Urodynamic evaluation of experimental bladder augmentation with seromuscular colocystoplasty

The use of de-epithelialized intestinal segment can avoid the complications associated of use to bowel segments for bladder augmentation.     

Urodynamic evaluation of the bilharzial urinary bladder

Urodynamic evaluations of 63 male bilharzial patients and 25 normal males were included in the present work. According to the uroflowmetric parameters, patients were classified into two groups: those with normal voiding (38 patients) and those with impaired voiding (25 patients). Fluid cystometry followed by a micturition study were conducted in all patients with impaired voiding, 14 patients with normal micturition, and for two of the control group. The urodynamic data were computed and analyzed. Nineteen patients with bilharzial calcification of the urinary bladder underwent the same urodynamic evaluation. No urodynamic differences were found between the control group, the patients with normal voiding, and the patients with bilharzial bladder calcification. Patients with impaired voiding showed a significantly lower peak flow and longer micturition time; the voiding pressures and the abdominal contribution (%) were also significantly higher. Three factors were associated with impairment of micturition in our patients: (1) bladder outlet obstruction, (2) hypoactive detrusor, and () high-grade vesicoureteral reflux.     

Urodynamic classification of patients with symptoms of overactive bladder

PURPOSE: We describe a new classification of patients with overactive bladder symptoms. MATERIALS AND METHODS: The office records of 132 patients who presented for evaluation of symptoms of urinary frequency, urinary urgency and/or urge incontinence, and who underwent videourodynamics were identified. All patients completed a 24-hour voiding diary and 24-hour pad test. Data collection included age, sex, hormone status, number of voids and incontinence episodes per 24 hours, functional bladder capacity, pad weight and associated genitourinary conditions. Videourodynamics were reviewed and patients were divided into 4 clinical categories, including type 1-no evidence of involuntary detrusor contractions on videourodynamics, type 2-involuntary detrusor contractions present, and patient aware and able to abort them, type 3-contractions present, patient aware and able to contract the sphincter but not abort contractions and type 4-contractions present and patient unaware but unable to contract the sphincter or abort contractions. RESULTS: Average patient age +/- SD was 64 years +/- 13. There were an average of 13 +/- 5 voids and 3 +/- 5 incontinence episodes per 24 hours. Average functional bladder capacity was 306 +/- 146 cc and average pad weight was 94 +/- 165 gm. Associated diagnoses included benign prostatic hypertrophy in 28% of cases, sphincteric incontinence in 17%, idiopathic urge incontinence in 29% and uterovaginal or bladder prolapse in 17%. Another 11% of patients had bladder outlet obstruction, impaired detrusor contractility or neurogenic bladder conditions. Of the cases 72 (55%), 32 (25%), 23 (17%) and 5 (4%) were categorized as classes 1 to 4, respectively. ANOVA revealed no statistically significant differences in the number of voids or incontinence episodes, functional bladder capacity or pad test when individual categories were compared to each other. CONCLUSIONS: This overactive bladder classification stratifies patients according to degrees of awareness, and control of bladder and sphincter function. It may prove useful as a guide for prognosis and therapy. Patients can be stratified into clinical groups based on the presence or absence of involuntary detrusor contractions, the ability to abort contractions and the ability to contract the urinary sphincter in response to contractions. Limiting the definition of overactive bladder to apply only to patients with no proved infection or other pathological condition would have eliminated more than 75% of those in this sample with symptoms of urinary urgency, frequency and/or urge incontinence.     

Urodynamic evaluation of bladder neck obstruction in chronic prostatitis

Urodynamic assessment was performed in 50 patients with symptoms which supported a diagnosis of chronic prostatitis and commonly suggested outflow obstruction. Twenty-three patients had bladder instability with an equal incidence with or without obstruction; this was demonstrated in 30 patients and was localised to the bladder neck in 24 and to the prostate in 6. A sensory problem presented on urodynamic testing in 26 patients (52% of the entire series), with a lower incidence (43%) in the obstructed group. Posterior urethritis was found in 28 (78%) of 36 patients subjected to cystourethroscopy. Endoscopic findings were suggestive of obstruction in 20 (95%) of 21 patients with urodynamic evidence of outflow obstruction and the sites of obstruction generally corresponded. The studies have provided urodynamic evidence that bladder neck obstruction could be a significant though not a predominant factor in the aetiology of the clinical syndrome of chronic prostatitis.     

