640 results on '"Mehnert, Ulrich'
Search Results
2. Epidemiology of Neurogenic Lower Urinary Tract Dysfunction
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Averbeck, Marcio Augusto, Mehnert, Ulrich, Al Mousa, Riyad T., Kessler, Thomas M., Liao, Limin, editor, and Madersbacher, Helmut, editor
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- 2023
- Full Text
- View/download PDF
3. Indwelling catheter vs intermittent catheterization: is there a difference in UTI susceptibility?
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Vera Neumeier, Fabian P. Stangl, Joëlle Borer, Collene E. Anderson, Veronika Birkhäuser, Oksana Chemych, Oliver Gross, Miriam Koschorke, Jonas Marschall, Shawna McCallin, Ulrich Mehnert, Helen Sadri, Lara Stächele, Thomas M. Kessler, and Lorenz Leitner
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Asymptomatic bacteriuria ,Intermittent catheterization ,Indwelling catheter ,Neurogenic lower urinary tract dysfunction ,Urinary tract infection ,Infectious and parasitic diseases ,RC109-216 - Abstract
Abstract Background Patients with neurogenic lower urinary tract dysfunction (NLUTD) often rely on some type of catheterization for bladder emptying. Intermittent catheterization (IC) is considered the gold standard and is preferred over continuous catheterization, since it is considered to cause fewer urinary tract infections (UTIs) than indwelling catheterization. The main objective of our study was to describe UTI prevalence (at visit) and incidence (within the last 12 months) and urine culture characteristics between patients using an indwelling catheter versus (vs) those performing IC. Methods In this cross-sectional study, we prospectively evaluated from 02/2020 to 01/2021 patients with NLUTD undergoing urine cultures for prophylactic reasons or due to UTI symptoms. At visit, all patients underwent a standardized interview on current UTI symptoms as well as UTI history and antibiotic consumption within the past year. Patients using an indwelling catheter (n = 206) or IC (n = 299) were included in the analysis. The main outcome was between-group differences regarding UTI characteristics. Results Patients using an indwelling catheter were older (indwelling catheter vs IC: median 66 (Q1-Q3: 55—77) vs 55 (42—67) years of age) and showed a higher Charlson comorbidity index (indwelling catheter vs IC: median 4 (Q1-Q3: 2–6) vs 2 (1–4) (both p
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- 2023
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4. Development of a Sham Protocol to Investigate Transcutaneous Tibial Nerve Stimulation in Randomised, Sham-Controlled, Double-Blind Clinical Trials
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Stephanie A. Stalder, Stéphanie van der Lely, Collene E. Anderson, Veronika Birkhäuser, Armin Curt, Oliver Gross, Lorenz Leitner, Ulrich Mehnert, Martin Schubert, Jure Tornic, Thomas M. Kessler, and Martina D. Liechti
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tibial nerve stimulation ,transcutaneous tibial nerve stimulation ,randomised controlled trials ,double-blind ,sham stimulation ,sham development ,Biology (General) ,QH301-705.5 - Abstract
Transcutaneous tibial nerve stimulation (TTNS) is a promising treatment for neurogenic lower urinary tract symptoms. However, the evidence is limited due to a general lack of randomised controlled trials (RCTs) and, also, inconsistency in the sham and blinding conditions. In the context of much-needed RCTs, we aimed to develop a suitable sham-control protocol for a clinical setting to maintain blinding but avoid meaningful stimulation of the tibial nerve. Three potential electrode positions (lateral malleolus/5th metatarsal/plantar calcaneus) and two electrode sizes (diameter: 2.5 cm/3.2 cm) were tested to determine which combination provided the optimal sham configuration for a TTNS approach, based on a visible motor response. Sixteen healthy volunteers underwent sensory and motor assessments for each sham configuration. Eight out of them came back for an extra TTNS visit. Sensory thresholds were present for all sham configurations, with linear regression models revealing a significant effect regarding electrode position (highest at plantar calcaneus) but not size. In addition, motor thresholds varied with the position—lowest for the 5th metatarsal. Only using this position and 3.2 cm electrodes attained a 100% response rate. Compared to TTNS, sensory and motor thresholds were generally higher for the sham configurations; meanwhile, perceived pain was only higher at the lateral malleolus. In conclusion, using the 5th metatarsal position and 3.2 cm electrodes proved to be the most suitable sham configuration. Implemented as a four-electrode setup with standardized procedures, this appears to be a suitable RCT protocol for maintaining blinding and controlling for nonspecific TTNS effects in a clinical setting.
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- 2023
- Full Text
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5. Optimizing clinical trial design using prospective cohort study data: a case study in neuro-urology
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Anderson, Collene E., Birkhäuser, Veronika, Stalder, Stephanie A., Bachmann, Lucas M., Curt, Armin, Jordan, Xavier, Leitner, Lorenz, Liechti, Martina D., Mehnert, Ulrich, Möhr, Sandra, Pannek, Jürgen, Schubert, Martin, van der Lely, Stéphanie, Kessler, Thomas M., and Brinkhof, Martin W. G.
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- 2021
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6. Abnormal Resting-State Network Presence in Females with Overactive Bladder
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Ulrich Mehnert, Matthias Walter, Lorenz Leitner, Thomas M. Kessler, Patrick Freund, Martina D. Liechti, and Lars Michels
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resting-state magnetic resonance imaging ,functional connectivity ,overactive bladder ,supraspinal control ,urinary urgency ,urgency urinary incontinence ,Biology (General) ,QH301-705.5 - Abstract
Overactive bladder (OAB) is a global problem reducing the quality of life of patients and increasing the costs of any healthcare system. The etiology of OAB is understudied but likely involves supraspinal network alterations. Here, we characterized supraspinal resting-state functional connectivity in 12 OAB patients and 12 healthy controls (HC) who were younger than 60 years. Independent component analysis showed that OAB patients had a weaker presence of the salience (Cohen’s d = 0.9) and default mode network (Cohen’s d = 1.1) and weaker directed connectivity between the fronto-parietal network and salience network with a longer lag time compared to HC. A region of interest analysis demonstrated weaker connectivity in OAB compared to HC (Cohen’s d > 1.6 or < −1.6), particularly within the frontal and prefrontal cortices. In addition, weaker seed (insula, ventrolateral prefrontal cortex) to voxel (anterior cingulate cortex, frontal gyrus, superior parietal lobe, cerebellum) connectivity was found in OAB compared to HC (Cohen’s d > 1.9). The degree of deviation in supraspinal connectivity in OAB patients (relative to HC) appears to be an indicator of the severity of the lower urinary tract symptoms and an indication that such symptoms are directly related to functional supraspinal alterations. Thus, future OAB therapy options should also consider supraspinal targets, while neuroimaging techniques should be given more consideration in the quest for better phenotyping of OAB.
