Pediatric incontinence questionnaire (PINQ): translation and transcultural adaptation to Brazilian Portuguese

Abstract Objective Lower urinary tract symptoms (LUTS) affect approximately 10% of children worldwide and are related to psychosocial manifestations and compromised quality of life, both for children and their families. The assessment of emotional conditions of LUTS in children is recommended by International Children's Continence Society; however, there is no specific instrument in the Brazilian Portuguese language. Therefore, the aim of this study was to translate, culturally adapt and assess the internal consistency of the Brazilian Portuguese version of the Pediatric Incontinence Questionnaire (PINQ). Material and methods This cross-sectional study was performed at two referral centers for childhood voiding dysfunction. The 20-item PINQ was translated into Brazilian Portuguese and culturally adapted according to Beaton, 2000. His-standard methodology consists of 6 phases: translation, synthesis, back-translation, expert committee, and pre-test. The internal consistency was assessed using Cronbach's alpha. Results The PINQ-br version was developed, validated by a committee of experts, and pre-tested on 44 children diagnosed with lower urinary tract symptoms, 23 boys and 21 girls (mean age: 9.7 and 9.6 years old respectively), as well as on their parents. The internal consistency was considered satisfactory, reaching Cronbach's alpha coefficient of 0.74 when applied to children and 0.82 when applied to parents. Conclusions The PINQ was translated and culturally adapted to Brazilian Portuguese to assess the impact of LUTS on the health-related quality of life in Brazilian children and adolescents.

Bladder and bowel symptoms experienced by children with osteogenesis imperfecta / Sintomas urinários e intestinais apresentados por crianças com osteogênese imperfeita

Abstract Objective: To estimate the prevalence and presentation of bladder, bowel, and combined bladder and bowel symptoms experienced by children with osteogenesis imperfecta and to describe the socio-demographic and clinical profile of these children. Method: A descriptive study was conducted with a convenience sample of parent-child pairs of toilet-trained children aged from 3 to 18 years. Pairs were interviewed using three tools: (1) Socio-Demographic and Clinical Questionnaire; (2) Dysfunctional Voiding Scoring System; (3) Rome III Criteria along with the Bristol Stool Scale. Data were stratified by socio-demographic and clinical variables and analyzed using descriptive statistics. Results: Thirty-one parent-child pairs participated in the study; 38.7% (n = 12) children reported bowel symptoms, 19.4% (n = 6) reported a combination of bladder issues (such as holding maneuvers and urgency) and bowel symptoms (such as hard or painful bowel movements and large diameter stools). There were no reports of isolated bladder issues. Among the child participants, 16 (51.7%) identified as female and 20 (64.5%) were 5-14 years old. The most prevalent type of osteogenesis imperfecta was type III (n = 12; 38.7%) and eight (25.8%) children reported using a wheelchair. Conclusion: This is the first study to examine the prevalence and presentation of bladder, bowel, and combined bladder and bowel symptoms in children with osteogenesis imperfecta, offering a preliminary socio-demographic and clinical profile of these children. This research is an important step toward effective screening, detection, and access to care and treatment, especially for clinicians working with this group of very fragile patients.

Resumo Objetivo: Estimar a prevalência e a apresentação de sintomas urinários, intestinais e urinários e intestinais combinados sofridos por crianças com osteogênese imperfeita e descrever o perfil sociodemográfico e clínico dessas crianças. Método: Foi realizado um estudo descritivo com uma amostra de conveniência de pares de pais-filhos de crianças treinadas para usar o banheiro com idades entre três e 18 anos. Os pares foram entrevistados utilizando três instrumentos: 1) o Questionário Sociodemográfico e Clínico; 2) o questionário Dysfunctional Voiding Scoring System; 3) os Critérios de Roma III juntamente com a Escala de Bristol para Consistência de Fezes. Os dados foram estratificados por variáveis sociodemográficas e clínicas e analisados com estatísticas descritivas. Resultados: Participaram do estudo 31 pares de pais-filhos, 38,7% (n = 12) crianças relataram sintomas intestinais, 19,4% (n = 6) relataram uma combinação de problemas urinários (como segurar e urgência miccional) e sintomas intestinais (como fezes duras ou evacuações dolorosas e fezes de grande dimensão). Não houve relatos de problemas urinários isolados. Entre as crianças, 16 (51,7%) eram meninas e 20 (64,5%) tinham entre 5 e 14 anos. O tipo mais prevalente de osteogênese imperfeita foi o III (n = 12; 38,7%) e 8 (25,8%) crianças relataram usar cadeira de rodas. Conclusão: Este é o primeiro estudo a examinar a prevalência e a apresentação de sintomas urinários, intestinais e urinários e intestinais combinados em crianças com osteogênese imperfeita e que mostra um perfil sociodemográfico e clínico preliminar dessas crianças. Nossa pesquisa é um passo importante com relação ao efetivo rastreamento, detecção e acesso ao cuidado e tratamento, principalmente para os profissionais de saúde que trabalham com esse grupo de pacientes tão frágeis.

