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Sartori AM, Kessler TM, Castro-Díaz DM, de Keijzer P, Del Popolo G, Ecclestone H, Frings D, Groen J, Hamid R, Karsenty G, Musco S, Padilla-Fernández B, Pannek J, Schouten N, van der Vorm A, Blok BFM. Summary of the 2024 Update of the European Association of Urology Guidelines on Neurourology. Eur Urol 2024; 85:543-555. [PMID: 38594103 DOI: 10.1016/j.eururo.2024.03.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2024] [Revised: 03/14/2024] [Accepted: 03/25/2024] [Indexed: 04/11/2024]
Abstract
BACKGROUND AND OBJECTIVE Most patients with neurourological disorders require lifelong medical care. The European Association of Urology (EAU) regularly updates guidelines for diagnosis and treatment of these patients. The objective of this review is to provide a summary of the 2024 updated EAU guidelines on neurourology. METHODS A structured literature review covering the timeframe 2021-2023 was conducted for the guideline update. A level of evidence and a strength rating were assigned for each recommendation on the basis of the literature data. KEY FINDINGS AND LIMITATIONS Neurological conditions significantly affect urinary, sexual, and bowel function, and lifelong management is required for neurourological patients to maintain their quality of life and prevent urinary tract deterioration. Early diagnosis and effective treatment are key, and comprehensive clinical assessments, including urodynamics, are crucial. Management should be customised to individual needs and should involve a multidisciplinary approach and address sexuality and fertility. Lifelong monitoring and follow-up highlight the importance of continuous care for neurourological patients. CONCLUSIONS AND CLINICAL IMPLICATIONS The 2024 EAU guidelines on neurourology provide an up-to-date overview of available evidence on diagnosis, treatment, and follow-up for neurourological patients. PATIENT SUMMARY Neurological disorders very frequently affect the lower urinary tract and sexual and bowel function and patients need lifelong management. We summarise the updated European Association of Urology guidelines on neurourology to provide patients and caregivers with the latest insights for optimal health care support.
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Affiliation(s)
- Andrea M Sartori
- Department of Neuro-Urology, Balgrist University Hospital, University of Zürich, Zürich, Switzerland; Harvard Medical School, Boston, MA, USA; Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA.
| | - Thomas M Kessler
- Department of Neuro-Urology, Balgrist University Hospital, University of Zürich, Zürich, Switzerland
| | - David M Castro-Díaz
- Department of Urology, Complejo Hospitalario Universitario de Canarias, Universidad de La Laguna, Tenerife, Spain
| | - Peter de Keijzer
- European Association of Urology Guidelines Office, Arnhem, The Netherlands
| | - Giulio Del Popolo
- Department of Neuro-urology, Careggi University Hospital, Florence, Italy
| | | | - Dennis Frings
- Department of Urology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Jan Groen
- Department of Urology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Rizwan Hamid
- Department of Neuro-Urology, London Spinal Injuries Centre, Stanmore, UK
| | - Gilles Karsenty
- Department of Urology, Aix Marseille University, Marseille, France
| | - Stefania Musco
- Department of Neuro-urology, Careggi University Hospital, Florence, Italy
| | - Bárbara Padilla-Fernández
- Department of Urology, Complejo Hospitalario Universitario de Canarias, Universidad de La Laguna, Tenerife, Spain
| | - Jürgen Pannek
- Neuro-Urology Department, Swiss Paraplegic Center, Nottwil, Switzerland; Department of Urology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Natasha Schouten
- European Association of Urology Guidelines Office, Arnhem, The Netherlands
| | | | - Bertil F M Blok
- Department of Urology, Erasmus Medical Center, Rotterdam, The Netherlands
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Bury MI, Fuller NJ, Wang X, Chan YY, Sturm RM, Oh SS, Sofer LA, Arora HC, Sharma TT, Nolan BG, Feng W, Rabizadeh RR, Barac M, Edassery SS, Goedegebuure MM, Wang LW, Ganesh B, Halliday LC, Seniw ME, Edassery SL, Mahmud NB, Hofer MD, McKenna KE, Cheng EY, Ameer GA, Sharma AK. Multipotent bone marrow cell-seeded polymeric composites drive long-term, definitive urinary bladder tissue regeneration. PNAS NEXUS 2024; 3:pgae038. [PMID: 38344009 PMCID: PMC10855019 DOI: 10.1093/pnasnexus/pgae038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Accepted: 01/16/2024] [Indexed: 03/02/2024]
Abstract
To date, there are no efficacious translational solutions for end-stage urinary bladder dysfunction. Current surgical strategies, including urinary diversion and bladder augmentation enterocystoplasty (BAE), utilize autologous intestinal segments (e.g. ileum) to increase bladder capacity to protect renal function. Considered the standard of care, BAE is fraught with numerous short- and long-term clinical complications. Previous clinical trials employing tissue engineering approaches for bladder tissue regeneration have also been unable to translate bench-top findings into clinical practice. Major obstacles still persist that need to be overcome in order to advance tissue-engineered products into the clinical arena. These include scaffold/bladder incongruencies, the acquisition and utility of appropriate cells for anatomic and physiologic tissue recapitulation, and the choice of an appropriate animal model for testing. In this study, we demonstrate that the elastomeric, bladder biomechanocompatible poly(1,8-octamethylene-citrate-co-octanol) (PRS; synthetic) scaffold coseeded with autologous bone marrow-derived mesenchymal stem cells and CD34+ hematopoietic stem/progenitor cells support robust long-term, functional bladder tissue regeneration within the context of a clinically relevant baboon bladder augmentation model simulating bladder trauma. Partially cystectomized baboons were independently augmented with either autologous ileum or stem-cell-seeded small-intestinal submucosa (SIS; a commercially available biological scaffold) or PRS grafts. Stem-cell synergism promoted functional trilayer bladder tissue regeneration, including whole-graft neurovascularization, in both cell-seeded grafts. However, PRS-augmented animals demonstrated fewer clinical complications and more advantageous tissue characterization metrics compared to ileum and SIS-augmented animals. Two-year study data demonstrate that PRS/stem-cell-seeded grafts drive bladder tissue regeneration and are a suitable alternative to BAE.
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Affiliation(s)
- Matthew I Bury
- Division of Pediatric Urology, Department of Surgery, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL 60611, USA
| | - Natalie J Fuller
- Division of Pediatric Urology, Department of Surgery, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL 60611, USA
| | - Xinlong Wang
- Department of Biomedical Engineering, McCormick School of Engineering, Northwestern University, Evanston, IL 60208, USA
| | - Yvonne Y Chan
- Department of Urologic Surgery, University of California at Davis, Davis, CA 95817, USA
| | - Renea M Sturm
- Department of Urology, David Geffen School of Medicine at UCLA, Los Angeles, CA 90095, USA
| | - Sang Su Oh
- Biologic Resources Laboratory, University of Illinois at Chicago, Chicago, IL 60612, USA
| | - Laurel A Sofer
- Department of Urology, University of Illinois at Chicago, Chicago, IL 60612, USA
| | - Hans C Arora
- Division of Pediatric Urology, Department of Surgery, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL 60611, USA
| | - Tiffany T Sharma
- Division of Pediatric Urology, Department of Surgery, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL 60611, USA
| | - Bonnie G Nolan
- Division of Pediatric Urology, Department of Surgery, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL 60611, USA
| | - Wei Feng
- Flow Cytometry Core, Research Resources Center, University of Illinois at Chicago, Chicago, IL 60612, USA
| | - Rebecca R Rabizadeh
- Division of Pediatric Urology, Department of Surgery, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL 60611, USA
| | - Milica Barac
- Division of Pediatric Urology, Department of Surgery, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL 60611, USA
| | - Sonia S Edassery
- Division of Pediatric Urology, Department of Surgery, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL 60611, USA
| | - Madeleine M Goedegebuure
- Department of Biomedical Engineering, McCormick School of Engineering, Northwestern University, Evanston, IL 60208, USA
| | - Larry W Wang
- Department of Urology, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA
| | - Balaji Ganesh
- Flow Cytometry Core, Research Resources Center, University of Illinois at Chicago, Chicago, IL 60612, USA
| | - Lisa C Halliday
- Biologic Resources Laboratory, University of Illinois at Chicago, Chicago, IL 60612, USA
| | - Mark E Seniw
- Simpson Querrey Institute, Northwestern University, Chicago, IL 60611, USA
| | - Seby L Edassery
- Center for Translational Research and Education, Loyola University Chicago, Chicago, IL 60153, USA
| | - Nadim B Mahmud
- Division of Hematology/Oncology, Department of Medicine, University of Illinois Cancer Center, Chicago, IL 60612, USA
| | | | - Kevin E McKenna
- Department of Urology, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA
- Department of Neuroscience, Feinberg School of Medicine, Northwestern University, Chicago, IL 60612, USA
| | - Earl Y Cheng
- Division of Pediatric Urology, Department of Surgery, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL 60611, USA
- Department of Urology, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA
- Simpson Querrey Institute, Northwestern University, Chicago, IL 60611, USA
- Stanley Manne Children's Research Institute, Louis A. Simpson and Kimberly K. Querrey Biomedical Research Center, Chicago, IL 60611, USA
- Center for Advanced Regenerative Engineering, Northwestern University, Evanston, IL 60208, USA
| | - Guillermo A Ameer
- Department of Biomedical Engineering, McCormick School of Engineering, Northwestern University, Evanston, IL 60208, USA
- Simpson Querrey Institute, Northwestern University, Chicago, IL 60611, USA
- Center for Advanced Regenerative Engineering, Northwestern University, Evanston, IL 60208, USA
- Vascular Surgery, Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL 60612, USA
| | - Arun K Sharma
- Division of Pediatric Urology, Department of Surgery, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL 60611, USA
- Department of Biomedical Engineering, McCormick School of Engineering, Northwestern University, Evanston, IL 60208, USA
- Department of Urology, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA
- Simpson Querrey Institute, Northwestern University, Chicago, IL 60611, USA
- Stanley Manne Children's Research Institute, Louis A. Simpson and Kimberly K. Querrey Biomedical Research Center, Chicago, IL 60611, USA
- Center for Advanced Regenerative Engineering, Northwestern University, Evanston, IL 60208, USA
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Dequirez PL, Pues M, Queval L, Vercleyen S, Carpentier A, Lebuffe G, Seguy D, Blanchard A, Vermersch P, Biardeau X. Standardized one-day evaluation before urinary reconstructive surgery for neurogenic lower urinary tract dysfunction: Feasibility and impact on surgical strategy and care pathway. Prog Urol 2023; 33:1014-1025. [PMID: 37858377 DOI: 10.1016/j.purol.2023.09.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Revised: 09/16/2023] [Accepted: 09/26/2023] [Indexed: 10/21/2023]
Abstract
OBJECTIVES To describe a concept of standardized preoperative one-day evaluation before urinary reconstructive or diversion surgery for the treatment of neurogenic lower urinary tract (LUT) dysfunction, and to evaluate its feasibility and its impact on the care pathway. MATERIALS AND METHODS All patients who underwent a one-day standardized evaluation before a urinary reconstructive or derivation surgery for the treatment of neurogenic LUT dysfunction between January 2017 and December 2021 in our institution were included. Data were collected retrospectively from standardized reports. The main outcome was the rate of completion of the tests and consultations planned during this evaluation. Secondary outcomes included the findings from the one-day evaluation and changes in the urological surgical strategy at different time points within one year. RESULTS One hundred and thirty-one patients benefited from this one-day standardized evaluation. The overall completeness rate of the data collected was 77.5%, increasing from 62.3% in 2017 to 89.3% in 2021. The urological surgical plan was modified for 19.1% of patients following this preoperative evaluation. The indication was then confirmed for 114 patients (87.0%) by the multidisciplinary meeting and was carried out unchanged during the following year for 89 patients (67.9%). An associated colostomy procedure was proposed for 18.3% of patients and was finally performed in 11.5%. CONCLUSION A standardized multidisciplinary preoperative one-day evaluation before performing reconstructive or diversion surgery for the treatment of neurogenic LUT dysfunction seems feasible and makes it possible to optimize the surgical plan and adapt the course of care. LEVEL OF EVIDENCE: 4
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Affiliation(s)
- P-L Dequirez
- Department of Urology, CHU de Lille, université de Lille, 59000 Lille, France.
| | - M Pues
- Department of Urology, CHU de Lille, université de Lille, 59000 Lille, France
| | - L Queval
- Department of Urology, CHU de Lille, université de Lille, 59000 Lille, France
| | - S Vercleyen
- Department of Urology, CHU de Lille, université de Lille, 59000 Lille, France
| | - A Carpentier
- Department of Urology, CHU de Lille, université de Lille, 59000 Lille, France
| | - G Lebuffe
- Department of Anesthesiology and Critical Care Anesthesiology, CHU de Lille, université de Lille, 59000 Lille, France
| | - D Seguy
- Department of Nutrition, CHU de Lille, université de Lille, 59000 Lille, France
| | - A Blanchard
- Department of Physical and Rehabilitation Medicine, CHU de Lille, université de Lille, 59000 Lille, France
| | - P Vermersch
- UMR-S1172 LilNCog, Lille Neuroscience and Cognition, CHU de Lille, Inserm, université de Lille, 59000 Lille, France
| | - X Biardeau
- Department of Urology, CHU de Lille, université de Lille, 59000 Lille, France; UMR-S1172 LilNCog, Lille Neuroscience and Cognition, CHU de Lille, Inserm, université de Lille, 59000 Lille, France
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4
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Truong XQ, Bakali Issaui Z, Gaillet S, Boissier R, Gondran-Tellier B, Delporte V, Lechevallier E, Karsenty G, Michel F. [Bladder augmentation in the era of botulinum toxin: Indications and results]. Prog Urol 2023; 33:547-554. [PMID: 37666743 DOI: 10.1016/j.purol.2023.07.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Revised: 07/23/2023] [Accepted: 07/25/2023] [Indexed: 09/06/2023]
Abstract
AIM To determine the surgical indication and results of bladder augmentation (BA) during the last decade in a neurourology center in the era of intradetrusor botulinum toxin injection. MATERIAL We conducted a retrospective study that included patients with BA between January 1, 2012 and December 31, 2022 in our centre. We collected pre-operative demographic, clinical, and urodynamic data, BA indication, and associated procedures. We analyzed early and late complications as well as continence and postoperative voiding mode in patients with first BA in a neurological pathology context. RESULTS We performed 77 BA over the study period. The main indication was neurogenic overactive bladder, which was secondarily resistant to botulinum toxin. The main associated procedure was continent cutaneous diversion (n=31, 57.4%). Among patients who had a first BA for neurogenic bladder, 34 patients had early complications (50%) including 12 patients with≥Clavien 3 complications (17.6%). After a median follow-up of 33 [14; 55] months, 23 patients had late complications (33.8%) and 59 patients had complete continence (86.8%). CONCLUSION In the era of botulinum toxin, the main indication of BA is the secondary failure of botulinum toxin for overactive neurogenic bladder. The BA provided continence in 86.8% of patients. It remains however an intervention with a significant rate of severe complications whose indication must be discussed by a multidisciplinary team. LEVEL OF EVIDENCE Weak.
