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1.
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
2.
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
3.
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
4.
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
5.
Top Spinal Cord Inj Rehabil ; 25(3): 195-204, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31548786

RESUMO

Neurogenic bladder is a chronic condition affecting patients of all ages with significant medical and quality of life implications. Goals of treatment consist of protection of the upper urinary tract and promotion of reliable urinary continence. Successful management involves medications and most often bladder drainage via clean intermittent catheterization. This article reviews current literature on medical management to achieve goals of treatment.


Assuntos
Bexiga Urinaria Neurogênica/terapia , Antagonistas Adrenérgicos alfa/uso terapêutico , Adulto , Toxinas Botulínicas/uso terapêutico , Cateteres de Demora , Criança , Antagonistas Colinérgicos/uso terapêutico , Humanos , Cateterismo Uretral Intermitente
6.
Top Spinal Cord Inj Rehabil ; 25(3): 205-213, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31548787

RESUMO

The authors review urologic dysfunction, including urine retention, incontinence, and recurrent and resistant urinary tract infection, in dogs as a sequela to acute spinal cord injury. Urologic sequelae to acute spinal cord injury (SCI) pose significant complications in human and canine patients impacting quality of life and long-term cost of treatment. Dogs with intervertebral disc extrusion may serve as a natural disease model of acute SCI for investigating translational interventions, both prophylactic and therapeutic, for urologic dysfunction in human SCI patients.


Assuntos
Doenças do Cão/terapia , Degeneração do Disco Intervertebral/veterinária , Deslocamento do Disco Intervertebral/veterinária , Traumatismos da Medula Espinal/veterinária , Bexiga Urinaria Neurogênica/terapia , Bexiga Urinaria Neurogênica/veterinária , Doença Aguda , Animais , Cateteres de Demora , Cães , Cateterismo Uretral Intermitente , Degeneração do Disco Intervertebral/complicações , Deslocamento do Disco Intervertebral/complicações , Traumatismos da Medula Espinal/complicações , Bexiga Urinaria Neurogênica/etiologia
7.
Arch Esp Urol ; 72(7): 662-669, 2019 Sep.
Artigo em Espanhol | MEDLINE | ID: mdl-31475677

RESUMO

OBJECTIVES: To describe the bladder management in spinal cord injury and to verify if the increase in the age of the patient who is suffering a spinal cord injury in recent years is conditioning a change in its treatment. METHODS: We performed a retrospective review of all acute traumatic spinal cord injured patients in Canary Islands between 2001-2015. Data were collected from the hospital records of a regional referral Spinal Cord Unit. RESULTS: The sample included 250 patients. Patients' mean age was observed to increase from 38 to 47 years during the study (p<0.05). Clean Intermittent Catheterization (CIC) was the most used bladder emptying method (42.4%), followed by normal voiding (NV) (26.4%) and permanent derivation (PD) (23.6%). There was a decrease in CIC use (48.1% to 40.3%) and an increase in PD use (13.5% to 32.5%) ( p<0.05 ). Cervical injuries were associated with NV (35.8%), while thoracic and lumbar injuries were associated with IC (67% and 41.7% respectively). Patients discharged to a health care residence were associated with IC (81.8%) (p<0.05). CONCLUSIONS: CIC is currently the most frequently used bladder emptying method in spinal cord injured patients in our population. The mean age of new spinal cord injury patients is progressively increasing and it promotes the use of indwelling catheter with an increased risk of urologic complications.


Assuntos
Traumatismos da Medula Espinal , Bexiga Urinaria Neurogênica/terapia , Adulto , Humanos , Pessoa de Meia-Idade , Estudos Retrospectivos , Espanha , Cateterismo Urinário
8.
Br J Hosp Med (Lond) ; 80(9): C133-C135, 2019 Sep 02.
Artigo em Inglês | MEDLINE | ID: mdl-31498674

RESUMO

Urinary catheterization is an important procedure that is regularly performed in hospital. All clinicians should have a good working knowledge of urinary catheters and the competence to manage them effectively. This topic will be discussed over two articles: this first article will focus on indications, and the second on techniques and managing failure. There are multiple indications for urethral catheter insertion and a range of catheter types and sizes. The choice of catheter is dependent on the patient and indication. This article discusses this in more detail to help guide clinicians involved in urethral catheterization.


