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4.
Can J Urol ; 29(3): 11154-11161, 2022 06.
Artículo en Inglés | MEDLINE | ID: mdl-35691037

RESUMEN

INTRODUCTION: Growing evidence supports acupuncture for several pain conditions including chronic prostatitis. This study aimed to determine the safety, tolerability, and effectiveness of acupuncture in reducing pain in women with interstitial cystitis/bladder pain syndrome (IC/BPS). MATERIALS AND METHODS: This prospective randomized single-blinded study compared electro-acupuncture (EA) to minimal acupuncture (MA) after 6 weekly treatments and again after 6 weeks of no treatment. Pain was assessed using the Brief Pain Inventory-Short Form (worst pain, average pain, pain severity, pain interference) and the Pain Catastrophizing Scale (PCS). Physical exams evaluated pelvic floor muscle tenderness. Mixed-effects models were used to estimate adjusted means over follow up. RESULTS: Patients were randomized to EA (n = 11) or MA (n = 10). There were no adverse events. Both groups' worst pain improved at 6 weeks, -2.91 ± 0.59 and -2.09 ± 0.68 for EA and MA respectively with no difference between groups (p = 0.37). Results were similar at 12 weeks. The EA group had greater improvement in pain interference at 6 weeks, -3.28 ± 0.51 versus -1.67 ± 0.58 (p = 0.049). The between group difference was not maintained at 12 weeks (p = 0.13). Average pain and pain severity showed no difference between groups (p > 0.05). The PCS improved overall at 6 weeks, -6.2 ± 2.5 (p = 0.03), with no difference between groups (p = 0.39). On physical exam, only the EA group showed a significant decrease in levator ani tenderness (p = 0.031) after treatment. CONCLUSIONS: Both EA and MA showed improvement in worst pain scores, however EA showed greater improvement in pain interference and pelvic floor muscle tenderness in women with IC/BPS.


Asunto(s)
Terapia por Acupuntura , Cistitis Intersticial , Terapia por Acupuntura/métodos , Cistitis Intersticial/terapia , Femenino , Humanos , Masculino , Mialgia , Dimensión del Dolor , Estudios Prospectivos
5.
Urology ; 163: 50-55, 2022 05.
Artículo en Inglés | MEDLINE | ID: mdl-34293374

RESUMEN

OBJECTIVES: To evaluate contemporary clinical presentations of priapism, their association with socioeconomic characteristics, and the role of prescribing providers in priapism episodes in a large cohort of patients managed at 3 major academic health systems. METHODS: We identified all consecutive patients presenting with ischemic priapism to the emergency departments of three major academic health systems (2014 -2019). Demographic characteristics, priapism etiologies, and clinical management were evaluated. Univariable and multivariable analyses were used to assess the contribution of socioeconomic characteristics and the role of prescribing providers in priapism episodes. RESULTS: We identified 102 individuals with a total of 181 priapism encounters. Hispanic race, lower income quartile, sickle-cell disease, and illicit drug use were associated with increased risk of recurrent episodes. Of ICI users, 57% received their prescriptions from non-urological medical professionals (NUMPs); the proportion with recurrent episodes was higher for NUMPs compared to urologists (24% vs 0%, P = 0.06) with no demographic differences identified between patients treated by either group. CONCLUSION: Socioeconomic disparities exist among patients presenting with recurrent episodes of priapism, potentially highlighting systemic issues with access to care and patient education. With most patients who developed ischemic priapism from ICI being prescribed these medications by NUMPs, further investigation is required to elucidate the prescribing and counseling patterns of these providers. Increased awareness of disparities and complications may improve patient safety.


Asunto(s)
Anemia de Células Falciformes , Priapismo , Anemia de Células Falciformes/complicaciones , Estudios de Cohortes , Humanos , Masculino , Priapismo/epidemiología , Priapismo/etiología , Factores de Riesgo , Factores Socioeconómicos
6.
Female Pelvic Med Reconstr Surg ; 27(12): 753-758, 2021 12 01.
Artículo en Inglés | MEDLINE | ID: mdl-34009830

