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1.
J Urol ; 204(6): 1284-1289, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-32924823

RESUMO

PURPOSE: The relationship between fluid intake and lower urinary tract symptoms in individuals with neurogenic bladder is unknown. We investigated the association between fluid intake and urinary symptoms in patients with multiple sclerosis. MATERIALS AND METHODS: A prospective cross-sectional study of patients with multiple sclerosis presenting to the neurology office was conducted. Fluid intake and lower urinary tract symptoms were assessed by the questionnaire based voiding diary and the American Urological Association Symptom Score, respectively. The relationship between fluid intake and lower urinary tract symptoms was assessed using univariate and multivariate analyses. RESULTS: Among 200 individuals with multiple sclerosis the mean total daily fluid intake was 2,489 ml (SD 1,883) and did not differ according to severity (ie mild, moderate, severe) of lower urinary tract symptoms (F=0.30, p=0.74). Fluid restricting behavior to control urinary symptoms was reported by 47% of subjects. Subjects who reported fluid restricting were more likely to have worse urinary symptoms (OR 1.95, 95% CI 1.53-2.47, p <0.01). After accounting for fluid restricting behavior on multivariate analysis, there was a minimal relationship between caffeinated fluid intake and lower urinary tract symptom severity (OR 1.00, 95% CI 1.00-1.01, p=0.01), and there was no relationship between total fluid intake and lower urinary tract symptom severity (OR 1.00, 95% CI 1.00-1.00, p=0.07). CONCLUSIONS: Caffeinated fluid intake has a minimal effect on lower urinary tract symptoms in patients with multiple sclerosis. On average, patients with multiple sclerosis do not hydrate excessively and a considerable proportion restrict fluid intake to control urinary symptoms. Fluid intake may not contribute considerably to lower urinary tract symptoms in patients with multiple sclerosis.


Assuntos
Bebidas/estatística & dados numéricos , Ingestão de Líquidos/fisiologia , Sintomas do Trato Urinário Inferior/diagnóstico , Esclerose Múltipla/complicações , Bexiga Urinaria Neurogênica/etiologia , Adulto , Bebidas/efeitos adversos , Cafeína/efeitos adversos , Estudos Transversais , Feminino , Humanos , Sintomas do Trato Urinário Inferior/etiologia , Sintomas do Trato Urinário Inferior/prevenção & controle , Masculino , Pessoa de Meia-Idade , Esclerose Múltipla/fisiopatologia , Estudos Prospectivos , Índice de Gravidade de Doença , Bexiga Urinária/fisiopatologia , Bexiga Urinaria Neurogênica/fisiopatologia , Micção/fisiologia
2.
Top Spinal Cord Inj Rehabil ; 26(2): 108-115, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32760189

RESUMO

Neurogenic lower urinary tract dysfunction (NLUTD), previously termed neurogenic bladder dysfunction, is a common secondary complication of spinal cord injury (SCI). It is associated with significant morbidity, reduced quality of life, increased health care costs, and mortality. Primary care providers (PCPs) play an important role in optimizing urohealth over the life span. This article will review NLUTD in SCI, its complication, surveillance, and management. PCPs should be aware of SCI-related NLUTD, its complications, management, and surveillance recommendations, and when to refer to a specialist.


Assuntos
Atenção Primária à Saúde , Traumatismos da Medula Espinal/complicações , Bexiga Urinaria Neurogênica/etiologia , Bexiga Urinaria Neurogênica/terapia , Infecções Urinárias/etiologia , Infecções Urinárias/terapia , Humanos , Qualidade de Vida
3.
Ir Med J ; 113(2): 26, 2020 02 13.
Artigo em Inglês | MEDLINE | ID: mdl-32407011

RESUMO

Presentation A 55-year-old male patient with neuropathic bladder secondary to multiple sclerosis (MS) presented to the EmergencyDepartment (ED) with abdominal pain and no output from his suprapubic catheter (SPC) that was changed 24 hourspreviously. Diagnosis On examination, the SPC-tip was clearly visible at the external urethral meatus. Treatment The patient was managed by gently deflating the anchoring balloon, exchanging the SPC and a period of observationto ensure adequate catheter drainage. Conclusion Important learning points from this case are to observe urine draining after routine SPC change and to examine thegenitalia when a misplaced SPC is suspected.


Assuntos
Remoção de Dispositivo/métodos , Falha de Equipamento , Uretra , Bexiga Urinaria Neurogênica/terapia , Cateterismo Urinário/métodos , Cateteres Urinários/efeitos adversos , Dor Abdominal/etiologia , Drenagem , Humanos , Masculino , Pessoa de Meia-Idade , Esclerose Múltipla/complicações , Bexiga Urinaria Neurogênica/etiologia , Cateterismo Urinário/efeitos adversos
4.
Urologe A ; 59(9): 1076-1081, 2020 Sep.
Artigo em Alemão | MEDLINE | ID: mdl-32424576

