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1.
Isr Med Assoc J ; 22(4): 241-243, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32286028

RESUMO

BACKGROUND: Transurethral prostatectomy is the gold standard surgical treatment of bladder outlet obstruction due to benign enlargement of the prostate, with more than 30,000 procedures performed annually in the United States alone. The success rate of this minimally invasive procedure is high and the results are durable. The development of urethral stricture is a long-term complication of the procedure and is noted in about 2% of patients. The stricture narrows the urethral lumen, leading to re-appearance of obstructive urinary symptoms. Traditionally, the evaluation of the stricture was performed by retrograde urethrography. Advancements in the fields of flexible endoscopy allowed rapid inspection of the urethra and immediate dilatation of the stricture in selected cases. OBJECTIVES: To compare the efficacy of urethrography versus cystoscopy in the evaluation of urethral strictures following transurethral prostatectomy. METHODS: A retrospective review was conducted of a series of 32 consecutive patients treated due to post-transurethral resection of prostate (TURP) urethral stricture. RESULTS: Twenty patients underwent both tests. In 16 there was concordance between the two tests. Four patients had no pathological findings in urethrography but had strictures in cystoscopy. All strictures were short (up to 10 mm) and were easily treated during cystoscopy, with no complaints or re-surgery needed in 24 months follow-up. CONCLUSIONS: Cystoscopy was superior to urethrography in the evaluation of post-TURP strictures. Strictures where often short and treated during the same procedure. We recommend that cystoscopy be the procedure of choice in evaluating obstructive urinary symptoms after TURP, and retrograde urethrography be preserved for selected cases.


Assuntos
Cistoscopia/métodos , Hiperplasia Prostática/cirurgia , Ressecção Transuretral da Próstata/métodos , Uretra/diagnóstico por imagem , Estreitamento Uretral/diagnóstico , Urografia/métodos , Idoso , Estudos de Coortes , Cistografia/métodos , Seguimentos , Humanos , Israel , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/diagnóstico por imagem , Complicações Pós-Operatórias/cirurgia , Hiperplasia Prostática/complicações , Hiperplasia Prostática/diagnóstico , Estudos Retrospectivos , Sensibilidade e Especificidade , Ressecção Transuretral da Próstata/efeitos adversos , Resultado do Tratamento , Estreitamento Uretral/etiologia , Estreitamento Uretral/cirurgia , Obstrução do Colo da Bexiga Urinária/diagnóstico , Obstrução do Colo da Bexiga Urinária/etiologia , Obstrução do Colo da Bexiga Urinária/cirurgia
2.
Med Arch ; 73(2): 81-86, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31391692

RESUMO

Aim: To determine the discriminatory power of penile urethral compression-release index (PCRI), clinical prostate score (CLIPS) and bladder outlet obstruction index 2 (BOON2) for the detection of bladder outlet obstruction (BOO), and the associated bladder abnormality in patients with benign prostatic enlargement (BPE). Material and methods: In study was included of 135 patients with proven BPE underwent urodynamic measurement (UDM) and PCR maneuver. PCR Index was calculated following the formula: (Qs-Qss)/Qss x 100(%). CLIPS score was calculated based on non-invasive variables (prostate volume, maximal urinary flow, residual urine and voided volume), while BOON2 was calculated using the formula intravesical prostate protrusion (IPP)-3 x Qmax-0.2 x mean voided volume. UDM results were plotted on Schaefer and URA nomograms. Results: A comparative analysis was made using ROC curves. The area under the curve (AUC) for PCRI is 0.85 (PTP 91.3%), while AUC for CLIPS and BOON2 is 0.8 (PTP 77.6%) and 0.82 (PTP 74.5%), respectively. PCRI with the cut-off point of 96% clearly distinguishes obstructed patients with normocontractile detrusor and the presence of detrusor overactivity (DO), versus those unobstructed. CLIPS (>10) shows good BOO prediction, but without the possibility of distinguishing between detrusor contractility grade and the occurrence of DO. BOON2 has shown that impaired contractility has influence on this number in obstructed patients. Conclusion: PCRI is a very good noninvasive urodynamic test for a group-wise detection of BOO in patients with BPE and associated bladder co-morbidities; it is therefore superior in comparison with to CLIPS or BOON2.


