Possibilities of objectivization of pelvic floor muscle exercises in patients with urine leakage after delivery.

BACKGROUND: Examination of pelvic floor muscle function is very important before starting exercises in patients with urine leakage and other pelvic floor dysfunctions. Perineometer and palpation examination is currently being used. A new trend in physiotherapy is the ultrasound examination of pelvic floor muscles. The examination can be performed by abdominal approach or perineal approach. We evaluate 2D and 3/4D images of pelvic floor muscles. METHODS: The International Consultation on Incontinence Questionnaire Urinary Incontinence Short Form (ICIQ-UI SF). OAB-q - overactive bladder questionnaire - short form. The Urinary Incontinence Quality of Life scale (I-QoL) - self-assessment scale for assessing the quality of life of patients with urinary incontinence. Adjusted Oxford scale to assess pelvic floor muscle strength. PERFECT scheme by Laycock and Jerwood. Pelvic floor examination by perineometer (Peritron-Ontario, L4V, Canada). Pelvic floor examination by 2D and 3/4D ultrasound examination (Volunson-i BT 11 Console, VCI volume contrast imaging software, (GE Healthcare Austria GmbH & Co OG, Zipf, Austria, RAB4-8-RS 3D/4D 4-8 MHz probe). High intensity exercise of pelvic floor muscles with stabilization elements. CONCLUSION: The effect of pelvic floor muscle training was objectively proved by the above mentioned objectivization methods with subjective improvement of quality of life. There was also a significant effect of education in USG exercise.

[Validation of a new tool for identification of barriers to cervical cancer prevention in Slovakia]. / Validácia nového nástroja pre indentifikáciu bariér v prevencii rakoviny krcka maternice na Slovensku.

OBJECTIVE: The aim of the work was to validate the Slovak version of the CPC-28 questionnaire (Beliefs about Papanicolaou and Cervical Cancer). DESIGN: Original study. SETTING: Department of Public Health, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, in co-operation with gynaecological centers in University Hospital Martin and district Martin, Slovakia. METHODS: The original English version of the CPC-28 questionnaire was translated into Slovak language. The questionnaire consists of 28 statements divided into six domains. Cronbach´s alpha coefficient was used to analyse the internal consistency of the questionnaire. Construction validity was evaluated by using Pearsons correlation coefficient. The results were processed in the statistical programs Epi Info 7.1.5. and Statistica 13, p-values < 0.05 were considered statistically significant. RESULTS: The Slovak version of the questionnaire was provided to 27 women. The women were given two questionnaires, and one of them was filled in immediately (test). After 14 days they filled in and returned second questionnaire (retest). The value of Cronbachs alpha was > 0.8 in all six domains which demonstrates the high internal consistency of the questionnaire. Pearsons coefficient was > 0.7 in all six domains and p-values < 0.001. CONCLUSION: The validated CPC-28 questionnaire in the Slovak language can be administered to women to collect data for identification of barriers to cervical cancer screening among women.

[Urinary incontinence in degenerative spinal disease]. / Kontinencné poruchy pri degeneratívnych ochoreniach chrbtice.

PURPOSE OF THE STUDY: The aim of the study was to evaluate the presence of urinary incontinence in patients with chronic degenerative spinal disease and to identify factors affecting the occurrence and changes in urinary incontinence after surgery. MATERIAL: The group evaluated comprised 214 patients undergoing surgery for degenerative spinal disease at our department between January 1 and December 31, 2008. The patients were categorised according to the type of their degenerative disease (cervical disc herniation, lumbar disc herniation, spinal stenosis, spinal instability or olisthesis) and the spine level involved (cervical or lumbar spine). The symptoms of urinary incontinence included leakage of urine and non-obstructive chronic urinary retention developing in association with the manifestation of vertebrogenic disorder. Patients with diseases known to increase the risk of incontinence were not included in the study. METHODS: Based on a retrospective analysis of the patients' clinical notes, the occurrence of urinary incontinence in each type of degenerative spinal disease was assessed. The effect of gender, age, body mass index (BMI), neurological status and spinal disease type on the development of incontinence was statistically evaluated. The efficacy of surgical treatment was assessed on the basis of the patients' subjective complaints at the first follow-up one month after surgery. The data were evaluated by the statistical programme InSTAT (analysis of variance ANOVA, t-test). All tests were two-sided; a 0.05 level of statistical significance was used. RESULTS: Of the 214 patients with degenerative spinal disease, 27 (12.6%) had urinary incontinence. A higher risk of developing incontinence was found in women (p = 0.008) and in patients with radicular weakness (p = 0.023). The patients with urinary incontinence had their BMI significantly lower than patients without this disorder (p = 0.019). Age had no effect. The differences in the occurrence of urinary incontinence amongst the different types of degenerative disease were regarded as approaching statistical significance (p = 0.09). The surgical treatment resulted in incontinence control in 15 (55.5 %) affected patients. DISCUSSION: A comparison of the factors leading to the development of urinary incontinence in degenerative spinal disease and those associated with the development of incontinence in the general population suggests that the aetiology in each case is different. The relationship between low back pain and urinary incontinence remains unknown. CONCLUSIONS: Degenerative spinal disease can result in acute or chronic urinary incontinence. Factors associated with its development include gender, BMI, radicular weakness and the type of degenerative disease. Surgical treatment improved or eliminated the symptoms of urinary incontinence in more than half of the patients affected.

