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Results for “Urethral Obstruction”

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PubMed2006

Partial urethral obstruction enhances NADPH-diaphorase activity in the monkey (Macaca fascicularis) bladder: light and electron microscopic studies.

The effect of partially obstructing the urethra on the nicotinamide adenine dinucleotide phosphate-diaphorase (NADPH-d) activity in neurons of the intramural ganglia of the monkey (Macaca fascicularis) bladder was examined by light and electron microscopy. Partial urethral ligation was done in adult male monkeys. The animals were sacrificed 2, 4 weeks after partial urethral obstruction. This was compared to controls (normal and sham operated). Urethral obstructed animals were observed to have increased urinary frequency and decreased urinary flow rate. Two weeks after urethral obstruction, the overall NADPH-d activity in the intramural ganglia of the bladder base was enhanced compared to control animals. The frequency of intensely stained NADPH-d positive neurons was increased compared to the control animals. About one-third of intensely stained NADPH-d positive neurons appeared to undergo degenerative changes. At 4 weeks after urethral obstruction, a wide occurrence of NADPH-d positive neurons in advanced stages of degeneration in the bladder base was observed. Cellular debris was strewn among normal looking ganglion cells and along the nerve processes. The proportion of intensely stained NADPH-d positive neurons was relatively lower than the controls. The total number of NADPH-d positive neurons and the nerve fibres in the entire bladder was significantly reduced when compared to control animals. Electron microscopy showed some NADPH-d activity in intramural ganglion cells in 2 weeks after partial urethral obstruction. NADPH-d reaction product (formazan) was deposited on the membranes of the rough endoplasmic reticulum, and the outer membranes of some mitochondria in the intramural neuron. At 4 weeks after urethral obstruction, NADPH-d was present in the membrane of the mitochondria and some mitochondria appeared swollen with disrupted cristae. Present results show that NADPH-d activity in neurons of the intramural ganglia of the monkey (Macaca fascicularis) urinary bladder was increased after two weeks and reduced after 4 weeks of partial urethral obstruction. It is speculated that the increased NADPH-d activity associated with partial urethral obstruction would lead to neuronal damage and death, which may contribute to detrusor overactivity. However, it warrants further investigation to understand the mechanism of neuronal cell death after partial urethral obstruction.

Animals↗

PubMed2006

Evaluation of palliative stenting for management of malignant urethral obstructions in dogs.

OBJECTIVE: To evaluate use of balloon-expandable and self-expanding metallic stents in management of malignant urethral obstructions in dogs. DESIGN: Original study. ANIMALS: 12 dogs with malignant urethral obstructions. PROCEDURES: The extent and location of urethral obstructions and the diameter of adjacent unaffected luminal segments were determined by use of fluoroscopically guided wires and measuring catheters. Stents were chosen to extend approximately 1 cm proximal and distal to the obstruction. Stent diameters were chosen to be approximately 10% greater than the diameter of healthy portions of the urethra to prevent displacement. Stents were placed in the urethra under fluoroscopic guidance to restore luminal patency. RESULTS: 3 dogs received balloon-expandable metallic stents, and 9 dogs received self-expanding metallic stents. The placement procedures were rapid, safe, and effective at restoring luminal patency and were not associated with major complications. Complications included recurrent urethral obstruction secondary to blood clot formation and urethral edema in 1 dog and stent dislodgement into the urinary bladder in 1 dog. All dogs were able to urinate immediately after the procedure. Nine dogs (3/4 females and 6/8 males) were continent or mildly incontinent after stent placement. Of the remaining 3 dogs, 2 developed severe incontinence and 1 had an atonic bladder. Seven dogs were considered to have good to excellent outcome, 3 had fair outcome, and 2 had poor outcome. CONCLUSIONS AND CLINICAL RELEVANCE: Transurethral placement of metallic stents was a safe and effective palliative treatment option for dogs with malignant urethral obstructions.

Animals↗

PubMed1999

[Function and nerve growth factor of the rat urinary bladder during urethral obstruction and its relief].

