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1.
Urologe A ; 59(1): 65-71, 2020 Jan.
Artigo em Alemão | MEDLINE | ID: mdl-31741004

RESUMO

Due to a safety alert issued by the US Food and Drug Administration (FDA) in 2011 for transvaginal mesh implants to treat female prolapse as a result of numerous reports of complications such as infection, chronic pain, dyspareunia, vaginal erosion, shrinkage and erosion into other organs nearly all industrial products have been withdrawn from the market in the meantime. The United Kingdom, Australia, and New Zealand extended warnings and prohibitions even on the implantation of midurethral slings (TVT, TOT). In view of these current international controversies regarding the use of implanted materials for the treatment of stress incontinence and prolapse and the lack of clear guidelines for the use of biomaterials, the opinion of the Working Group on Urological Functional Diagnostics and Female Urology should provide clarity. The Opinion is based on the SCENIHR Report of the "European Commission's Scientific Committee on Emerging and Newly Identified Health Risks", the "Consensus Statement of the European Urology Association and the European Urogynaecological Association on the Use of Implanted Materials for Treating Pelvic Organ Prolapse and Stress Urinary Incontinence" and in compliance with relevant EAU and national guidelines and the opinion of the Association for Urogynaecology and Plastic Pelvic Floor Reconstruction (AGUB eV). In addition, recommendations are given for the future handling of implants of slings and meshes for the treatment of stress incontinence and prolapse from a urologic viewpoint.


Assuntos
Prolapso de Órgão Pélvico/cirurgia , Slings Suburetrais/efeitos adversos , Telas Cirúrgicas/efeitos adversos , Incontinência Urinária por Estresse/cirurgia , Procedimentos Cirúrgicos Urológicos/instrumentação , Feminino , Alemanha , Humanos
2.
Urologe A ; 58(4): 389-397, 2019 Apr.
Artigo em Alemão | MEDLINE | ID: mdl-30810772

RESUMO

A serious voiding disorder or urinary incontinence represent indications for long-term catheterization of the urinary bladder. Treatment by a transurethral or suprapubic bladder catheter for life-long bladder drainage is accompanied by technical short-term complications and long-term sequelae. The mortality risk associated with inserting a suprapubic catheter is approximately 2% due to an incorrect bladder puncture. Long-term consequences of life-long bladder drainage are hematuria, infection, spasms, stone formation, obstruction, catheter loss, risk of falls and automanipulation especially in cognitively impaired persons. These constitute frequent reasons for emergency treatment or hospitalization. Further problem areas are dependency on caregivers to perform the catheter change and dermal problems in the area of the fistula stoma. To what extent this limits the quality of life of those affected remains unclear up to now. The acute complications and the long-term consequences of life-long bladder drainage make careful decision-making necessary after other therapeutic options have failed, are not appropriate or not desired.


Assuntos
Bexiga Urinária , Cateterismo Urinário , Incontinência Urinária , Idoso , Drenagem , Humanos , Qualidade de Vida
3.
World J Urol ; 37(7): 1415-1420, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30341450

RESUMO

PURPOSE: To analyze and compare preoperative patient characteristics and postoperative results in men with stress urinary incontinence (SUI) selected for an adjustable male sling system or an artificial urinary sphincter (AUS) in a large, contemporary, multi-institutional patient cohort. METHODS: 658 male patients who underwent implantation between 2010 and 2012 in 13 participating institutions were included in this study (n = 176 adjustable male sling; n = 482 AUS). Preoperative patient characteristics and postoperative outcomes were analyzed. For statistical analysis, the independent T test and Mann-Whitney U test were used. RESULTS: Patients undergoing adjustable male sling implantation were less likely to have a neurological disease (4.5% vs. 8.9%, p = 0.021), a history of urethral stricture (21.6% vs. 33.8%, p = 0.024) or a radiation therapy (22.7% vs. 29.9%, p = 0.020) compared to patients that underwent AUS implantation. Mean pad usage per day (6.87 vs. 5.82; p < 0.00) and the ratio of patients with a prior incontinence surgery were higher in patients selected for an AUS implantation (36.7% vs. 22.7%; p < 0.001). At maximum follow-up, patients that underwent an AUS implantation had a significantly lower mean pad usage during daytime (p < 0.001) and nighttime (p = 0.018). Furthermore, the patients' perception of their continence status was better with a subjective complete dry rate of 57.3% vs. 22.0% (p < 0.001). CONCLUSIONS: Patients selected for an AUS implantation showed a more complex prior history and pathogenesis of urinary incontinence as well as a more severe grade of SUI. Postoperative results reflect a better continence status after AUS implantation, favoring the AUS despite the more complicated patient cohort.


