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Biomedical subjects

Helmut Madersbacher

Publications and source records attributed to Helmut Madersbacher.

13 recordsLinked to original sources
PubMed2006

A novel product for intermittent catheterisation: its impact on compliance with daily life--international multicentre study.

OBJECTIVES: This study was undertaken to evaluate patient openness to changing and satisfaction with catheters used in intermittent catheterisation (IC) for urinary retention from neurogenic bladder dysfunction, and to compare patient response to conventional catheters and a novel packaged hydrophilic catheter: LoFric Primo. PATIENTS AND METHODS: Of 409 patients recruited, 378 (283 males, 95 females; mean age: 43.5 yr) completed a 12-d trial of the novel catheter. The diagnoses were spinal cord lesion in 65.6%, multiple sclerosis in 9.6%, spina bifida in 2.3%, and other neurologic conditions in 22.5%; the mean duration of IC was 4.6 yr. Patients evaluated their current catheter at recruitment and the novel catheter after the 2-wk trial by questionnaire. Patient satisfaction was expressed on a Visual Analogue Scale for seven topics covering use and general satisfaction. RESULTS: Of the 378 patients, 55.2% were happy to continue with the novel device, which was 74% of patients using standard polyvinyl chloride (PVC) catheters and 36% of those using prelubricated PVC (p=0.04). No individual patient factors were found to be significant in catheter choice. For the whole study population "ability to comply with daily life activities" was maintained with the novel product despite handling and general satisfaction being found more troublesome. CONCLUSIONS: The main finding was that more than 50% of the patients wished to continue with the novel catheter and reported increased satisfaction regarding introduction of the catheter, handling, time spent, perception of IC, general satisfaction, and ability to cope with daily life.

Activities of Daily Living↗
PubMed2006

Predictive value of initial urodynamic pattern on urinary continence in patients with myelomeningocele.

AIMS: To investigate whether the initial urodynamic pattern may predict urinary continence and the need for adjunctive incontinence surgery in patients with myelomeningocele. PATIENTS AND METHODS: One hundred and twenty-three patients with myelomeningocele were included in our retrospective study. The patients were divided based on the urodynamic pattern at initial evaluation into four categories: overactive detrusor with overactive (spastic) sphincter (group 1, n = 43), overactive detrusor with underactive/acontractile sphincter (group 2, n = 37), underactive/acontractile detrusor with overactive (spastic) sphincter (group 3, n = 8), and underactive/acontractile detrusor with underactive/acontractile sphincter (group 4, n = 35). Urinary continence status at the last follow-up and the need for adjunctive incontinence surgery were compared between the four groups. RESULTS: Mean follow-up was 10 years and mean age at the last follow-up 17 years. A socially acceptable continence status (continent or socially dry) was achieved in 74% and was significantly different among the four groups (P = 0.023): 86% and 87% of the patients in group 1 and 3 became continent or socially dry, but only 57% and 74% of those in group 2 and 4, respectively. Although none of the patients in group 3 underwent adjunctive incontinence surgery compared to about 25% in the other groups, statistically the difference was not significant (P = 0.48). CONCLUSIONS: The initial urodynamic pattern is very useful in counseling families by predicting urinary continence in patients with myelomeningocele. The chances of becoming continent or at least socially dry are best for patients with overactive (spastic) sphincter.

Adolescent↗
PubMed2006

Early proactive management improves upper urinary tract function and reduces the need for surgery in patients with myelomeningocele.

