December 16, 2010

Overactive and underactive bladder Dysfunction Is Reflected by Alterations in Urothelial ATP and NO release.

Overactive and underactive bladder Dysfunction Is Reflected by Alterations in Urothelial ATP and NO release.: "


Overactive and underactive bladder Dysfunction Is Reflected by Alterations in Urothelial ATP and NO release.

Neurochem Int. 2010 Dec 7;

Authors: Munoz A, Smith CP, Boone TB, Somogyi GT

ATP and NO are released from the urothelium in the bladder. Detrusor Overactivity (DO) following spinal cord injury results in higher ATP and lower NO release from the bladder urothelium. Our aim was to study the relationship between ATP and NO release in 1) early diabetic bladders, an overactive bladder model; and 2) in 'diuretic' bladders, an underactive bladder model. To induce diabetes mellitus female rats received 65mg/kg streptozocin (i.v.). To induce chronic diuresis rats were fed with 5% sucrose. At 28 days, in vivo open cystometry was performed. Bladder wash was collected to analyze the amount of ATP and NO released into the bladder lumen. For in vitro analysis of ATP and NO release, a Ussing chamber was utilized and hypoosmotic Krebs was perfused on the urothelial side of the chamber. ATP was analyzed with luminometry or HPLC-fluorometry while NO was measured with a Sievers NO-analyzer. In vivo ATP release was increased in diabetic bladders and unchanged in diuretic bladders. In vitro release from the urothelium followed the same pattern. NO release was unchanged both in vitro and in vivo in overactive bladders whereas it was enhanced in underactive bladders. We found that the ratio of ATP/NO, representing sensory transmission in the bladder, was high in overactive and low in underactive bladder dysfunction. In summary, ATP release has a positive correlation while NO release has a negative correlation with the bladder contraction frequency. The urinary ATP/NO ratio may be a clinically relevant biomarker to characterize the extent of bladder dysfunction.

PMID: 21145365 [PubMed - as supplied by publisher]
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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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November 6, 2010

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?: "
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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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October 19, 2010

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.: "
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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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October 16, 2010

Postoperative retention of urine: a prospective urodynamic study.

Postoperative retention of urine: a prospective urodynamic study.: "
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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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October 11, 2010

[Clinical evaluation in 69 cases with neurogenic bladder]

[Clinical evaluation in 69 cases with neurogenic bladder]: "

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[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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October 9, 2010

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.: "

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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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September 20, 2010

Prevalence and mechanism of bladder dysfunction in Guillain-Barré Syndrome.

Prevalence and mechanism of bladder dysfunction in Guillain-Barré Syndrome.: "
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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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Lower urinary tract dysfunction in familial amyloidotic polyneuropathy, Portuguese type.

Lower urinary tract dysfunction in familial amyloidotic polyneuropathy, Portuguese type.: "
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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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August 29, 2010

[A clinical study of voiding status in multiple sclerosis patients]

[A clinical study of voiding status in multiple sclerosis patients]: "

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[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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August 25, 2010

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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August 20, 2010

Different evolution of voiding function in underactive bladders with and without detrusor overactivity.

Different evolution of voiding function in underactive bladders with and without detrusor overactivity.: "
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Different evolution of voiding function in underactive bladders with and without detrusor overactivity.

J Urol. 2010 Jan;183(1):229-33

Authors: Cucchi A, Quaglini S, Rovereto B

PURPOSE: We assessed bladder voiding function in patients with idiopathic detrusor underactivity with and without detrusor overactivity for a different evolution in time. MATERIALS AND METHODS: We retrospectively analyzed clinical and urodynamic findings in 36 consecutive middle-aged men with idiopathic detrusor underactivity who were referred during 1989 to 2003 for voiding and storage lower urinary tract symptoms. After initial testing at time 1 urodynamics were repeated due to worse lower urinary tract symptoms severity at a median of 45 months (time 2). A total of 17 patients with voiding urgency showed urodynamic detrusor overactivity at times 1 and 2 (group 1) and 19 with no urgency (group 2) never had detrusor overactivity. As controls (group 3) we used 30 age matched, urodynamically normal men. Nonparametric statistics were used for data analysis. RESULTS: Compared with controls at time 1 groups 1 and 2 had lower bladder emptying efficiency and bladder contractility (contraction strength, velocity and energy reserve) with relatively higher contraction velocity and energy reserve in group 1 than in group 2. Compared with time 1 at time 2 the 2 detrusor underactivity groups showed an increased International Prostate Symptom Score (more increased in group 1), and decreased bladder contractility and emptying efficiency (less decreased in group 1). CONCLUSIONS: A likely explanation for our findings is that by causing relatively more rapid (less slow) detrusor contractions detrusor overactivity partly decreased the time needed and, thus, the total energy expended by underactive bladders for mounting micturition contractions. This compensatory efficiency would account for the relatively better evolution of bladder voiding function with time.

PMID: 19913829 [PubMed - indexed for MEDLINE]
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August 16, 2010

Urodynamics post stroke in patients with urinary incontinence: Is there correlation between bladder type and site of lesion?

Urodynamics post stroke in patients with urinary incontinence: Is there correlation between bladder type and site of lesion?: "
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Urodynamics post stroke in patients with urinary incontinence: Is there correlation between bladder type and site of lesion?

Ann Indian Acad Neurol. 2009 Apr;12(2):104-7

Authors: Gupta A, Taly AB, Srivastava A, Thyloth M

OBJECTIVE: Assessment of bladder by urodynamic study (UDS) in patients with urinary incontinence following stroke, and correlation with site of lesion. STUDY DESIGN AND SETTING: Retrospective cross-sectional study in the neurological rehabilitation unit of a tertiary care institute. MATERIALS AND METHODS: Forty patients (22 males) with arterial or venous, ischemic or hemorrhagic stroke, with urinary incontinence in the acute phase following the event, underwent UDS. Seventeen patients had right hemiplegia, 18 had left hemiplegia, and five had posterior circulation stroke with brainstem/cerebellar features. Bladder type was correlated with age, side, and site of lesion. RESULTS: The mean age was 46.80 +/- 16.65 years (range: 18-80 years). Thirty-six patients had arterial stroke and four had cortical venous thrombosis. UDS was performed after a mean of 28.32 +/- 10.27 days (range: 8-53 days) after the stroke. All but one patient had neurogenic bladder dysfunction, with 36 patients (90%) having overactive detrusor (OD) and three having underactive/areflexic detrusor. Among the 36 patients with OD, 25 patients (62.5%) had OD without detrusor-sphincter dyssynergy (DSD) and 11 (27.5%) had OD with DSD. Bladder management was advised based on the UDS findings. No significant correlation (P > 0.05) was found between type of bladder and age or side and site of lesion. CONCLUSIONS: UDS is a useful tool to assess and manage the bladder following stroke with urinary incontinence. In this study, no significant correlation was found between UDS findings and site of lesion.

