[Urinary bladder cancer as a late sequela of spinal cord injury : Decision-making aids for assessment of this causal association]. / Harnblasenkarzinom als Spätfolge einer Querschnittlähmung : Entscheidungshilfe für eine Zusammenhangsbegutachtung.

BACKGROUND: There is to date no convincing literature that has assessed the association between traumatic spinal cord injury (SCI) and the later development of urinary bladder cancer. The aim of this work is to present medical experts as well as the national accident insurance and the social courts decision-making aids based on the latest medical scientific knowledge, for assessment of this causal association. MATERIALS AND METHODS: A study conducted between April 1998 and March 2017 in the BG Trauma Hospital Hamburg forms the basis for the decision-making aids. Urinary bladder cancer was diagnosed in 32 out of 6432 treated outpatient and inpatient SCI patients. Furthermore, relevant published literature was taken into consideration for the decision-making aids. RESULTS: It was found that urinary bladder cancer in SCI patients occurs at a considerably younger age as compared to the general population, more frequently shows muscle invasive carcinoma with a higher grade at first diagnosis and a higher proportion of the more aggressive squamous cell carcinoma than that of the general population. Correspondingly, the survival time is extremely unfavorable. For medical experts a matrix was compiled where the various influencing factors, either for or against the recognition of an association between SCI and urinary bladder cancer, were weighted according to their relevance. CONCLUSION: The results showed that urinary bladder cancer in SCI patients differs considerably from that of able-bodied patients. These differences drastically shorten the survival time. A study on patients with spina bifida, i.e., a congenital spinal cord disorder, corroborates these observations. They indicate histopathological differences that have so far been intangible.

[Neuralgia of the pudendal nerve following violent trauma: analgesia by pudendal neuromodulation]. / Nervus-pudendus-Neuralgie infolge Gewalttrauma : Schmerzlinderung durch pudendale Neuromodulation.

Pudendal neuralgia is a neuropathic disease which is predominantly caused by pelvic trauma with pressure or stretching strain of the pudendal nerve. The Nantes criteria are used for the differential diagnostics of this disease and therapy includes pressure-relieving and analgesic measures using laparoscopic or open decompression procedures. This article reports the case of a female patient who developed pudendal neuralgia following violent trauma to the pelvic and urogenital regions. Due to the complexity of the symptoms combined sacral and pudendal neuromodulation (PNM) was carried out. A direct comparison of neuromodulative techniques revealed that PNM was superior resulting in almost complete freedom from pain. The PNM procedure could represent a therapeutic option for treatment of pudendal neuralgia.

[Neuro-urological dysfunction of the lower urinary tract in CNS diseases: pathophysiology, epidemiology, and treatment options]. / Neurourologische Funktionsstörungen des unteren Harntraktes bei Erkrankungen des ZNS : Pathophysiologie, Epidemiologie und Therapieoptionen.

The lower urinary tract (LUT) is regulated by a complex neural network that is subject to supraspinal control. Neurological disorders, especially of the central nervous system (CNS), can rapidly lead to disruption of this control. Multiple sclerosis, Parkinson's disease, multiple system atrophy, and stroke are neurological disorders which quite frequently cause dysfunction of the LUT. With respect to the pathophysiology of bladder dysfunction in CNS diseases there are various hypotheses regarding the individual disorders: disturbances of neural communication between the frontal cortex and pontine micturition center, between the pontine micturition center and the lumbosacral parts of the spinal cord, and between the basal ganglia, thalamus, and anterior cingulate gyrus appear to play a pivotal role in the development of bladder dysfunction. The symptoms and urodynamic presentation of LUT dysfunction can vary considerably depending on the disease and disease progression and can change in the course of the disease. The incidence and prevalence of LUT dysfunctions rise with increasing progression of the underlying neurological disease.Various conservative, minimally invasive, and open surgical procedures are available to prevent harmful sequelae and to improve the quality of life of these patients. As yet, however, few data exist on most of the treatment options in cases of the above-mentioned CNS diseases. Intermittent self-catheterization and antimuscarinic medications are among the most important conservative treatment options. Injection of botulinum neurotoxin type A into the detrusor muscle and increasingly sacral or pudendal neuromodulation are among the most important minimally invasive treatment options. Surgical methods include reconstructive continent or incontinent urinary diversion.When planning therapy the patient's current needs and neurological limitations as well as possible disease progression must be taken into consideration. It is often advisable to consult with and enlist the cooperation of the attending neurologist when planning treatment.

Morbidity of urodynamic testing in patients with spinal cord injury: is antibiotic prophylaxis necessary?

STUDY DESIGN: Prospective, non-randomized study. OBJECTIVES: To assess the incidence of urinary tract infection after urodynamics in patients with spinal cord injury. SETTING: Outpatient clinic of a university hospital in Germany. METHODS: Urinary tract infection and clinical symptoms in 109 consecutive outpatients with spinal cord injury following urodynamic evaluation were studied. RESULTS: Data from 72 patients were evaluable. Of these, seven patients (9.7%) developed a significant urinary tract infection. Five of these were symptomatic. Pre-existing asymptomatic bacteriuria was not associated with a higher risk for post-interventional infection. The technique of the bladder management did not correlate with urinary tract infection rates. CONCLUSION: In this study, symptomatic urinary tract infections after cystometry were not infrequent. Therefore, it seems that antibiotic prophylaxis cannot be omitted in patients with spinal cord injury undergoing urodynamic investigation.

[Initial results of Stoller peripheral neuromodulation in disorders of bladder function]. / Erste Ergebnisse der peripheren Neuromodulation nach Stoller bei Blasenfunktionsstörungen.

PURPOSE: The Stoller peripheral neurostimulation (SANS) is a new therapeutic procedure for bladder dysfunction. MATERIAL AND METHODS: Each of 11 patients (8 women, 3 men) underwent 12 SANS treatment sessions. INDICATIONS: overactive bladder (5 patients), chronic nonobstructive urinary retention (3 patients) and pelvic pain (3 patients). Median follow-up was 3 months. RESULTS: In 2 overactive bladder patients, the number of voids was reduced by at least 50%. In one patient with chronic retention, residual urine was temporarily decreased to <100 cc. 2 pelvic pain patients reported a slight improvement. In summary, 50% of the patients demonstrated a temporary response. Only 2 overactive bladder patients reported a permanent objective and subjective improvement. No complications were observed. CONCLUSION: As the success rate was low and the procedure is time-consuming, we recommend the SANS procedure only in selected cases. We perform SANS treatment only in patients with overactive bladder refractory to conservative treatment. Prerequisites for a successful treatment is a high patient motivation.