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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pain, dyspareunia, vaginal erosion, shrinkage and erosion into other organs nearly all industrial products have been withdrawn from the market in the meantime.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
3.
Urologe A ; 58(11): 1313-1323, 2019 Nov.
Artigo em Alemão | MEDLINE | ID: mdl-31659368

RESUMO

In this review article, the authors describe all relevant aspects of the new S2k guideline from the German Society of Urology (Deutschen Gesellschaft für Urologie, DGU) for the diagnosis and treatment of IC/PBS (interstitial cystitis/painful bladder syndrome). A list of necessary and optional examinations and the necessity of diagnosis of exclusion are summarized and evaluated. The treatment options listed (ranging from conservative, oral drug, and complementary medicine to interventional surgical procedures) also give the reader a good overview of the contents of the guideline and possible therapeutic approaches. Finally, the recommendations including consensus of the guideline group are also summarized in various information boxes.


Assuntos
Cistite Intersticial/diagnóstico , Cistite Intersticial/terapia , Guias de Prática Clínica como Assunto , Urologia/normas , Alemanha , Humanos , Dor , Exame Físico , Sociedades Médicas
4.
Urologe A ; 55(12): 1619-1633, 2016 Dec.
Artigo em Alemão | MEDLINE | ID: mdl-27885458

RESUMO

Differentiated non-invasive diagnostic procedures allow a discrimination between nocturnal enuresis and behavior-linked urinary incontinence in children with daytime symptoms, which are different entities of a pathological pediatric micturition syndrome. The article describes the diagnostic procedure as well as the therapeutic approach to all forms of micturition disorders in childhood. All behavioral, medical and biofeedback therapeutic methods according to the recently published S2k guidelines from the Association of the Scientific Medical Societies in Germany (AWMF) on enuresis and non-organic (functional) incontinence in children and adolescents are mentioned and discussed.


Assuntos
Enurese/diagnóstico , Enurese/terapia , Pediatria/normas , Incontinência Urinária/diagnóstico , Incontinência Urinária/terapia , Urologia/normas , Diagnóstico Diferencial , Medicina Baseada em Evidências/normas , Alemanha , Guias de Prática Clínica como Assunto , Resultado do Tratamento
5.
Urologe A ; 54(3): 368-72, 2015 Mar.
Artigo em Alemão | MEDLINE | ID: mdl-25391442

RESUMO

The use of botulinum toxin for the treatment of neurogenic detrusor overactivity was first described in 2000 and thereafter botulinum toxin has also been used in non-neurogenic overactive bladder. In current guidelines intravesical injection of onabotulinumtoxin A in refractory patients is recommended. Our aim is to provide some clinically relevant recommendations from the Working Group Urologische Funktionsdiagnostik und Urologie der Frau for diagnostics and treatment with onabotulinumtoxin A of patients with non-neurogenic overactive bladder.


Assuntos
Toxinas Botulínicas Tipo A/administração & dosagem , Guias de Prática Clínica como Assunto , Bexiga Urinária Hiperativa/tratamento farmacológico , Urologia/normas , Saúde da Mulher/normas , Administração Intravesical , Alemanha , Humanos
7.
Urologe A ; 50(7): 802-5, 2011 Jul.
Artigo em Alemão | MEDLINE | ID: mdl-21681456

RESUMO

Overactive-bladder syndrome is characterized by the symptoms pollakisuria, nocturia and urgency with and without urge incontinence. The primary diagnostic procedure includes noninvasive or minimally invasive techniques. Antimuscarinic drugs lead within the therapeutic cascade. Only after unsuccessful use of several antimuscarinics should further treatment options such as electromotive drug administration or infiltration of the detrusor muscle with botulinum toxin A be discussed. The presented review article tries to give an overview by including the existing head-to-head-studies in this field.


Assuntos
Antagonistas Colinérgicos/uso terapêutico , Noctúria/tratamento farmacológico , Bexiga Urinária Hiperativa/tratamento farmacológico , Incontinência Urinária de Urgência/tratamento farmacológico , Idoso , Toxinas Botulínicas Tipo A/uso terapêutico , Antagonistas Colinérgicos/efeitos adversos , Terapia Combinada , Feminino , Humanos , Pessoa de Meia-Idade , Antagonistas Muscarínicos/efeitos adversos , Antagonistas Muscarínicos/uso terapêutico , Noctúria/diagnóstico , Ensaios Clínicos Controlados Aleatórios como Assunto , Bexiga Urinária Hiperativa/diagnóstico , Urodinâmica/efeitos dos fármacos
8.
Urologe A ; 49(4): 498-503, 2010 Apr.
Artigo em Alemão | MEDLINE | ID: mdl-20376652

RESUMO

Urinary incontinence in men most commonly occurs after radical prostatectomy. Of these patients, 3-23% remain incontinent a year after prostatectomy. Data on conservative therapy for postoperative incontinence is contradictory. Nonetheless, conservative treatment strategies must generally be attempted before any operative technique. Early pelvic floor muscle training with or without biofeedback therapy and duloxetine seem to have a positive effect on continence. Further randomised controlled studies are necessary to accurately assess other conservative therapeutic options such as extracorporeal magnetic innervation and electrical stimulation therapy.


