Bladder Dysfunction In Patients Research Articles

Summary of evidence on prevention and management of bladder dysfunction in patients after radical hysterectomy.

To retrieve, analyse and summarize the relevant evidence on the prevention and management of bladder dysfunction in patients with cervical ancer after radical hysterectomy. Overview of systematic reviews. 11 databases were searched for relevant studies from top to bottom according to the '6S' model of evidence-based resources. Two independent reviewers selected the articles, extracted the data and appraised the quality of the included reviews based on different types of evaluation tools. A total of 13 studies were identified, including four clinical consultants, four guidelines, four systematic reviews and one randomized controlled trial. 29 best evidence were summarized from five aspects, including definition, risk factors, assessment, prevention and management.

Predictive value of clinical risk factors for bladder dysfunction in Syrian patients with type 2 diabetes mellitus

Diabetes mellitus (DM) is a prevalent disorder that affects the endocrine and metabolic systems. Among the various complications associated with DM, diabetic bladder dysfunction (DBD) is the most frequently occurring genitourinary complication. The presence of DBD can lead to complications that affect the upper urinary tract, significantly impacting the quality of life for individuals with DM. Therefore, it is crucial to identify early risk factors for DBD and predict its onset. Given the absence of studies involving bladder dysfunction in patients with type 2 diabetes mellitus (T2DM) in Syria, this study aims to examine the risk factors associated with bladder dysfunction in T2DM patients and develop a predictive model to identify DBD early. Patients diagnosed with T2DM were enrolled in six endocrinology centers spread across four Syrian provinces between January 2018 and December 2023. Factors that showed an association with DBD in the bivariate analysis, with a significance level of p < 0.05, were included in a multiple logistic regression analysis. The logistic regression analysis was used to identify independent risk factors and develop a prediction model. The receiver operating characteristic (ROC) curve was used to assess the predictive performance of the identified risk factors and the prediction model for DBD. One hundred and eighty-four patients were included in this study, and they were divided into the DBD group (n = 88) and the non‐DBD group (n = 96). Seven variables showed significance in the bivariate analysis. Furthermore, the multiple logistic regression analysis revealed that age (OR [95% CI]: 0.981 [0.614 − 1.337]), p < 0.007; diabetic peripheral neuropathy (DPN) (OR [95% CI]: 1.421 [1.027 − 3.308]), p = 0.03; glycated hemoglobin (HbA1c) (OR [95% CI]: 0.942 [0.821 − 1.141]), p = 0.042; and percentage of monocyte (Mono%) (OR [95% CI]: 1.109 [0.812 − 1.258]), p = 0.031 were independent risk factors for DBD. Analysis of the ROC curve revealed that the area under the curve (AUC) for age, DPN, HbA1c, and Mono were 0.703, 0.541, 0.613, and 0.836, respectively. Age, DPN, HbA1c, and Mono% were risk factors for DBD. The prediction model constructed based on the four risk factors had a good predictive value for predicting the occurrence of DBD.

Substantial incidence of bladder dysfunction in patients with VACTERL association: Implications for surveillance.

VACTERL association is defined as the nonrandom co-occurrence of a minimum of three of the following six key components: Vertebral anomalies, Anal atresia, Cardiac malformations, Tracheo-Esophageal fistula, Renal anomalies, and Limb abnormalities. Patients presenting with two components may also belong in the same spectrum. Additional components have been associated with VACTERL defects, including single umbilical artery, tethered spinal cord (TSC), and genital malformations. We observed a significant proportion of patients with bladder dysfunction (often called neurogenic bladder in the medical record) when reviewing a cohort of patients with VACTERL defects at our clinical center. Our finding calls attention to bladder dysfunction as an additional VACTERL phenotypic component. The prevalence of bladder dysfunction is greatest in those with genital anomalies, anorectal malformations, sacral dysplasia, renal anomalies, and TSC. We propose that patients with two or more VACTERL malformations be monitored for symptoms of bladder dysfunction if one or more of the identified risk factors are present until the achievement of urinary continence.

Predictive value of risk factors for bladder dysfunction in Chinese patients with type 2 diabetes mellitus: A case-control study.

