ABSTRACT
Purpose: The efficacy of sacral neuromodulation for treating refractory idiopathic lower urinary tract dysfunction is now well established. Nevertheless, results of this technique in neurological patients are still controversial. The aim of this study was to assess the results of sacral neuromodulation in neurogenic bladder dysfunction.
Material and methods: Between 1998 and 2008, a percutaneous nerve evaluation or a two-stage technique was performed in 62 patients (mean age 50.5 ± 14.8 years) with neurogenic lower urinary tract dysfunction. Before and during the temporary stimulation, each patient had an urodynamic evaluation and performed a bladder diary. The test was considered positive if the clinical and urodynamic improvement was over 50% and if the symptoms reappeared after turning the stimulation off.
Results: Lower urinary tract dysfunction was detrusor overactivity in 34 cases and chronic urinary retention in 28 cases. A DSD was associated in nine cases. Out of the 62 patients, 41 patients (66.1%) had more than 50% improvement on urodynamic evaluation and bladder diary and 37 were implanted. With a mean follow-up of 4.3 ± 3.7 years, results remained similar to the evaluation phase in 28 cases (75.7 %), were partially altered in three cases (8.1%) and lost in six cases (16.2%). In these six cases, neuromodulation failed on average 12.0 ± 12.4 months after implantation.
Conclusion: Sacral neuromodulation seems to constitute a serious therapeutic option for patients with neurogenic lower urinary tract dysfunction.
Introduction
Since 1988 and the work reported by Tanagho and Schmidt, sacral neuromodulation has gradually become a second line treatment for refractory lower urinary tract (LUT) dysfunction [...
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...wledge, our study evaluating sacral neuromodulation for neurogenic LUT dysfunction is the largest ever reported. Moreover, it combines a clinical and urodynamic evaluation of the results. However, this study is monocentric and retrospective and our population is heterogeneous with very different neurological diseases and so different pathophysiology. A multicentric and prospective study assessing the impact of sacral neuromodulation in different aetiology of neurological conditions is required to confirm these results.
Conclusion
Sacral neuromodulation provides quite interesting results for managing neurogenic LUT dysfunction. It should be considered an alternative therapy in these conditions.
In the mid-term the results are maintained. However, these depend on the type of the underlying neurologic disease and in particular, whether it may progress or not.
This can be investigated by a range of procedures. These include a CT scan of the kidneys and bladder in conjunction with an abdominal X-ray. Results obtained from the diagnosis and tests enable judgments’ relating to the stage to which the problem has developed and will inform decisions on the appropriate treatment
Gadsby, JG: Transcutaneous Electrical Nerve Stimulation for Chronic Low back Pain. Cochrane Review Abstracts. December 1997
2013). Inappropriate use of urinary catheter in patients as stated by the CDC includes patients with incontinence, obtaining urine for culture, or other diagnostic tests when the patient can voluntarily void, and prolonged use after surgery without proper indications. Strategies used focused on initiating restrictions on catheter placement. Development of protocols that restrict catheter placement can serve as a constant reminder for providers about the correct use of catheters and provide alternatives to indwelling catheter use (Meddings et al. 2013). Alternatives to indwelling catheter includes condom catheter, or intermittent straight catheterization. One of the protocols used in this study are urinary retention protocols. This protocol integrates the use of a portable bladder ultrasound to verify urinary retention prior to catheterization. In addition, it recommends using intermittent catheterization to solve temporary issues rather than using indwelling catheters. Indwelling catheters are usually in for a longer period. As a result of that, patients are more at risk of developing infections. Use of portable bladder ultrasound will help to prevent unnecessary use of indwelling catheters; therefore, preventing
This potent process is ideal for treating symptoms relating to unacknowledged stresses located in the sacral area with clients often reporting an increased sense of wellbeing and calmness.
• You may have a flexible tube (catheter) put into your bladder to drain urine.
Due to the breadth of the female urinary incontinence (UI) device market, categorizing it can aid in better understanding it. The first distinction to be made is between products which are designed to prevent urinary incontinence episodes, and those which are designed to manage them. Within the former category, exist products such as pharmaceuticals, surgical options, bulking agents, nerve stimulation devices, bladder supports and inserts. Within the UI management device category, we find devices which are more commonly associated with incontinence: absorbents, such as diapers and briefs, and indwelling drainage devices, such as catheters. While not discussed in this section, the GR Dome UriCap-F would fall into this management category as well. A table depicting this categorization can be seen in Figure 1.