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- 2023
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7. Urodynamics Are Essential to Predict the Risk for Upper Urinary Tract Damage after Acute Spinal Cord Injury
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Veronika Birkhäuser, Collene E. Anderson, Marko Kozomara, 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, and Thomas M. Kessler
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neuro-urology ,neurogenic lower urinary tract dysfunction ,urodynamics ,spinal cord injuries ,urinary bladder ,neurogenic ,Biology (General) ,QH301-705.5 - Abstract
We used clinical parameters to develop a prediction model for the occurrence of urodynamic risk factors for upper urinary tract (UUT) damage during the first year after acute spinal cord injury (SCI). A total of 97 patients underwent urodynamic investigation at 1, 3, 6, and 12 months after acute SCI, within the framework of a population-based longitudinal study at a single university SCI center. Candidate predictors included demographic characteristics and neurological and functional statuses 1 month after SCI. Outcomes included urodynamic risk factors for UUT damage: detrusor overactivity combined with detrusor sphincter dyssynergia, maximum storage detrusor pressure (pDetmax) ≥ 40 cmH2O, bladder compliance < 20 mL/cmH2O, and vesicoureteral reflux. Multivariable logistic regression was used for the prediction model development and internal validation, using the area under the receiver operating curve (aROC) to assess model discrimination. Two models showed fair discrimination for pDetmax ≥ 40 cmH2O: (i) upper extremity motor score and sex, aROC 0.79 (95% CI: 0.69–0.89), C-statistic 0.78 (95% CI: 0.69–0.87), and (ii) neurological level, American Spinal Injury Association Impairment Scale grade, and sex, aROC 0.78 (95% CI: 0.68–0.89), C-statistic 0.76 (95% CI: 0.68–0.85). We identified two models that provided fair predictive values for urodynamic risk factors of UUT damage during the first year after SCI. Pending external validation, these models may be useful for clinical trial planning, although less so for individual-level patient management. Therefore, urodynamics remains essential for reliably identifying patients at risk of UUT damage.
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- 2023
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8. 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, and Kessler, Thomas M
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- 2021
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9. Epidemiology of Neurogenic Lower Urinary Tract Dysfunction
- Author
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Averbeck, Marcio A., Mehnert, Ulrich, Al Mousa, Riyad, Kessler, Thomas M., Liao, Limin, editor, and Madersbacher, Helmut, editor
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- 2019
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- View/download PDF
10. Neuroimaging in Neuro-Urology
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Mehnert, Ulrich, van der Lely, Stéphanie, Seif, Maryam, Leitner, Lorenz, Liechti, Martina D., and Michels, Lars
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- 2020
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11. 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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Tornic, Jure, Liechti, Martina D., Stalder, Stephanie A., Birkhäuser, Veronika, van der Lely, Stéphanie, Leitner, Lorenz, Mehnert, Ulrich, and Kessler, Thomas M.
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- 2020
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12. RF010 / #118 SENSORY ASSESSMENTS IN PATIENTS WITH NEUROGENIC LOWER URINARY TRACT DYSFUNCTION UNDERGOING SACRAL NEUROMODULATION TESTING
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Stalder, Stephanie, primary, Liechti, Martina, additional, Van Der Lely, Stéphanie, additional, Knüpfer, Stephanie, additional, Anderson, Collene, additional, Leitner, Lorenz, additional, Mehnert, Ulrich, additional, Tornic, Jure, additional, and Kessler, Thomas, additional
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- 2023
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13. Scalp Topography of Lower Urinary Tract Sensory Evoked Potentials
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van der Lely, Stéphanie, Kessler, Thomas M., Mehnert, Ulrich, and Liechti, Martina D.
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- 2020
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14. Reliability of supraspinal correlates to lower urinary tract stimulation in healthy participants – A fMRI study
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Walter, Matthias, Leitner, Lorenz, Michels, Lars, Liechti, Martina D., Freund, Patrick, Kessler, Thomas M., Kollias, Spyros, and Mehnert, Ulrich
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- 2019
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15. Neuroimaging in the Evaluation of Neurogenic Bladder Dysfunction
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Mehnert, Ulrich, primary
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- 2020
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16. Reliability of supraspinal correlates to lower urinary tract stimulation in healthy participants - A fMRI study.
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Matthias Walter, Lorenz Leitner, Lars Michels, Martina D. Liechti, Patrick Freund, Thomas M. Kessler, Spyros S. Kollias, and Ulrich Mehnert
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- 2019
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17. Development of a Sham Protocol to Investigate Transcutaneous Tibial Nerve Stimulation in Randomised, Sham-Controlled, Double-Blind Clinical Trials
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Stalder, Stephanie A., primary, van der Lely, Stéphanie, additional, Anderson, Collene E., additional, Birkhäuser, Veronika, additional, Curt, Armin, additional, Gross, Oliver, additional, Leitner, Lorenz, additional, Mehnert, Ulrich, additional, Schubert, Martin, additional, Tornic, Jure, additional, Kessler, Thomas M., additional, and Liechti, Martina D., additional
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- 2023
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18. Management of lower urinary tract, bowel, and sexual dysfunction
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Mehnert, Ulrich, additional and Kessler, Thomas M., additional
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- 2020
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19. Autonomous nervous system dysfunction
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Nightingale, Tom E., additional, Mehnert, Ulrich, additional, Kessler, Thomas M., additional, and Krassioukov, Andrei V., additional
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- 2020
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20. A systematic review and activation likelihood estimation meta-analysis of the central innervation of the lower urinary tract: Pelvic floor motor control and micturition.
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Ilse M Groenendijk, Ulrich Mehnert, Jan Groen, Becky D Clarkson, Jeroen R Scheepe, and Bertil F M Blok
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Medicine ,Science - Abstract
PurposeFunctional neuroimaging is a powerful and versatile tool to investigate central lower urinary tract (LUT) control. Despite the increasing body of literature there is a lack of comprehensive overviews on LUT control. Thus, we aimed to execute a coordinate based meta-analysis of all PET and fMRI evidence on descending central LUT control, i.e. pelvic floor muscle contraction (PFMC) and micturition.Materials and methodsA systematic literature search of all relevant libraries was performed in August 2020. Coordinates of activity were extracted from eligible studies to perform an activation likelihood estimation (ALE) using a threshold of uncorrected p Results20 of 6858 identified studies, published between 1997 and 2020, were included. Twelve studies investigated PFMC (1xPET, 11xfMRI) and eight micturition (3xPET, 5xfMRI). The PFMC ALE analysis (n = 181, 133 foci) showed clusters in the primary motor cortex, supplementary motor cortex, cingulate gyrus, frontal gyrus, thalamus, supramarginal gyrus, and cerebellum. The micturition ALE analysis (n = 107, 98 foci) showed active clusters in the dorsal pons, including the pontine micturition center, the periaqueductal gray, cingulate gyrus, frontal gyrus, insula and ventral pons. Overlap of PFMC and micturition was found in the cingulate gyrus and thalamus.ConclusionsFor the first time the involved core brain areas of LUT motor control were determined using ALE. Furthermore, the involved brain areas for PFMC and micturition are partially distinct. Further neuroimaging studies are required to extend this ALE analysis and determine the differences between a healthy and a dysfunctional LUT. This requires standardization of protocols and task-execution.
