Neurogenic Bladder Disorders Research Articles

Expression of Wnt signaling proteins in rare congenital bladder disorders

Introduction and AimsCongenital bladder anomalies are rare and are a leading cause of end stage renal failure in children. The Wnt signaling pathway, important during embryonic development, has been implicated in the pathogenesis of these conditions through regulation of gene expression, including essential transcription factors. We investigated the expression of four Wnt transcriptional targets, namely, Pygopus 1 (Pygo1), FRA1, TCF7L1 and Connexin 43 (Cx43) in three rare congenital bladder disorders: bladder exstrophy (BE), neurogenic bladder (NGB) and posterior urethral valves (PUV). MethodsBladder tissue samples were collected from patients at the Great Ormond Street Hospital for Sick Children, London, UK, with control (normally-functioning bladder, N=9), BE (N=15), NGB (N=6) and PUV (N=5). Histological analysis was performed using the van Gieson stain to differentiate smooth muscle (SM) and connective tissue (CT) compartments. An unbiased, automated, semi-quantitative immunofluorescence analysis was performed to measure the labelling intensity of four Wnt-related proteins in tissue from these four groups. Results and DiscussionThere was a significant (p<0.05) increase in the expression of Pygo1 in the smooth muscle of all anomalies examined and also in the connective tissue in PUV compared to control. Cx43 also showed overexpression in the smooth muscle across all conditions; however, there was a reduced expression in NGB and an increase in PUV in connective tissue. TCF7L1 showed a significant decrease in both tissue compartments for NGB, whereas FRA1 expression remained unchanged across all anomalies. We also measured colocalization of Wnt-related proteins. TCF7L1 exhibited increased colocalization with Pygo1 and FRA1 in exstrophy compared to control. These results suggest a complex dysregulation of the Wnt pathway in congenital bladder disorders. ConclusionWnt signaling-related proteins show dysregulation in congenital bladder disorders compared to control tissue. Understanding these mechanisms should help towards non-invasive early diagnosis, drug target discovery and development of treatment strategies for these conditions.Summary tableSummary of Wnt-related protein expression and colocalization in bladder exstrophy (BE), neurogenic bladder (NGB) and posterior urethral valves (PUV) disorder compared to normally-functioning control bladder. The table shows the levels of expression as significantly up (↑) down (↓) or no change (-) of Pygopus 1 (Pygo1), Connexin 43 (Cx43), FRA1 and TCF7L1 expression in smooth muscle and connective tissue compartments in BE, NGB and PUV relative to control bladder tissue samples. The table also shows colocalization of six protein pairs of Pygo1 and FRA1; Pygo1 and Cx43; Pygo1 and TCF7L1; FRA1 and Cx43; FRA1 and TCF7L1 and Cx43 and TCF7L1 in bladder disorders compared to control.Summary tableProtein Expression (Smooth muscle)Pygo1Cx43FRA1TCF7L1BE↑↑--NGB↑↑-↓PUV↑↑--Protein Expression (Connective tissue)BE----NGB-↓-↓PUV↑↑--ColocalizationPygo1/FRA1Pygo1/Cx43Pygo1/TCF7L1FRA1/Cx43FRA1/TCF7L1Cx43/TCF7L1Exstrophy--↑-↑-NGB------PUV------

A novel clinical classification for male urinary incontinence: MI-CRONS

Introduction:The aim of this study is to develop a new simple and practical classification of male urinary incontinence (UI) based on the clinical features and type of urinary incontinence. Materials & methods:MI-CRONS classification is a system based on severity of incontinence and patients’ characteristics. Clinical evaluation of incontinence severity is based on preservation of voiding, proportion of void/lost urine, absorbable device usage, level of physical efforts that causes urine loss and nocturnal incontinence. Following patients’ characteristics of patients were included in classification system: history of radical prostatectomy, history of pelvic radiation, surgery for prostatic obstruction, neurogenic or non-neurogenic bladder disorders, and urethral strictures and disorders. This MI-CRONS classification system uses five uppercase Latin letters as follows: Male Incontinence — Cancer, Radiation, Obstruction, Neurogenic, Stricture. The classification could be used for stress, urgency, and mixed UI forms. Results:The new MI-CRONS classification system was applied to 85 of 86 patients evaluated in this retrospective study. Patients were classified by MI-CRONS to estimate an inclusiveness and complicity of proposed classification only. One patient was not classified using the new MI-CRONS classification due to history of bladder exstrophy and augmentation cystoplasty. Most of the men studied had a stress form of urinary incontinence and the most common types were 2 (n = 18) and 3 (n = 17) after radical prostatectomy. Conclusion:The MI-CRONS has demonstrated prompt potential for classifying male incontinence of any type. The classification is a simple tool to describe these patients and could be useful for daily practice and clinical trials. Although further multicenter studies are needed to evaluate the predictive value of this tool. A Delphi consensus would be proposed with international experts for the further development of MI-CRONS.

