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1.
Sheng Wu Yi Xue Gong Cheng Xue Za Zhi ; 37(2): 211-218, 2020 Apr 25.
Artigo em Chinês | MEDLINE | ID: mdl-32329271

RESUMO

For those patients with refractory lower urinary tract dysfunction who are not well treated by traditional therapy such as behavior therapy and drug therapy, neuromodulation technologies have gradually become alternative treatments. Several neuromodulation technologies are also used in animal experimental and clinical scientific research by more and more scholars, in order to find more effective methods and mechanisms of treatment of lower urinary tract dysfunction. This article introduces the principle and advantages of common neuromodulation technologies, which focuses on the application in lower urinary tract dysfunction treatment, and analyzes the direction and the broad prospect of neuromodulation.

2.
Neurourol Urodyn ; 39(5): 1410-1416, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32282088

RESUMO

AIMS: To assess the urodynamic findings during the filling phase in neurogenic bladder patients with or without vesicoureteral reflux (VUR) who underwent sacral neuromodulation (SNM). METHODS: We retrospectively reviewed the records of 19 patients with neurogenic lower urinary tract dysfunction (NLUTD) who underwent SNM at our center from July 2018 to July 2019. Clinical data and video-urodynamic parameters were collected. VUR grading systems were used to evaluate upper urinary tract function. RESULTS: The mean test duration was 24 ± 8.2 days. The urodynamic evaluation showed a significant increase in the mean maximum cystometric capacity (136.3 ± 118.2 vs 216.5 ± 137.8 mL; P = .0071) and compliance (8.7 ± 8.52 vs18.3 + 16.47 mL/H2 O; P = .016), as well as a decrease in maximum intravesical pressure (57 ± 39.23 vs 36.58 ± 31.16 H2 O; P = .0064). In the voiding phase, none of the patients had automatic urination at the baseline and testing phases. In 8 of 19 patients who had detrusor overactivity (DO), the DO disappeared (four patients) or was delayed (four patients). The VUR in 3 of 12 ureter units disappeared. The grade of VUR or the volume before VUR improved in 8 ureter units, and the remaining 1 did not change significantly. An implant was performed in 16 cases. After permanent implantation, all patients needed intermittent catheterization to empty the bladder. CONCLUSIONS: This retrospective study indicates that SNM can improve the urinary storage function of the bladder in appropriate patients with NLUTD. For patients with VUR, SNM can cure or reduce VUR by improving DO and bladder compliance.

3.
Neuromodulation ; 2020 Mar 20.
Artigo em Inglês | MEDLINE | ID: mdl-32196813

RESUMO

OBJECTIVES: This study aimed to evaluate whether patients stratified by age have the same level of benefits after a sacral neuromodulation (SNM) procedure for refractory lower urinary tract dysfunction. MATERIALS AND METHODS: This retrospective study comprised 211 patients with refractory lower urinary tract dysfunction who had been treated with SNM and recruited from multiple medical centers across China. Patients were grouped according to age: <40 (n = 58), 40-64 (n = 94), and > 64 (n = 59) years. Data were compared using voiding diaries and subjective scores pre-operatively, post-implantation of a stage I tined lead, and during a short-term follow-up period postimplantation of a stage II implanted pulse generator. RESULTS: In all groups, voiding diary data and subjective scores improved significantly over different periods. Residual urine improved in the 40-64 and > 64-year-old age groups. Quality of life scores improved in the <40-year-old age group. Voiding diary data among age groups varied at baseline; however, average urinary frequency did not differ at the last follow-up. Urgency and sexual life scores differed at baseline and these differences had resolved at the last follow-up. O'Leary-Sant and Pelvic Pain and Urgency/Frequency Symptoms Scale scores did not differ at baseline; however, significant differences were observed at the last follow-up. CONCLUSIONS: SNM success is unrelated to age, and age alone should not be considered a limiting factor in SNM. For older patients, an overactive bladder appears a better indication for SNM treatment; however, further studies are required to confirm this finding.

4.
Artigo em Inglês | MEDLINE | ID: mdl-32207219

RESUMO

OBJECTIVES: To assess prevalence of urinary incontinence (UI), including urgency UI (UUI), stress UI (SUI) and mixed UI (MUI) in individuals aged ≥40 years in China, Taiwan and South Korea. METHOD: This was a post hoc analysis of a cross-sectional, questionnaire-based internet survey. Participants were asked questions relating to urinary symptoms, health-related quality of life (HRQoL) and mental health (using the HRQoL 12-item short form health survey mental health and physical domains, and the Hospital Anxiety and Depression Scale), visits to healthcare professionals (HCPs) for any reason or for urinary symptoms, treatments for urinary symptoms and treatment satisfaction. RESULTS: Of 8284 survey participants, 1818 (22%) reported any UI (men 17.3%, women 26.4%). MUI was the most prevalent (overall 9.7%, men 6.8%, women 12.6%) followed by SUI (overall 7.9%, men 5.1%, women 10.7%) and UUI (overall 4.3%, men 5.5%, women 3.2%). HRQoL, anxiety and depression scores were poor in all participants with UI; MUI was associated with the worst scores. Of the participants with UI, 46.9% visited HCPs for urinary symptoms (highest proportion [62.7%] among participants with MUI). Approximately 80% of participants with UI followed treatment, with prescribed medicine being the most common form (38.1%). Over half of participants (59.6%) were somewhat, very, or extremely satisfied with their treatment. MUI was associated with least satisfaction. CONCLUSION: UI was associated with substantial problems, including an adverse impact on HRQoL. Medication failed to satisfy many individuals with UI. Efforts to educate the public and physicians about the impact of UI could improve diagnosis and treatment rates.

