RESUMEN
INTRODUCTION AND HYPOTHESIS: Most subjects with multiple sclerosis (MS) suffer from lower urinary tract symptoms (LUTS). Detrusor overactivity, detrusor hypocontractility and detrusor-sphincter dyssynergia are the most common bladder dysfunctions. Management is not straightforward due to the progressive course of the disease. Sacral neuromodulation (SNM) has received increasing attention among new effective treatments for bladder disorders associated with MS. The aim of this study was to review the published literature on the role of SNM in the treatment of LUTS in patients with MS. METHODS: A literature search was carried out up to December 2014, using relevant search terms in MEDLINE and EMBASE databases. The ClinicalTrials.gov and Controlled-trials.com online trial registries and the abstracts from international scientific meetings were searched for English-language studies containing relevant search terms. Relevant reviews and trials and prospective studies were analysed by two independent reviewers. RESULTS: Two prospective studies and four retrospective studies were included. Overall, MS patients represented small series (4 to 25 subjects). The longest follow-up was 7 years and the evaluation of the treatment outcomes was not homogeneous among the studies. The definition of objective cure was often unclear. The subjective cure rate was 45 %, patients' reported satisfaction was 85 % and all the results were stable over time. CONCLUSIONS: SNM seems to be a safe and effective treatment for LUTS in MS patients. Further and larger studies as well as randomized controlled trials are needed to confirm its clinical role in patients with MS.
Asunto(s)
Síntomas del Sistema Urinario Inferior/terapia , Esclerosis Múltiple/complicaciones , Estimulación Eléctrica Transcutánea del Nervio , Humanos , Síntomas del Sistema Urinario Inferior/etiologíaRESUMEN
CONTEXT: Progress in the science of pain has led pain specialists to move away from an organ-centred understanding of pain located in the pelvis to an understanding based on the mechanism of pain and integrating, as far as possible, psychological, social, and sexual dimensions of the problem. This change is reflected in all areas, from taxonomy through treatment. However, deciding what is adequate investigation to rule out treatable disease before moving to this way of engaging with the patient experiencing pain is a complex process, informed by pain expertise as much as by organ-based medical knowledge. OBJECTIVE: To summarise the evolving changes in the management of patients with chronic pelvic pain by referring to the 2012 version of the European Association of Urology (EAU) guidelines on chronic pelvic pain. EVIDENCE ACQUISITION: The working panel highlights some of the most important aspects of the management of patients with chronic pelvic pain emerging in recent years in the context of the EAU guidelines on chronic pelvic pain. The guidelines were completely updated in 2012 based on a systematic review of the literature from online databases from 1995 to 2011. According to this review, levels of evidence and grades of recommendation were added to the text. A full version of the guidelines is available at the EAU office or Web site (www.uroweb.org). EVIDENCE SYNTHESIS: The previously mentioned issues are explored in this paper, which refers throughout to dilemmas for the physician and treatment team as well as to the need to inform and engage the patient in a collaborative empirical approach to pain relief and rehabilitation. These issues are exemplified in two case histories. CONCLUSIONS: Chronic pelvic pain persisting after appropriate treatment requires a different approach focussing on pain. This approach integrates the medical, psychosocial, and sexual elements of care to engage the patient in a collaborative journey towards self-management.
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Dolor Crónico/terapia , Manejo del Dolor/normas , Dolor Pélvico/terapia , Dolor Crónico/diagnóstico , Dolor Crónico/fisiopatología , Dolor Crónico/psicología , Terapia Combinada , Prestación Integrada de Atención de Salud/normas , Medicina Basada en la Evidencia/normas , Humanos , Manejo del Dolor/efectos adversos , Dimensión del Dolor/normas , Grupo de Atención al Paciente/normas , Dolor Pélvico/diagnóstico , Dolor Pélvico/fisiopatología , Dolor Pélvico/psicología , Valor Predictivo de las Pruebas , Resultado del TratamientoRESUMEN
The role of muscle spasm is not a new concept in the genesis of pain. Botulinum neurotoxin type A (BoNTA) has been successfully employed in a variety of muscular and inflammatory conditions. The aim of our study was to review the published literature on the role of BoNTA injection of the pelvic floor muscle in the management of women with chronic pelvic pain (CPP). A systematic search of the literature published up to June 2012 on the use of BoNTA in the treatment of female pelvic floor muscle spasm was carried out using relevant search terms in MEDLINE and EMBASE databases. The results were limited to full-text English language articles. Relevant trials as well as relevant reviews were selected and analyzed by two independent reviewers. Five studies (2 case reports, 1 prospective pilot study, 1 retrospective study and 1 randomised double-blind placebo controlled study) were included in this systematic review. Overall, BoNTA has shown to be beneficial in relieving CPP related to pelvic floor spasm. The role of BoNTA as a treatment of CPP has been recognized for more than 10 years. Although data are still scarce preliminary results are encouraging. BoNTA is an attractive option for refractory CPP related to pelvic floor muscle spasm, but further studies using validated and reproducible outcome measures are needed, to establish its effectiveness, safeness, technique, optimal dosage, and duration of symptom relief.
