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1.
Tissue Eng Part A ; 24(1-2): 117-127, 2018 01.
Artigo em Inglês | MEDLINE | ID: mdl-28463605

RESUMO

Urethral defects are normally reconstructed using a patient's own genital tissue; however, in severe cases, additional grafts are needed. We studied the suitability of poly(l-lactide-co-ɛ-caprolactone) (PLCL) and poly(trimethylene carbonate) (PTMC) membranes for urethral reconstruction in vivo. Further, the compatibility of the materials was evaluated in vitro with human urothelial cells (hUCs). The attachment and viability of hUCs and the expression of different urothelial cell markers (cytokeratin 7, 8, 19, and uroplakin Ia, Ib, and III) were studied after in vitro cell culture on PLCL and PTMC. For the in vivo study, 32 rabbits were divided into the PLCL (n = 15), PTMC (n = 15), and control or sham surgery (n = 2) groups. An oval urethral defect 1 × 2 cm in size was surgically excised and replaced with a PLCL or a PTMC membrane or urethral mucosa in sham surgery group. The rabbits were followed for 2, 4, and 16 weeks. After the follow-up, urethrography was performed to check the patency of the urethra. The defect area was excised for histological examination, where the epithelial integrity and structure, inflammation, and fibrosis were observed. There was no notable difference on hUCs attachment on PLCL and PTMC membranes after 1 day of cell seeding, further, the majority of hUCs were viable and maintained their urothelial phenotype on both biomaterials. Postoperatively, animals recovered well, and no severe strictures were discovered by urethrography. In histological examination, the urothelial integrity and structure developed toward a normal urothelium with only mild signs of fibrosis or inflammation. According to these results, PLCL and PTMC are both suitable for reconstructing urethral defects. There were no explicit differences between the PLCL and PTMC membranes. However, PTMC membranes were more flexible, easier to suture and shape, and developed significant epithelial integrity.


Assuntos
Dioxanos/química , Poliésteres/química , Polímeros/química , Uretra/fisiologia , Animais , Células Cultivadas , Humanos , Imuno-Histoquímica , Masculino , Coelhos , Engenharia Tecidual/métodos
2.
Acta Obstet Gynecol Scand ; 94(8): 847-51, 2015 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-25912311

RESUMO

OBJECTIVE: The frequency of pregnancy complications together with renal scarring and voiding dysfunction-related risk factors were investigated in a cohort of women with a history of childhood vesicoureteral reflux (VUR). DESIGN: A retrospective cross-sectional cohort study. POPULATION: Eighty-seven primi- or multiparous middle-aged women diagnosed with primary non-obstructive VUR in childhood. METHODS: Pregnancy outcome was assessed from case records and from patient interviews. Urine flow tests for voiding patterns, renal ultrasound for detecting scars, and blood samples for renal function were investigated. The median follow-up time was 38 years. MAIN OUTCOME MEASURES: Prevalence of pregnancy complications in women with childhood VUR in relation to renal scars and voiding abnormalities. RESULTS: Maternal complications were seen in 64% of the women and fetal complications in 13%. The women with renal scars (48/87) more often had hypertension (33%), proteinuria (40%) and urinary tract infections (42%) during pregnancy than women without scarring. The frequency of fetal complications was not increased by renal scarring or proteinuria during pregnancy. Urinary tract infections during pregnancy (33% of the women) and voiding abnormalities (18%) did not increase the frequency of fetal or maternal complications. The women with fetal complications were more predisposed to frequent urinary tract infections during adult life (55%) than were those without fetal complications (24%) (p = 0.04). CONCLUSIONS: The maternal complication rates in women with childhood VUR were increased only by renal scarring. Frequent urinary tract infections during adulthood seemed to predict an elevated risk of fetal complications.


