Effectiveness of tolterodine in nonneurogenic voiding dysfunction.
The efficacy of tolterodine was analysed in children with non-neurogenic voiding dysfunction, using dysfunctional voiding symptom score (DVSS). Of 44 patients (mean age 9.3 yrs; M:F = 25:19), 36 received long acting tolterodine tartrate at a dose of 2mg OD and 8 at a dose of 4mg OD. The mean (SD) DVSS before and after the treatment was 17.1 (2.8) and 12.0 (2.4). There was a significant improvement in the mean DVSS score at the end of the treatment (Students t test P < 0.01). The dysfunctional symptoms were cured in 28(63.6 %), improved in 14(31.8 %) and failed to show improvement in 2 (4.6 %). Over all 95 % were compliant with the single daily medication. Our results demonstrate that long acting tolterodine is effective in children with voiding dysfunction. The single daily dose has good compliance and minimal side effect profile. (+info)
Assessing urgency in interstitial cystitis/painful bladder syndrome.
OBJECTIVES: Interstitial cystitis/painful bladder syndrome (IC/PBS) at present is a symptom-based diagnosis. The Interstitial Cystitis Symptom Index (ICSI), also known as the O'Leary-Sant Symptom Index, is a widely used scale that assesses the four cardinal symptoms of IC/PBS (ie, bladder pain, urgency, frequency, and nocturia), by asking how often each is experienced. In an ongoing case-control study of recent-onset IC/PBS, we compared the ICSI with a series of questions that addressed the severity of these symptoms. METHODS: Recruiting nationally, we enrolled women with IC/PBS symptoms of 12 months' duration or less. We assessed the severity of pain, frequency, and urgency using Likert and categorical scales, and how often these symptoms were experienced using the ICSI. We compared these scales by frequency distributions and interscale correlations. RESULTS: In 138 women with recent-onset IC/PBS, the scores for frequency were correlated and, for pain, appeared to be complementary. However, for urgency, the ICSI question of "the strong need to urinate with little or no warning" consistently yielded lower scores than the severity question of "the compelling urge to urinate that is difficult to postpone." Some patients denied urgency to the ICSI question yet reported intense urgency to the severity question. CONCLUSIONS: Compared with the severity question, the ICSI underestimated the prevalence and degree of urgency. This observation is consistent with the views of others that sudden urgency does not define the sensation experienced by many patients with IC/PBS. Clarifying this symptom description may assist in developing a usable case definition for IC/PBS. (+info)
Evaluation of voiding dysfunctions in children with chronic functional constipation.
There are controversial results about the role of dysfunctional bowel emptying in disorders of the urinary tract like urinary tract infection (UTI), vesicoureteral reflux (VUR) and enuresis. Constipation may cause UTI, enuresis and VUR due to the uninhibited bladder contraction. The aim of this study was to investigate the frequency of nocturnal enuresis, UTI and instability symptoms in chronic functional constipation (CFC). This study included 38 children with CFC and 31 children as the control group. Detailed past and present history of UTIs or symptoms pointing to this diagnosis, enuresis, encopresis, urgency and urge incontinence was obtained from both groups as well as the family history of UTI. Urinalysis, urine culture and stool parasite analysis as well as abdominal ultrasonography were performed on both groups. Age range of the children with CFC was 6-192 months (mean +/- standard deviation (SD) 63.5 +/- 51 months); that of the control group was 4-180 months (mean +/- SD 82 +/- 46.2 months). Frequency of UTI and urgency was significantly higher in the CFC group. However, frequencies of urge incontinence, nocturnal enuresis, and genitourinary abnormalities were not different between the two groups. In conclusion, risk of UTI and urgency is increased in CFC, but that of other voiding dysfunctions like urge incontinence do not change significantly. Therefore, we suggest that UTI and urgency should be questioned in children with CFC and vice versa. (+info)
Papillary cystadenocarcinoma of the prostate: a case report.
