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...



Homepage: Urovalve...







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March 27, 2010

Incontinence Detector Broadcasts The State of Your Pants

Incontinence Detector Broadcasts The State of Your Pants: "



An Australian company called Simavita is releasing an incontinence detection device to be used in nursing homes across New South Wales. The SIMsystem uses a strip that detects liquid and a cellular device to send a note to a nursing station or a care provider.



From the product page:



The SIM™box, when fitted into the individual resident's stretchpants (SIM™pants), transmits sensor readings from the SIM™strip in the SIMpad® over a wireless network to the SIM™server. The SIMsystem™ Manager software running on the SIM™server then detects key information about continence events and determines when to alert care staff about an event requiring attention.

Alerts are sent via text message to the carer's mobile phone, or via the facility's paging system if preferred. As carers are often unable to immediately respond to events, the software will display a summary log of alerts and manual observations can also be entered. The final bladder chart includes all observations in one easy-to-read report.



On completion of the 3-day assessment, the SIMsystem™ Manager produces shift, daily and 3-day reports that may be used by carers for the development of continence care plans.



The SIM™box and SIM™network have been built for ZigBee®, the industry standard protocol endorsed by the Continua Alliance, for low-power and low-range wireless applications. The SIM™box can operate continuously for at least 100 hours before the batteries need charging.



Product page: SIMsystem...



More from Australian Associated Press: Electronic underpants come to NSW...



(hat tip: Engadget)





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March 21, 2010

Assessment of urethral resistance at external sphincter zone during voiding by static withdrawal urethrometrogram.

Assessment of urethral resistance at external sphincter zone during voiding by static withdrawal urethrometrogram.: "

Related Articles

Assessment of urethral resistance at external sphincter zone during voiding by static withdrawal urethrometrogram.


Urol Int. 1984;39(6):327-31


Authors: Miyagawa I


We investigated the intraurethral pressure changes at the external sphincter zone during voiding act and during an attempt to contract the anal sphincter on 26 neurologically intact subjects (normal group) and 12 cases after intrapelvic surgery (6 after amputatio recti and 6 after radical hysterectomy) (disturbed group). During voiding the pressure was decreased in 25 of 26 cases of the normal group, but was increased in 11 of 12 cases of the disturbed group. In contracting the anal sphincter, urethral pressure rose in all cases of both normal and disturbed groups. A significant positive correlation (p less than 0.01) was found in the urethral pressure changes between voiding and during the attempt to contract the anal sphincter in the disturbed group, but not in the normal group. It is supposed that the pressure decreased during voiding is an indication of not only normally functioning external urethral sphincter but also non-underactive detrusor, and that the pressure increase means either underactive detrusor or spastic external urethral sphincter due to detrusor-sphincter dyssynergia. To measure the urethral pressure changes at the external sphincter zone during voiding is thought to be useful for assessment of the urethral resistance at that zone.


PMID: 6084356 [PubMed - indexed for MEDLINE]

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March 20, 2010

Investigation of postprostatectomy problems.

Investigation of postprostatectomy problems.: "

Related Articles

Investigation of postprostatectomy problems.


Urology. 1980 Feb;15(2):209-12


Authors: Abrams PH


Sixty patients presented with postprostatectomy problems. The symptoms of slow stream and hesitancy were associated with the urodynamic finding of an underactive detrusor more often than with persistent obstruction. The symptoms of persistent urgency, frequency, and urge incontinence were associated with bladder hypersensitivity and bladder instability. Stress incontinence was associated with low sphincter pressures demonstrated by urethral profilometry. Urodynamic studies enabled accurate diagnosis of these problems and indicated which patients had persistent obstruction (17 per cent) and would therefore benefit from additional outflow tract surgery.


PMID: 7355551 [PubMed - indexed for MEDLINE]

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March 14, 2010

Is a Neurogenic Bladder Genetic?

Neurogenic bladder is a condition characterized by lack of bladder control related to nerve damage. While the condition is not genetic, the birth defect spina bifida may trigger it in some individuals.