Botulinum toxin: a new differential diagnosis for a lytic bone lesion

BackgroundBotulinum toxin, produced by the Gram-positive anaerobe Clostridium botulinum, is composed of seven antigenic subtypes (A, B, C, D, E, F, and G). Currently, only Botulinum toxin type A, commonly referred to as “Botox,” is approved for clinical use, given its relatively safe clinical profile. Botulinum toxin type A has a wide range of therapeutic indications, including treatment for dystonia, migraine headache, neurogenic bladder, and large muscle spastic disorders. However, the toxin is most widely known for its cosmetic effects in treating wrinkles and facial lines.Case presentationThis article describes a 62-year-old Caucasian female who presented for investigation and workup of an isolated lytic lesion of her frontal bone a few weeks after administration of botulinum toxin injection into the corresponding site in the frontalis muscle. This presented as a large, palpable, painless forehead lump causing significant psychological distress. After no neoplastic cause for the lesion was found and histopathology was performed, our researchers concluded that the most likely explanation was that the bony lytic lesion resulted from inadvertent injection of the “Botox” neurotoxin through the intended target muscle and into the cortex of the underlying bone.ConclusionsOur search of the literature failed to identify any previous cases of this occurring. However, as the popularity of this cosmetic procedure only increases, we believe that this represents an important possible differential for isolated lytic lesion after administration of “Botox” injection.

Transcranial magnetic stimulation-based closed-loop modality for activity of daily living gain in spinal cord injury: a retrospective study using propensity score matching analysis.

Although transcranial magnetic stimulation (TMS)-based closed-loop (TBCL) modality was seldom recommended for functional restoring following spinal cord injury (SCI), several studies recently came to a positive suggestion. To explore the independent factors which influence activity of daily living (ADL) gain, and systematically investigate the efficacy of TBCL for ADL gain. A retrospective observational study. The First Affiliated Hospital of Guangxi Medical University. SCI patients with neurological dysfunction. A total of 768 patients who received TBCL (N.=548) or sole rehabilitation (SR, N.=220) were enrolled. Analysis on propensity score matching was also performed. Finally, the cumulative inefficiencies between TBCL and SR within entire patient population, matched-patients as well as subgroup on per SCI clinical characteristics were performed. Multivariate analysis showed that thoracolumbar injury, single/double injury, incomplete injury, no neurogenic bladder, no neurogenic intestinal and no respiratory disorder, as well as TBCL strategy were independent positive factors for ADL gain. Meanwhile, TBCL strategy was the outstanding positive factor. TBCL caused a lower cumulative inefficiency over SR at 1, 90 and 180 days (83.2% vs. 86.8%, 54.0% vs. 63.6%, and 38.3% vs. 50.9%, respectively; all P<0.05). Propensity matching also found TBCL caused a lower cumulative inefficiency over SR after 1, 90 and 180 days (82.4% vs. 86.4%, 51.1% vs. 62.5%, and 33.5% vs. 49.4%, respectively; all P<0.05). Subgroup analysis showed that TBCL caused a greater ADL gain regardless of injured site, segments of injury and injured extent, as well as whether concurrent with neurogenic bladder, neurogenic intestinal and respiratory disorder (all P<0.05). Further, TBCL was more effective in 180-days overall ADL gain within each subgroup (all P<0.05), except the subgroup whether concurrent with respiratory disorder (P>0.05). Our study indicates that TBCL strategy was the most outstanding independent positive factors for ADL gain. Further, TBCL is a better choice than SR in ADL gain for SCI-relevant neurological dysfunctions in case of adequate stimuli distance and individual temperature, regardless of discrepancy of clinical feature. This study helps to improve everyday management for rehabilitative intervention on SCI. For another thing, the present study may be good for neuromodulation practice on function restoring in SCI rehabilitation clinics.

The clinical characteristics of neuronal intranuclear inclusion disease and its relation with inflammation.

Neuronal intranuclear inclusion disease (NIID) is a great imitator with a broad spectrum of clinical manifestations that include dementia, parkinsonism, paroxysmal symptoms, peripheral neuropathy, and autonomic dysfunction. Hence, it may also masquerade as other diseases such as Alzheimer's disease, Parkinson's disease, and Charcot-Marie-Tooth disease. Recent breakthroughs on neuroimaging, skin biopsy, and genetic testing have facilitated the diagnosis. However, early identification and effective treatment are still difficult in cases of NIID. To further study the clinical characteristics of NIID and investigate the relationship between NIID and inflammation. We systematically evaluated the clinical symptoms, signs, MRI and electromyographical findings, and pathological characteristics of 20 NIID patients with abnormal GGC repeats in the NOTCH2NLC gene. Some inflammatory factors in the patients were also studied. Paroxysmal symptoms such as paroxysmal encephalopathy, stroke-like episodes, and mitochondrial encephalomyopathy lactic acidosis and stroke (MELAS)-like episode were the most common phenotypes. Other symptoms such as cognitive dysfunction, neurogenic bladder, tremor, and vision disorders were also suggestive of NIID. Interestingly, not all patients showed apparent diffusion-weighted imaging (DWI) abnormality or intranuclear inclusions, while abnormal GGC repeats of NOTCH2NLC were seen in all patients. And fevers were noticed in some patients during encephalitic episodes, usually with increasing leukocyte counts and neutrophil ratios. Both IL-6 (p = 0.019) and TNF-α (p = 0.027) levels were significantly higher in the NIID group than in normal controls. Genetic testing of NOTCH2NLC may be the best choice in the diagnosis of NIID. Inflammation might be involved in the pathogenesis of NIID.

