December 31, 2011

Intravesical electrical stimulation in the treatment of micturition dysfunction in children.

Intravesical electrical stimulation in the treatment of micturition dysfunction in children.:
Related Articles

Intravesical electrical stimulation in the treatment of micturition dysfunction in children.

Neurourol Urodyn. 2003;22(3):233-42

Authors: Gladh G, Mattsson S, Lindström S

AIMS: To evaluate the results of intravesical electrical stimulation (IVES) in an open prospective study to treat underactive detrusor in children. The treatment was offered as an alternative to clean intermittent catheterization (CIC). METHODS: Forty-four children were included, 21 girls and 3 boys (6-16 years, md 10) with idiopathic, 9 girls and 11 boys (4-18 years; md 13) with neurogenic underactive detrusor. IVES was given by a catheter electrode in the bladder (cathode) with the anode attached to the suprapubic abdominal skin. Continuous stimulation at 20 or 25 Hz was delivered by battery powered stimulators giving unipolar square-wave pulses (0,2 or 0,7 ms). Stimulation intensity was adjusted individually according to the acceptance of the child (12-64 mA). IVES was initially given at the clinic but 18 children had additional treatment at home. Effect of treatment was monitored by micturiton/incontinence diary, reports of bladder sensation, recordings of urinary flow, residual volume and frequency of urinary tract infections. RESULTS: The IVES-treatment was completed by 39/44 children. Long term normalization of the voiding (md 2,5 years follow up) was obtained for 20/24 children with idiopathic problems (83%) and 8/20 with neurogenic problems (40%). Another four had much improved bladder function. The neurogenic group required more stimulation sessions than the idiopathic group. Of those on CIC, 11/15 who completed IVES could discontinue the catheterization. The frequency of urinary tract infections and incontinence decreased significantly (P < 0.01). CONCLUSIONS: It is concluded that IVES is a promising method to treat the underactive detrusor in children.

PMID: 12707874 [PubMed - indexed for MEDLINE]

December 30, 2011

[Clinical findings of neurogenic bladder in patients with Parkinson's disease, multiple sclerosis and spinocerebellar degeneration]

[Clinical findings of neurogenic bladder in patients with Parkinson's disease, multiple sclerosis and spinocerebellar degeneration]:
Related Articles

[Clinical findings of neurogenic bladder in patients with Parkinson's disease, multiple sclerosis and spinocerebellar degeneration]

Hinyokika Kiyo. 1997 Nov;43(11):765-9

Authors: Shimizu K, Yasukawa M, Yamamoto M, Hirao Y, Momose H, Kashiwai H, Kawata Y, Yamada K

Clinical symptoms, urodynamic findings, and urological treatment of 35 patients with neurogenic bladder dysfunction caused by Parkinson's disease (11 patients), multiple sclerosis (10 patients), and spinocerebellar degeneration (14 patients) were reviewed retrospectively. Most of the patients had a relatively low stage of disease, when they were first seen by their urologists. Chief urological complaints were of irritation in 63.6% of Parkinson's disease and 64.3% of spinocerebellar degeneration cases, compared with obstruction in 80.0% of multiple sclerosis cases. Cystometry revealed underactive detrusor function in 69.2% of the patients with spinocerebellar degeneration but no abnormalities in the patients with Parkinson's disease or multiple sclerosis. Of 34 patients, excluding one patient lost to follow-up, the period of urological management ranged from one to 44 weeks with a mean of 11.0. The final methods of urinary drainage in 34 patients consisted of voluntary voiding in 20, clean intermittent catheterization in 11 including eight by self catheterization, incontinence into diaper in two, and indwelling catheter in one. Five patients were compelled to change urinary drainage method from voluntary voiding to clean intermittent catheterization because of increasing residual volume in four and progressing bladder deformity in one. However, none of them showed the clinical signs of primary disease progression. These findings indicate that in patients with Parkinson's disease, multiple sclerosis, and spinocerebellar degeneration, the urological symptoms can appear even in the early stage of disease. In addition, close follow-up is important in the urological management of neurogenic bladder patients with these diseases, because the disorders of the lower urinary tract may progress regardless of the status of the primary disease.

PMID: 9436018 [PubMed - indexed for MEDLINE]

December 7, 2011

Recurrent Uncomplicated Urinary Tract Infections in Women.

Recurrent Uncomplicated Urinary Tract Infections in Women.:

Recurrent Uncomplicated Urinary Tract Infections in Women.

J Womens Health (Larchmt). 2011 Dec 2;

Authors: Nosseir SB, Lind LR, Winkler HA

Abstract

Abstract Recurrent urinary tract infections most often present with symptoms of irritative voiding. In most cases, they are caused by reinfection with a previously isolated organism. Patients with one or more symptoms of uncomplicated recurrent urinary tract infection should undergo thorough examination and screening for underlying comorbidities that increase susceptibility. When frequent reinfections, empiric treatment relapse, persistent infections, or risk factors for complicated infections are encountered, patients may benefit from urodynamics, cystoscopy, renal ultrasound, intravenous urogram, or voiding cystourethrogram to evaluate for anatomic, functional, or metabolic abnormalities affecting the urinary tract (e.g., stones, stricture, obstruction, vesicoureteral reflux, lesions, detrusor underactivity). These patients may benefit from culture-guided empiric treatment and further evaluation by urology, nephrology, or infectious disease specialists. In patients with a history of uncomplicated urinary tract infections, empiric treatment guided by local antimicrobial resistance may efficiently treat a suspected recurrence. After successful treatment of the acute infection, postcoital prophylaxis, continuous prophylaxis, or self-start empiric treatment may be selected based on frequency of recurrent infections, temporal relation to intercourse, and patient characteristics. Ancillary measures such as probiotics, cranberry products, or local estrogen replacement may also be considered. This article will review the current definition, epidemiology, pathogenesis, diagnosis, work-up, treatment, treatment side effects, and prevention of recurrent urinary tract infections in women. A suggested algorithm for evaluation and treatment based on current literature is provided.


PMID: 22136339 [PubMed - as supplied by publisher]

November 30, 2011

Neuroselective current perception threshold evaluation of bladder mucosal sensory function.

Neuroselective current perception threshold evaluation of bladder mucosal sensory function.:
Related Articles

Neuroselective current perception threshold evaluation of bladder mucosal sensory function.

