ABSTRACT
Objective To investigate the influence of internal and external sphincter loss synergy on stress distributions and urine flow rates of lower urinary tract organs and tissues. Methods Based on collodion slice, the geometric model of the lower urinary tract was reconstructed, and finite element model of the lower urinary tract with muscle active force was established. Through fluid structure coupling simulation, the changes of tissue stress and urine flow rate were simulated under four conditions: normal contraction of internal and external sphincter, total loss of muscle active force and single loss of muscle active force for internal and external sphincters at the end of urination. Results The urethral stress changes in normal contraction of internal and external sphincter muscles were the same as the clinically measured urethral pressure changes. Compared with normal contraction, when the internal sphincter lost its muscle active force alone, stress of the internal sphincter and the urethra of the prostate was reduced by 33.6% and 13.8%, and flow rate of urine in this position was also reduced. When the external sphincter lost its muscle active force alone, the urethral stress of the external sphincter and external urethra was reduced by 59.5% and 24.03%, respectively. When the internal and external sphincter lost muscle active force, stress of the internal sphincter, the prostate, the external sphincter and the external urethra were reduced by 38.77%, 18.6%, 63.58%, 29.74%, respectively, and flow velocity in the corresponding position was also reduced. Conclusions Internal and external sphincter loss synergy resulted in the difference of tissue stress and urine flow rate. The results can provide the theoretical basis for surgical treatment of urinary incontinence caused by sphincter.
ABSTRACT
Objective: To evaluate the clinical outcome of botulinum A toxin (BTX-A) injection into external sphincter combined with oral baclofen in treatment of detrusor-external sphincter dyssynergia (DESD) after spinal cord injury (SCI). Methods: A total of 38 urodynamic examination-confirmed DESD patients, male 31 and female 7, with an average age of (36.5 ± 17.8) years old, were included in this study. 200 U of BTX-A toxin was dissolved in 8 ml of normal saline and the solution was injected at 8 different sites (1 ml per site) of the external sphincter via a 5F flexible cystoscopic needle. On the second day, 9 patients (BTX-A + baclofen group) were randomly selected for baclofen oral administration, 3/d for 3 months, the other 26 patients were taken as control. Urodynamic examination was repeated in all patients 4 weeks later; the voiding diary and urodynamic outcomes were compared before and after treatment. The adverse and toxic effects were observed in the patients who were followed up for 2-9 months. Results: One month after treatment the voiding and storing functions of bladder were improved to different degrees, with the mean maximum uroflow rate (Qmax), the mean urine volume, the mean maximal eystometric capacity and the bladder compliance increased significantly and the mean postvoid residual urine volume and the mean maximal voiding pressure decreased significantly (all P
ABSTRACT
@# Objective To explore the technique,efficacy and complications of external sphincterotomy with Holmium laser for the treatment of detrusor external sphincter dyssynergia (DSD). Methods 7 male cases with neurogenic DSD who received the procedure were reported. Results All patients got significant improvement after the operation in symptoms,laboratory,imaging and urodynamic index. No one required transfusion. 1 case lost the erection. There was no need of re-operation during the follow-up. Conclusion External sphincterotomy with Holmium laser for the treatment of DSD shows the advantages of less bleeding,safety and good effectiveness for the well selected patients.
ABSTRACT
Objective To observe the effect of transperineal injection of botulin A toxin on patients with detrusor-external sphincter dyssynergia caused by spinal cord injury. Methods Transperineal injection of botulin A toxin were performed in 6 patients with spinal cord injury (3 with cervical spinal cord injury and 3 with thoraco-lumbar spinal cord injury) complicated by detrusor-external sphincter dyssynergia.55 U of botulin A toxin was injected twice separately. The interval between 2 injections was 3 days.Before treatment, the residual volume of urine after voiding was determined and the maximum urethral pressure was measured by urodynamic testing.One month after treatment the examination mentioned above was repeated. Results The decrease in residual volume of urine was (133.3?70.9)ml.The decrease in maximum urethral pressure was (35.4?25.8)cmH 2O(both P
ABSTRACT
Objective:To evaluate the clinical outcome of botulinum A toxin(BTX-A)injection into external sphincter combined with oral baclofen in treatment of detrusor-external sphincter dyssynergia(DESD)after spinal cord injury(SCI). Methods:A total of 38 urodynamic examination-confirmed DESD patients,male 31 and female 7,with an average age of (36.5?17.8)years old,were included in this study.200 U of BTX-A toxin was dissolved in 8 ml of normal saline and the solution was injected at 8 different sites(1 ml per site)of the external sphincter via a 5F flexible cystoscopic needle.On the second day,9 patients(BTX-A+baclofen group)were randomly selected for baclofen oral administration,3/d for 3 months; the other 26 patients were taken as control.Urodynamic examination was repeated in all patients 4 weeks later;the voiding diary and urodynamic outcomes were compared before and after treatment.The adverse and toxic effects were observed in the patients who were followed up for 2-9 months.Results:One month after treatment the voiding and storing functions of bladder were improved to different degrees,with the mean maximum uroflow rate(Qmax),the mean urine volume,the mean maximal cystometric capacity and the bladder compliance increased significantly and the mean postvoid residual urine volume and the mean maximal voiding pressure decreased significantly(all P