Urodynamic evaluation of patients with spinal stenosis

Spinal stenosis, which may be congenital/developmental or acquired in origin, is a narrowing of the spinal canal, nerve root canals, or intervertebral foramina. Compression of the spinal cord or nerve roots may lead to structural neuronal damage, neuronal ischemia or edema, and axonal transport block. The most frequent symptom in patients with spinal stenosis is back pain and some have classic neurogenic claudication. We have performed urodynamic evaluations in 2 patients with combined cervical and lumbar spinal stenosis. A girl with achondroplastic dwarfism had urgency incontinence and detrusor hyperreflexia. An adult man with acquired degenerative spinal stenosis had difficulty voiding and findings compatible with the cauda equina syndrome.     

Vesicoureteric reflux in patients with bladder tumours

In the course of treatment of 224 patients with bladder neoplasms over an 18-year period, 44 patients were noted to have associated vesicoureteric reflux, bilateral in 12 and unilateral in 32. Reflux was suspected in 8 patients because of associated ureterotrigonal abnormalities such as paraureteric diverticulum, complete duplication of the ureter and gaping ureteric orifice, and it was diagnosed by micturating cystography obtained before the bladder tumour was treated. In the remaining 36 patients reflux developed after treatment of the bladder tumours. In most patients with reflux the clinical course was benign, but it caused recurrent pyelonephritis in 9 cases and secondary struvite calculi in 2. Five patients had antirefluxing ureteric reimplantation to control episodes of recurrent pyelonephritis. The pathogenesis and implications of vesicoureteric reflux in association with bladder tumours are discussed.     

Urodynamic parameters for the diagnosis of bladder outlet obstruction in women

INTRODUCTION: Bladder outlet obstruction (BOO) is often overlooked in the diagnosis of women with lower urinary tract symptoms. Although the incidence of BOO is not high in the female population with lower urinary tract symptoms, a correct diagnosis for BOO is important. This study was designed to compare the urodynamic parameters in women with bladder outlet obstruction (BOO), stress urinary incontinence (SUI) and asymptomatic volunteers. MATERIALS AND METHODS: Videourodynamic study was performed in 76 patients who were clinically diagnosed as BOO, 265 with stress urinary incontinence (SUI). In addition, 30 asymptomatic female volunteers were recruited and served as controls. Voiding pressure (P(det.Qmax)), maximum flow rate (Qmax), and urodynamic parameters were compared among the BOO, SUI and control groups and the criteria values for BOO in women were estimated. RESULTS: BOO was identified in 30 women with bladder outlet stricture, 40 women with dysfunctional voiding, and 6 women with high-grade cystocele. The mean P(det.Qmax) was significantly higher and the mean Qmax was significantly lower in the obstructed groups. When a P(det.Qmax) > or =35 cm H(2)O was set as the criteria for BOO, the sensitivity was 96.1% and specificity was 89.0%, whereas a P(det.Qmax) of > or =30 cm H(2)O had a sensitivity of 100% but the specificity was only 65.5%. If the criteria of BOO was set as P(det.Qmax) > or =35 cm H(2)O combined with Qmax < or =15 ml/s, the sensitivity for BOO was 81.6% and specificity was 93.9%. CONCLUSIONS: Our results demonstrate a P(det.Qmax) of > or =30 cm H(2)O is a good index value for screening of female BOO. When a P(det.Qmax) of > or =35 cm H(2)O combined with a Qmax < or =15 ml/s was found, a high suspicion of BOO should be raised, for which a specificity of 93.9% and sensitivity of 81.6% for BOO was obtained.     

