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1.
Chinese Journal of Geriatrics ; (12): 886-889, 2021.
Article in Chinese | WPRIM | ID: wpr-910935

ABSTRACT

Objective:To analyze the urodynamic and clinical features of detrusor underactivity(DU)in elderly men aged 60 years and over.Methods:Five hundred and seventy-three men aged 60 years and over underwent urodynamic measurements due to dysuria were retrospectively analyzed.According to the urodynamic parameters of bladder contractibility index(BCI)and bladder outlet obstruction index(BOOI), they were divided into the three groups: only detrusor underactivity(DU group)(BCI<100 and BOOI<20), only bladder outlet obstruction(BOO group)(BCI≥100 and BOOI≥40), and the combined non-DU and non-BOO group(NDB group)(BCI≥100 and BOOI<20). The urodynamic and clinical features were compared between the three groups.Results:The internalized 323 patients meeting inclusion and exclusion criteria were divided into 3 groups: 75 in the DU, 207 in the BOO and 41 in the NDB.The age was higher in DU and BOO groups than in NDB group( P<0.05). The DU group versus the NDB group showed the higher levels or values in the volume at first desire(FDV)[(279±80)ml vs.(238±72)ml], the proportions of incomplete bladder emptying(41% vs.17%), urine flow interruption(39% vs.15%)and retention(26% vs.7%), and the lower levels in the voiding efficiency(VE)[(61±32)% vs.(110±41)%], (all P<0.05). The DU group vs.the BOO group showed the increased levels or values in the FDV[(279±80)ml vs.(206±67)ml]and maximum cytometric capacity(MCC)(353±113 ml vs.281±94 ml)and the proportions of urine flow interruption(39% vs.22%), TURP(26% vs.6%), and retention(26% vs.14%), and the decreased levels or values in the VE[(61±32)% vs.(78±37%)], the proportions of DO(41% vs.77%), urgency(26% vs.43%)and nocturia(23% vs.39%)(all P<0.05). Conclusions:The main urodynamic and clinical features are manifested as the reduction of bladder sensation and bladder emptying rate, urine flow interruption, urinary retention and having a TURP history in elderly man with detrusor underactivity.The proportions of DU and BOO are increased along with aging.

2.
Chinese Journal of Urology ; (12): 824-829, 2021.
Article in Chinese | WPRIM | ID: wpr-911127

ABSTRACT

Objective:To evaluate the feasibility, safety and efficacy of the magnetic resonance imaging guided focused ultrasound surgery (MRgFUS) in the treatment of localized prostate cancer (PCa).Methods:The data of 5 patients treated by MRgFUS from August 2020 to June 2021 in our institution were retrospectively analyzed. The median age was 73 (58-80) years, with the median PSA of 7.34 (5.19-8.40) ng/ml, and a median prostate volume of 27.96 (21.50-37.91) ml. The median pretreatment international prostate symptom score (IPSS) was 13(0-18). Of the 3 patients with intention of erectile function preservation, the pretreatment international index of erectile function-15 (IIEF-15) score was 12, 23 and 3, respectively. All patients had histopathology-proven PCa of grade group ≤ International Society of Urological Pathology (ISUP) 3, pre-operative PSA level <20 ng/ml, and a clinical stage ≤T 2b. A total of 6 lesions was confirmed by biopsy, with 3 of ISUP grade group 3 and 3 of ISUP grade group 1. All 5 patients underwent MRgFUS which was guided by a real-time magnetic resonance imaging (MRI). PSA, MRI and repeated biopsy were conducted to monitor recurrence. Questionnaires consisted of IPSS, IIEF-15, and the International Consultation on Incontinence-questionnaire-Short Form (ICI-Q-SF) were recorded before and after MRgFUS to evaluate the impact on functional preservation. Results:A total of 5 patients received MRgFUS. In total, 5 of the 6 lesions were treated. 1 lesion unvisible on MRI was not clinically significant and was left untreated. The median time in MRI scanner was 190 (140-355) min, and the median sonication time was 64 (35-148) min with the median sonications of 8 (5-13). The median catheter indwelling time was 1 (1-8) days. No other adverse effects were reported. The PSA level of all 5 patients decreased, with the nadir PSA of 1.196 ng/ml, 4.398 ng/ml, 4.135 ng/ml, 1.562ng/ml and 1.350ng/ml, respectively. 4 of the patients had a PSA decrease over 50%. No PCa lesion was seen on MRI at 3-month follow-up visit. As for functional preservation, the post-MRgFUS IPSS declined compared with the baseline score, and the IPSS of last follow-up was 5(0-14). Of the 3 patients with intention to preserve the erectile function, the erectile function score of IIEF-15 were 12, 30 and 9 three months after the treatment, respectively. No incontinence occurred postoperatively.Conclusions:MRgFUS is a feasible and safe way for the treatment of low- to intermediate-risk localized PCa, with satisfactory performance on functional preservation and low incidence of complications. The oncological outcomes still need to be establised with longer follow-up time and larger sample studies.

