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1.
Urologiia ; (5): 44-47, 2019 Dec.
Artigo em Russo | MEDLINE | ID: mdl-31808631

RESUMO

AIM: to improve treatment results of patients with stress urinary incontinence and severe cystocele by optimizing surgical tactics and rehabilitation methods. MATERIALS AND METHODS: a total of 56 women aged 54 to 68 years with stages III-IV of the anterior vaginal wall prolapse (according to the POP-Q classification) and urethral sphincter insufficiency were evaluated. All patients underwent a transvaginal extraperitoneal anterior mesh repair without concomitant sling procedure. The severity of prolapse, a presence or absence of stress urinary incontinence, and ultrasound signs of sphincter insufficiency were re-evaluated two months after procedure. RESULTS: in all cases, the anterior wall prolapse was eliminated or reduced to subclinical stage. Two months after procedure, 48 patients (85,7%) noted the onset of stress urinary incontinence (moderate and severe) with progressive deterioration. In the remaining cases (14,3%), patients did not have any urinary incontinence. All patients underwent active rehabilitation for 6 months. In 6 cases (12,5%), there was a decrease in the severity of urinary incontinence to the level that had virtually didnt affect the quality of life; in remaining cases, conservative treatment was considered ineffective and sling procedure was recommended. DISCUSSION: A diagnosis of latent urinary incontinence remains to be controversial. To detect this form, a cough test with a prolapse reduction is usually performed. In addition, preoperative urodynamic testing can be used, since it has good sensitivity in identifying latent urinary incontinence, but it is an expensive procedure for the routine practice. A determination of the urethral sphincter insufficiency makes it possible to predict the development of the stress urinary incontinence with a high accuracy, but this method also has a number of limitations. CONCLUSION: patients with stages III-IV of the anterior vaginal wall prolapse and ultrasound signs of sphincter insufficiency have a risk of developing stress urinary incontinence after surgical treatment. In this group of patients, a simultaneous surgery can be recommended in order to correct prolapse and to prevent subsequent urinary incontinence.


Assuntos
Prolapso de Órgão Pélvico/cirurgia , Qualidade de Vida , Uretra/diagnóstico por imagem , Incontinência Urinária por Estresse/reabilitação , Prolapso Uterino/cirurgia , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Telas Cirúrgicas , Uretra/fisiopatologia , Incontinência Urinária por Estresse/complicações , Urodinâmica
2.
Life Sci ; 234: 116772, 2019 Oct 01.
Artigo em Inglês | MEDLINE | ID: mdl-31422097

RESUMO

AIMS: Ligation of the urethra to create partial bladder outlet obstruction has widely been used as an animal model of bladder obstruction, although obstructive bladder dysfunction may be due to both mechanical and functional obstruction. Previous studies in rodents have demonstrated that long-term nitric oxide (NO) deficiency can lead to detrusor overactivity, and lack of NO may thus cause impairment of bladder outlet relaxation. The aim of this study was to define the characteristics of bladder and urethral dysfunction induced by chronic NO deficiency through both in vivo and in vitro investigations. MAIN METHODS: Rats were divided into two groups, and one group received an NO synthase inhibitor (Nω-nitro-L-arginine methyl ester hydrochloride: L-NAME) in the drinking water for 4 weeks. Bladder and urethral function were evaluated by continuous cystometry and isovolumetric cystometry. In vitro functional studies of detrusor strips and measurement of the mRNA and protein expression of an ischemic marker and a gap junction protein were also performed in separate rats. KEY FINDINGS: L-NAME administration raised blood pressure and decreased plasma nitrite/nitrate level compared to the control group. L-NAME treatment increased the frequency of bladder contractions and the residual volume, and elevated urethral pressure and bladder contraction pressure. In addition, carbachol-induced contraction was reduced in isolated detrusor strips from the L-NAME group, and bladder expression of HIF-1 and connexin 43 showed upregulation. SIGNIFICANCE: These findings suggest that chronic administration of L-NAME to rats induces bladder hyperactivity with residual urine, and may provide a useful model of functional bladder obstruction.


Assuntos
NG-Nitroarginina Metil Éster , Óxido Nítrico Sintase/antagonistas & inibidores , Obstrução do Colo da Bexiga Urinária/induzido quimicamente , Obstrução do Colo da Bexiga Urinária/fisiopatologia , Animais , Modelos Animais de Doenças , Feminino , Nitratos/sangue , Óxido Nítrico Sintase/metabolismo , Nitritos/sangue , Ratos , Ratos Sprague-Dawley , Uretra/metabolismo , Uretra/fisiopatologia , Bexiga Urinária/metabolismo , Bexiga Urinária/fisiopatologia , Obstrução do Colo da Bexiga Urinária/sangue
3.
Ceska Gynekol ; 84(2): 115-120, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31238681

RESUMO

OBJECTIVE: Is it possible to estimate urethral mobility based on MUCP measurements? DESIGN: Retrospective study. SETTING: Department of Gynecology and Obstetrics, 1st Medical Faculty, Charles University, General Teaching Hospital, Prague. METHODS: This retrospective study included 567 patients from three prospective studies within years 2002 to 2009. Ultrasound examination was performed in 560 of them and maximal urethral closure pressure (MUCP) values were measured in 507 women. The MUCP was defined as the difference between maximum urethral pressure and bladder pressure. An ultrasound examination was performed using the transperineal approach in accordance with the recommendations of the German Urogynecology Working Group and ICS, IUGA terminology. The mobility was expressed as a distance between the position at rest and at the maximal Valsalva manoeuvre. Data were summarized as mean and median, with SD and quantile range for measures of variability. Either a matched pairs t-test or Wilcoxon test was used for statistical evaluation. RESULTS: Mean MUCP was 47.4 cm H2O (SD 22.2, first quantile 32, third quantile 62). Mean urethral descent was 20.6 mm (SD 8.2, first quantile 14.9, third quantile 25.6 mm). Using regression analysis there was an increase in urethral descent; this difference is statistically significant. For a MUCP increase of 10 cm H2O we could estimate an increase in urethral descent of 1.1 mm. CONCLUSION: We established a statistically significant relationship between urethral descent and MUCP. Unfortunately those differences are not clinically relevant, especially for MUCP over 20 cm H2O. For MUCP below 20 cm H2O low urethral descent is more likely. Clinical use of MUCP as predictor of urethral descent is limited due to the high variability involved.