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- 2021
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21. Detrusor Acontractility after Acute Spinal Cord Injury—Myth or Reality?
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Bywater, Mirjam, Tornic, Jure, Mehnert, Ulrich, and Kessler, Thomas M.
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- 2018
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22. Development of a Sham Protocol to Investigate Transcutaneous Tibial Nerve Stimulation in Randomised, Sham-Controlled, Double-Blind Clinical Trials
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Liechti, Stephanie A. Stalder, Stéphanie van der Lely, Collene E. Anderson, Veronika Birkhäuser, Armin Curt, Oliver Gross, Lorenz Leitner, Ulrich Mehnert, Martin Schubert, Jure Tornic, Thomas M. Kessler, and Martina D.
- Subjects
tibial nerve stimulation ,transcutaneous tibial nerve stimulation ,randomised controlled trials ,double-blind ,sham stimulation ,sham development ,sham protocol ,electrical stimulation - Abstract
Transcutaneous tibial nerve stimulation (TTNS) is a promising treatment for neurogenic lower urinary tract symptoms. However, the evidence is limited due to a general lack of randomised controlled trials (RCTs) and, also, inconsistency in the sham and blinding conditions. In the context of much-needed RCTs, we aimed to develop a suitable sham-control protocol for a clinical setting to maintain blinding but avoid meaningful stimulation of the tibial nerve. Three potential electrode positions (lateral malleolus/5th metatarsal/plantar calcaneus) and two electrode sizes (diameter: 2.5 cm/3.2 cm) were tested to determine which combination provided the optimal sham configuration for a TTNS approach, based on a visible motor response. Sixteen healthy volunteers underwent sensory and motor assessments for each sham configuration. Eight out of them came back for an extra TTNS visit. Sensory thresholds were present for all sham configurations, with linear regression models revealing a significant effect regarding electrode position (highest at plantar calcaneus) but not size. In addition, motor thresholds varied with the position—lowest for the 5th metatarsal. Only using this position and 3.2 cm electrodes attained a 100% response rate. Compared to TTNS, sensory and motor thresholds were generally higher for the sham configurations; meanwhile, perceived pain was only higher at the lateral malleolus. In conclusion, using the 5th metatarsal position and 3.2 cm electrodes proved to be the most suitable sham configuration. Implemented as a four-electrode setup with standardized procedures, this appears to be a suitable RCT protocol for maintaining blinding and controlling for nonspecific TTNS effects in a clinical setting.
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- 2023
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23. The Management of Urine Storage Dysfunction in the Neurological Patient
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Mehnert, Ulrich, Chartier-Kastler, Emmanuel, de Wachter, Stefan, van Kerrebroeck, Philip E.V.A., and van Koeveringe, Gommert A.
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- 2019
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24. 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
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Armin Curt, Martin W G Brinkhof, Xavier Jordan, Margret Hund-Georgiadis, Veronika Birkhäuser, Martina D Liechti, Collene E Anderson, Sarah Baumann, Michael Baumberger, Lori A Birder, Sander M Botter, Silvan Büeler, Célia D Cruz, Gergely David, Susanne Friedl, Oliver Gross, Knut Husmann, Miriam Koschorke, Lorenz Leitner, Eugenia Luca, Ulrich Mehnert, Sandra Möhr, Freschta Mohammadzada, Katia Monastyrskaya, Helen Sadri, Andrea M Sartori, Kai Sprengel, Stephanie A Stalder, Jivko Stoyanov, Cornelia Stress, Aurora Tatu, Cécile Tawadros, Stéphanie van der Lely, Jens Wöllner, Veronika Zubler, Jürgen Pannek, and Thomas M Kessler
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Medicine - Published
- 2020
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25. Prediction of autonomic dysreflexia during urodynamics: a prospective cohort study
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Matthias Walter, Stephanie C. Knüpfer, Jacquelyn J. Cragg, Lorenz Leitner, Marc P. Schneider, Ulrich Mehnert, Andrei V. Krassioukov, Martin Schubert, Armin Curt, and Thomas M. Kessler
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Autonomic dysreflexia ,Neurogenic detrusor overactivity ,Neurogenic lower urinary tract dysfunction ,Prediction ,Spinal cord injury ,Urodynamic investigation ,Medicine - Abstract
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.
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- 2018
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26. Urodynamics Are Essential to Predict the Risk for Upper Urinary Tract Damage after Acute Spinal Cord Injury
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Birkhäuser, Veronika, primary, Anderson, Collene E., additional, Kozomara, Marko, additional, Bywater, Mirjam, additional, Gross, Oliver, additional, Kiss, Stephan, additional, Knüpfer, Stephanie C., additional, Koschorke, Miriam, additional, Leitner, Lorenz, additional, Mehnert, Ulrich, additional, Sadri, Helen, additional, Sammer, Ulla, additional, Stächele, Lara, additional, Tornic, Jure, additional, Liechti, Martina D., additional, Brinkhof, Martin W. G., additional, and Kessler, Thomas M., additional
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- 2023
- Full Text
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27. Abnormal Resting-State Network Presence in Females with Overactive Bladder
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Mehnert, Ulrich, primary, Walter, Matthias, additional, Leitner, Lorenz, additional, Kessler, Thomas M., additional, Freund, Patrick, additional, Liechti, Martina D., additional, and Michels, Lars, additional
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- 2023
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28. bTUNED : transcutaneous tibial nerve stimulation for neurogenic lower urinary tract
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Stalder, Stephanie A., primary, Gross, Oliver, additional, Anderson, Collene E., additional, Bachmann, Lucas M., additional, Baumann, Sarah, additional, Birkhäuser, Veronika, additional, Bywater, Mirjam, additional, del Popolo, Giulio, additional, Engeler, Daniel S., additional, Agrò, Enrico Finazzi, additional, Friedl, Susanne, additional, Grilo, Nuno, additional, Kiss, Stephan, additional, Koschorke, Miriam, additional, Leitner, Lorenz, additional, Liechti, Martina D., additional, Mehnert, Ulrich, additional, Musco, Stefania, additional, Sadri, Helen, additional, Stächele, Lara, additional, Tornic, Jure, additional, van der Lely, Stéphanie, additional, Wyler, Stephen, additional, and Kessler, Thomas M., additional
