Research progress on voiding dysfunction in children / 中国小儿急救医学

Voiding dysfunction is common in children.The clinical manifestations include frequent micturition, urgent urination, micturition pain, delayed micturition, urinary incontinence, and enuresis.There may be only one symptom or multiple clinical manifestations at the same time, which is closely related to defecation dysfunction.Without timely diagnosis and treatment, in addition to affecting the quality of life, it often causes renal function damage and can even be life-threatening.Therefore, we should pay attention to the diagnosis and treatment of voiding dysfunction in children.

Research advances of sacral neuromodulation in the management of pediatric neurogenic bladder / 现代泌尿外科杂志

Pediatric neurogenic bladder (PNB) is defined as dysfunction of the detrusor and/or urethral sphincter due to myelodysplasia or spinal cord injury, manifesting as impaired urination or defecation, which seriously affects the patients’ quality of life. The main indication for sacral neuromodulation (SNM) is overactive bladder syndrome, which presents as refractory urinary frequency and urgency, urgency incontinence and non-obstructive urinary retention. Age more than 16 years are also recommended for this technique. Previous studies have revealed that SNM could significantly improve the outcome of refractory bladder bowel dysfunction. This paper reviews the advances of the application of SNM in the treatment of pediatric neurogenic bladder so as to provide reference for pediatricians.

Urodynamic assessment of voiding dysfunction associated with anorectal malformation / 中华实用儿科临床杂志

Anorectal malformation (ARM) accounts for the first place of digestive tract malformations in children, with the incidence of 1/5 000-1/1 500 in newborns.ARM is typically manifested as anal stenosis or anal atresia with or without fistulas and persistent cloaca.Genitourinary malformation is the most common malformation associated with ARM, with the incidence ranging 26%-55%.There were 35%-50% of ARM children develop spinal cord peripheral abnormalities or neurogenic lower urinary tract dysfunction, which usually causes voiding dysfunction associated with ARM.Urodynamic study is the best method to analyze the changes of lower urinary tract function, which can provide an objective classification for bladder and urethral function and guide the formulation of precision treatment plan and therapeutic efficacy during the follow-up period.This study aims to review the cause of voiding dysfunction asso-ciated with ARM and its urodynamic changes.

Urodynamic Manifestations of Severe Urination Disorders Caused by Multiple System Atrophy / 中国康复理论与实践

Objective:To explore the clinical characteristics of urination disorders in multiple system atrophy (MSA). Methods:The clinical data and imaging urodynamic examination of twelve MSA patients with severe urination disorders from June, 2013 to March, 2021 were retrospectively analyzed. Results:Among twelve cases, there were eight cases with acontractile detrusor, one case with detrusor overactivity, one case with detrusor-sphincter dyssynergia, one case with filling detrusor hyperactivity and voiding-phase dyssynergia (DO+DSD), and one case with normal urodynamics. Conclusion:The clinical symptoms of MSA are complex, and the early diagnosis is difficult. Electrophysiological and MRI examinations can be helpful for diagnosis.

Postnatal bladder dysfunction

Background: Voiding difficulty and urinary retention is a common phenomenon in immediate postpartum period. Absolute or relative failure to empty the bladder resulting from decreased bladder contractility (magnitude or duration) or increased bladder outlet resistance or both are defined as voiding dysfunction. It needs high index of suspicion or else can go undiagnosed and can lead to magnitude of problems. The study aims to calculate the incidence of dysfunction of bladder in postnatal women and to study risk factors associated with development of bladder dysfunction and management strategies in cases of bladder dysfunction.Methods: Authors did a prospective observational study in a tertiary care hospital. 200 postpartum women were screened for complaints of voiding dysfunction within 6 hours of removal of catheter in post caesarean patients and of normal vaginal delivery. Authors found that the voiding dysfunction was relatively common with an incidence of 20.20%. Following risk factors were analyzed: parity, mode of delivery, pain at suture site, baby weight, para-urethral tear.Results: Postpartum voiding dysfunction was found to be relatively common with statistically significant association found for pain at suture site and para urethral tear. Intra partum events contributed to voiding dysfunction. 93% of patients who with voiding dysfunction could be managed conservatively, and only 7% had to undergo intervention in the form of re catheterization.Conclusions: The early identification and treatment can reduce the pain and discomfort. Majority of the cases resolves with conservative management and nursing staff plays a key role in early detection of the symptoms.

