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Study design:Cross-sectional study.Objectives:Our aim was to compare the effects of repeated cystometric measurements in spinal cord injury (SCI) patients with neurogenic detrusor overactivity (NDO) who use indwelling catheters (IDC) or intermittent catheterization (IC).Setting:Turkey.Methods:A total of 20 SCI patients with NDO, 9 patients on IC and 11 on IDC for at least two consecutive months were included. After emptying the bladder, first involuntary detrusor contraction volume (1stIDCV), cystometric bladder capacity (CC), bladder compliance and maximum detrusor pressure (MPdet) were assessed by filling it with sterile physiological saline at room temperature at a continuous rate of 30 ml min−1. The bladder was re-emptied after the process and a second filling cystometry was performed in the same way.Results:When all study population were taken into account, 1stIDCV and CC measures were significantly increased in the second cystometry compared with the first cystometry (P=0.001 and P=0.022, respectively), whereas there was no statistically significant difference on bladder compliance and MPdet measures between the first and the repeated cystometry. There was no statistically significant difference on 1stIDCV, CC and bladder compliance measures between the first and the repeated cystometries for IC group, whereas there was statistically significant increase on these measures in the IDC group (P=0.003, P=0.008 and P=0.022, respectively). In addition there was no statistically significant difference on MPdet measures between the first and the repeated cystometries for both the urine drainage methods. When IC and IDC groups were compared according to mean values of differences in 1stIDCV, CC and bladder compliance measures between the two cystometries, the IDC group had a statistically significant increase in all parameters when compared with the IC group in the second cystometry performed (P=0.001, P=0.003 and P=0.048, respectively).Conclusion:Repeated cystometric measurements in SCI patients with NDO lead to an increase in 1stIDCV and CC. However, when the type of urine drainage method is taken into account, although repeated filling cystometry leads to an increase in 1stIDCV, MCC and bladder compliance in patients with IDC, it does not cause a difference in patients on IC. [ABSTRACT FROM AUTHOR]

Study design:Retrospective investigation.Objectives:To investigate the occurrence, characteristics and clinical consequences of urethral strictures in men with neurogenic lower urinary tract dysfunction (NLUTD) using intermittent catheterization (IC) for bladder evacuation.Setting:Spinal cord injury rehabilitation center.Methods:The patient database was screened for men with NLUTD who had presented for a routine video-urodynamic investigation between 2008 and 2012. Patient characteristics, bladder diary details, the occurrence of urethral strictures and performed urethrotomy procedures were collected from patient charts. Urethral strictures were classified using the Wiegand scoring system modified for men with NLUTD.Results:The occurrence rate of urethral strictures (that is, 25% confidence interval (CI) 21-30%) was significantly (P=0.0001) higher in men using IC (n=415) than in men using other bladder evacuation methods (that is, 14% CI 11-17%) (n=629). Urethral strictures had occurred after a median 5.9 years (range 0.5-48.9 years) of IC. There was no significant (P>0.08) effect of tetraplegia or catheter type on the stricture occurrence rate. Approximately one-third of the men suffering from urethral strictures underwent internal urethrotomies. The radiographic stricture severity score was not associated with the need for surgical correction of the stricture. The radiographic recurrence rate of urethral strictures in operated men was 100%, a median 14 years after the first urethrotomy.Conclusions:The occurrence rate of urethral strictures is significantly higher in men using IC than in men using other bladder evacuation methods. Every fourth men using IC may be affected by urethral strictures. However, only every third stricture may require a surgical intervention. [ABSTRACT FROM AUTHOR]

Objectives:This observational study aimed to determine the types of urological lesion encountered in veterans with traumatic spinal cord injury (SCI) with neurogenic bladder (NGB), and the usage of bladder management programs to deal with NGB.Setting:NGB (detrusor muscle and urethral sphincter dysfunction with loss of bladder sensation to void) is common in daily practice; however, information on types of urological lesions encountered in these veterans with NGB and how best to manage their NGB is limited.Methods:We retrospectively reviewed the electronic charts of veterans with SCI enrolled in our program and regularly followed in our SCI clinic. Demographic data collected included: age, gender, ethnicity and age, level, severity and cause of spinal injury. Also noted was presence of NGB, episodes of urinary tract infection (UTI), bladder program followed and urological lesions found on renal nuclear scans, renal ultrasounds and cystoscopies.Results:Of the 161 veterans with SCI, symptoms of NGB was present in 133 (82.6%). Veterans with NGB had more severe spinal injury and more frequent UTI (P<0.05). Renal atrophy and hydronephrosis were the most common urological lesions seen in patients with UTI. Clean intermittent catheterization (CIC) was the most frequently used bladder program resulting in less frequent occurrence of UTI.Conclusion:Renal atrophy and hydronephrosis were the most common urological lesions encountered in veterans with NGB especially in those with UTI. CIC was the most frequently used bladder management program with the least risk for UTI. [ABSTRACT FROM AUTHOR]

Study design:This study was designed as a comparative cross-sectional cross-over trial on children performing clean intermittent catheterization (CIC) with reused catheters for 1 or 3 weeks.Objectives:To determine the incidence of symptomatic urinary tract infection (UTI) and bacteriuria (defined as colony count of ⩾105 colony forming units per ml of a single strain of organism) in these two different frequencies of catheter change.Setting:Multidisciplinary children's neurogenic bladder clinics at two tertiary care hospitals in Kuala Lumpur Malaysia.Methods:Forty children aged between 2 and 16 years performing CIC for at last 3 years were recruited. Medical and social data were obtained from case files. Baseline urine cultures were taken. All children changed CIC catheters once in 3 week for the first 9 weeks followed by once a week for the next 9 weeks. Three-weekly urine cultures were obtained throughout the study. Standardization of specimen collection, retrieval and culture was ensured between the two centers.Results:At baseline, 65% of children had bacteriuria. This prevalence rose to 74% during the 3-weekly catheter change and dropped to 34% during the weekly catheter change (Z-score 6.218; P<0.001). Persistence of bacteriuria (all three specimens in each 9-week period) changed significantly from 60 to 12.5%, respectively (P<0.005). There was no episode of UTI during the 18-week study period.Conclusion:Reuse of CIC catheters for up to 3 weeks in children with neurogenic bladders appears to increase the prevalence of bacteriuria but does not increase the incidence of symptomatic UTI. [ABSTRACT FROM AUTHOR]

Study design:Retrospective case series.Objectives:The primary aim was to assess the clinical effects of sacral neuromodulation (SNM) for neurogenic bladder and/or bowel dysfunction with multiple symptoms secondary to spinal cord disease or injury.Setting:Beijing, China.Methods:Between 2011 and 2013, 23 patients with multiple bladder and/or bowel problems secondary to spinal cord disease or injury were treated with a preliminary test SNM. If at least 50% clinical improvement occurred, then the patient underwent a permanent SNM procedure. We evaluated the patients using a bladder diary, post-void residual volume measurement and the Wexner questionnaire score for constipation before the test phase, during the test phase and after the permanent SNM.Results:In the test phase, the rate of improvement in dysuria (29.4%) was significantly lower than urgency frequency (64.7%), urinary incontinence (69.2%) and constipation (75.0%). An implant was performed in 13 (56.5%) patients, including 4 patients who still used intermittent catheterization to exclude urine after permanent SNM because the symptom of dysuria could not be improved significantly and 1 patient who achieved ⩾50% improvement in lower urinary tract dysfunction but not in constipation. During follow-up (17.5±2.0 months), 1 patient (7.7%) failed and 1 patient had bilateral vesicoureteral reflux.Conclusion:Chronic SNM cannot always resolve all the bladder and bowel symptoms secondary to spinal cord disease or injury, but combined with other treatments may help improve multiple symptoms. [ABSTRACT FROM AUTHOR]

Aims:The majority of patients with spinal cord injury (SCI) will develop neurogenic lower urinary tract dysfunction (NLUTD). These patients require a long-term urological follow-up. The follow-up protocol has varied across SCI units in the United Kingdom and Eire. We reviewed the long-term management in the SCI units to identify changes in practice over a decade and compared them to current guidelines.Methods:We present results of a review of all SCI centres in the United Kingdom and Eire on their long-term urological management before and after the current guidelines and compared the results with European Association of Urology (EAU) Guidelines on NLUTD and the proposed British guidelines for the urological management of patients with SCI. Data were collected through questionnaires posted to SCI units.Results:SCI patients are followed up in outpatients annually in the SCI centres and the frequency of follow-up remains largely unchanged. More SCI units perform renal tract imaging annually as a part of SCI follow-up. Most units follow the proposed British guideline indications for urodynamics and do not perform 'routine urodynamics'.Conclusions:We conclude that the long-term management of SCI patients in SCI units in the United Kingdom and Eire has changed overtime to follow the proposed British guidelines. EAU guidelines offer a more extensive follow-up regime. Last, there is a continued lack of high-quality evidence to support an optimal long-term follow-up protocol. Importantly, there is a lack of evidence on clinical outcomes when these guidelines have been followed. [ABSTRACT FROM AUTHOR]

