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Voiding Dysfunction (voiding + dysfunction)

Distribution by Scientific Domains

Medical Sciences	100%

Distribution within Medical Sciences

Urology	33%
Obstetrics & Gynecology	20%

Selected Abstracts

Non-invasive Assessments of Pediatric Voiding Dysfunction

LUTS, Issue 2 2009
Shang-Jen CHANG
In the evaluation of pediatric dysfunction, the initial approach relies on non-invasive diagnostic tools. Through these examinations, the possible etiology of pediatric voiding dysfunction may be identified, and children who require further evaluation with invasive diagnostic tools may be differentiated. In addition, these non-invasive diagnostic tools can be used as surrogate parameters for follow-up of voiding function in children with neurogenic or non-neurogenic voiding dysfunction. Updated information and controversy on this issue are provided and discussed in the present review. Thorough and well-organized history taking and focused physical examination are essential. A 2-day bladder diary and a 14-daysbowel movement diary, at least, should be recorded. Dysfunctional voiding symptom scores have been recommended for identifying children with possible voiding dysfunction. Consensus on which scoring system is best for clinical practice has not been reached. Low inter-observer agreement in interpreting specific types of abnormal uroflow pattern and high inter-observer agreement in identifying "no abnormality" make uroflowmetry a first-line screening tool for pediatric voiding dysfunction. Optimal bladder capacity is paramount in the interpretation of uroflowmetry curves and postvoid residual urine (PVR). Voided volume <50 mL is not eligible, while bladder over-distention may result in an abnormal uroflow pattern and increased PVR volume. Renal ultrasonography has been recommended for the evaluation of children with enuresis. However, the gain achieved through routine renosonography may be small. Thickened bladder wall thickness warrants further investigation of voiding dysfunction. However, inter- and intra-examiner's variability does not yet make this examination popular. [source]

Managing patients with an overactive bladder and glaucoma: a questionnaire survey of Japanese urologists on the use of anticholinergics

BJU INTERNATIONAL, Issue 1 2005
Kumiko Kato
OBJECTIVES To establish the views of urologists on the use of anticholinergic drugs for treating the overactive bladder (OAB) in patients with glaucoma. SUBJECTS AND METHODS In February 2004 a self-description questionnaire was mailed to all 417 urologists who were members of the Tokai Society of Voiding Dysfunction, to determine current practice in Japan for patients with an OAB and glaucoma. Subgroups were analysed between the types of practice and the duration since the urologists had graduated from medical school. RESULTS Of the 155 respondents, 76 (49%) routinely enquired about a history of glaucoma before prescribing anticholinergics, and 45 (29%) routinely referred patients with such a history to ophthalmologists. To treat patients with OAB and glaucoma, 102 (66%) would prescribe anticholinergics if permission were available from the ophthalmologist, 33 (21%) chose other treatments and 17 (11%) abandoned treatment. Forty-nine urologists (32%) were currently prescribing anticholinergics to patients with glaucoma. As to knowledge about glaucoma, 132 (85%) urologists knew that there were two types of glaucoma and 98 (63%) knew about laser iridotomy. The proportion of urologists who knew of the two types of glaucoma and asked patients for this information was significantly higher in university than in general hospitals (P < 0.05). CONCLUSIONS Although anticholinergic drugs can precipitate angle-closure glaucoma by pupillary block, they are not contraindicated in open-angle glaucoma or in angle-closure glaucoma that has already been treated by laser iridotomy. Not all urologists are aware of this difference, at least in Japan. Some urologists avoid anticholinergics in all patients with glaucoma, while others pay little attention to glaucoma. Routine history taking and referral to ophthalmologists allows many patients with OAB and glaucoma to benefit safely from anticholinergics. Moreover, clinicians should be aware of patients with OAB who have not been evaluated by ophthalmologists but who are at risk of angle-closure glaucoma. [source]

Herpes zoster-associated voiding dysfunction in hematopoietic malignancy patients

