RESUMO
Female urethral diverticulum (UD) is a rare and benign condition that presents as an epithelium-lined outpouching of the urethra. It has various symptoms, of which incontinence in the form of postmicturition dribble is the most common. The gold standard for the diagnosis of UD is magnetic resonance imaging, and the treatment of choice is transvaginal diverticulectomy. Despite the high success rate of transvaginal diverticulectomy, postoperative complications such as de novo stress urinary incontinence (SUI), recurrence, urethrovaginal fistula, recurrent urinary tract infections, newly-onset urgency, and urethral stricture can occur. De novo SUI is thought to result from weakening of the anatomical support of the urethra and bladder neck or damage to the urethral sphincter mechanism during diverticulectomy. It can be managed conservatively or may require surgical treatment such as a pubovaginal sling, Burch colposuspension, or urethral bulking agent injection. Concomitant SUI can be managed by concurrent or staged anti-incontinence surgery. Recurrent UD may be a newly formed diverticulum or the result of a remnant diverticulum from the previous diverticulectomy. In cases of recurrent UD requiring surgical repair, placing a rectus fascia pubovaginal sling may be an effective method to improve the surgical outcome. Urethrovaginal fistula is a rare, but devastating complication after urethral diverticulectomy; applying a Martius flap during fistula repair may improve the likelihood of a successful result. Malignancies in UD are rarely reported, and anterior pelvic exenteration is the recommended management in such cases.
RESUMO
Female urethral diverticulum (UD) is a rare and benign condition that presents as an epithelium-lined outpouching of the urethra. It has various symptoms, of which incontinence in the form of postmicturition dribble is the most common. The gold standard for the diagnosis of UD is magnetic resonance imaging, and the treatment of choice is transvaginal diverticulectomy. Despite the high success rate of transvaginal diverticulectomy, postoperative complications such as de novo stress urinary incontinence (SUI), recurrence, urethrovaginal fistula, recurrent urinary tract infections, newly-onset urgency, and urethral stricture can occur. De novo SUI is thought to result from weakening of the anatomical support of the urethra and bladder neck or damage to the urethral sphincter mechanism during diverticulectomy. It can be managed conservatively or may require surgical treatment such as a pubovaginal sling, Burch colposuspension, or urethral bulking agent injection. Concomitant SUI can be managed by concurrent or staged anti-incontinence surgery. Recurrent UD may be a newly formed diverticulum or the result of a remnant diverticulum from the previous diverticulectomy. In cases of recurrent UD requiring surgical repair, placing a rectus fascia pubovaginal sling may be an effective method to improve the surgical outcome. Urethrovaginal fistula is a rare, but devastating complication after urethral diverticulectomy; applying a Martius flap during fistula repair may improve the likelihood of a successful result. Malignancies in UD are rarely reported, and anterior pelvic exenteration is the recommended management in such cases.
RESUMO
PURPOSE: To evaluate the efficacy of an alpha-1 adrenergic receptor (α1-AR) blocker for the treatment of female voiding dysfunction (FVD) through a pressure-flow study. METHODS: This was a randomized, double-blind, placebo-controlled trial. Women aged ≥18 years with voiding symptoms, as defined by an American Urological Association symptom score (AUA-SS) ≥15 and a maximum flow rate (Qmax) 100 mL and/or a postvoid residual (PVR) volume >150 mL, were randomly allocated to either the alfuzosin or placebo group. After 8 weeks of treatment, changes in the AUA-SS, Bristol female lower urinary tract symptoms (BFLUTS) questionnaire, Qmax/PVR, and voiding diary were compared between groups. Patients’ satisfaction with the treatment was compared. Patients were categorized into 3 groups according to the Blaivas-Groutz bladder outlet obstruction (BOO) nomogram: none, mild, and moderate to severe. Subgroup comparisons were also made. RESULTS: Of a total of 187 women, 154 (79 alfuzosin, 75 placebo) were included in the analysis. After 8 weeks of treatment, the AUA-SS decreased by 7.0 in the alfuzosin group and by 8.0 in the placebo group. Changes in AUA-SS subscores, BFLUTS (except the I-sum), the voiding diary, and Qmax/PVR were not significantly different between groups. Approximately 54% of the alfuzosin group and 62% of the placebo group were satisfied with the treatment. No significant difference was observed between groups according to the presence or grade of BOO. CONCLUSIONS: Alfuzosin might not be more effective than placebo for treating FVD. The presence or the grade of BOO did not affect the results. A further study with sufficient power is needed to determine the efficacy of α1-AR blockers for the treatment of FVD.
