Voiding patterns in men and women with lower urinary tract symptoms combined with nocturia

AIM: We evaluated differences between men and women with lower urinary tract symptoms (LUTS) combined with nocturia. METHODS: A total of 71 age-matched female-male pairs (median 58, range 20-81 years) who had moderate to severe LUTS and nocturia of more than once per night were enrolled in this study. RESULTS: In the younger group (<50 years), the International Prostate Symptom Score (I-PSS) results of the sexes were not significantly different. However, although total I-PSS results in the elderly group (> or =50 years) were not significantly different, quality of life index scores for women were higher (P = 0.002). On frequency-volume (FV) charts, mean total daytime voided volume (DVV) was significantly higher in younger men than in younger women (P = 0.017), but the mean nocturnal polyuria index (NPi) for women was higher than that for men (P = 0.047). However, maximum DVV (P = 0.009), mean DVV (P < 0.0001), total DVV (P < 0.0001), and mean nocturnal urine volume (P = 0.009) were significantly higher in elderly men than in elderly women. However, numbers of daytime voids were not different. CONCLUSION: Elderly women with LUTS have lower functional bladder capacities than elderly men, as suggested by their smaller mean voided volumes. However, no significant differences were observed between numbers of daytime voids, which was probably due to the smaller total daytime voided volumes of elderly women. In addition, although NPi for younger women and nocturnal urine volume for elderly men was higher, no other differences were observed in terms of other night-time parameters.     

两种方法解决介入治疗术后排尿困难效果的比较

冠状动脉造影术,使冠心病的诊断、治疗水平明显提高。但床上排尿困难是术后常见的护理问题,采用常规的方法,效果不佳,常需导尿术解决,既增加了患者的痛苦,又增加了护理工作量。我科2003年3月~2006年10月采取开塞露肛注刺激直肠诱发排便-排尿反射,较好地解决了床上排尿困难的问题。并与常规诱导排尿的方法进行了比较,现报告如下。临床资料对象选择冠状动脉造影术后排尿困难者60例,其中男性42例,女性18例,年龄20~78岁,平均53岁,随机分为对照组和观察组各30例,两组年龄、性别差异无显著性,具有可比性。方法(1)观察组:给予开塞露肛注排便以诱导…     

仙附,芪地强心口服液治疗老年人慢性心功能不全

目的：寻求老年人心功能不全有效、安全的治法方药。方法：用仙附、芪地强心口服液与巯甲丙脯酸对照治疗老年心功能不全,观察心脏功能和血浆血管活性肽、临床症状、体征及药物安全性。结果：仙附、芪地强心口服液和巯甲丙脯酸治疗心功能不全总有效率分别为８７．５％（２８／３２）、９０．３％（２８／３１）、９０．６％（２９／３２）,三者差别无显著性（Ｐ＞０．０５）;在临床近期治愈率方面,分别为４３．８％（１４／３２）、５１．６（１６／３１）、２５．０％（８／３２）,芪地组优于巯甲丙脯酸对照组;对改善患者临床症状、体征、心脏功能和血浆血管活性肽指标等方面都显示明显效果。结论：老年人心功能不全可以益气养阴、温阳治本、活血利水治标为基本大法,仙附、芪地强心口服液是治疗本病的安全有效方药     

膀胱全切术后体外可控性回肠代膀胱术

 目的　探讨膀胱全切术后尿流改道新方法即体外可控性回肠代膀胱术的可行性及疗效。方法　取一段回肠 ,将中间部分折叠成N形并缝制成贮尿囊 ;远端回肠从腹壁造瘘口穿出体外 ,于此处取腹壁皮瓣包绕外露肠管缝制成皮管 ,构建输出道 ;将尿液控制器置于皮管外 ,利用气囊控制排尿。结果　 10只杂交狗顺利度过手术期 ,术后 3月时贮尿囊最大容量为 (15 0± 4 0 )ml,最大充盈压为 (2 4 .4± 5 .3)cmH2 O。临床应用 5例 ,随访 (3～ 14 )月 ,术后 3月时贮尿囊最大容量达 (2 90± 80 )ml,最大充盈压为 (36 .3± 8.2 )cmH2 O ,最大尿流率为 (2 0 .3± 4 .7)ml s,无残余尿。X线影像学检查 ,肾脏显影良好 ,输尿管通畅。尿液控制器的气囊充气后 ,无尿液流出 ;气囊消气后 ,尿液呈粗线条流出。结论　该尿流改道术式具有体外自主控制排尿的特点 ,不必佩戴集尿袋或自行导尿 ,且手术操作比较简单、并发症少、安全可靠。     

Normal voiding patterns and determinants of increased diurnal and nocturnal voiding frequency in elderly men

