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1.
J Am Geriatr Soc ; 62(4): 740-6, 2014 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-24618012

RESUMO

The prevalence of urinary incontinence (UI) among older urban Latinos is high. Insight into etiologies of and contributing factors to the development of this condition is needed. This longitudinal cohort study identified correlates of 1-year incidence of UI in older community-dwelling Latino adults participating in a senior center-based physical activity trial in Los Angeles, California. Three hundred twenty-eight Latinos aged 60 to 93 participating in Caminemos, a randomized trial to increase walking, were studied. Participants completed an in-person survey and physical performance measures at baseline and 1 year. UI was measured using the International Consultation on Incontinence item: "How often do you leak urine?" Potential correlates of 1-year incidence of UI included sociodemographic, behavioral, medical, physical, and psychosocial characteristics. The overall incidence of UI at 1 year was 17.4%. Incident UI was associated with age, baseline activity of daily living impairment, health-related quality of life (HRQoL), mean steps per day, and depressive symptoms. Multivariate logistic regression models revealed that improvement in physical performance score (odds ratio (OR) = 0.69, 95% confidence interval (CI) = 0.50-0.95) and high baseline physical (OR = 0.60, 95% CI = 0.40-0.89) and mental (OR = 0.62, 95% CI = 0.43-0.91) HRQoL were independently associated with lower rates of 1-year incident UI. An increase in depressive symptoms at 1 year (OR = 4.48, 95% CI = 1.02-19.68) was independently associated with a higher rate of incident UI. One-year UI incidence in this population of older urban Latino adults participating in a walking trial was high but was lower in those who improved their physical performance. Interventions aimed at improving physical performance may help prevent UI in older Latino adults.


Assuntos
Atividades Cotidianas , Terapia Cognitivo-Comportamental/métodos , Hispânico ou Latino , Atividade Motora/fisiologia , Qualidade de Vida , Incontinência Urinária/etnologia , Idoso , Idoso de 80 Anos ou mais , California/epidemiologia , Estudos Transversais , Progressão da Doença , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Prognóstico , Fatores de Risco , Inquéritos e Questionários , Incontinência Urinária/fisiopatologia , Incontinência Urinária/reabilitação , Micção/fisiologia , Caminhada/fisiologia
2.
Female Pelvic Med Reconstr Surg ; 19(5): 293-7, 2013.
Artigo em Inglês | MEDLINE | ID: mdl-23982579

RESUMO

OBJECTIVES: The average American adult reads below the eighth-grade level. To determine whether self-reported health-related quality-of-life questionnaires used for pelvic floor disorders are appropriate for American women, we measured reading levels of questionnaires for urinary incontinence (UI), pelvic organ prolapse (POP), and fecal incontinence (FI). METHODS: An online literature search identified questionnaires addressing UI, POP, and FI. Readability was assessed using Flesch-Kincaid reading level and ease formulas. Flesch-Kincaid grade level indicates the average grade one is expected to completely and lucidly comprehend the written text. Flesch-Kincaid reading ease score, from 0 to 100, indicates how easy the written text can be read. RESULTS: Questionnaires were categorized by UI, POP, FI, and combined pelvic floor symptoms. The median Flesch-Kincaid reading level was 7.2, 10.1, 7.6, and 9.7, for UI, POP, FI, and combined pelvic floor symptoms, respectively. Reading levels varied greatly between questionnaires, with only 54% of questionnaires written below the eighth-grade level. CONCLUSIONS: We identified significant variation in reading levels among the questionnaires and found the 2 most commonly used questionnaires per survey in 2008 at Society of Urodynamics and Female Pelvic Medicine and Urogenital Reconstruction were above the recommended eighth-grade reading level. As specialty societies focus on standardizing questionnaires for research, reading levels should be considered so they are generalizable to larger populations of women with pelvic floor disorders.


Assuntos
Compreensão , Distúrbios do Assoalho Pélvico/psicologia , Qualidade de Vida , Inquéritos e Questionários/normas , Escolaridade , Incontinência Fecal/psicologia , Feminino , Humanos , Prolapso de Órgão Pélvico/psicologia , Incontinência Urinária/psicologia
3.
J Urol ; 187(6): 1966-70, 2012 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-22498223

