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Summary Purpose The aim of this study was to describe verbal instructions used to obtain a voluntary pelvic floor muscle contraction and to evaluate their understanding and acceptability. Methods This prospective study led in two phases. A questionnaire was submitted to experts to collect the most frequently used instructions to obtain a PFMC. Then a questionnaire was submitted to subjects in order to: estimate the pelvic floor anatomical knowledge; estimate understanding and acceptability of these instructions; select the best instruction. Results First phase: 46 experts proposed 356 instructions. Forty-four percent were functional instructions (“hold a gas”), 40% anatomical (“squeeze your anus”) and 16% allied both. Fifteen instructions for the women and 11 for the men were selected. Second phase: 33 subjects completed the questionnaire. More than 75% had correct answers for anatomical knowledge. The instructions judged by the subjects as the most adapted to obtain a PFMC were: “contract the anus”, “do as if you wanted to hold a strong desire to void”. The items including “perineum” or “vagina” were less understood. Conclusions The more understandable and acceptable instruction to assess the PFMC is the association of two simple instructions: one anatomical and one functional. Level of evidence 4.

Objectives: To determine whether diffusion-weighted magnetic resonance imaging (DWMRI), a noninvasive procedure, can contribute to the diagnosis of bladder pain syndrome/interstitial cystitis (BPS/IC). Methods: The pelvic DWMRI of patients with chronic pelvic pain syndrome was selected between January 2012 and June 2017. A radiologist analyzed the bladder wall signal; he was blinded to the patients’ clinical data. According to the 2008 European Society for the Study of Bladder Pain Syndrome/Interstitial Cystitis criteria, 2 groups of patients were determined: BPS/IC and no BPS/IC. The association between BPS/IC and the wall signal intensity was compared. Results: In the 106 patients included, 82 had criteria for BPS/IC and 24 did not. A significant difference in the distribution of the signal was found between the 2 groups (p = 0.01). High signal intensity of the bladder wall was related to the presence of a BPS/IC with a sensitivity of 28% and a specificity of 88%. No signal intensity of the bladder wall was related to the absence of a BPS/IC with a sensitivity of 96% and a specificity of 29%. Conclusions: In ­DWMRI, high bladder wall signal intensity helps to affirm a BPS/IC, whereas the absence of signal helps to exclude the diagnosis. Further studies are needed to confirm these preliminary results.

RESUME La miction est un acte reflexe, essentiellement integre dans la moelle sacree, sous controle encephalique via des voies de transmission medullaire. Le controle est double, a la fois somatique (contraction sphincterienne volontaire) et vegetatif, le systeme parasympathique sacre presidant a la contraction du detrusor et le systeme sympathique dorso-lombaire a la relaxation de ce muscle et a la contraction sphincterienne. Les centres activateurs et inhibiteurs encephaliques (frontaux etpontiques), permettent en sus de la regulation locale (transduction du signal par l’urothelium vesical), un cycle continence-miction harmonieux, avec un remplissage vesical sans elevation de pression et une miction facile, sans hypercontraction detrusorienne per-mictionnelle et complete sans residu. Mais cette miction, en dehors des cas pathologiques procedant d’une deshinibition du reflexe mictionnelpar lesions neurogenes medullaires ou encephaliques, est toujours modulee, volontairement acceptee ou differee. L’intervention du sous-cortex dans le controle vesical rends compte de la modulation inconsciente de ce reflexe pouvant etre alors exacerbe ou a l’inverse inhibe. C’est ainsi que des urgences mictionnellespsycho-comportementales, veritablement Pavloviennes, sont souvent observees en clinique (syndrome clef-serrure), de meme que des imperiosites psycho-sensorielles (audition d’eau ruisselante, temps froid, immersion des mains) ou psycho-emotionnelles (orgasme, frayeur, fou-rire). A l’inverse certaines inhibitions psycho-comportementales telle la paruresie, peuvent alterer le declenchement du reflexe mictionnel. Les mecanismes attentionnels jouent un role majeur dans la perception, l’integration et la modulation du besoin et donc de la repletion vesicale, interferant ainsi dans le controle elementaire cortico-protuberantiel du cycle continence-miction. Le concept de miction cognitive permet d’expliciter un certain nombre de comportements mictionnels, ou la miction n’est pas le fait de la necessite manometrique et volumetrique de se realiser, mais en realite dictee par d’autres considerations sociales ou environnementales (miction d’opportunite).

The usual complications after recent stroke such as disabling spasticity and shoulder pain seemed less frequent in recent years. This study examined the frequency of spasticity and shoulder pain in recent post-stroke patients over time in our physical and rehabilitation medicine department.This was a retrospective study of post-stroke inpatients over the last 15 years. Spasticity and shoulder pain prevalence were analyzed, as were demographic, clinical and stroke characteristics.We reviewed medical records for 786 patients (506 men); mean age 58.1 years (SD 13.2); 530 (68%) with ischemic stroke and 256 (32.36%) hemorrhagic stroke. After a first increase from 2000 to 2006, the prevalence of disabling spasticity decreased from 2006 to 2015 (31%-10%; P0.001). Shoulder pain at admission and during hospitalization also decreased (13% of patients in 2000 to 8% in 2015, P0.001). Disabling spasticity was associated with shoulder pain (26% of patients with disabling spasticity presented shoulder pain at admission vs 7% with hyperreflexia of the deep tendon reflexes, P0.05). Characteristics of stroke, time of admission after stroke and length of stay did not change over the years. We observed an increase in number of walking patients at admission and number with a functional paretic arm at admission and discharge (P0.05), which may explain the increase in functional independence measure scores at admission and discharge (both P0.05). Prevalence of cognitive disorders increased over the same period (24% in 2000 vs 63% in 2015, P0.05).Disabling spasticity and shoulder pain frequency in recent post-stroke patients decreased over the last 15 years, and functional abilities both at admission and discharge improved. Confirmation of these results in a multicentric study may be important evidence of an improvement in stroke healthcare both in stroke and physical and rehabilitation medicine units in the last 10 years in France and could affect future estimations of the need for rehabilitation care after stroke.

