1
|
Werneburg GT, Stoffel JT. Bladder Compliance: How We Define It and Why It Is Important. Urol Clin North Am 2024; 51:209-220. [PMID: 38609193 DOI: 10.1016/j.ucl.2023.12.001] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/14/2024]
Abstract
Bladder compliance is the relationship between detrusor pressure and bladder storage volume. We discuss the definition of compliance, how it may be accurately measured, and its clinical relevance. Specifically, we discuss the association between low compliance and upper urinary tract deterioration. We discuss medical and surgical therapies that have been demonstrated to improve compliance and reduce upper tract risk. Finally, we propose a model, which not only considers compliance but also differential pressure between the bladder and ureters, and how this may also be an accurate predictor of upper tract deterioration. We call for further investigation to test this model.
Collapse
Affiliation(s)
- Glenn T Werneburg
- Department of Urology, Glickman Urological and Kidney Institute, Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, OH 44195, USA.
| | - John T Stoffel
- Department of Urology, Neurourology and Pelvic Reconstruction Division, University of Michigan, 3875 Taubman Center, 1500 East Medical Center Drive, Ann Arbor, MI 48109, USA
| |
Collapse
|
2
|
Stoffel JT. Neurogenic Bladder: A Complex Puzzle with Multiple Pieces. Urol Clin North Am 2024; 51:xvii-xix. [PMID: 38609205 DOI: 10.1016/j.ucl.2024.02.008] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/14/2024]
Affiliation(s)
- John T Stoffel
- Department of Urology, University of Michigan, 3875 Taubman Center, 1500 East Medical Center Drive, Ann Arbor, MI 48109, USA.
| |
Collapse
|
3
|
Atiemo HO, Stoffel JT. A Primer for Primary Care Physicians Managing Neurogenic Bladder Patients. Urol Clin North Am 2024; 51:305-311. [PMID: 38609202 DOI: 10.1016/j.ucl.2024.02.003] [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] [Indexed: 04/14/2024]
Abstract
Primary care plays an important role in caring for neurogenic bladder patients. Clinicians should assess neurogenic bladder patients for common urologic symptoms/signs and refer to urology if refractory or safety issues are identified.
Collapse
Affiliation(s)
- Humphrey O Atiemo
- Department of Urology, Vattikuti Urology Institute, Henry Ford Hospital, Promedica Health System, 2142 North Cove Boulevard, Toledo, OH 43606, USA.
| | - John T Stoffel
- Division of Neurourology and Pelvic Reconstruction, Department of Urology, University of Michigan, 3875 Taubman Center, 1500 East Medical Center Drive, Ann Arbor, MI 48109, USA
| |
Collapse
|
4
|
Stoffel JT, Yu L. Urinary Catheters: Materials, Coatings, and Recommendations for Selection. Urol Clin North Am 2024; 51:253-262. [PMID: 38609197 DOI: 10.1016/j.ucl.2024.01.003] [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] [Indexed: 04/14/2024]
Abstract
Urinary catheters have been used for more than 3000 years, although materials have changed from wood to silver to rubber. Research continues to try and find the optimal catheter materials, which improve safety and quality of life. Advantages when comparing newer catheter materials are not always obvious but catheters coated with a hydrophilic layer may reduce urethral trauma and the incidence of urinary tract infections. However, extrapolation of the data is limited by lack of end-point standardization and heterogenous populations.
Collapse
Affiliation(s)
- John T Stoffel
- Department of Urology, University of Michigan, 3875 Taubman Center, 1500 East Medical Center Drive, Ann Arbor, MI 48109, USA.
| | - Lisa Yu
- Neurourology/Incontinence/Reconstruction, University of Michigan/Michigan Medicine, 1500 East Medical Center Drive, Ann Arbor, MI 48109, USA
| |
Collapse
|
5
|
Loftus CJ, Ratanawong JP, Myers JB, Lenherr SM, Stoffel JT, Welk B, Grove S, Elliott SP. Bladder management is the top health concern among adults with a spinal cord injury. Neurourol Urodyn 2024; 43:449-458. [PMID: 38116927 DOI: 10.1002/nau.25369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Revised: 11/10/2023] [Accepted: 12/07/2023] [Indexed: 12/21/2023]
Abstract
INTRODUCTION AND OBJECTIVE Individuals with spinal cord injury (SCI) commonly experience secondary complications though it is not known how they prioritize these different health domains. Using the Neurogenic Bladder Research Group (NBRG) SCI registry, our objective was to identify the top health concerns of individuals with SCI and identify factors that may be associated with these choices with particular focus on urologic issues that participants face. METHODS Participants in the NBRG registry were asked: "What are the top 3 problems that affect you on a daily basis?" Urinary symptoms and QoL were assessed with the Neurogenic Bladder Symptom Score (NBSS). Multivariate regression was used to identify factors related to selecting a top ranked health issue. RESULTS Among our 1461 participants, 882 (60.4%) were men and the median age was 45.1 years (IQR 25.3-64.9). Bladder management was the most commonly top ranked primary issue (39%) followed by pain (16.4%) and bowel management (11.6%). Factors associated with ranking bladder management as the primary concern included years since injury (OR 1.01 [1.00-1.02], p = 0.042), higher (worse) total NBSS (OR 1.05 [1.03-1.06], p < 0.001), and higher (worse) NBSS QoL (OR 1.25 [1.12-1.41], p < 0.001). Reporting chronic pain on a daily basis was associated with ranking pain as the primary health concern (OR 41.7 [15.7-170], p < 0.001). CONCLUSIONS In this cohort, bladder management was ranked as the top health issue and increasing time from injury was associated with increased concern over bladder management. More bladder symptoms were also associated with ranking bladder management as a primary concern while bladder management method and urinary tract infections rate were not.
Collapse
Affiliation(s)
| | - John P Ratanawong
- Department of Urology, University of Minnesota, Minneapolis, Minnesota, USA
| | - Jeremy B Myers
- Department of Surgery, Division of Urology, University of Utah, Salt Lake City, Utah, USA
| | - Sara M Lenherr
- Department of Surgery, Division of Urology, University of Utah, Salt Lake City, Utah, USA
| | - John T Stoffel
- Department of Urology, University of Michigan, Ann Arbor, Michigan, USA
| | - Blayne Welk
- Department of Surgery, Western University, London, Ontario, Canada
| | - Shawn Grove
- Department of Urology, University of Minnesota, Minneapolis, Minnesota, USA
| | - Sean P Elliott
- Department of Urology, University of Minnesota, Minneapolis, Minnesota, USA
| |
Collapse
|
6
|
Sandhu JS, Bixler BR, Dahm P, Goueli R, Kirkby E, Stoffel JT, Wilt TJ. Management of Lower Urinary Tract Symptoms Attributed to Benign Prostatic Hyperplasia (BPH): AUA Guideline Amendment 2023. J Urol 2024; 211:11-19. [PMID: 37706750 DOI: 10.1097/ju.0000000000003698] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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: 08/29/2023] [Accepted: 08/31/2023] [Indexed: 09/15/2023]
Abstract
PURPOSE The purpose of this American Urological Association (AUA) Guideline amendment is to provide a useful reference on the effective evidence-based management of male lower urinary tract symptoms secondary/attributed to BPH (LUTS/BPH). MATERIALS AND METHODS The Minnesota Evidence Review Team searched Ovid MEDLINE, the Cochrane Library, and the Agency for Healthcare Research and Quality (AHRQ) database to identify studies relevant to the management of BPH. The guideline was updated in 2023 to capture eligible literature published between September 2020 and October 2022. When sufficient evidence existed, the body of evidence was assigned a strength rating of A (high), B (moderate), or C (low) for support of Strong, Moderate, or Conditional Recommendations. In the absence of sufficient evidence, additional information is provided as Clinical Principles and Expert Opinions. RESULTS The BPH amendment resulted in changes to statements/supporting text on combination therapy, photoselective vaporization of the prostate (PVP), water vapor thermal therapy (WVTT), laser enucleation, and prostate artery embolization (PAE). A new statement on temporary implanted prostatic devices (TIPD) was added. In addition, statements on transurethral needle ablation (TUNA) and transurethral microwave thermotherapy (TUMT) were removed and information regarding these legacy technologies was added to the background section. References and the accompanying treatment algorithms were updated to align with the updated text. CONCLUSION This guideline seeks to improve clinicians' ability to evaluate and treat patients with BPH/LUTS based on currently available evidence. Future studies will be essential to further support these statements to improve patient care.
Collapse
Affiliation(s)
| | | | - Philipp Dahm
- Research and Education for Surgical Services at the Minneapolis Veterans Administration Medical Center, Minneapolis, Minnesota
| | | | - Erin Kirkby
- American Urological Association, Linthicum, Maryland
| | | | - Timothy J Wilt
- Research and Education for Surgical Services at the Minneapolis Veterans Administration Medical Center, Minneapolis, Minnesota
| |
Collapse
|
7
|
Myers JB, Stoffel JT, Elliott SP, Welk B, Herrick JS, Lenherr SM. Sex Differences in Bladder Management, Symptoms, and Satisfaction After Spinal Cord Injury. J Urol 2023; 210:659-669. [PMID: 37395612 DOI: 10.1097/ju.0000000000003611] [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: 10/09/2022] [Accepted: 06/20/2023] [Indexed: 07/04/2023]
Abstract
PURPOSE We sought to characterize sex-stratified differences in bladder management and bladder symptoms and satisfaction after spinal cord injury. MATERIALS AND METHODS This study was a prospective, cross-sectional, observational study; eligibility included: age ≥18 years and acquired spinal cord injury. Bladder management was grouped as (1) clean intermittent catheterization, (2) indwelling catheter, (3) surgery, and (4) voiding. Primary outcome was Neurogenic Bladder Symptom Score. Secondary outcomes were subdomains of the Neurogenic Bladder Symptom Score and bladder-related satisfaction. Multivariable regression was used in sex-stratified models to establish associations between participant characteristics and outcomes. RESULTS A total of 1,479 participants enrolled in the study. Of the patients 843 (57%) were paraplegic and 585 (40%) were women. Median age and time from injury were 44.9 (IQR 34.3, 54.1) and 11 (IQR 5.1, 22.4) years. Women utilized clean intermittent catheterization at a lower rate (42.6% vs 56.5%) and surgery at a higher rate (22.6% vs 7.0%), especially catheterizable channel creation with or without augmentation cystoplasty (11.0% vs 1.9%). Women had worse measures of bladder symptoms and satisfaction across all outcomes. In adjusted analyses, women and men utilizing indwelling catheters had fewer associated overall symptoms (Neurogenic Bladder Symptom Score), less incontinence, and fewer storage and voiding symptoms. Surgery was associated with fewer bladder symptoms (Neurogenic Bladder Symptom Score) and less incontinence in women, and was also associated with better satisfaction in both sexes. CONCLUSIONS There are significant sex-stratified differences in bladder management after spinal cord injury, which included a much higher use of surgery. Bladder symptoms and satisfaction are worse across all measurements in women. Women have a substantial associated benefit with surgery, while both sexes have fewer bladder symptoms with indwelling catheters compared to clean intermittent catheterization.
