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1.
Neurourol Urodyn ; 40(3): 883-890, 2021 03.
Artigo em Inglês | MEDLINE | ID: mdl-33645850

RESUMO

OBJECTIVES: Both detrusor underactivity (DU) and bladder outlet obstruction are the common causes of chronic urinary retention. Some novel treatment approaches focus on modulating micturition reflex and external urethral sphincter (EUS) function. This study used electrophysiologic (EP) studies to investigate the micturition reflex and EUS conditions of chronic urinary retention patients. METHODS: Sixty patients with urodynamic DU and chronic urinary retention were studied using (1) bulbocavernous reflex (BCR) by electric stimulation, (2) electromyography (EMG) of the EUS, and (3) nerve conduction velocity (NCV) studies of the pudendal nerve. The EP findings were analyzed in DU patients with different etiologies. RESULTS: The BCR was positive in 41.7% of patients. In EMG studies, denervation, reinnervation, and reduced recruitment of the EUS were observed in 21.7%, 71.7%, and 88.3% patients, respectively. Decreased amplitude of pudendal nerve conduction in NCV studies was noted in 73.3% of patients. Patients with sacral neuropathy had a lower BCR positive rate (p = 0.001), a nonsignificant but higher denervation rate (p = 0.059) in EMG studies, and a higher rate of decreased amplitude in NCV (p = 0.011) than those without sacral neuropathy. Excluding patients with sacral neuropathy or diabetes mellitus, a high percentage of neurologic deficits was still detected in EP studies. CONCLUSIONS: Chronic urinary retention patients with urodynamic DU not only have bladder dysfunction, but also potential neuropathy in the sacral reflexes, pudendal nerve, or urethral sphincter innervation. The neurologic deficits explored in EP studies may affect the decision-making around the therapy to restore the voiding function in DU.


Assuntos
Eletrofisiologia/métodos , Bexiga Inativa/complicações , Retenção Urinária/complicações , Urodinâmica/fisiologia , Idoso , Doença Crônica , Feminino , Humanos , Masculino , Estudos Retrospectivos , Obstrução do Colo da Bexiga Urinária/fisiopatologia , Bexiga Inativa/patologia
2.
J Urol ; 204(6): 1296-1304, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-32568608

RESUMO

PURPOSE: The UroCuff® Test is a noninvasive pressure flow study used to manage men with lower urinary tract symptoms. UroCuff Tests were performed on men with lower urinary tract symptoms to evaluate voiding characteristics and quantify changes in urodynamic parameters with age. MATERIALS AND METHODS: This cross-sectional study included all UroCuff Tests performed at 103 urology practices in the U.S. Tests were de-identified prior to collection and analysis. Inclusion criteria required initial pressure flow study with subsequent tests excluded, voided volume 50 ml or greater, at least 1 cuff inflation and patient age greater than 20 years. Pressure, maximum flow rate, flow rate efficiency (maximum flow rate/Pcuff), voided volume and post-void residual were plotted by age and stratified by Newcastle Noninvasive Nomogram category. RESULTS: A total of 50,680 patients 20 to 100 years old (median age 66.0) met inclusion criteria. Median Pcuff was 144.3 cmH2O and 60.8% of patients were categorized in the obstructed or high pressure/high flow Newcastle Noninvasive Nomogram quadrants. Median maximum flow rate was 10.9 ml per second and 55.8% had maximum flow rate greater than 10 ml per second. Median voided volume and post-void residual were 219.0 and 75.0 ml, respectively. All measures deteriorated with age (p <0.0001). Pcuff reflects the compensated/decompensated bladder function lifecycle. Values initially increased and reached peak pressure at age 62, then decreased by approximately 0.96 cmH2O per year until age 90. CONCLUSIONS: This study demonstrates that symptomatic patients enter urological practices at different urodynamic stages of bladder function and outlet obstruction, that Pcuff, maximum flow rate, voided volume, flow rate efficiency and post-void residual deteriorate with age, and that UroCuff is a sensitive evaluation of bladder performance.


Assuntos
Sintomas do Trato Urinário Inferior/diagnóstico , Hiperplasia Prostática/complicações , Obstrução do Colo da Bexiga Urinária/diagnóstico , Micção/fisiologia , Urodinâmica/fisiologia , Idoso , Idoso de 80 Anos ou mais , Estudos Transversais , Humanos , Sintomas do Trato Urinário Inferior/etiologia , Sintomas do Trato Urinário Inferior/fisiopatologia , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Índice de Gravidade de Doença , Obstrução do Colo da Bexiga Urinária/etiologia , Obstrução do Colo da Bexiga Urinária/fisiopatologia
3.
Rev Assoc Med Bras (1992) ; 66(2): 153-159, 2020 May 15.
Artigo em Inglês | MEDLINE | ID: mdl-32428149

RESUMO

OBJECTIVES: To prospectively investigate the alterations and normal ranges of ureteral jet dynamics after double-J-stent (DJS) removal in patients who underwent renal transplantation (RTx). METHODS: Patients who underwent RTx were prospectively evaluated between November 2017 and June 2018. After RTx, Doppler ultrasonography (D-US) was performed on all patients after DJS removal. Renal artery resistive index (RA-Ri), renal pelvis anterior-posterior diameter (RP-APD), pelvicalyceal system dilation (PCSD), and ureteral jet flow dynamics (maximum and average velocity; JETmax and JETave) were measured by D-US. Also, patients' demographics, estimated glomerular filtration rate (eGFR) levels, and acute rejection were investigated in the study. Patients were assessed two different times by D-US, about 6 and 12 weeks after DJS removal, and the two different measurements were compared with the Wilcoxon test and Chi-square test. RESULTS: A total of 25 patients were evaluated in the study. Nonobstructive PCSD rate (12% vs 8%), JETave (18.8 vs 12.9 cm/sec), and JETmax (29.2 vs 20 cm/sec) levels were significantly decreased (p values are 0.01, 0.010 and 0.014, respectively). In addition, monophasic and square pattern rates were significantly observed to increase over time (p=0.035); however, ureteral jet patterns were correlated between the two different D-US measurements (R=0.225, p=0.032). CONCLUSION: After RTx, dilation rate and ureteral jet flow velocities were significantly decreased, and monophasic and square JETpattern rates were significantly increased over time. Ureteral jet dynamics can provide useful information about the follow-up of peristaltic activity in the pelvic-ureteric system.