Motor nerve blocks with anesthetic drug for local anesthesia are commonly used in physical and rehabilitation medicine (PRM), especially in the field of spasticity. Guidelines in this context are currently lacking.Eighteen experts selected on the basis of their recognized experience by the scientific committees of the French PRM (SOFMER) and Anesthesia and Intensive care (SFAR) societies were invited to work and propose guidelines for the use of loco-regional anesthetic drug for motor nerve blocks in PRM setting. Eight issues were addressed: which neural blocks for which indications; drugs and contraindications; medical survey and attitude in case of adverse event; injection and guidance material; patient preparation and pain relief; efficacy assessment; patient information; education of PRM physiatrists. The Medline, Cochrane and Embase databases for the period 1999 to 2018 were consulted and 355 papers analyzed. The drafts were commented then approved by the whole group using electronic vote, before final approval by scientific committee of each society.No scientific evidence emerged from the literature. Thus, these guidelines are mainly based on the opinion of the expert panel. Guidelines for each issue are reported with the main points of arguments. The main question deals with the recommendation about doses for each drug: for lidocaine - up to 2mg/kg - "check contraindications, emergency truck available, no need of previous anesthetic consultation nor presence of anesthetic physician"; for ropivacaine - up to 1.5mg/kg, with a maximum of 100mg - the same but after intravenous line. Beyond these doses, SFAR guidelines have to be applied with the need of anesthetic physician.These are the first organizational guidelines devoted to increase the security of motor nerve block use in PRM settings.

AIMS To evaluate if urethrovaginal reflux (UVR) is an underestimated cause of insensible or postmicturition incontinence in adult women. METHODS An observational and retrospective study was carried out on the computerized records of a neuro-urology department. Female patients who had insensible or postmicturition incontinence were investigated. Retrograde and voiding urethrocystography (UCG), urodynamic evaluation, urethral pressure profilometry, and anamnestic and clinical examination had to be available. RESULTS Among the 79 adult female patients with insensible or postmicturition incontinence in whom the whole set of required evaluations was achieved, 16 had a UVR (mean age 47 ± 15 years). There were no urethral diverticula, urethrocele, vesicovaginal, or urethrovaginal fistula on their UCG. All of them also had a cystoscopy and a CT urography which did not establish any abnormality. CONCLUSIONS UVR is not an exclusive pathology of children. This mechanism seems to be an underestimated cause of urinary incontinence in adult women. Retrograde and voiding UCG appears to be the gold standard to confirm the intravaginal reflux.

Objectives: Persistent genital arousal disorder (PGAD) is a rare condition. Our aim was to study whether or not the pudendal nerve is involved in PGAD, by means of electromyographic (EMG) testing. Methods: Twenty-three women who fulfilled the five criteria of PGAD were included in this study. After an in-depth interview and routine investigations, a perineal EMG assessment was performed. Concentric needle electromyography (EMG) testing with motor unit potential analysis of the pelvic floor muscles (bulbocavernosus muscle and striated external anal sphincter), study of the sacral reflex latency (SRL), and measurement of pudendal nerve terminal motor latency (PNTML) were performed. Results: Perineal ENMG demonstrated neurogenic changes in 14 (60.8%) of the patients. Denervation was found in all 14 patients with abnormal electrophysiological findings. Among them, 12 (85.7%) had altered PTNML and/or SRL. PTNML was delayed on the anal branch in 9 out of 14 (bilateral in 5 cases) and on the perineal bra...

Introduction Sleep apnea syndrome (SAS) frequently occurs after a stroke. Its association with a poor prognosis is open to discussion. Objective To study, in a physical and rehabilitation medicine (PRM) unit, the possible repercussions of SAS on neurological and functional recovery as well as attentional abilities following a stroke. Patients and methods Forty-five patients, all of whom had recently had a stroke without previously documented SAS, were screened using the ApneaLink® system. An apnea-hypopnea index (AHI) score ≥10 was considered as indicative of SAS. The NIHSS, Fugl-Meyer (FM) and Functional Independence Measure (FIM) Scales were applied on admission and at two months as means of assessing neurological and functional recovery, which was expressed by the difference between the first and the second scores (delta FM, delta NIHSS, delta FIM). The Battery Attention William Lennox (BAWL) Test was given once in order to evaluate attention disorders. SAS severity was categorized according to the AHI. We compared the groups formed (mild, moderate and severe) using the same method. Results Twenty-eight patients (62.2%) presented AHI ≥ 10. Stroke characteristics were comparable in the SAS+ and the SAS– groups, with average post-stroke time lapse of 26 days, initial average FIM score of 71.2 points ± 26.3 and initial average NIHSS score of 8.9 ± 4.9. The demographic characteristics of the two groups were likewise comparable with the exception of age, as the SAS+ group was pronouncedly older (65.4 vs. 53.5 years). As for delta FIM, which evaluated functional recovery, it averaged 31.8 ± 20.6. Cases of SAS were found to be mild (37.1%), moderate (28.6%) or severe (34.3%). No significant difference was observed on admission or at 2 months as regards the clinical scales or the BAWL test between the two groups or according to severity, except for the NIHSS score at 2 months in the severe sub-group. Discussion and conclusion This study did not demonstrate the supposed repercussions of SAS on the recovery or attentional abilities of post-stroke patients. The tests were maybe given too early; they should take place at a lengthier time interval after the stroke, and also to be more complete.

Resume Introduction Depuis une dizaine d’annees, la toxine botulique de type A (BoNT-A) s’est imposee comme un traitement de reference de l’hyperactivite du detrusor neurologique. Chez ces malades dont le mode mictionnel est l’autosondage propre intermittent, les colonisations sont frequentes et l’injection intradetrusorienne presente un risque septique. Objectif L’objectif principal de l’etude etait d’etudier la prevalence des differents germes et leurs profils de resistance aux differentes classes d’antibiotique, dans une population de patients neurologiques, dont l’hyperactivite detrusorienne est traitee par injections endovesicales de BoNT-A. Methode Cette etude epidemiologique prospective s’est deroulee de septembre a octobre 2012 dans un service de neuro-urologie et urodynamique. Quatre-vingts patients dont l’examen cytobacteriologique des urines (ECBU) pre-intervention etait valide selon le protocole du service ont ete inclus. Resultats Quarante-quatre ECBU etaient positifs avec 45 germes identifies. Un Escherichia coli etait isole dans 42,5 % des cas, 7,5 % de Klebsiella pneumoniae , 2,5 % de Citrobacter freundii et enterocoques et 1,25 % de Staphylococcus aureus . Une resistance aux penicillines etait mise en evidence dans 51,11 % des cas, aux cephalosporines de troisieme generation dans 8,89 %, aux fluoroquinolones dans 28,89 % et aux sulfamides dans 24,44 %. Il n’existait pas de resistance a la fosfomycine. Conclusion Le germe le plus frequent etait l’ E. coli. Tous les germes isoles etaient sensibles a la fosfomycine. Niveau de preuve 3.

