119 research outputs found
Neurogenic bladder dysfunction: Surgical interventional approaches
This chapter describes the different surgical procedures for managing a neurogenic bladder. The procedures include electrical stimulation, bladder and urethral reconstructive surgery, bladder outlet obstruction management and the treatment of stress urinary incontinence. Electrical stimulation to manage bladder dysfunction in patients with neurological disorders has been used since 1950. Electrical stimulation therapies include intravesical electrostimulation, sacral neuromodulation and sacral anterior root stimulation with selective sacral rhizotomy. Cutaneous continent diversions may be performed in neurological patients, mainly in the young myelomeningocele patient or those with spinal cord injury (SCI) who cannot perform clean intermittent self-catheterization (CISC) via the urethra because of congenital abnormalities, urethral pain, obesity, strictures or poor hand mobility. Finally, the chapter describes the suprapubic catheter (SPC), and sphincter surgery, which relieves bladder outlet obstruction due to external urethral sphincter contraction
Lower urinary tract dysfunction in multiple sclerosis, in Midi Pyrénées: Evaluation of a care network
Injections intravĂ©sicales de toxine botulinique de type A aprĂšs Ă©chec dâentĂ©rocystoplastie dâagrandissement chez des patients neurologiques : une Ă©tude rĂ©trospective multicentrique
Recommandations pour lâutilisation de la toxine botulinique de type A (BotoxÂź) dans lâhyperactivitĂ© vĂ©sicale rĂ©fractaire idiopathique
RĂ©sumĂ©ObjectifsDĂ©finir des recommandations pour lâutilisation pratique de la toxine botulinique de type A (BoNTA) dans lâhyperactivitĂ© vĂ©sicale rĂ©fractaire idiopathique (HAVRI).MĂ©thodeĂlaboration de recommandations de bonne pratique par consensus formalisĂ©, validĂ©es par un groupe de 13 experts puis par un groupe de lecture indĂ©pendant.RĂ©sultatsEn cas dâinfection urinaire celle-ci doit ĂȘtre traitĂ©e et lâinjection reportĂ©e. Avant lâinjection, il est recommandĂ© de sâassurer de la faisabilitĂ© et de lâacceptabilitĂ© de lâauto-sondage. Lâinjection peut ĂȘtre rĂ©alisĂ©e aprĂšs une anesthĂ©sie locale urĂ©tro-vĂ©sicale (lidocaĂŻne), Ă©ventuellement complĂ©tĂ©e par lâinhalation de protoxyde dâazote et parfois sous anesthĂ©sie gĂ©nĂ©rale. Lâinjection sera rĂ©alisĂ©e au bloc opĂ©ratoire ou en salle dâendoscopie. La vessie ne doit pas ĂȘtre trop remplie (risque de perforation). Le traitement doit ĂȘtre appliquĂ© en 10 à 20 injections de 0,5 à 1mL rĂ©parties de maniĂšre homogĂšne dans la vessie en restant Ă distance des mĂ©ats urĂ©tĂ©raux. Il nâest pas recommandĂ© de laisser en place une sonde vĂ©sicale sauf en cas dâhĂ©maturie importante. Le patient doit ĂȘtre surveillĂ© jusquâĂ la reprise mictionnelle. Une note dâinformation sur les effets indĂ©sirables Ă©ventuels doit lui ĂȘtre remise Ă sa sortie. Une consultation doit ĂȘtre prĂ©vue 3 mois aprĂšs la premiĂšre injection (calendrier mictionnel, dĂ©bitmĂ©trie, rĂ©sidu post-mictionnel et examen cytobactĂ©riologique des urines). Un rĂ©sidu >200mL et/ou symptomatique doit faire discuter des auto-sondages. Une nouvelle injection pourra ĂȘtre envisagĂ©e lorsque le bĂ©nĂ©fice clinique de la prĂ©cĂ©dente sâestompe (entre 6 et 9 mois).ConclusionsLe respect de ces recommandations devrait permettre une utilisation optimale de la BoNTA.Niveau de preuve3.SummaryObjectivesProvide guidelines for practical usage of botulinum toxin type A (BoNTA) for refractory idiopathic Overactive Bladder management.Patients and methodsGuidelines using formalized consensus guidelines method. These guidelines have been validated by a group of 13 experts quoting proposals, subsequently reviewed by an independent group of experts.ResultsIn the case of patients with urinary tract infection, it must be treated and injection postponed. Before proposing an injection, it is recommended to ensure the feasibility and acceptability of self-catheterisation by patient. The injection can be performed after local anesthesia of the bladder and urethra (lidocaine), supplemented where necessary by nitrous oxide inhalation and sometimes under general anesthesia. Injection is performed in the operating room or endoscopy suite. The bladder should not be too filled (increased risk of perforation). Treatment should be applied in 10 to 20 injections of 0.5 to 1mL homogeneously distributed in the bladder at a distance from the urethral orifices. It is not recommended to leave a urinary catheter in place except in cases of severe hematuria. The patient should be monitored until resumption of micturition. After the first injection, an appointment must be scheduled within 3 months (micturition diary, uroflowmetry, measurement of residual urine and urine culture). Performance of self-catheterisation should be questioned in the case of a symptomatic post-void residual and/or a residue>200mL. A new injection may be considered when the clinical benefit of the previous injection diminishes (between 6 and 9 months). A period of three months must elapse between each injection.ConclusionsImplementation of these guidelines may promote best practice usage of BoNTA with optimal risk/benefit ratio
OnabotulinumtoxinA for neurogenic detrusor overactivity and dose differences: a systematic review
Syndrome clinique dâhyperactivitĂ© vĂ©sicale non neurologique et pathologie pelvi-pĂ©rinĂ©ale de la femme
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