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1.
Prog Urol ; 33(17): 1062-1072, 2023 Dec.
Artículo en Francés | MEDLINE | ID: mdl-37739836

RESUMEN

OBJECTIVE: To report the experience of a university hospital center with sacral neuromodulation for patients with bladder voiding disorders. MATERIAL AND METHODS: All patients who underwent sacral neuromodulation between 1998 and 2022 for bladder voiding disorders were included. Medical records were analyzed retrospectively, and population, efficacy and follow-up data were collected. RESULTS: A total of 134 patients underwent test implantation and 122 patients were analyzed. 68 patients (56%) were implanted with a definitive neuromodulation device. Mean age was 43±16 years and BMI 25.5±5.4kg/m2. 74% were women. Bladder voiding disorder was due to sphincter hypertonia in 51% of cases, with associated bladder hypocontractility in 29%. The spontaneous micturition rate after implantation increased from 34% to 92%. Implantation results appeared to be better in patients with sphincter hypertonia, whether or not associated with bladder hypocontractility. The benefit was most often present with a frequency of 5Hz (54.4%). Side-effects were present in 52% of cases at 5 years, and in 85% of cases were pain in relation to the implanted devices. They resolved under medical treatment or after revision of the device (27% of cases at 5 years). CONCLUSION: SNM is effective in micturition recovery, but has side effects. Urodynamic mechanism and etiology may provide clues for modulating NMS box settings and determining predictive factors for NMS success. Data from other centers are needed to identify reliable predictive factors.


Asunto(s)
Terapia por Estimulación Eléctrica , Enfermedades de la Vejiga Urinaria , Trastornos Urinarios , Humanos , Femenino , Adulto , Persona de Mediana Edad , Masculino , Vejiga Urinaria , Micción , Estudios Retrospectivos , Terapia por Estimulación Eléctrica/métodos , Enfermedades de la Vejiga Urinaria/terapia , Trastornos Urinarios/terapia , Hipertonía Muscular/terapia , Resultado del Tratamiento , Plexo Lumbosacro
2.
Biochem Biophys Res Commun ; 624: 164-170, 2022 10 08.
Artículo en Inglés | MEDLINE | ID: mdl-35952538

RESUMEN

Electroacupuncture (EA) can protect against acute urinary retention (AUR); however, the underlying mechanism remains unclear. Non-vesicular ATP release mediated by transient receptor potential (TRP) channels were identified as a key contributor to signaling in urothelial cells. In this study, the AUR model was established by urethral outlet obstruction in female Sprague-Dawley rats. EA was performed at SP6 and BL32 for 0.5 h prior to induction of AUR. EA reduced TRPV1 expression and urinary ATP concentrations in rat bladder, decreased the peak intravesical pressure during AUR, and attenuated abnormal voiding patterns and bladder pathological injury induced by AUR. Besides, 179 patients who experienced postoperative urinary retention were recruited and found that EA reduced urinary ATP concentrations and accelerated the recovery of spontaneous voiding. These observations indicate that EA exerts protection against AUR-induced bladder dysfunction by reducing urinary ATP concentrations through the regulation of TRPV1.


Asunto(s)
Electroacupuntura , Retención Urinaria , Adenosina Trifosfato/metabolismo , Animales , Femenino , Humanos , Ratas , Ratas Sprague-Dawley , Transducción de Señal , Canales Catiónicos TRPV/metabolismo , Vejiga Urinaria/metabolismo , Vejiga Urinaria/patología , Enfermedades de la Vejiga Urinaria/prevención & control , Enfermedades de la Vejiga Urinaria/terapia , Retención Urinaria/complicaciones , Retención Urinaria/etiología , Retención Urinaria/metabolismo
3.
J Urol ; 205(6): 1785-1791, 2021 06.
Artículo en Inglés | MEDLINE | ID: mdl-33525925