Aims Attention may play a key role in the contraction of pelvic floor muscles in stressful situations, meaning that mental distraction may be involved in urinary incontinence. Methods Informed consent was obtained from 20 healthy volunteers. The electromyographic (EMG) activity of the external anal sphincter (EAS) was recorded during voluntary contraction elicited by local stimulation. The trials were carried out twice: combined (or not) with a mental distraction task (PASAT), Paced auditory serial additional test. Reaction time, latency between the stimulus and maximum EAS EMG activity, duration of the contraction, maximum EAS EMG activity, and the area under the EAS EMG activity curve were measured. Results The mental distraction task led to a 3.98 times greater reaction time (RT), (P = 0.00001 Wilcoxon's test). The RT increased from 217 (IQR: 170–270) to 779 msec (IQR: 550–1,025, P

Resume But La physiopathologie des troubles de la miction et de la continence urinaire a fait l’objet de nombreuses recherches sans que l’on puisse trouver une cause uniciste aux pathologies mictionnelles. La notion de miction cognitive apporte de nouvelles pistes de recherche pour montrer le role fondamental du cortex et du sous-cortex dans ces pathologies. Materiel et methodes Il s’agit d’une revue de la litterature realisee a partir d’une recherche bibliographique sur Pubmed, Medline, Embase et Cochrane. Les termes utilises etaient cognition , urinary tract , urinary continence , neuroimaging , IRMf , micturition , urge , brain factor , cognitive therapy . Nous avons selectionne les 72 articles se rapportant reellement a la problematique de la miction et de la cognition. Resultats L’emergence des nouvelles techniques d’imageries a permis de montrer l’interconnexion de zones corticales dans le controle mictionnel tels que la substance grise periacqueductale, l’hypothalamus, l’insula, le gyrus cingulaire anterieur et le cortex prefrontal. Ces memes regions cerebrales sont impliquees dans les differentes facettes de la cognition. Une alteration du comportement mictionnel implique une modification d’activation de ces aires corticales. Conclusion Une meilleure comprehension de la partie cognitive de la miction et de la continence urinaire permettra d’ameliorer la prise en charge des pathologies associees.

Resume But Etudier les signes de dysautonomie dans une population de patients atteints de sclerose en plaques (SEP) et consultant pour des troubles urinaires. Patients et methodes Nous avons explore 65 patients atteints de SEP (âge moyen de 47,5 ans) se plaignant de troubles urinaires, par scores de symptomes, bilan urodynamique, tests cardiovasculaires de la fonction autonome et etude des reponses cutanees sympathiques. Resultats Quarante-cinq (69 %) patients avaient une hyperactivite vesicale avec fuites sur urgenturie, 48 (73 %) une dysurie, 14 (21 %) une retention urinaire et 13 (20 %) une incontinence fecale. Le bilan urodynamique objectivait un detrusor hyperactif dans 46 (70 %) cas et un detrusor hypoactif dans quatre (6 %) cas. Vingt-cinq (38 %) patients avaient une dysautonomie sans correlation avec les symptomes clinique ou urodynamique ou avec la gravite de la maladie (score EDSS). Conclusion Dans cette serie, nous avons observe une forte prevalence de signes de dysautonomie dans une population de patients atteints de SEP et consultant pour des troubles urinaires.

Objectives To determine whether a strong urge to void could affect a person's attentional performance. To determine whether an attentional task could decrease a strong urge to void a prospective study was performed. Subjects and Methods Healthy adults were asked to perform two neuropsychological tests, the modified Paced Auditory Serial Addition Test (mPASAT) and the Psychology Experiment Building Language Continuous Performance Test (pCPT), under two different conditions: no need to void, and a strong urge to void defined by a score of >70/100 mm on a visual analogue scale. Results In all, 21 healthy volunteers were included. There was no statistical difference between the mPASAT scores from the two sessions (P = 0.57). The mean total error score of the pCPT increased with the individual's urge to void (P = 0.043). The mean omission score decreased, but was not statistically different (P = 0.129), the commission error score increased with the urge to void (P = 0.017), with a shorter reaction time for the inter-stimuli intervals of 1 (P

Resume But Comparer au cours d’hyperactivites vesicales ou de dysuries idiopathiques non neurogenes, l’apport diagnostique des tests secretoires versus celui des tests cardiovasculaires de la fonction autonome (TCVSNA). Methode Cent vingt-quatre patients (57 femmes, 67 hommes, d’âge moyen 45 ans) ont ete explores. Toute pathologie neurologique, urologique ou iatrogene etait eliminees. Ont ete realises, outre un bilan urodynamique, les tests secretoires suivants : test de Schirmer (TSch), test au sucre (TS), debimetrie salivaire (DS) ; pour les tests cardiovasculaires de la fonction autonome (TCVSNA) : ratio 30/15 (R30/15), hypotension orthostatique (HO), respiration ample dirigee (RAD), manœuvre de Valsalva (MV), cold pressor test (CPT) et hand grip test (HGT). Resultats Huit fois les tests cardiovasculaires de la fonction autonome se sont averes positifs (quatre cas d’hyperactivite vesicale, quatre cas de dysurie-retention). Nous ne retrouvons aucune correlation entre les TCVSNA et les tests secretoires, qu’il s’agisse du TS ( p = 0,72), de la DS ( p = 1), ou du TSch ( p = 0,1). Il existe une correlation significative entre TSch et TS ( p = 0,049), mais pas entre TSch et DS ( p = 0,69) ou entre DS et TS ( p = 0,06). Conclusions Les tests secretoires n’ont pas suffit pour assurer le diagnostic de dysfonctionnement du systeme nerveux autonome devant un trouble vesicosphincterien, les TCVSNA demeurant toujours indispensables. Ces dysregulations du systeme nerveux vegetatif etaient rares (8/124 soit 6,5 %) dans le determinisme d’une hyperactivite vesicale ou d’une dysurie « idiopathiques ».

Objectives To assess the predictive value of a simple clinical test (posterior vaginal wall pull down maneuver) in the diagnosis of intrinsic sphincter deficiency. Methods The present prospective study included 62 women suffering from stress urinary incontinence. Every patient underwent a urogynecological examination including multichannel urodynamic testing (cystometry, urethral pressure profile, Valsalva Leak Point Pressure measurement) and a clinical examination including posterior vaginal wall pull down maneuver. Posterior vaginal wall pull down maneuver was carried out with the bladder filled with 400 mL of saline in a supine position, and was obtained by means of a split speculum allowing gentle pull down traction of the posterior vaginal wall. Posterior vaginal wall pull down maneuver was considered as positive when a urine leak was observed during the manoeuvre. Intrinsic sphincter deficiency was urodynamically defined by maximum urethral closure pressure ≤20 cmH2O. Correlations between positive/negative posterior vaginal wall pull down maneuver and urodynamic intrinsic sphincter deficiency were calculated. Results There was a statistical correlation between age and low maximum urethral closure pressure (P