Scoring Systems to Evaluate the Mortality Risk of Patients with Emphysematous Cystitis: A Retrospective Observational Study

Emphysematous cystitis (EC) is a complicated urinary tract infection (UTI) characterized by gas formation within the bladder wall and lumen. Immunocompetent people are less likely to suffer from complicated UTIs, but EC usually occurs in women with poorly controlled diabetes mellitus (DM). Other risk factors of EC include recurrent UTI, neurogenic bladder disorder, blood supply disorders, and prolonged catheterization, but DM is still the most important of all aspects. Our study investigated clinical scores in predicting clinical outcomes of patients with EC. Our analysis is unique in predicting EC clinical outcomes by using scoring system performance. We retrospectively collected EC patient data from the electronic clinical database of Taichung Veterans General Hospital between January 2007 and December 2020. Urinary cultures and computerized tomography confirmed EC. In addition, we investigated the demographics, clinical characteristics, and laboratory data for analysis. Finally, we used a variety of clinical scoring systems as a predictor of clinical outcomes. A total of 35 patients had confirmed EC, including 11 males (31.4%) and 24 females (68.6%), with a mean age of 69.1 ± 11.4 years. Their hospital stay averaged 19.9 ± 15.5 days. The in-hospital mortality rate was 22.9%. The Mortality in Emergency Department Sepsis (MEDS) score was 5.4 ± 4.7 for survivors and 11.8 ± 5.3 for non-survivors (p = 0.005). For mortality risk prediction, the AUC of ROC was 0.819 for MEDS and 0.685 for Rapid Emergency Medicine Score (REMS). The hazard ratio of univariate and multivariate logistic regression analyses of REMS for EC patients was1.457 (p = 0.011) and 1.374 (p = 0.025), respectively. Physicians must pay attention to high-risk patients according to clinical clues and arrange imaging studies as soon as possible to confirm the diagnosis of EC. MEDS and REMS are helpful for clinical staff in predicting the clinical outcome of EC patients. If EC patients feature higher scores of MEDS (≥12) and REMS (≥10), they will have higher mortality.

The Effect of Rehabilitation Nursing Interventions on the Quality of Life in Women With Neurogenic Bladder Dysfunction

Objective: Neurogenic bladder (NB) is one of the most common causes of urinary incontinence, and its many long-term problems negatively affect patients' quality of life, especially women, due to a lack of social roles. Due to the chronic nature of this disorder, the implementation of rehabilitation nursing interventions to improve the quality of life of these patients has been recommended. Therefore, this study aimed to evaluate the effectiveness of multidimensional rehabilitation nursing intervention of urinary incontinence on the quality of life of young and middle-aged women with neurogenic bladder. Materials &amp; Methods: The present research was a quasi-experimental study with a pre-test-post-test design that was conducted in Rofeideh Rehabilitation Hospital, Tehran, Iran, in 2021. Data were collected from 30 young and middle-aged women aged 18 to 60 years admitted with neurogenic bladder. The samples completed the demographic questionnaire and incontinence quality of life questionnaire (I-QOL) before and 6 weeks after the intervention during follow-up. Multidimensional rehabilitation nursing intervention of urinary incontinence included two-part training sessions: 1) clean intermittent catheterization and 2) behavioral therapy (Time voiding, delaying urination, diet, and medication) in 7 30-minutes sessions of training conducted daily and individually face-to-face in the first week and then a follow-up of patients in 5 weeks (second, third, fourth, fifth, and sixth weeks), one session per week in the form of virtual classes and online video calls in WhatsApp application. The collected data were analyzed in SPSS software version 25 using one-way ANOVA and paired t-test at a significance level of 0.05. Results: Most participants were 20-30 years old (30%) and married (53.3%). Before and after the intervention, the quality of life of patients with neurogenic bladder disorder increased from 46.46±11.07 to 66.23±9.46, which was statistically significant (t=14.20, P&lt;0.0001). Also, psychosocial impacts due to the disease were reduced based on one of the three subscales of the quality of life questionnaire. In addition, quality of life was significantly lower in younger, unemployed, single, spinal cord injury, body odor, and people with a neurogenic bladder disease diagnosis period of less than one year (P&lt;0001). Conclusion: According to our findings, clean intermittent catheterization and behavioral therapy could significantly improve patient's quality of life with NB. Therefore, it is recommended to investigate the long-term effectiveness of this intervention.