5.
BMC Urol ; 20(1): 29, 2020 Mar 18.
Artigo em Inglês | MEDLINE | ID: mdl-32188426

RESUMO

BACKGROUND: The robot-assisted radical prostatectomy (RARP) has been widely applied in recent years; however, only a few studies are reported about long-term urinary continence after surgery. The present study aimed to examine the outcomes of continence rates (CRs) and determine the risk and protective factors of urinary continence in patients with prostate cancer (PCa) undergoing RARP. METHODS: This retrospective study included 650 patients treated with RARP with perioperative data and at least one year of follow-up from September 2009 to November 2017. Also, the preoperative, intraoperative, and postoperative parameters of the patients were analyzed. Continence was defined as no pad use. Early and late continence was defined as the return of urinary continence within 3 months and beyond 12 months post-surgery, respectively. CRs were examined from 1 to 48 months postoperatively. Logistic regression analysis evaluated the association between the predictive factors and urinary continence in the early and late stages. RESULTS: No significant difference was detected in the CR from 12 to 48 months postoperatively (P = 0.766). Logistic regression analysis proved that pelvic lymph node dissection (PLND) was a significant risk factor of urinary continence at 1 month. Nerve-sparing (NS) was a significant protective factor of urinary continence at 1, 3, and 6 months. Advanced age was an independent risk factor of urinary continence at 6, 12, and 24 months. Other variables were not statistically significant predictors of urinary continence. CONCLUSIONS: The current results demonstrated that CR gradually improved with time within 1 year and stabilized 1 year after the surgery. PLND, NS, and age were significant determinants of continence in the early and late stages, respectively. These parameters could be used for preoperative identification of patients at high risk and counseling about postoperative expectations for urinary continence.

6.
World J Urol ; 2019 Nov 11.
Artigo em Inglês | MEDLINE | ID: mdl-31712957

RESUMO

PURPOSE: To evaluate the long-term effect of using small intestinal submucosa (SIS) for bladder augmentation in patients with neurogenic bladder. MATERIALS AND METHODS: A total of 15 patients (age range 14-65 years; mean age 29.6 years) were enrolled in our study. The patients had poor bladder capacity and compliance caused by a neurogenic disorder requiring bladder augmentation. A small intestinal submucosa (SIS) cystoplasty was performed alone or in combination with ureter reimplantation. We prospectively followed the cohort to assess the urodynamics parameters, morphologic changes and patient satisfaction and evaluate the clinical benefit of the SIS procedure in long term. The surgical indications and complications were analyzed. RESULTS: The duration of follow-up ranged from 4.5 to 8.3 years (mean 6.3 years). Nine patients had expected long-term benefit, leading to an overall success rate of 60%. Two patients experienced immediate failure, and four patients slowed decrease in bladder capacity over time. Compared with the baseline data, there were significant increases in bladder capacity (163.5 ± 80.90-275.6 ± 159.5 ml, p < 0.05) and a significant decrease in maximum detrusor pressure (45.07 ± 29.03-17.60 ± 10.34 cmH2O, p < 0.05). Histologic examinations showed a complete conversion of SIS, leaving the urothelial lining and bladder wall containing muscular, vascular, and relatively thick connective tissue. Major complications included vesicoureteral reflux in five patients, bladder stone formation in one patient, and bladder perforation in one patient. CONCLUSION: Bladder augmentation with an SIS graft offers a partial long-term success rate in neurogenic bladder patients. This procedure cannot be recommended as a substitute for enterocystoplasty, especially in patients with severe upper urinary tract deterioration and/or bladder fibrosis.

