Search

A 42-year-old woman was referred by neurology colleagues to our outpatient urology clinics. She presented with a non-monosymptomatic secondary enuresis, which started at 20 years of age When she was twenty-two she presented a single episode of a generalised tonic-clonic seizure, and she was treated with Carbamazepine (CBZ) with resolution of enuresis that reappeared when CBZ was stopped. Therefore, a video-EEG was performed, which documented an episode of enuresis during stage 1 of non-REM sleep without epileptic discharges and made it difficult for the patient to reach the deeper stages of sleep. According to these findings, the epileptic genesis of the enuresis was ruled out. A urodynamic invasive study was performed, and a normal active bladder associated with sleep disturbances was diagnosed as the combined cause of the non-monosymptomatic secondary nocturnal enuresis.Behavioural therapy and/or antimuscarinic treatments, alone or in combination, were used without success. Then the patient restarted CBZ at a low dose (200 mg/day), and a significant reduction of enuresis episodes (1 wet night every 9–10) was obtained with no changes in the bladder diary.CBZ effectiveness in such a case on an overactive bladder (OAB) could depend on its modulating effect in the central nervous system.

Background: Lower urinary tract symptoms (LUTSs) are a common complaint in adult and elderly men with bladder outlet obstruction, and have a considerable impact on their quality of life. Symptoms affect storage, voiding and post micturition stages. Among the latter, a feeling of incomplete emptying is one of the most bothersome for the patients; a condition that in turn contributes to affect urinary urgency, nocturia and frequency. Common recommendations include self-management practices (e.g., control of fluid intake, double-voiding and distraction techniques) to relieve patients' symptoms, whose effectiveness, however, is under debate. Methods: In this report we describe two pioneering procedures to favor bladder residual content voiding in people complaining of LUTS disorders. The first is based on motor imagery and the second on the use of odors. The beneficial effects of Mental imagery techniques on various tasks (e.g., in the treatment of several pathological conditions or as valid mnemonics aids have a long tradition and have received consistently experimental support. Thus, a patient (a 68-year-old Caucasian man) complaining of LUTS was trained to use a motor imagery technique (building up a visual image comprising the bladder, the detrusor muscle and the urethra, and to imagine the detrusor muscle contracting and the flow of urine expelled) for 90 days and two odors (coffee and a lavender scented cleanser) for 10 days, as a trigger for micturition. He was asked to record—immediately after the first morning micturition—the time interval between the first (free) and the second (cued) micturition. Results: Reported data suggest the efficacy of motor imagery in favoring the bladder residual urine voiding in a few minutes (M = 4.75 min.) compared to the control condition, i.e., the baseline of the patient (M = 79.5 min.), while no differences between the odor-based procedures (M 1st odorant = 70.6 min.; M 2nd odorant = 71.1 min) and the latter were observed. Conclusions: A procedure based on an imagery technique may, therefore, be of general value—as a suggested protocol—and accordingly can be applicable to clinical settings. An olfactory bladder control hypothesis cannot, however, be ruled out and is discussed as a promising future line of research. [ABSTRACT FROM AUTHOR]