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1.
Bol. méd. postgrado ; 36(2): 43-47, dic.2020. tab, graf
Article in Spanish | LILACS, LIVECS | ID: biblio-1117899

ABSTRACT

La uroflujometría es un estudio no invasivo del tracto urinario inferior que entrega información objetiva del flujo urinario y es ampliamente recomendado por las guías europeas en el estudio de pacientes con sintomatología urinaria baja. Se realizó un estudio descriptivo transversal cuyo propósito fue describir el uso de la uroflujometría en el estudio de síntomas del tracto urinario bajo en pacientes masculinos que acudieron a la consulta de Servicio de Urología del Hospital Central Universitario Dr. Antonio María Pineda de la ciudad de Barquisimeto, estado Lara durante el lapso 2018- 2019. La muestra estuvo conformada por 150 pacientes. Los resultados indican que el 62% de la muestra corresponde a pacientes entre 60 y 70 años de edad de los cuales 52% manifestaron síntomas urinarios leves. La uroflujometría evidenció que 56% de los pacientes tienen un flujo máximo entre 10 y 20 ml/seg lo cual sugiere una probable obstrucción al flujo de salida; 78% de los pacientes presentan un flujo promedio entre 0 a 10 ml/seg. El 53% de los pacientes mostró un volumen de vaciado < 300 ml y 49% un tiempo de flujo máximo entre 30 y 50 segundos. En conclusión, la uroflujometría es un examen simple y rápido que proporciona información útil sobre la salud de las vías urinarias inferiores(AU)


Uroflowmetry is a non-invasive study of the lower urinary tract that provides objective information on urinary flow and is widely recommended by European guidelines for the study of patients with lower urinary tract symptoms. We performed a cross-sectional descriptive study to describe the use of uroflowmetry for the study of lower urinary tract symptoms in males who attended the Servicio de Urología of the Hospital Central Universitario Dr. Antonio María Pineda (Barquisimeto, Lara state) during the 2018- 2019 period. The sample was made up of 150 males. The results show that 62% of the sample included males between 60 and 70 years old and 52% complained of mild urinary symptoms. Uroflowmetry results showed that 56% of patients had a maximum flow between 10 and 20 ml/sec suggestive of urinary tract obstruction; 78% had an average flow between 0 and 10 ml/sec while 53% had a micturition volume < 300 ml and 49% had a maximum flow time between 30 and 50 seconds. Uroflowmetry is a simple and fast test which provides useful information about the health of lower urinary tract(AU)


Subject(s)
Humans , Male , Middle Aged , Aged , Urethral Obstruction , Urinary Tract , Prostatism/diagnostic imaging , Conservative Treatment/methods , Urination , Urologic Diseases , Ultrasonography
2.
Prensa méd. argent ; 106(9): 550-554, 20200000.
Article in English | LILACS, BINACIS | ID: biblio-1362905

ABSTRACT

Objectives: This study aimed to assess the accuracy of post-void residual (PVR) urine volume measurements in patients with moderate bladder outlet obstruction. Materials and Methods: This prospective observational study was conducted between January and December 2019. The inclusion criteria were male patients with symptoms of moderate bladder outlet obstruction. On the other hand, patients with a history of diabetes, symptoms of urinary tract infection, and positive urine for pyuria, as well as patients using medications, such as diuretics, alpha-blockers, and anticholinergic drugs, were excluded. The patients were asked to drink 1000 mL of water one to two hours before the initial ultrasound scan. Pre-void bladder capacity was measured, followed by a post-void ultrasound for residual urine volume measurement at three intervals: immediately after voiding, 15-20 minutes after the first void, and one week later with an empty bladder. Assessment of per-void capacity was carried out, based on the patient's subjective sensation of bladder fullness (a strong desire to void). Results: A total of 78 male patients, with the mean age of 60 years, were included in this study (27 cases in group I; 37 cases in group II; and 14 cases in group III). The mean PVR volume was 92 mL in the first measurement, 62 mL in the second measurement, and 60 mL in the third measurement. Significant differences were found between the first and second PVR measurements and between the first and third PVR measurements (P<0.05). However, no significant difference was found between the second and third PVR measurements (P=0.107). On the other hand, significant differences were found between groups I and II and between groups I and III (P<0.05) in the three PVR measurements. Nevertheless, there was no significant difference between groups II and III in the three PVR measurements (P=0.204, 0.56, and 0.487 for the first, second, and third PVR measurements, respectively). Conclusion: A bladder ultrasound must be performed and interpreted carefully to avoid further unnecessary medications, investigations, or procedures. We recommend a second PVR measurement in patients with bladder outlet obstruction. Also, it is suggested to conduct similar studies in different conditions to confirm our findings.


