INTRODUCTION: Our objective was to conduct an individual patient data meta-analysis (IPDMA) of the two published randomized placebo-controlled trials of mirabegron in people with neurogenic lower urinary tract dysfunction (NLUTD) due to spinal cord injury (SCI) or multiple sclerosis (MS). METHODS: We identified two randomized, placebo-controlled trials. We extracted individual patient data from the trials and evaluated two primary outcomes: change in maximum cystometric capacity and change in the patient perception of bladder condition (PPBC). We also evaluated several secondary outcomes related to urodynamic function and quality of life. We conducted three exploratory analyses to test hypotheses based on our clinical experiences with mirabegron in NLUTD. Analysis of covariance with adjustment for baseline values was used for the statistical analysis. RESULTS: Our IPDMA included 98 patients from the two trials. The results showed that mirabegron was associated with a significant improvement in maximum cystometric capacity (+41 mL, p = 0.04) and in the PPBC (-0.8, p < 0.01) compared to placebo. Secondary outcomes including peak neurogenic detrusor overactivity pressure (-20 cm H2O, p < 0.01), incontinence-QOL score (+12, p < 0.01), and 24 h pad weights (-79 g, p = 0.04) also improved significantly compared to placebo. Exploratory analyses found similar improvements in people with MS and SCI; some outcomes improved to a greater degree among people with incomplete SCI, or SCIs that were below T7. CONCLUSIONS: Our IPDMA provides evidence supporting the use of mirabegron in patients with NLUTD due to SCI or MS. Further work evaluating differential responses in people with different SCI lesion characteristics may be warranted.

• Klíčová slova
• mirabegron, neurogenic bladder, urodynamics,
• MeSH
• acetanilidy * MeSH
• hyperaktivní močový měchýř * MeSH
• kvalita života MeSH
• lidé MeSH
• neurogenní močový měchýř * MeSH
• poranění míchy * komplikace   MeSH
• roztroušená skleróza * komplikace   MeSH
• thiazoly * MeSH
• urodynamika fyziologie   MeSH
• výsledek terapie MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• metaanalýza MeSH
• Názvy látek
• acetanilidy * MeSH
• mirabegron MeSH Prohlížeč
• thiazoly * MeSH

BACKGROUND: Treatment in children and adolescents with a neurogenic bladder is primarily conservative with the goal of preserving the upper urinary tract combined with a good reservoir function of the bladder. However, sometimes-even in childhood-conservative management does not prevent the development of a low-compliant bladder or overactive detrusor. MATERIAL & METHODS: After a systematic literature review covering the period 2000-2017, the ESPU/EUAU guideline for neurogenic bladder underwent an update. RESULTS: In these patients, surgical interventions such as botulinum toxin A injections into the detrusor muscle, bladder augmentation, and even urinary diversion may become necessary to preserve the function of the upper (and lower) urinary tracts. The creation of a continent catheterizable channel should be offered to patients with difficulties performing transurethral clean intermittent catheterization. However, a revision rate of up to 50% needs to be considered. With increasing age continence of urine and stool becomes progressively more important. In patients with persistent weak bladder outlets, complete continence can be achieved only by surgical interventions creating a higher resistance/obstruction at the level of the bladder outlet with a success rate of up to 80%. In some patients, bladder neck closure and the creation of a continent catheterizable stoma is an option. CONCLUSION: In all these patients close follow-up is mandatory to detect surgical complications and metabolic consequences early.