Assuntos
Complicações na Gravidez/epidemiologia , Refluxo Vesicoureteral/complicações , Adolescente , Adulto , Fatores Etários , Criança , Estudos Transversais , Feminino , Humanos , Rim/patologia , Gravidez , Complicações na Gravidez/patologia , Resultado da Gravidez , Proteinúria/epidemiologia , Proteinúria/patologia , Estudos Retrospectivos , Infecções Urinárias/epidemiologia , Infecções Urinárias/patologia , Refluxo Vesicoureteral/patologia , Adulto Jovem
3.
Pediatrics ; 131(4): 796-800, 2013 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-23509170

RESUMO

The American Academy of Pediatrics recently released its new Technical Report and Policy Statement on male circumcision, concluding that current evidence indicates that the health benefits of newborn male circumcision outweigh the risks. The technical report is based on the scrutiny of a large number of complex scientific articles. Therefore, while striving for objectivity, the conclusions drawn by the 8 task force members reflect what these individual physicians perceived as trustworthy evidence. Seen from the outside, cultural bias reflecting the normality of nontherapeutic male circumcision in the United States seems obvious, and the report's conclusions are different from those reached by physicians in other parts of the Western world, including Europe, Canada, and Australia. In this commentary, a different view is presented by non-US-based physicians and representatives of general medical associations and societies for pediatrics, pediatric surgery, and pediatric urology in Northern Europe. To these authors, only 1 of the arguments put forward by the American Academy of Pediatrics has some theoretical relevance in relation to infant male circumcision; namely, the possible protection against urinary tract infections in infant boys, which can easily be treated with antibiotics without tissue loss. The other claimed health benefits, including protection against HIV/AIDS, genital herpes, genital warts, and penile cancer, are questionable, weak, and likely to have little public health relevance in a Western context, and they do not represent compelling reasons for surgery before boys are old enough to decide for themselves.


Assuntos
Analgesia/métodos , Circuncisão Masculina , Infecções Sexualmente Transmissíveis/prevenção & controle , Humanos , Masculino
4.
Pediatr Nephrol ; 28(1): 77-82, 2013 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-22932995

RESUMO

BACKGROUND: We used ultrasound to measure kidney volumes in adults with a history of childhood vesicoureteral reflux (VUR) and assessed whether total renal volume, small kidney size or the thickness of the upper pole correlated with renal function or hypertension. METHODS: The kidneys of 123 adults were studied by ultrasound, calculating their volumes using an ellipsoid formula normalised to body surface area (Vol(N)). The thickness of the upper pole parenchyma and the number of small kidneys (<80% of normal volume) were recorded. Blood pressure measurements and laboratory tests were also performed. RESULTS: Kidneys with a history of VUR were 12% smaller than those without known VUR (p < 0.05), and those with prior dilating VUR were 16% smaller than those with non-dilating VUR (p < 0.05). There was a moderate correlation (r = 0.42, p < 0.05) between total Vol(N) and GFR values in the total patient series. Thirteen percent of the patients had a moderate decrease in kidney function. The occurrence of hypertension and proteinuria was not affected by either kidney size or a thin upper pole. CONCLUSIONS: Total Vol(N) in ultrasound in early adulthood could probably predict possible renal deterioration in later life. The occurrence of one small kidney was a common finding and seemed not to affect the prevalence of proteinuria or hypertension.


Assuntos
Rim/diagnóstico por imagem , Rim/patologia , Refluxo Vesicoureteral/diagnóstico por imagem , Refluxo Vesicoureteral/patologia , Adolescente , Adulto , Idade de Início , Criança , Pré-Escolar , Humanos , Lactente , Tamanho do Órgão , Ultrassonografia
5.
J R Soc Interface ; 9(77): 3444-54, 2012 Dec 07.
Artigo em Inglês | MEDLINE | ID: mdl-22896571

RESUMO

Different synthetic biomaterials such as polylactide (PLA), polycaprolactone and poly-l-lactide-co-ε-caprolactone (PLCL) have been studied for urothelial tissue engineering, with favourable results. The aim of this research was to further optimize the growth surface for human urothelial cells (hUCs) by comparing different PLCL-based membranes: smooth (s) and textured (t) PLCL and knitted PLA mesh with compression-moulded PLCL (cPLCL). The effects of topographical texturing on urothelial cell response and mechanical properties under hydrolysis were studied. The main finding was that both sPLCL and tPLCL supported hUC growth significantly better than cPLCL. Interestingly, tPLCL gave no significant advantage to hUC attachment or proliferation compared with sPLCL. However, during the 14 day assessment period, the majority of cells were viable and maintained phenotype on all the membranes studied. The material characterization exhibited potential mechanical characteristics of sPLCL and tPLCL for urothelial applications. Furthermore, the highest elongation of tPLCL supports the use of this kind of texturing. In conclusion, in light of our cell culture results and mechanical characterization, both sPLCL and tPLCL should be further studied for urothelial tissue engineering.