Reactivity of urinary bladder smooth muscle in guinea pigs to acetylcholine and carbachol--participation of acetylcholinesterase.

The authors examined the influence of acetylcholinesterase inhibitor (neostigmine) on the in vitro reactivity of urinary bladder smooth muscle (UBSM) in guinea pigs. The aim of the present study was to determine the participation of pharmacokinetic properties of acetylcholine and carbachol in different UBSM reactivity to these mediators. In vitro method of organ baths was used and reactivity of UBSM strips to cumulative doses of acetylcholine and carbachol was tested before and after the incubation with neostigmine (10(-4) mol.l(-1)). Neostigmine caused a significant increase of UBSM reactivity to acetylcholine. The UBSM reactivity to acetylcholine was significantly higher at concentrations of 10(-5) and 10(-4) mol.l(-1) compared to carbachol at the same concentrations. These findings indicate that in addition to different mediator affinity to muscarinic receptors and to their different intrinsic activity, the pharmacokinetic properties of acetylcholine and carbachol also participate in UBSM reactivity.

Mechanisms of reactivity of urinary bladder smooth muscle.

BACKGROUND: Mechanism of bladder smooth muscle contraction and relaxation and its pharmacological influence in various pathologic states are of incremental interest of investigators and clinicians. OBJECTIVES: The aim of our study was to assess the reactivity of urinary bladder smooth muscle in guinea pigs to two different pharmacological agents. METHODS: We compared the in vitro reactivity of smooth muscle strips of guinea pig urinary bladder to muscarinic stimulation by carbachol and acetylcholine. We prepared two kinds of strips, urothelium-denuded and with intact urothelium. Both kinds of strips were aerated under tension in Krebs-Henseleit's solution in organ-bath for 1 hour and after that cumulative concentration-response curves to carbachol (10(-9) - 10(-5) mol/l) and acetylcholine (10(-8) - 10(-3) mol/l) were constructed. RESULTS: We observed significantly higher reactivity of smooth muscle strips to carbachol, comparing to acetylcholine at the same concentrations both in strips with urothelium (at concentration 10(-5) mol/l: 22.1 g/100 mg vs 6.1 g/100 mg) and in urothelium-denuded strips (at concentration 10(-5) mol/l: 24.5 g/100 mg vs 5.1 g/100 mg). The reactivity differences between strips with and without urothelium were not significant, however, in higher concentrations of acetylcholine (10(-4) and 10(-5) mol/l) and carbachol (10(-6) and 10(-5) mol/l) we noticed no significant inhibition of contractile response of smooth muscle strips with intact urothelium. CONCLUSION: In our experiments we confirmed that carbachol was more potent constrictor than acetylcholine in detrusor smooth muscle strips of guinea pigs. The presence of urothelium did not change the reactivity significantly. (Fig. 4, Ref: 23.).

Neuromodulative treatment of overactive bladder--noninvasive tibial nerve stimulation.