RESUMO

PURPOSE: Although few data have been published on the safety of childbearing after surgery for stress urinary incontinence, a large proportion of physicians recommend that women wait to complete childbearing before pursuing surgical treatment for stress urinary incontinence. We systematically reviewed the available literature to examine the safety of pregnancy after stress urinary incontinence surgery, and to measure the effect of such pregnancy on continence outcomes. MATERIALS AND METHODS: The review was conducted according to the recommendations of the MOOSE (Meta-Analysis of Observational Studies in Epidemiology) group. We performed a systematic review to identify articles published before January 2011 on pregnancy after incontinence surgery. Databases searched include PubMed®, EMBASE® and the Cochrane Review. Our literature search identified 592 titles, of which 20 articles were ultimately included in the review. RESULTS: Data were tabulated from case reports, case series and physician surveys. The final analysis in each category included 32, 19 and 67 patients, respectively. Urinary retention developed during pregnancy in 2 women, 1 of whom was treated with a sling takedown and the other with intermittent catheterization. Of these 2 women 1 also had an episode of pyelonephritis during pregnancy, possibly related to the intermittent catheterization. The incidence of postpartum stress urinary incontinence ranged from 5% to 18% after cesarean delivery and from 20% to 30% after vaginal delivery. CONCLUSIONS: Although the data on outcomes in the literature are limited and further studies need to be performed on the subject, the current data suggests that any increase in risks for pregnancy after surgery for stress incontinence may be small. A low risk of urinary retention during pregnancy may exist. Although some data suggest that cesarean deliveries may result in a lower rate of recurrent stress urinary incontinence than vaginal deliveries, a formal analysis could not be performed with the available data.


Assuntos
Complicações na Gravidez , Resultado da Gravidez , Incontinência Urinária por Estresse/cirurgia , Procedimentos Cirúrgicos Urológicos/efeitos adversos , Adulto , Feminino , Humanos , Pessoa de Meia-Idade , Gravidez , Complicações na Gravidez/etiologia , Recidiva , Incontinência Urinária por Estresse/etiologia
4.
Curr Opin Urol ; 20(4): 275-9, 2010 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-20495460

RESUMO

PURPOSE OF REVIEW: Due to the desire for improved outcomes, the use of synthetic materials in vaginal prolapse repair has been increasing despite the lack of sound evidence of their efficacy and safety. RECENT FINDINGS: Given the limited number of randomized controlled trials evaluating repair of vaginal prolapse with the use of mesh and a paucity of data on long-term outcomes and complications, there is no clear evidence to suggest mesh should or should not be used. However, complications of mesh can range from minor to major but may lead to chronic, potentially debilitating conditions. SUMMARY: Tailoring surgical decision-making for the individual patient must take into account and balance the patient's anatomy, symptoms, and functional status. Repairing anatomy alone is not the only important factor. The use of synthetic materials in prolapse repair demands critical examination, given the devastating complications that can occur.


Assuntos
Prolapso de Órgão Pélvico/cirurgia , Complicações Pós-Operatórias/epidemiologia , Telas Cirúrgicas/efeitos adversos , Feminino , Humanos , Medição de Risco , Estados Unidos/epidemiologia , United States Food and Drug Administration
5.
J Urol ; 183(6): 2289-93, 2010 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-20400144

RESUMO

PURPOSE: Nuclear renal scan is currently the gold standard imaging study to determine differential renal function. We propose helical computerized tomography as a more efficient way to gain renal function information. Renal parenchymal volume is measured and percent total renal volume is used as a surrogate marker for differential renal function. MATERIALS AND METHODS: Computerized tomography and diuretic enhanced nuclear renal scan were performed in 33 patients with chronic obstruction. Computerized tomography was contrast enhanced in 23 cases and nonenhanced in 10. Diagnoses included ureteropelvic junction obstruction, ureteral stricture and extrinsic compression. Using semiautomated boundary delineation with manual editing method the parenchymal volume of each kidney was measured and percent renal volume was calculated. Percent renal volume was compared with percent renal function, as determined by nuclear renal scan. Correlations between the 2 measures were evaluated using the Spearman or Pearson coefficient. RESULTS: Strong correlations were observed between percent renal function and percent renal volume in all cases (r = 0.90, p <0.001), including the enhanced (r = 0.87, p <0.001) and nonenhanced (r = 0.95, p <0.001) groups. Moderately strong correlations were noted in the less than 40% (r = 0.76, p <0.001) and less than 30% (r = 0.64, p = 0.015) renal function subgroups. CONCLUSIONS: Differential renal volume measured from computerized tomography strongly correlates with differential renal function on nuclear renal scan for normal and chronically obstructed kidneys. Computerized tomography may serve as a single radiological diagnostic study for anatomical and functional assessment in patients in whom a poorly functioning kidney is suspected.


