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1.
Urologia ; 90(4): 763-765, 2023 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-34082626

RESUMEN

CASE: We present a case of spontaneous extra-peritoneal rupture of an acquired diverticulum an elderly male with symptoms of bladder outlet obstruction who presented in emergency with acute abdomen. OUTCOME: The acute phase was managed conservatively with bladder drainage and intravenous antibiotics. He recently underwent Transurethral Resection of Prostate. He is asymptomatic on follow-up. CONCLUSIONS: Acquired bladder diverticulum are rare in adults and are mostly seen in patients with high pressure bladder due to bladder outlet obstruction. Atraumatic extraperitoneal ruptures of diverticulum are uncommonly reported.


Asunto(s)
COVID-19 , Divertículo , Síntomas del Sistema Urinario Inferior , Resección Transuretral de la Próstata , Enfermedades de la Vejiga Urinaria , Obstrucción del Cuello de la Vejiga Urinaria , Adulto , Humanos , Masculino , Anciano , Vejiga Urinaria , Obstrucción del Cuello de la Vejiga Urinaria/diagnóstico , Enfermedades de la Vejiga Urinaria/complicaciones , Enfermedades de la Vejiga Urinaria/diagnóstico , Pandemias , COVID-19/complicaciones , Divertículo/complicaciones , Divertículo/diagnóstico , Divertículo/cirugía , Rotura Espontánea/cirugía , Síntomas del Sistema Urinario Inferior/cirugía
2.
J Pediatr Urol ; 12(2): 126.e1-6, 2016 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-26762535

RESUMEN

OBJECTIVE: Complicated bladder dysfunctions (BD) (associated with infections/urological complications or irresponsive to treatment) are a small proportion of all cases, but are highly morbid, clinically and psychosocially. Our aim is to describe a cohort of complicated pediatric BD, using subgroup analysis to compare presentations and responses to treatment among genders, age groups, and patients with or without non-monosymptomatic enuresis (NME). We also relate severe BD to other health conditions or to social/behavioral problems and report treatment results. METHOD: Thirty-five cases of complicated BD were reviewed. Neurogenic bladders and anatomical urological problems were excluded. Justifications for referral, comorbidities, and social aspects/familial dynamics were studied. Overactive bladders were primarily treated with oxybutynin. Transcutaneous parasacral neuromodulation was used in case of insufficient response or unbearable side effects. For infrequent voiders, timed voiding and transcutaneous neuromodulation were counseled. RESULTS: Incontinence/enuresis were the motives for referral in only a third of the cases. UTI (42.9%) was the main reason for referral. Hydronephrosis was observed in 8.6% of the children. Respiratory/ENT problems, obesity, and precocious puberty were highly prevalent. Schooling problems and neuropsychiatric disease were common. Social problems were common. Five patients presented urological problems secondary to BD (hydroureteronephrosis, VUR, trabeculated bladder). Twenty percent of cases required high anticholinergic doses and 37.1% transcutaneous electrostimulation. Eight (22.9%) patients abandoned but later resumed therapy, and 14.6% did not follow treatment. Boys tended to be older than girls and presented NME, respiratory, and behavioral problems more often, with a significant difference for asthma and anxiety/depression. Associated health problems and neuropsychiatric treatment tended to be more frequent among those presenting NME. Non-enuretic children tended to show better results from treatment (see Table). CONCLUSION: The social characteristics of our population (severe cases, socially deprived, very poor, not well educated, and with limited access to health care) determine a very specific sampling. Our research demonstrated that even severe cases of BD affecting socially deprived children may be treated, with adhesion to treatment and results comparable with other cohorts of BD, although the children need multidisciplinary attention and close follow-up. Boys, older children, and NME are more difficult to treat and often have other associated health and behavioral problems. Stress-related conditions were common in severe BD. A relatively high occurrence of precocious puberty was an unexpected finding in our research.


Asunto(s)
Enuresis Nocturna/etiología , Trastornos Psicóticos/complicaciones , Enfermedades Respiratorias/complicaciones , Enfermedades de la Vejiga Urinaria/complicaciones , Vejiga Urinaria/fisiopatología , Micción/fisiología , Niño , Femenino , Estudios de Seguimiento , Humanos , Masculino , Enuresis Nocturna/diagnóstico , Trastornos Psicóticos/diagnóstico , Enfermedades Respiratorias/diagnóstico , Estudios Retrospectivos , Factores de Tiempo , Enfermedades de la Vejiga Urinaria/diagnóstico
3.
BJU Int ; 117(5): 793-800, 2016 May.
Artículo en Inglés | MEDLINE | ID: mdl-26086897

