Neurogenic Patients Research Articles

Sacral neuromodulation for urinary incontinence

Sacral neuromodulation (SNM) was first approved in Europe in 1994 and the United States in 1997. Since its initial approval, indications for SNM have expanded to include urinary urgency/frequency, urgency urinary incontinence (UUI), non-obstructive urinary retention, and fecal incontinence. In the realm of idiopathic overactive bladder (OAB) and UUI multiple studies have highlighted the effectiveness of this therapy with the most recent data reporting a success rate of 93% at 2 year follow-up. Additionally, SNM has been compared to various other therapies for OAB/UUI. SNM demonstrated superiority in terms of symptom improvement when compared to anticholinergic medication and similar efficacy to 200 units of intradetrusor onabotulinum toxin. SNM has also demonstrated similar effectiveness in management of neurogenic patients although there remains a paucity of high level data in these patients. With the introduction of systems with improved MRI conditionality ongoing studies aim to evaluate effectiveness within this population.

Artificial urinary sphincter for neurogenic urinary incontinence: a narrative review.

The artificial urinary sphincter (AUS) is most known for its use in the treatment of moderate to severe post-prostatectomy stress urinary incontinence. However, another lesser-known indication includes stress incontinence related to intrinsic sphincter deficiency (ISD) in the neurogenic bladder population. The purpose of this review is to discuss specific technical considerations related to device implantation in this population, efficacy, durability, and complications. We performed a non-systematic literature review using the PubMed Database to identify articles specifically related to treatment of neurogenic urinary incontinence using an artificial urinary sphincter. More proximal placement of the cuff at the bladder neck is preferred in the neurogenic population due to higher rates of erosion and complications related to frequent clean intermittent catheterization or cystoscopic procedures when placed along the bulbar urethra. Robotic-assisted laparoscopic cuff placement has emerged as a safe and effective alternative to open surgery in select patients. Although continence rates are highly variable due the subjectivity of the term, functional continence (≤1 pad, ± nighttime incontinence) is reported to be between 75-90%. The need for secondary surgery for explanation with or without revision/replacement is higher in neurogenic patients compared to non-neurogenic patients. Neurogenic urinary incontinence is a complex condition due to the interplay of urethral resistance and bladder function/compliance. While there are a variety of strategies to treat neurogenic incontinence, high quality data from direct comparisons are lacking. Although AUS comes with a high revision rate, functional outcomes for continence with bladder neck placement are promising in this population.

An overview of intermittent self-catheterisation.

British Journal of Community NursingVol. 28, No. 3 ProfessionalAn overview of intermittent self-catheterisationSarah Jane PalmerSarah Jane PalmerE-mail Address: [email protected]Registered nurse and freelance writer, based at the Department for Work and Pensions as a disability analystSearch for more papers by this authorSarah Jane PalmerPublished Online:28 Feb 2023https://doi.org/10.12968/bjcn.2023.28.3.128AboutSectionsView articleView Full TextPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareShare onFacebookTwitterLinked InEmail View article References Bladder and Bowel Community. Intermittent self catheterisation. 2022. https://www.bladderandbowel.org/conservative-treatment/intermittent-self-catheterisation/ (accessed 16 February 2023) Google ScholarHarding C, Mossop H, Homer T et al. Alternative to prophylactic antibiotics for the treatment of recurrent urinary tract infections in women: multicentre, open label, randomised, non-inferiority trial. BMJ. 2022;376:e068229. https://doi.org/10.1136/bmj-2021-0068229 Medline, Google ScholarMarckiewicz A, Goldstine J, Nichols T. Emotional attributes, social connectivity and quality of life associated with intermittent catheterization. Int J Urol Nurs. 2020;14(1): 27-35. https://doi.org/10.1111/ijun.12222 Google ScholarNational Institute for Health and Care Excellence. Lower urinary tract symptoms in men: management. 2015. (accessed 16 February 2023) Google ScholarPickard R, Chadwick T, Oluboyede Y et al. Continuous low-dose antibiotic prophylaxis to prevent urinary tract infection in adults who perform clean intermittent self-catheterisation: the AnTIC RCT. Health Technol Assess. 2018;22(24):1-102. https://doi.org/10.3310/hta22240 Crossref, Medline, Google ScholarRoyal College of Nursing. Catheter care. 2019. https://www.rcn.org.uk/-/media/Royal-College-Of-Nursing/Documents/Publications/2021/July/009-915.pdf (accessed 16 February 2023) Google ScholarShamout S, Biardeau X, Corcos J, Campeau L. Outcome comparison of different approaches to self-intermittent catheterization in neurogenic patients: a systematic review. Spinal Cord. 2017;55(7):629-643. https://doi.org/10.1038/sc.2016.192 Crossref, Medline, Google ScholarWellspect. Most common challenges. 2023. https://www.wellspect.co.uk/bladder/about-isc/most-common-challenges (accessed 16 February 2023) Google Scholar FiguresReferencesRelatedDetails 2 March 2023Volume 28Issue 3ISSN (print): 1462-4753ISSN (online): 2052-2215 Metrics History Published online 28 February 2023 Published in print 2 March 2023 Information© MA Healthcare LimitedPDF download

