Search

International audience; Aim: To compare transanal irrigation with conservative bowel management for the treatment of bowel dysfunction in Spina bifida (SB) patients.Methods: Patients with SB and bowel dysfunction were randomly assigned to receive either transanal irrigation or conservative bowel management. The effectiveness of the treatment was defined as a decrease of 4 points in the neurogenic bowel dysfunction (NBD) score at week 10. Data on incontinence (Cleveland scores; Jorge-Wexner [JW]) and constipation (Knowles-Eccersley-Scott Symptom Constipation Score [KESS]) were recorded at 10 and 24 weeks after inclusion. Data were analysed on an intention-to-treat basis.Results: A total of 34 patients were randomised: 16 patients to conservative bowel management and 18 patients to transanal irrigation. A total of 19/31 (61%) patients improved at week 10, 13 (76%) in the transanal irrigation group versus six (43%) in the conservative group (p = 0.056). In the irrigation group, the decrease in NBD score was -6.9 (-9.9 to -4.02) versus -1.9 (-6.5 to -2.8) in the conservative group (p = 0.049 in univariate and p = 0.004 in multivariate analysis). The NBD, Cleveland (JW and KESS) and Rosenberg scores were significantly lower in the transanal irrigation group than in the conservative bowel management group at week 10.Conclusions: This prospective, randomised, controlled, multicentre study in adult patients with SB suggests that transanal irrigation may be more effective than conservative bowel management.

Purpose To adapt the Moorong Self-Efficacy Scale (MSES) in the French language and determine its psychometric proprieties. Materials and methods After a back-translation process, an expert committee was solicited to develop the French Self Efficacy Scale, thanks to a Delphi method, regarding theoretical framework and concepts explored. A total of 201 patients with SCI were included to explore internal consistency, internal and external structure validity assessed with the General Self-Efficacy scale, MOS Health Survey Short-Form, Hospital Anxiety and Depression Scale, Way of Coping Check-list, Perceived Stress Scale, Social Support Questionnaire, Self-Esteem questionnaire, and Satisfaction With Life Scale. The retest was performed 4 days later with a randomized version of the MSES-Fr. Results The 16 items are distributed in 3 different dimensions: Interpersonal Self-Efficacy (4 items), Instrumental Self-Efficacy (4 items) and Participation Self-Efficacy (6 items). The internal consistency was excellent (Cronbach α = .87). Results evidenced significant correlations with the MSES-Fr and other related psychological constructs (self-esteem, mood, quality of life). Reproducibility was good for the total score of the MSES-Fr (ICC = .74) and for the 3 dimensions of the scale. Conclusions The MSES-Fr is a valid and reliable tool to assess self-efficacy in persons with spinal cord injury.Implications for rehabilitationThe Moorong Self-Efficacy Scale (MSES) is commonly used in persons with SCI for evaluating the level of perceived effectiveness in living with a disability.Validity and reliability studies of the MSES-Fr show good psychometrics properties in people with SCI.The French version of the MSES has been cross-culturally translated and is ready to be used clinically.

INTRODUCTION AND OBJECTIVE:Several studies have suggested that spina bifida patients may have a poorer response to intradetrusor botulinum toxin A (BTX-A) injections than other neurological populat...

STUDY DESIGN: Prospective, open label, observational. OBJECTIVES: To present results of the first clinical study on a newly developed robotic exoskeleton (Atalante®, Wandercraft, Paris, France) that enables individuals with spinal cord injury (SCI) to perform ambulatory functions without technical aids. SETTING: Two sites specialized in SCI rehabilitation, France. METHODS: Inclusion criteria were presence of chronic complete SCI (AIS A) ranging from T5 to T12. The study protocol included 12 one-hour training sessions during 3 weeks. Patients walked on floor with robotic assistance and wore a harness connected to a mobile suspension system (without weight-bearing) to prevent from falling. Main outcome was the ability to walk 10 meters unassisted, secondary outcomes were assessment of other ambulatory functions, bladder and bowel functions, pain and spasticity. RESULTS: Twelve patients were enrolled, and 11 completed the protocol, mean age 33,9 years. Six patients had T6 levels of lesion or above. Seven patients passed the 10mWT at the 12th session unassisted (mean walking speed 0.13 m/s) while four required some human help. All patients succeeded at the other ambulatory tests (stand-up, sit-down, balance, turn). There were no significant change for bladder (Qualiveen) or bowel (NBD) functions, neuropathic pain (NPSI, NPRS), yet five patients reported a subjective improvement of their bowel function. Impact on spasticity was variable depending on the muscle examined (Ashworth). Ischial skin erosion was seen in one patient that needed local dressing. CONCLUSION: The Atalante system is safe and enables to perform ambulatory functions in patients with complete SCI.

