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1.
Rinsho Shinkeigaku ; 60(11): 752-757, 2020 Nov 27.
Artigo em Japonês | MEDLINE | ID: mdl-33115989

RESUMO

Surfer's myelopathy is non-traumatic spinal cord injury which develops in beginner surfers. The patient was a 17-year-old female who developed severe paraplegia with bilateral sensory dysfunction below the groin and bladder/rectal dysfunctions after her first surfing lesson. A spinal-cord MRI performed six hours after onset revealed an intramedullary hyperintensity area from T8 to the conus medullaris on the T2 weighted images. Expansion of this hyperintensity area was observed on Day 3 and showed a reduction on Day 8. After providing intravenous methylpredonisolone, intravenous glycerol and intravenous edaravone, motor function and bladder/rectal functions began to improve after approximately three weeks. In this study, the expansion of the lesion in the early stages of the disease course was observed by sequential spinal MRI. Furthermore, a time lag between improvement according to imaging and improvement in symptoms was also observed.


Assuntos
Traumatismos em Atletas/diagnóstico por imagem , Imagem de Tensor de Difusão/métodos , Traumatismos da Medula Espinal/diagnóstico por imagem , Esportes Aquáticos , Adolescente , Traumatismos em Atletas/complicações , Traumatismos em Atletas/tratamento farmacológico , Edaravone/administração & dosagem , Feminino , Glicerol/administração & dosagem , Humanos , Infusões Intravenosas , Metilprednisolona/administração & dosagem , Paraplegia/tratamento farmacológico , Paraplegia/etiologia , Doenças Retais/tratamento farmacológico , Doenças Retais/etiologia , Doenças da Medula Espinal , Traumatismos da Medula Espinal/complicações , Traumatismos da Medula Espinal/tratamento farmacológico , Fatores de Tempo , Resultado do Tratamento , Doenças da Bexiga Urinária/tratamento farmacológico , Doenças da Bexiga Urinária/etiologia
2.
BMC Surg ; 20(1): 161, 2020 Jul 21.
Artigo em Inglês | MEDLINE | ID: mdl-32693785

RESUMO

BACKGROUND: Hernia mesh erosion into the urinary bladder is a rare complication of hernioplasty, and mesh immigration is the most probable pathophysiology. There is no report describing mesh erosion induced by fixing tacks in inguinal hernia repair. CASE PRESENTATION: A 37-year-old man was admitted to our hospital with frequency, urgency and odynuria for 3 months. He received open right inguinal hernia repair in September 2014, and right laparoscopic hernioplasty for recurrence of the inguinal hernia in May 2015. In February 2019, he underwent a day-case transurethral cystoscopic operation for urethral and bladder stones. Cystoscopy revealed the existence of bladder stones and part of the eroded mesh on the right anterior wall, for which an open partial cystectomy was performed. The patient was followed up for 3 months postoperatively, during which no further mesh erosion or stone recurrence was detected by cystoscopy. CONCLUSION: This is the first case report describing mesh erosion into the urinary bladder by fixing tacks following laparoscopic inguinal hernia repair. In such a case, the eroded mesh and tacks need to be removed completely, but the effectiveness of a single transurethral procedure needs to be verified in more cases.


Assuntos
Hérnia Inguinal , Herniorrafia/efeitos adversos , Telas Cirúrgicas/efeitos adversos , Suturas/efeitos adversos , Doenças da Bexiga Urinária/cirurgia , Bexiga Urinária/lesões , Adulto , Hérnia Inguinal/cirurgia , Herniorrafia/instrumentação , Humanos , Laparoscopia/efeitos adversos , Masculino , Bexiga Urinária/cirurgia , Cálculos da Bexiga Urinária/etiologia , Cálculos da Bexiga Urinária/cirurgia , Doenças da Bexiga Urinária/etiologia
3.
Khirurgiia (Mosk) ; (6): 121-124, 2020.
Artigo em Russo | MEDLINE | ID: mdl-32573544

RESUMO

High incidence of iatrogenic lesions of genitourinary system (during gynecological and oncogynecological operations) followed by urogenital fistulae and great percentage of recurrences after reconstructive surgery justify the need to improve surgical reconstruction of genitourinary organs and urine discharge in these patients. Stage-by-stage surgical treatment of a patient with extensive vesicovaginal fistula is reported in the article. A defect was associated with loss of 2/3 of the volume of tissues of adjacent organs. Multiple operations in various clinics were failed to eliminate the fistula and resulted decrease of bladder capacity up to microcystis.


