Urodynamics, Neurourology and Pelvic Floor Dysfunctions

Gianfranco LambertiDonatella GiraudoStefania Musco Editors

Suprapontine Lesions and Neurogenic Pelvic DysfunctionsAssessment, Treatment and Rehabilitation

Urodynamics, Neurourology and Pelvic Floor Dysfunctions

Series Editor

Marco SoligoObstetrics and Gynecology DepartmentBuzzi Hospital - University of MilanMilan, Italy

The aim of the book series is to highlight new knowledge on physiopathology, diagnosis and treatment in the fields of pelvic floor dysfunctions, incontinence and neurourology for specialists (urologists, gynecologists, neurologists, pediatricians, physiatrists), nurses, physiotherapists and institutions such as universities and hospitals.

More information about this series at http://www.springer.com/series/13503

Gianfranco Lamberti • Donatella Giraudo Stefania MuscoEditors

Suprapontine Lesions and Neurogenic Pelvic DysfunctionsAssessment, Treatment and Rehabilitation

EditorsGianfranco LambertiNeurorehabilitation Unit and Pelvic Floor Dysfunction Rehabilitation CenterSS Trinità HospitalCuneoItaly

Stefania MuscoDepartment of NeurourologyCareggi University HospitalFlorenceItaly

Donatella GiraudoUrology DepartmentSan Raffaele HospitalMilanoItaly

ISSN 2510-4047 ISSN 2510-4055 (electronic)Urodynamics, Neurourology and Pelvic Floor DysfunctionsISBN 978-3-030-29774-9 ISBN 978-3-030-29775-6 (eBook)https://doi.org/10.1007/978-3-030-29775-6

© Springer Nature Switzerland AG 2020This work is subject to copyright. All rights are reserved by the Publisher, whether the whole or part of the material is concerned, specifically the rights of translation, reprinting, reuse of illustrations, recitation, broadcasting, reproduction on microfilms or in any other physical way, and transmission or information storage and retrieval, electronic adaptation, computer software, or by similar or dissimilar methodology now known or hereafter developed.The use of general descriptive names, registered names, trademarks, service marks, etc. in this publication does not imply, even in the absence of a specific statement, that such names are exempt from the relevant protective laws and regulations and therefore free for general use.The publisher, the authors, and the editors are safe to assume that the advice and information in this book are believed to be true and accurate at the date of publication. Neither the publisher nor the authors or the editors give a warranty, express or implied, with respect to the material contained herein or for any errors or omissions that may have been made. The publisher remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

This Springer imprint is published by the registered company Springer Nature Switzerland AGThe registered company address is: Gewerbestrasse 11, 6330 Cham, Switzerland

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Foreword

Since 2015, Springer has published five volumes on functional pelvic floor hot top-ics under the auspices of the Italian Society of Urodynamics (SIUD). Our volumes always try to portray at best functional aspects in different clinical settings: oncol-ogy, male urology, genital prolapse, paediatrics, giving original and innovative per-spectives in different backgrounds in an eclectic way.

The present volume fulfils our mission, looking at neurogenic pelvic floor dys-functions from an original and, at the present time, still poorly investigated point of view: the suprapontine lesions. Since recent years, neurourologists have been focus-ing mainly on spinal cord lesions, developing high-level expertise in their under-standing and management. More recently, also driven by the changing epidemiology of neurological disorders with an impact on pelvic floor functions, suprapontine lesions are increasingly becoming a matter of study. This book will offer an in-depth look on this topic from a multidisciplinary and multi-professional perspective, wid-ening the scenario of potentially interested readers, spanning from neurourologists and clinicians devoted to urodynamics, to those operating in stroke units, including all the rehabilitation professional figures who will find an updated understanding of the set of problems many of their patients are involved with. The international fac-ulty further guarantees an appealing experience with this book.

In the major interest of our patients, we do hope this volume will pique your interest.

Prof. Marco Soligo Adjunct Professor in Urogynecology - University of Milan

President of the Italian Society of Urodynamics (SIUD)Milan, Italy

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Preface

If we wanted to choose an area of rehabilitation, the field in which we can find the most multicultural and interprofessional evolution, this could be indeed the rehabili-tation of perineal and pelvic dysfunctions. Despite that, few are known about the role of pelvic rehabilitation in some specific neurological populations who poten-tially benefit on that. The purpose of this book is to provide a general introduction to the knowledge of pelvic disorders in people affected by suprapontine lesion. The book is addressed to professionals who are dealing with these types of illnesses for the first time as well as to those who are already experts and want to extend their knowledge and interests in this field.