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Affiliation(s)
- X Q Truong
- CCA d'urologie, service d'urologie et de transplantation rénale, hôpital de la Conception, Assistance publique des Hôpitaux de Marseille, Marseille, France
| | - Z Bakali Issaui
- CCA d'urologie, service d'urologie et de transplantation rénale, hôpital de la Conception, Assistance publique des Hôpitaux de Marseille, Marseille, France
| | - S Gaillet
- CCA d'urologie, service d'urologie et de transplantation rénale, hôpital de la Conception, Assistance publique des Hôpitaux de Marseille, Marseille, France
| | - R Boissier
- CCA d'urologie, service d'urologie et de transplantation rénale, hôpital de la Conception, Assistance publique des Hôpitaux de Marseille, Marseille, France
| | - B Gondran-Tellier
- CCA d'urologie, service d'urologie et de transplantation rénale, hôpital de la Conception, Assistance publique des Hôpitaux de Marseille, Marseille, France
| | - V Delporte
- CCA d'urologie, service d'urologie et de transplantation rénale, hôpital de la Conception, Assistance publique des Hôpitaux de Marseille, Marseille, France
| | - E Lechevallier
- CCA d'urologie, service d'urologie et de transplantation rénale, hôpital de la Conception, Assistance publique des Hôpitaux de Marseille, Marseille, France
| | - G Karsenty
- CCA d'urologie, service d'urologie et de transplantation rénale, hôpital de la Conception, Assistance publique des Hôpitaux de Marseille, Marseille, France
| | - F Michel
- CCA d'urologie, service d'urologie et de transplantation rénale, hôpital de la Conception, Assistance publique des Hôpitaux de Marseille, Marseille, France.
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Chen PC, Lee KH, Lee WC, Yeh TC, Kuo YC, Chiang BJ, Liao CH, Meng E, Kao YL, Lee YC, Kuo HC. Treating Neurogenic Lower Urinary Tract Dysfunction in Chronic Spinal Cord Injury Patients-When Intravesical Botox Injection or Urethral Botox Injection Are Indicated. Toxins (Basel) 2023; 15:toxins15040288. [PMID: 37104226 PMCID: PMC10145925 DOI: 10.3390/toxins15040288] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 04/01/2023] [Accepted: 04/11/2023] [Indexed: 04/28/2023] Open
Abstract
Lower urinary tract symptoms (LUTS), such as urgency, urinary incontinence, and/or difficulty voiding, hamper the quality of life (QoL) of patients with spinal cord injury (SCI). If not managed adequately, urological complications, such as urinary tract infection or renal function deterioration, may further deteriorate the patient's QoL. Botulinum toxin A (BoNT-A) injection within the detrusor muscle or urethral sphincter yields satisfactory therapeutic effects for treating urinary incontinence or facilitating efficient voiding; however, adverse effects inevitably follow its therapeutic efficacy. It is important to weigh the merits and demerits of BoNT-A injection for LUTS and provide an optimal management strategy for SCI patients. This paper summarizes different aspects of the application of BoNT-A injection for lower urinary tract dysfunctions in SCI patients and provides an overview of the benefits and drawbacks of this treatment.
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Affiliation(s)
- Po-Cheng Chen
- Urologic Department, En Chu Kong Hospital, New Taipei City 237414, Taiwan
| | - Kau-Han Lee
- Division of Urology, Department of Surgery, Chi Mei Medical Center, Tainan 71004, Taiwan
| | - Wei-Chia Lee
- Department of Urology, Kaohsiung Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Taoyuan 33302, Taiwan
| | - Ting-Chun Yeh
- Division of Urology, Department of Surgery, Taiwan Adventist Hospital, Taipei City 10556, Taiwan
| | - Yuh-Chen Kuo
- Department of Urology, Yangming Branch of Taipei City Hospital, Taipei 11146, Taiwan
- Department of Exercise and Health Sciences, University of Taipei, Taipei 111036, Taiwan
| | - Bing-Juin Chiang
- College of Medicine, Fu-Jen Catholic University, New Taipei City 24205, Taiwan
- Department of Urology, Cardinal Tien Hospital, New Taipei City 23148, Taiwan
| | - Chun-Hou Liao
- Divisions of Urology, Department of Surgery, Cardinal Tien Hospital, New Taipei City 23148, Taiwan
- School of Medicine, Fu Jen Catholic University, New Taipei City 242062, Taiwan
| | - En Meng
- Division of Urology, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei 11490, Taiwan
| | - Yao-Lin Kao
- Department of Urology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 704, Taiwan
| | - Yung-Chin Lee
- Department of Urology, Kaohsiung Municipal Siaogang Hospital, Kaohsiung 812, Taiwan
| | - Hann-Chorng Kuo
- Department of Urology, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation and Tzu Chi University, Hualien 97004, Taiwan
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Taskinen S, Mäkelä E. Additional surgery in patients with bladder augmentation. J Pediatr Urol 2023:S1477-5131(23)00124-9. [PMID: 37061366 DOI: 10.1016/j.jpurol.2023.03.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Revised: 03/10/2023] [Accepted: 03/28/2023] [Indexed: 04/17/2023]
Abstract
INTRODUCTION Bladder augmentation is an option to protect kidneys and treat incontinence in frequent neurogenic and congenital non-neurogenic disorders. However, patients may need also other procedures to treat incontinence or to aid catheterizations. In addition, the patients are prone to complications. OBJECTIVE To evaluate complications or additional surgeries in augmentation cystoplasty according to the etiology of the bladder dysfunction. STUDY DESIGN Data on additional surgical procedures related to bladder augmentation were collected from 128 patients who had undergone enterocystoplasty between 1990 and 2019, with a median age of 10.1 years (IQR 7.2-12.8) and a follow-up time of 11.8 years (IQR 5.7-18.6) after augmentation. RESULTS Eighty-three patients had a neurogenic disease, and 45 patients had a non-neurogenic disease. Bladder neck operations were performed either at the time of or after augmentation for 62 patients (48.4%), more commonly in the non-neurogenic than neurogenic group <0.01. In addition, continent stoma operations in 56 (36.8%) patients were more common in the non-neurogenic group (p < 0.01). Ten patients received kidney transplantation (four in the neurogenic, six in the non-neurogenic group); seven of these patients originally had dysplastic kidneys, two developed nephrological kidney disease, and one had hydronephrosis and renal insufficiency at the time of diagnosis of neurogenic bladder. Surgical problems resulting from bladder augmentation were treated in 28 patients (21.8%). The risk for surgical treatment because of complications was 4%, 17%, 24%, 27% and 27% at 1, 5, 10, 15 and 20 years follow up respectively. Complications were more common in patients in non-neurogenic than in patients with neurogenic group (p < 0.01). However, the greater proportion of continent stomas in non-neurogenic group explained the difference (Fig.). The most frequent complication requiring surgery during follow-up was bladder stones, which occurred in 24 (18.8%) patients. The first stone was treated at a median of 3.3 years (range 0.3-14.2) after augmentation. Stones were more common in patients with a continent stoma than without (p < 0.01). Other indications for surgical treatment were as follows: obstructive ileus in five patients, reduced bladder capacity in three patients, bladder perforation in two patients and lobulated bladder with infections in one patient. CONCLUSIONS The risk for surgical treatment was about 27% in 20-year follow-up after bladder augmentation, because of augmentation related complications. The most prevalent complication was bladder stone, that was mainly associated with continent stomas. Continent stomas were most prevalent in patients with non-neurogenic diagnosis.
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Affiliation(s)
- Seppo Taskinen
- Section of Pediatric Urology, New Children's Hospital, Helsinki University Hospital and University of Helsinki, Helsinki, Finland.
| | - Eija Mäkelä
- Section of Pediatric Urology, New Children's Hospital, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
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7
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Manunta A, Peyronnet B, Olivari-Philiponnet C, Chartier-Kastler E, Saussine C, Phé V, Robain G, Denys P, Even A, Samson E, Grise P, Karsenty G, Hascoet J, Castel-Lacanal E, Charvier K, Guinet-Lacoste A, Chesnel C, Amarenco G, Haffner F, Haddad M, Le Normand L, Perrouin-Verbe MA, Perrouin-Verbe B, De Seze M, Ruffion A, Gamé X. [Guidelines on the urological management of the adult patient with spinal dysraphism (spina bifida)]. Prog Urol 2023; 33:178-197. [PMID: 36609138 DOI: 10.1016/j.purol.2022.12.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2022] [Accepted: 12/10/2022] [Indexed: 01/06/2023]
Abstract
INTRODUCTION Improved life expectancy and prenatal screening have changed the demographics of spina bifida (spinal dysraphism) which has presently become a disease of adulthood. Urinary disorders affect almost all patients with spinal dysraphism and are still the leading cause of mortality in these patients. The aim of this work was to establish recommendations for urological management that take into account the specificities of the spina bifida population. MATERIALS AND METHODS National Diagnosis and Management Guidelines (PNDS) were drafted within the framework of the French Rare Diseases Plan at the initiative of the Centre de Référence Maladies Rares Spina Bifida - Dysraphismes of Rennes University Hospital. It is a collaborative work involving experts from different specialties, mainly urologists and rehabilitation physicians. We conducted a systematic search of the literature in French and English in the various fields covered by these recommendations in the MEDLINE database. In accordance with the methodology recommended by the authorities (Guide_methodologique_pnds.pdf, 2006), proposed recommendations were drafted on the basis of this literature review and then submitted to a review group until a consensus was reached. RESULTS Bladder dysfunctions induced by spinal dysraphism are multiple and varied and evolve over time. Management must be individually adapted and take into account all the patient's problems, and is therefore necessarily multi-disciplinary. Self-catheterisation is the appropriate micturition method for more than half of the patients and must sometimes be combined with treatments aimed at suppressing any neurogenic detrusor overactivity (NDO) or compliance alteration (anticholinergics, intra-detrusor botulinum toxin). Resort to surgery is sometimes necessary either after failure of non-invasive treatments (e.g. bladder augmentation in case of NDO resistant to pharmacological treatment), or as a first line treatment in the absence of other non-invasive alternatives (e.g. aponeurotic suburethral tape or artificial urinary sphincter for sphincter insufficiency; urinary diversion by ileal conduit if self-catheterisation is impossible). CONCLUSION Spinal dysraphism is a complex pathology with multiple neurological, orthopedic, gastrointestinal and urological involvement. The management of bladder and bowel dysfunctions must continue throughout the life of these patients and must be integrated into a multidisciplinary context.
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Affiliation(s)
- A Manunta
- Centre de référence Spina Bifida-Dysraphismes, CHU Pontchaillou, Rennes, France
| | - B Peyronnet
- Centre de référence Spina Bifida-Dysraphismes, CHU Pontchaillou, Rennes, France.