RESUMEN

PURPOSE: Parasacral transcutaneous electrical nerve stimulation has been used to manage lower urinary tract symptoms refractory to standard urotherapy. Nevertheless, its actual effectiveness in treatment of bladder and bowel dysfunction remains to be established. We sought to evaluate the effectiveness of parasacral transcutaneous electrical nerve stimulation in the treatment of children with bladder and bowel dysfunction. MATERIALS AND METHODS: This was a randomized clinical trial conducted with children and adolescents of 5-17 years of age diagnosed with bladder and bowel dysfunction. Patients with neurological or anatomical abnormalities of urinary or digestive tracts, those unable to attend treatment sessions 3 times a week, individuals with diabetes mellitus or diabetes insipidus and those using anticholinergic drugs or laxatives were excluded from the study. The sample was divided into 2 groups: a control group submitted to standard urotherapy plus sham electrotherapy applied to the scapular region and a treatment group submitted to urotherapy plus parasacral transcutaneous electrical nerve stimulation. All the patients were submitted to 3, 20-minute electrotherapy (parasacral transcutaneous electrical nerve stimulation or sham) sessions/week for a total of 20 sessions. RESULTS: Forty patients were evaluated, 20 in the control group and 20 in the treatment group. Mean age (±standard deviation) was 8.4±2.8 years and 52.5% were male. In 15 patients (37.5%), rectal diameter was ≥3 cm. Lower urinary tract symptoms improved in both groups following treatment, with no statistically significant differences in Dysfunctional Voiding Scoring System score, lower urinary tract symptoms or uroflowmetry patterns between the groups. Intragroup evaluation showed a significant improvement in enuresis in the treatment group. There was a significant improvement in functional constipation post-intervention in treatment group compared to control group (70% vs 20%, p=0.004). CONCLUSIONS: Parasacral transcutaneous electrical nerve stimulation is effective for treatment of bladder and bowel dysfunction in children and adolescents, particularly insofar as functional constipation is concerned.


Asunto(s)
Estreñimiento/terapia , Enfermedades Intestinales/terapia , Síntomas del Sistema Urinario Inferior/terapia , Estimulación Eléctrica Transcutánea del Nervio , Enfermedades de la Vejiga Urinaria/terapia , Adolescente , Niño , Preescolar , Método Doble Ciego , Femenino , Humanos , Masculino , Estudios Prospectivos , Región Sacrococcígea , Estimulación Eléctrica Transcutánea del Nervio/métodos
4.
Br J Nurs ; 29(9): S23-S26, 2020 May 14.
Artículo en Inglés | MEDLINE | ID: mdl-32407234

RESUMEN

Sacral neuromodulation is an internationally endorsed therapy recognised by the National Institute for Health and Care Excellence for patients who have refractory overactive bladder symptoms and/or idiopathic non-obstructive urinary retention when conservative treatments have failed or when patients have been unable to tolerate them. The Medtronic InterStim System used at the Queen Elizabeth Hospital Birmingham received CE mark approval in 1995 for bladder indications. To date, over 300 000 patients worldwide have been treated, with 61-90% reporting satisfaction with treatment (Sutherland et al, 2007; Leong et al, 2011). It is a safe and effective intervention that can positively impact upon the management of both of these conditions, in particular overactive bladder. This highly prevalent condition is distressing to the individual and has an economic burden to society comparable in magnitude with that of breast cancer and osteoporosis (Hu and Wagner, 2005).


Asunto(s)
Terapia por Estimulación Eléctrica , Enfermedades de la Vejiga Urinaria/terapia , Atención a la Salud , Hospitales , Humanos , Reino Unido , Vejiga Urinaria Hiperactiva/terapia , Retención Urinaria/terapia
5.
J Pediatr Urol ; 16(1): 36.e1-36.e6, 2020 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-31735518

RESUMEN

INTRODUCTION: Several studies have revealed that electrical stimulation is an effective modality for treatment of lower urinary tract (LUT) dysfunction via raising the capacity or compliance of the bladder or maybe by pelvic floor relaxation and reducing detrusor pressure as well. OBJECTIVE: This study aimed to assess the efficacy of transcutaneous interferential (IF) electrical stimulation on LUT symptoms as well as urine flow parameters in children with primary bladder neck dysfunction (PBND). STUDY DESIGN: We reviewed the charts of all children with persistent LUT symptoms who underwent IF electrical stimulation between 2010 and 2017. Twenty-three neurologically and anatomically normal children (mean age: 7.7 years, range: 5-13) with LUT symptoms were included in this study. Children had different LUT symptoms such as hesitancy, straining, urinary incontinence and constipation with no sufficient response to medical treatment (α -blocker) for at least 6 months. IF electrical stimulation was performed for 15 sessions, two times per week. All children were symptomatic and had abnormal urine flow pattern with an electromyographic (EMG) lag time of more than 6 s on uroflowmetry with EMG. A voiding chart, uroflowmetry with EMG and kidney and bladder ultrasounds were performed before and after the treatment for all children. Maximum and average urine flow rates, EMG lag time and postvoid residual volume were analyzed. In addition, alpha blocker therapy was continued during IF therapy. RESULTS: Mean maximum and average urine flow rates improved from 14.1 to 7.6-19.7 ml/s and 9.5 ml/s, respectively, while mean EMG lag time decreased from 11.7 to 5.2 s after the treatment (all P < 0.05). Also postvoid residual volume decreased significantly from 35.6 to 7.6 ml at the end of treatment courses. DISCUSSION: Pelvic floor EMG lag time, a documented parameter on uroflowmetry with EMG, defined as the time from the start of pelvic floor relaxation during a volitional voiding effort (the first stage of normal voiding) to the start of urine flow. Results showed that IF therapy decreased pelvic floor EMG lag time in children with PBND. In addition, increase in mean maximum and average urine flow rates in our patients indicated that pelvic IF therapy and behavioral modification improved voiding dysfunction in most of the patients and probably decreased bladder neck activity during voiding. Future studies with larger sample size are needed to support this finding. CONCLUSION: IF therapy appears safe, effective and reproducible in improvement of PBND in children.