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- 2023
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29. Development of a Sham Protocol to Investigate Transcutaneous Tibial Nerve Stimulation in Randomised, Sham-Controlled, Double-Blind Clinical Trials
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Stalder, Stephanie A; https://orcid.org/0000-0002-7914-8264, van der Lely, Stéphanie; https://orcid.org/0000-0002-2688-9042, Anderson, Collene E; https://orcid.org/0000-0002-4350-6816, Birkhäuser, Veronika; https://orcid.org/0000-0002-6646-7266, Curt, Armin; https://orcid.org/0000-0003-0136-8467, Gross, Oliver; https://orcid.org/0000-0002-3330-5623, Leitner, Lorenz; https://orcid.org/0000-0001-5764-3494, Mehnert, Ulrich; https://orcid.org/0000-0001-7963-8477, Schubert, Martin; https://orcid.org/0000-0003-4495-6533, Tornic, Jure; https://orcid.org/0000-0002-1831-4783, Kessler, Thomas M; https://orcid.org/0000-0002-1991-5919, Liechti, Martina D; https://orcid.org/0000-0002-3024-0975, Stalder, Stephanie A; https://orcid.org/0000-0002-7914-8264, van der Lely, Stéphanie; https://orcid.org/0000-0002-2688-9042, Anderson, Collene E; https://orcid.org/0000-0002-4350-6816, Birkhäuser, Veronika; https://orcid.org/0000-0002-6646-7266, Curt, Armin; https://orcid.org/0000-0003-0136-8467, Gross, Oliver; https://orcid.org/0000-0002-3330-5623, Leitner, Lorenz; https://orcid.org/0000-0001-5764-3494, Mehnert, Ulrich; https://orcid.org/0000-0001-7963-8477, Schubert, Martin; https://orcid.org/0000-0003-4495-6533, Tornic, Jure; https://orcid.org/0000-0002-1831-4783, Kessler, Thomas M; https://orcid.org/0000-0002-1991-5919, and Liechti, Martina D; https://orcid.org/0000-0002-3024-0975
- Abstract
Transcutaneous tibial nerve stimulation (TTNS) is a promising treatment for neurogenic lower urinary tract symptoms. However, the evidence is limited due to a general lack of randomised controlled trials (RCTs) and, also, inconsistency in the sham and blinding conditions. In the context of much-needed RCTs, we aimed to develop a suitable sham-control protocol for a clinical setting to maintain blinding but avoid meaningful stimulation of the tibial nerve. Three potential electrode positions (lateral malleolus/5th metatarsal/plantar calcaneus) and two electrode sizes (diameter: 2.5 cm/3.2 cm) were tested to determine which combination provided the optimal sham configuration for a TTNS approach, based on a visible motor response. Sixteen healthy volunteers underwent sensory and motor assessments for each sham configuration. Eight out of them came back for an extra TTNS visit. Sensory thresholds were present for all sham configurations, with linear regression models revealing a significant effect regarding electrode position (highest at plantar calcaneus) but not size. In addition, motor thresholds varied with the position-lowest for the 5th metatarsal. Only using this position and 3.2 cm electrodes attained a 100% response rate. Compared to TTNS, sensory and motor thresholds were generally higher for the sham configurations; meanwhile, perceived pain was only higher at the lateral malleolus. In conclusion, using the 5th metatarsal position and 3.2 cm electrodes proved to be the most suitable sham configuration. Implemented as a four-electrode setup with standardized procedures, this appears to be a suitable RCT protocol for maintaining blinding and controlling for nonspecific TTNS effects in a clinical setting.
- Published
- 2023
30. Urodynamics Are Essential to Predict the Risk for Upper Urinary Tract Damage after Acute Spinal Cord Injury
- Author
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Birkhäuser, Veronika; https://orcid.org/0000-0002-6646-7266, Anderson, Collene E; https://orcid.org/0000-0002-4350-6816, Kozomara, Marko; https://orcid.org/0000-0001-5126-9331, Bywater, Mirjam, Gross, Oliver; https://orcid.org/0000-0002-3330-5623, Kiss, Stephan, Knüpfer, Stephanie C; https://orcid.org/0000-0002-2914-1451, Koschorke, Miriam; https://orcid.org/0000-0001-5667-0474, Leitner, Lorenz; https://orcid.org/0000-0001-5764-3494, Mehnert, Ulrich; https://orcid.org/0000-0001-7963-8477, Sadri, Helen, Sammer, Ulla, Stächele, Lara; https://orcid.org/0000-0002-9723-0595, Tornic, Jure; https://orcid.org/0000-0002-1831-4783, Liechti, Martina D; https://orcid.org/0000-0002-3024-0975, Brinkhof, Martin W G; https://orcid.org/0000-0002-9319-665X, Kessler, Thomas M; https://orcid.org/0000-0002-1991-5919, Birkhäuser, Veronika; https://orcid.org/0000-0002-6646-7266, Anderson, Collene E; https://orcid.org/0000-0002-4350-6816, Kozomara, Marko; https://orcid.org/0000-0001-5126-9331, Bywater, Mirjam, Gross, Oliver; https://orcid.org/0000-0002-3330-5623, Kiss, Stephan, Knüpfer, Stephanie C; https://orcid.org/0000-0002-2914-1451, Koschorke, Miriam; https://orcid.org/0000-0001-5667-0474, Leitner, Lorenz; https://orcid.org/0000-0001-5764-3494, Mehnert, Ulrich; https://orcid.org/0000-0001-7963-8477, Sadri, Helen, Sammer, Ulla, Stächele, Lara; https://orcid.org/0000-0002-9723-0595, Tornic, Jure; https://orcid.org/0000-0002-1831-4783, Liechti, Martina D; https://orcid.org/0000-0002-3024-0975, Brinkhof, Martin W G; https://orcid.org/0000-0002-9319-665X, and Kessler, Thomas M; https://orcid.org/0000-0002-1991-5919
- Abstract
We used clinical parameters to develop a prediction model for the occurrence of urodynamic risk factors for upper urinary tract (UUT) damage during the first year after acute spinal cord injury (SCI). A total of 97 patients underwent urodynamic investigation at 1, 3, 6, and 12 months after acute SCI, within the framework of a population-based longitudinal study at a single university SCI center. Candidate predictors included demographic characteristics and neurological and functional statuses 1 month after SCI. Outcomes included urodynamic risk factors for UUT damage: detrusor overactivity combined with detrusor sphincter dyssynergia, maximum storage detrusor pressure (pDetmax) ≥ 40 cmH$_{2}$O, bladder compliance < 20 mL/cmH$_{2}$O, and vesicoureteral reflux. Multivariable logistic regression was used for the prediction model development and internal validation, using the area under the receiver operating curve (aROC) to assess model discrimination. Two models showed fair discrimination for pDetmax ≥ 40 cmH$_{2}$O: (i) upper extremity motor score and sex, aROC 0.79 (95% CI: 0.69-0.89), C-statistic 0.78 (95% CI: 0.69-0.87), and (ii) neurological level, American Spinal Injury Association Impairment Scale grade, and sex, aROC 0.78 (95% CI: 0.68-0.89), C-statistic 0.76 (95% CI: 0.68-0.85). We identified two models that provided fair predictive values for urodynamic risk factors of UUT damage during the first year after SCI. Pending external validation, these models may be useful for clinical trial planning, although less so for individual-level patient management. Therefore, urodynamics remains essential for reliably identifying patients at risk of UUT damage.
