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Abstract Introduction: Overactive bladder (OAB) is a clinical diagnosis of irritating urinary symptoms that influence on sufferers' life quality. There are effective treatments described in literature, but most of them present adverse effects. One way of treatment is the use of electrical stimulation, which has been widely used, but studies show varying results. Objective: To verify if intracavitary electrical stimulation can be effective in patients with OAB. Methods: online databases were searched with specific descriptors to find randomized clinical trials on overactive bladder treated with intracavitary electrical stimulation. Only articles with score equal or higher than 5 in methodological PEDro scale were used and those that described intra and / or inter-group P-value. Results: 217 articles were found, but only 6 were analyzed by the selection criteria. The studies show that electrical stimulation promotes the reduction of urinary frequency, urinary incontinence, nocturia, urgency and the number of protectors used, and improvements in maximum cystometric bladder capacity, symptoms of OAB and quality of life. Conclusion: Electrical stimulation was effective in patients with OAB and can be used before any invasive treatment due to none side effects.
Resumo Introdução: A bexiga hiperativa (BH) é um diagnóstico clínico de sintomas urinários irritantes que influenciam na qualidade de vida de seus portadores. Existem tratamentos eficazes descritos na literatura, porém a maioria deles apresenta efeitos adversos. Uma das formas de tratar é utilizando a eletroestimulação, a qual vem sendo muito utilizada, porém os estudos publicados apresentam resultados variados. Objetivo: Verificar se a eletroestimulação intracavitária pode ser eficaz nos distúrbios urinários de pacientes com BH. Métodos: Foram utilizadas bases de dados online com descritores específicos para busca de experimentos controlados randomizados, com pacientes portadores de BH tratados com eletroestimulação intracavitária. Foram selecionados apenas artigos com pontuação maior/igual a 5 na escala metodológica PEDro e que descrevessem P-valor intra e/ou intergrupos. Resultados: Foram encontrados 217 artigos, porém somente 6 atenderam aos critérios de seleção. A eletroestimulação promoveu a redução da frequência urinária, perda urinária, noctúria, urgência e do número de protetores utilizados diariamente, além de aumentar a capacidade cistométrica máxima da bexiga, melhorar os sintomas da BH e a qualidade de vida. Conclusão: A eletroestimulação mostrou-se eficaz em pacientes com BH, e por não apresentar efeitos colaterais, pode ser utilizada antes de qualquer tratamento invasivo.
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Objectives To validate the non-invasive tests that can predict the type of bladder dysfunction normally diagnosed by invasive urodynamics. Methods Children below 12 yrs of age were evaluated prospectively. Non-invasive urodynamic evaluation included history, clinical examination, frequency volume charting, ultrasonographic scan, urine analysis and renal function tests. Micturating cystourethrogram was carried out in children with recurrent urinary tract infections. All children underwent invasive urodynamic studies and the significance of association of the parameters of noninvasive assessment with invasive urodynamics was determined. Chi square test using Epi 6 software was used for statistical analysis of data. Results 41 children underwent invasive urodynamic studies. The commonest disorder was detrusor instability in 28 (68.2%). Dysynergic voiding was noted in 8 (19.5%). The study was normal in 5 (12.1%). Nocturnal enuresis with day time symptoms, holding maneuvers, small frequent voiding pattern (p<0.05) and a small capacity bladder with insignificant residue (p=0.0003) predicts detrusor instability. Straining (p= 0.0006), large capacity bladder with significant post void residue in the absence of vesicouretric reflux (p<0.05) predicts dysyneric voiding. On combining the various noninvasive tests and validating them against invasive urodynamics in diagnosing detrusor instability and dysnergic voiding, they have a sensitivity of 88.4% and 87.5%, specificity of 72.7% and 69.2%, positive predictive value of 0.88 and 0.63 and positive likelihood ratio of 3.1 & 2.2 respectively. Conclusions Functional voiding disorders can be diagnosed with reasonable accuracy by minimally invasive methods.