Collapse
Affiliation(s)
- Jeremy B Myers
- Department of Surgery (Urology), University of Utah, Salt Lake City, Utah
| | - John T Stoffel
- Department of Urology, University of Michigan, Ann Arbor, Michigan
| | - Sean P Elliott
- Department of Urology, University of Minnesota, Minneapolis, Minnesota
| | | | - Jennifer S Herrick
- Division of Epidemiology and Biostatistics, Department of Internal Medicine, University of Utah, Salt Lake City, Utah
| | - Sara M Lenherr
- Department of Surgery (Urology), University of Utah, Salt Lake City, Utah
| |
Collapse
|
8
|
Affiliation(s)
- Giulia I Lane
- Department of Urology, Division of Neurourology and Pelvic Reconstruction, University of Michigan, Ann Arbor, MI.
| | - John T Stoffel
- Department of Urology, Division of Neurourology and Pelvic Reconstruction, University of Michigan, Ann Arbor, MI
| |
Collapse
|
9
|
Sadeghi Z, Bethel EC, Daignault-Newton S, Barboglio Romo PG, Cameron AP, Clemens JQ, Gupta P, Yi Y, Stoffel JT. MP18-09 DOES SOCIOECONOMIC STATUS IMPACT CONTINUATION OF ONABOTULINUM TOXIN THERAPY FOR URGENCY URINARY INCONTINENCE? J Urol 2022. [DOI: 10.1097/ju.0000000000002551.09] [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: 11/25/2022]
|
10
|
Kasabwala K, Borofsky M, Grove S, Lenherr SM, Myers JB, Stoffel JT, Welk B, Elliott SP. Association of stone surgery with patient-reported complications after spinal cord injury. Neurourol Urodyn 2022; 41:820-829. [PMID: 35114016 DOI: 10.1002/nau.24887] [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: 08/26/2021] [Revised: 12/08/2021] [Accepted: 01/13/2022] [Indexed: 11/08/2022]
Abstract
AIMS To determine if a history of urinary stone surgery in individuals with spinal cord injury (SCI) is associated with an increased incidence of SCI-related complications and lower quality of life (QOL). METHODS The Neurogenic Bladder Research Group (NBRG) registry is a multicenter, prospective, observational study which measures QOL after acquired SCI. Over 1.5 years, 1479 participants were enrolled and grouped according to history of stone surgery. We evaluated SCI-related complications, QOL, and associations between patient factors and prior stone surgery using multivariable regression. RESULTS Participants were a median of 11 years post-SCI and 189 (12.8%) reported prior bladder or kidney stone surgery; 95.8% of these occurred after the SCI. Median time between SCI and first stone was 5.6 years (IQR: 1.8-12.8). Hospitalizations were higher for those with prior stone surgery, with common reasons including UTIs, blood clots, pressure ulcers, and pneumonia (p < 0.001). During the year of observation, the incidence of stone surgery was 17% in those with a prior history of stone surgery and 2% per year in those without prior stone surgery (p < 0.001). Controlling for covariates, bladder management strategy, age, BMI, and years since SCI were associated with history of stone surgery. CONCLUSIONS People with SCI and a history of surgical stone disease are at high risk for episodes of recurrent stones and increased hospitalizations, particularly those with kidney stones and indwelling catheter use. Identification of high-risk patients may guide tailored surveillance for complications and stone prevention strategies.
Collapse
Affiliation(s)
- Khushabu Kasabwala
- Department of Urology, University of Minnesota, Minneapolis, Minnesota, USA
| | - Michael Borofsky
- Department of Urology, University of Minnesota, Minneapolis, Minnesota, USA
| | - Shawn Grove
- Department of Urology, University of Minnesota, Minneapolis, Minnesota, USA
| | - Sara M Lenherr
- Division of Urology, University of Utah, Salt Lake City, Utah, USA
| | - Jeremy B Myers
- Division of Urology, University of Utah, Salt Lake City, Utah, USA
| | - John T Stoffel
- Department of Urology, University of Michigan, Ann Arbor, Michigan, USA
| | - Blayne Welk
- Department of Surgery (Urology), Western University, London, Ontario, Canada
| | - Sean P Elliott
- Department of Urology, University of Minnesota, Minneapolis, Minnesota, USA
| |
Collapse
|
11
|
Moghalu O, Stoffel JT, Elliott S, Welk B, Lenherr S, Herrick J, Presson A, Myers J. Psychosocial aspects of health-related quality of life and the association with patient-reported bladder symptoms and satisfaction after spinal cord injury. Spinal Cord 2021; 59:987-996. [PMID: 33495582 PMCID: PMC8483561 DOI: 10.1038/s41393-020-00609-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Revised: 12/10/2020] [Accepted: 12/11/2020] [Indexed: 01/28/2023]
Abstract
STUDY DESIGN Prospective, multi-centered, observational. OBJECTIVES To characterize the relationship between psychosocial aspects of health-related quality of life (HRQoL) and patient-reported bladder outcomes. SETTING Multi-institutional sites in the United States, cohort drawn from North America. METHODS We performed a cross-sectional analysis of data collected as part of the multicenter, prospective Neurogenic Bladder Research Group Spinal Cord Injury (SCI) Registry. Outcomes were: Neurogenic Bladder Symptom Score (NBSS), Neurogenic Bladder Symptom Score Satisfaction (NBSS-Satisfaction), and SCI-QoL Bladder Management Difficulties (SCI-QoL Difficulties). Adjusted multiple linear regression models were used with variables including demographic, injury characteristics, and the following psychosocial HRQoL measures; SCI-QoL Pain Interference (Pain), SCI-QoL Independence, and SCI-QoL Positive Affect and Well-being (Positive Affect). Psychosocial variables were sub-divided by tertiles for the analysis. RESULTS There were 1479 participants, 57% had paraplegia, 60% were men, and 51% managed their bladder with clean intermittent catheterization. On multivariate analysis, higher tertiles of SCI-QoL Pain were associated with worse bladder symptoms, satisfaction, and bladder management difficulties; upper tertile SCI-QoL Pain (NBSS 3.8, p < 0.001; NBSS-satisfaction 0.6, p < 0.001; SCI-QoL Difficulties 2.4, p < 0.001). In contrast, upper tertiles of SCI-QoL Independence and SCI-QoL Positive Affect were associated with improved bladder-related outcomes; upper tertile SCI-QoL Independence (NBSS -2.3, p = 0.03; NBSS-satisfaction -0.4, p < 0.001) and upper tertile SCI-QoL Positive Affect (NBSS -2.8, p < 0.001; NBSS-satisfaction -0.7, p < 0.001; SCI-QoL Difficulties -0.7, p < 0.001). CONCLUSIONS In individuals with SCI, there is an association between psychosocial HRQoL and bladder-related QoL outcomes. Clinician awareness of this relationship can provide insight into optimizing long-term management after SCI.
Collapse
Affiliation(s)
- Odinachi Moghalu
- Department of Surgery (Urology), University of Utah, Salt Lake City, UT, USA.
| | - John T Stoffel
- Department of Urology, University of Michigan, Ann Arbor, MI, USA
| | - Sean Elliott
- Department of Urology, University of Minnesota, Minneapolis, MN, USA
| | - Blayne Welk
- Department of Urology, Western University, London, ON, Canada
| | - Sara Lenherr
- Department of Surgery (Urology), University of Utah, Salt Lake City, UT, USA
| | - Jennifer Herrick
- Department of Internal Medicine, Division of Epidemiology and Biostatistics, University of Utah, Salt Lake City, UT, USA
| | - Angela Presson
- Department of Internal Medicine, Division of Epidemiology and Biostatistics, University of Utah, Salt Lake City, UT, USA
| | - Jeremy Myers
- Department of Surgery (Urology), University of Utah, Salt Lake City, UT, USA
| |
Collapse
|
12
|
Corona LE, Sion NR, Cameron AP, Barboglio Romo PG, Stoffel JT. Intermittent catheterization and urinary tract infection in multiple sclerosis patients. Can J Urol 2020; 27:10294-10299. [PMID: 32861254] [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] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
INTRODUCTION We sought to investigate whether starting clean intermittent catheterization (CIC) for multiple sclerosis (MS) patients with lower urinary tract symptoms (LUTS) and elevated post-void residual (PVR) would improve urinary quality of life (QoL) and decrease risk of urinary tract infection (UTI). MATERIALS AND METHODS We retrospectively reviewed an institutional data base for MS patients with PVR > 100 mL and obstructive LUTS. Patients were categorized by subsequent choice of treatment: CIC versus medical treatment. Outcomes compared over 1-year follow up included incidence of UTI, urinary QoL, emergency room visits, and adherence to therapy. RESULTS Between 2014 and 2017, 37 patients met inclusion criteria. Nineteen patients started daily CIC, while 18 patients had pharmacologic therapy. At 1-year follow up, the CIC group had less improvement in urinary symptoms (26% improvement from baseline versus 72%, p = 0.02) and 7 times greater odds of having minimum one UTI within 1 year (OR 6.8, p = 0.01). The CIC group was also more likely to start an additional treatment for LUTS, and to visit the ED (all p < 0.05). CONCLUSIONS In this group of MS patients with LUTS and elevated PVR, initiation of CIC was associated with increased incidence of UTI and less improvement in urinary symptoms over the subsequent year compared to pharmacologic treatment.
Collapse
Affiliation(s)
- Lauren E Corona
- Department of Urology, University of Michigan, Ann Arbor, Michigan, USA
| | | | | | | | | |
Collapse
|
13
|
Abstract
Aim: We sought to compare the outcomes of patients who underwent an open vs robotic ureteroneocystostomy for ureteral obstruction. Methods: Retrospective review was performed on adult patients who underwent primary ureteroneocystostomy for obstruction from January 2012 to April 2018. Intraoperative outcomes of estimated blood loss (EBL) and operative time, as well as postoperative outcomes of catheter and stent duration, length of hospital stay, inpatient nurse-controlled opioid use, patient-controlled analgesia (PCA), and outpatient opioid prescription, complications, readmission, radiologic and clinical stricture recurrence, and follow-up, were compared. Among the open cohort, indications for an open approach were evaluated, identifying patients with prior complex open abdominal surgery that would make an open approach preferable. Results: Open ureteroneocystostomy was performed in 27 patients compared with 18 who underwent a robotic approach. The open and robotic cohorts were not significantly different in age, gender, Charlson comorbidity index, stricture location or side, abdominal surgery (laparoscopic or open), pelvic radiation, or preoperative urinary tract infection. The robotic group had a significantly lower rate of prior open abdominal surgery. The robotic cohort had significantly lower EBL, length of stay (LOS), catheter duration, prescribed morphine milliequivalents (MME) at discharge, and rate of PCA usage. Among the open cohort, 13 (48%) patients demonstrated indications making an open approach preferable. Comparing the robotic group with the remaining 14 open patients revealed a significantly lower rate of inpatient PCA use, prescribed MME at discharge, LOS, and catheter duration. Mean operative time was higher in the robotic group. EBL was not significantly different in this subanalysis. Conclusions: Robotic ureteroneocystostomy provides similar outcomes when compared with an open approach in well-selected patients when assessing for recurrent ureteral obstruction or adverse events. Robotic surgery is associated with lower postoperative narcotic pain prescriptions at discharge, lower PCA usage, and shorter LOS, which are important benefits when compared with open surgery.
