collette haslam - Academia.edu (original) (raw)

Papers by collette haslam

Research paper thumbnail of The International Continence Society (ICS) survey on intermittent catheterization and global practices with regard to the reuse of catheters

Research paper thumbnail of Open label pilot study of urethral injections of Botulinum toxin to treat women in urinary retention due to a primary disorder of urethral sphincter relaxation (Fowler’s syndrome)

Neurourology and Urodynamics, 2013

Research paper thumbnail of Percutaneous tibial nerve stimulation for the management of the idiopathic and neurogenic overactive bladder: A safe and effective treatment

Neurourology and Urodynamics, 2014

Study design, materials and methods This is a prospective evaluation over 18 months of patients w... more Study design, materials and methods This is a prospective evaluation over 18 months of patients who found first line treatments intolerable or ineffective. PTNS treatment was administered in a weekly course of 30minute stimulations, using UrgentPC, from Uroplasty, for a total of 12 weeks. Symptoms were objectively assessed using the ICIQOAB and ICIQLUTS-QoL questionnaires and bladder diaries at baseline and after 12 weeks of treatment. Patients opting to continue treatment after 12 weeks returned for top-up session.

Research paper thumbnail of PO242 Factors influencing adherence to tibial nerve stimulation for the management of neurogenic overactive bladder

Journal of Neurology, Neurosurgery, and Psychiatry, 2017

Introduction Bladder dysfunction is common following neurological disease and Percutaneous Tibial... more Introduction Bladder dysfunction is common following neurological disease and Percutaneous Tibial Nerve Stimulation (PTNS) is an established minimally-invasive outpatient treatment for managing neurogenic overactive bladder symptoms (OAB). Following a 10–12 week treatment (once-weekly), responders return for top-up treatments (top-ups) when OAB recurs. This study aims to evaluate factors influencing patients’s decision to return for top-ups. Methods Patients with neurogenic OAB attending 12 week PTNS were prospectively evaluated using standardised bladder questionnaires (ICIQ-OAB, ICIQ-LUTSqol), three-day bladder diary and satisfaction questionnaire. Responders to PTNS were invited to return for top-ups and divided into returning for top-ups (group-1) and not returning (group-2). PTNS service evaluation questionnaire (PTNS-SEQ) retrospectively enquired about treatment effects, side-effects, and procedural/logistical difficulties. Results 73 patients completed PTNS-SEQ (non-responder...

Research paper thumbnail of What are the barriers faced in discussing Multiple sclerosis-related sexual dysfunction during clinic?

Neurourology and Urodynamics, 2017

Hypothesis / aims of study Sexual dysfunction (SD) in multiple sclerosis (MS) varies between 50-9... more Hypothesis / aims of study Sexual dysfunction (SD) in multiple sclerosis (MS) varies between 50-90% in men and 40-80% in women, and manifests as erectile dysfunction/ reduced vaginal lubrication, impaired genital sensations, difficulties in ejaculation and achieving orgasms and reduced libido. Despite having an immense impact on quality of life, sexual dysfunction is often under-reported. Previous studies in non-neurological patients have suggested that the clinic setting poses several challenges to discussing SD (1), however these have never been systematically evaluated in neurological disease. The aim of this study was to identify barriers faced by MS patients and their health care professionals (HCPs) in discussing SD during clinic.

Research paper thumbnail of A systematic revIew of sexual problems in women with multiple sclerosis: patterns of dysfunction and management options

Neurourology and Urodynamics, 2018

Research paper thumbnail of Urinary catheter management: what neurologists need to know

Practical Neurology, 2021

Patients with neurological disorders often have lower urinary tract dysfunction, manifesting as u... more Patients with neurological disorders often have lower urinary tract dysfunction, manifesting as urinary retention or urinary incontinence, and so commonly use catheters. Neurologists should therefore be aware of the different types of catheters and appliances and their risks, benefits and complications. Clean intermittent self-catheterisation is preferable to an indwelling catheter; however, if this is not possible, then a suprapubic indwelling catheter is preferable to a urethral catheter for long-term management. We review the decision-making process when selecting catheters for neurological patients, the evidence base regarding the different options and how neurologists can recognise and address complications. We also discuss alternatives to catheterisation, such as non-invasive containment products and surgical treatments, and the indications for urological referral.

