Urogenital dysfunction in male patients with Charcot-Marie-Tooth: a systematic review

Aims Purposes of this study were to describe lower urinary tract symptoms (LUTS) and related urodynamic patterns in patients with hereditary spastic paraplegia (HSP), and to characterize LUTS management and associated uronephrological complications. Methods We retrospectively reviewed medical files of HSP patients, consecutively followed in our Physical and Rehabilitation Medicine Department between 1999 and 2016. Clinical, urodynamic, and radiological data were collected and analyzed. Different treatments which have been prescribed and uronephrological complications were also recorded. Patients with other neurological or urological diseases were excluded. Results Thirty-three patients with HSP were included. Mean duration of follow-up was 8.1 ± 5 years, mean age 62 ± 14 years, and 70% were men. The most frequent LUTS was urgency and voiding dysfunction (both 69.7%). Incontinence and retention with a significant postvoid residue above 100 mL accounted for 66.7% and 57.6% of initial symptoms respectively. Neurogenic detrusor overactivity was diagnosed in 80.7% of patients. Two-thirds of our cohort were treated with anticholinergics and 9.1% required intradetrusor botulinum-toxin injections. Only 27.3% of patients performed clean intermittent self-catheterization. Febrile urinary tract infections (21.2%), urolithiasis (15,1%), hydronephrosis (6%), and chronic renal failure (9.1%) were found. Conclusion Given their high prevalence and the risk of uronephrological complications, LUTS should be systematically assessed in HSP patients. The systematic screening of urological dysfunction in this population would improve its management, decrease the incidence of uronephrological complications, and increase the quality of life

Myosin IIA/IIB restrict adhesive and protrusive signaling to generate front–back polarity in migrating cells

Myosin IIA and IIB synergistically generate front–back polarity through their effects on actomyosin bundling formation and stability, and adhesion maturation, which are mediated by localized Rac GEF depletion

Les troubles génitosexuels du blessé médullaire

Les conséquences dramatiques d’une lésion de la moelle épinière sont multiples. Il ne s’agit pas seulement de perdre le contrôle moteur volontaire et la sensibilité de la partie du corps située sous la lésion, mais aussi de ne plus pouvoir exercer de contrôle sur la fonction érectile, sur l’éjaculation et sur la continence urinaire et fécale. Les premiers travaux sur la fonction génitosexuelle chez le paraplégique ont véhiculé l’idée couramment admise par le monde médical que le paraplégique est impuissant et stérile. Heureusement cette idée petit à petit s’efface, et de nombreux travaux ont permis de démontrer la nécessité d’une prise en charge adaptée et l’efficacité de certaines thérapeutiques. Cela est particulièrement important au regard de la population traitée. Il s’agit dans 70 % des cas d’hommes jeunes puisque la tranche d’âge habituelle du traumatisme est entre 25 et 35 ans. À cette période de la vie l’activité sexuelle est souvent maximale et le potentiel de fertilité est inexprimé chez l’Homme

Editorial Comment: Long-term outcomes and risks factors for failure of intradetrusor onabotulinumtoxin A injections for the treatment of refractory neurogenic detrusor overactivity

International audienc

Long-term clinical and urodynamic effectiveness of augmentation ileocystoplasty with supra-trigonal cystectomy in individuals with spinal cord injury

International audiencePurpose: This study aimed to determine the long-term effectiveness of augmentation ileocystoplasty (AI) associated with supra-trigonal cystectomy on clinical and urodynamic variables, and the safety of the intervention in individuals with spinal cord injury (SCI). Materials and methods: Single-center, retrospective study of all patients with SCI who underwent AI with supra-trigonal cystectomy from January 1994, with a follow-up of more than 8 years. The primary outcome was the sustained long-term effectiveness of AI with supra-trigonal cystectomy on clinical and urodynamic variables. The secondary outcome was the long-term safety of this procedure. Results: We included 77 patients: 57% were female, mean (SD) age was 52.0 (13.0) years, 77% had paraplegia, and median time since onset was 25.0 [19; 30] years. Long-term success rate (evaluated 13 [10; 15] years post AI) was 93.5% for urodynamic parameters and 76.6% for urinary incontinence. Results of the short- and long-term post-AI assessments did not differ for any urodynamic or clinical variables. Bladder lithiasis occurred in 20.5% of cases and ≥ 1 febrile urinary tract infection occurred in 55.8%, mostly within the first 2 years of follow-up. No cases of bladder cancer were diagnosed. Conclusion: AI associated with supra-trigonal cystectomy in patients with SCI is safe and effective in both the short term and long term. Regular urodynamic assessment is not necessary in clinically stable patients with low bladder risk; however, close monitoring is important because of the risk of urological complications

Validation d'un questionnaire spécifique des troubles anorectaux dans la sclérose en plaques: STAR-Q

International audienceBackground: Bowel symptoms are commonly experienced by patients with Multiple sclerosis (PwMS), but no specific questionnaire validated in this population allows a rigorous assessment. Objective: Validation of a multidimensional questionnaire assessing bowel disorders in PwMS. Methods: A prospective, multicenter study was conducted between April 2020 and April 2021. The STAR-Q (Symptoms’ assessmenT of AnoRectal dysfunction Questionnaire), was built in 3 steps. First, literature review and qualitative interviews were performed to create the first version, discussed with a panel of experts. Then, a pilot study assessed comprehension, acceptation and pertinence of items. Finally, the validation study was designed to measure content validity, internal consistency reliability (alpha coefficient of Cronbach) and test–retest reliability [intraclass correlation coefficient (ICC)]. The primary outcome was good psychometric properties with Cronbach's α > 0.7 and ICC > 0.7. Results: We included 231 PwMS. Comprehension, acceptation and pertinence were good. STAR-Q showed a very good internal consistency reliability (Cronbach's α = 0.84) and test-retest reliability (ICC = 0.89). Final version of STAR-Q was composed of 3 domains corresponding in symptoms (Q1–Q14), treatment and constraints (Q15–Q18) and impact on quality of life (Q19). Three categories of severity were determined (STAR-Q ≤ 16: minor, between 17 and 20: moderate, and ≥ 21: severe). Conclusions: STAR-Q presents very good psychometric properties and allows a multidimensional assessment of bowel disorders in PwMS. Level of evidence:

