To evaluate the feasibility and guiding significance in postoperative management of the Whitaker test after complex reconstruction of the upper urinary tract.Patients who underwent complex ureteral reconstruction and received the Whitaker test after surgery between December 2018 and December 2019 were included. We judged it abnormal that the renal pelvis pressure was higher than 22 cmH2O or the pressure difference was greater than 15 cmH2O. The results were used as a reference for removing the nephrostomy tube. Based on whether the renal pelvic pressure was higher than 22 cmH2O, the patients were divided into the elevated pelvis pressure group and the normal group. Follow ups at 1 month and every 3 months were collected.A total of 19 patients were included. Fifteen patients did not present obvious abnormalities. One patient suffered from contrast infiltrating into the renal parenchyma, and the pressure was higher than 15 cmH2O. Ureteral stent implantation was performed. The other 3 patients had either elevated pelvis pressure or insufficient image, 2 of which prolonged the duration of nephrostomy tubes. The median follow-up time was 12.6 months. CTU/MRU after removing nephrostomy tubes indicated improved/stable hydronephrosis in all patients. The creatinine in the elevated pelvis pressure group was higher than that in the normal group (91.4 ± 27.6 vs 86.7 ± 16.5 μmol/L, P = .782), and the eGFR was lower (76.0 ± 14.0 vs 81.8 ± 24.1 mL/min/1.73m2, P = .695), but without significant difference. The change in creatinine during follow-up in the elevated renal pelvic pressure group was significantly different from that in the normal group (-13.6 ± 1.0 vs -0.2 ± 10.6 umol/L, P = .047).Postoperative Whitaker test can help judge whether nephrostomy could be removed. Elevated pressure in upper urinary tract after reconstruction suggests the need to prolong the time of the nephrostomy tube or even re-intervene. Proper management for patients with elevated renal pelvis pressure can help restore the renal function.
To evaluate clinical efficacy of holmium laser enucleation of the prostate in the treatment of benign prostatic hyperplasia (BPH) and overactive bladder (OAB).From May 2007 to May 2010, a total of 37 patients diagnosed BPH and OAB were treated by holmium laser enucleation of the prostate. After a mean follow-up of 4.9 months postoperatively, indices such as International Prostate Symptom Score (IPSS), quality of life (QOL) score, maximum flow rate (Qmax), residual urine volume and video urodynamics were monitored and statistically analyzed.The mean preoperative IPSS and QOL score were 29.6 ± 5.2 and 4.3 ± 0.9, and decreased to 4.6 ± 1.2 and 1.2 ± 1.0 postoperative. The mean Qmax was (6 ± 3) ml/s preoperative and increased to (21 ± 5) ml/s postoperative. Preoperative average residual urine volume was (167 ± 11) ml, decreased to (41 ± 18) ml after operation. During follow-up, 86.5% patients' symptoms and quality of life improved continuously, however 13.5% patients existed residual postoperative OAB symptoms.When BPH with OAB patients exist bladder outlet obstruction, bladder outlet obstruction should be relieved first then OAB symptoms can be relieved in majority of patients, but some patients have residual symptoms.
Objective To determine the effects of pudendal ncrve stimulation with different frequency(5 Hz,20 Hz) on bladder dysfunction dogs after spinal cord injury.Methods The study was done in 4 dogs which chronic spinal cord transection at T9-T10 level.All the dogs underwent electrical stimulation of pudendal nerve (5 Hz,20 Hz).Then,bladder capacity,compliance,non-voiding contraction number (NVC) and voiding efficiency before and during stimulation were compared.Results The bladder capacity and the compliance was increased ( 58.9 ± 17.4) ％ and (53.1 ± 4.9 ) ％ ( P ＜ 0.05 ) by pudendal nerve stimulation with low frequency (5 Hz).Detrusor overactivity can be inhibited and the NVC decreased from 1.7 ± 1.3 to 0.9 ± 1.1.Pudendal nerve stimulation with medium frequency ( 20 Hz) can induce bladder contraction and increased voiding efficiency from (5.8 ± 1.0) ％ to ( 16.3 ± 2.6 ) ％ ( P ＜0.05).Conclusions Pudendal nerve stimulation with low frequency can inhibit detrusor overactivity and increase the bladder capacity and compliance in spinal cord injury dogs.Pudendal nerve stimulation with medium frequency can induce bladder contraction and increased voiding efficicncy.