INTERNATIONAL JOURNAL OF DERMATOLOGY, Issue 1 2008
Shinichi Imafuku MD
Background, Voiding dysfunction is a rare but important complication of lumbo-sacral herpes zoster. Although the symptoms are transient, the clinical impact on immunocompromised patients cannot be overlooked. Methods, To clarify the time course of voiding dysfunction in herpes zoster, 13 herpes zoster patients with voiding dysfunction were retrospectively analyzed. Results, Of 13 patients, 12 had background disease, and six of these were hematopoietic malignancies; four of these patients were hematopoietic stem cell transplant (HSCT) recipients. Ten patients had sacral lesions, two had lumbar, and one had thoracic lesions. Interestingly, patients with severe rash, or with hematopoietic malignancy had later onset of urinary retention than did patients with mild skin symptoms (Mann,Whitney U analysis, P = 0.053) or with other background disease (P = 0.0082). Patients with severe skin rash also had longer durations (P = 0.035). In one case, acute urinary retention occurred as late as 19 days after the onset of skin rash. Conclusions, In immune compromised subjects, attention should be paid to patients with herpes zoster in the lumbo-sacral area for late onset of acute urinary retention even after the resolution of skin symptoms. [source]

Effect of a ,centralized intensive education system' for clean intermittent self-catheterization in patients with voiding dysfunction who start catheterization for the first time

INTERNATIONAL JOURNAL OF UROLOGY, Issue 7 2006
SEUNG-JUNE OH
Background:, This study evaluated the effects of a ,centralized intensive education system' (CIES) in terms of acquiring a proper clean intermittent self-catheterization (CISC) technique by patients with voiding dysfunction. Methods:, Between March 2002 and March 2003, we prospectively and consecutively enrolled 132 hospitalized patients who learnt and started CISC for the first time due to voiding dysfunction. Patients were enrolled either of two groups (the CIES group vs the ,individualized ward education system'[IWES] group) at the time of the urologic consultation for voiding dysfunction. Out of 132 patients who enrolled in the study, 112 (45 males and 67 females, mean age 57.3 with a range of 18,81) were included in the primary analyses. The questionnaire was applied immediately before discharge. Results:, There were similar patient demographics and clinical parameters for the CIES (n = 62) and the IWES groups (n = 50). Of 10 items including the methodology of CISC, six items discriminated significantly in favor of the CIES (P < 0.05). The patient satisfaction with CISC education was significantly different for the two groups in terms of response to the questionnaire. The CIES group was found to be more satisfied with the education received than the IWES group (P < 0.05). Moreover, the number of trials to gain confidence to perform CISC in CIES group was significantly fewer than that of IWES group (P < 0.001). Conclusion:, Our results demonstrate that CIES might be a superior training program for the patients with voiding dysfunction to acquire a proper CISC technique to the conventional IWES. [source]

Urodynamic findings in children with cerebral palsy

INTERNATIONAL JOURNAL OF UROLOGY, Issue 8 2005
M IHSAN KARAMAN
Abstract Aim: More than one-third of children with cerebral palsy are expected to present with dysfunctional voiding symptoms. The voiding dysfunction symptoms of the cerebral palsy patients in the present study were documented. Methods: Of the study group, 16 were girls and 20 were boys (mean age: 8.2 years). Children with cerebral palsy were evaluated with urodynamics consisting of flow rate, filling and voiding cystometry, and electromyography findings of the external urethral sphincter to determine lower urinary tract functions. Treatment protocols were based on the urodynamic findings. Anticholinergic agents to reduce uninhibited contractions and to increase bladder capacity were used as a treatment. Clean intermittent catheterization and behavioral modification were used for incomplete emptying. Results: Of the children, 24 (66.6%) were found to have dysfunctional voiding symptoms. Daytime urinary incontinence (47.2%) and difficulty urinating (44.4%) were the most common symptoms. Urodynamic findings showed that neurogenic detrusor overactivity (involuntary contractions during bladder filling) with a low bladder capacity was present in 17 (47.2%) children, whereas detrusor,sphincter dyssynergia was present in four patients (11%). The mean bladder capacity of patients with a neurogenic bladder was 52.2% of the expected capacity. Conclusions: The present study concluded that voiding dysfunction was seen in more than half of the children with cerebral palsy, which is a similar result to other published studies. We propose that a rational plan of management of these patients depends on the evaluation of the lower urinary tract dysfunction with urodynamic studies. These children benefit from earlier referral for assessment and treatment. [source]

Non-invasive Assessments of Pediatric Voiding Dysfunction

Lower urinary tract symptoms following neurological illness may be influenced by multiple factors: Observations from a neurorehabilitation service in a developing country,,

