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Urethral Obstruction (urethral + obstruction)

Distribution by Scientific Domains

Medical Sciences	94%

Selected Abstracts

First report of overactive detrusor in association with hypospadias detected by urodynamic screening

NEUROUROLOGY AND URODYNAMICS, Issue 1 2005
Cuneyd Ozkurkcugil
Abstract Aims The purpose of this study was to determine urodynamic features in hypospadic patients. Methods Thirty-seven patients with hypospadias (distal: 31, proximal: 6) underwent preoperative urodynamic study according to International Continence Society (ICS) recommendations. Statistical analysis were done for comparison between urethral obstruction and non-obstruction in patients with detrusor overactivity (DO) plus the relationship of DO with localization of hipospadias. Results Nearly 45.9% of the patients showed overactive detrusor. Urethral obstruction was found in 60.8% of the patients. The rate of DO was higher in proximal hipospadias, and urethral obstruction than distal type, and non-obstructed patients (P,>,0.005). The means overall cystometric capacity, maximum voiding detrusor pressure and maximal urinary flow measured were 132.6,± 111.14 ml (range 21,610), 72,±,53 cmH2O (range 12,181), and 7.9,±,7.1 ml/sec (range 2,30 ml/sec), respectively. Conclusions To the best of our knowledge, this is the first study ever to show that overactive detrusor is an accompanying entity in the hypospadic patients. © 2004 Wiley-Liss, Inc. [source]

Histological study of fetal kidney with urethral obstruction and vesicoureteral reflux: A consideration on the etiology of congenital reflux nephropathy

INTERNATIONAL JOURNAL OF UROLOGY, Issue 10 2003
KENJI SHIMADA
Purpose: A recent subject of interest regarding reflux nephropathy is the presence of renal abnormalities in neonates and infants who have no history of urinary tract infections. Debates have centered on the etiology of this renal abnormality , congenital reflux nephropathy; regarding whether it is the result of abnormal ureteral budding or of back pressure effect from sterile reflux. We examined the renal pathology of fetuses with urethral obstruction and vesicoureteral reflux, and we suggest herein a possible etiology of congenital reflux nephropathy. Methods: The renal pathology of seven autopsied fetuses with vesicoureteral reflux was studied. Reflux was demonstrated at autopsy by slow injection of contrast medium into the bladder. Severe urethral obstruction, either atresia or urethral valves, was evident in six of the subjects. Results: In six subjects, abnormality of the urinary tracts was detected by prenatal ultrasonography. Of these six subjects, three revealed characteristics of prune belly syndrome. Reflux was graded as moderate in five subjects, and severe in two. In three subjects autopsied at 21 weeks gestation or earlier, the kidneys were well-developed with normal corticomedullary configuration, and nephrogenesis was retained. In three cases autopsied at over 25 weeks of gestation, the kidneys were grossly cystic, and the nephrogenic zone was completely absent. Contrast medium was observed not only in the dilated ducts and tubules, but also in the subcapsular cysts. Extravasation of the contrast medium was seen in the peritubular space. In the last subject with normal lower urinary tract, abnormal segments among normal cortical structures were observed. Conclusion: Our findings of renal pathology in fetuses with reflux are quite similar to those seen in fetal hydronephrosis. Back pressure from reflux probably damages the developing kidney leading to a degeneration of the ampullae and a reduction in the number of nephrons. Both dilatation of the collecting ducts and tubules, and extravasation of the urine may result in interstitial fibrosis. We postulate that one of the important etiologies of congenital reflux nephropathy may be the result of back pressure from sterile reflux. [source]

Evaluation of clinical signs and causes of lower urinary tract disease in European cats

JOURNAL OF SMALL ANIMAL PRACTICE, Issue 12 2005
B. Gerber
Objectives: To investigate the clinical signs and causes of lower urinary tract disease (LUTD) in 77 cats. Methods: Cats diagnosed with LUTD over a two-year period were included in the study. Results: The study population comprised 67 male and 10 female cats. Uroliths occurred in 17 of the 77 cats (22 per cent), urethral plugs in eight cats (10 per cent) and urinary tract infection in six cats (8 per cent). In 44 cats (57 per cent), no specific cause for the disease was found and they were classified as having idiopathic LUTD. In two of the 77 cats (3 per cent) no definitive diagnosis was established. Pain was less common in cats with uroliths and haematuria was more often seen in cats with urinary tract infection. At presentation, urethral obstruction was diagnosed in 45 of the 77 cats (58 per cent). Clinical Significance: The causes of LUTD found in cats in this study are similar to those that have been previously documented, and idiopathic LUTD is the most frequent diagnosis. However, the rate of urethral obstruction, particularly in cats with idiopathic LUTD, was higher than in other reports. The cause of this difference is unknown. [source]