• Klíčová slova
• EAU guideline, Mitrofanoff stoma, bladder augmentation, bladder neck reconstruction, neurogenic bladder, sling procedure, urinary diversion,
• MeSH
• dítě MeSH
• diverze moči metody   MeSH
• lidé MeSH
• mladiství MeSH
• neurogenní močový měchýř chirurgie   terapie   MeSH
• urologické chirurgické výkony metody   MeSH
• Check Tag
• dítě MeSH
• lidé MeSH
• mladiství MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• přehledy MeSH
• směrnice MeSH

BACKGROUND: In childhood, the most common reason for a neurogenic bladder is related to spinal dysraphism, mostly myelodysplasia. AIMS: Herein, we present the EAU/ESPU guidelines in respect to the diagnostics, timetable for investigations and conservative management including clean intermittent catheterization (CIC). MATERIAL AND METHODS: After a systematic literature review covering the period 2000 to 2017, the ESPU/EUAU guideline for neurogenic bladder underwent an update. RESULTS: The EAU/ESPU guideline panel advocates a proactive approach. In newborns with spina bifida, CIC should be started as soon as possible after birth. In those with intrauterine closure of the defect, urodynamic studies are recommended be performed before the patient leaves the hospital. In those with closure after birth urodynamics should be done within the next 3 months. Anticholinergic medication (oxybutynin is the only well-investigated drug in this age group-dosage 0.2-0.4 mg/kg weight per day) should be applied, if the urodynamic study confirmed detrusor overactivity. Close follow-up including ultrasound, bladder diary, urinalysis, and urodynamics are necessary within the first 6 years and after that the time intervals can be prolonged, depending on the individual risk and clinical course. In all other children with the suspicion of a neurogenic bladder due to various reasons as tethered cord, inflammation, tumors, trauma, or other reasons as well as those with anorectal malformations, urodynamics-preferable video-urodynamics, should be carried out as soon as there is a suspicion of a neurogenic bladder and conservative treatment should be started soon after confirmation of the diagnosis of neurogenic bladder. With conservative treatment the upper urinary tract is preserved in up to 90%, urinary tract infections are common, but not severe, complications of CIC are quite rare and continence can be achieved at adolescence in up to 80% without further treatment. DISCUSSION AND CONCLUSIONS: The transition into adulthood is a complicated time for both patients, their caregivers and doctors, as the patient wants to become independent from caregivers and treatment compliance is reduced. Also, transition to adult clinics for patients with neurogenic bladders is often not well-established.

• Klíčová slova
• EAU/ESPU guidelinie, anticholinegics, conservative treatment, neurogenic bladder, spinal dysraphism,
• MeSH
• dítě MeSH
• intermitentní katetrizace MeSH
• konzervativní terapie * MeSH
• lidé MeSH
• mladiství MeSH
• neurogenní močový měchýř diagnóza   terapie   MeSH
• Check Tag
• dítě MeSH
• lidé MeSH
• mladiství MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• směrnice MeSH
• systematický přehled MeSH

AIM: We aimed to systematically assess the evidence on the efficacy and safety of alpha-blockers in patients with multiple sclerosis (MS) suffering from neurogenic lower urinary tract dysfunction (NLUTD). METHODS: The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement was used to perform this systematic review. An electronic search of Cochrane register, Embase, Medline, Scopus (last search 3 March 2018) and screening of reference lists as well as reviews were used to identify the studies. Articles were included if they reported on efficacy/safety of alpha-blockers for the treatment of NLUTD in patients with MS. RESULTS: After screening of 7'015 abstracts, three studies enrolling a total of 50 patients were included: one randomized, placebo-controlled, single-blind trial and two prospective cohort studies. Alpha-blocker treatment was successful in 50% to 96% of the patients. Pooling data from the three included studies, the relative risk for successful alpha-blocker treatment was 3.89 (95% confidence interval 2.7-7.0). The general safety profile of alpha-blockers was favorable with 8% of the patients reporting adverse events. CONCLUSIONS: Alpha-blockers may be effective and safe for treating NLUTD in female and male patients with MS but the studies were small and the overall quality of evidence was low. To make definitive conclusions, well designed randomized controlled trials are highly warranted.

