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[Experience of a double Malecot polyurethane intraurethral catheter in patients with dysuria].

We reviewed our experience of using double Malecot polyurethane intraurethral catheters (IUC). Ten patients with dysuria were treated between April 1991 and April 1993. Seven patients with benign prostatic hypertrophy (BPH) were judged as in a high risk group for operation. The three other patients had neurogenic bladder (two had underactive bladder and 1 had overactive bladder). Under local anesthesia, 150 ml of 0.1% Povidone iodine solution was infused into the bladder through a Nelaton catheter. Under guidance by ultrasonography, an IUC was placed into the bladder neck and posterior urethra using the specially designed introduction set. An long-term follow up of the BPH patients, two IUCs were removed for operation and one was exchanged for an indwelling catheter because of deterioration in general condition. In the neurogenic bladder patients, all IUC were removed because of the increase of residual urine, formation of a pseudourethra, or dislocation into the bladder. Side effects were observed in 6 patients such as, urethral bleeding and stone formation in the stent. Erosion and bleeding tendency in the urethral mucosa were shown in the prolonged duration cases. We conclude that a urethral stent is an effective devise for a high risk patient with benign prostatic hypertrophy but we must keep each patient under strict observation for complications during IUC placement.

Aged

Voiding disorders in young male adult.

Two hundred four male patients (aged twenty to forty-five years) with symptoms of lower urinary tract dysfunction have been investigated by urodynamic studies. Patients with symptoms of bladder overactivity (53 per cent) had a low incidence of bladder outflow obstruction but a high incidence of bladder hypersensitivity and bladder instability. Their symptomatic complaints accurately reflected their cystometric findings and, therefore, a urine flow rate estimation was the only necessary urodynamic investigation in most cases. Urine flow studies are an essential first investigation in all patients with possible bladder outflow obstruction (26 per cent), and full studies were necessary in many patients to discriminate the low flow rates produced both by outflow obstruction and by bladder underactivity which were diagnosed in a high proportion of patients. Similarly, in the neurologically abnormal patients (12 per cent), full urodynamic studies were necessary with the studies described in this article the minimum required.

Adult

[Long-term results and indications of intraurethral stents in elderly patients with prostatic hypertrophy complaining of urinary retention].

Thirty-two elderly male patients with benign prostatic hypertrophy complaining of urinary retention were treated by polyurethane intraurethral stents. All of them were unfit for prostatic surgery due to the presence of several complications, and had been indwelt with a urethral balloon catheter. Cystometry before stent insertion was performed in 23 of the 32 patients. Eleven patients showed overactive bladder, 5 patients normal bladder, and 7 patients underactive bladder. Duration of stent indwelling ranged from 2 days to 22 months (mean 6.7 months), and stent could successfully function for more than 6 months in 20 of the 32 patients (62.5%). Nine of these 20 patients (45%) could keep continence of urine, and urinary tract infections improved in 7 of these 20 patients (35%). The stent failed in 4 of the 5 patients who had had previous operations for prostatic hypertrophy. In a comparison of the findings of urodynamic study prior to insertion of stent with the results of the stent, the results were significantly better in the patients with overactive or normal bladder than in those with underactive bladder (p < 0.05, chi-square test). Bladder stone formation was found in one patient and was the only complication among the 32 patients. In conclusion, stent placement without incontinence or urinary tract infection can be successful for more than 6 months in patients who do not have an underactive bladder and who had not had a previous prostatic operation.

Aged

The bladder cooling reflex in man--characteristics and sensitivity to temperature.

The ice-water test is a simple supplementary urodynamic test that increases the precision of the diagnosis of overactive bladder subtypes. A similar bladder cooling reflex has recently been characterised in the cat and was found to originate from specific cold receptors in the bladder wall. In the present study, the threshold temperature of the human bladder cooling reflex was determined in patients with positive ice-water tests. Estimated threshold values were somewhat lower than those of the cat but still well above the temperatures required for cold stimulation of nociceptors. As in the cat, the strength of the cooling reflex varied inversely with the bladder temperature. These findings indicate that the human bladder cooling reflex is in principle organised in the same way as that of laboratory animals. The human bladder thus seems to be endowed with cold receptors with excitatory reflex connections to the detrusor.

Adult

A prospective crossover study comparing ICCS-recommended and Palmer-adjusted filling rates in children with spina bifida.

