Controle postural estático e risco de quedas em mulheres idosas com e sem incontinência urinária / Control postural estático y riesgo de caídas en mujeres ancianas con y sin incontinencia urinaria / Static postural control and risk of falls in older women with and without urinary incontinence

RESUMO A incontinência urinária (IU) está associada à ocorrência de quedas em idosos e pode ter relação com déficits no controle postural. O objetivo deste trabalho é comparar o controle postural estático, na condição de olhos abertos e fechados, e o risco de quedas entre idosas com IU e idosas sem IU. A amostra foi dividida em dois grupos: idosas com IU (n=21, idade=65,33±4,57 anos) e idosas sem IU (n=19, idade=66,37±5,26 anos). As características da perda urinária do grupo com IU foram avaliadas por meio do International Consultation on Incontinence Questionnaire: Short Form (ICIQ-SF). O controle postural estático dos grupos foi mensurado pelo deslocamento do centro de pressão (COP) por meio de uma plataforma de força; e o risco de quedas foi avaliado pelo teste timed up and go. Para a análise estatística, foi utilizado o teste U de Mann-Whitney e o teste qui-quadrado. A maioria das participantes com IU perdiam urina em pequena quantidade e todas perdiam em baixa frequência. Não foi observada diferença entre os grupos em relação às variáveis do COP (p>0,05) e o risco de quedas (p=0,082). Entretanto, na análise intragrupos, houve diferença na velocidade do COP de ambos os grupos na comparação olhos abertos versus olhos fechados (p<0,05). Não houve diferença no controle postural estático e no risco de quedas entre idosas com e sem IU.

RESUMEN La incontinencia urinaria (IU) está asociada con la presencia de caídas en los ancianos y puede estar relacionada con déficits en el control postural de ellos. El presente estudio tuvo como objetivo comparar el control postural estático con los ojos abiertos y con los ojos cerrados y el riesgo de caídas entre mujeres ancianas con IU y mujeres ancianas sin IU. La muestra se dividió en dos grupos: ancianas con IU (n=21, edad=65,33±4,57 años) y ancianas sin IU (n=19, edad=66,37±5,26 años). Las características de pérdida urinaria en el grupo con IU se evaluaron utilizando el International Consultation on Incontinence Questionnaire: Short Forma (ICIQ-SF). El control postural estático de los grupos se midió por el desplazamiento del centro de presión (COP) por medio de una plataforma de fuerza; y el riesgo de caídas fue evaluado por el test del timed up and go. En el análisis estadístico, se utilizaron la prueba U de Mann-Whitney y la prueba de Chi-cuadrado. La mayoría de las participantes con IU perdieron una pequeña cantidad de orina y todas la perdieron a baja frecuencia. No se observó diferencia entre los grupos en relación con las variables COP (p>0,05) y el riesgo de caídas (p=0,082). Sin embargo, en el análisis intragrupo hubo una diferencia en la velocidad de COP de ambos grupos en la comparación ojos abiertos versus ojos cerrados (p<0,05). No hubo diferencias en el control postural estático y en el riesgo de caídas entre las ancianas con y sin IU.

ABSTRACT Urinary incontinence (UI) is associated with the occurrence of falls in older people and may be related to failure in the postural control of older people. This study aims to compare static postural control under eyes-closed and eyes-open conditions as well as the risk of falls in older women with UI and without UI. The sample was divided in two groups: a group of older women with UI (n=21, age=65.33±4.57 years) and a group of older women without UI (n=19, age=66.37±5.26 years). The urinary loss characteristics of the UI group were evaluated with use of the International Consultation on Incontinence Questionnaire - Short Form (ICIQ-SF). The static postural control of the groups was measured using displacement of center of pressure (COP) through a force platform and the risk of falls was evaluated with the Timed Up and Go test (TUG). Statistical analysis was performed using Mann Whitney's U-Testand the chi-square test. Most participants with UI lost urine in small amounts and at low frequency. No difference was observed between the groups with respect to COP variables (p>0.05) and risk of falls (p=0.082). However, in the intragroup analysis, a difference was observed in the COP velocity of both groups comparing open and closed eyes (p<0.05). No difference was observed in the static postural control and risk of falls in older women with and without UI.