• Klíčová slova
• alpha-blockers, meta-analysis, multiple sclerosis, neuro-urology, neurogenic lower urinary tract dysfunction, systematic review,
• MeSH
• alfa blokátory terapeutické užití   MeSH
• lidé MeSH
• neurogenní močový měchýř farmakoterapie   etiologie   MeSH
• randomizované kontrolované studie jako téma MeSH
• roztroušená skleróza komplikace   MeSH
• symptomy dolních močových cest farmakoterapie   etiologie   MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• metaanalýza MeSH
• práce podpořená grantem MeSH
• systematický přehled MeSH
• Názvy látek
• alfa blokátory MeSH

• MeSH
• lidé MeSH
• lidokain MeSH
• mravy MeSH
• neurogenní močový měchýř * MeSH
• roztroušená skleróza * MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• dopisy MeSH
• komentáře MeSH
• Názvy látek
• lidokain MeSH

AIMS: To investigate the effect on urodynamics of 4 weeks treatment with solifenacin succinate in patients with neurogenic detrusor overactivity (NDO) due to multiple sclerosis (MS) or spinal cord injury (SCI). METHODS: SONIC was a prospective, multicenter, double-blind, phase 3b/4 study investigating the efficacy and safety of solifenacin 10 mg in patients with NDO due to MS or SCI. Patients (n = 189) were randomized to placebo or active treatment (solifenacin 5 mg, 10 mg or oxybutynin hydrochloride 15 mg) for 4 weeks, after a 2-week, single-blind, placebo run-in period. The primary endpoint was change in maximum cystometric capacity (MCC) from baseline to end of treatment. The primary analysis compared solifenacin 10 mg versus placebo; all other comparisons were considered secondary. Secondary endpoints included changes in urodynamic parameters, patient-reported outcomes, and safety assessments. RESULTS: In the primary analysis, solifenacin 10 mg significantly improved mean change from baseline MCC versus placebo (P < 0.001) and was associated with improvements in bladder volume at first contraction and at first leak as well as detrusor pressure at first leak. Similar results were obtained for oxybutynin versus placebo. Patient perception of bladder condition significantly improved with solifenacin 10 mg versus placebo (P = 0.041). There was a clear improvement in quality of life (QoL) in the solifenacin arms versus placebo. The overall incidence of adverse events was low. CONCLUSIONS: In patients with NDO due to MS and SCI, 4 weeks of treatment with solifenacin 10 mg improved urodynamic variables and QoL versus placebo and was well tolerated. Neurourol. Urodynam. 36:414-421, 2017. © 2015 Wiley Periodicals, Inc.

• Klíčová slova
• SONIC, cystometry, incontinence quality-of-life (I-QoL), multiple sclerosis (MS), neurogenic detrusor overactivity (NDO), solifenacin, spinal cord injury (SCI), urodynamic,
• MeSH
• dospělí MeSH
• dvojitá slepá metoda MeSH
• hyperaktivní močový měchýř farmakoterapie   patofyziologie   MeSH
• kvalita života MeSH
• lidé středního věku MeSH
• lidé MeSH
• mladý dospělý MeSH
• neurogenní močový měchýř farmakoterapie   patofyziologie   MeSH
• senioři MeSH
• solifenacin sukcinát aplikace a dávkování   škodlivé účinky   terapeutické užití   MeSH
• urodynamika účinky léků   fyziologie   MeSH
• urologické látky aplikace a dávkování   škodlivé účinky   terapeutické užití   MeSH
• výsledek terapie MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mladý dospělý MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• randomizované kontrolované studie MeSH
• Názvy látek
• solifenacin sukcinát MeSH
• urologické látky MeSH