Ten years’ experience of augmentation cystoplasty for varied indications and its outcome

Background: The aim of the study was to evaluate long term efficacy and complications of augmentation cystoplasty in patients with bladder dysfunction.  Methods: Our series comprises of 30 patients undergoing enterocystoplasty from March 2009 till December 2019. Clinical findings and investigations result along with surgical techniques used were noted for these patients. Postoperative complications along with urinary continence and renal outcome were evaluated.Results: Mean age of patients was 7 years and their mean follow up was for 4 years. Major complications occurred in 5 patients which were successfully managed and minor complication in 8 patients. Of these 16 patients were with neurogenic bladder and 14 with non-neurogenic bladder. The primary etiology of non-neurogenic bladder was extrophy epispadias complex (10 patients), posterior uretheral valves (2 patients), anterior uretheral valve (1 patient), and bilateral ectopic ureter (1 patient). The primary etiology of neurogenic bladder was meningomyocele (4 patients), anorectal malformation with vertebral anomalies (7 patients), partial sacral ageneis (4), nonneurogenic neurogenic bladder (1 patient). Relative continence was achieved in 97%. The preoperative serum creatinine and blood urea nitrogen (BUN) at the time of bladder augmentation (termed  creatinine-1 and BUN-1)and the serum  creatinine and BUN at the last follow up after bladder augmentation (termed  creatinine-2 and BUN-2)were sought and compared using chi square test showed statistically significant improvement (p<0.01).Conclusions: Augmentation cystoplasty is a necessary and safe procedure to increase the functional capacity of small contracted and poorly compliant bladder and allows patients to achieve relative continence and preserves renal function.

Reflujo vesicoureteral / Vesicoureteric reflux

El propósito de este artículo de revisión es compilar los factores más frecuentes asociados o vinculados al reflujo vesicouretral como: a) incidencia, b) mecanismo de transmisión genética, c) etiopatogenia del reflujo, d) su relación con la infección urinaria, e) patogénesis del daño parenquimatoso renal adquirido y congénito en niños con reflujo, f) reflujo intrarrenal y su asociación con el daño renal, g) rol de las disfunciones vesicales no-neurogénicas, h) métodos de diagnóstico y i) presentación clínica. Se analizan además, distintos aspectos del tratamiento del reflujo que siguen generando controversias; las indicaciones de la profilaxis antibiótica, el tratamiento quirúrgico clásico creando un túnel submucoso ureteral de longitud adecuada y el tratamiento endoscópico con sustancias de abultamiento. Aún persisten varios aspectos polémicos relacionados con el reflujo, en esta revisión se examinan algunos de ellos. Es el propósito de este trabajo que el lector interesado en el tema de la urología pediátrica se beneficie con la lectura de esta revisión

The intention of this review article was to compile outlining areas surrounding the effects of vesicoureteric reflux (VUR) and associated factors, such as: a) incidence, b) patterns of inheritance, c) etiology of VUR, d) relationship between reflux and urinary tract infection, e) diagnostic imaging studies, f) etiology of acquired and congenital kidney damage related to VUR, g) importance of intrarenal reflux in reflux nephropathy, h) role of high bladder pressures on the kidney and i) clinical presentation. In addition, we also discussed the management of VUR which is still controversial, the role of antibiotic therapy and indications of ureteric reimplantation or endoscopic correction of reflux; still debated in the pediatric urologic literature. Many unanswered questions remain, and are analyzed in this review. We hope the readers will profit from reading this review

Lower urinary tract symptoms and sexual dysfunction in men with multiple sclerosis

