D. Verollet

Pencil and paper test: a new tool to predict the ability of neurological patients to practice clean intermittent self-catheterization.

PURPOSE We created and validated the new pencil and paper test, which allows assessment of the ability of patients with a neurological disorder to practice clean intermittent self-catheterization. MATERIALS AND METHODS We developed a simple test including common gestures mimicking the usual maneuvers needed during clean intermittent self-catheterization, and involving the same cognitive and physical resources needed for this technique. We evaluated the test in 118 patients with a neurological condition. Instruments needed to perform the pencil and paper test are limited to a sheet of paper and a pencil. Each test item was quantified and graded with a total score of 15. A specific clean intermittent catheterization learning scale was used to classify the outcome of the ability to perform clean intermittent self-catheterization with a score range of 5--learning easy and self-catheterization complete to 0--learning impossible. RESULTS Enrolled in the study were 118 patients with a neurological condition. There was strong correlation between the global pencil and paper test score, and the ability to perform clean intermittent self-catheterization, as evaluated by the learning scale (r = 0.82, p = 0.000091). At a test cutoff of 10 and a clean intermittent self-catheterization cutoff of 3, which was the limit needed to practice self-catheterization alone, the positive predictive value of the pencil and paper test was 85% and its negative predictive value was 94% (Cronbachs α = 0.88). CONCLUSIONS The pencil and paper test is a valid way to predict the ability to practice clean intermittent self-catheterization in patients with a neurological disorder.

Therapeutic education and intermittent self-catheterization: recommendations for an educational program and a literature review.

PURPOSE To review the literature and to clarify the recommendations for therapeutic education programs for intermittent self-catheterization. MATERIALS AND METHODS The literature on Medline, Pubmed, and Cochrane Library, with specific keywords, as well as the recommendations based on expert consensus. RESULTS Clean intermittent self-catheterization (CICS) is the gold standard for managing chronic urinary retention, which allows the patients to improve their quality of life and to reduce the complications of upper urinary tract infections. Patient education needs to have a structured procedure in order to evaluate the ability to understand, accept and perform CISC. CONCLUSION Teaching self-catheterization is now well known; nevertheless, the effectiveness of CISC educational therapeutic programs remains to be demonstrated.

Need to void and attentional process interrelationships.

To determine whether a strong urge to void could affect a persons attentional performance. To determine whether an attentional task could decrease a strong urge to void a prospective study was performed.

Contribution of sacral neuromodulation to manage persistent voiding dysfunction after surgery for deep infiltrating endometriosis with colorectal involvement: preliminary results

OBJECTIVE Around 5% of women experience persistent voiding dysfunction after surgery for deep infiltrating endometriosis (DIE) with colorectal involvement. The gold standard to manage persistent voiding dysfunction is intermittent self-catherization, but this treatment may reduce quality of life of the patients due to care constraints. The objective of our study was to assess the contribution of sacral neuromodulation (SNM) in the management of persistent voiding dysfunction secondary to surgery for DIE with colorectal resection. STUDY DESIGN Five patients referred for persistent voiding dysfunction after surgery for DIE with colorectal resection were included and fitted with a temporary SNM system to test for feasibility. This consisted of placing an electrode unilaterally next to the S3 sacral nerve root and connecting it to an external pacemaker. The patients wore the electrode and the external neurostimulator for 21 days and kept a voiding diary. The SNM test was considered positive when a 50% decrease in self-catheterization was achieved after removal of the electrode. The system was implanted permanently in patients with a positive SNM test. Urodynamic tests were performed before and after the SNM test. RESULTS Two of the five patients had a positive SNM test and were implanted permanently. At 40 months the first patient had completely stopped self-catheterization and the second patient was performing self-catheterization twice a day with a post voiding residue volume of less than 100ml at 52 months. CONCLUSION SNM could be a curative technique in some patients with persistent voiding dysfunction after surgery for DIE. Further studies are required to better select patients who might benefit from SNM testing and subsequent device implantation.

Stand up urgency: is this symptom related to a urethral mechanism?

OBJECTIVE To study the role of womens position as a stimulus of urgency, and specifically the change of position, i.e. to stand up form a lying or sitting position. Thus, we compared clinical and urodynamics characteristics among women with overactive bladder syndrome (OAB) depending of the position which could trigger urgency. METHODS Thirty-eight females with complaints of urgency, without urinary infection, neurological or urological diseases, were prospectively enrolled. Patients completed a study-specific questionnaire asking about urgency and urge incontinence when in three different positions (standing up, sitting, and standing position). We named stand up urgency (SUU) an urgency, which was defined thanks to this questionnaire, according to the presence of urgency triggered by the change from sitting or lying to a standing position. All patients underwent cystometry in the standing position, urethral closure pressure measurement (MUCP) and Valsalva leak point pressure (VLPP) tests. Urodynamics characteristics were compared in the groups defined by the questionnaire. RESULTS SUU was associated with lower MUCP (57 vs. 77 cm H(2)O; P=0.017), but not with positive VLPP or DO. Among females with SUU, those with stand up urge incontinence (SUUI) also had lower MUCP (46 vs. 73 cm H(2)O; P=0.019) and more positive cough stress tests (73 vs. 13%; P=0.019). Conversely, urge incontinence in the sitting position was associated with DO (46% vs. 0%; P=0.02), but not with lower MUCP or positive VLPP. CONCLUSION SUU appeared to be related to impaired urethral closure mechanisms (lower MUCP), but future studies are needed to confirm this hypothesis.