Assuntos
Transplante de Rim/efeitos adversos , Stents/efeitos adversos , Ureter/fisiopatologia , Cateterismo Urinário/efeitos adversos , Urodinâmica/fisiologia , Adulto , Feminino , Seguimentos , Taxa de Filtração Glomerular , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Estatísticas não Paramétricas , Fatores de Tempo , Ultrassonografia Doppler/métodos , Ureter/diagnóstico por imagem , Adulto Jovem
4.
Urologe A ; 59(9): 1076-1081, 2020 Sep.
Artigo em Alemão | MEDLINE | ID: mdl-32424576

RESUMO

BACKGROUND: Nearly all patients with spinal cord injury (SCI) suffer from neurogenic lower urinary tract dysfunction (NLUTD). Untreated NLUTD is a risk factor for renal damage and can significantly affect quality of life (QoL). Patients with SCI frequently use complementary medicine to alleviate symptoms, namely for urologic problems. OBJECTIVES: We evaluated whether homeopathic treatment influences objective urodynamic parameters. MATERIALS AND METHODS: In a retrospective study, urodynamic data of patients with NLUTD due to SCI who received constitutional homeopathic treatment by the consultants of our hospital were evaluated before initiation of homeopathic treatment and at the most recent follow-up. Modifications in urologic treatment were taken into account. RESULTS: Urodynamic results from 35 patients who underwent homeopathic treatment (14 women, 21 men, median age 46 years, tetraplegia: n = 14; paraplegia: n = 21) were available at both time points and could therefore be evaluated. In all, 20 patients used intermittent catheterization, 6 persons had an indwelling catheter, and 9 persons emptied their bladders without a catheter. There were no significant differences in the urodynamic parameters before and during treatment. Changes in urologic therapy correlated with significant improvement in urodynamic findings. CONCLUSIONS: As all patients were under urologic surveillance, and immediate urologic treatment was established if necessary, a retrospective study design proved not to be suitable to detect possible influences of homeopathic treatment on urodynamic parameters in patients with SCI. Thus, a prospective randomized study is essential.


Assuntos
Sintomas do Trato Urinário Inferior/etiologia , Traumatismos da Medula Espinal/complicações , Bexiga Urinaria Neurogênica/etiologia , Urodinâmica/fisiologia , Adulto , Idoso , Feminino , Humanos , Sintomas do Trato Urinário Inferior/fisiopatologia , Sintomas do Trato Urinário Inferior/terapia , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Qualidade de Vida , Estudos Retrospectivos , Traumatismos da Medula Espinal/fisiopatologia , Bexiga Urinaria Neurogênica/fisiopatologia , Bexiga Urinaria Neurogênica/terapia
5.
Mol Med Rep ; 22(1): 219-226, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32468047

RESUMO

Bladder outlet obstruction (BOO), which is primarily caused by benign prostatic hyperplasia, is a common chronic disease. However, previous studies have most commonly investigated BOO using the acute obstruction model. In the present study, a chronic obstruction model was established to investigate the different pathological alterations in the bladder between acute and chronic obstruction. Compared with chronic obstruction, acute obstruction led to increased expression of proliferating cell nuclear antigen and interleukin­1ß, which are markers of proliferation and inflammation, respectively. Furthermore, increased fibrosis in the bladder at week 2 was observed. Low pressure promoted mice bladder smooth muscle cell (MBSMC) proliferation, and pressure overload inhibited cell proliferation and increased the proportion of dead MBSMCs. Further investigation using serum/glucocorticoid regulated kinase 1 (SGK1) small interfering RNAs indicated that low pressure may promote MBSMC proliferation by upregulating SGK1 and nuclear factor of activated T­cell expression levels. Therefore, the present study suggested that acute obstruction led to faster decompensation of bladder function and chronic bladder obstruction displayed an enhanced ability to progress to BOO.


Assuntos
Proteínas Imediatamente Precoces/metabolismo , Interleucina-1beta/metabolismo , Fatores de Transcrição NFATC/metabolismo , Proteínas Serina-Treonina Quinases/metabolismo , Piroptose , Obstrução do Colo da Bexiga Urinária/metabolismo , Doença Aguda , Animais , Morte Celular , Proliferação de Células/genética , Doença Crônica , Colágeno/metabolismo , Feminino , Camundongos , Camundongos Endogâmicos BALB C , Miócitos de Músculo Liso/metabolismo , Antígeno Nuclear de Célula em Proliferação/metabolismo , Piroptose/genética , RNA Interferente Pequeno , Transdução de Sinais/genética , Bexiga Urinária/citologia , Bexiga Urinária/patologia , Obstrução do Colo da Bexiga Urinária/genética , Obstrução do Colo da Bexiga Urinária/patologia , Urodinâmica/genética , Urodinâmica/fisiologia
6.
Isr Med Assoc J ; 22(4): 236-240, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32286027

