Systematic treatment for nocturnal urinary frequency following a sleep–micturition chart

Seven patients complaining of nocturnal urinary frequency were treated following a sleep-micturition chart. By clinical analysis of the data, the causes of nocturnal urinary frequency were divided into three diagnostic categories: a small bladder capacity group, a sleep disorder group and a large nocturnal urinary volume group. The three groups were treated by anticholinergic agents, sleeping pills and restriction of water intake at night respectively. With the administration of anti-cholinergic agents or sleeping pills nocturnal bladder capacity increased. By restriction of water intake at night nocturnal urinary volume decreased. In all patients nocturnal urinary frequency decreased and sleep efficiency was improved.     

Biogenic amine metabolites in delusional (psychotic) depression and melancholia subtypes of major depression

1. 1. The levels of the urinary main metabolites of norepinephrine 3-methoxy-4-hydroxyphenylglycol (MHPG), of dopamine homovanillic acid (HVA) and of serotonin 5-hydroxyindoleacetic acid (5-HIAA) were measured in 84 patients with major depressive disorder, 34 delusional and 50 nondelusional. Melancholia subtype was also defined (N=62).

2. 2. MHPG was significantly higher in the delusional depressed group (p=0.023). Female patients with delusional major depression also had significantly higher HVA excretion than female patients with non delusional major depression (p=0.036). 5-HIAA excretion was similar in the two patient subgroups.

3. 3. No significant differences in the three monoamine metabolites were found between the melancholic and nonmelancholic depressed patients.

Pneumonia and urinary tract infection after acute ischaemic stroke: a tertiary analysis of the GAIN International trial.

The third most common stroke complication is infection. We studied the rates of aspiration pneumonia and urinary tract infection (UTI), their risk factors and their effect on outcome in the 1455 Glycine Antagonist (Gavestinel) in Neuroprotection (GAIN) International patients with ischaemic stroke. Forward stepwise logistic regression and Cox proportional hazards modelling identified baseline factors that predicted events and the independent effect of events up to day 7 on poor stroke outcome at 3 months in patients alive at day 7, after correcting for prognostic factors. Higher baseline National Institute of Health Stroke Scale (NIHSS) and age, male gender, history of diabetes and stroke subtype predicted pneumonia, which occurred in 13.6% of patients. Female gender and higher baseline NIHSS and age predicted UTI, which occurred in 17.2% of patients. Pneumonia was associated with poor outcome by mortality (hazard ratio, 2.2; 95% confidence interval, 1.5-3.3), Barthel index (<60) (odds ratio, 3.8; 2.2-6.7), NIHSS (4.9; 1.7-14) and Rankin scale (>/=2) (3.4; 1.4-8.3). UTI was associated with Barthel index (1.9; 1.2-2.9), NIHSS (2.2; 1.2-4.0) and Rankin scale (3.1; 1.6-4.9). Pneumonia and UTI are independently associated with stroke poor outcome. Patients with identified risk factors must be closely monitored for infection.     

Roux-y乙状结肠新膀胱替代后肠黏膜组织学变化及对代谢的影响

背景：许多报道指出,尿流改道后会出现代谢紊乱和病理生理的变化,但是这些用肠道重建膀胱替代手术引起的代谢紊乱主要与肠管类型及长度相关。 目的： 观察Roux-y乙状结肠新膀胱替代后贮尿囊黏膜的变化及对代谢的影响。 设计、时间及地点：回顾性病例分析,于2000-06/2008-11在解放军第一八四医院泌尿外科完成。 对象：33例膀胱癌患者,男21例,女12例,平均年龄64岁。对照组为25例经胃肠镜活检无乙状结肠疾病史者。 方法：采用根治性膀胱全切、利用肛门括约肌控尿的Roux-y乙状结肠新膀胱术进行手术治疗膀胱癌患者,分析新膀胱引流管拔管前后血电解质、肌酐和尿素的变化,并对其中13例患者的贮尿囊黏膜于术前、术后36个月取材作病理学检查。对照组为25例无乙状结肠疾病史者乙状结肠黏膜。检测项目包括肠黏膜厚度及腺体数目。 主要观察指标：手术前、拔管前后电解质、肾功能和酸碱平衡、黏膜层厚度、腺体数目。 结果：30例患者术后血电解质、肌酐和尿素均保持在正常范围,拔管前后电解质、肌酐和尿素的变化差异无显著性意义,3例患者表现有轻度的酸中毒。对照组手术前后结肠黏膜镜下改变不明显,基本保持了正常的组织结构。手术组术后黏膜层厚度变薄[(577.6±169.4),(412.5±114.7) μm,P < 0.05],肠腺排列疏松,间质稀少,单位腺体数目减少[(26.4±3.5),(15.2±2.7)个/HP ,P < 0.05]。术后新膀胱内的肠绒毛逐渐萎缩,肠上皮细胞未见增生及恶性改变。 结论：Roux-y乙状结肠新膀胱替代后肠黏膜层厚度变薄,肠腺排列疏松,间质稀少,单位腺体数目减少,人体代谢无明显变化。     