Assuntos
Poliésteres/química , Engenharia Tecidual/métodos , Urotélio , Materiais Biocompatíveis , Adesão Celular , Proliferação de Células , Células Cultivadas , Humanos , Propriedades de Superfície
6.
J Pediatr Surg ; 46(1): e5-8, 2011 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-21238631

RESUMO

Resection of a large vascular sacrococcygeal teratoma (SCT) in a newborn has the potential to be a fatal procedure caused by hemolysis, rupture, or bleeding of the tumor. Usually, most blood supply of an SCT is derived from the middle sacral artery. As soon as these arteries have been ligated, further blood loss is minimal. There is only one previous presentation about preoperative embolization of these arteries. We present a case in which the feeding arteries of a giant SCT were embolized in an infant born at 30 weeks and 3 days of gestation. Although bleeding during the surgery was minimal, continuous need of transfusions and life-threatening hyperkalemia created severe problems during surgery, until tumor resection was completed. This is the smallest reported patient in whom SCT was preoperatively treated by embolization.


Assuntos
Embolização Terapêutica/métodos , Cuidados Pré-Operatórios/métodos , Neoplasias de Tecidos Moles/cirurgia , Neoplasias de Tecidos Moles/terapia , Teratoma/cirurgia , Teratoma/terapia , Perda Sanguínea Cirúrgica/prevenção & controle , Ablação por Cateter , Feminino , Doenças Fetais/diagnóstico por imagem , Hemorragia/prevenção & controle , Humanos , Hiperpotassemia/epidemiologia , Recém-Nascido , Recém-Nascido Prematuro , Complicações Intraoperatórias/epidemiologia , Região Sacrococcígea/irrigação sanguínea , Região Sacrococcígea/cirurgia , Neoplasias de Tecidos Moles/irrigação sanguínea , Teratoma/irrigação sanguínea , Ultrassonografia Pré-Natal
7.
J R Soc Interface ; 8(58): 671-7, 2011 May 06.
Artigo em Inglês | MEDLINE | ID: mdl-21106575

RESUMO

The reconstructive surgery of urothelial defects, such as severe hypospadias is susceptible to complications. The major problem is the lack of suitable grafting materials. Therefore, finding alternative treatments such as reconstruction of urethra using tissue engineering is essential. The aim of this study was to compare the effects of naturally derived acellular human amniotic membrane (hAM) to synthetic poly-L-lactide-co-ε-caprolactone (PLCL) on human urothelial cell (hUC) viability, proliferation and urothelial differentiation level. The viability of cells was evaluated using live/dead staining and the proliferation was studied using WST-1 measurement. Cytokeratin (CK)7/8 and CK19 were used to confirm that the hUCs maintained their phenotype on different biomaterials. On the PLCL, the cell number significantly increased during the culturing period, in contrast to the hAM, where hUC proliferation was the weakest at 7 and 14 days. In addition, the majority of cells were viable and maintained their phenotype when cultured on PLCL and cell culture plastic, whereas on the hAM, the viability of hUCs decreased with time and the cells did not maintain their phenotype. The PLCL membranes supported the hUC proliferation significantly more than the hAM. These results revealed the significant potential of PLCL membranes in urothelial tissue engineering applications.


