Jalesh N. Panicker

Pelvic Organ Dysfunction in Neurological Disease: Clinical Management and Rehabilitation

Foreword Preface List of contributors Part I. Neurologic Control of Pelvic Organ Functions: 1. Neurological control of the bladder in health and disease Derek J. Griffiths and Apostolos Apostolidis 2. Neurological control of the bowel in health and disease Prateesh M. Trivedi and Derek J. Griffiths 3. Neurological control of sexual function in health and disease Clare J. Fowler, Jalesh N. Panicker and Rajesh B. Kavia Part II. Evaluation and Management: 4. Approach and evaluation of neurogenic bladder dysfunction Jalesh N. Panicker, Vinay Kalsi and Marianne de Seze 5. General measures and non-pharmacological approaches Jeanette Haslam, Gwen Gonzales and Collette Haslam 6. Neurogenic bladder dysfunction: pharmacological interventional approaches Apostolos Apostolidis, Soumendra Datta, Xavier Game and Shahid Khan 7. Neurogenic bladder dysfunction: surgical interventional approaches Xavier Game, Thomas M. Kessler, Suzy Elneil and Rizwan Hamid 8. Approach and evaluation of neurogenic bowel dysfunction Klaus Krogh 9. Neurogenic bowel management Maureen Coggrave and Anton Emmanuel 10. Evaluation and management of neurogenic sexual dysfunction Charlotte Chaliha, Catherine M. Dalton, Sohier Elneil and Thomas M. Kessler Part III. Specific Conditions: 11. Cortical and subcortical disorders Ryuji Sakakibara, Clare J. Fowler and Takamichi Hattori 12. Parkinsons disease Ryuji Sakakibara, Clare J. Fowler and Takamichi Hattori 13. Multiple system atrophy Ryuji Sakakibara, Clare J. Fowler and Takamichi Hattori 14. Multiple sclerosis and other non-compressive myelopathies Catherine M. Dalton, Giuseppi Preziosi, Shahid Khan and Marianne de Seze 15. Spinal cord injury Xavier Game and Rizwan Hamid 16. Spina bifida and tethered cord syndrome Thomas M. Kessler and Gustav Kiss 17. Pelvic organ dysfunction following cauda equina damage Simon Podnar and Clare J. Fowler 18. Neuromuscular disorders Jalesh N. Panicker and Hadi Manji 19. Urinary retention Jalesh N. Panicker, Ranan DasGupta, Sohier Elneil and Clare J. Fowler Appendices: Appendix 1. Management algorithms Appendix 2. Surveys and questionnaires Index.

Pelvic Organ Dysfunction in Neurological Disease: Neurological control of sexual function in health and disease

© Cambridge University Press 2010. The neurology of human sexual responses is poorly understood, not only because it is a highly complex process involving much of the nervous system, but also because in comparison to the extent to which research has been carried out in experimental animals, humans have been relatively little studied. Whereas in animals the central and peripheral nervous system control of penile erection and copulatory behavior have been intensively examined, our knowledge about human function and the brain is based mainly on a synthesis of observations of reported abnormalities resulting from disease [1]. Now, however, functional brain imaging data have begun to complement those data. Homology between primates and rodents has been shown for many aspects of sexual responses but there remains much that is unknown about the more complex human processes, especially the neurological determinants of sexual desire. After defining the various phases of the human sexual cycle, this chapter outlines the roles of the subcortical and cortical regions, spinal connections and peripheral innervation involved in those phases, with reference to the experimental animal literature and mention of the dysfunctions that can result from neurological disease at each level. Findings from recent functional imaging experiments are discussed in the context of the role of the cortical regions in human neurological control of sexual function.

Botulinum toxin-A for the treatment of overactive bladder: UKcontributions

Background: Botulinum toxin-A (BoNT/A) is now established second-line management for refractory overactive bladder (OAB) and recognised in many incontinence guidelines and pathways. For those with neurogenic detrusor overactivity secondary to spinal cord injury or multiple sclerosis, the toxin is currently licensed in certain parts of the world, including the UK. It is an effective treatment in those in whom antimuscarinics and conservative measures have failed who have symptoms of OAB and or detrusor overactivity (DO). Methods: Treatment can be given in an outpatient setting and can be administered under local anaesthesia. Its efficacy lasts for between six and 12 months. Results: It has an acceptable safety profile with the biggest risk being urinary tract infection and difficulty emptying the bladder, necessitating clean intermittent self-catheterisation (CISC). Medium-term follow-up suggests repeated injections are also safe and efficacious. Conclusions: The mechanism of action of the toxin is more complicated than originally thought, and it seems likely that it affects motor and sensory nerves of the bladder. In the last 10 years much of the progress of this treatment from early experimental trials to mainstream clinical use, and a better understanding of how it works in the bladder, are as a result of research conducted in the UK. This review summarises the significant and substantial evidence for BoNT/A to treat refractory OAB from UK centres.

