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1.
Neurourol Urodyn ; 38(6): 1721-1727, 2019 08.
Article in English | MEDLINE | ID: mdl-31165506

ABSTRACT

AIM: To evaluate the performance of the new device compared with clean intermittent catheterization (CIC). METHODS: From March 2015 to March 2018, patients who were admitted to the urologic outpatient clinic. A new intraurethral self-retaining device (ISRD) was made of medical grade silicone and it was inspired by similar catheters that use sliding disks to adjust or fix tubes used to drain the bladder. Patients were randomized into two groups (experimental group [GI]-ISRD vs control group [GII]-CIC). The evaluation was performed at the time of enrollment and 6 months after treatment. Intervention was initiated from the antisepsis of the perineal region and subsequent introduction of the device through the external urethral meatus. The primary outcome was quality of life (QOL). Urinary tract infections (UTIs) episodes, data on urodynamic parameters, adverse effects and number of diapers per day. RESULTS: A total of 177 subjects were analyzed. We found a significant improvement on QOL analysis in the ISRD group (P < .01). ISRD group presented an important reduction (two episodes after ISRD use) on number of UTIs (P < .01) and diaper use, and significant improvement on bladder capacity (80 mL of the average improvement) (P < .01) and compliance (P = .01). Among all registered serious adverse effects, ISRD presented with lower proportion. CONCLUSIONS: The new device has shown to be a safe and promising alternative for adequate emptying of the neurogenic bladder in female patients. Our study has a limitation that is related to a limited period of observation.


Subject(s)
Equipment and Supplies , Urinary Bladder, Neurogenic/rehabilitation , Urination , Adolescent , Adult , Anti-Infective Agents, Local/therapeutic use , Child , Female , Humans , Incontinence Pads/statistics & numerical data , Intermittent Urethral Catheterization , Middle Aged , Patient Compliance , Prospective Studies , Quality of Life , Treatment Outcome , Urinary Bladder, Neurogenic/complications , Urinary Bladder, Neurogenic/psychology , Urinary Catheterization , Urinary Tract Infections/epidemiology , Urinary Tract Infections/etiology , Urodynamics
2.
J Wound Ostomy Continence Nurs ; 45(6): 521-526, 2018.
Article in English | MEDLINE | ID: mdl-30260906

ABSTRACT

PURPOSE: The purpose of this study was to describe and compare factors that affect urinary tract infection (UTI) rates in people with spina bifida (SB) and neurogenic bladder dysfunction before and following initiation of intermittent catheterization (IC). DESIGN: A quantitative, descriptive, correlational study. SUBJECTS AND SETTING: The study included people who were from Germany, a high-income nation, and Brazil, a middle-income nation. Brazilian participants were recruited from a public rehabilitation hospital in the state of Minas Gerais. German participants were drawn from different regions of the country. The study sample included 200 participants; participants were either individuals diagnosed with SB and neurogenic bladder dysfunction and using IC, or caregivers of persons using IC for bladder management. METHODS: Data were collected through a survey questionnaire developed for urological follow-up of SB patients. A translated and validated version of the form was used to collect data in Germany. To evaluate annual episodes of UTI, we considered the number of symptomatic UTI before and after IC. RESULTS: Participants from Brazil were significantly younger than German patients (median age 9 vs 20 years, P < .001). Brazilians predominately used assisted catheterization (63.0%), whereas most Germans performed self-catheterization (61.0%). Use of IC greatly reduced the incidence of UTI in both groups (mean 2.8 episodes per year before IC vs mean 1.1 episodes after starting IC, P < .001). Women had a higher number of UTI, both before and after IC, but enjoyed greater reduction in UTI after initiating IC than men. Self-catheterization also promoted a greater reduction of UTI than assisted IC (P = .022). CONCLUSIONS: Intermittent catheterization reduced annual episodes of UTI in both samples despite differences in catheterization technique. Patients practicing and performing self-catheterization achieved a greater reduction than those who relied on assisted IC. Comparative studies among additional countries with varying median income levels are needed to better understand the needs of individuals with SB and their families, and to plan and implement safe nursing interventions.


Subject(s)
Catheter-Related Infections/complications , Intermittent Urethral Catheterization/adverse effects , Urinary Tract Infections/etiology , Adolescent , Adult , Analysis of Variance , Brazil/epidemiology , Catheter-Related Infections/epidemiology , Child , Child, Preschool , Female , Germany/epidemiology , Humans , Infant , Intermittent Urethral Catheterization/methods , Male , Meningomyelocele/complications , Meningomyelocele/therapy , Middle Aged , Spinal Dysraphism/complications , Spinal Dysraphism/therapy , Statistics, Nonparametric , Surveys and Questionnaires , Urinary Bladder, Neurogenic/complications , Urinary Bladder, Neurogenic/therapy , Urinary Tract Infections/epidemiology
3.
Braz J Med Biol Res ; 50(10): e6638, 2017 Aug 17.
Article in English | MEDLINE | ID: mdl-28832768

