The Relationship Between Urinary Symptom Severity And Functional Status İn Patients With Stroke

Background Lower Urinary Tract Dysfunction (LUTD) is a condition that is common in stroke patients and affects their quality of life and psychological state. Aim To determine the factors affecting LUTD severity in stroke patients and to evaluate its relationship with functional status. Method 77 stroke patients were included in our study. Demographic and stroke characteristics of all patients were recorded. Functional Ambulation Scale (FAS), Functional Independence Measure (FIM), the Core Lower Urinary Tract Symptom Score (CLSS) Questionnaire, Beck Depression Scale were administered to the patient. 33 of 77 patients had urodynamic study and these patients constituted the subgroup of the study. Patients were grouped according to type of disorder, type of detrusor and detrusor sphincter dyssynergia (DSD) using urodynamic study findings. Result The mean CLSS of men was significantly higher than women ( P = 0.017). A significant positive correlation was found between age and CLSS ( P = 0.035 r = 0.24) and negative correlation was found between total FIM and all sub-parameter scores and mean of CLSS ( P = 0.001 r = -0.467). Conclusion LUTD is common in stroke patients and the presence of urinary symptoms is associated with poor functional status. No significant relationship was observed between urodynamic data except maximum flow rate and CLSS.

Management and Follow-Up Practices of Women With Recurrent Stress Urinary Incontinence Following Transobturator Mid-urethral Synthetic Sling Procedure: A 6-Year Retrospective Monocentric University-Based Study

Purpose: The purpose of this study is to evaluate the efficacy of management and follow-up practices in repeat retropubic mid-urethral synthetic sling (MUS) procedure after transobturator tape/tension-free vaginal tape-obturator (TOT/TVT-O) failure, and to clarify the possible etiology of recurrent stress urinary incontinence.Methods: The charts of all women patients who underwent tension-free vaginal tape (TVT) slings after previous failed transobturator MUS procedures between February 2012 and November 2018 at a single center were reviewed retrospectively. The transperineal ultrasound was performed to assess the pre-operative or post-operative urethral mobility and location of the slings. Furthermore, some essential evaluations were also made, mainly including medical history, physical examination, 1 h pad test, and urodynamic study. Finally, primary outcomes were evaluated according to the above items at 3, 6, and 12 months after the second operation, respectively.Results: Thirty-five patients were included in the primary transobturator MUS sling procedure. At the 6 months follow-up, 32 (91.42%) patients were socially continent and negative in 1 h pad test. The transperineal ultrasound measurement results revealed that the bladder neck descent (BND) values were significantly decreased after the repeat sling operation, and better urinary continence function was observed according to the post-operative urodynamic study. Multifactorial etiologies resulted in recurrent stress urinary incontinence (SUI), including poor surgical technique, inadequate sling tension when treating ISD, and inappropriate sling position. Then the detail of the surgical procedure varied with the results of pre-operative evaluations, affecting the validity of the second sling.Conclusion: Recurrent SUI has resulted from multi factors, pre-operative urodynamic study and transperineal ultrasound might be valuable tools to guide repeat sling operation and predict post-operative outcomes. A repeat TVT procedure may be regarded as a remedial measure for a failed transobturator MUS operation.

SYSTEMATIC REVIEW OF URODYNAMIC EVALUATION IN PATIENTS AFTER SPINAL CORD INJURY

Introduction The world-widely acknowledged method of diagnosing dysfunctions in the lower urinary tract is urodynamic study (UDS), however many of patients with adult neurogenic lower urinary tract dysfunction (ANLUTD) have not undergone this test or have been examined a couple of years after the spinal cord injury (SCI). Recent studies provide evidence of significance UDS in precise diagnosis and monitoring of ANLUTD. Aim The aim of this article is to analyze the value of UDS in the management of neurogenic bladder in patients after. Material and methods Research was performed on the databases Pubmed and Web of Science. Results Out of 2012 articles found by performing the above research procedure, 9 matched the inclusions criteria and were analyzed. Discussion One study showed significant differences in those groups regarding maximum cystometric capacity and volume at first involuntary contraction. Other authors proved significant differences in bladder function among groups with different C and L level of injuries. In follow up patients with maximum cystometric (MCC) capacity < 200 ml experienced significantly more often (p = 0.019) UUT deterioration than those with MCC ≥ 200 ml. In the study with annual UDS, 47.9% of the patients needed at least one type of intervention (in 82.6% of cases – urological interventions) basing on their UDS. None of those patients complained of new urological symptoms since their previous. Conclusions UDS should be performed as a standard examination in patients after SCI. Regular follow up UDS should be performed for prevention UUT deterioration. Keywords: spinal cord injury, urodynamic study, adult neurogenic lower urinary tract dysfunction.

Alterations of Autonomic Nervous System Activity in Children with Spina Bifida: A Case-Control Study

We compared heart rate variability parameters of patients with spina bifida with those of a control group during urodynamic study to evaluate the autonomic nervous system dysfunction of spina bifida. Continuous heart rate variability parameters were recorded during 3 successive periods (P0: 2 minutes before the start of filling; P1: start of filling to the first desire to void; P2: P1 to the end of filling or the start of voiding). Children with vesicoureteral reflux who underwent video-urodynamic study were established as a control group. We included 11 patients with spina bifida and 9 controls. At baseline, patients with spina bifida had lower values of RMSSD, pNN50, and HF, while LF/HF ratio was increased (5.04 ± 4.75 vs 0.67 ± 0.42, p = 0.014). During bladder filling, LF/HF values increased in the control group (P0 0.67 ± 0.42 vs P1 0.89 ± 0.34 vs P2 1.21 ± 0.64, p = 0.018) while it was decreased in spina bifida patients (P0 5.04 ± 4.75 vs P1 3.96 ± 4.35 vs P2 3.26 ± 4.03, p < 0.001). HF were significantly increased in spina bifida children during bladder filling (p = 0.002). In time domain, SDNN was increased only in control group during bladder filling. Parasympathetic activity domains were decreased in children with spina bifida at baseline. During the bladder filling phase, parasympathetic activity increased with fixed sympathetic activity in spina bifida group while the control group demonstrated a shifted balance toward sympathetic preponderance at the end of bladder filling. These findings may be related to the pathophysiology of neurogenic bladder in spina bifida.