AIMS: To investigate whether upper urinary tract function and the need for surgery in patients with myelomeningocele depends on the timing of initiating neurourological management. PATIENTS AND METHODS: One hundred thirty-three patients with myelomeningocele were included in our retrospective study. The patients were divided based on age at the initial evaluation into three categories: from day of birth to age 2 (group 1, n = 67), from age 3 to age 10 (group 2, n = 44), and after age 10 (group 3, n = 22). Upper urinary tract function and the need for surgery with the intention to preserve or normalize the upper urinary tract function were compared between the three groups. RESULTS: Mean follow-up was 11, 10, and 9 years in group 1, 2, and 3, respectively. The upper urinary tract function was normal in 91%, 80%, and 82% at the initial evaluation (P = 0.194) and in 99%, 86%, and 86% at the last follow-up (P = 0.012) in group 1, 2, and 3, respectively. Following failure of conservative therapy only, the proportions of patients undergoing surgical interventions with the intention to preserve or normalize the upper urinary tract function was significantly (P = 0.0002) different among the three groups: 15%, 34%, and 59%, respectively. CONCLUSIONS: Early proactive management improves upper urinary tract function and reduces the need for surgery in patients with myelomeningocele in the long-term. Therefore, initiation of proactive neurourological management as early as possible, ideally from the day of birth, is strongly recommended.

Adolescent↗
PubMed2006

Trospium chloride: the European experience.

The primary pharmacological therapy for overactive bladder syndrome is muscarinic receptor antagonists. Muscarinic receptor blockade is effective in decreasing the symptoms of urinary urgency and urgency incontinence, but can be associated with troublesome complications, such as dry mouth, blurred vision, constipation and CNS side effects. Trospium chloride, an antimuscarinic medication, has been available in Europe for > 20 years and has recently been approved by the FDA for the treatment of overactive bladder. Trospium chloride is a quaternary amine that is minimally metabolised, not highly protein bound and, importantly, has not been demonstrated to cross the unaltered blood-brain barrier in healthy volunteers. Some characteristics of this unique antimuscarinic agent and the European experience with trospium chloride are reviewed in this article.

Administration, Oral↗
PubMed2005

Prolonged sacral neuromodulation testing using permanent leads: a more reliable patient selection method?

OBJECTIVE: To assess the effect of prolonged sacral neuromodulation testing using permanent leads comparing the usual evaluation period of 4 to 7 days to a prolonged evaluation period of a minimum of 14 days. PATIENTS AND METHODS: A consecutive series of 20 patients (16 females and 4 males) undergoing prolonged sacral neuromodulation testing using permanent leads between September 2000 and March 2004 were evaluated retrospectively. 10 suffered from urgency-frequency syndrome, 3 from urge incontinence and 7 from non-obstructive chronic urinary retention. Key bladder diary variables at baseline, after the usual and prolonged evaluation period and at the last follow-up were compared. RESULTS: The median age was 52 years (interquartile range (IQR) 38-59) and the median evaluation period 28 days (IQR 18-29). 16 of the 20 patients (80%) had successful prolonged sacral neuromodulation testing and underwent the implantation of the IPG that was placed in the anterior abdominal wall in 6 and in the upper buttock in 10 patients. The eligibility for IPG implantation was significantly (p=0.031) increased from 50% after the usual to 80% after the prolonged evaluation period. At a median follow-up of 22 months (IQR 12-34), sacral neuromodulation was successful in 14 (88%) of the 16 IPG implanted patients but failed in 2. CONCLUSIONS: Prolonged sacral neuromodulation testing using permanent leads is more reliable for accurate patient selection than the usual evaluation period. Therefore, this method is strongly recommended and suggested to become the standard test procedure.

Abdominal Wall↗
PubMed2004

Intermittent catheterisation in older people: a valuable alternative to an indwelling catheter?

OBJECTIVES: To investigate whether intermittent catheterisation is a valuable alternative to an indwelling catheter in patients older than 70 years with post-void residuals more than 50% of the bladder capacity. PATIENTS AND METHODS: We retrospectively reviewed the medical records of 21 patients (14 women, 7 men) older than 70 years in whom intermittent catheterisation was initiated because of voiding dysfunction with post-void residuals more than 50% of the bladder capacity resistant to other treatment. Twelve patients mastered the technique of intermittent self-catheterisation, seven were catheterised by their partners and two by nurses. RESULTS: The mean age of patients was 76.5 years (range 71-83 years) and the mean observation period with regard to intermittent catheterisation was 27.9 months (range 5-129 months). For those relying on intermittent catheterisation, the urinary tract infection rate was 0.84 per year and patient (range 0-3), and urinary continence was restored in all of the six previously incontinent patients. Eighteen of the 21 patients reported a significantly improved quality of life owing to the restoration of urinary continence, decreasing of daytime frequency, nocturia and urge, and the lowering of the urinary tract infection rate. CONCLUSIONS: Intermittent (self-) catheterisation is a safe and valuable technique in older people with significant post-void residuals owing to detrusor underactivity. Urinary continence is restored, urge, daytime frequency and nocturia are decreased, and the urinary tract infection rate is diminished, resulting in improved quality of life. Therefore, intermittent (self-) catheterisation is strongly recommended in older people.