RESUMEN

OBJECTIVE: The aim of this study was to describe patient-reported longitudinal outcomes in a multidisciplinary female chronic pelvic pain (CPP) program. METHODS: We conducted a retrospective cohort study for women cared for in a tertiary, multidisciplinary, female (CPP) program between 2012 and 2017. Patient demographics were collected from electronic medical records. Patients completed the numerical rating scale for pain, Pain Disability Index (PDI), and Patient Global Impression of Improvement scale at each visit. Mixed-effects models were used to assess change in patient responses over time. RESULTS: Patients (N = 317) with a mean age of 44.3 years (SD, 14.6) and median duration of symptoms of 3 years (interquartile range, 1.0-7.0) were assessed in this analysis. The primary diagnosis was pelvic floor myofascial pain (67%). On multivariable analysis, numerical rating scale scores decreased by -0.11 point [95% confidence interval (CI), -0.20 to -0.01] every 3 months (P = 0.03). On multivariable analysis, total PDI score decreased by -0.88 point (95% CI, -1.43 to -0.33) (P = 0.003), and PDI sexual subscores decreased by -0.29 point (95% CI, -0.44 to -0.14) (P < 0.001) every 3 months. A higher (worse) Patient Global Impression of Improvement score was associated with a higher (worse) PDI score at follow-up (odds ratio, 1.04; 95% CI, 1.01-1.07; P = 0.01). CONCLUSIONS: Patients in a multidisciplinary CPP program demonstrated improvement over time in pain disability that was associated with an overall global impression of improvement.


Asunto(s)
Dolor Crónico , Síndromes del Dolor Miofascial , Adulto , Dolor Crónico/terapia , Femenino , Humanos , Dimensión del Dolor , Dolor Pélvico/terapia , Estudios Retrospectivos
7.
J Sex Med ; 17(6): 1175-1181, 2020 06.
Artículo en Inglés | MEDLINE | ID: mdl-32229093

RESUMEN

BACKGROUND: Many patients with erectile dysfunction (ED) after radical prostatectomy (RP) improve with conservative therapy but some do not; penile prosthesis implantation rates have been sparsely reported, and have used nonrepresentative data sets. AIM: To characterize rates and timing of penile prosthesis implantation after RP and to identify predictors of implantation using a more representative data set. METHODS: The Healthcare Cost and Utilization Project State Inpatient and State Ambulatory Surgery databases for Florida from 2006 to 2015 were used. Patients undergoing RP (2006-2012) were tracked longitudinally for penile prosthesis implantation. Patient and clinical data were analyzed using multivariable logistic regression. OUTCOMES: The primary outcome was risk-adjusted predictors of prosthesis implantation, and the secondary outcome was predictors of the highest quartile of time between RP and penile prosthesis. RESULTS: Of 29,288 men who had RP, 1,449 (4.9%) patients underwent subsequent prosthesis. The mean time from RP to prosthesis was 2.6 years (median: 2.1; interquartile range [IQR]: 1.2-3.5). Adjusted predictors of prosthesis implantation included open RP (odds ratio [OR]: 1.5, P < .01), African American race (OR: 1.7, P < .01) or Hispanic ethnicity (OR: 3.2, P < .01), and Medicare (OR: 1.4, P < .01) insurance. Oler patients (age >70 years; OR: 0.7, P < .01) and those from the highest income quartile relative to the lowest (OR: 0.8, P < .05) were less likely to be implanted. Adjusted predictors of longer RP-to-implantation time (highest quartile: median: 4.7 years; IQR: 3.9-6.0 years) included open RP (OR: 1.78, P < .01), laparoscopic RP (OR: 4.67, P < .01), Medicaid (OR: 3.03, P < .05), private insurance (OR: 2.57, P < .01), and being in the highest income quartile (OR: 2.52, P < .01). CLINICAL IMPLICATIONS: These findings suggest ED treatment healthcare disparities meriting further investigation; upfront counseling on all ED treatment modalities and close monitoring for conservative treatment failure may reduce lost quality of life years. STRENGTHS & LIMITATIONS: This study is limited by its use of administrative data, which relies on accurate coding and lacks data on ED questionnaires/prior treatments, patient-level cost, and oncologic outcomes. Quartile-based analysis of income and time between RP and prosthesis limits the conclusions that can be drawn. CONCLUSION: Less than 5% of post-RP patients undergo penile prosthesis implantation, with open RP, Medicare, African American race, and Hispanic ethnicity predicting post-RP implantation; living in the wealthiest residential areas predicts lower likelihood of implantation compared to the least wealthy areas. Patients with the longest time between RP and prosthesis are more likely to live in the wealthiest areas or have undergone open/laparoscopic RP relative to robotic RP. Bajic P, Patel PM, Nelson MH, et al. Penile Prosthesis Implantation and Timing Disparities After Radical Prostatectomy: Results From a Statewide Claims Database. J Sex Med 2020;17:1175-1181.


