Neurogenic Overactive Bladder Research Articles

Real-Life Treatment Outcome of Botulinum Toxin A Injection on Overactive Bladder and Voiding Dysfunction in Patients with Central Nervous System Lesions.

Neurogenic lower urinary tract dysfunction (NLUTD) is common in patients with neurological lesions in the central nervous system (CNS). Medical treatment usually cannot adequately relieve NLUTD. This study reported the real-life treatment outcome of botulinum toxin A (BoNT-A) for overactive bladders (OAB) and voiding dysfunction in patients with CNS lesions. We retrospectively analyzed the first-time treatment outcome of 74 patients who received detrusor 100 U BoNT-A for OAB and 45 patients who received a urethral sphincter 100 U BoNT-A injection for voiding dysfunction. The treatment outcome, therapeutic duration, and adverse events (AE) after BoNT-A were compared among different CNS lesions and among patients with different urodynamic characteristics. The study included 74 patients receiving detrusor injections for OAB (36 with cerebrovascular accidents, 13 with Parkinson's disease, and 25 with dementia) and 45 patients receiving a urethral sphincter injection for voiding dysfunction (26 with cerebrovascular accidents, 7 with Parkinson's disease, and 12 with dementia). After detrusor BoNT-A treatment, urinary continence was achieved in 28.4% of patients with neurogenic OAB, postoperative difficult urination in 59.5%, acute urinary retention (AUR) in 9.5%, and urinary tract infection (UTI) in 14.9%, with a therapeutic duration of 6.43 months. There were no differences among subgroups or between patients with detrusor overactivity (DO) and DO with detrusor underactivity (DU) in terms of treatment outcomes and AEs. The improvement rate of urethral sphincter BoNT-A injections was 75.6% without any difference among subgroups. After treatment, 24.4% of the patients had exacerbated urinary incontinence, 33.3% had persistent difficult urination, and 15.6% had UTI. Patients with dementia had higher rates of difficult urination and UTI, higher postvoid residual volume, and a shorter therapeutic duration. Patients with DU and those without urethral sphincter dyssynergia had less favorable outcomes after their urethral sphincter BoNT-A injection. The therapeutic efficacy of detrusor BoNT-A injection for OAB due to CNS lesions is limited, with high rates of difficult urination, AUR, and UTI. Although urethral sphincter BoNT-A injection is effective in treating voiding dysfunction; however, exacerbated urinary incontinence and persistent difficult urination remain a problem, particularly in patients with dementia.

Clarifying practical aspects of posterior tibial nerve stimulation for neurogenic overactive bladder: A scoping review

AbstractPatients with neurological diseases often suffer from overactive bladder. Posterior tibial nerve stimulation is mentioned in guidelines as a treatment when antimuscarinics fail or cannot be tolerated by patients, but the evidence is scant. This article summarizes the evidence on the practical aspects of tibial nerve stimulation for neurogenic overactive bladder (NOAB), such as electrical parameters and treatment duration, and identifies areas requiring further investigation. Scoping review. Literature search on PubMed, CINAHL, and Cochrane Library, including studies from 2010 to 2024 regarding tibial nerve stimulation for NOAB. Sixteen papers were considered: seven on transcutaneous tibial nerve stimulation (TTNS), seven on percutaneous tibial nerve stimulation (PTNS) and two protocols. Most studies enrolled neurological and non‐neurological patients or studied non‐randomized samples of a few patients. Clinical outcomes, treatment duration, number of sessions, and follow‐up times showed considerable heterogeneity, but some practical recommendations could be drawn. For PTNS, most authors suggest using 20 Hz and 200 μs, but the amplitude is highly variable among studies. For TTNS, 10 Hz and 200 μs are suggested, with considerable variability in the number of sessions and overall treatment duration. Most papers propose similar criteria regarding the frequency and duration of the stimulation, and all of them support the efficacy of tibial nerve stimulation, except for one. The areas requiring research include long‐term results, allowing for shaping adequate maintenance programmes to avoid losing the results achieved.

Does repetitive transcranial magnetic stimulation induce long-lasting neuroplastic changes to improve detrusor muscle function in stroke survivors with neurogenic overactive bladder?