RESUMEN

OBJECTIVES: To assess the efficacy of transcutaneous interferential electrical stimulation (IFES) and urotherapy in the management of non-neuropathic underactive bladder (UAB) in children with voiding dysfunction. PATIENTS AND METHODS: In all, 36 children with UAB without neuropathic disease [15 boys, 21 girls; mean (sd) age 8.9 (2.6) years] were enrolled and then randomly allocated to two equal treatment groups comprising IFES and control groups. The control group underwent only standard urotherapy comprising diet, hydration, scheduled voiding, toilet training, and pelvic floor and abdominal muscles relaxation. Children in the IFES group likewise underwent standard urotherapy and also received IFES. Children in both groups underwent a 15-session treatment programme twice a week. A complete voiding and bowel habit diary was completed by parents before, after treatment, and 1 year later. Bladder ultrasound and uroflowmetry/electromyography were performed before, at the end of treatment course, and at the 1-year follow-up. RESULTS: The mean (sd) number of voiding episodes before treatment was 2.6 (1) and 2.7 (0.76) times/day in the IFES and control groups, respectively, which significantly increased after IFES therapy in IFES group, compared with only standard urotherapy in the control group [6.3 (1.4) vs 4.7 (1.3) times/day, P < 0.002). The mean (sd) bladder capacity before treatment was 424 (123) and 463 (121) mL in the control and IFES groups, respectively, which decreased significantly at 1 year after treatment in the IFES group compared with the controls, at 227 (86) vs 344 (127) mL (P < 0.01). Maximum urine flow increased and voiding time decreased significantly in the IFES group compared with controls at the end of treatment sessions and 1 year later (P < 0.05). All the children had abnormal flow curves at the beginning of the study. The flow curve became normal in 14/18 (77%) of the children in the IFES group and six of 18 (33%) in the control group by the end of follow-up (P < 0.007). At the end of the treatment course, night-time wetting was improved in all children who had this symptom before the treatment in the IFES group (P < 0.01). CONCLUSION: Combining IFES and urotherapy is a safe and effective therapy in the management of children with UAB.


Asunto(s)
Estimulación Eléctrica Transcutánea del Nervio , Enfermedades de la Vejiga Urinaria/complicaciones , Enfermedades de la Vejiga Urinaria/terapia , Trastornos Urinarios/terapia , Adolescente , Niño , Femenino , Humanos , Masculino , Resultado del Tratamiento , Trastornos Urinarios/etiología
4.
BMC Urol ; 15: 56, 2015 Jul 01.
Artículo en Inglés | MEDLINE | ID: mdl-26126393

RESUMEN

BACKGROUND: To measure the effects of real-time visualisation during urethrocystoscopy on pain in patients who underwent ambulatory urethrocystoscopy. METHODS: An observational study was designed. From June 2012 to June 2013 patients who had ambulatory urethrocystoscopy participated in the study. In order to measure pain perception we used a numeric rating scale (NRS) 0 to 10. Additional data was collected including gender, reason for intervention, use of a rigid or a flexible instrument and whether the patient had had urethrocystoscopy before. RESULTS: 185 patients were evaluated. 125 patients preferred to watch their urethrocystoscopy on a real-time video screen, 60 patients did not. There was no statistically relevant difference in pain perception between those patients who watched their urethrocystoscopy on a real-time video screen and those who did not (p = 0.063). However, men who were allowed to watch their flexible urethrocystoscopy experienced significantly less pain, than those who did not (p = 0.007). No such effects could be measured for rigid urethrocystoscopy (p = 0.317). Furthermore, women experienced significantly higher levels of pain during the urethrocystoscopy than men (p = 0.032). CONCLUSIONS: Visualisation during urethrocystoscopy procedures in general does not significantly decrease pain in patients. Nevertheless, men who undergo flexible urethrocystoscopy should be offered to watch their procedure in real-time on a video screen. To make urethrocystoscopy less painful for both genders, especially for women, should be subject to further research.


Asunto(s)
Biorretroalimentación Psicológica/métodos , Cistoscopía/efectos adversos , Cistoscopía/métodos , Dolor/etiología , Dolor/prevención & control , Participación del Paciente/métodos , Adolescente , Adulto , Anciano , Atención Ambulatoria/métodos , Retroalimentación Sensorial , Femenino , Humanos , Masculino , Persona de Mediana Edad , Dolor/diagnóstico , Manejo del Dolor/métodos , Dimensión del Dolor , Participación del Paciente/psicología , Resultado del Tratamiento , Enfermedades de la Vejiga Urinaria/complicaciones , Enfermedades de la Vejiga Urinaria/patología , Enfermedades de la Vejiga Urinaria/psicología , Adulto Joven
5.
Int Urol Nephrol ; 46 Suppl 1: S35-44, 2014 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-25238893

RESUMEN

Muscarinic agonists are the most commonly used agents for treating the underactive bladder (UAB). However, because of the absence of pharmacologic specificity for bladder-only effects and possibly as a result of degenerative and other post-synaptic changes involving detrusor smooth muscle cells, they are simply not effective and side effects are common. If safe and effective therapy for UAB is made available, then most experts agree that the potential market would exceed industry expectations, just as antimuscarinic agents for overactive bladder did in the late 1990 s. The pharmaceutical and biotechnology industries that have a pipeline to urology and women's health should consider UAB as a potential target condition. A rational approach to treating the pathology of UAB is presented with a discussion of potential targets that may allow the development of safe and effective agents for the treatment of UAB.


