Treatment Of Neurogenic Bladder Research Articles

Acupoint selection rules of acupuncture and moxibustion in treating neurogenic bladder based on data mining.

To explore the rules of acupoint selection in the treatment of neurogenic bladder (NB) with acupuncture and moxibustion by using data mining. The clinical research literatures on acupuncture treatment of NB were collected from PubMed, Embase, Cochrane Library, CNKI, Wanfang Database, VIP Database and China Biology Medicine from retrieved to January 1, 2023. The acupoint prescription database was established using Excel 2019. SPSS Modeler 18.0 and SPSS Statistics 26.0 softwares were used to conduct the frequency, meri-dians, locations, specific acupoints analysis and association rules analysis, factor analysis, cluster analysis, etc., to explore the characteristics and rules of acupoint selection in acupuncture and moxibustion treatment of NB. Totally 313 papers were included, including 110 acupoints with a total frequency of 1 995. The high-frequency acupoints are Zhongji (CV3), Guanyuan (CV4), Sanyinjiao (SP6), etc. The commonly used meridians are the Bladder Meridian of Foot Taiyang and Conception Vessel. The involved acupoints are mostly located in the lumbosacral region and abdomen, and intersection acupoints, mu-front acupoints and back-shu acupoints are the majority in the specific acupoints. The core acupoints group was analyzed, and 17 groups of association rules, 7 factors and 6 effective cluster groups were obtained. Acupuncture and moxibustion treatment of NB follows the therapeutic principles of toni-fying the kidney, invigorating the spleen, and soothing the liver. The core acupoints group is CV3-CV4-SP6.

Exploring the Effect of Bladder Functional Training Combined with Repetitive Sacral Root Magnetic Stimulation in the Treatment of Neurogenic Bladder

To observe the therapeutic effect of bladder function training combined with repetitive sacral root magnetic stimulation (rSMS) on neurogenic bladder in patients with spinal cord injury. From January 2019 to May 2021, we selected 68 patients with neurogenic bladder and spinal cord injury who were hospitalised in the rehabilitation department of our hospital. The patients were divided into the rSMS group (36 cases) and control group (32 cases) according to a random number table. The rSMS group was treated with bladder functional training combined with rSMS, while the control group was treated only with bladder functional training. The training lasted for 40 days. Finally, we compared the therapeutic effects in the two groups. There was no significant difference in gender, age, course of disease, site and grade of spinal cord injury between the two groups. There was no statistically significant difference in urodynamic indexes between the two groups before treatment. After treatment, the residual urine volume of the rSMS group was 82.7 ± 34.6 ml, the maximum urine flow rate was 15.7 ± 4.8 ml/s, the bladder volume was 388.6 ± 51.3 ml, and the bladder pressure was 36.3 ± 6.3 cmH2O. After treatment, the residual urine volume in the rSMS group was significantly less than that in the control group (p < 0.05). The maximum urine flow, bladder volume and bladder pressure in the rSMS group were higher than those in the control group, and the differences were statistically significant (p < 0.05). After treatment and after 40 days' follow-up, the Barthel index scores of the patients in the rSMS group were 69.5 ± 9.3 and 73.5 ± 8.2, respectively, which were significantly higher than those of the patients in the control group (p < 0.05). The effective rates were 94.4% in the rSMS group and 81.3% in the control group, and the difference was statistically significant (p < 0.05). Comparing with bladder function training alone, bladder function training combined with rSMS was more effective in the treatment of neurogenic bladder, particularly for detrusor hyporeflexia/areflexia; it significantly improved patients' ability to urinate autonomously, reduced the residual urine volume of the bladder and improved patients' quality of life.

Diagnosis and Treatment of Japanese Children with Neurogenic Bladder: Analysis of Data from a National Health Insurance Database.

