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Kurze I, Böthig R, van Ophoven A. [Invasive neurostimulation in neuro-urology: state of the art]. Aktuelle Urol 2024. [PMID: 38631373 DOI: 10.1055/a-2261-4792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/19/2024]
Abstract
Modulation or stimulation of the nerves supplying the lower urinary tract is a possible treatment option for dysfunction of the lower urinary tract, pelvic floor and rectum if conservative or minimally invasive treatment approaches fail. This overview shows the possibilities and limitations of sacral neuromodulation, sacral deafferentation with sacral anterior root stimulation and conus deafferentation.Sacral neuromodulation (SNM) is a procedure for the treatment of refractory pelvic floor dysfunction of various origins (idiopathic, neurogenic or post-operative), such as overactive bladder, non-obstructive retention and faecal incontinence. A particular advantage of SNM is the possibility of prior test stimulation with a high prognostic value. The procedure is minimally invasive, reversible and associated with relatively low morbidity rates.Following the introduction of MRI-compatible SNM systems, there has been renewed interest in the treatment of neurogenic bladder dysfunction. A recent meta-analysis reports similar success rates as in the idiopathic patient population.Sacral deafferentation with implantation of a sacral anterior root stimulator (SARS/SDAF) is an excellent therapeutic option for patients with spinal cord injury, which can significantly improve the quality of life of those affected and, in addition to treating neurogenic lower urinary tract dysfunction, can also have a positive effect on neurogenic bowel dysfunction, neurogenic sexual dysfunction or autonomic dysreflexia. If conservative or minimally invasive treatment fails, it is crucial for the success of this procedure to consider SDAF/SARS at an early stage in order to avoid irreversible organic damage.Conus deafferentation (KDAF) is a less invasive surgical treatment option for patients with spinal cord injury for whom sacral deafferentation would be indicated but who would not benefit from the simultaneous implantation of a sacral anterior root stimulator. In principle, these patients also have the option of being subsequently treated with an extradural implant and thus utilising the advantages of anterior root stimulation. Indications for KDAF are autonomic dysreflexia, therapy-refractory detrusor overactivity, recurrent urinary tract infections, urinary incontinence and spasticity triggered by detrusor overactivity. With KDAF, we have a safe and efficient procedure with great potential for improving the spectrum of paraplegiological and neuro-urological treatment.
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Affiliation(s)
- Ines Kurze
- Querschnittgelähmten-Zentrum/Klinik für Paraplegiologie und Neuro-Urologie, Zentralklinik Bad Berka Gmbh, Bad Berka, Germany
| | - Ralf Böthig
- Abteilung für Neuro-Urologie, BG-Klinikum, Hamburg, Germany
| | - Arndt van Ophoven
- Neuro-Urology, Marien Hospital Herne Academic Teaching Hospital of the University Bochum, Herne, Germany
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Solinsky R, Garstang SV, Linsenmeyer TA. Comparing the role of renal ultrasound vs MAG3 renal scans for evaluation of neurogenic bladder after spinal cord injury. J Spinal Cord Med 2023; 46:825-829. [PMID: 35787244 PMCID: PMC10446777 DOI: 10.1080/10790268.2022.2088504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
Abstract
OBJECTIVE Compare ability of renal ultrasound and Tc-99m mercaptoacetyltriglycine (MAG3) renal scan to identify upper urinary tract stasis. DESIGN Retrospective chart review. SETTING Outpatient Neuro-urology clinic serving a large SCI population. PARTICIPANTS One hundred and sixty-five individuals with spinal cord injury, presenting for annual evaluation. INTERVENTIONS Renal ultrasound, MAG3 renal scan. OUTCOME MEASURES Radiologic evidence of upper urinary tract stasis as reviewed by independent radiologist. For renal ultrasounds, this included: mild hydronephrosis, dilation of collecting systems, pelviectasis, or caliectasis. For MAG3 renal scans, this included evidence of slow drainage of radioisotope, dilation of collecting systems, or reverse peristalsis. RESULTS Forty-five individuals with spinal cord injury demonstrated upper tract stasis, with 12 identified by renal ultrasound and 43 identified by MAG3 renal scan. There was a strong relative correlation between test results (Yule's Q = 0.90), though MAG3 renal scan identified a significantly higher rate of upper tract stasis within the same patients (P < 0.0001). The odds ratio of improved identification using MAG3 renal scan was 16.5 (95% CI 3.96-68.76). CONCLUSIONS While renal ultrasound is more effective at evaluating renal anatomy, MAG3 renal scan identifies significantly more upper urinary tract stasis than renal ultrasound and should be considered for SCI individuals with risk factors of upper tract injury.
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Affiliation(s)
- Ryan Solinsky
- Spaulding Rehabilitation Hospital, Boston, Massachusetts, USA
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, Massachusetts, USA
- Spaulding Research Institute, Boston, Massachusetts, USA
| | - Susan V. Garstang
- Division of Physical Medicine and Rehabilitation, University of Utah School of Medicine, Salt Lake City, Utah, USA
- Veterans Affairs Salt Lake City Healthcare System, Salt Lake City, Utah, USA
| | - Todd A. Linsenmeyer
- Kessler Institute for Rehabilitation, West Orange, New Jersey, USA
- Department of Physical Medicine and Rehabilitation, Rutgers New Jersey Medical School, Newark, New Jersey, USA
- Department of Surgery, Division of Urology, Rutgers New Jersey Medical School, Newark, New Jersey, USA
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Perrin A, Corcos J. The Utility of Urodynamic Studies in Neuro-Urological Patients. Biomedicines 2023; 11:biomedicines11041134. [PMID: 37189752 DOI: 10.3390/biomedicines11041134] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Revised: 04/01/2023] [Accepted: 04/03/2023] [Indexed: 05/17/2023] Open
Abstract
INTRODUCTION The utility of a clinical tool lies in its clinical performance evaluation and describes the relevance and usefulness of that tool in a medical setting. The utility of urodynamic and video-urodynamic studies in the management of specific urodynamic profiles in the diagnosis, treatment, and prognostic approach in neuro-urological patients is the focus of the current review. METHODS For this narrative review, a PubMed® search was performed by cross-referencing the keywords "urodynamics", "neurogenic bladder", "utility", "clinical utility" and "clinical performance" with various terms related to the management of neurogenic lower urinary tract dysfunction. Clinical practice guidelines and landmark reviews from the most renowned experts in the field were also used. ANALYSIS Assessment of the utility of urodynamic study was performed during the diagnostic, therapeutic and prognostic steps of the neuro-urological patients' management. We focused on its clinical performance in the identification and evaluation of several unfavorable events, such as neurogenic detrusor overactivity, detrusor-sphincter dyssynergia, elevated detrusor leak point pressure and the presence of vesico-ureteral reflux, which may be indicators for a higher risk for the development of urological comorbidities. CONCLUSION Despite the paucity of existing literature assessing the utility of urodynamic study-specifically video-urodynamic study-in neuro-urological patients, it does remain the gold standard to assess lower urinary tract function precisely in this patient category. With regard to its utility, it is associated with high clinical performance at every step of management. The feedback on possible unfavorable events allows for prognostic assessment and may lead us to question current recommendations.