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- 2023
31. Indwelling catheter vs intermittent catheterization: is there a difference in UTI susceptibility?
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Neumeier, Vera; https://orcid.org/0000-0002-8149-3710, Stangl, Fabian P; https://orcid.org/0000-0002-6219-2402, Borer, Joëlle, Anderson, Collene E; https://orcid.org/0000-0002-4350-6816, Birkhäuser, Veronika; https://orcid.org/0000-0002-6646-7266, Chemych, Oksana, Gross, Oliver; https://orcid.org/0000-0002-3330-5623, Koschorke, Miriam; https://orcid.org/0000-0001-5667-0474, Marschall, Jonas; https://orcid.org/0000-0002-0052-3210, McCallin, Shawna; https://orcid.org/0000-0002-4277-7753, Mehnert, Ulrich; https://orcid.org/0000-0001-7963-8477, Sadri, Helen, Stächele, Lara; https://orcid.org/0000-0002-9723-0595, Kessler, Thomas M; https://orcid.org/0000-0002-1991-5919, Leitner, Lorenz; https://orcid.org/0000-0001-5764-3494, Neumeier, Vera; https://orcid.org/0000-0002-8149-3710, Stangl, Fabian P; https://orcid.org/0000-0002-6219-2402, Borer, Joëlle, Anderson, Collene E; https://orcid.org/0000-0002-4350-6816, Birkhäuser, Veronika; https://orcid.org/0000-0002-6646-7266, Chemych, Oksana, Gross, Oliver; https://orcid.org/0000-0002-3330-5623, Koschorke, Miriam; https://orcid.org/0000-0001-5667-0474, Marschall, Jonas; https://orcid.org/0000-0002-0052-3210, McCallin, Shawna; https://orcid.org/0000-0002-4277-7753, Mehnert, Ulrich; https://orcid.org/0000-0001-7963-8477, Sadri, Helen, Stächele, Lara; https://orcid.org/0000-0002-9723-0595, Kessler, Thomas M; https://orcid.org/0000-0002-1991-5919, and Leitner, Lorenz; https://orcid.org/0000-0001-5764-3494
- Abstract
BACKGROUND Patients with neurogenic lower urinary tract dysfunction (NLUTD) often rely on some type of catheterization for bladder emptying. Intermittent catheterization (IC) is considered the gold standard and is preferred over continuous catheterization, since it is considered to cause fewer urinary tract infections (UTIs) than indwelling catheterization. The main objective of our study was to describe UTI prevalence (at visit) and incidence (within the last 12 months) and urine culture characteristics between patients using an indwelling catheter versus (vs) those performing IC. METHODS In this cross-sectional study, we prospectively evaluated from 02/2020 to 01/2021 patients with NLUTD undergoing urine cultures for prophylactic reasons or due to UTI symptoms. At visit, all patients underwent a standardized interview on current UTI symptoms as well as UTI history and antibiotic consumption within the past year. Patients using an indwelling catheter (n = 206) or IC (n = 299) were included in the analysis. The main outcome was between-group differences regarding UTI characteristics. RESULTS Patients using an indwelling catheter were older (indwelling catheter vs IC: median 66 (Q1-Q3: 55-77) vs 55 (42-67) years of age) and showed a higher Charlson comorbidity index (indwelling catheter vs IC: median 4 (Q1-Q3: 2-6) vs 2 (1-4) (both p < 0·001). A total of 40 patients from both groups were diagnosed with a UTI at visit (indwelling catheters vs IC: 8% (16/206) vs 8% (24/299); p = 0·782), and the number of UTIs within the past 12 months was not significantly different between groups. Overall, Escherichia coli (21%), Enterococcus faecalis (17%), and Klebsiella spp. (12%) were the most frequently detected bacteria. CONCLUSIONS In this cohort of patients with NLUTD, we did not find relevant differences in UTI frequency between groups. These results suggest that UTI-related concerns should not be given undue emphasis when counseling patients for catheter-related bladder empt
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- 2023
32. Abnormal Resting-State Network Presence in Females with Overactive Bladder
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Mehnert, Ulrich; https://orcid.org/0000-0001-7963-8477, Walter, Matthias; https://orcid.org/0000-0001-5347-1584, Leitner, Lorenz; https://orcid.org/0000-0001-5764-3494, Kessler, Thomas M; https://orcid.org/0000-0002-1991-5919, Freund, Patrick; https://orcid.org/0000-0002-4851-2246, Liechti, Martina D; https://orcid.org/0000-0002-3024-0975, Michels, Lars; https://orcid.org/0000-0003-3750-1100, Mehnert, Ulrich; https://orcid.org/0000-0001-7963-8477, Walter, Matthias; https://orcid.org/0000-0001-5347-1584, Leitner, Lorenz; https://orcid.org/0000-0001-5764-3494, Kessler, Thomas M; https://orcid.org/0000-0002-1991-5919, Freund, Patrick; https://orcid.org/0000-0002-4851-2246, Liechti, Martina D; https://orcid.org/0000-0002-3024-0975, and Michels, Lars; https://orcid.org/0000-0003-3750-1100
- Abstract
Overactive bladder (OAB) is a global problem reducing the quality of life of patients and increasing the costs of any healthcare system. The etiology of OAB is understudied but likely involves supraspinal network alterations. Here, we characterized supraspinal resting-state functional connectivity in 12 OAB patients and 12 healthy controls (HC) who were younger than 60 years. Independent component analysis showed that OAB patients had a weaker presence of the salience (Cohen's d = 0.9) and default mode network (Cohen's d = 1.1) and weaker directed connectivity between the fronto-parietal network and salience network with a longer lag time compared to HC. A region of interest analysis demonstrated weaker connectivity in OAB compared to HC (Cohen's d > 1.6 or < -1.6), particularly within the frontal and prefrontal cortices. In addition, weaker seed (insula, ventrolateral prefrontal cortex) to voxel (anterior cingulate cortex, frontal gyrus, superior parietal lobe, cerebellum) connectivity was found in OAB compared to HC (Cohen's d > 1.9). The degree of deviation in supraspinal connectivity in OAB patients (relative to HC) appears to be an indicator of the severity of the lower urinary tract symptoms and an indication that such symptoms are directly related to functional supraspinal alterations. Thus, future OAB therapy options should also consider supraspinal targets, while neuroimaging techniques should be given more consideration in the quest for better phenotyping of OAB.