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Toxinas Botulínicas Tipo A/administración & dosificación , Toxinas Botulínicas Tipo A/uso terapéutico , Diafragma Pélvico/fisiopatología , Dolor Pélvico/tratamiento farmacológico , Dolor Pélvico/etiología , Espasmo/complicaciones , Enfermedad Crónica , Manejo de la Enfermedad , Femenino , Humanos , Inyecciones Intramusculares , Evaluación de Resultado en la Atención de Salud , Dolor Pélvico/fisiopatología , Espasmo/fisiopatología , Resultado del TratamientoRESUMEN
This review reflects the presentations and subsequent discussions at the International consultation on Incontinence Research Society's annual meeting. It updates the current definitions and diagnostic and treatment algorithms for bladder pain syndrome and chronic pelvic pain syndrome (non-bacterial prostatitis), highlights some specific basic research findings from discussion participants, looks at what we can hope to eventually learn from a large multicenter National Institutes of Health study, reviews future research pathways as articulated by the National Urologic Research Agenda of the American Urological Association and others, discusses recent therapeutic efforts, and concludes with discussion points from the ICI-RS meeting.
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Dolor Crónico , Cistitis Intersticial , Dolor Pélvico , Animales , Dolor Crónico/clasificación , Dolor Crónico/diagnóstico , Dolor Crónico/terapia , Cistitis Intersticial/clasificación , Cistitis Intersticial/diagnóstico , Cistitis Intersticial/terapia , Técnicas de Diagnóstico Urológico , Medicina Basada en la Evidencia , Humanos , Dimensión del Dolor , Dolor Pélvico/clasificación , Dolor Pélvico/diagnóstico , Dolor Pélvico/terapia , Guías de Práctica Clínica como Asunto , Valor Predictivo de las Pruebas , Pronóstico , Índice de Severidad de la Enfermedad , Terminología como AsuntoRESUMEN
OBJECTIVES: Because the term "interstitial cystitis" (IC) has different meanings in different centers and different parts of the world, the European Society for the Study of Interstitial Cystitis (ESSIC) has worked to create a consensus on definitions, diagnosis, and classification in an attempt to overcome the lack of international agreement on various aspects of IC. METHODS: ESSIC has discussed definitions, diagnostic criteria, and disease classification in four meetings and extended e-mail correspondence. RESULTS: It was agreed to name the disease bladder pain syndrome (BPS). BPS would be diagnosed on the basis of chronic pelvic pain, pressure, or discomfort perceived to be related to the urinary bladder accompanied by at least one other urinary symptom such as persistent urge to void or urinary frequency. Confusable diseases as the cause of the symptoms must be excluded. Classification of BPS types might be performed according to findings at cystoscopy with hydrodistention and morphologic findings in bladder biopsies. The presence of other organ symptoms as well as cognitive, behavioral, emotional, and sexual symptoms, should be addressed. CONCLUSIONS: The name IC has become misleading and is replaced by BPS. This name is in line with recent nomenclature recommendations by the European Association of Urology and is based on the axial structure of the International Association for the Study of Pain classification. To facilitate the change of the name, ESSIC agreed to include IC in the overall term (BPS/IC) during this transition period.
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Cistitis Intersticial/clasificación , Cistitis Intersticial/diagnóstico , Proyectos de Investigación , Sociedades Médicas , Terminología como Asunto , Europa (Continente) , HumanosRESUMEN
Heart muscle cells are electrically coupled by gap junctions, clusters of low-resistance transmembrane channels composed of connexins (Cx). The expression of the three major connexins (Cx43, Cx40 and Cx45) present in cardiac myocytes is known to be developmentally regulated but it is not clear how the patterns in the human heart compare with those found in the mouse. This issue is of importance given the wide use of transgenic mice to investigate gene function with the aim of extrapolating the results to human. In the present study we applied immunoconfocal microscopy to investigate the spatial distribution of the three connexins in the developing mouse heart and foetal human heart. Although Cx45 labelling was present at low levels throughout the developing mouse heart and human foetal (9-week) heart, it was most prominent in the conduction tissues. In the developing mouse heart, Cx40 was widely expressed at embryonic day 12.5 (E12.5) but at E17.5 expression was restricted to the conduction tissues and atria. In the 9-week human foetal heart, the Cx40 labelling pattern was similar to the E15 mouse heart, being far more abundant in conduction tissues (bundle branches to Purkinje fibres) and atria than in the ventricular muscle. Cx43 labelling became more apparent in the ventricular myocardium as development of the mouse heart progressed but was virtually undetectable in the central conduction system. In the human foetal heart Cx43 was virtually undetectable in the atria but was the predominant connexin in the ventricles. We conclude that, at least in some key aspects, the pattern of connexin expression in the developing mouse heart parallels that found in the human embryonic heart.