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Benoit Peyronnet, Xavier Gamé, Gregory Vurture, Victor W Nitti, Benjamin M Brucker
The use of botulinum toxin A (BTX-A) has revolutionized the treatment of neurogenic lower urinary tract dysfunction (NLUTD) over the past three decades. Initially, it was used as a sphincteric injection for detrusor sphincter dyssynergia but now is used mostly as intradetrusor injection to treat neurogenic detrusor overactivity (NDO). Its use is supported by high-level-of-evidence studies and it has become the gold-standard treatment for patients with NDO refractory to anticholinergics. Several novelties have emerged in the use of BTX-A in neurourology over the past few years...
2018: Reviews in Urology
Argyrios Stampas, Radha Korupolu, Liang Zhu, Christopher P Smith, Kenneth Gustafson
OBJECTIVES: We investigated whether transcutaneous tibial nerve stimulation (TTNS) in acute spinal cord injury was safe and feasible, and could achieve neuromodulation and improve cystometrogram parameters during acute inpatient rehabilitation. MATERIALS AND METHODS: Participants were consecutive acute traumatic spinal cord injury patients admitted for acute inpatient rehabilitation, randomized to a 2-week trial of TTNS v sham stimulation. Primary outcomes were safety and feasibility of TTNS and secondary outcomes were bladder measures based on pre- and post-TTNS cystometrogram by group and within groups, including bladder capacity, detrusor hyperreflexia, pressures, and detrusor-sphincter dyssynergia, as well as filling sensations and desire to void...
October 3, 2018: Neuromodulation: Journal of the International Neuromodulation Society
M S Fernández Córdoba, C Parrondo Muiños, Y M Argumosa Salazar, V Marijuán Sahuquillo, M Ramírez Piqueras, T Moratalla Jareño, J Rojas Ticona, A Vidal Company
OBJECTIVES: To assess the utility of a new modality of video-urodynamic for study of lower urinary tract dysfunction and other uropathies in kids, replacing voiding cystourethrography by echo-enhanced cystosonography, without ionizing radiations. MATERIAL AND METHODS: Prospective study with simultaneous performance of filling cystometry and cystosonography in 43 kids during the last two years. The sonographic contrast was infused trough the urodynamic catheter. RESULTS: 18 girls and 25 boys, with an average age of 6...
August 3, 2018: Cirugía Pediátrica: Organo Oficial de la Sociedad Española de Cirugía Pediátrica
Satish S C Rao, Jessica A Valestin, Xuelian Xiang, Shaheen Hamdy, Catherine S Bradley, M Bridget Zimmerman
BACKGROUND: Office-based biofeedback therapy is effective for constipation with dyssynergic defecation, but must be performed by skilled staff, is only available in selected centres, and requires multiple visits. The efficacy of home-based biofeedback therapy is unknown. We compared clinical and subjective outcomes with home-based and office-based approaches. METHODS: In this randomised controlled trial, eligible patients were adult outpatients (age 18-80 years) who met the Rome III criteria for functional constipation and who had been referred to a tertiary-care centre after non-response to routine management, and who had dyssynergic defecation...
September 17, 2018: Lancet. Gastroenterology & Hepatology
Diana V Hunter, Seth D Holland, Matt S Ramer
Spinal cord injury (SCI) disconnects supraspinal micturition centers from the lower urinary tract resulting in immediate and long-term changes in bladder structure and function. While cervical and high thoracic SCI have a greater range of systemic effects, clinical data suggest that those with lower (suprasacral) injuries develop poorer bladder outcomes. Here we assess the impact of SCI level on acute changes in bladder activity. We used two SCI models, T3 and L2 complete transections in male Wistar rats, and compared bladder pressure fluctuations to those of naïve and bladder-denervated animals...
2018: Frontiers in Physiology
Lauren Folgosa Cooley, Stephanie Kielb
Prior to FDA approval of intradetrusor botulinum toxin (BoTA) injections for the treatment of neurogenic bladder, patients had limited treatment options including "off-label" use of pharmacotherapies (anticholinergics, beta agonists, and alpha-blockers) or invasive interventions including bladder augmentation and urinary diversion procedures. Herein, we provide a comprehensive literature review detailing the salient clinical literature that led to FDA approval of intradetrusor BoTA for neurogenic bladder...
August 21, 2018: PM & R: the Journal of Injury, Function, and Rehabilitation
Tianyi Niu, Carol J Bennett, Tina L Keller, J C Leiter, Daniel C Lu
Patients with chronic spinal cord injury (SCI) cannot urinate at will and must empty the bladder by self-catheterization. We tested the hypothesis that non-invasive, transcutaneous magnetic spinal cord stimulation (TMSCS) would improve bladder function in individuals with SCI. Five individuals with American Spinal Injury Association Impairment Scale A/B, chronic SCI and detrusor sphincter dyssynergia enrolled in this prospective, interventional study. After a two-week assessment to determine effective stimulation characteristics, each patient received sixteen weekly TMSCS treatments and then received "sham" weekly stimulation for six weeks while bladder function was monitored...
