Neuromodulation in neurogenic bladder.

While neuromodulation is a well-established treatment option for patients with non-neurogenic overactive bladder and urinary retention, its applicability to the neurogenic bladder population has only recently been examined more in depth. In this article we will discuss the outcomes, contraindications, and special considerations of sacral and percutaneous tibial nerve stimulation (PTNS) in patients with neurogenic lower urinary tract dysfunction

Dynamic MRI evaluation of urethral hypermobility post‐radical prostatectomy

Aims One postulated cause of post‐prostatectomy incontinence is urethral and bladder neck hypermobility. The objective of this study was to determine the magnitude of anatomical differences of urethral and bladder neck position at rest and with valsalva in continent and incontinent men post‐prostatectomy based on dynamic MRI. Methods All subjects underwent a dynamic MRI protocol with valsalva and non‐valsalva images and a standard urodynamic evaluation. MRI measurements were taken at rest and with valsalva, including (1) bladder neck to sacrococcygeal inferior pubic point line (SCIPP), (2) urethra to pubis, and (3) bulbar urethra to SCIPP. Data were analyzed in SAS using two‐tailed t tests. Results A total of 21 subjects (13 incontinent and 8 continent) had complete data and were included in the final analysis. The two groups had similar demographic characteristics. On MRI, there were no statistically significant differences in anatomic position of the bladder neck or urethra either at rest or with valsalva. The amount of hypermobility ranged from 0.8 to 2 mm in all measures. There were also no differences in the amount of hypermobility (position at rest minus position at valsalva) between groups. Conclusions We found no statistically significant differences in bladder neck and urethral position or mobility on dynamic MRI evaluation between continent and incontinent men status post‐radical prostatectomy. A more complex mechanism for post‐prostatectomy incontinence needs to be modeled in order to better understand the continence mechanism in this select group of men. Neurourol. Urodynam. 33:312–315, 2014 . © 2013 Wiley Periodicals, Inc.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/106760/1/nau22408.pd

Functional and anatomical differences between continent and incontinent men post radical prostatectomy on urodynamics and 3T MRI: A pilot study

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/112204/1/nau22616.pd

Ambulatory Surgery Centers and Their Intended Effects on Outpatient Surgery

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/113726/1/hesr12278.pdfhttp://deepblue.lib.umich.edu/bitstream/2027.42/113726/2/hesr12278-sup-0001-AppendixSA1.pd

A screening tool for clinically relevant urinary incontinence

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/111206/1/nau22564.pd

The Aging Overactive Bladder: a Review of Aging-Related Changes from the Brain to the Bladder

Purpose of reviewTo understand the current literature on age-related neural and detrusor changes associated with overactive bladder symptoms.Recent findingsRecent functional magnetic resonance imaging (fMRI) studies have unveiled an age-related decrease in the neural control of continence, represented in the insula, anterior cingulate cortex (ACC) and prefrontal cortex (PFC). Older individuals with overactive bladder symptoms also demonstrate heightened activation of the ACC with low volumes, representing increased bladder sensitivity or sense of urgency. At the level of the bladder, age-related changes in the urothelium, neurotransmitters/receptors (both muscarinic and purinergic), and inflammation [including nerve growth factor (NGF), monocyte chemoattractant protein-1 (MCP-1) and oxidative stress] are also associated with overactive bladder.SummaryOveractive bladder among older adults is a complex condition incorporating physiologic age-related changes from the brain to the bladder and beyond