OBJECTIVES: To present a system of urological care for patients with cervical spinal cord injury (SCI) in the Spinal Cord Unit in Prague. METHODS: Forty-one out of 412 patients hospitalized with acute SCI between 2007 and 2012 with motor complete SCI (AIS A,B) at the C4-C7 motor level and with sufficient follow-up duration were selected. Patients were trained using a male bladder catheterization model (37 with a transurethral catheter and 4 with a suprapubic catheter) to perform intermittent catheterization (IC) using an ergohand device, and were later encouraged to perform self-catheterization. RESULTS: On the basis of the motor level of the SCI, 8 out of the 41 study patients were assigned to group 1 (C4), 11 to group 2 (C5), 15 to group 3 (C6) and 7 to group 4 (C7). All patients in group 1 had an indwelling urinary catheter. In group 2, 6 patients (54.6%) learned to perform IC, with 2 of them needing another person's assistance. In 5 patients (45.5%), suprapubic cystostomy was maintained (insufficient functional grip, severe autonomic dysreflexia, prompt reflex erection). Group 3 included 12 patients (80%) performing intermittent catheterization and 3 patients (20%) with suprapubic cystostomy (insufficient functional grip, post-bladder-surgery condition, cognitive impairment). In group 4, only 1 patient (14.3%) had an indwelling catheter due to severe abductor spasticity, whereas the remaining 6 (85.7%) learned to perform IC. CONCLUSIONS: These findings suggest that patients with cervical SCI below the C5 motor level are able to learn self-catheterization, which increases independence and decreases the risk of urinary infection and stone formation.

• MeSH
• biologické modely MeSH
• cystostomie MeSH
• dospělí MeSH
• katetrizace močového měchýře metody   MeSH
• krční obratle MeSH
• kvadruplegie etiologie   rehabilitace   MeSH
• lidé středního věku MeSH
• lidé MeSH
• močový měchýř MeSH
• následné studie MeSH
• neurogenní močový měchýř etiologie   rehabilitace   MeSH
• péče o sebe MeSH
• pomůcky pro sebeobsluhu MeSH
• poranění míchy komplikace   rehabilitace   MeSH
• postura těla MeSH
• síla ruky MeSH
• učení MeSH
• zaváděcí katétry MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH
• Geografické názvy
• Česká republika MeSH

INTRODUCTION: Apart from the standard intramural administration of botulinum neurotoxin A (BoNT/A) to the detrusor, intense research is taking place into new means of administration in view of the complex mechanism of action of BoNT/A. METHODS: An open, randomised, prospective study was performed on a total of 23 patients with neurogenic detrusor overactivity. Following randomisation, patients were treated with 300 U of onabotulinumtoxinA (onaBoNT/A) in either the submucosa or the detrusor. Urodynamic examinations were carried out, and a bladder diary was kept both prior to and 12 weeks after the treatment. All patients stopped taking anticholinergics 1 week prior to the treatment. RESULTS: In both the submucosa and detrusor groups, we recorded a significant improvement in the monitored urodynamic parameters and significant decreases in the frequency of urinary incontinence episodes following the treatment. A comparison of the two groups showed no significant difference between the two forms of application, with the exception of voided volume (p = 0.007). CONCLUSION: A comparison of the two administration methods did not show any significant difference between onaBoNT/A administration to the submucosa and to the detrusor. Thus, the submucosal injection of onaBoNT/A represents an equally effective approach for its administration to patients.

• MeSH
• botulotoxiny typ A aplikace a dávkování   MeSH
• dospělí MeSH
• endoskopie MeSH
• hladké svalstvo účinky léků   MeSH
• injekce intramuskulární MeSH
• inkontinence moči terapie   MeSH
• kvalita života MeSH
• lidé středního věku MeSH
• lidé MeSH
• mladý dospělý MeSH
• močový měchýř účinky léků   MeSH
• neurogenní močový měchýř farmakoterapie   MeSH
• pilotní projekty MeSH
• poranění míchy prevence a kontrola   MeSH
• prospektivní studie MeSH
• sliznice účinky léků   MeSH
• urodynamika MeSH
• výsledek terapie MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mladý dospělý MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH
• randomizované kontrolované studie MeSH
• srovnávací studie MeSH
• Názvy látek
• botulotoxiny typ A MeSH