Research paper thumbnail of Use of a symptom-based questionnaire to screen for the presence of significant voiding dysfunction in patients with multiple sclerosis and lower urinary tract symptoms: a pilot study

Journal of Neurology, 2020

Introduction Lower urinary tract dysfunction is common in people with multiple sclerosis, leading... more Introduction Lower urinary tract dysfunction is common in people with multiple sclerosis, leading to overactive bladder symptoms, voiding difficulties or a combination. First-line medications for overactive bladder symptoms are effective. Current guidelines recommend measuring post-void residual volume (PVR) before commencing these treatments, as they can potentially exacerbate voiding difficulties in those with significant underlying voiding dysfunction (pre-treatment PVR > 100 ml). However, facilities to do so are not readily available to all clinicians, potentially delaying effective therapy. Aims To conduct a pilot study investigating the association between lower urinary tract symptoms and PVR volume in people with multiple sclerosis using a validated questionnaire and to determine if questionnaire scores can be used to exclude a significantly elevated (> 100 ml) PVR volume. Methods Patients with multiple sclerosis referred to a tertiary hospital uro-neurology service com...

Research paper thumbnail of Factors influencing adherence to Tibial Nerve Stimulation for the management of neurogenic overactive bladder

Research paper thumbnail of A practical approach to assessing and managing sexual dysfunction in multiple sclerosis

Practical Neurology, 2019

Sexual dysfunction is common in both men and women with multiple sclerosis but is often under-rep... more Sexual dysfunction is common in both men and women with multiple sclerosis but is often under-reported and undertreated. Neurologists report that a major barrier to discussing sexual dysfunction with patients is their lack of knowledge. Here we review the common presentations of sexual dysfunction, discuss its causes in people with multiple sclerosis, and provide a practical approach for neurologists to assess and manage these problems.

Research paper thumbnail of Systematic review of the prevalence, symptomatology and management options of sexual dysfunction in women with multiple sclerosis

Neurourology and Urodynamics, 2019

Sexual dysfunction (SD) is highly prevalent in women with multiple sclerosis (MS), however little... more Sexual dysfunction (SD) is highly prevalent in women with multiple sclerosis (MS), however little is known about treatment options. The aim of this paper is to review the prevalence, symptomatology, and management options of sexual dysfunction in women with MS.

Research paper thumbnail of Outcomes following percutaneous tibial nerve stimulation (PTNS) treatment for neurogenic and idiopathic overactive bladder

Clinical Autonomic Research, 2018

Research paper thumbnail of Factors influencing return for maintenance treatment with percutaneous tibial nerve stimulation for the management of the overactive bladder

BJU International, 2018

To identify factors influencing return for maintenance Percutaneous tibial nerve stimulation (PTN... more To identify factors influencing return for maintenance Percutaneous tibial nerve stimulation (PTNS) treatment after successful completion of a 12-week course of treatment for the overactive bladder (OAB). Patients and Methods: Patients with OAB symptoms referred for PTNS treatment underwent twelve sessions of weekly PTNS treatment and evaluated at baseline and week 12 using the International Consultation on Incontinence Questionnaire on OAB (ICIQ-OAB), lower urinary tract symptoms related quality of life questionnaire (ICIQ-LUT symptoms QOL) and bladder diary (BD). Responders to treatment, evaluated using two patient-reported outcome measurements, were invited to return for maintenance treatments when symptoms returned. A PTNS Service Evaluation Questionnaire (PTNS-SEQ) was used to evaluate factors influencing return for maintenance treatment. Results: 79 patients were evaluated (mean age 58.9 (14.7), female 72.6%) and clustered into three groups-group 1 (n=28) did not respond to 12 weekly sessions of PTNS treatment; group 2 (n=28) responded to treatment but did not return for maintenance treatment and group 3 (n=31) responded to treatment and returned for maintenance treatment. There were no significant differences in demographic characteristics, diagnosis, baseline symptom scores and BD parameters between the three groups. Patients belonging to groups 2 and 3 experienced a significant improvement from baseline to week 12 in total OAB scores (group 2:-1.54  1.85; group 3:-1.85  2.28, p<0.05). However, patients returning for maintenance treatment reported significant improvements specifically in nocturia (BD difference =-0.4  0.7, p<0.05 and ICIQ-LUT symptoms QOL difference-0.48  0.94, p<0.05), and perceived benefits of the treatment on their OAB symptoms compared to those not returning for maintenance treatment (difference between the two groups = 25.6%, p=0.030). Improvements in nocturia and perceived benefits predicted return for maintenance treatment through a logistic regression analysis. Factors related to the need for attending repeat clinic visits such as transportation, distance and time commitment were not found to differ between the two groups. Conclusions: Twelve-session weekly PTNS is a safe and effective treatment for OAB. Responders to treatment returning for maintenance PTNS more often reported significant improvements in nocturia and perceived benefits over time, compared to those not returning for maintenance treatment. The bladder diary provides a more objective assessment of treatment outcome following PTNS treatment.

