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1.
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
3.
Urologiia ; (5): 132-135, 2019 Dec.
Artigo em Russo | MEDLINE | ID: mdl-31808648

RESUMO

Three basic theories of the development of an overactive bladder that have experimental and clinical evidences have been described, including neurogenic, myogenic, and urothelial. Based on the results of the literature analysis, the authors suggested the existence of detrusor ischemic disease as a result of compressive impairment of its blood flow due to incomplete or short-term relaxation under overactivity or hydraulic compression of the vessels by excessive urine volume in case of hypoactive bladder.


Assuntos
Isquemia/fisiopatologia , Doenças da Bexiga Urinária/etiologia , Doenças da Bexiga Urinária/terapia , Bexiga Urinária/irrigação sanguínea , Hemodinâmica , Humanos , Contração Muscular/fisiologia , Fluxo Sanguíneo Regional/fisiologia , Bexiga Urinária/fisiopatologia , Obstrução do Colo da Bexiga Urinária/complicações , Micção/fisiologia , Urodinâmica/fisiologia , Urotélio
4.
Clin Interv Aging ; 14: 1159-1166, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31417246

RESUMO

Purpose: To evaluate the effect of deep brain stimulation (DBS) on urinary dysfunctions in Parkinson's patients. Patients and methods: A total of 416 patients, diagnosed with Parkinson's disease (PD) based on the UK Parkinson's Disease Society Brain Bank Diagnostic Criteria, were enrolled in the study, including 307 males and 109 females. The effects of DBS treatment on urinary functions during urination and bladder storage of these patients were evaluated using testing and assessment scales, such as the American Urological Association Symptom Index (AUA-SI), Overactive Bladder Symptom Scores (OAB-SS), Quality Of Life Scale (QOL), and urodynamic tests. The data were statistically analyzed with the chi-square test and  both independent-samples t-test and paired-samples t-test were used in this study. Results: Symptoms of urinary dysfunctions, such as urinary frequency, urgency, and incontinence, in the patients with PD were notably relieved by DBS treatment (P<0.05), and the OAB-SS and bladder storage problems were greatly improved as well (P<0.05). Compared with those in male patients, DBS surgery significantly improved the AUA-SI, urinary symptom scores, and QOL in female PD patients (P<0.05), as well as other functional indicators related to the urinary tract, including the maximum urinary flow rate, detrusor pressure at peak flow, and residual urine volume in female PD patients (P<0.05). Conclusion: DBS surgery is effective in improving urinary functions in PD patients, as primarily reflected by the alleviation of urinary symptoms such as urinary frequency, urgency, and incontinence. Female PD patients displayed better urinary function outcomes from DBS treatment than did male patients.


Assuntos
Estimulação Encefálica Profunda/métodos , Doença de Parkinson/complicações , Bexiga Urinária Hiperativa/etiologia , Bexiga Urinária Hiperativa/terapia , Fatores Etários , Idoso , Fatores de Transcrição Hélice-Alça-Hélice Básicos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Doença de Parkinson/fisiopatologia , Qualidade de Vida , Índice de Gravidade de Doença , Fatores Sexuais , Micção/fisiologia , Urodinâmica/fisiologia
5.
Exp Neurol ; 322: 113033, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31400304

RESUMO

Dysfunction of the lower urinary tract (LUT) is prevalent in neurological disorders, including multiple sclerosis, stroke, spinal cord injury and neurodegenerative conditions. Common symptoms include urgency, incontinence, and urinary retention. Recent advances in neuromodulation have resulted in improved treatments for overactive bladder symptoms of urgency, frequency, and nocturia. However, there are presently no treatments available for the induction of voiding to overcome urinary retention. We demonstrate that transcutaneous spinal cord stimulation (TSCS), a non-invasive intervention, applied over the thoracolumbar spine in neurologically intact rhesus macaques can activate the LUT, including activation of the bladder detrusor muscle, the urethral sphincter and pelvic floor muscles. Urodynamic studies show improved voiding efficiency and decreased post-voiding residual volumes in the bladder, while maintaining coordinated activity in the detrusor and sphincter with physiologic detrusor peak pressure, contraction duration, and urine flow rate remaining unchanged. We conclude that TSCS may represent a novel approach to activate the LUT and enable voiding in select neurological conditions.


