RESUMO
Recent evidence revealed that Hunner-type interstitial cystitis (HIC) is a robust inflammatory disease potentially associated with enhanced immune responses and histologically characterized by epithelial denudation and lymphoplasmacytic infiltration with frequent clonal expansion of infiltrating B cells. To date, few animal models that reproduce the histological and clinical correlates of HIC have yet been established. In the present study, we aimed to develop a novel animal model for HIC via autoimmunity to the bladder urothelium using the transgenic mouse model (URO-OVA) that expresses the membrane form of the model antigen ovalbumin (OVA) as a self-antigen on the bladder urothelium. OVA-specific lymphocytes (splenocytes) were generated by immunization of C57BL/6 mice with OVA protein and injected intravenously into URO-OVA mice. The splenocytes from OVA-immunized C57BL/6 mice showed increased interferon (IFN)-γ production in response to OVA stimulation in vitro. URO-OVA mice adoptively transferred with OVA-primed splenocytes developed cystitis exhibiting histological chronic inflammatory changes such as remarkable mononuclear cell infiltration predominantly composed of T and B lymphocytes, increased vascularity, and mucosal hyperemia in the bladder at days 7-28 with a peak at day 21 tested. No systemic inflammation was found in cystitis-induced URO-OVA mice, nor was any inflammation found in wild-type C57BL/6 mice adoptively transferred with OVA-primed splenocytes. Along with bladder inflammation, URO-OVA mice demonstrated significantly increased pelvic nociceptive responses, voiding dysfunction, and upregulated mRNA expression levels for IFN-γ, tumor necrosis factor-α (TNF-α), and substance P precursor in the bladder. This model reproduces the histological and clinical features of human HIC, providing a novel model for HIC research.
Assuntos
Antígenos/imunologia , Doenças Autoimunes/patologia , Cistite/etiologia , Dor Pélvica/etiologia , Transtornos Urinários/etiologia , Urotélio/imunologia , Animais , Cistite/patologia , Cistite Intersticial/patologia , Citocinas/genética , Citocinas/metabolismo , Modelos Animais de Doenças , Regulação da Expressão Gênica/imunologia , Camundongos , Camundongos Transgênicos , Ovalbumina/imunologia , Dor Pélvica/patologia , Bexiga Urinária/patologia , Transtornos Urinários/patologiaRESUMO
PURPOSE: This retrospective study aims at investigating the effects of moderately hypofractionated radiation therapy (HRT) on acute and late toxicities as well as on early biochemical control and therapeutic efficiency compared to conventional radiation therapy (CRT) in prostate cancer. PATIENTS AND METHODS: We analyzed 55 HRT patients irradiated with the total dose of 60â¯Gy in 20 fractions delivered over 4 weeks. These patients were compared to a control group of 55 patients who received CRT with a total of <78â¯Gy in 37-39 fractions delivered over circa 8 weeks. External beam radiation therapy (EBRT) was conducted using daily image-guided (cone beam CT) volumetric modulated arc therapy (VMAT) and a simultaneously integrated boost (SIB) for both groups to protect the rectum. Acute toxicities were evaluated according to Common Terminology Criteria for Adverse Events (CTCAE) v5, whereas chronic toxicities were assessed in accordance with LENT-SOMA. Patient traits were compared by implementing ttests and Wilcoxon-Whitney tests for continuous variables, whereas discrete characteristics were evaluated by applying two-tailed Fisher's exact tests. In addition, we calculated average treatment effects (ATE). Thereby, propensity score matching (PSM) based on nearest-neighbor matching considering age, comorbidities, and risk stratification as covariates was applied. The statistical analysis was conducted using Stata 14.2 (StataCorp LLC, TX, USA). RESULTS: As confirmed by the descriptive tests, the ATE revealed that the intensity and occurrence of urinary frequency (pâ¯= 0.034) and proctitis (pâ¯= 0.027) significantly decreased for the HRT group, whereas all other acute toxicities did not differ significantly between the HRT and CRT groups. For late toxicities, neither statistical tests nor ATE estimation showed significant differences. Also, no significant difference was found regarding the decrease in prostate specific antigen (PSA) after a median follow-up of 13 months (range 2-28 months), which indicates biochemical freedom from progression. CONCLUSION: HRT offers several medical and economic advantages and should therefore be considered as a useful alternative to CRT.