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We assessed several emotional variables in patients experiencing conventional urodynamic and ambulatory urodynamic monitoring (AUM) to verify the hypothesis that AUM is tolerated as well as conventional urodynamics. A total of 33 women and 7 men from 23 to 72 years of age who were undergoing both procedures were prospectively included in this study. Prior to and immediately after the procedures, each patient completed a self-administered questionnaire. Answers were given on a visual analogue scale. The degree of anxiety was higher for conventional urodynamics than for AUM (p = 0.045), while the degree of boredom experienced during AUM was higher than that during conventional urodynamics (p= 0.013). There was no significant difference in the degree of shame or bother experienced by the patients during the two procedures. In general, patients tolerated both examinations extremely well. The examiner-rated degree of intolerance during conventional urodynamics was influenced by the subjective pain score (p=0.001), while all other emotional variables except bother were not significantly related with the degree of intolerance during AUM (p=0.007). A total of 74.4% and 84.6% responded that they were willing to repeat conventional urodynamics and AUM, respectively, which were not significantly different. Although AUM produced a significantly higher level of boredom than conventional urodynamics, our data demonstrates that patients are as tolerant of AUM as they are of conventional urodynamic procedures.
Subject(s)
Middle Aged , Male , Humans , Female , Aged , Adult , Urodynamics , Urination Disorders/diagnosis , Urinary Incontinence/diagnosis , Surveys and Questionnaires , Pain Measurement , Pain , Monitoring, Ambulatory/methods , Fluoroscopy/methods , AnxietyABSTRACT
Abnormal contract and relaxation of the bladder is closely correlated with detrusor instability.In the recent years,with advanced studies of its related nervous system,deeper insights have been gained into the mechanism underlying the influence of nerve receptors on bladder contraction and relaxation in the pathological state,which involves the changes of M-AR,?-AR and P-AR.The receptors that regulate the contraction of the bladder mainly include M-AR and P-AR,and ?-AR is chiefly responsible for adjusting its relaxation.An understanding of these mechanisms may provide a direction and a foundation for the studies of clinical therapies and development of new drugs for this disease.
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Objective To study the different mRNA expressions of big and small conductance calcium activated potassium channels (Bkca and Skca), and calcium activated chloride channels (Clca) in normal and instable detrusors. Methods Model of bladder outlet obstruction (BOO) of female Wistar rats was prepared by ligating the proximal urethra in the perineum. Detrusor instability (DI) was confirmed by conscious cystometry. The mRNA was extracted from the detrusors of normal and DI rats for the detection of the expressions of Bkca, Skca2, Skca3, and Clca by RT PCR. The different channel expression between normal and instable detrusors was identified by gel imaging. Results The incidence of DI in BOO rats was 76.17%. Bladder capacity and the maximal detrusor pressure increased significantly ( P
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Objective To study the modulation alterations of calcium activated potassium channel (Kca) and calcium activated chloride channels (Clca) on detrusor instability(DI) and their roles in DI. Methods The detrusor instability (DI) animal model was established using female Wistar rats. Detrusor strips were obtained from normal and DI rats. The contraction frequency and amplitude of the strips were measured by an in vitro tension test. The actions of channel openers and blockers were studied. Results Spontaneous contraction frequency and amplitude of DI increased significantly. The block of big conductance calcium activated potassium channel(Bkca) by Iberiotoxin resulted in decrease of frequency but increase of amplitude in the control, but only increase of frequency in DI. The opener, NS1619, resulted in decreases of frequency and amplitude in the control, but only decreases of frequency in DI. The block of small conductance Kca (Skca) by apamin resulted in increases of frequency and amplitude in both control and DI groups, but the opener, Chlorzoxazone, resulted in decreases of frequency and amplitude in the control, but only decrease of frequency in DI. The contraction alterations of DI were significantly lower than those of the control no matter Kca was blocked or opened. NFA, a selective Clca blocker, resulted in no significant frequency and amplitude alteration in the control, but significant decrease in DI. Conclusion These results suggested that Kca and Clca play a critical role in the modulation of detrusor contraction, and the down regulation of Kca and up regulation of Clca suggests that disorder of calcium related regulation may play an important role in DI.