STUDY DESIGN: This was a multicentre, prospective, randomised study. OBJECTIVES: To compare the outcomes of intradetrusor and suburothelial onabotulinumtoxinA injections in patients with spinal cord injury and refractory neurogenic detrusor overactivity (NDO). SETTING: Urology departments of two tertiary hospitals in the Czech Republic. METHODS: A total of 32 spinal cord injury patients with severe NDO refractory to the standard anticholinergic treatment were randomised to receive either intradetrusor or suburothelial 300 IU onabotulinumtoxinA injections. Subjective satisfaction, bladder diary data and urodynamic data were compared in both groups before treatment and at 3 months post treatment. RESULTS: In all, 64.3% patients in the intradetrusor group and 88.8% patients in the suburothelial group were subjectively satisfied with the treatment. There was a significant post-treatment improvement in both groups regarding the number of catheterisations over 24 h, number of incontinence episodes over 24 h, catheterised volume, cystometric capacity, volume at first involuntary detrusor contraction, maximal detrusor pressure during filling and detrusor compliance. No significant differences between the groups were observed, with the exception of improvement of detrusor compliance, which was better in the intradetrusor group. There was one adverse effect comprising transient muscle weakness that was reported by one patient in the intradetrusor group. CONCLUSION: Results in both groups were comparable. The authors favour suburothelial onabotulinumtoxinA injection because this method allows more precise toxin localisation.

• MeSH
• botulotoxiny typ A aplikace a dávkování   škodlivé účinky   terapeutické užití   MeSH
• dospělí MeSH
• injekce MeSH
• inkontinence moči farmakoterapie   MeSH
• lidé středního věku MeSH
• lidé MeSH
• mladý dospělý MeSH
• močový měchýř MeSH
• nervosvalové látky aplikace a dávkování   škodlivé účinky   terapeutické užití   MeSH
• neurogenní močový měchýř farmakoterapie   etiologie   MeSH
• pilotní projekty MeSH
• poranění míchy komplikace   MeSH
• prospektivní studie MeSH
• spokojenost pacientů MeSH
• urodynamika fyziologie   MeSH
• urotel MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mladý dospělý MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• multicentrická studie MeSH
• randomizované kontrolované studie MeSH
• srovnávací studie MeSH
• Názvy látek
• botulotoxiny typ A MeSH
• nervosvalové látky MeSH

PURPOSE: Retrospective evaluation of conservative and surgical treatment of detrusor hyperactivity in patients with spinal dysraphisms having been observed in our clinic during the last 20 years. MATERIAL AND METHOD: In the period 1989/2009, 87 patients in the age between 0 and 35 years suffering from the above disease were monitored. The period was divided into three terms. Term I: 1989/1995, Term II: 1996/2005, Term III: 2006/2009. 28 patients were followed-up in the Term I, 58 patients in the Term II and 69 patients in the Term III. The applied types of therapy (conservative, surgical, mini-invasive methods) were specified within the mentioned patients' groups and substitution alterations were monitored. RESULTS: 54 patients were treated conservatively, 33 patients underwent an operation. During the Term I, 23 of the total 28 patients were treated conservatively, 5 (17.9%) patients were operated (3x ileocecal replacement, 2x ileocystoplasty). In Term II, 58 patients were treated, 23 (39.7%) thereof were operated (18x ileocystoplasty, 4x gastrocystoplasty, 1x sigmoideocystoplasty). In the Term III, 69 patients were followed-up and treated, 5 (7.2%) of them were operated (3x ileocystoplasty, 1x gastrocystoplasty, 1x sigmoideocystoplasty), and other 5 (7.2%) underwent a mini-invasive procedure by Botulinumtoxin A application.

• MeSH
• dítě MeSH
• dospělí MeSH
• kojenec MeSH
• lidé MeSH
• mladiství MeSH
• mladý dospělý MeSH
• neurogenní močový měchýř etiologie   chirurgie   terapie   MeSH
• předškolní dítě MeSH
• spina bifida komplikace   MeSH
• urologické chirurgické výkony metody   MeSH
• Check Tag
• dítě MeSH
• dospělí MeSH
• kojenec MeSH
• lidé MeSH
• mladiství MeSH
• mladý dospělý MeSH
• předškolní dítě MeSH
• Publikační typ
• anglický abstrakt MeSH
• časopisecké články MeSH