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1.
Int Braz J Urol ; 45(4): 798-806, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31184452

RESUMO

OBJECTIVES: To determine the differences between voiding symptoms obtained by open anamnesis (VS-Open) versus voiding symptoms obtained by directed anamnesis (VSDirected) to predict voiding dysfunction in women. MATERIALS AND METHODS: Retrospective study of women with prior anti-incontinence surgery evaluated during 5 years. In a standardized clinical history taking, each patient was asked to answer question number fi ve of the UDI-6 questionnaire ("Do you experience any difficulty emptying your bladder?"). If the answer was positive, the following voiding symptoms spontaneously described by the patient were documented: slow urine stream, straining to void, intermittent stream and feeling of incomplete bladder emptying, which were considered VS-Open. If the answer to this question was negative or if the patient had not reported the four voiding symptoms, she was asked in a directed manner about the presence of each of them, which were considered VS-Directed. Voiding dysfunction was considered the presence of a maximum fl ow ≤ 12 mL/s and/ or a postvoid residual > 100 mL. RESULTS: Ninety-one women are analyzed. Eighteen patients presented voiding dysfunction (19.8%), There was a statistical association between voiding dysfunction and the presence of any VS-Open (p = 0.037) and straining to void obtained by open anamnesis (p = 0.013). Sensitivity, specificity, PPV, NPV, positive likelihood ratio and negative likelihood ratio, respectively, were 44.4% and 27.8%, 80.8% and 94.5%, 36.3% and 55.6%, 85.5% and 84.1%, 2.324 and 5.129, and 0.686 and 0.764. There was no statistical association between voiding dysfunction and VS-Directed. CONCLUSIONS: VS-Open may predict better voiding dysfunction than VS-Directed in women.


Assuntos
Anamnese/métodos , Transtornos Urinários/diagnóstico , Transtornos Urinários/fisiopatologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Valores de Referência , Reprodutibilidade dos Testes , Estudos Retrospectivos , Inquéritos e Questionários , Bexiga Urinária/fisiopatologia , Incontinência Urinária/cirurgia , Urodinâmica
2.
Muscle Nerve ; 60(2): 202-210, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-31095755

RESUMO

INTRODUCTION: With increasing life expectancy, comorbidities become overt in Duchenne muscular dystrophy (DMD). Although micturition problems are common, bladder function is poorly understood in DMD. We studied dystrophin expression and multiple isoform involvement in the bladder during maturation to gain insights into their roles in micturition. METHODS: Dystrophin distribution was evaluated in rat bladders by immunohistochemical colocalization with smooth muscle, interstitial, urothelial, and neuronal markers. Protein levels of Dp140, Dp71, and smooth muscle were quantitated by Western blotting of neonatal to adult rat bladders. RESULTS: Dystrophin colocalized with smooth muscle cells and afferent nerve fibers. Dp71 was expressed two- to threefold higher compared with Dp140, independently of age. Age-related muscle mass changes did not influence isoform expression levels. DISCUSSION: Dystrophin is expressed in smooth muscle cells and afferent nerve fibers in the urinary bladder, which underscores that micturition problems in DMD may have not solely a myogenic but also a neurogenic origin. Muscle Nerve 60: 202-210, 2019.


Assuntos
Distrofina/metabolismo , Músculo Liso/metabolismo , Fibras Nervosas/metabolismo , Neurônios Aferentes/metabolismo , Bexiga Urinária/metabolismo , Animais , Masculino , Músculo Liso/inervação , Distrofia Muscular de Duchenne/complicações , Distrofia Muscular de Duchenne/fisiopatologia , Isoformas de Proteínas/metabolismo , Ratos , Bexiga Urinária/inervação , Transtornos Urinários/etiologia , Transtornos Urinários/fisiopatologia
3.
Actas urol. esp ; 43(4): 212-219, mayo 2019. tab, graf
Artigo em Espanhol | IBECS | ID: ibc-181087

RESUMO

Objetivos: Valorar el rendimiento diagnóstico de los patrones de micción disfuncional asociados al reflujo vesicoureteral (RVU) en niños mayores de 3 años, en función del resultado del primer tratamiento endoscópico (T1END), agrupados en una clasificación diseñada por nuestro grupo (CMD.URI-La Fe) y su comparación con otras clasificaciones existentes como la de Van Batavia et al. Material y métodos: Estudio transversal ambispectivo de una muestra de 50 niños. Criterios de exclusión: TEND previo, edad ≤ 3 años, anomalías anatómicas o neurológicas y antecedentes de cirugía uretral o abdominopélvica. Previamente al T1END se realizó una valoración de la función de vaciado vesical mediante flujometría + electromiografía (UF-EMG) y del residuo posmiccional (ecografía). Se obtuvieron otras variables procedentes del diario miccional, el espesor de la pared vesical premiccional (ecografía), así como variables clínicas. La corrección del RVU fue valorada mediante cistografía isotópica a los 3 meses del tratamiento. Se realizó una clasificación de los patrones miccionales en función de las variables significativas (URI-La Fe) y se valoró su rendimiento diagnóstico, comparándola al clasificar a los pacientes según propone Van Batavia et al. Resultados: Media de edad: 6,8 ± 2,28 años. Varones/mujeres (44%/56%). Grados de RVU: leve, moderado, severo. Tasa de corrección del RVU T1END: 77% (n = 38). Rendimiento diagnóstico (Van Batavia; URI-La Fe): predicción correcta (37,5%; 75%), sensibilidad (32,4%; 87,8%), especificidad (54,5%; 46,6%), valor predictivo positivo (70,6; 78,3%) y valor predictivo negativo (19,4%; 63,6%). Conclusiones: Nuestros resultados muestran la utilidad del estudio no invasivo y la clasificación de la disfunción miccional del niño mayor de 3 años previo al primer tratamiento endoscópico del RVU


