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1.
Eur Urol Focus ; 6(5): 1049-1057, 2020 Sep 15.
Artigo em Inglês | MEDLINE | ID: mdl-32540267

RESUMO

CONTEXT: Coronavirus disease 19 (COVID-19) has changed standard urology practice around the world. The situation is affecting not only uro-oncological patients but also patients with benign and disabling conditions who are suffering delays in medical attention that impact their quality of life. OBJECTIVE: To propose, based on expert advice and current evidence where available, a strategy to reorganize female and functional urological (FFU) activity (diagnosis and treatment). EVIDENCE ACQUISITION: The present document is based on a narrative review of the limited data available in the urological literature on SARS-Cov-2 and the experience of FFU experts from several countries around the world. EVIDENCE SYNTHESIS: In all the treatment schemes proposed in the literature on the COVID-19 pandemic, FFU surgery is not adequately covered and usually grouped into the category that is not urgent or can be delayed, but in a sustained pandemic scenario there are cases that cannot be delayed that should be considered for surgery as a priority. The aim of this document is to provide a detailed management plan for noninvasive and invasive FFU consultations, investigations, and operations. A classification of FFU surgical activity by indication and urgency is proposed, as well as recommendations adopted from the literature for good surgical practice and by surgical approach in FFU in the COVID-19 era. CONCLUSIONS: Functional, benign, and pelvic floor conditions have often been considered suitable for delay in challenging times. The long-term implications of this reduction in functional urology clinical activity are currently unknown. This document will help functional urology departments to reorganize their activity to best serve their patients. PATIENT SUMMARY: Many patients will suffer delays in urology treatment because of COVID-19, with consequent impairment of their physical and psychological health and deterioration of their quality of life. Efforts should be made to minimize the burden for this patient group, without endangering patients and health care workers.


Assuntos
Infecções por Coronavirus/prevenção & controle , Pandemias/prevenção & controle , Equipamento de Proteção Individual , Pneumonia Viral/prevenção & controle , Telemedicina , Doenças Urológicas/diagnóstico , Doenças Urológicas/terapia , Urologia/métodos , Assistência Ambulatorial , Betacoronavirus , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/transmissão , Cistite Intersticial/diagnóstico , Cistite Intersticial/terapia , Gerenciamento Clínico , Feminino , Humanos , Sintomas do Trato Urinário Inferior/diagnóstico , Sintomas do Trato Urinário Inferior/terapia , Masculino , Pneumonia Viral/epidemiologia , Pneumonia Viral/transmissão , Incontinência Urinária/diagnóstico , Incontinência Urinária/terapia , Retenção Urinária/diagnóstico , Retenção Urinária/terapia , Infecções Urinárias/diagnóstico , Infecções Urinárias/terapia , Procedimentos Cirúrgicos Urológicos , Fístula Vesicovaginal/diagnóstico , Fístula Vesicovaginal/terapia
2.
Am J Obstet Gynecol ; 223(2): 260.e1-260.e9, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32502559

RESUMO

BACKGROUND: Rates of postoperative incomplete bladder emptying vary significantly after pelvic reconstructive surgery. With enhanced recovery protocols the paradigm is shifting towards same-day discharge and the rates of incomplete bladder emptying are expected to increase. The optimal length of time for postoperative catheter drainage has not been clearly established. There are no current studies that assess the optimal timing of a repeat voiding trial in women who have unsuccessful same day voiding trials. OBJECTIVE: This study aimed to compare the outcomes of a second voiding trial performed 2-4 days (earlier group) vs 7 days (later group) postoperatively in women with incomplete bladder emptying after vaginal prolapse surgery. Secondary aims included postoperative urinary tract infection rates, total days with a catheter, and patient-reported catheter bother between groups. STUDY DESIGN: Across 2 sites, women undergoing multicompartment vaginal repair were enrolled. Within 6 hours postoperatively, subjects had an active retrograde voiding trial. Those who passed this voiding trial exited the study; those who had persistent incomplete bladder emptying (postvoid residual >100 mL) had a transurethral indwelling catheter placed and were randomized to return for an earlier (postoperative day 2-4) vs later (postoperative day 7) follow-up office voiding trial. Subjects were followed for 6 weeks after surgery. The primary outcome was the rate of unsuccessful repeat office voiding trial. Secondary outcomes included rates of urinary tract infection, total days with a catheter, and subjective catheter bother. A power calculation based on a projected 31% difference, a power of 0.8, and an alpha of 0.05 revealed that 30 subjects were needed in each group. RESULTS: A total of 102 subjects were enrolled; 38 exited on postoperative day 0, leaving 64 subjects for randomization (4 of whom withdrew after randomization). A comparison of data revealed that randomization was effective, with no differences between the earlier and later groups in terms of demographic data or surgical procedures. Using an intention-to-treat analysis, women in the earlier group were more likely to be unsuccessful in their follow-up office voiding trial (23.3%) than the later group (3.3%), with a risk difference of 20% (95% confidence interval, 3.56-36.44) and a relative risk of 7.00 (95% confidence interval, 0.92-53.47; P=.02). A number-needed-to-treat calculation found that for every 5 patients using a catheter for 7 days postoperatively, 1 case of persistent postoperative incomplete bladder emptying was prevented. Rates of catheter bother did not differ between groups at the time of the follow-up office voiding trial or at 6 weeks (P=.09 and P=.20, respectively). Urinary tract infection rates were higher in the earlier group but did not reach statistical significance (23% vs 7%, P=.07). Regression analysis revealed that subjects who required additional pain medication refills were 9.6 times (95% confidence interval, 1.24-73.77) more likely to have persistent incomplete bladder emptying after the follow-up office voiding trial. CONCLUSION: Women with incomplete bladder emptying after multicompartment prolapse repair had a 7-fold higher risk of an unsuccessful repeat office voiding trial if performed within 4 days of surgery than when performed within 7 days of surgery. In addition, requiring additional prescriptions for analgesia increased the risk of an unsuccessful follow-up office voiding trial.