Implementation of sacral neuromodulation for urinary indications. A Danish prospective study during the initial 15 months of a new service in a tertiary referral hospital

Objective Sacral neuromodulation (SNM) is a well-established treatment modality for idiopathic overactive bladder and urgency incontinence, idiopathic fecal incontinence and non-obstructive urinary retention. This study describes the start-up phase of establishing the SNM service. Primary objective: To investigate the patient-reported outcome measures of SNM on lower urinary tract dysfunction symptoms. Secondary objectives: To investigate bowel function, sexual satisfaction and to monitor SNM safety. Materials and methods Twenty-two patients with refractory idiopathic and neurogenic lower urinary tract dysfunction were offered a two-stage test-phase procedure and SNM device implantation. On completing the study, the patients rated their satisfaction with the treatment using a five-point Likert scale and a bother score of urinary, bowel and sexual symptoms on a scale of 1–10 (the worst). Their complications were assessed. Results Nineteen patients (86%) were responders during the test phase and had the pulse generator implanted. Seventeen patients were very satisfied/satisfied. A statistically significant change in urinary symptoms bother score was observed in the idiopathic and neurogenic patients, a reduction from 10 to 4 (p = .0057) and 10 to 3 (p = .014), respectively. Eleven patients (58%) had symptoms from two or three pelvic compartments. Nine patients (47%) had complications. All but one event was resolved. Conclusions SNM is safe in this heterogeneous group of patients with refractory lower urinary tract dysfunction of various etiologies. A substantial improvement was observed in the pelvic organ dysfunction, demanding a multidisciplinary approach. More studies are required to standardize the evaluation of the subjective and objective outcomes of SNM.

Quality of life in neurogenic patients based on different bladder management methods: A review.

To determine the overall quality of life and patient satisfaction associated with different bladder management strategies in neuro-urological patients. The second objective was to identify other associated factors that may further influence the patient's quality of life. Systematic Review. Studies from Pubmed, Cochrane, and Google Scholar databases were extracted using terms relating to 'quality of life', 'satisfaction', in 'neurogenic bladder' combined with 'bladder management methods' that included 'continent and non-continent urine diversion', 'intermittent-catheterization', 'indwelling catheter' and 'condom-catheter'. Only studies with a minimal proportion of 80% of neurogenic bladder patients were included. Search was conducted, and article titles and abstracts were rated. 136 papers were screened and assessed for eligibility. 25 studies were included in the final analysis and consisted of ten retrospective, nine prospective, five cross-sectional and a single randomized controlled trial. In total, 3002 patients were included, with a majority of male (55%) and spinal cord injury (88%) patients. 167 patients had incontinent urinary diversions, 464 had continent urinary diversions (bladder augmentation with or without cutaneous catheterizable channel), 1698 used intermittent catheterization (self or by an attendant), 550 had an indwelling catheter (urethral or suprapubic), and 123 had condom catheters. Quality of life was assessed using a wide variety of validated and non-validated questionnaires. Overall, patients with continent and incontinent diversion tended to have better scores. Use of catheters tended to have more unsatisfactory scores, with indwelling and attendant-intermittent catheterization often scoring worse. On the other hand, patients using self-intermittent catheterization tended to fair well. Normal micturition followed by self-catheterization yielded an overall higher quality of life. Data were too divergent to rank the other bladder management methods. However, by improving continence, each method aims to enhance quality of life.

