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Bakrim N, Chabannes É, Detree P, Balssa L, Wagner L, Kleinclauss F. [Sacral neuromodulation as treatment of non-neurological vesical emptying disorders]. Prog Urol 2021; 32:14-22. [PMID: 34332832 DOI: 10.1016/j.purol.2021.06.004] [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: 03/11/2021] [Revised: 06/05/2021] [Accepted: 06/14/2021] [Indexed: 10/20/2022]
Abstract
GOAL The goal was to evaluate the results of sacral neuromodulation (SNM) in non-neurological vesical emptying disorders. PATIENTS AND METHODS From February 2010 to October 2017, 28 patients presenting voiding symptoms or a non-obstructive chronic urine retention without neurological cause have been operated for an SNM (test phase). The test was positive in case of decreased number of proper intermittent self-catheterization (SC) or post-voiding residual urine (PVR) of at least 50 %. A 100 % positive result meant the return to a spontaneous voiding without SC with a non-significative PVR (<100ml). RESULTS The median follow-up was of 53.2±21.2 months. Twenty-four (85.7%) tests were positive, from which twenty-two (78.6%) were 100% positive. 16 (84.2%) out of 19 patients with SC had spontaneous voiding without PVR. The number of daily SC decreased from 4.6±1.5 to 0.4±1.2 in post-operative (P<0.001). The PVR was of 287.1±170.4ml vs. 30.4±48.6ml in post-operative (P<0.001). Fourteen patients (58.3%) underwent at least one chirurgical revision or a removal of material ; mainly for loss of efficiency, end of battery, electrode migration and pain on material. At the end of the follow-up, 70.8% of the responding patients had their device still efficient. CONCLUSION Results showed that SNM appears to be an efficient treatment of non-neurological emptying vesical troubles. Nevertheless, the re-operation rate was still significant. LEVEL OF EVIDENCE 3.
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Affiliation(s)
- N Bakrim
- Service d'urologie andrologie et transplantation rénale, CHRU Minjoz, Besançon, France; Université de Franche Comte, Besançon, France.
| | - É Chabannes
- Service d'urologie andrologie et transplantation rénale, CHRU Minjoz, Besançon, France
| | - P Detree
- Service d'urologie andrologie et transplantation rénale, CHRU Minjoz, Besançon, France
| | - L Balssa
- Service d'urologie andrologie et transplantation rénale, CHRU Minjoz, Besançon, France
| | - L Wagner
- Service d'urologie andrologie, CHU Caremeau, Nîmes, France
| | - F Kleinclauss
- Service d'urologie andrologie et transplantation rénale, CHRU Minjoz, Besançon, France; Université de Franche Comte, Besançon, France; Nanomedicine Lab, Imagery and Therapeutics", EA 4662, Besancon, France
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Abrar M, Stroman L, Malde S, Solomon E, Sahai A. Predictors of Poor Response and Adverse Events Following Botulinum Toxin-A for Refractory Idiopathic Overactive Bladder. Urology 2020; 135:32-37. [DOI: 10.1016/j.urology.2019.08.054] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2019] [Revised: 08/28/2019] [Accepted: 08/29/2019] [Indexed: 11/25/2022]
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Hysterectomy associated with de novo lower urinary tract symptoms in a Taiwanese population: a nationwide, population-based study. Int Urogynecol J 2018; 30:1711-1717. [DOI: 10.1007/s00192-018-3796-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2018] [Accepted: 10/15/2018] [Indexed: 12/18/2022]
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Tahseen S. Role of sacral neuromodulation in modern urogynaecology practice: a review of recent literature. Int Urogynecol J 2018; 29:1081-1091. [PMID: 29302716 DOI: 10.1007/s00192-017-3546-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2017] [Accepted: 12/12/2017] [Indexed: 12/01/2022]
Abstract
Sacral neuromodulation (SNM) offers promise in the therapy of many pelvic floor disorders. This innovative treatment has slowly gained popularity. A review of recent literature is presented in relation to its efficacy and complications in various pelvic floor conditions: overactive bladder and urge urinary incontinence, chronic urinary retention, painful bladder syndrome, pelvic pain and double incontinence. It is a minimally invasive, completely reversible safe procedure with good long-term outcomes. However, the treatment is costly, the revision rate is high and patients require life-long follow-up. SNM should always be considered in suitable patients before offering bladder augmentation procedures or urinary diversion or permanent catheterization for bladder dysfunction. SNM should also be considered in patients with double incontinence, after discussion in a urogynaecology/colorectal multidisciplinary team.
