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Bladder Dysfunction (bladder + dysfunction)
Selected AbstractsNew Method to Prevent Bladder Dysfunction after Radical Hysterectomy for Uterine Cervical CancerJOURNAL OF OBSTETRICS AND GYNAECOLOGY RESEARCH (ELECTRONIC), Issue 1 2000Dr. Yoshinori Kuwabara Abstract Objective: The purpose was to improve the surgical procedures to prevent bladder dysfunction after radical hysterectomy. Methods: Twelve patients with stage Ib cervical cancer underwent intraoperative electrical stimulation to identify the vesical branches of the pelvic nerves. Autonomic nerve localization in the vesicouterine ligament was examined in 10 patients immunohistochemically. According to the results of the above studies a new method to preserve the vesical branches was developed. Grades of postoperative bladder dysfunction were compared between new (n = 19) and conventional methods (n = 18). Results: Electrical stimulation on the outer surface of the posterior sheath of the vesicouterine ligament caused the increase of intravesical pressure. S-100 protein localized also on this area. Postoperative compliance of the detrusor in cases with the new method demonstrated less decrement from preoperative values than in cases with the conventional method. The new method required significantly fewer days to achieve residual urine volumes less than 50 ml after surgery. Conclusions: The new method significantly reduces bladder dysfunction after radical hysterectomy. [source] Genitourinary dysfunction in Parkinson's disease,MOVEMENT DISORDERS, Issue 1 2010Ryuji Sakakibara MD Abstract Bladder dysfunction (urinary urgency/frequency) and sexual dysfunction (erectile dysfunction) are common nonmotor disorders in Parkinson's disease (PD). In contrast to motor disorders, genitourinary autonomic dysfunctions are often nonresponsive to levodopa treatment. The brain pathology causing the bladder dysfunction (appearance of overactivity) involves an altered dopamine-basal ganglia circuit, which normally suppresses the micturition reflex. By contrast, hypothalamic dysfunction is mostly responsible for the sexual dysfunction (decrease in libido and erection) in PD, via altered dopamine-oxytocin pathways, which normally promote libido and erection. The pathophysiology of the genitourinary dysfunction in PD differs from that in multiple system atrophy; therefore, it might aid in differential diagnosis. Anticholinergic agents are used to treat bladder dysfunction in PD, although these drugs should be used with caution particularly in elderly patients who have cognitive decline. Phosphodiesterase inhibitors are used to treat sexual dysfunction in PD. These treatments might be beneficial in maximizing the patients' quality of life. © 2010 Movement Disorder Society [source] Bladder dysfunction in Parkinsonism: Mechanisms, prevalence, symptoms, and managementMOVEMENT DISORDERS, Issue 6 2006Kristian Winge MD Abstract The advent of functional imaging methods has increased our understanding of the neural control of the bladder. This review examines current concepts of the role of brain function in urinary control with particular emphasis on the putative role of dopamine receptors. Dopaminergic mechanisms play a profound role in normal bladder control and the dysfunction of these may result in symptoms of overactive bladder in Parkinsonism. The importance of this nonmotor disorder has been overlooked. We address the problem of bladder dysfunction as it presents to patients and their neurologist. The prevalence of bladder symptoms in Parkinson's disease is high; the most common complaint is nocturia followed by frequency and urgency. In multiple-system atrophy, the combination of urge and urge incontinence and poor emptying may result in a complex combination of complaints. The management of bladder dysfunction in Parkinsonism addresses treatment of overactive detrusor as well as incontinence. © 2006 Movement Disorder Society [source] Clinical guideline for male lower urinary tract symptomsINTERNATIONAL JOURNAL OF UROLOGY, Issue 10 2009Yukio Homma Abstract: This article is a shortened version of the clinical guideline for lower urinary tract symptoms (LUTS), which has been developed in Japan for symptomatic men aged 50 years and over irrespective of presumed diagnoses. The guideline was formed on the PubMed database between 1995 and 2007 and other relevant sources. The causes of male LUTS are diverse and attributable to diseases/dysfunctions of the lower urinary tract, prostate, nervous system, and other organ systems, with benign prostatic hyperplasia, bladder dysfunction, polyuria, and their combination being most common. The mandatory assessment should comprise medical history, physical examination, urinalysis, and measurement of serum prostate-specific antigen. Symptom and quality of life questionnaires, bladder diary, residual urine measurement, urine cytology, urine culture, measurement of serum creatinine, and urinary tract ultrasonography would be optional tests. The Core Lower Urinary Tract Symptom Score Questionnaire may be useful in quickly capturing important symptoms. Severe symptoms, pain symptoms, and other clinical problems would indicate urological referral. One should be careful not to overlook underlying diseases such as infection or malignancy. The treatment