Assuntos
Hiperplasia Prostática/fisiopatologia , Obstrução do Colo da Bexiga Urinária/diagnóstico , Idoso , Idoso de 80 Anos ou mais , Técnicas de Diagnóstico Urológico , Humanos , Masculino , Pessoa de Meia-Idade , Tamanho do Órgão , Pênis , Próstata/patologia , Hiperplasia Prostática/complicações , Hiperplasia Prostática/patologia , Medição de Risco , Uretra , Obstrução do Colo da Bexiga Urinária/etiologia , Obstrução do Colo da Bexiga Urinária/fisiopatologia , Urodinâmica
3.
Ther Umsch ; 73(9): 541-546, 2019.
Artigo em Alemão | MEDLINE | ID: mdl-31113319

RESUMO

Etiology, Diagnosis, and Management of Female Bladder Outlet Obstruction Abstract. Bladder outlet obstruction affects up to every fourth woman. This condition is causing difficulties to void. Patients complain about frequency, an urge to void, or they describe the feeling of post-void residual urine. Increased post-void residual urine or a pathological micturition pattern with increased pressure or pathological flow curves are suggestive for a bladder outlet obstruction. Common causes are genital organ prolapse, previous incontinence surgery, or dysfunctional voiding. Correspondingly, the underlying etiology is determining therapy: surgical correction of the pelvic organ prolapse usually eliminates the obstructive situation; a tightly placed incontinence sling should be loosened or incised, while dysfunctional disorders can be well addressed by pelvic floor rehabilitation.


Assuntos
Diafragma da Pelve/fisiopatologia , Obstrução do Colo da Bexiga Urinária , Retenção Urinária , Emoções , Feminino , Humanos , Obstrução do Colo da Bexiga Urinária/diagnóstico , Obstrução do Colo da Bexiga Urinária/etiologia , Obstrução do Colo da Bexiga Urinária/terapia , Urodinâmica
4.
Int Braz J Urol ; 45(4): 775-781, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31136110

RESUMO

PURPOSE: To identify how the most frequently used parameters in daily clinical practice diagnosing bladder outlet obstruction (BOO) due to benign prostate hyperplasia (BPH) correlate to each other. MATERIALS AND METHODS: The study included 452 patients with lower urinary tract symptoms (LUTS) of the UNICAMP urology outpatient clinic of LUTS. INCLUSION CRITERIA: patients with BOO due to BPH who agreed to participate in the study. EXCLUSION CRITERIA: patients with urinary tract infection, neurological diseases that compromised the lower urinary tract, prior prostatic surgery, radiotherapy or urethral stenosis. Patient assessment: history, international prostate symptoms score (IPSS), nocturnal quality of life score (NQoL) questionnaires, physical and digital rectal examination (DRE), PSA, transabdominal ultrasound with intravesical prostate protrusion (IPP), post-mictional residue and free urofl owmetry. RESULTS: There was no strong Spearman correlation among the studied variables. The only moderate correlations occurred between IPSS and NQoL (p<0001; c=0.56) and between IPP and prostate volume (p<0001; c=0.57). Weak correlations between IPP and post-mictional residue (p<0001; c=0.31) and free urofl owmetry (p<0001; c=-0.26); and between IPSS and free urofl owmetry (p<0001, c=-0.21) were observed. CONCLUSION: In this study, we found moderate, weak, very weak and absent correlation among the various parameters used in the diagnosis and management of BOO due to BPH. As the value of these tools is variable, the creation of a logical and objective algorithm was not possible and the treatment is based on the interpretation of clinical symptoms.


Assuntos
Sintomas do Trato Urinário Inferior/diagnóstico , Hiperplasia Prostática/diagnóstico , Obstrução do Colo da Bexiga Urinária/diagnóstico , Adulto , Idoso , Idoso de 80 Anos ou mais , Exame Retal Digital , Humanos , Sintomas do Trato Urinário Inferior/patologia , Sintomas do Trato Urinário Inferior/fisiopatologia , Masculino , Pessoa de Meia-Idade , Tamanho do Órgão , Próstata/patologia , Hiperplasia Prostática/patologia , Hiperplasia Prostática/fisiopatologia , Qualidade de Vida , Padrões de Referência , Análise de Regressão , Estatísticas não Paramétricas , Inquéritos e Questionários , Ultrassonografia/métodos , Obstrução do Colo da Bexiga Urinária/patologia , Obstrução do Colo da Bexiga Urinária/fisiopatologia , Micção/fisiologia , Urodinâmica/fisiologia
5.
Prog Urol ; 29(5): 288-292, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30962142

RESUMO

AIM: To assess the feasibility of voiding urethrocystoscopy (VUC) in males and describe the characteristics of dynamic movements of the prostatic lobes during micturition. MATERIAL AND METHODS: Patients scheduled for benign prostatic obstruction relief in a tertiary reference center were included in this prospective evaluation. During urethrocystoscopy with a small diameter flexible endoscope, the bladder was filled until desire to void. The patient was asked to void with endoscope in place facing the veru montanum. Movements of the prostatic lobes during micturition were characterized, video-recorded, and categorized based on the dynamics of the lateral lobes, the posterior lobe and the bladder neck. RESULTS: In all, 192 evaluations were conducted. In 161 cases (84%), the patient was able to void. Among these patients, 126 cases were stated as "closed" (coalescent), without opening of the initial part of the urethra and the bladder neck. In 38 cases, there was no opening of the lateral lobes (type 1A), and in 47 cases a partial opening of the distal parts of the lateral lobes was seen (type 1B). In 31 cases, a fixed posterior bladder neck was seen (type 2A) and in 10 cases a mobile median lobe, with a rolling ball effect, was seen (type 2B). In 25 cases, the lumen was completely open and equivocal in 10 cases. CONCLUSIONS: This study demonstrates the feasibility of VUC and describes for the first time the dynamics of prostatic lobes during micturition. This evaluation may lead to a new approach for understanding the mechanical aspects of benign prostatic obstruction. LEVEL OF EVIDENCE: 3.