Neurogenic bladder in patients with paraplegia: a two-center study of the real-life experience of the patients’ journey

International audienceIntroduction: Several patterns of urological dysfunctions have been described following spinal cord injury (SCI), depending on the level and the completeness of the injury. A better understanding of the natural history of neurogenic bladder in patients with SCI, and the description of their successive therapeutic lines based on their clinical and urodynamic pattern is needed to improve their management. This study aimed to describe the real-life successive therapeutic lines in patients with neurogenic lower urinary tract dysfunction (NLUTD) following SCI. Methods: We conducted a two-center retrospective review of medical files of patients with SCI followed in two French specialized departments of Physical Medicine and Rehabilitation between January 2000 and January 2018. All patients with SCI with a level of lesion bellow T3 and older than 18 years old were eligible. The primary outcome was the description of the natural journey of neurogenic bladder in this population, from the awakening bladder contraction to the last therapeutic line. Survival curves were calculated with a 95-confidence interval using the Kaplan–Meier method. Results: One hundred and five patients were included in this study. Most of the patients were young men with a complete SCI lesion. The median time of treatment introduction was 1 and 9 years for anticholinergics and intradetrusor injection of BoNT/A, respectively. Median duration of effect of treatments was 4 and 6 years post-introduction of anticholinergics and BoNT/A, respectively. Conclusion: This study describes NLUTD journey of patients with SCI demonstrating the mid-term efficacy of the two first therapeutic lines of NDO management. An improvement of non-surgical therapeutics is needed

Efficacy and safety of intradetrusor botulinum toxin injections for idiopathic overactive bladder syndrome in patients with an artificial urinary sphincter

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Weekly Sequential Antibioprophylaxis for Recurrent Urinary Tract Infections Among Patients With Neurogenic Bladder: A Randomized Controlled Trial

International audienceBACKGROUND:Recurrent urinary tract infections (R-UTIs) are the main cause of morbidity and hospitalisations in subjects with neurogenic bladder (NB) due to spinal cord injury (SCI). We evaluated the efficacy of weekly oral cyclic antibiotic (WOCA) prophylaxis, i.e. the alternate weekly administration of two antibiotics, in preventing R-UTI.METHODS:Randomized (1:1), open-label, superiority controlled trial, comparing WOCA prophylaxis to no prophylaxis (control) for six months in patients with NB due to SCI, using clean intermittent self-catheterization, and suffering from R-UTIs. Primary outcome: incidence of symptomatic antibiotic-treated UTIs. Secondary outcomes: number of febrile UTIs, number of hospitalisations, WOCA tolerance, antibiotic consumption, number of negative urine cultures, and emergence of bacterial resistance in urinary, intestinal and nasal microbiota.RESULTS:A total of 45 patients were either allocated to the WOCA group (n=23) or the control group (n=22). Median incidence of symptomatic antibiotic-treated UTIs was 1.0 [IQR 0.5; 2.5] in the WOCA group vs. 2.5 [IQR 1.2; 4.0] (p=0.0241) in the control group. No febrile UTI were recorded in the WOCA group vs. 9 (45.0%) (p<0.001) in the control group. Median number of additional antibiotic treatment was 0.0 [IQR 0.0; 2.0] vs. 3.0 [2.0; 5.0] (p=0.004) in the WOCA and control groups, respectively. Only few adverse events were reported. No impact on emergence of bacterial resistance was observed.CONCLUSIONS:WOCA is efficient and well-tolerated in preventing R-UTI in SCI patients. In our study, we did not observe any emergence of antibiotic resistance in digestive and nasal microbiological cultures

Efficacy and safety of intradetrusor botulinum toxin injections for idiopathic overactive bladder syndrome in patients with an artificial urinary sphincter

To assess the efficacy and safety of intradetrusor botulinum toxin type A injections (IBTI) for idiopathic overactive bladder (iOAB) in non-neurological adults with an artificial urinary sphincter (AUS). We retrospectively selected, in the 11 French centers, members of a collaborative network (GENULF (Groupe d’étude de neuro-urologie de langue francaise)), the patients who had had an artificial urinary sphincter implantation and who had subsequently developed iOAB requiring IBTI. This study was approved by the French association of urology ethics committee (no 2018012). Between 2006 and 2020, 33 patients were included from 5 French centers. Mean follow-up after the first IBTI was 47&nbsp;months. The average age of the studied population was 68&nbsp;years, with 70% of females. A complete resolution of symptoms at optimal IBTI dose was experienced by 21 (64%) patients. Seven (21%) patients had partial improvement. Five non-responder patients (15%) had no improvement at all. Maximum cystometric bladder capacity was 240&nbsp;ml pre-IBTI and 335&nbsp;ml post IBTI. Discontinuation free survival at 60&nbsp;months was 50%. Two erosions occurred during the 6&nbsp;months following an IBTI both in male patients with a perineal implantation. There were four AUS balloon perforations that occurred during the 6&nbsp;months following an IBTI, all of them in female patients. IBTI has a good efficacy for the treatment of iOAB in patients with an AUS. However, both patients and practicians must be aware of the risk of rare and usually mild complications