should be initiated with conservative therapy and/or medicine such as ,1 -blockers. Treatment with anticholinergic agents should be reserved only for urologists, considering the risk of urinary retention. The present guideline should help urologists and especially non-urologists treat men with LUTS. [source] Elimination disorders in people with intellectual disabilityJOURNAL OF INTELLECTUAL DISABILITY RESEARCH, Issue 10 2008E. Van Laecke Incontinence in children with intellectual and physical disabilities is an underestimated problem in paediatric urology. Literature is scarce, often limited to the incidence and urodynamics, and seldom focused on treatment and prevention. Lack of interest and knowledge of this population are the major reasons why urologists know so little. Very often continence difficulties are accepted and even expected in children with intellectual disabilities. The published prevalence of urinary incontinence in children with intellectual and physical disabilities varies between 23% and 86%. In our experience the prevalence ranges from 60% to 65%. The vast majority of these children have bladder dysfunction, showing overactive detrusor and sphincter dyssynergia on video-urodynamic examination. The uroflow pattern is disturbed in over 65% of these children but is not correlated with the degree of urinary incontinence. Over 70% of the children have reduced bladder capacity. This is due to low bladder compliance and restricted fluid intake which effects urinary incontinence and is an important cause of constipation. Constipation is a common problem in intellectual and physical disabled children and there is a correlation between constipation and urinary incontinence. Children with intellectual disability, particularly those with a greater degree of disability need more time to become continent than typically developing children. Children with mild intellectual disability do not differ significantly from typically developing children with regard to nocturnal enuresis and faecal continence but they are more prone to urinary incontinence during the day. Greater mobility is associated with a higher incidence of continence. Some factors that influence continence, such as intellectual and motor capacity cannot easily be influenced but others, such as bladder capacity, detrusor overactivity and fluid intake, are treatable. It is importance that children with intellectual and physical disabilities suffering urinary incontinence are referred for assessment and treatment to increase their quality of life. [source] New Method to Prevent Bladder Dysfunction after Radical Hysterectomy for Uterine Cervical CancerJOURNAL OF OBSTETRICS AND GYNAECOLOGY RESEARCH (ELECTRONIC), Issue 1 2000Dr. Yoshinori Kuwabara Abstract Objective: The purpose was to improve the surgical procedures to prevent bladder dysfunction after radical hysterectomy. Methods: Twelve patients with stage Ib cervical cancer underwent intraoperative electrical stimulation to identify the vesical branches of the pelvic nerves. Autonomic nerve localization in the vesicouterine ligament was examined in 10 patients immunohistochemically. According to the results of the above studies a new method to preserve the vesical branches was developed. Grades of postoperative bladder dysfunction were compared between new (n = 19) and conventional methods (n = 18). Results: Electrical stimulation on the outer surface of the posterior sheath of the vesicouterine ligament caused the increase of intravesical pressure. S-100 protein localized also on this area. Postoperative compliance of the detrusor in cases with the new method demonstrated less decrement from preoperative values than in cases with the conventional method. The new method required significantly fewer days to achieve residual urine volumes less than 50 ml after surgery. Conclusions: The new method significantly reduces bladder dysfunction after radical hysterectomy. [source] Sensor Mechanism and Afferent Signal Transduction of the Urinary Bladder: Special Focus on transient receptor potential Ion ChannelsLUTS, Issue 2 2010Masayuki TAKEDA In the urine storage phase, mechanical stretch stimulates bladder afferents. These urinary bladder afferent sensory nerves consist of small diameter A, - and C-fibers running in the hypogastic and pelvic nerves. Neuroanatomical studies have revealed a complex neuronal network within the bladder wall. The exact mechanisms that underline mechano-sensory transduction in bladder afferent terminals remain ambiguous; however, a wide range of ion channels (e.g. TTX-resistant Na+ channels, Kv channels and hyperpolarization-activated cyclic nucleotidegated cation channels, degenerin/epithelial Na+ channel), and receptors (e.g. TRPV1, TRPM8, TRPA1, P2X2/3, etc.) have been identified at bladder afferent terminals and have implicated in the generation and modulation of afferent signals, which are elcited by a wide range of bladder stimulations including physiological bladder filling, noxious distension, cold, chemical irritation and inflammation. The mammalian transient receptor potential (TRP) family consists of 28 channels that can be subdivided into six different classes: TRPV (Vanilloid), TRPC (Canonical), TRPM (Melastatin), TRPP (Polycystin), TRPML (Mucolipin), and TRPA (Ankyrin). TRP channels are activated by a diversity