Prevalence and psychosocial impact of lower urinary tract symptoms in patients with Duchenne muscular dystrophy

Patients with Duchenne muscular dystrophy (DMD) frequently report lower urinary tract symptoms at the outpatient rehabilitation clinic. The purpose of this study was to determine the prevalence of lower urinary tract symptoms in the Dutch male DMD population and their effect on quality of life. A postal questionnaire was sent to members of Dutch DMD patient organisations. 199 male patients with confirmed DMD and over the age of 3 years were included. 170/199 (85%) patients reported one or more lower urinary tract symptoms. Generally, post micturition dribble, straining and feeling of incomplete emptying were most frequently mentioned. 42% of patients (range 18–76%) experienced the symptoms as a problem. In 49/170 (29%) patients, it reduced quality of life. In conclusion, lower urinary tract symptoms in DMD patients are under reported and under diagnosed. However, the vast majority of male DMD patients with symptoms experience them as a problem, often reducing quality of life.     

The association between personality traits and treatment outcomes in Korean patients with lower urinary tract symptoms suggestive of benign prostatic hyperplasia (LUTS/BPH): a preliminary study

Objective

We investigated the association between personality traits and treatment outcomes in male Korean patients with lower urinary tract symptoms suggestive of benign prostatic hyperplasia (LUTS/BPH).

Method

We evaluated the personality traits and the severity of LUTS/BPH symptoms at baseline using the Korean versions of the 44-item Big Five Inventory (BFI-K) and International Prostate Symptom Score (IPSS), respectively. The IPSS was re-administered following a 12-week routine treatment regime, and we examined the relationship between treatment outcome and personality traits.

Results

Of the 176 patients initially screened, 101 agreed to participate in the study. Of those, 93 (92.1%) completed the 12-week trial and the BFI-K. Neuroticism was associated with a significantly worse treatment response, whereas extraversion was associated with a significantly better treatment response, and openness was associated with a high responder rate. Agreeableness, openness and conscientiousness were associated with improved week-12 IPSS total scores; however, the results were not statistically significant.

Conclusions

We found an association between treatment response and personality traits of neuroticism, extraversion and openness in patients with LUTS/BPH. However, further studies with larger samples and an improved design are needed to support our findings.     

Management of lower urinary tract symptoms in Parkinson's disease in the neurology clinic

This clinical review aims to evaluate lower urinary tract symptoms (LUTS) in Parkinson's disease (PD) patients and the current treatment options available for these symptoms in a neurology setting. The review also addresses when referral to urology is appropriate.

A literature search was conducted using the keywords ‘LUTS’, ‘non-motor symptoms’, ‘overactive bladder’, ‘Parkinson's disease’ and ‘urinary symptoms’ using the Medline/Pubmed search engine. Data collected ranged from 2000 to present with emphasis on recent publications.

This review was conducted because LUTS in PD has a major impact on quality of life and is associated with early institutionalization. Emphasis is placed on treating overactive bladder with conservative strategies and medical management in the neurology setting.

Quality of life can be improved and institutionalization can be delayed with a multimodal approach to bladder care.     

Central muscarinic inhibition of lower urinary tract nociception

Previous studies indicate cholinergic systems suppress somatic nociception. The present studies determined if cholinergic muscarinic systems suppress visceral nociception, specifically, chemical irritation of the lower urinary tract. Bladders of urethane-anesthetized rats were cannulated through the dome for continuous-infusion cystometrogram recordings. EMG electrodes recorded anal sphincter activity. Infusion of 0.5% acetic acid into the bladder to produce irritation increased bladder activity and anal sphincter activity (i.e. activation of a nociceptive vesicoanal reflex). Oxotremorine (a muscarinic agonist) and (−)butylthio[2.2.2] (a mixed muscarinic agonist/antagonist) dose-dependently inhibited vesicoanal reflex activity. This inhibition was antagonized by atropine (a centrally active muscarinic antagonist) but not by scopolamine methylbromide (a peripherally restricted muscarinic antagonist). Physostigmine (a centrally active cholinesterase inhibitor) also dose-dependently inhibited vesicoanal reflex activity in an atropine-sensitive manner, while neostigmine (a peripherally restricted cholinesterase inhibitor) did not. Atropine alone (i.e. administered without prior administration of muscarinic agonist or cholinesterase inhibitor) produced robust but transient (15 min) increases in vesicoanal activity and bladder activity under conditions of acetic acid infusion into the bladder. Under conditions of saline infusion into the bladder, atropine had the opposite effect on bladder activity (i.e. inhibition). These studies indicate that an endogenous cholinergic muscarinic system can be activated by lower urinary tract irritation to suppress visceral nociception through central nervous system mechanisms.     