NEUROUROLOGY AND URODYNAMICS, Issue 3 2010
Jalesh N. Panicker
Abstract Aims To evaluate the pattern of lower urinary tract dysfunction (LUTD) in patients with neurological disease in the setting of a rehabilitation service in a developing country, and analyze causes for unexpected lower urinary tract symptoms (LUTS). Methods Patients with neurological disorders and having significant LUTS were prospectively evaluated. Level of neurological lesion was localized by neurological examination and investigations. LUTD was evaluated by symptom analysis, bladder diaries and ultrasonography. Storage symptoms were managed using antimuscarinic medications and voiding dysfunction, when significant, was managed by catheterization and patients were regularly followed up. Patients with symptoms that had not been expected based upon their level of neurological lesion were further evaluated. Results Fifty patients (mean age 43.5,±,18.3 years) were included and according to neurological localization, were categorized into suprapontine (n,=,9; 18%), infrapontine/suprasacral (n,=,25; 50%) or infrasacral (n,=,16; 32%) groups. Incontinence was more common in patients with suprapontine and infrapontine/suprasacral lesions (n,=,20) (P,<,0.03), hesitancy more common with infrapontine/suprasacral lesions (n,=,20) (P,=,0.004) and retention more with infrasacral lesions (n,=,13) (P,<,0.001). Patients belonging to suprapontine and infrapontine/suprasacral groups more likely showed improvement at follow up (P,=,0.008). Fourteen patients (28%) had unexpected LUTS and this was due to urological causes (n,=,6) or multiaxial neurological involvement (n,=,8). Potentially treatable factors were managed, resulting in symptom relief. Conclusion LUTS in neurological disease may be at variance with the pattern expected based upon level of neurological lesion. Such patients may require further evaluation and consideration should be given to concomitant urological conditions and multiaxial neurological involvement. Neurourol. Urodynam. 29:378,381, 2010. © 2009 Wiley-Liss, Inc. [source]

Unilateral versus bilateral stage I neuromodulator lead placement for the treatment of refractory voiding dysfunction

NEUROUROLOGY AND URODYNAMICS, Issue 8 2008
Khanh Pham
Abstract Aims To determine if bilateral S3 lead placement during the stage I trial period improves the "success" rate for advancing to stage II (permanent) sacral neuromodulator placement. Methods A retrospective chart review of 124 (20 male and 104 female) patients undergoing stage I sacral neuromodulation (InterStim®, Medtronic, Minneapolis, Minnesota) implantation for the treatment of refractory voiding dysfunction was performed. Patients were divided into two cohorts based on unilateral versus bilateral stage I lead placement in the S3 foramina. Both groups were then evaluated and compared with regards to overall "success", defined as progression from stage I to stage II placement. Results Fifty-five (44%) patients underwent unilateral stage I lead placement and 69 (56%) received bilateral S3 leads. Successful stage I trials were reported in 32/55 (58%) and 53/69 (76%) of unilateral and bilateral cohorts, respectively (P,=,0.03). Five wound infections were reported,2 (3.6%) following unilateral and 3 (4.3%) after bilateral stage I lead placement. No other complications were encountered. Conclusions Bilateral stage I neuromodulation trial provides a significantly higher rate of improvement in refractory voiding symptoms to allow for the progress to stage II implantation. Neurourol. Urodynam. 27:779,781, 2008, © 2008 Wiley-Liss, Inc. [source]

Sacral nerve stimulation for voiding dysfunction: One institution's 11-year experience,

