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Neurogenic detrusor overactivity

Ana Claudia Paradella, André Ferraz de Arruda Musegante, Carlos Roberto Brites
Intravesical botulinum toxin A (BoNTA) injection has been widely used for the treatment of detrusor overactivity in patients with neurogenic bladder due to spinal cord injury who do not respond to conventional treatment. There is no consensus about antibiotic prophylaxis for this procedure. We conducted a retrospective analysis of medical records of adult patients with spinal cord injury who underwent detrusor BoNTA injection between January of 2007 and December of 2013 in a rehabilitation hospital. Occurrence of symptomatic urinary tract infection (UTI) was assessed in 3 groups in accordance with their use of antibiotics (prophylactic dosage, 3 days, more than 3 days) for the treatment of asymptomatic bacteriuria...
October 17, 2016: Brazilian Journal of Infectious Diseases
Charles Fattal, Claire Anquetil, Samer Abdelhamid
OBJECTIVE: To compare quality of life (QoL) in patients with spinal cord injury who underwent overactive detrusor treatment by Botulinum Toxin (BT) versus augmentation cystoplasty (AC). MATERIALS/PATIENTS AND METHODS: Prospective and descriptive study. Patients with refractory overactive bladder due to SCI were treated by at least 2 successive injections of BT or by AC. QoL was assessed using Qualiveen-30 (Q30). Clinical data and urodynamic parameters were collected and compared...
September 2016: Annals of Physical and Rehabilitation Medicine
Charles Joussain, Mélanie Popoff, Véronique Phé, Alexia Even, Laetitia Falcou, Emmanuel Chartier-Kastler, Brigitte Schurch, Pierre Denys
OBJECTIVE: Intradetrusor injection of onabotulinum toxin A (IDIBA) is the third-line therapy for patients with neurogenic detrusor overactivity (NDO). There is few evidence of long-term efficacy but no study assessed reasons for failure or abandonment of IDIBA and CISC (clean intermittent self-catheterization) combined strategy. We aimed to assess its long-term outcome in NDO management, and analyze failure and discontinuation. MATERIALS/PATIENTS AND METHODS: We retrospectively reviewed medical records of patients admitted in our neurourology department between 2001 and 2013...
September 2016: Annals of Physical and Rehabilitation Medicine
Charles Joussain, Jonathan Levy, Audrey Charlanes, Alexia Even, Laetitia Falcou, Emmanuel Chartier-Kastler, Pierre Denys
OBJECTIVE: Hereditary spastic paraplegia (HSP) represents a clinically and genetically heterogeneous group of neurodegenerative diseases, with a worldwide estimated prevalence of 1.3/100,000 [1]. The "pure" form of HSP is a characterized by a progressive spastic paraplegia, often associated with lower urinary tract symptoms (LUTS) (72.4% to 77.6%) [2,3]. However, urologic complications are rarely reported. The aim of this study was to characterize clinical and urodynamic aspects of LUTS following HSP, and to describe treatment and urological complications of LUTS in a large series of HSP patients...
September 2016: Annals of Physical and Rehabilitation Medicine
Rose Khavari, Christof Karmonik, Michael Shy, Sophie Fletcher, Timothy Boone
PURPOSE: Neurogenic Lower Urinary Tract Dysfunction (NLUTD) is common in multiple sclerosis (MS) patients with a significant impact on their quality of life. In this study, we seek to discover brain activity processes during the micturition cycle in female patients with MS and NLUTD. MATERIALS AND METHODS: We report brain activity via functional magnetic resonance imaging (fMRI) and simultaneous urodynamic testing (UDS) in twenty-three ambulatory female patients with MS...
September 21, 2016: Journal of Urology
Lorenz Leitner, Ulla Sammer, Matthias Walter, Stephanie C Knüpfer, Marc P Schneider, Burkhardt Seifert, Jure Tornic, Ulrich Mehnert, Thomas M Kessler
Many of the patients undergoing intradetrusor onabotulinumtoxinA injections for refractory neurogenic detrusor overactivity (NDO) present with chronic bacteriuria. In these patients, antibiotic prophylaxis has been widely recommended since bacteriuria might impair treatment efficacy and cause urinary tract infections (UTI) but the evidence is limited. The aim of this study was to evaluate if an antibiotic prophylaxis is needed in patients with asymptomatic bacteriuria undergoing intradetrusor onabotulinumtoxinA injections...