Assuntos
Estimulação da Medula Espinal , Uretra/fisiologia , Bexiga Urinária/fisiologia , Micção/fisiologia , Urodinâmica/fisiologia , Animais , Feminino , Macaca mulatta
6.
Neurology ; 93(10): e946-e953, 2019 09 03.
Artigo em Inglês | MEDLINE | ID: mdl-31371567

RESUMO

OBJECTIVE: To evaluate the differences in urodynamic findings between multiple system atrophy (MSA) and Parkinson disease (PD) and to identify the differential diagnostic ability of urodynamic study. METHODS: We reviewed patients with MSA or PD who underwent urodynamic studies between January 2011 and August 2018. Patients with probable MSA and PD determined by movement disorder specialists at our center were included. Patients with alleged MSA or PD from outside hospitals, atypical or secondary parkinsonism, and any history of pelvic operation or radiation therapy were excluded. RESULTS: A total of 219 patients, 107 with MSA (male:female 50:57) and 112 with PD (male:female 57:55), were included. Patients with MSA had shorter disease duration and were referred for urologic evaluation earlier (p < 0.001). Detrusor overactivity and associated urine leakage were prominent in PD (p < 0.001). Patients with MSA showed lower maximal flow rate (4.0 ± 5.8 vs 9.1 ± 8.3 mL/s, p < 0.001) and larger postvoid residual (290.8 ± 196.7 vs 134.0 ± 188.1 mL, p < 0.001) with decreased compliance (44.9% vs 10.7%, p < 0.001) and impaired contractility (24.9 ± 33.8 vs 65.7 ± 51.1, p < 0.001). Postvoid residual from a pressure-flow study had the highest sensitivity and specificity (74.8% and 75.9%), followed by detrusor pressure at maximal uroflow (72.6% and 70.5%), bladder contractility index, and postvoid residual from uroflowmetry (71.0% and 70.5%, respectively). CONCLUSIONS: Patients with MSA showed lower maximal flow rate, larger postvoid residual with decreased compliance, and impaired contractility, whereas patients with PD had higher incidence of detrusor overactivity and associated leakage. For differential diagnosis, postvoid residual from a pressure-flow study provided the best sensitivity and specificity. CLASSIFICATION OF EVIDENCE: This study provides Class III evidence that urodynamic measures can distinguish patients with MSA from those with PD.


Assuntos
Atrofia de Múltiplos Sistemas/diagnóstico , Atrofia de Múltiplos Sistemas/fisiopatologia , Doença de Parkinson/diagnóstico , Doença de Parkinson/fisiopatologia , Urodinâmica/fisiologia , Idoso , Diagnóstico Diferencial , Eletromiografia/métodos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos
7.
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
8.
Int Braz J Urol ; 45(4): 775-781, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31136110

RESUMO

PURPOSE: To identify how the most frequently used parameters in daily clinical practice diagnosing bladder outlet obstruction (BOO) due to benign prostate hyperplasia (BPH) correlate to each other. MATERIALS AND METHODS: The study included 452 patients with lower urinary tract symptoms (LUTS) of the UNICAMP urology outpatient clinic of LUTS. INCLUSION CRITERIA: patients with BOO due to BPH who agreed to participate in the study. EXCLUSION CRITERIA: patients with urinary tract infection, neurological diseases that compromised the lower urinary tract, prior prostatic surgery, radiotherapy or urethral stenosis. Patient assessment: history, international prostate symptoms score (IPSS), nocturnal quality of life score (NQoL) questionnaires, physical and digital rectal examination (DRE), PSA, transabdominal ultrasound with intravesical prostate protrusion (IPP), post-mictional residue and free urofl owmetry. RESULTS: There was no strong Spearman correlation among the studied variables. The only moderate correlations occurred between IPSS and NQoL (p<0001; c=0.56) and between IPP and prostate volume (p<0001; c=0.57). Weak correlations between IPP and post-mictional residue (p<0001; c=0.31) and free urofl owmetry (p<0001; c=-0.26); and between IPSS and free urofl owmetry (p<0001, c=-0.21) were observed. CONCLUSION: In this study, we found moderate, weak, very weak and absent correlation among the various parameters used in the diagnosis and management of BOO due to BPH. As the value of these tools is variable, the creation of a logical and objective algorithm was not possible and the treatment is based on the interpretation of clinical symptoms.


