RESUMO
Nocturia is a common source of sleep disturbance in men and can result from many different causes. A patient-generated frequency/volume chart, along with several simple mathematical formulas, is used to classify nocturia according to its principal aetiology. The categories are nocturnal polyuria (NP), reduced voided volumes, 24-h polyuria and a combination of the aforementioned factors. Identification of the precise type of nocturia can help direct treatment in the cause-specific manner. In particular, use of the antidiuretic desmopressin can be of benefit in those with NP and may also be useful as part of a combination treatment approach in nocturia of mixed aetiology.
Assuntos
Noctúria/etiologia , Algoritmos , Humanos , Masculino , Poliúria/etiologia , Micção , UrinaRESUMO
Sixty-seven consecutive patients participated in a prospective urodynamic study of the diagnosis and treatment of urinary bladder symptoms in multiple sclerosis. The etiology of symptoms was classified as either failure to store urine (30%), failure to empty the bladder (18%), or a combination of the two (50%). Treatment was individualized on the basis of the underlying pathophysiology and consisted of intermittent self-catheterization (21%), none (20%), surgical (12%), drugs (9%), voiding maneuvers (6%), and external condom drainage (6%). In 18 patients (27%), lesser forms of treatment were unsuccessful, and indwelling vesical catheters were required. Symptoms correlated poorly with urodynamic findings, and treatment based on symptoms alone would have been ineffective in over half the patients.
Assuntos
Esclerose Múltipla/complicações , Doenças da Bexiga Urinária/complicações , Adulto , Idoso , Compostos de Betanecol/uso terapêutico , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Propantelina/uso terapêutico , Prostatectomia , Bexiga Urinária/inervação , Bexiga Urinária/cirurgia , Cálculos da Bexiga Urinária/cirurgia , Doenças da Bexiga Urinária/tratamento farmacológico , Doenças da Bexiga Urinária/terapia , Cateterismo Urinário , UrodinâmicaRESUMO
Although the symptoms of benign prostatic hyperplasia are usually attributed to simple mechanical obstruction of the prostatic urethra by an enlarged prostate gland, the pathophysiology of this common urologic disorder actually involves multiple factors. These include abnormalities of detrusor function, neuromuscular abnormalities of the prostatic urethra, and sensory abnormalities of the bladder wall. Detrusor abnormalities include impaired detrusor contractility and involuntary detrusor contractions (detrusor instability or detrusor hyperreflexia). Neuromuscular abnormalities of the prostatic urethra are characterized by alpha-adrenergic overactivity which causes outlet obstruction or by alpha-adrenergic hypoactivity which may result in urinary incontinence. Sensory abnormalities of the bladder wall include hypersensitivity (sensory urgency) or hyposensitivity which can lead to overdistention and urinary retention. The diagnostic evaluation of patients with clinical prostatism must take these factors into account. Of particular importance is the recognition that a decreased urinary flow rate and/or increased postvoid residual urine volume may be caused by either bladder outlet obstruction or impaired detrusor contractility. Routine urodynamic studies do not permit a distinction between these two entities, but video/detrusor pressure/uroflow studies are usually definitive.
Assuntos
Hiperplasia Prostática , Urodinâmica , Humanos , Masculino , Hiperplasia Prostática/diagnóstico , Hiperplasia Prostática/fisiopatologia , Obstrução Uretral/diagnóstico , Obstrução do Colo da Bexiga Urinária/diagnóstico , Bexiga Urinaria Neurogênica/diagnóstico , Micção , Transtornos Urinários/diagnósticoRESUMO
UNLABELLED: OBJECTIVES; To discuss the rudiments of data that need to be collected in order to develop validated, reproducible, well-accepted efficacy instruments for assessing treatment outcomes in urinary incontinence (UI). METHODS: Information is presented from two reports issued by the Urodynamics Society: "Definition and Classification of Urinary Incontinence" and "Standards of Efficacy for Evaluation of Treatment Outcomes in Urinary Incontinence." RESULTS: Instruments to assess the efficacy of treatment should be reliable and valid. Such instruments include structured histories, questionnaires, structured physical examinations, urodynamics, voiding diaries, and pad tests. Recommended primary outcome variables include the number of incontinent episodes, volume of urinary loss, and type of incontinence. Secondary measures include patient satisfaction, quality of life, bladder symptoms, uroflow, postvoid residual urine, and other urodynamic variables. General considerations for the development of clinical trials include 1) using a standard lexicon, 2) consistent timing of follow-up, 3) proper outcome assessment at each follow-up, 4) proper data collection, 5) proper data analysis, and 6) formulating conclusions that are supported by the data. CONCLUSIONS: At the present time, there are no validated, reproducible, well-accepted efficacy instruments for assessing treatment outcomes in UI. Further work directed toward the development of such instruments is warranted.