Assuntos
Complicações Intraoperatórias/prevenção & controle , Obstrução do Colo da Bexiga Urinária/terapia , Bexiga Urinaria Neurogênica/terapia , Cateterismo Urinário , Cateteres Urinários , Incontinência Urinária/terapia , Retenção Urinária/terapia , Doença Aguda , Anestesia/métodos , Cateteres de Demora , Doença Crônica , Humanos , Índice de Gravidade de Doença , Bexiga Urinária/lesões
9.
Arch. esp. urol. (Ed. impr.) ; 72(7): 662-669, sept. 2019. tab, graf
Artigo em Espanhol | IBECS | ID: ibc-187852

RESUMO

Objetivos: Describir el manejo vesical en pacientes con una lesión medular y comprobar si el aumento de la edad media del paciente que está sufriendo una lesión medular en los últimos años está condicionando un cambio en su tratamiento. Materiales y métodos: Hemos realizado un estudio retrospectivo de todos los pacientes que han sufrido una lesión medular traumática aguda en Canarias entre el 2001-2015. Los datos se han recogido del registro hospitalario de una unidad de referencia regional para la lesión medular. Resultados: La muestra ha sido de 250 pacientes. La media de edad del paciente aumentó de 38 a 47 años a lo largo del estudio (p< 0,05). El cateterismo intermitente (CI) fue el método de vaciado vesical más usado (42,4%) seguido de la micción voluntaria (MV) (26,4%) y la derivación permanente (DP) (23,6%). Durante este tiempo hubo un descenso en el uso del CI (48,1% a 35,4%) y un aumento de la DP (13,5% a 32,5%) (p< 0,05). Las lesiones cervicales se relacionaron con la MV (35,8%) mientras que las lesiones dorsales y lumbares lo hicieron con el CI (67% y 41,7% respectivamente). El destino al alta a una residencia se asoció con la DP (81,8%) (p<0,05). Conclusiones: El CI es actualmente el método de vaciado vesical más usado en el lesionado medular en nuestro medio. El aumento de la edad media del paciente que sufre una lesión medular está favoreciendo un progresivo incremento de la derivación permanente con el riesgo de complicaciones urológicas que puede ocasionar


Objectives: To describe the bladder management in spinal cord injury and to verify if the increase in the age of the patient who is suffering a spinal cord injury in recent years is conditioning a change in its treatment. Methods: We performed a retrospective review of all acute traumatic spinal cord injured patients in Canary Islands between 2001-2015. Data were collected from the hospital records of a regional referral Spinal Cord Unit. Results: The sample included 250 patients. Patients' mean age was observed to increase from 38 to 47 years during the study (p < 0.05). Clean Intermittent Catheterization (CIC) was the most used bladder emptying method (42.4%), followed by normal voiding (NV) (26.4%) and permanent derivation (PD) (23.6%). There was a decrease in CIC use (48.1% to 40.3%) and an increase in PD use (13.5% to 32.5%) (p < 0.05). Cervical injuries were associated with NV (35.8%), while thoracic and lumbar injuries were associated with IC (67% and 41.7% respectively). Patients discharged to a health care residence were associated with IC (81.8%) (p < 0.05). Conclusions: CIC is currently the most frequently used bladder emptying method in spinal cord injured patients in our population. The mean age of new spinal cord injury patients is progressively increasing and it promotes the use of indwelling catheter with an increased risk of urologic complications


Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Traumatismos da Medula Espinal/complicações , Bexiga Urinaria Neurogênica/etiologia , Bexiga Urinaria Neurogênica/terapia , Cateterismo Urinário , Índice de Gravidade de Doença , Estudos Retrospectivos
10.
Transplant Proc ; 51(7): 2501-2502, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31405733

