Neurourologic dysfunction: evaluation, surveillance and therapy.

PURPOSE OF REVIEW: Neurogenic bladder dysfunction results from a variety of neurologic pathologies and can lead to significant patient morbidity and mortality. This article reviews the evaluation, surveillance and management of patients with spinal cord injury, multiple sclerosis, spina bifida and Parkinson's disease. RECENT FINDINGS: Recent studies of patients with neurogenic bladder have highlighted their risk for potentially preventable urologic complications ranging from renal failure to urinary tract infections. However, these same studies bring attention to the lack of compliance and consensus regarding the recommended evaluation of these high-risk patients. SUMMARY: Patients with neurovesical dysfunction must be followed at regular intervals to preserve upper tract function, maintain safe bladder pressures, prevent urinary tract infections and address continence. Future studies and guidelines are needed to direct the management of these complicated patients.

Analysis of patient and technical factors associated with midurethral sling mesh exposure and perforation.

OBJECTIVES: To evaluate the technical and patient characteristics associated with the development of mesh perforation and exposure in patients after midurethral sling surgeries. METHODS: After a retrospective review of referred patients, the risk of mesh perforation of the urinary tract over exposure in the vagina was analyzed with multivariate logistic regression, adjusting for the possible predictors of age, body mass index, smoking status at the time of mesh placement, presence of diabetes, type of sling placed, type of surgeon and trocar injury at the time of mesh placement. RESULTS: A total of 77 women were identified, 27 with mesh perforation and 50 with mesh exposure. The patients' average body mass index was 29.2, and 13% were diabetic. Nine (33%) patients in the perforation group and two (4%) patients in the exposure group had evidence of trocar injury to the bladder or urethra at the time of mesh placement (P < 0.001). After multivariate logistic regression analysis, trocar injury (odds ratio 25.90, 95% confidence interval 2.84-236.58, P = 0.004) and diabetes (odds ratio 9.90, 95% confidence interval 1.1.25-78.64, P = 0.03) were associated with an increased risk of mesh perforation. Increased body mass index (odds ratio 0.88, 95% confidence interval 0.77-0.99, P = 0.05) was associated with a decreased risk of mesh perforation. Finally, postoperative hematomas and blood transfusions occurred more commonly in the mesh perforation group (15% vs 0%, P = 0.01). CONCLUSIONS: Trocar injury, diabetes and bleeding complications at the time of surgery are associated with higher risk of mesh perforation in patients undergoing midurethral sling placement.