PMID: 20142855 [PubMed]
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August 12, 2010

Voiding dysfunction in patients with human T-lymphotropic-virus-type-1-associated myelopathy.

Voiding dysfunction in patients with human T-lymphotropic-virus-type-1-associated myelopathy.: "
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Voiding dysfunction in patients with human T-lymphotropic-virus-type-1-associated myelopathy.

Urol Int. 1991;47 Suppl 1:67-8

Authors: Komine S, Yoshida H, Fujiyama C, Masaki Z

Voiding dysfunction in patients with human T-lymphotropic-virus-type-1-associated myelopathy (HAM) was studied. All the patients were diagnosed as having HAM by neurologists. We have already reported on 16 consequent patients with HAM. Almost all of these patients had frequency, and many had urge incontinence of urine and difficulty on voiding. Urodynamic study revealed that their voiding symptoms seemed to be due to detrusor hyperactivity and detrusor-sphincter dyssynergia. However, we have recently treated 2 patients who had a different bladder function. They had both frequency and difficulty in voiding but without urgency. In the urodynamic study both patients did not have involuntary bladder contraction during the filling phase and could not void voluntarily. The reason why these 2 patients had an underactive detrusor is unclear. The fact that the average duration of HAM in the 16 patients previously mentioned was longer than that of the latter 2 patients may suggest that overactivity of the bladder is not prominent in the early phase of this disease.

PMID: 1949381 [PubMed - indexed for MEDLINE]
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August 10, 2010

[Neurogenic bladder in patients with lumbar vertebral disorders]

[Neurogenic bladder in patients with lumbar vertebral disorders]: "

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[Neurogenic bladder in patients with lumbar vertebral disorders]

Nippon Hinyokika Gakkai Zasshi. 1990 Sep;81(9):1322-9

Authors: Ando M, Nagamatsu H, Tanizawa A, Oshima H, Shinomiya K, Matsuoka T, Mizuo T, Ushiyama T

Bladder and urethral functions were evaluated urodynamically in 114 patients with lumbar disorders including prolapsed lumbar intervertebral disc (66 patients), lumbar canal stenosis (19 patients), lumbar spondylolysis and/or spondylolisthesis (21 patients), lumbar spondylosis deformans (5 patients) and ossification of the yellow ligament of the lumbar spine (3 patients). The patients consisted of 88 males and 26 females with an average age of 47 years (range 17 to 73 years). Symptomatic organic infravesical obstruction was excluded by physical and radiographic examination. Cystometry revealed preoperative neurogenic bladder in 23 patients (20%); normal detrusor with overactive sphincter in 2 (9%), underactive in 8 (36%), overactive in 5 (23%) and equivocal in 7 (32%). One patient not receiving cystometry revealed abnormal uroflowmetry with 140 ml residual urine. Twenty of them underwent electromyographic examination of the external sphincter and 15 (75%) had an overactive sphincter. Nine (39%) of them complained no urological symptoms. Neurogenic bladder seemed to highly associate in those having abnormal tendon reflex in the lower extremities, decreased bulbocavernosus reflex and sensory disturbance in the perineal area, but there was no statistical significance. Of twenty-three neurogenic bladder patients, eighteen underwent a lumbar vertebral operation and fifteen received postoperative urodynamic evaluation. Uroflowmetry was improved in more than half of the patients within 3 months after the operation and cystometry was normalized in 4 of 7 patients who underwent cystometry over 6 months after the operation. Preoperative overactive detrusor remained unchanged in two of three patients who underwent cystometry over 6 months after the operation.

PMID: 2232423 [PubMed - indexed for MEDLINE]
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August 2, 2010

Marion Kerr writes about Neurogenic Bladder

source: here

Having lived with multiple sclerosis for a number of years, I've now been diagnosed with something called neurogenic bladder. Are the two conditions related?

Neurogenic bladder is the loss of normal bladder function caused by damage to part of the nervous system. Disorders of the central nervous system, such as Alzheimer's disease, spina bifida, brain or spinal cord injury, multiple sclerosis, Parkinson's disease and stroke can all cause neurogenic bladder.

Peripheral diabetic neuropathy nerve damage due to pelvic surgery, slipped disc and vitamin B12 deficiency may also cause the condition.

What are the symptoms?

The particular symptoms experienced will very much depend on the underlying neurological disorder, and can include an overactive or underactive bladder. Overactive bladder tends to produce frequent passing of very small amounts of urine, problems emptying the bladder completely and loss of bladder control.

Underactive bladder can result in the bladder becoming too full, leaking of urine and urinary retention. It can also cause difficulties starting to urinate, emptying all the urine from the bladder or recognising when the bladder is full.

All bladder problems can lead to the development of urinary tract infections.
Do I just have to live with it or can neurogenic bladder be treated?

Medications are available to help manage symptoms. These include drugs that relax the bladder in cases of overactive bladder or medicines that make certain nerves more active for underactive bladder.

Antibiotics are required where bladder problems lead to infections. A referral to a chartered physiotherapist with experience in the area of treating continence problems may help. They will be able to teach you special exercises (Kegel exercises) and provide other treatments to help strengthen your pelvic-floor muscles.
In certain conditions, including multiple sclerosis, there may be a need to use a urinary catheter. This is a thin tube that is inserted into the bladder.

It may be in place all the time (an indwelling catheter) or may need to be placed in the bladder four to six times a day to keep the bladder from becoming too full (intermittent catheterisation).
Surgery for neurogenic bladder may be recommended in some cases. It is important to learn to recognise the symptoms of urinary tract infection, such as a burning sensation when you urinate, high temperature, low back pain and an increased frequency of urination.

If you suspect you have developed a urinary tract infection, see your doctor, as antibiotics will be needed to clear the infection.

July 29, 2010

The Unusual History and the Urological Applications of Botulinum Neurotoxin.

The Unusual History and the Urological Applications of Botulinum Neurotoxin.: "


The Unusual History and the Urological Applications of Botulinum Neurotoxin.