Neurogenic overactive bladder (OAB) is purported to result from damage to the central inhibitory pathways in the brain and spinal cord or peripheral afferent terminal sensitization in the bladder, which unmasks the primitive voiding reflex. Excitation of the pontine micturition center activates descending neural pathways to the spinal cord, resulting in sequential detrusor contraction and urethral relaxation. Damage to the central nervous system mechanism may disrupt normal micturition control, leading to involuntary micturition with concomitant detrusor overactivity.Low-frequency repetitive transcranial magnetic stimulation (rTMS), causing long-term depression of neuronal synaptic transmission, results in presynaptic neuron stimulation within several milliseconds after postsynaptic neuron stimulation. Low-frequency rTMS of the primary motor cortex may induce cortical inhibition via suppression of neural overactivity in descending projections, thereby reversing lower urinary tract symptoms by increasing pelvic floor tonicity and enhancing bladder capacity and bladder filling. Given the role of low-frequency rTMS in improving detrusor overactivity, we hypothesized that low-frequency active rTMS would inhibit cortical excitability and induce long-lasting neuroplastic changes to improve detrusor muscle function in stroke survivors with neurogenic OAB.

Effect of transcutaneous tibial nerve stimulation on the neurogenic overactive bladder in women with type 2 diabetes

Effect of transcutaneous tibial nerve stimulation on the neurogenic overactive bladder in women with type 2 diabetes

Bladder augmentation in the era of botulinum toxin: Indications and results

To determine the surgical indication and results of bladder augmentation (BA) during the last decade in a neurourology center in the era of intradetrusor botulinum toxin injection. We conducted a retrospective study that included patients with BA between January 1, 2012 and December 31, 2022 in our centre. We collected pre-operative demographic, clinical, and urodynamic data, BA indication, and associated procedures. We analyzed early and late complications as well as continence and postoperative voiding mode in patients with first BA in a neurological pathology context. We performed 77 BA over the study period. The main indication was neurogenic overactive bladder, which was secondarily resistant to botulinum toxin. The main associated procedure was continent cutaneous diversion (n=31, 57.4%). Among patients who had a first BA for neurogenic bladder, 34 patients had early complications (50%) including 12 patients with≥Clavien 3 complications (17.6%). After a median follow-up of 33 [14; 55] months, 23 patients had late complications (33.8%) and 59 patients had complete continence (86.8%). In the era of botulinum toxin, the main indication of BA is the secondary failure of botulinum toxin for overactive neurogenic bladder. The BA provided continence in 86.8% of patients. It remains however an intervention with a significant rate of severe complications whose indication must be discussed by a multidisciplinary team. Weak.

Intravesical injections of botulinum neurotoxin A to treat overactive bladder and/or detrusor overactivity related to multiple sclerosis: 5-Year continuation rate and specific risk factors for discontinuation—A study from the neuro-urology committee of the French Association of Urology

Background: While intravesical injections of botulinum neurotoxin A (BoNT-A) are currently recommended for patients experiencing refractory neurogenic overactive bladder and/or detrusor overactivity (OAB/DO), it is unclear how much this therapy is effective and sustainable in the long-term in patients with multiple sclerosis (MS). Objectives: To assess the mid-term continuation rate of BoNT-A injections to treat neurogenic OAB/DO in MS patients and to investigate MS-specific risk factors for discontinuation. Methods: This retrospective study involved 11 French university hospital centers. All MS patients who received BoNT-A to treat neurogenic OAB/DO between 2008 and 2013 and were subsequently followed up for at least 5 years were eligible. Results: Of the 196 MS patients included, 159 (81.1%) were still under BoNT-A 5 years after the first injection. The combination of the Expanded Disability Status Scale (EDSS < 6 or ⩾ 6) and of the MS type (relapsing–remitting vs progressive) predicted the risk of discontinuation. This risk was 5.5% for patients with no risk factor, whereas patients presenting with one or two risk factors were 3.3 and 5.7 times more likely to discontinue, respectively. Conclusion: BoNT-A is a satisfying mid-term neurogenic OAB/DO therapy for most MS patients. Combining EDSS and MS type could help predict BoNT-A discontinuation.

6 - Preliminary assessment of the efficacy and tolerability of solifenacin for the treatment of neurogenic overactive bladder in patients affected by multiple sclerosis

6 - Preliminary assessment of the efficacy and tolerability of solifenacin for the treatment of neurogenic overactive bladder in patients affected by multiple sclerosis

MP74-05 WHAT FACTORS DETERMINE WHICH FEMALE PATIENTS WITH OVERACTIVE BLADDER FOLLOW-UP?