Post void residue in women with pelvic organ prolapse: a prospective observational study

Background: The objective of the present study was to observe the post void residual volume (PVRV) in women with pelvic organ prolapse (POP) pre and postoperatively and to correlate stage of prolapse with lower urinary tract symptoms and quality of life in women with pelvic organ prolapse.Methods: This is a prospective observational cohort study of 100 women with symptomatic pelvic organ prolapse of stage II or greater. Patients were admitted for Vaginal hysterectomy with pelvic floor repair for pelvic organ prolapse in Gynaecology Department at Christian Medical College Hospital, Vellore, India over one year were recruited. This study was approved by the institutional review board and ethical committee of the hospital. Pre- and post-operative PVR were measured. The statistical analysis was done by using SPSS version 21 and P value < 0.05 was considered as statistically significant.Results: In this study 100 patients were recruited and 11% of women had pre-operative high post void residual volume of more than 100 ml. Stages of POP did not correlate with severity of LUTS and QOL. Pre-operative elevated PVR resolved post operatively in 91%, the P value <0.000 which was highly significant.Conclusions: 11% of women had preoperative high PVR. Stages of POP did not correlate with severity of lower urinary tract symptoms (LUTS) and quality of life(QOL). Pre-operative elevated PVR resolved post operatively in 91%, the P value < 0.000 which was highly significant. Majority of the patient with severe pelvic organ prolapse had elevated pre-op PVR which resolved post- operatively after surgical correction.

Alpha-1 Adrenergic Receptor Blockers for the Treatment of Lower Urinary Tract Symptoms in Women: A Systematic Review and Meta-Analysis / 대한배뇨장애요실금학회지

PURPOSE: To assess the effectiveness of alpha-1 adrenergic receptor blockers (α1-blockers) in the treatment of female lower urinary tract symptoms (LUTS). METHODS: A literature search was conducted using the PubMed/MEDLINE, Embase, and Cochrane Library databases. Fourteen studies with 1,319 patients were ultimately included. The study comprised 2 analyses: a comparison of urinary symptom scores, maximal flow rate (Qmax), and postvoid residual (PVR) urine volume before and after α1-blocker administration in 8 prospective, open-label studies and 5 randomized clinical trials (RCTs); and an evaluation of the same variables in α1-blocker and placebo groups in 4 RCTs.

Neurologic Mechanisms Underlying Voiding Dysfunction due to Prostatitis in a Rat Model of Nonbacterial Prostatic Inflammation / 대한배뇨장애요실금학회지

PURPOSE: The neurological molecular mechanisms underlying the voiding dysfunction associated with nonbacterial chronic prostatitis/chronic pelvic pain syndrome remain poorly understood. In this study, we assessed whether prostate inflammation activated bladder afferent neurons, leading to bladder dysfunction, and sought to elucidate the underlying mechanisms. METHODS: Thirty male Sprague-Dawley rats were divided into 3 groups: sham-saline, formalin-injected, and capsaicin-pretreated and formalin-injected. Chemical prostatitis was induced by 0.1 mL of 10% buffered formalin injected into the ventral prostate. Capsaicin was injected subcutaneously to desensitize capsaicin-sensitive nerves. In each group, conscious cystometry was performed, and c-fos expression within the spinal cord was determined immunocytochemically. Double immunofluorescent staining with c-fos and choline acetyltransferase (ChAT) was performed. On the third day after pseudorabies virus (PRV) infection, c-fos and PRV double-staining was performed. RESULTS: Intraprostatic formalin significantly increased the maximal voiding pressure and decreased the intercontraction interval, compared with controls. Pretreatment with capsaicin significantly reversed these effects. More c-fos-positive cells were observed in the sacral parasympathetic nucleus (SPN) and dorsal gray commissure (DCM) in the prostatitis group than in the sham group. c-fos-positive cells decreased in the capsaicin-pretreated group. Preganglionic neurons labeled by c-fos and ChAT were observed in the SPN in rats with prostatitis. Interneurons labeled by c-fos and PRV were identified in the DCM after PRV infection. CONCLUSIONS: Our results suggest that prostate inflammation activates afferent nerve fibers projecting to the lumbosacral spinal cord, producing reflex activation of spinal neurons innervating the bladder and bladder hyperreflexia. This is mediated by capsaicin-sensitive prostate afferent neurons.