To analyze risk factors associated with bladder dysfunction in patients with type 2 diabetes mellitus (T2DM) and to construct a prediction model for early prediction of diabetic bladder dysfunction (DBD). We included hospitalized patients with T2DM from the endocrinology department of Shenzhen Hospital, Southern Medical University, Shenzhen, China, from January 2019 to 2022. Factors associated with DBD in bivariate analysis with a p < 0.05 were included in a multivariate logistic regression analysis. Multivariate logistic regression analysis was used to determine independent risk factors and to construct a prediction model. The prediction model was presented as the model formula. The receiver operating characteristic (ROC) curve was used to evaluate the predictive value of the above risk factors and the prediction model for DBD. The model was internally verified by Boostrap resampling 1000 times. Two hundred and eleven patients were included in this study, and they were divided into the DBD group (n = 101) and the non-DBD group (n = 110). Eight variables showed significant significance in the bivariate analysis, including age, diabetic peripheral neuropathy (DPN), glycated hemoglobin (HbA1c), urinary microalbumin (mALB), red blood cell count (RBC), white blood cell count (WBC),absolute neutrophil count (ANC), percentage of monocyte (Mono%). Furthermore, multivariate logistic regression analysis revealed that age (OR [95%CI]: 1.077 [1.042-1.112]), p < 0.001; DPN (OR [95%CI]: 2.373 [1.013-5.561]), p = 0.047; HbA1c (OR [95%CI]: 1.170 [1.029-1.330]), p = 0.017 and ANC (OR [95%CI]: 1.234 [1.059-1.438]), p = 0.007 were independent risk factors for the DBD. The prediction model formula was Logit (p) = -6.611 + 0.074 age + 0.864 DPN + 0.157 HbA 1 c + 0.078 ANC. The area under the ROC curve (AUC) for the four risk factors were 0.676, 0.582, 0.618, and 0.674, respectively. The prediction model predicted DBD with higher accuracy than the individual risk factors, AUC = 0.817 (95%CI: 0.757-0.877), and the sensitivity and specificity were 88.1% and 50.0%, respectively. The model internal validation results showed that the AUC = 0.804 (95%CI: 0.707-0.901), and the calibration curve is close to the ideal diagonal line. Age, DPN, HbA1c, and ANC were risk factors for DBD. The prediction model constructed based on the four risk factors had a good predictive value for predicting the occurrence of DBD.

Neurogenic bladder dysfunction after total mesorectumectomy

AIM: to estimate the rate, causes and features of neurogenic bladder dysfunction in patients with rectal cancer after total mesorectumectomy.PATIENTS AND METHODS: the results of surgical treatment of 103 patients with rectal cancer were analyzed in the light of immediate and long-term outcomes, who underwent total mesorectumectomy using traditional (56-54.4%) and laparoscopic (47-45.6%) technologies. In 20 (19.4%) of 103 patients, the course of the immediate postoperative period was complicated by the development of neurogenic bladder dysfunction. In order to study the frequency of neurogenic bladder dysfunction depending on the technique of mesorectumectomy, the patients were divided into 2 groups. Group 1 included 9 patients who underwent laparoscopic total mesorectumectomy. Group 2 included 11patients who underwent traditional (open) mesorectumectomy.RESULTS: the study of the functional state of the bladder according to the flowmetric indicators revealed that the frequency of development of postoperative bladder dysfunction has a gender dependence. The frequency of neurogenic bladder dysfunction was 25% in men and 10,7% in women. It is shown that during 1 week and 6 months after surgery, the average urination rate tends to increase in women and decrease in men, regardless of the technique of total mesorectumectomy. In both groups, there was not a statistically significant decrease in the maximum volumetric velocity in both men and women within 6 months after surgery. At the same time, during this period, there was a decrease in the average rate of urination only in men, regardless of the technique of total mesorectumectomy. And in women, this indicator remained unchanged or slightly increased.CONCLUSION: it is shown that a complex system of therapeutic measures, including drug stimulation of the detrusor and urethral sphincter, repeated catheterization of the bladder, as well as epicystostomy performed according to indications, allows adequate correction of bladder dysfunction after total mesorectumectomy in patients with rectal cancer.

MP03-15 THE INFLUENCE OF STROKE LATERALITY ON FUNCTIONAL BRAIN ACTIVITY DURING MICTURITION: A URODYNAMIC-FUNCTIONAL MAGNETIC RESONANCE IMAGING STUDY

