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1.
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
2.
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
3.
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
4.
Low Urin Tract Symptoms ; 11(4): 232-240, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31207098

RESUMO

OBJECTIVE: This study evaluated the effect of human umbilical cord blood mononuclear cells (HUCB-MNCs) on bladder dysfunction in streptozotocin (STZ; 35 mg/kg, i.v.)-induced diabetic rats. METHODS: Adult male Sprague-Dawley rats (n = 30) were equally divided into three groups: control group, STZ-diabetic group, and HUCB-MNC-treated group (1 × 106 cells). HUCB-MNCs were isolated by density gradient centrifugation from eight healthy donors and injected into the corpus cavenosum in STZ-diabetic rats 4 weeks after the induction of diabetes. Studies were performed 4 weeks after HUCB-MNC or vehicle injection. In vitro organ bath studies were performed on bladder strips, whereas protein expression of hypoxia-inducible factor (HIF)-1α, vascular endothelial growth factor (VEGF), and α-smooth muscle actin (SMA) in the bladder and the ratio of smooth muscle cells (SMCs) to collagen were determined using western blotting and Masson trichrome staining. RESULTS: Neurogenic contractions of detrusor smooth muscle strips were 55% smaller in the diabetic group than control group (P < 0.05); these contractions were normalized by HUCB-MNC treatment. In addition, HUCB-MNC treatment restored the impaired maximal carbachol-induced contractile response in detrusor strips in the diabetic group (29%; P < 0.05). HUCB-MNC treatment improved the KCl-induced contractile response in the diabetic bladder (68%; P < 0.05), but had no effect on ATP-induced contractile responses. Increased expression of HIF-1α and VEGF protein and decreased expression of α-SMA protein and the SMC/collagen ratio in diabetic rats were reversed by HUCB-MNC. CONCLUSION: Administration of HUCB-MNCs facilitates bladder function recovery, which is likely related to downregulation of HIF-1α expression and attenuation of fibrosis in STZ-diabetic rats.


Assuntos
Diabetes Mellitus Experimental/complicações , Sangue Fetal/citologia , Leucócitos Mononucleares/fisiologia , Doenças da Bexiga Urinária/etiologia , Actinas/metabolismo , Animais , Western Blotting , Sangue Fetal/fisiologia , Humanos , Subunidade alfa do Fator 1 Induzível por Hipóxia/metabolismo , Masculino , Contração Muscular/fisiologia , Músculo Liso/fisiopatologia , Ratos , Ratos Sprague-Dawley , Bexiga Urinária/metabolismo , Bexiga Urinária/fisiopatologia , Doenças da Bexiga Urinária/fisiopatologia , Doenças da Bexiga Urinária/terapia , Fator A de Crescimento do Endotélio Vascular/metabolismo
5.
Scand J Urol ; 53(2-3): 156-160, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31092116

RESUMO

Background: Pelvic radiotherapy causes tissue atrophy and fibrosis, leading to urinary tract dysfunction. Tissue ischaemia poses a significant surgical challenge. This study examined the urological sequelae of radiotherapy, types of reconstructive urological surgery (RUS) required and functional outcomes. Methods: A retrospective review was performed of all radiotherapy patients who underwent RUS at a tertiary centre between 2007-2017. Details including time from radiotherapy, pre-operative assessments, type of surgery performed and functional outcome were analysed. Results: Fifty-four patients were identified. The primary malignancy was cervical (32), colorectal (9) and other urogenital/metastatic origins in the remaining cases. Mean time between radiation and RUS was 13 years. Sixty-nine reconstructive surgeries were performed. Twenty-two patients had fistulae, but only 27% were closed and 73% ended with urinary diversion. Eighteen had ureteric strictures, with 56% having associated bladder dysfunction. Twelve (67%) patients had RUS, of whom 83% required bowel interposition, and 33% primary diversion. Nine of 24 patients with contracted bladders were reconstructed and eight remain functionally continent. Renal function stabilised or improved in 87%. Nine patients (17%) had Clavien 3 or 4 complications. Conclusions: A variety of complex, major RUS were required. In 61%, urinary diversion was necessary, with radiotherapy fistulae being a particular challenge and closed in only a third. In total, 37% of patients were reconstructed achieving functional continence and restoration of upper-tract drainage with renal function preservation. This surgery was at a cost of a re-intervention rate of 28% and significant morbidity in 17%. RUS in the radiotherapy field should be performed in centres with experience.