OBJECTIVES: To assess the prevalence and interrelationship between lower urinary tract symptoms and sexual dysfunction in men with multiple sclerosis (MS). METHODS: In a cross-sectional study, we evaluated 41 men (mean age 41.1±9.9 years) with MS from February 2011 to March 2013, who were invited to participate irrespective of the presence of lower urinary tract symptoms or sexual dysfunction. Neurological impairment was assessed with the Expanded Disability Status Scale; lower urinary tract symptoms were evaluated with the International Continence Society male short-form questionnaire, and sexual dysfunction was evaluated with the International Index of Erectile Function. All patients underwent transabdominal urinary tract sonography and urine culture. RESULTS: The mean disease duration was 10.5±7.3 years. Neurological evaluation showed a median Expanded Disability Status Scale score of 3 [2-6]. The median International Continence Society male short-form questionnaire score was 17 [10-25]. The median International Index of Erectile Function score was 29 [15-46]. Twenty-nine patients (74.4%) had sexual dysfunction as defined by an International Index of Erectile Function score <45. Voiding dysfunction and sexual dysfunction increased with the degree of neurological impairment (r=0.02 [0.02 to 0.36] p=0.03 and r=-0.41 [-0.65 to -0.11] p=0.008, respectively). Lower urinary tract symptoms and sexual dysfunction also displayed a significant correlation (r=-0.31 [-0.56 to -0.01] p=0.04). CONCLUSIONS: Most male patients with MS have lower urinary tract symptoms and sexual dysfunction. The severity of the neurological disease is a predictive factor for the occurrence of voiding and sexual dysfunctions.

Postoperative breakthrough infection and re-operation in patients with duplicated collecting systems: A comparative analysis of surgical outcomes

OBJECTIVE@#The purpose of surgical intervention for ureteral duplication is to decrease the risk ofinfections, preserve renal function and avoid bladder dysfunction. The objective of this study was todetermine if there is a difference in outcome between total reconstruction of the urinary tract, anupper tract approach, or a lower tract approach.@*MATERIALS AND METHODS@#The outcomes of partial nephrectomy, common sheath re- implantation, totalreconstruction and transurethral incision of ureterocele were pooled and compared against eachother. Primary outcome criteria included breakthrough infection, voiding dysfunction and need for asecond surgery. Procedural dependence of the primary outcomes for each surgery was analyzed usingChi square test. Odds ratio was then computed for each procedure with total reconstruction as thestandard. Logistic regression analysis of the odds ratio was done to determine statistical significance.@*RESULTS@#A total of 128 patients were included in the study. Breakthrough infection was seen in 18.8%of those who underwent partial nephrectomy, 23.8% of those who underwent re- implantation, 19.4%of those who underwent total reconstruction, and 46.4% of those patients who underwent TUI-U.Only 1 patient from the partial nephrectomy group and 1 patient from the total reconstruction groupexperienced voiding dysfunction. Of the 23 patients who underwent TUI-U, 5 (17.9%) needed asecondary procedure, while 3 from the partial nephrectomy, and none from the re-implantation andtotal reconstruction groups required re-operations. Analysis showed that breakthrough urinary tractinfection is dependent on the type of procedure. Using total reconstruction as the standard, the oddsratio for partial nephrectomy is 0.962, 1.302 for common sheath re-implantation and 3.611 for TUI-U. Logistic regression analysis showed statistical difference in the odds ratio of TUI-U and totalreconstruction.@*CONCLUSION@#Breakthrough infection is shown to be dependent on the procedure. TUI-U has a 3.6-foldhigher chance of breakthrough infection compared to total reconstruction, hence up to 18% of patientswho opt for TUI-U should be counseled regarding the need for a secondary operation. The odds ofbreakthrough infection in common sheath re-implantation and partial nephrectomy is not significantlydifferent from total reconstruction. No evidence was established regarding the dependence of re-operations and voiding dysfunction to the primary procedure.

