Detrusor contraction duration and strength in the patients with benign prostatic enlargement.: “
Detrusor contraction duration and strength in the patients with benign prostatic enlargement.
Bosn J Basic Med Sci. 2004 Feb;4(1):29-33
Authors: Aganović D, Prcić A
OBJECTIVE: examine detrusor contraction duration (DCD) in relation with obstruction grade and strength of detrusor contractility; analyze individual correlations of this parameter with urodynamic, physiological and symptoms variables in patients with benign prostatic enlargement (BPE). SAMPLE AND METHODOLOGY: 102 patients with proved BPE, underwent complete urodynamic measurements (UDM), namely uroflowmetry, cystometry and pressure/flow studies. Postvoid residual urine (PVR) was measured and the International Prostate Symptom Score (I-PSS) was fulfilled by each patient. Methodology of measurement and definitions of UDM are based on definitions and terminology defined by the International Continence Society. RESULTS: After grouping the patients (average age 64,7+/-8,5) related to obstruction grades according to the Schafer nomogram, ANOVA has shown a group extension of the detrusor contraction duration related to higher levels of obstruction (LinPURR 0-VI; p<0,01), which is also followed by stronger detrusor contractility (Pdetmax; p<0,001). Dichotomizing of the patients with DCD cut off point 90 sec. has shown that 67% patients with underactive detrusor have DCD>90 sec, while extension of DCD and increase of the obstruction level are directly related to preserved detrusor contractility only in 20,5% cases. There is neither statistically significant difference of DCD in the patients that are not in obstruction allocated in two groups depending on detrusor contraction strength, (t=1.2, p>0.05); nor in the patients who are in obstruction range, divided on the same way (t=0.568, p>0.05). There is also no difference of the same patients groups regarding PVR (t=1.38 and t=1.17, p>0.05). Individual correlation of DCD with I-PSS has not been shown (r=0.16, p>0.05), although there is a statistically significant correlation with its obstructive subset (r=0.20, p<0.05), as well as, with LinPUR and URA nomograms (r=0.33, r=0.29; respectively, p<0.005) and with Pdetmax (r=0.26, p<0.01), PdetQmax (r=0.24, p<0.05), Qmax and Qaver (r=0.31, p<0.005). DCD does not have individual correlations with patients’ age, prostate volume and with cystometric capacity. CONCLUSION: DCD is rather independent urodynamical variable, which does not correlate with I-PSS. Generally, DCD is prolonged during obstruction, while extension of DCD only partially depends on detrusor contraction strength. Practically, individual correlations of DCD with the urodynamic factors, which characterize obstructions, are modest.
PMID: 15628977 [PubMed – indexed for MEDLINE]
“
Last Updated: July 27, 2020 by uabadmin
Recurrent Uncomplicated Urinary Tract Infections in Women.
Recurrent Uncomplicated Urinary Tract Infections in Women.:
Recurrent Uncomplicated Urinary Tract Infections in Women.
J Womens Health (Larchmt). 2011 Dec 2;
Authors: Nosseir SB, Lind LR, Winkler HA
Abstract
Abstract Recurrent urinary tract infections most often present with symptoms of irritative voiding. In most cases, they are caused by reinfection with a previously isolated organism. Patients with one or more symptoms of uncomplicated recurrent urinary tract infection should undergo thorough examination and screening for underlying comorbidities that increase susceptibility. When frequent reinfections, empiric treatment relapse, persistent infections, or risk factors for complicated infections are encountered, patients may benefit from urodynamics, cystoscopy, renal ultrasound, intravenous urogram, or voiding cystourethrogram to evaluate for anatomic, functional, or metabolic abnormalities affecting the urinary tract (e.g., stones, stricture, obstruction, vesicoureteral reflux, lesions, detrusor underactivity). These patients may benefit from culture-guided empiric treatment and further evaluation by urology, nephrology, or infectious disease specialists. In patients with a history of uncomplicated urinary tract infections, empiric treatment guided by local antimicrobial resistance may efficiently treat a suspected recurrence. After successful treatment of the acute infection, postcoital prophylaxis, continuous prophylaxis, or self-start empiric treatment may be selected based on frequency of recurrent infections, temporal relation to intercourse, and patient characteristics. Ancillary measures such as probiotics, cranberry products, or local estrogen replacement may also be considered. This article will review the current definition, epidemiology, pathogenesis, diagnosis, work-up, treatment, treatment side effects, and prevention of recurrent urinary tract infections in women. A suggested algorithm for evaluation and treatment based on current literature is provided.