Objectives: To assess the diagnostic performance of urinary dysfunction patterns associated with vesicoureteral reflux (VUR) in children over the age of 3 according to the result of the first endoscopic treatment (ENDT1), grouped into a classification designed by our group (CMD.URI-La Fe). Comparison with other current classifications such as that of Van Batavia et al. Material and methods: Ambispective cross-cutting study of a sample of 50 children. Exclusion criteria: previous ENDT, age ≤ 3 years, anatomical or neurological anomalies and a history of ureteral or abdominopelvic surgery. Prior to the ENDT1, a bladder voiding function assessment by uroflowmetry+electromyography (UF-EMG) and post-mictional residue (ultrasound). Other variables from the bladder diary, pre-mictional bladder wall thickness and other clinical variables. The correction of VUR was assessed by isotope cystography 3 months after the treatment. Urinary patterns were classified according to the significant variables (URI-La Fe), and the diagnostic performance of this classification was assessed, comparing it to the classification of patients as proposed by Van Batavia et al. Results: Mean age: 6.8±2.28 years. Males/females (44%/56%). Grades of VUR (mild/moderate/severe). ENDT1 VUR correction rate: 77% (n=38). Diagnostic performance (Van Batavia; URI-La Fe): correct prediction (37.5%; 75%), sensitivity (32.4%; 87.8%), specificity (54.5%; 46.6%), positive predictive value (70.6; 78.3%) and negative predictive value (19.4%; 63.6%). Conclusions: Our results show the usefulness of the non-invasive test and the classification of urinary dysfunction in children aged over 3 years prior to the first endoscopic treatment of VUR


Assuntos
Humanos , Masculino , Feminino , Pré-Escolar , Criança , Refluxo Vesicoureteral/cirurgia , Endoscopia/métodos , Micção/fisiologia , Criança , Refluxo Vesicoureteral/fisiopatologia , Prognóstico , Transtornos Urinários/fisiopatologia , Urodinâmica/fisiologia , Diagnóstico , Estudos Transversais
5.
Clin Orthop Relat Res ; 477(4): 872-878, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30844824

RESUMO

BACKGROUND: Lower urinary tract symptoms (LUTS) and urinary bother have been reported in adults undergoing surgery and have been associated with urinary tract infections, longer hospital stays, increased surgical costs, and decreased patient satisfaction. Previous reports indicate that up to one in two patients with lumbar spine pathology have moderate-to-severe LUTS, but little is known about LUTS in patients with cervical spine conditions. QUESTIONS/PURPOSES: (1) What is the prevalence of moderate-to-severe LUTS and clinically relevant urinary bother among patients undergoing elective cervical spine surgery? (2) Does the presence of myelopathy affect frequency of moderate-to-severe LUTS or clinically relevant urinary bother among patients undergoing elective cervical spine surgery? (3) Do MRI findings of spinal cord injury or compression correlate with presence and severity of LUTS? METHODS: We performed a cross-sectional study using clinical data collected from adult patients undergoing elective cervical spine surgery. Over an approximately 30-month period, we approached all patients who were evaluated in the preoperative clinic before undergoing elective cervical spine surgery. Of the 257 approached, 242 participated (94%). Study participants ranged in age from 34 to 83 years with a mean age of 58 years (SD 12). There were 108 males (45%) and 134 females (55%). A validated questionnaire, the International Prostate Symptom Score (IPSS), was used to identify LUTS. The IPSS score ranges from 0 to 35 points with LUTS presence defined as a score of ≥ 8 and LUTS severity categorized as mild (IPSS 0-7), moderate (IPSS 8-19), or severe (IPSS 20-35). Quality of life resulting from urinary bother is scored 0 to 6 with scores ≥ 4 considered clinically relevant urinary bother. Patients were grouped into a myelopathy group and a nonmyelopathy group based on diagnosis as assigned by the operating surgeon. MRIs were analyzed by one spine surgeon to identify the presence of cord signal, number of levels with cord compression (mm), and a calculated compression ratio score with cord compression and with compression ratio among patients with myelopathy. RESULTS: The prevalence of moderate LUTS in our patient sample was 40% (97 of 242; 95% confidence interval [CI], 34%-47%). The prevalence of severe LUTS in our patient sample was 8% (19 of 242; 95% CI, 5%-12%). Clinically relevant urinary bother was reported in 18% of patients (41 of 228; 95% CI, 13%-24%). After adjustment for age and sex, the odds of moderate-to-severe LUTS among patients with myelopathy was greater than that observed in patients without myelopathy (adjusted odds ratio, 2.0; p = 0.015). The prevalence of clinically relevant urinary bother was higher in patients with myelopathy (30% [26 of 88]) compared with those with no myelopathy (11% [15 of 140]; p < 0.001). With the numbers available, among patients with myelopathy, there was no difference in distribution of LUTS symptom severity or IPSS score according to cord signal presence (50% [23 of 46]) and absence (65% [31 of 48]; p = 0.153), number of levels with compression (70% [seven of 10 with four levels]; 59% [13 of 22 with three levels]; 51% [19 of 37] with two levels; and 60% [15 of 25] with one level; p = 0.730), millimeters of cord compression (r = 0.02; p = 0.854), or compression ratio (r = 0.09; p = 0.413). CONCLUSIONS: Nearly half of all patients undergoing elective cervical spine surgery had moderate-to-severe LUTS. This is more than double the prevalence that has been reported in a community-dwelling adult population. These symptoms can impair quality of life, lead to surgical complications (urinary retention or incontinence), and may be mistaken for cauda equina, prompting potentially unnecessary imaging and studies. Given that urinary bother is reported less frequently than LUTS, patients may be less likely to seek care for urinary symptoms before undergoing surgery. Therefore, it is important to increase provider awareness of the high prevalence of LUTS. LEVEL OF EVIDENCE: Level III, prognostic study.


