To introduce a micturition alert device dedicated to neurogenic bladders. Methods The design and mechanism of the micturition alert device were explained, the effectiveness was tested in a cranine experiment. Results The micturition alert device consisted of a permanent magnet sutured on the anterior bladder wall and a warning unit sutured on theinferior abdominal wall. The warning unit was assembled with a compass-l ike switch, a power supply, a buzzer and a power switch. Bladder volume determined the position of the magnet which determined the magnetic field at the point of the warning unit. The change of magnetic field was read by the warning unit. With increasing bladder volume from initial state to 200 mL in 8 dogs, the magnet moved cranially 32.8 mm averagely (from 31.3 mm to 34.1 mm) and the hand of warning unit turned 52° (from 47° to 57°). The value of the warning unit was correlated positively to the bladder volume (r =1.0, P lt; 0.01）. If the desired bladder volume was determined as 150 mL to activate the warning unit to alarm in advance, the fullness of bladder was 147.6 mL averagely from135 mL to 160 mL, with an error less than 15 mL (10%). Conclusion The micturition alert device including a warning unit and permanent magnet could monitor bladder volume continuously and alarm in time for the patients with loss of micturition desire. It is simple, easily-made, cheap and conveniently used. It is worth of further study.
Objective To study major influential factors of the micturition alert device dedicated to neurogenic bladders for the product design and cl inical appl ication of the device. Methods One ferrite permanent magnet with thickness and diameter of 3 mm and 10 mm, respectively, and three NdFeB permanent magnets with the thickness of 3 mm and diameter of 10, 15 and 20 mm, respectively, were used. The effects of thickness of the abdominal wall as well as the position and type of permanent magnets on the micturition alert device dedicated to neurogenic bladders were measured in vitro simulated test, when the abdominal wall was set to 2, 3, 4, 5, 6, 7, 8 and 9 cm, respectively, and the position of permanent magnets was 0, 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11 and 12 cm, respectively. The effect of the geomagnetic field on the device was measured under the condition that the thickness of the simulated abdominal wall was set to 2, 3, 4 and 5 cm, respectively,and the position of permanent magnets was 2, 3, 4, 5, 6, 7, 8, 9 and 10 cm, respectively. Results The value showed inthe warning unit was positively correlated with the position of the ferrite permanent magnet only when the thickness ofthe simulated abdominal wall was 2 cm (r=0.632, P lt; 0.05). The correlation between the value of the warning unit andthe position of NdFeB permanent magnets was significant (r gt; 0.622, P lt; 0.05), which was intensified with the increasingdiameter of NdFeB permanent magnets, but weakened with the increasing thickness of the simulated abdominal wall. The effect of the geomagnetic field was correlated with the exposition of the body, the position of the permanent magnet and the thickness of the abdominal wall. Conclusion The major influential factors of the micturition alert device dedicated to neurogenic bladder include the magnetism and location of the permanent magnet, the thickness of the abdominal wall and the geomagnetic field. These factors are correlated with and affect each other. Reasonable allocation of these factors may optimize the device.
Objective To investigate the biocompatibil ity of sil ica gel embedded permanent magnets of themicturition alert device dedicated to neurogenic bladder. Methods According to the national standards of biologicalevaluation of medical equipment (GB/T 16886), Shanghai Biomaterial Research and Test Center was confided to evaluate the biocompatibil ity of sil ica gel embedded permanent magnets both in vitro and in vivo, including cytotoxicity test, sensitization test, primary skin irritant test and acute general toxicity test. The cytotoxicity test was performed according to the agar diffusion method. The L929 cell discoloration index and cell lysis index were counted at 24 hours after the action of the specimen. The sensitization test was performed according to the maximal dose method. The skin response was evaluated in 30 male albino guinea-pigs at 24 and 48 hours after the routine induction and provocation of leaching l iquors of the specimen. The primary skin irritant test was evaluated in 2 male healthy New Zealand rabbits according to the local tissue response at 24, 48 and 72 hours after intradermal injection of leaching l iquors of the specimen. The acute general toxicity test was evaluated in 10 male Kumming mice musculus albus according to animal condition at 4, 24, 48 and 72 hours after injection of leaching l iquors of the specimen through the caudal vein. Both the general reaction of canines and the pathology of the local bladder walls were observed at 2, 4 and 8 weeks after a permanent magnet was fixed on the anterior wall of urinary bladder in three canines. Results No sensitization, no stimulation and no acute general toxicity were observed except sl ight cytotoxicity to sil ica gel embeddedpermanent magnets. After implantation of a permanent magnet, the canines showed excellent tolerace, which manifested as no abnormal ity in spirit, appetite, urine and stool, healed wounds and no infection. Adhesions occurred between the epiploon and the bladder wall around the permanent magnet in two canines at 2 and 4 weeks, and between the lower abdominal wall and the bladder wall around the permanent magnet in the other canine at 8 weeks. The local bladder wall below permanent magnet was thickened, the fibrous capsule around the permanent magnet was thin, but the bladder mucosa was normal. Inflammatory reaction such as congestion, edema and inflammatory cells lessened from the serosa layer to the mucosa layer microscopically. Conclusion Sil ica gel embedded permanent magnets used in the micturition alert device dedicated to neurogenic bladde has excellent biocompatibil ity and meet the criteria for cl inical appl ication．