Urol Int. 2010 Jul 27;

Authors: Hanchanale VS, Rao AR, Martin FL, Matanhelia SS

Introduction: Botulinum neurotoxin (BoNT) is probably the most potent biological toxin that can affect humans. Since its discovery by Justinus Kerner, BoNT has seen use in a wide range of cosmetic and non-cosmetic conditions such as cervical dystonia, cerebral palsy, migraines and hyperhidrosis. We tried to trace its history from its inception to its recent urological applications. Materials and Methods: Historical articles about botulinum toxin were reviewed and a Medline search was performed for its urological utility. We hereby present a brief review of historical aspects of BoNT and its applications in urology. Results: In 1793, the first known outbreak of botulism occurred due to 'spoiled' sausage in Wildebad, Germany. The German physician and poet Justinus Kerner published the first accurate description of the clinical symptoms of botulism (sausage poison). He was also the first to mention its potential therapeutic applications. In urology, BoNT has been used in bladder and urethral lesions with varying degree of success. Recently, BoNT applications were explained for prostatic disorders. BoNT applications in urology are in the treatment of detrusor external sphincter dyssynergia, detrusor overactivity, detrusor underactivity, spastic conditions of the urethral sphincter, chronic prostate pain, interstitial cystitis, non-fibrotic bladder outflow obstruction (including benign prostatic hyperplasia) and acute urinary retention in women. Conclusion: Justinus Kerner is the godfather of botulism research. The role of BoNT in urology has evolved exponentially and it is widely used as an adjuvant in voiding dysfunction. In the future, its utility will broaden and guide the urologist in managing various urological disorders.

PMID: 20664247 [PubMed - as supplied by publisher]
"

July 24, 2010

[Neurogenic bladder in patients with cervical cord compression disorders]

[Neurogenic bladder in patients with cervical cord compression disorders]: "

Related Articles

[Neurogenic bladder in patients with cervical cord compression disorders]

Nippon Hinyokika Gakkai Zasshi. 1990 Feb;81(2):243-50

Authors: Ando M

Bladder and urethral functions were evaluated urodynamically in 62 patients with cervical cord compression disorder caused by either ossification of the posterior longitudinal ligament of the cervical spine (32 patients), cervical spondylosis (14 patients), prolapsed cervical intervertebral disc (14 patients) or cervical spinal canal stenosis (2 patients). The patients included 46 males and 16 females with average age of 57 years (range 39 to 73 years). Symptomatic organic infravesical obstruction was excluded by physical and radiographic examination. Cystometry revealed preoperative neurogenic bladder in 22 patients (35%) including overactive detrusor in 10 patients (45%) and underactive in 6 (27%). Twenty-one of them underwent electromyographic examination of external sphincter and 14 (67%) had overactive sphincter. Bladder and urethral functions appeared to be impaired in association with myelopathy of the pyramidal and spinothalamic tract of the cervical cord, because of high incidence of neurogenic bladder associated with positive Babinski's reflex and sensory disturbance at the perineal and lower extremity area. Furthermore, since many patients with deep sensory disturbance in the lower extremities had underactive detrusor, it appears likely that underactive detrusor was accompanied with myelopathy in the posterior funiculus of the cervical cord which mediates bladder proprioceptive sensation. Of twenty-two neurogenic bladder patients, seventeen underwent a cervical bone operation and eleven received postoperative urodynamic evaluation. The average interval from the operation to urodynamic evaluation was 1.6 months (range 1.1 to 2.3 months). Over half of the patients were found to be improved urodynamically as well as neurologically.(ABSTRACT TRUNCATED AT 250 WORDS)

PMID: 2325322 [PubMed - indexed for MEDLINE]
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July 17, 2010

Incomplete Bladder Emptying in Patients With Stroke: Is Detrusor External Sphincter Dyssynergia a Potential Cause?

Incomplete Bladder Emptying in Patients With Stroke: Is Detrusor External Sphincter Dyssynergia a Potential Cause?: "

Related Articles

Incomplete Bladder Emptying in Patients With Stroke: Is Detrusor External Sphincter Dyssynergia a Potential Cause?

Arch Phys Med Rehabil. 2010 Jul;91(7):1105-1109

Authors: Meng NH, Lo SF, Chou LW, Yang PY, Chang CH, Chou EC

Meng NH, Lo SF, Chou LW, Yang PY, Chang CH, Chou EC. Incomplete bladder emptying in patients with stroke: is detrusor external sphincter dyssynergia a potential cause? OBJECTIVES: To delineate the frequency, clinical risk factors, and urodynamic mechanisms of incomplete bladder emptying (IBE) among patients with recent stroke. DESIGN: Retrospective study. SETTING: Inpatient setting in the rehabilitation ward of a university hospital. PARTICIPANTS: All patients with acute stroke admitted for rehabilitation between January and December 2005, excluding those with a history of lower-urinary tract symptoms and urologic diseases. Eighty-two patients (42 women and 40 men; mean age, 65.5y) were included. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: We measured postvoid residual (PVRs) by catheterization or by using an ultrasonic bladder scanner. Twenty-five patients (30.5%) had IBE with PVRs greater than 100mL on 2 consecutive days. Patients with IBE were evaluated by a urologist and subsequently underwent urodynamic studies. RESULTS: The presence of IBE was significantly associated with urinary tract infection (P<.001) and aphasia (P=.046). The presence of IBE was not related to sex, stroke location, nature of stroke (hemorrhagic or ischemic), history of diabetes mellitus, or previous stroke. Urodynamic studies done on 22 patients with IBE revealed acontractile detrusor in 8 patients (36%) and detrusor underactivity in 3 (14%). Eleven patients (50%) had detrusor-external sphincter dyssynergia (DESD) combined with normative detrusor function (5 patients) or detrusor hyperactivity (6 patients); all but 1 of these patients had a supratentorial lesion. The presence of DESD was associated with a longer onset-to-evaluation interval (P=.008) and spasticity of the stroke-affected lower limb (P=.002). Diabetes mellitus was associated with the presence of acontractile detrusor or detrusor underactivity (P=.03). CONCLUSIONS: IBE is common among patients with stroke and is caused by decreased detrusor contractility or DESD. Spasticity of the external urethral sphincter is a possible pathophysiologic mechanism of DESD.

PMID: 20599050 [PubMed - as supplied by publisher]
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May 24, 2010

Functional assessment of the bladder.

Functional assessment of the bladder.: "

Related Articles

Functional assessment of the bladder.

Ciba Found Symp. 1990;151:139-47; discussion 147-55

Authors: Nordling J

The urinary bladder has two functions: to store and to empty. A frequency-volume chart completed by the patient provides useful information about voiding intervals, possible factors provocative for incontinence, functional bladder capacity and daily urine volume. Filling cystometry is used primarily to evaluate reflex function in the storage phase, giving information about the presence or absence of detrusor instability and (in combination with urethral EMG) about detrusor-sphincter coordination. Information is also obtained about bladder sensation, bladder capacity and bladder compliance. Detrusor function during emptying is closely related to outflow conditions and therefore demands simultaneous registration of detrusor pressure and urinary flow rate. An inverse relation exists between detrusor pressure and flow rate, which means that reduced flow rate causes increased detrusor pressure for the same detrusor power. Underactive detrusor function will result in low detrusor pressure and low flow rate. The finding of a non-contractile detrusor may indicate psychogenic inhibition or a neurogenic lesion. Sacral evoked potentials and denervation supersensitivity tests may help to distinguish between these conditions.