A single centre 20-year retrospective cohort study: Percutaneous endoscopic colostomy.

Percutaneous endoscopic colostomy (PEC) represents an important intervention in specific patients. Limited data currently exist. We present the largest recorded study of patients undergoing PEC. Retrospective analysis of consultant logbooks highlighted all patients from 1997 to 2020. Two independent reviewers assessed records. Parameters measured were age, sex, indication, number of sites, complications, mortality and survival. Three subgroups were identified: recurrent sigmoid volvulus (RSV), pseudo-obstruction and neurogenic. ANOVA, chi-squared and Fischer's exact tests were utilized; Kaplan-Meier curves estimated survival and the log-rank test was applied. A p value of <0.05 was considered statistically significant. Ninety-six PEC insertions were done on 91 patients (five reinsertions). There were 66 men (69%) and the mean age was 73.1 years (interquartile range 23). The indications were RSV n=72, pseudo-obstruction n=13, neurogenic n=11. The 30-day complication rate was overall n=27 (28%), RSV n=23, pseudo-obstruction n=4. Nine patients leaked (9.9%) (eight RSV, one pseudo-obstruction), of whom five died. 90-day mortality was 14.6% (14 patients), 18.5% (13/72) for RSV, 7.7% (1/13) for pseudo-obstruction. Overall recurrence following PEC was 10.4%. The median follow-up was 25 months (interquartile range 4.6-62.2months). At 3, 5 and 10 years survival was 46%, 34% and 26% for RSV, 70%, 55% and 15% for pseudo-obstruction and 91%, 91% and 81% for neurogenic respectively. Recurrent sigmoid volvulus and pseudo-obstruction patients undergoing PEC compared to neurogenic patients have poorer outcomes with higher complication rates and shorter life expectancy. We advocate that high volume specialist units undertake PEC. The significant associated risks of PEC require careful consideration when determining patient suitability. Utilizing risk stratification scores may help guide shared decision making between patients, relatives and clinicians.

Management of complex ischial-urethral fistula in neurogenic patients performing clean intermittent self-catheterization.

Neurogenic patients performing clean-intermittent self-catheterization (CIC) may develop an urethral erosion, resulting in ischial-urethral fistulas (I-UF). In this work we present our single-center experience in dealing with this peculiar complication. In this work we included all neurogenic patients performing CIC treated at out Institution for I-UF. All patients had a spinal cord injury or myelomeningocele. We extracted from the patients' medical records the surgical management and postoperative clinical data. We defined failure the persistence of the fistula at X-ray contrast fistulography, retrograde urethrography, or uretrocystoscopy. We treated 11 patients (8 spinal cord injury, 3 myelomeningocele). Four patients have been treated with the placement of a new generation urethral stent (Uventa) after surgical toilette of the skin ulcer and placement of a temporary suprapubic catheter. All patients demonstrated a complete healing of the urethral lesion at stent removal and continued CIC without any difficulty. Four patients have been treated with perineal urethroplasty, requiring a buccal mucosal graft in two cases. In two patients a suprapubic permanent catheter was placed for a simpler bladder management due to the patients' comorbidities. In one case the incidental finding of an high grade muscle invasive urothelial bladder cancer, made it mandatory to perform an uretheroileocutaneostomy. This work represent a unique series of I-UF in neurogenic patients performing CIC. Surgical urethral reconstruction, often with the use of buccal mucosa in large lesions, may be a difficult solution in neurogenic patients, new generation stents (Uventa) represent a minimally invasive, effective, and safe alternative.