The Facts

The Cleveland Clinic describes neurogenic bladder as a potential complication of any disease or physical trauma that impacts the nerves controlling bladder function. Depending on the individual, neurogenic damage can trigger either overactive or underactive bladder function.

Spina Bifida

Children's Hospital Boston cites spina bifida as a common underlying cause of neurogenic bladder in children. This occurs when spinal changes caused by the birth defect disrupt the normal signal path of nerves related to bladder control.

Additional Causes

Children's Hospital Boston and the Medline Plus identify additional underlying causes of neurogenic bladder that include spinal cord injury, Alzheimer's disease, pelvic or central nervous system tumors, multiple sclerosis, diabetes and stroke recovery.

Diagnosis

Doctors diagnose neurogenic bladder through a combination of physical examination, medical history, urine testing and studies of bladder volume and pressure, according to Children's Hospital Boston.

Treatments

Medline Plus notes potential treatments for neurogenic bladder that include medications for overactive or underactive bladder, antibiotics to address infections and exercises to strengthen pelvic floor muscles.

source: ehow

Pyridostigmine in autonomic failure: can we treat postural hypotension and bladder dysfunction with one drug?

Pyridostigmine in autonomic failure: can we treat postural hypotension and bladder dysfunction with one drug?: "
Related Articles

Pyridostigmine in autonomic failure: can we treat postural hypotension and bladder dysfunction with one drug?


Clin Auton Res. 2006 Aug;16(4):296-8


Authors: Yamamoto T, Sakakibara R, Yamanaka Y, Uchiyama T, Asahina M, Liu Z, Ito T, Koyama Y, Awa Y, Yamamoto K, Kinou M, Hattori T


In a 66-year-old man with autonomic failure, pyridostigmine (180 mg/day orally) improved both postural hypotension and underactive detrusor bladder dysfunction. Acetylcholinesterase inhibition may be useful in the management of orthostatic hypotension and bladder dysfunction in autonomic failure patients.


PMID: 16862395 [PubMed - indexed for MEDLINE]

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March 9, 2010

Intravesical electromotive drug administration technique: preliminary results and side effects.

Intravesical electromotive drug administration technique: preliminary results and side effects.: "
Related Articles

Intravesical electromotive drug administration technique: preliminary results and side effects.


J Urol. 1998 Jun;159(6):1851-6


Authors: Riedl CR, Knoll M, Plas E, Pflüger H


PURPOSE: We performed intravesical electromotive drug administration (EMDA) for various bladder disorders during a 3-year period and assessed the technique, possible applications, complications and outcomes of this procedure. MATERIALS AND METHODS: Intravesical EMDA was performed with local anesthetics for transurethral surgery and in combination with dexamethasone for the treatment of noninfectious chronic cystitis (interstitial/radiation cystitis), with mitomycin C for recurrence prophylaxis of high risk superficial bladder cancer and with oxybutynin/bethanechol for the hyperreflexive/acontractile detrusor. A standardized power source and electrode catheter were used for 215 treatments in 84 patients. RESULTS: Transurethral bladder tumor resections were pain-free in 10 of 12 patients. Of the 25 patients with chronic noninfectious cystitis 15 were free of symptoms for a mean of 6.6 months, and there was a 73% increase in mean bladder capacity from 244 before to 421 cc after EMDA. Of the 16 patients with superficial bladder cancer 9 were free of recurrence for a mean of 14.1 months. In 10 of 14 patients with acontractile detrusors urodynamic examination showed detrusor contraction during EMDA of bethanechol. There were no contractions without electric current. EMDA of oxybutynin reduced detrusor hyperreflexia. A bladder ulcer was the single severe local complication and 4.6% of patients, mainly those with chronic cystitis, reported significant post-EMDA bladder/urethral pain. Minor side effects accounted for 23% of all treatments. No systemic side effects occurred. CONCLUSIONS: Intravesical EMDA is effective and innocuous. The therapeutic concept combines the advantages of increased drug administration without systemic side effects.


