RESUMO
OBJECTIVE: Neurogenic bladders can suffer from overactivity, underactivity or dyssynergia depending on the level of the initial lesion. These symptoms can lead to severe alterations of the upper urinary tract. One of the first-line treatments is the transcutaneous tibial posterior stimulation (TTNS), which was demonstrated to be efficient on urodynamics. But it is an invasive, expensive and sometimes not patient-accepted examination, contrary to the uroflowmetry. The aim of this study is to assess the feasibility of a follow-up with a uroflowmetry when treated by TTNS and show that the maximum flow rate increased after treatment, displaying a better detrusor contraction. METHODS: In total, 38 patients with neurogenic bladder undergoing a 12-weeks TTNS treatment and with 2 uroflowmetries interpretable before and after treatment were included. The maximum flow rate (Qmax), the urinated volume and the post-void residual (PVR) were retrieved from the uroflowmetry, and the USP-score and the urinary discomfort were asked at each appointment. RESULTS: Qmax is increased from 17,53ml/s to 18,26ml/s, as well as the PVR (from 76,97ml to 79,16ml). Urinated volume is decreased from 241,4ml to 193,66ml. Patients feel enhanced after TTNS according to the decrease in the USP-score and the urinary discomfort scale. CONCLUSION: The increase of the cystomanometric capacity and the delay of the detrusor overactivity due to TTNS explains the reduction of the urinated volume and the increase of PVR. Increased Qmax might show a better voluntary bladder contraction, with a restraint due to the lack of abdominal pressure measurement during voiding.
Assuntos
Estimulação Elétrica Nervosa Transcutânea , Bexiga Urinaria Neurogênica , Bexiga Urinária Hiperativa , Humanos , Bexiga Urinaria Neurogênica/terapia , Seguimentos , Bexiga Urinária , Bexiga Urinária Hiperativa/diagnóstico , Bexiga Urinária Hiperativa/terapia , Urodinâmica/fisiologiaRESUMO
OBJECTIVE: Our aim was to assess the usefulness of cranberry extract in multiple sclerosis (MS) patients suffering from urinary disorders. METHODS: In total, 171 adult MS outpatients with urinary disorders presenting at eight centers were randomized (stratification according to center and use of clean intermittent self-catheterization) to cranberry versus placebo in a 1-year, prospective, double-blind study that was analyzed using a sequential method on an intent-to-treat basis. An independent monitoring board analyzed the results of the analyses each time 40 patients were assessed on the main endpoint. Cranberry extract (36 mg proanthocyanidins per day) or a matching placebo was taken by participants twice daily for 1 year. The primary endpoint was the time to first symptomatic urinary tract infection (UTI), subject to validation by a validation committee. RESULTS: The second sequential analyses allowed us to accept the null hypothesis (no difference between cranberry and placebo). There was no difference in time to first symptomatic UTI distribution across 1 year, with an estimated hazard ratio of 0.99, 95% CI [0.61, 1.60] (p = 0.97). Secondary endpoints and tolerance did not differ between groups. CONCLUSION: Taking cranberry extract versus placebo twice a day did not prevent UTI occurrence in MS patients with urinary disorders. Trial Registration NCT00280592.
Assuntos
Anti-Infecciosos/uso terapêutico , Esclerose Múltipla/tratamento farmacológico , Extratos Vegetais/uso terapêutico , Proantocianidinas/uso terapêutico , Infecções Urinárias/prevenção & controle , Vaccinium macrocarpon , Adulto , Anti-Infecciosos/efeitos adversos , Método Duplo-Cego , Feminino , França , Frutas , Humanos , Análise de Intenção de Tratamento , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Esclerose Múltipla/complicações , Esclerose Múltipla/diagnóstico , Fitoterapia , Extratos Vegetais/efeitos adversos , Plantas Medicinais , Proantocianidinas/efeitos adversos , Estudos Prospectivos , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento , Infecções Urinárias/diagnóstico , Infecções Urinárias/microbiologiaRESUMO
Female urinary incontinence can be improved by nonsurgical pharmacologic as well as non-pharmacologic treatments. Hygiene and dietary rules apply to all forms of incontinence. If overweight, weight loss improves stress urinary incontinence. There are levels of evidence to show that pelvic floor muscle training and behavioral therapy improve incontinence. Duloxetine is better than placebo for improvement of quality of life and for the impression of an improvement, but its place is still not determined in the algorithm of conservative treatments. The effects of vaginal electrostimulation and oestrogen are inconsistent or inhomogeneous. In case of urgency incontinence, anticholinergics remain the first line treatment and the place of stimulation of posterieur tibial nerve is still to be defined.