Therapeutic Efficacy of Urethral Sphincteric Botulinum Toxin Injections for Female Sphincter Dysfunctions and a Search for Predictive Factors

External urethral sphincter (EUS) dysfunction is a common, bothersome female voiding dysfunction. This study aims to analyze the characteristics of different types of female EUS dysfunction, as well as to determine the outcome predictors of sphincteric botulinum toxin A (BoNT-A) injection. Women receiving sphincteric BoNT-A injections for refractory EUS dysfunction were retrospectively reviewed. A comparison of the baseline clinical, urodynamic parameters and the treatment responses were made for patients with different EUS dysfunctions. A total of 106 females were included. Significantly increased detrusor overactivity, detrusor contracting pressure and the bladder outlet obstruction index with decreased urge sensation were noted in patients diagnosed with dysfunctional voiding or detrusor sphincter dyssynergia comparing to those diagnosed with poor relaxation of the external urethral sphincter. The average subjective improvement rate was 67% for the injection. The therapeutic effect was not affected by the type of EUS dysfunction. The multivariate analysis revealed that bladder neck narrowing and catheterization history were predictive of negative outcomes. There is a distinct urodynamic presentation for each type of female EUS dysfunction. Sphincteric BoNT-A injection provides a good therapeutic outcome for refractory EUS dysfunction. A narrowing bladder neck and a history of catheterization suggest poor therapeutic outcomes.

Neurogenic urinary disorders in patients with tuberculous spondylitis before and after surgical treatment

ABSTRACT: Tuberculosis inflammation of vertebral column (spondylitis) can lead to neurogenic lower urinary tract dysfunction. There is lack of available publications for neurogenic lower urinary tract dysfunction in spinal tuberculosis. OBJECTIVE: To evaluate urodynamic disturbances in spinal tuberculosis before and after surgery for spondylitis. MATERIALS AND METHODS: We observed 19 patients with spinal tuberculosis, who had symptoms of micturitions impairment. 14 patients (73,6%) were male and 5 (26,4%) were female, average age was 43,7 7,9 years (2766). Control evaluation was performed after surgery on day 2128. RESULTS: Before surgery we found detrusor overactivity in 11 (57,9%) patients and 2 of those with detrusor overactivity had detrusor-sphincter dyssynergia. Detrusor hypo-/acontractility was diagnosed in 8 (42,1%). After surgery 5 patients (26,3%) exhibited improvement, in one case urodynamic disturbances were resolved. One patient developed detrusor overactivity and incontinence de novo and one patient had worsening neurological status, loss of sensitivity and acontractile bladder. CONCLUSION: Variable lower urinary tract dysfunction can be diagnosed in spinal tuberculosis. Only 26,3% of patients have improvement after surgery. New conditions or worsening of previous neurogenic lower urinary tract dysfunctions can be observed.

Detrusor sphincter dyssynergia: can a more specific definition distinguish between patients with and without an underlying neurological disorder?

Study design Cross-sectional study. Objectives To evaluate if specific definitions of detrusor sphincter dyssynergia (DSD) might distinguish between individuals with spinal cord injury (SCI) and those with no underlying neurological disorder (NO ND). Setting Single tertiary university SCI center. Methods A series of 153 individuals, 81 with traumatic SCI and 72 with NO ND, were prospectively evaluated and included in this study. All individuals underwent a clinical neuro-urological examination, a neurophysiological work-up and a video-urodynamic investigation and were diagnosed with DSD as defined by the International Continence Society (ICS). We determined the DSD grades/types according to the classifications by Yalla (grade 1–3), Blaivas (type 1–3) and Weld (type 1–2). Distribution of the DSD grades/types were compared between SCI and NO ND individuals. Associations between the various DSD grades/types and clinical parameters, such as risk factors for upper urinary tract damage (all individuals) or lower extremity motor scores, SCI injury levels and severity scores (only SCI group), were assessed. Results The distribution of all DSD types were similar between groups (p > 0.05). None of the DSD classifications allowed risk assessment for upper urinary tract damage. A significant association between DSD type and other clinical parameters could not be found (p > 0.05). Conclusions None of the investigated DSD definitions can distinguish between patients with SCI and with NO ND. The more complex DSD classifications by Yalla, Blaivas or Weld cannot compete with the ICS binary yes-no definition which is pragmatic and straightforward for managing patients in daily clinical practice. Sponsorship None.

QUALITY OF LIFE OF ADULT PATIENTS WITH DETRUSOR SPHINCTER DYSSYNERGIAAND HYPOCONTRACTILE BLADDER USING SELF INTERMITTENT CATHETERIZATION: 14 FRENCH VERSUS 12 FRENCH CATHETER