MP25-05 URINARY DIVERSION WITH OR WITHOUT CONCOMITANT BENIGN CYSTECTOMY FOR RADIOGENIC AND NON-RADIOGENIC CONDITIONS: A COMPARATIVE MORBIDITY ASSESSMENT ACCORDING TO THE UPDATED EAU GUIDELINES ON STANDARDIZED COMPLICATION REPORTING

You have accessJournal of UrologyCME1 May 2022MP25-05 URINARY DIVERSION WITH OR WITHOUT CONCOMITANT BENIGN CYSTECTOMY FOR RADIOGENIC AND NON-RADIOGENIC CONDITIONS: A COMPARATIVE MORBIDITY ASSESSMENT ACCORDING TO THE UPDATED EAU GUIDELINES ON STANDARDIZED COMPLICATION REPORTING Malte W. Vetterlein, Hang Yu, Maria Buhné, Philipp Gild, Mara Kölker, Armin Soave, Roland Dahlem, Margit Fisch, and Michael Rink Malte W. VetterleinMalte W. Vetterlein More articles by this author , Hang YuHang Yu More articles by this author , Maria BuhnéMaria Buhné More articles by this author , Philipp GildPhilipp Gild More articles by this author , Mara KölkerMara Kölker More articles by this author , Armin SoaveArmin Soave More articles by this author , Roland DahlemRoland Dahlem More articles by this author , Margit FischMargit Fisch More articles by this author , and Michael RinkMichael Rink More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002568.05AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: As opposed to radical cystectomy for cancer, few studies have focused on morbidity after urinary diversion (UD) ± benign cystectomy (BC). We here provide an in-depth evaluation of 30-d morbidity in patients undergoing UD±BC using the updated EAU guidelines for standardized reporting. METHODS: We performed a chart review of patients undergoing UD±BC in 2009-17. We tabulated 30-d complications by a predefined catalog and graded them by the Clavien-Dindo classification (CDC) and each individual Comprehensive Complication Index (CCI®). Traditional morbidity endpoints were used to compare UD+BC vs. UD alone. By multivariable regression models we evaluated the impact of the ablative part (BC) vs. the reconstructive part (UD) on cumulative perioperative morbidity. Multivariable analyses were repeated in a subgroup of irradiated patients. RESULTS: Of 97 patients, 46 (47%) and 51 (53%) underwent UD+BC and UD alone, respectively. Patients with UD+BC were older (median 66 vs. 56 yr) and more comorbid (median Charlson index 4.0 vs. 3.0) vs. UD alone (p≤0.020). Other baseline characteristics (gender, BMI, ASA status, kidney function, hx of radiotherapy) were comparable (all p≥0.4). In 49 (51%) patients, surgery was indicated by radiogenic issues, neurogenic bladder (12%), interstitial cystitis (12%), and genital disorders (10%). Non-radiogenic incontinence (2.1%), fistula (3.1%), bladder contracture (5.2%), and outlet obstruction (4.1%) were rare. Overall, 69 (71%) received continent UD and 26 (27%) a Mitrofanoff procedure, of which 12 (46%) had augmentation cystoplasty. We found 390 complications in 97 patients (100%), with 7 (7.2%) major complications (CDC ≥IIIb), 3 (3.1%) readmissions, and no deaths. There was no difference between the groups regarding the incidence of complication subgroups (gastrointestinal, infectious, etc.; all p≥0.05; Figure 1). The median CCI® was higher for UD+BC compared to UD alone (32 vs. 24; p=0.005). In multivariable analyses, neither BC in addition to UD (p=0.2) nor a hx of pelvic radiotherapy (p=0.2) were associated with a higher morbidity burden as measured by the CCI® after adjusting for confounders. Similar results were found in the subgroup of irradiated patients. CONCLUSIONS: Neither the ablative part nor prior radiotherapy did impact morbidity in our series. Hence, BC should be considered in patients who might benefit from the procedure to avoid long-term sequelae of the retained bladder. Source of Funding: n/a © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e429 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Malte W. Vetterlein More articles by this author Hang Yu More articles by this author Maria Buhné More articles by this author Philipp Gild More articles by this author Mara Kölker More articles by this author Armin Soave More articles by this author Roland Dahlem More articles by this author Margit Fisch More articles by this author Michael Rink More articles by this author Expand All Advertisement PDF DownloadLoading ...

