Recent advances in neuroimaging of bladder, bowel and sexual function

PURPOSE OF REVIEW: In this review, we summarize recent advances in the understanding of the neural control of the bladder, bowel and sexual function, in both men and women. RECENT FINDINGS: Evidence of supraspinal areas controlling the storage of urine and micturition in animals, such as the pontine micturition centre, emerged in the early 20th century. Neurological stimulation and lesion studies in humans provided additional indirect evidence for additional bladder-related brain areas. Thereafter, functional neuroimaging in humans with PET and fMRI provided more direct evidence of the involvement of these brain areas. The areas involved in the storage and expulsion of urine also seem to be involved in the central control of storage and expulsion of feces. Furthermore, most knowledge on the brain control of sexual function is obtained from dynamic imaging in human volunteers. Relatively little is known about the dysfunctional central circuits in patients with pelvic organ dysfunction. SUMMARY: fMRI has been the most widely used functional neuroimaging technique in the last decade to study the central control of bladder function, anorectal function and sexual function. The studies described in this review show which sensory and motor areas are involved, including cortical and subcortical areas. We propose the existence of a switch-like phenomenon located in the pons controlling micturition, defecation and orgasm

Electrical stimulation in the treatment of bladder dysfunction: Technology update

The urinary bladder has two functions: urine storage and voiding. Clinically, two major categories of lower urinary tract symptoms can be defined: storage symptoms such as incontinence and urgency, and voiding symptoms such as feeling of incomplete bladder emptying and slow urinary stream. Urgency to void with or without incontinence is called overactive bladder (OAB). Slow urinary stream, hesitancy, and straining to void with the feeling of incomplete bladder emptying are often called underactive bladder (UAB). The underlying causes of OAB or UAB can be either non-neurogenic (also referred to as idiopathic) and neurogenic, for example due to spinal cord injury or multiple sclerosis. OAB and UAB can be treated conservatively by lifestyle intervention or medication. In the case that conservative treatment does not provide sufficient benefit, electrical stimulation can be used. Sacral neurostimulation or neuromodulation (SNM) is offered as a third-line therapy to patients with non-neurogenic OAB or UAB. In SNM, the third or fourth sacral nerve root is stimulated and after a test period, a neuromodulator is implanted in the buttock. Until recently only a non-rechargeable neuromodulator was approved for clinical use. However, nowadays, a rechargeable sacral neuromodulator is also on the market, with similar safety and effectiveness to the non-rechargeable SNM system. The rechargeable device was approved for full body 1.5T and 3T MRI in Europe in February 2019. Regarding neurogenic lower urinary tract dysfunction, electrical stimulation only seems to benefit a selected group of patients

Multiuse Catheters for Clean Intermittent Catheterization in Urinary Retention: Is There Evidence of Inferiority?

In Europe, urinary retention is managed with single-use catheters but there is uncertainty regarding their superiority over multiuse catheters

Tien jaar expertise met aanpasbare continentietherapie voor post-prostatectomie urine-incontinentie

Doel van het onderzoek was de evaluatie van de resultaten van ProACT™-ballonnen voor de behandeling van post-prostatectomie urine-incontinentie (PPI). Tussen 2007 en 2016 werden bij 143 niet-bestraalde patiënten ProACT™-ballonnen geïmplanteerd. De mate van urine-incontinentie is bepaald, waarbij geen inlegger of één dunne inlegger voor de zekerheid werd gedefinieerd als succesvol. De preoperatieve mate van urine-incontinentie was mild (1–2 inleggers) bij 25%, matig (3–4 inleggers) bij 40% en ernstig (≥5 inleggers) bij 35% van de patiënten. Na een mediane follow-up van 56 maanden bleek de behandeling succesvol bij 46% van de patiënten en ervoer 64% van de patiënten een verbetering van het inleggThis study aimed to evaluate outcomes of ProACT™ balloons for the treatment of male stress urinary incontinence after radical prostatectomy. Included were 143 patients without a history of radiotherapy in whom these balloons were implanted between 2007 and 2016. Outcome was urinary continence: no pad or just one security pad per day was defined as successful. Preoperative incontinence was mild in 25%, moderate in 40%, and severe in 35% of patients. The Clavien-Dindo classification <30 days were: 6% grade I, 2% grade II, 2% grade IIIb. 90% of patients had no complication. After median 56 months of follow-up, 64% of patients were improved, including the 46% who were successfully treated. The ProACT™ device showed a clear beneficial continence outcome in patients with stress urinary incontinence after radical prostatectomy. The majority of patients was satisfied and perceived improvement ≥50% on daily pad use on the long term

