Use of the uroflow study in the diagnosis of bladder outlet obstruction in elderly men.
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The uroflow and pressure-flow data of 67 men aged 65 years or more were compared. At best, the uroflow study applying the Liverpool nomogram (25th percentile) and Bristol nomogram (OSD) diagnosed bladder outlet obstruction with sensitivity of 62.5% and 62.5% and specificity of 48.8% and 74.4% respectively. Using the 50th percentile of the Liverpool nomogram as the cut-off resulted in a negative predictive value of 100.0% allowing about 10% of men to have this diagnosis ruled out. We conclude that the uroflow study is inaccurate in diagnosing bladder outlet obstruction in elderly men. However, it can be used to rule out this condition in the small subset of men with maximum flow rates above the 50th percentile of the Liverpool nomogram. (+info)
Intravesically administered ketoprofen in treatment of detrusor instability: cross-over study.
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AIM: To evaluate the therapeutic efficacy of intravesically administered ketoprofen in patients with urodynamically verified detrusor instability. METHODS: This double-blind randomized placebo-controlled cross-over study included 30 patients with urodynamically verified detrusor instability. Their mean age was 44+/-3.6 years (range 37-49) and the median of the parity was 2 years (1-3). The mean duration of symptoms was 18.3+/-3.1 months (range 14-23). After a 6-week screening, patients were randomized to receive ketoprofen or placebo once a day for 4 weeks. Out of 30 patients, 16 started with ketoprofen, and 14 received placebo. After a week of washing period, 16 patients received placebo, and 14 received ketoprofen. The solution for intravesical application was 50 mL of saline with 2 mL (100 mg) of ketoprofen warmed to 37 degrees C. The placebo solution contained 2 mL of distilled water instead of ketoprofen. The assessment including micturition diaries, cystometric measurements, and bacteriological analysis of urine specimens was performed at the beginning of the study and after the treatment. RESULTS: The subjective cure rate was 18/30 after ketoprofen. The instability index was lower after ketoprofen than before treatment or after placebo (p<0.001). Maximal cystometric capacity and the urinary bladder volume at which the patients felt urgency to void were larger after ketoprofen than before it (p<0.001) or after placebo (p<0.001). The number of patients with uninhibited bladder contractions decreased significantly after ketoprofen, but not after placebo (p<0.001). No side effects were observed. CONCLUSION: Intravesically administrated ketoprofen is a feasible and effective treatment for detrusor instability. (+info)
Cognitive behavioral and behavioral interventions help young children cope during a voiding cystourethrogram.
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OBJECTIVE: To reduce young children's distress and increase coping behavior among children undergoing a voiding cystourethrogram (VCU). METHODS: Three- to seven-year-old children were stratified based on prior VCU experience and randomly assigned to an intervention (n = 20) or a standard care (n = 20) condition. The intervention included provision of information, coping skills training, and parent coaching. We hypothesized that the intervention would reduce children's distress as assessed by child report, parent and technician ratings, and behavioral observations. RESULTS: Children in the intervention displayed fewer distress behaviors and greater coping behaviors and were rated as more cooperative than children receiving standard care. Children's fear and pain ratings did not differ significantly between groups. CONCLUSIONS: A cognitive-behavioral treatment package effectively reduced children's distress, increased coping, and increased cooperation during voiding cystourethrogram procedures. This type of an intervention should be integrated into routine pediatric radiological procedures. (+info)
Distension of urinary bladder induces exaggerated coronary constriction in smokers with early atherosclerosis.
