Urodynamic Improvement Research Articles

Urodynamic and Frequency-Volume Chart Parameters Influencing Anticholinergic Resistance in Patients With Neurogenic Detrusor Overactivity.

Neurogenic detrusor overactivity (NDOA) is characterized by involuntary detrusor muscle contractions during bladder filling in patients with neurological disorders. Anticholinergic therapy is the primary treatment; however, the reasons for treatment resistance in NDOA are not well understood. This study aimed to identify predictors of treatment failure by comparing urodynamic and frequency-volume chart data between patients with NDOA who respond and patients who do not respond to anticholinergic therapy. We reviewed the records of 362 patients presenting with lower urinary tract symptoms and selected 85 who had NDOA and were on anticholinergic therapy. Ultimately, 67 patients were analyzed. We categorized these individuals into responders (group R) and nonresponders (group NR) based on clinical and urodynamic improvements. Three-day frequencyvolume charts and urodynamic study results were retrospectively reviewed. Of the 85 initial patients, 12 refused medication, and 6 were lost to follow-up. Pre- to posttreatment changes differed significantly between groups in the number of urgency urinary incontinence (UUI) episodes per 24 hours (P=0.001), maximum cystometric capacity (mL, P=0.003), NDOA frequency (P=0.004), and bladder compliance (mL/cm H2O, P=0.003). Multivariate analysis revealed that NDOA frequency (P=0.014) and UUI episodes per 24 hours (P=0.002) were significant factors associated with treatment failure. NDOA varies according to underlying neurological conditions. The frequencies of UUI episodes and NDOA in urodynamic studies can predict resistance to initial anticholinergic treatment.

The impact of antegrade continence enemas on bladder function in patients with neurogenic bladder and bowel

In neurologically intact children with constipation and lower urinary tract symptoms, treatment of constipation frequently results in improved or resolved lower urinary tract symptoms. The impact of treatment of constipation on bladder function in children with a neurogenic bowel and bladder is not well studied. The objective of this study was to evaluate the impact of antegrade continence enemas (ACE) via Chait tube on urodynamic study (UDS) parameters and urinary continence in patients with neurogenic bowel and bladder (NGB). We hypothesized that following ACE some patients would demonstrate improved UDS parameters and improved urinary continence. A review of patients with NGB who underwent a cecostomy was performed. Inclusion criteria required UDS within 12 months before and after Chait tube placement and no change in clean intermittent catheterization or anticholinergic medications. UDS parameters assessed included bladder capacity, bladder compliance, and bladder stability. In addition, the frequency of antegrade continence enemas and encopresis were reviewed as was the frequency of UTIs before and after the surgery. 8 children met inclusion criteria, including 5 girls and 3 boys, with a mean (range) age of 8.5 years (5-13). All children were on clean intermittent catheterization and 7 were on anticholinergic medications. The patients demonstrated a significant improvement in constipation and encopresis (p<0.05). All but 1 patient had resolution of encopresis, and 6 of 7 patients who had constipation before ACE management had a resolution of constipation. 2 patients (25%) developed urinary continence (i.e., dry between CIC), and 2 others had improvement in continence. 3, 2, and 2 patients had urodynamic improvement in bladder capacity, compliance, or stability, respectively. However, no significant improvement in urinary incontinence or UDS parameters was demonstrated for the group overall. Our data demonstrate that some children with neurogenic bowel and bladder will have improvement in continence and UDS parameters following the initiation of ACE. Despite significant improvement in constipation and encopresis, the frequency of bladder improvement in this population appears less than that reported in neurologically intact children following treatment of constipation. Confirmatory studies with a larger number of children are needed. However, since constipation appears to negatively impact bladder function in some children with neurogenic bowel and bladder, it is reasonable to try to eliminate significant constipation in these patients before increasing pharmaceutical management of their neurogenic bladder.

Clinical and urodynamic features of secondary tethered cord syndrome: How can they be found longitudinally?