NEUROUROLOGY AND URODYNAMICS, Issue 1 2007
Suzette E. Sutherland
Abstract Aim The purpose of this study was to review our institution's 11-year experience with SNS for the treatment of refractory voiding dysfunction. Dating back to 1993, it covers a span of time which describes the evolution of SNS as it includes PNE trials, non-tined (bone-anchored or fascial-anchored) leads, percutaneous tined leads with two-staged procedures, and even percutaneous pudendal trials. Methods A retrospective review was performed on SNS patients who received an implantable pulse generator (IPG) in our practice from 12/1993 to 12/2004. After Institutional Review Board approval, consents for chart review were obtained from 104 patients, representing 44% of this neuromodulatory patient population. Results Of our population, 87% were female and 13% were male. Average age at implant was 50 years,±,13.4 years. Duration of symptoms before implantation was 116 months (range 9,600 months). Eighty percent were implanted for a predominant complaint of urinary urgency and frequency (U/F). Overall, 22% had U/F only, 38% had concomitant urge incontinence (UI), and 20% had concomitant mixed incontinence (MI). Twenty percent were treated for non-obstructive urinary retention (UR), with half of these associated with a neurogenic etiology. Additionally, 46.2% had pelvic pain, 58.6% had bowel complaints, and 51% reported sexual dysfunction. In patients with U/F, mean voiding parameters as described by pre-implant voiding diaries revealed the following: 12.4 (±5.1) voids per 24 hr; 2.3 (±1.8) voids per night; 5.0 (±4.7) leaks per 24 hr; and 2.3 (±2.6) pads per 24 hr. Statistically significant improvements post-implantation were noted with mean decreases in the following: 4.3 voids per 24 hr; 1.0 void per night; 4.4 leaks per 24 hr; and 2.3 pads per 24 hr (all P,<,0.05). In the UR group a statistically significant improvement post-implantation was noted only in voids per night, with a mean decrease of 0.8 (P,<,0.05). With a mean follow up of 22 months (range 3,162 months), sustained subjective improvement was >50%, >80%, and >90% in 69%, 50%, and 35% of patients, respectively. By quality of life survey, 60.5% of patients were satisfied and 16.1% were dissatisfied with current urinary symptoms. Only 13% (14 patients) abandoned therapy, making up a significant portion of those dissatisfied with current urinary symptoms. Good overall lead durability was seen (mean 22 months, range 1,121 months), with the first successful lead proving to be the most durable (mean 28 months, range 1.4,120 months). Lead durability decreased progressively with subsequent trials. Overall, 53% of patients experienced at least one reportable event (RE) attributable to either lead or IPG. A total of 126 REs were noted, with 97% mild-to-moderate in severity. REs included lack of efficacy, loss of efficacy, infection, hematoma/seroma, migration, pain, undesirable change in sensation, and device malfunction. In this population, 47.1% of leads were tined while 52.9% were non-tined. Tined leads had an overall lower RE rate as compared to non-tined leads: 28% and 73%, respectively. Conclusions SNS is an effective method for treating certain types of voiding dysfunction. Although 53% of patients experienced at least one RE, 97% were mild-to-moderate and did not appear to affect the continued use of this therapy. With improved technology, such as percutaneous tined leads, the RE rate is decreasing. Further analyses of subsets of this population are currently underway. Neurourol. Urodynam. © 2006 Wiley-Liss, Inc. [source]

Presentation and management of major complications of midurethral slings: Are complications under-reported?,

NEUROUROLOGY AND URODYNAMICS, Issue 1 2007
Donna Y. Deng
Abstract Aims Midurethral slings have become the mainstay of stress urinary incontinence (SUI) treatment due to their efficacy and low complication rates. The purpose of this study was to report the presentation and treatment of major complications from these minimally invasive treatments presented to a tertiary referral practice and to highlight a discrepancy in major complications between literature and the food and drug administration (FDA) device failure database. Methods From 2001 through 2005, we reviewed all cases of midurethral sling complications that presented to our institution. A literature review of all complications due to midurethral slings during the same time period was performed as was the FDA manufacturer and user facility device experience (MAUDE) database queried for self-reported complications. Results A total of 26 patients referred to UCLA with voiding dysfunction after sling placement was found to have mesh in the urethra or bladder. Treatments required a combination of urethrolysis with mesh removal, urethral reconstruction with graft, and bladder excision. These were compared to major complications reported in the world literature of <1%. The MAUDE database contained 161 major complications out of a total of 928 complications reported for suburethral slings. There was significantly more major complications reported in MAUDE than in published literature. Conclusions Although rare, major complications of midurethral slings are more common than appear in literature. Devastating complications involving urethral and bladder perforations can present with mild urinary symptoms and thus are likely under-diagnosed and under-reported. Most of these cases need to be managed with additional reconstructive surgery. Neurourol. Urodynam. © 2006 Wiley-Liss, Inc. [source]

Urinary incontinence and voiding dysfunction after radical retropubic prostatectomy (prospective urodynamic study)

