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Langston ME, Cawthon PM, Lu K, Scherzer R, Newman JC, Covinsky K, Ferrucci L, Simonsick EM, Bauer SR. Associations of Lower Extremity Muscle Strength, Area, and Specific Force With Lower Urinary Tract Symptoms in Older Men: The Baltimore Longitudinal Study of Aging. J Gerontol A Biol Sci Med Sci 2024; 79:glae008. [PMID: 38195151 PMCID: PMC11071681 DOI: 10.1093/gerona/glae008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2023] [Indexed: 01/11/2024] Open
Abstract
BACKGROUND Lower urinary tract symptoms (LUTS) in older men are associated with an increased risk of mobility limitations. Lower extremity muscle quality may represent a novel shared mechanism of both LUTS and mobility limitations. METHODS We evaluated associations of thigh skeletal muscle measures (strength, area, and specific force) with total LUTS severity (American Urologic Association Symptom Index; AUASI) and voiding and storage subscores among 352 men aged ≥60 years enrolled in the Baltimore Longitudinal Study of Aging. Thigh muscle strength (Nm) was defined as maximum concentric 30°/s knee extensor torque, area (cm2), and specific force (Nm/cm2) defined as strength/area. Associations with AUASI score were estimated using multivariable linear regression and linear mixed models. RESULTS Mean thigh muscle strength at baseline was 139.7Nm. In cross-sectional multivariable models, each 39Nm increment in thigh muscle strength and 0.28Nm/cm2 increment in specific force was associated with -1.17 point (95% CI: -1.93 to -.41) and -0.95 point (95% CI: -1.63 to -0.27) lower AUASI score, respectively. Similar associations were observed for voiding and storage subscores, although somewhat attenuated. In longitudinal analyses, baseline muscle measures were not associated with annual change in AUASI, and current changes in muscle measures and AUASI were unrelated. CONCLUSIONS Cross-sectionally, higher thigh muscle strength and specific force were associated with decreased LUTS severity in older men. However, we did not observe concurrent worsening LUTS severity with declining thigh muscle strength, area, or specific force in longitudinal analyses.
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Affiliation(s)
- Marvin E Langston
- Department of Epidemiology and Population Health, Stanford University School of Medicine, Palo Alto, California, USA
| | - Peggy M Cawthon
- Department of Epidemiology and Biostatistics, University of California, San Francisco, California, USA
- Research Institute, California Pacific Medical Center, San Francisco, California, USA
| | - Kaiwei Lu
- Department of Medicine, University of California, San Francisco, California, USA
| | - Rebecca Scherzer
- Department of Medicine, University of California, San Francisco, California, USA
- San Francisco VA Medical Center, Division of General Internal Medicine, San Francisco, California, USA
| | - John C Newman
- Buck Institute for Research on Aging, Novato, California, USA
| | - Kenneth Covinsky
- Department of Medicine, University of California, San Francisco, California, USA
- San Francisco VA Medical Center, Division of General Internal Medicine, San Francisco, California, USA
| | - Luigi Ferrucci
- National Institute on Aging, Intramural Research Program, Baltimore, Maryland, USA
| | - Eleanor M Simonsick
- National Institute on Aging, Intramural Research Program, Baltimore, Maryland, USA
| | - Scott R Bauer
- San Francisco VA Medical Center, Division of General Internal Medicine, San Francisco, California, USA
- Department of Medicine, Urology, Epidemiology and Biostatistics, University of California, San Francisco, California, USA
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Bauer SR, Parker-Autry C, Lu K, Cummings SR, Hepple RT, Scherzer R, Covinsky K, Cawthon PM. Skeletal Muscle Health, Physical Performance, and Lower Urinary Tract Symptoms in Older Adults: The Study of Muscle, Mobility, and Aging. J Gerontol A Biol Sci Med Sci 2024; 79:glad218. [PMID: 37694941 DOI: 10.1093/gerona/glad218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Indexed: 09/12/2023] Open
Abstract
BACKGROUND Lower urinary tract symptoms (LUTS) and mobility limitations are bidirectionally associated among older adults, but the role of skeletal muscle remains unknown. We evaluated cross-sectional associations of muscle health and physical performance with LUTS. METHODS We used data from 377 women and 264 men aged >70 years in the Study of Muscle, Mobility and Aging (SOMMA). LUTS and urinary bother were assessed using the LURN Symptom Index-10 (SI-10; higher = worse symptoms). Muscle mass and volume were assessed using D3-creatine dilution (D3Cr) and magnetic resonance imaging. Grip strength and peak leg power assessed upper/lower extremity physical performance. 400-m walk, Short Physical Performance Battery (SPPB), and Four Square Step Test (FSST) assessed global physical performance. Mobility Assessment Tool-short form (MAT-sf) assessed self-reported mobility. We calculated Spearman correlation coefficients adjusted for age, body mass index, multimorbidity, and polypharmacy, chi-square tests, and Fisher's Z-test to compare correlations. RESULTS Among women, LURN SI-10 total scores were inversely correlated with FSST (rs = 0.11, p = .045), grip strength (rs = -0.15, p = .006), and MAT-sf (rs = -0.18, p = .001), but not other muscle and physical performance measures in multivariable models. LURN SI-10 was not associated with any of these measures among men. Forty-four percent of women in the lowest tertile of 400-m walk speed versus 24% in the highest tertile reported they were at least "somewhat bothered" by urinary symptoms (p < .001), whereas differences among men were not significant. CONCLUSIONS Balance and grip strength were associated with LUTS severity in older women but not men. Associations with other muscle and physical performance measures varied by LUTS subtype but remained strongest among women.