Assuntos
Sintomas do Trato Urinário Inferior/diagnóstico , Hiperplasia Prostática/diagnóstico , Obstrução do Colo da Bexiga Urinária/diagnóstico , Adulto , Idoso , Idoso de 80 Anos ou mais , Exame Retal Digital , Humanos , Sintomas do Trato Urinário Inferior/patologia , Sintomas do Trato Urinário Inferior/fisiopatologia , Masculino , Pessoa de Meia-Idade , Tamanho do Órgão , Próstata/patologia , Hiperplasia Prostática/patologia , Hiperplasia Prostática/fisiopatologia , Qualidade de Vida , Padrões de Referência , Análise de Regressão , Estatísticas não Paramétricas , Inquéritos e Questionários , Ultrassonografia/métodos , Obstrução do Colo da Bexiga Urinária/patologia , Obstrução do Colo da Bexiga Urinária/fisiopatologia , Micção/fisiologia , Urodinâmica/fisiologia
9.
Actas urol. esp ; 43(4): 212-219, mayo 2019. tab, graf
Artigo em Espanhol | IBECS | ID: ibc-181087

RESUMO

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


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


Assuntos
Humanos , Masculino , Feminino , Pré-Escolar , Criança , Refluxo Vesicoureteral/cirurgia , Endoscopia/métodos , Micção/fisiologia , Criança , Refluxo Vesicoureteral/fisiopatologia , Prognóstico , Transtornos Urinários/fisiopatologia , Urodinâmica/fisiologia , Diagnóstico , Estudos Transversais
10.
Prog Urol ; 29(5): 288-292, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30962142

RESUMO

AIM: To assess the feasibility of voiding urethrocystoscopy (VUC) in males and describe the characteristics of dynamic movements of the prostatic lobes during micturition. MATERIAL AND METHODS: Patients scheduled for benign prostatic obstruction relief in a tertiary reference center were included in this prospective evaluation. During urethrocystoscopy with a small diameter flexible endoscope, the bladder was filled until desire to void. The patient was asked to void with endoscope in place facing the veru montanum. Movements of the prostatic lobes during micturition were characterized, video-recorded, and categorized based on the dynamics of the lateral lobes, the posterior lobe and the bladder neck. RESULTS: In all, 192 evaluations were conducted. In 161 cases (84%), the patient was able to void. Among these patients, 126 cases were stated as "closed" (coalescent), without opening of the initial part of the urethra and the bladder neck. In 38 cases, there was no opening of the lateral lobes (type 1A), and in 47 cases a partial opening of the distal parts of the lateral lobes was seen (type 1B). In 31 cases, a fixed posterior bladder neck was seen (type 2A) and in 10 cases a mobile median lobe, with a rolling ball effect, was seen (type 2B). In 25 cases, the lumen was completely open and equivocal in 10 cases. CONCLUSIONS: This study demonstrates the feasibility of VUC and describes for the first time the dynamics of prostatic lobes during micturition. This evaluation may lead to a new approach for understanding the mechanical aspects of benign prostatic obstruction. LEVEL OF EVIDENCE: 3.