ABSTRACT

This study proposed a decision tree model to screen upper urinary tract damage (UUTD) for patients with neurogenic bladder (NGB). Thirty-four NGB patients with UUTD were recruited in the case group, while 78 without UUTD were included in the control group. A decision tree method, classification and regression tree (CART), was then applied to develop the model in which UUTD was used as a dependent variable and history of urinary tract infections, bladder management, conservative treatment, and urodynamic findings were used as independent variables. The urethra function factor was found to be the primary screening information of patients and treated as the root node of the tree; Pabd max (maximum abdominal pressure, >14 cmH2O), Pves max (maximum intravesical pressure, ≤89 cmH2O), and gender (female) were also variables associated with UUTD. The accuracy of the proposed model was 84.8%, and the area under curve was 0.901 (95%CI=0.844-0.958), suggesting that the decision tree model might provide a new and convenient way to screen UUTD for NGB patients in both undeveloped and developing areas.


Subject(s)
Data Mining/methods , Urinary Bladder, Neurogenic/complications , Urinary Tract/injuries , Female , Humans , Male , Middle Aged , Predictive Value of Tests , ROC Curve , Retrospective Studies , Urinary Bladder, Neurogenic/physiopathology , Urinary Tract/physiopathology
4.
Worldviews Evid Based Nurs ; 14(4): 324-333, 2017 Aug.
Article in English | MEDLINE | ID: mdl-28742287

ABSTRACT

AIMS: This study aimed to examine and map the scientific evidences regarding quality of life in neurogenic bladder patients and consequently their caregivers by means of a scoping review. DESIGN: This is a scoping review proposal of the Joanna Briggs Institute. METHODS: It was conducted to examine and map the scientific evidences about quality of life (QoL) in neurogenic bladder patients and their caregivers, to identify the meanings attributed to QoL and its relation with intermittent urinary catheterization. The following guiding question was: "What scientific evidence has been produced on the QoL of neurogenic bladder patients using intermittent urinary catheterization and their caregivers?" A total of 2945 research studies were identified using The Cochrane Library, CINAHL, LILACS, Academic Search Premier (via EBSCO platform), PubMed, SCOPUS, the platforms Web of Science, the b-on and Gray Literature. The keywords established were patient, intermittent urinary catheterization, neurogenic urinary bladder, quality of life and caregiver. RESULTS: From 2,945 studies, 13 studies were selected. Most of the selected studies that analyzed variables related to the patients' QoL were regarding the urinary catheterization technique, assessment of urinary incontinence, individual perceptions of the procedure and experiences with urinary catheter in childhood and adult life. The meanings attributed to QoL, when compared to adult and child individuals with normal bladder functioning, presented lower QoL scores. Concerning caregivers, the QoL of caregivers of children using intermittent urinary catheterization demonstrated low scores. LINKING EVIDENCE TO ACTION: The QoL of patient's who use intermittent urinary catheterization can be determined by improvement of urinary symptoms and self-confidence. Research related to QoL of patients who use urinary catheter indicates the importance of adequate professional support and appropriate health public policies.


Subject(s)
Caregivers/psychology , Patients/psychology , Quality of Life/psychology , Urinary Catheterization/adverse effects , Catheter-Related Infections/complications , Catheter-Related Infections/etiology , Humans , Self Care/methods , Self Care/psychology , Urinary Bladder, Neurogenic/complications , Urinary Bladder, Neurogenic/therapy , Urinary Catheterization/psychology
5.
Urology ; 99: 260-264, 2017 Jan.
Article in English | MEDLINE | ID: mdl-27566143

ABSTRACT

OBJECTIVE: To report the incidence of urethral stricture and its management in patients with spinal cord injury treated with clean intermittent self-catheterization (CIC). MATERIALS AND METHODS: The clinical records of 333 patients with spinal cord injury treated with CIC since 2001 were identified, and those who developed a urethral stricture during their follow-up, including their treatment and results achieved, were analyzed. RESULTS: The patients had a median age at the time of injury of 27 years, of which only 14 patients (4.2%) developed urethral stricture at a mean duration of self-catheterization of 9 years; 86% of them were treated with urethrotomy, without recurrence through a mean of 1-year follow-up. There are no previous reports of rates of urethral stricture in this type of patients in our institution; the rate found is considerably low, as is the recurrence after urethrotomy, which can be decreased by the continuous self-obturation achieved with catheterization. CONCLUSION: Urethral stricture as a complication of CIC in patients with spinal cord injury has a low incidence and can be effectively treated in those who develop it.