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Affiliation(s)
- Scott R Bauer
- Department of Medicine, University of California and the San Francisco Veterans Affairs Medical Center, San Francisco, California, USA
- Department of Urology, University of California, San Francisco, California, USA
| | - Candace Parker-Autry
- Department of Urology, Section on Female Pelvic Health, Wake Forest Baptist Health, Winston-Salem, North Carolina, USA
| | - Kaiwei Lu
- Department of Urology, Section on Female Pelvic Health, Wake Forest Baptist Health, Winston-Salem, North Carolina, USA
| | - Steven R Cummings
- San Francisco Coordinating Center, California Pacific Medical Center Research Institute, San Francisco, California, USA
- Department of Epidemiology and Biostatistics, University of California, San Francisco, California, USA
| | - Russell T Hepple
- Department of Physical Therapy, College of Public Health and Health Professions, University of Florida, Gainesville, Florida, USA
| | - Rebecca Scherzer
- Department of Medicine, University of California and the San Francisco Veterans Affairs Medical Center, San Francisco, California, USA
| | - Kenneth Covinsky
- Department of Medicine, University of California and the San Francisco Veterans Affairs Medical Center, San Francisco, California, USA
- Division of Geriatrics, Department of Medicine, University of California, San Francisco, California, USA
| | - Peggy M Cawthon
- San Francisco Coordinating Center, California Pacific Medical Center Research Institute, San Francisco, California, USA
- Department of Epidemiology and Biostatistics, University of California, San Francisco, California, USA
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Hoelscher SAA, de Angst IB, Buijnsters ZA, Bramer WM, Akkermans FW, Kuindersma ME, Scheepe JR, Hoen LA'. The effect of botulinum toxin A in children with non-neurogenic therapy-refractory dysfunctional voiding - A systematic review. J Pediatr Urol 2024; 20:211-218. [PMID: 38135586 DOI: 10.1016/j.jpurol.2023.10.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Revised: 09/15/2023] [Accepted: 10/27/2023] [Indexed: 12/24/2023]
Abstract
INTRODUCTION Dysfunctional voiding (DV) is a habitual voiding disorder caused by involuntary contraction or non-relaxation of the external urethral sphincter (EUS) during voiding. This contraction causes high post-void residuals (PVR), urinary incontinence and urinary tract infections (UTIs). Various treatments for DV are available, but some children do not respond. Intersphincteric botulinum toxin-A (BTX-A) may be a possible treatment for therapy-refractory children with DV. OBJECTIVE The aim of this systematic review is to summarize the effects and safety of intersphincteric BTX-A as a treatment for therapy-refractory DV in children. METHODS A systematic search in Embase, MEDLINE, Cochrane, and Web of Science databases was performed. Studies reporting on the usage of intersphincteric BTX-A as a treatment for DV in children were included. Data on PVR, maximum flow rate (Qmax), repeat injections and complications were extracted. RESULTS From a total of 277 articles, five cohort studies were identified, reporting on 78 children with DV of whom 53 were female (68 %) and 25 were male (32 %). Sample sizes ranged from ten to twenty patients. Mean or median age at the time of intervention ranged from 8 to 10.5 years. Meta-analysis could not be performed due to lack of data. The narrative synthesis approach was therefore used to summarize the results. All studies showed significant decrease in PVR after BTX-A injection. Three studies showed a 33-69 % improvement on incontinence after BTX-A injection. Less UTIs were reported after treatment. A temporary increase in incontinence, UTIs and transitory numbness to the gluteus muscle were reported as side-effects. CONCLUSIONS BTX-A could be a safe and effective treatment option for therapy-refractory DV in children by reducing PVR, UTIs and incontinence. Hereby, the synergistic effect of BTX-A and urotherapy should be emphasized in future management. Furthermore, this study identified gaps in current knowledge that are of interest for future research.
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Affiliation(s)
- S A A Hoelscher
- Department of Pediatric Urology, Sophia Children's Hospital, Erasmus MC, University Medical Center, Rotterdam, the Netherlands.
| | - I B de Angst
- Department of Pediatric Urology, Sophia Children's Hospital, Erasmus MC, University Medical Center, Rotterdam, the Netherlands.
| | - Z A Buijnsters
- Department of Pediatric Urology, Sophia Children's Hospital, Erasmus MC, University Medical Center, Rotterdam, the Netherlands
| | - W M Bramer
- Medical Library, Erasmus MC, University Medical Center, Rotterdam, the Netherlands
| | - F W Akkermans
- Department of Pediatric Urology, Sophia Children's Hospital, Erasmus MC, University Medical Center, Rotterdam, the Netherlands
| | - M E Kuindersma
- Department of Pediatric Urology, Sophia Children's Hospital, Erasmus MC, University Medical Center, Rotterdam, the Netherlands
| | - J R Scheepe
- Department of Pediatric Urology, Sophia Children's Hospital, Erasmus MC, University Medical Center, Rotterdam, the Netherlands
| | - L A 't Hoen
- Department of Pediatric Urology, Sophia Children's Hospital, Erasmus MC, University Medical Center, Rotterdam, the Netherlands.