Asunto(s)
Disfunción Eréctil , Implantación de Pene , Prótesis de Pene , Anciano , Disfunción Eréctil/etiología , Disfunción Eréctil/cirugía , Humanos , Masculino , Medicare , Prostatectomía/efectos adversos , Calidad de Vida , Estados Unidos
8.
Eur Urol Focus ; 6(2): 376-382, 2020 03 15.
Artículo en Inglés | MEDLINE | ID: mdl-30143471

RESUMEN

BACKGROUND: In women, compelling evidence associates lower urinary tract microbiota (LUTM) with lower urinary tract symptoms (LUTS); a similar association in men with benign prostate enlargement (BPE) is not established. OBJECTIVE: To determine whether associations exist between LUTM and LUTS. DESIGN, SETTING, AND PARTICIPANTS: Forty-nine male volunteers, aged 40-85 yr, were recruited from one academic tertiary care center. Twenty-eight patients undergoing BPE/LUTS surgery and 21 undergoing non-BPE/LUTS surgery were stratified by International Prostate Symptom Score (IPSS), and paired voided/catheterized urine specimens were collected for expanded quantitative urine culture (EQUC) and 16S ribosomal RNA gene sequencing. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: Primary and secondary outcomes were presence of detectable LUTM and specific bacterial members of the LUTM, respectively. Baseline data were compared. Univariable logistic regression models were used to calculate odds ratios (ORs) for IPSS category associated with the presence of bladder microbiota. Relative LUTM proportions were compared with IPSS using chi-square tests. RESULTS AND LIMITATIONS: Thirty-nine percent of catheterized and 98% of voided specimens contained LUTM. Catheterized and voided LUTM differed significantly. LUTM was detected in catheterized urine of 22.2% of men with mild LUTS, 30.0% with moderate LUTS, and 57.1% with severe LUTS (p=0.024). Increased IPSS category was associated with significantly higher odds of detectable bacteria (OR: 2.21, 95% confidence interval: 1.09-4.49). Small sample size limited this study, making it unable to identify significant differences in specific bacterial taxa based on IPSS. CONCLUSIONS: Voided urine does not adequately characterize the male bladder microbiome. In males with and without BPE, IPSS severity was associated with detectable bacteria in catheterized urine, which samples the bladder. Additional studies are needed to identify specific bladder bacteria associated with LUTS. PATIENT SUMMARY: To study bladder bacteria, urine should be collected with a catheter. Men with severe urinary symptoms are more likely to have detectable bladder bacteria than those with less severe symptoms.


Asunto(s)
Síntomas del Sistema Urinario Inferior/microbiología , Microbiota , Vejiga Urinaria/microbiología , Adulto , Anciano , Anciano de 80 o más Años , Humanos , Masculino , Persona de Mediana Edad
9.
J Urol ; 203(4): 786-791, 2020 04.
Artículo en Inglés | MEDLINE | ID: mdl-31642741

RESUMEN

PURPOSE: Stress urinary incontinence following radical prostatectomy is common and potentially debilitating. Surgical therapy with a urethral sling or an artificial urinary sphincter is an effective option with high patient satisfaction in men in whom conservative measures fail to treat post-prostatectomy incontinence. We sought to characterize the contemporary utilization of surgical therapy of post-prostatectomy incontinence using an all payer database. MATERIALS AND METHODS: We used the Healthcare Cost and Utilization Project databases for Florida from 2006 to 2015 and identified men who underwent radical prostatectomy between 2006 and 2012 using ICD procedure codes. Patients were tracked longitudinally for placement of an ambulatory or inpatient urethral sling, or an artificial urinary sphincter between 2006 and 2015. Patient and clinical data were extracted and analyzed with descriptive statistics. A multivariable logistic regression model was constructed to determine risk adjusted predictors of subsequent incontinence surgery. RESULTS: During the study period 29,287 men underwent radical prostatectomy, of whom 1,068 (3.6%) were treated with subsequent incontinence surgery a median of 23.5 months after prostatectomy. On multivariate analysis risk factors for incontinence surgery included age groups 61 to 70 years (OR 1.25, p=0.008) and 71 to 80 years (OR 1.34, p=0.022), Medicare insurance (OR 1.33, p <0.005) and an increased Charlson Comorbidity Index (OR 1.13 per unit increase, p <0.005). CONCLUSIONS: Of patients who underwent radical prostatectomy 3.6% subsequently underwent stress urinary incontinence surgery. Post-prostatectomy incontinence surgery is likely under performed and delayed in performance based on the previously reported prevalence of severe post-prostatectomy incontinence and the natural history of symptoms. Efforts to increase prompt repair of refractory or severe incontinence can greatly improve patient quality of life after radical prostatectomy.


