Objective: The ultrastructure of the nerve profile in women with urinary stress incontinence (USI... more Objective: The ultrastructure of the nerve profile in women with urinary stress incontinence (USI), who are supposed to have a normal bladder function, is still unknown. Methods: Bladder biopsy were obtained from 11 patients with USI (Age: 55±13 yrs ) and 4 patients ( Age : 58 ±17 yrs) diagnosed with detrusor overactivity /overactive bladder (DO/OAB). Axonal contents of unmyelinated nerve bundles and schwann cells within the suburothelium were studied using electron microscope. Results: A total of 175 and 63 axons were counted in USI and OAB/DO groups. The mean number of axons/nerve bundle was higher in USI patients in comparison to OAB/DO patients (4.11 vs. 3.15). 4 out of 63 axons (6.35%) in OAB/DO and 3 out of 175 axons (1.71%) in the USI group did not contain small vesicles. The mean number of axons/ nerve bundle without large dense-cored vesicles in OAB/DO and USI groups was similar (0.55). Degenerated axons were interestingly observed in both groups of patients. However, the mean number of the degen...
PurposeThe aim of this study was to demonstrate features predictive of treatment response for pat... more PurposeThe aim of this study was to demonstrate features predictive of treatment response for patient‐tailored overactive bladder (OAB) intervention with an implantable tibial neurostimulator using patient and technical prediction factors.Materials and MethodsThis study was designed as a follow‐up study based on parameter settings and patients' preferences during the pilot and extended study of the implantable tibial nerve stimulator (RENOVA™ iStim system). For this study, we compared all treatment parameters (stimulation amplitude, frequency, and pulse width) and usage data (duration of treatment) during the different follow‐up visits.ResultsWe obtained usage data from a total of 32 patients who were implanted with the system between February and September 2015. Age, sex, body mass index (BMI) and previous experience with percutaneous tibial nerve stimulation (PTNS) treatment were considered as possible prediction factors for treatment success. However, only BMI was considered ...
Aims of course/workshop Aims and Objectives: -Current concepts relating to the neurological contr... more Aims of course/workshop Aims and Objectives: -Current concepts relating to the neurological control of the bladder and the pelvic floor. -Urinary and pelvic floor symptoms in patients with cerebral lesions, multiple sclerosis, Parkinson's disease, spinal cord injury and cauda equina -Urinary and pelvic floor symptoms in bladder pain syndrome/IC and chronic pelvic pain syndromes (neurological basis of disease). -Investigating neurogenic bladder and pelvic floor dysfunction -Innovative therapies in treating neurogenic bladder and pelvic floor disorders: Indications and limitations of botulinum toxin -Innovative therapies in treating neurogenic bladder and pelvic floor disorders: Indications and limitations of neuromodulation
Start End Topic Speakers 14:00 14:05 Introduction to the Workshop Sohier Suzy Elneil 14:05 14:2... more Start End Topic Speakers 14:00 14:05 Introduction to the Workshop Sohier Suzy Elneil 14:05 14:25 Neurology of the bladder and the pelvic floor Thomas Kessler 14:25 14:45 Bladder Symptoms in the Neurological Patient Xavier Game 14:45 15:05 Pelvic Floor Dysfunction in the Neurological Patient Alex Digesu 15:05 15:20 Bladder and Pelvic Floor Assement in Neurogenic Bladder and Pelvic Floor Dysfunction Xavier Game
Hypothesis / aims of study CPP is a common condition, affecting up to 15% of women [1]. Multiple ... more Hypothesis / aims of study CPP is a common condition, affecting up to 15% of women [1]. Multiple aetiologies are implicated, including hyperalgesia of the levator ani secondary to muscle spasm [2]. Due to its muscle relaxing properties botulinum toxin type A has been proposed as a possible treatment in these women [3]. The toxin is produced from Clostridium botulinum and prevents acetylcholine release from peripheral presynaptic neurons at the neuromuscular junction. The exact mechanism of pain relief in women with CPP is still not fully understood, and effects on both the muscle and the sensory nerves may be involved.
BackgroundThis paper summarizes the discussion in a think tank at the ICI‐RS 2018 about the diagn... more BackgroundThis paper summarizes the discussion in a think tank at the ICI‐RS 2018 about the diagnosis of bladder pain syndrome (BPS).AimsTo review the guidelines, investigations and subtypes of BPS.Materials and MethodsReview of literature in the light of the think tank discussion.ResultsAll guidelines recommend completing history, physical examination, urine analysis, urine culture, and urine cytology to define the BPS phenotype but there are differences on further investigations. In those guidelines which recommend cystoscopy, the identification of Hunner's lesions (HLs) is recommended as this changes the treatment plan and outcome.ConclusionWe propose that the differentiation of Hunner's ulcers is an important step in the assessment of these patients. Further suggestions for research are suggested.
AimsBotulinum toxin A (BTX‐A) and sacral nerve stimulation (SNS) are established treatments for o... more AimsBotulinum toxin A (BTX‐A) and sacral nerve stimulation (SNS) are established treatments for overactive bladder (OAB) and are standard of care in refractory cases in international guidelines. Despite long term use over decades their “exact” working mechanisms are not entirely clear. At the ICI‐RS meeting in Bristol in 2017 a think tank was convened to address the question.MethodsThe think tank conducted a literature review and an expert consensus meeting focusing on current mechanisms and what could be learned from clinical experience and objective urodynamic data.ResultsBTX‐A results suggests effects on both filling and voiding parts of the micturition cycle. The salient data in this regard is presented as well as additional studies related to the urothelium and evidence for central effects. Urodynamics have consistently shown increases in bladder capacity, compliance, and reductions in detrusor pressures during filling, however post void residuals also increase in a dose‐depend...
