Chris Chapple, ICS Member and Neurourology & Urodynamics Editor in Chief, looks back at the publications from 2015. What has been published? What have people done differently? How can this year’s learning change research and practice?
Chris selected the most topical papers to review but also highlighted other noteworthy papers. The 5 topics that Chris selected were:
- Abdominal leak point pressures- how effective are these?
- Can we improve conservative management?
- What is the role of synthetic tapes?
- Neural reconstruction of LUT
Abdominal leak point pressures:
Chris reviewed 'Leak point pressures: how useful are they? by Abrams et al' which is an up to date review on the topic. It questions whether we know what bladder capacity we should be looking at? What size catheter to use? Or a baseline for measurement. It is difficult to pin point leakage pressure-standardised urodynamics required but there is no consensus on how to look at leak point pressure and it has limited uses. Chris stated the need to identify new ways of predicting urethral function.
This is an important topic for the ICS as we recognise that physiotherapy is an effective technique for reducing SUI. Chris selected Kari Bo’s ‘Does it work in the long term? A systematic review on pelvic floor muscle training for female stress incontinence’ to review and noted that in experienced hands you can get long term results but it depends on the practice and time with patients. Physiotherapy is effective but requires patient motivation and standardisation of electrical stimulation guidelines.
OAB was an ICS concept that was heavily criticised due to the fact it is a nonspecific symptom and not a condition, but its importance increases with the age of the patient. There are a range of techniques that can be used e.g. PTNS but these are poorly researched with limited long term results. This was assessed in ‘The management of overactive bladder: percutaneous tibial nerve stimulation, sacral nerve stimulation, or botulinium toxin? by Tubaro et al'. They concluded they are 3rd line therapies of OAB/DO, further research is needed to identify candidates for the different third-line treatments of OAB/IDO. PTNS need to look into parameters for long term efficacy and long term data for OAB.
This is a hot topic due to the medical legal aspect of tapes and slings. Chris highlights the lack of long term data on the use of slings, mini-slings and tapes, as discussed in 'Midterm prospective evaluation of TVT-secur reveals high failure rate by Cornu et al’. Within a year of introduction the high failure rate was highlighted and the use withdrawn in places like France. Chris highlights that we need to take an effective look at how to manage complications. Many studies have limited numbers of patients and no adequate reporting in literature, within next the 18 months in European we will need mandatory database’s to track this data.
This is another area that has received a lot of interest. If you look at definitions like ‘The underactive bladder: A new Clinical concept?’ by Chapple et al, this talks about retrospective analysis of UAB and asking which questions you should ask. And whether you can define UAB symptomatically? Chris stated it may be that you can’t, as UAB symptom complex is based on an urodynamic process of detrusor underactivity, which can only be shown urodynamically. There is a committee in the ICS currently looking into this which will come up with deliberations in the not too distant future for an option.
Chris outlined that we are all aware of the complexities of neural structure and the difficulties of neural reconstruction of the LUT in neural injury. In the past Brindley stimulators were used to stimulate spinal cord injury patients but in the latest review ‘Neural reconstruction methods of restoring bladder function by Gomez-Amaya et al' neurosurgeons have been trying out many different approaches, in animal models, to reconnect tissues by re-joining the nerves. There have been some limited successful results which may come into clinical practice. However Chris explained that we will need to look into different approaches for spinal cord injury patients in the future. One area that has had some benefits in humans has been to use innovation of the skin, to produce a sensitive area of the skin, that you can stimulate help bladder emptying. But the literature on this is mixed and a longer term study is required.
To watch the full lecture by Chris please click here.
To download all documents referenced in the lecture please click here.