Subject(s)
Intermittent Urethral Catheterization/adverse effects , Self Care/adverse effects , Spinal Cord Injuries/complications , Urethral Stricture/epidemiology , Urinary Bladder, Neurogenic/therapy , Adult , Cervical Vertebrae , Female , Humans , Incidence , Lumbar Vertebrae , Male , Mexico/epidemiology , Recurrence , Retrospective Studies , Spinal Cord Injuries/therapy , Thoracic Vertebrae , Urethral Stricture/etiology , Urinary Bladder, Neurogenic/complications
6.
Rev. bras. pesqui. méd. biol ; Braz. j. med. biol. res;50(10): e6638, 2017. tab, graf
Article in English | LILACS | ID: biblio-888941

ABSTRACT

This study proposed a decision tree model to screen upper urinary tract damage (UUTD) for patients with neurogenic bladder (NGB). Thirty-four NGB patients with UUTD were recruited in the case group, while 78 without UUTD were included in the control group. A decision tree method, classification and regression tree (CART), was then applied to develop the model in which UUTD was used as a dependent variable and history of urinary tract infections, bladder management, conservative treatment, and urodynamic findings were used as independent variables. The urethra function factor was found to be the primary screening information of patients and treated as the root node of the tree; Pabd max (maximum abdominal pressure, >14 cmH2O), Pves max (maximum intravesical pressure, ≤89 cmH2O), and gender (female) were also variables associated with UUTD. The accuracy of the proposed model was 84.8%, and the area under curve was 0.901 (95%CI=0.844-0.958), suggesting that the decision tree model might provide a new and convenient way to screen UUTD for NGB patients in both undeveloped and developing areas.


Subject(s)
Humans , Male , Female , Middle Aged , Data Mining/methods , Urinary Bladder, Neurogenic/complications , Urinary Tract/injuries , Predictive Value of Tests , Retrospective Studies , ROC Curve , Urinary Bladder, Neurogenic/physiopathology , Urinary Tract/physiopathology
7.
Urology ; 89: 33-8, 2016 Mar.
Article in English | MEDLINE | ID: mdl-26724409

ABSTRACT

OBJECTIVE: To evaluate the efficacy of physiotherapy for urinary manifestations in patients with human T-lymphotropic virus 1-associated lower urinary tract dysfunction. METHODS: Open clinical trial was conducted with 21 patients attending the physiotherapy clinic of the Hospital Universitário, Bahia, Brazil. Combinations of behavioral therapy, perineal exercises, and intravaginal or intra-anal electrical stimulation were used. RESULTS: The mean age was 54 ± 12 years and 67% were female. After treatment, there was an improvement in symptoms of urinary urgency, frequency, incontinence, nocturia, and in the sensation of incomplete emptying (P < .001). There was also a reduction in the overactive bladder symptom score from 10 ± 4 to 6 ± 3 (P < .001) and an increase in the perineal muscle strength (P <.001). The urodynamic parameters improved, with reduction in the frequency of patients with detrusor hyperactivity from 57.9% to 42.1%, detrusor-sphincter dyssynergia from 31.6% to 5.3%, detrusor hypocontractility from 15.8% to 0%, and detrusor areflexia from 10.5% to 0%, with positive repercussions in the quality of life in all patients. CONCLUSION: Physiotherapy was effective in cases of human T-lymphotropic virus 1-associated neurogenic bladder, reducing symptoms, increasing perineal muscle strength, and improving urodynamic parameters and quality of life.


Subject(s)
HTLV-I Infections/complications , Physical Therapy Modalities , Urinary Bladder, Neurogenic/complications , Urinary Bladder, Neurogenic/therapy , Female , Humans , Male , Middle Aged
8.
Einstein (Säo Paulo) ; 13(2): 279-282, Apr-Jun/2015. tab, graf
Article in English | LILACS | ID: lil-751434

ABSTRACT

Ochoa syndrome is rare and its major clinical problems frequently unrecognized. We describe facial characteristics of six patients to help health professional recognize the inverted smile that these patients present and refer them to proper treatment. Patients’ medical records were reviewed and patients’ urological status clinically reassessed. At last evaluation patients’ mean age was 15.5 years, and age ranged from 12 to 32 years. Mean follow-up was 35 months (12 to 60). Initial symptoms were urinary tract infections in four patients (67%) associated with enuresis and incontinence in three of them (50%). One patient had only urinary tract infection and two lower urinary tract symptoms without infections. Initial treatment consisted of clean intermittent catheterization with anticholinergics for all patients. Four patients (67%) were submitted to bladder augmentation. Two patients had end-stage renal disease during follow-up, one received kidney transplantation and one patient remained on the waiting list for a renal transplantation. Familial consanguinity was present in only one case. This significant condition is rare, but it must be recognized by pediatricians, nephrologists and urologists in order to institute early aggressive urological treatment.