Assuntos
Adenocarcinoma/radioterapia , Neoplasias da Próstata/radioterapia , Hipofracionamento da Dose de Radiação , Lesões por Radiação/etiologia , Radioterapia de Intensidade Modulada/métodos , Adenocarcinoma/sangue , Adenocarcinoma/patologia , Idoso , Idoso de 80 Anos ou mais , Cistite/etiologia , Cistite/patologia , Seguimentos , Gastroenteropatias/etiologia , Gastroenteropatias/prevenção & controle , Humanos , Masculino , Pessoa de Meia-Idade , Tratamentos com Preservação do Órgão/métodos , Órgãos em Risco/efeitos da radiação , Proctite/etiologia , Proctite/prevenção & controle , Pontuação de Propensão , Antígeno Prostático Específico/sangue , Neoplasias da Próstata/sangue , Neoplasias da Próstata/patologia , Lesões por Radiação/prevenção & controle , Radioterapia de Intensidade Modulada/efeitos adversos , Reto/efeitos da radiação , Estudos Retrospectivos , Glândulas Seminais/patologia , Glândulas Seminais/efeitos da radiação , Fatores de Tempo , Carga Tumoral , Bexiga Urinária/efeitos da radiação , Transtornos Urinários/etiologia , Transtornos Urinários/patologiaRESUMO
BACKGROUND: Benign Prostatic Hypertrophy [BPH] is associated with voiding dysfunctions. Urodynamic study is the gold standard for diagnosis of voiding dysfunctions but is invasive. Bladder wall thickness (BWT), post-void urine residue (PVR), and bladder emptying efficiency (BEE) are noninvasive predictors of voiding dysfunction. OBJECTIVE: To study the relationship among BWT, PVR, and BEE in BPH. SUBJECTS AND METHODS: A hospital-based cross-sectional prospective study of new BPH patients at Nnamdi Azikiwe University Teaching Hospital, Nnewi. The participants had abdominal ultrasonography measurement of anterior BWT (at bladder volume ≥200 mls), prostate volume (PV), and PVR using Prosound SSD3500 (Aloka Co Ltd, Tokyo, Japan) with an abdominal probe frequency of 3.5 MHz. Then the BEE was calculated. The anterior BWT was divided into two groups: <5 mm and ≥5 mm. The data were analyzed using SPSS version 20. Pearson's correlation was used to assess correlation and the differences between the means of the two groups of BWT were compared by Mann-Whitney test. A P- Value <0.05 was considered significant. RESULTS: Seventy seven men with a mean age of 66.66 ± 10.74 years were included in the study. Sixty one percent had symptoms lasting >12 months. The average anterior BWT, PBV, PVR, BEE, PV, and PSA were 4.55 ± 1.02 mm, 260.98 ± 57.44 mls, 58.36 ± 52.94 mls, 77.98 ± 17.37%, 66.31 ± 46.38 mls, and 8.04 ± 5.97 ng/ml, respectively. There was a significant positive correlation between BWT and duration of symptoms (P = 0.044) and a significant negative correlation between BWT and BEE (P = 0.005). An insignificant positive correlation was found between BWT and PVR (P = 0.255). Fifty four (70.1%) had BWT <5 mm and 29.9% had BWT ≥5 mm. The mean IPSS (P = 0.000), PV (P = 0.032) and PVR (P = 0.020) were significantly higher in the ≥5 mm group. The ≥5 mm group also had a significantly lower BEE (P = 0.002). CONCLUSION: Voiding dysfunction was more severe in patients with BWT of 5 mm or more. There was a positive, but insignificant, correlation between anterior BWT and PVR and a significant negative correlation between BWT and BEE.
Assuntos
Hiperplasia Prostática/patologia , Ultrassonografia/métodos , Bexiga Urinária/diagnóstico por imagem , Retenção Urinária , Transtornos Urinários/patologia , Idoso , Estudos Transversais , Humanos , Masculino , Pessoa de Meia-Idade , Músculo Liso/anatomia & histologia , Músculo Liso/diagnóstico por imagem , Músculo Liso/patologia , Nigéria , Estudos Prospectivos , Hiperplasia Prostática/complicações , Bexiga Urinária/anatomia & histologia , Bexiga Urinária/fisiopatologia , Transtornos Urinários/diagnóstico por imagem , Transtornos Urinários/etiologia , UrodinâmicaRESUMO
The ventriculus terminalis (VT) is a small ependyma-lined cavity within the conus medullaris that is in direct continuity with the central canal of the spinal cord. Cystic dilatation of the ventriculus terminalis on its own is an extremely rare pathological event in adults whose pathogenesis is uncertain. VT has been described in children as a normal developmental phenomenon. These lesions are often diagnosed incidentally during imaging and are in most cases asymptomatic, especially in children. Symptomatic dilatation of VT in adults is a rare condition with 61cases being reported to date. Symptomatic dilatation of VT in children has not been reported till now. We present a 5 year-old-boy with a sphincteric and walking disorder. The patient was assessed by clinical, electrophysiological and urodynamic investigations as well as magnetic resonance imaging (MRI) of the lumbar-sacral segment with and without gadolinium enhancement. Lumbar-sacral MRI demonstrated the presence of a cystic lesion containing cerebrospinal fluid (CSF), which did not enhance after gadolinium, compatible with the diagnosis of the ventriculus terminalis dilation.The patient underwent laminectomy and the cyst wall was fenestrated with a midline myelotomy. In 6-month of follow-up, urinary problems and gait disturbance improved.
