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Outlet Obstruction (outlet + obstruction)
Kinds of Outlet Obstruction Selected AbstractsOmental free flap reconstruction in complex head and neck deformities,HEAD & NECK: JOURNAL FOR THE SCIENCES & SPECIALTIES OF THE HEAD AND NECK, Issue 4 2002Albert Losken MD Abstract Background Microvascular free flaps continue to revolutionize coverage options in head and neck reconstruction. This article reviews our 25-year experience with omental free tissue transfers. Methods All patients who underwent free omental transfer to the head and neck region were reviewed. Results Fifty-five patients were included with omental transfers to the scalp (25%), craniofacial (62%), and neck (13%) region. Indications were tumor resections, burn wound, hemifacial atrophy, trauma, and moyamoya disease. Average follow-up was 3.1 years (range, 2 months,13 years). Donor site morbidities included abdominal wound infection, gastric outlet obstruction, and postoperative bleeding. Recipient site morbidities included partial flap loss in four patients (7%) total flap loss in two patients (3.6%), and three hematomas. Conclusions The omental free flap has acceptable abdominal morbidity and provides sufficient soft tissue coverage with a 96.4% survival. The thickness \and versatility of omentum provide sufficient contour molding for craniofacial reconstruction. It is an attractive alternative for reconstruction of large scalp defects and badly irradiated tissue. © 2002 Wiley Periodicals, Inc. Head Neck 24: 326,331, 2002; DOI 10.1002/hed.10082 [source] Pancreatico-duodenectomy for complicated groove pancreatitisHPB, Issue 3 2007SAKHAWAT H. RAHMAN Objectives. Groove pancreatitis (GP) describes a form of segmental pancreatitis, which affects the pancreatic head at the interface with the duodenum, and is frequently associated with ectopic pancreatic tissue in the duodenal wall. We present a series of symptomatic patients with complicated GP who underwent pancreaticoduodenectomy, and review the diagnostic challenges, imaging modalities, pathological features and clinical outcome of this rare condition. Patients and methods. This was a prospective case base study of clinical, radiological and pathological data collected between the years 2000 and 2005 on patients diagnosed with severe GP , confirmed by histopathological examination following pancreaticoduodenectomy. Results. In total 11 patients were included, presenting with chronic abdominal pain (n= 11), gastric outlet obstruction (n= 5) and jaundice (n= 1). Exocrine dysfunction with associated weight loss (median > 9 kg) was present in 10 patients, and type 2 diabetes in 2 patients. Radiological imaging (CT/MRCP/EUS) provided complementary investigations and correlated well with classic histopathological findings (duodenal wall thickening, mucosal irregularity and Brunner's gland hyperplasia, duodenal wall cysts and pancreatic heterotropia). Following pancreaticoduodenectomy (median follow-up period 52 weeks) all patients experienced significant pain alleviation and weight gain (average 3 kg at 2 months). Conclusion. Pancreaticoduodenectomy is associated with significant improvements in weight gain and alleviates the chronic pain associated with severe GP. [source] ,Cross-section gastroenterostomy' in patients with irresectable periampullary carcinomaHPB, Issue 2 2001O Horstmann Background The most frequent complication following gastroenterostomy (GE) for gastric outlet obstruction is delayed gastric emptying (DGE), which occurs in roughly 20% of patients. There is evidence that DGE may be linked to the longitudinal incision of the jejunum and that a transverse incision (cross-section GE) may decrease the incidence of DGE following GE. Patients and methods In contrast to the orthodox GE, the jejunum is severed transversely up to a margin of 1.5 cm at the mesenteric border and the anastomosis is created with a single running suture. A Braun anastomosis is added 20,30 cm distally to the GE. Patients were followed prospectively with special regard to the occurrence of DGE. Results Between 1 August 1994 and 1 August 1998, 25 patients underwent cross-section GE, mostly because of an irresectable periampullary carcinoma. Eight patients exhibited clinical signs of gastric outlet obstruction preoperatively, while in 17 the GE was performed on a prophylactic basis. A biliary bypass was added in 15 patients. There was no disruption of the GE, but one patient died in hospital (4%). The nasogastric tube was withdrawn on the first postoperative day (range 0,6 days), a liquid diet was started on the fifth day (range 2,7 days) and a full regular diet was tolerated at a median of 9 days (6,14 days). The incidence of DGE was 4%: only the single patient who died fulfilled the formal criteria for DGE. Discussion In contrast to orthodox GE, DGE seems to be of minor clinical importance following cross-section GE. As the technique is easy to perform, is free of specific complications and leads to a low incidence of DGE, it should be considered as an alternative to conventional GE. [source] Gastric adenocarcinoma