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Affiliation(s)
- Andry Perrin
- Department of Urology, Jewish General Hospital, McGill University, Montreal, QC H3T 1E2, Canada
| | - Jacques Corcos
- Department of Urology, Jewish General Hospital, McGill University, Montreal, QC H3T 1E2, Canada
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Swatesutipun V, Tangpaitoon T. The safety cutoff storage pressure for preventing upper urinary tract damage in neurogenic bladder from spinal cord pathology and risk factor analysis. Neurourol Urodyn 2022; 41:991-1001. [PMID: 35320589 DOI: 10.1002/nau.24911] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Revised: 02/25/2022] [Accepted: 02/27/2022] [Indexed: 11/12/2022]
Abstract
INTRODUCTION Low-compliance bladder or high bladder pressure undoubtedly leads to hydronephrosis and renal impairment. As four decades have elapsed since a previous study found a detrusor leak-point pressure (DLPP) >40 cm H2 O to result in hydronephrosis, we suspected the possibility of hydronephrosis or vesicoureteral reflux occurring at any point below the 40 cm H2 O DLPP reference. Therefore, this study aimed to determine the storage detrusor pressure value and risk factors related to upper urinary tract damage (UUTD). MATERIALS AND METHODS This study retrospectively reviewed the hospital records of 110 patients who visited the Neurogenic Bladder TU Service of Excellence Unit, Thammasat University Hospital, Pathum Thani, Thailand, and were diagnosed with neurogenic bladder between 2016 and 2020. The inclusion criteria were as follows: patients who were diagnosed with neurogenic bladder from spinal cord problems (spinal dysraphism, spinal cord disease [tumor, degenerative, arteriovenous malformation, etc.], or traumatic spinal cord injury) and underwent a complete examination, including urodynamic study and renal ultrasound. The exclusion criteria were as follows: patients who had previous pelvic irradiation, other concomitant neurological disease (stroke, Parkinson's disease, etc.), or other urological diseases (stone, tumor, etc.), and those who had an indwelling suprapubic or urethral catheter. We identified the cutoff point for storage pressure related to UUTD using receiver operating characteristic (ROC) curve analysis to identify the value that produced maximum sensitivity and specificity. To identify risk factors for developing UUTD, we included seven risk factors: intravesical pressure, poor compliance, detrusor overactivity (DO), detrusor sphincter dyssynergia (DSD), level of the spinal cord pathology, male sex, and spontaneous voiding in univariable and multivariable regression analyses. RESULTS Of the 110 patients who met the inclusion criteria, 22 were excluded from the study. Fifty-nine patients had a normal upper urinary tract, and 29 had UUTD. The mean age, sex, voiding pattern, type of spinal cord pathology, and level of spinal cord lesions were not different between the two groups. After performing ROC curve analysis, a cutoff value for daily storage pressure ≥15 cm H2 O provided 79.31% sensitivity and 67.80% specificity (area under the ROC curve: 0.73) for UUTD development. From univariable analysis, low compliance (cutoff values at <12.5 and <20 ml/cm H2 O) and a storage pressure ≥15 cm H2 O was related to UUTD with statistical significance (risk ratio [RR]: 3.16, 2.3, and 3.6, respectively [p < 0.05]). After performing multivariable analysis, a storage pressure ≥15 cm H2 O and both cutoff values for low compliance were related to UUTD with statistical significance (RR: 3.9, 2.4, and 3.2, respectively [p < 0.05]). However, other factors, including male sex, spontaneous voiding, suprasacral lesion, DSD, and DO, were not related to UUTD. CONCLUSION Our results demonstrated that low compliance and a storage pressure ≥15 cm H2 O were significantly associated with UUTD. Various bladder-management strategies have been developed to prevent UUTDs. However, the main concept continues to be the maintenance of a low storage pressure.
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Affiliation(s)
- Valeerat Swatesutipun
- Department of Surgery, Division of Urology, Thammasat University Hospital, Pathum Thani, Thailand
| | - Teerayut Tangpaitoon
- Department of Surgery, Division of Urology, Thammasat University Hospital, Pathum Thani, Thailand
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Farrelly E, Lindbo L, Seiger Å. The Stockholm Spinal Cord Uro Study: 3. Urodynamic characteristics in a regional prevalence group of persons with spinal cord injury and indications for improved follow-up. Scand J Urol 2021; 55:412-418. [PMID: 34279177 DOI: 10.1080/21681805.2021.1954994] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
AIMS Examine the outcome of urodynamic studies in a regional prevalence group of patients with traumatic spinal cord injury (SCI), explore relationships between urodynamic parameters and renal complications/other SCI-related dysfunctions, assess the role of urodynamics in SCI follow-up. METHODS In a cross-sectional study, 211 patients were included, who attended a yearly check-up and had urodynamics performed as part of the follow-up in addition to S-creatinine, S-cystatin-C, renal ultrasound, and a questionnaire regarding complications. Relationships between urodynamic parameters and renal complications/other SCI-related dysfunctions were explored by descriptive and comparative statistics. RESULTS Neurogenic detrusor overactivity (NDO) was found in 150, underactive/acontractile detrusor in 44, normal detrusor function in 17 patients. Maximum detrusor pressures during filling/voiding in NDO attained mean levels of >40 cm H2O in 68% of patients and >25 cm H2O in 83%. Reduced compliance of the bladder wall, cystometric bladder capacity <250 mL, and detrusor overactivity leakage during filling were associated with higher detrusor pressures. Detrusor overactivity during more than one-third of the filling phase was significantly related to signs of renal complications among patients with SCI duration 11-20 years. No significant relationships were found between other urodynamic parameters and renal/other SCI-related complications. Renal complications in underactive/acontractile and normal detrusor function co-varied with evidence of previous NDO and other co-morbidities which may negatively influence kidney function. CONCLUSIONS Maximum detrusor pressures during the filling/voiding phases attained high levels in a majority of patients. Detrusor overactivity during more than one-third of the filling phase was significantly related to signs of renal complications.