RESUMO

BACKGROUND: Urinary tract infection (UTI) is a common bacterial infection in children. ​​​​​​​Early treatment may prevent renal damage in pyelonephritis. The choice of empiric antibiotic treatment is based on knowledge of the local susceptibility of urinary bacteria to antibiotics. In Israel the recommended empiric oral antibiotic treatment are First or second generation cephalosporin, trimethoprim-sulfamethoxazole or amoxicillin-clavulanic acid. OBJECTIVES: To describe resistance rates of urine bacteria isolated from children with UTI in the community settings. Identify risk factors for resistance. METHODS: A retrospective cross-sectional study of UTI in children aged 3 months to 18 years diagnosed with UTI and treated as outpatients in a large community clinic between 7/2015 and 7/2017 with a diagnosis of UTI. RESULTS: A total of 989 urinary samples were isolated, 232 were included in the study. Resistance rates to cephalexin, cefuroxime, ampicillin/clavulanate and Trimethoprim-Sulfamethoxazole were 9.9%, 9.1%, 20.7%, and 16.5%, respectively. Urinary tract abnormalities and recurrent UTI were associated with an increase in antibiotic resistance rates. Other factors such as age, fever, and previous antibiotic treatment were not associated with resistance differences. CONCLUSIONS: Resistance rates to common oral antibiotics were low compared to previous studies performed in Israel in hospital settings. First generation cephalosporins are the preferred empiric antibiotics for febrile UTI for outpatient children. Amoxicillin/clavulanate is not favorable due to resistance of over 20% and the broad spectrum of this antibiotic. Care should be taken in children with renal abnormalities as there is a worrying degree of resistance rates to the oral first line antibiotic therapy.


Assuntos
Combinação Amoxicilina e Clavulanato de Potássio/uso terapêutico , Antibacterianos/uso terapêutico , Farmacorresistência Bacteriana , Infecções Urinárias/tratamento farmacológico , Infecções Urinárias/microbiologia , Adolescente , Fatores Etários , Distribuição de Qui-Quadrado , Criança , Pré-Escolar , Estudos Transversais , Feminino , Seguimentos , Humanos , Lactente , Israel , Masculino , Testes de Sensibilidade Microbiana , Pacientes Ambulatoriais/estatística & dados numéricos , Estudos Retrospectivos , Medição de Risco , Fatores Sexuais , Estatísticas não Paramétricas , Resultado do Tratamento , Urinálise/métodos , Infecções Urinárias/fisiopatologia , Urodinâmica/fisiologia
7.
Neurourol Urodyn ; 39(4): 1129-1136, 2020 04.
Artigo em Inglês | MEDLINE | ID: mdl-32163639

RESUMO

AIMS: The primary aim of this study was to assess the relationship between a strong desire to void (SDV) and rectal sensory function in patients with multiple sclerosis (PwMS) and anorectal disorders. The secondary aim was to identify clinical, urodynamic or manometric factors associated with greater rectal sensory function impairment in this population. METHODS: Thirty PwMS (mean age 49.2 ± 10.9 years) with anorectal disorders (constipation and/or fecal incontinence) participated in this observational study. Rectal sensory parameters during anorectal manometry were recorded at a strong desire to void and after urination (PV, post-void). The primary outcome was the desire to defecate volume. Secondary outcomes were first perception and maximum tolerated threshold volumes, presence and modulation of recto-anal inhibitory reflex. RESULTS: The mean desire to defecate volume was 125 ± 59 mL at SDV and 104 ± 64 mL at PV (P < .001). The mean maximum tolerated volume was 167 ± 61 mL at SDV vs 141 ± 64 mL after urination (P = .01). The other parameters were not different between SVD and PV conditions. No predictive factors for greater impairment of rectal sensory function were identified. CONCLUSION: This study suggests a relationship between bladder sensation and thus bladder capacity, and rectal sensory function in PwMS and with anorectal disorders.


Assuntos
Defecação/fisiologia , Incontinência Fecal/fisiopatologia , Esclerose Múltipla/fisiopatologia , Bexiga Urinária/fisiopatologia , Micção/fisiologia , Adulto , Idoso , Canal Anal/fisiopatologia , Constipação Intestinal/fisiopatologia , Feminino , Humanos , Masculino , Manometria , Pessoa de Meia-Idade , Reto/fisiopatologia , Sensação/fisiologia , Urodinâmica/fisiologia
8.
Neurourol Urodyn ; 39(4): 1170-1177, 2020 04.
Artigo em Inglês | MEDLINE | ID: mdl-32187720

RESUMO

AIM: The International Continence Society (ICS) has standardized quality control and interpretation of uroflowmetry and urodynamics. We evaluated traces from two large studies of male lower urinary tract symptoms (UPSTREAM and UNBLOCS) against ICS standards of urodynamic equipment and practice. METHODS: Ten percent of uroflowmetry and urodynamics traces were selected at random from hospital sites. A data capture template was designed from the ICS Fundamentals of Urodynamic Practice checklist. Two pretrained blinded assessors extracted the data, with a third assessor to arbitrate. Departmental records of calibration checks and equipment maintenance were scrutinized. RESULTS: Seven out of twenty-five (28%) departments reported no calibration checks. Four sites (16%) could not provide annual service records. In 32 out of 296 (10.8%) uroflowmetry traces, findings were affected by artifact. One hundred ten urodynamic study traces were reviewed; in 11 records (10%), key pressure traces were incompletely displayed. In 30 (27.2%), reference zero was not set to atmospheric pressure. Resting pressures were outside the expected range for 36 (32.7%). Pressure drift was seen in 18 traces (16.4%). At pressure-flow study commencement, permission to void was omitted in 15 (13.6%). Cough testing after voiding was done in 71.2%, but the resulting cough spikes were significantly different in 16.5%. Erroneous diagnosis of bladder outlet obstruction (BOO) was identified in six cases (5.5%). CONCLUSIONS: Erroneous diagnosis of BOO is a serious error of interpretation, as it could lead to unnecessary surgery. Other errors of standardization, testing, and interpretation were identified with lower risk of adverse implications. Inconsistent documentation of service records mean equipment accuracy is uncertain.


