Prevalence and mechanism of bladder dysfunction in Guillain-Barré Syndrome.: “
Prevalence and mechanism of bladder dysfunction in Guillain-Barré Syndrome.
Neurourol Urodyn. 2009;28(5):432-7
Authors: Sakakibara R, Uchiyama T, Kuwabara S, Mori M, Ito T, Yamamoto T, Awa Y, Yamaguchi C, Yuki N, Vernino S, Kishi M, Shirai K
AIM: To examine the prevalence and mechanism of urinary dysfunction in GBS. METHODS: Urinary symptoms were observed and neurological examinations made repeatedly during hospitalization of 65 consecutive patients with clinico-neurophysiologically definite GBS. The patients included 41 men, 24 women; mean age, 41 years old; mean Hughes motor grade, 3; AIDP, 28, AMAN, 37. Urodynamic studies consisted of uroflowmetry, measurement of post-micturition residuals, medium-fill water cystometry, and external anal sphincter electromyography. RESULTS: Urinary dysfunction was observed in 27.7% of GBS cases (urinary retention, 9.2%). Urinary dysfunction was related to the Hughes motor grade (P < 0.05), defecatory dysfunction (P < 0.05), age (P < 0.05), and negatively related to serum IgG class anti-ganglioside antibody GalNAc-GD1a (P < 0.05). Urinary dysfunction was more common in AIDP (39%) than in AMAN (19%). No association was found between antibody titer against neuronal nicotinic acetylcholine receptors and urinary dysfunction. Urodynamic studies in nine patients, mostly performed within 8 weeks after disease onset, revealed post-void residual in 3 (mean 195 ml), among those who were able to urinate; decreased bladder sensation in 1; detrusor overactivity in 8; low compliance in 1; underactive detrusor in 7 (both overactive and underactive detrusor in 5); and nonrelaxing sphincter in 2. CONCLUSION: In our series of GBS cases, 27.7% of the patients had urinary dysfunction, including urinary retention in 9.2%. Underactive detrusor, overactive detrusor, and to a lesser extent, hyperactive sphincter are the major urodynamic abnormalities. The underlying mechanisms of urinary dysfunction appear to involve both hypo- and hyperactive lumbosacral nerves. Neurourol. Urodynam. 28:432-437, 2009. (c) 2009 Wiley-Liss, Inc.
PMID: 19260087 [PubMed – indexed for MEDLINE]
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Last Updated: July 27, 2020 by uabadmin
Effects of transobturator adjustable tape sling procedure on the therapeutic outcome in patients with stress urinary incontinence and detrusor underactivity.
Effects of transobturator adjustable tape sling procedure on the therapeutic outcome in patients with stress urinary incontinence and detrusor underactivity.: “
Effects of transobturator adjustable tape sling procedure on the therapeutic outcome in patients with stress urinary incontinence and detrusor underactivity.
Int Neurourol J. 2010 Apr;14(1):20-5
Authors: Jo DG, Yang SA, Seo JT
PURPOSE: To evaluate the outcome and efficacy of transobturator adjustable (TOA) tape sling operations on women with intrinsic sphincter deficiency (ISD) and/or detrusor underactivity (DU) combined with stress urinary incontinence (SUI). MATERIALS AND METHODS: This retrospective analysis comprised 60 TOA patients. 30 patients hadDU (Qmax < 15ml/s) and/or ISD (Valsalva leak point pressure;VLPP < 60cmH(2)0) on the preoperative UDS and the rest only had SUI. I-QoL, visual analog scale (VAS), Patient’s Perception of Urgency Severity (PPUS), and Self-Assessment/Sandvik Questions were performed before and 1 year after surgery. The mesh tension was controlled at 1 day after surgery. The objective cure rate was defined as no leakage using the cough test with a full bladder. RESULTS: PATIENTS WERE DIVIDED INTO TWO GROUPS: Group A:SUI with ISD and/or DU, n=30; Group B:only SUI without ISD and DU, n=30. The two groups showed a difference in Qmax and VLPP preoperatively. Objective success rates were 18 (60.0%) completely cured, 10 (33.3%) improved in Group A, and 23 (76.7%) completely cured, 7 (23.3%) improved in Group B. Three cases needed tape-tension adjustment due to urinary leakage one-day after surgery (2 in Group A, 1 in Group B). There was no postoperative urinary retention. CONCLUSIONS: After TOA for SUI with ISD and/or DU, 3 cases were needed tension adjustment after surgery. TOA procedures seem to be effective and safe, more clinical studies with long-term follow up are required for a definite conclusion.
