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Decombe O, Germain T, Lenfant L, Denormandie A, Felber M, Robain G, Denys P, Chartier-Kastler E. Isolated continent cystostomy on neurologic native bladder: Functional results. Fr J Urol 2024; 34:102642. [PMID: 38701949 DOI: 10.1016/j.fjurol.2024.102642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Revised: 04/14/2024] [Accepted: 04/28/2024] [Indexed: 05/06/2024]
Abstract
INTRODUCTION Continent cutaneous urinary diversion (CCUD) is proposed to patients suffering from chronic neurologic retention and undergoing intermittent self-catheterization (ISC). In case of neurogenic detrusor overactivity (NDO), augmentation enterocystoplasty is often required. The aim was to identify the prevalence of urinary stomal and/or urethral leakage in patients who had not undergone enlargement. METHODS Monocentric, retrospective study of patients who underwent CCUD surgery in a neuro-urological context. Mitrofanoff's, Monti's or Casale's channels were performed. Patients selected had an underactive, stable, or stabilized bladder under adjuvant therapy with proper cystomanometric capacity. Prior or concomitant enterocystoplasty were excluded. Failure was defined as the occurrence of clinical leakage whatever it is through urinary stomal, or urethral. Urodynamic parameters were also reported. RESULTS Thirty-one patients underwent surgery. Nine women had a concomitant bladder neck sling and 1 urethral closure. The mean follow-up was 7 years. 8/31 (26%) had stomal leakage and 9 urethral leakage (29%). Five spinal cord injured patients (n=14) had stomal leakage (36%) and 6 urethral leakage (43%). Of the 25 postoperative urodynamic parameters, cystomanometric bladder capacity was 419mL (vs. 514mL) and 2 additional patients had de novo NDO (9 vs. 7). DISCUSSION The morbidity of augmentation enterocystoplasty is weighed against the presence of a well-controlled bladder preoperatively. Our study shows the appearance of leakage in some patients despite a well-balanced bladder, a decrease in mean cystomanometric capacity and an increase in the rate of NDO postoperatively. Good selection criteria for an isolated CCUD should be carefully revised and defined. LEVEL OF EVIDENCE Grade C - retrospective study.
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Affiliation(s)
- O Decombe
- Department of Urology, Sorbonne université, Pitié-Salpêtrière Academic Hospital, AP-HP, Paris, France.
| | - T Germain
- Department of Urology, Sorbonne université, Pitié-Salpêtrière Academic Hospital, AP-HP, Paris, France
| | - L Lenfant
- Department of Urology, Sorbonne université, Pitié-Salpêtrière Academic Hospital, AP-HP, Paris, France
| | - A Denormandie
- Department of Urology, Sorbonne université, Pitié-Salpêtrière Academic Hospital, AP-HP, Paris, France
| | - M Felber
- Department of Urology, Sorbonne université, Pitié-Salpêtrière Academic Hospital, AP-HP, Paris, France
| | - G Robain
- Department of rehabilitation, Sorbonne université, Rothschild Hospital, AP-HP, Paris, France
| | - P Denys
- Department of rehabilitation, Paris-Saclay University, Raymond-Poincaré Hospital, AP-HP, Paris, France
| | - E Chartier-Kastler
- Department of Urology, Sorbonne université, Pitié-Salpêtrière Academic Hospital, AP-HP, Paris, France
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Manunta A, Peyronnet B, Olivari-Philiponnet C, Chartier-Kastler E, Saussine C, Phé V, Robain G, Denys P, Even A, Samson E, Grise P, Karsenty G, Hascoet J, Castel-Lacanal E, Charvier K, Guinet-Lacoste A, Chesnel C, Amarenco G, Haffner F, Haddad M, Le Normand L, Perrouin-Verbe MA, Perrouin-Verbe B, De Seze M, Ruffion A, Gamé X. [Guidelines on the urological management of the adult patient with spinal dysraphism (spina bifida)]. Prog Urol 2023; 33:178-197. [PMID: 36609138 DOI: 10.1016/j.purol.2022.12.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2022] [Accepted: 12/10/2022] [Indexed: 01/06/2023]
Abstract
INTRODUCTION Improved life expectancy and prenatal screening have changed the demographics of spina bifida (spinal dysraphism) which has presently become a disease of adulthood. Urinary disorders affect almost all patients with spinal dysraphism and are still the leading cause of mortality in these patients. The aim of this work was to establish recommendations for urological management that take into account the specificities of the spina bifida population. MATERIALS AND METHODS National Diagnosis and Management Guidelines (PNDS) were drafted within the framework of the French Rare Diseases Plan at the initiative of the Centre de Référence Maladies Rares Spina Bifida - Dysraphismes of Rennes University Hospital. It is a collaborative work involving experts from different specialties, mainly urologists and rehabilitation physicians. We conducted a systematic search of the literature in French and English in the various fields covered by these recommendations in the MEDLINE database. In accordance with the methodology recommended by the authorities (Guide_methodologique_pnds.pdf, 2006), proposed recommendations were drafted on the basis of this literature review and then submitted to a review group until a consensus was reached. RESULTS Bladder dysfunctions induced by spinal dysraphism are multiple and varied and evolve over time. Management must be individually adapted and take into account all the patient's problems, and is therefore necessarily multi-disciplinary. Self-catheterisation is the appropriate micturition method for more than half of the patients and must sometimes be combined with treatments aimed at suppressing any neurogenic detrusor overactivity (NDO) or compliance alteration (anticholinergics, intra-detrusor botulinum toxin). Resort to surgery is sometimes necessary either after failure of non-invasive treatments (e.g. bladder augmentation in case of NDO resistant to pharmacological treatment), or as a first line treatment in the absence of other non-invasive alternatives (e.g. aponeurotic suburethral tape or artificial urinary sphincter for sphincter insufficiency; urinary diversion by ileal conduit if self-catheterisation is impossible). CONCLUSION Spinal dysraphism is a complex pathology with multiple neurological, orthopedic, gastrointestinal and urological involvement. The management of bladder and bowel dysfunctions must continue throughout the life of these patients and must be integrated into a multidisciplinary context.
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Affiliation(s)
- A Manunta
- Centre de référence Spina Bifida-Dysraphismes, CHU Pontchaillou, Rennes, France
| | - B Peyronnet
- Centre de référence Spina Bifida-Dysraphismes, CHU Pontchaillou, Rennes, France.