BACKGROUND: Conservative treatment of overactive bladder employes behavioral or invasive neuromodulatory inhibition of miction reflex and administration of anticholinergic drugs. MAIN PURPOSE: The aim of this study was to use non-invasive stimulation of the tibial nerve with the intention to achieve desired therapeutic effects without iatrogenic nerve damage using a superficial electrostimulation. METHODS: All patients suffered from overactive bladder (OAB) without bladder outlet obstruction. OAB was examined by the Behavioral urge score BUS (0.0--the best and 1.0--the worst score), the International prostate symptom score IPSS (0--the best and 35--the worst score) and the Incontinence quality of life questionnaire IQOL (0.0--the worst and 1.0--the best index). The patients were divided into 3 groups: Group I--patients with electrode attached behind the medial ankle of the left lower extremity. The intensity of stimulation corresponded to 70% of the maximum amplitude of response from musculus abductor hallucis. Frequency of stimulation was 1 Hz and duration of the square impulse was 0.1 ms. Surface stimulation lasted 30 minutes and was repeated once a week. Group II--patients were treated by oral oxybutynin 5 mg t.i.d. Group III--patients without treatment. The BUS, IPSS, and IQOL were repeated after the treatment. RESULTS: The study included 28 females of average age 54 year (range 45 to 63). Mean IPSS was 17 (range 12 to 21), mean index of quality of life IQOL was 30 (range 12 to 78) and mean BUS score was 0.68 (range 0.50 to 0.86). Group I with stimulation did achieve statistically significant changes following the treatment: decrease of mean IPSS from 17 +/- 3 points to 6 +/- 4 points after the treatment, increase in mean IQOL from 36 +/- 10 to 68 +/- 20 and decrease of mean BUS from 0.65 +/- 0.12 to 0.43 +/- 0.16. Group II had similar statistically significant differences after the treatment of OAB. Group III noted no changes in the complaints. CONCLUSION: Noninvasive stimulation had improved subjective symptom related to overactive bladder, had no adverse events and was well tolerated. (Fig. 1, Tab. 1, Ref. 18.).

[Importance of transrectal ultrasonography in the detection of local recurrence of prostatic carcinoma after radical prostatectomy]. / Význam transrektálnej ultrasonografie pri detekcii lokálnej recidívy karcinómu prostaty u pacientov po radikálnej prostatektómii.

OBJECTIVE: To assess the importance of transrectal ultrasonography in early detection of local recurrence of prostate carcinoma in patients after radical retropubic prostatectomy and compare it with digital rectal examination and the level of prostatic specific antigen. PATIENTS AND METHODS: In a group of 72 patients, at least six months after radical prostatectomy regularly after 3-6-month intervals the levels of prostatic specific antigen were monitored. When the level of specific prostatic antigen was repeatedly higher than 0.2 ng/ml or when it increased as compared with the previous examination the patient was submitted to digital rectal examination and transrectal ultrasonography of the bed after radical prostatectomy. In case of a positive sonographic finding, ultrasound-guided biopsy was performed. RESULTS: A local recurrence of the disease was confirmed by ultrasound-guided biopsy in 5 (6.9%) of 72 investigated patients on average 51 months (23-81) after radical prostatectomy. The mean preoperative value of the prostatic specific antigen was in these patients 23.4 ng/ml (10.6-33). In all patients the authors detected by transrectal ultrasonography a hypoechoic focus at the site of anastomosis. Of 5 patients with a local recurrence of the disease two (40%) had a negative digital rectal examination. CONCLUSION: The prostatic specific antigen monitored most accurately the local progression of the disease after radical prostatectomy. Transrectal ultrasonography detected a local recurrence of the disease in all five patients despite the negative digital rectal examination. Transrectal ultrasonography makes guided biopsy from the site of radical prostatectomy possible and thus increases the detection rate of local progress of the disease as compared with digital rectal examination. Elevation of the prostatic specific antigen with subsequent transrectal ultrasonographic examination makes it possible to detect as soon as possible early local recurrence of prostate carcinoma after radical prostatectomy.

[Diagnosis and treatment of functional disorders of the lower urinary tract in younger men]. / Diagnostika a liecba funkcných porúch dolných mocových ciest u mladsích muzov.

