Collette Haslam

Bio: Collette Haslam is an academic researcher from UCL Institute of Neurology. The author has contributed to research in topics: Overactive bladder & Percutaneous tibial nerve stimulation. The author has an hindex of 8, co-authored 21 publications receiving 224 citations. Previous affiliations of Collette Haslam include University College London.

Ensuring patient adherence to clean intermittent self-catheterization

Abstract: Patient performance of clean intermittent self-catheterization is a crucial component of the management of incomplete bladder emptying, which can arise from a variety of conditions. This allows patients to have more control over their bladder emptying, and avoids the inconveniences that come with an indwelling urethral catheter. There are, however, barriers that patients face when performing this task which may ultimately limit adherence. In this article, these barriers are discussed in more detail with potential solutions to counter them.

Urinary tract infections in multiple sclerosis.

Abstract: Background:Urinary tract infections (UTIs) are commonly reported by people with multiple sclerosis (PwMS) and significantly impact quality of life.Objective:To provide an overview of the problem of UTIs in PwMS and offer a practical approach for the diagnosis and management.Methods:A review of the literature through a Pubmed search up to October 2015 was performed using the following keywords: multiple sclerosis, neurogenic bladder, urinary tract infections, relapse, dipsticks, culture, recurrent and prevention.Results:Noteworthy topics include the definition of a confirmed symptomatic UTI as a positive urine culture defined by >105 colony-forming units (CFU)/mL or >104 CFU/mL if a urethral catheter urine sample is taken, or any count of bacteria in a suprapubic bladder puncture specimen, both in addition to symptoms including fever, pain, changes in lower urinary tract symptoms or neurological status. Urinalysis is useful to exclude a UTI; however, on its own is insufficient to confirm a UTI, for which u...

Open label feasibility study evaluating D-mannose combined with home-based monitoring of suspected urinary tract infections in patients with multiple sclerosis.

Abstract: Objective To assess the feasibility of using D-mannose, a natural food supplement, in patients with multiple sclerosis (MS) reporting recurrent urinary tract infections (UTIs) as a preventative. Methods A single-center, open-label, feasibility study enrolled patients with MS, using and not using urinary catheters, experiencing recurrent UTIs (≥3/year or ≥2/6 months). Participants were given D-mannose powder 1.5 grams twice daily for 16-weeks and were instructed to monitor suspected UTIs at home using urine dipsticks. Diaries were used to record compliance, number of prescriptions of antibiotics received for UTIs, results of urine dipsticks and cultures. Results Overall, 22 patients with MS, median age 50 years (46–59) were enrolled: 10 were not using catheters and 12 were using catheters. The compliance rates for using D-mannose and dipsticks for testing suspected UTIs were 100% and 90.2%, respectively. Sixty-one episodes of suspected UTIs were recorded, 19/61 (31.1%) were confirmed UTIs and 29/61 (47.5%) prescriptions of antibiotics were made. The number of monthly proven UTIs decreased both in catheter users and non-users (P < 0.01). No adverse effects were reported. Conclusion Using D-mannose in patients with MS experiencing recurrent UTIs and self-monitoring for infections is feasible and safe. Further studies are required to establish efficacy. CinicalTrials.gov (identifier NCT02490046).

Identifying barriers to help-seeking for sexual dysfunction in multiple sclerosis

Abstract: Sexual dysfunction (SD) is common in multiple sclerosis (MS), however, under-reported. The aim of this study was to identify barriers faced by patients with MS and healthcare professionals (HCPs) in discussing SD. This was a two-part prospective study carried out at a tertiary care centre. Patients with MS were surveyed using a 29-item questionnaire and SD was assessed using the MSISQ and ASEX questionnaires; depression screened with PHQ-2. HCPs were surveyed using a 23-item questionnaire. Seventy four patients (mean age 42.4 ± 10.7, 54 females) and 98 HCPs (mean age 45.8 ± 8.9, 90 females) participated. SD was significant, with primary (36.4%), secondary (27%) and tertiary (29.8%) contributory factors. Commonest barriers reported by patients were dominance of neurological symptoms (N = 30, 40.5%), presence of family or friends (N = 28, 37.8%), and not being asked (N = 25, 33.8%), while HCPs reported presence of family or friends (N = 34, 34.7%), lack of knowledge about SD (N = 30, 30.6%), and inadequate time during the consultation (N = 27, 27.6%). Barriers to discussing SD are similar between patients and HCPs. The most common barriers are addressable through modifications in the clinic environment, raising awareness and providing training opportunities.