A síndrome de Ochoa é rara, e seus principais problemas clínicos são frequentemente não reconhecidos. Descrevem-se aqui características faciais de seis pacientes para auxiliar profissionais de saúde a reconhecer o sorriso invertido que eles apresentam e encaminhá-los para o tratamento adequado. Os prontuários médicos foram revisados e a condição urológica dos pacientes foi reavaliada clinicamente. A média de idade na última avaliação foi de 15,5 anos, variando de 12 a 32 anos. O seguimento médio foi de 35 meses (12 a 60). Os sintomas iniciais foram infecções do trato urinário em quatro pacientes (67%) associadas com enurese e incontinência urinária em três deles (50%). Um paciente apresentou infecções do trato urinário isoladamente e dois apresentaram sintomas do trato urinário inferior, porém sem infecções. O tratamento inicial consistiu em cateterismo intermitente limpo, com anticolinérgicos em todos os pacientes. Reconstrução urinária foi realizada em quatro pacientes (67%) por meio de ampliação vesical. Dois pacientes apresentaram doença renal em estágio terminal no seguimento, um recebeu transplante renal e outro manteve-se em lista de espera para transplante renal. Consanguinidade familiar esteve presente em apenas um caso. Essa condição significativa é rara, porém deve ser reconhecida por pediatras, nefrologistas e urologistas, a fim de instituir tratamento urológico agressivo precoce.


Subject(s)
Adolescent , Adult , Child , Female , Humans , Male , Intermittent Urethral Catheterization/methods , Urinary Tract Infections/complications , Urologic Diseases/diagnosis , Cholinergic Antagonists/therapeutic use , Facies , Follow-Up Studies , Kidney Transplantation , Photography , Retrospective Studies , Smiling , Urinary Bladder, Neurogenic/complications , Urinary Bladder, Neurogenic/diagnosis , Urinary Bladder, Neurogenic/therapy , Urinary Incontinence/complications , Urinary Incontinence/therapy , Urinary Tract Infections/therapy , Urologic Diseases/complications , Urologic Diseases/therapy
9.
Einstein (Sao Paulo) ; 13(2): 279-82, 2015.
Article in English, Portuguese | MEDLINE | ID: mdl-25946049

ABSTRACT

Ochoa syndrome is rare and its major clinical problems frequently unrecognized. We describe facial characteristics of six patients to help health professional recognize the inverted smile that these patients present and refer them to proper treatment. Patients' medical records were reviewed and patients' urological status clinically reassessed. At last evaluation patients' mean age was 15.5 years, and age ranged from 12 to 32 years. Mean follow-up was 35 months (12 to 60). Initial symptoms were urinary tract infections in four patients (67%) associated with enuresis and incontinence in three of them (50%). One patient had only urinary tract infection and two lower urinary tract symptoms without infections. Initial treatment consisted of clean intermittent catheterization with anticholinergics for all patients. Four patients (67%) were submitted to bladder augmentation. Two patients had end-stage renal disease during follow-up, one received kidney transplantation and one patient remained on the waiting list for a renal transplantation. Familial consanguinity was present in only one case. This significant condition is rare, but it must be recognized by pediatricians, nephrologists and urologists in order to institute early aggressive urological treatment.


Subject(s)
Intermittent Urethral Catheterization/methods , Urinary Tract Infections/complications , Urologic Diseases/diagnosis , Adolescent , Adult , Child , Cholinergic Antagonists/therapeutic use , Facies , Female , Follow-Up Studies , Humans , Kidney Transplantation , Male , Photography , Retrospective Studies , Smiling , Urinary Bladder, Neurogenic/complications , Urinary Bladder, Neurogenic/diagnosis , Urinary Bladder, Neurogenic/therapy , Urinary Incontinence/complications , Urinary Incontinence/therapy , Urinary Tract Infections/therapy , Urologic Diseases/complications , Urologic Diseases/therapy
11.
Cir Cir ; 82(5): 496-504, 2014.
Article in Spanish | MEDLINE | ID: mdl-25259428

ABSTRACT

BACKGROUND: Appendicovesicostomy is commonly employed to facilitate drainage of urine through the catheter. Due to the tendency to less invasive procedures for the treatment of patients with neurogenic bladder, laparoscopy has been used as an alternative to open surgery, with the immediate advantages of postoperative recovery, shorter postoperative ileus, better cosmetic results, lower postoperative pain and early reintegration into everyday life. PURPOSE: Compare the results of laparoscopic procedure with open appendicovesicostomy. METHODS: We conducted an observational, analytical, longitudinal, ambispective cohort study, which included patients from 6-16 years of age diagnosed with neurogenic bladder, operated through laparoscopic and open appendicovesicostomy from January 2009 to June 2013. Information was obtained from clinical records. Six patients were operated laparoscopically and 14 by open approach. RESULTS: Surgical time was longer and statistically significant in the laparoscopic group with a median of 330 min (300-360 min) compared to open procedure of 255 min (180-360 min). Seven patients had complications in the open group and only one in the laparoscopic group. The difference in the dose of analgesics and time of use was statistically significant in favor of the laparoscopic group. The degree of urinary continence through the stoma was higher for laparoscopic (100%) compared to the open procedure (64%). CONCLUSIONS: In neurogenic bladder with urodynamic bladder capacity and leak point pressure bladder within acceptable values, laparoscopic appendicovesicostomy was a better alternative.