| | | | - E Chartier-Kastler
- Service d'Urologie, GH Pitié-Salpétrière, APHP, Paris, France; Sorbonne Université, Paris, France; Service de médecine physique et réadaptation, Hôpital Raymond-Poincaré, APHP, Garches, France
| | - C Saussine
- Service d'urologie, les hôpitaux universitaires de Strasbourg, Strasbourg, France
| | - V Phé
- Service d'urologie, Sorbonne Université, Assistance Publique-Hôpitaux de Paris, Hôpital Tenon, Paris, France
| | - G Robain
- Service de médecine physique et réadaptation, Hôpital Rotschild, APHP, Paris, France
| | - P Denys
- Service de médecine physique et réadaptation, Hôpital Raymond-Poincaré, APHP, Garches, France; Faculté de médecine Paris Ouest, Université de Versailles-Saint-Quentin-en-Yvelines, Garches, France
| | - A Even
- Service de médecine physique et réadaptation, Hôpital Raymond-Poincaré, APHP, Garches, France; Faculté de médecine Paris Ouest, Université de Versailles-Saint-Quentin-en-Yvelines, Garches, France
| | - E Samson
- Centre de référence Spina Bifida-Dysraphismes, CHU Pontchaillou, Rennes, France
| | - P Grise
- Service d'urologie, CHU Rouen, Rouen, France
| | - G Karsenty
- Aix-Marseille Université, urologie et transplantation rénale, Hôpital La Conception, AP-HM, Marseille, France
| | - J Hascoet
- Centre de référence Spina Bifida-Dysraphismes, CHU Pontchaillou, Rennes, France
| | - E Castel-Lacanal
- CHU Toulouse, service de médecine physique et de réadaptation et ToNIC, Toulouse NeuroImaging Center, Université de Toulouse, Inserm, UPS, Toulouse, France
| | - K Charvier
- Service de médecine physique et réadaptation, Hôpital Henry-Gabrielle, Hospices civils de Lyon, Saint-Genis-Laval, France
| | - A Guinet-Lacoste
- Sorbonne Université, GRC 001, GREEN Groupe de recherche clinique en neuro-urologie, AP-HP, Hôpital Tenon, 75020 Paris, France
| | - C Chesnel
- Sorbonne Université, GRC 001, GREEN Groupe de recherche clinique en neuro-urologie, AP-HP, Hôpital Tenon, 75020 Paris, France; Service de neuro-urologie et explorations périnéales, Hôpital Tenon, AP-HP, Paris, France
| | - G Amarenco
- Sorbonne Université, GRC 001, GREEN Groupe de recherche clinique en neuro-urologie, AP-HP, Hôpital Tenon, 75020 Paris, France; Service de neuro-urologie et explorations périnéales, Hôpital Tenon, AP-HP, Paris, France
| | - F Haffner
- ASBH, Association nationale Spina Bifida et Handicaps associés, 94420 Le Plessis Trevise, France
| | - M Haddad
- Service de chirurgie viscérale et urologie pédiatrique, AP-HM, Marseille, France
| | - L Le Normand
- Service d'urologie, CHU de Nantes, Nantes, France
| | | | - B Perrouin-Verbe
- Service de médecine physique et réadaptation, CHU de Nantes, Nantes, France
| | - M De Seze
- Spécialiste en médecine physique et de réadaptation, Clinique St.-Augustin, Bordeaux, France
| | - A Ruffion
- Service d'urologie, Hospices civils de Lyon, Lyon, France
| | - X Gamé
- Département d'urologie, transplantation rénale et andrologie, CHU Rangueil, Université Paul-Sabatier, Toulouse, France
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8
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Fan YH, Shen YC, Hsu CC, Chow PM, Chang PC, Lin YH, Chang SJ, Jiang YH, Liao CH, Wang CC, Wu CT, Kuo HC. Current Surgical Treatment for Neurogenic Lower Urinary Tract Dysfunction in Patients with Chronic Spinal Cord Injury. J Clin Med 2023; 12:jcm12041400. [PMID: 36835937 PMCID: PMC9963408 DOI: 10.3390/jcm12041400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2022] [Revised: 01/16/2023] [Accepted: 02/03/2023] [Indexed: 02/12/2023] Open
Abstract
This study aimed to present a comprehensive literature review of the efforts of a spinal cord injury workgroup in Taiwan regarding urologic surgery for neurogenic lower urinary tract dysfunction (NLUTD) in patients with chronic spinal cord injury (SCI). Surgical procedures should be viewed as a final option for managing patients with SCI who have persistent symptoms and complications that cannot be resolved by other means. Surgeries can be grouped according to their purpose: reducing bladder pressures, reducing urethra resistance, increasing urethra resistance, and urinary diversion. The choice of surgery depends on the type of LUTD based on urodynamic tests. Additionally, cognitive function, hand motility, comorbidities, efficacy of surgery, and related complications should be considered.
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Affiliation(s)
- Yu-Hua Fan
- Department of Urology, Taipei Veterans General Hospital, Taipei 11217, Taiwan
- Department of Urology, College of Medicine, National Yang Ming Chiao Tung University, Taipei 11217, Taiwan
| | - Yuan-Chi Shen
- College of Medicine, Chang Gung University, Taoyuan 33302, Taiwan
- Department of Urology, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung 83301, Taiwan
| | - Chih-Chen Hsu
- Department of Urology, Taipei Hospital, Ministry of Health and Welfare, Taipei 24233, Taiwan
| | - Po-Ming Chow
- Department of Urology, National Taiwan University Hospital and College of Medicine, Taipei 10002, Taiwan
| | - Po-Chih Chang
- Department of Urology, Chang Gung Memorial Hospital at Linkou, Taoyuan 33305, Taiwan
| | - Yu-Hua Lin
- Department of Chemistry, Fu Jen Catholic University, New Taipei City 24205, Taiwan
| | - Shang-Jen Chang
- Department of Urology, National Taiwan University Hospital and College of Medicine, Taipei 10002, Taiwan
| | - Yuan-Hong Jiang
- Department of Urology, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation and Tzu Chi University, Hualien 97004, Taiwan
| | - Chun-Hou Liao
- Divisions of Urology, Department of Surgery, Cardinal Tien Hospital, New Taipei City 23148, Taiwan
| | - Chung-Cheng Wang
- Department of Urology, En Chu Kong Hospital, New Taipei City 23702, Taiwan
| | - Chun-Te Wu
- College of Medicine, Chang Gung University, Taoyuan 33302, Taiwan
- Department of Urology, Chang Gung Memorial Hospital at Linkou, Taoyuan 33305, Taiwan
| | - Hann-Chorng Kuo
- Department of Urology, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation and Tzu Chi University, Hualien 97004, Taiwan
- Correspondence: ; Tel.: +886-3-8561825 (ext. 2117)
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9
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Wu SY, Jhang JF, Liu HH, Chen JT, Li JR, Chiu B, Chen SL, Kuo HC. Long-Term Surveillance and Management of Urological Complications in Chronic Spinal Cord-Injured Patients. J Clin Med 2022; 11:7307. [PMID: 36555924 PMCID: PMC9785560 DOI: 10.3390/jcm11247307] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2022] [Revised: 12/02/2022] [Accepted: 12/07/2022] [Indexed: 12/13/2022] Open
Abstract
Bladder dysfunction is a common complication after chronic spinal cord injury (SCI). Patients may experience renal function loss, urinary tract infection (UTI), urolithiasis, bladder cancer, and even life-threatening events such as severe sepsis or renal failure. Suitable patient care may prevent UTI and urinary incontinence, decrease medication use, and preserve renal function. As the primary goal is to preserve renal function, management should be focused on facilitating bladder drainage, the avoidance of UTI, and the maintenance of a low intravesical pressure for continence and complete bladder emptying. Currently, several bladder management options are available to SCI patients: (1) reflex voiding; (2) clean intermittent catheterization; (3) indwelling catheterization. The target organ may be the bladder or the bladder outlet. The purposes of intervention include the following: (1) increasing bladder capacity and/or decreasing intravesical pressure; (2) increasing bladder outlet resistance; (3) decreasing bladder outlet resistance; (4) producing detrusor contractility; (5) urinary diversion. Different bladder management methods and interventions may have different results depending on the patient's lower urinary tract dysfunction. This review aims to report the current management options for long-term bladder dysfunction in chronic SCI patients. Furthermore, we summarize the most suitable care plans for improving the clinical outcome of SCI patients.
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Affiliation(s)
- Shu-Yu Wu
- Department of Urology, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei City 23142, Taiwan
- Department of Urology, School of Medicine, Tzu Chi University, Hualien 97004, Taiwan
| | - Jia-Fong Jhang
- Department of Urology, School of Medicine, Tzu Chi University, Hualien 97004, Taiwan
- Department of Urology, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien 97002, Taiwan
| | - Hsin-Ho Liu
- Department of Urology, Taichung Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Taichung 42743, Taiwan
| | - Jian-Ting Chen
- Division of Urology, Department of Surgery, Yuanlin Christian Hospital, Changhua 51053, Taiwan
| | - Jian-Ri Li
- Department of Urology, Taichung Veterans General Hospital, Taichung 40705, Taiwan
| | - Bin Chiu
- Department of Urology, Far Eastern Memorial Hospital, New Taipei City 22000, Taiwan
| | - Sung-Lang Chen
- Department of Urology, Chung Shan Medical University Hospital, Taichung 40201, Taiwan
- Department of Urology, School of Medicine, Chung Shan Medical University, Taichung 40201, Taiwan
| | - Hann-Chorng Kuo
- Department of Urology, School of Medicine, Tzu Chi University, Hualien 97004, Taiwan
- Department of Urology, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien 97002, Taiwan
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10
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Gerwinn T, Salemi S, Schori LJ, Planta D, Eberli D, Horst M. Improved contractile potential in detrusor microtissues from pediatric patients with end stage lower urinary tract dysfunction. Front Cell Dev Biol 2022; 10:1007265. [PMID: 36268506 PMCID: PMC9577217 DOI: 10.3389/fcell.2022.1007265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2022] [Accepted: 09/20/2022] [Indexed: 11/14/2022] Open
Abstract
Autologous cell-based tissue engineering has been proposed as a treatment option for end stage lower urinary tract dysfunction (ESLUTD). However, it is generally accepted that cells isolated from patient bladders retain the pathological properties of their tissue of origin and therefore need to be improved before they can serve as a cell source for tissue engineering applications. We hypothesize that human three-dimensional (3D) microtissues of detrusor smooth muscle cells (SMCs) are valuable ex vivo disease models and potent building blocks for bladder tissue engineering. Detrusor SMCs isolated from bladder wall biopsies of pediatric ESLUTD patients and healthy controls were expanded and cultured into 3D microtissues. Gene and protein analyses were performed to explore the effect of microtissue formation on SMC viability, contractile potential, bladder wall specific extracellular matrix (ECM) composition and mediators of ECM remodeling. Through microtissue formation, remodeling and intensified cell-cell interactions, the ESLUTD SMCs lost their characteristic disease phenotype. These microtissues exhibited similar patterns of smooth muscle related contractile proteins and essential bladder wall-specific ECM components as microtissues from healthy control subjects. Thus, the presented data suggest improved contractile potential and ECM composition in detrusor SMC microtissues from pediatric ESLUTD patients. These findings are of great relevance, as 3D detrusor SMC microtissues might be an appropriate cell source for autologous cell-based bladder tissue engineering.
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Affiliation(s)
- Tim Gerwinn
- Division of Pediatric Urology, University Children’s Hospital Zurich, Zurich, Switzerland
- Children’s Research Center, University Children’s Hospital Zurich, Zurich, Switzerland
- Laboratory for Urologic Oncology and Stem Cell Therapy, Department of Urology, University Hospital Zurich, Zurich, Switzerland
- *Correspondence: Tim Gerwinn,
| | - Souzan Salemi
- Laboratory for Urologic Oncology and Stem Cell Therapy, Department of Urology, University Hospital Zurich, Zurich, Switzerland
| | - Larissa J. Schori
- Laboratory for Urologic Oncology and Stem Cell Therapy, Department of Urology, University Hospital Zurich, Zurich, Switzerland
| | - Dafni Planta
- Division of Pediatric Urology, University Children’s Hospital Zurich, Zurich, Switzerland
- Children’s Research Center, University Children’s Hospital Zurich, Zurich, Switzerland
- Laboratory for Urologic Oncology and Stem Cell Therapy, Department of Urology, University Hospital Zurich, Zurich, Switzerland
| | - Daniel Eberli
- Laboratory for Urologic Oncology and Stem Cell Therapy, Department of Urology, University Hospital Zurich, Zurich, Switzerland
| | - Maya Horst
- Division of Pediatric Urology, University Children’s Hospital Zurich, Zurich, Switzerland
- Children’s Research Center, University Children’s Hospital Zurich, Zurich, Switzerland
- Laboratory for Urologic Oncology and Stem Cell Therapy, Department of Urology, University Hospital Zurich, Zurich, Switzerland
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11
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Aftreth OP, Tenggardjaja CF, Reyblat P. Cystectomy for Benign Indications. Curr Urol Rep 2022; 23:195-201. [PMID: 36057019 DOI: 10.1007/s11934-022-01100-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/21/2022] [Indexed: 11/30/2022]
Abstract
PURPOSE OF REVIEW This article evaluates the historical influences, current use, surgical techniques, and recent evidence on outcomes for cystectomy performed for benign indications. RECENT FINDINGS At the population level, cystectomy for benign indications has similar perioperative morbidity to radical cystectomy for cancer. Postoperative patient satisfaction is high and functional outcomes appear good, including sexual function. Patient regret about diversion choice is low provided decisions are well informed. Cystectomy is important both as a primary procedure for benign disease and as an adjunct to primary urinary diversion. Early morbidity remains high but long-term results are encouraging. Further studies are needed to guide patient decision-making, to help inform diversion choice, and to understand the long-term impact of surgery and diversion choice on quality of life.
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Affiliation(s)
- Owen P Aftreth
- Department of Urology, Kaiser Permanente Los Angeles Medical Center, 4900 Sunset Boulevard Fl 2, Los Angeles, CA, 90027, USA
| | - Christopher F Tenggardjaja
- Department of Urology, Kaiser Permanente Los Angeles Medical Center, 4900 Sunset Boulevard Fl 2, Los Angeles, CA, 90027, USA
| | - Polina Reyblat
- Department of Urology, Kaiser Permanente Los Angeles Medical Center, 4900 Sunset Boulevard Fl 2, Los Angeles, CA, 90027, USA.
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12
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Song YT, Li YQ, Tian MX, Hu JG, Zhang XR, Liu PC, Zhang XZ, Zhang QY, Zhou L, Zhao LM, Li-Ling J, Xie HQ. Application of antibody-conjugated small intestine submucosa to capture urine-derived stem cells for bladder repair in a rabbit model. Bioact Mater 2022; 14:443-455. [PMID: 35415280 PMCID: PMC8978277 DOI: 10.1016/j.bioactmat.2021.11.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2021] [Revised: 10/26/2021] [Accepted: 11/12/2021] [Indexed: 02/08/2023] Open
Abstract
The need for bladder reconstruction and side effects of cystoplasty have spawned the demand for the development of alternative material substitutes. Biomaterials such as submucosa of small intestine (SIS) have been widely used as patches for bladder repair, but the outcomes are not fully satisfactory. To capture stem cells in situ has been considered as a promising strategy to speed up the process of re-cellularization and functionalization. In this study, we have developed an anti-CD29 antibody-conjugated SIS scaffold (AC-SIS) which is capable of specifically capturing urine-derived stem cells (USCs) in situ for tissue repair and regeneration. The scaffold has exhibited effective capture capacity and sound biocompatibility. In vivo experiment proved that the AC-SIS scaffold could promote rapid endothelium healing and smooth muscle regeneration. The endogenous stem cell capturing scaffolds has thereby provided a new revenue for developing effective and safer bladder patches. We developed an anti-CD29 antibody-crosslinked submucosa of small intestine scaffold (AC-SIS). AC-SIS is capable of specifically capturing urine-derived stem cells (USCs) as well as possesses a sound biocompatibility. AC-SIS promotes in situ tissue regeneration by facilitating the repair of bladder epithelium, smooth muscle and angiogenesis. Design and application of endogenous stem cell capturing scaffolds provides a new strategy for bladder repair.