Secondary tethered cord syndrome (TCS) can be diagnosed with signs of progressive deterioration in urological or neuro-orthopedic systems following primary untethering surgery. Though urological deterioration is a common secondary TCS manifestation, a paucity of diagnostic criteria makes diagnoses challenging. A detailed description of urological deterioration may help diagnose secondary TCS. Thus, the clinical and urodynamic features of the current secondary TCS cases were described. Fifty-one patients who had undergone reuntethering for secondary TCS experienced improvement or stabilization of progressive problems. Moreover, their clinical and videourodynamic changes were longitudinally described. Loss of postoperative spontaneous voiding was the first urological secondary TCS sign for those who could void spontaneously. Urological problems mostly occurred during elementary school (6-12 years). Major urological presentations were recalcitrant urinary tract infection or urinary incontinence. Follow-up videourodynamic studies revealed typical changes, from acontractile bladder to overactive and low-complaint bladders. While detrusor overactivity did not always occur during the progression, detrusor sphincter dyssynergia was always present in all patients with urological deterioration. All patients postoperatively showed significant urodynamic improvement regardless of preoperative bladder dysfunction. This included four cases of restoring spontaneous voiding. Nine patients experienced newly appearingnonprogressive neuro-orthopedic complications despite their urological improvement. Urological deterioration should prompt secondary TCS suspicion, and changes in clinical patterns and videourodynamic studies helped diagnose it. However, reuntethering can effectively address urological problems at the cost of some neuro-orthopedic functions in some patients.

3-T MRI and clinical validation of ultrasound-guided transperineal laser ablation of benign prostatic hyperplasia

BackgroundTransperineal laser ablation (TPLA) of the prostate is a novel, mini-invasive option for men with lower urinary tract symptoms (LUTS) due to benign prostate hyperplasia (BPH). Our aim was to assess the impact of ultrasound-guided TPLA regarding urodynamic improvement and sexual function, monitoring clinical data, postprocedural complications and imaging findings at 3-T multiparametric magnetic resonance imaging.MethodsForty-four patients aged ≥ 50 affected with moderate to severe LUTS (International Prostate Symptoms score ≥ 12) due to benign prostatic obstruction and refractoriness, intolerance or poor compliance to medical therapies underwent US-guided TPLA between May 2018 and February 2020. Clinical measurements included PSA, uroflowmetry, sexual function assessment (using the International Index of Erectile Function and Male Sexual Health Questionnaire-Ejaculatory Dysfunction short form) and quality of life questionnaire. Adverse events were evaluated using the Clavien-Dindo scale. Volume changes were measured by MRI and automatic segmentation software during 1-year follow-up. Registration: NCT04044573 – May 5th, 2018, https://www.clinicaltrials.govResultsMRI assessed the changes over time with a 53% mean reduction of adenoma volume and 71% of the ablated area, associated with clinical and functional improvement and resolution of LUTS in all cases. Five of 44 patients (11.3%) had urinary blockage due to clots and required re-catheterisation for 2 weeks. The overall adverse event rate was 7%.ConclusionUS-guided TPLA performed as a safe, manageable and effective treatment for LUTS. It could be considered an alternative effective mini-invasive procedure to standard treatments for BPH in the outpatient setting.

Virus-related neurological lower urinary tract dysfunction: Lessons learned during 4-year follow-up of patients with Congenital Zika Syndrome

We have previously reported on neurogenic bladder dysfunction among Congenital Zika Vírus Syndrome (CZS) patients, but it is unknown how they will respond to treatment. To assess whether children with neurological lower urinary tract dysfunction and CZS will respond to Standard therapies. A prospective observational cohort study of children with CZS referred for urological assessment between 2016 and 2020 to our quaternary center in Brazil. Urological protocol included clinical history, urinalysis and culture, renal and bladder ultrasonography and urodynamic study. Patients were treated based on findings from the first evaluation, with oxybutynin chloride for overactive bladder and low bladder compliance, clean intermittent catheterization for ineffective bladder emptying, or dual therapy when both were observed. Urological outcomes were evaluated between the first and second visits considering patient's adherence. Outcomes measured included clinical, imaging, and urodynamic variables. Data was analyzed using the IBM SPSS 22 software. From the cohort of 90 patients, 56 completed the second urodynamic assessment and were included. One presented underactive bladder and 55 overactive bladder. Among these 55, 39 were adherent and 16 non-adherents to the prescribed treatment. Among the 39 adherents, 8 adhered regularly to oxybutynin and clean intermittent catheterization (CIC), 29 to oxybutynin alone, and two to catheterization alone. During follow-up, the number of patients with urinary tract infection and postvoid residual increased, but all other parameters had improved. Renal and bladder ultrasonography improved in 10, maximum bladder pressure decreased in 22 and maximum cystometric capacity and compliance increased in 14 patients. Sixteen patients did not adhere regularly to the prescribed treatment and although the number of patients with urinary tract infection reduced with antibiotic therapy, their bladder capacity and compliance did not improve during follow-up. Ultrasonographic and urodynamic improvements were observed after 10.8±7.5 months of treatment, including one patient with ureterohydronephrosis that resolved. Adherence to CIC remains a challenge and reflected in the number of patients presenting urinary tract infection and postvoid residual. The immediate clinical relevance is the major study strength, given the previously uncharacterized therapy options for this patient population. The number of patients remains one of the study limitations, reducing our ability to perform more advanced statistical analyses. Patients with Zika-related neurological lower urinary tract dysfunction may benefit from conventional therapies. Results confirmed ultrasonographic and urodynamic improvements after treatment, although not statically significant. Adherence to treatment, specifically to CIC, remains a challenge.