The aim of this study was to investigate the disease-specific urinary levels variations of neurotrophins (NGF, BDNF), mediators of inflammation (TGFβ-1, PGE-2) and markers of extracellular matrix alterations (TIMP-2) in patients with multiple sclerosis (MS) spinal cord injury (SCI), or spina bifida (SB), and neurogenic detrusor overactivity (NDO). A prospective single-center study was conducted between March 2015 and March 2017. Patients aged over 18 years old, with neurological disease, with a urodynamic diagnosis of NDO were included. The urinary levels of NGF, BDNF, TIMP-2, PGE 2, and TGF-β1 were measured using dedicated ELISA kits. Forty-one patients were included: 6 with MS, 20 with SCI, and 15 with spina bifida. The average urinary level of NGF/Cr was significantly higher in MS patients compared to other neurologic populations (8 vs. 0.56 vs. 1.25 pg/mg of creatinine; p = 0.001) as well for the average urinary level of BDNF (88.3 vs. 5 vs. 4.8 pg/mg of creatinine; p

Purpose We aimed to review the current knowledge on the epidemiology, diagnosis, and management of urinary and sexual dysfunction in patients with TTR amyloidosis (ATTR). Methods We performed a review of the literature, screening for randomized controlled trials, prospective and retrospective series, position papers, and guidelines on urinary and sexual dysfunction in ATTR patients published in PubMed and Embase. Results Lower urinary tract dysfunction is present in up to 83% of patients with ATTR. Voiding symptoms are the most common, reported in 34.8−87.5% of patients, while urinary tract infections are reported in up to 50%. Urinary incontinence is observed in 16.7−37.5% of the ATTR population, mostly due to decreased urethral resistance. Sexual dysfunction affects over 40% of ATTR patients, with erectile dysfunction and sexual arousal disorder being the most common symptoms in male and female patients, respectively. In addition to a thorough clinical examination, invasive pressure-flow urodynamic testing is a cornerstone in the assessment of ATTR lower urinary tract dysfunction. The most common finding is detrusor underactivity and intrinsic sphincter deficiency. Poor bladder compliance can also be observed in patients, due to amyloid deposits on the bladder wall. Urinary tract imaging may be of interest to rule out upper urinary tract deterioration. Given the paucity of data in the ATTR population, treatment should be tailored to the individual patient. Conclusion Urinary and sexual dysfunction are highly prevalent in ATTR patients. Comprehensive assessment and multidisciplinary management are keys to avoiding upper urinary tract damage and improving patients’ quality of life.

To evaluate the determinants and prognostic value of post-operative maximum urethral closure pressure (MUCP) after AUS implantation in male patients. The charts of all male patients who had an AUS implantation between 2008 and 2018 at a single center were reviewed retrospectively for an exploratory study. A post-operative urethral profilometry was performed systematically as part of routine daily practice over the study period to assess the post-operative MUCP with the AUS consecutively closed (c-MUCP) and opened (o-MUCP). The difference between c-MUCP and the manufacturer’s theoretical pressure objective determined by the pressure regulating balloon (PRB) was calculated (diff-th-MUCP). The primary endpoint was social continence at 3 months defined as 0–1 protection/day. Ninety patients were included. The median age was 71 years, and the median follow-up was 50 months. The etiology of incontinence was radical prostatectomy in 84% of cases, and endoscopic prostate surgery in 6.6% of patients. There were 74.4% of patients who were socially continent at 3 months. The c-MCUP was significantly higher in the continent group (53 [42.2, 60.2] vs 62 [58, 70] p = 0.02). The diff-th-MUCP did not differ significantly between the two groups (18 [0, 23] vs 1 [− 2, 7.7] p = 0.29). The c-MUCP was not statistically associated with the risk of revision and/or explantation. The MUCP after AUS implantation in male patients often differs from the manufacturer’s pressure objective. The postoperative c-MUCP might be significantly associated with functional outcomes suggesting that it might be a valuable tool for treatment decision-making. This should be confirmed by larger studies.

Background and Purpose: Additional therapy may improve poststroke outcomes. Self-rehabilitation is a useful means to increase rehabilitation time. Mechanized systems are usual means to extend time for motor training. The primary aim was to compare the effects of self-rehabilitation using a mechanized device with control self-exercises on upper extremity impairment in patients with stroke. Methods: Phase III, parallel, concealed allocation, randomized controlled, multicenter trial, with 12-month follow-up. Patients aged 18 to 80 years, 3 weeks to 3 months poststroke with a Fugl-Meyer Assessment score of 10 to 40 points, were randomized to the Exo or control groups. All undertook two 30-minute self-rehabilitation sessions/day, 5 days/wk for 4 weeks in addition to usual rehabilitation. The Exo group performed games-based exercises using a gravity-supported mechanical exoskeleton (Armeo Spring). The control group performed stretching plus basic active exercises. Primary outcome was change in upper extremity Fugl-Meyer Assessment score at 4 weeks. Results: Two hundred fifteen participants were randomly allocated to the Exo group (107) or the control group (108). Mean age (SD), 58.3 (13.6) years; mean time poststroke, 54.8 (22.1) days; and mean baseline Fugl-Meyer Assessment score, 26.1 (9.5). There was no between-group difference in mean change in Fugl-Meyer Assessment score following the intervention: 13.3 (9.0) in the Exo group and 11.8 (8.8) in the control group ( P =0.22). There were no significant between-group differences in changes for any of the other outcomes at any time point (except for perception of the self-rehabilitation). There was no between-group difference in cost utility at 12 months. Conclusions: In patients with moderate-to-severe impairment in the subacute phase of stroke, the purchase and use of complex devices to provide additional upper limb training may not be necessary: simply educating patients to regularly move and stretch their limbs appears sufficient. Registration: URL: https://www.clinicaltrials.gov ; Unique identifier: NCT01383512.