Assuntos
Sintomas do Trato Urinário Inferior/diagnóstico , Obstrução do Colo da Bexiga Urinária/diagnóstico , Micção/fisiologia , Urodinâmica/fisiologia , Erros de Diagnóstico , Humanos , Sintomas do Trato Urinário Inferior/fisiopatologia , Masculino , Pessoa de Meia-Idade , Controle de Qualidade , Sociedades , Obstrução do Colo da Bexiga Urinária/fisiopatologia
9.
Neurourol Urodyn ; 39(4): 1178-1184, 2020 04.
Artigo em Inglês | MEDLINE | ID: mdl-32203630

RESUMO

AIMS: No one has assessed urodynamic studies (UDS) to determine those steps that elicit the greatest anxiety, distress, and pain in children. We sought to systematically evaluate a child's UDS experience to mollify these reactions. METHODS: Prospective study involving children aged ≥5 undergoing UDS over a 6-month period (from 10 December 2018 to 22 May 2019). Upon arrival, patients completed a visual analog scale for anxiety (VAS-A, 0-10) about the upcoming procedure. A research assistant assessed the patient's behavior during each major step of UDS using a validated brief behavioral distress scale. Nursing staff also obtained patients' pain ratings (0-10) for these key elements. Immediately after UDS, each child completed a posttest VAS-A along with a survey about the UDS experience. RESULTS: A total of 76 UDS were observed; almost half included sphincter needle electromyography (EMG). Mean patient VAS-A scores were 2.3 before UDS, compared to 0.8 afterward (P < .001). The highest proportion of distressful behaviors were observed during EMG needle (31%) and urethral catheter (29%) insertion, in agreement with the highest mean pain scores of 3.2 and 2.7, respectively. Fifty-four percent of children reported not being completely aware of what was going to happen before the procedure and 50% of those patients exhibited at least one interfering or potentially interfering behavior. Similarly, 60% of children with no prior history of UDS exhibited at least one interfering or potentially interfering behavior. CONCLUSIONS: EMG needle and urethral catheter placement, initial urodynamic testing and not knowing what to expect were associated with greater pain and distress during pediatric UDS.


Assuntos
Ansiedade/fisiopatologia , Dor/fisiopatologia , Uretra/fisiopatologia , Urodinâmica/fisiologia , Adolescente , Adulto , Ansiedade/psicologia , Criança , Pré-Escolar , Eletromiografia , Feminino , Humanos , Masculino , Dor/psicologia , Estudos Prospectivos , Inquéritos e Questionários , Escala Visual Analógica , Adulto Jovem
10.
Neurourol Urodyn ; 39(3): 969-977, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-32032447

RESUMO

AIMS: We compared brain activation patterns between female multiple sclerosis (MS) patients with voiding dysfunction (VD) and those without. We aim to expand current knowledge of supraspinal correlates of voiding initiation within a cohort of female MS patients with and without VD. MATERIALS AND METHODS: Twenty-eight ambulatory female MS patients with stable disease and lower urinary tract dysfunction were recruited for this study. Subjects were divided into group 1, without VD (n = 14), and group 2, with VD (n = 14), defined as postvoid residual urine of ≥40% of maximum cystometric capacity or need for self-catheterization. We recorded brain activity via functional magnetic resonance imaging (fMRI) with simultaneous urodynamic testing. Average fMRI activation maps (the Student t test) were created for both groups, and areas of significant activation were identified (P < .05). A priori regions of interest (ROIs), identified by prior meta-analysis to be involved in voiding, were selected. RESULTS: Group-averaged blood-oxygen level-dependent (BOLD) activation maps demonstrated significant differences between groups 1 and 2 during initiation of voiding with group 2 showing significantly lower levels of activation in all ROIs except for the left cerebellum and right cingulate gyrus. Interestingly, group 2 displayed negative BOLD signals, while group 1 displayed positive signals in the right and left pontine micturition center, right periaqueductal gray, left thalamus, and left cingulate gyrus. The activation map of group 1 was similar to healthy controls. CONCLUSIONS: Our results support the hypothesis that distinct supraspinal activation patterns exist between female MS patients with VD and those without.


Assuntos
Encéfalo/diagnóstico por imagem , Sintomas do Trato Urinário Inferior/fisiopatologia , Esclerose Múltipla/diagnóstico por imagem , Bexiga Urinaria Neurogênica/fisiopatologia , Transtornos Urinários/fisiopatologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Encéfalo/fisiopatologia , Estudos de Casos e Controles , Cerebelo/diagnóstico por imagem , Cerebelo/fisiopatologia , Feminino , Neuroimagem Funcional , Giro do Cíngulo/diagnóstico por imagem , Giro do Cíngulo/fisiopatologia , Humanos , Sintomas do Trato Urinário Inferior/etiologia , Imageamento por Ressonância Magnética/métodos , Pessoa de Meia-Idade , Esclerose Múltipla/complicações , Esclerose Múltipla/fisiopatologia , Substância Cinzenta Periaquedutal/diagnóstico por imagem , Substância Cinzenta Periaquedutal/fisiopatologia , Ponte/diagnóstico por imagem , Ponte/fisiopatologia , Tálamo/diagnóstico por imagem , Tálamo/fisiopatologia , Bexiga Urinária/fisiopatologia , Bexiga Urinaria Neurogênica/etiologia , Micção/fisiologia , Transtornos Urinários/etiologia , Urodinâmica/fisiologia
11.
Sci Rep ; 10(1): 1944, 2020 02 06.
Artigo em Inglês | MEDLINE | ID: mdl-32029796