August 22, 2018: Scientific Reports
Subhankar Chakraborty, Kelly Feuerhak, Anjani Muthyala, William S Harmsen, Kent R Bailey, Adil E Bharucha
BACKGROUND & AIMS: Some patients with defecatory disorders (DD) have high anal pressures that may impede rectal evacuation. Αlpha-1 adrenoreceptors mediate as much as 50% of anal resting pressure in humans. We performed a randomized, placebo-controlled study of the effects of alfuzosin, an alpha1-adrenergic receptor antagonist, on anal pressures alone in healthy women and also on bowel symptoms in women with DD. METHODS: In a double-blind study performed from March 2013 through March 2017, anal pressures were evaluated before and after 36 women with DD (constipation for at least 1 year) and 36 healthy women (controls) were randomly assigned (1:1) to groups given oral alfuzosin (2...
August 18, 2018: Clinical Gastroenterology and Hepatology
Ricardo Guilherme Viebig, Janaina Tomiye Yamakata Franco, Sergio Viebig Araujo, Daniel Gualberto
BACKGROUND: High resolution anorectal manometry (HRAM-WP) allows more simplified, objective, and uniform data acquisition and interpretation of the test results. OBJECTIVE: To validate a HRAM under water perfusion (Alacer Biomédica) with a 24-channel probe and to compare the results of anorectal manometry with other systems. METHODS: Individuals without critical evacuation disorders were selected. Patients with incontinence, anal surgery, dyssynergia or sphincter injury were excluded...
August 6, 2018: Arquivos de Gastroenterologia
Parag N Gad, Evgeniy Kreydin, Hui Zhong, Kyle Latack, V Reggie Edgerton
It is commonly assumed that restoration of locomotion is the ultimate goal after spinal cord injury (SCI). However, lower urinary tract (LUT) dysfunction is universal among SCI patients and significantly impacts their health and quality of life. Micturition is a neurologically complex behavior that depends on intact sensory and motor innervation. SCI disrupts both motor and sensory function and leads to marked abnormalities in urine storage and emptying. Current therapies for LUT dysfunction after SCI focus on preventing complications and managing symptoms rather than restoring function...
2018: Frontiers in Neuroscience
Jia-Fong Jhang, Hann-Chorng Kuo
OnabotulinumtoxinA (BoNT-A) was first used to treat neurogenic lower urinary tract dysfunction (LUTD) 30 years ago. Recently, application of BoNT-A in LUTD have become more common since the approval of intravesical BoNT-A injection for patients with both overactive bladders (OAB) and neurogenic detrusor overactivity (NDO) by regulatory agencies in many countries. Although unlicensed, BoNT-A has been recommended to treat patients with interstitial cystitis/bladder pain syndrome (IC/BPS) under different guidelines...
June 26, 2018: Toxins
Henriette Heinrich, Benjamin Misselwitz
Functional anorectal disorders such as faecal incontinence (FI), functional anorectal pain, and functional defecation disorders (FDD) are highly prevalent and represent a high socioeconomic burden. Several tests of anorectal function exist in this setting; however, high-resolution anorectal manometry (HR-ARM) is a new tool that depicts pressure all along the anal canal and can assess rectoanal coordination. HR-ARM is used in the diagnosis of FI and especially FDD although data in health is still sparse, and pressure phenomena seen during simulated defecation, such as dyssynergia, are highly prevalent in health...
April 2018: Visceral Medicine
Irina V Zabbarova, Youko Ikeda, Evan J Carder, Peter Wipf, Amanda S Wolf-Johnston, Lori A Birder, Naoki Yoshimura, Samuel E Getchell, Khalifa Almansoori, Pradeep Tyagi, Christopher H Fry, Marcus J Drake, Anthony J Kanai
AIMS: To determine the role of p75 neurotrophin receptor (p75NTR ) and the therapeutic effect of the selective small molecule p75NTR modulator, LM11A-31, in spinal cord injury (SCI) induced lower urinary tract dysfunction (LTUD) using a mouse model. METHODS: Adult female T8 -T9 transected mice were gavaged daily with LM11A-31 (100 mg/kg) for up to 6 weeks, starting 1 day before, or 7 days following injury. Mice were evaluated in vivo using urine spot analysis, cystometrograms (CMGs), and external urethral sphincter (EUS) electromyograms (EMGs); and in vitro using histology, immunohistochemistry, and Western blot...
May 28, 2018: Neurourology and Urodynamics
Zoran Radojicic, Sasa Milivojevic, Natasa Milic, Jelena Milin Lazovic, Marija Lukac, Aleksandar Sretenovic
OBJECTIVE: To examine the effects of bowel management on urinary incontinence in patients with spina bifida associated with overactive bladder (OAB) and detrusor sphincter dyssynergia (DSD). MATERIALS AND METHODS: The research was carried out during the period 2014-2017. A total of 35 patients (group 1) were administered bowel management combined with anticholinergic medication therapy and clean intermittent catheterization (CIC) and 35 patients (group 2) were treated only with anticholinergic medication therapy and CIC...