Assuntos
Feminino , Humanos , Antagonistas Adrenérgicos alfa , Sintomas do Trato Urinário Inferior , Nomogramas , Receptores Adrenérgicos alfa 1 , Obstrução do Colo da Bexiga Urinária , UrodinâmicaRESUMO
We compared changes in nocturia and sleep-related parameters between daytime and nighttime solifenacin dosing in patents with overactive bladder (OAB) and nocturia. We comparatively analyzed the data of a 12-week prospective, open-label, multicenter, randomized study. All 127 patients who presented to 5 centers in Korea for the treatment of OAB with nocturia between January 2011 and December 2013 were enrolled in this study. The patients were divided into 2 groups by medication timing: group 1, daytime (n = 62); and group 2, nighttime (n = 65). The International Prostate Symptom Score (IPSS), Overactive Bladder Symptom Score (OABSS), and Athens Insomnia Scale (AIS) were used to assess OAB symptoms and sleep quality. We evaluated the parameter changes before and 12 weeks after daytime or nighttime solifenacin administration. Baseline data, which included sex, age, body mass index (BMI), total AIS, IPSS, and OABSS, did not differ between the 2 groups. Total IPSS, OABSS, and total AIS significantly improved after solifenacin administration regardless of timing (P < 0.001). After solifenacin administration, the number of nocturia episodes decreased in the group 1 and 2 (P < 0.001). There were no significant intergroup differences in changes in AIS, IPSS, OABSS, and number of nocturia episodes 12 weeks after solifenacin administration. Treating OAB with solifenacin may improve nocturia and sleep quality, but advantages did not differ significantly by medication timing.
Assuntos
Humanos , Índice de Massa Corporal , Coreia (Geográfico) , Noctúria , Estudos Prospectivos , Próstata , Distúrbios do Início e da Manutenção do Sono , Succinato de Solifenacina , Bexiga Urinária HiperativaRESUMO
PURPOSE: To investigate the efficacy of androgen deprivation treatment (ADT) between continuous and intermittent ADT. MATERIALS AND METHODS: Between January 2006 and May 2015, 603 patients were selected and divided into continuous ADT (CADT) (n=175) and intermittent ADT (IADT) (n=428) groups. The median follow-up in this study was 48.19 (1.0-114.0) months. The primary end point was time to castration resistant prostate cancer (CRPC). The types of ADT were monotherapy and maximal androgen blockade (i.e., luteinizing hormone-releasing hormone agonist and antiandrogen). RESULTS: The characteristics of patients showed no significant differences between the CADT and IADT groups, except for the Gleason score (p<0.001). The median time to CRPC of all enrolled patients with ADT was 20.60±1.60 months. The median time to CRPC was 11.20±1.31 months in the CADT group as compared with 22.60±2.08 months in the IADT group. In multivariate analysis, percentage of positive core (p=0.047; hazard ratio [HR], 0.976; 95% confidence interval [CI], 0.953-1.000), Gleason score (p=0.007; HR, 1.977; 95% CI, 1.206-3.240), lymph node metastasis (p=0.030; HR, 0.498; 95% CI, 0.265-0.936), bone metastasis (p=0.028; HR, 1.921; 95% CI, 1.072-3.445), and CADT vs. IADT (p=0.003; HR, 0.254; 95% CI. 0.102-0.633) were correlated with the duration of progression to CRPC. The IADT group presented a significantly longer median time to CRPC compared with the CADT group. Additionally, patients in the IADT group showed a longer duration in median time to CRPC in subgroup analysis according to the Gleason score. CONCLUSIONS: This study found that IADT produces a longer duration in median time to CRPC than does CADT.