Assuntos
Intestino Delgado/transplante , Procedimentos Cirúrgicos Reconstrutivos/métodos , Bexiga Urinária/cirurgia , Vagina/cirurgia , Fístula Vesicovaginal/cirurgia , Feminino , Humanos , Tamanho do Órgão , Bexiga Urinária/patologia , Doenças da Bexiga Urinária/etiologia
4.
Sci Rep ; 10(1): 10030, 2020 06 22.
Artigo em Inglês | MEDLINE | ID: mdl-32572272

RESUMO

The effects of human amniotic fluid stem cell (hAFSC) transplantation on bladder function and molecular changes in spinal cord-injured (SCI) rats were investigated. Four groups were studied: sham and SCI plus phosphate-buffered saline (SCI + PBS), human embryonic kidney 293 (HEK293) cells, and hAFSCs transplantation. In SCI + PBS rat bladders, cystometry showed increased peak voiding pressure, voiding volume, bladder capacity, residual volume, and number of non-voiding contractions, and the total elastin/collagen amount was increased but collagen concentration was decreased at days 7 and 28. Immunoreactivity and mRNA levels of IGF-1, TGF-ß1, and ß3-adrenoceptor were increased at days 7 and/or 28. M2 immunoreactivity and M3 mRNA levels of muscarinic receptor were increased at day 7. M2 immunoreactivity was increased, but M2/M3 mRNA and M3 immunoreactivity levels were decreased at day 28. Brain derived-neurotrophic factor mRNA was increased, but immunoreactivity was decreased at day 7. HEK293 cell transplantation caused no difference compared to SCI + PBS group. hAFSCs co-localized with neural cell markers and expressed BDNF, TGF-ß1, GFAP, and IL-6. The present results showed that SCI bladders released IGF-1 and TGF-ß1 to stimulate elastin and collagen for bladder wall remodelling, and hAFSC transplantation improved these changes, which involved the mechanisms of BDNF, muscarinic receptors, and ß3-adrenoceptor expression.


Assuntos
Líquido Amniótico/citologia , Traumatismos da Medula Espinal/complicações , Transplante de Células-Tronco/métodos , Doenças da Bexiga Urinária/etiologia , Animais , Colágeno/metabolismo , Elastina/metabolismo , Feminino , Células HEK293/transplante , Humanos , Microscopia Confocal , Ratos , Ratos Sprague-Dawley , Reação em Cadeia da Polimerase em Tempo Real , Bexiga Urinária/metabolismo , Doenças da Bexiga Urinária/fisiopatologia , Doenças da Bexiga Urinária/terapia
5.
Neurourol Urodyn ; 39(5): 1345-1354, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32394603

RESUMO

AIMS: We examined the time course of urodynamic changes and the effect of the short or long-term inhibition of brain-derived neurotrophic factor (BDNF) from the early phase after spinal cord injury (SCI) in mice. METHODS: The spinal cord of female C57BL/6N mice was completely transected. We examined filling cystometry and bladder BDNF levels at 10, 20, and 30 days after SCI, with an additional day-5 measurement of BDNF. In a separate group of mice, anti-BDNF antibody (Ab) (10 µg/kg/h) was subcutaneously administered using osmotic pumps from day 3 after SCI, and single-filling cystometry was performed at 10 and 30 days (7 and 27 days of treatment, respectively) after SCI. RESULTS: Compared to spinal intact mice, bladder mucosal BDNF was increased at each time point after SCI with the maximal level at day 5 after SCI. Voiding efficiency was lower at each time point after SCI than that of spinal intact mice. The number of non-voiding contractions (NVC) during bladder filling was gradually increased with time. In both 10- and 30-day SCI groups treated with anti-BDNF Ab, voiding efficiency was improved, and the duration of notch-like intravesical pressure reductions during voiding bladder contractions was prolonged. The number of NVC was significantly decreased only in 30-day SCI mice with 27-day anti-BDNF treatment. CONCLUSIONS: Overexpression of BDNF is associated with the deterioration of voiding efficiency after SCI. The early-started, long-term inhibition of BDNF improved voiding dysfunction and was also effective to reduce the later-phase development of detrusor overactivity after SCI.