MP07-18 IDENTIFICATION OF THE MAJOR NADPH OXIDASE SUBTYPE IN THE MICTURITION CENTRE – PATHOLOGICAL IMPLICATIONS

You have accessJournal of UrologyCME1 May 2022MP07-18 IDENTIFICATION OF THE MAJOR NADPH OXIDASE SUBTYPE IN THE MICTURITION CENTRE – PATHOLOGICAL IMPLICATIONS Qin Wu, Ayse Gurpinar, Patrizia Camelliti, Maxwell Roberts, Michael Ruggieri, and Changhao Wu Qin WuQin Wu More articles by this author , Ayse GurpinarAyse Gurpinar More articles by this author , Patrizia CamellitiPatrizia Camelliti More articles by this author , Maxwell RobertsMaxwell Roberts More articles by this author , Michael RuggieriMichael Ruggieri More articles by this author , and Changhao WuChanghao Wu More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002529.18AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Oxidative inflammatory damage to the brain may lead to dysfunction of peripheral organs including bladder disorders. However, the source of reactive oxygen species (ROS) in specific brain regions that regulate the function of peripheral systems is poorly understood. Of all ROS-generating enzymes, the NADPH oxidase (Nox) family produces ROS as its sole function and offers an advantage over other enzymes as a drug targetable molecule to selectively control excessive ROS. Our pilot study demonstrated such system in the bladder. This study tested the hypothesis that the major Nox subtype, Nox 2 is expressed in the micturition regulatory regions - Pontine micturition centre (PMC) and periaqueductal gray (PAG), and such system is able to produce substantial superoxide. METHODS: Male adult C57BL/6J mice (2-5 months) were used. PAG, PMC were dissected according to a mouse stereotaxic atlas. Cardiac and bladder tissues were isolated under microscopic guidance. Western blot determined Nox 2 expression using Nox 2 primary antibody and Infra-red dye-conjugated secondary antibodies. Lucigenin enhanced chemiluminescence quantified real-time superoxide production in live tissues, verified by the superoxide scavenger Tiron. Paired and non-paired t-test tested the difference in two group means and ANOVA with pairwise comparisons tested multiple means. RESULTS: Western blot experiments demonstrated the presence of Nox 2 in PAG and PMC tissues, with a density comparable to that of positive control (n=6). There was a significant level of NADPH dependent superoxide production in both brain tissues (RLU/mg, PMC: 127±17; PAG102±13, N=11, higher than that from cardiac tissue (32±3, P<0.01); similar to that from bladder smooth muscle (91±19, p>0.05) and lower than that in bladder mucosa (262±55, p<0.01). The time course analysis shows that the rise of superoxide production in these two brain tissues was more sustained than in bladder mucosa and smooth muscle (Half peak duration PD50, minutes: PMC, 101±2; PAG, 99±2; bladder mucosa, 48±3, p<0.01; smooth muscle, 67±9, p<0.01). The superoxide generation from these brain tissues was significantly suppressed by the Nox inhibitor diphenyleneiodonium (DPI). CONCLUSIONS: These data provide the first evidence for the presence of Nox 2 in brain micturition centres and its high capacity to produce superoxide. The study has also identified the sustained nature of the superoxide rise from this ROS-generating pathway. The predominance of this system and its characteristics revealed by this study provide mechanistic basis for the pathology of aging and inflammation associated neurogenic bladder disorders. Source of Funding: BBSRC (BB/P004695/1)NIA (NIA1R01AG049321-01A1)QW: Jiangsu Overseas Visiting Scholar Program for University Prominent Young and Middle-aged Teachers and Presidents © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e122 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Qin Wu More articles by this author Ayse Gurpinar More articles by this author Patrizia Camelliti More articles by this author Maxwell Roberts More articles by this author Michael Ruggieri More articles by this author Changhao Wu More articles by this author Expand All Advertisement PDF DownloadLoading ...

Bladder cancer in patients with neurogenic bladder disorder: a comparative study of different etiologies.

The objective of this study was to conduct a comparative study of different etiologies of neurogenic bladder disorders (NBDs) in patients with bladder cancer (BC) regarding patient- and tumor-related parameters and their oncological outcome. Out of 98 patients with bladder tumors and neurogenic disease, 23 patients with BC and NBDs from Jan 1, 2010, to Dec 31, 2020, were included. The different etiologies of NBDs were merged in three groups based on the level of the nervous system (NS)-lesion: (i) central (n = 6), (ii) spinal cord (n = 10), and (iii) peripheral lesions (n = 7). Patients with lesions at the spinal cord level were younger at the time of BC diagnosis compared to patients with central or peripheral NS lesions (54 vs. 68 vs. 78years, p = 0.0219). However, the latency to malignant transformation was more than twice as long (33 vs. 15years, p = 0.0108). Most tumors were muscle-invasive or locally advanced BCs (62%) and presented lymph node metastases (55%), resulting in a poor mean overall survival of 30.9 ± 3.6months. No significant differences regarding histopathology, tumor stage, and oncological outcome could be observed between the groups. Patients with NBDs have a poor prognosis regardless of their etiology or the level of NS lesion. Patients with spinal cord lesions, including congenital NBDs, appear to develop BC at a young age, but compared to other etiologies latency from NBD to BC is longer.