Assuntos
Idoso , Idoso de 80 Anos ou mais , Humanos , Masculino , Pessoa de Meia-Idade , Adenocarcinoma/tratamento farmacológico , Antagonistas de Androgênios/administração & dosagem , Antineoplásicos Hormonais/administração & dosagem , Progressão da Doença , Esquema de Medicação , Seguimentos , Metástase Linfática , Gradação de Tumores , Neoplasias da Próstata/tratamento farmacológico , Neoplasias de Próstata Resistentes à Castração/tratamento farmacológico , Estudos Retrospectivos , Resultado do TratamentoRESUMO
PURPOSE: Our objective was to evaluate the use of a holmium laser for transurethral deroofing of a prostatic abscess in patients with severe and multiloculated prostatic abscesses. MATERIALS AND METHODS: From January 2011 to April 2014, eight patients who were diagnosed with prostatic abscesses and who underwent transurethral holmium laser deroofing at Pusan National University Hospital were retrospectively reviewed. RESULTS: Multiloculated or multifocal abscess cavities were found on the preoperative computed tomography (CT) scan in all eight patients. All patients who underwent transurethral holmium laser deroofing of a prostatic abscess had successful outcomes, without the need for secondary surgery. Of the eight patients, seven underwent holmium laser enucleation of the prostate (HoLEP) for the removal of residual adenoma. Markedly reduced multiloculated abscess cavities were found in the follow-up CT in all patients. No prostatic abscess recurrence was found. Transient stress urinary incontinence was observed in three patients. The stress urinary incontinence subsided within 3 weeks in two patients and improved with conservative management within 2 months in the remaining patient. CONCLUSIONS: Transurethral holmium laser deroofing of prostatic abscesses ensures successful drainage of the entire abscess cavity. Because we resolved the predisposing conditions of prostatic abscess, such as bladder outlet obstruction and prostatic calcification, by simultaneously conducting HoLEP, there was no recurrence of the prostatic abscesses after surgery. We recommend our method in patients requiring transurethral drainage.
Assuntos
Idoso , Idoso de 80 Anos ou mais , Humanos , Masculino , Pessoa de Meia-Idade , Abscesso/etiologia , Calcinose/complicações , Drenagem/métodos , Hólmio , Lasers de Estado Sólido/uso terapêutico , Doenças Prostáticas/etiologia , Estudos Retrospectivos , Tomografia Computadorizada por Raios X , Ressecção Transuretral da Próstata/métodos , Resultado do Tratamento , Obstrução do Colo da Bexiga Urinária/complicaçõesRESUMO
Androgen receptor (AR) signaling is important for prostate cancer (PCa) cell proliferation. Here, we showed that proliferation of hormone-sensitive prostate cancer cells such as LNCaP was significantly enhanced by testosterone stimulation whereas hormone-insensitive prostate cancer cells such as PC3 and VCaP did not respond to testosterone stimulation. Blocking of AR using bicalutamide abolished testosterone-induced proliferation of LNCaP cells. In addition, knockdown of AR blocked testosterone-induced proliferation of LNCaP cells. Basal expression of low-density lipoprotein receptor-related protein 6 (LRP6) was elevated in VCaP cells whereas stimulation of testosterone did not affect the expression of LRP6. However, expression of LRP6 in LNCaP cells was increased by testosterone stimulation. In addition, knockdown of LRP6 abrogated testosterone-induced proliferation of LNCaP cells. Given these results, we suggest that androgen-dependent expression of LRP6 plays a crucial role in hormone-sensitive prostate cancer cell proliferation.