Asunto(s)
Estimulación Eléctrica Transcutánea del Nervio , Enfermedades de la Vejiga Urinaria/terapia , Trastornos Urinarios/terapia , Adolescente , Niño , Preescolar , Femenino , Humanos , Masculino , Estudios Retrospectivos , Estimulación Eléctrica Transcutánea del Nervio/métodos , Resultado del Tratamiento
6.
Zhongguo Zhen Jiu ; 39(5): 467-72, 2019 May 12.
Artículo en Chino | MEDLINE | ID: mdl-31099215

RESUMEN

OBJECTIVE: To explore the clinical efficacy of electroacupuncture nerve stimulation therapy (ENST) for interstitial cystitis/painful bladder syndrome (IC/PBS). METHODS: A total of 68 patients with IC/PBS were randomly divided into an observation group and a control group, 34 cases in each one. The patients in the observation group were treated with ENST; abdominal four acupoints and sacral four acupoints were connected with a pair of electrodes and treated alternately every other day. The ENST was given 50 min per times, three times a week for 3 months. The patients in the control group were treated with perfusion therapy of four-medication combination (heparin sodinm, lidocaine, sodium bicarbonate, gentamicin sulfate), twice a week for the first 6-8 weeks, followed by twice per month for 3 months. The infusion fluid remained for 1 h before discharging. The O' Leary-Sant score, including interstitial cystitis symptom index (ICSI) and interstitial cystitis problem index (ICPI), 24 h urination frequency, visual analogue scale (VAS) and maximum bladder volume were observed before treatment and treatment of 1 month, 3 months and 6 months after treatment respectively; the adverse events during the treatment were also recorded. RESULTS: Compared before treatment, the O'Leary-Sant score (ICSI, ICPI), 24 h urination frequency, VAS and maximum bladder volume in the two groups were improved after 1, 3 months treatment and 6 months after treatment (all P<0.05). The scores of ICSI, ICPI, VAS and 24 h urination frequency in the observation group were significantly lower than those in the control group (P<0.05). The maximum bladder volume in the observation group was significantly higher than that in the control group (P<0.05). Six months after treatment, the total effective rate in the observation group was 87.5% (28/32), which was higher than 69.7% (23/33) in the control group (P<0.01). No significant adverse events occurred during the treatment. CONCLUSION: ENST could effectively relieve the clinical symptoms of IC/PBS, but its long-term efficacy needs further observation.


Asunto(s)
Cistitis Intersticial , Electroacupuntura , Enfermedades de la Vejiga Urinaria/terapia , Cistitis Intersticial/terapia , Humanos , Dolor , Manejo del Dolor , Resultado del Tratamiento
7.
Physiology (Bethesda) ; 34(2): 150-162, 2019 03 01.
Artículo en Inglés | MEDLINE | ID: mdl-30724129

RESUMEN

Autonomic nerves are attractive targets for medical therapies using electroceutical devices because of the potential for selective control and few side effects. These devices use novel materials, electrode configurations, stimulation patterns, and closed-loop control to treat heart failure, hypertension, gastrointestinal and bladder diseases, obesity/diabetes, and inflammatory disorders. Critical to progress is a mechanistic understanding of multi-level controls of target organs, disease adaptation, and impact of neuromodulation to restore organ function.