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Affiliation(s)
- Yu-Ting Song
- Laboratory of Stem Cell and Tissue Engineering, Orthopedic Research Institute, Med-X Center for Materials, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, Sichuan, 610041, China
| | - Yan-Qing Li
- Laboratory of Stem Cell and Tissue Engineering, Orthopedic Research Institute, Med-X Center for Materials, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, Sichuan, 610041, China
| | - Mao-Xuan Tian
- Laboratory of Stem Cell and Tissue Engineering, Orthopedic Research Institute, Med-X Center for Materials, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, Sichuan, 610041, China.,Department of Aesthetic Surgery, The People's Hospital of Pengzhou, Chengdu, Sichuan, 611930, China
| | - Jun-Gen Hu
- Laboratory of Stem Cell and Tissue Engineering, Orthopedic Research Institute, Med-X Center for Materials, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, Sichuan, 610041, China
| | - Xiu-Ru Zhang
- Laboratory of Stem Cell and Tissue Engineering, Orthopedic Research Institute, Med-X Center for Materials, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, Sichuan, 610041, China.,Surgery of Spine and Spinal Cord, Henan Provincial People's Hospital, Zhengzhou, Henan, 450000, China
| | - Peng-Cheng Liu
- Laboratory of Stem Cell and Tissue Engineering, Orthopedic Research Institute, Med-X Center for Materials, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, Sichuan, 610041, China.,Department of Burn and Plastic Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, 610041, China
| | - Xiu-Zhen Zhang
- Laboratory of Stem Cell and Tissue Engineering, Orthopedic Research Institute, Med-X Center for Materials, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, Sichuan, 610041, China
| | - Qing-Yi Zhang
- Laboratory of Stem Cell and Tissue Engineering, Orthopedic Research Institute, Med-X Center for Materials, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, Sichuan, 610041, China
| | - Li Zhou
- Research Core Facility of West China Hospital, Sichuan University, Chengdu, Sichuan, 610041, China
| | - Long-Mei Zhao
- Laboratory of Stem Cell and Tissue Engineering, Orthopedic Research Institute, Med-X Center for Materials, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, Sichuan, 610041, China
| | - Jesse Li-Ling
- Laboratory of Stem Cell and Tissue Engineering, Orthopedic Research Institute, Med-X Center for Materials, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, Sichuan, 610041, China.,Department of Medical Genetics and Prenatal Diagnosis, West China Second Hospital, Sichuan University, Chengdu, Sichuan, 610041, China
| | - Hui-Qi Xie
- Laboratory of Stem Cell and Tissue Engineering, Orthopedic Research Institute, Med-X Center for Materials, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, Sichuan, 610041, China
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13
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Matta R, Horns JJ, Jacobson DL, Schaeffer AJ, Wallis MC, Lau GA. National Trends and Outcomes in the Use of Intravesical Botulinum Toxin and Enterocystoplasty Among Patients With Myelomeningocele. Urology 2022; 166:289-296. [PMID: 35523288 PMCID: PMC9844129 DOI: 10.1016/j.urology.2022.04.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Revised: 04/13/2022] [Accepted: 04/18/2022] [Indexed: 01/19/2023]
Abstract
OBJECTIVE To compare trends in the treatment of patients with myelomeningocele receiving intravesical Botulinum (IVB) toxin and enterocystoplasty. METHODS We identified patients with myelomeningocele in a commercial insurance database from 2008-2017 and stratified them into adult and pediatric samples. Index procedure was identified as either IVB toxin injection or enterocystoplasty. The annual rate of treatments was measured and a change in treatment rate was identified. Time to enterocysplasty was calculated using survival analysis and factors associated with clinical outcomes up to 10 years after index procedure were determined using multivariate Poisson regression. RESULTS We identified 60,983 patients with myelomeningocele. Nearly twice as many pediatric patients had an enterocystoplasty (n = 317) compared to IVB (n = 138). Very few adult patients underwent enterocystoplasty (n = 25) compared to IVB (n = 116). We identified a significant increase in the annual rate of IVB use around mid-2010 among pediatric patients and around mid-2009 among adults. Twelve pediatric patients (8.6%) and 5 adults (4.3%) went on to receive an enterocystoplasty. Patients who received IVB as the index procedure experienced significantly lower rates of hospitalization days (RR 0.64; 95% CI 0.53-0.78), emergency department visits (RR 0.72; 95% CI 0.63-0.82), and an increased rate of urologic procedures (RR 1.44; 95% CI 1.28-1.62). CONCLUSION The annual rate of IVB use has increased among patients with myelomeningocele. Nearly 1 in 10 pediatric patients and 1 in 20 adults go on to receive enterocystoplasty. Patients who receive IVB experience lower rates of hospitalization and emergency department visits compared to patients who receive enterocystoplasty.
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Affiliation(s)
- Rano Matta
- Division of Urology, Department of Surgery, University of Utah School of Medicine, Salt Lake City, UT
| | - Joshua J Horns
- Surgical Population Analysis Research Core, Department of Surgery, University of Utah School of Medicine, Salt Lake City, UT
| | - Deborah L Jacobson
- Division of Urology, Department of Surgery, University of Utah School of Medicine, Salt Lake City, UT
| | - Anthony J Schaeffer
- Division of Urology, Department of Surgery, University of Utah School of Medicine, Salt Lake City, UT
| | - M Chad Wallis
- Division of Urology, Department of Surgery, University of Utah School of Medicine, Salt Lake City, UT
| | - Glen A Lau
- Division of Urology, Department of Surgery, University of Utah School of Medicine, Salt Lake City, UT.
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14
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Gacci M, Sakalis VI, Karavitakis M, Cornu JN, Gratzke C, Herrmann TRW, Kyriazis I, Malde S, Mamoulakis C, Rieken M, Schouten N, Smith EJ, Speakman MJ, Tikkinen KAO, Gravas S. European Association of Urology Guidelines on Male Urinary Incontinence. Eur Urol 2022; 82:387-398. [PMID: 35697561 DOI: 10.1016/j.eururo.2022.05.012] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Accepted: 05/17/2022] [Indexed: 11/04/2022]
Abstract
CONTEXT Urinary incontinence (UI) is a common condition in elderly men causing a severe worsening of quality of life, and a significant cost for both patients and health systems. OBJECTIVE To report a practical, evidence-based, guideline on definitions, pathophysiology, diagnostic workup, and treatment options for men with different forms of UI. EVIDENCE ACQUISITION A comprehensive literature search, limited to studies representing high levels of evidence and published in the English language, was performed. Databases searched included Medline, EMBASE, and the Cochrane Libraries. A level of evidence and a grade of recommendation were assigned. EVIDENCE SYNTHESIS UI can be classified into stress urinary incontinence (SUI), urge urinary incontinence (UUI), and mixed urinary incontinence. A detailed description of the pathophysiology and diagnostic workup has been reported. Simple clinical interventions, behavioural and physical modifications, and pharmacological treatments comprise the initial management for all kinds of UI. Surgery for SUI includes bulking agents, male sling, and compression devices. Surgery for UUI includes bladder wall injection of botulinum toxin A, sacral nerve stimulation, and cystoplasty/urinary diversion. CONCLUSIONS This 2022 European Association of Urology guideline summary provides updated information on definition, pathophysiology, diagnosis, and treatment of male UI. PATIENT SUMMARY Male urinary incontinence comprises a broad subject area, much of which has been covered for the first time in the literature in a single manuscript. The European Association of Urology Non-neurogenic Male Lower Urinary Tract Symptoms Guideline Panel has released this new guidance, with the aim to provide updated information for urologists to be able to follow diagnostic and therapeutic indications for optimising patient care.
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Affiliation(s)
- Mauro Gacci
- Unit of Urological Robotic Surgery and Renal Transplantation, University of Florence, Careggi Hospital, Florence, Italy; Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy.
| | - Vasileios I Sakalis
- Department of Urology, Agios Pavlos General Hospital of Thessaloniki, Thessaloniki, Greece
| | - Markos Karavitakis
- Department of Urology, University General Hospital of Heraklion, University of Crete Medical School, Heraklion, Crete, Greece
| | - Jean-Nicolas Cornu
- Department of Urology, CHU Hôpitaux de Rouen - Hôpital Charles Nicolle, Rouen, France
| | - Christian Gratzke
- Department of Urology, University Hospital Freiburg, Freiburg, Germany
| | | | - Iason Kyriazis
- Department of Urology, General University Hospital of Patras, Patras, Greece
| | - Sachin Malde
- Department of Urology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Charalampos Mamoulakis
- Department of Urology, University General Hospital of Heraklion, University of Crete Medical School, Heraklion, Crete, Greece
| | | | - Natasha Schouten
- European Association of Urology Guidelines Office, Arnhem, The Netherlands
| | - Emma J Smith
- European Association of Urology Guidelines Office, Arnhem, The Netherlands
| | - Mark J Speakman
- Department of Urology, Taunton & Somerset Hospital, Taunton, UK
| | - Kari A O Tikkinen
- Department of Urology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland; Department of Surgery, South Karelia Central Hospital, Lappeenranta, Finland
| | - Stavros Gravas
- Department of Urology, Medical School, University of Cyprus, Nicosia, Cyprus
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15
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Balanca A, Even A, Malot C, Chartier-Kastler E, Denys P, Joussain C. Long-term clinical and urodynamic effectiveness of augmentation ileocystoplasty with supra-trigonal cystectomy in individuals with spinal cord injury. World J Urol 2022; 40:2121-2127. [PMID: 35680652 DOI: 10.1007/s00345-022-04028-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2022] [Accepted: 04/23/2022] [Indexed: 11/28/2022] Open
Abstract
PURPOSE This study aimed to determine the long-term effectiveness of augmentation ileocystoplasty (AI) associated with supra-trigonal cystectomy on clinical and urodynamic variables, and the safety of the intervention in individuals with spinal cord injury (SCI). MATERIALS AND METHODS Single-center, retrospective study of all patients with SCI who underwent AI with supra-trigonal cystectomy from January 1994, with a follow-up of more than 8 years. The primary outcome was the sustained long-term effectiveness of AI with supra-trigonal cystectomy on clinical and urodynamic variables. The secondary outcome was the long-term safety of this procedure. RESULTS We included 77 patients: 57% were female, mean (SD) age was 52.0 (13.0) years, 77% had paraplegia, and median time since onset was 25.0 [19; 30] years. Long-term success rate (evaluated 13 [10; 15] years post AI) was 93.5% for urodynamic parameters and 76.6% for urinary incontinence. Results of the short- and long-term post-AI assessments did not differ for any urodynamic or clinical variables. Bladder lithiasis occurred in 20.5% of cases and ≥ 1 febrile urinary tract infection occurred in 55.8%, mostly within the first 2 years of follow-up. No cases of bladder cancer were diagnosed. CONCLUSION AI associated with supra-trigonal cystectomy in patients with SCI is safe and effective in both the short term and long term. Regular urodynamic assessment is not necessary in clinically stable patients with low bladder risk; however, close monitoring is important because of the risk of urological complications.
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Affiliation(s)
- A Balanca
- Neuro-Uro-Andrology Hospital Universitaire R.Poincare, AP-HP, 104 bvd R. Poincare, 92380, Garches, France
| | - A Even
- Neuro-Uro-Andrology Hospital Universitaire R.Poincare, AP-HP, 104 bvd R. Poincare, 92380, Garches, France
| | - C Malot
- Department of Sport Medicine and Readaptation, Hôpital Foch, 92150, Suresnes, France
| | - E Chartier-Kastler
- Neuro-Uro-Andrology Hospital Universitaire R.Poincare, AP-HP, 104 bvd R. Poincare, 92380, Garches, France.,Department of Urology, APHP-Pitié-Salpétrière Hospital, Sorbonne Université, Paris, France.,Inserm U1179, UFR Des Sciences de la Santé, University of Versailles Saint-Quentin, Montigny-le-Bretonneux, France
| | - P Denys
- Neuro-Uro-Andrology Hospital Universitaire R.Poincare, AP-HP, 104 bvd R. Poincare, 92380, Garches, France.,Inserm U1179, UFR Des Sciences de la Santé, University of Versailles Saint-Quentin, Montigny-le-Bretonneux, France
| | - C Joussain
- Neuro-Uro-Andrology Hospital Universitaire R.Poincare, AP-HP, 104 bvd R. Poincare, 92380, Garches, France. .,Inserm U1179, UFR Des Sciences de la Santé, University of Versailles Saint-Quentin, Montigny-le-Bretonneux, France.
