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Wang J, Ren L, Liu X, Liu J, Ling Q. Underactive Bladder and Detrusor Underactivity: New Advances and Prospectives. Int J Mol Sci 2023; 24:15517. [PMID: 37958499 PMCID: PMC10648240 DOI: 10.3390/ijms242115517] [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: 09/18/2023] [Revised: 10/20/2023] [Accepted: 10/22/2023] [Indexed: 11/15/2023] Open
Abstract
Underactive bladder (UAB) is a prevalent but under-researched lower urinary tract symptom that typically occurs alongside detrusor underactivity (DU). Unlike UAB, DU is a urodynamic diagnosis which the International Continence Society (ICS) defines as "a contraction of reduced strength and/or duration, resulting in prolonged bladder emptying and/or a failure to achieve complete bladder emptying within a normal time span". Despite the widespread prevalence of UAB/DU, there are significant gaps in our understanding of its pathophysiological mechanisms, diagnosis, and treatment compared with overactive bladder (OAB) and detrusor overactivity (DO). These gaps are such that clinicians regard UAB/DU as an incurable condition. In recent years, the understanding of UAB has increased. The definition of UAB has been clarified, and the diagnostic criteria for DU have been considered more comprehensively. Meanwhile, a number of non-invasive diagnostic methods have also been reported. Clinical trials involving novel drugs, electrical stimulation, and stem cell therapy have shown promising results. Therefore, this review summarizes recent reports on UAB and DU and highlights the latest advances in their diagnosis and treatment.
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Affiliation(s)
- Jiaxin Wang
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China; (J.W.)
- Institute of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Lida Ren
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China; (J.W.)
- Institute of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Xinqi Liu
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China; (J.W.)
- Institute of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Jihong Liu
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China; (J.W.)
- Institute of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Qing Ling
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China; (J.W.)
- Institute of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
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Haudebert C, Hascoet J, Samson E, Jezequel M, Voiry C, Brochard C, Richard C, Kerdraon J, Siproudhis L, Manunta A, Peyronnet B. Risk factors for upper urinary tract deterioration in adult patients with spina bifida. World J Urol 2023; 41:1187-1192. [PMID: 36808530 DOI: 10.1007/s00345-023-04314-1] [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] [Received: 12/12/2022] [Accepted: 01/23/2023] [Indexed: 02/21/2023] Open
Abstract
PURPOSE Neurogenic bladder associated with spina bifida disease remains a major cause for mortality or morbidity due to kidney damages. However, we currently do not know which urodynamic findings are associated with an higher risk of upper tract damages in spina bifida patients. The objective of the present study was to evaluate urodynamic findings associated with functional kidney failure and/or with morphological kidney damages. METHODS A large single-center restrospective study was conducted in our national referral center for spina bifida patients using our patients' files. All urodynamics curves were assessed by the same examinator. Functional and/or morphological evaluation of the upper urinary tract were done at the same moment as the urodynamic exam (between 1 week before and 1 month after). Kidney function was assessed using creatinine serum levels or 24 h urinary creatinine levels (creatinine clearance) for walking patients, or with the 24 h urinary creatinine level for wheelchair-users. RESULTS We included 262 spina bifida patients in this study. Fifty-five patients had a poor bladder compliance (21.4%) and 88 of them had detrusor overactivity (33.6%). Twenty patients had a stage 2 kidney failure (eGFR < 60 ml/min) and 81 patients out of 254 (30.9%) had an abnormal morphological examination. There were three urodynamic findings significantly associated with UUTD: bladder compliance (OR = 0.18; p = 0.007), Pdetmax (OR = 14.7; p = 0.003) and detrusor overactivity (OR = 1.84; p = 0.03). CONCLUSION In this large series of spina bifida patients, maximum detrusor pressure and bladder compliance are the main urodynamic findings determinants of UUTD risk.