Asunto(s)
Sistema Nervioso Autónomo/fisiopatología , Terapia por Estimulación Eléctrica/métodos , Cardiopatías/terapia , Animales , Diabetes Mellitus/fisiopatología , Diabetes Mellitus/terapia , Terapia por Estimulación Eléctrica/instrumentación , Enfermedades Gastrointestinales/fisiopatología , Enfermedades Gastrointestinales/terapia , Cardiopatías/fisiopatología , Humanos , Inflamación/fisiopatología , Inflamación/terapia , Obesidad/fisiopatología , Obesidad/terapia , Estimulación de la Médula Espinal/instrumentación , Estimulación de la Médula Espinal/métodos , Enfermedades de la Vejiga Urinaria/fisiopatología , Enfermedades de la Vejiga Urinaria/terapia , Estimulación del Nervio Vago/instrumentación , Estimulación del Nervio Vago/métodos
8.
J Pediatr Urol ; 15(1): 39.e1-39.e6, 2019 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-30473473

RESUMEN

INTRODUCTION: Historically, there have been few treatment options for children with severe refractory bladder and bowel dysfunction (BBD). Sacral neuromodulation (SNM) continues to show promising results in this challenging pediatric population with recalcitrant lower urinary tract symptoms. At the authors institution, they have begun offering explantation to those with persistent improvement after >6 months of having device turned off. The authors hypothesized that (1) SNM explantation for cure increases with extended follow-up and (2) those explanted for cure would have improved symptoms and quality of life when compared to those explanted for complication. MATERIALS & METHODS: The authors retrospectively reviewed all consecutive patients aged <18 years who underwent SNM placements at their institution (2012-2017). They excluded those without the second stage procedure. Reasons for device explantation were categorized as cure (resolution of symptoms with the device turned off for at least 6 months) or a complication (e.g. infection, need for magnetic resonance imaging, or pain). Non-parametric tests and survival analysis were used for analysis to account for differential follow-up time. Of those explanted, surveys were electronically sent to assess BBD severity and overall quality of life. RESULTS: Of 67 children who underwent a first stage procedure, 62 (92.5%) underwent a second stage procedure. 61 met inclusion criteria (68.9% female, 29.5% with previous filum section, median age at implantation 10.3 years). During follow-up (median 2.3 years), 12 patients (19.7%) had the SNM exchanged/revised because of lead fracture/breakage and return of urinary symptoms. To date, 50 patients remain with their SNM implanted, and 11 have been explanted. Adjusting for follow-up time, the risk of explantation was 6.5% at 2 years (2.2% for cure, 4.3% for complications) (Figure 1). Explantation increased to 24.5% at 3 years (16.5% for cure, 8.0% for complications) and 40.4% at 4 years (32.4% for cure, 8.0% for complications). Questionnaires were collected on patients after explant (median 2.2 years), with improvement in those explanted for cure compared to complication (Figure 2). DISCUSSION: Sacral neuromodulation explantation for cure is a novel concept previously not described in the literature. Limitations of this study include the relatively small numbers and lack of objective data in the cohort that remains with SNM device implanted. CONCLUSION: Sacral neuromodulation is a safe, viable option for the pediatric patient with refractory bladder dysfunction. Furthermore, SNM explantation for cure is an option with increasing likelihood after 2 years.


Asunto(s)
Terapia por Estimulación Eléctrica , Neuroestimuladores Implantables , Enfermedades Intestinales/terapia , Enfermedades de la Vejiga Urinaria/terapia , Niño , Remoción de Dispositivos , Terapia por Estimulación Eléctrica/efectos adversos , Terapia por Estimulación Eléctrica/instrumentación , Femenino , Humanos , Neuroestimuladores Implantables/efectos adversos , Plexo Lumbosacro , Masculino , Complicaciones Posoperatorias/cirugía , Falla de Prótesis , Inducción de Remisión , Estudios Retrospectivos , Análisis de Supervivencia
9.
Orv Hetil ; 159(43): 1735-1740, 2018 10.
Artículo en Húngaro | MEDLINE | ID: mdl-30346235

RESUMEN

Percutaneous tibial nerve stimulation (PTNS) is a minimally invasive, safe and well-tolerated neuromodulation technique for the lower urinary tract dysfunctions. PTNS delivers neuromodulation to the pelvic floor through the S2-4 junction of the sacral nerve plexus via the route of the posterior tibial nerve. Using the fine needle electrode insertion above the ankle, the tibial nerve is accessed, which connected to the stimulator. To date despite of its excessive clinical use, PTNS mechanism of action still remains unclear. The technique seems to be an efficacious and safe treatment for overactive bladder syndrome (OAB). It could be recommended according to the Urinary Incontinence Guideline of the European Association of Urology in women who did not have adequate improvement or could not tolerate anti-muscarinic therapy. The success rate is comparable to sacral nerve stimulation in OAB patients. PTNS has been used for fecal incontinence since 2003, however, many of the published studies are of poor quality. PTNS has also been shown to have positive effects on chronic pelvic pain, when the usual therapeutic steps did not result in satisfactory improvement. No major complications are reported in the literature, following PTNS treatment. Orv Hetil. 2018; 159(43): 1735-1740.


