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1.
Medicine (Baltimore) ; 100(6): e24573, 2021 Feb 12.
Artigo em Inglês | MEDLINE | ID: mdl-33578555

RESUMO

BACKGROUND: Diabetic neurogenic bladder (DNB) is one of the common complications of diabetes mellitus, which has a high prevalence rate. Some research suggested that acupuncture can improve the clinical symptoms of diabetic neurogenic bladder patients, but there is no systematic review or meta-analysis to assess this therapy. Therefore, this study aims to explore the effectiveness and safety of acupuncture for patients with DNB. METHODS: In this study, we will search for electronic databases including the Cochrane Library, Web of Science, PubMed, MEDLINE, EMBASE,China National Knowledge Infrastructure (CNKI), Wan-Fang, and Baidu Scholar Database from inception to December 2020. We will select randomized controlled trials that have been published in English or Chinese related to acupuncture for DNB. Selection of study, extraction of data, and assessment of study quality will be performed independently by 2 researchers, and we will use Revman 5.3 software which is provided by Cochrane assistance network, to perform the data analysis. RESULTS: This study will provide evidence of the effectiveness and safety of acupuncture for DNB. CONCLUSION: This study will clarify whether acupuncture is an effective treatment for DNB, and will also provide a reference for clinical practice and guidelines development.


Assuntos
Terapia por Acupuntura , Complicações do Diabetes/terapia , Bexiga Urinaria Neurogênica/terapia , Humanos , Metanálise como Assunto , Revisões Sistemáticas como Assunto
3.
Orv Hetil ; 162(4): 135-143, 2021 01 24.
Artigo em Húngaro | MEDLINE | ID: mdl-33486465

RESUMO

Összefoglaló. Az alsó húgyutak fo funkciója a vizelet tárolása és ürítése, amely muködések zavara az úgynevezett alsó húgyúti tünetegyüttes kialakulásához vezet, ami a kiváltó októl függoen vizeletürítési zavarral és vizeletretencióval is járhat. Kezeletlen esetekben a felso húgyutak károsodása következik be a magas hólyagnyomás által kiváltott vesicoureteralis reflux következtében, amely ureter- és veseüregrendszeri tágulat kialakulására, illetve fertozésekre és koképzodésre hajlamosít. A vizelettárolási/vizeletürítési zavarokat három fo csoportba sorolhatjuk, úgymint stressz- (terheléses) inkontinencia , hiperaktív hólyag (nedves/száraz) és neurogén hólyag. A jelen összefoglaló közlemény tárgyát képezo neurogén hólyag egy gyujtofogalom, mely magában foglal minden, releváns neurológiai kórkép talaján kialakult vizelettárolási és vizeletürítési zavart. Mivel a húgyhólyag mellett a záróizomzat és a hátsó húgycso is érintett, ezt a kórképet napjainkban "neurogén alsó húgyúti diszfunkció" elnevezéssel is szokás illetni. A kórállapotot a neurológiai diszfunkciók széles spektruma okozhatja, kezdve a helyi funkcionális zavartól a helyi idegi sérülésen át a felso és alsó motoneuron-sérülésig vagy a centrális degeneratív folyamatokig. Az eltéro etiológia ellenére a klinikai tünetek rendszerint két alapveto klinikai típusban manifesztálódhatnak: túlmuködo (fokozott detrusorkontraktilitást okozó automata) hólyag vagy alulmuködo hólyag formájában. Tekintettel a neurogén alsó húgyúti diszfunkció következtében létrejövo felso húgyúti komplikációkra, a közlemény egyik célja a betegség diagnózisát segíto algoritmus bemutatása a legújabb nemzetközi szakirodalmi ismeretek alapján. A neurogén hólyag kezelése jobbára nem terjedhet ki a kiváltó ok kezelésére, ezért a jelen összefoglaló másik célja azon gyógyszeres és invazív terápiás beavatkozások összefoglalása, melyek a felso húgyutak védelmét szolgálják az alacsony hólyagnyomás fenntartása révén. Orv Hetil. 2021; 162(4): 135-143. Summary. Storage and urination are the main functions of the lower urinary tract and its lesions lead to the so-called lower urinary tract syndrome causing either urinary incontinence or retention. In untreated cases, the upper urinary tract becomes injured via a vesicoureteral reflux resulting from increased bladder pressure and resultant dilations of the ureter and the renal pelvis which predispose to infection and stone formation. Lower urinary tract storage/urination disorders can be classified as stress incontinence, hyperactive bladder (wet/dry) and neurogenic bladder. Neurogenic bladder which is the subject of this review, is a collective term that encompasses all urinary storage and emptying disorders which develop on the basis of neurological diseases. Being not only the bladder, but also the sphincter and posterior urethra (generally termed as the "bladder outlet") affected, nowadays this condition is referred to as "neurogenic lower urinary tract dysfunction". A wide range of neurological dysfunctions could contribute to the development of this condition, ranging from local dysfunction (autonomic dysreflexia) or local nerve injury to upper/lower motoneuron injury or central degenerative processes. Regardless of the diverse etiology, the clinical symptoms eventually manifest in two major forms, i.e., overacting (automatic bladder with increased detrusor contractility) and underactive bladder. Considering the severity of complication occurring in the upper urinary tract in response to the pathophysiological changes in the lower urinary tract, one of the aims of this paper was to present an algorithm aiming to build up a state of the art diagnosis of the disease based on current international literature data. Since treatment of the neurogenic bladder usually can not target elimination of the underlying cause, the other goal of the present paper is to summarize the pharmacological treatment regimen and invasive therapeutic interventions that protect the upper urinary tract by maintaining low pressure values in the bladder. Orv Hetil. 2021; 162(4): 135-143.