OBJECTIVE: This study aimed to investigate whether the maximal cystometric capacity (MCC) in children with spina bifida (SB) is indeed lower, as predicted by the Palmer formula, and to evaluate the impact of different bladder filling rates on urodynamic parameters. MATERIALS AND METHODS: This prospective, randomized, two-sequence crossover-controlled study included 70 children aged 3-18 years with spina bifida under regular follow-up. In Group 1, the first two bladder fillings were performed at the ICCS-recommended rate, and the third at 75% of that rate (Palmer formula). In Group 2, the sequence was reversed. Urodynamic parameters, including maximal cystometric capacity (MCC), bladder compliance, detrusor activity, filling pressures, and detrusor leak point pressure (DLPP), were analyzed across fillings. RESULTS: Cystometric bladder capacity was lower during fillings performed at the Palmer-adjusted rate compared with those at the ICCS-recommended rate. The proportion of reduced compliance significantly decreased in Group 1 (p = 0.046) but remained unchanged in Group 2. A significant positive correlation was observed between expected bladder capacity (EBC) and measured MCC in both groups (&#x3c1; &#x2248; 0.5-0.6). The highest correlation and agreement were found in Group 1 during the third filling at the Palmer rate (ICC = 0.606). No significant intra- or intergroup differences were observed in detrusor pressure, end-filling pressure, DLPP, or overactive bladder prevalence. CONCLUSION: Bladder filling rate was associated with differences in both cystometric capacity and bladder compliance in children with spina bifida. Fillings performed according to the Palmer formula (approximately 75% of the ICCS-recommended rate) were associated with capacities that more closely approximated age-expected values and with modest differences in bladder compliance. Conversely, faster filling rates did not produce similar benefits. These findings suggest that slower filling strategies may improve measurement consistency and agreement with expected bladder capacity estimates. However, the magnitude and direct clinical impact of these differences should be interpreted cautiously, particularly in light of the potential influence of sequence-related effects.

Humans

Urethral and perineal instability.

50 out of 271 female patients showed urethral pressure variations of at least 15 cm H2O during bladder filling. These pressure fluctuations were accompanied by variations in the EMG activity of the anal and periurethral striated musculature. Urethral instability is frequently associated with bladder overactivity and occurs in younger people. Possible pathophysiological mechanisms and implications for therapy are discussed.

Adult

[Urinary disturbance due to HTLV-1 associated myelopathy].

Patients with human T-cell lymphotropic virus type 1 associated myelopathy (HAM) have complaints of urinary disturbance frequently. Symptoms and urodynamic examinations were evaluated in untreated twenty-one patients with HAM. Although two cases (11%) had no urinary symptom, nineteen cases (89%) suffered from dysuria, pollakisuria, incontinence or urgency. The combination of irritative and obstructive urinary disturbance was a characteristic symptom in the HAM patients. In three cases the urinary symptoms preceded the gait disturbance which is a main symptom of HAM. In urodynamic study overactive bladder was found in fourteen cases (66%), although three cases (15%) showed underactive or acontractile bladder with disturbance of urinary sensation. There was no abnormal finding by urethral pressure profile (UPP), but detrusor sphincter dyssynergia (DSD) was revealed frequently by EMG. This typical dysfunction of the HAM patients was thought to be caused by destruction of the lateral column of the spinal cord.

Adult

[The use of viloxazine in the treatment of primary enuresis].

The use of Viloxazine (a non tricyclic antidepressant) could be a less toxic alternative to Imipramine (cardiotoxic tricyclic antidepressant) in the treatment of childhood primary enuresis. Bladder overactivity, infection or psychological disturbances should be excluded before start of treatment, the drug seems to have a good efficacy in cases of "heavy sleepers".

Child

[Bladder deformity in traumatic spinal cord injury patients].

Fifty-nine patients with traumatic spinal cord injury were subjected for the analysis of bladder deformity. Bladder deformity means bladder trabeculation and deformity of bladder shape such as pine tree shape. We classified bladder deformity into grade 0 (none), grade I (mild), grade II (moderate) and grade III (severe). Upper urinary tract deterioration was found in 0% of grade 0 (16 pts.), 32% of grade I (22 pts.), 80% of grade II (10 pts.) and 82% of grade III (11 pts.). We suggested that bladder deformity was one of the risk factors of upper urinary tract deterioration. High grade (greater than grade II) bladder deformity was found more frequently in complete injury than in incomplete injury. There was no differentiation between overactive bladder-overactive sphincter and underactive bladder-overactive sphincter. All patients with low compliance bladder had a high grade bladder deformity. There was a significant relationship between severity of urinary tract infection and severity of bladder deformity. Intermittent catheterization program was effective for preventing bladder deformity.