Detecting Bladder Biomarkers for Closed-Loop Neuromodulation: A Technological Review / 대한배뇨장애요실금학회지

Neuromodulation was introduced for patients with poor outcomes from the existing traditional treatment approaches. It is well-established as an alternative, novel treatment option for voiding dysfunction. The current system of neuromodulation uses an open-loop system that only delivers continuous stimulation without considering the patient’s state changes. Though the conventional open-loop system has shown positive clinical results, it can cause problems such as decreased efficacy over time due to neural habituation, higher risk of tissue damage, and lower battery life. Therefore, there is a need for a closed-loop system to overcome the disadvantages of existing systems. The closed-loop neuromodulation includes a system to monitor and stimulate micturition reflex pathways from the lower urinary tract, as well as the central nervous system. In this paper, we reviewed the current technological status to measure biomarker for closed-loop neuromodulation systems for voiding dysfunction.

Experience of transurethral incision of the bladder neck for female primary bladder neck obstruction / 中华泌尿外科杂志

Objective To analyse and discuss the outcomes of female primary bladder neck obstruction(PBNO) with transurethral incision of the bladder neck(TUIBN).Methods From January 2004 to December 2013, 38 female patients who underwent transurethral incision of the bladder neck were retrospectively reviewed.The mean age of patients was 57.7 years and the duration of symptoms before diagnosis was 3.5 years.All patients presented with varying degree of difficulty of urination.There were 10 cases with lower abdominal discomfort and 20 cases with history of urinary infection. Preoperative examinations included physical examination, urine routine, international prostate symptom score ( IPSS ) , quality of life ( QOL) , ultrasonography, urodynamics and cystoscopy.The urodynamic diagnostic criteria for PBNO were a maximum uroflow rate ( Qmax ) 20 cmH2 O.All patients failed with 3-6 month alpha-blockers treatment and then underwent TUIBN.Results Follow-up data of all patients were available for 12-60 months ( average 29.6) after operation.Successful recovery after operation was achieved in 33 of 38 ( 86.84 %) .At the first year follow-up, the IPSS decreased from 26.63 ±3.15 to 13.00 ±7.18 (P<0.01), the Qmax increased from (8.65 ±1.32) ml/s to (15.91 ±3.89) ml/s (P <0.01), the postvoid residual decreased from (122.92 ±58.36) ml to (56.55 ±36.57) ml (P<0.01), and the Pdet.Qmax decreased from (52.18 ±7.31) cmH2O to (36.12 ± 4.74) cmH2O (P<0.01), respectively.Of the 5 cases in which the first operation was not successful, 3 cases ( 7.89%) underwent an additional TUIBN 1 to 2 years after the initial operation and 2 cases detected bilateral renal hydronephrosis by B-ultrasound before operation underwent life-long catheter cystostomy.The second operation of 3 cases was successful.Pathological examinations revealed fibrous tissue hyperplasia with chronic inflammation in 32 cases, glandular cystitis in 4 cases and chronic inflammation with squmaors metaplasia in 2 cases.Conclusions The diagnosis of primary bladder neck obstruction in women is based on typical symptoms, urodynamics and cystoscopy.TUIBN is a safe and effective therapy for PBNO.