Assuntos
Lesões por Radiação/cirurgia , Radioterapia/efeitos adversos , Procedimentos Cirúrgicos Reconstrutivos/métodos , Doenças Ureterais/cirurgia , Doenças da Bexiga Urinária/cirurgia , Fístula Urinária/cirurgia , Procedimentos Cirúrgicos Urológicos/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Neoplasias Colorretais/radioterapia , Constrição Patológica , Contratura/etiologia , Contratura/cirurgia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Neoplasias Ovarianas/radioterapia , Pelve , Lesões por Radiação/etiologia , Estudos Retrospectivos , Retalhos Cirúrgicos , Resultado do Tratamento , Doenças Ureterais/etiologia , Neoplasias Uretrais/radioterapia , Doenças da Bexiga Urinária/etiologia , Derivação Urinária/métodos , Fístula Urinária/etiologia , Neoplasias do Colo do Útero/radioterapia
6.
Medicine (Baltimore) ; 98(20): e15671, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-31096500

RESUMO

RATIONALE: Intravesical migrated intrauterine devices (IUDs) have been reported to cause bladder perforation, stone formation, or malignant transition. However, such extensive intravesical benign hyperplasia caused by an extravesical migrated IUD is firstly reported. PATIENT CONCERNS: A 38-year-old woman suffered from recurrent urinary urgency and dysuria and without macroscopic hematuria for about 1 month. DIAGNOSES: Urinary ultrasound and abdominal contrast-enhanced computed tomography (CT) revealed thickening of the bladder walls. Diagnostic transurethral resection and pathology initially misdiagnosed the intravesical lesions as non-invasive urothelial carcinoma. Further diagnostic and therapeutic transurethral resections and pathology confirmed the intravesical lesions to be extensive benign hyperplasia, which was extremely likely caused by the extravesical migrated IUD. INTERVENTIONS: The intravesical lesions received therapeutic transurethral resections. Then the migrated IUD was removed by open surgery. OUTCOMES: After above treatments, the patient's lower urinary tract symptoms gradually disappeared. No recurrent lesion was found in the bladder through CT 3 months later. LESSONS: Even an extravesical migrated IUD could silently cause extensive intravesical lesions. Whether symptomatic or not, any migrated IUD including extravesical and intravesical ones should be treated seriously, if possible, removed as soon as possible.


Assuntos
Hiperplasia/etiologia , Migração de Dispositivo Intrauterino/efeitos adversos , Doenças da Bexiga Urinária/etiologia , Adulto , Feminino , Humanos , Hiperplasia/cirurgia , Doenças da Bexiga Urinária/cirurgia
8.
Mol Med Rep ; 19(4): 2716-2728, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30720140

RESUMO

Due to the rising abuse of ketamine usage in recent years, ketamine­induced urinary tract syndrome has received increasing attention. The present study aimed to investigate the molecular mechanism underlying ketamine­associated cystitis in a mouse model. Female C57BL/6 mice were randomly divided into two groups: One group was treated with ketamine (100 mg/kg/day of ketamine for 20 weeks), whereas, the control group was treated with saline solution. In each group, micturition frequency and urine volume were examined to assess urinary voiding functions. Mouse bladders were extracted and samples were examined for pathological and morphological alterations using hematoxylin and eosin staining, Masson's trichrome staining and scanning electron microscopy. A cDNA microarray was conducted to investigate the differentially expressed genes following treatment with ketamine. The results suggested that bladder hyperactivity increased in the mice treated with ketamine. Furthermore, treatment with ketamine resulted in a smooth apical epithelial surface, subepithelial vascular congestion and lymphoplasmacytic aggregation. Microarray analysis identified a number of genes involved in extracellular matrix accumulation, which is associated with connective tissue fibrosis progression, and in calcium signaling regulation, that was associated with urinary bladder smooth muscle contraction. Collectively, the present results suggested that these differentially expressed genes may serve critical roles in ketamine­induced alterations of micturition patterns and urothelial pathogenesis. Furthermore, the present findings may provide a theoretical basis for the development of effective therapies to treat ketamine­induced urinary tract syndrome.