Assuntos
Complicações Pós-Operatórias/terapia , Prostatectomia , Incontinência Urinária por Estresse/terapia , Inibidores da Captação Adrenérgica/uso terapêutico , Biorretroalimentação Psicológica , Terapia Combinada , Cloridrato de Duloxetina , Terapia por Estimulação Elétrica , Terapia por Exercício , Humanos , Terapia de Campo Magnético , Masculino , Tiofenos/uso terapêutico
10.
Urologe A ; 48(5): 473-9, 2009 May.
Artigo em Alemão | MEDLINE | ID: mdl-19421797

RESUMO

Surgery is indicated after failure of conservative treatment modalities in women with urinary stress incontinence and/or urogenital prolapse. As postoperative success rates and patients' satisfaction rates are highly dependent on patient selection and correct indication, the preoperative diagnostic work-up is essential to identify risk factors to predict postoperative continence rates, possible side effects, or complications. In these cases, patients have to be not only informed about failures prior to surgery but also offered alternative treatment options.


Assuntos
Incontinência Urinária por Estresse/diagnóstico , Incontinência Urinária por Estresse/cirurgia , Prolapso Uterino/cirurgia , Feminino , Fidelidade a Diretrizes , Humanos , Complicações Pós-Operatórias/etiologia , Procedimentos Cirúrgicos Reconstrutivos , Incontinência Urinária por Estresse/etiologia , Urodinâmica/fisiologia , Prolapso Uterino/diagnóstico
13.
Urologe A ; 45 Suppl 4: 106-21, 2006 Sep.
Artigo em Alemão | MEDLINE | ID: mdl-16944079

RESUMO

Incontinence can be the result of impaired functioning of the detrusor muscle and/or the sphincter mechanism. For this reason, the pathomorphology and the pathophysiology should be documented before surgery, so that if it is not successful it is possible to deduce what alterations have been caused by an operation and the reason why the treatment has not been successful. Vaginal reconstruction of the pelvic floor following vaginal prolapse is a safe, effective surgical procedure, particularly for older women. Abdominal fixation of the vaginal stump through open or laparoscopic sacrocolpopexy gives long-lasting and anatomically favourable results especially for younger women who are sexually active, but is associated with a higher mortality rate. Incontinence treatment in men is itself gradually becoming accepted as a subspecialty. Pharmacological treatment that is used for urge incontinence takes the form of substances that relax or desensitize the detrusor (antimuscarinics, oestrogens, alpha-blockers, beta-mimetics, botulinum toxin A, resiniferatoxin, vinpocetin), while stress incontinence requires stimulation of the sphincter and pelvic floor (alpha-mimetics, oestrogens, duloxetin). Bladder function disturbances in children can be classified by noninvasive methods, but the therapy remains a difficult endurance test for the children, their parents and the doctor, often extending over years.


Assuntos
Incontinência Urinária/fisiopatologia , Incontinência Urinária/cirurgia , Urodinâmica/fisiologia , Adulto , Idoso , Animais , Toxinas Botulínicas Tipo A/uso terapêutico , Criança , Modelos Animais de Doenças , Terapia de Reposição de Estrogênios , Feminino , Humanos , Masculino , Adesão à Medicação , Antagonistas Muscarínicos/uso terapêutico , Resultado do Tratamento , Incontinência Urinária/classificação , Incontinência Urinária/tratamento farmacológico , Urodinâmica/efeitos dos fármacos
14.
Urologe A ; 45(7): 841-6, 2006 Jul.
Artigo em Alemão | MEDLINE | ID: mdl-16791628

RESUMO

Enuresis is one of the most frequent urinary symptoms in children. 80% suffer from primary enuresis nocturna. 20% have urinary incontinence with additional symptoms of frequency, urgency and daytime incontinence, which is also defined in children as overactive bladder in absence of urinary tract infections, neurological, anatomical or further local pathology (OAB in childhood). The underlying pathophysiology is a maturation arrest of the bladder control resulting in detrusor hyperactivity. In most of the cases the differentiation between enuresis and OAB is easily possible with non-invasive primary diagnostic procedures. Invasive diagnostic tools like video urodynamic studies may become necessary when first-line therapy fails. The treatment options comprise bladder training with timed voiding and drink protocols (urotherapy) as well as pharmacologic relaxation of detrusor instability by anticholinergic drugs.