It has been considered that the urethral obstruction influence the function and the nerve innervation of the bladder. In this study, the changes in the bladder function and the nerve growth factor (NGF) synthesized in the bladder were systematically analyzed both during partial urethral obstruction and after its relief in the rat. The maximum contraction pressure was temporally decreased and then increased 1.5 times of the normal level 6 week after the obstruction. NGF in the bladder, measured by ELISA method, was rapidly increased 5 times of the normal level 1 day after the obstruction. It gradually decreased 2 weeks after the obstruction but did not recover to the normal level. The maximum contraction pressure and the bladder NGF recovered to the normal level after the removal of 1 to 6 weeks obstruction. These results suggest that partial urethral obstruction reversibly increases the contractility and the NGF synthesis of the bladder.

Animals↗

PubMed1989

Transvaginal urethrolysis after obstructive urethral suspension procedures.

Obstructive uropathy after an operation for stress incontinence was treated by transvaginal urethrolysis in 13 women. Bladder outlet obstruction developed after retropubic urethropexy in 6 patients, after needle suspension in 4 and after a pubovaginal sling operation in 3. Transvaginal urethrolysis was accompanied by a needle suspension in 2 patients, an Inglemann-Sundberg denervation in 1 and a pubovaginal sling in 1. Of 13 patients 10 are voiding and none has stress incontinence but 3 continue to perform intermittent self-catheterization.

Adult↗

PubMed2003

Simple sling incision for the treatment of iatrogenic urethral obstruction.

OBJECTIVES: To review a single-institution experience with sling incision to treat urethral obstruction resulting from pubovaginal sling placement. Urethrolysis involving full mobilization of the urethra has traditionally been used to treat urethral obstruction resulting from a pubovaginal sling. Recently, sling incision has been reported to be a technically simpler, less potentially morbid technique to relieve such obstruction. METHODS: The charts of 14 women with iatrogenic urethral obstruction from pubovaginal slings who were treated with simple sling incision were reviewed. Presenting symptoms and physical findings and outcomes (primarily resolution of obstructive and irritative symptoms, change in postvoid residual volume, and change in continence status) were evaluated. RESULTS: Eleven patients had a biologic sling and three a mid-urethral polypropylene mesh sling. All patients had either obstructive or irritative findings or retention and 10 of 14 had an elevated postvoid residual volume. The average follow-up was 12 months. Overall, 13 (93%) of 14 had complete or significant improvement of presenting complaints, and 1 (7%) eventually required formal urethrolysis. Of the 13 with resolution of presenting complaints, 3 had residual irritative symptoms. Although 3 (21%) of 14 had some element of recurrent stress urinary incontinence, only 1 (7%) required treatment. CONCLUSIONS: Simple sling incision is an effective, technically simple, and safe treatment for women with iatrogenic urethral obstruction after placement of a pubovaginal sling. Its results are comparable to those of formal urethrolysis, and it may be considered as first-line treatment for iatrogenic obstruction after a sling procedure.

Equipment Failure↗

PubMed2000

Variations in strategy for the treatment of urethral obstruction after a pubovaginal sling procedure.

PURPOSE: We evaluated the success of several techniques for treating urethral obstruction and erosion after a pubovaginal sling procedure. MATERIALS AND METHODS: Between April 1998 and June 1999, 32 women 33 to 79 years old (average age 62) who underwent a pubovaginal sling procedure with various materials were referred for the assessment of urethral obstruction. Patients were evaluated with a urogynecologic history, physical examination, voiding diary, cystoscopy and video urodynamics. Surgical procedures to resolve urethral obstruction were performed transvaginally and the specific techniques used were based on the type of sling material, urethral erosion and concomitant stress incontinence or other urethral pathology. Outcome measures were assessed by disease specific quality of life questionnaires, voiding diary and urogynecologic questionnaire. RESULTS: Preoperatively 30 of the 32 women (93.7%) noticed urge incontinence, 20 (62.5%) performed intermittent self-catheterization, 6 (18.7%) had an indwelling catheter and 3 (9%) complained of concomitant stress urinary incontinence. After the sling takedown 29 patients (93.5%) achieved efficient voiding within week 1 postoperatively. Urge incontinence symptoms resolved in 20 cases (67%) but stress incontinence developed in 3 (9%). Of the 32 women 27 (84%) indicated that continence was much better than before the initial sling procedure. CONCLUSIONS: Managing urethral obstruction after a pubovaginal sling procedure is challenging. Using various techniques based on sling material, urethral erosion and bladder neck integrity a successful outcome is possible in the majority of cases.