Assuntos
Sintomas do Trato Urinário Inferior/epidemiologia , Procedimentos Ortopédicos , Doenças da Medula Espinal/cirurgia , Medula Espinal/cirurgia , Transtornos Urinários/epidemiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Vértebras Cervicais , Efeitos Psicossociais da Doença , Estudos Transversais , Procedimentos Cirúrgicos Eletivos , Feminino , Humanos , Sintomas do Trato Urinário Inferior/diagnóstico , Sintomas do Trato Urinário Inferior/fisiopatologia , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Oregon/epidemiologia , Procedimentos Ortopédicos/efeitos adversos , Prevalência , Qualidade de Vida , Medula Espinal/diagnóstico por imagem , Medula Espinal/fisiopatologia , Doenças da Medula Espinal/diagnóstico por imagem , Doenças da Medula Espinal/epidemiologia , Doenças da Medula Espinal/fisiopatologia , Transtornos Urinários/diagnóstico , Transtornos Urinários/fisiopatologia
6.
J Neurol ; 266(6): 1340-1350, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30834978

RESUMO

BACKGROUND/AIMS: The presence of non-motor symptoms in Huntington's disease (HD) has not been systematically assessed so far. Our objective was to know their prevalence and to compare it with a cohort of patients with Parkinson's disease (PD). MATERIALS AND METHODS: Participants were consecutively recruited from our outpatient clinic. They were assessed through the motor part of the Unified Huntington's Disease Rating Scale, the motor part of the Unified Parkinson's Disease Rating Scale, the total functional capacity scale and the PD non-motor symptoms questionnaire. RESULTS: We enrolled 123 participants: 53 HD, 45 PD and 25 healthy controls (HC). Non-motor symptoms were significantly more prevalent in HD patients than in HC. The most frequent non-motor symptoms in HD, involving more than 50% of patients, were attentional deficits, apathy, dysphagia, memory complaints, depression falls, insomnia and urinary urgency. The total score of non-motor symptoms correlated with disease duration, total functional capacity and disease stage. HD scored significantly higher than PD in 11 items (dysphagia, constipation, bowel incontinence, faecal tenesmus, weight loss, memory, apathy, attention, falls, nightmares, delusions) and in four domains (cognitive, hallucinations and delusions, digestive and cardiovascular). PD did not score significantly higher than HD in any domain. CONCLUSIONS: HD patients have a high prevalence of non-motor symptoms, which is even higher than in PD, and correlates with disease progression.


Assuntos
Apatia/fisiologia , Sintomas Comportamentais/fisiopatologia , Disfunção Cognitiva/fisiopatologia , Transtornos de Deglutição/fisiopatologia , Doença de Huntington/fisiopatologia , Doença de Parkinson/fisiopatologia , Distúrbios do Início e da Manutenção do Sono/fisiopatologia , Transtornos Urinários/fisiopatologia , Adulto , Idoso , Sintomas Comportamentais/etiologia , Disfunção Cognitiva/etiologia , Estudos Transversais , Transtornos de Deglutição/etiologia , Feminino , Humanos , Doença de Huntington/complicações , Masculino , Pessoa de Meia-Idade , Doença de Parkinson/complicações , Distúrbios do Início e da Manutenção do Sono/etiologia , Transtornos Urinários/etiologia
7.
Urol Int ; 102(4): 487-491, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30731473

RESUMO

BACKGROUND: Postmicturition dribble (PMD) is a common condition in the male population. OBJECTIVES: Despite its common occurrence, there are only a few studies on this topic so far. The aim of this study was to investigate possible physiological aspects of PMD. METHOD: Seventeen men complaining of PMD and 10 healthy subjects were assessed via uroflometry, IPSS questionnaire, IIEF-5 questionnaire, and an adapted visual analogue scale (VAS) for ejaculation force -(0-10) and the amount of bother concerning PMD (0-10) were completed. In addition to that, a retrograde urethrography at 40 and 60 cm water column as pressure unit to measure the width of the bulbar urethra was performed, and the amount of PMD was measured with an adjusted pad test. RESULTS: The PMD group showed a significantly worse IPSS score, a lower Qmax rate in uroflowmetry, a worse IIEF-5 score, and a worse VAS score concerning ejaculation force. In both groups, worse IPSS levels correlated with a low bulbar urethral diameter at 40 and 60 cm water column. -Another correlation was found between a high maximum urine flow rate and a larger bulbar urethral diameter at 40 and 60 cm. Both groups showed urine loss after micturition, with no bother (VAS 0) in the control group, whereas the PMD group showed a VAS of 6. CONCLUSIONS: PMD should be regarded as a physiological occurrence in men rather than a disease by itself. Suffering is only to be expected in combination with other lower urinary tract symptoms.


