Current management of neurogenic bladder dysfunction.
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The effect of thyrotropin-releasing hormone (TRH) on vesicourethral dysfunction in two patients with olivo-ponto-cerebellar atrophy was studied by urodynamic examination. The two patients had difficulty of urination with 200 ml of residual urine. Cystometrogram and electromyogram showed autonomous contraction without detrusor-sphincter dyssynergia. After administration of TRH, the symptom and volume of residual urine was not improved, autonomous contraction was not changed, while prostatic urethral pressure in urethral pressure profile was significantly increased in both patients.
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Simultaneous recording of intravesical pressure, sphincter electromyography and uroflowmetry (CMG.UFM.EMG study) was performed following cystometry simultaneously with electromyography (CMG.EMG study) on 20 patients with spinal cord injuries. Differences in the influence to micturition between the CMG.EMG study and CMG.UFM.EMG study is thought to be due to whether the catheter is indwelling in the urethra or not. We examined those differences and patient's rehabilitation maneuver (Cred'e maneuver). Micturition pressure and opening pressure measured by the CMG.EMG study were larger than that measured by the CMG.UFM.EMG study (P less than 0.05, P less than 0.01 respectively). Incidence of detrusor-sphincter dyssynergia measured by the CMG.EMG study was greater than that measured by the CMG.UFM.EMG study in the detrusor hyperreflexic cases. The Cred'e maneuver caused increase in opening pressure, micturition pressure and peak flow rate, but the voiding volume and voiding time did not increase to any effective extent. The Cred'e maneuver exaggerated the detrusor sphincter dyssynergia.
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