PMID: 2226057 [PubMed - indexed for MEDLINE]
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May 21, 2010

Effect of dominant hemispheric stroke on detrusor function in patients with lower urinary tract symptoms.

Effect of dominant hemispheric stroke on detrusor function in patients with lower urinary tract symptoms.: "

Related Articles

Effect of dominant hemispheric stroke on detrusor function in patients with lower urinary tract symptoms.

Int J Urol. 2010 May 17;

Authors: Kim TG, Yoo KH, Jeon SH, Lee HL, Chang SG

Objectives: To determine the effect of unilateral hemispheric lesion on voiding dysfunction by comparing urodynamic parameters in dominant, non-dominant and bilateral hemispheric stroke patients. Methods: We retrospectively reviewed the medical records of patients from a magnetic resonance imaging and urodynamic study. We identified 69 cases among 192 stroke patients who had undergone urodynamic study due to lower urinary tract symptoms from June 2003 to December 2008. Results: Among the analyzed variables in the urodynamic study, total bladder capacity, voided volume, postvoid residual urine volume, maximum flow rate, average flow rate, detrusor pressure at the maximum flow rate, and bladder compliance did not show statistically significant differences among dominant, non-dominant and bilateral hemispheric stroke patients groups (P > 0.05). The dominant hemispheric stroke group had detrusor overactivity in 64.2% of cases and detrusor underactivity in 35.8%; the non-dominant hemispheric stroke group had detrusor overactivity in 66.7% of cases and detrusor underactivity in 33.3%; and the bilateral stroke group had detrusor overactivity in 60.0% of cases and detrusor underactivity in 40.0% (P = 0.946). Conclusion: Urodynamic findings cannot be characterized by the laterality of the unilateral hemispheric ischemic lesion. There are no significant differences in lower urinary tract symptoms between dominant, non-dominant and bilateral hemispheric ischemic stroke patients.

PMID: 20482661 [PubMed - as supplied by publisher]
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May 17, 2010

The pathophysiology of urinary incontinence among institutionalized elderly persons.

The pathophysiology of urinary incontinence among institutionalized elderly persons.: "

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The pathophysiology of urinary incontinence among institutionalized elderly persons.

N Engl J Med. 1989 Jan 5;320(1):1-7

Authors: Resnick NM, Yalla SV, Laurino E

Although 1 million institutionalized elderly persons have urinary incontinence, little is known about the causes of this problem. We conducted clinical and physiologic studies to determine the causes of established incontinence in a representative sample of 605 institutionalized elderly persons (mean age, 89 years), of whom 40 percent were chronically incontinent of urine. Detailed urodynamic studies in 94 of the 245 incontinent patients (77 women and 17 men; 38 percent) showed that detrusor overactivity was the predominant cause in 61 percent, with concomitant impaired detrusor contractility present in half these patients. Other causes among women were stress incontinence (21 percent), underactive detrusor (8 percent), and outlet obstruction (4 percent). Among the relatively few men in this sample, outlet obstruction accounted for 29 percent of the cases. In 35 percent of the patients, at least two coexisting probable causes of incontinence were identified. Diagnoses among patients with impaired mobility or mentation differed little from those in unimpaired patients. We conclude that the pathophysiology of incontinence in this population is complex; that detrusor hyperreflexia with normal contractility ('uninhibited bladder') accounts for the minority of cases (29 percent), even among patients with dementia; and that the causes of incontinence are as diverse in severely impaired elderly persons as in those who are unimpaired.

PMID: 2909873 [PubMed - indexed for MEDLINE]
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May 12, 2010

[Bladder deformity in traumatic spinal cord injury patients]

[Bladder deformity in traumatic spinal cord injury patients]: "

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[Bladder deformity in traumatic spinal cord injury patients]

Hinyokika Kiyo. 1988 Jul;34(7):1173-8

Authors: Ogawa T, Yoshida T, Fujinaga T

Fifty-nine patients with traumatic spinal cord injury were subjected for the analysis of bladder deformity. Bladder deformity means bladder trabeculation and deformity of bladder shape such as pine tree shape. We classified bladder deformity into grade 0 (none), grade I (mild), grade II (moderate) and grade III (severe). Upper urinary tract deterioration was found in 0% of grade 0 (16 pts.), 32% of grade I (22 pts.), 80% of grade II (10 pts.) and 82% of grade III (11 pts.). We suggested that bladder deformity was one of the risk factors of upper urinary tract deterioration. High grade (greater than grade II) bladder deformity was found more frequently in complete injury than in incomplete injury. There was no differentiation between overactive bladder-overactive sphincter and underactive bladder-overactive sphincter. All patients with low compliance bladder had a high grade bladder deformity. There was a significant relationship between severity of urinary tract infection and severity of bladder deformity. Intermittent catheterization program was effective for preventing bladder deformity.

PMID: 3177138 [PubMed - indexed for MEDLINE]
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May 11, 2010

Urodynamics in a community-dwelling population of females 80 years or older. Which motive? Which diagnosis?

Urodynamics in a community-dwelling population of females 80 years or older. Which motive? Which diagnosis?: "


Urodynamics in a community-dwelling population of females 80 years or older. Which motive? Which diagnosis?

Int Braz J Urol. 2010 Mar-Apr;36(2):218-24

Authors: Valentini FA, Robain G, Marti BG, Nelson PP

PURPOSE: To determine why community-dwelling women aged 80 years or over were referred for urodynamic evaluation despite their advanced age and which urodynamic diagnosis was made. MATERIALS AND METHODS: One hundred consecutive females (80-93 years) were referred to our urodynamics outpatient clinic for evaluation of lower urinary tract symptoms (LUTS) between 2005 and 2008. Clinical evaluation comprised of a previous history of LUTS, previous medical history of neurological disease or dementia, pelvic floor dysfunction or prior pelvic surgery. Exclusion criteria were complete retention and severe dementia involving failure to understand simple instructions. Assessed items were results of uroflows (free flow and intubated flow), cystometry and urethral pressure profilometry, and final urodynamic diagnosis. RESULTS: The main complaint evoked by the patients was incontinence (65.0%) of which 61.5% was 'complicated' and urgency was reported by 70.0%. Interpretable free flow at arrival was very low (44.0%). Prevalence of detrusor overactivity was high, found in 45 patients of whom 16 had detrusor hyperactivity with impaired detrusor contractility. Detrusor overactivity and urgency were strongly associated (p = 0.004). Twenty-five patients had intrinsic sphincteric deficiency alone and 15 detrusor underactivity. CONCLUSION: In this particular community-dwelling with an elderly female population, urodynamics is easily feasible. Incontinence, mainly 'complicated' is the more frequent complaint and urgency the more frequent symptom. Urodynamic diagnosis underlines the high incidence of detrusor overactivity as well as impaired detrusor function.

PMID: 20450508 [PubMed - in process]
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May 9, 2010

Partial cystectomy for the myogenic decompensated bladder with excessive residual urine. Urodynamics, histology and 2-13 years follow-up.