Evaluation of decellularized matrix and ß-tricalcium phosphate as biomaterials for bone neoformation: in vivo study / Evaluación de la matriz descelularizada y ß-fosfato tricálcico como biomateriales para neoformación ósea: estudio in vivo

The aim of this study was to evaluate histologically the effect of two biomaterials, a biomaterial derived from porcine Urinary submucosa Bladder Matrix (UBM) and beta-TriCalcium Phosphate (ß-TCP), on bone defects. Twenty male New Zealand rabbits were used; the models were divided in two groups: the UBM group; the ß-TCP group, and a Negative Control (NC) group. Five-mm defects were created in the femur of each model and then the different biomaterials were set in place depending on each group. At 4 and 8 weeks, the animals in the models were sacrificed and samples of the defect site were collected to perform a Hematoxylin and Eosin stain (H&E). Histologically, ß-TCP group at 4 and 8 weeks presented neoformation of bone-like and cartilage-like tissue, with the presence of inflammatory infiltrate; at 4 and 8 weeks, the UBM group presented neoformation of bone-like and cartilage-like tissue with a low presence of inflammatory infiltrate, and the NC group presented the formation of connective tissue and, in a low proportion, neoformation of bone tissue and cartilage. Both biomaterials, UBM and ß-TCP, exhibited the capacity to promote bone neoformation; however, the UBM-based biomaterial produced a better-organized tissue with a lower inflammatory response compared with the ß-TCP group.

El objetivo de este estudio fue evaluar histológicamente el efecto de dos biomateriales: derivado de matriz de submucosa de vejiga urinaria porcina (UBM) y b-fosfato tricálcico (ß-TCP) en defectos óseos. Veinte conejos macho de raza Nueva Zelanda fueron empleados para este estudio; los modelos fueron divididos en dos grupos: UBM, ß-TCP y un grupo control negativo. Se crearon defectos de 5 mm en el fémur de cada uno de los modelos y posteriormente se colocó el biomaterial correspondiente de acuerdo a cada uno de los grupos. A las 4 y 8 semanas los modelos fueron sacrificados y se tomaron muestras del sitio del defecto óseo para realizar una tinción de Hematoxilina y Eosina. Histológicamente el grupo de ß-TCP tanto a las 4 como a las 8 semanas mostró neoformación de tejido óseo y tejido cartilaginoso con presencia de infiltrado inflamatorio; el grupo de UBM a las 4 y 8 semanas presentó neoformación de tejido óseo, tejido cartilaginoso y un bajo infiltrado inflamatorio; el grupo control negativo presentó formación de tejido conectivo y en baja proporción neoformación de tejido óseo y cartílago. Ambos biomateriales, UBM y ß-TCP mostraron la capacidad de promover la neoformación de tejido óseo; sin embargo, el biomaterial basado en UBM produjo un tejido mejor organizado y un menor infiltrado inflamatorio en comparación con el ß-TCP.

Rate of spontaneous voiding recovery after acute urinary retention due to bed rest in the hospital setting in a non-urological population clinical study of the relationship between lower limbs and bladder function

Abstract Objectives To understand the clinical relationship between lower limbs functions and the recovery of spontaneous voiding after an acute urinary retention (AUR) in older patients admitted to hospitals for non-urological causes using clinical parameters. Materials and Methods 56 adult patients (32 men; mean age: 77.9 ± 8.3 and 24 women; mean age 82.1 ± 4.6) with AUR were prospectively followed with validated Physical Performance Mobility Exam (PPME) instrument to evaluate the relationship between the recovery of mobility capacity and spontaneous voiding. After a short period of permanent bladder drainage patients started CIC along evaluation by PPME during hospitalization and at 7, 15, 30 60, 90, and 180 days of discharge. Mann-Whitney U, chi-square test and ANOVA tests were used. Results All patients were hospitalized for at least 15 days (Median 26.3 ± 4.1 days). Progressive improvement on mobility scale measured by PPME was observed after leaving ICU and along the initial 7 days of hospitalization but with a deterioration if hospitalization extends beyond 15 days (p<0.03). Prolonged hospital stay impairs mobility in all domains (p<0.05) except step-up and transfer skills (p<0.02) although a recovery rate on spontaneous voiding persistented. Restoration of spontaneous voiding was accompanied by improvement on mobility scale (p<0.02). Recovery of spontaneous voiding was markedly observed after discharging the hospital. All patients recovered spontaneous voiding until 6 months of follow-up. Conclusions Recovery to spontaneous voiding after acute urinary retention in the hospital setting may be anticipated by evaluation of lower limbs function measured by validated instruments.