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Marcou M, Apel H, Wullich B, Hirsch-Koch K. [Kidney transplantation in children with complex urogenital malformations-what should be considered?]. Urologie 2024; 63:351-356. [PMID: 38324034 DOI: 10.1007/s00120-024-02289-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 01/19/2024] [Indexed: 02/08/2024]
Abstract
BACKGROUND Congenital anomalies of the kidneys and urinary tract (CAKUT) are the most common cause of end-stage renal disease (ESRD) in children. Approximately one third of children with CAKUT have lower urinary tract dysfunction (LUTD). AIM This article highlights the important aspects that need to be considered in kidney transplantation of children with complex urogenital malformations. MATERIALS AND METHODS The paper reviews the existing literature regarding the evaluation, preparation, perioperative management, and follow-up of children with complex urogenital malformations and ESRD undergoing renal transplantation. RESULTS Comprehensive diagnostics are required before any pediatric kidney transplantation. If LUTD is suspected, voiding cystourethrography and a urodynamic examination should be performed. Treatment of symptomatic vesicoureterorenal reflux and LUTD is mandatory prior to pediatric kidney transplantation. Following successful kidney transplantation of children with congenital urogenital malformations, lifelong follow-up is required. Regular reevaluations of the bladder by means of urodynamic examinations are necessary. In patients following bladder augmentation with intestinal segments or urinary diversions in childhood, regular endoscopic examinations of the urinary tract are recommended to rule out secondary malignancy. CONCLUSION Treatment of children with complex urogenital malformations should be carried out in centers with appropriate expertise.
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Affiliation(s)
- Marios Marcou
- Urologische und Kinderurologische Klinik, Uniklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Krankenhausstr. 12, 91054, Erlangen, Deutschland.
- Transplantationszentrum Erlangen, Uniklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Deutschland.
| | - Hendrik Apel
- Urologische und Kinderurologische Klinik, Uniklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Krankenhausstr. 12, 91054, Erlangen, Deutschland
- Transplantationszentrum Erlangen, Uniklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Deutschland
| | - Bernd Wullich
- Urologische und Kinderurologische Klinik, Uniklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Krankenhausstr. 12, 91054, Erlangen, Deutschland
- Transplantationszentrum Erlangen, Uniklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Deutschland
| | - Karin Hirsch-Koch
- Urologische und Kinderurologische Klinik, Uniklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Krankenhausstr. 12, 91054, Erlangen, Deutschland
- Transplantationszentrum Erlangen, Uniklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Deutschland
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5
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Wiedemann A, Heppner HJ. [Urine retention-From the symptom to the structure]. Urologie 2023; 62:1223-1233. [PMID: 37878041 DOI: 10.1007/s00120-023-02216-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/26/2023]
Abstract
Urinary retention describes the inability to urinate. Based on the symptoms and the amount of the initial residual urine formation, a differentiation can be made between acute and chronic forms. The cause can be a subvesical obstruction or a bladder atony. In addition to emergency treatment in the form of initial relief of the strain on the bladder by insertion of a catheter, the indication for a definitive treatment with a clarification of the question whether an acute or chronic event is present is also important. Although the selection of the catheter is subject to few criteria, the further structured approach is complex. Both decision trees are presented in this article.
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Affiliation(s)
- A Wiedemann
- Urologische Abteilung, Evangelisches Krankenhaus Witten gGmbH, Pferdebachstr. 27, 58455, Witten, Deutschland.
| | - H J Heppner
- Klinik für Geriatrie und Geriatrische Tagesklinik, Klinikum Bayreuth - Medizincampus Oberfranken, Bayreuth, Deutschland
- Lehrstuhl für Geriatrie, Friedrich-Alexander-Universität Erlangen-Nürnberg, Nürnberg, Deutschland
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6
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Ho NX, Nambiar A. A robotic approach to clamshell augmentation enterocystoplasty. Ann R Coll Surg Engl 2023; 105:777-780. [PMID: 37642086 PMCID: PMC10618042 DOI: 10.1308/rcsann.2023.0061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/31/2023] Open
Abstract
Augmentation cystoplasty (AC) is a well-established surgical option for the management of overactive bladder where conservative management has failed. We describe the case of a man in his 50s with chronic bladder dysfunction secondary to refractory detrusor overactivity and small capacity bladder. His lower urinary tract symptoms (LUTS) of urinary frequency and nocturia persisted despite pharmacological therapy and peripheral neural modulation; hence, he underwent surgical intervention for management of his bladder dysfunction. A robot-assisted clamshell enterocystoplasty was performed with a successful outcome. His LUTS have improved significantly post surgery. This case highlights modern advances in minimally invasive and robotic surgical techniques in the management of functional urological conditions. It also further demonstrates that the robotic approach is a viable option for AC, an operation traditionally performed as open surgery.
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Affiliation(s)
- N X Ho
- The Newcastle upon Tyne Hospitals NHS Foundation Trust, UK
| | - A Nambiar
- The Newcastle upon Tyne Hospitals NHS Foundation Trust, UK
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7
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Shrivastava N, Sarangi SS, Tripathi S, Bhargava P, Bhirud DP, Jena R. Bladder diary for illiterates: A novel method. Urologia 2023; 90:748-756. [PMID: 37470311 DOI: 10.1177/03915603231187684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/21/2023]
Abstract
PURPOSE Bladder diary is an integral part of urologic evaluation of lower urinary tract symptoms. One of its limitations is the requirement of a literate patient or attendant to complete it. We propose a novel method for recording bladder diary in illiterate individuals, with the aid of easily available materials from hospital, without any expenditure from the patients. METHODS Forty-nine patients, who were required to fill the bladder diary as a part of their urological assessment, and were either illiterate or not literate enough to complete it themselves, were enrolled and admitted in the urology ward for 1 and a half days. Patients were provided with two 500 mL empty normal saline bottles for collection of each void, and a chart separately for day and night with diagrams of saline bottles to mark the corresponding level of urine. The amount of urine and frequency was also noted simultaneously by nursing staff each time for 24 h. The investigator interpreted the data marked on the charts by the patient and compared it with the data collected by the nursing officers. RESULTS No statistically significant difference was found between the data collected by the nursing staff and patient data interpreted by the investigators, which included 24-h urine volume(p = 0.562), nocturnal output (p = 0.941), average voided volume (p = 0.709), maximum voided volume (p = 0.369), fluid intake (p = 0.401), frequency, nocturia and episodes of urgency and incontinence (p = 1). CONCLUSION This method of recording bladder diary is a feasible, genuine, reliable and cost-free method which can be used in illiterates.