Overview of the Epidemiology of Lower Urinary Tract Dysfunction in South Korea / 대한배뇨장애요실금학회지

This review assessed the epidemiology of voiding dysfunctions in South Korea. Comprehensive understanding of this epidemiology is crucial because the senior population and the social burden are increasing because of voiding dysfunctions is growing. We searched the medical records using several terms related to voiding dysfunction: benign prostatic hyperplasia, urinary incontinence, lower urinary tract symptoms, overactive bladder, and nocturia. We then estimated the prevalence of voiding dysfunctions in South Korea; our data were comparable with those from other countries, with slight differences. The ranges of incidences varied widely between studies, mostly because investigators defined disorders differently. Voiding dysfunction greatly affects healthcare costs and individual quality of life; therefore, more proper and valuable epidemiologic data are needed. In addition, efforts to unify the definitions of various voiding dysfunctions and progress in investigational methodologies using multimedia are warranted.

Práticas de cuidado e desafios do autocateterismo intermitente limpo: as vozes dos escolares / Healthcare practices and challenges of the clean intermittent catheterization: the voices of the children

As crianças portadoras de disfunções miccionais, sendo de ordem neurológica (bexiga neurogênica) ou funcionais, necessitam de cuidados especiais para evitar a deterioração do sistema urinário inferior e insuficiência renal. Na maioria dos casos de bexiga neurogênica, indica-se, o cateterismo intermitente limpo. Também indicado para as disfunções não neurogênicas quando não se consegue bons resultados com outros tratamentos. São crianças com necessidades especiais de saúde (CRIANES), com mudanças na sua vida cotidiana e necessidade de cuidados especiais. O enfermeiro necessita interagir com as mesmas, de forma que, na fase escolar, possam juntos, planejar e administrar o autocuidado, necessários para facilitar o processo de viver saudável. Objeto de estudo: o autocateterismo intermitente limpo realizado pelo escolar portador de disfunção miccional. Objetivos: descrever as práticas de cuidados concernentes ao autocateterismo intermitente limpo realizado pelo escolar portador de disfunção miccional e analisar os desafios para a realização dessa prática de cuidado por esse escolar nos diversos espaços de socialização. Metodologia: estudo de natureza qualitativa, desenvolvido sob o método criativo sensível, através das dinâmicas de criatividade e sensibilidade Corpo Saber e Mapa Falante. Os participantes da pesquisa foram sete crianças portadoras de disfunção miccional, com idade entre 9-11 anos. O cenário de estudo foi um ambulatório de pediatria, situado em um hospital de ensino e pesquisa no estado do Rio de Janeiro. Os dados foram coletados no período entre fevereiro e março de 2015, e foram analisados a partir da análise de discurso em sua corrente francesa, sendo interpretados à luz do autocuidado de acordo com o conceito de Orem, a Teoria do Desenvolvimento Psicossocial de Erik Erikson e da educação em saúde com as concepções freirianas para a educação. Resultados:através da análise da prática de cuidados desses escolares, evidenciamos a preocupação com a higienização das mãos, da região íntima e do óstio de Mitrofanoff e, cuidados com o esvaziamento completo da bexiga. Quanto aos desafios, foram evidenciados a necessidade do uso de dispositivos para a visualização do meato urinário, dificuldades para a visualização do meato uretral feminino no período matutino, no posicionamento para a realização do autocateterismo, a presença de desconfortos com a sondagem uretral, a irregularidade na frequência do autocateterismo, as dificuldades para brincar em função da realização do autocateterismo, a (in) dependência no autocateterismo e o (des)velamento do autocateterismo nos diversos espaços de socialização. Conclusão: Revelou-se uma consciência ingênua na prática de cuidados, assim como fatores ambientais interferindo no autocuidado e riscos de infecção do trato urinário. Os diversos desafios enfrentados pelos escolares, na realização do autocateterismo, apontam para a necessidade de aproximação com estes de forma dinâmica e criativa, facilitando a exposição de suas dúvidas, medos e anseios, e para a promoção da conscientização crítica e a socialização dos saberes, capacitando-os para o autocuidado. Também na divulgação junto aos órgãos competentes, para a adequação social, com vistas à inclusão destas CRIANES nos diversos espaços de socialização.