Asunto(s)
Agonistas Muscarínicos/uso terapéutico , Músculo Liso/fisiopatología , Enfermedades de la Vejiga Urinaria/tratamiento farmacológico , Enfermedades de la Vejiga Urinaria/terapia , Vejiga Urinaria/fisiopatología , Animales , Inhibidores de la Colinesterasa/efectos adversos , Inhibidores de la Colinesterasa/uso terapéutico , Dinoprostona/uso terapéutico , Terapia por Estimulación Eléctrica , Humanos , Síntomas del Sistema Urinario Inferior/etiología , Agonistas Muscarínicos/efectos adversos , Contracción Muscular , Enfermedades de la Vejiga Urinaria/complicaciones
6.
Zhonghua Nan Ke Xue ; 16(2): 146-9, 2010 Feb.
Artículo en Chino | MEDLINE | ID: mdl-20369699

RESUMEN

OBJECTIVE: To investigate the features of chronic prostatitis with non-neurogenic detrusor sphincter dyssynergia (NNDSD) and the effects of pelvic floor biofeedback in the treatment of the disease. METHODS: We included in this study 113 male patients, aged 15 - 48 (mean 36) years and diagnosed as having chronic prostatitis for 1 -2 (mean 1.2) years based on such typical symptoms as frequent micturition, urgent micturition, voiding pain, difficult void, etc, that lasted over 3 months, and the score > or = 1 on the first and second parts of NIH-CPSI. Urethritis, interstitial cystitis, urethral stricture and neurogenic bladder were excluded. All the patients underwent urodynamic examinations for the uroflow curve, Q(max), Pdet. max and MUCP. Biofeedback was carried out for those with non-neurogenic detrusor sphincter dyssynergia, and the effects were evaluated at 10 weeks. RESULTS: Twenty-one (18.6%) of the 113 cases were found to be NNDSD. Biofeedback treatment achieved obvious decreases in Q(max) (8.2 +/- 4.1), Pdet. max (125.1 +/- 75.3), MUP (124.3 +/- 23.3) and MUCP (101.5 +/- 43.6), as compared with 15.1 +/- 7.3, 86.3 +/- 54.2, 65.4 +/- 23.0 and 43.5 +/- 16.7 before the treatment (P < 0.05). Statistically significant differences were observed between pre- and post-treatment scores on voiding pain (4.0 +/- 2.0 vs 2.2 +/- 1.7), urination (7.9 +/- 2.1 vs 2.2 +/- 1.9), life impact (9.6 +/- 2.7 vs 2.9 +/- 2.6) and total scores (21.7 +/- 4.8 vs 8.4 +/- 4.6) (P < 0.05). CONCLUSION: Chronic prostatitis patients with LUTS may have NNDSD, which is urodynamically characterized by low Q(max), high intra-bladder pressure and increased urethral pressure in some patients. Urodynamic examinations may contribute to definite diagnosis and appropriate choice of treatment. Pelvic floor biofeedback has satisfactory short-term effects in the treatment of these patients.


Asunto(s)
Prostatitis/diagnóstico , Prostatitis/terapia , Enfermedades de la Vejiga Urinaria/diagnóstico , Enfermedades de la Vejiga Urinaria/terapia , Adolescente , Adulto , Ataxia/complicaciones , Ataxia/diagnóstico , Ataxia/terapia , Biorretroalimentación Psicológica , Enfermedad Crónica , Humanos , Masculino , Persona de Mediana Edad , Prostatitis/complicaciones , Enfermedades de la Vejiga Urinaria/complicaciones , Urodinámica , Adulto Joven
7.
Urologe A ; 49(3): 381-6, 2010 Mar.
Artículo en Alemán | MEDLINE | ID: mdl-19943028

RESUMEN

Although diabetes mellitus is one of the most common diseases worldwide, only few studies evaluating diagnosis and treatment of lower urinary tract complications of this disorder exist. In addition to diabetic (impaired sensation, reduced detrusor muscle contractility, elevated residual urine), 30-50% of patients can develop an overactive bladder. Basic diagnostics should include patient history, bladder diary, post-void residual and urinalysis. Advanced diagnostics include uroflowmetry, symptom scores and urodynamics. The evidence for all treatment options in patients with diabetes mellitus is low. Residual urine may be treated with coping strategies, Metoclopramid, alpha blockers and intermittent catheterization, but there is no evidence for parasympathomimetic medication. Overactive bladders can be treated by behavioral therapy, biofeedback, electrostimulation or antimuscarinics. In addition to cooperation with colleagues from other specialties, intensive urologic research is required for the development of evidence-based strategies for long-term urologic care of patients with diabetes mellitus.


Asunto(s)
Complicaciones de la Diabetes/diagnóstico , Complicaciones de la Diabetes/terapia , Enfermedades de la Vejiga Urinaria/diagnóstico , Enfermedades de la Vejiga Urinaria/terapia , Humanos , Enfermedades de la Vejiga Urinaria/complicaciones
8.
BJU Int ; 105(6): 877-83, 2010 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-19689474