2016: Scientific Reports
Stephanie C Knüpfer, Susanne A Schneider, Mareike M Averhoff, Carsten M Naumann, Günther Deuschl, Klaus-Peter Jünemann, Moritz F Hamann
BACKGROUND: To assess the efficacy and safety of intradetrusor onabotulinumtoxinA (OnabotA) injection treatment in patients with neurogenic lower urinary tract dysfunction (NLUTD), especially for patients with Parkinson disease (PD). METHODS: PD patients refractory to oral antimuscarinic participated in an off-label use study and were evaluated prior and after 200 IU OnabotA injection into detrusor muscle, including trigone. Changes due to treatment were evaluated using bladder diaries, urodynamics, and questionnaires...
2016: BMC Urology
H Z Hu, N Granger, N D Jeffery
Management of persistent lower urinary tract dysfunction resulting from severe thoracolumbar spinal cord injury can be challenging. Severe suprasacral spinal cord injury releases the spinal cord segmental micturition reflex from supraspinal modulation and increases nerve growth factor concentration in the bladder wall, lumbosacral spinal cord, and dorsal root ganglion, which subsequently activates hypermechanosensitive C-fiber bladder wall afferents. Hyperexcitability of bladder afferents and detrusor overactivity can cause urine leaking during the storage phase...
September 2016: Journal of Veterinary Internal Medicine
Patrick C Campbell, Bronagh McDonnell, Kevin P Monaghan, Lauren Baysting, Oonagh Little, Karen D McCloskey
AIMS: To investigate the local, regulatory role of the mucosa on bladder strip contractility from normal and overactive bladders and to examine the effect of botulinum toxin A (BoNT-A). METHODS: Bladder strips from spontaneously hyperactive rat (SHR) or normal rats (Sprague Dawley, SD) were dissected for myography as intact or mucosa-free preparations. Spontaneous, neurogenic and agonist-evoked contractions were investigated. SHR strips were incubated in BoNT-A (3 h) to assess effects on contractility...
August 5, 2016: Neurourology and Urodynamics
Tao Cheng, Wei-Bing Shuang, Dong-Dong Jia, Min Zhang, Xu-Nan Tong, Wei-Dong Yang, Xu-Ming Jia, Shuo Li
BACKGROUND: Neurogenic detrusor overactivity (NDO) affects the quality of life (QoL) of millions of individuals worldwide. The purpose of this study was to assess the efficacy and safety of onabotulinumtoxinA in patients with NDO using a network meta-analytic approach, which can also quantify and compare the efficacy of onabotulinumtoxinA across different dosages. METHODS: PubMed, EMBASE, and the Controlled Trials Register were searched to identify randomized controlled trials comparing onabotulinumtoxinA to a control for NDO in adult patients...
2016: PloS One
Hae Min Jo, Hyo Sung Kim, Yun-Woo Cho, Sang-Ho Ahn
BACKGROUND: Little research has been expended on the use of bipolar radiofrequency (RF) lesioning of sacral nerves in spinal cord injured (SCI) patients with neurogenic detrusor overactivity (NDO), and no study has been undertaken to demonstrate its long-term effect. OBJECTIVE: To investigated the effect of bipolar RF ablation of the second and third sacral nerves over 2 years in SCI patients with NDO. STUDY DESIGN: A prospective, randomized controlled feasibility study...
July 2016: Pain Physician
Katarina Ivana Tudor, Ryuji Sakakibara, Jalesh N Panicker
The lower urinary tract (LUT) in health is regulated by coordinated multi-level neurological inputs which require an intact central and peripheral nervous system. Lower urinary tract dysfunction is, therefore, a common sequelae of neurological disease and the patterns of bladder storage and voiding dysfunction depend upon the level of neurological lesion. Evaluation includes history taking, bladder diary, urological examination when relevant, ultrasonography and urodynamic testing when indicated. Antimuscarinic agents are the first line treatment for patients with storage dysfunction...
July 11, 2016: Journal of Neurology
Ulrich Mehnert, Laetitia M de Kort, Jens Wöllner, Marko Kozomara, Gommert A van Koeveringe, Thomas M Kessler
: OnabotulinumtoxinA intradetrusor injections are considered a highly effective localized therapy for refractory detrusor overactivity. However, despite evidence for distant systemic effects of onabotulinumtoxinA, little is known on potential systemic side effects following intradetrusor injections. Given that onabotulinumtoxinA is a highly potent toxin this is an important safety issue specifically with regard to repeat injections and parallel treatments with botulinum toxin. Hence, it was the purpose of this prospective study to investigate, using heart rate variability (HRV) analysis, whether onabotulinumtoxinA causes systemic effects on cardiac function following intradetrusor injections...
