Background Neurogenic lower urinary tract dysfunction (NLUTD) in adults with spina bifida (SB) is an understudied problem with significant impacts on quality of life (QOL) and may lead to medically important complications including renal dysfunction, urinary infections, and incontinence. The goal of the ABLE-SB project is to investigate the QOL of an adolescent and adult SB population, with an emphasis on the impact of bladder management technique on overall QOL. Study Design This paper presents the protocol for the Adult Bladder and Quality of Life Evaluation in Spina Bifida (ABLE-SB) study, a multi-institutional (11 sites across North and South America) cross-sectional study of bladder-related patient-reported outcomes in adolescents and adults with spina bifida. Patients and Methods SB patients will be recruited from regular clinic visits with participating investigators. Inclusion criteria are SB patients ≥13 years old; exclusion criteria are recent health or bladder management changes. Estimated required sample size is calculated at 208 but has been increased to 300 to account for missing data and confounder adjustment. Demographic data will be collected by trained study coordinators, and patients will complete several patient-reported outcome measures (including the QUALAS, NBSS-SF, BRIEF health literacy assessment, and a cognitive function measure). The primary outcome is the QUALAS bladder and bowel domain, which is a validated measure of QOL in SB. The secondary outcome is bladder symptom burden, as measured by the NBSS-SF. Bladder management (primary exposure) will be grouped into 4 categories for the primary analysis: voiding/incontinent, CIC, indwelling catheter, or urinary diversion. Primary analysis will use multivariable linear regression to evaluate the association between bladder management strategy and QOL, with adjustment for prespecified demographic and clinical confounders, including age, sex, ambulatory status, cognitive function, prior urinary reconstruction, and bowel management. Study Registration: NCT07642466 (https://clinicaltrials.gov/study/NCT07642466, Registered June 4 2026). Protocol version 3.0, August 28, 2024.

You have accessJournal of UrologyCME1 May 2022PD24-07 FAILURE RATES OF BLADDER OUTLET SURGERIES FOR STRESS URINARY INCONTINENCE IN WOMEN WITH NEUROGENIC LOWER URINARY TRACT DYSFUNCTION: A MULTICENTER NEUROGENIC BLADDER RESEARCH GROUP STUDY DYSFUNCTION (NLUTD) Javier Santiago, Min Soo Choo, Anne Cameron, Richard Mora, Evgeniy Kreydin, David A Ginsberg, Natalia Hernandez, Paola Bustillos, Rose Khavari, Stephanie Daignault-Newton, and John Stoffel Javier SantiagoJavier Santiago More articles by this author , Min Soo ChooMin Soo Choo More articles by this author , Anne CameronAnne Cameron More articles by this author , Richard MoraRichard Mora More articles by this author , Evgeniy KreydinEvgeniy Kreydin More articles by this author , David A GinsbergDavid A Ginsberg More articles by this author , Natalia HernandezNatalia Hernandez More articles by this author , Paola BustillosPaola Bustillos More articles by this author , Rose KhavariRose Khavari More articles by this author , Stephanie Daignault-NewtonStephanie Daignault-Newton More articles by this author , and John StoffelJohn Stoffel More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002566.07AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: We evaluated the outcomes of bladder outlet procedures for treating stress urinary incontinence (SUI) in female patients with neurogenic lower urinary tract dysfunction (NLUTD). METHODS: A retrospective multi-institutional study by the Neurogenic Bladder Research Group of female patients with NLUTD and SUI who underwent urethral bulking injection (UBI), pubovaginal sling (PVS), or artificial urinary sphincter (AUS) for (SUI) from 2012-2020 was performed via CPT and ICD-9 codes. Women undergoing concomitant bladder reconstruction or botulinum toxin (BTX) were included. The primary outcome was failure of bladder outlet procedure defined as return to pre-operative baseline SUI symptoms and/or needing additional surgical intervention for SUI. Time to failure were evaluated and multi-variable analysis for variables associated with failure were assessed. RESULTS: Thirty-five female patients were included with diagnosis of spinal cord injury (35%), spina bifida (28%), and bladder exstrophy, multiple sclerosis or auto-immune neuropathy, pelvic surgery, or a supra-pontine disorder. There were 20, 14, and 1 cases of UBI, PVS, and AUS, respectively with a median follow up of 363 days. The median age was 46 years. BTX was performed exclusively with UBI (50%) and bladder reconstruction was performed more with sling vs UBI (29% vs 0%, p=0.02). Focusing on UBI and PVS, failure rates and time to failure between procedures were not significantly different on Kaplan Meier curves at median follow up of 5 and 14 months, respectively (75% failure at median 4.8 months for UBI vs 71% at 7.3 months for PVS, p=1). 6-month failure rates were 59% and 50% for UBI and PVS. Failure was only associated with increasing age on multivariable analysis. Additional surgeries for continence were performed in 60% and 57% patients after UBI and sling, respectively. CONCLUSIONS: Urethral bulking agents and sling placement both demonstrated similarly low durability in managing SUI in NLUTD in this cohort, with the majority of patients requiring secondary surgeries for continence. This warrants further study to better understand factors impacting failure. Source of Funding: None © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e417 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Javier Santiago More articles by this author Min Soo Choo More articles by this author Anne Cameron More articles by this author Richard Mora More articles by this author Evgeniy Kreydin More articles by this author David A Ginsberg More articles by this author Natalia Hernandez More articles by this author Paola Bustillos More articles by this author Rose Khavari More articles by this author Stephanie Daignault-Newton More articles by this author John Stoffel More articles by this author Expand All Advertisement PDF downloadLoading ...