RESUMEN

OBJECTIVE: To investigate differential gene expression profiles in the bladder of spontaneously hypertensive rat (SHR), as the underlying mechanisms involved in hypertension-associated bladder dysfunction remain to be clarified. MATERIALS AND METHODS: SHR and normotensive Wistar-Kyoto (WKY) rats were distributed initially in three groups: group 1 received doxazosin (30 mg/kg/day); group 2 received nifedipine (30 mg/kg/day); and group 3 received the vehicle orally for 4 weeks. The alterations in gene expression levels of candidate genes identified by microarray analysis with potential biological relevance were verified by real-time reverse transcription-polymerase chain reaction (RT-PCR). RESULTS: Voiding frequency was significantly higher, and mean voided volume was significantly lower in untreated SHRs than untreated WKY rats. Microarray analysis revealed that 25 of the differentially expressed genes in untreated SHRs compared to untreated WKY rats were related to G(s), G(i), G(q) and G(12/13) signalling, calcium handling, ion transport and smooth muscle-related genes. Furthermore, RT-PCR data, in accord with the microarray analysis, indicated that untreated SHRs had lower mRNA expression levels of Adcy2, Adcy3, Rgs2, Rgs3, Rgs4 and Arhgdia, and higher mRNA expression levels of Arhgef1, Arhgef11, Arhgef12, Geft, Rock1 and Rock2 than untreated WKY rats. The differential alterations in the micturition patterns and in the expression of several genes related to G-protein signalling pathway observed in SHRs were attenuated by treatment with doxazosin, but not nifedipine. CONCLUSION: Our data suggest that differential alterations in the expression of several genes related to G(s), G(q) and G(12/13) signalling pathways in the SHR bladder might be important in hypertension-associated bladder dysfunction.


Asunto(s)
Antihipertensivos/uso terapéutico , Doxazosina/uso terapéutico , Hipertensión/genética , Nifedipino/uso terapéutico , Enfermedades de la Vejiga Urinaria/genética , Análisis de Varianza , Animales , Expresión Génica/genética , Perfilación de la Expresión Génica , Hipertensión/complicaciones , Hipertensión/tratamiento farmacológico , Masculino , Análisis por Micromatrices , Ratas , Ratas Endogámicas SHR , Ratas Endogámicas WKY , Reacción en Cadena de la Polimerasa de Transcriptasa Inversa , Transducción de Señal/genética , Enfermedades de la Vejiga Urinaria/complicaciones , Enfermedades de la Vejiga Urinaria/tratamiento farmacológico
9.
Pol Merkur Lekarski ; 24 Suppl 4: 131-7, 2008.
Artículo en Polaco | MEDLINE | ID: mdl-18924526

RESUMEN

Functional bladder disorders in children are a common condition and they are observed in 5-15% of pediatric population. Recent observations of bladder function of the healthy newborns have changed our viewpoint on its behaviour in older children. By the age of 4 years, many if not most children have matured their urinary tract function and developed an adult pattern of urinary control. They are generally dry during the day and the night. The adult pattern is characterized during bladder filling by an absence of unstable or uninhibited (involuntary) detrusor contractions. Urodynamic studies have confirmed that even at bladder capacity and when the desire to void is strong, detrusor contraction will not occur unless it is voluntarily initiated. The voiding symptoms and urinary incontinence or urinary infection and are thought to be caused by behavioral factors that affect toilet training and prevent successful transition from the infantile to the adult pattern of urinary control. These syndromes of dysfunctional elimination differ greatly in manifestation, prognosis, and pathophysiology and comprise a clinical spectrum that varies widely. At the severe end of the spectrum are a small group of patients with Hinman's syndrome, also termed the non-neurogenic neurogenic bladder, dysfunctional voiding, or occult neuropathic bladder. Less severe uropathology is observed in the large group of children who present with refractory and often severe symptoms that reflect incomplete toilet training with diminished urinary control. Their obstruction is caused by an incoordination between bladder and sphincter that occurs only during bladder filling in the presence of unstable bladder contractions and is, therefore, of less potential risk to the urinary tract. Unstable bladder, the most common pattern of urinary dysfunction in childhood, occurs in up to 57% of symptomatic children aged 3 to 14 years. Voluntary constriction of the urinary sphincter during unstable bladder contractions produces urinary obstruction with high intravesical pressures. The assessment of children with lower urinary tract disorders should consist of a detailed history, a frequency/volume chart and a physical examination. Uroflowmetry and ultrasound examination can be added. Treatment of functional bladder disorders in children can be divided in urotherapy, consisting of standard therapy and some specialized types of urotherapy like biofeedback, neuromodulation, pharmacotherapy and botulinum toxin injections.


Asunto(s)
Enfermedades de la Vejiga Urinaria/diagnóstico , Enfermedades de la Vejiga Urinaria/terapia , Biorretroalimentación Psicológica , Toxinas Botulínicas/uso terapéutico , Preescolar , Humanos , Lactante , Recién Nacido , Examen Físico , Enfermedades de la Vejiga Urinaria/complicaciones , Incontinencia Urinaria/etiología , Infecciones Urinarias/etiología , Urodinámica
10.
Neurourol Urodyn ; 26(2): 267-70, 2007.
Artículo en Inglés | MEDLINE | ID: mdl-17078084

RESUMEN

AIMS: Potassium sensitivity test (PST) has been used as an optional tool in diagnosing painful bladder syndrome/interstitial cystitis (PBS/IC). The role of PST in the follow-up of patients with PBS/IC is elusive. We performed PST before and after treatment of PBS/IC with cyclosporine A (CyA) or pentosan polysulfate sodium (PPS), to test whether the result of repeated PST correlates with alleviation of PBS/IC-related symptoms. MATERIALS AND METHODS: Sixty-four patients who participated in a randomized clinical study comparing CyA and PPS in the treatment of PBS/IC were recruited to the present study. Patients underwent 0.4 M PST before and after 6 months of treatment. The primary end point was a change from positive PST to negative among patients who responded to both treatments determined by global response assessment (GRA). RESULTS: Potassium sensitivity test (PST) was more likely to change from positive to negative among patients who responded to their treatment according to GRA (P < 0.001). The PST change follows the clinical course (ICSI score, voiding frequency, VAS score), which was more beneficial in the CyA-treated patients. CONCLUSIONS: Potassium sensitivity test (PST) reflects symptom severity of PBS/IC patients. Change of pre-treatment positive PST to negative correlates well with clinical alleviation of PBS/IC-related symptoms. In patients with persistent symptoms it may be painful and does not offer additional information. Thus, we do not recommend PST to be used as a routine clinical test in monitoring of PBS/IC treatment efficacy.