Assuntos
Proliferação de Células , Proteína-6 Relacionada a Receptor de Lipoproteína de Baixa Densidade , Neoplasias da Próstata , Receptores Androgênicos , TestosteronaRESUMO
PURPOSE: To investigate the factors associated with the occurrence of and recovery from transient urinary incontinence (TUI) after holmium laser enucleation of the prostate (HoLEP). MATERIALS AND METHODS: From March 2009 to December 2012, 391 consecutive patients treated with HoLEP for benign prostatic hyperplasia were enrolled. Information regarding age, prostate volume, International Prostate Symptom Score, Overactive Bladder Symptom Score, peak urinary flow rate, postvoid residual urine, and operation time was collected. TUI was defined as a patient complaint of urine leakage, regardless of type. Logistic regression was used to investigate the factors associated with the occurrence of TUI, and the Kaplan-Meier test was used to analyze the TUI recovery period. RESULTS: TUI after HoLEP occurred in 65 patients (16.6%), 52 patients of whom (80.0%) showed recovery within three months. Stress and urge urinary incontinence and postvoid dribbling occurred in 16 patients (4.1%), 29 patients (7.4%), and 33 patients (8.4%), respectively. Age (odds ratio [OR]=3.494; 95% confidence interval [CI]=1.565~7.803; p=0.002) and total operation time (OR=3.849; 95% CI=1.613~9.185; p=0.002) were factors that significantly affected the occurrence of TUI. CONCLUSIONS: TUI, defined as any type of urine leakage, occurred after HoLEP in some patients, most of whom recovered within three months. Stress urinary incontinence occurred in only 4% of patients after HoLEP. Age and total operation time were associated with the occurrence of postoperative TUI.
Assuntos
Humanos , Hólmio , Estimativa de Kaplan-Meier , Lasers de Estado Sólido , Modelos Logísticos , Próstata , Hiperplasia Prostática , Fatores de Risco , Bexiga Urinária Hiperativa , Incontinência UrináriaRESUMO
Although prostate-specific antigen (PSA) is a very useful screening tool, prostate biopsy is still necessary to confirm prostate cancer (PCA). However, it is reported that PSA is associated with a high false-positive rate and prostate biopsy also has various procedure-related complications. Therefore, the authors have devised a nomogram, which can be used to estimate the risk of PCA, using available clinical data for men with a serum PSA less than 10 ng/mL. Prostate biopsies were obtained from 2,139 patients from January 1998 to March 2011. Of them, 1,171 patients with a serum PSA less than 10 ng/mL were only included in this study. Patient age, PSA, free PSA, prostate volume, PSA density and percent free PSA ratio were analyzed. Among 1,171 patients, 255 patients (21.8%) were diagnosed as PCA. Multivariate analyses showed that patient age, prostate volume, PSA and percent free PSA had statistically significant relationships with PCA (P < 0.05) and were used as nomogram predictor variables. The area under the (ROC) curve for all factors in a model predicting PCA was 0.759 (95% CI, 0.716-0.803).
Assuntos
Adulto , Idoso , Idoso de 80 Anos ou mais , Humanos , Masculino , Pessoa de Meia-Idade , Fatores Etários , Área Sob a Curva , Análise Multivariada , Nomogramas , Valor Preditivo dos Testes , Próstata/fisiologia , Antígeno Prostático Específico/sangue , Neoplasias da Próstata/diagnóstico , Curva ROC , Fatores de RiscoRESUMO
A 29-year-old woman with mild back pain when coughing and suprapubic discomfort after voiding was admitted to Pusan National University Hospital. Two weeks earlier, she had undergone a hysterectomy and right-sided ureteroneocystostomy for uterine atony and right ureteral injury with bladder rupture. Computed tomography showed that a ureteral J stent extended from the right ovarian vein to the right cardiac chamber. The stent was retrieved via both femoral veins with a snare loop and pigtail catheter. Computed tomography showed that the urinary and vascular tracts were normal 5 months after the procedure.