Research paper thumbnail of D-Mannose to Prevent Urinary Tract Infections in Multiple Sclerosis

Journal of Neurology, Neurosurgery & Psychiatry, 2016

Introduction Urinary tract infections (UTIs) are a significant problem in Multiple sclerosis (MS)... more Introduction Urinary tract infections (UTIs) are a significant problem in Multiple sclerosis (MS). D-mannose is a natural supplement shown recently to prevent UTIs, however benefits in multiple sclerosis (MS) are unknown. Objective To evaluate feasibility of using D-Mannose in MS patients reporting recurrent UTIs. Methods In this prospective single-centre, open-label study, participants were given D-mannose (Nature upplies Ltd, UK) 1.5 grams twice daily for 16-weeks and compliance recorded. Training was provided for recognising UTIs and self-monitoring using urine reagent-strip dipsticks. Results of dipsticks and cultures when UTIs were suspected, and antibiotic prescriptions, were recorded. Results Median compliance of 22 patients (18 females; median age 50 years (46–59), (group 1 not using catheters (n=10); group 2 catheter-users (n=12)) using D-Mannose was 100%; no adverse events were reported. In total, there were 61 episodes of suspected UTIs and 29 prescriptions for antibiotics. In group 1, median number of prescriptions was 1 (0–2.2) and culture-proven symptomatic UTIs 0.5 (0–1) and in group 2, 2 (0–3) prescriptions and 1 (0–2) culture-proven UTIs. Number of monthly UTIs significantly decreased in both groups (p<0.01). Conclusion The use of D-mannose in MS patients reporting recurrent UTIs is associated with a reduction in the number of UTIs and antibiotic prescriptions, without safety concerns. Larger studies are required to confirm efficacy.

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

Neurourology and urodynamics, Jan 4, 2016

To assess the feasibility of using D-mannose, a natural food supplement, in patients with multipl... more 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. 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. 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%) pr...

Research paper thumbnail of Urinary tract infections in multiple sclerosis

Multiple Sclerosis Journal, 2016

Background:Urinary tract infections (UTIs) are commonly reported by people with multiple sclerosi... more 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 >105colony-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 t...

Research paper thumbnail of The Possible Role of Opiates in Women with Urinary Retention-Observations from a Prospective Clinical Study

In Neurourology and Urodynamics Wiley Liss, 2009

Research paper thumbnail of Bladder Function In Neurological Patients

Research paper thumbnail of Barriers in Clinic to Discussing Sexual Dysfunction Due to Multiple Sclerosis