Subject(s)
Humans , Male , Middle Aged , Urethral Obstruction/complications , Urination , Urine , Urinary Bladder/pathology , Ultrasonography
3.
Prensa méd. argent ; 106(8): 503-507, 20200000.
Article in English | LILACS, BINACIS | ID: biblio-1363926

ABSTRACT

Objectives: This study aimed to assess the accuracy of post-void residual (PVR) urine volume measurements in patients with moderate bladder outlet obstruction. Materials and Methods: This prospective observational study was conducted between January and December 2019. The inclusion criteria were male patients with symptoms of moderate bladder outlet obstruction. On the other hand, patients with a history of diabetes, symptoms of urinary tract infection, and positive urine for pyuria, as well as patients using medications, such as diuretics, alphablockers, and anticholinergic drugs, were excluded. The patients were asked to drink 1000 mL of water one to two hours before the initial ultrasound scan. Pre-void bladder capacity was measured, followed by a post-void ultrasound for residual urine volume measurement at three intervals: immediately after voiding, 15-20 minutes after the first void, and one week later with an empty bladder. Assessment of per-void capacity was carried out, based on the patient's subjective sensation of bladder fullness (a strong desire to void). Results: A total of 78 male patients, with the mean age of 60 years, were included in this study (27 cases in group I; 37 cases in group II; and 14 cases in group III). The mean PVR volume was 92 mL in the first measurement, 62 mL in the second measurement, and 60 mL in the third measurement. Significant differences were found between the first and second PVR measurements and between the first and third PVR measurements (P<0.05). However, no significant difference was found between the second and third PVR measurements (P=0.107). On the other hand, significant differences were found between groups I and II and between groups I and III (P<0.05) in the three PVR measurements. Nevertheless, there was no significant difference between groups II and III in the three PVR measurements (P=0.204, 0.56, and 0.487 for the first, second, and third PVR measurements, respectively). Conclusion: A bladder ultrasound must be performed and interpreted carefully to avoid further unnecessary medications, investigations, or procedures. We recommend a second PVR measurement in patients with bladder outlet obstruction. Also, it is suggested to conduct similar studies in different conditions to confirm our findings.


Subject(s)
Humans , Male , Middle Aged , Aged , Urethral Obstruction , Urination , Urinary Bladder Neck Obstruction/urine , Prospective Studies , Ultrasonography , Urine Specimen Collection
4.
Article in Chinese | WPRIM | ID: wpr-826685

ABSTRACT

OBJECTIVE@#To explore the preventive effect of acupuncture at Ciliao (BL 32) on postpartum urinary retention as well as the time and volume of the first urination after delivery in elderly parturient women undergoing vaginal delivery.@*METHODS@#A total of 180 elderly parturient women (≥35 years old) undergoing vaginal delivery were randomly divided into a blank control group, a conditional control group and an observation group, 60 cases in each group. The patients in the blank control group were treated with routine nursing plan; based on the treatment of the blank control group, the patients in the conditional control group were treated with additional intervention measures such as applying hot towel on the bladder and fingers pressing to stimulate urination; based on the treatment of the blank control group, the patients in the observation group were treated with acupuncture at bilateral Ciliao (BL 32) one hour after delivery for 20 min (the acupuncture was given only once). The incidence rate of postpartum urinary retention as well as the time and volume of the first urination among the women without urinary retention were observed; the satisfaction rate of the 3 groups was recorded.@*RESULTS@#The incidence rate of postpartum urinary retention in the observation group was 5.0% (3/60), which was significantly lower than 26.7% (16/60) in the blank control group (<0.01) and 16.7% (10/60) in the conditional control group (<0.05); the incidence rate of postpartum urinary retention in the conditional control group was significantly lower than that in the blank control group [16.7% (10/60) vs 26.7%(16/60), <0.05]. In the elderly women without urinary retention, the first urination time in the observation group was significantly earlier than that in the blank control group and conditional control group (<0.01), and the first urination time in the conditional control group was earlier than that in the blank control group (<0.01). The volume of first urination in the observation group was higher than that in the blank control group and the conditional control group (<0.05, <0.01). The satisfaction rates in the observation group and conditional control group were higher than that in the blank control group (<0.01).@*CONCLUSION@#Acupuncture at Ciliao (BL 32) could effectively prevent the postpartum urinary retention, improve the time and volume of the first urination in elderly parturient women undergoing vaginal delivery.