Long-term Outcomes of Augmentation Cystoplasty in a Pediatric Population With Refractory Bladder Dysfunction: A 12-Year Follow-up Experience at Single Center / 대한배뇨장애요실금학회지

PURPOSE: Augmentation cystoplasty (AC) is a surgical procedure used in adults and children with refractory bladder dysfunction, including a small bladder capacity and inadequate bladder compliance, and in whom conservative and medical treatment has failed. This study was aimed to determine the long-term outcomes of AC in children. METHODS: A retrospective analysis was conducted of 42 patients (31 males; mean age, 14.2±6.2 years) who underwent AC for neurogenic and nonneurogenic bladder dysfunction, with a median 12.0±1.5 years of follow-up. All patients underwent AC using the ileum with or without continent reconstruction. Pre-AC, concurrent, and post-AC procedures and complications were analyzed. Patients who underwent ureterocystoplasty, were lost to follow-up, or had less than 10 years of follow-up were excluded. The primary outcomes were the complication and continence rates, the post-AC linear rate of height and weight gain, and renal function. The Student t-test was used to evaluate between-group differences and the paired t-test was used to evaluate longitudinal changes in measured variables. RESULTS: Renal function was stable or improved in 32 of 42 patients (76.2%), with a post-AC continence rate of 88.1%. Thirty patients (71.4%) required 72 procedures post-AC. There was no statistically significant difference in the mean percentile of height (P=0. 212) or weight (P=0.142) of patients in the pre- and post-AC periods. No cases of bladder perforation or malignancy were detected. CONCLUSIONS: We consider AC to be a safe and effective procedure that does not negatively affect future physical growth, while achieving a good rate of stable renal function. Patients need long-term follow-up to address long-term complications.

The value of urodynamic examination in treating the patient with prostatic hyperplasia accompany with dysfunction of the bladder / 中华泌尿外科杂志

Objective To investigate the value of urodynamic in treating those patients with benign prostatic hyperplasia complicated with bladder dysfunction.Methods 130 patients with benign prostatic hyperplasia were retrospectively reviewed between December 2015 and December 2016.The exclusive criteria included nervous system diseases,moderate to severe diabetes,moderate to severe hypertension,urethral stricture,bladder stones,prostate cancer,etc.The patient's age is ranged 51 to 92,mean 72 years old.The previous history of disease ranged from 3 months to 15 years,mean 4 years.All patients accepted the urodynamic examination.Different treatments were considered according to urodynamic studies.Results According to the classification of bladder outlet obstruction,130 cases were classified as bladder outlet obstruction in 109 cases,bladder suspicious obstruction in 15 cases,no bladder obstruction in 6 cases.According to the classification of bladder function,130 cases were divided into unstable bladder in 6 cases,low compliance bladder in 7 cases,bladder atony in 15 cases,bladder without tension in 3 cases,normal bladder function in 99 cases.3 cases without bladder tension,including BOO in 2 cases,suspected BOO in 1 case,were accepted the cystostomy.15 cases with less detrusor contraction,including BOO in 4 cases,suspected BOO in 9 cases,were accepted the cystostomy and TURP.Conservative treatment was performed in other 2 cases without obstruction.In 6 cases with unstable bladder,2 cases without obstruction accepted the conservative treatment,4 cases with suspected BOO accepted the TURP.In 7 patients with low compliance bladder,2 cases without obstruction accepted the conservative treatment,5 cases with suspected BOO accepted the TURP.The duration of following up was 3-6 months.The symptoms of the patients in this group improved significantly during following up.Conclusion For patients with benign prostatic hyperplasia complicated with bladder dysfunction,the results of urodynamics can help to choose the right treatment and improve effect of treatment.

Urothelial Dysfunction and Chronic Inflammation are Associated With Increased Bladder Sensation in Patients With Chronic Renal Insufficiency / 대한배뇨장애요실금학회지

