kuo
- Department of Urology, Buddhist Tzu Chi General Hospital, Hualien, Taiwan
| | - Mario De Gennaro
- Department of Nephrology-Urology Pediatric Ospedale Pediatrico Bambino Gesù, Rome, Italy
| | - Andrew Gammie
- Bristol Urological Institute, Bristol, United Kingdom
| | | | - Hidehiro Kakizaki
- Department of Renal and Urologic Surgery, Asahikawa Medical University, Asahikawa, Japan
| | - Hashim Hashim
- Bristol Urological Institute, Bristol, United Kingdom
| | - Philip Toozs-Hobson
- Department of Gynaecology and Pelvic Floor Medicine, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK
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Krhut J, Borovička V, Bílková K, Sýkora R, Míka D, Mokriš J, Zachoval R. Efficacy and safety of mirabegron for the treatment of neurogenic detrusor overactivity-Prospective, randomized, double-blind, placebo-controlled study. Neurourol Urodyn 2018; 37:2226-2233. [PMID: 29603781 DOI: 10.1002/nau.23566] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2017] [Accepted: 02/05/2018] [Indexed: 11/11/2022]
Abstract
AIMS To assess the efficacy and safety of mirabegron in the treatment of neurogenic detrusor overactivity. METHODS This prospective, multicenter, randomized, double-blind, placebo-controlled study was conducted in three tertiary centers, and included 78 patients suffering from spinal cord injury or multiple sclerosis. Patients were randomized for Mirabegron 50 mg (Group A) or placebo (Group B). Urodynamic parameters, the 24 h pad-weight test, and patient-reported outcomes were assessed. Safety assessments included monitoring the incidence and severity of adverse events. Changes in time and differences between groups were assessed with nonparametric Kruskal-Wallis one-way analysis of variance; P ≤ 0.05 was considered statistically significant. RESULTS In total, 66 patients were eligible for inclusion in the final analysis. There was a significant increase of volume at the first detrusor contraction (P = 0.00047) and an improvement in bladder compliance (P = 0.0041) in the mirabegron group compared with the placebo-treated group, whereas the increase in cystometric capacity did not reach statistical significance (P = 0.061). There was a clear tendency to reduced urine leakage (P = 0.056) in Group A. There were significant changes in all the patient-reported outcomes, favoring the mirabegron group. The incidence of drug-related adverse events was 3.13%. CONCLUSIONS Mirabegron (50 mg) improved both urodynamic variables and patient-reported outcomes in patients with NDO. The treatment was tolerated well.
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Affiliation(s)
- Jan Krhut
- Department of Urology, University Hospital, Ostrava, Czech Republic
| | | | - Karolína Bílková
- Spinal Cord Rehabilitation Unit, Rehabilitation Center, Kladruby, Czech Republic
| | - Radek Sýkora
- Department of Urology, University Hospital, Ostrava, Czech Republic
| | - David Míka
- Department of Urology, University Hospital, Ostrava, Czech Republic
| | - Jan Mokriš
- Department of Urology, Thomayer Hospital, Prague, Czech Republic
| | - Roman Zachoval
- Department of Urology, Thomayer Hospital, Prague, Czech Republic
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Abstract
OBJECTIVES To investigate the significance of the ice water test in patients with multiple sclerosis and to evaluate a novel ice water test nomogram in a large patient cohort. METHODS A total of 201 ice water tests of patients with multiple sclerosis were retrospectively evaluated. Incontinence episodes in 24 h and sex were correlated with the ice water test. Furthermore, an ice water test nomogram was developed in order to categorize the detrusor overactivity in severity degrees. Descriptive statistics were carried out for population characteristics. Correlations of categorical variables were calculated by the χ2 -test. The independent t-test was carried out for correlations of continuous variables. Furthermore, the data were evaluated in the novel ice water test nomogram. RESULTS The patient population consisted of 141 (70.1%) women and 60 (39.9%) men. A clinically positive ice water test (maximum detrusor pressure >15 cmH2 O) was identified in 75 patients (37.3%). Significantly more men presented a clinically positive ice water test (P = 0.006). In 16.5%, the ice water test unmasked an involuntary detrusor contraction, although routine cystometry did not show any detrusor overactivity. The ice water test nomogram could be successfully applied. The incontinence episodes and maximum detrusor pressure correlated positively with a higher categorization in the nomogram. Therapeutic interventions and follow-up controls could be successfully illustrated by the nomogram. CONCLUSIONS The ice water test is a simple tool for unmasking non-identified detrusor overactivity in neurogenic bladder dysfunction. A severity categorization of the detrusor overactivity can be facilitated by the use of the ice water test nomogram. After further validation, the ice water test could be ultimately used in future as objective assessment for bladder dysfunction.
