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Objective To assess clinical effect and safety of botulinum toxin A injection in external urethral sphincter for male patient with neurogenic detrusor underactivity (DU).Methods A prospective and self-controlled trail was conducted from August 2012 to October 2017.Male patients with nerve injury,dysuria more than 6 months,DU (bladder contractility index less than 100) were enrolled in this study.Exclusion criteria included patients with acute urinary tract infection,bladder stone,benign prostate hyperplasia,urethral stricture and urethral diverticulum.100 IU BTX-A was dissolved in 4ml normal saline,and the solution of BTX-A was injected into 4 different points(3-o'clock,6-o'clock,9-o'clock,and 12-o'clock) in external urinary sphincter with each point of 1ml solution.Patients were evaluated at baseline and 12 weeks after injection.The outcomes included post void residual (PVR),maximum flow rate (Qmax),maximum detrusor pressure during voiding phases (Pdet.max),maximum urethral closure pressure (MUCP),the case number of intermittent catheterization (IC) and the score of quality of life (QOL score).Adverse events were also recorded.Results A total of 58 male patients (all from Guangdong provincial work injury rehabilitation hospital) with mean age 28.6 years suffered from cerebral palsy (n =2),cerebrovascular accident(n =19)and spinal cord injury(n =37) were included into the study.Compared to baseline data,significant difference were observed at week 12 in PVR (56.68 ml vs.280.11 ml,P ＜ 0.001),Pdet.max (23.95 cmH2O vs.30.01 cmH2O,P =0.019),Qmax(6.74 ml/s vs.3.28 ml/s,P =0.042),MUCP(48.25 cmH2O vs.79.34 cmH2O,P ＜0.001),the case number of IC(40 vs.58,P ＜0.001) and QOL score(3.63 vs.5.22,P ＜ 0.001) respectively.5 cases developed perineal pain and 16 cases developed mild transient haematuria.These adverse events were disappeared by medical symptomatic treatment during 3-5 days.Conclusions BTX-A externalurethral sphincter injections help reduce urethra resistance and also improve the quality of life for patients with neurogenic detrusor underactivity.
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Objective@#To assess clinical effect and safety of botulinum toxin A injection in external urethral sphincter for male patient with neurogenic detrusor underactivity(DU).@*Methods@#A prospective and self-controlled trail was conducted from August 2012 to October 2017. Male patients with nerve injury, dysuria more than 6 months, DU(bladder contractility index less than 100) were enrolled in this study. Exclusion criteria included patients with acute urinary tract infection, bladder stone, benign prostate hyperplasia, urethral stricture and urethral diverticulum.100 IU BTX-A was dissolved in 4ml normal saline, and the solution of BTX- A was injected into 4 different points(3-o’clock, 6-o’clock, 9-o’clock, and 12-o’clock) in external urinary sphincter with each point of 1ml solution. Patients were evaluated at baseline and 12 weeks after injection. The outcomes included post void residual (PVR), maximum flow rate (Qmax), maximum detrusor pressure during voiding phases (Pdet.max), maximum urethral closure pressure (MUCP), the case number of intermittent catheterization (IC)and the score of quality of life (QOL score). Adverse events were also recorded.@*Results@#A total of 58 male patients (all from Guangdong provincial work injury rehabilitation hospital)with mean age 28.6 years suffered from cerebral palsy (n=2), cerebrovascular accident(n=19)and spinal cord injury(n=37) were included into the study. Compared to baseline data, significant difference were observed at week 12 in PVR (56.68 ml vs. 280.11 ml, P<0.001), Pdet.max(23.95 cmH2O vs. 30.01 cmH2O, P=0.019), Qmax(6.74 ml/s vs. 3.28 ml/s, P=0.042), MUCP(48.25 cmH2O vs. 79.34 cmH2O, P<0.001), the case number of IC(40 vs. 58, P<0.001) and QOL score(3.63 vs.5.22, P<0.001) respectively. 5 cases developed perineal pain and 16 cases developed mild transient haematuria. These adverse events were disappeared by medical symptomatic treatment during 3-5 days.@*Conclusions@#BTX-A externalurethral sphincter injections help reduce urethra resistance and also improve the quality of life for patients with neurogenic detrusor underactivity.
