Disfunción urinaria en la enfermedad de Parkinson: una revisión práctica / Urinary dysfunction in Parkinson's disease: a practical review

Resumen La enfermedad de Parkinson (EP) es una enfermedad multisistémica de naturaleza neurodegenerativa, que clínicamente se caracteriza por presencia de síntomas motores como bradicinesia, rigidez, temblor en reposo e inestabilidad postural. Sin embargo, también pueden estar presentes síntomas no motores que constituyen trastornos del ánimo, trastornos del sueño, disfunción cognitiva o disfunción autonómica. Dentro de las disfunciones autonómicas, los síntomas urinarios se han documentado en los pacientes con enfermedad de Parkinson. Los síntomas urinarios más comunes son la nicturia, urgencia urinaria, aumento de la frecuencia miccional e incontinencia de urgencia. El presente artículo hace una revisión narrativa de la literatura actual sobre los mecanismos fisiopatológicos, manifestaciones clínicas, diagnóstico y tratamiento de la disfunción urinaria en pacientes con enfermedad de Parkinson.

Parkinson's disease (PD) is a neurodegenerative multisystemic diseases, which is clinically characterized by the presence of motor symptoms such as bradykinesia, rigidity, resting tremor, and postural instability. However, non-motor symptoms constituting mood disorders, sleep disorders, cognitive dysfunction, or autonomic dysfunction may also be present. Within autonomic dysfunctions, urinary symptoms have been documented in patients with Parkinson's disease. The most common urinary symptoms are nocturia, urinary urgency, increased urinary frequency, and urge incontinence. This article makes a narrative review of the current literature on the pathophysiological mechanisms, clinical manifestations, diagnosis and treatment of urinary dysfunction in patients with Parkinson's disease.

Anatomy research on Denonvilliers fascia and its significance in nerve-preservation rectal cancer surgery / 中华胃肠外科杂志

Urinary and sexual dysfunctions due to intraoperative pelvic autonomic nerve injury have become the most common complications of rectal cancer surgery, seriously affecting postoperative quality of life. How to protect the nerve and urogenital function while ensuring radical resection for rectal cancer has become the focus of research. We previously carried out a series of systematic studies on Denonvilliers fascia, an important anatomical structure closely related to protection of pelvic autonomic nerve, and demonstrated the importance of Denonvilliers fascia in preservation of intraoperative pelvic autonomic nerve and protection of postoperative urogenital function from aspects of anatomy, physiology, tissue, operation practice and so on. Meanwhile, based on the interim results of our multicenter randomized controlled study, we confirmed that total mesorectal excision with preservation of Denonvilliers fascia (innovative TME, iTME) could effectively reduce the incidence of postoperative urinary and sexual dysfunctions in male patients with mid-low rectal cancer, without sacrificing oncologic outcome. In this article, combined with our research results, we review the literature on anatomy research progress of Denonvilliers fascia to demonstrate the significance and research prospect of Denonvilliers fascia in the pelvic autonomic nerve preservation surgery for rectal cancer.

Chinese consensus on Denonvilliers' fascia preserving total mesorectal excision (iTME) (2021 version) / 中华胃肠外科杂志

In 1982, total mesorectal excision(TME) was proposed by Professor R. J. Heald, which was a milestone-style for rectal cancer surgery. The concept of TME has reduced the local recurrence rate of mid-low rectal cancer (MLRC) significantly, thus becomes the gold standard for MLRC surgery. However, the incidence of urogenital dysfunction after TME remains high, among which urinary dysfunction reaches 30%-60%, and sexual dysfunction reaches 50%-70%. In recent years, studies have shown that the removal of Denonvilliers' fascia (DVF) during TME is an important cause of postoperative urination and sexual dysfunction. Therefore, DVF preserving total mesorectal excision (iTME) has been recognized by more and more surgical experts. On the basis of existing literature and clinical practice, we organize experts to discuss and vote, put forward recommendations for several issues of iTME, and finally formulate this expert consensus. The formulation of this consensus aims to increase surgeons' awareness of the value and functional protection of DVF during TME surgery, clarify the indications and contraindications of iTME, and standardize the procedure of iTME, so as to reduce postoperative urination and sexual dysfunction and improve the quality of life of patients with MLRC. The level of evidence and recommendation of this consensus is determined by Grading Recommendations, Assessment, Development and Evaluation (GRADE), and the consensus content is determined through expert voting and Delphi method.