Subject(s)
Acupuncture Points , Acupuncture Therapy , Adult , Female , Humans , Postpartum Period , Pregnancy , Urinary Bladder , Urinary Retention , Therapeutics , Urination
5.
Rev. Col. Bras. Cir ; 47: e20202605, 2020. tab
Article in English | LILACS | ID: biblio-1136559

ABSTRACT

ABSTRACT Introduction: despite being infrequent, urinary incontinence has a huge impact on the quality of life of patients undergoing radical prostatectomy, even with the robotic-assisted technique. Objective: to assess the evolution of urinary symptoms from preoperative to 12 months after robotic-assisted radical prostatectomy. Methods: data was collected from 998 patients who underwent robotic-assisted radical prostatectomy. Demographic data, preoperative and postoperative information on patients were documented. The ICIQ and IPSS questionnaires were also applied preoperatively and after 1, 3, 6 and 12 months after the operation. Results: Out of 998 patients, 257 correctly completed all questionnaires. The mean age of the patients was 60 ± 0.74 years. We found that the total IPSS increased initially and at 6 months after the operation, it was already lower than the initial preoperative value (7.76 at 6 months vs. 9.90 preoperative, p <0.001), being that questions regarding voiding symptoms were the first to improve followed by the questions regarding post micturition and storage symptoms. As for the ICIQ variables, there was an increase with radical prostatectomy and none of them returned to the preoperative level (p<0.001). Conclusions: robotic assisted radical prostatectomy causes, at first, a worsening of urinary symptoms in the lower tract with subsequent recovery. Recovery begins with voiding symptoms, followed by post micturition and storage symptoms. The symptoms assessed by the IPSS evolve to better parameters even than those of the preoperative period, while the symptoms of incontinence assessed by the ICIQ do not reach the preoperative levels in the studied interval.


RESUMO Introdução: apesar de infrequente, a incontinência urinária gera imenso impacto na qualidade de vida dos pacientes submetidos a prostatectomia radical, mesmo com a técnica robótica-assistida. Objetivo: avaliar a evolução dos sintomas urinários desde o pré-operatório até 12 meses após a prostatectomia radical robótica-assistida. Métodos: foram coletados os dados de 998 pacientes submetidos à prostatectomia radical robótica-assistida. Foram documentados dados demográficos, informações pré-operatórias e pós-operatórias dos pacientes. Também foram aplicados os questionários ICIQ e IPSS no pré-operatório e após 1, 3, 6 e 12 meses de pós-operatório. Resultados: de 998 pacientes, 257 preencheram corretamente todos os questionários. A idade média dos pacientes foi de 60±0,74 anos. Verificou-se que o IPSS total subia inicialmente e aos 6 meses após a operação, este já se tornava inferior ao valor inicial pré-operatório (7,76 aos 6 meses vs. 9,90 pré-operatório, p<0.001), sendo que as questões referentes a sintomas de esvaziamento foram as primeiras a melhorar e posteriormente as questões referentes a sintomas pós-miccionais e de armazenamento. Quanto às variáveis do ICIQ, houve elevação com a prostatectomia radical e nenhuma delas retornou ao patamar pré-operatório (p<0,001). Conclusões: a prostatectomia radical robótica assistida causa num primeiro momento uma piora nos sintomas urinários do trato inferior com uma recuperação subsequente. A recuperação se inicia pelos sintomas de esvaziamento, seguido dos sintomas pós-miccionais e de armazenamento. Os sintomas avaliados pelo IPSS acabam evoluindo a parâmetros melhores inclusive que os do pré-operatório, enquanto os sintomas de perda urinária avaliados pelo ICIQ não atingem os níveis pré-operatórios no intervalo estudado.


Subject(s)
Humans , Male , Aged , Prostatectomy/adverse effects , Prostatic Neoplasms/surgery , Quality of Life , Urinary Incontinence/etiology , Urination Disorders/etiology , Lower Urinary Tract Symptoms/complications , Robotic Surgical Procedures/adverse effects , Prostatectomy/methods , Urination , Treatment Outcome , Middle Aged
6.
Fisioter. Bras ; 20(5): 675-680, Outubro 24, 2019.
Article in Portuguese | LILACS | ID: biblio-1281736

ABSTRACT

A dengue pode desencadear manifestações neurológicas como a Síndrome de Encefalomielite Aguda Disseminada (ADEM), de caráter inflamatório, desmielinizante, que pode ter dentre as consequências déficits motores e sensitivos, neurite ótica e disfunções vesicais, como a retenção urinária, tornando o indivíduo dependente da realização do cateterismo vesical intermitente (CVI). Desta forma, o objetivo deste estudo é descrever o tratamento fisioterapêutico de uma paciente com retenção urinária, decorrente de Síndrome de ADEM pós-dengue. Paciente do sexo feminino, 52 anos, internada em hospital de média complexidade com diagnóstico de ADEM. Na avaliação inicial apresentava grau de força muscular 3 de membros inferiores e 4 de membros superiores, 2 de musculatura do assoalho pélvico (MAP) e retenção urinária, necessitando realizar CVI. Foram realizados 32 atendimentos com duração de uma hora, incluindo o treinamento do assoalho pélvico em diferentes posturas e eletroestimulação de superfície da MAP com equipamento da marca Ibramed. Paciente recebeu alta hospitalar com evidente melhora da força muscular global e sem necessidade de CVI, apresentando micção voluntária e sem resíduo pós-miccional, favorecendo a prevenção de agravos do trato urinário inferior e superior. (AU)