Sex Therapy Education in a Medical College

The purpose of this paper is: (1) to describe an attempt over three years, at teaching the principles of specific sex therapy to medical students at the London Hospital; (2) to examine their assessment of the usefulness of such teaching; and (3) to make hypotheses about the future value of sex therapy education on the careers of these students. A brief questionnaire was handed out to each student for completion at the end of a sexual dysfunction workshop. The results of ten workshops held in the 3 years are examined, together with changes that were made in the course as feedback was received. The usefulness of such an approach is considered, as are more long-term effects upon the attitudes and approaches used by students in their subsequent medical careers.     

Efficacy of desmopressin in patients with multiple sclerosis suffering from bladder dysfunction: a meta-analysis

OBJECTIVES: The current review evaluates the safety and efficacy of desmopressin in patients with multiple sclerosis (MS) who suffer from both daytime and nocturnal voiding frequency and from incontinence. MATERIALS AND METHODS: A literature search was carried out looking for studies published between 1990 and 2003 which evaluated desmopressin in MS patients with bladder dysfunction. RESULTS: The grand total mean effect sizes show the following estimates of clinical relevant differences: desmopressin has a moderate effect on the number of voids during the day or during the night over a period of 6 h after taking the drug. A large effect associated with the use of desmopressin was detected by the mean difference in urine volume (ml) in 6 h. A small effect was detected in the mean 24-h urine volume. Serum sodium levels were combined with plasma osmolality in some studies and were found to be not significantly affected by desmopressin treatment.     

肾移植术后尿瘘的定位诊断及治疗策略:14年回顾性分析

背景：尿瘘是肾移植术后最常见的外科并发症之一,目前对于肾移植术后尿瘘的治疗方法各中心报道不同,而且没有标准的分类标准和治疗规范。 目的：探讨肾移植术后不同部位尿瘘的诊断及最佳治疗方法。 设计、时间及地点：回顾性病例分析,1994年11月至2008年7月在解放军第三军医大学大坪医院野战外科研究所泌尿外科完成。 对象：确诊的68例肾移植术后尿瘘患者。 方法：根据尿瘘的部位将68例患者分为吻合口瘘及输尿管瘘。尿瘘部位根据膀胱造影、磁共振水成像及经手术探查结果确定。尿瘘诊断后先行保守治疗,即立即放置负压引流管引流伤口渗液,逆行插入双J导管及留置尿管。无效时立即手术修补尿瘘。分析不同部位尿瘘的发病特点及治疗效果。 主要观察指标：尿瘘的发病特点、病因、部位及治疗情况,比较不同部位尿瘘的治疗结果。 结果：吻合口瘘20例（29.4%）,输尿管瘘48例（70.6%）,平均发病时间分别为3.1±5.1±2.5、8.8±5.5天（p＜0.05)。吻合口瘘15例（75.0%）保守治疗成功,5例（25.0%）手术治疗,其中4例治愈无复发,1例因急性排斥反应切除移植肾;输尿管瘘中8例（16.7%）保守治疗成功,40例（83.3%）手术治疗,其中35例治愈（包括6例复发再次手术）,3例移植肾切除（2例修补失败,1例急性排斥反应）,2例因肺部感染死亡,吻合口瘘的保守治疗成功率较输尿管瘘高（75.0%vs16.7%,p＜0.01)。 结论：肾移植术后尿瘘的定位诊断对选择治疗方法有重要意义。吻合口瘘发生时间相对较早,漏尿量大。对于吻合口瘘可首选保守治疗,无效时再考虑手术治疗,而对于吻合口以上的输尿管瘘应尽早开放手术治疗。     