| | | | - E Chartier-Kastler
- Service d'Urologie, GH Pitié-Salpétrière, APHP, Paris, France; Sorbonne Université, Paris, France; Service de médecine physique et réadaptation, Hôpital Raymond-Poincaré, APHP, Garches, France
| | - C Saussine
- Service d'urologie, les hôpitaux universitaires de Strasbourg, Strasbourg, France
| | - V Phé
- Service d'urologie, Sorbonne Université, Assistance Publique-Hôpitaux de Paris, Hôpital Tenon, Paris, France
| | - G Robain
- Service de médecine physique et réadaptation, Hôpital Rotschild, APHP, Paris, France
| | - P Denys
- Service de médecine physique et réadaptation, Hôpital Raymond-Poincaré, APHP, Garches, France; Faculté de médecine Paris Ouest, Université de Versailles-Saint-Quentin-en-Yvelines, Garches, France
| | - A Even
- Service de médecine physique et réadaptation, Hôpital Raymond-Poincaré, APHP, Garches, France; Faculté de médecine Paris Ouest, Université de Versailles-Saint-Quentin-en-Yvelines, Garches, France
| | - E Samson
- Centre de référence Spina Bifida-Dysraphismes, CHU Pontchaillou, Rennes, France
| | - P Grise
- Service d'urologie, CHU Rouen, Rouen, France
| | - G Karsenty
- Aix-Marseille Université, urologie et transplantation rénale, Hôpital La Conception, AP-HM, Marseille, France
| | - J Hascoet
- Centre de référence Spina Bifida-Dysraphismes, CHU Pontchaillou, Rennes, France
| | - E Castel-Lacanal
- CHU Toulouse, service de médecine physique et de réadaptation et ToNIC, Toulouse NeuroImaging Center, Université de Toulouse, Inserm, UPS, Toulouse, France
| | - K Charvier
- Service de médecine physique et réadaptation, Hôpital Henry-Gabrielle, Hospices civils de Lyon, Saint-Genis-Laval, France
| | - A Guinet-Lacoste
- Sorbonne Université, GRC 001, GREEN Groupe de recherche clinique en neuro-urologie, AP-HP, Hôpital Tenon, 75020 Paris, France
| | - C Chesnel
- Sorbonne Université, GRC 001, GREEN Groupe de recherche clinique en neuro-urologie, AP-HP, Hôpital Tenon, 75020 Paris, France; Service de neuro-urologie et explorations périnéales, Hôpital Tenon, AP-HP, Paris, France
| | - G Amarenco
- Sorbonne Université, GRC 001, GREEN Groupe de recherche clinique en neuro-urologie, AP-HP, Hôpital Tenon, 75020 Paris, France; Service de neuro-urologie et explorations périnéales, Hôpital Tenon, AP-HP, Paris, France
| | - F Haffner
- ASBH, Association nationale Spina Bifida et Handicaps associés, 94420 Le Plessis Trevise, France
| | - M Haddad
- Service de chirurgie viscérale et urologie pédiatrique, AP-HM, Marseille, France
| | - L Le Normand
- Service d'urologie, CHU de Nantes, Nantes, France
| | | | - B Perrouin-Verbe
- Service de médecine physique et réadaptation, CHU de Nantes, Nantes, France
| | - M De Seze
- Spécialiste en médecine physique et de réadaptation, Clinique St.-Augustin, Bordeaux, France
| | - A Ruffion
- Service d'urologie, Hospices civils de Lyon, Lyon, France
| | - X Gamé
- Département d'urologie, transplantation rénale et andrologie, CHU Rangueil, Université Paul-Sabatier, Toulouse, France
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Gouriou Delumeau MJ, Ly O, Lefebvre S, Belin C, Orvoën G, Robain G, Haddad R. Évaluation des symptômes du bas appareil urinaire lors du dépistage du risque de chute : connaissances et pratiques des soignants impliqués dans la prise en charge des personnes âgées. Prog Urol 2022; 32:769-775. [DOI: 10.1016/j.purol.2022.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Revised: 06/30/2022] [Accepted: 07/01/2022] [Indexed: 10/16/2022]
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Mokhtari N, Bazinet A, Pinar U, Ruggiero M, Robain G, Chartier-Kastler E. Neurogenic stress urinary incontinence management. From past to recent techniques: What have we learnt? Prog Urol 2022; 32:809-812. [PMID: 35840454 DOI: 10.1016/j.purol.2022.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Revised: 05/10/2022] [Accepted: 06/16/2022] [Indexed: 10/17/2022]
Abstract
Urinary prostheses for the treatment of male stress urinary incontinence ranged from simple to adjustable bulbourethral compressing devices to complex artificial urinary sphincter. Those devices have remarkably evolved since the 1950s. In this article, we review the story of a patient who experienced this device evolution. His history provides us with the opportunity to retrieve the historical transformation of the incontinence prostheses around time. Moreover, this patient story challenges us on those devices past and present limitations.
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Affiliation(s)
- N Mokhtari
- Urologie, Sorbonne université, hôpital universitaire Pitié-Salpétrière, Paris, France
| | - A Bazinet
- Urologie, Sorbonne université, hôpital universitaire Pitié-Salpétrière, Paris, France; Department of Urology, University of Montreal, Maisonneuve-Rosemont Hospital, Montreal, Canada.
| | - U Pinar
- Urologie, Sorbonne université, hôpital universitaire Pitié-Salpétrière, Paris, France
| | - M Ruggiero
- Urologie, Sorbonne université, hôpital universitaire Pitié-Salpétrière, Paris, France
| | - G Robain
- Médecine physique et réadaptation, Sorbonne université, hôpital Rotschild, Paris, France
| | - E Chartier-Kastler
- Urologie, Sorbonne université, hôpital universitaire Pitié-Salpétrière, Paris, France
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Valentini F, Marti B, Robain G, Nelson P. Account for high flow rate-low detrusor pressure voids in female: Contribution of VBN model. Prog Urol 2020; 30:214-218. [DOI: 10.1016/j.purol.2019.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Revised: 09/27/2019] [Accepted: 10/18/2019] [Indexed: 11/28/2022]
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Valentini FA, Marti BG, Robain G, Zimern PE, Nelson PP. Is bladder voiding efficiency useful to evaluate voiding function in women older than 65 years? Prog Urol 2019; 29:567-571. [PMID: 31473103 DOI: 10.1016/j.purol.2019.08.270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Revised: 08/09/2019] [Accepted: 08/12/2019] [Indexed: 11/28/2022]
Abstract
AIMS The aims of the study were to evaluate the reproducibility of bladder voiding efficiency (BVE) between free flow (FF) and intubated flow(IF) in old women, and to search for a relationship of this index with complaint and urodynamic diagnosis. METHODS Urodynamic tracings of non-neurologic women referred for investigation of various lower urinary tract symptoms (LUTS) were analyzed. Urodynamic study included one FF followed by one cystometry and IF. Post void residual volume (PVR) was measured using a Bladder-scan. Exclusion criteria were voided volume<100ml and prolapse of grade>2. RESULTS One hundred and ninety women met the study criteria. The mean age was 74±6 years [65-96years]. The main complaint was urinary incontinence: stress (26), urge (53) and mixed (56). Forty-four women had various complaints without incontinence. Overall BVE IF (77.6±25.8) was significantly lower than BVE FF (90.4±15.3) (P<.0001). Age sub-groups stratification led similar results. BVE IF was significantly lower than BVE FF in women with incontinence whatever the cause. Urodynamic diagnosis was posed according to the ICS/IUGA recommendations and 2 sub-groups defined according with involvement of detrusor. BVE IF was significantly lower than BVE FF for detrusor dysfunction, except for detrusor overactivity. CONCLUSION In this large cohort of old non-neurologic women studied urodynamically for a variety of LUTS, BVE is higher when evaluated from a FF whatever age and for complaint of urinary incontinence. In addition, a low BVE value from an IF may suggest a detrusor dysfunction. LEVEL OF EVIDENCE 4.
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Affiliation(s)
- F A Valentini
- Sorbonne université and hôpital Rothschild, 75012 Paris, France.
| | - B G Marti
- Sorbonne université and hôpital Rothschild, 75012 Paris, France
| | - G Robain
- Sorbonne université and hôpital Rothschild, 75012 Paris, France
| | - P E Zimern
- UT Southwestern Medical Center in Dallas, 7539 TX, United States
| | - P P Nelson
- Sorbonne université and hôpital Rothschild, 75012 Paris, France
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Biardeau X, Haddad R, Chesnel C, Charlanes A, Hentzen C, Turmel N, Campagne S, Capon G, Fatton B, Gamé X, Jeandel C, Kerdraon J, Mares P, Mezzadri M, Petit AC, Peyronnet B, Soler JM, Thuillier C, Deffieux X, Robain G, Amarenco G, Manceau P. [Use of botulinum toxin A in pelvic floor dysfunctions in the elderly: A review]. Prog Urol 2019; 29:216-225. [PMID: 30621961 DOI: 10.1016/j.purol.2018.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2018] [Accepted: 11/14/2018] [Indexed: 10/27/2022]
Abstract
INTRODUCTION The present article is the final report of a multi-disciplinary meeting supported by the GRAPPPA (group for research applied to pelvic floor dysfunctions in the elderly). The objective was to conduct a comprehensive review on the role of botulinum toxin A (BonTA) in the treatment of pelvic floor dysfunctions in the elderly. METHODS The present article, written as a comprehensive review of the literature, combines data issued from the scientific literature with expert's opinions. Review of the literature was performed using the online bibliographic database MedLine (National Library of Medicine). Regarding intra-detrusor BonTA injections, only articles focusing on elderly patients (>65 yo) were included. Regarding other localizations, given the limited number of data, all articles reporting outcomes of BonTA were included, regardless of studies population age. In case of missing or insufficient data, expert's opinions were formulated. RESULTS Although, available data are lacking in this specific population, it appears that BonTA could be used in the non-fraily elderly patients to treat overactive bladder or even neurogenic detrusor overactivity, with a success rate comparable to younger population at 3 months (88.9% vs. 91.2%), 6 months (49.4% vs. 52.1%) and 12 months (23.1% vs. 22.3%), as well as a significant decrease in number of voids per day (11.4 vs. 5.29 P<0.001) and in the number of pads per day (4.0 vs. 1.3, P<0.01). Furthermore, BonTA is likely to be offered in the future as a treatment of fecal incontinence and obstructed defecation syndrome symptoms. Concerning bladder outlet obstruction/voiding dysfunction symptoms, intra-urethral sphincter BonTA should not be recommended. CONCLUSION BonTA injections are of interest in the management of various pelvic floor dysfunctions in the elderly, and its various applications should be better evaluated in this specific population in order to further determine its safety and efficacy.