Assuntos
Slings Suburetrais , Incontinência Urinária por Estresse/cirurgia , Esfíncter Urinário Artificial , Procedimentos Cirúrgicos Urológicos Masculinos/métodos , Idoso , Estudos de Coortes , Humanos , Masculino , Medidas de Resultados Relatados pelo Paciente , Seleção de Pacientes , Radioterapia/estatística & dados numéricos , Estudos Retrospectivos , Índice de Gravidade de Doença , Resultado do Tratamento , Estreitamento Uretral/epidemiologia
4.
Urologe A ; 57(2): 131-138, 2018 Feb.
Artigo em Alemão | MEDLINE | ID: mdl-28963575

RESUMO

BACKGROUND: Guillain-Barré syndrome (GBS) as acute inflammatory demyelinating polyradiculoneuropathy frequently leads to lower urinary tract dysfunction. The available knowledge in the medical literature is limited and good recommendations for diagnosis and therapy are rare. MATERIALS AND METHODS: In this study, 189 patients with GBS were screened for lower urinary tract dysfunction. In symptomatic patients, a urodynamic study was performed. Detrusor contractility, post-void residual, and changes of the symptoms over time were studied. Overall Barthel index and urinary control Barthel index as well as the relationship of time after onset of the disease and post-void residual were studied as possible screening criteria for urodynamic assessment. RESULTS: According to the urinary control Barthel index (BI), 115 of 189 patients (61%) presented lower urinary tract symptoms sometime during the course of disease. In 28 patients, these symptoms were temporary during the acute phase. At the time of urological assessment, 87 patients had lower urinary tract symptoms. At the end of rehabilitation, 37 had no symptoms anymore (BI 10), 20 were able to control micturition to a certain extent (BI 5), and 30 had no lower urinary tract control (BI 0). There was a significant negative correlation between post-void residual volume and overall BI (ρ -0.5823, p < 0.0001) and BI for urinary tract control (ρ -0.6430, p < 0.0001). CONCLUSIONS: Overall BI and BI for urinary tract control are suitable screening criteria for urodynamic assessment.


Assuntos
Síndrome de Guillain-Barré/complicações , Doenças da Bexiga Urinária/epidemiologia , Obstrução do Colo da Bexiga Urinária/diagnóstico , Bexiga Urinária/fisiopatologia , Transtornos Urinários/diagnóstico , Transtornos Urinários/etiologia , Síndrome de Guillain-Barré/epidemiologia , Síndrome de Guillain-Barré/fisiopatologia , Humanos , Doenças da Bexiga Urinária/diagnóstico , Doenças da Bexiga Urinária/fisiopatologia , Obstrução do Colo da Bexiga Urinária/fisiopatologia , Micção , Transtornos Urinários/fisiopatologia , Urodinâmica
5.
Aktuelle Urol ; 47(4): 305-9, 2016 08.
Artigo em Alemão | MEDLINE | ID: mdl-27500848

RESUMO

The syndrome of overactive bladder (OAB) with the symptoms of frequency, urgency and nocturia is often seen. After the diagnosis has been made by careful exclusion of other conditions, there are different symptomatic treatment strategies available. These include drug treatment as well as minimally invasive local surgical treatments and treatments which intervene with the control of the bladder by modulating central nervous areas. Alternative methods such as acupuncture may help in individual cases; the placebo effect is high and there is a lack of controlled studies.


Assuntos
Noctúria , Bexiga Urinária Hiperativa/tratamento farmacológico , Humanos
6.
Aktuelle Urol ; 47(4): 315-20, 2016 08.
Artigo em Alemão | MEDLINE | ID: mdl-27500850

RESUMO

The urethral syndrome with urethral pain and bladder voiding disorders is a diagnosis of exclusion. Possible aetiologies are diverse and include organic, functional and inflammatory pathologies of the urethra. Infections, inflammation of the paraurethral glands, spasms of the sphincter muscle and/or of the pelvic floor muscles, oestrogen deficiency, trauma, neuropathies, hypersensitivity and psychosomatic issues have been investigated as possible causes.Patients with urethral syndrome must be viewed, evaluated and treated holistically. They need a lot of time and attention during their evaluation and treatment. It is now well known that psychosocial aspects are involved in the development of many somatic conditions and may have a crucial impact on the course of a disease. This needs to be taken into consideration during the treatment process.