Journal of Neurology, Neurosurgery & Psychiatry, 2015

BackgroundSexual dysfunction is underdiagnosed in patients with multiple sclerosis (pwMS). Little... more BackgroundSexual dysfunction is underdiagnosed in patients with multiple sclerosis (pwMS). Little is known about barriers faced by patients and health care professionals (HCPs) in discussing sexual problems.Patients and methods74 PwMS (20 male, 54 female (mean age 45,877±8,823 years)) and 99 HCPs (8 male, 91 female; 82 (83%) nurses) completed questionnaires evaluating barriers to discussing sexual problems in clinic and sexual dysfunction (MSISQ-15 and ASEX), specifically developed for this study.ResultsSymptoms that interfere most with sexual activity are: Takes too long to orgasm (69.11%), bladder symptoms (66.17%), less intense orgasm (66.17%), lack of sexual interest (60.29%), genital numbness (50%). Most common barriers cited by patients include the prominence of other MS symptoms (43.5%), presence of family/friends in consultation room (41.8%), not being asked (37.3%). HCPs identified presence of family/friends in consultation room (57.6% agree), faced lack of knowledge (48.4%...

Research paper thumbnail of Single Centre Randomised Pilot Study of Two Regimens (30 Mins Daily or 30 Mins Weekly for 12 Weeks) of Transcutaneous Tibial Nerve Stimulation Using a Novel Device for Treating Multiple Sclerosis-Related Overactive Bladder Symptoms

Journal of Neurology, Neurosurgery & Psychiatry, 2015

IntroductionPercutaneous tibial nerve stimulation (PTNS) is effective for managing multiple scler... more IntroductionPercutaneous tibial nerve stimulation (PTNS) is effective for managing multiple sclerosis (MS)-related overactive bladder (OAB) symptoms. However the need for weekly clinic visits restricts its use. The purpose of this study was to evaluate safety and efficacy of a novel, self-applying device for managing OAB symptoms.Study design, materials and methods48 patients reporting OAB (MS n=24, idiopathic n=24), were randomized (1:1) to either daily or weekly treatments for 12 weeks with geko™, a novel device stimulating the tibial nerve transcutaneously. Efficacy was assessed using validated questionnaires (ICIQ-OAB, ICIQLUTS-QoL) and bladder diaries filled at weeks 4, 8, and 12. Urinary neurotrophins (Nerve growth factor (NGF) and Brain derived neurotrophic factor) were measured.Results34 patients (MS n=19) completed the study. 18 patients responded to treatment (53%); 72% of responders belonged to the MS cohort. Multilevel regression analysis suggested significant improvemen...

Research paper thumbnail of The International Continence Society (ICS) survey on intermittent catheterization and global practices with regard to the reuse of catheters

Research paper thumbnail of Open label pilot study of urethral injections of Botulinum toxin to treat women in urinary retention due to a primary disorder of urethral sphincter relaxation (Fowler’s syndrome)

Neurourology and Urodynamics, 2013

Research paper thumbnail of Percutaneous tibial nerve stimulation for the management of the idiopathic and neurogenic overactive bladder: A safe and effective treatment

Neurourology and Urodynamics, 2014

Study design, materials and methods This is a prospective evaluation over 18 months of patients w... more Study design, materials and methods This is a prospective evaluation over 18 months of patients who found first line treatments intolerable or ineffective. PTNS treatment was administered in a weekly course of 30minute stimulations, using UrgentPC, from Uroplasty, for a total of 12 weeks. Symptoms were objectively assessed using the ICIQOAB and ICIQLUTS-QoL questionnaires and bladder diaries at baseline and after 12 weeks of treatment. Patients opting to continue treatment after 12 weeks returned for top-up session.

Research paper thumbnail of PO242 Factors influencing adherence to tibial nerve stimulation for the management of neurogenic overactive bladder

Journal of Neurology, Neurosurgery, and Psychiatry, 2017

Introduction Bladder dysfunction is common following neurological disease and Percutaneous Tibial... more Introduction Bladder dysfunction is common following neurological disease and Percutaneous Tibial Nerve Stimulation (PTNS) is an established minimally-invasive outpatient treatment for managing neurogenic overactive bladder symptoms (OAB). Following a 10–12 week treatment (once-weekly), responders return for top-up treatments (top-ups) when OAB recurs. This study aims to evaluate factors influencing patients’s decision to return for top-ups. Methods Patients with neurogenic OAB attending 12 week PTNS were prospectively evaluated using standardised bladder questionnaires (ICIQ-OAB, ICIQ-LUTSqol), three-day bladder diary and satisfaction questionnaire. Responders to PTNS were invited to return for top-ups and divided into returning for top-ups (group-1) and not returning (group-2). PTNS service evaluation questionnaire (PTNS-SEQ) retrospectively enquired about treatment effects, side-effects, and procedural/logistical difficulties. Results 73 patients completed PTNS-SEQ (non-responder...