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Affiliation(s)
- X Biardeau
- Service d'urologie et d'andrologie, hôpital Claude-Huriez, université Lille, CHU Lille, 59000 Lille, France.
| | - R Haddad
- Service de médecine physique et réadaptation, hôpital Rotschild, 75012 Paris, France
| | - C Chesnel
- GRC 01, Green-groupe de recherche clinique en neuro-urologie, hôpital Tenon, Sorbonne universités, AP-HP, 75020 Paris, France; Service de neuro-urologie, hôpital Tenon, 4, rue de la Chine, 75020 Paris, France
| | - A Charlanes
- GRC 01, Green-groupe de recherche clinique en neuro-urologie, hôpital Tenon, Sorbonne universités, AP-HP, 75020 Paris, France; Service de neuro-urologie, hôpital Tenon, 4, rue de la Chine, 75020 Paris, France
| | - C Hentzen
- GRC 01, Green-groupe de recherche clinique en neuro-urologie, hôpital Tenon, Sorbonne universités, AP-HP, 75020 Paris, France; Service de neuro-urologie, hôpital Tenon, 4, rue de la Chine, 75020 Paris, France
| | - N Turmel
- GRC 01, Green-groupe de recherche clinique en neuro-urologie, hôpital Tenon, Sorbonne universités, AP-HP, 75020 Paris, France; Service de neuro-urologie, hôpital Tenon, 4, rue de la Chine, 75020 Paris, France
| | - S Campagne
- Service de gynécologie, CHU Estaing, 63003 Clermont-Ferrand, France
| | - G Capon
- Service d'urologie, centre hospitalier Pellegrin, 33076 Bordeaux, France
| | - B Fatton
- Service de gynécologie, CHU de Nîmes, 30000 Nîmes, France
| | - X Gamé
- Service d'urologie, transplantation rénale et andrologie, CHU Rangueil, 31000 Toulouse, France
| | - C Jeandel
- Service de gériatrie, CHU de Montpellier, 34000 Montpellier, France
| | - J Kerdraon
- GRC 01, Green-groupe de recherche clinique en neuro-urologie, hôpital Tenon, Sorbonne universités, AP-HP, 75020 Paris, France; Centre mutualiste de rééducation et réadaptation Kerpape, BP 78, 56275 Ploemeur cedex, France
| | - P Mares
- Service d'urologie, CHRU Carémeau, 30029 Nîmes cedex 9, France
| | - M Mezzadri
- Service de gynécologie, hôpital Lariboisière, AP-HP, 75010 Paris, France
| | - A-C Petit
- Centre de santé, 8, rue Neibecker, 93440 Dugny, France
| | - B Peyronnet
- Service d'urologie, CHU de Rennes, 35000 Rennes, France
| | - J-M Soler
- GRC 01, Green-groupe de recherche clinique en neuro-urologie, hôpital Tenon, Sorbonne universités, AP-HP, 75020 Paris, France; Service de médecine physique et réadaptation, centre Bouffard-Vercelli, 66290 Cerbère, France
| | - C Thuillier
- Service d'urologie, CHU de Grenoble, 38700 La Tronche, France
| | - X Deffieux
- GRC 01, Green-groupe de recherche clinique en neuro-urologie, hôpital Tenon, Sorbonne universités, AP-HP, 75020 Paris, France; Service de gynécologie, hôpital Antoine-Béclère, AP-HP, 92140 Clamart, France
| | - G Robain
- Service de médecine physique et réadaptation, hôpital Rotschild, 75012 Paris, France; GRC 01, Green-groupe de recherche clinique en neuro-urologie, hôpital Tenon, Sorbonne universités, AP-HP, 75020 Paris, France
| | - G Amarenco
- GRC 01, Green-groupe de recherche clinique en neuro-urologie, hôpital Tenon, Sorbonne universités, AP-HP, 75020 Paris, France; Service de neuro-urologie, hôpital Tenon, 4, rue de la Chine, 75020 Paris, France
| | - P Manceau
- GRC 01, Green-groupe de recherche clinique en neuro-urologie, hôpital Tenon, Sorbonne universités, AP-HP, 75020 Paris, France; Service de neuro-urologie, hôpital Tenon, 4, rue de la Chine, 75020 Paris, France; Service de neurologie, hôpital Avicennes, 93000 Bobigny, France
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- Groupe de recherche appliquée à la pathologie pelvi-périnéale des personnes âgées (GRAPPPA), 75020 Paris, France
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Egrot C, Dinh A, Amarenco G, Bernard L, Birgand G, Bruyère F, Chartier-Kastler E, Cosson M, Deffieux X, Denys P, Etienne M, Fatton B, Fritel X, Gamé X, Lawrence C, Lenormand L, Lepelletier D, Lucet JC, Marit Ducamp E, Pulcini C, Robain G, Senneville E, de Sèze M, Sotto A, Zahar JR, Caron F, Hermieu JF. [Antibiotic prophylaxis in urodynamics: Clinical practice guidelines using a formal consensus method]. Prog Urol 2018; 28:943-952. [PMID: 30501940 DOI: 10.1016/j.purol.2018.10.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2018] [Revised: 10/08/2018] [Accepted: 10/11/2018] [Indexed: 10/27/2022]
Abstract
OBJECTIVE The aim of this work was to issue clinical practice guidelines on antibiotic prophylaxis in urodynamics (urodynamic studies, UDS). MATERIALS AND METHODS Clinical practice guidelines were provided using a formal consensus method. Guidelines proposals were drew up by a multidisciplinary experts group (pilot group = steering group), then rated by a panel of 12 experts (rating group) using a formal consensus method, and then peer reviewed by a reviewing/reading group of experts (different from the rating group). RESULTS Urine (bacterial) culture with antimicrobial susceptibility testing is recommended for all patients before UDS (strong agreement). In patients with no neurologic disease, the risk factors for tract urinary infection (UTI) after UDS are age > 70 years, recurrent UTI, and post-void residual volume > 100ml. In patients with neurologic disease, the risk factors for UTI after UDS are recurrent UTI, vesicoureteral reflux, and intermicturition pressure > 40cmH2O. If the urine culture is negative before UDS and there is no risk factor for UTI, antibiotic prophylaxis is not recommended (Strong agreement). If the urine culture is negative before UDS, but there are one or more risk factors for UTI, antibiotic prophylaxis is optional. If antibiotic prophylaxis is initiated, a single oral dose (3g) of fosfomycin-tromethamine two hours before UDS is recommended (Strong agreement). If there is bacterial colonization on UCB before UDS, antibiotic therapy is optional (Undecided). If prescribed, it should be adapted to the antimicrobial susceptibility of the identified bacterium or bacteria, started the day before and stopped after UDS (except for fosfomycin-tromethamine: a single dose the day before UDS is necessary and sufficient) (Strong agreement). In the event of UTI before UDS, the UTI should be treated and UDS postponed (Strong agreement). The proposed recommendations should not be changed for patients with a hip or knee replacement (Strong agreement). No antibiotic prophylaxis of bacterial endocarditis is necessary, including in high-risk patients with valvular heart disease (Strong agreement). CONCLUSION These new guidelines should help to harmonize clinical practice and limit exposure to antibiotics. LEVEL OF EVIDENCE 4.
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Affiliation(s)
- C Egrot
- Service d'urologie, université Paris-7, hôpital Bichat Claude-Bernard, AP-HP, 46, rue Henri-Huchard, 75018 Paris, France.