Children suffering from voiding dysfunction, which stems from a neurological (neurogenic bladder) or a functional disorder, need special care to prevent deterioration of the lower urinary tract and kidney failure. In most cases of neurogenic bladder it is indicated clean intermittent catheterization. Also suitable for non-neurogenic dysfunction when you don`t get good results with other treatments. These are children with special health care needs(CSHCN), with changes in their daily lives. The nurse needs to interact with them, so that, at school age, they can together plan and manage the self-care necessary to facilitate the process of healthy living. Subject: clean intermittent catheterization performed by the children that suffers from voiding dysfunction. Objectives: To describe the practices from care concerning the clean intermittent catheterization performed by the children that suffers from voiding dysfunction and analyze the challenges for the realization of this practice by that children in the various spaces of socialization. Methodology: qualitative study developed under the sensitive creative method, through the dynamics of creativity and sensitivity "Corpo Saber e Mapa Falante". The survey participants were seven children with voiding dysfunction, aged 9-11 years.The study setting was an outpatient pediatric clinic located in a teaching hospital in the state of Rio de Janeiro. Data were collected between February and March 2015 and were analyzed from the speech analysis in its French stream being interpreted in the lightof the self-care according to the Orem concept, the Psychosocial Development Theory of Erik Erikson and of health education with Freirian concepts for education. Results: by analyzing the practice of these children we noted the concern on hands, genitals and the Mitrofanoff ostium hygienization, and, the complete evacuation of the bladder.Regarding the challenges, were highlighted the necessity of devices for visualizing the urinary meatus, difficulties in the visualization of the feminine urethral meatus in the morning, the position to perform the catheterization, the discomfort with the urethral probe, the irregularity in the frequency of catheterization, the difficulties to play due the realization of catheterization, the (in)dependence on autocatheterism and the (un)veiling of autocatheterism in various spaces of socialization. Conclusion: It was revealed an ingenuous consciousness in the practice of cares, as well as environmental factors interfering in the self-care and risk of urinary tract infection.The various challenges faced by the children in performing the catheterization point to the necessity of closer ties in a dynamic and creative way, facilitating the exposure of their doubts, fears and desires, to promote critical awareness and the socialization of knowledge, enabling them for self-care. Also, in the disclosure with the competent organs, to social adaptation, aiming to incorporate such CSHCN in various spaces of socialization.

Progress of application of urodynamics in children with voiding dysfunction / 中华实用儿科临床杂志

Voiding dysfunction is common in children,urodynamic study is necessary to evaluate voiding dysfunction.Recently,urodynamic studies in children with voiding dysfunction have been performed with increasing frequency as the techniques have been applied in most hospitals widely.New technologies,such as ultrasound urine flow in newborns and ambulatory urodynamics monitoring in children,have been used.Urodynamic has been used routinely in children with neurogenic bladder in China.This review summarized the application of urodynamics in children with voiding dysfunction and the relevant terminologies in pediatric urodynamics,in order to provide a reference for clinical applications and researches.

Incidence and risk factors of voiding dysfunction after mid-urethral sling surgery for stress urinary incontinence / 中华泌尿外科杂志

Objective To analyze the risk factors of voiding dysfunction after mid-urethral sling surgery for stress urinary incontinence.Methods Clinical data of 573 consecutive patients undergoing midurethral sling surgery from January 2003 to December 2010 were collected and analyzed retrospectively.All relative risk factors were evaluated by univariate and multivariate Logistic analysis to identify risk factors of voiding dysfunction.Results Voiding dysfunction occurred in 28 patients,with an incidence of 4.9％ (28/573).Univariate analysis showed that age,previous pelvic surgery,pre-operative postvoid residuals,maximum flow rate,average urine flow rate,Valsalva leak point pressure,concomitant anterior pelvic repair and operator performing＜50 procedures were the relative risk factors (P＜0.05) for voiding dysfunction.Multivariate logistic regression analysis revealed that the maximum flow rate (Qmax) ≤ 15 ml/s (OR=3.782,P=0.003) was an independent risk factor for voiding dysfunction and surgery experience was its protection factors (OR=0.295,P=0.016).Conclusions Qmax ≤ 15 ml/s on preoperative urodynamic study is an independent risk factor for voiding dysfunction after mid-urethral sling procedure.Improving skill of surgery and strengthening technical training will help to reduce the incidence of this complication.