PMID: 21120172 [PubMed – in process]
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Last Updated: July 27, 2020 by uabadmin
Bladder after total urogenital mobilization for congenital adrenal hyperplasia and cloaca–does it behave the same?
Bladder after total urogenital mobilization for congenital adrenal hyperplasia and cloaca–does it behave the same?: “
Bladder after total urogenital mobilization for congenital adrenal hyperplasia and cloaca–does it behave the same?
J Urol. 2009 Oct;182(4 Suppl):1892-7
Authors: Camanni D, Zaccara A, Capitanucci ML, Mosiello G, Iacobelli BD, De Gennaro M
PURPOSE: Followup of total urogenital mobilization for persistent urogenital sinus is well established anatomically and functionally. Nevertheless, studies comparing bladder function in different subsets of patients with urogenital sinus, such as congenital adrenal hyperplasia and cloaca, are scant. MATERIALS AND METHODS: We reviewed the records of patients with congenital adrenal hyperplasia and cloaca who underwent total urogenital mobilization and urodynamics in the last 10 years. Those with a short urogenital sinus (less than 2.5 cm) not requiring an abdominal approach and without spinal dysraphism were selected for study. Urodynamics were performed postoperatively before and after toilet training, and compared between patients with congenital adrenal hyperplasia and cloaca. Methods, definitions and units conformed to International Continence Society/International Children’s Continence Society standards. For the emptying phase we defined bladder outlet obstruction as maximum detrusor pressure greater than 70 cm H(2)O and underactive detrusor as maximum detrusor pressure less than 20 cm H(2)O plus post-void residual urine greater than 25 ml. RESULTS: Six patients with congenital adrenal hyperplasia and 6 with cloaca met study criteria. Three patients with congenital adrenal hyperplasia and 4 with cloaca underwent urodynamics before and after toilet training at a median age of 2 (range 2 to 4) and 5 years (range 3 to 8), respectively. Urodynamics were done in 1 patient with congenital adrenal hyperplasia before toilet training, and in 2 with congenital adrenal hyperplasia and 2 with cloaca after toilet training. All patients had normal urodynamics except 1 with congenital adrenal hyperplasia and detrusor overactivity, which normalized after toilet training. In all cloaca cases urodynamics were abnormal. Before toilet training bladder outlet obstruction was found in 2 patients, detrusor underactivity was found in 1 and detrusor overactivity was found in the remaining 1. After toilet training a detrusor underactivity pattern was found in 4 patients and bladder outlet obstruction was found in 2. All patients except 1 with cloaca had post-void residual urine before and after toilet training (median 100 ml, range 25 to 200). After toilet training all patients with congenital adrenal hyperplasia became spontaneously dry and all with cloaca were placed on clean intermittent catheterization. CONCLUSIONS: In the long term patients with cloaca show bladder outlet obstruction or underactive/acontractile detrusor patterns, which are not noted in patients with congenital adrenal hyperplasia. Therefore, in patients with cloaca urogenital sinus length may not be as good an indicator of functional results as it is in patients with congenital adrenal hyperplasia. Whether additional rectal dissection and repositioning surgical procedures in cloaca cases may have a role in explaining such a difference remains to be clarified.
PMID: 19695620 [PubMed – indexed for MEDLINE]
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Last Updated: July 27, 2020 by uabadmin
Long-term efficacy of percutaneous tibial nerve stimulation for different types of lower urinary tract dysfunction in children.