Effect of stimulation of anterior hypothalamic area on urinary bladder function of the anesthetized rat

Abstract. The hypothalamus is a key area for the integration of the autonomic features of affective behavior. Hypothalamic defence area (HDA) stimulation evokes major cardiorespiratory changes as well as modifications of general autonomic activity both in the anesthetized and conscious animal. Micturition is due to an increase in pelvic parasympathetic activity and, in the cat, the anterior hypothalamus has been implicated in urinary bladder control with the demonstration of a dorsolateral vesicoconstrictor pathway and a ventromedial inhibitory pathway. In this study we have investigated the effect of electrical and chemical stimulation of the HDA on bladder pressure and contractions in rat. Female rats (n = 15) were anesthetized, paralyzed and ventilated artificially. Arterial blood pressure, heart rate, urinary bladder pressure and pelvic nerve activity were recorded. HDA was electrically (1 ms, 100 Hz, 5–10 s train at intensities up to 150 µA) and chemically (sodium glutamate, 50nl, 2mM) stimulated. For statistical analysis the t–test was used, data were expressed as mean ± SEM. Values of t were taken as significant when p < 0.05.HDA stimulation at 100–150 µA evoked changes of both mean blood pressure (mBP) and bladder pressure (BlP). However, stimulation at < 30µA allowed a distinction within HDA of two different regions, at the same antero–posterior and lateral level, but separated 100–150µm in depth, which evoked differential effects on blood pressure and urinary bladder pressure. Results show that low intensity stimulation at ventral sites evoked a significant increase of mBP (from 102 ± 5.9 to 127 ± 8.6mmHg, n = 10, p < 0.0001) with little changes of BlP (from 12 ± 2.2 to 16 ± 2.9cmH₂O, n = 10, p < 0.0005), whilst at more dorsal sites significant increases of BlP were elicited (from 12 ± 8.3 to 38 ± 4.6cmH₂O,n = 10, p < 0.0001) with only a small rise of mBP (from 102 ± 6.2 to 111 ± 9.8mmHg, n = 10, p < 0.005). Glutamate injections at dorsal sites evoked a rise of BlP (from 11 ± 2.2 to 30 ± 3.0cmH₂O (n = 5; p < 0.0001) with small changes in BP, whilst at ventral sites (n = 4) glutamate microinjections evoked changes in BP but not of BlP. In conclusion stimulation at different sites within HDA can elicit separate changes in BP and BlP.     

Bladder dysfunction in a transgenic mouse model of multiple system atrophy

Multiple system atrophy (MSA) is an adult‐onset neurodegenerative disorder presenting with motor impairment and autonomic dysfunction. Urological function is altered in the majority of MSA patients, and urological symptoms often precede the motor syndrome. To date, bladder function and structure have never been investigated in MSA models. We aimed to test bladder function in a transgenic MSA mouse featuring oligodendroglial α‐synucleinopathy and define its applicability as a preclinical model to study urological failure in MSA. Experiments were performed in proteolipid protein (PLP)–human α‐synuclein (hαSyn) transgenic and control wild‐type mice. Diuresis, urodynamics, and detrusor strip contractility were assessed to characterize the urological phenotype. Bladder morphology and neuropathology of the lumbosacral intermediolateral column and the pontine micturition center (PMC) were analyzed in young and aged mice. Urodynamic analysis revealed a less efficient and unstable bladder in MSA mice with increased voiding contraction amplitude, higher frequency of nonvoiding contractions, and increased postvoid residual volume. MSA mice bladder walls showed early detrusor hypertrophy and age‐related urothelium hypertrophy. Transgenic hαSyn expression was detected in Schwann cells ensheathing the local nerve fibers in the lamina propria and muscularis of MSA bladders. Early loss of parasympathetic outflow neurons and delayed degeneration of the PMC accompanied the urological deficits in MSA mice. PLP‐hαSyn mice recapitulate major urological symptoms of human MSA that may be linked to αSyn‐related central and peripheral neuropathology and can be further used as a preclinical model to decipher pathomechanisms of MSA. © 2013 Movement Disorder Society     

Management of lower urinary tract symptoms in Parkinson's disease in the neurology clinic

This clinical review aims to evaluate lower urinary tract symptoms (LUTS) in Parkinson's disease (PD) patients and the current treatment options available for these symptoms in a neurology setting. The review also addresses when referral to urology is appropriate.