Collapse
Affiliation(s)
- Peyton A Skupin
- University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - John T Stoffel
- Department of Urology, University of Michigan, Ann Arbor, Michigan, USA
| | - Bahaa S Malaeb
- Department of Urology, University of Michigan, Ann Arbor, Michigan, USA
| | | | - Sapan N Ambani
- Department of Urology, University of Michigan, Ann Arbor, Michigan, USA
| |
Collapse
|
14
|
Cheng PJ, Keihani S, Roth JD, Pariser JJ, Elliott SP, Bose S, Khavari R, Crescenze I, Stoffel JT, Velaer KN, Elliott CS, Raffee SM, Atiemo HO, Kennelly MJ, Lenherr SM, Myers JB. Contemporary multicenter outcomes of continent cutaneous ileocecocystoplasty in the adult population over a 10‐year period: A Neurogenic Bladder Research Group study. Neurourol Urodyn 2020; 39:1771-1780. [DOI: 10.1002/nau.24420] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Accepted: 05/25/2020] [Indexed: 12/25/2022]
Affiliation(s)
| | - Sorena Keihani
- Division of UrologyUniversity of Utah Salt Lake City Utah
| | - Joshua D. Roth
- Department of UrologyIndiana University School of Medicine Indianapolis Indiana
| | | | - Sean P. Elliott
- Department of UrologyUniversity of Minnesota Minneapolis Minnesota
| | - Sanchita Bose
- Department of UrologyHouston Methodist Hospital Houston Texas
| | - Rose Khavari
- Department of UrologyHouston Methodist Hospital Houston Texas
| | - Iryna Crescenze
- Department of UrologyUniversity of Michigan Ann Arbor Michigan
| | - John T. Stoffel
- Department of UrologyUniversity of Michigan Ann Arbor Michigan
| | - Kyla N. Velaer
- Department of UrologyStanford University Stanford California
| | - Christopher S. Elliott
- Department of UrologyStanford University Stanford California
- Division of UrologySanta Clara Valley Medical Center San Jose California
| | | | | | | | | | | |
Collapse
|
15
|
Lane GI, Mao-Draayer Y, Barboglio-Romo P, Clemens JQ, Gupta P, Dunn R, Qin Y, Cameron AP, Stoffel JT. A prospective observational cohort study of posterior tibial nerve stimulation in patients with multiple sclerosis: design and methods. BMC Urol 2020; 20:58. [PMID: 32460741 PMCID: PMC7251681 DOI: 10.1186/s12894-020-00629-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2019] [Accepted: 05/14/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Posterior tibial nerve stimulation (PTNS) is a promising treatment for lower urinary tract symptoms (LUTS) in patients with MS. However, long term data focusing on PTNS impact on health-related quality of life (HRQOL), bowel and bladder symptoms are lacking. This paper describes a study protocol that examines the extended efficacy of PTNS on MS related bladder and bowel symptoms and resulting HRQOL. METHODS/DESIGN This is a single-centered, prospective, longitudinal, observational cohort study of patients with MS who suffer from LUTS and are refractory to two prior treatment modalities. Participants who have elected to pursue PTNS therapy for LUTS will be eligible. The primary outcome is the median number of urinary frequency and incontinence episodes on a 3-day voiding diary at 3, 12 and 24 months compared to baseline. Secondary outcome measures will include change in total AUA-SS, M-ISI, NBSS, SF-12, SSS and BCS scores from baseline The Expanded Disability Status Scale and magnetic resonance imaging will be evaluated at baseline and annually throughout the study. DISCUSSION This research protocol aims to expand on the existing literature regarding outcomes of PTNS in MS. Specifically, it will provide long term follow-up data on bladder, bowel, sexual and HRQOL outcomes. The completion of this study will provide longitudinal efficacy data of the impact of PTNS in MS patients. TRIAL REGISTRATION NCT04063852.
Collapse
Affiliation(s)
- Giulia I Lane
- Department of Urology, University of Michigan, 1500 East Medical Drive, Taubman Center 3875, Ann Arbor, MI, 48109, USA.
| | - Yang Mao-Draayer
- Department of Neurology, University of Michigan, Ann Arbor, MI, USA
| | - Paholo Barboglio-Romo
- Department of Urology, University of Michigan, 1500 East Medical Drive, Taubman Center 3875, Ann Arbor, MI, 48109, USA
| | - J Quentin Clemens
- Department of Urology, University of Michigan, 1500 East Medical Drive, Taubman Center 3875, Ann Arbor, MI, 48109, USA
| | - Priyanka Gupta
- Department of Urology, University of Michigan, 1500 East Medical Drive, Taubman Center 3875, Ann Arbor, MI, 48109, USA
| | - Rod Dunn
- Department of Urology, University of Michigan, 1500 East Medical Drive, Taubman Center 3875, Ann Arbor, MI, 48109, USA
| | - Yongmei Qin
- Department of Urology, University of Michigan, 1500 East Medical Drive, Taubman Center 3875, Ann Arbor, MI, 48109, USA
| | - Anne P Cameron
- Department of Urology, University of Michigan, 1500 East Medical Drive, Taubman Center 3875, Ann Arbor, MI, 48109, USA
| | - John T Stoffel
- Department of Urology, University of Michigan, 1500 East Medical Drive, Taubman Center 3875, Ann Arbor, MI, 48109, USA
| |
Collapse
|
16
|
Theisen KM, Mann R, Roth JD, Pariser JJ, Stoffel JT, Lenherr SM, Myers JB, Welk B, Elliott SP. Frequency of patient-reported UTIs is associated with poor quality of life after spinal cord injury: a prospective observational study. Spinal Cord 2020; 58:1274-1281. [PMID: 32409777 DOI: 10.1038/s41393-020-0481-z] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Revised: 04/28/2020] [Accepted: 04/29/2020] [Indexed: 11/09/2022]
Abstract
STUDY DESIGN Cross-sectional survey of the Neurogenic Bladder Research Group (NBRG) registry; a multicenter prospective observation study. OBJECTIVES To assess how patient-reported urinary tract infections (PRUTIs) in spinal cord injury (SCI) affect quality of life (QOL). SETTING Multiple United States hospitals. METHODS 1479 participants with SCI were asked about neurogenic bladder-related QOL. Eligibility: age ≥ 18 years with acquired SCI. PRUTI frequency over the last year was classified as 0, 1-3, 4-6, or >6. Four UTI QOL domains were assessed: (1) UTIs limited daily activities, (2) UTIs caused increased muscle spasms, (3) UTIs would not go away, and (4) UTIs made me avoid going out. Multivariable regression identified variables associated with poor QOL. RESULTS PRUTI frequency was 0 in 388 patients (26%), 1-3 in 677 (46%), 4-6 in 223 (15%), and more than 6 in 190 (13%). Increasing PRUTI rate was independently associated with worse QOL for all four questions. Compared with those with 0 PRUTIs, participants reporting >6 were more likely to limit daily activities (OR 9.0 [95% CI 8.1-21.2] p < 0.0001), experience increased muscle spasms (OR 12.4 [95% CI 7.5-20.6] p < 0.0001), perceive a UTI would not go away (OR 30.1 [95% CI 15.0-60.4] p < 0.0001), and avoid going out because of UTIs (OR 7.2 [95% CI 4.2-12.4] p < 0.0001). CONCLUSIONS An increasing rate of PRUTIs is independently associated with worse QOL. Thorough evaluation and treatment may improve QOL in this population.
Collapse
Affiliation(s)
| | - Rachel Mann
- University of Minnesota, Minneapolis, MN, USA
| | | | | | - John T Stoffel
- University of Michigan, Ann Arbor, MI, USA.,Neurogenic Bladder Research Group, Salt Lake City, Utah, USA
| | - Sara M Lenherr
- Neurogenic Bladder Research Group, Salt Lake City, Utah, USA.,University of Utah, Salt Lake City, UT, USA
| | - Jeremy B Myers
- Neurogenic Bladder Research Group, Salt Lake City, Utah, USA.,University of Utah, Salt Lake City, UT, USA
| | - Blayne Welk
- Neurogenic Bladder Research Group, Salt Lake City, Utah, USA.,Western University, London, ON, Canada
| | - Sean P Elliott
- University of Minnesota, Minneapolis, MN, USA.,Neurogenic Bladder Research Group, Salt Lake City, Utah, USA
| |
Collapse
|
17
|
Lane GI, Crescenze I, Clemens JQ, Stoffel JT, Cameron AP, Romo PB, Gupta P. Depth and Location of Sacral Suture Placement During Cadaveric Simulation of Open Sacrocolpopexy. Urology 2020; 150:219-222. [PMID: 32360628 DOI: 10.1016/j.urology.2020.04.078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Revised: 03/24/2020] [Accepted: 04/19/2020] [Indexed: 11/27/2022]
Abstract
OBJECTIVES To evaluate the location and depth of placement of sacral sutures in a cadaveric sacrocolpopexy model. MATERIALS AND METHODS Following a 1-hour instructional session, trainees performed an open sacrocolpopexy on unembalmed cadavers under guidance by a Female Pelvic Medicine & Reconstructive Surgery board-certified surgeon. At completion of the session, the presacral tissues were dissected and the location and depth of each sacral suture was identified. RESULTS A total of 19 sutures were placed by 9 trainees into 8 cadavers. The majority of sutures (14/19, 74%) were placed between L5 and S1. Three sutures (16%) were placed at L5 and 2 (11%) were placed at the S1 vertebral body. The mean depth of the anterior longitudinal ligament (ALL) was 1.4 mm. When assessing depth of suture placement, 13 of 19 (68%) were placed into the ALL without penetrating the disc space. Two sutures (11%) were placed in the tissues superficial to the ALL and 4 (22%) were placed deep to the ALL into the periosteum or disc. CONCLUSION This study of cadaveric simulation of open sacrocolpopexy finds that location of sacral suture placement is most commonly at the level of the L5-S1 disc space and that placement of sutures into the underlying disc occurs about 1 in 5 times.
Collapse
Affiliation(s)
- Giulia I Lane
- University of Michigan, Department of Urology, Division of Neurourology and Pelvic Reconstruction, Ann Arbor, MI.
| | | | - James Quentin Clemens
- University of Michigan, Department of Urology, Division of Neurourology and Pelvic Reconstruction, Ann Arbor, MI
| | - John T Stoffel
- University of Michigan, Department of Urology, Division of Neurourology and Pelvic Reconstruction, Ann Arbor, MI
| | - Anne P Cameron
- University of Michigan, Department of Urology, Division of Neurourology and Pelvic Reconstruction, Ann Arbor, MI
| | - Paholo Barboglio Romo
- University of Michigan, Department of Urology, Division of Neurourology and Pelvic Reconstruction, Ann Arbor, MI
| | - Priyanka Gupta
- University of Michigan, Department of Urology, Division of Neurourology and Pelvic Reconstruction, Ann Arbor, MI
| |
Collapse
|
18
|
Patel DP, Herrick JS, Stoffel JT, Elliott SP, Lenherr SM, Presson AP, Welk B, Jha A, Myers JB. Reasons for cessation of clean intermittent catheterization after spinal cord injury: Results from the Neurogenic Bladder Research Group spinal cord injury registry. Neurourol Urodyn 2019; 39:211-219. [PMID: 31578784 DOI: 10.1002/nau.24172] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [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: 06/28/2019] [Accepted: 09/12/2019] [Indexed: 11/06/2022]
Abstract
INTRODUCTION Clean intermittent catheterization (CIC) is recommended for bladder management after spinal cord injury (SCI) since it has the lowest complication rate. However, transitions from CIC to other less optimal strategies, such as indwelling catheters (IDCs) are common. In individuals with SCI who stopped CIC, we sought to determine how individual characteristics affect the bladder-related quality of life (QoL) and the reasons for CIC cessation. METHODS The Neurogenic Bladder Research Group registry is an observational study, evaluating neurogenic bladder-related QoL after SCI. From 1479 participants, those using IDC or urinary conduit were asked if they had ever performed CIC, for how long, and why they stopped CIC. Multivariable regression, among participants discontinuing CIC, established associations between demographics, injury characteristics, and SCI complications with bladder-related QoL. RESULTS There were 176 participants who had discontinued CIC; 66 (38%) were paraplegic and 110 (63%) were male. The most common reasons for CIC cessation among all participants were inconvenience, urinary leakage, and too many urine infections. Paraplegic participants who discontinued CIC had higher mean age, better fine motor scores, and lower educational attainment and employment. Multivariable regression revealed years since SCI was associated with worse bladder symptoms (neurogenic bladder symptom score), ≥4 urinary tract infections (UTIs) in a year was associated with worse satisfaction and feelings about bladder symptoms (SCI-QoL difficulties), while tetraplegia was associated better satisfaction and feelings about bladder symptoms (SCI-QoL difficulties). CONCLUSIONS Tetraplegics who have discontinued CIC have an improved QoL compared with paraplegics. SCI individuals who have discontinued CIC and have recurrent UTIs have worse QoL.