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Objective To compare the changes of detrusor physiological properties between the models of detrusor instability caused by neurogenic, obstructive and idiopathic factors. Methods Eighty female SD rats were enrolled in our study, including 17 rats of idiopathic detrusor instability (IDI), 33 for bladder outlet obstruction (BOO) by partial ligation of bladder outflow tract, 20 spinal cord injury (SCI) by transection of spinal cord at L1-2, 10 as normal control. Six weeks after insult, the change of detrusor excitability, autorhythmicity and contractility were examined by means of cystometry and the in vitro detrusor strip study. Results The occurrence rate of detrusor instability in BOO rats, SCI rats and IDI rats was 75.9%, 100% and 21.3%. The rats in three DI groups increased more significantly in excitability, autorhythmicity and contractility than control rats (P0.05). Conclusion Different types of DI have similarity in the detrusor myogenic changes, while the increase in spontaneous excitability of detrusor strip seems to be more important than others factors in the mechanism of DI.
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Objective To investigate the expression changes of connexin 43 (Cx43) gene and the functional changes of the gap junction intercellular communication (GJIC) among cultured unstable detrusor cells and their roles in the development of detrusor instability (DI). Methods Forty healthy female Wistar rats were divided into two groups: DI group and normal control group. RT-PCR and Western blot techniques were employed to detect the expression of Cx 43 mRNA and protein in the cultured detrusor cells. Scrape loading dye transfer (SLDT) technique was used to monitor the GJIC among cultured detrusor cells. Results The expression of Cx43 mRNA and protein in DI group was much higher than that in normal control group (P
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Objective To explore the myogenic basis of the increased excitability and contractile activity in detrusor instability (DI) and investigate the differences of spontaneous contractions by ryanodine receptor (RyR) channels regulation in sarcoplasmic reticulum (SR) between DI and normal bladder muscle and of the RyR channels protein expression. Methods DI model was confirmed by filling cystometry from rats that underwent partial bladder outlet obstruction (BOO) about 8 weeks ago. Muscle strips were dissected from fresh bladder under microscope and the isometric tension in DI and normal strips were detected. The contractions were recorded in these strips exposed to some agents. SR microsome protein was obtained from DI and normal bladder muscle preparations and was used for Western blot analysis to determinate RyR channels expression. Results Treated with RyR channels blocker ryanodine , the contractile frequence significantly increased in normal strips, but not in DI muscle. Western blot analysis showed that RyR channels expression in DI muscle was significantly less than that in normal preparations. Conclusion RyR channels act a negative role in spontaneous contractile activity and the presumed mechanism may involve in Ca 2+ release of RyR channels which causes activation of Ca 2+ -dependent K + channels to decrease contractility. But this crosstalk mechanism is weaken in DI muscle, which provides a chance for spontaneous contractile overactivity.
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Purpose: The pathogenesis of lower urinary tract symptoms (LUTS) without benign prostatic hyperplasia (BPH) in men is unclear. In this study, patients with LUTS without BPH were analyzed with a urodynamic study to search for effective treatments. MATERIALS AND METHODS: Ninety nine men with LUTS without BPH were assessed by their medical history, symptom score, uroflowmetry, filling cystometry and a pressure- flow study. The patients were divided into irritating and obstructive symptom groups according to their chief complaints. The urodynamic parameters between the two groups were compared. RESULTS: On urodynamics, 33 (33.3%) patients showed demonstrable evidence of detrusor instability (DI) of whom 10 had a concomitant bladder outlet obstruction (BOO), while 8 had concomitant detrusor underactivity (DU). BOO and DU was identified in 21 (21.2%) and 30 (30.3%) patients, respectively. Of the 61 patients presented with irritating symptoms, DI, BOO and an impaired contractility (IC) was found in 26.3, 13.1, and 13.1% of patients, respectively. Of the 38 patients with obstructive symptoms, DI, BOO and IC was found in 7.1, 8.1, and 17.2%, respectively. There was a significant positive correlation between the irritating symptoms and the presence of DI. CONCLUSIONS: Lower urinary tract symptoms in men are common and often misdiagnosed. This study demonstrated that 84 (84.8%) patients with lower urinary tract symptoms without a benign prostatic hyperplasia had urodynamic abnormalities such as DI, BOO and IC. A urodynamic study may to be useful in establishing a correct diagnosis and launching the appropriate therapy.