Assuntos
Procedimentos Cirúrgicos em Ginecologia , Prolapso de Órgão Pélvico/cirurgia , Complicações Pós-Operatórias/fisiopatologia , Procedimentos Cirúrgicos Reconstrutivos , Recuperação de Função Fisiológica , Cateterismo Urinário , Retenção Urinária/fisiopatologia , Vagina/cirurgia , Idoso , Feminino , Humanos , Pessoa de Meia-Idade , Complicações Pós-Operatórias/diagnóstico , Slings Suburetrais , Fatores de Tempo , Cateteres Urinários , Retenção Urinária/diagnóstico , Infecções Urinárias/epidemiologia
3.
Eur Urol Focus ; 6(5): 1049-1057, 2020 Sep 15.
Artigo em Inglês | MEDLINE | ID: covidwho-597672

RESUMO

CONTEXT: Coronavirus disease 19 (COVID-19) has changed standard urology practice around the world. The situation is affecting not only uro-oncological patients but also patients with benign and disabling conditions who are suffering delays in medical attention that impact their quality of life. OBJECTIVE: To propose, based on expert advice and current evidence where available, a strategy to reorganize female and functional urological (FFU) activity (diagnosis and treatment). EVIDENCE ACQUISITION: The present document is based on a narrative review of the limited data available in the urological literature on SARS-Cov-2 and the experience of FFU experts from several countries around the world. EVIDENCE SYNTHESIS: In all the treatment schemes proposed in the literature on the COVID-19 pandemic, FFU surgery is not adequately covered and usually grouped into the category that is not urgent or can be delayed, but in a sustained pandemic scenario there are cases that cannot be delayed that should be considered for surgery as a priority. The aim of this document is to provide a detailed management plan for noninvasive and invasive FFU consultations, investigations, and operations. A classification of FFU surgical activity by indication and urgency is proposed, as well as recommendations adopted from the literature for good surgical practice and by surgical approach in FFU in the COVID-19 era. CONCLUSIONS: Functional, benign, and pelvic floor conditions have often been considered suitable for delay in challenging times. The long-term implications of this reduction in functional urology clinical activity are currently unknown. This document will help functional urology departments to reorganize their activity to best serve their patients. PATIENT SUMMARY: Many patients will suffer delays in urology treatment because of COVID-19, with consequent impairment of their physical and psychological health and deterioration of their quality of life. Efforts should be made to minimize the burden for this patient group, without endangering patients and health care workers.


Assuntos
Infecções por Coronavirus/prevenção & controle , Pandemias/prevenção & controle , Equipamento de Proteção Individual , Pneumonia Viral/prevenção & controle , Telemedicina , Doenças Urológicas/diagnóstico , Doenças Urológicas/terapia , Urologia/métodos , Assistência Ambulatorial , Betacoronavirus , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/transmissão , Cistite Intersticial/diagnóstico , Cistite Intersticial/terapia , Gerenciamento Clínico , Feminino , Humanos , Sintomas do Trato Urinário Inferior/diagnóstico , Sintomas do Trato Urinário Inferior/terapia , Masculino , Pneumonia Viral/epidemiologia , Pneumonia Viral/transmissão , Incontinência Urinária/diagnóstico , Incontinência Urinária/terapia , Retenção Urinária/diagnóstico , Retenção Urinária/terapia , Infecções Urinárias/diagnóstico , Infecções Urinárias/terapia , Procedimentos Cirúrgicos Urológicos , Fístula Vesicovaginal/diagnóstico , Fístula Vesicovaginal/terapia
4.
Urology ; 137: 190-195, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31883878