of physical (voltage, heat, cold, mechanical stress) or chemical (pH, osmolality) stimuli and by binding of specific ligands, enabling them to act as multifunctional sensors at the cellular level. TRPV1, TRPV2, TRPV4, TRPM8, and TRPA1 have been described in different parts of the urogenital tract. Although only TRPV1 among TRPs has been extensively studied so far, more evidence is slowly accumulating about the role of other TRP channels, ion channels, and receptors in the pathophysiology of the urogenital tract, and may provide a new strategy for the treatment of bladder dysfunction. [source] Biomechanics of Diabetic BladdersLUTS, Issue 2009Chung Cheng WANG Objectives: Biomechanics is the mechanics applied to biology and we hereby review bladder biomechanics in diabetic bladder dysfunction. Methods: The important mechanical properties of bladder tissue include the stress-strain relationship, viscoelasticity and active contraction. Using biaxial mechanical testing methods, the diabetic bladders exhibited non-linear stress-strain mechanical relationships with increasing stiffness at higher stretches in both circumferential and longitudinal directions. Results: The diabetic bladders showed mechanical anisotropy with a greater compliance in the circumferential direction than in the longitudinal direction. The time-course study suggested that diuresis mainly contributed to the "early" changes of the mechanical properties with "late" changes induced by other diabetic effects. Conclusion: The biomechanical study of the urinary bladder has offered a novel understanding of the pathophysiology of diabetic cystopathy and we believe the collaboration of urology and engineering will contribute greatly to the treatment of diabetic bladder dysfunction in the future. [source] Genitourinary dysfunction in Parkinson's disease,MOVEMENT DISORDERS, Issue 1 2010Ryuji Sakakibara MD Abstract Bladder dysfunction (urinary urgency/frequency) and sexual dysfunction (erectile dysfunction) are common nonmotor disorders in Parkinson's disease (PD). In contrast to motor disorders, genitourinary autonomic dysfunctions are often nonresponsive to levodopa treatment. The brain pathology causing the bladder dysfunction (appearance of overactivity) involves an altered dopamine-basal ganglia circuit, which normally suppresses the micturition reflex. By contrast, hypothalamic dysfunction is mostly responsible for the sexual dysfunction (decrease in libido and erection) in PD, via altered dopamine-oxytocin pathways, which normally promote libido and erection. The pathophysiology of the genitourinary dysfunction in PD differs from that in multiple system atrophy; therefore, it might aid in differential diagnosis. Anticholinergic agents are used to treat bladder dysfunction in PD, although these drugs should be used with caution particularly in elderly patients who have cognitive decline. Phosphodiesterase inhibitors are used to treat sexual dysfunction in PD. These treatments might be beneficial in maximizing the patients' quality of life. © 2010 Movement Disorder Society [source] Bladder dysfunction in Parkinsonism: Mechanisms, prevalence, symptoms, and managementMOVEMENT DISORDERS, Issue 6 2006Kristian Winge MD Abstract The advent of functional imaging methods has increased our understanding of the neural control of the bladder. This review examines current concepts of the role of brain function in urinary control with particular emphasis on the putative role of dopamine receptors. Dopaminergic mechanisms play a profound role in normal bladder control and the dysfunction of these may result in symptoms of overactive bladder in Parkinsonism. The importance of this nonmotor disorder has been overlooked. We address the problem of bladder dysfunction as it presents to patients and their neurologist. The prevalence of bladder symptoms in Parkinson's disease is high; the most common complaint is nocturia followed by frequency and urgency. In multiple-system atrophy, the combination of urge and urge incontinence and poor emptying may result in a complex combination of complaints. The management of bladder dysfunction in Parkinsonism addresses treatment of overactive detrusor as well as incontinence. © 2006 Movement Disorder Society [source] The effect of familial aggregation on the children with primary nocturnal enuresisNEUROUROLOGY AND URODYNAMICS, Issue 5 2009Qing Wei Wang Abstract Objective To evaluate the effect of familial aggregation on the children with PNE by evaluating nocturnal urine output, bladder, and arouse function. Patients and Methods According to whether relatives of family of probands over three generations were affected by PNE, forty-five children with familial aggregation PNE (FPNE), seventy children with sporadic PNE (SPNE) and ten children with normal lower urinary tract function but waiting for operation (control group) were included. Questionnaire of arousal from sleep (AS scores), bladder diary and daytime urodynamic studies were performed in all patients. Results The incidences of severe PNE and nonmonosymptomatic PNE in FPNE group were significantly higher than those in SPNE group. The nocturnal urine output and AS scores in both PNE groups was significantly higher, maximal voided volume significantly smaller than those in control group. Moreover, the incidences of small bladder in FPNE group was 44%, significantly higher than that in SPNE group (21%), but no significantly difference was found in nocturnal polyuria and arousal AS scores between two PNE groups. There were 53% patents with daytime detrusor overactivity and 60% patents with urodynamic functional bladder outflow obstruction in FPNE group, significantly higher than those in SPNE group (19% and 37%). Maximum cystometric capacity significantly decreased from control group to FPNE group. Conclusion Familial aggregation has significant effects on the children with PNE, and FPNE are more likely to be severe symptoms and bladder dysfunction. It would be beneficial to have an urodynamic study for their diagnosis and treatment. Neurourol. Urodynam. 