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16
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Video-Urodynamic Characteristics and Predictors of Switching from Botulinum Neurotoxin a Injection to Augmentation Enterocystoplasty in Spinal Cord Injury Patients. Toxins (Basel) 2022; 14:toxins14010047. [PMID: 35051024 PMCID: PMC8777902 DOI: 10.3390/toxins14010047] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Revised: 01/05/2022] [Accepted: 01/07/2022] [Indexed: 01/27/2023] Open
Abstract
Botulinum neurotoxin type A (BoNT-A) injection and augmentation enterocystoplasty (AE) are alternative and effective management strategies for neurogenic detrusor overactivity (NDO) refractory to pharmacotherapy. A great majority of patients with spinal cord injury (SCI) may, however, prefer BoNT-A injections to AE, due to the less invasive characteristics. In this study we evaluated the influence of various video-urodynamic study (VUDS) parameters in SCI patients who continuously received repeat BoNT-A detrusor injections or switched to AE to improve their bladder conditions. We compared the changes in the urodynamic parameters before and after each mode of treatment. In this retrospective study, all SCI patients with refractory NDO who had received at least one BoNT-A injection were enrolled. VUDS was performed before and after both BoNT-A injection and AE. All of the urodynamic parameters of the storage and micturition-including the bladder capacity of every sensation, maximal flow rate (Qmax), post-voiding residual volume, detrusor pressure at Qmax, and bladder contractility index-were recorded. A total of 126 patients, including 46 women and 80 men, with a mean age of 41.8 ± 13.1 years, were recruited for this study. All of the patients receiving either BoNT-A injection or AE had a statistically significant increase of bladder capacity at every time-point during filling and a decrease in detrusor pressure at Qmax during voiding. Patients who switched from BoNT-A to AE had greater improvements in their urodynamic parameters when compared with those who continued with BoNT-A injections. Accordingly, SCI patients receiving BoNT-A injections but experiencing few improvements in their urodynamic parameters should consider switching to AE to achieve a better storage function and bladder capacity.
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17
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Factors impacting bowel symptoms in a contemporary spinal cord injury cohort: results from the Neurogenic Bladder Research Group Registry. Spinal Cord 2021; 59:997-1002. [PMID: 34345004 DOI: 10.1038/s41393-021-00667-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Revised: 06/28/2021] [Accepted: 06/29/2021] [Indexed: 11/08/2022]
Abstract
STUDY DESIGN Cross sectional. OBJECTIVES To identify variables associated with severe bowel symptoms in spinal cord injured people. SETTING National cohort. METHODS Adult spinal cord injured (SCI) people were recruited for an online registry and 1373 were included for analysis. Univariate analysis and logistic regression was used to evaluate associations between severity of bowel symptoms and variables. Bowel symptoms were assessed by the Neurogenic Bowel Dysfunction (NBD) score and patients scoring ≥14 were categorized as having severe bowel symptoms. Autonomic dysreflexia (AD) severity was measured using a six item questionnaire and reported as total AD score (0-24). Bladder management was categorized as: voiding, clean intermittent catheterization (CIC), surgery (augmentation/diversion) or indwelling catheter. RESULTS Severe bowel symptoms were reported in 570 (42%) On multivariable logistic regression, every point increase of AD total score was associated with 5% increased odds of having more severe bowel symptoms [OR 1.05 95% CI 1.03-1.10]. Type of bladder management was also associated with more severe symptoms (p = 0.0001). SCI people with indwelling catheters (OR = 2.16, 95% CI 1.40-3.32) or reconstructive surgery (OR = 1.79, 95% CI 1.08-3.32) were almost twice as likely to report more severe bowel symptoms than those performing CIC.
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18
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Conta G, Libanori A, Tat T, Chen G, Chen J. Triboelectric Nanogenerators for Therapeutic Electrical Stimulation. ADVANCED MATERIALS (DEERFIELD BEACH, FLA.) 2021; 33:e2007502. [PMID: 34014583 DOI: 10.1002/adma.202007502] [Citation(s) in RCA: 45] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Revised: 12/03/2020] [Indexed: 06/12/2023]
Abstract
Current solutions developed for the purpose of in and on body (IOB) electrical stimulation (ES) lack autonomous qualities necessary for comfortable, practical, and self-dependent use. Consequently, recent focus has been placed on developing self-powered IOB therapeutic devices capable of generating therapeutic ES for human use. With the recent invention of the triboelectric nanogenerator (TENG), harnessing passive human biomechanical energy to develop self-powered systems has allowed for the introduction of novel therapeutic ES solutions. TENGs are especially effective at providing ES for IOB therapeutic systems given their bioconformability, low cost, simple manufacturability, and self-powering capabilities. Due to the key role of naturally induced electrical signals in many physiological functions, TENG-induced ES holds promise to provide a novel paradigm in therapeutic interventions. The aim here is to detail research on IOB TENG devices applied for ES-based therapy in the fields of regenerative medicine, neurology, rehabilitation, and pharmaceutical engineering. Furthermore, considering TENG-produced ES can be measured for sensing applications, this technology is paving the way to provide a fully autonomous personalized healthcare system, capable of IOB energy generation, sensing, and therapeutic intervention. Considering these grounds, it seems highly relevant to review TENG-ES research and applications, as they could constitute the foundation and future of personalized healthcare.
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Affiliation(s)
- Giorgio Conta
- Department of Bioengineering, University of California, Los Angeles, Los Angeles, CA, 90095, USA
| | - Alberto Libanori
- Department of Bioengineering, University of California, Los Angeles, Los Angeles, CA, 90095, USA
| | - Trinny Tat
- Department of Bioengineering, University of California, Los Angeles, Los Angeles, CA, 90095, USA
| | - Guorui Chen
- Department of Bioengineering, University of California, Los Angeles, Los Angeles, CA, 90095, USA
| | - Jun Chen
- Department of Bioengineering, University of California, Los Angeles, Los Angeles, CA, 90095, USA
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19
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Romero-Maroto J, Martinez-Cayuelas L, Gómez-Pérez L, Sarrió-Sanz P, Olarte Barragán E, López-López AI. Long-term effectiveness and safety of bladder augmentation in spina bifida patients. Neurourol Urodyn 2021; 40:1576-1584. [PMID: 34082472 DOI: 10.1002/nau.24713] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Revised: 05/13/2021] [Accepted: 05/13/2021] [Indexed: 11/10/2022]
Abstract
AIMS To establish the long-term efficacy and safety of bladder augmentation in spina bifida patients. MATERIAL AND METHODS Sixteen patients were operated on using the Bramble technique. Preoperative and postoperative evaluation included clinical history, blood tests, urine cultures, cystography, pyelography, ultrasound, and filling cystometry. In the final review a standardized quality of life questionnaire was applied. RESULTS Median follow-up was 20 years (15-26). Kidney function was stabilized except for one case that required a kidney transplant. Hydronephrosis disappeared or improved (p = 0.03). Vesicoureteral reflux grades I-II was cured without reimplantation and grades III-IV responded better with reimplantation than without (p = 0.03). Quality of life improved in all patients, with all stating they would undergo the procedure again. After surgery, 94% of the patients exhibited diurnal continence but 25% exhibited nocturnal incontinence. Pressure at capacity decreased and bladder capacity increased (p < 0.001). One patient presented ureteral fistula with another presenting hemorrhage. Both required immediate surgical review. Late complications included urinary sphincter cuff erosion, renal lithiasis, four instances of bladder lithiasis and repeated pyelonephritis in one 24-year-old patient. All required surgery. The mean of urinary infections fell, from 2.5 per year (0.7) to 1 (0.5) (p = 0.03). CONCLUSION Augmentation cystoplasty (AC) maintains its efficacy and improves quality of life in the long term. However, serious surgical complications can ensue, along with minor or major subsequent complications. This should be considered before surgery and makes lifelong monitoring of patients necessary.
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Affiliation(s)
- Jesús Romero-Maroto
- Department of Pathology and Surgery, Universidad Miguel Hernández, Elche, Spain
| | | | - Luis Gómez-Pérez
- Department of Pathology and Surgery, Universidad Miguel Hernández, Elche, Spain.,Department of Urology, San Juan University Hospital, Alicante, Spain
| | - Pau Sarrió-Sanz
- Department of Urology, San Juan University Hospital, Alicante, Spain
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20
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Sinha S, Shah M. Augmentation cystoplasty in children with stages III and IV chronic kidney disease secondary to neurogenic bladder. Asian J Urol 2021; 9:313-317. [PMID: 36035352 PMCID: PMC9399548 DOI: 10.1016/j.ajur.2021.05.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Revised: 07/09/2020] [Accepted: 09/24/2020] [Indexed: 11/17/2022] Open
Affiliation(s)
- Sanjay Sinha
- Department of Urology, Apollo Hospitals, Hyderabad, India
- Department of Nephrology, Apollo Hospitals, Hyderabad, India
- Corresponding author. Departments of Urology, Apollo Hospitals, Hyderabad, India.
| | - Mehul Shah
- Department of Urology, Apollo Hospitals, Hyderabad, India
- Department of Nephrology, Apollo Hospitals, Hyderabad, India
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21
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Taghavi K, O'Hagan LA, Bortagaray J, Bouty A, M Hutson J, O'Brien M. Complication profile of augmentation cystoplasty in contemporary paediatric urology: a 20-year review. ANZ J Surg 2021; 91:1005-1010. [PMID: 33844426 DOI: 10.1111/ans.16736] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Revised: 02/23/2021] [Accepted: 02/25/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND The aim of this study was to describe the complication profile of augmentation cystoplasty in contemporary paediatric urology as well as its effect on bladder metrics. METHODS Consecutive operative cases were retrospectively reviewed at a single institution over 20 years (1999-2019). Short- and long-term outcomes and complications following augmentation cystoplasty were defined. RESULTS Of the 71 operative cases; the most common underlying diagnoses were neurogenic bladder (34%), exstrophy-epispadias complex (30%) and posterior urethral valves (23%). The most common tissue-type utilized was ileal (58%) and ureteric (30%). Peri-operative urine leak affected nine (13%) children but reservoir perforations were less common (4%). Mean end-of-study detrusor pressure improved significantly following bladder augmentation (38-17 cmH2 O, P < 0.001). Bladder capacity improved significantly (67-89%, P = 0.041). The median follow-up was 4.5 years (interquartile range: 1.9-10 years). Bladder urolithiasis affected 13 (18%) patients, and symptomatic urinary tract infections 36 (51%) patients. Formation of a continent catheterisable channel contributed a number of complications relating predominantly to stenosis (50%). Repeat augmentation cystoplasty was necessary in three (4%) cases. CONCLUSION Augmentation cystoplasty is a surgical intervention that improves bladder metrics. Given the potential complications, careful patient selection and appropriate pre-operative counselling are essential. Furthermore, pro-active post-operative management and transitional care are vital in the surgical care of children following augmentation cystoplasty.
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Affiliation(s)
- Kiarash Taghavi
- Department of Paediatric Urology, Royal Children's Hospital, Melbourne, Victoria, Australia.,Department of Paediatrics, The University of Melbourne, Melbourne, Victoria, Australia
| | - Lomani A O'Hagan
- School of Medicine, The University of Auckland, Auckland, New Zealand
| | - Juan Bortagaray
- Department of Paediatric Urology, Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Aurore Bouty
- Department of Paediatric Urology, Royal Children's Hospital, Melbourne, Victoria, Australia
| | - John M Hutson
- Department of Paediatric Urology, Royal Children's Hospital, Melbourne, Victoria, Australia.,Department of Paediatrics, The University of Melbourne, Melbourne, Victoria, Australia.,F. Douglas Stephens Surgical Research Group, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - Mike O'Brien
- Department of Paediatric Urology, Royal Children's Hospital, Melbourne, Victoria, Australia
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22
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Zhu GQ, Jeon SH, Lee KW, Cho HJ, Ha US, Hong SH, Lee JY, Kwon EB, Kim HJ, Lee SM, Kim HY, Kim SW, Bae WJ. Engineered Stem Cells Improve Neurogenic Bladder by Overexpressing SDF-1 in a Pelvic Nerve Injury Rat Model. Cell Transplant 2021; 29:963689720902466. [PMID: 32067480 PMCID: PMC7444235 DOI: 10.1177/0963689720902466] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
There is still a lack of sufficient research on the mechanism behind neurogenic
bladder (NB) treatment. The aim of this study was to explore the effect of
overexpressed stromal cell-derived factor-1 (SDF-1) secreted by engineered
immortalized mesenchymal stem cells (imMSCs) on the NB. In this study, primary
bone marrow mesenchymal stem cells (BM-MSCs) were transfected into immortalized
upregulated SDF-1-engineered BM-MSCs (imMSCs/eSDF-1+) or immortalized normal SDF-1-engineered BM-MSCs
(imMSCs/eSDF-1−). NB rats induced by bilateral pelvic nerve (PN)
transection were treated with imMSCs/eSDF-1+, imMSCs/eSDF-1−, or sham. After a 4-week treatment, the bladder function was assessed by
cystometry and voiding pattern analysis. The PN and bladder tissues were
evaluated via immunostaining and western blotting analysis. We found that imMSCs/eSDF-1+ expressed higher levels of SDF-1 in vitro and in vivo. The treatment of imMSCs/eSDF-1+ improved NB and evidently stimulated the recovery of bladder wall in NB
rats. The recovery of injured nerve was more effective in the NB+imMSCs/eSDF-1+ group than in other groups. High SDF-1 expression improved the levels of
vascular endothelial growth factor and basic fibroblast growth factor. Apoptosis
was decreased after imMSCs injection, and was detected rarely in the NB+imMSCs/eSDF-1+ group. Injection of imMSCs boosted the expression of neuronal nitric
oxide synthase, p-AKT, and p-ERK in the NB+imMSCs/eSDF-1+ group than in other groups. Our findings demonstrated that overexpression
of SDF-1 induced additional MSC homing to the injured tissue, which improved the
NB by accelerating the restoration of injured nerve in a rat model.