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Affiliation(s)
| | | | | | - Priyank Bhargava
- All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | | | - Rahul Jena
- All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
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8
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Jung J, Kim A, Yang SH. The Innovative Approach in Functional Bladder Disorders: The Communication Between Bladder and Brain-Gut Axis. Int Neurourol J 2023; 27:15-22. [PMID: 37015721 PMCID: PMC10072998 DOI: 10.5213/inj.2346036.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Accepted: 02/21/2023] [Indexed: 04/06/2023] Open
Abstract
Functional bladder disorders including overactive bladder and interstitial cystitis may induce problems in many other parts of our body such as brain and gut. In fact, diagnosis is often less accurate owing to their complex symptoms. To have correct diagnosis of these diseases, we need to understand the pathophysiology behind overlapped clinical presentation. First, we focused on reviewing literatures that have reported the link between bladder and brain, as the patients with bladder disorders frequently accompanied mood disorders such as depression and anxiety. Second, we reviewed literatures that have described the relationship between bladder and gut. There exist many evidences of patients who suffered from both bladder and intestinal diseases, such as irritable bowel syndrome and inflammatory bowel disease, at the same time. Furthermore, the interaction between brain and gut, well-known as brain-gut axis, might be a key factor that could change the activity of bladder and vice versa. For example, the affective disorders could alter the activity of efferent nerves or autonomic nervous system that modulate the gut itself and its microbiota, which might cause the destruction of homeostasis in bladder eventually. In this way, the communication between bladder and brain-gut axis might affect permeability, inflammation, as well as infectious etiology and dysbiosis in bladder diseases. In this review, we aimed to find an innovative insight of the pathophysiology in the functional bladder disorders, and we could provide a new understanding of the overlapped clinical presentation by elucidating the pathophysiology of functional bladder disorders.
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Affiliation(s)
- Jiwon Jung
- Department of Biomedical Engineering, College of Life Science and Biotechnology, Dongguk University, Seoul, Korea
| | - Aram Kim
- Department of Urology, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Korea
| | - Seung-Hoon Yang
- Department of Biomedical Engineering, College of Life Science and Biotechnology, Dongguk University, Seoul, Korea
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9
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Wiedemann A, Heppner HJ. [Urine retention-From the symptom to the structure]. Z Gerontol Geriatr 2023; 56:153-63. [PMID: 36788158 DOI: 10.1007/s00391-022-02133-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/26/2022] [Indexed: 02/16/2023]
Abstract
Urinary retention describes the inability to urinate. Based on the symptoms and the amount of the initial residual urine formation, a differentiation can be made between acute and chronic forms. The cause can be a subvesical obstruction or a bladder atony. In addition to emergency treatment in the form of initial relief of the strain on the bladder by insertion of a catheter, the indication for a definitive treatment with a clarification of the question whether an acute or chronic event is present is also important. Although the selection of the catheter is subject to few criteria, the further structured approach is complex. Both decision trees are presented in this article.
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10
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Choi HW, Lee KW, Kim YH. Microbiome in urological diseases: Axis crosstalk and bladder disorders. Investig Clin Urol 2023; 64:126-139. [PMID: 36882171 PMCID: PMC9995957 DOI: 10.4111/icu.20220357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Revised: 12/29/2022] [Accepted: 01/30/2023] [Indexed: 03/02/2023] Open
Abstract
Since the identification of the human urinary microbiome, numerous studies have characterized this microbial community and improved our knowledge of its association with urinary diseases. This association between urinary diseases and microbiota is not confined to the urinary microbiota; it is interconnected with the microbiota of other organs. The gastrointestinal, vaginal, kidney, and bladder microbiota all affect urinary diseases because they work with their respective organs to control the growth and operation of the immune, metabolic, and nervous systems through dynamic bidirectional communication along the bladder-centered axis. Therefore, disturbances in the microbial communities may result in the emergence of urinary diseases. In this review, we describe the increasing and intriguing evidence of complicated and critical relationships that may contribute to the development and progression of urinary diseases through disruption of the microbiota in various organs.
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Affiliation(s)
- Hae Woong Choi
- Division of Life Sciences, Korea University, Seoul, Korea
| | - Kwang Woo Lee
- Department of Urology, Soonchunhyang University Bucheon Hospital, Bucheon, Korea
| | - Young Ho Kim
- Department of Urology, Soonchunhyang University Bucheon Hospital, Bucheon, Korea.