Assuntos
Cistos/patologia , Compressão da Medula Espinal/patologia , Pré-Escolar , Constipação Intestinal/etiologia , Constipação Intestinal/patologia , Meios de Contraste , Cistos/complicações , Cistos/cirurgia , Dilatação Patológica/patologia , Epêndima/patologia , Gadolínio , Transtornos Neurológicos da Marcha/etiologia , Transtornos Neurológicos da Marcha/patologia , Humanos , Vértebras Lombares/patologia , Imageamento por Ressonância Magnética , Masculino , Compressão da Medula Espinal/complicações , Compressão da Medula Espinal/cirurgia , Transtornos Urinários/patologiaRESUMO
Estrogens, acting synergistically with androgens, are known from animal experiments to be important in lower urinary tract symptoms (LUTS) and benign prostate enlargement. Human exposure to environmental estrogens occurs throughout the life span, but the urologic health risks in men are largely unknown. Bisphenol A (BPA) is an endocrine disruptor implicated in male urogenital malformations. Given the role of estrogens in male LUTS, we studied the effects of BPA administered in combination with testosterone (T) on the urinary voiding behavior of adult male mice. Adult male mice underwent subcutaneous implantation with slow-release pellets of 25 mg BPA or 2.5 mg estradiol-17ß (E2), plus 25 mg T, and were compared with untreated (UNT) mice that underwent sham surgery. We studied urinary voiding behavior noninvasively for 1 mo before treatment and for 4 mo after treatment. After euthanasia, we evaluated bladder volume and mass. Mice treated with T+BPA had increased bladder volume ( P < 0.05) and mass ( P < 0.01) compared with UNT mice. After 4 mo of treatment with T+BPA, three of five mice developed voiding dysfunction in the form of droplet voiding or an intermediate pattern of voiding different from both UNT and T+E2-treated mice. Treatment of male mice with BPA or estradiol induces voiding dysfunction that manifests at later time points, implicating the endocrine disruptor, BPA, as a contributor to male LUTS.
Assuntos
Compostos Benzidrílicos/toxicidade , Disruptores Endócrinos/toxicidade , Sintomas do Trato Urinário Inferior/induzido quimicamente , Fenóis/toxicidade , Bexiga Urinária/efeitos dos fármacos , Transtornos Urinários/induzido quimicamente , Urodinâmica/efeitos dos fármacos , Animais , Compostos Benzidrílicos/administração & dosagem , Implantes de Medicamento , Disruptores Endócrinos/administração & dosagem , Estradiol/administração & dosagem , Estradiol/toxicidade , Sintomas do Trato Urinário Inferior/patologia , Sintomas do Trato Urinário Inferior/fisiopatologia , Masculino , Camundongos Endogâmicos C57BL , Tamanho do Órgão , Fenóis/administração & dosagem , Medição de Risco , Testosterona/administração & dosagem , Testosterona/toxicidade , Fatores de Tempo , Bexiga Urinária/patologia , Bexiga Urinária/fisiopatologia , Transtornos Urinários/patologia , Transtornos Urinários/fisiopatologiaRESUMO
OBJECTIVE: Accumulating evidences suggests that obesity and metabolic syndrome (MetS) contribute towards lower urinary tract symptoms (LUTS) through alterations in the phenotype of bladder and prostate gland. Clinical studies indicate a link between MetS and LUTS. Nevertheless, there is lack of suitable animal model(s) which could illustrate an association linking obesity to LUTS. We examined the lower urinary tract function in an obesity-initiated MetS mouse model. METHODS: Male C57BL/6N wild-type and obese B6.V-Lepob/J maintained on regular diet for 28 weeks were subjected to the assessment of body weight (BW), body length (BL), waist circumference (WC), body mass index (BMI), blood glucose (BG), plasma insulin (INS), plasma leptin (LEP), total cholesterol (CHO), free fatty acid (FFA), and measurement of urinary functions. Whole animal peritoneal and subcutaneous adipose tissue measurements as well as prostate and bladder volumes were analyzed by MRI followed by histological evaluation. These parameters were used to draw correlations between MetS and LUTS. RESULTS: Obesity parameters such as BW, WC, and BMI were significantly higher in B6.V-Lepob/J mice compared to C57BL/6N mice (P < 0.01). Higher levels of total CHO and FFA were noted in B6.V-Lepob/J mice than C57BL/6N mice (P < 0.05). These results were concurrent with frequency, lower average urine volume and other urinary voiding dysfunctions in B6.V-Lepob/J mice. MRI assessments demonstrate marked increase in body fat and prostate volume in these mice. Compared to C57BL/6N mice, histological analysis of the prostate from B6.V-Lepob/J mice showed increased proliferation, gland crowding, and infiltration of immune cells in the stroma; whereas the bladder urothelium was slightly thicker and appears more proliferative in these mice. The regression and correlation analysis indicate that peritoneal fat (R = 0.853; P < 0.02), CHO (R = 0.729; P < 0.001), BG (R = 0.712; P < 0.001) and prostate volume (R = 0.706; P < 0.023) strongly correlate with LUTS whereas BMI, WC, INS, and FFA moderately correlate with the prevalence of bladder dysfunction. CONCLUSION: Our results suggest that LUTS may be attributable in part to obesity and MetS. Validation of an in vivo model may lead to understand the underlying pathophysiological mechanisms of obesity-related LUTS in humans. Prostate 76:964-976, 2016. © 2016 Wiley Periodicals, Inc.