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Affiliation(s)
- Tanja Hüsch
- Department of Urology and Pediatric Urology, University Medical Center of Johannes Gutenberg University, Mainz, Germany
| | - André Reitz
- Department of Urology and Pediatric Urology, University Medical Center of Johannes Gutenberg University, Mainz, Germany.,KontinenzZentrum Hirslanden, Zurich, Switzerland
| | - Kurt Ulm
- Institute of Medical Informatics, Statistics and Epidemiology, Technical University of Munich, Munich, Germany
| | - Axel Haferkamp
- Department of Urology and Pediatric Urology, University Medical Center of Johannes Gutenberg University, Mainz, Germany
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Zabbarova IV, Ikeda Y, Carder EJ, Wipf P, Wolf-Johnston AS, Birder LA, Yoshimura N, Getchell SE, Almansoori K, Tyagi P, Fry CH, Drake MJ, Kanai AJ. Targeting p75 neurotrophin receptors ameliorates spinal cord injury-induced detrusor sphincter dyssynergia in mice. Neurourol Urodyn 2018; 37:2452-2461. [PMID: 29806700 DOI: 10.1002/nau.23722] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [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: 12/21/2017] [Accepted: 05/09/2018] [Indexed: 01/23/2023]
Abstract
AIMS To determine the role of p75 neurotrophin receptor (p75NTR ) and the therapeutic effect of the selective small molecule p75NTR modulator, LM11A-31, in spinal cord injury (SCI) induced lower urinary tract dysfunction (LTUD) using a mouse model. METHODS Adult female T8 -T9 transected mice were gavaged daily with LM11A-31 (100 mg/kg) for up to 6 weeks, starting 1 day before, or 7 days following injury. Mice were evaluated in vivo using urine spot analysis, cystometrograms (CMGs), and external urethral sphincter (EUS) electromyograms (EMGs); and in vitro using histology, immunohistochemistry, and Western blot. RESULTS Our studies confirm highest expression of p75NTRs in the detrusor layer of the mouse bladder and lamina II region of the dorsal horn of the lumbar-sacral (L6 -S1 ) spinal cord which significantly decreased following SCI. LM11A-31 prevented or ameliorated the detrusor sphincter dyssynergia (DSD) and detrusor overactivity (DO) in SCI mice, significantly improving bladder compliance. Furthermore, LM11A-31 treatment blocked the SCI-related urothelial damage and bladder wall remodeling. CONCLUSION Drugs targeting p75NTRs can moderate DSD and DO in SCI mice, may identify pathophysiological mechanisms, and have therapeutic potential in SCI patients.
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Affiliation(s)
- Irina V Zabbarova
- Department of Medicine, University of Pittsburgh, Renal-Electrolyte Division, Pittsburgh, Pennsylvania
| | - Youko Ikeda
- Department of Medicine, University of Pittsburgh, Renal-Electrolyte Division, Pittsburgh, Pennsylvania
| | - Evan J Carder
- Department of Chemistry, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Peter Wipf
- Department of Chemistry, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Amanda S Wolf-Johnston
- Department of Medicine, University of Pittsburgh, Renal-Electrolyte Division, Pittsburgh, Pennsylvania
| | - Lori A Birder
- Department of Medicine, University of Pittsburgh, Renal-Electrolyte Division, Pittsburgh, Pennsylvania.,Department of Pharmacology and Chemical Biology, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Naoki Yoshimura
- Department of Pharmacology and Chemical Biology, University of Pittsburgh, Pittsburgh, Pennsylvania.,Department of Urology, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Samuel E Getchell
- Department of Medicine, University of Pittsburgh, Renal-Electrolyte Division, Pittsburgh, Pennsylvania
| | - Khalifa Almansoori
- Department of Medicine, University of Pittsburgh, Renal-Electrolyte Division, Pittsburgh, Pennsylvania
| | - Pradeep Tyagi
- Department of Urology, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Christopher H Fry
- School of Physiology Pharmacology and Neuroscience, University of Bristol, Bristol, UK
| | - Marcus J Drake
- School of Physiology Pharmacology and Neuroscience, University of Bristol, Bristol, UK
| | - Anthony J Kanai
- Department of Medicine, University of Pittsburgh, Renal-Electrolyte Division, Pittsburgh, Pennsylvania.,Department of Pharmacology and Chemical Biology, University of Pittsburgh, Pittsburgh, Pennsylvania
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Pogonchenkova IV, Khan MA, Korchazhkina NB, Novikova EV, Bokova IA, Lyan NA. [The application of the physical factors for the medical rehabilitation of the children presenting with neurogenic dysfunction of the bladder]. Vopr Kurortol Fizioter Lech Fiz Kult 2017; 94:53-58. [PMID: 29388934 DOI: 10.17116/kurort201794653-58] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/28/2017] [Revised: 08/31/2017] [Accepted: 09/27/2017] [Indexed: 11/18/2022]
