November 30, 2011

Neuroselective current perception threshold evaluation of bladder mucosal sensory function.

Neuroselective current perception threshold evaluation of bladder mucosal sensory function.:
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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]:
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[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.:
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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-na├»ve 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]