7.
Int Neurourol J ; 23(2): 109-115, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31260610

RESUMO

PURPOSE: Sacral nerve stimulation has been used to treat overactive bladder. This study evaluated the effects of stimulation using different pulse widths on the inhibition of bladder overactivity by sacral nerve stimulation (SNM) in pigs. METHODS: Implant-driven stimulators were used to stimulate the S3 spinal nerve in 7 pigs. Cystometry was performed by infusing normal saline (NS) or acetic acid (AA). SNM at pulse widths of 64 µsec to 624 µsec was conducted at the intensity threshold at which observable perianal and/or tail movement was induced. Multiple cystometrograms were performed to determine the effects of different pulse widths on the micturition reflex. RESULTS: AA-induced bladder overactivity reduced the bladder capacity to 46.9%±7.1% of the NS control level (P<0.05). During AA infusion, SNM at 64 µsec, 204 µsec, and 624 µsec increased the bladder capacity to 126.1%±6.9%, 129.5%±7.3%, and 140.1%±7.6% of the AA control level (P<0.05). No significant differences were found among the results obtained using pulse widths of 64 µsec, 204 µsec, and 624 µsec (P>0.05). The actual intensity threshold varied from 0.7 to 8 V. The mean intensity threshold (T visual) for pulse widths of 64 µs, 204 µs, and 624 µs were 5.64±0.76 V, 3.11±0.48 V, and 2.52±0.49 V. T visual for pulse widths of 64 µsec was larger than the other two T visual for pulse widths of 204 µsec and 624 µsec (P<0.05). No significant differences were found among the T visual for pulse widths of 204 µsec and 624 µsec (P>0.05). CONCLUSION: This study indicated that different pulse widths could play a role in inhibiting bladder overactivity. It is not yet certain which pulse widths increased bladder capacity compared with AA levels, to minimize energy consumption and maintain patient comfort during stimulation, 204 µsec may be an appropriate pulse width for SNM.

8.
BMC Urol ; 19(1): 60, 2019 Jul 05.
Artigo em Inglês | MEDLINE | ID: mdl-31277635

RESUMO

BACKGROUND: The aim of this retrospective study was to evaluate the clinical efficacy and safety of botulinum toxin type A (BTX-A) injection into the urethral sphincter to treat patients with underactive bladder (UAB). METHODS: From September 2012 to December 2018, 35 patients with UAB who presented with dysuria were treated with BTX-A (Prosigne®, Lanzhou Biological Products, Lanzhou, China). All patients were evaluated using the International Continence Society standard for video-urodynamic examination before and 1 month after treatment. The index includes maximum urinary flow rate, detrusor leak point pressure, and maximum urethral pressure. Post-voiding residual urine volume was measured using ultrasound before, one and 3 months post injection. RESULTS: After 1 month of treatment, the maximum flow rate increased from 2.5 ± 1.1 ml/s to 6.6 ± 1.7 ml/s (P < 0. 05). The maximum urethral pressure decreased from 73.5 ± 5.8 cmH2o to 45.6 ± 4.3cmH2O (P < 0. 05). The detrusor leak point pressure decreased from 69.9 ± 20.7cmH2O to 26.3 ± 7.4cmH2O (P < 0. 01). Post-voiding residual urine decreased from 282.8 ± 134.2 ml to 125.0 ± 92.1 ml (P < 0. 01) but increased to 270.1 ± 129.0 ml 3 months post injection. Of the 35 patients, 57.1% (20/35) relied on clean intermittent catheterization (CIC) before injection, but 75.0% (15/20) of them could partly void 1 month after injection, and 25%(5/20) could void without CIC. Eight patients showed hydronephrosis before treatment; in three of them, hydronephrosis decreased slightly, while it resolved in two. All patients were followed for three to 6 months, and the effect lasted for about two to 3 months. No serious adverse events occurred in any patient. CONCLUSIONS: The results suggest that Prosigne® injection into the urethral sphincter is an effective, safe, and inexpensive way to treat UAB.


Assuntos
Toxinas Botulínicas Tipo A/administração & dosagem , Fármacos Neuromusculares/administração & dosagem , Uretra/efeitos dos fármacos , Bexiga Inativa/diagnóstico , Bexiga Inativa/tratamento farmacológico , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Resultado do Tratamento , Uretra/fisiologia , Bexiga Inativa/fisiopatologia
9.
Neurourol Urodyn ; 38(6): 1760-1766, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-31215070

RESUMO

AIM: The maximum urethral closure pressure (MUCPs) and functional urethral length (FUL) obtained with water-filled and air-charged catheters during urethral pressure profile (UPP) determination was compared in a single, blind, randomized, and prospective trial. METHODS: Thirty-three males with spinal cord injuries and neurogenic lower urinary tract dysfunction underwent UPP determinations using water-filled and air-charged catheters in random order; the patients were unaware of the catheter sequence. The variability of the same type of catheter and the agreement between the different types of catheters were compared. The Pearson correlation coefficient was used to check the correlation between the catheters and the Bland-Altman method was used to verify the agreement. RESULT: The intraclass correlation coefficients for MUCPs and FULs determined using water-filled and air-charged catheters were 0.89, 0.75, 0.94, and 0.78, respectively. The interclass correlation coefficients for MUCPs and FULs between the two catheters were 0.43 and 0.28, respectively. Bland-Altman plots suggested that the values measured by air-charged catheters were significantly higher than water-filled catheters (mean difference, 26.0 and 2.4 cmH2 O, respectively). There were wide 95% limits of agreement (-54.0 to 106.0 and -0.3 to 5.1 cmH 2 O, respectively) that exceeded the clinical range for differences in MUCP and FUL. CONCLUSION: Air-charged catheters usually give higher readings than water-filled catheters for UPP. Agreement between water-filled and air-charged catheters was not good. Nevertheless, the catheter type which is more relevant to the disease requires further study.