Assuntos
Cistoscopia/métodos , Hiperplasia Prostática/diagnóstico , Obstrução Uretral/diagnóstico , Obstrução do Colo da Bexiga Urinária/diagnóstico , Micção/fisiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos de Coortes , Estudos de Viabilidade , Humanos , Masculino , Pessoa de Meia-Idade , Tamanho do Órgão/fisiologia , Próstata/diagnóstico por imagem , Próstata/patologia , Hiperplasia Prostática/complicações , Obstrução Uretral/etiologia , Obstrução do Colo da Bexiga Urinária/etiologia , Urodinâmica/fisiologia
6.
Urology ; 127: 86-90, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-30817961

RESUMO

OBJECTIVE: To study the feasibility of transvesical prostate resection and its effect on urethral stricture. MATERIALS AND METHODS: We included 99 patients with symptomatic bladder outlet obstruction who underwent transvesical resection of prostate (TVRP; n = 48) and transurethral (TURP; n = 51) prostatectomy. We examined all the patients by means of digital rectal examination, transrectal ultrasound, and evaluated them by international prostate symptom score, quality of life score, uroflowmetric assessment and PSA level, and established definitive diagnosis. We followed up the patients in first month, third month, and the first year of the operation and monitored once a year in the following years. RESULTS: In this study, totally 99 symptomatic bladder outlet obstruction patients were included (TVRP = 48 and TURP = 51). Mean age of the patients were 66.5 ± 8.2vs 68 ± 9.8years for our patients with TVRP and TURP, respectively. Two groups displayed similar values in terms of improvements in the Qmax and PVR, and there were no statistically significant differences in between. We obtained similar values for resection time and weight of resected prostate tissue in both groups. Urethral stricture was not observed in TVRP group. In TURP group however, stricture was observed in 4 (7.8%) patients in bulbar urethra in sixth month at average. And there was also a concomitant urethral meatal stricture in one of these patients. When the 2 groups were compared, the rate of urethral stricture was statistically significantly higher in the TURP group (P = .001). CONCLUSION: Resection of prostate without using urethra significantly reduces the incidence of urethral stricture due to mucosal damage.


Assuntos
Hiperplasia Prostática/diagnóstico , Hiperplasia Prostática/cirurgia , Ressecção Transuretral da Próstata/métodos , Obstrução do Colo da Bexiga Urinária/diagnóstico , Obstrução do Colo da Bexiga Urinária/cirurgia , Idoso , Estudos de Casos e Controles , Estudos de Coortes , Estudos de Viabilidade , Seguimentos , Hematúria/diagnóstico , Hematúria/epidemiologia , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/fisiopatologia , Prostatectomia/efeitos adversos , Prostatectomia/métodos , Medição de Risco , Índice de Gravidade de Doença , Ressecção Transuretral da Próstata/efeitos adversos , Resultado do Tratamento , Ultrassom Focalizado Transretal de Alta Intensidade/métodos , Estreitamento Uretral/diagnóstico por imagem , Estreitamento Uretral/cirurgia , Retenção Urinária/diagnóstico , Retenção Urinária/epidemiologia , Infecções Urinárias/diagnóstico , Infecções Urinárias/epidemiologia
7.
Aging Male ; 22(2): 150-155, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-29985721

RESUMO

OBJECTIVE: To develop a questionnaire for the differential diagnosis of detrusor underactivity (DUA) and bladder outlet obstruction (BOO) without performing invasive pressure flow studies. STUDY DESIGN AND METHODS: Symptoms of men with DUA were analyzed and compared with those of men with BOO using eight questions from the developing questionnaire. Patients with DUA have a bladder contractility index (PdetQmax+5xQmax) less than 100, whereas those with BOO have a BOO index (PdetQmax-2xQmax) greater than 40 in urodynamic studies (UDS). Men with detrusor overactivity in UDS and neurogenic issues were excluded from the analysis. One urologist reviewed patients' medical records, and responded to eight questions without using information from UDS. Scores in the developing questionnaire were then compared to make a differential diagnosis between DUA and BOO. RESULTS: Overall, 318 men who underwent UDS were included. Symptoms were compared in patients diagnosed with DUA without BOO (n = 165) and BOO without DUA (n = 153). Questions 1, 2, 4, 5, 6, and 7 were significantly different between groups. The sensitivity and specificity of the questionnaire were 95.8% and 95.4%, respectively, for predicting DUA in patients with scores greater than 45 points (cutoff value). CONCLUSIONS: Men with DUA and BOO may be distinguished using a developing questionnaire without invasive evaluation. Men with scores greater than 45 points would be expected to have DUA but not BOO.