Proctalgies fugaces et neuropathie pudendale : étude neurophysiologique périnéale chez 55 patients ☆

OBJECTIVE Proctalgia fugax (PF) is a very common condition especially in women. Causes and pathophysiological mechanisms of PF are unknown. Recently, a pudendal neuropathy was clinically suspected in women with PF. The goal of our study was to demonstrate, or not, such abnormalities by means electrophysiological testing. PATIENTS AND METHODS Fifty-five patients with PF (45 female and 10 male, mean age 50.2 years) were evaluated. EMG testing with motor unit potential analysis of pelvic floor muscles (bulbocavernosus muscle and striated external anal sphincter), study of bulbocavernosus reflex and pudendal nerve terminal motor latencies (PNTML) were performed. RESULTS EMG testing was altered in two males out of 10 (20%) and 29/45 females (64%). In women, denervation was found bilateral in 25/29 (86%). Sacral latency was delayed in eight out of 29 (bilateral in five cases, unilateral in three cases) and PNTML altered in 17 cases (13 bilateral alteration, four unilateral). A significant difference (P<0.002 Chi(2) test) was demonstrated between male and female concerning pelvic floor muscles denervation. CONCLUSION Pelvic floor muscles denervation was a common feature in women suffering from PF, due to a stretch bilateral pudendal neuropathy. Distal lesions of the pudendal nerves, principally due to a stretch perineal neuropathy, can be imagined as a factor or co-factor of PF.

Nocturnal Urinary Disorders and Multiple Sclerosis: Clinical and Urodynamic Study of 309 Patients

Purpose: The aim of this study was to describe nocturia with or without leakage in a population of patients with multiple sclerosis. Materials and Methods: This is a retrospective, single center study of 309 patients with multiple sclerosis who were followed at an experienced neurourology center between 2011 and 2013. All patients had daytime urinary symptoms associated with this disorder. Among the patients with nocturia 2 groups were defined, including those with isolated nocturia but without nocturnal urinary incontinence and patients with nocturia associated with nocturnal urinary incontinence. The control group comprised patients without nocturia. The clinical variables and urodynamic data studied were gender, age, EDSS (Expanded Disability Status Scale), the USP (Urinary Symptoms Profile) questionnaire overactive bladder score, bladder capacity, detrusor activity and volume at the first detrusor contraction. Results: Of our patients 53.3% had nocturia, including 35.7% with nocturnal urinary incontinence. The average ± SD USP overactive bladder score was statistically greater in patients with nocturia than in controls (9.14 ± 4.3 vs 5.1 ± 3.5, p = 8.21E‐17). Mean maximum cystometric capacity was statistically higher in the control group than in patients with nocturia (380.17 ± 113.79 vs 313 ± 128.4 ml, p = 5.60E‐6). A similar outcome was found for the first contraction (mean 232.58 ± 146.05 vs 181.14 ± 100.11 ml, p = 0.041). Conclusion: Isolated nocturia or nocturnal urinary incontinence is a frequent problem encountered with multiple sclerosis. Our results suggest that an overactive detrusor is the main mechanism. Further studies are needed to verify the complications arising from nocturia.

Is a selective and dissociative voluntary contraction of the anterior and posterior pelvic floor muscles possible

l’érection. 40/49 pour les PGE (81,63 %), 12/39 pour les IPDE-V (30,76 %), 9/ 13 pour PGE + IPDE-V et PGE + papavérine (69,23 %). Quatre-vingt-quatre ont une anéjaculation à la masturbation et aux rapports (93,33 %). Le VM seul, a permit une éjaculation dans 16,21 % des cas. Douze éjaculations/74 patients (six antérograde, deux mixtes et quatre rétrogrades). Une éjaculation est constatée chez 20/38 patients (52,63 %) ayant bénéficiés de VM associé à la midodrine (un antérograde, six mixtes et 15 rétrogrades). Discussion et conclusion.– Comparée aux données de la littérature, notre étude est une mise au point descriptive sur un plus large échantillon des troubles d’érection et d’éjaculation spécifiques aux lésions médullaires sacrées et difficiles à traiter. Elle met l’accent aussi sur l’efficacité des moyens thérapeutiques. L’évaluation régulière de cette efficacité participe à une meilleure prise en charge et compréhension de leur mécanisme. Pour en savoir plus Podnar S, Oblak C, Vodusek DB. Sexual function in men with cauda equina lesions: a clinical and electromyographic study. J Neurol Neurosurg Psychiatry 2002;73:715–20. Khorrami MH, Javid A, Moshtaghi D. Sildenafil efficacy in erectile dysfunction secondary to spinal cord in jury depends on the level of cord injuries. Int J Androl 2010;33:861–4.

Devenir des troubles neuro-périnéaux après lésions sacrées

Les traumatismes sacres (fracture transverse par AVP (accident de la voie publique), defenestration ou chute d’une hauteur) ou les resections chirurgicales sacrees (tumeurs sacrees ou pelviennes, chirurgie d’endometriose) peuvent entrainer des complications urinaires, ano-rectales ou genito-sexuelles. Ces troubles peuvent facilement passer inapercus a la phase initiale dans un contexte souvent polytraumatique (51 % des patients avec lesion sacree peuvent avoir une lesion rachidienne associee) (1).