August 29, 2010

[A clinical study of voiding status in multiple sclerosis patients]

[A clinical study of voiding status in multiple sclerosis patients]: "

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[A clinical study of voiding status in multiple sclerosis patients]

Hinyokika Kiyo. 1991 Jan;37(1):25-9

Authors: Komatsu K, Nagano K, Yokoyama O, Kawaguchi K, Hisazumi H, Hayashi S

During a period of 4.5 years, neurological and urodynamic evaluation was done on 12 patients with multiple sclerosis between 20 and 67 years old with an average age of 47.6 years. Pyramidal dysfunction (100%), sensory disturbance (100%) and brain stem dysfunction (60%) were common neurological signs. All patients were assessed by the Kurtzke's rating of neurologic impairment in multiple sclerosis: an expanded disability status scale (EDSS). Of the 12 cases 6 were diagnosed as severe multiple sclerosis (EDSS greater than or equal to 4.5) and the remainders were diagnosed as relatively mild (EDSS less than 4.5). Neurourologic evaluation was performed by rapid filling carbon dioxide cystometry and sphincter electromyography. Cystometry revealed overactive bladder in 4 (33%), underactive bladder in 3 (25%) and normoactive bladder in 5 (42%) of the 12 cases. Of the 6 severe cases of multiple sclerosis, 3 (50%) showed overactive bladder, while only 1 of the 6 (17%) mild cases showed overactive bladder. Detrusor sphincter dyssynergia (DSD) was observed in 4 of the 9 (67%) severe cases and none of the 6 mild cases. The presence of overactive bladder or DSD seems to correlate with the severity of multiple sclerosis.

PMID: 2011964 [PubMed - indexed for MEDLINE]
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August 25, 2010

Does a Pre-Operative Urodynamic Diagnosis of Bladder Outflow Obstruction Improve Outcomes from Palliative Transurethral Prostatectomy?

Does a Pre-Operative Urodynamic Diagnosis of Bladder Outflow Obstruction Improve Outcomes from Palliative Transurethral Prostatectomy?: "


Does a Pre-Operative Urodynamic Diagnosis of Bladder Outflow Obstruction Improve Outcomes from Palliative Transurethral Prostatectomy?

Urol Int. 2010 Aug 21;

Authors: Gnanapragasam VJ, Leonard A

Objective: Palliative transurethral prostatectomy (TURP) is the mainstay of treatment for lower urinary tract symptoms, (LUTS) in men with prostate cancer. Functional outcomes, however, can often be unsatisfactory. Here the value of preoperative urodynamics was investigated in these men. Methods: A retrospective review was conducted of41men with prostate cancer and LUTS who were investigated by urodynamics prior to TURP. All were treated solely by primary androgen deprivation. 19 men with urodynamic proven bladder outflow obstruction (BOO) proceeded to palliative TURP. Results: Of the 41 men investigated by cystometry, the urodynamic diagnosis was BOO in 12 (29%) men, detrusor overactivity in 12 (29%) men with 7 (17%) having both diagnoses. 6 (15%) men were found to have underactive or acontractile detrusors while 4 (10%) had normal studies. In men who proceeded to TURP, all demonstrated improved flow rates (p = 0.003). At 12 months, 95% were voiding spontaneously with only 1 man requiring permanent re-catheterisation. These results compared very favourably to published outcomes which have not used urodynamics to select men for surgery. Conclusions: Urodynamics may help identify objective BOO prior to palliative TURP. Further prospective trials are justified to assess the role of urodynamics in this context.

PMID: 20733276 [PubMed - as supplied by publisher]
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August 20, 2010

Different evolution of voiding function in underactive bladders with and without detrusor overactivity.

Different evolution of voiding function in underactive bladders with and without detrusor overactivity.: "
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Different evolution of voiding function in underactive bladders with and without detrusor overactivity.