Partial cystectomy for the myogenic decompensated bladder with excessive residual urine. Urodynamics, histology and 2-13 years follow-up.: "

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Partial cystectomy for the myogenic decompensated bladder with excessive residual urine. Urodynamics, histology and 2-13 years follow-up.

Scand J Urol Nephrol. 1988;22(4):251-6

Authors: Klarskov P, Holm-Bentzen M, Larsen S, Gerstenberg T, Hald T

Partial cystectomy was performed for myogenic decompensated bladder with excessive residual urine in 11 patients, in whom training instructions and pharmacological treatment were unsuccessful. Postoperatively, the patients were followed for 2-13 years (median 4 years). Both symptoms and residual urine were reduced permanently. Urodynamic testing had demonstrated underactive detrusor function in all. The supposed etiology was infravesical obstruction in 4, overdistension due to sensory bladder paresis in 3 and unknown in 4. Histological examination of the resected bladders showed focal degeneration of the smooth muscle cells (detrusor myopathy) in 7, transmural edema and vast deposits of collagen in 8, mastocytosis in 3 and eosinophilic cystitis in 1. In conclusion we regard partial cystectomy an alternative to clean intermittent self-catheterization in selected patients with excessive residual urine.

PMID: 3238329 [PubMed - indexed for MEDLINE]
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May 8, 2010

[Vesical neuropathy in systemic vasculitis: 3 cases]

[Vesical neuropathy in systemic vasculitis: 3 cases]: "

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[Vesical neuropathy in systemic vasculitis: 3 cases]

Ann Med Interne (Paris). 1988;139(3):183-5

Authors: Amarenco P, Amarenco G, Guillevin L, Roullet E, Sobann M, Baudrimont M, Marteau R

Bladder neuropathy was diagnosed in 3 patients with systemic vasculitis (temporal arteritis: 1 case; periarteritis nodosa: 2 cases). Clinical characteristics were: dysuria, diminished or abolished bladder sensation leading to indolent bladder retention. Urodynamic investigation showed hypotonic and underactive detrusor, increased detrusor compliance, hyposensitive bladder, and/or overactive urethral closure. Needle electrode examination showed signs of denervation of periurethral muscles; sacral evoked latencies were increased, favouring pudenal nerve alterations. Symptoms and urodynamic abnormalities resolved following corticosteroid therapy. Clinical and therapeutic implications of bladder neuropathy in necrotizing vasculitis are emphasized.

PMID: 2904780 [PubMed - indexed for MEDLINE]
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May 6, 2010

Acute urinary retention in women: a prospective study of 18 consecutive cases.

Acute urinary retention in women: a prospective study of 18 consecutive cases.: "

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Acute urinary retention in women: a prospective study of 18 consecutive cases.

Scand J Urol Nephrol. 1987;21(1):29-31

Authors: Klarskov P, Andersen JT, Asmussen CF, Brenøe J, Jensen SK, Jensen IL, Lund P, Schultz A, Vedel T

Over a 9 month period 18 women were admitted for acute urinary retention to six different Copenhagen hospitals, serving a population of approximately 700,000 people. Urodynamically 9 patients had underactive detrusor function, 2 had infravesical obstruction and 3 had both underactive detrusor function and infravesical obstruction. In 4 patients bladder and urethral function were not classified. In 10 patients a provocative event preceded the retention episode. Eleven patients developed recurrent retention within 3 months and 7 patients had persistent severe obstructive voiding problems. Best prognosis was found for patients with correctable infravesical obstruction and for patients with minimal symptoms prior to the retention episode.

PMID: 3589520 [PubMed - indexed for MEDLINE]
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May 5, 2010

De novo detrusor underactivity after laparoscopic radical prostatectomy.

De novo detrusor underactivity after laparoscopic radical prostatectomy.: "


De novo detrusor underactivity after laparoscopic radical prostatectomy.

Int J Urol. 2010 Apr 28;

Authors: Matsukawa Y, Hattori R, Komatsu T, Funahashi Y, Sassa N, Gotoh M

Objective: The aim of this study was to investigate bladder function following laparoscopic radical prostatectomy, with a focus on de novo detrusor underactivity. Methods: Records on pre- and postoperative urodynamic studies were retrospectively investigated in 110 patients who underwent laparoscopic radical prostatectomy. Patients exhibiting de novo detrusor underactivity were selected on the basis of an overt strain voiding pattern during the postoperative pressure flow study with detrusor pressure at a maximum flow rate <10 cm H(2)O accompanied by an increase in abdominal pressure. In these patients, a follow-up urodynamic study was performed to assess subsequent long-term changes in the bladder function. Results: Of the 110 patients, 10 (9.1%) were observed to exhibit de novo detrusor underactivity during the postoperative urodynamic study. During the voiding phase of the pre- and postoperative pressure flow study in these 10 patients, the mean detrusor pressure at maximum flow rate showed a significant decrease postoperatively from 57.6 to 3.0 cm H(2)O (P < 0.001), although the mean abdominal pressure at maximum flow rate significantly increased from 23.1 to 102.5 cm H(2)O (P < 0.001). The follow-up urodynamic study performed on seven patients at 36 months following surgery revealed no significant change in each urodynamic parameter. De novo detrusor underactivity persisted even over the long term following surgery, and no improvement in bladder function was observed. Conclusions: Detrusor contractility may be impaired during radical prostatectomy. Postoperative detrusor underactivity following radical prostatectomy seems to be an irreversible phenomenon persisting even over the long term.

PMID: 20438594 [PubMed - as supplied by publisher]
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May 4, 2010

Can urodynamic studies be dispensed with in the initial urologic management of children with meningomyelocele? A study of 30 cases and review of the literature.

Can urodynamic studies be dispensed with in the initial urologic management of children with meningomyelocele? A study of 30 cases and review of the literature.: "
Related Articles

Can urodynamic studies be dispensed with in the initial urologic management of children with meningomyelocele? A study of 30 cases and review of the literature.

