Collette Haslam

Ensuring patient adherence to clean intermittent self-catheterization.

Patient performance of clean intermittent self-catheterization is a crucial component of the management of incomplete bladder emptying, which can arise from a variety of conditions. This allows patients to have more control over their bladder emptying, and avoids the inconveniences that come with an indwelling urethral catheter. There are, however, barriers that patients face when performing this task which may ultimately limit adherence. In this article, these barriers are discussed in more detail with potential solutions to counter them.

Open‐label study evaluating outpatient urethral sphincter injections of onabotulinumtoxinA to treat women with urinary retention due to a primary disorder of sphincter relaxation (Fowler's syndrome)

To assess the efficacy (defined as improvements in maximum urinary flow rate [Qmax] of ≥50%, post‐void residual urine volume [PVR] and scores on the International Prostate Symptom Score [IPSS] questionnaire) and safety of urethral sphincter injections of onabotulinumtoxinA in women with a primary disorder of urethral sphincter relaxation, characterised by an elevated urethral pressure profile (UPP) and specific findings at urethral sphincter electromyography (EMG), i.e. Fowlers syndrome.

SINGLE CENTRE RANDOMISED PILOT STUDY OF TWO REGIMENS (30 MINS DAILY OR 30 MINS WEEKLY FOR 12 WEEKS) OF TRANSCUTANEOUS TIBIAL NERVE STIMULATION USING A NOVEL DEVICE FOR TREATING MULTIPLE SCLEROSIS-RELATED OVERACTIVE BLADDER SYMPTOMS

Introduction Percutaneous tibial nerve stimulation (PTNS) is effective for managing multiple sclerosis (MS)-related overactive bladder (OAB) symptoms. However the need for weekly clinic visits restricts its use. The purpose of this study was to evaluate safety and efficacy of a novel, self-applying device for managing OAB symptoms. Study design, materials and methods 48 patients reporting OAB (MS n=24, idiopathic n=24), were randomized (1:1) to either daily or weekly treatments for 12 weeks with geko™, a novel device stimulating the tibial nerve transcutaneously. Efficacy was assessed using validated questionnaires (ICIQ-OAB, ICIQLUTS-QoL) and bladder diaries filled at weeks 4, 8, and 12. Urinary neurotrophins (Nerve growth factor (NGF) and Brain derived neurotrophic factor) were measured. Results 34 patients (MS n=19) completed the study. 18 patients responded to treatment (53%); 72% of responders belonged to the MS cohort. Multilevel regression analysis suggested significant improvements in questionnaire scores (ICIQ-OAB –10.2 (–13.5 to –6.9; p=0.001), ICIQLUTS-QOL –40.8 (–57.4 to –24.3; p=0.000)), without differences between weekly and daily-treated arms. No significant adverse effects were reported and patients rated the treatment as easy to use and comfortable. NGF levels at baseline were significantly greater in non-responders (p=0.05). Concluding message In this pilot study, a patch device suitable for self-application at home appears to be an effective, safe and convenient alternative for managing MS-related OAB symptoms.

BARRIERS IN CLINIC TO DISCUSSING SEXUAL DYSFUNCTION DUE TO MULTIPLE SCLEROSIS

Background Sexual dysfunction is underdiagnosed in patients with multiple sclerosis (pwMS). Little is known about barriers faced by patients and health care professionals (HCPs) in discussing sexual problems. Patients and methods 74 PwMS (20 male, 54 female (mean age 45,877±8,823 years)) and 99 HCPs (8 male, 91 female; 82 (83%) nurses) completed questionnaires evaluating barriers to discussing sexual problems in clinic and sexual dysfunction (MSISQ-15 and ASEX), specifically developed for this study. Results Symptoms that interfere most with sexual activity are: Takes too long to orgasm (69.11%), bladder symptoms (66.17%), less intense orgasm (66.17%), lack of sexual interest (60.29%), genital numbness (50%). Most common barriers cited by patients include the prominence of other MS symptoms (43.5%), presence of family/friends in consultation room (41.8%), not being asked (37.3%). HCPs identified presence of family/friends in consultation room (57.6% agree), faced lack of knowledge (48.4% agree), patient not ready (44.3% agree), lack of time (42.2%). Conclusions Sexual dysfunction is common in both men and women following multiple sclerosis. However both patients and HCPs face barriers to addressing the problem. Providing time and privacy during the consultation to discuss sexual dysfunction, and training to HCPs will help to address these barriers.

PERCUTANEOUS TIBIAL NERVE STIMULATION FOR OVERACTIVE BLADDER

Background Percutaneous Tibial Nerve Stimulation (PTNS) is a minimally invasive neuromodulation technique for treatment of overactive bladder (OAB). The aim of this study was to assess safety and efficacy in neurological patients. Methods In this prospective evaluation over 18 months at a tertiary centre, patients finding first-line treatments for OAB ineffective or intolerable underwent standard 12-week course of PTNS (Urgent PC, Uroplasty). Symptoms were evaluated using standardised questionnaires (ICIQ-OAB and ICIQLUTS-QoL) and bladder diaries. Results Of 74 consecutive patients (52 males; mean age 57; 25(33.8%) idiopathic OAB, 19 (25.7%) multiple sclerosis (MS), 30 (40.5%) other neurological conditions), 64(86%) completed treatment. Significant improvements (p<0.05) were noted in OAB scores, quality of life, 24-hour bladder frequency, number/severity of incontinent episodes. Patients found treatment comfortable and no adverse effects were reported. Thirty-two(61.5%) opted to continue; mean top-up interval 44.4 days (7–155 days). Patients reporting improvements in OAB symptoms, leakage severity and quality of life at week 12, as well as patients with MS and other neurological disorders, more often returned for top-up sessions(p<0.05). Conclusions PTNS is a safe and effective treatment in patients with neurological disorders, associated with significant improvements in overactive bladder symptoms and quality of life.