mistakenly diagnosed as an eating disorder: Case reportINTERNATIONAL JOURNAL OF EATING DISORDERS, Issue 3 2010FRANZCP, Leit-Chin Siew MBBS Abstract Objective: A number of organic conditions may mimic the symptoms of an eating disorder, however, gastric outlet obstruction mimicking anorexia nervosa has rarely been reported. Method: We report the case of a 51-year-old female admitted to an eating disorders unit with an initial diagnosis of anorexia nervosa. Results: The patient's upper gastrointestinal symptoms and weight loss were found to be secondary to gastric outlet obstruction from a gastric adenocarcinoma. Coincidental psychosocial stressors and past psychiatric history, among other factors, had confounded the diagnosis. Discussion: Organic causes of weight loss and upper gastrointestinal symptoms need to be fully excluded prior to making the diagnosis of an eating disorder, particularly when there are atypical features in the presentation. © 2009 by Wiley Periodicals, Inc. Int J Eat Disord 2010 [source] Changes of bladder activity and glycine levels in the lumbosacral cord after partial bladder outlet obstruction in ratsINTERNATIONAL JOURNAL OF UROLOGY, Issue 9 2008Minoru Miyazato Objectives: We investigated the time course of changes in bladder activity as well as in spinal and serum levels of glutamate and glycine after partial bladder outlet obstruction (BOO) in rats. Methods: A total of 36 female rats were divided into six groups: sham operation (control); 3 days, 14 days, and 28 days after BOO; 3 days and 28 days after relief of BOO. Under urethane anesthesia, isovolumetric cystometry was carried out in each group. Then, spinal and serum levels of glutamate and glycine were measured. Results: The interval between bladder contractions was shorter in all of the groups compared with the control group. The amplitude and duration of bladder contractions was decreased at 3 days, 14 days, and 28 days after BOO, and at 3 days after relief of BOO. Spinal and serum glutamate levels showed no changes. However, the spinal glycine level was decreased at 14 days and 28 days after BOO, and at 28 days after relief of BOO. Serum glycine level was also decreased at 28 days after BOO and 28 days after relief of BOO. Conclusions: Detrusor overactivity during the chronic phase of partial BOO is partly caused by a decrease of glycinergic neuronal activity in the lumbosacral cord. A 3-day period of BOO produces detrusor overactivity, which might be due to an irreversible decrease of spinal glycinergic neuronal activity. [source] Comparison of intravesical prostatic protrusion, prostate volume and serum prostatic-specific antigen in the evaluation of bladder outlet obstruction (Author's Reply)INTERNATIONAL JOURNAL OF UROLOGY, Issue 7 2007Kok Bin Lim No abstract is available for this article. [source] Bladder smooth muscle cell phenotypic changes and implication of expression of contractile proteins (especially caldesmon) in rats after partial outlet obstructionINTERNATIONAL JOURNAL OF UROLOGY, Issue 6 2003SEIJI MATSUMOTO Abstract Background: The purpose of the present study was to investigate morphological changes in bladder smooth muscle of rats with partial outlet obstruction. We investigated smooth muscle cell phenotypic changes and implication of synthetic phenotype in contractility decrease and bladder compliance after bladder outlet obstruction. Methods: Partial bladder outlet obstruction was introduced in female rats. Bladder were removed at 1, 3, 6, 10 and 20 weeks after the obstruction. Temporal pattern of changes in bladder mass, light microscopic pathogenesis and phenotypic expression of the bladder smooth muscle cells in the electron micrographs were investigated. Expression of contractile protein was also investigated by the immunoblotting method. Results: Marked increase in bladder mass with marked thickening of smooth muscle layer was observed at 1 week after obstruction. The ratio of myocytes exhibiting contractile and synthetic phenotypes was almost constant until 6 weeks after the obstruction, but thereafter, synthetic phenotypes gradually increased and the ratio (synthetic/contractile phenotype) was 1.5-fold at 20 weeks after the obstruction. Caldesmon was most markedly expressed after the obstruction among contractile proteins examined by the immunoblotting method. Conclusion: Phenotypic changes were confirmed in bladder smooth muscle, and the decrease of the ratio of contractile phenotype was observed after long-term obstruction of the bladder outlet. Among the contractile proteins in the bladder smooth muscle cell, caldesmon was considered a reliable marker for predicting the pathogenetic conditions of the bladder. [source] Adenoid cystic carcinoma of the prostate: A case report with immunohistochemical and in situ hybridization staining for prostate-specific antigenINTERNATIONAL JOURNAL OF UROLOGY, Issue 8 2001Sadatsugu Minei Abstract A 43-year-old man with urinary outlet obstruction was referred to our hospital. A digital rectal examination revealed an elastic hard prostate. The serum prostate-specific antigen (PSA), serum prostatic