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Affiliation(s)
- Guan Qun Zhu
- Department of Urology, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.,Catholic Integrative Medicine Research Institute, The Catholic University of Korea, Seoul, Republic of Korea
| | - Seung Hwan Jeon
- Department of Urology, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.,Catholic Integrative Medicine Research Institute, The Catholic University of Korea, Seoul, Republic of Korea
| | - Kyu Won Lee
- Department of Urology, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Hyuk Jin Cho
- Department of Urology, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - U-Syn Ha
- Department of Urology, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Sung-Hoo Hong
- Department of Urology, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Ji Youl Lee
- Department of Urology, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Eun Bi Kwon
- Department of Urology, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.,Catholic Integrative Medicine Research Institute, The Catholic University of Korea, Seoul, Republic of Korea
| | - Hyo-Jin Kim
- Department of Stem Cell Therapy, SL BIGEN, Seongnam, Republic of Korea
| | - Soon Min Lee
- Department of Stem Cell Therapy, SL BIGEN, Seongnam, Republic of Korea
| | - Hey-Yon Kim
- Department of Stem Cell Therapy, SL BIGEN, Seongnam, Republic of Korea
| | - Sea Woong Kim
- Department of Urology, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.,Catholic Integrative Medicine Research Institute, The Catholic University of Korea, Seoul, Republic of Korea
| | - Woong Jin Bae
- Department of Urology, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.,Catholic Integrative Medicine Research Institute, The Catholic University of Korea, Seoul, Republic of Korea
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23
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Jeon SH, Park MY. Transplantation of Brain-Derived Neurotrophic Factor-Expressing Mesenchymal Stem Cells Improves Lower Urinary Tract Symptoms in a Rat Model. KOREAN JOURNAL OF CLINICAL LABORATORY SCIENCE 2020. [DOI: 10.15324/kjcls.2020.52.4.417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Affiliation(s)
- Seung Hwan Jeon
- Department of Urology, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Mi-Young Park
- Department of Clinical Laboratory Science, Suwon Science College, Hwaseong, Korea
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24
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Abstract
PURPOSE OF REVIEW To review recent literature related to urologic malignancies in patients with neurogenic lower urinary tract dysfunction (NLUTD). We performed a literature search of electronic databases (PubMed, ScienceDirect, Scopus, and CIANHL), with a focus on articles published between January 2015 and December 2019. RECENT FINDINGS Recent reports demonstrate a lower incidence of bladder cancer in the NLUTD population than previously found, although still significantly higher than the general population. Bladder cancer in patients with NLUTD is usually diagnosed at a younger age, and is associated with higher rates of squamous cell cancer, a higher stage at presentation, and increased mortality. Evidence for screening for bladder cancer in NLUTD is conflicting, with no formal protocols proven for general use. NLUTD has been shown to have a lower rate of prostate cancer, and may be associated with an earlier diagnosis of renal cancer. SUMMARY Genitourinary malignancies, although still rare, are an important source of morbidity and mortality in patients with NLUTD. Physicians should recognize that bladder cancer in NLUTD is often a lethal disease. Further research is needed to assist physicians with early recognition of these malignancies to improve patient outcomes.
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25
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The Current Positioning of Augmentation Enterocystoplasty in the Treatment for Neurogenic Bladder. Int Neurourol J 2020; 24:200-210. [PMID: 33017891 PMCID: PMC7538291 DOI: 10.5213/inj.2040120.060] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Accepted: 06/14/2020] [Indexed: 11/13/2022] Open
Abstract
Augmentation enterocystoplasty (AEC) is a surgical procedure in which the bladder is enlarged using an intestinal segment in patients with lower urinary tract dysfunction who fail to achieve satisfactory results with all conservative treatments. Currently, surgical materials and procedures, concomitant correction of upper urinary tract abnormalities, or bladder neck reconstruction may vary depending on the experience and preferences of the surgeons. AEC has been proven to be successful with respect to surgical goals, such as achieving urinary continence, improving quality of life, and preserving the upper urinary tract over the long term. The advantage of AEC over intravesical injection of botulinum toxin—a more recent and less invasive procedure—is that the prevention of upper urinary tract damage and the improvement of urinary incontinence are more reliably guaranteed, especially considering that these surgical effects are permanent. Compared to less invasive treatments, the quality of life of patients after surgery is also much higher, and AEC may be more cost-effective in the long run. Thus, in patients with neurogenic bladder, AEC is still the gold standard surgical procedure with strong evidence in support of its efficacy. In this article, the indications, surgical methods, possible complications, long-term follow-up, and current positioning of AEC in lower urinary tract dysfunction is discussed.
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26
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Birkhäuser V, Liechti MD, Anderson CE, Bachmann LM, Baumann S, Baumberger M, Birder LA, Botter SM, Büeler S, Cruz CD, David G, Freund P, Friedl S, Gross O, Hund-Georgiadis M, Husmann K, Jordan X, Koschorke M, Leitner L, Luca E, Mehnert U, Möhr S, Mohammadzada F, Monastyrskaya K, Pfender N, Pohl D, Sadri H, Sartori AM, Schubert M, Sprengel K, Stalder SA, Stoyanov J, Stress C, Tatu A, Tawadros C, van der Lely S, Wöllner J, Zubler V, Curt A, Pannek J, Brinkhof MWG, Kessler TM. TASCI-transcutaneous tibial nerve stimulation in patients with acute spinal cord injury to prevent neurogenic detrusor overactivity: protocol for a nationwide, randomised, sham-controlled, double-blind clinical trial. BMJ Open 2020; 10:e039164. [PMID: 32792454 PMCID: PMC7430472 DOI: 10.1136/bmjopen-2020-039164] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
INTRODUCTION Neurogenic lower urinary tract dysfunction (NLUTD), including neurogenic detrusor overactivity (NDO) and detrusor sphincter dyssynergia, is one of the most frequent and devastating sequelae of spinal cord injury (SCI), as it can lead to urinary incontinence and secondary damage such as renal failure. Transcutaneous tibial nerve stimulation (TTNS) is a promising, non-invasive neuromodulatory intervention that may prevent the emergence of the C-fibre evoked bladder reflexes that are thought to cause NDO. This paper presents the protocol for TTNS in acute SCI (TASCI), which will evaluate the efficacy of TTNS in preventing NDO. Furthermore, TASCI will provide insight into the mechanisms underlying TTNS, and the course of NLUTD development after SCI. METHODS AND ANALYSIS TASCI is a nationwide, randomised, sham-controlled, double-blind clinical trial, conducted at all four SCI centres in Switzerland. The longitudinal design includes a baseline assessment period 5-39 days after acute SCI and follow-up assessments occurring 3, 6 and 12 months after SCI. A planned 114 participants will be randomised into verum or sham TTNS groups (1:1 ratio), stratified on study centre and lower extremity motor score. TTNS is performed for 30 min/day, 5 days/week, for 6-9 weeks starting within 40 days after SCI. The primary outcome is the occurrence of NDO jeopardising the upper urinary tract at 1 year after SCI, assessed by urodynamic investigation. Secondary outcome measures assess bladder and bowel function and symptoms, sexual function, neurological structure and function, functional independence, quality of life, as well as changes in biomarkers in the urine, blood, stool and bladder tissue. Safety of TTNS is the tertiary outcome. ETHICS AND DISSEMINATION TASCI is approved by the Swiss Ethics Committee for Northwest/Central Switzerland, the Swiss Ethics Committee Vaud and the Swiss Ethics Committee Zürich (#2019-00074). Findings will be disseminated through peer-reviewed publications. TRIAL REGISTRATION NUMBER NCT03965299.
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Affiliation(s)
- Veronika Birkhäuser
- Department of Neuro-Urology, Balgrist University Hospital, University of Zürich, Zürich, Switzerland
| | - Martina D Liechti
- Department of Neuro-Urology, Balgrist University Hospital, University of Zürich, Zürich, Switzerland
| | - Collene E Anderson
- Swiss Paraplegic Research, Nottwil, Switzerland
- Department of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland
| | | | - Sarah Baumann
- Department of Neuro-Urology, Balgrist University Hospital, University of Zürich, Zürich, Switzerland
| | - Michael Baumberger
- Spinal Cord and Rehabilitation Medicine, Swiss Paraplegic Centre, Nottwil, Switzerland
| | - Lori A Birder
- Neuro-Urology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Sander M Botter
- Swiss Center for Musculoskeletal Biobanking, Balgrist Campus AG, Zürich, Switzerland
| | - Silvan Büeler
- Department of Neuro-Urology, Balgrist University Hospital, University of Zürich, Zürich, Switzerland
| | - Célia D Cruz
- Instituto de Investigação e Inovação em Saúde, Translational Neuro-urology Group, Universidade do Porto, Porto, Portugal
- Faculdade de Medicina, Departemento de Biomedicina, Unidade de Biologia Experimental, Universidade do Porto, Porto, Portugal
| | - Gergely David
- Department of Neuro-Urology, Balgrist University Hospital, University of Zürich, Zürich, Switzerland
- Spinal Cord Injury Center, Balgrist University Hospital, University of Zürich, Zürich, Switzerland
| | - Patrick Freund
- Spinal Cord Injury Center, Balgrist University Hospital, University of Zürich, Zürich, Switzerland
| | - Susanne Friedl
- Spinal Cord Injury Center, Balgrist University Hospital, University of Zürich, Zürich, Switzerland
| | - Oliver Gross
- Department of Neuro-Urology, Balgrist University Hospital, University of Zürich, Zürich, Switzerland
| | | | - Knut Husmann
- Swiss Center for Musculoskeletal Biobanking, Balgrist Campus AG, Zürich, Switzerland
| | - Xavier Jordan
- Spinal Cord Injury Department, Clinique romande de réadaptation, Sion, Switzerland
| | - Miriam Koschorke
- Department of Neuro-Urology, Balgrist University Hospital, University of Zürich, Zürich, Switzerland
| | - Lorenz Leitner
- Department of Neuro-Urology, Balgrist University Hospital, University of Zürich, Zürich, Switzerland
| | - Eugenia Luca
- Spinal Cord Injury Department, Clinique romande de réadaptation, Sion, Switzerland
| | - Ulrich Mehnert
- Department of Neuro-Urology, Balgrist University Hospital, University of Zürich, Zürich, Switzerland
| | - Sandra Möhr
- Clinic of Neurorehabilitation and Paraplegiology, REHAB Basel, Basel, Switzerland
| | - Freschta Mohammadzada
- Spinal Cord Injury Center, Balgrist University Hospital, University of Zürich, Zürich, Switzerland
| | | | - Nikolai Pfender
- Spinal Cord Injury Center, Balgrist University Hospital, University of Zürich, Zürich, Switzerland
| | - Daniel Pohl
- Department of Gastroenterology and Hepatology, University Hospital Zürich, Zürich, Switzerland
| | - Helen Sadri
- Department of Neuro-Urology, Balgrist University Hospital, University of Zürich, Zürich, Switzerland
| | - Andrea M Sartori
- Department of Neuro-Urology, Balgrist University Hospital, University of Zürich, Zürich, Switzerland
- Institute for Regenerative Medicine, University of Zürich, Zürich, Switzerland
| | - Martin Schubert
- Spinal Cord Injury Center, Balgrist University Hospital, University of Zürich, Zürich, Switzerland
| | - Kai Sprengel
- Department of Trauma, University Hospital Zürich, Zürich, Switzerland
| | - Stephanie A Stalder
- Department of Neuro-Urology, Balgrist University Hospital, University of Zürich, Zürich, Switzerland
| | - Jivko Stoyanov
- Swiss Paraplegic Research, Nottwil, Switzerland
- Department of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland
| | - Cornelia Stress
- Department of Neuro-Urology, Balgrist University Hospital, University of Zürich, Zürich, Switzerland
| | - Aurora Tatu
- Department of Gastroenterology and Hepatology, University Hospital Zürich, Zürich, Switzerland
| | - Cécile Tawadros
- Spinal Cord Injury Department, Clinique romande de réadaptation, Sion, Switzerland
| | - Stéphanie van der Lely
- Department of Neuro-Urology, Balgrist University Hospital, University of Zürich, Zürich, Switzerland
| | - Jens Wöllner
- Neuro-Urology, Swiss Paraplegic Centre, Nottwil, Switzerland
| | - Veronika Zubler
- Department of Radiology, Balgrist University Hospital, Zürich, Switzerland
| | - Armin Curt
- Spinal Cord Injury Center, Balgrist University Hospital, University of Zürich, Zürich, Switzerland
| | - Jürgen Pannek
- Neuro-Urology, Swiss Paraplegic Centre, Nottwil, Switzerland
- Department of Urology, Inselspital University Hospital Bern, Bern, Switzerland
| | - Martin W G Brinkhof
- Swiss Paraplegic Research, Nottwil, Switzerland
- Department of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland
| | - Thomas M Kessler
- Department of Neuro-Urology, Balgrist University Hospital, University of Zürich, Zürich, Switzerland
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27
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Cheng PJ, Keihani S, Roth JD, Pariser JJ, Elliott SP, Bose S, Khavari R, Crescenze I, Stoffel JT, Velaer KN, Elliott CS, Raffee SM, Atiemo HO, Kennelly MJ, Lenherr SM, Myers JB. Contemporary multicenter outcomes of continent cutaneous ileocecocystoplasty in the adult population over a 10‐year period: A Neurogenic Bladder Research Group study. Neurourol Urodyn 2020; 39:1771-1780. [DOI: 10.1002/nau.24420] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Accepted: 05/25/2020] [Indexed: 12/25/2022]
Affiliation(s)
| | - Sorena Keihani
- Division of UrologyUniversity of Utah Salt Lake City Utah
| | - Joshua D. Roth
- Department of UrologyIndiana University School of Medicine Indianapolis Indiana
| | | | - Sean P. Elliott
- Department of UrologyUniversity of Minnesota Minneapolis Minnesota
| | - Sanchita Bose
- Department of UrologyHouston Methodist Hospital Houston Texas
| | - Rose Khavari
- Department of UrologyHouston Methodist Hospital Houston Texas
| | - Iryna Crescenze
- Department of UrologyUniversity of Michigan Ann Arbor Michigan
| | - John T. Stoffel
- Department of UrologyUniversity of Michigan Ann Arbor Michigan
| | - Kyla N. Velaer
- Department of UrologyStanford University Stanford California
| | - Christopher S. Elliott
- Department of UrologyStanford University Stanford California
- Division of UrologySanta Clara Valley Medical Center San Jose California
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Sekido N, Igawa Y, Kakizaki H, Kitta T, Sengoku A, Takahashi S, Takahashi R, Tanaka K, Namima T, Honda M, Mitsui T, Yamanishi T, Watanabe T. Clinical guidelines for the diagnosis and treatment of lower urinary tract dysfunction in patients with spinal cord injury. Int J Urol 2020; 27:276-288. [PMID: 32077161 DOI: 10.1111/iju.14186] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2019] [Accepted: 12/23/2019] [Indexed: 12/16/2022]
Abstract
The present article is an abridged English translation of the Japanese clinical guidelines for the diagnosis and treatment of lower urinary tract dysfunction in patients with spinal cord injury updated as of July 2019. The patients are adult spinal cord injured patients with lower urinary tract dysfunction; special consideration of pediatric and elderly populations is presented separately. The target audience is healthcare providers who are engaged in the medical care of patients with spinal cord injury. The mandatory assessment includes medical history, physical examination, frequency-volume chart, urinalysis, blood chemistry, transabdominal ultrasonography, measurement of post-void residual urine, uroflowmetry and video-urodynamic study. Optional assessments include questionnaires on the quality of life, renal scintigraphy and cystourethroscopy. The presence or absence of risk factors for renal damage and symptomatic urinary tract infection affects urinary management, as well as pharmacological treatments. Further treatment is recommended if the maximum conservative treatment fails to improve or prevent renal damage and symptomatic urinary tract infection. In addition, management of urinary incontinence should be considered individually in patients with risk factors for urinary incontinence and decreased quality of life.