Does botulinum therapy affect the urine microbiome of patients with neurogenic bladder? Metagenomic sequencing results

Introduction. Reorganization of the urinary microbiome in patients with neurogenic low urinary tract dysfunction (NLUTD) plays an important role in the pathogenesis of urinary tract infections (UTIs). However, we still do not know how the different types of NULTD therapy affect the microbiome. Purpose of the study. Was to assess the influence of botulinum toxin (BoNT) injections on the urinary microbiome. Materials and methods. Urine samples were obtained from 6 persons (4 females and 2 males) with NLUTD before BoNT therapy (200 UI) and 6 weeks after. Standard urine analysis, urine culture and 16S rRNA gene sequencing were performed. a total of 144,562 quality-filtered 16S rDNA sequence reads were processed through an Illumina MiSeq platform. Results. The results of the urine culture correlated with 16S rRNA sequencing results, but the greater number of bacterial taxa were detected. Analysis of the bacterial community in urine samples revealed between 2 and 21 species-level reads per individual. All patients before BoNT demonstrated abnormal urinary microbiome with a predominance of Enterobacteriales. In three cases in females, clinical and urodynamic improvement after botulinum therapy was associated with changing of the microbiome from Enterobacteriaceae to Lactobacillales. In one female and two males, no principal changes had happened. Conclusions. This is the first report comparing in pilot study the urinary microbiome before and after BoNT injections into the bladder wall. The results are restricted by the small number of participants. However, the promising observation about the influence of botulinum toxin therapy on urinary microbiome was obtained.

Place des alphabloquants chez la femme : revue de la littérature

Marketing authorization of alphablockers is limited principally to men with benign hypertrophy of prostate. The objective of this review is to evaluate clinical and urodynamic improvement of alphablockers in women. A review of the literature was carried out on all prospective studies about the use of alphablockers in women with urination disorders. Seventeen articles have been included. The selected articles were classified according to the studied population: lower urinary tract disorders, bladder emptying disorders without details on mechanism, bladder outlet obstruction, detrusor hypoactivity overactive bladder. Four studies were randomized against placebo. There was an improvement in the IPSS in 8 studies going as far as a decrease of 11,7 points (4.6 vs. 16.3 P<0.05). The voiding IPSS subscore was improved overall in 8 studies with a decrease of up to 6,2 points (9.6±5.5 vs. 14.8±4 P<0.01). Two trials showed an improvement of clinical scores versus placebo with an improvement of IPSS from -11.7 vs -9.5 (P<0.05) and -5.6 vs -2.6 (P<0.05). Urodynamic parameters were also often improved with a decrase of Qmax going to+5.8mL/s (P<0.05). Alphablocker also appear to improve non obstructive voiding disorders. The benefit in overactive bladder seems limited. Alphablockers may be indicated in voiding disorders of women. Their exact role must be established.