PMID: 9598474 [PubMed - indexed for MEDLINE]

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March 1, 2010

Cystometric Changes in Pressure-guided Acute Distension Rat Model of the Underactive Bladder™

Tzu Chi Medical Journal
Volume 21, Issue 2, June 2009, Pages 136-139

doi:10.1016/S1016-3190(09)60025-2
Copyright © 2009 Buddhist Compassion Relief Tzu Chi Foundation Published by Elsevier B.V.


Dae K. Kima, Jonathan Kaufmanb, Zhonghong Guanc, Pradeep Tyagid, Naoki Yoshimuraa, Kim A. Killingerd, Kenneth M. Petersd and Michael B. Chancellord,

aDepartment of Urology, Eulji University, Daejeon, Korea

bLipella Pharmaceuticals, Inc., Pittsburgh, PA, USA

cDepartment of Urology, State University of New York Downstate Medical School, New York, NY, USA

dDepartment of Urology, William Beaumont Hospital, Royal Oak, MI, USA

Received 19 September 2008;
revised 22 December 2008;
accepted 26 December 2008.
Available online 10 June 2009.

Abstract

Objective

Acute bladder distension results in pressure ischemia, subsequent reperfusion injury, and ultimately damage to the detrusor. We hypothesize that changes in pressure may be a key factor to damage resulting from over-distension and developed a pressure-guided distension model to evaluate cystometric changes.

Materials and Methods

Three groups of adult female Sprague Dawley rats (250 g) were used: a sham distended control group, a 3-day (3D) and 7-day (7D) follow-up group after pressure-guided distension. Under pentobarbital anesthesia, the urethra was clamped and saline was infused (0.04 mL/min) under continuous intravesical pressure monitoring. After reaching 120 cmH2O pressure, infusion was stopped and clamping was maintained for 30 minutes. For sham distension, all procedures except the saline infusion were done.

Results

There were no bladder ruptures during distension. Distension volumes needed to achieve the fixed pressure were variable (1.68–2.90 mL), but mean distension volumes were similar between the 3D and 7D groups (2.1 ± 0.1 mL vs. 2.2 ± 0.3 mL). After distension, maximal cystometric capacity and residual urine volume were increased at both time points. Voiding efficiencies were decreased significantly in both the 3D and 7D groups (p <>

Conclusion

Our pressure-guided distension model exhibits cystometric characteristics of bladder decompensation. This model for the underactive bladder™ (UAB) may prove useful to further the development of targeted UAB™ treatments.

Keywords: Bladder; Muscle; Retention; Underactive bladder

Delayed traumatic thoracic spinal epidural hematoma: a case report and literature review.

Delayed traumatic thoracic spinal epidural hematoma: a case report and literature review.

Related Articles

Am J Emerg Med. 2007 Jan;25(1):69-71

Authors: Hsieh CT, Chiang YH, Tang CT, Sun JM, Ju DT

Spinal epidural hematoma is a relatively uncommon disease, but an important cause leading to cord compression. Posttraumatic spinal epidural hematoma is a rare entity and remains a challenge for clinical physicians. Magnetic resonance imaging is the best choice for early diagnosis, and urgent surgical decompression with evacuation of hematoma could improve some neurologic deficits, especially vital cord functions. We presented a 77-year-old woman who sustained back pain after a fall 1 month before admission, complaining of progressive weakness and sensory loss in bilateral lower extremities since 2 weeks before admission. Radiography of the thoracic spine revealed decreased body height at T10 and compression fracture. Magnetic resonance imaging of the thoracic spine revealed epidural hematomas at the level of T11 to T12. An urgent decompressive laminectomy with evacuation of hematoma was performed immediately. Postoperatively, her previous neurologic deficits improved except for an underactive neurogenic bladder and fecal incontinence.

PMID: 17157687 [PubMed - indexed for MEDLINE]

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Neurogenic bladder in patients with cervical compressive myelopathy.

Neurogenic bladder in patients with cervical compressive myelopathy.

Related Articles

J Spinal Disord Tech. 2005 Aug;18(4):315-20

Authors: Misawa T, Kamimura M, Kinoshita T, Itoh H, Yuzawa Y, Kitahara J

We examined the urinary disturbances in 56 consecutive patients with cervical compressive myelopathy using the latest International Continence Society classification. Of the 56 patients with cervical compressive myelopathy, 29 (52%) had some urinary subjective complaints, whereas the remaining 27 (48%) had none. Urologic examination indicated that 8 of these 29 (28%) patients with urinary complaints had urologic disorders other than neurogenic bladder. Of the remaining 21 patients, only 6 (25%) were judged to have neurogenic bladder on urodynamic study. Urodynamic study may be of limited value in diagnosing urinary disturbance in cervical myelopathy. Further, four cases (83%) showed underactive bladder activity in voiding phase, and only one case (17%) showed overactive bladder activity in filling phase. These results were contrary to those of previous studies indicating that cervical compressive myelopathy is associated with overactive bladder activity in filling phase. There were no significant differences in motor or sensory Japanese Orthopedic Association scores between the patients with and without urinary complaints. However, the patients with urinary complaints had significantly longer durations of myelopathy and delayed motor evoked potential latencies than those without urinary complaints. After surgery, 19 of the 21 (90%) patients with urinary complaints showed recovery from urinary disturbance. Operations in patients with cervical myelopathy were also effective against urinary disturbance. Urinary complaints may be an indication for surgical treatment despite the results of urodynamic study.

PMID: 16021011 [PubMed - indexed for MEDLINE]

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Diagnosis and management of patients with overactive bladder syndrome and abnormal detrusor activity.

Diagnosis and management of patients with overactive bladder syndrome and abnormal detrusor activity.

Related Articles

Nat Clin Pract Urol. 2004 Dec;1(2):78-84; quiz 109

Authors: Semins MJ, Chancellor MB

Overactive bladder syndrome (OABS) is a widely recognized syndrome with symptoms that can include urinary urgency, frequency, nocturia, and incontinence. Although there may be several causative factors for OABS, detrusor overactivity is the most common. In addition, urinary incontinence can also be due to a distinct but equally bothersome condition underactive bladder syndrome, or detrusor underactivity. The incomplete bladder emptying that characterizes detrusor underactivity often arises from impaired contractile function of the detrusor muscle. The variations in etiologies of the two syndromes necessitate patient evaluations tailored to individual symptom presentation. Increased awareness of the differences between the manifestations of OABS and underactive bladder syndrome call for specific approaches to the management of bladder dysfunction.

PMID: 16474519 [PubMed - indexed for MEDLINE]

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Underactive bladder syndrome.

Underactive bladder syndrome.

Related Articles
Nurs Stand. 2005 May 11-17;19(35):57-64; quiz 66-7

Authors: Rigby D

Underactive bladder syndrome causes difficulty in voiding, resulting in incomplete bladder emptying. This article describes common causes of the condition, patient assessment and the available management options.

PMID: 15915959 [PubMed - indexed for MEDLINE]

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Do BPH patients have neurogenic detrusor dysfunction? A uro-neurological assessment.

Do BPH patients have neurogenic detrusor dysfunction? A uro-neurological assessment.