Assuntos
Transtornos Urinários/fisiopatologia , Micção , Urodinâmica , Adulto , Idoso , Estudos de Casos e Controles , Ejaculação , Humanos , Masculino , Pessoa de Meia-Idade , Fenômenos Fisiológicos , Estudos Prospectivos , Reologia , Índice de Gravidade de Doença , Inquéritos e Questionários , Uretra/fisiopatologia , Adulto Jovem
8.
Oncology ; 96(4): 183-191, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30625479

RESUMO

PURPOSE: Cancer-related fatigue is one of the most debilitating side effects of cancer and cancer therapy. We aimed to investigate co-occurring symptoms associated with persistent fatigue in men receiving external beam radiation therapy (EBRT) for nonmetastatic prostate cancer. METHODS: A sample of 47 men with prostate cancer scheduled to receive radiotherapy (RT) were followed at baseline and 1 year after RT. Clinical and demographic data were obtained from chart review. Symptom measurements included urinary dysfunction (American Urological Association symptoms score), fatigue (Functional Assessment of Cancer Therapy - Fatigue questionnaire), sleep disturbance (Patient-Reported Outcomes Measurement Information System - Sleep Disturbance form), pain (physical well-being domain pain item of the Functional Assessment of Cancer Therapy - General), and depressive symptoms (Hamilton Depression Rating Scale). Paired t tests, correlations, general linear models, and logistic regressions were used to determine associations between fatigue and other symptom scores. RESULTS: At 1 year after RT, 34% of subjects continued to experience fatigue. Urinary dysfunction was the best clinical predictor of persistent fatigue. Pain and depressive symptoms further improved the predictive power of the model. A multivariate linear regression model containing all these three clinical variables (urinary dysfunction, pain, and depressive symptoms) explained 74% of total variance associated with persistent fatigue after RT. CONCLUSIONS: Persistent fatigue at 1 year after EBRT in prostate cancer survivors is likely related to a cluster of symptoms elicited by chronic inflammation. Therapies that target each of these symptoms will likely reduce fatigue in this patient population.


Assuntos
Fadiga/etiologia , Neoplasias da Próstata/complicações , Neoplasias da Próstata/radioterapia , Afeto , Idoso , Depressão/diagnóstico , Depressão/etiologia , Depressão/psicologia , Fadiga/diagnóstico , Fadiga/fisiopatologia , Fadiga/psicologia , Nível de Saúde , Humanos , Masculino , Saúde Mental , Pessoa de Meia-Idade , Dor/diagnóstico , Dor/etiologia , Dor/fisiopatologia , Neoplasias da Próstata/diagnóstico , Qualidade de Vida , Doses de Radiação , Radioterapia/efeitos adversos , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento , Transtornos Urinários/diagnóstico , Transtornos Urinários/etiologia , Transtornos Urinários/fisiopatologia
9.
Urology ; 126: 59-64, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30654142

RESUMO

OBJECTIVE: To prospectively evaluated the utility of urodynamic evaluations (UDS) ordered in a tertiary referral center as part of a quality improvement project. METHODS: Patients with UDS ordered by 3 subspecialty physicians were included. Physicians were surveyed when ordering UDS and at the post-UDS clinic visit to assess indications for UDS, pre- and post-UDS diagnosis, treatment plan, confidence level, and perceived helpfulness of UDS. UDS trained nurses conducting studies were surveyed on patient reported reproducibility of their symptoms and perceived difficulty of UDS. RESULTS: From April 2017 to October 2017, 127 UDS were included of which 102 met study criteria. UDS were done for neurogenic (23%) and non-neurogenic lower urinary tract symptoms (76%). The majority were conducted for incontinence evaluation (79%), or after prior lower urinary tract surgery (33%). UDS nurses reported 90% of UDS fully or partially reproduced patient symptoms. Nurses found 18% of UDS difficult due to catheter malfunctions, physical limitations, and communication abilities. Post-UDS, providers found 97% of UDS interpretable. UDS resulted in a change in treatment plan in 78% of patients. On a Likert scale, mean pre-UDS confidence level was 2.9 ± 0.8 (range 0-5). This increased to 4.1 ± 0.6 post-UDS with 76% of evaluations having a change of at least 1 point. CONCLUSION: UDS in a tertiary referral center result in change in patient treatment plans over three-fourths of the time with high rates of interpretability.