Eur Urol. 2004 Jan;45(1):70-6

Authors: Ukimura O, Ushijima S, Honjo H, Iwata T, Suzuki K, Hirahara N, Okihara K, Mizutani Y, Kawauchi A, Miki T

OBJECTIVE: To evaluate human bladder mucosal sensory function by neuroselective Current Perception Threshold (CPT) measures from healthy and neuropathic bladders. METHODS: Eight healthy volunteers and 38 patients with urinary symptoms underwent conventional urodynamic tests including water-filling cystometry and ice water test. Standardized neuroselective CPT measures were obtained from the left index finger and the mucosa of the posterior bladder wall. Three different CPTs were obtained from each test site using a constant alternating current sinusoid waveform electrical stimulus presented at 2000Hz, 250Hz and 5Hz stimulation frequencies, which could selectively reflect the functions of the large myelinated fibers (A-beta-fiber), the small myelinated fibers (A-delta-fiber), and the unmyelinated fibers (C-fiber), respectively. RESULTS: As the determination of CPT values on the finger skin, the CPT values in the bladder could be determined using the neuroselective measures in all patients but three who had no sensory response (absence of sensation) caused by complete spinal injury. In the 8 patients with detrusor hyperreflexia due to incomplete spinal cord injury (supra-sacral lesion), the bladder CPT value (4.0+/-1.9) at 5Hz was significantly lower (p<0.01) than that in the controls (26.2+/-17.7). In the neurogenic bladders determined to be underactive (n=11, including post pelvic surgery, post infra-sacral level spinal cord injury and diabetes patients), the higher CPT values of bladder mucosal sensory functions were found at 5Hz (p<0.05), 250Hz (p=0.07), and 2000Hz (p<0.05) compared to the controls. CONCLUSIONS: Quantitative neuroselective measurement of CPT values in the human bladder mucosal function was feasible. Hypersensitivity or hyposensitivity of the urinary sensory function could be determined using the CPT values in comparison to control. The quantitative neuroselective estimation of the bladder sensory functions in different types of sensory peripheral nerve fibers may contribute to the appropriate selection of therapeutic strategy in patients with urinary sensory dysfunction.

PMID: 14667519 [PubMed - indexed for MEDLINE]

November 26, 2011

[A case of acute distigmine bromide intoxication in the therapeutic dosage for treatment of underactive neurogenic bladder]

[A case of acute distigmine bromide intoxication in the therapeutic dosage for treatment of underactive neurogenic bladder]:
Related Articles

[A case of acute distigmine bromide intoxication in the therapeutic dosage for treatment of underactive neurogenic bladder]

No To Shinkei. 2004 May;56(5):415-9

Authors: Tada M, Fujita N, Umeda M, Koike H, Nagai H

Distigmine bromide (Ubretid) is a long-acting anti-cholinesterase, widely used for the treatment of underactive neurogenic bladder and myasthenia gravis. Our study concerns a 73-year-old man treated with a potentially life-threatening cholinergic state due to distigmine bromide. He had been administered distigmine bromide orally for over two years at a daily dosage of 10 mg as a treatment for underactive neurogenic bladder. He suddenly developed diarrhea and consciousness disturbance during treatment of his urinary tract infection. Bradycardia and miosis were noted. Blood examination revealed extremely low levels of the plasma cholinesterase activity. The condition was diagnosed as distigmine bromide intoxication. All cholinergic symptoms disappeared in several days after the administration of distigmine bromide was terminated. Cholinergic crisis due to overdosage with anticholinesterases is well known, and the myasthenic patients are usually supervised in the early stages of dosage regulation to guard against the possibility of cholinergic crisis. However the use of oral distigmine bromide, even in therapeutic doses for urinary retention, could result in cholinergic crisis. We therefore conclude that extreme caution must be used in administering distigmine bromide.

PMID: 15279199 [PubMed - indexed for MEDLINE]

November 11, 2011

Twenty-seven years of complication-free life with clean intermittent self-catheterization in a patient with spinal cord injury: A case report.

Twenty-seven years of complication-free life with clean intermittent self-catheterization in a patient with spinal cord injury: A case report.:
Related Articles

Twenty-seven years of complication-free life with clean intermittent self-catheterization in a patient with spinal cord injury: A case report.

Arch Phys Med Rehabil. 2004 Oct;85(10):1705-7

Authors: Mizuno K, Tsuji T, Kimura A, Liu M, Masakado Y, Chino N

Currently, clean intermittent self-catheterization (CISC) is the most prevalent method of bladder management in patients with spinal cord injury (SCI) at discharge from rehabilitation centers. However, half of the patients discontinue using CISC and change to other methods of bladder management several months postdischarge despite the fact that it the best way to prevent urinary tract complications. Few studies, however, report the long-term consequences of CISC. In this case, we present a woman in her early fifties who had sustained thoracic SCI and had continued using CISC for 27 years without developing any complications. The possible reasons for her success were absence of incontinence because of underactive and normal capacity bladder; normal upper-extremity functions and absence of marked spasticity of lower extremities that facilitated CISC technique; and absence of sociovocational problems, enabling her to keep proper intervals between catheterizations each day. This case indicates that CISC is useful for long-term bladder management in patients with SCI, even for 25 years or more. Long-term outcomes of CISC and factors leading to success need to be delineated in future studies with larger samples.

PMID: 15468034 [PubMed - indexed for MEDLINE]

November 3, 2011

Core lower urinary tract symptom score (CLSS) for the assessment of female lower urinary tract symptoms: A comparative study.

Core lower urinary tract symptom score (CLSS) for the assessment of female lower urinary tract symptoms: A comparative study.:

Core lower urinary tract symptom score (CLSS) for the assessment of female lower urinary tract symptoms: A comparative study.

Int J Urol. 2011 Sep 23;

Authors: Fujimura T, Kume H, Tsurumaki Y, Yoshimura Y, Hosoda C, Suzuki M, Fukuhara H, Enomoto Y, Nishimatsu H, Homma Y

Abstract

Objective:  We have recently developed the core lower urinary tract symptom score (CLSS) questionnaire to readily address 10 important lower urinary tract symptoms (LUTS). The aim of the present study was to evaluate the performance of the CLSS in women compared with the International Prostate Symptom Score (IPSS) and Overactive Bladder Symptom Score (OABSS). Methods:  Three hundred and eighteen treatment-naïve consecutive female patients, including 48 controls, completed the three questionnaires. Quality of life (QOL) was determined as per the IPSS QOL Index. The clinical diagnoses were overactive bladder (n = 69), mixed incontinence (n = 42), stress incontinence (n = 17), pelvic organ prolapse (n = 56), interstitial cystitis (n = 31), bacterial cystitis (n = 16), underactive bladder (n = 16), and "other" (n = 23). Simple statistics and the relationship between symptom scores and poor QOL (QOL Index ≥4) were examined. Results:  All symptom scores were significantly increased in symptomatic women. The CLSS described the symptom profiles of patients with distinct conditions. The scores of corresponding symptoms on the three questionnaires were significantly correlated (r = 0.51-0.85; all P < 0.0001). Multivariate logistic regression modeling proved five CLSS symptoms (daytime frequency, nocturia, urgency incontinence, straining, and urethral pain) as independent predictors of poor QOL, with hazard ratios ranging from 2.0 to 4.2. The IPSS included only two (urgency and straining) significant symptoms. Conclusions:  The IPSS alone does not fully evaluate female LUTS, with a possible negative impact on QOL. Using the CLSS questionnaire would enable a simple and comprehensive assessment of female LUTS.