Assuntos
Incontinência Urinária/terapia , Feminino , Humanos , Masculino , Pesquisa , Inquéritos e Questionários , Resultado do Tratamento , Incontinência Urinária/classificação , Incontinência Urinária/diagnósticoRESUMO
Chemical dissolution of residual stone fragments was attempted in twelve instances via nephrostomy tube irrigation. Appropriate solutions containing either hemiacidrin or sodium bicarbonate were used for struvite and uric acid stones, respectively. Precautions were taken to prevent and recognize outflow obstruction and urinary infection. Seventy-five per cent of the stones so treated were completely dissolved, and there were no major complications. The incidence of retained stones, natural history, and indications for chemical dissolution are reviewed.
Assuntos
Cálculos Renais/tratamento farmacológico , Adulto , Idoso , Bicarbonatos/uso terapêutico , Citratos/uso terapêutico , Feminino , Humanos , Cálculos Renais/cirurgia , Masculino , Pessoa de Meia-Idade , Irrigação Terapêutica/efeitos adversos , Cálculos Ureterais/tratamento farmacológico , Infecções Urinárias/etiologiaRESUMO
Paraurethral cysts in the female neonate are uncommon lesions. All reported cases have either ruptured spontaneously or responded to simple marsupialization. However, complete urologic evaluation is mandatory because they simulate ectopic ureteroceles in appearance. Herein is reported our experience with 5 patients. The etiology, embryogenesis, natural history, differential diagnosis, and treatment are discussed.
Assuntos
Cistos/congênito , Doenças Uretrais/congênito , Cistos/embriologia , Cistos/cirurgia , Diagnóstico Diferencial , Feminino , Genitália Feminina/embriologia , Humanos , Lactente , Recém-Nascido , Doenças Uretrais/embriologia , Doenças Uretrais/cirurgiaRESUMO
The use of urodynamic evaluation as a diagnostic tool for evaluating subtle neurologic lesions involving the second, third, and fourth segments of the sacral spinal cord is redefined. Six illustrative cases are presented.
Assuntos
Doenças da Medula Espinal/diagnóstico , Urodinâmica , Adolescente , Adulto , Malformações Arteriovenosas/diagnóstico , Feminino , Humanos , Lactente , Masculino , Neoplasias Meníngeas/diagnóstico , Meningioma/diagnóstico , Pessoa de Meia-Idade , Compressão da Medula Espinal/diagnóstico , Neoplasias da Medula Espinal/diagnósticoRESUMO
Pelviureteric varices are well-documented sequelae of renal vein thrombosis, but there have been only 10 prior reports of idiopathic renal vein varicosities. Herein we report 3 more cases and review the literature. Two thirds of the patients presented with hematuria; one-fourth had flank pain, and one-third had saphenous vein varicosities. Pyelographic findings include scalloped deformities of the upper ureter and pelvis with displacement and intraluminal filling defects. The diagnosis may be suspected from the excretory urogram, but venography is definitive. Excision and ligation of the varicose veins were curative in all but 3 patients who required nephrectomy for life-threatening hemorrhage.
Assuntos
Veias Renais/diagnóstico por imagem , Adulto , Diagnóstico Diferencial , Feminino , Humanos , Pessoa de Meia-Idade , Radiografia , Varizes/etiologiaRESUMO
Recent studies suggest that clinical "prostatism" encompasses at least four conditions that may be present singly or in combination: prostatic urethral obstruction, impaired detrusor contractility, detrusor instability, and sensory urgency. In addition, primary vesical neck obstruction may be present in the absence of benign prostatic hyperplasia (BPH). Thus, the purpose of diagnostic evaluation in men with BPH is to identify precisely the pathophysiology of the patient's symptoms so that rational therapy can be selected.
Assuntos
Hiperplasia Prostática/fisiopatologia , Obstrução do Colo da Bexiga Urinária/fisiopatologia , Urodinâmica , Humanos , Masculino , Hiperplasia Prostática/complicações , Hiperplasia Prostática/diagnóstico , Obstrução do Colo da Bexiga Urinária/diagnóstico , Obstrução do Colo da Bexiga Urinária/etiologia , UrinaRESUMO
Lower urinary tract dysfunction can be considered in terms of two broad categories: problems caused by abnormalities of the filling and storage phase and problems related to the voiding phase. The author prefaces this discussion with a review of normal anatomy and physiology.
Assuntos
Sistema Urinário/fisiopatologia , Doenças Urológicas/fisiopatologia , Feminino , Humanos , Masculino , Vias Neurais , Sistema Nervoso Parassimpático/fisiologia , Ponte/fisiologia , Reflexo , Sistema Nervoso Simpático/fisiologia , Uretra/anatomia & histologia , Uretra/inervação , Uretra/fisiologia , Bexiga Urinária/anatomia & histologia , Bexiga Urinária/inervação , Bexiga Urinária/fisiologia , Bexiga Urinária/fisiopatologia , Doenças da Bexiga Urinária/diagnóstico , Doenças da Bexiga Urinária/fisiopatologia , Doenças da Bexiga Urinária/terapia , Obstrução do Colo da Bexiga Urinária/diagnóstico , Obstrução do Colo da Bexiga Urinária/fisiopatologia , Cateterismo Urinário , Incontinência Urinária/diagnóstico , Incontinência Urinária/fisiopatologia , Micção , UrodinâmicaRESUMO
Damage to the urethra may be functional or anatomic. In the former, to some extent, the urethra functions merely as a tube. Anatomic damage ranges from small urethrovaginal fistulas to total loss of the urethra, vesical neck, and trigone. For functional damage, the goal is compression of the proximal urethra, and the author favors a pubovaginal fascial sling, which is described. In the author's view, the best results in anatomic loss are obtained by performing an appropriate anti-incontinence procedure at the time of urethral reconstruction.
