March 31, 2016

Efficacy and Safety of Intravesical Onabotulinumtoxin A Injection in Patients with Detrusor Hyperactivity and Impaired Contractility.

Efficacy and Safety of Intravesical OnabotulinumtoxinA Injection in Patients with Detrusor Hyperactivity and Impaired Contractility.
Toxins (Basel). 2016;8(3)
Authors: Wang CC, Lee CL, Kuo HC
Abstract
We investigated the efficacy and safety of intravesical onabotulinumtoxinA injection in patients with detrusor hyperactivity and impaired contractility (DHIC). Twenty-one patients with urodynamically proven DHIC and 21 age-matched patients with overactive bladder (OAB) with urodynamic detrusor overactivity were treated with intravesical injections of 100 U of onabotulinumtoxinA. The overactive bladder symptom score, urgency severity score, patient perception of bladder condition, global response assessment, voiding diary, and procedure-related adverse events (AE) at baseline, two weeks, one, three, and six months after treatment were assessed. The results showed that the subjective symptom scores improved significantly in both groups, and the scores did not differ between the groups. The decrease in urgency episodes and urgency urinary incontinence were noted in OAB patients but not in DHIC patients. Although the incidence of AEs was comparable between the groups, the therapeutic efficacy lasted for a mean of 4.9 ± 4.8 months in DHIC patients and 7.2 ± 3.3 months in OAB patients (p = 0.03). We concluded that the efficacy of intravesical onabotulinumtoxinA injection for DHIC patients was limited and short-term. Nevertheless, AEs did not increase in DHIC. Intravesical onabotulinumtoxinA might not be a good indication in patients with DHIC and high post-voiding residual urine. Physicians should inform patients of the potential benefits and risks of onabotulinumtoxinA injection for treatment of DHIC.
PMID: 26999209 [PubMed - as supplied by publisher]
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March 19, 2016

The many faces of impaired bladder emptying.

The many faces of impaired bladder emptying.
Curr Opin Urol. 2014 Apr 21;
Authors: Andersson KE
Abstract
PURPOSE OF REVIEW: Impaired bladder emptying is a common clinical problem for which currently no effective drug treatment is available. There has been an increasing interest in the condition, and the present review updates the terminology issues, common causes, and potential future pharmacological treatment possibilities.
RECENT FINDINGS: Impaired bladder emptying can be described in many ways, but general agreement on the terminology has not yet been reached. The disorder can have many underlying causes, including aging, bladder outflow obstruction, diabetes mellitus, and neurogenic disturbances. There is no effective pharmacological treatment, and to what extent drug treatment of the associated morbidities (e.g., diabetes mellitus, Parkinson's disease, and multiple sclerosis) also can improve impaired bladder emptying has only been investigated to a limited extent.
SUMMARY: Impaired bladder emptying may be caused by a spectrum of pathophysiologically defined disorders. To describe the condition, underactive bladder (UAB) can be used as a general term, covering detrusor underactivity as the urodynamic diagnosis, and the UAB syndrome for its symptomatic manifestations. In order to understand UAB, identification of the underlying cause(s) is necessary. Effective pharmacologic therapy is lacking and further basic research is needed to find targets for treatment.
PMID: 24752226 [PubMed - as supplied by publisher]
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March 16, 2016

Urological evaluation of patients that had undergone in utero myelomeningocele closure: A prospective assessment at first presentation and early follow-up. Do their bladder benefit from it?