Assuntos
Sintomas do Trato Urinário Inferior/fisiopatologia , Uretra/fisiopatologia , Bexiga Urinaria Neurogênica/fisiopatologia , Cateteres Urinários , Urodinâmica , Adulto , Idoso , Humanos , Sintomas do Trato Urinário Inferior/diagnóstico , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Reprodutibilidade dos Testes , Método Simples-Cego , Traumatismos da Medula Espinal/complicações , Bexiga Urinaria Neurogênica/diagnóstico , Adulto Jovem
10.
Neurourol Urodyn ; 38(4): 1038-1043, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30843257

RESUMO

AIMS: We investigated the effects of sacral neuromodulation using the new six-contact electrode vs the four-contact electrode in pigs. METHODS: Randomly, a six-contact electrode was implanted in eight pigs in one side of the third sacral (S3) foramen, and a four-contact electrode was implanted in the other side using the same method. Using an external neurostimulator, the number of contact points (sensitive voltage ≤ 2 V) of both electrodes (SacralStim and InterStim systems) was calculated. Cystometry was performed by infusing normal saline or acetic acid. Then sacral neuromodulation with the SacralStim and InterStim systems was induced at a voltage at which we could observe perianal and/or tail movement. Multiple cystometrograms were performed to determine the effects of the two systems on the micturition reflex. RESULTS: The mean number of sensitive points of six-contact electrodes of the SacralStim system (2.63 ± 0.32) was higher than that of the quadripolar-lead electrodes of the InterStim system (1.38 ± 0.18), and the difference was statistically significant (P < 0.05). Acetic acid-induced bladder overactivity significantly reduced bladder capacity to 54.89% ± 4.7% of the normal saline control level. During acetic acid infusion, sacral neuromodulation with the SacralStim system suppressed bladder overactivity and significantly increased bladder capacity to 70.41% ± 5.4% of the normal saline control level, compared with the acetic acid level ( P < 0.05). Moreover, sacral neuromodulation with the InterStim system also significantly increased bladder capacity to 69.63% ± 5.3% of the normal saline control level, compared with the acetic acid level ( P < 0.05). No significant differences were found in the results obtained using the two systems ( P > 0.05). CONCLUSIONS: The six-contact electrode of the SacralStim system had more sensitive points (<2 V) than that of the quadripolar-lead electrode of InterStim system. Potentially, it has more postimplantation programming options and battery savings manifested by lower voltage will increase the longevity of the stimulator. Further studies of sacral neuromodulation with six-contact electrodes in clinical practice are needed.


Assuntos
Terapia por Estimulação Elétrica/métodos , Bexiga Urinária Hiperativa/terapia , Micção/fisiologia , Animais , Eletrodos , Feminino , Masculino , Reflexo/fisiologia , Sacro , Suínos
11.
World J Urol ; 37(11): 2481-2492, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-30809700

RESUMO

PURPOSE: The efficacy and safety of a novel remotely programmed BetterStim sacral neuromodulation (SNM) system was evaluated in patients with refractory overactive bladder (OAB) in a prospective, controlled, multicenter trial. METHODS: A total of 84 patients referred for SNM therapy from October 2015 to January 2018 were studied. Of the patients who qualified for implantation, 37 and 33 were randomly assigned to treatment and control groups, respectively. Patients in the treatment group underwent stimulation upon implantation, while stimulation was delayed in the control group for 3 months. Follow-up visits, consisting of voiding diary outcome, questionnaires regarding overactive bladder symptom score (OABSS) and quality of life were conducted at 1, 3, and 6-month post-implantation. RESULTS: Compared with the control group, subjects in the treatment group exhibited statistically significant improvement in OAB symptoms at 3 months. The overall success rate was achieved in 72% of the treatment group, compared with 12% of the control group at 3 months. At 6 months, there were no significant differences in key voiding diary variables between the two groups. Further, this study demonstrated sustained improvement in urinary symptom interference in OAB patients. In addition, nearly all patients expressed great satisfaction with the remote-programming methods. No serious adverse events occurred, and device-related adverse events rate was 12.86%. CONCLUSION: This clinical study demonstrates subjective and objective success of the BetterStim SNM system. Importantly, our data suggest that remote programming can be safely used as a viable option for the conventional programming with a high degree of patient satisfaction.