RESUMO

BACKGROUND: Nearly all patients with spinal cord injury (SCI) suffer from neurogenic lower urinary tract dysfunction (NLUTD). Untreated NLUTD is a risk factor for renal damage and can significantly affect quality of life (QoL). Patients with SCI frequently use complementary medicine to alleviate symptoms, namely for urologic problems. OBJECTIVES: We evaluated whether homeopathic treatment influences objective urodynamic parameters. MATERIALS AND METHODS: In a retrospective study, urodynamic data of patients with NLUTD due to SCI who received constitutional homeopathic treatment by the consultants of our hospital were evaluated before initiation of homeopathic treatment and at the most recent follow-up. Modifications in urologic treatment were taken into account. RESULTS: Urodynamic results from 35 patients who underwent homeopathic treatment (14 women, 21 men, median age 46 years, tetraplegia: n = 14; paraplegia: n = 21) were available at both time points and could therefore be evaluated. In all, 20 patients used intermittent catheterization, 6 persons had an indwelling catheter, and 9 persons emptied their bladders without a catheter. There were no significant differences in the urodynamic parameters before and during treatment. Changes in urologic therapy correlated with significant improvement in urodynamic findings. CONCLUSIONS: As all patients were under urologic surveillance, and immediate urologic treatment was established if necessary, a retrospective study design proved not to be suitable to detect possible influences of homeopathic treatment on urodynamic parameters in patients with SCI. Thus, a prospective randomized study is essential.


Assuntos
Sintomas do Trato Urinário Inferior/etiologia , Traumatismos da Medula Espinal/complicações , Bexiga Urinaria Neurogênica/etiologia , Urodinâmica/fisiologia , Adulto , Idoso , Feminino , Humanos , Sintomas do Trato Urinário Inferior/fisiopatologia , Sintomas do Trato Urinário Inferior/terapia , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Qualidade de Vida , Estudos Retrospectivos , Traumatismos da Medula Espinal/fisiopatologia , Bexiga Urinaria Neurogênica/fisiopatologia , Bexiga Urinaria Neurogênica/terapia
5.
Curr Opin Urol ; 30(4): 507-512, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32427629

RESUMO

PURPOSE OF REVIEW: To provide an overview of available electrical stimulation devices in neurogenic patients with lower urinary tract disease. RECENT FINDINGS: It is advocated to do more studies in neurogenic patients as results seem promising and useful but most studies did not include neurogenic patients or neurogenic patients were not analyzed or reported separately. Most studies included a small heterogenous neurogenic group with multiple pathophysiologic origin focusing on effect of a treatment instead of results of a treatment in a specific neurogenic group. Neuromodulation or stimulation has the advantage that it acts on different organs, like bladder and bowel, so can treat neurogenic patients, who mostly suffer from multiple organ failure. SUMMARY: Brindley procedure, sacral neuromodulation (SNM) and posterior tibial nerve stimulation (PTNS) are available for a while already. The Brindley procedure (including sacral anterior root stimulation in combination with a rhizotomy of posterior sacral roots) is developed for selected spinal cord injury patient with a complete spinal injury, and has shown results for many years in neurogenic patients. An alternative to the rhizotomy is not established yet. SNM and PTNS are other modalities that are used in nonneurogenic patients, but are not yet indicated and much studied in neurogenic patients.


Assuntos
Terapia por Estimulação Elétrica/métodos , Rizotomia , Nervo Tibial , Bexiga Urinaria Neurogênica/terapia , Bexiga Urinária/inervação , Denervação , Estimulação Elétrica , Terapia por Estimulação Elétrica/efeitos adversos , Humanos , Neuroestimuladores Implantáveis , Sintomas do Trato Urinário Inferior/fisiopatologia , Sintomas do Trato Urinário Inferior/terapia , Região Sacrococcígea , Raízes Nervosas Espinhais/fisiopatologia , Raízes Nervosas Espinhais/cirurgia , Bexiga Urinaria Neurogênica/etiologia
6.
Medicine (Baltimore) ; 99(17): e19843, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32332636

RESUMO

BACKGROUND: The most common and bothersome lower urinary tract complication of diabetes mellitus is diabetic neurogenic bladder (DNB). Acupuncture has certain advantages in treating bladder dysfunction including urinary retention and incontinence. Therefore, we think that electroacupuncture (EA) may be beneficial to DNB patients. However, it is not clear whether EA combined with basic western medicine could optimize the therapeutic effect for DNB. METHOD/DESIGN: This is a sham-controlled, patient-blinded, pioneer randomized controlled trial (RCT). One hundred fifty eligible patients will be randomly divided into 3 groups: A. basic western medicine (BWC), B. EA with BWC, C. sham EA with BWC. EA treatment will be given twice a week for 12 weeks at bilateral BL23, BL32, BL33, and BL35. The BWC group will received Alpha-lipoic acid (ALA) and methylcobalamin (MC) treatment for 12 weeks, 2 treatment sessions per week. The primary outcome is scored by the 72-hour bladder diary (72h-BD). The secondary outcomes will be scored by the American Urological Association symptom index (AUA-SI), Post-void residual urine volume (PVR) and urodynamic tests. All the assessments will be conducted at baseline and the 12th weeks after the intervention starts. The follow-up assessments will be performed with 72h-BD and AUA-SI in the 4th, 12th, and 24th weeks after intervention ends. DISCUSSION: This trial protocol provides an example of the clinical application acupuncture treatment in the management of DNB. This RCT will provide us information on the effect of treating DNB patients with only acupuncture, western medicine therapy (ALA + MC) as well as the combination of both. The additive effect or synergistic effect of acupuncture and basic western medicine will then be analyzed. TRIAL REGISTRATION: Chinese Clinical Trial Registry, ChiCTR2000030421.


