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Introduction. This study is relevant due to the high prevalence of organic brain pathology and the negative influence of urination disorders on the quality of life.Objective. To analyse the impaired function of lower urinary tracts in patients with organic brain pathology.Materials & methods. We analysed 607 patients with severe organic brain pathology (105 had traumatic spinal cord injury (TSCI) and 457 had consequences of acute stroke (AS)). We performed clinical urological examinations. During the survey, attention was paid to the presence of urinary tract pathology at the examining time and anamnesis. Structural changes in the urinary tract were objectively assessed. We objectively assessed structural changes in urinary tracts including prostate adenoma in men, insufficiency of pelvic floor muscles in women and strictures of the urethra or ureters. The degree of the spastic syndrome was assessed with the Ashworth Scale. The neurourological examination included cystometry with the measurement of bladder volume and post-void residual urine. The cognitive status of the patients was assessed with the MMSE (Mini-Mental State Examination) questionnaire. The correlation analysis between the degree of spastic syndrome measured with the Ashworth Scale and urination disorders was performed with Spearman rank correlation.Results. All patients had neurogenic dysfunction of the lower urinary tract. A combination of bladder retention and emptying disorders was found in 62 men older than 45yo with benign prostate hyperplasia (10,2% of all cases). An impaired accumulation function in history was found in 45 women older than 45yo (7,4% of all observations). The level of spasticity was 3 or 4 points on the Ashworth Scale in patients with TSCI and 2 to 4 points in those with AS. The analysis of correlations between the degree of spasticity and urination disorders showed a moderate relationship (r = 0,4) in patients with TSCI and a medium relationship (r = 0.65) in patients with AS.Conclusion. Neurogenic dysfunction of the lower urinary tract accompanies patients with severe organic brain pathology throughout their life and requires adequate correction.

Objective: The pathophysiology of empty nose syndrome (ENS) remains unclear despite significant research. The pathophysiologic mechanism of ENS was systematically reviewed. Data Sources: MEDLINE and Embase. Review Methods: Data were systematically reviewed for studies that provided original data on pathophysiology. Results: A total of 2476 studies were screened, and 19 met the inclusion criteria: 13 case-control and 6 cross-sectional. Nine pathophysiologic themes were identified. • Demographics: ENS symptoms had no relationship with climatic factors. • Symptomatology: ENS patients demonstrated high symptom severity. • Mental health: Anxiety and depression including hyperventilation were reported in >50% of ENS patients and correlated with ENS symptom severity. • Anatomic features: Structural changes in response to turbinate surgery were similar between ENS and non-ENS patients. • Airflow analysis: Airflow parameters were similar between ENS and non-ENS patients after turbinate surgery. On computational fluid dynamic analysis, differences were found on multiple outcomes. • Diagnostic testing: The menthol detection test was impaired in ENS, and cotton placement in the airway improved ENS symptoms. • Cognitive function: Functional magnetic resonance imaging showed activation in emotional processing area during breathing. • Olfactory function: Subjective impairment was reported in ENS, but quantitative measures were similar to non-ENS patients. • Mucosal physiology/innate immunity: Turbinate histopathology in ENS showed a tissue-remodeling pattern. Nasal nitric oxide level was lower in ENS patients. Conclusion: There is evidence of high comorbid mental health disorders in ENS patients. An abnormal trigeminal-thermoreceptor response may be present in some patients. The influence of altered airflow and the evidence of surgery as the cause for ENS are unclear. [ABSTRACT FROM AUTHOR]