The effect of glutamate antagonists on c-fos expression induced in spinal neurons by irritation of the lower urinary tract

Chemical irritation of the lower urinary tract (LUT) of the rat increases the expression of c-fos in neurons in the dorsal horn, dorsal commissure and intermediolateral region of the spinal cord. The role of glutamatergic synapses in this response was examined using two glutamate receptor antagonists, MK-801 (an NMDA antagonist) and CNQX (an AMPA antagonist). In rats with an intact spinal cord, MK-801 (3.5 mg/kg, i.v.) administered 15 min before bladder irritation decreased (50–60%) the number of c-fos-positive cells in all regions of the cord. A smaller dose of MK-801 (0.8 mg/kg, i.v.) was ineffective. In spinal transected rats (4–7 days prior to the experiment) MK-801 (3.5 mg/kg, i.v.) decreased c-fos expression only in the medial dorsal horn. CNQX (1.2 mg/kg, i.v.) was ineffective in both preparations. These results indicate that activation of NMDA receptors at glutamate synapses in the central nervous system may play a role in the processing of nociceptive input from the LUT and may also be involved in reflex pathways mediating micturition.     

Duloxetine 60 mg once-daily in the treatment of painful physical symptoms in patients with major depressive disorder

BACKGROUND: While emotional symptoms such as depressed mood and loss of interest have traditionally been considered to constitute the core symptoms of major depressive disorder (MDD), the prevalence and importance of painful physical symptoms such as back pain, abdominal pain, and musculoskeletal pain is becoming increasingly appreciated. Antidepressants possessing dual serotonin/norepinephrine (5-HT/NE) reuptake inhibition may demonstrate greater efficacy in the alleviation of pain. The efficacy of duloxetine, a balanced and potent dual reuptake inhibitor of 5-HT and NE, was evaluated within a cohort of depressed patients with associated painful physical symptoms. METHODS: In this multicenter, double-blind, placebo-controlled study, patients meeting DSM-IV criteria for MDD were randomized to receive placebo (N=141) or duloxetine 60 mg QD (N=141). Patients were required to have a 17-item Hamilton Rating Scale for Depression (HAMD17) total score 15, a Clinical Global Impression of Severity (CGI-S) score 4, and a Brief Pain Inventory (BPI) Average Pain score 2 at baseline. The primary efficacy measure was the BPI Average Pain score, while secondary measures included other BPI items, the HAMD17 total score, CGI-S, the Patient Global Impression of Improvement (PGI-I) scale, Visual Analog Scales (VAS) for pain, and the Symptom Questionnaire, Somatic Subscale (SQSS). Safety was evaluated by recording treatment-emergent adverse events (spontaneously reported), vital signs, and laboratory analytes. RESULTS: Mean changes in BPI Average Pain for duloxetine- and placebo-treated patients differed significantly at most visits, but only approached significance at endpoint p=0.066. For the main effect of treatment (pooling all visits), significant advantages for duloxetine-treated patients were found in 10 of 11 assessed BPI pain severity and pain interference items, in addition to VAS overall pain and back pain. Mean changes in pain measures for duloxetine-treated patients corresponded to improvements of 25-50%, compared with 19-39% for placebo. Mean changes at endpoint in depression rating scales (HAMD17, CGI-S, PGI-I) did not differ significantly between duloxetine and placebo treatment groups due to unusually high placebo response. The magnitude of placebo treatment effects (as measured by HAMD17 total score and Maier subscale) was significantly smaller in patients with 1 previous depressive episode, compared to those patients with no previous episodes. In patients with 1 previous depressive episode the advantage of duloxetine over placebo was similar to previous studies. Rates of discontinuation due to adverse events were 14.2% vs. 2.1% for duloxetine and placebo, respectively p<0.001. Treatment-emergent adverse events reported at a significantly higher rate by duloxetine-treated patients included nausea, dry mouth, fatigue, and decreased appetite. CONCLUSIONS: In this study, duloxetine (60 mg QD) was shown to be an effective treatment for the painful physical symptoms which are frequently associated with depression. Improvements in pain severity occurred independently of changes in depressive symptom severity.     