PURPOSE: We determined the normal value of diurnal and nocturnal voiding frequency, and its determinants in a population based sample of elderly men. MATERIALS AND METHODS: We collected data on 1,688 men 50 to 78 years old recruited from the population of Krimpen, The Netherlands. Measurements consisted of self-administered questionnaires, including the International Prostate Symptom Score (I-PSS), a 3-day frequency-volume chart, transrectal prostatic ultrasound, uroflowmetry and post-void residual urine volume measurement. RESULTS: Diurnal voiding frequency is independent of age and more frequent in men with benign prostatic hyperplasia (BPH). Nocturia 2 or more times is present in 30% of men 50 to 54 and in 60% of those 70 to 78 years old, while nocturia 3 or more times is present in 4% and 20%, respectively. In addition, nocturia is strongly associated with BPH and nocturnal polyuria but apparently not with cardiovascular symptoms, hypertension or diabetes mellitus. We noted poor agreement of the responses on the frequency-volume charts and the I-PSS question on nocturia. Using the I-PSS leads to a higher prevalence of nocturia. CONCLUSIONS: Diurnal frequency is independent of age (median 5 voids, interquartile range 4 to 6) but higher in men with BPH. Nocturia increases with advancing age and is more frequent in men with nocturnal polyuria. BPH is an independent risk factor for nocturia and increased diurnal voiding frequency. In those with nocturia there is a great difference in subjective symptoms and objective data, indicating that the weight of the I-PSS question on nocturia for making treatment decisions should be reconsidered.     

Brain activation during the voiding phase of micturition in healthy adults: A meta‐analysis of neuroimaging studies

Several studies have used a variety of neuroimaging techniques to measure brain activity during the voiding phase of micturition. However, there is a lack of consensus on which regions of the brain are activated during voiding. The aim of this meta‐analysis is to identify the brain regions that are consistently activated during voiding in healthy adults across different studies. We searched the literature for neuroimaging studies that reported brain co‐ordinates that were activated during voiding. We excluded studies that reported co‐ordinates only for bladder filling, during pelvic floor contraction only, and studies that focused on abnormal bladder states such as the neurogenic bladder. We used the activation‐likelihood estimation (ALE) approach to create a statistical map of the brain and identify the brain co‐ordinates that were activated across different studies. We identified nine studies that reported brain activation during the task of voiding in 91 healthy subjects. Together, these studies reported 117 foci for ALE analysis. Our ALE map yielded six clusters of activation in the pons, cerebellum, insula, anterior cingulate cortex (ACC), thalamus, and the inferior frontal gyrus. Regions of the brain involved in executive control (frontal cortex), interoception (ACC, insula), motor control (cerebellum, thalamus), and brainstem (pons) are involved in micturition. This analysis provides insight into the supraspinal control of voiding in healthy adults and provides a framework to understand dysfunctional voiding. Clin. Anat., 2018. © 2018 Wiley Periodicals, Inc.     

Urological symptoms among 23,240 men in the general danish population – concerns about symptoms,their persistence and influence on primary care contacts

Objective: To analyse possible associations between men’s likelihood of contacting a general practitioner (GP) for urological symptoms and the persistence of the symptoms, the influence on daily activities and the level of concern about the symptoms.

Design: Web-based nationwide cross-sectional questionnaire study.

Setting: The general population in Denmark.

Subjects: 48,910 randomly selected men aged 20+ years.

Main outcome measures: Urological symptom prevalence and odds ratios for GP contact with urological symptoms in regard to concern for the symptom, influence on daily activities and the persistence of the symptom.

Results: Some 23,240 men responded to the questionnaire, yielding a response rate of 49.8%. The prevalence of at least one urological symptom was 59.9%. Among men experiencing at least one urological symptom almost one-fourth reported contact to general practice regarding the symptom. Approximately half of the symptoms reported to be extremely concerning were discussed with a GP.

Conclusion: Increased symptom concern, influence on daily activities and long-term persistence increased the likelihood of contacting a GP with urological symptoms. This research points out that guidelines for PSA testing might be challenged by the high prevalence of urological symptoms.

• Key points

• ?The decision process of whether to contact the general practitioner (GP) is influenced by different factors, but contradictory results has been found in triggers and barriers for help-seeking with urological symptoms.

• ??Increased symptom concern, influence on daily activities and long-term persistence consistently increased the likelihood of contacting a general practitioner with urological symptoms in men.

• ??Only 50% of the symptoms reported to be extremely concerning were however discussed with the GP.

• ??Guidelines for PSA testing might be challenged by the high prevalence of urological symptoms.

     

多系统萎缩非运动症候的临床研究

目的总结多系统萎缩(multiple system atrophy,MSA)以非运动症候和运动症候为首发症状的构成比和MSA非运动症候的具体症候构成比。方法选择MSA患者31例,其中MSA-P型18例,MSA-C型13例。进行详细病史记录和神经系统体检,记录运动症候及非运动症候具体表现及出现时间。结果 23例MSA以非运动症候首发。非运动症候的首发症状以快速眼动睡眠异常、排尿障碍、性功能障碍及直立性低血压常见。31例MSA患者均有非运动症候表现。以直肠功能障碍(93.5%)、排尿障碍(90.3%)、直立性低血压(64.5%)、睡眠呼吸暂停(61.3%)、快速眼动睡眠异常(48.4%)最为常见。MSA-P型与MSA-C型在年龄、性别、首发病程、就诊病程及非运动症候构成比较,差异无统计学意义(P>0.05)。结论 MSA患者普遍存在自主神经功能障碍等非运动症候表现,且以首发症状多见。MSA-C型患者中以非运动症候起病较MSA-P型患者更为多见。