Permanent Bladder Research Articles

Case presentation of urinary tract infection by <i>StenotrophomonaS maltophilia</i>

Stenotrophomonas maltophilia is an emerging aerobic, non-fermentative, gram-negative multidrug-resistant global opportunistic bacillus. S. maltophilia causes a wide range of infections including respiratory tract infections, blood stream infections and, less commonly, biliary tract infections, skin and soft tissue infections, as well as bone and joint infections. It is increasingly being reported to cause urinary tract infections (UTIs). As for the case report, a 87-year-old male patient visited the Biopathology Laboratory of Nikea Primary Healthcare Center, Piraeus, Greece, for routine examination, being referred by the family doctor (GP). Patient history revealed diabetes mellitus type 2, arterial hypertension, hypercholesterolemia, hypertriglyceridemia, hyperuricemia, chronic obstructive pulmonary disease, diagnosed before 30 years prostate cancer Gleasongrade 6, operated before 15 years, followed by hormone therapy and radiation therapy. Patient history also revealed urinary tract stones with 3 episodes of obstructive pyelonephritis during the last 5 years, followed by hospital admissions and administration of intravenous antibiotic treatment. During the hospital admissions, he had a permanent bladder catheter and received special antimicrobial treatment, for various microorganisms detected in his urine samples, such as Escherichia coli, Klebsiella pneumoniae, Proteus mirabilis and Enterococcus faecalis. Urinary incontinence has been a symptom for 15 years, after the prostate cancer surgery. Moreover, during the last 5 years, the patient faced many difficulties in his daily life because of the urinary incontinence. The situation was managed by bladder catheterisation, which further worsened his condition with recurrent UTIs and new episodes of pyelonephritis with subsequent hospitalization. Urinalysis showed proteinuria, intense pyuria, abundance of micro-organisms and abundance of red blood cells. The urine culture grew monomicrobial Stenotrophomonas maltophilia 105 CFU/ml. The bacterium was identified by the RapID™ REMEL ONE identification system (Thermo Fisher Scientific). Antimicrobial susceptibility testing revealed susceptibility to Trimethoprime/Sulfamethoxazole, Levofloxacin, Ceftriaxone and moderate susceptibility to Ciprofloxacin and Norfloxacin.The patient received treatment with Trimethoprime/Sulfamethoxazole.

Urinary retention induced by psychotropics: A case report

IntroductionNeurological bladder is considered a functional disability that has a significant impact on the quality of life and psychological state of patients. Psychotropic drugs, in turn, can worsen the urinary dysfunction caused by this disease.ObjectivesOur objective is to illustrate, through the case of a patient suffering from a neurological bladder decompensated by the treatment of a characterized depressive episode, the link between these two pathologies.MethodsWe report the case of Ms. M.W., aged 51, with a history of high blood pressure stabilized under nebivolol and a neurological bladder diagnosed 10 years ago with episodic pollakiuria, admitted to the psychiatric department for repeated suicide attempts. She had never used psychoactive substances and had no family psychiatric history. The patient presented depressive symptoms evolving for 5 months. The diagnosis of a characterized depressive episode with melancholic features was made and the patient was treated with sertraline. From the first intake of the drug, the patient presented acute urinary retention (UR) requiring the placement of a permanent bladder catheter. The urinary symptoms improved upon stopping the treatment. Sertraline was changed to olanzapine and escitalopram. The patient stopped the treatment after one month because of the worsening of urinary symptoms requiring the installation of a suprapubic catheter. The urinary problem, together with the cessation of treatment, were responsible for a worsening of psychiatric symptoms leading to multiple suicide attempts. Given the advanced stage of the neurological bladder demonstrated by the urodynamic tests, our patient was treated with paroxetine, quetiapine and oxazepam along with psychotherapeutic education. The evolution was characterized by improvement in psychiatric symptoms and the urinary symptoms were stable.ResultsThe lack of improvement after treatment discontinuation could be explained by an underlying neurological bladder manifesting with pollakiuria. The current literature on UR induced by psychotropic treatments is quite rare limited in case reports. This effect occurs especially when selective serotonin reuptake inhibitors (SSRIs) are prescribed in combination with other antipsychotics. Unlike first generation antipsychotics, atypical antipsychotics have muscarinic receptor antagonist properties which can induce UR. Among atypical antipsychotics, olanzapine has been shown to have the greatest antimuscarinic effects. Regarding SSRIs, they are associated with a lower risk of UR than other antidepressants and sertraline had the highest risk of UR.ConclusionsSSRIs can induce UR particularly in combination with atypical antipsychotics. Coordination of care across multiple specialties and understanding the side effects of psychotropic medications can enable faster diagnoses and adequate management.Disclosure of InterestNone Declared

Trans - Perineal laser ablation of the prostate in high surgical risk patients affected by severe lower urinary tract symptoms related to benign prostatic obstruction.

