March 24, 2012

Low-frequency electrotherapy for female patients with detrusor underactivity due to neuromuscular deficiency.

Low-frequency electrotherapy for female patients with detrusor underactivity due to neuromuscular deficiency.:
Low-frequency electrotherapy for female patients with detrusor underactivity due to neuromuscular deficiency.
Int Urogynecol J. 2012 Mar 23;
Authors: Xu DF, Zhang S, Wang CZ, Li J, Qu CY, Cui XG, Zhao SJ
Abstract

INTRODUCTION AND HYPOTHESIS: The aim of the study was to assess the efficacy of low-frequency electrotherapy (LFE) for female patients with early-stage detrusor underactivity (DUA) due to neuromuscular deficiency. METHODS: A total of 102 female patients were divided randomly into four groups: LFE-NC (normal compliance), LFE-LC (low compliance), CON (control)-NC and CON-LC. Patients in the LFE-NC and LFE-LC groups received LFE, and those in the CON-NC and CON-LC groups received conservative treatment. Urodynamic evaluation was performed before and after treatment. RESULTS: After treatment, 82 % of the LFE-NC regained detrusor contractility, whereas only 2 (8 %) of the CON-NC had normal detrusor contraction. None of LFE-LC or CON-LC regained detrusor contractility (p < 0.01). The per cent of LFE-NC who relied on catheterization for bladder emptying decreased by 43 % (p < 0.01). Those in the LFE-LC, CON-NC and CON-LC groups decreased by only 4, 12 or 0 % (p > 0.05). CONCLUSIONS: LFE was more effective for DUA patients with normal compliance; these patients benefited from LFE, but DUA patients with low compliance did not.


PMID: 22441580 [PubMed - as supplied by publisher]

March 20, 2012

Risk factors that affect the treatment of interstitial cystitis using intravesical therapy with a dimethyl sulfoxide cocktail.

Risk factors that affect the treatment of interstitial cystitis using intravesical therapy with a dimethyl sulfoxide cocktail.:
Risk factors that affect the treatment of interstitial cystitis using intravesical therapy with a dimethyl sulfoxide cocktail.
Int Urogynecol J. 2012 Mar 17;
Authors: Hung MJ, Chen YT, Shen PS, Hsu ST, Chen GD, Ho ES
Abstract

INTRODUCTION AND HYPOTHESIS: Dimethyl sulfoxide (DMSO) bladder instillation is a standard therapy for interstitial cystitis (IC); however, there are varying degrees of success. We hypothesize that first-line intravesical therapy with a DMSO cocktail will optimize treatment outcome. METHODS: Ninety women with newly diagnosed IC were enrolled consecutively for the treatment. The IC symptom and problem index was used as an outcome measure. RESULTS: Six (6.7%) patients dropped out of the treatment due to intolerable bladder irritation. Fifty-five (65.5%) of the remaining 84 patients, who completed the treatment, experienced ≧50% symptomatic improvement. After a regression analysis, three clinical variables were found to affect treatment adversely, i.e., the presence of advanced cystoscopic glomerulations, microscopic hematuria, and urodynamic detrusor underactivity, respectively. CONCLUSIONS: Our results suggest bladder instillation with a DMSO cocktail may well be considered as first-line therapy for IC patients. However, there exists a subgroup of nonresponders who may have severe disease.


PMID: 22426874 [PubMed - as supplied by publisher]

March 15, 2012

Does diabetes mellitus-induced bladder remodeling affect lower urinary tract function?-ICI-RS 2011.

Does diabetes mellitus-induced bladder remodeling affect lower urinary tract function?-ICI-RS 2011.:
Does diabetes mellitus-induced bladder remodeling affect lower urinary tract function?-ICI-RS 2011.
Neurourol Urodyn. 2012 Mar 13;
Authors: Kirschner-Hermanns R, Daneshgari F, Vahabi B, Birder L, Oelke M, Chacko S
Abstract

AIMS: Due to an increase in aging population and changing eating habits diabetes mellitus (DM) type II is a rapidly increasing condition worldwide. Although not so detrimental as other co-morbidities, uropathy contributes to a significantly reduced quality-of-life in those affected. The purpose of this ICS-RS report is to highlight clinical and basic research data to outline directions for further research and possible treatment approaches. METHODS: This report is based on a think tank presentation and discussion at the ICI-RS 2011, original research data and literature research. RESULTS: Clinical and experimental data confirm that detrusor overactivity, both neurogenic and myogenic, and changes in transmitter regulation leading to a hyper- excitability of the detrusor are the major findings in diabetic neuropathic bladders. These findings seem to be related to an earlier stage of DM, whereas detrusor underactivity appears to be linked to later stages of DM. Detrusor smooth muscle cells seem to be modulated directly by hyperglycemia. Data support the theory that hyperglycemia-induced oxidative stress in the detrusor smooth muscle and that micro- and macrovascular events are also responsible for urologic complications of DM. CONCLUSIONS: DM causes bladder remodelling leading to uropathy in a mulitfactorial way. Future research should focus on the effects of DM as a function of time and develop novel animal models looking at defined aspects as well as interaction of different aspects- such as oxidative stress in neurogenic, myogenic and urothelial components and the role of inflammation and hypoxia caused by vascular complications. Neurourol. Urodynam. © 2012 Wiley Periodicals, Inc.


