29 results on '"Leitner, Lorenz'
Search Results
2. bTUNED: transcutaneous tibial nerve stimulation for neurogenic lower urinary tract dysfunction
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Stalder, Stephanie A, Gross, Oliver, Anderson, Collene E, Bachmann, Lucas M, Baumann, Sarah, Birkhäuser, Veronika, Bywater, Mirjam, Del Popolo, Giulio, Engeler, Daniel S, Agrò, Enrico Finazzi, Friedl, Susanne, Grilo, Nuno, Kiss, Stephan, Koschorke, Miriam, Leitner, Lorenz, Liechti, Martina D, Mehnert, Ulrich, Musco, Stefania, Sadri, Helen, Stächele, Lara, Tornic, Jure, van der Lely, Stéphanie, Wyler, Stephen, Kessler, Thomas M, and University of Zurich
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610 Medicine & health ,10046 Balgrist University Hospital, Swiss Spinal Cord Injury Center - Published
- 2023
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3. Temporal development of unfavourable urodynamic parameters during the first year after spinal cord injury
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Collene E. Anderson, Marko Kozomara, Veronika Birkhäuser, Mirjam Bywater, Oliver Gross, Stephan Kiss, Stephanie C. Knüpfer, Miriam Koschorke, Lorenz Leitner, Ulrich Mehnert, Helen Sadri, Ulla Sammer, Lara Stächele, Jure Tornic, Martina D. Liechti, Martin W.G. Brinkhof, Thomas M. Kessler, and University of Zurich
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10062 Urological Clinic ,Urology ,610 Medicine & health ,10046 Balgrist University Hospital, Swiss Spinal Cord Injury Center - Abstract
To describe the temporal development of and risk factors for the occurrence of unfavourable urodynamic parameters during the first year after spinal cord injury (SCI).This population-based longitudinal study used data from 97 adult patients with a single-event traumatic or ischaemic SCI who underwent video-urodynamic investigation (UDI) at a university SCI centre. The first occurrences of unfavourable urodynamic parameters (detrusor overactivity combined with detrusor sphincter dyssynergia [DO-DSD], maximum storage detrusor pressure ≥40 cmHThe majority of the population (87/97 [90%]) had at least one unfavourable urodynamic parameter. Most unfavourable urodynamic parameters were initially identified during the 1- or 3-month UDI, including 92% of the DO-DSD (78/85), 82% of the maximum storage pressure ≥40 cmHThe first UDI should take place within 3 months after SCI as to facilitate early diagnosis of unfavourable urodynamic parameters and timely treatment. Neuro-urological guidelines and individualised management strategies for patients with SCI may be strengthened by considering sex and SCI characteristics in the scheduling of UDIs.
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- 2023
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4. Sacral Neuromodulation for Neurogenic Lower Urinary Tract Dysfunction
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Liechti, Martina D, van der Lely, Stéphanie, Knüpfer, Stephanie C, Abt, Dominik, Kiss, Bernhard, Leitner, Lorenz, Mordasini, Livio, Tornic, Jure, Wöllner, Jens, Mehnert, Ulrich, Bachmann, Lucas M, Burkhard, Fiona C, Engeler, Daniel S, Pannek, Jürgen, Kessler, Thomas M, and University of Zurich
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610 Medicine & health ,10046 Balgrist University Hospital, Swiss Spinal Cord Injury Center - Published
- 2022
5. Neurogenic Lower Urinary Tract Dysfunction in the First Year After Spinal Cord Injury: A Descriptive Study of Urodynamic Findings
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Marko Kozomara, Veronika Birkhäuser, Collene E. Anderson, Mirjam Bywater, Oliver Gross, Stephan Kiss, Stephanie C. Knüpfer, Miriam Koschorke, Lorenz Leitner, Ulrich Mehnert, Helen Sadri, Ulla Sammer, Lara Stächele, Jure Tornic, Martin W. G. Brinkhof, Martina D. Liechti, Thomas M. Kessler, and University of Zurich
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10062 Urological Clinic ,Urology ,Urinary Bladder ,Humans ,610 Medicine & health ,10046 Balgrist University Hospital, Swiss Spinal Cord Injury Center ,Spinal Cord Injuries - Abstract
We aimed to provide a real-world description of neurogenic lower urinary tract dysfunction within the first year after spinal cord injury with a focus on unfavorable urodynamic parameters that are associated with urological morbidity.Urodynamic investigations from 97 patients with traumatic or ischemic acute spinal cord injury and managed according to the European Association of Urology Guidelines on Neuro-Urology were analyzed at a single university spinal cord injury center at 1 month, 3 months, 6 months, and 12 months after injury. Unfavorable urodynamic parameters were defined as detrusor overactivity in combination with detrusor sphincter dyssynergia, maximum storage detrusor pressure of 40 cm HOne or more unfavorable urodynamic parameter was observed in 87 out of 97 patients (90%) within the first year after spinal cord injury. Eighty-eight percent of the patients showed detrusor overactivity with detrusor sphincter dyssynergia, 39% a maximum storage detrusor pressure of 40 cm HUsing a standardized urodynamic follow-up schedule, we found unfavorable urodynamic parameters in a majority of the population within the first year after spinal cord injury. As early treatment based on urodynamic findings might reduce the risk of deterioration of upper and lower urinary tract function, thereby improving long-term outcomes, there is need for further research regarding recommendations for a urodynamic follow-up schedule during the first year after spinal cord injury.
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- 2022
6. Randomised Controlled Trials Assessing the Clinical Value of Urodynamic Studies: A Systematic Review and Meta-analysis
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Nicolas S. Bodmer, Carla Wirth, Veronika Birkhäuser, Andrea M. Sartori, Lorenz Leitner, Marcio A. Averbeck, Stefan de Wachter, Enrico Finazzi Agro, Andrew Gammie, Howard B. Goldman, Ruth Kirschner-Hermanns, Peter F.W.M. Rosier, Maurizio Serati, Eskinder Solomon, Gommert van Koeveringe, Lucas M. Bachmann, Thomas M. Kessler, University of Zurich, and Bachmann, Lucas M
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2748 Urology ,Urodynamics ,Lower urinary tract symptoms ,Prostatic hyperplasia ,Stress ,Urinary incontinence ,Urology ,610 Medicine & health ,10046 Balgrist University Hospital, Swiss Spinal Cord Injury Center ,Human medicine - Abstract
Context: The role of urodynamic studies (UDSs) in the diagnosis of lower urinary tract symptoms (LUTS) is crucial. Although expert statements and guidelines underline their value for clinical decision-making in various clinical settings, the academic debate as to their impact on patient outcomes continues. Objective: To summarise the evidence from all randomised controlled trials assess-ing the clinical usefulness of UDS in the management of LUTS. Evidence acquisition: For this systematic review, searches were performed without language restrictions in three electronic databases until November 18, 2020. The inclusion criteria were randomised controlled study design and allocation to receive UDS or not prior to any clinical management. Quality assessment was per-formed by two reviewers independently, using the Cochrane Collaboration & rsquo;s tool for assessing the risk of bias. A random-effect meta-analysis was performed on the uniformly reported outcome parameters. Evidence synthesis: Eight trials were included, and all but two focused on women with pure or predominant stress urinary incontinence (SUI). A meta-analysis of six studies including 942 female patients was possible for treatment success, as defined by the authors (relative risk 1.00, 95% confidence interval: 0.93 & ndash;1.07), indi-cating no difference in efficacy when managing women with UDS. Conclusions: Although UDSs are not replaceable in diagnostics, since there is no other equivalent method to find out exactly what the lower urinary tract problem is, there are little data supporting its impact on outcomes. Randomised controlled trials have focussed on a small group of women with uncomplicated SUI and showed no added value, but these findings cannot be extrapolated to the overall patient population with LUTS, warranting further well-designed trials. Patient summary: Despite urodynamics being the gold standard to assess lower uri-nary tract symptoms (LUTS), as it is the only method that can specify lower urinary tract dysfunction, more studies assessing the clinical usefulness of urodynamic studies (UDSs) in the management of LUTS are needed. UDS investigation is not increasing the probability of success in the treatment of stress urinary incontinence. (c) 2022 The Authors. Published by Elsevier B.V. on behalf of European Association of Urology. This is an open access article under the CC BY license (http://creativecommons. org/licenses/by/4.0/).