度洛西汀、米氮平、帕罗西汀与阿米替林治疗伴躯体症状抑郁症的对照研究

目的探讨度洛西汀、米氮平、帕罗西汀与阿米替林治疗伴躯体症状抑郁症的疗效和安全性。方法将符合国际疾病分类第10版（ICD一10）诊断标准的伴躯体症状的抑郁症患者117例,随机分为4组,分别给予度洛西汀、米氮平、帕罗西汀与阿米替林治疗,疗程8周。采用汉密尔顿抑郁量表（HAMD）、汉密尔顿焦虑量表（HAMA）和副反应量表（TESS）评定疗效及不良反应。结果4组药物均能迅速起效,第2周末HAMD、HAMA评分较治疗前差异有统计学意义（P〈0．05）,治疗8周后,4组闯疗效无统计学意义（P〉0．05）,4组HAMD、HAMA评分较治疗前有统计学意义（P〈0．01）,4个治疗组不良反应有统计学意义（P．〈0．01）。结论治疗伴躯体症状的抑郁症,四药总体疗效相似,均起效较快,度洛西汀、米氮平和帕罗西汀不良反应相对少,依从性好。提示四种药物均为治疗伴躯体症状的抑郁症一线药物,度洛西汀、米氮平和帕罗西汀值得临床推广。     

Analysis of the upper urinary tract function in multiple sclerosis patients

Aims –  The objective of this study was to analyse the upper urinary tract (UT) function in a group of consecutive multiple sclerosis (MS) patients, who had not previously been treated by urologist.
Materials and methods –  Ninety-two MS patients suffering from lower UT dysfunction were included in the study. The group of patients consisted of 69 women and 23 men. The average Expanded Disability Status Scale (EDSS) score in our group was 4.29 (0–8.5). Functional examination of the kidneys using assessment of creatinine clearance and morphological examination of the kidneys using ultrasound was performed in all patients. Analysis of the upper UT function is presented.
Results –  The average serum creatinine clearance in our group was 132.84 ml/min/1.73 m² (46.8–510). Lower levels than normal were found in three patients (3.3%). Abnormal ultrasound findings were recorded in five patients (5.4%). The creatinine clearance was correlated with the clinical subtype of MS, the severity expressed by EDSS, the urodynamic parameters, the duration of the disease, the duration of the symptoms of lower UT and the EDSS score. We did not find a statistically significant correlation for any of these parameters.
Conclusions –  Our results suggest that impairment of the upper UT function is exceptional in MS patients.     

Post-stroke lower urinary system dysfunction and its relation with functional and mental status: a multicenter cross-sectional study

Background: Review of the literature clearly reveals that little is known about the association between functional and mental status, and Lower Urinary Tract Dysfunction (LUTD) in patients with stroke.

Objective: The aim of this study was to assess functional and mental status in stroke patients and to identify possible associations with the prevalence, severity and bother of LUTD.

Material and methods: This study was designed as a cross-sectional study and included 260 stroke patients enrolled from six different hospitals in Turkey. The patients were questioned using the Danish Prostatic Symptom Score (DAN-PSS) Questionnaire to evaluate LUTD, and evaluated using the Modified Barthel Index (MBI), Incontinence Quality of Life Questionnaire (I-QoL), and the Mini Mental State Examination (MMSE).