Assuntos
Síndrome Metabólica/complicações , Obesidade/complicações , Transtornos Urinários/etiologia , Tecido Adiposo/patologia , Animais , Biometria , Composição Corporal , Colesterol/sangue , Modelos Animais de Doenças , Leptina/sangue , Sintomas do Trato Urinário Inferior/etiologia , Sintomas do Trato Urinário Inferior/patologia , Sintomas do Trato Urinário Inferior/fisiopatologia , Imageamento por Ressonância Magnética , Masculino , Síndrome Metabólica/fisiopatologia , Camundongos , Camundongos Endogâmicos C57BL , Obesidade/fisiopatologia , Peritônio , Próstata/patologia , Bexiga Urinária/patologia , Transtornos Urinários/patologia , Transtornos Urinários/fisiopatologiaRESUMO
INTRODUCTION AND HYPOTHESIS: The objective of this study was to compare the histological characteristics of pathological specimens of excised midurethral sling mesh and surrounding vaginal tissue in patients who presented preoperatively with pain and/or exposure of mesh to patients who underwent mesh excision for voiding dysfunction without pain and/or erosion. METHODS: This is a retrospective case-control study of women who underwent excision of midurethral sling mesh between 2008 and 2013. Three groups were identified: (1) voiding dysfunction without pain or exposure (control group), (2) pain and/or mesh exposure, and (3) voiding dysfunction with pain and/or mesh exposure. All original pathological specimens were rereviewed by one pathologist blinded to indication for excision and the previous pathology report. Degree of inflammation and fibrosis were recorded based on a 4-point scale along with the presence of giant cell reaction. RESULTS: A total of 130 subjects met inclusion criteria: 60 (46.2 %) with voiding dysfunction only, 21 (16.2 %) with pain/erosion, and 49 (37.7 %) with both pain/exposure and voiding dysfunction. The voiding dysfunction only group was found to have significantly higher levels of inflammation, median grade 2 (1-3), compared to the other two groups with a p value of 0.007. There were no statistical differences in fibrosis and giant cell reaction between the three groups. CONCLUSIONS: Midurethral sling mesh excised for voiding dysfunction demonstrates elevated levels of inflammation compared to mesh that is excised for pain and/or exposure. The vaginal tissue fibrosis and giant cell reaction are similar in patients who undergo mesh excision for voiding dysfunction and pain, and/or mesh exposure.
Assuntos
Dor/patologia , Slings Suburetrais/efeitos adversos , Telas Cirúrgicas/efeitos adversos , Transtornos Urinários/patologia , Vagina/patologia , Adulto , Estudos de Casos e Controles , Remoção de Dispositivo , Feminino , Fibrose/patologia , Células Gigantes de Corpo Estranho/patologia , Humanos , Inflamação/patologia , Pessoa de Meia-Idade , Dor/etiologia , Estudos Retrospectivos , Transtornos Urinários/etiologiaRESUMO
BACKGROUND: The purpose of this study is to compare the patterns of voiding dysfunction according to the locations of brainstem lesions. METHODS: Between November 2008 and December 2011, a total of 30 patients participated in this study. All 30 subjects, consisting of 16 men and 14 women, aged between 41 and 82 years (mean age, 63.0±11.0 years) underwent a urodynamic study within 7 days after the onset of a stroke. RESULTS: Twenty-one (70%) patients had a pontine lesion and 9 (30%) had a medullary lesion. Fourteen of these patients (46.7%) had bladder storage disorder, 7 patients (23.3%) had bladder emptying disorder, and 9 patients (30%) had a normal report. Five of the patients who had a medullary lesion (55.6%) had bladder emptying disorder, whereas only 2 patients who had a pontine lesion (9.5%) had bladder emptying disorder. Thirteen patients who had a pontine lesion (61.9%) showed bladder storage disorder. DISCUSSION: The descending pathway from the midbrain tegmentum is inhibitory, and the pathway from the pontine tegmentum is stimulatory. Because of their location pontine lesions could disrupt the descending fibers of the midbrain tegmentum and medullary lesions could disrupt the descending fibers of the pontine tegmentum.