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Aizawa N, Fujita T. Inhibitory effects of vibegron, a β 3-adrenoceptor agonist, on the myogenic contractile and mechanosensitive afferent activities in an obstructed rat bladder. Eur J Pharmacol 2022; 933:175272. [PMID: 36108733 DOI: 10.1016/j.ejphar.2022.175272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Revised: 08/05/2022] [Accepted: 09/08/2022] [Indexed: 11/22/2022]
Abstract
To determine the role of β3-adrenoceptor agonists on bladder sensory facilitation related to bladder myogenic contractile activities in bladder hyperactivity, we investigated the effects of vibegron, a β3-adrenoceptor agonist, on the bladder and sensory function by evaluating cystometry and mechanosensitive single-unit afferent activities (SAAs), respectively, in a male rat model of bladder outlet obstruction (BOO). BOO was created by partial ligation of the urethra. Ten days after the surgical procedure, cystometric and SAA measurements were taken under two distinct conditions: a conscious-restrained condition, in which the bladder was constantly filled with saline, and a urethane-anesthetized condition involving an isovolumetric process with saline. For each measurement, vibegron (3 mg/kg) or its vehicle was administered intravenously after the data were reproducibly stable. In addition, the expression of β3-adrenoceptor and substance P (SP), a sensory neuropeptide, in the bladder was further evaluated following immunohistochemical procedures. Number of non-voiding contractions (NVCs) in cystometry was decreased after vibegron-administration, which was a significant change from vehicle group. Number of microcontractions and SAAs of Aδ- and C-fibers were significantly decreased by vibegron-administration. Furthermore, β3-adrenocepor and SP were co-expressed in the suburothelium layer of the bladder. These findings indicated that vibegron showed inhibitory effects on NVCs and microcontractions of the bladder, and SAAs of the Aδ- and C-fibers in BOO rats. The study suggested that vibegron can partly inhibit the mechanosensitive afferent transduction via Aδ- and C-fibers by suppressing bladder myogenic contractile activities in the rat bladder hyperactivity associated with BOO.
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Aizawa N, Fujimori Y, Nakanishi O, Hayashi T, Goi Y, Kobayashi JI, Fujita T. Efficacy of the combination of KPR-5714, a novel transient receptor potential melastatin 8 (TRPM8) antagonist, and β 3-adrenoceptor agonist or anticholinergic agent on bladder dysfunction in rats with bladder overactivity. Eur J Pharmacol 2021; 899:173995. [PMID: 33675781 DOI: 10.1016/j.ejphar.2021.173995] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Revised: 02/24/2021] [Accepted: 02/28/2021] [Indexed: 02/07/2023]
Abstract
Transient receptor potential melastatin 8 (TRPM8) channels may contribute to the pathophysiological bladder afferent hyperactivity, thus a TRPM8 antagonist would be a promising therapeutic target for the bladder hypersensitive disorders including urinary urgency in overactive bladder (OAB). We aimed to investigate a pharmacological effect of KPR-5714, a novel selective TRPM8 antagonist, on TRPM8 channels, M3 receptors and β3-adrenoceptors using the transfected cells of each gene at first. Then, combination effects of KPR-5714 and mirabegron, a β3-adrenoceptor agonist, or tolterodine tartrate, an anticholinergic agent, were studied on rhythmic bladder contractions (RBCs) in normal rats and bladder function in frequent-voiding rats. In vitro measurements showed that KPR-5714 acts on neither β3-adrenoceptor nor M3 receptor. In normal rats, KPR-5714 and mirabegron significantly reduced the frequency of RBCs, and a combined administration showed an additive effect. In rats with cerebral infarction, KPR-5714 and mirabegron significantly reduced the voiding frequency, and a combined administration showed an additive effect. In rats exposed to cold temperature, KPR-5714 and tolterodine tartrate significantly reduced the voiding frequency accompanied by the increased mean voided volume, and a combined administration showed additive effects. The present study demonstrated that the combined administration of KPR-5714 and mirabegron or tolterodine tartrate showed the additive effects on bladder dysfunction in different animal models, suggesting that the combination therapy of TRPM8 antagonist and β3-adrenoceptor agonist or anticholinergic agent can be the potential treatment option for obtaining additive effects in comparison with monotherapy for OAB.
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MESH Headings
- Acetanilides/pharmacology
- Adrenergic beta-3 Receptor Agonists/pharmacology
- Animals
- Calcium Signaling
- Cyclic AMP/metabolism
- Disease Models, Animal
- Drug Therapy, Combination
- Female
- HEK293 Cells
- Humans
- Muscarinic Antagonists/pharmacology
- Rats, Sprague-Dawley
- Receptors, Adrenergic, beta-3/drug effects
- Receptors, Adrenergic, beta-3/metabolism
- TRPM Cation Channels/antagonists & inhibitors
- TRPM Cation Channels/metabolism
- Thiazoles/pharmacology
- Tolterodine Tartrate/pharmacology
- Urinary Bladder/drug effects
- Urinary Bladder/metabolism
- Urinary Bladder/physiopathology
- Urinary Bladder, Overactive/drug therapy
- Urinary Bladder, Overactive/etiology
- Urinary Bladder, Overactive/metabolism
- Urinary Bladder, Overactive/physiopathology
- Urodynamics/drug effects
- Rats
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Affiliation(s)
- Naoki Aizawa
- Department of Pharmacology and Toxicology, Dokkyo Medical University School of Medicine, Tochigi, Japan.