RESUMO

OBJECTIVE: To address renewed interest in nonmesh transvaginal Pelvic Organ Prolapse (POP) repair since the FDA reclassification of transvaginal mesh, our goal was to develop a transvaginal sacrospinous fixation for anterior and apical POP using only autologous fascia lata. We report our experience in 33 patients. METHODS: Autologous Anterior and Apical Pelvic Organ Prolapse (AAA-POP) repair utilizes a 4 × 14 cm piece of fascia lata harvested through a 3-4-inch upper thigh incision. The graft is reconfigured to provide apical fixation to the sacrospinous ligaments and distal fixation to the obturator fascia. Patients were followed by history, SEAPI scores, POP-Q scores, and Visual Analogue Pain Score. Treatment success was defined as absence of symptomatic anterior or apical POP. RESULTS: Thirty-three patients (mean age 63, mean follow-up 12 months) underwent AAA-POP. Treatment was successful in 31 patients (94%), and 2 failures were due to uterine prolapse. Mean harvest site Visual Analog Pain score was 0.27. Five and 7 patients developed nonbothersome thigh bulges and wound paresthesias, respectively. All 4 harvest-site seromas resolved, with 2 requiring simple aspiration. Eleven patients developed urinary retention, 10 (91%) of them after concurrent pubovaginal sling. All resolved after sling loosening (6 patients) or sling lysis (4 patients). CONCLUSION: AAA-POP is an efficacious treatment for patients desiring nonmesh POP repair. Postoperative harvest site issues are minor and typically resolve with expectant management. Patients should be counseled about the potential risk of failure with a uterine-sparing approach and the risk of urinary retention with concurrent pubovaginal sling.


Assuntos
Fascia Lata/transplante , Procedimentos Cirúrgicos em Ginecologia , Prolapso de Órgão Pélvico/cirurgia , Feminino , Procedimentos Cirúrgicos em Ginecologia/efeitos adversos , Procedimentos Cirúrgicos em Ginecologia/métodos , Humanos , Pessoa de Meia-Idade , Diafragma da Pelve/cirurgia , Prolapso de Órgão Pélvico/diagnóstico , Prolapso de Órgão Pélvico/fisiopatologia , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/epidemiologia , Coleta de Tecidos e Órgãos/efeitos adversos , Coleta de Tecidos e Órgãos/métodos , Resultado do Tratamento , Retenção Urinária/diagnóstico , Retenção Urinária/epidemiologia , Retenção Urinária/etiologia , Vagina/cirurgia
6.
BMC Infect Dis ; 19(1): 1051, 2019 Dec 12.
Artigo em Inglês | MEDLINE | ID: mdl-31830905

RESUMO

BACKGROUND: Cryptococcal prostatitis is a rare clinical disease and has never been reported in China. CASE PRESENTATION: We report on a male HIV-infected patient with pulmonary and prostate cryptococcosis that was misdiagnosed (as tuberculosis) and delayed diagnosed. Although the patients accepted anti-fungal treatment and anti-retroviral treatment finally, the physician's mistakes reflect the rarity of this condition in China. CONCLUSION: Cryptococcal prostatitis is a rare disease that unusually presents in immunodeficient patients. Physicians should have a heightened awareness of this particular infection in the immunodeficient population.


Assuntos
Infecções Oportunistas Relacionadas com a AIDS/diagnóstico , Criptococose/diagnóstico , Cryptococcus neoformans/isolamento & purificação , Pneumonia por Pneumocystis/diagnóstico , Prostatite/diagnóstico , Retenção Urinária/diagnóstico , Retenção Urinária/microbiologia , Infecções Oportunistas Relacionadas com a AIDS/tratamento farmacológico , Antifúngicos/administração & dosagem , Antifúngicos/uso terapêutico , China , Criptococose/complicações , Criptococose/tratamento farmacológico , Diagnóstico Tardio , Erros de Diagnóstico , Fluconazol/administração & dosagem , Fluconazol/uso terapêutico , Flucitosina/administração & dosagem , Flucitosina/uso terapêutico , Humanos , Masculino , Pessoa de Meia-Idade , Pneumonia por Pneumocystis/tratamento farmacológico , Pneumonia por Pneumocystis/microbiologia , Prostatite/tratamento farmacológico , Prostatite/microbiologia , Resultado do Tratamento , Voriconazol/administração & dosagem , Voriconazol/uso terapêutico
7.
Emerg Med Clin North Am ; 37(4): 649-660, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31563200

RESUMO

Urinary retention is a common problem encountered in the emergency department. Acute urinary retention (AUR) presents as a sudden inability to voluntarily void, and is typically associated with lower abdominal pain. Its etiology can be varied and multifactorial. Treatment of AUR aims to relieve the obstruction and mitigate the underlying cause of retention. This can generally be accomplished in the emergency department without immediate urologic consultation; however, certain clinical features may require specialist involvement. This article provides an overview of the common causes of urinary retention, as well as emergency department evaluation, treatment, and disposition of patients with acute retention.