Assuntos
Âmnio/metabolismo , Poliésteres/química , Engenharia Tecidual/métodos , Urotélio/metabolismo , Sobrevivência Celular , Citometria de Fluxo/métodos , Humanos , Queratina-19/metabolismo , Queratina-7/metabolismo , Queratina-8/metabolismo , Fenótipo , Propriedades de Superfície , Fatores de Tempo
8.
Pediatr Surg Int ; 25(6): 537-8, 2009 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-19444456

RESUMO

We report an unusual case of nasogastric tube, during insertion, perforating the upper and lower segments of atretic esophagus (type C) and ending up in the stomach. Symptoms and imaging of the newborn are presented and the causative factors of the incident discussed.


Assuntos
Atresia Esofágica/complicações , Intubação Gastrointestinal/efeitos adversos , Atresia Esofágica/terapia , Perfuração Esofágica/etiologia , Humanos , Recém-Nascido , Masculino , Fístula Traqueoesofágica/complicações , Fístula Traqueoesofágica/terapia
9.
Neurourol Urodyn ; 28(8): 1015-21, 2009.
Artigo em Inglês | MEDLINE | ID: mdl-19274759

RESUMO

AIMS: Examine bladder function behind an abnormal urine flow curve pattern or lower urinary tract symptoms (LUTS) in women with earlier vesicoureteral reflux (VUR). METHODS: Seventeen earlier female VUR patients with weak, fractionated or tower-shaped flow pattern, 10 patients with normal voiding and 2 patients with a big bladder were urodynamically studied. RESULTS: A third of the patients had a large (>800 ml) cystometric bladder capacity. Sensitivity of the bladder was decreased especially in weak urine flow group. Half of these patients felt the "first sensation" when at least 40% of the bladder capacity was filled. Neither the earlier treatment modality nor grade of childhood VUR had an influence on the bladder sensitivity. Urinary tract infections were reported significantly more often (P = 0.028) in patients with decreased bladder sensitivity than in the other patients. Overactive detrusor and decreased bladder compliance were uncommon findings. The detrusor pressure was good exceeding 15 cm H(2)O during the maximum flow rate in almost all patients. Abnormal sphincteric EMG activity during voiding was found in 70% of all patients and especially in fractionated flow group (89%). The EMG activity was seen twice as often in patients with earlier bilateral dilating VUR as in those who had suffered of non-dilating VUR (P = 0.005). CONCLUSIONS: Despite of high frequency of symptoms in female patients with earlier VUR, detrusor overactivity was a rarity, but decreased sensitivity and large capacity of the bladder were found frequently. The patients with weak or fractionated urine flow seemed to suffer from an overactive urethral sphincter.


Assuntos
Transtornos Urinários/etiologia , Transtornos Urinários/fisiopatologia , Urodinâmica , Refluxo Vesicoureteral/complicações , Refluxo Vesicoureteral/fisiopatologia , Adulto , Idoso , Feminino , Humanos , Pessoa de Meia-Idade , Adulto Jovem
10.
Scand J Urol Nephrol ; 43(1): 42-6, 2009.
Artigo em Inglês | MEDLINE | ID: mdl-18752152

RESUMO

OBJECTIVE: Complete androgen insensitivity syndrome (CAIS) is a rare disease. However, there is a higher rate of CAIS in girls with inguinal hernia. The aim of this study was to estimate the incidence of CAIS in girls with inguinal hernia and to find a proper screening test for CAIS in these girls. MATERIAL AND METHODS: A total of 109 consecutive girls attending the University Hospitals of Turku and Tampere, Finland, for inguinal hernia repair between January 2003 and December 2007 participated in the study. After induction of anaesthesia, vaginal length was measured with a small, lubricated Hegar dilator. During hernia repair, tension was placed on the round ligament to identify the contents of the hernial sac. The karyotype of all patients was measured, with identification of the Y-chromosome from a buccal mucosa swab sample. Vaginal length measurements were plotted against age and standards for vaginal length in prepuberty were established. RESULTS: Four patients were found to have very short vaginas, with one CAIS patient confirmed as having a 46XY karyotype from the verification of the Y-chromosome from buccal mucosa. The other three patients with abnormal vaginal length were karyotypically normal XX girls and had visible ovaries, fallopian tubes or round ligament, which suggests an error in the measurements. Unlike all the other operated girls, the CAIS patient lacked a round ligament. CONCLUSIONS: The incidence of CAIS in girls undergoing hernia repair was 1%. The CAIS patient had a significantly shorter vagina than girls with normal karyotype. Vaginal length is a useful additional clinical tool in screening girls for karyotyping CAIS, especially if abnormalities in the round ligament and contents of the hernial sac are suspected. It is recommended that ovaries and fallopian tubes are searched for if the round ligament is not found to be normal during the hernia operation. If no ovaries or fallopian tubes are found, consent for karyotyping should be sought in cases where the vaginal length is <4 cm in girls older than 4 years and <3 cm in younger girls.