Study design:Multi-center, cross-sectional study.Objectives:Our aim was to evaluate the treatment methods and follow-up of neurogenic bladder in patients with traumatic spinal cord injury retrospectively using a questionnaire.Setting:Turkey.Methods:Three hundred and thirty-seven patients who had spinal cord injury for at least 2 years were enrolled from six centers in the neurogenic bladder study group. They were asked to fill-out a questionnaire about treatments they received and techniques they used for bladder management.Results:The study included 246 male and 91 female patients with a mean age of 42±14 years. Intermittent catheterization (IC) was performed in 77.9% of the patients, 3.8% had indwelling catheters, 13.8% had normal spontaneous micturition, 2.6% performed voiding maneuvers, 1.3% used diapers and 0.6% used condom catheters. No gender difference was found regarding the techniques used in bladder rehabilitation (P>0.05). Overall, 63.2% of patients used anticholinergic drugs; anticholinergic drug use was similar between genders (P>0.05). The most common anticholinergic drug used was oxybutynin (40.3%), followed by trospium (32.6%), tolterodine (19.3%) darifenacin (3.3%), propiverine (3.3%) and solifenacin (1.1%). The specialties of the physicians who first prescribed the anticholinergic drug were physiatrists (76.2%), urologists (22.1%) and neurologists (1.7%). Only four patients had previously received injections of botulinum-toxin-A into the detrusor muscle and three of them stated that their symptoms showed improvement. Most of the patients (77%) had regular follow-up examinations, including urine cultures, urinary system ultrasound and urodynamic tests, when necessary; the reasons for not having regular control visits were living distant from hospital (15.3%) and monetary problems (7.7%). Of the patients, 42.7% did not experience urinary tract infections (UTI), 36.4% had bacteriuria but no UTI episodes with fever, 15.9% had 1-2 clinical UTI episodes per year and 5% had ⩾3 clinical UTIs. The clinical characteristics of patients with and without UTI (at least one symptomatic UTI during 1 year) were similar (P>0.05). The frequency of symptomatic UTI was similar in patients using different bladder management techniques (P>0.05).Conclusion:The most frequently used technique for bladder rehabilitation in patients with SCI was IC (77.9%). In all, 63.2% of patients used anticholinergic drugs, oxybutynin being the most commonly used drug. Also, 77% of patients had regular control visits for neurogenic bladder; 42.7% did not experience any UTIs. [ABSTRACT FROM AUTHOR]

Study design:Qualitative study using individual in-depth interviews.Objectives:The objective of this study was to explore the factors influencing the choice of bladder management for male patients with spinal cord injury (SCI).Setting:Public hospitals in Malaysia.Methods:Semistructured (one-on-one) interviews of 17 patients with SCI; 7 were in-patients with a recent injury and 10 lived in the community. All had a neurogenic bladder and were on various methods of bladder drainage. Interviews were audio-recorded, transcribed verbatim and analyzed using thematic analyses.Results:The choice of bladder management was influenced by treatment attributes, patients' physical and psychological attributes, health practitioners' influences and social attributes. Participants were more likely to choose a treatment option that was perceived to be convenient to execute and helped maintain continence. The influence of potential treatment complications on decision making was more variable. Health professionals' and peers' opinions on treatment options had a significant influence on participants' decision. In addition, patients' choices depended on their physical ability to carry out the task, the level of family support received and the anticipated level of social activities. Psychological factors such as embarrassment with using urine bags, confidence in self-catheterization and satisfaction with the current method also influenced the choice of bladder management method.Conclusion:The choice of bladder management in people with SCI is influenced by a variety of factors and must be individualized. Health professionals should consider these factors when supporting patients in making decisions about their treatment options. [ABSTRACT FROM AUTHOR]

Study design:Retrospective study.Objectives:To analyze the neurogenic bladder characteristics and treatment approaches in patients with upper and lower cervical spinal cord injury (SCI) in order to make proper and reasonable decisions to the relevant patients.Setting:Rehabilitation center in Ankara, Turkey.Method:Ninety patients with cervical SCI were included. The urodynamic analyses of the patients were conducted retrospectively by using the urodynamic laboratory records. The patients were divided into two groups as the upper cervical SCI (UCSCI) group (C1-C5) and lower cervical SCI (LCSCI) group (C6-C8).Results:In this study, 82 male (91.1%) and 8 (8.9%) female patients were included. There were 51 UCSCI patients with the mean age of 34.2±16.1 years and 39 LCSCI patients with the mean age of 30.4±12.5 years. Detrusor overactivity and preservation of the bladder-filling sensation were significantly more frequent in the UCSCI group than in the LCSCI group (P=0.048, P=0.000 respectively). Moreover, there were statistically significant differences between the groups regarding the bladder-emptying methods, residual volume and the frequency of anticholinergic and alpha blocker use (all P<0.05). No significant difference was found between the groups regarding the frequency of autonomic dysreflexia, detrusor hypocompliancy and the bladder-storage and -emptying disorders (all P>0.05).Conclusion:Our results demonstrate that there are differences in the upper and lower SCI cases in terms of neurogenic bladder characteristics and treatment approaches. [ABSTRACT FROM AUTHOR]

Study design:Double-blind, randomised, multicentre study.Objectives:Efficacy and tolerability of propiverine extended-release (ER) compared with immediate-release (IR) were evaluated in patients with proven neurogenic detrusor overactivity (NDO).Setting:Six Spinal Cord Injury Units located in Austria, Germany and Romania.Methods:Propiverine ER 45 mg s.i.d. or IR 15 mg t.i.d. were administered in patients with proven NDO. Outcomes were assessed at baseline (V1), and after 21 days of treatment (V2): Reflex volume served as primary, leak point volume and maximum detrusor pressure as secondary efficacy outcomes, treatment-related adverse events as tolerability outcomes.Results:Sixty-six patients with proven NDO were enrolled. Reflex volume (ml) increased significantly in the IR (V1: 100.9, V2: 202.9) and in the ER (V1: 89.8, V2: 180.3) group, no significant intergroup difference. Leak point volume increased, and maximum detrusor pressure decreased significantly in both groups, no significant intergroup differences. The percentage of patients presenting with incontinence was reduced by 14% in the IR and by 39% in the ER group, the difference is significant. Treatment-related adverse events manifested in 42 and 36% following propiverine IR and ER, respectively.Conclusion:The urodynamic efficacy outcomes demonstrated both galenic formulations to be equieffective. However, following propiverine ER 45 mg s.i.d. higher continence rates compared with propiverine IR 15 mg t.i.d. were achieved, possibly indicative of more balanced plasma-levels. A slight tendency for superior tolerability outcomes of propiverine ER compared with IR was demonstrated.Sponsorship:The study was sponsored by an unrestricted educational grant of APOGEPHA Arzneimittel GmbH, Dresden, Germany. [ABSTRACT FROM AUTHOR]

Study design:Retrospective analysis.Objectives:To investigate the urodynamic effects of solifenacin treatment for neurogenic detrusor overactivity (NDO) in patients with spinal cord injury (SCI).Setting:Paraplegic center in Switzerland.Methods:Retrospective analysis of case histories and urodynamic data of 35 SCI patients receiving solifenacin for treatment of NDO between 2008 and 2012. Patients were categorized as being at risk of renal damage when maximum detrusor pressure was >40 cm H2O or detrusor compliance was <20 ml cm−1 H2O.Results:Solifenacin treatment was initiated 7.3 years after SCI. Most patients (63%) had already been taking other antimuscarinic drugs. After 13.1 months (median, interquartile range 6.1-19.5 months), solifenacin treatment had resulted in significant (P<0.03) improvements in bladder capacity (median +30.0 ml), maximum detrusor pressure (median −7.0 cm H2O), reflex volume (median +62.5 ml) and detrusor compliance (median +25.0 ml cm−1 H2O). Furthermore, fewer patients presented with a risk of renal damage. However, this difference was not significant (P>0.1). The number of patients suffering from incontinence had not changed significantly. Eight and two patients discontinued solifenacin treatment as a result of insufficient efficacy and intolerable adverse events, respectively. One patient had discontinued solifenacin treatment without further explanation.Conclusion:Solifenacin treatment significantly improved bladder capacity, detrusor compliance, reflex volume and maximum detrusor pressure. Solifenacin treatment seems to be an effective oral treatment of NDO after SCI. [ABSTRACT FROM AUTHOR]

Purpose:For patients with incomplete cervical cord injuries, appropriate urinary management based on an assessment of voiding and storage function of the bladder is necessary for a better prognosis, especially during the recovery phase. In our review of medical records of such patients, we identified factors related to recovery of bladder function and parameters for predicting prognosis.Methods:In this study, we included 234 patients with incomplete cervical cord injuries admitted to Kanagawa Rehabilitation Hospital. Their medical records were retrospectively reviewed for various parameters related to final urinary management measures at discharge. Parameters included age, severity of paralysis, bladder function over time, urinary sensation and cystometry results.Results:Patients were managed using urethral catheterization, suprapubic cystostomy, clean intermittent catheterization (CIC) by oneself or care givers, CIC with occasional spontaneous voiding, or spontaneous voiding alone. Bladder function improved in majority of the patients during hospitalization. The severity of paralysis and urinary sensation are predictive parameters for improvement in voiding function. In patients who were admitted with catheterization but were discharged with spontaneous voiding, the period for recovery was 85.2 days on average (range 16-142 days).Conclusions:Selection of urinary management measures for patients with incomplete cervical cord injuries can be performed adequately by considering the severity of paralysis and urinary sensation. [ABSTRACT FROM AUTHOR]

