Vaginal distention rodent model for fecal incontinence: a pilot study on the effect on defecation behavior

Objectives: Vaginal balloon inflation simulates the compressive forces on the pelvic floor during the second phase of natural delivery. The foremost use of this animal model of vaginal distention (VD) is to study the mechanisms underlying urinary incontinence. As damage to the pelvic floor during natural birth is a common cause of fecal incontinence, the present paper aimed to investigate the effect of VD on defecation behavior in adult rats. Methods: Vaginal distention was performed in 8 rats for 2 hours, and in 3 rats for 4 hours, and sham inflation was performed in 4 rats. With the use of a latrine box in the rat home-cage and 24/7 video tracking, the defecation behavior was examined. The time spent in and outside the latrine was monitored for two weeks preoperatively and three weeks postoperatively, and a defecation behavior index (DBI; range: 0 [continent] to 1 [incontinent]) was defined. Pelvic floor tissue was collected postmortem and stained with hematoxylin and eosin. Results: Vaginal balloon inflation for 2 hours resulted in fecal incontinence in 29% of the animals (responders) whereas the DBI scores of non-responders (71%) and control animals did not change in the postoperative phase compared with the baseline score. A 4-hour balloon inflation resulted in fecal incontinence in 1 animal and caused a humane endpoint in 2 animals with markedly more tissue damage in the 4-hour responder compared with the 2-hour responders. Conclusions: Vaginal balloon inflation, with an optimum duration between 2 and 4 hours, can be used as a model to study changes in defecation behavior in rats induced by pelvic floor damage. (AU)

Situación actual de la RTU de próstata en pacientes con PSA elevado / Role and current situation of Turp in patients with elevated PSA

OBJETIVO: El objetivo de esta revisión fue evaluar el papel de la resección transuretral de próstata (RTUP) en pacientes con PSA elevado. Se analizaron los resultados tanto en pacientes sintomáticos como asintomáticos.MÉTODOS: Se revisó la literatura actual (1987-2009) en relación con esta población específica de pacientes. Esta investigación se realizó mediante búsqueda en Medline.RESULTADOS: Inicialmente, estrategias terapéuticas distintas a la RTUp suelen ser utilizadas en pacientes con PSA elevado y sin evidencia de CP (CP). Este trabajo discute el valor de la RTUp en pacientes con PSA elevado o incremento progresivo del PSA. En este contexto, la RTUPp se puede realizar con o sin biopsia prostática concomitante. Además, la RTUp se puede proponer a pacientes con y sin STUI.CONCLUSIONES: En esta revisión, se evaluó el papel de la RTUp en pacientes con PSA elevado o incremento progresivo del PSA sin diagnóstico de CP. Creemos que la RTUp tiene un lugar en esta población de pacientes, incluso en aquellos que no presenten STUI. Esta estrategia está bien fundamentada después de una revisión extensa de la literatura disponible. En la mayoría de los casos, una RTUp se traducirá en una normalización del PSA, así como un beneficio sintomático. Además, este procedimiento permitirá una extensa evaluación histológica, que podría aportar un potencial diagnóstico incidental de CP(AU)

OBJECTIVES: The aim of this review is to evaluate the place of transurethral resection of the prostate (TURP) in patients with elevated and/or rising prostate specific antigen (PSA). The role of TURP in these patients traisassessed in symptomatic as well as in asymptomatic patients.METHODS: Current literature (1987-2009) was re-viewed with regard to this specific population. This re-search was performed using the Medline online search tools.RESULTS: Initially, possible therapeutic strategies other than TURP could be used in patients with elevated and/or rising PSA values and no sign of proven prostate can-cer. Consequently, the value of TURP in patients with ele-vated and/or rising PSA and no proven prostate cancer is discussed. In this setting, TURP can be executed with or without concomitant prostate biopsies. Furthermore, TURP can be proposed to patients with and without lo-wer urinary tract symptoms.CONCLUSIONS: In this review, we evaluated the role of TURP in patients with elevated and/or rising PSA va-lues and no proven prostate cancer. We believe TURP has a place in this particular population even in patients without lower urinary tract symptoms. This strategy is well founded on solid ground after an extensive review of the available literature. In most cases, a TURP will result in a normalization of PSA as well as a symptomatic be-nefit. Additionally, this procedure will allow histological evaluation which might show a possible life threatening prostate cancer in some patients(AU)