Assuntos
Sinalização do Cálcio , Matriz Extracelular/metabolismo , Ketamina/efeitos adversos , Doenças da Bexiga Urinária/etiologia , Doenças da Bexiga Urinária/metabolismo , Animais , Biomarcadores , Peso Corporal , Modelos Animais de Doenças , Feminino , Camundongos , Modelos Biológicos , Membrana Mucosa/metabolismo , Membrana Mucosa/patologia , Doenças da Bexiga Urinária/patologia , Doenças da Bexiga Urinária/fisiopatologia
9.
N Z Vet J ; 67(3): 148-154, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30742780

RESUMO

CASE HISTORY: A group of 39, 19-22-month-old Friesian bulls were administered an ivermectin/closantel anthelmintic via intended S/C injection in the ischiorectal fossa on 15 June 2017 (Day 0). Over the next 50 days, 22 affected bulls presented various degrees of anorexia, abdominal pain and urine dribbling. Seventeen bulls were examined by transrectal ultrasonography which revealed urinary bladder distension in all 17, and peritoneal fluid accumulation in some. Overall, eight bulls died or were subjected to euthanasia. On-farm postmortem examination of three bulls revealed urinary bladder rupture. CLINICAL FINDINGS: On Day 50 one affected live bull was admitted to Massey University for further investigation. This bull continuously dribbled urine and had an overtly distended urinary bladder as determined by rectal palpation and ultrasonography. PATHOLOGICAL FINDINGS: Postmortem examination of this bull revealed a markedly distended urinary bladder, massive subcapsular and pericapsular renal oedema with retroperitoneal fluid accumulation, minimal hydronephrosis and no evidence of mechanical urinary outflow obstruction. The right ischiorectal fossa contained multifocal areas of tissue fibrosis that extended into areas innervated by the distal cutaneous branch of the pudendal nerve and the pelvic nerve. Histopathological changes consisted of extensive fibrosis, myonecrosis and neurodegeneration, and evidence of granulation tissue and inflammation at the putative injection site and in surrounding tissues. DIAGNOSIS: A local inflammatory reaction at the presumed injection site together with localised peripheral neurodegeneration and myelopathy may have led to detrusor-sphincter dyssynergia causing urine retention. CLINICAL RELEVANCE: These cases of urine retention and bladder rupture in cattle were of putative iatrogenic origin. Veterinarians should be aware of this rare complication after S/C injections in the ischiorectal fossa.


Assuntos
Doenças dos Bovinos/induzido quimicamente , Ivermectina/efeitos adversos , Salicilanilidas/efeitos adversos , Retenção Urinária/veterinária , Animais , Antiparasitários/administração & dosagem , Antiparasitários/efeitos adversos , Bovinos , Doenças dos Bovinos/etiologia , Doenças dos Bovinos/mortalidade , Combinação de Medicamentos , Ivermectina/administração & dosagem , Masculino , Ruptura , Salicilanilidas/administração & dosagem , Bexiga Urinária/patologia , Doenças da Bexiga Urinária/etiologia , Doenças da Bexiga Urinária/mortalidade , Doenças da Bexiga Urinária/patologia , Doenças da Bexiga Urinária/veterinária , Retenção Urinária/induzido quimicamente , Retenção Urinária/complicações , Retenção Urinária/mortalidade
11.
Neurourol Urodyn ; 38(3): 975-980, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-30801799