Asunto(s)
Complicaciones Posoperatorias/cirugía , Prostatectomía/efectos adversos , Cabestrillo Suburetral/estadística & datos numéricos , Incontinencia Urinaria/cirugía , Esfínter Urinario Artificial/estadística & datos numéricos , Anciano , Bases de Datos Factuales/estadística & datos numéricos , Florida , Humanos , Masculino , Persona de Mediana Edad , Satisfacción del Paciente , Complicaciones Posoperatorias/diagnóstico , Complicaciones Posoperatorias/etiología , Próstata/cirugía , Neoplasias de la Próstata/cirugía , Calidad de Vida , Estudios Retrospectivos , Índice de Severidad de la Enfermedad , Estados Unidos , Incontinencia Urinaria/diagnóstico , Incontinencia Urinaria/etiología
10.
Urol Pract ; 7(2): 109-114, 2020 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-37317422

RESUMEN

INTRODUCTION: Business education in surgical residency, defined as contract negotiation, investing, financial planning and information on practice types, is currently lacking, and it is unknown if early career urologists possess this business education. Thus, we investigated how young urologists perceive their business knowledge and which vehicles of education they most prefer. METHODS: A 12-question survey was distributed to all urology residents, fellows and recent graduates to assess their self-reported business preparedness. Questions were administered concerning financial planning, familiarity with business models, ancillary income opportunities, coding and billing, contract negotiation, and awareness/use of AUA (American Urological Association) resources. Data were stratified by training year and practice type. The respondents were also asked their most preferred format for business education. RESULTS: A response rate of 10% was obtained with 230 total responses, including 89 (38.7%) from practicing urologists and 141 (61.3%) from trainees. The majority (88.3%) of respondents were not comfortable planning the business side of their practice and 71% were not aware of the AUA resources. Only 8% of practicing urologists and trainees were extremely comfortable with contract negotiation and 70% were not comfortable with assessing their own financial value. A majority was interested in podcasts, websites and online education. CONCLUSIONS: The survey results demonstrate a significant unmet need among early career urologists regarding business education. This self-reported lack of business literacy presents a blind spot in urological training. The development of an accessible business curriculum along with practical resources may have a vital role in the promotion of wellness and financial success among early career urologists.

12.
Curr Urol Rep ; 20(7): 34, 2019 May 18.
Artículo en Inglés | MEDLINE | ID: mdl-31104156

RESUMEN

PURPOSE OF REVIEW: To summarize recent investigation into associations between the genitourinary microbiota and prostatic disease. RECENT FINDINGS: The genitourinary tract is not sterile. There are microbial communities (microbiota) in each niche of the genitourinary tract including the bladder, prostate, and urethra, which have been the subject of increasing scientific interest. Investigators have utilized several unique methods to study them, resulting in a highly heterogeneous body of literature. To characterize these genitourinary microbiota, diverse clinical specimens have been analyzed, including urine obtained by various techniques, seminal fluid, expressed prostatic secretions, and prostatic tissue. Recent studies have attempted to associate the microbiota detected from these samples with urologic disease and have implicated the genitourinary microbiota in many common conditions, including benign prostatic hyperplasia (BPH), prostate cancer, and chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS). In this review, we summarize the recent literature pertaining to the genitourinary microbiota and its relationship to the pathophysiology and management of three common prostatic conditions: BPH, prostate cancer, and CP/CPPS.


Asunto(s)
Microbiota , Dolor Pélvico/microbiología , Enfermedades de la Próstata/microbiología , Sistema Urogenital/microbiología , Enfermedad Crónica , Humanos , Masculino
13.
Int Urogynecol J ; 30(11): 1835-1842, 2019 11.
Artículo en Inglés | MEDLINE | ID: mdl-30993388