Assuntos
Terapia por Estimulação Elétrica/métodos , Telemedicina , Bexiga Urinária Hiperativa/terapia , Adulto , Idoso , Terapia por Estimulação Elétrica/efeitos adversos , Terapia por Estimulação Elétrica/instrumentação , Feminino , Humanos , Neuroestimuladores Implantáveis , Plexo Lombossacral , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Resultado do Tratamento
12.
Neurourol Urodyn ; 38(2): 653-659, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-30620102

RESUMO

AIMS: To compare the accuracy of using a bladder scanner to measure bladder volume through intermittent catheterization (IC) in patients and to introduce the Bladder Deformation Index (BDI) to develop a correction method. METHODS: Bladder volume was assessed by a nurse with the scanner. A second nurse catheterized the patient's bladder. A third nurse measured the urine volume in a 500-mL or 1000-mL graduated cylinder. RESULTS: Sixty one patients were included and 590 pairs of data were obtained. The mean bladder volume measured using a scanner and IC was (332.3 ± 156.1) mL and (339.1 ± 158.8) mL. The mean absolute difference was 30.8 mL. The correlation coefficient was 0.929. Patients were classified into 2 groups depending on whether they had undergone augmentation cystoplasty. The mean absolute difference was 109.2 and 20.4 mL. The correlation coefficient was 0.712 and 0.981. According to the BDI, bladders can be classified into 3 groups. The mean absolute difference was 21.9, 60.4, and 109.4 mL. The correlation coefficient was 0.970, 0.839, and 0.783. The linear regression equations of Grade I and Grade II were Y = 1.11X + 3.1 and Y = 0.76X + 161.5. CONCLUSIONS: The results showed that bladder shape plays a critical role in accuracy which is inversely associated with BDI. This degree of accuracy is sufficient; especially measurement adjusted using the linear regression equation in patients with high BDI. However, although the preliminary results of the study are promising, a large-scale prospective study should be needed to address the validation of the data in the future.


Assuntos
Ultrassonografia/métodos , Bexiga Urinária/diagnóstico por imagem , Adolescente , Adulto , Idoso , Criança , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Tamanho do Órgão , Estudos Prospectivos , Cateterismo Urinário , Adulto Jovem
13.
Neuromodulation ; 22(6): 730-737, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-30609180

RESUMO

PURPOSE: This five-year, retrospective, multicenter study evaluated the long-term safety and efficiency of sacral neuromodulation (SNM) in Chinese patients with urinary voiding dysfunction. PATIENTS AND METHODS: This is a Chinese national, multicenter, retrospective study that included 247 patients (51.2% female) who received an implantable pulse generator (IPG) (InterStim, Medtronic, Minneapolis, MN, USA) between 2012 and 2016. Success was considered if the initial ≥50% improvement in any of primary voiding diary variables persisted compared with baseline. The results were further stratified by identifying patients who showed >50% improvement and those although showed <50% improvement but still wanted to receive IPG; these data were collected and analyzed for general improvement. RESULTS: Following test stimulation, 187 patients (43%) declined implantation and 247 (57%) underwent implantation using InterStim®. Among 247 patients, 34 (13.7%) had overactive bladder (OAB), 59 (23.8%) had interstitial cystitis/bladder pain syndrome (IC/BPS), 47 (19%) had idiopathic urinary retention (IUR), and 107 (44.1%) had neurogenic bladder (NB). IPG efficiency rate for OAB, interstitial cystitis/bladder pain syndrome, idiopathic urinary retention, and neurogenic bladder were 42.5, 72.4, 51.6, and 58.8%, respectively. The mean duration of follow-up was 20.1 ± 12.8 months. CONCLUSIONS: SNM appears effective in the long term, with a total IPG implantation rate of approximately 57% (ranging between 42.5 and 72.4% depending on indication). Interstitial cystitis/bladder pain syndrome appear to be the best indication for stage I testing. Chinese neurogenic bladder patients are most inclined to choose SNM. SNM is relatively safe, with low postoperation adverse events of 16.1% and reoperation rate of 3.2% during the follow-up period.


Assuntos
Eletrodos Implantados , Sacro/inervação , Estimulação Elétrica Nervosa Transcutânea/métodos , Transtornos Urinários/epidemiologia , Transtornos Urinários/terapia , Adulto , Idoso , China/epidemiologia , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Sacro/fisiologia , Fatores de Tempo , Estimulação Elétrica Nervosa Transcutânea/instrumentação , Resultado do Tratamento , Transtornos Urinários/fisiopatologia
14.
Low Urin Tract Symptoms ; 11(1): 48-55, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-28967230