Assuntos
Neuropatias Diabéticas/terapia , Eletroacupuntura , Bexiga Urinaria Neurogênica/terapia , Adolescente , Adulto , Idoso , Neuropatias Diabéticas/fisiopatologia , Eletroacupuntura/efeitos adversos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Método Simples-Cego , Ácido Tióctico/uso terapêutico , Resultado do Tratamento , Bexiga Urinaria Neurogênica/tratamento farmacológico , Bexiga Urinaria Neurogênica/etiologia , Bexiga Urinaria Neurogênica/fisiopatologia , Urodinâmica , Vitamina B 12/análogos & derivados , Vitamina B 12/uso terapêutico , Complexo Vitamínico B/uso terapêutico , Adulto Jovem
7.
Neurol Clin ; 38(2): 269-292, 2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-32279710

RESUMO

Parkinson disease (PD) is well recognized by its motor features of bradykinesia, tremor, rigidity, and gait and balance difficulties. However, PD is also characterized by a myriad of nonmotor symptoms, which may occur even before motor symptoms, early in the course of disease, and throughout the advancing disease. These nonmotor symptoms span multiple different systems, invoke multiple different neurotransmitters, and require multiple strategies for treatment including pharmacologic and nonpharmacologic interventions and, often, multiple different disciplines. This article discusses symptoms, assessments, and therapeutics for the nonmotor symptoms of PD including those affecting mood, cognition, behavior, sleep, autonomic function, and sensory systems.


Assuntos
Doença de Parkinson/complicações , Doença de Parkinson/terapia , Transtornos Cognitivos/etiologia , Transtornos Cognitivos/terapia , Constipação Intestinal/etiologia , Constipação Intestinal/terapia , Humanos , Hipotensão Ortostática/etiologia , Hipotensão Ortostática/terapia , Transtornos Mentais/etiologia , Transtornos Mentais/terapia , Transtornos do Sono-Vigília/etiologia , Transtornos do Sono-Vigília/terapia , Bexiga Urinaria Neurogênica/etiologia , Bexiga Urinaria Neurogênica/terapia
8.
Am J Phys Med Rehabil ; 99(11): 1056-1066, 2020 11.
Artigo em Inglês | MEDLINE | ID: mdl-32149818

RESUMO

Neurogenic bladder disorders are common among patients with spinal cord lesions, which often result in upper and lower urinary tract complications. Urinary tract infection has remained the most frequent type of infection in this population. Our aim is to review systematically the literature on the outcome of different intervention methods to reduce urinary tract infection incidence. A literature search was conducted in the database of Medline, PubMed, Embase, and Scopus. After screening 1559 articles, 42 were included in this review. The intervention methods can be categorized into the four following groups: (1) indwelling catheterization and intermittent catheterization, (2) medications, (3) surgery, and (4) others. Intermittent catheterization is still the most recommended treatment for persons with spinal cord lesions. Hydrophilic catheters are more suitable for adults than children because of complex handling. Bladder management with spontaneous voiding is initially considered for infants and toddlers with spina bifida. Antibiotics treatment should be based on the results of urine cultures. Shortening the course of antibiotics treatment can reduce its adverse effects but may increase urinary tract infection recurrence. Because botulinum toxin injections and bladder surgery can improve urodynamic function, both are conducive toward lowering urinary tract infection incidence.


Assuntos
Doenças da Medula Espinal/complicações , Bexiga Urinaria Neurogênica/complicações , Cateterismo Urinário/métodos , Infecções Urinárias/prevenção & controle , Procedimentos Cirúrgicos Urológicos/métodos , Agentes Urológicos/uso terapêutico , Adolescente , Adulto , Antibacterianos/administração & dosagem , Toxinas Botulínicas/administração & dosagem , Criança , Pré-Escolar , Feminino , Humanos , Incidência , Lactente , Masculino , Pessoa de Meia-Idade , Traumatismos da Medula Espinal/complicações , Resultado do Tratamento , Bexiga Urinaria Neurogênica/etiologia , Infecções Urinárias/epidemiologia , Infecções Urinárias/etiologia , Adulto Jovem
9.
Neurourol Urodyn ; 39(4): 1162-1169, 2020 04.
Artigo em Inglês | MEDLINE | ID: mdl-32196732

RESUMO

AIM: To develop a short form (SF) of the 24-item Neurogenic Bladder Symptom Score (NBSS). METHODS: We used three previously published datasets. First, we selected the most responsive questions within each of the domains. Internal validity of the NBSS-SF was assessed using Cronbach's α. External validity was assessed by evaluating hypothesized relationships with other questionnaires and testing correlations with the full NBSS domains. Test-retest reliability of the NBSS-SF domains was determined using an intraclass coefficient (ICC). RESULTS: Using data from a prior responsiveness study, we selected questions for the NBSS-SF from the incontinence domain (three), storage/voiding domain (three), consequences domain (two); these would make up the NBSS-SF. We used the original NBSS validation cohort of 230 patients with multiple sclerosis (MS), spinal cord injury (SCI), or spina bifida, and found the Cronbach's α was .76 for the NBSS-SF; the external validity was high, with correlations between specific NBSS-SF domains/total scores and the Qualiveen-SF, ICIQ, and AUASS generally similar to those seen with the NBSS. Correlations between the NBSS-SF domains and the full NBSS domains were high. The NBSS-SF ICC in a subset of 120 patients was 0.84. The NBSS-SF performed similarly in two additional independent datasets. CONCLUSIONS: The total score of the NBSS-SF has appropriate validity, reliability, and could be used instead of the full NBSS to minimize the assessment burden. The full NBSS may be better suited if the primary focus of the study is on neurogenic bladder symptoms, or if individual NBSS domains are of interest.


Assuntos
Bexiga Urinaria Neurogênica/diagnóstico , Micção/fisiologia , Adulto , Estudos de Coortes , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Esclerose Múltipla/complicações , Esclerose Múltipla/fisiopatologia , Qualidade de Vida , Reprodutibilidade dos Testes , Traumatismos da Medula Espinal/complicações , Traumatismos da Medula Espinal/fisiopatologia , Inquéritos e Questionários , Bexiga Urinaria Neurogênica/etiologia , Bexiga Urinaria Neurogênica/fisiopatologia
10.
Neurourol Urodyn ; 39(3): 969-977, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-32032447

RESUMO

AIMS: We compared brain activation patterns between female multiple sclerosis (MS) patients with voiding dysfunction (VD) and those without. We aim to expand current knowledge of supraspinal correlates of voiding initiation within a cohort of female MS patients with and without VD. MATERIALS AND METHODS: Twenty-eight ambulatory female MS patients with stable disease and lower urinary tract dysfunction were recruited for this study. Subjects were divided into group 1, without VD (n = 14), and group 2, with VD (n = 14), defined as postvoid residual urine of ≥40% of maximum cystometric capacity or need for self-catheterization. We recorded brain activity via functional magnetic resonance imaging (fMRI) with simultaneous urodynamic testing. Average fMRI activation maps (the Student t test) were created for both groups, and areas of significant activation were identified (P < .05). A priori regions of interest (ROIs), identified by prior meta-analysis to be involved in voiding, were selected. RESULTS: Group-averaged blood-oxygen level-dependent (BOLD) activation maps demonstrated significant differences between groups 1 and 2 during initiation of voiding with group 2 showing significantly lower levels of activation in all ROIs except for the left cerebellum and right cingulate gyrus. Interestingly, group 2 displayed negative BOLD signals, while group 1 displayed positive signals in the right and left pontine micturition center, right periaqueductal gray, left thalamus, and left cingulate gyrus. The activation map of group 1 was similar to healthy controls. CONCLUSIONS: Our results support the hypothesis that distinct supraspinal activation patterns exist between female MS patients with VD and those without.


Assuntos
Encéfalo/diagnóstico por imagem , Sintomas do Trato Urinário Inferior/fisiopatologia , Esclerose Múltipla/diagnóstico por imagem , Bexiga Urinaria Neurogênica/fisiopatologia , Transtornos Urinários/fisiopatologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Encéfalo/fisiopatologia , Estudos de Casos e Controles , Cerebelo/diagnóstico por imagem , Cerebelo/fisiopatologia , Feminino , Neuroimagem Funcional , Giro do Cíngulo/diagnóstico por imagem , Giro do Cíngulo/fisiopatologia , Humanos , Sintomas do Trato Urinário Inferior/etiologia , Imagem por Ressonância Magnética/métodos , Pessoa de Meia-Idade , Esclerose Múltipla/complicações , Esclerose Múltipla/fisiopatologia , Substância Cinzenta Periaquedutal/diagnóstico por imagem , Substância Cinzenta Periaquedutal/fisiopatologia , Ponte/diagnóstico por imagem , Ponte/fisiopatologia , Tálamo/diagnóstico por imagem , Tálamo/fisiopatologia , Bexiga Urinária/fisiopatologia , Bexiga Urinaria Neurogênica/etiologia , Micção/fisiologia , Transtornos Urinários/etiologia , Urodinâmica/fisiologia
11.
Medicine (Baltimore) ; 99(1): e18558, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31895798

RESUMO

BACKGROUND: The invasive surgical intervention for neurogenic bladder dysfunction (NBD) following spinal cord injury (SCI) involves permanently altering one's body system and carries many surgical related risks and medication side effects are often seen in long term usage of pharmaceutical medications. Therefore, acupuncture and moxibustion therapies have been recommended due to their efficacy, simplicity of operation, cost effectiveness and safety. This protocol is designed for systematic review and network meta-analysis, which will perform comparisons or rankings of efficacy among the currently available acupuncture and moxibustion techniques and provide evidence to guide the best practice in acupuncture and moxibustion treatments of NBD due to SCI. METHODS/DESIGN: The Cochrane Library, EMBASE, PubMed, Web of Science, CENTRAL, CNKI, The VIP Database, The Wanfang database, CDFD, CMFD will be searched from inception to November 1, 2019. All randomized controlled trials containing eligible interventions(s) and outcome(s) will be included. The quality of included trials will be assessed using the "Risk of bias" tool from the Cochrane Handbook (V.5.1.0). Data analysis will be conducted by using STATA software (Version 13.0). Continuous outcome will be indicated as mean difference (MD) or standard mean difference (SMD), and enumeration data will be presented with odds risk (OR) or relative risk (RR). RESULTS: This systematic review and network meta-analysis study aims to determine the most effective and safe approach in relieving urinary symptoms, and whether it produces better results in urodynamic examination. And a high-quality ranking of the therapeutic classes will be presented. The report will follow the PRISMA checklist for network meta-analysis. Results of the search strategy and the study selection will be presented in a PRISMA compliant flow chart. CONCLUSION: This study aims to propose a standard clinical decision-making guideline for acupuncture and moxibustion treatment of NBD after SCI.