RESUMO

INTRODUCTION: Bladder dysfunction after spinal cord injury (SCI) often requires clean intermittent catheterization (CIC) or other management strategies. A common dilemma in those desiring to perform CIC independently but lacking the appropriate upper extremity (UE) motor function is the timing of reconstructive surgery. METHODS: We assessed the National Spinal Cord Injury Data Set for the years 2000-2016. Our cohort consisted of persons with cervical SCI, who underwent complete motor examination upon discharge from rehabilitation and at 1-year follow-up. Using a previously published algorithm, UE motor scores were transformed to predict a patient's ability to independently perform CIC. Improvements in the predicted ability to self-catheterize were evaluated. RESULTS: Of the 1428 individuals meeting the inclusion criteria, improvements in the predicted UE motor function necessary to independently self-catheterize were observed in 39%, 42%, and 38% of those deemed possibly able, only able with surgical assistance, or unable to self-catheterize at rehabilitation discharge, respectively. On multivariate analysis, only increasing Association Impairment Scale (AIS) classification and AIS classification improvement over the first year were associated with an increased odds of improving predicted CIC ability (odds ratio [OR] = 1.44 for AIS C and 1.97 for AIS D compared with AIS A, and OR = 1.90 for AIS classification improvement versus stable AIS classification, P < 0.05 for each). CONCLUSION: Improvements in UE motor function to independently perform CIC occur in approximately 40% of persons with cervical SCI in the first year after rehabilitation discharge. Those with incomplete injuries are more likely to improve. These findings should enhance patient bladder management counseling and guide surgeons in determining an appropriate timeline for offering reconstruction.


Assuntos
Cateterismo Uretral Intermitente/métodos , Autocuidado , Traumatismos da Medula Espinal/fisiopatologia , Extremidade Superior/fisiopatologia , Doenças da Bexiga Urinária/terapia , Adulto , Algoritmos , Estudos de Coortes , Estudos Transversais , Avaliação da Deficiência , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Exame Neurológico , Desempenho Psicomotor , Traumatismos da Medula Espinal/complicações , Traumatismos da Medula Espinal/reabilitação , Doenças da Bexiga Urinária/etiologia
12.
Int Urogynecol J ; 30(4): 589-594, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30710159

RESUMO

INTRODUCTION AND HYPOTHESIS: The aim of this study was to evaluate the functional outcomes and urodynamic findings after laparoscopic sacrocolpopexy (LSC) in patients with stages II-IV pelvic organ prolapse (POP). METHODS: In this single-center prospective study, we evaluated 63 women (mean age 62.5 ± 7.5 years) women with symptomatic and advanced POP (stage II-IV) who underwent LSC without concomitant anti-incontinence surgery. The preoperative evaluation incuded history, clinical examination, and urodynamic testing. Women were followed up at 1, 3, 6, and 12 months after surgery and then annually using history, examination, and uroflowmetry. At 6 months, we performed urodynamic testing. To evaluate urinary symptoms, we used the Urogenital Distress Inventory (UDI)-6 questionnaire before and 6 months after surgery. RESULTS: Median follow- up was 22 months (range 8-48). After surgery, maximum flow (Qmax) significantly improved compared with baseline (14.17 ± 2.3 vs 27 ± 8.4 ml/s; p = 0.02), and the percentage of patients with elevated postvoid residual (PVR) significantly decreased (33.3% vs 11.1%; p = 0.001). Detrusor overactivity and bladder outlet obstruction disappeared in 73.6% and 85.7% of patients, respectively, while detrusor underactivity persisted in 66.6% of women. Twenty women (31.7%) reported stress urinary incontinence (SUI) before surgery (14 clinically evident and 6 as occult form), which persisted in only 7/20 (11%) patients following LSC, with no de novo cases. The most common preoperative symptoms were voiding symptoms, present in 42/63 (66.6%) patients, which resolved in 36 (85.7%). The overactive bladder syndrome disappeared in 60% of women, with no de novo cases. Results were reflected by a significant decrease in UDI-6 score from a median of 16 (0-45) at baseline to 5.5 (0-17) at the final follow-up (p = 0.001). The domain on storage symptoms (median 3 vs 1) and voiding symptoms (median 3 vs 1) of UDI-6 showed an improvement after surgery (p = 0.001). CONCLUSIONS: The urodynamic finding showed that LSC in women with advanced POP provides good functional outcomes.