In our study, we aimed to test the efficacy and safety of Trans-Perineal Laser Ablation of the prostate (TPLA®) in the surgical treatment of high-risk Benign Prostatic Obstruction (BPO) patients. We defined a high-risk BPO patient as an elderly man affected by severe comorbidities, among which coagulation issues due to pre-existent medications or diseases. From October 2020 to June 2022, we prospectively enrolled high-risk patients affected by a moderate to severe and/or complicated BPO condition. The analysis of the efficacy of the Trans-Perineal Laser Ablation was defined as the primary endpoint of the study. Secondary endpoints were post-operative surgical complications and patient-reported quality of life. Globally, 40 consecutive patients were enrolled. Median (IQR) age was 80 (72.5-84) years. Median Charlson Comorbidity Index was 6 (5-7). Median prostate volume was 38 (30.5-73) cc. In all cases, a TPLA® procedure was performed under local anesthesia, and patients being discharged within the same day of the procedure. A progressive reduction of median prostate volumes was reported at 3 and 6 months post-operatively, compared to baseline [38 (30.5-73) vs 35 (26-49) vs 34 (28-49) cc, p < 0.001]. Median International Prostate Symptom Score (IPSS) improved accordingly [25 (19-30) vs 10.5 (7.5-13) vs 8 (6-11.5), p < 0.001]. A permanent bladder catheter was successfully removed in 13 out of 23 (56.5%) cases. Within 90 days from surgery, 19 (47.5%) patients experienced at least one surgical complication. According to the Clavien-Dindo classification, complications were classified as grade I in 16 (40%) cases, grade II in 9 (22.5%), and grade III in 1 (2.5%). We did not observe any grade IV or V complications. The Trans-Perineal Laser Ablation of the Prostate is a feasible, safe, and effective Minimally Invasive Surgical Technique, when offered to elderly, high-risk patients affected by severe Benign Prostatic Obstruction.

Vesicostomy: An alternative approach for complicated adult patients with urinary retention

Purpose:Patients with permanent urethral catheterization for chronic urinary retention frequently experience several complications, such as bladder stones and/or urinary tract infections. In this study, we performed vesicostomy in adult patients with urinary retention who developed complications during long-term indwelling catheterization. Methods:Patients with a permanent bladder catheter for urinary retention, and bladder stones and/or urinary tract infection between April 2019 and October 2021 were enrolled in this retrospective study. Vesicostomy and additional surgeries, such as vesicolithotomy, were performed if necessary. Residual urine volume was measured with computed tomography 7 days after the operation. We followed-up all patients 3 months postoperatively to identify complications. Results:Nine patients were included in this study; eight were male and one was female. The median age at operation was 65 (range, 23–92) years. Concurrent operations were lithotomy in five, cystostomy closure in one, removal of a bladder foreign body in one, and nephrectomy in one. The postoperative median residual urine volume in the bladder was 32 (range, 5–51) ml. Perioperative complications comprised delirium (Clavien–Dindo grade II) in two patients and stomal bleeding (Clavien–Dindo grade II) in one patient. There were no complications of bladder stones, febrile urinary tract infection, or stomal stenosis postoperatively. Conclusions:Vesicostomy for adult patients with urinary retention was useful and safe. Our results suggest that vesicostomy could be a bladder drainage option for select adult patients who are not candidates for permanent indwelling catheterization.

Preclinical evaluation of singlet oxygen-cleavable prodrugs in combination with protoporphyrin IX-photodynamic therapy in an orthotopic rat model of non-muscle-invasive bladder cancer.