Effect of S-methyl-l-thiocitrulline dihydrochloride on rat micturition reflex

ABSTRACT Objective: To evaluate the effect of neuronal nitric oxide synthase on the striated urethral sphincter and the urinary bladder. Materials and Methods: A coaxial catheter was implanted in the proximal urethra and another one in the bladder of female rats, which were anesthetized with subcutaneous injection of urethane. The urethral pressure with saline continuous infusion and bladder isovolumetric pressure were simultaneously recorded. Two groups of rats were formed. In group I, an intrathecal catheter was implanted on the day of the experiment at the L6-S1 level of the spinal cord; in group II, an intracerebroventricular cannula was placed 5-6 days before the experiment. Results: It was verified that the group treated with S-methyl-L-thio-citrulline, via intrathecal pathway, showed complete or partial inhibition of the urethral sphincter relaxation and total inhibition of the micturition reflexes. The urethral sphincter and the detrusor functions were recovered after L-Arginine administration. When S-methyl-L-thio-citrulline was administered via intracerebroventricular injection, there was a significant increase of urethral sphincter tonus while preserving the sphincter relaxation and the detrusor contractions, at similar levels as before the use of the drugs. Nevertheless there was normalization of the urethral tonus when L-Arginine was applied. Conclusions: The results indicate that, in female rats anaesthetized with urethane, the nNOS inhibitor administrated through the intrathecal route inhibits urethral sphincter relaxation, while intracerebroventricular injection increases the sphincter tonus, without changing bladder function. These changes were reverted by L-Arginine administration. These findings suggest that the urethral sphincter and detrusor muscle function is modulated by nitric oxide.

Can intraurethral stimulation inhibit micturition reflex in normal female rats?

ABSTRACT Objective The study was designed to determine the effect of low frequency (2.5Hz) intraurethral electrical stimulation on bladder capacity and maximum voiding pressures. Materials and Methods The experiments were conducted in 15 virgin female Sprague-Dawley rats (220–250g). The animals were anesthetized by intraperitoneal injection of urethane (1.5g/kg). Animal care and experimental procedures were reviewed and approved by the Institutional Animal Care and Use Committee of Antwerp University (code: 2013-50). Unipolar square pulses of 0.06mA were used to stimulate urethra at frequency of 2.5Hz (0.2ms pulse width) in order to evaluate the ability of intraurethral stimulation to inhibit bladder contractions. Continuous stimulation and intermittent stimulation with 5sec ‘‘on’’ and 5sec ‘‘off’’ duty cycle were applied during repeated saline cystometrograms (CMGs). Maximum voiding pressures (MVP) and bladder capacity were investigated to determine the inhibitory effect on bladder contraction induced by intraurethral stimulation. Results The continuous stimulation and intermittent stimulation significantly (p<0.05) decreased MVP and increased bladder capacity. There was no significant difference in MVP and bladder capacity between continuous and intermittent stimulation group. Conclusions The present results suggest that 2.5Hz continuous and intermittent intraurethral stimulation can inhibit micturition reflex, decrease MVP and increase bladder capacity. There was no significant difference in MVP and bladder capacity between continuous and intermittent stimulation group.

Urinary Incontinence and Physician's Attitude

No abstract available.

Análise da composição do matriz extracelular das camadas urotelial e muscular da bexiga de mulheres em diferentes idades / Analysis of the extracellular matriz of urothelial and muscle layers of the bladder in women at different ages

Acomplacência da bexiga depende de músculos lisos, fibras colágenas, fibras elásticas e suas relações. O objetivo deste trabalho é determinar a composição da matriz extracelular em amostras de bexigas normais através de análise bioquímica de colágeno e glicosaminoglicanos em amostras obtidas de mulheres em diferentes grupos de idade, analisando separadamente as camadas urotelial e muscular. Avaliamos 17 amostras de bexiga divididas em três grupos: infância (N=5), menacme (N=6) e pós-menopausa (N=6). As bexigas foram analisadas para concentração de GAG total e colágeno e para análise qualitativa de GAG por eletroforese em gel de agarose. Na camada muscular, não houve diferença entre os grupos tanto para GAG quanto para colágeno. Na camada urotelial, a análise da concentração de colágeno não mostrou diferença entre os grupos, mas a concentração de GAG no grupo da pós-menopausa (0.21 +- 0.12 ug de ácido hexurônico/mg de tecido seco) apresentou diferença em relação aos grupos do menacme (1.78 +- 1.62 ug de ácido hexurônico/mg de tecido seco) e da infância (2.29 +- 1.32 ug de ácido hexurônico/mg de tecido seco). Nosso trabalho concluiu que a concentração de GAG está substancialmente diminuída na cadama urotelial da bexiga de mulheres na pós-menopausa.