In pediatric patients with neurogenic bladder (NGB), urinary tract evaluation, early diagnosis, and individualized management are important. We aimed to clarify the current status of diagnosis and treatment of NGB in Japanese children. This descriptive, observational, retrospective cohort study using the JMDC claims database included NGB patients aged ≤17 years over a 12-month follow-up period. Of the 1065 pediatric NGB patients, 38.9% had spina bifida. Dermatological and gastrointestinal comorbidities were common in the baseline period. Renal/bladder ultrasound was a commonly performed investigation (38.3%), but urodynamics was infrequently used (3.0%). Of all the overactive bladder medications, anticholinergics were used commonly (17.9% patients), and most patients used anticholinergics alone (without combination therapy). Clean intermittent catheterization (CIC; alone or in combination with medications) was performed in 9.3% of patients, and 3.9% of patients were concomitantly treated with medications. The most common incident complication was lower urinary tract infection (18.1%), which was especially common in patients with open spina bifida (54.1%). Despite guideline recommendations, lower urinary tract dysfunction is not thoroughly evaluated. Adequate understanding of patient status is critical to optimal patient management (behavioral therapy, CIC, and medication) in clinical practice.

GAO Wei-bin's clinical experience in treatment of neurogenic bladder with acupuncture

The paper introduces GAO Wei-bin's clinical experience in acupuncture treatment for neurogenic bladder. In association with the etiology, the location and types of neurogenic bladder and in accordance with nerve anatomy and meridian differentiation, the acupoints are selected accurately in treatment. Four acupoint prescriptions are allocated. For frequent urination and urinary incontinence, the foot-motor-sensory area of scalp acupuncture, Shenshu (BL 23) and Huiyang (BL 35) are used. For all kinds of urine retention, especially the patients who are not suitable for acupuncture at the lumbar region, Zhongji (CV 3), Qugu (CV 2), Henggu (KI 11) and Dahe (KI 12) are selected. For all kinds of urine retention, Zhongliao (BL 33) and Ciliao (BL 32) are applicable. For the patients with both dysuria and urinary incontinence, Zhongliao (BL 33), Ciliao (BL 32) and Huiyang (BL 35) are chosen. In treatment of neurogenic bladder, both biao (root causes) and ben (primary symptoms) are considered, as well as the accompanying symptoms; and electroacupuncture is combined accordingly. During the delivery of acupuncture, the sites where the acupoints located are detected and palpated so as to rationally control the depth of needle insertion and the operation of reinforcing and reducing needling techniques.

Neurogenic Bladder in Dogs, Cats and Humans: A Comparative Review of Neurological Diseases.

Lower urinary tract disease (LUTD) includes abnormalities in the structure and function of the bladder and the urethra. LUTD caused by neurological disease is defined neurogenic bladder (NB). The integrity of the central nervous system (CNS) and peripheral nervous system (PNS) is required to explicate normal micturition, maintaining the proper function of bladder and urethra. The location and type of neurological lesions influence the pattern of clinical manifestations, potential treatment, and prognosis. Though, in dogs and cats, spinal cord injury is considered mainly responsible for bladder and/or urethra incompetence, other disorders, congenital or acquired, involving CNS or PNS, could play a role in NB. In veterinary medicine, the information about the epidemiology, prevalence, etiopathogenesis, diagnosis and treatment of NB are scattered. The aim of this study is to provide an overview of the epidemiology, prevalence, clinical findings, diagnosis and prognosis for NB in dogs and cats compared with humans.

Expression profiles of long non-coding RNAs in neurogenic bladder of spinal cord injured rats: a transcriptomic analysis.

BackgroundGrowing evidence has indicated that long non-coding RNAs (lncRNAs) are important regulators of pathological and physiological processes through various mechanisms. However, the signature of lncRNA expression and the possible roles of lncRNAs in spinal cord injury (SCI) rat neurogenic bladder (NB) have not been comprehensively explored. In this study, the expression profiles of lncRNAs and mRNAs were explored in the bladder tissue of SCI rats using next-generation sequencing (NGS).MethodsTwenty female Wistar rats were randomly divided into SCI 1–3 and normal control (NC) groups. The spinal cord was completely transected at the T9–T10 level to establish the SCI model. Bladder tissues were collected on days 7, 14, and 28 after the operation. The expression profiles of lncRNAs were detected by NGS. Differentially expressed lncRNAs (DELs) were chosen for qRT-PCR verification to validate the RNA sequencing results. The functions of the predicted target genes were then evaluated using Gene Ontology (GO) enrichment and Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway analysis.ResultsCompared with the NC group, the SCI 1–3 groups had 468, 117, and 408 DELs [fold change (FC) >2], including 247, 38, and 201 up-regulated and 163, 79, and 207 down-regulated lncRNAs, respectively. Likewise, 6,654, 2,133, and 5,706 mRNAs (FC >2) were differentially expressed between SCI 1–3 and NC rats, of which 4,821, 1,195, and 3,695 were up-regulated, and 1,833, 938, and 2,011 were down-regulated, respectively. Specifically, Miat, Mir155hg, and H19 were significant DELs in all SCI groups. Moreover, GO revealed that the DELs were related to several terms, including immune response, and KEGG was mainly enriched in 10 pathways, such as the transforming growth factor β signaling pathway.ConclusionsThe results revealed the expression profiles and possible roles of lncRNAs in SCI rat NB. This study may help identify possible NB mechanisms following SCI from the perspective of lncRNAs and provides new potential lncRNAs for the early diagnosis and treatment of human NB in the future.