Long-term efficacy of percutaneous tibial nerve stimulation for different types of lower urinary tract dysfunction in children.: “
Long-term efficacy of percutaneous tibial nerve stimulation for different types of lower urinary tract dysfunction in children.
J Urol. 2009 Oct;182(4 Suppl):2056-61
Authors: Capitanucci ML, Camanni D, Demelas F, Mosiello G, Zaccara A, De Gennaro M
PURPOSE: We evaluated the efficacy of percutaneous tibial nerve stimulation for different types of pediatric lower urinary tract dysfunction. MATERIALS AND METHODS: A total of 14 children with idiopathic overactive bladder, 14 with dysfunctional voiding, 5 with underactive bladder, 4 with underactive valve bladder and 7 with neurogenic bladder resistant to conventional therapy underwent percutaneous tibial nerve stimulation weekly for 12 weeks. The stimulation effect was evaluated by comparing bladder diary, flowmetry and urinalysis before and after treatment. Improved patients were followed by bladder diary and urinalysis. Followup data at 1 and 2 years were compared with those obtained after stimulation. Data were analyzed using Fisher’s exact test. RESULTS: Symptom improvement was significantly greater in nonneurogenic than in neurogenic cases (78% vs 14%, p <0.002). Of patients 18% with underactive bladder and 50% with underactive valve bladder were unresponsive. Of 14 overactive bladder cases 12 and all 14 of dysfunctional voiding were improved (p not significant). Of improved patients 5 of 12 with overactive bladder and 12 of 14 with dysfunctional voiding were cured (p <0.01). On uroflowmetry voided volume and post-void residual urine became normal in a greater number of dysfunctional voiding than overactive bladder cases (57% vs 20% and 57% vs 25%, each p not significant). At 1 year of followup the cure rate was greater in dysfunctional voiding than in overactive bladder cases (71% vs 41%) and it remained the same at the 2-year evaluation. Chronic stimulation was necessary to maintain results in 29% of dysfunctional voiding and 50% of overactive bladder cases. CONCLUSIONS: Percutaneous tibial nerve stimulation is reliable and effective for nonneurogenic, refractory lower urinary tract dysfunction in children. Efficacy seems better in dysfunctional voiding than in overactive bladder cases. There is evidence that percutaneous tibial nerve stimulation should be part of the pediatric urology armamentarium when treating functional incontinence.
PMID: 19695611 [PubMed – indexed for MEDLINE]
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Last Updated: July 27, 2020 by uabadmin
Postoperative retention of urine: a prospective urodynamic study.
Postoperative retention of urine: a prospective urodynamic study.: “
Postoperative retention of urine: a prospective urodynamic study.
BMJ. 1991 Apr 13;302(6781):894-6
Authors: Anderson JB, Grant JB
OBJECTIVE–To investigate the cause of post-operative retention of urine in elderly men. DESIGN–Prospective study. SETTING–Northern General Hospital, Sheffield. PATIENTS–32 consecutive men (median age 73, range 55-85) referred to the urology department who were unable to pass urine either within 48 hours after operation and required catheterisation (23) or after removal of a catheter inserted at the initial operation (nine). INTERVENTION–Intermittent self catheterisation. MAIN OUTCOME MEASURES–Urological investigation by medium fill and voiding cystometry within four weeks after operation, and minimum follow up three months thereafter. RESULTS–6 patients resumed normal voiding before urodynamic assessment, three proceeded straight to prostatectomy, and one was unfit for self catheterisation. Of 22 men who underwent urodynamic investigation, only five had bladder outflow obstruction, who subsequently had successful prostatectomy; 15 showed either a low pressure-low flow system (seven) or complete detrusor failure (eight) and two showed pelvic parasympathetic nerve damage. With intermittent self catheterisation spontaneous voiding returned in all but one man within a median of 8 weeks (range 6-32 weeks). Recovery of bladder function took significantly longer in men with detrusor failure than in those with an underactive bladder (median 10 weeks (range 6-32 weeks) v median 8 weeks (range 6-8 weeks); p = 0.05). Three months later all patients had re-established their own normal voiding pattern with minimal residual urine on ultrasonography and satisfactory flow rates. CONCLUSIONS–Postoperative urinary retention in elderly men is not an indication for prostatectomy; a normal pattern of micturition can be re-established by intermittent self catheterisation in most men.