You have accessJournal of UrologyCME1 Apr 2023MP03-15 THE INFLUENCE OF STROKE LATERALITY ON FUNCTIONAL BRAIN ACTIVITY DURING MICTURITION: A URODYNAMIC-FUNCTIONAL MAGNETIC RESONANCE IMAGING STUDY Aidin Abedi, Veronica Stefania Montero Arcila, Luis Alejandro Morales Ojeda, Rita Jen, Priya Kohli, Nhi Ha, Sarah Ponce, David Chapman, David Ginsberg, Kay Jann, and Evgeniy Kreydin Aidin AbediAidin Abedi More articles by this author , Veronica Stefania Montero ArcilaVeronica Stefania Montero Arcila More articles by this author , Luis Alejandro Morales OjedaLuis Alejandro Morales Ojeda More articles by this author , Rita JenRita Jen More articles by this author , Priya KohliPriya Kohli More articles by this author , Nhi HaNhi Ha More articles by this author , Sarah PonceSarah Ponce More articles by this author , David ChapmanDavid Chapman More articles by this author , David GinsbergDavid Ginsberg More articles by this author , Kay JannKay Jann More articles by this author , and Evgeniy KreydinEvgeniy Kreydin More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003214.15AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Hemispheric differences in brain function account for the differential effects of stroke laterality on various domains of cognition, sensory-motor function, and decision making. Similarly, the size and location of stroke determine the type and severity of bladder dysfunction in patients with neurogenic lower urinary tract dysfunction (NLUTD). However, the changes in functional brain activity in relation to the side of stroke are yet to be understood. This study aimed to determine the differential patterns of micturition-related neural activity in right- vs. left-sided strokes. METHODS: Patients with a history of chronic (>1yr) ischemic or hemorrhagic strokes and NLUTD were enrolled. Patients underwent urodynamic assessment while micturition-related brain activity was simultaneously assessed using functional magnetic resonance imaging with the blood-oxygen-level-dependent (BOLD) technique. Statistical parametric mapping (SPM) was used to assess the changes in BOLD signal during a 10-second period of maximum urgency. The signal intensity was compared between left- versus right-sided strokes, with age, gender, and time since stroke as covariates. Statistically significant clusters were identified using a p value of <0.001 and cluster size of >25 voxels. RESULTS: A total of 23 patients (16 men, 69.57%; mean age 53.61±9.82) were enrolled, of whom 16 (69.57%) suffered from right-sided strokes. Analysis of the BOLD signal changes during the period of maximum urgency yielded increased intensity in patients with left-sided strokes in eight areas spanning the anterior cingulate (Brodmann area 32), inferior frontal gyrus, middle frontal gyrus, and limbic area (cingulate gyrus) on the left hemisphere; frontal sub-gyral area on the right; and superior frontal gyrus (Brodmann area 8) bilaterally. Two clusters located in the left cerebellar anterior lobe and right limbic lobe (posterior cingulate) showed decreased BOLD signal in left-sided strokes compared to right-sided counterparts. CONCLUSIONS: This study demonstrated the differences in micturition-related brain activity between left- and right-sided strokes and identified ten areas of differential activity. Patients with right-sided strokes demonstrated markedly diminished brain activity in several brain regions that are known to play a role in LUT control. Consistent with the inherent functional differences across the brain hemispheres, stroke laterality is correlated with the changes in brain activation during micturition. Source of Funding: Urology Care Foundation © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e29 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Aidin Abedi More articles by this author Veronica Stefania Montero Arcila More articles by this author Luis Alejandro Morales Ojeda More articles by this author Rita Jen More articles by this author Priya Kohli More articles by this author Nhi Ha More articles by this author Sarah Ponce More articles by this author David Chapman More articles by this author David Ginsberg More articles by this author Kay Jann More articles by this author Evgeniy Kreydin More articles by this author Expand All Advertisement PDF downloadLoading ...

Botulinum Toxin Type A in Neurogenic Overactive Bladder Dysfunction in Patients with Multiple Sclerosis

Introduction Lower Urinary tract symptoms are common in patients with multiple sclerosis (MS) and have a negative influence on the quality of life (QoL). Detrusor overactivity is the most frequent symptom. Lifestyle modifications are the first therapeutic line followed by oral medication in patients with storage dysfunction. When these drugs are ineffective or intolerable, botulinum toxin bladder injection is an alternative treatment. The aim of this work is to evaluate the effectiveness and the impact on QoL of patients with MS and refractory or intolerant to oral therapy overactive bladder (OAB) after botulinum toxin type A bladder injection. Materials and Methods Retrospective study with six-months follow-up of patients with MS diagnosis and a refractory or intolerable to oral drugs OAB treated with botulinum toxin injections. All patients completed urological evaluation and a QoL questionnaire prior to the injection, 3 and 6-months after. Evaluation of the urodynamics tests prior and 3-months post injection was made. Outcomes Sixteen patients were treated. The QoL questionnaire showed progressive improvement 3 and 6-months after the injection. There was decrease in the number of daily voids urination and in the urinary incontinence episodes. There was an upgrade in the bladder capacity from 191 to 338 ml average (p 0.0004) and 75% evidenced disappearance of detrusor overactivity (p 0.0005). Thirteen (13) patients (81.25%) made spontaneous urination with post-voiding residue &lt;100 ml after injection. Three (3) episodes of urinary tract infection were evidenced. Conclusion Botulinum toxin generates a positive impact on the QoL of patients with neurogenic OAB with MS.