Assuntos
Terapia por Acupuntura/métodos , Moxibustão/métodos , Traumatismos da Medula Espinal/complicações , Bexiga Urinaria Neurogênica/terapia , Feminino , Humanos , Masculino , Metanálise em Rede , Ensaios Clínicos Controlados Aleatórios como Assunto , Projetos de Pesquisa , Revisões Sistemáticas como Assunto , Resultado do Tratamento , Bexiga Urinaria Neurogênica/etiologia
12.
Transplant Proc ; 52(1): 191-195, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31901322

RESUMO

PURPOSE: The study aimed to evaluate the feasibility and effectiveness of the endoscopic treatment in transplanted patients with neurogenic bladder who complained of symptomatic vesicoureteral reflux (VUR). MATERIAL AND METHODS: Fifteen patients with VUR who were previously diagnosed with a neurogenic bladder were included in the study. The Lich-Gregoire technique was used for ureterovesical anastomosis during transplantation, and a double J stent was inserted routinely in the ureter to protect the anastomosis. The sting operation was performed under general anesthesia in the lithotomy position. A 4.8 Fr double J stent (Boston Scientific, Boston, MA) was inserted to prevent the risk of ureteral obstruction. Successful treatment was defined as absent acute glomerulopyelonephritis (AGPN) during follow-up and as absent VUR on radiological evaluation. RESULTS: Clinical success was achieved in 6 of 10 patients (60%) who presented with recurrent febrile urinary tract infection (UTI) and in 4 of 6 (66%) patients who presented with gradually graft function deterioration. In 3 patients, the ureteral neo-orifice could not be localized during the operation owing to severe trabeculation of the bladder wall. The other 2 patients with a previous history of augmented bladder procedures had a hypotension attack during bladder filling; hence, the operation was stopped to prevent further complications. Two patients, whose clinical symptoms did not resolve after the sting procedure, accepted open ureteral reimplantation surgery. CONCLUSION: Endoscopic management of the VUR in the transplant patients with neurogenic bladder function is safe and effective in at least half of the patients in a mid-term follow-up period.


Assuntos
Transplante de Rim/efeitos adversos , Bexiga Urinaria Neurogênica/etiologia , Bexiga Urinaria Neurogênica/cirurgia , Procedimentos Cirúrgicos Urológicos/métodos , Refluxo Vesicoureteral/etiologia , Refluxo Vesicoureteral/cirurgia , Anastomose Cirúrgica/métodos , Criança , Pré-Escolar , Endoscopia/métodos , Feminino , Humanos , Masculino , Estudos Retrospectivos , Adulto Jovem
13.
Neurourol Urodyn ; 39(2): 762-770, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31943361

RESUMO

AIM: Neurogenic lower urinary tract dysfunction (NLUTD) is very common in multiple sclerosis (MS) patients. Early diagnosis and treatment are crucial to avoid irreversible damage and improve quality of life. Our aim was to develop recommendations to improve NLUTD identification in MS patients, along with their referral and management. METHODS: A multidisciplinary group of 14 experts in the management of patients with MS and NLUTD (nine urologists, three neurologists, and two rehabilitators) was selected. A comprehensive review of the literature was undertaken and a set of recommendations was generated and submitted to a Delphi panel of 114 experts. Recommendations were presented according to the grade of agreement (GA). RESULTS: Early diagnosis in asymptomatic patients with risk factors for complications is recommended (GA 94%). Postvoid residual volume should be measured if changes in urinary symptoms (GA 87%), preferably ultrasound-guided (GA 86%). Early referral to urologist is recommended if urinary incontinence (GA 91%), significant post-void residual volume (94%), quality of life impairment (GA 98%) and recurrent urinary infections (GA 97%). The initial evaluation should include physical examination (GA 99%) and urodynamics including cystometry (GA 89%), pressure-flow study (90%) and electromyography (GA 70%). The panel recommends multidisciplinary collaboration (GA 100%) with a rehabilitation specialist and trained nurses in the management of NLUTD (GA 99%). CONCLUSIONS: Multidisciplinary management for patients with NLUTD due to MS is advised, including urologists, neurologists, rehabilitation, and nurses. Panel recommends early diagnosis with post-void residual volume in symptomatic patients before referring to urologist and urodynamics when referred.