Summary Introduction Intermittent self-catheterisation has revolutionised the management of neurogenic bladder-sphincter dysfunctions. The Liquick Base catheter is characterised by a streamlined Ergothan tip. The purpose of this study is to assess the tolerance and perception of patients using this catheter. Materials and methods A French prospective multicentre observational study was conducted on patients with neurogenic bladder-sphincter dysfunctions. Upon inclusion in the study, the doctor completed a questionnaire on the patient's pathology. After 3 and 6 months, the doctor checked for neurogenic developments or observations and looked for any complications relating to intermittent self-catheterisation. The patient completed a questionnaire to assess his or her perception of using the catheter. Results Out of 42 patients included in the study, two were excluded. Out of the 40 assessed patients (30 males, 10 females) with an average age of 50.1 ± 14.9 years, there were no reported cases of false passage. Bleeding occurred at least once in 10 patients (25%) in the first three months and in three out of 20 patients (15%) between 3 and 6 months. Two (5%) patients sought medical attention in the first three months for complications related to the catheter and 4 patients sought medical attention (10%) between 3 and 6 months. After 3 months 90% of patients were still using the catheter and after 6 months 90% of patients were still using the catheter. Conclusion The Liquick Base catheter is well tolerated. Patient perception is positive for all parameters being examined, leading to the continued use of the catheter in 90% of cases. Level of evidence 2.

National audience

Management of pregnancy and delivery in women with lower urinary tract reconstruction is challenging and the currently available literature is insufficient to guide clinical practice. We report pregnancy and delivery outcomes in this specific population.We conducted a national multicenter retrospective study (16 centers) including 68 women with 96 deliveries between 1998 and 2019. These women had at least 1 successful pregnancy and delivery after augmentation enterocystoplasty, catheterizable channel creation and/or artificial urinary sphincter implantation. Maternal and fetal complications during pregnancy and delivery were reported, as well as postpartum functional outcomes, according to the delivery mode. The chi-square test and Student's t-test were used to compare categorical and continuous variables, respectively.Overall 32% of reported pregnancies were complicated by febrile urinary tract infections, 13.5% by renal colic and 14.6% required upper urinary tract diversion. In addition, 10% of patients reported transient self-catheterization difficulties and 13.5% reported de novo or increased urinary incontinence. The preterm delivery rate was 35.3%. Elective C-section was performed in 61% of pregnancies. Twenty complications occurred during delivery (20%), including 19 during elective C-section. Urinary continence at 1 year was unchanged for 93.5% of deliveries. Delivery mode (p=0.293) and multiparity (p=0.572) had no impact on urinary continence.In this population C-section appeared to be associated with a high risk of complications. In the absence of any obstetric or neurological contraindications, vaginal delivery should be proposed as the first line option to the majority of these women.

Objective To analyze and quantify sacral spinal excitability through bulbocavernosus reflex (BCR) stimulus-response curves. Methods Thirty subjects with upper motor neuron lesions (UMN) and nine controls were included in this prospective, monocentric study. Sacral spinal excitability was assessed using stimulus-response curves of the BCR, modeled at different bladder filling volumes relative to the desire to void (as defined by the International Continence Society) during a cystometry. Variations in α (i.e. the slope of the stimulus-response curve) were considered as an indicator of the modulation of sacral spinal excitability. Results In all subjects, α increased during bladder filling suggesting the modulation of spinal sacral excitability during the filling phase. This increase was over 30% in 96.7% of neurological subjects and 88.9% of controls. The increase was higher before the first sensation to void in the neurological population (163.15%), compared to controls, (29.91%), p Conclusions We showed the possibility of using BCR stimulus-response curves to characterize sacral spinal response with an amplification of this response during bladder filling as well as a difference in this response amplification in patients with UMN in comparison with a control group. Significance BCR, through stimulus-response curves, might be an indicator of pelvic-perineal exaggerated reflex response and possibly a tool for evaluating treatment effectiveness.

INTRODUCTION AND OBJECTIVE:Stress urinary incontinence (SUI) is relatively common in women with spina bifida. However, there is very little data available on the outcomes of surgical treatment of S...