Assuntos
Adulto , Feminino , Humanos , Dor nas Costas , Catéteres , Tosse , Veia Femoral , Migração de Corpo Estranho , Coração , Histerectomia , Ruptura , Proteínas SNARE , Stents , Ureter , Bexiga Urinária , Inércia Uterina , VeiasRESUMO
PURPOSE: The objective of this study was to identify the relationships among symptom bother, physical and mental stress and health-related quality of life (HRQoL) in women with overactive bladder (OAB) syndrome. METHODS: The participants were 106 women who were diagnosed with OAB (urgency, urge urinary incontinence, frequency, and/or nocturia) at P university hospital. Data were collected from Dec 23, 2011 to Aug 31, 2012. RESULTS: The mean score for symptom bother was 43.1 points, for physical stress, 12.8 which was slightly higher than mental stress (11.8), and for HRQoL, 63.9. For symptom type, there were statistically significant differences in the symptom bother (F=8.67, p<.001) and HRQL (F=3.32, p= .023). The Symptom bother of OAB was positively correlated with physical stress (r=.23, p= .014) and mental stress (r=.33, p<.001) and negatively correlated with the subscales of HRQoL; coping (r=-.66, p<.001), concern (r=-.71, p<.001), sleep (r=-.59, p<.001), and social interaction (r=-.58, p<.001). CONCLUSION: From the results, bother symptom was associated with physical, mental stress and HRQoL. These results suggest that nursing intervention programs for OAB should be developed not only to relieve the symptoms but also to reduce stress and improve the quality of life.
Assuntos
Feminino , Humanos , Relações Interpessoais , Enfermagem , Qualidade de Vida , Avaliação de Sintomas , Bexiga Urinária Hiperativa , Incontinência UrináriaRESUMO
PURPOSE: We analyzed factors associated with early recovery of continence after laparoscopic radical prostatectomy. MATERIALS AND METHODS: Among 467 patients treated with laparoscopic radical prostatectomy for localized prostate cancer between 2007 and 2012, 249 patients who underwent a preoperative urodynamic study were enrolled. The patients' age, prostate volume, preoperative serum prostate-specific antigen (PSA), Gleason score, pathologic stage, and preoperative urodynamic parameters were recorded. The preoperative membranous and prostatic urethral length on magnetic resonance image, nerve sparing technique, and type of surgical procedure (extrafascial and intrafascial) were analyzed. Patients were considered to have early recovery of continence when they needed no pad in 3 months or less after surgery. RESULTS: Ninety-two patients were in the early recovery group and 157 were in the late recovery group. The membranous urethral lengths were 12.06+/-2.56 and 11.81+/-2.87 mm, and prostatic urethral lengths were 36.39+/-6.15 and 37.45+/-7.55 mm in each group, respectively. The membranous-posterior urethral length ratios were 0.25+/-0.06 and 0.24+/-0.06, and prostatic-posterior urethral length ratios were 0.75+/-0.06 and 0.76+/-0.06, respectively. In and of themselves, the membranous and prostatic urethral lengths were not associated with recovery duration however, the membranous-total and prostatic-total urethral length ratios were related (p=0.024 and 0.024, respectively). None of the urodynamic parameters correlated with continence recovery time. In the multivariate analysis, the type of surgical procedure (odds ratio [OR], 7.032; 95% confidence interval [CI], 2.660 to 18.590; p<0.001) and membranous urethral length (OR, 0.845; 95% CI, 0.766 to 0.931; p=0.001) were significantly related to early recovery of continence. CONCLUSIONS: The current intrafascial surgical procedure is the most important factor affecting early recovery of continence after laparoscopic radical prostatectomy.