PMID: 1709058 [PubMed – indexed for MEDLINE]
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Last Updated: July 27, 2020 by uabadmin
[Clinical evaluation in 69 cases with neurogenic bladder]
[Clinical evaluation in 69 cases with neurogenic bladder]: “
[Clinical evaluation in 69 cases with neurogenic bladder]
Hinyokika Kiyo. 1991 Feb;37(2):123-8
Authors: Sasagawa M, Magome A, Kikuyama A, Kobayashi S, Kawamura K, Suzuki K, Tsugawa R
Clinical evaluation was made in 69 cases of neurogenic bladder experienced during the past 3 years. Thirty seven of the patients were male and 32 female, and they ranged in age from 4 to 88 years with an average of 63.2 years, The basic diseases of neurogenic bladder were brain lesions in 27 cases, spinal cord lesions in 18 cases, and peripheral nerve lesions in 13 cases. Three cases were of the mixed type and the basic disease was unknown in 8 cases. Cerebrovascular diseases were the most frequent, followed by spinal cord injuries and intrapelvic operations. Duration from the onset of urological symptoms to the first visit to our clinic was less than 1 month in half of the patients. The chief complaints at the first visit were pollakisuria in 25 cases (25.8%), incontinence in 18 cases (18.6%), urinary difficulty in 25 cases (25.8%) and urinary retention in 13 cases (13.4%). Urological conditions at the first visit were spontaneous urination in 53 cases (76.8%), indwelling catheterization in 12 cases (17.4%) and clean intermittent catheterization in 4 cases (5.8%). Urological complications seen at the first examination were urinary tract infections (UTI) in 27 cases (39.1%) and chronic renal failure in 2 cases (2.9%). The patients were classified by cystometrography into 3 patterns: 42 cases (60.9%) with underactive detrusor, 21 cases (30.4%) with overactive detrusor and 6 cases (8.7%) with normal detrusor. Detrusor sphincter dyssynergia was observed in 29 cases (42.0%), 40.7% had brain lesions, 44.4% spinal cord lesions, and 46.2% peripheral nerve lesions.(ABSTRACT TRUNCATED AT 250 WORDS)
PMID: 1675545 [PubMed – indexed for MEDLINE]
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Last Updated: July 27, 2020 by uabadmin
Clinical manifestation of human T-cell lymphotropic virus type-I-associated myelopathy and vesicopathy.
Clinical manifestation of human T-cell lymphotropic virus type-I-associated myelopathy and vesicopathy.: “
Clinical manifestation of human T-cell lymphotropic virus type-I-associated myelopathy and vesicopathy.
Urol Int. 1991;46(2):149-53
Authors: Imamura A, Kitagawa T, Ohi Y, Osame M
Patients with human T-cell lymphotropic virus type I (HTLV-I)-associated myelopathy (HAM) sometimes have accompanying voiding disturbances. We performed clinical surveys and urodynamic examinations on 25 untreated patients with HAM. Although 4 cases (16%) were entirely aware of urinary symptoms, the onset of urinary symptoms preceded other pyramidal symptoms in 6 cases (24%). All cases suffered from dysuria. The cause of dysuria was thought mainly to be detrusor external sphincter dyssynergia, but in some cases an underactive detrusor and poor opening of the bladder neck at voiding were also the causes of dysuria. There was a tendency for urinary dysfunction to become worse as the primary disease progresses. Patients with HAM must be carefully followed up by urologists in order to prevent deterioration of the urinary tract.
PMID: 2053222 [PubMed – indexed for MEDLINE]
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Last Updated: July 27, 2020 by uabadmin
Prevalence and mechanism of bladder dysfunction in Guillain-Barré Syndrome.