Urological evaluation of patients that had undergone in utero myelomeningocele closure: A prospective assessment at first presentation and early follow-up. Do their bladder benefit from it?
Neurourol Urodyn. 2014 Apr 11;
Authors: Macedo A, Leal M, Rondon A, Ortiz V, Moron AF, Cavalheiro S
Abstract
AIMS: To report our data on initial urological presentation after in utero myelomeningocele (MMC) closure.
METHODS: A prospective urological assessment at first presentation was designed for patients that had undergone in utero MMC closure and referred to our urological facility. The protocol consisted of detailed medical history, renal sonography, voiding cystourethrogram, and urodynamic evaluation.
RESULTS: In utero MMC closure was performed in 19 patients at gestational age of 25.6 weeks 25-27. Birth occurred at a mean gestational age of 31.8 weeks 26-36. Hyperactive bladder was observed in 89.5% 17/19. Bladder compliance was normal in two cases (10.5%), was markedly reduced in 10 patients (52.6%) and not possible to be determined due to urinary leakage in 7 patients (36.8%). We observed normal bladder capacity in 8 patients (42.1%), reduced in 11 (57.9%), and detrusor-sphincter dyssynergia in 9 patients (47.4%). Underactive bladder was diagnosed in one case. Clean Intermittent Catheterization was initiated by 11 patients (57.9%) mostly in association with anticholinergics 10/11. Vesicoureteral reflux was found in 5 patients (26.3%) and 9 had pyelonephritis at a mean follow-up of 5.4 months 2-17.
CONCLUSIONS: Our data suggested that despite in utero MMC surgery, patients are at risk for bladder abnormal function and renal deterioration and should be aggressively treated, not differently from those operated in the post-natal term. This study has the merit of being a prospectively set evaluation performed by one investigator, including the urodynamic study. We acknowledge the need of long-term follow up. Neurourol. Urodynam. © 2014 Wiley Periodicals, Inc.
PMID: 24729268 [PubMed - as supplied by publisher]
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March 11, 2016

Updates of underactive bladder: a review of the recent literature.

Updates of underactive bladder: a review of the recent literature.
Int Urol Nephrol. 2016 Mar 1;
Authors: Li X, Liao L
Abstract
Underactive bladder (UAB) is a major component of lower urinary tract symptoms. The physiopathology mechanisms underlying UAB include detrusor underactivity, acontractile detrusor, and reduced or absent bladder sensation. UAB can influence lower and upper urinary tract function and lead to serious consequences; however, the symptom syndrome is poorly understood and incompletely researched at present. Moreover, there is no agreement among authorities regarding the terminology, definition, epidemiology, classification, risk factors, animal model, pathogenesis, diagnosis, and treatment of UAB. In this review, we discuss the current terminology, epidemiology, physiopathology, evaluation, and management of UAB.
PMID: 26931421 [PubMed - as supplied by publisher]
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March 4, 2016

Underactive bladder in women: is there any evidence?

Underactive bladder in women: is there any evidence?
Curr Opin Urol. 2016 Feb 26;
Authors: Cohn JA, Brown ET, Kaufman MR, Dmochowski RR, Reynolds WS
Abstract
PURPOSE OF REVIEW: Underactive bladder (UAB) is a clinical symptom complex only recently gaining recognition as a clinical diagnosis. Lack of consensus agreement on a definition of UAB has limited its recognition and diagnosis in clinical practice. The purposes of this review are to: present existing definitions of UAB, review recent data regarding clinical and urodynamic diagnosis of the condition, and examine up-to-date hypotheses regarding its pathophysiology, with a focus on women.
RECENT FINDINGS: The process to develop a consensus definition for UAB as a clinical symptom complex is ongoing. Symptoms associated with UAB, such as weak stream, straining to void, and history of urinary retention are well correlated to detrusor underactivity on urodynamics, which frequently develops in elderly women. In addition to aging, UAB may be the end stage of a variety of contributing pathologic conditions such as diabetes and ischemic disease. In some women, UAB may result from a progression from overactive bladder to UAB.
SUMMARY: Existing evidence supports UAB in women as a symptom complex with a clinical and pathophysiologic profile distinguishable from other lower urinary tract-associated clinical conditions. Consensus definitions of clinical and urodynamic diagnostic parameters will be essential to more widespread recognition of UAB.
PMID: 26927630 [PubMed - as supplied by publisher]
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March 1, 2016

Female Bladder Outlet Obstruction.

Female Bladder Outlet Obstruction.
Curr Urol Rep. 2016 Apr;17(4):31
Authors: Hoffman DS, Nitti VW
Abstract
The non-specific symptoms the patients express upon the presentation of female bladder outlet obstruction make it a challenge to diagnose. There are subtle differences between the obstructed patient and those whose bladders are underactive and/or fail to mount a detrusor contraction. These disparities can be extracted through a thorough history and examination. At times, the clinician may utilize nomograms, non-invasive uroflow, and urodynamics with the addition of fluoroscopy to establish the diagnosis of obstruction. Management of the obstruction depends on the nature of the condition, whether functional or anatomical. The increase in the number of sling procedures performed to treat stress urinary incontinence has resulted in a rise in the number of iatrogenic obstructions. The temporal relationship between surgery and obstruction is the key to identifying the problem.
PMID: 26902625 [PubMed - as supplied by publisher]
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