Dengue can trigger neurological manifestations such as Acute Disseminated Encephalomyelitis (ADEM), with inflammatory, demyelinating condition, which may have, among the consequences, motor and sensory deficits, optic neuritis and bladder dysfunctions, such as urinary retention, making the individual dependent on intermittent bladder catheterization (IBC). Therefore, the objective of this study was to describe the physiotherapeutic treatment of a patient with urinary retention, due to ADEM syndrome after dengue. A 52-year-old female patient admitted to a hospital of medium complexity with a diagnosis of ADEM. In the initial evaluation, she presented a degree 3 of muscular strength in the lower limbs and 4 in the upper limbs, 2 in pelvic floor musculature (PFM) and urinary retention, requiring IBC. We performed 32 one hour sessions, including pelvic floor muscle training in different positions and surface electrostimulation of PFM with Ibramed brand equipment. Patient was discharged with evident improvement of global muscle strength and without IBC, presenting voluntary voiding and without post void residual, favoring the prevention of lower and upper urinary tract injuries. (AU)


Subject(s)
Humans , Urinary Retention , Pelvic Floor , Encephalomyelitis, Acute Disseminated , Urination , Urinary Bladder, Neurogenic , Dengue , Muscle Strength
7.
Säo Paulo med. j ; 137(5): 446-453, Sept.-Oct. 2019. tab, graf
Article in English | LILACS | ID: biblio-1059096

ABSTRACT

ABSTRACT BACKGROUND: Lower urinary tract symptoms significantly worsen quality of life. The hypothesis that they might lead to serious systolic blood pressure alterations through inducing sympathetic nervous activity has not been studied so far. OBJECTIVES: To investigate the relationship between benign prostate enlargement-related storage and voiding symptoms and systolic blood pressure. DESIGN AND SETTING: Cross-sectional single-center study on data from a hospital patient record system. METHODS: We evaluated the medical records of all consecutive patients with benign prostate enlargement-related lower urinary tract symptoms admitted between January 2012 and December 2017. Storage and voiding symptoms were assessed separately. International Prostate Symptom Score, uroflowmetry, postvoiding residual urine volume and systolic blood pressure were recorded. Pearson correlation and linear regression analysis were used. RESULTS: Positive correlations were found between systolic blood pressure and all of the storage symptoms. Among these, urgency had the most significant effect. There were 166 patients (41.4%) with urgency for urination, which increased mean systolic blood pressure from 124.88 mmHg (average value in elevated blood pressure group) to 132.28 mmHg (average value in stage-1 hypertension group). Hesitancy in urinating and feeling of incomplete bladder emptying had weak positive correlations with systolic blood pressure. There was a negative correlation between systolic blood pressure and intermittency of urination. CONCLUSIONS: With increasing numbers of urine storage symptoms, systolic blood pressure also increases, while the opposite occurs for voiding symptoms in patients with benign prostate enlargement. We conjecture that storage symptoms may lead to this increase through inducing sympathetic hyperactivity. Further prospective studies with larger groups are needed to confirm these findings.


Subject(s)
Male , Middle Aged , Aged , Prostatic Hyperplasia/complications , Urination/physiology , Blood Pressure/physiology , Lower Urinary Tract Symptoms/complications , Hypertension/complications , Organ Size , Prostate/physiopathology , Severity of Illness Index , Cross-Sectional Studies , Lower Urinary Tract Symptoms/physiopathology , Hypertension/physiopathology
8.
Int. braz. j. urol ; 45(4): 775-781, July-Aug. 2019. tab, graf
Article in English | LILACS | ID: biblio-1019893

ABSTRACT

ABSTRACT Purpose To identify how the most frequently used parameters in daily clinical practice diagnosing bladder outlet obstruction (BOO) due to benign prostate hyperplasia (BPH) correlate to each other. Materials and methods The study included 452 patients with lower urinary tract symptoms (LUTS) of the UNICAMP urology outpatient clinic of LUTS. Inclusion criteria: patients with BOO due to BPH who agreed to participate in the study. Exclusion criteria: patients with urinary tract infection, neurological diseases that compromised the lower urinary tract, prior prostatic surgery, radiotherapy or urethral stenosis. Patient assessment: history, international prostate symptoms score (IPSS), nocturnal quality of life score (NQoL) questionnaires, physical and digital rectal examination (DRE), PSA, transabdominal ultrasound with intravesical prostate protrusion (IPP), post-mictional residue and free uroflowmetry. Results There was no strong Spearman correlation among the studied variables. The only moderate correlations occurred between IPSS and NQoL (p <0001; c=0.56) and between IPP and prostate volume (p <0001; c=0.57). Weak correlations between IPP and post-mictional residue (p <0001; c=0.31) and free uroflowmetry (p <0001; c=-0.26); and between IPSS and free uroflowmetry (p <0001, c=-0.21) were observed. Conclusion In this study, we found moderate, weak, very weak and absent correlation among the various parameters used in the diagnosis and management of BOO due to BPH. As the value of these tools is variable, the creation of a logical and objective algorithm was not possible and the treatment is based on the interpretation of clinical symptoms.


