[Physiotherapy and neurogenic lower urinary tract dysfunction in multiple sclerosis patients: a randomized controlled trial]. / Kinésithérapie et symptômes du bas appareil urinaire chez des patients atteints de la sclérose en plaques : étude contrôlée randomisée.

AIM: This randomized controlled trial compare the efficacy of pelvic floor muscle training vs. transcutaneous posterior tibial nerve stimulation. PATIENTS AND METHODS: Inclusion criteria were EDSS score<7 and presence of lower urinary tract symptoms. Exclusion criteria were multiple sclerosis relapse during the study, active urinary tract infection and pregnancy. The primary outcome was quality of life (SF-Qualiveen questionnaire). Secondary outcomes included overactive bladder (USP questionnaire) score and frequency of urgency episodes (3-day bladder diary). Sample size was calculated after 18 patients were included. Data analysis was blinded. Each patient received 9 sessions of 30 minutes weekly. Patients were randomized in pelvic floor muscles exercises with biofeedback group (muscle endurance and relaxation) or transcutaneous posterior tibial nerve stimulation group (rectangular alternative biphasic current with low frequency). RESULTS: A total of 31 patients were included. No difference appeared between groups for quality of life, overactive bladder and frequency of urgency episodes (respectively P=0.197, P=0.532 et P=0.788). These parameters were significantly improved in pelvic floor muscle training group (n=16) (respectively P=0.004, P=0.002 et P=0.006) and in transcutaneous posterior tibial nerve stimulation group (n=15) (respectively P=0.001, P=0.001 et P=0.031). CONCLUSIONS: Pelvic floor muscle training and transcutaneous posterior tibial nerve stimulation improved in the same way symptoms related to urgency in MS patients with mild disability. LEVEL OF EVIDENCE: 2.

[Pelvic floor muscles training, electrical stimulation, bladder training and lifestyle interventions to manage lower urinary tract dysfunction in multiple sclerosis: a systematic review]. / Troubles du bas appareil urinaire chez des patients atteints de la sclérose en plaques et kinésithérapie pelvi-périnéale : revue systématique.

AIM: To assess the effectiveness of conservative therapeutic approaches in a multiple sclerosis population. MATERIAL: Review was performed in PubMed, PEDro, Scopus and Cochrane Library using combinations of the following keywords: multiple sclerosis; bladder dysfunction; overactive bladder; detrusor hyperreflexia; urge incontinence; urgency; stress incontinence; pelvic floor muscle; biofeedback; PTNS; tibial nerve; bladder training; physical therapy; physiotherapy; conservative treatment and behavioral therapy. RESULTS: Six randomized articles including 289 patients were selected. Four papers exhibited strong scores for the methodological quality assessment. The parameters always significantly improved concerned: number of incontinence episodes (decreased from 64% to 86% after treatment versus before treatment), quality of life (P≤0.001), severity of irritative symptoms (decreased by more than 50% after treatment versus before treatment), and nocturia (P=0.035 to P<0.001). Activities and participation, maximum flow rate, mean voided volume and daytime frequency were not significantly improved in all trials. CONCLUSIONS: The physical therapy techniques could be effective for the treatment of urinary disorders in multiple sclerosis populations with mild disability. However, the analyses are based on six studies within only four showed good methodological quality. No strong conclusions regarding treatment approaches can be drawn from this review.

[Contribution of the preoperative urodynamic findings in the determination of risks factors of urinary incontinence after radical retropubic prostatectomy]. / Apport de l'exploration urodynamique préopératoire dans la détermination des facteurs de risques de l'incontinence post-prostatectomie radicale totale.

UNLABELLED: The aim of the study was to determine whether preoperative urodynamic evaluation helps the physiotherapist to adapt preoperative management of patients undergoing radical retropubic prostatectomy (RP) by identifying a group at risk of incontinence. MATERIAL AND METHODS: We compared the preoperative urodynamic evaluation of 229 men scheduled for RP with their continence status, evaluated by standardized pad-test and questionnaire, at 6 weeks and 4 months postoperatively. RESULTS: The primary urinary incontinence risk has been obtained for five patient's categories, namely normal, bladder instability, bladder outlet obstruction, hypocontractility, and mixed results. None of the patients diagnosed with detrusor instability and bladder outlet obstruction was continent at six weeks from surgery. At four months, although it improves, the continence status remains significantly poorer than observed in all other groups. CONCLUSION: Preoperative urodynamic evaluation of patients scheduled for RP allows identifying patients with a high risk of postoperative urinary incontinence.

Adjuvant radiation therapy does not cause urinary incontinence after radical prostatectomy: results of a prospective randomized study.

PURPOSE: We analyzed the potential influence of adjuvant radiotherapy on urinary continence after radical prostatectomy. MATERIALS AND METHODS: A total of 100 patients with N0M0 prostate cancer randomized in a prospective study on postoperative radiotherapy for locally advanced disease (positive surgical margin, capsular perforation and/or seminal vesicle infiltration) were studied. Objective pad weighing tests corroborated by direct personal interviews were used to evaluate urinary continence at regular postoperative intervals. RESULTS: Of the patients 48 received 60 Gy. external radiotherapy with 18 MV photon beams between 12 and 16 weeks postoperatively, and 52 were followed expectantly. Risk factors were similar in both groups. With a mean followup of 24 months, no difference in complete urinary continence was observed. Of the irradiated group 77% and of the surveillance group 83% were totally dry. The fate of the bladder neck had no significant influence on final continence status, although there was a trend for faster recovery when the bladder neck was preserved. CONCLUSIONS: In this prospective randomized study 60 Gy. external radiation therapy administered between 3 and 4 months after radical prostatectomy for pathologically locally advanced prostate cancer had no significant influence on urinary continence.

[Urinary continence after radical prostatectomy: importance of the vesico-urethral anastomosis. Objective evaluation]. / Continence urinaire après prostatectomie radicale: importance de l'anastomose vésico-urétrale. Evaluation objective.

Urinary continence after radical prostatectomy is frequently evaluated subjectively. The authors describe their technique of vesicourethral anastomosis and report their method of objective evaluation of postoperative urinary continence. At the 6th postoperative week, 15% of patients presented with severe incontinence. This percentage fell to 3.3% by the 16th postoperative week.