| | - A Dinh
- Unité de maladies infectieuses, UVSQ, hôpital Raymond-Poincaré, AP-HP, 92380 Garches, France
| | - G Amarenco
- GRC 01, groupe de recherche clinique en neuro-urologie (GREEN), Sorbonne université, hôpital Tenon, AP-HP, 75020 Paris, France
| | - L Bernard
- Service de médecine interne et maladies infectieuses, centre hospitalier régional Bretonneau, 37000 Tours, France
| | - G Birgand
- Centre de prévention des infections associées aux soins, CHU de Nantes, 5, rue du Pr-Boquien, 44000 Nantes, France
| | - F Bruyère
- Service d'urologie, centre hospitalier régional universitaire de Tours, 37000 Tours, France
| | - E Chartier-Kastler
- Médecine Sorbonne Université, hôpital universitaire de la Pitié-Salpêtrière, 75013 Paris, France
| | - M Cosson
- Laboratoire BioTIM, école centrale de Lille, université de Lille, CHU de Lille, 59000 Lille, France
| | - X Deffieux
- Service de gynécologie obstétrique, université Paris-Sud, hôpital Antoine-Béclère, groupe hospitalier Sud, AP-HP, 92140 Clamart, France
| | - P Denys
- Service de neuro-urologie, hôpital Raymond-Poincaré, AP-HP, 92380 Garches, France
| | - M Etienne
- Service de maladies infectieuses et tropicales, hôpital Charles-Nicolle, CHU de Rouen, 76000 Rouen, France
| | - B Fatton
- Unité d'urogynécologie, groupe hospitalier Carémeau, CHU de Nîmes, 30029 Nîmes, France
| | - X Fritel
- Service de gynécologie-obstétrique, CHU de Poitiers, 86000 Poitiers, France
| | - X Gamé
- Département d'urologie, transplantation rénale et andrologie, CHU Rangueil, TSA 50032, 31059 Toulouse, France
| | - C Lawrence
- Service microbiologie et hygiène, hôpital Raymond-Poincaré, AP-HP, 92380 Garches, France
| | - L Lenormand
- Service d'urologie, centre fédératif de pelvipérinéologie, CHU de Nantes, place A.-Ricordeau, 44093 Nantes cedex 01, France
| | - D Lepelletier
- Service bactériologie et hygiène hospitalière, CHU de Nantes, 44093 Nantes cedex 01, France
| | - J-C Lucet
- Service de bactériologie, hygiène, virologie, parasitologie, hôpital Bichat-Claude-Bernard, AP-HP, Paris, France
| | - E Marit Ducamp
- Service de médecine physique et réadaptation, urodynamique, clinique Saint-Augustin, 33200 Bordeaux, France
| | - C Pulcini
- Infectious Diseases Department, université de Lorraine, APEMAC, CHRU de Nancy, 54000 Nancy, France
| | - G Robain
- Service de rééducation neurologique, hôpital Rothschild, AP-HP, 75012 Paris, France
| | - E Senneville
- Service universitaire des maladies infectieuses et du voyageur, centre hospitalier Gustave-Dron, CHRU de Lille, 59200 Tourcoing, France
| | - M de Sèze
- Service de médecine physique et réadaptation, urodynamique, clinique Saint-Augustin, 33200 Bordeaux, France
| | - A Sotto
- Service des maladies infectieuses et tropicales, CHU de Nîmes, place du Professeur-Robert-Debré, 30029 Nîmes cedex, France
| | - J-R Zahar
- Département de microbiologie, hôpital Avicenne, AP-HP, groupe hospitalier Paris-Seine-Saint-Denis, 93000 Bobigny, France; Unité de recherche Inserm 1137, IAME, université Paris-13, 93000 Bobigny, France
| | - F Caron
- Service des maladies infectieuses, groupe de recherche sur l'adaptation microbienne (EA2656), université de Rouen, CHU de Rouen, 76000 Rouen, France
| | - J-F Hermieu
- Service d'urologie, université Paris-7, hôpital Bichat Claude-Bernard, AP-HP, 46, rue Henri-Huchard, 75018 Paris, France
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Mazuet J, Cogné M, Robain G, Combrisson H, Maurey-Guenec C, Glize B, De Seze M. Effect of intrathecal botulinum toxin A injection on sheep's cystomanometric parameters: A comparative study. Ann Phys Rehabil Med 2018. [DOI: 10.1016/j.rehab.2018.05.660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Hentzen C, Haddad R, Sheikh Ismaël S, Chesnel C, Robain G, Amarenco G. Efficacy of posterior tibial nerve stimulation (PTNS) on overactive bladder in older adults. Eur Geriatr Med 2018; 9:249-253. [PMID: 34654250 DOI: 10.1007/s41999-017-0013-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2017] [Accepted: 11/28/2017] [Indexed: 12/18/2022]
Abstract
INTRODUCTION The main objective of this retrospective study is to determine the efficacy of transcutaneous posterior tibial nerve stimulation (TPTNS) in older patients with overactive bladder (OAB) syndrome. The secondary objective is to look for predictive factors of efficacy of this treatment. METHODS All patients aged over 65 years with OAB syndrome for which TPTNS was introduced between 2010 and 2016 in two neuro-urology centers were included. Age, gender, etiology of OAB, urinary symptoms and detrusor overactivity (DO) were retrospectively collected. The main outcome was efficacy of TPTNS (i.e., purchase of the device between 3 and 6 months). RESULTS A total of 264 patients were included (mean age 74.1 ± 6.5 years; 63.3% of women), of whom 53% had neurogenic OAB. Urinary incontinence was reported by 83.7% of patients and DO was found on urodynamic studies in 154 patients. The overall efficacy of TPTNS was 45.1%. None of the tested factors were significantly predictive of efficacy, especially age (≥ 75 years, p = 0.62), associated stress urinary incontinence (p = 0.69) and presence of DO (p = 0.60), whether neurogenic or not. CONCLUSION TPTNS is an effective treatment in older patients with OAB syndrome. No predictive factors of efficacy were found, especially age and DO. This treatment seems to be a good alternative to antimuscarinics against overactive bladder in older adults.
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Affiliation(s)
- C Hentzen
- Department of Neuro-urology, Tenon Hospital, AP-HP, 4 Rue de la Chine, 75020, Paris, France. .,Clinical Research Group of Perineal Dysfunctions in Older Adults, GRAPPPA, Paris, France.
| | - R Haddad
- Department of Physical Medicine and Rehabilitation, Rothschild Hospital, AP-HP, Paris, France.,Clinical Research Group of Perineal Dysfunctions in Older Adults, GRAPPPA, Paris, France
| | - S Sheikh Ismaël
- Department of Neuro-urology, Tenon Hospital, AP-HP, 4 Rue de la Chine, 75020, Paris, France.,Clinical Research Group of Perineal Dysfunctions in Older Adults, GRAPPPA, Paris, France
| | - C Chesnel
- Department of Neuro-urology, Tenon Hospital, AP-HP, 4 Rue de la Chine, 75020, Paris, France.,Clinical Research Group of Perineal Dysfunctions in Older Adults, GRAPPPA, Paris, France
| | - G Robain
- Department of Physical Medicine and Rehabilitation, Rothschild Hospital, AP-HP, Paris, France.,Clinical Research Group of Perineal Dysfunctions in Older Adults, GRAPPPA, Paris, France
| | - G Amarenco
- Department of Neuro-urology, Tenon Hospital, AP-HP, 4 Rue de la Chine, 75020, Paris, France.,Clinical Research Group of Perineal Dysfunctions in Older Adults, GRAPPPA, Paris, France
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Valentini FA, Marti BG, Robain G. Do urodynamics provide a better understanding of voiding disorders in women over 80? Prog Urol 2018; 28:230-235. [PMID: 29307483 DOI: 10.1016/j.purol.2017.12.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2017] [Revised: 10/14/2017] [Accepted: 12/05/2017] [Indexed: 11/17/2022]
Abstract
AIMS Population ageing has as consequence an increasing number of women older than 80 years with lower urinary tract symptoms (LUTS). Despite old age, urodynamic study is often performed to diagnose the cause of LUTS. Our purpose is to discuss the contribution of urodynamics to manage that population. METHODS Urodynamic studies of 169 consecutive women older than 80 years, respectively 124 non-neurological (non-N) and 45 neurological (N), were retrospectively analysed. RESULTS Number of co-morbidities was lower in non-N (2.5 vs. 3.1) with predominance of cardiovascular and endocrinology while musculo-skeletal, cognitive and previous pelvic surgery predominated in N. Among main complaint, incomplete retention or dysuria was more frequent in N while incontinence and frequency were predominant in non-N. More frequent urodynamic diagnosis (UD) was "normal" i.e. non contributive (25.0%) and intrinsic sphincter deficiency (ISD=21.7%) in non-N, detrusor overactivity (DO=42.2%) and detrusor underactivity (DU=38.8%) in N. In non-N, there were 94 treatment proposals based on the complaint when UD was "normal" and on UD for DO, DU and ISD. In N, treatment proposals were mainly prompted voiding or self-catheterization based on DU diagnosis. CONCLUSION Usefulness of urodynamics to manage LUT dysfunction in women older than 80 y is greatly dependent on their neurological status. In non-neurological women this is non debatable but proposed treatment needs to take into account existing co-morbidities. In neurological women the main usefulness is to unmask DU and to propose the best management in order to avoid complete retention. LEVEL OF EVIDENCE 4.