You have accessJournal of UrologyCME1 Apr 2023MP74-05 WHAT FACTORS DETERMINE WHICH FEMALE PATIENTS WITH OVERACTIVE BLADDER FOLLOW-UP? Connelly Miller, Arshia Harandi, Jonathan Aronov, Jennifer Ramgopal, Philip Fonesca, Holly Smith, Brian Shkolnik, Jacob Hartman-Kenzler, Aaron Huang, and Jason Kim Connelly MillerConnelly Miller More articles by this author , Arshia HarandiArshia Harandi More articles by this author , Jonathan AronovJonathan Aronov More articles by this author , Jennifer RamgopalJennifer Ramgopal More articles by this author , Philip FonescaPhilip Fonesca More articles by this author , Holly SmithHolly Smith More articles by this author , Brian ShkolnikBrian Shkolnik More articles by this author , Jacob Hartman-KenzlerJacob Hartman-Kenzler More articles by this author , Aaron HuangAaron Huang More articles by this author , and Jason KimJason Kim More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003348.05AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Overactive bladder (OAB) is a common condition responsible for significant morbidity in female patients. Treatment can be complex and multifaceted, requiring strict treatment compliance and often several clinical encounters for effective symptom management. Recognizing risk factors for loss to follow-up is critical to identifying patients who may require supplementary interventions to improve adherence. METHODS: Adult female patients presenting for a new patient visit for OAB symptoms (frequency, urgency, incontinence, nocturia) were identified at an outpatient urology clinic between July 2020 and June 2021. Medical records were abstracted for demographic data, smoking history, medical comorbidities, and baseline OAB symptom severity. Prospective chart review was performed to identify additional urology clinic visits for any reason at 1-month, 3-month, and present-day time horizons. The Student’s t-test for quantitative variables and the chi-squared test for qualitative variables were used to compared characteristics of patients who did and did not have follow-up visits by those time horizons. RESULTS: 816 female patients were included in the analysis, of which 63.1% had a follow-up visit recorded between the initial visit and present-day. There was no difference in follow-up by age or race (see Table 1). Patients with follow-up visits within the catchment period were more likely to live closer (p<.05), have neurogenic OAB (p<.05), and endorse incontinence (p<.05). They were also more likely to have a history of hypertension (p<.01) and heart disease (p<.05), and at the 1-month and 3-month time horizons to report a history of chronic pain (p<.05 and p<.01, respectively). CONCLUSIONS: This study recapitulates known associations between distance to clinic and baseline symptom severity with chance of follow-up, but also reveals a correlation between follow-up for overactive bladder and certain medical comorbidities, which may provide real-world evidence for the potential role of multidisciplinary approaches in the treatment of OAB. The lack of age-based and racial inequity in follow-up rates is also noteworthy. Further research could target interventions to reduce attrition through the creation of a hazard score to identify patients at high-risk for loss to follow-up. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e1070 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Connelly Miller More articles by this author Arshia Harandi More articles by this author Jonathan Aronov More articles by this author Jennifer Ramgopal More articles by this author Philip Fonesca More articles by this author Holly Smith More articles by this author Brian Shkolnik More articles by this author Jacob Hartman-Kenzler More articles by this author Aaron Huang More articles by this author Jason Kim More articles by this author Expand All Advertisement PDF downloadLoading ...

PD14-05 FACTORS ASSOCIATED WITH DISCONTINUATION OF ONABOTULINUM TOXIN-A THERAPY FOR OVERACTIVE BLADDER IN A DIVERSE URBAN POPULATION

You have accessJournal of UrologyCME1 Apr 2023PD14-05 FACTORS ASSOCIATED WITH DISCONTINUATION OF ONABOTULINUM TOXIN-A THERAPY FOR OVERACTIVE BLADDER IN A DIVERSE URBAN POPULATION Arshia Aalami Harandi, Mariel Liebeskind, and Nitya Abraham Arshia Aalami HarandiArshia Aalami Harandi More articles by this author , Mariel LiebeskindMariel Liebeskind More articles by this author , and Nitya AbrahamNitya Abraham More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003261.05AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Although overactive bladder (OAB) is a common condition affecting 16% of Americans, few patients continue second-line and third-line treatment. This study sought to investigate factors associated with discontinuation of intravesical Onabotulinom Toxin-A (BTX-A) injections among a diverse urban population. METHODS: This was a retrospective review of patients who underwent BTX-A injection for OAB at a university hospital between November 2015 and December 2021. Patients were considered to have discontinued BTX-A therapy if they only received one treatment and it had been more than 1 year since last date of service. Patients with neurogenic OAB were excluded. Patient demographics, past medical history, symptoms, and post-operative outcomes were compared between groups with Chi-squared, Student’s t-test, or Fisher’s exact test. RESULTS: BTX-A injections were administered to 272 patients who met study criteria of which 114 (41.9%) had discontinued BTX-A therapy. Our cohort included 235 (86%) women and had a mean age of 61.5 and mean BMI of 30.8. Patients discontinuing BTX-A therapy had a higher median income ($59K vs. $50K, p<.01) and were more likely to have reported nocturia (61.7% vs. 39.3%, p<.001). Patients who discontinued were less likely to have reported subjective improvement of symptoms at their first post-procedure visit (73.0% vs. 83.6%, p<.05). Similarly, patients who developed post-operative urinary retention were more likely to discontinue BTX-A therapy (17% retention in discontinuation group vs. 8% in those who continued p<.05). There were no associations between discontinuation and Race/Ethnicity, distance to clinic, smoking history, or post-operative urinary tract infections. CONCLUSIONS: Adverse outcome after BTX-A injection, such as post-operative urinary retention, is associated with discontinuation of therapy, whereas subjective improvement in symptoms is associated with continuation of therapy. Given the large proportion (>40%) of patients who discontinued BTX-A treatment, further research is needed to identify barriers to continuation of care. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e414 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Arshia Aalami Harandi More articles by this author Mariel Liebeskind More articles by this author Nitya Abraham More articles by this author Expand All Advertisement PDF downloadLoading ...