Photodynamic therapy (PDT) initially employed red light, which caused some patients to experience permanent bladder contractions. PDT using the FDA-approved drug hexaminolevulinate (HAL), which produces protoporphyrin IX (PpIX) in the tumor, showed some promise but has low efficacy in treating non-muscle-invasive bladder cancer (NMIBC). We developed singlet oxygen-activatable prodrugs of two anticancer drugs, paclitaxel and mitomycin C, to enhance the antitumor effect of PpIX-PDT without producing systemic side effects, by promoting only local release of the active chemotherapeutic agent. Orthotopic NMIBC model was used to compare the efficacy of prodrugs only, PpIX-PDT, and prodrugs + PpIX-PDT. 532 nm laser with a total power of 50 mW for 20 min (60 J, single treatment) was used with HAL and prodrugs. Histology and microscopic methods with image analysis were used to evaluate the tumor staging, antitumor efficacy, and local toxicity. Prodrug + PpIX-PDT produced superior antitumor efficacy than PpIX-PDT alone with statistical significance. Both PpIX-PDT alone and combination therapy resulted in mild damage to the bladder epithelium in the normal bladder area with no apparent damage to the muscle layer. Overall, SO-cleavable prodrugs improved the antitumor efficacy of PpIX-PDT without causing severe and permanent damage to the bladder muscle layer.

Clinical Guidelines of Patient-Centered Bladder Management of Neurogenic Lower Urinary Tract Dysfunction due to Chronic Spinal Cord Injury - Part 2

Bladder management of chronic spinal cord injured (SCI) patients usually starts with conservative treatment or minimally invasive procedures. This article reports the current evidence and expert opinions on the patient-centered bladder management of neurogenic lower urinary tract dysfunction (NLUTD) among patients with chronic SCI in Taiwan. We evaluated the role of clean intermittent catheterization (CIC), cystostomy, medical treatment, and minimally invasive therapy for treating urinary incontinence and voiding dysfunction in patients with chronic SCI. The bladder management for chronic SCI patients should be individualized. A balance between upper urinary tract protection and life quality improvement should be considered. Hand dexterity, abdominal muscle power, bladder sensation, and degree of urethral sphincter dyssynergia might affect the improvement of voiding efficiency and NLUTD. Intradetrusor Botulinum Toxin Type A (BoNT-A) injection has been proven to effectively treat neurogenic detrusor overactivity in SCI patients. However, CIC is still required in some patients after treatment. The urethral sphincter BoNT-ABoNT-A injection can effectively relax the dyssynergic sphincter; however, exacerbation of urinary incontinence usually limits its application in SCI patients. Repeat BoNT-ABoNT-A injection is necessary to maintain the therapeutic efficacy; therefore, some SCI patients might discontinue the treatment and convert to a permanent bladder management by surgical intervention. Identification of high-risk SCI patients is important to prevent renal functional deterioration in those with chronic SCI-NLUTD. Avoiding renal function deterioration and improving the quality of life of SCI patients with NLUTD are the most important aspects of treatment. Annual active surveillance of bladder and renal function is necessary.

Application Effect of Bladder Function Training Combined with Kangaiping Pills on Permanent Bladder Stoma after Radical Prostatectomy.

Objective To investigate the application effect of bladder function training combined with Kangaiping pills on permanent bladder stoma after radical prostatectomy (RP). Methods The clinical data of 80 patients with a permanent bladder stoma after RP in our hospital from December 2018 to December 2019 were retrospectively analyzed, and they were equally split into the experimental group (EG) and control group (CG) according to the odd and even hospitalization numbers. EG received bladder function training combined with Kangaiping pills while CG received routine nursing for permanent bladder stomas to compare the urodynamic indexes and quality of life (QOL) scores after intervention between the two groups. Results Compared with CG, EG after intervention achieved an obviously higher number of patients with bladder function grade I (∗), higher urodynamic indexes (P < 0.001), a higher SF-36 score (P < 0.001), a lower LUTS score (P < 0.001), and a lower total incidence of postoperative adverse reactions (P < 0.05). Conclusion Bladder function training combined with Kangaiping pills is a reliable method to improve the bladder function of patients with a permanent bladder stoma after RP. This intervention method greatly enhances the QOL of patients and reduces the risk of postoperative adverse reactions, which is recommended for clinical application.

Risk factors for failure of long-term dutasteride add-on treatment to alpha-adrenergic antagonist for patients with lower urinary tract symptoms and benign prostatic enlargement.