Objective: The ultrastructure of the nerve profile in women with urinary stress incontinence (USI... more Objective: The ultrastructure of the nerve profile in women with urinary stress incontinence (USI), who are supposed to have a normal bladder function, is still unknown. Methods: Bladder biopsy were obtained from 11 patients with USI (Age: 55±13 yrs ) and 4 patients ( Age : 58 ±17 yrs) diagnosed with detrusor overactivity /overactive bladder (DO/OAB). Axonal contents of unmyelinated nerve bundles and schwann cells within the suburothelium were studied using electron microscope. Results: A total of 175 and 63 axons were counted in USI and OAB/DO groups. The mean number of axons/nerve bundle was higher in USI patients in comparison to OAB/DO patients (4.11 vs. 3.15). 4 out of 63 axons (6.35%) in OAB/DO and 3 out of 175 axons (1.71%) in the USI group did not contain small vesicles. The mean number of axons/ nerve bundle without large dense-cored vesicles in OAB/DO and USI groups was similar (0.55). Degenerated axons were interestingly observed in both groups of patients. However, the mean number of the degen...
PurposeThe aim of this study was to demonstrate features predictive of treatment response for pat... more PurposeThe aim of this study was to demonstrate features predictive of treatment response for patient‐tailored overactive bladder (OAB) intervention with an implantable tibial neurostimulator using patient and technical prediction factors.Materials and MethodsThis study was designed as a follow‐up study based on parameter settings and patients' preferences during the pilot and extended study of the implantable tibial nerve stimulator (RENOVA™ iStim system). For this study, we compared all treatment parameters (stimulation amplitude, frequency, and pulse width) and usage data (duration of treatment) during the different follow‐up visits.ResultsWe obtained usage data from a total of 32 patients who were implanted with the system between February and September 2015. Age, sex, body mass index (BMI) and previous experience with percutaneous tibial nerve stimulation (PTNS) treatment were considered as possible prediction factors for treatment success. However, only BMI was considered ...
Aims of course/workshop Aims and Objectives: -Current concepts relating to the neurological contr... more Aims of course/workshop Aims and Objectives: -Current concepts relating to the neurological control of the bladder and the pelvic floor. -Urinary and pelvic floor symptoms in patients with cerebral lesions, multiple sclerosis, Parkinson's disease, spinal cord injury and cauda equina -Urinary and pelvic floor symptoms in bladder pain syndrome/IC and chronic pelvic pain syndromes (neurological basis of disease). -Investigating neurogenic bladder and pelvic floor dysfunction -Innovative therapies in treating neurogenic bladder and pelvic floor disorders: Indications and limitations of botulinum toxin -Innovative therapies in treating neurogenic bladder and pelvic floor disorders: Indications and limitations of neuromodulation
Start End Topic Speakers 14:00 14:05 Introduction to the Workshop Sohier Suzy Elneil 14:05 14:2... more Start End Topic Speakers 14:00 14:05 Introduction to the Workshop Sohier Suzy Elneil 14:05 14:25 Neurology of the bladder and the pelvic floor Thomas Kessler 14:25 14:45 Bladder Symptoms in the Neurological Patient Xavier Game 14:45 15:05 Pelvic Floor Dysfunction in the Neurological Patient Alex Digesu 15:05 15:20 Bladder and Pelvic Floor Assement in Neurogenic Bladder and Pelvic Floor Dysfunction Xavier Game
Hypothesis / aims of study CPP is a common condition, affecting up to 15% of women [1]. Multiple ... more Hypothesis / aims of study CPP is a common condition, affecting up to 15% of women [1]. Multiple aetiologies are implicated, including hyperalgesia of the levator ani secondary to muscle spasm [2]. Due to its muscle relaxing properties botulinum toxin type A has been proposed as a possible treatment in these women [3]. The toxin is produced from Clostridium botulinum and prevents acetylcholine release from peripheral presynaptic neurons at the neuromuscular junction. The exact mechanism of pain relief in women with CPP is still not fully understood, and effects on both the muscle and the sensory nerves may be involved.
BackgroundThis paper summarizes the discussion in a think tank at the ICI‐RS 2018 about the diagn... more BackgroundThis paper summarizes the discussion in a think tank at the ICI‐RS 2018 about the diagnosis of bladder pain syndrome (BPS).AimsTo review the guidelines, investigations and subtypes of BPS.Materials and MethodsReview of literature in the light of the think tank discussion.ResultsAll guidelines recommend completing history, physical examination, urine analysis, urine culture, and urine cytology to define the BPS phenotype but there are differences on further investigations. In those guidelines which recommend cystoscopy, the identification of Hunner's lesions (HLs) is recommended as this changes the treatment plan and outcome.ConclusionWe propose that the differentiation of Hunner's ulcers is an important step in the assessment of these patients. Further suggestions for research are suggested.
AimsBotulinum toxin A (BTX‐A) and sacral nerve stimulation (SNS) are established treatments for o... more AimsBotulinum toxin A (BTX‐A) and sacral nerve stimulation (SNS) are established treatments for overactive bladder (OAB) and are standard of care in refractory cases in international guidelines. Despite long term use over decades their “exact” working mechanisms are not entirely clear. At the ICI‐RS meeting in Bristol in 2017 a think tank was convened to address the question.MethodsThe think tank conducted a literature review and an expert consensus meeting focusing on current mechanisms and what could be learned from clinical experience and objective urodynamic data.ResultsBTX‐A results suggests effects on both filling and voiding parts of the micturition cycle. The salient data in this regard is presented as well as additional studies related to the urothelium and evidence for central effects. Urodynamics have consistently shown increases in bladder capacity, compliance, and reductions in detrusor pressures during filling, however post void residuals also increase in a dose‐depend...
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