RESUMO

Patients with pelvic organ prolapse (POP) often have accompanying lower urinary tract symptoms. Symptoms such as stress urinary incontinence(SUI-UD) and detrusor overactivty(DO) would co-exist in a number of patients. Management entails relieving the obstructive element. To determine the clinical outcome of patients with urodynamics mixed type urinary incontinence(MUI-U) after vaginal pelvic reconstructive surgery(PRS), a retrospective study was conducted. MUI-U was defined as having urodynamic findings of both of DO/DOI (derusor overactivity incontinence) and SUI-UD. Main outcome measures: Objective cure- absence of involuntary detrusor contraction on filling cystometry and no demonstrable leakage of urine during increased abdominal pressure; Subjective cure- assessment index score of <1 on UDI-6 question #2 and #3. Of the 82 patients evaluated, 14 underwent vaginal PRS with concomitant mid-urethral sling(MUS) insertion while 68 had vaginal PRS alone. Pre-operatively, 49(60%) patients had stage III and 33(40%) had stage IV prolapse. Post-operatively, 1-year data shows an objective cure of 56% (46/82) and subjective cure of 54% (44/82). MUI-U was significantly improved. Improvement of SUIUD and results of the 1-hour pad test were more pronounced in patients with concomitant MUS insertion. Ergo, vaginal PRS cures symptoms of MUI-U in >50% of patients and concomitant MUS can be offered to SUI predominant MUI.


Assuntos
Prolapso de Órgão Pélvico/fisiopatologia , Prolapso de Órgão Pélvico/cirurgia , Incontinência Urinária por Estresse/fisiopatologia , Incontinência Urinária por Estresse/cirurgia , Urodinâmica/fisiologia , Idoso , Feminino , Humanos , Sintomas do Trato Urinário Inferior/fisiopatologia , Sintomas do Trato Urinário Inferior/cirurgia , Masculino , Pessoa de Meia-Idade , Período Pós-Operatório , Qualidade de Vida , Estudos Retrospectivos , Slings Suburetrais , Resultado do Tratamento , Procedimentos Cirúrgicos Urológicos/métodos , Vagina/fisiopatologia , Vagina/cirurgia
12.
Neurourol Urodyn ; 39(4): 1115-1123, 2020 04.
Artigo em Inglês | MEDLINE | ID: mdl-32110842

RESUMO

AIMS: The aim of our study was to investigate noninvasive predictors for detrusor underactivity (DUA) in male patients with lower urinary tract symptoms (LUTS) and benign prostatic enlargement (BPE). METHODS: A consecutive series of patients aged 45 years or older with non-neurogenic LUTS were prospectively enrolled. Patients underwent standard diagnostic assessment including International Prostatic Symptoms Score, uroflowmetry, urodynamic studies (cystometry and pressure-flow studies), transrectal ultrasound of the prostate, and ultrasound measurements of the bladder wall thickness (BWT). Logistic regression analysis was used to investigate predictors of DUA, defined as a bladder contractility index < 100 mm H2 O. A nomogram was developed based on the multivariable logistic regression model. RESULTS: Overall 448 patients with a mean age of 66 ± 11 years were enrolled. In a multivariable logistic age-adjusted regression model BWT (odds ratio [OR]: 0.50 per mm; 95% confidence interval [CI], 0.30-0-66; P = .001) and Qmax (OR: 0.75 per mL/s; 95% CI, 0.70-0.81; P = .001) were significant predictors for DUA. The nomogram based on the model presented good discrimination (area under the curve [AUC]: 0.82), good calibration (Hosmer-Lemeshow test, P > .05) and a net benefit in the range of probabilities between 10% and 80%. CONCLUSIONS: According to our results, BWT and Qmax can noninvasively predict the presence of DUA in patients with LUTS and BPE. Although our study should be confirmed in a larger prospective cohort, we present the first available nomogram for the prediction of DUA in patients with LUTS.


Assuntos
Sintomas do Trato Urinário Inferior/diagnóstico , Nomogramas , Hiperplasia Prostática/diagnóstico , Bexiga Inativa/diagnóstico , Bexiga Urinária/diagnóstico por imagem , Urodinâmica/fisiologia , Idoso , Humanos , Sintomas do Trato Urinário Inferior/diagnóstico por imagem , Sintomas do Trato Urinário Inferior/fisiopatologia , Masculino , Pessoa de Meia-Idade , Contração Muscular , Estudos Prospectivos , Hiperplasia Prostática/diagnóstico por imagem , Hiperplasia Prostática/fisiopatologia , Ultrassonografia , Bexiga Urinária/fisiopatologia , Bexiga Inativa/diagnóstico por imagem , Bexiga Inativa/fisiopatologia
13.
Rev. Assoc. Med. Bras. (1992) ; 66(2): 153-159, Feb. 2020. tab, graf
Artigo em Inglês | LILACS, Sec. Est. Saúde SP | ID: biblio-1136178

RESUMO

SUMMARY OBJECTIVES To prospectively investigate the alterations and normal ranges of ureteral jet dynamics after double-J-stent (DJS) removal in patients who underwent renal transplantation (RTx). METHODS Patients who underwent RTx were prospectively evaluated between November 2017 and June 2018. After RTx, Doppler ultrasonography (D-US) was performed on all patients after DJS removal. Renal artery resistive index (RA-Ri), renal pelvis anterior-posterior diameter (RP-APD), pelvicalyceal system dilation (PCSD), and ureteral jet flow dynamics (maximum and average velocity; JETmax and JETave) were measured by D-US. Also, patients' demographics, estimated glomerular filtration rate (eGFR) levels, and acute rejection were investigated in the study. Patients were assessed two different times by D-US, about 6 and 12 weeks after DJS removal, and the two different measurements were compared with the Wilcoxon test and Chi-square test. RESULTS A total of 25 patients were evaluated in the study. Nonobstructive PCSD rate (12% vs 8%), JETave (18.8 vs 12.9 cm/sec), and JETmax (29.2 vs 20 cm/sec) levels were significantly decreased (p values are 0.01, 0.010 and 0.014, respectively). In addition, monophasic and square pattern rates were significantly observed to increase over time (p=0.035); however, ureteral jet patterns were correlated between the two different D-US measurements (R=0.225, p=0.032). CONCLUSION After RTx, dilation rate and ureteral jet flow velocities were significantly decreased, and monophasic and square JETpattern rates were significantly increased over time. Ureteral jet dynamics can provide useful information about the follow-up of peristaltic activity in the pelvic-ureteric system.


RESUMO OBJETIVOS Investigar prospectivamente as alterações e as variações normais da dinâmica do jato ureteral após a remoção do J-stent duplo (DJS) em pacientes submetidos a transplante renal (RTx). MÉTODOS Pacientes submetidos a RTx foram avaliados prospectivamente entre novembro de 2017 e junho de 2018. Após o RTx, o D-US foi realizado em todos os pacientes após a remoção do DJS. Índice de resistência da artéria renal (RA-Ri), diâmetro ântero-posterior da pelve renal (AP-DPR), dilatação do sistema pelvicaliceal (PCSD) e dinâmica do jato ureteral (velocidade máxima e média; JETmax e JETave) foram medidos por D-US. Além disso, a demografia dos pacientes, os níveis estimados de taxa de filtração glomerular (eGFR) e a rejeição aguda foram investigados no estudo. Os pacientes foram avaliados em dois momentos diferentes pelo D-US, cerca de 6 e 12 semanas após a remoção do DJS, e as duas medidas diferentes foram comparadas com o teste de Wilcoxon e o teste do qui-quadrado. RESULTADOS Um total de 25 pacientes foi avaliado no estudo. Taxa de PCSD não obstrutiva (12% vs. 8%), JETave (18,8 vs. 12,9 cm/seg) e JETmax (29,2 vs. 20 cm/seg), os níveis foram significativamente diminuídos (valores de p são 0,01, 0,010 e 0,014, respectivamente). Além disso, as taxas de padrão monofásico e quadrado foram significativamente observadas para aumentar ao longo do tempo (p=0,035); no entanto, padrões de jato ureteral foram correlacionados entre as duas diferentes medidas D-US (R=0,225, p=0,032). CONCLUSÃO Após o RTx, a velocidade de dilatação e as velocidades de fluxo do jato ureteral foram significativamente diminuídas e as taxas de JET padrão monofásico e quadrado foram significativamente aumentadas ao longo do tempo. A dinâmica do jato ureteral pode fornecer informações úteis sobre o acompanhamento da atividade peristáltica no sistema pélvico-ureteral.


Assuntos
Humanos , Masculino , Feminino , Adulto , Adulto Jovem , Ureter/fisiopatologia , Urodinâmica/fisiologia , Cateterismo Urinário/efeitos adversos , Stents/efeitos adversos , Transplante de Rim/efeitos adversos , Fatores de Tempo , Ureter/diagnóstico por imagem , Estudos Prospectivos , Seguimentos , Ultrassonografia Doppler/métodos , Estatísticas não Paramétricas , Taxa de Filtração Glomerular , Pessoa de Meia-Idade
14.
Female Pelvic Med Reconstr Surg ; 26(2): 141-145, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31990803

RESUMO

OBJECTIVES: This study aimed to identify differences in severity of overactive bladder (OAB) symptoms in women of different races and ethnicities using urodynamic study (UDS) parameters. METHODS: We performed a 5-year retrospective chart review from January 2014 to January 2019 of women 18 years and older who endorsed OAB symptoms and underwent UDS at a racially and ethnically diverse academic urban medical center. Logistic and linear regressions were used to examine the associations of various UDS parameters between racial/ethnic groups, after adjusting for age, diabetes, and parity. RESULTS: A total of 161 women with an average age of 59 years were included in the study. The racial/ethnic composition of the group was Hispanic (62%), black (24%), and white (11%). Symptoms on presentation included urgency and/or frequency (11.8%), urge incontinence (23.0%), or mixed urinary symptoms (65.2%). Black and Hispanic women presented with differing symptoms (urgency/frequency vs mixed urinary symptoms). Half of the patients (n = 82) had detrusor overactivity. Compared with whites, blacks were 3.4-fold more likely to have detrusor overactivity (95% confidence interval, 0.99-11.40) and had lower volumes at time of "strong desire" (-102.6 mL, P = 0.003). Hispanics had on average 75.88 mL less volume at sensation of "strong desire" (P = 0.016) than did whites. CONCLUSIONS: Our study suggests that minority race and ethnicity may be associated with worse performance on certain UDS parameters. Future studies should aim to understand if these differences are due to genetic, disease-related, behavioral, and/or socioeconomic factors and whether these differences are associated with worse subjective OAB.