Objective: Bladder stones make up 5% of urinary tract stone diseases, and 5% of all bladder stones are seen in women. All kinds of pathologies, chronic urinary tract infections, and foreign bodies causing urinary flow to be dysfunctional are regarded as predisposing factors in general. Well-defined endoscopic, laparoscopic, and open surgical procedures can be performed for treatment. In this study, we retrospectively examined data from female patients who were operated after being diagnosed with bladder stones in our clinic. Methods: Data from 92 females who were operated after being diagnosed with bladder stones at our clinic between January 2006 and October 2014 were retrospectively analyzed. The patients' demographic information, complaints on admission, etiological factors in stone formation, and pre-/post-operative data were retrospectively analyzed. Results: The ages of the patients ranged between 17 and 85 years (mean, 46.8 years). When the backgrounds of the patients were studied, a history of the following was found: gynecological procedures in 49 patients [12 patients with transobturator tape (TOT), trans-vaginal tape in 10 (TVT), trans-abdominal hysterectomy and bilateral salpingo-oophorectomy in 9 (TAH-BSO), cystocele repair in 7, cesarean section in 8 (C/S), intrauterine device migration in 3, and neurogenic bladder dysfunction in 9]. The average stone size was 25.4 mm (range, 7-50 mm). Except for 9 patients with an excess load of stones or in whom the stones could not be previously removed using endoscopic methods, all patients were endoscopically treated. Conclusion: Together with a more frequent application of urogynecological procedures, bladder stones in females have become an important fact in clinical practice that should not be ignored. Therefore, despite the safe and successful use of endoscopic surgical procedures, this topic needs to be supported and developed with new studies. [ABSTRACT FROM AUTHOR]

Patients with impaired bladder volume sensation have the necessity to monitor bladder level in order to avoid urinary tract infections and urinary reflux that can lead to renal failure. In this paper the the effectiveness of an embedded and wearable solution for bladder volume monitoring using the bioimpedance measurement is tested. Data are streamed real-time using Bluetooth wireless technology. The bioimpedance measurements on a healthy subject prove the effectiveness of the proposed solution. In the future the system will be evaluated in real world scenarios with patients affected by spinal paralysis and bladder neurogenic dysfunction. [ABSTRACT FROM AUTHOR]

Diabetic bladder dysfunction (DBD) is the most common urological complication of diabetes. It encompasses both storage and voiding problems, with a broad spectrum of clinical presentations. The pathophysiological mechanisms are multifactorial, involving myogenic, neuronal and urothelial dysfunctions. Diabetes is also associated with increased risk of urinary tract infection. We reviewed the current research to update our knowledge of the pathophysiology and recommendations for management. We surmise that the mixed presentations of DBD can be explained by the temporal theory causing an early phase of compensatory bladder function and a later phase of decompensated bladder function. Secondly, polyuria and hyperglycaemia independently contribute to the pathogenesis of DBD. Further research is required to delineate the differences between type 1 and type 2 diabetes. The development of type 2 diabetic in vitro models and correlation in humans is required. Management strategies remain unchanged and further understanding of the molecular mechanisms is required to target therapeutics. [ABSTRACT FROM AUTHOR]

Objective To evaluate urinary dysfunction and quality of life before and after surgery for deep infiltrating endometriosis (DIE). Methods This prospective study included 50 patients with DIE who required surgery. Urinary dysfunction was evaluated before and after surgery by both urodynamic tests and electromyography, and the Bristol Female Lower Urinary Tract Symptoms (BFLUTS) quality-of-life questionnaire. Results Preoperative electromyography showed that 14 patients (28%) had neurogenic alteration involving sacral reflex and pelvic floor muscles correlated with the presence of colorectal endometriosis (p = 0.003). Postoperative quality of life and BFLUTS total scores were improved compared to preoperative scores (p = 0.001 and p = 0.005, respectively). After an initial improvement in BFLUTS, an alteration is observed at long-term (median follow-up of 66 months). In the 34 patients with pre- and postoperative urodynamic measurements, no difference was found before and after surgery. De novo peripheral neuropathy was only observed in patients who underwent DIE resection with colorectal resection (p = 0.02). Conclusions Our results support that patients with DIE have a high incidence of preoperative urinary symptoms and neurogenic dysfunction. Colorectal resection appears to be a determinant factor of de novo peripheral neuropathy. [ABSTRACT FROM AUTHOR]