ObjectiveTo investigate the effectiveness of ileal mucosal seromuscular patch for bladder expansion combined with rehabilitation training for treating neurogenic bladder dysfunction (NBD) with hyperreflexia. MethodsA retrospective study was performed on the clinical data of 61 patients with NBD and hyperreflexia who were treated and followed up between July 2008 and June 2013. There were 36 males and 25 females, aged 6-23 years (mean, 10 years). The reasons included meningomyelocele operation (43 patients), surgery for lipoma in lumbar vertebra (4 patients), operation of thoracolubar teratoma (2 patients), and lumbosacral spina bifida (12 patients). The results of urodynamics indicated that bladder volume decreased obviously and the residual urine increased. The voiding cystourethrography (VCUG) showed the vesicoureteral reflux (VUR), including 6 cases (10 sides) of grade V, 7 cases (12 sides) of grade IV, and 6 cases (8 sides) of grade III. The color doppler ultrosound showed mild hydronephrosis in 23 cases (41 sides), moderate hydronephrosis in 25 cases (42 sides), and severe hydronephrosis in 13 cases (22 sides). The blood biochemical examination suggested chronic renal failure (CRF) in 13 cases. The treatment included augmentation for bladder and rehabilitation training after operation. ResultsThe operation time was (157±26) minutes; the intraoperative blood loss was (43±15) mL, and no patient was given blood transfusion. The patients were followed up 1.5-6.0 years (mean, 4.5 years). Vesical fistula occurred in 4 cases, urinary infection in 5 cases, dysuresia in 2 cases, and cystolith in 1 case after operation. At 1 year after operation, the International Consultation on Incontinence Questionnaire-Urinary Incontience Short Form (CIQ-SF) score was significantly better than preoperative score (H=89.813, P=0.000). The urodynamic data showed that the difference value between observed and theoretical bladder volumes, bladder compliance, residual urine volume, maximum flow rate, and maximum storage detrusor pressure were significantly better than preoperative ones (P<0.05). And the color doppler ultrasound showed mild hydronephrosis in 34 cases (56 sides), moderate hydronephrosis in 18 cases (33 sides), and severe hydronephrosis in 9 cases (16 sides). VCUG showed that bladder volume obviously increased, no contracture was observed; and VUR was improved. And renal function was improved in 13 patients with CRF. ConclusionIleal mucosal seromuscular patch for bladder expansion combined with postoperative rehabilitation training has good effectiveness in treating NBD with hyperreflexia.
ObjectiveTo investigate the efficiency of double moxibustion combined with intermittent catheterization on urination diary in patients with neurogenic bladder (NB) after spinal cord injury (SCI).MethodsFrom August 2014 to August 2016, hospitalized patients with NB after SCI were reviewed retrospectively and classified into the moxibustion group and the routine group. The urination diary related indicators, International Urinary Incontinence Advisory Committee Urinary Incontinence Questionnaire Short Form (ICI-SQ-SF) score, and routine urine leucocyte count were collected.ResultsA total of 278 patients were enrolled in the study, in whom, the data of 96 were incomplete, and 26 got lost to follow-up. The routine group and the moxibustion group finally contained 70 and 86 respectively. There was no significant difference between the two groups in sex, age, average course of the disease, SCI segment or grading of injury (P>0.05). After 2 months treatment, the urine routine leucocyte count decreased to (5.72± 0.36)/μL in the routine group and (3.22±0.27)/μL in the moxibustion group, and the ICI-Q-SF score decreased to 8.61±0.45 in the routine group and 5.07±0.38 in the moxibustion group. The urine routine leucocyte count and ICI-Q-SF score were lower than those before treatment, and were lower in the moxibustion group than those in the routine group (P<0.05). In the 7th to 8th week, in the routine group, the average single urine volume was (300±70) mL, the interval between two micturition was (3.5±0.6) hours, the frequency of urinary incontinence was (3.3±0.4) times per week, and the average residual urine volume was (125±42) mL; in the moxibustion group, they were (326±78) mL, (3.8±1.1) hours, (2.3±0.3) times per week, and (103±37) mL, respectively. The indexes were not statistically significant different from those in the 1st to 2nd week (P>0.05), except the average single urine volume in the routine group and all the indexes in the moxibustion group (P<0.05). They were all better in the moxibustion group than those in the routine group (P<0.05).ConclusionThe treatment of moxibustion and intermittent catheterization may improve bladder function, reduce residual urine, reduce urinary incontinence and improve the quality of life for patients with NB after SCI.
