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Biomedical subjects

J J Wyndaele

Publications and source records attributed to J J Wyndaele.

At least 19 recordsLinked to original sources
PubMed2002

Value of increase in bladder capacity in treatment of refractory monosymptomatic nocturnal enuresis in children.

OBJECTIVES: To evaluate children with refractory monosymptomatic nocturnal enuresis to determine whether detrusor overactivity (DOA) plays a role in 4 weeks of unsuccessful treatment with retention control training (RCT); whether an increase in bladder capacity can eventually be obtained by RCT plus oxybutynin; and whether the increase in capacity is the primary key to success. METHODS: Sixty-eight children with refractory monosymptomatic nocturnal enuresis were included. They all had a maximal cystometric capacity less than the age-expected value. RCT was done by water loading and retention to the point of urgency once daily. During training, changes in bladder capacity were evaluated by voiding charts. If after 4 weeks of RCT, less than a 10% increase in bladder capacity was noted, oral oxybutynin was added. RESULTS: The incidence of DOA was 66%. After 4 weeks of RCT, the bladder capacity increased in 20.6%. Combining RCT with oxybutynin led in the end to normalization of the bladder capacity in 79.4%. Older age and high-pressure DOA negatively influenced the ability to increase the bladder capacity. Fifteen children became completely dry, mainly by converting enuresis to nocturia. CONCLUSIONS: Unsuccessful RCT is often caused by DOA, especially if a bladder capacity rise of at least 10% cannot be achieved within 4 weeks. If oxybutynin is added to the treatment, normalization of bladder capacity can be obtained in most. This increased bladder capacity cures enuresis only in a minority by sharpening their arousal and provoking nocturia.

Administration, Oral↗
PubMed2002

Cystometrical sensory data from a normal population: comparison of two groups of young healthy volunteers examined with 5 years interval.

OBJECTIVE: To describe the pattern of sensations reported during standardized cystometry in a group of healthy young volunteers and compare them with a group examined 5 years before. METHODS: A group of 50 young healthy volunteers without any symptoms or history reported the sensations they felt during cystometry. These results were compared with those of another group of 38 young healthy volunteers examined in the same lab in 1995 by another investigator. RESULTS: All participants perceived a first sensation of bladder filling, first desire to void and strong desire to void. Each sensation was easily distinguishable from the others. The volumes at which these sensations came up varied widely. The ratio between volumes at consecutive sensations and at full bladder was fairly constant. All but two parameters were not significantly different from those found in 1995. CONCLUSIONS: Our data give additional weight to previous findings that there exists a normal pattern of sensations reported during cystometric bladder filling. This sensory pattern probably corresponds with specific physiological mechanisms as suggested before. Deviations from this pattern indicate or illustrate pathology.

Adolescent↗
PubMed2002

Intermittent catheterization: which is the optimal technique?

STUDY DESIGN: Literature review to evaluate the practical techniques used for intermittent catheterization (IC) and intermittent self-catheterization (ISC). OBJECTIVES: To ascertain the requirements for proper IC and ISC. To evaluate if a best technique exists. METHODS: Relevant articles on the subject are reviewed. CONCLUSION: There is a wide variety of materials and techniques applied for IC and ISC. This does not seem to change the practical outcome much if the basic principles are used: good education and training, clean and atraumatic technique, good patient compliance in the long-term. There is neither one best technique nor one best material for IC. Both depend greatly on the patient's individual anatomic, social and economic state.

Humans↗
PubMed2002

Complications of intermittent catheterization: their prevention and treatment.

STUDY DESIGN: Literature review to evaluate the complications seen in patients on intermittent catheterization (IC) and intermittent self-catheterization (ISC). OBJECTIVES: To find the prevalence of most complications seen in patients on IC. To study the prevention and the treatment of these complications. SETTING: An international literature review. METHODS: Most relevant articles on the subject are reviewed. CONCLUSION: Urinary tract infection is the most frequent complication in patients performing IC. Catheterization frequency and the avoidance of bladder overfilling are amongst the most important prevention measures. Asymptomatic bacteriuria does not need to be treated with antibiotics. Long-term antibacterial prevention does seem to bear a risk of development of bacterial resistance. Previous treatment with indwelling catheters is a risk factor for chronic infection and urinary sepsis. Prostatitis is more frequently present than often thought. Epididymitis and urethritis are rare. Trauma from catheterization occurs regularly, but lasting effects are more limited. However, the prevalence of urethral strictures and false passages increases with longer use of IC. The use of hydrophilic catheters might be able to lower the urethral complication rate but additional proof through comparative studies is needed. The most important prevention measures are good education of all involved in IC, good patient compliance, the use of a proper material and the application of a good catheterization technique.

