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1.
Curr Urol Rep ; 20(9): 54, 2019 Aug 03.
Artigo em Inglês | MEDLINE | ID: mdl-31377881

RESUMO

PURPOSE OF REVIEW: The purpose of this review is to summarize the role and significance of inflammation as a putative additional factor contributing to lower urinary tract symptoms and the progression of benign prostatic hyperplasia. We review (1) the histologic definition of prostatic inflammation and its prevalence, (2) the effects inflammation in the prostate including on risk of acute urinary retention, and (3) the effects of systemic inflammation on the prostate and on voiding. RECENT FINDINGS: Inflammation is a highly prevalent finding in the prostate, both on a histological and biochemical level. Men with inflammation have higher IPSS scores and increased prostate size; however, these differences appear to be imperceptibly small. Men with inflammation do experience a significantly increased risk of developing acute urinary retention, an event that is associated with significant morbidity. Recently, attempts have been made to identify more specific biochemical markers of local inflammation, and to identify regional patterns of inflamed tissue within the prostate which may be associated with higher IPSS scores, accelerated progression, and AUR. The effects of systemic inflammatory states, most notably MetS, and their role in LUTS have also been examined. Inflammation is a common finding in prostates of aging men, but its contribution to lower urinary tract symptoms and benign prostatic hyperplasia progression appears to be small when considered as a clinically relevant entity. Advances in the understanding of different forms of inflammation, and their impact when experienced in different locations within the prostate, may refine this knowledge. Systemic inflammation affects voiding, including in the absence of a prostate, but again significant effects of systemic inflammation on the prostate itself are also difficult to demonstrate. Prostatic inflammation is associated with a significantly increased risk of acute urinary retention.


Assuntos
Inflamação/fisiopatologia , Sintomas do Trato Urinário Inferior/fisiopatologia , Hiperplasia Prostática/fisiopatologia , Prostatite/fisiopatologia , Doença Aguda , Progressão da Doença , Humanos , Sintomas do Trato Urinário Inferior/etiologia , Masculino , Hiperplasia Prostática/etiologia , Prostatite/complicações , Retenção Urinária/etiologia , Retenção Urinária/fisiopatologia
2.
Artigo em Russo | MEDLINE | ID: mdl-31407683

RESUMO

OBJECTIVE: To study diagnostic capabilities of somatosensory evoked potentials (SSEP) in clarifying the mechanisms of formation of urinary disorders. MATERIAL AND METHODS: The authors studied the characteristics of nerve impulses during stimulation of the pudendal and tibial nerves in patients with neurogenic urinary retention and cerebral ischemic stroke in the parietal lobes (4 patients), spinal ischemic stroke (10 patients), myelitis at the level of thoracic segments (7 patients), spinal cord cauda equina tumors (3 patients). RESULTS AND CONCLUSION: The study of SSEPs made it possible to determine the localization and nature of damage to the structures of the central nervous system and to establish the neurogenic cause of urinary disorders.


Assuntos
Potenciais Somatossensoriais Evocados , Retenção Urinária , Estimulação Elétrica , Humanos , Neurogênese , Nervo Tibial , Retenção Urinária/fisiopatologia
4.
Int J Colorectal Dis ; 34(8): 1431-1443, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31280352

RESUMO

PURPOSE: Postoperative urinary retention is a common adverse effect after rectal surgery. Current methods for assessing postoperative urinary retention (residual urine volume) are inaccurate and unable to predict long-term retention. Voiding efficiency is an effective indicator of postoperative urinary retention in urological and gynaecological fields, but not in colorectal surgery. We aimed to determine whether voiding efficiency in the initial 24 h after urinary catheter removal was more effective in predicting the incidence of postoperative urinary retention than residual urine volume. METHODS: In this retrospective, observational study using prospectively collected data from patients who visited the colorectal department of a single institution, 549 patients who underwent rectal cancer surgery between April 2012 and May 2016 were initially enrolled, of which 46 were excluded and 503 finally included. RESULTS: The incidence of postoperative urinary retention was 18.5% (93/503). Multivariable logistic regression analyses revealed that the association of postoperative urinary retention with voiding efficiency < 50% was stronger than that with residual urine volume > 100 mL (odds ratio, 38.30 (residual urine volume) and 138.0 (voiding efficiency)). Voiding efficiency was significantly lower in patients with long-term than in those with short-term postoperative urinary retention (adjusted p value = 0.02), whereas residual urine volume was not different between the two groups. Multivariable logistic regression analysis for long-term postoperative urinary retention showed the strongest association with voiding efficiency < 20% (odds ratio, 25.70). CONCLUSIONS: Voiding efficiency is a more effective predictor of postoperative urinary retention than residual urine volume in rectal cancer patients.