A literature search was conducted using the keywords ‘LUTS’, ‘non-motor symptoms’, ‘overactive bladder’, ‘Parkinson's disease’ and ‘urinary symptoms’ using the Medline/Pubmed search engine. Data collected ranged from 2000 to present with emphasis on recent publications.

This review was conducted because LUTS in PD has a major impact on quality of life and is associated with early institutionalization. Emphasis is placed on treating overactive bladder with conservative strategies and medical management in the neurology setting.

Quality of life can be improved and institutionalization can be delayed with a multimodal approach to bladder care.     

Create a predictive model for neurogenic bladder patients: upper urinary tract damage predictive nomogram

Abstract

Objective: To create a nomogram to evaluate the risk of upper urinary tract damage (UUTD) in patients with neurogenic bladder (NGB)

Methods: A retrospective analysis was conducted on 301 patients with NGB who were admitted to certain hospitals. Data collected included clinical symptoms, patients’ characteristics, laboratory parameters, imaging findings, and urodynamic parameters. The least absolute shrinkage and selection operator（LASSO）regression model was used to optimise the selection of predictors. Multivariate logistic regression analysis was performed to develop a UUTD risk predictive model. Validation was performed by bootstrap.

Results: The predictors included in the nomogram included sex, duration of disease, history of UTI, bladder compliance, and fecal incontinence. The model presented good discrimination with a C-index value of 0.796 (95% confidence interval: 0.74896–0.84304) and good calibration. The C-index value of the interval validation was 0.7872112. The results of decision curve analysis (DCA) demonstrated that the UUTD-risk predictive nomogram was clinically useful.

Conclusion: The nomogram incorporating the sex, duration of disease, history of UTI, bladder compliance, and fecal incontinence could be an important tool of UUTD risk prediction in NGB patients.     

Predictive value of clinical characteristics in patients with suspected cauda equina syndrome

Background and purpose:  Overlooking a potential diagnosis of cauda equina syndrome (CES) can result in severe long-term neurologic deficits. There is a growing trend to order urgent magnetic resonance imaging (MRI) scans of the lumbar spine in any patient presenting with signs suspicious for CES. A substantial number of these MRI scans do not show cauda compression. The purpose of this study is to assess whether clinical characteristics can predict MRI-confirmed cauda compression.
Methods:  We retrospectively studied 58 consecutive cases of suspected CES who presented at our hospital's emergency room.
Results:  Eight of 58 patients had cauda compression on MRI. When measured, MRI + CES patients (6) had more than 500 ml urinary retention. Moreover, when these patients had at least two of the following characteristics: bilateral sciatica, subjective urinary retention or rectal incontinence symptoms, MRI was more probable to demonstrate cauda compression with an OR of 48.00, 95% (CI 3.30–697.21), which was also significant ( P of 0.04). The presence of other symptoms or signs alone was not significantly different between both groups.
Conclusion:  In our series, urinary retention of more than 500 ml alone or in combination with two or more specific clinical characteristics were the most important predictors of MRI confirmed cauda compressions.     

Low molecular weight constituents of male mouse urine mediate the pregnancy block effect and convey information about the identity of the mating male

Mouse urine contains a complex mixture of chemosignals including a variety of small volatile molecules that are bound to major urinary proteins. In addition to signalling maleness, male urine also conveys information about individuality, which allows recently mated female mice to distinguish the urinary chemosignals of the mating male from those of an unfamiliar male. The highly polymorphic nature of the major urinary proteins makes them a likely candidate for conveying individuality information in the context of the pregnancy block effect. This was investigated by comparing the pregnancy-blocking effectiveness of a high molecular weight urinary fraction, containing major urinary proteins, with that of a low molecular weight fraction containing volatile ligands. Not only was the high molecular weight fraction ineffective in blocking pregnancy, but it also appeared to be less important in signalling individuality than the low molecular fraction. The high molecular weight fraction was ineffective in inducing expression of the immediate early gene product egr-1 in the accessory olfactory bulb. In contrast, the low molecular weight fraction induced egr-1 expression in the mitral/tufted neurons in the anterior subregion of the accessory olfactory bulb, suggesting that they activate the V1R class of vomeronasal receptor neuron.