| | | | - Osamu Nakanishi
- Discovery Research R&D, Kissei Pharmaceutical Co., Ltd., Azumino, Japan
| | - Takemitsu Hayashi
- Discovery Research R&D, Kissei Pharmaceutical Co., Ltd., Azumino, Japan
| | - Yoshiaki Goi
- Discovery Research R&D, Kissei Pharmaceutical Co., Ltd., Azumino, Japan
| | | | - Tomoe Fujita
- Department of Pharmacology and Toxicology, Dokkyo Medical University School of Medicine, Tochigi, Japan
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13
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Rousset P, Bischoff E, Charlot M, Grangeon F, Dubernard G, Paparel P, Lega JC, Golfier F. Bladder endometriosis: Preoperative MRI analysis with assessment of extension to ureteral orifices. Diagn Interv Imaging 2020; 102:255-263. [PMID: 33339775 DOI: 10.1016/j.diii.2020.11.011] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Revised: 11/24/2020] [Accepted: 11/25/2020] [Indexed: 12/21/2022]
Abstract
PURPOSE The purpose of this study was to retrospectively evaluate the performance of magnetic resonance imaging (MRI) in locating endometriosis implants within the bladder wall with assessment of ureteral orifice extension using surgical findings as standard of reference. MATERIALS AND METHODS MRI examinations of 39 consecutive women (mean age: 31.2±5.5 [SD] years; age range: 22-42years) operated in 3 university hospitals for bladder endometriosis over a 6-year period were reviewed by 2 independent readers. Interobserver agreement was assessed using Kappa tests. Results of consensus reading were used to calculate sensitivity, specificity and accuracy of MRI for the diagnosis, location and extent of endometriosis implants using surgical findings as the standard of reference. RESULTS Mean bladder repletion volume was 134±110 [SD] mL (range: 21-479mL). The mean largest endometriosis implant diameter was 30±7 [SD] mm (range: 19-41mm). On MR images, 34/39 (87%) endometriosis implants were present in the two anterior thirds of the dome (k=0.45), 31/39 (79%) extended or were present in the posterior third pouch (k=0.92) and 25/39 (64%) extended into the bladder base (k=0.84) with sensitivities of 100% (31/31; 95% confidence interval [CI]: 89-100%), 100% (30/30; 95% CI: 88-100%) and 90% (19/21; 95% CI: 69-98%), respectively, specificities of 83% (5/6, 95% CI: 36-100), 88% (7/8, 95% CI: 47-100%), 87% (13/15; 95% CI: 52-96), respectively and accuracies of 97% (36/37, 95% CI: 86-100%), 97% (37/38; 95% CI: 86-100%), and 89% (32/36; 95% CI: 74-97%), respectively. In 9 (9/25; 36%) patients with bladder base involvement, a zero distance was reported between endometriosis implants and ureteral orifices, all but one presenting with low-to-moderate bladder volumes. In the two patients who needed ureteral resection-reimplantation, ureteral dilation was associated with a zero distance. External adenomyosis was reported in 26/39 (66%) patients (k=0.94). CONCLUSION A dedicated preoperative MRI work-up for bladder endometriosis helps accurately depict and locate endometriosis implants. Adequate bladder filling is needed to improve appropriate estimate of the distance between endometriosis implants and ureteral orifices to better predict requirement of ureteral resection-reimplantation.
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Affiliation(s)
- Pascal Rousset
- Lyon 1 Claude-Bernard University, EMR 3738, Hospices Civils de Lyon, Lyon Sud University Hospital, Department of Radiology, 69495 Pierre-Bénite, France.
| | - Elodie Bischoff
- Hospices Civils de Lyon, Lyon Sud University Hospital, Department of Radiology, 69495 Pierre-Bénite, France
| | - Mathilde Charlot
- Hospices Civils de Lyon, Lyon Sud University Hospital, Department of Radiology, 69495 Pierre-Bénite, France
| | - Flavia Grangeon
- Lyon 1 Claude-Bernard University, EMR 3738, Hospices Civils de Lyon, Lyon Sud University Hospital, Department of Radiology, 69495 Pierre-Bénite, France
| | - Gil Dubernard
- Lyon 1 Claude-Bernard University, LabTAU, Hospices Civils de Lyon, Croix-Rousse Hospital, Obstetrics and Gynaecology Department, 69004 Lyon, France
| | - Philippe Paparel
- Lyon 1 Claude-Bernard University, Hospices Civils de Lyon, Lyon Sud University Hospital, Urology Department, 69495 Pierre-Bénite, France
| | - Jean-Christophe Lega
- Lyon 1 Claude-Bernard University, UMR CNRS 5558, Hospices Civils de Lyon, Lyon Sud University Hospital, Internal and Vascular Medicine Department, 69495 Pierre-Bénite, France
| | - François Golfier
- Lyon 1 Claude-Bernard University, EMR 3738, Hospices Civils de Lyon, Lyon Sud University Hospital, Gynecological Oncological, and Obstetrics Department, 69495 Pierre-Bénite, France
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14
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Nieto-Calvache AJ, López-Girón MC, Messa-Bryon A, Ceballos-Posada ML, Duque-Galán M, Ríos-Posada JGD, Plazas-Córdoba LA, Chancy-Castaño MM. Urinary tract injuries during treatment of patients with morbidly adherent placenta. J Matern Fetal Neonatal Med 2019; 34:3140-3146. [PMID: 31631730 DOI: 10.1080/14767058.2019.1678135] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
INTRODUCTION Urinary tract injuries (UTI) are a frequent complication of morbidly adherent placenta (MAP) management. In this study, we aim to characterize the type of UTI that occurs and to define if their incidence varies after establishing a fixed interdisciplinary group for the protocolized management of patients with MAP. METHODOLOGY All patients with confirmed MAP attended between 2011 and 2019 in our institution, were included. We analyzed the effect of a change in the surgical protocol including rigid ureteral catheters, vesicouterine dissection before hysterotomy and interdisciplinary planning, in the bladder or ureteral injuries incidence. RESULTS The study included 65 women. UTI was identified in 27.7% of patients and was associated with a greater volume of blood loss, transfusion requirement, hospital stay, and the need for additional surgeries. There was a high frequency of UTI in patients without protocolized management. The use of rigid ureteral catheters and retrovesical dissection before hysterotomy were associated with a less ureteral injury. CONCLUSIONS Developing expertise among the members of the surgical team is essential to improve results. Using rigid ureteral catheters, performing retrovesical dissection before hysterotomy, and performing less extensive surgeries in selected patients are associated with a low frequency of ureteral injuries.
