Aims The working group initiated by the ICS Standardisation Steering Committee has updated the International Continence Society Standard "Good Urodynamic Practice" published in 2002. Methods On the basis of the manuscript: "ICS standard to develop evidence-based standards," a new ICS Standard was developed in the period from December 2013 to December 2015. In July, a draft was posted on the ICS website for membership comments and discussed at the ICS 2015 annual meeting. The input of ICS membership was included in the final draft before ICS approval and subsequent peer review (for this journal). Results This evidence-based ICS-GUP2016 has newly or more precisely defined more than 30 terms and provides standards for the practice, quality control, interpretation, and reporting of urodynamics; cystometry and pressure-flow analysis. Furthermore, the working group has included recommendations for pre-testing information and for patient information and preparation. On the basis of earlier ICS standardisations and updating according to available evidence, the practice of uroflowmetry, cystometry, and pressure-flow studies are further detailed. Conclusion ICS-GUP2016 updates and adds on to ICS-GUP2002 to improve urodynamic testing and reporting both for individual care and scientific purposes.

International Continence Society Good Urodynamic Practices and Terms 2016: Urodynamics, uroflowmetry, cystometry, and pressure‐flow study

Deficits in urologic function after spinal cord injury (SCI) manifest both as a failure to store and empty, greatly impacting daily life. While current management strategies are necessary for urological maintenance, they oftentimes are associated with life-long side effects. Our objective was to investigate the efficacy of spinal cord epidural stimulation (scES) as a promising therapy to improve bladder control after SCI. A bladder mapping study was undertaken for sixteen sessions over the course of four months in an individual with chronic, motor complete SCI. Varying combinations of stimulating cathode electrodes were initially tested during filling cystometry resulting in the identification of an effective configuration for reflexive bladder emptying at the caudal end of the electrode array. Subsequent systematic testing of different frequencies at a fixed stimulus intensity and pulse width yielded lowest post-void residual volumes at 30 Hz. These stimulation parameters were then tested in four additional research participants and found to also improve reflexive voiding efficiency. Taken together with SCI studies on step, stand, voluntary motor control and cardiovascular regulation, these findings further corroborate that scES has an all-encompassing potential to increase the central state of excitability, allowing for the control of multiple body functions, including the urological system.

/pdf/lumbosacral-spinal-cord-epidural-stimulation-improves-2fmnbm3kap.pdf

Lumbosacral spinal cord epidural stimulation improves voiding function after human spinal cord injury.

Aims To review the recommendations on basic urodynamic testing in the International Continence Society (ICS) standardization documents, specifying key recommendations for delivery and interpretation in clinical practice. Methods Fundamental expectations described in the ICS standards on good urodynamic practices, urodynamic equipment, and terminology for lower urinary tract (LUT) function were identified and summarized. Results The ICS standard urodynamic protocol includes clinical history, including symptom and bother score(s), examination, 3-day voiding chart/diary, representative uroflowmetry with post-void residual, and cystometry with pressure-flow study (PFS). Liquid filled catheters are connected to pressure transducers at the same vertical pressure as the patient's pubic symphysis, taking atmospheric pressure as the zero value. Urodynamic testing is done to answer specific therapy-driven questions for treatment selection; provocations are applied to give the best chance of reproducing the problem during the test. Quality of recording is monitored throughout, and remedial steps taken for any technical issues occurring during testing. Labels are applied during the test to document events, such as patient-reported sensation, provocation tests, and permission to void. After the test, the pressure and flow traces are scrutinized to ensure artefacts do not confound the findings. An ICS standard urodynamic report details the key aspects, reporting clinical observations, technical, and quality issues. Urodynamic services must maintain and calibrate equipment according to manufacturer stipulations. Conclusions The review provides a succinct summary of practice expectations for a urodynamic unit offering cystometry and pressure flow studies (PFS) to an appropriate standard.

https://onlinelibrary.wiley.com/doi/pdf/10.1002/nau.23773

Fundamentals of urodynamic practice, based on International Continence Society good urodynamic practices recommendations

Objective Locomotor training (LT) as a therapeutic intervention following spinal cord injury (SCI) is an effective rehabilitation strategy for improving motor outcomes, but its impact on non-locomotor functions is unknown. Given recent results of our labs' pre-clinical animal SCI LT studies and existing overlap of lumbosacral spinal circuitries controlling pelvic-visceral and locomotor functions, we addressed whether LT can improve bladder, bowel and sexual function in humans at chronic SCI time-points (> two years post-injury). Study design Prospective cohort study; pilot trial with small sample size. Methods Eight SCI research participants who were undergoing 80 daily one-hour sessions of LT on a treadmill using body-weight support, or one-hour of LT and stand training on alternate days, as part of another research study conducted at the Kentucky Spinal Cord Injury Research Center, University of Louisville, were enrolled in this pilot trial. Urodynamic assessments were performed and International Data Set questionnaire forms completed for bladder, bowel and sexual functions at pre-and post-training time points. Four usual care (non-trained; regular at-home routine) research participants were also enrolled in this study and had the same assessments collected twice, at least 3 months apart. Results Filling cystometry documented significant increases in bladder capacity, voiding efficiency and detrusor contraction time as well as significant decreases in voiding pressure post-training relative to baseline. Questionnaires revealed a decrease in the frequency of nocturia and urinary incontinence for several research participants as well as a significant decrease in time required for defecation and a significant increase in sexual desire post-training. No significant differences were found for usual care research participants. Conclusions These results suggest that an appropriate level of sensory information provided to the spinal cord, generated through task-specific stepping and/or loading, can positively benefit the neural circuitries controlling urogenital and bowel functions. Trial registration ClinicalTrials.gov NCT03036527.

