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.
Availability of nerve block therapy, chiropractic treatment and high dose of pain medicine which will promote numbness, reduce sciatic nerve pain, minimize fatigue and decrease pain sensation. Similarly, implanted pain pumps which delivers a medicine directly to the spinal cord and symptoms can be controlled by smaller dose than needed dose with oral medication.
Different studies had different result numbers or different percentage reduction rates which was primarily based on their indifferences in regards to study design utilized and sample size. As evidenced by research results (Magers, June 2013) and (Welden, 2013), these showed a reduction of urinary catheter days resulted in reduced CAUTI rates. Though different outcome results between the different research studies, they all strongly significantly supported the notion that a nurse-driven protocol to assess and evaluate the appropriateness and use of urethral catheter compared with a no protocol is essential to help in the reduction of CAUTIs. Interpreting these results, (Meddings et al., 2013) showed a drop greater than 52% in CAUTIs and a decrease in catheterization by 37%. The study results from the six scholarly research study articles showed nearly similar or corresponding outcomes. The results were significant enough to support the PICO question. In general, though the difference in sample size, the results still strongly supported excellent outcomes when a nurse-driven protocol is used to evaluate the necessity of continued urethral catheter use. (Chen et al., 2013, para.
Behavioral methods such as bladder training and timed voiding can help in treating urinary incontinence during and after pregnancy. This can be done at home and doesn’t have any serious side effects. In bladder training, you can prolong the intervals of urination as much as you can. Continue this pattern for some period and then extend the intervals for much longer periods until you’re able to manage the bathroom visits normally. Toileting assist...
One of the most common infections that occur in the urinary system is UTIs or Urinary Tract Infection. A UTI is when bacteria gets into the urinary system, either externally or from the digestive tract, and causes pain and irritation in the urinary tract (Friedl, n.d.). UTIs are typically treated with antibiotics. A common disease of the urinary system is incontinence, which is when you lose some or all of your bladder control (Friedl, n.d.). This can also cause retention problems, which is when you have trouble releasing urine from the bladder (Friedl, n.d.). Incontinence can be treated with medication and exercise that can help to retrain the muscle around the bladder and urethra area (Friedl, n.d.). Interstitial cystitis (IC), also known as painful bladder syndrome (BPS), is a type of chronic bladder condition that is primarily found in women (Zimmermann, 2016). IC can cause bladder pressure and pain, bladder scarring, and can cause less elasticity in the bladder (Zimmermann, 2016). Another form of inflammation in the urinary system is Prostatitis, the swelling of the prostate gland. Prostatitis is significant in that it only occurs in men and is often caused by advanced age (Zimmermann, 2016). It is generally cured by antibiotics. Kidney stones are an extremely painful condition that occurs in the urinary system when chemicals in the urine become
..., Ducker, T.B., ….. Young, W. (1997). International Standards for Neurological and Functional Classification of Spinal Cord Injury: International Medical Society of Paraplegia, 35, 266 – 274.
In addition, Sympathetic nervous system stimulation caused by norepinephrine increases the prostatic smooth muscle tone, which further worsens LUTS (Buttaro et al., 2013). The symptoms can be either obstructive or irritative in nature. Obstructive symptoms include slow urine flow, urinary hesitancy, need to strain to initiate urine flow, feeling of incomplete emptying, and terminal dribbling. Irritative symptoms include urinary urgency, frequency, and nocturia (DuBeau, Yalla, & Resnick, 2011). Irritative symptoms are due to reduced functional bladder capacity, instability or infection. Occasionally there will be hematuria. All these symptoms may be present over years with the intensity gradually increasing. Mr. Martinez Jose has a combination of obstructive and irritative symptoms, such as decreased urine flow, increased nocturia and slight terminal dysuria, for two years with worsening of symptoms during last two weeks (South University Online (SUO), 2015). Digital rectal examination shows enlargement, which can be soft or firm, with smooth mucosal surface and no distinction between lobes (McCance, & Huether,
This article is for people whose kidneys fail to work. This condition is called end-stage renal disease (ESRD).
... middle of paper ... ... There are claims, although no documented evidence, that reflexology treatment after surgery shortens a patient's recovery time, requiring less hospitalization and making more hospital beds available (http://www.reflexology.org/aor/refinfo/adv9701.htm). Reflexology is best used as an aid to modern treatments.
Autonomic Neuropathy affects the internal organs primarily. It can affect the cardiovascular system by hampering its ability to regulate pulse, blood pressure, and body temperature. It can affect the digestive system with gastroparesis, dysphagia, and uncontrollable weight loss and malnutrition. Frequent urinary tract infections are common, as well. Sexual responses, other than drive and desire, are also affected in this type. It can affect the individual's ability to recognize symptoms associated with low blood sugar, thus putting the individual at risk for further nerve damage and diabetic risks (Dyck, Feldmen, & Vinick).
Neurobiology is a theory that deals with the brain and your nerves. It determines if you are a left or right brain person. One of the theorists is named Roger Sperry. He was a very big neurobiologist. A disease that deals with this theory is ADD/ADHD.
One last symptom of paralysis is the loss of bladder control. Because of my inability to urinate on my own, I sought a urologist to provide me with a permanent cystostomy to help prevent dysreflexia and reduce occurances of urinary infections. I have spent countless hours with infectious disease doctors because I have chronic urinary infections that often result in severe
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As the human body goes through different experiences, the brain grows, develops, and changes according to the environmental situations it has been exposed to. Some of these factors include drugs, stress, hormones, diets, and sensory stimuli. [1] Neuroplasticity can be defined as the ability of the nervous system to respond to natural and abnormal stimuli experienced by the human body. The nervous system then reorganizes the brain’s structure and changes some of its function to theoretically repair itself by forming new neurons. [2] Neuroplasticity can occur during and in response to many different situations that occur throughout life. Some examples of these situations are learning, diseases, and going through therapy after an injury.
Neuroplasticity Neuroplasticity refers to the brain’s ability to remap itself in response to experience. The theory was first proposed by Psychologist William James who stated “Organic matter, especially nervous tissue, seems endowed with a very extraordinary degree of plasticity". Simply put, the brain has the ability to change. He used the word plasticity to identify the degree of difficulty involved in the process of change. He defined plasticity as ".the possession of a structure weak enough to yield to an influence, but strong enough not to yield all at once" (James, 1890).
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