Assuntos
Infartos do Tronco Encefálico/patologia , Infartos do Tronco Encefálico/fisiopatologia , Bulbo/patologia , Síndrome do Ovário Policístico/etiologia , Transtornos Urinários/etiologia , Doença Aguda , Adulto , Idoso , Idoso de 80 Anos ou mais , Infartos do Tronco Encefálico/complicações , Feminino , Humanos , Masculino , Bulbo/fisiopatologia , Pessoa de Meia-Idade , Síndrome do Ovário Policístico/patologia , Síndrome do Ovário Policístico/fisiopatologia , Ponte/patologia , Ponte/fisiopatologia , Acidente Vascular Cerebral/patologia , Acidente Vascular Cerebral/fisiopatologia , Transtornos Urinários/patologia , Transtornos Urinários/fisiopatologiaRESUMO
OBJECTIVE: To comprehensively analyze the 5-year outcomes of tamsulosin treatment for patients with benign prostatic hyperplasia. METHODS: Tamsulosin (0.2 mg/day) was given to 112 patients who had International Prostate Symptom Scores ≥8. They were prospectively followed for 5 years with periodic evaluation. If tamsulosin had to be discontinued, the reason was determined. Treatment failure was considered in the case of disease progression (postvoid residual urine volume ≥200 mL, acute urinary retention, febrile urinary tract infection or hydronephrosis as a result of bladder outlet obstruction), conversion to other α1-blockers or need for surgery. An intention-to-treat analysis was carried out. RESULTS: A total of 34 patients (30.4%) continued the same medication for the overall study period, whereas 78 patients (69.6%) discontinued the medication. International Prostate Symptom Scores, Benign Prostatic Hyperplasia Problem Index and Quality of Life Index were significantly improved over the 5-year period. Treatment failure was observed in 21 patients (18.8%). Baseline prostate volume and postvoid residual urine volume were independent factors to predicting treatment failure. A total of 21 patients (18.8%) discontinued tamsulosin because of an improvement of symptoms. They were younger and had lower prostate-specific antigen levels than the remaining 91 patients. Their symptoms were stable even 1 year after termination of therapy. CONCLUSIONS: Long-term efficacy of tamsulosin was observed, although only a small portion of patients continued the treatment. α1-blocker monotherapy might be not appropriate for achieving a good long-term outcome in patients with a large prostate volume and a large amount of postvoid residual urine volume. Persistent improvement of symptoms, even after termination of tamsulosin, was observed in young patients with low prostate-specific antigen levels.
Assuntos
Antagonistas de Receptores Adrenérgicos alfa 1/administração & dosagem , Hiperplasia Prostática/tratamento farmacológico , Hiperplasia Prostática/patologia , Sulfonamidas/administração & dosagem , Antagonistas de Receptores Adrenérgicos alfa 1/efeitos adversos , Idoso , Progressão da Doença , Seguimentos , Humanos , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Pacientes Desistentes do Tratamento , Valor Preditivo dos Testes , Modelos de Riscos Proporcionais , Estudos Prospectivos , Hiperplasia Prostática/cirurgia , Sulfonamidas/efeitos adversos , Tansulosina , Resultado do Tratamento , Retenção Urinária/tratamento farmacológico , Retenção Urinária/patologia , Retenção Urinária/cirurgia , Transtornos Urinários/tratamento farmacológico , Transtornos Urinários/patologia , Transtornos Urinários/cirurgiaRESUMO
OBJECTIVE: Analyze if bladder mucosa of patients with bladder pain syndrome (BPS) have more estrogen receptor (ER) and progesterone receptor (PR) than the normal population. MATERIAL AND METHOD: Between July 2009 and December 2010, 15 female patients with chronic bladder pain syndrome and 10 female patients without bladder pain were enrolled in the present study. Three pieces of trigonal bladder mucosa were biopsied and sent for estrogen receptor and progesterone receptor immunohistochemistry staining by the Benchmark automated machine. The results were reported as positive and negative and then compared between the two groups. RESULTS: Estrogen receptor was found in 14 out of 15 patients in the BPS group (93%) and in 7 out of 10 patients in the control group (70%). Progesterone receptor was found in 10 out of 15 patients in the BPS group (66.7%) and 5 out of 10 patients in the control group. Both were not significantly different with p = 0.267 and p = 0.678, respectively. CONCLUSION: The authors concluded that ER and PR might not play a role in the etiopathogenesis of BPS/IC. However other receptors should be further investigated about their role in this type of pain.