Video-urodynamic effects of vibegron, a new selective β3-adrenoceptor agonist, on antimuscarinic-resistant neurogenic bladder dysfunction in patients with spina bifida.

To evaluate the efficacy, safety and tolerability of vibegron for the treatment of antimuscarinic-resistant neurogenic bladder dysfunction in patients with spina bifida. In this retrospective study, 15 patients with antimuscarinic-resistant neurogenic bladder dysfunction due to spina bifida underwent a video-urodynamic study before and during the administration of vibegron 50 mg once daily instead of antimuscarinic agents from February 2019 through April 2021. The video-urodynamic study was carried out to evaluate bladder compliance, maximum cystometric bladder capacity, detrusor overactivity, detrusor leak point pressure and vesicoureteral reflux before and >3 months after the beginning of vibegron administration. Treatment with vibegron significantly improved bladder compliance and maximum cystometric bladder capacity compared with antimuscarinic agents, respectively (7.4 ± 4.2 vs 30.4 ± 48.2 mL/cmH2 O, P = 0.0001; 231.4 ± 81.2 vs 325.2 ± 106.5 mL, P = 0.0005). Detrusor overactivity did not change after the administration of vibegron. Bladder deformity, which was confirmed in 12 patients, improved in half of the patients after taking vibegron. Vesicoureteral reflux, which was confirmed in two patients, was extinguished after taking vibegron. Newly occurring adverse events were not observed, and all patients continued to take vibegron during the treatment period. Favorable efficacy of vibegron for antimuscarinic-resistant neurogenic bladder dysfunction due to spina bifida was shown video-urodynamically without apparent adverse events. Vibegron is a favorable option for the treatment of antimuscarinic-resistant neurogenic bladder dysfunction in patients with spina bifida.

Effects of behavioural therapy versus interferential current on bladder dysfunction in multiple sclerosis patients; a randomised clinical study

ObjectivesThis study examines the effect of behavioural therapy (biofeedback) and interferential current on bladder dysfunction in multiple sclerosis patients. MethodsFifty patients with secondary progressive type multiple sclerosis (SPMS) suffering from bladder dysfunction were divided equally into two groups randomly. Group A (GA) received behavioural therapy (biofeedback training), while Group B (GB) received interferential current training. Both groups were assessed by urodynamics for detrusor pressure and maximum flow rate before and after eight weeks of behavioural therapy and interferential training. ResultsBoth groups, GA and GB, showed significant increase in the detrusor pressure and maximum flow rate after eight weeks of training. There was no significant difference between both methods. However, GA showed more improvement by close observation. ConclusionsBoth behavioural therapy and interferential current training effectively managed bladder dysfunction in patients with SPMS, with more evident effects in behavioural therapy patients by close observation.

Neurogenic bladder dysfunction in patients emerged from chronic disorders of consciousness

The observational study aimed to analyze the neurogenic bladder dysfunction in patients during the recovery from the chronic disorder of consciousness. We compared etiology, level of consciousness, age with the neurogenic bladder dysfunction in these cases. The study result suggested that the increase in the consciousness level partially restores the bladder function, which significantly reduces the risk of infections and somatic disorders, thereby affecting the duration and quality of life. Recovery of the bladder function also depends on the etiology of the disorder of consciousness: patients in the anoxic group had the least chance of bladder function recovery making global brain ischemia an unfavorable factor. Correlations between urination dysfunctions with age and level of consciousness at admission have not been found.