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- 2023
33. bTUNED: transcutaneous tibial nerve stimulation for neurogenic lower urinary tract dysfunction
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Stalder, Stephanie A; https://orcid.org/0000-0002-7914-8264, Gross, Oliver; https://orcid.org/0000-0002-3330-5623, Anderson, Collene E; https://orcid.org/0000-0002-4350-6816, Bachmann, Lucas M; https://orcid.org/0000-0002-9868-154X, Baumann, Sarah, Birkhäuser, Veronika; https://orcid.org/0000-0002-6646-7266, Bywater, Mirjam, Del Popolo, Giulio; https://orcid.org/0000-0002-1202-6078, Engeler, Daniel S; https://orcid.org/0000-0003-1383-4701, Agrò, Enrico Finazzi; https://orcid.org/0000-0002-0308-8824, Friedl, Susanne; https://orcid.org/0000-0001-8686-8537, Grilo, Nuno; https://orcid.org/0000-0002-7188-972X, Kiss, Stephan, Koschorke, Miriam; https://orcid.org/0000-0001-5667-0474, Leitner, Lorenz; https://orcid.org/0000-0001-5764-3494, Liechti, Martina D; https://orcid.org/0000-0002-3024-0975, Mehnert, Ulrich; https://orcid.org/0000-0001-7963-8477, Musco, Stefania; https://orcid.org/0000-0001-5844-5684, Sadri, Helen, Stächele, Lara; https://orcid.org/0000-0002-9723-0595, Tornic, Jure; https://orcid.org/0000-0002-1831-4783, van der Lely, Stéphanie; https://orcid.org/0000-0002-2688-9042, Wyler, Stephen, Kessler, Thomas M; https://orcid.org/0000-0002-1991-5919, Stalder, Stephanie A; https://orcid.org/0000-0002-7914-8264, Gross, Oliver; https://orcid.org/0000-0002-3330-5623, Anderson, Collene E; https://orcid.org/0000-0002-4350-6816, Bachmann, Lucas M; https://orcid.org/0000-0002-9868-154X, Baumann, Sarah, Birkhäuser, Veronika; https://orcid.org/0000-0002-6646-7266, Bywater, Mirjam, Del Popolo, Giulio; https://orcid.org/0000-0002-1202-6078, Engeler, Daniel S; https://orcid.org/0000-0003-1383-4701, Agrò, Enrico Finazzi; https://orcid.org/0000-0002-0308-8824, Friedl, Susanne; https://orcid.org/0000-0001-8686-8537, Grilo, Nuno; https://orcid.org/0000-0002-7188-972X, Kiss, Stephan, Koschorke, Miriam; https://orcid.org/0000-0001-5667-0474, Leitner, Lorenz; https://orcid.org/0000-0001-5764-3494, Liechti, Martina D; https://orcid.org/0000-0002-3024-0975, Mehnert, Ulrich; https://orcid.org/0000-0001-7963-8477, Musco, Stefania; https://orcid.org/0000-0001-5844-5684, Sadri, Helen, Stächele, Lara; https://orcid.org/0000-0002-9723-0595, Tornic, Jure; https://orcid.org/0000-0002-1831-4783, van der Lely, Stéphanie; https://orcid.org/0000-0002-2688-9042, Wyler, Stephen, and Kessler, Thomas M; https://orcid.org/0000-0002-1991-5919
- Abstract
OBJECTIVE To present the protocol for a randomized controlled trial (RCT) evaluating the efficacy and safety of transcutaneous tibial nerve stimulation (TTNS) for refractory neurogenic lower urinary tract dysfunction (NLUTD). STUDY DESIGN AND RESULTS bTUNED (bladder and TranscUtaneous tibial Nerve stimulation for nEurogenic lower urinary tract Dysfunction) is an international multicentre, sham-controlled, double-blind RCT investigating the efficacy and safety of TTNS. The primary outcome is success of TTNS, defined as improvements in key bladder diary variables at study end compared to baseline values. The focus of the treatment is defined by the Self-Assessment Goal Achievement (SAGA) questionnaire. Secondary outcomes are the effect of TTNS on urodynamic, neurophysiological, and bowel function outcome measures, as well as the safety of TTNS. CONCLUSIONS A total of 240 patients with refractory NLUTD will be included and randomized 1:1 into the verum or sham TTNS group from March 2020 until August 2026. TTNS will be performed twice a week for 30 min during 6 weeks. The patients will attend baseline assessments, 12 treatment visits and follow-up assessments at the study end.
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- 2023
34. Temporal development of unfavourable urodynamic parameters during the first year after spinal cord injury
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Anderson, Collene E; https://orcid.org/0000-0002-4350-6816, Kozomara, Marko; https://orcid.org/0000-0001-5126-9331, Birkhäuser, Veronika; https://orcid.org/0000-0002-6646-7266, Bywater, Mirjam, Gross, Oliver; https://orcid.org/0000-0002-3330-5623, Kiss, Stephan, Knüpfer, Stephanie C; https://orcid.org/0000-0002-2914-1451, Koschorke, Miriam; https://orcid.org/0000-0001-5667-0474, Leitner, Lorenz; https://orcid.org/0000-0001-5764-3494, Mehnert, Ulrich; https://orcid.org/0000-0001-7963-8477, Sadri, Helen, Sammer, Ulla, Stächele, Lara; https://orcid.org/0000-0002-9723-0595, Tornic, Jure, Liechti, Martina D; https://orcid.org/0000-0002-3024-0975, Brinkhof, Martin W G; https://orcid.org/0000-0002-9319-665X, Kessler, Thomas M; https://orcid.org/0000-0002-1991-5919, Anderson, Collene E; https://orcid.org/0000-0002-4350-6816, Kozomara, Marko; https://orcid.org/0000-0001-5126-9331, Birkhäuser, Veronika; https://orcid.org/0000-0002-6646-7266, Bywater, Mirjam, Gross, Oliver; https://orcid.org/0000-0002-3330-5623, Kiss, Stephan, Knüpfer, Stephanie C; https://orcid.org/0000-0002-2914-1451, Koschorke, Miriam; https://orcid.org/0000-0001-5667-0474, Leitner, Lorenz; https://orcid.org/0000-0001-5764-3494, Mehnert, Ulrich; https://orcid.org/0000-0001-7963-8477, Sadri, Helen, Sammer, Ulla, Stächele, Lara; https://orcid.org/0000-0002-9723-0595, Tornic, Jure, Liechti, Martina D; https://orcid.org/0000-0002-3024-0975, Brinkhof, Martin W G; https://orcid.org/0000-0002-9319-665X, and Kessler, Thomas M; https://orcid.org/0000-0002-1991-5919
- Abstract
Objectives: 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). Patients and methods: 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 cmH2 O, bladder compliance <20 mL/cmH2 O, vesico-ureteric reflux [VUR] and any unfavourable parameter [composite outcome]) were evaluated using time-to-event analysis. Results: The 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 cmH2 O (31/38), and 100% of the VUR (seven of seven) observations. No low bladder compliance was observed. The risk of DO-DSD was elevated in patients with thoracic SCI compared to those with lumbar SCI (adjusted hazard ratio [aHR] 2.38, 95% confidence interval [CI] 1.16-4.89). Risk of maximum storage detrusor pressure ≥40 cmH2 O was higher in males than females (aHR 8.33, 95% CI 2.51-27.66), in patients with a cervical SCI compared to those with lumbar SCI (aHR 14.89, 95% CI 3.28-67.55), and in patients with AIS Grade B or C compared to AIS Grade D SCI (aHR 6.17, 95% CI 1.78-21.39). No risk factors were identified for the composite outcome of any unfavourable urodynamic parameter. Conclusions: The 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 consid
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- 2023
35. Optimized Measurement Parameters of Sensory Evoked Cortical Potentials to Assess Human Bladder Afferents - A Randomized Study
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van der Lely, Stéphanie, Liechti, Martina D., Schmidhalter, Melanie R., Schubert, Martin, Bachmann, Lucas M., Kessler, Thomas M., and Mehnert, Ulrich
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- 2019
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36. Urodynamics Are Essential to Predict the Risk for Upper Urinary Tract Damage after Acute Spinal Cord Injury
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Kessler, Veronika Birkhäuser, Collene E. Anderson, Marko Kozomara, 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, and Thomas M.