International audience; Aims - To assess the relative risks of pelvic organ prolapse (POP) and urinary complications in adult spina bifida patients with neurogenic acontractile detrusor voiding with Valsalva versus those using clean-intermittent catheterization (CIC). Methods - We conducted a retrospective analysis including all spina bifida patients with neurogenic acontractile detrusor with a minimum follow-up of 12 months. Patients were then divided in two groups according to their bladder management: voiding with Valsalva versus CIC. The primary endpoint was any de novo or worsened rectal and/or pelvic organ prolapse (POP) diagnosed during follow-up. The secondary outcome was urinary complications defined as febrile urinary tract infections (UTI) and/or urolithiasis and/or renal failure. Results - Fifty-five patients (50.9% were males) met the inclusion/exclusion criteria: 28 voiding with Valsalva and 27 performing CIC. At baseline, the rates of vaginal prolapse (44.4% vs 50%; P = 0.99), and rectal prolapse/intussusception (25.9% vs 21.4%; P = 0.76) were similar in both groups. After a median follow-up of 80.6 and 65.6 months, respectively (P = 0.29), the rate of de novo or worsened rectal prolapse/intussusception was higher in the Valsalva voiding group than in the CIC group (32.1% vs 3.7%; P = 0.01). De novo or worsened vaginal prolapses were also more common in the Valsalva voiding group, but it did not reach statistical significance (33.3% vs 11.1%; P = 0.29). Conclusions - Valsalva voiding might be harmful in adult spina bifida patients with neurogenic acontractile detrusor as it may increase the risk of rectal prolapse/intussusception. Overall, the prevalence of POP and rectal prolapse was high in both groups.

Resume Objectif Le traitement par neurostimulation tibiale posterieure transcutanee (NTPT) a montre son efficacite dans le traitement de l’hyperactivite vesicale (HAV), mais son effet chez les patients diabetiques est mal connu. Le but de cette etude etait de comparer l’efficacite du traitement par NTPT chez les patients diabetiques ayant une HAV et chez les patients ayant une HAV sans diabete. Methodes Une etude prospective monocentrique incluait tous les patients traites par NTPT pour troubles vesico-sphincteriens entre 2012 et 2016. Le critere de jugement principal etait l’efficacite ≥ 50 % de la symptomatologie evaluee au moyen d’une echelle visuelle analogique (EVA) a deux mois. Le traitement instaure consistait en une seance de NTPT quotidienne de 20 min. Les criteres de jugement secondaires etaient les donnees du calendrier mictionnel, l’Urinary Symptom Profile (score d’hyperactivite vesicale), le retentissement sur le moral et sur les activites de la vie quotidienne evalues par EVA. Resultats Soixante et onze patients ont ete inclus, dont 10 etaient diabetiques. Le taux d’efficacite (EVA ≥ 50 %) n’etait pas significativement different dans le groupe des patients diabetiques (70 % vs. 44,1 % dans le groupe non diabetique ; p = 0,17), de meme que l’EVA efficacite moyenne (4/10 vs. 4/10 ; p = 0,98). Le sous-score USP HAV diminuait significativement dans les deux groupes a 2 mois (−3 points dans le groupe diabetique ; −1,9 points dans le groupe non diabetique ; p = 0,03 et p Conclusion Les resultats fonctionnels de la NTPT semblent similaires dans le traitement de l’HAV chez les patients diabetiques et chez les patients non diabetiques. Niveau de preuve 4.

Objectifs L’objectif de cette etude etait d’evaluer l’association entre 6 marqueurs urinaires (NGF, BDNF, TIMP-2, TGF-B1 et PGE2) et l’insuffisance sphincterienne chez les adultes spina bifida. Methodes Une etude prospective monocentrique a ete menee entre mars 2015 et mars 2017 incluant tous les patients spina bifida adultes ayant consulte consecutivement pour examen urodynamique. Une imagerie de l’appareil urinaire etait egalement effectuee chez tous les patients. A la fin de la periode d’inclusion, les prelevements urinaires etaient decongeles pour realisation des dosages de NGF, BDNF, TIMP-2, PGE2, TGF-B1 a l’aide de kits ELISA dedies et de MMP-2 par zymographie. L’association entre taux de marqueurs urinaires et signe clinique (incontinence urinaire d’effort) et urodynamique (pression de cloture uretrale maximale [PCUM] abaissee) etait recherchee. Resultats Quarante patients ont ete inclus. Parmi eux, 17 avaient une IUE (42,5 %). La PCUM moyenne etait de 56,7 cmH2O Le TIMP-2/Cr et le BDNF/Cr urinaires etaient les deux seuls marqueurs correles a la PCUM (r = −0,37 ; p = 0,02 dans les deux cas, Fig. 1 ). Le TIMP-2/Cr etait significativement plus eleve dans le groupe IUE (p = 0,003 ; Fig. 2 ) de meme que le BDNF/Cr (p = 0,02 ; Fig. 2 ). Le NGF/Cr, le TGF-B1/Cr et le MMP2 urinaires ne differaient pas significativement entre les groupes IUE et pas d’IUE. Conclusion Le TIMP-2 et le BDNF urinaires pourraient etre associes a l’insuffisance sphincterienne chez les adultes spina bifida. Ces resultats suggerent une implication physiopathologique du remodelage de la matrice extracellulaire et donc une composante de fibrose dans l’insuffisance sphincterienne des adultes spina bifida, ainsi qu’une composante neurogene en tant que telle.