You have accessJournal of UrologyUrodynamics/Lower Urinary Tract Dysfunction/Female Pelvic Medicine: Neurogenic Voiding Dysfunction (MP48)1 Apr 2020MP48-17 ALPHA-1 ANTAGONIST TREATMENT FOR OBSTRUCTIVE URINARY SYMPTOMS IN PATIENTS WITH MULTIPLE SCLEROSIS Daniel Raza*, Lauren Corona, Diana O'Dell, Priyanka Gupta, Quentin Clemens, Paholo Barboglio-Romo, Anne Cameron, and John Stoffel Daniel Raza*Daniel Raza* More articles by this author , Lauren CoronaLauren Corona More articles by this author , Diana O'DellDiana O'Dell More articles by this author , Priyanka GuptaPriyanka Gupta More articles by this author , Quentin ClemensQuentin Clemens More articles by this author , Paholo Barboglio-RomoPaholo Barboglio-Romo More articles by this author , Anne CameronAnne Cameron More articles by this author , and John StoffelJohn Stoffel More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000000903.017AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Patients with multiple sclerosis (MS) commonly develop obstructive urinary symptoms and urinary retention, which affect quality of life. Although alpha-1 antagonists (A1A) are frequently prescribed to treat obstructive symptoms in numerous pathologies, the efficacy of these medications for treating obstructive symptoms in MS has not been well studied. We investigated the efficacy of A1A for reducing post-void residual (PVR) and lower urinary tract symptoms (LUTS) in symptomatic MS patients. METHODS: We retrospectively reviewed MS patients treated with alpha -1 antagonists as primary treatment for obstructive lower urinary tract symptoms (2006-2018). All patients had documented LUTS with obstructive symptoms/findings, a recorded PVR value before and after A1A treatment, and had been evaluated by a neurourology provider. PVR and quality of life measurements were compared for each patient prior to treatment and again after at least one month of follow-up. Primary outcome was change in PVR at last follow-up after starting medication. Secondary measures included changes in urinary quality of life as measured by the Total American Urological Association Symptom Score (AUA-SS) and Total Michigan Incontinence Symptom Index (M-ISI) score at last follow up. RESULTS: We identified 25 MS patients treated with alpha blockers for obstructive LUTS. Mean patient age was 51 years, 64% were female and mean treatment time was 13 months (range 1-33 months). The mean pre-treatment PVR was 175 +/- 115cc. The mean reductionin PVR per individual at last follow up after starting alpha blockers was 79 ml (95% CI 39 – 118, p < 0.001). Fifty-four percent of patients had a >50% reduction in PVR and 32% had a 25-50% improvement after treatment. Age, gender, BMI, location of the MS lesions, disease duration and disease subtype were not predictive of >25% improvement of PVR. Total AUA-SS was reduced from a mean 19 score to mean 13 (p=0.007) after treatment. M-ISI did not show significant improvement. CONCLUSIONS: Alpha-1 antagonist treatment for MS patients with obstructive LUTS significantly reduced PVR and AUA-SS at last follow up in this cohort. Source of Funding: none © 2020 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 203Issue Supplement 4April 2020Page: e701-e701 Advertisement Copyright & Permissions© 2020 by American Urological Association Education and Research, Inc.MetricsAuthor Information Daniel Raza* More articles by this author Lauren Corona More articles by this author Diana O'Dell More articles by this author Priyanka Gupta More articles by this author Quentin Clemens More articles by this author Paholo Barboglio-Romo More articles by this author Anne Cameron More articles by this author John Stoffel More articles by this author Expand All Advertisement PDF downloadLoading ...

Underactive bladder (UAB) is an important and complex urological condition resulting from the urodynamic finding of detrusor underactivity. It can manifest in a wide range of lower urinary tract symptoms, from voiding to storage complaints, and can overlap with other conditions, including overactive bladder and bladder outlet obstruction. However, UAB continues to be poorly understood and inadequately researched. In this article, we review the contemporary literature pertaining to recent advances in defining, understanding, and managing UAB.

Background: Although urinary symptoms are prevalent in multiple sclerosis (MS), there is little information whether bladder function differs by gender or disease subtype.Objective: Differences in MS bladder function within subgroups were investigated by comparing female to male and relapsing remitting (RRMS) to secondary progressive (SPMS) patients. Methods:We reviewed 118 MS patients referred for urologic evaluation between 2007 and 2012 and extracted demographic, questionnaire (AUASI, M-ISI), and urodynamic data.Variables were analyzed by gender and MS subtype, and a multivariable regression model was generated to adjust for age and gender. Results:The cohort consisted of83/35 female/male and 57/61RRMS/SPMS subjects.Urinary questionnaire and urodynamic findings were similar between genders, with the exception of higher maximum voiding pressures in males (p=0.003).RRMS patients reported more bothersome urinary symptoms compared to SPMS (AUASI21 vs. 15, p=0.004) and RRMS was independently associated with higher symptom scores on multivariable analysis (OR 17.1, p=0.008).There were no differences in urodynamic findings between subtypes. Conclusions:Male and female MS patients had similar urinary symptom scores and urodynamic findings, with the exception of higher voiding pressures in males.RRMS patients reported significantly more severe urinary symptoms on AUASI, compared to SPMS, despite having similar urodynamic findings.

We confirm intense local inflammatory reactions in patients undergoing pubovaginal sling using 8-ply small intestinal submucosa, and present a case series of such inflammation after tension free pubovaginal sling and tape procedures.