Adult↗

PubMed1997

Increased NADPH-diaphorase reactivity in bladder afferent pathways following urethral obstruction in guinea pigs.

The distribution of reduced nicotinamide adenine dinucleotide phosphate diaphorase (NADPH-d) reactivity and its alterations after urethral obstruction were examined histochemically in bladder afferent pathways in male guinea pigs. The bladder afferent neurons in L6-S2 dorsal root ganglia (DRG) and their central projections in the corresponding spinal cord segments were identified by retrograde axonal transport following injection of Fast Blue (FB) into the bladder walls. In control animals, a large number of DRG neurons in L6-S2 segments were moderately or weakly stained for NADPH-d, with a small number of them being intensely stained. Following urethral obstruction, NADPH-d reactivity was noticeably increased in the same cells beginning at 24 hours, and was markedly enhanced at 48 hours. Results of cell count showed that the number of intensely stained NADPH-d cells was significantly increased in L6-S2 DRG of the urethral obstructed animals when compared with that of the controls (P < 0.01). In the corresponding spinal cord segments, NADPH-d reactivity in the fibre bundle extending from the Lissauer's tract to the sacral parasympathetic nucleus (SPN) became more pronounced. In sections double labelled for NADPH-d and FB, increased NADPH-d reactivity was detected in the FB-labelled bladder afferent neurons in DRG and their projections in the spinal cord. Present results indicate that neuronal NADPH-d in the bladder afferent pathways is plastic and could be upregulated following urethral obstruction. It is suggested that such alteration may be involved in the processing of nociceptive inputs as a result of overdistension of the bladder after urethral obstruction.

Afferent Pathways↗

PubMed2001

Urodynamic follow-up of experimental urethral obstruction in individual guinea pigs.

It is unknown whether changes in bladder function due to urethral obstruction follow a specific sequence. To answer this, we adapted a small animal model to allow repeated complete pressure-flow studies, enabling individual follow-up of changes in bladder function on urethral obstruction. Obstruction was induced in guinea pigs by placing a silver ring around the urethra. Urodynamic studies were repeated under anesthesia with ketamine/xylazine. Bladders were filled and bladder pressure measured through a single suprapubic catheter. Urine flow rate was measured using an ultrasound probe around the penis. Accurate measurements of bladder pressure and urine flow rates were obtained at 1-week intervals for 11 weeks in individual guinea pigs. In the control animals, the urodynamic parameters did not show significant changes. In the obstructed group, urethral resistance (P(low,ave)) increased from 20 to 35 cm H(2)O after 4 weeks and remained at that level. The maximum flow rate (Q(max)) increased from 0.17 to 0.24 mL/s after 2 to 3 weeks. After this peak, it gradually decreased to lower than the starting value after 10 to 11 weeks. The pressure at maximum flow rate (p(Qmax)) increased from 24 to 47 cm H(2)O after 6 to 7 weeks and thereafter declined. During weeks 1 through 4 of obstruction, unstable contractions were seen. All animals followed a similar sequence of patterns but at variable rates. Our animal model allows complete urodynamic follow-up of individual animals with urethral obstruction. We observed a specific sequence of changes in urodynamic patterns and parameters of bladder function.

Animals↗

PubMed1997

Concentration of ionized calcium in plasma from cats with urethral obstruction.