Results: At least one LUTD finding was reported in 243 (93.5%) patients; the most commonly encountered complaint in these patients was nocturia (75.8%). The mean MBI, MMSE, and I-QoL scores were found to be significantly lower in LUTD (+) patients compared to LUTD (?) patients (p = 0.000, p = 0.005, and p < 0.01, respectively). Similarly all parameters (MBI, MMSE, and I-QoL scores) assessed were found to be significantly lower for patients with urinary incontinence than those without incontinence (p = 0.000, p = 0.000, and p < 0.01, respectively).

Conclusion: LUTD is a common problem in patients with stroke. LUTD is associated with poorer cognitive and functional status and the quality of life in these patients. We, therefore, suggest that bladder dysfunction should not be overlooked during rehabilitation of stroke patients.     

Deep brain stimulation effects on lower urinary tract function: Systematic review and meta-analysis

IntroductionWhile efficacy of deep brain stimulation for motor symptoms of neurological disorders is well accepted, its effects on the autonomic system remain controversial. We aimed to systematically assess all available evidence of deep brain stimulation effects on lower urinary tract function.MethodsThis systematic review was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. Studies were identified by electronic search of Cochrane Central Register of Controlled Trials, Embase, Medline, Scopus, and Web of Science (last search July 12, 2019) and by screening of reference lists and reviews.ResultsAfter screening 577 articles, we included 29 studies enrolling a total of 1293 patients. Deep brain stimulation of the globus pallidus internus (GPi), pedunculopontine nucleus (PPN), and subthalamic nucleus (STN) had an inhibitory effect on detrusor function, while deep brain stimulation of the ventral intermediate nucleus of the thalamus (VIM) showed an excitatory effect. In the meta-analysis, deep brain stimulation of the STN led to a significant increase in maximum bladder capacity (mean difference 124 mL, 95% confidence interval 60–187 mL, p = 0.0001) but had no clinically relevant effects on other urodynamic parameters. Adverse events (reported in thirteen studies) were most commonly respiratory issues, postural instability, and dysphagia. Risk of bias and confounding was relatively low.ConclusionsDeep brain stimulation does not impair lower urinary tract function and might even have beneficial effects. This needs to be considered in the deep brain stimulation decision-making process helping to encourage and to reassure prospective patients.     

The effect of pelvic floor muscle training on sexual function in men with lower urinary tract symptoms after stroke

Abstract

Background:

Erectile dysfunction and lower urinary tract symptoms (LUTS) are common sequelae in men after stroke.

Objective:

The objective of this study was to evaluate the effect of pelvic floor muscle training (PFMT) on measured erectile function as an indicator of sexuality in men with LUTS after stroke.

Method:

A sample of 516 men with stroke was invited to participate in this single-blinded, randomized controlled trial according to in- and exclusion criteria. This resulted in 31 participants who were randomized to either a Treatment Group (n?=?16) or a Control Group (n?=?15). The intervention included 12?weeks of PFMT.

The effect was measured on the International Index of Erectile Function (IIEF-5) questionnaire.

Results:

Thirty participants (median age: 68 years; interquartile range: 60–74 years) completed the study, 15 in each group. The results of the IIEF-5 sum score showed a significant improvement (P?<?0.04) from pre-test to post-test in the Treatment Group, but not in the Control Group. Within pre-test and 6-month follow-up, the median sum score decreased in both groups, worsened in the Control Group [Treatment Group, 3 (17%) versus Control Group, 5 (31%)]. There were differences between the groups at post-test and at follow-up, but they were not statistically significant.

Conclusion:

The results showed that, as measured by erectile function in men with LUTS after stroke, PFMT may have short-term and long-term effect, although no statistically significant effect was demonstrated between the groups.     