PURPOSE: Chronic kidney disease (CKD) or end-stage renal disease (ESRD) patients usually have lower urinary tract symptoms, such as frequency and urgency. Additionally, they frequently suffer from urinary tract infections. This study investigated dysfunction and chronic inflammation of the bladder urothelium in ESRD/CKD patients. METHODS: This study enrolled 27 patients with CKD (n=13) or ESRD (n=14) for urodynamic studies and bladder biopsies. Patients presented with detrusor underactivity (DU; n=8) or bladder oversensitivity (BO; n=19). Bladder biopsies were performed in these patients and in 20 controls. The bladder mucosa was examined for E-cadherin and zonula occludens-1 (ZO-1) expression, activated mast cell count (through tryptase staining), and urothelial apoptosis (through terminal deoxynucleotidyl transferase-mediated dUTP-biotin nick-end labeling [TUNEL]). The urodynamic parameters were also compared with variables regarding urothelial dysfunction. RESULTS: The bladder mucosa samples of ESRD and CKD patients revealed significantly higher mast cell counts, more urothelial apoptosis, and lower levels of ZO-1 expression than the control samples. E-cadherin expression was significantly reduced in ESRD/CKD patients with DU, but not in ESRD/CKD patients with BO. Increased mast cell and apoptotic cell counts were also associated with ESRD/CKD with BO. Less expression of ZO-1 and E-cadherin was significantly associated with increased bladder sensation and a small bladder capacity. CONCLUSIONS: Bladder urothelial dysfunction and chronic inflammation were present to a noteworthy extent in patients with ESRD or CKD. Increased inflammation and defective barrier function were more notable in ESRD/CKD bladders with BO than in those with DU. The clinical characteristics of these patients may involve urothelial pathophysiology.

Retención urinaria posparto: conducta clínica y modelos experimentales para su estudio / Postpartum urinary retention: clinical behavior and experimental models for study

Resumen ANTECEDENTES: puesto que la retención urinaria posparto no es un suceso que se considere grave, la información de su tratamiento en las unidades obstétricas es muy limitada, sobre todo en América Latina. MÉTODO: búsqueda de información publicada, en español e inglés, entre los años 2000 y 2016 relacionada con las medidas preventivas y tratamientos de la retención urinaria posparto en dos bases de datos de bibliografía biomédica: Pubmed y Scopus. RESULTADOS: se encontraron 31 artículos científicos en inglés relacionados con el tratamiento de la retención urinaria posparto y pocos estudios en modelos animales de retención urinaria aguda, ninguno en español. El diagnóstico de la retención urinaria posparto se establece con el auxilio de métodos invasivos y no invasivos: catéteres y ultrasonido. El tratamiento incluye acciones preventivas (reducción de problemas del parto mediante adiestramiento adecuado del personal de las unidades obstétricas o la aplicación de masaje en la región sacra) y posteriores al parto (uso de catéteres uretrales o suprapúbicos). CONCLUSIONES: la retención urinaria posparto es una complicación clínica que requiere entender que el diagnóstico y tratamiento tempranos contribuyen sustancialmente a disminuir la alta prevalencia de disfunciones vesicales femeninas. En esta revisión se evidenció la necesidad de estudios preclínicos que permitan conocer la repercusión a largo plazo de la retención urinaria y probar nuevos tratamientos.

Abstract BACKGROUND: since postpartum urinary retention is not a condition that is considered severe, information of its treatment in obstetrical units is very limited, especially in Latin America. METHOD: search of published information in Spanish and English, between 2000 and 2016 related to preventive measures and treatment of postpartum urinary retention in two data bases of biomedical bibliography: Pubmed and Scopus. RESULTS: 31 scientific articles in English related to the treatment of postpartum urinary retention were found as well as a few studies of acute urinary retention in animal models, none of them in Spanish. The diagnosis of postpartum urinary retention is established using invasive and non-invasive methods: catheters and ultrasound. Treatment includes preventive measures (reduction of delivery issues through appropriate training of obstetrical unis or the use of massage on the sacral region) and after delivery (use of urethral or suprapubic catheters). CONCLUSIONS: postpartum urinary retention is a clinical complication, thus we have to understand that early diagnosis and treatment substantially contribute to decreasing the high prevalence of female bladder dysfunctions. In this review, we proved the need for preclinical tests that allow us to recognize the long term repercussion of urinary retention and test new treatments.

The correlation of diabetic duration with bladder dysfunction among middle-aged or older patients with type 2 diabetes mellitus / 中华泌尿外科杂志