Adolescent

[Neurogenic bladder in patients with cervical cord compression disorders].

Bladder and urethral functions were evaluated urodynamically in 62 patients with cervical cord compression disorder caused by either ossification of the posterior longitudinal ligament of the cervical spine (32 patients), cervical spondylosis (14 patients), prolapsed cervical intervertebral disc (14 patients) or cervical spinal canal stenosis (2 patients). The patients included 46 males and 16 females with average age of 57 years (range 39 to 73 years). Symptomatic organic infravesical obstruction was excluded by physical and radiographic examination. Cystometry revealed preoperative neurogenic bladder in 22 patients (35%) including overactive detrusor in 10 patients (45%) and underactive in 6 (27%). Twenty-one of them underwent electromyographic examination of external sphincter and 14 (67%) had overactive sphincter. Bladder and urethral functions appeared to be impaired in association with myelopathy of the pyramidal and spinothalamic tract of the cervical cord, because of high incidence of neurogenic bladder associated with positive Babinski's reflex and sensory disturbance at the perineal and lower extremity area. Furthermore, since many patients with deep sensory disturbance in the lower extremities had underactive detrusor, it appears likely that underactive detrusor was accompanied with myelopathy in the posterior funiculus of the cervical cord which mediates bladder proprioceptive sensation. Of twenty-two neurogenic bladder patients, seventeen underwent a cervical bone operation and eleven received postoperative urodynamic evaluation. The average interval from the operation to urodynamic evaluation was 1.6 months (range 1.1 to 2.3 months). Over half of the patients were found to be improved urodynamically as well as neurologically.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult

Detrusor hyperactivity with impaired contractile function. An unrecognized but common cause of incontinence in elderly patients.

Little is known about the causes of urinary incontinence in institutionalized elderly people, despite the fact that $8 billion is annually devoted to diapering those afflicted. We have identified a specific physiological abnormality--detrusor hyperactivity with impaired contractile function (DHIC)--that, although previously unrecognized, is the second most common (33%) cause of incontinence in this setting. Detrusor hyperactivity with impaired contractile function is a distinct physiological subset of detrusor hyperreflexia and presents with a seemingly paradoxical set of findings: the bladder is overactive but empties ineffectively. This imparied emptying is due to diminished detrusor contractile function and is associated with bladder trabeculation, a slow velocity of bladder contraction, little detrusor reserve power, and a significant amount of residual urine. Aside from its high prevalence, the importance of DHIC is that it may present as urinary retention, may closely mimic prostatic outlet obstruction, may explain why past therapeutic trials for detrusor hyperreflexia have failed, and may necessitate a change in the current nosology of bladder dysfunction. Furthermore, DHIC may represent a more advanced stage in the natural history of detrusor hyperreflexia, a stage characterized by deterioration of detrusor contractile efficiency. Thus, this previously unrecognized cause of incontinence in the elderly is common and raises several important issues.

Aged

Treating neurogenic detrusor overactivity in order to manage autonomic dysreflexia - A systematic review.

INTRODUCTION: Autonomic dysreflexia (AD) is a severe and potentially life-threatening complication of a spinal cord injury (SCI), particularly in patients with lesions at or above the sixth thoracic level. Neurogenic detrusor overactivity (NDO) is one of the main triggering factors. The impact of NDO treatment on AD remains insufficiently clarified. METHODS: We conducted a systematic review of the literature in PubMed and Cochrane Database between January 1990 and May 2025. Eligible studies included patients with SCI and AD undergoing treatment for NDO, including antimuscarinics, botulinum toxin (BTX) or augmentation cystoplasty. The primary outcome was the assessment of systolic blood pressure (SBP) parameters in patients undergoing cystomanometry. RESULTS: Of the thirteen eligible studies, only five were included. No study evaluated augmentation cystoplasty. One study (12 patients) evaluating fesoterodine and four studies (95 patients) evaluating BTX injection demonstrated improved urodynamic parameters and a decrease in severity of AD during urodynamic studies and in daily life. Improvements in AD-HR-QoL and I-QoL scores were also demonstrated. DISCUSSION: Controlling NDO with fesoterodine or BTX injection reduces the prevalence and severity of AD, likely by limiting abnormal C-fiber recruitment and reducing neurogenic inflammation. BTX additionally modulates TRPV1-expressing afferents, which further reduces AD risk. Although hypertensive peaks improve, submaximal parameters remain unchanged, highlighting the need for additional complementary strategies. CONCLUSION: The use of BTX and fesoterodine for NDO treatment effectively reduces AD episodes in patients with SCI. Further long-term studies are needed to confirm the cardiovascular benefits and inform future therapeutic strategies.