28:423,426, 2009. © 2008 Wiley-Liss, Inc. [source] Prevalence and mechanism of bladder dysfunction in Guillain,Barré Syndrome,NEUROUROLOGY AND URODYNAMICS, Issue 5 2009Ryuji Sakakibara Abstract Aim To examine the prevalence and mechanism of urinary dysfunction in GBS. Methods Urinary symptoms were observed and neurological examinations made repeatedly during hospitalization of 65 consecutive patients with clinico-neurophysiologically definite GBS. The patients included 41 men, 24 women; mean age, 41 years old; mean Hughes motor grade, 3; AIDP, 28, AMAN, 37. Urodynamic studies consisted of uroflowmetry, measurement of post-micturition residuals, medium-fill water cystometry, and external anal sphincter electromyography. Results Urinary dysfunction was observed in 27.7% of GBS cases (urinary retention, 9.2%). Urinary dysfunction was related to the Hughes motor grade (P,<,0.05), defecatory dysfunction (P,<,0.05), age (P,<,0.05), and negatively related to serum IgG class anti-ganglioside antibody GalNAc-GD1a (P,<,0.05). Urinary dysfunction was more common in AIDP (39%) than in AMAN (19%). No association was found between antibody titer against neuronal nicotinic acetylcholine receptors and urinary dysfunction. Urodynamic studies in nine patients, mostly performed within 8 weeks after disease onset, revealed post-void residual in 3 (mean 195 ml), among those who were able to urinate; decreased bladder sensation in 1; detrusor overactivity in 8; low compliance in 1; underactive detrusor in 7 (both overactive and underactive detrusor in 5); and nonrelaxing sphincter in 2. Conclusion In our series of GBS cases, 27.7% of the patients had urinary dysfunction, including urinary retention in 9.2%. Underactive detrusor, overactive detrusor, and to a lesser extent, hyperactive sphincter are the major urodynamic abnormalities. The underlying mechanisms of urinary dysfunction appear to involve both hypo- and hyperactive lumbosacral nerves. Neurourol. Urodynam. 28:432,437, 2009. © 2009 Wiley-Liss, Inc. [source] External urethral sphincter activity in diabetic ratsNEUROUROLOGY AND URODYNAMICS, Issue 5 2008Guiming Liu Abstract Aim To examine the temporal effects of diabetes on the bladder and the external urethral sphincter (EUS) activity in rats. Methods Female Sprague-Dawley rats (n,=,24) were divided into two groups: streptozotocin-induced diabetic rats and age-matched controls. Cystometrograms (CMGs) were taken under urethane anesthesia and electromyograms (EMG) of the EUS were evaluated in all rats at 6 and 20 weeks after diabetes induction. After EMG assessment, the tissues of the urethra were harvested for morphological examination. Results Diabetes caused reduction of body weight, but an increase in bladder weight. CMG measurements showed diabetes increased threshold volume, contraction duration, high-frequency oscillations (HFO), and residual volume. Peak contraction amplitude increased in 6-week but not 20-week diabetic rats. EUS-EMG measurements showed increased frequency of EUS-EMG bursting discharge during voiding in 6-week diabetic rats (8.1,±,0.2 vs. 6.9,±,0.6/sec) but not in 20-week (5.8,±,0.3 vs. 6.0,±,0.2/sec) diabetic rats compared with controls. EUS-EMG bursting periods were also increased in both 6-week and 20-week diabetic rats compared with controls. EUS-EMG silent periods were reduced in 6-week diabetic rats, but were not changed in 20-week diabetic rats compared with controls. Active periods did not change in 20-week diabetic rats, but increased in 6-week diabetic rats compared with controls. Morphometric analysis showed atrophy of the EUS after 20 week but not 6 weeks of DM induction. Conclusions Our data indicates diabetes causes functional and anatomical abnormalities of the EUS. These abnormalities may contribute to the time-dependent bladder dysfunction in diabetic rats. Neurourol. Urodynam. 