Conservative treatment of the neuropathic bladder in spinal cord injured patients.

Different conservative treatment modalities for the lower urinary tract dysfunction in patients with spinal cord lesion are reviewed. Conservative treatment is still the mainstay of the urological management in these patients. Growing experience has changed the classical approach. Spontaneous voiding with and without triggered voiding and/or bladder expression has proven to be less safe except in well defined patients with regular urological follow-up. Nowadays, intermittent catheterisation and self catheterisation with and without bladder relaxants are accepted as the methods of choice. Condom catheters are still needed if incontinence persists, while penile clamps have no place in the treatment of patients with spinal cord lesions. Long-term indwelling catheters should be avoided. External electrical stimulation can be used to correct the neurogenic dysfunction by neuromodulation and/or to induce a direct therapeutic response in the lower urinary tract.

Conservative treatment of stress urinary incontinence in women: who will benefit?

The aim of the study was to find out which factors can predict the outcome of conservative treatment of urinary stress incontinence in women. One hundred and four women with stress urinary incontinence were evaluated by recall, and by clinical and urodynamic investigation and were given pelvic floor muscle exercises with or without the use of biphasic low-frequency electrostimulation and visual biofeedback. Two groups could be distinguished. The first consisted of 37 patients in whom conservative therapy proved successful; the second consisted of 67 patients in whom incontinence continued. The study investigated whether there was a significant difference in patients' characteristics between the two groups. The number of conservative treatment sessions was not different between the two groups. The presence of a high body mass index, previous pelvic surgery, strong levator muscles and urethral hypermobility appeared to be poor prognostic features. More research is required to evaluate which patients can benefit from conservative treatment and which criteria can predict the outcome of pelvic floor physiotherapy in women with stress incontinence. This way, patients selection is possible and excessive costs can be saved.

Patient satisfaction and complications following sacral nerve stimulation for urinary retention, urge incontinence and perineal pain: a multicenter evaluation.

The aim of the study was to determine the success rate, the complications, the failures and the solutions found in troublesome cases. A retrospective study was performed in three university centers in Belgium. Between March 1994 and April 1998, a quadripolar electrode and a pulse generator were implanted in 53 patients (8 men, 45 women, 43 +/- 12 years, mean follow-up 24 +/- 8 months, range 13-39 months). During the first few months, 45 (85%) of the 53 patients had an objective response. Eight late failures occurred, with a mean failure delay of 9 +/- 5 months. We performed 15 revisions in 12 patients. Major complications were pain and current-related troubles. The outcome was significantly better (P = 0.001) in post-stress incontinence surgery patients. Device-related pain was found more frequently in patients with dysuria and/or retention or perineal pain, and the test stimulation was less reliable (P = 0.025) in patients with a psychiatric history. Sacral nerve stimulation is efficient in treating patients with refractory lower urinary tract symptoms and/or perineal pain.

The role of bladder biofeedback in the treatment of children with refractory nocturnal enuresis associated with idiopathic detrusor instability and small bladder capacity.

PURPOSE: Not all children with primary nocturnal enuresis, an unstable detrusor and small bladder capacity can be treated successfully with anticholinergics and bladder drill. We report our use of bladder biofeedback in patients who did not respond to 3 months of such treatment. MATERIALS AND METHODS: A total of 24 patients (median age 10.4 years) were studied. For bladder biofeedback a transurethral catheter was placed and connected with a 3-way connector. The bladder was slowly filled through this catheter and the intravesical pressure could be seen on a vertical tube, which was also connected to the transurethral catheter. The perineal bulbar detrusor inhibiting reflex was used in cases of involuntary bladder contraction. During the day patients retained urine as long as possible and completed a micturition chart. RESULTS: Of the 24 patients bed-wetting stopped completely in 17 and decreased in 6, and treatment failed in 1. All patients were followed for at least 6 months after treatment. There were 2 cases of recurrence in the group that was cured. CONCLUSIONS: Intravesical biofeedback can successfully treat patients with refractory primary enuresis associated with unstable detrusor and small bladder capacity.

Optimal parameters for transurethral intravesical electrostimulation determined in an experiment in the rat.

OBJECTIVE: Parameters of current for transurethral intravesical electrostimulation (IVES) are studied in the rat to determine the settings which elicit optimal detrusor contractions. Action mechanisms related to the induction of detrusor contractions upon ives are also investigated. METHODS: In 24 female Wistar rats transurethral IVES was performed using 95 combinations of different pulse durations and frequencies. The reference electrode was positioned in the bladder, in the urethra, or on the abdominal wall. RESULTS AND CONCLUSIONS: The optimal detrusor contractions are induced in the rat with a current of 10 Hz frequency and 20 ms pulse duration. A mathematical correlation is found between frequency and pulse duration which permits to determine the best combination. Evidence for the existence of local factors inducing detrusor contractions by IVES is given. The detrusor contractions proved independent of the position of the reference electrode.

Transurethral microwave thermotherapy in the treatment of chronic abacterial prostatitis: a 2 years follow-up.

OBJECTIVE: Transurethral microwave thermotherapy (TUMT) is a minimally invasive, outpatient treatment, applied as a single session of 1-hour duration. SUBJECTS AND METHODS: A group of 11 patients with chronic abacterial prostatitis, who failed to respond to a variety of conventional treatments, underwent this therapy in our centre. RESULTS: The results after two years of follow-up are encouraging: 88% remain free of symptoms. CONCLUSION: Thermotherapy seems to add a new alternative for this hard to manage disease.