To identify the clinical factors resulting in the failure of dutasteride add-on treatment to alpha-adrenergic antagonist for patients with lower urinary tract symptoms and benign prostatic enlargement (BPE). We retrospectively surveyed the patient cohort who had been enrolled in the study of dutasteride add-on treatment to alpha-adrenergic antagonist from December 2009 to November 2011. Treatment failure was defined as receiving surgery for BPE or requiring intermittent catheterization or permanent bladder catheter for urinary retention or huge postvoid residual urine. Clinical parameters before dutasteride treatment were compared between the successful and failed group. Of 92 patients, 23 (25%) were defined as treatment failure at 7-109months (mean: 38months) after dutasteride add-on treatment. In the failed group, the patient' age was younger (71.6 ± 6.8 vs 75.4 ± 8.4, p = 0.033), prostatic volume (PV) was larger (76 ± 41 vs 49 ± 26ml, p = 0.005), voiding efficiency was lower (54 ± 27 vs 68 ± 24%, p = 0.045) and bladder outlet obstruction index was higher (73 ± 30 vs 48 ± 30, p = 0.015). The cox proportional-hazards model indicated that only intravesical prostatic protrusion (IPP) was associated with treatment failure. Non-failure rate at 3years after dutasteride add-on treatment was 89% with patients of IPP < 13mm versus 51% with those of IPP ≥ 13mm (p < 0.001). IPP ≥ 13mm is the risk factor resulting in the failure of dutasteride add-on treatment to alpha-adrenergic antagonist. This kind of information should be provided to the patients early in the clinical practice so that they could consider the necessity of BPE surgery in the long run.

An exploratory first-in-man study to investigate the pharmacokinetics and safety of liposomal dexamethasone at a 2- and 1-week interval in patients with metastatic castration resistant prostate cancer.

Dexamethasone has antitumor activity in metastatic castration resistant prostate cancer (mCRPC). We aimed to investigate intravenous liposome‐encapsulated dexamethasone disodium phosphate (liposomal dexamethasone) administration in mCRPC patients.In this exploratory first‐in‐man study, patients in part A received a starting dose of 10 mg followed by five doses of 20 mg liposomal dexamethasone at 2‐week intervals. Upon review of part A safety, patients in part B received 10 weekly doses of 18.5 mg. Primary outcomes were safety and pharmacokinetic profile, secondary outcome was antitumor efficacy.Nine mCRPC patients (5 part A, 4 part B) were enrolled. All patients experienced grade 1–2 toxicity, one (part B) patient experienced grade 3 toxicity (permanent bladder catheter‐related urosepsis). No infusion‐related adverse events occurred. One patient had upsloping glucose levels ≤9.1 mmol/L. Trough plasma concentrations of liposomal‐ and free dexamethasone were below the lower limit of quantification (LLOQ) in part A, and above LLOQ in three patients in part B (t 1/2 ~50 h for liposomal dexamethasone), trough concentrations of liposomal‐ and free dexamethasone increased toward the end of the study. In seven of nine patients (78%) patients, stable disease was observed in bone and/or CT scans at follow‐up, and in one (part B) of these seven patients a >50% PSA biochemical response was observed.Bi‐ and once weekly administrations of IV liposomal dexamethasone were well‐tolerated. Weekly dosing enabled trough concentrations of liposomal‐ and free dexamethasone >LLOQ. The data presented support further clinical investigation in well‐powered studies.Clinical trial registration: ISRCTN 10011715.

Prospective cohort study on hospitalised patients with suspected urinary tract infection and risk factors por multidrug resistance

Urinary tract infections (UTIs) are among the most common bacterial infections and a frequent cause for hospitalization in the elderly. The aim of our study was to analyse epidemiological, microbiological, therapeutic, and prognostic of elderly hospitalised patients with and to determine independent risk factors for multidrug resistance and its outcome implications. A single-centre observational prospective cohort analysis of 163 adult patients hospitalized for suspected symptomatic UTI in the Departments of Internal Medicine, Infectious Diseases and Short-Stay Medical Unit of a tertiary hospital was conducted. Most patients currently admitted to hospital for UTI are elderly and usually present high comorbidity and severe dependence. More than 55% met sepsis criteria but presented with atypical symptoms. Usual risk factors for multidrug resistant pathogens were frequent. Almost one out of five patients had been hospitalized in the 90 days prior to the current admission and over 40% of patients had been treated with antibiotic in the previous 90 days. Infection by MDR bacteria was independently associated with the previous stay in nursing homes or long-term care facilities (LTCF) (OR 5.8, 95% CI 1.17–29.00), permanent bladder catheter (OR 3.55, 95% CI 1.00–12.50) and urinary incontinence (OR 2.63, 95% CI 1.04–6.68). The degree of dependence and comorbidity, female sex, obesity, and bacteraemia were independent predictors of longer hospital stay. The epidemiology and presentation of UTIs requiring hospitalisation is changing over time. Attention should be paid to improve management of urinary incontinence, judicious catheterisation, and antibiotic therapy.