Assuntos
Nefropatias/diagnóstico , Nefropatias/fisiopatologia , Rim/diagnóstico por imagem , Rim/fisiopatologia , Compostos Radiofarmacêuticos , Tecnécio Tc 99m Mertiatida , Tomografia Computadorizada Espiral , Feminino , Humanos , Rim/patologia , Masculino , Pessoa de Meia-Idade , Tamanho do Órgão , Cintilografia
6.
Biomed Res ; 30(4): 207-15, 2009 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-19729851

RESUMO

Cell culture and animal studies have demonstrated strong chemopreventative effects of green tea and its associated polyphenols in multiple cancers, though the exact mechanisms of action are not well understood. This in vitro study examined the antiproliferative/pro-apoptotic potential of green tea extract (GTE), polyphenon-60 (PP-60), (-)-epicatechin gallate (ECG) and (-)-epigallocatechin-3-gallate (EGCG) in both normal and malignant human bladder cells. Cell growth (proliferation/apoptosis) was measured in UROtsa (normal), SW780 (tumorigenic; low-grade), and TCCSUP (tumorigenic; high-grade) human bladder urothelial cells by cell proliferation (XTT) assay after treatment with 0-80 microg/mL of GTE, PP-60, ECG and EGCG for 72 h. Molecular signaling pathways of catechin-induced apoptosis were analyzed using Human signal transduction RT(2) Profiler PCR array (SuperArray). Compared to control-treated cells, treatment with catechin agents significantly suppressed cell growth in a dose-dependent fashion (P < 0.01), with strongest effects evoked by ECG and EGCG in UROtsa cells, ECG in low-grade RT4 and SW780 cells, and PP-60 and EGCG in high-grade TCCSUP and T24 cells. Microarray analysis indicated distinct differences in mRNA gene expression regarding growth signaling pathway activation induced by EGCG in normal/tumorigenic human bladder cell lines, providing a rationale for the putative therapeutic usage of green tea polyphenols against bladder disease.


Assuntos
Apoptose/efeitos dos fármacos , Catequina/farmacologia , Proliferação de Células/efeitos dos fármacos , Extratos Vegetais/farmacologia , Chá , Neoplasias da Bexiga Urinária/metabolismo , Linhagem Celular Tumoral , Ensaios de Seleção de Medicamentos Antitumorais , Perfilação da Expressão Gênica , Regulação Neoplásica da Expressão Gênica/efeitos dos fármacos , Humanos , Análise de Sequência com Séries de Oligonucleotídeos , Transdução de Sinais/efeitos dos fármacos , Neoplasias da Bexiga Urinária/tratamento farmacológico
7.
Life Sci ; 83(1-2): 12-8, 2008 Jul 04.
Artigo em Inglês | MEDLINE | ID: mdl-18544457

RESUMO

Genitourinary tract inflammation/ailments affect the quality of life and health of a large segment of society. In recent years, studies have demonstrated strong antioxidant effects of green tea and its associated polyphenols in inflammatory states. This in vitro study examined the antioxidant capabilities (and putative mechanisms of action) of green tea extract (GTE), polyphenon-60 (PP-60, 60% pure polyphenols), (-)-epicatechin-3-gallate (ECG) and (-)-epigallocatechin-3-gallate (EGCG) in normal/malignant human bladder cells following catechin treatment+/-1 mM H2O2 (oxidative agent). Cell viability, apoptosis and reactive oxygen species (ROS) formation were evaluated. Our results showed that H2O2 exposure significantly reduced normal (UROtsa) and high-grade (TCCSUP, T24) bladder cancer (BlCa) cell viability compared with control-treated cells (p<0.001). No affect on low-grade RT4 and SW780 BlCa cell viability was observed with exposure to H2O2. Compared to H2O2-treated UROtsa, treatment with PP-60, ECG and EGCG in the presence of H2O2 significantly improved UROtsa viability (p<0.01), with strongest effects evoked by ECG. Additionally, though not as effective as in UROtsa cells, viability of both high-grade TCCSUP and T24 BlCa cells, in comparison to H2O2-treated cells, was significantly improved (p<0.01) by treatment with PP-60, ECG, and EGCG in the presence of H2O2. Overall, our findings demonstrate that urothelium cell death via H2O2-induced oxidative stress is mediated, in part, through superoxide (O2-.;), and potentially, direct H2O2 mechanisms, suggesting that green tea polyphenols can protect against oxidative stress/damage and bladder cell death.