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- 2022
7. Optimizing clinical trial design using prospective cohort study data: a case study in neuro-urology
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Thomas M. Kessler, Collene E Anderson, Lucas M. Bachmann, Martina D. Liechti, Stephanie A Stalder, Veronika Birkhäuser, Martin W. G. Brinkhof, Lorenz Leitner, Xavier Jordan, Sandra Möhr, Martin Schubert, Jürgen Pannek, Stéphanie van der Lely, Armin Curt, Ulrich Mehnert, University of Zurich, and Brinkhof, Martin W G
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030506 rehabilitation ,medicine.medical_specialty ,medicine.medical_treatment ,Urology ,Population ,610 Medicine & health ,Article ,law.invention ,Cohort Studies ,03 medical and health sciences ,0302 clinical medicine ,Randomized controlled trial ,law ,Medicine ,Humans ,Prospective cohort study ,education ,Spinal cord injury ,Spinal Cord Injuries ,education.field_of_study ,Clinical Trials as Topic ,Rehabilitation ,business.industry ,Urinary Bladder, Overactive ,Clinical study design ,General Medicine ,medicine.disease ,Clinical trial ,2728 Neurology (clinical) ,Neurology ,2808 Neurology ,Physical therapy ,10046 Balgrist University Hospital, Swiss Spinal Cord Injury Center ,Neurology (clinical) ,0305 other medical science ,business ,030217 neurology & neurosurgery ,Cohort study - Abstract
Study Design Simulations using data from a prospective cohort study. Objectives To illustrate how prospective cohort data can be employed in randomized controlled trial (RCT) planning to assess feasibility and operational challenges, using TASCI (Transcutaneous tibial nerve stimulation in patients with Acute Spinal Cord Injury to prevent neurogenic detrusor overactivity: a nationwide randomized, sham-controlled, double-blind clinical trial) as a case study. Setting Spinal cord injury rehabilitation centers in Switzerland. Methods TASCI is nested in the multicenter Swiss Spinal Cord Injury Cohort Study (SwiSCI), which prospectively includes patients with acute spinal cord injury. In simulations, data from 640 patients, collected by SwiSCI, were used to investigate different scenarios of patient eligibility and study consent, as well as the performance of the randomization list. Descriptive analysis was used to describe the population of interest and the simulation results; multivariable logistic regression analysis was performed to identify predictors of discharge within the TASCI intervention time period. Results The recruitment target of 114 patients is obtainable within the originally envisioned three-year time period under the most favorable recruitment scenario examined. The distribution of the primary prognostic factor produced imbalance in the randomization lists and informed further discussion of the cut-off values used in stratification. Influxes of patients resulted in overlapping intervention periods for multiple participants, which guided resource allocation. Early discharge was related to the primary prognostic factor and study center, but is only anticipated in about 8% of participants. Conclusions Prospective cohort data are a very valuable resource for planning RCTs.
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- 2020
8. A Method to Determine the Efficacy of a Commercial Phage Preparation against Uropathogens in Urine and Artificial Urine Determined by Isothermal Microcalorimetry
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Sigg, Aurelia Pahnita, Mariotti, Max, Grütter, Anabel E, Lafranca, Tecla, Leitner, Lorenz, Bonkat, Gernot, Braissant, Olivier, University of Zurich, and Braissant, Olivier
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Microbiology (medical) ,isothermal microcalorimetry ,bacteriophages ,phage cocktail ,E. coli ,P. mirabilis ,Virology ,2404 Microbiology ,technology, industry, and agriculture ,2406 Virology ,610 Medicine & health ,10046 Balgrist University Hospital, Swiss Spinal Cord Injury Center ,Microbiology ,2726 Microbiology (medical) - Abstract
Background: Urinary tract infections are commonly encountered and often treated with antibiotics. However, the inappropriate use of the latter has led to the appearance of resistant strains. In this context we investigate the use of calorimetry to rapidly determine if a phage cocktail can be used as alternative to antibiotics. Methods: We used a commercially available phage cocktail from an online pharmacy and tested it against a strain of Escherichia coli and a strain of Proteus mirabilis. We used isothermal microcalorimetry to follow the metabolic activity of the bacterial culture treated with the phage cocktail. Results: Isothermal microcalorimetry was able to follow the dynamic of the bacterial metabolic activity reduction by the phage cocktail. Both pathogens were strongly inhibited; however, some regrowth was observed for E. coli in urine. Conclusions: Isothermal microcalorimetry proved to be a valuable technique when investigating the efficacy of phage cocktails against uropathogens. We foresee that isothermal microcalorimetry could be used to obtain rapid phagograms.
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- 2022
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9. Bacteriophages: a Panacea in Neuro-Urology?
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Lorenz Leitner, Thomas M. Kessler, Jochen Klumpp, University of Zurich, and Klumpp, Jochen
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Urologic Diseases ,2748 Urology ,medicine.medical_specialty ,medicine.drug_class ,Urology ,Urinary system ,Antibiotics ,030232 urology & nephrology ,610 Medicine & health ,Panacea (medicine) ,03 medical and health sciences ,0302 clinical medicine ,Antibiotic resistance ,medicine ,Humans ,Neuro urology ,Bacteriophages ,In patient ,Phage Therapy ,Intensive care medicine ,business.industry ,Bacterial Infections ,Clinical research ,Bacteriophage Therapy ,030220 oncology & carcinogenesis ,Urinary Tract Infections ,10046 Balgrist University Hospital, Swiss Spinal Cord Injury Center ,Nervous System Diseases ,business - Abstract
Bacterial urinary tract infections (UTIs) are very frequent, especially in patients with neurogenic lower urinary tract dysfunction (NLUTD). The steady increase in antibiotic resistance among causative bacteria prompts the search for highly effective therapeutic alternatives with little or no side effects. Bacteriophages - obligate intracellular viruses that solely infect and kill bacteria - are promising tools for treating bacterial infections and have been used for this purpose for almost a century. Recent clinical studies using bacteriophage therapy for UTIs showed encouraging results. In particular, patients with recurrent UTIs, such as individuals with NLUTD who rely on assisted bladder emptying, might benefit from this treatment method. However, bacteriophages are not yet a panacea. More high-quality basic and clinical research on bacteriophage therapy is needed to answer questions on the use of this therapeutic option and its potential to provide a solution to the global threat of multidrug-resistant bacteria. PATIENT SUMMARY: Urinary tract infections are very common, especially in patients with neurogenic lower urinary tract dysfunction. In this review we discuss the potential of bacteriophage therapy as an alternative to antibiotics for treating patients with bladder infections.
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- 2020
10. Considering non-bladder etiologies of overactive bladder: A functional neuroimaging study
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Walter, Matthias, Leitner, Lorenz, Betschart, Cornelia, Engeler, Daniel S, Freund, Patrick, Kessler, Thomas M, Kollias, Spyros, Liechti, Martina D, Scheiner, David A, Michels, Lars, Mehnert, Ulrich, and University of Zurich
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10043 Clinic for Neuroradiology ,610 Medicine & health ,10046 Balgrist University Hospital, Swiss Spinal Cord Injury Center ,10174 Clinic for Gynecology - Published
- 2021
11. Detrusor sphincter dyssynergia: can a more specific definition distinguish between patients with and without an underlying neurological disorder?