Bladder compliance is dependent on smooth muscle, collagen fibers, elastic fiber and their ratios. The luminal surface of the urothelium is covered by an adhering glycosaminoglycan (GAG) layer. The aim of this study was to determine the composition of the extracellular matrix (ECM) in normal samples of women bladders through biochemistry analysis of collagen and GAG on samples obtained from individuals from different age groups, analyzing separately the urothelial and muscular layers. We studied samples taken from bladders of 17 patients divided in three different groups: childhood (N=5), menacme (N=6) and menopause (N=6). Bladders were analyzed for total GAG and collagen concentration per mg dry tissue and for the contents of GAG species, as determined by agarose electrophoresis and reported as the percent of total sulfated GAG. In muscular layer, collagen and GAG concentration showed no difference between groups. In urothelial layer, collagen concentration showed no difference between groups but GAG concentration in menopause (0.21 +- 0.12 ug hexuronic acid/mg dry tissue) was different from menacme (1.78 +- 1.62 ug hexuronic acid/mg dry tissue) and childhood (2.29 +- 1.32 ug hexuronic acid/mg dry tissue). There was no difference between sulfated GAG in three groups. In conclusion, GAG concentration in urothelial layer was substantially lower in menopause women.

Effects of Level of Consciousness on Urodynamic Procedure in Female Cats

Urodynamic evaluation is an invasive and uncomfortable procedure that can cause physical distress and is difficult to perform in uncooperative patients. The aim of this study was to evaluate the effects of consciousness on urodynamic evaluation in an animal model. Repeated cystometry, electromyogram, and measurement of serum cortisol concentrations were performed in female cats under conscious (CON), conscious sedation (CS) and deep anesthesia (DA) conditions. Urodynamic evaluation showed that there were no statistical differences in maximum detrusor pressure or bladder capacity observed among the three conditions. Under the DA condition, but not the CON and CS conditions, bladder contraction was accompanied by an un-relaxed anal sphincter. Residue urine volume significantly increased in the DA condition compared to the CON and CS conditions. The levels of serum cortisol significantly increased after performing urodynamic evaluation under the CON condition, whereas these levels were not significantly increased under the CS and DA conditions. This study showed that conscious sedation has no adverse effects on the urodynamic variables, and that it significantly reduces distress in cats undergoing the examination. These results may provide novel insights for performing urodynamic studies in uncooperative patients.

Palpation Device for the Identification of Kidney and Bladder Cancer: A Pilot Study

PURPOSE: To determine the ability of a novel palpation device to differentiate between benign and malignant tissues of the kidney and bladder by measuring tissue elasticity. MATERIALS AND METHODS: A novel palpation device was developed, mainly composed of a micromotor, a linear position sensor, a force transducer, and a hemisphere tip and cylindrical body probe. Motion calibration as well as performance validation was done. The tissue elasticity of both benign and malignant tissues of the kidney and bladder was measured using this device. A single investigator performed the ex-vivo palpation experiment in twelve kidneys and four bladder specimens. Malignant tissues were made available from partial nephrectomy specimens and radical cystectomy specimens. Palpations for benign renal parenchyma tissue were carried out on nephroureterectomy specimens while non-involved areas in the radical cystectomy specimens were used for benign bladder samples. Elastic modulus (Young's modulus) of tissues was estimated using the Hertz-Sneddon equation from the experimental results. These were then compared using a t-test for independent samples. RESULTS: Renal cell carcinoma tissues appear to be softer than normal kidney tissues, whereas tissues from urothelial carcinoma of the bladder appear to be harder than normal bladder tissues. The results from renal cell carcinoma differed significantly from those of normal kidney tissues (p=0.002), as did urothelial carcinoma of the bladder from normal bladder tissues (p=0.003). CONCLUSION: Our novel palpation device can potentially differentiate between malignant and benign kidney and bladder tissues. Further studies are necessary to verify our results and define its true clinical utility.