Asunto(s)
Antiinflamatorios no Esteroideos/uso terapéutico , Ciclosporina/uso terapéutico , Cistitis Intersticial/fisiopatología , Cistitis Intersticial/terapia , Inmunosupresores/uso terapéutico , Manejo del Dolor , Dolor/fisiopatología , Poliéster Pentosan Sulfúrico/uso terapéutico , Potasio/fisiología , Enfermedades de la Vejiga Urinaria/fisiopatología , Enfermedades de la Vejiga Urinaria/terapia , Anciano , Cistitis Intersticial/complicaciones , Femenino , Humanos , Masculino , Persona de Mediana Edad , Dolor/etiología , Estudios Prospectivos , Encuestas y Cuestionarios , Enfermedades de la Vejiga Urinaria/complicaciones , Micción/fisiología , Urotelio/fisiología
11.
BJU Int ; 93(6): 745-50, 2004 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-15049984

RESUMEN

OBJECTIVES: To assess the long-term outcome of the efficacy of transurethral resection of the prostate (TURP) in men with detrusor underactivity (DUA), a cause of lower urinary tract symptoms (LUTS) in a significant minority of men. PATIENTS AND METHODS: Neurologically intact men with LUTS, who were investigated in our department between 1972 and 1986, diagnosed with DUA and who underwent surgical intervention, were invited for a repeat symptomatic and urodynamic assessment. Identical methods were used, allowing direct comparison of the results. RESULTS: In all, 224 men were initially diagnosed with DUA; 87 (39%) of these died in the interim and 22 followed had a TURP, with a mean follow-up since surgery of 11.3 years. There were no significantly sustained reductions in any symptoms. There was a small but significant reduction of questionable clinical significance in the bladder outlet obstruction index, but this did not translate into an improved flow rate. Comparison with 58 age-matched patients with DUA who remained untreated showed no significant advantage of surgical intervention in the long-term; on the contrary, there was more chronic retention in those who had had surgery. CONCLUSIONS: There are no long-term symptomatic or urodynamic gains from TURP in men shown to have DUA. The results of TURP in men with DUA are important, as urologists who surgically treat patients based on the symptoms and uroflowmetry alone will do so in a significant minority of men with DUA. These results strengthen the argument for a routine preoperative urodynamic assessment.


Asunto(s)
Hiperplasia Prostática/fisiopatología , Resección Transuretral de la Próstata/normas , Enfermedades de la Vejiga Urinaria/fisiopatología , Retención Urinaria/fisiopatología , Adulto , Anciano , Algoritmos , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Hiperplasia Prostática/complicaciones , Hiperplasia Prostática/cirugía , Resultado del Tratamiento , Enfermedades de la Vejiga Urinaria/complicaciones , Cateterismo Urinario , Retención Urinaria/etiología , Urodinámica
12.
Scand J Urol Nephrol ; 37(2): 120-3, 2003.
Artículo en Inglés | MEDLINE | ID: mdl-12745719

RESUMEN

OBJECTIVE: We previously reported a 70% cure rate for bladder biofeedback in children with primary nocturnal enuresis associated with small bladder capacity and detrusor instability. In this paper we report on bladder capacity and incidence of enuresis after 60 months of follow-up and discuss the role of decreased bladder capacity in nocturnal enuresis. MATERIAL AND METHODS: We prospectively evaluated 21 boys and 3 girls (mean age 10.4 years) treated with bladder biofeedback between October 1993 and July 1995. Baseline bladder capacity and capacity at the end of treatment and at 60 months follow-up were determined from a micturition chart. RESULTS: At the end of primary treatment 17/24 patients had stopped bedwetting. In 4/17 responders and 4/7 non-responders the bladder capacity was <90% of normal for age. At 60 months, 4 patients had been lost to follow-up, 15 were dry at night and 4 continued bedwetting. One patient underwent surgery and was excluded from the study. Only 2/15 dry patients but 3/4 patients with persistent nocturnal enuresis had a bladder capacity of <90% of normal. CONCLUSIONS: Bladder biofeedback can be successfully used to treat children with refractory nocturnal enuresis associated with small bladder capacity and unstable detrusor. Normalization of bladder capacity and continuous growth of the bladder in order to keep the capacity normal would seem to be crucial to the long-term resolution of bedwetting in this select patient population.