acid phosphate and ,-seminoprotein levels were found to be within the normal range, and transrectal ultrasound sonography provided normal findings. The patient underwent a subcapsular prostatectomy under a diagnosis of benign prostatic hyperplasia. Histopathologically, the lesion was diagnosed as an adenoid cystic carcinoma of the prostate. Because a further examination revealed a pathologic extension into the urinary bladder, a radical cystoprostatectomy was performed. The expression of PSA protein and PSA mRNA was studied by means of immunohistochemistry and an in situ hybridization technique. The adenoid cystic carcinoma in the patient did not show any positive signs for PSA protein or PSA mRNA. [source] The Relationship Between the Action of Arginine Vasopressin and Responsiveness to Oral Desmopressin in Older Men: A Pilot StudyJOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 4 2007Theodore M. Johnson II OBJECTIVES: To identify whether oral desmopressin (ddAVP) reduced nocturnal urine volume (NUV) in older men with nocturia without obvious bladder outlet obstruction and to determine whether deficiencies in arginine vasopressin (AVP) release and action demonstrated using water deprivation testing predicted responsiveness to ddAVP. DESIGN: Participants had a 2-day Clinical Research Center (CRC) evaluation followed by a double-blinded, placebo-controlled, crossover trial of individually titrated oral ddAVP. SETTING: Participants were from a single Department of Veterans Affairs Medical Center. MEASUREMENTS: Maximum urine osmolality and percentage increase in osmolality were measured after subjects received aqueous vasopressin as part of the overnight water deprivation study; these data were used to categorize participants as normal, having partial central AVP deficiency, or having impaired renal responsiveness to AVP. Response to ddAVP was assessed using data from frequency-volume records. RESULTS: Fourteen participants completed the CRC stay and ddAVP trial. Subjects given ddAVP reduced NUV significantly from baseline (P=.02) and had significantly lower NUV than when on placebo (P=.01). The mean net reduction in NUV from ddAVP compared to placebo was 14±18%. Using water deprivation testing to categorize participants, 10 were normal, two had partial central AVP deficiency, and two had impaired renal responsiveness. The mean net reduction in NUV for those with abnormal water deprivation tests was 11±25%, versus 15±16% for those with normal water deprivation testing (P=.70). CONCLUSION: In this small randomized, controlled trial in older men with nocturia, ddAVP reduced NUV. Counter to expectations, participants deemed normal according to water deprivation tests had approximately equivalent responsiveness to ddAVP. Although this study cannot offer definitive conclusions on the lack of prediction of water deprivation testing for ddAVP benefit, these data offer additional information that may help clarify the pathophysiology and optimal treatment of nocturia in older men. [source] Advances in mechanisms of postsurgical gastroparesis syndrome and its diagnosis and treatmentJOURNAL OF DIGESTIVE DISEASES, Issue 2 2006Ke DONG Postsurgical gastroparesis syndrome (PGS) is a complex disorder characterized by post-prandial nausea and vomiting, and gastric atony in the absence of mechanical gastric outlet obstruction, and is often caused by operation at the upper abdomen, especially by gastric or pancreatic resection, and sometimes also by operation at the lower abdomen, such as gynecological or obstetrical procedures. PGS occurs easily with oral intake of food or change in the form of food after operation. These symptoms can be disabling and often fail to be alleviated by drug therapy, and gastric reoperations usually prove unsuccessful. The cause of PGS has not been identified, nor has its mechanism quite been clarified. PGS after gastrectomy has been reported in many previous studies, with an incidence of approximately 0.4,5.0%. PGS is also a frequent complication of pylorus-preserving pancreatoduodenectomy (PPPD), and the complication occurs in the early postoperative period in 20,50% of patients. PGS caused by pancreatic cancer cryoablation (PCC) has been reported about in 50,70% of patients. Therefore, PGS has a complex etiology and might be caused by multiple factors and mechanisms. The frequency of this complication varies directly with the type and number of gastric operations performed. The loss of gastric parasympathetic control resulting from vagotomy contributes to PGS via several mechanisms. It has been reported that the interstitial cells of Cajal (ICC) may play a role in the pathogenesis of PGS. Recent studies in animal models of diabetes suggest specific molecular changes in the enteric nervous system may result in delayed gastric emptying. The absence of the duodenum, and hence gastric phase III, may be a cause of gastric stasis. It was thought that PGS after PPPD might be attributable, at least in part, to delayed recovery of gastric phase III, due to lowered concentrations of plasma motilin after resection of the duodenum. The damage to