Assuntos
Remoção de Dispositivo , Neoplasias Retais/fisiopatologia , Neoplasias Retais/cirurgia , Cateterismo Urinário/efeitos adversos , Retenção Urinária/etiologia , Retenção Urinária/fisiopatologia , Micção , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Curva ROC
5.
Urologe A ; 58(6): 634-639, 2019 Jun.
Artigo em Alemão | MEDLINE | ID: mdl-31139864

RESUMO

BACKGROUND: Sacral neuromodulation (SNM) has been used in the treatment of refractory overactive bladder syndrome, nonobstructive urinary retention and faecal incontinence for almost 40 years now. It is not to be confused with the sacral anterior root stimulation which is exclusively used for bladder dysfunction due to spinal paraplegia. MECHANISM OF ACTION: The principles of SNM are yet to be fully understood. Nevertheless, there is proof of modulating the activity of several micturition-associated, afferent neurons in the spine, brainstem and cerebrum. Thus, premature detrusor contractions are suppressed, the desire to void is delayed and detrusor-sphincter coordination improves. TECHNIQUES OF IMPLANTATION AND STIMULATION: Motor reactions are an important indicator of correct electrode placement. The implantation procedure consists of two stages with an initial trial phase to determine the best possible treatment response through an external generator before implanting the whole stimulating device. Yearly check-up examinations are recommended; wireless adjustments allow for long-lasting symptom reduction. INDICATION AND OUTCOME: Success rates in the treatment of the refractory overactive bladder syndrome and the non-obstructive urinary retention lie above 70% and can still be perceived as sufficient after 5 years of ongoing SNM therapy. There is also profound evidence of SNM being an effective option for patients with faecal incontinence or chronic obstipation. CONTRAINDICATIONS AND RISKS: Children, pregnant women and patients in need of frequent MRI examinations are usually not eligible for SNM therapy. Infection of the implant, technical failure (including lead displacement and battery depletion) and pain in the implantation site are important adverse effects which might require surgical revision. CONCLUSIONS: The indications for SNM in the German health care system can be expected to be expanded upon the chronic pelvic pain syndrome, erectile dysfunction and additional gastrointestinal conditions. Technical progress will continue to improve the risk-benefit ratio of SNM.


Assuntos
Terapia por Estimulação Elétrica/métodos , Incontinência Fecal/terapia , Neuroestimuladores Implantáveis , Plexo Lombossacral/fisiopatologia , Dor Pélvica/terapia , Bexiga Urinária Hiperativa , Bexiga Urinária/inervação , Retenção Urinária/terapia , Criança , Incontinência Fecal/etiologia , Incontinência Fecal/fisiopatologia , Feminino , Humanos , Masculino , Dor Pélvica/fisiopatologia , Gravidez , Sacro , Bexiga Urinária Hiperativa/terapia , Bexiga Inativa , Retenção Urinária/etiologia , Retenção Urinária/fisiopatologia
7.
J Med Vasc ; 44(1): 86-89, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30770087

RESUMO

Isolated aneurysms of the common iliac artery are rare, affecting less than 0.01% of the general adult population. Most of these aneurysms are asymptomatic and are discovered as an incidental finding. We describe an elderly patient presented with a urinary retention, which the investigations had led to the diagnosis of a large left common iliac artery aneurysm.