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Thomas M. Kessler, Lorenz Leitner, Oliver Gross, Maria Rasenack, Martin Schubert, University of Zurich, and Kessler, Thomas M
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medicine.medical_specialty ,Neurogenic bladder ,030232 urology & nephrology ,Spinal cord diseases ,610 Medicine & health ,Neurological disorder ,Article ,03 medical and health sciences ,0302 clinical medicine ,Internal medicine ,medicine ,Humans ,Urinary Bladder, Neurogenic ,Spinal cord injury ,Spinal Cord Injuries ,Upper urinary tract ,business.industry ,General Medicine ,medicine.disease ,Clinical Practice ,Urodynamics ,2742 Rehabilitation ,Cross-Sectional Studies ,2728 Neurology (clinical) ,Neurology ,2808 Neurology ,Ataxia ,10046 Balgrist University Hospital, Swiss Spinal Cord Injury Center ,Neurology (clinical) ,Detrusor sphincter dyssynergia ,business ,Risk assessment ,030217 neurology & neurosurgery - Abstract
Study designCross-sectional study.ObjectivesTo evaluate if specific definitions of detrusor sphincter dyssynergia (DSD) might distinguish between individuals with spinal cord injury (SCI) and those with no underlying neurological disorder (NO ND).SettingSingle tertiary university SCI center.MethodsA series of 153 individuals, 81 with traumatic SCI and 72 with NO ND, were prospectively evaluated and included in this study. All individuals underwent a clinical neuro-urological examination, a neurophysiological work-up and a video-urodynamic investigation and were diagnosed with DSD as defined by the International Continence Society (ICS). We determined the DSD grades/types according to the classifications by Yalla (grade 1–3), Blaivas (type 1–3) and Weld (type 1–2). Distribution of the DSD grades/types were compared between SCI and NO ND individuals. Associations between the various DSD grades/types and clinical parameters, such as risk factors for upper urinary tract damage (all individuals) or lower extremity motor scores, SCI injury levels and severity scores (only SCI group), were assessed.ResultsThe distribution of all DSD types were similar between groups (p > 0.05). None of the DSD classifications allowed risk assessment for upper urinary tract damage. A significant association between DSD type and other clinical parameters could not be found (p > 0.05).ConclusionsNone of the investigated DSD definitions can distinguish between patients with SCI and with NO ND. The more complex DSD classifications by Yalla, Blaivas or Weld cannot compete with the ICS binary yes-no definition which is pragmatic and straightforward for managing patients in daily clinical practice.SponsorshipNone.
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- 2021
12. Bacteriophages: what role may they play in life after spinal cord injury?
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Lorenz Leitner, Thomas M. Kessler, Shawna McCallin, University of Zurich, and Kessler, Thomas M
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Phage therapy ,medicine.drug_class ,viruses ,medicine.medical_treatment ,Antibiotics ,Population ,Personalized treatment ,MEDLINE ,Spinal cord diseases ,610 Medicine & health ,Bioinformatics ,03 medical and health sciences ,0302 clinical medicine ,medicine ,Humans ,Bacteriophages ,Phage Therapy ,education ,Spinal cord injury ,Spinal Cord Injuries ,Cause of death ,Urinary tract infection ,0303 health sciences ,education.field_of_study ,Bacteria ,030306 microbiology ,business.industry ,030208 emergency & critical care medicine ,Bacterial Infections ,General Medicine ,medicine.disease ,Anti-Bacterial Agents ,Clinical Practice ,2742 Rehabilitation ,2728 Neurology (clinical) ,Neurology ,2808 Neurology ,Perspective ,10046 Balgrist University Hospital, Swiss Spinal Cord Injury Center ,Neurology (clinical) ,business - Abstract
Bacterial infections are the leading cause of death in people with a spinal cord injury (SCI). Bacteriophages (phages) are viruses that solely infect and kill bacteria. The idea of using phages to treat bacterial infections, i.e., phage therapy, is very promising and potentially allows a more specific and personalized treatment of bacterial infections than antibiotics. While multi-drug resistant infections affect individuals from the general population, alternative therapeutic options are especially warranted in high-risk populations, such as individuals with SCI. However, more clinical data must be collected before phage therapy can be implemented in clinical practice, with numerous possible, subsequent applications.
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- 2021
13. Intravesical bacteriophages for treating urinary tract infections in patients undergoing transurethral resection of the prostate: a randomised, placebo-controlled, double-blind clinical trial
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Leitner, Lorenz, Ujmajuridze, Aleksandre, Chanishvili, Nina, Goderdzishvili, Marina, Chkonia, Irina, Rigvava, Sophia, Chkhotua, Archil, Changashvili, Giorgi, McCallin, Shawna, Schneider, Marc P, Liechti, Martina D, Mehnert, Ulrich, Bachmann, Lucas M, Sybesma, Wilbert, Kessler, Thomas M, University of Zurich, and Kessler, Thomas M
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610 Medicine & health ,10046 Balgrist University Hospital, Swiss Spinal Cord Injury Center ,2725 Infectious Diseases - Published
- 2021
14. Behandlung von Harnwegsinfektionen mit Harnblasenspülungen: Vom Leitungswasser zu Bakteriophagen
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Leitner, Lorenz, Kessler, Thomas M, and University of Zurich
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0301 basic medicine ,Gynecology ,10062 Urological Clinic ,03 medical and health sciences ,medicine.medical_specialty ,030104 developmental biology ,0302 clinical medicine ,business.industry ,030232 urology & nephrology ,medicine ,610 Medicine & health ,10046 Balgrist University Hospital, Swiss Spinal Cord Injury Center ,business - Abstract
ZusammenfassungHarnwegsinfektionen (HWIs) gehören zu den grössten medizinischen Herausforderungen, insbesondere stellt uns der weltweit dramatische Anstieg von Antibiotikaresistenzen vor ungelöste Probleme. Patienten mit Dauerkatheter oder intermittierendem Katheterismus haben ein hohes Risiko für rezidivierende HWIs, aber auch für eine Übertherapie mit Antibiotika. Harnblasenspülungen mit Leitungswasser oder physiologischer Kochsalzlösung respektive Harnblaseninstillationen mit säurehaltigen, antiseptischen oder antimikrobiellen Substanzen sind eine vielversprechende Option zur Prophylaxe und Therapie von HWIs. Im Kampf gegen Antibiotikaresistenzen könnten Bakteriophagen, Viren, die ausschliesslich Bakterien befallen und abtöten, zu einem Durchbruch bei der Therapie von HWIs und bakteriellen Infektionen im Allgemeinen führen – doch der Weg dazu ist weit, und gut geplante prospektive Studien werden die nötige Evidenz liefern müssen.
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- 2021
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- View/download PDF
15. Update from TASCI, a Nationwide, Randomized, Sham-controlled, Double-blind Clinical Trial on Transcutaneous Tibial Nerve Stimulation in Patients with Acute Spinal Cord Injury to Prevent Neurogenic Detrusor Overactivity
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Martin W. G. Brinkhof, Lorenz Leitner, Martin Schubert, Stéphanie van der Lely, Collene E Anderson, Martina D. Liechti, Veronika Birkhäuser, Lucas M. Bachmann, Xavier Jordan, Stephanie A Stalder, Thomas M. Kessler, Jürgen Pannek, Ulrich Mehnert, Sandra Möhr, Armin Curt, University of Zurich, and Kessler, Thomas M
- Subjects
2748 Urology ,Urology ,Urinary system ,030232 urology & nephrology ,Tibial nerve stimulation ,610 Medicine & health ,Double blind ,03 medical and health sciences ,0302 clinical medicine ,Double-Blind Method ,Humans ,Medicine ,In patient ,Urinary Bladder, Neurogenic ,Spinal Cord Injuries ,Preparatory phase ,Urinary Bladder, Overactive ,business.industry ,Clinical trial ,030220 oncology & carcinogenesis ,Anesthesia ,Transcutaneous Electric Nerve Stimulation ,Acute spinal cord injury ,10046 Balgrist University Hospital, Swiss Spinal Cord Injury Center ,Tibial Nerve ,business - Abstract
Transcutaneous tibial nerve stimulation has the potential to revolutionize the management of lower urinary tract dysfunction in patients with acute spinal cord injury. TASCI is a nationwide randomized, sham-controlled, double-blind clinical trial for which the preparatory phase has been successfully completed.