Urinary Catheter Care Approach for Urinary Tract Infection among Nurses in Tertiary Care Hospital

Urinary tract infections (UTIs) are the most common infection in hospital setting, the period of hospital-derived waste that affects individuals today. A significant number of seventy-five percent of urinary tract infections acquired in the hospital are associated with the use of a permanent bladder catheter (IDC), considering that there are about 15-25% chance of an inpatient requiring catheter insertion during your stay [1].

Tolerance and Resistance of Pseudomonas aeruginosa Biofilms to Antimicrobial Agents-How P. aeruginosa Can Escape Antibiotics.

Pseudomonas aeruginosa is one of the six bacterial pathogens, Enterococcus faecium, Staphylococcus aureus, Klebsiella pneumoniae, Acinetobacter baumannii, Pseudomonas aeruginosa, and Enterobacter spp., which are commonly associated with antimicrobial resistance, and denoted by their acronym ESKAPE. P. aeruginosa is also recognized as an important cause of chronic infections due to its ability to form biofilms, where the bacteria are present in aggregates encased in a self-produced extracellular matrix and are difficult or impossible to eradicate with antibiotic treatment. P. aeruginosa causes chronic infections in the lungs of patients with cystic fibrosis and chronic obstructive lung disease, as well as chronic urinary tract infections in patients with permanent bladder catheter, and ventilator-associated pneumonia in intubated patients, and is also an important pathogen in chronic wounds. Antibiotic treatment cannot eradicate these biofilm infections due to their intrinsic antibiotic tolerance and the development of mutational antibiotic resistance. The tolerance of biofilms to antibiotics is multifactorial involving physical, physiological, and genetic determinants, whereas the antibiotic resistance of bacteria in biofilms is caused by mutations and driven by the repeated exposure of the bacteria to high levels of antibiotics. In this review, both the antimicrobial tolerance and the development of resistance to antibiotics in P. aeruginosa biofilms are discussed. Possible therapeutic approaches based on the understanding of the mechanisms involved in the tolerance and resistances of biofilms to antibiotics are also addressed.

PD26-08 THERMO-EXPANDABLE METALLIC URETHRAL STENT FOR MANAGING ELDERLY PEOPLE WITH INDWELLING URINARY CATHETER: A COMPELLING OPTION TO AVOID LONG-TERM CATHETERIZATION