Assuntos
Antioxidantes/farmacologia , Catequina/análogos & derivados , Flavonoides/farmacologia , Fenóis/farmacologia , Bexiga Urinária/efeitos dos fármacos , Antioxidantes/química , Apoptose , Camellia sinensis/química , Catequina/química , Catequina/farmacologia , Linhagem Celular , Células Cultivadas , Flavonoides/química , Humanos , Peróxido de Hidrogênio/antagonistas & inibidores , Oxidantes/antagonistas & inibidores , Estresse Oxidativo , Fenóis/química , Extratos Vegetais/farmacologia , Polifenóis , Espécies Reativas de Oxigênio/metabolismo , Transdução de Sinais , Bexiga Urinária/citologia , Urotélio/citologia
8.
J Endourol ; 21(7): 760-2, 2007 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-17705766

RESUMO

Unilateral pulmonary edema of the dependent lung presented after laparoscopic living-donor nephrectomy in two patients. Treatment with O(2) supplementation and diuretics resulted in relief of symptoms and radiographic improvement. The presumed causes of this previously unreported complication of laparoscopic living donor nephrectomy include prolonged lateral decubitus positioning and high fluid requirements.


Assuntos
Transplante de Rim/efeitos adversos , Laparoscopia/efeitos adversos , Doadores Vivos , Nefrectomia/efeitos adversos , Edema Pulmonar/etiologia , Adulto , Humanos , Masculino , Edema Pulmonar/diagnóstico por imagem , Radiografia
9.
ScientificWorldJournal ; 7: 808-17, 2007 Mar 30.
Artigo em Inglês | MEDLINE | ID: mdl-17619764

RESUMO

Botulinum toxins are well known for their ability to disrupt neurotransmission and cause muscle paralysis. Recently, urologists have discovered their beneficial effects in patients with neurogenic and overactive bladder conditions. This review is intended to provide a quick overview for urologists of the structure, function, and clinical uses of botulinum neurotoxin A in the lower urinary tract.


Assuntos
Toxinas Botulínicas Tipo A/administração & dosagem , Músculo Esquelético/fisiopatologia , Bexiga Urinaria Neurogênica/prevenção & controle , Bexiga Urinaria Neurogênica/fisiopatologia , Bexiga Urinária Hiperativa/prevenção & controle , Bexiga Urinária Hiperativa/fisiopatologia , Bexiga Urinária/fisiopatologia , Humanos , Contração Muscular/efeitos dos fármacos , Músculo Esquelético/efeitos dos fármacos , Resultado do Tratamento , Bexiga Urinária/efeitos dos fármacos
11.
J Endourol ; 20(10): 749-52, 2006 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-17094749

RESUMO

BACKGROUND AND PURPOSE: Recent studies have demonstrated a higher incidence of nephrolithiasis in the morbidly obese. Nephrolithiasis also has been described as a potential outcome after gastric bypass surgery. This is the first study to our knowledge that examines the incidence of nephrolithiasis in the morbidly obese in the setting of gastric bypass surgery at a tertiary referral center. PATIENTS AND METHODS: We retrospectively reviewed the records of patients undergoing laparoscopic gastric Roux-en-Y bypass surgery for morbid obesity at our institution for the incidence of nephrolithiasis preoperatively, de novo stones postoperatively, and both preoperative and postoperative stone formation. RESULTS: Of the 972 patients who underwent a laparoscopic gastric bypass for the treatment of morbid obesity between 1990 and the present, 85 (8.8%) were found to have upper urinary-tract calculi preoperatively, and 32 (3.2%) had de novo stones postoperatively. Of those 85 who had stones preoperatively, 26 (31.4%) developed recurrent stones postoperatively. CONCLUSIONS: These results support findings in the current literature that nephrolithiasis has a higher incidence in the morbidly obese population. The combination of preoperative stone history and gastric bypass surgery may place patients at a higher risk of future stone formation. This latter group of patients should be screened for postoperative stone formation.


Assuntos
Nefrolitíase/complicações , Obesidade Mórbida/complicações , Adulto , Idoso , Índice de Massa Corporal , Derivação Gástrica , Humanos , Incidência , Pessoa de Meia-Idade , Nefrolitíase/epidemiologia , Obesidade Mórbida/epidemiologia , Assistência Perioperatória , Período Pós-Operatório , Prevalência , Recidiva , Estudos Retrospectivos
12.
Urol Clin North Am ; 33(4): 491-501, ix, 2006 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-17011385

RESUMO

Pharmacotherapy is the first-line treatment for overactive bladder, but many patients discontinue drug therapy because of intolerable side effects, expense, or lack of longterm adherence. Alternative treatments are needed for patients who are unable to tolerate pharmacotherapy or who do not derive the desired benefits. Sacral nerve stimulation therapy has evolved into one of the most widely accepted treatment modalities in the arena of neurourology. Sacral nerve stimulation activates or "resets" the somatic afferent inputs that play a pivotal role in the modulation of sensory processing for micturition reflex pathways in the spinal cord. This minimally invasive technology offers a safe, reliable, and durable treatment for lower urinary tract dysfunction.