Assuntos
Retenção Urinária/diagnóstico , Humanos , Retenção Urinária/etiologia , Retenção Urinária/terapia
9.
J Surg Res ; 243: 83-89, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31170554

RESUMO

BACKGROUND: Postoperative urinary retention (POUR) can impact quality outcomes, leading to urinary tract infections, longer lengths of stay, and increased healthcare costs. The incidence of POUR in bariatric patients is unknown. Our primary objective was to determine the incidence and risk factors contributing to POUR in primary bariatric surgery. METHODS: A retrospective review was conducted on patients who underwent a laparoscopic sleeve gastrectomy (LSG) or laparoscopic Roux-en-Y gastric bypass (LRYGB) from 2013 to 2017. POUR was defined as the inability to urinate postoperatively, requiring urinary catheterization. Univariate and multivariate analyses were performed on perioperative variables and their correlation with POUR. RESULTS: During the study period, 603 patients underwent surgery: 317 (52.6%) LSG and 286 (47.4%) LRYGB. Overall, 49 (8.1%) patients developed POUR. There were no significant differences in preoperative demographics between patients with and without POUR. Patients who underwent an LSG had an increased incidence of POUR compared with LRYGB (P = 0.002). In both procedures, POUR was associated with decreased neostigmine, isolated nondepolarizing muscle relaxant, and reduced intraoperative fluid. LSG and congestive heart failure, as well as LSG and body weight, were independently associated with POUR. Female patients who experienced POUR had significantly increased length of stay. CONCLUSIONS: Risk factors associated with POUR after primary bariatric surgery include LSG, less intraoperative neostigmine and intravenous fluids, and isolated nondepolarizing muscle relaxants. These risk factors can help educate patients and providers, as well as identify quality initiatives that focus on perioperative and anesthetic management to reduce POUR and length of hospital stay.


Assuntos
Cirurgia Bariátrica , Complicações Pós-Operatórias/etiologia , Retenção Urinária/etiologia , Adulto , Idoso , Cirurgia Bariátrica/métodos , Feminino , Humanos , Incidência , Laparoscopia , Tempo de Internação , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Assistência Perioperatória/métodos , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/epidemiologia , Estudos Retrospectivos , Fatores de Risco , Retenção Urinária/diagnóstico , Retenção Urinária/epidemiologia
10.
J Urol ; 202(4): 795-800, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31009288

RESUMO

PURPOSE: We report our experience with long-term outcomes of holmium laser enucleation of the prostate during a period of 18 years. MATERIALS AND METHODS: We reviewed a prospectively collected database from March 1998 through June 2016 for patients who underwent holmium laser enucleation of the prostate for symptomatic benign prostatic hyperplasia as performed or supervised by a single expert surgeon. Demographic and perioperative data were collected, including scores on the I-PSS (International Prostate Symptom Score), quality of life, peak flow rate, post-void residual urine and prostate specific antigen. Perioperative and late adverse events were also assessed. RESULTS: At a median followup of 9.1 years 1,476 patients with a mean age of 70.7 years were included in study. Mean catheter time and hospital stay were 1.2 and 1.3 days, respectively. Mean ± SD I-PSS and quality of life scores (15.9 ± 6.5 vs 6.8 ± 5.6 and 3.1 ± 1.4 vs 1.5 ± 1.4, respectively, each p <0.001) were significantly improved after holmium laser enucleation of the prostate compared to preoperative values. Likewise the mean peak flow rate and post-void residual urine were significantly improved (mean 7.2 ± 4.0 vs 17.7 ± 10.4 ml per second and 204 ± 258 vs 43 ± 73 ml, respectively, each p <0.001) in the 132 patients who could be followed more than 10 years. Perioperative blood transfusion was required in 0.8% of patients. Prostate specific antigen was significantly reduced by 66.7% at the most recent followup (p <0.001). Postoperative complications included urethral stricture and bladder neck contracture in 21 (1.4%) and 30 patients (2.1%), respectively. Repeat holmium laser enucleation of the prostate was required in 21 patients (1.4%). CONCLUSIONS: Holmium laser enucleation of the prostate is a safe, effective and durable procedure to treat benign prostatic hyperplasia during long-term followup.


