Clinical Significance of Suprapubic Cystostomy in the Treatments of Patients with Voiding Difficulty / 대한비뇨기과학회지

PURPOSE: We assessed the clinical significance of a suprapubic cystostomy for the treatment of patients with voiding difficulties, and analyzed the related courses and complications. PATIENTS AND METHODS: A review of 55 patients managed with suprapubic cystostomy was undertaken. The changes in the serum Cr, urinary pH and white blood cell values, after a suprapubic cystostomy, were analyzed. The stone-free rate after insertion of a suprapubic catheter was estimated by the Kaplan-Meier method. RESULTS: The original diseases included: spinal cord injury in 20 (36.3%), inoperable benign prostatic hyperplasia in 12 (21.8%), cerebrovascular accident in 10 (18.2%), diabetic cystopathy in 4 (7.3%), recurrent urethral stricture in 3 (5.5%), spinal stenosis in 2 (3.6%), prostatic cancer in 2 (3.6%) and 1 (1.18%) each of Parkinson's disease and multiple sclerosis. The indications for the need for a cystostomy were: poor hand function in 35 (64%), patient request in 8, worsening of the original disease in 6, vesicoureteral reflux in 3, severe urethral damage in 2 and a recurrent urinary tract infection in 1. The most common complication was the formation of bladder calculi, which occurred in 9 (16%). There were no serious complications associated with the procedure. The mean serum creatinine levels changed from 1.01+/-0.09mg/ml to 0.90 +/-0.09mg/ml, but with no statistical significance. The stone-free rates at 1 and 5 years after the procedure were 91.9 and 61.6%, respectively. The urinary pH of the stone-forming group was significantly higher than that of the stone-free group (p<0.05). CONCLUSIONS: Although continuous cystostomy drainage is not considered an ideal management for bladder emptying, the long-term uses of suprapubic catheters are well tolerated by patients, despite the frequent catheter-related complications. Therefore, a suprapubic cystostomy, as a management, may be indicated in some patients with severe urethral damage and limited activity of the upper extremities.

Effects of Ylang-Ylang Essential Oil on the Relaxation of Rat Bladder Muscle in vitro and White Rabbit Bladder in vivo

Current and primary treatment modality in overactive bladder includes the administration of anticholinergics. The demand for new agents has been rising since anticholinergics have proven to come with many side effects. This study was designed to investigate the effects of ylang-ylang essential oil (YYEO) on the relaxation of urinary bladder muscle in vitro and in vivo. Effects of YYEO were assessed on resting tension, and electrical field stimulation- and various drug-induced contraction in vitro by checking the isometric tension changes of muscle strips and same procedures were repeated in the presence of methylene blue, Nw-Nitro-L-arginine methyl ester hydrochloride (L-NAME), or N-ethylmaleimide, and in vivo. YYEO decreased significantly the contractility of strips. There was no statistically significant difference between the treated group only with YYEO and the pretreated group with YYEO and methylene blue or L-NAME. When N-ethylmaleimide was employed, there was a statistically significant decrease in the rate of contraction. In vivo studies showed the same results compared with in vitro study. The results of this study indicate that YYEO has a relaxing effect on the bladder, and such mechanism is thought to be brought about by a pathway mediated by c-AMP.

Effects of Ylang-Ylang Oil on the Relaxation of Rat Bladder Muscles

PURPOSE: In cases of overactive bladders, especially hyperreflexic neurogenic bladders, that arise in patients with spine disorder above sacral micturition center, current primary treatment modalities include the administration of anticholinergics and the intermittent catheterization. Because anticholinergics have many side effects including dry mouth, the demand for new agents has been rising. This study was designed to investigate the effects of ylang-ylang (YY) essential oil, which is currently used in aromatherapy, on the relaxation of urinary bladder muscle in vitro. MATERIALS AND METHODS: Isometric tension changes of isolated rat bladder muscle strips were recorded in an organ bath using a pressure transducer. Effects of YY oil were assessed on resting tension, electrical field stimulation(EFS)-, bethanechol-, ATP- and KCl-induced contraction. In order to determine the mechanism of YY oil, effects of YY oil on above all stimulations were assessed in the presence of methylene blue, L-NAME(N-nitro-L-arginine methyl ester) and N-ethylmaleimide. RESULTS: The contractility of strips pre-treated with YY oil was significantly decreased on all stimulation-induced contractions. There was no statistically significant difference between treated group only with YY oil and pre-treated group with YY oil and methylene blue. Similar findings were obtained when L-NAME(another NOS inhibitor) was used. When N-ethylmaleimide(c-AMP inhibitor) was employed, there was a statistically significant decrease in the rate of contraction induced by EFS, bethanechol, KCl and ATP applications. CONCLUSION: From the obtained data, the results of this study indicate that YY essential oil has relaxing effect on the bladder, and such mechanism is thought to be brought about by a pathway mediated by c-AMP.

Clinical Evaluation of Female Patients with Acute Urinary Retention

PURPOSE: While acute urinary retention(AUR) secondary to bladder outlet obstruction in the male occurs commonly and rarely causes difficulty with diagnosis and treatment but AUR in female is an uncommon findings. This study was performed to evaluate AUR in possible causes by urodynamic study and analyzed the results of treatment. MATERIAL AND METHODS: We have retrospectively tried to evaluate the possible causes of AUR in 41 female patients. Urine analysis, urine culture, urodynamic study and selectively cystoscopy were performed in 41patients. We analysed the urodynamic feature respectively and classified into areflexia type, hyperreflexia type, detrusor hyperreflexia with impaired contractility(DHIC) type and normal finding. RESULTS: The mean age of patients was 57.9 years. Major causes of AUR were CNS lesion(13 cases, 31.7%), diabetes mellitus(6 cases, 15.3%) and spinal lesion(4 cases, 10.2%). Urethral catheterization was employed as initial treatment in 32 cases(78.0%). Catheter was removed after mean 5.2 days and selective urodynamic study was done in 36 cases. Urodynamically, there were hyperreflexia type 16 cases(44.4%), areflexic type 9 cases(25%), DHIC type 6 case(16.7%), normal finding 5 cases(13.9%). The treatments of areflexic type included intermittent catheterization(IC) in 4 cases (44.4%), urethral catheterization in 3 cases (33.3%), medical therapy in 2 cases(22.2%). The treatments of hyperreflexia type included IC in 4 cases(25%), urethral catheterization in 1 case(6.3%) and medical therapy in 11 cases(68.8%). The treatments of DHIC type included IC in 2 cases(5.5%), urethral catheterization in 1 case(2.8%), medical therapy in 2 cases(5.5%) and ileal conduit in 1 case(2.8%). CONCLUSIONS: Causes of female AUR were commonly considered the functional urinary retention and rarely organic urinary retention, but there were various causes. Our study indicated the need to consider the gender and urodynamic finding on the evaluation and treatment of AUR.