Assuntos
Transtornos Urinários/diagnóstico , Transtornos Urinários/fisiopatologia , Urodinâmica , Feminino , Humanos , Masculino , Medicina , Pessoa de Meia-Idade , Estudos Prospectivos , Centros de Atenção Terciária , Atenção Terciária à Saúde
10.
Urology ; 126: 54-58, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30682465

RESUMO

OBJECTIVE: To evaluate whether voiding parameters differ in patients with the common overlapping pelvic pain disorders, interstitial cystitis/bladder pain syndrome (IC/BPS), and myofascial pelvic pain (MPP). METHODS: Uroflow and voiding diary assessed voiding phenotypes in this prospective cohort study (ICEPAC) of women comparing IC/BPS, IC/BPS +MPP, MPP, and healthy control (HC) subjects. RESULTS: In 36 HC, 24 IC/BPS, 37 IC/BPS + MPP, and 14 MPP subjects, the voiding diary measurements indicate lower voided volumes in IC/BPS and IC/BPS + MPP groups (185 ± 24 mL, 169 ± 20 mL, respectively) compared to HC and MPP groups (294 ± 24 mL, 226 ± 36 mL, respectively; P <.05, P <.05), as well as higher 24-hour voiding frequency (11.6 ± 0.8 and 11 ± 1.2 voids/24 hours, respectively; HC 7.1 ± 0.5 voids/24 hours; P <.05, P <.05; MPP group 9 ± 1.2 voids/24 hours; P <.05, P <.05). Uroflow showed higher HC average flow rate (12.87 ± 0.92) compared to IC/BPS, IC/BPS+MPP, and MPP (8.31 ± 1.20, 8.02 ± 0.80, 8.17 ± 1.38, respectively; P <.01, P <.01, P <.05) and peak flow rate (27.0 ± 1.83) and IC/BPS, IC/BPS+MPP and MPP (16.20 ± 2.2, 17.33 ± 1.64, 17.21 ± 2.69 respectively; P <.01, P <.01, P <.05). CONCLUSION: This quantitative evaluation of voiding diary and uroflow metrics reveals distinct voiding phenotypes, which can aid in the diagnosis of chronic pelvic pain syndromes. Patients with IC/BPS had more pain with a full bladder despite similar overall pain scores. Peak and average flow rates do not provide any differentiating power between IC/BPS and MPP patients. A longer time to peak flow may favor MPP though this finding needs confirmation.


Assuntos
Cistite Intersticial/complicações , Síndromes da Dor Miofascial/complicações , Dor Pélvica/complicações , Transtornos Urinários/etiologia , Adulto , Estudos Transversais , Cistite Intersticial/fisiopatologia , Feminino , Humanos , Pessoa de Meia-Idade , Síndromes da Dor Miofascial/fisiopatologia , Dor Pélvica/fisiopatologia , Fenótipo , Micção , Transtornos Urinários/genética , Transtornos Urinários/fisiopatologia , Urodinâmica
11.
Neuromodulation ; 22(6): 730-737, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-30609180

RESUMO

PURPOSE: This five-year, retrospective, multicenter study evaluated the long-term safety and efficiency of sacral neuromodulation (SNM) in Chinese patients with urinary voiding dysfunction. PATIENTS AND METHODS: This is a Chinese national, multicenter, retrospective study that included 247 patients (51.2% female) who received an implantable pulse generator (IPG) (InterStim, Medtronic, Minneapolis, MN, USA) between 2012 and 2016. Success was considered if the initial ≥50% improvement in any of primary voiding diary variables persisted compared with baseline. The results were further stratified by identifying patients who showed >50% improvement and those although showed <50% improvement but still wanted to receive IPG; these data were collected and analyzed for general improvement. RESULTS: Following test stimulation, 187 patients (43%) declined implantation and 247 (57%) underwent implantation using InterStim®. Among 247 patients, 34 (13.7%) had overactive bladder (OAB), 59 (23.8%) had interstitial cystitis/bladder pain syndrome (IC/BPS), 47 (19%) had idiopathic urinary retention (IUR), and 107 (44.1%) had neurogenic bladder (NB). IPG efficiency rate for OAB, interstitial cystitis/bladder pain syndrome, idiopathic urinary retention, and neurogenic bladder were 42.5, 72.4, 51.6, and 58.8%, respectively. The mean duration of follow-up was 20.1 ± 12.8 months. CONCLUSIONS: SNM appears effective in the long term, with a total IPG implantation rate of approximately 57% (ranging between 42.5 and 72.4% depending on indication). Interstitial cystitis/bladder pain syndrome appear to be the best indication for stage I testing. Chinese neurogenic bladder patients are most inclined to choose SNM. SNM is relatively safe, with low postoperation adverse events of 16.1% and reoperation rate of 3.2% during the follow-up period.


Assuntos
Eletrodos Implantados , Sacro/inervação , Estimulação Elétrica Nervosa Transcutânea/métodos , Transtornos Urinários/epidemiologia , Transtornos Urinários/terapia , Adulto , Idoso , China/epidemiologia , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Sacro/fisiologia , Fatores de Tempo , Estimulação Elétrica Nervosa Transcutânea/instrumentação , Resultado do Tratamento , Transtornos Urinários/fisiopatologia
12.
Neurourol Urodyn ; 38(1): 254-260, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-30350888