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- 2020
16. Neuroimaging in Neuro-Urology
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Lars Michels, Martina D. Liechti, Ulrich Mehnert, Maryam Seif, Stéphanie van der Lely, Lorenz Leitner, University of Zurich, and Mehnert, Ulrich
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Urologic Diseases ,2748 Urology ,Parkinson's disease ,Urology ,media_common.quotation_subject ,Urinary system ,030232 urology & nephrology ,Neuroimaging ,610 Medicine & health ,Disease ,Bioinformatics ,Urination ,03 medical and health sciences ,0302 clinical medicine ,10043 Clinic for Neuroradiology ,Medicine ,Humans ,Spinal cord injury ,media_common ,medicine.diagnostic_test ,business.industry ,Multiple sclerosis ,medicine.disease ,030220 oncology & carcinogenesis ,10046 Balgrist University Hospital, Swiss Spinal Cord Injury Center ,Nervous System Diseases ,business ,Functional magnetic resonance imaging - Abstract
Neuroimaging allows in vivo visualization of neuronal structures/processes to assess their involvement in bodily functions. This is particularly valuable for the assessment of complex, multilevel neuronal controlled functions, such as urine storage and micturition. Using positron emission tomography or functional magnetic resonance imaging, significant alterations of supraspinal lower urinary tract (LUT) control have been described in patients with neurogenic LUT dysfunction due to spinal cord injury, Parkinson's disease, and multiple sclerosis. Severity of such alterations often correlates with symptom/dysfunction severity, both of which could be partly mitigated by therapeutic interventions. However, the overall evidence and study quality are presently very limited, and a multidisciplinary approach will be required to achieve clinical relevance in the long term. PATIENT SUMMARY: We reviewed the findings of neuroimaging studies in patients with bladder dysfunction due to neurological trauma/disease. Changes in the nervous systems of these patients alter bladder control, and neuroimaging may become a valuable tool for assessing these alterations.
- Published
- 2020
17. Transcutaneous Tibial Nerve Stimulation for Treating Neurogenic Lower Urinary Tract Dysfunction: A Pilot Study for an International Multicenter Randomized Controlled Trial
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Stephanie A Stalder, Thomas M. Kessler, Lorenz Leitner, Jure Tornic, Stéphanie van der Lely, Ulrich Mehnert, Martina D. Liechti, Veronika Birkhäuser, University of Zurich, and Kessler, Thomas M
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Adult ,Male ,2748 Urology ,Blinding ,Randomization ,Urology ,Urinary system ,030232 urology & nephrology ,Pilot Projects ,610 Medicine & health ,law.invention ,03 medical and health sciences ,0302 clinical medicine ,Randomized controlled trial ,Refractory ,Double-Blind Method ,Lower Urinary Tract Symptoms ,law ,Neuromodulation ,medicine ,Humans ,Prospective Studies ,Urinary Bladder, Neurogenic ,Adverse effect ,Prospective cohort study ,Aged ,business.industry ,Middle Aged ,medicine.anatomical_structure ,030220 oncology & carcinogenesis ,Anesthesia ,Transcutaneous Electric Nerve Stimulation ,Feasibility Studies ,Female ,10046 Balgrist University Hospital, Swiss Spinal Cord Injury Center ,Tibial Nerve ,business - Abstract
Background Tibial nerve stimulation (TNS) is an effective and safe treatment for idiopathic lower urinary tract dysfunction (LUTD), but its value in neurological patients is unclear. Objective To test the feasibility, acceptability, and safety of a randomized, sham-controlled, double-blind transcutaneous TNS (TTNS) setup for treating neurogenic LUTD. Design, setting, and participants A pilot study including nine patients with refractory neurogenic LUTD investigated prospectively at a university neuro-urology department. Intervention Randomized, sham-controlled, double-blind verum and sham TTNS was performed for 30 min twice a week, for 6 wks. Outcome measurements and statistical analysis Outcomes were feasibility, acceptability, and safety of the TTNS protocol. Secondarily, potential efficacy was investigated. Descriptive statistics were used. Results and limitations All procedures were feasible and well tolerated by all nine patients. Using verum TTNS, a motor response could be triggered in all patients and a sensory response in all but one. At the beginning and end of treatment, seven and six (78% and 67%) patients believed to receive verum TTNS, and five and six (56% and 67%) correctly guessed their group allocation, respectively. No treatment-related adverse events occurred. A comparison of baseline versus 6 wks of verum and sham TTNS led to relevant symptom and functional changes in only a limited number of piloted patients. Conclusions Verum and sham TTNS combined with the blinding procedures proved feasible and safe. Both interventions and procedures, as well as the randomization process, were well accepted by the patients. While the subsensory threshold TTNS approach in combination with the sham condition is advantageous for patients’ blinding, the clinical findings raised some doubt regarding sufficient TNS. Hence, relevant methodological adjustments concerning the adequate stimulation current and corresponding sham condition are needed before starting randomized controlled trials to clarify the value and role of TTNS in neuro-urology. Patient summary Transcutaneous tibial nerve stimulation is a promising treatment option for neurogenic lower urinary tract dysfunction, but methodological adjustments in treatment application are required before further prospective studies can be initiated.
- Published
- 2020
18. TASCI-transcutaneous tibial nerve stimulation in patients with acute spinal cord injury to prevent neurogenic detrusor overactivity: protocol for a nationwide, randomised, sham-controlled, double-blind clinical trial
- Author
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Birkhäuser, Veronika, Liechti, Martina D, Anderson, Collene E, Bachmann, Lucas M, Baumann, Sarah, Baumberger, Michael, Birder, Lori A, Botter, Sander M, Büeler, Silvan, Cruz, Célia D, David, Gergely, Freund, Patrick, Friedl, Susanne, Gross, Oliver, Hund-Georgiadis, Margret, Husmann, Knut, Jordan, Xavier, Koschorke, Miriam, Leitner, Lorenz, Luca, Eugenia, Mehnert, Ulrich, Möhr, Sandra, Mohammadzada, Freschta, Monastyrskaya, Katia, Pfender, Nikolai, Pohl, Daniel, Sadri, Helen, Sartori, Andrea M, Schubert, Martin, Sprengel, Kai, et al, and University of Zurich
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10021 Department of Trauma Surgery ,10219 Clinic for Gastroenterology and Hepatology ,610 Medicine & health ,10046 Balgrist University Hospital, Swiss Spinal Cord Injury Center ,11359 Institute for Regenerative Medicine (IREM) ,2700 General Medicine - Published
- 2020
19. Bladder management in patients undergoing spine surgery: An assessment of care delivery
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Mazda Farshad, Thomas M. Kessler, Lorenz Leitner, José Aguirre, Florian Wanivenhaus, Lucas M. Bachmann, Martina D. Liechti, University of Zurich, and Kessler, Thomas M
- Subjects
medicine.medical_specialty ,Lower urinary tract dysfunction ,Urinary system ,610 Medicine & health ,2732 Orthopedics and Sports Medicine ,Spine surgery ,medicine ,Urethral catheterization ,RC346-429 ,Adverse effect ,are delivery ,Orthopedic surgery ,Urinary retention ,business.industry ,Bladder management ,Perioperative ,2746 Surgery ,Postoperative urinary retention ,Surgery ,Catheter ,2728 Neurology (clinical) ,Postoperative monitoring ,10046 Balgrist University Hospital, Swiss Spinal Cord Injury Center ,International Prostate Symptom Score ,Neurology. Diseases of the nervous system ,medicine.symptom ,business ,RD701-811 - Abstract