RESUMEN

INTRODUCTION AND HYPOTHESIS: The current etiology of interstitial cystitis/painful bladder syndrome (IC/PBS) is poorly understood and multifactorial. Recent studies suggest the female urinary microbiota (FUM) contribute to IC/PBS symptoms. This study was designed to determine if the FUM, analyzed using mid-stream voided urine samples, differs between IC/PBS patients and controls. METHODS: This prospective case-controlled study compared the voided FUM of women with symptoms of urinary frequency, urgency, and bladder pain for > 6 months with the voided FUM of healthy female controls without pain. Bacterial identification was performed using 16S rRNA gene sequencing and EQUC, a validated enhanced urine culture approach. Urotype was defined by a genus present at > 50% relative abundance. If no genus was present above this threshold, the urotype was classified as 'mixed.' Group comparisons were performed for urotype and diversity measures. RESULTS: A mid-stream voided specimen was collected from 21 IC/PBS patients and 20 asymptomatic controls. The two groups had similar demographics. Urotypes did not differ between cohorts as assessed by either EQUC or 16S rRNA gene sequencing. We detected no significant differences between cohorts by alpha diversity. Cohorts also were not distinct using principle component analysis or hierarchical clustering. Detection by EQUC of bacterial species considered uropathogenic was high in both cohorts, but detection of these uropathogenic species did not differ between groups (p = 0.10). CONCLUSIONS: Enhanced culture and DNA sequencing methods provide evidence that IC/PBS symptoms may not be related to differences in the FUM, at least not its bacterial components. Future larger studies are needed to confirm this preliminary finding.


Asunto(s)
Bacterias/aislamiento & purificación , Cistitis Intersticial/microbiología , Microbiota , Uretra/microbiología , Vejiga Urinaria/microbiología , Adulto , Estudios de Casos y Controles , Femenino , Humanos , Persona de Mediana Edad , Estudios Prospectivos
14.
J Urol ; 201(1): 154-159, 2019 01.
Artículo en Inglés | MEDLINE | ID: mdl-30125569

RESUMEN

PURPOSE: Post-hospital syndrome is an acquired transient period of health vulnerability following inpatient admission. We assessed the impact of a preoperative hospitalization on outcomes following penile prosthesis surgery and sought to optimize surgical timing after inpatient admission. MATERIALS AND METHODS: We used the Healthcare Cost and Utilization Project State Inpatient Databases and State Ambulatory Surgery Database for California from 2007 to 2011 and for Florida from 2009 to 2014. Patients were identified as having undergone prosthesis placement by ICD-9 and CPT codes. The primary exposure was post-hospital syndrome, defined as any inpatient admission 90 days or less before prosthesis placement. Patients were further categorized by how recently the inpatient hospitalization occurred. The primary study outcome was 30-day hospital readmission. Secondary outcomes were length of stay, and device and postoperative complications. RESULTS: We identified 16,923 patients who received a penile prosthesis, of whom 477 (3%) had post-hospital syndrome exposure 90 days or less before prosthesis placement. After risk adjustment patients with post-hospital syndrome had higher odds of 30-day readmission (OR 3.0, 95% CI 2.2-4.1), length of stay 2 days or longer (OR 1.7, 95% CI 1.3-2.3) and device complications (OR 1.7, 95% CI 1.2-2.5). When categorizing patients by 30-day intervals, we found a linear decrease in the risk of 30-day readmission as the interval increased between post-hospital syndrome exposure and prosthesis surgery. CONCLUSIONS: Post-hospital syndrome exposure is a risk adjusted predictor of 30-day readmissions, prolonged length of stay and device complications. Medical optimization and delayed surgery can help combat the adverse effects associated with post-hospital syndrome exposure and may improve surgical outcomes.


Asunto(s)
Salud Global , Hospitalización , Implantación de Pene , Prótesis de Pene , Complicaciones Posoperatorias/etiología , Anciano , California , Florida , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Medición de Riesgo , Factores Socioeconómicos , Síndrome , Factores de Tiempo , Resultado del Tratamiento
15.
Curr Urol ; 9(2): 104-5, 2016 May.
Artículo en Inglés | MEDLINE | ID: mdl-27390583

RESUMEN

Urinary tract fungus balls are a rare pathologic entity which may be asymptomatic or have variable presentations. To date, there have been no documented cases of fungus balls presenting as painful bladder syndrome. Painful bladder syndrome is a constellation of symptoms which may include pelvic pain, urgency and frequency not explained by other causes. Here, we present the first case of these two entities concurrently. Our patient had a longstanding history of diabetes, nephrolithiasis and recurrent urinary tract infections. He presented with symptoms of painful bladder syndrome and work-up revealed filling defects within the renal collecting system concerning for malignancy. Subsequent ureteroscopy revealed dense white debris consistent with candida fungus balls. Following clearance of the debris and antifungal therapy, our patient has remained asymptomatic.