MP11-08 RESTRICTED ACCESS TO MIRABEGRON IN CHILDREN WITH NEUROGENIC BLADDER

You have accessJournal of UrologyCME1 May 2022MP11-08 RESTRICTED ACCESS TO MIRABEGRON IN CHILDREN WITH NEUROGENIC BLADDER Christopher Jaeger, Andrea Balthazar, Caleb Nelson, Tanya Logvinenko, and Hsin-Hsiao Scott Wang Christopher JaegerChristopher Jaeger More articles by this author , Andrea BalthazarAndrea Balthazar More articles by this author , Caleb NelsonCaleb Nelson More articles by this author , Tanya LogvinenkoTanya Logvinenko More articles by this author , and Hsin-Hsiao Scott WangHsin-Hsiao Scott Wang More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002533.08AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Mirabegron, a beta-3 agonist, is approved to treat neurogenic bladder (NB) in children ≥3 years in the United States. It is efficacious with a more favorable side effect profile than anticholinergics in children with NB. Yet, some patients with NB experience coverage denials or substantial delays in starting the medication that could have deleterious effects on urologic health. Our objective was to understand the factors associated with mirabegron access at our center. METHODS: Institutional data was queried identifying all pediatric patients who were prescribed mirabegron from 2012 through 2021. Covariates included patient demographics, neurologic diagnosis, number of anticholinergic medications, mirabegron prescription & start date, insurance, and insurance-related communications. A multivariate logistic regression model was fitted to investigate the impact of various factors on restricted access. Restricted access is defined as insurance denial or a delay in the mirabegron start date by ≥30 days from the initial prescription date. RESULTS: 114 pediatric patients with NB, 88/114 (77%) with a spina bifida diagnosis, were prescribed mirabegron after its release in 2012. The median age at first mirabegron prescription was 12 years (IQR 9-17). 41 patients (36%) experienced restricted access to mirabegron - 29 were denied and 12 were delayed. For those whose access was restricted, the median overall delay was 112 days (IQR: 48-376) following the initial prescription vs 0 days (IQR: 0-1) for those whose access was not restricted. After adjusting for age and number of trialed anticholinergics, undergoing a prior authorization (PA) with an insurance provider (OR=24.0 (95% CI 7.5-109.0), p<0.001) was the only predictor significantly associated with restricted mirabegron access. Being 13 years or older was marginally associated with restricted access (OR= 2.5 (95% CI: 1.0-7.0), p=0.06). CONCLUSIONS: Mirabegron is an effective medication now approved for the treatment of pediatric NB. Over one-third of our NB patients have experienced significant barriers to mirabegron access at our institution. The need for PA was identified as the most significant risk factor associated with restricted access. Payor-mandated restrictions on mirabegron require patients to fail inferior medications and ultimately risk inadequate treatment. Source of Funding: N/A © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e159 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Christopher Jaeger More articles by this author Andrea Balthazar More articles by this author Caleb Nelson More articles by this author Tanya Logvinenko More articles by this author Hsin-Hsiao Scott Wang More articles by this author Expand All Advertisement PDF DownloadLoading ...