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Affiliation(s)
- F A Valentini
- Service de médecine physique et de la réadaptation, université Pierre-et-Marie-Curie, hôpital Rothschild, 5, rue Santerre, 75012 Paris, France.
| | - B G Marti
- Hôpital Saint-Antoine, 75012 Paris, France
| | - G Robain
- Service de médecine physique et de la réadaptation, université Pierre-et-Marie-Curie, hôpital Rothschild, 5, rue Santerre, 75012 Paris, France
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Kerdraon J, Peyronnet B, Gamé X, Fatton B, Haddad R, Hentzen C, Jeandel C, Mares P, Mezzadri M, Petit AC, Robain G, Vetel JM, Amarenco G. Physiopathologie de l’hypoactivité détrusorienne de la personne âgée. Prog Urol 2017; 27:402-412. [DOI: 10.1016/j.purol.2017.04.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2017] [Accepted: 04/13/2017] [Indexed: 01/21/2023]
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Valentini FA, Marti BG, Nelson PP, Zimmern PE, Robain G. Usefulness of an algebraic fitting of nomograms allowing evaluation detrusor contractility in women. Prog Urol 2016; 27:261-266. [PMID: 27426046 DOI: 10.1016/j.purol.2016.06.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2016] [Revised: 06/17/2016] [Accepted: 06/21/2016] [Indexed: 10/21/2022]
Abstract
AIMS Nomograms based on Valentini-Besson-Nelson (VBN) model implying only 3 measurements (filling bladder volume, maximum flow-rate [Qmax] and detrusor pressure at Qmax) were recently developed to evaluate detrusor contractility (k) and urethral obstruction (U) in women. As their algebraic fitting leads to fast evaluations (Excel® software), our aims were applications to populations of non-neurologic women without and with bladder outlet obstruction (BOO). METHODS The software was applied to measurements obtained during pressure flow studies. Hidden hypothesis of nomograms were no significant contribution of abdominal pressure between onset of flow and Qmax and standard nervous excitations until Qmax. Studied populations were 202 women without symptom suggestive of obstruction and 125 women with proven anatomical urethral obstruction who underwent urodynamic study. RESULTS For non-obstructed women, a good agreement was found between the values of k and U obtained using nomograms or a complete VBN analysis of the recorded curves. Whatever the obstructive status, there was a good correlation between the value of k and U. Evolution with ageing was similar with higher values of k and U in the BOO group. Curves k(age) and U(age) gave coefficients allowing an age adjustment. The high k value in the detrusor overactive (DO) group was consistent with a similar effect to that of BOO on the detrusor. CONCLUSION Evaluation of detrusor contractility (k) and urethral obstruction (U) can be obtained from the point of Qmax during pressure-flow study. Evolution with ageing is similar with (higher values) or without BOO. DO also induces an increased detrusor contractility. LEVEL OF EVIDENCE 4.
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Affiliation(s)
- F A Valentini
- Hôpital Rothschild, médecine physique et de réadaptation, 5, rue Santerre, 75012 Paris, France; Université Pierre-et-Marie-Curie, 4, place Jussieu, 75005 Paris, France.
| | - B G Marti
- Hôpital Saint-Antoine, 75012 Paris, France
| | - P P Nelson
- Hôpital Saint-Antoine, 75012 Paris, France
| | - P E Zimmern
- University of Texas Southwestern, Dallas, TX 75390, USA
| | - G Robain
- Hôpital Rothschild, médecine physique et de réadaptation, 5, rue Santerre, 75012 Paris, France
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Josse L, Azouvi P, Pradat-Diehl P, Robain G, Yelnik A, Albert T, Bourzam M, Peyre J, Vautrin F. Mobile clinical teams for stroke and neurological handicaps in the community: A pilot project in the Île-de-France area. Ann Phys Rehabil Med 2015. [DOI: 10.1016/j.rehab.2015.07.145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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15
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Loiseau K, Valentini F, Robain G. Usefulness of ice water test to unmask detrusor overactivity. Prog Urol 2015; 25:649-54. [PMID: 26094099 DOI: 10.1016/j.purol.2015.05.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2015] [Revised: 05/15/2015] [Accepted: 05/19/2015] [Indexed: 11/27/2022]
Abstract
PURPOSE Ice Water Test (IWT) is not frequently used today. IWT triggers a non-inhibited involuntary detrusor contraction (NIDC) when the bladder is being filled with cold saline solution. NIDC is unmasked via a segmental reflex loop different from the physiological micturition reflex. Our purpose was to search for usefulness of IWT to expose detrusor overactivity (DO). METHODS One hundred and seventy-nine IWT performed in patients with overactive bladder syndrome (OAB) and conventional cystometry (CC) non-contributive to diagnosis were retrospectively analyzed. An increase of detrusor pressure of 15cm H2O allowed defining positive IWT (with leakage) or intermediate (without leakage). RESULTS The population comprised of 131 women (58.2±17.3 years) and 48 men (56.1±15.3 years). Main complaints were mixed or urge incontinence (76/179). Hundred and twenty-four patients had a history of neurological disease. From CC, detrusor behavior was founded uncategorized for 106, normal for 53 patients and underactive for 20. These results did not contribute to diagnose a DO. IWT was positive for 22 patients and intermediate for 20. DO was unmasked by IWT for 42 patients (23.4%) of whom 34 had neurological disease. The positive predictive value was 80.9%, the negative predictive value was 34.3%. CONCLUSION In patients with OAB syndrome, IWT is contributory to unmask DO when CC is not contributive. Our study underlines the interest to perform IWT when urodynamic diagnosis is unclear.
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Affiliation(s)
- K Loiseau
- Service de MPR neurologique, hôpital Rothschild, AP-HP, 5, rue Santerre, 75012 Paris, France.
| | - F Valentini
- Service de MPR neurologique, hôpital Rothschild, AP-HP, 5, rue Santerre, 75012 Paris, France; Université Pierre-et-Marie-Curie, Paris 06, 75005 Paris, France
| | - G Robain
- Service de MPR neurologique, hôpital Rothschild, AP-HP, 5, rue Santerre, 75012 Paris, France; Université Pierre-et-Marie-Curie, Paris 06, 75005 Paris, France
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Dompeyre P, Fritel X, Fauconnier A, Robain G. [Pelvic floor muscle contraction and maximum urethral closure pressure]. Prog Urol 2014; 25:200-5. [PMID: 25468000 DOI: 10.1016/j.purol.2014.10.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2014] [Revised: 10/19/2014] [Accepted: 10/20/2014] [Indexed: 10/24/2022]
Abstract
OBJECTIVES The aim of this study was to precise the relationship between the pelvic floor muscle (PFM) contraction and the maximum urethral closure pressure (MUCP) at rest and during a containing effort. MATERIALS Longitudinal study, observational, single-center retrospective performed in successively 358 women addressed for urodynamics. MUCP at rest and during a containing effort, gain of MUCP, functional urethral length (FUL), scores USP and ICQ-SF, cervico-urethral mobility (CUM) according to POP-Q classification and leak point pressure were analyzed according to the PFM contraction. RESULTS One hundred and seventy-three had genuine stress urinary incontinence, 25 urge urinary incontinence, 148 mixed incontinence and 12 had no urinary incontinence. PFM contraction was not associated with a hysterectomy, age, parity, BMI, CUM, FUL, MUCP at rest, the severity of the incontinence assessed by ICIQ-SF score and leak point pressure. There was a proportional relationship between PFM contraction and the value of MUCP measured during this contraction (P<0.0001) on the one hand, and the gain of MUCP (P<0.0001) on the other. MUCP at rest was independent from the MUCP during the containing effort and the gain of MUCP. CONCLUSIONS The strength of contraction of the PFM is not correlated with MUCP at rest but proportional to the augmentation of the MUCP during the containing effort.
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Affiliation(s)
- P Dompeyre
- Service de gynécologie-obstétrique, CHI Poissy-Saint-Germain-en-Laye, 78300 Poissy, France; Laboratoire privé d'explorations périnéales, 78300 Poissy, France.