Assuntos
Prolapso de Órgão Pélvico/complicações , Prolapso de Órgão Pélvico/cirurgia , Doenças da Bexiga Urinária/fisiopatologia , Incontinência Urinária por Estresse/fisiopatologia , Urodinâmica , Vagina/cirurgia , Idoso , Feminino , Seguimentos , Humanos , Laparoscopia , Pessoa de Meia-Idade , Prolapso de Órgão Pélvico/fisiopatologia , Período Pós-Operatório , Período Pré-Operatório , Sacro/cirurgia , Inquéritos e Questionários , Doenças da Bexiga Urinária/etiologia , Obstrução do Colo da Bexiga Urinária/etiologia , Obstrução do Colo da Bexiga Urinária/fisiopatologia , Bexiga Urinária Hiperativa/etiologia , Bexiga Urinária Hiperativa/fisiopatologia , Bexiga Inativa/etiologia , Bexiga Inativa/fisiopatologia , Incontinência Urinária por Estresse/etiologia
13.
Investig Clin Urol ; 60(1): 35-39, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30637359

RESUMO

Purpose: To evaluate patients' tolerance to indwelling urinary catheters (IUCs) before and after reducing their balloon volumes. IUCs are a source of discomfort or pain. Materials and Methods: All consecutive patients hospitalized in our department with IUCs were included during the study period with some exclusion. Each patient was his/her own control before and two hours after reduction of the balloon volume (RBV) by half using two types of assessments, a visual analog scale for pain and a catheter-related bladder discomfort (CRBD) symptom questionnaire. Results: Forty-nine patients were included in our study that completed the assessments. The mean scores for pain before and after RBVs were 2.80 and 2.02, respectively. The difference was significant (p<0.05). The mean grades of the CRBD before and after RBVs were 1.02 and 0.75, respectively. The difference was significant (p<0.05). Conclusions: A 50% RBV has shown a significant amelioration in tolerating the catheter.


Assuntos
Cateteres de Demora/efeitos adversos , Dor Pós-Operatória/etiologia , Doenças da Bexiga Urinária/etiologia , Cateteres Urinários/efeitos adversos , Adulto , Idoso , Idoso de 80 Anos ou mais , Desenho de Equipamento , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Medição da Dor/métodos , Complicações Pós-Operatórias , Estudos Prospectivos , Índice de Gravidade de Doença , Ressecção Transuretral da Próstata/métodos , Neoplasias da Bexiga Urinária/cirurgia , Cateterismo Urinário/instrumentação , Incontinência Urinária de Urgência/etiologia , Adulto Jovem
14.
Obstet Gynecol ; 133(2): 313-322, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-30633149

RESUMO

Bowel and bladder injuries are relatively rare, but there can be serious complications of both open and minimally invasive gynecologic procedures. As with most surgical complications, timely recognition is key in minimizing serious patient morbidity and mortality. Diagnosis of such injuries requires careful attention to surgical entry and dissection techniques and employment of adjuvant diagnostic modalities. Repair of bowel and bladder may be performed robotically, laparoscopically, or using laparotomy. Repair of these injuries requires knowledge of anatomic layers and suture materials and testing to ensure that intact and safe repair has been achieved. The participation of consultants is encouraged depending on the primary surgeon's skill and expertise. Postoperative care after bowel or bladder injury requires surveillance for complications including repair site leak, abscess, and fistula formation.


Assuntos
Procedimentos Cirúrgicos em Ginecologia/efeitos adversos , Enteropatias/cirurgia , Intestinos/lesões , Doenças da Bexiga Urinária/cirurgia , Bexiga Urinária/lesões , Feminino , Humanos , Doença Iatrogênica , Enteropatias/diagnóstico , Enteropatias/etiologia , Enteropatias/prevenção & controle , Doenças da Bexiga Urinária/diagnóstico , Doenças da Bexiga Urinária/etiologia , Doenças da Bexiga Urinária/prevenção & controle
15.
J Minim Invasive Gynecol ; 26(3): 417-426.e6, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30359783