Profiles of psychiatric symptoms among amphetamine type stimulant and ketamine using inpatients in Wuhan,China

Amphetamine type stimulants (ATS) and ketamine have emerged as major drug problems in China, and chronic extensive exposure to these substances frequently co-occurs with psychiatric symptoms. This study compares the psychiatric symptoms of patients reporting ATS use only, ATS and ketamine use, or ketamine use only who were admitted to an inpatient psychiatry ward in Wuhan, China between 2010 and 2011. Data on 375 study participants collected during their ward admission and extracted from their clinical records included their socio-demographics, scores on the Brief Psychiatric Rating Scale (BPRS), and urine toxicology screens.ResultsThe ketamine-only group had significantly lower total BPRS scores and significantly lower scores on Thinking Disorder, Activity, and Hostility-Suspicion BPRS subscales than the ATS-only and ATS + ketamine groups (p < 0.001 for all comparisons). The ketamine-only group also had significantly higher scores on the subscales of Anxiety-Depression and Anergia. The ATS-only group had significantly higher scores on subscales of Thinking Disorder, Activity, and Hostility-Suspicion and significantly lower scores on Anxiety-Depression and Anergia subscales than the ketamine-only and ATS + ketamine groups (p < 0.001 for all comparisons). A K-means cluster method identified three distinct clusters of patients based on the similarities of their BPRS subscale profiles, and the identified clusters differed markedly on the proportions of participants reporting different primary drugs of abuse. The study findings suggest that ketamine and ATS users present with different profiles of psychiatric symptoms at admission to inpatient treatment.     

Pneumonia and urinary tract infection after acute ischaemic stroke: a tertiary analysis of the GAIN International trial.

The third most common stroke complication is infection. We studied the rates of aspiration pneumonia and urinary tract infection (UTI), their risk factors and their effect on outcome in the 1455 Glycine Antagonist (Gavestinel) in Neuroprotection (GAIN) International patients with ischaemic stroke. Forward stepwise logistic regression and Cox proportional hazards modelling identified baseline factors that predicted events and the independent effect of events up to day 7 on poor stroke outcome at 3 months in patients alive at day 7, after correcting for prognostic factors. Higher baseline National Institute of Health Stroke Scale (NIHSS) and age, male gender, history of diabetes and stroke subtype predicted pneumonia, which occurred in 13.6% of patients. Female gender and higher baseline NIHSS and age predicted UTI, which occurred in 17.2% of patients. Pneumonia was associated with poor outcome by mortality (hazard ratio, 2.2; 95% confidence interval, 1.5-3.3), Barthel index (<60) (odds ratio, 3.8; 2.2-6.7), NIHSS (4.9; 1.7-14) and Rankin scale (>/=2) (3.4; 1.4-8.3). UTI was associated with Barthel index (1.9; 1.2-2.9), NIHSS (2.2; 1.2-4.0) and Rankin scale (3.1; 1.6-4.9). Pneumonia and UTI are independently associated with stroke poor outcome. Patients with identified risk factors must be closely monitored for infection.     

与氯胺酮滥用相关的短期和长期心理症状清单的编制（英文）

背景:氯胺酮滥用在中国日渐增多,但目前还没有一个方法可以将氯胺酮对依赖个体的心理影响作用进行分类。目的:编制能反映氯胺酮依赖人群中因该物质滥用所致的急性心理影响和长期心理影响的量表。方法:我们编制了一个初步的症状清单,共有35个条目("是"或"否"的二分法问题),内容是关于使用氯胺酮后即刻产生的主观感受以及氯胺酮滥用后感受到的长期作用。从中国广州市两个大医院招募氯胺酮依赖住院患者,共入组187例。随机选择一半的样本进行探索性因子分析(exploratory factor analysis,EFA),以精简条目并确定量表的基本结构。对另一半样本进行验证性因子分析(confirmatory factor analysis,CFA),以评估所提取因子结构的稳健性。结果:35个症状中常见的急性期症状是"身体的漂浮或盘旋感"(94%)、"在动感音乐的环境下心情更加舒畅、欣快感"(86%)、和"兴奋话多,精力充沛"(67%)。常见的慢性症状是"记忆力下降"(93%)、"性格变化"(86%)和"反应变慢"(81%)。探索性因子分析最终得到的最佳模型量表,共22个条目,构成四个因子:两个因子代表慢性症状(社交退缩和睡眠障碍),一个因子是关于急性精神病样症状的,而第四个因子整合了急性的药物所致的欣快感和长期的性欲下降。验证性因素分析显示这4个因子能解释最终22个条目量表总方差的50%,并且模型拟合良好(拟合指数,GFI=83.3%;近似误差均方根,RMSEA=0.072)。结论:四因子模型(社交退缩、睡眠障碍、精神病样症状和使用毒品时的欣快感)能较为客观地反映氯胺酮滥用相关的短期和长期心理症状。对这一22个条目的量表,今后的研究工作需要扩大样本量,以验证实该四因子结构的效度,评估量表的重测信度,并确定是否能将该量表用于氯胺酮依赖的鉴别诊断和治疗监测。     