Objective To analyze the overactive bladder symptom score (OABSS) in evaluating bladder dysfunction in the different stages among type 2 diabetes mellitus patients,and to explore the value of bladder hyperactivity symptom score in screening early diabetic bladder dysfunction.Methods A total of 1 157 patients with type 2 diabetes mellitus,aged 40-88 yearswith mean age of 60.2 years,were enrolled from October 2013 to October 2016.The survey included the patients' characteristics,past history,current history,OABSS and quality of life (QOL) index scores.T test,single factor analysis of variance and multiple regression analysis are used to analyze the results.Results As many as 1 157 were qualified for final statistical analysis.OABSS is 1.94 ± 1.23 in group with diabetes duration ＜ 10 years,3.24 ± 1.45in group with diabetes duration 10-20 years,and 4.00 ± 1.72 in group with diabetes duration ＞ 20 years.The differences of OABSS in the different duration of diabetes was statistically significant.As diabetic duration increased,OABSS value increased (F =48.419,P ＜ 0.001).The difference of OABSS in the different HbA1c level,age and concurrent peripheral neuropathy was statistically significant.There was no significant difference of OABSS in the different BMI and distinct therapies.There was no significant difference of OABSS in diabetes with hypertension and without hypertension,with cardiopathy and without cardiopathy,with cerebrovascular disease (CVD) and without CVD,with hyperhpemia and without hyperlipemia.The significant factors were used to make multivariate analysis.The results showed that the duration of diabetes,HbA1 c level,age,peripheral neuropathy were still statistically significant.Standardized partial regression coefficient of diabetic duration was 0.366.OABSS was positively correlated with QOL score (r =0.434,P ＜ 0.001).Conclusions The related symptoms in OABSS with diabetic bladder dysfunction is correlated with the duration of diabetes,HbA1c level,age,concurrent peripheral neuropathy among type 2 diabetes.The duration of diabetes was the most significant factor.OABSS is likely to be one of the tools to assess the early symptoms of diabetic bladder dysfunction.

The correlation of diabetic duration with bladder dysfunction among middle-aged or older patients with type 2 diabetes mellitus / 中华泌尿外科杂志

Objective To analyze the overactive bladder symptom score (OABSS) in evaluating bladder dysfunction in the different stages among type 2 diabetes mellitus patients,and to explore the value of bladder hyperactivity symptom score in screening early diabetic bladder dysfunction.Methods A total of 1 157 patients with type 2 diabetes mellitus,aged 40-88 yearswith mean age of 60.2 years,were enrolled from October 2013 to October 2016.The survey included the patients' characteristics,past history,current history,OABSS and quality of life (QOL) index scores.T test,single factor analysis of variance and multiple regression analysis are used to analyze the results.Results As many as 1 157 were qualified for final statistical analysis.OABSS is 1.94 ± 1.23 in group with diabetes duration ＜ 10 years,3.24 ± 1.45in group with diabetes duration 10-20 years,and 4.00 ± 1.72 in group with diabetes duration ＞ 20 years.The differences of OABSS in the different duration of diabetes was statistically significant.As diabetic duration increased,OABSS value increased (F =48.419,P ＜ 0.001).The difference of OABSS in the different HbA1c level,age and concurrent peripheral neuropathy was statistically significant.There was no significant difference of OABSS in the different BMI and distinct therapies.There was no significant difference of OABSS in diabetes with hypertension and without hypertension,with cardiopathy and without cardiopathy,with cerebrovascular disease (CVD) and without CVD,with hyperhpemia and without hyperlipemia.The significant factors were used to make multivariate analysis.The results showed that the duration of diabetes,HbA1 c level,age,peripheral neuropathy were still statistically significant.Standardized partial regression coefficient of diabetic duration was 0.366.OABSS was positively correlated with QOL score (r =0.434,P ＜ 0.001).Conclusions The related symptoms in OABSS with diabetic bladder dysfunction is correlated with the duration of diabetes,HbA1c level,age,concurrent peripheral neuropathy among type 2 diabetes.The duration of diabetes was the most significant factor.OABSS is likely to be one of the tools to assess the early symptoms of diabetic bladder dysfunction.

Central Nervous System-Peripheral Immune System Dialogue in Neurological Disorders: Possible Application of Neuroimmunology in Urology / 대한배뇨장애요실금학회지

Previous concepts of immune-privileged sites obscured the role of peripheral immune cells in neurological disorders and excluded the consideration of the potential benefits of immunotherapy. Recently, however, numerous studies have demonstrated that the blood-brain barrier in the central nervous system is an educational barrier rather than an absolute barrier to peripheral immune cells. Emerging knowledge of immune-privileged sites suggests that peripheral immune cells can infiltrate these sites via educative gates and that crosstalk can occur between infiltrating immune cells and the central nervous system parenchyma. This concept can be expanded to the testis, which has long been considered an immune-privileged site, and to neurogenic bladder dysfunction. Thus, we propose that the relationship between peripheral immune cells, the brain, and the urologic system should be considered as an additional possible mechanism in urologic diseases, and that immunotherapy might be an alternative therapeutic strategy in treating neurogenic bladder dysfunction.