MP02-09 TOILETING BEHAVIORS IN ADULT WOMEN WITH RECURRENT URINARY TRACT INFECTIONS IN A LARGE POPULATION SURVEY STUDY

You have accessJournal of UrologyUrodynamics/Lower Urinary Tract Dysfunction/Female Pelvic Medicine: Non-neurogenic Voiding Dysfunction I (MP02)1 Sep 2021MP02-09 TOILETING BEHAVIORS IN ADULT WOMEN WITH RECURRENT URINARY TRACT INFECTIONS IN A LARGE POPULATION SURVEY STUDY Elisabeth Sebesta, Elizabeth Rourke, Roger Dmochowski, Melissa Kaufman, and W. Stuart Reynolds Elisabeth SebestaElisabeth Sebesta More articles by this author , Elizabeth RourkeElizabeth Rourke More articles by this author , Roger DmochowskiRoger Dmochowski More articles by this author , Melissa KaufmanMelissa Kaufman More articles by this author , and W. Stuart ReynoldsW. Stuart Reynolds More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000001963.09AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Urinary tract infections (UTIs) are extremely prevalent in the female population. In female children, recurrent UTIs (rUTIs) have been linked to toileting habits including infrequent voiding, poor fluid intake, stool retention, and toilet hygiene, and often management targets such behaviors. However, the same association has not been made in adult women. In this study, we aimed to assess whether women with rUTIs report more unhealthy bladder and bowel habits. METHODS: This is a secondary analysis of a sample of 6,074 non-institutionalized, adult U.S. women recruited through online advertisement with ResearchMatch. Women completed validated questionnaires assessing demographic and clinical history, toileting behaviors (TB-WEB), urinary symptoms (ICIQ-FLUTS), and bowel habits (ICIQ-BS). Subjects were excluded if they were pregnant, used a urinary catheter, or had a history of cystectomy, neurogenic bladder, or neurological disorder. Our primary comparison was between women who did and did not report a history of rUTIs (i.e. three of more UTIs requiring treatment in the last year). All statistics were performed in STATA, with p <0.05 considered significant. RESULTS: Of our sample, 324 (5.3%) reported a history of rUTIs. Age and race were similar between the two groups, with average age 40.8 ± 15 years. Comorbid conditions including diabetes, heart disease, hypertension, irritable bowel syndrome, anxiety, and depression were more common in women with rUTIs. Women with rUTIs more commonly reported holding urine when away from home or busy, avoiding public toilets, and waiting to void until a strong urge and/or leakage. Additionally, women with rUTIs reported sitting to void less often when away from home, and more commonly crouch or hover over the toilet or squat on the seat both at home or away, although these differences were not significant. Finally, women with rUTIs more frequently reported constipation. CONCLUSIONS: In this cross-sectional study, adult women rUTIs reported a higher prevalence of unhealthy bladder habits including limiting bathroom use and holding urine, constipation, and comorbid conditions. In the future it is worth considering whether modification such behaviors may be a target for management of these women. Source of Funding: None © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e14-e15 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Elisabeth Sebesta More articles by this author Elizabeth Rourke More articles by this author Roger Dmochowski More articles by this author Melissa Kaufman More articles by this author W. Stuart Reynolds More articles by this author Expand All Advertisement Loading ...

Aseptic meningitis as paraneoplastic syndrome related to chronic myeloid leukemia in chronic phase

Chronic myeloid leukemia (CML) is a clonal hemopoietic stem cell disorder characterized by reciprocal translocation between the long arms of chromosomes 9 and 22 that produces the fusion BCR-ABL1 gene. Major manifestations in CML patients are increased white cell count and splenomegaly. In this case, the patient presented with aseptic meningitis and showed symptoms, such as disorientation, double vision, and neurogenic bladder disorder. Pulse steroid and antibiotic treatment was ineffective for these symptoms; however, the combination therapy with these drugs and dasatinib was very effective. Moreover, our patient had myelopathy that could have been induced by dasatinib after the treatment was started. To our knowledge, this is the first report of meningitis of the paraneoplastic syndrome associated with CML.

Outcome of Different Approaches to Reduce Urinary Tract Infection in Patients With Spinal Cord Lesions

Neurogenic bladder disorders are common among patients with spinal cord lesions, which often result in upper and lower urinary tract complications. Urinary tract infection has remained the most frequent type of infection in this population. Our aim is to review systematically the literature on the outcome of different intervention methods to reduce urinary tract infection incidence. A literature search was conducted in the database of Medline, PubMed, Embase, and Scopus. After screening 1559 articles, 42 were included in this review. The intervention methods can be categorized into the four following groups: (1) indwelling catheterization and intermittent catheterization, (2) medications, (3) surgery, and (4) others. Intermittent catheterization is still the most recommended treatment for persons with spinal cord lesions. Hydrophilic catheters are more suitable for adults than children because of complex handling. Bladder management with spontaneous voiding is initially considered for infants and toddlers with spina bifida. Antibiotics treatment should be based on the results of urine cultures. Shortening the course of antibiotics treatment can reduce its adverse effects but may increase urinary tract infection recurrence. Because botulinum toxin injections and bladder surgery can improve urodynamic function, both are conducive toward lowering urinary tract infection incidence.

Use of intracutaneous or subcutaneous botulinum toxin for postherpetic neuralgia

Botulinum neurotoxin (BoNT), atoxin of the anaerobic spore-forming bacterium Clostridium botulinum is used as adrug for alleviating muscle spasticity. Other indications include the cosmetic application in facial muscles, hyperhidrosis and neurogenic bladder disorders. It has been approved since 2010 as the first prophylactic treatment for chronic migraine. The analgesic effect of BoNT was observed early on and is currently the subject of intensive research. Painful postherpetic neuralgia is acommon complication of an infection with herpes zoster virus. Despite modern treatment algorithms and medication, satisfactory pain treatment is not achieved in all patients. The use of BoNT could represent anew treatment option. The aim of this article is to provide an overview of the current evidence for the use of BoNT for postherpetic neuralgia. We conducted asystematic literature search with the keywords "botulinum" and "neuropathic" and included original articles in which BoNT was used subcutaneously or intradermally for the treatment of postherpetic neuralgia. The initial search yielded 212 results. After atitle and abstract screening, the number was reduced to 11 relevant publications (5case reports or series and 6 prospective studies). The results in the currently available literature show that BoNT is an effective therapeutic option for postherpetic neuralgia. In all studies, asignificant effect on the pain and also on relevant patient-oriented secondary variables, such as the quality of life and especially the quality of sleep was shown. The only reported side effect was pain during administration.