Assuntos
Anticorpos/administração & dosagem , Fator Neurotrófico Derivado do Encéfalo/antagonistas & inibidores , Traumatismos da Medula Espinal/complicações , Doenças da Bexiga Urinária/tratamento farmacológico , Bexiga Urinária/metabolismo , Micção/efeitos dos fármacos , Urodinâmica/efeitos dos fármacos , Animais , Fator Neurotrófico Derivado do Encéfalo/metabolismo , Feminino , Camundongos , Camundongos Endogâmicos C57BL , Traumatismos da Medula Espinal/tratamento farmacológico , Traumatismos da Medula Espinal/metabolismo , Traumatismos da Medula Espinal/fisiopatologia , Bexiga Urinária/efeitos dos fármacos , Bexiga Urinária/fisiopatologia , Doenças da Bexiga Urinária/etiologia , Doenças da Bexiga Urinária/metabolismo , Doenças da Bexiga Urinária/fisiopatologia
6.
Anesthesiology ; 133(1): 64-77, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32304405

RESUMO

BACKGROUND: Catheter-related bladder discomfort occurs because of involuntary contractions of the bladder smooth muscle after urinary catheterization. Magnesium is associated with smooth muscle relaxation. This study hypothesized that among patients having transurethral resection of bladder tumor, magnesium will reduce the incidence of postoperative moderate-to-severe catheter-related bladder discomfort. METHODS: In this double-blind, randomized study, patients were randomly allocated to the magnesium group (n = 60) or the control group (n = 60). In magnesium group, a 50 mg/kg loading dose of intravenous magnesium sulfate was administered for 15 min, followed by an intravenous infusion of 15 mg · kg · h during the intraoperative period. Patients in the control group similarly received normal saline. The primary outcome was the incidence of catheter-related bladder discomfort above a moderate grade at 0 h postoperatively. None, mild, moderate, and severe catheter-related bladder discomfort at 1, 2, and 6 h postoperatively, patient satisfaction, and magnesium-related adverse effects were also assessed. RESULTS: The incidence of catheter-related bladder discomfort above a moderate grade at 0 h postoperatively was significantly lower in the magnesium group than in the control group (13 [22%] vs. 46 [77%]; P < 0.001; relative risk = 0.283; 95% CI, 0.171 to 0.467; absolute risk reduction = 0.55; number needed to treat = 2); similar results were observed for catheter-related bladder discomfort above a moderate grade at 1 and 2 h postoperatively (5 [8%] vs. 17 [28%]; P = 0.005; relative risk = 0.294; 95% CI, 0.116 to 0.746; and 1 [2%] vs. 14 [23%]; P < 0.001; relative risk = 0.071; 95% CI, 0.010 to 0.526, respectively). Patient satisfaction on a scale from 1 to 7 was significantly higher in the magnesium group than in the control group (5.1 ± 0.8 vs. 3.5 ± 1.0; P < 0.001; 95% CI, 1.281 to 1.919). Magnesium-related adverse effects were not significantly different between groups. CONCLUSIONS: Magnesium reduced the incidence of catheter-related bladder discomfort above a moderate grade and increased patient satisfaction among patients having transurethral resection of bladder tumor.


Assuntos
Sulfato de Magnésio/uso terapêutico , Complicações Pós-Operatórias/tratamento farmacológico , Doenças da Bexiga Urinária/tratamento farmacológico , Neoplasias da Bexiga Urinária/cirurgia , Procedimentos Cirúrgicos Urológicos , Administração Intravenosa , Idoso , Método Duplo-Cego , Feminino , Humanos , Sulfato de Magnésio/administração & dosagem , Masculino , Pessoa de Meia-Idade , Relaxamento Muscular/efeitos dos fármacos , Dor Pós-Operatória , Satisfação do Paciente , Comportamento de Redução do Risco , Resultado do Tratamento , Doenças da Bexiga Urinária/etiologia , Neoplasias da Bexiga Urinária/complicações , Cateterismo Urinário/efeitos adversos
9.
J Neurol ; 267(2): 369-379, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31646384

RESUMO

Hereditary spastic paraplegias (HSP) share as cardinal feature progressive spastic gait disorder. SPG4 accounts for about 25% of cases and is caused by mutations in the SPAST gene. Although HSP is an upper motor neuron disease, the relevance of non-motor symptoms is increasingly recognized because of the potential response to treatment. Our study sets out to evaluate non-motor symptoms and their relevance with regard to health-related quality of life. In 118 genetically confirmed SPG4 cases and age- and gender-matched controls, validated questionnaires were used to evaluate fatigue, depression, pain, and restless legs syndrome. In addition, self-reported medical information was collected concerning comorbidities and bladder, bowel, and sexual dysfunction. In a sub-study, cognition was evaluated using the CANTAB® test-battery and the Montreal Cognitive Assessment in 26 SPG4 patients. We found depression and pain to be significantly increased. The frequency of restless legs syndrome varied largely depending on defining criteria. There were no significant deficits in cognition as examined by CANTAB® despite a significant increase in self-reported memory impairment in SPG4 patients. Bladder, sexual, and defecation problems were frequent and seemed to be underrecognized in current treatment strategies. All identified non-motor symptoms correlated with health-related quality of life, which was reduced in SPG4 compared to controls. We recommend that clinicians regularly screen for depression, pain, and fatigue and ask for bladder, sexual, and defecation problems to recognize and treat non-motor symptoms accordingly to improve quality of life in patients with SPG4.


