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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; 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

Introduction Asymmetrical postural behaviours are frequent and related to poor equilibrium after a stroke. Proprioceptive neck vibration could correct the postural asymmetry through a sensory recalibration but the long lasting effect has not yet tested. Objective To test the long-lasting effects of repetitive neck muscle vibration (rNMV) on postural disturbances and on spatial frame reference in chronic patients. Methods Twenty chronic stroke patients (mean age: 61.4 y11, mean delay since stroke: 5.5y3), 10 right (RDB) and 10 left (LDB) brain damage, underwent a program of 10 vibrations of 10 min sessions during two weeks–the evaluation of postural asymmetry on force platform (weight body asymmetry WBA), spatial frames (subjective straight ahead SSA, longitudinal body axis LBA, subjective visual vertical SVV) and clinical assessment (Motricity Index, Sensibility, Spasticity, Berg Balance Scale, time up and go) were ascertained before (D−15, D0) and at the end of the vibrations (D + 15, D + 22, D + 45). Results In the post-test, a significant reduction in WBA was established in the RBD (P = 0.009) and was maintained at D + 15 (P = 0.01) and D + 22 (P = 0.05), no effect was observed in the LBD. In addition, no significant modification was found on the spatial frame in both group. A significant improvement was found for the motricity and time up and go in the RBD. Discussion rNMV causes a reduction of postural asymmetry in the RBD group independently of the space representation improvement. Likewise, rNMV can modify the postural asymmetry in chronic patients but this result was not maintained at D + 45.

Introduction and hypothesis We aimed to compare outcomes of open and robot-assisted artificial urinary sphincter (AUS) implantation in female patients.

Introduction/Background Upper urinary tract damage due to neurogenic lower urinary tract dysfunction has long been reported as the first cause of death in spina bifida patients. However, recent data regarding the causes of death of patients with spinal dysraphism are scarce. The aim of the present study was to assess the current epidemiology of spina bifida in France report the contemporary causes of in-hospital death of spina bifida patients. Material and method We analyzed data from the French national code registry database (Programme de Medicalisation des Systemes d’Information) from 2009 to 2014 to estimate the number of living births of spina bifida patients and the number of in-hospital deaths and their cause categorized as follows: urological, pulmonary, neurological, digestive, muscular/skin, cardiovascular, skeletal, infectious, cancer, others. The prevalence was calculated by doing the ratio of spina bifida living births over the total number of living births per year based on the Institut National de la Statistique et des Etudes Economiques (INSEE) data. Results The number of spina bifida living births per year ranged from 113 (2009) to 131 (2013) and was stable over the study period. The total number of living births during this period was between 811,510 (2013) and 832,799 (2010). The prevalence of spina bifida in France was therefore estimated between 1.3 and 1.6/100,000. The number of in-hospital deaths of spina bifida patients per year fluctuated between 14 (2012) and 31 (2011) making a total of 138 in-hospital deaths over the study period. The leading cause of in-hospital death was urological disorders (17%). Other main causes of death were pulmonary disorders (17%), neurological disorders (14%) and bowel disorders (11%). Conclusion The current prevalence of spina bifida in France range from 1.3 to 1.6/100,000. Urological disorders remain the leading cause of death in spina bifida patients.

Introduction/Background Spinal dysraphism is the first congenital cause of neurogenic bladder. Open spinal dysraphism (mainly myelomeningocele) being diagnosed in the neonatal period, neurogenic lower urinary tract dysfunctions (NULTD) are well-known as they have been described in many series. Conversely, closed spinal dysraphisms are often diagnosed later and little data regarding NULTD exist. The aim of this study was to compare the NULTD in patients with closed dysraphism (CD) to those in patients with open dysraphism (OD). Material and method A prospective study was conducted between 2007 and 2016 including all spina bifida patients seen in a multidisciplinary national referral center. At the first visit, lower urinary tract function was assessed as follow: history of past urological surgery, type of spinal dysraphism, Abbreviated Injury Scale, method of bladder emptying, Urinary Symptom Profil (USP) and Qualiveen scores and urodynamic parameters. Results In total, 395 patients were included: 274 with OD (69.4%) and 121 with CD (30.6%). Patients in the CD group were older (35.9 vs. 29.5 years, P Conclusion NLUTD were as frequent and troublesome in patients with open vs. closed spinal dysraphism. However the need for a surgical treatment was more common in patients with OD.

Objective The objective of this preliminary study is to test the long-lasting effects of repetitive neck muscle vibration (rNMV) on postural disturbances and on spatial frame reference in chronic patients. Material/patients and methods Twenty chronic stroke patients (mean age 61.4y ± 11, mean delay since stroke 5.5y ± 3), 10 right (RDB) and 10 left (LDB) brain damage, having gained the capacity to stand for more than 30 s were included. They underwent 10 vibrations of 10 min sessions during two weeks – the evaluation of postural asymmetry on force platform (weight body asymmetry [WBA]), spatial frames (subjective straight ahead [SSA], longitudinal body axis [LBA], subjective visual vertical [SVV]) and clinical assessment (Motricity Index, Sensibility, Spasticity, Berg Balance Scale, Time Up and Go) were ascertained twice before (D-15, D0) and ultimately at the end of the vibrations (D + 15, D + 22, D + 45). Results In the posttest, a significant reduction in WBA was established in the RBD (P = 0.009) and was maintained at D + 15 (P = 0.01) and D + 22 (P = 0.05) on the contrary, no effect was observed in the LBD group. In addition, no significant modification was found on the spatial frame in both RBD and LBD. A significant improvement was found for the Motricity and Time Up and Go at D + 22 in the RBD group whereas no modifications were found in the LBD. Discussion – conclusion rNMV causes a reduction of postural asymmetry in the RBD group independently of the space representation improvement. Likewise, rNMV can modify the postural asymmetry of patients at distance from their stroke but this result was not maintained at D + 45.