The influence of intravesical administration of resiniferatoxin (RTX) on the chemical coding of sympathetic chain ganglia (SChG) neurons supplying the porcine urinary bladder.

Resiniferatoxin (RTX) is used as an experimental drug in therapy of neurogenic urinary bladder disorders. The present study investigated the chemical coding of sympathetic chain ganglia (SChG) neurons supplying porcine urinary bladder after intravesical RTX instillation. The SChG neurons were visualized with retrograde tracing method and their chemical profile was disclosed with double-labeling immunohistochemistry using antibodies against dopamine β-hydroxylase (DβH; marker of noradrenergic neurons), neuropeptide Y (NPY), vasoactive intestinal polypeptide (VIP), somatostatin (SOM), galanin, Leu(5)-enkephalin and neuronal nitric oxide synthase (nNOS). It was found that in both the control (n = 5) and RTX-treated pigs (n = 5), the vast majority (90.4 ± 2.8 and 89.7 ± 2.3%, respectively) of FB-positive (FB+) nerve cells were DβH+. RTX instillation caused a decrease in the number of FB+/DβH+ neurons immunopositive to NPY (71.1 ± 12.1 vs 43.2 ± 6.7%), VIP (21.3 ± 10.7 vs 5.3 ± 4.3%) or SOM (16.5 ± 4.6 vs 2.3 ± 2.6%) and a distinct increase in the number of FB+/DβH+ neurons immunoreactive to nNOS (0.8 ± 1 vs 5.3 ± 1.9 %). The present study for the first time has provided some information that therapeutic effects of RTX on the mammalian urinary bladder can be partly mediated by SChG neurons.

Emerging subspecialties in neurology: autonomic disorders.

Autonomic nervous system (ANS) dysfunction as a cause of disease is an increasingly recognized health problem, not only in the field of neurology, but also in cardiology, gastroenterology, endocrinology, urology, psychiatry, and primary care medicine. Patients may present with a myriad of symptoms including orthostatic intolerance, recurrent syncope, labile blood pressure, disorders of sweating and thermoregulation, neurogenic bladder, sexual dysfunction, gastrointestinal dysmotility, pupil abnormalities, and sleep disorders. These symptoms may, in turn, be a consequence of genetic (e.g., hereditary sensory and autonomic neuropathies, transthyretin amyloidosis), neurodegenerative (e.g., Parkinson disease [PD], multiple system atrophy [MSA]), autoimmune (e.g., autoimmune ganglionopathies), or acquired disorders (e.g., spinal cord lesions, type 2 diabetes). Although autonomic symptoms may be among the most debilitating features of these progressive conditions, they are often treatable. Autonomic disorders specialists require a comprehensive knowledge of the anatomy, physiology, and pharmacology of the ANS, understanding of the pathophysiology and management of acute and chronic autonomic conditions, and expertise in the performance and interpretation of clinical and laboratory evaluation of the ANS. The authors thank Dr. Horacio Kaufmann for reviewing an earlier version of this manuscript.

Changes in chemical coding of sympathetic chain ganglia (SChG) neurons supplying porcine urinary bladder after botulinum toxin (BTX) treatment.

Botulinum toxin (BTX) is a neurotoxin used in medicine as an effective drug in experimental therapy of neurogenic urinary bladder disorders. We have investigated the influence of BTX on the chemical coding of sympathetic chain ganglia (SChG) neurons supplying the porcine urinary bladder. The toxin was injected into the wall of the bladder. SChG neurons were visualized by a retrograde tracing method with fluorescent tracer fast blue (FB) and their chemical coding was investigated by double-labelling immunohistochemistry with antibodies against dopamine β-hydroxylase (DβH; a marker of noradrenergic neurons), neuropeptide Y (NPY), vasoactive intestinal polypeptide (VIP), somatostatin (SOM), galanin (GAL), Leu5-enkephalin (L-ENK) and neuronal nitric oxide synthase (nNOS). In both the control (n = 5) and BTX-treated pigs (n = 5), the vast majority (91 ± 2.3 % and 89.8 ± 2.5 %, respectively) of FB-positive (FB+) nerve cells were DβH+. BTX injections caused a decrease in the number of FB+/DβH+ neurons that were immunopositive to NPY (39.5 ± 4.5 % vs 74.5 ± 11.9 %), VIP (8.9 ± 5.3 % vs 22.3 ± 8.8 %), SOM (5.8 ± 2.3 % vs 17.4 ± 3.7 %) or GAL (0.9 ± 1.2 % vs 5.4 ± 4.4 %) and a distinct increase in the number of FB+/DβH+ neurons that were immunoreactive to L-ENK (3.7 ± 2.9 % vs 1.1 % ± 0.8 %) or nNOS (7.7 ± 3.5 % vs 0.8 ± 0.6 %). Our study provides novel evidence that the therapeutic effects of BTX on the mammalian urinary bladder are partly mediated by SChG neurons.