Key words:
Bladder; Spinal cord injury; Pudendal nerve stimulation; Dogs; Urodynamics
Objective
To present the experience of artificial urinary sphincter implantation as a part of urinary tract reconstruction for patients with refractory urinary incontinence.
Methods
Between April 2002 and April 2016, a total of 30 patients (median age, 40.2 years, 29 males, 1 female ) with urinary incontinence had accepted artificial urinary sphincter placement during urinary tract reconstruction. Assessments included case selection, perioperative management, urinary continence, artificial urinary sphincter status, complications, quality of life and additional procedures.
Results
The mean follow-up time was 52.8 months ranged from 25 months to 13 years. At the latest visit, 23 patients (76.7%) maintained the primary artificial urinary sphincter. Four patients (13.3%) had artificial urinary sphincter revisions. Explantations were performed in three patients. Twenty-two patients were socially continent, of which 14 patients were totally dry, leading to the overall success rate as 73.3%. There was a significant reduction in pad count from 3.8±0.3 to 1.1±0.3 diapers per day (P<0.001). There was a significant reduction on the impact of urinary incontinence on quality of life, with a decrease from 6.9 ± 0.3 to 1.9 ± 0.5 (P<0.001) on a visual analogue scale (VAS). The complication rate was 26.7%; including infections (n=4), erosions (n=3), and mechanical failure (n=1).
Conclusions
Artificial urinary sphincter implantation is an effective treatment as a key procedure for urinary tract reconstruction, especially in complicated urinary incontinence cases. Other than post-prostatectomy incontinence cases, the quality and choice of management modalities should be tailored to the unique needs of each individual with caution.
Key words:
Artificial urinary sphincter; Urinary incontinence; Urinary tract reconstruction; Complication; Follow up
This study aimed to assess the predictive value of the Bladder Deformity Index (BDI) in determining upper urinary tract (UUT) damage among patients with neurogenic bladder (NB).
621 Background: At ASCO 2003, interim results of GT vs T in MBC patients (pts) were presented (#25), demonstrating significantly longer time to disease progression for GT with manageable toxicity. Here we present the results of the pain and QoL assessments. Methods: Pts with MBC with prior (neo)adjuvant anthracyclines were randomized to GT (G 1250 mg/m2 d1,8; T 175 mg/m2 d1) or T (175 mg/m2 d1) q21d. Pts completed the Brief Pain Inventory (BPI) and Rotterdam Symptom Checklist (RSCL) prior to each cycle; only data from validated translations were included. Analgesic level was assessed prior to each cycle. Mixed effect repeated-measure analysis was used to study overall and cycle-specific differences. This abstract presents the results of sensitivity analyses with five longitudinal models (e.g., pattern mixture models) that were performed to study potential bias due to informative dropout. Results: 529 pts were randomized (267 GT and 262 T). Arms were balanced; 70% had visceral metastases and 72% had KPS 90. Median cycles were 6 for GT (range, 0–20) and 5 for T (range, 0–16). 291 pts completed BPI and 350 completed RSCL. 85% of expected questionnaires were completed. The mean RSCL global QoL score for patients receiving GT was significantly and consistently better than that reported by T arm patients; this difference was also clinically significant. No consistent differences were seen in the other RSCL scales. Mean changes and trends in pain intensity and interference were similar across treatment arms. Data from the sensitivity analyses consistently supported these findings. Of pts requiring analgesics at baseline (n=216), more GT pts were able to decrease analgesic level for >1 cycle (25 vs 15%). Conclusions: For pts with MBC, the addition of gemcitabine to paclitaxel extended time to progression and resulted in a better global rating of QoL. The combination palliated pain as well as monotherapy in the predominantly asymptomatic population. Author Disclosure Employment or Leadership Consultant or Advisory Stock Ownership Honoraria Research Funding Expert Testimony Other Remuneration Eli Lilly & Co. Eli Lilly & Co. Eli Lilly & Co. Eli Lilly & Co.
