The clinical features of nocturnal enuresis in adult men and women / 中华泌尿外科杂志

Objective:To discover the clinical features of nocturnal enuresis (NE) in adults and to detect factors that correlated with the symptom severity.Methods:This cross-sectional study recruited NE subjects from September 2017 through December 2020. All patients had experienced enuresis at least once per week and with a symptom duration of 3 months or longer. Followed by documentation of history and medical records, three-day bladder diary was adopted to assess their voiding pattern, and urodynamic parameters were obtained to evaluate lower urinary tract function.Results:A total of 106 NE patients (43 male and 63 female) were identified. There is no statistical difference regarding the average age (men: 57.8±15.6 vs. women: 56.1±14.0, P>0.05) and BMI (men: 23.9±3.4 vs. women: 23.3±4.3, P>0.05) between men and women. Comorbidities are extremely common in NE patients (n=85, 80.2%), with the incidence rate higher in men compared to women [88.4% (38/43)vs. 74.6% (47/63), P<0.05]. Hypertension (n=58, 54.7%), hyperlipemia (n=41, 38.7%), diabetes mellitus (n=38, 35.8%), coronary heart disease (n=22, 20.8%) were the most frequently reported conditions. On bladder diaries, subjects were frequently manifested nocturnal polyuria (NP, 47/106, 44.3%), reduced nocturnal bladder capacity (NBC, 74/106, 69.8%), or combination of both(33/106, 31.3%). Urodynamic studies suggested that the incidence of reduce bladder compliance, detrusor overactivity (DO), stress incontinence, bladder outlet obstruction(BOO), detrusor underactivity(DU)and detrusor hyperreflexia with impaired contractility(DHIC)was 27.4%(29/106), 39.6%(42/106), 17.9%(19/106), 9.4%(10/106), 25.5%(27/106)and 15.1%(16/106), respectively. Women were more likely to suffer from stress urinary incontinence [2.3%(1/43) men vs. 28.6% (18/63) women, P<0.01], while men were prone to have bladder outlet obstruction [ 23.3%(10/43) men vs. 0 women, P<0.01]. Correlation analysis demonstrated that obesity( r=0.63, P<0.01), systemic comorbidities( r=0.40, P<0.01), presence of NP( r=0.50, P<0.01) and NP+ NBC( r=0.47, P<0.01), post-void residual( r=0.53, P<0.01), reduced compliance( r=0.21, P=0.04), DU( r=0.28, P<0.01), stress incontinence( r=0.42, P<0.01)and DHIC ( r=0.35, P<0.01)are positively correlated with NE severity. Whereas, reduced Q max( r=-0.35, P<0.01), low capacity( r=0.21, P=0.03), and reduced bladder sensation( r=-0.21, P=0.03) correlate negatively with NE severity. Conclusions:The presence of NE is not only a sign of bladder dysfunction, but also an implication of obesity, systematic chronic diseases, urine production malfunctioning. Therefore, a thorough history regarding the lower urinary tract function and systemic comorbidities should be taken carefully, so that, an integrated and personalized treatment can be carried out.

Effect of Safety Bladder Capacity Catheterization on Lower Urinary Tract Function in Patients With Suprasacral Spinal Cord Injury / 中国康复理论与实践

Objective:To evaluate the effect of safety bladder capacity catheterization on lower urinary tract function in patients with supracacral spinal cord injury. Methods:A total of 60 patients with lower urinary tract dysfunction after suprasacral spinal cord injury in our hospital from January to December, 2019 were divided into control group (n = 30) and observation group (n = 30) randomly. Both groups were given intermittent catheterization, the frequency of catheterization was determined according to postvoid residual volume in the control group, while it was according to safety bladder capacity in the observation group. Their maximum destrusor pressure, postvoid residual volume, safety bladder capacity, urinary tract infection and detrusor wall thickness were compared. Results:Eight weeks after intervention, the maximum destrusor pressure and postvoid residual volume decreased, and the safety bladder capacity increased in the observation group (t > 5.623, P < 0.05), and were better than that of the control group (t > 2.242, P < 0.05); the detrusor wall thickness significantly decreased in the observation group (t = 7.871, P < 0.05), and was lower than that of the control group (t = 3.049, P < 0.01). The number of urinary tract infection patients was less in the observation group than in the control group (χ2 = 4.320, P = 0.038). Conclusion:Intermittent catheterization based on safety bladder capacity can improve lower urinary tract function in patients with suprasacral spinal cord injury.