Abstract
This article describes the modern technologies for the medical rehabilitation of the children presenting with neurogenic dysfunction of the bladder aimed at improving the act of urination at all levels of innervation. The most frequent variant of neurogenic dysfunction of the bladder in the children is the hyper-reflexive one; it is this variant in which the most pronounced disorders of urodynamics due to intravesical hypertension and detrusor hypoxia are observed. The urodynamic disorders are known to contribute to the formation of the characteristic clinical picture associated with the hyper-reflexive urinary bladder dysfunction in the children characterized by the mandatory urination syndrome, pollakiuria, imperative urges, and mandatory urinary incontinence in the combination with enuresis. The treatment of urinary bladder dysfunction includes both behavioural and medication therapeutic modalities. The "golden standard" for the pharmacotherapy of neurogenic bladder dysfunction of the hyper-reflexive type in the childhood is the use of M-cholinoblockers, such as oxybutynin. The popularity of the physiotherapeutic methods is attributable to their influence on the main links of pathogenesis, the absence of side effects, and the possibility of application in the children of the early age. The combined treatment of neurogenic bladder dysfunction includes the use of a wide range of physiotherapeutic methods the action of which is aimed at regulating the act of urination at all levels of innervation of the bladder, normalizing the tone of the muscles of the bladder, eliminating sphincter insufficiency, improving circulation and accelerating the maturation of the neuromuscular apparatus of the pelvic organs. At present, the natural and preformed methods of physiotherapy are finding the wide application for the management of neurogenic dysfunction of the bladder in the children in the conjunction with therapeutic physical exercises, massage, and the biological feedback (BFB) technique.
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Affiliation(s)
- I V Pogonchenkova
- Moscow Scientific and Practical Centre for Medical Rehabilitation, Restorative and Sports Medicine
| | - M A Khan
- Moscow Scientific and Practical Centre for Medical Rehabilitation, Restorative and Sports Medicine.,I.M. Sechenov First Moscow State Medical University
| | | | - E V Novikova
- Moscow Scientific and Practical Centre for Medical Rehabilitation, Restorative and Sports Medicine.,I.M. Sechenov First Moscow State Medical University
| | - I A Bokova
- I.M. Sechenov First Moscow State Medical University
| | - N A Lyan
- Moscow Scientific and Practical Centre for Medical Rehabilitation, Restorative and Sports Medicine.,I.M. Sechenov First Moscow State Medical University
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Kroll P, Gajewska E, Zachwieja J, Sobieska M, Mańkowski P. An Evaluation of the Efficacy of Selective Alpha-Blockers in the Treatment of Children with Neurogenic Bladder Dysfunction--Preliminary Findings. Int J Environ Res Public Health 2016; 13:E321. [PMID: 26999168 DOI: 10.3390/ijerph13030321] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/28/2015] [Revised: 02/24/2016] [Accepted: 02/29/2016] [Indexed: 11/17/2022]
Abstract
The aim of this study was to assess the usefulness of selective α1-blockers in children with neurogenic urinary tract dysfunctions and increased leak point pressure (LPP). 14 children from age 6 to 16 years with neurogenic urinary tract dysfunctions (neurogenic bladder) and LPP > 40 cm H₂O were enrolled in the study. All patients received a selective α1-blocker (doxazosin) for 6-8 weeks with an initial dosage of 0.03 mg/kg. During the observation period the continuation of oral anticholinergics, Clean Intermittent Catheterization (CIC), observation of "urinary dryness" and urinary incontinence periods were recommended. Patients were scheduled for a follow-up visit and urodynamic investigation after 6-8 weeks after the doxazosin therapy was started. In 4 patients, urine leakage occurred at lower pressures; in 9 patients, no significant changes in urine leak point pressures were detected; in 3 patients, there was a significant increase in the bladder capacity; in one patient, deterioration in continence was noted. The differences both in LPP and LPV before and after the treatment were not statistically significant. Our observations are consistent with the conclusions from other studies and showed no evident efficacy of doxazosin in children with neurogenic bladder.