Aged↗
PubMed2004

European experience of 200 cases treated with botulinum-A toxin injections into the detrusor muscle for urinary incontinence due to neurogenic detrusor overactivity.

OBJECTIVES: To present a comprehensive experience with botulinum-A toxin (BTA) injected into the detrusor muscle in patients with spinal cord injuries/diseases causing neurogenic incontinence. METHODS: Ten European medical centers provided the results of 231 patients with neurogenic detrusor overactivity who were treated with BTA. 300 units of Botox (Allergan Inc.) were injected cystoscopically into the detrusor muscle at 30 different locations, while sparing the trigonum. Urinary continence status, concomitant anticholinergic medication use and patient satisfaction were recorded. Key urodynamic parameters (reflex volume, maximum detrusor pressure during voiding, detrusor compliance and maximum cystometric bladder capacity) at baseline and at the first and second urodynamic follow-up examinations were analyzed. RESULTS: By the time of the initial (mean 12 weeks after injection) as well as at the second urodynamic follow-up examinations (mean 36 weeks after injection), the mean cystometric bladder capacity (p < 0.0001) and the mean reflex volume (p < 0.01) increased significantly, while the mean voiding pressure (p < 0.0001) decreased significantly. The mean bladder compliance had increased significantly (p < 0.0001) by the first follow-up examination and non-significantly by the time of the second follow-up. No injection related complications or toxin related side effects were reported. The patients considerably reduced or even stopped taking anticholinergic drugs without recurrence of reflex incontinence and were satisfied with the treatment. CONCLUSIONS: This retrospective European multicenter study presents the most extensive experience to date with BTA injections into the detrusor muscle to treat neurogenic incontinence due to detrusor overactivity and confirms that this new treatment is safe and valuable. Significant improvement of bladder function corresponds with continence and the subjective satisfaction indicated by the treated patients.

Botulinum Toxins, Type A↗
PubMed2004

An empirical treatment algorithm for incontinent children.

PURPOSE: Successful response rates of monotherapeutic strategies in urge incontinent children are limited. We evaluate whether adjuvant treatment improves outcomes. MATERIALS AND METHODS: Incontinent children were evaluated according to International Consultation on Incontinence standards. Propiverine (0.4 mg/kg) was applied 2 times daily for 4 weeks (treatment period 1) before reevaluation. Primary outcome was achievement of continence and secondary outcome was improvement of functional bladder capacity. In partial responders an alternative adjuvant treatment was initiated for another 12 weeks (treatment period 2). RESULTS: Of 70 enrolled patients 29 achieved continence (responders) and 35 responded partially and were assigned to adjuvant treatment, which consisted of selective alpha-blocker for functional bladder outflow obstruction (6), desmopressin for excessive nocturnal urine production (19) and biofeedback for increased pelvic floor activity during micturition (10). Only 6 nonresponders (9%) were assigned to specialized management. After treatment 2, 20 of the 35 partial responders achieved continence, thus avoiding specialized management. CONCLUSIONS: Propiverine monotherapy for incontinent children is effective. However, applying adjuvant treatment modalities to partial responders increases overall efficacy rates.

Adolescent↗
PubMed2002

Neurogenic bladder dysfunction in patients with myelomeningocele.