- Subjects
neuro-urology ,neurogenic lower urinary tract dysfunction ,urodynamics ,spinal cord injuries ,urinary bladder ,neurogenic ,overactive ,decision support techniques ,clinical decision-making ,predictive value of tests - Abstract
We used clinical parameters to develop a prediction model for the occurrence of urodynamic risk factors for upper urinary tract (UUT) damage during the first year after acute spinal cord injury (SCI). A total of 97 patients underwent urodynamic investigation at 1, 3, 6, and 12 months after acute SCI, within the framework of a population-based longitudinal study at a single university SCI center. Candidate predictors included demographic characteristics and neurological and functional statuses 1 month after SCI. Outcomes included urodynamic risk factors for UUT damage: detrusor overactivity combined with detrusor sphincter dyssynergia, maximum storage detrusor pressure (pDetmax) ≥ 40 cmH2O, bladder compliance < 20 mL/cmH2O, and vesicoureteral reflux. Multivariable logistic regression was used for the prediction model development and internal validation, using the area under the receiver operating curve (aROC) to assess model discrimination. Two models showed fair discrimination for pDetmax ≥ 40 cmH2O: (i) upper extremity motor score and sex, aROC 0.79 (95% CI: 0.69–0.89), C-statistic 0.78 (95% CI: 0.69–0.87), and (ii) neurological level, American Spinal Injury Association Impairment Scale grade, and sex, aROC 0.78 (95% CI: 0.68–0.89), C-statistic 0.76 (95% CI: 0.68–0.85). We identified two models that provided fair predictive values for urodynamic risk factors of UUT damage during the first year after SCI. Pending external validation, these models may be useful for clinical trial planning, although less so for individual-level patient management. Therefore, urodynamics remains essential for reliably identifying patients at risk of UUT damage.
- Published
- 2023
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37. Abnormal Resting-State Network Presence in Females with Overactive Bladder
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Michels, Ulrich Mehnert, Matthias Walter, Lorenz Leitner, Thomas M. Kessler, Patrick Freund, Martina D. Liechti, and Lars
- Subjects
resting-state magnetic resonance imaging ,functional connectivity ,overactive bladder ,supraspinal control ,urinary urgency ,urgency urinary incontinence ,neuro-urology ,early diagnosis research - Abstract
Overactive bladder (OAB) is a global problem reducing the quality of life of patients and increasing the costs of any healthcare system. The etiology of OAB is understudied but likely involves supraspinal network alterations. Here, we characterized supraspinal resting-state functional connectivity in 12 OAB patients and 12 healthy controls (HC) who were younger than 60 years. Independent component analysis showed that OAB patients had a weaker presence of the salience (Cohen’s d = 0.9) and default mode network (Cohen’s d = 1.1) and weaker directed connectivity between the fronto-parietal network and salience network with a longer lag time compared to HC. A region of interest analysis demonstrated weaker connectivity in OAB compared to HC (Cohen’s d > 1.6 or < −1.6), particularly within the frontal and prefrontal cortices. In addition, weaker seed (insula, ventrolateral prefrontal cortex) to voxel (anterior cingulate cortex, frontal gyrus, superior parietal lobe, cerebellum) connectivity was found in OAB compared to HC (Cohen’s d > 1.9). The degree of deviation in supraspinal connectivity in OAB patients (relative to HC) appears to be an indicator of the severity of the lower urinary tract symptoms and an indication that such symptoms are directly related to functional supraspinal alterations. Thus, future OAB therapy options should also consider supraspinal targets, while neuroimaging techniques should be given more consideration in the quest for better phenotyping of OAB.
- Published
- 2023
- Full Text
- View/download PDF
38. <scp>bTUNED</scp> : transcutaneous tibial nerve stimulation for neurogenic lower urinary tract
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Stephanie A. Stalder, Oliver Gross, Collene E. Anderson, Lucas M. Bachmann, Sarah Baumann, Veronika Birkhäuser, Mirjam Bywater, Giulio del Popolo, Daniel S. Engeler, Enrico Finazzi Agrò, Susanne Friedl, Nuno Grilo, Stephan Kiss, Miriam Koschorke, Lorenz Leitner, Martina D. Liechti, Ulrich Mehnert, Stefania Musco, Helen Sadri, Lara Stächele, Jure Tornic, Stéphanie van der Lely, Stephen Wyler, and Thomas M. Kessler
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Urology - Published
- 2023
39. Exploring influence of subliminal interoception on whole-brain functional network connectivity dynamics.
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Behnaz Jarrahi, Dante Mantini, Ulrich Mehnert, and Spyros S. Kollias
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- 2015
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40. Bacteriophages for treating urinary tract infections in patients undergoing transurethral resection of the prostate: a randomized, placebo-controlled, double-blind clinical trial
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Lorenz Leitner, Wilbert Sybesma, Nina Chanishvili, Marina Goderdzishvili, Archil Chkhotua, Aleksandre Ujmajuridze, Marc P. Schneider, Andrea Sartori, Ulrich Mehnert, Lucas M. Bachmann, and Thomas M. Kessler
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Bacteriophages ,Antibiotics ,Urinary tract infection ,Randomized placebo-controlled double-blind trial ,Resistance ,Diseases of the genitourinary system. Urology ,RC870-923 - Abstract
Abstract Background 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. Methods and design 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. Discussion 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. Trial registration This study has been registered at clinicaltrials.gov ( www.clinicaltrials.gov/ct2/show/NCT03140085 ). April 27, 2017.
