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1.
Neurourol Urodyn ; 38(7): 1844-1851, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31286547

RESUMO

PURPOSE: To predict the persistence of storage symptoms after transurethral resection of the prostate (TURP) using a nomogram derived from the ice water test (IWT). METHODS: The IWTs of 73 men with lower urinary tract symptoms and prostatic bladder outlet obstruction were retrospectively analyzed. The strength of the detrusor contraction was approximated by using the detrusor gradient of Δpdet /Δt at maximum detrusor pressure and the area under the curve. The parameters were utilized in a nomogram, which facilitated a severity categorization from 1 to 10. Patients with a positive IWT in the categories 1 to 2 were assigned to group A, categories 3 to 4 to group B and categories 5 and higher to group C. After TURP, patients with persisting storage symptoms were offered a botulinum toxin injection. RESULTS: There were 32 patients (44%) with negative and 41 patients (56%) with positive IWTs. Patients with negative IWTs were classified in category 1. Regarding patients with positive IWTs, 14 (34%) were correlated to group A, 14 (34%) to group B, and 13 (32%) to group C. The necessity of a subsequent botulinum toxin injection correlated significantly with a higher nomogram category (P < .001) as well as higher severity categorization (P < .001). In multivariate analysis, the nomogram category was an independent predictor for botulinum toxin injection (P = .002, OR, 6.9, CI, 2.0-23.9). CONCLUSION: The quantification of the detrusor contraction during the IWT allowed stratification of patients in risk categories for persistent storage symptoms after TURP and the potential need for later botulinum toxin injections.


Assuntos
Técnicas de Diagnóstico Urológico , Sintomas do Trato Urinário Inferior/cirurgia , Hiperplasia Prostática/cirurgia , Ressecção Transuretral da Próstata , Obstrução do Colo da Bexiga Urinária/cirurgia , Bexiga Urinária Hiperativa/diagnóstico , Idoso , Idoso de 80 Anos ou mais , Humanos , Sintomas do Trato Urinário Inferior/fisiopatologia , Masculino , Pessoa de Meia-Idade , Nomogramas , Estudos Retrospectivos , Obstrução do Colo da Bexiga Urinária/fisiopatologia , Bexiga Urinária Hiperativa/fisiopatologia , Urodinâmica/fisiologia
3.
Aktuelle Urol ; 48(3): 238-242, 2017 May.
Artigo em Alemão | MEDLINE | ID: mdl-28445906

RESUMO

Purpose This study evaluates the hypothesis that bipolar stimulation of the S3 and S4 sacral roots may enhance the efficacy of the percutaneous nerve evaluation (PNE) test. Material and Methods In this case-control-study, we enrolled 43 patients undergoing bipolar PNE and 57 controls undergoing unipolar PNE. For bipolar PNE, four test electrodes were placed at the bilateral S3 and S4 roots. The electrodes at the S3 and S4 roots of each side were connected to obtain bipolar stimulation. The test protocol over eight days included unilateral and bilateral stimulation of the S3 and S4 sacral roots. Eight days after implantation, the electrodes were removed and test results from bladder diaries were collected. Results The unipolar test procedure was successful in 47 % (27/57) of cases. The bipolar test procedure was successful in 58 % (25/43). In the bipolar group, 63 % (12/19) of patients with neurogenic tract dysfunction profited from treatment, vs. 57 % (13/23) in the unipolar group. Patients without a neurologic disease had a successful test in 58 % (14/24) of cases treated with bipolar PNE vs. 41 % (14/24) treated with unipolar PNE. Multivariate analysis did not reveal a statistically significant difference between groups. Conclusion Although not significant in this population, bipolar PNE may improve efficacy compared to the unipolar test procedure. Similar observations were made in subgroups of neurogenic and non-neurogenic bladder dysfunctions.


Assuntos
Sacro/inervação , Raízes Nervosas Espinhais/fisiopatologia , Estimulação Elétrica Nervosa Transcutânea/métodos , Resultado do Tratamento , Transtornos Urinários/terapia , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Exame Neurológico , Nervos Periféricos/fisiopatologia , Sistema Urinário/inervação , Transtornos Urinários/fisiopatologia , Urodinâmica/fisiologia
4.
Eur Urol ; 51(5): 1350-5; discussion 1355-6, 2007 May.
Artigo em Inglês | MEDLINE | ID: mdl-17070984

RESUMO

OBJECTIVES: To describe a new approach to the pudendal nerve from a dorsal direction in terms of topographic anatomy and to discuss pudendal nerve neurophysiology in light of the rationale behind pudendal nerve stimulation to treat lower urinary tract disorders. MATERIALS AND METHODS: Cadavers of four women aged 78-87 yr were studied. After placing the cadavers in prone position with a 40 degrees -60 degrees flexion of the hips and determining anatomic landmarks, a 20-G insulated needle was inserted close to the pudendal nerve. Then the topographic relationships of the puncture with the pudendal canal were explored by dissection. RESULTS: The mean points of insertion of the needle were 14 cm inside the great trochanter, 9 cm above the ischiatic tuberosity, and 6 cm outside the gluteal fold. If the needle was inserted 6.5 cm under the previous with an orifice of 60 degrees and this route was followed, the needle could have a contact area with the pudendal nerve larger, leading to a greater stimulation efficacy with less stimulation intensities. The rectum was so far away that a rectal injury with the needle seemed unlikely. No vascular structure was at the contact of the nerve. CONCLUSIONS: The described new puncture technique to reach the pudendal nerve provides easy and safe accessibility of the nerve for stimulation. In light of our increasing understanding of the rationale behind neuromodulative stimulation, the pudendal nerve could be a promising target for continuous lower urinary tract neuromodulation by implant.