Background: Lower urinary tract dysfunction is common in the early postoperative phase after spine surgery. Although it is essential for an optimal patient management to balance benefits and harms, it is not known which patient benefit from a perioperative indwelling catheter. We therefore evaluated urological parameters prior and after spine surgery performing a quality assessment of our current clinical practice in bladder management. Methods: Preoperatively, all patients completed the International Prostate Symptom Score and were interviewed for urological history. Decision for preoperative urethral catheter placement was individually made by the responsible anesthesiologist according to an in-house protocol. Within and between group analyses using univariate and probability matching statistics were performed for patients with intraoperative urethral catheter-free management (n = 54) and those with a preoperatively placed catheter (n = 46). Post void residual (PVR) was measured prior and after surgery or after removal of the urethral catheter, respectively. The outcome measures consisted of postoperative urinary retention (POUR) and postoperative urological complications (PUC), defined as POUR and any catheter-related adverse events. Results: Hundred patients undergoing spine surgery were prospectively evaluated. Sixteen of the 54 (30%) patients with urethral catheter-free management developed POUR. Length of surgery and volume of intravenous infusion were associated with POUR (p
- Published
- 2021
20. A novel infusion-drainage device to assess lower urinary tract function in neuro-imaging
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Jörg Diefenbacher, Thomas M. Kessler, Ulrich Mehnert, Johann Wanek, Spyros Kollias, Lars Michels, Matthias Walter, Martina D. Liechti, Lorenz Leitner, Behnaz Jarrahi, University of Zurich, and Mehnert, Ulrich
- Subjects
2748 Urology ,Adult ,Male ,medicine.medical_specialty ,Brain activity and meditation ,Urology ,Urinary Bladder ,030232 urology & nephrology ,610 Medicine & health ,Statistical parametric mapping ,03 medical and health sciences ,0302 clinical medicine ,Neuroimaging ,10043 Clinic for Neuroradiology ,Functional neuroimaging ,Humans ,Medicine ,Urinary bladder ,medicine.diagnostic_test ,business.industry ,Functional Neuroimaging ,Diagnostic Techniques, Urological ,Magnetic resonance imaging ,Equipment Design ,Magnetic Resonance Imaging ,Surgery ,medicine.anatomical_structure ,10036 Medical Clinic ,Drainage ,10046 Balgrist University Hospital, Swiss Spinal Cord Injury Center ,Female ,Synchronism ,business ,Functional magnetic resonance imaging ,030217 neurology & neurosurgery ,Biomedical engineering - Abstract
Objective To evaluate the applicability and precision of a novel infusion-drainage device (IDD) for standardised filling paradigms in neuro-urology and functional magnetic resonance imaging (fMRI) studies of lower urinary tract (LUT) (dys)function. Subjects/patients and methods The IDD is based on electrohydrostatic actuation which was previously proven feasible in a prototype setup. The current design includes hydraulic cylinders and a motorised slider to provide force and motion. Methodological aspects have been assessed in a technical application laboratory as well as in healthy subjects (n=33) and patients with LUT dysfunction (n=3) undergoing fMRI during bladder stimulation. After catheterisation, the bladder was pre-filled until a persistent desire to void was reported from each subject. The scan paradigm comprised of automated, repetitive bladder filling and withdrawal of 100 mL body warm (37° C) saline interleaved with rest and sensation rating. Neuroimaging data were analysed using Statistical Parametric Mapping 12. Results Volume delivery accuracy was between 99.1±1.2% and 99.9±0.2%, for different flowrates and volumes. MR compatibility was demonstrated with a small decrease in signal-to-noise ratio (SNR), i.e. 1.13% for anatomical and 0.54% for functional scans and a decrease of 1.76% for time-variant SNR. Automated, repetitive bladder filling elicited robust (p=0.05, family-wise error corrected) brain activity in areas previously reported to be involved in supraspinal LUT control. There was a high synchronism between the LUT stimulation and the blood oxygenation level dependent (BOLD) signal changes in such areas. Conclusion We were able to develop a magnetic resonance (MR) compatible and MR synchronised IDD to routinely stimulate the LUT during fMRI in a standardized manner. The device provides LUT stimulation at high system accuracy resulting in significant supraspinal BOLD signal changes in interoceptive and LUT control areas in congruence to the applied stimuli. The IDD is commercially available, portable, and multi-configurable. Such a device may help to improve precision and standardization of LUT tasks in neuroimaging studies on supraspinal LUT control, and may therefore facilitate multi-site studies and comparability between different LUT investigations in the future. This article is protected by copyright. All rights reserved.
- Published
- 2016
21. The Challenge of Asymptomatic Bacteriuria and Symptomatic Urinary Tract Infections in Patients with Neurogenic Lower Urinary Tract Dysfunction
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Jens Wöllner, Jure Tornic, Lorenz Leitner, Thomas M. Kessler, Ulrich Mehnert, Lucas M. Bachmann, and University of Zurich
- Subjects
Male ,2748 Urology ,medicine.medical_specialty ,Bacteriuria ,Urology ,Urinary system ,030232 urology & nephrology ,610 Medicine & health ,urologic and male genital diseases ,Gastroenterology ,03 medical and health sciences ,0302 clinical medicine ,Risk Factors ,Internal medicine ,medicine ,Prevalence ,Humans ,In patient ,Prospective Studies ,Urinary Bladder, Neurogenic ,Asymptomatic bacteriuria ,Urinary bladder ,business.industry ,Incidence (epidemiology) ,Incidence ,Middle Aged ,medicine.disease ,Urodynamics ,medicine.anatomical_structure ,Urinary Tract Infections ,Female ,10046 Balgrist University Hospital, Swiss Spinal Cord Injury Center ,business - Abstract
We investigated the prevalence of asymptomatic bacteriuria and the incidence of symptomatic urinary tract infections in patients with neurogenic lower urinary tract dysfunction undergoing urodynamics. We also assessed predictors of symptomatic urinary tract infections.We evaluated a prospective consecutive series of 317 patients, including 106 women and 211 men, with neurogenic lower urinary tract dysfunction. Of the patients 111 (35%) voided spontaneously, 141 (44%) relied on intermittent self-catheterization and 65 (21%) relied on an indwelling catheter. Before urodynamics the urine samples were collected by sterile catheterization for dipstick testing and urine culture. We assessed the association of patient characteristics with symptomatic urinary tract infections after urodynamics in patients with asymptomatic bacteriuria and developed a prediction model based on the most important risk factors.Before urodynamics urine cultures were negative in 123 patients (39%) and positive in 194 (61%).A symptomatic urinary tract infection will develop in the followup year in about 1 of 5 patients with asymptomatic bacteriuria. This rather low overall probability precludes routine antibiotic prophylaxis or treatment in patients with neurogenic lower urinary tract dysfunction who have asymptomatic bacteriuria since 4 of 5 would be overtreated. However, in patients with a history of previous symptomatic urinary tract infections antibiotic prescription might be justified.
