[Pregnancy and delivery for women with congenital spinal cord defects and neurogenic bladder]. / Conséquences urologiques de la grossesse et de l'accouchement chez les patientes porteuses d'une vessie neurologique par anomalie congénitale médullaire.

INTRODUCTION: Data are scarce regarding pregnancy and delivery among women with a neurogenic bladder due to congenital spinal cord defects. OBJECTIVE: To report the obstetrical and urological outcomes of women with congenital spinal cord defects and vesico-sphincteric disorders. METHODS: A retrospective multicentric study included all consecutive women with a neurogenic bladder due to congenital spinal defects, who delivered between January 2005 and December 2014. The following data were collected: demographics, neuro-urological disease characteristics, urological and obstetrical history, complications during pregnancy, neonatal outcomes, and changes in urological symptoms. RESULTS: Overall, sixteen women, median age 29,4 years old (IQR 22-36), had a total of 20 pregnancies and 21 births (15 caesareans, 5 vaginal deliveries). Prior to the beginning of their first pregnancy, 12 patients were under intermittent self-catheterization. Symptomatic urinary tract infections during pregnancy occurred in 11 pregnancies, including 4 pyelonephritis. In 4 women, stress urinary incontinence had worsened but recovered post-partum. In 3 women, de novo clean intermittent catheterization became necessary and had to be continued post-partum. During 3 pregnancies, anticholinergic treatment had been started or increased because of urge urinary incontinence worsened. These changes were maintained after delivery. The median gestational age at birth was 39.0 weeks (IQR 37.8-39.5). There were 15 caesarean sections, of which 9 were indicated to prevent a potential aggravation of vesico-sphincteric disorders. Among the 5 pregnancies with vaginal delivery, there was no post-partum alteration of the sphincter function. CONCLUSION: Successful pregnancy outcome is possible in women with congenital spinal cord defects and vesico-sphincteric disorders but it requires managing an increased risk of urinary tract infections, caesarean section, and occasionally worsened urinary incontinence. LEVEL OF EVIDENCE: 5.

Usefulness of ice water test to unmask detrusor overactivity.

PURPOSE: Ice Water Test (IWT) is not frequently used today. IWT triggers a non-inhibited involuntary detrusor contraction (NIDC) when the bladder is being filled with cold saline solution. NIDC is unmasked via a segmental reflex loop different from the physiological micturition reflex. Our purpose was to search for usefulness of IWT to expose detrusor overactivity (DO). METHODS: One hundred and seventy-nine IWT performed in patients with overactive bladder syndrome (OAB) and conventional cystometry (CC) non-contributive to diagnosis were retrospectively analyzed. An increase of detrusor pressure of 15cm H2O allowed defining positive IWT (with leakage) or intermediate (without leakage). RESULTS: The population comprised of 131 women (58.2±17.3 years) and 48 men (56.1±15.3 years). Main complaints were mixed or urge incontinence (76/179). Hundred and twenty-four patients had a history of neurological disease. From CC, detrusor behavior was founded uncategorized for 106, normal for 53 patients and underactive for 20. These results did not contribute to diagnose a DO. IWT was positive for 22 patients and intermediate for 20. DO was unmasked by IWT for 42 patients (23.4%) of whom 34 had neurological disease. The positive predictive value was 80.9%, the negative predictive value was 34.3%. CONCLUSION: In patients with OAB syndrome, IWT is contributory to unmask DO when CC is not contributive. Our study underlines the interest to perform IWT when urodynamic diagnosis is unclear.

Oral anticoagulant treatment - evaluating the knowledge of patients admitted in physical medicine and rehabilitation units.

INTRODUCTION: While numerous therapeutic education programs exist in physical medicine and rehabilitation (PM&R), they rarely concern pharmacological treatments. Nevertheless, drugs prescribed during a hospital stay can have a significant risk of adverse events. Vitamin K antagonists (VKA) are among them. OBJECTIVE OF THE STUDY: To assess patients' knowledge on their oral anticoagulant treatment before their hospital discharge. METHODS: Fifty patients were enrolled in this prospective, monocenter study. Their level of knowledge was assessed by a semi-structured interview between the pharmacist and the patients and/or their caregivers. RESULTS: Seventy percent of patients were able to give the name of the drug they were taking, 82% could explain its effect and finally, 24% of patient knew their INR target values. Twenty-two percent of patients were able to describe the symptoms in case of overdose and what to do in that case. Forty percent of patients were aware of food interactions and 60% of self-medication risks. The patient's knowledge and behavior acquired during their hospital stay are not enough to guarantee a safe treatment management upon discharge. Based on this study, therapeutic patient education sessions were implemented. CONCLUSION: These results suggest that specific drug therapy management sessions should be developed as part of PM&R's therapeutic education programs for patients.

Lower respiratory events in seated tracheotomized tetraplegic patients.

AIM: Retrospective study on the changing position impact on respiratory events in 14 rehabilitation tracheotomized tetraplegic patients, during 25 months. METHODS: Three positions were compared: permanently supine (16 periods), seated on or=6 days/week (10 periods). The end-point was the incidence of the following respiratory events: pneumonia, atelectasis and plugging of tracheal/bronchial secretions. Patients were considered as their own control but data were pooled for analysis. RESULTS: Pneumonia and plugging incidences were significantly higher in the permanently supine position than in the seated or=6 days position. Atelectasis occurred only in the supine position. CONCLUSION: Plugging prevalence was significantly higher in the permanently supine position (53.3%) than in the seated or=6 days position (14.6%, P=0.001).

Claw toes in hemiplegic patients after stroke.

OBJECTIVE: The aim of this study was to analyze the prevalence of claw toes and its correlation to other lower limb disorders as well as the global functional recovery in a population of hemiplegic patients 1year post-stroke. PATIENTS AND METHODS: This prospective study included 39 stroke patients hospitalized in the Physical Medicine and Rehabilitation (PM&R) department of a hospital between September2000 and September2001. The evaluation looked for incidence of claw toes during the first year post-stroke and whether there was a potential link to triceps surae spasticity, motor impairment of the leg and patients' functional abilities (Barthel Index, postural assessment scale for stroke patients [PASS], functional ambulation classification [FAC]). RESULTS: We conducted a total of 64 evaluations (one to four by patient). In 18 out of 39 (46%) patients, we found an occurrence of claw toes. In 15 out of 18 (83%) patients, who regained average functional capacities, its onset took place before the end of the third month post-stroke (Barthel: 30-70, PASS: 15-33, FAC: 3-4) and it was significantly linked to equinus and/or varus foot (p<0.0001). CONCLUSION: The occurrence of claw toes in hemiplegic patients is common and happens early on post-stroke. Equinus and/or varus foot and average functional capacities were associated to claw toes. Despite the few studies devoted to this condition in stroke patients, this condition must be diagnosed early and taken into account to improve the patient's rehabilitation care.