Intravesical botulinum-A toxin in children with refractory non-neurogenic overactive bladder

Overactive bladder (OAB) with urinary incontinence poses a potentially significant impact on daily activities and quality of life. OAB can be unresponsive to specific urotherapy and antispasmodic medication. Due to its successful outcomes in the treatment of neurogenic bladder, intravesical botulinum-A toxin (BTX-A) became a possible solution for children refractory to treatment. To analyse the outcomes of intravesical BTX-A injections on bladder volume and incontinence in children with refractory OAB. The charts of children diagnosed with refractory non-neurogenic OAB who underwent BTX-A treatment in our centre since 2011 were retrospectively analysed. The functional bladder volume (FBV) is expressed as a percentage of the expected bladder capacity (EBC) for age. Dependent variables were compared using the Wilcoxon Signed Rank test. A multivariate logistic regression was used to identify predictors of the response on urinary incontinence. Fifty children (41 boys) with a median age of 9.9 years were included. In the short term, there was a significant increase in FBV after initial BTX-A treatment from a median of 52.9%-70% (p=0.000). In the short (<6 months) and long term (6-12 months) 72% and 46% showed improvement of continence, respectively. Male gender and small baseline FBV predict a positive outcome on continence in the long term. The most prevalent complications were urinary tract infections occurring in five cases (10%). Although BTX-A injections serve as an effective therapy to increase bladder volume in non-neurogenic OAB children, the outcomes on urinary incontinence are highly variable. This may be a consequence of the multifactorial aspects of this condition. BTX-A will enable children to inhibit their bladder urgency. The effectiveness of post-BTX-A urotherapy training will therefore most probably be higher. We believe that BTX-A injections should be reserved for children refractory to both specific urotherapy and medication. An appropriate population seems to be children with severe OAB symptoms, confirmed detrusor overactivity in urodynamic study and reduced bladder volume. In refractory OAB children, BTX-A injections are safe and effective in enlarging bladder volume and reducing OAB symptoms, particularly in the first six months after injection.

Effectiveness and safety of sacral neuromodulation on neurogenic bladder and bowel dysfunction in patients with spina bifida

To evaluate the effectiveness and safety of sacral neuromodulation (SNM) in the treatment of neurogenic bladder and bowel dysfunction in patients with spina bifida. The clinical data of 33 patients with neurogenic bladder and bowel dysfunction caused by spina bifida treated with SNM between July 2012 and May 2021 were retrospectively analyzed. There were 19 males and 14 females, with an average age of 26.0 years (range, 18.5-36.5 years). The disease duration ranged from 12 to 456 months, with an average of 195.8 months. The types of spina bifida included 8 cases of occult spina bifida and 25 cases of meningocele/myelomeningocele. Clinical symptoms included 19 cases of urgency-frequent urination, 18 cases of urinary incontinence, 27 cases of chronic urinary retention, and 29 cases of bowel dysfunction. Image urodynamics showed that 4 patients had detrusor overactivity (DO) and 29 patients had detrusor underactivity (DU). Vesicoureteral reflux (VUR) was found in 5 ureters (4 patients). SNM procedure was divided into experiential treatment and permanent implantation. Patients who were evaluated as successful or willing to be permanently implanted after experiential treatment would implant the permanent pulse generator. The duration of experiential treatment was 14-28 days, with an average of 19.2 days; there was no complication during this period, and the overall success rate was 69.69% (23/33). At the end of experiential treatment, the urination frequency in 24 hours, urine volume per time, urinary urgency score, and urine leakage of patients were significantly improved when compared with those before experiential treatment ( P<0.05); there was no significant difference in postvoid residual volume between before and after experiential treatment ( t=1.383, P=0.179). The success rate of patients with chronic urinary retention after experiential treatment (25.93%) was significantly lower than that of urgency-frequent urination (63.16%) and urinary incontinence (61.11%) ( χ 2=7.260, P=0.064). Compared with those before experiential treatment, the maximum cystometric capacity and compliance increased and the maximum detrusor pressure during filling decreased significantly ( P<0.05). Among the 4 patients with DO before experiential treatment, DO disappeared in 2 cases; 27 patients with DU before experiential treatment did not recover the normal contraction of detrusor during micturition. Among the 5 ureters with VUR before experiential treatment, 2 VUR disappeared at the end of experiential treatment, and the VUR grade or the bladder volume before VUR of the other 3 ureters were improved. At the end of experiential treatment, the neurogenic bowel dysfunction (NBD) score and the grade of bowel dysfunction significantly improved ( P<0.05). A total of 19 patients received permanent implantation, of which 11 patients needed to empty the bladder in combination with intermittent catheterization. SNM is effective for neurogenic bladder and bowel dysfunction in patients with spina bifida. At the same time, it can significantly improve the urodynamic parameters during urine storage and avoid upper urinary tract damage.