Subject(s)
Humans , Male , Adult , Aged , Aged, 80 and over , Prostatic Hyperplasia/diagnosis , Urinary Bladder Neck Obstruction/diagnosis , Lower Urinary Tract Symptoms/diagnosis , Organ Size , Prostate/pathology , Prostatic Hyperplasia/physiopathology , Prostatic Hyperplasia/pathology , Quality of Life , Reference Standards , Urination/physiology , Urodynamics/physiology , Urinary Bladder Neck Obstruction/physiopathology , Urinary Bladder Neck Obstruction/pathology , Surveys and Questionnaires , Regression Analysis , Ultrasonography/methods , Statistics, Nonparametric , Digital Rectal Examination , Lower Urinary Tract Symptoms/physiopathology , Lower Urinary Tract Symptoms/pathology , Middle Aged
9.
Int. braz. j. urol ; 45(4): 703-712, July-Aug. 2019. tab, graf
Article in English | LILACS | ID: biblio-1019887

ABSTRACT

ABSTRACT Introduction Robot-assisted radical prostatectomy (RARP) is the most recent surgical technique for localized prostate cancer. The Da Vinci (Intuitive Surgical, Sunnyvale, CA) system was first introduced in Brazil in 2008, with a fast growing number of surgeries performed each year. Objective Our primary endpoint is to analyze possible predictors of functional outcomes, related to patient and tumor features. As secondary endpoint, describe functional outcomes (urinary continence and sexual potency) from RARP performed in the Sírio-Libanês Hospital (SLH), a private institution, in São Paulo, from April 2008 to December 2015. Materials and Method Data from 104 consecutive patients operated by two surgeons from the SLH (MA and SA) between 2008 and 2015, with a minimum 12 months follow-up, were collected. Patient features (age, body mass index - BMI, PSA, date of surgery and sexual function), tumor features (tumor stage, Gleason and surgical margins) and follow-up data (time to reach urinary continence and sexual potency) were the variables collected at 1, 3, 6 and 12 month and every 6 months thereafter. Continence was defined as the use of no pad on medical interview and sexual potency defined as the capability for vaginal penetration with or without fosphodiesterase type 5 inhibitors. Results Mean age was 60 years old and mean BMI was 28.45 kg/m2. BMI >30kg/m2 (p<0.001) and age (p=0.011) were significant predictors for worse sexual potency after surgery. After 1, 3, 6 and 12 months, 20.7%, 45.7%, 60.9% and 71.8% from patients were potent, respectively. The urinary continence was reached in 36.5%, 80.3%, 88.6% and 92.8% after 1, 3, 6 and 12 months, respectively. Until the end of the study, only one patient was incontinent and 20.7% were impotent. Conclusion Age was a predictor of urinary and erectile function recovery in 12 months. BMI was significant factor for potency recovery. We obtained in a private hospital good functional results after 12 months of follow-up.


Subject(s)
Humans , Male , Adult , Aged , Aged, 80 and over , Prostatectomy/methods , Urination/physiology , Penile Erection/physiology , Recovery of Function/physiology , Robotic Surgical Procedures/methods , Prostatic Neoplasms/surgery , Prostatic Neoplasms/physiopathology , Time Factors , Urinary Incontinence/physiopathology , Brazil , Adenocarcinoma/surgery , Adenocarcinoma/physiopathology , Body Mass Index , Retrospective Studies , Age Factors , Treatment Outcome , Kaplan-Meier Estimate , Erectile Dysfunction/physiopathology , Middle Aged
11.
Article in English | WPRIM | ID: wpr-764126

ABSTRACT

In upcoming fourth industrial revolution era, it is inevitable to address smart healthcare as not only scientist but also clinician. We have the task to plan and realize this through human imagination, creativity, and applicability for the clarification of the direction of the development and utilization of this technology. One thing that is clear is that it is important to understand what information is needed, how to interpret it, what will be the outcomes, and how to respond in artificial intelligence and Internet of Things era. Therefore, we would like to briefly discuss the characteristics of smart healthcare, and, suggest one approach that is easily applicable in the current situation.