Collapse
Affiliation(s)
- Darshan P Patel
- Division of Urology, Department of Surgery, University of Utah, Salt Lake City, Utah
| | - Jennifer S Herrick
- Division of Epidemiology and Biostatistics, Department of Internal Medicine, University of Utah, Salt Lake City, Utah
| | - John T Stoffel
- Department of Urology, University of Michigan, Ann Arbor, Michigan
| | - Sean P Elliott
- Department of Urology, University of Minnesota, Minneapolis, Minnesota
| | - Sara M Lenherr
- Division of Urology, Department of Surgery, University of Utah, Salt Lake City, Utah
| | - Angela P Presson
- Division of Epidemiology and Biostatistics, Department of Internal Medicine, University of Utah, Salt Lake City, Utah
| | - Blayne Welk
- Department of Surgery, University of Western Ontario, London, Ontario, Canada
| | - Amitabh Jha
- Department of Physical Medicine and Rehabilitation, University of Utah, Salt Lake City, Utah
| | - Jeremy B Myers
- Division of Urology, Department of Surgery, University of Utah, Salt Lake City, Utah
| | | |
Collapse
|
19
|
Crescenze IM, Gupta P, Adams G, Oldendorf A, Stoffel JT, Romo PGB, Clemens JQ, Cameron AP. Advanced Management of Patients With Ulcerative Interstitial Cystitis/Bladder Pain Syndrome. Urology 2019; 133:78-83. [PMID: 31442473 DOI: 10.1016/j.urology.2019.07.036] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Revised: 07/23/2019] [Accepted: 07/24/2019] [Indexed: 10/26/2022]
Abstract
OBJECTIVE To describe a stepwise management of patients with interstitial cystitis/bladder pain syndrome (IC/BPS) with Hunner's lesions and present single institution long-term outcomes. METHODS This is a retrospective review of a single tertiary center experience with management of patients with Hunner's lesions from January 2005 to January of 2015. Patients who met the diagnostic criteria for IC/BPS were included. Systematic approach to treatment of patients with Hunner's lesions is proposed based on our results. RESULTS Fifty-five patients with IC/BPS and Hunner's lesions were included. Mean age was 65.0 ±12.7 years, 76.4% (42/55) were female, and median symptom duration was 2 years (interquartile range [IQR] 1.7). All patients had a biopsy to rule out malignancy with therapeutic fulguration which resulted in subjective symptom improvement in 81.8% (45/55) and median time to repeat procedures was 12 months (IQR 621). Triamcinolone injection into the lesion was done in 35 patients and 91.4% (32/35) reported subjective improvement. Repeat injections were done for 74% (26/35) and median time between injections was 8 months (IQR 4, 13). AUA symptom scores and quality of life improved significantly with both treatment modalities. Adjunctive treatment with cyclosporine was used in 47.2% (26/55), and 7.2% (4/55) went on to have a cystectomy. CONCLUSION Patients with Hunner's lesions benefit from early progression from conservative treatments to endoscopic management. Excellent symptom control can be achieved with biopsy/fulguration and triamcinolone injections but recurrence is common and repeat treatments are needed for most patients.
Collapse
|
20
|
Myers JB, Lenherr SM, Stoffel JT, Elliott SP, Presson AP, Zhang C, Rosenbluth J, Jha A, Patel DP, Welk B. Patient Reported Bladder Related Symptoms and Quality of Life after Spinal Cord Injury with Different Bladder Management Strategies. J Urol 2019; 202:574-584. [PMID: 30958741 DOI: 10.1097/ju.0000000000000270] [Citation(s) in RCA: 50] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE Neurogenic bladder significantly impacts individuals after spinal cord injury. We hypothesized that there would be differences in bladder related symptoms and quality of life for 4 common bladder management methods. MATERIALS AND METHODS In this prospective observational study we measured neurogenic bladder related quality of life after spinal cord injury. Study eligibility included age 18 years or greater and acquired spinal cord injury. Bladder management was grouped as 1) clean intermittent catheterization, 2) an indwelling catheter, 3) surgery (bladder augmentation, a catheterizable channel or urinary diversion) and 4) voiding (a condom catheter, involuntary leaking or volitional voiding). The primary outcomes were the NBSS (Neurogenic Bladder Symptom Score) and the SCI-QoL Difficulties (Spinal Cord Injury Quality of Life Measurement System Bladder Management Difficulties). Secondary outcomes were the NBSS subdomains and satisfaction with urinary function. Multivariable regression was done to establish differences between the groups, separated by level. RESULTS Of the 1,479 participants enrolled in the study 843 (57%) had paraplegia and 894 (60%) were men. Median age was 44.9 years (IQR 34.4-54.1) and median time from injury was 11 years (IQR 5.1-22.4). Bladder management was clean intermittent catheterization in 754 cases (51%), an indwelling catheter in 271 (18%), surgery in 195 (13%) and voiding in 259 (18%). In regard to primary outcomes, in cases of paraplegia and tetraplegia an indwelling catheter and surgery were associated with fewer urinary symptoms on the NBSS compared to clean intermittent catheterization while voiding was associated with more symptoms. In paraplegia and tetraplegia cases surgery was associated with fewer bladder management difficulties according to the SCI-QoL Difficulties. In regard to secondary outcomes, surgery was associated with improved satisfaction in individuals with paraplegia or tetraplegia. CONCLUSIONS In individuals with spinal cord injury fewer bladder symptoms were associated with an indwelling catheter and surgery, and worse bladder symptoms were noted in voiding individuals compared to those on clean intermittent catheterization. Satisfaction with the urinary system was improved after surgery compared to clean intermittent catheterization.
Collapse
Affiliation(s)
- Jeremy B Myers
- Department of Surgery (Urology), University of Utah, Salt Lake City, Utah
| | - Sara M Lenherr
- Department of Surgery (Urology), University of Utah, Salt Lake City, Utah
| | - John T Stoffel
- Departments of Urology, University of Michigan, Ann Arbor, Michigan
| | | | - Angela P Presson
- Division of Epidemiology and Biostatistics, Department of Internal Medicine, University of Utah, Salt Lake City, Utah
| | - Chong Zhang
- Division of Epidemiology and Biostatistics, Department of Internal Medicine, University of Utah, Salt Lake City, Utah
| | - Jeffery Rosenbluth
- Department of Physical Medicine and Rehabilitation, University of Utah, Salt Lake City, Utah
| | - Amitabh Jha
- Department of Physical Medicine and Rehabilitation, Salt Lake City Veterans Medical Center, Salt Lake City, Utah
| | - Darshan P Patel
- Department of Surgery (Urology), University of Utah, Salt Lake City, Utah
| | | | | |
Collapse
|
21
|
Elliott CS, Stoffel JT, Myers JB, Lenherr SM, Welk B, Elliott SP, Shem K. Validation of Upper Extremity Motor Function as a Key Predictor of Bladder Management After Spinal Cord Injury. Arch Phys Med Rehabil 2019; 100:1939-1944. [PMID: 31348899 DOI: 10.1016/j.apmr.2019.06.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [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: 03/06/2019] [Revised: 05/17/2019] [Accepted: 06/18/2019] [Indexed: 10/26/2022]
Abstract
OBJECTIVE To validate if better upper extremity (UE) motor function predicts clean intermittent catheterization (CIC) adoption and adherence after spinal cord injury (SCI) using a validated instrument (as opposed to prior research using scales based on expert opinion). DESIGN We examined data from the Neurogenic Bladder Research Group SCI registry, a multicenter, prospective, observational study assessing persons with neurogenic bladder following SCI. All participants who were unable to volitionally void and were >1 year post injury were included. Participants were dichotomized into those performing CIC vs those using other bladder management methods. In addition to demographic and clinical characteristics, UE motor function was examined using the SCI-Fine Motor Function Index using validated categorization levels: (1) no activities requiring hand function, (2) some activities involving gross hand movement, (3) some activities requiring dexterity or coordinated UE movement, or (4) most activities requiring dexterity and coordinated UE movement. Associations were examined using logistic regression. SETTING Multicenter study. PARTICIPANTS Registry participants unable to volitionally void after SCI (N=1236). INTERVENTION Not applicable. MAIN OUTCOME MEASURE Upper extremity motor function association with CIC. RESULTS A total of 1326 individuals met inclusion criteria (66% performing CIC, 60% male, and 82% white). On multivariate analysis, better UE motor function was associated with a statistically increased odds of performing CIC (odds ratio, 3.10 [Level 3] and odds ratio, 8.12 [Level 4] vs Levels 1 and 2 [P<.001]). CONCLUSION In persons with SCI who are unable to volitionally void, UE motor function is highly associated with CIC. These results validate prior findings and continue to suggest that following SCI, the degree of preserved UE motor function is associated with CIC more than any other factor.
Collapse
Affiliation(s)
- Christopher S Elliott
- Department of Urology, Stanford University Medical Center, Stanford, California; Division of Urology, Santa Clara Valley Medical Center, San Jose, California.
| | - John T Stoffel
- Department of Urology, University of Michigan, Ann Arbor, Michigan
| | - Jeremy B Myers
- Division of Urology, University of Utah, Salt Lake City, Utah
| | - Sara M Lenherr
- Division of Urology, University of Utah, Salt Lake City, Utah
| | - Blayne Welk
- Division of Urology, Western University, London, Ontario, Canada
| | - Sean P Elliott
- Department of Urology, University of Minnesota, Minneapolis, Minnesota
| | - Kazuko Shem
- Department of Physical Medicine and Rehabilitation, Santa Clara Valley Medical Center, Fruitdale, California
| |
Collapse
|
22
|
Lane GI, Roberts WW, Mann R, O'Dell D, Stoffel JT, Clemens JQ, Cameron AP. Outcomes of renal calculi in patients with spinal cord injury. Neurourol Urodyn 2019; 38:1901-1906. [DOI: 10.1002/nau.24091] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Accepted: 06/17/2019] [Indexed: 11/06/2022]
Affiliation(s)
- Giulia I. Lane
- Department of UrologyUniversity of Michigan Ann Arbor Michigan
| | | | - Rachel Mann
- Department of UrologyUniversity of Minnesota Minneapolis Minnesota
| | - Diana O'Dell
- Department of UrologyUniversity of Michigan Ann Arbor Michigan
| | - John T. Stoffel
- Department of UrologyUniversity of Michigan Ann Arbor Michigan
| | | | - Anne P. Cameron
- Department of UrologyUniversity of Michigan Ann Arbor Michigan
| |
Collapse
|
23
|
Crescenze IM, Myers JB, Lenherr SM, Elliott SP, Welk B, MPH DO, Qin Y, Presson AP, Stoffel JT. Predictors of low urinary quality of life in spinal cord injury patients on clean intermittent catheterization. Neurourol Urodyn 2019; 38:1332-1338. [DOI: 10.1002/nau.23983] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2018] [Revised: 10/21/2018] [Accepted: 11/16/2018] [Indexed: 11/05/2022]
Affiliation(s)
| | | | | | - Sean P. Elliott
- Department of UrologyUniversity of MinnesotaMinneapolis Michigan
| | - Blayne Welk
- Division of UrologyWestern UniversityLondon Ontario Toronto Canada
| | | | - Yongmei Qin
- Department of UrologyUniversity of MichiganAnn Arbor Michigan
| | | | - John T. Stoffel
- Department of UrologyUniversity of MichiganAnn Arbor Michigan
| | | |
Collapse
|
24
|
Srinivasan D, Stoffel JT, Bradley K, Sung RS. Outcomes of Kidney Transplant Recipients With Posttransplant Genitourinary Infectious Complications: A Single Center Study. EXP CLIN TRANSPLANT 2018; 17:470-477. [PMID: 30381050 DOI: 10.6002/ect.2017.0196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVES Long-term outcomes of kidney transplant recipients with postoperative genitourinary tract infections are not well characterized. In this single center retrospective study, we aimed to investigate the long-term effects of early posttransplant genitourinary infections under a protocol that included 1 month of antibiotic prophylaxis on graft failure and patient outcomes. MATERIALS AND METHODS Electronic medical records of 1752 recipients of kidney-alone transplant between January 2000 and December 2008 were reviewed. Of these, 344 patients had postoperative genitourinary tract infections within 6 months of transplant. Infections included urinary tract infections, recurrent urinary tract infections, and pyelonephritis. All patients received 1-month of treatment with antibiotic prophylaxis for genitourinary infections after graft placement. Kaplan-Meier survival curves and multivariable regression modeling were performed to determine survival outcomes. RESULTS In the 344 patients with postoperative infections, the most common cause was Escherichia coli (34.9%). Kaplan-Meier graft survival results showed no significant differences (P = .08) among those with and those without postoperative urinary tract infections; however, patient survival (P = .01) was significantly different. Multivariate analysis demonstrated no significant trend regarding graft failure (hazard ratio: 1.28; 95% confidence interval, 0.95-1.71; P = .09) or patient death (hazard ratio: 1.33; 95% confidence interval, 0.98-1.79; P = .06) in patients with and without genitourinary infections. The major cause of graft failure was infection in the infection cohort (17.4%). CONCLUSIONS Kidney transplant recipients who develop urinary tract infections within 6 months of transplant may be at increased risk of graft failure or patient death; however, further studies are needed to elucidate the relationship between posttransplant infections and long-term outcomes.