Assuntos
Aneurisma Ilíaco/complicações , Retenção Urinária/etiologia , Idoso , Implante de Prótese Vascular , Humanos , Aneurisma Ilíaco/diagnóstico por imagem , Aneurisma Ilíaco/cirurgia , Masculino , Recuperação de Função Fisiológica , Resultado do Tratamento , Retenção Urinária/diagnóstico por imagem , Retenção Urinária/fisiopatologia , Urodinâmica
10.
Low Urin Tract Symptoms ; 11(2): O59-O64, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-29473339

RESUMO

OBJECTIVE: The aim of the present study was to examine the clinical features and implications of a feeling of incomplete emptying despite little post-void residual (PVR), because it remains unclear why patients are bothered by such an undefined feeling. METHODS: Data were collected prospectively from 173 consecutive patients (135 men, 38 women) with a complaint of a feeling of incomplete emptying with PVR <50 mL at an initial visit. The International Prostate Symptom Score (IPSS), quality of life (QoL) score, overactive bladder symptom score (OABSS), prostate volume, and PVR were determined. Subjective symptoms were re-evaluated after 8 weeks of medication for co-occurring urinary symptoms. RESULTS: Most patients presented with high scores for a feeling of incomplete emptying, determined by Item 1 on the IPSS. The score for a feeling of incomplete emptying was positively correlated with all IPSS-related scores. Men with a feeling of incomplete emptying more often had co-occurring voiding symptoms with higher scores than women. Significant symptom relief was achieved for a feeling of incomplete emptying as well as voiding and storage symptoms after treatment. In men, there was a positive correlation between the extent of symptom relief of a feeling of incomplete emptying and voiding symptoms. CONCLUSIONS: A feeling of incomplete emptying with little PVR is frequently observed in routine clinical practice in both men and women, along with voiding and storage symptoms. This feeling was simultaneously improved by medications for co-occurring urinary symptoms.


Assuntos
Sintomas do Trato Urinário Inferior/fisiopatologia , Bexiga Urinária Hiperativa/fisiopatologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Qualidade de Vida , Retenção Urinária/fisiopatologia
11.
Neurourol Urodyn ; 38(1): 165-170, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-30248183

RESUMO

AIMS: Cerebral palsy (CP) is characterized by motor impairments as a result of brain injury during development. Patients can have neurogenic bladder dysfunction and are often unable to catheterize through their native urethra. Catheterizable channel (CC) creation can facilitate clean intermittent catheterization (CIC). We have observed that patients with large capacity, low-pressure bladders can develop de novo neurogenic detrusor overactivity (NDO) postoperatively. We sought to better characterize this finding. METHODS: We reviewed the charts of patients 17 years or older with CP seen between 2006 and 2017. Patients undergoing creation of any type of CC without augmentation cystoplasty, due to adequate storage on pre-operative urodynamics (UDS), were included. Pre- and post-operative UDS were reviewed. Frequency of incontinence and use of anticholinergics or intravesical injections of onabotulinum toxin A (Btx) were reviewed. RESULTS: Eight patients with CP underwent CC creation without augmentation. Preoperatively, six of eight patients were in chronic retention with two others performing CIC. Following CC creation, patients in retention required additional NDO management with anticholinergics, mirabegron, or onabotulinumtoxin A. Among those with complete UDS data, 67% demonstrated lower maximum cystometric capacity postoperatively. Median follow-up was 25 months. CONCLUSIONS: CC creation facilitates CIC in adults with CP who are in chronic retention due to pseudodyssynergia. Despite preoperative UDS suggesting an adequate capacity, low-pressure bladder, such patients often manifest de novo NDO and worsening incontinence upon initiation of CIC after surgery. These findings should be considered when determining whether to perform augmentation at the time of CC in adults with CP.