Chinese medicine therapies for neurogenic bladder after spinal cord injury: A protocol for systematic review and network meta-analysis.

Background:Neurogenic bladder (NB), a refractory disease, is characterized by voiding dysfunction of bladder and/or urethra, and spinal cord injury (SCI) is a common cause. Chinese medicine therapies have been applied extensively in the treatment of NB, especially in China, and the results are promising but varying. Thus, the aim of this work is to assess the efficacy and safety of various Chinese medicine therapies for NB after SCI.Methods:A retrieval will be performed in 8 online databases (the Cochrane Library, Web of Science, PubMed, EMBASE Database, China Biological Medicine Database, Chinese Scientific Journals Database, Wan Fang databases, and China National Knowledge Infrastructure) from their inception throughout June 2021. Only randomized controlled trials of testing Chinese medicine therapies for NB after SCI will be enrolled. The outcome indicators measured will be overall response rate, urodynamic tests, clinical assessment, and safety assessments. The methodological quality of this Bayesian-based network meta-analysis will be conducted with the “Risk of Bias” tool. Stata14.0 and WinBUGS 1.4.3 will be used to analyze the data. Furthermore, the assessment of heterogeneity, inconsistency, subgroup, sensitivity, and publication bias will also be taken into consideration with the help of Cochrane Collaboration's tool.Results:The findings of this study will be submitted to a peer-reviewed journal for publication.Conclusion:This work will furnish evidence-based recommendations to figure out the optimal Chinese medicine therapy or their combinations for NB induced by SCI, and in turn contribute to further research and public health.

Efficacy and safety of heat-sensitive moxibustion in the treatment of neurogenic bladder after spinal cord injury: A protocol for systematic review and meta-analysis.

Background:Spinal cord injury (SCI) is one of the most disabling and destructive neurological diseases. Neurogenic bladder dysfunction (NBD) is one of the serious complications after SCI, 80% of patients after SCI will have neurogenic bladder symptoms. NBD after SCI may lead to urinary retention, urinary incontinence, and urinary tract infection. In severe cases, it can lead to renal failure or even death. NBD after SCI not only seriously affects the patient's quality of life but also physical and mental health. NBD after SCI is a social and medical problem. In recent years, more and more clinical studies prove that heat-sensitive can improve the clinical symptoms of NBD after SCI. Therefore, this article conducts a systematic evaluation and meta-analysis on the efficacy and safety of heat-sensitive moxibustion in treating NBD after SCI.Methods:Search 8 electronic databases including PubMed, Embase, Web of Science, The Cochrane Library, Clinical Trials, China National Knowledge Infrastructure, China Science and Technology Journal Database, Wanfang Database, and China Biomedical Literature Database. We will search above electronic databases from the inception to May 2021, without any language restriction. Clinical randomized controlled trials containing heat-sensitive moxibustion for NBD after SCI and eligible interventions(s) and outcome(s) were included, with no limitation of language and publication status. Two researchers will independently conduct literature search, screening, information extraction, quality assessment, and data analysis. Review Manager 5.3 software will be used for statistical analysis.Results:The findings will be submitted to a peer-reviewed publication.Conclusion:This systematic review and meta-analysis will provide a standard clinical decision-making guideline for heat-sensitive moxibustion treatment of NBD after SCI.INPLASY registration number:INPLASY202150071.

