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Objective: To evaluate the effect of homogeneous spinal-shortening axial decompression procedure (HSAD) on bladder function in patients with spina bifida tethered syndrome. Methods and materials: Patients with tethered spinal cord syndrome were collected prospectively, and all patients were treated with lumbar HSAD. Patients' urodynamic evaluation mainly included detrusor function, sphincter function, sphincter coordination (Ig TLR, ratio of tension and loose of urethral sphincter), and bladder compliance. Meanwhile, all patients were followed up with ICI-Q-SF, SF-12, and Rantala scores. Results: Twenty-four patients were included, with the average age of 27 ± 16 years. At the final follow-up, patients' detrusor function, sphincter function, sphincter coordination, and bladder compliance, were all improved dramatically (all P < 0.01). The preoperative SF-12 score, ICQ, and Rantala score were [52.16 ± 5.64, 14.11 ± 5.25, 7.84 ± 4.87], whereas the postoperative mean was [33.53 ± 3.53, 9.05 ± 4.89, 15 ± 3.77] (P < 0.01, respectively). According to objective evaluation, 16.7% of them recovered to normal. According to the subjective evaluation, 25% of the patients returned to normal. Only one patient (4.2%) deteriorated. Limitations include none-randomized controlled design and limited patient samples. Conclusions: The HSAD can significantly restore the bladder function in patients with long-term urinary incontinence. [ABSTRACT FROM AUTHOR]

Purpose of Review: In this review, current literature on management of neurogenic bladder in patients with multiple sclerosis (MS) is summarized. Topics include a review of MS, a brief overview of general treatment options, the effects of MS may manifest on lower urinary tract symptoms (LUTS), and clinical assessment of these patients. The utility of urodynamic evaluation in this patient population and the use of antibiotic prophylaxis in patients with MS on immunomodulatory medications are reviewed. Recent Findings: Unlike neurogenic bladder in spinal cord patients, lower urinary tract dysfunction in MS patients rarely leads to upper urinary tract deterioration. Currently there is no consensus on imaging as a screening tool to assess renal deterioration in this patient population. Internationally, there are differing opinions on the necessity of performing invasive urodynamic (UDS) investigation in MS patients during initial assessment. However, UDS evaluation can be useful in the guidance of treatment options and patient counseling and prior to more invasive interventions. Summary: Depending on the severity of MS, lower urinary tract symptoms are common and can evolve with progression of the disease. Although individual guidelines exist for management of patients with MS and select aspects of neurogenic LUTS, an optimal guideline for initial evaluation and surveillance is not available. The evaluation of patients with MS reporting LUTS should be uniquely tailored and take into consideration individual symptoms, disease course, comorbidities, and medications. Additionally, MS patients on immunomodulation medications that undergo UDS should be considered for prophylactic antibiotics. [ABSTRACT FROM AUTHOR]

Purpose of review: Pelvic organ prolapse (POP) is a significant problem with many options for surgical correction. Following prolapse surgery, de novo lower urinary tract symptoms (LUTS) are not uncommon. We review the current literature on de novo lower urinary tract symptoms following POP repair and discuss the role of urodynamics in the evaluation of the prolapse patient. Recent findings: Patients with occult stress urinary incontinence (SUI) appear to be at higher risk of developing de novo SUI after POP repair. Prolapse reduction in patients undergoing urodynamic evaluation is important. Different types of POP repair influence rates of de novo SUI. Also, prophylactic anti-incontinence procedures at time of POP repair appear to lower the incidence of de novo SUI, but at the cost of increased risk of complications and morbidity. Pre-existing overactive bladder (OAB) symptoms may either improve or persist, and de novo OAB can develop. The specific role of urodynamic study testing for POP is still being determined. Summary: Increasingly, women are seeking surgical treatment for POP. Aside from complications related to surgery in general, proper patient counseling is important regarding the risk of development of de novo voiding problems following surgery. Despite a growing body of literature looking at de novo voiding symptoms after prolapse repair, more studies are still needed. [ABSTRACT FROM AUTHOR]