ICC might play a role in the pathogenesis of PGS after PCC, for which multiple factors are possibly responsible, including ischemic and neural injury to the antropyloric muscle and the duodenum after freezing of the pancreatoduodenal regions or reduction of circulating levels of motilin. As the treatment of gastroparesis is far from ideal, non-conventional approaches and non-standard medications might be of use. Multiple treatments are better than single treatment. This article reviews almost all the papers related to PGS from various journals published in English and Chinese in recent years in order to facilitate a better understanding of PGS. [source] Chronic constipation in children: Organic disorders are a major causeJOURNAL OF PAEDIATRICS AND CHILD HEALTH, Issue 1-2 2005BR Southwell Abstract: Diagnostic tools for paediatric chronic constipation have been limited, leading to over 90% of patients with treatment-resistant constipation being diagnosed with chronic idiopathic constipation, with no discernible organic cause. Work in our institution suggests that a number of children with intractable symptoms actually have slow colonic transit leading to slow transit constipation. This paper reviews recent data suggesting that a significant number of the children with chronic treatment-resistant constipation may have organic causes (slow colonic transit and outlet obstruction) and suggests new approaches to the management of children with chronic treatment-resistant constipation. [source] Helicobacter pyloriinfection and gastric outlet obstruction , prevalence of the infection and role of antimicrobial treatmentALIMENTARY PHARMACOLOGY & THERAPEUTICS, Issue 7 2002J. P. Gisbert Summary The prevalence of Helicobacter pylori infection in peptic ulcer disease complicated by gastric outlet obstruction seems to be, overall, lower than that reported in non-complicated ulcer disease, with a mean value of 69%. However, H. pylori infection rates in various studies range from 33% to 91%, suggesting that differences in variables, such as the number and type of diagnostic methods used or the frequency of non-steroidal anti-inflammatory drug intake, may be responsible for the low prevalence reported in some studies. The resolution of gastric outlet obstruction after the eradication of H. pylori has been demonstrated by several studies. It seems that the beneficial effect of H. pylori eradication on gastric outlet obstruction is observed early, just a few weeks after the administration of antimicrobial treatment. Furthermore, this favourable effect seems to remain during long-term follow-up. Nevertheless, gastric outlet obstruction does not always resolve after H. pylori eradication treatment and an explanation for the failures is not completely clear, non-steroidal anti-inflammatory drug intake perhaps playing a major role in these cases. Treatment should start pharmacologically with the eradication of H. pylori even when stenosis is considered to be fibrotic, or when there is some gastric stasis. In summary, H. pylori eradication therapy should be considered as the first step in the treatment of duodenal or pyloric H. pylori -positive stenosis, whereas dilation or surgery should be reserved for patients who do not respond to such medical therapy. [source] Novel Biomarkers for Diagnosis and Therapeutic Assessment of Overactive Bladder: Urinary Nerve Growth Factor and Detrusor Wall ThicknessLUTS, Issue 2009Hann-Chorng KUO Clinical diagnosis of overactive bladder (OAB) varies greatly and is based on subjective symptoms. A better way to diagnose and assess therapeutic outcome in patients who present with OAB needs to be developed. Evidence has shown that urinary proteins, such as nerve growth factor (NGF) and prostaglandin E2 (PGE2) levels increase in patients with OAB, bladder outlet obstruction (BOO) and detrusor overactivity (DO). Urinary NGF level increases physiologically in normal subjects at urge to void, but increases pathologically in OAB patients at small bladder volume and at urgency sensation. Patients with OAB dry and OAB wet have significantly higher urinary NGF levels compared to controls and patients with increased bladder sensation. Urinary NGF levels decrease after antimuscarinic therapy and further decrease after detrusor botulinum toxin injections in refractory OAB. A higher urinary NGF level could be a biomarker for sensory nerve-mediated DO. Urinary NGF levels could be a potential biomarker for diagnosis of OAB and serve for the assessment of the therapeutic effect of antimuscarinic therapy. Another potential biomarker for the diagnosis of OAB is detrusor wall thickness. It has been hypothesized that the bladder wall increases in thickness in patients with OAB. The thickened detrusor wall might decrease in response to antimuscarinic treatment, and measurement of detrusor wall thickness might be a useful biomarker for the evaluation of OAB. However, current investigations do not yet provide a uniform observation among various studies. [source] Do ,1 -adrenoceptor antagonists improve lower urinary tract symptoms by reducing bladder outlet resistance?,NEUROUROLOGY