J Pediatr Urol. 2007 Jun;3(3):195-9

Authors: Chandra Mishra S

OBJECTIVE: To identify whether a relationship exists between information gathered from voiding patterns, neurological status and radiological findings, and the actual dysfunction seen on cystometry in children with spina bifida. PATIENTS AND METHODS: Thirty consecutive children with spina bifida underwent clinical evaluation, urinary tract imaging and cystometry. The clinical and radiological data were correlated with actual bladder dysfunction. RESULTS: Cystometry was abnormal in 87% with overactive detrusor in 77%. Seventeen patients (57%) had significant residual urine of whom all had neurological or voiding abnormalities. Irrespective of radiological findings (abnormal in 53%), 90% of these patients had detrusor overactivity and 10% an underactive detrusor. In the group with insignificant residual urine (n=13), upper tract was abnormal in six (46%) of which four had neurological/voiding abnormalities and detrusor overactivity. The other two patients with normal neurologic status and voiding pattern had normal cystometry, but their upper tract damage was inexplicable. Of the patients with insignificant residual urine and normal upper tracts (n=7), four had neurologic/voiding abnormalities, three with an overactive detrusor and one underactive detrusor, and of the other three, one had an overactive detrusor. CONCLUSIONS: Patients with significant residual urine can be presumed to have detrusor overactivity and may be initially managed with clean intermittent catheterization and bladder relaxants. Cystometry is indicated if upper tract shows deterioration. In patients with insignificant residual urine and abnormal clinical evaluation or radiology, detrusor overactivity can be presumed and urodynamic studies deferred. Patients with insignificant residual urine, normal radiology but abnormal clinical findings must undergo initial cystometry.

PMID: 18947734 [PubMed]
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May 3, 2010

Sympathetic nervous system and dysfunction of the lower urinary tract.

Sympathetic nervous system and dysfunction of the lower urinary tract.: "

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Sympathetic nervous system and dysfunction of the lower urinary tract.

Clin Sci (Lond). 1986;70 Suppl 14:69s-76s

Authors: George NJ, Reading C

Careful clinical and investigative protocols allow the identification of a homogeneous group of patients with prostatodynia or 'anxious bladder syndrome' (underactive detrusor function). Psychophysiological studies and urodynamic measurements in such patients demonstrate remarkably consistent results, which, whilst lending support to the hypothesis that the sympathetic nervous system may effect bladder and urethral function, do not offer objective proof that adrenergic mechanisms are directly responsible for the observed dysfunctional state. observed dysfunctional state.

PMID: 3720192 [PubMed - indexed for MEDLINE]
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May 2, 2010

Urodynamic profile in myelopathies: A follow-up study.

Urodynamic profile in myelopathies: A follow-up study.: "

Urodynamic profile in myelopathies: A follow-up study.

Ann Indian Acad Neurol. 2009 Jan;12(1):35-9

Authors: Gupta A, Taly AB, Srivastava A, Thyloth M

AIMS: To study the significance of filling cystometry in assessment and management of neurogenic bladder in myelopathies and correlate neurological recovery and bladder management in the follow up. STUDY DESIGN: Retrospective analysis of reports of filling cystometry in patients with traumatic and non-traumatic myelopathy. SETTING: Neuro-rehabilitation unit of a tertiary care university hospital. METHODS: The study was carried out between September 2005 and June 2006 and included all subjects with myelopathy who underwent filling cystometry. ASIA impairment scale was used to assess neurological status during admission as well as in the follow up. Bladder management was advised based on the cystometric findings. Neurological recovery and mode of bladder management were correlated during the follow up after a minimum of 6 months. RESULTS: Fifty-two subjects (38 males, 14 females), mean age 33.26 +/- 14.66 years (10-80) underwent filling cystometry. Twenty patients had cervical, 24 had thoracic and 8 had lumbar myelopathy. Cystometric findings were overactive detrusor observed in 43 patients, (21 had detrusor sphincter dyssynergia (DSD), 22 without DSD) and areflexic/underactive detrusor in 9. Post-void residual (>15% of voided urine) was significant in 27 patients. Twenty-three patients (44%) reported for follow up (16 males, 7 females) after a mean duration of 9.04 +/- 2.44 months (6-15 months). Neurological recovery was seen in 61% cases, while 1 patient showed deterioration. Only 26% patients reported change in bladder management during follow up. Correlation between neurological recovery and bladder management was found to be insignificant (P > 0.05) using spearman correlation co-efficient. CONCLUSIONS: Filling cystometry is valuable for assessment and management of neurogenic bladder after myelopathy. No significant relationship was observed between neurological recovery and neurogenic bladder management in the follow up in the present study.

PMID: 20151007 [PubMed]
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April 29, 2010

Restoration of bladder contraction by bone marrow transplantation in rats with underactive bladder.

Restoration of bladder contraction by bone marrow transplantation in rats with underactive bladder.: "
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Restoration of bladder contraction by bone marrow transplantation in rats with underactive bladder.


Biomed Res. 2007 Oct;28(5):275-80


Authors: Nishijima S, Sugaya K, Miyazato M, Kadekawa K, Oshiro Y, Uchida A, Hokama S, Ogawa Y


We attempted to increase bladder contraction by bone marrow cell transplantation in rats with underactive bladder due to bladder outlet obstruction (BOO). Twelve female rats were anesthetized with halothane to create BOO. After 1 month, the urethral obstruction was removed and they were divided into a transplant group and a sham-operated group (n = 6 each). Bone marrow cells (1 x 10(7) / 0.2 mL) isolated from green fluorescent protein transgenic rats were injected into the bladder wall of the transplant group. Rats from the sham-operated group received injection of culture medium alone. One month after transplantation, isovolumetric cystometry parameters and histological features of bladder were observed as well as intact control rats (n = 6). The amplitude of bladder contractions was larger and the interval between contractions was shorter in the transplant group than the sham-operated group, and there were no differences in these parameters between the transplant group and the control group. Some green fluorescent muscle layers were found in the bladder wall of the transplant group, and these layers were also labeled by anti alpha-smooth muscle actin antibody. These results suggest that transplanted bone marrow cells may improve bladder contractility by differentiating into smooth muscle-like cells.


PMID: 18000341 [PubMed - indexed for MEDLINE]

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Underactive pharmaceutical bladder activity.

Underactive pharmaceutical bladder activity.: "
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Underactive pharmaceutical bladder activity.


BJU Int. 2007 Oct;100(4):945-6


Authors: Wyllie MG



PMID: 17822472 [PubMed - indexed for MEDLINE]

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April 28, 2010

[Lower urinary tract dysfunction and diabetes mellitus]

[Lower urinary tract dysfunction and diabetes mellitus]: "

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[Lower urinary tract dysfunction and diabetes mellitus]


Prog Urol. 2007 May;17(3):371-8


Authors: Chartier-Kastler E, Robain G, Mozer P, Ruffion A


Diabetic neuropathy can induce multi-organ functional disease including lower urinary tract dysfunction. After a review of the various neurological lesions associated with diabetes mellitus, the authors describe the voiding disorders observed in diabetics and their specificity. These disorders, usually characterized by a large, flaccid, underactive bladder, must always be interpreted as a function of other diseases of the male or female pelvis that alter an often precarious balance. The management problems raised by this neuropathy are related to the fact that it may not be correctly diagnosed prior to a surgical procedure, for example. A better knowledge of the risk factors and natural history of diabetic bladder must therefore be promoted.


PMID: 17622061 [PubMed - indexed for MEDLINE]

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Is the use of parasympathomimetics for treating an underactive urinary bladder evidence-based?