Related Articles

Urol Int. 2005;74(1):44-50

Authors: Sakakibara R, Hamano S, Uchiyama T, Liu Z, Yamanishi T, Hattori T

INTRODUCTION: Most men with benign prostatic hyperplasia (BPH) are middle- aged and elderly. Neurogenic detrusor dysfunction (NDD) may also occur in these populations. We made an uro-neurological assessment in such patients in order to investigate the possibility of a concurrent NDD in patients diagnosed with BPH, and to correlate the presence of NDD with treatment outcome. MATERIALS AND METHODS: 28 men, mean age 66.4 years, referred by urologists at the outpatient clinic as BPH (initial diagnosis: BPH alone, 24, BPH and NDD, 4) with regards to digital examination and lower urinary tract symptoms, underwent urodynamic study and neurological examination. MRI scans were performed to confirm the diagnosis. RESULTS: Urodynamic study (except for 2, acontractile detrusor (AD)) showed equivocal obstruction (EO), 6; underactive detrusor (UD), 9 (voiding phase); detrusor overactivity (DO), 12; urethral relaxation, 1, and reduced sensation, 5 (filling phase). EO correlated with the presence of UD (p = 0.03). DO did not correlate with the prostate size or urodynamically-defined outlet obstruction. Reduced sensation was common in patients >65 years of age (p = 0.05). Neurological examination/imaging showed exaggerated reflexes, 1; decreased reflexes, 6; multiple cerebral infarction, 8; cervical spondylosis, 1 (in patients with DO); lumbar spondylosis, 5 (in patients with AD/UD), and the final diagnosis was made: definite BPH, 6; probable BPH, 9; BPH and NDD, 13, and NDD were common in the patients aged >65 years (p = 0.015). Transurethral prostatectomy and alpha-blocker were mostly successful, but the failure rate was reported in definite BPH, none, probable BPH, 29%, and BPH and NDD, 33%. CONCLUSIONS: BPH patients, particularly those >65 years of age, commonly have NDD. Multiple cerebral infarction (upper neuron disorder) and lumbar spondylosis (lower neuron disorder) might contribute to DO and UD, respectively. A uro-neurological assessment is important to select typical BPH patients for maximizing therapeutic benefit.

PMID: 15711108 [PubMed - indexed for MEDLINE]

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Combination of a cholinergic drug and an alpha-blocker is more effective than monotherapy for the treatment of voiding difficulty in patients with underactive detrusor.

Combination of a cholinergic drug and an alpha-blocker is more effective than monotherapy for the treatment of voiding difficulty in patients with underactive detrusor.

Related Articles

Int J Urol. 2004 Feb;11(2):88-96

Authors: Yamanishi T, Yasuda K, Kamai T, Tsujii T, Sakakibara R, Uchiyama T, Yoshida K

AIM: The aim of the present study was to compare the effectiveness of a cholinergic drug, an alpha-blocker and combinations of the two for the treatment of underactive detrusor. METHODS: One hundred and nineteen patients with underactive bladder were assigned to three groups: the cholinergic group, consisting of 40 patients taking bethanechol chloride (60 mg/day) or distigmine bromide (15 mg/day); the alpha-blocker group, consisting of 38 patients taking urapidil (60 mg/day); and the combination group, consisting of 41 patients taking both a cholinergic drug and an alpha-blocker. The effectiveness of each therapy was assessed 4 weeks after initialization of the therapy. RESULTS: Total urinary symptom scores (International Prostate Symptom Score, IPSS) remained unchanged after the cholinergic therapy, but were significantly lower after the alpha-blocker treatment (P = 0.0001) and the combination therapy (P = 0.0001). With regard to the total IPSS, there were significant differences between the cholinergic and the alpha-blocker groups (P = 0.0008), and also between the cholinergic and combination groups (P = 0.0033), in favor of the latter. The average and maximum flow rates did not increase significantly after monotherapy with either the cholinergic drug or the alpha-blocker, but they significantly increased after combination therapy compared to baseline values (P = 0.0033 and P= 0.0004, respectively). Postvoid residual volume did not decrease significantly after the cholinergic drug therapy, but decreased significantly after the alpha-blocker (P = 0.0043) and the combination therapies (P = 0.0008). The percentage of residual urine decreased significantly after therapy in all groups (P = 0.0005, P= 0.0176 and P= 0.0001, respectively). CONCLUSION: Combination therapy with a cholinergic drug and an alpha-blocker appears to be more useful than monotherapy for the treatment of underactive detrusor.

PMID: 14706012 [PubMed - indexed for MEDLINE]

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A prospective controlled quantitative study of ultrastructural changes in the underactive detrusor.

A prospective controlled quantitative study of ultrastructural changes in the underactive detrusor.