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Affiliation(s)
- Elisabeth Farrelly
- Division of Clinical Geriatrics, Department NVS, Karolinska Institute, Solna, Sweden.,Department of Surgical and Perioperative Sciences, Urology and Andrology, Umeå University Hospital, Umeå, Sweden
| | | | - Åke Seiger
- Division of Clinical Geriatrics, Department NVS, Karolinska Institute, Solna, Sweden.,Aleris Rehab Station, Stockholm, Sweden
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Önal B, Kırlı EA, Selçuk B, Buğdaycı D, Can G, Çetinel B. Risk factors predicting upper urinary tract deterioration in children with spinal cord injury. Neurourol Urodyn 2020; 40:435-442. [PMID: 33205858 DOI: 10.1002/nau.24580] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Revised: 11/04/2020] [Accepted: 11/04/2020] [Indexed: 11/08/2022]
Abstract
AIM The aim of this study is to determine the risk factors predicting upper urinary tract (UUT) deterioration in children with spinal cord injury (SCI). METHODS The medical records of 108 children with SCI who were referred to our unit between 1996 and 2018 were retrospectively reviewed. The data included general patient demographics, SCI characteristics, bladder management methods, presence of urinary tract infection, radiological evaluation of the UUT and lower urinary tract (LUT), and videourodynamic findings. The receiver operating characteristic (ROC) curve analysis was performed to determine the cutoff values of the maximum detrusor pressure during filling and the bladder volume ratio (BVR) for predicting UUT deterioration. Multivariate analyses were used to determine the risk factors predicting UUT deterioration. RESULTS Complete data were available for 76 children. The median patient age was 15 years (2-17). The leading causes of SCI were motor vehicle accidents (44%) and fall (33%). UUT deterioration was identified in 33 patients (43%). Iatrogenic SCI etiology, abnormal radiological LUT findings, and detrusor pressures greater than 70 cmH2 O were found to be independent risk factors for UUT deterioration using regression analysis. In addition, ROC analysis revealed that a BVR less than 0.7 was the cutoff value for UUT deterioration in children with SCI. CONCLUSION Abnormal radiological LUT findings, iatrogenic SCI etiology, detrusor pressure greater than 70 cmH2 O, and a BVR less than 0.7 were independent risk factors for UUT deterioration in children with SCI.
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Affiliation(s)
- Bülent Önal
- Department of Urology, Cerrahpasa School of Medicine, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Elif A Kırlı
- Department of Urology, Cerrahpasa School of Medicine, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Berin Selçuk
- Department of Urology, Cerrahpasa School of Medicine, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Derya Buğdaycı
- Department of Physical Medicine and Rehabilitation, Istanbul Physical Medicine and Rehabilitation Training and Research Hospital, Istanbul, Turkey
| | - Günay Can
- Department of Public Health, Cerrahpasa School of Medicine, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Bülent Çetinel
- Department of Urology, Cerrahpasa School of Medicine, Istanbul University-Cerrahpasa, Istanbul, Turkey
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Autonomic Dysreflexia After Spinal Cord Injury: Beyond the Basics. CURRENT PHYSICAL MEDICINE AND REHABILITATION REPORTS 2020. [DOI: 10.1007/s40141-020-00300-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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8
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Finazzi Agrò E, Bianchi D, Iacovelli V. Pitfalls in Urodynamics. Eur Urol Focus 2020; 6:820-822. [PMID: 31982363 DOI: 10.1016/j.euf.2020.01.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2019] [Revised: 12/22/2019] [Accepted: 01/16/2020] [Indexed: 11/16/2022]
Abstract
Although urodynamics (UDS) is essential for the diagnosis and treatment of neurogenic lower urinary tract dysfunction, several possible pitfalls can be identified. In this paper we identify pitfalls in UDS and highlight limiting factors. UDS pitfalls that depend on the patient, on the physician, or on the test itself are described and analyzed. PATIENT SUMMARY: In this report we looked into pitfalls of urodynamics. Urodynamics is an essential tool in the diagnosis and treatment of neurogenic lower urinary tract dysfunction and always requires standardization and quality control to limit possible pitfalls.