Assuntos
Uretra/fisiopatologia , Incontinência Urinária por Estresse/cirurgia , Urodinâmica/fisiologia , Feminino , Humanos , Masculino , Gravidez , Estudos Prospectivos , Estudos Retrospectivos , Resultado do Tratamento , Bexiga Urinária/fisiopatologia , Incontinência Urinária por Estresse/diagnóstico , Procedimentos Cirúrgicos Urológicos/efeitos adversos
4.
Low Urin Tract Symptoms ; 11(4): 248-254, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31250566

RESUMO

The aim of this study was to determine whether aging-related detrusor underactivity (DU) involves a decrease in 5-hydroxytryptamine (5-HT-positive)-expressing urethral cells and whether 5-HT stimulation of urethral sensory fibers improves detrusor function. Cystometries were performed in young (6 months) and aged (18-24 months) female Wistar rats. Aged rats with voiding contractions (VC) that were 2SD below the mean of those in young rats were considered to have DU. Bladder voiding efficiency (BVE) was calculated during saline or 5-HT solution cystometries. Rats were perfusion-fixed with a fixative solution (paraformaldehyde, PFA 4%) through the circulatory system and the urethra sectioned to count the number of 5-HT-immunoreactive (IR) cells. Isovolumetric cystometry was performed while irrigating the urethra with saline or 5µM-HT solution. Two-tailed unpaired t tests were used to determine the significance of differences. In aged DU rats, the mean (±SD) VC frequency was 0.24 ± 0.07 per minute, with an amplitude of 15 ± 3 cm H2 O. The mean (±SD) number of 5-HT-IR cells in the urethra of aged DU and young rats was 90 ± 11 and 182 ± 25, respectively (P < 0.01). 5-HT improved the mean (±SD) BVE of aged DU rats from 49 ± 3% to 78 ± 2% (P < 0.001). In isovolumetric cystometries, detrusor pressure during irrigation of the urethra with saline was 18 ± 1 cm H2 O, compared with 39 ± 2 cm H2 O during irrigation with 5-HT solution (P < 0.05). In rats, DU associated with aging is accompanied by a decrease in the number of 5-HT-positive cells. The results suggest that decreased 5-HT availability decreases urethral sensory fiber excitation, leading to a decrease the number of effective VC.


Assuntos
Serotonina/uso terapêutico , Uretra/efeitos dos fármacos , Bexiga Inativa/tratamento farmacológico , Envelhecimento/fisiologia , Animais , Feminino , Ratos , Ratos Wistar , Serotonina/metabolismo , Uretra/citologia , Uretra/fisiopatologia , Bexiga Urinária/efeitos dos fármacos , Bexiga Urinária/fisiopatologia , Bexiga Inativa/metabolismo , Bexiga Inativa/fisiopatologia , Urodinâmica/efeitos dos fármacos
5.
Low Urin Tract Symptoms ; 11(4): 241-247, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31207119

RESUMO

OBJECTIVE: This study investigated the effects of tadalafil on the urethra and detrusor in the initial phase of diabetes in rats. METHODS: Thirty-six female Sprague-Dawley rats were assigned to a non-diabetes (ND), diabetes (D), or tadalafil-treated diabetes (DT) group (n = 12 per group), with the DT group receiving oral tadalafil (2 mg/kg/d) for 7 days before the experiments. Seven weeks after diabetes induction (by a single intraperitoneal injection of streptozotocin), urethral and intravesical pressure were simultaneously recorded in vivo, whereas responses of detrusor strips to potassium chloride (30 mM), electrical field stimulation (EFS) and carbachol were measured in vitro. RESULTS: The intravesical pressure at which the urethra started to relax was significantly lower in the DT than D group (mean [± s.d.] 18.9 ± 2.9 vs 29.1 ± 6.6 cm H2 O; P < .05). In addition, the reduction in urethral pressure was significantly larger in the DT than D group (-10.9 ± 4.0 vs -4.0 ± 2.9 cm H2 O; P < .05). Detrusor stimulation revealed that the mean contractile responses to EFS and carbachol were significantly lower in the ND and DT groups than in the D group (120.7 ± 26.5% and 130.8 ± 15.8% vs 200.1 ± 47.9% of the 30 mM KCl-induced contraction, respectively, in response to 50 Hz EFS [P < .05]; 211.1 ± 35.4% and 208.4 ± 25.3% vs 425.7 ± 125.0% of the 30 mM KCl-induced contraction, respectively, in response to 10-3 M carbachol [P < .05]). CONCLUSIONS: Tadalafil restored urethral relaxation function and detrusor responses to EFS and carbachol during the initial phase of diabetes.