ObjectiveTo discuss the effect of the whole-course management model of intermittent catheterization (IC) in patients with neurogenic bladder (NB).MethodsPatients with NB caused by incomplete spinal cord injury admitted to Department of Rehabilitation Medicine of West China Hospital of Sichuan University between May and October 2019 were selected. According to the random number table, the patients were randomly divided into the trial group and the control group. The control group adopted the traditional management mode of IC, and the trial group adopted the whole-course management mode of IC. The urination diary (single catheterization volume, residual urine volume, and times of urine leakage), bacteria count and leukocyte count in urine routine were compared between the two groups.ResultsFinally 80 patients were included, with 40 cases in each group. There was no significant difference in urination diary, bacteria count or leukocyte count in urine routine between the two groups (P>0.05). There was no significant difference between the two groups in urination diary in the second week of management (P>0.05). At the 12th week of management, there were statistically significant differences in urination diary between the two groups (P<0.05). The bacteria count and leukocyte count in the second and 12th week of the management in the trial group were lower than those in the control group (P<0.05).ConclusionsThe whole-course management of IC for patients with NB caused by incomplete spinal cord injury can effectively improve bladder volume, and reduce residual urine volume and times of urine leakage. It also can reduce the incidence of urinary tract infection, reduce urinary complications, and ultimately improve the quality of life of patients.
Objective To evaluate the effectiveness and safety of sacral neuromodulation (SNM) in the treatment of neurogenic bladder and bowel dysfunction in patients with spina bifida. Methods The clinical data of 33 patients with neurogenic bladder and bowel dysfunction caused by spina bifida treated with SNM between July 2012 and May 2021 were retrospectively analyzed. There were 19 males and 14 females, with an average age of 26.0 years (range, 18.5-36.5 years). The disease duration ranged from 12 to 456 months, with an average of 195.8 months. The types of spina bifida included 8 cases of occult spina bifida and 25 cases of meningocele/myelomeningocele. Clinical symptoms included 19 cases of urgency-frequent urination, 18 cases of urinary incontinence, 27 cases of chronic urinary retention, and 29 cases of bowel dysfunction. Image urodynamics showed that 4 patients had detrusor overactivity (DO) and 29 patients had detrusor underactivity (DU). Vesicoureteral reflux (VUR) was found in 5 ureters (4 patients). SNM procedure was divided into experiential treatment and permanent implantation. Patients who were evaluated as successful or willing to be permanently implanted after experiential treatment would implant the permanent pulse generator. ResultsThe duration of experiential treatment was 14-28 days, with an average of 19.2 days; there was no complication during this period, and the overall success rate was 69.69% (23/33). At the end of experiential treatment, the urination frequency in 24 hours, urine volume per time, urinary urgency score, and urine leakage of patients were significantly improved when compared with those before experiential treatment (P<0.05); there was no significant difference in postvoid residual volume between before and after experiential treatment (t=1.383, P=0.179). The success rate of patients with chronic urinary retention after experiential treatment (25.93%) was significantly lower than that of urgency-frequent urination (63.16%) and urinary incontinence (61.11%) (χ2=7.260, P=0.064). Compared with those before experiential treatment, the maximum cystometric capacity and compliance increased and the maximum detrusor pressure during filling decreased significantly (P<0.05). Among the 4 patients with DO before experiential treatment, DO disappeared in 2 cases; 27 patients with DU before experiential treatment did not recover the normal contraction of detrusor during micturition. Among the 5 ureters with VUR before experiential treatment, 2 VUR disappeared at the end of experiential treatment, and the VUR grade or the bladder volume before VUR of the other 3 ureters were improved. At the end of experiential treatment, the neurogenic bowel dysfunction (NBD) score and the grade of bowel dysfunction significantly improved (P<0.05). A total of 19 patients received permanent implantation, of which 11 patients needed to empty the bladder in combination with intermittent catheterization. ConclusionSNM is effective for neurogenic bladder and bowel dysfunction in patients with spina bifida. At the same time, it can significantly improve the urodynamic parameters during urine storage and avoid upper urinary tract damage.
ObjectiveTo systematically review the effect of clamping catheter and free drainage for patients with neurogenic bladder with indwelling catheter. MethodsThe PubMed, EMbase, CINAHL, EBSCO, Cochrane Library, CBM, CNKI, VIP and WanFang Data databases were electronically searched to collect randomized controlled trials (RCTs) related to the objects from inception to January 8, 2022. Two reviewers independently screened literature, extracted data and assessed the risk of bias of the included studies. Meta-analysis was then performed by using RevMan 5.3 software. ResultsA total of 7 RCTs involving 586 patients were included. Meta-analysis showed that clamping catheter significantly reduced time of first void (SMD=−1.03, 95%CI −1.71 to −0.36, P=0.03) and increased volume of first void (MD=52.72, 95%CI 28.84 to 76.59, P<0.01). However, there was no significant difference in residual urine volume, incidence of urinary retention or urinary tract infection between the two groups. ConclusionCurrent evidence shows that the advantage of clamping catheter for patients with neurogenic bladder with indwelling catheter is not obvious. Due to the limited quality and quantity of the included studies, more high quality studies are needed to verify the above conclusion.