Assuntos
Sintomas do Trato Urinário Inferior/terapia , Esclerose Múltipla/terapia , Bexiga Urinaria Neurogênica/terapia , Consenso , Técnica Delfos , Gerenciamento Clínico , Progressão da Doença , Humanos , Sintomas do Trato Urinário Inferior/etiologia , Sintomas do Trato Urinário Inferior/fisiopatologia , Esclerose Múltipla/complicações , Neurologia , Equipe de Assistência ao Paciente , Qualidade de Vida , Encaminhamento e Consulta , Fatores de Risco , Bexiga Urinaria Neurogênica/etiologia , Bexiga Urinaria Neurogênica/fisiopatologia , Incontinência Urinária/etiologia , Incontinência Urinária/fisiopatologia , Incontinência Urinária/terapia , Infecções Urinárias/etiologia , Infecções Urinárias/fisiopatologia , Infecções Urinárias/terapia , Urodinâmica , Procedimentos Cirúrgicos Urológicos , Urologia
14.
J Urol ; 203(6): 1207-1213, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-31951496

RESUMO

PURPOSE: We determined the long-term risks of additional surgery after bladder augmentation in a modern spina bifida cohort accounting for differential followup. MATERIALS AND METHODS: We retrospectively reviewed patients with spina bifida who were born after 1972 and were followed at our institution after augmentation surgery performed between 1979 and 2018. Outcomes included diversion, bladder stones, perforation, reaugmentation, laparotomy for bowel obstruction, and benign and malignant bladder tumors. Survival analysis was used for the entire cohort and the modern cohort (detubularized and reconfigured ileocystoplasty beginning in 2000). RESULTS: A total of 413 patients were included in the study. At a median followup of 11.2 years 80.9% of the patients had undergone ileocystoplasty and 44.1% had undergone 370 additional surgeries. Ten-year risk of any reoperation was 43.9%, with 17.4% of patients undergoing 2 or more and 9.9% undergoing 3 or more additional surgeries. Outcomes included conversion to a diversion (2.7% at 10-year followup) and bladder stones (28.2% with recurrence in 52.4%) irrespective of detubularized reconfigured status (p ≥0.20). Bladder perforation risk was 9.6% for patients undergoing vs 23.7% for those not undergoing detubularized reconfigured ileocystoplasty (p=0.01). Similarly reaugmentation rate was 5.3% for patients undergoing vs 15.2% for those not undergoing detubularized reconfigured ileocystoplasty (p=0.001). Finally, 10-year reperforation risk was 32.1% for patients undergoing vs 73.8% for those not undergoing detubularized reconfigured ileocystoplasty (p=0.053). Other risks included bowel obstruction (4.5% with recurrence in 15.8%), nephrogenic adenoma (2.2% with regrowth in 48.2%) and malignancy (0.0% at 20 years). For 222 patients in the modern cohort (median followup 9.1 years) 10-year risk of any reoperation was 46.0%, which consisted of diversion in 4.0%, stones in 32.9% (recurrence in 44.5%), perforation in 8.8% (recurrence in 42.2%), reaugmentation in 4.3%, obstruction in 4.9% (recurrence in 10.0%), adenoma in 4.7% (regrowth in 40.0%) and cancer in 0.0%. CONCLUSIONS: Bladder augmentation is long-lasting. While benefiting continence and renal outcomes, this operation frequently requires additional surgeries, necessitating close followup. Since survival analysis based risks of alternative management options such as incontinent diversion are unavailable, comparisons with augmentation are unfeasible.


Assuntos
Disrafismo Espinal/complicações , Bexiga Urinaria Neurogênica/cirurgia , Bexiga Urinária/cirurgia , Adenoma/epidemiologia , Adenoma/cirurgia , Adolescente , Criança , Feminino , Seguimentos , Humanos , Obstrução Intestinal/epidemiologia , Obstrução Intestinal/cirurgia , Masculino , Reoperação/estatística & dados numéricos , Estudos Retrospectivos , Bexiga Urinária/lesões , Cálculos da Bexiga Urinária/epidemiologia , Cálculos da Bexiga Urinária/cirurgia , Neoplasias da Bexiga Urinária/epidemiologia , Neoplasias da Bexiga Urinária/cirurgia , Bexiga Urinaria Neurogênica/etiologia , Derivação Urinária/estatística & dados numéricos , Adulto Jovem
15.
World Neurosurg ; 134: e847-e854, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31715410

RESUMO

BACKGROUND: There is accumulating evidence of a potential beneficial effect of early surgical intervention after acute cervical spinal cord injury (SCI). However, around one third of all SCIs affect the thoracic spine. This cohort has not been extensively investigated, mainly because of less sensitive clinical readout measures. Apart from regaining full sensorimotor function, improvements in bladder and bowel management remain of the highest priority for patients with chronic paraplegia. Therefore, this study investigates the effect of early decompression (here defined as <8 hours) versus delayed management on neurologic and functional outcome. METHODS: We retrospectively analyzed data from the institutional database, in which follow-up data were collected prospectively according to the European Multicenter Study about Spinal Cord Injury standards. Within a 13-year period, we identified 43 patients who met inclusion and exclusion criteria. Of these, 32 (74%) were managed surgically within the first 8 hours. There was a trend toward a higher rate of patients with clinically complete SCI in the early group at baseline. RESULTS: After 1 year, we did not observe a benefit on the neurologic outcome as assessed via the American Spinal Injury Association Impairment Scale grade. Functional outcome was evaluated using the Spinal Cord Independence Measure (SCIM). The early decompressed group demonstrated significantly improved SCIM 6 (i.e., bladder management) (P < 0.045) and SCIM 9-11 subitems (i.e., mobility, transfer) (P < 0.019). CONCLUSIONS: Early decompression was an independent predictor for improved functional bladder outcome and mobility after 1 year. This effect needs to be studied in future prospective, multicenter studies.