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Affiliation(s)
- Enrico Finazzi Agrò
- Department of Experimental Medicine and Surgery, Tor Vergata University, Rome, Italy
| | | | - Valerio Iacovelli
- Department of Experimental Medicine and Surgery, Tor Vergata University, Rome, Italy; Ospedale San Carlo di Nancy, Rome, Italy
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Braga A, Serati M, Illiano E, Manassero F, Milanesi M, Natale F, Torella M, Pistolesi D, De Nunzio C, Soligo M, Finazzi Agrò E. When should we use urodynamic testing? Recommendations of the Italian Society of Urodynamics (SIUD). Part 2 - Male and neurogical population. MINERVA UROL NEFROL 2019; 72:187-199. [PMID: 31166102 DOI: 10.23736/s0393-2249.19.03447-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Recent studies in literature, have raised some doubts on the routine use of urodynamic testing. Many physicians and articles recommend a selective use of this tool, considering carefully risks and benefits. These recommendations are intended to guide clinicians in the right selection of the male and neurological patients to submit to a urodynamic evaluation. This is the second part of a previous article regarding the urodynamic recommendations in the female population. We reviewed the literature, regarding the use of UDS in male and neurological population with lower urinary tract symptoms (LUTS). Specifically, we analyzed and compared the guidelines and recommendations of the most important urology and urogynecology international scientific societies. These publications were used to create the evidence basis for characterizing the recommendations to perform urodynamic testing. A panel of 10 experts was composed and Delphi process was followed to obtain the panelist consensus. The final recommendations were approved by the unanimous consensus of the panel and compared with the best practice recommendations available in the literature. The recommendations are provided for diagnosis and management of common LUTS in male and neurological population. This review provides a summary of the most effective utilization of urodynamic studies for the global evaluation of patients with LUTS, and how to use them when really needed, avoiding unnecessary costs and patient inconveniences.
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Affiliation(s)
- Andrea Braga
- Department of Obstetrics and Gynecology, EOC - Beata Vergine Hospital, Mendrisio, Switzerland -
| | - Maurizio Serati
- Department of Obstetrics and Gynecology, Del Ponte Hospital, University of Insubria, Varese, Italy
| | - Ester Illiano
- Division of Urology and Andrology Clinic, Department of Surgical and Biomedical Sciences, University of Perugia, Perugia, Italy
| | - Francesca Manassero
- Division of Urology, Department of Translational Research and New Technologies, University of Pisa, Pisa, Italy
| | - Martina Milanesi
- Department of Urology, AOU Careggi Hospital, University of Florence, Florence, Italy
| | - Franca Natale
- Department of Urogynecology, San Carlo of Nancy Hospital, Rome, Italy
| | - Marco Torella
- Department of Woman, Child and General and Specialized Surgery, Second University of Naples, Naples, Italy
| | - Donatella Pistolesi
- Division of Urology, Department of Translational Research and New Technologies, University of Pisa, Pisa, Italy
| | - Cosimo De Nunzio
- Department of Urology, Sant'Andrea Hospital, Sapienza University, Rome, Italy
| | - Marco Soligo
- Department of Women, Mothers and Neonates, Buzzi Children's Hospital, ASST Fatebenefratelli Sacco, University of Milan, Milan, Italy
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10
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Musco S, Padilla-Fernández B, Del Popolo G, Bonifazi M, Blok BFM, Groen J, 't Hoen L, Pannek J, Bonzon J, Kessler TM, Schneider MP, Gross T, Karsenty G, Phé V, Hamid R, Ecclestone H, Castro-Diaz D. Value of urodynamic findings in predicting upper urinary tract damage in neuro-urological patients: A systematic review. Neurourol Urodyn 2018; 37:1522-1540. [PMID: 29392753 DOI: 10.1002/nau.23501] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2017] [Accepted: 12/01/2017] [Indexed: 11/07/2022]
Abstract
AIM The main goals of neurogenic lower urinary tract dysfunction (NLUTD) management are preventing upper urinary tract damage (UUTD), improving continence, and quality of life. Here, we aimed to systematically assess all available evidence on urodynamics predicting UUTD in patients with NLUTD. METHODS A systematic review according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) Statement was performed in March 2017. Only neuro-urological patients assessed by urodynamics were included. Any outcome of upper urinary tract function were evaluated. RESULTS Forty-nine studies (1 randomized controlled trial, 9 prospective, and 39 retrospective case series) reported urodynamic data on 4930 neuro-urological patients. Of those, 2828 (98%) were spina bifida (SB) children. The total number of adults was 2044, mainly having spinal cord injury (SCI) (60%). A low bladder compliance was found in 568 (46.3%) and 341 (29.3%) of the paediatric and adult population, respectively. Hydronephrosis (HDN) was detected in 557 children (27.8%) in 19/28 studies and 178 adults (14.6%), mainly SCI, in 14/21 studies. Nine out of 30 multiple sclerosis (MS) patients affected by HDN (16.8%) showed low compliance in 4/14 studies. CONCLUSIONS Patients with SB and SCI have a higher risk of developing UUTD (mainly reported as HDN) compared to those with MS. Reduced compliance and high DLPP were major risk factors for UUTD. Although our findings clarify the mandatory role of urodynamics in the management of NLUTD, standardization and better implementation of assessments in daily practice may further improve outcomes of neuro-urological patients based on objective measurements, that is, urodynamics.
