M. Jousse

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.

Evidence for autonomic nervous system dysfunction in females with idiopathic overactive bladder syndrome

Micturition and continence are largely under the control of the autonomic nervous system (ANS). In this study, we analyzed ANS function using autonomic cardiovascular (CV) testing in females with idiopathic overactive bladder syndrome (iOAB) versus control females. Our hypothesis was that ANS dysfunction could comprise part of the pathophysiology of iOAB.

Dysautonomie et troubles urinaires au cours de la sclérose en plaques. Étude clinique, urodynamique et cardiovasculaire☆

OBJECTIVE To assess symptoms related to autonomic nervous system alteration in a population of patients suffering from multiple sclerosis (MS) and presenting with urinary symptoms. PATIENTS AND METHODS We investigated 65 patients (mean age 47.5 years) suffering from MS, and presenting with urological dysfunction by means of symptom scores, urodynamic investigation, cardiovascular autonomic function tests (orthostatic hypotension testing, Valsalva test, deep breath test, cold pressor test) and sympathetic skin responses. RESULTS Forty-five (69%) patients suffered from overactive bladder, 48 (73%) from voiding dysfunction, 14 (21%) from urinary retention and 13 (20%) from fecal incontinence. Urodynamic investigation demonstrated overactive detrusor in 46 (70%) cases, and underactive detrusor in four (6%) cases. Twenty-five (38%) patients had dysautonomia without correlation neither with clinical or urodynamic data, nor gravity of multiple sclerosis (EDSS). CONCLUSION In this series, the prevalence of dysautonomia was high in patients suffering from MS and presenting with urinary disorders.

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.

Posterior vaginal wall pull down maneuver: a clinical test to diagnose intrinsic sphincter deficiency in women suffering from genuine urinary stress incontinence.

To assess the predictive value of a simple clinical test (posterior vaginal wall pull down maneuver) in the diagnosis of intrinsic sphincter deficiency.

Autosondages urinaires et temps de vidange : étude expérimentale de la vitesse de drainage des différentes sondes d’autocathétérisme ☆

OBJECTIVE To assess the flow rate obtained by catheters used in self intermittent catheterization. MATERIAL In vitro comparative study designed to compare the average flow rate obtained by intravesical catheters, by repeated flowmetric measures. The catheters studied were the most used in France in Fr10, 12 and 14 for female catheters and in Fr12, 14 and 16 for male catheters. RESULTS We observed a strict relationship between Charriere and flow rate, both in female and male catheters These results were statistically significant (P<0.05). For female catheters, the average flow rate varied from 2.83 to 3.7 mL/s for Fr10 catheters, from 4.31 to 5.35 mL/s for Fr12 catheters and from 7.00 to 7.85 mL/s for Fr14 catheters (P<0.05). For male catheters, the average flow rate varied from 4.53 to 5.00 mL/s for Fr12 catheters, from 6.95 to 8.17 mL/s for Fr14 catheters and from 10.4 to 11.07 mL/s for Fr16 catheters (P<0.05). In female and male population, despite the observed flow rate differences between catheters, there were no statistically significant differences. CONCLUSION This study demonstrated a better flow rate when Charriere increases. Thus, an objective adaptation of self catheterizations materiel is possible when the patient wishes to improve flow rate in order to reduce self intermittent catheterization duration.

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.

Correlation between voiding dysfunction symptoms and uroflowmetry in women suffering from stress urinary incontinence.

Objectives: To determine whether the completion of a voiding dysfunction (VD) questionnaire could have a good predictive value for uroflowmetry findings, in a population of stress urinary incontinence (SUI) women. Materials and Methods: From a urodynamic database of 415 SUI women, 93 with isolated SUI who underwent urodynamic investigations were eligible for this study. Patients with obvious etiologies of obstruction were excluded. VD symptoms were analyzed using the Bristol Female Lower Urinary Tract Symptoms Questionnaire. Bladder outlet obstruction (BOO) was defined as a maximal flow rate under 15 ml/s for a urine volume > 200 ml, or a post-void residual volume greater than 50 ml, or an abnormal pattern of the flow curve. The sensitivity, specificity, positive and negative predictive value of questioning VD were calculated. Statistical analysis was done using a Wilcoxon test for continuous data and Fisher exact test for categorical data, and multivariate analysis. Results: Reported VD had a poor specificity (41%) and positive predictive value (32%) of BOO on uroflowmetry. No statistical correlation was found between VD symptoms and BOO defined on uroflowmetry (P=0.64) in this specific SUI population showing no obvious etiologies of obstruction. Conclusions: No correlation was found between obstructive symptoms and BOO as defined on uroflowmetry, in a specific population of SUI women. Our results suggest that uroflowmetry may be necessary rather than multichannel urodynamics.

Article originalAutosondages urinaires et temps de vidange : étude expérimentale de la vitesse de drainage des différentes sondes d’autocathétérismeSelf intermittent catheterization and voiding duration: In vitro flow rate assessment of catheters used in self-catheterization☆

OBJECTIVE To assess the flow rate obtained by catheters used in self intermittent catheterization. MATERIAL In vitro comparative study designed to compare the average flow rate obtained by intravesical catheters, by repeated flowmetric measures. The catheters studied were the most used in France in Fr10, 12 and 14 for female catheters and in Fr12, 14 and 16 for male catheters. RESULTS We observed a strict relationship between Charriere and flow rate, both in female and male catheters These results were statistically significant (P<0.05). For female catheters, the average flow rate varied from 2.83 to 3.7 mL/s for Fr10 catheters, from 4.31 to 5.35 mL/s for Fr12 catheters and from 7.00 to 7.85 mL/s for Fr14 catheters (P<0.05). For male catheters, the average flow rate varied from 4.53 to 5.00 mL/s for Fr12 catheters, from 6.95 to 8.17 mL/s for Fr14 catheters and from 10.4 to 11.07 mL/s for Fr16 catheters (P<0.05). In female and male population, despite the observed flow rate differences between catheters, there were no statistically significant differences. CONCLUSION This study demonstrated a better flow rate when Charriere increases. Thus, an objective adaptation of self catheterizations materiel is possible when the patient wishes to improve flow rate in order to reduce self intermittent catheterization duration.