Use of a latex biomembrane for bladder augmentation in a rabbit model: biocompatibility, clinical and histological outcomes

PURPOSE: To investigate histological features and biocompatibility of a latex biomembrane for bladder augmentation using a rabbit model. MATERIAL AND METHODS: After a partial cystectomy, a patch of a non-vulcanized latex biomembrane (2x4 cm) was sewn to the bladder with 5/0 monofilament polydioxanone sulfate in a watertight manner. Groups of 5 animals were sacrificed at 15, 45 and 90 days after surgery and the bladder was removed. The 5-µm preparations obtained from grafted area and normal bladder were stained with hematoxylin-eosin. Immunohistochemical staining was performed with a primary antibody against alpha-actin to assess muscle regeneration. RESULTS: No death, urinary leakage or graft extrusion occurred in any group. All bladders showed a spherical shape. Macroscopically, after 90 days, the latex biomembrane was not identifiable and the patch was indistinguishable from normal bladder. A bladder stone was found in one animal (6.6 percent). On the 90th day, histology revealed continuity of transitional epithelium of host bladder tissue on the patch area. At this time, the muscle layers were well organized in a similar fashion to native bladder muscle layers. The inflammatory process was higher on grafted areas when compared to controls: 15 days - p < 0.0001, 45 days - p < 0.001, and 90 days - p < 0.01. The anti alpha-actin immunoexpression peaked at 45 days, when the graft was observed covered by muscle cells. CONCLUSION: The latex biomembrane is biocompatible and can be used in models for bladder augmentation in rabbits. It promotes epithelium and muscle regeneration without urinary leakage.

Mecanismos de continência e teoria integral da incontinência urinária feminina / Continence mechanisms and the integral theory of female urinary incontinence

É um tradicional conceito em Medicina que toda disfunção está relacionada a defeitos anatômicos. Isto levou à elaboração de várias teorias, nas quais as alterações morfológicas seriam fatores causais para a incontinência urinária. Talvez a teoria que mais se firmou ao longo do tempo foi a de Enhorning que, em 1967, elaborou a Teoria de equalização da pressão intra-abdominal, segundo a qual a condição básica para a continência urinária é a topografia intra-abdominal do colo vesical. Esta teoria foi aceita durante muito tempo como explicação satisfatória para a gênese da incontinência urinária, muito embora, algumas constatações colocassem dúvidas sobre seus princípios. As contradições da teoria proposta por Enhorning motivaram Petros e Ulmsten, 1990, a elaborarem nova explicação para a gênese da IUE. Nesse âmbito, propuseram a chamada Teoria integral da incontinência urinária feminina. Segundo esta teoria, os sintomas decorrentes da IUE e da hiperatividade vesical seriam secundários, por diferentes razões, à frouxidão da vagina e de seus ligamentos de suporte, resultado da alteração do tecido conectivo.

Técnica de cierre de cuello vesical en pacientes neurogénicos / Bladder neck closure in neurogenic patients

Los pacientes con vejiga neurogénica e incompetencia esfinteriana requieren usar pañales permanentes con consecuencias sociales y psicológicas que afectan su calidad de vida. Estos pacientes, dentro de su manejo quirúrgico si son de difícil manejo, podrían requerir un cierre de cuello vesical. Esta cirugía, con un abordaje extravesical ha tenido resultados poco satisfactorios. El objetivo de este trabajo es evaluar los resultados de la técnica intravesical para el cierre de cuello en términos de continencia. Métodos: Desde el año 2004, y en forma prospectiva, ingresaron al estudio aquellos pacientes con indicación de cierre de cuello. Todos fueron sometidos a una técnica intravesical para el cierre de cuello y se evaluó su resultado en términos de continencia urinaria. Resultados: se realizó el cierre de cuello vesical con técnica intravesical en 4 pacientes con vejiga neurogénica (2 niños y 2 niñas), sin complicaciones perioperatorias. Tras un período de seguimiento de 6 a 24 meses, todos se cateterizan a través de un Mitrofanoff cada 3 ó 4 hrs y todos son continentes urinarios. Conclusiones: la técnica de abordaje intravesical, respecto a la extravesical, mejora la exposición de la anatomía del cuello vesical, resultando técnicamente más segura, facilitando la separación entre ambos cabos. Debido al éxito relativo de la cirugía de cuello en la literatura, y pese al corto periodo de seguimiento de nuestros pacientes, proponemos esta técnica como una alternativa cuando se plantea el cierre de cuello vesical.