The treatment for IC is just to reduce the symptoms. There is no cure. You can treat it be oral drugs and changing your eating patterns. You treat it by nerve stimulants, and other drugs. Foods that are highly acidic and alcoholic, even salty will affect the flares of these pains. Considerations when a person has this disease is that they're in pain, and you can't make them do a lot of things. If they can't get up, then provide the best treatment you can by them laying down. A C.N.A will also have to watch their intake, to make sure the diet is still in affect so not to flare up any pains. Also, make sure they stop smoking because smoking is a major cause of bladder cancer. Do range of motion on the person with IC, because small exercise helps with relief of the symptoms. You may also do bladder training with your patient, to help them not use the bathroom so frequently. The training method is keep a schedule of when they should urinate, and stick to the schedule. If they have to go before then find a distraction to help them not think about it. If worse comes to worse, surgery is a possible answer too.
With this paper, we examined the literature on deep brain stimulation in order to answer the following questions: how does deep brain stimulation work in the treatment of Parkinson's disease, how effective is deep brain stimulation in treating Parkin...
Interventions: Measure intake and output to make sure patient is voiding efficiently. Running warm water over perineal area to stimulate urination (Lowdermilk, Perry, Cashion & Alden,
Hydrocephalus is a genetic disorder commonly described as “water on the brain.” In actuality, this is a condition in which there is an excessive accumulation of cerebrospinal fluid (CSF), a clear watery fluid that surrounds the space between the brain and spinal cord, in the brain. Normally, the production together with the absorption process of CSF is specifically balanced to ensure that the brain tissue remains buoyant, that nutrients can be delivered and waste removed, and that there is a compensation for changes in intracranial blood volume. Hydrocephalus blocks this balanced flow as well as absorption, and on account of CSF being produced continuously, 16 oz each day to be exact, the blocking creates a surplus of CSF resulting in the said pressure against the brain tissue. The surplus accretion of CSF additionally motivates ventricular dilation in which the gaps between the brain, known as ventricles, abnormally widen.
In this section the researchers explain the complications that can occur based on non-adherence to a proper self-catheterization regimen. A spinal cord injury can cause an interruption in neural pathways which affect the function of the bladder causing urinary incontinence, urinary retention, urinary reflux, and recurrent urinary tract infections. These problems can ultimately lead to an increase in renal morbidity and mortality (Shaw & Logan, 2013) Later, in the discussion section of the article, the authors focus on the importance of nursing education to teach patients proper methods to perform and cope with ISC in order to eliminate these common occurrences in patients suffering from SCIs (Shaw & Logan, 2013). The perception of performing this task may vary from patient to patient. This research helps identify various educational approaches that could be taken to accommodate all patients. Therefore, the research is significant to nursing due to the fact that nurses are considered the primary educators and are expected to address practical issues with patients performing ISC and help them manage the psychological issues that are faced with this
Recently, two overviews on the management of LBP in primary care, compared between international CPGs, recommended using diagnostic classification (diagnostic triage) to group patients with LBP into one of three broad categories: LBP with significant neurological deficits, specific LBP, and non-specific LBP36,38. LBP with significant neurological deficits is pain that follows a specific nerve root distribution from a compression41 such as prolapsed lumbar disc, spinal stenosis, or surgical scarring42. Specific LBP is due to serious
Swain, S., Hughes, R., Perry, M., Harrison, S. and Object, object (2012) ‘Management of lower urinary tract dysfunction in neurological disease: Summary of NICE guidance’, BMJ, 345(aug08 1), pp. e5074–e5074. doi: 10.1136/bmj.e5074.
Simple musculoskeletal back pain has symptoms of pain in the lumbrasacral area of the back (Jackson & Simpson, 2006). The upper thighs and knees are also known to be affected (Jackson & Simpson, 2006). This pain is usually described as a dull pain (Jackson & Simpson, 2006). Spinal nerve root pain is localised down the leg, and usually continues below the knee and into the feet (Jackson & Simpson, 2006). It has been d...
To access for BPH one asks the patient about difficulty in starting or continuing urination, reduced force or weak stream, sensation of incomplete bladder emptying, straining to begin urination, post void dribbling or leaking (Ignatavicius & Workman, 2013, p. 1630). The nurse I was working with explained that do to the patients underlying health issues he was not a surgical candidate, and that to help the patient void he had an indwelling foley catheter placed long-term.