RESUMO

OBJECTIVE: Urologic complications are among the most common complications after kidney transplantation. These complications are urinary retention, hematuria, hemorrhage, urinary leakage, vesicoureteral reflux, pyelonephritis, and nephrolithiasis. Although neurogenic bladder is one of the indications for kidney transplantation, it is not considered in the literature to be an expected complication after transplantation. In this case, we discuss the nursing care of a patient who underwent kidney transplantation from a living donor and developed neurogenic bladder. CASE REPORT: A 60-year-old woman underwent kidney transplantation from a living donor, and neurogenic bladder developed in the patient 1 year after kidney transplantation. Clear intermittent catheterization treatment was administered for the kidney transplant recipient with neurogenic bladder. Clear intermittent catheterization treatment was stopped in the patient who had frequent urinary tract infections and, alternatively, sacral neuromodulation treatment was administered to the patient. CONCLUSIONS: The nursing care of a patient with neurogenic bladder after kidney transplantation aims to prevent excessive bladder distension, infection, stone formation, vesicoureteral reflux, renal failure, urinary tract damage, and incontinence, and to ensure regular and complete discharge of the bladder. The most common treatment modalities for these objectives are permanent or intermittent catheterization, sacral neuromodulation, and medical therapy. In the care of the patient with neurogenic bladder after kidney transplantation, nurses should provide appropriate care related to treatment options and bladder training, plan urination schedules of the patient, and monitor for possible complications.


Assuntos
Transplante de Rim/efeitos adversos , Bexiga Urinaria Neurogênica/etiologia , Bexiga Urinaria Neurogênica/enfermagem , Bexiga Urinaria Neurogênica/terapia , Feminino , Humanos , Cateterismo Uretral Intermitente/efeitos adversos , Pessoa de Meia-Idade , Estimulação Elétrica Nervosa Transcutânea/métodos , Infecções Urinárias/etiologia , Infecções Urinárias/terapia
11.
Arch Phys Med Rehabil ; 100(10): 1939-1944, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31348899

RESUMO

OBJECTIVE: To validate if better upper extremity (UE) motor function predicts clean intermittent catheterization (CIC) adoption and adherence after spinal cord injury (SCI) using a validated instrument (as opposed to prior research using scales based on expert opinion). DESIGN: We examined data from the Neurogenic Bladder Research Group SCI registry, a multicenter, prospective, observational study assessing persons with neurogenic bladder following SCI. All participants who were unable to volitionally void and were >1 year post injury were included. Participants were dichotomized into those performing CIC vs those using other bladder management methods. In addition to demographic and clinical characteristics, UE motor function was examined using the SCI-Fine Motor Function Index using validated categorization levels: (1) no activities requiring hand function, (2) some activities involving gross hand movement, (3) some activities requiring dexterity or coordinated UE movement, or (4) most activities requiring dexterity and coordinated UE movement. Associations were examined using logistic regression. SETTING: Multicenter study. PARTICIPANTS: Registry participants unable to volitionally void after SCI (N=1236). INTERVENTION: Not applicable. MAIN OUTCOME MEASURE: Upper extremity motor function association with CIC. RESULTS: A total of 1326 individuals met inclusion criteria (66% performing CIC, 60% male, and 82% white). On multivariate analysis, better UE motor function was associated with a statistically increased odds of performing CIC (odds ratio, 3.10 [Level 3] and odds ratio, 8.12 [Level 4] vs Levels 1 and 2 [P<.001]). CONCLUSION: In persons with SCI who are unable to volitionally void, UE motor function is highly associated with CIC. These results validate prior findings and continue to suggest that following SCI, the degree of preserved UE motor function is associated with CIC more than any other factor.