The patients with neurogenic bladder and sphincteric incompetence require to use permanent diapers with social and psychological consequences that affect their quality of life. These patients, if they have a intractable incontinence, could require a bladder neck closure. This surgery, with a extrabladder approach has had little satisfactory results. The objective of this work is to evaluate the results of the intrabladder technique for bladder neck closure in continence terms. Methods: from 2004 we enrolled in a prospective study the patients with indication of bladder neck clousure. All were underwent a intrabladder technique for the bladder neck closureand the outcomes was evaluated in terms of urinary continence. Results: 4 patients with neurogenic bladder (2 males and 2 females), were underwent a this bladder neck closure technique, without postoperative complications. After 6 to 24 months, all the patients use their catheterizable continent conduit (Mitrofanoff) and all are urinary continent. Conclusions: The intrabladder approach, with respect to the extrabladder approach, improves the exhibition of the anatomy of the bladder neck, is a safe technique, and it facilitates the separation between both ends. Although the follow up is limited, we recommended this technique as a option for the bladder neck closure.

Experiencia en ampliaciones vesicales no secretoras en niños / Non-secreating bladder augmentation in children

En vejigas patológicas que requieren de ampliación por fracaso al tratamiento médico, clásicamente se han realizado ampliaciones vesicales con segmentos gastrointestinales; sin embargo, en niños hemos tenido complicaciones debido al mucus que producen: cateterismo difícil, infección tracto urinario (ITU), litiasis, perforación, desbalance electrolítico y potencial desarrollo de malignidad. Es por esto que desde el año 1993 hemos iniciado un programa de ampliaciones vesicales no secretoras. Materiales y método: Se estudiaron retrospectivamente los pacientes ampliados en nuestro servicio, se realizaron55 ampliaciones vesicales de los cuales en 21 fue con uréter, 7 autoampliaciones mas segmento intestinal desmucosado, y 29 con sigmoides desmucosado. Se analizó patología, indicación, estudio preoperatorio, técnica quirúrgica, cirugía complementaria y su seguimiento con especial interés en las complicaciones. Resultados: La edad promedio fue 8 años, la patología de base más frecuente fue la vejiga neurogénica y el seguimiento global promedio fue de 44 meses. Al analizar por grupos: en las 21 ureterocistoplastias se uso 1 uréter completo en 8 casos, los 2 uréteres en 4, y en 9 se uso solo un segmento ureteral (tranureteroanastomosis), en 4 de estos pacientes se realizó Mitrofanoff. La capacidad vesical mejoró en un 37,5 por ciento en los pacientes en que se usó 1 o los 2 uréteres, y 230 por ciento en los que se uso solo un segmento ureteral. Se observaron 3 complicaciones, 2 de ellas de resolución quirúrgica. En los 29 pacientes en que se realizó ampliación vesical con sigmoides desmucosados la capacidad vesical aumento en un 339,5 por ciento y la acomodación en 876 por ciento. Se realizó centrifugado de orina observándose un 7,5 por ciento de mucosidad(0-30 por ciento) en comparación con 95 por ciento de mucosidad en las ampliaciones secretoras. La cistoscopía con biopsia se realizó en un tercio de los pacientes, en mas de un 90 por ciento...

Bladder augmentation in the adult has classically been performed with gastrointestinal segments with excellent results. However in children our experience has shown severe difficulties associated with overproduction of intestinal mucus; infection, difficult catheterization, stone formation, electrolytic misbalance and potential malignancy are some of the complications associated with this procedure. In1993 we develop a protocol of non-secreting bladder augmentations for the pediatric patient. Material and Methods: We retrospectively analyzed 55 bladder augmentations performed at our institution. Out of the 55, 21 were with ureter, 7 auto-augmentations with intestinal segment (mucosa previously removed), 29 with sigmoid (mucosa previously removed). Perioperative data and outcomes were analyzed. Results:Mean age was 8 years. Neurogenic bladder was the most prevalent condition. Mean follow up was 44months. Out of the 21 cistoureteroplasties, 8 cases were done with only 1 ureter, 4 with both and in 9 cases only a partial segment of the ureter was used. In this group a Mitrofanoff valve was employed in 4patients. Bladder capacity was improved in 375 percent in bladder augmented with one or both ureter and in 230 percent in the ones with a partial ureteral segment. Complications were observed in 3 patients, 2 required surgical management. In the 29 bladders augmented with sigmoid, capacity and compliance increased in 339.5 percent and 876 percent respectively. Urine analysis showed 7.5 percent of mucus in comparison with 95 percent usually found in secreting augmentations. Control cystoscopy was performed in one third of the patients. In 90 percent biopsy of the augmented bladder showed urothelium with patches of digestive epithelium associated with glandular atrophy. Conclusion: The absence of complications derived from mucus secretion favor the use of this type of augmentation. Despite the fact that the use of ureter requires for previous ureternephrosis...