MP60-07 BRAIN CARBON MONOXIDE SUPPRESSES THE RAT MICTURITION VIA BRAIN GABA RECEPTORS

You have accessJournal of UrologyCME1 Apr 2023MP60-07 BRAIN CARBON MONOXIDE SUPPRESSES THE RAT MICTURITION VIA BRAIN GABA RECEPTORS Masaki Yamamoto, Takahiro Shimizu, Suo Zou, Shogo Shimizu, Youichirou Higashi, Mikiya Fujieda, and Motoaki Saito Masaki YamamotoMasaki Yamamoto More articles by this author , Takahiro ShimizuTakahiro Shimizu More articles by this author , Suo ZouSuo Zou More articles by this author , Shogo ShimizuShogo Shimizu More articles by this author , Youichirou HigashiYouichirou Higashi More articles by this author , Mikiya FujiedaMikiya Fujieda More articles by this author , and Motoaki SaitoMotoaki Saito More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003318.07AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Carbon monoxide (CO) is a well-known toxic gas but is also reported as a gasotransmitter besides nitric oxide and hydrogen sulfide. Endogenous CO is produced by heme oxygenase (HO)-induced heme catabolism and shows physiological functions such as anti-inflammation and neuromodulation. In this study, we examined effects of centrally administered CORM3 (CO donor) and ZnPP (HO inhibitor) on the rat micturition. METHODS: Urethane anesthetized (0.8 g/kg, ip) male Wistar rats (350-450 g) were used. A catheter was inserted into the bladder to perform continuous cystometry (12 ml/h saline infusion). Three hours after the surgery, CORM3 (1 or 10 nmol/rat), ZnPP (10 or 30 nmol/rat) or vehicle was intracerebroventricularly (ICV) administered. In some rats, effects of ICV pretreated SR95531 (SR, GABAA antagonist, 0.1 nmol/rat) on the CORM3 (10 nmol/rat, ICV)-induced responses were examined. Continuous cystometry and evaluation of intercontraction intervals (ICI) and maximal voiding pressure (MVP) were started 30 min before the first ICV administration. In some rats, before and after ZnPP administration (30 nmol/rat, ICV), single cystometry (12 ml/h saline infusion) was performed. RESULTS: CORM3 dose-dependently prolonged ICI without changing MVP (Figure 1A-B). On the other hand, ZnPP dose-dependently shortened ICI without changing MVP (Figure 1C-D). In single cystometry, ZnPP significantly reduced single-voided volume and bladder capacity without changing post-voiding residual volume (Table 1). The ZnPP (30 nmol/rat, ICV)-induced ICI shortening was reversed in the central presence of CORM3 (10 nmol/rat, ICV) (Figure 2). The CORM-3-induced ICI prolongation was suppressed by SR (Figure 3). CONCLUSIONS: Brain CO endogenously suppresses the rat micturition via brain GABAA receptors. Thus, the brain CO might be a new therapeutic target for neurogenic bladder overactivity. Source of Funding: JSPS KAKENHI (#21K09428, #20K07827) © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e845 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Masaki Yamamoto More articles by this author Takahiro Shimizu More articles by this author Suo Zou More articles by this author Shogo Shimizu More articles by this author Youichirou Higashi More articles by this author Mikiya Fujieda More articles by this author Motoaki Saito More articles by this author Expand All Advertisement PDF downloadLoading ...