Related Articles

J Urol. 2003 Apr;169(4):1374-8

Authors: Brierly RD, Hindley RG, McLarty E, Harding DM, Thomas PJ

PURPOSE: We quantify and compare ultrastructural changes seen at high power on electron microscopic examination of detrusor biopsies from underactive and control bladders. MATERIALS AND METHODS: The detrusor underactivity group consisted of 14 patients (mean age 64.0 years) with post-micturition residuals greater than 300 ml., impaired contractility and no obstruction on urodynamics. A total of 17 patients who voided normally voiders with residual volume less than 50 ml. served as the control group. Bladder biopsies were obtained endoscopically using cold cup technique and processed using standard methods. All specimens were randomized and studied at high power (x12,000 to x24,000) by an examiner who was blinded to the groups. All complete cells within each random grid field were counted up to a total of 500. The number of disrupted cells per 500 cells was noted. RESULTS: Disruptive cell profiles were found in all biopsies. Median cell count was 20 cells/500 in 14 controls and 96.5 cells/500 in the underactive detrusor group (p <0.001). The number of disruptive cell profiles did not correlate with age in the control group (r = 0.34, p = 0.18). CONCLUSIONS: There were distinct morphological changes in the detrusor associated with bladder dysfunction with approximately 4 times more disruptive cells in patients with an underactive bladder. However, there was no correlation between age and number of disruptive cells, suggesting that this is not a process of aging per se. Ultrastructure studies may have a role as an adjunct to urodynamics in the diagnosis of bladder dysfunction.

PMID: 12629365 [PubMed - indexed for MEDLINE]

Modulation of viscero-somatic H-reflex during bladder filling: a possible tool in the differential diagnosis of neurogenic voiding dysfunctions.

Modulation of viscero-somatic H-reflex during bladder filling: a possible tool in the differential diagnosis of neurogenic voiding dysfunctions.

Related Articles

Eur Urol. 2002 Sep;42(3):281-8

Authors: Carbone A, Palleschi G, Parascani R, Morello P, Conte A, Inghilleri M

OBJECTIVE: Despite evidence that the activation of visceral afferents modulates spinal motoneurone activity in humans, the circuits responsible for this modulation remain unclear. The aim of the present study was to assess the effect of urinary bladder filling on the excitability of somatic spinal motoneurones in patients affected by overactive bladder secondary to neurogenic and non-neurogenic causes in both patients with bladder underactivity and normal subjects by means of a urodynamic evaluation. METHODS: In order to evaluate the influence of bladder filling on somatic reflexes, we studied the H-reflex evoked by electrical stimuli applied to the tibial nerve at the popliteal fossa and recorded from the soleus muscle. The H-reflex was tested in the following conditions: (1). empty bladder; (2). medium bladder filling; (3). maximum bladder filling; (4). five minutes after bladder emptying. The H-reflex amplitude at empty bladder was considered as the control value. RESULTS: In healthy subjects, we observed a progressive reduction in the H-reflex amplitude during bladder filling. In spinal cord-injured patients affected by a neurogenic overactive bladder, bladder filling failed to inhibit the H-reflex amplitude; a decrease in the H-reflex amplitude similar to that displayed by normal subjects was observed in patients with a non-neurogenic overactive bladder. By contrast, H-reflex behavior was unmodified in neurogenic underactive bladder patients and was similar to normal subjects in psychogenic underactive patients. CONCLUSIONS: As behavior of the H-reflex varies during bladder filling in neurogenic and non-neurogenic overactive bladder patients as well as in neurogenic and non-neurogenic underactive bladder patients, H-reflex modulation may be considered a useful tool in the differential diagnosis of voiding dysfunctions.

PMID: 12234514 [PubMed - indexed for MEDLINE]

Clinical symptoms and surgical outcome in lumbar spinal stenosis patients with neuropathic bladder.