Urodynamic studies in patients undergoing bladder replacement surgery

A high incidence of nocturnal incontinence has been a problem in patients undergoing continent urinary diversion when intact bowel segments are used. Detubularization has been advocated to solve this problem. Fifteen patients underwent continent urinary diversions and 4 underwent bladder augmentation with a variety of intestinal segments. Detubularization of the right colon anastomosed to the urethra was used in the first 3 patients, all of whom experienced nocturnal incontinence. Urodynamic studies showed high pressure contractions of the intestinal pouch of 60 to 100 cm. water pressure after the pouch was filled with 50 to 150 cc fluid. Incorporation of an ileal patch into the detubularized segment of colon was effective in reducing these pressures to 15 to 60 cm. water. This method reduced but did not eliminate the incidence of nocturnal incontinence. It is suggested that other factors may account for this problem.     

尿动力学检查在糖尿病患者膀胱功能评定中的意义

目的探讨尿动力学检查在糖尿病患者膀胱功能障碍诊断中的意义。方法伴有下尿路症状(LUTS)的糖尿病患者42例，年龄38～78岁，男24例，女18例。糖尿病发病1个月一25年。结果42例患者完成尿动力学全项检查41例，尿动力学表现异常者38例(93％)，尿动力学表现正常3例(7％)；膀胱逼尿肌收缩减低14例(34％)；膀胱逼尿肌反射消失10例(24％)；膀胱出口梗阻13例(32％，13／41)；女性压力性尿失禁1例。结论伴有LUTS的糖尿病患者膀胱功能异常发生率高，尿动力学检查可以明确膀胱逼尿肌功能，对合并糖尿病的LUTS患者正确诊断和治疗具有重要意义．糖尿病患者行膀胱尿道手术前进行尿动力学检查可提高手术成功率。     

Urodynamic evaluation after endoscopic modified bladder neck suspension.

A total of 45 simplified double-needle bladder neck suspensions for genuine stress incontinence were clinically and urodynamically evaluated pre- and postoperatively. After a mean follow-up of 26 months, the subjective cure rate was 82.2% and the objective cure rate was 86.6%. Comparison of the pre- and postoperative urodynamic parameters showed a significant change in the maximum urethral closure pressure, functional urethral length, bladder capacity and maximum urine flow rate but no significant alteration in maximum detrusor pressure and first sensation during bladder filling. In summary, the modified bladder neck suspension effectively restores normal urethral function urodynamically.     

Urodynamic effect of acute alpha-receptor blockade in patients with bladder neck dysfunction

Forty-nine male patients, median age 35 years (range 16-59) with bladder neck dysfunction (BND) were investigated before and after intravenous administration of phentolamine to evaluate the effect of acute alpha-blockade on micturition parameters and to identify patients, who might benefit from alpha-blocking therapy. Under the influence of phentolamine we found a significant decrease in the mean values of maximal urethral closure pressure (MUCP), pressure at the bladder neck and prostatic profile length (PPL), a decreased bladder capacity, a more complete bladder emptying, and a small but significant improvement in peak flow rate (PFR). However, according to a flow-rate nomogram analysis with correction for voided volume, only two patients significantly improved their PFR. A subgroup of 20 "responders", defined as patients with any improvement of PFR after phentolamine, not caused by increased detrusor pressure was characterized by significantly longer opening time and lesser maximal flow rate before phentolamine (more severe BND). All other pressure-flow parameters as well as the static pressure at bladder neck niveau were not different. We conclude that it is not possible before phentolamine administration to select a group of patients, which might benefit from alpha-blockade and it is suggested that this procedure might be included in the evaluation of patients with suspected BND.     