Assuntos
Terapia a Laser/métodos , Lasers de Estado Sólido/uso terapêutico , Prostatectomia/métodos , Hiperplasia Prostática/cirurgia , Retenção Urinária/cirurgia , Idoso , Idoso de 80 Anos ou mais , Seguimentos , Humanos , Terapia a Laser/efeitos adversos , Terapia a Laser/instrumentação , Tempo de Internação/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Próstata/efeitos da radiação , Próstata/cirurgia , Prostatectomia/efeitos adversos , Prostatectomia/instrumentação , Hiperplasia Prostática/complicações , Qualidade de Vida , Estudos Retrospectivos , Fatores de Tempo , Retenção Urinária/diagnóstico , Retenção Urinária/etiologia
11.
J Coll Physicians Surg Pak ; 29(3): 281-283, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30823960

RESUMO

Ectopic prostatic tissue detected outside the genitourinary system has been rarely reported. A case with a giant pelvic adenoma that originated from ectopic prostatic tissue is presented. A 71-year male was detected with lower abdominal mass for eight months and recurrent acute urinary retention for one week. This patient already had mild lower urinary tract symptoms for three years. The physical examination, laboratory tests, ultrasonography, and MRI of this patient were analysed, and the pathological diagnosis was ectopic prostatic adenoma. The suprapubic incision for pelvic exploration and tumorectomy was chosen. The recognition and awareness of this unusual lesion is important, in order not to confuse this particular lesion with other pelvic tumors.


Assuntos
Coristoma/patologia , Neoplasias Pélvicas/diagnóstico por imagem , Próstata , Hiperplasia Prostática/diagnóstico por imagem , Dor Abdominal/diagnóstico , Dor Abdominal/etiologia , Biópsia por Agulha , China , Coristoma/diagnóstico por imagem , Humanos , Imuno-Histoquímica , Laparotomia/métodos , Imagem por Ressonância Magnética/métodos , Masculino , Pessoa de Meia-Idade , Neoplasias Pélvicas/cirurgia , Hiperplasia Prostática/cirurgia , Doenças Raras , Resultado do Tratamento , Ultrassonografia Doppler/métodos , Retenção Urinária/diagnóstico , Retenção Urinária/etiologia
12.
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
13.
J Am Vet Med Assoc ; 254(4): 483-486, 2019 Feb 15.
Artigo em Inglês | MEDLINE | ID: mdl-30714866

RESUMO

OBJECTIVE To evaluate the effect of urinary bladder lavage on in-hospital recurrence of urethral obstruction (UO) and durations of urinary catheter retention and hospitalization for male cats. DESIGN Randomized controlled clinical trial. ANIMALS 137 male cats with UO. PROCEDURES Following random allocation, cats either did (flush group; n = 69) or did not (no-flush group; 68) undergo urinary bladder lavage with saline (0.9% NaCl) solution after alleviation of the obstruction and placement of a urethral catheter. Signalment, prior history of UO, presence of crystalluria, difficulty of urinary tract catheterization, in-hospital UO recurrence rate, and durations of urinary catheter retention and hospitalization were compared between the flush and no-flush groups. RESULTS Baseline characteristics did not differ significantly between the 2 treatment groups. The in-hospital UO recurrence rate (9/69 [13%]) and median durations of urinary catheter retention (37 hours; range, 3 to 172 hours) and hospitalization (3 days; range, 0.5 to 12 days) for the flush group did not differ significantly from the in-hospital UO recurrence rate (13/68 [19%]) and median durations of urinary catheter retention (36 hours; range, 1 to 117 hours) and hospitalization (3 days; range, 1 to 9 days) for the no-flush group. CONCLUSIONS AND CLINICAL RELEVANCE Results indicated that, for male cats with UO, urinary bladder lavage at the time of urethral catheterization had no significant effect on in-hospital recurrence rate of the condition, duration of urinary catheter retention, or duration of hospitalization; however, additional studies are necessary to validate or refute these findings.