May 26, 2018: BJU International
Rizwan Hamid, Marcio Augusto Averbeck, Humberto Chiang, Arturo Garcia, Riyad T Al Mousa, Seung-June Oh, Anita Patel, Mauricio Plata, Giulio Del Popolo
Spinal cord injury (SCI) usually affects younger age groups with male preponderance. The most common traumatic cause is road traffic accident followed by sports accidents and gun-shot injuries. Infections and vascular events make up non-traumatic causes. There is regional variance in incidence and prevalence of SCI. Most systematic reviews have been undertaken from USA, Canada, and Australia with only few from Asia with resultant difficulty in estimation of worldwide figures. Overall, the incidence varies from 12 to more than 65 cases/million per year...
May 11, 2018: World Journal of Urology
Ryosuke Takahashi, Yasusuke Kimoto, Masatoshi Eto
AIMS: External sphincterotomy (ES) is a therapeutic option for male spinal cord injury patients with detrusor sphincter dyssynergia. However, some patients need to change their voiding management after ES. One of the potential causes of failure is reportedly detrusor dysfunction, but long-term urodynamic follow-up data after ES is limited. In the present study, we reviewed the urodynamic data before and after ES and analyzed it for possible causes of ES failure. METHODS: A total of 37 patients who were followed up at our center for at least 5 years after ES were included...
May 1, 2018: Neurourology and Urodynamics
Pablo Ercoli, Belinda García, Enrique Del Campo, Sergio Pinillos
We report the case of a previously healthy 2-year-old child who presented with significant abdominal distension. After several interventions that proved ineffective, pathologic aerophagia was eventually diagnosed. In pediatrics, pathologic aerophagia is an uncommon disorder that almost exclusively affects children with an underlying neurological condition. It may lead to multiple diagnostic tests and unnecessary aggressive therapies. A recent case report associated aerophagia with a novel concept of abdomino-phrenic dyssynergia...
May 2018: Revista Española de Enfermedades Digestivas
Wendy Yen Xian Peh, Roshini Mogan, Xin Yuan Thow, Soo Min Chua, Astrid Rusly, Nitish V Thakor, Shih-Cheng Yen
The disruption of coordination between smooth muscle contraction in the bladder and the relaxation of the external urethral sphincter (EUS) striated muscle is a common issue in dysfunctional bladders. It is a significant challenge to overcome for neuromodulation approaches to restore bladder control. Bladder-sphincter dyssynergia leads to undesirably high bladder pressures, and poor voiding outcomes, which can pose life-threatening secondary complications. Mixed pelvic nerves are potential peripheral targets for stimulation to treat dysfunctional bladders, but typical electrical stimulation of pelvic nerves activates both the parasympathetic efferent pathway to excite the bladder, as well as the sensory afferent pathway that causes unwanted sphincter contractions...
2018: Frontiers in Neuroscience
M Somers, C Peleman, K Van Malderen, W Verlinden, S Francque, H De Schepper
BACKGROUND: The treatment of fecal incontinence (FI) depends upon the dominant pathophysiology: impaired sphincter contractility or overflow due to pelvic floor dyssynergia and insufficient rectal emptying. In this study, we aimed to define the manometric and anorectal ultrasound characteristics in FI patients with and without constipation. METHODS: We did a retrospective study of 365 anal manometries, performed between October 2012 and July 2015, in patients with FI...
October 2017: Acta Gastro-enterologica Belgica
Veronique Vitton, Henri Damon, Alban Benezech, Dominique Bouchard, Sarah Brardjanian, Charlène Brochard, Benoit Coffin, Nadia Fathallah, Thierry Higuero, Pauline Jouët, Anne-Marie Leroi, Laure Luciano, Guillaume Meurette, Thierry Piche, Alain Ropert, Jean-Marc Sabate, Laurent Siproudhis
Chronic constipation is a common symptom that regularly affects the quality of life of adult patients. Its treatment is mainly based on dietary rules, laxative drugs, perineal rehabilitation and surgical treatment. The French National Society of Coloproctology offers clinical practice recommendations on the basis of the data in the current literature, including those on recently developed treatments. Most are noninvasive, and the main concepts include the following: stimulant laxatives are now considered safe drugs and can be more easily prescribed as a second-line treatment; biofeedback therapy remains the gold standard for the treatment of anorectal dyssynergia that is resistant to medical treatment; transanal irrigation is the second-line treatment of choice in patients with neurological diseases, but it may also be proposed for patients without neurological diseases; and although interferential therapy may be a new promising treatment, it needs further evaluation...
April 2018: European Journal of Gastroenterology & Hepatology
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