Hazel Ecclestone

Transcutaneous Electrical Nerve Stimulation for Treating Neurogenic Lower Urinary Tract Dysfunction: A Systematic Review

CONTEXT Transcutaneous electrical nerve stimulation (TENS) is a promising therapy for non-neurogenic lower urinary tract dysfunction and might also be a valuable option in patients with an underlying neurological disorder. OBJECTIVE We systematically reviewed all available evidence on the efficacy and safety of TENS for treating neurogenic lower urinary tract dysfunction. EVIDENCE ACQUISITION The review was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Statement. EVIDENCE SYNTHESIS After screening 1943 articles, 22 studies (two randomised controlled trials, 14 prospective cohort studies, five retrospective case series, and one case report) enrolling 450 patients were included. Eleven studies reported on acute TENS and 11 on chronic TENS. In acute TENS and chronic TENS, the mean increase of maximum cystometric capacity ranged from 69ml to 163ml and from 4ml to 156ml, the mean change of bladder volume at first detrusor overactivity from a decrease of 13ml to an increase of 175ml and from an increase of 10ml to 120ml, a mean decrease of maximum detrusor pressure at first detrusor overactivity from 18 cmH20 to 72 cmH20 and 8 cmH20, and a mean decrease of maximum storage detrusor pressure from 20 cmH20 to 58 cmH2O and from 3 cmH20 to 8 cmH2O, respectively. In chronic TENS, a mean decrease in the number of voids and leakages per 24h ranged from 1 to 3 and from 0 to 4, a mean increase of maximum flow rate from 2ml/s to 7ml/s, and a mean change of postvoid residual from an increase of 26ml to a decrease of 85ml. No TENS-related serious adverse events have been reported. Risk of bias and confounding was high in most studies. CONCLUSIONS Although preliminary data suggest TENS might be effective and safe for treating neurogenic lower urinary tract dysfunction, the evidence base is poor and more reliable data from well-designed randomised controlled trials are needed to make definitive conclusions. PATIENT SUMMARY Early data suggest that transcutaneous electrical nerve stimulation might be effective and safe for treating neurogenic lower urinary tract dysfunction, but more reliable evidence is required.

Long-term effectiveness and complication rates of bladder augmentation in patients with neurogenic bladder dysfunction: A systematic review

To systematically evaluate effectiveness and safety of bladder augmentation for adult neuro‐urological patients.

Value of urodynamic findings in predicting upper urinary tract damage in neuro-urological patients: A systematic review

The main goals of neurogenic lower urinary tract dysfunction (NLUTD) management are preventing upper urinary tract damage (UUTD), improving continence, and quality of life. Here, we aimed to systematically assess all available evidence on urodynamics predicting UUTD in patients with NLUTD.

A Quality Assessment of Patient-Reported Outcome Measures for Sexual Function in Neurologic Patients Using the Consensus-based Standards for the Selection of Health Measurement Instruments Checklist: A Systematic Review

CONTEXT Impaired sexual function has a significant effect on quality of life. Various patient-reported outcome measures (PROMs) are available to evaluate sexual function. The quality of the PROMs to be used for neurologic patients remains unknown. OBJECTIVE To systematically review which validated PROMs are available to evaluate sexual function in neurologic patients and to critically assess the quality of the validation studies and measurement properties for each identified PROM. EVIDENCE ACQUISITION A systematic review was performed according to the Preferred Reporting Items for Systematic Review and Meta-analysis statement. The included publications were assessed according to the Consensus-Based Standards for the Selection of Health Measurement Instruments checklist. EVIDENCE SYNTHESIS Twenty-one studies for PROMs regarding sexual function were identified for the following patient groups: spinal cord injury (11 studies), multiple sclerosis (MS; 6 studies), Parkinsons disease (2 studies), traumatic brain injury (1 study), and epilepsy (1 study). The evidence for the quality of PROMs was found to be variable, and overall evaluation of measurement properties was lacking in 71% of the studies. The measurement error and responsiveness were not studied in any of the publications. CONCLUSIONS Several PROMs have been identified to evaluate sexual function in neurologic patients. Strong evidence was found only for the Multiple Sclerosis Intimacy and Sexuality Questionnaire-15 and Multiple Sclerosis Intimacy and Sexuality Questionnaire-19 for patients with MS, although evidence was lacking for certain measurement properties as well. Future research should focus on identifying relevant PROMs and establishing adequate quality for all measurement properties in studies with high methodological quality. PATIENT SUMMARY A quality assessment of patient-reported outcome measures (PROMs) for sexual function in neurologic patients was made. The evidence found for good PROMs was limited. Studies with high methodological quality are needed to improve the quality of PROMs to evaluate sexual function in neurologic patients.