Effect of Preoperative Flow Rate on Postoperative Retention and Voiding Difficulty After Transobturator Tape Operation

PURPOSE: Controversy exists over the preoperative risk factors for postoperative urinary retention after the midurethral sling procedure for stress urinary incontinence (SUI). We intended to analyze the effect of preoperative flow rate on postoperative urinary retention after the transobturator tape (TOT) operation. MATERIALS AND METHODS: A total of 322 patients who underwent TOT from June 2006 to May 2012 were included in this retrospective study. All patients were preoperatively investigated for urinary symptoms and underwent preoperative urodynamic studies including urine flow rate. Postoperative urinary retention, voiding difficulty, and uroflowmetry were checked. Urinary retention was defined as the need for additional catheterization longer than 1 day. Patients were divided by preoperative peak flow rate (Qmax) of 15 mL/s (low Qmax group and normal Qmax group). RESULTS: There were 3 cases of postoperative urinary retention (0.9%) and 52 cases of voiding difficulty (16.1%). The low Qmax group included 40 patients (12.4%) and the normal Qmax group included 282 patients (87.5%). Between the two groups, there were no significant differences in age, previous pelvic surgery history, or past medical history. The low Qmax group had higher scores for voided volume and detrusor pressure at Qmax. However, there was no significant difference in postoperative voiding difficulty between the two groups. Furthermore, three patients who experienced postoperative retention showed high flow rates preoperatively. CONCLUSIONS: Our results suggest that voiding difficulty in the group with low preoperative flow was tolerable and the treatment success rate was comparable to that in patients in the normal flow group. According to our analysis, patients with a low flow rate preoperatively can be safely treated with TOT for SUI.

The Treatment Experience Used Famciclovir in Herpes Zoster with Voiding Dysfunction in Female Patients

OBJECTIVE: Voiding dysfunction may be occurred due to the herpes zoster with lumbosacral lesion. We studied the clinical symptoms in patients with voiding dysfunction caused by herpes zoster. METHODS: We have investigated the medical records in 10 patients. These patients had urinary symptoms associated with herpes zoster. RESULTS: Dermatome levels were sacral(s) in 10 patients (s2, 4 patients; s3, 6 patients). Urologic symptoms were acute urinary retention in 10 patients who showed detrusor areflexia (7 patients) or detrusor hyporeflexia (3 patients) in urodynamics. All patients were managed by inserting catheter with alpha blocker. After 1 week we removed indwelling catheter. All patients were no problem in urination. CONCLUSION: The cause of voiding dysfunction is not known clearly in herpes zoster infection. But we investigated that Famciclovir 750 mg using oral medication and the urethral catheter insertion performed by one week was recovered from herpes zoster. Authors think it is useful for patients with impaired urination.

Autocuidado e qualidade de vida de idosas com Parkinson e disfunção miccional / Self-care and quality of life of elderly women with Parkinson's disease and bladder dysfunction