Asunto(s)
Síntomas del Sistema Urinario Inferior/terapia , Nervio Tibial , Estimulación Eléctrica Transcutánea del Nervio/métodos , Enfermedades de la Vejiga Urinaria/terapia , Trastornos Urinarios/terapia , Humanos , Resultado del Tratamiento , Vejiga Urinaria Hiperactiva/terapia
10.
Neuromodulation ; 21(7): 700-706, 2018 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-29949663

RESUMEN

OBJECTIVE: This study is aimed at determining if tibial nerve stimulation (TNS) can modulate both bladder underactivity and overactivity. METHODS: In α-chloralose anesthetized cats, tripolar cuff electrodes were implanted on both tibial nerves and TNS threshold (T) for inducing toe twitching was determined for each nerve. Normal bladder activity was elicited by slow intravesical infusion of saline; while bladder overactivity was induced by infusion of 0.25% acetic acid to irritate the bladder. Bladder underactivity was induced during saline infusion by repeated application (2-6 times) of 30-min TNS (5 Hz, 4-8T, 0.2 msec) to the left tibial nerve, while TNS (1 Hz, 4T, 0.2 msec) was applied to the right tibial nerve to reverse the bladder underactivity. RESULTS: Prolonged 5-Hz TNS induced bladder underactivity by significantly increasing bladder capacity to 173.8% ± 10.4% of control and reducing the contraction amplitude to 40.1% ± 15.3% of control, while 1 Hz TNS normalized the contraction amplitude and significantly reduced the bladder capacity to 130%-140% of control. TNS at 1 Hz in normal bladders did not change contraction amplitude and only slightly changed the capacity, but in both normal and underactive bladders significantly increased contraction duration. The effects of 1 Hz TNS did not persist following stimulation. Under isovolumetric conditions when the bladder was underactive, TNS (0.5-3 Hz; 1-4T) induced large amplitude and sustained bladder contractions. In overactive bladders, TNS during cystometry inhibited bladder overactivity at 5 Hz but not at 1 Hz. CONCLUSIONS: This study indicates that TNS at different frequencies might be used to treat bladder underactivity and overactivity.


Asunto(s)
Fenómenos Biofísicos/fisiología , Terapia por Estimulación Eléctrica/métodos , Nervio Tibial/fisiología , Enfermedades de la Vejiga Urinaria/terapia , Ácido Acético/toxicidad , Animales , Biofisica , Gatos , Modelos Animales de Enfermedad , Femenino , Masculino , Reflejo/fisiología , Enfermedades de la Vejiga Urinaria/inducido químicamente
11.
Neuromodulation ; 21(8): 805-808, 2018 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-29265565

RESUMEN

INTRODUCTION: Sacral neuromodulation (SNM) is a safe and effective therapy for patients with lower urinary tract dysfunction (LUTD). It is used in patients who have exhausted conservative and first line therapeutic options. The selection of eligible candidates could predict a successful therapeutic outcome. Although many factors have been identified, psychological/psychiatric disturbances are neither well understood nor are routinely evaluated prior to implantation. CASE REPORTS: We report three cases where identified psychological/psychiatric disturbances post-implantation could have influenced explantation in an otherwise successful implantation of SNM device assessed both subjectively and objectively. The device had to be explanted in two of the three. One more patient has requested but has not-yet undergone explantation and is receiving treatment for severe depression. One of the explanted cases has successfully undergone re-implantation after successful treatment of her diagnosed psychological condition, while the other's request for re-implantation has not yet been fulfilled. CONCLUSIONS: Psychological/psychiatric disturbance have possibly affected the treatment outcome and explantation of SNM in our patients despite a high success in resolution of the urinary symptoms. Addressing such disturbances when determining patient eligibility for SNM therapy could reduce the explantation rate after a successful therapeutic response, and is an interesting point of interest for future research into predictors of successful SNM implantation and therapy.