3.
Chinese Journal of Urology ; (12): 472-474, 2021.
Article in Chinese | WPRIM | ID: wpr-911052

ABSTRACT

This study prospectively collected the clinical data of patients who received sacral neuromodulation(SNM)variable-frequency stimulation (VFS) mode from June 2020 to December 2020, in order to explore the efficacy and safety of VFS mode in the treatment of refractory lower urinary tract dysfunction. The inclusion criteria were as follows: ①SNM was implanted; ②age ≥18 years old; ③The traditional constant-frequency stimulation (CFS) mode has poor therapeutic effect, and can not be improved after repeated adjustment of stimulation parameters; ④Patients with overactive bladder (OAB) symptoms, who fail to respond to conservative treatment or are intolerant to conservative treatment; ⑤The drugs that affect the lower urinary tract symptoms and pelvic function should not be increased or decreased during the trial; ⑥provision of informed consent. A total of six patients meeting the criteria were included in the study, with three males and three females. The age ranged from 47 to 74 years, with an average age of 55 years. Among those patients, three cases were diagnosed of OAB, two cases were diagnosed of interstitial cystitis, and one case was diagnosed of neurogenic bladder. All patients had received CFS-SNM for an average of 20.6 months before upgrading to VFS mode, and suffered from severe frequency of urination at the same time. Compared with the severity of symptoms during the baseline period and the CFS period, a trend of improvement was found among four patients during the VFS period. The severity of symptoms was mainly based on the average daily urination frequency and OAB-Q score. For the two patients with interstitial cystitis, OAB symptoms worsened during the VFS period, while the VAS score did not change significantly. In general, VFS-SNM is not inferior to CFS-SNM in improving the symptoms of frequent micturition. For patients with interstitial cystitis, multiple sets of VFS parameters can be tried under the premise of satisfactory pain management.

4.
Chinese Journal of Geriatrics ; (12): 1407-1411, 2021.
Article in Chinese | WPRIM | ID: wpr-911028

ABSTRACT

Objective:To evaluate the efficacy and safety of robotic arm assisted laparoscopic hysterosacral fixation in patients with pelvic organ prolapse(POP), and its impact on lower urinary tract function.Methods:This study retrospectively analyzed the clinical data of POP patients who had undergone robotic arm assisted laparoscopic hysterosacral fixation at our center from June 2019 to October 2020, and conducted exploratory research.Results:A total of 6 patients were included in the study, with POP quantitative staging above stage Ⅲ.The ages ranged from 70 to 82 years.The number of births each patient had given ranged from 1 to 3, & all were via vaginal deliveries.There were no significant changes in urodynamic parameter scores in any patients before and after surgery, but half of the patients had detrusor overactivity before surgery, which all disappeared after surgery.In addition, synchronous X-ray images showed that the postoperative pelvic organs were closer to the normal anatomical position.At the same time, quantitative staging of POP had achieved clear improvement, and related scale scores also significantly improved.One patient complained of occasional lumbar and back discomfort with postoperative over-stretching during outpatient review, which improved after symptomatic treatment.Conclusions:robotic arm assisted Laparoscopic hysterosacral fixation is satisfactory in efficacy and safety for POP patients, with good postoperative restoration of the uterus to the anatomical position and has insignificant influence on the function of the lower urinary tract.It is worth further assessment for wide application.