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Affiliation(s)
- Albaro José Nieto-Calvache
- Tertiary Obstetric Unit, Department of Obstetrics and Gynecology, Fundación Valle del Lili, Cali, Colombia.,Abnormally Invasive Placenta Unit, Fundación Valle del Lili, Cali, Colombia.,Department of Health Sciences, School of Medicine, Universidad ICESI, Cali, Colombia
| | - María Camila López-Girón
- Department of Health Sciences, School of Medicine, Universidad ICESI, Cali, Colombia.,Clinical Research Center, Fundación Valle del Lili, Cali, Colombia
| | - Adriana Messa-Bryon
- Tertiary Obstetric Unit, Department of Obstetrics and Gynecology, Fundación Valle del Lili, Cali, Colombia.,Abnormally Invasive Placenta Unit, Fundación Valle del Lili, Cali, Colombia.,Department of Health Sciences, School of Medicine, Universidad ICESI, Cali, Colombia
| | - M Lili Ceballos-Posada
- Tertiary Obstetric Unit, Department of Obstetrics and Gynecology, Fundación Valle del Lili, Cali, Colombia.,Abnormally Invasive Placenta Unit, Fundación Valle del Lili, Cali, Colombia.,Department of Health Sciences, School of Medicine, Universidad ICESI, Cali, Colombia.,Department Urology, Fundación Valle del Lili, Cali, Colombia
| | - Manuel Duque-Galán
- Tertiary Obstetric Unit, Department of Obstetrics and Gynecology, Fundación Valle del Lili, Cali, Colombia.,Abnormally Invasive Placenta Unit, Fundación Valle del Lili, Cali, Colombia.,Department of Health Sciences, School of Medicine, Universidad ICESI, Cali, Colombia.,Department Urology, Fundación Valle del Lili, Cali, Colombia
| | - Juan Gabriel de Ríos-Posada
- Tertiary Obstetric Unit, Department of Obstetrics and Gynecology, Fundación Valle del Lili, Cali, Colombia.,Abnormally Invasive Placenta Unit, Fundación Valle del Lili, Cali, Colombia.,Department of Health Sciences, School of Medicine, Universidad ICESI, Cali, Colombia.,Department Urology, Fundación Valle del Lili, Cali, Colombia
| | - Luis Alberto Plazas-Córdoba
- Tertiary Obstetric Unit, Department of Obstetrics and Gynecology, Fundación Valle del Lili, Cali, Colombia.,Abnormally Invasive Placenta Unit, Fundación Valle del Lili, Cali, Colombia.,Department of Health Sciences, School of Medicine, Universidad ICESI, Cali, Colombia.,Department Urology, Fundación Valle del Lili, Cali, Colombia
| | - Margarita María Chancy-Castaño
- Tertiary Obstetric Unit, Department of Obstetrics and Gynecology, Fundación Valle del Lili, Cali, Colombia.,Abnormally Invasive Placenta Unit, Fundación Valle del Lili, Cali, Colombia.,Department of Health Sciences, School of Medicine, Universidad ICESI, Cali, Colombia.,Department Urology, Fundación Valle del Lili, Cali, Colombia
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15
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Park E, Lee JW, Kang M, Cho K, Cho BH, Lee KS. Detecting Bladder Biomarkers for Closed-Loop Neuromodulation: A Technological Review. Int Neurourol J 2018; 22:228-36. [PMID: 30599493 DOI: 10.5213/inj.1836246.123] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2018] [Accepted: 12/11/2018] [Indexed: 12/19/2022] Open
Abstract
Neuromodulation was introduced for patients with poor outcomes from the existing traditional treatment approaches. It is well-established as an alternative, novel treatment option for voiding dysfunction. The current system of neuromodulation uses an open-loop system that only delivers continuous stimulation without considering the patient's state changes. Though the conventional open-loop system has shown positive clinical results, it can cause problems such as decreased efficacy over time due to neural habituation, higher risk of tissue damage, and lower battery life. Therefore, there is a need for a closed-loop system to overcome the disadvantages of existing systems. The closed-loop neuromodulation includes a system to monitor and stimulate micturition reflex pathways from the lower urinary tract, as well as the central nervous system. In this paper, we reviewed the current technological status to measure biomarker for closed-loop neuromodulation systems for voiding dysfunction.
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16
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Freitas Filho LG, Carnevale J, Leite MTC, Kanasiro F, Budib LJ. Bladder acontratility after hypospadia repair. Urol Case Rep 2018; 19:25-27. [PMID: 29888182 PMCID: PMC5991308 DOI: 10.1016/j.eucr.2018.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2018] [Revised: 04/24/2018] [Accepted: 05/01/2018] [Indexed: 11/30/2022] Open
Affiliation(s)
| | | | | | | | - Luiz J Budib
- Department of Urology, Hospital Santa Marcelina, Brazil
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17
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Hentzen C, Haddad R, Ismael SS, Peyronnet B, Gamé X, Denys P, Robain G, Amarenco G; GRAPPPA (Clinical research Group of perineal dysfunctions in older adults). Intermittent Self-catheterization in Older Adults: Predictors of Success for Technique Learning. Int Neurourol J 2018; 22:65-71. [PMID: 29609423 DOI: 10.5213/inj.1835008.504] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2017] [Accepted: 03/01/2018] [Indexed: 11/17/2022] Open
Abstract
Purpose The main goal of this retrospective study is to explore the predictors of success in learning clean intermittent self-catheterization (CISC) in patients over 65 years of age. The secondary goal is to assess whether in this population, the risk of failure to perform CISC is greater, compared with patients under 65 with similar pathologies. Methods All patients older than 65 consulting between January 2011 and January 2016 for learning CISC were included. A control population younger than 65 matching with sex, body mass index, and pathology was selected. Results One hundred sixty-nine of the 202 patients (83.7%) over 65 succeeded in learning CISC. Obesity (P<0.05), low pencil and paper test (PP test) (P<0.01) and low functional independence measure (FIM) (P<0.01) scores were risk factors of failure. No significant differences were found with sex or pathology. In multivariate analysis, low PP test perineum access (odds ratio [95% confidence interval], 2.30 [1.32–4.42]), low FIM motor (1.04 [1.01–1.08]), and FIM cognition (1.18 [1.03–1.37]) scores were independent factors of learning failure. Compared to control group, age over 65 was not predictive of failure (P=0.15). Conclusions Our study shows that success in learning CISC does not depend on age but on difficulties in mobility, access to perineum and probably cognitive disorders.