Prevalence and mechanism of bladder dysfunction in Guillain-Barré Syndrome.: “
Prevalence and mechanism of bladder dysfunction in Guillain-Barré Syndrome.
Neurourol Urodyn. 2009;28(5):432-7
Authors: Sakakibara R, Uchiyama T, Kuwabara S, Mori M, Ito T, Yamamoto T, Awa Y, Yamaguchi C, Yuki N, Vernino S, Kishi M, Shirai K
AIM: To examine the prevalence and mechanism of urinary dysfunction in GBS. METHODS: Urinary symptoms were observed and neurological examinations made repeatedly during hospitalization of 65 consecutive patients with clinico-neurophysiologically definite GBS. The patients included 41 men, 24 women; mean age, 41 years old; mean Hughes motor grade, 3; AIDP, 28, AMAN, 37. Urodynamic studies consisted of uroflowmetry, measurement of post-micturition residuals, medium-fill water cystometry, and external anal sphincter electromyography. RESULTS: Urinary dysfunction was observed in 27.7% of GBS cases (urinary retention, 9.2%). Urinary dysfunction was related to the Hughes motor grade (P < 0.05), defecatory dysfunction (P < 0.05), age (P < 0.05), and negatively related to serum IgG class anti-ganglioside antibody GalNAc-GD1a (P < 0.05). Urinary dysfunction was more common in AIDP (39%) than in AMAN (19%). No association was found between antibody titer against neuronal nicotinic acetylcholine receptors and urinary dysfunction. Urodynamic studies in nine patients, mostly performed within 8 weeks after disease onset, revealed post-void residual in 3 (mean 195 ml), among those who were able to urinate; decreased bladder sensation in 1; detrusor overactivity in 8; low compliance in 1; underactive detrusor in 7 (both overactive and underactive detrusor in 5); and nonrelaxing sphincter in 2. CONCLUSION: In our series of GBS cases, 27.7% of the patients had urinary dysfunction, including urinary retention in 9.2%. Underactive detrusor, overactive detrusor, and to a lesser extent, hyperactive sphincter are the major urodynamic abnormalities. The underlying mechanisms of urinary dysfunction appear to involve both hypo- and hyperactive lumbosacral nerves. Neurourol. Urodynam. 28:432-437, 2009. (c) 2009 Wiley-Liss, Inc.
PMID: 19260087 [PubMed – indexed for MEDLINE]
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Last Updated: July 27, 2020 by uabadmin
Lower urinary tract dysfunction in familial amyloidotic polyneuropathy, Portuguese type.
Lower urinary tract dysfunction in familial amyloidotic polyneuropathy, Portuguese type.: “
Lower urinary tract dysfunction in familial amyloidotic polyneuropathy, Portuguese type.
Neurourol Urodyn. 2009;28(1):26-32
Authors: Andrade MJ
AIM: Study lower urinary dysfunction in familial amyloidotic polyneuropathy (FAP). METHODS: Fifty-four FAP patients were studied. Clinical examination, urodynamics and ultrasound of the urinary tract were performed. RESULTS: Urinary symptoms appeared during the first three years of the disease in 50% of the patients. The initial urinary symptom was dysuria in 39% and incontinence in 24% of the patients, sensitivity and contractility disturbances of the detrusor were found at the initial stages. Non-relaxing urethral sphincter was found in 51,7% and dyssynergia in 37,5% of the cases. Ultrasound revealed thickening of the vesical wall in 42,5% of the patients, more common in males (M:16; F:7). Opening of the vesical neck was found in 56% of the cases (M:19; F:11) with paradoxical closure during the attempt to void. Fluctuations in the opening of the vesical neck were found in eight patients, also more frequently in males (M:6; F:2). CONCLUSIONS: In addition to reduced sensation, underactive detrusor, opening of the vesical neck and external sphincter deficit, we found data suggesting failure of relaxation of the internal and external sphincter. The overdistention associated with an open vesical neck and external sphincter deficit justifies incontinence in those patients. The retention is due to inadequate contraction of the detrusor, probably associated with non-relaxing of the internal and external sphincter. These dysfunctions derive from deposition of amyloid substance in the detrusor, but overdistention is likely to play a role. Early therapeutic intervention in these patients is vital to avoid secondary injuries.