Assuntos
Cateterismo Uretral Intermitente , Traumatismos da Medula Espinal/fisiopatologia , Extremidade Superior/fisiopatologia , Bexiga Urinaria Neurogênica/terapia , Adulto , Fatores Etários , Estudos de Coortes , Comorbidade , Grupos de Populações Continentais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Obesidade/complicações , Sistema de Registros , Bexiga Urinaria Neurogênica/fisiopatologia
12.
Zhen Ci Yan Jiu ; 44(5): 363-6, 2019 May 25.
Artigo em Chinês | MEDLINE | ID: mdl-31155870

RESUMO

OBJECTIVE: To observe the therapeutic effect of plum-blossom needle tapping plus moxibustion in the treatment of post-stroke neurogenic bladder(PSNB). METHODS: A total of 60 PSNB patients were equally randomized into control group (16 men and 14 women, 65.6±7.9 years in age, 10.1±6.3 months in the duration of disease) and treatment group (18 men and 12 women, 63.8±8.5 years in age, 9.8±6.5 months in the duration of disease). Patients of the control group were treated by asking the patients to make a pelvic muscular exercise and passive intermittent urethral catheterization. For patients of the treatment group, a plum-blossom needle was used to alternatively tap the bilateral Shenshu(BL23), Qihaishu(BL24), Guanyuanshu(BL26), Xiaochangshu(BL27), Pangguangshu(BL28), Huiyang(BL35), Shangliao(BL31), etc., followed by performing moxibustion over the skin of Shenque(CV8), Guanyuan(CV4), Qihai(CV6) and Zhongji(CV3), etc. about 15 min. In addition, patients without spontaneous urination were also received urethral catheterization as those in the control group. The treatment was given once every day except the weekends and for two months. The integrated symptom score was assessed. The frequencies of diurnal urination and urinary incontinence, and the urination volume every time were respectively recorded for consecutive 3 days before and after the treatment, and the residual urine volume was also measured. The therapeutic effect was evaluated based on the status and frequency of diurnal urination and residual urine volume each time. RESULTS: Of the two 30 cases in the control and treatment groups, 2(6.7%) and 5(16.7%) were cured, 8(26.7%) and 12(40.0%) experienced marked improvement in their symptoms, 13(43.3%) and 11(36.7%) were improved, 7(23.3%) and 2(6.7%) failed, with the effective rates being 76.7% and 93.3%, respectively. The effective rate of the treatment group was significantly higher than that of the control group(P<0.05). After the treatment, the integrated symptom score, residual urine volume, and frequencies of diurnal urination and urinary incontinence were significantly decreased, and the diurnal urination volume was obviously increased in comparison with their own pre-treatment in both groups(all P<0.05). The therapeutic effect of the treatment group was significantly superior to that of the control group in reducing the integrated symptom score, residual urine volume, and frequencies of diurnal urination and urinary incontinence(P<0.05), and in increasing the diurnal urination volume(P<0.05). CONCLUSION: Plum-blossom needle tapping plus moxibustion is an effective option for the treatment of PSNB in improving symptoms, in reducing the residual urine volume and frequencies of diurnal urination and urinary incontinence, and in increasing the diurnal urination volume, deserving being promoted in primary care.


Assuntos
Moxibustão , Prunus domestica , Acidente Vascular Cerebral , Bexiga Urinaria Neurogênica , Idoso , Feminino , Flores , Humanos , Masculino , Pessoa de Meia-Idade , Acidente Vascular Cerebral/complicações , Bexiga Urinaria Neurogênica/etiologia , Bexiga Urinaria Neurogênica/terapia
13.
Arch Esp Urol ; 72(5): 483-499, 2019 Jun.
Artigo em Espanhol | MEDLINE | ID: mdl-31223126