NEUROUROLOGY AND URODYNAMICS, Issue 1 2006
Attila Majoros
Abstract Aims During this prospective study we analyzed the effects of radical retropubic prostatectomy (RRP) on bladder and sphincter function by comparing preoperative and postoperative urodynamic data. The aim of the study was to determine the reason for urinary incontinence after RRP and explain why one group of patients will be immediately continent after catheter removal, while others need some time to reach complete continence. Methods Urodynamic examination was performed in 63 patients 3,7 days before and 2 months after surgery. Results Forty-three (68.2%) and 53 (84.1%) patients regained continence at 2 and 9 months following RRP, respectively. Ten patients (15.9%) were immediately continent after catheter removal. Urodynamic stress incontinence was detected in 18 (28.6%), and detrusor overactivity incontinence in 2 (3.2%) patients 2 months after surgery. The amplitude of preoperative maximal voluntary sphincteric contractions was significantly higher in the postoperative continent group (125 vs. 96.5 cmH2O, P,<,0.0001). The patients who were immediately continent following catheter removal had no lower urinary tract symptoms (LUTS) and urodynamic abnormality preoperatively, and they had significantly higher preoperative and postoperative maximum urethral closure pressure (at rest and during voluntary sphincter contraction) than those who became continent later on. Conclusions These data suggest that the main cause of incontinence after RRP is sphincteric weakness. In the continent group, those who became immediately continent had significantly higher maximum urethral closure pressure values at rest and at voluntary sphincteric contraction even before the surgery. Neurourol. Urodynam. © 2005 Wiley-Liss, Inc. [source]

Botulinum toxin for the treatment of lower urinary tract symptoms: A review

NEUROUROLOGY AND URODYNAMICS, Issue 1 2005
A. Sahai
Abstract Aims To review the available literature on the application of botulinum toxin in the urinary tract, with particular reference to its use in treating detrusor overactivity (DO). Methods Botulinum toxin, overactive bladder (OAB), detrusor instability, DO, detrusor sphincter dyssynergia (DSD), and lower urinary tract dysfunction were used on Medline Services as a source of articles for the review process. Results DO poses a significant burden on patients and their quality of life. Traditionally patients have been treated with anti-cholinergic drugs if symptomatic, however, a significant number find this treatment either ineffective or intolerable due to side effects. Recent developments in this field have instigated new treatment options, including botulinum toxin, for patients' refractory to first line medication. Botulinum toxin, one of the most poisonous substances known to man, is a neurotoxin produced by the bacterium Clostridium botulinum. Botulinum toxin injections into the external urethral sphincter to treat detrusor sphincter dyssynergia has been successfully used for some years but recently its use has expanded to include voiding dysfunction. Intradetrusal injections of botulinum toxin into patients with detrusor overactivity and symptons of the overactive bladder have resulted in significant increases in mean maximum cystometric capacity and detrusor compliance with a reduction in mean maximum detrusor pressures. Subjective and objective assessments in these patients has shown significant improvements that last for 9,12 months. Repeated injections have had the same sustained benefits. Conclusions Application of botulinum toxin in the lower urinary tract has produced promising results in treating lower urinary tract dysfunction, which needs further evaluation with randomised, placebo-controlled trials. © 2004 Wiley-Liss, Inc. [source]

Is detrusor hypertrophy in women associated with voiding dysfunction?

AUSTRALIAN AND NEW ZEALAND JOURNAL OF OBSTETRICS AND GYNAECOLOGY, Issue 6 2009
Orawan LEKSKULCHAI
Background:, In men, bladder wall thickness ,5 mm seems to be a useful predictor of outlet obstruction, with a diagnostic value exceeding that of free uroflowmetry indices. There are no data in the literature examining whether this may also apply in women. Aims:, To identify the relationships between detrusor wall thickness (DWT) and symptoms and urodynamic findings suggestive of voiding dysfunction. Methods:, This is a retrospective study analysing data sets of 686 women seen for urodynamic testing in a tertiary urogynaecological unit. Hesitancy, poor stream and stop,start voiding were recorded as symptoms of voiding dysfunction. All women underwent free uroflowmetry and multichannel urodynamic testing. We used the urethral resistance factor (URA) and the obstruction coefficient (OCO), methods employed to quantify bladder outlet resistance in men. Transperineal ultrasound for DWT was performed after voiding and catheter removal. Statistical analysis was carried out by using the statistical software (spss 15.0; SPSS Inc., Chicago, IL, USA). Results:, Symptoms of voiding dysfunction were reported by 33.1% of patients and 22.4% had urodynamically diagnosed voiding dysfunction. The mean DWT in symptomatic women was not statistically different from the mean DWT in those without symptoms. URA and OCO of symptomatic women were significantly different from those of asymptomatic women (P < 0.01). DWT was not associated with parameters of voiding function, URA or OCO. Conclusions:, Contrary to the situation in men, increased DWT in women does not seem to be associated with symptoms or signs of voiding dysfunction. Therefore, DWT cannot be used as a predictor of voiding difficulty in women. [source]

