Prevalence of Bladder and Bowel Dysfunction in Duchenne Muscular Dystrophy Using the Childhood Bladder and Bowel Dysfunction Questionnaire.

INTRODUCTION: Lower urinary tract symptoms (LUTS) and gastrointestinal (GI) problems are common in Duchenne muscular dystrophy (DMD), but not systematically assessed in regular care. We aimed to determine the prevalence of bladder and bowel dysfunction (BBD) in DMD patients compared with healthy controls (HC). METHODS: The Childhood Bladder and Bowel Dysfunction Questionnaire (CBBDQ) based on the International Rome III criteria and the International Children's Continence Society was filled out by 57 DMD patients and 56 HC. Additionally, possible associations of BBD with, for example, medication use or quality of life were evaluated in an additional questionnaire developed by experts. RESULTS: In 74% of patients versus 56% of HC ≥ 1 LUTS (n.s.) were reported, 68% of patients versus 39% of HC reported ≥1 bowel symptom (p = 0.002) and 53% of patients versus 30% of HC reported combined LUTS and bowel symptoms (p = 0.019). A negative impact of BBD on daily life functioning was reported by 42% of patients. CONCLUSIONS: These data underscore that standard screening for BBD is needed and that the CBBDQ could be of added value to optimize DMD care.

Sacral neuromodulation in patients with refractory overactive bladder symptoms after failed Botulinum toxin therapy: Results in a large cohort of patients.

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.

Associations of Psychometric Affective Parameters with Urodynamic Investigation for Urinary Frequency.

OBJECTIVES: To assess an association between affective symptoms and conventional urodynamic results in a pilot study. METHODS: The study represents a retrospective analysis of prospectively obtained clinical data, voiding diaries, urodynamic parameters and Hospital Anxiety and Depression Scale (HADS). RESULTS: A total of 74 patients with urinary frequency attending a multidisciplinary pelvic care centre was included in this study. There was a significant association between the total HADS scores and presence of DO (P = 0.019). In addition, results showed an association between HADS anxiety scores (≥8) and Detrusor Overactivity (DO) (P = 0.018) and between HADS depression scores (≥8) and the feeling of urgency (P = 0.028). Comparative analysis showed differences in age, mean voiding volume, bladder capacity and strong desire between patients with DO and those without. CONCLUSION: This pilot study revealed an association between psychometric parameters and urodynamic results indicating a common pathway of bladder function and affective complaints. Further research is needed to elucidate which parts of the bladder-brain axis are involved and how these parts correspond by means of urodynamics.

Patient-reported outcome after treatment of urinary incontinence in a multidisciplinary pelvic care clinic.

OBJECTIVES: To assess patient-reported outcome and satisfaction regarding urinary incontinence 1 year after the end of treatment in a multidisciplinary pelvic care clinic. METHODS: A total of 647 patients with urinary incontinence seen in an academic multidisciplinary pelvic care clinic were prospectively included in a specific triage system. Patient-reported improvement of urinary incontinence and patient satisfaction were assessed by telephone survey 1 year after the end of treatment. RESULTS: Just 15.6% of patients presented with one single pelvic floor problem, most had two or three pelvic functional disorders simultaneously, such as urinary incontinence, pelvic organ prolapse and constipation or fecal incontinence. One year after the end of treatment, of 440 responders (68%), 18.2% reported no remaining complaints, and 33.4% reported only one complaint. Patients reported a significant improvement of the mean severity (scale 0-10) of urinary incontinence from 7.2 ±1.6 pretreatment (=T0) to 4.3 ± 3.0 1 year after the end of treatment (P < 0.001). A total of 20.6% of patients reported no urinary incontinence after 1 year (P < 0.001), and 27.6% (P < 0.001) stopped using incontinence pads. Patients claimed high satisfaction with the clinic and care received, with 35.8% being "satisfied" and 45.5% "very satisfied." CONCLUSION: At 1 year after the end of treatment, one out of five patients with urinary incontinence recovered completely, and more than one out of four stopped using incontinence absorption pads. One out of three patients went from having a multifactorial health problem to a monofactorial health problem. High satisfaction rates were reported by more than four out of five patients.