119 results on '"J Pannek"'
Search Results
2. [Course of neurogenic bladder dysfunction in patients with spinal cord injury under homeopathic treatment]
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J, Pannek, S, Pannek-Rademacher, and F, Amsler
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Adult ,Male ,Urodynamics ,Lower Urinary Tract Symptoms ,Quality of Life ,Humans ,Female ,Prospective Studies ,Middle Aged ,Urinary Bladder, Neurogenic ,Spinal Cord Injuries ,Aged ,Retrospective Studies - Abstract
Nearly all patients with spinal cord injury (SCI) suffer from neurogenic lower urinary tract dysfunction (NLUTD). Untreated NLUTD is a risk factor for renal damage and can significantly affect quality of life (QoL). Patients with SCI frequently use complementary medicine to alleviate symptoms, namely for urologic problems.We evaluated whether homeopathic treatment influences objective urodynamic parameters.In a retrospective study, urodynamic data of patients with NLUTD due to SCI who received constitutional homeopathic treatment by the consultants of our hospital were evaluated before initiation of homeopathic treatment and at the most recent follow-up. Modifications in urologic treatment were taken into account.Urodynamic results from 35 patients who underwent homeopathic treatment (14 women, 21 men, median age 46 years, tetraplegia: n = 14; paraplegia: n = 21) were available at both time points and could therefore be evaluated. In all, 20 patients used intermittent catheterization, 6 persons had an indwelling catheter, and 9 persons emptied their bladders without a catheter. There were no significant differences in the urodynamic parameters before and during treatment. Changes in urologic therapy correlated with significant improvement in urodynamic findings.As all patients were under urologic surveillance, and immediate urologic treatment was established if necessary, a retrospective study design proved not to be suitable to detect possible influences of homeopathic treatment on urodynamic parameters in patients with SCI. Thus, a prospective randomized study is essential.HINTERGRUND: Nahezu alle Patienten mit Rückenmarkschädigung (SCI) leiden unter einer neurogenen Blasenfunktionsstörung (nBFS). Eine unbehandelte BFS ist ein Risikofaktor für eine Schädigung des Harntrakts, zudem kann sie die Lebensqualität der Betroffenen massiv beeinträchtigen. Personen mit SCI benutzen oft komplementärmedizinische Therapien, besonders bei urologischen Problemen.Wir evaluierten, ob sich die urodynamischen Parameter bei Patienten, die eine homöopathische Therapie erhielten, signifikant veränderten.In einer retrospektiven Analyse wurden die urodynamischen Daten von Patienten mit SCI und nBFS, die an unserer Klinik eine homöopathische Behandlung erhielten, vor und unter Therapie evaluiert. Veränderungen der urologischen Therapie wurden miteinbezogen.Es wurden 35 homöopathisch behandelte Patienten (21 Männer, 14 Frauen, medianes Alter 46 Jahre; Paraplegie: n = 21; Tetraplegie: n = 14) identifiziert, bei denen urodynamische Messungen sowohl vor als auch unter Therapie vorlagen. Das Blasenmanagement erfolgte bei 20 Betroffenen mittels intermittierendem Katheterismus, bei 6 Patienten mittels Dauerkatheter und in 9 Fällen ohne Katheter. Beim Vergleich der urodyamischen Parameter ergaben sich für das Gesamtkollektiv keine signifikanten Unterschiede zwischen den beiden Messzeitpunkten. Eine Veränderung der urologischen Therapie korrelierte mit einer signifikanten Verbesserung einiger urodynamischen Parameter.Da im Falle einer Befundverschlechterung unmittelbar eine urologische Intervention erfolgte, erwies sich ein retrospektives Studiendesign als nicht geeignet, mögliche Einflüsse der homöopathischen Therapie auf urodynamische Parameter bei Patienten mit SCI zu detektieren. Eine prospektive randomisierte Studie ist daher unabdingbar.
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- 2020
3. [Use of synthetic slings and mesh implants in the treatment of female stress urinary incontinence and prolapse : Statement of the Working Group on Urological Functional Diagnostics and Female Urology of the Academy of the German Society of Urology]
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K, Höfner, C, Hampel, R, Kirschner-Hermanns, S H, Alloussi, R M, Bauer, S, Bross, T, Bschleipfer, M, Goepel, A, Haferkamp, T, Hüsch, A, Kaufmann, G, Kiss, J, Kranz, M, Oelke, J, Pannek, A, Reitz, M, Rutkowski, W, Schäfer, H, Schulte-Baukloh, S, Schumacher, C, Seif, and D, Schultz-Lampel
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Suburethral Slings ,Germany ,Urinary Incontinence, Stress ,Humans ,Urologic Surgical Procedures ,Female ,Surgical Mesh ,Pelvic Organ Prolapse - Abstract
Due to a safety alert issued by the US Food and Drug Administration (FDA) in 2011 for transvaginal mesh implants to treat female prolapse as a result of numerous reports of complications such as infection, chronic pain, dyspareunia, vaginal erosion, shrinkage and erosion into other organs nearly all industrial products have been withdrawn from the market in the meantime. The United Kingdom, Australia, and New Zealand extended warnings and prohibitions even on the implantation of midurethral slings (TVT, TOT). In view of these current international controversies regarding the use of implanted materials for the treatment of stress incontinence and prolapse and the lack of clear guidelines for the use of biomaterials, the opinion of the Working Group on Urological Functional Diagnostics and Female Urology should provide clarity. The Opinion is based on the SCENIHR Report of the "European Commission's Scientific Committee on Emerging and Newly Identified Health Risks", the "Consensus Statement of the European Urology Association and the European Urogynaecological Association on the Use of Implanted Materials for Treating Pelvic Organ Prolapse and Stress Urinary Incontinence" and in compliance with relevant EAU and national guidelines and the opinion of the Association for Urogynaecology and Plastic Pelvic Floor Reconstruction (AGUB eV). In addition, recommendations are given for the future handling of implants of slings and meshes for the treatment of stress incontinence and prolapse from a urologic viewpoint.
- Published
- 2019
4. Überaktive Blase – wann welche Therapie?
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J. Pannek
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Gynecology ,medicine.medical_specialty ,business.industry ,Urology ,030232 urology & nephrology ,medicine.disease ,03 medical and health sciences ,0302 clinical medicine ,Overactive bladder ,Sacral nerve stimulation ,030220 oncology & carcinogenesis ,medicine ,Nocturia ,medicine.symptom ,business - Abstract
Die OAB (uberaktive Blase/„overactive bladder“) stellt einen klinischen Symptomenkomplex dar. Die initiale Therapie sollte daher auf den klinischen Symptomen und einer Basisdiagnostik beruhen. Bei der Wahl der Ersttherapie spielt die Patientenpraferenz eine entscheidende Rolle. Neben verhaltenstherapeutischen Ansatzen stehen Elektrostimulation und medikamentose Therapien zur Verfugung. Bei nicht ausreichendem Ansprechen sollte vor einer Therapieeskalation mit minimal-invasiven Behandlungen, wie Onabotulinumtoxin-Injektionen in den Detrusor oder sakrale Neuromodulation, eine erweiterte Diagnostik erfolgen. Chirurgische Masnahmen wie z. B. Blasenaugmentation sind nur in Ausnahmefallen erforderlich.
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- 2017
5. Case Taking explained by means of paraplegic patients with relapsing urinary tract disorders, showing only few homeopathically exploitable symptoms
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G Keller, MS Jus, and J Pannek
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Pediatrics ,medicine.medical_specialty ,business.industry ,Materials Chemistry ,Medicine ,business ,Urinary tract disorder - Published
- 2017
6. The homeopathic remedy carcinosinum in clinical practice
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S Pannek-Rademacher, MS Jus, M Cachin-Jus, F Amsler, and J Pannek
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Clinical Practice ,medicine.medical_specialty ,Pediatrics ,business.industry ,Homeopathic remedy ,Materials Chemistry ,medicine ,Alternative medicine ,Intensive care medicine ,business - Published
- 2017
7. Homeopathic care of patients with spinal cord injury in Switzerland
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S Pannek-Rademacher, MS Jus, F Amsler, and J Pannek
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medicine.medical_specialty ,Pediatrics ,business.industry ,Materials Chemistry ,Alternative medicine ,medicine ,medicine.disease ,business ,Spinal cord injury - Published
- 2017
8. Use of thlaspi bursa pastoris in patients with advanced prostate cancer
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S Pannek-Rademacher and J Pannek
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Oncology ,Prostate cancer ,medicine.medical_specialty ,business.industry ,Internal medicine ,Materials Chemistry ,Medicine ,In patient ,Thlaspi bursa-pastoris ,business ,medicine.disease - Published
- 2017
9. Lachesis and hamamelis – homeopathic alternatives to surgical treatment
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J Pannek and S Pannek-Rademacher
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medicine.medical_specialty ,business.industry ,Materials Chemistry ,Alternative medicine ,medicine ,Intensive care medicine ,Surgical treatment ,business - Published
- 2017
10. Diagnosis, treatment and prophylaxis of urinary tract infections – the urologist's perspective
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J Pannek
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medicine.medical_specialty ,Pediatrics ,Diagnosis treatment ,business.industry ,Urinary system ,Perspective (graphical) ,Materials Chemistry ,medicine ,Alternative medicine ,Intensive care medicine ,business - Published
- 2017
11. Treatment of stress urinary incontinence in men with spinal cord injury: minimally invasive=minimally effective?
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J Wöllner and J Pannek
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Adult ,Male ,medicine.medical_specialty ,Urinary Incontinence, Stress ,Urinary system ,030232 urology & nephrology ,Urinary incontinence ,Sling (weapon) ,03 medical and health sciences ,0302 clinical medicine ,medicine ,Humans ,Abscess ,Spinal cord injury ,Spinal Cord Injuries ,Aged ,Retrospective Studies ,Aged, 80 and over ,030219 obstetrics & reproductive medicine ,business.industry ,Retrospective cohort study ,General Medicine ,Middle Aged ,medicine.disease ,Surgery ,Treatment Outcome ,Urethra ,medicine.anatomical_structure ,Neurology ,Neurology (clinical) ,medicine.symptom ,business ,Paraplegia - Abstract
Retrospective chart review. To assess the outcome of minimally invasive treatment of stress urinary incontinence with alloplastic slings in patients with neurogenic lower urinary tract dysfunction. Switzerland. The patient database of a tertiary urologic referral center was screened for male patients with SCI who underwent implantation of a suburethral sling between June 2009 and December 2015. Patient characteristics and bladder management details were collected by chart review. Sixteen patients were identified. Of those, 13 received a transobturator tape (TOT) and three underwent implantation of an retropubic adjustable system (RAS). In the TOT group, nine patients became continent, one patient was improved and three patients remained unchanged. Three patients underwent minor revisions due to impaired wound healing. In the RAS group, no patient improved and one RAS had to be removed due to severe wound infection; in a second patient, an abscess with destruction of the urethra occurred. In our experience, alloplastic slings seem to be an effective minimally invasive treatment option in male patients with SUI due to SCI. TOT seem to be more effective than RAS and was associated with less severe complications. The selection criteria for the optimal patient and the optimal sling have to be further defined.