Asunto(s)
Terapia por Estimulación Eléctrica/métodos , Terapia por Estimulación Eléctrica/psicología , Trastornos Mentales/complicaciones , Enfermedades de la Vejiga Urinaria/terapia , Adulto , Femenino , Humanos , Plexo Lumbosacro/fisiología , Adulto Joven
12.
BMC Urol ; 17(1): 58, 2017 Jul 13.
Artículo en Inglés | MEDLINE | ID: mdl-28705210

RESUMEN

BACKGROUND: Bladder spasm is a common side effect of urological surgery. Main treatment modalities include opioids or anticholinergic medication; however, bladder spasms still occur even after these interventions. Recent studies indicate that transcutaneous stimulation of the foot can result in 50% increase in bladder capacity in healthy adults, and inhibit bladder detrusor overactivity in spinal cord injured patients. In this study, we examined the effects of transcutaneous electrical stimulation of the foot on bladder spasms related symptoms. METHODS: Sixty-six male patients who underwent prostate or bladder surgeries due to benign prostatic hyperplasia or bladder diseases were randomly divided into two groups: the control group (n = 36) and the treatment group (n = 30). The control group received the routine postoperative care. The treatment group received daily transcutaneous electrical stimulation of the foot during 3 days after surgery; each time lasted for 60 min. All patients were evaluated by the Visual Analogue Scale for pain sensation, frequency of bladder spasm episodes, and a total score of bladder spasms symptoms. RESULTS: In the control group, the patients with bladder surgery had a higher Visual Analogue Scale score than patients with prostate surgery (P = 0.024). In both treatment and control groups, the Visual Analogue Scale score, spasm frequency, and total score of bladder spasm symptoms decreased from day 1 to day 3 (P <0.001). The Visual Analogue Scale score at day 2, total score of bladder spasm symptoms at day 2 and day 3 were significantly lower in the treatment group than in the control group (P <0.05). CONCLUSION: These results provided preliminary evidence suggesting beneficial effects of stimulating somatic afferent nerves in the foot on postoperative bladder spasms. TRIAL REGISTRATION: The study was registered with Chinese Clinical Trial Registry on June 13 2016 ( http://www.chictr.org.cn/ ) (Identifier: ChiCTR-INR-16008635).


Asunto(s)
Vías Aferentes , Complicaciones Posoperatorias/terapia , Espasmo/terapia , Estimulación Eléctrica Transcutánea del Nervio , Enfermedades de la Vejiga Urinaria/terapia , Anciano , Pie/inervación , Humanos , Masculino , Persona de Mediana Edad , Hiperplasia Prostática/cirugía , Estimulación Eléctrica Transcutánea del Nervio/métodos , Enfermedades de la Vejiga Urinaria/cirugía
13.
Curr Urol Rep ; 18(2): 14, 2017 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-28213858

RESUMEN

PURPOSE OF REVIEW: Dysfunctional voiding is defined as "habitual contraction of the urethral sphincter during voiding." Children with dysfunctional voiding remain a challenge, and the approach to and management of LUT dysfunction varies widely among programs and providers with the role of pharmacotherapy being ill defined. RECENT FINDINGS: Animated biofeedback is the current treatment modality of choice in children who are not responsive to standard urotherapy. Comprehensive biofeedback programs incorporate continued elimination education, voiding diaries, and home exercises with high success rates. Recent studies suggest botulinum toxin A results in persistent satisfactory results in select children with refractory dysfunctional voiding. Conservative measures including an aggressive bowel regimen and timed voiding are the mainstays of treatment, and motivated children with persistent symptoms often respond favorably to escalating urotherapy with biofeedback. Pharmacotherapy plays an ancillary role in the management of dysfunctional voiding.


Asunto(s)
Enfermedades de la Vejiga Urinaria/terapia , Antagonistas Adrenérgicos alfa/uso terapéutico , Biorretroalimentación Psicológica/métodos , Toxinas Botulínicas Tipo A/uso terapéutico , Antagonistas Colinérgicos/uso terapéutico , Terapia por Ejercicio , Humanos , Enfermedades de la Vejiga Urinaria/fisiopatología
14.
Urology ; 102: 68-72, 2017 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-28093307