BACKGROUND: Functional disorders of the lower urinary tract can manifest by different symptoms. This could be caused by inaccurate diagnosis and non-causal treatment in young men. Urodynamics is helpful in the differential diagnosis and treatment of such cases. OBJECTIVES: Examination of lower urinary tract functions in young men and causal treatment of both bladder neck obstruction or impaired bladder. METHODS: In a prospective study, a group of 38 young men were treated at mean age of 42 years (range 19-50 yrs). Chronic abacterial prostatitis was treated in all cases unsuccessfully. Patients with positive urinary infection, previous surgery of the lower urinary tract and neurogenic bladder were excluded. Urodynamics confirmed a bladder neck obstruction or impaired bladder, the symptom score revealed subjective difficulties (maximum 35 points). Patients with the obstruction underwent transurethral incision of the bladder neck. Patients with impaired bladder were administrated with distigmine bromid (Ubretid) 5 mg for 1 year, every other day. All patients were re-examined one year following the treatment. RESULTS: Bladder neck obstruction occurred in 18 cases, and impaired bladder in 20 cases. Significant differences were found in relation to age (47 vs. 31 years, p < 0.01) and detrusor pressure at maximum flow (62 vs. 30 cmH2O, p < 0.01). There were no differences in peak flow rate (9 vs. 10 ml/s, p = 0.75), symptom score (19 vs. 18, p = 0.46), residual urine (45 vs. 100, p = 0.08) and maximum cystometric capacity (341 vs. 383 ml, p = 0.10). Transurethral bladder neck incision or distigmine administration improved the symptom score by 68.4% vs. 33.3%, peak flow rate 50.0% vs. 23.1% and residual urine 100% vs. 75%. CONCLUSIONS: Treatment of lower urinary tract disorders is successful in causal treatment of bladder neck obstruction and impaired bladder. (Tab. 2, Fig. 2, Ref. 12.)

[Diagnosis of intrinsic urethral sphincter insufficiency in women]. / Diagnostika intrinzickej nedostatocnosti uretrálneho zvieraca u zien.

OBJECTIVE: Evaluation of intrinsic sphincter deficiency (ISD) according to the urethral leak point pressure in female population with stress urinary incontinence. DESIGN: Prospective clinical study. SETTING: Department of Urology, Jessenius School of Medicine Comenius University Martin, Slovak Republic. METHODS: Study population compromise of 204 females with lower urinary tract symptoms. Exclusion criteria were neurogenic bladder and unstable bladder. Valsalva leak point pressures were evaluated (VLPP). ISD was defined if VLPP below 65 cm H2O has been occurred. Pad weighing test (PWT) was positive after leakage of 2 g per hour and more. RESULTS: Stress urinary incontinence was in 134 and continence in 70 cases (control group). The first stage of incontinence was in 83, the second stage in 45 and the third stage in 6 cases of incontinence group. ISD has been occurred in 14 cases (10.5%), 8 cases with the second stage and 6 cases with the third stage. The best correlation was between VLPP and PWT, symptoms of incontinence and age of patients. All ISD cases underwent antiincontinent surgery with urethral suspension, some years ago. CONCLUSION: ISD has been risen in the second stage (6%) and the third stage (4.5%), also, in the female population with stress urinary incontinence.

[Determination of infravesical obstruction in men with benign prostatic hyperplasia using pressure-flow measurement and analysis with the Dx/CLIM software program]. / Stanovenie infravezikálnej obstrukcie u muzov s benígnou hyperpláziou prostaty pomocou tlakovo-prietokových meraní a analýzy Dx/CLIM.

BACKGROUND: Quantification of infravesical obstruction is important in the management of clinical benign prostatic hyperplasia (BPH). OBJECTIVES: The assessment of obstruction degree according to the urethral resistance parameter (URA) and bladder contractility (W) with software Dx/CLIM. METHODS: The study retrospectively analysed a group of 61 patients with BPH in order to assess the degree of obstruction and bladder contractility. Each of the patients underwent pressure/flow studies with Dx/CLIM analysis (URA < 29 cm H2O-unobstructed, Wmax > 12.8 W/m2-normal bladder contractility) and symptom score evaluation (maximum 15 points). In a dose-finding, placebo-controlled study 12 patients received 2 mg of doxazosin (alpha-1 blocker) and 11 patients received placebo during 4 weeks of treatment. RESULTS: 15 patients were unobstructed (25%) out of whom 10 had poor bladder contractility. Obstruction was present in 46 patients (75%) out of whom 18 had impaired contractility. During treatment, the symptom score decreased statistically significantly in both groups (p < 0.05). URA decreased significantly only in the 2 mg group (2 mg group: baseline URA = 53.9, final mean URA = 40.1, p < 0.05; placebo group: baseline URA = 52.9, final mean URA = 56.1). Detrusor contractility was not significantly affected. CONCLUSIONS: Pressure/flow studies with Dx/CLIM analysis are very useful in the selection of BPH patients for treatment modalities and in the assessment of efficacy. Doxazosín decreases urethral resistance effectively. (Tab. 3, Fig. 3, Ref. 12.)