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- 2017
12. [Erratum to: Overactive bladder-which treatment when?]
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J, Pannek
- Published
- 2018
13. Initial experience with the treatment of neurogenic detrusor overactivity with a new β-3 agonist (mirabegron) in patients with spinal cord injury
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J Pannek and J Wöllner
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Adult ,Male ,medicine.medical_specialty ,Time Factors ,Urinary system ,030232 urology & nephrology ,Urology ,Urinary incontinence ,Severity of Illness Index ,Statistics, Nonparametric ,03 medical and health sciences ,0302 clinical medicine ,medicine ,Humans ,Spinal cord injury ,Spinal Cord Injuries ,Retrospective Studies ,Upper urinary tract ,Urinary bladder ,Urinary Bladder, Overactive ,Urinary retention ,business.industry ,General Medicine ,Middle Aged ,medicine.disease ,Thiazoles ,Urodynamics ,Treatment Outcome ,medicine.anatomical_structure ,Neurology ,030220 oncology & carcinogenesis ,Urological Agents ,Acetanilides ,Female ,Neurology (clinical) ,medicine.symptom ,Paraplegia ,business ,Mirabegron ,Switzerland ,Follow-Up Studies ,medicine.drug - Abstract
It is a retrospective chart analysis.In patients with neurogenic lower urinary tract dysfunction (NLUTD) due to spinal cord injury (SCI), neurogenic detrusor overactivity (NDO) can cause both deterioration of the upper urinary tract and urinary incontinence. Antimuscarinic treatment is frequently discontinued due to side effects or lack of efficacy, whereas injection of onabotulinumtoxin into the detrusor is a minimally invasive procedure with risks of urinary retention, infection and haematuria. Mirabegron, a new β-3 agonist, is a potential new agent for treatment of NDO. Aim of the study was to evaluate the efficacy of mirabegron in SCI patients with NLUTD.Swiss Paraplegic Center, Nottwil, Switzerland.A retrospective chart analysis of SCI patient treated with mirabegron.Fifteen patients with NDO were treated with mirabegron for a period of at least 6 weeks. Significant reduction of the frequency of bladder evacuation per 24 h (8.1 vs 6.4, P=0.003), and of incontinence episodes per 24 h (2.9 vs 1.3, P=0.027) was observed. Furthermore, we observed improvements in bladder capacity (from 365 to 419 ml), compliance (from 28 to 45 ml cm(-1) H(2)0) and detrusor pressure during storage phase (45.8 vs 30 cm H(2)0). At follow-up, 9/15 patients were satisfied with the therapy, 4/15 reported side effects (3 × aggravation of urinary incontinence, 1 × constipation).Mirabegron may evolve as an alternative in the treatment of NDO. We observed improvements in urodynamic and clinical parameters. Due to the limited number of patients and the retrospective nature of the study, prospective, placebo-controlled studies are necessary.
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- 2015
14. Komplementärmedizinische Therapie bei Patienten mit fortgeschrittenem Prostatakarzinom: 2 Fallbeispiele
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J. Pannek and S. Pannek-Rademacher
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Gynecology ,medicine.medical_specialty ,business.industry ,Urology ,medicine ,business - Abstract
Trotz optimierter Diagnostik und Therapie des Prostatakarzinoms ist eine kurative Behandlung nur bei einem Teil der Betroffenen moglich. Bei fortgeschrittenem Karzinom konnen Komplikationen entstehen, welche die Lebensqualitat der Patienten massiv einschranken, wie z. B. rezidivierende Blasentamponaden bei lokalem Tumorzerfall. Wir berichten uber den erfolgreichen Einsatz des homoopathischen Heilmittels Thlaspi bursa pastoris bei 2 Patienten, in denen konventionelle Behandlungsmethoden nicht ausreichend erfolgreich waren. Die Fallbeispiele legen nahe, dass komplementarmedizinische Therapiemasnahmen effektive additive Behandlungsoptionen bei Patienten mit fortgeschrittenem Prostatakarzinom sein konnen.
- Published
- 2016
15. [Overactive bladder-which treatment when?]
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J, Pannek
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Male ,Urinary Bladder, Overactive ,Lumbosacral Plexus ,Urinary Bladder ,Electric Stimulation Therapy ,Patient Preference ,Muscarinic Antagonists ,Solifenacin Succinate ,Injections, Intramuscular ,Tadalafil ,Diagnosis, Differential ,Behavior Therapy ,Humans ,Female ,Botulinum Toxins, Type A ,Gabapentin ,Physical Therapy Modalities - Abstract
The term OAB (overactive bladder) describes a symptom complex. Therefore, initial treatment should be based on clinical symptoms and the results of basic diagnostics. Patient preference is essential for the choice of the initial treatment. Behavioural therapy, electrostimulation and medical treatment are available treatment options. If these are not effective, extended diagnostic examinations should be performed prior to minimally invasive treatments, like onabotulinumtoxin injections in the detrusor or sacral neuromodulation. Surgical interventions like augmentation cystoplasty are rarely required today.
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- 2017
16. Implementation of clinical quality management including standardized reporting and individualized management during first rehabilitation of patients with spinal cord
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I. Bersch, J. Schneider, D. Sigrist-Nix, A. Scheel-Sailer, K. Schmitt, M. Baumberger, and J. Pannek
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Rehabilitation ,Process (engineering) ,business.industry ,medicine.medical_treatment ,media_common.quotation_subject ,education ,Information technology ,medicine.disease ,Change management (ITSM) ,International Classification of Functioning, Disability and Health ,Process-based management ,Nursing ,medicine ,Orthopedics and Sports Medicine ,Quality (business) ,business ,Psychology ,Spinal cord injury ,media_common - Abstract
Introduction/Background Clinical quality management (QM) during acute and post-acute rehabilitation after newly acquired spinal cord injury (SCI) remains challenging due to complex impaired functioning including bio-psycho-social aspects. International societies developed recommendation for standardized reporting with respect to the international classification of functioning (ICF). However, there is still a lack of implementation of these recommendations. Therefore, this study aims to analyze reasons and create strategies to implement these guidelines in daily practice. Material and Method Situation analyses, consensus process and requirement analyses of clinical QM in a specialized SCI rehabilitation centre. Results SCI specific and validated assessments were applied consequently after newly acquired SCI when a controlling system existed (e.g., Spinal Cord Injury independence Measure III: SCIM III) and partly with recommendation (e.g., International Standards for the Neurological Classification of Spinal Cord Injury (ISNCSCI)). The individual management appeared complex and could not be easily reported in a standardized and comparable way. The leadership decided to use a consensus process to develop an assessment standard according to national and international requirements (Common Data Elements, EMSCI, SwiSCI, ICF Core Sets, association of national quality (ANQ)). For data and process based management the information technology (IT) had to fulfil different requirements (reminder system, clear visibility, connectivity of information). Education tools in specific health professional groups concerning the goal-orientated use of assessments were needed to increase knowledge and to use the assessments. Improvement in patient-centred communication and interdisciplinary team culture optimized the individualized rehabilitation management. Conclusion Implementation of QM during acute and post-acute care after SCI succeeds when respecting national and international standards, when clinical IT systems are integrated in the decision making, when health professionals are aware of patient-centred communication and continuous education covering these aspects takes place. Change management may happen when representatives of all intended groups are engaged and adequate resources available.
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- 2018
17. Urodynamic or video-urodynamic assessment in patients with spinal cord injury: this is not a question!
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J Wöllner and J Pannek
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Male ,Video Recording ,MEDLINE ,Sepsis ,medicine ,Humans ,Fluoroscopy ,In patient ,Urinary Bladder, Neurogenic ,Spinal cord injury ,Spinal Cord Injuries ,Video recording ,Urinary bladder ,medicine.diagnostic_test ,business.industry ,General Medicine ,Middle Aged ,medicine.disease ,Urodynamics ,medicine.anatomical_structure ,Neurology ,Anesthesia ,Neurology (clinical) ,business ,Switzerland - Abstract
Case report.The objective of this study was to demonstrate the additional value of combined video-urodynamic investigations compared with urodynamic investigation alone in patients with neurogenic lower urinary tract dysfunction due to spinal cord injury (SCI).The study was conducted in a spinal cord injury rehabilitation center in Switzerland.A patient with complete SCI since 1984 evacuated the bladder by reflex voiding. Owing to the lack of clinical symptoms, he refused urologic controls for 15 years. In July 2014, he was referred to our hospital with acute septicemia.The hydronephrosis responsible for the septicemia was successfully treated by intravenous antibiotics and ureteral stenting. Subsequently, a neuro-urologic assessment was performed. Urodynamic examination was normal. Video-urodynamics, however, revealed massive morphologic alterations of the lower and upper urinary tracts, which were responsible for the septicemia.Our case demonstrates the necessity of regular video-urodynamic controls even in asymptomatic SCI patients. Persons using triggered voiding may be at a higher risk for secondary changes, as a sustained detrusor pressure is necessary for this technique.