Assuntos
Uretra , Micção , Humanos , Doenças da Bexiga Urinária , Transtornos Urinários
7.
Aktuelle Urol ; 47(4): 310-4, 2016 08.
Artigo em Alemão | MEDLINE | ID: mdl-27500849

RESUMO

As regards treatment for overactive bladder, physiotherapeutic interventions can be seen as an alternative to drug treatment. Targeted pelvic floor and bladder training is used to decrease the number of voids and the incontinence episodes or to increase the average voided volume in women with overactive bladder (3 systematic reviews with evidence level 1/1a).An additional option to treat women with overactive bladder is to use functional electrical stimulation and magnetic stimulation.2 systematic reviews 1 2 and 2 RCTs 3 4 reveal a low level of evidence (2 studies with level 2/2b) for the use of electrical stimulation (transcutaneous, vaginal or transanal) to reduce incontinence episodes and the number of voids and to increase the average voided volume. The trial from Yamanishi et al. (2014) shows that magnetic stimulation has a positive effect 5. Further studies are needed to evaluate the benefit of conservative treatment procedures for overactive bladder.


Assuntos
Terapia por Estimulação Elétrica , Bexiga Urinária Hiperativa/tratamento farmacológico , Feminino , Humanos , Diafragma da Pelve , Modalidades de Fisioterapia , Incontinência Urinária
8.
Aktuelle Urol ; 47(4): 300-4, 2016 08.
Artigo em Alemão | MEDLINE | ID: mdl-27328304

RESUMO

With increasing age many women suffer from lower urinary tract dysfunction (LUTD) and female sexual dysfunction. An increasing body of evidence supports an association between the 2 conditions. Especially women with urodynamically proved detrusor hyperactivity suffer from sexual dysfunction and there is some evidence that in patients with stress incontinence sexual health improves after successful surgery.


Assuntos
Incontinência Urinária por Estresse , Feminino , Humanos , Sexualidade
9.
Aktuelle Urol ; 47(1): 60-4, 2016 Feb.
Artigo em Alemão | MEDLINE | ID: mdl-26560847

RESUMO

Urinary incontinence is a common medical and social problem in elderly people. It leads to a massive reduction in the quality of life of affected persons and their dependants and causes an enormous socio-economic burden, which will increase significantly within the next years and decades as the age structure of the German population changes. Successful treatment of urinary incontinence in the elderly requires a good pathophysiological understanding of the underlying problem as well as individually tailored diagnostic procedures, which must be oriented at the patient's wishes, the social environment and the resulting therapeutic consequences. This especially applies to persons with symptoms of dementia. Comorbidities such as diabetes mellitus, reduced mobility and a medication-induced decrease in cognitive function play a major role in the severity of urgency and urinary incontinence in the elderly. Also the frequently described concomitant diagnosis of urinary tract infection must be exactly evaluated. Before antibiotic treatment is given, it should be clarified if the patient suffers from "harmless" bacteriuria or a urinary tract infection requiring treatment. Patients with an age-associated decrease in brain power must be diagnosed quite carefully, because these patients may potentially be harmed by pharmacological treatment for overactive bladder syndrome.


Assuntos
Incontinência Urinária/etiologia , Idoso , Antibacterianos/efeitos adversos , Antibacterianos/uso terapêutico , Bacteriúria/diagnóstico , Bacteriúria/epidemiologia , Bacteriúria/etiologia , Bacteriúria/terapia , Comorbidade , Estudos Transversais , Demência/diagnóstico , Demência/terapia , Diagnóstico Diferencial , Feminino , Humanos , Masculino , Dinâmica Populacional , Bexiga Urinária Hiperativa/diagnóstico , Bexiga Urinária Hiperativa/epidemiologia , Bexiga Urinária Hiperativa/etiologia , Bexiga Urinária Hiperativa/terapia , Incontinência Urinária/diagnóstico , Incontinência Urinária/epidemiologia , Incontinência Urinária/terapia , Infecções Urinárias/diagnóstico , Infecções Urinárias/epidemiologia , Infecções Urinárias/terapia , Urodinâmica/fisiologia
10.
Urologe A ; 54(7): 963-71, 2015 Jul.
Artigo em Alemão | MEDLINE | ID: mdl-26162272