Assuntos
Cistite Intersticial/patologia , Imuno-Histoquímica , Dor Pélvica/patologia , Receptores de Estrogênio/análise , Receptores de Progesterona/análise , Adulto , Idoso , Biópsia , Estudos de Casos e Controles , Cistite Intersticial/diagnóstico , Cistite Intersticial/terapia , Cistoscopia , Dilatação , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Mucosa/patologia , Dor Pélvica/etiologia , Dor Pélvica/terapia , Síndrome , Bexiga Urinária/patologia , Transtornos Urinários/diagnóstico , Transtornos Urinários/patologia , Transtornos Urinários/terapia , Adulto JovemRESUMO
The article presents the results of the study aimed to the evaluation the efficacy of combination therapy with alpha1-blocker (tamsulosin) and phosphodiesterase type 5 inhibitor (sildenafil) in patients with urination disorders and erectile dysfunction (ED). A pilot observational study involving 60 men aged from 50 and 80 years divided into 3 groups of 20 people was performed. Group 1 of patients received sildenafil 25 mg daily (dynamico), Group 2--tamsulosin 0.4 mg daily (Omnic-Ocas), and Group 3--tamsulosin 0.4 mg (Omnic-Ocas) and sildenafil 25 mg (dynamico) daily. The visits were carried out at the stage of screening, further--every 10 days (a total number--4 visits). Combination therapy of urination disorders and ED contributed to the significant improvement in uroflowmetry, the stopping of complaints according to the IPSS and IIEF-15 questionnaires, and improving the quality of life (according to the QoL questionnaire). Combination therapy significantly decreased obstructive and irritative symptoms, increased the maximum urine flow rate within the period of observation, as well as significantly decreased the residual urine volume, more pronounced when compared with monotherapy. Significant positive effect on erectile component and all components of the overall satisfaction in the sexual sphere were registered, that as a consequence led to the positive impact on the quality of life in patients treated with PDE5 inhibitor. Given the high prevalence of urinary disorders and erectile dysfunction, combined therapy with alpha1-blockers and PDE5 inhibitors in this case should be a promising area for drug therapy.
Assuntos
Antagonistas de Receptores Adrenérgicos alfa 1/administração & dosagem , Disfunção Erétil/tratamento farmacológico , Inibidores da Fosfodiesterase 5/administração & dosagem , Piperazinas/administração & dosagem , Sulfonamidas/administração & dosagem , Sulfonas/administração & dosagem , Transtornos Urinários/tratamento farmacológico , Idoso , Idoso de 80 Anos ou mais , Quimioterapia Combinada , Disfunção Erétil/complicações , Disfunção Erétil/patologia , Disfunção Erétil/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Projetos Piloto , Purinas/administração & dosagem , Citrato de Sildenafila , Tansulosina , Transtornos Urinários/complicações , Transtornos Urinários/patologia , Transtornos Urinários/fisiopatologiaRESUMO
Melanosis of the urinary bladder is an extremely rare benign condition in which melanin deposits occur in the urothelial and stromal cells. We report such a case in which melanosis of the urinary bladder was detected in a 55-year-old woman with known multiple sclerosis during an extended workup due to urinary urgency complaints. The findings were confirmed by biopsy.
Assuntos
Melanose , Doenças da Bexiga Urinária , Transtornos Urinários , Feminino , Humanos , Pessoa de Meia-Idade , Bexiga Urinária/patologia , Doenças da Bexiga Urinária/diagnóstico , Transtornos Urinários/patologia , Cistoscopia , Melanose/diagnóstico , Doenças Raras/patologiaRESUMO
BACKGROUND/PURPOSE: The pathophysiology of female lower urinary tract symptoms (LUTS) may involve bladder, urethral, and pelvic floor dysfunctions. This study analyzed the relationship between clinical symptoms and lower urinary tract dysfunctions (LUTD) in women. METHODS: A total of 1605 consecutive women were included. LUTS were classified as storage, voiding, pain, and postmicturition symptoms. All patients underwent videourodynamic study (VUDS) and the final diagnosis of LUTD was made based on VUDS findings. Patients were stratified into three major disorder groups: sensory, motor, and bladder outlet disorders. The main symptoms and associated symptoms were used for analysis in varying LUTD. RESULTS: Normal tracing was found in 272 patients (16.9%), sensory bladder disorders in 459 (28.6%), motor bladder disorders in 560 (34.9%), and bladder outlet disorders were found in 314 patients (19.6%). Frequent urination was the main symptom in patients with normal, bladder oversensitivity, interstitial cystitis, and idiopathic detrusor overactivity (DO). In patients with voiding dysfunction due to detrusor underactivity, bladder neck dysfunction and urethral stricture, dysuria was the most common symptom. However, 707 (44%) of overall women had both storage and voiding symptoms. DO was present in 533 women and in 149 (66%) of 212 with bladder outlet obstruction. However, DO was only found in 42.5% of women with urgency and in 69.4% of women with urgency incontinence based on reported LUTS. CONCLUSION: Storage and voiding symptoms are common in women with LUTD. The differential diagnosis of LUTD in women cannot be based on LUTS alone.