Distinguishing Features of the Urinary Bacterial Microbiome in Patients with Neurogenic Lower Urinary Tract Dysfunction.

We aimed to characterize the urinary microbiome of catheterizing patients with neurogenic lower urinary tract dysfunction (NLUTD) and to evaluate differences based on type of bladder management or frequency of urinary tract infections. This is a prospective, cross-sectional study of urine samples from asymptomatic, catheterizing patients with neurogenic lower urinary tract dysfunction who used either clean intermittent catheterization or indwelling catheters. Patients without symptoms of urinary tract infection provided a catheterized urine sample for urinalysis, culture and bacterial community microbiome analysis. A total of 95 patients submitted urine for analysis, of whom 69 had sufficient sequence reads (>1,203) for microbiome analysis. Cases with low bacterial signal amplification were associated with use of vaginal estrogen, no intradetrusor botulinum toxin A use and no growth on standard urine culture. The most abundant operational taxonomic units were from the phylum Proteobacteria, classified as Enterobacteriaceae and Escherichia. Alpha diversity varied among those who used indwelling catheters vs clean intermittent catheterization, and those who underwent botulinum toxin A injection vs not. On linear discriminate analysis, the relative abundance of the operational taxonomic units identified as Pseudomonas was higher among patients using indwelling catheters relative to clean intermittent catheterization. The operational taxonomic unit identified as Aerococcus was at a higher relative abundance among males compared to females. Enterobacteriaceae and Escherichia were the most abundant genera in the urinary microbiome of patients with neurogenic lower urinary tract dysfunction. Urinary microbiome diversity varied based on bladder management type. Future clinical correlations between microbiome of neurogenic patients and clinical presentation may help guide treatment strategies.

Population-Based Study of Prevalence, Bother and Behavior Related to Treatment for Lower Urinary Tract Symptoms and Overactive Bladder among Polish Neurogenic Patients.

Background: The aim of this study was to perform a cross-sectional study of Polish neurogenic patients to measure, at the population level, the prevalence, bother and behavior associated with treatment for lower urinary tract symptoms (LUTS) and overactive bladder (OAB). Methods: This epidemiological study was based on data from LUTS POLAND, a computer-assisted and population-representative telephone survey. Participants were classified by age, sex and place of residence. Results: LUTS POLAND includes 6005 completed interviews, of which 1166 (19.4%) were for individuals who had ever received any treatment by neurologists and/or neurosurgeons. Among these neurogenic participants, LUTS prevalence was 72.3%, statistically higher than for non-neurogenic respondents. At the population level, neurogenic patients had about a 20% higher risk for LUTS presence than non-neurogenic participants (relative risk: 1.17–1.21). LUTS prevalence did not differ between men and women. Frequency was the most common of the LUTS. Forty percent of neurogenic respondents described having more than one LUTS subtype (i.e., storage, voiding, and/or post-micturition symptom subtype), and more than 50% of respondents reported OAB symptoms. Both storage and voiding symptoms were bothersome, and many neurogenic individuals (42.3–51.0%) expressed anxiety about bladder function affecting quality of life. Only one-third (34.9–36.6%) of neurogenic participants had sought treatment for their LUTS, and the majority of such individuals received and maintained treatment. Conclusions: LUTS and OAB symptoms were highly prevalent and bothersome among Polish neurogenic patients at the population level. Because the scale of seeking treatment for LUTS was low, Polish neurogenic patients may not be adequately informed about multiple effects of LUTS and OAB.

