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Context: Nocturia is among the most common and bothersome lower urinary tract symptoms (LUTS), but there is no clear consensus on how to identify and manage this symptom in the neurological population. Objective: To systematically review the literature about nocturia in neurological patients. Evidence acquisition: Studies were identified by electronic search of Cochrane and Medline databases. The studies were included if their participants had acquired neurological pathology among multiple sclerosis (MS), Parkinson's disease (PD), stroke, spinal cord injury (SCI), and reported data on the epidemiology, aetiology, diagnosis, or treatment of nocturia. An independent extraction of the articles was performed by two authors using predetermined datasets, including quality-of-study indicators. Evidence synthesis: A total of 132 studies were included; 46 evaluated the epidemiology of nocturia, 28 the possible aetiologies, 10 the diagnostic tools, and 60 the treatments. Nocturia prevalence ranged from 15% to 96% depending on the pathology and definition used. It was one of the most frequently reported LUTS in PD and stroke patients. Several validated questionnaires were found to screen for nocturia in this population. Causalities were numerous: LUT, renal, sleep, cardiovascular dysfunctions, etc. Treatments targeted these mechanisms, with an overall risk of bias assessed as high or serious. The highest level of evidence was seen in MS patients: pelvic floor muscle training, cannabinoids, and desmopressin were effective, but not melatonin. In stroke patients, transcutaneous sacral and transcutaneous tibial nerve stimulation (TTNS) improved nocturia; in PD patients, TTNS, solifenacin, and rotigotine did not. Conclusions: Nocturia is highly prevalent in patients with neurological disorders. Causalities and treatments are not different from the general population, but are poorly studied in neurological patients. Patient Summary: In this report, we looked at the published studies about nocturia the fact of waking to void during the hours of sleep in patients with neurological diseases. We found that nocturia is very frequent in this population, that the causes are the same as in the general population but may be combined, and that treatments are also the same but have an overall weak level of evidence. We conclude that more research is needed on this topic. (C) 2020 European Association of Urology. Published by Elsevier B.V. All rights reserved.

Observational prospective population-based incidence study. The main objective of this study was to assess the incidence of traumatic spinal cord injuries (TSCIs) and incidence rates, in order to provide estimates by age, gender, characteristics and cause. This study was conducted at acute-care spinal cord injury (SCI) hospitals and SCI centers from 11 Italian regions, between 1 October 2013 and 30 September 2014. Data of all consecutive patients with acute TSCI who met the inclusion criteria were obtained through case reporting by clinicians. The data were collected into a web database. Incidence rates and incidence rate ratios were calculated and stratified by age, gender, cause, level and completeness. From 50% of the entire population of Italy, 445 new cases of TSCI were included. The crude incidence rate of TSCI was 14.7 cases per million per year (95% CI: 13.4–16.4); the overall male to female ratio was 4:1 and the mean age was 54. Complete information was available in 85% of the sample and revealed tetraplegia in 58% and incomplete lesion in 67% of cases. The leading cause of TSCI was falls (40.9%) followed by road traffic accidents (33.5%). The leading cause was falls for patients over 55 and road traffic accidents for patients under 55. The changing trend of TSCI epidemiology concerns the increase in the average age of TSCI people and the increase of both cervical and incomplete lesions. The etiology shows the primacy of falls over road traffic accidents and suggests the need for a change in prevention policies.

Background Intermittent self catheterization questionnaire (ISC-Q) is a questionnaire exploring four issues related to self-intermittent catheterization (ISC): ease of use, convenience, discreteness and psychological well-being. The aim of the study was to develop and validate the Italian version of the ISC-Q. Methods Two independent translations of the ISC-Q were performed and compared by an expert committee. A back translation to English was made by a linguistic expert, blinded to the original version. Patients using ISC to void their bladder were from 19 different spinal cord units; questionnaires were examined anonymously in a single center. A subgroup of 47 patients repeated the test at 2 weeks distance and completed the Qualiveen questionnaire to assess the convergent validity of ISC-Q. The internal consistency was determined from Cronbach's α coefficient. Criterion validity was determined through the concurrent use of Qualiveen. Reliability was performed by Intraclass Correlation Coefficient and test-retest. The sensitivity was determined by the effect size-based estimate for small change (ES) and Minimal Detectable Change 95 (MDC95). In the study 217 subjects (65.6% males, 34.4% females) were enrolled. Mean age: 43±10.1 years. Mean duration of ISC: 3.3±6.9 years. Results Cronbach's α ranged from 0.79 to 0.81. Pearson correlation between the different parts of ISC-Q and total score ranged from 0.24 to 0.78. ICC values were higher than 0.9. Convergent validity was faint to null. ES ranged from 3.8 to 6 points. MDC95 ranged from 4.1 to 12.1. Conclusions The Italian ISC-Q has the same psychometric characteristics of the original questionnaire. ISC-Q is a valid, reliable and sensitive patient related outcome, specifically focused on ISC. our work provides a new validated measure for Italian patients to explore in future studies the role and impact of ISC.

Urinary disorders are uncommon in the initial phases of multiple sclerosis, but increase in frequency as the disease progresses, with a negative impact on quality of life. The goal of this study was to propose a protocol for the diagnosis and treatment of urinary disorders in multiple sclerosis, based on data from the scientific literature and the experience of Italian clinical centres. In particular, the following clinical aspects were considered: what to do with patients with asymptomatic multiple sclerosis; what to do with symptomatic patients; how and when to perform a second-level diagnostic evaluation; and how to treat urinary disorders. A diagnostic-therapeutic algorithm is proposed, that can be applied in Italian clinical centres.