27:429,434, 2008. © 2008 Wiley-Liss, Inc. [source] Update on the neurology of Parkinson's disease,NEUROUROLOGY AND URODYNAMICS, Issue 1 2007Clare J. Fowler Abstract The differential diagnosis of a patient with apparent Parkinson's Disease (PD) and bladder symptoms is considered and the bladder dysfunction of Multiple System Atrophy (MSA) is reviewed. Recent insights into the progression of the neuropathology of PD have enabled thinking about the stage of the disease at which bladder dysfunction is likely to occur and the expected clinical context of the problem. Bladder symptoms of neurological origin are likely in a patient who has had treated motor symptoms for some years and in whom the ongoing neuropathology has progressed beyond involvement of the basal ganglia, so that symptoms due to cortical dysfunction as well as the adverse effects of dopaminergic medication are also confounding factors. Bladder symptoms in a man with lesser neurological disability should be investigated to exclude underlying outflow obstruction. Possible management options are considered. Neurourol. Urodynam. © 2006 Wiley-Liss, Inc. [source] Endothelin-A-receptor antagonist LU 302146 inhibits electrostimulation-induced bladder contractions in vivoNEUROUROLOGY AND URODYNAMICS, Issue 5 2006J.R. Scheepe Abstract Objectives Endothelin (ET) is a strong constrictor of smooth muscle structures. The relevance of Endothelin-A receptors in the bladder was demonstrated in several in vitro studies. The aim of this functional study was to evaluate the acute effect of the selective ET-A-antagonist LU 302146 (LU) on neurostimulation-induced bladder contractions in vivo. Methods Eight male mini pigs were anesthesized. The bladder was exposed and a double lumen catheter was inserted to perform intravesical pressure (pves) measurements. Laminectomy was performed for sacral anterior root stimulation (SARS) of S2. Four animals received the selective ET-A-antagonist LU, three atropine and one animal was treated with vehicle. Pves was recorded before and after drug administration as well as before and during neurostimulation. At the end of each LU trial, a supplementary application of 4 mg atropine was administered followed by a final SARS. Results In all experiments reproducible pves values were elicited during electrostimulation before administration of the test substance. The selective ET-A-antagonist reduced stimulation-induced bladder contraction by a mean of 57%. Additional administration of atropine inhibited the detrusor contraction almost completely during SARS. The vehicle had no effect on bladder contraction. Conclusions In the presented animal model, ET-1 inhibition with the selective ET receptor-A-antagonist LU 302146 decreases stimulation-induced bladder contraction in vivo. The results suggest that the selective ET-A antagonist LU acts on the atropine-resistant component of efferent detrusor activation since additional administration of atropine almost completely abolish detrusor contraction. This observation in addition to the involvement of ET-1 in bladder smooth muscle proliferation, raises the possibility that ET-receptor antagonists might be beneficial in patients with neurogenic bladder dysfunction or in patients with functional or anatomical BOO. Neurourol. Urodynam. © 2006 Wiley-Liss, Inc. [source] Lipid signaling changes in smooth muscle remodeling associated with partial urinary bladder outlet obstructionNEUROUROLOGY AND URODYNAMICS, Issue 2 2006Edward LaBelle Abstract Aims Hypertrophy of the urinary bladder smooth muscle (detrusor) is associated with partial bladder outlet obstruction (PBOO). Hypertrophied detrusor smooth muscle (DSM) reveals altered contractile characteristics. In this study, we analyzed the lipid-dependent signaling system that includes phospholipase A2 in PBOO-induced DSM remodeling and hypertrophy to determine whether the release of arachidonic acid (AA) from phospholipid is altered in the detrusor. Methods Partial bladder outlet obstruction (PBOO) was produced by partial ligation of the urethra in New Zealand white rabbits. Two weeks after the surgery, the bladder function was studied by keeping the rabbits in metabolic cages for 24 hr. Bladders were removed from rabbits that had bladder dysfunction (increased urinary frequency and decreased void volume) and the DSM separated from mucosa and serosa. The isolated smooth muscle was incubated with [3H] AA to equilibrate the cytoplasmic AA. The level of AA release was compared with the level obtained with 2-week sham-operated rabbits. Results The rate of AA release was high in DSM from bladders with PBOO-induced hypertrophy. Carbachol stimulated AA release in control DSM but DSM from obstructed rabbits revealed no further increase from the elevated basal AA release. The half-maximal concentration of carbachol that was required to stimulate AA release from control samples of detrusor was 35 µM. Conclusions The increased levels of AA release that are observed in this tissue after PBOO indicate the activation of phospholipase A2. The finding that carbachol could induce contraction, but not an increase in AA, indicates that the carbachol-induced contraction in the obstructed bladders is independent of lipid signaling pathways that involve AA. It is possible that the increased rate of arachidonic acid release from obstructed bladders correlates with the enhanced rates of prostaglandin production reported by other investigators from the same tissue. Neurourol. Urodynam. © 2006 Wiley-Liss, Inc. [source] The effect of tamsulosin on the response of the rabbit bladder to partial outlet obstructionNEUROUROLOGY AND URODYNAMICS, Issue 1 2006Robert M. Levin Abstract Aim To determine if tamsulosin treatment prevents or decreases the incidence and severity of outlet obstruction-induced bladder dysfunction in rabbits. Materials and Methods Male New Zealand White rabbits were treated with tamsulosin or vehicle for 4 weeks with treatments initiated 1 week prior to sham or obstruction surgery. Cystometry was done on anesthetized rabbits 21 days after surgery. The