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Affiliation(s)
- Stefania Musco
- Department of Neuro-Urology, Careggi University Hospital, Florence, Italy
| | - Barbara Padilla-Fernández
- Department of Urology, Hospital Universitario de Canarias, Universidad de La Laguna, Santa Cruz de Tenerife, Spain
| | - Giulio Del Popolo
- Department of Neuro-Urology, Careggi University Hospital, Florence, Italy
| | - Matteo Bonifazi
- Department of Neuro-Urology, Careggi University Hospital, Florence, Italy
| | - Bertil F M Blok
- Department of Urology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Jan Groen
- Department of Urology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Lisette 't Hoen
- Department of Urology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Jürgen Pannek
- Neuro-Urology, Swiss Paraplegic Center, Nottwil, Switzerland
| | - Jerome Bonzon
- Neuro-Urology, Swiss Paraplegic Center, Nottwil, Switzerland
| | - Thomas M Kessler
- Neuro-Urology, Spinal Cord Injury Center & Research, University of Zürich, Balgrist University Hospital, Zürich, Switzerland
| | - Marc P Schneider
- Neuro-Urology, Spinal Cord Injury Center & Research, University of Zürich, Balgrist University Hospital, Zürich, Switzerland
| | - Tobias Gross
- Department of Urology, University of Bern, Inselspital, Bern, Switzerland
| | - Gilles Karsenty
- Department of Urology, Aix Marseille University, Marseille, France
| | - Véronique Phé
- Department of Urology, Pitié-Salpêtrière Academic Hospital, Paris 6 University, Paris Cedex 13, France
| | - Rizwan Hamid
- Department of Neuro-Urology, London Spinal Injuries Centre, Stanmore, UK
| | - Hazel Ecclestone
- Department of Neuro-Urology, London Spinal Injuries Centre, Stanmore, UK
| | - David Castro-Diaz
- Department of Urology, Hospital Universitario de Canarias, Universidad de La Laguna, Santa Cruz de Tenerife, Spain
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Schurch B, Iacovelli V, Averbeck MA, Carda S, Altaweel W, Finazzi Agrò E. Urodynamics in patients with spinal cord injury: A clinical review and best practice paper by a working group of The International Continence Society Urodynamics Committee. Neurourol Urodyn 2017; 37:581-591. [DOI: 10.1002/nau.23369] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2017] [Accepted: 06/30/2017] [Indexed: 11/11/2022]
Affiliation(s)
- Brigitte Schurch
- Department of Clinical Neurosciences; Neuropsychology and Neurorehabilitation Service; Vaudois University Hospital of Lausanne; Lausanne Switzerland
| | - Valerio Iacovelli
- Department of Experimental Medicine and Surgery; Unit of Functional Urology; Tor Vergata University Hospital; University of Rome Tor Vergata; Rome Italy
| | | | - Stefano Carda
- Department of Clinical Neurosciences; Neuropsychology and Neurorehabilitation Service; Vaudois University Hospital of Lausanne; Lausanne Switzerland
| | - Waleed Altaweel
- King Faisal Specialist Hospital and Research Centre; Alfaisal University; Riyadh Saudi Arabia
| | - Enrico Finazzi Agrò
- Department of Experimental Medicine and Surgery; Unit of Functional Urology; Tor Vergata University Hospital; University of Rome Tor Vergata; Rome Italy
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12
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Elmelund M, Klarskov N, Bagi P, Oturai PS, Biering-Sørensen F. Renal deterioration after spinal cord injury is associated with length of detrusor contractions during cystometry-A study with a median of 41 years follow-up. Neurourol Urodyn 2016; 36:1607-1615. [PMID: 27813141 DOI: 10.1002/nau.23163] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2016] [Accepted: 09/22/2016] [Indexed: 11/08/2022]
Abstract
AIMS To investigate which urodynamic parameters are associated with renal deterioration over a median of 41 years follow-up after traumatic spinal cord injury. METHODS Medical records of patients with a traumatic spinal cord injury sustained 1944-1975 were reviewed from time of injury until 2012. Patients who attended regular renography and/or renal clearance examinations and had minimum one cystometry and pressure-flow study were included. Renal deterioration was diagnosed as split renal function ≤30% in one kidney or relative glomerular filtration rate ≤51% of expected according to age and gender. Detrusor function, presence of detrusor sphincter dyssynergia, maximum detrusor pressure, post-void residual volume, and cystometric bladder capacity were obtained. In patients with detrusor overactivity, a detrusor overactivity/cystometry ratio was calculated using duration of detrusor contraction(s) during filling cystometry divided by total duration of filling cystometry. RESULTS A total of 73 patients were included in the study, and the median follow-up time was 41 years after injury (range 24-56). Sixty-four patients (88%) used reflex triggering or bladder expression as bladder emptying method for the longest period after injury. During follow-up 60% changed to clean intermittent catheterization. The majority of the patients (68%) had neurogenic detrusor overactivity. In 35 patients, a detrusor-overactivity/cystometry ratio could be calculated and a detrusor overactivity/cystometry ratio > 0.33 was significantly associated with renal deterioration (P < 0.02). No significant association was found between maximum detrusor pressure or other urodynamic parameters and renal deterioration. CONCLUSIONS Duration of detrusor overactivity longer than one third of the duration of cystometry is associated with renal deterioration after spinal cord injury.
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Affiliation(s)
- Marlene Elmelund
- Clinic for Spinal Cord Injuries, Rigshospitalet, University of Copenhagen, Hornbaek, Denmark.,Department of Obstetrics and Gynecology, Herlev Hospital, University of Copenhagen, Herlev, Denmark
| | - Niels Klarskov
- Department of Obstetrics and Gynecology, Herlev Hospital, University of Copenhagen, Herlev, Denmark
| | - Per Bagi
- Department of Urology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Peter S Oturai
- Department of Clinical Physiology, Nuclear Medicine and PET, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Fin Biering-Sørensen
- Clinic for Spinal Cord Injuries, Rigshospitalet, University of Copenhagen, Hornbaek, Denmark