Open-label study evaluating outpatient urethral sphincter injections of onabotulinumtoxinA to treat women with urinary retention due to a primary disorder of sphincter relaxation (Fowler's syndrome).

Abstract: Objectives To assess the efficacy (defined as improvements in maximum urinary flow rate [Qmax] of ≥50%, post-void residual urine volume [PVR] and scores on the International Prostate Symptom Score [IPSS] questionnaire) and safety of urethral sphincter injections of onabotulinumtoxinA in women with a primary disorder of urethral sphincter relaxation, characterised by an elevated urethral pressure profile (UPP) and specific findings at urethral sphincter electromyography (EMG), i.e. Fowler's syndrome. Patients and Methods In this open-label pilot Institutional Review Board-approved study, 10 women with a primary disorder of urethral sphincter relaxation (elevated UPP, sphincter volume, and abnormal EMG) presenting with obstructed voiding (five) or in complete urinary retention (five) were recruited from a single tertiary referral centre. Baseline symptoms were assessed using the IPSS, and Qmax and PVR were measured. After 2% lidocaine injection, 100 U of onabotulinumtoxinA was injected into the striated urethral sphincter, divided on either side, under EMG guidance. Patients were reviewed at 1, 4 and 10 weeks after injection, and assessed using the IPSS, Qmax and PVR measurements. The UPP was repeated at week 4. Results The mean (range) patient age was 40 (25–65) years, and the mean symptom scores on the IPSS improved from 25.6 to 14.1, and the mean ‘bother’ score reduced from 6.1 to 3.5 at week 10. As compared with a baseline mean Qmax of 8.12 mL/s in the women who could void, the Qmax improved to 15.8 mL/s at week 10. Four of the five women in complete retention could void spontaneously, with a mean Qmax of 14.3 mL/s at week 10. The mean PVR decreased from 260 to 89 mL and the mean static UPP improved from 113 cmH2O at baseline to 90 cmH2O. No serious side-effects were reported. Three women with a history of recurrent urinary tract infections developed a urinary tract infection. There were no reports of stress urinary incontinence. Seven of the 10 women opted to return for repeat injections. Conclusions This pilot study shows an improvement in patient-reported lower urinary tract symptoms, and the objective parameters of Qmax, PVR and UPP, at 10 weeks after urethral sphincter injections of onabotulinumtoxinA. No serious side-effects were reported. This treatment could represent a safe outpatient treatment for young women in retention due to a primary disorder of urethral sphincter relaxation. However, a larger study is required to confirm the findings of this pilot study.

Adult conservative management

Abstract: was included in the ICI 5 edition PFMT (24) vs PFMT + resistance device (28) 52 Women with SUI or MUI (stress predominant) PFMT: As below without device PFMT +resistance; 5 quick and 5 slow (sustained), high-intensity contractions daily. Advised to hold contractions as long as possible, relaxing their PFM for an equivalent time before repeating the process. Intravaginal resistance: instructions to use the Pelvic-Toner Device concurrently whilst exercising. Two clinic visits and one phone call Reported cure (based on the Q11 of the ICIQFluts) PFMT 0/13 PFMT+resistance 1/15 Non-sign. difference btw groups (p=0.429) Improvement (post-Tx) PFMT 10/19 PFMT+resistance 11/21 Non-sign. difference btw groups 16 weeks of treatment, outcomes assessed at post-Tx and at 6 month follow-up Dropouts (at 6 month) PFMT 9/24 PFMT + resistance 15/28

Lower urinary tract dysfunction in the neurological patient: clinical assessment and management