EVALUATION OF URETEROCYSTOPLASTY AS AN ALTERNATIVE FOR AUGMENTATION ILIOCYSTOPLASTY IN THE PRESENCE OF DILATED URETERS

Background: Ureterocystoplasty has been considered as an alternative for iliocystoplasty when there is dilated ureters inassociation with renal impairment/extensive ileal resection, several studies reported variable results after ureterocystoplasty Aim of the work: To compare the outcomes of augmentation ureterocystoplasty in patients with dilated ureters to conventional augmentation iliocystoplasty in patients who can undergo both procedures. Patients and Methods: In a prospective randomized clinical study, 10 patients will undergo ureterocystoplasty; another 10 patients will undergo iliocystoplasty. The inclusion criteria include patients with unilateral or bilateral ureteric dilatation after failure of conservative measures. The Exclusion criteria were insufficient ureteric dilatation, elevated S.creat. or previous extensive ileal resection Results: Our results showed significant improvement in capacity and compliance in all groups, the degree of urodynamic improvement was however inferior when the distal segment of 2 ureters were used for augmentation versus the use of ileum or an entire ureter of a nonfunctioning kidney, the degree of hydronephrosis improved or resolved in all patients, continence improved in all patients despite the requirement for CIC in most patients, the frequency of urinary tract infections was similar in both groups. Conclusions: Our study concludes that augmentation with sufficient amount of ureteric tissue provides adequate augmentation with similar urodynamic outcome to augmentation with the use ofileum, however if the ureteric tissue used was insufficient such as when using the distal segment of 1 or 2 ureters especially when the ureters are not sufficiently dilated the improvement in urodynamic outcome was inferior to the use of ileum.

Correlation between Clinical and Urodynamic Improvement in Patients with Overactive Bladder Syndrome on Anticholinergic Drugs

Correlation between Clinical and Urodynamic Improvement in Patients with Overactive Bladder Syndrome on Anticholinergic Drugs

Intra-detrusor injections of botulinum toxin type a in children with spina bifida: A multicenter study

Intradetrusor injections of botulinum toxin type A (IDBTX-A) have become the gold standard in adults for treatment of neurogenic detrusor overactivity refractory to anticholinergics. Data regarding IDBTX-A in pediatric patients with spinal dysraphism are scarce. The purpose of this study was to assess the effectiveness of IDBTX-A in children with spina bifida. All patients aged under 16 years old who underwent IDBTX-A between 2002 and 2016 at six institutions were included in a retrospective study. Our primary endpoint was the injection's success defined subjectively as both clinical improvement (no incontinence episodes between clean intermittent catheterization (CIC), absence of urgency, less than 8 CIC per day) and urodynamic improvement (resolution of detrusor overactivity, normal bladder compliance for age), lasting ≥ 12 weeks. Predictive factors of success were assessed through univariate analysis. Fifty-three patients with a mean age of 8.5 years were included. Thirty-three (62.3%) had repeated injections (from 2 to 8 injections) resulting in a total number of 141 IBTX-A performed. The global success rate of the first injection (clinical and urodynamic) was 30%. Patients with closed spinal dysraphism had a significantly better success rate than patients with myelomeningocele ( P = 0.002). The clinical success rate was 66% and was significantly associated with maximum urethral closure pressure (34 cm vs. 54.4 cm H 2 O; P = 0.02). The urodynamic success rate was 34%. Patients with closed spinal dysraphism had higher success rate vs. patients with myelomeningocele (48.2% vs. 17.4%; P = 0.02). Patients in whom the first IDBTX-A succeeded urodynamically had higher baseline bladder compliance (15.5 ml/cm H 2 O vs. 7 ml/cm H 2 O; P = 0.02). Maximum cystometric capacity ( P < 0.0001) and compliance ( P = 0.01) significantly improved after the first IDBTX-A. After a mean follow up of 3.7 years, 23 patients (43.4%) required augmentation cystoplasty. Despite IBTX-A enabled clinical improvement in most patients (66%), urodynamic outcomes were poor, resulting in a low global success rate (30%).