Assuntos
Paraplegia/fisiopatologia , Paraplegia/terapia , Paraplegia Espástica Hereditária/fisiopatologia , Paraplegia Espástica Hereditária/terapia , Adulto , Idoso , Transtornos Cognitivos/etiologia , Transtornos Cognitivos/psicologia , Depressão/etiologia , Depressão/psicologia , Fadiga/etiologia , Fadiga/psicologia , Incontinência Fecal/etiologia , Feminino , Humanos , Masculino , Transtornos da Memória/etiologia , Testes de Estado Mental e Demência , Pessoa de Meia-Idade , Dor/etiologia , Paraplegia/psicologia , Qualidade de Vida , Síndrome das Pernas Inquietas/etiologia , Síndrome das Pernas Inquietas/psicologia , Autorrelato , Disfunções Sexuais Fisiológicas/etiologia , Paraplegia Espástica Hereditária/psicologia , Doenças da Bexiga Urinária/etiologia , Adulto Jovem
10.
Int J Impot Res ; 32(1): 122-125, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31024114

RESUMO

Explantation of an inflatable penile prosthesis (IPP) reservoir in the setting of acute infection can be challenging. We identified three such cases of infection and simultaneous extraction of multiple reservoirs among patients with the most recent prosthetic surgeries performed between March 2016 and November 2018. These cases were reviewed with particular emphasis on preoperative and operative management. All three patients underwent successful simultaneous explantation of all retained hardware with subsequent clinical improvement in their clinical status. Prior to surgery, none of the patients were aware of the presence of more than one reservoir. All three patients recovered well post operatively. A subset of prosthetics patients have undergone multiple implant procedures at various sites. Due to the importance of retrieving all foreign material in the setting of acute infection, the authors advocate for a low threshold to obtain cross-sectional imaging to identify the tissue plane and laterality of any retained components, with particular emphasis on creating an operative plan for reservoir retrieval.


Assuntos
Remoção de Dispositivo , Implante Peniano/métodos , Prótese de Pênis/efeitos adversos , Idoso , Humanos , Masculino , Pessoa de Meia-Idade , Desenho de Prótese , Falha de Prótese , Doenças da Bexiga Urinária/etiologia
11.
Neurourol Urodyn ; 39(2): 586-593, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31868966

RESUMO

AIMS: To determine the effects of early sacral neuromodulation (SNM) and pudendal neuromodulation (PNM) on lower urinary tract (LUT) function, minipigs with complete spinal cord injury (cSCI) were analyzed. SNM and PNM have been proposed as therapeutic approaches to improve bladder function, for example after cSCI. However, further evidence on efficacy is required before these methods can become clinical practice. METHODS: Eleven adults, female Göttingen minipigs with cSCI at vertebral level T11-T12 were included: SNM (n = 4), PNM (n = 4), and SCI control (SCIC: n = 3). Tissue from six healthy minipigs was used for structural comparisons. Stimulation was started 1 week after cSCI. Awake urodynamics was performed on a weekly basis. After 16 weeks follow-up, samples from the urinary bladder were taken for analyses. RESULTS: SNM improved bladder function with better capacities and lower detrusor pressures at voiding and avoided the emergence of detrusor sphincter dyssynergia (DSD). PNM and untreated SCI minipigs had less favorable outcomes with either DSD or constant urinary retention. Structural results revealed SCI-typical fibrotic alterations in all cSCI minipigs. However, SNM showed a better-balanced distribution of smooth muscle to connective tissue with a trend towards the reduced progression of bladder wall scarring. CONCLUSION: Early SNM led to an avoidance of the emergence of DSD showing a more physiological bladder function during a 4 month follow-up period after cSCI. This study might pave the way for the clinical continuation of early SNM for the treatment of neurogenic LUT dysfunction after SCI.