Assuntos
Doenças do Gato/diagnóstico , Irrigação Terapêutica/veterinária , Obstrução Uretral/veterinária , Cateterismo Urinário/veterinária , Retenção Urinária/veterinária , Animais , Doenças do Gato/terapia , Gatos , Hospitalização , Masculino , Recidiva , Obstrução Uretral/diagnóstico , Obstrução Uretral/terapia , Bexiga Urinária , Retenção Urinária/diagnóstico , Retenção Urinária/terapia
14.
Int Urogynecol J ; 30(9): 1519-1525, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-30715577

RESUMO

INTRODUCTION AND HYPOTHESIS: To assess whether detrusor underactivity (DU) is a risk factor for voiding dysfunction (VD) after transobturator tape (TOT) and if a detrusor pressure at maximum flow (PdetQmax) value predicts postoperative VD in DU patients. Also, we examined uncomplicated patients for postoperative VD. METHODS: This is a prospective long-term study on SUI patients who underwent TOT. Exclusion criteria were preoperative POP stage ≥ 2, previous anti-incontinence surgery and comorbidities. Patients were grouped by detrusor contractility using the projected isovolumetric pressure (PIP) index (PdetQmax + maximum flow rate) with values of 30-75 cmH2O indicating normal contractility. Follow-up was at 1, 3, 6 and 12 months, and then annually. All patients underwent a stress test and responded to the Urogenital Distress Inventory questionnaire and to the King's Health Questionnaire. The subjective cure was evaluated using the Patient Global Impression of Improvement. We determined the diagnostic accuracy of PdetQmax levels using ROC curve analysis, with a cut-off point calculated for optimal sensitivity and specificity. RESULTS: In 2007-2013, 118 patients underwent TOT. We included 50 in the undercontractility group (G1) and 50 in the normocontractility group (G2). Continence rates were 82% in G1 and 84% in G2 (mean follow-up 76 months). VD increased from 18 to 36% (p < 0.05) in G1 and from 14 to 16% (p = 0.198) in G2. De novo VD was 28% in G1 and 2% in G2. In the G1 group PdetQmax ≤ 12 cmH2O predicted postoperative VD with 71.4% specificity and 80.0% sensitivity. CONCLUSIONS: DU adversely affects the voiding phase of micturition after TOT. In DU patients, PdetQmax ≤ 12 cmH2O predicts postoperative VD.


Assuntos
Complicações Pós-Operatórias/etiologia , Slings Suburetrais/efeitos adversos , Bexiga Inativa/cirurgia , Incontinência Urinária por Estresse/cirurgia , Retenção Urinária/etiologia , Adulto , Idoso , Técnicas de Diagnóstico Urológico/estatística & dados numéricos , Feminino , Humanos , Pessoa de Meia-Idade , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/fisiopatologia , Estudos Prospectivos , Fatores de Risco , Sensibilidade e Especificidade , Inquéritos e Questionários , Bexiga Inativa/complicações , Bexiga Inativa/fisiopatologia , Incontinência Urinária por Estresse/complicações , Incontinência Urinária por Estresse/fisiopatologia , Retenção Urinária/diagnóstico , Retenção Urinária/fisiopatologia , Micção , Urodinâmica
15.
Lancet Infect Dis ; 19(4): e132-e142, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30454904

RESUMO

Angiostrongylus cantonensis is the most common cause of eosinophilic meningitis worldwide. Infection typically occurs through ingestion of undercooked molluscs or vegetables contaminated by infective larvae. Endemic regions were previously limited to southeast Asia and the Pacific basin; however, this parasite is seeing an alarming increase in global distribution with reported cases in more than 30 countries, including several states in the USA. Although infection typically results in meningitis, a broad spectrum of CNS involvement and severity is emerging as diagnostic methods (such as real-time PCR) continue to improve diagnosis. In this Grand Round, we report a case of a 20-year-old active duty US marine serving in Okinawa, Japan, afflicted with severe CNS angiostrongyliasis marked by radiculomyelitis with quadriparesis, hyperaesthesia, and urinary retention. We present this case to highlight that no clear guidelines exist for the treatment of severe CNS angiostrongyliasis and provide our consensus recommendation that treatment algorithms include use of dual corticosteroids plus anthelmintics when radicular symptoms are present. In this Grand Round we review the clinical features, epidemiology, advances to diagnostic techniques, and available data on current treatment options for CNS angiostrongyliasis. This diagnosis should be highly considered in the differential diagnosis of a patient presenting with meningeal symptoms, paraesthesia or hyperaesthesia, and CSF eosinophilia so that treatment can be started early, which is particularly important in children, because of their increased risk of severe disease and mortality. We recommend combined therapy with albendazole and prednisolone, with consideration for increased steroid dosing in severe cases.