J Urol. 2010 Jan;183(1):229-33

Authors: Cucchi A, Quaglini S, Rovereto B

PURPOSE: We assessed bladder voiding function in patients with idiopathic detrusor underactivity with and without detrusor overactivity for a different evolution in time. MATERIALS AND METHODS: We retrospectively analyzed clinical and urodynamic findings in 36 consecutive middle-aged men with idiopathic detrusor underactivity who were referred during 1989 to 2003 for voiding and storage lower urinary tract symptoms. After initial testing at time 1 urodynamics were repeated due to worse lower urinary tract symptoms severity at a median of 45 months (time 2). A total of 17 patients with voiding urgency showed urodynamic detrusor overactivity at times 1 and 2 (group 1) and 19 with no urgency (group 2) never had detrusor overactivity. As controls (group 3) we used 30 age matched, urodynamically normal men. Nonparametric statistics were used for data analysis. RESULTS: Compared with controls at time 1 groups 1 and 2 had lower bladder emptying efficiency and bladder contractility (contraction strength, velocity and energy reserve) with relatively higher contraction velocity and energy reserve in group 1 than in group 2. Compared with time 1 at time 2 the 2 detrusor underactivity groups showed an increased International Prostate Symptom Score (more increased in group 1), and decreased bladder contractility and emptying efficiency (less decreased in group 1). CONCLUSIONS: A likely explanation for our findings is that by causing relatively more rapid (less slow) detrusor contractions detrusor overactivity partly decreased the time needed and, thus, the total energy expended by underactive bladders for mounting micturition contractions. This compensatory efficiency would account for the relatively better evolution of bladder voiding function with time.

PMID: 19913829 [PubMed - indexed for MEDLINE]
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August 16, 2010

Urodynamics post stroke in patients with urinary incontinence: Is there correlation between bladder type and site of lesion?

Urodynamics post stroke in patients with urinary incontinence: Is there correlation between bladder type and site of lesion?: "
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Urodynamics post stroke in patients with urinary incontinence: Is there correlation between bladder type and site of lesion?

Ann Indian Acad Neurol. 2009 Apr;12(2):104-7

Authors: Gupta A, Taly AB, Srivastava A, Thyloth M

OBJECTIVE: Assessment of bladder by urodynamic study (UDS) in patients with urinary incontinence following stroke, and correlation with site of lesion. STUDY DESIGN AND SETTING: Retrospective cross-sectional study in the neurological rehabilitation unit of a tertiary care institute. MATERIALS AND METHODS: Forty patients (22 males) with arterial or venous, ischemic or hemorrhagic stroke, with urinary incontinence in the acute phase following the event, underwent UDS. Seventeen patients had right hemiplegia, 18 had left hemiplegia, and five had posterior circulation stroke with brainstem/cerebellar features. Bladder type was correlated with age, side, and site of lesion. RESULTS: The mean age was 46.80 +/- 16.65 years (range: 18-80 years). Thirty-six patients had arterial stroke and four had cortical venous thrombosis. UDS was performed after a mean of 28.32 +/- 10.27 days (range: 8-53 days) after the stroke. All but one patient had neurogenic bladder dysfunction, with 36 patients (90%) having overactive detrusor (OD) and three having underactive/areflexic detrusor. Among the 36 patients with OD, 25 patients (62.5%) had OD without detrusor-sphincter dyssynergy (DSD) and 11 (27.5%) had OD with DSD. Bladder management was advised based on the UDS findings. No significant correlation (P > 0.05) was found between type of bladder and age or side and site of lesion. CONCLUSIONS: UDS is a useful tool to assess and manage the bladder following stroke with urinary incontinence. In this study, no significant correlation was found between UDS findings and site of lesion.

PMID: 20142855 [PubMed]
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August 12, 2010

Voiding dysfunction in patients with human T-lymphotropic-virus-type-1-associated myelopathy.

Voiding dysfunction in patients with human T-lymphotropic-virus-type-1-associated myelopathy.: "
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Voiding dysfunction in patients with human T-lymphotropic-virus-type-1-associated myelopathy.

Urol Int. 1991;47 Suppl 1:67-8

Authors: Komine S, Yoshida H, Fujiyama C, Masaki Z

Voiding dysfunction in patients with human T-lymphotropic-virus-type-1-associated myelopathy (HAM) was studied. All the patients were diagnosed as having HAM by neurologists. We have already reported on 16 consequent patients with HAM. Almost all of these patients had frequency, and many had urge incontinence of urine and difficulty on voiding. Urodynamic study revealed that their voiding symptoms seemed to be due to detrusor hyperactivity and detrusor-sphincter dyssynergia. However, we have recently treated 2 patients who had a different bladder function. They had both frequency and difficulty in voiding but without urgency. In the urodynamic study both patients did not have involuntary bladder contraction during the filling phase and could not void voluntarily. The reason why these 2 patients had an underactive detrusor is unclear. The fact that the average duration of HAM in the 16 patients previously mentioned was longer than that of the latter 2 patients may suggest that overactivity of the bladder is not prominent in the early phase of this disease.