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Çetinel B, Önal B, Can G, Talat Z, Erhan B, Gündüz B. Risk factors predicting upper urinary tract deterioration in patients with spinal cord injury: A retrospective study. Neurourol Urodyn 2016; 36:653-658. [PMID: 26934371 DOI: 10.1002/nau.22984] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2015] [Accepted: 02/05/2016] [Indexed: 11/10/2022]
Abstract
AIMS To determine the risk factors predicting upper urinary tract (UUT) deterioration in patients with spinal cord injury (SCI). METHODS Medical records of 303 SCI patients who referred to the urodynamic unit of a rehabilitation hospital between 1996 and 2003 were retrospectively reviewed. The data included general patient demographics, SCI characteristics, bladder management methods, serum creatinine level, presence of urinary tract infection, indwelling catheter time, radiological findings of upper and lower urinary tract, and video-urodynamic (VUD) findings. Univariate and multivariate analyses were used to determine the risk factors predicting UUT deterioration. ROC analysis was done to determine the cut-off values of detrusor pressure and cystometric bladder capacity volume predicting UUT deterioration. RESULTS Complete data were available on 255 patients. Median patient age was 33 years (18-75). The leading causes of SCI were motor vehicle accidents (40%) and falls (29%). Upper urinary tract deterioration was determined in 63 patients (25%). Abnormal radiological LUT findings, the absence of antimuscarinic drug usage in the history, detrusor pressures greater than 75 cmH2 O and cystometric bladder capacity less than 200 ml were found to be independent risk factors in logistic regression analysis. ROC analysis revealed that values ≥75 cmH2 O for maximum detrusor pressure, <200 ml for bladder capacity, and >6 months for indwelling catheter time were cutoff values for UUT deterioration. CONCLUSION Abnormal radiological LUT findings, the absence of antimuscarinic drug usage, detrusor pressures ≥75 cmH2 O, and cystometric bladder capacity <200 ml were independent risk factors predicting UUT deterioration SCI patients. Neurourol. Urodynam. 36:653-658, 2017. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Bülent Çetinel
- Department of Urology, Cerrahpasa School of Medicine, Istanbul University, Istanbul, Turkey
| | - Bülent Önal
- Department of Urology, Cerrahpasa School of Medicine, Istanbul University, Istanbul, Turkey
| | - Günay Can
- Department of Public Health, Cerrahpasa School of Medicine, Istanbul University, Istanbul, Turkey
| | - Zübeyr Talat
- Department of Urology, Cerrahpasa School of Medicine, Istanbul University, Istanbul, Turkey
| | - Belgin Erhan
- Sirinevler 70nci Yıl Physical Therapy and Rehabilitation Hospital, Istanbul, Turkey
| | - Berrin Gündüz
- Sirinevler 70nci Yıl Physical Therapy and Rehabilitation Hospital, Istanbul, Turkey
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Tarcan T, Demirkesen O, Plata M, Castro-Diaz D. ICS teaching module: Detrusor leak point pressures in patients with relevant neurological abnormalities. Neurourol Urodyn 2015; 36:259-262. [DOI: 10.1002/nau.22947] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2015] [Accepted: 11/25/2015] [Indexed: 11/06/2022]
Affiliation(s)
- Tufan Tarcan
- Department of Urology; Marmara University School of Medicine; Istanbul Turkey
| | - Oktay Demirkesen
- Department of Urology; Istanbul University Cerrahpaşa Medical Faculty; Istanbul Turkey
| | - Mauricio Plata
- Department of Urology; Hospital Universitario de la Fundación Santa Fé de Bogotá/Universidad de los Andes; Bogotá Colombia
| | - David Castro-Diaz
- University Hospital of the Canary Islands; University of La Laguna; Santa Cruz de Tenerife Spain
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Groen J, Pannek J, Castro Diaz D, Del Popolo G, Gross T, Hamid R, Karsenty G, Kessler TM, Schneider M, 't Hoen L, Blok B. Summary of European Association of Urology (EAU) Guidelines on Neuro-Urology. Eur Urol 2015; 69:324-33. [PMID: 26304502 DOI: 10.1016/j.eururo.2015.07.071] [Citation(s) in RCA: 292] [Impact Index Per Article: 32.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2015] [Accepted: 07/31/2015] [Indexed: 11/24/2022]
Abstract
CONTEXT Most patients with neuro-urological disorders require life-long medical care. The European Association of Urology (EAU) regularly updates guidelines for the diagnosis and treatment of these patients. OBJECTIVE To provide a summary of the 2015 updated EAU Guidelines on Neuro-Urology. EVIDENCE ACQUISITION Structured literature searches in several databases were carried out to update the 2014 guidelines. Levels of evidence and grades of recommendation were assigned where possible. EVIDENCE SYNTHESIS Neurological disorders often cause urinary tract, sexual, and bowel dysfunction. Most neuro-urological patients need life-long care for optimal life expectancy and quality of life. Timely diagnosis and treatment are essential to prevent upper and lower urinary tract deterioration. Clinical assessment should be comprehensive and usually includes a urodynamic investigation. The neuro-urological management must be tailored to the needs of the individual patient and may require a multidisciplinary approach. Sexuality and fertility issues should not be ignored. Numerous conservative and noninvasive possibilities of management are available and should be considered before a surgical approach is chosen. Neuro-urological patients require life-long follow-up and particular attention has to be paid to this aspect of management. CONCLUSIONS The current EAU Guidelines on Neuro-Urology provide an up-to-date overview of the available evidence for adequate diagnosis, treatment, and follow-up of neuro-urological patients. PATIENT SUMMARY Patients with a neurological disorder often suffer from urinary tract, sexual, and bowel dysfunction and life-long care is usually necessary. The update of the EAU Guidelines on Neuro-Urology, summarized in this paper, enables caregivers to provide optimal support to neuro-urological patients. Conservative, noninvasive, or minimally invasive approaches are often possible.
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Affiliation(s)
- Jan Groen
- Department of Urology, Erasmus Medical Center, Rotterdam, The Netherlands.