- Published
- 2015
18. [Use of Complementary Medicine in Patients with Advanced Prostate Cancer: 2 Case Reports]
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J, Pannek and S, Pannek-Rademacher
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Complementary Therapies ,Male ,Spinal Neoplasms ,Materia Medica ,Humans ,Prostatic Neoplasms ,Bone Neoplasms ,Middle Aged ,Combined Modality Therapy ,Aged ,Neoplasm Staging ,Phytotherapy ,Thlaspi - Abstract
Despite optimised diagnosis and treatment, prostate cancer can only be cured in a specific subset of patients. Advanced prostate cancer may lead to complications that severely impair the patient's quality of life, e. g. recurrent intravesical blood clotting due to local tumor necrosis. We report the successful use of the homeopathic remedy Thlaspi bursa pastoris in 2 patients for whom conventional treatment was not sufficiently effective. These case reports imply that complementary or alternative medical treatment may be an efficient adjunctive treatment in patients with advanced prostate cancer.
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- 2016
19. Erratum zu: Überaktive Blase – wann welche Therapie?
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J. Pannek
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Gynecology ,medicine.medical_specialty ,business.industry ,Urology ,Published Erratum ,medicine ,business - Abstract
Erratum zu: Urologe 2017 https://doi.org/10.1007/s00120-017-0522-1 Das Manuskript enthalt eine nicht zutreffende Aussage zur Verfugbarkeit des Wirkstoffs Mirabegron in Deutschland. Als das Manuskript nach Begutachtung am 20.07.2017 zur Publikation angenommen wurde, war der Wirkstoff Mirabegron in …
- Published
- 2018
20. [Melanosis of the urinary bladder]
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J, Wöllner, J, Janzen, and J, Pannek
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Aged, 80 and over ,Diagnosis, Differential ,Rare Diseases ,Urinary Bladder Diseases ,Humans ,Female ,Melanosis - Abstract
Melanosis of the bladder is rare. Only 10 cases have been described in the literature. We present the case of an 80-year-old woman with neurogenic lower urinary tract dysfunction due to spinal paralysis. During the diagnostic work-up which included cystoscopy, black spots in the bladder wall were observed. Histopathological evaluation revealed a benign suburothelial melanosis. Thus, with cystoscopic suspicion of a malignancy (melanoma), a biopsy is mandatory and regular cystoscopic follow-up is recommended.
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- 2015
21. Stability of distributed MPC in an intersection scenario.
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T Sprodowski and J Pannek
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- 2015
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22. Squamous cell carcinoma of the urinary bladder in patients with chronic spinal cord injury: A case series.
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Levien P, Pannek J, Janzen J, and Wöllner J
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- Humans, Male, Middle Aged, Female, Aged, Adult, Urinary Bladder, Neurogenic etiology, Urinary Bladder, Neurogenic complications, Chronic Disease, Spinal Cord Injuries complications, Urinary Bladder Neoplasms complications, Urinary Bladder Neoplasms diagnosis, Carcinoma, Squamous Cell complications, Carcinoma, Squamous Cell diagnosis
- Abstract
Introduction: Patients with spinal cord injury/disorder (SCI/D) and neurogenic lower urinary tract dysfunction (NLUTD) are on a 16-28 folder higher risk for bladder cancer [1]. Whereas in the general population 90% of bladder tumors are transitional cell carcinoma (TCC) patients with NLUTD have a shift to squamous cell carcinoma with 36,8% and only 46.3% TCC [2]. In addition, there is a significant increase in the bladder cancer-specific death rate in SCI patients (3rd most common) compared to the general population (10th most common) [2]. Chronic inflammation and mechanical irritation by permanent indwelling catheters are discussed as risk factors for developing bladder cancer. Typical symptoms of bladder cancer are often absent in patients with NLUTD and a reliable screening has not been established., Case Presentation: We present a case series of six patients with SCI and with squamous cell carcinoma diagnosed in the last 5 years in our institution. In five patients, bladder management was performed by indwelling suprapubic catheters, one patient used reflex voiding. Three patients were diagnosed during the regular, annual neuro-urological check-up, the remaining due to increasing spasticity and autonomic dysregulation. Subsequently, five patients underwent cystectomy with ileal conduit or uretercutaneostomy, one patient refused further surgical treatment. Four patients died within one year after diagnosis., Discussion: Squamous cell carcinoma of the bladder is more common in patients with NLUTD. Chronic inflammation and mechanical irritation may be the reasons for carcinoma genesis. A regular check including cystoscopy is strongly recommended to detect tumor development early., (© 2024. The Author(s), under exclusive licence to International Spinal Cord Society.)
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- 2024
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23. Prevalence, causes, and risk profile of rehospitalizations in persons with spinal cord injury within the first 10 years after primary rehabilitation.
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Eriks-Hoogland IE, Studer L, Müller LL, Hirsch B, Pannek J, Gemperli A, and Ehrmann C
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Study Design: Retrospective cohort study., Objectives: This study aims to identify the prevalence, causes, time pattern and risk profile of rehospitalizations in persons with spinal cord injury (SCI) within a 10-year period following primary rehabilitation and identify most common secondary health conditions (SHCs) and risk profile leading to rehospitalizations., Setting: Specialized hospital and rehabilitation center for SCI in Switzerland., Methods: A retrospective analysis was conducted on clinical data from persons with SCI, discharged from initial rehabilitation between January 1, 2010, and December 31, 2012, and followed up over a period of ten years post-discharge. Descriptive statistical methods were utilized to compute the rehospitalization prevalence and to identify the primary reasons., Results: 225 participants were included, 70% were male (n = 179), and the mean age was 50 years (SD 19, Range 17-88). 54% were classified as having paraplegia (n = 122), and 77% incomplete injuries (n = 180). Over the 10-year observation period post-discharge, 120 were readmitted at least once, (prevalence 53%). In total, 66 persons (29%) were rehospitalized once or twice, while 54 persons (24%) were rehospitalized three or more times, with a maximum of 14 times. In the 10-year period, the most common SHCs leading to rehospitalization were infections (19%), pressure injuries (18%), and gastrointestinal problems (16%). During the study period, 57 persons (25%) passed away., Conclusions: Rehospitalization after primary rehabilitation is frequent and in the majority of the cases due to SHCs. The study findings are valuable for resource planning in healthcare and can guide the implementation of preventive measures to avoid SHCs., (© 2024. The Author(s), under exclusive licence to International Spinal Cord Society.)
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- 2024
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24. Patient-reported signs and symptoms of urinary tract infections after video-urodynamic studies in individuals with neurogenic lower urinary tract dysfunction-A single-center observational study.
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van Beek J, Sobhani H, Wöllner J, Pannek J, and Krebs J
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- Humans, Male, Female, Middle Aged, Aged, Adult, Spinal Cord Injuries complications, Spinal Cord Injuries physiopathology, Lower Urinary Tract Symptoms physiopathology, Lower Urinary Tract Symptoms diagnosis, Risk Factors, Incidence, Patient Reported Outcome Measures, Urinary Tract Infections diagnosis, Urinary Bladder, Neurogenic physiopathology, Urinary Bladder, Neurogenic diagnosis, Urodynamics, Video Recording
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Background: Video-urodynamic studies (VUDS) are the recommended standard of diagnostic care to objectively assess neurogenic lower urinary tract dysfunction (NLUTD) in individuals with spinal cord injury/disease (SCI/D). This examination requires the insertion of a catheter into the bladder, which increases the risk of a urinary tract infection (UTI). Data on symptomatic UTIs after VUDS are limited., Methods: A single-center, observational study was conducted to evaluate the incidence of patient-reported UTI signs and symptoms 7 days after VUDS. No peri-interventional antibiotics were administered. The effect of sex, age, SCI/D duration, bladder evacuation method, bacteriuria, UTI prophylaxis, UTI history, or unfavorable VUDS results on the occurrence of patient-reported UTI signs or symptoms after VUDS was examined using binary logistic regression analysis., Results: A total of 140 individuals with a mean age of 59.1 ± 14.0 years and a median SCI/D duration of 15.0 years (6/29 years) were evaluated. Seven days (mean 7 ± 1 days) after VUDS, 42 (30%) individuals reported at least one UTI sign or symptom. In the majority, signs and symptoms resolved without the need for antibiotic treatment, which was required in seven participants (5%). Male sex significantly (p = 0.04) increased the odds (odds ratio 3.74) of experiencing UTI signs and symptoms after VUDS., Conclusions: In individuals with NLUTD, 30% experienced UTI signs and symptoms 1 week after VUDS. However, these signs and symptoms were transient and only 5% required antibiotic treatment. Thus, antibiotic prophylaxis does not seem necessary in all individuals with SCI/D undergoing VUDS., (© 2024 Wiley Periodicals LLC.)
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- 2024
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25. Effects of a Prophylactic Treatment with Horseradish Root and Nasturtium Herb on Urinary Tract Infections in Individuals with Chronic Neurogenic Lower Urinary Tract Dysfunction: A Retrospective Cohort Study.
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Bieri AM, Wöllner J, Pannek J, and Krebs J
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Introduction: Recurrent urinary tract infections (UTIs) are common in individuals with neurogenic lower urinary tract dysfunction (NLUTD) and greatly affect their quality of life. There is currently no established prophylactic measure based on evidence. We have therefore evaluated the effects of a horseradish root and nasturtium herb product on the frequency of UTIs in a retrospective cohort., Methods: Clinical data of patients with chronic NLUTD who were receiving the phytotherapeuticum for at least 12 months were analyzed. The number of UTIs was categorized as no UTIs, sporadic UTIs (1-2/year) and recurrent UTIs (≥3/year). The change in the annual number of patient-reported symptomatic UTIs and antibiotic prescriptions was investigated., Results: Data of 43 individuals (mean age 49 ± 13 years, median NLUTD duration 17.9 years) were analyzed. The proportion of individuals with recurrent UTIs decreased significantly (p < 0.0001) from 58.1% (42.1-73.0%) to 23.3% (11.8-38.6%) during phytotherapy, whereas the proportion of individuals without UTIs increased significantly (p = 0.001) from 14.0% (5.3-27.9%) to 39.5% (25.0-55.6%). In addition, there was a significant (p = 0.008) decrease in the number of antibiotic prescriptions., Conclusion: Prophylactic treatment with horseradish root and nasturtium herb seems to be a promising option for the prevention of UTIs., (© 2024 S. Karger AG, Basel.)