Humans↗
PubMed2002

Results of a questionnaire evaluating the effects of different methods of toilet training on achieving bladder control.

OBJECTIVE: To analyse if family situation, personal habits and toilet training methods can influence the achievement of bladder control. SUBJECTS AND METHODS: A questionnaire with 41 questions was distributed to 4332 parents of children completing the last 2 years of normal primary school. The questionnaire had been tested for reproducibility of the answers in a random subgroup of 80 parents. The aims of the investigation were explained in an accompanying letter and the response rate was 76.7%. The result were analysed using the chi-square test (Yates corrected). RESULTS: Two groups of children were identified, one with no lower urinary tract symptoms (3404) and one with complaints of daytime and night-time wetting, and urinary tract infections (928). The groups were termed the 'control' and 'symptom' groups, respectively. There were no differences in the family situation between the groups. The symptom group reported more 'below average' school results and less independence in homework and hygiene. The age at which toilet training started was significantly higher in the symptom group and scheduled voiding was used significantly less. The reaction of the parents when the attempt at voiding was unsuccessful was significantly different; in the control group most parents just postponed the effort and had the child try again later, whereas in the symptom group more parents asked the child to push, made special noises or opened the water tap. CONCLUSIONS: These data show significant differences in toilet training between children with and with no lasting problems of bladder control. Postponing the onset of the training after 18 months of age and using certain methods to provoke voiding (asking to push, opening the water tap) probably increases the risk of later problems with bladder control.

Age of Onset↗
PubMed2002

Urinothorax: a rare pleural effusion.

A 68-year old man suffered severe respiratory distress, secondary to massive pleural effusion on the right side several hours after removing the nephrostomy tube from both right and left kidneys. A chest tube was placed and a yellowish fluid was evacuated. This was found to be urine from a fistula between the right pelvis and the chest cavity. Diagnosis and management of urinothorax are discussed.

Aged↗
PubMed2002

Voiding habits and wetting in a population of 4,332 Belgian schoolchildren aged between 10 and 14 years.

OBJECTIVE: To determine the prevalence of daytime- with/without night-time wetting, in Belgium, in a group of 10 to 14 year old schoolchildren, and to study the voiding habits. SUBJECTS AND METHODS: A questionnaire of 41 questions was developed and completed by 4,332 parents at home. RESULTS: Wetting or soiling episodes were reported by a total of 528 (12%) of the children: monosymptomatic nocturnal enuresis by 62 (1%), daytime wetting with/without night-time wetting by 343 (8%), and faecal soiling by 123 (3%). We found significantly more girls in the wetting group, and the capacity to regularly postpone the voiding was significantly lower in this group. Significantly more children had nocturia in the group with wetting. CONCLUSIONS: Children with daytime wetting with/without night-time wetting have very often bladder-sphincter dysfunctions, which is in turn correlated with recurrent urinary tract infections. Eight percent of the 10 to 12 year old schoolchildren report daytime wetting with/without night-time wetting with some frequency. Surprisingly few parents, especially in the daytime wetting group, searched for medical help. Physicians and paediatricians should be encouraged to be more attentive to wetting in children and initiate discussion about urinary en faecal problems with parents and children.

Adolescent↗
PubMed2002

[Normality of bladder function. A study of young healthy volunteers].

Through urodynamic evaluations of sensation and of motor function in 39 young healthy volunteers, we were able to gain information on what can be considered "normal" in lower urinary tract function and to evaluate technical urodynamic tests. Most urodynamic parameters show large variations. Numeric data considered pathological in literature are found in our symptomfree study group. The principle of urodynamic testing should be to reproduce the symptoms patients complain about during the test and then correlate these symptoms with the urodynamic data. Different urodynamic data in a normal population are presented. Several of these were not available before.

Adult↗
PubMed2001

Conservative treatment of stress urinary incontinence in women: who will benefit?

The aim of the study was to find out which factors can predict the outcome of conservative treatment of urinary stress incontinence in women. One hundred and four women with stress urinary incontinence were evaluated by recall, and by clinical and urodynamic investigation and were given pelvic floor muscle exercises with or without the use of biphasic low-frequency electrostimulation and visual biofeedback. Two groups could be distinguished. The first consisted of 37 patients in whom conservative therapy proved successful; the second consisted of 67 patients in whom incontinence continued. The study investigated whether there was a significant difference in patients' characteristics between the two groups. The number of conservative treatment sessions was not different between the two groups. The presence of a high body mass index, previous pelvic surgery, strong levator muscles and urethral hypermobility appeared to be poor prognostic features. More research is required to evaluate which patients can benefit from conservative treatment and which criteria can predict the outcome of pelvic floor physiotherapy in women with stress incontinence. This way, patients selection is possible and excessive costs can be saved.