Subject(s)
Humans , Male , Diagnosis , Lower Urinary Tract Symptoms , Multiple Endocrine Neoplasia Type 1 , Prostatic Hyperplasia , Urinary Bladder Neck Obstruction , UrodynamicsABSTRACT
PURPOSE: Detrusor instability is common in men with benign prostatic hypertroplasia(B.P.H.) and known to be reversed in about two thirds of patients after operation. We evaluated the fate of detrusor instability in B.P.H patients after operation. MATERIALS AND METHODS: In 11 patients with urgency or urge incontinence combined with B.P.H., cystometries were performed at baseline and 3 months after operation. RESULTS: Detrusor instability associated with B.P.H was reversed postoperatively in 7 patients (63.6%). CONCLUSIONS: Detrusor instability with urgency or urge incontinence can be managed by operation for B.P.H. This will improve the quality of life for B.P.H. patients.
Subject(s)
Humans , Male , Prostatectomy , Prostatic Hyperplasia , Quality of Life , Urinary Incontinence, UrgeABSTRACT
PURPOSE: The presence of urge incontinence may affect the results of stress urinary incontinence (SUI) treatment. In this study, women with SUI were divided according to their accompaniment with urge incontinence or not. The aim was to define a group in whom a urodynamic assessment was unnecessary prior to offering surgery. In other words, we wished to define a group where the treatment plan could be determined only with the clinical opinions based on the symptoms and physical examinations. MATERIALS AND METHODS: Two hundred and fifty five women with SUI between January 1997 and February 2001 were enrolled in this study. The women with SUI symptoms were divided into a group of patients who had symptoms of pure SUI, and those who had SUI as well as urge incontinence. The clinical and urodynamic variables were analyzed to identify the sub-groups of women where a urodynamic study was unnecessary before initiating treatment for SUI. RESULTS: Of the 101 women with symptoms of pure SUI, only 5 had a detrusor instability (DI). Of the 154 women with coexisting urge incontinence symptoms, only 33.8% (52/154) had DI, suggesting the poor predictability of urge incontinence symptoms for a diagnosis of DI based on the urodynamic study. An identification of SUI by the urodynamics were noted in 77.6% (198/255), which almost corresponding to the rate (76.9%) of positive urine leakage confirmed at the provocative stress test. CONCLUSIONS: If a patient has symptoms of pure SUI associated with a positive stress test, the SUI can be treated without a urodynamic study. For women with symptoms of mixed urinary incontinence, it may be better to undergo a urodynamic study before launching a definitive treatment.
Subject(s)
Female , Humans , Diagnosis , Exercise Test , Physical Examination , Urinary Incontinence , Urinary Incontinence, Urge , UrodynamicsABSTRACT
PURPOSE: The presence of urge incontinence may affect the results of stress urinary incontinence (SUI) treatment. In this study, women with SUI were divided according to their accompaniment with urge incontinence or not. The aim was to define a group in whom a urodynamic assessment was unnecessary prior to offering surgery. In other words, we wished to define a group where the treatment plan could be determined only with the clinical opinions based on the symptoms and physical examinations. MATERIALS AND METHODS: Two hundred and fifty five women with SUI between January 1997 and February 2001 were enrolled in this study. The women with SUI symptoms were divided into a group of patients who had symptoms of pure SUI, and those who had SUI as well as urge incontinence. The clinical and urodynamic variables were analyzed to identify the sub-groups of women where a urodynamic study was unnecessary before initiating treatment for SUI. RESULTS: Of the 101 women with symptoms of pure SUI, only 5 had a detrusor instability (DI). Of the 154 women with coexisting urge incontinence symptoms, only 33.8% (52/154) had DI, suggesting the poor predictability of urge incontinence symptoms for a diagnosis of DI based on the urodynamic study. An identification of SUI by the urodynamics were noted in 77.6% (198/255), which almost corresponding to the rate (76.9%) of positive urine leakage confirmed at the provocative stress test. CONCLUSIONS: If a patient has symptoms of pure SUI associated with a positive stress test, the SUI can be treated without a urodynamic study. For women with symptoms of mixed urinary incontinence, it may be better to undergo a urodynamic study before launching a definitive treatment.