Assuntos
Descompressão Cirúrgica/métodos , Procedimentos Neurocirúrgicos/métodos , Paraplegia/fisiopatologia , Traumatismos da Medula Espinal/cirurgia , Tempo para o Tratamento/estatística & dados numéricos , Bexiga Urinaria Neurogênica/fisiopatologia , Adulto , Idoso , Intervenção Médica Precoce , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Limitação da Mobilidade , Paraplegia/etiologia , Recuperação de Função Fisiológica , Estudos Retrospectivos , Traumatismos da Medula Espinal/complicações , Traumatismos da Medula Espinal/fisiopatologia , Vértebras Torácicas , Resultado do Tratamento , Bexiga Urinaria Neurogênica/etiologia
16.
Neurourol Urodyn ; 39(2): 854-862, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31845396

RESUMO

AIMS: To systematically compare the impact of catheter-based bladder drainage methods on the rate of urinary tract infections (UTIs) amongst patients with neurogenic bladder. METHODS: A search of Cochrane Library, Embase, Medline, and Grey literature to February 2019 was performed using methods prepublished on PROSPERO. Reporting followed the Preferred Reporting Items for Systematic Review and Meta-analysis guidelines. Eligible studies were published in English and compared UTI incidence between neurogenic bladder patients utilizing bladder drainage methods of the indwelling urethral catheter (IUC), suprapubic catheter (SPC) or intermittent self-catheterization (ISC). The odds ratio of UTI was the sole outcome of interest. RESULTS: Eight nonrandomized observational cohort studies were identified, totaling 2321 patients who utilized either IUC, SPC, or ISC. Studies enrolled patients with neurogenic bladder due to spinal cord injury (seven studies) or from any cause (one study). UTI rates were compared between patients utilizing IUC vs SPC (four studies), IUC vs ISC (six studies), and SPC vs ISC (four studies). Compared with IUC, five of six studies suggested ISC use was associated with lower rates of UTI. Studies comparing IUC vs SPC and SPC vs ISC gave mixed results. Meta-analysis was not appropriate due to study methodology heterogeneity. CONCLUSIONS: Low-level evidence suggests amongst patients with neurogenic bladder requiring catheter-based drainage, the use of ISC is associated with lower rates of UTI than IUC. Comparisons of IUC vs SPC and SPC vs ISC gave mixed results. Future randomized trials are required to confirm these findings.


Assuntos
Cateteres de Demora , Cistostomia , Traumatismos da Medula Espinal/complicações , Bexiga Urinaria Neurogênica/terapia , Cateterismo Urinário/métodos , Cateteres Urinários , Infecções Urinárias/epidemiologia , Estudos de Coortes , Drenagem/instrumentação , Drenagem/métodos , Humanos , Incidência , Razão de Chances , Projetos de Pesquisa , Autocuidado , Uretra , Bexiga Urinaria Neurogênica/etiologia , Cateterismo Urinário/instrumentação
17.
Zhongguo Zhen Jiu ; 39(11): 1177-80, 2019 Nov 12.
Artigo em Chinês | MEDLINE | ID: mdl-31724353

RESUMO

OBJECTIVE: To observe the clinical efficacy of SU Jia-fu's Wenjing Tongdu external treatment combined with long-snake moxibustion at the governor vessel for neurogenic bladder after spinal cord injury. METHODS: A total of 64 patients with neurogenic bladder after spinal cord injury were randomly divided into an observation group and a control group, 32 cases in each group. The patients in the control group were treated with routine acupuncture and rehabilitation of bladder function; based on the treatment in the control group, the patients in the observation group were treated with SU Jia-fu's Wenjing Tongdu external treatment combined with long-snake moxibustion at the governor vessel, twice a week for 8 weeks. Urodynamic test, including residual urine volume (RUV), maximum flow rate of urination (Qmax), bladder pressure at filling phase (Pves), maximum detrusor pressure (Pdet-max) and maximum urinary bladder volume (VMCC), was performed before and after 8-week treatment. RESULTS: The urodynamic indexes in the two groups were improved compared with before treatment (P<0.01, P<0.05); after treatment, VMCC in the observation group was significantly higher than the control group (P<0.01), while RUV and Pves in the observation group were significantly lower than the control group (P<0.05). After treatment, there was no significant difference in Qmax and Pdet-max between the two groups (P>0.05). CONCLUSION: Based on routine acupuncture and rehabilitation of bladder function, SU Jia-fu's Wenjing Tongdu external treatment combined with long-snake moxibustion at the governor vessel could effectively improve urodynamic indexes, reduce residual urine, reduce bladder pressure and increase the maximum capacity of bladder, thereby improving bladder compliance and bladder function.