AND URODYNAMICS, Issue 3 2008Maurits M. Barendrecht Abstract Aims To test the hypothesis that improvements of lower urinary tract symptoms (IPSS) upon treatment with an ,-blocker are due to reduction of bladder outlet obstruction (assessed as the bladder outlet obstruction index, BOOI); relationships of either with free flow Qmax were also explored. Methods The database of a large placebo-controlled, randomized, double-blind study with the ,-blocker tamsulosin was analyzed retrospectively. Patients were stratified into lower and upper halves according to baseline IPSS, Qmax or BOOI and treatment-associated alterations thereof. In these strata differences between values for the other two parameters were analyzed, for example, improvement of IPSS and Qmax were compared in patients with below and above median improvement of BOOI. Results Patients with below and above median baseline for one parameter, for example, IPSS had rather similar values for the other two parameters, for example, Qmax and BOOI. Likewise, patients based upon baseline strata for one parameter had rather similar improvements of the other two parameters. Most importantly, patients with below and above median treatment-associated improvements of one parameter, for example, BOOI exhibited only small if any difference for alterations of the other two parameters, for example, IPPS and Qmax. Conclusions We conclude that IPSS, free flow Qmax and BOOI are only loosely related at baseline. More importantly, treatment-induced improvements of these parameters are also only loosely related. These data do question the hypothesis that ,-blockers largely improve lower urinary tract symptoms by reducing bladder outlet obstruction and suggest that they may also act independent of prostatic smooth muscle tone. Neurourol. Urodynam. 27:226,230, 2008. © 2007 Wiley-Liss, Inc. [source] Effect of lumbar-epidural administration of tramadol on lower urinary tract function,,NEUROUROLOGY AND URODYNAMICS, Issue 1 2008S.K. Singh Abstract Aims Intrathecal and epidural administration of µ-agonist opioids is associated with urinary retention, a potentially serious adverse-event. In animal studies tramadol has been found not to affect voiding function. We evaluated urodynamic effects of epidural tramadol in humans. Methods Fifteen adults planned for cystoscopy under local-anesthesia underwent urodynamics (UDS) at baseline and 30 min after administration of 100 mg tramadol in lumbar-epidural space. UDS consisted of filling cystometry, pressure-flow study and pelvic floor electromyography (EMG). Subsequently, all underwent cystoscopy and were observed for 6 hr. Results After injection of tramadol, a significant rise was observed in bladder capacity (391.8,±,179.6 ml vs. 432.7,±,208.8 ml; P,=,0.019) and compliance (60.1,±,51.5 ml/cm H2O vs. 83.0,±,63.0 ml/cm H2O; P,=,0.011) without a significant change in filling pressure (22.5,±,13.2 cm H2O vs. 24.1,±,15.1 cm H2O; P,=,0.576). Filling sensations were delayed significantly (P,,,0.05). EMG during filling phase showed a significant fall (P,=,0.027). Peak flow-rate (Qmax), average flow-rate, postvoid residue and detrusor pressure-at-Qmax did not show significant change from baseline (P,>,0.05). Three patients had bladder outlet obstruction which did not worsen after the injection. Guarding reflex was inhibited in seven out of 12 patients who had it at baseline (P,=,0.016). Conclusions Epidural tramadol increases the bladder capacity and compliance and delays filling-sensations, without ill effect on voiding. This seems true even for patients with obstructed outflow; however, due to small number of patients a definite conclusion cannot be derived. These results will guide clinician to avoid catheterization in cases where epidural tramadol is used for postoperative pain. The inhibitory effects of tramadol on EMG activity are intriguing and need further studies. Neurourol. Urodynam. © 2007 Wiley-Liss, Inc. [source] Management of refractory urinary urge incontinence following urogynecological surgery with sacral neuromodulation,,NEUROUROLOGY AND URODYNAMICS, Issue 1 2007Jonathan S. Starkman Abstract Aims We sought to explore our patient outcomes utilizing sacral neuromodulation in the management of refractory urinary urge incontinence following urogynecological surgical procedures. Methods A total of 25 women with urinary urge incontinence following urogynecological surgery were selected for SNS therapy and retrospectively analyzed. All patients completed a comprehensive urological evaluation. Clinical data was recorded to determine outcomes and identify parameters that would be predictive of response to neuromodulation. Outcomes were determined via subjective patient questionnaire and graded as follows: significant response (,80% improvement), moderate response (,50% and <80% improvement), and poor response (<50% response). Results Nineteen patients had a previous pubovaginal sling (10 with concomitant pelvic prolapse repair), 3 a previous retropubic suspension, and 3 a transperitoneal vesicovaginal fistula repair. Urethrolysis was performed in 4 patients to alleviate