Utilization of pretransplant cystography and hydrodistention among anuric patients on renal replacement therapy and its impact on cost and timing of transplantation

OBJECTIVE@#To describe utilization of pretransplant cystography and hydrodistention among anuric end stage renal disease patients (ESRD) on renal replacement therapy (RRT) and its impact on cost and timing of transplantation.@*METHODS@#A chart review was done on all anuric ESRD pretransplant patients on renal replacement therapy who underwent cystography and hydrodistention from 2014 to 2019. The authors analyzed patient demographics, post-transplant outcomes, process indicators and costs incurred due to cystography and hydrodistention.@*RESULTS@#A total of 151 patients were included in the study. There was female predominance (86, 57%) with a median age of 32 (range 18-61) years. Majority of the patients underwent hemodialysis (144, 95%). Glomerulonephritis was the prevailing etiology of ESRD (119, 79%). Majority had normal bladder capacity (107, 71.5%), while 44 (29%) patients had small bladder capacity who subsequently underwent hydrodistention. There is a moderately negative correlation between bladder capacity and duration of dialysis and anuria. Hydrodistention did not significantly increase duration from diagnosis to kidney transplant (4.2 vs 3.5 months; p = .083). Median cost of cystography was Php 4377 (range 1978 – 5282) and the average total cost incurred per patient due to hydrodistention was Php 643.53.@*CONCLUSION@#Longer duration of RRT and anuria yields to lesser bladder capacity. Cystography is recommended in ESRD patients who are anuric for at least three years. Hydrodistention does not significantly prolong duration of diagnosis to kidney transplant.

Capacidad vesical funcional mediante ultrasonido en pacientes con enuresis primaria monosintomática / Functional bladder capacity by ultrasound in patients with monosymptomatic primary enuresis

La enuresis primaria monosintomática es un problema clínico común que afecta del 5 al 10% de los niños en edad escolar. La etiología exacta no se conoce, pero se ha propuesto una capacidad vesical funcional disminuida como factor predisponente. Existen pocos reportes en la literatura del uso de ultrasonido para su evaluación. Objetivo: Determinar si la capacidad vesical funcional medida por ultrasonido está disminuida en enuresis primaria monosintomática comparada con población sana. Pacientes y Método: Estudio trasversal analítico de febrero de 2014 a mayo de 2015 incluyendo 40 pacientes con enuresis y 40 sin enuresis, 5 a 15 años de edad, midiendo la capacidad vesical funcional mediante ecógrafo Siemens Acuson S2000TM con transductor 3,5 y 5 MHz por un solo operador cegado. Se realizó estadística descriptiva y analítica mediante el programa IBM SPSS 20 TM. Resultados: Los pacientes con enuresis presentaron menor capacidad vesical funcional 171,7 ml vs controles 225,5 ml (p = 0,025). Resultó factor de riesgo OR = 2,81 (IC 95%: 1,06-7,42) tener un familiar de primera línea con antecedente de enuresis y OR = 4,0 (IC 95%: 1,48-10,78) para segunda línea. La capacidad vesical funcional presentó correlación débil con la capacidad vesical normal estimada mediante la fórmula de Kaefer. Conclusión: La capacidad vesical funcional es menor en quien padece enuresis que en los que no la padecen y existe poca correlación con las fórmulas que determinan la capacidad vesical normal esperada como la de Kaefer. Se reafirmó que el antecedente hereditario de enuresis juega un papel importante como factor de riesgo.

Nocturnal enuresis is a common clinical problem affecting 5% to 10% of school-age children. Etiology is not known but a diminished functional bladder capacity it has been proposed as a predisposing factor. There exist only a few studies evaluating it by ultrasound. Objective: To identify if there is a difference of the functional bladder capacity measured by ultrasound between nocturnal enuresis group and healthy children. Patients and Method: A cross-sectional study from February 2014 to May 2015 including two groups, nocturnal enuresis and a control group of 40 patients each, 5 to 15 years old. A single blinded operator measured the functional bladder capacity by ultrasound with an Acuson S2000 SiemensTM 3.5 and 5 MHz transducer. Analytics and descriptive statistics were performed using IBM SPSS 20TM software. Results: Patients with enuresis showed a decreased functional bladder capacity vs. controls (171.7 ml vs 225.5 ml; p = 0.025). A history of first-degree relative with enuresis increased the risk of having enuresis OR = 2.81 (95% CI: 1.06-7.42), a second-degree relative presented OR = 4.0 (95% CI: 1.48-10.78). Functional bladder capacity presented a weak correlation with the bladder capacity estimated by Kaefer’s formula. Conclusion: The functional bladder capacity is lower in the patients with nocturnal enuresis when compared to control group. There is little correlation between functional bladder capacity and Kaefer’s formula to determine the normal bladder capacity. We reaffirmed that the family history with enuresis strongly increases the risk of developing nocturnal enuresis.