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Affiliation(s)
- Camille Haudebert
- Department of Urology, University of Rennes, 2 rue Henri Le Guilloux, 35000, Rennes, France.
| | - Juliette Hascoet
- Department of Urology, University of Rennes, 2 rue Henri Le Guilloux, 35000, Rennes, France
| | - Emmanuelle Samson
- Department of Physical Medicine and Rehabilitation, Department of Urology, Rennes, France
- Referral Center for Spina BIFIDA, NEUROSPHINX Network, Rennes, France
| | - Magali Jezequel
- Referral Center for Spina BIFIDA, NEUROSPHINX Network, Rennes, France
| | - Caroline Voiry
- Department of Physical Medicine and Rehabilitation, Department of Urology, Rennes, France
| | - Charlène Brochard
- Referral Center for Spina BIFIDA, NEUROSPHINX Network, Rennes, France
- Department of Gastro-Enterology, University of Rennes, Rennes, France
| | - Claire Richard
- Department of Physical Medicine and Rehabilitation, Department of Urology, Rennes, France
- Referral Center for Spina BIFIDA, NEUROSPHINX Network, Rennes, France
| | - Jacques Kerdraon
- Referral Center for Spina BIFIDA, NEUROSPHINX Network, Rennes, France
| | - Laurent Siproudhis
- Referral Center for Spina BIFIDA, NEUROSPHINX Network, Rennes, France
- Department of Gastro-Enterology, University of Rennes, Rennes, France
| | - Andréa Manunta
- Department of Urology, University of Rennes, 2 rue Henri Le Guilloux, 35000, Rennes, France
- Referral Center for Spina BIFIDA, NEUROSPHINX Network, Rennes, France
| | - Benoit Peyronnet
- Department of Urology, University of Rennes, 2 rue Henri Le Guilloux, 35000, Rennes, France
- Referral Center for Spina BIFIDA, NEUROSPHINX Network, Rennes, France
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Pelvic Organ Prolapse in Patients with Congenital Genitourinary Conditions. CURRENT BLADDER DYSFUNCTION REPORTS 2022. [DOI: 10.1007/s11884-022-00669-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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Arlandis S, Bø K, Cobussen-Boekhorst H, Costantini E, de Heide M, Farag F, Groen J, Karavitakis M, Lapitan MC, Manso M, Arteaga SM, Nambiar AK, Riogh ANA, O'Connor E, Omar MI, Peyronnet B, Phé V, Sakalis VI, Sihra N, Tzelves L, van Poelgeest-Pomfret ML, van den Bos TWL, van der Vaart H, Harding CK. European Association of Urology Guidelines on the Management of Female Non-neurogenic Lower Urinary Tract Symptoms. Part 2: Underactive Bladder, Bladder Outlet Obstruction, and Nocturia. Eur Urol 2022; 82:60-70. [PMID: 35181193 DOI: 10.1016/j.eururo.2022.01.044] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2022] [Accepted: 01/26/2022] [Indexed: 12/24/2022]
Abstract
CONTEXT Female lower urinary tract symptoms (LUTS) are a common presentation in urological practice. Thus far, only a limited number of female LUTS conditions have been included in the European Association of Urology (EAU) guidelines compendium. The new non-neurogenic female LUTS guidelines expand the remit to include these symptoms and conditions. OBJECTIVE To summarise the management of underactive bladder (UAB), bladder outlet obstruction (BOO), and nocturia in females. EVIDENCE ACQUISITION The literature search was updated in September 2021 and evidence synthesis was conducted using modified GRADE approach as outlined for all EAU guidelines. A new systematic review on BOO was carried out by the panel for purposes of this guideline. EVIDENCE SYNTHESIS The important considerations for informing guideline recommendations are presented, along with a summary of all the guideline recommendations. CONCLUSIONS Non-neurogenic female LUTS are an important presentation of urological dysfunction. Initial evaluation, diagnosis, and management should be carried out in a structured and logical fashion on the basis of the best available evidence. This guideline serves to present this evidence to practising urologists and other health care providers in an easily accessible and digestible format. PATIENT SUMMARY This report summarises the main recommendations from the European Association of Urology guideline on symptoms and diseases of the female lower urinary tract (bladder and urethra) not associated with neurological disease. We cover recommendations related to the treatment of underactive bladder, obstruction of the bladder outlet, and nighttime urination.
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Affiliation(s)
- Salvador Arlandis
- Urology Department, La Fe University and Polytechnic Hospital, Valencia, Spain.
| | - Kari Bø
- Department of Sports Medicine, Norwegian School of Sport Sciences, Oslo, Norway
| | | | | | | | - Fawzy Farag
- Department of Urology, Sohag University Hospital, Sohag, Egypt; Department of Urology, East Suffolk and North Essex NHS Foundation Trust, Ipswich, UK
| | - Jan Groen
- Department of Urology, Erasmus Medical Center, Rotterdam, The Netherlands
| | | | - Marie Carmela Lapitan
- College of Medicine, Philippine General Hospital, National Institutes of Health, University of the Philippines Manila, Manila, Philippines
| | - Margarida Manso
- Department of Urology, Centro Hospitalar Universitário São João, Porto, Portugal
| | | | - Arjun K Nambiar
- Department of Urology, Freeman Hospital, Newcastle-upon-Tyne, UK
| | | | | | | | - Benoit Peyronnet
- European Association of Urology, Arnhem, The Netherlands; Department of Urology, University of Rennes, Rennes, France
| | - Veronique Phé
- Department of Urology, AP-HP, Pitié-Salpêtrière Academic Hospital, Sorbonne University, Paris, France
| | - Vasileios I Sakalis
- Department of Urology, Agios Pavlos General Hospital of Thessaloniki, Thessaloniki, Greece
| | - Néha Sihra
- Department of Urology, Guy's and St. Thomas' NHS Foundation Trust, London, UK
| | - Lazaros Tzelves
- Second Department of Urology, National and Kapodistrian University of Athens, Sismanogleio General Hospital, Athens, Greece
| | | | | | - Huub van der Vaart
- Department of Obstetrics and Gynecology, University Medical Center, Utrecht, The Netherlands
| | - Christopher K Harding
- Department of Urology, Freeman Hospital, Newcastle-upon-Tyne, UK; Translational and Clinical Research Institute, Newcastle University, Newcastle-upon-Tyne, UK
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Maria Assis G, Silmara Miranda R, Claudia Lima Dornellas A, Maria Benedita Messias A, Teles Batista V, Júnior Gomes J. Clean intermittent catheterization in patients with spinal cord injury: knowledge of nurses. ESTIMA 2020. [DOI: 10.30886/estima.v18.828_in] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Introduction: Spinal cord injury results in failure to empty the bladder, leaving the individual exposed to the risk of recurrent urinary tract infection, vesicoureteral reflux and even loss of renal function. Clean intermittent catheterization (CIC) is the method of choice for emptying the bladder in these cases. Although it has a simple technique, its performance should be well oriented in order to avoid complications such as infections or traumas. Guidance for the technique should be performed during the hospitalization period due to the injury and the nurse is responsible for this action. Objective: To evaluate the knowledge of nurses working in a trauma care hospital in relation to clean intermittent catheterization. Methods: Questionnaire constructed based on the guidelines of the European Association of Urological Nurses, applied to 18 nurses from a university hospital, a reference in the treatment of spinal trauma, regarding neurological dysfunction of the lower urinary tract and clean intermittent catheterization. Results: The participants presented expressive knowledge about lower urinary tract neurological dysfunction and CIC. There were errors regarding the CIC technique in the indication of the use of procedure gloves, in the lubrication of the catheter, collection of periodic urine cultures, use of antibiotics and in the need for instructions before discharge from hospital. Conclusion: Although the sample demonstrated knowledge on several issues related to the subject, the errors indicate the need for training and especially awareness of the responsibility of guidance before discharge from hospital.
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Affiliation(s)
- Gisela Maria Assis
- Faculdade de Medicina de São José do Rio Preto – Pós-Graduação em Enfermagem em Estomaterapia – São José do Rio Preto (SP), Brazil
| | - Roberta Silmara Miranda
- Faculdade de Medicina de São José do Rio Preto – Pós-Graduação em Enfermagem em Estomaterapia – São José do Rio Preto (SP), Brazil
| | - Ana Claudia Lima Dornellas
- Faculdade de Medicina de São José do Rio Preto – Pós-Graduação em Enfermagem em Estomaterapia – São José do Rio Preto (SP), Brazil
| | - Aline Maria Benedita Messias
- Faculdade de Medicina de São José do Rio Preto – Pós-Graduação em Enfermagem em Estomaterapia – São José do Rio Preto (SP), Brazil
| | - Valeria Teles Batista
- Faculdade de Medicina de São José do Rio Preto – Pós-Graduação em Enfermagem em Estomaterapia – São José do Rio Preto (SP), Brazil
| | - João Júnior Gomes
- Faculdade de Medicina de São José do Rio Preto – Pós-Graduação em Enfermagem em Estomaterapia – São José do Rio Preto (SP), Brazil