bladder outlet obstruction prior to sacral neuromodulation. Mean patient age was 59.8 years and length of follow-up was 7.2 months. Twenty-two women (88%) had the IPG placed during a Stage 2 procedure. Twenty patients maintained at least a 50% improvement in clinical symptoms at last follow-up and 6 patients were continent. Overall, the number of pads/day improved from 4.2 to 1.1 (P,<,0.001). There were no significant differences in response to neuromodulation based upon age, duration of symptoms, type of surgery, or urodynamic parameters. Conclusion Sacral neuromodulation appears to be an effective therapy in patients with refractory urge incontinence following urogynecological surgery. Larger prospective studies with longer follow-up are needed to assess the durability of this therapeutic modality. 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] Theoretical analysis of the effects of viscous losses and abdominal straining on urinary outlet function,NEUROUROLOGY AND URODYNAMICS, Issue 1 2004Srboljub M. Mijailovich Abstract Aims The aim of this study was to theoretically explore the relationship between the tube law (TL) of the urethra and the pressure,flow (p,Q) relationship during micturition. The understanding of this relation is important for the evaluation of outlet obstruction by urodynamic interpretation of p,Q plots. Methods We simulated the outlet function by a lumped theoretical model, and suggested how the TL can be used to quantitatively predict the p,Q relationship of the system. Our analysis considered the relation between the TL and the steady state p,Q plot for various TLs including the hysteresis of the pressure,area relationship. Results and Conclusions The inclusion of pressure losses distal to the flow controlling zone and experimentally measured p,A relations of the urethra in the model lead to the predictions that flow in the flow controlling zone is not always critical but is often in the sub-critical range, that an increase in abdominal pressure can increase the flow under certain conditions, and that hysteresis in the pressure,area relation is correlated to the hysteresis in the p,Q plot. Neurourol. Urodynam. 23:76,85, 2004. Published 2003 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] Comparative study of pressure-flow parametersNEUROUROLOGY AND URODYNAMICS, Issue 3 2002Lars M. Eri Abstract Methods for quantification of bladder outlet obstruction (BOO) are still controversial. Parameters such as detrusor opening pressure (pdet.open), maximum detrusor pressure (pdet.max), minimum voiding pressure (pdet.min.void), and detrusor pressure at maximum flow rate (Pdet.Qmax) separate obstructed from nonobstructed patients to some extent, but two nomograms, the Abrams-Griffiths nomogram and the linearized passive urethral resistance relation (LinPURR), are more accepted for this purpose, along with the urethral resistance algorithm. In this retrospective, methodologic study, we evaluated the properties of these parameters with regard to test-retest reproducibility and ability to detect a moderate (pharmacologic) and a pronounced (surgical) relief of bladder outlet obstruction. We studied the pressure-flow charts of 42 patients who underwent 24 weeks of androgen suppressive therapy, 42 corresponding patients who received placebo, and 30 patients who had prostate surgery. The patients performed repeat void pressure-flow examinations before and after treatment or placebo. The various parameters were compared. Among the bladder pressure parameters, Pdet.Qmax seemed to have some advantages, supporting the belief that it is the most relevant detrusor pressure parameter to include in nomograms to quantify BOO. In assessment of a large decrease in urethral resistance, such as after TURp, resistance parameters that are based on maximum flow rate as well as detrusor pressure are preferable. Neurourol. Urodynam. 21:186,193, 2002. © 2002 Wiley-Liss, Inc. [source] Interactions between prostate volume, filling cystometric estimated parameters, and data from pressure-flow studies in 565 men with lower urinary tract symptoms suggestive of benign prostatic hyperplasiaNEUROUROLOGY AND URODYNAMICS, Issue 5 2001Mardy D. Eckhardt Abstract The aim of this study was to establish the characteristics and to investigate the interactions between prostate volume, degree of obstruction, bladder contractility, the prevalence of residual volume, bladder compliance, bladder capacities, and the prevalence of instability in a large, well-defined group of men with lower urinary tract symptoms (LUTS) suggestive of benign prostatic hyperplasia (BPH). The 565 consecutive men included in this study met the criteria of the International Consensus Committee on BPH and voided more than 150 mL during uroflowmetry. Their residual urine volume and prostate size were estimated, and filling cystometry and pressure-flow studies were performed. Fifty-three percent of the men appeared to have obstruction. We found a positive correlation between prostate volume and Schäfer's obstruction grade, except that mean prostate volume decreased at Schäfer's grades 5 and 