Morbidity of incontinence surgery in women over 70 years old: a retrospective cohort study

BJOG : AN INTERNATIONAL JOURNAL OF OBSTETRICS & GYNAECOLOGY, Issue 6 2005
Harriet Pugsley
Objective To compare the success rate and complications after colposuspension and tension-free vaginal tape (TVT) insertion in women aged 70 years or more compared with younger women. Design A retrospective study of patients having surgery between November 2000 and October 2002. Setting A tertiary referral, academic urogynaecology unit in a University teaching hospital. Population Two hundred and twenty-six women having surgical treatment for urinary incontinence. Methods Data on cure/improvement and complications were extracted from the notes. Patients were grouped by age at surgery and the odds ratios (OR) and 95% confidence intervals (CI) for each outcome were calculated. Main outcome measures Subjective cure rate and the incidence of complications by age group. Results One hundred and three patients had colposuspension, 11 (10.7%) aged 70 or more. One hundred and twenty-three patients had TVT insertions, 23 (18.7%) aged 70 or more. The cure rate for each procedure was similar between age groups. After colposuspension, urinary tract infection (UTI; OR 11.33; 95% CI 2.61, 49.28) and long term self-catheterisation (percentage of difference 9.1; 95% CI 3.0, 15.2) were more common in women over 70. After TVT, repeat urodynamics (OR 3.91; 95% CI 1.11, 13.76), recurrent UTI (OR 4.22; 95% CI 1.03, 17.26) and tape division (OR 29.12; 95% CI 3.20, 264.86) were more common in older women. Conclusions Incontinence surgery carries a higher risk of complications in the elderly including UTI and voiding dysfunction. Extended antibiotic prophylaxis and intermittent self-catheterisation training should be offered to elderly women before surgery. [source]

Why do women have voiding dysfunction and de novo detrusor instability after colposuspension?

BJOG : AN INTERNATIONAL JOURNAL OF OBSTETRICS & GYNAECOLOGY, Issue 4 2002
L. Bombieri
Objective To investigate the causes of voiding dysfunction and new detrusor instability after colposuspension. Design Prospective, observational study. Setting Urogynaecology unit, district general hospital. Population Seventy-seven women undergoing colposuspension for genuine stress incontinence. Methods The following factors were investigated: 1. bladder neck elevation by magnetic resonance imaging before and after surgery; 2. urethral compression by measuring bladder neck approximation to the pubis with magnetic resonance imaging after surgery (anterior compression) and the distance between the medial stitches during surgery (lateral compression); 3. clinical and urodynamic factors. Main outcome measures 1. Post-operative voiding function (i.e. first day of voiding and day of catheter removal); 2. objective evidence of detrusor instability three months post-operatively. Results Pre-operative peak flow rate (P= 0.004), straining during voiding (P= 0.005), increasing age (P< 0.001), operative elevation (P< 0.001) and anterior urethral compression (P= 0.001) were associated with the number of days of post-operative catheterisation. Increasing age (P= 0.02), previous bladder neck surgery (P= 0.04), operative elevation (P= 0.049) and anterior urethral compression (P< 0.001) were associated with detrusor instability at three months. Conclusion Surgical factors (bladder neck elevation and compression) are associated with voiding dysfunction and detrusor instability after colposuspension. These findings have implications for prevention. [source]

Improved sacral neuromodulation in the treatment of the hyperactive detrusor: signal modification in an animal model