Assuntos
Inquéritos e Questionários , Obstrução do Colo da Bexiga Urinária/diagnóstico , Bexiga Inativa/diagnóstico , Idoso , Diagnóstico Diferencial , Humanos , Masculino , Pessoa de Meia-Idade , Reprodutibilidade dos Testes , Estudos Retrospectivos , Sensibilidade e Especificidade
9.
Neurourol Urodyn ; 37(S4): S75-S85, 2018 06.
Artigo em Inglês | MEDLINE | ID: mdl-30133794

RESUMO

AIMS: Urinary retention in women is poorly understood, compared to the equivalent condition in men, and was the subject of a dedicated session organized at the International Consultation on Incontinence Research Society (ICI-RS) in Bristol, United Kingdom, 2017. METHODS: The current understanding of the pathophysiological correlates of idiopathic voiding dysfunction in women, the role of urodynamics, neurophysiology, and non-invasive tests in characterizing functional bladder outlet obstruction due to a non-relaxing urethral sphincter, and poorly defined diagnosis of detrusor underactivity were reviewed. RESULTS: Putative factors underlying the pathogenesis of urinary retention following urinary tract infections were discussed. Further research is required to explore the association between bladder wall inflammation and alterations in detrusor contractile functions. The complex interrelationship between urinary retention and psychological co-morbidities and sexual trauma were explored, and the overlap between these and psychological co-morbidities and functional neurological problems with functional urological problems were recognized. Understanding the mechanism of action of sacral neuromodulation, often a successful treatment for urinary retention, would provide insight into the underlying factors that may be responsible for urinary retention. Specifically, there is a need to understand the role of the endogenous enkephalinergic system in the pathogenesis of urinary retention and to identify predictors of successful treatment with sacral neuromodulation. Based on current understanding and potential directions of research in the future, an algorithm for the evaluation of women with voiding dysfunction was proposed. CONCLUSIONS: In the future, recommendations for research should lead to a better understanding of urinary retention in women and its treatment.


Assuntos
Uretra/fisiopatologia , Obstrução do Colo da Bexiga Urinária/fisiopatologia , Retenção Urinária/fisiopatologia , Urodinâmica/fisiologia , Feminino , Humanos , Contração Muscular/fisiologia , Obstrução do Colo da Bexiga Urinária/diagnóstico , Obstrução do Colo da Bexiga Urinária/terapia , Retenção Urinária/diagnóstico , Retenção Urinária/terapia
10.
Eur Urol Focus ; 4(1): 14-16, 2018 01.
Artigo em Inglês | MEDLINE | ID: mdl-29665998

RESUMO

It is well known that lower urinary tract symptoms (LUTS) have a multifactorial etiology. Therefore, there is an increased need for improved diagnostics for the optimal assessment of patients with LUTS in order to identify the various causes of symptoms and improve disease phenotyping. Research has focused on the development of improved urodynamic technologies and the development of noninvasive tests that could replace urodynamic studies. This mini-review will present the most recently published studies on the topic including new technologies in the diagnosis of bladder outlet obstruction, novel metrics for bladder sensation, analysis of filling phase rhythm, measurement of detrusor wall tension, and brain imaging during urodynamic studies. PATIENT SUMMARY: Lower urinary tract symptoms (LUTS) have a multifactorial etiology; therefore there is a need for the development of new tests that can help LUTS diagnosis. The present mini-review highlights the new tests and novel concepts in the field.


Assuntos
Sintomas do Trato Urinário Inferior/etiologia , Obstrução do Colo da Bexiga Urinária/diagnóstico , Bexiga Urinária/diagnóstico por imagem , Urodinâmica/fisiologia , Algoritmos , Humanos , Sintomas do Trato Urinário Inferior/diagnóstico , Imagem por Ressonância Magnética , Masculino , Neuroimagem/métodos , Espectroscopia de Luz Próxima ao Infravermelho/métodos , Ultrassonografia Doppler/métodos , Bexiga Urinária/fisiopatologia , Obstrução do Colo da Bexiga Urinária/fisiopatologia
12.
Eur Urol Focus ; 4(1): 54-56, 2018 01.
Artigo em Inglês | MEDLINE | ID: mdl-29705282

RESUMO

Urodynamics can distinguish bladder outlet obstruction from detrusor underactivity. Clear identification of the mechanism of a man's voiding symptoms can help give the best chance of good outcome from surgery. Publication of results from the UPSTREAM study will help in establishing the exact place for urodynamic testing in male lower urinary tract symptoms.