PMID: 21951201 [PubMed - as supplied by publisher]

September 29, 2011

Quantifying the effect of urodynamic catheters on urine flow rate measurement.

Quantifying the effect of urodynamic catheters on urine flow rate measurement.:

Quantifying the effect of urodynamic catheters on urine flow rate measurement.

Neurourol Urodyn. 2011 Sep 26;

Authors: Harding C, Horsburgh B, Dorkin TJ, Thorpe AC

Abstract

INTRODUCTION: The effect of urodynamic catheters on urine flow rate (Q(max) ) is well documented but under-researched. Several studies show reduced Q(max) but methodologies and patient demographics differ. The aims of this study were to further quantify the effect of urodynamic catheters on Q(max) and to explore if this was consistent across different urodynamic diagnoses. METHODS: Four groups of 50 consecutive men attending for urodynamic studies (UDS) were retrospectively analyzed: Group 1 comprised 50 men with normal UDS, Group 2 was 50 men with BOO, and Group 3 contained 50 men with detrusor underactivity. Groups 1-3 had UDS performed using both 10 Fr filling and 4 Fr measuring catheters in situ. Group 4 comprised 50 men who had UDS performed with a smaller catheter assembly (8 Fr dual-lumen). Values of Q(max) with and without catheters present were compared using paired Student's t-tests. Differences between groups were compared using ANOVA. RESULTS: Q(max) measured during UDS in men from Groups 1-3 showed a mean reduction of 38% compared to Q(max) from "free" uroflowmetry. ANOVA indicated this reduction was significantly greater among men with normal UDS. Interestingly the group who underwent UDS with a smaller catheter assembly showed no significant reduction in Q(max) measured with catheters in situ. CONCLUSION: Our findings are in line with previous work suggesting that smaller calibre urethral catheters do not cause a significant obstructive effect during voiding. In addition it would appear that the reduction in Q(max) with larger urethral catheters in situ is greatest in those with normal urodynamics. Neurourol. Urodynam. © 2011 Wiley-Liss, Inc.


PMID: 21953734 [PubMed - as supplied by publisher]

September 25, 2011

Natural history of detrusor contractility--minimum ten-year urodynamic follow-up in men with bladder outlet obstruction and those with detrusor.

Natural history of detrusor contractility--minimum ten-year urodynamic follow-up in men with bladder outlet obstruction and those with detrusor.:
Related Articles

Natural history of detrusor contractility--minimum ten-year urodynamic follow-up in men with bladder outlet obstruction and those with detrusor.

Scand J Urol Nephrol Suppl. 2004;(215):101-8

Authors: Al-Hayek S, Thomas A, Abrams P

OBJECTIVE: To check the long-term effect, in male patients, of treated and untreated bladder outlet obstruction (BOO) on detrusor contractility and to explore the relationship between ageing and detrusor underactivity (DUA). MATERIAL AND METHODS: Men investigated at the urodynamic department of Southmead Hospital in Bristol between 1972 and 1986 were traced and three groups were invited for repeat pressure-flow urodynamic studies (PFS). The first two groups included patients over 40 years old, with untreated or surgically treated BOO, and the third group had patients with DUA from all age groups. RESULTS: 196 patients (with a minimum 10 year gap from the first assessment) agreed to have repeat PFS. There was no statistically significant change in bladder contractility index (BCI) in patients with BOO treated by transurethral resection of the prostate (TURP) (mean difference in BCI was 0.01, 95% confidence interval -0.07 to 0.09, n=114). There was also no significant difference in BCI in untreated patients with BOO (p=0.10, n=53). The follow-up BCI was higher in untreated patients than in the surgically treated group. The BCI in patients with DUA did not change significantly after a minimum of 10 years' follow-up. CONCLUSIONS: There is no evidence to suggest that detrusor contractility declines with long-term BOO. Relieving the obstruction surgically does not improve the contractility. This is important when considering and counselling for TURP. Underactive detrusors remain underactive, but do not get worse with time, which could indicate that this is not an ageing process per se and may even have a congenital basis.

PMID: 15545204 [PubMed - indexed for MEDLINE]

September 16, 2011

Assessment of lower urinary tract symptoms in men by international prostate symptom score and core lower urinary tract symptom score.

Assessment of lower urinary tract symptoms in men by international prostate symptom score and core lower urinary tract symptom score.:

Assessment of lower urinary tract symptoms in men by international prostate symptom score and core lower urinary tract symptom score.

BJU Int. 2011 Aug 26;

Authors: Fujimura T, Kume H, Nishimatsu H, Sugihara T, Nomiya A, Tsurumaki Y, Miyazaki H, Suzuki M, Fukuhara H, Enomoto Y, Homma Y

Abstract

Study Type - Therapy (symptom prevalence) Level of Evidence 2a What's known on the subject? and What does the study add? The International Prostate Symptom Score (IPSS) has been most commonly used for the symptom assessment of men with lower urinary tract symptoms (LUTS). However, LUTS in men are so variable that they may not be fully captured by the IPSS questionnaire alone. This study has demonstrated that the Care Lower Urinary Tract Symptom Score (CLSS) questionnaire, which addresses 10 important symptoms, is an appropriate initial assessment tool for LUTS in men with various diseases/conditions. OBJECTIVE: • International Prostate Symptom Score (IPSS) has been commonly used to assess lower urinary tract symptoms (LUTS). We have recently developed Core Lower Urinary Tract Symptom Score (CLSS). The aim of this study is to compare IPSS and CLSS for assessing LUTS in men. PATIENTS AND METHODS: • Consecutive 515 men fulfilled IPSS and CLSS questionnaires. • IPSS QOL Index was used as the QOL surrogate. • The clinical diagnoses were BPH (n = 116), BPH with OAB wet (n = 80), prostate cancer (n = 128), prostatitis (n = 68), underactive bladder (n = 8), others (n = 72), and controls (e.g., occult blood) (n = 42). • Simple statistics and predictability of poor QOL (QOL Index 4 or greater) were examined. RESULTS: • All symptom scores were significantly increased in symptomatic men compared with controls. Scores of corresponding symptoms of two questionnaires were significantly correlated (r = 0.58-0.85, all P < 0.0001). • A multivariate regression model to predict poor QOL indicated nine symptoms (daytime frequency, nocturia, urgency, urgency incontinence, slow stream, straining, incomplete emptying, bladder pain and urethral pain) as independent factors. • The hazard ratios for bladder pain (2.2) and urgency incontinence (2.0) were among the highest. • All the nine symptoms are addressed in CLSS, while three symptoms (urgency incontinence, bladder, and urethral pain) are dismissed in IPSS. CONCLUSION: • CLSS questionnaire is more comprehensive than IPSS questionnaire for symptom assessment of men with various diseases/conditions, although both questionnaires can capture LUTS with possible negative impact on QOL.