| | - Jürgen Pannek
- Department of Neuro-Urology, Swiss Paraplegic Center, Nottwil, Switzerland
| | - David Castro Diaz
- Department of Urology, University Hospital of the Canary Islands, Tenerife, Spain
| | - Giulio Del Popolo
- Department of Neuro-Urology, Careggi University Hospital, Florence, Italy
| | - Tobias Gross
- Department of Urology, University of Bern, Inselspital, Bern, Switzerland
| | - Rizwan Hamid
- Department of Neuro-Urology, London Spinal Injuries Centre, Stanmore, UK
| | - Gilles Karsenty
- Department of Urology, Aix Marseille University, Marseille, France
| | - Thomas M Kessler
- Department of Neuro-Urology, Spinal Cord Injury Center, University of Zürich, Balgrist University Hospital, Zürich, Switzerland
| | - Marc Schneider
- Department of Neuro-Urology, Spinal Cord Injury Center, University of Zürich, Balgrist University Hospital, Zürich, Switzerland
| | - Lisette 't Hoen
- Department of Urology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Bertil Blok
- Department of Urology, Erasmus Medical Center, Rotterdam, The Netherlands
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Cruz F, Nitti V. Chapter 5: Clinical data in neurogenic detrusor overactivity (NDO) and overactive bladder (OAB). Neurourol Urodyn 2014; 33 Suppl 3:S26-31. [DOI: 10.1002/nau.22630] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2014] [Accepted: 04/18/2014] [Indexed: 11/07/2022]
Affiliation(s)
- Francisco Cruz
- Hospital São João; IBMC & Faculty of Medicine do Porto; Porto Portugal
| | - Victor Nitti
- Department of Urology; New York University School of Medicine; New York USA
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Shin JC, Lee Y, Yang H, Kim DH. Clinical significance of urodynamic study parameters in maintenance of renal function in spinal cord injury patients. Ann Rehabil Med 2014; 38:353-9. [PMID: 25024959 PMCID: PMC4092176 DOI: 10.5535/arm.2014.38.3.353] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2014] [Accepted: 04/01/2014] [Indexed: 11/28/2022] Open
Abstract
Objective To analyze association between urodynamic study (UDS) parameters and renal function in spinal cord injured (SCI) patients with neurogenic detrusor overactivity. Methods Patients with a suprasacral SCI, who underwent UDS and radioisotope renogram at least twice between January 1, 2006 and January 31, 2013, were included. UDS (cystometric capacity, reflex volume, compliance, and maximal detrusor pressure) and radioisotope renogram (total effective renal plasma flow [ERPF] of both kidneys) data were collected. The following were conducted to reanalyze any association between reflex volume and ERPF: initial and follow-up results of consecutive evaluations were compared; a mixed-model regression analysis to account for clustered data was conducted to evaluate the association between UDS parameters and ERPF; and finally, a mixed-model analysis type 3 test with data pairs, of which the first evaluation showed involuntary detrusor contraction. Results A total of 150 patients underwent 390 evaluations which were arranged into 240 pairs of consecutive evaluations, of which 171 had first evaluations with observed involuntary detrusor contraction. The following results were obtained: cystometric capacity was significantly larger and maximal detrusor pressure was significantly lower on follow-up; on univariate analysis, reflex volume and maximal detrusor pressure were significant, and multivariate analysis using these two parameters showed that maximal detrusor pressure is significantly associated with total ERPF; and no significant differences were observed. Conclusion Maximal detrusor pressure should be closely monitored in the urologic management of neurogenic detrusor overactivity in SCI patients. The results also may serve as a reference for regular UDS follow-up.
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Affiliation(s)
- Ji Cheol Shin
- Department of Rehabilitation Medicine and Research Institute of Rehabilitation Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Youngsang Lee
- Department of Medicine, The Graduate School, Yonsei University, Seoul, Korea
| | - HeaEun Yang
- Rehabilitation Institute of Neuromuscular Disease, Yonsei University College of Medicine, Seoul, Korea
| | - Dae Hyun Kim
- Department of Rehabilitation Medicine and Research Institute of Rehabilitation Medicine, Yonsei University College of Medicine, Seoul, Korea
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Rovner E, Dmochowski R, Chapple C, Thompson C, Lam W, Haag‐Molkenteller C. Onabotulinumtoxin
A
improves urodynamic outcomes in patients with neurogenic detrusor overactivity. Neurourol Urodyn 2013; 32:1109-15. [DOI: 10.1002/nau.22376] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2012] [Accepted: 01/07/2013] [Indexed: 01/23/2023]
Affiliation(s)
- Eric Rovner
- Department of UrologyMedical University of South CarolinaCharlestonSouth Carolina
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Abstract
Patients with congenital and acquired neurogenic bladder dysfunction due to central and peripheral nervous lesions are significantly limited in their daily lives. The neurogenic dysfunction of the bladder and lower urinary tract are often misinterpreted and later fed to a diagnosis. Without therapy severe complications, including renal damage, could be the consequence in the follow up. Therefore, dedicated diagnostics have to be done to recognize the different disorders and to determine the specific therapy. For these patients a lifelong bladder monitoring and neuro-urological management is necessary. This article describes techniques of neuro-urological testings and the interpretation in case of neurogenic disorders.
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Urodynamic Management of Neurogenic Bladder in Spinal Cord Injury. Med J Armed Forces India 2011; 65:300-4. [PMID: 27408280 DOI: 10.1016/s0377-1237(09)80086-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2009] [Accepted: 08/24/2009] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND A spinal cord injury is devastating and produces profound changes in the life style of the individual and his family. It is difficult to predict bladder and sphincter behaviour on the basis of clinical somatic neurological deficits. METHODS A prospective study of 100 spinal cord injury patients was conducted to establish a bladder management protocol. The urodynamic variables were assessed frequently. Clean Intermittent Catheterization (CIC) along with antimuscarinic drugs was instituted and response monitored. Nonresponders were offered Intradetrusor Botulinum toxin. RESULT Spinal shock lasted for upto six months and only 8% could be converted to CIC during the acute phase. A total of 82% patients underwent three to four urodynamic studies which revealed an increase in cystometric capacity and a decrease in the maximum detrusor pressures. This lowered the incidence of incontinence episodes and prevented upper urinary tract damage. Botulinum toxin provided only temporary relief. CONCLUSION Aggressive management of neurogenic bladder (NB) dysfunction is a crucial component of the rehabilitation programme for spinal cord injury patients. Repeated urodynamic studies are an essential aid in managing the evolving nature of the bladder dysfunction. Meticulous bladder management protocol can prevent upper urinary tract complications.