Antecedentes: la apendicovesicostomía suele practicarse para facilitar el drenaje de orina por medio del cateterismo. La tendencia a ofrecer procedimientos menos invasivos a pacientes con vejiga neurogénica ha hecho de la laparoscopia una alternativa a la cirugía abierta, por sus ventajas de recuperación, menor tiempo de íleo postoperatorio, mejor cosmética, menor dolor postquirúrgico y reintegración temprana a la vida cotidiana. Objetivo: comparar los resultados de la apendicovesicostomía laparoscópica con la abierta. Material y métodos: estudio de cohorte, observacional, analítico, longitudinal, ambispectivo, que incluyó pacientes de 6 a 16 años, con diagnóstico de vejiga neurogénica, intervenidos mediante laparoscopia y cirugía abierta entre enero de 2009 y junio 2013, recuperándose la información de los expedientes clínicos. Resultados: seis pacientes se operaron mediante laparoscopia y 14 con cirugía abierta. El tiempo quirúrgico fue mayor en el grupo intervenido mediante laparoscopia, con una mediana de 330 minutos (300-360), en comparación con el abierto de 255 minutos (180-360), diferencia estadísticamente significativa. Siete pacientes del grupo abierto tuvieron complicaciones y solo 1 del grupo laparoscópico. La diferencia en la dosis de analgésicos y en el tiempo de su consumo fue estadísticamente significativa a favor del grupo intervenido mediante laparoscopia. El grado de continencia urinaria por la derivación fue mayor para el procedimiento laparoscópico (100%) que para el abierto (64%). Conclusiones: la apendicovesicostomía laparoscópica resultó una mejor alternativa para pacientes con vejiga neurogénica con parámetros urodinámicos de capacidad vesical y presión de punto de fuga dentro de valores aceptables.


Subject(s)
Appendix/surgery , Intermittent Urethral Catheterization/methods , Laparoscopy/methods , Umbilicus/surgery , Urinary Bladder, Neurogenic/surgery , Urinary Bladder/surgery , Urologic Surgical Procedures/methods , Abnormalities, Multiple , Adolescent , Analgesics/therapeutic use , Child , Female , Humans , Intermittent Urethral Catheterization/instrumentation , Laparotomy/methods , Length of Stay/statistics & numerical data , Meningomyelocele , Pain, Postoperative/drug therapy , Pain, Postoperative/etiology , Retrospective Studies , Teratoma , Treatment Outcome , Urinary Bladder, Neurogenic/complications
12.
Int Braz J Urol ; 37(5): 636-41, 2011.
Article in English | MEDLINE | ID: mdl-22099276

ABSTRACT

PURPOSE: To report our results and rationale for treating large bladder calculi in patients with neuropathic voiding dysfunction (NVD) using percutaneous cystolithalopaxy. MATERIALS AND METHODS: Ten patients with a previously diagnosed NVD presenting with a large stone burden were identified from our department database and a retrospective review of case notes and imaging was performed. RESULTS: Percutaneous access to remove bladder stones (range 8x7 to 3x2 cm) had a mean surgery length of 150 min and blood loss of 23 mL. Six of the seven patients treated percutaneously were discharged on the day of surgery and suffered no complications, while one patient experienced poor suprapubic tube drainage and required overnight admission with discharge the following day. Transurethral removal of stone burden (range 4x4 to 4x3 cm) had a mean surgery length of 111 min and blood loss of 8 mL. Each of these three patients were under our care for less than 23 hours, and one patient required a second attempt to remove 1x0.5 cm of stone fragments. There was no statistical difference between mean operative times and estimated blood loss, p = 0.5064 and p = 0.0944 respectively, for the two treatment methods. CONCLUSION: In this small series, percutaneous cystolithalopaxy was a safe, effective, and often preferred minimally invasive option for removal of large calculi in patients with NVD. We suggest possible guidelines for best endoscopic approach in this population, although a larger and prospectively randomized series will be ideal for definitive conclusions.


Subject(s)
Cystoscopy/methods , Lithotripsy/methods , Nephrostomy, Percutaneous/methods , Urinary Bladder Calculi/therapy , Urinary Bladder, Neurogenic/complications , Adult , Female , Humans , Male , Middle Aged , Retrospective Studies , Urinary Bladder Calculi/pathology , Young Adult
13.
Int Braz J Urol ; 37(5): 642-8, 2011.
Article in English | MEDLINE | ID: mdl-22099277