To evaluate in a prospective study the impact of the “three-drug therapy” (antimuscarinic, alpha-blocker and tricyclic antidepressants) on the treatment of refractory detrusor overactivity (DO). Data from 27 consented patients with refractory DO were available for study. They were asked to complete a daily urinary chart and underwent urodynamic evaluation (UD) before and 60 days after treatment. Response to treatment was considered the presence of one or less involuntary detrusor contractions (IDC) on post-treatment UD. Statistical analysis was performed with Fisher and Mann–Whitney tests, besides Spearman’s correlation. P values <0.05 were considered significant. The mean follow-up was 15 months. The comparison of the daily urinary chart before and after treatment showed significant increase on bladder capacity and decreases on urgency, urge-incontinence and frequency. Objective data from UD showed that the mean maximum bladder capacity (MBC) ranged from 200 to 300 mL ( P < 0.001) with treatment. The same trend was observed with the other UD variables. When compared to baseline, the questionnaire OAB-v8 showed significant improvement ( P < 0.01). Main side effects comprised dry mouth and constipation (40%), with average scores of 5.16 and 3.08, respectively (visual scale from 0 to 10). Triple therapy may be an effective, easily employed and well-tolerated option to refractory DO treatment. More studies are necessary to achieve more consistent data on the matter. [ABSTRACT FROM AUTHOR]

On the basis of data obtained in previous experimental investigations, the application of a new physical entity, 'strain' (σ), was evaluated in bladder dynamics. In this preliminary study 12 cases of urodynamically evaluated subjects are reported; the significance of the traditional P(V) curves is critically compared with the new σ(V) curve, proposed by the authors. [ABSTRACT FROM AUTHOR]

A double-blind crossover study of the alphablocker Nicergoline was carried out in sixteen patients affected by benign prostatic bladder outflow obstruction. The 'irritative' symptoms of prostatic hypertrophy, including nocturnal frequency and dysuria, were improved after Nicergoline significantly more than after placebo. In 10 further patients with prostatic hypertrophy, peak and mean flow rates increased by 50% and 77% respectively after the acute administration of Nicergoline. No side effects were detected. In conclusion Nicergoline seems to be active and well tolerated in the treatment of benign prostatic obstruction. [ABSTRACT FROM AUTHOR]

In an attempt to simplify urodynamic evaluation, the data obtained from cystometry, urethral profile and flowmetry were analysed using the ICS recommendations for standardization and terminology. All studies were compiled from check lists feasible for computation. The aim was to establish standards and 'typical' changes for the normal bladder and pathological states to enable automatic readout of computed data. The results did, in fact, show 'typical' changes but failed to establish standard measurements suitable for completely computed diagnoses. [ABSTRACT FROM AUTHOR]

Clinical and urodynamic effects of a new modification of the Marshall-Marchetti-Krantz procedure for correction of urinary stress incontinence were studied 3-6 years after surgery. A clinical follow-up was made in 239 patients, and 39 had a urodynamic assessment. The subjective cure rate for incontinence was 69% while in another 20% there was improvement. Symptoms caused by the prolapse were relieved in 83%. The incidence of late complications was below 1%. Urodynamic measurements indicated a cure rate of 66%. Pressure transmission to the urethra was significantly improved. At follow-up, the functional length of the urethra and urethral closure pressure values were significantly higher than before operation. The incidence of urge (incontinence) and voiding difficulties was unchanged. [ABSTRACT FROM AUTHOR]

The authors prospectively evaluated 24 consecutive female patients with type III stress urinary incontinence, ranging in age from 36 to 70 years (mean 55 years). All patients were operated upon and had a vesicourethral suspension by a Gore-Tex suburethral sling. All were evaluated urodynamically 6 and 30 months after surgery. In this group of patients clinical cure of incontinence was observed in 83.3% (20) and in the remaining 4 patients it was significantly improved. In 2 patients there was an erosion of the urethra and the sling had to be removed 3.5 years later. Five other women remained dry but complained of occasional irritative symptoms, and several urinary tract infections were recorded (2–3 per year), which were documented by positive urine cultures. In the remaining 17 patients no erosion was observed and no irritative symptoms were reported. The urodynamic evaluation revealed an excellent postoperative result both 6 months and 30 months after surgery. [ABSTRACT FROM AUTHOR]

Urodynamic testing is a widely used modality for evaluation of lower urinary tract symptoms with minimal morbidity to the patient. We report a case of strangulated urethral prolapse in a 74-year-old female that occurred right after urodynamic evaluation. The urethral prolapse was managed conservatively and the patient fully recovered without the need for surgical intervention. [ABSTRACT FROM AUTHOR]