Abstract: Lower urinary tract (LUT) dysfunction is a common sequela of neurological disease, resulting in symptoms that have a pronounced effect on quality of life. The site and nature of the neurological lesion affect the pattern of dysfunction. The risk of developing upper urinary tract damage and renal failure is much lower in patients with slowly progressive non-traumatic neurological disorders than in those with spinal cord injury or spina bifida; this difference in morbidity is taken into account in the development of appropriate management algorithms. Clinical assessment might include tests such as uroflowmetry, post-void residual volume measurement, renal ultrasound, (video-)urodynamics, neurophysiology, and urethrocystoscopy, depending on the indication. Incomplete bladder emptying is most often managed by intermittent catheterisation, and storage dysfunction by antimuscarinic drugs. Intradetrusor injections of onabotulinumtoxinA have transformed the management of neurogenic detrusor overactivity. Neuromodulation offers promise for managing both storage and voiding dysfunction. An individualised, patient-tailored approach is required for the management of LUT dysfunction associated with neurological disorders.

Nonantibiotic prevention and management of recurrent urinary tract infection

Abstract: Urinary tract infections (UTIs) are highly prevalent, lead to considerable patient morbidity, incur large financial costs to health-care systems and are one of the most common reasons for antibiotic use worldwide. The growing problem of antimicrobial resistance means that the search for nonantibiotic alternatives for the treatment and prevention of UTI is of critical importance. Potential nonantibiotic measures and treatments for UTIs include behavioural changes, dietary supplementation (such as Chinese herbal medicines and cranberry products), NSAIDs, probiotics, D-mannose, methenamine hippurate, estrogens, intravesical glycosaminoglycans, immunostimulants, vaccines and inoculation with less-pathogenic bacteria. Some of the results of trials of these approaches are promising; however, high-level evidence is required before firm recommendations for their use can be made. A combination of these agents might provide the optimal treatment to reduce recurrent UTI, and trials in specific population groups are required.

Management of neurogenic bladder in patients with multiple sclerosis

Abstract: Lower urinary tract (LUT) dysfunction is common in patients with multiple sclerosis and is a major negative influence on the quality of life of these patients. The most commonly reported symptoms are those of the storage phase, of which detrusor overactivity is the most frequently reported urodynamic abnormality. The clinical evaluation of patients' LUT symptoms should include a bladder diary, uroflowmetry followed by measurement of post-void residual urine volume, urinalysis, ultrasonography, assessment of renal function, quality-of-life assessments and sometimes urodynamic investigations and/or cystoscopy. The management of these patients requires a multidisciplinary approach. Intermittent self-catheterization is the preferred option for management of incomplete bladder emptying and urinary retention. Antimuscarinics are the first-line treatment for patients with storage symptoms. If antimuscarinics are ineffective, or poorly tolerated, a range of other approaches, such as intradetrusor botulinum toxin A injections, tibial nerve stimulation and sacral neuromodulation are available, with varying levels of evidence in patients with multiple sclerosis. Surgical procedures should be performed only after careful selection of patients. Stress urinary incontinence owing to sphincter deficiency remains a therapeutic challenge, and is only managed surgically if conservative measures have failed. Multiple sclerosis has a progressive course, therefore, patients' LUT symptoms require regular, long-term follow-up monitoring.

Organization of the neural switching circuitry underlying reflex micturition.

Abstract: The functions of the lower urinary tract to store and periodically eliminate urine are regulated by a complex neural control system in the brain and spinal cord that coordinates the activity of the bladder and urethral outlet. Experimental studies in animals indicate that urine storage is modulated by reflex mechanisms in the spinal cord, whereas voiding is mediated by a spinobulbospinal pathway passing through a coordination centre in the rostral brain stem. Many of the neural circuits controlling micturition exhibit switch-like patterns of activity that turn on and off in an all-or-none manner. This study summarizes the anatomy and physiology of the spinal and supraspinal micturition switching circuitry and describes a computer model of these circuits that mimics the switching functions of the bladder and urethra at the onset of micturition.