Assuntos
Bexiga Urinária Hiperativa , Incontinência Urinária de Urgência , Urodinâmica/fisiologia , Afro-Americanos/estatística & dados numéricos , Autoavaliação Diagnóstica , Grupo com Ancestrais do Continente Europeu/estatística & dados numéricos , Feminino , Hispano-Americanos/estatística & dados numéricos , Humanos , Pessoa de Meia-Idade , História Reprodutiva , Medição de Risco/métodos , Fatores de Risco , Índice de Gravidade de Doença , Bexiga Urinária Hiperativa/diagnóstico , Bexiga Urinária Hiperativa/etnologia , Bexiga Urinária Hiperativa/fisiopatologia , Incontinência Urinária de Urgência/diagnóstico , Incontinência Urinária de Urgência/etnologia , Incontinência Urinária de Urgência/fisiopatologia
16.
J Urol ; 203(4): 792-801, 2020 04.
Artigo em Inglês | MEDLINE | ID: mdl-31763948

RESUMO

PURPOSE: In a preliminary clinical trial we assessed the efficacy of ejaculatory hood sparing GreenLight™ Laser prostate photoselective vaporization to preserve antegrade ejaculation and urodynamic relief of obstruction compared to standard GreenLight prostate photoselective vaporization. MATERIALS AND METHODS: Standard prostate photoselective vaporization was classically performed in 24 patients. Ejaculatory hood sparing vaporization was performed with preservation of the paracollicular and supracollicular tissue proximal to the verumontanum in 25 patients. Patients were assessed at baseline, and 1, 3, 6 and 12 months postoperatively using the Ej-MSHQ (Ejaculatory Domain of Male Sexual Health Questionnaire) and the IIEF-15 (International Index of Erectile Function-15). The I-PSS (International Prostate Symptom Score), uroflowmetry and post-void residual urine volume were reported at each followup visit. A standard urodynamic study was performed at 6 months. RESULTS: Antegrade ejaculation was reported in 85% and 31.6% of patients after hood sparing and standard prostate vaporization, respectively (p=0.001). A significant reduction in the EJ-MSHQ score was reported after standard vaporization at 6 and 12 months (each p <0.001) with no significant difference after hood sparing vaporization (p=0.18 and 0.078, respectively). The median EJ-MSHQ score was 28.5 (range 1 to 33) and 27 (range 1 to 33) for hood sparing vaporization, and 9.5 (range 1 to 35) and 9 (range 0 to 33) for standard vaporization at 6 (p=0.005) and 12 months (p <0.001), respectively. Each group showed a decline in the mean total IIEF-15 score at 1 year but it was statistically significant only after standard vaporization (p=0.001). All urinary outcome measures revealed comparable significant improvement at all followups. Postoperative urodynamic assessment demonstrated a significant comparable decrease in the Bladder Outlet Obstruction Index from a median of 64 (range 21 to 207) to 23.5 (range 10 to 53) after hood sparing vaporization (p=0.005) and from 87 (range 38 to 186) to 19.5 (range 7 to 51) after standard vaporization (p=0.001). At 1 year the overall re-treatment rate was comparable in the 2 groups (p=0.26). CONCLUSIONS: In well informed, sexually interested patients ejaculatory hood sparing GreenLight prostate photoselective vaporization is feasible and effective treatment of small to moderate sized benign prostatic hyperplasia with a superior sexual function related outcome. Short-term relief of obstruction is objectively comparable to that of standard prostate photoselective vaporization.


Assuntos
Disfunção Erétil/diagnóstico , Terapia a Laser/efeitos adversos , Tratamentos com Preservação do Órgão/efeitos adversos , Complicações Pós-Operatórias/diagnóstico , Prostatectomia/efeitos adversos , Hiperplasia Prostática/cirurgia , Método Duplo-Cego , Ejaculação/fisiologia , Disfunção Erétil/etiologia , Disfunção Erétil/fisiopatologia , Disfunção Erétil/prevenção & controle , Estudos de Viabilidade , Seguimentos , Humanos , Terapia a Laser/instrumentação , Terapia a Laser/métodos , Lasers de Estado Sólido/efeitos adversos , Lasers de Estado Sólido/uso terapêutico , Masculino , Pessoa de Meia-Idade , Tratamentos com Preservação do Órgão/métodos , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/fisiopatologia , Complicações Pós-Operatórias/prevenção & controle , Próstata/patologia , Próstata/cirurgia , Prostatectomia/métodos , Hiperplasia Prostática/patologia , Fatores de Tempo , Resultado do Tratamento , Urodinâmica/fisiologia
17.
Am J Physiol Renal Physiol ; 318(1): F86-F95, 2020 01 01.
Artigo em Inglês | MEDLINE | ID: mdl-31736349

RESUMO

The postvoid residual (PVR) is an important measure of bladder function, but obtaining PVR is burdensome because bladder volume must be measured at the time of voiding. The PVR measurement problem has led to experimental tricks in animal studies (infusing the bladder at supraphysiological rates and limiting animal observation windows) to keep the number of observed voids statistically robust while reducing the time an experimenter must be present. Our solution to the PVR measurement problem is a system called Automatic Monitoring for Efficient, Awake, Sensitive, Urine Residual Estimation (AMEASURE). AMEASURE combines metabolic cages and optimization algorithms to estimate continuously PVR for every voiding event 24 h/day for multiple weeks, without artificial bladder infusion, continuous experimenter supervision, anesthesia, or restraints. Using AMEASURE, we obtained voided volumes, PVRs, and other urodynamic parameters continuously for 21 days in 10 healthy female Sprague-Dawley rats. Importantly, this required only one manual measurement of animals' bladder volume every 12 h. We validated the accuracy of the system experimentally and in simulation. We detected marked differences in voiding frequency and efficiency between light and dark cycles and found that voiding frequency increased over time during the dark cycle (but not the light cycle), due to surgical recovery, cage acclimation, and socialization. This tool enhances the relevance of rodent models to the study of human lower urinary tract by expanding observation periods and obviating the need to infuse the bladder and facilitates the study of conditions for which behavioral, social, or circadian factors play essential roles.