Assuntos
Sintomas do Trato Urinário Inferior/fisiopatologia , Bexiga Urinária/fisiopatologia , Urodinâmica/fisiologia , Idoso , Idoso de 80 Anos ou mais , Humanos , Masculino , Pessoa de Meia-Idade , Obstrução do Colo da Bexiga Urinária/diagnóstico , Obstrução do Colo da Bexiga Urinária/fisiopatologia , Obstrução do Colo da Bexiga Urinária/cirurgia , Bexiga Urinária Hiperativa/fisiopatologia , Bexiga Inativa/diagnóstico , Bexiga Inativa/fisiopatologia , Bexiga Inativa/cirurgia , Micção/fisiologia
13.
J Pediatr Urol ; 14(2): 162.e1-162.e5, 2018 04.
Artigo em Inglês | MEDLINE | ID: mdl-29496422

RESUMO

INTRODUCTION: Posterior urethral valve (PUV) is the most common cause of pediatric end stage renal disease (ESRD), imposing a major health burden on medical community caregivers and adversely affecting the quality of life of patients. Chronic kidney disease (CKD) stage III or estimated GFR of <60 mL/min/1.73 m2 is known to be associated with more adverse renal, cardiovascular, and clinical outcomes. Thus, it is desirable to identify factors predicting the rapid and early progression of disease. In the present study, baseline characteristics and urodynamic study (UDS) parameters of boys with PUV are correlated with CKD progression to IIIB or more. AIMS AND OBJECTIVES: To study the correlation of bladder contractility index (BCI) with development of CKD stage IIIB (eGFR of <45 mL/min/1.73 m2) or more in boys with PUV. METHODOLOGY: Baseline characteristics and demographical variables of 270 boys with PUV who underwent valve fulguration at the hospital between 2000 and 2010 were recorded and certain UDS parameters in follow-up were noted such as bladder contractility index (BCI = PdetQmax + 5 Qmax), end filling pressure (EFP), compliance (ΔC), bladder outlet obstruction index (BOOI = Pdet Qmax - 2 Qmax), and bladder volume efficiency (BVE = Voided volume/total capacity). Fate of patients in follow-up was checked in December 2015. RESULTS: Mean follow-up period was 8.5 years (range 5-15) and median age of patients at the time of evaluation was 5.8 years. At the end of the study, 21.8% (59/270) of patients had progressed to CKD stage IIIB or more (primary end point). Cox regression analysis was applied to risk factors predicting development of CKD stage IIIB. In the multivariate model, bladder contractility index (BCI) (HR 0.8; p = 0.004), end filling pressure (EFP) (HR 2.1; p = 0.010), and compliance (ΔC) (p = 0.020) were significantly associated with the event (i.e. an eGFR of <45 mL/min/1.73 m2), whereas BOOI (p = 0.053) and bladder BVE (p = 0.267) were not. ROC cut-off level for BCI predicting the primary end point was 75 (AUC ± SE, 0.73 ± 0.03, sensitivity of 78.2%, and specificity of 62.5%). CONCLUSION: In a well performed UDS, BCI may be a useful tool for early detection of boys with PUV who are likely to progress to CKD stage IIIB or more.


Assuntos
Falência Renal Crônica/etiologia , Insuficiência Renal Crônica/complicações , Estreitamento Uretral/complicações , Obstrução do Colo da Bexiga Urinária/complicações , Biomarcadores , Criança , Pré-Escolar , Estudos de Coortes , Bases de Dados Factuais , Progressão da Doença , Feminino , Seguimentos , Humanos , Índia , Falência Renal Crônica/fisiopatologia , Masculino , Contração Muscular/fisiologia , Valor Preditivo dos Testes , Modelos de Riscos Proporcionais , Curva ROC , Insuficiência Renal Crônica/etiologia , Estudos Retrospectivos , Medição de Risco , Fatores de Tempo , Estreitamento Uretral/diagnóstico , Bexiga Urinária/fisiopatologia , Obstrução do Colo da Bexiga Urinária/diagnóstico , Urodinâmica , Refluxo Vesicoureteral/complicações , Refluxo Vesicoureteral/diagnóstico
14.
BMC Urol ; 18(1): 12, 2018 Mar 05.
Artigo em Inglês | MEDLINE | ID: mdl-29502524