5.
Chinese Journal of Urology ; (12): 746-751, 2020.
Article in Chinese | WPRIM | ID: wpr-869744

ABSTRACT

Objective:To investigate the detection rate and the characteristics of detected prostate cancer foci on multi-parametric MRI (mp-MRI) and to evaluate the potential influence factors.Methods:A total of 66 patients undergoing radical prostatectomy (RP) from August 2017 to July 2019 in Beijing Hospital were retrospectively studied. The median age was 67(56-80)years, with the median preoperative PSA level of 8.73 (1.22-72.46)ng/ml, and median prostate volume of 35.9(16.8-131.8) ml. All patients underwent mp-MRI before surgery and the whole mount section of RP specimens was prepared. Two radiologists reviewed all the foci independently and then matched each foci with an urological pathologist. The primary outcome was the detection rate of prostate cancer. The potential influence factors were also investigated.Results:Of all 66 patients, a total of 62(93.9%) patients were diagnosed with prostate cancer on a preoperative mp-MRI. On whole mount section, 109 prostate cancer foci were detected, of which 77 foci were correctly diagnosed on mp-MRI, with the overall sensitivity of 70.6%. For all the foci detected, 53(48.6%) were grade group 1 disease of International Society of Urological pathology (ISUP), 31(27.5%) were ISUP grade group 2 disease, 19(17.4%) were ISUP grade group 3 disease, and 6(5.5%) were ≥ISUP grade group 4 disease. Mp-MRI detected 62/67(92.5%) lesions with tumor diameter ≥1 cm, 49/56(87.5%) lesions with tumor Gleason score ≥7, and 59/66(89.4%) index lesions. The tumor diameter( OR=3.183, 95% CI 1.580-6.411, P=0.001)and index lesion status( OR=4.042, 95% CI 1.127-14.503, P=0.032)were independently associated with the detection of prostate cancer foci on mp-MRI. Conclusions:mp-MRI is an effective technique for prostate cancer detection. Sensitivity increased with increased tumor size and index lesion status. The tumor diameter and index lesion status were independently associated with the detection of prostate cancer foci on mp-MRI.

6.
Chinese Journal of Geriatrics ; (12): 418-423, 2020.
Article in Chinese | WPRIM | ID: wpr-869398

ABSTRACT

Objective:To investigate the safety and efficacy of sacral neuromodulation(SNM)therapy for the treatment of lower urinary tract dysfunction(LUTD)in elderly patients.Methods:Clinical data of 91 elderly patients with LUTD from multiple medical institutions who received SNM during the period from January 2012 to December 2016 were retrospectively analyzed.Patients were divided into four groups: the interstitial cystitis(IC)group(n=28), the neurogenic bladder(NB)group(n=36), the overactive bladder syndrome(OAB)group(n=13)and the idiopathic dysuria(ID)group(n=14). Different sets of evaluation parameters were used for different diseases.Patients’ baseline data and data in stage I(test phase)and stage Ⅱ(permanent SNM)were recorded, statistically analyzed and compared.Results:Ninety-one people underwent SNM treatment.Of them, 53 patients received permanent implants(stage Ⅱ), and the total conversion rate of stage I to stage Ⅱ was 58.2%(53/91). Patients receiving permanent implants(stage Ⅱ)had a preoperative period ranging from 3 months to 30 years, and were followed up for 2 to 58 months after treatment, with an average follow-up of 19.6 months.The improvement rates in stage I for urinary urgency, daily urination frequency, daily nocturnal urination frequency, maximum urine volume, daily average urine volume, daily urine leakage frequency, and quality of life score were 35.4%, 31.6%, 33.7%, 32.6%, 49.2%, 43.2% and 13.2%, respectively.The improvement rates in stage Ⅱ for urinary urgency, daily urination frequency, daily nocturnal urination frequency, maximum urine volume, daily average urine volume, daily urine leakage frequency, and quality of life score were 43.2%, 40.0%, 37.8%, 50.5%, 70.5%, 70.4% and 43.2%, respectively.Three adverse events occurred, including 1 case of recurrent symptoms, 1 case of moderate infection, and 1 case of electrical lead dislocation.Conclusions:Sacral nerve stimulation has definitive and consistent curative effects on LUTD in elderly people.The follow-up time should be extended to further study the safety of sacral nerve stimulation.

7.
Chinese Journal of Geriatrics ; (12): 582-585, 2019.
Article in Chinese | WPRIM | ID: wpr-745563

ABSTRACT

Objective To investigate an initial therapeutic effect and safety of an implantation of artificial urinary sphincter(AUS)for treatment of male incontinence.Methods Clinical data of 5 male patients hospitalized in our center from November 2013 to November 2017 and treated with AUS were retrospectively analyzed.The usage of pads and the improvement of relevant score were compared before and after operation.Results The 5 males had incontinence secondary to post-prostatectomy,aged 71-78 years with an average of 75.4 years.All AUS devices were successfully activated and manipulated.After implantation,patients were followed up for a mean of 28.4 months.A social continence was got in four cases,a totally dry in one case.Complications occurred in 2 cases:1 case had mechanical failure and reached the standard of social urine control after replacing devices;another case had an unknown cause.Conclusions AUS implantation is a safe and effective treatment for male patients with the moderate to severe urinary incontinence.