Prolonged and Devastating Clinical Course in Atypical Neuromyelitis Optica

Neuromyelitis optica (NMO) is an inflammatory demyelinating disease affecting the optic nerve and the spinal cord. Antibodies (Ab) to Aquaporin-4 (AQP-4) and sometimes to myelin oligodendrocyte glycoprotein (MOG) are characteristic serological findings. We present the case of a 9-year-old boy with seronegative atypical NMO showing recurrent episodes of isolated longitudinal extensive transverse myelitis (LETM). He presented in December 2010 with paresis of his left leg following flu vaccination. LETM with areas of beginning necrosis was diagnosed. Blood-brain barrier disruption, oligoclonal band and highly elevated interleukin 6 were found in cerebrospinal fluid. Clinically, the entire spinal cord was affected with tetraparesis and inverted breathing. He was treated with steroids, plasmapheresis, cyclophosphamide (CPM), and immunoglobulins. Paraplegia starting from Th9 and a neurogenic bladder disorder persisted. AQP4- and MOG-Ab were repeatedly tested negative. There was no evidence of optic neuritis during the follow-up period. In July 2013, he experienced a first relapse with weakness of the upper extremities following oral herpes infection. CSF, blood, and magnetic resonance images showed identical findings to the first episode. After steroids, plasmapheresis and CPM he showed no clinical improvement and lost his hand function. After 27 days, application of CPM again following oral herpes infection he experienced a second relapse with tetraparesis, sensibility loss starting at Th2, dry mouth, and neck pain. Lumbar puncture was no longer possible. He showed no improvement to steroids and plasmapheresis, but the inflammation progressed to the midbrain. Finally, respiratory failure, seizures, and cardiac arrest September 2013. In conclusion, we suspect NMO-spectrum disorder (high-risk NMO), possibly triggered by infection or vaccination without NMO- and MOG-Ab nor optic nerve involvement. The clinical picture is characterized by a polyphasic course with late relapses and poor prognosis. Our case demonstrates an unusual clinical course of LETM and should open discussion about the variable clinical picture of NMO in childhood.

Catheter policies for management of long term voiding problems in adults with neurogenic bladder disorders.

Management of the neurogenic bladder has the primary objectives of maintaining continence, ensuring low bladder pressure (to avoid renal damage) and avoiding or minimising infection. Options include intermittent urethral catheterisation, indwelling urethral or suprapubic catheterisation, timed voiding, use of external catheter (for men), drug treatment, augmentation cystoplasty and urinary diversion. The primary objective was to determine the effects of different methods of managing long-term voiding problems (persisting after three months) with catheters in patients with neurogenic bladder.Specific hypotheses to be addressed included:1. that intermittent catheterisation is better than indwelling catheterisation;2. that indwelling urethral catheterisation is better than suprapubic catheterisation;3. that external (sheath) catheters are better than indwelling or intermittent urethral catheters;4. that external (sheath) catheters are better than suprapubic catheters;5. that intermittent catheterisation is better than timed voiding. We searched the Cochrane Incontinence Group Specialised Register (searched 3 July 2013), which contains trials identified from the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE and MEDLINE in process, and handsearched journals and conference proceedings. We sought additional trials from other sources such as the reference lists of relevant articles and by contacting consultants in Spinal Cord Injury Centres throughout the United Kingdom. All randomised and quasi-randomised controlled trials comparing methods of using catheters to manage urinary voiding in people with neurogenic bladder. Abstracts were independently inspected by the reviewers and full papers were obtained where necessary. Approximately 400 studies were scrutinised. No trials were found that met the inclusion criteria, and five studies were excluded from the review. Despite a comprehensive search no evidence from randomised or quasi-randomised controlled trials was found. It was not possible to draw any conclusions regarding the use of different types of catheter in managing the neurogenic bladder.

Acute lower urinary tract dysfunction (LUTD) following traumatic brain injury (TBI) in rats

The aim of this study was to assess experimental traumatic brain injury (TBI)-induced lower urinary tract dysfunction (LUTD) by monitoring systemic and urodynamic parameters using an implantable telemetry system. A single lateral fluid percussion TBI (FP-TBI; 3.4 atm) was administered to 10 female rats. Pressure micro-catheters were implanted in the abdominal aorta and bladder dome for simultaneous data recording. Hemodynamic and urodynamic variables recorded 24 hr before and 24 hr after injury were analyzed and compared. TBI in the acute phase resulted in LUTD affecting bladder emptying, characterized by failure of voiding reflex, high capacity bladder, increased voided volume, prolonged intermicturition intervals, and loss of compliance. The dominant symptom was urinary retention (100%) and incontinence (60%). The effects followed a pattern of initial loss of bladder function followed by either altered recovery of reflex micturition or a period of incontinence. With a moderate injury symptoms were temporary in 90% of animals and permanent in 10% of animals. Injury produced only transient hypertension (≤1 hr) with a maximum systolic pressure of 172.64 ± 14.53 mmHg (70% of animals). The results demonstrate that experimental FP-TBI causes temporary bladder dysfunction that in more severe cases becomes permanent. Telemetry recordings revealed a sequence of events following injury that establishes moderate TBI as a risk factor for neurogenic bladder disorder. Results also suggest a correlation between lateral FP-TBI and incontinence.