bladders were then removed, weighed, and prepared for in vitro whole bladder studies. Responses to 32 Hz field stimulation (FS), carbachol, phenylephrine, and KCl were measured. Results Obstruction resulted in a significant increase in bladder weight, which was unchanged by tamsulosin treatment and a significant increase in micturition pressure in the vehicle-treated group but not in the tamsulosin-treated group. Compliance was significantly decreased in both obstructed groups. The vehicle-treated obstructed rabbits had a very sharp increase in intravesical pressure as the bladder reached capacity; this was not seen in the tamsulosin-treated obstructed rabbits. Tamsulosin did not change the pattern of modifications in contractile responses induced by bladder outlet obstruction. Conclusions In vitro responses of vehicle and tamsulosin-treated obstructed rabbit groups in this study were similar. A greater micturition pressure was found for the vehicle-treated obstructed group than for the tamsulosin-treated obstructed group, which was probably due to decreased urethral resistance in the latter. On a functional basis, the higher compliance at capacity and decreased micturition pressure in the tamsulosin-treated obstructed group would be considered beneficial for bladder function. Neurourol. Urodynam. © 2005 Wiley-Liss, Inc. [source] Perugia urodynamic method of analysis (PUMA): A new advanced method of urodynamic analysis applied clinically and compared with other advanced methodsNEUROUROLOGY AND URODYNAMICS, Issue 3 2003Massimo Porena Abstract Aims The aim of this study is to compare PUMA curves with different pathologic conditions causing bladder dysfunction in 158 men and 83 women. Methods PUMA results in terms of bladder outlet obstruction and detrusor contractility were compared in 92 men with benign prostatic hypertrophy (BPH) and pves,pdet (i.e., pabd,0) with the results of the urodynamics operator's opinion, the provisional International Continence Society method, Abrams and Griffith's diagram, urethral resistence factor (URA), Schäfer's diagram, and Watt factor. PUMA curves correlated reliably with different pathologic conditions such as obstructive BPH, orthotopic bladder, cystocele, the neurological bladder, and bladder diverticulum. Statistical analysis indicated excellent agreement between PUMA and URA; agreement with other methods was good in cases of obstruction and nonobstruction. In doubtful cases, as diagnosed by standard methods, PUMA agreed only with the Abrams and Griffith's diagram. PUMA and Wmax were in good agreement on detrusor con traction force. Agreement between PUMA and Schäfer's diagram was excellent for patients with detrusor hypercontractility and good for patients with detrusor hypocontractility and normocontractility. PUMA is the only method applicable to women. It is easy to perform. When integrated with other diagnostic tests, it provides realistic data for diagnosis, medical or surgical therapy, and outcome. Neurourol. Urodynam. 22:206,222, 2003. © 2003 Wiley-Liss, Inc. [source] BPH with coexisting overactive bladder dysfunction,an everyday urological dilemmaNEUROUROLOGY AND URODYNAMICS, Issue 3 2001Tomas Knutson Abstract The aim of this study was to use a systematic schedule, including urodynamics, to describe the rate of coexisting overactive bladder (OB) in patients with bladder outlet obstruction (BOO) caused by benign prostatic hyperplasia (BPH). We also identified differences between the patients with pure BOO compared with those with BOO combined with OB (BOO,+,OB). One hundred and sixty-two men referred to our clinic due to LUTS were included. Patients with a history that might affect their bladder function were excluded. After cystometry and pressure,flow studies, the patients were divided into pure BOO and BOO,+,OB. Of the 162 men, 55% had pure BOO. BOO,+,OB was found in 45%. Age, s-PSA, voided volume, and obstruction grade differed significantly between the groups. The patients with BOO,+,OB were older, had a higher s-PSA, voided smaller volumes, and were more obstructed. We found no differences in TRUS-volume, Q-max, IPS score, or PVR. There was a strong association between OB and BOO, the percentage of OB increasing with increased obstruction. TRUS-volume, Q-max, IPS score, and PVR did not predict whether the patients had a combined BOO,+,OB or not. These findings indicate that BOO is a progressive disease, which in time causes pronounced obstruction and perhaps in itself contributes to the development of OB. Neurourol. Urodynam. 