ABSTRACT

PURPOSE: Neurogenic detrusor overactivity (NDO) is common in patients who suffer from multiple sclerosis (MS). When the usual pharmacological treatment fails, botulinum toxin type A (BTX-A) injections can be proposed. The safety and efficacy of this treatment are already well known, but only a few studies focus on its use in patients with MS. MATERIALS AND METHODS: Seventy-one patients with MS underwent their first BTX-A injection for refractory NDO. They had clinical and urodynamic cystometry assessment before and three months after injection. The patients were divided in three groups according to treatment efficacy: full success (total urinary continence, no overactive detrusor), improvement, or total failure (urge incontinence and overactive detrusor). RESULTS: 77% of the patients had clinical improvement or full success of the treatment with a reduction of their urgency and incontinence. Significant urodynamic improvement after treatment was shown on different parameters: volume at first involuntary bladder contraction (p = 0.0000001), maximum cystometric capacity (p = 0.0035), maximum detrusor pressure (p = 0.0000001). 46% of the patients were in the "full success" group. 31% of the patients had a partial improvement. 23% of the patients had no efficacy of the treatment. Duration of MS was a predictive factor of treatment failure (p = 0.015). CONCLUSIONS: Despite that a full success was obtained in 46% of the cases, BTX-A injection therapy failed to treat refractory NDO in 23% of patients suffering from MS. Duration of the disease was a predictive factor for an inefficient treatment. The injection therapy should be considered as soon as oral anti cholinergic drugs fail to reduce NDO.


Subject(s)
Botulinum Toxins, Type A/administration & dosage , Multiple Sclerosis/complications , Neuromuscular Agents/administration & dosage , Urinary Bladder, Neurogenic/drug therapy , Urinary Bladder, Overactive/drug therapy , Female , Humans , Injections, Intramuscular , Male , Middle Aged , Retrospective Studies , Treatment Outcome , Urinary Bladder, Neurogenic/complications , Urinary Bladder, Overactive/complications , Urodynamics
14.
Int. braz. j. urol ; 37(5): 636-641, Sept.-Oct. 2011. ilus, tab
Article in English | LILACS | ID: lil-608133

ABSTRACT

PURPOSE: To report our results and rationale for treating large bladder calculi in patients with neuropathic voiding dysfunction (NVD) using percutaneous cystolithalopaxy. MATERIALS AND METHODS: Ten patients with a previously diagnosed NVD presenting with a large stone burden were identified from our department database and a retrospective review of case notes and imaging was performed. RESULTS: Percutaneous access to remove bladder stones (range 8x7 to 3x2 cm) had a mean surgery length of 150 min and blood loss of 23 mL. Six of the seven patients treated percutaneously were discharged on the day of surgery and suffered no complications, while one patient experienced poor suprapubic tube drainage and required overnight admission with discharge the following day. Transurethral removal of stone burden (range 4x4 to 4x3 cm) had a mean surgery length of 111 min and blood loss of 8 mL. Each of these three patients were under our care for less than 23 hours, and one patient required a second attempt to remove 1x0.5 cm of stone fragments. There was no statistical difference between mean operative times and estimated blood loss, p = 0.5064 and p = 0.0944 respectively, for the two treatment methods. CONCLUSION: In this small series, percutaneous cystolithalopaxy was a safe, effective, and often preferred minimally invasive option for removal of large calculi in patients with NVD. We suggest possible guidelines for best endoscopic approach in this population, although a larger and prospectively randomized series will be ideal for definitive conclusions.


Subject(s)
Adult , Female , Humans , Male , Middle Aged , Young Adult , Cystoscopy/methods , Lithotripsy/methods , Nephrostomy, Percutaneous/methods , Urinary Bladder Calculi/therapy , Urinary Bladder, Neurogenic/complications , Retrospective Studies , Urinary Bladder Calculi/pathology
15.
Int. braz. j. urol ; 37(5): 642-648, Sept.-Oct. 2011. tab
Article in English | LILACS | ID: lil-608134

ABSTRACT

PURPOSE: Neurogenic detrusor overactivity (NDO) is common in patients who suffer from multiple sclerosis (MS). When the usual pharmacological treatment fails, botulinum toxin type A (BTX-A) injections can be proposed. The safety and efficacy of this treatment are already well known, but only a few studies focus on its use in patients with MS. MATERIALS AND METHODS: Seventy-one patients with MS underwent their first BTX-A injection for refractory NDO. They had clinical and urodynamic cystometry assessment before and three months after injection. The patients were divided in three groups according to treatment efficacy: full success (total urinary continence, no overactive detrusor), improvement, or total failure (urge incontinence and overactive detrusor). RESULTS: 77 percent of the patients had clinical improvement or full success of the treatment with a reduction of their urgency and incontinence. Significant urodynamic improvement after treatment was shown on different parameters: volume at first involuntary bladder contraction (p = 0.0000001), maximum cystometric capacity (p = 0.0035), maximum detrusor pressure (p = 0.0000001). 46 percent of the patients were in the "full success" group. 31 percent of the patients had a partial improvement. 23 percent of the patients had no efficacy of the treatment. Duration of MS was a predictive factor of treatment failure (p = 0.015). CONCLUSIONS: Despite that a full success was obtained in 46 percent of the cases, BTX-A injection therapy failed to treat refractory NDO in 23 percent of patients suffering from MS. Duration of the disease was a predictive factor for an inefficient treatment. The injection therapy should be considered as soon as oral anticholinergic drugs fail to reduce NDO.