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Tseng LH, Lin YH, Chang SD, Ko YJ, Lloyd LK. Urethral overdilation for women with voiding dysfunction. Taiwan J Obstet Gynecol 2015; 54:54-7. [PMID: 25675920 DOI: 10.1016/j.tjog.2014.11.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/22/2013] [Indexed: 11/19/2022] Open
Affiliation(s)
- Ling-Hong Tseng
- Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital Lin-Kou Branch and University of Chang Gung School of Medicine, Taoyuan, Taiwan.
| | - Yi-Hao Lin
- Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital Lin-Kou Branch and University of Chang Gung School of Medicine, Taoyuan, Taiwan
| | - Shuenn-Dyh Chang
- Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital Lin-Kou Branch and University of Chang Gung School of Medicine, Taoyuan, Taiwan
| | - Yet-Jane Ko
- Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital Lin-Kou Branch and University of Chang Gung School of Medicine, Taoyuan, Taiwan
| | - L Keith Lloyd
- Division of Urology, University of Alabama School of Medicine, Birmingham, AL, USA
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A systematic review and meta-analysis comparing immediate and delayed catheter removal following uncomplicated hysterectomy. Int Urogynecol J 2014; 26:665-74. [DOI: 10.1007/s00192-014-2561-0] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2014] [Accepted: 10/18/2014] [Indexed: 12/11/2022]
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7
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Ahmed MR, Sayed Ahmed WA, Atwa KA, Metwally L. Timing of urinary catheter removal after uncomplicated total abdominal hysterectomy: a prospective randomized trial. Eur J Obstet Gynecol Reprod Biol 2014; 176:60-3. [DOI: 10.1016/j.ejogrb.2014.02.038] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2013] [Revised: 11/19/2013] [Accepted: 02/21/2014] [Indexed: 10/25/2022]
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Kessler TM, La Framboise D, Trelle S, Fowler CJ, Kiss G, Pannek J, Schurch B, Sievert KD, Engeler DS. Sacral Neuromodulation for Neurogenic Lower Urinary Tract Dysfunction: Systematic Review and Meta-analysis. Eur Urol 2010; 58:865-74. [PMID: 20934242 DOI: 10.1016/j.eururo.2010.09.024] [Citation(s) in RCA: 136] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2010] [Accepted: 09/06/2010] [Indexed: 12/17/2022]
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9
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Gamé X, Fowler CJ. [The primary disorder of sphincter relaxation or Fowler's syndrome]. Prog Urol 2010; 20:553-9. [PMID: 20832031 DOI: 10.1016/j.purol.2010.03.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2010] [Revised: 03/04/2010] [Accepted: 03/22/2010] [Indexed: 11/28/2022]
Abstract
The primary disorder of sphincter relaxation or Fowler's syndrome constitutes the first cause of urinary retention in young women after ruling neurological, iatrogenic and local origins out. It includes painless urinary retention, polycystic ovaries in more than 50% of the cases, high maximum urethral closure pressure, increase in sphincter volume and striated urethral sphincter electromyography abnormalities. So far, the only treatment restoring micturation in this condition is sacral neuromodulation.
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Affiliation(s)
- X Gamé
- Department of Uro-Neurology, UCL Institute of Neurology, The National Hospital for Neurology and Neurosurgery, Queen Square, London WC1N 3BG, Royaume-Uni.