Assuntos
Eosinofilia/diagnóstico , Hiperestesia/diagnóstico , Meningite/diagnóstico , Quadriplegia/diagnóstico , Infecções por Strongylida/diagnóstico , Retenção Urinária/diagnóstico , Corticosteroides/uso terapêutico , Albendazol/uso terapêutico , Angiostrongylus cantonensis/efeitos dos fármacos , Angiostrongylus cantonensis/patogenicidade , Angiostrongylus cantonensis/fisiologia , Animais , Anti-Helmínticos/uso terapêutico , Diagnóstico Diferencial , Eosinofilia/tratamento farmacológico , Eosinofilia/parasitologia , Eosinofilia/patologia , Humanos , Hiperestesia/tratamento farmacológico , Hiperestesia/parasitologia , Hiperestesia/patologia , Imagem por Ressonância Magnética , Masculino , Meningite/tratamento farmacológico , Meningite/parasitologia , Meningite/patologia , Prednisolona/uso terapêutico , Quadriplegia/tratamento farmacológico , Quadriplegia/parasitologia , Quadriplegia/patologia , Índice de Gravidade de Doença , Infecções por Strongylida/tratamento farmacológico , Infecções por Strongylida/parasitologia , Infecções por Strongylida/patologia , Retenção Urinária/tratamento farmacológico , Retenção Urinária/parasitologia , Retenção Urinária/patologia , Adulto Jovem
16.
BJOG ; 126(6): 804-813, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30548529

RESUMO

OBJECTIVE: To evaluate if immediate catheter removal (ICR) after laparoscopic hysterectomy is associated with similar retention outcomes compared with delayed removal (DCR). STUDY DESIGN: Non-inferiority randomised controlled trial. POPULATION: Women undergoing laparoscopic hysterectomy in six hospitals in the Netherlands. METHODS: Women were randomised to ICR or DCR (between 18 and 24 hours after surgery). PRIMARY OUTCOME: The inability to void within 6 hours after catheter removal. RESULTS: One hundred and fifty-five women were randomised to ICR (n = 74) and DCR (n = 81). The intention-to-treat and per-protocol analysis could not demonstrate the non-inferiority of ICR: ten women with ICR could not urinate spontaneously within 6 hours compared with none in the delayed group (risk difference 13.5%, 5.6-24.8, P = 0.88). However, seven of these women could void spontaneously within 9 hours without additional intervention. Regarding the secondary outcomes, eight women from the delayed group requested earlier catheter removal because of complaints (9.9%). Three women with ICR (4.1%) had a urinary tract infection postoperatively versus eight with DCR (9.9%, risk difference -5.8%, -15.1 to 3.5, P = 0.215). Women with ICR mobilised significantly earlier (5.7 hours, 0.8-23.3 versus 21.0 hours, 1.4-29.9; P ≤ 0.001). CONCLUSION: The non-inferiority of ICR could not be demonstrated in terms of urinary retention 6 hours after procedure. However, 70% of the women with voiding difficulties could void spontaneously within 9 hours after laparoscopic hysterectomy. It is therefore questionable if all observed urinary retention cases were clinically relevant. As a result, the clinical advantages of ICR may still outweigh the risk of bladder retention and it should therefore be considered after uncomplicated laparoscopic hysterectomy. TWEETABLE ABSTRACT: The advantages of immediate catheter removal after laparoscopic hysterectomy seem to outweigh the risk of bladder retention.


Assuntos
Remoção de Dispositivo/métodos , Histerectomia/efeitos adversos , Laparoscopia/efeitos adversos , Cuidados Pós-Operatórios , Cateterismo Urinário/métodos , Retenção Urinária , Adulto , Feminino , Humanos , Histerectomia/métodos , Laparoscopia/métodos , Pessoa de Meia-Idade , Avaliação de Resultados em Cuidados de Saúde , Cuidados Pós-Operatórios/efeitos adversos , Cuidados Pós-Operatórios/instrumentação , Cuidados Pós-Operatórios/métodos , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/fisiopatologia , Complicações Pós-Operatórias/terapia , Fatores de Tempo , Cateteres Urinários , Retenção Urinária/diagnóstico , Retenção Urinária/etiologia , Retenção Urinária/fisiopatologia , Retenção Urinária/terapia , Micção/fisiologia
17.
Int J Nurs Knowl ; 30(1): 49-54, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-29214730

RESUMO

PURPOSE: To develop conceptual and operational definitions for defining characteristics and related factors for nursing diagnosis of urinary retention, as contained in Taxonomy II of NANDA-I. DATA SOURCES: Integrative literature review and elaboration of terms related to urinary retention. DATA SYNTHESIS: It includes operational and conceptual definitions of the nursing diagnosis urinary retention. CONCLUSIONS: It is necessary to review the definition of this nursing diagnosis and most of its defining characteristics and related factors. IMPLICATIONS FOR NURSING PRACTICE: The use of internationally known terms for various disciplines in areas of common knowledge helps to standardize the language used by professionals.