RESUMO

BACKGROUND: Ultrasonography and functional cine magnetic resonance imaging (MRI) are noninvasive and x-ray free tools, which are currently widely used in clinical diagnostics and scientific research of male and female urinary incontinence. The increasing use and improving techniques of modern imaging tools are closely linked to rapid development of minimally invasive surgery in patients with urinary incontinence and insights gained in continence mechanisms. METHODS: Whereas ultrasonography is a cost-efficient and readily available diagnostic tool for a routine use, the more expensive functional MRI, as a tool with more precise visualization of functional interactions and spatial representation of anatomical structures of the pelvic floor, is suitable for complex diagnostic purposes and scientific research. Both tools are already well established for evaluations of the female pelvic floor. For evaluation of the male pelvic floor, and in particular postprostatectomy incontinence, perineal ultrasonography and functional cine MRI are becoming increasingly evident. CONCLUSION: Further development of both imaging tools will contribute to new insights into the continence mechanism and improve the techniques of radical prostatectomy and minimally invasive surgery of male and female urinary incontinence in the future.


Assuntos
Técnicas de Diagnóstico Urológico , Aumento da Imagem/métodos , Imagem Cinética por Ressonância Magnética/tendências , Ultrassonografia/tendências , Incontinência Urinária/diagnóstico , Feminino , Humanos , Imagem Cinética por Ressonância Magnética/métodos , Masculino , Ultrassonografia/métodos
11.
Urologe A ; 54(6): 887-99; quiz 900, 2015 Jun.
Artigo em Alemão | MEDLINE | ID: mdl-26081822

RESUMO

Stress urinary incontinence in men is predominantly iatrogenic whereby radical prostatectomy is the most common cause with persistent stress urinary incontinence rates varying between 10 % and 25 %. The first line therapy for postoperative male stress urinary incontinence is physiotherapy, especially pelvic floor muscle rehabilitation. If conservative treatment fails to show sufficient improvement, surgical therapy is recommended. Several treatment options are currently available for the surgical treatment of male stress urinary incontinence including artificial sphincters, adjustable and functional sling systems, bulking agents and implantable balloon systems.


Assuntos
Terapia por Exercício/métodos , Prostatectomia/efeitos adversos , Slings Suburetrais , Incontinência Urinária por Estresse/etiologia , Incontinência Urinária por Estresse/terapia , Esfíncter Urinário Artificial , Medicina Baseada em Evidências , Humanos , Masculino , Resultado do Tratamento
12.
Urologe A ; 53(10): 1543-50; quiz 1551 - 2, 2014 Oct.
Artigo em Alemão | MEDLINE | ID: mdl-25228458

RESUMO

Geriatric patients are defined as being over 70 years of age and are vulnerable due to multimedication and multimorbidity. The typical incontinence type in geriatric patients is the overactive bladder syndrome as a result of anatomical alterations and the influence of conditions which typically occur in the elderly, e.g. diabetes mellitus, vaginal atrophy, constipation, neurological affections and dementia. This multimorbidity leads to multimedication but many pharmaceutical compounds aimed at indications of diseases distant from the urinary tract can also influence the continence situation. This has been proven for cardiac medications, such as alpha-blockers and diuretics, neurological drug therapy and analgesics. Diagnostic investigations in geriatric patients are usually non-invasive and include geriatric assessment to quantify incontinence symptoms but invasive diagnostic tools are required if the primary therapy fails or an operative intervention is planned. Pharmacotherapy considers the special requirements of the very old patient with cognitive impairment and vulnerability due to falls or delirium. In the group of anticholinergic drugs, trospium chloride seems to be the favorite substance to treat this group of patients because this hydrophilic compound is considered to be unable to cross the blood-brain barrier and therefore minimizes the risk of side effects in the central nervous system (CNS).