Assuntos
Síndrome de Resistência a Andrógenos/epidemiologia , Hérnia Inguinal/epidemiologia , Síndrome de Resistência a Andrógenos/patologia , Criança , Pré-Escolar , Comorbidade , Feminino , Finlândia/epidemiologia , Humanos , Incidência , Lactente , Cariotipagem , Masculino , Pré-Menopausa , Vagina/patologia
11.
Eur Urol ; 54(1): 188-94, 2008 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-17764825

RESUMO

OBJECTIVES AND METHODS: Voiding problems related to childhood vesicoureteral reflux (VUR) in a cohort of 120 patients (109 females, 11 males) were studied at early middle age (range, 33-50 yr). Forty-four patients had been operated on. The study included an interview by means of a symptom questionnaire, a urine flow measurement, a residual urine measurement, and a urine sample. RESULTS: The flow curve shape was abnormal in 40% (tower-shaped in 7%, weak in 18%, interrupted in 8%, and big bladder in 8% of patients). Forty-five percent of operated patients and 70% of nonoperated patients had a normal flow curve shape. Almost half of the operated patients (45%) had either an interrupted or a weak flow. Figures for stress incontinence and urgency incontinence among the female patients were twice those in the controls, 35% versus 16% (p=0.05) and 20% versus 11%, respectively. Urinary tract infections (UTIs) were diagnosed in 76% of the adult female VUR patients and in 57% of their controls (p=0.041). Twenty-five percent of the female VUR patients (none of the controls) reported suffering from UTI more often than once a year. CONCLUSIONS: Adult patients with childhood VUR have abnormal urine flow curve shapes and UTIs significantly more often than controls (p=0.00005 and p=0.04, respectively). Patients who were operated on for VUR especially seemed to have an interrupted or weak flow curve shape. A high percentage of these patients also suffered from urgency and stress incontinence and annual UTIs.


Assuntos
Transtornos Urinários/diagnóstico , Refluxo Vesicoureteral/diagnóstico , Adulto , Técnicas de Diagnóstico Urológico , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Transtornos Urinários/fisiopatologia , Urodinâmica , Refluxo Vesicoureteral/fisiopatologia , Refluxo Vesicoureteral/cirurgia
13.
Nephrol Dial Transplant ; 21(9): 2491-7, 2006 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-16751652

RESUMO

BACKGROUND: Outcome of renal function and blood pressure (BP) at early middle age was clarified in patients treated for vesicoureteral reflux (VUR) during childhood. METHODS: Information of renal function was available from 147 (55%) of 267 patients treated for non-obstructive VUR of any grade. Twelve patients had died of kidney-related conditions and eight had gone into terminal uraemia. A total of 127 patients participated in the study. RESULTS: The mean age of the participants was 41 years. No signs of renal scars were detected by ultrasound examination in 53 (42%) subjects. Unilateral scarring was seen in 44 (35%) and bilateral in 30 (24%) subjects. Glomerular filtration rate (GFR) showed moderate or severe renal insufficiency in four (3%) participants, all with bilateral scars. Normal GFR was found in one-third of the patients. Twenty-five (83%) subjects with bilateral scars and 60 (62%) of the other participants had abnormal GFR values (P < 0.05). Proteinuria was found in 12 (9%) and albuminuria in 30 (24%) participants. Hypertension was diagnosed earlier in 14 (11%) patients, eight having bilateral scarring (P < 0.01). Diastolic BP was significantly lower in subjects without scars compared with those having scars in one or both kidneys (P < 0.05). CONCLUSIONS: Renal function was slightly lowered in more than half of the participants. Findings of the participants with unilateral scarring or unscarred kidneys were similar, except for the increased tendency for hypertension in subjects with scars. A total of 83% of the patients with bilateral kidney scars had lowered kidney function, a quarter presented with proteinuria and a half with hypertension. Long-term follow-up for all the patients with earlier VUR is emphasized.