The urinary-specific quality of life of multiple sclerosis patients: Dutch translation and validation of the SF-Qualiveen

Aims: The SF-Qualiveen is a short questionnaire that measures the impact of urinary symptoms on the quality of life of patients with urological dysfunction due to neurological disorders. The aim of this study is to translate, culturally adapt and validate a Dutch version of the SF-Qualiveen for use in Multiple Sclerosis (MS) patients. Methods: Cross-cultural adaptation of the original English SF-Qualiveen into Dutch was performed according to standardized guidelines. Adult MS patients with symptomatic urinary disorders who visited the Urology or Rehabilitation outpatient clinic of the Erasmus Medical Center completed the SF-Qualiveen and the Urinary Distress Inventory-6 (UDI-6), that evaluates bother caused by lower urinary tract symptoms and was used as a gold standard, at baseline and 1-2 weeks later. A control group recruited from the Otolaryngology outpatient clinic completed the questionnaires once. Reliability and validity were determined. Results: Fifty MS patients and 50 controls were included. SF-Qualiveen scores in patients were higher than in controls (on a scale of 0-4: 1.73 vs. 0.34; P 0.8) and reproducibility (Intraclass correlation coefficients >0.8) were good for the total SF-Qualiveen. Content validity was adequate and a significant relationship between SF-Qualiveen and UDI-6 (r = 0.510-0.479, P < 0.

Outcome and complications of adjustable continence therapy (ProACT™) after radical prostatectomy: 10 years’ experience in 143 patients

Aims: To evaluate our outcomes of the adjustable continence balloons ProACT™ for the treatment of male stress urinary incontinence after radical prostatectomy. Methods: Between May 2007-August 2016 the ProACT™ was implanted in 143 patients without a history of radiotherapy. Endpoints were patient-reported changes in pad counts and complications. Treatment was considered successful if no pad or just one “security” pad per day sufficed, and improved if daily pad use was reduced by ≥50%. Results: Incontinence before implantation was mild in 36 (25%), moderate in 57 (40%), and severe in 50 (35%) patients. Complications within 30 days were classified by the Clavien-Dindo classification; eight (5.6%) grade I, three (2.1%) grade II, three (2.1%) grade IIIb, and 129 (90.2%) patients had no complication. Revision was done in 43 (30%) patients. The IPSS quality of life item improved significantly from 5.0 (IQR 4.0-5.0) preoperative to 2.0 (IQR 1.0-4.0) and 1.0 (IQR 0.0-3.0) 6 and 12 months after implantation, respectively. After a median follow up of 56 months (range 28 to 79, n = 112), 72 (64%) patients were improved, including 51 (45%) patients were successful. Daily pad use decreased from 3.0 to 1.0 (67% reduction). The median outcome on the Patient Global Impression of Improvement scale was “much better,” and 97 (87%) patients perceived improvement. Conclusions: The minimally invasive ProACT™ device showed a clear beneficial continence outcome in patients with stress urinary incontinence after radical prostatectomy. The majority of the patients were satisfied and perceived improvement ≥50% on daily pad use on the long term

Acute effect of sacral neuromodulation for treatment of detrusor overactivity on urodynamic parameters