Assuntos
Plexo Lombossacral/fisiopatologia , Traumatismos da Medula Espinal/fisiopatologia , Traumatismos da Medula Espinal/terapia , Doenças da Bexiga Urinária/fisiopatologia , Doenças da Bexiga Urinária/terapia , Bexiga Urinária/fisiopatologia , Animais , Feminino , Sintomas do Trato Urinário Inferior/etiologia , Sintomas do Trato Urinário Inferior/terapia , Músculo Liso/patologia , Recuperação de Função Fisiológica , Traumatismos da Medula Espinal/complicações , Suínos , Porco Miniatura , Resultado do Tratamento , Doenças da Bexiga Urinária/etiologia , Retenção Urinária/fisiopatologia , Retenção Urinária/terapia , Urodinâmica
12.
Ceska Gynekol ; 84(4): 289-292, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31818112

RESUMO

OBJECTIVE: The aim of this work is to present a case of traumatic bladder rupture in a patient with total uterine prolapse. Additionally, we provide a brief description of this issue. DESIGN: Case report. SETTING: Department of Obstetrics and Gynaecology, 3rd Faculty of Medicine, Charles University and Královské Vinohrady University Hospital, Prague; Departement of Radiology, 3rd Faculty of Medicine, Charles University and Královské Vinohrady University Hospital, Prague. RESULTS: We present a case report of a patient with a total uterine prolapse that has been examined for a lower abdominal pain, hematuria and difficulties with urination. The problems arose suddenly after the fall on the ground. These symptoms are typical for bladder rupture, but other more frequent causes have to be ruled out. CT scan showed a contrast agent leak from the bladder. The patient was indicated for surgical revision and suture of the bladder wall. CONCLUSION: Separately, rupture of the bladder occurs rarely. Most often, this injury is part of a wider trauma - especially after car crashes. However, our case report suggests that this option should be considered.


Assuntos
Acidentes por Quedas , Doenças da Bexiga Urinária , Bexiga Urinária , Prolapso Uterino , Feminino , Humanos , Gravidez , Ruptura , Doenças da Bexiga Urinária/etiologia
13.
Urologiia ; (5): 132-135, 2019 Dec.
Artigo em Russo | MEDLINE | ID: mdl-31808648

RESUMO

Three basic theories of the development of an overactive bladder that have experimental and clinical evidences have been described, including neurogenic, myogenic, and urothelial. Based on the results of the literature analysis, the authors suggested the existence of detrusor ischemic disease as a result of compressive impairment of its blood flow due to incomplete or short-term relaxation under overactivity or hydraulic compression of the vessels by excessive urine volume in case of hypoactive bladder.


Assuntos
Isquemia/fisiopatologia , Doenças da Bexiga Urinária/etiologia , Doenças da Bexiga Urinária/terapia , Bexiga Urinária/irrigação sanguínea , Hemodinâmica , Humanos , Contração Muscular/fisiologia , Fluxo Sanguíneo Regional/fisiologia , Bexiga Urinária/fisiopatologia , Obstrução do Colo da Bexiga Urinária/complicações , Micção/fisiologia , Urodinâmica/fisiologia , Urotélio
14.
Taiwan J Obstet Gynecol ; 58(6): 880-884, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31759548

RESUMO

OBJECTIVE: Transvaginal oocyte retrieval has become the common method for infertility couples undergoing artificial reproductive technology. Although it was considered to be safe, rare complications including urinary bladder injury were reported. CASE REPORT: We described two cases of bladder injury with refractory blood clots after oocyte retrieval, for whom conservative treatment failed. Diagnostic cystoscopy was performed and an Ellik evacuator was used for clot dissolution successfully. CONCLUSION: Urinary bladder injury with clots retention is a rare complication following ovary puncture. When tenacious clots become organized, the removal with traditional bladder irrigation may be difficult. We introduce Ellik evacuator as an effective and reliable procedure for evacuating tenacious clots in the urinary bladder.


Assuntos
Cistoscopia/métodos , Hematúria/cirurgia , Recuperação de Oócitos/efeitos adversos , Trombose/cirurgia , Doenças da Bexiga Urinária/cirurgia , Bexiga Urinária/lesões , Adulto , Endossonografia/métodos , Feminino , Hematúria/diagnóstico , Hematúria/etiologia , Humanos , Trombose/diagnóstico , Trombose/etiologia , Doenças da Bexiga Urinária/diagnóstico , Doenças da Bexiga Urinária/etiologia , Vagina
15.
J Nepal Health Res Counc ; 17(3): 262-267, 2019 Nov 13.
Artigo em Inglês | MEDLINE | ID: mdl-31735933