- Published
- 2019
22. Reliability of supraspinal correlates to lower urinary tract stimulation in healthy participants: A fMRI study
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Lorenz Leitner, Martina D. Liechti, Thomas M. Kessler, Spyros Kollias, Lars Michels, Ulrich Mehnert, Patrick Freund, Matthias Walter, University of Zurich, and Mehnert, Ulrich
- Subjects
Adult ,Male ,2805 Cognitive Neuroscience ,medicine.medical_specialty ,Ventrolateral prefrontal cortex ,Adolescent ,Intraclass correlation ,Cognitive Neuroscience ,Urinary Bladder ,610 Medicine & health ,Audiology ,Insular cortex ,behavioral disciplines and activities ,050105 experimental psychology ,Young Adult ,03 medical and health sciences ,0302 clinical medicine ,Region of interest ,Functional neuroimaging ,10043 Clinic for Neuroradiology ,medicine ,Humans ,0501 psychology and cognitive sciences ,medicine.diagnostic_test ,business.industry ,05 social sciences ,Brain ,Middle Aged ,Magnetic Resonance Imaging ,medicine.anatomical_structure ,Neurology ,nervous system ,2808 Neurology ,Female ,Orbitofrontal cortex ,10046 Balgrist University Hospital, Swiss Spinal Cord Injury Center ,Functional magnetic resonance imaging ,business ,Insula ,030217 neurology & neurosurgery ,psychological phenomena and processes - Abstract
Previous functional neuroimaging studies provided evidence for a specific supraspinal network involved in lower urinary tract (LUT) control. However, data on the reliability of blood oxygenation level-dependent (BOLD) signal changes during LUT task-related functional magnetic resonance imaging (fMRI) across separate measurements are lacking. Proof of the latter is crucial to evaluate whether fMRI can be used to assess supraspinal responses to LUT treatments. Therefore, we prospectively assessed task-specific supraspinal responses from 20 healthy participants undergoing two fMRI measurements (test-retest) within 5-8 weeks. The fMRI measurements, conducted in a 3T magnetic resonance (MR) scanner, comprised a block design of repetitive bladder filling and drainage using an automated MR-compatible and MR-synchronized infusion-drainage device. Following transurethral catheterization and bladder pre-filling with body warm saline until participants perceived a persistent desire to void (START condition), fMRI was recorded during repetitive blocks (each 15 s) of INFUSION and WITHDRAWAL of 100 mL body warm saline into respectively from the bladder. BOLD signal changes were calculated for INFUSION minus START. In addition to whole brain analysis, we assessed BOLD signal changes within multiple 'a priori' region of interest (ROI), i.e. brain areas known to be involved in the LUT control from previous literature. To evaluate reliability of the fMRI results between visits, we applied different types of analyses: coefficient of variation (CV), intraclass correlation coefficient (ICC), Sorensen-Dice index, Bland-Altman method, and block-wise BOLD signal comparison. All participants completed the study without adverse events. The desire to void was rated significantly higher for INFUSION compared to START or WITHDRAWAL at both measurements without any effect of visit. At whole brain level, significant (p
- Published
- 2019
23. Adapted Bacteriophages for Treating Urinary Tract Infections
- Author
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Ulrich Mehnert, Thomas M. Kessler, Nina Chanishvili, Wilbert Sybesma, Archil Chkhotua, Aleksandre Ujmajuridze, Marina Goderdzishvili, Lorenz Leitner, University of Zurich, and Kessler, Thomas M
- Subjects
0301 basic medicine ,Microbiology (medical) ,medicine.medical_specialty ,antibiotic resistance ,Urology ,Urinary system ,030106 microbiology ,lcsh:QR1-502 ,bacteriophage therapy ,610 Medicine & health ,adaptation ,medicine.disease_cause ,Gastroenterology ,Microbiology ,lcsh:Microbiology ,2726 Microbiology (medical) ,law.invention ,03 medical and health sciences ,Antibiotic resistance ,Randomized controlled trial ,law ,Internal medicine ,medicine ,Adverse effect ,Original Research ,biology ,Pseudomonas aeruginosa ,business.industry ,Streptococcus ,2404 Microbiology ,biology.organism_classification ,Proteus mirabilis ,Tolerability ,Staphylococcus aureus ,10046 Balgrist University Hospital, Swiss Spinal Cord Injury Center ,urinary tract infection ,business ,Pyo bacteriophage - Abstract
Urinary tract infections (UTIs) are among the most widespread microbial diseases and their economic impact on the society is substantial. The continuing increase of antibiotic resistance worldwide is worrying. As a consequence, well-tolerated, highly effective therapeutic alternatives are without delay needed. Although it has been demonstrated that bacteriophage therapy may be effective and safe for treating UTIs, the number of studied patients is low and there is a lack of randomized controlled trials (RCTs). The present study has been designed as a two-phase prospective investigation: (1) bacteriophage adaptation, (2) treatment with the commercially available but adapted Pyo bacteriophage. The aim was to evaluate feasibility, tolerability, safety, and clinical/microbiological outcomes in a case series as a pilot for a double-blind RCT. In the first phase, patients planned for transurethral resection of the prostate were screened (n = 130) for UTIs and enrolled (n = 118) in the study when the titer of predefined uropathogens (Staphylococcus aureus, E. coli, Streptococcus spp., Pseudomonas aeruginosa, Proteus mirabilis) in the urine culture was ≥104 colony forming units/mL. In vitro analysis showed a sensitivity for uropathogenic bacteria to Pyo bacteriophage of 41% (48/118) and adaptation cycles of Pyo bacteriophage enhanced its sensitivity to 75% (88/118). In the second phase, nine patients were treated with adapted Pyo bacteriophage and bacteria titer decreased (between 1 and 5 log) in six of the nine patients (67%). No bacteriophage-associated adverse events have been detected. The findings of our prospective two-phase study suggest that adapted bacteriophage therapy might be effective and safe for treating UTIs. Thus, well-designed RCTs are highly warranted to further define the role of this potentially revolutionizing treatment option.
- Published
- 2018
24. Prediction of autonomic dysreflexia during urodynamics: a prospective cohort study
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Jacquelyn J. Cragg, Armin Curt, Stephanie C. Knüpfer, Martin Schubert, Marc P. Schneider, Matthias Walter, Lorenz Leitner, Thomas M. Kessler, Ulrich Mehnert, Andrei V. Krassioukov, University of Zurich, and Kessler, Thomas M
- Subjects
Male ,Urinary system ,030232 urology & nephrology ,lcsh:Medicine ,610 Medicine & health ,Neurogenic detrusor overactivity ,Spinal cord injury ,2700 General Medicine ,Autonomic dysreflexia ,Cohort Studies ,Lesion ,03 medical and health sciences ,0302 clinical medicine ,Urodynamic investigation ,Humans ,Medicine ,Prospective Studies ,Prospective cohort study ,Stroke ,business.industry ,lcsh:R ,Neurogenic lower urinary tract dysfunction ,General Medicine ,Odds ratio ,Middle Aged ,Spinal cord ,medicine.disease ,Urodynamics ,medicine.anatomical_structure ,Anesthesia ,Female ,10046 Balgrist University Hospital, Swiss Spinal Cord Injury Center ,medicine.symptom ,Prediction ,business ,030217 neurology & neurosurgery ,Research Article - Abstract
Background: Autonomic dysreflexia is a severe and potentially life-threatening condition in patients with spinal cord injury, as it can lead to myocardial ischemia, brain hemorrhage, or even death. Urodynamic investigation is the gold standard to assess neurogenic lower urinary tract dysfunction due to spinal cord injury and reveal crucial pathological findings, such as neurogenic detrusor overactivity. However, neurogenic detrusor overactivity and urodynamic investigation are known to be leading triggers of autonomic dysreflexia. Therefore, we aimed to determine predictors of autonomic dysreflexia in individuals with spinal cord injury during urodynamic investigation. Methods: This prospective cohort study included 300 patients with spinal cord injuries and complete datasets of continuous non-invasive cardiovascular monitoring, recorded during same session repeat urodynamic investigation. We used logistic regression to reveal predictors of autonomic dysreflexia during urodynamic investigation. Results: We found that level of injury and presence of neurogenic detrusor overactivity were the only two independent significant predictors for autonomic dysreflexia during urodynamic investigation. A lesion at spinal segment T6 or above (odds ratio (OR) 5.5, 95% CI 3.2–9.4) compared to one at T7 or below, and presence of neurogenic detrusor overactivity (OR 2.7, 95% confidence interval (CI) 1.4–4.9) were associated with a significant increased odds of autonomic dysreflexia during urodynamic investigation. Both odds persisted after adjustment for age, sex, and completeness and stage of injury (adjusted OR (AOR) 6.6, 95% CI 3.8–11.7, and AOR 2.2, 95% CI 1.1–4.5, respectively). Further stratification by lesion level showed level-dependent significantly increased adjusted odds of autonomic dysreflexia, i.e., from C1–C4 (AOR 16.2, 95% CI 5.9–57.9) to T4–T6 (AOR 2.6, 95% CI 1.3–5.2), compared to lesions at T7 or below. Conclusions: In patients with neurogenic lower urinary tract dysfunction due to spinal cord injury, autonomic dysreflexia is independently predicted by lesion level and presence of neurogenic detrusor overactivity. Considering the health risks associated with autonomic dysreflexia, such as seizures, stroke, retinal bleeding, or even death, we recommend both continuous cardiovascular monitoring during urodynamic investigation in all spinal cord-injured patients with emphasis on those with cervical lesions, and appropriate neurogenic detrusor overactivity treatment to reduce the probability of potentially life-threatening complications. Trial registration ClinicalTrials.gov, NCT01293110 .