Humans

[Vesical neuropathy in systemic vasculitis: 3 cases].

Bladder neuropathy was diagnosed in 3 patients with systemic vasculitis (temporal arteritis: 1 case; periarteritis nodosa: 2 cases). Clinical characteristics were: dysuria, diminished or abolished bladder sensation leading to indolent bladder retention. Urodynamic investigation showed hypotonic and underactive detrusor, increased detrusor compliance, hyposensitive bladder, and/or overactive urethral closure. Needle electrode examination showed signs of denervation of periurethral muscles; sacral evoked latencies were increased, favouring pudenal nerve alterations. Symptoms and urodynamic abnormalities resolved following corticosteroid therapy. Clinical and therapeutic implications of bladder neuropathy in necrotizing vasculitis are emphasized.

Adult

Structural basis of geriatric voiding dysfunction. II. Aging detrusor: normal versus impaired contractility.

Little information on the structural norm of the aging detrusor is currently available. To gain insight into the pathophysiology of geriatric voiding dysfunction, detrusor biopsies were examined by electron microscopy to identify structural correlates of specific, urodynamically defined abnormalities of vesical function in 35 elderly subjects. Prospective urodynamic grouping of the subjects and segregation of the detrusor specimens by ultrastructural features were done independently and blindly. One structural pattern so identified, the dense band pattern, matched the urodynamic group with neither detrusor overactivity nor bladder outlet obstruction. This neither group included 11 women and 2 men 65 to 91 years old (mean age 76 years). Except for 2 patients with minimal stress incontinence, all were symptom-free. None of the patients had diabetes or a neurological deficit. Urodynamically, 10 patients had impaired and 3 had normal detrusor contractility. The dense band structural pattern was characterized by overall normal configuration of muscle cells and cell junctions, sarcolemma (muscle cell membrane) dominated by dense bands with depleted caveolae in interposed zones and slight widening of spaces between muscle cells with little-collagen content. Specimens from the 10 subjects with impaired contractility displayed, in addition, widespread degeneration of muscle cells and axons. The remaining 3 specimens, without degeneration, matched the subjects with normal contractility, who were continent and symptom-free. It is proposed that the dense band pattern represents the structural norm of aging detrusor, heralds a process of muscle cell de-differentiation in the detrusor accompanying natural aging, and may affect exchange and storage of ions involved in the excitation-contraction coupling mechanism of muscle cells through depletion of caveolae. Widespread degeneration of muscle cells and axons, superimposed on the dense band pattern, is proposed as the structural correlate of impaired detrusor contractility in the aging detrusor.

Aged

[Clinical effects of clenbuterol-HCL in urge incontinence and stress incontinence].

A total of 49 patients complaining of pollakisuria and incontinence; 20 patients with overactive neurogenic bladder and 29 patients with stress incontinence, were treated with clenbuterol, and the effects of the drug were studied. Subjective symptoms were improved markedly in 8 patients (17%), moderately in 14 patients (29%), and slightly in 10 patients (21%). The symptoms were unchanged in 15 patients (31%) and aggravated in 1 patient (2%). In objective observation, the volume at first desire to void (P less than 0.01) and the maximum urethral closure pressure (P less than 0.05) significantly increased. The objective symptoms were improved markedly in 2 patients (5%), moderately in 12 patients (27%), and slightly in 11 patients (25%). The symptoms were unchanged in 15 patients (34%) and aggravated in 4 patients (9%). Overall improvement was graded as marked in 7 patients (15%), moderate in 17 patients (35%), slight in 11 patients (23%), unchanged in 13 patients (27%) and aggravated in none. In neurogenic bladder, the overall improvement was graded as marked in 2 patients (11%), moderate in 4 patients (21%), slight in 4 patients (21%), unchanged in 9 patients (47%) and aggravated in none. In stress incontinence, the overall improvement was graded as marked in 5 patients (17%), moderate in 13 patients (45%), slight in 7 patients (24%), unchanged in 4 patients (14%) and aggravated in none. Side effects were noted in 12 patients (25%) and they were all not serious. Finger tremor was the most common side effect (5 patients).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult