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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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Loftus CJ, Ratanawong JP, Myers JB, Lenherr SM, Stoffel JT, Welk B, Grove S, Elliott SP. Bladder management is the top health concern among adults with a spinal cord injury. Neurourol Urodyn 2024; 43:449-458. [PMID: 38116927 DOI: 10.1002/nau.25369] [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: 09/18/2023] [Revised: 11/10/2023] [Accepted: 12/07/2023] [Indexed: 12/21/2023]
Abstract
INTRODUCTION AND OBJECTIVE Individuals with spinal cord injury (SCI) commonly experience secondary complications though it is not known how they prioritize these different health domains. Using the Neurogenic Bladder Research Group (NBRG) SCI registry, our objective was to identify the top health concerns of individuals with SCI and identify factors that may be associated with these choices with particular focus on urologic issues that participants face. METHODS Participants in the NBRG registry were asked: "What are the top 3 problems that affect you on a daily basis?" Urinary symptoms and QoL were assessed with the Neurogenic Bladder Symptom Score (NBSS). Multivariate regression was used to identify factors related to selecting a top ranked health issue. RESULTS Among our 1461 participants, 882 (60.4%) were men and the median age was 45.1 years (IQR 25.3-64.9). Bladder management was the most commonly top ranked primary issue (39%) followed by pain (16.4%) and bowel management (11.6%). Factors associated with ranking bladder management as the primary concern included years since injury (OR 1.01 [1.00-1.02], p = 0.042), higher (worse) total NBSS (OR 1.05 [1.03-1.06], p < 0.001), and higher (worse) NBSS QoL (OR 1.25 [1.12-1.41], p < 0.001). Reporting chronic pain on a daily basis was associated with ranking pain as the primary health concern (OR 41.7 [15.7-170], p < 0.001). CONCLUSIONS In this cohort, bladder management was ranked as the top health issue and increasing time from injury was associated with increased concern over bladder management. More bladder symptoms were also associated with ranking bladder management as a primary concern while bladder management method and urinary tract infections rate were not.
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Affiliation(s)
| | - John P Ratanawong
- Department of Urology, University of Minnesota, Minneapolis, Minnesota, USA
| | - Jeremy B Myers
- Department of Surgery, Division of Urology, University of Utah, Salt Lake City, Utah, USA
| | - Sara M Lenherr
- Department of Surgery, Division of Urology, University of Utah, Salt Lake City, Utah, USA
| | - John T Stoffel
- Department of Urology, University of Michigan, Ann Arbor, Michigan, USA
| | - Blayne Welk
- Department of Surgery, Western University, London, Ontario, Canada
| | - Shawn Grove
- Department of Urology, University of Minnesota, Minneapolis, Minnesota, USA
| | - Sean P Elliott
- Department of Urology, University of Minnesota, Minneapolis, Minnesota, USA
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Khadour YA, Ebrahem B, Khadour FA. Arabic version of the SF-Qualiveen: cross-cultural adaptation, translation, and validation of urinary disorder-specific instruments in patients with spinal cord injury. J Orthop Surg Res 2024; 19:56. [PMID: 38217026 PMCID: PMC10785342 DOI: 10.1186/s13018-023-04411-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Accepted: 11/26/2023] [Indexed: 01/14/2024] Open
Abstract
BACKGROUND The Short-Form Qualiveen (SF-Qualiveen) questionnaire assesses the effect of bladder and urinary symptoms on patients' quality of life (QoL) with urological impairment caused by neurological diseases. There is no validated SF-Qualiveen questionnaire in Arabic, so this study aims to provide a translated and validated version of the SF-Qualiveen questionnaire among Arabic patients experiencing spinal cord injury (SCI). METHODS Psychometric features such as content and construct validity, test-retest reliability, and internal consistency were analyzed. Construct validity was evaluated by contrasting the SF-Qualiveen with the Neurogenic Bladder Symptom Score Short-Form (NBSS-SF) questionnaire. Internal consistency was measured using Cronbach's alpha, whereas the intraclass correlation coefficient (ICC) was employed to assess the test-retest reliability. Factorial validity was established by principal component analysis (PCA). RESULTS The internal consistency of the total SF-Qualiveen and the domains "Bother with limitations," "Fear," "Feeling," and "Frequency of limitations" showed good internal consistency (Cronbach's alpha of > 0.7). ICC was 0.90 for the total score, 0.83 for the bother with limitations, 0.80 for fears, 0.84 for feeling, and 0.81 for frequency of limitations. The correlation analysis revealed a positive association between the total scores on the NBSS-SF and the domains of the SF-Qualiveen, comprising bother with limitations (r = 0.53, p = 0.02), fears (r = 0.44, p = 0.03), feelings (r = 0.49, p = 0.04), and frequency of limitations (r = 0.46, p = 0.02). The best-fit four-factor model for confirming overall item communalities ranged from 0.552 to 0.814, which indicates moderate to high communalities, and confirms the homogeneity of the SF-Qualiveen using PCA. CONCLUSIONS The findings of this validation study revealed that the SF-Qualiveen is a reliable and valid instrument appropriate for Arabic-speaking patients with SCI in both research and clinical practices.
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Affiliation(s)
- Younes A Khadour
- Department of Physical Therapy, Cairo University, Cairo, 11835, Egypt
- Department of Rehabilitation, Faculty of Medicine, Al Baath University, Homs, Syria
| | - Bashar Ebrahem
- Department of Physical Therapy, Health Science Faculty, Al-Baath University, Homs, Syria
| | - Fater A Khadour
- Department of Rehabilitation, Faculty of Medicine, Al Baath University, Homs, Syria.
- Department of Physical Therapy, Health Science Faculty, Al-Baath University, Homs, Syria.
- Department of Rehabilitation, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095#, Jie-Fang Avenue, Qiaokou District, Wuhan, 430030, Hubei, China.
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Khadour YA, Zheng M, Khadour FA. The validity and reliability of the Arabic version of the short form of neurogenic bladder symptoms score in patients with spinal cord injury. J Orthop Surg Res 2023; 18:464. [PMID: 37370161 DOI: 10.1186/s13018-023-03956-6] [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: 02/24/2023] [Accepted: 06/24/2023] [Indexed: 06/29/2023] Open
Abstract
BACKGROUND The Neurogenic Bladder Symptom Score-Short Form (NBSS-SF) evaluates the impact of disease-specific symptoms on the quality of life in individuals with neurogenic bladder (NB). There is no data on the validity and reliability of the NBSS-SF questionnaire in the Arabic language, so this study aimed to examine the psychometric characteristics of the Arabic NBSS-SF in patients with spinal cord injury (SCI). METHODS International standards were followed when culturally adapting the questionnaire. The Arabic version was conducted in patients with neurogenic bladder caused by SCI twice within a 14 day period. Psychometric properties such as content validity, construct validity, internal consistency, and test-retest reliability were tested. Internal consistency and test-retest reliability was evaluated using Cronbach's alpha, and the Intraclass Correlation Coefficient (ICC), respectively. Construct validity was assessed by comparing the NBSS-SF with the Short Form (SF-12) and the Qualiveen questionnaire. RESULTS One hundred and one patients with SCI participated in the study. The internal consistency for the overall NBSS-SF score (Cronbach's α of 0.82) and for each subdomain was variable (urinary incontinence 0.84; storage/voiding 0.72; consequences 0.57). ICC was 0.91 for the overall score and 0.94 for the urinary incontinence subdomain, 0.72 for storage/voiding, and 0.90 for consequences. The correlation analysis showed that the Arabic version of NBSS-SF has good construct validity. CONCLUSION Our results showed that the Arabic version of NBSS-SF is a valid and reliable instrument for evaluating NB symptoms in the Arabic population suffering from SCI.
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Affiliation(s)
- Younes A Khadour
- Department of Rehabilitation, Faculty of Medicine, Al Baath University, Homs, Syria
- Department of Physical Therapy, Health Science Faculty, Al-Baath University, Homs, Syria
- Department of Physical Therapy, Physical Therapy Department for Neuromuscular and Neurosurgical Disorder and Its Surgery, Cairo University, Cairo, Egypt
| | - Meng Zheng
- Department of Orthopaedic Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Fater A Khadour
- Department of Rehabilitation, Faculty of Medicine, Al Baath University, Homs, Syria.
- Department of Physical Therapy, Health Science Faculty, Al-Baath University, Homs, Syria.
- Department of Rehabilitation, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095#, Jie-Fang Avenue, Qiaokou District, Wuhan, 430030, Hubei, China.
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Sekido N, Kitta T, Sengoku A, Takahashi R, Nomi M, Matsuoka M, Mitsui T. [DEVELOPMENT OF JAPANESE TRANSLATION OF THE NEUROGENIC BLADDER SYMPTOM SCORE]. Nihon Hinyokika Gakkai Zasshi 2023; 114:35-52. [PMID: 38644185 DOI: 10.5980/jpnjurol.114.35] [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] [Indexed: 04/23/2024]
Abstract
(Objectives) To develop Japanese translations of the standard and short forms of the Neurogenic Bladder Symptom Score (Subjects and methods) The questionnaires were forward translated by a Japanese healthcare professional and non-medical professional and backward translated by two native English-speaking translators. Then, the products were harmonized by the participants involved in the translational processes. Finally, 15 persons with spinal cord lesions were interviewed to improve the provisional Japanese translations based on their suggestions. (Results) Throughout the forward and backward translations and their harmonization, no major translational problems were encountered, other than those attributable to differences in syntax between English and Japanese. The persons could complete the provisional Japanese translations of the standard and short forms in median 7.0 and 3.0 minutes, respectively. Although none of them reported difficulty in answering the questions, 6, 3, and 5 persons pointed out that the tenth question (the seventh question in the short form) and the answers to the nineteenth and twenty-second questions, respectively, were not easy to understand. Taking their suggestions into consideration, we finalized the Japanese translations with the help of a developer of the questionnaire as well as the back-translators. (Conclusions) After a multi-step review process, linguistically valid Japanese translations of the standard and short forms of the Neurogenic Bladder Symptom Score (Neurogenic Bladder Symptom Score Japanese version 1.0) were completed. We hope that these Japanese translations will facilitate future research on patient-reported outcomes in persons with neurogenic lower urinary tract dysfunction.
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Affiliation(s)
| | - Takeya Kitta
- Department of Renal and Urologic Surgery, Asahikawa Medical University
| | - Atsushi Sengoku
- Department of Urology, Hyogo Prefectural Rehabilitation Central Hospital
| | | | - Masashi Nomi
- Department of Urology, Hyogo Prefectural Rehabilitation Central Hospital
| | - Mihoko Matsuoka
- Department of Rehabilitation Medicine, Aijinkai Rehabilitation Hospital
| | - Takahiko Mitsui
- Department of Urology, University of Yamanashi Graduate School of Medical Sciences
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Predictors for outcomes of noninvasive, individualized transcranial magnetic neuromodulation in multiple sclerosis women with neurogenic voiding dysfunction. CONTINENCE (AMSTERDAM, NETHERLANDS) 2022; 4:100517. [PMID: 36568960 PMCID: PMC9788803 DOI: 10.1016/j.cont.2022.100517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Purpose Multiple sclerosis (MS) is a multifocal demyelinating disease that affects the central nervous system (CNS) and commonly leads to neurogenic lower urinary tract dysfunction (NLUTD). Proper storage and release of urine relies on synchronized activity of the LUT, which is meticulously regulated by supraspinal circuits, making it vulnerable to diseases such as MS. NLUTD, characterized by voiding dysfunction (VD), storage issues, or a combination of both is a common occurrence in MS. Unfortunately, there are limited treatment options for NLUTD, making the search for alternative treatments such as transcranial rotating permanent magnet stimulation (TRPMS) of utmost importance. To assess effectiveness of treatment we also need to understand underlying factors that may affect outcomes, which we addressed here. Methods Ten MS subjects with VD and median age of 54.5 years received daily TRPMS sessions for two weeks. Five pre-determined regions of interest (ROIs) known to be involved in the micturition cycle were modulated (stimulated or inhibited) using TRPMS. Clinical data (non-instrumented uroflow and urodynamics parameters, PVR, bladder symptom questionnaires) and neuro-imaging data were collected at baseline and following TRPMS via 7-Tesla Siemens MAGNETOM Terra magnetic resonance imaging (MRI) scanner. Each participant underwent functional MRI (fMRI) concurrently with a repeated urodynamic study (UDS). Baseline data of each arm was evaluated to determine any indicators of successful response to treatment.
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Allen GM, Palermo AE, McNaughton KMD, Boswell-Ruys CL, Lee BB, Butler JE, Gandevia SC, McCaughey EJ. Effectiveness of Abdominal Functional Electrical Stimulation for Improving Bowel Function in People With a Spinal Cord Injury: A Study Protocol for a Double-Blinded Randomized Placebo-Controlled Clinical Trial. Top Spinal Cord Inj Rehabil 2022; 28:22-31. [PMID: 36457354 PMCID: PMC9678222 DOI: 10.46292/sci22-00008] [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] [Indexed: 11/17/2022]
Abstract
Background People with a spinal cord injury (SCI) have a high rate of bowel-related morbidity, even compared with people with other neurological disorders. These complications lower quality of life and place a financial burden on the health system. A noninvasive intervention that improves the bowel function of people with an SCI should reduce morbidity, improve quality of life, and lead to cost savings for health care providers. Objectives To investigate the effectiveness of noninvasive abdominal functional electrical stimulation (FES) for improving bowel function in people with a chronic SCI. Methods A prospective, double-blinded, 1:1 randomized, placebo-controlled intervention trial will be conducted with 80 adults with chronic SCI (>12 months since injury) above T8 single neurological level. The intervention will be a 45-minute abdominal FES (or placebo) session, 3 days per week, for 6 weeks. Main Study Parameters/Endpoints Primary endpoint is whole gut transit time before and after 6 weeks of abdominal FES. Secondary endpoints measured before and after 6 weeks of abdominal FES are (1) colonic transit time; (2) quality of life (EQ-5D-5L); (3) participant-reported bowel function (International SCI Bowel Function Basic Data Set Questionnaire and visual analogue scale); (4) respiratory function (forced vital capacity, forced expiratory volume in 1 second, peak expiratory flow, maximal inspiratory pressure, and maximal expiratory pressure); (5) bladder symptoms (Neurogenic Bladder Symptom Score); (6) daily bowel management diary; and (7) unplanned hospital visits. Conclusion Safety data will be collected, and a cost utility analysis using quality of life scores will be performed. Trial registration Australian New Zealand Clinical Trials Registry (ANZCTR): ACTRN12621000386831.
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Affiliation(s)
- Gabrielle M Allen
- Neuroscience Research Australia, Randwick, New South Wales, Australia
- School of Medical Sciences, University of New South Wales, Kensington, New South Wales, Australia
| | - Anne E Palermo
- Neuroscience Research Australia, Randwick, New South Wales, Australia
- School of Medical Sciences, University of New South Wales, Kensington, New South Wales, Australia
| | - Keith M D McNaughton
- Neuroscience Research Australia, Randwick, New South Wales, Australia
- School of Medical Sciences, University of New South Wales, Kensington, New South Wales, Australia
| | - Claire L Boswell-Ruys
- Neuroscience Research Australia, Randwick, New South Wales, Australia
- School of Medical Sciences, University of New South Wales, Kensington, New South Wales, Australia
- Prince of Wales Hospital, Randwick, New South Wales, Australia
| | - Bonsan B Lee
- Neuroscience Research Australia, Randwick, New South Wales, Australia
- School of Medical Sciences, University of New South Wales, Kensington, New South Wales, Australia
- Prince of Wales Hospital, Randwick, New South Wales, Australia
| | - Jane E Butler
- Neuroscience Research Australia, Randwick, New South Wales, Australia
- School of Medical Sciences, University of New South Wales, Kensington, New South Wales, Australia
| | - Simon C Gandevia
- Neuroscience Research Australia, Randwick, New South Wales, Australia
- School of Medical Sciences, University of New South Wales, Kensington, New South Wales, Australia
- Prince of Wales Clinical School, University of New South Wales, Kensington, Australia
| | - Euan J McCaughey
- Neuroscience Research Australia, Randwick, New South Wales, Australia
- School of Medical Sciences, University of New South Wales, Kensington, New South Wales, Australia
- Queen Elizabeth National Spinal Injuries Unit, Queen Elizabeth University Hospital, Glasgow, Scotland
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Moreno-Palacios J, Castro-Nuñez P, Padilla-Fernández B, Beltran-Martinez L, Katz-Nestor O, Braschi E, Garrido G. Cross-cultural adaptation and validation of the neurogenic bladder symptom score for Spanish speakers. Neurourol Urodyn 2021; 40:1939-1944. [PMID: 34396560 DOI: 10.1002/nau.24768] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Revised: 06/09/2021] [Accepted: 08/01/2021] [Indexed: 12/12/2022]
Abstract
AIM To perform a cross-cultural adaptation and validation of the Neurogenic Bladder Symptom Score (NBSS) to Spanish in patients with neurogenic lower urinary tract dysfunction. MATERIALS AND METHODS The questionnaire was culturally adapted according to international guidelines. It was applied, twice in a range of 14-28 days. Psychometric properties were tested such as content validity, construct validity, internal consistency, and test-retest reliability. RESULTS A total of 82 patients between 18 and 78 years old (mean age of 43.9) participated in the study, and completed the first NBSS assessment; only 39 (32.19%) performed the test-retest study. The internal consistency was tested by Cronbach α with a result of 0.86 (95% CI, 0.81-0.90). The reliability was tested by interclass correlation coefficient with a result of 0.91 [0.87-0.95] (p < 0.0001). The construct validity was tested by Pearson correlation between NBSS and Qualiveen-SF, which showed a moderate correlation with a result of 0.57 (p < 0.0001). One-way analysis of variance with trend analysis demonstrated that patients who reported having a more severe problem with their bladder function had a higher NBSS total score (p < 0.001). CONCLUSION The results of this study demonstrated that the Spanish version of the NBSS has a good internal consistency and reliability, proving its applicability.
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Affiliation(s)
- J Moreno-Palacios
- Urology Department, Unidad Medica de Alta Especialidad, Hospital de Especialidades "Dr. Bernardo Sepúlveda Gutiérrez", IMSS, Ciudad de México, México
| | - P Castro-Nuñez
- Urology Department, Unidad Medica de Alta Especialidad, Hospital de Especialidades "Dr. Bernardo Sepúlveda Gutiérrez", IMSS, Ciudad de México, México
| | - B Padilla-Fernández
- Urology Department, Complejo Hospitalario Universitario de Canarias, Tenerife, Spain
| | - L Beltran-Martinez
- Urology Department, Unidad Medica de Alta Especialidad, Hospital de Especialidades "Dr. Bernardo Sepúlveda Gutiérrez", IMSS, Ciudad de México, México
| | - O Katz-Nestor
- Neuro-Urology Unit, Hospital de Agudos José M. Ramos Mejía, Buenos Aires, Argentina
| | - Emmanuel Braschi
- National Institute of Psychophysical Rehabilitation of the South (INAREPS), Mar del Plata, Argentina
| | - G Garrido
- Urology Division, Hospital de Clínicas Jose de San Martin, Universidad de Buenos Aires, Buenos Aires, Argentina
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Iijima N, Yamauchi J, Yagishita N, Araya N, Aratani S, Tanabe K, Sato T, Takata A, Yamano Y. Clinical course of neurogenic bladder dysfunction in human T-cell leukemia virus type-1-associated myelopathy/tropical spastic paraparesis: a nationwide registry study in Japan. Orphanet J Rare Dis 2021; 16:355. [PMID: 34372895 PMCID: PMC8351405 DOI: 10.1186/s13023-021-01990-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Accepted: 07/29/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Most patients with human T-cell leukemia virus type 1-associated myelopathy/tropical spastic paraparesis (HAM/TSP) develop neurogenic bladder dysfunction. However, longitudinal changes and treatment effects remain poorly understood. This study aimed to characterize the clinical course of urinary dysfunction in this population. METHODS This prospective observational study included 547 patients enrolled in HAM-net, a nationwide registry for HAM/TSP in Japan. Urinary dysfunction severity was evaluated using the HAM/TSP-bladder dysfunction symptom score (HAM-BDSS) and the HAM/TSP-bladder dysfunction severity grade (HAM-BDSG). These specific measures were recently developed for assessing urinary dysfunction in HAM/TSP. We analyzed longitudinal changes over a 6-year follow-up period, associations between urinary and gait dysfunction, and treatment efficacy of urinary catheterization and mirabegron (a β3-adrenergic agonist for overactive bladder symptoms). RESULTS The mean (standard deviation [SD]) age and disease duration at enrollment were 61.9 (10.7) years and 16.6 (11.6) years, respectively, and 74.6% of patients were women. Only 8.0% were free from urinary symptoms (HAM-BDSG 0), 65.4% had urinary symptoms or were on medication (HAM-BDSG I), and 23.2% and 3.3% used intermittent and indwelling catheters (HAM-BDSG II and III), respectively. HAM-BDSG and BDSS were worse in patients with greater gait dysfunction (p < 0.001 for both). During the 6-year follow-up, 66.7% of patients with HAM-BDSG 0 developed new urinary symptoms. Of those with HAM-BDSG I at enrollment, 10.8% started using urinary catheters. Importantly, HAM-BDSS significantly improved after initiating catheterization (mean [SD] change, - 8.93 [10.78], p < 0.001). The number of patients receiving mirabegron increased in the fourth year. Multivariable linear regression analysis significantly associated mirabegron with improvement in HAM-BDSS (- 5.82, 95% confidence interval - 9.13 to - 2.51, p = 0.001). CONCLUSIONS Urinary dysfunction affected 92% of patients and progressed over the 6-year follow-up. Urinary symptoms were more severe in patients with poorer gait function. Urinary catheterization and mirabegron were effective in relieving symptoms. Effective utilization of real-world data is key to establishing evidence for rare diseases, such as HAM/TSP.
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Affiliation(s)
- Naoki Iijima
- Division of Neurology, Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki, 2168511, Japan
| | - Junji Yamauchi
- Division of Neurology, Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki, 2168511, Japan.,Department of Rare Diseases Research, Institute of Medical Science, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Naoko Yagishita
- Department of Rare Diseases Research, Institute of Medical Science, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Natsumi Araya
- Department of Rare Diseases Research, Institute of Medical Science, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Satoko Aratani
- Department of Rare Diseases Research, Institute of Medical Science, St. Marianna University School of Medicine, Kawasaki, Japan.,LSI Medience Co., Tokyo, Japan
| | - Kenichiro Tanabe
- Department of Rare Diseases Research, Institute of Medical Science, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Tomoo Sato
- Division of Neurology, Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki, 2168511, Japan.,Department of Rare Diseases Research, Institute of Medical Science, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Ayako Takata
- Department of Preventive Medicine, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Yoshihisa Yamano
- Division of Neurology, Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki, 2168511, Japan. .,Department of Rare Diseases Research, Institute of Medical Science, St. Marianna University School of Medicine, Kawasaki, Japan.
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McNicholas DP, Floyd MS, Mann KR, Khadr RN, Young CA. Letter to the editor re: the effect of pelvic floor exercise program on incontinence and sexual dysfunction in multiple sclerosis patients Altunan et al., IJUN, (2021) 53:1059. Int Urol Nephrol 2021; 53:2297-2298. [PMID: 34292491 DOI: 10.1007/s11255-021-02958-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Accepted: 07/09/2021] [Indexed: 11/26/2022]
Affiliation(s)
- Daniel P McNicholas
- Department of Neurourology & North West Spinal Cord Injury Unit, Southport & Ormskirk Hospital NHS Trust, Town Lane, Liverpool, PR8 6PN, UK.
| | - Michael S Floyd
- Department of Neurourology & North West Spinal Cord Injury Unit, Southport & Ormskirk Hospital NHS Trust, Town Lane, Liverpool, PR8 6PN, UK
| | - Katie R Mann
- Clinical Specialist Physiotherapist, Department of Physiotherapy, Southport & Ormskirk Hospital NHS Trust, Town Lane, Southport, PR8 6PN, UK
| | - Rauf N Khadr
- Department of Neurourology & North West Spinal Cord Injury Unit, Southport & Ormskirk Hospital NHS Trust, Town Lane, Liverpool, PR8 6PN, UK
| | - Carolyn A Young
- Department of Neurology, Walton Centre NHS Foundation Trust, Lower Lane, Liverpool, UK
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Floyd MS, Khadr RN, Young CA. Letter to the editor re: Worsening disability status in multiple sclerosis predicts urologic complications. Int Urol Nephrol. May; 52(5):859–863. doi: 10.1007/s11255-020-02381-6. Epub 2020 Jan 25 by Abello et al. Int Urol Nephrol 2020; 52:2307-2308. [DOI: 10.1007/s11255-020-02551-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Accepted: 06/20/2020] [Indexed: 11/30/2022]
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Yamakawa N, Yagishita N, Matsuo T, Yamauchi J, Ueno T, Inoue E, Takata A, Nagasaka M, Araya N, Hasegawa D, Coler-Reilly A, Tsutsumi S, Sato T, Araujo A, Casseb J, Gotuzzo E, Jacobson S, Martin F, Puccioni-Sohler M, Taylor GP, Yamano Y. Creation and validation of a bladder dysfunction symptom score for HTLV-1-associated myelopathy/tropical spastic paraparesis. Orphanet J Rare Dis 2020; 15:175. [PMID: 32620176 PMCID: PMC7333329 DOI: 10.1186/s13023-020-01451-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Accepted: 06/23/2020] [Indexed: 12/19/2022] Open
Abstract
Background Urinary dysfunction is one of the main features of human T-cell leukemia virus type 1-associated myelopathy/tropical spastic paraparesis (HAM/TSP). However, a comprehensive assessment of the severity is difficult because a standardized assessment measure is unavailable. Therefore, this study aimed to develop a novel symptom score for the assessment of urinary dysfunction in HAM/TSP. We interviewed 449 patients with HAM/TSP using four internationally validated questionnaires for assessment of urinary symptoms (27 question items in total): the International Prostate Symptom Score; the International Consultation on Incontinence Questionnaire-Short Form; the Overactive Bladder Symptom Score; and the Nocturia Quality-of-Life questionnaire. We developed a symptom score based on the data of 322 patients who did not use urinary catheters by selecting question items from questionnaires focused on descriptive statistics, correlation analysis, and exploratory factor analysis. The score distribution, reliability, and validity of the developed score were evaluated. Results First, 16 questions related to quality of life, situations, or subjective assessment were omitted from the 27 questions. Exploratory factor analysis revealed that the remaining 11 questions pertained to three factors: frequent urination, urinary incontinence, and voiding symptoms. Three questions, which had similar questions with larger factor loading, were deleted. Finally, we selected eight question items for inclusion in the novel score. The score distribution exhibited no ceiling or floor effect. The Cronbach’s alpha (0.737) demonstrated reliable internal consistency. The new score comprised two subscales with acceptable factorial validity (inter-factor correlation coefficient, 0.322): storage symptoms (frequent urination plus urinary incontinence) and voiding symptoms. The correlation between each item and the subscales suggested acceptable construct validity. Conclusions We developed a novel score, the HAM/TSP-Bladder Dysfunction Symptom Score, and demonstrated its reliability and validity. The applicability of this score to patients using catheters should be examined in future research.