O comprometimento físico-mental, emocional, social e econômico associados aos sinais, sintomas e complicações secundárias a doença de Parkinson, especialmente a disfunção miccional, interfere no nível de incapacidade do indivíduo e pode influenciar negativamente a qualidade de vida. O presente estudo tem como objeto de investigação o autocuidado e qualidade de vida de idosas com Parkinson e disfunção miccional e tem como objetivos: determinar os efeitos da disfunção miccional na qualidade de vida de idosas com Doença de Parkinson através do questionário de qualidade e vida e contextualizar a percepção das idosas sob a perspectiva do autocuidado. Trata-se de um estudo quantitativo e qualitativo, exploratório e prospectivo, realizado no período de maio a junho de 2011, incluindo 20 idosas com idade a partir de 60 anos, com disfunção miccional ocasionada pela Doença de Parkinson e após assinarem o Termo de Consentimento Livre e Esclarecido. Na coleta de dados foram utilizados os instrumentos para caracterização sóciodemográfica, avaliação da Qualidade de Vida através do King Health Questionaire e três questões norteadoras que permitiram a livre contextualização das idosas. A análise quantitativa revelou que uma média maior de 50% das idosas mostrou percepção de sua saúde ruim, efeitos negativos e limitantes nas atividades da vida diária e de autocuidado, limitações físico-sociais, emocionais e no padrão de sono/energia. A análise qualitativa foi baseada na análise de conteúdo de Bardin, emergindo cinco categorias dos discursos das idosas: A Doença de Parkinson: o significado de suas vivências; Percepção e repercussão da disfunção miccional na qualidade de vida; Disfunção miccional: sentimentos relacionados à dependência para o autocuidado e Qualidade de vida: estratégias e desafios frente às adversidades. A Doença de Parkinson e a disfunção miccional demonstraram repercussões psicossociais devastadoras, evidenciadas por condições de fragilidade, dependência para o autocuidado e isolamento social impostos pela disfunção miccional. O estudo demonstrou a importância da busca de novas alternativas para melhorar a qualidade de vida de idosas com disfunção miccional ocasionada por Doença de Parkinson enfatizando a relevância das ações de enfermagem para o autocuidado.(AU)

The impaired development of physical, mental, emotional, social and economic aspects associated with the signs, symptoms and secondary complications of Parkinson's disease, especially voiding dysfunction, interferes with the individual's level of disability and can negatively influence the life quality. This study has as a objective of investigation the voiding self-care and quality of life of elderly women with Parkinson's disease and bladder dysfunction. It is a quantitative study with clipping qualitative, exploratory and prospective, conducted from May to June of 2011, including 20 elderly women aged above 60 years with voiding dysfunction caused by Parkinson's disease and after signing the Statement of Informed Consent. Data collection instruments were used for socio-demographic, assessment of quality of life through the King Health Questionnaire and three guiding questions in order to free the context of the elderly. The quantitative analysis revealed that an average greater than 50% of the women showed awareness their bad health, negative and limiting activities of daily living and self-care, physical limitations, social, emotional and pattern of sleep/energy. Qualitative analysis was based on content analysis of Bardin, emerging discourses of the five categories elderly, Parkinson's disease; The meaning of their experiences, perceptions and impact of voiding dysfunction on quality of life; Voiding dysfunction; Feelings related to their dependence to self-care and quality of life; Strategies and challenges in the face of adversity. Parkinson's Disease and voiding dysfunction showed devastating psychosocial effects, as evidenced by conditions of frailty, dependence for self-care and social isolation imposed by voiding dysfunction. The study demonstrated the importance of finding new alternatives to improve the quality of life of elderly women with voiding dysfunction caused by disease Parkinson's emphasis on the importance of nursing actions for self-care. (AU)

The efficacy of motor imagery therapy in treating neurogenic bladder control difficulties after spinal cord injury / 中华物理医学与康复杂志

Objective To explore the clinical efficacy of motor imagery therapy in treating neurogenic bladder dysfunction after traumatic spinal cord injury (SCI).Methods Seventy patients with neurogenic bladder control problems after SCI were randomly divided into an experimental group and a control group using a random number table.All patients of the two groups were given general bladder function intervention,including intermittent catheterization,inducing voiding by reflex detrusor contraction,Credé's maneuver urination,etc.Additionally,the patients in the experimental group were given supplemental motor imagery therapy.The times of urinary incontinence,average bladder capacity,maximum voided volume and residual urine volume of the two groups were measured before treatment and at 2 months after treatment.The two groups' outcomes were quantified using a quality of life (QOL) score.Results Incidents of urinary incontinence,average bladder capacity,residual urine volume,voided volume and the QOL score showed significant improvements in both groups,but the experimental group showed better improvements than the control group.The differences were statistically significant.Conclusion The combination of general bladder function intervention with motor imagery therapy can improve the voiding function of patients with neurogenic bladder disorders after SCI more significantly and enhance their QOL.