Assuntos
Paralisia Cerebral/complicações , Cateterismo Uretral Intermitente/métodos , Bexiga Urinária/fisiopatologia , Retenção Urinária/fisiopatologia , Retenção Urinária/terapia , Adolescente , Adulto , Toxinas Botulínicas Tipo A/efeitos adversos , Antagonistas Colinérgicos/efeitos adversos , Doença Crônica , Feminino , Seguimentos , Humanos , Masculino , Fármacos Neuromusculares/efeitos adversos , Retenção Urinária/etiologia , Urodinâmica , Procedimentos Cirúrgicos Urológicos , Adulto Jovem
12.
Low Urin Tract Symptoms ; 11(1): 66-71, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-29024564

RESUMO

OBJECTIVE: The aim of the present study was to analyze treatment outcomes and identify videourodynamic factors predictive of successful urethral onabotulinumtoxinA treatment of neurogenic and non-neurogenic detrusor underactivity (DU). METHODS: Patients with DU refractory to medical treatment were treated with injections totaling 100 U onabotulinumtoxinA into the urethral sphincter. Treatment outcomes were assessed 1 month after treatment using the Global Response Assessment. The videourodynamic parameters evaluated included bladder neck status during voiding, bladder sensation, detrusor pressure, maximum flow rate, and post-void residual volume. Treatment outcome was analyzed by patient and baseline videourodynamic characteristics. RESULTS: In all, 60 patients (27 with non-neurogenic and 33 with neurogenic DU) were included in the study and received urethral sphincter injections of 100 U onabotulinumtoxinA in total. Good outcomes were reported in 36 (60%) patients (20 [74.1%] with non-neurogenic and 16 [48.5%] with neurogenic DU). Treatment outcome was significantly better in patients with non-neurogenic than neurogenic DU (P = .039). However, good treatment outcome was not related to age, gender, or any videourodynamic variables, except for an open bladder neck during voiding vs non-opening bladder neck (94.3% vs. 12.0%; P < .0001). The duration of the therapeutic effect was similar between patients with non-neurogenic and neurogenic DU (mean [± SD] 7.37 ± 3.69 vs. 7.69 ± 3.18 months, respectively; P = .788). In all, 12 patients reported de novo urinary incontinence after urethral onabotulinumtoxinA injection, 4 of whom developed stress urinary incontinence and 8 who had exacerbated urgency urinary incontinence. CONCLUSION: Urethral sphincter injection of onabotulinumtoxinA is effective in 60% of patients with DU. Careful videourodynamic interpretation of bladder neck opening enables urologists to select appropriate candidates for onabotulinumtoxinA treatment.


Assuntos
Toxinas Botulínicas Tipo A/administração & dosagem , Bexiga Urinaria Neurogênica/tratamento farmacológico , Bexiga Inativa/tratamento farmacológico , Retenção Urinária/tratamento farmacológico , Agentes Urológicos/administração & dosagem , Idoso , Feminino , Humanos , Injeções , Masculino , Pessoa de Meia-Idade , Uso Off-Label , Estudos Retrospectivos , Resultado do Tratamento , Uretra , Bexiga Urinaria Neurogênica/complicações , Bexiga Urinaria Neurogênica/fisiopatologia , Bexiga Inativa/complicações , Bexiga Inativa/fisiopatologia , Retenção Urinária/etiologia , Retenção Urinária/fisiopatologia , Urodinâmica/fisiologia , Gravação em Vídeo
13.
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 , 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
14.
Neurourol Urodyn ; 38(1): 305-309, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-30407653

RESUMO

AIMS: To describe urologic complications in patients with chronically elevated post-void residual (PVR) volumes and to evaluate other related risk factors during a long-term follow-up in patients managed conservatively. METHODS: Non-neurogenic patients who refused surgical intervention of the prostate and had PVR volumes >300 mL on two or more separate occasions at least 6 months apart were included. We followed this cohort over time, recorded complications and evaluated risk factors for complications. RESULTS: Twenty-eight men with a mean age of 74 were followed for a median of 56 months (IQR: 26-101 months); 26 had benign prostatic hyperplasia with a median prostate size of 55 cc. Baseline median PVR was 468 cc (IQR: 395-828) and follow-up median PVR was 508 cc (IQR: 322-714). During follow-up, 13 patients (46%) had at least one complication with acute urinary retention being the most common occurring in 10 patients (36%) with 15 episodes. Other complications presented in less than 15%, and no patients developed permanent renal insufficiency. Patients with prostate size ≥ 100 cc had significantly higher total number of acute retention episodes (P-value: 0.01). CONCLUSIONS: Although the presence of CUR could commonly predispose to episodes of acute retention, severe complications are infrequent although present. Additionally, prostate size may play a role in increasing some adverse outcomes. With proper counseling about different complications, patients with retention who denied surgical treatment can be safely followed for at least 5 years without renal deterioration.