Low energy shock wave therapy attenuates mitochondrial dysfunction and improves bladder function in HCl induced cystitis in rats

BackgroundWe examine the effects of low energy shock wave (LESW) on bladder and mitochondrial function in a rat model of HCl induced cystitis, and the influence of dynamic bladder filling volume on LESW responses. Dysregulation of mitochondria function may impact the urothelial barrier and contribute to bladder dysfunction in patients with Interstitial cystitis/bladder pain syndrome (IC/BPS). MethodsFemale Sprague–Dawley rats underwent urethral catheterization and intravesical instillation of 0.2 ml of 0.4 N HCl (N = 32) or 0.2 ml saline (N = 8) kept for 90 s. After HCl instillation, the bladder received LESW treatment while filled with 0 ml, 0.2 ml or 0.4 ml saline or no LESW treatment. Continuous cystometry (CMG) was performed on day 8. The bladder was harvested after CMG for histology and Western blotting. ResultsHCl provoked bladder overactivity, bladder wall inflammation marked by infiltration of mast cells, increased bax/bcl2 ratio consistent with increased TUNEL staining and increased release of mitochondrial-integrity markers (cleaved caspase 3 and Cytochrome c). LESW treatment suppressed HCl provoked bladder overactivity in association with lower inflammatory reaction, mast cells infiltration, and a lower bax/bcl2 ratio also reflected by reduced TUNEL staining and mitochondrial-integrity markers irrespective of the volume of saline in bladder at the time of LESW. ConclusionsThese findings support that antiinflammatory effect of LESW in chemical cystitis is associated with the reversal of the molecular-cellular perturbations in mitochondrial dependent intrinsic apoptotic pathway.

Urinary biomarkers of inflammation and tissue remodeling may predict bladder dysfunction in patients with benign prostatic hyperplasia.

To evaluate the expression of urinary biomarkers of inflammation and tissue remodeling in patients with BPH undergoing surgery and evaluate the association of biomarkers with postoperative urodynamic outcomes MATERIALS AND METHODS: We analyzed urine samples from 71 patients treated with TURP from 2011 to 2017. Urinary levels of epidermal growth factor (EGF), matrix-metalloproteinase-1 (MMP-1), interleukin-6 (IL-6), nerve growth factor (NGF) and monocyte-chemoattractant protein-1 (MCP-1) (by commercial ELISA kit) were measured, adjusted by urinary creatinine (Cr) and analyzed according to patients clinical and urodynamic characteristics (baseline and 12-month postoperative urodynamic) RESULTS: MMP-1/Cr levels were significantly higher among subjects with higher detrusor pressure on preoprative urodynamic. MCP-1/Cr levels were significantly higher amongs subjects with preoperative DO. Preoperative levels of NGF/Cr (0.13 vs 0.08, p = 0.005) and MMP-1/Cr (0.11 vs 0.04, p = 0.021) were predictors of persistent DO 12months after surgery. The following factors were shown to be useful for predicting the persistence of DO in the postoperative period: NGF/Cr, with an AUC of 0.77 (95% CI 0.62-0.92) (p = 0.006), and MMP-1/Cr, with an AUC of 0.72 (95% CI 0.56-0.88) (p = 0.022). MMP-1/Cr was associated with higher detrusor pressure and MCP-1/CR with DO. NGF/Cr and MMP-1/Cr were shown to be predictors of persistent postoperative DO.

Urodynamic findings of bladder dysfunction in patients with Type 2 DM

Bladder dysfunction is one of the most common complications of diabetes, even exceeding nephropathy or peripheral neuropathy. Diabetic cystopathyaffects patients in both sexes, and its prevalence increases over time with diabetes; our concern is to evaluate the urodynamic findings of bladder dysfunction in diabetic patients.A cross sectional study conducted at Ghazi Al-Hariri Surgical specialized hospital during the period from the firsts of January 2018 to the end of Mar 2019, in which 118 diabetic patients (71 female and 47 male) with lower urinary tract symptoms were enrolled in the current study. The mean age (62±13) years old, 37.3% of patients presented with urgency as the main type of dysfunction. Diabetic cystopathy were found in (40,4%) of the male and (43.7%) of the female, while detrusor over activity were found in (15.5%) of the male and (18.3%) of the female, bladder outlet obstruction were represent (8.5%) of the male with significant association. Highly significant (&lt;0.001) increase in female compliance and flow rate than that in male but highly significant decrease were found in female filling IV pressure. We concluded that Bladder over activity of the patients in the current study was found in more than half of the patients and diabetic cystopathy is the most common urodynamic finding in diabetic bladder dysfunction in patients with DM.

Urinary Symptoms and Bladder Dysfunction in Patients with Neuromyelitis Optica Spectrum Disorders: Evaluation with Urodynamics and Management.

