Asunto(s)
Toxinas Botulínicas Tipo A , Incontinencia Urinaria de Urgencia , Humanos , Toxinas Botulínicas Tipo A/uso terapéutico , Toxinas Botulínicas Tipo A/administración & dosificación , Incontinencia Urinaria de Urgencia/terapia , Incontinencia Urinaria de Urgencia/tratamiento farmacológico , Terapia por Estimulación Eléctrica/métodos , Resultado del Tratamiento , Factores de Tiempo , Plexo Lumbosacro , Fármacos Neuromusculares/uso terapéuticoRESUMEN
AIMS: Sacral neuromodulation (SNM) and Botulinum toxin A (BoNT-A) injections are well-known third-line treatment options in patients with refractory overactive bladder (OAB). Our aim is to evaluate the success rate of SNM in patients who received prior therapy with BoNT-A injections. METHODS: All patients with OAB symptoms referred for SNM between 2006 and 2019 were included. History taking and 3-day voiding diaries assessed the complaints and suitability for SNM. The success rate of SNM in patients who received prior BoNT-A was compared with BoNT-A naive patients. Success was defined as an improvement of 50% or greater in voiding diary parameters. Satisfaction was registered at their most recent visit. RESULTS: A total of 263 patients underwent SNM test stimulation, of which 75 (16 male/57 female) received prior BoNT-A and 188 (46 male/142 female) were BoNT-A naive. Success rate for SNM in BoNT-A naive patients was 72.9% and in BoNT-A patients 66.7% (p = 0.316). Success rate after ≤2 BoNT-A injections was 68.5%, compared to 61.1% after ≥3 injections (p > 0.05). Success rate in patients perceiving lack of efficacy of BoNT-A was 67.4% (p > 0.05), subjected to temporary CISC was 73.7% (p > 0.05) and with temporary effect of BoNT-A was 50% (p > 0.05). In 86% of BoNT-A patients the system was still activated and used to their satisfaction at their last follow-up visit (mean FU, 40.70 months). CONCLUSION: SNM in patients with refractory OAB who failed prior BoNT-A is an excellent approach. The number of injections nor reason of BoNT-A discontinuation have predictive value for success with SNM.
Asunto(s)
Toxinas Botulínicas Tipo A/efectos adversos , Terapia por Estimulación Eléctrica , Vejiga Urinaria Hiperactiva , Femenino , Humanos , Masculino , Región Sacrococcígea , Sacro , Resultado del Tratamiento , Vejiga Urinaria Hiperactiva/tratamiento farmacológicoRESUMEN
A 29-year-old male patient was involved in a crush injury of the right pelvis. Trauma screening showed a right-sided fracture of the pubic bone. CT imaging of the abdomen showed an urethral rupture with cranial displacement of the bladder, the so-called 'pie in the sky' sign.
Asunto(s)
Accidentes de Trabajo , Fracturas Óseas/diagnóstico , Dolor Pélvico/diagnóstico , Hueso Púbico/lesiones , Uretra/lesiones , Adulto , Fracturas Óseas/diagnóstico por imagen , Humanos , Masculino , Dolor Pélvico/etiología , Radiografía , Vejiga Urinaria/anatomía & histología , Vejiga Urinaria/patologíaRESUMEN
PURPOSE: We evaluated whether patients with overactive bladder and incontinence who discontinued intravesical botulinum toxin therapy can be successfully treated with sacral neuromodulation. MATERIALS AND METHODS: All patients who were referred to our center after discontinuation of botulinum toxin-A between 2005 and 2010 were included in this observational study. All patients underwent test stimulation with sacral neuromodulation and were evaluated with voiding diaries. Success was defined as more than 50% improvement in leakage episodes. Successful test stimulation was subsequently followed by a definitive implant. Patient satisfaction with sacral neuromodulation therapy was evaluated 1 year after the definitive implant. RESULTS: A total of 20 patients were included in the study. Of these patients 17 (85%) had discontinued botulinum toxin-A because of lack of efficacy and 3 had been treated successfully with botulinum toxin-A but requested a more permanent solution. The mean interval between the botulinum toxin-A and the sacral neuromodulation test stimulation was 23 months. In 14 patients (70%) the test stimulation was successful and they received a definitive implant. Of the 14 patients 5 even showed a decrease of greater than 90% in leakage episodes. One year after implantation 11 patients (79%) were satisfied with the sacral neuromodulation treatment. CONCLUSIONS: Despite the small sample size, this study indicates that patients who are dissatisfied with or in whom botulinum toxin-A treatment fails can respond successfully to sacral neuromodulation. The success rate of the test stimulation was comparable to that of patients who have never been treated with botulinum toxin-A. The 1-year satisfaction rate was comparable that of patients without a history of botulinum toxin-A treatment.
Asunto(s)
Terapia por Estimulación Eléctrica , Vejiga Urinaria Hiperactiva/terapia , Incontinencia Urinaria/terapia , Adulto , Anciano , Anciano de 80 o más Años , Toxinas Botulínicas Tipo A/uso terapéutico , Femenino , Humanos , Masculino , Persona de Mediana Edad , Fármacos Neuromusculares/uso terapéutico , Sacro , Vejiga Urinaria Hiperactiva/tratamiento farmacológicoRESUMEN
A 52-year-old woman presented with recurrent urinary tract infections and flank pain. Both an abdominal CT-scan and a plain abdominal X-ray showed bilateral nephrocalcinosis and a kidney stone in the left ureter. These findings are suggestive of medullary sponge kidneys.
Asunto(s)
Riñón Esponjoso Medular/diagnóstico , Tomografía Computarizada por Rayos X/métodos , Cálculos Ureterales/diagnóstico , Infecciones Urinarias/diagnóstico , Dolor Abdominal/diagnóstico , Femenino , Humanos , Litotricia , Riñón Esponjoso Medular/complicaciones , Riñón Esponjoso Medular/terapia , Persona de Mediana Edad , Resultado del Tratamiento , Cálculos Ureterales/etiología , Cálculos Ureterales/terapia , Infecciones Urinarias/etiología , Infecciones Urinarias/terapiaRESUMEN
Neuromodulation is used as a treatment for overactive bladder syndrome, if conservative management is ineffective or only partially effective. Sacral neuromodulation is now a minimally invasive treatment as a result of improvements in surgical technique, and it has good long-term results. Nevertheless the risk of complications such as pain and decreasing effect is still present. Developments in alternative neuromodulation treatments, such as posterior tibial nerve stimulation, pudendal nerve stimulation and intravesical injection therapy with botulinum neurotoxin, have extended the role of neuromodulation. Intravesical injection therapy with botulinum toxin, along with sacral neuromodulation, has been included in the treatment algorithm of overactive bladder syndrome if this does not respond to conservative therapy. When choosing for a neuromodulation therapy, the side-effects and complications of the treatments should be considered alongside the specific patient situation and evidence for effectiveness and long-term effectiveness.