A 91-year-old man presented with nocturnal frequency and urge incontinence of a few days duration due to involvement of prostate cancer (PCa) accompanied by a large cyst in the left lobe of the prostate gland and urinary bladder wall. Channeling transurethral resection of prostate was performed to relieve the main symptoms and the resected material was histologically diagnosed as papillary cystadenocarcinoma arising from the epithelium of microscopic retention cysts. Following shrinkage of the large cyst, the patient is doing well on a combination regimen of a luteinizing hormone-releasing hormone analogue and bicaltamide. Papillary cystadenocarcinoma of the prostate was originally defined as papillary PCa arising from, not accompanied by, prostatic cysts. Cysts associated with PCa are subdivided into primary (or true) and secondary (or pseudo) cysts. Cancer cells in primary cysts originate from the epithelial lining. Papillary growth type cysts belong to this group and are regarded as papillary cystadenocarcinoma. The secondary (or pseudo) cysts, which have no epithelial lining and consist of hemorrhagic and/or necrotic contents are associated with invasive PCa. In the present case, the microscopic retention cysts revealed by histologic examination were of the primary type. This case of papillary cystadenocarcinoma, arising from a primary cyst, is the 13th such report from among previously reported cases in Japan. (+info)
Evaluation of lower urinary tract symptoms and how bothersome it was with or without urinary incontinence in apparently healthy persons of both sexes.
We evaluated the effect of urinary incontinence on the degree of being bothersome in apparently healthy males and females by a questionnaire survery. From March to May, 2003 apparently healthy subjects underwent multiphasic health screening after informed of the nature of this study and were asked to fill out the questionnaires of International Prostate Symptom Score (IPSS) with IPSS QOL index (IPSS-QI) and the short form version of the Urogenital Distress Inventory (UDI-6). The data were subjected to analytical studies. Of the 388 participants who responded completely to both questionnaires, 172 (44.3%) had urinary incontinence; 143 were women (36.9%) and 29 men (7.5%). The mean age of the women was 46.0 years (range 18.0 to 76.0) and that of men was 47.5 years (range 22.0 to 76.0). Compared with continent participants, women and men with mixed urinary incontinence had a significantly higher IPSS severity (P = 0.0002 and P = 0.0014, respectively). In terms of contribution on QOL impairment, the women and men with mixed urinary incontinence considered it significantly more bothersome compared with continent participants (P = 0.0004 and P = 0.0003, respectively). These data showed that urinary incontinence was relatively common among apparently healthy women, but not men, and type of incontinence had a different impact on the degree of being bothersome in both sexes. (+info)
Burch colposuspension versus fascial sling to reduce urinary stress incontinence.
BACKGROUND: Many surgical procedures are available for women with urinary stress incontinence, yet few randomized clinical trials have been conducted to provide a basis for treatment recommendations. METHODS: We performed a multicenter, randomized clinical trial comparing two procedures--the pubovaginal sling, using autologous rectus fascia, and the Burch colposuspension--among women with stress incontinence. Women were eligible for the study if they had predominant symptoms associated with the condition, a positive stress test, and urethral hypermobility. The primary outcomes were success in terms of overall urinary-incontinence measures, which required a negative pad test, no urinary incontinence (as recorded in a 3-day diary), a negative cough and Valsalva stress test, no self-reported symptoms, and no retreatment for the condition, and success in terms of measures of stress incontinence specifically, which required only the latter three criteria. We also assessed postoperative urge incontinence, voiding dysfunction, and adverse events. RESULTS: A total of 655 women were randomly assigned to study groups: 326 to undergo the sling procedure and 329 to undergo the Burch procedure; 520 women (79%) completed the outcome assessment. At 24 months, success rates were higher for women who underwent the sling procedure than for those who underwent the Burch procedure, for both the overall category of success (47% vs. 38%, P=0.01) and the category specific to stress incontinence (66% vs. 49%, P<0.001). However, more women who underwent the sling procedure had urinary tract infections, difficulty voiding, and postoperative urge incontinence. CONCLUSIONS: The autologous fascial sling results in a higher rate of successful treatment of stress incontinence but also greater morbidity than the Burch colposuspension. (ClinicalTrials.gov number, NCT00064662 [ClinicalTrials.gov] .). (+info)