PMID: 22415965 [PubMed - as supplied by publisher]

March 14, 2012

The role of prostanoids in urinary bladder physiology.

The role of prostanoids in urinary bladder physiology.:
The role of prostanoids in urinary bladder physiology.
Nat Rev Urol. 2012 Mar 13;
Authors: Rahnama'i MS, van Kerrebroeck PE, de Wachter SG, van Koeveringe GA
Abstract

Five primary prostanoids are synthesized by the cyclooxygenase enzymes, COX-1 and COX-2: the prostaglandins PGE(2), PGF(2α), PGI(2), PGD(2) and thromboxane A2. High levels of these signaling molecules have been implicated-in both animal models and human studies-in decreased functional bladder capacity and micturition volume and increased voiding contraction amplitude. Thus, inhibition of prostanoid production or the use of prostanoid receptor antagonists, might be a rational way to treat patients with detrusor muscle overactivity. Similarly, prostanoid receptor agonists, or agents that stimulate their production, might have a function in treating bladder underactivity. Although some promising results have been reported, the adverse effects of nonselective cyclooxygenase inhibitors are a major concern that restricts their use in the treatment of functional bladder disorders. Further preclinical and clinical studies are needed before cyclooxygenase inhibitors, prostanoid receptor agonists and antagonists become worthwhile therapeutic tools in this setting.


PMID: 22410675 [PubMed - as supplied by publisher]

March 10, 2012

Urinary disorders associated with bilharziasis. Urodynamic evaluation. Findings in 10 cases.

Urinary disorders associated with bilharziasis. Urodynamic evaluation. Findings in 10 cases.:
Urinary disorders associated with bilharziasis. Urodynamic evaluation. Findings in 10 cases.
Med Trop (Mars). 2011 Dec;71(6):572-4
Authors: Guinet A, Jousse M, Verollet D, Le Breton F, Amarenco G
Abstract

Bilharziasis urinary disorders are characterized by recurent hematuria, overactive bladder symptoms (urgency, frequency and urge incontinence) and sometimes weak stream with or without urinary retention. We report 10 cases of urodynamic assessment. RESULTS: The main urodynamic symptom was overactive detrusor with uninhibited detrusor contraction during the filling phase. Only 1 patient had underactive detrusor leading to urinary retention. Urinary symptoms were secondary to a neurogenic abnormality (spinal lesion) in 2 cases, and to a specific lesion of bladder mucosa in 8 cases. CONCLUSION: Urodynamic investigations are usefull in bilharziasis urinary disorders in order to specify the pathophysiology of urinary symptoms and to point a specific neurogenic (spinal) alteration in the genesis of the urinary symptoms.


PMID: 22393623 [PubMed - in process]

March 1, 2012

Women with pure stress urinary incontinence symptoms assessed by the initial standard evaluation including measurement of post-void residual volume and a stress test: Are urodynamic studies still needed?

Women with pure stress urinary incontinence symptoms assessed by the initial standard evaluation including measurement of post-void residual volume and a stress test: Are urodynamic studies still needed?:

Women with pure stress urinary incontinence symptoms assessed by the initial standard evaluation including measurement of post-void residual volume and a stress test: Are urodynamic studies still needed?

Neurourol Urodyn. 2012 Feb 28;

Authors: Jeong SJ, Kim HJ, Lee BK, Rha W, Oh JJ, Jeong CW, Kim JH, Yoon CY, Hong SK, Byun SS, Lee SE

Abstract

AIMS: The significance of preoperative urodynamic studies in women with a "clinically-defined pure stress urinary incontinence (SUI) symptom" has been debated in recent years. We evaluated changes of reliability of pure SUI symptoms for prediction of pure urodynamic SUI (USUI) when the assessment of post-void residual (PVR) volume and a stress test, designated as the initial standard evaluation in the NICE and AUA guidelines, were added to the process for the diagnosis of pure SUI symptoms. METHODS: We reviewed records of 1,019 women aged 30-80 who underwent urodynamic study for incontinence. Criteria for pure SUI symptoms were defined as absence of overactive bladder symptoms and voiding difficulties based on a frequency-volume chart and AUA Symptom Index. We then added assessment of PVR volume and a stress test to the process for clinical diagnosis. RESULTS: Of subjects, 211 (20.7%) could be classified as having a pure SUI symptom. Of these, only 167 (79.1%) had pure USUI and 33 (15.7%) had detrusor overactivity. Eight (3.8%) had detrusor underactivity/bladder outlet obstruction. Sensitivity and specificity of pure SUI symptoms for pure USUI were 28.6% and 89.9%. Addition of assessment of PVR volume and a stress test resulted in an increase of predictive accuracy of only 3.6%. CONCLUSIONS: As one-fifth of women with pure SUI symptoms exhibit the pathophysiologies that could affect the surgical outcomes despite additional use of PVR assessment and a stress test in the clinical diagnostic process, urodynamic evaluation is considered necessary before anti-incontinence surgery in this population. Neurourol. Urodynam. © 2012 Wiley Periodicals, Inc.


PMID: 22374678 [PubMed - as supplied by publisher]