RESUMO

BACKGROUND: Colorectal malignancy is a very common disease of the gastrointestinal tract. Surgery following neoadjuvant chemoradiotherapy has been found to improve the survival of the patients with colorectal carcinoma. Research on bowel, bladder and sexual dysfunction following colorectal surgery remains limited in Nepal. The aim of this study is to evaluate the incidence of the bowel, bladder, and sexual dysfunction after colorectal surgery. METHODS: It is a cross-sectional study carried out at National Academy of Medical Science, Bir hospital. Patients who underwent low anterior resection and abdominoperineal resection with curative intention post neoadjuvant chemoradiotherapy were included in the study. RESULTS: A total of 26 patients [20 (76.9%) males and 6 (23.1%) females] who underwent surgery for the colorectal malignant disease were included. 24 (92.30%) underwent low anterior resection and 2(7.6%) patient underwent abdominoperineal resection respectively after neoadjuvant chemo radiotherapy. 19(79.16%) of the patients developed bowel dysfunction with mean low anterior resections score of 22.88±4.394. And 5(20.83%) had normal bowel function. Bladder dysfunction was seen in 3 (11.5%) patients. And rest of the 23 (88.5%) patient had normal bladder function. In males, Sexual Dysfunction was observed in 11 (42.3%)and no sexual dysfunction was observed in 15(57.69%). While in females, 38.46% had no sexual desire and 50% had dyspareunia due to vaginal dryness. CONCLUSIONS: This study clearly demonstrated a higher incidence of bowel and sexual dysfunction compared to bladder dysfunction following low anterior resection and abdominoperineal resection for colorectal malignant diseases.


Assuntos
Neoplasias Colorretais/cirurgia , Enteropatias/epidemiologia , Complicações Pós-Operatórias/epidemiologia , Disfunções Sexuais Fisiológicas/epidemiologia , Doenças da Bexiga Urinária/epidemiologia , Adulto , Idoso , Estudos Transversais , Feminino , Humanos , Incidência , Enteropatias/etiologia , Masculino , Pessoa de Meia-Idade , Nepal/epidemiologia , Complicações Pós-Operatórias/etiologia , Disfunções Sexuais Fisiológicas/etiologia , Doenças da Bexiga Urinária/etiologia
16.
A A Pract ; 13(11): 423-425, 2019 Dec 01.
Artigo em Inglês | MEDLINE | ID: mdl-31567125

RESUMO

We report a case of an iatrogenic bladder perforation sustained during laparoscopic lysis of adhesions performed for small bowel obstruction. The only sign, discovered by the anesthesiology team, was an inflated urinary catheter collection bag. This case revalidates the "catheter bag" sign and advocates for the placement of an indwelling transurethral urinary catheter before surgical incision in high-risk patients with previous pelvic and/or bladder pathology. In addition, vigilance from anesthesia providers and commitment to communication between anesthesia, surgical, and nursing care teams is emphasized to quickly discover complications and treat accordingly.


Assuntos
Obstrução Intestinal/cirurgia , Laparoscopia/efeitos adversos , Doenças da Bexiga Urinária/etiologia , Cateteres de Demora , Feminino , Humanos , Doença Iatrogênica , Pessoa de Meia-Idade , Aderências Teciduais , Resultado do Tratamento , Doenças da Bexiga Urinária/cirurgia , Procedimentos Cirúrgicos Urológicos
17.
Exp Mol Pathol ; 111: 104304, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31479659

RESUMO

Diabetes induces time-dependent alterations in urinary bladders. Long-term diabetes causes an underactive bladder. However, the fundamental mechanisms are still elusive. This study aimed to examine the histological changes and the potential molecular pathways affected by long-term diabetes in the rat bladder. Diabetes was induced in 8-week-old male Lewis rats by streptozotocin, while age-matched control rats received citrate buffer only. Forty-four weeks after diabetes induction, bladders were harvested for histological and molecular analyses. The expressions of proteins related to fibrosis, apoptosis and oxidative stress as well as the cellular signaling pathway in the bladder were examined by immunoblotting. Histological examinations illustrated diabetes caused detrusor hypertrophy and fibrotic changes in the bladder. Immunoblotting analysis demonstrated higher collagen I but lower elastin expression in the bladder in diabetic rats. These were accompanied by an increase in the expression of transforming growth factor-beta1, along with the downregulation of matrix metalloptoteinase-1, and upregulation of tissue inhibitor of metalloproteinase-1. Diabetic rats showed an increase in nitrotyrosine, but decrease in nuclear factor erythroid-related factor 2 (Nrf2) levels in the bladder. Enhanced apoptotic signaling was observed, characterized by increased expression of Bcl-2-associated X protein (Bax), decreased expression of Bcl-2, in the diabetic bladder. The nerve growth factor level was decreased in the diabetic bladder. A significant suppression in the protein expressions of phosphorylated extracellular signal-regulated kinases 1/2 was found in diabetic bladders. This study demonstrated that long-term diabetes caused molecular changes that could promote fibrosis and apoptosis in the bladder. Oxidative stress may be involved in this context.


