Physical therapy in patients with neurogenic bladder dysfunction

Lorenzo-Gómez M1, Padilla-Fernández B2, Julia R3, Hernández-Sánchez T1, Márquez-Sánchez M4, García-Cenador M3, Rodríguez-Martín M1, García-Sánchez M1, Castro-Díaz D2

Research Type

Clinical

Abstract Category

Neurourology

Abstract 374
E-Poster 2
Scientific Open Discussion ePoster Session 18
Thursday 5th September 2019
13:05 - 13:10 (ePoster Station 9)
Exhibition Hall
Retrospective Study Conservative Treatment Neuropathies: Central Neuropathies: Peripheral Physiotherapy
1.Complejo Asistencial Universitario de Salamanca, 2.Hospital Universitario de Canarias, 3.Universidad de Salamanca, 4.IBSAL (Instituto de Investigación Biosanitaria de Salamanca)
Presenter
B

Bárbara Padilla-Fernández

Links

Abstract

Hypothesis / aims of study
Neurourological patients should follow multimodal treatments, and several specialties are involved in the correct management of their bladder dysfunction when present.
The aim of this original study is to show physical therapy's results in a sample of patients with neurogenic bladder.
Study design, materials and methods
Retrospective study of 1073 patients treated with physical therapy in a single centre in Spain from January 2005 to January 2019. In this sample, 153 patients were diagnosed with neurogenic bladder. 
According to the response to treatment, patients were divided in three groups: 
•	Group A: patients with a great improvement after treatment;
•	Group B: patients with a mild-moderate improvement after treatment; 
•	Group C: patients with no improvement after physical therapy. 
Variables investigated: age, secondary diagnoses, physical examination, complementary studies, neurogenic bladder dysfunction's ethiology, average follow-up, ICIQ-SF and SF-36 questionnaires' scores at three and six months, and yearly thereafter.
Descriptive statistics were performed.
Results
Gender: 130 women (84.96%) and 23 men (15.03%). Average age was 64.05 years (range 9-89), without statistical differences between groups. 
Table 1 shows the neurological disorders leading to bladder dysfunction and the response to treatment. The biggest groups were DM type II an disc herniation.
Table 2 shows the results depending on the type of therapy given to the patients. Pelvic floor muscle training with Biofeedback (BFB) + electromyography with surface electrodes was offered to the mayority of the patients alone or in association with Posterior tibial nerve stimulation (PTNS),
Interpretation of results
In the physical therapy unit of a single centre, 14% of patients with pelvic floor dysfunction had a primary diagnosis of neurogenic bladder. Given the reduced number of patients in most groups, it was not possible to perform inferential statistics. However, most patients showed an improvement after the different modalities of physical therapy. Pelvic floor muscle training with biofeedback is usually associated with the strengthening of pelvic floor muscles to prevent urine leakage, but they also suppress urgency, help to relax the muscle to improve bladder emptying and relieve pelvic pain caused by muscle spasm. Only studies with a small number of patients have shown a possible effect of pelvic floor muscle training in neurourological patients. Multicentre studies could give more light to the role of pelvic floor muscle training with biofeedback in this population.
Concluding message
Adjuvant physical therapy is beneficial regarding lower urinary tract symptoms in 94.96% of the patients studied (54.90% with a great improvement and 30.06% with moderate improvement) irrespective to the ethiology.
Pelvic floor muscle training with Biofeedback (BFB) + electromyography with surface electrodes without stimulation with or without Posterior tibial nerve stimulation (PTNS), were the most effective treatment modalities.
Figure 1 Table 1
Figure 2 Table 2
Disclosures
<span class="text-strong">Funding</span> None <span class="text-strong">Clinical Trial</span> No <span class="text-strong">Subjects</span> Human <span class="text-strong">Ethics Committee</span> IRB of the Complejo Asistencial Universitario de Salamanca <span class="text-strong">Helsinki</span> Yes <span class="text-strong">Informed Consent</span> Yes