Subject(s)
Female , Humans , Diagnosis , Exercise Test , Physical Examination , Urinary Incontinence , Urinary Incontinence, Urge , UrodynamicsABSTRACT
Our an objective was to study the efficacy of Capsaicin extracted from Capsaicin frutescen in treating the patients with hypersensitive bladder and primary detrusor instability. Eleven patients, 3 males and 8 females, with average age of 60.3ฑ14.3 years were treated by intravesical instillation 1 mM/L Capsaicin in 30% ethanol in an amount half of the bladder capacity for 30 minutes after instillation 2% xylocaine without adrenaline for 15 minutes three out of the 11 patients who could not tolerate the pain by this method were anesthesized with regional or general anesthesia. The results were as follow :- 1. Clinical symptoms were improved significantly, i e. the frequency was reduced from day : night = 19.45ฑ17.99 : 7.09ฑ6.30 to 12.00ฑ8.91 : 4.09ฑ3.8 at p < 0.05 and leakage almost disappeared. 2. Maximal bladder capacity increased from 197.45ฑ156.06 ml to 323.45ฑ129.46 ml which was statistically significant (p=0.009). 3. Detrusor pressure at maximal bladder capacity increased from 32.63ฑ22.76 cmH2O to 36.63ฑ19.21 cmH2O but was not statistically significant (P=0.823). 4. Voiding pressure nonsignificantly increased from 47.1ฑ6.4 cmH2O to 48.1ฑ6.6 cmH2O (p=0.959). The adverse effects found were burning pain at suprapubic area, sweating and hematuria.
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Objective To study the functional changes of gap junctional mediated intercellular communication in detrusor instability so as to demonstrate the feasibility of blocking excitatory communication as the target of therapy for DI. Methods The function of GJIC in the cultured bladder detrusor cells were detected by FRAP. Results At the fourth minutes after bleaching,the mean fluorescences recovery rates of the DI groups bladder detrusor cells was (35.791?0.836)%,the control groups (8.645?0.673)%.The mean fluorescences recovery rates of the DI groups were significant higher than those in control groups (P
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PURPOSE: The process of micturition is depend on the bladder contracton power and urethral resistance. The higher urethral resistance in the BPH, the greater power(W) is needed to open the urethra and keep it open during voiding. It has been known that the occurrence of unstable bladder did correlate with the degree of obstruction. Unstable detrusor will exhibit greater contraction power with more efficient voiding(evidenced by higher flow rate, less voiding time). We performed this study to define the differences of urodynamic voiding parameters including detrusor contractility between unstable and stable bladder in the BPH. MATERIALS AND METHODS: In all subjects bladder outlet obstruction was ascertained urodynamically and BPH was diagnosed by digital rectal examination and transrectal ultrasound. The patients were divided into 2 groups. Group 1 included 25 men chosen randomly among BPH patients with bladder outlet obstruction and detrusor instability. Group 2 consisted of 22 men chosen at random among BPH patients with stable obstructed bladders. For each subject a number of urodynamic parameters derived from pressure-flow study were evaluated. RESULTS: Obstructive findings were found in the pressure-flow study in the both groups. Patients ages were 64.1 in the unstable and 61.9 years old in the stable group. Peak flow rate, minimum urethral opening pressure, maximum detrusor pressure, detrusor pressure at peak flow, maximum external voiding power were 14.2ml/sec, 24.3cmH2O, 52.1cmH2O, 42.9cmH2O, 537.3mW, respectively in the unstable group and 11.6ml/sec, 17.5cmH2O, 45.3cmH2O, 34.1cmH2O, 388.2mWm in the stable group. Voiding time was shorter in the unstable group(41.9sec) than in the stable group(54.5sec). Maximum cystometric capacity was significantly greater in the stable