Subject(s)
Artificial Intelligence , Creativity , Delivery of Health Care , Humans , Imagination , Internet , Urination
12.
Article in English | WPRIM | ID: wpr-764123

ABSTRACT

PURPOSE: The brainstem plays an important role in the control of micturition, and brainstem strokes are known to present with micturition dysfunction. Micturition dysfunction in cases of lateral medullary infarction (LMI) is uncommon, but often manifests as urinary retention. In this study, we investigated the neuro-anatomical correlates of urinary retention in patients with LMI. METHODS: This was a hospital-based retrospective study conducted in the neurology unit of a quaternary-level teaching hospital. Inpatient records from January 2008 to May 2018 were searched using a computerized database. Cases of isolated LMI were identified and those with micturition dysfunction were reviewed. MRI brain images of all patients were viewed, and individual lesions were mapped onto the Montreal Neurological Institute (MNI) space manually using MRIcron. Nonparametric mapping toolbox software was used for voxel-based lesion-symptom analysis. The Liebermeister test was used for statistical analysis, and the resultant statistical map was displayed on the MNI template using MRIcron. RESULTS: During the study period, 31 patients with isolated LMI were identified. Their mean age was 48 years and 28 (90%) were male. Six of these patients (19%) developed micturition dysfunction. All 6 patients had urinary retention and 1 patient each had urge incontinence and overflow incontinence. In patients with LMI, the lateral tegmentum of the medulla showed a significant association with urinary retention. CONCLUSIONS: In patients with isolated LMI, we postulate that disruption of the descending pathway from the pontine micturition centre to the sacral spinal cord at the level of the lateral tegmentum results in urinary retention.


Subject(s)
Brain , Brain Stem , Hospitals, Teaching , Humans , Infarction , Inpatients , Magnetic Resonance Imaging , Male , Neurology , Retrospective Studies , Spinal Cord , Stroke , Urinary Incontinence, Urge , Urinary Retention , Urination
13.
Article in English | WPRIM | ID: wpr-764116

ABSTRACT

This article reviewed the current knowledge on time-course manifestation of diabetic urethral dysfunction (DUD), and explored an early intervention target to prevent the contribution of DUD to the progression of diabetes-induced impairment of the lower urinary tract (LUT). In the literature search through PubMed, key words used included “diabetes mellitus,” “diabetic urethral dysfunction,” and “diabetic urethropathy.” Polyuria and hyperglycemia induced by diabetes mellitus (DM) can cause the time-dependent changes in functional and morphological manifestations of DUD. In the early stage, it promotes urethral dysfunction characterized by increased urethral pressure during micturition. However, the detrusor muscle of the bladder tries to compensate for inducing complete voiding by increasing the duration and amplitude of bladder contractions. As the disease progresses, it can induce an impairment of coordinated micturition due to dyssynergic activity of external urethra sphincter, leading to detrusor-sphincter dyssynergia. The impairment of relaxation mechanisms of urethral smooth muscles (USMs) may additionally be attributable to decreased responsiveness to nitric oxide, as well as increased USM responsiveness to α1-adrenergic receptor stimulation. In the late stage, diabetic neuropathy may play an important role in inducing LUT dysfunction, showing that the decompensation of the bladder and urethra, which can cause the decrease of voiding efficiency and the reduced thickness of the urothelium and the atrophy of striated muscle bundles, possibly leading to the vicious cycle of the LUT dysfunction. Further studies to increase our understandings of the functional and molecular mechanisms of DUD are warranted to explore potential targets for therapeutic intervention of DM-induced LUT dysfunction.


Subject(s)
Ataxia , Atrophy , Diabetes Mellitus , Diabetic Neuropathies , Early Intervention, Educational , Hyperglycemia , Lower Urinary Tract Symptoms , Muscle, Smooth , Muscle, Striated , Nitric Oxide , Polyuria , Relaxation , Urethra , Urinary Bladder , Urinary Tract , Urination , Urothelium
14.
Article in English | WPRIM | ID: wpr-764115

ABSTRACT

PURPOSE: To test the hypothesis that naftopidil prolongs intercontraction intervals in rats undergoing chronic stress as observed in previous animal models, voiding behavior and bladder function were measured and analyzed. METHODS: Female Sprague-Dawley rats weighing 200–230 g were exposed to repeated variate stress (RVS) for 1 week, chronic variable mild stress for 2 weeks, or simple mild stress for 1 week. Voiding behavior was assessed in metabolic cages. Voiding frequency and urine output were measured, and changes of these values were compared for the different types of stress. Micturition reflex was analyzed using unconscious cystometry. Naftopidil was administered orally at 30 mg/kg/day for 2 weeks. RESULTS: Unexpectedly, no stress-exposed rats exhibited increased micturition frequency compared to the normal nonstressed control. However, intercontraction intervals were shortened with each type of stress in the unconscious condition, especially by RVS (P<0.01). Naftopidil prolonged the shortened intervals. CONCLUSIONS: Although voiding behavior appears approximately normal in rats chronically exposed to emotional stress, internal bladder function can be affected. With anesthesia, micturition intervals were moderately shortened by emotional stress and clearly improved by naftopidil. Therefore, naftopidil appears to act at the spinal level at least.