8.
Chinese Journal of Geriatrics ; (12): 1273-1277, 2019.
Article in Chinese | WPRIM | ID: wpr-801263

ABSTRACT

Objective@#To evaluate the effectiveness and safety of sacral neuromodulation(SNM)in the treatment of non-neurogenic and non-obstructive dysuria in elderly patients.@*Methods@#Six elderly patients with non-neurogenic and non-obstructive(2 males and 4 females)treated with SNM were recruited from multiple medical centers across the country in this retrospective study from January 2012 to December 2016.All patients received two or more conservative treatments including behavior therapy, oral therapy, etc., with no good effect.Data of the average residual urine volume, average urine volume, maximum urine volume, average urinary frequency and quality of life score before operation, after implantation of stage Ⅰ tined lead, and at the end of follow-up after implantation of stage Ⅱ implanted pulse generator(IPG)were compared.@*Results@#The average age in the 6 patients was 69.5(65~79)years.The results of SNM treatment showed that the objective findings and/or subjective symptoms in all patients were significantly improved in more than 50% of indexes before treatment.All patients chose embedding of IPG at the end of stage Ⅰ, with 100.0% of the conversion rate from stage Ⅰ to stage Ⅱ.The curative effect was stable in general.At stages of baseline, personal experience and end of follow-up respectively, the average residual urine volumes were(161.7±110.2)ml, (70.0±52.2)ml, and(50.0±44.7)ml, the average urine volume were(105.0±74.0)ml, (163.3±93.1)ml, and(155.0±92.3)ml, and the maximum urine volume were(146.7±81.2)ml, (216.7±93.1)ml, and(206.7±112.7)ml, which showed continuously significant improvements with patients' great satisfaction.The mean duration of fellow-up in 6 cases was 17.5 months(7-57 months). No severe adverse reactions such as wound infection, electrode dislocation and hematoma were observed.@*Conclusions@#SNM treatment is safe and effective for elderly patients with non-neurogenic and non-obstructive dysuria who are refractory to other treatments.SNM has a stable medium-term curative effect and a high-transfer-rate from stage Ⅰ to stage Ⅱ, which is appropriate for non-neurogenic and non-obstructive dysuria.The duration of SNM may be positively correlated with the improvement of residual urine volume and urination frequency.

9.
Chinese Journal of Geriatrics ; (12): 1273-1277, 2019.
Article in Chinese | WPRIM | ID: wpr-824551

ABSTRACT

Objective To evaluate the effectiveness and safety of sacral neuromodulation(SNM) in the treatment of non-neurogenic and non-obstructive dysuria in elderly patients.Methods Six elderly patients with non-neurogenic and non-obstructive(2 males and 4 females)treated with SNM were recruited from multiple medical centers across the country in this retrospective study from January 2012 to December 2016.All patients received two or more conservative treatments including behavior therapy,oral therapy,etc.,with no good effect.Data of the average residual urine volume,average urine volume,maximum urine volume,average urinary frequency and quality of life score before operation,after implantation of stage Ⅰ tined lead,and at the end of follow-up after implantation of stage Ⅱ implanted pulse generator(IPG) were compared.Results The average age in the 6 patients was 69.5 (65 ~ 79) years.The results of SNM treatment showed that the objective findings and/or subjective symptoms in all patients were significantly improved in more than 50% of indexes before treatment.All patients chose embedding of IPG at the end of stage Ⅰ,with 100.0% of the conversion rate from stage Ⅰ to stage Ⅱ.The curative effect was stable in general.At stages of baseline,personal experience and end of follow-up respectively,the average residual urine volumes were (161.7±110.2)ml,(70.0±52.2) ml,and(50.0±44.7)ml,the average urine volume were(105.0± 74.0)ml,(163.3 ± 93.1) ml,and (155.0 ± 92.3) ml,and the maximum urine volume were (146.7 ± 81.2) ml,(216.7 ± 93.1) ml,and (206.7 ± 112.7) ml,which showed continuously significant improvements with patients' great satisfaction.The mean duration of fellow-up in 6 cases was 17.5 months(7-57 months).No severe adverse reactions such as wound infection,electrode dislocation and hematoma were observed.Conclusions SNM treatment is safe and effective for elderly patients with non-neurogenic and non-obstructive dysuria who are refractory to other treatments.SNM has a stable medium-term curative effect and a high-transfer-rate from stage Ⅰ to stage Ⅱ,which is appropriate for non-neurogenic and non-obstructive dysuria.The duration of SNM may be positively correlated with the improvement of residual urine volume and urination frequency.

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