Assuntos
Cistoscopia/métodos , Hiperplasia Prostática/diagnóstico , Obstrução Uretral/diagnóstico , Obstrução do Colo da Bexiga Urinária/diagnóstico , Micção/fisiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos de Coortes , Estudos de Viabilidade , Humanos , Masculino , Pessoa de Meia-Idade , Tamanho do Órgão/fisiologia , Próstata/diagnóstico por imagem , Próstata/patologia , Hiperplasia Prostática/complicações , Obstrução Uretral/etiologia , Obstrução do Colo da Bexiga Urinária/etiologia , Urodinâmica/fisiologia
11.
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
12.
Curr Urol Rep ; 20(5): 26, 2019 Apr 05.
Artigo em Inglês | MEDLINE | ID: mdl-30953228

RESUMO

PURPOSE OF REVIEW: The goal of this study is to delineate the role of advanced urologic evaluation with urodynamics prior to renal transplantation. We seek to report on its indications, possible findings, and subsequent treatment pathways. RECENT FINDINGS: This body of literature is largely comprised of retrospective, single-site studies. Patient selection for urodynamics can be determined based on patient history and voiding symptoms. Many of these renal transplant patients have urodynamic abnormalities such as decreased bladder capacity and compliance. Appropriate treatment of these abnormalities allows for average rates of graft survival. Urodynamic evaluation is not needed in every renal transplant recipient. However, in patients with oliguria or bladder dysfunction, urodynamics can often reveal significant pathology. The well-selected patient with lower urinary tract symptoms may also benefit from urodynamic evaluation. Treatment options are widely variable, from observation to reconstructive surgery, and should be based on the patient and urodynamic findings.


Assuntos
Falência Renal Crônica/fisiopatologia , Falência Renal Crônica/cirurgia , Transplante de Rim , Urodinâmica , Humanos , Rim/fisiopatologia , Rim/cirurgia , Cuidados Pré-Operatórios , Urodinâmica/fisiologia , Doenças Urológicas/fisiopatologia , Doenças Urológicas/cirurgia
13.
Neurourol Urodyn ; 38(4): 1081-1085, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30848841

RESUMO

AIMS: Purposes of this study were to describe lower urinary tract symptoms (LUTS) and related urodynamic patterns in patients with hereditary spastic paraplegia (HSP), and to characterize LUTS management and associated uronephrological complications. METHODS: We retrospectively reviewed medical files of HSP patients, consecutively followed in our Physical and Rehabilitation Medicine Department between 1999 and 2016. Clinical, urodynamic, and radiological data were collected and analyzed. Different treatments which have been prescribed and uronephrological complications were also recorded. Patients with other neurological or urological diseases were excluded. RESULTS: Thirty-three patients with HSP were included. Mean duration of follow-up was 8.1 ± 5 years, mean age 62 ± 14 years, and 70% were men. The most frequent LUTS was urgency and voiding dysfunction (both 69.7%). Incontinence and retention with a significant postvoid residue above 100 mL accounted for 66.7% and 57.6% of initial symptoms respectively. Neurogenic detrusor overactivity was diagnosed in 80.7% of patients. Two-thirds of our cohort were treated with anticholinergics and 9.1% required intradetrusor botulinum-toxin injections. Only 27.3% of patients performed clean intermittent self-catheterization. Febrile urinary tract infections (21.2%), urolithiasis (15,1%), hydronephrosis (6%), and chronic renal failure (9.1%) were found. CONCLUSION: Given their high prevalence and the risk of uronephrological complications, LUTS should be systematically assessed in HSP patients. The systematic screening of urological dysfunction in this population would improve its management, decrease the incidence of uronephrological complications, and increase the quality of life.


Assuntos
Sintomas do Trato Urinário Inferior/etiologia , Qualidade de Vida , Paraplegia Espástica Hereditária/complicações , Urodinâmica/fisiologia , Idoso , Gerenciamento Clínico , Feminino , Humanos , Cateterismo Uretral Intermitente , Sintomas do Trato Urinário Inferior/fisiopatologia , Sintomas do Trato Urinário Inferior/terapia , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Paraplegia Espástica Hereditária/fisiopatologia
14.
Neurourol Urodyn ; 38(4): 1100-1105, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30843290