Correlation between Clinical and Urodynamic Improvement in Patients with Overactive Bladder Syndrome on Anticholinergic Drugs

Background: The International Continence Society (ICS) defined overactive bladder syndrome (OAB) as urinary urgency with or without urge incontinence, often accompanied by frequency and nocturia in absence of infection. Urinary urgency is the complaint of a sudden compelling desire to void which is difficult to defer with patients often suffering from anxiety due to fear of leakage. Urge urinary incontinence is defined as involuntary leakage of urine, accompanied or immediately preceded by urgency. Overactive bladder syndrome is a symptomatic diagnosis. On the other hand, detrusor overactivity (DO) is a urodynamic finding, characterized by involuntary detrusor contractions during the filling phase, which may be spontaneous or provoked. These terms aren't interchangeable, as overactive bladder syndrome patients may not have detrusor activity on urodynamic testing. Aim of the Work: to determine the relation between clinical improvement and urodynamic based improvement in patients with overactive bladder syndrome receiving anticholinergic drugs. Patients and Methods: this study included thirty-eight patients, who presented to the Outpatient Urology Clinic at Ahmed Maher Teaching Hospital with symptoms of OAB syndrome. This study design was prospective. Patients clinical histories were taken, they were examined thoroughly, and completed an IPSS questionnaire. This was followed by a urinalysis, free uroflowmetry and a pelvi-abdominal ultrasound. Results: this study included thirty-eight patients who were divided into two groups. Group A included twenty-one patients, fifteen females and six males with mean age of 48.2 years old (21-60), who did not have detrusor overactivity in the first urodynamic study. On the other hand, group B included seventeen patients, ten females and seven males with mean age of 43.7 years old (18-58), who had detrusor overactivity in the initial urodynamic study. Patients in both groups received Solifenacin 10 mg once daily for twelve weeks before completing another IPSS questionnaire and undergoing a follow up urodynamic study. Conclusion: in this study, we concluded that there was strong correlation between urodynamic and clinical improvement in OAB patients after Solifenacin treatment as patients who were improved urodynamicaly reported improvement of their symptoms while those with poor urodynamic response reported that their symptoms were either the same as before treatment or worse. We also concluded that Solifenacin 10 mg once daily led to significant improvement in IPSS results of OAB patients with significant increase in volume to first desire and maximum cystometric capacity.

Intradetrusor Injections of Botulinum Toxin Type A in Children With Spina Bifida: A Multicenter Study

To assess the effectiveness of intradetrusor injections of botulinum toxin type A (IDBTX-A) in children with spina bifida. All patients aged less than 16 years old who underwent IDBTX-A between 2002 and 2016 at 6 institutions were included in a retrospective study. Our primary endpoint was the success rate of IDBTX-A defined as both clinical improvement (no incontinence episodes between clean intermittent catheterizations [CICs], absence of urgency, and less than 8 CICs per day) and urodynamic improvement (resolution of detrusor overactivity and normal bladder compliance for age) lasting ≥12 weeks. Predictive factors of success were assessed through univariate analysis. Fifty-three patients with a mean age of 8.5 years were included. All patients were under CIC and 88.7% had received anticholinergics with either poor efficacy or bothersome adverse events. The global success rate of the first injection (clinical and urodynamic) was 30%. Patients with closed spinal dysraphism had a significantly better success rate than patients with myelomeningocele (P = .002). The clinical success rate was 66% and was significantly associated with maximum urethral closure pressure (34 cm H2O vs 54.4 cm H2O, P = .02). The urodynamic success rate was 34%. Maximum cystometric capacity (P <.0001) and compliance (P = .01) significantly improved after the first IDBTX-A and maximum detrusor pressure tended to decrease (P = .09) except in the subgroup of patients with poor compliance. After a mean follow-up of 3.7 years, 23 patients (43.4%) required augmentation cystoplasty. Excluding 6 patients who were lost to follow-up, 38.3% of patients were still undergoing botulinum toxin injections at last follow-up. In this series, despite the fact that IDBTX-A enabled clinical improvement in 66% patients, urodynamic outcomes were poor resulting in a low global success rate (30%).

Ten years of intraoperative floppy iris syndrome in the era of α-blockers.