Continent catheterizable tubes/stomas in adult neuro‐urological patients: A systematic review

To systematically review all available evidence on the effectiveness and complications of continent cutaneous stoma or tube (CCS/T) to treat bladder‐emptying difficulties in adult neuro‐urological patients.

Neuro-urological History and Clinical Examination

As with most medical conditions, a thorough history and examination is key to fully understanding neuro-urological pathology. History taking should be holistic, covering urological, neurological and general complaints. In addition quality of life should be assessed, along with social situation and patient aims and expectations. Red flag symptoms should always be assessed.

Clinical Neuro-urophysiological Investigations

A neuro-urologist’s primary aim is to prevent irreversible renal deterioration. Urodynamic studies remain a key procedure in the risk stratification of patients with neuro-urological complaints; however, there are a number of additional electrodiagnostic investigations available which can add a deeper understanding of lower urinary tract dysfunction. In this chapter, we outline uro-neurophysiological investigations that can be performed in order to better understand patients’ underlying pathology and improve patient management.

Does videourodynamic classification depend on patient positioning in patients with stress urinary incontinence

Introduction and Aims: Videocystometrogram (VCMG) is used to assess patients with SUI. A common classification system of SUI is the Blaivas and Olsson classification. The position this grading is performed in has never been established.

MP63-13 DOES VIDEOURODYNAMIC CLASSIFICATION DEPEND ON PATIENT POSITIONING IN PATIENTS WITH STRESS URINARY INCONTINENCE?

35 (33.3%) stage IV. Sixty three (60%) women were identified as occult stress incontinent, twenty seven (25.7%) as continent, and 15 (14.3%) as stress urinary incontinent (leaked without prolapse reduction). From the 63 OSUI subjects, 48 (76.2%) were identified in both evaluations, and 8 were identified only during physical examination, and 7 only during urodynamics. The sensitivity to detect OSUI during physical examination and urodynamics was 88.9% and 87.3% respectively (p1⁄40.783). The value of Kappa to measure the agreement between both tests was 0.648 (95% CI, 0.4410.854). Anterior (p1⁄40.006) and posterior (p<0.001) compartment stage IV prolapse showed increased risk of OSUI. Despite 86 (81.9%) patients mentioned storage symptoms, only 8 (7.6%) had urodynamic demonstrated detrusor overactivity. CONCLUSIONS: Urodynamic study and physical examination are equivalent and concordant to demonstrate OSUI, thus it’s not mandatory to perform urodynamics to identify OSUI.

MP63-14 OVERNIGHT AMBULATORY URODYNAMICS FINDINGS IN PATIENTS WITH NOCTURIA AND/OR NOCTURNAL ENURESIS

35 (33.3%) stage IV. Sixty three (60%) women were identified as occult stress incontinent, twenty seven (25.7%) as continent, and 15 (14.3%) as stress urinary incontinent (leaked without prolapse reduction). From the 63 OSUI subjects, 48 (76.2%) were identified in both evaluations, and 8 were identified only during physical examination, and 7 only during urodynamics. The sensitivity to detect OSUI during physical examination and urodynamics was 88.9% and 87.3% respectively (p1⁄40.783). The value of Kappa to measure the agreement between both tests was 0.648 (95% CI, 0.4410.854). Anterior (p1⁄40.006) and posterior (p<0.001) compartment stage IV prolapse showed increased risk of OSUI. Despite 86 (81.9%) patients mentioned storage symptoms, only 8 (7.6%) had urodynamic demonstrated detrusor overactivity. CONCLUSIONS: Urodynamic study and physical examination are equivalent and concordant to demonstrate OSUI, thus it’s not mandatory to perform urodynamics to identify OSUI.