Research paper thumbnail of What are the barriers faced in discussing Multiple sclerosis-related sexual dysfunction during clinic?

Neurourology and Urodynamics, 2017

Hypothesis / aims of study Sexual dysfunction (SD) in multiple sclerosis (MS) varies between 50-9... more Hypothesis / aims of study Sexual dysfunction (SD) in multiple sclerosis (MS) varies between 50-90% in men and 40-80% in women, and manifests as erectile dysfunction/ reduced vaginal lubrication, impaired genital sensations, difficulties in ejaculation and achieving orgasms and reduced libido. Despite having an immense impact on quality of life, sexual dysfunction is often under-reported. Previous studies in non-neurological patients have suggested that the clinic setting poses several challenges to discussing SD (1), however these have never been systematically evaluated in neurological disease. The aim of this study was to identify barriers faced by MS patients and their health care professionals (HCPs) in discussing SD during clinic.

Research paper thumbnail of A systematic revIew of sexual problems in women with multiple sclerosis: patterns of dysfunction and management options

Neurourology and Urodynamics, 2018

Research paper thumbnail of Urinary catheter management: what neurologists need to know

Practical Neurology, 2021

Patients with neurological disorders often have lower urinary tract dysfunction, manifesting as u... more Patients with neurological disorders often have lower urinary tract dysfunction, manifesting as urinary retention or urinary incontinence, and so commonly use catheters. Neurologists should therefore be aware of the different types of catheters and appliances and their risks, benefits and complications. Clean intermittent self-catheterisation is preferable to an indwelling catheter; however, if this is not possible, then a suprapubic indwelling catheter is preferable to a urethral catheter for long-term management. We review the decision-making process when selecting catheters for neurological patients, the evidence base regarding the different options and how neurologists can recognise and address complications. We also discuss alternatives to catheterisation, such as non-invasive containment products and surgical treatments, and the indications for urological referral.

Research paper thumbnail of Use of a symptom-based questionnaire to screen for the presence of significant voiding dysfunction in patients with multiple sclerosis and lower urinary tract symptoms: a pilot study

Journal of Neurology, 2020

Introduction Lower urinary tract dysfunction is common in people with multiple sclerosis, leading... more Introduction Lower urinary tract dysfunction is common in people with multiple sclerosis, leading to overactive bladder symptoms, voiding difficulties or a combination. First-line medications for overactive bladder symptoms are effective. Current guidelines recommend measuring post-void residual volume (PVR) before commencing these treatments, as they can potentially exacerbate voiding difficulties in those with significant underlying voiding dysfunction (pre-treatment PVR > 100 ml). However, facilities to do so are not readily available to all clinicians, potentially delaying effective therapy. Aims To conduct a pilot study investigating the association between lower urinary tract symptoms and PVR volume in people with multiple sclerosis using a validated questionnaire and to determine if questionnaire scores can be used to exclude a significantly elevated (> 100 ml) PVR volume. Methods Patients with multiple sclerosis referred to a tertiary hospital uro-neurology service com...

Research paper thumbnail of Factors influencing adherence to Tibial Nerve Stimulation for the management of neurogenic overactive bladder

Research paper thumbnail of A practical approach to assessing and managing sexual dysfunction in multiple sclerosis

Practical Neurology, 2019

Sexual dysfunction is common in both men and women with multiple sclerosis but is often under-rep... more Sexual dysfunction is common in both men and women with multiple sclerosis but is often under-reported and undertreated. Neurologists report that a major barrier to discussing sexual dysfunction with patients is their lack of knowledge. Here we review the common presentations of sexual dysfunction, discuss its causes in people with multiple sclerosis, and provide a practical approach for neurologists to assess and manage these problems.