RESUMO

AIMS: To test the different formulae to calculate the bladder volume using ultrasound; the accuracy of patients hearing/feeling "bubbles" at the end of urodynamics testing as a measure of being empty; and how good we are at estimating PVR using X-ray at the end of video urodynamics testing. METHODS: This was a prospective cohort study. Using Sonosite 180 plus, bladder volumes were calculated as, height × width × depth × proportionality constant (0.52, 0.625, 0.65, and 0.7) Patients were asked whether the patient heard or felt "bubbles" at the end of the investigation. Each patient was fluoroscopically screened and the clinician estimated the volume and compared with single-use catheter volume. RESULTS: A total of 85 patients were assessed. All four formulae were significantly correlated. The PC, 0.52, correlated best (r = 0.938, P < 0.001) with no significant difference with the actual volumes ( P = 0.275). The "bubbles test" had a positive predictive value of 93%. A video postvoid residual (PVR) estimation significantly correlated with catheterised bladder volume ( r = 0.842, P < 0.001). There was no significant difference between the estimated and actual bladder volumes ( P = 0.579). CONCLUSION: This study showed that although all four formulae correlated significantly, the PC of 0.52 was the only formula without a significant difference from the actual volume. More work is needed to produce patient individualised PC. Our clinicians were able to accurately estimate the PVR on X-ray. This study has identified the best formula to accurately estimate bladder volume and that video estimation along with the "bubbles" test can avoid unnecessary intervention.


Assuntos
Cateteres , Técnicas de Diagnóstico Urológico , Bexiga Urinária/diagnóstico por imagem , Retenção Urinária/diagnóstico por imagem , Urodinâmica/fisiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Algoritmos , Cateterismo , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Ultrassonografia , Adulto Jovem
15.
Urology ; 127: 19-23, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-30822479

RESUMO

OBJECTIVE: To explore whether there is an association between nonwhite race and frailty among older adults presenting to an academic nononcologic urology practice. MATERIALS AND METHODS: This is a prospective study of individuals ages ≥65years presenting to a nononcologic urology practice between December 2015 and November 2016. All individuals had a Timed Up and Go Test (TUGT, where a slower TUGT time of ≥15 seconds is suggestive of frailty. TUGT times, race (white vs nonwhite), and other clinical data were extracted from the electronic medical record using direct queries. Multivariable logistic regression was used to identify the association between race and slower TUGT times while adjusting for age, gender, number of medications, body mass index, and number of urologic diagnoses. RESULTS: Among the 1715 individuals in our cohort, 33.9% were of nonwhite race and 15.3% had TUGT ≥15 seconds. A higher percentage of nonwhite individuals had TUGT times ≥15 seconds compared to white individuals (23.6% vs 11.1%, P <.01). TUGT times ≥15 seconds were significantly associated with nonwhite race after adjusting for clinical factors (adjusted odds ratio 2.5, 95% confidence interval 1.8-3.3). CONCLUSION: Among older adults presenting to an academic nononcologic urology practice, nonwhite race was associated with increased odds of frailty. A greater understanding of the relationship between race and frailty is needed to better address the needs of this vulnerable population.


Assuntos
Grupos de Populações Continentais/etnologia , Fragilidade/etnologia , Urodinâmica/fisiologia , Urologia/métodos , Centros Médicos Acadêmicos , Idoso , Idoso de 80 Anos ou mais , Assistência Ambulatorial/estatística & dados numéricos , Estudos de Coortes , Grupo com Ancestrais do Continente Europeu/estatística & dados numéricos , Feminino , Avaliação Geriátrica/métodos , Humanos , Modelos Logísticos , Masculino , Análise Multivariada , Estudos Prospectivos , Estados Unidos
16.
Rehabilitación (Madr., Ed. impr.) ; 53(1): 8-12, ene.-mar. 2019. tab
Artigo em Espanhol | IBECS | ID: ibc-185406

RESUMO

Objetivo: Identificar las situaciones que puedan hacer variar en algún sentido los resultados de las herramientas Pad test 1 y 24horas e ICIQ-SF. Participantes: Cinco fisioterapeutas que realizaron las entrevistas y tratamiento a 81 pacientes intervenidos de prostatectomía radical. Método: Se realizó un estudio cualitativo fenomenológico descriptivo, mediante técnica de grupo focal de 5 personas (4 mujeres y un hombre) responsables del tratamiento y valoración de pacientes con incontinencia urinaria tras prostatectomía. Se transcribieron las grabaciones realizadas y se utilizó el programa Atlas.ti7 para codificar las variables. Resultados: Se identificaron importantes factores a tener en cuenta en el uso de los instrumentos de medida para el diagnóstico y valoración de la incontinencia urinaria en todas las herramientas utilizadas. Conclusiones: Existen situaciones que pueden modificar la objetividad de las distintas pruebas para la valoración de la incontinencia urinaria. Así se ha detectado, entre otras, una menor ingesta de líquidos, una menor actividad, utilización de pinza manual o de orinales para evitar las pérdidas, así como la interferencia con el uso de determinados fármacos