Clinical symptoms and surgical outcome in lumbar spinal stenosis patients with neuropathic bladder.: "

Related Articles
J Spinal Disord. 2001 Oct;14(5):404-10

Authors: Kawaguchi Y, Kanamori M, Ishihara H, Ohmori K, Fujiuchi Y, Matsui H, Kimura T

We evaluated the clinical and radiologic features of patients with lumbar spinal stenosis with neuropathic bladder. Based on cystometrogram analysis, the patients were divided into two groups--the neuropathic bladder (NB) group: the NB+ group (23 patients), and the nonneuropathic bladder group: the NB- group (14 patients). The symptom of incontinence was characteristic in patients in the NB+ group. Patients in the NB+ group had a more severe neurologic disturbance, compared with those in the NB- group. The more severe neurologic disturbance was caused by the more striking finding of degenerative spinal stenosis associated with developmental narrowing of the spinal canal. Decompressive surgery had a beneficial effect on the recovery of the neurologic symptoms in both groups. Residual urine volume was reduced after surgery. Postoperative cystometrogram was carried out in nine patients in the NB+ group. It showed a normal pattern in six patients; however, three patients remained in an underactive pattern. Furthermore, four patients still required clear intermittent self-catheterization after surgery.

PMID: 11586140 [PubMed - indexed for MEDLINE]

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Influence of surgical bladder reduction on urodynamic parameters: three techniques investigated in a rat model.

Influence of surgical bladder reduction on urodynamic parameters: three techniques investigated in a rat model.

Related Articles

J Urol. 2000 Jan;163(1):306-10

Authors: D'Hauwers K, Wyndaele JJ, Renty P, Poortmans A, Wuyts F, van Marck E

PURPOSE: Bladder wall wrapping and invagination have been used for the surgical treatment of the underactive detrusor and improvement of bladder emptying has been described. In a rat model we investigated the evolution in time of urodynamic parameters after 3 techniques of surgical bladder reduction. MATERIAL AND METHODS: Female Wistar rats underwent at random, a bladder reduction with vertical wrapping, the horizontal variant or invagination of the wall. Cystometry was performed before and 30 minutes after surgery, and after 1, 5 and 10 weeks. Sham operated animals had cystometries performed at day 1 and after 1, 5 and 10 weeks. At week 10 contraction of four differently orientated detrusor strips was examined in vitro. A histological study was done. RESULTS: Contraction pressure was not improved in vivo after 10 weeks follow-up. Capacity, despite an early significant reduction, became slightly higher than presurgery in both wrapping groups and even significantly higher in the invagination group. In each group residual volume almost doubled. In vitro some strips containing operated parts did contract more strongly than controls but not significantly. Strips which contain operated parts showed slightly increased fibrosis in the invagination and the vertical wrapping group and a huge amount of fibrosis in the horizontal wrapping group. CONCLUSIONS: This experiment indicated that the rationales behind the techniques of surgical bladder reduction are not correct. The partial successes in men may be explained by the original intrinsic deficiencies of the detrusor which prevent a secondary bladder enlargement as reaction to the volume reduction.

PMID: 10604381 [PubMed - indexed for MEDLINE]

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Common urological problems in women.

Common urological problems in women.

Related Articles
Aust Fam Physician. 1998 Dec;27(12):1098-104

Authors: O'Connell HE, McKertich KM

BACKGROUND: Significant advances in the management of some common urinary problems have occurred in recent years. Problems that are likely to present to the general practitioner include urinary incontinence, voiding dysfunction, recurrent bacterial cystitis and interstitial cystitis. OBJECTIVE: The aim of this article is to highlight the advances that have occurred in the management of these common problems and their management strategy in the primary care setting. DISCUSSION: The management of incontinence, particularly stress urinary incontinence includes an accurate diagnosis and treatment tailored to the condition identified. Urinary incontinence due to the overactive and/or underactive bladder is more difficult to cure but significant improvement can be achieved in the majority of people. While severe incontinence requires an accurate diagnosis, non-operative strategies without a urodynamic diagnosis can be used in the treatment of milder forms. It is important to obtain an accurate diagnosis when the patient is not improving with conservative strategies. The problem of recurrent bacterial infections is common in women of all ages but cure should be possible in the majority of affected women. While the enigmatic entity of interstitial cystitis is increasingly recognised in out patients the exact basis for this condition remains obscure. Symptomatic improvement is achievable to a variable degree in most patients.

PMID: 9919732 [PubMed - indexed for MEDLINE]

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