OBJECTIVE: To measure ionized calcium concentration in plasma from cats with urethral obstruction and to correlate these values with results of clinical biochemical analyses and physical examinations. DESIGN: Prospective study. ANIMALS: 24 male cats. PROCEDURE: Blood samples were obtained from each cat on admission, and PCV, pH, and concentrations of ionized calcium, total calcium, glucose, total solids, sodium, potassium, BUN, creatinine, chloride, magnesium, albumin, and phosphorus were determined. Mentation, tissue perfusion, and ECG recordings were also assessed. RESULTS: 18 (75%) cats had low ionized calcium concentrations (reference range, 2.4 to 2.8 mEq/L). Hypocalcemia was considered mild (2.0 to 2.36 mEq/L) in 9 (37.5%) cats, moderate (1.6 to 1.98 mEq/L) in 6 (25%), and severe (< 1.6 mEq/L) in 3 (12.5%). Significant positive correlations were found between ionized calcium concentration and heart rate, pH, and concentrations of sodium, chloride, and total calcium. Significant negative correlations were found between ionized calcium concentration and concentrations of potassium, BUN, creatinine, and phosphorus. CLINICAL IMPLICATIONS: Most cats with urethral obstruction had a low concentration of ionized calcium. This may contribute to cardiac electrical and mechanical dysfunction in some severely affected cats. Although effects of i.v. administration of calcium were not evaluated, results of this study strengthen the rationale for its use in cats with urethral obstruction.

Animals↗

PubMed1994

Similarity of the American Urological Association Symptom Index among men with benign prostate hyperplasia (BPH), urethral obstruction not due to BPH and detrusor hyperreflexia without outlet obstruction.

OBJECTIVE: To compare the specificity of the American Urological Association (AUA) Symptom Index for benign prostatic hyperplasia (BPH) versus other urodynamically verified micturitional dysfunction in men. PATIENTS AND METHODS: Fifty-seven consecutive men who had been referred for video-urodynamic evaluation of voiding symptoms were evaluated. The patients were divided into three groups: (i) BPH group (n = 24); (ii) non-BPH obstructed group (n = 20; nine bladder neck obstruction, 11 bulbous urethral stricture); and (iii) detrusor hyper-reflexia group: detrusor hyper-reflexia without outlet obstruction (n = 13). RESULTS: The mean AUA symptom score for the BPH group was 18.9 (range 7-28). The mean score for the 20 non-BPH obstructed group was 17.6 (range 4-28) and the mean score for the 13 men with detrusor hyper-reflexia was 20.5 (range 12-27). There was no statistical difference in the AUA symptom score among the three groups. CONCLUSION: The AUA Symptom Index does not specifically identify BPH or bladder outlet obstruction. The index cannot differentiate the site of obstruction as noted by the similar scores among men with BPH from those with bladder neck obstruction and urethral strictures. Moreover, The AUA Symptom Index scores are similar between men with voiding symptoms secondary to bladder dysfunction and bladder outlet obstruction.

Aged↗

PubMed1993

Management of urethral obstruction with transvaginal urethrolysis.

Transvaginal urethrolysis was performed in 48 patients with urethral obstruction following 1 or more urethral suspension procedures. A needle suspension procedure had been performed in 19 patients (40%), retropubic urethropexy in 17 (35%) and pubovaginal sling in 10 (21%). A good response as indicated by normal voiding with minimal or no irritative symptoms was achieved in 33 patients (65%). The most common presenting complaints were irritative voiding symptoms (71%) and urinary retention (60%). Fluoroscopic urodynamic evaluation frequently demonstrated urethral hypersuspension, a cystocele and/or elevated voiding pressures. No patient had stress urinary incontinence as a result of the procedure. Urethral obstruction should be recognized as a potential complication following surgical correction of female stress urinary incontinence. Transvaginal urethrolysis is a safe and effective method to manage this problem.

Adult↗

PubMed1986

Unsuspected proximal urethral obstruction in young and middle-aged men.