International audience; Objective - To assess and analyze the contemporary causes of in-hospital deaths of spina bifida patients. Methods - It was a cross-sectional observational study of the longitudinal national cohort of all patients hospitalized in French public and private hospitals. We analyzed the data from the French hospital discharge database (Programme de Médicalisation des Systemes d'Information, PMSI) from 2009 to 2014. The number of in-hospital deaths was extracted using the combination of the ICD-10 codes "Q05" or "Q760" and a discharge code = 9. Results - There were 138 in-hospital deaths of spina bifida patients over the 6-year study period. The median age at death was 41 years (IQR: 25-52). The median age at death was significantly lower in patients with vs without hydrocephalus (26.6 vs 45.5 years; P

INTRODUCTION AND OBJECTIVES:To assess the relative risks of pelvic organ prolapse (POP) and urinary complications in adult spina bifida patients with neurogenic acontractile detrusor voiding with V...

CONTEXT: Bladder management in spina bifida patients relies on clean intermittent catheterization and oral antimuscarinics with a significant failure rate. The efficacy of intradetrusor injections of botulinum toxin has been confirmed in patients with spinal cord injury or multiple sclerosis but not in patients with myelomeningocele. OBJECTIVE: To conduct a systematic review of current evidence regarding the efficacy of intra-detrusor injections of Botulinum Toxin A (BTX-A) in spina bifida patients with neurogenic detrusor overactivity (NDO) refractory to antimuscarinics. METHODS: A research has been conducted on Medline and Embase using the keywords: ("spina bifida" OR "myelomeningocele" OR "dysraphism") AND "toxin." The search strategy and studies selection were performed using the PICOS method according to the PRISMA statement. RESULT: Twelve published series were included (n = 293 patients). All patients were

Objectifs La neurostimulation du nerf tibial posterieure transcutanee (NSTP) est devenue ces dernieres annees, pour les patients ayant une hyperactivite vesicale (HAV), une option therapeutique reconnue. Le but de cette etude etait de rapporter les resultats de la NSTP chez les patientes atteintes d’HAV. Methodes Les donnees cliniques des patientes ayant une HAV, traitees par NSTP ont ete collectees prospectivement entre 2013 et 2018 dans un centre universitaire. Le traitement etait auto-administre par les patientes, au domicile a l’aide du dispositif urostim 2. Les seances devaient durer 20 minutes, quotidiennement, sur une periode minimum de 3 mois. Une seance de formation initiale d’une heure avec une infirmiere dediee etait realisee. Le critere de jugement principal etait l’impression d’amelioration, evaluee par la patiente a 3 mois a l’aide d’une echelle visuelle analogique (EVA) allant de 0 a 10. Les criteres secondaires etaient les donnees du calendrier mictionnel et le questionnaire USP. Resultats Soixante-deux patientes ont ete incluses. La moyenne d’âge des patientes etait de 58,3 ans. Cinquante-trois patientes avaient une incontinence urinaire par urgenturie (85,5 %) et 9 avaient une HAV sans fuites (14,5 %). La plupart des patientes avaient une hyperactivite detrusorienne au bilan urodynamique (71,1 %) et la majorite etaient resistantes aux traitements anticholinergiques (67,7 %). La moyenne de l’EVA efficacite a 3 mois etait de 4,8 (± 3,5). Le score d’HAV de l’USP diminuait significativement de 11,1 (± 4,1) a 9 (± 4) a 12 semaines (p = 0,0006). La capacite vesicale fonctionnelle s’ameliorait significativement avec un volume urine passant de 309,2 (± 168,5) a 355 (± 213,3) mL (p = 0,02). Le nombre d’episodes d’incontinence urinaire quotidien diminuait significativement egalement passant de 4,9 a 3,4 (p = 0,002). Le taux d’arret du traitement a 3 mois etait de 46,9 %. Conclusion La NSTP transcutanee semble etre une option therapeutique efficace chez les patientes atteintes d’HAV. Des etudes complementaires sont necessaires pour evaluer l’efficacite, les effets secondaires et le cout-efficacite de ce traitement comparativement a la NSTP percutanee.

Aims To assess the predictive values of six urinary markers (nerve growth factor [NGF], brain-derived neurotrophic factor [BDNF], matrix metalloproteinase 2 [MMP-2], tissue inhibitor metalloproteinase 2 [TIMP-2], transformation growth factor β-1 [TGF-B1], and prostaglandin 2 [PGE2]) for adverse urodynamic features and for upper urinary tract damage in adult patients with spina bifida. Materials and methods A single-center prospective trial was conducted from March 2015 to March 2017 including all consecutive adult patients with spina bifida seen for urodynamic testing. The urine was collected and stored at -80°C. A urodynamic and an upper urinary tract were systematically performed. At the end of the inclusion period, urines were defrosted and urinary nerve growth factor, BDNF, TIMP-2, and TGF-B1 were assessed using validated ELISA kits. The urinary markers levels were adjusted on the urinary creatinine level. Urinary MMP-2 levels were assessed by zymography. Results Fourty patients were included. Only TIMP-2 and MMP-2 were significantly associated with poor bladder compliance (P = .043 and P = .039, respectively). TIMP-2 was also the only urinary marker significantly associated with upper urinary tract damage on imaging (OR = 19.81; P = .02). Of all urodynamic parameters, bladder compliance and maximum detrusor pressure were the only ones associated with upper urinary tract damage on imaging (P = .01 and P = .02), The diagnostic performances of urinary TIMP-2 for upper urinary tract damage were slightly superior to PdetMax and bladder compliance with an area under the curve of 0.72. Conclusion Urinary TIMP-2 and MMP-2 were significantly associated with poor bladder compliance and urinary TIMP-2 was significantly associated with upper urinary tract damage. These findings support a pathophysiological role of extracellular matrix remodeling in poor bladder compliance of adult patients with spina bifida.