You have accessJournal of UrologyUrodynamics/Lower Urinary Tract Dysfunction/Female Pelvic Medicine: Male Incontinence: Therapy I1 Apr 2018PD26-08 THERMO-EXPANDABLE METALLIC URETHRAL STENT FOR MANAGING ELDERLY PEOPLE WITH INDWELLING URINARY CATHETER: A COMPELLING OPTION TO AVOID LONG-TERM CATHETERIZATION Cyrielle Rambaud, Sébastien Gonfrier, Cyprien Arlaud, Laetitia Imbert de la Phalecque, Jérémy Fallot, Romain Haider, Brannwel Tibi, Olivier Guérin, and Matthieu Durand Cyrielle RambaudCyrielle Rambaud More articles by this author , Sébastien GonfrierSébastien Gonfrier More articles by this author , Cyprien ArlaudCyprien Arlaud More articles by this author , Laetitia Imbert de la PhalecqueLaetitia Imbert de la Phalecque More articles by this author , Jérémy FallotJérémy Fallot More articles by this author , Romain HaiderRomain Haider More articles by this author , Brannwel TibiBrannwel Tibi More articles by this author , Olivier GuérinOlivier Guérin More articles by this author , and Matthieu DurandMatthieu Durand More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2018.02.1347AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Management of chronic urinary retention in elderly people is challenging and time consuming, leading to high risk to place indwelling urinary catheter (IUC). The use of urethral stent (045-TW Memokath) may be an option in selected patients to avoid long-term catheterization. We assess the efficacy and treatment-related complications in such maintaining urethral patency. METHODS All patient over 70 yo with failed removal of long-term urinary catheter were proposed to a multidisciplinary decision-making. Alternative treatment (AT) was offered after decision process. Urethral stent was indicated for treatment of patients with severe IUC-associated urethral injury and re-current or permanent bladder neck obstruction but unfit for long general anesthesia. All patients were followed using plain radiography, uroflowmetry and urine analysis. RESULTS 118 patients were enrolled with a mean age of 86.4 yo (women: 33.2%). AT were offered to 62.7% (n=74), including 18 urethral stents, 30 catheter withdrawals, 22 photovaporizations of the prostate, 2 prostatic artery embolizations and 2 other surgeries. Overall, the success rate was 89.2% at 7 days and raised up to 92% at 1month. Among the 80 men, an AT was performed in 53 men including 18 urethral stents. Clinical characteristics men who received urethral sents compared to others are presented table 1. The success rate of urethral stent, at 7 days, was 94.5%, with one stent removed for a retention. In all, 10 stents were still functioning at the end of follow-up after a mean 175 days [40-434]. Six patients had died of reasons unrelated to the stent with a functioning stent in situ after an average of 58 days. One stent was removed after 192 days due to an infection. No other serious infections or stent migrations has been reported. Residual urine was <200ml after placement of the stents. CONCLUSIONS In our cohort, urethral stents allowed to 94.4% of frailty patients to avoid an IUC. Urethral stents are indicated for frailed patients with a risk to tear off their catheters. This alternative option to IUC may allow to improve autonomy and quality of life. More data are needed, to confirm the safety and the efficacy of this technic. © 2018FiguresReferencesRelatedDetails Volume 199Issue 4SApril 2018Page: e554-e555 Advertisement Copyright & Permissions© 2018MetricsAuthor Information Cyrielle Rambaud More articles by this author Sébastien Gonfrier More articles by this author Cyprien Arlaud More articles by this author Laetitia Imbert de la Phalecque More articles by this author Jérémy Fallot More articles by this author Romain Haider More articles by this author Brannwel Tibi More articles by this author Olivier Guérin More articles by this author Matthieu Durand More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

The effect of self-care agency on self-perceived burden of patients with permanent bladder fistula

Objective To explore the effect of self-care agency on the self-perceived burden of patients with permanent bladder fistula. Methods From January 2016 to January 2017, the general data questionnaire, the Self-Perceived Burden Scale(SPBS), the Exercise of Self-Care Agency Scale(ESCA) was used to investigate 388 cases of permanent bladder fistula in 2 hospitals in Lanzhou, Baiyin and Dingxi city, and the results were statistically analyzed. Results The total score of SPBS was (36.01±1.34) points, which was in the middle level. The total score of ESCA was (51.05±10.23) points, which was in low level. The total score of SPBS was negatively correlated with the total score of ESCA and each dimension (r=-0.496--0.168, P<0.01 or 0.05). Stratified regression analysis showed that self-care skills, self-responsibility, self-concept and health knowledge level in self-care ability were important influencing factors (P<0.05). Conclusions Nursing staff can improve the self-care ability, reduce the self-perceived burden, and improve the quality of life of patients. Key words: Cystostomy; Self-care agency; Self-perceived burden

Clinical presentation and prognosis in MOG-antibody disease: a UK study.