Effects of different speeds and ways of instillation on bladder volume, pressure and pelvic nerve firing / 中国病理生理杂志

AIM: To investigate the changes of bladder volume , pressures and pelvic nerve firing induce by different speeds and ways of instillation .METHODS:Female SD rats (n=20) were randomly divided into 2 groups.The rats in group A was performed using 3-F polyethylene tubing inserted into the bladder through the urethra .The rats in group B were performed using 3-F tubing inserted into the dome of the bladder and secured by silk suture .The rats in both groups were infused with saline into the bladder at different speeds of 50, 100, 200 and 400μL/min.The changes of bladder vol-ume and pressure were recorded by urodynamic measuring devices .The changes of pelvic nerve firing during instillation were recorded by multi-channel physiologic recorder .RESULTS:In group A, the maximum firing frequency , bladder leak point pressure ( BLPP) and maximum voiding pressure ( MVP) were increased with the increase in the instillation speed . No significant difference of the maximum bladder capacity (MBC) at different speeds was observed .In group B, the maxi-mum firing frequency had no significant difference at different speeds .MBC was decreased with the increase in the instilla-tion speed , and exhibited significant decrease at 200 and 400 μL/min.No significant difference of BLPP and MVP at dif-ferent speeds was observed .Compared with group A , the maximum firing frequency and MBC in group B significantly de-creased at different speeds .However , BLPP and MVP in group B were higher than those in group A at the speeds of 50 and 100 μL/min.CONCLUSION:Different instillation speeds with the method of group A will not change the bladder volume but influence the pelvic nerve firing , so the process of method A may take various speeds according to different aims .How-ever, process of method B at the speed of over 200 μL/min may not be good to MBC, thus instillation under 200 μL/min is re-commended .

Correlations of simple bladder capacity measurement and urodynamic examination used for bladder function assessment of patients with spinal cord injury / 现代临床护理

ObjectiveTo explore the correlations of simple bladder capacity measurement and urodynamic examination used for assessing the bladder function of patients with spinal cord injury.Methods From December 2011 to September 2013,a total of 37 patients with spinal cord injury were recruited.Their bladder functions were examined by both simple bladder capacity measurement and urodynamics in the first week after admission.The type of neurogenic bladder,residue urine,bladder capacity and the changes of bladder pressure were documented and compared.Results The simple bladder capacity measurement and urodynamics showed no significant differences in the parameters including residual urine,and bladder pressures when inputting 50mL,100mL,300mL and 400mL water(P>0.05). But there were significant differences in the results of bladder capacity and bladder pressure when inputting 200mL water(P<0.05). The intra-class coefficients between the results by the two methods were 0.606~0.919(P<0.01).The Kappa coefficient of the health professionals’judgments according to the two methods was 0.825(P<0.001).Conclusions The results of simple bladder capacity measurement are reliable.It can be used as the supplement for urodynamics to monitor the bladder function of patients with spinal cord injury.

Application of Trospium Chloride in Treatment of Overactive Bladder (review) / 中国康复理论与实践

@#Trospium chloride is an anticholinergic agent with predominantly peripheral nonselective antimuscarinic activity and water solubility. It has potential therapeutic value in decreasing detrusor contracivity and tonity, so as to increase predominantly mean maximal bladder capacity and compliance. Multicenter studys showed that the tolerability and efficacy of trospium chloride was as same as oxybutynin and better than toterodine. Adverse events of trospium chloride is the same as other anticholinergic agents, however its specially constitutional feature so as not to have toxicity to central nervous system. Trospium chloride has potential therapeutic value in the neurourological rehabilitation.