A population-based analysis of clinical features and lymph node dissection in head and neck malignant neurogenic tumors

BackgroundThe influence of lymph node dissection (LND) on survival in patients with head and neck neurogenic tumors remains unclear. We aimed to determine the effect of LND on the outcomes of patients with head and neck neurogenic tumors.MethodsData of patients with surgically treated head and neck neurogenic tumors were identified from the Surveillance, Epidemiology, and End Results (SEER) database (1975–2016) to investigate the relationship between LND and clinical outcomes by survival analysis. Subgroup analysis was performed in IVa and IVb group.ResultsIn total, 662 head and neck neurogenic tumor patients (median age: 49.0 [0–91.0] years) met the inclusion criteria, of whom 13.1% were in the IVa group and 86.9% were in the IVb group. The median follow-up time was 76.0 months (range: 6.0–336.0 months), and the 5-year and 10-year overall survival was 82.4% (95% CI, 0.79–0.85) and 69.0% (95% CI, 0.64–0.73). Cox regression analysis revealed older age (P < .001), advanced stage (P = .037), African American race (P = .002), diagnosis before 2004 (P < .001), and chemotherapy administration (P < .001) to be independent negative predictors of overall survival. Kaplan-Meier analysis demonstrated that LND was not a predictor of clinical nodal negativity (cN0) in either IVa or IVb patients.ConclusionsIn head and neck neurogenic patients, LND may not impact the outcome of cN0 in either IVa or IVb group. These data can be recommended in guiding surgical plan and future studies.

The Application of Skin Expander in Subcontaneous Cystoplasty: A Novel Method to Solve the Dysfunction of Bladder

The patients of neurogenic bladder or radical cystectomy suffered much of the bladder dysfunction, leading mass wealth losses and misfortune of individual and society. We designed a new method to solve the problem: subcontaneous cystoplasty. Three skin expanders were buried around the abdominal ureter exit after cutaneous ureterostomy, then the inner skin bag were constructed by the expanded skin. The subcutaneous tunnel connected to the urine bag were pressed outside by belt to control the voiding. Skin urethra bulge, controlling the direction of the urination, located at the terminal of subcutaneous tunnel. Patients can put pressure to the subcontaneous urine bag to exhaust the urine. It may affect the appearance, but it can avoid many defects caused by ileocolic-cystoplasty, and may help neurogenic patients get ride of external urine bags.

The Application of Skin Expander in Subcontaneous Cystoplasty: A Novel Method to Solve the Dysfunction of Bladder

The patients of neurogenic bladder or radical cystectomy suffered much of the bladder dysfunction, leading mass wealth losses and misfortune of individual and society. We designed a new method to solve the problem: subcontaneous cystoplasty. Three skin expanders were buried around the abdominal ureter exit after cutaneous ureterostomy, then the inner skin bag were constructed by the expanded skin. The subcutaneous tunnel connected to the urine bag were pressed outside by belt to control the voiding. Skin urethra bulge, controlling the direction of the urination, located at the terminal of subcutaneous tunnel. Patients can put pressure to the subcontaneous urine bag to exhaust the urine. It may affect the appearance, but it can avoid many defects caused by ileocolic-cystoplasty, and may help neurogenic patients get ride of external urine bags.

The Multiple Sclerosis Intimacy and Sexuality Questionnaire (MSISQ-15): translation, adaptation and validation of the Polish version for patients with multiple sclerosis and spinal cord injury

BackgroundPolish physicians and researchers lack an extensive and precise instrument in their native language for evaluating sexual dysfunction in individuals with neurogenic disorders. The aim of this study was to create a culturally adapted, validated, Polish language version of the Multiple Sclerosis Intimacy and Sexuality Questionnaire (MSISQ-15) for persons with multiple sclerosis (MS) and spinal cord injury (SCI).MethodsInternational recommendations and standardized methods for instrument validation were followed. Sexually active patients with MS and SCI completed the MSISQ-15, International Index of Erection Function (IIEF-15, men), and Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire (PISQ-31, women). IIEF-15 and PISQ-31 were used as reference questionnaires. Responses were collected at baseline (test) and after 2 weeks (re-test).ResultsWe recruited 299 Polish-speaking patients with MS or SCI. Interviews disclosed that the translated questionnaire had optimal content validity/cross-cultural adaptation. MSISQ-15 scores correlated significantly with the severity of sexual dysfunction as evaluated by IIEF-15 (r = − 0.487) and PISQ-31 (r = − 0.709). These correlations substantiated the high quality construct/criterion validity. An analysis of reliability presented good internal consistency (Cronbach’s alpha of 0.93 for the total score of MS patients and 0.86 for the total score of SCI patients) and reproducibility (intraclass correlation coefficients of 0.91 for the total score of MS patients and 0.92 for the total score of SCI patients). There were no ceiling or floor effects.ConclusionsThe Polish version of MSISQ-15 exhibited excellent measurement properties. It is a suitable and reliable instrument to assess sexual dysfunction in MS and SCI individuals. The Polish MSISQ-15 will enhance routine clinical practice and assist research for neurogenic patients in Poland.

Sexual Health in the Neurogenic Patient

In this review, the current literature addressing sexual health in common neurologic conditions will be summarized. Conditions discussed include stroke, multiple sclerosis, spinal cord injury, and spina bifida. There is an increasing awareness of sexual dysfunction in patients with neurologic injury and of the role of sexual therapy in improving quality of life. Sexual health in a neurogenic patient is dependent upon a variety of factors. Determining the most influential sources of sexual dysfunction is important for providing effective treatment.

Sclérose en plaques et autosondage intermittent

Lower urinary tract dysfunctions are frequent in patients with multiple sclerosis (MS). These disorders impair quality of life and can cause urological complications. In cases of urinary retention or incomplete bladder emptying, clean intermittent self-catheterization is the preferred option where possible. To identify data concerning the use of intermittent self-catheterization by patients with MS. A review was done using Medline/Pubmed with selection of articles in either English or French. The key words were: «multiple sclerosis and intermittent catheterization, self-catheterization, neuro-urology/urinary guidelines, continent stoma, continent vesicostomy». Studies were selected if they concerned either multiple sclerosis exclusively or with a majority of cases concerning MS. Intermittent self-catheterization is recommended and commonly used in patients with MS. Studies are rare in this specific population. Questions still remain about indications and practicalities in this disease. Indications must be individually evaluated according to symptoms and complications. The use of self-catheterization can improve symptomatology or quality of life, however, global urinary management is necessary. Urinary infection is the most frequently reported side effect. The teaching of self-catheterization should take into account physical and cognitive impairment. Due to the developing nature of the pathology, indications and the patients' ability to carry out self-catheterization should be regularly assessed. The search was limited to a single bibliographic source and studies are rare. Further studies are necessary to increase knowledge of self-catheterization specificities in MS patients compared to other neurogenic patients.

Management of Chronic Bacteriuria in Neurogenic Bladders

Lower urinary tract dysfunction is a major cause of morbidity in patients with neurogenic conditions. One of the significant issues in this group is urinary tract infections. In this review, the causes of bacteriuria along with the symptoms, diagnosis, prevention and treatment options will be discussed. As in other areas of neuro-urology there is a lack of randomized controlled trials in this field. Most of the evidence is from retrospective cohort studies. Nonetheless, there are a number of guidelines and consensus statements from international organizations to standardize the treatment of recurrent urinary infections in this complex group of patients. The management of recurrent urinary infections symptoms in neurogenic patients is challenging as these patients do not always exhibit classical signs and symptoms. The evidence base is not so strong for treatment pathways. We need structured randomized control studies to better understand and manage this complex condition in this cohort of patients.