Assuntos
Terapia por Estimulação Elétrica , Bexiga Urinária/inervação , Transtornos Urinários/terapia , Idoso , Idoso de 80 Anos ou mais , Cadáver , Feminino , Humanos , Nervos Periféricos/anatomia & histologia , Punções/métodos
5.
Nat Clin Pract Urol ; 2(4): 199-204; quiz 1 p following 204, 2005 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-16474763

RESUMO

BACKGROUND: A 68-year-old man presented with a history of significant urinary urge incontinence, pollakiuria, and weak bladder sensation. He also reported mild fecal incontinence and a hypotrophic and slightly weaker left leg. At 63 years of age he had presented to a urologist for treatment of irritative lower urinary tract symptoms and incontinence. A transurethral resection of the prostate had been performed. After the operation, the symptoms had persisted and the incontinence seriously worsened. INVESTIGATIONS: Clinical neurologic examination, videourodynamic examination, neurophysiologic examination, and MRI of the spinal cord. DIAGNOSIS: Neurogenic bladder dysfunction caused by adult tethered cord syndrome with myelon up to S2 level, spina bifida occulta, and lipoma infiltrating the conus medullaris. MANAGEMENT: Conservative anticholinergic treatment failed, and injection of botulinum-A toxin is planned.


Assuntos
Defeitos do Tubo Neural/complicações , Ressecção Transuretral da Próstata/efeitos adversos , Bexiga Urinaria Neurogênica/etiologia , Idoso , Algoritmos , Humanos , Masculino , Defeitos do Tubo Neural/diagnóstico , Índice de Gravidade de Doença
6.
J Urol ; 171(3): 1156-60, 2004 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-14767291

RESUMO

PURPOSE: In most spinal cord injured (SCI) patients the objective assessment of afferent neuronal pathways from the lower urinary tract and the recording of a disturbed urethral sensation and/or desire to void are still difficult. Viscerosensory evoked potentials (VSEPs) might be helpful, but they remain technically difficult to obtain and interpretation is delicate. As a new approach, sympathetic skin response (SSR) of the hand and foot were recorded after electrical stimulation of the posterior urethral mucosa. This technique should allow assessment of the integrity or deterioration of the autonomic afferent pathway. MATERIALS AND METHODS: A total of 20 males and 8 females with SCI somatosensory incomplete 15, somatosensory complete 13 and 6 healthy male volunteers were prospectively examined. During urodynamic examination electrical stimulation (single square pulses of 0.2 ms, 2 to 3-fold sensory threshold, 60 mA in complete SCI patients) of the posterior urethra/bladder neck was performed using a bipolar electrode inserted into a microtip pressure catheter. SSR recordings of the right palm and sole were simultaneously taken using surface electrodes and were analyzed by an electromyography unit. Patient reports on evoked urethral sensations at individual sensory thresholds were simultaneously noted. Additionally, well-known electrophysiological measurements such as pudendal sensory evoked potential and urethral VSEP were recorded to check clinical assessed somatosensory and viscerosensory status, and to compare SSR results with these conventional methods. RESULTS: Electrical stimulation of the posterior urethra evoked clear urethral sensation and SSRs in normal subjects. In 14 of 15 sensory incomplete SCI patients with disturbed urethral sensation SSRs could be recorded as well. Electrically evoked urethral sensations resembled the subjective desire to void at full bladder reported by controls and patients. In 13 sensory complete SCI patients with loss of any urethral sensation SSRs could not be recorded even at maximal electrical stimulation strength. All subjects with electrically induced urethral sensation had positive evoked (supralesional) SSRs of the hand. However, none of the patients with absent urethral sensation presented SSRs. Simultaneously recorded VSEPs could not be recorded clearly in 5 patients and 2 control subjects, whereas SSRs delivered clear results in all controls and patients, matching their reports. CONCLUSIONS: SSR recordings above a spinal lesion level after urethral electrostimulation might provide a useful and technically simple objective diagnostic tool to assess integrity of autonomic (visceral) afferent nerves from the lower urinary tract. Somatosensory deficits are not always paralleled by viscerosensory loss and vice versa. In this study SSRs were superior to VSEPs, the latter being more difficult to record. The subjective sensations reported by subjects during stimulation could be confirmed in an objective way in 100% of cases by positive/negative SSR findings.


Assuntos
Resposta Galvânica da Pele , Traumatismos da Medula Espinal/fisiopatologia , Bexiga Urinaria Neurogênica/fisiopatologia , Sistema Urogenital/inervação , Sistema Urogenital/fisiopatologia , Adulto , Vias Aferentes , Sistema Nervoso Autônomo , Potenciais Evocados , Feminino , Humanos , Masculino , Estudos Prospectivos , Traumatismos da Medula Espinal/complicações , Sistema Nervoso Simpático , Uretra/inervação , Bexiga Urinaria Neurogênica/etiologia
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