Assuntos
Hiperplasia Prostática/complicações , Retenção Urinária/terapia , Idoso , Idoso de 80 Anos ou mais , Tratamento Conservador , Seguimentos , Humanos , Masculino , Hiperplasia Prostática/fisiopatologia , Resultado do Tratamento , Retenção Urinária/etiologia , Retenção Urinária/fisiopatologia
15.
Neurourol Urodyn ; 38(1): 81-86, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-30411811

RESUMO

AIMS: To examine the protective effects of caffeine in rats with diabetes mellitus (DM) by using urodynamics. METHODS: Female Sprague-Dawley rats (n = 24) were divided into four groups: control group, DM group, DM + caffeine (5 mg/kg/day), and DM + caffeine (10 mg/kg/day). DM was induced by streptozotocin (STZ). Cystometric studies were conducted on all rats. After 8 weeks of treatment with caffeine, the urodynamic parameters, including bladder capacity, residual urine volume, voiding time, and peak voiding pressure, were measured. RESULTS: DM rats had a higher bladder capacity and post-void residual urine volume (PVR), an increased voiding time and peak voiding pressure, and a markedly lower voiding efficiency than the control group rats. After treatment with caffeine, bladder capacity, post-void residual urine volume, and peak voiding pressure were significant lower than those in the DM group, but voiding efficiency was markedly higher. CONCLUSION: The results suggested that caffeine (5 or 10 mg/kg/day) may improve the bladder function at 8 weeks after STZ induction. Thus, this may represent a potential strategy to increase voiding efficiency in diabetes.


Assuntos
Cafeína/uso terapêutico , Estimulantes do Sistema Nervoso Central/uso terapêutico , Diabetes Mellitus Experimental/complicações , Bexiga Urinária/fisiopatologia , Animais , Relação Dose-Resposta a Droga , Feminino , Ratos , Ratos Sprague-Dawley , Retenção Urinária/tratamento farmacológico , Retenção Urinária/etiologia , Retenção Urinária/fisiopatologia , Micção/efeitos dos fármacos , Urodinâmica
16.
Low Urin Tract Symptoms ; 11(3): 104-108, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30182536

RESUMO

OBJECTIVE: Acute urinary retention (AUR) is the sudden and painful inability to urinate spontaneously. AUR is one of the most significant complications of benign prostatic enlargement. The management of AUR is based on transurethral catheterization. Subsequent therapy is uncertain, but AUR seems to benefit from the use of alpha-blockers. The aim of this study was to evaluate the variables that could predict which patients would recover spontaneous micturition after trial without catheter. METHODS: The present prospective observational study included men with AUR in an Italian tertiary care institute in 2016. Patients were catheterized and treated orally with fluoroquinolones, alpha-blockers, and Serenoa repens extracts. Preoperative variables as age, C-reactive protein (CRP), previous prostate-specific antigen values, urinary retention volume, prostate volume, and scores on a modified International Prostate Symptom Score questionnaire (IPSS-4), were investigated in relation to spontaneous micturition recovery. RESULTS: Mean (±SD) age was 68.4 ± 7.1 years. Spontaneous and valid micturition recovery was observed in 11 patients (29.7%), whereas 26 (70.3%) needed to be catheterized again. The IPSS-4 score was significantly lower (9 vs 17; P < .001) and CRP values were significantly higher (43.00 vs 1.00 mg/dL; P < .001) in patients who recovered spontaneous micturition. The IPSS-4 scores and CRP showed an area under the curve of 0.85 and 0.87, respectively. for the prediction of spontaneous and valid micturition recovery. CONCLUSION: CRP and IPSS-4 could be useful tools to predict spontaneous micturition recovery after catheterization associated with medical therapy for AUR.