Purpose Persistent genital arousal disorder (PGAD) is a newly recognized condition rarely reported. Its recognition is useful to avoid labelling women suffering from PGAD as "mad". Methods A comprehensive literature review using Pubmed, Medline, Embase and Cochrane: "persistant genital arousal", "restless genital syndrome", "persitant genital arousal syndrome" and "persistant sexual arousal syndrome". In the 300 articles, 37 really dealt with PGAD. Results PGAD prevalence seemed to be more common than suspected (1%). PGAD has officially been defined in terms of five diagnostic criteria. Patients were on average from 35 to 54 years old. Among them, 29.9% to 67% were menopausal. PGAD was highly associated with overactive bladder (OAB) (67%), restless legs syndrome (RLS) (67%) and pelvic varices (55%). Genital sensations were experienced as unwanted, intrusive, on the verge of an orgasm. The unwanted genital sensations were experienced at the clitoris, labia and vagina or a combination of these localizations in 78%, 28%, 55% and 44% women, respectively. There are many suspected etiologies. Clinical management is the need of an electric and multidisciplinary approach (history, examination, investigation as pelvic MRI, pelvic ultrasound, biological exam). Treatments were various including psychological therapies, psychotropic treatment (56% women reported a persistent reduction of symptom [50%-90%] with clonazepam), transcutaneous electrical nerve stimulation (TENS)… Conclusion This literature review provides readers with guidance on the management of PGAD.

International audience; BACKGROUND: Modic 1 changes are usually associated with degenerative disc disease (DDD). We aimed to compare Modic 1 changes with advanced degenerative disc disease (>50%-intervertebral space narrowing [IVSN]) to Modic 1 changes with less advanced lumbar degenerative disc disease (≤50%-IVSN).METHODS: We conducted a cross-sectional study. The computerized MRI database from a French tertiary care hospital was searched. Patients were included if they were ≥ 18 years old and had a lumbar MRI between January 1, 2006 and January 31, 2008, that showed a Modic 1 signal at a single level. The strength of the magnet was 1.5 T. MRI were reviewed by 2 assessors. Age and gender were recorded. MRI changes involving the intervertebral disc and the vertebral endplate subchondral bone were assessed for Modic 1 signal, intervertebral space narrowing, asymmetrical degenerative disc disease, spondylolisthesis, anterior and posterior intervertebral disc herniation, and anterior and lateral osteophytes. These outcomes were compared between >50%-IVSN Modic 1 and ≤50%-IVSN Modic 1 groups. For bivariate analysis, comparisons involved nonparametric Kruskal-Wallis test for quantitative variables and nonparametric Fisher's exact test for qualitative variables. Multivariate analysis was conducted to determine factors independently associated with 50%-IVSN Modic 1 patients, ≤50%-IVSN Modic 1 patients were younger (mean[SD] age 51.5[14.1] vs 58.8[12.6] years, p = 0.019), Modic 1 were more frequent at L5/S1 level (19[61.3%] vs 18[25.7%], p = 0.001), and anterior and lateral osteophytes were less frequent (13[41.9%] vs 55[78.6%], p 50%-IVSN Modic, while >50%-IVSN Modic 1 are rather found in older women at L4/L5 level.

Resume But Evaluer le debit de vidange des catheters d’autosondage. Materiel Etude experimentale comparant in vitro, par mesures debitmetriques repetees, les debits moyens de drainage des differents catheters d’autosondage les plus utilises en France, en fonction de leur charriere (Ch10, 12 et 14 pour la femme ; Ch12, 14 et 16 pour l’homme). Resultats L’augmentation de charriere etait significativement associee a une augmentation du debit moyen. Pour les catheters destines aux femmes, le debit moyen variait de 2,83 a 3,7 mL/s pour les sondes Ch10, de 4,31 a 5,35 mL/s pour les sondes Ch12 et de 7,00 a 7,85 mL/s pour les sondes Ch14 ( p p Conclusion Cette etude experimentale a observe que l’augmentation de charriere etait significativement associee a une augmentation du debit moyen, ce qui pourrait aider le clinicien a adapter le materiel prescrit pour l’autosondage selon les besoins des patient(e)s.

Resume But Frequentes, les proctalgies fugaces (PF) sont de physiopathologie et d’etiopathogenie mal elucidee. Recemment une etiologie neurogene a ete suspectee sur des arguments cliniques. Nous avons voulu verifier s’il existait des arguments electrophysiologiques pouvant etayer une telle hypothese. Patients et methodes cinquante-cinq patients ayant des PF ont ete explores (45 femmes, dix hommes, âge moyen 50,2 ans). Les explorations electrophysiologiques comportaient un examen de detection des muscles bulbocaverneux et du sphincter anal, une etude des latences du reflexe bulbocaverneux (LRBC) et des latences distales motrices (LDM) des branches perineales et anales des nerfs pudendaux. Resultats Les explorations etaient anormales chez deux des dix hommes (20 %) et 29/45 femmes (64 %). Chez les femmes, la denervation etait bilaterale (25/29, 86 %). Les reflexes bulbocaverneux etaient allonges de maniere bilaterale chez cinq des 29 patientes, et unilaterale chez trois des 29 patientes. Les LDM etaient allongees de maniere bilaterale chez 13 patientes et unilaterale chez quatre patientes. Il existait une difference significative ( p 2 ) entre hommes et femmes quant a l’existence d’une denervation. Conclusion Dans cette serie, un processus neurogene peripherique etait donc frequent chez les patientes avec PF, s’integrant dans le cadre d’une neuropathie pudendale bilaterale multitronculaire dans la majorite des cas. Un facteur neurogene peripherique pourrait donc etre evoque comme favorisant l’emergence d’une PF, voire determinant celle-ci dans un certain nombre de cas.

Resume But Etablir une revue de la litterature concernant l’hypothese d’un dysfonctionnement du systeme nerveux autonome dans le syndrome d’hyperactivite vesicale idiopathique de la femme. Methode Revue systematique de la litterature (Pubmed, Medline, Cochrane database) concernant le syndrome d’hyperactivite vesicale de la femme et les explorations cardiovasculaires du systeme nerveux autonome (variabilite de la frequence cardiaque et tests cardiovasculaires). Mots cles utilises : hyperactivite vesicale, incontinence urinaire, femme, urgenturie, systeme nerveux autonome. Resultats L’analyse de la variabilite de la frequence cardiaque (VFC) chez des patientes ayant un syndrome d’hyperactivite vesicale et des temoins a mis en evidence des parametres de VFC differents entre ces deux populations, soit une hypertonie sympathique relative dans le syndrome d’hyperactivite vesicale. Les tests cardiovasculaires sympathiques semblaient plus frequemment alteres dans le syndrome d’hyperactivite vesicale. Conclusion L’ensemble de ces etudes suggere une dysfonction du systeme nerveux autonome sympathique dans le syndrome d’hyperactivite vesicale idiopathique de la femme, mais les methodologies sont trop variables et les effectifs trop faibles pour permettre d’etablir un lien physiopathologique certain.

