Lower urinary tract symptoms in Parkinson's disease and multiple system atrophy / 中华老年医学杂志

Parkinson's disease(PD)and multiple system atrophy(MSA)are two common Parkinsonian syndromes with overlapping clinical manifestations, and clinical differential diagnosis is difficult.Lower urinary tract symptoms are one of the common non-motor symptoms of the two diseases.The incidence of lower urinary tract symptoms in MSA is higher, the onset is earlier, and the micturition period is more prominent.The urinary dysfunction in patients with PD is mainly caused by the central mechanism, leading to overactive bladder.MSA has more extensive lesions with both central and peripheral involvement, leading to overactive bladder and severe voiding dysfunction.Urodynamics can be used to evaluate bladder and urethral function.MSA has more prominent weak detrusor activity, residual urine volume, and early changes of urethral sphincter.The treatment of lower urinary tract symptoms in patients with PD is mainly based on anticholinergic drugs to improve overactive bladder, while in MSA patients with increased residual urine volume, intermittent catheterization is the main method to improve lower urinary tract symptoms.This article reviewed the epidemiology, pathological mechanism, urodynamics and treatment of lower urinary tract symptoms of the two diseases, so as to assist in their differential diagnosis and treatment.

[Outpatient urodynamic monitoring in patients with BPH: world and russian experience].

Outpatient urodynamic monitoring (AUM) - registration of the patients urination parameters for a certain time (for example, during the day), which is carried out in natural conditions for him. Monitoring allows you to identify hidden or periodically occurring (circadian) changes, which are not always possible to record with a single study. The research was searched in the PubMed and Elibrary.ru databases using the keywords "home uroflowmetry", "outpatient urodynamic examination", "outpatient urodynamic monitoring", "outpatient uroflowmetric monitoring". The difficulties in performing AUM lie not only in the hardware (the presence of a portable device, minimally invasive or non-invasive research, software that guarantees the storage and transmission of data), but also the difficulties associated with teaching patients and overcoming conservatism on the part of medical personnel. Today, there are several urodynamic devices and uroflowmeters designed for research at home. Outpatient (home) urodynamic monitoring is one of the most promising studies for implementation in everyday clinical practice in the provision of medical care to patients with urination disorders on the background of benign prostatic hyperplasia. The integration of home uroflowmetric monitoring into the eHealth system, of course, remains an inevitable trend in the development of modern healthcare.

Responses of functional brain networks to bladder control in healthy adults: a study using regional homogeneity combined with independent component analysis methods.

OBJECTIVE: A functional magnetic resonance imaging (fMRI) study was performed during urodynamic examination in healthy adults to determine the responses of functional brain networks to bladder control during urine storage. METHODS: The brain imaging was performed in empty and full bladder states during urodynamic examination. First, we used independent component analysis (ICA) to obtain several resting state network masks, then the brain regions with significantly different regional homogeneity (ReHo) values between the two states were determined using a paired t test (p < 0.05; Gaussian random field correction [GRF]: voxel p < 0.01 and cluster p < 0.05) and presented in their corresponding resting state network (RSN) masks. RESULTS: Data sets obtained from the remaining 20 subjects were analyzed after motion correction. Nine RSNs were identified by group-ICA, including the salience network (SN), default mode network (DMN), central executive network (CEN), dorsal attention network (dAN), auditory network (AN), sensorimotor network (SMN), language network (LN), visual network (VN), and cerebellum network (CN). The ReHo values were significantly increased (p < 0.05, GRF corrected) within the SN, DMN, and CEN in the full bladder state compared with the empty bladder state. CONCLUSION: Significant changes within the three functional brain networks were demonstrated when the bladder was full, suggesting that SN provides bladder sensation and DMN may provide self-reference, self-reflection, and decision-making about whether to void after assessment of the external environment, while CEN may provide support related to episodic memory, which provides new insight into the processing of bladder control and could serve as a premise to further explore the pathologic process underlying bladder dysfunction.