Assuntos
Diabetes Mellitus Experimental/complicações , Inibidores da Fosfodiesterase 5/uso terapêutico , Tadalafila/uso terapêutico , Uretra/efeitos dos fármacos , Bexiga Urinária/efeitos dos fármacos , Animais , Carbacol/farmacologia , Estimulação Elétrica , Feminino , Contração Muscular/efeitos dos fármacos , Músculo Liso/efeitos dos fármacos , Músculo Liso/fisiopatologia , Ratos , Ratos Sprague-Dawley , Uretra/fisiopatologia , Bexiga Urinária/fisiopatologia
6.
Actas urol. esp ; 43(5): 221-227, jun. 2019. tab
Artigo em Espanhol | IBECS | ID: ibc-181088

RESUMO

Objetivo: Evaluar las diferencias clínicas y urodinámicas en mujeres con vejiga hiperactiva (VH) referidas a urología funcional y unidades urodinámicas en España, asociadas con la presencia o ausencia de hiperactividad del detrusor (HD). Material y métodos: Estudio observacional, transversal, multicéntrico y prospectivo realizado en España en mujeres con diagnóstico clínico de VH derivadas para estudio urodinámico (EUD) del cual se realizó lectura centralizada. Las pacientes completaron el diario miccional de 3días (DM3d) con la Patient Perception of Intensity of Urgency Scale (PPIUS), el Cuestionario de Autoevaluación del Control de la Vejiga (CACV) y la Overactive Bladder Questionnaire Short Form (OABq-SF). Se compararon los cuestionarios y las variables del EUD de mujeres con VH con y sin HD empleándose el test de Mann-Whitney (variables continuas) y el test de χ2 (variables categóricas). Resultados: Se evaluaron 247 mujeres con VH, de ellas 103 presentaron HD. Según la presencia o no de HD se observaron diferencias significativas en el número de episodios de incontinencia urinaria de urgencia (IUU), frecuencia miccional, nicturia, volumen miccional medio y número de absorbentes (p < 0,05 para todas las comparaciones). En pacientes con VH y HD un mayor porcentaje presenta capacidad vesical reducida, urgencia, IUU y volúmenes menores para el primer deseo miccional, fuerte deseo miccional y capacidad cistomanométrica máxima en EUD vs pacientes sin HD (p < 0,05 para todas las comparaciones). En los cuestionarios solo hubo diferencias en la subescala de síntomas del CACV entre ambos grupos (p = 0,011). Conclusiones: La presencia de HD en mujeres con VH se relaciona con una alteración más severa de la fase de llenado vesical


Objective: To evaluate the clinical and urodynamic differences (associated with the presence or absence of detrusor overactivity [DO]) in women with overactive bladder (OAB) referred to Functional Urology and Urodynamic Units in Spain. Material and methods: Observational, cross-sectional, multicenter and prospective study conducted in Spain in women with clinical diagnosis of OAB, who had been referred to urodynamic study (UDS) of which centralized reading was performed. Patients completed the 3-day voiding diary (DM3d) with the PPIUS scale (Patient Perception of Intensity of Urgency Scale), the B-SAQ (Bladder Self-Assessment Questionnaire) and the OABq-SF (Overactive Bladder Questionnaire Short Form). The questionnaires and UDS variables of women with OAV, with or without DO, were compared using the Mann-Whitney test (continuous variables) and the chi-square test (χ2) (categorical variables). Results: A total of 247 women with OAB were evaluated, and 103 of them had DO. According to the presence or absence of DO, significant differences were observed in the number of episodes of urge urinary incontinence (UUI), urinary frequency, nocturia, mean micturition volume and number of pads (P < .05 for all comparisons). A higher percentage of patients with OAB and DO presented reduced bladder capacity, urgency, urge urinary incontinence (UUI) and lower volume for first voiding desire, strong desire to void and maximum cystomanometric capacity in UDS compared with patients without DO (P < .05 for all comparisons). The only significant differences between both groups were regarding the B-SAQ symptoms scale (P = .011). Conclusions: The presence of DO in women with OAB is related to a more severe alteration of the bladder filling phase


Assuntos
Humanos , Feminino , Pessoa de Meia-Idade , Bexiga Urinária Hiperativa/fisiopatologia , Sintomas do Trato Urinário Inferior/fisiopatologia , Incontinência Urinária de Urgência/fisiopatologia , Incontinência Urinária de Urgência/complicações , Uretra/fisiopatologia , Estudos Transversais , Estudos Prospectivos , Inquéritos e Questionários , Urodinâmica
7.
Cochrane Database Syst Rev ; 5: CD012832, 2019 05 25.
Artigo em Inglês | MEDLINE | ID: mdl-31128077