MP03-10 BRAIN α7 NICOTINIC ACETYLCHOLINE RECEPTORS SUPPRESS THE RAT MICTURITION REFLEX VIA BRAIN HYDROGEN SULFIDE

You have accessJournal of UrologyCME1 Apr 2023MP03-10 BRAIN α7 NICOTINIC ACETYLCHOLINE RECEPTORS SUPPRESS THE RAT MICTURITION REFLEX VIA BRAIN HYDROGEN SULFIDE Nobutaka Shimizu, Takahiro Shimizu, Shogo Shimizu, Youichirou Higashi, Suo Zou, Hideo Fukuhara, Takashi Karashima, Keiji Inoue, and Motoaki Saito Nobutaka ShimizuNobutaka Shimizu More articles by this author , Takahiro ShimizuTakahiro Shimizu More articles by this author , Shogo ShimizuShogo Shimizu More articles by this author , Youichirou HigashiYouichirou Higashi More articles by this author , Suo ZouSuo Zou More articles by this author , Hideo FukuharaHideo Fukuhara More articles by this author , Takashi KarashimaTakashi Karashima More articles by this author , Keiji InoueKeiji Inoue More articles by this author , and Motoaki SaitoMotoaki Saito More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003214.10AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: We previously reported that brain α7 nicotinic acetylcholine receptors (α7 nAChRs) and brain hydrogen sulfide (H2S) suppressed the rat micturition reflex via brain GABA receptors. However, it is unclear how the brain α7 nAChRs and brain H2S are related to each other in regulation of the micturition reflex. In this study, we examined whether brain H2S is involved in the suppression of micturition induced by stimulation of brain α7 nAChR. METHODS: Urethane anesthetized (0.8 g/kg, ip) male Wistar rats (350-420 g) were used. A catheter was inserted into the bladder to perform continuous cystometry (12 ml/h saline infusion). We examined effects of intracerebroventricularly (icv) pretreated GYY4137 (GYY, H2S donor, 1 or 3 nmol/rat) or AOAA (non-selective inhibitor of H2S synthesis, 3 or 10 μg/rat) on PHA568487 (PHA, α7 nAChR agonist, 0.3 or 1 nmol/rat, icv)-induced intercontraction intervals (ICI) prolongation. Continuous cystometry and evaluation of ICI and maximal voiding pressure (MVP) was started 120 min after the surgery and the first icv administration was performed 60 min after starting cystometry. RESULTS: PHA at a lower dose (0.3 nmol/rat) showed no significant effect on ICI, while under pretreatment with GYY, PHA (0.3 nmol/rat) significantly prolonged ICI even at a lower dose (Figure 1). PHA at a higher dose (1 nmol/rat) induced ICI prolongation and the PHA-induced prolongation was significantly suppressed by AOAA (Figure 2). The AOAA-induced suppression of the PHA-induced ICI prolongation was cancelled by supplementation of brain H2S via GYY (Figure 3). PHA at each dose showed no effect on MVP (data not shown). CONCLUSIONS: Brain α7 nAChRs suppressed the rat micturition reflex via brain H2S, therefore, brain α7 nAChRs and H2S might be new therapeutic targets for neurogenic bladder overactivity. Source of Funding: Smoking Research Foundation in Japan, KAKENHI (#20K07827), The Kochi Medical School Hospital President’s Discretionary Grant © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e25 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Nobutaka Shimizu More articles by this author Takahiro Shimizu More articles by this author Shogo Shimizu More articles by this author Youichirou Higashi More articles by this author Suo Zou More articles by this author Hideo Fukuhara More articles by this author Takashi Karashima More articles by this author Keiji Inoue More articles by this author Motoaki Saito More articles by this author Expand All Advertisement PDF downloadLoading ...

Efficacy of Intravesical Botulinum Toxin A Injection in the Treatment of Refractory Overactive Bladder in Children.