RESUMO

INTRODUCTION: Pelvic Floor Biofeedback Therapy (PFBT) can be an effective treatment for pediatric lower urinary tract symptoms (LUTS). Due to differing perceptions of efficacy and practice patterns, we sought to further evaluate PFBT in our practice. We hypothesized that PFBT results in quiescence of EMG activity during voiding and improves questionnaire scores in patients with LUTS. METHODS: We retrospectively reviewed all patients undergoing PFBT and refined the analysis to females ≥6 years old with ≥2 sessions with completed voiding questionnaires pre- and post-treatment, active EMG during voiding, with non-neurogenic urinary tract complaints refractory to standard urotherapy. Validated Bladder Bowel Dysfunction (BBD) questionnaires were collected at each visit. Quiescence of EMG activity and changes in BBD score were the primary outcomes. RESULTS: 229 patients underwent ≥1 PFBT session, of which 64 females ≥6 years of age with ≥2 PFBT sessions and completed pre and post PFBT voiding questionnaires were identified. In this group, mean age at PFBT start was 10.1 (6.2-17.0). Patients completed 3.1 sessions (2-6). No difference was seen in post-void residual (PVR) between first and last session (23.8 vs 22.6 mL, P = 0.55). Median questionnaire score decreased from 18 (4-42) before to 13 (2-28) following PFBT (P < 0.0001). Responders, characterized by silencing of the EMG after PFBT, occurred in 31% (20/64). Non-responders were younger (P = 0.007) with higher pre-PFBT questionnaire scores. CONCLUSION: The use of PFBT appears to result in a significant reduction in symptom scores, though quiescence of EMG was observed following therapy in less than 1/3 of patients.


Assuntos
Biorretroalimentação Psicológica/métodos , Sintomas do Trato Urinário Inferior/terapia , Diafragma da Pelve/fisiopatologia , Transtornos Urinários/terapia , Micção/fisiologia , Adolescente , Criança , Feminino , Humanos , Sintomas do Trato Urinário Inferior/fisiopatologia , Estudos Retrospectivos , Inquéritos e Questionários , Resultado do Tratamento , Transtornos Urinários/fisiopatologia
13.
Clin Anat ; 32(1): 60-67, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30303589

RESUMO

Normal voiding needs a coordinated, sustained bladder contraction of adequate size and duration. It requires a decrease in resistance of the bladder neck and urethra and no obstruction. Voiding problems can arise from abnormal storage of urine or problems with urinary control. The aim of this article was to review the functional anatomy and physiology of urinary control and micturition and the pathophysiology of urinary control problems. The Medline (PubMed) database, Cochrane Library, and Science Citation Index were searched electronically to identify original published studies on bladder anatomy, function and urinary control. References were searched from relevant chapters in specialized texts and all were included. Voiding problems are the most common presenting urological symptoms in general medical practice. Urinary incontinence occurs when the normal process of storing and passing urine is disrupted. A history of coexisting fecal incontinence suggests a neuropathic etiology. A better understanding of the physiology of urinary control could lead to preventive measures for postoperative urinary retention and incontinence such as fluid restriction and to appropriate anesthesia/analgesia, autonomic nerve preservation, total mesorectal excision (TME) for rectal cancer, and biofeedback exercises. It could also suggest appropriate therapeutic measures for established urinary incontinence. Clin. Anat., 2018. © 2018 Wiley Periodicals, Inc.


Assuntos
Bexiga Urinária/inervação , Transtornos Urinários/fisiopatologia , Micção/fisiologia , Humanos , Bexiga Urinária/fisiologia
14.
Neurourol Urodyn ; 38(1): 239-247, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-30311665

RESUMO

AIM: To investigate if Multiple Sclerosis (MS) lesion characteristics affect functional brain connectivity (FC) during bladder voiding. METHODS: Twenty-seven ambulatory female patients with MS completed our functional magnetic resonance imaging (fMRI)/urodynamic testing (UDS) platform. Individual fMRI activation maps were generated at initiation of voiding. FC patterns of these regions were calculated and compared. Similarity of the FC pattern from one patient relative to all others was expressed by a parameter FC_sim. A statistical analysis was performed to reveal the relationship of the existence of an enhancing brain lesion, the size of the largest lesion and the ability to void spontaneously to this FC similarity measure. RESULTS: FC_sim values were significantly lower for patients with an enhancing MS lesion (11.7 ± 3.1 vs 5.3 ± 2.1 P < 0.001). Lesion size smaller than 20 mm inversely correlated significantly with FC_sim (R = -0.43, P = 0.05). Patients with the ability to void spontaneously had a higher FC_sim value (12.0 ± 2.8 vs 9.3 ± 4.4 s, P = 0.08). Patients that exhibited a decrease of compliance also showed a significantly lower FC_sim value (11.3 ± 3.5 vs 4.7 ± 0.7, P < 1e-5). CONCLUSION: FC connectivity analysis derived from an fMRI task-based study including repetitive voiding cycles is able to quantify the heterogeneity of connectivity patterns in the brain of MS patients. FC similarity decreased with maximum lesion size or the presence of enhancing lesions affecting the ability to void spontaneously.


Assuntos
Encéfalo/diagnóstico por imagem , Esclerose Múltipla/diagnóstico por imagem , Transtornos Urinários/diagnóstico por imagem , Micção/fisiologia , Encéfalo/fisiopatologia , Mapeamento Encefálico , Feminino , Humanos , Imagem por Ressonância Magnética , Esclerose Múltipla/complicações , Esclerose Múltipla/fisiopatologia , Transtornos Urinários/etiologia , Transtornos Urinários/fisiopatologia , Urodinâmica/fisiologia
15.
J Mol Neurosci ; 68(3): 357-367, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30259317

RESUMO

Neural injury, inflammation, or diseases commonly and adversely affect micturition reflex function that is organized by neural circuits in the CNS and PNS. One neuropeptide receptor system, pituitary adenylate cyclase-activating polypeptide (PACAP; Adcyap1), and its cognate receptor, PAC1 (Adcyap1r1), have tissue-specific distributions in the lower urinary tract. PACAP and associated receptors are expressed in the LUT and exhibit changes in expression, distribution, and function in preclinical animal models of bladder pain syndrome (BPS)/interstitial cystitis (IC), a chronic, visceral pain syndrome characterized by pain, and LUT dysfunction. Blockade of the PACAP/PAC1 receptor system reduces voiding frequency and somatic (e.g., hindpaw, pelvic) sensitivity in preclinical animal models and a transgenic mouse model that mirrors some clinical symptoms of BPS/IC. The PACAP/receptor system in micturition pathways may represent a potential target for therapeutic intervention to reduce LUT dysfunction following urinary bladder inflammation.