Assuntos
Bexiga Urinaria Neurogênica/terapia , Bexiga Urinária/fisiopatologia , Transtornos Urinários/terapia , Humanos , Pressão
4.
J Urol ; 205(1): 213-218, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-32856985

RESUMO

PURPOSE: Neurogenic lower urinary tract dysfunction is a significant source of morbidity for individuals with spinal cord injury and is managed with a range of treatment options that differ in efficacy, tolerability and cost. The effect of insurance coverage on bladder management, symptoms and quality of life is not known. We hypothesized that private insurance is associated with fewer bladder symptoms and better quality of life. MATERIALS AND METHODS: This is a cross-sectional, retrospective analysis of 1,226 surveys collected as part of the prospective Neurogenic Bladder Research Group SCI Registry. We included patients with complete insurance information, which was classified as private or public insurance. The relationship between insurance and bladder management, bladder symptoms and quality of life was modeled using multinomial logistic regression analysis. Spinal cord injury quality of life was measured by the Neurogenic Bladder Symptom Score. RESULTS: We identified 654 privately insured and 572 publicly insured individuals. The demographics of these groups differed by race, education, prevalence of chronic pain and bladder management. Publicly insured patients were more likely to be treated with indwelling catheters or spontaneous voiding and less likely to take bladder medication compared to those with private insurance. On multivariate analysis insurance type was not associated with differences in bladder symptoms (total Neurogenic Bladder Symptom Score) or in urinary quality of life. CONCLUSIONS: There is an association between insurance coverage and the type of bladder management used following spinal cord injury, as publicly insured patients are more likely to be treated with indwelling catheters. However, insurance status, controlling for bladder management, did not impact bladder symptoms or quality of life.


