F. Le Breton

Emptying cystometry: A feasibility and validation pilot study on female patients

INTRODUCTIONnTo assess the feasibility and the accuracy of emptying cystometry in order to simplify the manometric follow-up of overactive detrusor in neurological patients under anticholinergic or botulinum toxin injections.nnnMATERIALnFemale patients with a stable detrusor underwent both a conventional cystometry and sequential measurements of bladder pressure during emptying (emptying cystometry). At the end of the standard cystometry, a CH12 urinary catheter was introduced in the bladder and was connected to a three-way stopcock. The second way of the stopcock permitted the emptying. The third way of the stopcock was connected to a vertical graduated tube to measure the bladder pressure each 50mL during the bladder emptying.nnnRESULTSnEleven female patients were included (mean age: 59.4years). Nine patients (82%) had neurogenic bladder. Mean cystometric capacity was 439mL (SD: 35mL). During the emptying cystometry, 8 to 10 measures were taken (mean: 9.4). The mean detrusor pressure was 1.7cmH2O (SD 2.1) for the filling cystometry and 2.3cmH2O (SD: 2.7) for the emptying cystometry. The agreement between the detrusor pressure between the two cystometries was good with intra-class correlation coefficient at 0.66 [0.48-0.77]xa0-xa0and the correlation was high (r=0.7; P<0.000001).nnnCONCLUSIONnIn a small, selected sample of patients, emptying cystometry provides similar results of detrusor pressure to filling cystometry. This technique could constitute a home monitoring of bladder pressures in a selected population of patients with intermittent catheterization in whom a manometric follow-up of detrusor overactivity is required.nnnLEVEL OF EVIDENCEn4.

Démonstration neurophysiologique d’un réflexe périnéo-vésico-sensitif inhibiteur

INTRODUCTIONnNeed to void level depends on two parameters, bladder volume and attentional process. If it is well known that the maximum voluntary contraction of the perineal muscles may transiently inhibit the micturition reflex itself, no work demonstrates the effect of this contraction on the intensity of the need itself.nnnMETHODSnAn experimental, prospective, open, monocentric study was conducted between March and April 2017. In total, 15 subjects with no neurological history or neuro-perineal disorders consulting for functional constipation were included. Need to void level was evaluated by means of an electronic urgentometer. A control contraction of the dominant hand muscles was compared to a voluntary contraction of the external anal sphincter during a strong desire to void (B3). These contractions were recorded by means of surface electromyography. The main evaluation criterion was the comparison between the difference in visual analogic scale of the desire to void before (VAS-base) and after control voluntary contraction (VAS-hand) versus the same index (BAS-base then VAS-anal) after contraction of the external anal sphincter during a new B3. The comparison of maximum bladder capacities (MBC) measured after each record was the secondary endpoint. Wilcoxon signed rank test was used for statistical analysis.nnnRESULTSnVoiding desire VAS decreased significantly (-13.14±12 vs -1.5±6; P=0.03) and MBC increased significantly (502.43±96.71mL vs 435.78±125.54mL; P=0.02) after anal compared to control contraction.nnnCONCLUSIONnThis study suggests the existence of sensitive pathways inhibition by perineal contraction through a sensitive perineo-vesical inhibitory reflex.nnnLEVEL OF EVIDENCEn3.

Reproductibilité du calendrier mictionnel chez les patients atteints de sclérose en plaques. Étude prospective monocentrique

INTRODUCTIONnMultiple sclerosis (MS) is a neurological condition characterized by variable levels of symptoms. This variability could also affect bladder dysfunction and impact on the reproducibility or stability of bladder diary (BD). The aim of the study is to investigate the reproducibility and reliability of BD in MS, and then determine its linked factors.nnnMETHODSnThe MS patient provided a 21xa0days BD and they documented the time of every void. The main criterion was assessed by voiding frequency, represented by the coefficient of variation (CV=average/standard deviation), expressed as a percentage. Two groups were described: stable BD group (CV≤15xa0%) and instable BD group (CV>15xa0%). Secondary criteria were completion of BD (complete or not) and the difference of voiding frequency variation between weekend and week.nnnRESULTSnThirty-one patients were included (mean age 51.06xa0years, SD 11.33) with 65xa0% of women. Mean CV is 23xa0% (SD 0.11). The mean completion of BD was 19.35xa0days (SD 3.99). 8xa0patients had a CV≤15xa0%. Stable group was older than instable group (P=0.03). There was no other difference between the 2xa0groups. There is a strong correlation between mean voiding frequency weekend and week (ρ=0.94, P<0.05). The longer duration of BD, the less reliability is notified.nnnCONCLUSIONnBD is not a stable reproducible in MS population. Both lack of compliance or variability of LUTS in MS may explain the unreliability of BD. However, BD utility should be discussed in this population.nnnLEVEL OF EVIDENCEn4.