Assuntos
Polipeptídeo Hipofisário Ativador de Adenilato Ciclase/metabolismo , Receptores de Polipeptídeo Hipofisário Ativador de Adenilato Ciclase/metabolismo , Doenças da Bexiga Urinária/metabolismo , Transtornos Urinários/metabolismo , Micção , Animais , Humanos , Polipeptídeo Hipofisário Ativador de Adenilato Ciclase/genética , Receptores de Polipeptídeo Hipofisário Ativador de Adenilato Ciclase/genética , Transdução de Sinais , Doenças da Bexiga Urinária/fisiopatologia , Transtornos Urinários/fisiopatologia
16.
Brain Behav ; 8(12): e01164, 2018 12.
Artigo em Inglês | MEDLINE | ID: mdl-30451394

RESUMO

AIMS: Deep brain stimulation (DBS) is known to dramatically improve motor complications in patients with Parkinson's disease (PD), but its effect on urinary symptoms and health-related quality of life (HRQOL) remains unknown. We aimed to examine the relationship between urinary symptoms and HRQOL in patients with PD who underwent DBS. METHODS: The International Prostate Symptom Score (IPSS) and overactive bladder symptom score (OABSS) were determined to evaluate urinary symptoms in patients with PD who underwent DBS. Postoperative evaluations were performed at 3 months, 1 year, and 3 years postoperatively. We also performed a urodynamic study (UDS) in 13 patients with PD preoperatively and postoperatively. A follow-up UDS was performed 2.0 ± 0.5 years postoperatively. RESULTS: The preoperative urinary symptoms questionnaire was completed by 28 patients, of whom 14 completed the postoperative urinary symptoms questionnaire after 3 months, 18 after 1 year, and 10 after 3 years. The mean OABSS and IPSS did not change significantly at any follow-up periods postoperatively. When assessing the relationship between urinary symptoms and HRQOL and motor functions, the OABSS and IPSS showed significant positive correlations with HRQOL at 3 months postoperatively. The OABSS and IPSS showed significant positive correlations with activities of daily living (ADL) during the off-phase at 3 years postoperatively. All urodynamic parameters remained unchanged postoperatively. CONCLUSIONS: Deep brain stimulation did not significantly affect urinary dysfunctions in patients with PD. Urinary symptoms might partially contribute to HRQOL at 3 months postoperatively and ADL during the off-phase at 3 years postoperatively.


Assuntos
Estimulação Encefálica Profunda , Doença de Parkinson/terapia , Qualidade de Vida , Transtornos Urinários/psicologia , Atividades Cotidianas , Idoso , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Doença de Parkinson/fisiopatologia , Cuidados Pós-Operatórios , Inquéritos e Questionários , Resultado do Tratamento , Bexiga Urinária Hiperativa/fisiopatologia , Bexiga Urinária Hiperativa/psicologia , Transtornos Urinários/fisiopatologia , Urodinâmica/fisiologia
17.
Eur Neurol ; 80(3-4): 121-125, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30391939

RESUMO

In order to investigate lower urinary tract function in hereditary spastic paraplegia (HSP), we recruited 12 HSP patients: 8 men, 4 women; mean age, 64.6 years; mean disease duration, 18.9 years; walk without cane, 2, walk with cane, 6, wheelchair bound, 3. We performed urinary symptom questionnaires and a urodynamic testing in all patients. As a result, urinary symptoms were observed in all but 3, including urinary urgency/frequency (also called overactive bladder) in 9 and hesitancy/poor stream in 6. Urodynamic abnormalities included detrusor overactivity during bladder filling in 10, underactive detrusor on voiding in 8 (detrusor hyperactivity with impaired contraction [DHIC] in 5), detrusor-sphincter dyssynergia (DSD) on voiding in 3, and post-void residual in 5. Sphincter electromyography showed neurogenic motor unit potential in 4. In conclusion, we observed high frequency of urinary symptoms in HSP. Urodynamics indicated that the main mechanism is DHIC with/without DSD for their urinary symptom, and sacral cord involvement in some cases. These findings facilitate patients' care including clean, intermittent catheterization.


