Multiple Sclerosis. Véronique Phé, MD, PhD Pitié-Salpêtrière Academic Hospital Department of Urology Paris 6 University Paris, FRANCE
|
|
- Ann Robinson
- 5 years ago
- Views:
Transcription
1 Queen Square Uro-neurology course, London, UK 20 th -21 st October 2016 Multiple Sclerosis Véronique Phé, MD, PhD Pitié-Salpêtrière Academic Hospital Department of Urology Paris 6 University Paris, FRANCE
2 Affiliations to disclose: Astellas: Enter Organisation/Relationship consultant, speaker, investigator Boston scientific: consultant Allergan: consultant, speaker Medtronic: speaker aaa Pierre Fabre: consultant Ipsen: investigator Funding for speaker to attend: Enter X in appropriate box Self-Funded x Institution (non-industry) funded Sponsored by: Enter Company Name
3 Prevalence of LUT symptoms in MS Reported by % of patients (Panicker 2009) Symptoms might occur during the early stages of the neurological disease and sometimes at the initial presentation (10%) (Nortvedt 2007) But generally after 6 years of evolution of MS (Mayo 1992) Only 43% of patients with the disease with moderate to severe OAB symptoms had their symptoms evaluated by a urologist (Mahajan 2010)
4
5 Clinical presentation Wide range of LUT symptoms (Norvedt 2007, Giannantoni 1998, Amarenco 1995, Betts 1993, Koldejwin 1995, De Seze 2007) - Storage phase: 17-82% - Voiding phase: 34-73% - Storage + voiding phase>50% - Stress urinary incontinence: 56% Correlation of prevalence of LUT symptoms with - Severity of pyramidal syndrome - Presence of cerebellar syndrome - EDSS score - But precise correlation between neurological lesions and LUT dysfunction difficult - And symptoms can vary with time ((Cianco 2007) No correlation between type of symptoms and (Mahajan 2010) - Age - Duration and type of MS
6 Urodynamic presentation References N= Duration of MS Detrusor overactivity Detrusor hypoactivity Detrusor normal activity Low bladder compliance Detrusor sphincteric dyssynergia Amarenco ,8 70% 9% 21% 2% 82% Araki ,8 44% 37% 3% 3% 41% Betts % 0% 9% Gallien % 25% 34% 59% Giannantoni ,5 81% 24% 10% 10% 42% Kasabian % 31% 13% 5% Koldewijn ,5 34% 8% 34% 13% Frequent coexistence - DO+ DSD (43-80%) - DO + acontractility (5-9%) Poor clinical/urodynamic correlations
7 Urological complications of LUT dysfunction Lower UTIs : 13-80% Upper UTIs: 0-23% Morphological modifications of bladder: 4-30% Ureteral reflux: 0-15% Stones : 2-11% Upper urinary tract dilation: 0-25% Kidney failure: 0-10% Bladder cancer: 0.29% 3 risk factors (De Sèze 2007, Castel- Lacanal 2015) - Duration of MS (>15 y) - High intravesical pressures - Indwelling catheter
8 Clinical investigations- Bladder diary The ICS recommends the use of a bladder diary
9 Clinical investigations- Quality of life assessment Only Qualiveen (MAPI research trust, Lyon, France) is validated for evaluation of the QOL of patients with neurological disease (Bonniaud 2005) Recommended by the EAU 30-item questionnaire - Bother (9 items) - Constraints (8 items) - Fears (8 items) - Feelings (5items) Currently translated into six different languages.
10 Clinical investigations- Urinalysis See yesterday course
11 Ultrasonography Renal ultrasonography - Entirely normal - Hydronephrosis - Stones Uroflowmetry and Post-void residual volume
12 Urodynamic investigations DO NOT offer urodynamic investigations routinely to patients who are known to have a low risk of renal complications DO offer urodynamics in the initial diagnosis of patients DO offer urodynamics Risk factors predisposing to upper urinary tract damage Concomitant SUI Failure of first-line treatment Surgical treatment
13 Other investigations Creatinine clearance Cystoscopy, retrograde uretrocystography on a case-by-case basis
14 Management Goals: To protect the upper urinary tract To achieve continence To improve quality of life
15 Guidelines for managing bladder dysfunction: consensual approach Urologists Primary care Neurologists Stakeholders Nurses- eg. continence nurses Patient groups
16 Management Storage symptoms
17 General measures and physical treatments A fluid intake of L/day Reduction in caffeine intake <100 mg/day to reduce symptoms of the storage phase (Bryant 2002) Pelvic floor rehabilitation (De Ridder 1999, De Sèze 2014) MS Patients with mild disability Intact neural control of their pelvic floor muscles No cognitive impairments
18 Antimuscarinics In patients with MS, the evidence base supporting the clinical use of antimuscarinics is limited Not all currently available antimuscarinics have been systematically investigated in patients with MS and their use is often based upon data from other patient groups Cochrane Review (Nicholas, 2010) - 3 RCT in MS Hebjorn 1977, n=64, oxybutinin Gajewski 1986, n=34, oxybutinin Fader 2007, n=34, flavoxate - incontinence episodes and intravesical pressure - Improvement of QOL But sides effects: >2/3 of patients stop the treatment after 6 months
19 Intradetrusor botulinum toxin A injections DIGNITY (Cruz 2011, Ginsberg 2012) N=241 placebo, N=227 botox, 57.3% MS EDSS <6.5 Outcomes in MS Same efficacy as SCI: urinary incontinence, urodynamics, QOL Complications vs placebo - Acute urinary retention 29.5% (vs 4.6%) - De novo ISC 31.4% (vs 4.5%) - UTIs 53.5% (vs 29.2%)
20 Intradetrusor botulinum toxin A injections Khan, 2011 Prospective, n=137 MS, repeated injections of Botox 300 U FU= 29 mo (9-80) Almost all ISC 83% incontinent before Botox vs 76% dry 4 wks after Botox