See de Seze (doi:10.1093/brain/awx292) for a scientific commentary on this article. A condition associated with an autoantibody against MOG has been recently recognized as a new inflammatory disease of the central nervous system, but the disease course and disability outcomes are largely unknown. In this study we investigated clinical characteristics of MOG-antibody disease on a large cohort of patients from the UK. We obtained demographic and clinical data on 252 UK patients positive for serum immunoglobulin G1 MOG antibodies as tested by the Autoimmune Neurology Group in Oxford. Disability outcomes and disease course were analysed in more detail in a cohort followed in the Neuromyelitis Optica Oxford Service (n = 75), and this included an incident cohort who were diagnosed at disease onset (n = 44). MOG-antibody disease affects females (57%) slightly more often than males, shows no ethnic bias and typically presents with isolated optic neuritis (55%, bilateral in almost half), transverse myelitis (18%) or acute disseminated encephalomyelitis-like presentations (18%). In the total Oxford cohort after a median disease duration of 28 months, 47% of patients were left with permanent disability in at least one of the following: 16% patients had visual acuity ≤6/36 in at least one eye, mobility was limited in 7% (i.e. Expanded Disability Status Scale ≥ 4.0), 5% had Expanded Disability Status Scale ≥ 6.0, 28% had permanent bladder issues, 20% had bowel dysfunction, and 21% of males had erectile dysfunction. Transverse myelitis at onset was a significant predictor of long-term disability. In the incident cohort 36% relapsed after median disease duration of 16 months. The annualized relapse rate was 0.2. Immunosuppression longer than 3 months following the onset attack was associated with a lower risk of a second relapse. MOG-antibody disease has a moderate relapse risk, which might be mitigated by medium term immunosuppression at onset. Permanent disability occurs in about half of patients and more often involves sphincter and erectile functions than vision or mobility.

Sacrectomía parcial por abordaje posterior único. [Partial sacrectomy by single posterior approach.

&lt;p class="TRABAJOS"&gt;&lt;strong&gt;Introducción: &lt;/strong&gt;Los tumores del sacro corresponden a menos del 7% de los tumores espinales. Prevalecen los secundarios por mieloma múltiple o carcinomas de próstata, mama, pulmón o colón. De los primarios, el cordoma es el maligno más frecuente y el tumor de células gigantes el benigno.&lt;/p&gt;&lt;p class="TRABAJOS"&gt;Por su evolución, compromiso de estructuras extra óseas y la escasa respuesta a la coadyuvancia, la cirugía es el tratamiento más utilizado, la vía de abordaje y la necesidad de instrumentación dependerá del tumor a tratar.&lt;/p&gt;&lt;p class="TRABAJOS"&gt;&lt;strong&gt;Objetivos:&lt;/strong&gt; Los objetivos de este trabajo son: evaluar la utilización de resección parcial de sacro, analizar la técnica quirúrgica y reconocer complicaciones.&lt;/p&gt;&lt;p class="TRABAJOS"&gt;&lt;strong&gt;Material y métodos:&lt;/strong&gt; Cuatro pacientes con diagnóstico de tumor sacro ubicado por debajo de S1, que consulta por dolor y que las imágenes confirman la lesión. A todos se les realiza una resección en bloque por vía posterior preservando S1. Se describe la técnica.&lt;/p&gt;&lt;p class="TRABAJOS"&gt;&lt;strong&gt;Resultados:&lt;/strong&gt; La anatomopatológica fue: un cordoma, un tumor maligno de vaina nerviosa, un condrosarcoma y una metástasis de carcinoma prostático. Se preservo la función de S1 en todos los pacientes; uno presenta disfunción vesical permanente. Se observaron una dehiscencia de herida, una infección y fistula de líquido cefalorraquídeo. Con un seguimiento entre 6 y 24 meses todos los pacientes se encuentran libre de patología.&lt;/p&gt;&lt;p class="TRABAJOS"&gt;&lt;strong&gt;Conclusiones: &lt;/strong&gt;La resección parcial del sacro por abordaje único vía posterior puede ser indicada cuando la lesión comprometa desde S2 hacia distal y sin compromiso sacroilíaco. La preservación de raíces es de vital importancia para garantizar mejores resultados post operatorios y menor tasa de infección.&lt;/p&gt;

Effect of Peer Teaching Used in Nursing Education on the Performance and Competence of Students in Practical Skills Training

ABSTRACTPeer teaching is an effective educational approach for nursing students. It has been used in nursing as an adjunct to lectures and to support learning in clinical practice. This study evaluated the efficacy of peer teaching model which is used in skills training of student nurses. As an experimental study, it included 57 first years and 10 senior students from the nursing department. First years constituted the interventional group and the control group while seniors made up the peer educators. This study revealed that the experimental group students had obtained adequate skills in nasopharyngeal aspiration, permanent bladder catheterization practices and take blood pressure compare to their counterparts (p<0.05).The approach is helpful for improving students’ ability in practical training. The study results add to the literature supporting the use of peer teaching approach in nursing training practical education.

Rate of spontaneous voiding recovery after acute urinary retention due to bed rest in the hospital setting in a nonurological population clinical study of the relationship between lower limbs and bladder function.