Assuntos
Taxa de Filtração Glomerular/fisiologia , Nefropatias/fisiopatologia , Refluxo Vesicoureteral/cirurgia , Adolescente , Adulto , Criança , Pré-Escolar , Cistoscopia , Progressão da Doença , Feminino , Seguimentos , Humanos , Lactente , Rim/diagnóstico por imagem , Nefropatias/diagnóstico , Nefropatias/etiologia , Masculino , Pessoa de Meia-Idade , Prognóstico , Radiografia , Renografia por Radioisótopo , Estudos Retrospectivos , Índice de Gravidade de Doença , Ultrassonografia , Urodinâmica/fisiologia , Refluxo Vesicoureteral/complicações
14.
BJU Int ; 94(7): 1105-11, 2004 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-15541137

RESUMO

OBJECTIVE: To show, for pressure-time data from cystometrography (CMG), the potential practical clinical application of automatically identified, displayed, analysed and quantified compliance and contractility, as undesirable high-pressure detrusor storage may be caused by inefficient compliance or uninhibited contractions (UNC). MATERIAL AND METHODS: Bladder contractility was measured by UNC and compliance by relaxed-state detrusor pressure (RSDP), i.e. the detrusor (bladder-abdominal) pressure with all UNC removed. Forty-one CMG examinations were used retrospectively to: (i) validate the separation and identification, by comparing the resulting separate graphs (data) of UNC and RSDP with an expanded time scale for raw vesical and rectal data; (ii) show that the separation is correct by examples; and (iii) show the potential practical utility by results for typical cases. RESULTS: Separation into RSDP and UNC was correctly identified and plotted. The examples showed the utility and four types of UNC ('high', contractions of >25 cmH(2)O of long duration; 'medium', >25 cmH(2)O of short duration; 'low', 4-25 cmH(2)O of short duration; and 'frequent', of 2-6 cmH(2)O). CONCLUSIONS: UNCs as small as 2 cmH(2)O can be detected and measured. The explicit enhanced estimate of compliance and contractility will be useful in the follow-up when comparing different patients and studies, and assist in more appropriate diagnosis and treatment. Because the treatment for bladders with poor contractility differs greatly from those with detrusor instability, the ability to reliably and accurately differentiate between these causes is important.


Assuntos
Contração Muscular/fisiologia , Reflexo Anormal/fisiologia , Doenças da Bexiga Urinária/fisiopatologia , Incontinência Urinária/fisiopatologia , Humanos , Pressão , Doenças da Bexiga Urinária/diagnóstico
15.
BJU Int ; 94(6): 895-7, 2004 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-15476530

RESUMO

OBJECTIVES: To: (i) calculate traditional compliance (CTrad) for a normal bladder by DeltaV/DeltaPdet, where DeltaV is the mean volumetric capacity and DeltaPdet is the detrusor pressure rise; (ii) assess its usefulness; (iii) identify the variables that are necessary for correctly assessing bladder compliance; and (iv) using these variables, report a method that, because it includes the effect of patient age, sex and size, correctly assesses compliance for management strategies. METHODS: We obtained the mean volumetric capacity of a normal bladder (V(cap,NL)) and the mean detrusor pressure rise (P(cap,NL)) on filling a normal bladder to its volumetric capacity from our and other published work; (ii) calculated CTrad for a normal bladder; (ii) showed that the variables necessary for assessing compliance correctly are DeltaV, DeltaPdet, V(cap,NL), and P(cap,NL); and (iii) showed that the relationship among these is the dimensionless number, NWahl(-1), calculated as (DeltaV/V(cap,NL))/(DeltaPdet/P(cap,NL)). This value for individuals with a normal bladder was calculated, tabulated and graphed. RESULTS: Because a normal individual's bladder capacity increases with age while the detrusor pressure increase does not, CTrad increases with age and therefore cannot be used for assessing compliance. Published data substantiate our result that CTrad for an individual with a normal bladder varies from 6.3 at 0.5 years old to 90 mL/cmH2O at 18 years old. NWahl(-1) correctly assesses bladder compliance because it is the same for all normal cases; consequently NWahl(-1) is more practical for clinical use. CONCLUSIONS: Bladder compliance is standardized using DeltaV, DeltaPdet, V(cap,NL), and P(cap,NL) to give NWahl(-1), and bladder compliance is usefully reported using this value.