Assuntos
Antagonistas Colinérgicos/uso terapêutico , Avaliação Geriátrica/métodos , Bexiga Urinária Hiperativa/diagnóstico , Bexiga Urinária Hiperativa/tratamento farmacológico , Incontinência Urinária/diagnóstico , Incontinência Urinária/tratamento farmacológico , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Bexiga Urinária Hiperativa/prevenção & controle , Incontinência Urinária/prevenção & controle
13.
Urologe A ; 53(3): 333-4, 336, 338, 2014 Mar.
Artigo em Alemão | MEDLINE | ID: mdl-24585116

RESUMO

Prevalence, pathophysiology, diagnostic and therapeutic approaches of urinary incontinence are well studied in women; however, studies on male urinary incontinence focus on incontinence following surgery of the bladder or prostate, predominantly incontinence after radical prostatectomy. Aging men suffer from incontinence, most frequently urge incontinence (overactive bladder, OAB), nearly as often as women do.The domain of conservative therapy of urinary stress incontinence in men is pelvic floor training. It remains unclear whether biofeedback procedures, electrostimulation therapy, or magnetic stimulation therapy can enhance pelvic floor training. There are data suggesting that an off-label therapy with Duloxetin®, a selective serotonin-noradrenaline reuptake inhibitor (SSNRI), improves urinary incontinence following radical prostatectomy. Antimuscarinic agents in combination with bladder training have been proven as safe and effective treatment in men with OAB. Data, however, suggest that men with OAB are far less frequently treated than women.


Assuntos
Terapia por Estimulação Elétrica/métodos , Terapia por Exercício/métodos , Saúde do Homem , Antagonistas Muscarínicos/uso terapêutico , Tiofenos/uso terapêutico , Incontinência Urinária por Estresse/etiologia , Inibidores da Captação Adrenérgica/uso terapêutico , Cloridrato de Duloxetina , Humanos , Masculino , Diafragma da Pelve , Prostatectomia/efeitos adversos , Resultado do Tratamento , Incontinência Urinária por Estresse/diagnóstico , Incontinência Urinária por Estresse/terapia
14.
J Biomed Mater Res A ; 102(4): 1079-84, 2014 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-23625516

RESUMO

Use of textile structures for reinforcement of pelvic floor structures has to consider mechanical forces to the implant, which are quite different to the tension free conditions of the abdominal wall. Thus, biomechanical analysis of textile devices has to include the impact of strain on stretchability and effective porosity. Prolift(®) and Prolift + M(®), developed for tension free conditions, were tested by measuring stretchability and effective porosity applying mechanical strain. For comparison, we used Dynamesh-PR4(®), which was designed for pelvic floor repair to withstand mechanical strain. Prolift(®) at rest showed moderate porosity with little stretchability but complete loss of effective porosity at strain of 4.9 N/cm. Prolift + M(®) revealed an increased porosity at rest, but at strain showed high stretchability, with subsequent loss of effective porosity at strain of 2.5 N/cm. Dynamesh PR4(®) preserved its high porosity even under strain, but as consequence of limited stretchability. Though in tension free conditions Prolift(®) and Prolift + M(®) can be considered as large pore class I meshes, application of mechanical strain rapidly lead to collapse of pores. The loss of porosity at mechanical stress can be prevented by constructions with high structural stability. Assessment of porosity under strain was found helpful to define requirements for pelvic floor devices. Clinical studies have to prove whether devices with high porosity as well as high structural stability can improve the patients' outcome.


Assuntos
Cicatriz/patologia , Diafragma da Pelve/fisiopatologia , Próteses e Implantes , Têxteis , Anisotropia , Fenômenos Biomecânicos , Elasticidade , Humanos , Teste de Materiais , Porosidade , Telas Cirúrgicas , Suporte de Carga
15.
Urologe A ; 52(4): 527-32, 2013 Apr.
Artigo em Alemão | MEDLINE | ID: mdl-23443936

RESUMO

The understanding of the female pelvic floor during the last 20 years was very much influenced by the new techniques of sonographic and magnetic resonance imaging (MRI). Functional imaging of the male pelvic floor is, however, still in its infancy. In analogy to ultrasound examinations of the female pelvic floor, perineal ultrasound can be also be applied to men. The mobility of the proximal urethra, scarring of the bladder neck or implanted suburethral meshes can be easily visualized. Studies on healthy men provide information about different muscular structures during micturition. Morphology and function of the external sphincter can be visualized with transrectal or intraurethral ultrasound and also with a perineal approach. Using functional MRI the complex interactions of bladder, urethra, external sphincter and pelvic floor muscles can be evaluated. Functional MRI is so far not generally available but enables a better understanding of the function of the male pelvic floor. Imaging of the male pelvic floor makes a substantial contribution for improving surgical procedures for male incontinence in the future.