Proximal urethral obstruction, a common cause of prostatism in young and middle-aged men, often is misdiagnosed as prostatitis, neurogenic bladder or a psychogenic voiding disorder. Simple urodynamic studies (uroflowmetry and cystometry) do not distinguish a poor flow owing to bladder neck obstruction from that caused by poor detrusor contractility in these patients. Only the simultaneous measurement of detrusor pressure and uroflowmetry can make this distinction. A total of 23 patients with unsuspected proximal urethral obstruction underwent synchronous video-pressure-flow electromyography studies, and were treated and followed for a minimum of 1 year. Treatment by transurethral prostatic resection or bladder neck incision almost always was curative but alpha-adrenoceptor blocking agents have not been effective. All patients who underwent transurethral prostatic resection or bladder neck incision at the 5 and 7 o'clock positions have had retrograde ejaculation but both patients who underwent unilateral bladder neck incision reported antegrade ejaculation.

Adult↗

PubMedDate not supplied

Functional urethral obstruction in 3 dogs: clinical and urethral pressure profile findings.

Three dogs with dysuria and urine retention caused by excessive functional urethral resistance are described. All dogs had clinical histories and urologic signs that previously would have been classified as detrusor-urethral dyssynergia. Diagnosis of functional urinary obstruction was established by exclusion of anatomic urinary obstruction and confirmed by urethral pressure profilometry. In 2 cases, multiple pressure deflections recorded in the urethral pressure profile suggested spasm of urethral musculature, whereas in a 3rd dog, abnormally high pressures were recorded along a portion of the proximal urethra. Functional urinary obstruction was associated with prostatitis in 1 dog and with a history of urethral calculi in 1 dog, and no underlying disorder could be identified in the remaining dog. All 3 dogs improved with medical treatments that included alpha adrenergic antagonists. The etiology, diagnosis, and pharmacologic management of functional urinary obstruction are discussed.

Animals↗

PubMed2004

Lateral excision of tension-free vaginal tape for the treatment of iatrogenic urethral obstruction.

OBJECTIVE: To report our experience on lateral excision of tape in women with iatrogenic urethral obstruction after the tension-free vaginal tape (TVT) procedure. METHODS: Seven women had iatrogenic urethral obstruction based on their clinical and urodynamic findings. All underwent lateral excision of the tape using the vaginal approach. Lower urinary tract symptoms, postvoid residual volume and urodynamic data were evaluated before and after excision. RESULTS: Before excision, all subjects had either irritative symptoms or increased postvoid residual volume (more than 100 mL), and 6 (85.7%) voided with strain. The mean time from initial surgery to tape excision was 28 days (range 4 to 108), with an average follow-up of 32 months (range 24-39). After the excision, voiding dysfunction was resolved in 6 of 7 patients. The remaining patient had significant improvement with only occasional symptoms of irritation. Two (28.6%) women reported recurrent stress incontinence and 1 (14.3%) required surgical treatment. The intervals for the 2 recurrent patients from TVT to excision were 4 days. The intervals for the 5 continent women were 15 to 108 days. CONCLUSION: Urethral obstruction after TVT is a relatively uncommon condition. It can be effectively treated with transvaginal lateral excision of the tape. Recurrent stress incontinence seems to be less likely to occur when the takedown procedure occurs beyond 14 days after the initial TVT operation.

Female↗

PubMed2002

Congenital posterior urethral obstruction: re-do fulguration.

In patients with congenital posterior urethral obstruction, transurethral fulguration (TUF) is usually the treatment of choice if the patient is in a stable condition. However, few papers have described the proportion of patients who need further fulguration. We reviewed 83 boys with a congenital obstructive posterior urethral membrane (COPUM) to assess the role of re-do fulguration, as judged by prospective video recordings. Between December 1990 and March 2000, 83 boys (aged from newborn to 15 years) underwent cystourethroscopy for investigation of a urethral anomaly and were found to have a COPUM. TUF was performed endoscopically with a hook diathermy electrode. Two to 3 months later boys who had cauterisation had a further urethroscopy and diathermy as required. Of the 83 membranous lesions in the posterior urethra, 38 were considered severe, 20 moderate, and 21 minor. Four patients had inadequate data to be properly classified. Eighteen (47.4%) of the 38 patients who had a severe obstructive membrane equired further endoscopic intervention to obliterate residual membrane elements. As over 45% of patients who had a severe obstructing membrane needed further fulguration, it is important to follow patients carefully and to repeat the cystourethroscopy.