PMID: 21883834 [PubMed - as supplied by publisher]

September 13, 2011

Detrusor contraction duration and strength in the patients with benign prostatic enlargement.

Detrusor contraction duration and strength in the patients with benign prostatic enlargement.: "
Related Articles

Detrusor contraction duration and strength in the patients with benign prostatic enlargement.

Bosn J Basic Med Sci. 2004 Feb;4(1):29-33

Authors: Aganović D, Prcić A

OBJECTIVE: examine detrusor contraction duration (DCD) in relation with obstruction grade and strength of detrusor contractility; analyze individual correlations of this parameter with urodynamic, physiological and symptoms variables in patients with benign prostatic enlargement (BPE). SAMPLE AND METHODOLOGY: 102 patients with proved BPE, underwent complete urodynamic measurements (UDM), namely uroflowmetry, cystometry and pressure/flow studies. Postvoid residual urine (PVR) was measured and the International Prostate Symptom Score (I-PSS) was fulfilled by each patient. Methodology of measurement and definitions of UDM are based on definitions and terminology defined by the International Continence Society. RESULTS: After grouping the patients (average age 64,7+/-8,5) related to obstruction grades according to the Schafer nomogram, ANOVA has shown a group extension of the detrusor contraction duration related to higher levels of obstruction (LinPURR 0-VI; p<0,01), which is also followed by stronger detrusor contractility (Pdetmax; p<0,001). Dichotomizing of the patients with DCD cut off point 90 sec. has shown that 67% patients with underactive detrusor have DCD>90 sec, while extension of DCD and increase of the obstruction level are directly related to preserved detrusor contractility only in 20,5% cases. There is neither statistically significant difference of DCD in the patients that are not in obstruction allocated in two groups depending on detrusor contraction strength, (t=1.2, p>0.05); nor in the patients who are in obstruction range, divided on the same way (t=0.568, p>0.05). There is also no difference of the same patients groups regarding PVR (t=1.38 and t=1.17, p>0.05). Individual correlation of DCD with I-PSS has not been shown (r=0.16, p>0.05), although there is a statistically significant correlation with its obstructive subset (r=0.20, p<0.05), as well as, with LinPUR and URA nomograms (r=0.33, r=0.29; respectively, p<0.005) and with Pdetmax (r=0.26, p<0.01), PdetQmax (r=0.24, p<0.05), Qmax and Qaver (r=0.31, p<0.005). DCD does not have individual correlations with patients' age, prostate volume and with cystometric capacity. CONCLUSION: DCD is rather independent urodynamical variable, which does not correlate with I-PSS. Generally, DCD is prolonged during obstruction, while extension of DCD only partially depends on detrusor contraction strength. Practically, individual correlations of DCD with the urodynamic factors, which characterize obstructions, are modest.

PMID: 15628977 [PubMed - indexed for MEDLINE]
"

August 12, 2011

Urologic dysfunction and neurologic outcome in coma survivors after severe traumatic brain injury in the postacute and chronic phase.

Urologic dysfunction and neurologic outcome in coma survivors after severe traumatic brain injury in the postacute and chronic phase.: "


Urologic dysfunction and neurologic outcome in coma survivors after severe traumatic brain injury in the postacute and chronic phase.

Arch Phys Med Rehabil. 2011 Jul;92(7):1134-8

Authors: Giannantoni A, Silvestro D, Siracusano S, Azicnuda E, D'Ippolito M, Rigon J, Sabatini U, Bini V, Formisano R

Giannantoni A, Silvestro D, Siracusano S, Azicnuda E, D'Ippolito M, Rigon J, Sabatini U, Bini V, Formisano R. Urologic dysfunction and neurologic outcome in coma survivors after severe traumatic brain injury in the postacute and chronic phase.

PMID: 21704794 [PubMed - in process]
"

July 26, 2011

Urodynamic findings in young men with chronic lower urinary tract symptoms.

Urodynamic findings in young men with chronic lower urinary tract symptoms.: "


Urodynamic findings in young men with chronic lower urinary tract symptoms.

Neurourol Urodyn. 2011 Jul 20;

Authors: Karami H, Valipour R, Lotfi B, Mokhtarpour H, Razi A

AIM: To assess frequency of urodynamic abnormalities in young men with chronic lower urinary tract symptoms (LUTS). MATERIALS AND METHODS: We assessed 456 men (18-40 years old) with chronic LUTS. Those with the history of urogenital malignancies, neurological disease, urethral stricture or trauma, acute UTI, congenital urological disease, and diabetes mellitus were excluded. Patients were classified by special urodynamic diagnosis. RESULTS: Mean patient age was 25.8 ± 5.9 years old and the mean symptom duration was 12.3 ± 3.2 months. Urodynamic studies showed bladder neck dysfunction in 96 of cases (21%), dysfunctional voiding in 69 (15.1%), detrusor overactivity in 62 (13.6%), small cystometric capacity in 49 (10.7%), and acontractile detrusor in 48 (10.5%), underactive detrusor in 11 (2.4%), low compliance in 18 (3.9%), detrusor overactivity plus acontractile detrusor in 6 (1.3%), low compliance plus small cystometric capacity in 5 (1.0%), detrusor overactivity plus small cystometric capacity together with low compliance in 4 (0.8%), low compliance plus Underactive detrusor in 3 (0.6%) and normal urodynamics in 85 (18.6%). Mean Q(max) in patients with bladder neck dysfunction, dysfunctional voiding, underactive detrusor, acontractile detrusor, underactive detrusor plus low compliance, and acontractile detrusor plus detrusor overactivity were lower than those of the other groups. Mean postvoid residues in patients with underactive detrusor, and underactive detrusor plus low compliance, were higher than those in the remaining groups. Positive four-glass test in patient with normal urodynamic was greater than those in the remaining groups. CONCLUSION: A few clinical symptoms or noninvasive tests were useful in young men with chronic LUTS; hence, urodynamics are advised to make the correct diagnosis in this regard. Neurourol. Urodynam. © 2011 Wiley-Liss, Inc.

PMID: 21780163 [PubMed - as supplied by publisher]
"

Urinary dysfunction in early and untreated Parkinson's disease.

Urinary dysfunction in early and untreated Parkinson's disease.: "


Urinary dysfunction in early and untreated Parkinson's disease.