PMID: 19089892 [PubMed – indexed for MEDLINE]
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Last Updated: July 27, 2020 by uabadmin
[A clinical study of voiding status in multiple sclerosis patients]
[A clinical study of voiding status in multiple sclerosis patients]: “
[A clinical study of voiding status in multiple sclerosis patients]
Hinyokika Kiyo. 1991 Jan;37(1):25-9
Authors: Komatsu K, Nagano K, Yokoyama O, Kawaguchi K, Hisazumi H, Hayashi S
During a period of 4.5 years, neurological and urodynamic evaluation was done on 12 patients with multiple sclerosis between 20 and 67 years old with an average age of 47.6 years. Pyramidal dysfunction (100%), sensory disturbance (100%) and brain stem dysfunction (60%) were common neurological signs. All patients were assessed by the Kurtzke’s rating of neurologic impairment in multiple sclerosis: an expanded disability status scale (EDSS). Of the 12 cases 6 were diagnosed as severe multiple sclerosis (EDSS greater than or equal to 4.5) and the remainders were diagnosed as relatively mild (EDSS less than 4.5). Neurourologic evaluation was performed by rapid filling carbon dioxide cystometry and sphincter electromyography. Cystometry revealed overactive bladder in 4 (33%), underactive bladder in 3 (25%) and normoactive bladder in 5 (42%) of the 12 cases. Of the 6 severe cases of multiple sclerosis, 3 (50%) showed overactive bladder, while only 1 of the 6 (17%) mild cases showed overactive bladder. Detrusor sphincter dyssynergia (DSD) was observed in 4 of the 9 (67%) severe cases and none of the 6 mild cases. The presence of overactive bladder or DSD seems to correlate with the severity of multiple sclerosis.
PMID: 2011964 [PubMed – indexed for MEDLINE]
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Last Updated: July 27, 2020 by uabadmin
Does a Pre-Operative Urodynamic Diagnosis of Bladder Outflow Obstruction Improve Outcomes from Palliative Transurethral Prostatectomy?
Does a Pre-Operative Urodynamic Diagnosis of Bladder Outflow Obstruction Improve Outcomes from Palliative Transurethral Prostatectomy?: “
Does a Pre-Operative Urodynamic Diagnosis of Bladder Outflow Obstruction Improve Outcomes from Palliative Transurethral Prostatectomy?
Urol Int. 2010 Aug 21;
Authors: Gnanapragasam VJ, Leonard A
Objective: Palliative transurethral prostatectomy (TURP) is the mainstay of treatment for lower urinary tract symptoms, (LUTS) in men with prostate cancer. Functional outcomes, however, can often be unsatisfactory. Here the value of preoperative urodynamics was investigated in these men. Methods: A retrospective review was conducted of41men with prostate cancer and LUTS who were investigated by urodynamics prior to TURP. All were treated solely by primary androgen deprivation. 19 men with urodynamic proven bladder outflow obstruction (BOO) proceeded to palliative TURP. Results: Of the 41 men investigated by cystometry, the urodynamic diagnosis was BOO in 12 (29%) men, detrusor overactivity in 12 (29%) men with 7 (17%) having both diagnoses. 6 (15%) men were found to have underactive or acontractile detrusors while 4 (10%) had normal studies. In men who proceeded to TURP, all demonstrated improved flow rates (p = 0.003). At 12 months, 95% were voiding spontaneously with only 1 man requiring permanent re-catheterisation. These results compared very favourably to published outcomes which have not used urodynamics to select men for surgery. Conclusions: Urodynamics may help identify objective BOO prior to palliative TURP. Further prospective trials are justified to assess the role of urodynamics in this context.
PMID: 20733276 [PubMed – as supplied by publisher]
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