Assuntos
Humanos , Laparoscopia , Imageamento por Ressonância Magnética , Análise Multivariada , Gradação de Tumores , Próstata , Antígeno Prostático Específico , Prostatectomia , Neoplasias da Próstata , Incontinência Urinária , UrodinâmicaRESUMO
PURPOSE: We present our initial experience and surgical outcomes for the most recent refinement of bilateral intrafascial nerve-sparing extraperitoneal laparoscopic radical prostatectomy (nsELRP). MATERIALS AND METHODS: Among 62 patients who underwent laparoscopic radical prostatectomy, 50 patients underwent intrafascial nsELRP by a single surgeon at Pusan National University Hospital from November 2011 to April 2012. As part of the intrafascial technique, the dissection plane is directly on the prostatic capsule to preserve most of the periprostatic fascia containing small vessels and nerves, endopelvic fascia, neurovascular bundle, and puboprostatic ligament. Postoperative continence recovery was established by daily consumption of pads. Follow-up was done at 2 weeks, 6 weeks, and 3 months after surgery. RESULTS: The patients' mean age was 66.5+/-6.2 years. The mean operation time and mean blood loss were 149.3+/-28.1 minutes and 155.4+/-168.1 ml, respectively. The mean hospitalization time and mean catheterization time were 6.3+/-5.1 days and 5.5+/-4.7 days, respectively. Two weeks after the operation, a total of 14 patients (28.0%) were pad-free but the other incontinent patient group used on average 2.3 pads per day. After 6 weeks, 35 patients (70.0%) achieved pad-free status and 7 patients (14.0%) required more than 2 pads per day. At 3 months after surgery, a total of 31 patients were available for follow-up, and 26 patients (83.9%) were pad-free. CONCLUSIONS: Compared with conventional laparoscopic prostatectomy, the intrafascial nsELRP procedure enables the preservation of periprostatic structures that are essential to the recovery of surgical structures related to continence. As a result, early postoperative continence can be achieved.
Assuntos
Humanos , Cateterismo , Catéteres , Fáscia , Seguimentos , Hospitalização , Laparoscopia , Ligamentos , ProstatectomiaRESUMO
PURPOSE: To evaluate the efficacy and safety of the tension-free placement of a monofilament polypropylene mesh for the repair of an anterior vaginal wall prolapse (AVWP). MATERIALS AND METHODS: Women aged > or = 30 years with an AVWP stage of II or greater were included. Forty-nine women underwent trans-vaginal repair using a Gynemesh(TM) PS. Forty-six women who had symptomatic stress urinary incontinence received a midurethral sling (MUS). At the 12-month follow-up, evaluations were made for changes in the Pelvic Organ Prolapse Quantification (POP-Q) stage and Pelvic Floor Distress Inventory. Cure was defined as a POP-Q stage of 0 and improvement as a stage of I. Complications were also evaluated. RESULTS: The cure rate was 71.4%, and the improvement rate was 18.4%. Obstructive/discomfort, irritative, and stress subscale scores of the Urinary Distress Inventory anterior and posterior subscale scores of the POP Distress Inventory and the obstructive subscale score of the Colo-Rectal-Anal Distress Inventory were significantly improved. Thirty-two of the 46 women (69.6%) who received MUS procedures reported no leakage after surgery. Complications were 2 cases of increased intraoperative bleeding and 1 case of vaginal erosion. CONCLUSIONS: Trans-vaginal repair using a Gynemesh(TM) PS is a feasible and effective procedure for the treatment of AVWP with no significant complications.
Assuntos
Idoso , Animais , Feminino , Humanos , Camundongos , Seguimentos , Hemorragia , Sintomas do Trato Urinário Inferior , Diafragma da Pelve , Prolapso de Órgão Pélvico , Polipropilenos , Prolapso , Slings Suburetrais , Incontinência UrináriaRESUMO
To investigate the efficacy and safety of desmopressin in patients with mixed nocturia, Patients aged > or =18 yr with mixed nocturia (> or =2 voids/night and a nocturnal polyuria index [NPi] >33% and a nocturnal bladder capacity index [NBCi] >1) were recruited. The optimum dose of oral desmopressin was determined during a 3-week dose-titration period and the determined dose was maintained for 4 weeks. The efficacy was assessed by the frequency-volume charts and the sleep questionnaire. The primary endpoint was the proportion of patients with a 50% or greater reduction in the number of nocturnal voids (NV) compared with baseline. Among 103 patients enrolled, 94 (79 men and 15 women) were included in the analysis. The proportion of patients with a 50% or greater reduction in NV was 68 (72%). The mean number of NV decreased significantly (3.20 to 1.34) and the mean nocturnal urine volume, nocturia index, NPi, and NBCi decreased significantly. The mean duration of sleep until the first NV was prolonged from 118.4+/-44.1 to 220.3+/-90.7 min (P<0.001). The overall impression of patients about their quality of sleep improved. Adverse events occurred in 6 patients, including one asymptomatic hyponatremia. Desmopressin is an effective and well-tolerated treatment for mixed nocturia.