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- 2024
- Full Text
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26. An in-vitro model for bacteria-related catheter encrustations.
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Pannek J, Mahler J, Kurmann C, Widmer A, Krebs J, and Wöllner J
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- Humans, Catheters, Indwelling microbiology, Catheters, Indwelling adverse effects, Proteus mirabilis isolation & purification, Pseudomonas aeruginosa, In Vitro Techniques, Catheter-Related Infections prevention & control, Catheter-Related Infections microbiology, Escherichia coli, Urinary Catheterization adverse effects, Urinary Catheterization instrumentation, Models, Biological, Urinary Catheters microbiology, Urinary Catheters adverse effects
- Abstract
Purpose: About 50% of individuals with long-term indwelling catheters are affected by catheter encrustations and bladder stone formation. Therefore, prophylaxis of catheter encrustations is important. Currently, however, neither an established prophylaxis nor a standardized in-vitro model to test different measures exist. We have therefore developed and qualitatively evaluated an in-vitro model of catheter encrustation., Methods: Size 14 French suprapubic catheters were incubated under sterile conditions at 37 degrees Celsius in five different media: (1) sterile artificial urine (n = 16), (2) artificial urine with E. coli (n = 8), (3) with Pseudomonas aeruginosa (n = 8), (4) with Proteus mirabilis (n = 8), and (5) with a mix of these three strains (n = 8). Catheter balloons were inflated either a glycerine or a bactericidal solution. After 6 weeks, the catheters were removed from the solution, dried, and weighed, and a photometric determination of the retrieved encrustations was performed., Results: Most frequently and pronounced encrustations were detected in the Pseudomonas group. The median weight of these encrustations (50% struvite and brushite) was 84.4 mg (47.7 mg / 127.3 mg). Even on catheters stored in sterile urine, encrustations (69.2% struvite) were found. Bacterial growth was not affected by the medium used for catheter blockage., Conclusion: Although in-vitro models appear to be limited because they lack "the human factor", they are valuable for systematically assessing physico-chemical factors affecting encrustations. Therefore, our model, being reliable and cost-effective, may foster further research despite its limitations., (© 2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)
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- 2024
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27. Summary of the 2024 Update of the European Association of Urology Guidelines on Neurourology.
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Sartori AM, Kessler TM, Castro-Díaz DM, de Keijzer P, Del Popolo G, Ecclestone H, Frings D, Groen J, Hamid R, Karsenty G, Musco S, Padilla-Fernández B, Pannek J, Schouten N, van der Vorm A, and Blok BFM
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- Humans, Europe, Urologic Diseases therapy, Urologic Diseases diagnosis, Societies, Medical, Nervous System Diseases therapy, Nervous System Diseases diagnosis, Urology standards, Practice Guidelines as Topic
- Abstract
Background and Objective: Most patients with neurourological disorders require lifelong medical care. The European Association of Urology (EAU) regularly updates guidelines for diagnosis and treatment of these patients. The objective of this review is to provide a summary of the 2024 updated EAU guidelines on neurourology., Methods: A structured literature review covering the timeframe 2021-2023 was conducted for the guideline update. A level of evidence and a strength rating were assigned for each recommendation on the basis of the literature data., Key Findings and Limitations: Neurological conditions significantly affect urinary, sexual, and bowel function, and lifelong management is required for neurourological patients to maintain their quality of life and prevent urinary tract deterioration. Early diagnosis and effective treatment are key, and comprehensive clinical assessments, including urodynamics, are crucial. Management should be customised to individual needs and should involve a multidisciplinary approach and address sexuality and fertility. Lifelong monitoring and follow-up highlight the importance of continuous care for neurourological patients., Conclusions and Clinical Implications: The 2024 EAU guidelines on neurourology provide an up-to-date overview of available evidence on diagnosis, treatment, and follow-up for neurourological patients., Patient Summary: Neurological disorders very frequently affect the lower urinary tract and sexual and bowel function and patients need lifelong management. We summarise the updated European Association of Urology guidelines on neurourology to provide patients and caregivers with the latest insights for optimal health care support., (Copyright © 2024 European Association of Urology. Published by Elsevier B.V. All rights reserved.)
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- 2024
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28. The Swiss Spinal Cord Injury Cohort Study (SwiSCI) biobank: from concept to reality.
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Zeh RM, Glisic M, Capossela S, Bertolo A, Valido E, Jordan X, Hund-Georgiadis M, Pannek J, Eriks-Hoogland I, Stucki G, and Stoyanov J
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- Humans, Male, Adult, Middle Aged, Aged, Female, Cohort Studies, Switzerland epidemiology, Reproducibility of Results, Biological Specimen Banks, RNA, Spinal Cord Injuries epidemiology
- Abstract
Objectives: To describe the concept, establishment and the operationalization of the biobank of the Swiss Spinal Cord Injury Cohort Study (SwiSCI), the available biosamples, and demographic and clinical characteristics of study participants., Setting: The SwiSCI biobank is a platform for research within SwiSCI. It collects and processes serum, plasma, PBMCs, RNA, DNA, and urine from three rehabilitation centers. Samples are collected at admission to first rehabilitation and at discharge. Additionly, the biobank provides services to projects nested in SwiSCI or otherclinical trials among Spinal Cord Injury population., Methods: Descriptive statistics were used for an overview of available biosamples, study participant characteristics, and comparison of the participating centers., Results: Between the SwiSCI biobank establishment on June 27th, 2016, and October 19th, 2023, the SwiSCI Study has obtained informed consent from 524 individuals. Of these, 315 (60.1%) have agreed to donate biospecimens to the biobank. The average age of the contributors was 54 years (range: 38-65), with the majority being male (80%). Most participants suffered from traumatic injuries (66%) and were classified as paraplegic (64%). Approximately 80% presented with motor and sensory-incomplete SCI. The median Spinal Cord Independence Measure (SCIM) score was 31 (Interquartile Range: 19-58). The proportion of individuals providing paired biosamples at two distinct time points ranged from 63% (for RNA) to 65% (for urine and urine sediment)., Conclusions: The SwiSCI biobank is a unique platform designed to serve as a basis for collaborative SCI research, including multi-omics approaches. The longitudinal collection of biospecimens and cryopreservation of multiple aliquots for each participant are fundamental for scrutinizing the temporal associations, ensuring research reproducibility, and achieving an adequate sample size for future investigations., (© 2024. The Author(s).)
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- 2024
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29. COVID-19 and spinal cord injury: clinical presentation, clinical course, and clinical outcomes of people hospitalised.
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Eriks-Hoogland IE, Barth MA, Müller LL, Braun D, Curt A, Arora M, Middleton JW, and Pannek J
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- Humans, Male, Aged, Middle Aged, Female, Retrospective Studies, Paraplegia complications, Quadriplegia complications, Disease Progression, COVID-19 complications, Spinal Cord Injuries complications, Spinal Cord Injuries diagnosis, Spinal Cord Injuries therapy
- Abstract
Study Design: Retrospective study OBJECTIVES: To describe the presenting symptoms/signs, clinical course and outcomes in hospitalised people with spinal cord injury (SCI) and symptomatic COVID-19 infections., Setting: One university hospital and two SCI centres in Switzerland., Methods: Descriptive analysis of symptoms/signs, clinical course and outcomes of people with SCI with symptomatic COVID-19 infections and need for hospitalisation., Results: Twenty-two people with SCI were included, 15 (68%) were male, median age 64.5 years (interquartile range, IQR, 52-73 years). Nine (41%) had tetraplegia, and eight (36%) were classified with motor-complete lesions. Frequent clinical symptoms were fever (59%), coughing (54%), fatigue (50%), and dyspnoea (27%). Most frequent complications were bacterial pulmonary superinfection (18%), and acute respiratory distress syndrome (18%). Fifteen persons (68%) needed oxygen therapy during the course of hospitalisation, and 7 (32%) people were ventilated. Median length of stay (LOS) was 23 days (IQR 15-35), varying by age for people under 60 years with a median LOS of 9 days (IQR 8-27), and for those older than 60 years with a median of 34 days (IQR 17-39), respectively. In total, 3 persons (14%) died during hospitalisation, all older with paraplegia., Conclusions: Typical symptoms like fever and coughing were not present in all people. People with tetraplegia did not demonstrate worse outcomes, on the contrary, they had shorter LOS, no difference in ventilation needs, and no higher mortality compared to people with paraplegia. Older people showed longer LOS. This study recommends close supervision of the SCI population to detect early signs and symptoms of COVID-19 infection., (© 2024. The Author(s), under exclusive licence to International Spinal Cord Society.)
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- 2024
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30. Identification of brain functional connectivity during acute transcutaneous tibial nerve stimulation: A 3T fMRI study.
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Wöllner J, Krebs J, Richter JK, Neuenschwander J, Gunziger A, Hunkeler N, Abramovic M, Vallesi V, Mahler J, Verma RK, Berger MF, Pannek J, and Wyss PO
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- Humans, Prospective Studies, Brain Mapping methods, Tibial Nerve diagnostic imaging, Magnetic Resonance Imaging methods, Brain
- Abstract
Objectives: A feasibility proof-of-concept study was conducted to assess the effects of acute tibial nerve stimulation (TNS) on the central nervous system in healthy volunteers using functional magnetic resonance imaging (fMRI)., Materials and Methods: Fourteen healthy volunteers were included in a prospective, single-site study conducted on a clinical 3T MRI scanner. Four scans of functional MRI, each lasting 6 min, were acquired: two resting-state fMRI scans (prior and following the TNS intervention) and in-between two fMRI scans, both consisting of alternating rest periods and noninvasive acute transcutaneous TNS (TTNS). Whole brain seed-based functional connectivity (FC) correlation analysis was performed comparing TTNS stimulation with rest periods. Cluster-level familywise error (FWE) corrected p and a minimal cluster size of 200 voxels were used to explore FC patterns., Results: Increased FC is reported between inferior frontal gyrus, posterior cingulate gyrus, and middle temporal gyrus with the precuneus as central receiving node. In addition, decreased FC in the cerebellum, hippocampus, and parahippocampal areas was observed., Conclusions: Altered FC is reported in areas which have been described to be also involved in lower urinary tract control. Although conducted with healthy controls, the assumption that the underlying therapeutic effect of TNS involves the central nervous system is supported and has to be further examined in patients with incomplete spinal cord injury., (© 2023 Wiley Periodicals LLC.)