RESUMO

BACKGROUND: To preliminary investigate the effects of silodosin 8 mg once daily on obstruction urodynamic parameters and subjective symptoms in Caucasian patients with lower urinary tract symptoms suggestive of benign prostatic enlargement. METHODS: We performed a single-center, open-label, single-arm, post-marketing interventional clinical trial. Inclusion criteria were: Caucasian subjects aged ≥50 years waiting to undergo surgery for lower urinary tract symptoms suggestive of benign prostatic enlargement, international prostate symptom total score ≥ 13, international prostate symptom-quality of life score ≥ 3, prostate volume ≥ 30 ml, maximum urine flow rate ≤ 15 mL/s, bladder outlet obstruction index > 40. Eligible subjects received one capsule of silodosin 8 mg once daily for 8 weeks. Invasive urodynamic evaluations were performed at baseline and at 8-weeks follow-up. International prostate symptom questionnaire was administered at baseline, after 4-weeks and 8-weeks of treatment. RESULTS: Overall, 34 subjects were included. Mean bladder outlet obstruction index significantly decreased from 70.6 to 39.2 and bladder outlet obstruction index class improved in 16 patients (53.3%). Statistically significant improvements of mean total international prostate symptom score, mean storage sub-score, mean voiding sub-score and mean quality of life sub-score were evident after 4-weeks of treatment with further improvements after 8-weeks. At the end of the treatment, all patients declared that their condition improved enough to spare or delay surgery. CONCLUSIONS: Silodosin 8 mg once daily significantly improves benign prostatic obstruction in Caucasian patients with lower urinary tract symptoms suggestive of benign prostatic enlargement waiting for surgery. TRIAL REGISTRATION: EudraCT n. 2015-002277-38 Date of registration: 15th December 2017.


Assuntos
Grupo com Ancestrais do Continente Europeu , Indóis/administração & dosagem , Sintomas do Trato Urinário Inferior/tratamento farmacológico , Hiperplasia Prostática/tratamento farmacológico , Obstrução do Colo da Bexiga Urinária/tratamento farmacológico , Agentes Urológicos/administração & dosagem , Idoso , Humanos , Sintomas do Trato Urinário Inferior/diagnóstico , Sintomas do Trato Urinário Inferior/epidemiologia , Masculino , Pessoa de Meia-Idade , Hiperplasia Prostática/diagnóstico , Hiperplasia Prostática/epidemiologia , Obstrução do Colo da Bexiga Urinária/diagnóstico , Obstrução do Colo da Bexiga Urinária/epidemiologia
15.
PLoS One ; 13(2): e0190704, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29462145

RESUMO

OBJECTIVE: To analyze the underlying lower urinary tract dysfunctions by video-urodynamic studies in men who have persistent storage symptoms after initial drug therapy for lower urinary tract symptoms (LUTS) suggestive of benign prostatic hyperplasia (BPH). METHODS: The medical records of 614 men ≥40 years of age with LUTS and an International Prostate Symptom Score of ≥8 were retrospectively analyzed. All patients had persistent storage symptoms after medical treatment for at least 6 months. A video-urodynamic study was done to investigate the underlying bladder or bladder outlet dysfunction. Predictors of bladder outlet obstruction (BOO) by baseline urine flow metrics and prostate parameters were investigated. RESULTS: The final results revealed bladder neck dysfunction (BND) in 137/614 (22.3%), benign prostatic obstruction (BPO) in 246/614 (40.1%), detrusor overactivity (DO) in 193/614 (31.4%), and DO with detrusor underactivity (DO+DU) in 38/614 (6.2%) patients. Among the patients, 221/281 (78.6%) with a total prostatic volume (TPV) ≥40 ml had BOO, including 43/281 (15.3%) with BND and 178/281 (63.3%) with BPO. If we combined TPV ≥40 ml and Qmax <12 ml/s as predictors of BOO, BOO was found in 176/215 (81.8%) patients including 34/215 (15.8%) with BND and 142/215 (66.0%) with BPO. BOO was also found in 48.8% of men with a TPV <40ml, and in 36.3% of men with TPV< 40 ml and Qmax ≥ 12 ml/s. In 102 men with TPV <40 ml and Qmax ≥12 ml/s, 64 (62.7%) had DO. CONCLUSION: BOO, including BND and BPO, comprise 62.4% (383/614) of men with persistent storage symptoms after initial medical treatment for LUTS/BPH. In men who have persistent storage symptoms after medical treatment for LUTS/BPH, BOO should be carefully investigated and appropriate management being given to improve LUTS.