Botulinum toxin-A for the treatment of overactive bladder

Background: Botulinum toxin-A (BoNT/A) is now established second-line management for refractory overactive bladder (OAB) and recognised in many incontinence guidelines and pathways. For those with neurogenic detrusor overactivity secondary to spinal cord injury or multiple sclerosis, the toxin is currently licensed in certain parts of the world, including the UK. It is an effective treatment in those in whom antimuscarinics and conservative measures have failed who have symptoms of OAB and or detrusor overactivity (DO). Methods: Treatment can be given in an outpatient setting and can be administered under local anaesthesia. Its efficacy lasts for between six and 12 months. Results: It has an acceptable safety profile with the biggest risk being urinary tract infection and difficulty emptying the bladder, necessitating clean intermittent self-catheterisation (CISC). Medium-term follow-up suggests repeated injections are also safe and efficacious. Conclusions: The mechanism of action of the toxin is more complicated than originally thought, and it seems likely that it affects motor and sensory nerves of the bladder. In the last 10 years much of the progress of this treatment from early experimental trials to mainstream clinical use, and a better understanding of how it works in the bladder, are as a result of research conducted in the UK. This review summarises the significant and substantial evidence for BoNT/A to treat refractory OAB from UK centres.

Pelvic Organ Dysfunction in Neurological Disease: Index

Foreword Preface List of contributors Part I. Neurologic Control of Pelvic Organ Functions: 1. Neurological control of the bladder in health and disease Derek J. Griffiths and Apostolos Apostolidis 2. Neurological control of the bowel in health and disease Prateesh M. Trivedi and Derek J. Griffiths 3. Neurological control of sexual function in health and disease Clare J. Fowler, Jalesh N. Panicker and Rajesh B. Kavia Part II. Evaluation and Management: 4. Approach and evaluation of neurogenic bladder dysfunction Jalesh N. Panicker, Vinay Kalsi and Marianne de Seze 5. General measures and non-pharmacological approaches Jeanette Haslam, Gwen Gonzales and Collette Haslam 6. Neurogenic bladder dysfunction: pharmacological interventional approaches Apostolos Apostolidis, Soumendra Datta, Xavier Game and Shahid Khan 7. Neurogenic bladder dysfunction: surgical interventional approaches Xavier Game, Thomas M. Kessler, Suzy Elneil and Rizwan Hamid 8. Approach and evaluation of neurogenic bowel dysfunction Klaus Krogh 9. Neurogenic bowel management Maureen Coggrave and Anton Emmanuel 10. Evaluation and management of neurogenic sexual dysfunction Charlotte Chaliha, Catherine M. Dalton, Sohier Elneil and Thomas M. Kessler Part III. Specific Conditions: 11. Cortical and subcortical disorders Ryuji Sakakibara, Clare J. Fowler and Takamichi Hattori 12. Parkinsons disease Ryuji Sakakibara, Clare J. Fowler and Takamichi Hattori 13. Multiple system atrophy Ryuji Sakakibara, Clare J. Fowler and Takamichi Hattori 14. Multiple sclerosis and other non-compressive myelopathies Catherine M. Dalton, Giuseppi Preziosi, Shahid Khan and Marianne de Seze 15. Spinal cord injury Xavier Game and Rizwan Hamid 16. Spina bifida and tethered cord syndrome Thomas M. Kessler and Gustav Kiss 17. Pelvic organ dysfunction following cauda equina damage Simon Podnar and Clare J. Fowler 18. Neuromuscular disorders Jalesh N. Panicker and Hadi Manji 19. Urinary retention Jalesh N. Panicker, Ranan DasGupta, Sohier Elneil and Clare J. Fowler Appendices: Appendix 1. Management algorithms Appendix 2. Surveys and questionnaires Index.