Effect of meditation on physiological and psychological stress of patients underwent urodynamic examination / 中国实用护理杂志

Objective:To explore the effects of meditation on patients underwent urodynamic examination.Methods:Totally 90 patients with benign prostatic hyperplasia who underwent urodynamic examination in the Department of Urology at the hospital from September 2018 to December 2019 were enrolled in the present study. They were assigned to experimental group and control group, with 45 cases in each group. The control group received routine nursing, basis on this, the experimental group carried out meditation training. The examination time, examination success rate as well as the incidence of complications were recorded between two groups. The systolic blood pressure, diastolic blood pressure and heart rate was compared at 10 min before the start of examination, 10 min after the start of examination, 10 min after the end of examination, respectively. In addition, the psychological stress was assessed by Self-rating Anxiety Scale (SAS) and Self-rating Depression Scale (SDS) at 1 day before the start of examination, 1 hour before the start of examination and 10 min after the end of examination.Results:The examination time were (33.56±4.95) min and the incidence of hematuria were 4.4% (2/45) in the experimental group, significantly lower than (36.42±6.32) min and 17.8% (8/45) in the control group, the difference was statistically significant (t value was 2.460, χ 2 value was 4.050, P<0.05). At 10 min before the start of examination, 10 min after the start of examination, the systolic blood pressure and diastolic blood pressure were (129.18±10.99) mmHg (1 mmHg=0.133 kPa), (130.73±11.81) mmHg and (89.42±14.50) mmHg, (98.36±15.51) mmHg in the experimental group, significantly lower than (135.93±10.17) mmHg, (139.49±10.64) mmHg and (96.29±13.85) mmHg, (105.80±12.02) mmHg in the control group ( t values were 2.297-3.695, P<0.01 or 0.05); at 10 min before the start of examination, 10 min after the start of examination, 10 min after the end of examination, the heart rate were (85.53±11.82) times/min, (90.51±8.82) times/min, (74.09±8.20) times/min in the experimental group, significantly lower than (92.80±11.95) times/min, (95.84±10.02) times/min, (77.60±8.51) times/min in the control group, the difference was statistically significant ( t values were 2.900, 2.680, 1.992, P<0.01 or 0.05). At 1 hour before the start of examination, the SAS and SDS scores were (54.42±3.85) pionts and (54.11±4.65) points in the experimental group, significantly lower than (58.44±7.37) pionts and (56.11±4.48) pionts in the control group, the difference was statistically significant ( t values were 3.247, 2.079, P<0.01 or 0.05). Conclusion:The meditation can help to relieve the physiological and psychological stress of patients who underwent urodynamic examination, shorten the examination time as well as reduce complications.

Functional connectivity within prefrontal cortex in patients with overactive bladder based on rs-fNIRS measurement synchronous urodynamic monitoring / 中华泌尿外科杂志