RESUMO

OBJECTIVES: The purpose of this document is to establish practical recommendations on neurogenic bladder (NB) management based on scientific evidence and medical and nursing perspective in Spinal Cord Injury (SCI) Units as a first multidisciplinary consensual approach in Spain. METHODS: This paper reports results from the first modified Delphi consensus building exercise on this procedure. A committee of recognised opinion-leaders in rehabilitation and urology with special interest in NB was constituted. A working group formed by rehabilitation doctors, urologists and nursing staff of SCI and Neurorehabilitation Units of a number of Spanish hospitals and specialised centres associated with the panel of NB experts have prepared this document. RESULTS: This review provided an overview of the main aspects described by the different clinical guidelines already available and highlighted the need to focus on recommendations in special priority situations in which there was no consensus. In view of the considerable impact this condition has on quality of life, patients should be offered help to better understand the disorder and they should be taught how to use the treatment techniques to obtain satisfactory results and promote their autonomy. CONCLUSIONS: This article presents a version of guidelines for patients with NB. The guidelines define the clinical profile of patients to provide the best evidence- based care and also an overview of the current drug and surgical treatments of NB.


Assuntos
Bexiga Urinaria Neurogênica , Consenso , Humanos , Qualidade de Vida , Espanha , Bexiga Urinaria Neurogênica/diagnóstico , Bexiga Urinaria Neurogênica/terapia
14.
Hinyokika Kiyo ; 65(4): 123-126, 2019 Apr.
Artigo em Japonês | MEDLINE | ID: mdl-31247690

RESUMO

We report a case of misdirection of a catheter for clean intermittent catheterization (CIC) into the ureter. A four-year-old girl with neurogenic bladder due to myelomeningocele had been managed with CIC by her parents for several years. From about a month before her visit, macroscopic hematuria appeared intermittently followed by abdominal pain and fever-up for a short time which ceased spontaneously. As cystography demonstrated bilateral vesicoureteral reflux, we performed endoscopic intraureteral injection of Deflux[TM] and during the operation we confirmed influx of bloody urine from the right ureteral orifice but not from the left one. As computed tomography revealed a tubular foreign body located in the upper portion of the right ureter, another endoscopic operation was performed and it was removed successfully. The removed foreign body was identified as a disposable catheter that was used for CIC.


Assuntos
Cateterismo Uretral Intermitente , Meningomielocele , Bexiga Urinaria Neurogênica , Refluxo Vesicoureteral , Pré-Escolar , Feminino , Humanos , Cateterismo Uretral Intermitente/efeitos adversos , Meningomielocele/terapia , Ureter , Bexiga Urinaria Neurogênica/terapia , Refluxo Vesicoureteral/etiologia
15.
J Urol ; 202(3): 574-584, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-30958741

RESUMO

PURPOSE: Neurogenic bladder significantly impacts individuals after spinal cord injury. We hypothesized that there would be differences in bladder related symptoms and quality of life for 4 common bladder management methods. MATERIALS AND METHODS: In this prospective observational study we measured neurogenic bladder related quality of life after spinal cord injury. Study eligibility included age 18 years or greater and acquired spinal cord injury. Bladder management was grouped as 1) clean intermittent catheterization, 2) an indwelling catheter, 3) surgery (bladder augmentation, a catheterizable channel or urinary diversion) and 4) voiding (a condom catheter, involuntary leaking or volitional voiding). The primary outcomes were the NBSS (Neurogenic Bladder Symptom Score) and the SCI-QoL Difficulties (Spinal Cord Injury Quality of Life Measurement System Bladder Management Difficulties). Secondary outcomes were the NBSS subdomains and satisfaction with urinary function. Multivariable regression was done to establish differences between the groups, separated by level. RESULTS: Of the 1,479 participants enrolled in the study 843 (57%) had paraplegia and 894 (60%) were men. Median age was 44.9 years (IQR 34.4-54.1) and median time from injury was 11 years (IQR 5.1-22.4). Bladder management was clean intermittent catheterization in 754 cases (51%), an indwelling catheter in 271 (18%), surgery in 195 (13%) and voiding in 259 (18%). In regard to primary outcomes, in cases of paraplegia and tetraplegia an indwelling catheter and surgery were associated with fewer urinary symptoms on the NBSS compared to clean intermittent catheterization while voiding was associated with more symptoms. In paraplegia and tetraplegia cases surgery was associated with fewer bladder management difficulties according to the SCI-QoL Difficulties. In regard to secondary outcomes, surgery was associated with improved satisfaction in individuals with paraplegia or tetraplegia. CONCLUSIONS: In individuals with spinal cord injury fewer bladder symptoms were associated with an indwelling catheter and surgery, and worse bladder symptoms were noted in voiding individuals compared to those on clean intermittent catheterization. Satisfaction with the urinary system was improved after surgery compared to clean intermittent catheterization.