BACKGROUND: Bladder desensitization has been investigated as an alternative treatment for refractory detrusor overactivity. Most open and controlled clinical trials conducted with intravesical RTX showed that desensitization delays the appearance of involuntary detrusor contractions during bladder filling and decreases the number of episodes of urgency incontinence. Urgency is being recognised as the fundamental symptom of overactive bladder (OAB), a symptomatic complex which recent epidemiological studies have shown to affect more than 10% of the Western population. As anti-muscarinic drugs, the first line treatment for OAB, are far from being able to fully control urgency, the opportunity to test other therapeutic approaches is created. The present work was, therefore, designed as an exploratory investigation to evaluate the effect of bladder desensitization on urinary urgency. METHODS: Twenty-three OAB patients with refractory urgency entered, after given informed consent, a 30 days run-in period in which medications influencing the bladder function were interrupted. At the end of this period patients filled a seven-day voiding chart where they scored, using a 0-4 scale, the bladder sensations felt before each voiding. Then, patients were instilled with 100 ml of 10% ethanol in saline (vehicle solution) and 30 days later a second seven-day voiding chart was collected. Finally, patients were instilled with 100 ml of 50 nM RTX in 10% ethanol in saline. At 1 and 3 months additional voiding charts were collected. At the end of the vehicle and 3 months period patients were asked to give their subjective impression about the outcome of the treatment and about the willingness to repeat the previous instillation. RESULTS: At the end of the run-in period the mean number of episodes of urgency per week was 71 +/- 12 (mean +/- SEM). After vehicle instillation, the mean number of episodes of urgency was 56 +/- 11, but only 4 patients (17%) considered that their urinary condition had improved enough to repeat the treatment. At 1 and 3 months after RTX the number of episodes of urgency decreased to 39 +/- 9 (p = 0.002) and 37 +/- 6 (p = 0.02), respectively (p indicates statistical differences against vehicle). The percentage of patients with subjective improvement after RTX and willing to repeat the instillation at a later occasion was 69%. CONCLUSION: In OAB patients with refractory urgency bladder desensitization should be further investigated as an alternative to the standard management. Additionally, the specific effect of RTX on TRPV1 receptors suggests that urothelium and sub-urothelial C-fibers play an important role to the generation of urgency sensation. (+info)
Cerebral control of the bladder in normal and urge-incontinent women.
AIM: To identify age-related changes in the normal brain/bladder control system, and differences between urge incontinence in younger and older women, as shown by brain responses to bladder filling; and to use age, bladder volume, urge incontinence and detrusor overactivity (DO) as probes to reveal control system function. Functional MRI was used to examine regional brain responses to bladder infusion in 21 females (26-85 years): 11 "cases" with urge incontinence and DO (proven previously) and 10 normal "controls". Responses and their age dependence were determined at small and large bladder volumes, in whole brain and in regions of interest representing right insula and anterior cingulate (ACG). In "controls", increasing bladder volume/sensation led to increasing insular responses; with increasing age, insular responses became weaker. In younger "cases", ACG responded abnormally strongly at large bladder volumes/strong sensation. Elderly "cases" showed strong ACG responses even at small bladder volume but more moderate responses at larger volumes; if DO occurred, pontine micturition center (PMC) activation did not increase. CONCLUSION: Among normal "controls", increasing age leads to decreased responses in brain regions involved in bladder control, including right insula, consistent with its role in mapping normal bladder sensations. Strong ACG activation occurs in urge-incontinent "cases" and may be a sign of urgency, indicating recruitment of alternative pathways when loss of bladder control is feared. Easier ACG provocation in older "cases" reflects lack of physiological reserve or different etiology. ACG responses seem associated with PMC inhibition: reduced ACG activity accompanies failure of inhibition (DO). (+info)