RESUMO

BACKGROUND: A variety of minimally invasive surgical approaches are available as an alternative to transurethral resection of prostate (TURP) for the management of lower urinary tract symptoms (LUTS) in men with benign prostatic hyperplasia (BPH). A recent addition to these is prostatic urethral lift (PUL). OBJECTIVES: To assess the effects of PUL for the treatment of LUTS in men with BPH. SEARCH METHODS: We performed a comprehensive search of multiple databases (the Cochrane Library, MEDLINE, Embase, LILACS, Scopus, Web of Science, and Google Scholar), trials registries, other sources of grey literature, and conference proceedings with no restrictions on the language of publication or publication status up until 31 January 2019. SELECTION CRITERIA: We included parallel group randomized controlled trials (RCTs). While we planned to include non-RCTs if RCTs had provided low-certainty evidence for a given outcome and comparison, we could not find any non-RCTs. DATA COLLECTION AND ANALYSIS: Two review authors independently screened the literature, extracted data, and assessed risk of bias. We performed statistical analyses using a random-effects model and interpreted them according to the Cochrane Handbook for Systematic Reviews of Interventions. We planned subgroup analyses by age, prostate volume, and severity of baseline symptoms. We used the GRADE approach to rate the certainty of the evidence. MAIN RESULTS: We included two RCTs with 297 participants comparing PUL to sham surgery or TURP. The mean age was 65.6 years and mean International Prostate Symptom Score was 22.7. Mean prostate volume was 42.2 mL. We considered review outcomes measured up to and including 12 months after randomization as short-term and later than 12 months as long-term. For patient-reported outcomes, lower scores indicate more urological symptom improvement and higher quality of life. In contrast, higher scores refers to better erectile and ejaculatory function.PUL versus sham: based on one study of 206 randomized participants with short follow-up (up to three months), PUL may lead to a clinically important improvement in urological symptom scores (mean difference (MD) -5.20, 95% confidence interval (CI) -7.44 to -2.96; low-certainty evidence) and likely improves quality of life (MD -1.20, 95% CI -1.67 to -0.73; moderate-certainty evidence). We are uncertain whether PUL increases major adverse events (very low-certainty evidence). There were no retreatments reported in either study group by three months. PUL likely results in little to no difference in erectile function (MD -1.40, 95% CI -3.24 to 0.44; moderate-certainty evidence) and ejaculatory function (MD 0.50, 95% CI -0.38 to 1.38; moderate-certainty evidence).PUL versus TURP: based on one study of 91 randomized participants with a short follow-up (up to 12 months), PUL may result in a substantially lesser improvement in urological symptom scores than TURP (MD 4.50, 95% CI 1.10 to 7.90; low-certainty evidence). PUL may result in a slightly reduced or similar quality of life (MD 0.30, 95% CI -0.49 to 1.09; low-certainty evidence). We are very uncertain whether PUL may cause fewer major adverse events but increased retreatments (both very low-certainty evidence). PUL probably results in little to no difference in erectile function (MD 0.80, 95% CI -1.50 to 3.10; moderate-certainty evidence), but probably results in substantially better ejaculatory function (MD 5.00, 95% CI 3.08 to 6.92; moderate-certainty evidence).With regards to longer term follow-up (up to 24 months) based on one study of 91 randomized participants, PUL may result in a substantially lesser improvement in urological symptom score (MD 6.10, 95% CI 2.16 to 10.04; low-certainty evidence) and result in little worse to no difference in quality of life (MD 0.80, 95% CI 0.00 to 1.60; low-certainty evidence). The study did not report on major adverse events. We are very uncertain whether PUL increases retreatment (very low-certainty evidence). PUL likely results in little to no difference in erectile function (MD 1.60, 95% CI -0.80 to 4.00; moderate-certainty evidence), but may result in substantially better ejaculatory function (MD 4.30, 95% CI 2.17 to 6.43; low-certainty evidence).We were unable to perform any of the predefined secondary analyses for either comparison.We found no evidence for other comparisons such as PUL versus laser ablation or enucleation. AUTHORS' CONCLUSIONS: PUL appears less effective than TURP in improving urological symptoms both short-term and long term, while quality of life outcomes may be similar. The effect on erectile function appears similar but ejaculatory function may be better. We are uncertain about major adverse events short-term and found no long-term information. We are very uncertain about retreatment rates both short-term and long-term. We were unable to assess the effects of PUL in subgroups based on age, prostate size, or symptom severity and also could not assess how PUL compared to other surgical management approaches. Given the large numbers of alternative treatment modalities to treat men with LUTS secondary to BPH, this represents important information that should be shared with men considering surgical treatment.


Assuntos
Sintomas do Trato Urinário Inferior/etiologia , Hiperplasia Prostática/complicações , Uretra/cirurgia , Idoso , Humanos , Masculino , Ressecção Transuretral da Próstata , Uretra/fisiopatologia
8.
Med Phys ; 46(7): 3034-3043, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31049993

RESUMO

PURPOSE: Assessment of urethral dynamics is clinically regarded to be important in analyzing the functional impact of pathological features like urethral obstruction, albeit it is difficult to perform directly in vivo. To facilitate such an assessment, urethra phantoms may serve well as investigative tools by reconstructing urethral dynamics based on anthropomorphic factors. Here, our aim is to design a new class of anatomically realistic, deformable urethra phantoms that can simulate the geometric, mechanical, and hydrodynamic characteristics of the male prostatic urethra. METHODS: A new lost-core tube casting protocol was devised. It first involved the drafting of urethra geometry in computer-aided design software. Next, 3D printing was used to fabricate the urethra geometry and an outer mold. These parts were then used to cast a urinary tract using a polyvinyl alcohol (PVA)-based material (with 26.6 ± 4.0 kPa Young's elastic modulus). After forming a surrounding tissue-mimicking slab using an agar-gelatin mixture (with 17.4 ± 3.4 kPa Young's modulus), the completed urethra phantom was connected to a flow circuit that simulates voiding. To assess the fabricated phantoms' morphology, ultrasound imaging was performed over different planes. Also, color Doppler imaging was performed to visualize the flow profile within the urinary tract. RESULTS: Deformable phantoms were devised for the normal urethra and a diseased urethra with obstruction due to benign prostatic hyperplasia (BPH). During voiding, the short-axis lumen diameter at the verumontanum of the BPH-featured phantom (0.91 ± 0.08 mm) was significantly smaller than that for the normal phantom (2.49 ± 0.20 mm). Also, the maximum flow velocity of the BPH-featured phantom (59.3 ± 5.8 cm/s; without Doppler angle correction) was found to be higher than that of the normal phantom (22.7 ± 9.0 cm/s). CONCLUSION: The fabricated phantoms were effective in simulating urethra deformation resulting from urine passage during voiding. They can be used for mechanistic studies of urethral dynamics and for the testing of urodynamic diagnostic techniques in urology.


