Suprapontine Lesions and Neurogenic Pelvic Dysfunctions : Assessment, Treatment and Rehabilitation

"This book provides a detailed review of neurogenic pelvic dysfunctions following a suprapontine lesion, since a clear understanding of the pathogenesis of vesical and bowel dysfunctions has become increasingly important in medical education. It covers both urinary incontinence and retention, constipation and faecal incontinence resulting from ischemic, haemorrhagic and traumatic brain injury and Parkinson's disease. It also offers a concise yet comprehensive summary of the neurologic examination of the pelvis: all chapters include the most up-to-date scientific and clinical information with the relevant level of clinical evidence. The book is divided into three sections, which integrate basic science with clinical medicine. The first section features a general introduction and essential background into micturition and bowel neural control, focusing on cortical control. Section 2 is devoted to common clinical problems regarding the neurologic assessment of the perineum, while the last section summarises urological and bowel dysfunction in suprapontine lesions. Providing a clear, concise and informative introduction to urology, it is a practical guide for professionals, medical students and residents in Physical Medicine and Rehabilitation, Urology and Neurology." -- prové de l'editor Foreword 6 Preface 7 Contents 9 1: The Bladder, the Rectum and the Sphincters: Neural Pathways and Peripheral Control 11 1.1 Introduction 11 1.2 The Bladder Function 12 1.2.1 Spinal Cord Afferents 13 1.2.2 Spinal Cord Efferents 16 1.2.3 The Periaqueductal Grey and the Pontine Micturition Centre 17 1.2.4 The Cortical Control 19 1.3 The Bowel Function 20 References 23 2: Reflex Testing and Pelvic Examination 32 2.1 The Somatic Component 32 2.2 The Sympathetic and Parasympathetic Components 34 2.2.1 Clinical Evaluation of Reflexes 35 2.2.1.1 Surface or Exteroceptive Reflexes (Polysynaptic Reflexes) 35 2.2.2 Abdominal Reflexes 35 2.2.2.1 “Deep” Abdominal Reflexes 36 2.2.3 The Cremasteric Reflex (in the Male) 36 2.2.4 The Anocutaneous Reflex, Anal Wink, Anal Reflex, Perineal Reflex 37 2.2.5 Clitoral-Anal Reflex/Bulbocavernosus Reflex 38 2.2.6 Guarding Reflex 38 2.3 Reflex Alterations and Clinical Pictures 39 References 39 3: Investigation of the Central Nervous System in Neurogenic Pelvic Dysfunctions by Imaging 43 3.1 Introduction 43 3.2 What Do We Know About Methodology? 44 3.3 What Do We Know About the Central Control of Micturition in Healthy Subjects? 45 3.3.1 Systematizing the Knowledge About Brain and Bladder 45 3.3.2 Structures Involved in the Central Control of the Bladder: The Storage Phase and the Voiding Phase 47 3.3.2.1 Brainstem 48 3.3.2.2 Thalamus 49 3.3.2.3 Cerebellum 49 3.3.2.4 Insula and ACC 49 3.3.2.5 PFC 49 3.4 What Do We Know About Pathologies? An Example: Multiple Sclerosis (MS) 50 References 50 4: Urodynamic Patterns and Prevalence of N-LUTDs in Suprapontine Lesions 52 4.1 Introduction 52 4.2 Cerebrovascular Accident (Stroke) 53 4.3 Parkinsonian Syndrome 53 4.3.1 Parkinson’s Disease (PD) 53 4.3.2 Multiple System Atrophy (MSA) 54 4.4 Dementia 55 4.5 Brain Tumors 55 4.6 Cerebral Palsy 56 4.7 Head Injury 56 4.8 Conclusion 57 References 57 5: Suprapontine Lesions and Neurogenic Pelvic Dysfunctions 60 5.1 Cerebrovascular Accidents (CVAs) 60 5.2 Traumatic Brain Injury 62 5.3 Normal-Pressure Hydrocephalus 62 5.4 Cerebral Palsy 63 5.5 Brain Tumour (BT) 63 5.6 Parkinsonian Syndrome 63 5.6.1 Parkinson’s Disease 63 5.6.2 Multiple System Atrophy 64 5.7 Unresponsive Wakefulness Syndrome 64 References 65 6: Management of the Central Nervous System Chronic Pelvic Pain 68 6.1 Neuroimaging 69 6.2 Patient Assessment: Symptoms and Signs in Chronic Pelvic Pain 69 6.3 Treatment 