Objective: To identify situations that may alter the results of the 1-hour and 24-hour Pad test and the short-form International Consultation in Incontinence Questionnaire (SF-ICIQ). Participants: Five physiotherapists, who conducted the interviews and treatment of 81 patients undergoing radical prostatectomy. Method: A qualitative descriptive phenomenological study was carried out, using a focus group technique with five people (4 women and 1 man) responsible for the treatment and assessment of patients with urinary incontinence after prostatectomy. Recordings were transcribed and the Atlas.ti7 programme was used to carry out the coding of the variables. Results: Important factors were identified in the use of measuring instruments for the diagnosis and assessment of urinary incontinence in all the tools used. Conclusions: Some situations can modify the objectivity of the various tests for the assessment of urinary incontinence. Some of the factors identified were lower fluid intake, less activity, use of manual clamp or urinals to avoid leakage, as well as the interference of certain drugs


Assuntos
Humanos , Masculino , Incontinência Urinária/diagnóstico , Prostatectomia/reabilitação , Psicometria/instrumentação , Neoplasias da Próstata/reabilitação , Urodinâmica/fisiologia , Incontinência Urinária/reabilitação , Reprodutibilidade dos Testes , Sensibilidade e Especificidade , Pesquisa Qualitativa , Grupos Focais
17.
Neurourol Urodyn ; 38(2): 478-498, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-30779378

RESUMO

INTRODUCTION: Patients with nocturia have to face many hurdles before being diagnosed and treated properly. The aim of this paper is to: summarize the nocturia patient pathway, explore how nocturia is diagnosed and treated in the real world and use the Delphi method to develop a practical algorithm with a focus on what steps need to be taken before prescribing desmopressin. METHODS: Evidence comes from existing guidelines (Google, PubMed), International Consultation on Incontinence-Research Society (ICI-RS) 2017, prescribing information and a Delphi panel (3 rounds). The International Continence Society initiated this study, the authors represent the ICI-RS, European Association of Urology, and Society of Urodynamics, Female Pelvic Medicine and Urogenital Reconstruction (SUFU). RESULTS: Diagnostic packages: consensus on, history taking for all causalities, intake diary (fluid, food) and bladder diary, not for its duration. Pelvic (women) or rectal (men) examination, prostate-specific antigen, serum sodium check (SSC), renal function, endocrine screening: when judged necessary. Timing or empty stomach when SSC is not important. Therapeutic packages: the safe candidates for desmopressin can be phenotyped as no polydipsia, heart/kidney failure, severe leg edema or obstructive sleep apnea syndrome. Lifestyle interventions may be useful. Initiating desmopressin: risk management consensus on three clinical pictures. Follow-up of desmopressin therapy: there was consensus on SSC day 3 to 7, and at 1 month. Stop therapy if SSC is <130 mmol/L regardless of symptoms. Stop if SSC is 130 to 135 mmol/L with symptoms of hyponatremia. CONCLUSION: A summary of the nocturia patient pathway across different medical specialists is useful in the visualization and phenotyping of patients for diagnosis and therapy. By summarizing basic knowledge of desmopressin, we aim to ease its initiation and shorten the patient journey for nocturia.