group(434.2ml) than in the unstable group(287.5ml) (p<0.01). Maximum contraction power, peak flow detrusor power, opening contraction power were significantly greater in the unstable group(38.8+/-20.2microW/mm2, 34.0+/-18.5microW/mm2, 24.0+/-3.1microW/mm2, respectively) than in the stable group(14.2+/-7.4microW/mm2, 12.9+/-8.1microW/mm2, 11.2+/-1.6microW/mm2)(p<0.01). Voiding efficiency was significantly higher in the unstable population(68.6+/-28.9%) than in the stable one(47.5+/-31.3%)(p=0.02). There were significant positive correlations between opening contraction power with maximum detrusor pressure(r=0.45) and peak flow detrusor pressure (r=0.48) (p<0.01). CONCLUSIONS: In this study, there were more powerful micturition power and more efficient voiding in unstable bladder group. Conclusively, it seems that unstable bladder possibly works as an energy saving device thereby maintaining efficient voiding despite obstruction.
Subject(s)
Humans , Male , Digital Rectal Examination , Prostatic Hyperplasia , Ultrasonography , Urethra , Urinary Bladder , Urinary Bladder Neck Obstruction , Urination , UrodynamicsABSTRACT
AIMS OF STUDY: Present study designed to observe inhibitory effects of propiverine HC1 and tiropramide against the smooth muscle contraction of female rat bladder. Propiverine has both direct smooth muscle relaxation and anticholinergic effect and has relatively fewer side effect than conventionally used drugs such as oxybutinin. Tiropramide has been known as modulatory agents of gastrointestinal motility but also has inhibitory effects against the bladder contraction. METHODS: 30 adult female Sprague-Dawley rats were used. Bladder body above ureteral orifice was resected under pentobarbital anesthesia. 1 x 0.5 cm sized smooth muscle strip was made, and incubated in Tyrode`s solution aerated with 95% oxygen. After reaching equilibrium state, each strip was stimulated by field stimulation (FS, 1-32 Hz) and bethanechol administration (0.0000001-0.0001M). From each strip, degree of muscle contraction was recorded by physiograph (Gilson IC-MP). After the control stimulations, each strip was treated by atropine, tiropramide, oxybutinin and propiverine HC1. After 30 minutes, same stimulation were repeated and degree of muscle contraction was compared to pre incubation data. RESULTS: Frequency and dose dependent muscle contractions were noted for both FS and bethanechol stimulation. Greater degree of contractions were noted for FS than for bethanechol stimulation. Inhibitory effects of tiropramide, propiverine HC1 and oxybutinin were greater than those of atropine at FS (1-32 Hz). At high concentration (0.0001M), all of the drugs but atropine inhibited field stimulated smooth muscle contraction more than 90%. At lower concentration (0. 0000001-0.000001M), inhibitory actions of oxybutinin and propiverine HC1 were greater than that of tiropramide (p>0.05). Propiverine HC1 and oxybutinin had similar inhibitory effect for all con-centration. At higher concentration (0.0001M), inhibitory effects of tiro-pramide were more than 98% whereas those of oxybutinin and propiverine HC1 were 88%. At low concentration (0.0000001-0.000001M), oxybutinin exhibited greater inhibition against the bethanechol induced contraction than did tiropramide and propiverine HC1. With these results, it was suggested that in low concentration, oxybutinin and propiverine HCI had greater inhibitory effect than did tiropramide against smooth muscle contraction of the bladder. In high concentration though, tiropramide had superior inhibitory effect than did oxybutinin and propiverine HC1. Since, no difference was noted between oxybutinin and propiverine HC1 for the inhibitory action of bladder contraction, propiverine HC1 seems reasonable substitute for the treatment of detrusor hyperreflexia with less side effects. Also these results indicate that tiropramide can be used for the management of unstable bladder.