Alimentation, régimes et diététique dans le syndrome clinique d’hyperactivité vésicale : revue de la littérature

Overactive bladder symptoms (OAB) are frequent and can impact quality of life for these patients. Numerous and various treatments could be proposed in order to improve well-being and quality of life, but all these treatments have side effects and determine for many patients, important care constraints. We present here a review of food and diet in OAB.nnnMATERIAL AND METHODSnLiterature review from PubMed Medline database and Google scholar to August 2016, without time restriction. Two hundred and ninety-six articles were screened, in English and in French, and finally, 10 were retained. HAS recommandation have been used for level of evidence.nnnRESULTSnOn the 10 studies included, only two randomised controled trial were included. The first one showed decreases on urgency (by a half) (P=0.02) and on frequency (by a third) (P=0.035), secondary to reduction of caffeine consumption by a half after education [LE2]. The second randomized trial showed significant decreases on the first need to void in urodynamic study after caffeine consumption (170mL vs. 210mL) [LE2]. Feed like bread, chicken or nutrient like vitamin C or D were assessed in cohort or observational studies and appear as protective factors of OAB onset. Instead carbonated drinks may have a negative impact on symptoms, increasing urinary incontinence (OR 1.41 [95xa0% CI: 1.02-1.95]) [LE2], and there are contradictory results for alcohol consumption.nnnCONCLUSIONnDiet seems to have an impact on overactive bladder syndrome and particularly caffeine consumption, which increases storage symptoms.

Évaluation prospective de l’impact des anticholinergiques sur la sécheresse buccale et oculaire chez 35 patients atteints de sclérose en plaque avec hyperactivité vésicale neurogène

INTRODUCTIONnMouth and eye dryness are frequently reported by patients with multiple sclerosis (MS) as side effects of antimuscarinic drugs used for neurogenic overactive bladder. We evaluated the impact of antimuscarinic drugs prescription on these symptoms.nnnMETHODSnMS patients consulting for overactive bladder were included. Xerostomia were evaluated at baseline and thirty days after treatment by self-reporting questionnaires (Xerostomia Quality of Life [X-Qol] and Xerostomia Questionnaire [XQ]), by salivary flow rate and sugar test. Xerophtalmia were evaluated by a self-reporting questionnaire (Ocular Surface Disease Index [OSDI]) and Schirmer test. Iatrogenic anticholinergic impregnation was evaluated by the Anticholinergic Drug Scale.nnnRESULTSnFrom January to December 2014, 35 patients were included. Mean age was 50.1±10.2 years, mean EDSS=4.9. Mean anticholinergic impregnation was 0.6±1.0. Before treatment, none correlation was found between anticholinergic impregnation and other parameters. Twenty-two patients were evaluated after treatment. At baseline and thirty days after treatment, mean scores were respectively: 0.78±0.51 and 0.73±0.43 (P=0.67) for X-Qol, 9.22±11.8 and 7.03±11.4 (P=0.32) for XQ, 18.8±14.9 and 13.9±11.6 (P=0.06) for OSDI. Mean salivary flow rates were respectively 1.54±1.11 and 1.22±1.3 (P=0.53), positive sugar tests concerned respectively 68% and 55% of patients (P=0.53), and positive Schirmer test concerned 50% before and after treatment.nnnCONCLUSIONnEye and mouth dryness exist in our MS population, even before prescription of antimuscarinic treatment, and is not getting worse after prescription. Those symptoms should not be the reason to stop an efficient treatment, but should be the reason to find and treat their aetiology.nnnLEVEL OF EVIDENCEn4.