The book takes its cue from the literature and gives more in-depth insights on the diagnosis and treatment of neurogenic urinary and bowel dysfunctions considering also the evolution of the functional imaging techniques in the last decades which has helped us to better understand the physiopathological differences and peculiarities of this subtype of neurological patients having suprapontine lesions and secondary pelvic dysfunctions. The interdisciplinary and multidisciplinary fields of actions involving doctors and health professionals (often with profoundly different back-grounds) are often still uncharted, but surely, it should tend towards an increasingly holistic view, in which overall components cannot be dissociable from the context. Furthermore, the relationships and networks between damage, brain function, blad-der and intestinal behaviour are still poorly understood. Thus, the management of pelvic floor dysfunctions in such complex patients is a harder challenge to face compared to non-neurological or even in spinal cord-injured patients.

We hope that this book can open up ways of communication among different professionals by making this topic more accessible, often inexplicably confined (concerning the epidemiological impact and quality of life), to few specialized centres.

In order to make the material more friendly, we have tried to easily explain the various subtopics to be understandable even by professionals who are not specialists in neurourology. We hope we have succeeded in giving a reasonably exhaustive view of this area of its extensive and complex investigations and treatments, in such a way as to involve professionals of other specialties (e.g. rehabilitation, internal medicine, neurology) who often are involved in these pathologies.

After a general introduction on the neurophysiopathology of suprapontine lesions, the book is divided into chapters, each one concerning a specific subtopic

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including the diagnosis and treatment of the various pelvic dysfunctions among the different types of neurological suprapontine lesions. The influence of the clinical experience in the daily management of these problems is evident in the development and writing of the authors’ contributions.

The main epidemiological aspects, always in relation to the patient with a supra-pontine lesion, clinical evaluation of the perineum and the main reflexes, functional imaging of the central nervous system, urodynamic investigation and chronic pelvic pain are then taken into consideration. Particular attention has been paid to the reha-bilitative aspects of bowel dysfunctions, often neglected in these neurological sub-populations compared to spinal cord injury patients. Again, also, two interesting but still poorly addressed arguments have been taken into account, namely, pelvic floor muscle training and sexual dysfunctions. The various chapters necessary for educa-tional purposes are actually to be understood as inseparable moments of a unitary and continuous process.

The writing of this book would not have been possible without the tolerance and goodwill of many of our colleagues to whom we extend our gratitude. Finally, we are very grateful to our many patients who, despite the personal tragedy of brain damage, have made the development of our observations possible.

Milano, Italy Donatella Giraudo Florence, Italy Stefania Musco Piacenza, Italy Gianfranco Lamberti

Preface

ix

Contents

1 The Bladder, the Rectum and the Sphincters: Neural Pathways and Peripheral Control . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1Gianfranco Lamberti and Antonella Biroli

2 Reflex Testing and Pelvic Examination . . . . . . . . . . . . . . . . . . . . . . . . . . 23Donatella Giraudo and Francesco Verderosa

3 Investigation of the Central Nervous System in Neurogenic Pelvic Dysfunctions by Imaging . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35Achim Herms and Alida M. R. Di Gangi Herms

4 Urodynamic Patterns and Prevalence of N-LUTDs in Suprapontine Lesions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 45Eugenia Fragalà

5 Suprapontine Lesions and Neurogenic Pelvic Dysfunctions . . . . . . . . . 53Julien Renard, Eugenia Fragalà, Gianfranco Lamberti, Federica Petraglia, Francesco Verderosa, Anna Cassio, and Giovanni Panariello

6 Management of the Central Nervous System Chronic Pelvic Pain . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 61Marilena Gubbiotti and Antonella Giannantoni

7 Management of Bowel Dysfunction in Patients with Central Nervous System Diseases . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 71Gabriele Bazzocchi, Mimosa Balloni, Erica Poletti, Roberta Manara, Paola Mongardi, Marica Vicchi, Eugenia Fragalà, Elena Demertzis, Antonella Manzan, and Humberto Cerrel Bazo