International audience; OBJECTIVE : To investigate computed tomography (CT) texture analysis of the bladder wall as a predictor of urodynamics findings in adult patient with spina bifida.METHODS : A single-center prospective trial was conducted from March 2015 to March 2017 including all consecutive adult spina bifida patients seen for urodynamic testing. A contrast-enhanced abdominal CT was systematically performed in all patients during the same visit. Texture features of the bladder wall related to the gray-level histogram and gray-level co-occurrence were evaluated on CT images. Multivariate analysis was performed to identify independent predictors of poor bladder compliance and detrusor overactivity among clinical and texture parameters.RESULTS : Fourty patients were included. The Lasso penalized logistic regression analysis identified 2 texture parameters as potential predictors of poor bladder compliance: Skewness (coefficient weight, -1.81) and S.1.1.SumVarnc (coefficient weight, -3.52). Multivariate logistic regression analysis confirmed skewness (odds ratio [confidence interval 95%] = 0.40 [0.14, 0.97], P = .04) as an independent predictor of poor bladder compliance. The Lasso penalized logistic regression analysis identified one texture parameters as potential predictor of detrusor overactivity: Kurtosis (coefficient weight, -3.52), which was confirmed in multivariate logistic regression analysis (odds ratio [confidence interval 95%] = 1.12 [1.01, 1.55], P = .02).CONCLUSION : Our findings demonstrate that CT texture analysis of the bladder wall might be an interesting tool to identify spina bifida patients with high risk urodynamic features.

Purpose To describe the epidemiologic characteristics of urethrocutaneous fistulae (UCF) in sacro-perineal pressure ulcer (SPPU) in neurourological patients and to assess outcomes after surgical urinary diversion. Materials and methods Through the French-speaking Neurourology Study Group and Association of Urology network, a retrospective multicenter study in nine major urology and physical medicine and rehabilitation (PMR) units was conducted. All patients with SPPU associated with UCF between 2000 and 2016 were included. Data concerning: sociodemography, clinical, medical and biological comorbidities, neurological and urological history, pressure ulcer characteristics, and finally urinary diversion surgery were collected. Complications and SPPU healing/relapse were assessed. Results In all, 74 patients were included. The median age on diagnosis: 45.9 years (interquartile range [IQR], 38.7-53.4) and median follow-up: 15.1 months (IQR, 5.7-48.8). A psychiatric disorder was the most frequent comorbidity (44.6%). Only 59.5% and 50% had regular PMR and urologic follow-up, respectively. Seventy-one patients (95.9%) underwent urinary diversion surgery. Among those, relapse occurred in 15 (21.1%) at the end of the follow-up. The diversion was noncontinent in 85.9%. The major complications rate was 26.8%. A total of 30 late complications in 21 patients were reported. The most frequent was obstructive pyelonephritis (n = 9). All of the patients who underwent surgical diversion without cystectomy (n = 5) developed a pyocyst. Finally, the pressure ulcer healing rate when patients underwent both urinary diversion and pressure ulcer surgery was 74.4%. Conclusions Our retrospective data suggest that UCF complicating SPPU is a rare and severe pathology. The combination of radical urinary diversion with cystectomy and pressure ulcer surgery should be performed as often as possible.

International audience; Aims - To compare the neurogenic lower urinary tract dysfunction (NLUTD) in patients with closed spinal dysraphism (CSD) versus patients with open spinal dysraphism (OSD) as well as their management patterns. Methods - A prospective cross-sectional study was conducted between September 2007 and December 2015 including all spina bifida patients seen at the multidisciplinary French national referral center for spina bifida. NLUTD and its management were compared between the OSD and CSD groups. Results - Three hundred and eighteen patients were included for analysis: 100 with a CSD (31.5%) and 218 with an OSD (68.6%). The prevalence of urinary incontinence did not differ significantly between the two groups (43% vs 52.8%; P = 0.11), the mean Qualiveen score was also similar (2.7 vs 2.5, P = 0.22). The voiding mechanism was clean intermittent catheterization, spontaneous voiding, suprapubic tube, and ileal conduit in 55% versus 44%; 29.8% versus 47%; 2.8% versus 3% and 11.9% versus 6% of OSD and CSD patients, respectively (P = 0.02). There were comparable prevalences of detrusor overactivity (36.5% vs 38.8%; P = 0.68) and impaired bladder compliance (34.9% vs 31.7%; P = 0.56) in both groups. Augmentation cystoplasty was more common in patients with OSD (32.1% vs 11%; P