RESUMO

It is widely accepted that nerve-sparing radical hysterectomy is associated with less postoperative morbidity compared with radical hysterectomy, whereas clinical safety is similar in the 2 procedures. However, there is insufficient evidence to compare these procedures performed via a laparoscopic approach. We performed a systematic review and meta-analysis of studies to compare the clinical efficacy and the rate of bladder dysfunction, including urodynamic assessment, in laparoscopic nerve-sparing radical hysterectomy (LNSRH) and laparoscopic radical hysterectomy (LRH). Thirty articles including a total of 2743 participants were analyzed. Operating times were shorter (MD, 29.88 minutes; 95% confidence interval [CI], 11.92-47.83 minutes) and hospital stays were longer (MD, -1.56 days; 95% CI, -2.27 to -0.84 days) in the LRH group compared with the LNSRH group. In addition, blood loss and the number of resected lymph nodes were not significantly different between the 2 groups. However, resected parametrium length (MD, -0.02 cm; 95% CI, -0.05 to -0.00 cm) and vaginal cuff width (MD, -0.06 cm; 95% CI, -0.09 to -0.04) were smaller in the LNSRH group. Furthermore, LNSRH tended to result in more satisfactory micturition (odds ratio, 2.90; 95% CI, 2.01-4.19), shorter catheterization time (MD, -7.20 days; 95% CI, -8.10 to -6.29 days), and shorter recovery to normal postvoid residual urine time (MD, -7.71 days; 95% CI, -8.92 to -6.50 days). Other bladder dysfunction symptoms, including urinary retention, nocturia, dysuria, urinary incontinence, and frequency/urgency were more frequent in the LRH group. Furthermore, LNSRH achieved better results in urodynamic assessments (all p < .05). In conclusion, LNSRH was associated with lower rates of impaired bladder function and a shorter extent of resection compared with LRH. Clinical applications involving LNSRH should be explored with caution.


Assuntos
Histerectomia , Laparoscopia , Tratamentos com Preservação do Órgão/métodos , Doenças da Bexiga Urinária , Neoplasias do Colo do Útero/cirurgia , Útero/inervação , Adulto , Feminino , Humanos , Histerectomia/efeitos adversos , Histerectomia/métodos , Histerectomia/estatística & dados numéricos , Laparoscopia/efeitos adversos , Laparoscopia/métodos , Laparoscopia/estatística & dados numéricos , Excisão de Linfonodo , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Tratamentos com Preservação do Órgão/efeitos adversos , Tratamentos com Preservação do Órgão/estatística & dados numéricos , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Resultado do Tratamento , Bexiga Urinária/patologia , Bexiga Urinária/fisiopatologia , Doenças da Bexiga Urinária/epidemiologia , Doenças da Bexiga Urinária/etiologia , Neoplasias do Colo do Útero/epidemiologia , Útero/patologia , Útero/cirurgia
16.
J Gynecol Obstet Hum Reprod ; 48(1): 45-49, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30321609

RESUMO

OBJECTIVES: Determining the incidence and causes of lower urinary tract injury in patients undergoing total laparoscopic hysterectomy and examining the procedures applied for management. METHODS: Patients who underwent total laparoscopic hysterectomy in a large referral center between 1 January 2015 and 31 October 2017 for benign gynecological reasons were included in the study. Patients who underwent laparoscopic supracervical hysterectomy, laparoscopy-assisted vaginal hysterectomy and robot-assisted laparoscopic hysterectomy were not included in this study. The hospital records of all patients included in the study were examined and the incidence, causes and management of lower urinary tract injuries were reviewed. RESULTS: Total lower urinary tract injury rate was found as 2.01%, and these injuries were evaluated separately as bladder and ureter injuries. All the bladder injuries had occurred on the posterior wall of the bladder during vesicouterine dissection; six cases were intraoperatively detected and one case was detected on the first postoperative day. Most of ureteral injury cases were detected in the early postoperative period (75%). The rates of previous cesarean section and endometriosis were significantly higher in patients with injury to the bladder and ureter than in the control group (p<0,001). There was no significant difference between the patients with lower urinary tract injury and the control group regarding uterine weight, estimated blood loss, bilateral salpingo-oophorectomy, the presence and location of fibroids, and laparoscopic or vaginal closure of the vaginal cuff. CONCLUSION: Laparoscopic hysterectomy may be a good option in appropriate patients, but in case of previous cesarean section and endometriosis cases, patients should be informed about the possible complications in detail before the operation and care should be taken during dissection.