Can Bladder Capacity and Urine Specific Gravity as well as Other Variables Predict the Responsiveness to Desmopressin in Enuretic Children? / 대한비뇨기과학회지

PURPOSE: The relationship of the functional bladder capacity and the urine specific gravity, as well as other variables, to the responsiveness to desmopressin in children with nocturnal enuresis was investigated. MATERIALS AND MTHODS: A total of 57 children with nocturnal enuresis who visited our outpatient department were evaluated based on their charts. The predictors of the response evaluated includes age, the number of wet nights, the urine specific gravity, and the maximum functional bladder capacity [as a percentage of predicted bladder capacity based on Satoshi Hamano's formula (patient age 2)x25=cc]. Responders to desmopressin were classified as excellent (less than 2 nights of wetting/14 nights), good (50% or greater decrease but more than 2 nights wetting/14 nights) and non responders, who were defined by a less than 50% decrease in wet nights. RESULTS: Of the 46 patients who were evaluated, 20 (43.5%) achieved an excellent response to desmopressin. Twelve (26.1%) patients were good responders and 14 (30.4%) were non responders. The cumulative rate of the good and non-responders was 26 (56.5%). There were no significant differences in the bladder capacity ratio, age, and the number of wet nights. However, response to desmopressin was significantly associated with the urine specific gravity (p<0.05). CONCLUSIONS: The urine specific gravity was found to be a significant prognostic factors of the response to desmopressin.

Can Bladder Capacity and Urine Specific Gravity as well as Other Variables Predict the Responsiveness to Desmopressin in Enuretic Children? / 대한비뇨기과학회지

PURPOSE: The relationship of the functional bladder capacity and the urine specific gravity, as well as other variables, to the responsiveness to desmopressin in children with nocturnal enuresis was investigated. MATERIALS AND MTHODS: A total of 57 children with nocturnal enuresis who visited our outpatient department were evaluated based on their charts. The predictors of the response evaluated includes age, the number of wet nights, the urine specific gravity, and the maximum functional bladder capacity [as a percentage of predicted bladder capacity based on Satoshi Hamano's formula (patient age 2)x25=cc]. Responders to desmopressin were classified as excellent (less than 2 nights of wetting/14 nights), good (50% or greater decrease but more than 2 nights wetting/14 nights) and non responders, who were defined by a less than 50% decrease in wet nights. RESULTS: Of the 46 patients who were evaluated, 20 (43.5%) achieved an excellent response to desmopressin. Twelve (26.1%) patients were good responders and 14 (30.4%) were non responders. The cumulative rate of the good and non-responders was 26 (56.5%). There were no significant differences in the bladder capacity ratio, age, and the number of wet nights. However, response to desmopressin was significantly associated with the urine specific gravity (p<0.05). CONCLUSIONS: The urine specific gravity was found to be a significant prognostic factors of the response to desmopressin.

Clinical and Urodynamic Effects of Propiverine Hydrochloride for Neurogenic Bladder Patient with Urinary Frequency and Incontinence / 대한비뇨기과학회지

PURPOSE: Patients with neurogenic bladder ultimately undergo morphometric and functional changes of their bladder and urethra. As a result, voiding symptoms such as frequency, nocturia, urgency and incontinence appear Propiverine hydrochloride(BUP-4) is a benzylic acid derivative with musculotropic antispamodic activity and moderate anticholinergic effect. We evaluated the clinical and urodynamic effects of BUP-4 for patients with neurogenic urinary frequency and incontinence MATERIALS AND METHODS: Twenty six patients with neurogenic bladder suffering from urinary frequency and incontinence(including 5 placebo) were given 20mg of BUP-4 orally a day and its clinical and urodynamic effect were evaluated. RESULTS: In the group treated with BUP-4 for four weeks, 57.9% in 19 patients with frequency, 53.3% in 15 nocturia, 50.0% in 14 weak stream, 55.6% in 9 intermittency, 50.0% in 10 dribbling, 64.3% in 14 urgency, 55.6% in 9 hesitancy, 73.7% in 19 incontinence showed improvement of their symptom. Urodynamic study performed after treatment with BUP-4 for 4 weeks or more revealed greater than 10% increase in bladder capacity compared to pretreatment study in 11 patients out of 21(52.4%) and their maximum bladder capacity increased significantly from 181.7+/-101.3 to 249.4+/- 184.7mL(p=0.012). Maximum detrusor pressure decreased from 52.5+/-35.6 to 50.9+/- 26.8cmH2O(p=0.010). Changes in compliance and volume on the first urge sense were statistically insignificant. In placebo group, no significant symptomatic and urodynamic improvement were reported. Side effects of the drug had appeared in 7 patients(33.3%) out of 21 after 4 weeks of treatment -5 cases of dry mouth and 2 cases of nausea - but they were not severe enough to stop the treatment. CONCLUSIONS: The use of BUP-4 in patients with neurogenic bladder results in improvement of symptoms and urodynamic profile(bladder capacity and maximum detrusor pressure). Thus, BUP-4 could be used as one of the first line drugs in the treatment of patients with neurogenic bladder.