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Affiliation(s)
- Noritoshi Sekido
- Department of Urology, Toho University Ohashi Medical Center, Tokyo, Japan
| | - Yasuhiko Igawa
- Department of Urology, Nagano Prefectural Shinshu Medical Center, Suzaka, Nagano, Japan
| | - Hidehiro Kakizaki
- Department of Renal and Urologic Surgery, Asahikawa Medical University, Asahikawa, Hokkaido, Japan
| | - Takeya Kitta
- Department of Renal and Genitourinary Surgery, Graduate School of Medical Science, Hokkaido University, Sapporo, Hokkaido, Japan
| | - Atsushi Sengoku
- Department of Urology, Hyogo Prefectural Rehabilitation Central Hospital, Kobe, Hyogo, Japan
| | - Satoru Takahashi
- Department of Urology, Nihon University School of Medicine, Tokyo, Japan
| | - Ryosuke Takahashi
- Department of Urology, Spinal Injuries Center, Iizuka, Fukuoka, Japan
| | - Katsuyuki Tanaka
- Department of Urology, Kanagawa Rehabilitation Hospital, Atsugi, Kanagawa, Japan
| | - Takashige Namima
- Department of Urology, Tohoku Rosai Hospital, Sendai, Miyagi, Japan
| | - Masashi Honda
- Division of Urology, Tottori University Faculty of Medicine, Yonago, Tottori, Japan
| | - Takahiko Mitsui
- Department of Urology, University of Yamanashi Graduate School of Medical Sciences, Chuo, Yamanashi, Japan
| | - Tomonori Yamanishi
- Department of Urology, Continence Center, Dokkyo Medical University, Mibu, Tochigi, Japan
| | - Toyohiko Watanabe
- Department of Urology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
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Doherty S, Vanhoestenberghe A, Duffell L, Hamid R, Knight S. A Urodynamic Comparison of Neural Targets for Transcutaneous Electrical Stimulation to Acutely Suppress Detrusor Contractions Following Spinal Cord Injury. Front Neurosci 2019; 13:1360. [PMID: 31956301 PMCID: PMC6951414 DOI: 10.3389/fnins.2019.01360] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Accepted: 12/02/2019] [Indexed: 01/18/2023] Open
Abstract
Objectives To assess and compare the effect of transcutaneous Dorsal Genital Nerve Stimulation (DGNS), Tibial Nerve Stimulation (TNS), Sacral Nerve Stimulation (SNS), and Spinal Stimulation (SS) on Neurogenic Detrusor Overactivity (NDO) and bladder capacity in people with Spinal Cord Injuries (SCI). Materials and Methods Seven male participants with supra-sacral SCI were tested. Standard cystometry (CMG) was performed to assess bladder activity at baseline and with stimulation applied at each site. This was conducted over four separate sessions. All stimulation was monophasic, 15 Hz, 200 μS pulses and applied at maximum tolerable amplitude. Results were analysed against individual control results from within the same session. Results Dorsal Genital Nerve Stimulation increased bladder capacity by 153 ± 146 ml (p = 0.016) or 117 ± 201%. DGNS, TNS and SNS all increased the volume held following the first reflex contraction, by 161 ± 175, 46 ± 62, and 34 ± 33 ml (p = 0.016, p = 0.031, p = 0.016), respectively. SS results showed small reduction of 33 ± 26 ml (p = 0.063) from baseline bladder capacity in five participants. Maximum Detrusor Pressure before leakage was increased during TNS, by 10 ± 13 cmH2O (p = 0.031) but was unchanged during stimulation of other sites. DGNS only was able to suppress at least one detrusor contraction in five participants and reduced first peak detrusor pressure below 40 cmH2O in these 5. Continuous TNS, SNS, and SS produced non-significant changes in bladder capacity from baseline, comparable to conditional stimulation. Increase in bladder capacity correlated with stimulation amplitude for DGNS but not TNS, SNS or SS. Conclusion In this pilot study DGNS acutely suppressed detrusor contractions and increased bladder capacity whereas TNS, SNS, and SS did not. This is the first within individual comparison of surface stimulation sites for management of NDO in SCI individuals.
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Affiliation(s)
- Sean Doherty
- Aspire Centre for Rehabilitation Engineering and Assistive Technologies, University College London, London, United Kingdom.,London Spinal Cord Injury Centre, Royal National Orthopaedic Hospital, London, United Kingdom
| | - Anne Vanhoestenberghe
- Aspire Centre for Rehabilitation Engineering and Assistive Technologies, University College London, London, United Kingdom
| | - Lynsey Duffell
- Aspire Centre for Rehabilitation Engineering and Assistive Technologies, University College London, London, United Kingdom
| | - Rizwan Hamid
- London Spinal Cord Injury Centre, Royal National Orthopaedic Hospital, London, United Kingdom
| | - Sarah Knight
- London Spinal Cord Injury Centre, Royal National Orthopaedic Hospital, London, United Kingdom
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Winde F, Backhaus K, Zeitler JA, Schlegel N, Meyer T. Bladder Augmentation Using Lyoplant ®: First Experimental Results in Rats. Tissue Eng Regen Med 2019; 16:645-652. [PMID: 31824826 DOI: 10.1007/s13770-019-00209-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2018] [Revised: 06/26/2019] [Accepted: 07/18/2019] [Indexed: 11/30/2022] Open
Abstract
Background Congenital defects of the urinary bladder (micro- or contracted bladder, bladder exstrophy) remain a challenging problem for pediatric surgeons. Even when conservative treatment options are fully exhausted, irreversible renal dysfunction can be observed in a large number of cases that can even lead to chronic renal failure and the need for kidney transplantation. To protect kidney function bladder augmentation using intestinal tissue is commonly applied as the standard treatment method. However due to the unphysiological nature of intestinal tissue a number of problems and complications such as urinary tract infections or bladder stone formation limit the clinical success of this approach. Moreover a number of substitutes for the implementation of a bladder augmentation have been tested without success to date. Here we used an experimental model to test wether the biocompatible collagen mesh Lyoplant may be a suitable candidate for bladder augmentation. Methods We implanted a biocompatible collagen mesh (Lyoplant®) in a bladder defect rat model for bladder augmentation (Lyoplant®-group: n = 12; sham group n = 4). After 6 weeks the abdomen was reopened and the initial implant as well as the bladder were resected for histological and immunohistochemical examination. Results All but one rat exhibited physiological growth and behaviour after the operation without differences between the Lyoplant®-group (n = 12) and the sham group (n = 3). One rat from the sham group had to be excluded because of a suture leakage. No wound healing complications, wound infections and no herniation were observed. After 5 weeks the implants showed an adequate incorporation in all cases. This was confirmed by immunohistological analyses where a significant cell infiltration and neovascularization was observed. Conclusion In summary, Lyoplant® appears to be a promising tool in experimental bladder augmentation/regeneration in rats.
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Affiliation(s)
- F Winde
- 1Pediatric Surgery-, Pediatric Trauma - and Pediatric Urology Unit, Department of General-, Visceral-, Transplant-, Vascular- and Pediatric Surgery, University Hospital Wuerzburg, Würzburg, Germany
| | - K Backhaus
- 1Pediatric Surgery-, Pediatric Trauma - and Pediatric Urology Unit, Department of General-, Visceral-, Transplant-, Vascular- and Pediatric Surgery, University Hospital Wuerzburg, Würzburg, Germany
| | - J A Zeitler
- 2Department of Chemical Engineering and Biotechnology, University of Cambridge, Cambridge, UK
| | - N Schlegel
- 3Experimental Surgery Unit, Department of General-, Visceral-, Transplant-, Vascular- and Pediatric Surgery, University of Wuerzburg, Würzburg, Germany
| | - Th Meyer
- 1Pediatric Surgery-, Pediatric Trauma - and Pediatric Urology Unit, Department of General-, Visceral-, Transplant-, Vascular- and Pediatric Surgery, University Hospital Wuerzburg, Würzburg, Germany
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Cheng PJ, Myers JB. Augmentation cystoplasty in the patient with neurogenic bladder. World J Urol 2019; 38:3035-3046. [PMID: 31511969 DOI: 10.1007/s00345-019-02919-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2019] [Accepted: 08/20/2019] [Indexed: 12/12/2022] Open
Abstract
PURPOSE To review the indications and techniques of augmentation cystoplasty (AC) in patients with neurogenic bladder (NGB) while also examining the long-term outcomes, complications, and follow-up surgeries. METHODS PubMed/MEDLINE, Cochrane Library, and Embase databases were searched for articles related to AC and NGB. RESULTS AC is indicated for an overactive or poorly compliant bladder refractory to conservative therapies, such as anticholinergic medications and bladder botulinum toxin injections. A variety of surgical techniques using gastrointestinal segments, alternative tissues, and synthetic materials have been described, though bowel remains the most durable. Ileocystoplasty is the most common type of AC, which uses a detubularized patch of ileum that is anastomosed to a bivalved bladder. Some patients undergo concomitant surgeries at the time of AC, such as catheterizable channel creation to aid with clean intermittent catheterization, ureteral reimplantation to treat vesicoureteral reflux, and bladder outlet procedure to treat incontinence. Following AC, the majority of patients experience an improvement in bladder capacity, compliance, and continence. Most patients also experience an improvement in quality of life. AC has significant complications, such as chronic UTIs, bladder and renal calculi, metabolic disturbances, bowel problems, perforation, and malignancy. AC also has a high rate of follow-up surgeries, especially if the patient undergoes concomitant creation of a catheterizable channel. CONCLUSIONS Enterocystoplasty remains the gold standard for AC, though more research is needed to better evaluate the morbidity of different surgical techniques and the indications for concomitant surgeries. Experimental methods of AC with tissue engineering are a promising area for further investigation.
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Affiliation(s)
- Philip J Cheng
- Division of Urology, Department of Surgery, University of Utah, 30 North 1900 East, Salt Lake City, UT, 84132, USA
| | - Jeremy B Myers
- Division of Urology, Department of Surgery, University of Utah, 30 North 1900 East, Salt Lake City, UT, 84132, USA.
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Budzyn J, Trinh H, Raffee S, Atiemo H. Bladder Augmentation (Enterocystoplasty): the Current State of a Historic Operation. Curr Urol Rep 2019; 20:50. [PMID: 31342172 DOI: 10.1007/s11934-019-0919-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
PURPOSE OF REVIEW The goal of this paper was to evaluate the current use of enterocystoplasty, a historical operation for bladder dysfunction but with continued and increasing modern relevance. RECENT FINDINGS Since the advent of third line neuromodulation techniques for neurogenic and idiopathic overactive bladder (OAB), the usage of enterocystoplasty has decreased. However, this procedure continues to be utilized in pediatric urology patients and the most refractory OAB patients. Adult urologist should be familiar with this operative technique in an effort to manage pediatric patients transitioning to adulthood. Minimally invasive techniques for this surgical procedure have been described with very limited outcome data. It is important for all urologists to be familiar with enterocystoplasty, both technically and with the unique needs of these patients postoperatively. Further studies evaluating the outcomes of this procedure in idiopathic overactive bladder patients and efforts to standardize recommendations for neurogenic bladder patients will help guide care in the future.
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Affiliation(s)
- Jeffrey Budzyn
- Henry Ford Health System, 2799 West Grand Blvd, K9, Detroit, MI, 48202, USA
| | - Hamilton Trinh
- Henry Ford Health System, 2799 West Grand Blvd, K9, Detroit, MI, 48202, USA
| | - Samantha Raffee
- Henry Ford Health System, 2799 West Grand Blvd, K9, Detroit, MI, 48202, USA
| | - Humphrey Atiemo
- Henry Ford Health System, 2799 West Grand Blvd, K9, Detroit, MI, 48202, USA.