Asunto(s)
Biorretroalimentación Psicológica , Enuresis/terapia , Enfermedades de la Vejiga Urinaria/terapia , Niño , Enuresis/complicaciones , Enuresis/diagnóstico , Femenino , Humanos , Masculino , Estudios Prospectivos , Resultado del Tratamiento , Vejiga Urinaria/anatomía & histología , Enfermedades de la Vejiga Urinaria/complicaciones , Urodinámica/fisiología
14.
Neurourol Urodyn ; 21(5): 444-9, 2002.
Artículo en Inglés | MEDLINE | ID: mdl-12232878

RESUMEN

AIMS: To elucidate whether preoperative urodynamic findings can predict outcomes of transurethral resection of the prostate (TUR-P). METHODS: Sixty-two patients with symptomatic benign prostatic hyperplasia were categorized in three different ways based on findings of preoperative pressure-flow study (PFS) and cystometry: urodynamic obstruction (determined by the Abrams-Griffiths nomogram), detrusor instability (DI), and combination of both. Outcomes of TUR-P regarding symptom, function, and quality of life (QOL) were analyzed by changes in the International Prostate Symptom Score (I-PSS), maximum flow rate in uroflowmetry, and QOL index before and after TUR-P, respectively. Overall outcome was defined as success when all of the three categories showed successful improvement. RESULTS: Neither urodynamic obstruction alone nor DI alone predicted outcomes of TUR-P. However, symptomatic and overall outcomes were significantly worse in patients who were not obstructed but had DI. Postoperative persistent DI was more frequently noted in patients without clear obstruction (60%) than in those with obstruction (27%). Patients with equivocal obstruction showed less satisfactory symptomatic outcomes of TUR-P when DI was accompanied. Persistent DI might be the principle cause of unfavorable outcomes. CONCLUSIONS: Preoperative evaluation of DI is of benefit because it enhances predictive value of the PFS.


Asunto(s)
Hiperplasia Prostática/complicaciones , Hiperplasia Prostática/cirugía , Resección Transuretral de la Próstata/efectos adversos , Enfermedades de la Vejiga Urinaria/complicaciones , Obstrucción del Cuello de la Vejiga Urinaria/complicaciones , Anciano , Predicción , Humanos , Masculino , Resultado del Tratamiento , Obstrucción del Cuello de la Vejiga Urinaria/fisiopatología , Urodinámica
15.
Eur Urol ; 42(3): 262-7, 2002 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-12234511

RESUMEN

OBJECTIVE: For patients with the combination of severe bladder outlet obstruction (BOO) and severe overactive bladder (OB), no straightforward and safe treatment exists due to the risk of urge incontinence after TURP. In this study we have used a biodegradable polyglycolic stent to simulate the status after TURP and register the risk for urge incontinence. METHODS: A total of 37 patients with severe OB, combined with moderate to severe BOO, were asked if they wanted to participate. Under cystoscopic vision a polyglycolic biodegradable stent was inserted in the prostatic urethra. RESULTS: Twenty-five of the patients noticed no or only minor leakage and 19 of these have been subjected to TURP with good results. Three patients are on the waiting-list for TURP. Twelve of 37 patients were found to have major leakage after stent insertion. During the stent period, we noted five cases of complications, due to UTI, stent crash and irritation. All of these patients recovered within three weeks. CONCLUSIONS: A biodegradable PGA stent seems to be a new and unique tool to test the risk for post-TURP incontinence in patients with combined BOO and severe OB.


Asunto(s)
Implantes Absorbibles , Técnicas de Diagnóstico Urológico/instrumentación , Stents , Resección Transuretral de la Próstata/efectos adversos , Obstrucción del Cuello de la Vejiga Urinaria/cirugía , Incontinencia Urinaria/diagnóstico , Incontinencia Urinaria/etiología , Anciano , Anciano de 80 o más Años , Humanos , Masculino , Persona de Mediana Edad , Ácido Poliglicólico , Valor Predictivo de las Pruebas , Medición de Riesgo , Enfermedades de la Vejiga Urinaria/complicaciones , Obstrucción del Cuello de la Vejiga Urinaria/complicaciones
16.
J Urol ; 166(4): 1470-5, 2001 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-11547115

RESUMEN

PURPOSE: We reviewed our 5-year experience with a modified 4 to 6-session biofeedback program combining noninvasive urodynamic approaches with various psychological techniques, including externalizing the voiding problem, empowerment and praise, to treat children with detrusor-sphincter dyssynergia. MATERIALS AND METHODS: Biofeedback was performed with a urodynamics processor that enables simultaneous recording of urine flow and electromyography, and visual display of flow/electromyography activity. Initially normal and abnormal voiding were explained in a unique way and the children observed relaxation and contraction of the pelvic floor muscles while visualizing the electromyography monitor. The bladders were filled naturally and surface electrodes were placed. Psychological strategies were used to engage and motivate the children to achieve maximal cooperation. The children voided while attempting relaxation and post-void residual urine volume was measured by bladder scan. Special and specific praise was provided for progress and increasing self-esteem. Patients returned monthly to review these concepts and practice voiding. RESULTS: Of 87 children 77 completed the program, including 7 boys and 70 girls 3 to 17 years old (mean age 7.8) who required an average of 4.7 sessions (median 4). Results were achieved within 6 sessions in 82% of cases. Of the 77 children 59 (76%) had recurrent urinary tract infections, 38 (49%) had associated bladder instability, 19 (24%) had vesicoureteral reflux and 44 (58%) had constipation. Subjectively 47 patients (61%) reported pronounced improvement in urinary symptoms, while another 24 (32%) reported moderate improvement after biofeedback training. Objectively 47 children (61%) had normal flow with minimal electromyography activity during voiding and a normal post-void residual urine of less than 20% voided volume (p <0.002). In 28 cases (36%) flow studies improved (p <0.03) but post-void residual urine remained elevated. Vesicoureteral reflux resolved in 9 cases after biofeedback training. This approach was equally successful in children in all age groups. Those with more than a 2-year history of symptoms, poor bladder emptying and severe constipation had only moderate improvement. CONCLUSIONS: The modified biofeedback program including appropriate explanations and psychological approaches appeared effective for treating 92% of children with detrusor-sphincter dyssynergia. It is less invasive and requires less time than traditional methods, and patients are more compliant with treatment.