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- 2024
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31. Immune Status of Individuals with Traumatic Spinal Cord Injury: A Systematic Review and Meta-Analysis.
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Valido E, Boehl G, Krebs J, Pannek J, Stojic S, Atanasov AG, Glisic M, and Stoyanov J
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- Humans, Biomarkers, C-Reactive Protein, Male, Female, Spinal Cord Injuries
- Abstract
Individuals with spinal cord injury (SCI) have higher infection rates compared to those without SCI. In this review, the immune status difference between individuals with and without traumatic SCI is investigated by examining their peripheral immune cells and markers. PubMed, Cochrane, EMBASE, and Ovid MEDLINE were searched without language or date restrictions. Studies reporting peripheral immune markers' concentration and changes in functional capabilities of immune cells that compared individuals with and without SCI were included. Studies with participants with active infection, immune disease, and central nervous system (CNS) immune markers were excluded. The review followed the PRISMA guidelines. Effect estimates were measured by Weighted Mean Difference (WMD) using a random-effects model. Study quality was assessed using the National Heart, Lung, and Blood Institute Quality Assessment Tool. Fifty-four studies (1813 with SCI and 1378 without SCI) contributed to the meta-analysis. Leukocytes ( n = 23, WMD 0.78, 95% CI 0.17; 1.38, I
2 83%), neutrophils ( n = 11, WMD 0.76, 95% CI 0.09; 1.42, I2 89%), C-reactive protein (CRP) ( n = 12, WMD 2.25, 95% CI 1.14; 3.56, I2 95%), and IL6 ( n = 13, WMD 2.33, 95% CI 1.20; 3.49, I2 97%) were higher in individuals with SCI vs. without SCI. Clinical factors (phase of injury, completeness of injury, sympathetic innervation impairment, age, sex) and study-related factors (sample size, study design, and serum vs. plasma) partially explained heterogeneity. Immune cells exhibited lower functional capability in individuals with SCI vs. those without SCI. Most studies (75.6%) had a moderate risk of bias. The immune status of individuals with SCI differs from those without SCI and is clinically influenced by the phase of injury, completeness of injury, sympathetic innervation impairment, age, and sex. These results provide information that is vital for monitoring and management strategies to effectively improve the immune status of individuals with SCI.- Published
- 2023
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32. Quality of life from the patient perspective at the end of the first rehabilitation after the onset of spinal cord injury/disorder - A qualitative interview-based study.
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Tsoy N, Langewitz W, Müri S, Notter S, Pannek J, Post MWM, Rednic LN, Rubinelli S, and Scheel-Sailer A
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Context: At present, there is a lack of information concerning patients' perspectives on their quality of life (QoL) after a recently acquired spinal cord injury/disorder (SCI/D)., Objective: To explore patients' perspectives on their QoL during their first inpatient rehabilitation after the onset of SCI/D., Methods: Qualitative study. Semi-structured face-to-face interviews were conducted with 20 participants aged 18 years or older at least three months after the onset of SCI/D and two weeks before they were discharged from their first rehabilitation. Audio-recorded interviews were transcribed and analyzed according to the thematic content analysis. Interviewees rated their QoL with the SCI QoL data set., Results: The interviewees judged their satisfaction with life as a whole, their physical and mental health, as relatively high with values between six and eight (with 10 meaning complete satisfaction). They highlighted social aspects, health topics, and the experience of autonomy as relevant to their concept of QoL. The aspects that positively influenced QoL included the level of well-being in the current social and institutional environment, the increased level of energy, strength, and autonomy in daily life, and an improved mental state derived from general positive personal attitudes. In contrast, the social restrictions during the COVID-19 pandemic, physical issues including pain, a lack of progress associated with psychological dissatisfaction, and limitations in personal independence decreased patients' QoL., Conclusion: Since the interviewees described different aspects from the areas of social, health and autonomy as important for their QoL, exploring and addressing these areas should be used to achieve an individualized first rehabilitation.
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- 2023
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33. [Rehabilitation after Spinal Cord Injury : Current trends and principles].
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Harder M, Baumberger M, Pannek J, Decker J, and Bersch I
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- Humans, Activities of Daily Living, Spinal Cord Injuries diagnosis, Occupational Therapy, Autonomic Nervous System Diseases complications, Emergency Medicine
- Abstract
Traumatic and non traumatic spinal cord injury are rare and an orphan disease in comparison to common diseases. Those affected represent a very special patient population in the treatment even at the site of the accident and in emergency medicine and require a high level of professional expertise. The rehabilitation with the complexity of a spinal cord injury can only succeed with a multiprofessional team that is less focused on the often similar diagnoses according to the International Classification of Diseases (ICD) but on functional disorders and associated activity impairments. Only then the best possible integration and participation/inclusion in sociocultural and professional life can be achieved. In addition to the importance of classical physiotherapy and occupational therapy, this article highlights important but often missing team players, such as neurourology and electrical stimulation. In addition, the problems of frequent and some less recognized complications, such as autonomic dysfunction and the benefits of airway management are highlighted. For a comprehensive overview of rehabilitation in spinal cord injury, reference textbooks and guidelines are recommended that are cited in the text., (© 2023. The Author(s), under exclusive licence to Springer Medizin Verlag GmbH, ein Teil von Springer Nature.)
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- 2023
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34. Fungistatic Effect of Phthalide Lactones on Rhodotorula mucilaginosa .
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Gach J, Olejniczak T, Pannek J, and Boratyński F
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- Humans, Yeasts, Allergens, Azoles pharmacology, Rhodotorula
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Currently, there is an increasing number of cases of fungal infections caused by opportunistic strains of the yeast Rhodotorula mucilaginosa , mainly in immunocompromised patients during hospitalization. The excessive use of antibiotics and azole compounds increases the risk of resistance to microorganisms. A new alternative to these drugs may be synthetic phthalide lactones with a structure identical to or similar to the natural ones found in celery plants, which show low toxicity and relatively high fungistatic activity. In the present study, the fungistatic activity of seven phthalide lactones was determined against R. mucilaginosa IHEM 18459. We showed that 3- n -butylidenephthalide, the most potent compound selected in the microdilution test, caused a dose-dependent decrease in dry yeast biomass. Phthalide accumulated in yeast cells and contributed to an increase in reactive oxygen species content. The synergistic effect of fluconazole resulted in a reduction in the azole concentration required for yeast inhibition. We observed changes in the color of the yeast cultures; thus, we conducted experiments to prove that the carotenoid profile was altered. The addition of lactones also triggered a decline in fatty acid methyl esters.
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- 2023
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35. Unplanned hospital admissions due to secondary health conditions after spinal cord injury: a population-based description of determinants of length of stay.
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Jedrusik AM, Brinkhof MWG, Müller LL, Meier SB, Pannek J, and Eriks-Hoogland IE
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- Humans, Male, Middle Aged, Female, Length of Stay, Prospective Studies, Retrospective Studies, Hospitalization, Hospitals, Spinal Cord Injuries complications, Spinal Cord Injuries epidemiology, Spinal Cord Injuries therapy
- Abstract
Study Design: Population-based prospective study., Objectives: To provide a population-based description of length of stay (LOS) and person-related risk factors following unplanned hospital admission due to a secondary health condition (SHC) in persons with spinal cord injury (SCI)., Setting: Specialized SCI hospital and rehabilitation center in Switzerland., Methods: Descriptive analysis of LOS using routine clinical data of persons with SCI, who were acutely hospitalized between 01.01.2017-30.06.2018. Multivariable regression analysis was used to derive marginal predictions of LOS by acute SHCs and person characteristics., Results: The study included 183 persons, 83% were male, and the median age was 57 years (interquartile range, IQR, 49-67 years). SCI cause was traumatic in 160 (88.4%) cases, 92 (50.3%) were persons with tetraplegia, 147 (80.3%) were classified as motor complete lesions (American Spinal Injury Association Impairment Scale (AIS) A or B) and median time since injury (TSI) was 24 (IQR 13-34) years. Median LOS was 19 (IQR 9-39) days, varying from 74 (IQR 39-92) days for pressure ulcers, 13 (IQR 8-24) days for urinary tract infections (UTI), to 27 (IQR 18-47) days for fractures. LOS was prolonged in persons with multiple co-morbidities or those developing complications during hospitalization. Sex, SCI etiology and lesion level were not associated with LOS., Conclusions: This population-based description identified substantial variation in LOS between acute SHCs and clinical complications as the main, potentially modifiable, person-related risk factors for extended hospital stay., (© 2023. The Author(s), under exclusive licence to International Spinal Cord Society.)
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- 2023
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36. Diabetic Neuropathy.
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Ziegler D, Keller J, Maier C, and Pannek J
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- Humans, Diabetic Neuropathies diagnosis, Diabetic Neuropathies therapy, Diabetes Mellitus
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Competing Interests: DZ received research funding from Wörwag, fees for lectures from Wörwag, Pfizer, Viatris, Berlin-Chemie, Sanofi, Eva, Nevro, and TrigoCare. and fees for consulting Biogen, Wörwag, Berlin-Chemie, Viatris, Novartis, Novaremed, Bayer, Grünenthal, Nevro, Procter & Gamble, Clexio, Stada, GSK, and TrigoCare.
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- 2023
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37. Satisfaction with Homeopathic Service and Care for Persons with Spinal Cord Injury.