PMID: 22136339 [PubMed – as supplied by publisher]
Last Updated: July 27, 2020 by uabadmin
Neuroselective current perception threshold evaluation of bladder mucosal sensory function.
Neuroselective current perception threshold evaluation of bladder mucosal sensory function.:
Neuroselective current perception threshold evaluation of bladder mucosal sensory function.
Eur Urol. 2004 Jan;45(1):70-6
Authors: Ukimura O, Ushijima S, Honjo H, Iwata T, Suzuki K, Hirahara N, Okihara K, Mizutani Y, Kawauchi A, Miki T
OBJECTIVE: To evaluate human bladder mucosal sensory function by neuroselective Current Perception Threshold (CPT) measures from healthy and neuropathic bladders. METHODS: Eight healthy volunteers and 38 patients with urinary symptoms underwent conventional urodynamic tests including water-filling cystometry and ice water test. Standardized neuroselective CPT measures were obtained from the left index finger and the mucosa of the posterior bladder wall. Three different CPTs were obtained from each test site using a constant alternating current sinusoid waveform electrical stimulus presented at 2000Hz, 250Hz and 5Hz stimulation frequencies, which could selectively reflect the functions of the large myelinated fibers (A-beta-fiber), the small myelinated fibers (A-delta-fiber), and the unmyelinated fibers (C-fiber), respectively. RESULTS: As the determination of CPT values on the finger skin, the CPT values in the bladder could be determined using the neuroselective measures in all patients but three who had no sensory response (absence of sensation) caused by complete spinal injury. In the 8 patients with detrusor hyperreflexia due to incomplete spinal cord injury (supra-sacral lesion), the bladder CPT value (4.0+/-1.9) at 5Hz was significantly lower (p<0.01) than that in the controls (26.2+/-17.7). In the neurogenic bladders determined to be underactive (n=11, including post pelvic surgery, post infra-sacral level spinal cord injury and diabetes patients), the higher CPT values of bladder mucosal sensory functions were found at 5Hz (p<0.05), 250Hz (p=0.07), and 2000Hz (p<0.05) compared to the controls. CONCLUSIONS: Quantitative neuroselective measurement of CPT values in the human bladder mucosal function was feasible. Hypersensitivity or hyposensitivity of the urinary sensory function could be determined using the CPT values in comparison to control. The quantitative neuroselective estimation of the bladder sensory functions in different types of sensory peripheral nerve fibers may contribute to the appropriate selection of therapeutic strategy in patients with urinary sensory dysfunction.