ObjectivesTo understand the clinical relationship between lower limbs functions and the recovery of spontaneous voiding after an acute urinary retention (AUR) in older patients admitted to hospitals for non-urological causes using clinical parameters.Materials and Methods56 adult patients (32 men; mean age: 77.9 ± 8.3 and 24 women; mean age 82.1 ± 4.6) with AUR were prospectively followed with validated Physical Performance Mobility Exam (PPME) instrument to evaluate the relationship between the recovery of mobility capacity and spontaneous voiding. After a short period of permanent bladder drainage patients started CIC along evaluation by PPME during hospitalization and at 7, 15, 30 60, 90, and 180 days of discharge. Mann-Whitney U, chi-square test and ANOVA tests were used.ResultsAll patients were hospitalized for at least 15 days (Median 26.3 ± 4.1 days). Progressive improvement on mobility scale measured by PPME was observed after leaving ICU and along the initial 7 days of hospitalization but with a deterioration if hospitalization extends beyond 15 days (p<0.03). Prolonged hospital stay impairs mobility in all domains (p<0.05) except step-up and transfer skills (p<0.02) although a recovery rate on spontaneous voiding persistented. Restoration of spontaneous voiding was accompanied by improvement on mobility scale (p<0.02). Recovery of spontaneous voiding was markedly observed after discharging the hospital. All patients recovered spontaneous voiding until 6 months of follow-up.ConclusionsRecovery to spontaneous voiding after acute urinary retention in the hospital setting may be anticipated by evaluation of lower limbs function measured by validated instruments.

Cauda Equina Syndrome: A case study and review of the literature

Spinal pathology commonly features in physiotherapy caseloads and a detailed knowledge of the features of Cauda Equina Syndrome (CES) is essential. While CES is a rare presentation, if missed the consequences of permanent bladder, bowel and sexual dysfunction are devastating. CES has a varied presentation in terms of chronology and symptomatology, leading to difficulty in accurate diagnosis in a clinical setting. The case study of a 48 year old female who developed CES while attending physiotherapy is presented. Her subjective and physical examination findings together with her lumbar Magnetic Resonance Imaging (MRI) findings are outlined. The patient underwent an L5/S1 subtotal laminectomy and discectomy and the patient's status at eight months post-operatively is presented. A comprehensive review of the aetiology, sub-classifications and clinical features of CES is also provided.

Risk factor analysis for postoperative urinary retention after surgery for degenerative lumbar spinal stenosis

Background ContextPostoperative urinary retention (POUR) may not be considered a major complication after surgery for degenerative lumbar spinal stenosis. However, improper management of transient POUR leads to bladder overdistension and permanent bladder detrusor damage. Systematic monitoring of POUR may be recommended in vulnerable patients. PurposeThe aim of the present study was to determine the incidence of and risk factors for POUR. Study Design/SettingThis is a retrospective nested case-control study. Patient SampleA total of 284 consecutive patients (M : F=125:159; mean age, 63.3 years) who underwent spine surgery for degenerative lumbar spinal stenosis were reviewed. Outcome MeasuresA multivariable logistic model was utilized to identify risk factors. MethodsA systematic postoperative voiding care protocol was applied for all patients to monitor them for the development of POUR. An indwelling urethral catheter was inserted intraoperatively and removed in the postanesthesia care unit. The patients were encouraged to void within 6 hours postoperatively and every 4–6 hours thereafter. After each voiding, the postvoid residual urine (PVR) was measured by an ultrasound bladder scan. POUR was defined as the inability to void or having a PVR≥100 mL for more than 2 days after surgery. ResultsThe incidence of POUR was 27.1% (77/284). Older age (odds ratio, 1.062; 95% confidence interval, 1.029–1.095) and a long duration of surgery (odds ratio, 1.003; 95% confidence interval, 1.001–1.005) were significant risk factors. A formula for determining the probability of POUR was developed, and a probability of ≥0.26 was regarded as the cut-off value (sensitivity of 0.75 and specificity of 0.57; C-statics, 0.684). ConclusionPOUR was a common morbidity after surgery for degenerative lumbar spinal stenosis. We recommend adopting a systematic postoperative voiding care protocol to prevent bladder overdistension and detrusor damage, especially for elderly patients and those who have undergone longer surgeries.