20:237,247, 2001. © 2001 Wiley-Liss, Inc. [source] Protective role of aquaporin-4 water channels after contusion spinal cord injuryANNALS OF NEUROLOGY, Issue 6 2010Atsushi Kimura MD Objective Spinal cord injury (SCI) is accompanied by disruption of the blood-spinal cord barrier and subsequent extravasation of fluid and proteins, which results in edema (increased water content) at the site of injury. However, the mechanisms that control edema and the extent to which edema impacts outcome after SCI are not well elucidated. Methods Here, we examined the role of aquaporin-4 (AQP4) water channels after experimental contusion injury in mice, a clinically relevant animal model of SCI. Results Mice lacking AQP4 (AQP4,/, mice) exhibited significantly impaired locomotor function and prolonged bladder dysfunction compared with wild-type (WT) littermates after contusion SCI. Consistent with a greater extent of functional deterioration, AQP4,/, mice showed greater neuronal loss and demyelination, with prominent cyst formation, which is generally absent in mouse SCI. The extent of spinal cord edema, as expressed by percentage water content, was persistently increased above control levels in AQP4,/, mice but not WT mice at 14 and 28 days after injury. Immunohistochemical analysis indicated that blood vessels in the vicinity of the lesion core had incomplete barrier function because of sparse tight junctions. Interpretation These results suggest that AQP4 plays a protective role after contusion SCI by facilitating the clearance of excess water, and that targeting edema after SCI may be a novel therapeutic strategy. ANN NEUROL 2010;67:794,801 [source] Ventricular dilation: Association with gait and cognition,ANNALS OF NEUROLOGY, Issue 4 2009Walter M. Palm MD Objective Normal pressure hydrocephalus is characterized by gait impairment, cognitive impairment, and urinary incontinence, and is associated with disproportionate ventricular dilation. Here we report the distribution of ventricular volume relative to sulcal cerebrospinal fluid (CSF) volume, and the association of increasing ventricular volume relative to sulcal CSF volume with a cluster of gait impairment, cognitive impairment, and urinary incontinence in a stroke-free cohort of elderly persons from the general population. Methods Data are based on 858 persons (35.4% men; age range, 66,92 years) who participated in the Age, Gene/Environment Susceptibility,Reykjavik Study. Gait was evaluated with an assessment of gait speed. Composite scores representing speed of processing, memory, and executive function were constructed from a neuropsychological battery. Bladder function was assessed with a questionnaire. Magnetic resonance brain imaging was followed by semiautomated segmentation of intracranial CSF volume. White matter hyperintensity (WMH) volume was assessed with a semiquantitative scale. For the analysis of ventricular dilation relative to the sulcal spaces, ventricular volume was divided by sulcal CSF volume (VV/SV). Results Disproportion between ventricular and sulcal CSF volume, defined as the highest quartile of the VV/SV z score, was associated with gait impairment (odds ratio [OR], 1.9; 95% confidence interval [CI], 1.1,3.3) and cognitive impairment (OR, 1.8; 95% CI, 1.1,3.0). We did not find an association between the VV/SV z score and bladder dysfunction. Interpretation The prevalence and severity of gait impairment and cognitive impairment increases with ventricular dilation in persons without stroke from the general population, independent of WMH volume. Ann Neurol 2009;66:485,493 [source] Botulinum injections for the treatment of bladder symptoms of multiple sclerosisANNALS OF NEUROLOGY, Issue 5 2007MRCS, Vinay Kalsi MBBS Objective Our objective was to demonstrate the efficacy and impact on quality of life of detrusor injections of botulinum neurotoxin type A in the treatment of bladder dysfunction in patients with multiple sclerosis. Methods Forty-three patients with multiple sclerosis suffering from severe urgency incontinence were treated with detrusor injections of botulinum neurotoxin type A. Data from cystometric assessment of the bladder, voiding diaries, quality-of-life questionnaires, and procontinence medication usage were collected before treatment and 4 and 16 weeks after injection. The same data were also collected after repeat treatments. Results Highly significant improvements (p < 0.0001) in incontinence episodes and urinary urgency, daytime frequency and nocturia, were the symptomatic reflection of the significant improvements in urodynamically demonstrated bladder function. Although 98% of patients had to perform self-catheterization after treatment, there were sustained improvements in all quality-of-life scores. The mean duration of effect was 9.7 months. Similar results were seen with repeat treatments. Interpretation Minimally invasive injections of botulinum neurotoxin type A have been shown to be exceptionally effective in producing a prolonged improvement in urinary continence in patients with multiple sclerosis. This treatment is likely to have a major impact on future management. Ann Neurol 2007 [source] Pregnancy and delivery: a urodynamic viewpointBJOG : AN INTERNATIONAL JOURNAL OF OBSTETRICS & GYNAECOLOGY, Issue 11 2000C. Chaliha Research Fellow (Urogynaecology) Objective The aims of this study were to establish prospectively the prevalence of objective bladder dysfunction before and after delivery by means of urodynamic investigations and to assess the effect of obstetric variables on bladder function. Design Prospective longitudinal study. Twin channel subtracted cystometry was performed in the standing and sitting position, with a cough stress test at the end of filling. The investigations were repeated three months postpartum. Participants Two hundred and eighty-six nulliparae with singleton pregnancies who were delivered between April 1996 and November 1997 attended for antenatal assessment after 34 weeks of gestation and 161 who returned postpartum. Setting Department of Obstetrics and Gynaecology in a London teaching hospital. Results The mean urodynamic