Background: Lower urinary tract dysfunction (LUTD) and sexual dysfunction (SD) are common in neurological patients due to a combination of lesions affecting relevant neural control, constraints imposed by sensorimotor and cognitive deficits and - particularly for SD - psychosocial consequences of chronic neurological disease. Summary: This review summarizes the etiology, diagnosis and treatment of LUTD and SD in neurological patients. Key Messages: LUTD may lead to serious health problems; both LUTD and SD significantly affect quality of life. Management of patients with spinal cord injury and dysraphism is undertaken in specialized centers according to established guidelines. Treatment of neurological patients with noncomplicated neurogenic LUTD or SD should preferentially be guided by a neurologist. Clinical Impact: For rational treatment of urinary symptoms, an accurate assessment is mandatory; the bladder and the sphincter need to be defined as normal, over- or underactive. Urodynamic testing is the gold standard for functional diagnosis; assessment of residual urine and uroflow are the minimal requirements before considering management. Dysfunction of desire, arousal and orgasm (ejaculation) may be diagnosed by medical history and are amenable to counselling and treatment, which is - in the case of erectile dysfunction - evidence based. Further high-quality studies are necessary to test the best approaches for diagnosing and managing particular types of neurogenic LUTD and SD in the different neurological patient populations. © 2014 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

The temporal lobes and other cortical regions are involved in the emotional, cognitive and sensorimotor aspects of central control of sexual behaviour, whereas the insula, anterior cingulate and hypothalamus coordinate the activation of the autonomic nervous system. Facilitatory and inhibitory descending pathways modify the activity of thoracolumbar sympathetic and sacral parasympathetic and somatic spinal centres which control the sexual response, i.e. arousal, orgasm and ejaculation. A normal hormonal milieu and vascular system, but also a healthy psychosocial context, are necessary for a fulfilled sexual life. Sexual dysfunction is not uncommon in the general population, particularly in the elderly; it is more common in neurological patients. It significantly lowers their quality of life. The neurologist should diagnose sexual dysfunction in his patients and provide basic management including explanation, suggestions and - if necessary - drugs. [ABSTRACT FROM AUTHOR]

Background. The pain drawing (PD) has proven to have good inter-examiner reliability and high sensitivity in assessing neurogenic pain and dysfunction (NP) originating from the lower back. Studies on its use in the neck/shoulder region have not been found. Objectives. To investigate inter-examiner reliability of a first impression assessment of NP in the neck/shoulder region using a simplified PD made by the patient. Also, to investigate concordance between first impression assessment and a final assessment based on a complete clinical examination. Design. A clinical trial on 50 primary care patients with discomfort in the neck/shoulder region assessed by two independent examiners. One examiner was experienced in assessing the PD and the other was not. A first impression assessment was based solely on the PD. A final assessment was based on clinical examination also including history interviews, physical examinations, and possible radiological reports. NP was considered if at least two physical examination findings indicated neurological deficit in the area of discomfort. Concordance between the first impression assessment and the final assessment was calculated as sensitivity with the final assessment as the key. Results. Inter-examiner reliability based solely on the first impression assessment of the pain drawing reached 88% overall agreement and a sensitivity of 90%. Signs of NP were found in 92% of the patients according to the final assessment. Two thirds of the patients added to their pain drawing during the history interview. Conclusions. First impression assessment of the PD seems to be a reliable, easily learned, and sensitive diagnostic method for assessing NP in the neck/shoulder region. NP may be greatly underestimated, especially as patients withhold symptoms of discomfort when they fill in the PD. [ABSTRACT FROM AUTHOR]

48 boys examined with urethrocystography on all together 129 occasions and shown to have orificial insufficiency of prostatic ducts were studied for associated abnormalities. In 44 cases the insufficiency could be attributed to urinary infection complicating urethral obstruction or neurogenic dysfunction of the urinary bladder or to any one of these three abnormalities alone. The age at which the insufficiency occurred, the time it persisted, and the extent to which it involved the prostate were also studied. [ABSTRACT FROM AUTHOR]