| | - X Fritel
- Inserm CIC802, service de gynécologie-obstétrique, université de Poitiers, CHU de Poitiers, 86000 Poitiers, France
| | - A Fauconnier
- Service de gynécologie-obstétrique, CHI Poissy-Saint-Germain-en-Laye, 78300 Poissy, France
| | - G Robain
- Service de médecine physique et de réadaptation, UPMC, Paris 6, hôpital Rothschild, AP-HP, 75012 Paris, France
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Billault C, Chartier-kastler E, Rouprêt M, Robain G, Phé V. Résultats fonctionnels des ballons ajustables peri-uretraux act® chez les femmes âgées de plus de 80ans et ayant une incontinence urinaire d’effort par insuffisance sphinctérienne. Prog Urol 2014; 24:798. [DOI: 10.1016/j.purol.2014.08.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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18
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Hadiji N, Previnaire JG, Benbouzid R, Robain G, Leblond C, Mieusset R, Enjalbert M, Soler JM. Are oxybutynin and trospium efficacious in the treatment of detrusor overactivity in spinal cord injury patients? Spinal Cord 2014; 52:701-5. [PMID: 25047051 DOI: 10.1038/sc.2014.113] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2013] [Revised: 03/28/2014] [Accepted: 06/06/2014] [Indexed: 11/10/2022]
Abstract
OBJECTIVES To evaluate the efficacy of anticholinergic agents in the treatment of neurogenic overactive bladder (NOAB) and neurogenic detrusor overactivity (NDO) in spinal cord injury (SCI) patients on clean intermittent catheterisation (CIC). METHODS Chronic suprasacral SCI patients on CIC presenting with at least one urinary leakage a day were included. Urodynamics and voiding diaries were performed at baseline and 1 month follow-up. In case of NDO at baseline, an anticholinergic drug was prescribed. RESULTS The 231 SCI patients presented with one to five urinary leakages per day (mean 2.1). Urodynamics showed NDO in all patients. A new anticholinergic treatment was started in all, either in monotherapy (134 patients) or in association with the existing anticholinergic drug (oxybutynin+trospium bitherapy, 97 patients). The mean maximum bladder capacity significantly increased from 225 to 441 ml, and the mean involuntary detrusor contractions (IDC) significantly decreased from 67 to 41 cm H2O. Only 75 SCI patients (32%) were fully continent. However, 25 out of these 75 patients showed persistent NDO, with amplitudes of IDC above 40 cm H2O in 12 patients. Incontinence was still found in 156 SCI patients (67%), with an average of 1,2 leakages a day. In 100 patients, amplitudes of IDC remained above 40 cm H2O. There was no statistical difference between patients on anticholinergic monotherapy or bitherapy at follow-up. CONCLUSION Anticholinergic treatment is not always satisfactory in terms of control of NDO and rarely allows full continence. Urodynamic follow-up is mandatory in all patients, even in those showing clinical continence.
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Affiliation(s)
- N Hadiji
- Centre Bouffard-vercelli-Laboratoire de neuro-urologie et de sexologie, Cerbère, France
| | - J G Previnaire
- Département médullaire, centre Calvé, Fondation Hopale, Berck-Sur-Mer, France
| | - R Benbouzid
- Centre Bouffard-vercelli-Laboratoire de neuro-urologie et de sexologie, Cerbère, France
| | - G Robain
- AP-HP Hôpital Rothschild-Unité fonctionnelle de Médecine physique et de Réadaptation, Paris, France
| | - C Leblond
- Centre Bouffard-vercelli-Laboratoire de neuro-urologie et de sexologie, Cerbère, France
| | - R Mieusset
- CECOS- Hôpital Paule de Viguier, Toulouse, France
| | - M Enjalbert
- 1] Centre Bouffard-vercelli-Laboratoire de neuro-urologie et de sexologie, Cerbère, France [2] Centre Hospitalier de Perpignan, Perpignan, France
| | - J M Soler
- Centre Bouffard-vercelli-Laboratoire de neuro-urologie et de sexologie, Cerbère, France
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Robain G, Chapelle O, Loiseau K, Valentini F. Urinary dysfunction and frailty in elderly. Ann Phys Rehabil Med 2014. [DOI: 10.1016/j.rehab.2014.03.556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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20
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Loiseau K, Valentini F, Robain G. Management of urinary dysfunction in multiple sclerosis (MS) patients: Our experience vs United-Kingdom (UK) consensus. Ann Phys Rehabil Med 2014. [DOI: 10.1016/j.rehab.2014.03.1119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Loiseau K, Valentini F, Robain G. Prise en charge (PEC) de troubles urinaires de patients ayant une sclérose en plaques (SEP) : France versus consensus du Royaume-Uni (UK). Ann Phys Rehabil Med 2014. [DOI: 10.1016/j.rehab.2014.03.1140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Robain G, Reiss B, De Seze M. Urodynamic for PMR in MS, SCI, Stroke and Parkinson disease. Ann Phys Rehabil Med 2014. [DOI: 10.1016/j.rehab.2014.03.302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Phé V, Even A, Rouprêt M, Denys P, Robain G, Chartier-Kastler E. Long-term functional outcomes after management of neurogenic bladder dysfunction with ileal conduit in an adult spina bifida population: A monocentric experience among a multidisciplinary team. Ann Phys Rehabil Med 2014. [DOI: 10.1016/j.rehab.2014.03.307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Gomes Paiva A, Kharboutly H, Bouzit M, Pasqui V, Robain G, Thoumie P. Balance assessment of hemiplegic subjects on a robotic dynamic posturography platform “IsiMove”. Ann Phys Rehabil Med 2013. [DOI: 10.1016/j.rehab.2013.07.358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Gomes Paiva A, Kharboutly H, Bouzit M, Pasqui V, Robain G, Thoumie P. Évaluation de l’équilibre des sujets hémiplégiques sur une plateforme de posturographie dynamique robotisée « IsiMove ». Ann Phys Rehabil Med 2013. [DOI: 10.1016/j.rehab.2013.07.351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Popoff M, Chartier-Kastler E, Phe V, Robain G, Denys P. Continent catheterizable vesicostomy and injections of intravesical botulinum toxin for the treatment of overactive bladder: Case series. Ann Phys Rehabil Med 2013. [DOI: 10.1016/j.rehab.2013.07.597] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Popoff M, Chartier-Kastler E, Phe V, Robain G, Denys P. Dérivation cutanée continente et traitement de l’hyperactivité du détrusor neurologique par toxine botulinique A. Ann Phys Rehabil Med 2013. [DOI: 10.1016/j.rehab.2013.07.591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Cour F, Robain G, Claudon B, Chartier-Kästler E. [Childhood sexual abuse: how important is the diagnosis to understand and manage sexual, anorectal and lower urinary tract symptoms]. Prog Urol 2012; 23:780-92. [PMID: 23830273 DOI: 10.1016/j.purol.2012.10.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2012] [Accepted: 10/15/2012] [Indexed: 01/23/2023]
Abstract
OBJECTIVE To understand and manage the sequels of childhood sexual abuse on sexual, anorectal and lower urinary tract functions. MATERIAL AND METHODS Review of articles published in the Medline database, selected according to their scientific relevance and published guidelines on this subject together with our own experience. RESULTS A history of sexual abuse is frequently found when assessing dysfunction or symptoms of the lower urinary tract. In this context, urinary stress incontinence is rarely involved but it can be linked by epidemiological factors. Dysuria with urgency is the most frequent expressed symptom. When associated with anorectal disorders and pelvic pain or a sexual disorder in particular dyspareunia, a sexual abuse should be evoked and specific questions asked to the patient. Although these symptoms are frequently encountered in 12 to 33% of women, and 8 to 16% of men, few practitioners, whatever their speciality ask about them as routine. It is important that the physician diagnose the existence of sexual abuse, in particular when the symptoms mentioned by the patient are not conclusive, in spite of thorough urological assessment. Patients finding the initial examination difficult and painful and the failure of the initial treatment should lead to questions concerning abuse, if neglected by the initial medical inquiry. CONCLUSIONS Clinicians involved in perineal functional pathology are able to acquire standardized modalities of inquiry about child sexual abuse for a better time management and efficacy in the therapeutic approach. The interest of a multidisciplinary diagnostic and therapeutic approach is primordial, associating psychological therapy and if necessary perineal re-education. This can avoid unnecessary tests and out-patient visits. Directing patients towards a multidisciplinary approach is highly advisable.
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Affiliation(s)
- F Cour
- Service d'urologie, université de Versailles-Saint-Quentin-en-Yvelines, hôpital Foch, 40, rue Worth, 92150 Suresnes, France.
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Perrouin-verbe M, Phé V, Rouprêt M, Even-schneider A, Giuliano F, Robain G, Denys P, Bitker M, Chartier-kastler E. Résultats fonctionnels à long terme des dérivations urinaires cutanées continentes chez le patient neurologique : expérience monocentrique. Prog Urol 2012. [DOI: 10.1016/j.purol.2012.08.120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Claudon B, Robain G, Valentini F. Gait study in hemiplegic patients: Role of spasticity on baropodometric parameters. Ann Phys Rehabil Med 2012. [DOI: 10.1016/j.rehab.2012.07.859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Valentini FA, Granger B, Hennebelle DS, Eythrib N, Robain G. Repeatability and variability of baropodometric and spatio-temporal gait parameters--results in healthy subjects and in stroke patients. Neurophysiol Clin 2011; 41:181-9. [PMID: 22078730 DOI: 10.1016/j.neucli.2011.08.004] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2010] [Revised: 07/31/2011] [Accepted: 08/01/2011] [Indexed: 11/18/2022] Open
Abstract
AIMS OF THE STUDY Our purpose was to determine the repeatability and variability of baropodometric and spatio-temporal gait parameters in both hemiparetic patients and healthy subjects. HYPOTHESIS parameters with a good repeatability and a low variability could be used to follow gait evolution. POPULATION AND METHOD Twelve stroke patients and 10 healthy subjects were included. Each participant performed trials (F-Scan® system and Bessou Locometer) at 48 h intervals under identical conditions. The following parameters were analyzed: displacement of the center of pressure (COP), peaks of pressure under forefoot and hindfoot, step length, single and double support time, and walking velocity. Comparisons were made within and between sessions, inter-trials and between sides. RESULTS Neither visit effects in either population nor side effects in healthy subjects were observed. Repeatability assessed by the intraclass correlation coefficient ("ICC agreement" ICC) was excellent to adequate overtime for anterior-posterior (AP) displacement of the COP, step length, simple support time and walking velocity in both hemiparetic patients (ICC 0.92; 0.84; 0.91; 0.94) and healthy subjects (ICC 0.85; 0.44; 0.64; 0.56). The coefficient of variation (CV) was low in paretic side for AP and single support time, and at a less degree for the lateral deviation of the COP (ML) and the posterior margin (PM). CONCLUSION In this study, baropodometric (AP and PM) and spatio-temporal gait (step length, single support time and walking velocity) parameters were found to show good repeatability overtime; these parameters are the ones most likely to be useful in assessing the effects of treatments that are proposed to improve gait in stroke patients.