Purpose To review the literature and to clarify the recommendations for therapeutic education programs for intermittent self-catheterization. Materials and methods The literature on Medline, Pubmed, and Cochrane Library, with specific keywords, as well as the recommendations based on expert consensus. Results Clean intermittent self-catheterization (CICS) is the gold standard for managing chronic urinary retention, which allows the patients to improve their quality of life and to reduce the complications of upper urinary tract infections. Patient education needs to have a structured procedure in order to evaluate the ability to understand, accept and perform CISC. Conclusion Teaching self-catheterization is now well known; nevertheless, the effectiveness of CISC educational therapeutic programs remains to be demonstrated.

Objectives: To determine whether the completion of a voiding dysfunction (VD) questionnaire could have a good predictive value for uroflowmetry findings, in a population of stress urinary incontinence (SUI) women. Materials and Methods: From a urodynamic database of 415 SUI women, 93 with isolated SUI who underwent urodynamic investigations were eligible for this study. Patients with obvious etiologies of obstruction were excluded. VD symptoms were analyzed using the Bristol Female Lower Urinary Tract Symptoms Questionnaire. Bladder outlet obstruction (BOO) was defined as a maximal flow rate under 15 ml/s for a urine volume > 200 ml, or a post-void residual volume greater than 50 ml, or an abnormal pattern of the flow curve. The sensitivity, specificity, positive and negative predictive value of questioning VD were calculated. Statistical analysis was done using a Wilcoxon test for continuous data and Fisher exact test for categorical data, and multivariate analysis. Results: Reported VD had a poor specificity (41%) and positive predictive value (32%) of BOO on uroflowmetry. No statistical correlation was found between VD symptoms and BOO defined on uroflowmetry ( P =0.64) in this specific SUI population showing no obvious etiologies of obstruction. Conclusions: No correlation was found between obstructive symptoms and BOO as defined on uroflowmetry, in a specific population of SUI women. Our results suggest that uroflowmetry may be necessary rather than multichannel urodynamics.

Objective Correction of obstructive sleep apnea (OSAS) by non-invasive continuous pressure ventilation (CPAP) allows an improvement of attentional and executive functions, especially post-stroke. On the other hand, in chronic obstructive pulmonary disease, correction of hypercapnia by bilevel positive airway pressure ventilation (BiPAP) improves cognitive impairment. We present a case of a brain-injured patient who remains hypercapnic despite an effective CPAP for the correction of an OSAS. Material/patients and methods We present a 36-year-old patient with visuo-spatial disorders, dysexecutive syndrome, cerebellar syndrome, swallowing disorders after a rupture of a right vertebral artery aneurysm 2 years before. Oral feeding by adapted texture (mixed), tracheotomy, CPAP for OSAS for several months were needed. We performed cognitive assessments (MoCA: Montreal Cognitive Assessment and BAWL: Attentional Battery William Lennox), pre- (T1) and post- (T2) correction of hypercapnia by night BiPAP, 2 months later. Results After correction of hypercapnia (T1 PaCO2 = 7.36 kPa or 55 mmHg then T2 PaCO2 = 5.86 kPa or 44 mmHg), improvement of: Global cognitive efficiency (MoCA score: + 4/30); Attention (MoCA attention items: +2/6); Simple reaction times (BAWL: –32 ms, from percentile 5 at T1 to percentile 15 at T2); Memory encoding (MoCA 5 words test: + 2/5 points and no false memories anymore). In addition, dysphagia improves by mealtime reduction (50 min versus 1h40) and laryngeal penetration decrease, which allows a withdrawal of the tracheotomy. Discussion – conclusion In this case, the improvement of global cognitive capacities, attention and cognitive processing speed seems to result from the decrease of capnia. The persistence of sequelae of the intracranial aneurysm rupture (specially visuo-spatial and cerebellar) suggests that improvements on cognitive functions stem from the correction of hypercapnia. This case suggests the importance of a normalization of capnia in brain-injured patients with ventilatory disorders to improve the cognitive (global and attentional) capacities and autonomy in daily life (feeding and tracheotomy withdrawal). Larger studies are needed to confirm this.

Aims Micturition and continence are largely under the control of the autonomic nervous system (ANS). In this study, we analyzed ANS function using autonomic cardiovascular (CV) testing in females with idiopathic overactive bladder syndrome (iOAB) versus control females. Our hypothesis was that ANS dysfunction could comprise part of the pathophysiology of iOAB. Methods Twenty-three females with iOAB and 29 controls were enrolled into this prospective study. Patients performed CV autonomic testing, including two sympathetic tests (hand grip exercise and cold pressor test), two parasympathetic tests (deep breathing and 30:15 ratio), and two mixed tests (Valsalva manoeuvre and blood pressure [BP] response to standing). Patients with iOAB also underwent conventional urodynamic studies in order to define iOAB as either with or without demonstrable detrusor overactivity (DO). Results Both groups were similar with respect to age and menopausal status. Females with iOAB had significantly more positive tests than controls (P

L’incontinence urinaire est un probleme frequemment observe chez la femme. Plusieurs types d’incontinence peuvent etre decrits: l’incontinence d’effort, l’incontinence par urgence mictionnelle, l’incontinence mixte (IM). L’examen clinique est toujours necessaire pour eliminer une cause specifique de l’incontinence et tout particulierement une etiologie neurologique ou les fuites peuvent constituer le premier symptome avant l’apparition de deficits moteur ou sensitif. Les explorations urodynamiques peuvent preciser les differents facteurs physiopathologiques des fuites et permettent ainsi un meilleur choix therapeutique.

We created and validated the new pencil and paper test, which allows assessment of the ability of patients with a neurological disorder to practice clean intermittent self-catheterization.We developed a simple test including common gestures mimicking the usual maneuvers needed during clean intermittent self-catheterization, and involving the same cognitive and physical resources needed for this technique. We evaluated the test in 118 patients with a neurological condition. Instruments needed to perform the pencil and paper test are limited to a sheet of paper and a pencil. Each test item was quantified and graded with a total score of 15. A specific clean intermittent catheterization learning scale was used to classify the outcome of the ability to perform clean intermittent self-catheterization with a score range of 5--learning easy and self-catheterization complete to 0--learning impossible.Enrolled in the study were 118 patients with a neurological condition. There was strong correlation between the global pencil and paper test score, and the ability to perform clean intermittent self-catheterization, as evaluated by the learning scale (r = 0.82, p = 0.000091). At a test cutoff of 10 and a clean intermittent self-catheterization cutoff of 3, which was the limit needed to practice self-catheterization alone, the positive predictive value of the pencil and paper test was 85% and its negative predictive value was 94% (Cronbach's α = 0.88).The pencil and paper test is a valid way to predict the ability to practice clean intermittent self-catheterization in patients with a neurological disorder.