Assuntos
Disparidades em Assistência à Saúde/estatística & dados numéricos , Cobertura do Seguro/estatística & dados numéricos , Seguro Saúde/estatística & dados numéricos , Satisfação do Paciente/estatística & dados numéricos , Traumatismos da Medula Espinal/complicações , Bexiga Urinaria Neurogênica/terapia , Adulto , Cateteres de Demora/economia , Cateteres de Demora/estatística & dados numéricos , Estudos Transversais , Feminino , Disparidades em Assistência à Saúde/economia , Humanos , Cobertura do Seguro/economia , Seguro Saúde/economia , Masculino , Pessoa de Meia-Idade , Medidas de Resultados Relatados pelo Paciente , Satisfação do Paciente/economia , Estudos Prospectivos , Qualidade de Vida , Estudos Retrospectivos , Traumatismos da Medula Espinal/economia , Traumatismos da Medula Espinal/terapia , Resultado do Tratamento , Bexiga Urinária/inervação , Bexiga Urinária/fisiopatologia , Bexiga Urinaria Neurogênica/diagnóstico , Bexiga Urinaria Neurogênica/economia , Bexiga Urinaria Neurogênica/etiologia , Cateterismo Urinário/economia , Cateterismo Urinário/estatística & dados numéricos
5.
Annu Int Conf IEEE Eng Med Biol Soc ; 2020: 3873-3876, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-33018846

RESUMO

Managing the urinary bladder is of primary importance to clinicians and patients after trauma to the spinal cord. Sacral Anterior Root Stimulators that control the bladder have been available as clinical technology for many years, however these devices cannot measure the fullness of the urinary bladder or detect the onset of reflex voiding. In order to address this fundamental limitation, it is necessary to develop a method for recording the neural signals that encode bladder fullness. This paper presents a proof of concept technique for recording bladder afferents from the extradural sacral roots using a multiple electrode cuff. Results are provided from acute in-vivo experiments performed in sheep.


Assuntos
Raízes Nervosas Espinhais , Bexiga Urinaria Neurogênica , Animais , Humanos , Sacro/diagnóstico por imagem , Ovinos , Bexiga Urinaria Neurogênica/terapia , Micção
6.
Medicine (Baltimore) ; 99(25): e20680, 2020 Jun 19.
Artigo em Inglês | MEDLINE | ID: mdl-32569199

RESUMO

RATIONALE: Herpes zoster (HZ) involving sacral dermatome is very rare, which can sometimes cause voiding dysfunction. PATIENT CONCERNS: A 52-year-old man presented with acute pain and voiding dysfunction, following HZ in his right sacral dermatomes. DIAGNOSES: Twenty two days before presentation HZ occurred and 9 days after the onset of the HZ, he had trouble with starting urination and weak urine stream which was managed with tamsulosin 0.4 mg orally once a day and intermittent urinary catheterization. He was treated with 150 mg of pregabalin 2 times a day, tramadol 50 mg 2 times, and acetaminophen 600 mg 2 times a day. However, his pain intensity was 5 on the numerical analogue scale (NRS) from 0 (no pain) to 10 (worst pain imaginable). INTERVENTIONS: Fluoroscopy guided caudal block was performed with a mixture of 0.5% lidocaine 10 mL and triamcinolone 40 mg. OUTCOMES: One day after the procedure, the pain decreased to 1 on the NRS score. In addition, voiding difficulty greatly improved. Three days after the intervention, the patient reported complete resolution of pain and voiding dysfunction. He currently remains symptom free at a 3-month follow-up. LESSONS: A caudal block with steroid can be an effective option for treatment of acute voiding dysfunction and pain following sacral HZ.