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Affiliation(s)
- F A Valentini
- ER6-université Pierre-et-Marie-Curie (Paris-06), Service de rééducation neurologique, hôpital Rothschild, 5, rue Santerre, 75012 Paris, France.
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Valentini F, Marti B, Robain G, Nelson P, Osaghae S. UP-2.42: Phasic or terminal detrusor overactivity in women: age, urodynamic findings and sphincter behavior relationships. Urology 2010. [DOI: 10.1016/j.urology.2010.07.276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Fritel X, Fauconnier A, Bader G, Cosson M, Debodinance P, Deffieux X, Denys P, Dompeyre P, Faltin D, Fatton B, Haab F, Hermieux JF, Kerdraon J, Mares P, Mellier G, Michel-Laaengh N, Nadeau C, Robain G, de Tayrac R, Jacquetin B. Diagnostic et prise en charge de l’incontinence urinaire d’effort de la femme adulte. Recommandations pour la pratique clinique du Collège national des gynécologues et obstétriciens français (CNGOF). ACTA ACUST UNITED AC 2010. [DOI: 10.1007/s11608-010-0321-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Laurent G, Valentini F, Loiseau K, Hennebelle D, Robain G. Claw toes in hemiplegic patients after stroke. Ann Phys Rehabil Med 2010; 53:77-85. [DOI: 10.1016/j.rehab.2009.12.005] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2009] [Accepted: 11/20/2009] [Indexed: 11/30/2022]
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Abstract
Diabetic neuropathy can induce multi-organ functional disease including lower urinary tract dysfunction. After a review of the various neurological lesions associated with diabetes mellitus, the authors describe the voiding disorders observed in diabetics and their specificity. These disorders, usually characterized by a large, flaccid, underactive bladder, must always be interpreted as a function of other diseases of the male or female pelvis that alter an often precarious balance. The management problems raised by this neuropathy are related to the fact that it may not be correctly diagnosed prior to a surgical procedure, for example. A better knowledge of the risk factors and natural history of diabetic bladder must therefore be promoted.
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Abstract
Lower urinary tract dysfunction is frequent in Parkinson's disease and other Parkinsonian syndromes and can cause urinary incontinence complicating a urgency-frequency syndrome or on the contrary, dysuria. These disorders are a frequent urological presenting complaint due to their impact on the patient's quality of life. Urologists must be aware of the different natural histories of diseases such as Parkinson's disease and Parkinsonian syndromes such as multisystem atrophy, which often have a severe course and are marked by resistance to neuropharmacological treatments. These various diseases can also directly induce urinary symptoms, independently of urological complications. Inversely, the development of urinary disorders, especially obstructive symptoms, in a patient with Parkinsonian syndrome may require review of the neurological diagnosis. Finally, therapeutic management is complex due to the difficulty of using pharmacological treatments, and the risk of deterioration after surgical treatment of obstructive uropathy.
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Affiliation(s)
- Ph Vassel
- Centre de médecine physique et de réadaptation de Coubert, France.
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Abstract
Although lower urinary tract dysfunction and dementia are classically associated, some patients with advanced dementia do not experience incontinence. Management of these patients must be based on careful assessment of the respective roles of ageing of the urinary tract and dementia in the pathogenesis of incontinence. It is also important to distinguish those dementia syndromes that are inevitably accompanied by urinary incontinence (such as normal pressure hydrocephalus) and those in which urinary incontinence is a late phenomenon (such as Alzheimer's disease). The diagnostic and therapeutic strategy must then be based on a stepwise approach, by eliminating all simple causes of lower urinary tract dysfunction and preferring the most conservative treatments possible.
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Affiliation(s)
- G Robain
- Service de médecine physique et de réadaptation, Jean Rostand, Paris VI, Ivry, France.
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Robain G, Valentini F, Renard-Deniel S, Chennevelle JM, Piera JB. [A baropodometric parameter to analyze the gait of hemiparetic patients: the path of center of pressure]. Ann Readapt Med Phys 2006; 49:609-13. [PMID: 16780987 DOI: 10.1016/j.annrmp.2006.05.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/13/2006] [Accepted: 05/12/2006] [Indexed: 05/10/2023]
Abstract
PURPOSE Hemiparetic gait has been previously evaluated by several biomechanical methods, but plantar pressure distribution has been much less studied. Our purpose was to analyze the changes in the path of the center of pressure (COP) following the occurrence of hemiparesis using an F-Scan in-shoe transducer. MATERIALS AND METHODS Twenty patients, mean age 50 years [26-67] with hemiparesis due to vascular causes underwent gait analysis (by the F-Scan system). All patients had steady neurological status and were self-sufficient for gait. Podo-orthoses were removed during the test. Five to six cycles of gait, about 8 m, were recorded. Comparison of the COP path was performed between hemiparetic and healthy foot. The group control consisted of 9 healthy volunteer subjects. RESULTS Differences in the COP path were found in the hemiparetic foot of patients: a significant decrease for the anteroposterior displacement (P=0.002) and the lateral displacement (P=0.04) and a significant anterior displacement of the more posterior contact COP (P=0.005). The "gait line" was irregular, with slowing down going forward and, for some, going back. These results are likely consistent with the equine of the foot. No change was observed in the control group. CONCLUSION The use of an F-Scan in the shoe transducer allows for revealing the importance of the COP path in analyzing hemiparetic gait; this noninvasive investigation would be helpful for evaluating the best therapy to propose to and to follow-up patients with hemiparesis.
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Affiliation(s)
- G Robain
- Service de médecine physique et réadaptation, groupe hospitalier Charles-Foix-Jean-Rostand, 7, avenue de la République, 94205 Ivry-sur-Seine, France
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Chennevelle JM, Robain G, Bailly B, Scavennec C, Saint-Honoré J, Bissery A, Piera JB. [Validation of a bowel movement notation system in neurology]. Soins 2002:43-5. [PMID: 12271778] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/19/2023]
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Robain G, Chennevelle JM, Petit F, Piera JB. [Incidence of constipation after recent vascular hemiplegia: a prospective cohort of 152 patients]. Rev Neurol (Paris) 2002; 158:589-92. [PMID: 12072827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/25/2023]
Abstract
Constipation is a major problem for institutionalized patients. This prospective study was performed on a population of 152 in-patients of a stroke rehabilitation center. Constipation was defined as less than three stools weekly or the use of laxative medication. Constipation occurred in sixty percent of the patients. The incidence of constipation was not related to age or sex but was strongly related to functional status of patients assessed by Barthel Index (p<0.003). The influence of both brain lesion or reduce activity is evaluated.
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Affiliation(s)
- G Robain
- Service de Rééducation. Hôpital Charles Foix-Jean Rostand, 39, rue Jean le Galleu, 94200 Ivry sur Seine.
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Abstract
The flowing of fluid along the urethra can facilitate the bladder micturition contraction, a reflex appropriate to achieve complete bladder emptying. The response has been observed in animals studied in the decerebrate, spinal, or anesthetized intact state but is difficult to demonstrate in awake, healthy humans. The aim of this study was to investigate this reflex in the awake, intact state using urodynamics in the ewe. The animals were fully awake and lay gently restrained on a recording table. The bladder was catheterized, and urethral flows were obtained by slowly injecting saline at the level of the proximal urethra. Bladder and rectal pressure were monitored, and the responses to urethral flow were tested at various bladder volumes. Urethral flows consistently evoked detrusor contractions in all animals. The response started approximately 2 seconds after the beginning of the flow and largely outlasted the stimulus. Its amplitude was similar to that of the bladder-to-bladder micturition reflex, and, like the latter, it always required some degree of bladder filling to appear. The reflex was selectively suppressed by local anesthesia of the urethral mucosa, indicating that the effect must originate from urethral receptors. Small urethral flows thus appear to elicit large bladder micturition contractions in awake healthy animals, and the reflex could be quite significant during the normal micturition. That this reflex is found in all studied species further supports the notion that the negative results in normal awake humans are owing to descending inhibitory controls rather than to the lack of appropriate pathways.