Aim: The aim of this study is to evaluate the acute effects of sacral neuromodulation (SNM) on various urodynamic parameters. Methods: Patients with overactive bladder and detrusor overactivity (DO) who were planned for percutaneous nerve evaluation (PNE) were included. Directly after the PNE, a urodynamic study (UDS) was performed. The stimulation was turned off during the first UDS (UDS 1), and during the second filling cycle, stimulation was turned on (UDS 2). The UDS was followed by a test phase of 1 week and the bladder diaries were evaluated during an outpatient clinic visit. Primary outcome measures were the differences in UDS parameter values with SNM off and on. Results: Ten female patients were included in the study and completed the study protocol. Eight patients showed ≥50% improvement of symptoms following a test phase. There were no differences between UDS 1 and UDS 2 in the UDS parameters; bladder volume at first sensation, bladder volume at first DO, highest DO pressure, bladder capacity, maximum flow rate, and pressure at maximum flow rate. Discussion: None of the aforementioned urodynamic parameters was influenced by acute SNM in patients who responded to SNM. To the best of our knowledge, this is the first study investigating the ac

The validation of the Dutch OAB-q SF: An overactive bladder symptom bother and health-related quality of life short-form questionnaire

Aims: The overactive bladder quality of life short-form questionnaire (OAB-q SF) evaluates both symptom bother and health-related quality of life in patients with OAB, a highly prevalent disease. The objective of this study was to translate and validate a Dutch version of the OAB-q SF. Methods: The translation into Dutch and validation process of the OAB-q SF was performed according to standardized guidelines. Patients with OAB who visited the department of Urology outpatient clinic completed the questionnaires OAB-q SF, European Quality of life 5-Dimension 5-Level questionnaire (EQ-5D-5L), Urogenital Distress Inventory 6 (UDI-6), and the International Consultation on Incontinence Questionnaire Overactive Bladder (ICIQ-OAB) at baseline (test) and 2 weeks later (retest). A reference group from the department of Allergology outpatient clinic completed the same questionnaires once. The evaluated measurement properties included content validity, internal consistency, reproducibility, criterion validity, and construct validity. Results: Fifty-two patients were included in the study group and 51 references were included. The content validity was adequate and the internal consistency was excellent (Cronbach's α > 0.80). The reproducibility was good with intraclass correlation coefficients higher than 0.70. Patient'

Outcome and complications of adjustable continence therapy (ProACTTM ) in the treatment of urinary incontinence after transurethral resection of the prostate: A multicenter study

Aim: To evaluate the outcome of adjustable continence balloons in the treatment of stress urinary incontinence (SUI) after transurethral resection of the prostate (TURP). Methods: In two tertiary centers, adjustable continence balloons were implanted in 29 patients with post‐TURP SUI between 2007 and 2018. Endpoints of this retrospective multicenter study were patient‐reported changes in pad count and complications. Dry was defined as no pad or one securit

The validation of the Dutch SF-Qualiveen, a questionnaire on urinary-specific quality of life, in spinal cord injury patients

Background: Optimizing the patients' quality of life is one of the main goals in the urological management of spinal cord injury (SCI) patients. In this study we validated the Dutch SF-Qualiveen, a short questionnaire that measures the urinary-specific quality of life, in SCI patients. No such measure is yet available for this patient group. Methods: In 2015-2016 SCI patients with urinary symptomatology who visited the outpatient clinics of Urology at the Erasmus Medical Centre and Rehabilitation at Rijndam Revalidation completed the SF-Qualiveen and UDI-6 during the visit and 1-2 weeks later. The UDI-6, a urinary tract symptom inventory, served as gold standard. Controls, recruited from the Otolaryngology outpatient clinic, completed the questionnaires once. Content-, construct-, and criterion validity and reliability (internal consistency and reproducibility) of the SF-Qualiveen were determined. Results: Fifty seven SCI patients and 50 controls were included. 12 SCI patients asserted that the SF-Qualiveen covered their bladder problems (good content validity). Patients' SF-Qualiveen scores being positively associated with severity of urinary symptoms and patients' scores being higher than those of controls indicated good construct validity. The positive association that was found between SF-Qualiveen and UDI-6 in patients (r = 0.66-0.67, P < 0.001) and controls (r = 0.63, P < 0.001) confirmed good criterion validity. Internal consistency (Cronbach's alpha 0.89-0.92) and reproducibility (intraclass correlation coefficient 0.94) of the SF-Qualiveen were good. Conclusions: The Dutch SF-Qualiveen is a valid and reliable tool to measure the urinary-specific quality of life in SCI patients