- Published
- 2018
25. Bacteriophages for treating urinary tract infections in patients undergoing transurethral resection of the prostate: a randomized, placebo-controlled, double-blind clinical trial
- Author
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Thomas M. Kessler, Lucas M. Bachmann, Nina Chanishvili, Lorenz Leitner, Archil Chkhotua, Marina Goderdzishvili, Wilbert Sybesma, Ulrich Mehnert, Marc P. Schneider, Andrea M. Sartori, Aleksandre Ujmajuridze, University of Zurich, and Kessler, Thomas M
- Subjects
0301 basic medicine ,Male ,2748 Urology ,medicine.medical_specialty ,Urinalysis ,medicine.drug_class ,Urology ,medicine.medical_treatment ,Antibiotic sensitivity ,030106 microbiology ,Antibiotics ,Resistance ,610 Medicine & health ,lcsh:RC870-923 ,Placebo ,law.invention ,03 medical and health sciences ,Study Protocol ,Antibiotic resistance ,Randomized controlled trial ,Double-Blind Method ,law ,Internal medicine ,medicine ,Humans ,Bacteriophages ,Phage Therapy ,Transurethral resection of the prostate ,Urinary tract infection ,medicine.diagnostic_test ,business.industry ,Transurethral Resection of Prostate ,General Medicine ,2743 Reproductive Medicine ,lcsh:Diseases of the genitourinary system. Urology ,3. Good health ,Surgery ,Clinical trial ,030104 developmental biology ,Treatment Outcome ,Reproductive Medicine ,Urinary Tract Infections ,10046 Balgrist University Hospital, Swiss Spinal Cord Injury Center ,business ,Randomized placebo-controlled double-blind trial - Abstract
Urinary tract infections (UTI) are among the most prevalent microbial diseases and their financial burden on society is substantial. The continuing increase of antibiotic resistance worldwide is alarming. Thus, well-tolerated, highly effective therapeutic alternatives are urgently needed. Although there is evidence indicating that bacteriophage therapy may be effective and safe for treating UTIs, the number of investigated patients is low and there is a lack of randomized controlled trials. This study is the first randomized, placebo-controlled, double-blind trial investigating bacteriophages in UTI treatment. Patients planned for transurethral resection of the prostate are screened for UTIs and enrolled if in urine culture eligible microorganisms ≥104 colony forming units/mL are found. Patients are randomized in a double-blind fashion to the 3 study treatment arms in a 1:1:1 ratio to receive either: a) bacteriophage (i.e. commercially available Pyo bacteriophage) solution, b) placebo solution, or c) antibiotic treatment according to the antibiotic sensitivity pattern. All treatments are intended for 7 days. No antibiotic prophylaxes will be given to the double-blinded treatment arms a) and b). As common practice, the Pyo bacteriophage cocktail is subjected to periodic adaptation cycles during the study. Urinalysis, urine culture, bladder and pain diary, and IPSS questionnaire will be completed prior to and at the end of treatment (i.e. after 7 days) or at withdrawal/drop out from the study. Patients with persistent UTIs will undergo antibiotic treatment according to antibiotic sensitivity pattern. Based on the high lytic activity and the potential of resistance optimization by direct adaptation of bacteriophages, and considering the continuing increase of antibiotic resistance worldwide, bacteriophage therapy is a very promising treatment option for UTIs. Thus, our randomized controlled trial investigating bacteriophages for treating UTIs will provide essential insights into this potentially revolutionizing treatment option. This study has been registered at clinicaltrials.gov ( www.clinicaltrials.gov/ct2/show/NCT03140085 ). April 27, 2017.
- Published
- 2017
26. Intradetrusor onabotulinumtoxinA injections for refractory neurogenic detrusor overactivity incontinence: do we need urodynamic investigation for outcome assessment?
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Koschorke, Miriam, Leitner, Lorenz, Sadri, Helen, Knüpfer, Stephanie C, Mehnert, Ulrich, Kessler, Thomas M, University of Zurich, and Kessler, Thomas M
- Subjects
2748 Urology ,610 Medicine & health ,10046 Balgrist University Hospital, Swiss Spinal Cord Injury Center - Published
- 2017
27. Antibiotic prophylaxis may not be necessary in patients with asymptomatic bacteriuria undergoing intradetrusor onabotulinumtoxinA injections for neurogenic detrusor overactivity
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Ulla Sammer, Matthias Walter, Burkhardt Seifert, Stephanie C. Knüpfer, Thomas M. Kessler, Lorenz Leitner, Marc P. Schneider, Ulrich Mehnert, Jure Tornic, University of Zurich, and Kessler, Thomas M
- Subjects
Male ,Urological manifestations ,Neurology ,Bladder ,030232 urology & nephrology ,Acetylcholine Release Inhibitors ,urologic and male genital diseases ,0302 clinical medicine ,Medicine ,Prospective Studies ,Antibiotic prophylaxis ,Botulinum Toxins, Type A ,Prospective cohort study ,Asymptomatic Infections ,media_common ,Multidisciplinary ,Urinary bladder ,Middle Aged ,female genital diseases and pregnancy complications ,medicine.anatomical_structure ,030220 oncology & carcinogenesis ,Anesthesia ,10046 Balgrist University Hospital, Swiss Spinal Cord Injury Center ,Female ,Adult ,medicine.medical_specialty ,Bacteriuria ,Urinary system ,media_common.quotation_subject ,Urination ,610 Medicine & health ,Article ,Injections ,03 medical and health sciences ,Internal medicine ,Humans ,Adverse effect ,Aged ,1000 Multidisciplinary ,10242 Brain Research Institute ,business.industry ,Urinary Bladder, Overactive ,10060 Epidemiology, Biostatistics and Prevention Institute (EBPI) ,Odds ratio ,Antibiotic Prophylaxis ,medicine.disease ,business - Abstract
Many of the patients undergoing intradetrusor onabotulinumtoxinA injections for refractory neurogenic detrusor overactivity (NDO) present with chronic bacteriuria. In these patients, antibiotic prophylaxis has been widely recommended since bacteriuria might impair treatment efficacy and cause urinary tract infections (UTI) but the evidence is limited. The aim of this study was to evaluate if an antibiotic prophylaxis is needed in patients with asymptomatic bacteriuria undergoing intradetrusor onabotulinumtoxinA injections. Between 06/2012 and 12/2014, a consecutive series of 154 patients undergoing a total of 273 treatment cycles were prospectively evaluated. Before treatment urine samples were collected, patients with no clinical signs for UTI underwent onabotulinumtoxinA injections, no antibiotic prophylaxis was given. Asymptomatic bacteriuria was found in 73% (200/273 treatments). Following treatment, UTI occurred in 5% (9/200) and 7% (5/73) of patients with and without bacteriuria, respectively. Intradetrusor onabotulinumtoxinA injections were clinically and urodynamically successful in 70% (192/273). There was no association between bacteriuria and treatment-related adverse events (odds ratio 0.64, 95% CI 0.23–1.81, p = 0.4) nor between bacteriuria and therapy failure (odds ratio 0.78, 95% CI 0.43–1.43, p = 0.4). Thus, we conclude that antibiotic prophylaxis needs to be critically reconsidered in patients undergoing intradetrusor onabotulinumtoxinA injections, especially taking into account the alarming antibiotic resistance worldwide., Scientific Reports, 6, ISSN:2045-2322