Assuntos
Imagens de Fantasmas , Próstata/fisiologia , Urodinâmica , Fenômenos Biomecânicos , Humanos , Masculino , Próstata/diagnóstico por imagem , Próstata/fisiopatologia , Hiperplasia Prostática/diagnóstico por imagem , Hiperplasia Prostática/patologia , Hiperplasia Prostática/fisiopatologia , Ultrassonografia , Uretra/diagnóstico por imagem , Uretra/patologia , Uretra/fisiopatologia , Sistema Urinário/anatomia & histologia , Sistema Urinário/diagnóstico por imagem , Sistema Urinário/patologia
9.
Eur J Obstet Gynecol Reprod Biol ; 237: 13-17, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30978581

RESUMO

OBJECTIVE: The aim of this study was to perform a score predictive of ALPP <60 cm H2O from clinical factors in women with stress urinary incontinence (SUI). STUDY DESIGN: We performed a descriptive and observational study of women referred for a urodynamic study for stress urinary incontinence. Patients were divided into three groups: ALPP: >90 cm H2O, between 60 and 90 cm H2O and <60 cm H2O. A logistic regression study was performed in order to complete clinical predictors of ALPP < 60 cm H2O. Variables that were significant in the multivariate analysis were included in the score. RESULTS: We studied 158 patients: 65 presented ALPP > 90 cm H2O, 64 between 60-90 cm H2O and 29 <60 cm H2O. In the multivariate analysis, were presented as independent predictors of ALPP < 60 cm H2O, the presence of a fixed urethra (p 0.01), empty bladder test positive (p 0.02) and presence of symptoms grade III in the classification of Stamey (p 0.03). The accuracy of the test was: score 0, 42%; score 1, 58%; score 2, 81%. Receiver Operating Characteristic (ROC) analysis for the overall cutoff points revealed an area under the curve of 0,75. CONCLUSIONS: Presence of a fixed urethra, positive empty bladder test and patients with a high degree of SUI symptoms according to the Stamey score are independent clinical predictors of intrinsic sphincter deficiency. This score could represent a useful clinical tool to predict the presence of ALPP <60 cm H2O based on clinical parameters.


Assuntos
Técnicas de Diagnóstico Urológico , Incontinência Urinária por Estresse/diagnóstico , Urodinâmica/fisiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Pessoa de Meia-Idade , Uretra/fisiopatologia , Bexiga Urinária/fisiopatologia , Incontinência Urinária por Estresse/fisiopatologia
10.
J Pharmacol Sci ; 139(4): 333-339, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30871873

RESUMO

The pharmacological profile of ASP2205 fumarate (ASP2205), a novel 5-HT2C receptor agonist, was evaluated in vitro and in vivo. ASP2205 showed potent and selective agonistic activity for the human 5-HT2C receptor, with an EC50 of 0.85 nM in the intracellular Ca2+ mobilization assay. Rat 5-HT2C receptor was also activated by ASP2205 with an EC50 of 2.5 nM. Intraduodenal administration (i.d.) of ASP2205 (0.1-1 mg/kg) significantly elevated the leak point pressure (LPP) in anesthetized rats in a dose-dependent manner. This ASP2205 (0.3 mg/kg i.d.)-induced LPP elevation was inhibited by SB242084 (0.3 mg/kg i.v.), a selective 5-HT2C receptor antagonist. Urethral closure responses induced by intravesical pressure loading in rats were enhanced by ASP2205 (0.3 mg/kg i.v.), which was abolished by pretreatment with SB242084 (0.3 mg/kg i.v.) and bilateral transection of the pudendal nerve. In contrast, ASP2205 (0.3 mg/kg i.v.) did not change the resting urethral pressure in rats. These results indicate that ASP2205 can enhance the pudendal nerve-mediated urethral closure reflex via the 5-HT2C receptor, resulting in the prevention of involuntary urine loss.


Assuntos
Fumaratos/farmacologia , Pressão , Reflexo/efeitos dos fármacos , Agonistas do Receptor 5-HT2 de Serotonina/farmacologia , Uretra/fisiologia , Animais , Azepinas , Relação Dose-Resposta a Droga , Feminino , Fumaratos/uso terapêutico , Quinolinas , Ratos Sprague-Dawley , Agonistas do Receptor 5-HT2 de Serotonina/uso terapêutico , Uretra/inervação , Uretra/fisiopatologia , Incontinência Urinária por Estresse/prevenção & controle
11.
Biomed Res Int ; 2019: 6715257, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30906779

RESUMO

Female urethral strictures are rare. Guidelines on how to diagnose and treat these strictures are lacking. At present, only expert opinion is available to guide clinical practice. Once the diagnosis is suspected based on obstructive voiding symptoms and uroflowmetry, most clinicians will use in addition video-urodynamics (including urethrography), urethral calibration and cystourethroscopy for confirmation of the diagnosis. Clinical inspection and gynaecological examination are also important. Urethral dilation is usually the first-line treatment despite the lack of long-term success. Female urethroplasty is associated with higher success rates. A multitude of techniques are described but not one technique has shown superiority above another. This narrative review aims to provide a clinical guide for diagnosis and treatment to the urologist motivated to perform female urethroplasty.


