Abrams P, Andersson KE, Birder L, Brubaker L, Cardozo L, Chapple C, et al.. Fourth International Consultation on Incontinence Recommendations of the International Scientific Committee: evaluation and treatment of urinary incontinence, pelvic organ prolapse, and fecal incontinence

Neurourology and Urodynamics (Impact Factor: 2.87). 12/2009; 29(1):213-40. DOI: 10.1002/nau.20870
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    • "Sacral neuromodulation (SNM) [1] has become a well-established and widely accepted treatment for patients with refractory LUTD such as non-obstructive chronic urinary retention, urgency frequency syndrome, and urgency incontinence [2-6] and it has been incorporated into the guidelines of the European Association of Urology (EAU) (, the International Consultation on Incontinence (ICI) [7], and the National Institute for Health and Clinical Excellence (NICE) ( Originally, SNM was not considered an option for neurogenic LUTD but some studies suggested that it is also effective in neurological patients [3,8]. "
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    ABSTRACT: BackgroundSacral neuromodulation has become a well-established and widely accepted treatment for refractory non-neurogenic lower urinary tract dysfunction, but its value in patients with a neurological cause is unclear. Although there is evidence indicating that sacral neuromodulation may be effective and safe for treating neurogenic lower urinary tract dysfunction, the number of investigated patients is low and there is a lack of randomized controlled trials.Methods and designThis study is a prospective, randomized, placebo-controlled, double-blind multicenter trial including 4 sacral neuromodulation referral centers in Switzerland. Patients with refractory neurogenic lower urinary tract dysfunction are enrolled. After minimally invasive bilateral tined lead placement into the sacral foramina S3 and/or S4, patients undergo prolonged sacral neuromodulation testing for 3–6 weeks. In case of successful (defined as improvement of at least 50% in key bladder diary variables (i.e. number of voids and/or number of leakages, post void residual) compared to baseline values) prolonged sacral neuromodulation testing, the neuromodulator is implanted in the upper buttock. After a 2 months post-implantation phase when the neuromodulator is turned ON to optimize the effectiveness of neuromodulation using sub-sensory threshold stimulation, the patients are randomized in a 1:1 allocation in sacral neuromodulation ON or OFF. At the end of the 2 months double-blind sacral neuromodulation phase, the patients have a neuro-urological re-evaluation, unblinding takes place, and the neuromodulator is turned ON in all patients. The primary outcome measure is success of sacral neuromodulation, secondary outcome measures are adverse events, urodynamic parameters, questionnaires, and costs of sacral neuromodulation.DiscussionIt is of utmost importance to know whether the minimally invasive and completely reversible sacral neuromodulation would be a valuable treatment option for patients with refractory neurogenic lower urinary tract dysfunction. If this type of treatment is effective in the neurological population, it would revolutionize the management of neurogenic lower urinary tract dysfunction.Trial registrationTrial registration number:; Identifier: NCT02165774.
    BMC Urology 08/2014; 14(1):65. DOI:10.1186/1471-2490-14-65 · 1.41 Impact Factor
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    • "Overactive bladder (OAB) is a descriptive term, defined by the International Continence Society as the urinary symptoms of urgency, with or without urge urinary incontinence, usually associated with frequency and nocturia.1 Detrusor overactivity (DO), although associated with OAB, is a urodynamic observation characterized by involuntary contractions during the filling phase, which may be spontaneous or provoked.1 DO is further divided into idiopathic DO (IDO), ie, DO with no clear cause, and neurogenic DO (NDO), which is DO in a patient with an underlying neurological condition (commonly multiple sclerosis, or after spinal injury). "
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    ABSTRACT: Overactive bladder (OAB) is a symptom syndrome including urgency, frequency, and nocturia - with or without incontinence. It is a common manifestation of detrusor overactivity (DO). DO is a urodynamic observation of spontaneous or provoked contractions of the detrusor muscle is seen during the filling phase of the micturition cycle. OAB is, therefore, both a motor and sensory disorder. Botulinum toxin is a purified form of the neurotoxin from Clostridium botulinum and has been used in medicine for many years. Over the last 10 years, it has been used for the treatment of DO and OAB when standard treatments, such as bladder training and oral anticholinergic medication, have failed to provide symptom relief. Botulinum toxin acts by irreversibly preventing neurotransmitter release from the neurons in the motor end plate and also at sensory synapses, although the clinical effect is not permanent due to the growth of new connections within treated tissues. It is known that botulinum toxin modulates vanillioid, purinergic, capsaicin, and muscarinic receptor expression within the lamina propria, returning them to levels seen in normal bladders. Clinically, the effect of botulinum toxin on symptoms of OAB and DO is profound, with large effects upon the symptom of urgency, and also large effects on frequency, nocturia, leakage episodes, and continence rates. These effects have been seen consistently within eight randomized trials and numerous case series. Botulinum toxin appears safe, with the only common side effect being that of voiding difficulty, occurring in up to 10% of treated patients. Dosing regimens are variable, depending on which preparation is used, but it is clear that dose recommendations have fallen over the last 5 years. There is limited evidence about the efficacy of repeat treatments. Botulinum toxin is an effective and safe second-line treatment for patients with OAB and DO.
    Research and Reports in Urology 05/2014; 6:51-57. DOI:10.2147/RRU.S44665
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    • "The UI is defined as involuntary loss of urine according to the International Continence Society [2], leading to impairment in quality of life, personal hygiene and social interaction [1]. The main types of urinary incontinence are stress urinary incontinence (SUI) that is characterized by involuntary loss when the intra-abdominal pressure exceeds urethral pressure in the absence of detrusor muscle contraction [3], since urgency urinary incontinence (UUI) is the complaint of involuntary leakage accompanied by or immediately preceded by urgency and when there is a junction of both the mixed urinary incontinence (MUI) [4]. "
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    ABSTRACT: Background Urinary incontinence (UI) is defined as any involuntary loss of urine that can influence the quality of life, personal hygiene and social interaction. The types of UI that most affect women are stress urinary incontinence, urge incontinence and mixed urinary incontinence. There are several risk factors that result in specific treatments. We aimed to investigate the evolution of female urinary continence after physical therapy intervention and its associated factors. Method A retrospective cross-sectional study was conducted with 71 participants who were discharged from physiotherapy sector from August 2006 to April 2012 and met the inclusion criteria. Results Among the studied variables, the number of sessions and completion of home pelvic floor exercises showed a significant association. The urinary continence appeared in 43.7% of the cases, and factors, performance of home exercises, and number of sessions showed a significant association. Conclusion The number of sessions and completion of home pelvic floor exercises showed a significant relationship with each other.
    International Archives of Medicine 05/2014; 7(1):24. DOI:10.1186/1755-7682-7-24 · 1.08 Impact Factor
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