Objective To assess lower urinary tract symptoms (LUTSs) in patients with neuromyelitis optica spectrum disorders (NMOSDs) and bladder dysfunction through urodynamics (filling and voiding phase of cystometrography) and management based on findings. Patients and Methods The study included 42 (34 females) patients admitted to the rehabilitation department. Neurologic evaluation was performed and severity of myelitis was assessed using the American Spinal Injury Association Impairment Scale. All patients underwent urodynamics, and management was based on the findings. Results Mean age was 34.5 years (range: 11–64 years; standard deviation: 13.1). Twenty-three (54.8%) patients had a first episode of myelitis, whereas 19 patients had relapses (number of episodes varying from 2 to 7). Eleven (26%) patients had increased frequency, 16 (37%) had urgency, 12 (28%) had urge incontinence, 8 (18.6%) had stress incontinence, 22 (52.4%) had nocturia, 31 (72%) had retention of urine, 22 (52.4%) had incomplete evacuation, and 14 (33.3%) patients had mixed urinary complaints. The common urodynamic findings were neurogenic detrusor overactivity (NDO) with detrusor-sphincter dyssynergia (DSD) in 14 (33.3%) patients, NDO without DSD in 8 (19%), and acontractile detrusor in 20 (47.6%). Pharmacotherapy was advised to 22 (52.4%) patients, whereas clean intermittent catheterization (CIC)/self-catheterization was advised to 39 (92.9%) patients. Conclusions Urinary retention was observed to be the most common urinary complaint in patients with NMOSD followed by NDO with or without sphincter dyssynergia. Urodynamics should be performed in all patients with LUTSs for best management. CIC remains the gold standard for the management of neurogenic bladder dysfunction.

Anatomical feasibility of anastomosing intercostal nerves (D10&D11) and subcostal nerve (D12) to S2 ventral root and lumbar plexus for management of bladder function after spinal cord injury

ObjectiveThe transfer of peripheral nerves originating above the level of injured spinal cord into the nerves/roots below the injury is a promising approach. It facilitates the functional recovery in lower extremity, bladder/bowel and sexual function in paraplegics. We assessed anatomical feasibility of transfer of lower intercostal nerves to S2 ventral root in human cadaver for management of neurogenic bladder dysfunction in patients with spinal cord injury. MethodsStudy was performed in five formalin fixed cadavers. Cadavers were placed in prone position. A transverse incision was made along 11th ribs on both sides and 10th, 11th Intercostal nerves (ICN) and subcostal nerve were harvested up to maximum possible length. In four cadavers the ventral root of S2 was exposed by endoscope and in one by the standard open laminectomy. Intercostal nerves were brought down to lumbo-sacral region, S2 ventral root was cut cranially and feasibility of intercostal to S2 anastomosis was assessed. ResultsThe mean length of intercostal nerves was 18.4 cm for the 10th 19.5 cm for the 11th and 22.15 cm for the subcostal nerve. The length of harvested nerve and the nerve length necessary to perform sacral roots neurotization were possible in all cases by only by subcostal nerve while T11 and T10 ICN fall short of the required length. ConclusionFor Spinal cord lesions located at the conus, subcostal nerve could be connected to ventral root of S2 in an attempt to restore bladder function while 10th and 11th ICN had enough length to neurotize lumbar plexus.

Combination Therapy for Bladder Dysfunction in Patients with Neurogenic Detrusor Overactivity

Neurogenic bladder is a common condition and top health priority present in 20–70% of patients with neurologic diseases including multiple sclerosis (MS), Parkinson’s disease (PD), spinal cord injury (SCI), and cerebrovascular accidents (CVA). Current gold-standard medications for overactive bladder (OAB), such as anti-muscarinics, have undesirable side effects, or have limited data in neurogenic patients. Combining therapy for urinary urge incontinence (UUI) has shown the potential to increase efficacy while maintaining or improving tolerability of treatment. Our objective was to review and synthesize recent combination therapy studies for UUI in patients with neurogenic detrusor overactivity (NDO). Non-pharmacologic and pharmacologic combination therapies have been investigated for UUI in patients with NDO. Adding intravaginal neuromuscular electrical stimulation (IVES) or transcutaneous tibial stimulation (TTNS) may not be superior to pelvic floor muscle training (PFMT) on its own. Recent studies on dual therapies have focused on combining drugs with different mechanisms. In adults, a combination of desmopressin with mirabegron showed superior efficacy compared to either drug alone or solifenacin. In children, combination studies have focused on adding gabapentin to drug regimens with promising safety and efficacy. Overall, there are few combination therapy trials for OAB in neurogenic patients compared to those in patients with idiopathic OAB. There is an unmet medical need for combination therapies in patients with UUI due to neurogenic bladder. It is important to gather practice patterns and encourage providers to share their experiences. In addition, more rigorous clinical studies are needed to explore new combinations.