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Objective To investigate correlation between bladder wall thickness (BWT) and upper urinary tract damage (UTD) in patients with neurogenic lower urinary tract dysfunction (NLUTD),and to evaluate the value of BWT in predicting UTD.Methods To retrospectively analyze clinical data of NLTUDpatients admitted from January 2013 to October 2017.Of the 161 patients,92 were male and 69 were female.The mean age was (39.5 ± 18.4) years old,ranged from 18 to 81 years old.83 cases had hydronephrosis,64 cases had unilateral or bilateral ureteral dilation and 14 cases had ureteral reflux.In 30 cases,the serum creatinine was abnormal (290.7 ± 164.0) μmol/L,ranging 125-938 pmol/L.The mean GFR in 17 cases was(45.2 ± 23.0) ml/(min · 1.73 m2),ranged from 84.3 to 14.6 mL/ (min · 1.73 me).According to the presence or absence of UTD,NLUTD patients were divided into experimental group and control group,101 cases of UTD combined experimental group,and 60 cases of UTD-free control group.There were 60 male patients and 41 female patients in the experimental group with mean age of (37.9 ± 19.1) years old.In the control group,there were 32 male patients and 28 female patients with mean age of (42.3 ± 16.8) years old,There was no statistical difference between the two groups (P ＞ 0.05).There were 59 cases and 5 cases of hydronephrosis in the experimental group and the control group,respectively.There were 12 cases and 2 cases of ureteral dilation patients in the experimental group and the control group,respectively.The differences in BWT and urodynamic parameters between the two groups were compared.The ROC curve was used to determine the cutoff value of BWT in the diagnosis of UTD and the correlation between BWT and UTD and urodynamic parameters was analyzed.Results 161 patients had a BWT of 2 to 25 mm with a median value of 7.0 (7.1) mm.119 patients underwent urodynamic examination with bladder compliance of 0.8 to 141.5 ml/cmH2O,median value of 12.7 (22.8) ml/cmH2O.The median value of median pressure capacity (MCC) was 256 (171) ml,ranged from 49 to 700 ml.The median value of Pdetmax was34 (19.1)cmH2O,ranged from 3 to 144 cmH2O.The median BWT values of the test and control groups were 9.0 (5.0) mm and 4.0 (5.7) mm,respectively (Z =-5.931,P ＜ 0.001).The median bladder compliance was 9.3 (15.3) ml/cmH2O and 24.2 (38.7) ml/cmH2 O,respectively (Z =-4.07,P ＜ 0.05).The MCC was 225.0 (159.0) ml and 310.6 (140.5) ml,respectively (Z =-2.22,P ＜ 0.05).The median Pdetmax during filling was 40.0 (20.4) emH2 O and 29.2 (18.4) cmH2 O,respectively (Z =-2.92,P ＜ 0.05).Using multivariate correlation analysis,BWT was negatively correlated with bladder compliance (r =-0.419,P ＜0.001) and negatively correlated with maximum bladder pressure capacity (r =-0.198,P =0.031),with the largest filling period.Pdetmax was positively correlated (r =0.251,P =0.006).Using the ROC curve to determine the threshold,the sensitivity of the UTD is 86.1％ and the specificity is 53.3％ when BWT≥4.8 mm.Conclusions BWT thickening is one of the risk factors for UTD in patients with NLUTD.When BWT is greater than 4.8 mm,NLUTD patients are more likely to have UTD and can be used as an examination method for the diagnosis of UTD in NLUTD patients.
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Objective To investigate the therapeutic effect of ciprofloxacin (Cipro) conjugated with 11 poly-arginine peptide (R11) on rabbit model with bacterial cystitis (BC). Methods 50 New Zealand rabbits of 4-month old were chosen to establish the models and evenly divided into 5 groups randomly : Group A: normal control; Group B: intravesical instillation (II) of R11; Group C: II of Cipro; Group D: II of R11-Cipro; Group E: intravenous injection of Cipro. Several parameters were observed which included: urinary frequency, positive rate of urine culture, histopathological analysis of cystitis stained with hematoxylin and eosin. Results Severe inflammatory responses and massive infiltration of inflammatory cells were observed after the models were established. R11-Cipro group was better than intravenous injection of Cipro group in treating cystitis (P < 0.05). R11-Cipro group was better than the other four groups in urinary frequency and urine culture. Conclusions Intravesical instillation of R11-Cipro demonstrated significant therapeutic effect on bacterial cystitis. R11 , as an efficient vector, could deliver specific antibiotics to bladder mucosa precisely and function well locally.
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<p><b>OBJECTIVE</b>To compare holmium laser enucleation (HoLEP) versus open prostatectomy (OP) for large volume benign prostatic hyperplasia.</p><p><b>METHODS</b>The randomized controlled trials (RCTs) pertaining to HoLEP and OP for management of large volume benign prostatic hyperplasia were retrieved from Medline and Embase. Meta-analysis was performed using Review Manager 5.0 software.</p><p><b>RESULTS</b>Three RCTs were included in the analysis. No significant differences were found in IPSS or Qmax between HoLEP and OP (P>0.05). Compared with OP, HoLEP was associated with significantly less blood loss, a shorter catheterization time and a shorter hospital stay, but a longer operating time. HoLEP and OP were similar in terms of urethral stricture, stress incontinence, transfusion requirement and the rate of reintervention.</p><p><b>CONCLUSION</b>HoLEP and OP have similar therapeutic effects in the management of large volume benign prostatic hyperplasia. Although with a longer operating time and less resected tissue, HoLEP causes less blood loss and requires a shorter catheterization time and a shorter hospital stay. HoLEP has a comparable safety to OP in terms of the adverse events.</p>