Central Regulation of Micturition and Its Association With Epilepsy / 대한배뇨장애요실금학회지

Micturition is a complex process involving the bladder, spinal cord, and the brain. Highly sophisticated central neural program controls bladder function by utilizing multiple brain regions, including pons and suprapontine structures. Periaqueductal grey, insula, anterior cingulate cortex, and medial prefrontal cortex are components of suprapontine micturition centers. Under pathologic conditions such as epilepsy, urinary dysfunction is a frequent symptom and it seems to be associated with increased suprapontine cortical activity. Interestingly, micturition can also trigger seizures known as reflex epilepsy. During voiding behavior, frontotemporal cortical activation has been reported and it may induce reflex seizures. As current researches are only limited to present clinical cases, more rigorous investigations are needed to elucidate biological mechanisms of micturition to advance our knowledge on the process of micturition in physiology and pathology.

Preliminary analysis for risk factors of upper urinary tract dysfunction associated with ketamine abuse / 中华泌尿外科杂志

Objective To identify the risk factors of chronic ketamine-induced upper urinary tract dysfunction (KUUTD).Methods Medical records of 103 patients with ketamine-associated urinary dysfunction(KAUD) from Sep.2009 to Jul.2015 were retrospectively reviewed.All the patients were divided into the upper urinary tract dysfunction group(n =39)or the normal group(n =64)according to the diagnostic criteria.Indexes such as general features (age,gender,BMI),drug-abusing characteristics (abusing time,frequency,dose,abstinent period),duration of LUTS,pelvic pain and urgency/frequency symptom score(PUF score),serum parameters (WBC,ALT,AST,γ-GT),bladder diary (daytime inter-void interval,nocturia,average urine volume),urodynamic data (maximum cystometric capacity,post-void residual,maximum urethral closure pressure,maximum and average flow rate,instable contraction,bladder compliance) and imaging manifestations were compared between the two groups.Logistic regression analysis was performed for the evaluation of variables with statistical significance.Results There was significantly difference between the two groups in BMI (t =2.127,P =0.043),drug-abusing frequency (t =2.335,P =0.029),abstinent period (t =3.451,P =0.003),duration of LUTS (t =2.289,P =0.036),PUF score (t =3.030,P =0.004),γ-GT value(t =2.697,P =0.012),MCC(t =5.056,P ＜ 0.001),MUCP(t =3.015,P =0.008),BC (t =8.562,P ＜ 0.001) and imaging findings of bladder contracture (x2 =15.155,P ＜0.001).The multivariate Logistic regression analysis showed that drug-abusing frequency(OR =1.279,P =0.038),abstinent period(OR =0.394,P =0.028),γ-GT value (OR =1.007,P =0.032),MCC (OR =0.775,P =0.011)and BC (OR =0.013,P =0.008)were the key factors of KUUTD.Conclusion Consecutive and frequent drug abuse,combination with chronic obstructive cholangitis,reduced capacity and low compliance bladder are the risk factors of upper urinary tract dysfunction associated with ketamine abuse.

Efficacy and Safety of Solifenacin Succinate for Urinary Difficulty in Brain Lesion: Multicenter Prospective Study

OBJECTIVE: We studied the efficacy and safety of solifenacin for urinary difficulty in brain lesion from multicenter prospective study. METHOD: Eighty patients with brain lesion who visited from 5 multicenter department of rehabilitation medicine from May 2009 to June 2010 were included. Patients were treated with solifenacin 5 mg to 10 mg for 12 weeks. The outcome measure was mean change in daily micturation frequency, daily frequency of incontinence, urgency episodes, and nocturia episodes from baseline to week 12. Patient's attitude to drug was assessed using the BSW Questionnaire (Benefit, Satisfaction and Willingness to Continue Questions). RESULTS: Sixty-one of 80 were evaluated for effect. All voiding parameters showed significant improvement after 12 weeks of treatment (p<0.05). There was no significant difference in efficacy of solifenacin between ischemic and hemorrhagic stroke. A twenty-two patients experienced 27 adverse events (AE). The most frequent AE were dry mouth (12.5%) and constipation (6.3%). Treatment related adverse events with solifenacin were mainly mild in severity, and only led to discontinuation in 6.3% of patients. CONCLUSION: Solifenacin succinate improve urinary difficulty symptoms with acceptable efficacy and safety in patient with brain lesion.

The effect of electrical stimulation of the pelvic floor combined with acupuncture on urinary dysfunction in spinal cord injury patients / 中华物理医学与康复杂志

Objective To observe the effect of electrical stimulation of the pelvic floor muscles (PES) combined with acupuncture on urinary dysfunction in patients with spinal cord injury (SCI). Methods Sixty-two patients with SCI were randomly divided into a treatment group ( n =31 ) and a control group ( n =31 ).All subjects received routine bladder function training and a drinking water schedule for 8 weeks.In addition,the treatment group was given PES 30-40 min/d 6 times/week and acupuncture for 30 min/d,6 times/week for the 8 weeks.Residual volume of urine was evaluated using ultrasound and a daily voiding diary.Uurodynamic examinations and catheter extraction were used to assess the urinary function pre- and post-treatment. Results No significant difference was found between the two groups before treatment,but after 8 weeks of treatment the residual volume of urine detected by ultrasound and voiding frequency were significantly lower in the treatment group than in the control group.First desire to urinate and maximal urinary bladder capacities in the treatment group were also significant higher than in the control group.The efficacy of treatment was also sustained significantly longer in the treatment group. Conclusion PES combined with acupuncture therapy is more effective than routine bladder function training for SCI patients with urinary dysfunction.