Collapse
Affiliation(s)
- Dushyanth Srinivasan
- From the Department of Internal Medicine, Yale University, New Haven, Connecticut, USA
| | | | | | | |
Collapse
|
25
|
Myers JB, Lenherr SM, Stoffel JT, Elliott SP, Presson AP, Zhang C, Rosenbluth J, Jha A, Patel D, Welk B. The effects of augmentation cystoplasty and botulinum toxin injection on patient-reported bladder function and quality of life among individuals with spinal cord injury performing clean intermittent catheterization. Neurourol Urodyn 2018; 38:285-294. [DOI: 10.1002/nau.23849] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2018] [Accepted: 09/10/2018] [Indexed: 11/11/2022]
Affiliation(s)
- Jeremy B. Myers
- Department of Surgery (Urology); University of Utah; Salt Lake City Utah
| | - Sara M. Lenherr
- Department of Surgery (Urology); University of Utah; Salt Lake City Utah
| | - John T. Stoffel
- Department of Urology; University of Michigan; Ann Arbor Michigan
| | - Sean P. Elliott
- Department of Urology; University of Minnesota; Minneapolis Minnesota
| | - Angela P. Presson
- Department of Internal Medicine; University of Utah Division of Epidemiology and Biostatistics; Salt Lake City Utah
| | - Chong Zhang
- Department of Internal Medicine; University of Utah Division of Epidemiology and Biostatistics; Salt Lake City Utah
| | - Jeffery Rosenbluth
- Department of Physical Medicine and Rehabilitation; University of Utah; Salt Lake City Utah
| | - Amitabh Jha
- Department of Physical Medicine and Rehabilitation; Salt Lake City Veterans Medical Center; Salt Lake City Utah
| | - DarshanP Patel
- Department of Surgery (Urology); University of Utah; Salt Lake City Utah
| | - Blayne Welk
- Department of Surgery; University of Western Ontario; London Ontario Canada
| | | |
Collapse
|
26
|
Serlin DC, Heidelbaugh JJ, Stoffel JT. Urinary Retention in Adults: Evaluation and Initial Management. Am Fam Physician 2018; 98:496-503. [PMID: 30277739] [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: 06/08/2023]
Abstract
Urinary retention is the acute or chronic inability to voluntarily pass an adequate amount of urine. The condition predominantly affects men. The most common causes are obstructive in nature, with benign prostatic hyperplasia accounting for 53% of cases. Infectious, inflammatory, iatrogenic, and neurologic causes can also affect urinary retention. Initial evaluation should involve a detailed history that includes information about current prescription medications and use of over-the-counter medications and herbal supplements. A focused physical examination with neurologic evaluation should be performed, and diagnostic testing should include measurement of postvoid residual (PVR) volume of urine. There is no consensus regarding a PVR-based definition for acute urinary retention; the American Urological Association recommends that chronic urinary retention be defined as PVR volume greater than 300 mL measured on two separate occasions and persisting for at least six months. Initial management of urinary retention involves assessment of urethral patency with prompt and complete bladder decompression by catheterization. Suprapubic catheters improve patient comfort and decrease bacteriuria and the need for recatheterization in the short term; silver alloy-coated and antibiotic-impregnated catheters offer clinically insignificant or no benefit. Further management is decided by determining the cause and chronicity of the urinary retention and can include initiation of alpha blockers with voiding trials. Patients with urinary retention related to an underlying neurologic cause should be monitored in conjunction with neurology and urology subspecialists.
Collapse
Affiliation(s)
- David C Serlin
- University of Michigan Medical School, Ann Arbor, MI, USA
| | | | - John T Stoffel
- University of Michigan Medical School, Ann Arbor, MI, USA
| |
Collapse
|
27
|
Redshaw JD, Lenherr SM, Elliott SP, Stoffel JT, Rosenbluth JP, Presson AP, Myers JB. Protocol for a randomized clinical trial investigating early sacral nerve stimulation as an adjunct to standard neurogenic bladder management following acute spinal cord injury. BMC Urol 2018; 18:72. [PMID: 30157824 PMCID: PMC6116487 DOI: 10.1186/s12894-018-0383-y] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2018] [Accepted: 08/06/2018] [Indexed: 11/10/2022] Open
Abstract
Background Neurogenic bladder (NGB) dysfunction after spinal cord injury (SCI) is generally irreversible. Preliminary animal and human studies have suggested that initiation of sacral neuromodulation (SNM) immediately following SCI can prevent neurogenic detrusor overactivity and preserve bladder capacity and compliance. We designed a multicenter randomized clinical trial to evaluate the effectiveness of early SNM after acute SCI. Methods/Design The scientific protocol comprises a multi-site, randomized, non-blinded clinical trial. Sixty acute, acquired SCI patients (30 per arm) will be randomized within 12 weeks of injury. All participants will receive standard care for NGB including anticholinergic medications and usual bladder management strategies. Those randomized to intervention will undergo surgical implantation of the Medtronic PrimeAdvanced Surescan 97,702 Neurostimulator with bilateral tined leads along the S3 nerve root in a single-stage procedure. All patients will undergo fluoroscopic urodynamic testing at study enrollment, 3 months, and 1-year post randomization. The primary outcome will be changes in urodynamic maximum cystometric capacity at 1-year. After accounting for a 15% loss to follow-up, we expect 25 evaluable patients per arm (50 total), which will allow detection of a 38% treatment effect. This corresponds to an 84 mL difference in bladder capacity (80% power at a 5% significance level). Additional parameters will be assessed every 3 months with validated SCI-Quality of Life questionnaires and 3-day voiding diaries with pad-weight testing. Quantified secondary outcomes include: patient reported QoL, number of daily catheterizations, incontinence episodes, average catheterization volume, detrusor compliance, presence of urodynamic detrusor overactivity and important clinical outcomes including: hospitalizations, number of symptomatic urinary tract infections, need for further interventions, and bowel and erectile function. Discussion This research protocol is multi-centered, drawing participants from large referral centers for SCI and has the potential to increase options for bladder management after SCI and add to our knowledge about neuroplasticity in the acute SCI patient. Trial registration ClinicalTrials.gov #NCT03083366 1/27/2017.
Collapse
Affiliation(s)
- Jeffrey D Redshaw
- Department of Surgery, Division of Urology, University of Utah School of Medicine, 30 N. 1900 E. 3B110, Salt Lake City, UT, 84132, USA.
| | - Sara M Lenherr
- Department of Surgery, Division of Urology, University of Utah School of Medicine, 30 N. 1900 E. 3B110, Salt Lake City, UT, 84132, USA
| | - Sean P Elliott
- Department of Urology, University of Minnesota, Minneapolis, MN, USA
| | - John T Stoffel
- Department of Urology, University of Michigan, Ann Arbor, MI, USA
| | - Jeffrey P Rosenbluth
- University of Utah School of Medicine, Physical Medicine and Rehabilitation, Salt Lake City, UT, USA
| | - Angela P Presson
- Division of Epidemiology, University of Utah, Salt Lake City, UT, USA
| | - Jeremy B Myers
- Department of Surgery, Division of Urology, University of Utah School of Medicine, 30 N. 1900 E. 3B110, Salt Lake City, UT, 84132, USA
| | | |
Collapse
|
28
|
Barboglio Romo PG, Stoffel JT. Author Reply. Urology 2018; 118:207. [DOI: 10.1016/j.urology.2017.11.059] [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]
|
29
|
Stoffel JT, Van der Aa F, Wittmann D, Yande S, Elliott S. Fertility and sexuality in the spinal cord injury patient. World J Urol 2018; 36:1577-1585. [PMID: 29948051 DOI: 10.1007/s00345-018-2347-y] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [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: 02/16/2018] [Accepted: 05/17/2018] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND After a spinal cord injury, patients have different perceptions of sexuality, sexual function, and potential for fertility. These changes can greatly impact quality of life over a lifetime. PURPOSE The purpose of this workgroup was to identify common evidence based or expert opinion themes and recommendations regarding treatment of sexuality, sexual function and fertility in the spinal cord injury population. METHODS As part of the SIU-ICUD joint consultation of Urologic Management of the Spinal Cord Injury (SCI), a workgroup and comprehensive literature search of English language manuscripts regarding fertility and sexuality in the spinal cord injury patient were formed. Articles were compiled, and recommendations in the chapter are based on group discussion and follow the Oxford Centre for Evidence-based Medicine system for levels of evidence (LOEs) and grades of recommendation (GORs). RESULTS Genital arousal, ejaculation, and orgasm are significantly impacted after spinal cord injury in both male and female SCI patients. This may have a more significant impact on potential for fertility in male spinal cord injury patients, particularly regarding ability of generate erection, semen quantity and quality. Female patients should be consulted that pregnancy is still possible after injury and a woman should expect resumption of normal reproductive function. As a result, sexual health teaching should be continued in women despite injury. Pregnancy in a SCI may cause complications such as autonomic dysreflexia, so this group should be carefully followed during pregnancy. CONCLUSIONS By understanding physiologic changes after injury, patients and care teams can work together to achieve goals and maximize sexual quality of life after the injury.
