J.J. Wyndaele

International standards to document remaining autonomic function after spinal cord injury.

Study design:Experts opinions consensus.Objective:To develop a common strategy to document remaining autonomic neurologic function following spinal cord injury (SCI).Background and Rationale:The impact of a specific SCI on a persons neurologic function is generally described through use of the International Standards for the Neurological Classification of SCI. These standards document the remaining motor and sensory function that a person may have; however, they do not provide information about the status of a persons autonomic function.Methods:Based on this deficiency, the American Spinal Injury Association (ASIA) and the International Spinal Cord Society (ISCoS) commissioned a group of international experts to develop a common strategy to document the remaining autonomic neurologic function.Results:Four subgroups were commissioned: bladder, bowel, sexual function and general autonomic function. On-line communication was followed by numerous face to face meetings. The information was then presented in a summary format at a course on Measurement in Spinal Cord Injury, held on June 24, 2006. Subsequent to this it was revised online by the committee members, posted on the websites of both ASIA and ISCoS for comment and re-revised through webcasts. Topics include an overview of autonomic anatomy, classification of cardiovascular, respiratory, sudomotor and thermoregulatory function, bladder, bowel and sexual function.Conclusion:This document describes a new system to document the impact of SCI on autonomic function. Based upon current knowledge of the neuroanatomy of autonomic function this paper provides a framework with which to communicate the effects of specific spinal cord injuries on cardiovascular, broncho-pulmonary, sudomotor, bladder, bowel and sexual function.

Cystometrical sensory data from a normal population: comparison of two groups of young healthy volunteers examined with 5 years interval.

OBJECTIVE To describe the pattern of sensations reported during standardized cystometry in a group of healthy young volunteers and compare them with a group examined 5 years before. METHODS A group of 50 young healthy volunteers without any symptoms or history reported the sensations they felt during cystometry. These results were compared with those of another group of 38 young healthy volunteers examined in the same lab in 1995 by another investigator. RESULTS All participants perceived a first sensation of bladder filling, first desire to void and strong desire to void. Each sensation was easily distinguishable from the others. The volumes at which these sensations came up varied widely. The ratio between volumes at consecutive sensations and at full bladder was fairly constant. All but two parameters were not significantly different from those found in 1995. CONCLUSIONS Our data give additional weight to previous findings that there exists a normal pattern of sensations reported during cystometric bladder filling. This sensory pattern probably corresponds with specific physiological mechanisms as suggested before. Deviations from this pattern indicate or illustrate pathology.

International lower urinary tract function basic spinal cord injury data set

Objective:To create the International Lower Urinary Tract Function Basic Spinal Cord Injury (SCI) Data Set within the framework of the International SCI Data Sets.Setting:International working group.Methods:The draft of the Data Set was developed by a working group consisting of the members appointed by the International Continence Society, the European Association of Urology, the American Spinal Injury Association (ASIA), the International Spinal Cord Society (ISCoS) and a representative of the Executive Committee of the International SCI Standards and Data Sets. The final version of the Data Set was developed after review and comments by the members of the Executive Committee of the International SCI Standards and Data Sets, the ISCoS Scientific Committee, ASIA Board, relevant and interested (international) organizations and societies (around 40) and persons, and the ISCoS Council. Endorsement of the Data Set by relevant organizations and societies will be obtained. To make the Data Set uniform, each variable and each response category within each variable have been specifically defined in a way that is designed to promote the collection and reporting of comparable minimal data.Results:Variables included in the International Lower Urinary Tract Function Basic SCI Data Set are as follows: date of data collection, urinary tract impairment unrelated to spinal cord lesion, awareness of the need to empty the bladder, bladder emptying, average number of voluntary bladder emptyings per day during the last week, incontinence within the last 3 months, collecting appliances for urinary incontinence, any drugs for the urinary tract within the last year, surgical procedures on the urinary tract and any change in urinary symptoms within the last year. Complete instruction for data collection, data sheet and training cases available at the website of ISCoS (www.iscos.org.uk) and ASIA (www.asia-spinalinjury.org).

Correlation between clinical neurological data and urodynamic function in spinal cord injured patients

In 92 patients with spinal cord lesion, out of spinal shock, the data from a clinical neurological examination of the lumbosacral area are compared with the data from a full urodynamic investigation, including evaluation of sensation in the lower urinary tract. A significant correlation can be found between different levels of spinal cord lesion, the function of bladder neck and sphincter and the anal bulbocavernosus reflexes. Higher lesions correspond more with a reflexic lower urinary tract and somatic motor activity, lower lesions more with areflexia. With a lesion between thoracic 10 and lumbar 2 as many reflexic as areflexic lower urinary tract dysfunctions were found. The presence or absence of perineal sensation of light touch corresponded significantly with the presence or absence of sensation in the lower urinary tract. Detrusor and striated sphincter reflexia/areflexia corresponded significantly with the presence/absence of bulbocavernosus and anal reflexes. Clinical neurological examination gives useful information which acceptably corresponds with the LUT function. However to decide on a detailed individual diagnosis, clinical examination is in our opinion insufficient. Urodynamic tests are needed for a profound evaluation of the function of different parts of the lower urinary tract and their interaction.