PURPOSE OF REVIEW: The general management strategies in children with myelodysplasia are widely accepted, however diagnostic and therapeutic details still need to be discussed and clarified. RECENT FINDINGS: Ten articles are reviewed. Two articles are dealing with general clinical aspects; one underlines the need for urodynamics as a prerequisite for an adequate treatment strategy, the other recommends to evaluate adolescents and adults with myelodysplasia, because only the ultimate outcome allows a judgement of how effective our efforts are to achieve the goals. Increased excretion of glycosaminoglycan in myelodysplasia children above 5 years of age could become a marker for beginning bladder damage and deserves further interest. The question whether children with normal urodynamics after closing the spinal cord should be followed or not is clearly answered in a further article which also discusses the results of detethering in these patients. Four articles report on pharmacotherapy with new substances or new ways of application (intravesical oxybutynin, extended release oxybutynin formulation, intravesical resiniferatoxin). The results of collagen injections in children with neurogenic sphincter underactivity clearly demonstrate that the long-term results are disappointing. Last, but not least, a retrospective review on acute abdominal symptoms and signs in children with myelodysplasia clearly shows that these patients should be transferred to a centre because of complex reasons and treatment modalities. SUMMARY: Urodynamics - abnormal or normal - are a prerequisite for adequate treatment and follow-up in children with myelodysplasia. More studies should focus on adolescents and adults with myelodysplasia to judge the effectiveness of our diagnostic and therapeutic efforts. New ways of application and new developments in pharmacotherapy to relax the overactive detrusor may possibly further decrease the need for surgery in the future. With regards to sphincter underactivity, results with collagen injections in this group of patients are disappointing and provide no alternative to operative treatment options.

Adolescent↗
PubMedDate not supplied

Overactive bladder--a practical approach to evaluation and management.

The overactive bladder (OAB) is a highly prevalent condition characterized by the combination of urgency and frequency with or without urge incontinence. The pathophysiology is multifactorial; the background is complicated and not yet fully understood. The basic diagnostic workup comprises symptoms assessment, targeted physical examination, urine analysis, post-void residual urine estimation which mostly allows to make a working diagnosis and to find out which patients can be treated also by the nonspecialist. The bladder diary is an optimal diagnostic instrument with a lot of information, whereas urodynamics are expensive and somewhat unverified in their value. The symptom-focused diagnosis is absolutely sufficient to start nonoperative therapy for OAB symptoms. The OAB presents a treatment challenge, as the management of OAB patients is not standardized. An algorithm should include an initial period of at least 6 weeks of conservative therapy consisting of antimuscarinic drugs in combination with behavioral therapy including pelvic floor exercises. If this combination is not successful, the primary diagnosis should be questioned and additional diagnostic tests may be required. If the therapy is successful after 8 weeks, a continuation should be considered in case the symptoms occur after stopping pharmacological therapy. Further therapy depends on the severity of the initial symptoms, the presence of side effects and the motivation of the patient. If pharmacotherapy is not successful or additional therapy desirable, electrical neuromodulation can be added for another period of 6 weeks for up to 3-6 months considering firstly non-invasive therapeutic modalities before recommending invasive sacral neuromodulation. Neuromodulation should be discussed before more invasive procedures, such as bladder augmentation, are considered. There are potentially promising new therapies on the horizon for the OAB. The use of intravesical agents, which decrease the afferent-sensory input, may herald a new therapeutic paradigm for the treatment of the OAB. Refinements in the techniques and the delivery vehicle for electrical stimulation may offer an even less invasive method of neuromodulation. Finally, ongoing research in biotechnology and tissue engineering may produce a functional, stable, compatible tissue substitute suitable for bladder augmentation. The objectives are (1) to define the overactive bladder, (2) to understand the prevalence of the overactive bladder and its impact on the quality of life, (3) to review the basic evaluation of the patient with symptoms suggestive of the overactive bladder and how to differentiate the overactive bladder from other types of urinary dysfunction, and (4) to understand the rationale for and the approach to therapy for the overactive bladder.

Cognitive Behavioral Therapy↗