BJU INTERNATIONAL, Issue 7 2003
C. Seif
OBJECTIVE To investigate different stimulation signals for the peripheral nerve evaluation test (PNE, carried out before implanting a sacral neuromodulator for functional voiding dysfunction) in an animal model and to determine their efficacy, as up to 80% of patients do not respond to the PNE test. MATERIALS AND METHODS PNE foramen electrodes were placed in the S3 of 12 anaesthetized Göttingen minipigs. First, detrusor instabilities were induced by the intravesical instillation of formalin. A 10-min stimulation phase with both a quasi-trapezoidal (QT) signal and a rectangular signal followed. An interval of 30 min elapsed between the series of stimulations. The attained bladder pressure values were registered on a urodynamic unit and evaluated as contractions and amplitudes per minute. Six minipigs were treated in the same way but were not stimulated and served as a control group. RESULTS After formalin instillation, the mean (sd) number of involuntary detrusor contractions was 3.5 (0.8)/min and the sum of amplitudes 7.2 (1.1) cmH2O/min. Subsequent NaCl instillation and QT-stimulation reduced the contractions to 0.3 (0.3)/min and the sum of amplitudes to 0.8 (0.4) cmH2O/min. Stimulation with a rectangular signal, as used in the PNE test, followed after an interval of 10 min, giving 1.1 (0.1) contractions/min and a sum of amplitudes of 5.1 (2.4) cmH2O/min. Within the control group there was no significant reduction. CONCLUSIONS These results show that QT-stimulation suppresses uncontrollable detrusor contractions in the minipig more effectively than the conventional rectangular stimulation presently applied in sacral neuromodulation. [source]

Reduction in nocturnal functional bladder capacity is a common factor in the pathogenesis of refractory nocturnal enuresis

BJU INTERNATIONAL, Issue 3 2002
C.K. Yeung
Objective,To evaluate the diurnal and nocturnal bladder reservoir function in patients with refractory primary nocturnal enuresis (PNE). Patients and methods,Ninety-five children (68 boys, 27 girls, mean age 9.3 years) with significant PNE (3 wet nights/week) that was refractory to treatment with desmopressin ± an enuretic alarm were assessed using detailed recording of voiding frequency and urinary volume both day and night, natural filling cystometry during the day and continuous cystometry with simultaneous electroencephalogram monitoring during sleep at night. Results,Patients could be broadly categorized into two groups. Group A comprised those with normal daytime urodynamics and functional bladder capacity (FBC) on detailed frequency-volume recording, but who developed marked detrusor instability associated with a significant reduction in nocturnal FBC and small-volume voiding only after sleep at night (33 patients, 35%); and group B, those with abnormal daytime urodynamics and with reduced FBC and small-volume voiding both day and night, but who somehow managed to mask their bladder symptoms during the day (62 patients, 65%). There was no evidence of nocturnal polyuria in either group and the ratios of day,:,night urinary output volumes for type A and type B patients were 1.48 and 1.99, respectively. Conclusions,A reduction in nocturnal FBC, either occurring only after sleep at night in association with the appearance of detrusor instability in patients with normal daytime urodynamics and FBC, or as a manifestation of occult voiding dysfunction or bladder outlet obstruction that affects the bladder reservoir function both day and night, appears to be a common factor and probably the main cause for a mismatch between nocturnal urine output and bladder storage capacity in patients with severe bed-wetting that was refractory to treatment. [source]

Nephrocalcinosis in children: a retrospective multi-centre study

ACTA PAEDIATRICA, Issue 10 2009
Anita Ammenti
Abstract Aim:, To review the data of children with NC and to analyse aetiology, clinical manifestations, growth and renal function at presentation; to relate growth and renal function to changes in NC in patients with a follow-up of at least 12 months. Methods:, Data of 41 children from four institutions were gathered retrospectively. Results:, Presenting symptoms were failure to thrive in the first year of life (41%), urinary tract infections, bladder voiding dysfunction or abdominal pain (17%) and psychomotor delay (10%). In 24% of cases NC was detected incidentally. Glomerular function at diagnosis was normal in 83% of children. During a median follow-up of 4 yrs and 5 months in 28 patients, growth standard deviation score improved from a median of ,2.2 to ,1.0 and glomerular function remained stable in 89% of patients, in spite of worsening of the degree of NC in 62% of cases. The most frequent causes of NC were hereditary tubulopathies and vitamin D intoxication. Conclusion:, Our results show that the treatment of the underlying conditions is associated with catch-up growth and stabilization of glomerular function in many children, but not with the reduction in the degree of NC in the majority of cases. We believe that early recognition of conditions leading to NC is clinically useful and suggest a diagnostic flowchart, which may be helpful in the approach to NC. [source]