Subject(s)
Anesthesia , Animals , Female , Humans , Lower Urinary Tract Symptoms , Models, Animal , Rats , Rats, Sprague-Dawley , Reflex , Stress, Psychological , Urinary Bladder , Urination
15.
Article in English | WPRIM | ID: wpr-764114

ABSTRACT

PURPOSE: Sacral nerve stimulation has been used to treat overactive bladder. This study evaluated the effects of stimulation using different pulse widths on the inhibition of bladder overactivity by sacral nerve stimulation (SNM) in pigs. METHODS: Implant-driven stimulators were used to stimulate the S3 spinal nerve in 7 pigs. Cystometry was performed by infusing normal saline (NS) or acetic acid (AA). SNM at pulse widths of 64 μsec to 624 μsec was conducted at the intensity threshold at which observable perianal and/or tail movement was induced. Multiple cystometrograms were performed to determine the effects of different pulse widths on the micturition reflex. RESULTS: AA-induced bladder overactivity reduced the bladder capacity to 46.9%±7.1% of the NS control level (P0.05). The actual intensity threshold varied from 0.7 to 8 V. The mean intensity threshold (T visual) for pulse widths of 64 μs, 204 μs, and 624 μs were 5.64±0.76 V, 3.11±0.48 V, and 2.52±0.49 V. T visual for pulse widths of 64 μsec was larger than the other two T visual for pulse widths of 204 μsec and 624 μsec (P0.05). CONCLUSIONS: This study indicated that different pulse widths could play a role in inhibiting bladder overactivity. It is not yet certain which pulse widths increased bladder capacity compared with AA levels, to minimize energy consumption and maintain patient comfort during stimulation, 204 μsec may be an appropriate pulse width for SNM.


Subject(s)
Acetic Acid , Humans , Reflex , Spinal Nerves , Swine , Tail , Urinary Bladder , Urinary Bladder, Overactive , Urination
16.
Article in English | WPRIM | ID: wpr-764103

ABSTRACT

PURPOSE: The aim of this study was to characterize the responsiveness of miniature excitatory postsynaptic currents (mEPSCs) to α1-adrenoceptor blockers in substantia gelatinosa (SG) neurons from the spinal cord to develop an explanation for the efficacy of α1-adrenoceptor blockers in micturition dysfunction. METHODS: Male adult Sprague-Dawley rats were used. Blind whole-cell patch-clamp recordings were performed using SG neurons in spinal cord slices. Naftopidil (100μM), tamsulosin (100μM), or silodosin (30μM), α1-adrenoceptor blockers, was perfused. The frequency of mEPSCs was recorded in an SG neuron to which the 3 blockers were applied sequentially with wash-out periods. Individual frequencies in a pair before naftopidil and tamsulosin perfusion were plotted as baseline, and the correlation between them was confirmed by Spearman correlation coefficient; linear regression was then performed. The same procedure was performed before naftopidil and silodosin perfusion. Frequencies of pairs after naftopidil and tamsulosin perfusion and after naftopidil and silodosin perfusion were similarly analyzed. The ratios of the frequencies after treatment to before were then calculated. RESULTS: After the treatments, Spearman ρ and the slope were decreased to 0.682 from 0.899 at baseline and 0.469 from 1.004 at baseline, respectively, in the tamsulosin group relative to the naftopidil group. In the silodosin group, Spearman ρ and the slope were also decreased to 0.659 from 0.889 at baseline and 0.305 from 0.989 at baseline, respectively, relative to the naftopidil group. Naftopidil significantly increased the ratio of the frequency of mEPSCs compared to tamsulosin and silodosin (P=0.015 and P=0.004, respectively). CONCLUSIONS: There was a difference in responsiveness in the frequency of mEPSCs to α1-adrenoceptor blockers, with the response to naftopidil being the greatest among the α1-adrenoceptor blockers. These data are helpful to understand the action mechanisms of α1-adrenoceptor blockers for male lower urinary tract symptoms in clinical usage.


Subject(s)
Adrenergic alpha-1 Receptor Antagonists , Adult , Animals , Excitatory Postsynaptic Potentials , Humans , Linear Models , Lower Urinary Tract Symptoms , Male , Neurons , Perfusion , Rats , Rats, Sprague-Dawley , Spinal Cord , Substantia Gelatinosa , Urination
17.
Article in English | WPRIM | ID: wpr-764096

ABSTRACT

PURPOSE: In recent years, the importance of patient satisfaction and quality of life—referred to as patient-related outcomes— has been emphasized, in addition to the evaluation of symptoms and severity through questionnaires. However, the questionnaires that can be applied to Korean patients with neurogenic bladder are limited. Therefore, the current study linguistically validated the Intermittent Self-Catheterization Questionnaire (ISC-Q) as an instrument to evaluate the quality of life of Korean patients with neurogenic bladder who regularly perform clean intermittent catheterization (CIC). METHODS: The validation process included permission for translation, forward translations, reconciliation, backward translation, cognitive debriefing, and proofreading. Two bilingual translators independently translated the original version of the ISC-Q into Korean and then combined the initial translations. A third bilingual translator performed a backward translation of the reconciled version into English. Five Korean-speaking patients with neurogenic bladder carried out the cognitive debriefing. RESULTS: During the forward translation process, the 24 questions of the ISC-Q were translated into 2 Korean versions. The terms used in each version were adjusted from the original version to use more conceptually equivalent expressions in Korean. During the backward translation process, several changes were involving substitutions of meaning. In the cognitive debriefing process, 5 patients were asked to complete the questionnaire. All patients agreed that the questionnaire explained their situation well. CONCLUSIONS: This study presents a successful linguistic validation of the Korean version of the ISC-Q, which could be a useful tool for evaluating treatment satisfaction in patients with neurogenic bladder performing CIC regularly.