21 UI Episodes/Day (Mean Change From Baseline) *P<.001 vs. placebo based on least-squared means; P<.001 vs. placebo based on mean change from baseline. OnabotA = onabotulinumtoxina; UI = urinary incontinence. Proportion of Patients Achieving 100% UI Reduction (%) Efficacy and Safety of OnabotulinumtoxinA 100U for Treatment of Urinary Incontinence Due to Neurogenic Detrusor Overactivity in Non-catheterising Multiple Sclerosis Patients Chartier-Kastler et al., EAU OnabotulinumtoxinA 100U significantly reduced daily UI episodes versus placebo Over 50% of onabotulinumtoxina-treated patients achieved 100% UI reduction * OnabotA 100U (n=66) Placebo (n=78) 10.3
22 I-QOL Scores (Mean Change From Baseline) * Improvements in I-QOL total summary score were significantly greater with onabotulinumtoxina 100U versus placebo and were approximately 3 times the MID Compared with placebo, onabotulinumtoxina 100U treatment resulted in significant improvements in MCC and significant reductions in MDP during first IDC OnabotA (n=66) 9.92 Placebo (n=78) MID OnabotulinumtoxinA was well tolerated with no unexpected safety signals CIC rate was 15.2% with 100U onabotulinumtoxina in this study compared to 31% with 200U in non-catheterising MS patients in the phase 3 studies 1 Conclusions In non-catheterising MS patients who were inadequately managed by 1 anticholinergic, treatment with onabotulinumtoxina 100U resulted in significant and clinically-meaningful improvements from baseline in incontinence, urodynamic parameters, and QOL *P<.001 vs. placebo based on least-squared means. 1 Ginsberg D, et al. Adv Ther (9):819. I-QOL = Incontinence Quality of Life; MID = minimally important difference (+11 points); OnabotA = onabotulinumtoxina.
23 Tibial nerve stimulation De Sèze, 2011 Prospective and multicentric N=70 MS, EDSS <7 Stimulation 20 min/d Improvement of symptoms at D30 and 90 in 82.6% et 83.3% of patients Well-tolerated
24 Sacral neuromodulation Minardi, 2012 Retrospective n=25 MS FU 49.4 mo, age 45.2 y
25 Augmentation cystoplasty Karsenty 2006
26 Incontinent urinary diversion If catheterisation is impossible, incontinent diversion with urine collecting devices are indicated. Ultimately, it could be considered in patients Who are wheelchair bound or bed-ridden (skin ulcers included) With intractable and untreatable incontinence In devastated LUTS When the upper urinary tract is severely compromised In patients who refuse other therapies Always discuss cystectomy Complications: skin, stoma, infection permanent follow-up
27 Incontinent urinary diversion: Ileal conduit Guillotreau 2011 Prospective N=48 neurological patients, among them n=38 MS with EDSS 7.5 Cystectomy + ileal conduit (laparoscopy) Indications - Recurrent UTIs (60.4%) - Chronic urinary retention or indwelling catheter (54.2%) - Urinary incontinence (37.5%) - Chronic renal disease (22.9%) - False passage due to catheterization (6.3%) - Improvement of bladder related QOL - No improvement of overall QOL
28 Management Voiding symptoms
29 Catheterization Intermittent self-catheterization= method of choice to empty the bladder Suprapubic catheter - Preservation of the urethra - But risk of infection in 60% patients Indwelling catheter: to avoid? - Complications: Kidney, infections, stones, urethral lesions Barnes DG et al, Br J Urol 1993;72(2): Perrouin-Verbe B et al, Paraplegia 1995;33(11): Perkash I et al, J Urol 1993;149(5): Mitsui T, et al, Eur Urol 2000;38(4): Jacobs Scet al, J Urol 1978;119(6):740-1
30 Self-intermittent cateterization Castel-Lacanal et al Prospective, N=23 MS, 15F/8M, 49.3 y+/-10.3, EDSS 4.5 (1-7.5) FU 9.3 mo +/- 3 mo
31 Continent urinary diversion For cosmetic reasons, the umbilicus is often used for the stoma site Pre-requisites: Patient request for it Well controlled bladder (Urodynamics +++) Hand dexterity must be good (tetraplegic patients are challenging patients) The continence rates are over 80% and good protection of the upper urinary tract is achieved. But complications: stenosis, leakage
32 Continent urinary diversion Karsenty 2006
33 Follow-up monitoring Presence of specific risk factors - Duration of multiple sclerosis >15 years - Presence of an indwelling catheter - Ample uninhibited detrusor contractions - High detrusor pressure - DSD For patients who are risk-free: systematic annual evaluation - 3-day bladder diary - Uroflowmetry with measurement of the post-void residual volume - Urodynamic investigation every 3 years (GENULF) or in the event of second-line or intravesical treatment being required, or when a patient is considered to be at risk of damage to the upper urinary tract (UK consensus) For patients who are deemed to have a higher risk of rapid worsening of LUT symptoms - Ultrasonography of the urinary tract - Measurement of renal creatinine clearance - Quality-of-life assessment - Urodynamic Expert multidisciplinary team
34 Conclusions LUT symptoms are common in patients with MS Symptoms vary in type and severity, and can evolve with progression of the disease Consensual approach and consideration of possible progression of the disease ISC is essential for the management of voiding symptoms, but might also have a role in management of those with storage symptoms Intradetrusor botulinum toxin A injections are a highly effective treatment Surgical options should be performed only after careful selection of patients Regular long-term follow-up monitoring
Guidelines on Neurogenic Lower Urinary Tract Dysfunction
Guidelines on Neurogenic Lower Urinary Tract Dysfunction (Text update March 2009) M. Stöhrer (chairman), B. Blok, D. Castro-Diaz, E. Chartier- Kastler, P. Denys, G. Kramer, J. Pannek, G. del Popolo, P.