Effects of laparoscopic radical resection of mid-low rectal cancer on sexual and urinary functions of male patients / 中华消化外科杂志

Objective To evaluate the effects of laparoscopic radical resection of mid-low rectal cancer on sexual and urinary functions of male patients. Methods The clinical data of 150 patients with mid-low rectal cancer who were admitted to the PLA General Hospital from May 2006 to March 2009 were retrospectively analyzed. Sixty-eight patients were allocated to laparoscopic group and 82 to open group. The incidences of erectile and ejaculatory dysfunction and the short- and long-term urinary dysfunction of patients in the 2 groups were compared seperately at 6 and 12 months after the operation. All data were analyzed using the chi-square test. Results The incidences of erectile and ejaculation dysfunction at 6 months after operation, incidence of ejaculation dysfunction at 12 months after operation, and long-term urinary dysfunction were 15% (10/68), 16% (11/68), 10% (7/68) and 0 in the laparoscopic group, and 22% (18/82), 23% (19/82), 21% (17/82) and 2% (2/82) in the open group, respectively, no significant difference between the two groups was found (x2 = 1. 285, 1. 137, 3. 013, 1.681, P>0. 05). The incidences of erectile dysfunction at 12 months after operation and short-term urinary dysfunction were 7% (5/68) and 4% (3/68) in the laparoscopic group, and 17% (14/82) and 20% (16/82) in the open group, respectively, a significant difference between the two groups was observed (x = 4. 565, 5.930, P <0.05). Conclusion Laparoscopic radical resection of mid-low rectal cancer can reduce the injury of pelvic autonomic nerve and improve the life quality of patients.

A Study of Frequency and Factors of Voiding Dysfunction Occurred after Epidural Anesthesia Using Bupivacaine / 대한비뇨기과학회지

PURPOSE: Epidural anesthesia(EPA) has been performed in various operations; however, it frequently induces postoperative voiding dysfunction. The frequency, duration and risk factors of voiding dysfunction occurring after EPA using long-acting anesthetics bupivacaine were evaluated. MATERIALS AND METHODS: 100 patients, who underwent orthopedic surgery (under knee, operation time

Assessment of Bladder Function in Adults with Cerebral Palsy; A Preliminary Study

OBJECTIVE: The aim of this study was to evaluate the bladder function in adults with cerebral palsy (CP). METHOD: Thirteen adults with CP were participated in this study. Nine of these thirteen subjects had urological symptoms. The urological history taking, urine analysis, urine culture, voiding cystourethrography (VCUG) and urodynamic study were done. RESULT: The urinary incontinence was the most common presenting symptom. All subjects without urological symptoms showed normal urodynamic findings. Eight of the subjects who had urological symptoms had abnormal findings on urodynamic study. All subjects showed normal findings on voiding cystourethrography. Based on urodynamic findings, six subjects were treated with anticholinergic drug and five (83.3%) of these subjects showed improvement of their urological symptoms. CONCLUSION: Many adults with CP might have the problems in urination. Our study showed that many symptomatic subjects had abnormal urodynamic findings and much of these urological symptoms was improved with proper treatment. These adults with CP would, therefore, benefit from proper assessment and treatment, expecially in the subjects who have urological symptoms.

Controlled Clinical Trials Using the Envelope Method for Urinary Dysfunction. The Effectiveness of the zhongji (cv-3) / 全日本鍼灸学会雑誌

At the 45th Japanese National Acupuncture and Moxibustion Conference, Kitakoji et al. of the Research Committee's Urology Group reported the results of controlled clinical trials, using the envelope method, on the effectiveness of acupuncture for urinary dysfunction. This was presented as a case in which the “Guidelines and Recommendations for clinical Trials in Acupuncture” were applied in actual clinical research. A controlled investigation was carried out by the Information and Evaluation Group, Research Section, Aichi Regional Association, at multiple institutions (9 hospitals and clinics) on the effectiveness of the zhongji (cv-3) point for urinary dysfunction, using the envelope method of Kitakoji et al. Although the zhongji (cv-3) point was not found to be effective against urinary dysfunction, we were able to demonstrate that it is possible to conduct controlled clinical trials at multiple institutions based on soft data.