Subject(s)
Catheterization , Catheters , Humans , Intermittent Urethral Catheterization , Linguistics , Patient Satisfaction , Quality of Life , Translations , Urinary Bladder, Neurogenic , Urination
18.
Article in English | WPRIM | ID: wpr-762586

ABSTRACT

Congenital rubella infection is a transplacental infection that can cause intrauterine growth retardation, cataracts, patent ductus arteriosus, hearing loss, microcephaly, thrombocytopenia, and severe fetal injury. It has been shown that type 1 diabetes mellitus develops in 12%–20% of patients with congenital rubella infection, and disorders in the oral glucose tolerance test is observed in 40% of patients. No biochemical or serological markers exist which could indicate that type 1 diabetes was caused by a congenital rubella infection. We report a 13-year-old male patient who was admitted to our hospital with complaints of new-onset polyuria, polydipsia, urination, and weight loss. In addition, he was found to have neurosensory hearing loss, patent ductus arteriosus, and microcephaly. Immunemediated type 1 diabetes mellitus was considered due to the fact that the autoantibodies of diabetes mellitus were positive.


Subject(s)
Adolescent , Autoantibodies , Cataract , Diabetes Mellitus , Diabetes Mellitus, Type 1 , Ductus Arteriosus, Patent , Fetal Growth Retardation , Glucose Tolerance Test , Hearing Loss , Humans , Male , Microcephaly , Polydipsia , Polyuria , Rubella , Thrombocytopenia , Urination , Weight Loss
19.
Article in English | WPRIM | ID: wpr-785856

ABSTRACT

Shift workers often experience problems associated with circadian disruption associated with artificial light at night and nocturia is commonly noted in night-shift workers. Nocturia associated with circadian disruption is due to increased urine production of the kidney and decreased storage function of the bladder. A recent discovery of peripheral clock genes in the bladder and their role in contractile property of the bladder support that micturition is closely related to the circadian rhythm. Moreover, there are clinical studies showed that shift workers more often experienced nocturia due to circadian disruption. However, comparing with other health problems, concerns on nocturia and voiding dysfunction associated with circadian disruption are insufficient. Therefore, further studies about voiding dysfunction associated with the circadian disruption in shift workers are necessary.


Subject(s)
Circadian Clocks , Circadian Rhythm , Kidney , Nocturia , Urinary Bladder , Urination
20.
Article in English | WPRIM | ID: wpr-785847

ABSTRACT

PURPOSE: To evaluate seasonal variations of overactive bladder (OAB) symptoms in women who visited hospital clinics.METHODS: Medical records of female patients treated for OAB symptoms from January 2011 to December 2017 were retrospectively reviewed. Patients with pyuria at the first visit, those who did not complete the questionnaire, and those with <3 overactive bladder symptom scores (OABSS) were excluded. Uroflowmetric parameters, 3-day micturition diary, and OABSS were analyzed.RESULTS: A total of 582 patients with OAB symptoms who visited the hospital were enrolled in this study. Patients were grouped into 1 of the 3 season groups (cold, intermediate, and hot) depending on the average temperature of the month that the patient first visited the urologic department outpatient clinic. The total OABSS was significantly different between the 3 season groups (cold [7.25±3.20] vs. intermediate [6.24±3.40] vs. hot [5.51±3.20], P=0.001). The proportion of patients who had moderate OAB symptoms (6≤OABSS) was higher in the cold season group (56.2%) than in the other season groups (intermediate, 42.1%; hot, 31.8%; P=0.002). Differences in the number of micturitions (12.12±4.56 vs. 10.95±4.39, P=0.021) and number of urgent urinary incontinence episodes (2.06±0.94 vs. 2.48±0.87, P=0.001) between the cold and hot season groups were also significant. However, differences in the nocturia episode, total daytime voided volume, and mean voided volume between season groups were not significant.CONCLUSIONS: Different urinary symptoms and uroflowmetric parameters were correlated with seasonal variation. OAB symptoms might be worse in cold season than in other seasons.


Subject(s)
Ambulatory Care Facilities , Female , Humans , Medical Records , Nocturia , Pyuria , Retrospective Studies , Seasons , Urinary Bladder, Overactive , Urinary Incontinence , Urination
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