Clinical Observation of Heat-sensitive Moxibustion for Bladder Dysfunction After Poisonous Snakebite / 上海针灸杂志

Objective To discuss the safety and effectiveness of heat-sensitive moxibustion for bladder dysfunction after poisonous snakebite. Method Twenty-six patients with bladder dysfunction due to poisonous snakebite were intervened by heat-sensitive moxibustion, and the changes of residual urine volume and uroflowmetry parameters were analyzed by using type-B ultrasonic scanning and uroflowmetry. Result According to the ultrasonic scanning and uroflowmetry, the residual urine volume was significantly changed after treatment in the 26 subjects (P<0.05), and the maximum urine flow rate (Qmax) was also significantly different from that before treatment (P<0.05). Conclusion Heat-sensitive moxibustion can improve the residual urine volume and Qmax in bladder dysfunction after poisonous snakebite, and it’s a safe and reliable method.

Clinical Study on Heat-sensitive Moxibustion for Poisonous Snakebites-induced Bladder Dysfunction of Different Degrees / 上海针灸杂志

Objective To observe the safety and severity of heat-sensitive moxibustion in treating poisonous snakebites-induced bladder dysfunction of different degrees.Method Twenty-six patients diagnosed with bladder dysfunction due to poisonous snakebites were examined by type-B ultrasonic scanning for residual urine volume and uroflowmetry. The patients were treated with heat-sensitive moxibustion. The residual urine volume and uroflowmetry parameters were compared between different severity degrees of bladder dysfunction before and after treatment.Result The residual urine volumes were changed significantly in the mild group and moderate group after treatment (P0.05). The maximum urine flow rate (Qmax) was significantly changed in the mild group after the treatment (P0.05).Conclusion Heat-sensitive moxibustion is significantly effective in treating mild-moderate bladder dysfunction due to poisonous snakebites, and it’s safe and reliable.

The clinical presentation and diagnosis of ketamine-associated urinary tract dysfunction in Singapore

Ketamine is a short-acting anaesthetic agent that has gained popularity as a 'club drug' due to its hallucinogenic effects. Substance abuse should be considered in young adult patients who present with severe debilitating symptoms such as lower urinary tract symptoms, even though the use of controlled substances is rare in Singapore. Although the natural history of disease varies from person to person, a relationship between symptom severity and frequency/dosage of abuse has been established. It is important to be aware of this condition and have a high degree of clinical suspicion to enable early diagnosis and immediate initiation of multidisciplinary and holistic treatment. A delayed diagnosis can lead to irreversible pathological changes and increased morbidity among ketamine abusers.

The significance of urodynamic analysis in evaluating neurogenic vesicoureteral reflux in patients with thoracolumbar spinal cord injury / 中华物理医学与康复杂志

Objective To investigate the utility of urodynamic testing in the evaluation of neurogenic vesicoureteral reflux in patients with thoracolumbar spinal cord injury at the T10 to L2 level.Methods Twenty-six patients with thoracolumbar spinal cord injury at the T10 to L2 level and who displayed vesicoureteral reflux were enrolled and divided into a detrusor hyper-reflexia group (n =21) and a detrusor a-reflexia group (n =5)according to their cystourethrograms and urodynamic test results.Their bladder volume,detrusor pressure (Pdet) and compliance were observed and analyzed at the vesicoureteral reflux point and the leak point.Results The bladder volume and compliance of the detrusor hyper-reflexia group at the vesicoureteral reflux point were (122.46 ± 87.89) ml and (5.94 ± 4.96) ml/H2 O respectively,significantly different from the detrusor a-reflexia group (P ＜ 0.01).At the leak point,the average bladder volume of the detrusor hyper-reflexia group was (210.81 ± 69.72)ml,while the average bladder compliance was (9.53 ± 5.43)ml/H2O and the average detrusor pressure was (42.29 ± 9.57)cm H2O.All were significantly different from the detrusor a-reflexia group's averages.Moreover,there was a significant difference in the Pdet between the leak point and the vesicoureteral reflux points in the detrusor hyper-reflexia group.Conclusions Patients with thoracolumbar spinal cord injuries at the T10 to L2 level with neurogenic bladder and detrusor hyper-reflexia have low bladder volumes and compliance,and vesicoureteral reflux tends to occur at an early stage after injury with a destrusor pressure lower than 40 cm H2 O.For patients with detrusor a-reflexia,vesicoureteral reflux and bladder leakage may occur when detrusor pressure is low.