Objective:To detect the abnormalities within the functional connectivity (FC) of the prefrontal cortex (PFC) in patients with overactive bladder (OAB) and to explore its central pathogenesis.Methods:Seven OAB patients (OAB group, 6 females, mean age 47.6±16.0 years) and 13 healthy controls [HC] (HC group, 10 females, mean age 49.9±9.2 years) were prospectively enrolled from August to December 2020. All subjects underwent rs-fNIRS scanning synchronized with urodynamic monitoring, and two rs-fNIRS scans were performed when the bladder was empty and when the desire to void was strong/urodynamic monitoring indicated detrusor hyperactivity (DO). The Pearson's correlation coefficients (r value, i. e., FC value) between time series of the 22 channels were calculated, and a 22×22 FC matrix for each subject was obtained. A paired-sample t-test ( P<0.05, FDR corrected) was used to compare the difference in FC values between the HC group and the OAB group when the bladder was empty and the desire to void was strong. A two-sample t-test ( P<0.05, FDR corrected) was used to compare the group differences in FC values between OAB and HC groups. Results:In this study, 7 patients were included in the OAB group, including 1 male and 6 female. The mean age was (47.6±16.0) years old. In HC group, 13 healthy subjects were included, including 3 males and 10 females. The mean age was (49.9±9.2) years. There was no significant difference in baseline data between the two groups, including age, sex composition, years of education, handedness and urgency score at the second scan ( P>0.05). Residual urine volume in both groups was less than 10 ml. The OABSS score, 3-day urine diary parameters (frequency of urination/24 h, frequency of urinary incontinence/24 h, frequency of urgency/24 h) and maximum detrusor pressure during urine storage in OAB group were significantly higher than those in HC group, with statistical significance ( P<0.01). The average urination volume/time, bladder capacity at first sensation and maximum bladder capacity in OAB group were significantly lower than those in HC group, and the differences were statistically significant ( P<0.01). In the process of bladder filling to strong desire to void, the detrusor pressure in HC group was stable without DO, and 6 cases in OAB group had DO. Compared to empty bladder state, healthy subjects with strong desire to void showed significantly increased FC within PFC in 5 Brodmann area (BA9, BA10, BA44, BA45, BA46)and 13 edges, such as the BA9(left dorsolateral prefrontal cortex [DLPFC]: ch 4, 5, 7 and right DLPFC: ch 3), BA10(left frontopolar area: ch 12, 21 and right frontopolar area: ch 10, 18), BA44(left pars opercularis Broca's area: ch 15), BA45(left pars triangularis: ch 22), BA46(left DLPFC: ch 6, 14); significantly decreased FC in 3 brain regions (BA9, BA10 and BA46) and 2 edges, such as the BA9(left DLPFC: ch 7), BA10(left frontopolar area: ch21 and right frontopolar area: ch 17), BA46(right DLPFC: ch 9). There was no significant difference in FC within PFC between OAB and HC groups with empty bladder. However, during the strong desire to void state, the FC within PFC in OAB patients was significantly abnormal when compared with HC. OAB patients showed significantly increased FC within PFC in 4 brain regions (BA9, BA10, BA45 and BA46) and 4 edges, such as the BA9(right DLPFC: ch 1 and left DLPFC: ch 7), BA10(right frontopolar area: ch 17), BA45(left pars triangularis: ch 22), BA46(right DLPFC: ch 9, 16); significantly decreased FC in 3 brain regions (BA9, BA10 and BA46) and 4 edges, such as the BA9 (right DLPFC: ch 3 and left DLPFC: ch 4), BA10(left frontopolar area: ch 12, 21), BA46(left DLPFC: ch 14) Conclusion:Compared with HC group, the PFC in OAB group showed significant abnormalities, which may lead to "dyssynergia" of PFC internal functions, result in frontal lobe dysfunction, involving sensory integration, motivation drive, emotional control and decision whether to urinate or not, etc., leading to urinary control dysfunction, which manifested as typical clinical symptoms of OAB. Our findings contribute to the understanding of the central pathogenesis of OAB and may provide a theoretical basis for the emergence of targeted brain therapy in the future.

Research progress of noninvasive diagnosis of male bladder outlet obstruction / 中国综合临床

Currently, invasive urodynamic testing is the " gold standard" for the diagnosis of bladder outlet obstruction (BOO). However, this test is invasive, easy to cause hematuria, urinary tract infection and other complications, the application conditions are limited.In order to solve this problem, various non-invasive methods to diagnose or predict BOO have been studied.The use of existing inspection indicators such as ultrasound measurement, penile cuff test, near infrared spectroscopy and other new non-invasive methods provide a new research direction for the non-invasive diagnosis of bladder outlet obstruction.

Construct bladder function training model of orthotopicilealneobladder according to the results of urodynamic examination / 中华泌尿外科杂志

Objective To stage orthotopicilealneobladder function and construct the corresponding training mode according to the results of urodynamic examination.Methods 38 patients with bladder cancer underwent radical resection+orthotopicilealneobladder surgery between August 2013 and August 2017,and the urodynamic examination results of 3 months,6 months,1 year,2 years,3 years of were retrospectively analyzed.The bladder function of the patients with orthotopicilealneobladder was staged according to urodynamic examination,and the bladder function training mode was formed.Results As the follow-up time increased after surgery,day/night urine control increased,the maximum urine flow rate,the average urine flow rate increased,urination time shortening,bladder capacity increased,bladder basic pressure decreased,bladder filling state pressure,bladder compliance increased,micturition maximal bladder pressure,maximum abdominal pressure and maximum detrusor pressure increased,and all the indexes tended to be stable after 1 year.Bladder function training orthotopicilealneobladder is divided into four periods,respectively are Hospitalization period,recovery period(3 months after surgery),rehabilitation period(3 months to 1 year after surgery),stable period(1 year after surgery),and formed different stages of orthotopicilealneobladder bladder function training content.The focus nursing of each stage is that early period-drainage tube care,recovery period-incontinence care,rehabilitation period-urinary training,stable period-complications handling.Conclusions According to the results of urodynamic examination,it is possible to propose a targeted,scientific and practical bladder function training model for the orthotopicilealneobladder.