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Chu DI, Abraham AG, Tasian GE, Denburg MR, Ross ME, Zderic SA, Furth SL. Urologic care and progression to end-stage kidney disease: a Chronic Kidney Disease in Children (CKiD) nested case-control study. J Pediatr Urol 2019; 15:266.e1-266.e7. [PMID: 30962011 PMCID: PMC6588473 DOI: 10.1016/j.jpurol.2019.03.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2018] [Revised: 01/13/2019] [Accepted: 03/11/2019] [Indexed: 12/23/2022]
Abstract
INTRODUCTION Children with chronic kidney disease (CKD) risk progressing to end-stage kidney disease (ESKD). The majority of CKD causes in children are related to congenital anomalies of the kidney and urinary tract, which may be treated by urologic care. OBJECTIVE To examine the association of ESKD with urologic care in children with CKD. STUDY DESIGN This was a nested case-control study within the Chronic Kidney Disease in Children (CKiD) prospective cohort study that included children aged 1-16 years with non-glomerular causes of CKD. The primary exposure was prior urologic referral with or without surgical intervention. Incidence density sampling matched each case of ESKD to up to three controls on duration of time from CKD onset, sex, race, age at baseline visit, and history of low birth weight. Conditional logistic regression analysis was performed to estimate rate ratios (RRs) for the incidence of ESKD. RESULTS Sixty-six cases of ESKD were matched to 153 controls. Median age at baseline study visit was 12 years; 67% were male, and 7% were black. Median follow-up time from CKD onset was 14.9 years. Seventy percent received urologic care, including 100% of obstructive uropathy and 96% of reflux nephropathy diagnoses. Cases had worse renal function at their baseline visit and were less likely to have received prior urologic care. After adjusting for income, education, and insurance status, urology referral with surgery was associated with 50% lower risk of ESKD (RR 0.50 [95% confidence interval [CI] 0.26-0.997), compared to no prior urologic care (Figure). After excluding obstructive uropathy and reflux nephropathy diagnoses, which were highly correlated with urologic surgery, the association was attenuated (RR 0.72, 95% CI 0.24-2.18). DISCUSSION In this study, urologic care was commonly but not uniformly provided to children with non-glomerular causes of CKD. Underlying specific diagnoses play an important role in both the risk of ESKD and potential benefits of urologic surgery. CONCLUSION Within the CKiD cohort, children with non-glomerular causes of CKD often received urologic care. Urology referral with surgery was associated with lower risk of ESKD compared to no prior urologic care but depended on specific underlying diagnoses.
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Affiliation(s)
- D I Chu
- Division of Urology, Department of Surgery, Children's Hospital of Philadelphia, Philadelphia, PA, USA.
| | - A G Abraham
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - G E Tasian
- Division of Urology, Department of Surgery, Children's Hospital of Philadelphia, Philadelphia, PA, USA; Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA; Center for Pediatric Clinical Effectiveness, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - M R Denburg
- Division of Nephrology, Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - M E Ross
- Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - S A Zderic
- Division of Urology, Department of Surgery, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - S L Furth
- Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA; Division of Nephrology, Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA, USA
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Perrouin-Verbe MA, Léon P, Denys P, Mongiat-Artus P, Chartier-Kastler E, Phé V. Long-term functional outcomes of augmentation cystoplasty in adult spina bifida patients: A single-center experience in a multidisciplinary team. Neurourol Urodyn 2018; 38:330-337. [PMID: 30350892 DOI: 10.1002/nau.23857] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2018] [Accepted: 09/23/2018] [Indexed: 12/19/2022]
Abstract
AIM To report the very long-term functional outcomes of augmentation cystoplasty (AC) in adult spina bifida patients. METHODS All consecutive adult spina bifida patients who underwent AC between 1991 and 2008 were enrolled. Early postoperative complications (Clavien-Dindo classification) and long-term outcomes (voiding modalities, urodynamic parameters, renal function, continence, and quality of life) were assessed. RESULTS Twenty-eight patients with a median age of 20 years (IQR 17-25) were included. They all underwent AC with a supratrigonal cystectomy (SC). The median follow-up was 13.6 years (IQR 6-16.5). Thirteen early postoperative complications (12 grade I-II, 1 grade III) were observed in 11 patients (39%). Eight patients (29%) had upper urinary tract infections managed with antibiotics, with 2 patients requiring ureteral stents. Bladder stones occurred in 2 patients (7%) and were managed with endoscopy and cystostomy. One bladder perforation was reported. One bladder cancer was observed 26 years after surgery. Creatinine clearance and all urodynamic parameters were significantly improved post-operatively. The overall complication and reoperation rates were 57% and 14%, respectively. At last follow up, the continence rate was 71% (n = 20), with 93% (n = 26) performing intermittent self-catheterization. Quality of life was improved for 71% of patients. CONCLUSION In adult spina bifida population, AC is a high-risk procedure with an overall complication rate of 57% and a reoperation rate of 14%. However, AC is beneficial to the overall health of the patients since it provides a satisfying continence rate, an improvement of quality of life, and long-term protection of the upper urinary tract.
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Affiliation(s)
- Marie-Aimée Perrouin-Verbe
- Pitié-Salpétrière Academic Hospital, Department of Urology, Sorbonne University, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Priscilla Léon
- Pitié-Salpétrière Academic Hospital, Department of Urology, Sorbonne University, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Pierre Denys
- Department of Physical Medicine and Rehabilitation, Raymond Poincaré Hospital, Garches, France
| | | | - Emmanuel Chartier-Kastler
- Pitié-Salpétrière Academic Hospital, Department of Urology, Sorbonne University, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Véronique Phé
- Pitié-Salpétrière Academic Hospital, Department of Urology, Sorbonne University, Assistance Publique-Hôpitaux de Paris, Paris, France
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Langer S, Radtke C, Györi E, Springer A, Metzelder ML. Bladder augmentation in children: current problems and experimental strategies for reconstruction. Wien Med Wochenschr 2018; 169:61-70. [PMID: 30084093 PMCID: PMC6394595 DOI: 10.1007/s10354-018-0645-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2018] [Accepted: 06/21/2018] [Indexed: 12/31/2022]
Abstract
Bladder augmentation is a demanding surgical procedure and exclusively offered for selected children and has only a small spectrum of indications. Paediatric bladder voiding dysfunction occurs either on a basis of neurological dysfunction caused by congenital neural tube defects or on a basis of rare congenital anatomic malformations. Neurogenic bladder dysfunction often responds well to a combination of specific drugs and/or intermittent self-catheterization. However, selected patients with spinal dysraphism and children with congenital malformations like bladder exstrophy and resulting small bladder capacity might require bladder augmentation. Ileocystoplasty is the preferred method of bladder augmentation to date. Because of the substantial long-and short-term morbidity of augmentation cystoplasty, recent studies have tried to incorporate new techniques and technologies, such as the use of biomaterials to overcome or reduce the adverse effects. In this regard, homografts and allografts have been implemented in bladder augmentation with varying results, but recent studies have shown promising data in terms of proliferation of urothelium and muscle cells by using biological silk grafts.
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Affiliation(s)
- Sophie Langer
- General Hospital Vienna, Clinical Department of Paediatric Surgery, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Christine Radtke
- General Hospital Vienna, Clinical Department of Plastic and Reconstructive Surgery, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Eva Györi
- General Hospital Vienna, Clinical Department of Plastic and Reconstructive Surgery, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Alexander Springer
- General Hospital Vienna, Clinical Department of Paediatric Surgery, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Martin L Metzelder
- General Hospital Vienna, Clinical Department of Paediatric Surgery, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria.
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Lam Van Ba O, Soustelle L, Wagner L, Siegler N, Boukaram M, Naoum KB, Droupy S, Chevrot A, Costa P. Impact on quality of life and sexual satisfaction of continent cystostomy with enterocystoplasty in an adult neurologic population. Neurourol Urodyn 2018; 37:1405-1412. [PMID: 29464756 DOI: 10.1002/nau.23461] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2017] [Revised: 10/31/2017] [Accepted: 11/04/2017] [Indexed: 01/14/2023]
Abstract
AIMS To evaluate long-term general and urinary quality of life (QOL) and sexual satisfaction in adult neurologic patients undergoing continent cystostomy surgery associated with a bladder enlargement to treat neurogenic lower urinary tract dysfunction. METHODS Monocentre, retrospective series of adult neurologic patients who underwent continent cystostomy with bladder enlargement and followed-up in the long-term. We assessed during follow-up, urinary and renal function and patients filled QOL questionnaires on general QOL, sexuality and urinary (short form Qualiveen) disability. RESULTS Fifty-three patients were included and followed-up 77 months on average. Rates of patients' satisfaction, stomal and urethral continences were respectively of 98.7% (n = 51), 94.1% (n = 48), and 80.4% (n = 41). Impact of surgery on general QOL and autonomy were strong and positive (respective mean scores of 4.8 and 4.7 on a scale ranging from 1 to 5). Mean overall urinary Qualiveen QOL score was 0.8 (0.09-2.67) indicating a low negative impact of urinary disability on QOL. In patients <45 years, 52.6% (n = 10) reported a moderate to important improvement of their sexuality after surgery. Renal function remained stable during follow-up. CONCLUSION In the long-term, continent cystostomy with bladder enlargement provides great satisfaction to almost most patients. It has a strong positive impact on general and specific urinary QOL, patients' autonomy and urinary continence. In young patients a positive impact on sexuality was also noticed. These encouraging data, that need to be confirmed, constitute interesting information to provide to neurologic patients to help them deciding whether they are willing to undergo continent cystostomy surgery.
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Affiliation(s)
| | | | - Laurent Wagner
- Department of Urology, Nîmes University Hospital, Nîmes, France
| | - Nicolas Siegler
- Department of Urology, Nîmes University Hospital, Nîmes, France
| | - Michel Boukaram
- Department of Urology, Nîmes University Hospital, Nîmes, France
| | - Kamel Ben Naoum
- Department of Urology, Nîmes University Hospital, Nîmes, France
| | - Stéphane Droupy
- Department of Urology, Nîmes University Hospital, Nîmes, France
| | - Armand Chevrot
- Department of Urology, Nîmes University Hospital, Nîmes, France
| | - Pierre Costa
- Department of Urology, Nîmes University Hospital, Nîmes, France
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Benz KS, Jayman J, Doersch K, Maruf M, Baumgartner T, Kasprenski M, Gearhart JP. Bladder Re-augmentation in Classic Bladder Exstrophy: Risk Factors and Prevention. Urology 2018; 115:157-161. [PMID: 29447946 DOI: 10.1016/j.urology.2018.02.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2017] [Revised: 01/29/2018] [Accepted: 02/02/2018] [Indexed: 10/18/2022]
Abstract
OBJECTIVE To characterize the causes of re-augmentation in patients with classic bladder exstrophy (CBE). METHODS A prospectively maintained institutional database of 1327 exstrophy-epispadias complex patients was reviewed for patients with CBE who underwent more than 1 augmentation cystoplasty (AC) procedure. Data regarding bladder capacities, complications following AC, and reasons for re-augmentation were evaluated. RESULTS A total of 166 patients with CBE underwent AC. Of these, 67 (40.4%) were included in the control group and 17 (10%) patients underwent a re-augmentation. There were several indications for re-augmentation including continued small bladder capacity (17 of 17), inadequate bladder necks (8 of 17), failed rattail augmentation (2 of 17), stomal incontinence (1 of 17), a urethrocutaneous fistula (1 of 17), and an hourglass augmentation (1 of 17). Of note, 5 of the 17 patients (29%) had a re-augmentation procedure with a ureteral reimplantation. The sigmoid colon was the most commonly used bowel segment in the failed initial AC (8 patients), whereas the ileum was the most commonly used segment during re-augmentation (12 patients). In the re-augmentation cohort, the mean amount of bowel used during the first AC procedure was 12 cm (standard deviation [SD] 3.6) compared with 19 cm (SD 5.0) during re-augmentation. The mean amount of bowel used for control group augmentations was 20.8 cm (SD 4). The mean re-augmentation preoperative bladder capacity of 100 mL (SD 60) immediately increased after re-augmentation to 180.8 mL (SD 56.4) (P = .0001). CONCLUSION Bladder re-augmentation is most commonly required in the setting of a small bladder capacity after an initial AC, when an insufficient amount of bowel is used during the first AC procedure.
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Affiliation(s)
- Karl S Benz
- Robert D. Jeffs Division of Pediatric Urology, James Buchanan Brady Urological Institutions, Johns Hopkins Hospital, Johns Hopkins Medical Institutions, Charlotte Bloomberg Children's Hospital, Baltimore, MD
| | - John Jayman
- Robert D. Jeffs Division of Pediatric Urology, James Buchanan Brady Urological Institutions, Johns Hopkins Hospital, Johns Hopkins Medical Institutions, Charlotte Bloomberg Children's Hospital, Baltimore, MD
| | - Karen Doersch
- Robert D. Jeffs Division of Pediatric Urology, James Buchanan Brady Urological Institutions, Johns Hopkins Hospital, Johns Hopkins Medical Institutions, Charlotte Bloomberg Children's Hospital, Baltimore, MD; Texas A&M Health Science Center College of Medicine, Temple, TX
| | - Mahir Maruf
- Robert D. Jeffs Division of Pediatric Urology, James Buchanan Brady Urological Institutions, Johns Hopkins Hospital, Johns Hopkins Medical Institutions, Charlotte Bloomberg Children's Hospital, Baltimore, MD
| | - Timothy Baumgartner
- Robert D. Jeffs Division of Pediatric Urology, James Buchanan Brady Urological Institutions, Johns Hopkins Hospital, Johns Hopkins Medical Institutions, Charlotte Bloomberg Children's Hospital, Baltimore, MD
| | - Matthew Kasprenski
- Robert D. Jeffs Division of Pediatric Urology, James Buchanan Brady Urological Institutions, Johns Hopkins Hospital, Johns Hopkins Medical Institutions, Charlotte Bloomberg Children's Hospital, Baltimore, MD
| | - John P Gearhart
- Robert D. Jeffs Division of Pediatric Urology, James Buchanan Brady Urological Institutions, Johns Hopkins Hospital, Johns Hopkins Medical Institutions, Charlotte Bloomberg Children's Hospital, Baltimore, MD.
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Quality of Life and the Neurogenic Bladder: Does Bladder Management Technique Matter? CURRENT BLADDER DYSFUNCTION REPORTS 2017. [DOI: 10.1007/s11884-017-0443-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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