Patient Satisfaction and Complications Following Sacral Nerve Stimulation for Urinary Retention, Urge Incontinence and Perineal Pain: a Multicenter Evaluation

Abstract: The aim of the study was to determine the success rate, the complications, the failures and the solutions found in troublesome cases. A retrospective study was performed in three university centers in Belgium. Between March 1994 and April 1998, a quadripolar electrode and a pulse generator were implanted in 53 patients (8 men, 45 women, 43 ± 12 years, mean follow-up 24 ± 8 months, range 13–39 months). During the first few months, 45 (85%) of the 53 patients had an objective response. Eight late failures occurred, with a mean failure delay of 9 ± 5 months. We performed 15 revisions in 12 patients. Major complications were pain and current-related troubles. The outcome was significantly better (P= 0.001) in post-stress incontinence surgery patients. Device-related pain was found more frequently in patients with dysuria and/or retention or perineal pain, and the test stimulation was less reliable (P= 0.025) in patients with a psychiatric history. Sacral nerve stimulation is efficient in treating patients with refractory lower urinary tract symptoms and/or perineal pain.

International Urodynamic Basic Spinal Cord Injury Data Set

Objective:To create the International Urodynamic Basic Spinal Cord Injury (SCI) Data Set within the framework of the International SCI Data Sets.Setting:International working group.Methods:The draft of the data set was developed by a working group consisting of members appointed by the Neurourology Committee of the International Continence Society, the European Association of Urology, the American Spinal Injury Association (ASIA), the International Spinal Cord Society (ISCoS) and a representative of the Executive Committee of the International SCI Standards and Data Sets. The final version of the data set was developed after review and comments by members of the Executive Committee of the International SCI Standards and Data Sets, the ISCoS Scientific Committee, ASIA Board, relevant and interested (international) organizations and societies (around 40) and persons and the ISCoS Council. Endorsement of the data set by relevant organizations and societies will be obtained. To make the data set uniform, each variable and each response category within each variable have been specifically defined in a way that is designed to promote the collection and reporting of comparable minimal data.Results:Variables included in the International Urodynamic Basic SCI Data Set are date of data collection, bladder sensation during filling cystometry, detrusor function, compliance during filing cystometry, function during voiding, detrusor leak point pressure, maximum detrusor pressure, cystometric bladder capacity and post-void residual volume.

The basics behind bladder pain: a review of data on lower urinary tract sensations

Abstract Interstitial cystitis is a syndrome consisting of frequency, urgency, and bladder pain that increases with bladder filling and improves temporarily after voiding.

Experience with augmentation cystoplasty. A review

Good experience with clam cystoplasty is reported for 28 patients (14 female), 89% of whom had a neuropathic bladder. Prolonged conservative treatment had failed in all cases. The efficacy of the operation in terms of continence, increased bladder compliance, and bladder capacity was confirmed. Complications were common and included inability to void (70%) requiring clean intermittent catheterisation (CIC), recurrent urinary tract infection (59%) and stone formation (22%). Due to these complications, further surgery was required for 44% of the patients. Although clam enterocystoplasty is an efficient way to reconstruct a functionally disturbed urinary tract, careful patient selection is essential. Lifetime follow-up and recognition of the most frequent complications is mandatory.

Study of the afferent nervous system and its evaluation in women with impaired detrusor contractility treated with bethanechol

OBJECTIVES To study the effects of subcutaneous bethanechol on the afferent nervous system and correlate these with the efficiency of this treatment in women with impaired detrusor contractility and to evaluate whether patients likely to respond to bethanechol can be identified before treatment through sensation evaluation. METHODS Eighteen women with impaired detrusor contractility were given subcutaneous bethanechol for 10 days, and the flow pattern and postvoid residual urine volume were monitored. The afferent nervous system was studied before and after therapy by evaluating the sensation of filling during cystometry and by determining the bladder electrical perception threshold (EPT). RESULTS At the end of therapy, 61% voided without a postvoid residual volume. In these women, the sensation of filling and electrical sensitivity were significantly increased compared with before treatment. In women who still voided with a postvoid residual volume, the sensation of filling had increased to a lesser extent and no change in EPT was found. Women in whom bethanechol was unsuccessful had a higher pretreatment EPT than women who were successful. No such difference was found for the sensation of filling. CONCLUSIONS An increase in bladder sensitivity correlated with improvement in bladder emptying and can be evaluated by studying the sensation of filling and EPT. Patients likely to respond to bethanechol can be identified before treatment on the basis of the EPT level. Therefore, it would be valuable to initiate EPT measurement in the diagnosis of patients with impaired detrusor contractility.

Bladder Compliance What Does it Represent: Can We Measure it, and is it Clinically Relevant?

To report the conclusion of the Think Thank 8 on Compliance Discussions during the second ICI‐RS meeting in 2010.