Assuntos
Sintomas do Trato Urinário Inferior/diagnóstico , Adulto , Idoso , Idoso de 80 Anos ou mais , Humanos , Sintomas do Trato Urinário Inferior/tratamento farmacológico , Sintomas do Trato Urinário Inferior/fisiopatologia , Masculino , Pessoa de Meia-Idade , Tamanho do Órgão , Próstata/patologia , Hiperplasia Prostática/diagnóstico , Hiperplasia Prostática/tratamento farmacológico , Hiperplasia Prostática/fisiopatologia , Estudos Retrospectivos , Obstrução do Colo da Bexiga Urinária/diagnóstico , Obstrução do Colo da Bexiga Urinária/fisiopatologia , Urodinâmica , Gravação em Vídeo
16.
J Urol ; 199(6): 1591-1599, 2018 06.
Artigo em Inglês | MEDLINE | ID: mdl-29329895

RESUMO

PURPOSE: We compared long-term storage symptom outcomes between photoselective laser vaporization of the prostate with a 120 W high performance system and holmium laser enucleation of the prostate. We also determined factors influencing postoperative improvement of storage symptoms in the long term. MATERIALS AND METHODS: Included in our study were 266 men, including 165 treated with prostate photoselective laser vaporization using a 120 W high performance system and 101 treated with holmium laser enucleation of the prostate, on whom 60-month followup data were available. Outcomes were assessed serially 6, 12, 24, 36, 48 and 60 months postoperatively using the International Prostate Symptom Score, uroflowmetry and the serum prostate specific antigen level. Postoperative improvement in storage symptoms was defined as a 50% or greater reduction in the subtotal storage symptom score at each followup visit after surgery compared to baseline. RESULTS: Improvements in frequency, urgency, nocturia, subtotal storage symptom scores and the quality of life index were maintained up to 60 months after photoselective laser vaporization or holmium laser enucleation of the prostate. There was no difference in the degree of improvement in storage symptoms or the percent of patients with postoperative improvement in storage symptoms between the 2 groups throughout the long-term followup. However, the holmium laser group showed greater improvement in voiding symptoms and quality of life than the laser vaporization group. On logistic regression analysis a higher baseline subtotal storage symptom score and a higher BOOI (Bladder Outlet Obstruction Index) were the factors influencing the improvement in storage symptoms 5 years after prostate photoselective laser vaporization or holmium laser enucleation. CONCLUSIONS: Our serial followup data suggest that storage symptom improvement was maintained throughout the long-term postoperative period for prostate photoselective laser vaporization with a 120 W high performance system and holmium laser enucleation without any difference between the 2 surgeries. Also, more severe storage symptoms at baseline and a more severe BOOI predicted improved storage symptoms in the long term after each surgery.


Assuntos
Terapia a Laser/métodos , Hiperplasia Prostática/cirurgia , Ressecção Transuretral da Próstata/métodos , Obstrução do Colo da Bexiga Urinária/cirurgia , Transtornos Urinários/diagnóstico , Idoso , Seguimentos , Humanos , Terapia a Laser/instrumentação , Lasers de Estado Sólido , Masculino , Pessoa de Meia-Idade , Próstata/cirurgia , Hiperplasia Prostática/complicações , Estudos Retrospectivos , Índice de Gravidade de Doença , Fatores de Tempo , Ressecção Transuretral da Próstata/instrumentação , Resultado do Tratamento , Obstrução do Colo da Bexiga Urinária/diagnóstico , Obstrução do Colo da Bexiga Urinária/etiologia , Transtornos Urinários/etiologia , Urodinâmica
17.
Neurourol Urodyn ; 37(4): 1501-1505, 2018 04.
Artigo em Inglês | MEDLINE | ID: mdl-29356059

RESUMO

AIMS: This study aimed to identify signs and symptoms which show differences between men with detrusor underactivity (DU) compared to those with both DU and bladder outlet obstruction (BOO). METHODS: One thousand six hundred and twelve urodynamic tests on male patients were analyzed retrospectively. Signs and symptoms which showed a statistically significant difference between patients with DU alone and patients with both DU+BOO were identified. RESULTS: In the DU only group, considering only patients without a history of bladder outlet surgery, the number of daytime micturitions was lower, maximum voided volume on the bladder diary was higher, and slow stream was reported less often, whereas urinary tract infections were reported more often than for DU+BOO males. The average urine flow rate and abdominal pressure at maximum flow were greater in the DU males, compared to the DU+BOO males. CONCLUSIONS: These data suggest that by combining symptoms, medical history and signs, that could be measured without the need for invasive urodynamics, it may be possible to identify men with DU in a non-invasive way. By doing so, men with DU could be separated from men with both DU+BOO, with sufficient specificity to allow the use of any new non-surgical treatment modalities, such as new and effective medical therapy.