Assuntos
Bexiga Urinária/fisiologia , Adolescente , Adulto , Criança , Pré-Escolar , Complacência (Medida de Distensibilidade) , Feminino , Humanos , Lactente , Masculino , Pressão , Valores de Referência , Sensibilidade e Especificidade , Urodinâmica
16.
BJU Int ; 94(6): 898-900, 2004 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-15476531

RESUMO

OBJECTIVE: To devise a new, practical and more accurate method for measuring bladder compliance, and to show that traditional estimates of compliance are impractical. MATERIALS AND METHODS: Childhood bladder capacity varies greatly with age while detrusor pressure in a normal bladder does not. Consequently, traditional bladder compliance (DeltaV/DeltaP) increases with age, i.e. maturation. Therefore we devised a standard method that includes normal values of pressures and volumes to calculate and report bladder compliance in children, and that also applies to adults. A dimensionless number (NWahl(-1)) was computed for standardizing bladder compliance, comparing the normalized capacity to normalized pressure by the ratio (DeltaV/V(cap,NL))/(DeltaP/P(cap,NL)), where DeltaP is the pressure at bladder capacity, DeltaV the volume at bladder capacity, V(cap,NL) the volume at mean expected bladder capacity and P(cap,NL) the pressure at mean expected bladder capacity. V(cap,NL) is obtained from nomograms of published data. RESULTS: The bladder compliance of patients undergoing urodynamic testing was calculated using NWahl(-1) and the traditional equation (DeltaV/DeltaP). NWahl(-1) provided a more accurate diagnosis and therefore was of more practical use. CONCLUSIONS: Bladder compliance depends on patient age, sex and size; the new estimate used to standardize bladder compliance is based on these factors and is a dimensionless number. This may help when comparing patients and assessing outcomes.


Assuntos
Bexiga Urinária/fisiologia , Urodinâmica/fisiologia , Adolescente , Adulto , Criança , Pré-Escolar , Complacência (Medida de Distensibilidade) , Feminino , Humanos , Lactente , Masculino , Pressão , Valores de Referência , Sensibilidade e Especificidade
17.
J Urol ; 169(6): 2344-6, 2003 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-12771796

RESUMO

PURPOSE: We evaluated the comparability and repeatability of analyses based on urodynamic reports. MATERIALS AND METHODS: We assessed interobserver and intra-observer agreement when interpreting urodynamic examinations performed in children. Four pediatric urologists analyzed 17 sets of urodynamic data and gave their interpretations of the possible underlying condition of the tested subjects. The consensus among observers was analyzed using the kappa statistic. RESULTS: Poor agreement was observed on suggested diagnoses based on uroflow curves. Good consensus was noted on maximal flow rates but the interpretations of urethral pressure profile curves and the resulting diagnoses regarding sphincter function differed significantly. It also appeared to be difficult to reach agreement regarding bladder compliance and detrusor activity. CONCLUSIONS: The consistency of the interpretations of urodynamic studies should be improved before they are accepted as measures for comparing urodynamic diagnoses or effects of treatment between patient series.


Assuntos
Urodinâmica , Doenças Urológicas/diagnóstico , Adolescente , Criança , Feminino , Humanos , Masculino , Variações Dependentes do Observador , Reprodutibilidade dos Testes , Uretra/fisiopatologia , Bexiga Urinária/fisiopatologia
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