Electromyographic activity of the anterolateral abdominal wall muscles during the vesical filling and evacuation

The role of the anterolateral abdominal wall muscles [AAWMs] during the vesical filling and evacuation has not been sufficiently addressed in the literature. We have investigated the hypothesis that the AAWMs exhibit the increased electromyographic [EMG] activity on the vesical distension and contraction which presumably assists vesical evacuation. The effects of the vesical balloon distension on the vesical pressure [VP], vesical neck [VNP] pressures and the AAWMs' EMG activity were studied in 28 healthy volunteers aged 40.7 +/- 9.7 years [18 men, 10 women]. These effects were tested after the individual anesthetization of the bladder and AAWMs and after saline infiltration. The VP and the VNP showed a gradual increase upon the incremental vesical balloon distension which started at a distending volume of 120-140 ml. At a mean volume of 364.6 +/- 23.8 ml, the VP increased to a mean of 36.6 +/- 3.2 cmH2O, the VNP decreased to 18.4 +/- 2.4 cmH2O, and the AAWMs EMG registered a significant increase. This effect disappeared in the individual bladder and in the AAWMs' anesthetization. However, it did not disappear in the saline administration. The AAWMs appear to contract simultaneously with vesical contraction. This action presumably increases the IAP and it assists vesical contraction. The AAWMs contraction on vesical contraction seems to be mediated through a reflex which is called the 'vesico-abdominal wall reflex'. Further studies are required to investigate the role of this reflex in vesical disorders

Enuresis persisting into adulthood

Nocturnal enuresis is a very common finding in children to the extent that many families and caregivers, alike, may dismiss it as a developmental stage rather than a disease. Persistence of nocturnal enuresis into adulthood, however, has received little discussion and is surrounded by fallacies. All existing literature cited in PubMed between 1970 and 2005 were reviewed using the search entries "nocturnal enuresis AND adult". Of the 220 papers reviewed, enuresis persisting into adulthood was covered in only 87. Those aspects pertinent to this subset of patients were placed in focus. In contrast to the numerous researches on childhood enuresis, persistent adulthood enuresis is an underdiscussed subject, distinct in a few aspects of its etiology and management described herein

Equipamento para cistometria / Equipment cystometry

This work evaluates a microprocessed cistometry equipment developed by the Biomedical Engineering Div. of the HCPA. The system provides an useful means of quantifying bladders pressures and volume during the filling of bladder...

Age-related changes in the urinary bladder of the female albino rats

Disturbances of the urinary bladder functions are common in elderly people particularly women. So, it was the aim of the present work to detect the age-associated changes in the urinary bladder that might play a role in the bladder dysfunctions. Twenty albino rats were used in the present work and divided into two equal groups, each consisted of ten rats. The first group included the adult rats [aged 3 months] and served as control group, while the second one was the senile rats aged [aged 24 months]. Specimens of the urinary bladder were taken, processed and examined using the light microscope [LM]] as well as the scanning electron microscope [SEM]. Light microscopic examination of the urinary bladder of the aged rats showed marked mucosal damage, ranging from degeneration of the epithelial cells to complete denudation of the mucosa with exposed lamina propria. Cellular infiltration and increased dilated and congested blood vessels of the lamina propria were also encountered. The smooth muscle cells of the musculosa showed variable degrees of degeneration with wide separation of the muscle bundles. Massive increase in the collagen fibres deposition was detected in the lamina propria, muscle layer and adventitia. SEM examination revealed loss of the polygonal cell pattern appearance of the superficial epithelial cells and increased the collagen fibres deposition in all the portions of the mucosa. It was concluded that the observed age related changes might be contributing factors in the urinary bladder disturbances in elderly population