Collapse
Affiliation(s)
| | | | - D Wittmann
- University of Michigan, Ann Arbor, MI, USA
| | - S Yande
- Ruby Hall Clinic, Pune, India
| | - S Elliott
- University of British Columbia, Vancouver, BC, Canada
| |
Collapse
|
30
|
Crescenze I, Covalschi D, Lenherr SM, Myers JB, Presson AP, Zhang C, Elliot S, Welk B, Stoffel JT. PD04-06 LEVEL OF INJURY DOES NOT PREDICT URINARY QUALITY OF LIFE IN PATIENTS WITH SPINAL CORD INJURY ON CLEAN INTERMITTENT CATHETERIZATION. J Urol 2018. [DOI: 10.1016/j.juro.2018.02.284] [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: 11/29/2022]
|
31
|
Kirk PS, Santiago-Lastra Y, Qin Y, Stoffel JT, Clemens JQ, Cameron AP. The effects of cystoscopy and hydrodistention on symptoms and bladder capacity in interstitial cystitis/bladder pain syndrome. Neurourol Urodyn 2018; 37:2002-2007. [DOI: 10.1002/nau.23555] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2018] [Accepted: 02/26/2018] [Indexed: 11/12/2022]
Affiliation(s)
- Peter S. Kirk
- Dow Division of Health Services Research; Department of Urology; University of Michigan Health System; Ann Arbor Michigan
| | | | - Yongmei Qin
- Dow Division of Health Services Research; Department of Urology; University of Michigan Health System; Ann Arbor Michigan
| | - John T. Stoffel
- Division of Neurourology and Pelvic Reconstruction; Department of Urology; University of Michigan Health System; Ann Arbor Michigan
| | - James Q. Clemens
- Division of Neurourology and Pelvic Reconstruction; Department of Urology; University of Michigan Health System; Ann Arbor Michigan
| | - Anne P. Cameron
- Division of Neurourology and Pelvic Reconstruction; Department of Urology; University of Michigan Health System; Ann Arbor Michigan
| |
Collapse
|
32
|
Morhardt DR, Hadj-Moussa M, Chang H, Wolf JS, Roberts WW, Stoffel JT, Faerber GJ, Cameron AP. Outcomes of Ureteroscopic Stone Treatment in Patients With Spinal Cord Injury. Urology 2018; 116:41-46. [PMID: 29545043 DOI: 10.1016/j.urology.2018.01.026] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2017] [Revised: 01/10/2018] [Accepted: 01/18/2018] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To evaluate the association of clinical factors on outcomes in patients with spinal cord injury (SCI) undergoing ureteroscopy. Immobility, recurrent urinary tract infection, and lower urinary tract dysfunction contribute to renal stone formation in patients with SCI. Ureteroscopy is a commonly utilized treatment modality; however, surgical complication rates and outcomes have been poorly defined. Evidence guiding safe and effective treatment of stones in this cohort remains scarce. METHODS Records were retrospectively reviewed for patients with SCI who underwent ureteroscopy for kidney stones from 1996 to 2014 at a single institution. Multivariate relationships were evaluated using a general estimating equation model. RESULTS Forty-six patients with SCI underwent a total of 95 ureteroscopic procedures. After treatment, stone-free rate was 17% and 20% with <2-mm fragments. The complication rate was 21%. On multivariate analysis, SCI in cervical (C) levels was associated with higher risk of complications (C3: odds ratio [OR] 3.83, 95% confidence interval [CI] 2.17-6.98; C6: OR 3.83, 95% CI 1.08-13.53). American Spinal Injury Association Scale A classification was associated with a lower probability of stone-free status (OR 0.16, 95% CI 0.03-0.82). Patients averaged 2.2 procedures yet more procedures were associated with lower stone-free status (OR 0.83, 95% CI 0.03-0.32). Chronic obstructive pulmonary disease and bladder management modality were not associated with stone-free status or complications. CONCLUSION In patients with SCI, higher injury level and complete SCI were associated with worse stone clearance and more complications. Stone-free rate was 17%. Overall, flexible ureteroscopy is a relatively safe procedure in this population. Alternative strategies should be considered after failed ureteroscopy.
Collapse
Affiliation(s)
| | | | - He Chang
- Department of Urology, University of Michigan, Ann Arbor, MI
| | - J Stuart Wolf
- Department of Urology, University of Michigan, Ann Arbor, MI
| | | | - John T Stoffel
- Department of Urology, University of Michigan, Ann Arbor, MI
| | - Gary J Faerber
- Department of Urology, University of Michigan, Ann Arbor, MI
| | - Anne P Cameron
- Department of Urology, University of Michigan, Ann Arbor, MI
| |
Collapse
|
33
|
Pagliara TJ, Gor RA, Liberman D, Myers JB, Luzny P, Stoffel JT, Elliott SP. Outcomes of revision surgery for difficult to catheterize continent channels in a multi-institutional cohort of adults. Can Urol Assoc J 2017; 12:E126-E131. [PMID: 29283085 DOI: 10.5489/cuaj.4656] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
INTRODUCTION The study aimed to describe the strategies of surgical revision for catheterizable channel obstruction and their outcomes, including restenosis and new channel incontinence. METHODS We retrospectively queried the charts of adults who underwent catheterizable channel revision or replacement from 2000-2014 for stomal stenosis, channel obstruction, or difficulty with catheterization at the Universities of Minnesota, Michigan, and Utah. The primary endpoint was channel patency as measured by freedom from repeat surgical intervention. Secondary endpoints included post-revision incontinence and complication rates. Revision surgeries were classified by strategy into "above fascia," "below fascia," and "channel replacement" groupings. RESULTS A total of 51 patients who underwent 68 repairs (age 18-82 years old; mean 45) were identified who met our inclusion criteria. Channel patency was achieved in 66% at a median 19 months post-revision for all repair types. There was no difference in patency by the type of channel being revised, but there was based on revision technique, with channel replacement and above the fascia repairs being more successful (p=0.046). Channel incontinence occurred in 40% and was moderate to severe in 12%. The type of channel being revised was strongly associated (p=0.003) with any postoperative channel incontinence. Surgical complications occurred in 29% of all revision procedures, although most were low-grade. CONCLUSIONS Surgical revision of continent catheterizable channels for channel obstruction can be performed with acceptable rates of durable patency and incontinence; however, the surgeon needs to have experience in complex urinary diversion and familiarity with a variety of surgical revision strategies.
Collapse
Affiliation(s)
| | - Ronak A Gor
- University of Minnesota, Minneapolis, MN; United States
| | | | | | - Patrik Luzny
- University of Utah, Salt Lake City, UT; United States
| | | | | | | |
Collapse
|
34
|
Shepard CL, Doerge EJ, Eickmeyer AB, Kraft KH, Wan J, Stoffel JT. Ambulatory Care Use among Patients with Spina Bifida: Change in Care from Childhood to Adulthood. J Urol 2017; 199:1050-1055. [PMID: 29113842 DOI: 10.1016/j.juro.2017.10.040] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/26/2017] [Indexed: 02/09/2023]
Abstract
PURPOSE We examined the ambulatory health care visit use of children with spina bifida, adults who transitioned to adult care and adults who continued to seek care in a pediatric setting. MATERIALS AND METHODS We evaluated use during a 1-year period of patients with spina bifida who visited any outpatient medical clinic within an integrated health care system. Patients were categorized as pediatric (younger than 18 years) or adult (age 18 or older). Adults were divided into those who did not fully transition to adult care and patients who fully transitioned (adult). Frequency and type of health care use were compared. Subanalysis was performed for patients 18 to 25 years old to examine variables associated with successful complete transition to adult care. RESULTS During 1 year 382 children, 88 patients who did not transition and 293 adult patients with spina bifida had 4,931 clinic visits. Children had greater ambulatory care use (7.25 visits per year) compared to fully transitioned adults (5.33 visits per year, p=0.046). Children more commonly visited surgical clinics (52.3% of visits) and adults more commonly visited medical clinics (48.9%) (p <0.005). Adult transitioned patients were more likely to be female (p=0.004). Of the patients 18 to 25 years old, those who did not transition to adult care had similar outpatient visit types but greater use of inpatient and emergency care than those who transitioned. CONCLUSIONS Children with spina bifida used more ambulatory care than adults and were more likely to visit a surgical specialist. Adult patients with spina bifida who successfully transitioned to adult care were more likely to be female, and patients who failed to transition were more likely to receive more inpatient and emergency care.
Collapse
Affiliation(s)
- Courtney L Shepard
- Division of Pediatric Urology and Dow Health Services Research, University of Michigan, Ann Arbor, Michigan.
| | - Ella J Doerge
- Department of Urology, University of Michigan, Ann Arbor, Michigan
| | - Adam B Eickmeyer
- Division of Pediatric Urology, University of Michigan, Ann Arbor, Michigan
| | - Kate H Kraft
- Division of Pediatric Urology, University of Michigan, Ann Arbor, Michigan
| | - Julian Wan
- Division of Pediatric Urology, University of Michigan, Ann Arbor, Michigan
| | - John T Stoffel
- Division of Neurourology and Pelvic Reconstruction, University of Michigan, Ann Arbor, Michigan
| |
Collapse
|
35
|
Patel DP, Lenherr SM, Stoffel JT, Elliott SP, Welk B, Presson AP, Jha A, Rosenbluth J, Myers JB. Study protocol: patient reported outcomes for bladder management strategies in spinal cord injury. BMC Urol 2017; 17:95. [PMID: 29017505 PMCID: PMC5635498 DOI: 10.1186/s12894-017-0286-3] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2017] [Accepted: 10/02/2017] [Indexed: 12/20/2022] Open
Abstract
Background The majority of spinal cord injury (SCI) patients have urinary issues, such as incontinence, retention, and frequency. These problems place a significant burden on patients’ physical health and quality of life (QoL). There are a wide variety of bladder management strategies available to patients with no clear guidelines on appropriate selection. Inappropriate bladder management can cause hospitalizations and serious complications, such as urosepsis and renal failure. Patients believe that both independence and ability to carry out daily activities are just as important as physical health in selecting the right bladder-management strategy but little is known about patient’s QoL with different bladder managements. Our study’s aim is to assess patient reported QoL measures with various bladder managements after SCI. This manuscript describes the approach, study design and common data elements for our central study. Methods This is a multi-institutional prospective cohort study comparing three different bladder-management strategies (clean intermittent catheterization, indwelling catheters, and surgery). Information collected from participants includes demographics, past medical and surgical history, injury characteristics, current and past bladder management, and SCI /bladder-related complications. Patient reported outcomes and QoL questionnaires were administered at enrollment and every 3 months for 1 year. Aims of this study protocol are: (1) to assess baseline QoL differences between the three different bladder-management strategies; (2) determine QoL impact when those using either form of catheter management undergo a surgery over the 1 year of follow-up among patients eligible for surgery; (3) assess the effects of changes in bladder management and complications on QoL over a 1-year longitudinal follow-up. Discussion By providing information about patient-reported outcomes associated with different bladder management strategies after SCI, and the impact of bladder management changes and complications on QoL, this study will provide essential information for shared decision-making and guide future investigation. Trial registration Trial registration number: www.clinicaltrials.gov: Identifier: NCT0261608; U.S. National Library of Medicine, wwwcf.nlm.nih.gov: Identifier: HSRP20153564.
Collapse
Affiliation(s)
- Darshan P Patel
- Division of Urology, Department of Surgery, University of Utah Health Care, 30 North 1900 East, Room #3B420, Salt Lake City, UT, 84132, USA
| | - Sara M Lenherr
- Division of Urology, Department of Surgery, University of Utah Health Care, 30 North 1900 East, Room #3B420, Salt Lake City, UT, 84132, USA
| | - John T Stoffel
- Department of Urology, University of Michigan, Ann Arbor, Michigan, USA
| | - Sean P Elliott
- Department of Urology, University of Minnesota, Minneapolis, Minnesota, USA
| | - Blayne Welk
- Divsion of Urology, University of Western Ontario, London, Ontario, Canada
| | - Angela P Presson
- Divsion of Epidemiology, Department of Internal Medicine, University of Utah Health Care, Salt Lake City, Utah, USA
| | - Amitabh Jha
- Department of Physical Medicine and Rehabilitation, University of Utah Health Care, Salt Lake City, Utah, USA
| | - Jeffrey Rosenbluth
- Department of Physical Medicine and Rehabilitation, University of Utah Health Care, Salt Lake City, Utah, USA
| | - Jeremy B Myers
- Division of Urology, Department of Surgery, University of Utah Health Care, 30 North 1900 East, Room #3B420, Salt Lake City, UT, 84132, USA.
| | | |
Collapse
|
36
|
Santiago-Lastra Y, Mathis MR, Andraska E, Thompson AL, Malaeb BS, Cameron AP, Clemens JQ, Stoffel JT. Extended Case Duration and Hypotension Are Associated With Higher-grade Postoperative Complications After Urinary Diversion for Non-oncological Disease. Urology 2017; 111:189-196. [PMID: 28923410 DOI: 10.1016/j.urology.2017.05.061] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2017] [Revised: 05/08/2017] [Accepted: 05/16/2017] [Indexed: 12/20/2022]
Abstract
OBJECTIVE To report survival for patients who undergo urinary diversion for benign indications and to identify risk factors for morbidity at 90 days. METHODS This is a retrospective review of consecutive urinary diversions with or without cystectomy for non-oncological indications at a single institution. The indication for diversion was intractable incontinence, upper tract deterioration, urinary fistula, and unmanageable bladder pain. Patients were categorized according to their most severe complication within 90 days of surgery, using the Clavien-Dindo system. Multivariable analysis was performed to identify factors associated with high-grade complications. Survival analysis was performed. RESULTS Between 2007 and 2014, 141 patients underwent urinary diversion for non-oncological indications. The postoperative rate of high-grade adverse events (class III or greater) was 28%. Risk factors for class III or greater complications at 90 days included prolonged intraoperative mean arterial pressure below 75% of baseline, operative duration greater than 343 minutes, and postoperative vasopressor requirement. Kaplan-Meier survival analysis demonstrated a 1- and 5-year survival of 88.4% and 77.2%, respectively. The long-term survival of patients who experienced higher-grade complications was not statistically different from the survival of the rest of the group. The study was limited by a retrospective design and sample size in identifying additional variables associated with increased risk of long-term mortality. CONCLUSION Urinary diversion for non-oncological conditions has a good 5-year survival in this cohort. Extended case duration and hemodynamic instability during or immediately after urinary diversion are associated with a high-grade complication within 90 days of the procedure.