The influence of crystalloid type on acid,base and electrolyte status of cats with urethral obstruction

JOURNAL OF VETERINARY EMERGENCY AND CRITICAL CARE, Issue 4 2008
DACVECC, DACVIM (Medicine), Kenneth J. Drobatz DVM
Abstract Objective: To compare the effect of a balanced isotonic crystalloid solution with that of 0.9% sodium chloride on the acid,base and electrolyte status of cats with urethral obstruction. Design: Randomized prospective clinical trial. Setting: Academic veterinary emergency room. Animals: Sixty-eight cats with naturally occurring urethral obstruction. Interventions: Cats were randomized to receive either a balanced isotonic crystalloid solution (Normosol-R, n=39) or 0.9% sodium chloride (n=29) for fluid therapy. Baseline venous blood gas and blood electrolyte values were obtained at the time of admission and at intervals during the course of therapy. Measurements and main results: Baseline values were similar between groups. Cats receiving Normosol-R had a significantly higher blood pH at 12 hours, a significantly greater increase in blood pH from baseline at 6 and 12 hours, as well as a significantly higher blood bicarbonate concentration at 12 hours and a significantly greater increase in blood bicarbonate from baseline at 6 and 12 hours. Conversely, the increase in blood chloride from baseline was significantly higher at 2, 6, and 12 hours in cats receiving 0.9% sodium chloride. There were no significant differences in the rate of decline of blood potassium from baseline between groups. Subgroup analysis of hyperkalemic cats (K+>6.0 mmol/L) and acidemic cats (pH<7.3) yielded similar findings. Conclusions: While both crystalloid solutions appear safe and effective for fluid therapy in cats with urethral obstruction, the use of a balanced electrolyte solution may allow more rapid correction of blood acid,base status within the first 12 hours of fluid therapy. The use of a potassium-containing balanced electrolyte solution does not appear to affect the rate of normalization of blood potassium in treated cats with urethral obstruction. [source]

Uterus masculinus: an unusual complication in a case of feline urethral obstruction

JOURNAL OF VETERINARY EMERGENCY AND CRITICAL CARE, Issue 1 2006
Gabriella Sfiligoi DVM
Abstract A 6-year-old, male castrated domestic short hair cat presented for urethral obstruction. Despite passage of a urinary catheter, urine could not be drained through the catheter, but urine flow was noted around the catheter. Special imaging studies, including ultrasound and fluoroscopy, revealed that the catheter had been passed into an abnormal small bicornuate structure that entered the urethra from dorsally within the pelvic canal. This structure was believed to be a uterus masculinus or remnants of the Mullerian ducts. The anomalous structure was not felt to be related to the cause of the urethral obstruction, but was simply an incidental finding which resulted in difficult catheterization. [source]

Short-term effect of a single levodopa dose on micturition disturbance in Parkinson's disease patients with the wearing-off phenomenon

MOVEMENT DISORDERS, Issue 5 2003
Tomoyuki Uchiyama MD
Abstract We investigated the short-term effects of a single dose of levodopa (L -dopa) on micturition function in PD patients with wearing-off phenomenon. Eighteen PD patients who had median Hoehn and Yahr scores of 5 during the off phase and 3 during the on phase were recruited. We carried out urodynamic studies before and about 1 hour after the patients had taken 100 mg of L -dopa with dopa-decarboxylase inhibitor (DCI). After taking the L -dopa/DCI, urinary urgency and urge incontinence aggravated, whereas voiding difficulty was alleviated in all 12 patients. When compared to the baseline assessment, urodynamic study results after taking 100 mg of L -dopa/DCI showed aggravated detrusor hyperreflexia; decreased maximum bladder capacity (P = 0.006); an increased maximum Watts Factor value (P = 0.001), reflecting the detrusor power on voiding; an increased Abrams-Griffiths number (P = 0.042), reflecting urethral obstruction on voiding; decreased residual urine volume (P = 0.025); and increased static urethral closure pressure (P = 0.012). One hundred milligrams of L -dopa/DCI worsened detrusor hyperreflexia, producing worsened urinary urgency and urge incontinence during the storage (bladder-filling) phase. It also increased detrusor contractility much more than it did urethral obstruction in the voiding phase, producing overall lessening of voiding difficulty and improving voiding efficiency in our PD patients with the wearing-off phenomenon. © 2003 Movement Disorder Society [source]