Prevalence of Bladder Dysfunction in Acute Decompensated Heart Failure

Background The primary therapeutic objective during the treatment of acute decompensated heart failure (ADHF) is relief from volume overload. This is achieved primarily through urinary losses of sodium and water from diuretics. Urine output is a primary source of data for monitoring and titrating therapy in these patients. To our knowledge, the prevalence and natural history of bladder dysfunction in patients with ADHF undergoing diuresis has not been described. Hypothesis Bladder dysfunction will be common among patients with ADHF. Methods Patients admitted to Yale New Haven hospital with worsening heart failure requiring IV diuresis were prospectively enrolled. After a forced void, bladder ultrasounds were conducted using a Verathon® BVI 3000 bladder scanner. Three values were taken for each patient and averaged. In a subset of these patients, an ambulatory outpatient follow-up bladder scan was performed. Results 283 patients were enrolled and underwent determination of post void residual (PVR) volume. The average PVR volume was 131 ± 169 ml. Only 41% of patients had a normal PVR ( 100 ml and 23% of the patients had a PVR greater than 200 ml, which meets criteria for acute urinary retention. Surprisingly, we did not find a significant difference in the PVR retention volume between men (138 ± 166 ml) and women (118 ± 173 ml; p=0.32). There was also no difference in the prevalence of a PVR greater than 200 ml between men and women (p=0.19). Similarly, age and diabetic status were not correlated with PVR (p=NS for both) and in patients with a PVR >200 ml both the age (65 ± 15 years vs. 64 ± 13 years, p=0.62) and odds of having diabetes (OR=1.1, p=0.78) were not different. A total of 106 patients returned for an ambulatory a median of 43 days after discharge and had a repeat determination of PVR. Notably, there was a significant improvement in PVR volume post discharge with a mean 58 ± 134 ml (p 200 ml while hospitalized but only 4.7% had a PVR>200 ml at the return visit. Conclusion Significant bladder dysfunction is highly prevalent in ADHF patients and was not associated with traditional causes for bladder dysfunction. This dysfunction was largely resolved upon outpatient follow-up. Additional research is needed to understand the cause and clinical implications of the high rate of bladder dysfunction in patients with ADHF.

Комплексное уродинамическое исследование у пациентов с недержанием мочи после оперативного лечения локализованного рака предстательной железы

Radical treatment of prostate cancer (PCa) is often associated with the development of urinary incontinence (UI). The etiology of UI after prostatectomy is multifactorial and can be caused by both urethral sphincter deficiency and bladder dysfunction. To date, there are no comparative studies of the development of UI in patients after either organ-preserving treatment or radical prostatectomy (RP). Considering this fact, our aim was to carry out the comparative assessment of urodynamic changes in these categories of patients. A retrospective study (n=158) was conducted. All patients were divided into three groups, depending on the method of treatment, HIFU (Group 1, n=32), retropubic RP (Group 2, n=46); robot-assisted RP (Group 3, n=80). The mean age was 71.8+/-3.68, 69.5+/-4.63 and 65.8+/-3.4 years in Group 1, 2 and 3, respectively (p<0.01). The average score was ICIQ-SF-14 points. The median follow-up was 2.7 years. In all cases a multi-channel urodynamics study in accordance with ICS standards was performed. Detrusor overactivity (DO) was detected in 22 (68.7%), 24 (52.1%) and 64 (80%) patients in Group 1, 2 and 3, respectively (p<0.001). In 14% of patients with DO (18%, 12% and 12% Group 1, 2 and 3, p<0.05), leakage test with stress provocative maneuver was negative. The decrease in the bladder compliancy was revealed in 75.9% of patients, and in 8.8% cases (n=14) it was associated with anatomical changes (12.5%, 8.6% and 7.5% in Group 1, 2 and 3, respectively, p<0.01). The mean maximum detrusor pressure was reduced in all patients. Bladder outlet obstruction was detected in 46.6%, 21.7% and 12.5% cases (p<0.001). There was no significant difference in the level of maximum urethral pressure in all groups, but it was significant in patients with negative breakdown at the threshold of abdominal pressure and DO (p<0.05, k=0.87). The high incidence of postoperative bladder dysfunction in patients of the studied groups revealed by us differs from the existing literature data, which dictates the need for a detailed assessment of bladder dysfunction when choosing a tactic for treating UI. In connection with the above, we consider it necessary to conduct further studies with a mandatory pre- and postoperative urodynamic assessment of the lower urinary tract in patients after surgical treatment of prostate cancer without UI.