PMID: 1949381 [PubMed - indexed for MEDLINE]
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August 10, 2010

[Neurogenic bladder in patients with lumbar vertebral disorders]

[Neurogenic bladder in patients with lumbar vertebral disorders]: "

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[Neurogenic bladder in patients with lumbar vertebral disorders]

Nippon Hinyokika Gakkai Zasshi. 1990 Sep;81(9):1322-9

Authors: Ando M, Nagamatsu H, Tanizawa A, Oshima H, Shinomiya K, Matsuoka T, Mizuo T, Ushiyama T

Bladder and urethral functions were evaluated urodynamically in 114 patients with lumbar disorders including prolapsed lumbar intervertebral disc (66 patients), lumbar canal stenosis (19 patients), lumbar spondylolysis and/or spondylolisthesis (21 patients), lumbar spondylosis deformans (5 patients) and ossification of the yellow ligament of the lumbar spine (3 patients). The patients consisted of 88 males and 26 females with an average age of 47 years (range 17 to 73 years). Symptomatic organic infravesical obstruction was excluded by physical and radiographic examination. Cystometry revealed preoperative neurogenic bladder in 23 patients (20%); normal detrusor with overactive sphincter in 2 (9%), underactive in 8 (36%), overactive in 5 (23%) and equivocal in 7 (32%). One patient not receiving cystometry revealed abnormal uroflowmetry with 140 ml residual urine. Twenty of them underwent electromyographic examination of the external sphincter and 15 (75%) had an overactive sphincter. Nine (39%) of them complained no urological symptoms. Neurogenic bladder seemed to highly associate in those having abnormal tendon reflex in the lower extremities, decreased bulbocavernosus reflex and sensory disturbance in the perineal area, but there was no statistical significance. Of twenty-three neurogenic bladder patients, eighteen underwent a lumbar vertebral operation and fifteen received postoperative urodynamic evaluation. Uroflowmetry was improved in more than half of the patients within 3 months after the operation and cystometry was normalized in 4 of 7 patients who underwent cystometry over 6 months after the operation. Preoperative overactive detrusor remained unchanged in two of three patients who underwent cystometry over 6 months after the operation.

PMID: 2232423 [PubMed - indexed for MEDLINE]
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August 2, 2010

Marion Kerr writes about Neurogenic Bladder

source: here

Having lived with multiple sclerosis for a number of years, I've now been diagnosed with something called neurogenic bladder. Are the two conditions related?

Neurogenic bladder is the loss of normal bladder function caused by damage to part of the nervous system. Disorders of the central nervous system, such as Alzheimer's disease, spina bifida, brain or spinal cord injury, multiple sclerosis, Parkinson's disease and stroke can all cause neurogenic bladder.

Peripheral diabetic neuropathy nerve damage due to pelvic surgery, slipped disc and vitamin B12 deficiency may also cause the condition.

What are the symptoms?

The particular symptoms experienced will very much depend on the underlying neurological disorder, and can include an overactive or underactive bladder. Overactive bladder tends to produce frequent passing of very small amounts of urine, problems emptying the bladder completely and loss of bladder control.

Underactive bladder can result in the bladder becoming too full, leaking of urine and urinary retention. It can also cause difficulties starting to urinate, emptying all the urine from the bladder or recognising when the bladder is full.

All bladder problems can lead to the development of urinary tract infections.
Do I just have to live with it or can neurogenic bladder be treated?

Medications are available to help manage symptoms. These include drugs that relax the bladder in cases of overactive bladder or medicines that make certain nerves more active for underactive bladder.

Antibiotics are required where bladder problems lead to infections. A referral to a chartered physiotherapist with experience in the area of treating continence problems may help. They will be able to teach you special exercises (Kegel exercises) and provide other treatments to help strengthen your pelvic-floor muscles.
In certain conditions, including multiple sclerosis, there may be a need to use a urinary catheter. This is a thin tube that is inserted into the bladder.

It may be in place all the time (an indwelling catheter) or may need to be placed in the bladder four to six times a day to keep the bladder from becoming too full (intermittent catheterisation).
Surgery for neurogenic bladder may be recommended in some cases. It is important to learn to recognise the symptoms of urinary tract infection, such as a burning sensation when you urinate, high temperature, low back pain and an increased frequency of urination.

If you suspect you have developed a urinary tract infection, see your doctor, as antibiotics will be needed to clear the infection.