More informationUrinary Aspects of Multiple Sclerosis chronic condition with innovative treatment strategies. Dr. Boris Friedman May 2, 2012 OBJECTIVES
Urinary Aspects of Multiple Sclerosis chronic condition with innovative treatment strategies Dr. Boris Friedman May 2, 2012 OBJECTIVES 1) Definition and classification of MS 2) Interventional radiology
More informationThe Neurogenic Bladder
The Neurogenic Bladder Outline Brandon Haynes, MD Resident Physician Department of Urology Jelena Svircev, MD Assistant Professor Department of Rehabilitation Medicine Anatomy and Bladder Physiology Bladder
More informationNEUROGENIC BLADDER. Dr Harriet Grubb Dr Alison Seymour Dr Alexander Joseph
NEUROGENIC BLADDER Dr Harriet Grubb Dr Alison Seymour Dr Alexander Joseph OUTLINE Definition Anatomy and physiology of bladder function Types of neurogenic bladder Assessment and management Complications
More informationGUIDELINES ON NEUROGENIC LOWER URINARY TRACT DYSFUNCTION
GUIDELINES ON NEUROGENIC LOWER URINARY TRACT DYSFUNCTION M. Stöhrer (chairman), D. Castro-Diaz, E. Chartier-Kastler, G. Kramer, A. Mattiasson, J-J. Wyndaele Introduction NLUTD (neurogenic lower urinary
More informationLower Urinary Tract Symptoms K Kuruvilla Zachariah Associate Specialist
Lower Urinary Tract Symptoms K Kuruvilla Zachariah Associate Specialist Lower Urinary Tract Symptoms Storage Symptoms Frequency, urgency, incontinence, Nocturia Voiding Symptoms Hesitancy, poor flow, intermittency,
More informationRecommandations de prise en charge des vessies neurogènes EAU 2006
Annexe 4-1 Recommandations de prise en charge des vessies neurogènes EAU 2006 (Version courte) 685 686 GUIDELINES ON NEUROGENIC LOWER URINARY TRACT DYSFUNCTION M. Stöhrer (chairman), D. Castro-Diaz, E.
More informationDiagnosis and treatment of overactive bladder (non-neurogenic) in adults: AUA/SUFU guideline.
Diagnosis and treatment of overactive bladder (non-neurogenic) in adults: AUA/SUFU guideline. TARGET POPULATION Eligibility Decidable (Y or N) Inclusion Criterion non-neurogenic OAB Exclusion Criterion
More informationBladder dysfunction in ALD and AMN
Bladder dysfunction in ALD and AMN Sara Simeoni, MD Department of Uro-Neurology National Hospital for Neurology and Neurosurgery Queen Square, London 10:15 Dr Sara Simeoni- Bladder issues for AMN patients
More informationPelvic Floor Therapy for the Neurologic Client Carina Siracusa, PT, DPT, WCS
Pelvic Floor Therapy for the Neurologic Client Carina Siracusa, PT, DPT, WCS OhioHealth, Columbus Ohio Disclosures I have nothing to disclose Objectives Describe the role of a pelvic floor therapist in
More informationGUIDELINES ON NEURO-UROLOGY
GUIDELINES ON NEURO-UROLOGY (Text update pril 2014) J. Pannek (co-chair), B. Blok (co-chair), D. Castro-Diaz, G. del Popolo, J. Groen, G. Karsenty, T.M. Kessler, G. Kramer, M. Stöhrer Eur Urol 2009 Jul;56(1):81-8
More informationNeuropathic Bladder. Magda Kujawa Consultant Urologist Stockport NHS Foundation Trust 12/03/2014
Neuropathic Bladder Magda Kujawa Consultant Urologist Stockport NHS Foundation Trust 12/03/2014 Plan Physiology- bladder and sphincter behaviour in neurological disease Clinical consequences of Symptoms
More informationEAU GUIDELINES ON NEURO-UROLOGY
EAU GUIDELINES ON NEURO-UROLOGY (Limited text update March 2017) B. Blok (Co-chair), J. Pannek (Co-chair) D. Castro-Diaz, G. del Popolo, J. Groen, R. Hamid, G. Karsenty, T.M. Kessler Guidelines Associates:
More informationGUIDELINES ON NEURO-UROLOGY
GUIDELINES ON NEURO-UROLOGY (Limited text update March 2015) B. Blok (Co-chair), J. Pannek (Co-chair), D. Castro Diaz, G. del Popolo, J. Groen, T. Gross (Guidelines ssociate), R. Hamid, G. Karsenty, T.M.