Adult↗
PubMed2001

Can the sensory threshold toward electrical stimulation be used to quantify the subjective perception of bladder filling? A study in young healthy volunteers.

OBJECTIVES: To evaluate whether electrosensation can be used as a quantitative measurement for the sensations felt during bladder distension. METHODS: A total of 48 healthy volunteers were examined. Sensations of bladder distension were evaluated during medium-fill cystometry. Electrosensation was quantified by obtaining electrical thresholds at different sites in the lower urinary tract with constant current stimulation at 2.5 and 95 Hz. RESULTS: Both currents were perceived differently. Thresholds at 95 Hz were significantly higher than at 2.5 Hz for each location. With neither current could a significant correlation be found between the parameters of filling perception and electrosensation in the lower urinary tract. CONCLUSIONS: Although the use of electrical thresholds is a valuable technique in the diagnosis of neuropathic disorders in the lower urinary tract, at the current settings it cannot be used to quantify the perception of bladder filling.

Adult↗
PubMed2001

Conservative treatment of the neuropathic bladder in spinal cord injured patients.

Different conservative treatment modalities for the lower urinary tract dysfunction in patients with spinal cord lesion are reviewed. Conservative treatment is still the mainstay of the urological management in these patients. Growing experience has changed the classical approach. Spontaneous voiding with and without triggered voiding and/or bladder expression has proven to be less safe except in well defined patients with regular urological follow-up. Nowadays, intermittent catheterisation and self catheterisation with and without bladder relaxants are accepted as the methods of choice. Condom catheters are still needed if incontinence persists, while penile clamps have no place in the treatment of patients with spinal cord lesions. Long-term indwelling catheters should be avoided. External electrical stimulation can be used to correct the neurogenic dysfunction by neuromodulation and/or to induce a direct therapeutic response in the lower urinary tract.

Animals↗
PubMed2001

Cystosarcoma phyllodes of the prostate with rhabdomyoblastic differentiation.

A 36-year-old man presented with recurrent urinary obstruction and an enlarged, partially cystic prostate tumour on ultrasonography. Microscopically, the tumour was composed of cystically dilated ducts with leaf-like stromal projections in the lumen. A portion of the stroma was very cellular with atypia and a high mitotic rate. In addition, there was a small focus with well differentiated rhabdomyoblasts. This case is the second description of a cystosarcoma phyllodes of the prostate with rhabdomyoblasts differentiation. With radical surgery and chemotherapy only partial remission could be obtained.

Adult↗
PubMed2001

Results of a questionnaire evaluating different aspects of personal and familial situation, and the methods of potty-training in two groups of children with a different outcome of bladder control.

OBJECTIVE: This study aimed to investigate the family situation, personal behaviour and current micturition habits, the time of beginning and the method of potty-training in two groups of children with different outcomes of bladder control. MATERIAL AND METHODS: Parents of 140 children, between 7 and 15 years old, filled in a questionnaire comprising 43 questions. They were divided into a symptom group (n = 73) and a symptom-free group (n = 67) according to the outcome of bladder control. RESULTS: Parents remembered clearly the method of training and the time of starting the potty-training to achieve continence in their child, and the exact age at which these objectives were achieved. There was some confusion regarding the term incontinence: the majority of the parents (70%) considered their child to be continent in spite of day-wetting several times a week. All children with urge syndrome who had undergone a urodynamic investigation (n = 50) had an objective functional bladder disorder. CONCLUSIONS: Methods of training differed between the groups with and without lasting problems. The symptom group started training at a later age, had more tendency to punish and were more demanding when micturition did not start readily. The findings from the questionnaire strengthen the hypothesis that urge syndrome can be due to poor methods of potty-training. Very few parents searched spontaneously for help, which should prompt practitioners and paediatricians to be more alert to this problem.

Child↗
PubMed2001

Does bladder tone influence sensation of filling and electro-sensation in the bladder? A blind controlled study in young healthy volunteers using bethanechol.