Research paper thumbnail of Systematic review of the prevalence, symptomatology and management options of sexual dysfunction in women with multiple sclerosis

Neurourology and Urodynamics, 2019

Sexual dysfunction (SD) is highly prevalent in women with multiple sclerosis (MS), however little... more Sexual dysfunction (SD) is highly prevalent in women with multiple sclerosis (MS), however little is known about treatment options. The aim of this paper is to review the prevalence, symptomatology, and management options of sexual dysfunction in women with MS.

Research paper thumbnail of Outcomes following percutaneous tibial nerve stimulation (PTNS) treatment for neurogenic and idiopathic overactive bladder

Clinical Autonomic Research, 2018

Research paper thumbnail of Factors influencing return for maintenance treatment with percutaneous tibial nerve stimulation for the management of the overactive bladder

BJU International, 2018

To identify factors influencing return for maintenance Percutaneous tibial nerve stimulation (PTN... more To identify factors influencing return for maintenance Percutaneous tibial nerve stimulation (PTNS) treatment after successful completion of a 12-week course of treatment for the overactive bladder (OAB). Patients and Methods: Patients with OAB symptoms referred for PTNS treatment underwent twelve sessions of weekly PTNS treatment and evaluated at baseline and week 12 using the International Consultation on Incontinence Questionnaire on OAB (ICIQ-OAB), lower urinary tract symptoms related quality of life questionnaire (ICIQ-LUT symptoms QOL) and bladder diary (BD). Responders to treatment, evaluated using two patient-reported outcome measurements, were invited to return for maintenance treatments when symptoms returned. A PTNS Service Evaluation Questionnaire (PTNS-SEQ) was used to evaluate factors influencing return for maintenance treatment. Results: 79 patients were evaluated (mean age 58.9 (14.7), female 72.6%) and clustered into three groups-group 1 (n=28) did not respond to 12 weekly sessions of PTNS treatment; group 2 (n=28) responded to treatment but did not return for maintenance treatment and group 3 (n=31) responded to treatment and returned for maintenance treatment. There were no significant differences in demographic characteristics, diagnosis, baseline symptom scores and BD parameters between the three groups. Patients belonging to groups 2 and 3 experienced a significant improvement from baseline to week 12 in total OAB scores (group 2:-1.54  1.85; group 3:-1.85  2.28, p<0.05). However, patients returning for maintenance treatment reported significant improvements specifically in nocturia (BD difference =-0.4  0.7, p<0.05 and ICIQ-LUT symptoms QOL difference-0.48  0.94, p<0.05), and perceived benefits of the treatment on their OAB symptoms compared to those not returning for maintenance treatment (difference between the two groups = 25.6%, p=0.030). Improvements in nocturia and perceived benefits predicted return for maintenance treatment through a logistic regression analysis. Factors related to the need for attending repeat clinic visits such as transportation, distance and time commitment were not found to differ between the two groups. Conclusions: Twelve-session weekly PTNS is a safe and effective treatment for OAB. Responders to treatment returning for maintenance PTNS more often reported significant improvements in nocturia and perceived benefits over time, compared to those not returning for maintenance treatment. The bladder diary provides a more objective assessment of treatment outcome following PTNS treatment.

Research paper thumbnail of D-Mannose to Prevent Urinary Tract Infections in Multiple Sclerosis

Journal of Neurology, Neurosurgery & Psychiatry, 2016

Introduction Urinary tract infections (UTIs) are a significant problem in Multiple sclerosis (MS)... more Introduction Urinary tract infections (UTIs) are a significant problem in Multiple sclerosis (MS). D-mannose is a natural supplement shown recently to prevent UTIs, however benefits in multiple sclerosis (MS) are unknown. Objective To evaluate feasibility of using D-Mannose in MS patients reporting recurrent UTIs. Methods In this prospective single-centre, open-label study, participants were given D-mannose (Nature upplies Ltd, UK) 1.5 grams twice daily for 16-weeks and compliance recorded. Training was provided for recognising UTIs and self-monitoring using urine reagent-strip dipsticks. Results of dipsticks and cultures when UTIs were suspected, and antibiotic prescriptions, were recorded. Results Median compliance of 22 patients (18 females; median age 50 years (46–59), (group 1 not using catheters (n=10); group 2 catheter-users (n=12)) using D-Mannose was 100%; no adverse events were reported. In total, there were 61 episodes of suspected UTIs and 29 prescriptions for antibiotics. In group 1, median number of prescriptions was 1 (0–2.2) and culture-proven symptomatic UTIs 0.5 (0–1) and in group 2, 2 (0–3) prescriptions and 1 (0–2) culture-proven UTIs. Number of monthly UTIs significantly decreased in both groups (p<0.01). Conclusion The use of D-mannose in MS patients reporting recurrent UTIs is associated with a reduction in the number of UTIs and antibiotic prescriptions, without safety concerns. Larger studies are required to confirm efficacy.