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Bokor A, Csibi N, Lukovich P, Brubel R, Joó JG, Rigó J. [Importance of nerve-sparing surgical technique in the treatment of deep infiltrating endometriosis]. Orv Hetil 2015; 156:1960-5. [PMID: 26588855 DOI: 10.1556/650.2015.30290] [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] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Traditional surgeries performed in cases of deep infiltrating endometriosis lead to impaired quality of life. AIM To summarize the postoperative outcome and to compare the rate of postoperative complications after different therapeutic approaches applied in deep infiltrating endometriosis. METHOD The authors analized the articles published between March 31, 2004 and March 31, 2015, in the database http://www.pubmed.org using the following keywords: endometriosis, deep infiltrating, nerve sparing, surgery. RESULTS Non-nerve sparing surgery resulted in temporary urinary dysfunction in 19.1-38.5% of patients, while it occurred in 0.61-33.3% of patients after nerve-sparing surgery. Non-nerve sparing surgical technique resulted in an average of 121 days of need for self-catheretisation. When nerve-sparing surgeries were performed the duration of self-catheterisation varied between 7 to 39.8 days. After nerve sparing surgeries, permanent bladder dysfunction was not detected in any case. CONCLUSIONS Because of the successful treatment of the patients symptoms and the lower postoperative complication rate, nerve-sparing surgical technique leads to a significant improvement of the quality of life.
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Affiliation(s)
- Attila Bokor
- I. Szülészeti és Nőgyógyászati Klinika, Semmelweis Egyetem, Általános Orvostudományi Kar Budapest, Baross u. 27., 1085
| | - Noémi Csibi
- I. Szülészeti és Nőgyógyászati Klinika, Semmelweis Egyetem, Általános Orvostudományi Kar Budapest, Baross u. 27., 1085
| | - Péter Lukovich
- I. Sebészeti Klinika, Semmelweis Egyetem, Általános Orvostudományi Kar Budapest
| | - Réka Brubel
- I. Szülészeti és Nőgyógyászati Klinika, Semmelweis Egyetem, Általános Orvostudományi Kar Budapest, Baross u. 27., 1085
| | - József Gábor Joó
- I. Szülészeti és Nőgyógyászati Klinika, Semmelweis Egyetem, Általános Orvostudományi Kar Budapest, Baross u. 27., 1085
| | - János Rigó
- I. Szülészeti és Nőgyógyászati Klinika, Semmelweis Egyetem, Általános Orvostudományi Kar Budapest, Baross u. 27., 1085
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Abstract
Control of the lower urinary tract is a complex, multilevel process that involves both the peripheral and central nervous system. Neurogenic lower urinary tract dysfunction (LUTD) is a widespread chronic illness that impairs millions of people worldwide. Neurogenic LUTD has a major impact on quality of life, affecting emotional, social, sexual, occupational and physical aspects of daily life, and in addition to the debilitating manifestations for patients, it also imposes a substantial economic burden on every healthcare system. First-line treatment for neurogenic LUTD includes antimuscarinics and some form of catheterization, preferably intermittent self-catheterization. However, the treatment effect is often unsatisfactory, so that other options have to be considered. Moreover, neurogenic LUTD is a challenge because all available treatment modalities (i.e. conservative, minimally invasive and invasive therapies) may fail. In recent years, botulinum neurotoxin type A (BoNT/A) treatment has been shown to be an effective pharmacological therapy option in patients refractory to antimuscarinic and neurogenic detrusor overactivity (NDO). Several studies have shown that BoNT/A injection significantly reduces detrusor muscle overactivity. Also BoNT/A treatment of NDO has revealed a significant improvement of lower urinary tract function with regard to reduced urinary incontinence, reduced detrusor pressure, increased bladder capacity and improved quality of life in NDO.