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Kuo HC, Liu SH. Effect of repeated detrusor onabotulinumtoxinA injections on bladder and renal function in patients with chronic spinal cord injuries. Neurourol Urodyn 2011; 30:1541-5. [PMID: 21717505 DOI: 10.1002/nau.21146] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2011] [Accepted: 04/01/2011] [Indexed: 11/10/2022]
Abstract
AIMS To investigate the therapeutic effects of repeated detrusor onabotulinumtoxinA injections on urinary incontinence and renal function in patients with chronic spinal cord injuries (SCI). METHODS Patients with suprasacral SCI were enrolled. OnabotulinumtoxinA 200 U detrusor injections were repeated every 6 months for four times. Patients were instructed to perform clean intermittent catheterization during the treatment and follow-up periods. Videourodynamic study and 99mTc-DTPA renal scanning for glomerular filtration rate (GFR) were performed at screening and every 3 months to assess the therapeutic effects on bladder and renal function. Quality of life was measured by the UDI-6, IIQ-7, and self-assessed QoL indices. Adverse events were also recorded. RESULTS A total of 33 patients completed the study, 30 had improvement in incontinence grade (n = 18) or became completely dry (n = 12) after initial and subsequent onabotulinumtoxinA injections. Mean bladder capacity increased from 207 ± 111 to 412 ± 33 ml and mean detrusor pressure decreased from 39.8 ± 21.7 to 20.6 ± 19.1 cmH(2) O (all P < 0.05). However, the mean GFR decreased from 93.4 ± 20.4 to 83.5 ± 24 ml/min (P = 0.028). A significant reduction in GFR was noted in patients with bladder compliance that increased by <10 cmH(2) O (P = 0.002) and in patients with Pdet decreased by <10 cmH(2) O after treatment (P = 0.036). All 30 patients with improvement in incontinence grade satisfied with treatment result. CONCLUSION This pilot study revealed that repeated detrusor injections of 200 U onabotulinumtoxinA could reduce incontinence grade, increase bladder capacity, and decrease intravesical pressure but this study did not demonstrate an improvement in GFR over a 24-month period in patients with chronic SCI.
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Affiliation(s)
- Hann-Chorng Kuo
- Department of Urology, Buddhist Tzu Chi General Hospital and Tzu Chi University, Hualien, Taiwan.
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Klausner AP, Steers WD. The neurogenic bladder: an update with management strategies for primary care physicians. Med Clin North Am 2011; 95:111-20. [PMID: 21095415 DOI: 10.1016/j.mcna.2010.08.027] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Patients with lesions of the central nervous system often have neurogenic bladder dysfunction. Lifelong bladder monitoring and management in these patients is necessary to prevent severe complications, including renal damage. The urodynamic test, performed by neurourologists or other specially trained providers, is the definitive test for diagnosis and management of neurogenic bladder dysfunction. This article describes the indications and technique of urodynamic testing and the interpretation of the results of such testing. The management of patients with neurogenic bladder dysfunction is also discussed.
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Affiliation(s)
- Adam P Klausner
- Division of Urology, Department of Surgery, Virginia Commonwealth University School of Medicine, PO Box 980118, Richmond, VA 23298-0118, USA.
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23
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Linsenmeyer TA. Update on bladder evaluation recommendations and bladder management guideline in patients with spinal cord injury. CURRENT BLADDER DYSFUNCTION REPORTS 2008. [DOI: 10.1007/s11884-007-0012-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Ho CH, Linsenmeyer TA, Millis SR. The reproducibility of urodynamic studies of neurogenic bladders in spinal cord injury. J Spinal Cord Med 2007; 23:276-83. [PMID: 17536298 DOI: 10.1080/10790268.2000.11753537] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
OBJECTIVE To evaluate the reproducibility (test-retest reliability) of urodynamic studies in neurogenic bladders of subjects with spinal cord injuries (SCI). DESIGN Retrospective case series. SETTING Urology department of a major rehabilitation center. SUBJECTS Fifty individuals with SCI who had urodynamic studies performed from February 2000 to April 2000. MAIN OUTCOME MEASURES Two trials (Time 1 and Time 2) of urodynamic studies done 5 minutes apart, with the following collected: bladder volume at first sensation, maximum cystometric capacity, presence of uninhibited contractions, opening pressure, maximum detrusor pressure, duration of bladder contraction, volume voided, and post-void residual (PVR) volume. The corresponding data were then compared. Statistical analysis was performed using the Lin's concordance correlation coefficient and kappa. RESULTS Analysis of the data showed statistically significant levels of agreement between Time 1 and Time 2 with regard to the various corresponding parameters for both the filling and voiding phases. For 3 of the most important parameters-the opening pressure, maximum detrusor pressure, and duration of contraction-the Lin's concordance correlation coefficient (r(c)) was .86 (95% CI, .78-.95; p < .0005), .91 (95% CI, .86-.96; p < .0005), and .97 (95% CI, .95-.99, p < .0005), respectively. CONCLUSION The study demonstrates good short-term intrasubject reproducibility of urodynamic studies in individuals with SCI.
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Affiliation(s)
- C H Ho
- Kessler Institute for Rehabilitation, 1199 Pleasant Valley Way, West Orange, NJ 07052, USA
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Drake MJ, Cortina-Borja M, Savic G, Charlifue SW, Gardner BP. Prospective evaluation of urological effects of aging in chronic spinal cord injury by method of bladder management. Neurourol Urodyn 2005; 24:111-6. [PMID: 15605371 DOI: 10.1002/nau.20091] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
AIMS Risk of treatment-related problems in spinal cord injury (SCI) mandates assessment of complication rates of different bladder management methods (BMMs). The current study evaluated aging-related complications of various BMMs over a 6-year period in a population with spinal cord injury for at least 20 years. MATERIALS AND METHODS Clinical parameters were compared using a linear mixed effects model, controlling for various confounding variables, to establish complication trends with aging and their association with BMM. Results for people whose BMM was changed during the study were evaluated separately as well as in combination with the whole population. RESULTS One hundred and ninety six people (mean age 57.4 and years post injury (YPI) 33) were evaluated on three occasions. Both age and YPI were significantly associated with rising complication rates regardless of BMM. The BMMs assessed differed in terms of complication rates. In comparison with balanced reflex voiding, straining was significantly better for renal structural abnormality. Intermittent catheterization was associated with significantly worse renal function, possibly for demographic reasons. Overall, 28.8% changed BMM during the study period, particularly, those using straining or balanced reflex voiding. The probability of change increased with age and YPI. Reasons for change of BMM were varied and there was no specific association between reason for change and BMM. CONCLUSIONS Aging and duration of injury substantially influence urological complication rates, and BMM options differ in respect of prevalence and incidence of complications. At a late stage post injury there remains a high probability of change in BMM. The findings indicate the importance of long-term planning from the time of injury to minimize late complications.
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Affiliation(s)
- M J Drake
- School of Surgical Sciences, University of Newcastle, United Kingdom.
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Affiliation(s)
- T M Lane
- Institute of Urology and Nephrology, Middlesex Hospital, London, UK.
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