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- 2017
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41. Neurogenic Lower Urinary Tract Dysfunction in the First Year After Spinal Cord Injury: A Descriptive Study of Urodynamic Findings
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Kozomara, Marko, primary, Birkhäuser, Veronika, additional, Anderson, Collene E., additional, Bywater, Mirjam, additional, Gross, Oliver, additional, Kiss, Stephan, additional, Knüpfer, Stephanie C., additional, Koschorke, Miriam, additional, Leitner, Lorenz, additional, Mehnert, Ulrich, additional, Sadri, Helen, additional, Sammer, Ulla, additional, Stächele, Lara, additional, Tornic, Jure, additional, Brinkhof, Martin W. G., additional, Liechti, Martina D., additional, and Kessler, Thomas M., additional
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- 2023
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42. Does electrical stimulation in the lower urinary tract increase urine production? A randomised comparative proof-of-concept study in healthy volunteers.
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Stéphanie van der Lely, Martina D Liechti, Werner L Popp, Melanie R Schmidhalter, Thomas M Kessler, and Ulrich Mehnert
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Medicine ,Science - Abstract
Trial designDuring electrical stimulation in the lower urinary tract for the purpose of current perception threshold and sensory evoked potential recording, we observed that bladder volume increased rapidly. The aim of this prospective randomised comparative proof-of-concept study was to quantify urine production per time during stimulation of the lower urinary tract using different stimulation frequencies.MethodsNinety healthy subjects (18 to 36 years old) were included. Forty females and 50 males were randomly assigned to one of the following study groups: dome, trigone or proximal, membranous (males only) or distal urethra. Starting from 60mL prefilling, stimulation was performed at two separate visits with a 14 French custom-made catheter using randomly applied frequencies of 0.5Hz, 1.1Hz, 1.6Hz (each with 500 stimuli). After each stimulation cycle per frequency, urine production was assessed. Main outcome measures represented urine production during stimulation, daily life and their ratio.ResultsLower urinary tract electrical stimulation increased urine production per time compared to bladder diary baseline values. Linear mixed model showed that frequency (pConclusionsUrine production is increased during electrical stimulation with a bigger impact of higher frequencies. This might be relevant for methodological aspects in the assessment of lower urinary tract afferent function and for patients with impaired renal urine output. Inhibition of renal sympathetic nerve activity by vagal afferents may be the underlying mechanism.
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- 2019
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43. bTUNED: transcutaneous tibial nerve stimulation for neurogenic lower urinary tract dysfunction
- Author
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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
- Subjects
610 Medicine & health ,10046 Balgrist University Hospital, Swiss Spinal Cord Injury Center - Published
- 2023
- Full Text
- View/download PDF
44. Temporal development of unfavourable urodynamic parameters during the first year after spinal cord injury
- Author
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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
- Subjects
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.
- Published
- 2023
- Full Text
- View/download PDF
45. Design and Application of a New Automated Fluidic Visceral Stimulation Device for Human fMRI Studies of Interoception
- Author
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Behnaz Jarrahi, Roger Gassert, Johann Wanek, Lars Michels, Ulrich Mehnert, and Spyros S. Kollias
- Subjects
MR-compatible sensors and actuators ,fMRI ,electrohydrostatic actuation ,automation ,visceral afferent processing ,Computer applications to medicine. Medical informatics ,R858-859.7 ,Medical technology ,R855-855.5 - Abstract
Mapping the brain centers that mediate the sensory-perceptual processing of visceral afferent signals arising from the body (i.e., interoception) is useful both for characterizing normal brain activity and for understanding clinical disorders related to abnormal processing of visceral sensation. Here, we report a novel closed-system, electrohydrostatically driven master-slave device that was designed and constructed for delivering controlled fluidic stimulations of visceral organs and inner cavities of the human body within the confines of a 3T magnetic resonance imaging (MRI) scanner. The design concept and performance of the device in the MRI environment are described. In addition, the device was applied during a functional MRI (fMRI) investigation of visceral stimulation related to detrusor distention in two representative subjects to verify its feasibility in humans. System evaluation tests demonstrate that the device is MR-compatible with negligible impact on imaging quality [static signal-to-noise ratio (SNR) loss
- Published
- 2016
- Full Text
- View/download PDF
46. Temporal development of unfavourable urodynamic parameters during the first year after spinal cord injury
- Author
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Anderson, Collene E., primary, Kozomara, Marko, additional, Birkhäuser, Veronika, additional, Bywater, Mirjam, additional, Gross, Oliver, additional, Kiss, Stephan, additional, Knüpfer, Stephanie C., additional, Koschorke, Miriam, additional, Leitner, Lorenz, additional, Mehnert, Ulrich, additional, Sadri, Helen, additional, Sammer, Ulla, additional, Stächele, Lara, additional, Tornic, Jure, additional, Liechti, Martina D., additional, Brinkhof, Martin W.G., additional, and Kessler, Thomas M., additional
- Published
- 2022
- Full Text
- View/download PDF
47. Sacral Neuromodulation for Neurogenic Lower Urinary Tract Dysfunction
- Author
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Liechti, Martina D., primary, van der Lely, Stéphanie, additional, Knüpfer, Stephanie C., additional, Abt, Dominik, additional, Kiss, Bernhard, additional, Leitner, Lorenz, additional, Mordasini, Livio, additional, Tornic, Jure, additional, Wöllner, Jens, additional, Mehnert, Ulrich, additional, Bachmann, Lucas M., additional, Burkhard, Fiona C., additional, Engeler, Daniel S., additional, Pannek, Jürgen, additional, and Kessler, Thomas M., additional
- Published
- 2022
- Full Text
- View/download PDF
48. O120 / #800 DEVELOPMENT AND EVALUATION OF AN APPROPRIATE SHAM PROCEDURE TO INVESTIGATE TRANSCUTANEOUS TIBIAL NERVE STIMULATION IN RANDOMIZED, SHAM-CONTROLLED, DOUBLE-BLIND CLINICAL TRIALS
- Author
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Stalder, Stephanie, primary, Liechti, Martina, additional, Van Der Lely, Stéphanie, additional, Birkhäuser, Veronika, additional, Anderson, Collene, additional, Tornic, Jure, additional, Mehnert, Ulrich, additional, and Kessler, Thomas, additional
- Published
- 2022
- Full Text
- View/download PDF
49. Neurogenic Lower Urinary Tract Dysfunction in the First Year After Spinal Cord Injury: A Descriptive Study of Urodynamic Findings
- Author
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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
- Subjects
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.
- Published
- 2022
50. An fMRI-compatible multi-configurable handheld response system using an intensity-modulated fiber-optic sensor.
- Author
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Behnaz Jarrahi, Johann Wanek, Ulrich Mehnert, and Spyros S. Kollias
- Published
- 2013
- Full Text
- View/download PDF
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