Assuntos
Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Administração Oral , Antidiuréticos/administração & dosagem , Desamino Arginina Vasopressina/administração & dosagem , Esquema de Medicação , Noctúria/complicações , Poliúria/complicações , Estudos Prospectivos , Inquéritos e Questionários , Sono/efeitos dos fármacos , Bexiga Urinária/fisiopatologia , Urodinâmica/fisiologiaRESUMO
Adenocarcinomas arising in the female urethra have been rarely reported. Here we report a case of laparoscopic radical cystourethrectomy with incontinent urinary diversion in a patient with adenocarcinoma in the urethra and bladder. A 60-year-old female presenting with a history of recurrent cystitis and painless hematuria was referred to our facility with voiding difficulty and a urethral mass. Radiologic evaluation showed an enhanced mass in the urethra and bladder neck. Cystoscopic biopsy of the mass in the bladder neck revealed an adenocarcinoma. Laparoscopic radical cystourethrectomy with anterior vaginal wall excision followed by extracorporeal incontinent urinary diversion was performed.
Assuntos
Feminino , Humanos , Pessoa de Meia-Idade , Adenocarcinoma , Biópsia , Cistite , Divertículo , Hematúria , Laparoscopia , Pescoço , Uretra , Bexiga Urinária , Derivação UrináriaRESUMO
For the evaluation of the kidney impairment, serum creatinine concentrations or glomerular filtration rates are mainly used, and the conditions of solitary or transplanted kidney and chronic dialysis are also taken into the considerations. Some symptoms and signs of the chronic renal disability in spite of adequate treatment add one additional grade. For evaluating bladder and urethral impairment, the criteria include voiding symptoms and signs. The patients with urinary diversions have impairment grades depending on the alteration of upper urinary tract function. For penile impairment, the degrees are evaluated using the international index of erectile function, nocturnal penile tumescence and color doppler ultrasonography. For evaluating impairment of other male reproductive organs, functional and anatomical changes of these organs, analysis of the semen or hormones and the state of solitary testis are used as the criteria. For evaluating impairment of female reproductive organs, pregnancy potential, requirement of continuous treatment and the ability of sexual intercourse are used. Also, degree of impairment is modified according to the ages in evaluating female reproductive systems. We have tried to make this evaluation system objective, scientific, and convenient, but still find it leaving much to be desired.
Assuntos
Feminino , Humanos , Masculino , Avaliação da Deficiência , Genitália Feminina/fisiopatologia , Genitália Masculina/fisiopatologia , Nefropatias/classificação , Coreia (Geográfico) , Desenvolvimento de Programas , Índice de Gravidade de Doença , Doenças Uretrais/classificação , Doenças da Bexiga Urinária/classificação , Doenças Urológicas/classificaçãoRESUMO
PURPOSE: This study was performed to investigate prolyl 4-hydroxylase (P4H) expression changes and an inhibitor-mediated effect on bladder fibrosis in rats with partial bladder outlet obstruction(PBOO). MATERIALS AND METHODS: Twenty female Sprague-Dawley rats were divided into four groups. Group A(n=5) consisted of rats with PBOO treated with 2mg/kg P4H inhibitor, group B(n=5) consisted of rats with PBOO treated with 20mg/kg P4H inhibitor, group C(n=5) consisted of rats with PBOO treated with normal saline and group D(n=5) consisted of normal control animals. After PBOO for two weeks in the A, B, and C group rats, each amount of inhibitor was administered orally once a day for two weeks. After a total of four weeks, the bladders from all of the group rats were removed and evaluated. RESULTS: The muscle thickness calculated from Masson's trichrome staining was 0.85+/-0.22mm, 1.06+/-0.15mm, 1.19+/-0.30 and 0.49+/-0.10mm for group A, B, C, and D rats, respectively. The overall P4H expression was 65.7+/-15.2%, 13.4+/-8.4%, 73.8+/-15.5% and 10.0+/-10.0% for group A, B, C, and D rats, respectively. The overall collagen I protein expression was 16.9+/-18.0%, 17.0+/-24.1%, 30.5+/-13.4% and 8.8+/-8.7% for group A, B, C, and D rats, respectively. The overall collagen III protein expression was 9.6+/-4.2%, 8.8+/-2.9%, 12.5+/-10.6% and 7.5+/-3.5% for group A, B, C, and D rats, respectively. These results showed that PBOO led to increased muscle thickness and to an increased expression of P4H, collagen I and III protein, as compared with the group D control animals. Muscle thickness and expression of P4H, collagen I and III protein was decreased in rats treated with the P4H inhibitor-treated groups decreased as compared with rats in group C (saline-treated animals). The ratio of collagen I/III was 1.8, 1.9, 2.4 and 1.2 in group A, B, C, and D rats, respectively. CONCLUSIONS:Our results suggest that the P4H inhibitor may be potentially utilized to reduce bladder fibrosis caused by PBOO.