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Affiliation(s)
- Stephanie Knuepfer
- Spinal Cord Injury Center & Research, University Zürich, Balgrist University Hospital, Zürich, Forchstrasse 340, 8008 CH, Switzerland
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Larijani FJ, Moghtaderi M, Hajizadeh N, Assadi F. Preventing kidney injury in children with neurogenic bladder dysfunction. Int J Prev Med 2013; 4:1359-64. [PMID: 24498490 PMCID: PMC3898440] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2013] [Accepted: 03/04/2013] [Indexed: 11/26/2022] Open
Abstract
The most common cause of neurogenic bladder dysfunction (NBD) in newborn infants is myelomeningocele. The pathophysiology almost always involves the bladder detrusor sphincter dyssynergy (DSD), which if untreated can cause severe and irreversible damage to the upper and lower urinary tracts. Early diagnosis and adequate management of NBD is critical to prevent both renal damage and bladder dysfunction and to reduce chances for the future surgeries. Initial investigation of the affected newborn infant includes a renal and bladder ultrasound, measurement of urine residual, determination of serum creatinine level, and urodynamics study. Voiding cystogram is indicated when either hydronephrosis or DSD is present. The main goal of treatment is prevention of urinary tract deterioration and achievement of continuance at an appropriate age. Clean intermittent catheterization (CIC) in combination with anticholinergic (oxybutynin) and antibiotics are instituted in those with high filling and voiding pressures, DSD and/or high grade reflux immediately after the myelomeningocele is repaired. Botulium toxin-A injection into detrusor is a safe alternative in patients with insufficient response or significant side effects to anticholinergic (oral or intravesical instillation) therapy. Surgery is an effective alternative in patients with persistent detrusor hyperactivity and/or dyssynergic detrusor sphincter despites of the CIC and maximum dosage of anticholinergic therapy. Children with NBD require care from a multidisciplinary team approach consisting of pediatricians, neurosurgeon, urologist, nephrologists, orthopedic surgeon, and other allied medical specialists.
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Affiliation(s)
- Faezeh Javadi Larijani
- Department of Pediatrics, Division of Nephrology, Children Medical Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Mastaneh Moghtaderi
- Department of Pediatrics, Division of Nephrology, Children Medical Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Nilofar Hajizadeh
- Department of Pediatrics, Division of Nephrology, Children Medical Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Farahnak Assadi
- Department of Pediatrics, Division of Nephrology, Rush University Medical Center, Chicago, IL, USA,Correspondence to: Prof. Farahnak Assadi, Department of Pediatrics, Division of Nephrology, Rush Children's Hospital, Rush University Medical Center, Chicago, 18 Scarlet Oak, Dr Haverford, PA 19041, USA. E-mail:
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Krasmik D, Krebs J, van Ophoven A, Pannek J. Urodynamic results, clinical efficacy, and complication rates of sacral intradural deafferentation and sacral anterior root stimulation in patients with neurogenic lower urinary tract dysfunction resulting from complete spinal cord injury. Neurourol Urodyn 2013; 33:1202-6. [PMID: 24038405 DOI: 10.1002/nau.22486] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [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: 06/18/2013] [Accepted: 07/29/2013] [Indexed: 11/10/2022]
Abstract
AIMS To investigate the outcome and complications of sacral deafferentation (SDAF) and sacral anterior root stimulation (SARS) in patients with neurogenic lower urinary tract dysfunction (NLUTD) resulting from complete spinal cord injury (SCI). METHODS Retrospective chart analysis of 137 patients who underwent SDAF/SARS at a single institution. Patients were categorized as being at risk of renal damage when the maximum detrusor pressure was >40 cmH2 O or detrusor compliance was <20 ml/cmH2 O. RESULTS After a mean follow-up time of 14.8 ± 5.3 years, SDAF/SARS treatment significantly (P < 0.001) reduced the number of patients suffering from elevated detrusor pressure from 65 to 2, and from low detrusor compliance from 62 to 13, respectively. Mean bladder capacity significantly (P < 0.001) improved from 272.4 ± 143.0 to 475.0 ± 82.7 ml. The mean number of symptomatic UTI also decreased significantly (P < 0.001) from 6.2 ± 4.5 to 2.5 ± 2.6 per year. The number of patients suffering from incontinence had significantly (P < 0.001) decreased from 70 to 44. At the last follow-up visit, 107 (78.1%) patients were still using the stimulator. A total of 84 complications requiring surgical revision were observed. Defects of the stimulator cables or the receiver plate were the most common events (n = 38). The retrospective design pertains to the limitations of the study. CONCLUSIONS Sacral deafferentation and SARS are an effective treatment option for refractory NLUTD in patients with complete SCI, despite a substantial long-term complication rate.
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Affiliation(s)
- D Krasmik
- Department of Neurourology, Marienhospital Herne, Herne, Germany
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