Assuntos
Paraplegia Espástica Hereditária/complicações , Transtornos Urinários/epidemiologia , Transtornos Urinários/etiologia , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Paraplegia Espástica Hereditária/urina , Transtornos Urinários/fisiopatologia , Urodinâmica
18.
Neurourol Urodyn ; 37(8): 2510-2518, 2018 11.
Artigo em Inglês | MEDLINE | ID: mdl-30088676

RESUMO

AIMS: Overactive bladder (OAB) is one of the most common complications of both type 1 (T1DM) and type 2 diabetes mellitus (T2DM). In healthy conditions, menthol infused intravesically reduces the threshold for initiating micturition reflex, but no study evaluated its effects in diabetic conditions. Therefore, we have used mouse models of T1DM and T2DM to evaluate the effects of menthol on cystometric alterations and increased bladder contractility in vitro. METHODS: For T1DM induction, male C57BL6 mice were injected with streptozotocin (STZ) and evaluated after 4 weeks. For T2DM induction, mice were fed with high-fat diet (HFD) for 12 weeks to induce obesity. Urodynamic profiles were assessed by filling cystometry through the infusion of menthol (100 µM for 30 min) or vehicle (DMSO 0.1%). Contractile responses to carbachol, potassium chloride (KCl), and electrical-field stimulation (EFS) were measured in isolated bladders after 20 min incubation with menthol (100 µM) or vehicle. RESULTS: Filling cystometry showed that STZ-injected mice exhibited higher bladder capacity, threshold pressure, and non-voiding contractions (NVCs), which were significantly reduced by menthol infusion. The increased voiding frequency in STZ group were unaffected by menthol. In HFD-fed obese mice menthol significantly attenuated the increased threshold pressure and NVC frequency, but unaffected the changes of voiding frequency. In both STZ-injected and HFD-fed mice, incubation of isolated bladders with menthol normalized the enhanced contractile responses to carbachol, KCl, and EFS stimulation. CONCLUSIONS: Menthol may be a potential pharmacological option for the treatment of OAB as a consequence of T1DM and T2DM.


Assuntos
Diabetes Mellitus Tipo 1/complicações , Diabetes Mellitus Tipo 2/complicações , Mentol/uso terapêutico , Bexiga Urinária Hiperativa/tratamento farmacológico , Bexiga Urinária Hiperativa/etiologia , Transtornos Urinários/tratamento farmacológico , Transtornos Urinários/etiologia , Animais , Diabetes Mellitus Experimental/fisiopatologia , Dieta Hiperlipídica , Estimulação Elétrica , Masculino , Camundongos , Camundongos Endogâmicos C57BL , Camundongos Obesos , Contração Muscular/efeitos dos fármacos , Cloreto de Potássio/farmacologia , Bexiga Urinária/fisiopatologia , Bexiga Urinária Hiperativa/fisiopatologia , Transtornos Urinários/fisiopatologia , Urodinâmica
19.
Am J Physiol Renal Physiol ; 315(5): F1422-F1429, 2018 11 01.
Artigo em Inglês | MEDLINE | ID: mdl-30156116

RESUMO

Investigators have for decades used mouse voiding patterns as end points for studying behavioral biology. It is only recently that mouse voiding patterns were adopted for study of lower urinary tract physiology. The spontaneous void spot assay (VSA), a popular micturition assessment tool, involves placing a mouse in an enclosure lined by filter paper and quantifying the resulting urine spot pattern. The VSA has advantages of being inexpensive and noninvasive, but some investigators challenge its ability to distinguish lower urinary tract function from behavioral voiding. A consensus group of investigators who regularly use the VSA was established by the National Institutes of Health in 2015 to address the strengths and weaknesses of the assay, determine whether it can be standardized across laboratories, and determine whether it can be used as a surrogate for evaluating urinary function. Here we leverage experience from the consensus group to review the history of the VSA and its uses, summarize experiments to optimize assay design for urinary physiology assessment, and make best practice recommendations for performing the assay and analyzing its results.


Assuntos
Bioensaio/métodos , Bexiga Urinária/fisiopatologia , Transtornos Urinários/fisiopatologia , Micção , Urodinâmica , Animais , Bioensaio/normas , Modelos Animais de Doenças , Camundongos , Reprodutibilidade dos Testes , Fatores de Tempo , Transtornos Urinários/diagnóstico
20.
Nat Neurosci ; 21(9): 1229-1238, 2018 09.
Artigo em Inglês | MEDLINE | ID: mdl-30104734

RESUMO

Voluntary urination ensures that waste is eliminated when safe and socially appropriate, even without a pressing urge. Uncontrolled urination, or incontinence, is a common problem with few treatment options. Normal urine release requires a small region in the brainstem known as Barrington's nucleus (Bar), but specific neurons that relax the urethral sphincter and enable urine flow are unknown. Here we identify a small subset of Bar neurons that control the urethral sphincter in mice. These excitatory neurons express estrogen receptor 1 (BarESR1), project to sphincter-relaxing interneurons in the spinal cord and are active during natural urination. Optogenetic stimulation of BarESR1 neurons rapidly initiates sphincter bursting and efficient voiding in anesthetized and behaving animals. Conversely, optogenetic and chemogenetic inhibition reveals their necessity in motivated urination behavior. The identification of these cells provides an expanded model for the control of urination and its dysfunction.


Assuntos
Tronco Encefálico/fisiologia , Neurônios/fisiologia , Uretra/inervação , Uretra/fisiologia , Micção/fisiologia , Animais , Tronco Encefálico/citologia , Eletromiografia , Receptor alfa de Estrogênio/genética , Receptor alfa de Estrogênio/fisiologia , Masculino , Camundongos , Vias Neurais/fisiologia , Odorantes , Optogenética , Transtornos Urinários/genética , Transtornos Urinários/fisiopatologia
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