Assuntos
Feminino , Humanos , Ratos , AnimaisRESUMO
PURPOSE: This study examined the expression of clusterin and Ki-67 in human transitional cell carcinoma(TCC). In addition, the relationship of clusterin and Ki-67 expression with the clinicopathological factors and prognosis of human TCC was investigated. MATERIALS AND METHODS: 149 human TCC tissues were obtained from 149 patients who underwent a radical cystectomy(n=81) or transurethral resection(n=68). The expression of clusterin and Ki-67 was analyzed using immunohistochemical staining. The results were evaluated with respect to the clinicopathological factors. RESULTS: Positive clusterin expression was observed in 21.1% of the total TCC tissues. The expression of clusterin was not significantly related to age, gender, tumor stage and grade. However, recurrence-free survival rate of the patients with positive clusterin expression was significantly lower than that of patients with negative clusterin expression(p=0.02). The expression level of Ki-67 in the TCC tissues was associated with the tumor stage(p<0.001) and grade(p<0.001), but not with age and gender. Furthermore, the recurrence-free survival rate of patients with strong Ki-67 expression was significantly lower than that of patients with weak Ki-67 expression(p<0.001). The expression of clusterin was not significantly related to the level of Ki-67 expression. However, in the patients showing strong Ki-67 expression, the recurrence-free survival rate of the patients with positive clusterin expression was significantly lower than that of the patients with negative clusterin expression(p<0.001). CONCLUSIONS: These results suggest that the expression of clusterin and Ki-67 can be used as a useful predictor of the prognosis of patients with human TCC.
Assuntos
Humanos , Carcinoma de Células de Transição , Clusterina , Prognóstico , Taxa de SobrevidaRESUMO
PUROPOSE: This study was aimed at evaluating the clinical efficacy, satisfaction and complication of patients with transobturator tape (TOT) operation for the elderly women suffering with stress urinary incontinence (SUI). MATERIAL AND METHODS: 58 women with stress urinary incontinence who underwent TOT procedure between March 2004 and June 2006 were included in this study. To assess whether outcome was influenced by the patient's age, the patients were divided into two age groups: women aged 60 years and older (n=22) and women aged less than 60 years (n=36). Preoperatively, the patients were evaluated with history taking, a physical examination, a one-hour pad test, uroflowmetry and urodynamic study. The procedure was carried out using a previously established method under local anesthesia. The post-operative symptoms and patient satisfaction were assessed by questionnaire. RESULTS: There was no significant difference between the 2 groups in terms of the success rate: cure (71.4% vs. 78.2%, p=0.746), improved (19.1% vs. 9.3%, p=0.415), and same as preoperation (9.5% vs. 12.5%, p=1.000) for above 60 years old women and less than 60 years old women, respectively. In addition, the patient satisfaction rate was not different significantly between 2 groups. De novo urge symptoms were observed in 2 women aged 60 years and older. The intraoperative complications were not found. CONCLUSIONS: TOT procedure in elderly women with SUI offers high success rate and satisfaction for operation. TOT should play a significant role in treating them, due to its safety and availability. However, we do not know how long the improvement of voiding symptoms will last, and so additional longer term follow-up should be done.