J Neurol Neurosurg Psychiatry. 2011 Jun 13;

Authors: Uchiyama T, Sakakibara R, Yamamoto T, Ito T, Yamaguchi C, Awa Y, Yanagisawa M, Higuchi Y, Sato Y, Ichikawa T, Yamanishi T, Hattori T, Kuwabara S

Background Urinary dysfunction is common in Parkinson's disease (PD); however, little is known about urinary dysfunction in early and untreated PD patients. Methods Fifty consecutive untreated PD patients (mean age, 66.7; mean disease duration, 23.6&emsp14;months; and mean Hoehn & Yahr scale, 1.9) were recruited; those with other conditions that might have influenced urinary function were excluded. Patients were evaluated using a urinary questionnaire and urodynamic studies. Results Sixty-four per cent complained of urinary symptoms (storage, 64.0%; voiding, 28.0%). Urodynamic studies showed abnormal findings in the storage phase in 84%, with detrusor overactivity (DO) and increased bladder sensation without DO in 58.0% and 12.0% of patients, respectively. In the voiding phase, detrusor underactivity, impaired urethral relaxation such as detrusor sphincter dyssynergia, and bladder outlet obstruction were present in 50.0%, 8.0% and 16% of patients, respectively. In patients with both storage and voiding phase abnormalities, DO+detrusor underactivity was the most common finding. Few patients experienced urge incontinence and/or quality-of-life impairment owing to urinary dysfunction; none had low-compliance bladder or abnormal anal-sphincter motor unit potential. These urinary symptoms and urodynamic findings were not correlated with gender, disease severity or motor symptom type. Conclusion Urinary dysfunction, manifested primarily as storage disorders with subclinical voiding disorders and normal anal-sphincter electromyography, occurs in early and untreated PD patients. In cases with severe voiding disorder and/or abnormal anal-sphincter electromyography, other diagnoses should be considered.

PMID: 21670077 [PubMed - as supplied by publisher]
"

Detrusor underactivity: A plea for new approaches to a common bladder dysfunction.

Detrusor underactivity: A plea for new approaches to a common bladder dysfunction.: "


Detrusor underactivity: A plea for new approaches to a common bladder dysfunction.

Neurourol Urodyn. 2011 Jun;30(5):723-8

Authors: van Koeveringe GA, Vahabi B, Andersson KE, Kirschner-Herrmans R, Oelke M

Detrusor underactivity (DU) is defined by the International Continence Society as a contraction of reduced strength and/or duration resulting in prolonged or incomplete emptying of the bladder but has yet received only little attention. The purpose of this report is to summarize the ICI-RS meeting in Bristol in 2010 exploring current knowledge on DU and outline directions for future research.

PMID: 21661020 [PubMed - in process]
"

June 15, 2011

Urodynamic Parameters Development and Complications of Clean Intermittent Self-Catheterization in Chinese Schoolchildren with Neurogenic Underactive Bladder.

Urodynamic Parameters Development and Complications of Clean Intermittent Self-Catheterization in Chinese Schoolchildren with Neurogenic Underactive Bladder.: "


Urodynamic Parameters Development and Complications of Clean Intermittent Self-Catheterization in Chinese Schoolchildren with Neurogenic Underactive Bladder.

Urol Int. 2011 May 10;

Authors: Wang QW, Song DK, Zhang XP, Wu YD, Zhang RL, Wei JX, Wen JG

Objective: To evaluate the urodynamic parameters, development of bladder function and complications of clean intermittent self-catheterization (CIC) in Chinese schoolchildren with neurogenic underactive bladder. Methods: Ninety-three children with neurogenic underactive bladder were successfully treated with CIC or combined with oxybutynin for two years follow-up. According to bladder compliance before CIC, they were subdivided into a normal bladder compliance (NBC) group and a low bladder compliance (LBC) group. Urodynamic parameters and complications were recorded. Results: At follow-up, the incidence of neurogenic detrusor overactivity was found to have significantly decreased in both groups. Moreover, maximum cystometric capacity (CC) and relatively safe CC in the NBC group was significantly higher than those before CIC. However, relatively safe CC was significantly lower than that before CIC, and detrusor leakage point pressure was significantly higher than that before CIC in the LBC group. The incidences of bacteriuria, vesicureteral reflux (VUR), febrile urinary tract infections (UTI) and macroscopic hematuria were, respectively, 62, 13, 25 and 15%, and those of VUR and febrile UTI in the LBC group were significantly higher than those in the NBC group. Conclusion: For these cases, the complications of CIC are rare, and bladder compliance seems to be correlated with the development of bladder function and complications during CIC.

PMID: 21555862 [PubMed - as supplied by publisher]
"

May 25, 2011

Urological outcome after myelomeningocele: 20 years of follow-up.

Urological outcome after myelomeningocele: 20 years of follow-up.: "


Urological outcome after myelomeningocele: 20 years of follow-up.

BJU Int. 2011 Mar;107(6):994-9

Authors: Thorup J, Biering-Sorensen F, Cortes D

• To evaluate the urological outcome in a long-term follow-up of individuals with myelomeningocele and relate the findings obtained to urodynamic variables in childhood.

PMID: 20860652 [PubMed - indexed for MEDLINE]
"

May 11, 2011

Detrusor Arreflexia as an End Stage of Neurogenic Bladder in HAM/TSP?

Detrusor Arreflexia as an End Stage of Neurogenic Bladder in HAM/TSP?: "


Detrusor Arreflexia as an End Stage of Neurogenic Bladder in HAM/TSP?

Case Report Med. 2011;2011:289389

Authors: Tannus M, Tanajura D, Sundberg MA, Oliveira P, Castro N, Santos AM

The HTLV-1 virus is a known agent involved in the development of HAM/TSP. Past studies have typically observed patients with autonomic dysfunction consisting of detrusor overactivity and detrusor-sphincter dyssynergia, with the occasional observation of underactive detrusor or detrusor arreflexia. However, studies have not yet evaluated the progression of neurogenic bladder over time. In this paper, we describe a HAM/TSP patient with the initial development of overactive detrusor, and subsequent development of detrusor arreflexia. Given a paucity of studies characterizing the effects of HTLV-1 on the autonomic nervous system, particularly aspects controlling continence, this patient's clinical course may represent one type of end point for patients with HAM/TSP and neurogenic bladder. Further cohort or case-series studies, with particular emphasis on the progression of neurogenic bladder, are needed to evaluate the significance of this described case in relation to typical disease progression patterns.

PMID: 21541226 [PubMed - in process]
"

May 5, 2011

Acute urinary retention in a 23-year-old woman with mild encephalopathy with a reversible splenial lesion: a case report.

Acute urinary retention in a 23-year-old woman with mild encephalopathy with a reversible splenial lesion: a case report.: "


Acute urinary retention in a 23-year-old woman with mild encephalopathy with a reversible splenial lesion: a case report.

J Med Case Reports. 2011 Apr 20;5(1):159

Authors: Kitami M, Kubo SI, Nakamura S, Shiozawa S, Isobe H, Furukawa Y

ABSTRACT: INTRODUCTION: Patients with clinically mild encephalitis/encephalopathy with a reversible splenial lesion present with relatively mild central nervous system disturbances. Although the exact etiology of the condition remains poorly understood, it is thought to be associated with infective agents. We present a case of a patient with mild encephalitis/encephalopathy with a reversible splenial lesion, who had the unusual feature of acute urinary retention. Case presentation A 23-year-old Japanese woman developed mild confusion, gait ataxia, and urinary retention seven days after onset of fever and headache. Magnetic resonance imaging demonstrated T2 prolongation in the splenium of the corpus callosum and bilateral cerebral white matter. These magnetic resonance imaging abnormalities disappeared two weeks later, and all of the symptoms resolved completely within four weeks. Except for the presence of acute urinary retention (due to underactive detrusor without hyper-reflexia), the clinical and radiologic features of our patient were consistent with those of previously reported patients with mild encephalitis/encephalopathy with a reversible splenial lesion. To the best of our knowledge, this is the first report of acute urinary retention recognized in a patient with mild encephalitis/encephalopathy with a reversible splenial lesion. Conclusion Our findings suggest that mild encephalitis/encephalopathy with a reversible splenial lesion can be associated with impaired bladder function and indicate that acute urinary retention in this benign disorder should be treated immediately to avoid bladder injury.

PMID: 21507219 [PubMed - as supplied by publisher]
"

April 22, 2011

Two screening tests for urinary voiding dysfunction used in 209 consecutive patients undergoing lumbar spine operations.

Two screening tests for urinary voiding dysfunction used in 209 consecutive patients undergoing lumbar spine operations.: "
Related Articles

Two screening tests for urinary voiding dysfunction used in 209 consecutive patients undergoing lumbar spine operations.

Scand J Urol Nephrol. 2010 Mar;44(2):106-12

Authors: Orlin JR, Klevmark B, Bjørnsen L, Hermansen P, Sanchez M

OBJECTIVE: A study of the prevalence of urinary voiding dysfunction was carried out preoperatively in 209 patients undergoing lumbar spine operations, using two non-invasive screening tests: free uroflowmetry and ultrasound measurement of residual urine. The value of using the two urodynamic screening tests in the evaluation of a larger group of patients with sciatica from disc lesions or spinal stenosis has not been published as an article before. MATERIAL AND METHODS: In 209 consecutive patients, 159 with lumbar disc lesions and 50 with lumbar spinal stenosis, the main indications for operative treatment were pain and/or somatic paresis. In preoperative interviews, information about voiding, anal and sexual functions were obtained. Then uroflowmetry was performed and the volume of residual urine was measured. In this study, the definition of normal bladder function is based on normal flow rates, the shape of the curves, normal voided volumes and the absence of significant residual urine. Bladder dysfunction differs from normal function by one, two, three or all four of these parameters. RESULTS: Normal bladder function was found in 66 patients (31.6%). The other 143 (68.4%) had signs that could indicate sensory paresis and/or neurogenic detrusor underactivity. Seventy-nine of the 143 were also tested 3 months postoperatively. In 58% the bladder function had improved. CONCLUSIONS: The very high prevalence of abnormal uroflowmetry and/or postvoiding residual urine suggestive of possible bladder dysfunction (68.4%) indicates that the two tests should be used routinely in cases of lumbar disc lesions and spinal stenosis. The two tests provide documentation of preoperative voiding function and a possibility of comparison with postoperative findings.

PMID: 20095869 [PubMed - in process]
"

April 21, 2011

Lower urinary tract function in patients with pituitary adenoma compressing hypothalamus.

Lower urinary tract function in patients with pituitary adenoma compressing hypothalamus.: "
Related Articles

Lower urinary tract function in patients with pituitary adenoma compressing hypothalamus.

J Neurol Neurosurg Psychiatry. 2005 Mar;76(3):390-4

Authors: Yamamoto T, Sakakibara R, Uchiyama T, Liu Z, Ito T, Yamanishi T, Hattori T

BACKGROUND: The micturition reflex is under the tonic influence of suprapontine structures including the anteromedial frontal cortex, basal ganglia, and hypothalamus. However, there have been few reports about the role of the hypothalamus on the lower urinary tract (LUT) function in humans. OBJECTIVE: To investigate LUT function in patients with pituitary adenomas. METHODS: Urodynamic studies were carried out in three patients with LUT symptoms who had pituitary adenomas extending upwards to the hypothalamus. RESULTS: All three male patients (age 28 to 62 years) developed LUT symptoms (urinary urgency and frequency (3); urinary incontinence (3); voiding difficulty and retention (2)) along with weight loss, psychiatric symptoms, unsteady gait, and/or visual disturbances. One had the syndrome of inappropriate secretion of antidiuretic hormone, but none had diabetes insipidus. Two had resection of the tumour and subsequent radiation therapy, but LUT dysfunction persisted. The third patient had partial resection of the tumour to ameliorate hydrocephalus. Urodynamic studies showed detrusor overactivity during the storage phase in all patients; during the voiding phase there was underactive detrusor in two and non-relaxing sphincter in one. CONCLUSIONS: Hypothalamic lesions can cause severe LUT dysfunction in both the storage and voiding phases of micturition. This may reflect the crucial role of the hypothalamus in regulating micturition in humans.

PMID: 15716534 [PubMed - indexed for MEDLINE]
"

April 1, 2011

Sacral neuromodulation in patients with multiple sclerosis.

Sacral neuromodulation in patients with multiple sclerosis.: "


Sacral neuromodulation in patients with multiple sclerosis.

World J Urol. 2011 Mar 15;

Authors: Minardi D, Muzzonigro G

PURPOSE: We present a case series of patients with multiple sclerosis (MS) and neurogenic lower urinary tract dysfunction treated by sacral neuromodulation (SNM). METHODS: We reviewed charts of 25 patients who were treated for refractory lower urinary tract symptoms; during the SNM testing phase, patient management included evaluation of number of daily voiding, number of episodes of incontinence, residual urine and quality of life score. Patients who experienced greater than 50% improvement in symptoms of frequency and incontinence episodes and/or a greater than 50% decrease in the number of catheterizations and a greater than 50% increase in voided volumes were offered placement of the permanent InterStim(TM) . RESULTS: Fifteen patients were implanted with InterStim(TM); mean duration of MS was 13.66 years; mean follow-up of patients was 49.4 months. Nine patients were on clean intermittent catheterization, and in all of them, a significant decrease in residual volume with increase in voided volume and number of voiding per day; in 6 patients, the main problem was incontinence, and in them incontinence, episodes decreased and voided volume increased. Sixty-six per cent of patients have a functioning device after a mean follow-up of 61.2 months. CONCLUSIONS: SNM is a good option in the treatment of voiding dysfunction in patients with MS in a medium to long-term follow-up. Urinary retention due to detrusor underactivity is not a good indication for SNM; it should be offered to MS patients with refractory urgency urinary incontinence and MS patients with urinary retention due to detrusor-sphincter dyssynergia (DSD).

PMID: 21400258 [PubMed - as supplied by publisher]
"

March 24, 2011

Idiopathic Parkinson's disease patients at the urologic clinic.

Idiopathic Parkinson's disease patients at the urologic clinic.: "


Idiopathic Parkinson's disease patients at the urologic clinic.