IntroductionThe use of alpha-1 receptor antagonists in the treatment of benign prostatic hyperplasia (BPH) has created a problem in ophthalmic surgery, the so-called intraoperative floppy iris syndrome (IFIS). This consists of a billowing iris, insufficient pupillary dilation with progressive intraoperative miosis, and protrusion of iris tissue through the tunnel and side port incision that are made for access to the anterior chamber during surgery. IFIS presents particular difficulties in cataract surgery which is carried out through the pupil with manipulations in the immediate vicinity of the iris. The complications range from poor visibility of the operative field to iris damage with the surgical instruments and to rupture of the posterior capsule, with loss of lens material into the vitreous body.Material and methodsA comprehensive literature review was performed using MEDLINE with MeSH terms and keywords ‘benign prostatic hyperplasia’, ‘intraoperative floppy iris syndrome’, ‘adrenergic alpha-antagonist’ and ‘cataract surgery’. In addition, reference lists from identified publications were reviewed to identify reports and studies of interest from 2001 to 2017.ResultsThe A total of 95% of experienced ophthalmologic surgeons reported that systematic treatment with tamsulosin represents a challenging surgical condition increasing the risk of complications. Alpha-blockers are commonly prescribed, with 1,079,505 packages of tamsulosin prescribed each month in 2014 in Austria. Dose modification may be one way to reduce the risk of IFIS. A lower incidence of IFIS was reported in patients on tamsulosin in Japan, but the recommended dosage was lower than that used in Europe and the US (0.2 mg vs. 0.4 mg).ConclusionsWe showed that not all patients taking tamsulosin experience IFIS. Moreover, larger investigations with a prospective design are needed, including studies to monitor the pre- and post-therapeutic ophthalmologic changes under tamsulosin, as well as urodynamic improvements resulting from this therapy.

Early treatment improves urodynamic prognosis in neurogenic voiding dysfunction: 20 years of experience

ObjectiveTo evaluate the association between early treatment and urodynamic improvement in pediatric and adolescent patients with neurogenic bladder. MethodologyRetrospective longitudinal and observational study (between 1990 and 2013) including patients with neurogenic bladder and myelomeningocele treated based on urodynamic results. The authors evaluated the urodynamic follow‐up (bladder compliance and maximum bladder capacity and pressure) considering the first urodynamic improvement in two years as the outcome variable and early referral as the exposure variable, using a descriptive and multivariate analysis with logistic regression model. ResultsAmong 230 patients included, 52% had an early referral. The majority were diagnosed as overactive bladder with high bladder pressure (≥40cm H2O) and low bladder compliance (3mL/cmH2O) and were treated with oxybutynin and intermittent catheterization. Urodynamic follow‐up results showed 68% of improvement at the second urodynamic examination decreasing bladder pressure and increasing bladder capacity and compliance. The percentage of incontinence and urinary tract infections decreased over treatment. Early referral (one‐year old or less) increased by 3.5 the probability of urodynamic improvement in two years (95% CI: 1.81–6.77). ConclusionTreatment onset within the first year of life improves urodynamic prognosis in patients with neurogenic bladder and triplicates the probability of urodynamic improvement in two years. The role of neonatologists and pediatricians in early referral is extremely important.

Early treatment improves urodynamic prognosis in neurogenic voiding dysfunction: 20 years of experience

ObjectiveTo evaluate the association between early treatment and urodynamic improvement in pediatric and adolescent patients with neurogenic bladder. MethodologyRetrospective longitudinal and observational study (between 1990 and 2013) including patients with neurogenic bladder and myelomeningocele treated based on urodynamic results. The authors evaluated the urodynamic follow-up (bladder compliance and maximum bladder capacity and pressure) considering the first urodynamic improvement in two years as the outcome variable and early referral as the exposure variable, using a descriptive and multivariate analysis with logistic regression model. ResultsAmong 230 patients included, 52% had an early referral. The majority were diagnosed as overactive bladder with high bladder pressure (≥40cm H2O) and low bladder compliance (3mL/cmH2O) and were treated with oxybutynin and intermittent catheterization. Urodynamic follow-up results showed 68% of improvement at the second urodynamic examination decreasing bladder pressure and increasing bladder capacity and compliance. The percentage of incontinence and urinary tract infections decreased over treatment. Early referral (one-year old or less) increased by 3.5 the probability of urodynamic improvement in two years (95% CI: 1.81–6.77). ConclusionTreatment onset within the first year of life improves urodynamic prognosis in patients with neurogenic bladder and triplicates the probability of urodynamic improvement in two years. The role of neonatologists and pediatricians in early referral is extremely important.

Outcomes of intra-detrusor injections of botulinum toxin in patients with spina bifida: A systematic review.

