The effects of urodynamic analysis and individualized bladder training on bladder function after spinal cord injury / 中华物理医学与康复杂志

Objective To explore any effect of combining urodynamic analysis with individualized bladder training in rehabilitating neurogenic bladder dysfunction after spinal cord injury.Methods Urology patients who had suffered a spinal cord injury were randomly divided into an experimental group and a control group.Both groups were given routine drugs and intermittent catheterization based on a urodynamics analysis using the Laborie urodynamic analyzer.The experimental group also received individualized bladder training for eight weeks.The bladder balance time and urinary infection rate of both groups were recorded 2,4,6 and 8 weeks after the intervention.Results After treatment,all of the patients wcrc able to achieve bladder balance,but the average bladder balance time of the experimental group was significantly shorter than that of the patients in the control group with similar injuries.After 2,4,6 and 8 weeks the incidence of urinary infection in the experimental group was significantly lower than in the control group.Moreover,after the treatment the average bladder storage volume (VH2O),bladder compliance (BC),bladder pressure (Pves) and detrusor pressure (Pdet) of both groups were significantly better than before the treatment,but the results of the experimental group were,on average,significantly better than those in the control group.Conclusion Individualized bladder training can effectively promote bladder balance and reduce the risk of urinary infection after spinal cord injury.

Electrical stimulation of the pelvic floor combined with bladder training for treating urinary dysfunction after incomplete spinal cord injury / 中华物理医学与康复杂志

Objective To evaluate the effect of electrical stimulation of the pelvic floor muscles combined with bladder training on urinary dysfunctionafter incomplete spinal cord injury.Methods Sixty-two incomplete spinal cord injury patients who had received an operation between November 2009 and December 2014 were enrolled and divided randomly into a control group (n=32) and a treatment group (n =30).Both groups were treated with conventional intermittent catheterization,while the treatment group was additionally given electrical stimulation of the pelvic floor muscles combined with bladder training.The residual urine volume was recorded before and after the treatment.Uurodynamic examinations were conducted,and the rate of successful catheter extraction and of urinary tract infection on the 15th and 30th day of treatment,were recorded and analyzed.Results All of the patients were followed-up for an average of 18.5 months.Significant improvement was observed in the residual urine volume,the maximum or average urinary flow rate,and the detrusor pressure at peak flow of both groups.However,at the end of follow-up the treatment group recorded significantly better results on all these measures than the control group.The successful catheter extraction rate of the treatment group (96.7％) was significantly higher than that of the control group and their average number of catheterization days was significantly fewer.The urinary tract infection rates on the 15th and 30th day of treatment were 16.7％ and 6.7％ in the treatment group,significantly lower than in the control group.Conclusions Electrical stimulation of the pelvic floor combined with bladder training significantly improves urination function after an operation for incomplete spinal cord injury,decreases the days of catheterization and lowers the rate of urinary tract infection.Such combined therapy is worth promoting in clinical practice.

A clinical observation on Yishen-Tiaodu moxibustion combined with bladder training in the treatment of neurogenic bladder after spinal cord injury operation / 国际中医中药杂志

objective To evaluate effect of the Yishen-Tiaodu moxibustion combined with bladder training to treat neurogenic bladder after spinal cord injury operation.Methods 72 patients met the inclusion criteria of neurogenic bladder were divided into two groups according to random number table: a control group was treated with bladder training, and a treatment group on the basis of the control group was treated withYishen-Tiaodu moxibustion therapy. Both groups were treated for 3 months. The urodynamics as well as the change of urinalysis and kidney function were observed in both groups.Results The original bladder feeling (90.2 ± 6.9 mlvs. 53.1 ± 6.9 ml,t=22.812)、maximum urinary output(302.1 ± 37.8 mlvs. 207.7 ± 40.9 ml, t=10.170), the maximum bladder capacity (399.8 ± 74.1 mlvs. 330.9 ± 50.2 ml,t=4.619) in the treatment group were higher than the control group after treatment (P<0.01). Residual urine volume (82.9 ± 32.9 mlvs. 109.8 ± 51.8 ml,t=2.630) in the treatment group was lower than the control group (P<0.01); the 24h urinary protein (70.8 ± 9.1 mgvs. 96.3 ± 14.9 mg,t=8.763), Urea (5.7 ± 2.1 mmol/Lvs. 9.3 ± 2.9 mmol/L,t=6.033), Scr (100.8 ± 19.6μmol/Lvs. 119.2 ± 19.7μmol/L,t=3.973), BUN (5.2 ± 1.8 mmol/Lvs. 6.7 ± 2.4 mmol/L,t=3.000) in the treatment group were significantly decreased than the control group(P<0.01).Conclusions Yishen-Tiaodu moxibustion combined with bladder training could effectively improve urodynamics for the neurogenic bladder in patients with SCI, and decrease the incidence of urinary tract infections.