More informationEAU GUIDELINES ON NEURO-UROLOGY
EAU GUIDELINES ON NEURO-UROLOGY (Limited text update March 2016) B. Blok (Co-chair), J. Pannek (Co-chair) D. Castro-Diaz, G. del Popolo, J. Groen, R. Hamid, G. Karsenty, T.M. Kessler. Guidelines Associates:
More informationBotulinum Toxin Injection for OAB: Indications & Technique
Classification of LUTS Botulinum Toxin Injection for OAB: Indications & Technique Sherif Mourad, MD Professor of Urology, Ain Shams University General Secretary of International Continence President of
More informationTREATMENT OF OVERACTIVE BLADDER IN ADULTS FUGA 2016 KGH
TREATMENT OF OVERACTIVE BLADDER IN ADULTS FUGA 2016 KGH CONTENTS Overactive bladder (OAB) Treatment of OAB Beta-3 adrenoceptor agonist (Betmiga ) - Panacea? LASER treatment - a flash in the pan or the
More information2/9/2008. Men Women. Prevalence of OAB. Men: 16.0% Women: 16.9% Prevalence (%) < Age (years)
Definition Botox for Overactive Bladder Donna Y. Deng Assistant Professor UCSF Department of Urology Urinary urgency With or without urge incontinence Usually with frequency & nocturia International Continence
More informationCASES FOR TRAINING OF THE INTERNATIONAL SPINAL CORD INJURY LOWER URINARY TRACT FUNCTION BASIC DATA SET CASE 1
1 CASES FOR TRAINING OF THE INTERNATIONAL SPINAL CORD INJURY LOWER URINARY TRACT FUNCTION BASIC DATA SET CASE 1 35 years old man, who previously has been completely healthy, was shot twice in the neck
More informationUK Consensus on Bladder Management in MS
Continence Care Forum Annual Conference UK Consensus on Bladder Management in MS Clare J.Fowler National Hospital for Neurology and Neurosurgery & Institute of Neurology, UCL Association of British Neurologists
More informationNeurogenic Bladder. Spina Bifida Education Day Conference SBA of Northeastern New York Albany, New York April 14, Eric Levey, M.D.
Neurogenic Bladder Spina Bifida Education Day Conference SBA of Northeastern New York Albany, New York April 14, 2018 Eric Levey, M.D. Pediatrics & Neurodevelopmental Disabilities Chief Medical Officer,
More informationABSTRACT ORIGINAL RESEARCH
Adv Ther (2013) 30:819 833 DOI 10.1007/s25-013-0054-z ORIGINAL RESEARCH OnabotulinumtoxinA is Effective in Patients with Urinary Incontinence due to Neurogenic Detrusor Activity Regardless of Concomitant
More informationLUTS after TURP: How come and how to manage? Matthias Oelke
LUTS after TURP: How come and how to manage? Matthias Oelke Department of Urology Global Congress on LUTD, Rome, 26 th June 2015 Disclosures Consultant, speaker, trial participant and/or research grants
More informationUrogynecology in EDS. Joan L. Blomquist, MD Greater Baltimore Medical Center August 2018
Urogynecology in EDS Joan L. Blomquist, MD Greater Baltimore Medical Center August 2018 One in three like me Voiding Issues Frequency/Urgency Urinary Incontinence neurogenic bladder Neurologic supply
More informationBotulinum Toxin: Applications in Urology
Botulinum Toxin: Applications in Urology Dr. Lee Jonat, PGY-4 Department of Urologic Sciences University of British Columbia Outline Mechanism of Action Technical Considerations Adverse Events Neurogenic
More informationIncontinence in neurological disease
nice bulletin Incontinence in neurological disease NICE provided the content for this booklet which is independent of any company or product advertised NICE Bulletin - Incontinence in neurological disease.indd
More informationUrinary Incontinence. Vibhash Mishra Consultant Urological Surgeon Royal Free Hospital
Urinary Incontinence Vibhash Mishra Consultant Urological Surgeon Royal Free Hospital Affects women of all ages Impacts physical, psychological & social wellbeing Impact on families & carers Costs the
More informationClinical guideline Published: 8 August 2012 nice.org.uk/guidance/cg148
Urinary incontinence in neurological disease: assessment and management Clinical guideline Published: 8 August 2012 nice.org.uk/guidance/cg148 NICE 2018. All rights reserved. Subject to Notice of rights
More informationMr. GIT KAH ANN. Pakar Klinikal Urologi Hospital Kuala Lumpur.