Evaluation of bladder dysfunction in children with congenital vesical ureteral reflux through videourodynamic examination / 中华实用儿科临床杂志

Objective To explore the relationship between congenital vesical ureteral reflux(VUR) and bladder dysfunction in children through videourodynamic examination.Methods Sixty-seven children with congenital VUR in the First Affiliated Hospital of Zhengzhou University from Apr.2011 to Jul.2013 were included,and their clinical information of urnary tract infection,detrusor activity,dysfunctional voiding and grade of VUR were recorded.All the children were categorized as normal,isolated detrusor overactivity (DO)and dysfunctional voiding (DV) (with or without DO) according to the manifestation of urodynamic patterns,who were also divided into groups of low grade (Ⅰ-Ⅱ) VUR or high grade (Ⅲ-Ⅴ) VUR.Data of video-urodynamic examination,urinalysis,and voiding cystourethrogram were collected to investigate the relationship between bladder dysfunction,sides and grade of VUR and urinary tract infection.Results Totally 73.1％ (49/67 cases) of children with VUR were found having bladder dysfunction,which consisted of 49.3％ (33/49 cases) of DO,23.8％ (16/49 cases) of DV.Children with isolated DO tended to manifest unilateral,low grade reflux (grade Ⅰ-Ⅱ) with less urinary infection.However,children with DV,isolated or combined with DO manifest bilateral,high grade reflux(grade Ⅲ-Ⅳ),and often with urinary infection.Conclusions Video urodynamic study is useful for evaluation of bladder function in children with VUR,which is important in management of VUR.

Botulinum toxin injection for the treatment of lower urinary tract dysfunction / 中华物理医学与康复杂志

Objective To investigate the effectiveness of botulinum toxin A (BTX-A) injection to the external urethral sphincter guided by ultrasound in the treatment of various types of lower urinary tract dysfunction.Methods Twenty-two patients with urinary retention caused by neurological dysfunction (neurogenic bladder) were recruited,of which 18 were men and 4 women.They had various types of lower urinary tract dysfunction including detrusor external sphincter dyssynergia (DESD) in 7,nonrelaxing urethral sphincters in 5,and detrusor underactivity in 10.BTX-A (100 U) was injected into the external urethral sphincter at three different points guided by ultrasound.Clinical effects and urodynamic parameters were compared at baseline and after treatment.Results After treatment the urinary function and urodynamic parameters in each group improved significantly compared with the baseline.Maximum efficacy was observed at the 4th week.In the DESD group,3 patients (43％) had an excellent result and 3 (43％) had significant improvement; in the nonrelaxing sphincter group 3 (60％) had excellent results and 2 (40％) showed significant improvement; in the detrusor underactivity group 5 (50％) had excellent results and 3 (30％) had significant improvement.There were no obvious side effects.Conclusions BTX-A injections guided by ultrasound can accurately locate the external urethral sphincter.It is a simple and repeatable method for the treatment of lower urinary tract dysfunction.

Urodynamic study of bladder dysfunction after radical resection of rectal carcinoma / 中国医师进修杂志

Objective To investigate the diagnosis and treatment of bladder dysfunction after radical resection of rectal carcinoma.Methods One hundred and sixty-five patients with bladder dysfunction after radical resection of rectal carcinoma were observed by urodynamic study.The results included maximum urinary flow rate,postvoid residual,urine volume,pressure of detrusor,maximum urethral closure pressure.These patients were treated by different methods.Results Bladder with underactive detrusor were 116 patients,109 patients returned to normal voiding after 3 months,7 patients were performed with suprapubic cystostomy.Detrusor overactivity were 42 patients,insufficiency of urethral sphincter were 7 patients,all symptoms of them improved after treatment.Conclusion Patients with bladder dysfunction after radical resection of rectal carcinoma should do check to clear etiology,according to the results to take the appropriate means to treatment.