This study aimed to evaluate the efficacy of intravesical botulinum toxin A (BoNT-A) injections for the treatment of pediatric overactive bladder (OAB) by exploring the differential treatment outcomes in children with different OAB etiologies and those who received additional intrasphincteric BoNT-A injections. We performed a retrospective review of all pediatric patients who received intravesical BoNT-A injections between January 2002 and December 2021. All patients underwent a urodynamic study at baseline and three months after BoNT-A administration. A Global Response Assessment (GRA) score of ≥2 at three months after BoNT-A injection was defined as successful treatment. Fifteen pediatric patients (median age, 11 years), including six boys and nine girls, were enrolled in the study. A statistically significant decrease in detrusor pressure from baseline to three months postoperatively was observed. Thirteen (86.7%) patients reported successful results (GRA ≥ 2). The cause of OAB and additional intrasphincteric BoNT-A injections did not affect the improvement in urodynamic parameters and treatment success. The study demonstrated that intravesical BoNT-A injection is effective and safe for the treatment of neurogenic and non-neurogenic OAB in children refractory to conventional therapies. Additionally, intrasphincteric BoNT-A injections do not provide additional benefits in the treatment of pediatric OAB.

Urine Biomarkers in the Management of Adult Neurogenic Lower Urinary Tract Dysfunction: A Systematic Review.

Neurogenic lower urinary tract dysfunction requires lifelong surveillance and management for the perseveration of patients' quality of life and the prevention of significant morbidity and mortality. Urine biomarkers are an attractive noninvasive method of surveillance for these patients. The aim of this systematic review is to search for and critically appraise studies that investigate the clinical usefulness of urine biomarkers in the management of neurogenic lower urinary tract dysfunction (NLUTD) in adults. This review was conducted according to PRISMA and MOOSE guidelines. Search strategy included PubMed, CENTRAL, and Scopus (until October 2022). Studies investigating potential urine biomarkers for the management of adults with NLUTD were included. Fifteen studies fulfilled the criteria. To date, a variety of different urine molecules have been investigated for the diagnosis and management of neurogenic overactive bladder and detrusor overactivity (nerve growth factor, brain-derived neurotrophic factor, prostaglandin E2, prostaglandin F2α, transformation growth factor β-1, tissue inhibitor metalloproteinase-2, matrix metalloproteinase-2, substance P, microRNA), diagnosis of vesicoureteral reflux (exosomal vitronectin), urinary tract infection (neutrophil gelatinase-associated lipocalin, interleukin 6) and bladder cancer screening (cytology, BTA stat, survivin) in neurological patients. Further studies are needed to specify the utility of each molecule in the management algorithm of adult NLUTD.

This Month in Pediatric Urology.

You have accessJournal of UrologyThis Month in Pediatric Urology1 Apr 2023This Month in Pediatric Urology Julian Wan Julian WanJulian Wan More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003184AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail Naturally occurring substances being adapted to medicinal use is part of the lore of biomedical science. Penicillin was once just a term referring to secretion from the mold, Penicillium notatum. In 1928, Alexander Fleming fortuitously recognized the presence and importance of the bactericidal band around the mold that had contaminated a culture plate of Staphylococcus aureus.1 This finding along with the work being done on sulfonamides ushered in the antibiotic era. In a similar fashion, botulinum toxin found its way into therapeutic use. Botulism is an uncommon but potentially fatal condition resulting typically from the ingestion of botulinum toxin produced by Clostridium botulinum bacteria.2 One of the characteristic symptoms is weakness of the eye muscles with drooping eyelids. Among infants, it creates so-called floppy baby syndrome and led to a recommendation of avoiding feeding honey to infants under age 1 year due to it acting as a reservoir of C botulinum spores. This early clinical presentation in eye muscles and muscle weakness led to interest in using the purified toxin (onabotulinumtoxin A) to treat strabismus.3 Success there led to applications elsewhere including the treatment of dysfunctional bladders and has led to calls for wider use in pediatric urology.4 Franco et al (page 774) in a multi-institutional study report on the long-term safety and tolerance of repeated cystoscopic intradetrusor injections of botulinum toxin in the treatment of children with neurogenic bladder overactivity.5 They found that the injections were well tolerated and there were few serious treatment-related adverse events; notably the development of urinary tract infection was similar to the rate seen prior to injection. These findings confirm what many pediatric urologists have already known when using botulinum toxin in this manner but may serve as an important step in adding it formally to the available treatment options. The data may help garner regulatory approval, thereby broadening acceptance with third-party payers, and allow wider access and use. REFERENCES 1. . New light on the history of penicillin. Med Hist. 1982; 26(1):1-24. Crossref, Medline, Google Scholar 2. . Clostridium botulinum and the clinical laboratorian: a detailed review of botulism, including biological warfare ramifications of botulinum toxin. Arch Pathol Lab Med. 2004; 128(6):653-662. Crossref, Medline, Google Scholar 3. . Botulinum toxin injection into extraocular muscles as an alternative to strabismus surgery. Ophthalmology. 1980; 87(10):1044-1049. Crossref, Medline, Google Scholar 4. . It is time to liberalize the administration of botulinum toxin in the pediatric urology clinic!. J Urol. 2022; 208(3):534-535. Link, Google Scholar 5. . Long-term safety and tolerability of repeated treatments with onabotulinumtoxinA in children with neurogenic detrusor overactivity. J Urol. 2023; 209(4):774-784. Link, Google Scholar © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue 4April 2023Page: 655-655 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Julian Wan More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Time of onset and factors associated with delayed response post intradetrusor injection of onabotulinumtoxin a in patients with neurogenic and idiopathic overactive bladder syndrome.