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

Neurourology and urodynamics, Jan 4, 2016

To assess the feasibility of using D-mannose, a natural food supplement, in patients with multipl... more 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. 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. 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%) pr...

Research paper thumbnail of Urinary tract infections in multiple sclerosis

Multiple Sclerosis Journal, 2016

Background:Urinary tract infections (UTIs) are commonly reported by people with multiple sclerosi... more 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 >105colony-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 t...

Research paper thumbnail of The Possible Role of Opiates in Women with Urinary Retention-Observations from a Prospective Clinical Study

In Neurourology and Urodynamics Wiley Liss, 2009

Research paper thumbnail of Bladder Function In Neurological Patients

Research paper thumbnail of Barriers in Clinic to Discussing Sexual Dysfunction Due to Multiple Sclerosis

Journal of Neurology, Neurosurgery & Psychiatry, 2015

BackgroundSexual dysfunction is underdiagnosed in patients with multiple sclerosis (pwMS). Little... more BackgroundSexual dysfunction is underdiagnosed in patients with multiple sclerosis (pwMS). Little is known about barriers faced by patients and health care professionals (HCPs) in discussing sexual problems.Patients and methods74 PwMS (20 male, 54 female (mean age 45,877±8,823 years)) and 99 HCPs (8 male, 91 female; 82 (83%) nurses) completed questionnaires evaluating barriers to discussing sexual problems in clinic and sexual dysfunction (MSISQ-15 and ASEX), specifically developed for this study.ResultsSymptoms that interfere most with sexual activity are: Takes too long to orgasm (69.11%), bladder symptoms (66.17%), less intense orgasm (66.17%), lack of sexual interest (60.29%), genital numbness (50%). Most common barriers cited by patients include the prominence of other MS symptoms (43.5%), presence of family/friends in consultation room (41.8%), not being asked (37.3%). HCPs identified presence of family/friends in consultation room (57.6% agree), faced lack of knowledge (48.4%...

Research paper thumbnail of Single Centre Randomised Pilot Study of Two Regimens (30 Mins Daily or 30 Mins Weekly for 12 Weeks) of Transcutaneous Tibial Nerve Stimulation Using a Novel Device for Treating Multiple Sclerosis-Related Overactive Bladder Symptoms

Journal of Neurology, Neurosurgery & Psychiatry, 2015

IntroductionPercutaneous tibial nerve stimulation (PTNS) is effective for managing multiple scler... more IntroductionPercutaneous tibial nerve stimulation (PTNS) is effective for managing multiple sclerosis (MS)-related overactive bladder (OAB) symptoms. However the need for weekly clinic visits restricts its use. The purpose of this study was to evaluate safety and efficacy of a novel, self-applying device for managing OAB symptoms.Study design, materials and methods48 patients reporting OAB (MS n=24, idiopathic n=24), were randomized (1:1) to either daily or weekly treatments for 12 weeks with geko™, a novel device stimulating the tibial nerve transcutaneously. Efficacy was assessed using validated questionnaires (ICIQ-OAB, ICIQLUTS-QoL) and bladder diaries filled at weeks 4, 8, and 12. Urinary neurotrophins (Nerve growth factor (NGF) and Brain derived neurotrophic factor) were measured.Results34 patients (MS n=19) completed the study. 18 patients responded to treatment (53%); 72% of responders belonged to the MS cohort. Multilevel regression analysis suggested significant improvemen...