[Occurrence of prostatic intraepithelial neoplasia in needle biopsy of the prostate and its clinical significance]. / Výskyt prostatickej intraepiteliálnej neoplázie v materiáli získanom punkcnou biopsiou prostaty a jej klinický význam.

From March 1994 to September 1996 485 patients of median age 67 years (range 49-82) underwent transrectal prostate needle biopsy at the Urological Clinic JLF UK in Martin. PIN was detected in 31 (6.4%) patients. Median age of patients with PIN was 67 years (range 58-75). There were 21 (68%) patients with low-grade PIN and 10 (32%) patients with high-grade PIN. In this group concomitant invasive cancer of the prostate was detected in 6 (19.4%) patients with PIN, of whom 5 (16.0%) had high-grade PIN and 1 (3.4%) nad low-grade PIN. Median concentration of PSA in patients with PIN was 9.1 ng/ml (range 1.3-85 ng/ml), significantly higher (p < 0.001) than PSA concentration in patients with BPH. We did not find significant differences between PSA concentrations in patients with PIN and in those with prostate cancer (p = 0.77). In conclusion we recommend clinical management of patients newly diagnosed with PIN.

[Levels of prostate-specific antigen, acid phosphatase, alkaline phosphatase and pain in the prediction of bone metastases in patients with newly diagnosed prostatic carcinoma]. / Hodnota prostatického specifického antigénu, kyslej fosfatázy, alkalickej fosfatázy a bolesti v predpovedi kostných metastáz u pacientov s novozisteným karcinómom prostaty.

In a retrospective analytical study the authors evaluated in 86 patients, mean age 69 years (range 55-85 years), with a newly diagnosed untreated prostate carcinoma the sensitivity, specificity, positive and negative predictive value of specific prostatic antigen (PSA), acid phosphatase (AP), alkaline phosphatase (AP') and pain in relation to possible affection of bones by secondaries. The authors found a highly negative predictive value for assessment of bone metastases when PSA values were lower than 10 ng/ml (96%), at levels under 20 ng/ml (94%) and a highly positive predictive value at levels higher than 50 ng/ml (97%). When AP and AP' are negative and there is no pain the occurrence of secondaries is of low probability. These results make it possible to differentiate some patients where scintigraphy of the skeleton is not inevitable. This procedure can be applied above all in patients where radical prostatectomy is not indicated.

[The volume of the prostate in benign hyperplasia and evaluation of infravesical obstruction]. / Objem benígnej hyperplázie prostaty v hodnotení infravezikálnej obstrukcie.

In a prospective study group of 22 patients we analyzed the relationship between the volume of benign prostatic hypertrophy (BPH) and infravesical obstruction. We diagnosed obstruction with urodynamic measurement (pressure flow studies) in 16 patients (72.7%). Volume of BPH was investigated by the transrectal ultrasound. We found obstruction in 11 from 14 patients (63.6%) with BPH > or = 30 ml and in 5 from 8 patients (36.4%) with BPH < 30 ml. The diagnostic accuracy of prostatic volume measurement in the diagnosis of infravesical obstruction was only 63.6%. The volume of BPH did not correlate with the infravesical obstruction. (Tab. 3, Fig. 1, Ref. 14.)

[The urodynamic examination in prostatism]. / Urodynamické vysetrenia pri prostatizme.

In a prospective study comprising 29 patients the authors analyzed comprehensively subjective complaints of prostatism using the score of prostatic symptoms (PSS) with the objective urodynamic finding (uroflowmetry, cystometry, pressure flow measurement) in men with benign prostatic hyperplasia. The Boyarsky and Madsen-Iversen PSS did not correlate with the infravesical obstruction assessed by the pressure flow measurements. An obstruction was detected in 23 patients (79.3%), incl. a marginal one in 6 patients (20.7%), the diagnostic sensitivity of free uroflowmetry being 90.9%. Cystometry did not reveal a significant difference between the group with and without an obstruction, instability of the detrusor was found in 12 patients (41.4%) with a significant difference of the maximal cystometric capacity, as compared with the group of patients with a stable detrusor.