values both in pregnancy and postpartum lower than values defined in a non-pregnant population. The prevalence of genuine stress incontinence and detrusor instability were antenatally 9% and 8%, respectively, and postpartum 5% and 7%, respectively. Obstetric and neonatal factors were not related to urodynamic variables. Conclusions Despite the reported high prevalence of urinary incontinence related to pregnancy and childbirth, neither pregnancy nor delivery resulted in any consistent effects on objective bladder function. Postpartum urodynamic measurements were not related to either obstetric or neonatal variables, but were dependent on antenatal values. [source] Long-term outcome of tension-free vaginal tape for treating stress incontinence in women with neuropathic bladdersBJU INTERNATIONAL, Issue 6 2010Ahmad Abdul-Rahman Study Type , Therapy (case series) Level of Evidence 4 OBJECTIVE To evaluate the long-term safety and efficacy of the tension-free vaginal tape (TVT) for the treatment of stress urinary incontinence (SUI) in women with neuropathic bladder dysfunction. PATIENTS AND METHODS Twelve women (mean age 53.3 years, range 41,80) with neuropathic bladder dysfunction and SUI confirmed by video-cystometrography (VCMG) were treated with a TVT in one institution by an expert neuro-urologist between November 1997 and December 2000. The patient's notes, clinical annual follow-up and VCMG after the procedure, and the incontinence impact questionnaire (IIQ) forms (Urinary Distress Inventory, and IIQ-7) were assessed during the long-term clinical follow-up for SUI, in addition to a health-related quality of life assessment. The cure of SUI was defined as no loss of urine on physical exercise, confirmed VCMG after the procedure, and by clinical assessment. RESULTS The mean (range) follow-up was 10 (8.5,12) years. Nine patients were using clean intermittent self-catheterization before the insertion of TVT and continued to do so afterward. At 10 years of follow-up, one patient had died (with failed TVT initially), and two were lost to follow-up at 5 years after surgery, but up to 5 years they did not complain of UI and VCMG did not show SUI. The remaining seven of the nine patients were completely dry, and two improved and were satisfied with using one or two pads/day. Two patients showed neurogenic detrusor overactivity confirmed on VCMG, with no evidence of SUI. One patient needed a transient urethral catheter for urinary retention after surgery, one had a bladder injury that required leaving the catheter for 5 days, but no urethral erosions were reported during the follow-up. CONCLUSIONS In women with neuropathic bladder dysfunction secondary to a variety of spinal cord pathologies, and who have SUI necessitating a definitive intervention, insertion of TVT should be considered a desirable treatment, with very good long-term outcomes. [source] Cerebral mechanisms and voiding functionBJU INTERNATIONAL, Issue 4 2007Ranan DasGupta Some of the most recent work investigating the cerebral mechanisms involved in bladder control has been very helpful in adding to our understanding of bladder dysfunction. The group behind this work, from London, presents a mini-review which will help to update our knowledge in this area. Authors from Australia present a review describing the interactions between bone and prostate cancer cells in metastatic disease. This area has generated much interest and is something for which we should develop a full understanding, to optimise our treatments for this condition. [source] Endoscopic treatment with polydimethylsiloxane in children with dilating vesico-ureteric refluxBJU INTERNATIONAL, Issue 4 2006FABIO BARTOLI The much-visited topic of endoscopic treatment of VUR in children with an injectable agent is assessed by authors from Italy. However, in this study using Macroplastique, they had a 72% success rate after the first injection, 97% after the second, and 100% after the third. What is interesting is that 68% of the cases had grade IV,V VUR. OBJECTIVE To report our experience of treating dilating vesico-ureteric reflux (VUR) in children, using an injectable form of polydimethylsiloxane (MacroplastiqueTM, MPQ; Uroplasty BV, Geleen, The Netherlands), as medical treatment for moderate or severe VUR is associated with a high proportion of persistence or development of new scars. PATIENTS AND METHODS The study included 32 children (40 ureters) with VUR; 13 (32%) were grade III, 20 (50%) grade IV and seven (18%) grade V. They were treated over a period of 42 months, 66% for some form of bladder dysfunction and 38% had associated diseases. The main indications were VUR grade, recurrent urinary tract infection and progression of reflux nephropathy. MPQ was injected under general anaesthesia via an 11 F cystoscope, × 30 objective, with a 5 F working channel. RESULTS The mean (sd) follow-up was 28.5 (10.2) months; VUR resolved in 80% of patients and improved to minimal VUR in the remaining 20%. The resolution/improvement rate was 72% after the first injection, 97% after the second and 100% after the third. There were no significant complications. CONCLUSION The endoscopic implantation of MPQ always corrected VUR even though 68% of the cases were grade IV,V. It should become the treatment of choice for severe VUR. [source] | |||||||||||||||||||||||||