Frequency and causes of fluid absorption: a comparison of three techniques for resection of the prostate under continuous pressure monitoring

OBJECTIVE: To compare in a prospective study three techniques for draining irrigation fluid during transurethral resection of the prostate (TURP) and to assess which method minimizes the risk of increased intravesical pressure and decreased plasma sodium level, as a sign of fluid absorption. PATIENTS AND METHODS: The study included 90 patients with benign prostatic hyperplasia (BPH), randomized into three equal groups, who underwent TURP using different techniques for draining the irrigation fluid. Group 1 had suprapubic drainage via the Freka(R) CystTUR Standard device (Fresenius, Germany); group 2 underwent TURP with an Iglesias continuous-flow resectoscope; and group 3 had suprapubic drainage using the Korth 'flow controller' (Olympus, Germany). The intravesical pressure was monitored continuously during surgery; an 'increased' pressure was defined as being >20 cmH2O. As fluid absorption decreases the plasma sodium level during surgery, the latter was also determined and the difference before and after surgery calculated. RESULTS: The intravesical pressure was increased in 10% of those in group 1, 90% in group 2 and none of group 3. The differences between group 1 and 2 and between group 2 and 3 were significant (P<0.001). The differences in the decrease of plasma sodium levels in groups 1-3 were not significant, but there was a significant correlation (P=0.0075) between increased intravesical pressure and minimum levels of plasma sodium. CONCLUSIONS: The three techniques for draining irrigation fluid produced significant differences in 'increased' intravesical pressure. In general, the levels of plasma sodium were not significantly different among the three techniques but patients with lower plasma sodium levels tended to have an increased intravesical pressure. In these cases, fluid absorption seems to be avoidable by an appropriate drainage technique. Nevertheless, considerable fluid absorption can occur at pressures of <20 cmH2O.     

Weibliches Genitale

Ohne Zusammenfassung     

Beckenbodendysfunktion und ihre Therapie aus urologischer Sicht

The function of the pelvic floor and sphincter muscles consists of the maintenance of continence by a sufficient and stable tone and a normal reflex contraction and of a micturition without any obstruction by complete relaxation. The dysfunction can exist as overfunction in form of spastic condition, hyperreactivity or detrusor sphincter dysfunction or as underfunction in form of hyporeactivity or areflexia. The spastic condition is caused by a insufficient inhibition by the somatic A- and C-fibers. This dysfunction leads to urge-syndrome, urge-incontinence, pelvic pain-syndrome or residual urine and is diagnosed by urethral pressure profile or urethral calibration. The therapy is performed by antispastic drugs, biofeedback training and neuromodulation. The detrusor sphincter dysfunction is characterized by a missing relaxation of the striated muscles during micturition and leads to recurrent urinary tract infections, residual urine and finally to decompensation of the detrusor muscle and overflow incontinence. Therapeutically antispastic drugs, neuromodulation and intermittent catheterisation are used. The underfunction shows hyporeactivity or areflexia of the pelvic floor muscles and leads to stress incontinence by insufficient or missing pelvic floor contractions under stress. For therapy of choice, pelvic floor reeducation is performed, in case of failure suspension techniques are used.     

Hypochlorhydria‐induced calcium malabsorption does not affect fracture healing but increases post‐traumatic bone loss in the intact skeleton