Assuntos
Anestesia Caudal/métodos , Herpes Zoster/complicações , Neuralgia Pós-Herpética/tratamento farmacológico , Manejo da Dor/métodos , Sacro/virologia , Bexiga Urinaria Neurogênica/virologia , Anestésicos Locais/uso terapêutico , Fluoroscopia , Glucocorticoides/uso terapêutico , Humanos , Lidocaína/uso terapêutico , Masculino , Pessoa de Meia-Idade , Medição da Dor , Tansulosina/uso terapêutico , Triancinolona/uso terapêutico , Bexiga Urinaria Neurogênica/terapia , Cateterismo Urinário , Agentes Urológicos/uso terapêutico
7.
Neurourol Urodyn ; 39(6): 1885-1888, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32526088

RESUMO

Coronavirus disease-2019 (COVID-19) pandemic significantly altered our daily life as well as our professional practice. COVID-19 has disrupted our lives both professionally and personally. We know the urological management in a neurogenic patient needs to be tailored to the individual circumstances, this is even more pertinent during these uncertain times. International Continence Society is the premier international organization in functional urology. Lately, it has established an institute to facilitate teaching and training opportunities all over the world. The School of Neurourology teamed with the School of Modern Technology and set up a Webinar-"How to manage the neuro-urological patients in the current pandemic." This was set up as a case-based discussion to deliberate the management of our patients in the present climate and examine the role of modern technology in overcoming the current barriers.


Assuntos
Infecções por Coronavirus , Pandemias , Pneumonia Viral , Telemedicina , Bexiga Urinaria Neurogênica/terapia , Urologia/tendências , Betacoronavirus , Coronavirus , Gerenciamento Clínico , Previsões , Humanos , Guias de Prática Clínica como Assunto , Sociedades Médicas
8.
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
9.
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
10.
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
11.
Neurourol Urodyn ; 39(5): 1410-1416, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32282088

RESUMO

AIMS: To assess the urodynamic findings during the filling phase in neurogenic bladder patients with or without vesicoureteral reflux (VUR) who underwent sacral neuromodulation (SNM). METHODS: We retrospectively reviewed the records of 19 patients with neurogenic lower urinary tract dysfunction (NLUTD) who underwent SNM at our center from July 2018 to July 2019. Clinical data and video-urodynamic parameters were collected. VUR grading systems were used to evaluate upper urinary tract function. RESULTS: The mean test duration was 24 ± 8.2 days. The urodynamic evaluation showed a significant increase in the mean maximum cystometric capacity (136.3 ± 118.2 vs 216.5 ± 137.8 mL; P = .0071) and compliance (8.7 ± 8.52 vs18.3 + 16.47 mL/H2 O; P = .016), as well as a decrease in maximum intravesical pressure (57 ± 39.23 vs 36.58 ± 31.16 H2 O; P = .0064). In the voiding phase, none of the patients had automatic urination at the baseline and testing phases. In 8 of 19 patients who had detrusor overactivity (DO), the DO disappeared (four patients) or was delayed (four patients). The VUR in 3 of 12 ureter units disappeared. The grade of VUR or the volume before VUR improved in 8 ureter units, and the remaining 1 did not change significantly. An implant was performed in 16 cases. After permanent implantation, all patients needed intermittent catheterization to empty the bladder. CONCLUSIONS: This retrospective study indicates that SNM can improve the urinary storage function of the bladder in appropriate patients with NLUTD. For patients with VUR, SNM can cure or reduce VUR by improving DO and bladder compliance.


Assuntos
Terapia por Estimulação Elétrica/métodos , Plexo Lombossacral , Bexiga Urinaria Neurogênica/fisiopatologia , Urodinâmica , Refluxo Vesicoureteral/fisiopatologia , Adulto , Eletrodos Implantados , Feminino , Humanos , Sintomas do Trato Urinário Inferior/fisiopatologia , Sintomas do Trato Urinário Inferior/terapia , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Resultado do Tratamento , Bexiga Urinaria Neurogênica/terapia , Bexiga Urinária Hiperativa/fisiopatologia , Bexiga Urinária Hiperativa/terapia , Micção , Procedimentos Cirúrgicos Urológicos , Adulto Jovem
12.
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
13.
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
14.
Neurourol Urodyn ; 39(2): 498-506, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31794087