Transobturator tape (TOT): Two years follow-up,

NEUROUROLOGY AND URODYNAMICS, Issue 1 2007
Saad Juma
Abstract Aims The aim of this study is to report the functional results, patient satisfaction, and morbidity of the Transobturator tape procedure (TOT) in the treatment of stress incontinence (SUI). Methods One hundred and thirty patients were prospectively evaluated with history, physical examination, quality of life questionnaire including Incontinence Impact Questionnaire (IIQ), urogenital distress inventory (UDI), and analog global satisfaction scale (GSS), and urodynamic studies. Results One hundred and seventeen patients (90%) had history of SUI, and 78 (60%) had urge incontinence. Pads/day (PPD) used was 2.48,±,2.42, and the score of IIQ 16.13,±,7.86, UDI 10.95,±,3.4, and GSS 1.41,±,1.67. All patients underwent TOT using the ObTapeÔ. Hospital stay was 0.84,±,0.76 days and catheter duration was 1.42,±,2.08 days. At a follow-up of 16.85,±, 4.68 months, 13 patients (10%) have recurrent SUI, 21 (16.15%) persistent urge incontinence, and 1 (1.92%) de novo urge incontinence. The mean PPD is 0.15,±,0.56, IIQ 1.47,±,5.14, UDI 3.28,±,3.09, and GSS 8.29,±,1.64. Two patients (1.52%) developed urethral obstruction, five (3.84%) had vaginal extrusion of the tape, and two (1.52%) had intra-operative bladder perforation. Conclusions These results demonstrate the safety and efficacy of the TOT. The short hospitalization and catheterization, low incidence of de novo urge incontinence and obstructive voiding offers a distinct advantage over existing techniques. No significant difference in outcome between patients with VLPP ,60 cm H2O, and patients with VLPP >60 cm H2O was observed. Neurourol. Urodynam. © 2006 Wiley-Liss, Inc. [source]

First report of overactive detrusor in association with hypospadias detected by urodynamic screening

Antenatal urodynamic studies in the fetal lamb: experimental protocol and preliminary results

PRENATAL DIAGNOSIS, Issue 3 2003
Renaud de Tayrac
Abstract Objectives To set up a fetal lamb model for intrauterine fetal urodynamic studies. Methods Fourteen fetal lambs underwent placement of a bladder catheter at a mean gestational age of 87 days. Three fetuses also had a partial urethral obstruction by the simultaneous placement of a peri-urethral constricting ring. Urodynamic and ultrasound studies were performed weekly by the filling cystometry method. Results Hundred and six voiding cycles were recorded during 25 urodynamic studies between 84- and 133-days gestation. All voiding profiles were biphasic with a mean duration of 4.2 min (range 1,10), a mean voiding pressure of 23 cm of water (range 7,33) and a mean periodicity of 19.2 min (range 11,50). The obstructed animals had bladder overactivity. This correlated with ultrasound and post-mortem findings of megacystis and bilateral hydroureteronephrosis. The fetal mortality rate was 85.7% and the mean duration of survival post surgery was 45 ± 5.7 days. Conclusion Serial urodynamic studies could be performed in a fetal lamb model. Following partial urethral obstruction, bladder overactivity was observed. Copyright © 2003 John Wiley & Sons, Ltd. [source]

Urodynamic evaluation of fesoterodine metabolite, doxazosin and their combination in a rat model of partial urethral obstruction

BJU INTERNATIONAL, Issue 2 2010
Claudius Füllhase
OBJECTIVE To evaluate the urodynamic effects of fesoterodine, a new antimuscarinic agent, alone and combined with doxazosin, in a rat model of partial urethral obstruction (PUO), as 35,83% of men with bladder outlet obstruction (BOO) secondary to benign prostatic hyperplasia (BPH) have overactive bladder (OAB) syndrome, and as the combination of ,1 -adrenoceptor- and muscarinic-receptor antagonists has been proposed to be beneficial for these patients. MATERIALS AND METHODS Thirty-seven male Sprague-Dawley rats (250 g) had surgically induced PUO; 2 weeks later they were evaluated by cystometry with no anaesthesia or any restraint. After a 1-h period either 5-hydroxymethyl tolterodine (5-HMT, the active metabolite of fesoterodine, previously known as SPM 7605), doxazosin or a combination of both, was given intravenously (0.1 mg/kg body weight), and cystometry was continued for another 45 min. Fifteen healthy, age-matched rats served as a control. RESULTS At 2 weeks after surgery the obstructed rats had an greater bladder weight, threshold pressure (TP) and micturition frequency (MF), and lower bladder capacity (BCap) and micturition volume (MV) than the controls. 5-HMT did not cause urinary retention in obstructed rats, but decreased TP, maximum pressure (MP), spontaneous bladder activity (SA) and, paradoxically, increased MF. Doxazosin alone decreased TP, MP, MF and increased BCap and MV. 5-HMT and doxazosin together did not depress the ability to empty the bladder, and showed decreased TP, MP and SA. CONCLUSIONS 5-HMT, alone and in combination, did not impair the voiding ability in obstructed rats. Doxazosin counteracted some of the ,negative' effects of 5-HMT in this model (increase of MF) and did not attenuate the ,positive' effects (decrease of bladder SA). In this model, the combination of 5-HMT and doxazosin appeared to be urodynamically safe and well tolerated. [source]

