Valsalva leak point pressure: Steps toward standardization

Valsalva leak point pressure (VLPP) has been used as the urodynamic indicator of intrinsic sphincteric deficiency in patients with stress urinary incontinence. However, further validation of VLPP as a tool for diagnosis and assessment of treatment outcome has been delayed mainly because of the lack of a universally accepted standardized methodology. The urodynamic parameters in need of standardization for measurement of VLPP include urethral catheter size, zeroing of the transducer, patient position, bladder volume, type of stress, and timing of measurement. Such standard-ization likely will allow for further validation of VLPP and its use in distinguishing the right treatment options for the correction of stress urinary incontinence.     

Mesenchymal stem cell therapy in a rat model of birth-trauma injury: functional improvements and biodistribution

Introduction and hypothesis

We evaluated the potential role of human mesenchymal stem cells (hMSCs) in improvement of urinary continence following birth-trauma injury.

Methods

Human MSCs were injected periurethrally or systemically into rats immediately after vaginal distention (VD) (n?=?90). Control groups were non-VD (uninjured/untreated, n?=?15), local or systemic saline (injection/control, n?=?90), and dermofibroblast (cell therapy/control, n?=?90). Leak-point pressure (LPP) was measured 4, 10, and 14 days later. Urethras were morphometrically evaluated. In another sets of VD and non-VD rats, the fate of periurethrally injected hMSC, biodistribution, and in vivo viability was studied using human Alu genomic repeat staining, PKH26 labeling, and luciferase-expression labeling, respectively.

Results

Saline- and dermofibroblast-treated control rats demonstrated lower LPP than non-VD controls at days 4 and 14 (P?<?0.01). LPP after systemic hMSC and periurethral hMSC treatment were comparable with non-VD controls at 4, 10, and 14 days (P?>?0.05). Local saline controls demonstrated extensive urethral tissue bleeding. The connective tissue area/urethral section area proportion and vascular density were higher in the local hMSC- versus the saline-treated group at 4 and 14 days, respectively. No positive Alu-stained nuclei were observed in urethras at 4, 10, and 14 days. PKH26-labelled cells were found in all urethras at 2 and 24 h. Bioluminescence study showed increased luciferase expression from day 0 to 1 following hMSC injection.

Conclusions

Human MSCs restored the continence mechanism with an immediate and sustained effect in the VD model, while saline and dermofibroblast therapy did not. Human MSCs remained at the site of periurethral injection for <7 days. We hypothesize that periurethral hMSC treatment improves vascular, connective tissue, and hemorrhage status of urethral tissues after acute VD injury.

     

Diabetic uropathy

Diabetes mellitus (DM) is becoming more common in the United States affecting an estimated 18.2 million Americans. Not only is the number of American's with DM staggering, but so are the medical and economic costs of DM. DM accounts for nearly 15% of all health care costs in the United States. The chronic hyperglycemia of DM is associated with long-term damage, dysfunction and failure of multiple organ systems, including the genitourinary system. Genitourinary complications are common among diabetics. Of individuals diagnosed with DM, 80% have lower urinary tract complications, while 50% develop nephropathy and 35-75% develop sexual dysfunction. In order to decrease the number and severity of diabetic urologic complications, early recognition and a more comprehensive understanding of how diabetes impacts the genitourinary tract is imperative.     

Practice guidelines and clinical risk assessment models: is it time to reform?

Background

Clinical practice guidelines and Risk Assessment Models (RAMs) are some useful tools to bring medical evidences into our daily clinical practice. Despite the improvement over the time, they still have some shortcomings.

Discussion

One of these shortcomings is the arbitrary cutoffs used in these tools to facilitate the decision making process. This problem is to some extent due to the "Black or White" approach of modern medicine in making the decisions, whilst in the real world and our daily practice we used mostly an uncertain approach, which is called recently as "Fuzzy" thinking approach.

Summary

The authors of this article believe that the fuzzy type of thinking may resolve the above mentioned shortcomings of clinical practice guideline or risk assessment models and they tried to discuss about this using an example about Venous Thromboembolism related guidelines and RAMs.