Efficient calcium absorption is essential for skeletal health. Patients with impaired gastric acidification display low bone mass and increased fracture risk because calcium absorption is dependent on gastric pH. We investigated fracture healing and post‐traumatic bone turnover in mice deficient in Cckbr, encoding a gastrin receptor that affects acid secretion by parietal cells. Cckbr?/? mice display hypochlorhydria, calcium malabsorption, and osteopenia. Cckbr?/? and wildtype (WT) mice received a femur osteotomy and were fed either a standard or calcium‐enriched diet. Healed and intact bones were assessed by biomechanical testing, histomorphometry, micro‐computed tomography, and quantitative backscattering. Parathyroid hormone (PTH) serum levels were determined by enzyme‐linked immunosorbent assay. Fracture healing was unaffected in Cckbr?/? mice. However, Cckbr?/? mice displayed increased calcium mobilization from the intact skeleton during bone healing, confirmed by significantly elevated PTH levels and osteoclast numbers compared to WT mice. Calcium supplementation significantly reduced secondary hyperparathyroidism and bone resorption in the intact skeleton in both genotypes, but more efficiently in WT mice. Furthermore, calcium administration improved bone healing in WT mice, indicated by significantly increased mechanical properties and bone mineral density of the fracture callus, whereas it had no significant effect in Cckbr?/? mice. Therefore, under conditions of hypochlorhydria‐induced calcium malabsorption, calcium, which is essential for callus mineralization, appears to be increasingly mobilized from the intact skeleton in favor of fracture healing. Calcium supplementation during fracture healing prevented systemic calcium mobilization, thereby maintaining bone mass and improving fracture healing in healthy individuals whereas the effect was limited by gastric hypochlorhydria. © 2016 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 34:1914–1921, 2016.

     

The natural history of lower urinary tract symptoms in females: analysis of a health screening project

OBJECTIVE: To analyse over 6.5 yr the natural history of lower urinary tract symptoms (LUTS) of continent women participating in a health investigation. METHODS: Women participating in a health screening survey in the area of Vienna in 1998-1999 underwent a detailed health investigation and completed the Bristol Female LUTS questionnaire. In 2005, all women still living in the area of Vienna were contacted by mail to complete the Bristol LUTS questionnaire again. For the current study, only women without urinary incontinence at baseline and follow-up were eligible. RESULTS: A total of 223 women (mean age, 50.3 yr; range, 21-79) were included in this 6.5-yr longitudinal study. At baseline, 80 women (35.9%) reported LUTS; this number increased to 105 (47.1%) 6.5 yr later. The calculated mean annual incidence of LUTS was 5.3% and revealed no clear dependency on age: 20-39 yr, 5.6%; 40-59 yr, 5.9%; > or =60 yr, 3.7%. The mean annual remission rate of LUTS was 4.6% without clear age dependency. Symptoms most likely to improve were "urgency"; "frequency"; "nocturia" and "feeling of incomplete bladder emptying" had the highest tendency of worsening. CONCLUSIONS: This longitudinal study on the natural history of LUTS in women without urinary incontinence provides estimates for incidence and remission rates over 6.5 yr. Compared with men, LUTS in women are a dynamic rather than a necessarily progressive disorder.     

The Suprapubic Arch Sling Procedure for Treatment of Stress Urinary Incontinence: A 5-Year Retrospective Study

Background

Up to now, numerous similar products concerning the surgical treatment of female stress urinary incontinence (SUI) have been developed.

Objective

To assess the long-term efficacy and safety of the suprapubic arch (SPARC) sling system in women with SUI.

Design, setting, and participants

This was a long-term retrospective study. All patients underwent a comprehensive pre- and postoperative evaluation. Forty-six women were available for clinical follow-up investigation after SPARC sling placement.

Intervention

Eighty-six women with SUI and a positive cough test underwent SPARC sling placement between June 2001 and January 2004.

Measurements

At follow-up all 46 patients underwent a cough test, a pad test, uroflowmetry, and sonographic postvoid residual volume measurement. Women rated their subjective continence status (continent, slightly incontinent, incontinent) and were asked if they would undergo the procedure again and if they would recommend it to a friend. Objective cure was defined as a pad weight 0–1 g and a negative cough test. Subjective cure was defined as no use of pads.

Results and limitations

The median follow-up was 5.2 yr. The objective cure rate was 76%; the subjective cure rate was 52%. Sixty-three percent of the patients rated themselves as continent, 33% as slightly incontinent, and 4% as severely incontinent. Most of the women (98%) would recommend the SPARC procedure to a friend and would undergo the procedure again.

Conclusions

The SPARC sling system is an effective and safe procedure for the treatment of female SUI. Patient satisfaction is independent of complete dryness.