The value of bladder wall thickness in predicting upper urinary tract damage in patients with neurogenic lower urinary tract dysfunction / 中华泌尿外科杂志

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.

[Saw palmetto fruit extract improves LUTS in type â ¢A prostatitis patients].

OBJECTIVE: To assess the clinical efficacy of the saw palmetto fruit extract (SPFE) in the treatment of lower urinary tract symptoms (LUTS) in patients with type ⅢA prostatitis. METHODS: This retrospective study included 54 cases of type ⅢA prostatitis treated in the Outpatient Department of our hospital from January to December 2015. The patients were aged 35.06 ± 5.85 years, with a mean disease course of 3.8 ± 2.1 years, and all received oral medication of SPFE Capsules at the dose of 320 mg qd for 12 weeks. We assessed the therapeutic effects by comparing the NIH-chronic prostatitis symptom indexes (NIH-CPSI), voiding diary, International Prostate Symptom Scores (IPSS), and results of urodynamic examination before and after treatment. RESULTS: Compared with the baseline, both NIH-CPSI and IPSS were significantly decreased after medication (27.61 ± 3.76 vs 18.6 ± 5.34, P <0.01; 20.44 ± 4.51 vs 10.96±4.62, P <0.01), and urodynamic examination and voiding diary showed dramatic post-medication improvement in the average urinary flow rate (ï¼»8.05±1.42ï¼½ vs ï¼»12.05±2.60ï¼½ ml/s, P <0.01 ), maximum urinary flow rate (ï¼»14.22±1.74ï¼½ vs ï¼»21.32±4.51ï¼½ ml/s, P <0.01), residual urine volume (ï¼»46.15±16.57ï¼½ vs ï¼»14.55±10.21ï¼½ ml, P <0.01), maximum urethral closure pressure (ï¼»76.52±3.53ï¼½ vs ï¼»65.32±4.75ï¼½ cm H2O, P <0.01), mean urinary volume (ï¼»124.63±40.55ï¼½ vs ï¼»285.93±58.68ï¼½ ml, P <0.01), urination frequency (16.96±4.17 vs 8.96±2.50, P <0.01), and nocturia frequency (8.94±3.23 vs 3.15±1.90, P <0.01). No apparent adverse reactions were observed in any of the patients. CONCLUSIONS: SPFE Capsules can safely and effectively improve LUTS and thus the quality of life of patients with type ⅢA prostatitis.

Saw palmetto fruit extract improves LUTS in type ⅢA prostatitis patients / 中华男科学杂志

Objective@#To assess the clinical efficacy of the saw palmetto fruit extract (SPFE) in the treatment of lower urinary tract symptoms (LUTS) in patients with type ⅢA prostatitis.@*METHODS@#This retrospective study included 54 cases of type ⅢA prostatitis treated in the Outpatient Department of our hospital from January to December 2015. The patients were aged 35.06 ± 5.85 years, with a mean disease course of 3.8 ± 2.1 years, and all received oral medication of SPFE Capsules at the dose of 320 mg qd for 12 weeks. We assessed the therapeutic effects by comparing the NIH-chronic prostatitis symptom indexes (NIH-CPSI), voiding diary, International Prostate Symptom Scores (IPSS), and results of urodynamic examination before and after treatment.@*RESULTS@#Compared with the baseline, both NIH-CPSI and IPSS were significantly decreased after medication (27.61 ± 3.76 vs 18.6 ± 5.34, P <0.01; 20.44 ± 4.51 vs 10.96±4.62, P <0.01), and urodynamic examination and voiding diary showed dramatic post-medication improvement in the average urinary flow rate (［8.05±1.42］ vs ［12.05±2.60］ ml/s, P <0.01 ), maximum urinary flow rate (［14.22±1.74］ vs ［21.32±4.51］ ml/s, P <0.01), residual urine volume (［46.15±16.57］ vs ［14.55±10.21］ ml, P <0.01), maximum urethral closure pressure (［76.52±3.53］ vs ［65.32±4.75］ cm H2O, P <0.01), mean urinary volume (［124.63±40.55］ vs ［285.93±58.68］ ml, P <0.01), urination frequency (16.96±4.17 vs 8.96±2.50, P <0.01), and nocturia frequency (8.94±3.23 vs 3.15±1.90, P <0.01). No apparent adverse reactions were observed in any of the patients.@*CONCLUSIONS@#SPFE Capsules can safely and effectively improve LUTS and thus the quality of life of patients with type ⅢA prostatitis.