Pelvic Organ Dysfunction in Neurological Disease: Pelvic Organ Dysfunction in Neurological Disease

Foreword Preface List of contributors Part I. Neurologic Control of Pelvic Organ Functions: 1. Neurological control of the bladder in health and disease Derek J. Griffiths and Apostolos Apostolidis 2. Neurological control of the bowel in health and disease Prateesh M. Trivedi and Derek J. Griffiths 3. Neurological control of sexual function in health and disease Clare J. Fowler, Jalesh N. Panicker and Rajesh B. Kavia Part II. Evaluation and Management: 4. Approach and evaluation of neurogenic bladder dysfunction Jalesh N. Panicker, Vinay Kalsi and Marianne de Seze 5. General measures and non-pharmacological approaches Jeanette Haslam, Gwen Gonzales and Collette Haslam 6. Neurogenic bladder dysfunction: pharmacological interventional approaches Apostolos Apostolidis, Soumendra Datta, Xavier Game and Shahid Khan 7. Neurogenic bladder dysfunction: surgical interventional approaches Xavier Game, Thomas M. Kessler, Suzy Elneil and Rizwan Hamid 8. Approach and evaluation of neurogenic bowel dysfunction Klaus Krogh 9. Neurogenic bowel management Maureen Coggrave and Anton Emmanuel 10. Evaluation and management of neurogenic sexual dysfunction Charlotte Chaliha, Catherine M. Dalton, Sohier Elneil and Thomas M. Kessler Part III. Specific Conditions: 11. Cortical and subcortical disorders Ryuji Sakakibara, Clare J. Fowler and Takamichi Hattori 12. Parkinsons disease Ryuji Sakakibara, Clare J. Fowler and Takamichi Hattori 13. Multiple system atrophy Ryuji Sakakibara, Clare J. Fowler and Takamichi Hattori 14. Multiple sclerosis and other non-compressive myelopathies Catherine M. Dalton, Giuseppi Preziosi, Shahid Khan and Marianne de Seze 15. Spinal cord injury Xavier Game and Rizwan Hamid 16. Spina bifida and tethered cord syndrome Thomas M. Kessler and Gustav Kiss 17. Pelvic organ dysfunction following cauda equina damage Simon Podnar and Clare J. Fowler 18. Neuromuscular disorders Jalesh N. Panicker and Hadi Manji 19. Urinary retention Jalesh N. Panicker, Ranan DasGupta, Sohier Elneil and Clare J. Fowler Appendices: Appendix 1. Management algorithms Appendix 2. Surveys and questionnaires Index.

Pelvic Organ Dysfunction in Neurological Disease: Contents

Foreword Preface List of contributors Part I. Neurologic Control of Pelvic Organ Functions: 1. Neurological control of the bladder in health and disease Derek J. Griffiths and Apostolos Apostolidis 2. Neurological control of the bowel in health and disease Prateesh M. Trivedi and Derek J. Griffiths 3. Neurological control of sexual function in health and disease Clare J. Fowler, Jalesh N. Panicker and Rajesh B. Kavia Part II. Evaluation and Management: 4. Approach and evaluation of neurogenic bladder dysfunction Jalesh N. Panicker, Vinay Kalsi and Marianne de Seze 5. General measures and non-pharmacological approaches Jeanette Haslam, Gwen Gonzales and Collette Haslam 6. Neurogenic bladder dysfunction: pharmacological interventional approaches Apostolos Apostolidis, Soumendra Datta, Xavier Game and Shahid Khan 7. Neurogenic bladder dysfunction: surgical interventional approaches Xavier Game, Thomas M. Kessler, Suzy Elneil and Rizwan Hamid 8. Approach and evaluation of neurogenic bowel dysfunction Klaus Krogh 9. Neurogenic bowel management Maureen Coggrave and Anton Emmanuel 10. Evaluation and management of neurogenic sexual dysfunction Charlotte Chaliha, Catherine M. Dalton, Sohier Elneil and Thomas M. Kessler Part III. Specific Conditions: 11. Cortical and subcortical disorders Ryuji Sakakibara, Clare J. Fowler and Takamichi Hattori 12. Parkinsons disease Ryuji Sakakibara, Clare J. Fowler and Takamichi Hattori 13. Multiple system atrophy Ryuji Sakakibara, Clare J. Fowler and Takamichi Hattori 14. Multiple sclerosis and other non-compressive myelopathies Catherine M. Dalton, Giuseppi Preziosi, Shahid Khan and Marianne de Seze 15. Spinal cord injury Xavier Game and Rizwan Hamid 16. Spina bifida and tethered cord syndrome Thomas M. Kessler and Gustav Kiss 17. Pelvic organ dysfunction following cauda equina damage Simon Podnar and Clare J. Fowler 18. Neuromuscular disorders Jalesh N. Panicker and Hadi Manji 19. Urinary retention Jalesh N. Panicker, Ranan DasGupta, Sohier Elneil and Clare J. Fowler Appendices: Appendix 1. Management algorithms Appendix 2. Surveys and questionnaires Index.