Assuntos
Enurese/diagnóstico , Enurese/terapia , Bexiga Urinária Hiperativa/diagnóstico , Bexiga Urinária Hiperativa/terapia , Criança , Ensaios Clínicos como Assunto , Enurese/complicações , Humanos , Pediatria/métodos , Guias de Prática Clínica como Assunto , Padrões de Prática Médica , Resultado do Tratamento , Bexiga Urinária Hiperativa/complicações
17.
Urologe A ; 43(7): 778-86, 2004 Jul.
Artigo em Alemão | MEDLINE | ID: mdl-15156284

RESUMO

Functional bladder disorders are one of the most frequent urinary disorders in children. Today, we strictly differentiate enuresis from pediatric urinary incontinence. In most cases, these classifications will be achieved with non-invasive, primary diagnostic procedures. In monosymptomatic enuresis, further invasive examinations are not necessary. However, in pediatric urinary incontinence invasive diagnostic tools such as video-urodynamic studies are mandatory for a correct classification. Recently established guidelines on the diagnostic procedures for the evaluation of pediatric bladder disorders will help to standardize the diagnostic work-up.


Assuntos
Enurese/etiologia , Doenças da Bexiga Urinária/diagnóstico , Incontinência Urinária/etiologia , Criança , Diagnóstico Diferencial , Enurese/classificação , Enurese/diagnóstico , Feminino , Humanos , Masculino , Ultrassonografia , Doenças da Bexiga Urinária/classificação , Doenças da Bexiga Urinária/etiologia , Incontinência Urinária/classificação , Incontinência Urinária/diagnóstico , Urodinâmica/fisiologia , Gravação em Vídeo/instrumentação
18.
Urologe A ; 42(12): 1579-87, 2003 Dec.
Artigo em Alemão | MEDLINE | ID: mdl-14668985

RESUMO

In addition to cognitive failures, urinary incontinence is the central symptom in patients with demential syndromes. Cerebral atrophic processes with loss of cerebral bladder control result in the typical uninhibited bladder with urge syndrome and urge incontinence. In principle, all diagnostic and therapeutic options are available for those patients. However, the extent and invasivity of diagnostic as well as therapeutic procedures should individually be adapted to the patient's symptoms, age, physical and mental status. In most of the cases, non-invasive diagnostic procedures, with the bladder diary as the central diagnostic tool, are able to classify the bladder disorder. The patient's capability of active cooperation to the therapy and the prerequisites in nursing support determine the therapeutic strategies which are above all pharmacological relaxation of the detrusor, continence training programmes including behavioural modification and optimizing the patient's supply with pads. In most of the cases complete continence cannot be achieved. Therefore the primary aim of the therapy in patients with demential syndromes must be the guarantee of social continence which allows the patient an integration in his social environment.


Assuntos
Doença de Alzheimer/psicologia , Terapia Comportamental/métodos , Demência/psicologia , Bexiga Urinaria Neurogênica/diagnóstico , Bexiga Urinaria Neurogênica/terapia , Incontinência Urinária/diagnóstico , Incontinência Urinária/reabilitação , Doença de Alzheimer/complicações , Doença de Alzheimer/diagnóstico , Doença de Alzheimer/terapia , Demência/complicações , Demência/diagnóstico , Demência/terapia , Diagnóstico Diferencial , Humanos , Registros Médicos , Bexiga Urinaria Neurogênica/etiologia , Bexiga Urinaria Neurogênica/psicologia , Incontinência Urinária/etiologia , Incontinência Urinária/psicologia , Incontinência Urinária/terapia
19.
Urology ; 58(6): 887-92, 2001 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-11744452

RESUMO

OBJECTIVES: To investigate the therapeutic value of sacral neuromodulation in patients with neurogenic disorders in whom conservative treatment options were unsuccessful. Neurogenic disorders may result in various forms of lower urinary tract dysfunction. METHODS: Twenty-seven patients (19 women, 8 men) aged 18 to 63 years (mean 44.9 years) were subjected to percutaneous test stimulation of the sacral spinal nerves. Their urologic symptoms consisted of bladder storage failure (n = 15) due to detrusor hyperreflexia and/or bladder hypersensitivity, failure to empty due to detrusor areflexia (n = 11), and combined bladder hypersensitivity and detrusor areflexia (n = 1). Twelve patients (11 women and 1 man) underwent chronic sacral neuromodulation with unilateral electrode implantation into one of the dorsal S3 foramina. The follow-up was 89.3 months (range 13 to 126). RESULTS: Severe side effects were encountered in 2 patients (1 with infection and 1 with adverse sensation during stimulation) and moderate side effects in another 3 patients. In 1 patient, the implant had to be removed during the immediate postoperative period. In 3 patients, the implant was not effective. In 8 patients, the symptoms of lower urinary tract dysfunction were significantly attenuated (50% or more) for 54 months (range 11 to 96). After this period, all implants became ineffective, except one, which was still in use at the last follow-up visit. CONCLUSIONS: Unilateral chronic sacral neuromodulation using sacral foramen electrodes can be a valuable, but only temporary, treatment for neurogenic bladder dysfunction. The technique of chronic sacral neuromodulation should be refined to achieve the same and lasting results with implantation systems as achieved with preoperative test stimulation.


Assuntos
Terapia por Estimulação Elétrica/métodos , Bexiga Urinaria Neurogênica/terapia , Transtornos Urinários/terapia , Adolescente , Adulto , Eletrodos Implantados , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Sacro , Bexiga Urinaria Neurogênica/fisiopatologia
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