PURPOSE: The influence of bladder tone on filling sensation and electro-sensation in the bladder was studied in young healthy volunteers. MATERIALS AND METHODS: A total of 22 healthy volunteers 18 to 30 years old were included in our study, of whom 15 received a subcutaneous injection of 5 mg bethanechol and 7 received a subcutaneous injection of water to serve as randomly selected controls. In each group filling perception was evaluated during medium fill cystometry before and 25 minutes after injection. The bladder electrical threshold was determined in each group by constant current stimulation before and 25 minutes after injection. RESULTS: In the study group there was a marked decrease in the volume at which various filling sensations occurred after bethanechol was given. The pressure at which all filling sensations were perceived was higher after bethanechol than at baseline cystometry. The electrical threshold decreased with bethanechol. In the control group no change was noted in the perception of filling or electro-sensation. CONCLUSIONS: Bethanechol has a distinct influence on the filling sensation and on electrical bladder stimulation. Each sensation is sharpened after the administration of bethanechol. Several hypotheses are possible to explain these effects.

Adolescent↗
PubMed2001

Renal failure in patients with neurogenic lower urinary tract dysfunction.

People with multiple sclerosis, paraplegia and neural tube defects typically have neurogenic lower urinary tract dysfunction (NLUTD). This encompasses detrusor hyperreflexia with or without detrusor sphincter dyssynergia and hypo- or acontractility. Their effects undermine safe, effective and controlled storage and voiding of urine and predispose to reflux nephropathy. Therefore, patients in these diagnostic groups with NLUTD would be expected to have increased risk of renal failure. The aim of this study was to quantify this risk using the General Practice Research Database (GPRD). All patients registered in the database between 1994 and 1997 and aged 10-69 were included in the study. The prevalence and incidence of renal failure and renal replacement therapy in the general population was ascertained, as was the prevalence of multiple sclerosis, paraplegia and neural tube defects. The prevalence of renal failure in each of the special populations was then compared with the prevalence in the unaffected general population. The age-standardised prevalence of renal failure in the GPRD population aged 10-69 years was 14 per 10,000. The rate ratio of renal failure compared with the general population in each of the years 1994-1997 for neural tube defects ranged between males (M) 6.8-9.0 and females (F) 9.2-11.5, for paraplegia M 4.1-9.0, F 4.0-7.0, and for multiple sclerosis M 0.4-1.3, F 0.5-2.2. As expected, people with paraplegia or neural tube defects were found to have a substantially increased risk of renal failure compared with the general population. We could not demonstrate an increased risk of renal failure in people with multiple sclerosis. We believe this finding requires further study, but may reflect a problem in the recognition of renal failure in this group of patients. We recommend that all three patient groups should be regularly screened so that renal impairment may be detected prior to the development of renal failure.

Adolescent↗
PubMed2001

Twelve-month treatment of overactive bladder: efficacy and tolerability of tolterodine.

CONTEXT: Tolterodine is a bladder-selective antimuscarinic agent designed for the treatment of overactive bladder. Traditional antimuscarinic therapies are poorly tolerated due to a high incidence of anticholinergic adverse events and consequently few patients remain on long term therapy. OBJECTIVE: To evaluate the long term efficacy and tolerability of tolterodine in patients with symptoms of overactive bladder. DESIGN: Twelve-month open-label extension of 4 randomised, placebo-controlled, double-blind, multinational, multicentre trials of 4 weeks' duration. PATIENTS: 714 patients (aged 18 to 92 years) with symptoms of overactive bladder who completed the double-blind portion of the studies. INTERVENTION: Tolterodine 2 mg twice daily for up to 12 months. MAIN OUTCOME MEASURES: Micturition diary variables: number of micturitions per 24 hours, number of urge incontinence episodes per 24 hours, mean urine volume voided per micturition. Safety variables: adverse events, study discontinuation rate. RESULTS: A total of 441 patients (62%) completed 12 months' open-label treatment with tolterodine, which significantly reduced the number of micturitions per 24 hours [mean change -2.4, 95% confidence interval (CI) -2.7 to -2.2, median change -20%, p < 0.0001] and number of urge incontinence episodes per 24 hours (mean change -1.3, 95% CI -1.6 to -1.0, median change -74%, p < 0.0001), while the mean volume voided per micturition was significantly increased (+33 ml, 95% CI +28 to +38, median change +18%; p < 0.0001). 41% of patients reported dry mouth (27% mild, 10% moderate, 3% severe). Dosage reduction to 1 mg twice daily was required in 23% of patients. 15% of patients withdrew from the study due to adverse events, with 5% having associated dry mouth. CONCLUSIONS: The high percentage of patients completing 12 months' treatment indicates that tolterodine is an effective and well tolerated agent for long term treatment of overactive bladder.

Adolescent↗