Objectifs L’objectif principal de notre etude etait de rapporter les difficultes rencontrees et les complications au cours de la grossesse et de l’accouchement chez les patientes ayant un antecedent de grossesse et d’accouchement apres reconstruction urologique complexe. Methodes Nous avons realise une etude retrospective multicentrique dans 16 centres. Ont ete incluses les patientes aux antecedents d’enterocystoplastie d’agrandissement (EA), et/ou de derivation cutanee continente (DCC), et/ou de sphincter urinaire artificiel (SUA) et ayant presente une grossesse et accouchement. Resultats Soixante-huit femmes ayant presente 96 accouchements entre 1998 et janvier 2019 ont ete incluses. Cinquante pour cent presentaient un dysraphisme spinal, 30 % une lesion medullaire, 15 % une exstrophie vesicale et 6 % une autre pathologie. Cinquante-deux pour cent avaient une EA, 25 % une DCC et 5 % un SUA. Au cours de la grossesse, 10 % ont presente des difficultes d’auto-sondages et 14,6 % ont necessite un drainage du haut appareil urinaire pour colique nephretique ou pyelonephrite aigue. Concernant l’accouchement, le taux de cesarienne etait de 64 % dont 13 % en urgence. Le taux de prematurite etait de 35 %. Un sur 3 des cesariennes se sont compliquees, principalement par lesion de la reconstruction urologique. La continence urinaire a 6 mois de l’accouchement etait non modifiee pour 93,5 % des femmes, quel que soit le mode d’accouchement (p = 0,293) ( Tableau 1 , Tableau 2 , Tableau 3 ). Conclusion A notre connaissance, il s’agit de la plus grosse cohorte rapportant les complications de la grossesse et de l’accouchement apres reconstruction du bas appareil urinaire. La voie basse, lorsqu’elle est possible, doit etre privilegiee en premiere intention, la cesarienne etant a risque de lesion du montage urologique, et ne semblant pas prevenir une incontinence post-partum.

Objectifs L’objectif de cette etude etait de comparer les resultats de la cystectomie par voie ouverte (CO), par voie laparoscopique pure (CL) et par voie robot-assistee (CRA) associee a une derivation cutanee non continente trans-ileale chez les sujets neurologiques. Methodes Tous les patients ayant eu une cystectomie pour vessie neurologique dans un centre entre 2006 et 2017 ont ete inclus dans une etude retrospective. La derivation etait une derivation cutanee trans-ileale non continente type Bricker dans 100 % des cas dans les 3 groupes, toujours realises en extra-corporel. La plupart des CO et CL etaient realisees par un chirurgien experimente (> 20 cystectomies au debut de l’etude et > 50 procedures laparoscopiques) et la plupart des CRA par un autre chirurgien sans aucune experience de la cystectomie et ayant realise moins de 10 interventions laparoscopiques ou robot-assistees en autonomie au debut de l’etude. Resultats Quatre-vingt-dix patients ont ete inclus : 41 robot, 23 cœlioscopique et 26 ouvert ( Tableau 1 ). La duree operatoire etait plus courte dans le groupe CO que dans les groupes CL et CRA (295,6 vs. 383,7 vs. 374,4 min ; p = 0,03). La duree d’hospitalisation etait plus courte dans le groupe CRA et dans le groupe CL que dans le groupe CO (16,5 vs. 13,5 vs. 13,2 jours ; p = 0,03). Le taux de complications majeures etaient plus importants dans les groupe CO et CL que dans le groupe CRA (30,8 % vs. 30,4 % vs. 9,8 % ; p = 0,05) de meme que le taux d’utilisation d’une PCA morphine en postoperatoire (62,5 % vs. 77,8 % vs. 22,9 % ; p = 0,003). Le taux de complications tardives etait similaire dans les 3 groupes (13 % vs. 14,3 % vs. 21,9 % ; p = 0,60) ( Tableau 2 ). Conclusion La voie laparoscopique, qu’elle soit ou non robot-assistee, pourrait diminuer la duree d’hospitalisation par rapport a la voie ouverte pour l’exerese d’une vessie neurologique avec derivation cutanee non continente trans-ileale, au prix d’une duree operatoire plus longue. L’avantage de la voie robotique sur la voie cœlioscopique pourrait etre une reduction du taux de complications majeures et des douleurs postoperatoires.