Bladder management in spina bifida patients relies on clean intermittent catheterization and oral antimuscarinics with a significant failure rate. The efficacy of intradetrusor injections of botulinum toxin has been confirmed in patients with spinal cord injury or multiple sclerosis but not in patients with myelomeningocele. To conduct a systematic review of current evidence regarding the efficacy of intra-detrusor injections of Botulinum Toxin A (BTX-A) in spina bifida patients with neurogenic detrusor overactivity (NDO) refractory to antimuscarinics. A research has been conducted on Medline and Embase using the keywords: ("spina bifida" OR "myelomeningocele" OR "dysraphism") AND "toxin." The search strategy and studies selection were performed using the PICOS method according to the PRISMA statement. Twelve published series were included (n = 293 patients). All patients were <18 years old. There was no randomized study comparing BTX-A versus placebo and most studies had no control group. Most studies reported a clinical and urodynamic improvement with resolution of incontinence in 32-100% of patients, a decrease in maximum detrusor pressure from 32 to 54%, an increase of maximum cystometric capacity from 27 to 162%, and an improvement in bladder compliance of 28-176%. Two studies suggested lower efficacy in patients with low compliance bladder compared to those with isolated detrusor overactivity. Intradetrusor injections of BTX-A could be effective in children with spina bifida but this assumption is not supported by high level of evidence studies. There is no data available in adult patients. Neurourol. Urodynam. 36:557-564, 2017. © 2016 Wiley Periodicals, Inc.

Benefits of mesenchymal stem cells after partial bladder outlet obstruction

Partial bladder outlet obstruction (pBOO) results in significant morbidity and mortality in the pediatric and adult populations. Mesenchymal stem cells (MSC) have been widely studied in many organ systems for the treatment and prevention of fibrotic and inflammatory conditions. Therefore, we hypothesize that systemic administration of MSC will demonstrate short-term biochemical, histological, and urodynamic benefits in an animal model for pBOO. After University ethics approval, 5 × 106 green fluorescent protein GFP-labeled MSC were intravenously injected concurrently with pBOO in adult Sprague-Dawley rats. Five groups (n=3/group) were analyzed: a) unobstructed controls; b) pBOO for seven days with intravenous MSC (7d+MSC); c) pBOO for seven days without intravenous MSC (7d-MSC); d) pBOO for 14 days with intravenous MSC (14d+MSC), e) pBOO for 14 days without MSC (14d-MSC). Urodynamics were performed at the end of the experimental period and bladders were weighed. Immunohistochemistry was performed for GFP detection and reverse transcription polymerase chain reaction (RT-PCR) to detect mRNA of: TGF-B, HIF-1a, RhoA, GRP-78, lumican, and decorin. All animals remained healthy. GFP was detected in all treatment groups. MSC treatment resulted in a significant decrease in bladder capacity (0.91 cc vs. 2.15 cc, p=0.04). Treatment also resulted in significant decreases in mRNA levels of: TGF-B, HIF-1a, Rho-A, and GRP-78. Systemic treatment with MSC was well tolerated and resulted in MSC accumulation after pBOO. Despite our low numbers, we were able to successfully demonstrate short-term urodynamic improvements and widespread, significant decreases in inflammatory mediators. We believe that this decreased inflammatory cascade will help prevent long-term detrusor deterioration.

Long-term Follow-up of Sigmoid Bladder Augmentation for Low-compliance Neurogenic Bladder

To assess the clinical and urodynamic outcomes of patients with low-compliance neurogenic bladder who were treated with sigmoid bladder augmentation (SBA) over a long-term follow-up. We retrospectively reviewed 52 patients with low-compliance neurogenic bladder who underwent SBA alone or with antireflux techniques in our hospital from 2006 to 2014. Clinical outcomes regarding bladder function, incontinence, medications, catheterization schedules, subsequent interventions, bowel function, and patient satisfaction were addressed. The mean follow-up was 49 months. All patients experienced significant increases in safe cystometric capacity from 113.8 ± 65.9 mL to 373.1 ± 66.7 mL (P <.001), bladder compliance from 2.96 ± 1.55 mL/cm H2O to 14.07 ± 5.45 mL/cm H2O (P <.001), and decreases in creatinine from 88.1 ± 38.6 μmol/L to 77.1 ± 30.4 μmol/L (P <.001) compared with those before surgery. Six patients (11.5%) required anticholinergic medicine to control neurogenic detrusor overactivity, and 11 (21.1%) had recurrent febrile urinary tract infections after SBA. Among 47 prehydronephrosis patients (grade I-II in 10 and III-V in 37), 16 still had minor hydronephrosis after SBA, but the hydronephrosis had been improved significantly (all posthydronephroses were grade I-II instead). All patients reported significant improvements in constipation, and no patient had obvious metabolic acidosis or bladder perforation after SBA. All patients expressed extreme satisfaction with the operation. SBA provided durable clinical and urodynamic improvement for patients with low-compliance neurogenic bladder and constipation. SBA alone, without ureteral reimplantation, seemed sufficient for neurogenic bladder. Furthermore, there was a high level of patient satisfaction with SBA.