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Distension of the urinary bladder causes an increase in efferent sympathetic activity, which can precipitate myocardial ischemia. Smoking has been shown to modulate activities of afferent nerves from the distended urinary bladder and to impair endothelial function in response to sympathetic activation. To assess the effect of bladder distension on coronary dynamics in smokers, we measured epicardial and microvascular responses in 24 patients with early atherosclerosis (< 50% diameter stenosis). Patients were classified into habitual smokers (group 1, n = 14) and nonsmokers (group 2, n = 10). Habitual smokers were randomized into two subgroups on the basis of the use of doxazosin, as follows: subgroup 1A (n = 7), without administration of doxazosin before catheterization; subgroup 1B (n = 7), with dosing doxazosin. In response to bladder distension (mean intravesical pressure 21.5 mmHg), bladder distension significantly decreased coronary diameter at the stenotic segments, coronary blood flow, and increased coronary resistance compared with baseline values, in subgroup 1A patients. In subgroup 1B patients during bladder distension, coronary diameter, coronary blood flow, and coronary resistance did not show significant changes compared with baseline values. There were significant differences of coronary diameter at the stenotic segments, coronary blood flow, and of changes of coronary vascular resistance between subgroup 1A and group 2 during bladder distension, despite similar changes in rate-pressure product. The present study showed that urinary bladder distension caused an abnormal vasomotor response of epicardial vasoconstriction and a concomitant increased coronary resistance, which leads to reduction in coronary blood flow in patients with early atherosclerosis. Smoking may further impair the response, implying that smoking has exaggerated response to sympathetic stimulation of conduit and resistance vessels. The abnormal response was abolished by pretreated administration of doxazosin, suggesting that the involved mechanisms are related to alpha(1)-adrenoceptors. (+info)
Minipig model for the study of voiding parameters in the conscious state and natural posture: normal urodynamic profiles.
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OBJECTIVE: To provide baseline data on an animal model in which collecting and voiding can be accurately characterized urodynamically in the conscious state and natural posture. METHODS: Thirty-one female Yucatan microswines (age 4-8 months, weight 11-43 kg) were used. Portcatheters were placed in the bladder and peritoneal cavity, and reservoirs were implanted under the back skin for easy access. For urodynamic study, conscious pigs were restrained in specially designed adjustable cages. The portcatheter reservoirs were connected by 20-gauge needles and tubings to a UDS-120 digital computer polygraph to measure the total bladder pressure (pves) and abdominal pressure (pabd). A flow meter was placed behind and underneath the animal to measure the uroflow. Diuresis was induced with furosemide, and 2-4 voiding cycles were monitored. Isovolumetric detrusor pressure (pdet, isv) was obtained in the last cycle by manual interruption of flow per vagina. Urodynamic investigations were performed satisfactorily in all animals. RESULTS: The voided volume was 102-340 ml (mean 181.7 +/- 11.9 ml). Seven pigs had residual urine (4-39 ml, mean 14.3 +/- 4.7 ml). The initial opening pressure at the start of voiding was 19.9 +/- 1.5 cmH2O; detrusor pressure at maximum flow rate was 15.7 +/- 1.3 cmH2O; average flow was 12.6 +/- 0.7 ml/s; maximum flow rate was 20.7 +/- 1.1 ml/s; pdet, isv was 51.6 +/- 2.4 cmH2O; flow time was 15.9 +/- 1.2 seconds; mean resistance factor (R) was 0.06 +/- 0.01 cmH2O ml-2s2; mean urethral resistance factor (URA) was 7.10 +/- 0.51 cmH2O; and mean strength of voiding detrusor contraction was 3.91 +/- 0.20 W/m2. CONCLUSION: The above model allows reliable measurement of pressure-flow parameters in the conscious state and natural posture, permitting in-vivo urodynamic characterization of obstructive voiding dysfunction and correlation with detrusor structure. (+info)
Pelvic floor muscle contraction during a cough and decreased vesical neck mobility.