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Affiliation(s)
- G Robain
- Department of Rehabilitation, Hôpital Jean Rostand, Ivry/Seine, France.
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Abstract
The aim of this study was to analyze the urethral pressure responses to cough in men to better characterize the neurogenic mechanisms of male urethral function. A prospective study was carried out on 41 men referred for urodynamic assessment. Urethral pressure profiles at rest and during coughing, and urethral pressure response to voluntary perineal contraction were recorded and analyzed in relation to the neurological status of the patients. Voluntary perineal contraction resulted in a urethral pressure increase (delta pU) of approximately 150 cm H2O in neurologically normal patients. Delta pU could be reduced to any degree in patients with either central or peripheral neurological lesions. Urethral pressure response to cough could be easily classified into two main patterns. Pattern I was characterized by a marked increase in urethral closure pressure during the cough (ratio of urethral to rectal pressure increase: 248 +/- 106%), occurring at the distal part of the posterior urethra. All the neurologically normal patients and the majority of those with upper motoneuron lesions had a pattern I response. Pattern II was defined by the absence of any significant increase in urethral closure pressure at any site of the posterior urethra and was observed in 80% of the patients with signs of lower motoneuron lesions. The pattern of the response to cough was significantly related to the neurological status of the patients (P < 0.001). It was dissociated from the response to voluntary contraction, as would be expected for a reflex versus a voluntary response in neurological patients.
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Affiliation(s)
- G Robain
- Department of Rehabilitation, Jean Rostand Hospital, Ivry/Seine, France.
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Abstract
The aim of this study was to determine the urological abnormalities linked to spontaneous spongiform encephalopathy and their occurrence in the course of the disease. The animals used in this were 11 healthy and 20 scrapie-affected ewes. The scrapie-affected ewes were studied at a rate of once a month (1 to 5 measures; mean, 2.55) until they died. Urodynamic explorations were performed. The bladder activity was explored using cystometry. The urethral activity was measured during cystometry and during a urethral pressure profile. Both were analyzed using International Continence Society recommendations. Results showed in scrapie-affected ewes a decrease in functional bladder capacity and an increase in detrusor contraction incidence during filling of the bladder and in the occurrence of significant urethral instability. Bladder abnormalities were seen only in scrapie-affected ewes and worsened during the course of the disease. Urethral instability was not typical of the disease but was significantly more frequent in scrapie-affected ewes. It was concluded that lower urinary tract dysfunction occurred in scrapie-affected ewes and worsened during the course of the disease. This dysfunction is in agreement with overactive detrusor function due to neurological lesions.
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Affiliation(s)
- H Combrisson
- Laboratory of Physiology and Therapeutic, Ecole Nationale Vétérinaire d'Alfort, Maisons-Alfort, France.
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Chartier-Kastler E, Robain G, Amarenco G, Richard F, Durand A, Denys P. [Treatments with alpha-stimulants in urology]. Prog Urol 2000; 10:370-8. [PMID: 10951929] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
Abstract
Neuropharmacology is a rapidly expanding field due to the regular discovery of new neurotransmitters or neuroreceptors. Hopes have now been raised for the treatment of vesicosphincteric disorders by developing molecules with a potential selective clinical action on the detrusor or the urethra. After a brief review of the neuroanatomy and general neuropharmacology of the sympathetic nervous system, the current indications for alpha agonists are reviewed and discussed. These indications include the treatment of priapism, retrograde ejaculation, and incontinence due to sphincter incompetence. The more recent use of agents with a central mechanism of action is also discussed (detrusor hyperactivity of spinal cord injury patients). The authors review the current indications and note that, although the use of these drugs is very specific and limited in the field of urology, it is nevertheless based on an interesting concept. Like molecules at the stage of clinical trials for peripheral or central targets, the mechanism of action of these molecules on the sympathetic adrenergic system needs to be more fully elucidated. Their adverse effects remain the limiting factor for use on peripheral targets.
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Affiliation(s)
- E Chartier-Kastler
- Service d'urologie, G.H. Pitié-Salpêtrière, Université Paris VI, France.
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Bonnet A, Pichon J, Vidailhet M, Gouider-Khouja N, Robain G, Perrigot M, Agid Y. Urinary Disturbances in Striatonigral Degeneration and Parkinson's Disease: Clinical and Urodynamic Aspects. J Urol 1999. [DOI: 10.1016/s0022-5347(05)68897-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- A.M. Bonnet
- INSERM U 289 and Federation de Neurologie, and Service de Reeducation Fonctionelle Neurologique, Hopital de la Salpetriere, Paris, France
| | - J. Pichon
- INSERM U 289 and Federation de Neurologie, and Service de Reeducation Fonctionelle Neurologique, Hopital de la Salpetriere, Paris, France
| | - M. Vidailhet
- INSERM U 289 and Federation de Neurologie, and Service de Reeducation Fonctionelle Neurologique, Hopital de la Salpetriere, Paris, France
| | - N. Gouider-Khouja
- INSERM U 289 and Federation de Neurologie, and Service de Reeducation Fonctionelle Neurologique, Hopital de la Salpetriere, Paris, France
| | - G. Robain
- INSERM U 289 and Federation de Neurologie, and Service de Reeducation Fonctionelle Neurologique, Hopital de la Salpetriere, Paris, France
| | - M. Perrigot
- INSERM U 289 and Federation de Neurologie, and Service de Reeducation Fonctionelle Neurologique, Hopital de la Salpetriere, Paris, France
| | - Y. Agid
- INSERM U 289 and Federation de Neurologie, and Service de Reeducation Fonctionelle Neurologique, Hopital de la Salpetriere, Paris, France
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Bonnet AM, Pichon J, Vidailhet M, Gouider-Khouja N, Robain G, Perrigot M, Agid Y. Urinary disturbances in striatonigral degeneration and Parkinson's disease: clinical and urodynamic aspects. Mov Disord 1997; 12:509-13. [PMID: 9251068 DOI: 10.1002/mds.870120406] [Citation(s) in RCA: 53] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Although urinary disturbances are more frequent in multiple system atrophy (MSA) than in Parkinson's disease (PD), the striatonigral degeneration (SND) type of MSA is difficult to distinguish from PD, especially when the latter is associated with orthostatic hypotension or urinary symptoms. The pattern of urinary symptoms and urodynamic dysfunction was analyzed in 15 SND and 35 PD patients with urinary complaints. In SND, dysuria with or without chronic retention, frequently associated with a hypoactive detrusor and low urethral pressure, permitted early and reliable diagnosis. In PD, urgency to void, with or without difficulty voiding, but without chronic retention, associated with detrusor hyperreflexia and normal urethral sphincter function, predominated. In clinical practice, the study of urinary symptoms and bladder function may help to distinguish SND from PD in patients with urinary disturbances.
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Affiliation(s)
- A M Bonnet
- INSERM U 289, Hôpital de la Salpêtrière, Paris, France
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Moutard ML, Robain G, Ponsot G. Reproductibilité de la cystomanométrie chez l'enfant. Neurophysiol Clin 1997. [DOI: 10.1016/s0987-7053(97)85711-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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Robain G, Combrisson H, Perrigot M. Effects of metoclopramide on the urethral pressure profile of healthy dogs. J Urol 1995; 154:1545-7. [PMID: 7658587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
PURPOSE The purpose of the present work was to study the effect of metoclopramide on urethral pressure since urethral relaxation is an important factor in vesical voiding. MATERIALS AND METHODS Urethral pressure was measured in 6 dogs, anesthetized with propofol before and 1, 5 and 10 minutes after the administration of metoclopramide (0.5 mg/kg.) or placebo. RESULTS A single injection of metoclopramide induced a large decrease in maximal urethral closure pressure (53 to 90%; mean 71%, p < 0.001--Anova). The decrease with placebo, 5 to 44% (mean 26%), was not significant (Anova test: p = 0.06). CONCLUSION It is argued that a central dopaminergic action most probably accounts for this effect of metoclopramide on urethral pressure.
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Affiliation(s)
- G Robain
- Department of Rehabilitation, Hôpital Jean Rostand, Ivry/Seine, France
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