8 Management of the Suprapontine Neurogenic Lower Urinary Tract Dysfunction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 81Gaetano De Rienzo, Gianfranco Lamberti, Luisa De Palma, Donatella Giraudo, Elena Bertolucci, Giuseppina Gibertini, Caterina Gruosso, and Roberta Robol

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9 Pelvic Floor Muscle Training and Neurogenic Overactive Bladder in Stroke and Multiple Sclerosis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 93Kari Bø

10 Sexual Dysfunction in Suprapontine Lesions . . . . . . . . . . . . . . . . . . . . . 107David B. Vodušek

Contents

1© Springer Nature Switzerland AG 2020G. Lamberti et al. (eds.), Suprapontine Lesions and Neurogenic Pelvic Dysfunctions, Urodynamics, Neurourology and Pelvic Floor Dysfunctions, https://doi.org/10.1007/978-3-030-29775-6_1

G. Lamberti (*) Neurorehabilitation Unit and Pelvic Floor Dysfunction Rehabilitation Center, SS Trinità Hospital, Cuneo, Italy

A. Biroli Neurological and Autonomic Dysfunction Rehabilitation Unit, S.G. Bosco Hospital, Turin, Italy

1The Bladder, the Rectum and the Sphincters: Neural Pathways and Peripheral Control

Gianfranco Lamberti and Antonella Biroli

1.1 Introduction

Despite the fundamental contribution given by functional imaging in recent years, to date, the relationships between the different pathways in coordinating the alternation between the bladder-filling phase and the emptying phase have not yet been clarified nor, above all, which area should be considered as the “final decision maker” for activating micturition. The periaqueductal grey (PAG) and the pontine micturition centre (PMC) (Fig. 1.1), under physiological conditions with mutual influence, under the voluntary control of the prefrontal cortex (PFC) (Fig. 1.2), control the function. These three areas, in turn influenced by various afferents, coordinate the synchroni-sation between recruitment and inhibition of smooth and striated muscles [1–6] which regulate the behaviour of the bladder (the system’s reservoir), the bladder neck and the urethra. The neural control is peripherally guaranteed by the parasympathetic sacral nerve (pelvic nerves), by the sympathetic thoracic lumbar nerve (hypogastric nerves) and by the sacral somatic nerve [pudendal nerve] [7, 8].

The importance of bladder control in controlling the homeostasis of the organism is guaranteed by the regular emptying of the bladder itself, which must be both safe and appropriate.

Processing the sensation of the bladder filling up is a cognitive element for main-taining equilibrium [9–11] which must determine finalised behaviours and conse-quent coherent motor activities [12].

The progression of the feeling of fullness begins with nerve signals whose fre-quency, intensity and unpleasantness increase proportionally to the bladder filling,

2

until the individual is obliged to urinate: the fullness cannot be maintained indefi-nitely and at some point the bladder must be emptied.

1.2 The Bladder Function

The filling and the emptying phase:Urodynamic tests record the perception of the fullness level: the “first filling

sensation” in healthy subjects (a sensation that is often not precisely perceptible, which often one does not pay attention to) occurs at about 40% of the total capacity of the detrusor; the International Continence Society (ICS) defines the “first desire to urinate as the sensation during a flow cystometry, which would lead the patient to urinate at the first opportune moment, although with the possibility of postponing further the emptying” [13] and usually refers to approximately 60% of the total

CC

HY

INF

3

FNX

DLF

PAG

1PBN

2

SOL

Fig. 1.1 Cerebral and brainstem nuclei and pathways related to micturition and defecation. Abbreviations: CC Corpus callosum, FNX Fornix, HY Hypothalamus, DLF Fasciculus longitudinalis dorsalis, PAG Periaqueductal grey, PBN Parabrachial nucleus, SOL Nucleus solitarius. 1 = Pontine micturition centre (PMC). 2 = Kölliker-Fuse nucleus. 3 = Pontine continence centre (PCC)

Dorsal anteriorcingulate cortex

Amygdala

Orbitofrontalprefrontal

cortex

Ventromedialprefrontal

cortexHippocampus Dorsolateral

prefrontalcortex

Fig. 1.2 Hippocampus, amygdala, subregions of prefrontal cortex and dorsal anterior cingulate cortex, cerebral areas associated with the control of the temporal and spatial appropriateness of social continence

G. Lamberti and A. Biroli