- Published
- 2016
28. Urodynamic Investigation: A Valid Tool to Define Normal Lower Urinary Tract Function?
- Author
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Stephanie C. Knüpfer, Matthias Walter, Ulrich Mehnert, Lorenz Leitner, Thomas M. Kessler, Ulla Sammer, and University of Zurich
- Subjects
Male ,Muscle Physiology ,Physiology ,030232 urology & nephrology ,Social Sciences ,lcsh:Medicine ,0302 clinical medicine ,Surveys and Questionnaires ,Medicine and Health Sciences ,Psychology ,Prospective Studies ,Prospective cohort study ,lcsh:Science ,Flow Rate ,030219 obstetrics & reproductive medicine ,Multidisciplinary ,Urinary bladder ,Physics ,Classical Mechanics ,Middle Aged ,Urinary Bladder Neck Obstruction ,Bioassays and Physiological Analysis ,medicine.anatomical_structure ,Physical Sciences ,10046 Balgrist University Hospital, Swiss Spinal Cord Injury Center ,Female ,Sensory Perception ,Anatomy ,Detrusor sphincter dyssynergia ,Muscle Electrophysiology ,Research Article ,Biotechnology ,Muscle Contraction ,Cohort study ,Adult ,medicine.medical_specialty ,Catheters ,Bladder ,Urology ,Urinary Bladder ,610 Medicine & health ,1100 General Agricultural and Biological Sciences ,Fluid Mechanics ,Research and Analysis Methods ,Continuum Mechanics ,Young Adult ,03 medical and health sciences ,Bladder outlet obstruction ,Lower Urinary Tract Symptoms ,1300 General Biochemistry, Genetics and Molecular Biology ,Lower urinary tract symptoms ,medicine ,Humans ,1000 Multidisciplinary ,Urinary Bladder, Overactive ,Electromyography ,business.industry ,Electrophysiological Techniques ,Gold standard ,Urinary bladder neck obstruction ,lcsh:R ,Biology and Life Sciences ,Fluid Dynamics ,Renal System ,medicine.disease ,Urodynamics ,Medical Devices and Equipment ,lcsh:Q ,business ,Neuroscience - Abstract
Objectives To evaluate whether urodynamic investigation (UDI), the gold standard to assess refractory lower urinary tract symptoms (LUTS), is appropriate to select healthy volunteers with apparent normal lower urinary tract function as control subjects for comparative studies. Subjects and Methods 42 healthy subjects (22 women, mean age 32±10 years; 20 men, mean age 37±12 years) without LUTS were included into this prospective single-centre cohort study. All subjects recorded a 3-day bladder diary, completed validated questionnaires regarding LUTS, and underwent neuro-urological assessment as well as free uroflowmetry. Same session repeat UDI was performed according to “Good Urodynamic Practice” recommended by the International Continence Society, but using an air-charged instead of a water-filled catheter, and evaluated by a blinded investigator. Results All 3-day bladder diaries, LUTS questionnaires, neuro-urological assessments and free uroflowmetries were within normal limits. Overall (either during the first or second UDI), same session repeat UDI revealed pathological findings in 71% (30/42): Detrusor overactivity was detected in 14% (3/22) and 30% (6/20), post void residual >100mL in 14% (3/22) and 25% (5/20), bladder outlet obstruction in 9% (2/22) and 20% (4/20) and detrusor sphincter dyssynergia in 77% (17/22) and 65% (13/20) of our women and men, respectively. Repeatability of detrusor overactivity (κ = 0.78, 95% CI: 0.54–1.02) and detrusor sphincter dyssynergia (κ = 0.77, 95% CI: 0.55–0.98) showed substantial agreement between both UDIs. All other assessed urodynamic parameters had wide 95% limits of agreement for differences in the parameters indicating poor repeatability. Conclusions More than 70% of our healthy subjects showed pathological urodynamic findings. Although UDI is the gold standard to assess refractory LUTS, it seems not to be applicable in healthy subjects to define normal lower urinary tract function. Therefore, we do not recommend using UDI to select healthy control subjects.
- Published
- 2016
29. Protocol for a prospective magnetic resonance imaging study on supraspinal lower urinary tract control in healthy subjects and spinal cord injury patients undergoing intradetrusor onabotulinumtoxinA injections for treating neurogenic detrusor overactivity
- Author
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Patrick Freund, Lars Michels, Matthias Walter, Thomas M. Kessler, Lorenz Leitner, Ulrich Mehnert, Spyros Kollias, University of Zurich, and Kessler, Thomas M
- Subjects
Nervous system ,2748 Urology ,medicine.medical_specialty ,Urinary system ,Urology ,Central nervous system ,030232 urology & nephrology ,Neuroimaging ,610 Medicine & health ,Spinal cord injury ,Neurogenic detrusor overactivity ,Injections, Intramuscular ,03 medical and health sciences ,Study Protocol ,0302 clinical medicine ,10043 Clinic for Neuroradiology ,OnabotulinumtoxinA intradetrusor injections ,medicine ,Humans ,Prospective Studies ,Botulinum Toxins, Type A ,Urinary Bladder, Neurogenic ,Urinary Tract ,Spinal Cord Injuries ,Upper urinary tract ,Urinary bladder ,medicine.diagnostic_test ,business.industry ,Urinary Bladder, Overactive ,Magnetic resonance imaging ,General Medicine ,2743 Reproductive Medicine ,medicine.disease ,Magnetic Resonance Imaging ,3. Good health ,medicine.anatomical_structure ,Reproductive Medicine ,Neuromuscular Agents ,10036 Medical Clinic ,Anesthesia ,10046 Balgrist University Hospital, Swiss Spinal Cord Injury Center ,business ,030217 neurology & neurosurgery - Abstract
Background The control of the lower urinary tract is a complex, multilevel process involving both the peripheral and central nervous system. Due to lesions of the neuraxis, most spinal cord injury patients suffer from neurogenic lower urinary tract dysfunction, which may jeopardise upper urinary tract function and has a negative impact on health-related quality of life. However, the alterations to the nervous system following spinal cord injury causing neurogenic lower urinary tract dysfunction and potential effects of treatments such as intradetrusor onabotulinumtoxinA injections on lower urinary tract control are poorly understood. Methods/Design This is a prospective structural and functional magnetic resonance imaging study investigating the supraspinal lower urinary tract control in healthy subjects and spinal cord injury patients undergoing intradetrusor onabotulinumtoxinA injections for treating neurogenic detrusor overactivity. Neuroimaging data will include structural magnetic resonance imaging (T1-weighted imaging and diffusion tensor imaging) as well as functional, i.e. blood oxygen level-dependent sensitive magnetic resonance imaging using a 3 T magnetic resonance scanner. The functional magnetic resonance imaging will be performed simultaneously to three different bladder stimulation paradigms using an automated magnetic resonance compatible and synchronised pump system. All subjects will undergo two consecutive and identical magnetic resonance imaging measurements. Healthy subjects will not undergo any intervention between measurements but spinal cord injury patients will receive intradetrusor onabotulinumtoxinA injections for treating neurogenic detrusor overactivity. Parameters of the clinical assessment including bladder diary, urinalysis, medical history, neuro-urological examination, urodynamic investigation as well as standardised questionnaires regarding lower urinary tract function and quality of life will serve as co-variates in the magnetic resonance imaging analysis. Discussion This study will identify structural and functional alterations in supraspinal networks of lower urinary tract control in spinal cord injury patients with neurogenic detrusor overactivity compared to healthy controls. Post-treatment magnetic resonance imaging measurements in spinal cord injury patients will provide further insights into the mechanism of action of treatments such as intradetrusor onabotulinumtoxinA injections and the effect on supraspinal lower urinary tract control. Trial registration ClinicalTrials.gov NCT01768910.
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