Collapse
Affiliation(s)
| | - Michael R Mathis
- Department of Anesthesiology and Critical Care, University of Michigan Hospital and Health System, Ann Arbor, MI
| | | | - Aleda L Thompson
- Department of Anesthesiology and Critical Care, University of Michigan Hospital and Health System, Ann Arbor, MI
| | - Bahaa S Malaeb
- Department of Urology, University of Michigan Hospital and Health System, Ann Arbor, MI
| | - Anne P Cameron
- Department of Urology, University of Michigan Hospital and Health System, Ann Arbor, MI
| | - J Quentin Clemens
- Department of Urology, University of Michigan Hospital and Health System, Ann Arbor, MI
| | - John T Stoffel
- Department of Urology, University of Michigan Hospital and Health System, Ann Arbor, MI
| |
Collapse
|
37
|
Cox L, He C, Bevins J, Clemens JQ, Stoffel JT, Cameron AP. Gentamicin bladder instillations decrease symptomatic urinary tract infections in neurogenic bladder patients on intermittent catheterization. Can Urol Assoc J 2017; 11:E350-E354. [PMID: 29382457 DOI: 10.5489/cuaj.4434] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
INTRODUCTION This study aimed to determine if gentamicin bladder instillations reduce the rate of symptomatic urinary tract infection (UTI) in neurogenic bladder (NGB) patients on intermittent self-catheterization (ISC) who have recurrent UTIs. Secondary aims were to examine the effects of intravesical gentamicin on the organism resistance patterns. METHODS We retrospectively reviewed our prospective NGB database. Inclusion criteria were NGB patients performing ISC exclusively for bladder drainage with clinical data available for six months before and six months after initiating prophylactic intravesical gentamicin instillations. Symptomatic UTIs were defined as symptoms consistent with UTI plus the need for antibiotic treatment. RESULTS Twenty-two patients met inclusion criteria; etiology of NGB was 63.6% spinal cord injury, 13.6% multiple sclerosis. Median time since injury/diagnosis was 14 years and 6/22 (27.3%) had undergone urological reconstruction. Patients had fewer symptomatic UTI's (median 4 vs. 1 episodes; p<0.004) and underwent fewer courses of oral antibiotics after initiating gentamicin (median 3.5 vs. 1; p<0.01). Days of oral antibiotic therapy decreased from 15 before to five after gentamicin, but this did not reach significance. There were fewer telephone encounters for UTI concerns per patient (median 3 vs. 0; p=0.03). The proportion of multi-drug-resistant organisms in urine cultures decreased from 58.3% to 47.1% (p=0.04) and the rate of gentamicin resistance did not increase. Adverse events were mild and rare. CONCLUSIONS Gentamicin bladder instillations decrease symptomatic UTI episodes and reduce oral antibiotics in patients with NGB on ISC who were suffering from recurrent UTIs. Antibiotic resistance decreased while on gentamicin instillations.
Collapse
Affiliation(s)
- Lindsey Cox
- Department of Urology; University of Michigan, Ann Arbor, MI, United States
| | - Chang He
- Department of Urology; University of Michigan, Ann Arbor, MI, United States
| | - Jack Bevins
- College of Medicine; University of Michigan, Ann Arbor, MI, United States
| | - J Quentin Clemens
- Department of Urology; University of Michigan, Ann Arbor, MI, United States
| | - John T Stoffel
- Department of Urology; University of Michigan, Ann Arbor, MI, United States
| | - Anne P Cameron
- Department of Urology; University of Michigan, Ann Arbor, MI, United States
| |
Collapse
|
38
|
Abstract
PURPOSE OF REVIEW This review examines current terminology used to define non-neurogenic chronic urinary retention (CUR), describes the pathophysiology of urinary retention, and highlights contemporary diagnostic and treatment algorithms. RECENT FINDINGS There is no standardized definition for the condition, but volumes >300 ml are commonly used to describe CUR. It is a clinical diagnosis which does not require urodynamics. Pathophysiologic causes of CUR be from myogenic, neurogenic, bladder outlet obstruction, or a combination of these sources. Treatment algorithms recommend stratifying patients with chronic urinary retention by risk and by symptoms before initiating treatment. Common CUR outcome endpoints need to be better utilized so that treatment modalities can be compared. Non-neurogenic CUR is a heterogeneous condition that has multiple definitions, underlying physiologies, and possible endpoints. Standardization is needed to better understand and treat CUR.
Collapse
Affiliation(s)
- John T Stoffel
- Department of Urology, University of Michigan, Ann Arbor, MI, USA.
| |
Collapse
|
39
|
Stoffel JT, Santiago-Lastra Y. Introducing "The Impact of Neurologic Disease on the Urinary Tract". Urol Clin North Am 2017; 44:xvii-xviii. [PMID: 28716331 DOI: 10.1016/j.ucl.2017.05.001] [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: 10/19/2022]
Affiliation(s)
- John T Stoffel
- Department of Urology, University of Michigan, 3875 Taubman Center, East Medical Center Drive, SPC 5330, Ann Arbor, MI 48109, USA.
| | - Yahir Santiago-Lastra
- Department of Urology, University of California-San Diego, 9444 Medical Center Drive, MC #7897, La Jolla, CA 92037-7897, USA.
| |
Collapse
|
40
|
Abstract
Background/Objective: A post-bladder tumor resection dose of MMC can reduce non-invasive papillary (pTa) bladder cancer recurrences by up to 40%; this treatment is recommended in both the AUA and EUA non-muscle-invasive bladder cancer guidelines. A common complication of this treatment is eosinophilic cystitis. Symptoms range from mild urinary frequency and urgency to debilitating pain and dysuria. Currently, there is no established treatment algorithm for MMC-induced cystitis. Methods: Members of the Urologic Surgery Quality Collaborative (USQC), a group composed of over 160 private and academic urologists, met to discuss the management of patients with cystitis following MMC therapy. They devised a treatment algorithm based on experiences of urologic oncologists and neurourologists to aid in the diagnosis and management of MMC-induced cystitis. Results: The assessment begins with urinalysis and culture, followed by cystoscopy. For mild symptoms, behavioral therapy, including timed voids, fluid restriction and Kegel exercises are trialed. If symptoms have not resolved, treatment with an antihistamine, followed by a combination of anticholinergic and alpha-blocker medications. For persistent symptoms or severe symptoms at presentation, a course of prednisone plus antihistamine is prescribed. If symptoms are improving but have not resolved, this treatment is extended for a full 4 weeks prior to steroid taper. If symptoms do not improve, any visible bladder ulcerations are resected intraoperatively followed by an additional course of prednisone and antihistamine. Intravesical DMSO instillations and intra-ulcer steroid injection can be used as a final effort to treat this condition. Conclusion: We present the first formal management algorithm with escalating treatment intensity tailored to patient symptoms.
Collapse
Affiliation(s)
- Amy N Luckenbaugh
- Department of Urology, University of Michigan Health System, Ann Arbor, MI, USA
| | - Rory M Marks
- Department of Internal Medicine, University of Michigan Health System, Ann Arbor, MI, USA
| | - David C Miller
- Department of Urology, University of Michigan Health System, Ann Arbor, MI, USA
| | - Alon Z Weizer
- Department of Urology, University of Michigan Health System, Ann Arbor, MI, USA
| | - John T Stoffel
- Department of Urology, University of Michigan Health System, Ann Arbor, MI, USA
| | | |
Collapse
|
41
|
Suskind AM, Cox L, Clemens JQ, Oldendorf A, Stoffel JT, Malaeb B, Qin Y, Cameron AP. The Value of Urodynamics in an Academic Specialty Referral Practice. Urology 2017; 105:48-53. [PMID: 28408338 DOI: 10.1016/j.urology.2017.02.049] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2017] [Revised: 02/15/2017] [Accepted: 02/20/2017] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To describe and evaluate the use of urodynamics (UDS) studies for all indications in an academic specialty referral urology practice. MATERIALS AND METHODS This is a prospective questionnaire-based study wherein clinicians completed a pre- and post-UDS questionnaire on each UDS that they ordered for all clinical indications between May 2013 and August 2014. Questions pertained to patient demographics and history, the clinical indication for the UDS, the clinician's pre- and post-UDS clinical impressions, and changes in post-UDS management plans. Pre- and post-UDS diagnoses were compared using the McNemar test. RESULTS Clinicians evaluated a total of 285 UDS studies during the study period. The average age of study participants was 56.0 (±16.4) years, 59.5% were female, and 29.3% had a neurologic diagnosis. The most common indication for performing UDS was to discern the predominant type of urinary incontinence (stress vs urgency) in patients with mixed incontinence symptoms (38.5%) and to assess the safety of the bladder during filling (38.2%). UDS statistically significantly changed the ordering clinician's clinical impression of the patient's lower urinary tract diagnosis for stress urinary incontinence and for urgency and urgency urinary incontinence (both had P values of <.05). Fluoroscopy was found to be helpful in 29.5% of urodynamic studies, and clinicians reported that UDS changed their treatment plans in 42.5% of the studies, most commonly pertaining to changes related to surgery (35.0%). CONCLUSION Overall, UDS was a clinically useful tool that altered the clinical impression and treatment plan in a large percentage of carefully selected patients.
Collapse
Affiliation(s)
- Anne M Suskind
- Department of Urology, University of California, San Francisco, San Francisco, CA.
| | - Lindsey Cox
- Department of Urology, Medical University of South Carolina, Charleston, SC
| | | | - Ann Oldendorf
- Department of Urology, University of Michigan, Ann Arbor, MI
| | - John T Stoffel
- Department of Urology, University of Michigan, Ann Arbor, MI
| | - Bahaa Malaeb
- Department of Urology, University of Michigan, Ann Arbor, MI
| | - Yongmei Qin
- Department of Urology, University of Michigan, Ann Arbor, MI
| | - Anne P Cameron
- Department of Urology, University of Michigan, Ann Arbor, MI
| |
Collapse
|
42
|
Stoffel JT, Peterson AC, Sandhu JS, Suskind AM, Wei JT, Lightner DJ. AUA White Paper on Nonneurogenic Chronic Urinary Retention: Consensus Definition, Treatment Algorithm, and Outcome End Points. J Urol 2017; 198:153-160. [PMID: 28163030 DOI: 10.1016/j.juro.2017.01.075] [Citation(s) in RCA: 52] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/26/2017] [Indexed: 10/20/2022]
Abstract
PURPOSE The AUA (American Urological Association) QIPS (Quality Improvement and Patient Safety) committee created a white paper on the diagnosis and management of nonneurogenic chronic urinary retention. MATERIALS AND METHODS Recommendations for the white paper were based on a review of the literature and consensus expert opinion from the workgroup. RESULTS The workgroup defined nonneurogenic chronic urinary retention as an elevated post-void residual of greater than 300 mL that persisted for at least 6 months and documented on 2 or more separate occasions. It is proposed that chronic urinary retention should be categorized by risk (high vs low) and symptomatology (symptomatic versus asymptomatic). High risk chronic urinary retention was defined as hydronephrosis on imaging, stage 3 chronic kidney disease or recurrent culture proven urinary tract infection or urosepsis. Symptomatic chronic urinary retention was defined as subjectively moderate to severe urinary symptoms impacting quality of life and/or a recent history of catheterization. A treatment algorithm was developed predicated on stratifying patients with chronic urinary retention first by risk and then by symptoms. The proposed 4 primary outcomes that should be assessed to determine effectiveness of retention treatment are 1) symptom improvement, 2) risk reduction, 3) successful trial of voiding without catheterization, and 4) stability of symptoms and risk over time. CONCLUSIONS Defining and categorizing nonneurogenic chronic urinary retention, creating a treatment algorithm and proposing treatment end points will hopefully spur comparative research that will ultimately lead to a better understanding of this challenging condition.