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Podnar S. Neurophysiologic Testing in Neurogenic Bladder Dysfunction: Practical or Academic? CURRENT BLADDER DYSFUNCTION REPORTS 2010. [DOI: 10.1007/s11884-010-0048-5] [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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Podnar S. Neurophysiology of the neurogenic lower urinary tract disorders. Clin Neurophysiol 2007; 118:1423-37. [PMID: 17466586 DOI: 10.1016/j.clinph.2007.01.022] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2006] [Revised: 01/08/2007] [Accepted: 01/30/2007] [Indexed: 10/23/2022]
Abstract
The nervous system structures involved in the control of the lower urinary tract (LUT) are usually divided using a neuroanatomical classification system into suprapontine, pontine, spinal and sacral. In all patients with LUT symptoms, after exclusion of local causes, a nervous system disorder needs to be considered. For the diagnosis of neurogenic LUT disorders, in addition to clinical assessment, neurophysiologic testing might be useful. Imaging and other laboratory studies (e.g., cystometry) often provide relevant additional information. Neurophysiologic tests are more useful in patients with sacral compared with suprasacral disorders. Although in patients with LUT disorders external urethral sphincter (EUS) electromyography (EMG) would seem the most appropriate, anal sphincter EMG is the single most useful diagnostic test, particularly for focal sacral lesions, and atypical parkinsonism. Another clinically useful method that tests the sacral segments, and complements EMG, is the sacral (penilo/clitoro-cavernosus) reflex. Kinesiologic EMG is useful to demonstrate detrusor sphincter dyssynergia (i.e., increased EUS activity during bladder contraction), which is particularly common in spinal cord disease. Somatosensory evoked potential (SEP) and motor evoked potential (MEP) studies (cortical and lumbar) may be useful to diagnose clinically silent central lesions. MEP, in addition, seems to be very promising in research into cortical excitability. Theoretically, cortical SEP on bladder/urethra stimulation would be much more useful than pudendal SEP because it tests thin nerve afferents from the pelvic viscera. However, the utility of this technique is limited by technical difficulties, which can be partially overcome by the concomitant recording of a palmar sympathetic skin response (SSR). SSR recorded from the saddle region is also useful for testing the lumbosacral sympathetic system. Although the technique of detrusor EMG has been recently described in humans, a clinically useful test for evaluating the sacral parasympathetic system, which is crucial for LUT functioning, is still lacking.
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Affiliation(s)
- Simon Podnar
- Institute of Clinical Neurophysiology, Division of Neurology, University Medical Center Ljubljana, SI-1525 Ljubljana, Slovenia.
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Vidart A, Mozer P, Chartier-Kastler E, Ruffion A. Chapitre G - Les conséquences neuro-urologiques de la chirurgie gynécologique (endométriose, hystérectomie simple, colpo-hystérectomie élargie), de la chirurgie colo-rectale et de la radiothérapie pelvienne. Prog Urol 2007; 17:381-4. [PMID: 17622063 DOI: 10.1016/s1166-7087(07)92334-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Apart from damage to bladder innervation, a number of local diseases and treatments such as radiotherapy can induce lower urinary tract functional disorders. Some of these disorders can be treated according to the principles used in the management of neurogenic bladder The purpose of this review is to report the functional consequences of pelvic endometriosis, radiotherapy, colorectal surgery and urinary incontinence surgery with particular emphasis on situations in which a neurogenic mechanism is suspected.
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Affiliation(s)
- A Vidart
- Service d'urologie, GH Pitié Salpétrière, Paris VI, France.
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Brookoff D, Bennett DS. Neuromodulation in Intractable Interstitial Cystitis and Related Pelvic Pain Syndromes. PAIN MEDICINE 2006. [DOI: 10.1111/j.1526-4637.2006.00132.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Gehrich AP, Aseff JN, Iglesia CB, Fischer JR, Buller JL. Chronic urinary retention and pelvic floor hypertonicity after surgery for endometriosis: a case series. Am J Obstet Gynecol 2005; 193:2133-7. [PMID: 16325629 DOI: 10.1016/j.ajog.2005.07.013] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2005] [Revised: 06/14/2005] [Accepted: 07/05/2005] [Indexed: 11/21/2022]
Abstract
OBJECTIVE The purpose of this study was to evaluate 4 cases of chronic urinary retention and pelvic floor muscle spasms after surgery for endometriosis. STUDY DESIGN These patients underwent a complete history, physical exam, and diagnostic work- up. The results were analyzed with regards to type and extent of inciting surgery, diagnostic findings, postoperative recovery, and treatment success. RESULTS The patients' mean age was 39.5 years and all had undergone various surgical interventions for endometriosis. In addition to urinary retention, all developed debilitating pelvic floor muscle spasm postoperatively. Physical exam revealed pelvic floor hypertonicity and urodynamics indicated hypoactive detrusor contractility. Neurodiagnostic testing gave evidence of neuropathy in all subjects. CONCLUSION Extensive endometriosis surgery may pose a risk for postoperative bladder dysfunction and pelvic floor muscle spasm.
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Affiliation(s)
- Alan P Gehrich
- Washington Continence Center/Institute for Pelvic Floor Disorders, Washington Hospital Center, Washington, DC, USA.
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