Mr. GIT KAH ANN Pakar Klinikal Urologi Hospital Kuala Lumpur drgitka@yahoo.com 25 Jan 2007 HIGHLIGHTS Introduction ICS Definition Making a Diagnosis Voiding Chart Investigation Urodynamics Ancillary Investigations
More informationSummary. Neuro-urodynamics. The bladder cycle. and voiding. 14/12/2015. Neural control of the LUT Initial assessment Urodynamics
Neuro-urodynamics Summary Neural control of the LUT Initial assessment Urodynamics Marcus Drake, Bristol Urological Institute SAFETY FIRST; renal failure, dysreflexia, latex allergy SYMPTOMS SECOND; storage,
More informationManagement of LUTS after TURP and MIT
Management of LUTS after TURP and MIT Hong Sup Kim Konkuk University TURP & MIT TURP : Gold standard MIT TUIP TUNA TUMT HIFU LASER Nd:YAG, ILC, HoLRP, KTP LUTS after TURP and MIT Improved : about 70% Persistent
More informationManagement of OAB. Lynsey McHugh. Consultant Urological Surgeon. Lancashire Teaching Hospitals
Management of OAB Lynsey McHugh Consultant Urological Surgeon Lancashire Teaching Hospitals Summary Physiology Epidemiology Definitions NICE guidelines Evaluation Conservative management Medical management
More informationBladder Dysfunction in Multiple Sclerosis. by Nancy J. Holland, EdD, RN and Nancy C. Reitman, MA, RN
Clinical Bulletin Information for Health Professionals Bladder Dysfunction in Multiple Sclerosis by Nancy J. Holland, EdD, RN and Nancy C. Reitman, MA, RN Effective bladder management strategies make it
More informationUrinary Incontinence. Lora Keeling and Byron Neale
Urinary Incontinence Lora Keeling and Byron Neale Not life threatening. Introduction But can have a huge impact on quality of life. Two main types of urinary incontinence (UI). Stress UI leakage on effort,
More informationManagement, Evaluation, and Treatment of Overactive Bladder and Urinary Incontinence
Management, Evaluation, and Treatment of Overactive Bladder and Urinary Incontinence Arthur Mourtzinos, MD, MBA Co-Vice Chair, Institute of Urology Director, Continence Center Assistant Professor of Urology,
More informationOveractive Bladder Syndrome
Overactive Bladder Syndrome behavioural modifications to pharmacological and surgical treatments Dr Jos Jayarajan Urologist Austin Health, Eastern Health Warringal Private, Northpark Private, Epworth Overactive
More informationOveractive Bladder (OAB) and Quality of Life
Overactive Bladder (OAB) and Quality of Life Dr. Byron Wong MBBS (Sydney), FRCSEd, FRCSEd (Urol), FCSHK, FHKAM (Surgery) Specialist in Urology Central Urology Clinic Hong Kong Continence Society Annual
More informationUrodynamics in Neurological Lower Urinary Tract Dysfunction. Mr Chris Harding Consultant Urologist Freeman Hospital Newcastle-upon-Tyne
Urodynamics in Neurological Lower Urinary Tract Dysfunction Mr Chris Harding Consultant Urologist Freeman Hospital Newcastle-upon-Tyne Learning Objectives Review functional neurology relevant to lower
More informationUrodynamics Mismatch - Should We Listen to the Study, or the Patient?
Urodynamics Mismatch - Should We Listen to the Study, or the Patient? A Practical Approach to the Diagnosis and Treatment of Lower Urinary Tract Dysfunction Victor W. Nitti MD Professor of Urology and
More informationPhiladelphia College of Osteopathic Medicine. Victoria J. Kopec Philadelphia College of Osteopathic Medicine,
Philadelphia College of Osteopathic Medicine DigitalCommons@PCOM PCOM Physician Assistant Studies Student Scholarship Student Dissertations, Theses and Papers 2015 Does Treatment With OnabotulinumtoxinA
More informationWhat should we consider before surgery? BPH with bladder dysfunction. Inje University Sanggye Paik Hospital Sung Luck Hee
What should we consider before surgery? BPH with bladder dysfunction Inje University Sanggye Paik Hospital Sung Luck Hee Diagnostic tests in three categories Recommendation: there is evidence to support
More informationHow to assess and predict success or failure of intra-detrusor injections with onabotulinumtoxina
Reviews How to assess and predict success or failure of intra-detrusor injections with onabotulinumtoxina Mikolaj Przydacz A F, Tomasz Golabek A,E,F, Piotr Chlosta A,E,F Department of Urology, Jagiellonian
More informationLower Urinary Tract Symptoms (LUTS) and Nurse-Led Clinics. Sean Diver Urology Advanced Nurse Practitioner candidate Letterkenny University Hospital
Lower Urinary Tract Symptoms (LUTS) and Nurse-Led Clinics Sean Diver Urology Advanced Nurse Practitioner candidate Letterkenny University Hospital 01/02/2018 Lower Urinary Tract Symptoms LUTS - one of
More informationHow to manage a patient with bladder dysfunction
3 rd Congress of the European Academy of Neurology Amsterdam, The Netherlands, June 24 27, 2017 Teaching Course 13 How to manage a patient with autonomic dysfunction - Level 2 How to manage a patient with
More informationDiagnostic approach to LUTS in men. Prof Dato Dr. Zulkifli Md Zainuddin Consultant Urologist / Head Of Urology Unit UKM Medical Center
Diagnostic approach to LUTS in men Prof Dato Dr. Zulkifli Md Zainuddin Consultant Urologist / Head Of Urology Unit UKM Medical Center Classification of LUTS Storage symptoms Voiding symptoms Post micturition
More informationManagement of Female Stress Incontinence
Management of Female Stress Incontinence Dr. Arvind Goyal Associate Professor (Urology& Renal Transplant) Dayanand Medical College & Hospital, Ludhiana, Punjab, India Stress Incontinence Involuntary loss
More informationTuesday 24 June Poster Session 1: Voiding Dysfunction Chairmen: C. Chapple and L. Stewart
Tuesday 24 June 10.30 11.30 Poster Session 1: Voiding Dysfunction Chairmen: C. Chapple and L. Stewart P001 Can oral antibiotic prophylaxis reduce the rate of infection after conventional urodynamic studies?