Objective:To evaluate the clinical and urodynamic impact of intravesical electrostimulation (IVES) on incomplete spinal cord injury (SCI) patients suffering from chronic neurogenic non-obstructive urinary retention (N-NOR).Methods:One-hundred and two patients underwent at least 28 consecutive daily IVES sessions because objective evidence of detrusor acontractility instead of hypocontractility was detected. Diary entries written at various stages by each patient were compared (7 days before the IVES cycle, 15-21 days into the cycle and 7 days before its end). Responders were patients with a mean 50% reduction in both the number of daily catheterizations and post-void residual urine. Responders underwent further urodynamics at the end of the IVES cycle; patients experiencing first sensation of bladder filling, and the mean volume of first sensation of bladder filling per ml, Qmax ml s−1, among others, were evaluated. Nineteen individuals who repeated another IVES round were included in this study.Results:Thirty-eight subjects (37.2%) responded to IVES and of those, 83.3% recovered the first sensation of bladder filling after the IVES round. Nineteen responders repeated IVES within 1 year, owing to loss of efficacy. They obtained similar voiding symptoms improvement and urodynamic results as after the first IVES cycle. A timespan of <2 years from SCI to IVES, and the presence of first sensation of bladder filling at baseline represented significant predictive parameters for IVES success (P<0.05) using χ2-test.Conclusions:IVES represents a possible therapeutic option for incomplete SCI patients with N-NOR. [ABSTRACT FROM AUTHOR]

Study design:This was a multicentre, prospective, randomised study.Objectives:To compare the outcomes of intradetrusor and suburothelial onabotulinumtoxinA injections in patients with spinal cord injury and refractory neurogenic detrusor overactivity (NDO).Setting:Urology departments of two tertiary hospitals in the Czech Republic.Methods:A total of 32 spinal cord injury patients with severe NDO refractory to the standard anticholinergic treatment were randomised to receive either intradetrusor or suburothelial 300 IU onabotulinumtoxinA injections. Subjective satisfaction, bladder diary data and urodynamic data were compared in both groups before treatment and at 3 months post treatment.Results:In all, 64.3% patients in the intradetrusor group and 88.8% patients in the suburothelial group were subjectively satisfied with the treatment. There was a significant post-treatment improvement in both groups regarding the number of catheterisations over 24 h, number of incontinence episodes over 24 h, catheterised volume, cystometric capacity, volume at first involuntary detrusor contraction, maximal detrusor pressure during filling and detrusor compliance. No significant differences between the groups were observed, with the exception of improvement of detrusor compliance, which was better in the intradetrusor group. There was one adverse effect comprising transient muscle weakness that was reported by one patient in the intradetrusor group.Conclusion:Results in both groups were comparable. The authors favour suburothelial onabotulinumtoxinA injection because this method allows more precise toxin localisation. [ABSTRACT FROM AUTHOR]

Study design:Interventional, multi-center, open-label, randomized and crossover study.Objectives:The study objectives were to describe the current catheterization habits of the French neurogenic bladder patients using intermittent catheterization (IC), and to evaluate the ease of use, reliability and patients' comfort and patients' acceptance of the new 'no-touch', presumably easy-to-use VaPro catheter.Setting:Patients were recruited from 11 centers in France.Methods:In total, 106 men and women (age 18-65 years) with neurogenic bladder using IC at least four times a day were randomized into two groups. All subjects were trained to use the approved 'no-touch' method. A questionnaire evaluating patients' experiences was distributed before the start of the trial and after each 15-day period of catheter use, that is, VaPro vs conventional catheter.Results:The majority of patients in this French IC user panel had very strong catheterization habits: 2/3 of them had been using IC for 2 years with high ease of use and comfort. Nevertheless, >50% of patients would recommend the VaPro catheter to other people who need IC. More than three out of four patients felt confident and more secure with the new catheter. Men and spinal cord injury (SCI) patients were significantly more positive about the VaPro catheter than women and patients without SCI, respectively.Conclusion:The VaPro catheter is an acceptable and reliable alternative to the existing hydrophilic-coated 'no-touch' catheter.Sponsorship:This study was sponsored by Hollister France Inc. [ABSTRACT FROM AUTHOR]

Study design:Retrospective review study.Objectives:To identify whether it is safe to perform a magnetic resonance imaging (MRI) exam on patients who have a sacral anterior root stimulator (SARS).Setting:Adult patients with spinal cord injury and implanted SARS attending the National Spinal Injuries Centre who have had MRI scans.Methods:Retrospective review between 1989 and 2010. The effect of the MRI scans on the function of the SARS (Finetech-Brindley, UK) was assessed up to 6 months following MRI at 0.2 and 1.5 T.Results:A total of 18 patients with SARS implants had MRI scans at 0.2 and 1.5 T of the cervical, thoracic and lumbar spine, head, shoulder and pelvis. MRI examinations were abandoned on two occasions in one patient due to radiofrequency interference. One patient's stimulator ceased to function 5 months following MRI; both of these patients showing complications had their MRI examinations at 0.2 T. There were no adverse effects at 1.5 T. In one patient the SARS was removed within 6 months after MRI due to an unrelated medical condition. A total of 17 patients showed no symptoms that required terminating the examination. In all the 11 patients with a complete and functioning implant before MRI at 1.5 T, the SARS was functioning appropriately, and no change in bladder function was reported up to 6 months following MRI.Conclusion:It is safe to perform an MRI scan on patients with SARS providing the examination is conducted in a 1.5 T system. [ABSTRACT FROM AUTHOR]

Study design:Bladder capacity, bladder compliance, the volume of the first overactive contraction, maximal volume during cystometry (CMG) and the vesicoureteral reflux, bladder wall deformity before and after semiconditional stimulation on DPN.Objectives:To evaluate the effect of the semiconditional electrical stimulation on dorsal penile nerve (DPN) to improve the complicated bladder function in male with spinal cord injury (SCI).Setting:Semiconditional stimulation system and urodynamic laboratory in a university hospital.Participants:Six men (age, 33-59 years) with SCI incurred from 38 to 156 months before this study.Intervention:semiconditional stimulation parameters were set during CMG and semiconditional stimulation on DPN by surface electrodes via Empi Focus stimulator was applied from 14 to 28 days, at home. Parameters about bladder function were measured before and after stimulation applied.Result:All parameters for bladder after semiconditional stimulation were increased. Also, the vesicoureteral reflux and bladder wall deformity was improved in five of six patients.Conclusion:Semiconditional electrical stimulation on DPN effectively suppresses neurogenic detrusor overactivity and distend the bladder physiologically in the SCI patient with a complicated bladder. The bladder capacity and compliance as well as the bladder wall deformity were improved as a result of this treatment. [ABSTRACT FROM AUTHOR]

Study design:Our aim was to locate research and communicate the evidence found from scientific studies pertaining to the treatment of neurogenic detrusor overactivity (NDO) in the chronic stage of spinal cord injury (SCI).Objective:To address the controversy over the traditional (antimuscarinics) and the 'new' treatments for NDO and try to offer an insight on the rationale underlying the development of new drugs such as botulinum toxin (BTX), vanilloids, nociceptin/orphanin FQ. As a final point, to provide information on a new class of cation channels, the Degenerin/Epithelial Na+Channel (Deg/ENaC) Family that could be future targets for the management of NDO.Setting:International.Methods:Overview of English literature on drug management of NDO.Results:Agents that block the 'efferent' function of micturition reflex, such as antimuscarinics, are currently first-line therapy for NDO. They reach the highest level of evidence (1a) and grade of recommendation (A). However, many patients and physicians believe that the 'efferent' pharmacological management of NDO is not completely satisfactory. Consequently, research is trying to address issues of efficacy, tolerability and convenience of new therapeutic strategies targeting the 'afferent' function.Conclusion:Antimuscarinic therapy increases the bladder capacity and delays the initial urge to void. However, in some patients they fail to achieve the patient's therapeutic goals. New interesting approaches have been investigated in the last few years. BTX seems to be very promising in treating neurogenic overactive bladder (OAB), but other compounds are now on the horizon. [ABSTRACT FROM AUTHOR]

Study design:A systematic literature review.Objectives:To systematically assess the existing knowledge about treatment of neurogenic lower urinary tract dysfunction (NLUTD) in pregnant women with traumatic spinal cord injury (SCI), as urologic management of these patients is mandatory, but no guidelines are available.Setting:Paraplegic center in Switzerland.Methods:Studies were identified by electronic search of PubMed and MedLine. Data were pooled and analyzed quantitatively.Results:The evidence level of all 14 reports (163 patients, 226 pregnancies) included was low. In 13 studies, information was gathered by a retrospective review of the medical records or by questionnaires. In all studies, reported data were incomplete. SCI was cervical in 34.7%, thoracic in 61.2% and lumbar in 4.1% of the pregnant women. In all 34.7% of the women used indwelling catheters, 25% performed intermittent catheterization, 11.5% used the Credé maneuver and 28.8% voided spontaneously. A total of 64% of the patients had at least one symptomatic urinary tract infection (UTI) during pregnancy. UTIs were more common in women with indwelling catheters (100%) than in those performing intermittent catheterization (38.5%), using the Credé technique (17%) or voiding spontaneously (53.3%). One study demonstrated a significant reduction in UTI during pregnancy without complications in mothers or infants.Conclusion:No evidence-based recommendations can be drawn from the existing literature to guide urologists in the management of NLUTD in pregnant women with SCI. The number of studies is small, and data acquisition and presentation are often inadequate. Thus, further research is urgently needed. [ABSTRACT FROM AUTHOR]