Assuntos
Sintomas do Trato Urinário Inferior/diagnóstico , Obstrução do Colo da Bexiga Urinária/diagnóstico , Bexiga Inativa/diagnóstico , Idoso , Diagnóstico Diferencial , Humanos , Sintomas do Trato Urinário Inferior/fisiopatologia , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Sensibilidade e Especificidade , Avaliação de Sintomas , Obstrução do Colo da Bexiga Urinária/fisiopatologia , Bexiga Inativa/fisiopatologia , Micção/fisiologia , Urodinâmica
18.
J Pediatr Surg ; 53(2): 316-320, 2018 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-29223674

RESUMO

AIM: Renal tubular dysfunction (RTD) causing obligate production of hypoosmolar urine in boys with posterior urethral valves (PUVs) has been described. It is not known how clinically significant this is. We hypothesize that a feedback loop is present in many PUV boys who suffer deterioration of their lower urinary tract (LUT). RTD results in hypoosmolar urine, obligate polyuria, and bladder stretch-injury. The increasing back-pressure worsens RTD, thus exacerbating the injury. Coexisting renal dysplasia and acquired renal scarring exacerbate this. We compared the concentrating ability (random clinic urine osmolality) of PUV boys who had no LUT deterioration to those who required intervention, examining the confounding effect of renal impairment with a subgroup analysis comparing those with plasma creatinine ≤80µmol/l. METHODS: A retrospective review of our PUV database was performed. Age, intervention, and highest recorded random clinic urine osmolality (>1year) with concurrent plasma creatinine were recorded (normal urine osmolality 500-850 mOsm/kg). Data are given as median values, analyzed by Mann-Whitney u-test, with P<0.05 deemed significant. MAIN RESULTS: Urine osmolality was available in 77 boys with PUV out of 125 in our series. Of these, 34 required subsequent intervention (e.g., Mitrofanoff procedure, bladder augmentation). Age at testing trended towards being higher in the intervention group [7.9 (4.3-10.9) years vs. nonintervention 6.3 (4-8.4); P=0.06]. Urine osmolality was significantly reduced in the intervention group [411(293-547) vs. 631 (441-805) mOsm/kg; P<0.001]. Subgroup analysis comparing only those with creatinine ≤80µmol/l was respectively 451 (322-567) mOsm/kg (n=22) vs. 645 (469-810) mOsm/kg (n=40), P<0.01. CONCLUSION: This study confirms that hypoosmolar urine is highly associated with progression of LUT dysfunction, requiring intervention. Even boys with normal creatinine values have a greater risk of LUT deterioration if they have a RTD and produce hypoosmolar urine. LEVEL OF EVIDENCE: IV (retrospective service development project).


Assuntos
Obstrução do Colo da Bexiga Urinária/terapia , Urina/química , Criança , Pré-Escolar , Progressão da Doença , Seguimentos , Humanos , Testes de Função Renal , Masculino , Concentração Osmolar , Poliúria/diagnóstico , Poliúria/etiologia , Prognóstico , Insuficiência Renal/diagnóstico , Insuficiência Renal/etiologia , Estudos Retrospectivos , Obstrução do Colo da Bexiga Urinária/diagnóstico , Obstrução do Colo da Bexiga Urinária/fisiopatologia
19.
Trop Doct ; 48(1): 80-84, 2018 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-28637376

RESUMO

Cystometrography (CMG) is a means of studying bladder pressure. It is a very useful diagnostic tool in patients with lower urinary tract symptoms for which a simple cystoscopy will not offer sufficient information to form a diagnosis. Of the 8893 patients who underwent screening for urological conditions in rural northeast India during 2010-2014, 280 with lower urinary tract symptoms were investigated with a combination of cystoscopy and CMG. By corresponding CMG diagnosis and treatment, we could examine patients' overall satisfaction with both the procedure and the treatment. We describe a low-cost method of CMG and our results using this method in rural areas of India.


Assuntos
Cistoscopia , Obstrução do Colo da Bexiga Urinária/diagnóstico , Bexiga Urinária/fisiopatologia , Retenção Urinária/diagnóstico , Adulto , Idoso , Cistoscopia/economia , Cistoscopia/métodos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , População Rural , Obstrução do Colo da Bexiga Urinária/fisiopatologia , Retenção Urinária/fisiopatologia , Urodinâmica
20.
Urology ; 112: 1-5, 2018 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-28888751

RESUMO

Numerous surgical options are available for the management of stress urinary incontinence in women, including urethral bulking agents, pubovaginal slings, retropubic bladder neck suspensions, midurethral slings, and even artificial urinary sphincters. We discuss the incidence, etiology, diagnosis, evaluation, and management of bladder outlet obstruction after anti-incontinence surgery in women. This problem presents with a wide range of symptoms. Urodynamic evaluation is not always diagnostic but can be helpful. Management options range from conservative to invasive. The optimal timeline for intervention is still not well defined, but general guiding principles of management are presented and a comprehensive review of current literature is presented.


Assuntos
Complicações Pós-Operatórias , Obstrução do Colo da Bexiga Urinária , Incontinência Urinária por Estresse/cirurgia , Feminino , Humanos , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/terapia , Obstrução do Colo da Bexiga Urinária/diagnóstico , Obstrução do Colo da Bexiga Urinária/epidemiologia , Obstrução do Colo da Bexiga Urinária/etiologia , Obstrução do Colo da Bexiga Urinária/terapia
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