More informationModule 5 Management Of Urinary Incontinence
Management Of Urinary Incontinence V3: Last Reviewed September 2017 Learning Outcomes Outline conservative management options Discover the options available to manage the different types of incontinence
More informationPost operative voiding dysfunction and the Value of Urodynamics. Dr Salwan Al-Salihi Urogynaecologist Obstetrician and Gynaecologist
Post operative voiding dysfunction and the Value of Urodynamics Dr Salwan Al-Salihi Urogynaecologist Obstetrician and Gynaecologist Learning objectives: v Pathophysiology of post op voiding dysfunction.
More informationSpinal Cord Injury. R Hamid Consultant Neuro-Urologist London Spinal Injuries Unit, Stanmore & National Hospital for Neurology & Neurosurgery, UCLH
Spinal Cord Injury R Hamid Consultant Neuro-Urologist London Spinal Injuries Unit, Stanmore & National Hospital for Neurology & Neurosurgery, UCLH SCI 800 1000 new cases per year in UK Car accidents 35%
More informationKathleen C. Kobashi, MD, FACS Head, Section of Urology and Renal Transplantation Virginia Mason Medical Center, Seattle, WA
Kathleen C. Kobashi, MD, FACS Head, Section of Urology and Renal Transplantation Virginia Mason Medical Center, Seattle, WA Disclosures Advisory Board and/or Speaker Allergan Medtronic Astellas AUA Guidelines
More informationNATIONAL INSTITUTE FOR HEALTH AND CLINICAL EXCELLENCE SCOPE
NATIONAL INSTITUTE FOR HEALTH AND CLINICAL EXCELLENCE 1 Guideline title SCOPE Urinary incontinence in women: the management of urinary incontinence in women 1.1 Short title Urinary incontinence in women
More informationAccepted Manuscript. Assessment of renal deterioration and associated risk factors in patients with multiple sclerosis
Accepted Manuscript Assessment of renal deterioration and associated risk factors in patients with multiple sclerosis Nabeel A. Shakir, Arthi Satyanarayan, Jessica Eastman, Benjamin M. Greenberg, Gary
More informationHospital and Tzu Chi University, Hualien, Taiwan
LUTS (2012) 4, 29 34 ORIGINAL ARTICLE Difficult Urination Does Not Affect the Successful Outcome after 100U OnabotulinumtoxinA Intravesical Injection in Patients with Idiopathic Detrusor Overactivity Yih-Chou
More informationUrodynamics in women. Aims of Urodynamics in women. Why do Urodynamics?
Urodynamics in women Chendrimada Madhu MD, MA, MRCOG Subspecialty Trainee in Urogynaecology Southmead Hospital 2013 Aims of Urodynamics in women n Confirmation of incontinence and its cause n Definition
More informationStimulation of the Sacral Anterior Root Combined with Posterior Sacral Rhizotomy in Patients with Spinal Cord Injury. Original Policy Date
MP 7.01.58 Stimulation of the Sacral Anterior Root Combined with Posterior Sacral Rhizotomy in Patients with Spinal Cord Injury Medical Policy Section Issue 12:2013 Original Policy Date 12:2013 Last Review
More informationPolicy for Prostatism/Lower Urinary Tract Symptoms in men
NHS Halton Clinical Commissioning Group NHS Liverpool Clinical Commissioning Group NHS St Helens Clinical Commissioning Group NHS South Sefton Clinical Commissioning Group NHS Southport and Formby Clinical
More informationManaging urinary morbidity after brachytherapy. Kieran O Flynn Department of Urology, Salford Royal Foundation Trust, Manchester
Managing urinary morbidity after brachytherapy Kieran O Flynn Department of Urology, Salford Royal Foundation Trust, Manchester Themes Can we predict urinary morbidity? Prevention of urinary morbidity
More informationNON-Neurogenic Chronic Urinary Retention AUA White Paper
NON-Neurogenic Chronic Urinary Retention AUA White Paper Great Lakes SUNA Inside Urology March 16, 2018 Michelle J. Lajiness FNP-BC Nurse Practitioner DMC Urology Incidence Really unknown Lack consensus
More informationCase Based Urology Learning Program
Case Based Urology Learning Program Resident s Corner: UROLOGY Case Number 23 CBULP 2011 077 Case Based Urology Learning Program Editor: Associate Editors: Manager: Case Contributors: Steven C. Campbell,
More informationIntermittent self-catheterisation (ISC) Information for patients Spinal Injuries
Intermittent self-catheterisation (ISC) Information for patients Spinal Injuries page 2 of 12 What is clean intermittent self-catheterisation (CISC)? Urinary catheterisation is a procedure used to drain
More informationTools for Evaluation. Urodynamics Case Studies. Case 1. Evaluation. Case 1. Bladder Diary SUI 19/01/2018
Urodynamics Case Studies Christopher K. Payne, MD Vista Urology & Pelvic Pain Partners Emeritus Professor of Urology, Stanford University Tools for Evaluation Ears, Eyes, and Brain Bladder diary Stress
More informationManagement of neurogenic bladder in children. In: Guidelines on paediatric urology.