RESUMO

BACKGROUND: Treatment in children and adolescents with a neurogenic bladder is primarily conservative with the goal of preserving the upper urinary tract combined with a good reservoir function of the bladder. However, sometimes-even in childhood-conservative management does not prevent the development of a low-compliant bladder or overactive detrusor. MATERIAL & METHODS: After a systematic literature review covering the period 2000-2017, the ESPU/EUAU guideline for neurogenic bladder underwent an update. RESULTS: In these patients, surgical interventions such as botulinum toxin A injections into the detrusor muscle, bladder augmentation, and even urinary diversion may become necessary to preserve the function of the upper (and lower) urinary tracts. The creation of a continent catheterizable channel should be offered to patients with difficulties performing transurethral clean intermittent catheterization. However, a revision rate of up to 50% needs to be considered. With increasing age continence of urine and stool becomes progressively more important. In patients with persistent weak bladder outlets, complete continence can be achieved only by surgical interventions creating a higher resistance/obstruction at the level of the bladder outlet with a success rate of up to 80%. In some patients, bladder neck closure and the creation of a continent catheterizable stoma is an option. CONCLUSION: In all these patients close follow-up is mandatory to detect surgical complications and metabolic consequences early.


Assuntos
Bexiga Urinaria Neurogênica/cirurgia , Bexiga Urinaria Neurogênica/terapia , Derivação Urinária/métodos , Procedimentos Cirúrgicos Urológicos/métodos , Adolescente , Criança , Feminino , Humanos , Masculino
15.
Neurourol Urodyn ; 39(1): 45-57, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31724222

RESUMO

BACKGROUND: In childhood, the most common reason for a neurogenic bladder is related to spinal dysraphism, mostly myelodysplasia. AIMS: Herein, we present the EAU/ESPU guidelines in respect to the diagnostics, timetable for investigations and conservative management including clean intermittent catheterization (CIC). MATERIAL AND METHODS: After a systematic literature review covering the period 2000 to 2017, the ESPU/EUAU guideline for neurogenic bladder underwent an update. RESULTS: The EAU/ESPU guideline panel advocates a proactive approach. In newborns with spina bifida, CIC should be started as soon as possible after birth. In those with intrauterine closure of the defect, urodynamic studies are recommended be performed before the patient leaves the hospital. In those with closure after birth urodynamics should be done within the next 3 months. Anticholinergic medication (oxybutynin is the only well-investigated drug in this age group-dosage 0.2-0.4 mg/kg weight per day) should be applied, if the urodynamic study confirmed detrusor overactivity. Close follow-up including ultrasound, bladder diary, urinalysis, and urodynamics are necessary within the first 6 years and after that the time intervals can be prolonged, depending on the individual risk and clinical course. In all other children with the suspicion of a neurogenic bladder due to various reasons as tethered cord, inflammation, tumors, trauma, or other reasons as well as those with anorectal malformations, urodynamics-preferable video-urodynamics, should be carried out as soon as there is a suspicion of a neurogenic bladder and conservative treatment should be started soon after confirmation of the diagnosis of neurogenic bladder. With conservative treatment the upper urinary tract is preserved in up to 90%, urinary tract infections are common, but not severe, complications of CIC are quite rare and continence can be achieved at adolescence in up to 80% without further treatment. DISCUSSION AND CONCLUSIONS: The transition into adulthood is a complicated time for both patients, their caregivers and doctors, as the patient wants to become independent from caregivers and treatment compliance is reduced. Also, transition to adult clinics for patients with neurogenic bladders is often not well-established.


Assuntos
Tratamento Conservador , Bexiga Urinaria Neurogênica/diagnóstico , Bexiga Urinaria Neurogênica/terapia , Adolescente , Criança , Feminino , Humanos , Cateterismo Uretral Intermitente , Masculino
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
18.
Neoreviews ; 20(12): e711-e724, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31792158

RESUMO

Spinal dysraphism, which includes conditions such as myelomeningocele and sacral agenesis, is one of the most common causes of congenital lower urinary tract dysfunction. Early evaluation of the neurogenic bladder serves to minimize renal damage, and the main goals of management include preserving renal function, achieving acceptable continence, and optimizing quality of life. The survival of patients with such conditions has improved to greater than 80% reaching adulthood, owing to advances in diagnostic and therapeutic modalities. The result is a real, and unfortunately often unmet, need for successful transitional care in this complex patient population. Clinicians must be able to identify the unique challenges encountered by patients with neurogenic bladder as they shift through different stages of their life.