RESUMEN

OBJECTIVE: To evaluate the impact of functional bladder capacity (FBC) on clinical outcomes after a staged neuromodulation procedure. MATERIALS AND METHODS: Adults in our prospective neuromodulation database were evaluated. Data were collected from medical records, voiding diaries (FBC defined as average volume per void), Interstitial Cystitis Symptom Index-Problem Index, Overactive Bladder Questionnaire, and Global Response Assessment over 3 months. Descriptive statistics, Pearson's chi-square tests, Wilcoxon rank sum tests, logistic regression, repeated measures analyses, and Spearman correlation coefficients were performed. RESULTS: Of the 216 patients (mean age 59 years; 84% female), most had urinary urgency and frequency with or without urge incontinence (71%), a sacral lead placement (82%), and implantable pulse generator (IPG) implantation (92%). Baseline FBC was similar between implanted and not implanted patients (P = .17); however implanted patients had a median 19 mL increase in FBC after lead placement compared to a 2.7 mL decrease in explanted patients (P = .0014). There was a strong association between percent change in FBC after lead placement and IPG implantation (P = .021; C-statistic 0.68), but baseline FBC (mL) was not associated. Baseline FBC (mL), or percent change in FBC after lead placement, was not related to symptom improvement. When grouped by baseline FBC < 150 mL and FBC ≥ 150 mL, FBC only improved significantly in the <150 group but both demonstrated significant improvements in symptoms. CONCLUSION: FBC improvements were associated with IPG implantation but not other symptom measures. Patients with low FBC (baseline FBC < 150) also achieved significant improvements in symptoms.


Asunto(s)
Terapia por Estimulación Eléctrica , Enfermedades de la Vejiga Urinaria/fisiopatología , Enfermedades de la Vejiga Urinaria/terapia , Vejiga Urinaria/fisiopatología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Factores de Tiempo , Urodinámica
15.
Zhongguo Zhen Jiu ; 37(10): 1105-7, 2017 Oct 12.
Artículo en Chino | MEDLINE | ID: mdl-29354981

RESUMEN

The clinical syndrome differentiation system of acupuncture-moxibustion was proposed in this paper, which should reflect the core of acupuncture theory and characteristics of treatment, and take syndrome differentiation of meridian as key component. In case of meridian syndrome differentiation guided by syndrome differentiation of eight principles, extra emphasis should be placed on the differences of jing-jin diseases and zangfu diseases. Differentiating location should be key in jing-jin diseases; the acupoints should be selected according to location, and appropriate technique should be applied according to symptoms. Zangfu diseases should based on syndrome differentiation of meridian and assisted by syndrome differentiation of zangfu; the key of zangfu diseases treatment was meridian-based acupoint selection, assisted by location-based acupoint selection; the emphasis should be placed on special acupoints, and reinforcing and reducing technique was selected according to cold-heat and deficiency-excess.


Asunto(s)
Terapia por Acupuntura/métodos , Enfermedades Gastrointestinales/terapia , Moxibustión , Enfermedades Musculares/terapia , Enfermedades de la Vejiga Urinaria/terapia , Yin-Yang , Puntos de Acupuntura , Humanos , Meridianos , Síndrome
16.
Urology ; 94: 224-6, 2016 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-27034090

RESUMEN

Sacral neuromodulation (SNM) has been used off-label in the United States for over a decade in the pediatric population. Many published studies have demonstrated efficacy with SNM in this population; however, a significant number of children with refractory bowel bladder dysfunction (BBD) also have underlying comorbidities. Children with certain spinal abnormalities pose a problem for the urologist treating BBD. Patients with caudal regression can have various sacral anomalies, making SNM challenging or impossible. We present the first case in the United States of pudendal neuromodulation in a pediatric BBD patient with caudal regression.


Asunto(s)
Terapia por Estimulación Eléctrica , Enfermedades Intestinales/etiología , Enfermedades Intestinales/terapia , Meningocele/complicaciones , Región Sacrococcígea/anomalías , Enfermedades de la Vejiga Urinaria/etiología , Enfermedades de la Vejiga Urinaria/terapia , Anomalías Múltiples , Niño , Femenino , Humanos , Neuroestimuladores Implantables , Nervio Pudendo , Vejiga Urinaria
17.
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
18.
Sci Rep ; 5: 17547, 2015 Dec 01.
Artículo en Inglés | MEDLINE | ID: mdl-26621821

RESUMEN

This study examined the influence of age, gender and race on nitric oxide (NO) release over acupuncture points, meridian without acupoint, and non-meridian regions of the Pericardium (PC) and Bladder (BL) meridian as well as aging on LU meridian in 61 healthy subjects. Biocapture tubes were attached to the skin surface, and total nitrite and nitrate was biocaptured and quantified using chemiluminescence. In elder ages compared to adults, NO levels over the ventral forearm were significantly decreased over LU on radial regions but not altered over PC on medial regions. Conversely, NO content was elevated over BL regions only in overweight/obesity of elder ages. NO levels over PC regions were marginally elevated in overweight/obese males compared to females but did not alter between races. These results suggest a selective reduction of NO release over LU meridian with aging, which is consistent with a progressive decline in lung function and increase in chronic respiratory disease in elder ages. Increased NO levels along the BL meridian in older obese subjects may reflect a modified NO level along somatic-bladder pathway for counteracting bladder dysfunctions with aging. Both of them support somatic-organ connections in the meridian system associated with potential pathophysiological changes with aging.