Collapse
Affiliation(s)
| | | | | | - Anne M Suskind
- University of Calfornia, San Francisco, San Francisco, California
| | - John T Wei
- University of Michigan, Ann Arbor, Michigan
| | | |
Collapse
|
43
|
Helfand AM, Beach R, Hadj-Moussa M, Krishnan N, He C, Montgomery JS, Morgan TM, Weizer AZ, Hafez K, Lee CT, Stoffel JT, Skolarus TA. Treatment of ureteral anastomotic strictures with reimplantation and survival after cystectomy and urinary diversion. Urol Oncol 2017; 35:33.e1-33.e9. [DOI: 10.1016/j.urolonc.2016.07.018] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2016] [Revised: 06/14/2016] [Accepted: 07/25/2016] [Indexed: 11/16/2022]
|
44
|
Tracey JM, Stoffel JT. Secondary and tertiary treatments for multiple sclerosis patients with urinary symptoms. Investig Clin Urol 2016; 57:377-383. [PMID: 27847911 PMCID: PMC5109793 DOI: 10.4111/icu.2016.57.6.377] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2016] [Accepted: 09/09/2016] [Indexed: 01/23/2023] Open
Abstract
Multiple sclerosis patients with refractory urinary symptoms after treatment with behavioral therapy and medications still have treatment options. Prior to starting treatments, baseline symptoms should be assessed and treatment goals thoroughly discussed. Catheterization, botulinum toxin, and reconstructive surgery all can play a role in improving both safety and quality of life for these patients. Newer modalities, such as neuromodulation, may also have an increasing role in the future as more data develop regarding efficacy. Risks need to be weighed against any perceived benefit and disease status before more aggressive therapy is initiated.
Collapse
Affiliation(s)
- James M Tracey
- Department of Urology, University of Michigan, Ann Arbor, MI, USA
| | - John T Stoffel
- Department of Urology, University of Michigan, Ann Arbor, MI, USA
| |
Collapse
|
45
|
Wessells H, Angermeier KW, Elliott S, Gonzalez CM, Kodama R, Peterson AC, Reston J, Rourke K, Stoffel JT, Vanni AJ, Voelzke BB, Zhao L, Santucci RA. Male Urethral Stricture: American Urological Association Guideline. J Urol 2016; 197:182-190. [PMID: 27497791 DOI: 10.1016/j.juro.2016.07.087] [Citation(s) in RCA: 188] [Impact Index Per Article: 23.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/19/2016] [Indexed: 01/30/2023]
Abstract
PURPOSE The purpose of this Guideline is to provide a clinical framework for the diagnosis and treatment of male urethral stricture. MATERIALS AND METHODS A systematic review of the literature using the Pubmed, Embase, and Cochrane databases (search dates 1/1/1990 to 12/1/2015) was conducted to identify peer-reviewed publications relevant to the diagnosis and treatment of urethral stricture. The review yielded an evidence base of 250 articles after application of inclusion/exclusion criteria. These publications were used to create the Guideline statements. Evidence-based statements of Strong, Moderate, or Conditional Recommendation were developed based on benefits and risks/burdens to patients. Additional guidance is provided as Clinical Principles and Expert Opinion when insufficient evidence existed. RESULTS The Panel identified the most common scenarios seen in clinical practice related to the treatment of urethral strictures. Guideline statements were developed to aid the clinician in optimal evaluation, treatment, and follow-up of patients presenting with urethral strictures. CONCLUSIONS Successful treatment of male urethral stricture requires selection of the appropriate endoscopic or surgical procedure based on anatomic location, length of stricture, and prior interventions. Routine use of imaging to assess stricture characteristics will be required to apply evidence based recommendations, which must be applied with consideration of patient preferences and personal goals. As scientific knowledge relevant to urethral stricture evolves and improves, the strategies presented here will be amended to remain consistent with the highest standards of clinical care.
Collapse
Affiliation(s)
- Hunter Wessells
- American Urological Association Education and Research, Inc., Linthicum, Maryland
| | - Keith W Angermeier
- American Urological Association Education and Research, Inc., Linthicum, Maryland
| | - Sean Elliott
- American Urological Association Education and Research, Inc., Linthicum, Maryland
| | | | - Ron Kodama
- American Urological Association Education and Research, Inc., Linthicum, Maryland
| | - Andrew C Peterson
- American Urological Association Education and Research, Inc., Linthicum, Maryland
| | - James Reston
- American Urological Association Education and Research, Inc., Linthicum, Maryland
| | - Keith Rourke
- American Urological Association Education and Research, Inc., Linthicum, Maryland
| | - John T Stoffel
- American Urological Association Education and Research, Inc., Linthicum, Maryland
| | - Alex J Vanni
- American Urological Association Education and Research, Inc., Linthicum, Maryland
| | - Bryan B Voelzke
- American Urological Association Education and Research, Inc., Linthicum, Maryland
| | - Lee Zhao
- American Urological Association Education and Research, Inc., Linthicum, Maryland
| | - Richard A Santucci
- American Urological Association Education and Research, Inc., Linthicum, Maryland
| |
Collapse
|
46
|
Srinivasan D, Stoffel JT, Mathur AK, Kapeles S, Bradley K, Sung RS. Long-Term Outcomes of Kidney Transplant Recipients with Bladder Dysfunction: A Single-Center Study. Ann Transplant 2016; 21:222-34. [PMID: 27090659 DOI: 10.12659/aot.895975] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Long-term outcomes of kidney transplantation recipients with bladder dysfunction or prior bladder surgery are not well characterized. MATERIAL AND METHODS Electronic records of 1753 recipients of kidney-alone transplant between January 2000 and December 2008 were reviewed. We found that 1652 recipients had normal bladder function, 80 had bladder dysfunction, and 21 had bladder substitute or urinary diversion. Kaplan-Meier survival curves and multivariable regression modeling were performed to determine survival outcomes. RESULTS Kaplan-Meier graft survival (p=.11) and patient survival (p=.18) were lower in recipients with bladder surgery but not statistically significant. Multivariate analysis demonstrated inferior graft survival (HR 3.57, 95% CI 1.06-12.1, p =0.04) and a trend towards inferior patient survival (HR 3.19, 95% CI .71-14.5, p=0.13) in reci-pients with bladder surgery. The major cause of graft failure was chronic rejection for normal function (17.1%) and bladder dysfunction (28.5%), and infection for bladder surgery (28.5%). Post-operative urinary infectious and surgical complications were higher in recipients with bladder dysfunction (35%) and substitutes (52.3%) compared with normal function (12.8%). CONCLUSIONS Kidney transplant recipients with prior bladder surgery have an increased risk of graft failure and an increased risk of infectious urinary complications. These risks should be considered in recipient selection and post-transplant management.
Collapse
Affiliation(s)
| | - John T Stoffel
- Department of Urology, University of Michigan, Ann Arbor, MI, USA
| | - Amit K Mathur
- Department of Surgery, Mayo Clinic Arizona, Phoenix, AZ, USA
| | - Steven Kapeles
- Department of Surgery, University of Michigan, Ann Arbor, MI, USA
| | - Kori Bradley
- Department of Surgery, University of Michigan, Ann Arbor, MI, USA
| | - Randall S Sung
- Department of Surgery, University of Michigan, Ann Arbor, MI, USA
| |
Collapse
|
47
|
Santiago-Lastra Y, Mathis MR, Andraska E, Thompson AM, Malaeb BS, Cameron AP, Clemens JQ, Stoffel JT. PD12-10 CASE DURATION AND PERIOPERATIVE HYPOTENSION ARE ASSOCIATED WITH GREATER INCIDENCE OF HIGH GRADE COMPLICATIONS IN PATIENTS WHO UNDERGO URINARY DIVERSION FOR BENIGN INDICATIONS. J Urol 2016. [DOI: 10.1016/j.juro.2016.02.905] [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: 11/26/2022]
|
48
|
Abstract
Detrusor sphincter dyssynergia (DSD) is the urodynamic description of bladder outlet obstruction from detrusor muscle contraction with concomitant involuntary urethral sphincter activation. DSD is associated with neurologic conditions such as spinal cord injury, multiple sclerosis, and spina bifida and some of these neurogenic bladder patients with DSD may be at risk for autonomic dysreflexia, recurrent urinary tract infections, or upper tract compromise if the condition is not followed and treated appropriately. It is diagnosed most commonly during the voiding phase of urodynamic studies using EMG recordings and voiding cystourethrograms, although urethral pressure monitoring could also potentially be used. DSD can be sub-classified as either continuous or intermittent, although adoption of this terminology is not widespread. There are few validated oral pharmacologic treatment options for this condition but transurethral botulinum toxin injection have shown temporary efficacy in reducing bladder outlet obstruction. Urinary sphincterotomy has also demonstrated reproducible long term benefits in several studies, but the morbidity associated with this procedure can be high.
Collapse
Affiliation(s)
- John T Stoffel
- Department of Urology, University of Michigan, Ann Arbor, MI, USA
| |
Collapse
|
49
|
Myers JB, Stoffel JT, Welk B, Elliott S. TAU focused issue on adult management of neurogenic bladder. Transl Androl Urol 2016; 5:1-2. [PMID: 26904406 PMCID: PMC4739986 DOI: 10.3978/j.issn.2223-4683.2016.01.03] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
|
50
|
Cameron AP, Rodriguez GM, Gursky A, He C, Clemens JQ, Stoffel JT. The Severity of Bowel Dysfunction in Patients with Neurogenic Bladder. J Urol 2015; 194:1336-41. [DOI: 10.1016/j.juro.2015.04.100] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/24/2015] [Indexed: 01/19/2023]
Affiliation(s)
- Anne P. Cameron
- Departments of Urology, and Physical Medicine and Rehabilitation (GMR), University of Michigan, Ann Arbor, Michigan
| | - Gianna M. Rodriguez
- Departments of Urology, and Physical Medicine and Rehabilitation (GMR), University of Michigan, Ann Arbor, Michigan
| | - Amy Gursky
- Departments of Urology, and Physical Medicine and Rehabilitation (GMR), University of Michigan, Ann Arbor, Michigan
| | - Chang He
- Departments of Urology, and Physical Medicine and Rehabilitation (GMR), University of Michigan, Ann Arbor, Michigan
| | - J. Quentin Clemens
- Departments of Urology, and Physical Medicine and Rehabilitation (GMR), University of Michigan, Ann Arbor, Michigan
| | - John T. Stoffel
- Departments of Urology, and Physical Medicine and Rehabilitation (GMR), University of Michigan, Ann Arbor, Michigan
| |
Collapse
|