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Maria Assis G, Silmara Miranda R, Claudia Lima Dornellas A, Maria Benedita Messias A, Teles Batista V, Júnior Gomes J. Cateterismo intermitente limpo no paciente com lesão medular: conhecimento dos enfermeiros. ESTIMA 2020. [DOI: 10.30886/estima.v18.828_pt] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Introdução: A lesão medular resulta em falha no esvaziamento da bexiga, deixando o indivíduo exposto a risco de infecção recorrente de trato urinário, refluxo vesicoureteral e até perda da função renal. O cateterismo intermitente limpo (CIL) é o método de escolha para esvaziamento da bexiga nesses casos. Apesar de ter uma técnica simples, sua realização deve ser bem orientada a fim de evitar complicações como infecções ou traumas. A orientação para a técnica deve ser realizada ainda no período de internação pela lesão, cujo responsável é o enfermeiro. Objetivo: Avaliar o conhecimento dos enfermeiros que atuam em hospital de atendimento ao trauma com relação ao cateterismo intermitente limpo. Métodos: Questionário construído com base nas diretrizes da Associação Europeia de Enfermeiros Urológicos, aplicado a 18 enfermeiros de um hospital universitário, referência no atendimento do trauma raquimedular, a respeito de disfunção neurológica de trato urinário inferior e cateterismo intermitente limpo. Resultados: Os participantes apresentaram conhecimento expressivo a respeito da disfunção neurológica de trato urinário inferior e CIL. Houve erros quanto à técnica do CIL nos quesitos de indicação do uso luvas de procedimento, na lubrificação do cateter, coleta de culturas periódicas de urina, uso antibióticos e na necessidade de orientação antes da alta hospitalar. Conclusão: Apesar de a amostra demonstrar conhecimento em várias questões relacionadas ao tema, os erros indicam necessidade de capacitação e principalmente de conscientização quanto à responsabilidade de orientação antes da alta hospitalar.
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Affiliation(s)
- Gisela Maria Assis
- Faculdade de Medicina de São José do Rio Preto – Pós-Graduação em Enfermagem em Estomaterapia – São José do Rio Preto (SP), Brazil
| | - Roberta Silmara Miranda
- Faculdade de Medicina de São José do Rio Preto – Pós-Graduação em Enfermagem em Estomaterapia – São José do Rio Preto (SP), Brazil
| | - Ana Claudia Lima Dornellas
- Faculdade de Medicina de São José do Rio Preto – Pós-Graduação em Enfermagem em Estomaterapia – São José do Rio Preto (SP), Brazil
| | - Aline Maria Benedita Messias
- Faculdade de Medicina de São José do Rio Preto – Pós-Graduação em Enfermagem em Estomaterapia – São José do Rio Preto (SP), Brazil
| | - Valeria Teles Batista
- Faculdade de Medicina de São José do Rio Preto – Pós-Graduação em Enfermagem em Estomaterapia – São José do Rio Preto (SP), Brazil
| | - João Júnior Gomes
- Faculdade de Medicina de São José do Rio Preto – Pós-Graduação em Enfermagem em Estomaterapia – São José do Rio Preto (SP), Brazil
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Diagnosis and treatment of urinary and sexual dysfunction in hereditary TTR amyloidosis. Clin Auton Res 2019; 29:65-74. [PMID: 31452024 PMCID: PMC6763525 DOI: 10.1007/s10286-019-00627-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2019] [Accepted: 08/02/2019] [Indexed: 01/08/2023]
Abstract
Purpose We aimed to review the current knowledge on the epidemiology, diagnosis, and management of urinary and sexual dysfunction in patients with TTR amyloidosis (ATTR). Methods We performed a review of the literature, screening for randomized controlled trials, prospective and retrospective series, position papers, and guidelines on urinary and sexual dysfunction in ATTR patients published in PubMed and Embase. Results Lower urinary tract dysfunction is present in up to 83% of patients with ATTR. Voiding symptoms are the most common, reported in 34.8−87.5% of patients, while urinary tract infections are reported in up to 50%. Urinary incontinence is observed in 16.7−37.5% of the ATTR population, mostly due to decreased urethral resistance. Sexual dysfunction affects over 40% of ATTR patients, with erectile dysfunction and sexual arousal disorder being the most common symptoms in male and female patients, respectively. In addition to a thorough clinical examination, invasive pressure-flow urodynamic testing is a cornerstone in the assessment of ATTR lower urinary tract dysfunction. The most common finding is detrusor underactivity and intrinsic sphincter deficiency. Poor bladder compliance can also be observed in patients, due to amyloid deposits on the bladder wall. Urinary tract imaging may be of interest to rule out upper urinary tract deterioration. Given the paucity of data in the ATTR population, treatment should be tailored to the individual patient. Conclusion Urinary and sexual dysfunction are highly prevalent in ATTR patients. Comprehensive assessment and multidisciplinary management are keys to avoiding upper urinary tract damage and improving patients’ quality of life.
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