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Pannek J, Mahler J, Wöllner J, and Krebs J
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- Humans, Cross-Sectional Studies, Surveys and Questionnaires, Switzerland, Homeopathy
- Abstract
Background: The aim of the study was to investigate the satisfaction of individuals with spinal cord injury (SCI) with a homeopathic service at an SCI rehabilitation center., Patients and Methods: A cross-sectional questionnaire study was performed at an SCI rehabilitation center in Switzerland. It included patients with chronic SCI who presented themselves to a homeopathic service offered by the hospital in a 12-months period. The participants filled in standardized questionnaires in German: "Measure Yourself Medical Outcome Profile" (MYMOP), Treatment Satisfaction Questionnaire for Medication (TSQM-9), the European Project on Patient Evaluation of General Practice Care (EUROPEP) questionnaire, and a self-administered questionnaire., Results: The data of 14 patients were analyzed. Symptom severity as well as bother by the symptoms that led to homeopathic treatment decreased under homeopathic treatment (severity: from 4.3 to 3.3; bother: from 4.2 to 2.9) and remained lower over time (severity: 2.6; bother: 2.7), suggesting a sustained effect. Irrespective of the test instrument used, satisfaction rates were higher for homeopathic service than for homeopathic medication, which was rated as successful by 50% of the participants., Conclusion: Persons with SCI suffering from secondary complications of SCI who accessed homeopathic care reported high satisfaction rates with the service. Therefore, homeopathic service can be considered as an additive measure in persons with SCI suffering from recurrent symptoms.,
Hintergrund Evaluierung der Zufriedenheit von Personen mit Querschnittlähmung (QSL) mit einer homöopathischen Betreuung an einem Rehabilitationszentrum für QSL.Patient*innen und Methodik An einem Rehabilitationszentrum für QSL in der Schweiz wurde eine Querschnittserhebung mittels Fragebögen durchgeführt. Eingeschlossen wurden Personen mit chronischer QSL, die sich in einer von der Klinik angebotenen homöopathischen Sprechstunde in einem 12-Monats-Intervall vorstellten. Die Teilnehmenden füllten standardisierte Fragebogen in deutscher Sprache aus: "Measure Yourself Medical Outcome Profile" (MYMOP), Treatment Satisfaction Questionnaire for Medication (TSQM-9), den "European Project on Patient Evaluation of General Practice Care (EUROPEP)" Fragebogen sowie einen selbst-erstellten Fragebogen.Ergebnisse Die Daten von 14 Teilnehmenden wurden ausgewertet. Der Schweregrad der Symptome sowie die Belastung durch die Symptome die zur homöopathischen Behandlung geführt haben, wurden unter der homöopathischen Therapie geringer (Schweregrad: von 4.3 auf 3.3; Belastung: von 4.2 auf 2.9) und blieben über den Untersuchungszeitraum geringer (Schweregrad: 2.6; Belastung 2.7), was einen anhaltenden Effekt nahelegt. Unabhängig von dem verwendeten Testinstrument waren die Zufriedenheitsraten für die homöopathische Betreuung höher als diejenigen für die homöopathische Medikation, die von 50% der Teilnehmenden als erfolgreich bewertet wurde.Schlussfolgerung Personen mit QSL, die wegen Sekundärkomplikationen eine homöopathische Sprechstunde aufsuchten, berichteten eine hohe Zufriedenheit mit dieser Betreuung. Daher kann eine homöopathische Betreuung als zusätzliche Massnahme bei Personen mit QSL mit persistierender Symptomatik in Betracht gezogen werden., (© 2023 S. Karger AG, Basel.)- Published
- 2023
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38. Sex differences in urological management during spinal cord injury rehabilitation: results from a prospective multicenter longitudinal cohort study.
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Anderson CE, Birkhäuser V, Liechti MD, Jordan X, Luca E, Möhr S, Pannek J, Kessler TM, and Brinkhof MWG
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- Humans, Male, Female, Longitudinal Studies, Prospective Studies, Sex Characteristics, Cohort Studies, Spinal Cord Injuries epidemiology, Spinal Cord Injuries rehabilitation
- Abstract
Study Design: Prospective, multicenter, longitudinal cohort study., Objectives: To describe female-male differences in first-line urological management during spinal cord injury (SCI) rehabilitation., Setting: Inpatient specialized post-acute SCI rehabilitation in Switzerland., Methods: Data on bladder storage medication (antimuscarinic and beta-3 agonist) use, suprapubic catheter placement, demographic and SCI characteristics was collected within 40 days of SCI and at rehabilitation discharge from May 2013-September 2021. Prevalence and indicators of bladder storage medication and suprapubic catheter use at discharge were investigated with sex-stratified descriptive and logistic regression analyses., Results: In 748 patients (219 females, 29%), bladder storage medication use at discharge had a prevalence of 24% (95% CI: 18-29%) for females and 30% (95% CI: 26-34%) for males and was indicated by cervical AIS grade A, B, C and traumatic SCI in both sexes. Thoracic AIS grade A, B, C SCI (males), and lumbar/sacral AIS grade A, B, C SCI (females) predicted higher odds of bladder storage medication use (SCI characteristic*sex interaction, p < 0.01). Prevalence of suprapubic catheter use at discharge was 22% (95% CI: 17-28%) for females and 17% (95% CI: 14-20%) for males. Suprapubic catheter use was indicated by cervical AIS grade A, B, C SCI, and age >60 in both sexes. Females with thoracic grade A, B, C SCI tended to have higher odds of suprapubic catheter use (SCI characteristic*sex interaction, p = 0.013)., Conclusions: We identified sex differences in urological management especially in persons with AIS grade C or higher sub-cervical SCI. There is scope for well-powered, female-specific research in SCI in order to understand the underlying mechanisms and support patient-tailored management., (© 2022. The Author(s), under exclusive licence to International Spinal Cord Society.)
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- 2023
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39. Early Changes in Androgen Levels in Individuals with Spinal Cord Injury: A Longitudinal SwiSCI Study.
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Itodo OA, Raguindin PF, Wöllner J, Eriks-Hoogland I, Jordan X, Hund-Georgiadis M, Muka T, Pannek J, Stoyanov J, and Glisic M
- Abstract
We aimed to explore longitudinal changes in androgen levels in individuals with spinal cord injury (SCI) within initial inpatient rehabilitation stay and identify clinical/injury characteristics associated with hormone levels. Linear regression analysis was applied to explore the association between personal/injury characteristics and androgen hormones (total testosterone, free testosterone, sex hormone-binding globulin (SHBG), dehydroepiandrosterone (DHEA), and dehydroepiandrosterone sulfate (DHEA-S)) at admission to rehabilitation. Longitudinal changes in androgen levels were studied using linear mixed models. Analyses were stratified by sex and by injury type. We included 70 men and 16 women with SCI. We observed a non-linear association between age, time since injury, and androgens at baseline. At admission to initial rehabilitation, mature serum SHBG (full-length, protein form which lacks the N-terminal signaling peptide) was higher, while DHEA and DHEA-S were lower among opioid users vs. non-users. Serum levels of total testosterone and DHEA-S increased over rehabilitation period [β 3.96 (95%CI 1.37, 6.56), p = 0.003] and [β 1.77 (95%CI 0.73, 2.81), p = 0.01], respectively. We observed no significant changes in other androgens. Restricting our analysis to men with traumatic injury did not materially change our findings. During first inpatient rehabilitation over a median follow up of 5.6 months, we observed an increase in total testosterone and DHEA-S in men with SCI. Future studies need to explore whether these hormonal changes influence neurological and functional recovery as well as metabolic parameters during initial rehabilitation stay.
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- 2022
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40. Sacral Neuromodulation for Neurogenic Lower Urinary Tract Dysfunction.
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Liechti MD, van der Lely S, Knüpfer SC, Abt D, Kiss B, Leitner L, Mordasini L, Tornic J, Wöllner J, Mehnert U, Bachmann LM, Burkhard FC, Engeler DS, Pannek J, and Kessler TM
- Subjects
- Humans, Electrodes, Implanted, Sacrum, Lower Urinary Tract Symptoms therapy, Urinary Tract, Electric Stimulation Therapy
- Abstract
BACKGROUND: Neurogenic lower urinary tract dysfunction (NLUTD) is a highly prevalent and disabling condition; nevertheless, standard treatments often remain unsatisfactory. Sacral neuromodulation (SNM) is a well-established therapy for non-NLUTD, but there is a lack of randomized controlled trials to show benefit in patients with NLUTD. METHODS: For this sham-controlled, double-blind, multicenter trial, patients with refractory NLUTD (and intended SNM) were recruited at four Swiss SNM referral centers. After lead placement into the sacral foramina S3 (rarely, S4), all participants underwent SNM testing. If successful (≥50% improvement in key bladder diary variables), the neurostimulator was implanted for permanent stimulation. For 2 months, neuromodulation was optimized using subsensory stimulation with individually adjusted parameters. Thereafter, the neurostimulator remained on or was switched off (1:1 random allocation to group SNM ON or SNM OFF, respectively) for 2 months, followed by a neurourologic reevaluation. The primary outcome was success, as defined above, of SNM compared with baseline. RESULTS: Of 124 patients undergoing SNM testing, 65 (52%) had successfully improved lower urinary tract function. Of these, 60 patients (median age, 49.5 years; 43 women) were randomly assigned to the intervention. After 2 months of intervention, the SNM ON group demonstrated a success rate of 76%. In the SNM OFF group, 42% of patients showed sustained SNM effects despite their neurostimulator being switched off during the last 2 months (odds ratio, 4.35; 95% confidence interval, 1.43 to 13.21; P=0.009). During the entire study period, there were 11 adverse events (6 dropouts; no dropouts during the intervention phase). CONCLUSIONS: SNM effectively corrected refractory NLUTD in the short term in well-selected neurologic patients. (Funded by the Swiss National Science Foundation, Vontobel–Stiftung, Gottfried und Julia Bangerter–Rhyner Stiftung, Dr. Urs Mühlebach, and the Swiss Continence Foundation; ClinicalTrials.gov number, NCT02165774.)
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- 2022
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41. Characterizing the Services of a Rehabilitation Centre Specialized in Spinal Cord Injury/Disorder using the International Classification of Service Organization in Rehabilitation 2.0 and Implications for Health Reporting: A Demonstration Project.