Assuntos
Próstata/patologia , Hiperplasia Prostática/complicações , Recuperação de Função Fisiológica , Retenção Urinária/fisiopatologia , Retenção Urinária/terapia , Micção , Doença Aguda , Idoso , Área Sob a Curva , Proteína C-Reativa/metabolismo , Humanos , Masculino , Pessoa de Meia-Idade , Tamanho do Órgão , Estudos Prospectivos , Hiperplasia Prostática/patologia , Curva ROC , Índice de Gravidade de Doença , Cateterismo Urinário , Retenção Urinária/etiologia
17.
J Trauma Nurs ; 25(6): 356-359, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30395035

RESUMO

The objective of this retrospective study was to gain a better understanding of patient and care factors that may contribute to urinary retention in critically ill trauma patients. Fifty trauma patients over a 1-year period with an International Classification of Diseases, Tenth Revision (ICD-10) code for urinary retention were identified and analyzed. Most patients had an indwelling urinary catheter placed on admission, and it was reinserted in 39 patients. Male gender, orthopedic trauma, and anesthesia were possible contributing factors for urinary retention in our sample population. The use of paralytics and more than one operative intervention had a significant relationship with prescribing bladder medications. It is imperative to have protocols based on best evidence to guide management of urinary retention in this critically ill trauma patient population.


Assuntos
Cateteres de Demora/efeitos adversos , Estado Terminal/terapia , Prazosina/análogos & derivados , Tansulosina/uso terapêutico , Retenção Urinária/tratamento farmacológico , Adulto , Estudos de Coortes , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prazosina/uso terapêutico , Prognóstico , Estudos Retrospectivos , Fatores de Risco , Traumatismos da Coluna Vertebral/complicações , Centros de Traumatologia , Resultado do Tratamento , Cateterismo Urinário/efeitos adversos , Cateterismo Urinário/métodos , Retenção Urinária/etiologia , Retenção Urinária/fisiopatologia
19.
Eur Urol ; 74(5): 633-643, 2018 11.
Artigo em Inglês | MEDLINE | ID: mdl-30139634

RESUMO

CONTEXT: Detrusor underactivity (DUA) is a common but relatively under-researched bladder dysfunction. Underactive bladder (UAB) is the symptom-based correlate of DUA. Recently, there has been renewed interest in this topic. OBJECTIVE: To systematically review and summarise the most recent literature and discuss this in the context of what is already known. EVIDENCE ACQUISITION: A systematic review of the literature was performed in December 2017 using Medline and Scopus databases. Separate searches of each database used a complex search strategy including "free text" protocols. Search terms included "underactive bladder", "detrusor underactivity", "acontractile bladder", "detrusor failure", "detrusor areflexia", "atonic bladder", "chronic retention", and "impaired bladder contractility". EVIDENCE SYNTHESIS: The initial search retrieved a total of 1690 studies; of these 44 were included in the final analyses. CONCLUSIONS: Although there has been an expansion in the literature concerning all aspects of DUA and UAB, knowledge on its epidemiology and aetiopathogenesis is still lacking; there remains a need to develop accurate reproducible diagnostic criteria and effective treatments, in particular drug therapies. PATIENT SUMMARY: Recently, there has been renewed interest in underactive bladder with expanding research in this area. The lack of simple, reproducible, noninvasive diagnostic criteria has precluded an accurate estimation of the magnitude of the problem. Recent studies have highlighted the potential role of impaired bladder blood supply in causing bladder underactivity.


Assuntos
Bexiga Inativa/tratamento farmacológico , Bexiga Urinária/efeitos dos fármacos , Retenção Urinária/tratamento farmacológico , Agentes Urológicos/uso terapêutico , Adulto , Idoso , Idoso de 80 Anos ou mais , Animais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Recuperação de Função Fisiológica , Fatores de Risco , Resultado do Tratamento , Bexiga Urinária/fisiopatologia , Bexiga Inativa/diagnóstico , Bexiga Inativa/epidemiologia , Bexiga Inativa/fisiopatologia , Retenção Urinária/diagnóstico , Retenção Urinária/epidemiologia , Retenção Urinária/fisiopatologia , Urodinâmica/efeitos dos fármacos , Agentes Urológicos/efeitos adversos
20.
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
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