Rectoanal inhibitory reflex (RAIR) is a physiological modulated reflex involved in anorectal continence and defined by a relaxation of internal anal sphincter following rectal distension. Its existence depends on intramural autonomic ganglions and its modulation on the integrity of the autonomic nervous system (ANS).The aim of this study was to analyse RAIR modulation in terms of amplitude and duration in multiple sclerosis (MS) patients.Twenty-one patients with MS and 40 control patients had anorectal manometry. Qualitative assessment (presence or absence) of RAIR was evaluated together with its modulation in amplitude and in duration.All patients had present RAIR for each volume of rectal distension (10-50 ml). Seven patients (33.3%) in the MS group had abnormal RAIR modulation in amplitude (odds ratio (OR) = 2.78, compared to control group, p = 0.11). Nine patients (42.9%) in the MS group had abnormal RAIR modulation in duration (p = 0.14, OR = 2.54, compared to control group). Alteration of RAIR modulation was not correlated with Expanded Disability Status Scale, faecal incontinence and constipation (p0.05). Course of MS (relapsing-remitting MS or secondary progressive form) seems to be correlated to alteration of modulation in amplitude and in duration (OR = 1.31 and 1.07).Even if our results do not have the required statistical significance (p0.05), they are interesting. If RAIR is always present in MS, its modulation seems to be altered. A hypothesis for this lack of RAIR modulation could be the alteration of ANS, often involved in MS besides somatic nervous system lesions.

La dyschesie anorectale est un symptome frequent de consultation en situation fonctionnelle ou s’integrant a une pathologie neurologique. Les plaintes anamnestiques du patient dyschesique sont polymorphes, traduisant des mecanismes differents. La manometrie anorectale permet d’apprehender certains des mecanismes responsables: trouble de la relaxation de l’appareil sphincterien lors de la defecation (anisme), hypertonie anale de repos, troubles sensitifs du complexe rectoanal, troubles de la commande anale. Neanmoins, la manometrie ne permet pas de mettre en evidence les causes mecaniques d’une dyschesie (consistance des selles, prolapsus pelvien...). Cet examen est rarement realise isolement.

Introduction/Background Ambulatory care is the most frequent type of rehabilitation for chronic diseases. French guidelines recommend after a stroke assessment and rehabilitation by a multidisciplinary team for all the patients with a persistent deficiency. According to the needs of each patient, different ways to provide home rehabilitation can be used in France. For simple needs targeting specific deficiency, rehabilitation can be provided by a professional alone in ambulatory care. Only Physiotherapy (PT) and speech therapy (ST) are refunded by the national health insurance. For complex needs a PRM multidisciplinary team, can be ordered either in day hospital (the patient living home and receiving rehabilitation during repeated stays) which is the main organization, or mobile rehabilitation team, the team coming each day at home like an early supported discharge team (not very developed in France). Material and method We report here the global activity base on the analysis of the national registry on the 80,000 annual new strokes (excluding transient attacks and deceased) Results After the acute care, 37% of stroke patients received a multidisciplinary rehabilitation during a mean of 3 months (33% in an inpatient center and 4% in an outpatient center). For the patient discharge at home 30% (directly discharge from an acute center) to 50% (discharge from a rehabilitation center) receive PT and 9 to 15% ST. At the chronic phase 35% of the patients receive PT at home. Ambulatory occupational therapy and ST are less developed and less available. Conclusion Effort is needed to improve multidisciplinary rehabilitation at home in France. Home hospital could be interesting to develop for dependent and fragile patients, mobile rehabilitation team for the rehabilitation of the instrumental activities of daily livings, and day hospital for rehabilitation requiring technical platform of a rehabilitation center.

Les troubles anorectaux (TAR) sont frequents dans les pathologies neurologiques centrales telles que la sclerose en plaques (SEP), les pathologies medullaires, les accidents vasculaires cerebraux (AVC), les traumatismes crâniens (TC) et la maladie de Parkinson. Leurs mecanismes sont complexes, secondaires a la maladie neurologique mais aussi aux medicaments quotidiens, a l’alitement prolonge ou encore au manque d’exercice physique. Leur retentissement sur la vie quotidienne est important. Leur prise en charge specifique repose avant tout sur une optimisation de la defecation et du transit et sur une education specifique des patients. Une bonne prise en charge, en facilitant le transit et l’evacuation des selles, ameliore le quotidien des patients.

L’incontinence urinaire est souvent associee a une dysfonction sexuelle. Les mecanismes physiopathologiques sont souvent identiques : âge, prolapsus, menopause, hysterectomie, chirurgie abdominale ou perineale anterieure. La neuropathie d’etirement avec denervation du plancher perineal peut determiner incontinence et troubles sexuels tels qu’une anorgasmie. Les fuites percoitales peuvent etre dues a une hyperpression abdominale, a une instabilite uretrale ou a un reflexe spinal par stimulation perineale cutanee induisant des contractions non inhibees du detrusor. Les facteurs psychologiques devant toujours etre apprehendes tant sur le plan diagnostique que therapeutique.

L’innervation de l’appareil urinaire est sous le controle principal du systeme nerveux autonome (SNA), cependant, celui-ci reste peu explore dans l’analyse des troubles vesicosphincteriens (TVS). Les tests cardiovasculaires du SNA tels que le ratio 30:15 ou la recherche d’hypotension orthostatique sont pourtant de realisation simple. La perturbation de deux de ces tests confirme une dysautonomie lorsqu’elle est suspectee, qu’elle soit peripherique (diabete par ex.) ou centrale.

Les symptomes de dysautonomie sont frequents au cours de la sclerose en plaques (SEP). Nous avons investigue 65 SEP (âge moyen de 47,5 ans) avec troubles urinaires, par scores de symptomes, bilan urodynamique, tests cardiovasculaires de la fonction autonome et etude des reponses cutanees sympathiques. Quarante-cinq patients avaient une incontinence urinaire, 48 une dysurie, 14 une retention urinaire et 13 une incontinence fecale. Le bilan urodynamique objectivait un detrusor hyperactif dans 46 cas et un detrusor hypoactif dans quatre cas. Vingt-cinq patients sur 65 (38 %) avaient une dysautonomie sans correlation avec la typologie clinique ou urodynamique ou avec la gravite de la maladie. La dysautonomie est frequente au cours de la SEP et peut etre consideree comme un des facteurs physiopathologiques des troubles urinaires.

Les stenoses rachidiennes sont de localisation principalement lombaire, associees dans 10 a 20 % des cas a une stenose cervicale. L’association aux troubles vesicosphincteriens (TVS) varie entre 10 et 14 % des cas au niveau lombaire, jusqu’a 50 % des cas au niveau cervical. Il existe une grande variabilite de l’expression clinique des troubles urinaires qui semble correlee a la severite de la stenose canalaire. Les anomalies cystomanometriques revelant des signes de neurovessies varient entre 50 et 80 % des cas. A travers une revue de la litterature, nous proposons d’analyser les donnees cliniques et cystomanometriques dans les stenoses rachidiennes lombaires et cervicales.