Subject(s)
Female , Humans , Male , Middle Aged , Botulinum Toxins, Type A/administration & dosage , Multiple Sclerosis/complications , Neuromuscular Agents/administration & dosage , Urinary Bladder, Neurogenic/drug therapy , Urinary Bladder, Overactive/drug therapy , Injections, Intramuscular , Retrospective Studies , Treatment Outcome , Urodynamics , Urinary Bladder, Neurogenic/complications , Urinary Bladder, Overactive/complications
16.
J Urol ; 185(6 Suppl): 2576-81, 2011 Jun.
Article in English | MEDLINE | ID: mdl-21527198

ABSTRACT

PURPOSE: Most groups have reported disappointing results with autoaugmentation or detrusor myectomy for low capacity/compliance neuropathic bladders. Failure may be due to an ischemic diverticulum or mucosal shrinkage. We investigated whether a Silimed® silicone balloon placed in the bladder after autoaugmentation could prevent these problems, improving surgical results. MATERIALS AND METHODS: We compared the results of standard bladder autoaugmentation in 12 children (group 1) with those in 10 (group 2) who underwent the same surgery using a bladder conformer. The conformer was a silicone balloon filled with saline that remained in the bladder for 2 weeks. All patients had a neuropathic bladder with poor capacity and compliance, resulting in urinary leakage between catheterizations. Preoperative and postoperative evaluation included a voiding diary, ultrasound, voiding cystourethrogram and urodynamics. RESULTS: In group 1 only 1 patient became dry, 4 had little improvement in continence, 4 remained unchanged and 3 became worse. In group 2, 6 patients (60%) become continent without medication, 2 (20%) become continent with oxybutynin and 2 remained unchanged. Bladder capacity and compliance did not change significantly in group 1. However, in group 2 capacity changed from a mean of 140 to 240 ml and mean ± SD compliance increased from 15.6 ± 16.8 to 34.3 ± 22.8 ml/cm H(2)O (p = 0.02). CONCLUSIONS: The inflatable balloon improved our long-term results of bladder auto-augmentation. A larger series may be necessary to confirm procedure efficacy and safety.


Subject(s)
Catheterization , Urinary Bladder, Neurogenic/therapy , Urinary Incontinence/therapy , Adolescent , Catheterization/instrumentation , Child , Equipment Design , Female , Follow-Up Studies , Humans , Male , Remission Induction , Retrospective Studies , Silicones , Time Factors , Urinary Bladder, Neurogenic/complications , Urinary Incontinence/etiology
17.
Vis. enferm. actual ; 5(17): 12-19, 2009. ilus
Article in Spanish | LILACS | ID: lil-651556

ABSTRACT

Los pacientes que sufren lesiones medulares son proclives a padecer, entre otros problemas, trastornos urinarios. El sistema urinario regulado por los centros nerviosos puede encontrarse alterado cuando se produce una lesión medular. En la vejiga neurogénica, los nervios que llevan estos mensajes no funcionan adecuadamente. El tratamiento puede consistir en una cirugía o en maniobras específicas basadas en la educación del paciente para promover el autocuidado. Este trabajo presenta una muestra de las opciones que tiene el paciente para mitigar estos problemas con las alternativas de cuidados de enfermería. El presente artículo consta de dos partes. La Primera intenta reflejar algunas posibilidades técnicas con las que cuenta la ciencia hoy para aliviar y tratar este trastorno que puede significar un cambio radical en la vida del paciente.


Subject(s)
Humans , Urinary Bladder, Neurogenic/complications , Urinary Catheterization/adverse effects , Spinal Cord Injuries/complications , Spinal Cord Injuries/pathology , Urinary Bladder, Neurogenic/etiology
18.
Neurourol Urodyn ; 27(4): 311-4, 2008.
Article in English | MEDLINE | ID: mdl-17914742