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Scheel-Sailer A, Selb M, Baumberger M, Gemperli A, Eriks-Hoogland I, Jelmoni L, Metzger S, Pannek J, Sigrist-Nix D, and Stucki G
- Subjects
- Humans, Rehabilitation Centers, Switzerland, Physical and Rehabilitation Medicine, Spinal Cord Injuries rehabilitation
- Abstract
Objectives: To characterize the services of a rehabilitation centre specialized in spinal cord injury/disorder (SCI/D) using the International Classification of Service Organization in Rehabilitation (ICSO-R) 2.0, and to evaluate its potential use in meeting health reporting and certification requirements., Methods: The post-acute and outpatient rehabilitation services at this specialized SCI/D centre were described, the SCI/D Framework of rehabilitation service type definitions considered, various rehabilitation centre stakeholders were consulted, and data were collected using the centre's digital quality management system and institutional management tool. A structured internet search identified the national health reporting and certification systems relevant for SCI/D rehabilitation. The resulting systems were subsequently mapped with ICSO-R 2.0 categories., Results: ICSO-R 2.0 categories pertaining to the provider dimension were generally the same across the post-acute and outpatient services. ICSO-R 2.0 highlighted the nuances in service delivery between these 2 service types. Most of the categories could be mapped to at least 1 of the 10 health reporting and certification systems detected in the website search., Conclusion: ICSO-R 2.0 can be used to comprehensively describe the rehabilitation services of a specialized SCI/D centre in Switzerland. Despite some challenges, ISCO-R 2.0 has the potential to facilitate national health reporting and certification.
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- 2022
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42. Definitions of Urinary Tract Infection Used in Interventional Studies Involving Neurourological Patients-A Systematic Review.
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Sartori AM, Padilla-Fernández B, 't Hoen L, Blok BFM, Castro-Díaz DM, Del Popolo G, Musco S, Hamid R, Ecclestone H, Groen J, Karsenty G, Phé V, Kessler TM, and Pannek J
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- Humans, Bacteriuria diagnosis, Urinary Tract Infections complications, Urinary Tract Infections diagnosis, Urinary Tract Infections prevention & control
- Abstract
Context: Neurourological patients often encounter bacteriuria without any symptoms or may experience symptoms suspicious of urinary tract infections (UTIs). However, there is a lack of guidelines that unequivocally state the definition of UTIs in this specific patient group., Objective: To present all used definitions of UTIs in neurourological patients., Evidence Acquisition: This systematic review was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) statement. Studies were identified by electronic search of Medline, Embase, Cochrane controlled trials databases, and clinicaltrial.gov without a time limitation (last search September 2020) and by screening of reference lists and reviews. The occurrences of the various UTI definitions were counted and the frequencies calculated., Evidence Synthesis: After screening 7164 abstracts, we included 32 studies enrolling a total of 8488 patients with a neurourological disorder who took part in an interventional clinical study. UTI definitions were heterogeneous. The concordance to predefined definitions was low., Conclusions: Interventional clinical studies rarely report specific definitions for UTIs, and both clinical and laboratory criteria used are heterogeneous. A generally accepted UTI definition for neurourological patients is urgently needed., Patient Summary: Patients suffering from neurological disorders often experience symptoms in their lower urinary tract that resemble urinary tract infections. Furthermore, they can have positive urine cultures without symptoms (the so-called asymptomatic bacteriuria). However, clinical studies rarely report specific definitions for urinary tract infections, and when it is done, they are heterogeneous. A generally accepted urinary tract infection definition for neurourological patients is urgently needed. TAKE HOME MESSAGE: Interventional clinical studies on neurourological patients rarely report specific definitions for urinary tract infections (UTIs), and both clinical and laboratory criteria used are heterogeneous. A generally accepted UTI definition for neurourological patients is urgently needed., (Copyright © 2021 European Association of Urology. Published by Elsevier B.V. All rights reserved.)
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- 2022
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43. Efficacy and Safety of Surgical Treatments for Neurogenic Stress Urinary Incontinence in Adults: A Systematic Review.
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Musco S, Ecclestone H, 't Hoen L, Blok BFM, Padilla-Fernández B, Del Popolo G, Groen J, Pannek J, Kessler TM, Karsenty G, Phé V, Sartori AM, Castro-Diaz D, and Rizwan H
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- Adult, Female, Humans, Male, Retrospective Studies, Urologic Surgical Procedures methods, Suburethral Slings adverse effects, Urinary Incontinence complications, Urinary Incontinence, Stress etiology, Urinary Sphincter, Artificial adverse effects
- Abstract
Context: Controversy still exists regarding the balance of benefits and harms for the different surgical options for neurogenic stress urinary incontinence (N-SUI)., Objective: To identify which surgical option for N-SUI offers the highest cure rate and best safety without compromising urinary tract function and bladder management., Evidence Acquisition: A systematic review was performed under the auspices of the European Association of Urology Guidelines Office and the European Association of Urology Neuro-Urology Guidelines Panel according to the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) statement., Evidence Synthesis: A total of 32 studies were included. Overall, 852 neurourological patients were surgically treated for N-SUI. The treatment offered most often (13/32 studies) was an artificial urinary sphincter (AUS; 49%, 416/852) and was associated with a need for reintervention in one-third of patients. More than 200 surgical revisions were described. Overall, 146/852 patients (17%) received concomitant bladder augmentation, mainly during placement of an AUS (42%, 62/146) or autologous sling (34% of women and 14% of men). Following pubovaginal sling placement, dryness was achieved in 83% of cases. A significant improvement in N-SUI was observed in 87% (82/94) of women following placement of a synthetic midurethral sling. Efficacy after insertion of an adjustable continence therapy device (ACT 40%, proACT 60%) was reported for 38/128 cases (30%). The cure rate for bulking agents was 35% (9/25) according to 2/32 studies, mainly among men (90%). The risk of bias was highly relevant. Baseline and postoperative cystometry were missing in 13 and 28 studies, respectively., Conclusions: The evidence is mainly reported in retrospective studies. More than one intervention is often required to achieve continence because of coexisting neurogenic detrusor overactivity, low compliance, or the onset of complications in the medium and long term. Urodynamic data are needed to better clarify the success of N-SUI treatment with the different techniques., Patient Summary: Our review shows that insertion of an artificial urinary sphincter for urinary incontinence is effective but is highly associated with a need for repeat surgery. Other surgical options may have lower continence rates or a risk of requiring intermittent catheterization, which patients should be informed about before deciding on surgery for their incontinence., (Copyright © 2021 European Association of Urology. Published by Elsevier B.V. All rights reserved.)
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- 2022
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44. Bladder management in individuals with spinal cord injury or disease during and after primary rehabilitation: a retrospective cohort study.
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Krebs J, Wöllner J, Rademacher F, and Pannek J
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- Adult, Aged, Cystostomy, Female, Humans, Male, Middle Aged, Retrospective Studies, Urinary Bladder, Urinary Catheterization methods, Spinal Cord Injuries complications, Spinal Cord Injuries rehabilitation, Urinary Bladder, Neurogenic etiology, Urinary Bladder, Neurogenic therapy
- Abstract
Purpose: The purpose of this study was to investigate the course of bladder evacuation and the predictors of intermittent self-catheterization (ISC) in individuals with neurogenic lower urinary tract dysfunction (NLUTD) during and after primary rehabilitation., Methods: The patient database of a single spinal cord injury rehabilitation center was screened for patients with NLUTD admitted for primary rehabilitation. Patient characteristics and bladder evacuation details were collected during and after rehabilitation. Binary logistic regression analysis was used to evaluate predictors of ISC: sex, age > 65 years, injury severity, and bladder capacity ≥ 400 ml., Results: Data of 255 men (74.3%) and 88 women (25.7%) with a mean age of 54 ± 19 years were analyzed. Early in rehabilitation, 21.6% of the evaluated individuals used ISC. In 17.8%, the bladder was evacuated by transurethral catheterization (TUC). The proportion of TUC decreased during rehabilitation and dropped below 2% at the last follow-up. In contrast, the proportion of ISC and suprapubic catheterization (SPC) increased to 28% and 12.8%, respectively, during rehabilitation. These proportions increased further thereafter and reached 37.7% and 18.6% for ISC and SPC, respectively. Age and injury severity were significant (p ≤ 0.041) negative predictors, whereas male sex and above-average bladder capacity were positive predictors of ISC., Conclusions: There is a shift toward bladder evacuation by ISC and SPC during and after primary rehabilitation. Bladder evacuation by ISC, regarded as the gold standard, is less common in individuals > 65 years or with high-level tetraplegia. The optimal bladder evacuation method needs to be established individually, considering all medical and psychosocial factors rather than simply following a guideline., (© 2022. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)
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- 2022
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45. Management of stress urinary incontinence in female patients with spinal cord injury by autologous fascial sling: time for a revival?
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Pannek J and Wöllner J
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- Female, Humans, Retrospective Studies, Urethra injuries, Spinal Cord Injuries complications, Spinal Cord Injuries surgery, Suburethral Slings, Urinary Incontinence, Stress etiology, Urinary Incontinence, Stress surgery
- Abstract
Study Design: This study is a retrospective chart analysis., Objectives: Surgical treatment of stress urinary incontinence (SUI) in women with neurogenic lower urinary tract dysfunction (NLUTD) is a challenge, as minimally invasive procedures do not seem to be effective, whereas synthetic implants are associated with substantial risks. Thus, we evaluated the results of an autologous sling procedure in this group of patients SETTING: This study was performed at a spinal cord injury rehabilitation center in Switzerland., Methods: In this retrospective analysis, we evaluated the objective, subjective, and urodynamic results in women undergoing autologous sling insertion for SUI due to NLUTD at our institution., Results: The data of 17 women who underwent fascial sling surgery were analyzed. After a median follow-up of 40 months, 8 women (47%) were continent, and another 8 patients (47%) significantly improved (1 pad/day). Median video-urodynamic parameters remained unchanged after sling insertion, but two women developed de novo detrusor overactivity. Postoperative complications occurred in 6 of the 17 patients (35.3%), which required surgical interventions in 2 women (12%) (urethral erosion by the sling and complete occlusion of the urethra after removal of the catheter), which could be resolved without loss of continence., Conclusion: In our case series, autologous fascial slings were effective in the treatment of SUI in women with NLUTD. As they are more effective than minimally invasive procedures, are associated with fewer complications than AUS, and seem to omit possible severe long-term consequences of synthetic slings, they are an excellent treatment option in this group of patients. Urodynamic controls are recommended, as de novo detrusor overactivity may occur after sling insertion., (© 2022. The Author(s), under exclusive licence to International Spinal Cord Society.)