Assuntos
Cesárea , Endometriose , Histerectomia/efeitos adversos , Complicações Intraoperatórias , Laparoscopia/efeitos adversos , Complicações Pós-Operatórias , Ureter/lesões , Doenças Uretrais , Doenças da Bexiga Urinária , Bexiga Urinária/lesões , Adulto , Cesárea/estatística & dados numéricos , Endometriose/epidemiologia , Feminino , Humanos , Histerectomia/estatística & dados numéricos , Complicações Intraoperatórias/epidemiologia , Complicações Intraoperatórias/etiologia , Complicações Intraoperatórias/terapia , Laparoscopia/estatística & dados numéricos , Pessoa de Meia-Idade , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/terapia , Doenças Uretrais/epidemiologia , Doenças Uretrais/etiologia , Doenças Uretrais/terapia , Doenças da Bexiga Urinária/epidemiologia , Doenças da Bexiga Urinária/etiologia , Doenças da Bexiga Urinária/terapia
17.
Neuromodulation ; 22(6): 697-702, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-30506765

RESUMO

OBJECTIVES: Incomplete spinal cord injury (SCI) accounts for two-thirds of all SCIs in clinical practice. Preclinical research on the effect of sacral neuromodulation (SNM) on bladder function, however, has been focused only on animal models of complete SCI. We aimed to evaluate the effect of early SNM on bladder responses in a rat model of incomplete SCI. MATERIALS AND METHODS: Altogether, 21 female Sprague-Dawley rats were equally assigned to control (CTR), SCI + sham stimulation (SHAM), and SCI + SNM (SNM) groups. In the SHAM and SNM groups, incomplete SCI was created by producing a moderate contusion with an NYU-MASCIS impactor at the T9-T10 level of the spine, with needle electrodes implanted bilaterally into the S2 or S3 sacral foramen. Only SNM group underwent electrical stimulation for 28 days, beginning on day 7 after SCI. Cystometry was performed 35 days after SCI. RESULTS: Although the interval between voiding contractions was significantly longer in the SHAM group than the CTR group (25.5 ± 1.4 vs. 12.5 ± 1.7 min; p < 0.05), there were no significant differences between the SNM group (16.5 ± 1.5 min) and the CTR group. Maximum voiding contraction pressure did not differ among the groups. The SNM group had a significantly lower frequency (3.5 ± 0.5 vs. 14.6 ± 2.0; p < 0.05) and maximum pressure (11.4 ± 6.2 vs. 21.3 ± 1.8 cmH2 O; p < 0.05) of nonvoiding contractions than the SHAM group. CONCLUSIONS: Our results provide experimental evidence that early SNM treatment may prevent or diminish bladder dysfunctions (e.g., detrusor overactivity, abnormal micturition reflex) in a clinical condition of incomplete SCI.


Assuntos
Modelos Animais de Doenças , Sacro/fisiologia , Traumatismos da Medula Espinal/terapia , Estimulação da Medula Espinal/métodos , Doenças da Bexiga Urinária/terapia , Animais , Contusões , Feminino , Ratos , Ratos Sprague-Dawley , Sacro/inervação , Traumatismos da Medula Espinal/complicações , Traumatismos da Medula Espinal/fisiopatologia , Bexiga Urinária/inervação , Bexiga Urinária/fisiologia , Doenças da Bexiga Urinária/etiologia , Doenças da Bexiga Urinária/fisiopatologia
19.
BMJ Case Rep ; 20182018 Oct 25.
Artigo em Inglês | MEDLINE | ID: mdl-30366891

RESUMO

Spontaneous rupture of the urinary bladder is extremely rare. We report a case of a 70-year-old man with spontaneous bladder rupture secondary to neglected giant vesicle calculi who presented as acute renal failure. The patient was stabilised with per-urethral catheterisation and extravesical drain placement. About 700 mL pus mixed with urine was drained through the per-urethral catheter and approximately 2000 mL of pus was drained through the extravesical drain. Cystolithotomy showed two large calculi which were removed.


