Neurogenic detrusor overactivity (NDO) is characterized by involuntary detrusor contractions that often occur following spinal cord injury (SCI). In addition, patients with SCI above T6 are at risk for autonomic dysreflexia (AD). Amniotic membranes (AM) are used for the management of wound healing in multiple medical disciplines. Thus, this study aims to evaluate the efficiency of amniotic bladder therapy (ABT) in managing NDO, specifically in patients with SCI. The patients received intra-detrusor injections under general anesthesia of 100 mg micronized AM (Clarix Flo) diluted in 10 mL 0.9% preservative-free sodium chloride. Clinical evaluations, including maximum detrusor pressure, maximum cystometric capacity, and frequency of AD, were conducted, alongside the completion of questionnaires (Qualiveen questionnaire) preoperatively and postoperatively at weeks 2, 4, 8, and 12. Eight consecutive patients with an average age of 39.6 ± 13.6 years were included. After ABT, a significant decrease in the severity of urinary tract symptoms was observed based on the Qualiveen questionnaire: 3.9 ± 0.17 at baseline to 2.9 ± 0.21 at week 2, 2.1 ± 0.53 at week 4, and 1.4 ± 0.20 at week 8 (P < 0.01). Improved clinical symptoms were associated with a decreased maximum detrusor pressure, increased maximum cystometric capacity, and reduced frequency of AD. In conclusion, we investigated ABT as a potential treatment option for NDO associated with SCI. Further investigations are warranted to validate the effectiveness of ABT in this patient population and determine treatment durability.

Research ObjectivesResearch Objective: To evaluate the use of amniotic bladder therapy (ABT) in the management of neurogenic detrusor overactivity (NDO) specifically in patients with spinal cord injury (SCI).DesignRetrospective study.SettingReferral Center.ParticipantsConsecutive NDO patients who experienced involuntary detrusor contractions near or at the maximum cystometric capacity (MCC), failed previous treatment modalities including oral and intra-vesical therapies, had traumatic spinal cord injury above T6, and were using intermittent catheterizations to empty the bladder.InterventionsIntra-detrusor injection of 100mg micronized amniotic membrane (Clarix Flo) diluted in 10ml 0.9% preservative-free sodium chloride under general anesthesia.Main Outcome MeasuresQualiveen questionnaire, maximum detrusor pressure (MDP), MCC, and frequency of autonomic dysreflexia (AD) were assessed.ResultsEight consecutive patients with an average age of 39.6 ± 13.6 years were included. After ABT, there was a significant decrease in the severity of urinary tract symptoms based on the Qualiveen questionnaire: 3.9 ± 0.17 at baseline to 2.9 ± 0.21 at 2 weeks, 2.1 ± 0.53 at 4 weeks, 1.4 ± 0.20 at 8 weeks, 1.4 ± 0.05 at 3 months, 1.3 ± 0.05 at 4 months, and 1.4 ± 0.10 at 5 months. This was associated with an increase in maximum MCC from 208.63 ± 34.98 mL before treatment to 430.25 ± 32.4 mL at 4 weeks and 427.25 ± 24.9 mL at 3 months. MDP decreased from 67.38 ± 2.88 cmH2O to 33 ± 1.2 cmH2O and 33.38 ± 1.85 cmH2O at similar timepoints. All patients reported no AD episodes at 3 to 5 months, despite experiencing daily or every other day before treatment.ConclusionsABT appears to be a promising option for NDO in SCI patients by improving both quantitative and qualitative aspects of their lives. Further studies are warranted.Author(s) DisclosuresThe authors have no relevant conflict of interests to disclose.

Introduction COVID-19 pandemic has been one of the main global health concerns in 2020, and many aspects of the disease remain enigmatic. While some patients infected with the disease-causing virus SARS-CoV2 have no or mild symptoms, others experience severe symptoms requiring hospitalization. Of these more severe patients, some remain stable while others experience cytokine storm syndrome or an exaggerated immune response that has been correlated with disease severity and progression of acute respiratory deterioration. It is currently unknown why some patients with COVID-19 demonstrate this response and others do not. In light of the apparent prominent role of the inflammatory mediators (i.e. cytokines) in COVID-19 pathogenesis, the ability to identify screening tools not only for the SARS-CoV2 virus but also for cytokines is important. The present investigation was designed to identify the urinary cytokine signature in COVID-19 patients. Methods The study enrolled 17 COVID-19 patients and 10 control subjects (SARS-CoV-2 negative) 18 years or older with glomerular filtration rate of > 60mL/min. Urine samples were collected and cytokines quantitated using the Luminex multiplex assay. The cytokines analyzed were growth-regulated oncogene (GRO), interleukin-8 (IL-8), and interleukin-6 (IL-6). Results The levels of GRO and IL-6 were significantly elevated in urine samples obtained from COVID-19 patients compared to controls (mean 16.8 pg/ml vs. 9.2 pg/ml ± 2.39, p < 0.0171 and mean 16.8 pg/ml vs 9.2 pg/ml ± 2.42, p < 0.0157, respectively). Conversely, IL-8 level was similar between COVID-19 patients and controls (15.6 pg/ml vs 11.3 pg/ml ± 1.3, p<0.1833). Conclusion The present investigation found that the levels of urinary cytokines GRO and IL-6 were significantly elevated in COVID-19 patients compared to controls and may serve as urinary biomarkers of disease progression. Furthermore, IL-8 although elevated in COVID-19 patients, did not reach statistical significance in our population sample. The findings of this proof of concept study underscore that the urinary cytokines may serve as prognostic and diagnostic accessible biomarkers in COVID-19.