RESUMO

OBJECTIVE: The aim of the present study was to determine the prevalence of overactive bladder (OAB) in individuals aged ≥40 years in China, Taiwan, and South Korea. METHODS: The present cross-sectional population-representative Internet-based study investigated OAB symptoms in men and women aged ≥40 years using the overactive bladder symptom score. Additional instruments included the International Index of Erectile Function (men only) and the Sexual Quality of Life - Female (women only) questionnaires, as well as Patient Perception of Bladder Condition (PPBC). RESULTS: In all, 8284 individuals participated in the study. The prevalence of OAB was 20.8% overall (women 22.1%, men 19.5%) and increased significantly with age, from 10.8% in those aged 40-44 years to 27.9% in those aged >60 years (P = .001). The presence of comorbid conditions (e.g. neurological disease, diabetes) was associated with a significantly increased prevalence of OAB. Increasing symptom severity was associated with significantly worsening patient perception of bladder condition responses. Just under half (48%) of those with no OAB had no lower urinary tract symptoms (LUTS), whereas 88% of those with severe symptoms had all 3 LUTS (International Continence Society definition) symptom categories (voiding, post-micturition, and storage symptoms). Of those without OAB, 10% reported visiting healthcare professionals for urinary symptoms, compared with 64% of those with severe OAB symptoms (P = .001). Increased symptom severity was significantly associated with lower sexual quality of life in both men and women. CONCLUSIONS: OAB symptoms were found to affect 1 in 5 individuals aged ≥40 years in China, Taiwan, and South Korea, becoming more common with increasing age. The results suggest that many more individuals with OAB could benefit by consulting healthcare professionals.


Assuntos
Bexiga Urinária Hiperativa/epidemiologia , Adulto , Idoso , China/epidemiologia , Estudos Transversais , Feminino , Humanos , Sintomas do Trato Urinário Inferior/epidemiologia , Masculino , Pessoa de Meia-Idade , Prevalência , Qualidade de Vida , República da Coreia/epidemiologia , Taiwan/epidemiologia
15.
Low Urin Tract Symptoms ; 11(2): O78-O84, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-29527813

RESUMO

OBJECTIVE: Lower urinary tract symptoms (LUTS) in males can reduce patients' quality of life (QoL) and affect sexual function and satisfaction. Although this has been documented in the US, Canada, Germany, Italy, UK, and Sweden, data are limited on the effects of LUTS on QoL and sexual function in Asian men. The present subgroup analysis of an Internet-based survey correlated the incidence of male LUTS by severity and category with self-assessed QoL and sexual function and satisfaction measures. METHODS: Males aged ≥40 years were randomly selected from consumer survey panels in China, Taiwan, and South Korea. LUTS were defined using the International Continence Society (ICS) 2002 symptom definitions; symptom severity was assessed by the International Prostate Symptom Score (IPSS). The effect of LUTS on QoL was assessed using Patient Perception of Bladder Condition (PPBC) and IPSS QoL scores. Sexual function and satisfaction were assessed using the International Index of Erectile Function (IIEF). RESULTS: Men with moderate-to-severe LUTS and overlap of voiding, storage, and post-micturition symptom categories reported dissatisfaction with their QoL and sexual function. LUTS severity was negatively correlated with IIEF scores. Overlap of LUTS categories had a greater effect on QoL and sexual satisfaction than the incidence of just 1 LUTS. CONCLUSION: The findings of the present study suggest that LUTS is prevalent in >60% of Asian males aged ≥40 years and is associated with reduced QoL and sexual function, particularly in those with overlap of LUTS categories and greater symptom severity.


Assuntos
Sintomas do Trato Urinário Inferior/complicações , Qualidade de Vida/psicologia , Comportamento Sexual , China/epidemiologia , Humanos , Incidência , Sintomas do Trato Urinário Inferior/epidemiologia , Sintomas do Trato Urinário Inferior/psicologia , Masculino , Pessoa de Meia-Idade , República da Coreia/epidemiologia , Índice de Gravidade de Doença , Comportamento Sexual/fisiologia , Comportamento Sexual/psicologia , Disfunções Sexuais Fisiológicas/epidemiologia , Disfunções Sexuais Fisiológicas/etiologia , Taiwan/epidemiologia
16.
Int Urol Nephrol ; 50(12): 2179-2186, 2018 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-30302665

RESUMO

PURPOSE: To explore the effects of electrical stimulation of the sacral dorsal root ganglion (DRG) on bladder reflexes in α-chloralose-anesthetized cats. METHODS: Bladder activity was recorded under isovolumetric conditions. A pair of hook electrodes was placed in the right S1 and S2 DRGs of 12 adult male cats, which were stimulated over a range of frequencies (0.25-30 Hz) and at threshold intensity. RESULTS: Stimulation of S1 and S2 DRGs inhibited or evoked bladder contractions under isovolumetric conditions depending on the frequency of stimulation in nine cats. Stimulation at low frequencies (3-7 Hz on S1 or S2 DRG) significantly inhibited isovolumetric rhythmic bladder contractions, while excitatory effects were observed at two frequency ranges, including lower frequencies (0.25-1.5 Hz on S1 DRG and 0.25-1.25 Hz on S2 DRG) and middle frequencies (15-30 Hz on S1 and S2 DRGs). CONCLUSIONS: These results suggest that the sacral DRG might be a potential valuable target for electrical stimulation in the treatment of bladder dysfunction.


