Abstract
Purpose
The aims of this study were to: (a) analyse the most frequent morphofunctional features of the lower urinary tract observed during videourodynamic examination in patients with neurogenic bladder due to multiple sclerosis; (b) investigate the role of the videourodynamic examination in the clinical management of these patients; and (c) demonstrate the relationship between morphological and functional variables.
Materials and methods
We performed videourodynamic examinations in 75 patients affected by neurogenic bladder secondary to multiple sclerosis.
Results
The introduction of pharmacological therapy, based on clinical and functional evaluation of the lower urinary tract, is correlated with satisfactory morphofunctional outcomes, reducing moderate-to-severe postvoid residual (PVR; p < 0.1) and compliance (p < 0.05) at the price of reduced bladder sensation. Clinical management of these patients based on morphological evaluation of the lower urinary tract decreased the occurrence of detrusor-sphincter dyssynergy (DSD) and detrusor overactivity incontinence at the following examination.
Conclusions
Our study confirmed a relationship between detrusor overactivity and hypertonic bladder, bladder diverticula, vesicoureteral reflux, between detrusor underactivity and PVR and between DSD and bladder diverticula. Our data show how the videourodynamic examination may improve evaluation and urological management of these patients.
Riassunto
Obiettivo
Questo studio è stato condotto con un triplice obiettivo: analizzare i reperti morfo-funzionali vescicosfinterici più frequentemente rilevati con l’esame video-urodinamico in pazienti con vescica neurologica secondaria a sclerosi multipla, studiare il ruolo di questo esame nella loro gestione clinica e dimostrare l’esistenza di un rapporto di dipendenza tra variabili funzionali e morfologiche.
Materiali e metodi
Sono stati studiati 75 pazienti con vescica neurologica secondaria a sclerosi multipla mediante l’esecuzione dell’esame video-urodinamico.
Risultati
L’introduzione della terapia farmacologica basata sulla valutazione clinica e funzionale dell’unità vescico-sfinterica consente di ottenere risultati morfofunzionali buoni, con il miglioramento del residuo postminzionale (RPM) moderato-severo (p<0,1) e della compliance (p<0,05), a scapito della sensibilità vescicale (p<0,1). La gestione clinica dei pazienti basata anche su valutazioni morfologiche del basso tratto urinario consente di ottenere risultati statisticamente migliori, con la riduzione dei casi di dissinergia detrusore-sfintere esterno (DESD) e iperattività detrusoriale con fuga di urina nell’esame di controllo.
Conclusioni
I dati ottenuti da questo studio consentono di dimostrare l’esistenza di un rapporto di causalità tra iperattività detrusoriale e ipertono parietale, diverticoli vescicali e reflusso vescico-ureterale (RVU), tra ipoattività detrusoriale e RPM, e tra DESD e diverticoli vescicali; permettono inoltre di avvalorare l’utilità dell’esame videourodinamico nella valutazione e nel management urologico di questi pazienti.
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Caramella, D., Donatelli, G., Armillotta, N. et al. Videourodynamics in patients with neurogenic bladder due to multiple sclerosis: our experience. Radiol med 116, 432–443 (2011). https://doi.org/10.1007/s11547-011-0620-2
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DOI: https://doi.org/10.1007/s11547-011-0620-2