Asunto(s)
Puntos de Acupuntura , Óxido Nítrico/metabolismo , Obesidad/metabolismo , Obesidad/terapia , Enfermedades de la Vejiga Urinaria/metabolismo , Enfermedades de la Vejiga Urinaria/terapia , Adolescente , Adulto , Factores de Edad , Anciano , Femenino , Antebrazo , Humanos , Masculino , Persona de Mediana Edad , Factores Sexuales
19.
Urologe A ; 54(3): 373-7, 2015 Mar.
Artículo en Alemán | MEDLINE | ID: mdl-25784446

RESUMEN

Neuromodulative procedures have become an inherent component in the therapy of functional urinary bladder and pelvic floor function disorders. Sacral neuromodulation has been used in Germany for more than 20 years and reresents the standard neuromodulative therapy. Technical improvements in the field of test stimulation and the phasing out of the large pulse generator models represent current changes with the resulting advantages and disadvantages. Pudendal neuromodulation (PNM) has been known for many years as a procedure for treatment of chronic diseases of the urinary bladder and the lesser pelvis and is predominantly used as second-line neuromodulative therapy; however, for pelvic pain syndromes and in particular for pudendal neuralgia, it represents a promising minimally invasive first-line therapy. Due to the technically demanding puncture procedure, PNM has so far only been used in Germany in specialized centers. Through the development of new operation techniques, the prerequisites for a wider multicentric use, with the future aim of approval of the procedure, have been achieved. External transdermal pudendal neuromodulation is a promising therapeutic approach and after further testing in randomized studies could find an application as a conservative step before minimally invasive pudendal neuromodulation. Although the technique of laparoscopic electrode placement on neural structures of the lesser pelvis is technically attractive, it predominantly finds a monocentric use and must in due course be critically compared with established minimally invasive procedures.


Asunto(s)
Terapia por Estimulación Eléctrica/métodos , Terapia por Estimulación Eléctrica/tendencias , Trastornos del Suelo Pélvico/terapia , Enfermedades de la Vejiga Urinaria/terapia , Humanos , Resultado del Tratamiento
20.
Urology ; 85(1): 205-10, 2015 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-25444633

RESUMEN

OBJECTIVE: To assess the efficacy of animated biofeedback and pelvic floor muscle (PFM) exercise in managing children with non-neuropathic underactive bladder (UB). METHODS: A total of 50 children with UB without underlying neuropathic disease, aged 5-16 years, were included in this study. They were randomly divided into 2 equal treatment groups comprising standard urotherapy (hydration, scheduled voiding, toilet training, and diet) with (group A) or without (group B) animated biofeedback and PFM exercise. The follow-up period for each participant was 1 year. A complete voiding and bowel habit diary was recorded by participants' parents before and after 2 evaluations. In addition, uroflowmetry with electromyography and bladder ultrasound were performed before, 6 months, and 1 year after treatment. Results were compared between the 2 cohorts. RESULTS: Mean number of voiding episodes was significantly increased in group A after biofeedback therapy compared with group B with only standard urotherapy (6.6 ± 1.6 vs 4.5 ± 1 times a day; P <.000). Urinary tract infection did not relapse in 9 of 11 (81%) and 8 of 15 (38%) patients in groups A and B, respectively (P <.02). Postvoid residual volume and voiding time decreased considerably, whereas maximum urine flow increased significantly in group A compared with group B (17.2 ± 4.7 vs 12.9 ± 4.6 mL/s; P <.01). CONCLUSION: Combination of animated biofeedback and PFM exercise effectively improves sensation of bladder fullness and contractility in children with UB due to voiding dysfunction.


Asunto(s)
Biorretroalimentación Psicológica/métodos , Terapia por Ejercicio , Diafragma Pélvico , Enfermedades de la Vejiga Urinaria/terapia , Trastornos Urinarios/terapia , Adolescente , Niño , Preescolar , Método Doble Ciego , Femenino , Humanos , Masculino
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