Asunto(s)
Ataxia/terapia , Biorretroalimentación Psicológica , Enfermedades de la Vejiga Urinaria/terapia , Incontinencia Urinaria/terapia , Adolescente , Ataxia/complicaciones , Ataxia/fisiopatología , Niño , Preescolar , Electromiografía , Femenino , Humanos , Masculino , Evaluación de Programas y Proyectos de Salud , Factores de Tiempo , Enfermedades de la Vejiga Urinaria/complicaciones , Enfermedades de la Vejiga Urinaria/fisiopatología , Incontinencia Urinaria/etiología , Incontinencia Urinaria/fisiopatología , Urodinámica
17.
Eur J Pediatr Surg ; 11(4): 263-7, 2001 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-11558018

RESUMEN

48 Mitrofanoff principles (MTR) were performed on 46 patients (male : female ratio, 30 : 16) with a mean age of 9.1 years (range 2.5 to 24 years). The primary diagnoses were neurogenic bladder in 11, infravesical obstruction in 7 and bladder exstrophy-epispadias complex in 28 patients. The most common type of conduit was appendix (38 cases); other conduits were constructed from the ileum (seven) and ileocaecum (one). In two cases with bladder substitution the uterine tube and tubularised bladder stump were used as perineal MTR. 33 of the 46 children underwent augmentation cystoplasty in conjunction with the MTR procedure. The Malone procedure for antegrade colonic enema (ACE) was performed at the same stage with MTR in eight cases. To achieve continence, bladder neck reconstruction was performed in 32 patients and the bladder neck was closed in four patients during the same operation and MTR procedure. The mean follow-up period was 28.7 months (range one month to 57 months). To assess the psychological aspects of the MTR procedure, the Rosenberg Self-Esteem Scales were completed by 12 children older than eight years of age. Nine patients had problems with the MTR (19.5 %). Three appendiceal MTR had strictures at the skin level, 2 of which needed minor surgical revisions. A mucocele formation at the skin level of an appendix was removed successfully. We did not observe any complaints among the other appendiceal conduits. All the tapered ileum conduits were difficult to catheterise, and 1 of them had a leakage from the stoma. None of the three transversely tubularised ileum MTRs had problems with catheterisation or leakage. A stricture of the conduit from the uterine tube was observed. 36 of the 42 patients are now continent, giving a ratio of 86 %. The results of the Rosenberg Self-Esteem Scales revealed that there was an increase in the percentage of patients with high self-esteem, and a decrease in depressive feelings after the MTR procedure. We conclude that the MTR procedure provides excellent continence, offers good prospects of a socially acceptable life with increased self-esteem, and the appendix seems to be the ideal organ for continent urinary diversion, with the transverse tubularised ileal tube as a second choice.


Asunto(s)
Enfermedades de la Vejiga Urinaria/psicología , Enfermedades de la Vejiga Urinaria/cirugía , Derivación Urinaria/psicología , Reservorios Urinarios Continentes , Adolescente , Adulto , Apéndice/cirugía , Niño , Preescolar , Trastorno Depresivo/etiología , Femenino , Humanos , Íleon/cirugía , Masculino , Pruebas Psicológicas , Estudios Retrospectivos , Enfermedades de la Vejiga Urinaria/complicaciones , Cateterismo Urinario/psicología
18.
Urologiia ; (6): 40-4, 2001.
Artículo en Ruso | MEDLINE | ID: mdl-11785081

RESUMEN

Transurethral endoscopic incision of the urinary bladder's diverticular neck has been performed in 29 patients aged 44 to 90 years (mean age 65 years). 25(86.2%) patients had verified concomitant diseases and high anesthesia risk prohibiting radical surgery. According to preoperative diagnosis, the volume of the diverticula ranged from 20 to 700 ml, the diameter of the neck--from 0.3 to 2.0 cm. 10 patients had multiple diverticula. Uroflowmetry registered the maximal urinary flow rate (Qmax) within 2.1-5.3 ml/s. In all the patients surgery was performed under epidural anesthesia, simaltaneously with transurethral resection (TUR) of benign prostatic hyperplasia in 18 patients, with TUR of the urinary bladder neck or incision of the prostate because of its sclerosis in 11 patients. In 2 cases there was also TUR of the bladder for papillary cancer involving the bladder wall and the diverticulum, in 6 cases one-stage pneumatic or mechanical cystolithotripsy was performed. No intraoperative complications occurred. After the operation all the patients resumed normal micturition. Control examination after 6-48-month follow-up Qmax rose to 14.1-23.0 ml/s. Neither ultrasound investigation nor cystography detected diverticulum in 13 patients. The size of the diverticulum diminished in size in 16 patients. Residual urine in large diverticula (14 patients) was 50 ml maximum. 12 months after the operation 1 patient developed recurrent sclerosis of the prostate with reappearance of residual urine. He was reoperated (TUR of the prostate) without incision of the neck of the diverticulum. Postoperative complications were the following: mild electric burn of the thigh (1 case), acute epididimitis treated conservatively (1 case) and early postoperative bleeding which required endoscopic revision of the bladder and coagulation of the bleeding vessel from the cut neck of the diverticulum (1 case). Thus, transurethral incision of the bladder's diverticular neck is effective and low-traumatic intervention which in patients with severe somatic pathology is an alternative to the open surgery, while in patients without such pathology it does not complicate open operation (diverticulectomy) if it becomes necessary.