Assuntos
Inibidores da Liberação da Acetilcolina/uso terapêutico , Toxinas Botulínicas Tipo A/uso terapêutico , Antagonistas Colinérgicos/uso terapêutico , Bexiga Urinaria Neurogênica/terapia , Cateterismo Urinário/métodos , Anormalidades Múltiplas/diagnóstico por imagem , Terapias Fetais , Humanos , Hidronefrose/etiologia , Hidronefrose/prevenção & controle , Meningocele/complicações , Meningocele/diagnóstico por imagem , Meningomielocele/complicações , Meningomielocele/diagnóstico por imagem , Meningomielocele/cirurgia , Região Sacrococcígea/anormalidades , Região Sacrococcígea/diagnóstico por imagem , Espinha Bífida Oculta/complicações , Espinha Bífida Oculta/diagnóstico por imagem , Disrafismo Espinal/complicações , Disrafismo Espinal/diagnóstico por imagem , Disrafismo Espinal/cirurgia , Transição para Assistência do Adulto , Ultrassonografia Pré-Natal , Bexiga Urinária , Bexiga Urinaria Neurogênica/diagnóstico , Bexiga Urinaria Neurogênica/fisiopatologia , Infecções Urinárias , Urodinâmica , Urologia , Refluxo Vesicoureteral , Conduta Expectante
19.
Neurourol Urodyn ; 38 Suppl 5: S134-S141, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31821635

RESUMO

AIMS: Efforts to engineer and repair genitourinary tissue to treat lower urinary tract dysfunction (LUTD) have recently increased thanks in part to advances in stem cell (SC) research. At the International Consultation on Incontinence-Research Society meeting in Bristol in 2018 a proposal was convened to address the question: has the potential of SCs in treating LUTD reached clinical maturity? METHODS: The proposal conducted a literature review and an expert consensus meeting focusing on available data from animal models and clinical trials involving the use of SCs for LUTD. RESULTS: To date, there are only small studies investigating bladder replacement using scaffolds with or without SC. Results have been conflicting because of the variability in cell numbers, biomaterials types, and graft surface differences. Similarly, preclinical results suggest a possible role of SC in bladder outlet obstruction (BOO); however, SC clinical trials for BOO are lacking. Research into the use of SC for female stress urinary incontinence (SUI) is close to reaching clinical maturity. In the Canadian phase 3 randomized controlled trial (RCT), a beneficial effect of adult muscle-derived cells (AMDC) over placebo was detected in reducing the frequency of incontinence episodes, especially after prior anti-incontinence surgery. Only two small studies have been published on male SUI. CONCLUSIONS: Questions remain regarding the mechanism of action of SC injected into the LUT and the viability of cells seeded onto grafts placed into the LUT. Also, the optimal time for intervention with SC therapy in the LUT remains to be elucidated.


Assuntos
Transplante de Células-Tronco/métodos , Obstrução do Colo da Bexiga Urinária/terapia , Bexiga Urinaria Neurogênica/terapia , Incontinência Urinária por Estresse/terapia , Incontinência Urinária/terapia , Animais , Humanos , Engenharia Tecidual , Tecidos Suporte , Obstrução do Colo da Bexiga Urinária/fisiopatologia , Bexiga Urinaria Neurogênica/fisiopatologia , Incontinência Urinária/fisiopatologia , Incontinência Urinária por Estresse/complicações , Sistema Urogenital/fisiopatologia
20.
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
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