PMID: 14667519 [PubMed – indexed for MEDLINE]
Last Updated: July 27, 2020 by uabadmin
[A case of acute distigmine bromide intoxication in the therapeutic dosage for treatment of underactive neurogenic bladder]
[A case of acute distigmine bromide intoxication in the therapeutic dosage for treatment of underactive neurogenic bladder]:
[A case of acute distigmine bromide intoxication in the therapeutic dosage for treatment of underactive neurogenic bladder]
No To Shinkei. 2004 May;56(5):415-9
Authors: Tada M, Fujita N, Umeda M, Koike H, Nagai H
Distigmine bromide (Ubretid) is a long-acting anti-cholinesterase, widely used for the treatment of underactive neurogenic bladder and myasthenia gravis. Our study concerns a 73-year-old man treated with a potentially life-threatening cholinergic state due to distigmine bromide. He had been administered distigmine bromide orally for over two years at a daily dosage of 10 mg as a treatment for underactive neurogenic bladder. He suddenly developed diarrhea and consciousness disturbance during treatment of his urinary tract infection. Bradycardia and miosis were noted. Blood examination revealed extremely low levels of the plasma cholinesterase activity. The condition was diagnosed as distigmine bromide intoxication. All cholinergic symptoms disappeared in several days after the administration of distigmine bromide was terminated. Cholinergic crisis due to overdosage with anticholinesterases is well known, and the myasthenic patients are usually supervised in the early stages of dosage regulation to guard against the possibility of cholinergic crisis. However the use of oral distigmine bromide, even in therapeutic doses for urinary retention, could result in cholinergic crisis. We therefore conclude that extreme caution must be used in administering distigmine bromide.
PMID: 15279199 [PubMed – indexed for MEDLINE]
Last Updated: July 27, 2020 by uabadmin
Twenty-seven years of complication-free life with clean intermittent self-catheterization in a patient with spinal cord injury: A case report.
Twenty-seven years of complication-free life with clean intermittent self-catheterization in a patient with spinal cord injury: A case report.:
Twenty-seven years of complication-free life with clean intermittent self-catheterization in a patient with spinal cord injury: A case report.
Arch Phys Med Rehabil. 2004 Oct;85(10):1705-7
Authors: Mizuno K, Tsuji T, Kimura A, Liu M, Masakado Y, Chino N
Currently, clean intermittent self-catheterization (CISC) is the most prevalent method of bladder management in patients with spinal cord injury (SCI) at discharge from rehabilitation centers. However, half of the patients discontinue using CISC and change to other methods of bladder management several months postdischarge despite the fact that it the best way to prevent urinary tract complications. Few studies, however, report the long-term consequences of CISC. In this case, we present a woman in her early fifties who had sustained thoracic SCI and had continued using CISC for 27 years without developing any complications. The possible reasons for her success were absence of incontinence because of underactive and normal capacity bladder; normal upper-extremity functions and absence of marked spasticity of lower extremities that facilitated CISC technique; and absence of sociovocational problems, enabling her to keep proper intervals between catheterizations each day. This case indicates that CISC is useful for long-term bladder management in patients with SCI, even for 25 years or more. Long-term outcomes of CISC and factors leading to success need to be delineated in future studies with larger samples.
PMID: 15468034 [PubMed – indexed for MEDLINE]
Last Updated: July 27, 2020 by uabadmin
Core lower urinary tract symptom score (CLSS) for the assessment of female lower urinary tract symptoms: A comparative study.
Core lower urinary tract symptom score (CLSS) for the assessment of female lower urinary tract symptoms: A comparative study.:
Core lower urinary tract symptom score (CLSS) for the assessment of female lower urinary tract symptoms: A comparative study.
Int J Urol. 2011 Sep 23;
Authors: Fujimura T, Kume H, Tsurumaki Y, Yoshimura Y, Hosoda C, Suzuki M, Fukuhara H, Enomoto Y, Nishimatsu H, Homma Y
Abstract
Objective: We have recently developed the core lower urinary tract symptom score (CLSS) questionnaire to readily address 10 important lower urinary tract symptoms (LUTS). The aim of the present study was to evaluate the performance of the CLSS in women compared with the International Prostate Symptom Score (IPSS) and Overactive Bladder Symptom Score (OABSS). Methods: Three hundred and eighteen treatment-naïve consecutive female patients, including 48 controls, completed the three questionnaires. Quality of life (QOL) was determined as per the IPSS QOL Index. The clinical diagnoses were overactive bladder (n = 69), mixed incontinence (n = 42), stress incontinence (n = 17), pelvic organ prolapse (n = 56), interstitial cystitis (n = 31), bacterial cystitis (n = 16), underactive bladder (n = 16), and “other” (n = 23). Simple statistics and the relationship between symptom scores and poor QOL (QOL Index ≥4) were examined. Results: All symptom scores were significantly increased in symptomatic women. The CLSS described the symptom profiles of patients with distinct conditions. The scores of corresponding symptoms on the three questionnaires were significantly correlated (r = 0.51-0.85; all P < 0.0001). Multivariate logistic regression modeling proved five CLSS symptoms (daytime frequency, nocturia, urgency incontinence, straining, and urethral pain) as independent predictors of poor QOL, with hazard ratios ranging from 2.0 to 4.2. The IPSS included only two (urgency and straining) significant symptoms. Conclusions: The IPSS alone does not fully evaluate female LUTS, with a possible negative impact on QOL. Using the CLSS questionnaire would enable a simple and comprehensive assessment of female LUTS.