Assuntos
Estimulação Elétrica , Gânglios Espinais/fisiologia , Contração Muscular , Reflexo , Bexiga Urinária/fisiologia , Animais , Gatos , Masculino , Sacro
17.
Medicine (Baltimore) ; 97(34): e11554, 2018 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-30142751

RESUMO

Lower urinary tract symptoms (LUTS) are reported to affect over half of all adults, and they are associated with significantly impaired quality of life (QOL). We performed a population-based study to evaluate the overall prevalence and impact of LUTS including overactive bladder (OAB) in adults aged ≥40 years in China.Adults aged ≥40 years were eligible to participate in this internet-based survey, provided that they had the ability to access the internet, to use a computer and to read the local language. The survey contained questions relating to International Continence Society (ICS) symptom definitions, the International Prostate Symptom Score (IPSS) and the Overactive Bladder Symptom Score (OABSS). The primary study objective was to determine the prevalence of LUTS using the ICS 2002 symptom definition.Among the 4136 respondents, 2080 (50.3%) were men and 1347 (32.6%) were aged ≥60 years. LUTS prevalence according to ICS criteria was 60.3% in men and 57.7% in women. All 3 ICS symptom groups (voiding, storage, and postmicturition) were present in 22.8% of women and 24.2% of men, making this the most common combination of ICS symptom groups. The most bothersome symptoms were terminal dribble and nocturia. According to IPSS scores, 32.9% of participants had at least moderate symptoms. The prevalence of OAB was 23.9%. The presence of LUTS-particularly all 3 ICS symptom groups-was associated with reduced sexual QOL in women, reduced satisfaction with erectile function in men, higher anxiety and depression scores, and reduced health-related QOL (physical health and mental health domains). The overall percentage of participants with LUTS visiting healthcare professionals for urinary symptoms was 38%.In conclusion, LUTS affect the majority of adults aged ≥40 years in China, and prevalence increases with increasing age. LUTS are associated with impaired QOL and mental health, but fewer than half of individuals in China with LUTS seek healthcare for their symptoms. There is therefore a need to improve awareness and treatment of the condition.ClinicalTrials.gov identifier: NCT02618421.


Assuntos
Sintomas do Trato Urinário Inferior/epidemiologia , Qualidade de Vida/psicologia , Bexiga Urinária Hiperativa/epidemiologia , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , China/epidemiologia , Estudos Transversais , Feminino , Humanos , Sintomas do Trato Urinário Inferior/complicações , Sintomas do Trato Urinário Inferior/psicologia , Masculino , Pessoa de Meia-Idade , Prevalência , Inquéritos e Questionários , Bexiga Urinária Hiperativa/etiologia , Bexiga Urinária Hiperativa/psicologia
18.
Neurourol Urodyn ; 37(8): 2462-2469, 2018 11.
Artigo em Inglês | MEDLINE | ID: mdl-29862555

RESUMO

AIM: To examine the roles of opioid receptors in the inhibition of nociceptive and nonnociceptive bladder reflexes by sacral dorsal root ganglion (DRG) stimulation in cats. METHODS: Hook electrodes were placed in the right S1 and S2 DRG of cats. The bladders were infused with physiologic saline or 0.25% acetic acid (AA). Naloxone (0.1, 0.3, and 1 mg/kg), an opioid receptor antagonist, was administered intravenously. S1 or S2 DRG stimulation was applied before and after administering the drug. Multiple cystometrograms were performed to determine the effects of DRG stimulation and opioid receptors on the micturition reflex under nociceptive and non-nociceptive conditions. RESULTS: AA significantly (P < 0.01) reduced bladder capacity (BC). DRG stimulation at threshold (T) and 1.5 T significantly increased BC of the saline control under nociceptive and non-nociceptive conditions. When saline was infused, naloxone (0.1-1 mg/kg) significantly (P < 0.01) reduced BC; however, naloxone did not change BC during AA irritation. During saline infusion, naloxone (0.3 and 1 mg/kg) partly blocked S1 DRG stimulation-induced inhibition but had only a slight effect on S2 DRG stimulation. During AA infusion, naloxone (0.3 and 1 mg/kg) only partially blocked S1 DRG stimulation at T intensity but not during 1.5 T stimulation. However, no doses of naloxone significantly affected S2 DRG stimulation. CONCLUSION: Opioid receptors play a role in sacral DRG stimulation on non-nociceptive condition but are not involved in the inhibitory effect of stimulation in nociceptive conditions.