6. Significant negative correlations existed between Schäfer's grade and cystometric bladder capacity and effective capacity. Bladder outlet obstruction results in incomplete emptying. Of all men, 26% had a significant residual volume (,>,20% of cystometric capacity). Thirty-nine percent did not have residual volume. Of the 565 men, 46% had an unstable bladder. In particular, patients with an unstable bladder in the sitting and lying positions have a significantly higher Schäfer's grade and contractility grade and a significantly lower cystometric and effective bladder capacity compared with patients without instability. Patients with a residual volume or instability were significantly older. We conclude that in men with LUTS suggestive of BPH, abnormalities of bladder and bladder outlet function vary greatly and have complex mutual interactions. Neurourol. Urodynam. 20:579,590, 2001. © 2001 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] Moderate and high affinity serotonin reuptake inhibitors increase the risk of upper gastrointestinal toxicity,PHARMACOEPIDEMIOLOGY AND DRUG SAFETY, Issue 4 2008James D. Lewis MD, MSCE Abstract Objective Serotonin release from platelets is important for regulating hemostasis. Some prior studies suggest an association between use of selective serotonin reuptake inhibitors and gastrointestinal bleeding and a possible synergistic effect of these medications with non-steroidal anti-inflammatory drugs (NSAIDs). This study examined the effect of medications that inhibit serotonin uptake on upper gastrointestinal toxicity. Methods 359 case subjects hospitalized for upper gastrointestinal bleeding, perforation, or benign gastric outlet obstruction were recruited from 28 hospitals. 1889 control subjects were recruited by random digit dialing from the same region. Data were collected during structured telephone interviews. Antidepressant medications were characterized according to their affinity for serotonin receptors. Exposure to medications required use on at least 1,day during the week prior to the index date. Results Any moderate or high affinity serotonin reuptake inhibitor (MHA-SRI) use was reported by 61 cases (17.1%) and 197 controls (10.4%). After adjusting for potential confounders, MHA-SRI use was associated with a significantly increased odds of hospitalization for upper gastrointestinal toxicity (adjusted OR,=,2.0, 95%CI 1.4,3.0). A dose,response relationship in terms of affinity for serotonin uptake receptors was not observed (p,=,0.17). No statistical interaction was observed for use of high dose NSAIDs or aspirin concomitantly with MHA-SRIs (p,=,0.5). When MHA-SRIs were used concomitantly with high dose NSAIDs, the adjusted odds ratio for the association with upper gastrointestinal toxicity was 3.5 (95%CI 1.9,6.6). Conclusions Use of MHA-SRIs is associated with an increased risk of hospitalization for upper gastrointestinal toxicity. Copyright © 2008 John Wiley & Sons, Ltd. [source] Eviprostat suppresses urinary oxidative stress in a rabbit model of partial bladder outlet obstruction and in patients with benign prostatic hyperplasiaPHYTOTHERAPY RESEARCH, Issue 2 2010Seiji Matsumoto Abstract Eviprostat is a phytotherapeutic agent that has been used widely for more than 40 years in the treatment of benign prostatic hyperplasia (BPH) in Japan and Germany, and is known to have antioxidant activity. The present study investigated the effect of Eviprostat on the levels of the urinary oxidative stress marker 8-hydroxy-2,-deoxyguanosine (8-OHdG) in a rabbit model of surgical partial bladder outlet obstruction (PBOO) and in patients with lower urinary tract symptoms (LUTS) associated with BPH. In the rabbit model, 8-OHdG levels in urine collected after 3 weeks of PBOO were 3.8-fold higher than in the urine of sham-operated rabbits. When twice-daily Eviprostat was administered orally throughout the 3-week PBOO period, the increase in urinary 8-OHdG levels was suppressed by 70%. In the clinical study, nine patients who received Eviprostat for 4 weeks showed 2.5-fold lower urinary 8-OHdG levels than before treatment. During Eviprostat treatment, the total International Prostate Symptom Score (IPSS) decreased from 16.56 ± 2.74 to 13.67 ± 2.30 and the quality of life score from 4.22 ± 0.40 to 3.22 ± 0.46. The findings provide evidence that the antioxidant activity of Eviprostat is responsible for its beneficial effects in the treatment of BPH. Copyright © 2009 John Wiley & Sons, Ltd. [source] Review article Testosterone therapy in the ageing male: what about the prostate?ANDROLOGIA, Issue 6 2004D. Schultheiss Summary. The concerns about testosterone therapy in ageing men with late-onset hypogonadism mainly address the risk of prostatic disease, i.e. either benign prostatic hyperplasia (BPH) or prostate cancer (PCa). Both conditions are highly dependent on androgen action and recent clinical data on the cancer-preventive effect of the 5, -reductase inhibitor finasteride have supported the possible role of androgens in PCa. However, the clinical data especially on the long-term effects of exogenous androgen substitution in