Introduction A few studies have found short-term effects of tendon vibration therapy on upper limb function in chronic hemiplegia [1] , [2] . We report the effect of tendon vibrations of the elbow and wrist flexor muscles on recovery of the upper limb in a recent hemiplegic patient. Observation A 69-year-old woman was admitted to our department for right hemiplegia and aphasia after a left middle cerebral artery (MCA) stroke and a left cerebellar infarct secondary to cardiac arrhythmia. Initial NIHSS 22/44. Motor function on upper limb was limited to slight abduction and elevation of the shoulder, slight flexion of the wrist and elbow. The initial Functional Independence Measure score was 38/126. Intensive classical reeducation was started with little progress of upper limb recovery despite upper limb suspension, bimanual work and mirror therapy for 1 month. Two months after the stroke, the vibration program began. Evaluation using Fugl-Meyer assessment (FMA) for the upper limb, the Action Research Arm Test (ARAT) and the modified Tardieu Scale was performed at days 0, 7, 21, 28 and 35. The tolerance and feasibility were studied. Vibrations (80 Hz) were applied on right distal biceps brachii, flexor carpi radialis and ulnaris muscle tendons during 16 min, twice a day, 5 days a week for 2 weeks on days 7 to 21. No side effects or pain were reported. The FMA score increased 6 points the first week, 9 points during the vibration period, 9 new points the third week, and then stabilized. The ARAT score increased from 0 to 11 during the vibration period and reach 24 at D35. Discussion Tendon vibration seemed to give a new impetus to motor recovery in this patient and leads to the elaboration of a controlled trial to assess its real effectiveness in subacute stroke.

Les troubles ano-rectaux sont frequemment rencontres dans les neuropathies peripheriques, quelles que soient la cause et la distribution de la lesion (meningoradiculaire, plexique, tronculaire, somatique et/ou vegetative). Ils restent peu etudies en dehors du diabete et des complications obstetricales (neuropathie pudendale et lesions plexiques). Les plaintes sont dominees par l’incontinence fecale et la dyschesie ano-rectale. Ils n’entrainent pas de complications medicales graves, mais ils grevent considerablement la qualite de vie des patients. L’incontinence fecale est polyfactorielle: trouble de la sensibilite rectale entrainant des urgences defecatoires, impaction des selles avec incontinence par «regorgement», defaillance des mecanismes de continence active volontaire. La dyschesie peut repondre egalement a plusieurs mecanismes: trouble de la motricite colorectale, trouble iatrogene, alimentation inadaptee. La dyschesie ano-rectale doit etretraitee car elle peut s’aggraver, une neuropathie pudendale d’etirement pouvant compliquer les efforts de poussee et entrainer une incontinence fecale par constipation terminale. Meme si la prise en charge repose sur la clinique, les examens complementaires, manometries ano-rectales, EMG, defecographie, permettent l’evaluation des troubles et peuvent orienter les choix therapeutiques.

Objective The positive effects on motor cortical excitability of stimulating proprioception with tendon vibration therapy have previously been reported in healthy individuals and in chronic stroke patient (Marconi et al., 2008 and 2011). The aim of this study is to evaluate the feasibility of a protocol of tendon vibration therapy in a neurorehabilitation service, with a view to proceeding to an efficacy study. Material/Patients and methods We performed a prospective, single-centre study, including 11 patients, 8 men, mean age 61,7 ± 10,6, with upper limb motor deficit secondary to a first stroke (5 ischaemic). Average time post-stroke was 116.8 days. Mean NIHSS at inclusion was 7,9 ± 5,7. Two 15-minute sessions per day for 5 days of vibration therapy associated to voluntary movement were applied to the elbow and wrist flexor and extensors of the hemiplegic arm. The vibration therapy was in addition to standard rehabilitation. The feasibility was assessed by the implementation of the protocol (logistic regression of sessions, who did it? Where? When?), adverses outcomes and tolerance. Assessment of motor function at baseline and at day 7 was performed with Fugl-Meyer (upper limb), ARAT, Box and Blocks Test and ARMEO was used to assess the volume of exploration of the arm. Functional recovery was measured by the difference between the two scores. Results Nine patients were eligible (1 transferred to another ward for a septicaemia; 1 incomplete assessment at day 7). 97.7% of planned vibration sessions were performed. There were no adverse outcomes. Treatment was well tolerated; 1 patient reported transient paraesthesias and 4 patients reported significant fatigue whilst undergoing therapy. Every patient improved motor control: mean delta (±SD): ARAT: +8.6 points ± 14.2; BBT: +3.5 points ± 10.8; Fugl Meyer: +3.3 points ± 4.2; volume of exploration ARMEO: +38% ± 75.1%. Discussion - Conclusion This preliminary, open-labelled, study demonstrates that this protocol is achievable in a neurorehabilitation clinic setting. Given the functional improvement seen, randomised controlled trials should be performed to further evaluate the effects on motor control.

Aims Once a catheterization technique has been learned and acquired, psychological barriers have been overcome and a specific catheter has been selected, a patient will need to use clean intermittent self-catheterization (CISC) on a long-term basis. Over this long period of time, several technical or anatomical difficulties and local complications may be observed. The aim of this study was to construct and validate a specific test, referred to as the ICDQ (intermittent catheterization difficulty questionnaire), in order to evaluate and quantify patients' difficulties during CISC. Methods The questionnaire was validated in neurogenic patients. Thirteen items were chosen, concerning ease of catheter insertion and withdrawal, the presence of pain, limb spasticity, urethral sphincter spasms, and local urethral bleeding during catheterization. The frequency and intensity of these difficulties were scored. The comprehension, relevance, psychological and time consumption acceptance and face validity were evaluated. Reliability (internal consistency and test–retest reliability using the Intraclass Correlation Coefficient [ICC]) was carried out. Results The ICDQ was validated in 70 neurogenic patients (mean age 51.6 ± 13, 44 females, 26 males). Comprehension and acceptance of the questionnaire were good. Cronbach's alpha was α = 0.88. The ICC demonstrated good test–retest reliability. Conclusion The ICDQ is a valid test for the evaluation of catheter use, and of patients' difficulties during CISC. However, in order to facilitate CISC, we propose the interpretation of ICDQ results, drug combinations such as the use of alpha-blockers or botulinum toxin injections in the external urethral sphincter, or a change of catheter. Neurourol. Urodynam. 35:85–89, 2016. © 2014 Wiley Periodicals, Inc.