International audience

Resume Introduction A ce jour, il n’existe ni definition de l’echec d’une premiere injection intra-detrusorienne de toxine botulique Botox ® 200 U pour hyperactivite detrusorienne neurogene (HDN), ni recommandation sur sa prise en charge. L’objectif principal de cette enquete etait de determiner la definition en pratique de cet echec et l’objectif secondaire de rapporter les pratiques actuelles dans sa prise en charge. Materiels et methodes Un questionnaire, etabli en s’appuyant sur les donnees de la litterature, a ete envoye par courrier electronique aux experts membres du comite de neuro-urologie de l’Association francaise d’urologie et du Groupe d’etude en neuro-urologie de langue francaise. Il leurs etait demande de completer le questionnaire en ligne. Les experts n’ayant pas repondu au premier courrier ont ete chacun sollicites deux fois, toujours par courrier electronique. Resultats Vingt et un des 42 experts sollicites ont repondu au questionnaire. Pour 19 des experts (90,5 %), la definition de l’echec etait une combinaison de criteres cliniques et urodynamiques. Parmi les criteres urodynamiques proposes, la persistance d’une pression detrusorienne > 40 cm H 2 O etait le plus plebiscite (18/21 ; 85,7 %). Dix-neuf experts (19/21 ; 90,5 %) consideraient que l’effet de la toxine botulique sur l’incontinence urinaire devait etre pris en compte dans la definition de l’echec. Concernant la prise en charge de l’echec, une large majorite des participants (15/20 ; 75 %) consideraient que le traitement de premiere ligne en cas d’echec d’une premiere injection de Botox ® 200 U devrait etre une injection de Botox ® a un dosage plus eleve (300 U) qu’il y ait ou non des facteurs de risque urodynamiques (16/20 ; 80 %). Conclusion Ce travail a permis d’obtenir une premiere vue d’ensemble de la definition de l’echec des injections intra-detrusoriennes de toxine botulique dans l’HDN et de sa prise en charge. Pour 90,5 % des experts repondeurs, la definition de l’echec des injections intra-detrusoriennes de toxine botulique pour HDN devrait etre clinique et urodynamique et 75 % des personnes ayant repondu consideraient qu’en cas d’echec d’une premiere injection de Botox ® 200 U, la reinjection de Botox ® a la dose de 300 U etait l’option therapeutique a preferer. Niveau de preuve 4.

Intermittent catheterisation (IC) is considered the gold standard for bladder dysfunction-related voiding problems following spinal cord injury (SCI). Despite this, up to 50% of individuals were no longer using IC 5 years after discharge from the rehabilitation centre. Hence, we initiated the IC Education Programme to offer standardized IC training and improve adherence. The programme was a European initiative undertaken by eight rehabilitation centres in Norway, France and Italy. The aim of this study is to evaluate the effectiveness of the IC Education Programme. The control group comprised individuals with SCI discharged from one of the participating rehabilitation centres using IC up to 1 year before the Education Programme was initiated. A questionnaire was sent by post to this group before the IC Education Programme started. The second group comprised individuals who had participated in and been discharged using the IC Education Programme; they received the questionnaire up to 1 year after programme initiation. Anonymous responses from the two groups were compared to assess outcomes such as ongoing use of IC, satisfaction with training and attitude towards bladder issues. Three hundred sixteen responses (from 500 questionnaires sent) were received from the control group (63%) and 84 (of 142) from the IC Education Programme group (59%). The IC Education Programme significantly increased the percentage of individuals still using IC during the first year at home (99 vs. 83% for the Education Programme and control groups, respectively; p

AIMS To assess the outcomes of switching to a different brand of botulinum toxin A (BTA, from Botox® to Dysport®) in case of failure of intradetrusor injections (IDI) of Botox® in the treatment of neurogenic detrusor overactivity (NDO). METHODS The charts of all patients who underwent a switch to IDI of Dysport® after failure of an IDI of Botox® at six departments of neurourology were retrospectively reviewed. The main outcomes of interest were the bladder diary data and four urodynamic parameters: maximum cystometric capacity (MCC), maximum detrusor pressure (PDET max), and volume at first uninhibited detrusor contraction (UDC). RESULTS Fifty-seven patients were included. After the first injection of Dysport®, no adverse events were reported. A significant decrease in number of urinary incontinence episodes per day was observed in 52.63% of patients (P

Resume Objectifs Decrire les effets sur le systeme nerveux central des medications anticholinergiques utilisees dans le traitement de l’hyperactivite vesicale chez le sujet âge. Methodes Une etude de la litterature apres une recherche Medline des articles publies jusqu’a mars 2014 a ete effectuee. Les mots cles portaient sur l’hyperactivite vesicale, les medicaments anticholinergiques et antimuscariniques, le systeme nerveux central, la cognition, la personne âgee. Les articles retenus etaient les articles pertinents sur le traitement anticholinergique de l’hyperactivite vesicale du sujet âge. Resultats Plusieurs anticholinergiques sont disponibles pour le traitement de l’hyperactivite vesicale : oxybutynine, tolterodine, fesoterodine, darifenacine, trospium chloride, solifenacine. Parmi toutes ces molecules, le passage de la barriere hemato-encephalique est le plus important pour l’oxybutynine, moindre pour la solifenacine, la darifenacine et la tolterodine, et le plus bas pour la fesoterodine et le trospium. Les effets secondaires centraux dependent de la susceptibilite pharmacologique du patient, de la permeabilite de la barriere hemato-encephalique, de l’importance de la degenerescence neuronale cholinergique, de la charge anticholinergique totale et du statut cognitif de base du patient. Les effets anticholinergiques centraux sont varies allant du trouble mnesique a la confusion, des hallucinations a la deterioration, jusqu’au coma. Parmi les differents anticholinergiques, l’oxybutynine a la moins bonne tolerance et la fesoterodine et le trospium la meilleure. Conclusion Les anticholinergiques ameliorent significativement les symptomes urinaires d’hyperactivite vesicale mais ils affectent les performances cognitives particulierement chez la personne âgee. Leur frequence et la pertinence clinique de la degradation cognitive restent assez mal evaluees. L’existence de ces effets centraux doit conduire a une evaluation stricte avant le traitement et au cours de son suivi afin de re-evaluer l’interet du traitement dans cette population fragile.