Risk Factors for Renal Function Impairment in Childen with Meningomyelocele; a Single Center Study

Introduction: Chronic kidney disease and its complications are among the most frequent cause of morbidity and mortality in patients with meningomyelocele. Objective: In this study, we aimed to determine the risk factors leading to chronic kidney disease progression in these patients. Material and Method: Fifty patients with meningomyelocele were analyzed retrospectively. Age, gender, followup period, serum creatinine, glomerular filtration rate, vesicoureteral reflux (VUR), initial urodynamic findings and initiation time of clean intermittent catheterization (CIC) were noted. The progression of Chronic kidney disease (CKD) was evaluated by DMSA renal scintigraphy, changes in serum creatinine (Screa), and glomerular filtration rate (GFR). Results: 30 of the 50 patients were included in the study. VUR was detected in 63% of the patients, and scar was detected in 83% by renal scintigraphy. The median value of Screa was 0.5 mg/dl in admission, while the median Screa was 1.02 mg/dl (min-max: 0.27-5) at the last visit and the difference was statistically significant (p=0.001). A statistically significant was found between CKD progression and GFR in admission (p=0.001), CIC onset age (p=0.03), degree of VUR (p=0.046), presence of renal scar (p=0.002). It was shown that delay in admission (p=0.011; OR 1.36; CI 1.07-1.73) and low GFR in admission (p=0.036 OR 0.915 CI 0.842-0.994) were the most important risk factors. Conclusion: In our study, it was shown that delay in neurogenic bladder treatment, delay in the initiation of CIC, and low GFR at admission were important risk factors for the progression of CKD in children with meningomyelocele. Therefore, we aimed to emphasize the importance of regular follow-up of these children in Pediatric Nephrology Clinics from the neonatal period.

Management of urinary and bowel dysfunction in rabbit model of spinal cord injury using Schwann cells and muscle progenitors: functional study and evidence for novel mechanism of action.

We tried to investigate the role of Schwann and satellite cells in the treatment of neurogenic bladder and bowel dysfunction; following spinal cord injury in the rabbit model. Twelve male New Zealand rabbits underwent induction of neurogenic bladder by spinal cord injury. Rabbits underwent the fibertractography analysis to confirm the induction of spinal cord injury. Then, animals were randomly divided into two groups. In group I (n = 4), Schwann cells were obtained from autologous peroneal nerve. In group II (n = 4), the co-culture of nerve-muscle cells was obtained from autologous peroneal nerve and quadriceps muscle. Animals in the control group (n = 4) did not undergo any rehabilitation therapy. One and 4months after injection of cells into the external anal sphincter, electromyography, urethral pressure profiles, urodynamic studies, voiding cystourethrogram, and manometry was performed to confirm the efficacy of treatment in short- (1month) and long-term (4months) follow-ups. The investigations validated that no statistically significant difference was detected between the two experimental groups in a short-term follow-up (p-value > 0.05). However, the functional features were improved in group II in long-term follow-up. In both groups, the external anal sphincter contracted in response to electrical signals delivered to the muscle. However, more signals were detected in group II in electromyography evaluation. The immunohistochemical staining demonstrated that the histological features of the bladder and spinal cord were more satisfactory in group II in all follow-ups compared to group I, in terms of less edema, inflammation, presence of progenitor cells, and expression of muscle and nerve markes. Our results suggested that the injection of nerve-muscle co-culture cells into the external anal sphincter may be a helpful tactic for ameliorating the urological complications; following spinal cord injury induction in the rabbit model.

The Current Positioning of Augmentation Enterocystoplasty in the Treatment for Neurogenic Bladder.

Augmentation enterocystoplasty (AEC) is a surgical procedure in which the bladder is enlarged using an intestinal segment in patients with lower urinary tract dysfunction who fail to achieve satisfactory results with all conservative treatments. Currently, surgical materials and procedures, concomitant correction of upper urinary tract abnormalities, or bladder neck reconstruction may vary depending on the experience and preferences of the surgeons. AEC has been proven to be successful with respect to surgical goals, such as achieving urinary continence, improving quality of life, and preserving the upper urinary tract over the long term. The advantage of AEC over intravesical injection of botulinum toxin—a more recent and less invasive procedure—is that the prevention of upper urinary tract damage and the improvement of urinary incontinence are more reliably guaranteed, especially considering that these surgical effects are permanent. Compared to less invasive treatments, the quality of life of patients after surgery is also much higher, and AEC may be more cost-effective in the long run. Thus, in patients with neurogenic bladder, AEC is still the gold standard surgical procedure with strong evidence in support of its efficacy. In this article, the indications, surgical methods, possible complications, long-term follow-up, and current positioning of AEC in lower urinary tract dysfunction is discussed.

Effect of sacral neuromodulation on bowel dysfunction in patients with neurogenic bladder.

The aim of this retrospective study was to evaluate the clinical effect of sacral neuromodulation (SNM) on bowel dysfunction in patients with neurogenic bladder using the neurogenic bowel dysfunction (NBD) score. Between July 2012 and July 2019, 41 patients with both neurogenic bladder and bowel dysfunction underwent permanent SNM implantation. The NBD score was used to evaluate the bowel symptoms before the testing phase and at follow-up. The first follow-up was at the time of discharge after permanent implantation. The second follow-up was conducted by telephone after discharge. The mean NBD score before the testing phase was 11.0±5.83, whilst it significantly decreased to 5.2±5.32 (n=41, P<0.05) at the first follow-up (32±3.9days). Before the testing phase, there were 9 patients with very minor NBD, 10 with minor NBD, 13 with moderate NBD and 9 with severe NBD. At the first follow-up, there were 26 patients with very minor NBD, 7 with minor NBD, 4 with moderate NBD and 4 with severe NBD (P<0.05). Twenty-six patients were interviewed in the long-term follow-up (34±30.9months). The NBD score in these 26 patients was 5.6±5.18, which was not significantly different from the NBD score (5.5±5.33) at the first follow-up (n=26, P>0.05). SNM facilitates a significant reduction in NBD score in patients with neurogenic bladder and bowel dysfunction. The improvement in NBD symptoms can also be used as a future indicator to determine the clinical efficacy of permanent SNM implantation in the treatment of neurogenic bladder.

Spontaneous vesicorectal fistula: a rare complication of neurogenic bladder

BackgroundWe report a rare case of spontaneous vesicorectal fistula.Case presentationA 13-year-old female spina bifida patient who complained of fecal and urinary incontinence was eventually diagnosed with a spontaneous vesicorectal fistula. We hypothesized that infection, neurogenic bowel and neurogenic bladder caused her vesicorectal fistula. The patient refused the operation, and she is currently in a delicate balance.ConclusionsEarly repair of the fistula is necessary. The treatment of neurogenic bladder after fistula repair is difficult and deserves further observation and follow-up.

Neuromodulação não invasiva em crianças com Bexiga Neurogênica: uma revisão integrativa

INTRODUÇÃO: O tratamento da Bexiga Neurogênica (BN) pode ser feito através do manejo farmacológico e/ou não farmacológico. Dentro do tratamento não farmacológico temos a neuromodulação não invasiva (NMNI) realizada com aplicação de eletrodos transcutâneos que sugere uma modulação nos componentes excitatórios e inibitórios do controle da bexiga. OBJETIVO: Reunir evidencias que avaliem o efeito da NMNI na BN de crianças com disfunções neurológicas. MÉTODOS: Trata-se de um artigo de revisão integrativa que foi elaborada seguindo sete etapas. A busca foi feita nas bases de dados PubMed, Biblioteca Virtual de Saúde (BVS) e ScienceDirect. A escolha dos artigos foi realizada inicialmente por dois avaliadores independentes, obedecendo os critérios de elegibilidade: realizar tratamento para BN utilizando estimulação elétrica não invasiva com objetivo de neuromodulação da via urinária; população amostral composta por crianças com alteração miccional em decorrência de alguma disfunção neurológica e possuir os textos disponíveis na íntegra nas plataformas online de busca, no período de Agosto a Novembro de 2018. Foram incluídos artigos que utilizaram NMNI como tratamento da BN em crianças. RESULTADOS: Foram encontrados 440 artigos e apenas 5 atenderam aos critérios de inclusão. Ao todo, participaram dos estudos 141 crianças com acometimentos neurológicos. Os principais elementos utilizados nas avaliações foram diário miccional, o estudo urodinâmico, a coleta da história clínica e o exame físico. Os parâmetros de estimulação e posicionamento de eletrodos foram variados. CONCLUSÃO: A NMNI apresentou bons resultados no tratamento de crianças com BN e, foi observado também, efeitos positivos no intestino neurogênico, porém, são necessários mais estudos que sugiram protocolos bem delineados para a reprodução na prática clínica.