Assuntos
Terapia por Estimulação Elétrica/instrumentação , Próteses e Implantes , Bexiga Urinária Hiperativa/terapia , Desenho de Equipamento , Humanos , Plexo Lombossacral
13.
J Endourol ; 19(8): 973-5, 2005 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-16253061

RESUMO

BACKGROUND AND PURPOSE: While performing laparoscopic nephroureterectomy, different techniques are used for removal of the distal ureter and bladder cuff. We present a series of patients with urothelial carcinoma of the renal pelvis or ureter who underwent hand-assisted laparoscopic nephroureterectomy (HALNU) with open cystotomy for removal of the distal ureter and bladder cuff. PATIENTS AND METHODS: From January 2000 to August 2004, 34 patients underwent HALNU. The hand-port device was placed in a lower-midline infraumbilical incision in all cases. After laparoscopic removal of the kidney and ureter down to the bladder, the hand port incision was extended caudally to allow open cystotomy. Intravesical dissection was performed at the ureteral orifice, and the bladder cuff and distal ureter were removed in a traditional open fashion. RESULTS: The mean operative time was 317 +/- 150 (SD) minutes, but the median operative time was 247 minutes. The mean estimated blood loss was 252 +/- 146 mL. The mean length of stay was 7.6 +/- 6.0 days, but the median stay was 5 days postoperatively (range 3-25). The mean morphine equivalent required postoperatively was 33 +/- 22 mg. The time of Foley catheter removal ranged from 3 to 15 days (mean 6.1 +/- 3.8 days), with no cases of extravasation by cystography at removal. Within a mean follow-up of 13.9 months, no recurrence of urothelial carcinoma was seen at the site of the excised ureteral orifice. CONCLUSION: A HALNU utilizing an open cystotomy for removal of the entire distal ureter with a bladder cuff provides excellent oncologic control while not adding significantly to the operative time or the morbidity of the procedure.


Assuntos
Laparoscopia/métodos , Nefrectomia/métodos , Ureter/cirurgia , Bexiga Urinária/cirurgia , Idoso , Analgésicos Opioides/uso terapêutico , Perda Sanguínea Cirúrgica , Cateterismo , Remoção de Dispositivo , Humanos , Complicações Intraoperatórias , Neoplasias Renais/cirurgia , Tempo de Internação , Neoplasias Hepáticas/secundário , Neoplasias Pulmonares/secundário , Morfina/uso terapêutico , Complicações Pós-Operatórias , Neoplasias Ureterais/cirurgia
14.
BJU Int ; 96(3): 397-400, 2005 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-16042737

RESUMO

OBJECTIVE: To evaluate the effects of vesicostomy on the urinary tract of myelodysplastic children in whom conservative bladder management with clean intermittent catheterization (CIC) has failed to preserve upper and lower urinary tract function. PATIENTS AND METHODS: Sixteen children with myelodysplasia underwent vesicostomy. Indications included worsening hydronephrosis, vesico-ureteric reflux (VUR), recurrent urinary tract infections (UTIs), and increasing renal insufficiency despite CIC and/or difficulty with CIC. The mean (range) age at vesicostomy was 36.5 (9-82) months and the follow-up 7.4 (2-16) years. RESULTS: Hydronephrosis resolved or improved in 12 of 14 children, the incidence of UTI decreased to one or fewer per year in 10, VUR resolved or improved in nine, and renal function improved or stabilized in six of seven patients. One patient initially presented with renal insufficiency and subsequently required dialysis despite vesicostomy. Complications occurred in three of 15 children, and included stomal stenosis and bladder calculi. The vesicostomy was closed in six patients after a mean of 4.4 (1.5-9) years. Four of these patients required concomitant bladder augmentation. CONCLUSIONS: Vesicostomy in myelodysplastic children is effective in preventing and/or resolving the deleterious consequences of a 'hostile' bladder. The procedure is uncomplicated, well tolerated, reversible and should be considered in managing children in whom conservative management by CIC has failed.


Assuntos
Cistostomia/métodos , Disrafismo Espinal/complicações , Bexiga Urinaria Neurogênica/cirurgia , Criança , Pré-Escolar , Estudos de Coortes , Feminino , Humanos , Hidronefrose/etiologia , Hidronefrose/cirurgia , Lactente , Masculino , Estudos Retrospectivos , Resultado do Tratamento , Infecções Urinárias/prevenção & controle , Refluxo Vesicoureteral/etiologia , Refluxo Vesicoureteral/cirurgia
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