Urotherapy in Non-neurogenic Pediatric Voiding Dysfunction

Non-neurogenic pediatric voiding dysfunction is defined as a problem during bladder filling or emptying without any neurogenic abnormality in children. The appropriate treatment of non-neurogenic pediatric voiding dysfunction is important because the disorder is frequently seen in clinical practice and might result in damages of the child's bladder or kidney. Urotherapy can be defined as nonsurgical nonpharmacological treatment for voiding dysfunction, categorized into standard urotherapy or specific intervention. Understanding of the underlying pathophysiology of non-neurogenic pediatric voiding dysfunction will lead to a change in management, from expensive and potentially harmful medications and invasive procedures to effective, noninvasive treatment of urotherapy.

Urodynamic analysis on spinal cord injury patients with urinary voiding dysfunction / 中华泌尿外科杂志

Objective To find the differences of bladder and urethra dysfunction between sacral spinal cord injury and Thoracolumbar spinal cord injury.Methods According to the criteria of inclusion and exclusion, we collected 30 patients in the study group.There were 22 males and 8 females, aged 17 -74 ( mean, 47 ) years, with duration between 7 - 36 ( mean, 18) months.There were nineteen cases of thoracolumbar spinal cord injury and 11 cases of sacral spinal cord injury in the study group.We conducted a retrospective analysis of the urodynamic data of the 30 patients in the group.They were divided into a sacral spinal cord injury group and a thoracolumbar spinal cord injury group according to the location of the site of injury.The urodynamic findings of the two groups were comparable.SPSS 16.0 was used to compare the differences between the groups by ANOVA/rank sum test.Results We measured the free flow rate parameters between thoracolumbar and sacral spinal cord injury groups.The maximum free flow rate was ( 13.0 ±5.1 ) vs ( 13.0 ±5.8) ml/s, the free flow rate at 2 s was (6.5 ±5.1 ) vs (6.9 ±6.4) ml/s, the mean free flow rate was (5.4± 2.4) vs ( 3.4 ± 0.5 ) ml/s, urine output volume was ( 279.1 ±131.1 ) vs (450.0 ± 26.6) ml and the residual urine volume was (209.5 ± 180.7 ) vs (434.0 ± 215.0) ml.The residual urine volume and urine output volume of sacral the spinal cord injury group was higher than the thoracic spinal cord injury group (P ＜ 0.05).We also measured the the cystometric parameters.The maximum urinary flow rate was (16.0±23.3) vs (7.1 ±3.3) ml/s, average flow rate was (4.6 ±2.3) vs (3.9 ± 2.3) ml/s, the flow rate after voiding 2 s was (4.6 ± 3.1 ) vs (2.2 ± 3.2) ml/s, urine output volume was (268.4 ± 113.9) vs ( 129.0 ± 97.9) ml, detrusor pressure of maximum flow rate was (58.8 ± 22.0) vs (56.5 ± 14.5) cm H2 O, flow rate of maximum detrusor pressure was (4.8 ± 2.0) vs (4.8 ± 4.4) ml/s,the maximum detrusor pressure was (68.0 ± 31.0) vs (54.6 ± 20.2) cm H2O and the average pressure of voiding period was (47.4 ±20.0) vs (42.6 ± 13.9) cm H2O.The urine output volume of the thoracolumbar spinal cord injury group was lower than sacral spinal cord injury group ( P ＜ 0.05 ).There were no significant differences in bladder sensation and coordination of bladder/urethra between the thoracolumbar spinal cord injury group and the sacral spinal cord injury group (P ＞ 0.05).The incidence of low compliance bladder in the thoracolumbar spinal cord injury patients (4/11) was higher than the sacral spinal injury group, the incidence of high compliance bladder in the sacral spinal cord injury patients (11/19) was higherthan the thoracolumbar group.Conclusions The urodynamics' difference between the sacral spinal cord injury group and thoracolumbar spinal cord injury group was observed in bladder compliance and bladder detrusor contractility changes.Relatively, the incidence of decreased detrusor contractility and high compliance bladder in sacral spinal cord injury patients was higher, and the cidence of detrusor hyperreflexia and low compliance bladder in thoracolumbar spinal cord injury patients was higher.