Medición de presión intrabdominal por método intravesical: validación de la técnica en humanos / Intra-abdominal pressure measurement using intravesical method: validation of the technique in humans

Currently the compartmental abdominal syndrome is recognized as a relevant clinical picture in the context of the critical surgical patient. For an adequate diagnosis and handling of the picture, measurement of the pressure in the mentioned compartment, the abdomen is fundamental. Several methods have been applied with this objetive, where the most utilized is that of intra-vesical measurement. The objetive of our study is the validation of the technique of intra-vesical measure of pressure in humans. Patients that are to undergo laparoscopic surgery were included. Intra-abdominal pressure was measured via intra-peritoneal de Veres needle technique associated to a CO2 insufflator performing increasing pressure curve up to tha safe limit of (18 mmHg. Parallely the intra-vesical pressure was measured with a three-way N°18 Foley probe (latex, Kendall), adjusting the secondary way to a pressure transducer. 20 patients were evaluated, with a total of 220 measurements. Through linear regression method a strong positive correlation was observed between de Veres needle and Foley probe with r = 0.713, P=0,00001. The method seems valid with a projected line of y = 4.77 + 0.69x, for a 95 per cent confidence interval. There were two cases where, clearly for the observer, there was no correlation, in one of them due to multiple previous surgeries (it was even necessary to change to open surgery) and in another case it was an obese patient (IMC 29.56). We come to the conclusion that measurement of intravesical pressure as a method for evaluating the intra-abdominal pressure is adequate on humans, considering a lower sensitivity to the changes in abdominal pressure, therefore the clinical conduct in the particular case must be taken with several measurements and associated to the relevant symptomatology described for the abdominal compartmental syndrome. We also recommend precaution on obese patients and those with multiple previous surgeries.

Relationship between Urinary Endogenous Steroid Metabolites and Lower Urinary Tract Function in Postmenopausal Women

To investigate the relationship between the endogenous steroid hormones and the lower urinary tract function in postmenopausal women. Thirty postmeopausal volunteer women who did not have lower urinary tract symptoms or hormone replacement therapy were enrolled in this study. Urodynamic studies included uroflowmetry, multi-channel cystometry, and urethral pressure profilometry were conducted. Gas Chromatography- Mass Spectroscopy (GC-MS) was used to measure the urinary endogenous steroid hormone metabolites. The relationship between the urinary profile of the endogenous steroids and the urodynamic parameters of these patients were investigated. The mean ages of the patients were 60.6 +/- 5.5 years, and the Body Mass Index (BMI) averaged 24.56 +/- 2.23 (kg/m2). Of the progesterone metabolites, pregnandiol was significantly related to the residual volume in the uroflowmetry and the functional urethral length parameters (R=0.98, p=0.000; R= -0.65, p=0.04). Pregnantriol was significantly related to the maximum flow rate, the residual volume in uroflowmetry, the maximum urethral closure pressure and the functional urethral length (R=-0.64, p=0.04; R=0.82, p=0.01; R=0.04, p=0.04; R=- 0.79, p=0.01). In the androgen metabolites, androstenedione, 5-AT, 11- keto Et, 11-betahydroxy Et, THS, and THE were significantly related to the residual volume in uroflowmetry (R=0.92, p=0.001; R=0.84, p=0.008; R=0.99, p=0.000; R=0.72, p=0.03; R=0.97, p=0.000; R=0.85, p=0.00). beta-THF/alpha-THF was significantly related to the maximum flow rate, the residual volume in uroflowmetry, the maximum urethral closure pressure and the functional urethral length (R=-0.76, p=0.02; R=0.67, p=0.04; R=0.74, p=0.02; R=-0.92, p=0.000). alpha-cortol was significantly related to the residual volume in uroflowmetry, the maximum urethral closure pressure and the functional urethral length (R=0.81, p=0.01; R=0.71, p=0.03; R=-0.87, p=0.000). Of the estrogen metabolites, estrone (E1) was significantly related to the normal desire to void (R=0.68, p=0.04) and 17 beta-estradiol/estrone was also significantly related to the normal and strong desire to void (R=-0.70, p=0.03 and R=-0.74, p=0.02, respectively). The urinary progesterone and androgen metabolite concentrations were positively related to the residual volume in uroflowmetry and positively or negatively related to MUCP and FUL. However, the urinary estrone concentration was positively related to the normal desire to void and 17 beta-estradiol/estrone was significantly related to the normal and strong desire to void.