regard to prostate safety are nonconclusive in many respects. As sufficient clinical studies on these risks will not be available in the near future, the approach of testosterone therapy towards prostate complications should be kept on a safe but practical basis. This review includes some recommendations in regard to testosterone therapy and prostate monitoring in patients with BPH and bladder outlet obstruction, with previous history of curative treatment for PCa or with prostatic intraepithelial neoplasia. [source] Laparoscopic management of gastric outlet obstructionANZ JOURNAL OF SURGERY, Issue 9 2009Cathryn K. Dillon No abstract is available for this article. [source] Combined biliary and gastric bypass procedures as effective palliation for unresectable malignant diseaseANZ JOURNAL OF SURGERY, Issue 6 2009Christopher D. Mann Abstract Background:, Although endoscopic treatment of jaundice is increasingly used in the palliation of unresectable malignant disease, surgical bypass still has a role to play in this setting. This study aimed to reappraise the short-term and long-term results of combined biliary/gastric bypass (hepaticojejunostomy and gastrojejunostomy) as palliation for unresectable malignant disease. Methods:, All patients undergoing simultaneous biliary and gastric bypass procedures for unresectable malignant disease between August 2000 and January 2006 were identified and outcomes reviewed. Results:, One hundred and two patients underwent open surgical biliary drainage procedures for palliation of malignant disease. Underlying malignant disease included pancreatic carcinoma (n = 88), duodenal adenocarcinoma (n = 6) and distal cholangiocarcinoma (n = 3). Thirty-one of the patients underwent a planned palliative bypass procedure, the remainder being carried out after unresectable disease was identified at laparotomy. Postoperative mortality and morbidity rates were higher in the group undergoing planned bypass. During follow up, two patients developed recurrent jaundice that required transhepatic stenting and two patients developed late gastric outlet obstruction requiring refashioning of the gastrojejunostomy. Conclusion:, Combined surgical biliary and gastric bypass achieved effective palliation of jaundice and gastric outlet obstruction until death in >95% of patients in this series. It remains first-line therapy in patients identified as having unresectable disease at laparotomy. [source] Is detrusor hypertrophy in women associated with voiding dysfunction?AUSTRALIAN AND NEW ZEALAND JOURNAL OF OBSTETRICS AND GYNAECOLOGY, Issue 6 2009Orawan 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] Regulation of bladder muscarinic receptor subtypes by experimental pathologiesAUTONOMIC & AUTACOID PHARMACOLOGY, Issue 3 2006M. R. Ruggieri Sr Summary 1 The M3 muscarinic receptor subtype is widely accepted as the receptor on smooth muscle cells that mediates cholinergic contraction of the normal urinary bladder and other smooth muscle tissues, however, we have found that the M2 receptor participates in contraction under certain abnormal conditions. The aim of this study was to determine the effects of various experimental pathologies on the muscarinic receptor subtype mediating urinary bladder contraction. 2 Experimental pathologies resulting in bladder hypertrophy (denervation and outlet obstruction) result in an up-regulation of bladder M2 receptors and a change in the receptor subtype mediating contraction from M3 towards M2. Preventing the denervation-induced bladder hypertrophy by urinary diversion prevents this shift in contractile phenotype indicating that hypertrophy is responsible as opposed to denervation per se. 3 The hypertrophy-induced increase in M2 receptor density and contractile response is accompanied by an increase in the tissue concentrations of mRNA coding for the M2 receptor subtype, however, M3 receptor protein density does not correlate with changes in M3 receptor tissue mRNA concentrations across different experimental pathologies. 4 This shift in contractile phenotype from M3 towards M2 subtype is also observed in aged male Sprague,Dawley rats but not females or either sex of the Fisher344 strain of rats. 5 Four repeated, sequential agonist concentration response curves also cause this shift in contractile phenotype in normal rat bladder strips in vitro, as evidenced by a decrease in the affinity of the M3 selective antagonist p -fluoro-hexahydro-sila-diphenidol (p -F-HHSiD). 6 A similar decrease in the contractile affinity of M3 selective antagonists (darifenacin and p -F-HHSiD) is also observed in bladder specimens from patients with neurogenic bladder as well as certain organ transplant donors. 7 It is concluded that although the M3 receptor subtype predominately mediates contraction under normal circumstances, the M2 receptor subtype can take over a contractile role when the M3 subtype becomes inactivated by, for example, repeated agonist exposures or bladder hypertrophy. This finding has substantial implications for the clinical treatment of abnormal bladder contractions. [source] | ||||||||||||||||||||||||||||