Urodynamic effects of solifenacin in untreated female patients with symptomatic overactive bladder

Objectives: To investigate the urodynamic effects of solifenacin in untreated female patients with symptomatic overactive bladder (OAB). Methods: A total of 52 untreated female patients with OAB symptoms were given 5 mg solifenacin once daily for 12 weeks. Before and after treatment, the frequency volume chart, overactive bladder symptom score (OABSS), postvoid residual volume, filling cystometry and adverse events were evaluated. Results: After solifenacin treatment, OAB symptoms were improved, voided volume was increased and voiding number was decreased. Bladder capacities at the first sensation of bladder filling, first desire to void and strong desire to void were significantly increased. Intravesical pressure at the first sensation of bladder filling was significantly decreased. Detrusor overactivity (DO) disappeared in five patients. For 28 patients with persisting DO after treatment, bladder capacity at DO was significantly increased. Both groups with and without DO at baseline had significant improvements of OAB symptoms. Conclusions: Solifenacin urodynamically increases bladder capacity in female patients with symptomatic OAB.     

ABH secretor status in patients with bladder tumours

Summary The ABO blood groups and secretor status of a group of patients with bladder tumours were investigated and compared with those of a group of patients of a similar age suffering from a variety of genito-urinary diseases. Some of the control patients were known to have been exposed to potential carcinogens, and the findings in this group were analysed separately. No significant differences were found when comparisons of these three groups of patients were made.     

Urodynamic evaluation of a bladder flap tube as urinary sphincter

The sphincteric properties of the normal urethra of seven female dogs were compared to those of a bladder flap tube pulled through the rectus muscle and anastomosed to the skin for urethral replacement. The functional length and distribution of closure pressure at rest were similar in the urethra and the bladder flap tube. When sneezing was triggered in the dogs to provoke a stress condition, contraction of the rectus muscle induced pressure changes in the distal neourethra similar to those obtained under the same stress condition from the striated urethral sphincter. However, with a full bladder, stress forced the newly fashioned bladder neck to open; yet, owing to sufficient resistance in the distal neourethra (rectus muscle), stress incontinence occurred only in two animals.     

Upper tract tumours in patients with vesico-ureteral reflux and recurrent bladder tumours

27 patients with recurrent low-grade, low-stage transitional cell carcinoma (TCC) of the bladder and uni- or bilateral vesico-ureteral reflux were followed for up to 18 years in order to study a possible higher incidence of TCC of the upper tract. None of the patients developed tumours of the upper collecting system during the follow-up period. Routine bladder instillations with Thiotepa may be one explanation of such a finding.     

Urodynamic results of sacral neuromodulation correlate with subjective improvement in patients with an overactive bladder

OBJECTIVES: Standard urodynamic investigations showed no correlation between the efficacy of sacral neuromodulation (SNS) and urodynamic data. Ambulant urodynamic investigations (ACM) are presented as more sensitive and reliable in detecting and quantifying bladder overactivity. In this study we looked at the correlation and results of ambulant urodynamic data and the clinical effects of SNS. METHODS: Data of patients with bladder overactivity, who underwent an ACM before and during SNS were investigated. Blind analyses of the ACM were performed and the detrusor activity index (DAI) was calculated as the degree of bladder overactivity of the detrusor. The ACM parameters, before and during SNS, were analyzed and correlated to the clinical effect of SNS. RESULTS: In 22 of the 34 patients a DAI before and during stimulation could be calculated because of quality aspects. In all other patients, the other ambulatory urodynamic parameters could be analyzed and a significant reduction was found in bladder overactivity. A significant correlation (p = 0.03) was found in DAI reduction of the ACM before and during SNS as compared to the clinical improvement in overactive bladder symptoms. CONCLUSIONS: The objective and subjective results show a decrease in bladder overactivity during SNS. During SNS bladder instabilities are still present, which is in accordance with the published literature. The reduction of the DAI during SNS as compared to before SNS correlates significantly to the clinical effect of SNS.     

Reliability of CT in preoperative evaluation of bladder carcinoma

Sixty patients with bladder carcinoma were examined by CT prior to radical cystectomy. CT indicated perivesical tumour growth or extension to neighbouring organs correctly in 68% of these cases. Overstaging was observed in 23% and understaging in 8% of the cases. Most of the difficulties concerned assessment of tumours in the anterior bladder wall and identification of the plane between the bladder and the seminal vesicle. In most instances CT provided no supplementary information to clinical staging, but was useful when obesity or previous irradiation impeded clinical staging.