OBJECTIVE: To compare the impact of catheter size 14 French vs 12 French on quality of life of patients using Clean intermittent selfcatheterization. SUBJECTInclusion criteria patients using CISC for neurogenic (DSD) bladder, hypo contractile bladder. Exclusion criteria patient with urethral stricture, history of urethral, bladder, or prostate surgery, pediatric patients. METHODS: It was a comparative, observational, study which comprised of total 40 patients diagnosed with neurogenic bladder (detrusor sphincter dyssynergia), hypo contractile bladder, out of which 20 patients were given 12french catheter and 20 patients were given 14 French catheters as per coin randomization method. The patients were assessed for quality of life by using WHO QoL-BREF. T- test was utilised to compare the mean. p<o.05 was taken to be statistically signicant. RESULTS: In physical domain the mean score was higher in patients using 12 French catheter (56.01) compared with patients using 14 French catheter (55.1) but difference was statistically insignicant with p-value (0.688). In Psychological domain the mean score was higher in patients using 12 French catheters (63.90) compared with patients using 14 French catheters (63.30) with p-value (0.793). In Social relationships domain the mean score was higher in patients using 14 French catheters (62.20) compared with patients using 12 French catheters (61.55) but difference was statistically insignicant with p-value (0.855). similarly in the social relationships domain the mean score was higher in patients using 14 French catheter (58.65) compared with patients using 12 French catheter (58.53) with p-value 0.935. CONCLUSION: Higher score in physical and psychological domain implies less pain, greater treatment compliance and improving the patient's QoL, but higher score observed in physical and psychological domain was statistically insignicant. Based on above study we concluded that there was no signicant difference in quality of life of patients using 12 French or 14 French for CISC.

THE EFFECT OF OXYBUTYNIN ON NEUROGENIC DETRUSOR OVERACTIVITY IN SPINAL CORD INJURY PATIENT: A HOSPITAL BASED INTERVENTIONAL STUDY

Neurogenic bladder dysfunction is one of prominent impairments following Spinal Cord Injury (SCI) and is seen in 90% of patients.This study has been undertaken to correlate the effect of anticholinergic drug (oxybutynin) on urodynamic parameters in neurogenic bladder of SCI patients.This is a hospital based non randomized prospective interventional study.After initial baseline urodynamic study,patients with detrusor areflexia were excluded from the study group and thirty patients showing detrusor overactivity and detrusor sphincter dyssynergia were treated with oral oxybutynin 5 mg for 7 days followed by repeat urodynamic evaluation thereafter.Our study concluded that mean bladder compliance improved from 6.114 to 17.95 ml/cmH2O after intervention and mean bladder capacity also increased after intervention (229.7ml) from (165.3ml) and changes were statistically significant.Antimuscarinic (Oxybutynin) is an effective drug in management of neurogenic bladder in SCI patients increases bladder compliance and capacity and results are objectively achieved within seven days

Urinary Symptoms and Bladder Dysfunction in Patients with Neuromyelitis Optica Spectrum Disorders: Evaluation with Urodynamics and Management

Objective To assess lower urinary tract symptoms (LUTSs) in patients with neuromyelitis optica spectrum disorders (NMOSDs) and bladder dysfunction through urodynamics (filling and voiding phase of cystometrography) and management based on findings. Patients and Methods The study included 42 (34 females) patients admitted to the rehabilitation department. Neurologic evaluation was performed and severity of myelitis was assessed using the American Spinal Injury Association Impairment Scale. All patients underwent urodynamics, and management was based on the findings. Results Mean age was 34.5 years (range: 11–64 years; standard deviation: 13.1). Twenty-three (54.8%) patients had a first episode of myelitis, whereas 19 patients had relapses (number of episodes varying from 2 to 7). Eleven (26%) patients had increased frequency, 16 (37%) had urgency, 12 (28%) had urge incontinence, 8 (18.6%) had stress incontinence, 22 (52.4%) had nocturia, 31 (72%) had retention of urine, 22 (52.4%) had incomplete evacuation, and 14 (33.3%) patients had mixed urinary complaints. The common urodynamic findings were neurogenic detrusor overactivity (NDO) with detrusor-sphincter dyssynergia (DSD) in 14 (33.3%) patients, NDO without DSD in 8 (19%), and acontractile detrusor in 20 (47.6%). Pharmacotherapy was advised to 22 (52.4%) patients, whereas clean intermittent catheterization (CIC)/self-catheterization was advised to 39 (92.9%) patients. Conclusions Urinary retention was observed to be the most common urinary complaint in patients with NMOSD followed by NDO with or without sphincter dyssynergia. Urodynamics should be performed in all patients with LUTSs for best management. CIC remains the gold standard for the management of neurogenic bladder dysfunction.

Is baseline routine renal ultrasound indicated for all MS patients?

BackgroundMost patients with multiple sclerosis (MS) develop multiple urological complaints due to hyperactive or hypoactive bladder, and may have detrusor-sphincter dyssynergia. Routine renal ultrasound (RUS) screening has been recommended for both symptomatic and asymptomatic MS patients; however, there is little data to support this practice.MethodsProspectively screened consecutive MS clinic patients in 2016–2017 with functional systems scores (FSS) indicating moderate to severe neurogenic bladder symptoms (FSS bladder ≥2) were sent for RUS. We also screened for history of urinary tract infections.Results872 patients were screened between 3 September 2016 and 13 April 2017. 58 patients met inclusion criteria for RUS. 6 were excluded due to non-compliance with testing or unavailability of results; 52 patients were imaged. Only 3/52 patients were found to have renal pathology requiring follow-up. Of those three, one had known symptomatic nephrolithiasis, and one had subsequently normal findings, leaving one patient newly found to have valid abnormal upper urinary tract (UUT) findings. Multiple incidental findings were also discovered.ConclusionThe minimal yield for significant UUT pathology found in this enriched group of symptomatic MS patients indicates that RUS screening for asymptomatic MS patients without clear risk factors is not indicated. Red flags for high risk of UUT complications should be used as triggers for baseline RUS screening in MS patients.