Assuntos
Medidas de Resultados Relatados pelo Paciente , Qualidade de Vida , Traumatismos da Medula Espinal/complicações , Bexiga Urinaria Neurogênica/terapia , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Satisfação do Paciente/estatística & dados numéricos , Estudos Prospectivos , Resultado do Tratamento , Bexiga Urinária/inervação , Bexiga Urinária/fisiopatologia , Bexiga Urinária/cirurgia , Bexiga Urinaria Neurogênica/etiologia , Bexiga Urinaria Neurogênica/fisiopatologia , Bexiga Urinaria Neurogênica/psicologia , Cateterismo Urinário/métodos , Micção/fisiologia , Procedimentos Cirúrgicos Urológicos/métodos , Adulto Jovem
16.
Urol Int ; 102(4): 476-481, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30999304

RESUMO

BACKGROUND: Intermittent self-catheterization (ISC) is by far the most appealing therapy to achieve a complete bladder emptying in patients with neurogenic lower urinary tract dysfunction (NLUTD). Four questionnaires have been developed in French in order to assess patient's satisfaction, difficulties and acceptance of this technique. OBJECTIVES: The aim of this study was to translate, culturally adapt and validate Dutch versions of the Intermittent Catheterization Satisfaction Questionnaire (InCaSaQ), the Intermittent Catheterization Acceptance Test (ICAT), the Intermittent Self Catheterization Questionnaire (ISCQ) and the Intermittent Catheterization Difficulty Questionnaire (ICDQ). METHODS: (1) Translation and cross-cultural adaptation of the questionnaires were performed according to the standardized guidelines. (2) The test of the pre-final version was performed by a group of bilingual lay people by comparing the original version of the questionnaires and the back translated one, assessing the comparability of language and comparability of interpretation. (3) Problematic issues were reviewed for correction. (4) Reliability was examined by intra-class correlation coefficients (ICC) statistics and Cronbach alpha analysis. RESULTS: Pre-test by 45 raters who are fluent in the source language led to an adapted and improved version of the translated questionnaires. Fifty native Dutch-speaking patients performing ISC (>6 months) due to an NLUTD were prospectively included. InCaSaQ, ICAT, ISCQ and ICDQ showed good internal consistency (α respectively (test and re-test): 0.79-0.88, 0.88-0.92, 0.85-0.88, and 0.88-0.86) and reproducibility (ICC respectively 0.77, 0.84, 0.84, and 0.87). CONCLUSION: The translated versions of InCaSaQ, ICAT, ISCQ and ICDQ are reliable and valid, allowing self-reported assessment of satisfaction, acceptance, difficulties and quality of life related to ISC in Dutch-speaking patients with NLUTD.


Assuntos
Cateterismo/métodos , Sintomas do Trato Urinário Inferior/terapia , Autocuidado/métodos , Inquéritos e Questionários , Bexiga Urinaria Neurogênica/terapia , Doenças Urológicas/terapia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Cateterismo/psicologia , Feminino , Humanos , Idioma , Masculino , Pessoa de Meia-Idade , Países Baixos , Satisfação do Paciente , Psicometria , Qualidade de Vida , Reprodutibilidade dos Testes , Índice de Gravidade de Doença , Estatística como Assunto , Adulto Jovem
17.
J Urol ; 202(1): 153-158, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-30916625