PMID: 21951201 [PubMed – as supplied by publisher]
Last Updated: July 27, 2020 by uabadmin
Quantifying the effect of urodynamic catheters on urine flow rate measurement.
Quantifying the effect of urodynamic catheters on urine flow rate measurement.:
Quantifying the effect of urodynamic catheters on urine flow rate measurement.
Neurourol Urodyn. 2011 Sep 26;
Authors: Harding C, Horsburgh B, Dorkin TJ, Thorpe AC
Abstract
INTRODUCTION: The effect of urodynamic catheters on urine flow rate (Q(max) ) is well documented but under-researched. Several studies show reduced Q(max) but methodologies and patient demographics differ. The aims of this study were to further quantify the effect of urodynamic catheters on Q(max) and to explore if this was consistent across different urodynamic diagnoses. METHODS: Four groups of 50 consecutive men attending for urodynamic studies (UDS) were retrospectively analyzed: Group 1 comprised 50 men with normal UDS, Group 2 was 50 men with BOO, and Group 3 contained 50 men with detrusor underactivity. Groups 1-3 had UDS performed using both 10 Fr filling and 4 Fr measuring catheters in situ. Group 4 comprised 50 men who had UDS performed with a smaller catheter assembly (8 Fr dual-lumen). Values of Q(max) with and without catheters present were compared using paired Student’s t-tests. Differences between groups were compared using ANOVA. RESULTS: Q(max) measured during UDS in men from Groups 1-3 showed a mean reduction of 38% compared to Q(max) from “free” uroflowmetry. ANOVA indicated this reduction was significantly greater among men with normal UDS. Interestingly the group who underwent UDS with a smaller catheter assembly showed no significant reduction in Q(max) measured with catheters in situ. CONCLUSION: Our findings are in line with previous work suggesting that smaller calibre urethral catheters do not cause a significant obstructive effect during voiding. In addition it would appear that the reduction in Q(max) with larger urethral catheters in situ is greatest in those with normal urodynamics. Neurourol. Urodynam. © 2011 Wiley-Liss, Inc.
PMID: 21953734 [PubMed – as supplied by publisher]
Last Updated: July 27, 2020 by uabadmin
Natural history of detrusor contractility–minimum ten-year urodynamic follow-up in men with bladder outlet obstruction and those with detrusor.
Natural history of detrusor contractility–minimum ten-year urodynamic follow-up in men with bladder outlet obstruction and those with detrusor.:
Natural history of detrusor contractility–minimum ten-year urodynamic follow-up in men with bladder outlet obstruction and those with detrusor.