Complete Summary GUIDELINE TITLE Management of neurogenic bladder in children. In: Guidelines on paediatric urology. BIBLIOGRAPHIC SOURCE(S) Management of neurogenic bladder in children. In: Tekgul S,
More informationOveractive bladder syndrome (OAB)
Service: Urology Overactive bladder syndrome (OAB) Exceptional healthcare, personally delivered What is OAB? An overactive bladder or OAB is where a person regularly gets a sudden and compelling need or
More informationeuropean urology 52 (2007)
european urology 52 (2007) 1729 1735 available at www.sciencedirect.com journal homepage: www.europeanurology.com Neuro-urology Do Repeat Intradetrusor Botulinum Toxin Type A Injections Yield Valuable
More informationURINARY INCONTINENCE. Urology Division, Surgery Department Medical Faculty, University of Sumatera Utara
URINARY INCONTINENCE Urology Division, Surgery Department Medical Faculty, University of Sumatera Utara Definition The involuntary loss of urine May denote a symptom, a sign or a condition Symptom the
More informationgiovanni.montini@aosp.bo.it VD: definition Voiding dysfunction refers to daytime voiding disorders in children who do not have neurologic, anatomic, obstructive, or infectious abnormalities of the urinary
More informationINCONTINENCE AND OTHER UROLOGICAL DILEMMAS DR. ANNA LAWRENCE UROLOGIST AUCKLAND HOSPITAL 161 UROLOGY
INCONTINENCE AND OTHER UROLOGICAL DILEMMAS DR. ANNA LAWRENCE UROLOGIST AUCKLAND HOSPITAL 161 UROLOGY COVERING INCONTINENCE BE ON JUST NAPPIES CATHETERS TYPES AVAILABLE AND WHEN TO USE THEM JJ STENTS???
More informationPaediatric Urotherapy Training
Paediatric Urotherapy Training Frances Shit NS, MSc (Hons), ET, Dept. of Surgery, PWH, CUHK HKSAR Urinary Incontinence in Children Urine leakage in a child from 5 years of age Leakage occurs on a regular
More informationIntravesical Botox Injections
Intravesical Botox Injections Department of Urology Patient Information What What is is Botox? Botox? Botox or Botulinum Type-A is toxin produced by bacteria called Clostridium Botulinum. It is given intravesically
More informationObjectives. Prevalence of Urinary Incontinence URINARY INCONTINENCE: EVALUATION AND CURRENT TREATMENT OPTIONS
URINARY INCONTINENCE: EVALUATION AND CURRENT TREATMENT OPTIONS Lisa S Pair, MSN, CRNP Division of Urogynecology and Pelvic Reconstructive Surgery Department of Obstetrics and Gynecology University of Alabama
More informationIntermittent Catheterisation What do we need to know? Workshop
Intermittent Catheterisation What do we need to know? Workshop Hanny Cobussen-Boekhorst, PhD, MANP, RN Continence and Urostomy care Radboud University Medical Center Department of Urology Nijmegen, The
More informationURODYNAMICS IN MALE LUTS: NECESSARY OR WASTE OF TIME?
URODYNAMICS IN MALE LUTS: NECESSARY OR WASTE OF TIME? Andrea Tubaro, MD, FEBU Chairman Department of Urology Sant Andrea Hospital Sapienza University of Rome, Italy Disclosures Consultant, paid speaker,
More informationOveractive bladder. Information for patients from Urogynaecology
Overactive bladder Information for patients from Urogynaecology An overactive bladder (OAB) is a very common problem. It can cause distressing symptoms that are difficult to control. These can include
More informationUse of the Botulinum Toxin A in the Treatment of the Neurogenic Detrusor Overactivity
Use of the Botulinum Toxin A in the Treatment of the Neurogenic Detrusor Overactivity Editorial Raluca Borcăiaș 1,2, A. Manu-Marin 3, S. Nedelea 1,2, S. Rascu 1,2, V. Jinga 1,2 1 Prof. Dr. Th. Burghele
More informationPatient Information. Basic Information on Overactive Bladder Symptoms. pubic bone. urethra. scrotum. bladder. vaginal canal
Patient Information English Basic Information on Overactive Bladder Symptoms The underlined terms are listed in the glossary. What is the bladder? pubic bone bladder seminal vesicles prostate rectum The
More informationPhysiology & Neurophysiology of lower U.T.
Physiology & Neurophysiology of lower U.T. Classification of voiding dysfunction Evaluation of a child with voiding dysfunction Management Storage Ø Adequate volume of urine Ø At LOW pressure Ø With NO
More informationTHE ACONTRACTILE BLADDER - FACT OR FICTION?
THE ACONTRACTILE BLADDER - FACT OR FICTION? Jacob Golomb Department of Urology Chaim Sheba Medical Center Tel Hashomer NEUROGENIC UNDERACTIVE DETRUSOR Central (complete/incomplete): Spinal cord injury-
More informationUroToday International Journal. Volume 5 - March 2012
www.urotodayinternationaljournal.com Volume 5 - March 2012 Consensus Statement on Neurogenic Detrusor Overactivity: Multiple Sclerosis and Spinal Pamela I. Ellsworth, MD (Program Chair) 1 ; Patricia K.
