Browsing by Subject "neurogenic bladder"

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    Long Term Sequela of Pediatric Bladder Reconstruction
    (Springer, 2015-12) Roth, Joshua; Keenan, Alison; Cain, Mark; Whittam, Benjamin; Department of Urology, IU School of Medicine
    Children with refractory neurogenic bladder (NGB) who have failed maximal medical management are presented with options for bladder reconstruction. It is critical to understand the long-term sequela of bladder augmentation and bladder neck reconstruction to properly counsel families regarding these procedures. Benefits may include preservation of renal function, continence, reduced risk of renal-related mortality, and potential improvements in quality of life (QOL). However, these advantages must be balanced with the risks of bladder calculi, perforation, need for additional surgery, acid/base disturbances, vitamin B12 deficiency, and malignancy. Therefore, careful patient selection and preoperative counseling are paramount for those undergoing bladder reconstruction which includes intestinal bladder augmentation, as these patients require lifelong vigilant follow-up.
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    Transitioning Young Adults with Neurogenic Bladder – Are We Asking Too Much?
    (Elsevier, 2019) Roth, Joshua D.; Szymanski, Konrad M.; Ferguson, Ethan J.; Cain, Mark P.; Misseri, Rosalia; Pediatrics, School of Medicine
    Introduction Significant numbers of young adults with chronic health conditions fail to transition. Objective We aimed to evaluate how ready urologic patients who have transitioned were actually prepared for that process. Due to the cognitive impairments frequently seen with spina bifida (SB), we hypothesize that these individuals will be less prepared to transition medical care to adult providers compared to their healthy counterparts. Methods Participants included consecutive patients in the transitional SB clinic at our institution and controls (college student without obvious physical disability or interest in healthcare related fields aged 18-25). Both groups were administered the Transition Readiness Assessment Questionnaire (TRAQ) over a nine-month period. Five TRAQ domains assess 20 skills necessary to transition. Likert scale responses range from 1 “No, I do not know how” to 5 “Yes, I always do this when I need to” (which we considered appropriate for transitioned patients). Demographics and the number of daily medications taken were collected. Patients and healthy controls were compared using 1) total and domain TRAQ scores, 2) the proportion of non-transitioned skills (“1”) and 3) fully transitioned skills (“5”). Non-parametric statistics were used. Results 43 unique SB patients (30.8% shunted, 46.5% female) and 100 controls were enrolled. SB patients were older than controls (21 vs 20 years, p<0.001). There was no gender difference between groups (p=0.33). Transitioned patients and college students were fully transitioned only in the “Talking with Providers” domain ( Figure ). College students performed significantly better than patients in the domains of “Appointment Keeping” (p=0.04) and “Tracking Health Issues” (p=0.02). Transitioned patients were less likely to be interested in learning how to perform skills in the domains of “Appointment Keeping” and “Tracking Health Issues” (p<0.001 for both domains). Discussion We describe the transition readiness of young adults with SB compared to healthy controls and other youths with chronic health conditions. Limitations include the small sample size, potentially limiting generalizability, as well as cross-sectional nature. Conclusion “Transitioned” patients with SB had lower TRAQ scores in some domains compared to healthy college students, who themselves had scores indicating that they were not fully ready for transition. Increased attention to transition readiness in people with SB is necessary, as even healthy young adults struggle with these tasks and are poorly prepared for transition.
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    Urinary Biomarkers Under Investigation for Overactive Bladder Syndrome
    (Springer, 2015-12) Guirguis, Nayera; Heit, Michael; Department of Obstetrics and Gynecology, IU School of Medicine
    Overactive bladder (OAB) is a symptom syndrome of urinary urgency, frequency, nocturia, and urge incontinence suggestive of lower urinary tract dysfunction. Detrusor overactivity (DO) during urodynamic testing may be the cause of symptoms in 54–70 % of OAB study participants. The identification of urinary biomarkers is warranted due to the high false negative rate of urodynamic testing results for the diagnosis of DO and for the evaluation of treatment response in study participants with OAB symptoms. We reviewed the published literature on urinary biomarkers under investigation for OAB with Pub Med up to June 2015 using search keywords that included “overactive bladder,” “nerve growth factor (NGF),” “brain-derived nerve growth factor (BDNF),” “prostaglandins,” “cytokines,” and “CRP.” Current evidence suggests that NGF and BDNF appear to be most promising candidates for urinary biomarkers for the diagnosis and the evaluation treatment response.