Assuntos
Gânglios Espinais/fisiopatologia , Nociceptores/fisiologia , Receptores Opioides/fisiologia , Animais , Gatos , Estimulação Elétrica , Eletrodos Implantados , Feminino , Masculino , Naloxona/farmacologia , Antagonistas de Entorpecentes/farmacologia , Dor/fisiopatologia , Reflexo/efeitos dos fármacos , Micção/efeitos dos fármacos
19.
World J Urol ; 36(11): 1853-1862, 2018 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-29796775

RESUMO

PURPOSE: To examine the prevalence, symptomatology, and risk factors for nocturia using data from an internet-based questionnaire conducted in China, South Korea, and Taiwan. METHODS: Data from a cross-sectional, population-representative, internet-based study conducted among men and women aged ≥ 40 years were analysed post hoc. Nocturia prevalence and bother were analysed by sex and age group, and with regard to comorbid conditions and lower urinary tract symptoms (LUTS). Multivariate and univariate logistic regression models to identify risk factors for nocturia were constructed, with nocturia involving ≥ 2 nocturnal voids as the dependent variable. RESULTS: Among the 8284 participants, the prevalence of nocturia involving ≥ 1, ≥ 2, or ≥ 3 voids was slightly higher for women (76.1, 37.3, and 17.5%, respectively) compared with men (74.0, 34.5, and 15.5%, respectively). The prevalence and associated bother of nocturia increased with age. Greater proportions of patients with comorbid conditions or wet/more severe overactive bladder syndrome (OAB) experienced nocturia than those without. Multivariate analysis identified that female sex, age > 60 years, diabetes, cardiac disease, body mass index, International Prostate Symptom Score (IPSS) voiding score, stress urinary incontinence, wet OAB, and Hospital Anxiety And Depression Scale (HADS) anxiety score were associated with ≥ 2 nocturnal voids. Hypertension was associated with ≥ 2 nocturnal voids in women but not men, and alcohol consumption in men but not women. CONCLUSIONS: Nocturia is a common and bothersome condition affecting a large proportion of men and women aged ≥ 40 years in China, South Korea, and Taiwan. Factors associated with nocturia included age, sex, comorbid conditions, and LUTS. TRIAL REGISTRATION: This study is registered at ClinicalTrials.gov: NCT02618421.


Assuntos
Noctúria/epidemiologia , Inquéritos e Questionários , Bexiga Urinária Hiperativa/epidemiologia , Incontinência Urinária por Estresse/epidemiologia , Adulto , Distribuição por Idade , Idoso , China/epidemiologia , Estudos Transversais , Feminino , Humanos , Modelos Logísticos , Sintomas do Trato Urinário Inferior/diagnóstico , Sintomas do Trato Urinário Inferior/epidemiologia , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Noctúria/diagnóstico , Prevalência , Qualidade de Vida , República da Coreia/epidemiologia , Medição de Risco , Índice de Gravidade de Doença , Distribuição por Sexo , Taiwan/epidemiologia , Bexiga Urinária Hiperativa/diagnóstico , Incontinência Urinária por Estresse/diagnóstico
20.
J Ultrasound Med ; 37(11): 2647-2656, 2018 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-29608019

RESUMO

OBJECTIVES: This study aimed to compare urodynamic studies (UDS) and perineal ultrasonography (US) for the assessment of mixed urinary incontinence (MUI) in women in China. METHODS: Adult women with MUI and healthy control participants were enrolled from 2 centers in China (Zhejiang and Beijing) between September 2010 and April 2017. Baseline clinical characteristics were recorded. The MUI type was categorized by the King's Health Questionnaire: stress-predominant, urge-predominant, or equal predominance. Urodynamic studies were performed, followed within 1 week by perineal US. Tolerability of the investigations was compared by a 3-point scale: better than, worse than, or equal to. RESULTS: For UDS parameters, compared with controls, the urge-predominant MUI group had a lower maximal flow rate, smaller bladder volume, higher detrusor pressure at urethral opening, higher detrusor pressure at maximal flow, and higher incidence of detrusor overactivity; the stress-predominant MUI group had a lower maximal urethral closure pressure and functional urethral length; and the equal MUI group had a higher detrusor pressure at maximal flow and lower maximal urethral closure pressure (P < .05). For US parameters, compared with controls, the stress-predominant MUI group had a greater dynamic posterior urethral angle, dynamic angle of urethral inclination, descent of the bladder neck, and dynamic pubourethral distance; the urge-predominant MUI group had a greater detrusor thickness; and the equal MUI group had a greater descent of the bladder neck (P < .05). All UDS and US parameters differed significantly between the stress-predominant and urge-predominant groups (P < .05). The dynamic angle of urethral inclination, descent of the bladder neck, and dynamic pubourethral distance were inversely correlated with detrusor pressure at maximal flow and functional urethral length, while detrusor wall thickness was positively correlated with detrusor pressure at maximal flow and functional urethral length. Perineal US was better tolerated than UDS. CONCLUSIONS: Perineal US parameters show good correlations with UDS parameters. Ultrasonography is better tolerated than UDS and provides additional morphologic data. Perineal US could facilitate the diagnosis of urge-predominant MUI.


Assuntos
Bexiga Urinária/diagnóstico por imagem , Bexiga Urinária/fisiopatologia , Incontinência Urinária/diagnóstico por imagem , Incontinência Urinária/fisiopatologia , Urodinâmica/fisiologia , Adulto , Idoso , China , Feminino , Humanos , Pessoa de Meia-Idade , Estudos Prospectivos , Método Simples-Cego , Inquéritos e Questionários , Ultrassonografia , Incontinência Urinária/diagnóstico
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