Assuntos
Apoptose , Diabetes Mellitus Experimental/complicações , Fibrose/patologia , Estresse Oxidativo , Doenças da Bexiga Urinária/patologia , Bexiga Urinária/patologia , Animais , Biomarcadores/metabolismo , Fibrose/etiologia , Fibrose/metabolismo , Masculino , Ratos , Ratos Endogâmicos Lew , Transdução de Sinais , Bexiga Urinária/metabolismo , Doenças da Bexiga Urinária/etiologia , Doenças da Bexiga Urinária/metabolismo
18.
Prog Urol ; 29(11): 572-578, 2019 Sep.
Artigo em Francês | MEDLINE | ID: mdl-31495496

RESUMO

INTRODUCTION: To compare non-continent urinary diversion (NCUD) and other bladder managements in patients with multiple sclerosis (MS), in terms of satisfaction and burden of care. MATERIAL AND METHODS: All patients with MS that were proposed a NCUD in our center for refractory lower urinary tract disorders between January 2005 and March 2018 were eligible. Patients were attributed to two distinct groups: "NCUD" and "Other bladder management". The primary endpoint was the satisfaction related to the bladder management quoted by a numerical rating scale (NRS) from 0 to 10. The secondary endpoints included, among other things, the evaluation of the burden of care associated with the bladder management. RESULTS: Twenty-three patients were included in the "NCUD" group and 11 in the "Other bladder management" group, with 4 patients pursuing with spontaneous voiding, 3 with intermittent catheterization, 2 that have undergone a sphincterotomy, 1 still performing self-intermittent catheterization and 1 with a supra-pubic catheter. The "NCUD" group had a significant higher NRS than the "Other bladder management" group (8.22±1.78 vs. 6.27±2.45; P=0.0056). The daily average duration of care was 16.42minutes in the "NCUD" group and 35.6minutes in the "Other bladder management" group (P=0.1111) CONCLUSION: This exploratory study, even if not conclusive, brings to light the preliminary results needed to elaborate a high level of evidence protocol regarding the satisfaction and the burden of care associated with NCUD in MS patients. LEVEL OF EVIDENCE: 4.


Assuntos
Esclerose Múltipla/complicações , Doenças da Bexiga Urinária/etiologia , Doenças da Bexiga Urinária/cirurgia , Derivação Urinária/métodos , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos
19.
Am J Surg Pathol ; 43(11): 1547-1553, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31368913

RESUMO

Condyloma acuminatum rarely occurs in the urinary bladder and is considered to be a risk factor for squamous cell carcinoma, although there are only a few publications with limited cases. We studied 51 cases of condyloma acuminatum of the urinary bladder from transurethral resections of the urinary bladder of 38 patients from the consult files of one of the authors. Transurethral resections of the urinary bladder were obtained from 25 males with a median age of 73 years (range: 41 to 87 y) and 13 females with a median age of 68 years (range: 30 to 86 y). The follow-up period ranged from 15 months to 20 years (median: 6 y). Bladder lesions were accompanied by urethral lesions in 4 men. Eight patients (8/38; 21.0%) had a history of immunosuppression. Seven patients (7/8; 87.5%) from this group had multiple and/or recurrent condylomas. One patient (1/38; 2.6%) with renal transplantation had 10 separate bladder condylomas over time. One patient (1/38; 2.6%) had extensive anogenital condylomas and anal intraepithelial neoplasia grade 3. One patient (1/8; 12.5%) with renal transplantation presented with a solitary condyloma with synchronous squamous cell carcinoma in situ. Three female patients (3/38; 7.9%) had a history of premalignant vagina/cervix lesions. In total, 17 patients (17/38; 44.7%) had squamous cell carcinoma of the bladder, either invasive or in situ. In all cases, the squamous cell carcinoma (either in situ or invasive) was diagnosed either concurrent with the diagnosis of bladder condyloma or within 1 year of the condyloma diagnosis). In total, 9 of 38 (23.7%) patients had invasive squamous cell carcinoma with or without in situ squamous cell carcinoma. Eight of 38 (21.0%) patients had squamous cell carcinoma in situ only (without a definitive invasive component-in 3 cases invasive squamous cell carcinoma could not be excluded with certainty). In total, 19 patients (19/38; 50%) were positive for either low-risk human papillomavirus (LR-HPV) or high-risk human papillomavirus (HR-HPV) or both (3 were positive for both LR-HPV and HR-HPV, 12 patients for only LR-HPV, and 4 for only HR-HPV). Of the 19 patients that were negative for both LR-HPV and HR-HPV, 9 of 19 (47.4%) patients had associated squamous cell carcinoma. Of the 12 patients with only LR-HPV, 4 (33.3%) had associated squamous cell carcinoma (either invasive or in situ). Of the 7 patients with HR-HPV (with or without LR-HPV), 4 (57.1%) has associated squamous cell carcinoma. In summary, condyloma acuminatum of the urinary bladder shows a strong association with squamous cell carcinoma of the bladder, regardless of the condyloma's HPV in situ hybridization results. Immunosuppression is associated with condylomas of the bladder. It is important to distinguish bladder condylomas from papillary urothelial carcinoma, given their different risks for panurothelial disease and risk of squamous cell carcinoma. Recognition of bladder condylomas histologically is often challenging given their rarity, and that they can be negative for both LR-HPV and HR-HPV. The lack of a history of other anogenital human papillomavirus-related lesions further increases the difficulty in establishing the correct diagnosis.