Assuntos
Doenças Uretrais/complicações , Incontinência Urinária/etiologia , Incontinência Urinária/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Pessoa de Meia-Idade , Estudos Retrospectivos , Procedimentos Cirúrgicos Operatórios/métodos , Doenças Uretrais/patologia , Doenças Uretrais/fisiopatologia , Vagina/cirurgiaRESUMO
BPH is not synonymous with prostatic obstruction. The cause of symptoms in men with prostatism is multifactorial, comprising four conditions: (1) prostatic urethral obstruction, (2) impaired detrusor contractility, (3) detrusor instability, and (4) sensory urgency. Some men have an isolated obstruction at the vesical neck, termed primary vesical neck obstruction, that may have a different cause from that of BPH, and others have a learned voiding dysfunction wherein they are unable to relax completely during micturition. There is no simple means of distinguishing the various conditions that underlie voiding symptoms in men. Neither simple cystometry nor uroflow suffice. Detrusor pressure and uroflow studies usually are definitive, but more sophisticated analysis may be necessary.
Assuntos
Obstrução do Colo da Bexiga Urinária , Humanos , Masculino , Hiperplasia Prostática/complicações , Hiperplasia Prostática/diagnóstico , Uretra/fisiopatologia , Bexiga Urinária/fisiopatologia , Obstrução do Colo da Bexiga Urinária/diagnóstico , Obstrução do Colo da Bexiga Urinária/etiologia , Obstrução do Colo da Bexiga Urinária/fisiopatologia , Bexiga Urinaria Neurogênica/complicações , Bexiga Urinaria Neurogênica/diagnóstico , UrodinâmicaRESUMO
Assessment of urinary incontinence begins with a thorough history and physical examination. This article reviews the collection of subjective, semi-objective, and objective data that allows for comprehensive evaluation of the incontinent female patient. These results will help direct further evaluation and develop an efficient and effective treatment plan.
Assuntos
Incontinência Urinária/diagnóstico , Endoscopia , Feminino , Humanos , Anamnese , Exame Físico , Incontinência Urinária/classificação , UrodinâmicaRESUMO
Neurogenic bladder dysfunction, if not properly diagnosed and treated, can lead to rapid deterioration of renal function by compromise of the upper urinary tracts. Two major categories of neurogenic bladder (detrusor hyperreflexia areflexia) have been discussed including the pathophysiology of the voiding dysfunction and the typical radiographic findings. Radiologists studying patients with suprasacral cord lesions should be aware of the causes, symptoms, and treatment of autonomic dysreflexia. Although video urodynamics is the state-of-the-art modality for evaluating complex or refractory neurogenic bladder, the practicing radiologist with an understanding of this condition can detect many radiographic changes in the lower urinary tract that suggest neurogenic dysfunction of various types.
Assuntos
Bexiga Urinaria Neurogênica/fisiopatologia , Feminino , Humanos , Masculino , Músculo Liso/inervação , Músculo Liso/fisiopatologia , Bexiga Urinária/inervação , Bexiga Urinária/fisiopatologia , Bexiga Urinaria Neurogênica/classificaçãoRESUMO
Urinary incontinence may be the result of various forms of detrusor overactivity. Several surgical therapies have been devised, but with the exception of procedures to relieve urethral obstruction, none abolishes the overactivity or restores normal micturition. In general, ablative neurosurgery is considered only in patients with chronic neurologic disease. Bladder augmentation is useful in selected patients. The indications for urinary diversion in patients with detrusor overactivity and urge incontinence are quite limited.
Assuntos
Obstrução Uretral/fisiopatologia , Incontinência Urinária/fisiopatologia , Animais , Humanos , Músculo Liso/fisiologia , Músculo Liso/cirurgia , Obstrução Uretral/complicações , Obstrução Uretral/cirurgia , Bexiga Urinária/fisiologia , Bexiga Urinária/cirurgia , Doenças da Bexiga Urinária/fisiopatologia , Doenças da Bexiga Urinária/cirurgia , Derivação Urinária/métodos , Incontinência Urinária/etiologia , Incontinência Urinária/cirurgiaRESUMO
Surgical treatment of urinary incontinence in elderly men is usually reserved for those patients for whom medical therapy has failed. In properly selected patients, however, an operative approach may offer the best chance for cure.