Neurogenic bladder in the settings of congenital Zika syndrome: a confirmed and unknown condition for urologists

Congenital Zika syndrome (CZS) is a recently discovered condition that affects central nervous system structures that control the lower urinary tract. The first cases of neurogenic bladder (NB) were recently reported as a sequalae of CZS in neurologically impaired children. Our goal is to further evaluate NB in the setting of CZS, identifying urological risk indicators in hopes that early diagnosis will mitigate the impact of the disease. Urological assessment was performed in all patients with CZS and neurological impairment who were referred to our urodynamic clinic between June 2016 and May 2018. Neurogenic bladder was confirmed by urodynamic evaluation, and urological risk was based on urodynamic results. Sixty-nine patients with CZS were tested. The majority (63 patients, 91.3%) presented with overactive bladder with increased pressures and reduced capacity for age (table 1). Different urodynamic patterns were observed, and the association of reduced bladder capacity for age, high bladder-filling pressure, and increased postvoid residual were frequently observed. NB continues to be consistently diagnosed in our cohort of CZS, mostly with high-risk indicators for renal impairment. When not intervened upon in a timely manner, NB can cause progressive damage to the urinary tract, but the lack of knowledge that CZS causes NB delays investigation and treatment. Parents and health professionals will need to be sensitized to the risks that ZIKV can pose to the urinary tract so that appropriate therapies are initiated to prevent irreversible renal damage. NB is a common condition among our patients with CZS and microcephaly. This is a new cause of NB, unknown to urologists. While further investigation is necessary to understand long-term disease behavior and therapeutic response, increased knowledge among urologists may help to reduce morbidity related to untreated NB and to mitigate the disease burden for patients and families.

The treatment of urinary retention of neurogenic bladder of one patient with diabetes from the perspective of governor vessel: A case report (从督脉论治神经原性膀胱尿储留验案一例)

ObjectiveTo report the clinical effect of traditional acupuncture and moxibustion in the treatment of neurogenic bladder. MethodsA single case of a 57-year-old female with neurogenic bladder retention of urine considering governor vessel in the use of acupuncture and moxibustion. Acupoints selected: Shènshū (肾俞BL 23), Pángguāngshū(膀胱俞BL 28), Yāoyángguān (腰阳关GV 3), Mìngmén(命门 GV 4) . Moxibustion was applied on Guānyuán (关元 CV4) at the same time. ResultsAfter 6 times of treatment, the patient's urination function return to normal, avoid the adverse effect of retention catheterization. ConclusionIt is suggested that the combination of acupuncture and moxibustion, and the integration of syndrome differentiation and disease differentiation can effectively treat retention of urine due to neurogenic bladder of patient with diabetes.

Intravesical Botulinum Toxin for Neurogenic Bladder—Can We Just Irrigate the Bladder with Botulinumtoxin?

Historically, patients failing treatment with anti-muscarinic medications were subjected to bladder augmentation or urinary diversion, invasive procedures with significant complications. The approval of botulinum toxin A (BTX-A) intravesical injections revolutionized the treatment of neurogenic bladder (NGB). Ongoing research efforts to find even less invasive methods of treatments are exploring the possibility of intravesical botulinum toxin instillations for the treatment of neurogenic bladder. This paper reviews BTX-A in the treatment of neurogenic bladder, intravesical instillation of other medications in the treatment of this disease, available research on intravesical instillation of BTX-A for neurogenic bladder, and other forms of voiding dysfunction. Initial research has been done on rodents and human subjects. Some studies on BTX-A intravesical instillations have shown preliminary success and others have shown no improvement compared to placebo. Research groups have used a variety of mechanisms to overcome the low permeability of the bladder wall, including protamine sulfate, DMSO, and liposomes. While studies have shown improvements in markers of bladder pain response, a variety of urodynamic study (UDS) parameters, and patient satisfaction scores, none have shown a decrease in contraction amplitude. The most recent development is the use of liposomes as a delivery system for intravesical instillation of BTX. They have seen some preliminary success as some endpoints were met, others not. There is limited research on intravesical instillation of BTX-A for neurogenic detrusor overactivity. While available data suggests some degree of success in modulating symptoms, the data does not show an increase in bladder capacity or decreased voiding pressure. Further research is needed on the impact of BTX-A intravesical instillations in the NGB patient population.