Assuntos
Carcinoma de Células Escamosas/patologia , Condiloma Acuminado/patologia , Lesões Pré-Cancerosas/patologia , Doenças da Bexiga Urinária/patologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Carcinoma de Células Escamosas/diagnóstico , Carcinoma de Células Escamosas/etiologia , Condiloma Acuminado/diagnóstico , Condiloma Acuminado/etiologia , Diagnóstico Diferencial , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Lesões Pré-Cancerosas/diagnóstico , Lesões Pré-Cancerosas/etiologia , Fatores de Risco , Doenças da Bexiga Urinária/diagnóstico , Doenças da Bexiga Urinária/etiologia , Neoplasias da Bexiga Urinária/diagnóstico , Neoplasias da Bexiga Urinária/etiologia , Neoplasias da Bexiga Urinária/patologia
20.
Acta Neurochir (Wien) ; 161(9): 1887-1894, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31263950

RESUMO

BACKGROUND: Data regarding long-term outcomes following surgery for cauda equina syndrome (CES) is scarce. In addition, these studies rely on patient descriptions of the presence or absence of symptoms, with no gradation of severity. This study aimed to assess long-term bladder, bowel, sexual and physical function using validated questionnaires in a CES cohort. METHODS: A pre-existing ethically approved database was used to identify patients who had undergone surgery for CES between August 2013 and November 2014. Patients were contacted over a 1-month period between August and September 2017 and completed validated questionnaires via telephone, assessing bladder (Urinary Symptom Profile), bowel (Neurogenic Bowel Dysfunction Score), sexual dysfunction (Arizona Sexual Experiences Scale) and physical function (Physical Component Summary of SF-12 Questionnaire), with scores compared between those presenting with incomplete CES (CES-I) and CES with retention (CES-R). Patients were also asked which of their symptoms currently they would most value treatment for and what healthcare services they had accessed post-operatively. RESULTS: Forty-six of 77 patients (response rate 72%, inclusion rate 60%) with a mean age of 45 years (21-83) and mean time since admission of 43 months (range 36-60) took part in the follow-up study. The prevalence of bladder dysfunction was 76%, bowel dysfunction 13%, sexual dysfunction 39% and physical dysfunction 48%. Patients presenting with CES-R had significantly worse long-term outcomes in bladder (stream domain), bowel and sexual function in compared to those with CES-I. Pain was chosen as the symptom patients would most value treatment for by 57%, but only 7% reported post-operative pain management referral. CONCLUSIONS: With a mean follow-up time of 43 months, these findings confirm the high prevalence of long-term bladder, sexual and physical dysfunction in CES patients and that a diagnosis of CES-R confers poorer outcomes. This study provides useful, objective data to guide the expectations of patients and clinicians.


Assuntos
Síndrome da Cauda Equina/cirurgia , Procedimentos Neurocirúrgicos/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos de Coortes , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Intestino Neurogênico/epidemiologia , Intestino Neurogênico/etiologia , Medidas de Resultados Relatados pelo Paciente , Complicações Pós-Operatórias/epidemiologia , Recuperação de Função Fisiológica , Estudos Retrospectivos , Disfunções Sexuais Fisiológicas/epidemiologia , Disfunções Sexuais Fisiológicas/etiologia , Inquéritos e Questionários , Resultado do Tratamento , Doenças da Bexiga Urinária/epidemiologia , Doenças da Bexiga Urinária/etiologia , Adulto Jovem
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