Assuntos
Uretra/cirurgia , Estreitamento Uretral/cirurgia , Procedimentos Cirúrgicos Urológicos , Feminino , Genitália Feminina/fisiopatologia , Genitália Feminina/cirurgia , Humanos , Retalhos Cirúrgicos , Uretra/fisiopatologia , Estreitamento Uretral/fisiopatologia , Micção/fisiologia , Urodinâmica
12.
Injury ; 50(5): 1053-1057, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30857738

RESUMO

Urethral injury in major trauma is infrequent, with complex problems of diagnosis and treatment. The aims of this study are to determine the incidence and epidemiological factors relating to urethral injury in major trauma, as well as determine if any additional prognostic factors are evident within this cohort of patients. A retrospective review of patients sustaining urethral injury following major trauma was made over a 6-year period, from 2010 to 2015. Quantitative analysis was made using the national trauma registry for England and Wales, the Trauma Audit and Research Network (TARN) database, identifying all patients with injury codes for urethral injury. 165 patients with urethral injuries were identified, over 90% were male, most commonly injured during road traffic accidents and with an associated overall mortality of 12%. Urethral injury in association with pelvic fracture occurred in 136 patients (82%), representing 0.6% of all pelvic fractures, and was associated with double the rate of mortality. Urethral injury was associated with unstable pelvic fractures (LC2, LC3, APC3, VS, CM) but not with a specific pelvic fracture type. This study confirms the rare incidence of this injury in major trauma at 1 per 2 million population per year.


Assuntos
Traumatismos Abdominais/complicações , Fraturas Ósseas/complicações , Traumatismo Múltiplo/fisiopatologia , Ossos Pélvicos/lesões , Uretra/lesões , Traumatismos Abdominais/diagnóstico por imagem , Adulto , Estudos de Avaliação como Assunto , Feminino , Fraturas Ósseas/diagnóstico por imagem , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Traumatismo Múltiplo/epidemiologia , Ossos Pélvicos/diagnóstico por imagem , Guias de Prática Clínica como Assunto , Reino Unido/epidemiologia , Uretra/diagnóstico por imagem , Uretra/fisiopatologia
13.
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
14.
Int Urol Nephrol ; 51(4): 609-615, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30798475

RESUMO

PURPOSE: Urinary incontinence (UI) is one of the most bothersome surgical side effects after robot-assisted radical prostatectomy (RARP). Alteration of both smooth and striate urethral sphincter occurs after RARP. Since the contraction of perineal muscles is involved in the complex mechanism of urinary continence, the uroflow stop test (UST) seems to predict early continence recovery after RARP. The UST was added of perineal surface electromyography (EMG) evaluation to evaluate the latency time (LT) between muscular contraction and the complete stop of urine flow. Our aim was to present UST-EMG as a new tool in the investigation of UI, implying pelvic floor integrity, and to evaluate whether an early return (≤ 3 months) to preoperative LT could be associated with early recovery of UC (≤ 3 months). METHODS: After prospectively enrolling 137 patients who underwent RARP with a minimum follow-up of 6 months, we identified two groups: Group 1 (93 patients) with early (≤ 3 months) pre-surgical LT recovery and Group 2 (44 patients) with late > 3 months or not able to reach pre-surgical LT recovery. RESULTS: Between the two groups, there were significant differences in terms of different surgical technique (nerve-sparing versus non-nerve-sparing) and pads use at 3 and 6 months after RARP (p < 0.05). No differences were recorded neither in postoperative maximum flow-rate, nor in postoperative symptoms score. CONCLUSIONS: UST with EMG can be considered as a noninvasive, reproducible and easily performable tool. LT is applicable in the clinical evaluation to predict urinary continence recovery after RARP.


Assuntos
Diafragma da Pelve/fisiopatologia , Prostatectomia/efeitos adversos , Procedimentos Cirúrgicos Robóticos/efeitos adversos , Uretra/fisiopatologia , Incontinência Urinária por Estresse/fisiopatologia , Absorventes Higiênicos , Idoso , Eletromiografia , Humanos , Pessoa de Meia-Idade , Contração Muscular , Períneo , Valor Preditivo dos Testes , Período Pré-Operatório , Estudos Prospectivos , Prostatectomia/métodos , Recuperação de Função Fisiológica , Fatores de Tempo , Incontinência Urinária por Estresse/etiologia , Urodinâmica
15.
Biomed Res Int ; 2019: 7826085, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30809546

RESUMO

Background: Excision and primary anastomotic (EPA) urethroplasty remains the gold standard definitive treatment for short urethral stricture disease. For patients, postoperative erectile function and quality of life are the main goals of the surgery. Patient-reported outcome measures (PROMs) are therefore of major importance. Objective: The objective of this study was to prospectively analyse functional outcomes and patient satisfaction. Design Settings and Participants: We prospectively evaluated 47 patients before and after EPA from August 2009 until February 2017. The first follow-up visit occurred after a median of 2.2 months (n = 47/47), with the second and third follow-ups occurring at a median of 8.5 months (n = 38/47) and 20.2 months (n = 31/47). Before surgery and at each follow-up visit, the patients received five questionnaires: the International Prostate Symptom Score (IPSS), the International Prostate Symptom Score with the Quality of Life (IPSS-QOL) score, the Urogenital Distress Inventory Short Form (UDI-6) score, the International Index of Erectile Function-5 (IIEF-5) score, and the ICIQ-Lower Urinary Tract Symptoms Quality of Life (ICIQ-LUTS-QOL) score. Surgical Procedure: Surgery was performed in all cases using the same standardized EPA technique. Outcome Measurements and Statistical Analysis: Voiding symptoms, erectile dysfunction, and quality of life were analysed using paired sample t-tests, with a multiple-testing Bonferroni correction. Any requirement for instrumentation after surgery was considered treatment failure. Results and Limitations: Patients with mild or no baseline erectile dysfunction showed significant decline in erectile function at first follow-up (mean IIEF-5 of 23.27 [standard deviation; SD: 2.60] vs. 13.91 [SD: 7.50]; p=0.002), but this had recovered completely at the third follow-up (IIEF-5: 23.25 [SD: 1.91]; p=0.659). Clinically significant improvements were noted in IPSS, IPSS-QOL-score, UDI-6-score, and ICIQ-LUTS-QOL-score at the first follow-up (p<0.0001). These improvements remained significant at the second and third follow-ups (p<0.0001) for all PROMs. Three of the patients experienced stricture recurrence. The main limitations of this study were incomplete questionnaires, loss to follow-up, and low number of patients. Conclusions: EPA results in an initial decline in erectile function, but full recovery occurred at a median of 20 months. Voiding improved significantly, and a major improvement in quality of life was noted, which persisted for up to 20 months after surgery. Patient Summary: This study showed the importance of patient-reported outcome measures in indicating the actual outcome of urethral stricture disease surgery.