Objective To study risk factors of urinary calculus formation in spinal cord injured patients.Methods The clinical data of 128 patients with spinal cord injury following urinary calculi were retrospectively reviewed.Results Among the 128 cases,there were 32 cases receiving bladder stoma;34 cases,regular replacement of indwelling catheter;12 cases,intermittent catheterization;19 cases,triggered reflex voiding;11 cases,voiding by abdominal straining;20 cases,condom catheters with urine collection devices.120 cases presented with urinary tract infection,and 11 cases presented serum calcium increase.Video urodynamic suggested detrusor areflexia in 39 cases,detrusor overactivity in 63 cases,detrusor external sphincter dyssynergia in 41 cases,detrusor bladder neck dyssynergia in 11 cases,external urethral sphincter overactivity in 27 cases,and urethral sphincter deficiency in 11 cases.The pathology of several physiological conditions coexisted in some patients.Conclusion Bladder management after spinal cord injury have a major impact on urinary stones formation.Low urinary tract infection,detrusor-urethral sphincter dyssynergia and other lower urinary tract dysfunction,long-term indwelling urinary catheter and cystostomy were main risk factors for urinary calculus formation.The abnormal calcium metabolism after spinal cord injury may be a risk factor for calculus formation.
The aim of this study was to explore the mechanisms of central brain action in patients with neurogenic underactive bladder (UAB) treated with intravesical electrical stimulation (IVES).
Abstract Background With the adoption of sentinel lymph node (SLN) biopsy as the standard of care, there is an increasing need for the rapid and accurate intra-operative diagnosis of SLNs. CBCSG-001c was a prospective multicenter trial to validate the One-step nucleic acid amplification (OSNA) assay in China. The primary endpoint was the concordance rates of intraoperative OSNA assay with the in-depth permanent histological analyses based both on cases and SLNs. Methods: From Feb. to Dec. 2010, 1188 SLNs from 552 breast cancer patients were enrolled in the CBCSG-001c study at 5 centers. SLNs were cut into alternating ∼2mm sections. One half of the sections were sampled for H&E, with 4 sections at different intervals. The other half was fully tested with the OSNA assay. Predetermined cutoffs were calibrated so only metastases >0.2 mm were detected. Results: The concordance rate was 89.1% (95% CI, 86.3−91.5%), sensitivity 87.7% (95% CI, 81.0−92.7%), and specificity 89.6% (95% CI, 86.3−92.4%) based on 552 cases, and the concordance rate was 91.4% (95% CI, 89.7−92.9%), sensitivity 83.7% (95% CI, 77.7−88.6%), and specificity 92.9% (95% CI, 91.1−94.4%) based on the 1188 SLNs. This quantitative molecular assessment allows the distinction of the size of the metastasis, and the PPV of OSNA [++] for macrometastases was 83.2% (95% CI, 75.0- 89.1%). Discordant results were thought to be partly due to the fact that different tissue sections were used for OSNA assay and histology, and SLNs with ITCs were not considered as histological positive nodes. After discordant case investigation, the senstivity of OSNA assay was significantly higher than that of intraoprative frozen section and touch imprint cyctology. Discussion: As the largest OSNA study to date, our results, together with that of Japan, Germany, and France study, proved the OSNA assay based on CK19 mRNA expression to be a reliable and standardized tool for the intraoperative detection of SLN metastases of breast cancer patients as compared to in-depth permanent histology. The high sensitivity of OSNA assay means reducing the risk of second operation for ALND, medical care costs and patients anxiety. Citation Information: Cancer Res 2011;71(24 Suppl):Abstract nr P3-07-03.
'/%3e%3cuse xlink:href='%23a' transform='rotate(23.036 .093 25.536)'/%3e%3cuse xlink:href='%23a' transform='rotate(45.87 1.273 16.18)'/%3e%3cuse xlink:href='%23a' transform='rotate(69.945 .996 12.078)'/%3e%3cuse xlink:href='%23a' transform='rotate(20.66 -19.689 31.932)'/%3e%3c/svg%3e)