Assessment and management of irritative voiding symptoms

Irritative voiding symptoms are to the urinary tract much as a cough is to the pulmonary system, that is, a nonspecific manifestation of multiple potential underlying causes. Key to the evaluation and management of patients with these symptoms is a clear understanding of the differential diagnosis, the diagnostic tests required for evaluation, and the role of specialists in diagnosis and treatment. This article outlines a general diagnostic approach for patients with irritative voiding symptoms. Treatment approaches for the diseases, as well as the initial management that may be performed in the primary care setting, are also discussed.     

排泄性尿路超声造影在儿童膀胱输尿管反流诊断中的研究进展

膀胱输尿管反流（VUR）与儿童泌尿道感染密切相关。排泄性尿路超声造影（CeVUS）是诊断儿童VUR的一种安全且可靠的影像学检查方法。本文主要就CeVUS在评估儿童VUR方面的研究进展做一综述。     

排泄性尿路超声造影在儿童膀胱输尿管反流诊断中的应用

膀胱输尿管反流与儿童泌尿道感染关系密切。排泄性尿路超声造影是诊断儿童膀胱输尿管反流的一种安全且可靠的的影像学检查方法,但目前在国内的应用相对较少。本文就排泄性尿路超声造影评估儿童膀胱输尿管反流的研究进展进行综述。     

Effects of timed voiding for the management of urinary incontinence in adults: systematic review

AIM: The aim of this paper is to present a systematic review assessing the effectiveness of timed voiding for the management of urinary incontinence in adults. BACKGROUND: Despite the widespread use of systematic voiding programmes, their effectiveness is unclear, and the evidence for timed voiding has not been subject to rigorous and systematic evaluation. The impact on psychosocial factors and cost is also untested. The physiological basis for timed voiding is also poorly established. METHODS: The systematic review incorporated the methodology of the Cochrane Collaboration. All randomized or quasi-randomized controlled trials that addressed timed voiding for the management of urinary incontinence in adults were searched, appraised, analysed and summarized. The date of the latest search was 2002. Data were extracted independently and appraised according to the level of concealment of random allocation prior to formal entry; few and identifiable withdrawals and dropouts and an analysis based on an intention to treat. The relative risk for dichotomous data was calculated with 95% confidence intervals. Where data were insufficient to support quantitative analysis, a narrative overview was undertaken. RESULTS: Two trials of timed voiding met the inclusion criteria. In both, timed voiding was combined with other strategies. Participants were predominantly cognitively and physically impaired older women who resided in nursing home settings. Within-group improvements for the intervention groups were reported for both trials. One trial additionally reported a statistically significant reduction in night-time incontinence for the intervention group. The quality of the trials was modest and interpretation was limited by the potential for bias associated with inadequate concealment, missing data and no analysis by intention to treat. CONCLUSION: Terms used to describe voiding programmes that involve a fixed interval of voiding are variable. No conclusions can be drawn at this point about the effectiveness of timed voiding for the management of urinary incontinence in adults.     

Radiographic appearance of the pars nuda urethrae in the voiding urethrogram

The pars nuda is the most anterior segment of the male membranous urethra, extending from the urogenital diaphragm to the urethral bulb. It differs from adjacent urethral segments in being incompletely supported by corpus cavernosum and musculature. Usually, this part of the urethra is difficult to distinguish in a voiding urethrogram. Occasionally, however, it may stand out clearly in certain phases of urethral muscular activity, resulting in a roentgen picture which may mimic an abnormality.     

Prolapsed simple ureterocele: evaluation by transvaginal voiding sono-urethrography

Prolapsed ureterocele is a rare complication that may present with acute bladder outlet obstruction, generally in female infants. We present a case of prolapsed simple ureterocele in an adult woman, evaluated by transvaginal micturating sono-urethrography. High-frequency transvaginal sonography of the urethra performed during micturation revealed the relationship of the ureterocele with the urethral wall.     

骶神经调节治疗慢性排尿功能障碍的护理

目的探讨骶神经调节治疗慢性排尿功能障碍的护理措施,为今后护理常规的制订提供依据。方法回顾分析6例慢性排尿功能障碍患者接受骶神经调节治疗的护理资料。结果6例骶神经调节测试患者中有5例客观和(或)主观指标均改善了50%以上,其中2例接受了永久电极和可程控式骶神经调节器植入术,术后客观和(或)主观指标得到了显著改善。术前和术后患者心理稳定,能较好地配合治疗和护理。6例患者随访15~26个月,未发现明显不良反应和并发症。结论术前积极的心理护理和充分的术前准备是保证骶神经调节治疗顺利进行的关键,术后康复指导和正确的护理是促进患者尽快康复、减少并发症发生的重要措施。     

经尿道前列腺电切术后患者排尿顺畅的措施和临床分析

目的观察经尿道前列腺电切术后,良性前列腺增生患者排尿症状的改变情况及临床分析。方法选择上海市长宁区同仁医院2008年3月至2013年3月收治的100例良性前列腺增生患者为研究对象,对患者的术前和术后排尿症状,如国际前列腺症状评分（IPSS）和生活质量（QOL）评分等进行评定。结果术前IPSS为（23±8）分、QOL评分为（5．2±1．2）分、平均梗阻症状评分为（3．9±1．2）分及平均刺激症状评分为（3．8±0．9）分;术后IPSS为（9±2）分、QOL评分为（1．5±0．9）分、平均梗阻症状评分（2．1±1．1）分及平均刺激症状评分为（1．4±0．8）分,术后与术前相比,各项指标均有明显改善,差异有统计学意义（P〈0．05）。结论良性前列腺增生患者经尿道前列腺电切术后,排尿症状得到明显改善,值得临床推广应用。     

Successful alpha-1 receptor blockade therapy in a toddler with infrequent and difficult voiding

A 3-year-old neurologically intact and behaviorally normal boy developed infrequent and difficult voiding subsequent to a soft tissue injury to the glans penis. Symptoms persisted for at least 9 months, and the course was complicated by diagnostic imaging evidence of a “markedly distended” bladder and a voiding diary that suggested elevated bladder volumes. Treatment with an alpha-1 receptor blocker normalized voiding within 24 hours. Discontinuation of the medication after 2 weeks resulted in recurrence of symptoms within 48 hours. Readministration of the medication resulted in prompt resolution of symptoms.     

The influences of prompted voiding for urinary incontinence among older people in nursing homes

Research question: What are the influences of prompted voiding (PV) for urinary incontinence (UI) among older people in nursing homes? Research problem: This study aims to evaluate the effects of PV for UI of older people's subjects in nursing homes. Management of UI among older people is needed to overcome the possibility of new problem for older people. A randomized controlled study was performed of pre‐test post‐test design for 12 subjects (6 of control and 6 of intervention group). An intervention group followed PV instructions for 24 hours during 28 days, while the control group was instructed to urinate in toilet or to use diapers. Outcome variables were measured using incontinence severity index (ISI). There was statistically significant main effect across ISI among intervention group pre‐ (8.67 ± 1.97) and post‐ (6.67 ± 2.73) intervention of PV (P = .007). While there was statistically significant differenced ISI between control and intervention group (9.67 ± 1.86 vs 6.67 ± 2.73) post‐intervention of PV (P = .005). There was higher reduced ISI in the intervention group (?M ?2.00 ± 1.09) after 28 days of PV (P = .001). PV could be used to increase the older people's initiative to go to toilet and decrease incontinence episodes during a short time by their self in the nursing home.