Effect of spontaneous urination training on postoperative urine retention and catheteration duration of cervical cancer patients / 现代临床护理

Objective To investigate the effect of spontaneous urination training on postoperative urine retention and catheteration duration of cervical cancer patients. Methods Seventy patients were divided into the control group (n=34) and control group(n=36). according to the admission time Both groups received bladder function training. Besides this, the control group also received intermittent clamping of urine catheter while the observation group received spontaneous urination training . The two groups were compared in terms of incidence of urinary retention and catheteration duration. Result The incidence of urinary retention in the observation group was lower than that of the control group, there was significant difference between the this groups (P<0.05). Conclusion For the patients after cervical cancer operation , both bladder function training and urination training can reduce the incidence of urine retention .

Effects of Bladder Training and/or Tolterodine in Female Patients with Overactive Bladder Syndrome: A Prospective, Randomized Study

We compared the effects of bladder training and/or tolterodine as first line treatment in female patients with overactive bladder (OAB). One hundred and thirty-nine female patients with OAB were randomized to treatment with bladder training (BT), tolterodine (To, 2 mg twice daily) or both (Co) for 12 weeks. Treatment efficacy was measured by micturition diary, urgency scores and patients' subjective assessment of their bladder condition. Mean frequency and nocturia significantly decreased in all treatment groups, declining 25.9% and 56.1%, respectively, in the BT group; 30.2% and 65.4%, respectively, in the To group; and 33.5% and 66.3%, respectively in the Co group (p<0.05 for each). The decrease in frequency was significantly greater in the Co group than in the BT group (p<0.05). Mean urgency score decreased by 44.8%, 62.2% and 60.2% in the BT, To, and Co groups, respectively, and the improvement was significantly greater in the To and Co groups than in the BT group (p<0.05 for each). Although BT, To and their combination were all effective in controlling OAB symptoms, combination therapy was more effective than either method alone. Tolterodine alone may be instituted as a first-line therapy, but may be more effective when combined with bladder training.

Diagnosis and Treatment of Urinary Incontinence in Women

Urinary incontinence (UI) is a prevalent condition that can adversely affect a woman's quality of life. The prevalence of UI among Korean women was estimated up to 42% of the married female population. Overactive bladder syndrome (OAB) is a symptomatic diagnosis based on the presence of urgency, with or without urge incontinence, and usually accompanied by frequency and nocturia, in the absence of obvious pathologic or metabolic disease. Stress urinary incontinence (SUI), the complaint of involuntary loss of urine during effort or exertion or during sneezing or coughing, is the most common type of UI among women. Recommended initial evaluation methods of UI include validated symptom-questionnaire, 24 hour-voiding diary, 1-hour pad test, and provocative stress test. The initial management of OAB requires an integrated approach using behavioral and pharmacologic methods. Patients should be educated about the functioning of the lower urinary tract system, fluid and dietary management, timed or prophylactic voiding and bladder training regimens, and pelvic floor exercises (PFE). Although muscarinic receptor antagonists have been shown to be effective for the treatment of OAB, adverse effects, such as dry mouth, constipation, and blurred vision have limited their usefulness. Most cases of OAB are not cured, but the symptoms are reduced, with an associated improvement in the patients' quality of life. Patients who are not benefited by behavioral and pharmacologic intervention may respond to intravesical administration of drugs, including blockers of afferent input; intradetrusor injection of botulinum toxin, neuromodulation, and augmentation cystoplasty. The initial treatment of SUI includes behavioral changes and PFE. Bladder training, vaginal devices, and urethral inserts may also reduce stress incontinence. Surgical procedures are more likely to cure SUI than nonsurgical procedures. Based on a line of evidences available at this time, colposuspension (such as Burch) and pubovaginal sling (including the newer midurethral synthetic slings such as TVT) are the most effective surgical treatments.

Effectiveness of a Behavioral Intervention Program for Urinary Incontinence in a Community Setting / 간호학회지

PURPOSE: The purposes of this study were to examine the effectiveness of a behavioral intervention program combining pelvic floor muscle exercise with bladder training for urinary incontinence and also to conduct follow-up assessment after self-training. METHODS: This study was conducted using a non-equivalent control group, pretest-posttest design. The subjects were 60 middle-aged women (control group, n=30; intervention group, n=30) who experienced an episode of urinary incontinence at least once a week. The program was run over a 4 week period (once a week) and composed of urinary incontinence education, pelvic floor muscle exercise, and bladder training. RESULTS: Overall, there was a significant difference in urinary incontinence symptoms and psycho-social wellbeing related to urinary incontinence between the treatment and control group. Of the variables, weekly leakage frequencies, leakage amounts on each occasion, leakage index, frequencies of nocturia, and quality of life were significantly different between the groups. Follow-up assessment (9th week) indicated that overall incontinence symptoms and psycho-social well-being were significantly different between the posttest and follow-up assessments. Most variables of incontinence symptoms and psycho-social well-being were significantly improved at follow-up assessment versus posttest. CONCLUSIONS: The program was overall effective in terms of relieving symptoms and improving psycho-social well-being related to urinary incontinence, and this effect continued after a 4-weeks self-training period. In the respect that this is a community-based application study, the results can be meaningful and applicable.