RESUMO

PURPOSE: Urinary tract infections are common and severe complications in patients with spina bifida. Management includes intermittent bladder catheterization with single use or reused sterile catheters. There is insufficient evidence to set a standard among the different techniques. We determined whether single use polyvinylchloride catheters would reduce urinary tract infections compared to reused polyvinylchloride catheters in patients with neurogenic bladder due to spina bifida. MATERIALS AND METHODS: We performed a 2-arm randomized parallel clinical trial from 2015 to 2016 with an 8-week followup at our center in patients with neurogenic bladder caused by spina bifida. Patients were divided into single use and reused polyvinylchloride catheter groups. Evaluations were done on days 0, 7, 14, 28, 42 and 56. Participants reported symptoms and urine cultures were obtained. The primary outcome was urinary tract infection frequency, defined as positive urine culture plus fever, flank pain, malaise, or cloudy or odorous urine. Study eligibility criteria were age 2 years or greater, spina bifida diagnosis with regular clean intermittent bladder catheterization and no urinary tract infection at initial evaluation. RESULTS: The calculated sample size was 75. Of the patients 135 were screened, 83 were randomized and 75 completed followup. Mean age was 12.7 years (range 2-56) and there were 29 males and 46 females. No statistical difference was found between the single use vs reused catheter groups in the frequency of asymptomatic bacteriuria (32.4% vs 23.7%, p = 0.398) or urinary tract infections (35.2% vs 36.8%, p = 0.877). CONCLUSIONS: Single use polyvinylchloride catheters for intermittent bladder catheterization did not decrease the incidence of urinary tract infections in our patients with neurogenic bladder compared to reused polyvinylchloride catheters. These results are consistent with the 2014 Cochrane Review.


Assuntos
Cateterismo Uretral Intermitente/instrumentação , Cateterismo Uretral Intermitente/métodos , Disrafismo Espinal/complicações , Bexiga Urinaria Neurogênica/terapia , Infecções Urinárias/prevenção & controle , Adolescente , Adulto , Materiais Biocompatíveis , Criança , Pré-Escolar , Equipamentos Descartáveis , Reutilização de Equipamento , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Cloreto de Polivinila , Bexiga Urinaria Neurogênica/etiologia , Cateteres Urinários , Infecções Urinárias/etiologia , Adulto Jovem
18.
Curr Urol Rep ; 20(5): 21, 2019 Mar 23.
Artigo em Inglês | MEDLINE | ID: mdl-30904966

RESUMO

PURPOSE OF REVIEW: We highlight the substantial gaps in knowledge on urologic care of female spinal cord injury (SCI) patients. RECENT FINDINGS: Males account for approximately 80% of people living with SCI in developed nations. Although there is a robust body of literature in some aspects of urologic care of individuals with SCI, such as treatments for neurogenic detrusor overactivity, there are relatively few studies focusing specifically on females. There are also few studies focusing on other aspects of urologic care of women with SCI such as sexual dysfunction, pelvic organ prolapse, and bladder cancer. Established guidelines for bladder management exist, generally recommending intermittent catheterization, but the fact remains that a substantial number of women with SCI utilize indwelling catheters for bladder management. There remains a paucity of literature using patient-reported measures regarding both outcomes and experiences of urologic management in the SCI population. Bladder management is challenging for many women with SCI. There are few studies on other urologic concerns in women with SCI.


Assuntos
Sintomas do Trato Urinário Inferior/terapia , Traumatismos da Medula Espinal/complicações , Bexiga Urinaria Neurogênica/terapia , Cateteres de Demora , Feminino , Humanos , Sintomas do Trato Urinário Inferior/etiologia , Medidas de Resultados Relatados pelo Paciente , Prolapso de Órgão Pélvico/etiologia , Prolapso de Órgão Pélvico/fisiopatologia , Prolapso de Órgão Pélvico/terapia , Qualidade de Vida , Fatores Sexuais , Disfunções Sexuais Fisiológicas/etiologia , Disfunções Sexuais Fisiológicas/fisiopatologia , Disfunções Sexuais Fisiológicas/terapia , Traumatismos da Medula Espinal/epidemiologia , Traumatismos da Medula Espinal/mortalidade , Uretra/patologia , Bexiga Urinaria Neurogênica/etiologia , Bexiga Urinária Hiperativa/etiologia , Bexiga Urinária Hiperativa/fisiopatologia , Bexiga Urinária Hiperativa/terapia , Incontinência Urinária/etiologia , Incontinência Urinária/fisiopatologia , Incontinência Urinária/terapia
19.
J Int Med Res ; 47(5): 2011-2017, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30880527