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- 2022
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46. Systematic review of the changes in the microbiome following spinal cord injury: animal and human evidence.
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Valido E, Bertolo A, Fränkl GP, Itodo OA, Pinheiro T, Pannek J, Kopp-Heim D, Glisic M, and Stoyanov J
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- Animals, Bacteria, Humans, Inflammation, Gastrointestinal Microbiome, Metabolic Diseases, Probiotics, Spinal Cord Injuries microbiology
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Study Design: Systematic review., Objectives: To investigate the changes in the microbiome among human and animal populations with spinal cord injury (SCI)., Methods: Four databases (EMBASE, Medline (Ovid), Web of Science, Cochrane Central Register of Trials (CENTRAL)) and Google Scholar were searched. No language restrictions were applied. Data extraction was done in parallel and independently by two reviewers. The search was last conducted on 07 April 2021., Results: There were 6869 studies retrieved, 43 full-text studies reviewed, and 19 studies included. There were seven animal gut studies, six human gut studies, and six urinary tract studies identified. There were no publications found on other body sites. Among the included studies, we observed a consistent and significant difference in gut microbiome composition between populations with SCI and able-bodied populations. This is characterized by a decrease in beneficial butyrate-producing bacteria (Faecalbacterium, Megamonas, Roseburia) and an increase in inflammation-associated bacteria (Alistipes, Anaerotruncus, and Lachnoclostridium). On the other hand, the urine of individuals with SCI was polymicrobial and members of Enterobacteriaceae (Escherichia coli, Klebsiella pneumoniae) were frequently observed. Probiotics were shown to induce a significant but transient shift in the urinary tract microbiome. The studies had low to moderate risks of bias., Conclusions: There are limited studies on the changes in microbiome among SCI populations. The gut microbiome was characterized by bacterial profiles associated with chronic inflammation and metabolic disorder while the studies of the urinary tract microbiome show the dominance of bacterial genera associated with urinary tract infection., (© 2022. The Author(s).)
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- 2022
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47. An instrument for assessing quality of life in persons with neurogenic lower urinary tract dysfunction: validation of the German short-form Qualiveen questionnaire.
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Krebs J, Wöllner J, Widmer A, and Pannek J
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- Cross-Sectional Studies, Humans, Middle Aged, Quality of Life, Reproducibility of Results, Surveys and Questionnaires, Urinary Bladder, Multiple Sclerosis, Spinal Cord Injuries complications
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Study Design: Prospective validation study., Objectives: To validate and evaluate the measurement properties of the German Qualiveen short-form (SF) questionnaire in individuals with chronic neurogenic lower urinary tract dysfunction (NLUTD) resulting from spinal cord injury (SCI)., Setting: Tertiary neuro-urologic referral center in Switzerland., Methods: Fifty individuals with chronic (>12 months) NLUTD resulting from SCI presenting for a urodynamic follow-up examination were enrolled to complete both the full version Qualiveen and the SF-Qualiveen questionnaires twice within three weeks. The criterion validity and test-retest reliability were evaluated by calculating the interclass correlation coefficients. Internal consistency was evaluated by calculating Cronbach's alpha. Finally, the cross-sectional construct validity was evaluated using Spearman's rank correlations between the scores of the two questionnaires for bladder evacuation, urinary continence, and urinary tract infection sub-groups., Results: The mean age of the evaluated individuals was 53 years. The median duration of NLUTD was 14.9 years. The SF-Qualiveen showed good to excellent criterion validity with correlation coefficients greater than 0.8. Internal consistency was good overall and in the domains "bother with limitations" as well as "feelings" (>0.75). However, internal consistency in the domains "frequency of limitations" and "fears" was moderate-poor (0.68-0.37). The test-retest reliability was excellent with correlation coefficients greater than 0.9. Finally, the cross-sectional construct validity ranged from moderate to excellent (0.60-0.97)., Conclusions: The German SF-Qualiveen has shown excellent reliability and validity and variable internal consistency. Its brevity will increase compliance, and we therefore recommend to include the SF-Qualiveen in urologic assessments., (© 2021. The Author(s), under exclusive licence to International Spinal Cord Society.)
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- 2022
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48. Urological Management at Discharge from Acute Spinal Cord Injury Rehabilitation: A Descriptive Analysis from a Population-based Prospective Cohort.
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Anderson CE, Birkhäuser V, Jordan X, Liechti MD, Luca E, Möhr S, Pannek J, Kessler TM, and Brinkhof MWG
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Background: There is limited epidemiological evidence describing contemporary neuro-urological management of persons with acute spinal cord injury (SCI)., Objective: To describe neurogenic lower urinary tract dysfunction (NLUTD) management at discharge from SCI rehabilitation., Design Setting and Participants: The population-based Swiss Spinal Cord Injury (SwiSCI) cohort study prospectively collected data from 602 adults undergoing specialized postacute SCI rehabilitation from 2013 to 2020. The management strategy was based on the European Association of Urology (EAU) Guidelines on Neuro-Urology., Outcome Measurements and Statistical Analysis: Data were collected at discharge using the International SCI Lower Urinary Tract Function Basic Data Set. Multivariable logistic regression adjusting for demographics, SCI characteristics, and center, with inverse probability weighting accounting for sampling bias, was used to produce prevalence estimates and identify predictors of lower urinary tract symptoms (LUTS) and NLUTD management outcomes., Results and Limitations: At discharge (median time after SCI: 5.0 mo [Q1-Q3: 3.0-7.2]), the prevalence of LUTS or managed NLUTD was 82% (95% confidence interval [CI]: 79-85%). SCI completeness was the main predictor of LUTS and managed NLUTD. The risk of urinary incontinence was elevated in females (odds ratio 1.98 [95% CI: 1.18-3.32]) and with complete lesions (odds ratio 4.71 [95% CI: 2.52-8.81]). Voiding dysfunction was most commonly managed with intermittent catheterization (prevalence 39% [95% CI: 35-42%]), followed by indwelling catheterization (prevalence 22% [95% CI: 18-25%]). The prevalence of antimuscarinic or mirabegron use was 29% (95% CI: 26-33%). Urodynamic and renal function data were not collected., Conclusions: Our population-based description of urological management in Swiss SCI centers utilizing the EAU Guidelines on Neuro-Urology may be used as a reference for evaluation in other settings. Data further indicate a need for sex-specific neuro-urological management research., Patient Summary: At discharge from spinal cord injury (SCI) rehabilitation, a majority of patients have lower urinary tract problems, especially those with complete SCI. Women have a higher risk of urinary incontinence., (© 2022 The Authors.)
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- 2022
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49. [How is evidence-based medicine defined? Homeopathy-a therapeutic option in medical practice!]
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Weiermayer P, Keusgen M, Pannek J, Panhofer P, Geiger M, Etter-Kalberer G, Tournier AL, Ulbrich Zürni S, Kruse S, Kretzdorn K, and Frass M
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- Evidence-Based Medicine, Homeopathy
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- 2022
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50. Immunomodulation for primary prevention of urinary tract infections in patients with spinal cord injury during primary rehabilitation: protocol for a randomized placebo-controlled pilot trial (UROVAXOM-pilot).
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Krebs J, Stoyanov J, Wöllner J, Valido E, and Pannek J
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- Escherichia coli, Humans, Immunomodulation, Multicenter Studies as Topic, Pilot Projects, Primary Prevention, Randomized Controlled Trials as Topic, Spinal Cord Injuries complications, Spinal Cord Injuries diagnosis, Urinary Tract Infections diagnosis, Urinary Tract Infections prevention & control
- Abstract
Background: Urinary tract infections (UTIs) are common in individuals with neurogenic lower urinary tract dysfunction (NLUTD) following spinal cord injury (SCI). They are not only a great burden for affected individuals, but also cause considerable health costs. Furthermore, recurrent antibiotic treatments of UTIs contribute to the growing problem of bacterial resistance to antimicrobial compounds. Even though there is a multitude of different measures to prevent UTIs in individuals with NLUTD, no clear evidence exists for any of these. Oral immunomodulation with UTI-relevant Escherichia coli lysate may be a promising preventative measure with a good safety profile in individuals with NLUTD. However, currently available data are sparse., Methods: This is a randomized, quasi-blinded, placebo-controlled, mono-centric pilot trial investigating the feasibility of a main trial regarding the effects of a lyophilized lysate of E. coli strains for oral application (Uro-Vaxom®, OM Pharma SA, Meyrin, Switzerland). There will be two parallel groups of 12 participants each. Individuals with acute SCI (duration SCI ≤ 56 days) from 18 to 70 years of age admitted for primary rehabilitation will be eligible. Blood and urine samples will be taken prior to intervention start, at the end of the intervention, and 3 months after intervention termination. The trial intervention will last 90 days. The participants will not be informed regarding the treatment allocation (quasi-blinded). The nursing staff will prepare the daily dose of the allocated treatment from the original packaging. The trial personnel and the biostatistician will be blinded. Feasibility (e.g., recruitment rate, patient attrition), clinical (e.g., number of symptomatic UTIs), and laboratory parameters (e.g., urinary culture, urinary proteo- and microbiome, blood cell counts) as well as adverse events will be collected., Discussion: Effective and efficient measures for the prevention of UTIs in individuals with NLUTD are urgently needed. If the conclusion of this pilot is positive regarding feasibility, the effects of oral immunomodulation with a E. coli lysate will be investigated in a larger, sufficiently powered, multi-center trial., Trial Registration: ClinicalTrials.gov NCT04049994 . Registered on 8 August 2019., (© 2021. The Author(s).)
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- 2021
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