Assuntos
Imagem por Ressonância Magnética/métodos , Distúrbios do Assoalho Pélvico/diagnóstico , Diafragma da Pelve/diagnóstico por imagem , Diafragma da Pelve/patologia , Ultrassonografia/métodos , Humanos , Masculino
16.
Urologe A ; 52(2): 265-74; quiz 275-6, 2013 Feb.
Artigo em Alemão | MEDLINE | ID: mdl-23354910

RESUMO

Based on the measurement of simple physiological parameters urodynamic testing can reproduce clinical symptoms in a quantitative way, associates changes in physiological parameters to pathophysiological conditions and helps to establish a diagnosis in numerous lower urinary tract dysfunctions. Furthermore, urodynamic testing allows lower urinary tract dysfunctions to be classified as storage failure, voiding failure or combined storage and voiding failure. Therapeutic decision-making is based on this classification.


Assuntos
Sintomas do Trato Urinário Inferior/diagnóstico , Sintomas do Trato Urinário Inferior/fisiopatologia , Urodinâmica/fisiologia , Adulto , Criança , Feminino , Humanos , Masculino , Uretra/fisiopatologia , Bexiga Urinária/fisiopatologia , Bexiga Urinaria Neurogênica/diagnóstico , Bexiga Urinaria Neurogênica/fisiopatologia , Incontinência Urinária/diagnóstico , Incontinência Urinária/fisiopatologia
17.
World J Urol ; 31(1): 229-33, 2013 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-22227822

RESUMO

BACKGROUND: Urinary tract symptoms are an underestimated problem in multiple sclerosis (MS). OBJECTIVE: Hundred urodynamics of MS patients have been evaluated prospectively. DESIGN, SETTING AND PARTICIPANTS: In an inpatient rehabilitation, all persons with MS who also suffered from urinary tract symptoms received a voiding diary, post-void sonography and an urodynamic examination according to International Continence-Society-Standard. RESULTS AND LIMITATIONS: Between 10/2009 and 3/2011, 100 patients (79 women; 21 men; mean EDSS, 4.52 ± 2.26) were examined who had primary progressive MS (9×), relapsing-remitting MS (41×), secondary progressive MS (43×) and CIS (1×). The mean duration of MS was 10.26 ± 10.09 years and mean duration of LUTS, 6.9 ± 7.75 years. Urodynamic testing showed normal findings in 22 patients, detrusor overactivity in 7, increased bladder sensation without detrusor overactivity in 21, detrusor-sphincter dyssynergia in 26, detrusor hypocontractility in 12, detrusor acontractility in 4 and unclear diagnosis in 8 patients. Statistically significant risk factors for pathological urodynamic findings were as follows: wheelchair dependency, use of more than one incontinence pad per day and a MS type other than relapsing-remitting. CONCLUSIONS: The urodynamic investigation at hand showed urinary tract dysfunction in 78 of 100 MS patients with lower urinary tract symptoms (LUTS). The long latency between the occurrence of MS and/or the beginning of LUTS and the first neuro-urological evaluation indicates a deficit in treatment. Beyond national guidelines, all MS patients should at regular intervals be questioned about LUTS and receive urodynamic assessment especially according to the presented risk profile.


Assuntos
Sintomas do Trato Urinário Inferior/fisiopatologia , Esclerose Múltipla/fisiopatologia , Urodinâmica/fisiologia , Adulto , Feminino , Humanos , Tampões Absorventes para a Incontinência Urinária/estatística & dados numéricos , Sintomas do Trato Urinário Inferior/etiologia , Masculino , Pessoa de Meia-Idade , Esclerose Múltipla/complicações , Esclerose Múltipla Crônica Progressiva/complicações , Esclerose Múltipla Crônica Progressiva/fisiopatologia , Esclerose Múltipla Recidivante-Remitente/complicações , Esclerose Múltipla Recidivante-Remitente/fisiopatologia , Estudos Prospectivos , Fatores de Risco , Índice de Gravidade de Doença , Bexiga Urinária Hiperativa/etiologia , Bexiga Urinária Hiperativa/fisiopatologia , Incontinência Urinária/etiologia , Incontinência Urinária/fisiopatologia
19.
Urologe A ; 51(3): 384-9, 2012 Mar.
Artigo em Alemão | MEDLINE | ID: mdl-22113548