Neurourol Urodyn. 2011 Mar 14;

Authors: Ragab MM, Mohammed ES

AIMS: To quantitatively evaluate the urinary symptoms at different stages of idiopathic Parkinson's disease (IPD) severity and its relation to urodynamic parameters. METHODS: This study was conducted on 49 patients with probable IPD to quantitatively evaluate their urinary symptoms using International Prostate Symptom Score and urodynamic tests. Four, 10, 29, 5, and 1 cases were classified as stages 1-5, respectively, according to Hoehn and Yahr staging of IPD severity. RESULTS: The most prevailing urinary symptom in IPD was nocturia (77.5%) followed by urgency (36.7%) and frequency (32.6%). Urodynamic tests revealed neurogenic detrusor overactivity in 33 patients (67.3%), detrusor underactivity in 6 patients (12.2%), and 10 (20.4%) patients with normal detrusor function. Irritative symptom index score correlated significantly with disease severity as well as the volume at initial desire to void and maximum bladder capacity meanwhile obstructive symptom index score had no significant correlation with any of the urodynamic parameters or disease severity. Total IPSS symptoms score significantly correlated with quality of life score. The mean of urodynamic parameters did not differ in IPD patients who did or did not receive anticholinergic or dopaminergic drugs. CONCLUSION: The irritative urinary symptoms manifested urodynamically as neurogenic detrusor overactivity are more common in IPD patients than obstructive symptoms. These irritative symptoms deteriorate progressively with the disease severity and significantly affect the quality of life of these patients. The International Prostate Symptom Score is a valuable tool in evaluating the urinary dysfunction in such patients. © 2011 Wiley-Liss, Inc.

PMID: 21404318 [PubMed - as supplied by publisher]
"

March 16, 2011

Is lumbar spondylosis a cause of urinary retention in elderly women?

Is lumbar spondylosis a cause of urinary retention in elderly women?: "
Related Articles

Is lumbar spondylosis a cause of urinary retention in elderly women?

J Neurol. 2005 Aug;252(8):953-7

Authors: Sakakibara R, Yamamoto T, Uchiyama T, Liu Z, Ito T, Yamazaki M, Awa Y, Yamanishi T, Hattori T

OBJECTIVES: Lumbar spondylosis (LS) is a common spinal degenerative disorder which causes various types of lower urinary tract dysfunction (LUTD). However, it is not certain whether LS may cause urinary retention in elderly women. METHODS: In a period covering the past 3 years, we retrospectively reviewed: a) urodynamic case records of women with urinary retention (post-void residuals, PVR > 100 ml), b) the records of women with LUTD due to LS (cauda equina syndrome and spinal canal narrowing by MRI), and c) uro-neurological features of women who belonged to both a) and b). RESULTS: a) One-hundred women with a mean age of 58 years had urinary retention. The most common underlying disease was multiple system atrophy [19], followed by multiple sclerosis [13] and cervical/thoracic tumours [8]. LS was the fourth most common [5], with the highest age (71 years) of all diseases. b) Nineteen women with LUTD had LS (12, canal narrowing of 50-70%; 7 > 70 %), with a mean PVR volume of 60 ml. A fourth [5] of them had urinary retention, with severe spinal canal narrowing (all 5 > 70%). c) Thus, 5 women belonged to both a) and b). In 4 of these women, LUTD followed or occurred together with typical cauda equina syndrome symptoms such as sciatica and saddle anesthesia. However, one elderly woman presented with painless urinary retention, and absent ankle reflexes were the sole neurological abnormality. The urodynamic abnormalities underlying urinary retention included an underactive detrusor in all 5, bladder sensory impairment in 3, an unrelaxing sphincter in 2, a low compliance detrusor in one, neurogenic sphincter motor unit potentials in 2 of 4 studied, and cholinergic supersensitivity of the detrusor in one of 3 studied. Surgical decompression ameliorated urinary retention in 1 of 2 women who had surgery. CONCLUSIONS: In our series, only 5 percent of the women with urinary retention had LS, but LS poses a potential risk for retention, particularly in elderly women with severe spinal canal narrowing. Preganglionic somato-autonomic dysfunctions underlie this condition. It may appear as the sole initial complaint in cases in which no other obvious neurological abnormalities are found.

PMID: 15778810 [PubMed - indexed for MEDLINE]
"

March 10, 2011

Urodynamics in women from menopause to oldest age: What motive? What diagnosis?

Urodynamics in women from menopause to oldest age: What motive? What diagnosis?: "


Urodynamics in women from menopause to oldest age: What motive? What diagnosis?

Int Braz J Urol. 2011 Jan-Feb;37(1):100-7

Authors: Valentini FA, Robain G, Marti BG

Purpose: To analyze age-associated changes as a motive for urodynamics and urodynamic diagnosis in community-dwelling menopausal women and to discuss the role of menopause and ageing. Materials and Methods: Four hundred and forty nine consecutive menopausal women referred for urodynamic evaluation of lower urinary tract (LUT) symptoms, met the inclusion criteria and were stratified into 3 age groups: 55-64 years (A), 65-74 years (B), and 75-93 years (C). Comprehensive assessment included previous medical history and clinical examination. Studied items were motive for urodynamics, results of uroflows (free flow and intubated flow) and cystometry, urethral pressure profilometry, and final urodynamic diagnosis. Results: The main motive was incontinence (66.3%) with significant increase of mixed incontinence in group C (p = 0.028). Detrusor function significantly deteriorated in the oldest group, mainly in absence of neurological disease (overactivity p = 0.019; impaired contractility p = 0.028). In the entire population, underactivity predominated in group C (p = 0.0024). A progressive decrease of maximum urethral closure pressure occurred with ageing. In subjects with no detrusor overactivity there was a decrease with age of detrusor pressure at opening and at maximum flow, and of maximum flow while post void residual increased only in the C group. Conclusion: In our population of community-dwelling menopausal women, incontinence was the main motive for urodynamics increasing with ageing. A brisk change in LUT function of women older than 75 years underlined deterioration in bladder function with a high incidence of detrusor hyperactivity with or without impaired contractility while change in urethral function was progressive. Effect of ageing appears to be predominant compared to menopause.

PMID: 21385486 [PubMed - in process]
"

March 7, 2011

Alteration of autonomic function in female urinary incontinence.

Alteration of autonomic function in female urinary incontinence.: "


Alteration of autonomic function in female urinary incontinence.

Int Neurourol J. 2010 Dec;14(4):232-7

Authors: Kim JC, Joo KJ, Kim JT, Choi JB, Cho DS, Won YY

Stress urinary incontinence (SUI) and urge urinary incontinence (UUI) have different mechanisms of action. We believe that alteration of autonomic nervous system (ANS) activity may contribute to UUI because the lower urinary tract is regulated through the sympathetic and parasympathetic nervous systems. Heart rate variability (HRV) allows measurement of autonomic nervous function, therefore we measured and compared HRV parameters in women with urinary incontinence.