RESUMO

OBJECTIVE: This study aimed to evaluate the effect of continuous care intervention on the quality of life (QoL) of patients with neurogenic bladder. METHODS: Eighty-two patients with neurogenic bladder dysfunction caused by spinal cord injury were included into the study. All of the patients had continuous care intervention (for 3 months), including clean intermittent self-catheterization, drinking guidance, and bladder training guidance. A health record was established for each patient before discharge and was used to record changes in the patients when followed up. Scores of QoL, which were based on the World Health Organization Quality of Life-BREF, occurrence of complications, and compliance of all patients were recorded. RESULTS: After 3-month care intervention, there were significantly fewer complications than before the intervention. Patients' compliance and QoL were significantly higher after 3 months of care intervention than before the intervention. CONCLUSION: Continuous care intervention can improve patients' compliance and reduce urinary complications.


Assuntos
Qualidade de Vida , Bexiga Urinaria Neurogênica/terapia , Adolescente , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Cooperação do Paciente , Adulto Jovem
20.
Pediatr Int ; 61(7): 706-711, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30779413

RESUMO

BACKGROUND: Overnight catheter drainage (OCD) is introduced to avoid overdistention of the bladder at night-time when clean intermittent catheterization proves ineffective for daytime management of neurogenic bladder. We adopted OCD using disposable silicone no-balloon (DSnB) catheters, with the distal end outside the body opening into diapers. OCD using DSnB catheter, however, had risks of retrograde bacterial contamination. Therefore, in this study, the validity of equipping DSnB catheters with check valves to prevent retrograde bacterial contamination was examined. METHODS: For the in vitro study, excised saline-filled swine bladders were drained using DSnB catheters with or without check valves, and the time required for intravesical pressure to reach 5 cmH2 O was measured. For the in vivo study, in cross-over experiments comparing DSnB catheters with and without check valves, OCD using DSnB catheters for 10 h was performed in rabbits under analgesia. Bacterial growth from urine samples before and after OCD and residual urine volume were examined. RESULTS: For the in vitro experiment, the median drainage time was 368.2 s (range, 88-1,085 s) and 344.7 s (range, 28-840 s) with and without check valves, respectively (n = 6), which was not significantly different. For the in vivo experiment, in cross-over experiments (n = 8) new bacterial growth rates after OCD did not differ, and median residual urine volume was 17.1 mL (range, 0-75 mL) and 1.2 mL (range, 0-5 mL) with and without check valves, respectively (P = 0.055). CONCLUSIONS: Installing a check valve in the DSnB catheter did not decrease new bacterial growth, while tending to increase residual urine volume. DSnB catheters without check valves appear to be better for continuous drainage of urine from bladder.


Assuntos
Equipamentos Descartáveis , Drenagem/instrumentação , Bexiga Urinaria Neurogênica/terapia , Cateterismo Urinário/instrumentação , Cateteres Urinários , Animais , Estudos Cross-Over , Equipamentos Descartáveis/microbiologia , Drenagem/efeitos adversos , Drenagem/métodos , Técnicas In Vitro , Masculino , Coelhos , Distribuição Aleatória , Suínos , Cateterismo Urinário/efeitos adversos , Cateterismo Urinário/métodos , Cateteres Urinários/efeitos adversos , Cateteres Urinários/microbiologia , Infecções Urinárias/etiologia , Infecções Urinárias/prevenção & controle
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