Assuntos
Moxibustão , Traumatismos da Medula Espinal , Bexiga Urinaria Neurogênica , Terapia por Acupuntura , Animais , Humanos , Moxibustão/métodos , Traumatismos da Medula Espinal/complicações , Bexiga Urinaria Neurogênica/etiologia , Bexiga Urinaria Neurogênica/terapia , Urodinâmica
18.
Curr Urol Rep ; 20(11): 76, 2019 Nov 16.
Artigo em Inglês | MEDLINE | ID: mdl-31734847

RESUMO

PURPOSE OF REVIEW: Advancements in the care of patients affected by myelomeningocele have flourished in recent years especially with respect to renal preservation and continence. Involvement of urologists both prenatally and early in life has driven many developments in preventative care and early intervention. As of yet, however, the ideal management algorithm that offers these patients the least invasive diagnostic testing and interventions while still preserving renal and bladder function remains ill defined. RECENT FINDINGS: In a shift from prior years where the use of surgical intervention and intermittent catheterization were more liberally employed, some providers have more recently advocated for monitoring patients in a more conservative manner with a variety of diagnostic tests until radiographic or clinical changes are discovered. The criteria used to define the need for catheterization and the timing to initiate CIC or more invasive interventions is disparate across pediatric urology and there is published data to support several approaches. This review presents some of these criteria for use of CIC and some newer evidence to support different approaches along with supporting the trend toward individualized medicine and use of risk stratification in developing clinical treatment algorithms.


Assuntos
Cateterismo Uretral Intermitente , Disrafismo Espinal/terapia , Conduta Expectante , Humanos , Rim/fisiopatologia , Medição de Risco , Disrafismo Espinal/complicações , Disrafismo Espinal/cirurgia , Bexiga Urinaria Neurogênica/etiologia , Bexiga Urinaria Neurogênica/fisiopatologia
19.
Sichuan Da Xue Xue Bao Yi Xue Ban ; 50(4): 566-570, 2019 Jul.
Artigo em Chinês | MEDLINE | ID: mdl-31642237

RESUMO

OBJECTIVE: To explore the application value of American Urological Association symptom index (AUA-SI) score in female patients of type 2 diabetes mellitus with neurogenic bladder. METHODS: This study included 289 female patients with type 2 diabetes who were hospitalized in our hospital from July 2015 to July 2018. To each of them, residual urine volume (RUV) test, fundus test, and random urinary albumin creatinine ratio (UACR) test were performed, and a questionnaire survey was conducted using AUA-SI scale. Multivariate logistic regression was used to analyze the risk factors of diabetic neurogenic bladder (DNB) in women with type 2 diabetes.RUV≥100 mL was used as the diagnostic golden standard for DNB, and the patients were divided into DNB group and non-DNP group. The ROC curve was used to evaluate the diagnostic performance of AUA-SI. Linear regression was used to test the linear trend of AUA-SI score with diabetic retinopathy stage and diabetic nephropathy stage. RESULTS: The levels of the fasting plasma glucose, hemoglobin A1c (HbA1c) and AUA-SI score in DNP group were higher than those in non-DNP group (P < 0.001). Multivariate logistic regression analysis showed that AUA-SI score had the greatest predictive value for the occurrence of DNB 〔odds ratio (OR)=1.876, P < 0.001〕.The area under the curve (AUC) was 0.843, P=0.000, 95% confidence interval (CI) (0.799, 0.888). The optimal diagnostic threshold was 7.5, the corresponding sensitivity was 0.747, and the specificity was 0.822. There was a positive correlation between the severity of AUA-SI score and the stage of diabetic retinopathy and diabetic nephropathy (P < 0.01). CONCLUSION: AUA-SI score can be used to screen female patients with DNB, while it seems parallel to the severity of DNP, diabetic retinopathy and diabetic nephropathy.


Assuntos
Diabetes Mellitus Tipo 2/complicações , Bexiga Urinaria Neurogênica/diagnóstico , Feminino , Humanos , Fatores de Risco , Sensibilidade e Especificidade , Sociedades Médicas , Inquéritos e Questionários , Estados Unidos , Bexiga Urinaria Neurogênica/etiologia
20.
Medicine (Baltimore) ; 98(39): e17322, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31574865

RESUMO

BACKGROUND: This study will aim to assess the effectiveness of the rehabilitation training (RT) combined acupuncture for the treatment of patients with neurogenic bladder (NB) secondary to the spinal cord injury (SCI). METHODS: We will conduct a comprehensive literature search from the following databases from the inceptions to the present with no language limitation: PUBMED, EMBASE, Cochrane Library, SinoMed, Web of Science, Allied and Complementary Medicine Database, VIP, WANGFANG, Chinese Biomedical Literature Database, and China National Knowledge Infrastructure. Additionally, we will also search gray literature, including dissertations and conference proceedings. RevMan V.5.3 software will be used for the study selection, assessment of bias of bias, and data synthesis. RESULTS: This study will synthesize the available evidence of RT combined with acupuncture for NB secondary to SCI, including episodes of urinary incontinence, urinary retention, urinary tract infection, bladder overactivity, quality of life, and adverse events. CONCLUSION: This study will determine whether RT combined acupuncture is an effective and safety therapy for NB secondary to SCI. SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD42019146127.


Assuntos
Terapia por Acupuntura/métodos , Traumatismos da Medula Espinal , Bexiga Urinaria Neurogênica , Humanos , Traumatismos da Medula Espinal/complicações , Traumatismos da Medula Espinal/reabilitação , Resultado do Tratamento , Bexiga Urinaria Neurogênica/etiologia , Bexiga Urinaria Neurogênica/terapia
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