You have accessJournal of UrologyUrodynamics/Lower Urinary Tract Dysfunction/Female Pelvic Medicine: Non-neurogenic Voiding Dysfunction I (MP02)1 Sep 2021MP02-17 ASSESSMENT OF OVERACTIVE BLADDER SYMPTOMS IN DECONDITIONED PATIENTS RECOVERING FROM POST-ACUTE COVID-19 SYNDROME Fareea Khaliq, Melissa Wills, Nivedita Dhar, Ali Bitar, Sorabh Dhar, Dragana Komnenov, Michael Chancellor, Ryan Timar, and Steven Lucas Fareea KhaliqFareea Khaliq , Melissa WillsMelissa Wills , Nivedita DharNivedita Dhar , Ali BitarAli Bitar , Sorabh DharSorabh Dhar , Dragana KomnenovDragana Komnenov , Michael ChancellorMichael Chancellor , Ryan TimarRyan Timar , and Steven LucasSteven Lucas View All Author Informationhttps://doi.org/10.1097/JU.0000000000001963.17AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: SARS-CoV2 infection that results in coronavirus disease (COVID-19) manifests in multiple organ systems, including the respiratory, the heart and circulatory as well as the gastrointestinal systems. However, little is known about its impact on the genitourinary system. Preliminary reports indicate some patients may develop a so-called "post-acute COVID-19 Syndrome or Long COVID," in which they experience persistent symptoms after recovering from their initial illness. The objective of the present investigation was to determine such impact on bladder function in patients who were treated for COVID-19 in the acute care hospital and then transferred to inpatient rehabilitation at the Rehabilitation Institute of Michigan for long-term care of deconditioning secondary to the viral illness. METHODS: We used AUA Urology Care Foundation Overactive Bladder (OAB) Assessment Tool to screen all recovering COVID-19 patients at the Rehabilitation Institute of Michigan from 6/1/2020 to 12/31/2020. Primary outcomes include patient responses to 5 symptom and 4 quality-of-life questions (QOL). We reported median symptom scores, as well as quality-of-life scores, based on new or worsening urinary symptoms stratified by sex. RESULTS: We identified 25 patients with de novo and 20 patients with worsening OAB symptoms. In our cohort, 20 patients with pre-existing OAB experienced no change in their symptoms. In patients with new onset OAB symptoms, the median symptom score was 17. Patients with worsening OAB symptoms had a median pre-COVID-19 symptom score of 8 which was exacerbated post-COVID-19 as indicated by the median symptom score of 19. The median total QOL score for both men and women was 19. In patients with worsening OAB, median pre-COVID-19 QOL score was 9 compared to median post-COVID-19 QOL score of 19. Median age was 66 (range 41-82). CONCLUSIONS: In a population of deconditioned patient recovering from the COVID-19 infection at an inpatient rehabilitation facility we noted that OAB symptoms either occurred de novo or worsened, and QOL scores declined in the majority of patients (45 out of 65). Urological manifestation may be an important part of Post-Acute COVID-19 Syndrome that may impact quality of life and hinders full recovery from COVID-19. More research is needed to raise awareness of urologic impact of Long COVID and to further delineate the pathophysiological mechanisms of de novo or worsening urological symptoms in Post-Acute COVID-19 Syndrome. Source of Funding: N/A © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e18-e19 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.Metrics Author Information Fareea Khaliq More articles by this author Melissa Wills More articles by this author Nivedita Dhar More articles by this author Ali Bitar More articles by this author Sorabh Dhar More articles by this author Dragana Komnenov More articles by this author Michael Chancellor More articles by this author Ryan Timar More articles by this author Steven Lucas More articles by this author Expand All Advertisement PDF downloadLoading ...