The objective of this study was to determine risk factors for delayed response in patients with neurogenic and idiopathic overactive bladder (OAB) after intradetrusor onabotulinumtoxin A injection. This is a retrospective study that included 87 patients who underwent onabotulinumtoxin A intradetrusor injection from October 2011 to November 2019. Patients were followed up at 2, 4, and 12 weeks post intervention in the outpatient clinic and over the phone. The data of patients with early response were compared with those with late response using univariate and multivariate analyses. The study included 87 patients. The mean age was 41 ± 15.3 standard deviation, and 69% of the participants were female. Fifty-one percent were diagnosed with neurogenic OAB. A median response time to onabotulinumtoxin A injection of 7 days was demonstrated, and patients who responded during the first 7 days post procedure were considered early responders. Independent predictors for late response include diabetes (Relative risk: 3.89, P = 0.018, and 95% confidence interval [CI]: 1.26-11.98), >1 BTX-A session (Relative risk: 4, P = 0.011, and 95% CI: 1.38-11.6), and wet OAB (RR: 9.94, P = 0.002, and 95% CI: 2.31-42.17). The median time of onset post intradetrusor injection of onabotulinumtoxin A was found to be 7 days. Diabetes mellitus, wet OAB, and <1 Botox sessions were independent risk factors for late onset of response.

Long-Term Effects of Percutaneous Tibial Nerve Stimulation Treatment for Neurogenic Overactive Bladder Due to Multiple Sclerosis: 24-Month Results

Long-Term Effects of Percutaneous Tibial Nerve Stimulation Treatment for Neurogenic Overactive Bladder Due to Multiple Sclerosis: 24-Month Results

Efficacy of overactive neurogenic bladder treatment: A systematic review of randomized controlled trials.

Overactive bladder (OAB) symptoms of frequency, urgency and urge incontinence are frequently associated with known neurological diseases like multiple sclerosis (MS), spinal cord injury (SCI), Parkinson's disease (PD), stroke. The aim of our study was to review the efficacy of pharmacological and non-pharmacological treatments for neurogenic overactive bladder. We searched two electronic databases (PubMed and EMBASE) for randomized controlled trials focusing on pharmacological and non-pharmacological medical treatments for overactive bladder symptoms associated with neurological diseases published up to 30 April 2022. A total of 157 articles were retrieved; 94 were selected by title and abstract screening; after removal of 17 duplicates, 77 records were evaluated by full-text examination. Sixty-two studies were finally selected. The articles selected for review focused on the following interventions: anticholinergics (n = 9), mirabegron (n = 5), comparison of different drugs (n = 3), cannabinoids (n = 2), intravesical instillations (n = 3), botulinum toxin (n = 16), transcutaneous tibial nerve stimulation (TTNS) (n = 6), acupuncture (n = 2), transcutaneous electrical nerve stimulation TENS (n = 4), pelvic floor muscle training (PFMT) (n = 10), others (n = 2). Anticholinergics were more effective than placebo in decreasing the number of daily voids in patients with PD (mean difference [MD]- 1.16, 95 % CI - 1.80 to - 0.52, 2 trials, 86 patients, p < 0.004), but no significant difference from baseline was found for incontinence episodes and nocturia. Mirabegron was more effective than placebo in increasing the cystometric capacity in patients with MS (mean difference [MD] 89.89 mL, 95 % CI 29.76 to 150.01, 2 trials, 98 patients, p < 0.003) but no significant difference was observed for symptom scores and bladder diary parameters. TTNS was more effective than its sham-control in decreasing the number of nocturia episodes (MD -1.40, 95 % CI -2.39 to -0.42, 2 trials, 53 patients, p < 0.005) but no significant changes of OAB symptom scores were reported. PFMT was more effective than conservative advice in decreasing the ICIQ symptom score (MD, -1.12, 95 % CI -2.13 to -0.11, 2 trials, 91 patients, p = 0.03), although the number of incontinence episodes was not significantly different between groups. The results of the meta-analysis demonstrate a moderate efficacy of all considered treatments without proving the superiority of one therapy over the others. Combination treatment using different pharmacological and non-pharmacological therapies could achieve the best clinical efficacy due to the favorable combination of the different mechanisms of action. This could be associated with fewer side effects due to drug dosage reduction. These data are only provisional and should be considered with caution, due to the few studies included in metaanalysis and to the small number of patients.