Assuntos
Lesão Renal Aguda/etiologia , Doenças da Bexiga Urinária/etiologia , Idoso , Doença Crônica , Humanos , Masculino , Ruptura Espontânea/etiologia , Ruptura Espontânea/cirurgia , Cálculos da Bexiga Urinária/complicações , Cálculos da Bexiga Urinária/cirurgia , Doenças da Bexiga Urinária/cirurgia , Retenção Urinária/etiologia , Retenção Urinária/cirurgia , Infecções Urinárias/complicações
20.
J Pediatr Urol ; 14(4): 319.e1-319.e7, 2018 08.
Artigo em Inglês | MEDLINE | ID: mdl-30253979

RESUMO

BACKGROUND: Baseline and interval dimercaptosuccinic acid (DMSA) scans and urodynamic (UD) studies are often obtained in infants and young children with spinal dysraphism (SD). OBJECTIVE: To identify practical UD parameters which accurately stratify urologic risk young children with SD. STUDY DESIGN: 130 expectantly managed infants/young children with SD and initial DMSA and UD before age 2 were reviewed. End fill pressure (EFP), bladder trabeculations, vesicoureteral reflux (VUR), initial volume (IV) drained at UD catheter placement, and detrusor pressure at initial volume (DPIV) were evaluated for association with subsequent febrile urinary tract infection (UTI), DMSA abnormalities, and early clean intermittent catheterization (CIC). A combination of factors to accurately stratify risk was sought. Groups were compared by log-rank test. The association of CIC and febrile UTI incidence was evaluated. RESULTS: 31/130 patients developed DMSA abnormalities, 52/130 started early CIC, and 61/130 developed a febrile UTI with median follow-up of 3.8 years. Trabeculations, VUR, EFP ≥40 cm H2O, IV ≥50% estimated bladder capacity (EBC), and DPIV >10 cm H2O were associated with subsequent abnormal DMSA scan (p < 0.001). The best predictor was combination of trabeculation and/or VUR (p < 0.001) (Figure). Among patients who maintained a non-trabeculated bladder without VUR during follow-up, 0/51 developed DMSA abnormalities compared with 31/79 who developed one or both (p < 0.001). Patients with trabeculations and/or VUR were more likely to start early CIC (8/51 vs. 44/79; p < 0.001) and have febrile UTI (11/51 vs. 50/79; p < 0.001). In those with trabeculations, CIC was associated with decreased incidence of febrile UTI (incidence rate ratio (IRR) 0.5, 95% CI 0.3-0.9); in those without trabeculations, CIC was associated with increased incidence of febrile UTI (IRR 1.8, 95% CI 1.1-3.1). CONCLUSIONS: VUR, bladder trabeculations, EFP ≥40 cm H20, IV ≥50% of EBC, and DPIV >10 cm H2O were associated with subsequent DMSA abnormalities in young children with SD managed expectantly. Many of these parameters were associated with febrile UTI and early CIC. The combination of trabeculations and/or VUR outperformed other UD parameters in identifying those high and low-risk for adverse urologic outcomes. Routine DMSA scan may have limited utility in patients with a non-trabeculated bladder without VUR, as none developed an abnormal DMSA. Most (71%) abnormal DMSAs were in patients with trabeculations and/or VUR following a febrile UTI. Given these findings and that incidence of febrile UTI may be lower in those with trabeculations while on CIC, patients with trabeculations and/or VUR should be managed aggressively to protect kidneys.


Assuntos
Disrafismo Espinal/fisiopatologia , Doenças da Bexiga Urinária/epidemiologia , Urodinâmica , Refluxo Vesicoureteral/epidemiologia , Criança , Pré-Escolar , Feminino , Humanos , Masculino , Estudos Retrospectivos , Medição de Risco/métodos , Disrafismo Espinal/complicações , Succímero , Doenças da Bexiga Urinária/diagnóstico por imagem , Doenças da Bexiga Urinária/etiologia , Doenças da Bexiga Urinária/patologia , Refluxo Vesicoureteral/diagnóstico por imagem , Refluxo Vesicoureteral/etiologia
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