[Evidence of sensory bladder inhibitor reflex]. / Démonstration neurophysiologique d'un réflexe périnéo-vésico-sensitif inhibiteur.

INTRODUCTION: Need to void level depends on two parameters, bladder volume and attentional process. If it is well known that the maximum voluntary contraction of the perineal muscles may transiently inhibit the micturition reflex itself, no work demonstrates the effect of this contraction on the intensity of the need itself. METHODS: An experimental, prospective, open, monocentric study was conducted between March and April 2017. In total, 15 subjects with no neurological history or neuro-perineal disorders consulting for functional constipation were included. Need to void level was evaluated by means of an electronic urgentometer. A control contraction of the dominant hand muscles was compared to a voluntary contraction of the external anal sphincter during a strong desire to void (B3). These contractions were recorded by means of surface electromyography. The main evaluation criterion was the comparison between the difference in visual analogic scale of the desire to void before (VAS-base) and after control voluntary contraction (VAS-hand) versus the same index (BAS-base then VAS-anal) after contraction of the external anal sphincter during a new B3. The comparison of maximum bladder capacities (MBC) measured after each record was the secondary endpoint. Wilcoxon signed rank test was used for statistical analysis. RESULTS: Voiding desire VAS decreased significantly (-13.14±12 vs -1.5±6; P=0.03) and MBC increased significantly (502.43±96.71mL vs 435.78±125.54mL; P=0.02) after anal compared to control contraction. CONCLUSION: This study suggests the existence of sensitive pathways inhibition by perineal contraction through a sensitive perineo-vesical inhibitory reflex. LEVEL OF EVIDENCE: 3.

[Reproducibility of bladder diary in patients with multiple sclerosis]. / Reproductibilité du calendrier mictionnel chez les patients atteints de sclérose en plaques. Étude prospective monocentrique.

INTRODUCTION: Multiple sclerosis (MS) is a neurological condition characterized by variable levels of symptoms. This variability could also affect bladder dysfunction and impact on the reproducibility or stability of bladder diary (BD). The aim of the study is to investigate the reproducibility and reliability of BD in MS, and then determine its linked factors. METHODS: The MS patient provided a 21 days BD and they documented the time of every void. The main criterion was assessed by voiding frequency, represented by the coefficient of variation (CV=average/standard deviation), expressed as a percentage. Two groups were described: stable BD group (CV≤15 %) and instable BD group (CV>15 %). Secondary criteria were completion of BD (complete or not) and the difference of voiding frequency variation between weekend and week. RESULTS: Thirty-one patients were included (mean age 51.06 years, SD 11.33) with 65 % of women. Mean CV is 23 % (SD 0.11). The mean completion of BD was 19.35 days (SD 3.99). 8 patients had a CV≤15 %. Stable group was older than instable group (P=0.03). There was no other difference between the 2 groups. There is a strong correlation between mean voiding frequency weekend and week (ρ=0.94, P<0.05). The longer duration of BD, the less reliability is notified. CONCLUSION: BD is not a stable reproducible in MS population. Both lack of compliance or variability of LUTS in MS may explain the unreliability of BD. However, BD utility should be discussed in this population. LEVEL OF EVIDENCE: 4.