16.
Fed Pract ; 33(Suppl 4): 37S-43S, 2016 05.
Artículo en Inglés | MEDLINE | ID: mdl-30766218

RESUMEN

Increasing evidence, albeit small, suggests that testosterone replacement therapy can be cautiously considered in selected hypogonadal men treated with curative intent for low-risk prostate cancer and without evidence of active disease.

17.
Curr Urol ; 8(3): 166-8, 2015 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-26889138

RESUMEN

The association between the development of bladder cancer and chronic bladder irritation is well established in the literature. Chronic urinary tract irritation can be the result of bacterial infections, foreign bodies, trauma of repeated catheterization, neurogenic bladder, urolithiasis, or chronic bladder outlet obstruction, all which have been implicated in the pathogenesis of non-bilharzial squamous cell carcinoma of the bladder (SCC). With many of the aforementioned factors present in patients with spinal cord injury, several retrospective studies have demonstrated a 16-28 fold increased relative risk of bladder cancer, with SCC accounting for 10 times more cases of bladder cancer compared to the general population. In this report, we present the case of incidentally-discovered SCC of the bladder found within sphincter/prostate chips of a patient with neurogenic bladder due to spinal cord injury n clean intermittent catheterization ho underwent sphincterotomy with negative cystoscopic findings.

18.
Urol Nurs ; 33(5): 233-5, 2013.
Artículo en Inglés | MEDLINE | ID: mdl-24354112

RESUMEN

Bladder stones account for 5% of all urinary stone disease and can develop on a foreign body, such as a misplaced suture, eroded surgical mesh, or ureteral stent. In this case study, the authors present a patient with bladder stones associated with pubic hairs introduced during a monthly indwelling Foley catheter change. Clinicians have an important role in instructing patients on the use of proper technique and hygiene practices during urethral catheterization to minimize the potential for urinary complications.


Asunto(s)
Cuerpos Extraños/complicaciones , Cabello , Compuestos de Magnesio , Fosfatos , Traumatismos de la Médula Espinal/complicaciones , Cálculos de la Vejiga Urinaria/etiología , Cateterismo Urinario/efectos adversos , Anciano , Cuerpos Extraños/enfermería , Humanos , Masculino , Traumatismos de la Médula Espinal/enfermería , Estruvita , Cálculos de la Vejiga Urinaria/enfermería
19.
Curr Urol ; 7(2): 110-2, 2013 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-24917769

RESUMEN

Abdominoscrotal hydrocele (ASH) is a very rare clinical finding. It is characterized by a large scrotal hydrocele in communication with the abdominal cavity through the inguinal canal. Most reports of ASH have been in the pediatric population. We present the case of a 67-year-old man, with severe liver disease, who was discovered to have massive bilateral ASH secondary to ascites.

20.
J Rehabil Res Dev ; 45(4): 627-37, 2008.
Artículo en Inglés | MEDLINE | ID: mdl-18712648

RESUMEN

Urinary retention is a serious urological problem associated with spinal cord injuries (SCIs) and other pelvic disorders. Effective methods of pelvic nerve stimulation were investigated for this problem. Following anesthesia in five dogs, the bladder was surgically exposed. Bladder and anal sphincter pressures were recorded. Testing was first conducted with probe electrodes. Barb electrodes were then implanted with a needle near the pelvic plexus nerves and the bladder wall. We tested different electrode arrangements and stimulating parameters to induce bladder contractions without skeletal muscle stimulation. The pelvic plexus nerves near the bladder were identified, and the barb electrodes were effectively implanted. Stimulation with bipolar and bilateral electrodes induced pressures over 30 cmH(2)O without skeletal muscle activation. Common stimulation parameters were 40 pps, 400 microseconds pulse duration, and 15 to 25 mA stimulating current applied for 3 s. Effective electrode implantation methods were shown. Also identified were electrode arrangements and stimulating parameters that induced strong bladder contractions without skeletal muscle activation. However, voiding studies were not conducted. Further studies with barb electrodes are warranted, and these methods may have applications for bladder stimulation following SCI.


Asunto(s)
Terapia por Estimulación Eléctrica/instrumentación , Terapia por Estimulación Eléctrica/métodos , Plexo Hipogástrico/fisiología , Vejiga Urinaria Neurogénica/terapia , Vejiga Urinaria/inervación , Animales , Modelos Animales de Enfermedad , Perros , Electrodos , Diseño de Equipo , Vejiga Urinaria/fisiología , Vejiga Urinaria Neurogénica/fisiopatología
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