June 21, 2016: Experimental Neurology
Masashi Yano, Ryuji Sakakibara, Fuyuki Tateno, Osamu Takahashi, Haruka Nakamura, Megumi Sugiyama, Lee Fang-Ching, Syuichi Kamijima, Naoto Kamiya, Hiroyoshi Suzuki
AIM OF STUDY: Urinary dysfunction in Creutzfeldt-Jakob disease (CJD) patients is attributed to functional incontinence, since they often have immobility and loss of motivation. In contrast, previously no urodynamic findings are available in CJD patients. CASE REPORT: We had 2 CJD patients who had urinary frequency and urinary retention. We performed urodynamics with the spouse's informed consent in order to explore the mechanism of urinary dysfunction in those cases...
October 2016: International Urology and Nephrology
Michael A Avallone, Bryan S Sack, Ahmad El-Arabi, Michael L Guralnick, R Corey O'Connor
AIMS: To determine if minimizing the number of onabotulinumtoxinA (BTX) injection sites to one to three locations provides similar clinical efficacy and duration of effect compared to the established technique in treating patients with neurogenic (NDO) or idiopathic detrusor overactivity (IDO). METHODS: Prospective data were collected on BTX naïve patients with NDO or IDO who were intolerant or refractory to oral medications. Patients were treated with 100-300 U of BTX via one to three injection sites...
June 10, 2016: Neurourology and Urodynamics
T A T Marcelissen, M S Rahnama'i, A Snijkers, B Schurch, P De Vries
INTRODUCTION: Intravesical botulinum toxin (BoNT-A) is a safe and effective treatment for overactive bladder syndrome. There are many reports on the clinical experience with BoNT-A, especially in patients with neurogenic detrusor overactivity. The US Food and Drug Administration has recently approved its use for idiopathic overactive bladder (iOAB). Various studies have reported positive results for iOAB in the short-term. Yet little is known about the results after repeated BoNT-A injections...
June 7, 2016: World Journal of Urology
Sheng-Fu Chen, Chia-Hwei Chang, Hann-Chorng Kuo
Chornic spinal cord injury (SCI) will induce bladder urothelium dysfunction. This study investigated the therapeutic effects on urothelial dysfunction after repeated detrusor injections of onabotulinumtoxinA (BoNT-A) in SCI patients with neurogenic detrusor overactivity (NDO). Twenty chronic suprasacral SCI patients with NDO were enrolled. The patients received 300 U BoNT-A injection into the detrusor every six months. The urothelium was assessed by cystoscopic biopsy at baseline and six months after each BoNT-A treatment...
2016: Toxins
Ana Coelho, Raquel Oliveira, Francisco Cruz, Célia Duarte Cruz
Spinal cord injury (SCI) often leads to neurogenic detrusor overactivity (NDO) due to sprouting of sensory afferents on the lumbosacral spinal cord. NDO is characterized by high frequency of voiding contractions and increased intravesical pressure that may lead to urinary incontinence. The latter has been described as one of the consequences of SCI that mostly decreases quality of life. Bladder wall injections of botulinum toxin A (Onabot/A) are an effective option to manage NDO. The toxin strongly impairs parasympathetic and sensory fibers coursing the bladder wall...
May 25, 2016: Experimental Neurology
Hyeong Gon Kim, Hyoung Keun Park, Sung Hyun Paick, Woo Suk Choi
BACKGROUND: The aim of this study was to compare the two types of mid-urethral slings for stress urinary incontinence (SUI) with intrinsic sphincter deficiency (ISD). METHODS: This retrospective study included patients who underwent tension-free vaginal tape (TVT) procedure or transobturator tape (TOT) procedure by a single surgeon for SUI with ISD, defined as Valsalva leak point pressure (VLPP) < 60 cmH2O in a urodynamic study. Cases of neurogenic bladder, previous SUI surgery, and concomitant cystocele repair were excluded...
2016: PloS One
Huiyi H Chang, Leif A Havton
Detrusor underactivity (DU) is defined as a contraction of reduced strength and/or duration during bladder emptying and results in incomplete and prolonged bladder emptying. The clinical diagnosis of DU is challenging when present alone or in association with other bladder conditions such as detrusor overactivity, urinary retention, detrusor hyperactivity with impaired contractility, aging, and neurological injuries. Several etiologies may be responsible for DU or the development of an underactive bladder (UAB), but the pathobiology of DU or UAB is not well understood...
May 21, 2016: Experimental Neurology
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