Assuntos
Noctúria/diagnóstico , Noctúria/terapia , Urodinâmica/fisiologia , Adulto , Idoso , Antidiuréticos/uso terapêutico , Consenso , Desamino Arginina Vasopressina/uso terapêutico , Feminino , Humanos , Estilo de Vida , Masculino , Pessoa de Meia-Idade , Noctúria/fisiopatologia , Sociedades
18.
J Pediatr Surg ; 54(4): 805-808, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30770128

RESUMO

INTRODUCTION AND AIM: Children with neuropathic lower urinary tract dysfunction usually suffer from associated bowel dysfunction, urinary tract infection and vesicoureteral reflux. This work aimed to highlight the impact of bowel management on bladder dynamics. PATIENTS AND METHODS: In the period from January 2011 to January 2013, 30 patients, 21 girls and 9 boys with neuropathic lower urinary tract dysfunction were studied. All suffered from urinary tract and bowel dysfunctions. All children were on urological treatment. They had their bowel managed by assurance and psychological support, dietary modification, retrograde or antegrade enemas and maintenance therapy. They were evaluated initially and on follow up by history, physical examination, ultrasound, urodynamics, Wexener score and bowel control chart. RESULTS: Mean age was 8.3 ±â€¯3.47 years (range from 4 to 18). There was a significant decrease in bowel dysfunction (Wexener score decreased from 12.67 ±â€¯1.54 to 10.17 ±â€¯1.76, p = 0.00), rectal diameter (decreased from 34.83 ±â€¯5.91 to 27.90 ±â€¯5.32 mm, p = 0.00), and frequency of UTI (p = 0.00). Detrusor leak point pressure decreased from 37.33 ±â€¯24.95 to 30 ±â€¯17.35 cmH2O, (p = 0.42). The cystometric capacity increased from 136.63 ±â€¯45.69 to 155.17 ±â€¯39.29 ml. (p = 0.001). Reflux and kidney function improved but was not statistically significant (p = 0.25 and p = 0.066 respectively). CONCLUSION: Management of bowel dysfunction is of utmost importance in the treatment of children with neuropathic bladder dysfunction. It has a positive effect on lower urinary tract function and decreasing the incidence of complications. This is a LEVEL III prospective study.


Assuntos
Enteropatias/terapia , Bexiga Urinaria Neurogênica/complicações , Bexiga Urinária/fisiopatologia , Urodinâmica/fisiologia , Adolescente , Criança , Pré-Escolar , Feminino , Humanos , Enteropatias/complicações , Masculino , Estudos Prospectivos , Bexiga Urinaria Neurogênica/fisiopatologia
19.
Aktuelle Urol ; 50(2): 184-189, 2019 Apr.
Artigo em Alemão | MEDLINE | ID: mdl-30763976

RESUMO

In specialist urology clinics, 50 - 70 % of patients have chronic urological diseases such as recurrent urinary tract infections, a somatoform overactive bladder, adult and infantile enuresis, a chronic pelvic pain syndrome, and the psychosomatic form of post-prostatectomy incontinence. The 12-month prevalence of psychological disorders in the general adult population is 28 % 1. As many as 20 % of children and adolescents are found to have psychological abnormalities 2. These are frequently accompanied by somatoform symptoms, often consisting of a psychosomatic voiding disorder with a consecutive complex pelvic floor dysfunction 3 4 5 6. Most patients report a long history of suffering as both the functional nature and the psychosocial stress causing and perpetuating the discomfort have remained unrecognised. Therefore, most patients have undergone various treatment attempts that were not indicated and thus unsuccessful and maybe even associated with complications. This tends to further increase the somatisation and the symptoms.To treat the root cause, it is necessary to eliminate the underlying psychosomatic voiding disorder and pelvic floor dysfunction. This requires a multimodal treatment approach such as PELVICFIT®, which combines a body-oriented training based on progressive muscle relaxation, training of body perception, and medical psychotherapy. This is crucial because patients must learn how to (re)gain control of the external urethral sphincter, achieve a physiological voiding behaviour, and reduce psychosocial stress in order to successfully treat the chronified symptoms 7 8 9.


Assuntos
Transtornos Psicofisiológicos/terapia , Doenças Urológicas/psicologia , Doenças Urológicas/terapia , Doença Crônica , Humanos , Bexiga Urinária Hiperativa , Transtornos Urinários/psicologia , Transtornos Urinários/terapia , Urodinâmica/fisiologia
20.
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
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