Resume Introduction La megavessie congenitale est caracterisee par l’association d’un syndrome des mictions rares, et d’une capacite vesicale fonctionnelle augmentee en l’absence de toute pathologie neurologique ou urologique. Frequente, elle est peu rapportee dans la litterature. Cette etude permet l’analyse comparee des caracteristiques cliniques et urodynamiques des megavessies congenitales asymptomatiques et symptomatiques. Patients et methodes Analyse retrospective de 126 patients adultes ayant une megavessie. Les caracteristiques cliniques, urodynamiques, radiologiques et therapeutiques ont ete etudiees. A partir de ces donnees, les patients ont ete repartis en 2 groupes : patients asymptomatiques et symptomatiques (dysurie, retention urinaire complete ou incomplete) ; et les donnees ont ete comparees. Resultats Quatre-vingt-un pour cent des patients ayant une megavessie etaient des femmes. Vingt et un patients etaient asymptomatiques (17 %), 105 patients etaient symptomatiques (83 %). Les patients du groupe symptomatique etaient significativement plus âges (54,3 ans ± 14,7). La dysurie (53 %) et la retention d’urine (27 %) etaient les symptomes les plus frequents dans le groupe symptomatique. Le debit maximal et moyen a la debitmetrie etaient significativement plus eleves dans le groupe asymptomatique ( p = 0,0074). L’hypoesthesie vesicale etait retrouvee dans les 2 groupes sans difference significative. Par contre, les megavessies symptomatiques etaient significativement plus hypocontractiles ( p = 0,0001). Dix-neuf patients (18 %) avaient une complication uro-nephrologique grave. Conclusion La megavessie congenitale est certainement sous-estimee. Elle est a rechercher devant un tableau de dysurie/retention chez un patient ayant un syndrome des mictions rares ou devant des complications uro-nephrologiques (infections urinaires febriles, reflux vesico-ureteral, dilatation des cavites pyelocalicielles). L’hypothese d’une defaillance structurelle de la vessie ou d’une dysautonomie a expression vesicale peut etre avancee. Niveau de preuve 5.

L’evaluation et le traitement de premiere ligne sont possibles au cours des troubles sphincteriens de la sclerose (SEP) en plaques sans recours direct a un centre de reference de neuro-urologie. L’echographie vesicorenale est le test principal eliminant une retention et une alteration du haut appareil. En l’absence de residu, et devant un syndrome d’hyperactivite vesicale (urgences, fuites, pollakiurie), un traitement anticholinergique peut etre essaye.

La manometrie anorectale (MAR) est un outil d’evaluation largement utilisee dans les troubles anorectaux (TAR) fonctionnels (dyschesie, incontinence fecale) et neurologiques. Nombre de parametres (pressions de repos, perception du besoin, synchronisme abdominoperineal) obtenus lors de cet examen sont valides en termes de reproductibilite et de valeur normative au sein de chaque laboratoire, sans qu’aucune valeur ne soit cependant universellement acceptee. Il en est de meme pour le reflexe rectoanal inhibiteur (RRAI), element essentiel de cette exploration manometrique anorectale, puisque permettant de verifier l’integrite de l’innervation intrinseque. De meme, la modulation du RRAI, quant a elle, sous la dependance du systeme nerveux extrinseque, n’a que recemment fait l’objet d’une etude specifique, ayant permis l’adoption de valeurs normatives de modulation, dans une population non neurologique. Nous presentons, ici, une mise au point sur les valeurs normatives de definition et de modulation en amplitude et en duree du RRAI.

Les troubles ano-rectaux au cours des accidents vasculaires cerebraux sont frequents, mais les etudes epidemiologiques prospectives sont rares. Ces troubles sont domines par l’incontinence fecale et la constipation. La constipation est le plus souvent multifactorielle, d’etiopathogenie non specifique (sujet alite, medications anticholinergiques, regime peu adapte) ou directement secondaire a l’AVC (paralysie motrice recto-anale, troubles sensitifs anorectaux, asynchronisme abdomino-pelvien). Son traitement est toujours necessaire (regime, mucilages, suppositoires exonerateurs par distension volumetrique rectale, lavements evacuateurs, evacuation de fecalome) en raison des risques potentiels (incontinence fecale de regorgement, decompensation ou perennisation de troubles vesico-sphincteriens). L’incontinence anale procede elle aussi de causes iatrogenes (sedatifs, fecalome...), mais aussi de lesions secondaires a l’AVC (paralysie sphincterienne, troubles de la conscience initiaux, troubles psychocomportementaux sequellaires). La reeducation perineale par biofeedback peut etre efficace.

Attention may play a key role in the contraction of pelvic floor muscles in stressful situations, meaning that mental distraction may be involved in urinary incontinence.Informed consent was obtained from 20 healthy volunteers. The electromyographic (EMG) activity of the external anal sphincter (EAS) was recorded during voluntary contraction elicited by local stimulation. The trials were carried out twice: combined (or not) with a mental distraction task (PASAT), Paced auditory serial additional test. Reaction time, latency between the stimulus and maximum EAS EMG activity, duration of the contraction, maximum EAS EMG activity, and the area under the EAS EMG activity curve were measured.The mental distraction task led to a 3.98 times greater reaction time (RT), (P = 0.00001 Wilcoxon's test). The RT increased from 217 (IQR: 170-270) to 779 msec (IQR: 550-1,025, P0.0001) when the EAS contraction was combined with PASAT. However, the maximum EAS EMG activity was weaker during PASAT than in the absence of a mental distraction task: 0.0850 mv versus 0.0701 mv, that is, 1.21 times weaker (P = 0.00077, Wilcoxon's test). Finally, when the two conditions (respectively with and without the mental distraction task) were compared, no significant difference was found in the area under the EAS EMG activity curve (0.0157 mv sec vs. 0.0162 mv sec, ratio 1.01, P = 0.52).The mental distraction task altered voluntary contraction of the pelvic floor muscles.

To determine whether a strong urge to void could affect a person's attentional performance. To determine whether an attentional task could decrease a strong urge to void a prospective study was performed.Healthy adults were asked to perform two neuropsychological tests, the modified Paced Auditory Serial Addition Test (mPASAT) and the Psychology Experiment Building Language Continuous Performance Test (pCPT), under two different conditions: no need to void, and a strong urge to void defined by a score of70/100 mm on a visual analogue scale.In all, 21 healthy volunteers were included. There was no statistical difference between the mPASAT scores from the two sessions (P = 0.57). The mean total error score of the pCPT increased with the individual's urge to void (P = 0.043). The mean omission score decreased, but was not statistically different (P = 0.129), the commission error score increased with the urge to void (P = 0.017), with a shorter reaction time for the inter-stimuli intervals of 1 (P0.001) and 2 s (P = 0.036), suggesting a tendency to hurry.A strong urge to void can alter attentional performance, with a tendency to hurry, in healthy volunteers taking part in a sustained attention test pCPT involving the use of the anterior cingulate cortex.