Долгосрочная безопасность и эффективность троспия хлорида при лечении нейрогенного гиперактивного мочевого пузыря вследствие болезни Паркинсона – есть ли влияние на когнитивный статус?

To evaluate the efficiency of long-term use of trospium chloride (Spazmex) for the treatment of patients with neurogenic overactive bladder due to Parkinson's disease (PD) and to determine the influence of therapy on the cognitive status of patients.60 patients with PD and neurogenic overactive bladder with stages 2.5, 3 and 4 according to Hoehn-Yahr scale were included in the main group. The mean age was 58.2+/-5.7 years. All patients were prescribed trospium chloride at entry into the study, with doses titrated gradually according to clinical efficacy (30 to 90 mg). The comparison group included 15 patients with PD and neurogenic overactive bladder at stages 2,5 and 3, who received tibial neuromodulation according to the standard technique with skin electrodes. The mean age of patients was 56.4+/-4.6 years. At baseline, both groups were comparable in terms of gender, age and cognitive status (p=0.801). All patients received treatment for 52 weeks. The efficiency of therapy was assessed according to bladder diaries, while safety outcomes included postvoid residual, side effects, cognitive status according to the MoCA scale and quality of life according to the SF-Qualiveen questionnaire.clinical efficacy and satisfaction were achieved in all patients who completed the study (47 patients in the main group and 15 patients in the comparison group). Good clinical efficacy was demonstrated in both groups, since there was a decrease in the number of urinations, episodes of urgency and urinary incontinence. In addition, there was an improvement in the quality of life according to the SF-Qualiveen scale. The cognitive status during the entire follow-up period remained without significant changes in both groups.Trospium chloride is an effective drug in patients with PD. It does not affect cognitive functions during long-term use. Trospium chloride should be considered as first-line drug in those with urologic manifestations of PD.

Sacral Neuromodulation Outcomes in Male Patients With Overactive Bladder (Neurogenic and Non-Neurogenic)

Sacral neuromodulation (SNM) is an effective, guidelines supported, third line treatment for overactive bladder (OAB). While the prevalence of OAB is similar between males and females, no studies assess the outcomes of SNM in male patients alone. In this retrospective study, we followed 53 male patients with neurogenic and idiopathic OAB to assess efficacy, personal satisfaction, complications and need for other treatments.

Intravesical Botulinum toxin-A injection in pediatric overactive neurogenic bladder with Detrusor overactivity: Radiologic and clinical outcomes.

The neurogenic bladder is one of the most serious and painful disorders seen in pediatric urology clinics. The upper urinary tract can be impaired by increased bladder pressure. Botulinum toxin-A (BTX-A) is one of the new therapeutic interventions for this disease. Thus, this research was designed to determine the clinical as well as radiological outcomes intravesical BTX-A injections in patients with overactive neurogenic bladder with Detrusor over activity. From March 2012 to March 2019, this cohort study was conducted at Shahid Labbafinejad hospital in Tehran, Iran. Thirty-five pediatric patients with a neurogenic bladder and Detrusor overactivity who fulfilled the eligibility criteria received BTX-A injections. Demographic data, including spinal cord lesions or congenital malformations, upper and lower urinary tract nuclear scans, evidence of vesicoureteral reflux (VUR) and its severity, and hydronephrosis and 72 h voiding diary before and after intervention were all recorded. The mean ± standard deviation age of participants was 9.47 ± 4.61 years. After injection, nocturia and urination frequency as general symptoms of the overactive neurogenic bladder improved (p < 0.05). Also, the severity of hydronephrosis was decreased in 33% of patients following injection. In our study, 32 out of 35 patients had vesicoureteral reflux. Of those, there was complete resolution and downgrading of VUR in 17 (53.12%) and 13 (40.62%) respectively. In the evaluation of voiding cystourethrography (VCUG) before and after the injection, downgrading of VUR was seen in 53% of the cases. In the 99mTc-DMSA nuclear scan before and after the injection, the appearance of a new parenchymal scar and uptake reduction was not observed, which indicates the cessation of scar formation in all patients. Although Enuresis, Urgency, Frequency, Nocturia, and UUI significantly improved after injection.