An unresolved relationship: the relationship between lesion severity and neurogenic bladder in patients with spinal cord injury.

OBJECTIVES: We aimed to investigate the relationship between the severity of the spinal lesion and urodynamic findings, bladder drainage method at discharge, and incidence of renal calculi in patients with spinal cord injury (SCI). STUDYDESIGN: Retrospective. SETTING: In-patient rehabilitation unit of a tertiary research hospital. METHODS: A total of 131 patients who were admitted to our clinic with a diagnosis of SCI and placed into a rehabilitation program were included in the study. The severity of the lesion was determined according to the American Spinal Injury Association Impairment Scale (AIS). We evaluated the relationship between the severity of the lesion and the detrusor hyperactivity and compliance as determined by urodynamic investigation, the bladder drainage method used at discharge, and the renal calculi rate as determined by ultrasonography. RESULTS: While no difference was found between the patients with complete and incomplete injuries in terms of age, sex, disease duration, detrusor hyperactivity and compliance, the bladder drainage method was found to show a significant change according to the severity of the lesion. None of the patients were found to have hydronephrosis and the rate of renal calculi showed no statistically significant difference according to the severity of the lesion. CONCLUSIONS: We concluded that urodynamic examination is required in each patient with SCI as the severity of the lesion is not sufficient to determine the bladder type, and patients with complete and incomplete injuries should be monitored with the same sensitivity in terms of complications.

Correlations of simple bladder capacity measurement and urodynamic examination used for bladder function assessment of patients with spinal cord injury / 现代临床护理

ObjectiveTo explore the correlations of simple bladder capacity measurement and urodynamic examination used for assessing the bladder function of patients with spinal cord injury.Methods From December 2011 to September 2013,a total of 37 patients with spinal cord injury were recruited.Their bladder functions were examined by both simple bladder capacity measurement and urodynamics in the first week after admission.The type of neurogenic bladder,residue urine,bladder capacity and the changes of bladder pressure were documented and compared.Results The simple bladder capacity measurement and urodynamics showed no significant differences in the parameters including residual urine,and bladder pressures when inputting 50mL,100mL,300mL and 400mL water(P>0.05). But there were significant differences in the results of bladder capacity and bladder pressure when inputting 200mL water(P<0.05). The intra-class coefficients between the results by the two methods were 0.606~0.919(P<0.01).The Kappa coefficient of the health professionals’judgments according to the two methods was 0.825(P<0.001).Conclusions The results of simple bladder capacity measurement are reliable.It can be used as the supplement for urodynamics to monitor the bladder function of patients with spinal cord injury.

Complications of Urodynamic Examinations: 38 Cases Report / 中国康复理论与实践

@#Objective To investigate the complications of urodynamic examinations. Methods All the complications in 1450 urodynamic examinations were analyzed retrospectively. Results There were all 38 complications (2.62%), including 25 hematuria (1 with severe hematuria requiring emergency operation), 9 fever, 1 anal hemorrhage, 3 failure in bladder catheter intubation. Conclusion Avoiding unnecessary urodynamic examinations and adopting appropriate precaution may reduce the complications of urodynamic examinations.

Complications of Urodynamic Examinations: 38 Cases Report / 中国康复理论与实践

@#Objective To investigate the complications of urodynamic examinations. Methods All the complications in 1450 urodynamic examinations were analyzed retrospectively. Results There were all 38 complications (2.62%), including 25 hematuria (1 with severe hematuria requiring emergency operation), 9 fever, 1 anal hemorrhage, 3 failure in bladder catheter intubation. Conclusion Avoiding unnecessary urodynamic examinations and adopting appropriate precaution may reduce the complications of urodynamic examinations.