Assuntos
Disfunção Erétil/fisiopatologia , Uretra/cirurgia , Estreitamento Uretral/cirurgia , Idoso , Anastomose Cirúrgica , Disfunção Erétil/complicações , Disfunção Erétil/epidemiologia , Humanos , Sintomas do Trato Urinário Inferior/complicações , Sintomas do Trato Urinário Inferior/epidemiologia , Sintomas do Trato Urinário Inferior/fisiopatologia , Masculino , Pessoa de Meia-Idade , Satisfação do Paciente , Ereção Peniana/fisiologia , Hiperplasia Prostática/complicações , Hiperplasia Prostática/epidemiologia , Hiperplasia Prostática/fisiopatologia , Qualidade de Vida , Inquéritos e Questionários , Uretra/fisiopatologia , Estreitamento Uretral/epidemiologia , Estreitamento Uretral/fisiopatologia
16.
PLoS One ; 14(1): e0209668, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30615677

RESUMO

AIM: To examine the position of the TVT-O sling 10 years postoperatively and its association with outcome. METHODS: A total of 124 patients who received a TVT-O sling at two centers in 2004 and 2007 were invited for follow-up. The position of the sling on perineal ultrasound was described relative to the bladder neck and the lower margin of the pubic symphysis at rest and on Valsalva. Objective cure was defined as a negative cough stress test at 300 ml. Subjective cure was evaluated with the Kings´ Health Questionnaire (KHQ), Incontinence Outcome Questionnaire (IOQ), Female Sexual Function Index Questionnaire (FSFI) and the Patient Global Impression of Improvement score (PGII). RESULTS: 78 of 124 patients (57%) were available for follow-up 10 years after surgery. I Eleven (14%) had undergone reoperation and were excluded. Tapes were visualized in the remaining 67 (54%) women. The subjective and objective cure rates in this sub-cohort were 67% (45/67) and 77% (52/67), respectively. In these 67 women the mean distances from the bladder neck to the proximal edge of the tape (BNTD) during Valsalva maneuver were significantly higher in cured women compared to the not-cured women (11.2 vs. 9.4mm). The distance between tape and urethra (TUD) was significantly lower in cured vs. not cured patients (2.6 vs. 4.1mm). All women with a TUD of >5mm (n = 5) were incontinent. Tape position was not associated with overactive bladder symptoms. CONCLUSIONS: Tape position near the bladder neck and large distance to the urethra is associated with incontinence 10 years after TVT-O.


Assuntos
Slings Suburetrais , Uretra/fisiopatologia , Incontinência Urinária por Estresse/cirurgia , Idoso , Feminino , Seguimentos , Humanos , Pessoa de Meia-Idade , Inquéritos e Questionários , Resultado do Tratamento , Ultrassonografia , Incontinência Urinária por Estresse/diagnóstico por imagem , Incontinência Urinária por Estresse/fisiopatologia , Urodinâmica/fisiologia
17.
Int Urogynecol J ; 30(3): 393-399, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-29594319

RESUMO

INTRODUCTION AND HYPOTHESIS: We evaluate the 2-year outcome of the rolled fortified vaginal flap (RFVF) operation for the treatment of stress urinary incontinence (SUI) due to intrinsic sphincteric deficiency (ISD). METHODS: A prospective study of 20 women suffering from SUI due to ISD was conducted. All patients were subjected to history-taking, clinical examination, cough stress test, and urodynamics. Symptom severity and quality of life (QoL) were assessed using the Arabic version of the International Consultation on Incontinence Questionnaire Urinary Incontinence Short Form (ICIQ-UI-SF). All studied women were followed up for 24 months to detect success rate, any postoperative complications, and reveal changes in the quality of life. RESULTS: Mean age was 53 ± 8 years. Preoperative Valsalva leak point pressure was 50.1 ± 11.3 cmH2O. After a follow-up period of 24 months, only 2 patients (10%) showed mild stress incontinence with mean VLPP 80± 3 cm H2O. Postoperative mean maximum flow rate (Q-max) and mean Pdet-Qmax showed no significant difference from the preoperative results (P = 0.115 and 0.187 respectively). The quality of life domain of the ICIQ-UI-SF decreased significantly from 73.5 ± 12.1% (preoperatively) to 2.6 ± 8.1% (after a 1-year follow-up), P < 0.001 and then showed a slight increase to 4.5 ± 10.6 at 24 months' follow-up. CONCLUSION: The RFVF operation has a success rate of 90% after a 24-month follow-up. It significantly improved the quality of life of women with SUI due to ISD.