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18
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Abstract
Underactive bladder (UAB), which has been described as a symptom complex suggestive of detrusor underactivity, is usually characterized by prolonged urination time with or without a sensation of incomplete bladder emptying, usually with hesitancy, reduced sensation on filling, and slow stream often with storage symptoms. Several causes such as aging, bladder outlet obstruction, diabetes mellitus, neurologic disorders, and nervous injury to the spinal cord, cauda equine, and peripheral pelvic nerve have been assumed to be responsible for the development of UAB. Several contributing factors have been suggested in the pathophysiology of UAB, including myogenic failure, efferent and/or afferent dysfunctions, and central nervous system dysfunction. In this review article, we have described relationships between individual contributing factors and the pathophysiology of UAB based on previous reports. However, many pathophysiological uncertainties still remain, which require more investigations using appropriate animal models.
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Affiliation(s)
- Naoki Aizawa
- Department of Continence Medicine, The University of Tokyo Graduate School of Medicine, Tokyo, Japan
| | - Yasuhiko Igawa
- Department of Continence Medicine, The University of Tokyo Graduate School of Medicine, Tokyo, Japan
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19
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Kaufmann A. [Urodynamic studies prior to urinary incontinence surgery : What is useful?]. Urologe A 2017; 56:1539-1547. [PMID: 29079907 DOI: 10.1007/s00120-017-0530-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Surgery is often necessary after failure of conservative therapy for urinary incontinence. Guidelines recommend urodynamic studies before surgery. A distinction is made between non-invasive (uroflowmetry) and invasive methods (cystometry and pressure-flow study, if necessary as combined videourodynamics, as well as urethral pressure profile). All examinations serve to objectify and quantify the symptoms, to correctly assign symptoms to the pathophysiology and anatomy as well as to identify risk factors, which often have a significant influence on the success of surgical therapy. Given appropriate experience, complications and often significant sequelae of bladder dysfunction affecting the patient's quality of life and life expectancy can be recognized. Urodynamic studies are performed to help narrow down potential diagnoses, to develop therapeutic strategies, and to obtain prognostic parameters. The following article is intended to provide some support.
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Affiliation(s)
- A Kaufmann
- Zentrum für Kontinenz und Neuro-Urologie, Kliniken Maria Hilf GmbH, Akademisches Lehrkrankenhaus der Uniklinik RWTH Aachen, Viersener Straße 450, 41063, Mönchengladbach, Deutschland.
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20
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Song HS, Choo GY, Jin LH, Yoon SM, Lee T. Transvaginal cystocele repair by purse-string technique reinforced with three simple sutures: surgical technique and results. Int Neurourol J 2012; 16:144-8. [PMID: 23094221 DOI: 10.5213/inj.2012.16.3.144] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2012] [Accepted: 09/27/2012] [Indexed: 11/08/2022] Open
Abstract
PURPOSE Different techniques for cystocele repair including the conventional anterior colporrhaphy and mesh technique are known. Our goal was to evaluate the anatomical success and safety of our method of transvaginal anterior vaginal wall repair by the purse-string technique reinforced with three simple additional sutures in the repair of cystocele over a 4-year follow-up period. METHODS This was a retrospective review of 69 consecutive patients (grades 2 to 4) who underwent the above operations between 2001 and 2011, including their success rates as assessed by use of the Baden-Walker halfway classification system. RESULTS Of the patients, 62 patients (98%) were completely cured of cystocele and 1 patient showed grade 2 cystocele recurrence that required no further treatment. Two patients with grade 4 cystocele were completely cured. There was no vaginal erosion related to the cystocele repair. CONCLUSIONS Transvaginal anterior colporrhaphy by a purse-string technique reinforced with simple additive sutures appears to be a simple, safe, and easily performed approach in cystocele repair. There is no need for other material for reinforcement, even in high-grade cystocele, which is an advantage of our technique.
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21
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Tolkach Y, Gadjiev N, Korol V, Gonchar I. Vesico-Acetabular Fistula and Urolithiasis in the Hip Joint Cavity due to Persistent Bladder Entrapment after Acetabular Fracture. Korean J Urol 2011; 52:221-4. [PMID: 21461289 PMCID: PMC3065137 DOI: 10.4111/kju.2011.52.3.221] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2010] [Accepted: 01/27/2011] [Indexed: 11/18/2022] Open
Abstract
We report a rare case of vesico-acetabular fistula due to an improperly treated pelvic fracture with urinary stone formation in the joint cavity. This complication was related to an unrecognized mechanism of bladder wall entrapment in the acetabular floor defect during weight bearing. This situation led to several mistreatment decisions in our case and should be always considered by urologists dealing with patients after major pelvic trauma. In this case report, we analyze the publications related to this problem, discuss the main mechanisms of bladder wall damage after acetabular fracture, and propose tips for diagnosis and treatment.
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Affiliation(s)
- Yuri Tolkach
- Urology Clinic, Military Medical Academy, Saint-Petersburg, Russia
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