More informationOveractive Bladder in Clinical Practice
Overactive Bladder in Clinical Practice Alan J. Wein Christopher Chapple Overactive Bladder in Clinical Practice Authors Alan J. Wein Division of Urology University of Pennsylvania Health System Philadelphia
More informationNEUROMODULATION FOR UROGYNAECOLOGISTS
NEUROMODULATION FOR UROGYNAECOLOGISTS Introduction The pelvic floor is highly complex structure made up of skeletal and striated muscle, support and suspensory ligaments, fascial coverings and an intricate
More informationOnabotulinumtoxin - A Injections for the Treatment of Neurogenic Detrusor Overactivity
Onabotulinumtoxin - A Injections for the Treatment of Neurogenic Detrusor Overactivity Raluca Borcăiaș 1, S. Rașcu 1,2, V. Jinga 1,2, D. Mischianu 1,3, A. Manu-Marin 4 1 Carol Davila University of Medicine
More informationManaging Female Urinary Incontinence Within Primary Care
Managing Female Urinary Incontinence Within Primary Care Angela Patterson Lead Clinical Nurse Specialist in Bladder and Bowel Dysfunction. South Eastern HSCT Background More than 14 million in the UK affected
More informationLUTS & Cancer pathway. Mr Francis Thomas Urology Consultant DRI &BDGH
LUTS & Cancer pathway Mr Francis Thomas Urology Consultant DRI &BDGH Topics Male and female LUTS Urinary retention Post void Residual urine Referral pathway LUTS Raised PSA Hematuria Services in community
More informationPRE-OPERATIVE URODYNAMIC
PRE-OPERATIVE URODYNAMIC STUDIES: IS THERE VALUE IN PREDICTING POST-OPERATIVE STRESS URINARY INCONTINENCE IN WOMEN UNDERGOING PROLAPSE SURGERY? Dr K Janse van Rensburg Dr JA van Rensburg INTRODUCTION POP
More informationClinical Study Predictors of Response to Intradetrusor Botulinum Toxin-A Injections in Patients with Idiopathic Overactive Bladder
Advances in Urology Volume 2009, Article ID 328364, 4 pages doi:10.1155/2009/328364 Clinical Study Predictors of Response to Intradetrusor Botulinum Toxin-A Injections in Patients with Idiopathic Overactive
More informationKingston Continence Service Clinical Audit on the Use of Video Urodynamic Studies
Kingston Continence Service Clinical Audit on the Use of Video Urodynamic Studies Lead researcher Dr. Anika Kibria Advanced Trainee in Geriatric Medicine A Video urodynamic Study (VUS) The technique combines
More informationNeuroanatomy, Neurophysiology and Clinical Presentation of Visceral Urological Pain
Neuroanatomy, Neurophysiology and Clinical Presentation of Visceral Urological Pain Prof Dr K. Everaert Functional urology Department of Urology Ghent University Hospital Gent, Belgium Chronic pelvic pain
More informationSecond-line Treatment for OAB
Patient Information English 35 Second-line Treatment for OAB The underlined terms are listed in the glossary. Sometimes the drugs your doctor prescribed do not improve your overactive symptoms (OAB). In
More informationLow-dose onabotulinumtoxina improves urinary symptoms in noncatheterizing patients with MS
Published Ahead of Print on July 20, 2018 as 10.1212/WNL.0000000000005991 ARTICLE OPEN ACCESS CLASS OF EVIDENCE Low-dose onabotulinumtoxina improves urinary symptoms in noncatheterizing patients with MS
More informationDysfunctional voiding
Dysfunctional voiding The importance of assessment, diagnosis and treatment of dysfunctional voiding and its role in recurrent UTI Dr Dean Wallace Consultant Paediatric Nephrologist RMCH Objectives Development
More informationManagement of Urinary Incontinence in Older Women. Dr. Cecilia Cheon Department of Obs. & Gyn. Queen Elizabeth Hospital
Management of Urinary Incontinence in Older Women Dr. Cecilia Cheon Department of Obs. & Gyn. Queen Elizabeth Hospital Epidemiology Causes Investigation Treatment Conclusion Elderly Women High prevalence
More informationResearch Article Urinary Catheterization May Not Adversely Impact Quality of Life in Multiple Sclerosis Patients
ISRN Neurology, Article ID 167030, 4 pages http://dx.doi.org/10.1155/2014/167030 Research Article Urinary Catheterization May Not Adversely Impact Quality of Life in Multiple Sclerosis Patients Rebecca
More informationThe patient, your co-pilot in assessing LUTS
The patient, your co-pilot in assessing LUTS Frank Van der Aa Leuven, Belgium This symposium is supported by Astellas Pharma Europe Ltd., including speaker honoraria and production of materials the slides
More informationAdVance Male Sling System
AdVance Male Sling System Clinical study summary This document is a compilation and summary of several AdVance Male Sling System peer-reviewed journal articles. The information presented here is taken
More informationVoiding Dysfunction Block lecture, 5 th year student. Choosak Pripatnanont, Department of Surgery, PSU.
Voiding Dysfunction 2009 Block lecture, 5 th year student. Choosak Pripatnanont, Department of Surgery, PSU. Objectives Understand and explain physiologic function and dysfunction of lower urinary tract.
More informationDiagnosis and Mangement of Nocturia in Adults
Diagnosis and Mangement of Nocturia in Adults Christopher Chapple Professor of Urology Sheffield Teaching Hospitals University of Sheffield Sheffield Hallam University UK 23 rd October 2015 Terminology
More informationBotulinum Toxin Treatment for Overactive Bladder: Efficacy, Mechanism of Action, Techniques and Practical Tips W16, 15 October :00-17:00
Botulinum Toxin Treatment for Overactive Bladder: Efficacy, Mechanism of Action, Techniques and Practical Tips W16, 15 October 2012 14:00-17:00 Start End Topic Speakers 14:00 14:15 Introduction Mohammad
More informationUrogynecology Office. Can You Hold? An Update on the Treatment of OAB. Can You Hold? Urogynecology Office
Urogynecology Office Urogynecology Office Can You Hold? An Update on the Treatment of OAB Can You Hold? Karen Noblett, MD Professor and Chair Department of OB/GYN University of California, Riverside Disclosures
More information