Is the use of parasympathomimetics for treating an underactive urinary bladder evidence-based?: "
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Is the use of parasympathomimetics for treating an underactive urinary bladder evidence-based?


BJU Int. 2007 Apr;99(4):749-52


Authors: Barendrecht MM, Oelke M, Laguna MP, Michel MC


An underactive urinary bladder (UUB), often occurring after surgery, can lead to urinary retention even in otherwise healthy people. We systematically reviewed published reports to determine whether the use of parasympathomimetic agents is warranted in patients with a UUB. Agents allegedly useful in treating UUB were identified from urology and pharmacology textbooks. A systematic search for randomized clinical trials in patients with UUB using these agents revealed 10 such studies. Controls typically received placebo or no treatment. While three studies reported statistically significant improvements relative to the control group, six did not and one even reported a significant worsening of symptoms. There was no evidence for differences between individual drugs, specific uses of such drugs, or in outcome measures. We conclude that the available studies do not support the use of parasympathomimetics for treating UUB, specifically when frequent and/or serious possible side-effects are taken into account.


PMID: 17233798 [PubMed - indexed for MEDLINE]

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April 23, 2010

Demonstration of muscarinic and nicotinic receptor binding activities of distigmine to treat detrusor underactivity.

Demonstration of muscarinic and nicotinic receptor binding activities of distigmine to treat detrusor underactivity.: "


Demonstration of muscarinic and nicotinic receptor binding activities of distigmine to treat detrusor underactivity.


Biol Pharm Bull. 2010;33(4):653-8


Authors: Harada T, Fushimi K, Kato A, Ito Y, Nishijima S, Sugaya K, Yamada S


The present study was undertaken to examine whether distigmine, a therapeutic agent used to treat detrusor underactivity, binds directly to muscarinic and nicotinic receptors. We used radioreceptor binding assays and compared the effects of distigmine with those of neostigmine and donepedil. The inhibitory effect of distigmine on the blood acetylcholinesterase (AChE) activity was significantly weaker than that of neostigmine. Distigmine, neostigmine, and donepezil competed for specific binding sites of [N-methyl-(3)H]scopolamine methyl chloride ([(3)H]NMS ) and [(3)H]oxotremorine-M in the bladder, submaxillary gland and cerebral cortex of rats in a concentration-dependent manner, indicating significant binding activity of muscarinic receptors. Distigmine displayed significantly higher affinity for binding sites of [(3)H]oxotremorine-M compared with those of [(3)H]NMS as revealed by large ratios of its K(i) value for [(3)H]NMS to that for [(3)H]oxotremorine-M, suggesting that it has preferential affinity for agonist sites of muscarinic receptors. Distigmine seemed to bind to the agonist sites of muscarinic receptors in a competitive manner. Repeated oral administration of distigmine caused a significant decrease in the maximal number of binding sites (B(max)) for [(3)H]NMS in the bladder and submaxillary gland but not cerebral cortex. Distigmine also bound to nicotinic receptors in the rat cerebral cortex. In conclusion, distigmine shows direct binding to muscarinic receptors in the rat bladder, and repeated oral administration of distigmine causes downregulation of muscarinic receptors in the rat bladder. The observed direct interaction of distigmine with the bladder muscarinic receptors may partly contribute to the therapeutic and/or side effects seen in the treatment of detrusor underactivity.


PMID: 20410601 [PubMed - in process]

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April 12, 2010

Functional improvement in spinal cord injury-induced neurogenic bladder by bladder augmentation using bladder acellular matrix graft in the rat.

Functional improvement in spinal cord injury-induced neurogenic bladder by bladder augmentation using bladder acellular matrix graft in the rat.: "
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Functional improvement in spinal cord injury-induced neurogenic bladder by bladder augmentation using bladder acellular matrix graft in the rat.


World J Urol. 2007 Apr;25(2):207-13


Authors: Urakami S, Shiina H, Enokida H, Kawamoto K, Kikuno N, Fandel T, Vejdani K, Nunes L, Igawa M, Tanagho EA, Dahiya R


Spinal cord injury (SCI) rostral to the lumbosacral level causes bladder hyperreflexia and detrusor-sphincter dyssynergia (DSD), which are accompanied by bladder hypertrophy. We hypothesize that bladder augmentation using a bladder acellular matrix graft (BAMG) can improve the function of SCI-mediated neurogenic bladder. In female rats (n = 35), SCI was induced by transection of the spinal cord at the lower thoracic level. Eight weeks following spinalization, bladder augmentation using BAMG was performed after hemicystectomy of the hypertrophic bladder. Cystometrography was performed at 8 weeks after spinalization and again at 8 weeks after augmentation. Several urodynamic parameters were measured and the grafted bladder was histologically evaluated. Thirty one rats were alive 8 weeks after spinalization. Twenty two (71%) rats developed hyperreflexic bladders and nine (29%) rats had underactive bladders before bladder augmentation. Twenty six rats survived until 8 weeks after augmentation. Urodynamic parameters showed improvement in some bladder functions in both hyperreflexic and underactive bladders after augmentation. In addition, bladder compliance was increased in hyperreflexic bladders and decreased in underactive bladders. Bladder augmentation decreased bladder capacity in high-capacity rats and increased it in low-capacity rats. Histological evaluation showed complete regeneration of BAMG in SCI-induced neurogenic bladder at 8 weeks after augmentation. This is the first report suggesting that the voiding function in SCI-induced neurogenic bladder can be improved by augmentation using BAMG. Improved voiding function was accompanied by histological regeneration of BAMG.


PMID: 17221271 [PubMed - indexed for MEDLINE]

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April 7, 2010

Aging and the underactive detrusor: a failure of activity or activation?

Aging and the underactive detrusor: a failure of activity or activation?: "
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Aging and the underactive detrusor: a failure of activity or activation?


Neurourol Urodyn. 2010 Mar;29(3):408-12


Authors: Smith PP


AIMS: To examine the known and potential contributions of motor, sensory, and biomechanical dysfunctions to the clinical problems of detrusor underactivity and detrusor hyperactivity/impaired contractility. METHODS: A review of the current literature on non-obstructive voiding dysfunction associated with aging was conducted. The functional impact of age-induced biomechanical tissue change via alterations in sensory transduction is considered. RESULTS: Impaired contractility has been regarded as etiologic of detrusor underactivity. However, an age-related degradation in detrusor contractility as the primary contributor to impaired bladder emptying has not been conclusively demonstrated. To the extent that detrusor contraction force and duration are dependent upon efferent nerve activity and thus reflex responses to sensory activity, there is a potential impact of impaired sensory function on voiding efficiency. Structural and functional tissue changes accompanying aging may result in altered bladder afferent function, with subsequent reflex impairment of detrusor voiding function. CONCLUSIONS: The relative contributions of motor, sensory, and biomechanical dysfunctions to impaired voiding performance independent of outlet obstruction associated with aging remain to be elucidated.