Assessment of Efficacy and Tolerability of Medicinal Cannabinoids in Patients With Multiple Sclerosis

Cannabinoids have antispastic and analgesic effects; however, their role in the treatment of multiple sclerosis (MS) symptoms is not well defined. To conduct a systematic review and meta-analysis to assess the efficacy and tolerability of medicinal cannabinoids compared with placebo in the symptomatic treatment of patients with MS. MEDLINE and the Cochrane Library Plus up to July 26, 2016. No restrictions were applied. The search was completed with information from ClinicalTrials.gov. Randomized, double-blind, and placebo-controlled trials evaluating the effect of medicinal cannabinoids by oral or oromucosal route of administration on the symptoms of spasticity, pain, or bladder dysfunction in adult patients with MS. The Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) reporting guidelines were followed. Effect sizes were calculated as standardized mean difference (SMD) for efficacy, and rate ratio (RR) for tolerability. Within each study, those SMDs evaluating the same outcome were combined before the meta-analysis to obtain a single value per outcome and study. Pooling of the studies was performed on an intention-to-treat basis by means of random-effect meta-analysis. Spasticity (on the Ashworth and Modified Ashworth scales and subjective), pain, bladder dysfunction, adverse events, and withdrawals due to adverse events. Seventeen selected trials including 3161 patients were analyzed. Significant findings for the efficacy of cannabinoids vs placebo were SMD = -0.25 SD (95% CI, -0.38 to -0.13 SD) for spasticity (subjective patient assessment data), -0.17 SD (95% CI, -0.31 to -0.03 SD) for pain, and -0.11 SD (95% CI, -0.22 to -0.0008 SD) for bladder dysfunction. Results favored cannabinoids. Findings for tolerability were RR = 1.72 patient-years (95% CI, 1.46-2.02 patient-years) in the total adverse events analysis and 2.95 patient-years (95% CI, 2.14-4.07 patient-years) in withdrawals due to adverse events. Results described a higher risk for cannabinoids. The serious adverse events meta-analysis showed no statistical significance. The results suggest a limited efficacy of cannabinoids for the treatment of spasticity, pain, and bladder dysfunction in patients with MS. Therapy using these drugs can be considered as safe. PROSPERO Identifier: CRD42014015391.

Análise da relação entre sintomas urinários e topografia da lesão cerebral em pacientes com acidente vascular cerebral

Objetivo: Analisar a relação entre a topografia da lesão cerebral e disfunção vesical em pacientes com acidente vascular cerebral (AVC) isquêmico e hemorrágico comparando a região cerebral afetada com os sintomas do trato urinário inferior (STUI).Materiais e Métodos: Estudo retrospectivo, desenvolvido no Hospital da Rede SARAH de Neurorreabilitação, Brasil, com 132 pacientes com AVC crônico atendidos no programa de reabilitação neurológica adulto, no período de janeiro de 2008 a dezembro de 2011.Resultados: Cento e seis pacientes (80,3%) apresentaram sequela de acidente vascular cerebral isquêmico e 26 (19,7%) acidente vascular cerebral hemorrágico. A média de idade foi de 56±13,1 anos e o tempo médio da ocorrência do AVC foi de 21,4 meses. Em relação ao comportamento miccional, 35,6% (n=47) eram continentes vesicais, 45,5% (n=60) com sintomas do trato urinário inferior, e 18,9% (n=25) com incontinência urinária contínua. Observou-se que na ocorrência de lesões extensas acometendo a área frontal parietal-temporal-occiptal (p=0,001), alterações cognitivas (p=0,001) e afasia (p=0,001) houve relação estatística significativa com a presença de incontinência urinária contínua nestes pacientes. Nos pacientes com lesão fronto-parietal houve associação com o sintoma urgência (p=0,050), urgeincontinência urinária (p=0,042), incontinência urinária de esforço (p=0,019) e polaciúria (p=0,042).Conclusão: Segundo a amostra estudada, observamos que alterações cognitivas e afasia tiveram correlação com a incontinência urinária contínua. Em relação a topografia de lesão cerebral houve associação entre lesões em região fronto-parietal com os sintomas de urgência, urgeincontinência, incontinência de esforço e polaciúria; e na ocorrência de lesão cerebral extensa houve prevalência de incontinência urinária contínua.