Create a predictive model for neurogenic bladder patients: upper urinary tract damage predictive nomogram

Abstract

Objective: To create a nomogram to evaluate the risk of upper urinary tract damage (UUTD) in patients with neurogenic bladder (NGB)

Methods: A retrospective analysis was conducted on 301 patients with NGB who were admitted to certain hospitals. Data collected included clinical symptoms, patients’ characteristics, laboratory parameters, imaging findings, and urodynamic parameters. The least absolute shrinkage and selection operator（LASSO）regression model was used to optimise the selection of predictors. Multivariate logistic regression analysis was performed to develop a UUTD risk predictive model. Validation was performed by bootstrap.

Results: The predictors included in the nomogram included sex, duration of disease, history of UTI, bladder compliance, and fecal incontinence. The model presented good discrimination with a C-index value of 0.796 (95% confidence interval: 0.74896–0.84304) and good calibration. The C-index value of the interval validation was 0.7872112. The results of decision curve analysis (DCA) demonstrated that the UUTD-risk predictive nomogram was clinically useful.

Conclusion: The nomogram incorporating the sex, duration of disease, history of UTI, bladder compliance, and fecal incontinence could be an important tool of UUTD risk prediction in NGB patients.     

1例以精神症状起病的克一雅病

1临床资料 患者,男性,52岁,陕西籍,汉族,已婚。因“进行性反应迟钝,言行异常5月余”于2008年3月收住院。2007年9月患者发热,体温38.5℃,经抗炎、对症治疗1周,体温恢复正常。继而出现耳鸣、呃逆、口齿不清、行走不稳、反应迟钝、记忆力减退、言行异常、睡眠增多等症状。2007年10月就诊于西安某三甲医院行头颅CT示：左侧基底节区腔梗塞。2007年11月行头颅MRI示：右侧侧脑室腔梗;脑脊液结果：红细胞计数：2/mm3,白细胞计数：40/mm3,淋巴细胞计数：91%,单核细胞计数：8%,浆细胞计数：1%,病毒系列（-）。血清叶酸：2.73ng/ml,血清维生素B12：836.00pg/ml。     

氯胺酮在神经病理性疼痛治疗中的作用及治疗进展——根据病例报道的综述

持续存在的有害刺激常可导致中枢痛觉致敏作用,这种作用可使某种强度不大的刺激引起机体感知到强烈的疼痛.     

1例脑外伤后特殊精神症状报道

颅脑外伤导致精神症状在临床上并不少见,特别是在额颞叶闭合性损伤,脑挫伤患者中,常常伴发精神症状,如精神萎靡,抑郁,躁狂,睡眠障碍,性格改变等。现报道1例脑外伤后性欲亢进患者。     

Duloxetine-related tardive dystonia and tardive dyskinesia: a case report

Tardive dyskinesia and tardive dystonia are caused by dopamine receptor blocking agents, mostly antipsychotics and sometimes antidepressants or calcium channel blockers. Duloxetine-related tardive syndrome is rarely reported in the literature. We report one case of tardive dystonia and tardive dyskinesia occurring in a 58-year-old female with major depressive disorder, who developed distressing oral dyskinesia, mandibular dystonia with trismus and dystonia over left neck after treatment of duloxetine (30–60 mg per day) for 18 months. Despite discontinuation of duloxetine, she only obtained partial remission. Even though this association has been rarely reported, duloxetine may pose a potential risk of inducing tardive syndrome. Clinicians should cautiously detect early signs of movement abnormality when prescribing antidepressants.