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OBJECTIVE: To test the hypothesis that a voluntary pelvic muscle contraction initiated in preparation for a cough, a maneuver we call the Knack, significantly reduces vesical neck displacement. METHODS: A convenience sample of 22 women consisted of 11 young, continent nulliparas (mean age [+/- standard deviation] 24.8 +/- 7.0 years) and 11 older, incontinent paras (mean age [+/-SD] 66.9 +/- 3.9 years). With the use of perineal ultrasound, we quantified vesical neck displacement at rest and during coughs using caliper tracing and a coordinate system. The subjects coughed with and without voluntary pelvic floor muscle contraction. RESULTS: Vesical neck mobility during coughs was significantly decreased when voluntary contraction was used: from a median (range) of 5.4 (20.0) mm without volitional contraction to 2.9 (18.3) mm with volitional contraction (P <.001). The younger women demonstrated a median (range) decrease in excursion from 4.6 (19.5) to 0.0 (17.0) mm (P =.007), and the older incontinent women demonstrated a median (range) decrease from 6.2 (10.0) to 3.5 (15.4) mm (P =.003). At rest, the median vesical neck position in the group of older incontinent women was significantly further dorsocaudal (P =.001) than in the younger women. CONCLUSION: A pelvic floor muscle contraction in preparation for, and throughout, a cough can augment proximal urethra support during stress, thereby reducing the amount of dorsocaudal displacement. (+info)
Ambulatory urodynamic monitoring of external urethral sphincter behavior in chronic prostatitis patients.
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AIM: To study the behavior of external urethral sphincter in chronic prostatitis (CP) patient under natural filling. METHODS: Twenty-one CP patients and 17 normal volunteers were involved in the study. Both the patients and volunteers underwent ambulatory urodynamic monitoring (AM) and conventional medium filling cystometry (CMG). Urodec 500 was used for AM and Menuet for CMG. AM findings from CP patients were compared with those from normal volunteers, and the results from AM were compared with those from CMG. RESULTS: In AM, the resting and voiding external urethral sphincter (EUS) pressures and maximum urethral closure pressures (MUCP) were significantly higher in CP patients [(121.5 +/- 10.3) and (85. 6 +/- 3.5) cm water, respectively] than in normal volunteers [(77.6 +/- 11.4) and (10.3 + 1.6) cm water, respectively)]. CONCLUSION: The behavioral changes of EUS in CP patients included spasm and instability of EUS, which were demonstrated using AM under natural filling; the findings were also in accord with the results of CMG. (+info)
Ultrasound imaging of the lower urinary system in women after Burch colposuspension.
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OBJECTIVE: Most of the relevant surgical procedures employed in the management of genuine stress urinary incontinence (GSI) involve the technique of bladder neck elevation. The appropriate level of suspension is an important (but frequently overlooked) consideration as the clinical consequences of over-correction of the posterior angle are voiding dysfunction and urgency symptoms. The aim of our study was to compare ultrasound characteristics in women with GSI with those of women before and after Burch colposuspension. The findings of our study should have implications for GSI management. DESIGN: Prospective randomized clinical study at the Department of Obstetrics and Gynecology, Charles University, Prague, Czech Republic. SETTING: Department of Obstetrics and Gynecology, Charles University, Prague, Czech Republic. METHODS: Seventy women with previously untreated GSI (preoperative group) and 52 women (42 of whom had been in the preoperative group) who were studied 3-12 months after receiving Burch colposuspension (postoperative group) took part in the study. The standard transperineal and introital ultrasound scans were performed. The mobility of the bladder neck was assessed transperineally with a curved array probe after instillation of 300 mL of saline. The bladder was then evacuated and the thickness of the urinary bladder wall in the sagittal plane in defined regions (base, vertex and anterior wall) was measured. RESULTS: We found significant differences in bladder neck position, mobility, and in bladder wall thickness. Where symptoms of urgency occurred, the average bladder wall thickness was > 5 mm, the gamma angle < 40 degrees, and lower bladder neck mobility was evident. CONCLUSION: These findings supported our hypothesis that signs of urgency follow over-elevation of the bladder neck. These results helped us significantly to refine our GSI management. (+info)