Study design:Self-catheterising males aged 18 years with spinal cord lesion and normal/impaired urethral sensation were enrolled in this comparative, randomised, crossover and open-labelled multicentre trial.Objectives:When possible, intermittent catheterisation is the preferred method of bladder emptying for neurogenic bladder dysfunction. Hydrophilic-coated catheters have improved safety and ease of use, and a new compact catheter for men has been developed to improve discretion.Methods:Participants self-catheterised at least four times daily for 14 days with a standard or compact catheter. The primary outcome measure was discomfort, using a visual analogue scale. Non-inferiority was defined as a difference in mean discomfort score of <0.9 cm. Other assessments included ease of use, discretion and the degree of pain, stinging or resistance.Results:A total of 36 individuals participated and 30 were included in the intention-to-treat analysis. The mean difference between catheters for participant discomfort was −0.347 cm (95% confidence intervals: −1.493, 0.800). There were significant differences (P0.0001) in favour of the compact catheter for disposal and discretion, and inserting, storing, carrying and controlling the catheter. Fewer participants experienced resistance with the compact catheter. Participants were less likely to touch the coated part of the compact catheter. One adverse event was reported for each catheter.Conclusions:The coated compact catheter is at least as acceptable to the user as the standard catheter, with no inferiority observed in the level of discomfort. Secondary endpoints suggest that there are advantages of using the compact catheter, particularly with regard to discretion and ease of use.Setting:France/Denmark. [ABSTRACT FROM AUTHOR]

Study design:The study was designed as a single-arm clinical trial.Objectives:To investigate the therapeutic effects of detrusor botulinum toxin A (BoNT-A) treatment in patients with different levels of spinal cord injury (SCI) and types of detrusor sphincter dyssynergia (DSD).Setting:Patients with chronic suprasacral SCI and neurogenic detrusor overactivity (NDO) were treated with 200-U BoNT-A detrusor injection in a tertiary university hospital in Taiwan.Methods:Outcome assessment of urodynamic parameters and therapeutic satisfaction were performed at 3 and 6 months among patients with different demographics, SCI levels and types of DSD. The treatment outcomes were assessed by changes in Urogenital Distress Inventory 6-item short form (UDI-6), quality of life (QoL) index and detrusor pressure at maximum flow rate (Pdet.Qmax).Results:A total of 38 patients with a mean age of 40.1±12.4 years and median duration of SCI of 10.3 years were enrolled. Satisfactory response was reported in 23 (60%) patients. Significant improvements in the UDI-6 and QoL were reported and significant increases of cystometric bladder capacity and post-void residual were noted in overall patients after treatment. Patients with different clinical demographics and urodynamic parameters had similar treatment outcomes and UDI-6 scores. In 11 patients receiving repeat injections of 300 U of BoNT-A after failure of a previous 200 U injection, the treatment outcomes were not significantly different, except that the PdetQmax at 6 months were higher in the group that received 200 U of BoNT-A.Conclusion:Patients with different SCI levels or DSD types had similar treatment outcomes after detrusor 200 U BoNT-A injections for NDO. [ABSTRACT FROM AUTHOR]

Objectives:To assess the concomitant clinical improvement in incomplete spinal cord injury patients (SCIPs) suffering from neurogenic bowel symptoms (NBSs), neurogenic lower urinary tract symptoms (NLUTSs) and neurogenic erectile dysfunction (NED) using sacral neuromodulation (SNM) for NBSs and NLUTSs.Methods:Seventy-five SCIPs were selected. Before and during the follow-ups post-SNM, NLUTSs and NBSs were detected mainly through specific diaries. Erectile function was assessed using the International Index of Erectile Function composed of 5 questions (IIEF5). Quality of life (QoL) was measured with the Short Form 36 Health Survey questionnaire (SF-36). During the first stage, in which a permanent electrode was inserted percutaneously into the third sacral foramina and stimulated using an external generator, patients with NBSs or NLUTSs were required to improve their symptoms by at least 50% compared with baseline before proceeding to the second stage in which the generator was placed in the patient's buttock. NED patients needed to increase their IIEF5 score by at least 25% compared with baseline (evaluated initially 3 months after the second stage) in order to continue follow-up.Results:Fourteen out of 37 subjects who manifested two functional pelvic dysfunctions at baseline maintained notable clinical improvement in two pelvic functions (median follow-up >3 years). Six had non-obstructive retention (NOR) and NED, six double incontinence, and two constipation with NOR. In the general and mental health domains of the SF-36, all patients improved their scores by at least 20% compared with baseline.Conclusions:SNM may be beneficial to selected incomplete SCIP with concomitant pelvic functional disturbances. [ABSTRACT FROM AUTHOR]

Study design:Community-based, cross-sectional study.Objectives:This study aimed at examining and comparing the pharmacological treatments administered to traumatic and nontraumatic spinal-cord-injured patients (TSCI, NTSCI).Setting:The Interval Rehabilitation Center, Trois-Rivieres, Province of Quebec, Canada.Methods:Medical records from a cohort of 175 chronic spinal-cord-injured patients (94 TSCI and 81 NTSCI individuals) were thoroughly studied.Results:More than 19 classes and more than 300 drugs were found to be administered to SCI patients. Among them, drugs against bowel and bladder problems, blood clot or deep venous thrombosis, cardiovascular problems, depression or anxiety, stomach acidity, infections, pain, inflammation, sleeping problems and vitamin deficiency were the most commonly used (between 35 and 66% of all SCI patients). Differences between groups were found specifically for antidepressants and anxiolytics used mainly by TSCI patients whereas bisphosphonates, bronchodilators, lipid regulators and anti-inflammatory drugs were used mainly by NTSCI patients.Conclusion:The results revealed an unexpectedly large number of drugs that are prescribed to both groups of SCI patients. Given the existence of between-group differences and known risks of drug-drug interactions, it is suggested that recommendations for each group should be made to carefully examine either the necessity or the effectiveness of each treatment as well as the possibility of developing alternative strategies based on physical activity, nutrition and lifestyle to eventually reduce, hopefully, the number of pharmacological treatments administered to these individuals. [ABSTRACT FROM AUTHOR]

Study design:Monocentric cohort study.Objective:To investigate the acquisition of knowledge about spinal cord injury (SCI)-related complications in SCI patients.Setting:Level 1 trauma center.Methods:All patients with a traumatic or non-traumatic SCI were included in the study. Data were collected at admission, post-admission at 1 and 3 months and post-discharge at 6, 18 and 30 months. The discharge of all patients was between 3 and 6 months post-admission. Knowledge about pressure ulcers and bladder management was tested using the 'Knowledge' score. This score has a minimum and maximum of 0 and 20 points. To detect differences across the multiple time intervals, the Friedman test was used. Differences in the number of patients with poor (0-8), average (9-12) and good knowledge (13-20) between the different age classifications (age at injury) were calculated using a χ2-test.Results:A total of 214 patients were included. At discharge subjects had increased their knowledge score to 11.2 compared with 5.4 on admission (P<0.001). After 30 months, however, the mean score decreased to 10.8 points. At the time of discharge, the number of patients who achieved poor, average or good knowledge were 48 (22.4%), 65 (30.4%) and 101 (47.2%), respectively. Subjects of ∼50 years old and tetraplegics had better (P<0.001) knowledge compared with subjects of ∼50 years old and paraplegics, respectively.Conclusion:In this study, less than 50% of SCI patients had good knowledge about bladder management and pressure ulcers after being discharged. [ABSTRACT FROM AUTHOR]

Study design:A survey administered to 66 individuals with spinal cord injury (SCI) implementing a choice-based conjoint (CBC) analysis. Six attributes with three levels each were defined and used to generate choice sets with treatment scenarios. Patients were asked to choose the scenario that they preferred most.Objectives:To determine the utility weights for treatment characteristics as well as the overall preference for the three types of neural prostheses (NP), that is Brindley, rhizotomy-free Brindley, and pudendal nerve stimulation. Earlier studies have revealed the importance of restoration of bladder function, but no studies have been performed to determine the importance of NP features.Setting:Two academic affiliated medical systems' SCI outpatient and inpatient rehabilitation programs, Cleveland, OH.Methods:CBC analysis followed by multinomial logit modeling. Individual part-worth utilities were estimated using hierarchical Bayes.Results:Side effects had the greatest significant impact on subject choices, followed by the effectiveness on continence and voiding. NPs with rhizotomy-free sacral root stimulation were preferred (45% first choice) over pudendal afferent nerve stimulation (39% second choice) and sacral root stimulation with rhizotomy (53% third choice). Almost 20% did not want to have an NP at all times.Conclusion:CBC has shown to be a valuable tool to support design choices. The data showed that persons would prefer a bladder NP with minimally invasive electrodes, which would give them complete bladder function, with no side effects and that can be operated by pushing a button and they do not have to recharge themselves. [ABSTRACT FROM AUTHOR]

Study design:Non-randomized pilot trial.Objectives:To determine whether Escherichia coli 83972-coated urinary catheters in persons with spinal cord injury (SCI) practicing an intermittent catheterization program (ICP) could (1) achieve bladder colonization with this benign organism and (2) decrease the rate of symptomatic urinary tract infection (UTI).Setting:Outpatient SCI clinic in a Veterans Affairs hospital (USA).Methods:Participants had neurogenic bladders secondary to SCI, were practicing ICP, had experienced at least one UTI and had documented bacteruria within the past year. All participants received a urinary catheter that had been pre-inoculated with E. coli 83972. The catheter was left in place for 3 days and then removed. Participants were followed with urine cultures and telephone calls weekly for 28 days and then monthly until E. coli 83972 was lost from the urine. Outcome measures were (1) the rate of successful bladder colonization, defined as the detection (102 cfu ml−1) of E. coli 83972 in urine cultures for >3 days after catheter removal and (2) the rate of symptomatic UTI during colonization with E. coli 83972.Results:Thirteen participants underwent 19 insertions of study catheters. Eight participants (62%) became successfully colonized for >3 days after catheter removal. In these 8 participants, the rate of UTI during colonization was 0.77 per patient-year, in comparison with the rate of 2.27 UTI per patient-year before enrollment.Conclusions:E. coli 83972-coated urinary catheters are a viable means of achieving bladder colonization with this potentially protective strain in persons practicing ICP.Spinal Cord (2009) 47, 565–569; doi:10.1038/sc.2008.166; published online 13 January 2009 [ABSTRACT FROM AUTHOR]

Study design:Investigational technique evaluation.Objective:To evaluate the clinical value and limitations of one-channel cystometry as a method for urodynamic testing in patients with spinal cord lesion (SCL).Setting:Spinal Cord Injury Centers Asia.Methods:Protocol, equipment and practical performance of the one-channel cystometry as used in Ho Chi Minh City and Chiang Mai were studied.Results:One-channel cystometry permits to accurately evaluate bladder pressure development at constant filling speed. It shows detrusor muscle behaviour as detrusor overactivity and allows evaluating sensation of bladder filling. It can strongly suggest detrusor external sphincter dyssynergia. The need of bladder-relaxant drugs and their effectiveness can be evaluated. The major limitation is that the one pressure line will show changes of intravesical pressure independent of their cause, which makes a continuous thorough observation mandatory throughout the test. Other limitations are a filling rate higher than physiological and a filling solution at room temperature. As in more elaborate urodynamic testing, the observations do therefore not necessarily reflect the function of the lower urinary tract in daily life.Conclusion:One-channel cystometry is easy to perform, cheap and clinically valid. The results need to be integrated in the overall knowledge of the patient's neurological situation. The method permits one to gather a lot of information on bladder function in persons with SCL. With proper interpretation and a clear understanding of the shortcomings, it is a good guide for bladder management. It is applicable everywhere.Spinal Cord (2009) 47, 526–530; doi:10.1038/sc.2008.161; published online 23 December 2008 [ABSTRACT FROM AUTHOR]

Objective:To determine the efficacy and safety of sacral neuromodulation (SNM) in incomplete spinal cord injured (SCI) subjects affected by neurogenic lower urinary tract symptoms (NLUTS).Methods:Twenty-four SCI patients were enrolled. The individuals were divided into two groups: 13 individuals in the urinary retention category and 11 suffering from overactive bladder syndrome. All subjects underwent definitive SNM implantation (Medtronic, Inc.). Voiding symptoms were assessed using patient bladder diaries, which recorded both pre-SNM and before each follow-up (1, 3 and 6 months, and then every 6 months). Outcome measures were per 24 h: number of voids and voided volume per void for both groups; number of urinary leakages, pad use and nocturia for patients with overactive bladder syndrome; and volume per catheterization and number of catheterizations for urinary retention subjects only. Final checkups were completed by June 2008.Results:Median follow-up was 61 months. Up to the final visit, all subjects maintained a clinical improvement of more than 50% compared with baseline. Twenty-two side effects were recorded. Four subjects with urinary retention needed a new implant in the controlateral S3 sacral root because of loss of efficacy. One patient with urinary retention developed a wound infection at the implanted pulse generator site.Conclusions:Our study contains the largest series of implanted SCI patients ever published. SNM is a therapy to consider in the treatment of NLUTS for partial SCI patients, even if the loss of clinical benefits for patients with retentive NLUTS must be taken into account. All adverse events were treated effectively.Spinal Cord (2009) 47, 486–491; doi:10.1038/sc.2008.172; published online 24 February 2009 [ABSTRACT FROM AUTHOR]

Study design: A retrospective study of patients with motor complete spinal cord lesion and somatosensory preservation (American Spinal Injury Association (ASIA) impairment scale B).Objective: To determine whether neuropathic bladder dysfunction is more or less severe with more or fewer complications in patients with somatosensory preservation.Setting: 2nd Department of Physical and Rehabilitation Medicine, Neuropathic Bladder Unit, National Rehabilitation Center, EIAA, Athens, Greece.Methods: The classification of spinal cord injured patients was determined according to ASIA protocol. All patients underwent urodynamics and retrograde cystography, with a follow-up period of at least 18 months. The study sample consisted of 154 patients: 28 ASIA B patients compared with 126 ASIA A patients. We analyzed 140 traumatic and 14 nontraumatic lesions for (1) specific type of neuropathic bladder, (2) detrusor overactivity volume and pressure, (3) bladder compliance, (4) vesicoureteric reflux, (5) formation of bladder stones, (6) method of bladder emptying and (7) daily dose of anticholinergics needed to achieve safe bladder function. We also studied the presence of spasticity, autonomic dysreflexia and pain syndrome.Results: Statistically significant differences were found between ASIA A and B patients in daily dose of anticholinergics needed to achieve safe bladder function, in the incidence of incontinence episodes and in formation of bladder stones.Conclusion: Patients with somatosensory incomplete lesion of spinal cord seem to have an advantage in the management of neuropathic bladder dysfunction (fewer anticholinergics needed, fewer incontinence episodes and fewer bladder stones).Spinal Cord (2008) 46, 673–678; doi:10.1038/sc.2008.16; published online 4 March 2008 [ABSTRACT FROM AUTHOR]

Study Design:Randomized, double blind, placebo-controlled trial with a crossover design.Objective:To evaluate cranberry tablets for the prevention of urinary tract infection (UTI) in spinal cord injured (SCI) patients.Setting:Spinal Cord Injury Unit of a Veterans Administration Hospital, MA, USA.Methods:Subjects with spinal cord injury and documentation of neurogenic bladder were randomized to receive 6 months of cranberry extract tablet or placebo, followed by the alternate preparation for an additional 6 months. The primary outcome was the incidence of UTI.Results:Forty-seven subjects completed the trial. We found a reduction in the likelihood of UTI and symptoms for any month while receiving the cranberry tablet (P<0.05 for all). During the cranberry period, 6 subjects had 7 UTI, compared with 16 subjects and 21 UTI in the placebo period (P<0.05 for both number of subjects and incidence). The frequency of UTI was reduced to 0.3 UTI per year vs 1.0 UTI per year while receiving placebo. Subjects with a glomerular filtration rate (GFR) greater than 75 ml min−1 received the most benefit.Conclusion:Cranberry extract tablets should be considered for the prevention of UTI in SCI patients with neurogenic bladder. Patients with a high GFR may receive the most benefit.Sponsorship:Spinal Cord Research Foundation, sponsored by the Paralyzed Veterans of AmericaSpinal Cord (2008) 46, 622–626; doi:10.1038/sc.2008.25; published online 8 April 2008 [ABSTRACT FROM AUTHOR]

Study design:Clonal typing of neurogenic clones.Objective:To determine whether neurogenic clones carried over weeks in the urine of asymptomatic children with neurogenic bladder were similar to known uropathogenic clones associated with disease.Setting:Michigan State University; VA Medical Center, Minneapolis, MN, USA.Methods:Escherichia coli isolates from the urine of 15 children previously followed were typed by multilocus sequence typing and compared to 2 human pyelonephritis genome strains, 29 pediatric or adult symptomatic urinary tract infection strains, 15 pediatric asymptomatic bacteriuria strains, 6 animal urinary tract infection strains and a neonatal meningitis-septicemia prototype K1 strain. Phylotypes and virulence genotypes were determined using PCR.Results:Twenty-nine E. coli isolates were classified into 15 clones. Six of 15 clones were the same sequence type or a close relative to a clone that caused disease in a human or animal. These clones were considered uropathogens. The remaining nine clones were not closely related to a clone that caused disease and were considered commensal clones. Uropathogens were predominantly group B2, exhibited more virulence genes and were carried for more weeks in the neurogenic bladder compared to commensal clones. Nine of 15 children carried one or more uropathogenic clones; 4 children carried one or more commensal clones and 2 children carried both uropathogenic and commensal clones.Conclusion:Children with neurogenic bladder most commonly carried commensal clones. Uropathogenic clones were associated with prolonged carriage, however, carriage was not associated with symptomatic disease or deterioration of the upper urinary tract.Spinal Cord (2008) 46, 633–638; doi:10.1038/sc.2008.60; published online 17 June 2008 [ABSTRACT FROM AUTHOR]

Study design:Retrospective investigation using urodynamic studies and medical records.Objective:To evaluate the safety of sensation-dependent bladder emptying in complete spinal cord injury (SCI) patients, based on the preservation of the desire to void.Setting:Spinal Cord Injury Unit, Yonsei Rehabilitation Hospital, Seoul, Korea.Methods:This study was performed retrospectively on 79 complete SCI patients with lesions above T11, who had preserved the desire to void during conventional urodynamic studies. Patients were classified according to detrusor compliance and maximal bladder capacity. The clinical and urodynamic characteristics of each group were analyzed.Results:Forty-five (57.0%) patients were classified as group A and 34 (43.0%) patients were classified as group B. There were no significant differences in clinical features, such as voiding methods and the presence of autonomic dysreflexia between the two groups. Compared with group B, there were significantly more areflexic neurogenic bladder cases in group A (P<0.05). There were significantly higher maximal detrusor pressures in group B (P<0.05). There were significantly more cases with the preservation of the strong desire to void in group B (P<0.05).Conclusion:Not all patients with discomplete SCIs accepted the use of sensation-dependent bladder emptying. The safe use of sensation-dependent bladder emptying will be determined based on the results of urodynamic studies.Spinal Cord (2008) 46, 210–215; doi:10.1038/sj.sc.3102102; published online 24 July 2007 [ABSTRACT FROM AUTHOR]

Objectives:To evaluate follow-up treatments used after treatment of detrusor–sphincter dyssynergia (DSD) by a temporary urethral sphincter stent.Materials and methods:Between February 1994 and June 2003, 147 men with a mean age of 41.3±14.4 years were treated by temporary urethral stent inserted across the external sphincter for DSD. The underlying neurologic disease was quadriplegia in 85 cases, multiple sclerosis in 24 cases and paraplegia in 21 cases. A Nissenkorn (Bard) stent was used in 130 cases and a Diabolo (Porgès) stent was used in 17 cases. All patients were either unable to or they refused to perform intermittent self-catheterization. DSD was demonstrated by urodynamic studies in every case.Results:The mean duration of temporary stenting was 10.15±16.07 months. After temporary stenting, 92 patients were treated by permanent stent (Ultraflex, Boston Scientifics), 7 started intermittent self-catheterization, 12 had repeated changes of the temporary stent, 4 had an indwelling catheter, 3 underwent cystectomy with non-continent diversion, 2 were treated by endoscopic sphincterotomy, 1 was treated by bladder neck incision, 1 was treated by neuromodulation and 1 was treated by cystostomy. Fifteen patients were lost to follow-up. Two patients died during follow-up (not related to DSD).Conclusion:After treatment of DSD by a temporary urethral sphincter stent, 70.7% of patients subsequently require a permanent urethral sphincter stent. This period allows selection of patients unlikely to benefit from permanent urethral sphincter stent.Spinal Cord (2008) 46, 74–77; doi:10.1038/sj.sc.3102069; published online 1 May 2007 [ABSTRACT FROM AUTHOR]

Study design:Retrospective study.Objectives:To assess in the long-term clinical and urodynamic results of intraurethral stents in a group of patients with spinal cord injury.Setting:Spinal Cord Injury Unit, Juan Canalejo Hospital, A Coruña, Spain.Methods:Forty-seven consecutive male patients were studied from 1993 to 2002. All of them suffered from hyperreflexia with detrusor–sphincter dyssynergia (DSD) owing to spinal cord injury, and were treated by means of the placement of an intraurethral stent at the external sphincter.Results:After surgery, significant decreases in all the parameters studied were observed. The number of patients with symptoms of urinary tract infection decreased by 25% (P<0.031). Post-void residual urine volume experienced an average decrease of 224.3 cm3 (P=0.001). Episodes of dysreflexia decreased from 35.1 to 16.2% (P=0.039). The urodynamic study showed an average reduction of 44.36 cm H2O in the maximum detrusor pressure (P<0.0001). Complications in the upper urinary tract descended from 46.8 to 23.4% after placing the stent (P=0.013). The most frequent stent complication was displacement, followed by stenosis, lithiasis and intraprosthetic calcification. In all, 8.5% required the stent removal.Conclusions:Intraurethral stent is a good choice for the long-term management of DSD in spinal cord-injured patients, even in those who had been previously submitted to prior sphincterotomy. It has the advantage of being a potentially reversible procedure, so patients prefer it to more invasive therapies such as sphincterotomy.Spinal Cord (2007) 45, 621–626; doi:10.1038/sj.sc.3102011; published online 9 January 2007 [ABSTRACT FROM AUTHOR]

Study design:Prospective, cross-sectional study, based on cases of spinal cord injury (SCI).Setting:Three outpatient medical departments in Seoul, Korea.Objectives:To assess depressive symptoms in patients on clean intermittent catheterization after SCI.Methods:In total, 102 subjects (68 males and 34 females, mean age 39.5 with a range of 18–75 years) were included in the primary analysis. A control group of 110 was selected from the routine health checkup. All subjects completed the Beck Depression Inventory (BDI).Results:For patients and controls, the average total BDI scores were 20.3±1.0 and 11.4±0.5, respectively (P<0.001). With regard to severity of depression among patient groups, three (3.0%) reported normal; four (3.9%) reported mild to moderate depression; 24 (23.5%) reported moderate to severe depression; and 71 (69.6%) reported severe depression. On the multivariate logistic regression analysis, a positive association with the risk of depression was observed in gender and type of catheterization. Female patients had a 3.8-fold higher risk (odds ratio (OR) 13.83; 95% confidence interval (CI) 1.42–10.31; P=0.008) of depression than male patients. In the same model, patients who were unable to perform catheterization independently had a 4.6-fold higher risk (OR 4.62; 95% CI 1.67–12.81, P=0.003) of depression than those who were able to perform self-catheterization.Conclusions:The results demonstrate that the patients with neurogenic bladder secondary to SCI have higher degrees of depression than normal population. In addition, our findings also suggest that depression is closely related to gender and patient's ability to perform self-catheterization.Spinal Cord (2006) 44, 757–762. doi:10.1038/sj.sc.3101903; published online 24 January 2006 [ABSTRACT FROM AUTHOR]

Study design:Retrospective review.Objective:This retrospective review observes the evolution of bladder management by time and reports adult urological outcomes and complications in paediatric onset spinal cord injury (SCI).Setting:Spinal Injuries Unit RNOH Stanmore.Method:In total, 10 traumatic SCI patients with mean age at injury of 13.6 years underwent treatment, for a mean period of 13.1 years. Characteristics of injury were noted. Two diagnostic subgroups, neurogenic detrusor overactivity (NDO), and acontractile detrusor were made. Complications, treatment changes, operative procedures with follow-up were noted.Results:In group 1 (6/10 patients) with NDO, five had DSD. Initial bladder management was reflex/urge voiding (n=4), suprapubic catheterisation (SPC), (n=1) and self-intermittent catheterisation (SIC), (n=1). Two patients had multiple upper tract complications with decreased renal function, two recurrent symptomatic urinary infections and one; bladder calculus. In total, 12 operative procedures were performed to treat complications and change bladder management to, SIC+oxybutynin (n=3), ileal conduit (n=1), sacral anterior root stimulator implant (SARSI), (n=1), voiding on urge (n=1). In group 2 (4/10 patients) with a-contractile detrusor two had low compliance. Initial bladder management was SIC (n=3) and voiding on urge/straining (n=1). Two patients converted from SIC to permanent catheter drainage and reported complications. Incidental kidney stone was diagnosed in one. A total of four interventions were carried out with final management of SIC (n=2), voiding on urge/straining (n=1) and Mitrofanoff+ileocystoplasty (n=1).Conclusion:Bladder management in paediatric SCI is dependent on neurological level and type of injury; it changes with growth and is affected by changes in bladder management.Spinal Cord (2006) 44, 729–733. doi:10.1038/sj.sc.3101902; published online 31 January 2006 [ABSTRACT FROM AUTHOR]

Study design:Analysis of answers to a new questionnaire.Objective:To examine current practice patterns of physicians in the urological surveillance and management of spinal cord injury (SCI) patients in Japan.Setting:Nationwide questionnaire survey to physicians in Japan.Methods:A Japanese version of the 14-item questionnaire survey carried out in US was mailed to 770 members of the Japanese Neurogenic Bladder Society (JNBS).Results:We received answers to our questionnaire from 333 (43.2%) members of JNBS. The responders were all urologists. For surveillance of the upper urinary tract (UUT), 239 (71.8%) respondents preferred abdominal ultrasound. Cystometry was performed routinely by 174 (52.3%) respondents for the evaluation of vesicourethral function. Cystoscopy was carried out in cases of hematuria (88.0%) and bladder stone (55.3%). Surveillance of the urinary tract was performed every year in 154 (46.2%). For detection of bladder cancer, which 119 (37.9%) respondents have experienced, 94.9% physicians perform cystoscopy, 76.3% urinary cytology, and 60.4% ultrasound. For initial treatment of detrusor-sphincter dyssynergia (DSD), 225 (69.2%) respondents chose α-blocker, and 94 (28.9%) chose clean intermittent catheterization (CIC) with/without anticholinergic agent(s). For initial treatment of overactive bladder, 245 (74.7%) chose anticholinergic agent(s) only and 63 (19.2%) chose anticholinergic agent(s) with CIC. For initial treatment of areflexic bladder, 233 (73.7%) chose CIC and 63 (19.9%) chose Credé maneuver or tapping.Conclusions:This survey shows that there are some differences in urological surveillance and management of SCI patients between Japan and the US. Reasons for the discrepancy should be examined.Spinal Cord (2006) 44, 362–368. doi:10.1038/sj.sc.3101854; published online 6 December 2005 [ABSTRACT FROM AUTHOR]

Study design:Retrospective study, based on cases of spinal cord injury (SCI).Objectives:To establish hazard ratios for risk of epididymo-orchitis in SCI.Setting:South Korea.Methods:A total of 140 male patients injured before 1987 were eligible for this investigation and have been followed up on a yearly basis from January 1987 to December 2003.Results:The average age at which the lesion occurred was 24.8 years old (range, 18–53). The average time since SCI was 16.9 years (range, 1–37). A total of 34 lesions (24.3%) were complete and 106 (75.7%) were incomplete. Over the 17 years, 39 patients (27.9%) were diagnosed with epididymo-orchitis. Epididymo-orchitis was more common for patients with a history of urethral stricture (66.7 versus 25.2%, P=0.014). We also found that epididymo-orchitis was more common for patients on clean intermittent catheterization (CIC) than with indwelling urethral catheterization (42.2% versus 8.3%, P=0.030). In multivariate analysis, patients on CIC had a 7.0-fold higher risk (odds ratio, 6.96; 95% confidence interval, 1.26–38.53; P=0.026); however, a history of urethral stricture lost statistical significance (P=0.074). For other variables, no positive association with epididymo-orchitis was observed.Conclusions:In this study, CIC was an independent risk factor for the development of epididymo-orchitis in patients with SCI. In addition, our findings suggest that urethral stricture may be a contributing factor for the development of epididymo-orchitis in these patients. Correct instructions about CIC are of utmost importance.Spinal Cord (2006) 44, 165–169. doi:10.1038/sj.sc.3101825; published online 6 September 2005 [ABSTRACT FROM AUTHOR]

Objective:This in vitro model was designed to determine whether using a no-touch method for catheter preparation and insertion would affect the degree of contamination transmitted to intermittent urinary catheters. Setting: Northview Laboratories, Northbrook, IL 60062, USA. Methods:This was a parallel experimental study conducted in vitro at an independent testing laboratory under Good Manufacturing Practices. Six different models of intermittent urinary catheter were tested in triplicate, in accordance with the manufacturer's Instructions For Use (IFU). Gloved hands were contaminated with a known amount of Staphylococcus aureus or Escherichia coli, preparation for insertion was mimicked according to the manufacturer's IFU. The number of bacteria transferred to the catheter was then quantified using a validated technique. The null hypothesis tested was that the bacterial contamination resulting from handling would be the same for all of the catheters. The primary outcome measure was the amount of bacteria, expressed as colony forming units (CFU), recovered from the catheters. The catheter wrappers were sampled to confirm that active transfer of microorganisms had taken place and nonhandled samples served as the negative controls. Results:For both test organisms, the number of bacteria recovered from the catheters was significantly lower (P<0.05) for the catheters featuring the no-touch design (∼5 CFU/plate versus 2.1 × 102 to 4.4 × 102 for the traditional hydrophilic catheters). The bacterial recovery from those catheters with the no-touch design often fell below the nominal detection limit. Conclusion:The results of this study allow the null hypothesis to be rejected; it can be concluded that the no-touch method provides a significant benefit in reducing the potential for external contamination of an intermittent urinary catheter. This result supports the recent recommendations for aseptic intermittent catheterization promoted within the guidelines issued by the European Association of Urologists (EAU). Sponsorship:The study was funded by Hollister Incorporated. [ABSTRACT FROM AUTHOR]

STUDY DESIGN:: Prospective, open label, cross-over-designed clinical study. OBJECTIVE:: To evaluate the effectiveness of an instillation of lidocaine into the bladder with versus without electromotive drug administration (EMDA) to anesthetize the bladder before botulinum-A toxin injections. SETTING:: Neurourology, Swiss Paraplegic Center, Balgrist University Hospital, Zurich, Switzerland. METHODS:: In all, 28 patients with severe neurogenic detrusor overactivity but preserved bladder sensibility were treated with botulinum-A toxin injections into the detrusor muscle. A measure of 300?u of botulinum-A toxin (Botox®) was injected at 30 sites sparing the trigone. Prior to the injection, the bladder was anesthesized with conventional lidocaine instillation in a group of 10 patients and with lidocaine instillation enhanced by EMDA in 28 patients. The patients scored the injection pain on a 10-point rating scale. Pain rating scores with versus without EMDA enhancement of the lidocaine instillation were analyzed and the costs of the EMDA procedure were compared to general/spinal anesthesia. RESULTS:: The mean pain score of the 10 patients who underwent the injections of Botox® after conventional lidocaine instillation was 4.0 (SD 1.6). Following EMDA enhanced lidocaine instillation slight even or no pain occurred during the injections of Botox®, and the mean pain score was 0.5 (SD 0.2). Compared to spinal or general anesthesia, the local anesthesia saved around 15% of the costs. CONCLUSIONS:: EMDA enhanced instillation of lidocaine enables a sufficient anesthesia of the bladder wall that ensures a painless application of the botulinum-A toxin injections into the detrusor muscle. This method may avoid general or spinal anesthesia in patients with preserved bladder sensibility. It ensures considerable cost reduction, avoids anesthesia-related risks and complications and enables the procedure on an outpatient basis.Spinal Cord (2004) 42, 338-341. doi:10.1038/sj.sc.3101593 Published online 9 March 2004 [ABSTRACT FROM AUTHOR]

STUDY DESIGN:: Intercostal nerve to spinal nerve root anastomosis in chronic spine-injured patients. OBJECTIVES:: To analyze the effectiveness of neurogenic bladder reinnervation in spinal cord-injured patients through artificial creation of sprouting (intercostal nerve to spinal nerve root anastomosis). SETTING:: Center of Neurosurgery, Moscow, Russia. Operations were performed by Professor A Livshits. (At present, Professor A Livshits is working at the Spinal Care Unit, Meir General Hospital, Kfar Saba, Israel.) METHODS:: A total of 11 patients with spinal cord injury of the L1 level were operated on in the late (chronic) stage. The neurological status and urodynamics were investigated before and 12 months after operation. A laminectomy from T11 to L3 was performed. Next, a neurolysis of the 11th and 12th intercostal nerves was carried out, at a distance of 20-21?cm, and transferred to the vertebral canal. The S2-S3 roots were then cut in their proximal portion and anastomosed end-to-end to the intercostal nerves. The results of urodynamic studies were calculated by the Wilcoxon signed rank test for comparison before and 12 months after operation. RESULTS OF URODYNAMIC STUDIES:: Bladder capacity (ml) before operation - 489±79, after operation - 350±39, urine volume (ml) before - 18.2±17, after - 306.4±39.8, residual urine (ml) before - 459±99.4, after - 50±11.8. Detrusor tone (rel. units) before - 0.6±1.5, after 1.2±0.2; voiding pressure (cmH2O) before - 4.4±5.2, after - 30.5±4.9. Force of detrusor contraction before - 5±5.8, after - 32.8±5.5. Sphincter resistance (cmH2O) before - 6.5±3.8, after - 21.1±4.2. Significant improvements in bladder function were observed during the 10th to 12th postoperative months. Restoration of reflex voiding occurred in all patients; in eight of the 11 paresthesic in the groin and scrotum and reappearance of the bulbocavernous, anal and cremasteric reflexes were noted. CONCLUSION:: These results suggest that a restitutive process occurs in the bladder under novel conditions of its nerve supply provided by the intercostal nerve and by new connections established between it and the bladder nerves. Spinal cord lesions that might benefit from nerve crossover surgery would be located at the conus, so functional intercostal nerves could be connected to sacral roots to bypass the injury in an attempt to restore central connections to the bladder.Spinal Cord (2004) 42, 211-217. doi:10.1038/sj.sc.3101574 [ABSTRACT FROM AUTHOR]

OBJECTIVE:: To describe the urothelium of the neurogenic bladder in patients with myelomeningocele on clean intermittent catheterization. SETTING::Outpatient practice. METHODS:: Samples of bladder wall obtained from two groups of patients were examined for urothelium. The first group included 12 children and young adults with myelomeningocele and neurogenic bladder on intermittent catheterization for bladder emptying. The second group included eight children with vesicoureteral reflux and non-neurogenic bladder. Nine patients from the first group and four patients from the second group had urothelium. A contiguous section of each of the 13 samples with urothelium was stained for uroplakin expression, a marker of superficial bladder urothelium by immunohistochemistry. RESULTS:: Samples from children with reflux revealed normal bladder epithelium and a uniform layer of umbrella cells (95% CI: 0-60%). In contrast, the epithelium from all patients with myelomeningocele was abnormal (95% CI: 66-100%). Epithelium from five patients (four children, one adult) revealed chronic inflammation. Three patients (two children, one adult) had squamous metaplasia. The apical surface of the epithelium in all patients with chronic inflammation had some reactivity with anti-uroplakin antibody, but the cells staining positive for uroplakin were scattered along the lumenal surface of the epithelium. The apical surface of patients with squamous metaplasia was negative for uroplakin. CONCLUSION:: The urothelium of the neurogenic bladder in young patients with myelomeningocele is abnormal, with loss of uroplakin expression and altered urothelial proliferation.Spinal Cord (2004) 42, 163-168. doi:10.1038/sj.sc.3101565 [ABSTRACT FROM AUTHOR]

STUDY DESIGN:: Cross-sectional descriptive study. OBJECTIVES:: To assess long-term effects and quality of life (QoL) of using sacral anterior root stimulation (SARS) in spinal cord injured patients. SETTING:: Neurosurgical and Urological Departments of a large teaching hospital and a large rehabilitation centre in the Netherlands. METHODS:: In all, 42 patients with complete spinal cord injury (SCI) implanted between 1987 and 2000 were included. A questionnaire was constructed to determine complications, technical failures and personal experiences of the patients. The Qualiveen questionnaire was used and the outcome was compared with data obtained from a reference group of 400 SCI patients with neurogenic bladder problems not using the bladder controller. The Qualiveen questionnaire measures disease-specific aspects in four domains with respect to limitations, constraints, fears and feelings and general QoL aspects, suitable for use in SCI patients with urinary disorders. RESULTS:: The results of 37 patients are presented. Our results with the bladder controller with respect to medical and technical complications and infection rates are similar to the results presented by others. From users' experiences, the most important advantages reported were a decreased infection rate (68%), improved social life (54%) and continence (54%). Comparison of the obtained results of our patient group with the Qualiveen questionnaire with a reference group not using the bladder controller indicates that the specific impact of urinary disorders in the four domains on QoL is reduced and that general QoL is improved. CONCLUSION:: SARS is effective and safe for neurogenic bladder management in patients with complete SCI. Users' experiences are positive. Furthermore, this therapy seems to reduce the effects of urinary-disorder-specific QoL aspects, and to increase the QoL in general.Spinal Cord (2003) 41, 397-402. doi:10.1038/sj.sc.3101465 [ABSTRACT FROM AUTHOR]

STUDY DESIGN:: Prospective investigation using serial urodynamic studies. OBJECTIVE:: To evaluate type of neurogenic bladder and to observe changes of autonomous detrusor contraction (ADC) after the normalization of the compliance and capacity of the bladder in cauda equina injury. SETTING::Spinal Cord Injury Unit, Yonsei Rehabilitation Hospital, Seoul, Korea. METHODS:: Urodynamic studies were performed in 50 patients with complete cauda equina injury from trauma with an infusion ratio of 30 ml/min. Findings of urodynamic studies and clinical features of patients with low compliance were compared with those of the normal compliant patients. Fourteen patients with low compliance received oral administration of oxybutynin and propiverine and intravesical instillation of oxybutynin to increase the compliance and capacity of the bladder, and follow-up urodynamic studies to monitor the change were undertaken. RESULTS:: Bladder compliance was decreased in 14 (28%) patients and normal in 36 (72%) patients. There was a significantly long time interval between the onset of injury and the initiation of rehabilitative treatment in the neurogenic bladder group with low compliance when compared to those of the normal compliance group (P<0.05). Clean intermittent catheterization was used as the voiding method, significantly less than the normal compliance group (P<0.05). ADC was observed in six out of fourteen patients with low compliance neurogenic bladder, but none in the normal compliance group. Upon the completion of conservative treatment, ADC disappeared in four patients whose compliance and capacity of the bladder were normalized on follow-up urodynamic studies. CONCLUSION:: ADC was only observed in the low compliant bladder and as ADC disappeared when compliance and capacity of the bladder was normalized; low compliance appeared to be the main cause of ADC. In addition, this study supports that the maintenance of compliance of the bladder may be the most important... [ABSTRACT FROM AUTHOR]

Assesses the results of cutaneous non-continent diversion for neurogenic bladder management. Diversion indicated for upper urinary tract protection; Procedures for the establishment of low-pressure urinary drainage without the use of an indwelling urethral or suprapubic catheter; Objective of the management of neurogenic bladder dysfunction.

Presents a retrospective analysis of augmentation ileocystoplasty in patients with neurogenic bladder due to spinal cord injury or spina bifida. Purpose of the augmentation ilecocystaoplasty treatment; Discussion on urinary incontinence and vesicoureteral reflux; Information on the neurogenic bladder patients treated at the Kanagawa Rehabilitation Hospital in Japan.

STUDY DESIGN:&EMSP;:Prospective monocentric follow-up study. OBJECTIVES:&EMSP;:To assess long-term functional and urodynamic results of augmentation enterocystoplasty in spinal cord injury (SCI) patients with detrusor hyperreflexia and reflex incontinence who failed to respond to conservative treatment. SETTINGS:&EMSP;:Department of Urology (Pitié-Salpétrière Hospital, Paris, France), Department of Neurological Rehabilitation (Raymond Poincaré Hospital, Garches, France), Assistance Publique – Hopitaux de Paris, University Paris VI and V, France. METHODS:&EMSP;:Prospective study of 17 SCI patients (four above T6 level, nine between T6 and T12, and four below T12) with history of refractory urge incontinence to pharmacotherapy. Partial cystectomy (subtrigonal for 15) was performed with Hautmann enterocystoplasty (15) or detubularized clam cystoplasty (two). RESULTS:&EMSP;:Mean follow-up was 6.3±3.8 years (range 1.25–10.5 years). Fifteen of 17 (88.5%) patients were completely continent under self clean intermittent catheterization (CIC) (mean 4.6/day, range 4–7). The remaining two patients with pudendal nerve denervation had persistent stress urinary incontinence. No operative complications were noted. Long-term complications included recurrent pyelonephritis for one patient. Maximal cystometric capacity increased from 174.1±103.9 to 508.1±215.8 ml (P<0.05). Maximal end filling pressure decreased from 65.5±50.2 to 18.3±7.9 cm H2O (P<0.05). CONCLUSION:&EMSP;:Urodynamic evaluation and clinical assessment demonstrate long-term success of augmentation enterocystoplasty in an homogeneous population (SCI) without delayed complications in SCI patients.Spinal Cord (2000) 38, 490–494. [ABSTRACT FROM AUTHOR]

OBJECTIVE:&EMSP;:We prospectively analyzed the dose dependent outcome and side effects of neurogenic bladder patients with intravesical application of oxybutynin at our centre. MATERIALS AND METHODS:&EMSP;:We examined the data of 32 patients with neurogenic bladders and detrusor hyperreflexia. We registered clinical outcome, continence situation, side effects and urodynamic data of patients with (A) standard dosages of intravesical oxybutynin (0.3 mg/kg bodyweight per day) and (B) with increasing dosages in steps of 0.2 mg/kg bodyweight per day up to 0.9 mg/kg bodyweight per day. RESULTS:&EMSP;:We examined 32 patients aged 1 to 34 years, mean age 12 years. 21/32 patients became totally continent with the dosage (A). They showed a significant (P<0.01) decrease in the median max detrusor pressure (MDP) and a significant (P<0.01) increase in the median compliance and the median age adjusted bladder capacity (AABC). Eleven out of 32 patients remained incontinent under this dosage (A). Their median MDP, their median compliance and their median AABC remained nearly unchanged. Seven out of 11 incontinent patients under dosage (A) were treated efficiently with the higher dosages (B). Their median necessary dosage escalation to achieve treatment success was 0.7 mg/kg bodyweight per day (range 0.5 to 0.9 mg/kg bodyweight per day). Their median MDP was significantly (P<0.05) decreased and their median compliance and median AABC were significantly (P<0.05) increased. Four out of 11 patients remained incontinent and showed only little improvement in urodynamic data. Two out of 11 patients with the dosage escalation (B) showed side effects at a dosage of 0.9 mg/kg bodyweight per day. CONCLUSIONS:&EMSP;:The intravesical application of oxybutynin was a well tolerated and efficacious therapy. The topical oxybutynin therapy dosage (A) was efficient in 66% of our selected patients, the escalating dosage titration (B) could increase the efficiency to 87%. Spinal Cord (2000) 38,... [ABSTRACT FROM AUTHOR]

This study is an analysis of the Memotherm® prosthesis in spinal cord injured patients with Detrusor-external sphincter dyssynergia (DESD). Twenty-four patients were evaluated urodynamically before and after placement of the intraurethral stent prosthesis. All the patients had been chronically managed with an indwelling urinary catheter, intermittent catheterization or condom catheters. Sixty-six per cent had history of recurrent urinary tract infection, 37% had symptoms of autonomic dysreflexia. Nine patients had previous external sphincterotomy. Follow-up ranged from 3–39 months (mean 15.4 months). After stent insertion all patients were able to achieve spontaneous reflex voiding with the use of condom catheter. Postoperative urodynamics parameters bladder leak point pressure and residual urine volume decreased significantly after stent insertion. Stent insertion was accomplished without any operative complications. In four patients stent migration (16%) required telescoping a new system over the migrated stent. In two patients the stent was removed because of problems of infection and calculus formation. In conclusion, this system (Memotherm®) is an attractive, and potentially reversible treatment for DESD in SCI patients. [ABSTRACT FROM AUTHOR]