Long-Term Sacral Magnetic Stimulation for Refractory Stress Urinary Incontinence

ObjectiveTo evaluate the effects of sacral magnetic stimulation (SMS) on functional and urodynamic improvement in patients with refractory stress urinary incontinence (SUI). DesignA sham-controlled, double-blind, parallel study design with a 4.5-month follow-up. SettingA tertiary hospital. ParticipantsWomen (age, 45–75y) with SUI refractory to first-line management (N=34) were allocated to either an experimental (n=20) group or a sham (n=14) group. InterventionsThe SMS protocol consisted of 5-Hz, 20-minute treatments administered over the bilateral third sacral roots, with the intensity set at approximately 70% of the maximal output, for 12 consecutive weekdays. Main Outcome MeasuresUrodynamic assessments and 2 life stress questionnaires, namely, the Urge-Urinary Distress Inventory (U-UDI) and the Overactive Bladder Questionnaire (OAB-q), were administered pre- and post-SMS intervention. We administered the U-UDI (primary outcome measure) and the OAB-q at 3-week intervals during the follow-up period until 18 weeks after the final intervention. ResultsThe experimental group exhibited significant improvements in both U-UDI and OAB-q scores postintervention (P=.011–.014) and at follow-up visits (P<.001–.007) compared with the sham group. In addition, significant increases in bladder capacity, urethral functional length, and the pressure transmission ratio (P=.009–.033) were noted postintervention. Multivariate regression analysis revealed that patients with more severe symptoms benefited more from SMS. A poorer baseline U-UDI score and a shorter urethral functional length were associated with a greater response to SMS. ConclusionsOur observations of a greater response to SMS in patients with more severe SUI than in those with mild symptoms, as well as the long-term benefits of the treatment, confirm the efficacy of SMS in treating SUI.

Intradetrusor Injections of Onabotulinum Toxin-A in Children With Urinary Incontinence due to Neurogenic Detrusor Overactivity Refractory to Antimuscarinic Treatment.

PurposeThis was a prospective single-arm study to assess the efficacy and safety of intradetrusor injections of onabotulinum toxin-A in children with urinary incontinence associated with neurogenic detrusor overactivity due to myelomeningocele. All patients had failed the first-line treatment of a combination of oral antimuscarinics and intermittent catheterization.Materials and MethodsThe study group consisted of 31 children with myelomeningocele with a mean age of 7.95 years (range, 5-3 years) who were followed up for a mean of 29 weeks. The amount of onabotulinum toxin A injected was 10 U/kg with a maximal dose of 300 U. There were 20 to 30 injection sites with rigid cystoscopic guidance under general anesthesia.ResultsThirty of 31 patients reported dryness between intermittent catheterization intervals. The mean reduction in maximum detrusor pressure and the mean increase in maximum cystometric capacity from baseline were 53% and 51.5%, respectively, 6 weeks after injection. We found a 324% increase in mean bladder compliance and a 57% increase in mean intermittent catheterization volumes. The mean duration of efficacy was 28 weeks with a single injection and 36 weeks for repeated injections (minimum, 16 weeks; maximum, 52 weeks). The mean time interval between repeated onabotulinum toxin-A injections was 7 months (maximum, 13 months). Intradetrusor injections of onabotulinum toxin-A were well tolerated.ConclusionsOnabotulinum toxin-A injections into the bladder wall provide a significant symptomatic and urodynamic improvement in children with neurogenic detrusor overactivity due to myelomeningocele who are on intermittent catheterization. The treatment seems to be safe and very well tolerated.