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Affiliation(s)
- Natsuko Yamakawa
- Department of Rare Diseases Research, Institute of Medical Science, St. Marianna University School of Medicine, Kawasaki, Japan.,Department of Neurology, Tokai Central Hospital, Kakamigahara, Japan
| | - Naoko Yagishita
- Department of Rare Diseases Research, Institute of Medical Science, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Tomohiro Matsuo
- Department of Urology, Nagasaki University Graduate School of Biochemical Sciences, Nagasaki, Japan
| | - Junji Yamauchi
- Department of Rare Diseases Research, Institute of Medical Science, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Takahiko Ueno
- Department of Medical Informatics, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Eisuke Inoue
- Department of Medical Informatics, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Ayako Takata
- Department of Preventive Medicine, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Misako Nagasaka
- Department of Oncology, Karmanos Cancer Institute/Wayne State University, Detroit, MI, USA.,Department of Advanced Medical Innovation, St. Marianna University Graduate School of Medicine, Kawasaki, Japan
| | - Natsumi Araya
- Department of Rare Diseases Research, Institute of Medical Science, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Daisuke Hasegawa
- Department of Rare Diseases Research, Institute of Medical Science, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Ariella Coler-Reilly
- Department of Rare Diseases Research, Institute of Medical Science, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Shuntaro Tsutsumi
- Department of Advanced Medical Innovation, St. Marianna University Graduate School of Medicine, Kawasaki, Japan
| | - Tomoo Sato
- Department of Rare Diseases Research, Institute of Medical Science, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Abelardo Araujo
- Laboratory for Clinical Research in Neuroinfections, Evandro Chagas National Institute of Infectious Diseases, FIOCRUZ, Rio de Janeiro, Brazil
| | - Jorge Casseb
- Institute of Tropical Medicine of Sau Paulo, Sao Paulo, SP, Brazil
| | - Eduardo Gotuzzo
- Instituto de Medicina Tropical "Alexander von Humbldt", Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Steven Jacobson
- Viral immunology Section, Neuroimmunology Branch, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, USA
| | - Fabiola Martin
- Faculty of Medicine, University of Queensland, 288 Herston Road, Herston, QLD, 4006, Australia
| | - Marzia Puccioni-Sohler
- Escola de Medicina e Cirurgia da Universidade Federal do Estado do Rio de Janeiro/ Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Graham P Taylor
- Section of Virology, Department of Medicine, Imperial College London, St Mary's Campus, Norfolk Place, London, W2 1PG, UK
| | - Yoshihisa Yamano
- Department of Rare Diseases Research, Institute of Medical Science, St. Marianna University School of Medicine, Kawasaki, Japan. .,Department of Advanced Medical Innovation, St. Marianna University Graduate School of Medicine, Kawasaki, Japan.
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