Assuntos
Retalhos Cirúrgicos , Uretra/fisiopatologia , Uretra/cirurgia , Incontinência Urinária por Estresse/cirurgia , Vagina/cirurgia , Adulto , Feminino , Seguimentos , Humanos , Pessoa de Meia-Idade , Pressão , Estudos Prospectivos , Qualidade de Vida , Índice de Gravidade de Doença , Inquéritos e Questionários , Urodinâmica , Manobra de Valsalva
18.
Int Urogynecol J ; 30(3): 489-493, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-29644382

RESUMO

INTRODUCTION AND HYPOTHESIS: Pelvic organ prolapse (POP) reduction is often performed in the preoperative assessment of women before POP surgery. Using urethral pressure reflectometry (UPR), we sought to investigate how POP reduction affects the urethral closure mechanism. METHODS: Women with anterior or posterior vaginal wall prolapse stage ≥II with and without POP reduction were examined with a speculum. We performed prolapse staging according to the Pelvic Organ Prolapse Quantification system, UPR measurements at rest and during squeezing, and standardized stress tests with 300 ml saline. All examinations were repeated after insertion of a speculum. RESULTS: We included 38 women: 22 with anterior and 16 with posterior vaginal wall prolapse POP-Q stage ≥II. During POP reduction, resting and squeezing urethral pressures decreased by 2.5 cmH2O (p = 0.007) and 5.1 cmH2O (p < 0.0001), respectively, in all women. During POP reduction, the number of positive stress tests increased from four (18%) to eight (36%) in women with anterior vaginal wall prolapse and from one (6%) to nine (56%) in women with posterior vaginal wall prolapse. CONCLUSIONS: POP reduction decreases urethral pressure, especially during squeezing, and consequently increases the number of positive stress tests. The test itself artificially deteriorates the urethral closure mechanism.


Assuntos
Prolapso de Órgão Pélvico/fisiopatologia , Prolapso de Órgão Pélvico/cirurgia , Uretra/fisiopatologia , Incontinência Urinária por Estresse/fisiopatologia , Feminino , Exame Ginecológico , Humanos , Pessoa de Meia-Idade , Prolapso de Órgão Pélvico/complicações , Pressão , Incontinência Urinária por Estresse/etiologia , Urodinâmica
19.
Ultrasound Obstet Gynecol ; 53(1): 124-128, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-29947126

RESUMO

OBJECTIVE: To evaluate changes in urethral mobility and configuration after prolapse repair. METHODS: This was a retrospective study of 92 patients who were examined between 2005 and 2016 before and after surgery for pelvic organ prolapse (POP) without concomitant anti-incontinence surgery. All patients were assessed with an interview, POP quantification and translabial four-dimensional ultrasound. Urethral mobility was evaluated using semi-automated urethral motion profile software in which x- and y-coordinates of six equidistant points along the length of the urethra were determined both at rest and on Valsalva, relative to the posteroinferior margin of the pubic symphysis. Urethral kinking was measured by placing tangents distal and proximal to any visually identified change in the urethral axis. Imaging data obtained before and after prolapse surgery were compared. RESULTS: Mean age was 58 years and mean follow-up was 5.8 months. Prolapse symptoms had resolved in 85% of patients. Highly significant reductions in urethral mobility and urethral kinking were seen after surgery (all P ≤ 0.001). Similar changes were observed after anterior vaginal repair with or without apical repair, without concomitant posterior repair (n = 23; all P < 0.05). CONCLUSIONS: POP surgery was associated significantly with 'straightening' of the urethra and reduction in urethral mobility. The effect seems to be due largely to cystocele repair. Copyright © 2018 ISUOG. Published by John Wiley & Sons Ltd.


Assuntos
Prolapso de Órgão Pélvico/cirurgia , Uretra/fisiopatologia , Incontinência Urinária por Estresse/diagnóstico por imagem , Adulto , Idoso , Feminino , Humanos , Pessoa de Meia-Idade , Estudos Retrospectivos , Inquéritos e Questionários , Ultrassonografia , Uretra/diagnóstico por imagem , Urodinâmica
20.
Low Urin Tract Symptoms ; 11(2): O186-O192, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-29266769

RESUMO

OBJECTIVE: Stress urinary incontinence (SUI) is a common disease condition in elderly women, suggesting that its etiology may be linked to aging. To investigate the hypothesis that urethral dysfunction and histopathological changes are possible contributors to SUI in elderly women, several parameters of urethral function, as well as histological parameters, were compared between young and aged rats. METHODS: Virgin female rats were examined at 3 different ages, namely 3, 12, and 24 months, corresponding to young, middle-aged, and aged rats, respectively. Urethral function was assessed by measuring the leak point pressure (LPP), pudendal nerve stimulation (PNS)-induced elevation in urethral pressure, and phenylephrine-induced increase in urethral perfusion pressure (UPP). Histopathological assessments were performed following hematoxylin and eosin (HE), Masson's trichrome, and immunofluorescence staining of urethral tissue. RESULTS: LPP of aged rats was significantly reduced compared to that of both young and middle-aged rats. PNS-induced elevation in urethral pressure in aged rats was also significantly lower than that in young rats. In contrast, there were no significant differences in the phenylephrine-induced increase in UPP between young and aged rats. Connective tissue area in the external urethral sphincter (EUS) layer was increased in aged rats, whereas the smooth muscle layer was histologically similar to that in young rats. The number of EUS fibers was significantly reduced in aged rats, whereas the cross-sectional area of EUS fibers increased from differed compared with young rats. CONCLUSION: We have demonstrated age-related changes in EUS function and morphology in the rat urethra, which are considered to be etiological risk factors for SUI in humans.


Assuntos
Modelos Animais de Doenças , Uretra/fisiopatologia , Incontinência Urinária por Estresse/fisiopatologia , Envelhecimento , Animais , Feminino , Imunofluorescência , Ratos , Ratos Sprague-Dawley , Uretra/inervação , Uretra/patologia , Incontinência Urinária por Estresse/etiologia
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