Assuntos
Monitorização Ambulatorial/métodos , Monitorização Fisiológica/métodos , Micção/fisiologia , Urodinâmica/fisiologia , Animais , Feminino , Ratos , Ratos Sprague-Dawley
18.
Neurourol Urodyn ; 39(1): 116-124, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31578766

RESUMO

AIMS: To evaluate the combined effect of age and multiparity on the micturition reflex, including pelvic floor muscle activation. METHODS: Young and mature nulliparous rabbits were compared to young and mature multiparas (n = 6 per group). Cystometrograms and urethral pressure (UP) were performed while simultaneously recording the electromyogram (EMG) activity of the pubococcygeus and bulbospongiosus muscles to establish their functional correlation to urological function. RESULTS: Multiparity and age significantly influence the bladder and UP affecting the voiding efficiency and intercontraction interval. Such interaction also reduced the UP threshold, timing, and duration. Other bladder and urethral variables were predominantly affected only by age. Urodynamic alterations correlated with abnormal patterns or absent EMG activity of the pubococcygeus and bulbospongiosus muscles. CONCLUSIONS: The present findings strongly suggest that multiparity and age affects specific pelvic floor muscle reflex activation during micturition, and may contribute to alterations in bladder and urethral function. This data broadens our understanding of the critical role of the appropriate activity of the individual pelvic floor muscles in micturition.


Assuntos
Músculo Esquelético/fisiopatologia , Diafragma da Pelve/fisiopatologia , Uretra/fisiopatologia , Bexiga Urinária/fisiopatologia , Micção/fisiologia , Animais , Eletromiografia , Feminino , Masculino , Paridade , Períneo/fisiopatologia , Gravidez , Coelhos , Reflexo , Urodinâmica/fisiologia
19.
Neurourol Urodyn ; 39(1): 286-294, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31692125

RESUMO

OBJECTIVES: The aim of this study is to develop a method to evaluate the fluid dynamics of urine flow in the lower urinary tract (LUT), especially that of vorticity. MATERIALS AND METHODS: This investigation included three sub-studies to demonstrate urine flow in the entire LUT. First, we attempted to observe vorticity generation in the urinary bladder during spontaneous voiding using transabdominal color Doppler ultrasonography (CDUS). Second, we performed transrectal CDUS to evaluate the vorticity of urine flow in the prostatic urethra. Patients with prostate cancer were enrolled before robotic surgery and divided into the vorticity and non-vorticity groups based on CDUS findings for comparisons of longitudinal urethral diameter and prostatic urethral angle. Third, the vorticity of the voided urine stream was observed using a high-speed video-camera. Micturition was done in a standing position while synchronously monitored for urine flow using uroflowmetry. RESULTS: Vorticity formation could be dynamically demonstrated in the urinary bladder and prostatic urethra using CDUS. The prostatic urethral angle of the vorticity group was more than that of the non-vorticity group. High-speed video recording could clearly capture vorticity and spiral shape generation in voided urine. The distance from the external urethral orifice to the first twist changed in accordance with urine flow rate. CONCLUSIONS: In a series of sub-studies, this investigation proved vorticity generation in the LUT and voided urine. Vorticity was detectable in the LUT and in voided urine using CDUS and a high-speed video-camera. Vorticity generation might be associated with urethral morphology.


Assuntos
Uretra/fisiopatologia , Bexiga Urinária/fisiopatologia , Micção/fisiologia , Urodinâmica/fisiologia , Idoso , Humanos , Masculino , Pessoa de Meia-Idade , Neoplasias da Próstata/diagnóstico por imagem , Neoplasias da Próstata/fisiopatologia , Ultrassonografia , Uretra/diagnóstico por imagem , Bexiga Urinária/diagnóstico por imagem
20.
J Urol ; 203(4): 779-785, 2020 04.
Artigo em Inglês | MEDLINE | ID: mdl-31647388

RESUMO

PURPOSE: We sought to identify the symptoms and noninvasive test parameters associated with detrusor underactivity and develop a prediction model of detrusor underactivity. We analyzed clinical data on male patients with lower urinary tract symptoms who underwent pressure-flow studies. MATERIALS AND METHODS: Included in analysis were 909 men who met study criteria and whose data included the International Prostate Symptom Score, free uroflowmetry, post-void residual urine volume and prostate volume. Using these data we examined the significant symptoms and noninvasive test parameters associated with detrusor underactivity and developed a prediction model of detrusor underactivity. RESULTS: Of the 909 patients 454 (50%) were classified with detrusor underactivity. On logistic regression analysis older patient age, smaller prostate volume, a lower urgency symptom score, a higher weak stream symptom score and a lower maximum flow rate were selected as independent predictors of detrusor underactivity. The prediction model of detrusor underactivity consisting of these 5 factors showed satisfactory performance (C statistic 0.724). CONCLUSIONS: We developed a prediction model of detrusor underactivity in male patients with nonneurogenic lower urinary tract symptoms. The model was based on 5 predictive factors, namely older age, smaller prostate volume, 2 symptoms (less urgency and a weak stream) and a lower maximum flow rate. The model helps estimate the probability of detrusor underactivity in clinical practice without an invasive pressure-flow study.


Assuntos
Modelos Biológicos , Bexiga Inativa/epidemiologia , Bexiga Urinária/fisiopatologia , Urodinâmica/fisiologia , Fatores Etários , Idoso , Bases de Dados Factuais/estatística & dados numéricos , Humanos , Modelos Logísticos , Masculino , Tamanho do Órgão , Próstata/patologia , Estudos Retrospectivos , Medição de Risco/métodos , Fatores de Risco , Bexiga Inativa/diagnóstico , Bexiga Inativa/fisiopatologia
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