Asunto(s)
Divertículo/cirugía , Endoscopía , Enfermedades de la Vejiga Urinaria/cirugía , Adulto , Anciano , Anciano de 80 o más Años , Carcinoma Papilar/complicaciones , Carcinoma Papilar/cirugía , Divertículo/complicaciones , Divertículo/diagnóstico , Divertículo/diagnóstico por imagen , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Hiperplasia Prostática/complicaciones , Hiperplasia Prostática/cirugía , Factores de Tiempo , Resección Transuretral de la Próstata , Ultrasonografía , Enfermedades de la Vejiga Urinaria/complicaciones , Enfermedades de la Vejiga Urinaria/diagnóstico , Enfermedades de la Vejiga Urinaria/diagnóstico por imagen , Neoplasias de la Vejiga Urinaria/complicaciones , Neoplasias de la Vejiga Urinaria/cirugía
19.
Urology ; 55(5A Suppl): 24-8; discussion 31-2, 2000 May.
Artículo en Inglés | MEDLINE | ID: mdl-10767447

RESUMEN

Biofeedback is a form of learning or re-education in which the participant is retrained within a closed feedback loop. Information about one or more of the patient's normally unconscious physiologic processes is made available to the patient as a visual, auditory, or tactile signal. Objective responses are recorded on a polygraph trace so that they can be easily observed. Subjective responses are more difficult to monitor and it is often difficult to separate these effects of biofeedback from the placebo effect. Biofeedback has been successfully employed in cases of urinary incontinence due to detrusor instability. Indeed, a recent report has shown that biofeedback-assisted behavioral treatment is more effective than either oxybutynin or placebo in the treatment of urge and mixed urinary incontinence in older, community-dwelling women. Patients embarking on biofeedback need to be well motivated and intelligent enough to understand what is expected of them. The treatment is time consuming for both the patient and the operator, but the benefits of successful treatment include a reduction in morbidity and side effects associated with other therapies. Biofeedback can be employed as an adjunct to other forms of treatment, such as drug therapy, and is particularly useful in children.


Asunto(s)
Biorretroalimentación Psicológica , Enfermedades de la Vejiga Urinaria/complicaciones , Enfermedades de la Vejiga Urinaria/terapia , Incontinencia Urinaria/complicaciones , Incontinencia Urinaria/terapia , Electromiografía , Humanos , Enfermedades de la Vejiga Urinaria/fisiopatología , Incontinencia Urinaria/fisiopatología
20.
Urology ; 55(5A Suppl): 17-23; discussion 31-2, 2000 May.
Artículo en Inglés | MEDLINE | ID: mdl-10767446

RESUMEN

Electrical stimulation is an effective and well-tolerated treatment for overactive bladder. Initial work in animals indicated the potential of this treatment, and early clinical experience in Europe further supported its likely efficacy. Although the mechanism of action of electrical stimulation remains unproven in humans, it is believed to be a neuromodulating therapy which affects the neural signaling that controls continence. There is also strong evidence that electrical stimulation affects striated muscle. The therapy can cause hypertrophy of skeletal muscle fibers, possibly by the recruitment of faster-conducting motor units, which would not normally be recruited during voluntary efforts. In addition, electrical stimulation can alter the expression of myosin isoforms, favoring a conversion to type I muscle. Despite our incomplete understanding of the mechanism of action of electrical stimulation, clinical devices have been developed quickly. Case series have been reported throughout Europe. These were followed by controlled clinical trials in the United States. There is good evidence that the use of vaginal electrical stimulators can reduce the occurrence of symptoms of overactive bladder in about half of the patients treated. Multiple uses of nonimplanted stimulation, including thigh stimulation, anal stimulation, and direct pelvic muscle stimulation, have been reported. In these trials, it is common for objective findings to be poorly correlated with subjective reports of improvements or cure. Patients frequently report that the urge-to-leak time improves, but this is difficult to measure objectively. The use of nonimplanted devices is effective and well tolerated, and should precede the use of implanted devices. A direct comparison with other effective methods of treatment for overactive bladder is warranted.


Asunto(s)
Terapia por Estimulación Eléctrica , Enfermedades de la Vejiga Urinaria/complicaciones , Enfermedades de la Vejiga Urinaria/terapia , Incontinencia Urinaria/complicaciones , Incontinencia Urinaria/terapia , Adulto , Niño , Ensayos Clínicos como Asunto , Femenino , Predicción , Humanos
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