Scand J Urol Nephrol Suppl. 2004;(215):101-8
Authors: Al-Hayek S, Thomas A, Abrams P
OBJECTIVE: To check the long-term effect, in male patients, of treated and untreated bladder outlet obstruction (BOO) on detrusor contractility and to explore the relationship between ageing and detrusor underactivity (DUA). MATERIAL AND METHODS: Men investigated at the urodynamic department of Southmead Hospital in Bristol between 1972 and 1986 were traced and three groups were invited for repeat pressure-flow urodynamic studies (PFS). The first two groups included patients over 40 years old, with untreated or surgically treated BOO, and the third group had patients with DUA from all age groups. RESULTS: 196 patients (with a minimum 10 year gap from the first assessment) agreed to have repeat PFS. There was no statistically significant change in bladder contractility index (BCI) in patients with BOO treated by transurethral resection of the prostate (TURP) (mean difference in BCI was 0.01, 95% confidence interval -0.07 to 0.09, n=114). There was also no significant difference in BCI in untreated patients with BOO (p=0.10, n=53). The follow-up BCI was higher in untreated patients than in the surgically treated group. The BCI in patients with DUA did not change significantly after a minimum of 10 years’ follow-up. CONCLUSIONS: There is no evidence to suggest that detrusor contractility declines with long-term BOO. Relieving the obstruction surgically does not improve the contractility. This is important when considering and counselling for TURP. Underactive detrusors remain underactive, but do not get worse with time, which could indicate that this is not an ageing process per se and may even have a congenital basis.
PMID: 15545204 [PubMed – indexed for MEDLINE]
Last Updated: July 27, 2020 by uabadmin
Assessment of lower urinary tract symptoms in men by international prostate symptom score and core lower urinary tract symptom score.
Assessment of lower urinary tract symptoms in men by international prostate symptom score and core lower urinary tract symptom score.:
Assessment of lower urinary tract symptoms in men by international prostate symptom score and core lower urinary tract symptom score.
BJU Int. 2011 Aug 26;
Authors: Fujimura T, Kume H, Nishimatsu H, Sugihara T, Nomiya A, Tsurumaki Y, Miyazaki H, Suzuki M, Fukuhara H, Enomoto Y, Homma Y
Abstract
Study Type – Therapy (symptom prevalence) Level of Evidence 2a What’s known on the subject? and What does the study add? The International Prostate Symptom Score (IPSS) has been most commonly used for the symptom assessment of men with lower urinary tract symptoms (LUTS). However, LUTS in men are so variable that they may not be fully captured by the IPSS questionnaire alone. This study has demonstrated that the Care Lower Urinary Tract Symptom Score (CLSS) questionnaire, which addresses 10 important symptoms, is an appropriate initial assessment tool for LUTS in men with various diseases/conditions. OBJECTIVE: • International Prostate Symptom Score (IPSS) has been commonly used to assess lower urinary tract symptoms (LUTS). We have recently developed Core Lower Urinary Tract Symptom Score (CLSS). The aim of this study is to compare IPSS and CLSS for assessing LUTS in men. PATIENTS AND METHODS: • Consecutive 515 men fulfilled IPSS and CLSS questionnaires. • IPSS QOL Index was used as the QOL surrogate. • The clinical diagnoses were BPH (n = 116), BPH with OAB wet (n = 80), prostate cancer (n = 128), prostatitis (n = 68), underactive bladder (n = 8), others (n = 72), and controls (e.g., occult blood) (n = 42). • Simple statistics and predictability of poor QOL (QOL Index 4 or greater) were examined. RESULTS: • All symptom scores were significantly increased in symptomatic men compared with controls. Scores of corresponding symptoms of two questionnaires were significantly correlated (r = 0.58-0.85, all P < 0.0001). • A multivariate regression model to predict poor QOL indicated nine symptoms (daytime frequency, nocturia, urgency, urgency incontinence, slow stream, straining, incomplete emptying, bladder pain and urethral pain) as independent factors. • The hazard ratios for bladder pain (2.2) and urgency incontinence (2.0) were among the highest. • All the nine symptoms are addressed in CLSS, while three symptoms (urgency incontinence, bladder, and urethral pain) are dismissed in IPSS. CONCLUSION: • CLSS questionnaire is more comprehensive than IPSS questionnaire for symptom assessment of men with various diseases/conditions, although both questionnaires can capture LUTS with possible negative impact on QOL.