The pathophysiology of lower urinary tract symptoms after brachytherapy for prostate cancer

BJU INTERNATIONAL, Issue 6 2006
Jerry G. Blaivas
Brachytherapy for prostate cancer has many good effects, but is also associated, like every treatment, with side-effects, some of which have been previously reported in the BJU International. In this section, authors from New York assessed the pathophysiology underlying LUTS which persisted for at least 6 months after brachytherapy, and found a relatively high incidence of detrusor overactivity and other conditions affecting the lower urinary tract. OBJECTIVES To determine the spectrum of pathophysiology underlying the lower urinary tract symptoms (LUTS) persisting for ,,6 months after brachytherapy for localized prostate cancer. PATIENTS AND METHODS A database of men from two practice settings was searched for men who developed LUTS persisting for ,,6 months after completing brachytherapy for localized prostate cancer. Patients were evaluated with a structured history and physical examination, International Prostate Symptom Score (IPSS), 24-h voiding diary, noninvasive free-flow uroflowmetry, postvoid residual urine volume (PVR), cystoscopy and a video-urodynamic study. Specific data collected included symptoms, elapsed time since brachytherapy, Gleason score, IPSS, total number of voids/24 h, maximum voided volume, cystoscopic findings, and urodynamics findings (PVR, maximum urinary flow rate, Schaefer obstruction grade, Watts factor, incidence of detrusor overactivity (DO) urethral obstruction and low bladder compliance). These data were compared with those from a previous study of men with LUTS who did not have prostate cancer. RESULTS The study included 47 men (aged 54,88 years); the median (range) interval between brachytherapy and evaluation was 1.5 (0.5,13) years. Thirty-seven men complained of overactive bladder symptoms (79%), and 31 of incontinence (71%), 21 of obstructive symptoms (44%), and persistent dysuria in 12 (26%). Comparison of urodynamic findings in men with unselected causes of LUTS vs LUTS due to brachytherapy revealed the following comparisons: DO in 252 of 541 (47%) unselected vs 28 of 33 (85%) brachytherapy, (P < 0.001); and urethral obstruction in 374 of 541 (69%) unselected vs 24 of 33 (73%) brachytherapy (P = 0.85). CONCLUSION The pathophysiology and severity of persistent LUTS in men after brachytherapy differs from that of men with LUTS in the general population. Men after brachytherapy have a much higher incidence of DO, prostatic and urethral strictures and prostatic urethral stones. [source]

Congenital urethral obstruction: the video-endoscopic perspective

BJU INTERNATIONAL, Issue 5 2006
Yunfan (Chris) Lu
First page of article [source]

Penile epithelioid sarcoma and the case for a histopathological diagnosis in Peyronie's disease

BJU INTERNATIONAL, Issue 6 2003
M.F. Usta
Objectives To devise a set of clinical criteria that would identify which penile abnormality could be malignant and warrant biopsy, between Peyronie's disease (a pathological fibrosis involving the tunica albuginea of the penis) and epithelioid sarcoma (ES) of the penis (a rare malignant condition which can resemble Peyronie's disease in clinical presentation). Patients and methods The pathology reports and histological slides of men with Peyronie's disease who underwent penile biopsy were reviewed for ES. The medical charts of suspicious cases were then reviewed by a pathologist, unaware of the origin, for consistencies in signs, symptoms and clinical findings. These consistencies were then to be used to develop criteria for biopsy. Thirty-two men underwent penile biopsy from 1992 to 2001. Results Because there were no actual cases of ES, a specific set of criteria for ES could not be established. A review of previously published cases was then used for comparison with the present patients. Conclusions Many of the previously reported cases included signs and symptoms of urethral narrowing or compression, causing lower urinary tract symptoms. In addition, the penile nodule size was reported to progressively enlarge over time. Because of the high prevalence of Peyronie's disease and low prevalence of ES, biopsy of every penile nodule is not judicious. However, signs and symptoms of urethral obstruction, and a progressively growing and persistently painful nodule should suggest a possible malignancy and warrant biopsy. [source]