/pdf/improvements-in-bladder-bowel-and-sexual-outcomes-following-36ld8ndy34.pdf

Improvements in bladder, bowel and sexual outcomes following task-specific locomotor training in human spinal cord injury

Objectives

To systematically review the long-term urological follow-up strategies for patients with neurogenic lower urinary tract dysfunction (NLUTD), focusing on three main groups of neurological diseases: (i) spinal cord injuries, (ii) spinal dysraphism, and (iii) multiple sclerosis.



Patients and Methods

Data acquisition comprised electronic search on the Medical Literature Analysis and Retrieval System Online (MEDLINE) database and the EMBASE database in August 2014 to retrieve English language studies. MEDLINE and EMBASE search included the following medical subject heading (MeSH) terms: (i) neurogenic bladder and (ii) neurogenic bladder dysfunction. Each of these terms was crossed with (i) long-term care and (ii) long-term surveillance. Only studies related to NLUTD and urological follow-up were included. Studies were also identified by hand search of reference lists and review articles.



Results

Initial records identified through database searching included 265 articles. In all, 23 articles were included in the quantitative synthesis. The proposed time schedule of investigations as well as the amount and type of investigation were different according to specific neurological lesions. They depend on the dysfunctional pattern of the lower urinary tract (LUT) and its risk profile. However, there is a lack of high-evidence level studies to support an optimal long-term follow-up protocol.



Conclusions

The goal of neuro-urological management is the best possible preservation of upper urinary tract (UUT) and LUT function in relation to the individual neurological disorder. Regular and risk adapted controls (‘urochecks’) allow detection of risk-factors in time before irreversible changes of the LUT and UUT have occurred. With risk- and patient-oriented lifelong regular urological care an optimised quality of life and life-expectancy can be achieved, although there is a complete lack of high-evidence level studies on this topic.

https://onlinelibrary.wiley.com/doi/pdf/10.1111/bju.13084

Follow-up of the neuro-urological patient: a systematic review.

These guidelines provide benchmarks for the performance of urodynamic equipment, and have been developed by the International Continence Society to assist purchasing decisions, design requirements, and performance checks. The guidelines suggest ranges of specification for uroflowmetry, volume, pressure, and EMG measurement, along with recommendations for user interfaces and performance tests. Factors affecting measurement relating to the different technologies used are also described. Summary tables of essential and desirable features are included for ease of reference. It is emphasized that these guidelines can only contribute to good urodynamics if equipment is used properly, in accordance with good practice.

International Continence Society guidelines on urodynamic equipment performance.

ENT-flexible endoscopes are an important tool for ear, nose and throat (ENT) professionals to examine the upper airway. Although image quality has improved significantly in the past decade, there is no generally accepted approach to measure this objectively. Sharpness, visual noise and color fidelity are aspects of image quality that can objectively be measured. The purpose of this study was to explore the relationship between these quality metrics and the subjective perception of image quality by ENT-professionals. The image quality of six different flexible endoscopes was assessed objectively and subjectively. Objective measurements were obtained using the Rez Checker Target Nano Matte and comprised sharpness (MTF50), visual noise and color fidelity (CIE &#x394;E 2000). Subjective image quality ranking was obtained by presenting images of a single larynx to 30 ENT-professionals in a forced pairwise comparison and asking them to select the image with the best image quality. Differences in image quality between endoscopes are reliably detected by objective measurement and subjective assessment. A strong positive correlation was found between sharpness and subjective ranking (p &lt; 0.005). Visual noise and color fidelity may be relevant, but did not correlate with the subjective assessment and were probably overshadowed by the strong correlation between sharpness and subjective ranking in the data. The authors found that number of pixels on screen to display the registered image differs per type of endoscope, however more pixels do not necessarily imply a sharper image. The authors will continue their investigation of image quality metrics and their relation to diagnostic accuracy which can provide feedback on design and manufacturing optimization to the industry. 

The Objective Measurement and Subjective Perception of Flexible ENT Endoscopes’ Image Quality

https://doi.org/10.1016/j.clinph.2022.08.009

Plasticity of visual evoked potentials in patients with neurofibromatosis type 1

http://www.valueinhealthjournal.com/article/S1098301522001425/pdf

Update on a Model to Minimize Population Health Loss in Times of Scarce Surgical Capacity During the COVID-19 Crisis and Beyond

Hypothesis / aims of study Elderly men generally develop Lower Urinary Tract Symptoms (LUTS), such as low flow rate and incomplete emptying of the bladder. Possible causes are a weakly contracting bladder or a bladder outlet obstruction. Invasive pressure-flow studies are necessary to differentiate between these causes. A potentially cheaper non-invasive method to diagnose bladder outlet obstruction is to record the sound at the perineum during voiding. Earlier studies in models and volunteers concluded that pressure variations at the urethral wall could be measured in the form of audible sound [1,2]. However, optimization of the measurement setup was required.

Geert Geleijnse

Papers

International Continence Society guidelines on urodynamic equipment performance.

The Objective Measurement and Subjective Perception of Flexible ENT Endoscopes’ Image Quality

Plasticity of visual evoked potentials in patients with neurofibromatosis type 1

Update on a Model to Minimize Population Health Loss in Times of Scarce Surgical Capacity During the COVID-19 Crisis and Beyond

A method for assessing the quality of perineal sound recorded during voiding to non-invasively diagnose bladder outlet obstruction.