PMID: 21253334 [PubMed - in process]
"

February 12, 2011

Ultrasound estimated bladder weight in men attending the uroflowmetry clinic.

Ultrasound estimated bladder weight in men attending the uroflowmetry clinic.: "


Ultrasound estimated bladder weight in men attending the uroflowmetry clinic.

Neurourol Urodyn. 2011 Feb 9;

Authors: Bright E, Pearcy R, Abrams P

AIMS: To determine if measurements of ultrasound estimated bladder weight (UEBW) provide an additional diagnostic tool when assessing men with lower urinary tract symptoms (LUTS) in the uroflowmetry clinic. METHODS: One hundred men with LUTS attending the uroflowmetry clinic underwent transabdominal ultrasound measurement of bladder weight, using the BVM 9500 bladder scanner (Verathon Medical, Bothell, WA). These data were explored for any correlation between measurements of maximum flow rate (Q(max) ) with UEBW, age, height, weight, body mass index (BMI), ICIQ M-LUTS score, M-LUTS voiding score, M-LUTS incontinence score, IPSS, IPSS quality of life score, voided volume, and post-void residual urine. Based on previously reported probabilities of bladder outlet obstruction (BOO), patients were grouped for analysis (Group 1 = Q(max) <10, Group 2 = Q(max) 10-15, Group 3 = Q(max) >15). A one-way ANOVA was undertaken to assess any difference in mean UEBW between the three groups. RESULTS: Statistically significant negative correlations between Q(max) and age (r = -0.308, P = 0.002), M-LUTS voiding score (r = -0.298, P = 0.003), IPSS (r = -0.295, P = 0.003), and post-void residual (r = -0.213, P = 0.033) were observed. A statistically significant positive correlation between Q(max) and voided volume (r = 0.503, P < 0.01) was observed. No association between Q(max) and UEBW was observed (r = 0.12, P = 0.243). Mean UEBW for the three groups was remarkably similar. One-way ANOVA identified there was no statistically significant effect of UEBW on Q(max) F(2, 97) = 0.175, P = 0.840. CONCLUSION: Mean UEBW did not differ significantly between the three Q(max) groups. Further work is required to investigate the relationship of Q(max) and UEBW in men with urodynamic confirmation of either BOO or detrusor underactivity. Neurourol. Urodynam. © 2011 Wiley-Liss, Inc.

PMID: 21308749 [PubMed - as supplied by publisher]
"

Progressive supranuclear palsy presenting with urinary retention and sleep apnea.

Progressive supranuclear palsy presenting with urinary retention and sleep apnea.: "

Progressive supranuclear palsy presenting with urinary retention and sleep apnea.

Clin Auton Res. 2011 Jan 6;

Authors: Tateno F, Sakakibara R, Kishi M, Yuasa T, Ogawa E, Takahashi O, Yoshio S, Sugiyama M, Uchiyama T, Yamamoto T, Yamanishi T

We report a case of a 62-year-old Japanese-Australian woman with progressive supranuclear palsy (PSP) who presented with prominent urinary retention, neurogenic changes in sphincter electromyography, and obstructive sleep apnea syndrome. Urodynamic study revealed a combination of detrusor overactivity during filling and underactivity during voiding. All these non-motor symptoms in PSP mimicked those of multiple system atrophy.

PMID: 21210294 [PubMed - as supplied by publisher]
"

January 22, 2011

Videourodynamics in patients with neurogenic bladder due to multiple sclerosis: our experience.

Videourodynamics in patients with neurogenic bladder due to multiple sclerosis: our experience.: "

Videourodynamics in patients with neurogenic bladder due to multiple sclerosis: our experience.

Radiol Med. 2011 Jan 12;

Authors: Caramella D, Donatelli G, Armillotta N, Manassero F, Traversi C, Frumento P, Pistolesi D, Selli C

PURPOSE: The aims of this study were to: (a) analyse the most frequent morphofunctional features of the lower urinary tract observed during videourodynamic examination in patients with neurogenic bladder due to multiple sclerosis; (b) investigate the role of the videourodynamic examination in the clinical management of these patients; and (c) demonstrate the relationship between morphological and functional variables. MATERIALS AND METHODS: We performed videourodynamic examinations in 75 patients affected by neurogenic bladder secondary to multiple sclerosis. RESULTS: The introduction of pharmacological therapy, based on clinical and functional evaluation of the lower urinary tract, is correlated with satisfactory morphofunctional outcomes, reducing moderate-to-severe postvoid residual (PVR; p < 0.1) and compliance (p < 0.05) at the price of reduced bladder sensation. Clinical management of these patients based on morphological evaluation of the lower urinary tract decreased the occurrence of detrusor-sphincter dyssynergy (DSD) and detrusor overactivity incontinence at the following examination. CONCLUSIONS: Our study confirmed a relationship between detrusor overactivity and hypertonic bladder, bladder diverticula, vesicoureteral reflux, between detrusor underactivity and PVR and between DSD and bladder diverticula. Our data show how the videourodynamic examination may improve evaluation and urological management of these patients.

PMID: 21225364 [PubMed - as supplied by publisher]
"

January 16, 2011

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 8;

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) '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]
"

Voiding dynamics in women with stress urinary incontinence and high-stage cystocele.

Voiding dynamics in women with stress urinary incontinence and high-stage cystocele.: "

Voiding dynamics in women with stress urinary incontinence and high-stage cystocele.

Int J Urol. 2011 Jan 10;

Authors: Seki N, Shahab N, Hara R, Takei M, Yamaguchi A, Naito S

Objectives:  The aim of this study was to identify the urodynamic features of women with stress urinary incontinence (SUI) or with high-stage (stage 3 or greater) cystocele (HSC) as compared with symptom-free women. Methods:  Fifty-six neurologically intact women with SUI and 47 women with HSC but without SUI were prospectively evaluated. All patients underwent full urodynamics, in addition to basic clinical evaluations. The urodynamic parameters of SUI and HSC were compared to the ones obtained from 78 urologically symptom-free normal women over the same period. Results:  Patients with HSC, after correction of cystocele using a temporary vaginal pessary, had consistently lower maximum urinary flow rate with a lower detrusor pressure during micturition than the controls or those with SUI. On the other hand, patients with SUI had an equivalent to higher maximum urinary flow rate, normal detrusor contraction strength with a lower detrusor pressure during micturition than the controls. Both maximum Watts factor and bladder contractility index were significantly lower in the whole HSC cohort in comparison to the controls and patients with SUI. The urodynamic characteristics observed among the three groups were all maintained even after adjusting for age. Conclusions:  Women with SUI demonstrate voiding with low-pressure, normal contraction strength with an equivalent to high urinary flow rate. Women with HSC demonstrate voiding with low pressures with weak contraction strengths and low urinary flow rates, suggesting a higher prevalence of detrusor underactivity. Chronically decreased or increased urethral resistance might alter voiding dynamics and performance.

PMID: 21219445 [PubMed - as supplied by publisher]
"