RESUMO

BACKGROUND: The diagnostic options for persistent urinary incontinence following prostatectomy are limited despite incidence numbers of up to 40%. Perineal ultrasound, which is already well established in urogynecology to quantify urethral mobility, can also be used for the diagnostics of incontinence in men. The present study investigated whether there is a difference in reproducibility concerning the quantification of urethral mobility between men and women. MATERIAL AND METHODS: A total of 27 men and 27 women aged 65-85 years participated in the study. All underwent perineal ultrasound examination following standardized criteria under the three conditions of rest, contraction and a Valsalva maneuvre. Ultrasound images were taken under each condition and given to two independent examiners for evaluation. For all conditions it was recorded which of the three reference points for the quantification of urethral mobility, the urethra, internal urethral meatus and the base of the urinary bladder, could be assessed. The results were compared by means of a coefficient of agreement (p0) and the difference of the results between the two groups was validated for statistical significance using Student's t-test. RESULTS: At a t-value of 1.58 (p=0.154) there were no significant differences in the reproducibility in visualizing the three sonographic reference points, the urethra, internal urethral meatus and the base of the urinary bladder, between men and women. CONCLUSIONS: Using perineal ultrasound for quantification of urethral mobility in the diagnostics of incontinence in men after prostatectomy is just as reproducible in men as in women. For both sexes the technique is comfortable and pain-free due to the non-invasive nature. Perineal ultrasound is a cheap, non-invasive and reproducible diagnostic procedure which can be recommended for the evaluation of incontinence and the selection of a suitable surgical procedure also in men.


Assuntos
Períneo/diagnóstico por imagem , Incontinência Urinária por Estresse/diagnóstico por imagem , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Complicações Pós-Operatórias/diagnóstico por imagem , Prostatectomia , Sensibilidade e Especificidade , Fatores Sexuais , Ultrassonografia , Uretra/diagnóstico por imagem , Bexiga Urinária/diagnóstico por imagem
20.
Ultraschall Med ; 32 Suppl 2: E182-90, 2011 Dec.
Artigo em Alemão | MEDLINE | ID: mdl-22194048

RESUMO

PURPOSE: The aim of our study was to show how using contrast inversion extends the diagnostic value of perineal ultrasound, in particular with regard to paraurethral pathologies. MATERIALS AND METHODS: To assess the practical value of contrast inversion in the daily routine, 42 women with urinary incontinence underwent perineal ultrasound examination. Pictures were converted to contrast inversion and then checked for the visibility of sonographic reference points for urogynecological measurements (urethra, meatus urethrae internus, vesical base) by two independent evaluators both in B-mode and contrast inversion. Visibility was compared using a coefficient of agreement. The results were then tested for significance. In addition, in our clinical routine we detected several paraurethral pathologies (e. g. paraurethral abscess, glandula paraurethralis, urethral diverticulum), each being presented in B-mode and contrast inversion. RESULTS: There was no significant difference between contrast inversion and B-mode with regard to the reproducibility of visibility of the three sonographic reference points. Contrast inversion was superior for depicting paraurethral pathologies and postoperative anatomical findings. CONCLUSION: With respect to routine evaluation, the two modes do not reveal any significant difference. For the sonographic evaluation of paraurethral pathologies, contrast inversion provides better contour sharpness than B-mode, suggesting a higher diagnostic value for ambiguous anatomical settings. The nature of contrast inversion nevertheless facilitates misinterpretations and requires frequent comparison with B-mode pictures. In conclusion, we propose contrast inversion as an initial screen and a refinement to established diagnostic methods, such as MRI and voiding cysturethrography, not as their substitute.


Assuntos
Meios de Contraste/administração & dosagem , Interpretação de Imagem Assistida por Computador , Períneo/diagnóstico por imagem , Ultrassonografia/métodos , Uretra/diagnóstico por imagem , Doenças Uretrais/diagnóstico por imagem , Bexiga Urinária/diagnóstico por imagem , Incontinência Urinária/diagnóstico por imagem , Abscesso/diagnóstico por imagem , Adulto , Idoso , Feminino , Humanos , Imagem por Ressonância Magnética , Pessoa de Meia-Idade , Complicações Pós-Operatórias/diagnóstico por imagem , Sensibilidade e Especificidade , Resultado do Tratamento , Doenças Uretrais/cirurgia , Incontinência Urinária/cirurgia , Urodinâmica/fisiologia , Útero/diagnóstico por imagem , Vagina/diagnóstico por imagem
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