Assuntos
Diagnóstico de Enfermagem , Humanos , Terminologia Padronizada em Enfermagem , Retenção Urinária/diagnóstico
18.
Med Mal Infect ; 49(4): 270-274, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30420166

RESUMO

OBJECTIVES: To present a rare neurological complication of dengue fever. PATIENTS AND METHODS: A 24-year-old female presented with acute myelitis seven days after dengue fever onset. RESULTS: The patient presented with intense fever. The day-7 examination revealed a paraparesis, T2 sensory level, and urinary retention. The patient complained of electric discharges in the four limbs. The sitting and standing positions were impossible. An MRI of the spinal cord performed on day 8 revealed diffuse medullar hyper intense lesions on T2-weighted sequences at the cervical and thoracic levels, with enhancement of the thoracic lesion after gadolinium injection. Laboratory tests revealed positive dengue antigen on day 5 and positive IgM/IgG on day 8. Treatment with intravenous pulse methylprednisolone was initiated. CONCLUSION: Dengue virus has not often been reported as a cause of myelitis. Physicians must be aware of this rare complication in patients living in or coming from endemic areas.


Assuntos
Vírus da Dengue/fisiologia , Dengue/complicações , Mielite/virologia , Doença Aguda , Administração Intravenosa , Dengue/diagnóstico , Dengue/tratamento farmacológico , Feminino , Humanos , Metilprednisolona/administração & dosagem , Mielite/diagnóstico , Mielite/tratamento farmacológico , Paraparesia/diagnóstico , Paraparesia/tratamento farmacológico , Paraparesia/virologia , Pulsoterapia , Retenção Urinária/diagnóstico , Retenção Urinária/tratamento farmacológico , Retenção Urinária/virologia , Adulto Jovem
19.
Rev. enferm. UERJ ; 26: e25840, jan.-dez. 2018. ilus
Artigo em Português | LILACS, BDENF - Enfermagem | ID: biblio-991144

RESUMO

Objetivo: identificar evidências científicas sobre as práticas para o diagnóstico da retenção urinária. Método: trata-se de uma Scoping Review. A busca foi realizada nas bases de dados Literatura Latino-Americana e do Caribe em Ciências da Saúde, Web of Science, National Library of Medicine, Cumulative Index to Nursing and Allied Health Literature, The Cochrane Library e SCOPUS. Das 2482 referências encontradas, 23 foram selecionadas. Resultados: os 23 artigos que foram agrupados de acordo com a clínica do paciente: clínica cirúrgica, clínica de reabilitação e clínica obstétrica. E as práticas utilizadas para o diagnóstico da retenção urinária: cateterismo urinário de alívio, por meio do ultrassom portátil de bexiga, com a associação do ultrassom portátil de bexiga e do cateterismo urinário e/ou com medidas não invasivas. Conclusão: o diagnóstico da retenção urinária é um assunto que vem sendo discutido há algum tempo, no entanto, ainda não há um consenso, e a sua prática é realizada muitas vezes sem eficácia.


Objective: to identify scientific evidence on urinary retention diagnostic practices. Method: this scoping review searched the Latin American & Caribbean Health Sciences Literature, Web of Science, National Library of Medicine, Cumulative Index to Nursing and Allied Health Literature, The Cochrane Library and SCOPUS databases. Of the 2482 references found, 23 were selected. Results: the 23 articles were grouped by patient clinic (surgery, rehabilitation or obstetrics) and by urinary retention diagnostic practices (intermittent urinary catheterization, by portable bladder ultrasound, combination of portable bladder ultrasound and urinary catheterization and/ or non-invasive measures). Conclusion: diagnosis of urinary retention is an issue that has been discussed for some time. However, there is still no consensus, and in practice it is often performed ineffectively.


Objetivo:identificar evidencias científicas sobre las prácticas para el diagnóstico de la retención urinaria. Método: se trata de una Scoping Review. Se realizó la búsqueda en las bases de datos Literatura Latinoamericana y del Caribe en Ciencias de la Salud, Web of Science, National Library of Medicine, Cumulative Index to Nursing and Allied Health Literature, The Cochrane Library y SCOPUS. De las 2482 referencias encontradas, se seleccionaron 23. Resultados: los 23 artículos se agruparon según la clínica del paciente: clínica quirúrgica, clínica de rehabilitación y clínica de obstetricia. Y las prácticas utilizadas para el diagnóstico de retención urinaria: cateterismo urinario de alivio, a través de ecografía (portátil) de vejiga, con la combinación de ecografía de vejiga y del cateterismo urinario y/o con medidas no invasivas. Conclusión: el diagnóstico de la retención urinaria es un tema que está siendo discutido desde hace algún tiempo, sin embargo, todavía no existe un consenso y su práctica se realiza a menudo ineficazmente.


Assuntos
Humanos , Retenção Urinária/diagnóstico , Cuidados de Enfermagem , Pesquisa em Enfermagem , Revisão , Prática Clínica Baseada em Evidências
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