Managing Sphincter Deficiency Stress Urinary Incontinence in the Neurogenic Patient: Diagnosis and Management Strategies

In this review, we present the current literature on the diagnosis and management of stress urinary incontinence induced by sphincter deficiency associated with neurogenic lower urinary tract dysfunction. Because sphincter deficiency stress urinary incontinence is not a common condition, there are no guidelines or large-scale clinical studies that focus on the diagnosis and management of this condition. Although there is consensus that urodynamic investigation is the only method to assess the function of the lower urinary tract, there is no established urodynamic criteria to diagnose neurogenic sphincter deficiency. As for the treatment of sphincter deficiency stress urinary incontinence in neurogenic patients, artificial urinary sphincter has a better success rate and a higher complication and reoperation rate than other methods including sling surgery and injection of bulking agents. Although there is a progress in the evaluation and management of neurogenic patients with sphincter deficiency stress urinary incontinence, a prospective multicenter clinical study on this condition should be highly recommended.

Neurostimulation in neurogenic patients.

To provide an overview of available electrical stimulation devices in neurogenic patients with lower urinary tract disease. It is advocated to do more studies in neurogenic patients as results seem promising and useful but most studies did not include neurogenic patients or neurogenic patients were not analyzed or reported separately. Most studies included a small heterogenous neurogenic group with multiple pathophysiologic origin focusing on effect of a treatment instead of results of a treatment in a specific neurogenic group. Neuromodulation or stimulation has the advantage that it acts on different organs, like bladder and bowel, so can treat neurogenic patients, who mostly suffer from multiple organ failure. Brindley procedure, sacral neuromodulation (SNM) and posterior tibial nerve stimulation (PTNS) are available for a while already. The Brindley procedure (including sacral anterior root stimulation in combination with a rhizotomy of posterior sacral roots) is developed for selected spinal cord injury patient with a complete spinal injury, and has shown results for many years in neurogenic patients. An alternative to the rhizotomy is not established yet. SNM and PTNS are other modalities that are used in nonneurogenic patients, but are not yet indicated and much studied in neurogenic patients.

Treatment of neurogenic lower urinary tract symptoms: main contributions from 2018 and 2019.

This review aims to update the studies involving the treatment of lower urinary tract symptoms (LUTS) in neurogenic patients, published in the last two years. Treatment of neurogenic LUTS (NLUTS) patients with β3 adrenoreceptor agonists was investigated in real-life conditions. A randomized controlled trial compared the efficacy of antimuscarinics versus onabotulinum toxin A in neurogenic patients. The use of desmopressin to treat nocturia in multiple sclerosis patients is also reported. The long-term treatment with BontA efficacy, its discontinuation, and possible strategies to maintain patients on treatment were also evaluated. Sacral neuromodulation and tibial nerve stimulation are continuously being evaluated in neurogenic patients, especially in the last years. The management of urinary tract infections and vesical lithiasis, two common complications in NLUTS patients, and the management of both these patients was assessed in clinical trials.A trial evaluating the use of the anti-Nogo-A antibody after a spinal cord injury to facilitate neuronal rewiring and prevent or improve NLUTS was reported for the first time.

Urological malignancies in neurogenic patients.

To review recent literature related to urologic malignancies in patients with neurogenic lower urinary tract dysfunction (NLUTD). We performed a literature search of electronic databases (PubMed, ScienceDirect, Scopus, and CIANHL), with a focus on articles published between January 2015 and December 2019. Recent reports demonstrate a lower incidence of bladder cancer in the NLUTD population than previously found, although still significantly higher than the general population. Bladder cancer in patients with NLUTD is usually diagnosed at a younger age, and is associated with higher rates of squamous cell cancer, a higher stage at presentation, and increased mortality. Evidence for screening for bladder cancer in NLUTD is conflicting, with no formal protocols proven for general use. NLUTD has been shown to have a lower rate of prostate cancer, and may be associated with an earlier diagnosis of renal cancer. Genitourinary malignancies, although still rare, are an important source of morbidity and mortality in patients with NLUTD. Physicians should recognize that bladder cancer in NLUTD is often a lethal disease. Further research is needed to assist physicians with early recognition of these malignancies to improve patient outcomes.