PMID: 21883834 [PubMed – as supplied by publisher]
Last Updated: July 27, 2020 by uabadmin
Detrusor contraction duration and strength in the patients with benign prostatic enlargement.
Detrusor contraction duration and strength in the patients with benign prostatic enlargement.: “
Detrusor contraction duration and strength in the patients with benign prostatic enlargement.
Bosn J Basic Med Sci. 2004 Feb;4(1):29-33
Authors: Aganović D, Prcić A
OBJECTIVE: examine detrusor contraction duration (DCD) in relation with obstruction grade and strength of detrusor contractility; analyze individual correlations of this parameter with urodynamic, physiological and symptoms variables in patients with benign prostatic enlargement (BPE). SAMPLE AND METHODOLOGY: 102 patients with proved BPE, underwent complete urodynamic measurements (UDM), namely uroflowmetry, cystometry and pressure/flow studies. Postvoid residual urine (PVR) was measured and the International Prostate Symptom Score (I-PSS) was fulfilled by each patient. Methodology of measurement and definitions of UDM are based on definitions and terminology defined by the International Continence Society. RESULTS: After grouping the patients (average age 64,7+/-8,5) related to obstruction grades according to the Schafer nomogram, ANOVA has shown a group extension of the detrusor contraction duration related to higher levels of obstruction (LinPURR 0-VI; p<0,01), which is also followed by stronger detrusor contractility (Pdetmax; p<0,001). Dichotomizing of the patients with DCD cut off point 90 sec. has shown that 67% patients with underactive detrusor have DCD>90 sec, while extension of DCD and increase of the obstruction level are directly related to preserved detrusor contractility only in 20,5% cases. There is neither statistically significant difference of DCD in the patients that are not in obstruction allocated in two groups depending on detrusor contraction strength, (t=1.2, p>0.05); nor in the patients who are in obstruction range, divided on the same way (t=0.568, p>0.05). There is also no difference of the same patients groups regarding PVR (t=1.38 and t=1.17, p>0.05). Individual correlation of DCD with I-PSS has not been shown (r=0.16, p>0.05), although there is a statistically significant correlation with its obstructive subset (r=0.20, p<0.05), as well as, with LinPUR and URA nomograms (r=0.33, r=0.29; respectively, p<0.005) and with Pdetmax (r=0.26, p<0.01), PdetQmax (r=0.24, p<0.05), Qmax and Qaver (r=0.31, p<0.005). DCD does not have individual correlations with patients’ age, prostate volume and with cystometric capacity. CONCLUSION: DCD is rather independent urodynamical variable, which does not correlate with I-PSS. Generally, DCD is prolonged during obstruction, while extension of DCD only partially depends on detrusor contraction strength. Practically, individual correlations of DCD with the urodynamic factors, which characterize obstructions, are modest.
PMID: 15628977 [PubMed – indexed for MEDLINE]
“
Last Updated: July 27, 2020 by uabadmin
Urologic dysfunction and neurologic outcome in coma survivors after severe traumatic brain injury in the postacute and chronic phase.
Urologic dysfunction and neurologic outcome in coma survivors after severe traumatic brain injury in the postacute and chronic phase.: “
Urologic dysfunction and neurologic outcome in coma survivors after severe traumatic brain injury in the postacute and chronic phase.
Arch Phys Med Rehabil. 2011 Jul;92(7):1134-8
Authors: Giannantoni A, Silvestro D, Siracusano S, Azicnuda E, D’Ippolito M, Rigon J, Sabatini U, Bini V, Formisano R
Giannantoni A, Silvestro D, Siracusano S, Azicnuda E, D’Ippolito M, Rigon J, Sabatini U, Bini V, Formisano R. Urologic dysfunction and neurologic outcome in coma survivors after severe traumatic brain injury in the postacute and chronic phase.
PMID: 21704794 [PubMed – in process]
“
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