Adolescent↗

PubMedDate not supplied

Early urethral obstruction sequence: a lethal entity?

Early urethral obstruction sequence (EUOS) is characterized by severe bladder distension by the end of the first trimester of pregnancy, resulting in renal dysplasia or hydronephrosis, oligohydramnios and subsequent lung hypoplasia. We reviewed the outcome of 18 fetuses with suspected EUOS. The mean gestational age at the time of diagnosis was 15 weeks. In 1 fetus, a vesicoamniotic shunt was placed unsuccessfully. Pregnancy was terminated in 11 fetuses and 9 showed signs of pulmonary hypoplasia and severe renal disease on autopsy. In 3 cases, the autopsy material could be evaluated. Premature delivery occurred in 2 patients, and 5 chose to deliver at term. All 7 fetuses died soon after birth because of respiratory failure and lung hypoplasia; renal abnormalities were also found on autopsy. Since it is currently not clear whether prenatal intervention will prevent renal dysplasia and it is not known how early it should be done to prevent pulmonary hypoplasia, we believe that termination of pregnancy should be discussed when EUOS is suspected.

Adult↗

PubMed2002

Diagnosis and treatment of voiding dysfunction caused by urethral obstruction after anti-incontinence surgery.

Voiding dysfunction after surgical treatment of stress incontinence may occur as a result of urethral obstruction secondary to hyperelevation of the bladder neck. The diagnosis of urethral obstruction after anti-incontinence surgery is often based upon patient symptomatology and physical examination without confirmation by urodynamic, endoscopic or other diagnostic studies. Urethrolysis seems effective in treating urethral obstruction and voiding dysfunction after surgical treatment of stress urinary incontinence. The reported high success rates of less-invasive procedures have not been confirmed by larger studies. Randomized prospective clinical trials are required to determine the optimal surgical treatment for prolonged voiding dysfunction after anti-incontinence procedures.

Female↗

PubMed2003

Effect of preemptive treatment of capsaicin or resiniferatoxin on the development of pre-micturition contractions after partial urethral obstruction in the rat.

PURPOSE: Neuroplasticity in afferent pathways, including C-fiber bladder afferents, is believed to be one of the major causes of changes in bladder function after partial urethral obstruction. We determined if capsaicin sensitive C-fiber bladder afferents are involved in the development of pre-micturition contractions after partial urethral obstruction in the rat. MATERIALS AND METHODS: Female Wistar rats were preemptively treated with capsaicin (100 mg/kg subcutaneously) or resiniferatoxin (0.3 mg/kg subcutaneously) prior to the creation of obstruction. Before and 6 weeks after obstruction micturition profiles were compared among the 3 groups, including obstructed rats preemptively treated with capsaicin (BO/CAP) or resiniferatoxin (BO/RTX) and untreated obstructed rats (BO/-). In addition, conscious filling cystometry was performed after obstruction. RESULTS: Instillation of capsaicin solutions into the eye or bladder induced significant irritative reactions in BO/- but not in BO/CAP or BO/RTX, indicating that the effect of pretreatment with capsaicin or resiniferatoxin lasted 6 weeks. Voided volume per micturition on micturition profiles was decreased after partial urethral obstruction in all 3 groups. On conscious filling cystometry a significant increase in bladder capacity, voided volume and micturition threshold pressure was noted in BO/CAP but not in BO/RTX compared with BO/-. In contrast, there was no significant change in residual volume, voiding efficiency or micturition pressure among the 3 groups. The prevalence of pre-micturition contractions was 100% in BO/CAP and BO/RTX, and 83% in BO/-. CONCLUSIONS: Capsaicin sensitive C-fiber afferents are not essential to induce pre-micturition contractions but they are involved in functional alterations in bladder afferent pathways after partial urethral obstruction in rats.

Afferent Pathways↗