70 6.3.1 First-Line Agents 70 6.3.1.1 Antidepressants 70 6.3.1.2 Membrane Stabilizers/Anticonvulsants 71 6.3.2 Second-Line Agents 71 6.3.2.1 Opioids 71 6.3.2.2 Tramadol 72 6.3.3 Third-Line Agents 72 6.3.3.1 Cannabinoids 72 6.3.4 Fourth-Line Agents 72 6.3.4.1 Antipsychotics 72 6.3.4.2 Other Anticonvulsant Agents 73 6.3.5 Emerging Therapies 73 6.3.5.1 Toxins 73 6.3.6 Combination Therapies 73 6.3.6.1 Palmitoylethanolamide 73 References 74 7: Management of Bowel Dysfunction in Patients with Central Nervous System Diseases 77 7.1 Introduction 77 7.2 Objectives of Intestinal Rehabilitation in the Person with CNS Lesions 78 7.3 Tools for Assessment and Monitoring of Bowel Dysfunction 79 7.4 Care Devices 80 7.5 “Step-by-Step” Approach to Bowel Management in the Person with CNS Lesions 82 7.5.1 First Step 83 7.5.2 Second Step 83 7.5.3 Third Step: Adoption of TAI with “Positive-Pressure” Devices 83 References 84 8: Management of the Suprapontine Neurogenic Lower Urinary Tract Dysfunction 87 8.1 Pharmacotherapy 87 8.2 Antimuscarinics 88 8.3 Mirabegron 89 8.4 Cannabinoid Agonists 89 8.5 Botulinum Toxin 89 8.6 Percutaneous and Transcutaneous Tibial Nerve Stimulation 90 8.7 Bladder Catheterism 94 8.8 Frequency of Catheterisation 95 8.9 Recommendations 96 8.10 Patients and Caregivers 96 References 96 9: Pelvic Floor Muscle Training and Neurogenic Overactive Bladder in Stroke and Multiple Sclerosis 99 9.1 Introduction 99 9.2 Methods 100 9.3 Results 100 9.3.1 Stroke 108 9.3.2 MS 108 9.4 Discussion 108 References 110 10: Sexual Dysfunction in Suprapontine Lesions 112 10.1 Sexual Function and the Nervous System 112 10.2 Change in Sexual Function with Aging 113 10.3 Evaluation of Patients with Sexual Dysfunction and Neurologic Disorders 113 10.4 Sexual Dysfunction in Patients with Suprapontine Lesions 113 10.4.1 Head and Brain Injuries 113 10.4.2 Hypothalamopituitary Disorders 114 10.4.3 Cerebrovascular Disease 114 10.4.4 Parkinsonism and Basal Ganglia Disorders 114 10.4.5 Multiple Sclerosis 115 10.4.6 Epilepsy 115 10.5 Treatment of Sexual Dysfunction 116 10.5.1 Treatment of Neurogenic Erectile Dysfunction 116 10.5.2 Intracavernous Injection Therapy with Vasoactive Drugs 117 10.5.3 Other Treatment Options 118 10.5.4 Premature Ejaculation 118 10.5.5 Treatment in Women with Sexual Dysfunction 118 10.5.6 Treatment of Hypersexuality 118 10.6 Concluding Comments 119 References 119 Front Matter ....Pages i-x The Bladder, the Rectum and the Sphincters: Neural Pathways and Peripheral Control (Gianfranco Lamberti, Antonella Biroli)....Pages 1-21 Reflex Testing and Pelvic Examination (Donatella Giraudo, Francesco Verderosa)....Pages 23-33 Investigation of the Central Nervous System in Neurogenic Pelvic Dysfunctions by Imaging (Achim Herms, Alida M. R. Di Gangi Herms)....Pages 35-43 Urodynamic Patterns and Prevalence of N-LUTDs in Suprapontine Lesions (Eugenia Fragalà)....Pages 45-52 Suprapontine Lesions and Neurogenic Pelvic Dysfunctions (Julien Renard, Eugenia Fragalà, Gianfranco Lamberti, Federica Petraglia, Francesco Verderosa, Anna Cassio et al.)....Pages 53-60 Management of the Central Nervous System Chronic Pelvic Pain (Marilena Gubbiotti, Antonella Giannantoni)....Pages 61-69 Management of Bowel Dysfunction in Patients with Central Nervous System Diseases (Gabriele Bazzocchi, Mimosa Balloni, Erica Poletti, Roberta Manara, Paola Mongardi, Marica Vicchi et al.)....Pages 71-80 Management of the Suprapontine Neurogenic Lower Urinary Tract Dysfunction (Gaetano De Rienzo, Gianfranco Lamberti, Luisa De Palma, Donatella Giraudo, Elena Bertolucci, Giuseppina Gibertini et al.)....Pages 81-92 Pelvic Floor Muscle Training and Neurogenic Overactive Bladder in Stroke and Multiple Sclerosis (Kari Bø)....Pages 93-105 Sexual Dysfunction in Suprapontine Lesions (David B. Vodušek)....Pages 107-114