Subject(s)
Adult , Animals , Female , Humans , Rats , Anesthesia , Atropine , Bethanechol , Gastrointestinal Motility , Muscle Contraction , Muscle, Smooth , Oxygen , Pentobarbital , Rats, Sprague-Dawley , Reflex, Abnormal , Relaxation , Ureter , Urinary BladderABSTRACT
PURPOSE: Detrusor instability (DI) is a main cause of persistent voiding difficulty after TURP in patients with benign prostatic hyperplasia (BPH). So we retrospectively estimated the effect of TURP in BPH patients with DI. MATERIALS AND METHODS: Of the 81 patients who had undergone TURP due to prostatism, 35 patients with BPH were followed at 3 weeks and 6 months postoperatively (21 without DI cases vs. 14 with DI; 6 persistent DI, 7 resolved DI, 1 missing case at 3 weeks and 4 persistent DI, 7 resolved DI, 2 missing cases at 6 months). We compared each group using symptom score (IPSS) and urodynamic parameters. RESULTS: Each irritative and obstructive symptoms were significantly improved in both group (p0.05). There were no significant differences in all parameters between 3 weeks and 6 months postoperative period (p>0.05). The amplitude of improvement had no significant difference between two group. There were no significant differences in IPSS and urodynamic parameters between persistent and resolved DI group. CONCLUSION: We suggest that TURP is good therapeutic option even in BPH patients with DI at short term postoperative period, but attempt to predict which patients would have persistent DI following TURP was failed.
Subject(s)
Humans , Postoperative Period , Prostatic Hyperplasia , Prostatism , Retrospective Studies , Transurethral Resection of Prostate , Urinary Bladder , UrodynamicsABSTRACT
Detrusor instability is defined as involuntary detrusor contraction above 15 cmH2O during normal bladder filling without neuralgic disorder. Recently clinical evaluation of the patients with detrusor instability was being made more commonly by urodynamic study. We analysed urodynamic study (filling and voiding cystometry) on 26 patients diagnosed as BPH with detrusor instability (Group A) on the Department of Urology, Korea University Haehwa Hospital during the period from September. 1988 to July, 1989. The results were compared with the 22 patients who were diagnosed as BPH without detrusor instability (Group B). The results was followed : 1. In Group A, bladder volume of urge to void (148.81 +- 87.61 ml) and maximum cystometric capacity (231.80 +- 116.49ml) were lower than the results of Group B (232.41 +- 101.69ml and 429.82 +- 121.16ml) in filling cystometry. 2. In Group A, the compliance was low in 21 (<20ml/cm H20) and mean compliance was 10.38 +- 10.29ml/cm H20. It was much lower than that of the Group B (28.66 +- 17.19ml/cm H20) (p <0.005). 3. In voiding cystometry, typical obstructive pattern was 32 cases and 11 cases were failed due to urge incontinence during filling cystometry. 4. Among 26 cases of BPH with detrusor instability, Oxybutynin were given on 12 cases in which postoperative incontinence were persisted in spite of UTI control. 5. 10 (83.3%) in 12 cases of BPH group treated with Oxybutynin showed subjective improvement of irritative voiding symptoms. 6. Detrusor pressure at maximum cystometric capacity were 74.2 +- 29.7 cmH20 in Group A and 45.2 +- 25.7 cmH20 in Group B. (p<0.005).
Subject(s)
Humans , Compliance , Korea , Urinary Bladder , Urinary Incontinence, Urge , Urodynamics , UrologyABSTRACT
Detrusor intability is one of the most common micturation dysfunction diseases in clinic. Detrusor is a kind of excitable tissue. High excitability of detrusor plays a major role in the cause of DI. The increase in excitability is myogenic in DI, and it is not directly related to neurogenic factors. The transmembrane potential, ion channels and signal transmission between cells are the main factors in the production of cell excitability changes. It is worth to study the myogenic factors to explore the treatment of detrusor instability. Proper treatment of the primary diseases, depress the excitability and block the signal transmission would be effective therapeutic strategies.