PMID: 19760756 [PubMed - in process]

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Effect of lumbar epidural administration of neostigmine on lower urinary tract function.

Effect of lumbar epidural administration of neostigmine on lower urinary tract function.: "
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Effect of lumbar epidural administration of neostigmine on lower urinary tract function.


Neurourol Urodyn. 2010 Mar;29(3):443-8


Authors: Agarwal MM, Singh SK, Batra YK, Mavuduru R, Mandal AK


BACKGROUND: Neostigmine is cholinomimetic and is used for postoperative analgesia. Its urodynamics effects on voiding function have not been elucidated. MATERIALS AND METHODS: Adult patients without bothersome voiding symptoms planned for rigid cystoscopy under local anesthesia were enrolled. They underwent multichannel urodynamics (filling cystometry and pressure-flow study) before and 30 min after lumbar epidural administration of Neostigmine (2 microg/kg). RESULTS: Indications for cystoscopy were check examination for follow up of carcinoma urinary bladder (n = 3), staging for carcinoma cervix (5), and removal of ureteral stent (4). Patients' mean age was 51.9 +/- 11.7 years and international Prostatic symptom score 2.34 +/- 3.41. A trend of decreased maximum cystometric capacity (MCC) was observed after Neostigmine (413.50 +/- 142.45 ml vs. 357.00 +/- 145.62 ml; P = 0.056) without any change in end-filling pressure. Five patients developed detrusor overactivity (DO) and one had increase in its amplitude (P = 0.031). Four patients developed rhythmic rectal contractions and one had increase in its amplitude (P = 0.219). There was no difference in any of the voiding parameters. Mean Visual Analog Pain Score (VAS scale 0-10) during cystoscopy for this group was significantly lower than that in a similar group of patients who did not receive Neostigmine prior to rigid cystoscopy (1.16 +/- 0.94 vs. 4.57 +/- 1.45; P = 0.0001). The drug was well tolerated in majority of the patients. CONCLUSION: Epidural Neostigmine is effective in providing analgesia during diagnostic rigid cystoscopy. It leads to development of DO and decrease in bladder capacity without any effect on voiding function. These findings may help clinicians to use it for transurethral procedure-related pain relief without apprehension of voiding difficulty.


PMID: 19260084 [PubMed - in process]

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April 5, 2010

Two cases of giant vesical diverticulum in females

[Two cases of giant vesical diverticulum in females]: "

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[Two cases of giant vesical diverticulum in females]


Hinyokika Kiyo. 1985 Mar;31(3):489-94


Authors: Fujioka T, Matsui S, Adachi M, Banya Y, Ohinata M, Kubo T, Ohhori T


Two rare cases of giant vesical diverticulum without infravesical obstruction in female are presented. The first case, a 58-year-old female, was admitted because of diverticulum with continuous urinary infection, which was diagnosed by urological examinations for hematuria. The second case, a 58-year-old female, was admitted with the diagnosis of diverticulum, which was done by the gynecologist during laparotomy for the suspicion of a right ovarian cyst. Neither patient complained of difficulty in urination in spite of remarkable residual urine and no neurologic abnormalities were detected. The cystograms of the two cases revealed over-goose-egg sized diverticula and vesical capacity was over 800 ml, in both cases. The other urograms and endoscopy showed no evidence of vesical trabeculation or any obstructive changes of bladder neck or urethra in either case. Therefore, mucosal diverticulectomy in the first and total diverticulectomy in the second, was performed for the residual urine. Each surgical specimen showed the muscle layer of the walls. In the post-operative course, urination was improved in spite of the underactive detrusor pattern of the cystometry in the first case. But residual urine volume was not decreased after the operation in the second case. These two cases seem to be congenital vesical diverticulum. But it is hard to rule out the possibility of secondary diverticulum due to neurogenic disorders of urinary bladder.


PMID: 3927663 [PubMed - indexed for MEDLINE]

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April 2, 2010

Ultrasound imaging of sacral reflexes.

Ultrasound imaging of sacral reflexes.: "
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Ultrasound imaging of sacral reflexes.


Urology. 2006 Sep;68(3):652-4


Authors: de Jong TP, Klijn AJ, Vijverberg MA, de Kort LM


OBJECTIVES: To investigate the reliability of examination of the guarding reflex of the pelvic floor by dynamic perineal ultrasonography in children with bladder dysfunction and in controls. METHODS: A total of 40 patients with nonneurogenic bladder/sphincter dyssynergia, 40 with spina bifida, and 40 controls underwent a dynamic ultrasound examination of the pelvic floor while coughing and while being tapped on the abdominal wall. The reflex action of the puborectal muscle in females, and the combined action of the puborectal muscle and external sphincter muscle in males, were recorded. RESULTS: Of the 40 patients with nonneurogenic bladder/sphincter dyssynergia, 38 had a normal reflex action of the puborectal muscle during the abdominal tap and 36 had a normal reflex action when coughing. Two of these patients had unexplained underactive bladder syndrome and were using clean intermittent catheterization, and two could not be assessed because of hypermobility of the bladder neck when coughing but had a normal reaction during abdominal tapping. Of the 40 patients with spina bifida, none had puborectal activity during coughing and 5 had some puborectal activity during tapping. Of the 40 controls, 39 had normal reflex activity during both coughing and tapping. CONCLUSIONS: The question of whether a child has nonneurogenic or neuropathic bladder/sphincter dysfunction is often difficult to answer on the basis of urodynamic studies alone. Dynamic perineal ultrasound recording of the S2-S4 reflex arches provides reliable additional information and is noninvasive to the patient.


PMID: 16979732 [PubMed - indexed for MEDLINE]

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March 30, 2010

Magnet to the Scrotum! Urovalve Surinate Bladder Management System Ready To Go On Trial in U.S.

Magnet to the Scrotum! Urovalve Surinate Bladder Management System Ready To Go On Trial in U.S.: "



Urovalve, Inc. of Newark, N.J. has announced that the FDA has granted an Investigational Device Exemption (IDE) approval for the company's Surinate Bladder Management System, allowing Urovalve to conduct a clinical study for the device in the United States. The Surinate system consists of a device inserted into the urethra that bridges the bladder neck, prostrate and external sphincter and provides a valved connection between the bladder and the bulbous urethra. The valve is magnetically controlled and can be activated remotely by the wearer by using a hand held magnet to self-regulate flow. When the hand held switching magnet is brought within 3 - 4 centimeters of the check valve magnet, it draws the check magnet away from the valve seat, permitting urine to flow out through the urethra. It is used for managing problems such as urinary retention and incontinence and can stay in place for 28 days.







Press release: Urovalve Granted IDE Approval by FDA to Conduct Clinical Study of Surinate® Bladder Management System...



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