Assuntos
Doenças Urológicas/diagnóstico , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Pessoa de Meia-Idade , Distúrbios do Assoalho Pélvico/diagnóstico , Distúrbios do Assoalho Pélvico/patologia , Distúrbios do Assoalho Pélvico/fisiopatologia , Doenças Uretrais/diagnóstico , Doenças Uretrais/patologia , Doenças Uretrais/fisiopatologia , Doenças da Bexiga Urinária/diagnóstico , Doenças da Bexiga Urinária/patologia , Doenças da Bexiga Urinária/fisiopatologia , Transtornos Urinários/diagnóstico , Transtornos Urinários/patologia , Transtornos Urinários/fisiopatologia , Urodinâmica , Doenças Urológicas/patologia , Doenças Urológicas/fisiopatologia , Adulto JovemRESUMO
INTRODUCTION AND HYPOTHESIS: The aim of the present study was to assess the relationship between lower urinary tract symptoms, anatomical findings, and baseline characteristics in women with pelvic organ prolapse (POP). METHODS: A cross-sectional observational study was performed, enrolling consecutive women seeking cares for lower urinary tract symptoms (LUTS) with evidence of POP. Data regarding baseline characteristics, LUTS, and physical examination were gathered for each patient. Multivariate analysis (multiple linear regression (MLR)) and artificial neural networks (ANNs) were performed to design predicting models. RESULTS: A total of 1,344 women were included. Age, BMI, pelvic organ prolapse quantification (POP-Q) stage I, and previous surgery for urinary incontinence resulted predictors of urgency and stress incontinence. POP-Q stages III-IV were related to voiding dysfunction and POP symptoms. Age, BMI, and menopausal status resulted predictors for sexual dysfunction. Receiver operating characteristic comparison confirmed that ANNs were more accurate than MLRs in identifying predictors of LUTS. CONCLUSIONS: LUTS result from a fine interaction between baseline characteristics and anatomical findings. ANNs are valuable instrument for better understanding complex biological models.
Assuntos
Redes Neurais de Computação , Diafragma da Pelve/patologia , Prolapso de Órgão Pélvico/complicações , Transtornos Urinários/etiologia , Idoso , Estudos Transversais , Feminino , Humanos , Itália/epidemiologia , Pessoa de Meia-Idade , Análise Multivariada , Prolapso de Órgão Pélvico/epidemiologia , Prolapso de Órgão Pélvico/patologia , Disfunções Sexuais Fisiológicas/etiologia , Disfunções Sexuais Fisiológicas/patologia , Transtornos Urinários/patologiaRESUMO
Cerebellar diseases represent about 2-3% of neurologic pathologies; they usually are classified as:--heredodegeneratives--pure cerebellar syndromes. Such diseases--aside from their aetiology--lead, through several evolutive stages, to different micturitional disorders, in most cases represented by hyperreflexic non dyssynergic bladder and urinary incontinence. On the basis of anatomopathological studies, also considering our 16 years long personal series (1992-2008), we were able to establish a relationship between such disorders and specific cerebellum anomalies, mostly of Purkinje network.
Assuntos
Doenças Cerebelares/complicações , Transtornos Urinários/complicações , Idoso , Doenças Cerebelares/patologia , Doenças Cerebelares/fisiopatologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Transtornos Urinários/patologia , Transtornos Urinários/fisiopatologiaRESUMO
BACKGROUND: One of the characteristics of urinary symptoms in women is their lack of specificity. Patients with stress incontinence or urgency, local irritation, infection, distal stenosis or a neoplastic process have very similar symptoms. OBJECTIVE: Determine the frequency of bladder structural lesions detected by urethrocistoscopy in which we performed bladder biopsies. MATERIAL AND METHOD: Descriptive, retrospective, analytical study of files and videos of 331 patients treated in Urodifem de Occidente (private Urogynecology Center). Thirty-five biopsies were taken. The statistical analysis was expressed as means standard deviations, ranges, percentages and Fishers test. RESULTS: Patients ages range 30-90 years average 60+13.76. Predominant symptoms were: irritative vesical syndrome 62.8%; pelvic pain 45.71%; urge incontinence 31.4%; hematuria 31.4%; vesical voiding dysfunction 11.4%. Principal endoscopic findings: Urethrotrigonitis; glomerular lesions or Hunner ulcers; vesical trabeculations; tumor or suspect lesions. Histopathologic findings were: Interstitial Cystitis 42.9%; chronic Cystitis 11.4%; Cystitis glandularis 8.6%; Cystitis follicular 11.4%; bladder cancer 5.7%; Vesical Papilloma 5.7%. CONCLUSIONS: This study supports the practice of vesical biopsy when lesions other than those from chronic infection are observes in the presence of tumors or suspect lesions.
Assuntos
Biópsia , Dor Pélvica/patologia , Neoplasias da Bexiga Urinária/patologia , Bexiga Urinária/patologia , Transtornos Urinários/patologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Carcinoma de Células de Transição/complicações , Carcinoma de Células de Transição/diagnóstico , Carcinoma de Células de Transição/patologia , Cistite/complicações , Cistite/diagnóstico , Cistite/patologia , Cistoscopia , Feminino , Hematúria/diagnóstico , Hematúria/etiologia , Hematúria/patologia , Humanos , Pessoa de Meia-Idade , Papiloma/complicações , Papiloma/diagnóstico , Papiloma/patologia , Dor Pélvica/diagnóstico , Dor Pélvica/etiologia , Estudos Retrospectivos , Neoplasias da Bexiga Urinária/complicações , Neoplasias da Bexiga Urinária/diagnóstico , Transtornos Urinários/diagnóstico , Transtornos Urinários/etiologiaRESUMO
OBJECTIVES: Voiding dysfunction may result in lower urinary tract symptoms in children and is associated with urinary tract infection, renal damage and vesicoureteral reflux (VUR). The aim of this study was to assess the relationship between detrusor pressure, VUR and abnormal renal scintigraphy findings in children with dysfunctional voiding. PATIENTS AND METHODS: Between 2004 and 2007, 30 children with VUR and voiding dysfunction, 22 girls and 8 boys, median age 8.2 years, were evaluated. Urodynamic study, renal scan and voiding cystourethrography were performed in all patients. RESULTS: The degree of the renal scarring was found to be associated with the detrusor pressures (p = 0.018). The highest detrusor pressure was shown in the group of urge syndrome. The degree of the VUR was found to be correlated with the detrusor pressures (p = 0.038). In our study group, VUR had resolved in 11 (37%) patients, had improved in grade in 10 (33%) patients and remained unchanged in 9 (30%) patients after anticholinergic therapy. No significant relationship was found between the duration of therapy and the voiding patterns (p = 0.389). CONCLUSION: Every child with VUR should undergo a careful evaluation of its bladder function. The patients who have high detrusor pressures should be evaluated carefully for the presence of VUR and renal damage.
Assuntos
Nefropatias/etiologia , Bexiga Urinária/fisiopatologia , Transtornos Urinários/complicações , Urodinâmica , Refluxo Vesicoureteral/etiologia , Adolescente , Criança , Pré-Escolar , Bases de Dados como Assunto , Enurese Diurna/complicações , Enurese Diurna/fisiopatologia , Feminino , Humanos , Rim/patologia , Nefropatias/patologia , Masculino , Enurese Noturna/complicações , Enurese Noturna/fisiopatologia , Pressão , Compostos Radiofarmacêuticos , Índice de Gravidade de Doença , Ácido Dimercaptossuccínico Tecnécio Tc 99m , Incontinência Urinária de Urgência/complicações , Incontinência Urinária de Urgência/fisiopatologia , Transtornos Urinários/patologia , Transtornos Urinários/fisiopatologia , Transtornos Urinários/terapia , Urografia , Refluxo Vesicoureteral/fisiopatologia , Refluxo Vesicoureteral/terapiaRESUMO
BACKGROUND: In men, bladder wall thickness > or =5 mm seems to be a useful predictor of outlet obstruction, with a diagnostic value exceeding that of free uroflowmetry indices. There are no data in the literature examining whether this may also apply in women. AIMS: To identify the relationships between detrusor wall thickness (DWT) and symptoms and urodynamic findings suggestive of voiding dysfunction. METHODS: This is a retrospective study analysing data sets of 686 women seen for urodynamic testing in a tertiary urogynaecological unit. Hesitancy, poor stream and stop-start voiding were recorded as symptoms of voiding dysfunction. All women underwent free uroflowmetry and multichannel urodynamic testing. We used the urethral resistance factor (URA) and the obstruction coefficient (OCO), methods employed to quantify bladder outlet resistance in men. Transperineal ultrasound for DWT was performed after voiding and catheter removal. Statistical analysis was carried out by using the statistical software (spss 15.0; SPSS Inc., Chicago, IL, USA). RESULTS: Symptoms of voiding dysfunction were reported by 33.1% of patients and 22.4% had urodynamically diagnosed voiding dysfunction. The mean DWT in symptomatic women was not statistically different from the mean DWT in those without symptoms. URA and OCO of symptomatic women were significantly different from those of asymptomatic women (P < 0.01). DWT was not associated with parameters of voiding function, URA or OCO. CONCLUSIONS: Contrary to the situation in men, increased DWT in women does not seem to be associated with symptoms or signs of voiding dysfunction. Therefore, DWT cannot be used as a predictor of voiding difficulty in women.