Pelvic Organ Dysfunction in Neurological Disease: List of contributors

Foreword Preface List of contributors Part I. Neurologic Control of Pelvic Organ Functions: 1. Neurological control of the bladder in health and disease Derek J. Griffiths and Apostolos Apostolidis 2. Neurological control of the bowel in health and disease Prateesh M. Trivedi and Derek J. Griffiths 3. Neurological control of sexual function in health and disease Clare J. Fowler, Jalesh N. Panicker and Rajesh B. Kavia Part II. Evaluation and Management: 4. Approach and evaluation of neurogenic bladder dysfunction Jalesh N. Panicker, Vinay Kalsi and Marianne de Seze 5. General measures and non-pharmacological approaches Jeanette Haslam, Gwen Gonzales and Collette Haslam 6. Neurogenic bladder dysfunction: pharmacological interventional approaches Apostolos Apostolidis, Soumendra Datta, Xavier Game and Shahid Khan 7. Neurogenic bladder dysfunction: surgical interventional approaches Xavier Game, Thomas M. Kessler, Suzy Elneil and Rizwan Hamid 8. Approach and evaluation of neurogenic bowel dysfunction Klaus Krogh 9. Neurogenic bowel management Maureen Coggrave and Anton Emmanuel 10. Evaluation and management of neurogenic sexual dysfunction Charlotte Chaliha, Catherine M. Dalton, Sohier Elneil and Thomas M. Kessler Part III. Specific Conditions: 11. Cortical and subcortical disorders Ryuji Sakakibara, Clare J. Fowler and Takamichi Hattori 12. Parkinsons disease Ryuji Sakakibara, Clare J. Fowler and Takamichi Hattori 13. Multiple system atrophy Ryuji Sakakibara, Clare J. Fowler and Takamichi Hattori 14. Multiple sclerosis and other non-compressive myelopathies Catherine M. Dalton, Giuseppi Preziosi, Shahid Khan and Marianne de Seze 15. Spinal cord injury Xavier Game and Rizwan Hamid 16. Spina bifida and tethered cord syndrome Thomas M. Kessler and Gustav Kiss 17. Pelvic organ dysfunction following cauda equina damage Simon Podnar and Clare J. Fowler 18. Neuromuscular disorders Jalesh N. Panicker and Hadi Manji 19. Urinary retention Jalesh N. Panicker, Ranan DasGupta, Sohier Elneil and Clare J. Fowler Appendices: Appendix 1. Management algorithms Appendix 2. Surveys and questionnaires Index.

PAW26 Are the beneficial effects of Botulinum toxin for refractory detrusor overactivity in multiple sclerosis sustained with repeat injections

Objectives Intradetrusor injection of Botulinum toxin type A, although not yet licenced, has proven to be highly effective for urge incontinence in multiple sclerosis (MS) due to refractory detrusor overactivity (DO). Here we evaluate the impact of repeat injections on patient reported outcome measures (PROMs) to examine whether benefits are sustained. Methods People with MS having urodynamically proven refractory DO were injected 300 U Botox© by flexible cystoscopy. Urogenital Distress Inventory (UDI-6), Incontinence Impact Questionnaire (IIQ-7) and EQ-5D were used to record bladder symptoms and quality of life before and 4u2005weeks after injection. Re-injection was dictated by return of symptoms and urodynamically proven DO. Results Between 2002 and 2009, 137 patients (106 women, 31 men; mean age 47.8u2005years (range 24–79)) received detrusor injections. Mean follow-up was 29u2005months (range 8–80u2005months). 95 had re-injections (maximum 6 injections, mean 2.9) at inter-injection intervals of median 13u2005months (IQR 11–16u2005months). Duration of interval did not change and improvement in PROMs were significant and sustained following each injection. 74% became continent at 4u2005weeks following treatment. Infection was the commonest side effect (17%). All but two patients required self-catheterisation. Conclusion Repeat Botulinum toxin injections for refractory DO remains reliably effective in improving bladder symptoms and quality of life when repeated for at least 2u2005years.