The Effects of Bladder Training, Tolterodine and Bladder Training with Tolterodine in Female Patients with Overactive Bladder: Prospective, Randomized Study / 대한비뇨기과학회지

PURPOSE: There are few reports concerning the first-line treatment of choice for an overactive bladder. The aim of this study was to compare the effects of bladder training, tolterodine, and bladder training with tolterodine, as first-line treatments in patients with an overactive bladder. MATERIALS AND METHODS: A prospective randomized study was conducted on 99 female patients with overactive bladders. The patients were treated with bladder training, tolterodine (2mg twice daily), and bladder training with tolterodine, as first-line treatments, for 12 weeks. Of the 99 patients, 74 (bladder training: 24, tolterodine: 24, combined: 26) were followed up for 12 weeks. The treatment efficacy was measured by a micturition diary, subjective urgency scores and subjective perception of bladder condition at the end of the treatment. The safety and tolerability were assessed from adverse events and treatment withdrawals. RESULTS: After 12 weeks of treatment, the mean frequency of micturition and nocturia decreased by 27.1 and 55.8% in the bladder training group, 30.3 and 61.9% in the tolterodine group and 32.6 and 63.2% in the combined therapy group. The subjective mean urgency score decreased by 48.4, 62.5 and 63.2% in the three respective groups. The subjective perception of bladder symptom scores at the end of the treatments were 1.5, 1.42 and 1.31, with significant improvement rates of 50.0, 58.3 and 69.3% in the bladder training, tolterodine and combined therapy groups, respectively. Adverse events, and withdrawals due to adverse events, were 23.1 and 7.7% in the tolterodine and 28.6 and 7.1% in the combined therapy groups, but there were none in the bladder training group. CONCLUSIONS: Bladder training, tolterodine and combined therapy are all effective first-line treatments in female patients with overactive bladders. There are some enhanced effects with the combined therapy than with the bladder training and tolterodine monotherapies. Because of its high success rate, relatively low cost and absence of adverse events, bladder training should be included as a first-line treatment.

A case of nonneurogenic neurogenic bladder (Hinman syndrome) / 대한비뇨기과학회지

Nonneurogenic neurogenic bladder is a condition in which the patient is with day and night wetting, infected urine, residual urine, reflux and upper tract damage without neurologic lesion or anatomical obstruction. Recently it is known that some patients with pediatric unstable bladder may contract their external sphincter to inhibit the detrusor contraction and pathological persistence of this "hold on" habit after they master a normal mature pattern of cortical control over the detrusor may result in nonneurogenic neurogenic bladder. The condition is reversible by bladder training with various methods. We report a case of nonneurogenic neurogenic bladder who is treated by self CIC after ileocecocystoplasty because bladder retraining has been failed due to high fever and severe frequency.

Curative Effect of Desmopressin Acetate Combined with Bladder Training Therapy on Primary Nocturnal Enuresis in Children / 实用儿科临床杂志

Objective To observe the curative effect and recurrence rate of desmopressin acetate(DDAVP) combined with bladder training therapy on primary nocturnal enuresis(PNE) in chlidren.Methods One hundred children with PNE were randomly divided into control group and observation group(50 cases in each group).Children in control group were treated with simple DDAVP,and patients in observation group were treated with bladder training while DDAVP was using.The course of treatment were 3 months.The therapeutic effect between the 2 groups when the treatment was finished was compared and then followed up all the cases for 3 months to compare the near-term and long-term recurrence rate between the 2 groups.SPSS 13.0 software was used to analyze the data.Results The total effective rate in control group was 72.9%,and the near-term recurrence rate and the long-term recurrence rate were 22.9% and 54.3%,respectively.The total effective rate in observation group was 91.3%,and the near-term recurrence rate and the long-term recurrence rate were 11.9% and 28.6%,respectively.The total effective rate was significantly higher in observation group than that in control group(Z=-1.972,P=0.049).The near-term recurrence rate in 2 groups had no significant difference(?2=1.632,P=0.201).The long-term recurrence rate was extremely lower in observation group than that in control group(?2=5.249,P=0.022).Conclusions There is significant curative effect that DDAVP combined with bladder training therapy on PNE in children,and it can lower the long-term recurrence rate.