ABSTRACT

AIMS: We evaluated the effect of botulinum toxin type A (BTX-A) injections in the trigone on the antireflux mechanism and evaluated its short-term efficacy. MATERIALS AND METHODS: Between April and December 2006, 21 patients (10 men and 11 women) were prospectively evaluated. All were incontinent due to refractory NDO and underwent detrusor injection of 300 units of BTX-A, including 50 units into the trigone. Baseline and postoperative evaluation after eight weeks included cystogram, urinary tract ultrasound and urodynamics. RESULTS: At baseline, 20 patients had no vesicoureteral (VUR) and one had grade II unilateral VUR. Postoperative evaluation revealed no cases of de novo VUR and the patient with preinjection VUR had complete resolution of the reflux. Ultrasound showed 5 (23.8%) patients with hydronephrosis before BTX-A injection and only one (4.8%) at the followup evaluation (p=0.066). After treatment, 9 (42.8%) patients became dry, 11 (52.4%) were improved and one (4.8%) had no improvement. Improved patients received antimuscarinic treatment and 8 (38.1%) became dry, with a final total continence rate of 80.1%. Cystometric capacity increased from 271+/-92 to 390+/-189 ml (p=0.002), reflex volume varied from 241+/-96 to 323+/-201 ml (p=0.020) and maximum detrusor pressure reduced from 66+/-39 to 38+/-37 cm H(2)O (p<0.001). CONCLUSIONS: Our results confirm the safety of trigone injections of BTX-A in terms of development of VUR and upper urinary tract damage. Whether they are beneficial for patients with NDO or other causes of voiding dysfunction will need further studies.


Subject(s)
Botulinum Toxins, Type A/administration & dosage , Neuromuscular Agents/administration & dosage , Urinary Bladder, Neurogenic/drug therapy , Urinary Bladder, Overactive/drug therapy , Urinary Incontinence/etiology , Adolescent , Adult , Aged , Botulinum Toxins, Type A/adverse effects , Female , Humans , Injections, Intramuscular , Male , Middle Aged , Muscarinic Antagonists/therapeutic use , Neuromuscular Agents/adverse effects , Prospective Studies , Time Factors , Treatment Outcome , Urinary Bladder, Neurogenic/complications , Urinary Bladder, Neurogenic/pathology , Urinary Bladder, Overactive/complications , Urinary Bladder, Overactive/pathology , Urinary Incontinence/drug therapy , Urinary Incontinence/pathology , Urodynamics , Urography , Vesico-Ureteral Reflux/chemically induced
19.
Cir Pediatr ; 20(1): 54-6, 2007 Jan.
Article in Spanish | MEDLINE | ID: mdl-17489495

ABSTRACT

Urofacial syndrome was described by Elejade in 1979, who coined the term "Ochoa's Syndrome". It includes abnormal micturition, upper urinary tract dilatation, constipation and facial peculiar expression while smiling. In 1995, 3 boys with 2, 7 and 9 years old, come to the La Plata Children's Hospital, affected for this syndrome, with young, normal and no consanguinity parents. Clean intermittent catheterization was indicated in all cases, with oxibutinin in one of them, with enuresis in all the cases and normal serum creatinine for three years, when discontinued the follow-up. This cases been demonstrated the genetic condition of this syndrome, because there were 3 brothers in different steps of this condition, with the same age of initiation and progression We describe the three first cases in Argentine


Subject(s)
Constipation/complications , Facies , Urinary Bladder, Neurogenic/complications , Urinary Tract/abnormalities , Argentina , Child , Child, Preschool , Dilatation, Pathologic/complications , Humans , Male , Syndrome
20.
Rev. chil. urol ; 72(3): 279-282, 2007. tab
Article in Spanish | LILACS | ID: lil-545987

ABSTRACT

Se presenta nuestra serie clínica constituida por 14 pacientes de sexo masculino, portadores de Incontinencia Urinaria (IU) debido a vejiga neurogénica con falla esfinteriana, quienes luego de fracaso de tratamiento médico, fueron sometidos a tratamiento quirúrgico para mejorar su continencia, entre los años 1998 y 2006. La cirugía realizada consistió en elevar el cuello vesical con una cinta (Sling) de Fascia de músculo Recto Anterior, pasada por debajo del Cuello Vesical o Uretra Prostática y fijada a la aponeurosis del mismo músculo. En la mayoría de los casos, se realizó una Entero-Cistoplastía de ampliación(ECP) en el mismo acto quirúrgico. La complicación más frecuente, derivada del Sling, fue la estenosis uretral (2 casos). Se obtuvo un alto grado de satisfacción en cuanto a continencia: el 57 por ciento de los pacientes está completamente continente y el 21,5 por ciento se moja a grandes esfuerzos.


We report our experience in 14 consecutive male patients with urinary incontinence secondary to neurogenic bladder with sphincter deficiency. All patients underwent surgical management between 1998 and 2006. Surgery was indicated only after medical treatment failure. Anterior rectus fascia was used as a hammock to suspend the bladder neck by anchoring the fascia to the muscle’s aponeurosis. In most cases simultaneous augmentation cystoplasty was performed. Urethral stenosis was observed in 2 cases. Patient satisfaction was achieved in most cases with a 57 percent ofcomplete continence and 21.5 percent of minor stress incontinence.


Subject(s)
Humans , Male , Child , Adolescent , Adult , Suburethral Slings , Urinary Incontinence/surgery , Intraoperative Complications , Postoperative Complications , Postoperative Care , Follow-Up Studies , Fascia/transplantation , Urinary Incontinence/etiology , Urinary Incontinence/physiopathology , Transplantation, Autologous , Urodynamics , Urinary Bladder, Neurogenic/complications
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