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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    • "Electrical stimulation for urinary incontinence performed according to the technique proposed by Walsh (2002), in the outpatient department of a teaching hospital in Milan (Italy). All patients were initially treated for urinary incontinence with pelvic floor exercises, according to the European guidelines (Abrams et al., 2010). They performed the exercises under the supervision of a nurse specialist, once a week in the outpatient department, and every day at home. "
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    ABSTRACT: Urinary incontinence is common after radical prostatectomy. Pelvic floor muscle training (PFMT) and functional electrical stimulation (FES) can be used to reduce urine leakage. Some patients have difficulty in performing PFMT, and do not obtain clinically significant results. FES might be helpful to them, but its role is unclear in the literature. To verify if FES can reduce urine leakage in patients who do not benefit from PFMT. To obtain mid-term data regarding the persistence of the results through FES or PFMT, associated with a maintenance programme. Prospective and retrospective study (104 PFMT patients, 34 FES) using 24-h pad-test to quantify leakage. Rehabilitation ended when patients obtained leakage <10 g/day. Rehabilitated patients followed a maintenance PFMT programme and performed a follow-up 24-h pad test after 3 months; 51% (PFMT) and 32% (FES) of patients reached leakage <10 g/day. Overall, 82.3% in the PFMT group and 82.3% in the FES group reduced leakage by at least 50% through rehabilitation. No significant difference existed between the two treatments (p = 0.32). After 3 months, 51 rehabilitated patients out of 56 (PFMT) and 11 out of 11 (FES), respectively, showed persistence of the results. PFMT cannot be replaced by machines, but FES can help those who are unable to execute PFMT to strengthen their sphincter and later learn PFMT. Even those who did not achieve rehabilitation had clinically relevant results in both groups. These methods seem useful for incontinent patients after prostatectomy.
    International Journal of Urological Nursing 02/2015; 9(1). DOI:10.1111/ijun.12056 · 0.19 Impact Factor
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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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