Effect of the Extracts of Pumpkin Seeds on the Urodynamics of Rabbits：An Experimental Study

Pumpkin seeds were prepared into oil n-butyle alcohol and ether extracts.The effects of the three extracts on the urodynamics of rabbits were observed.It was concluded that the oil preparation could remarkably reduce the bladder pressure ,increase the bladder compliance, reduce the urethral pressure. Other two kinds of preparations had no effect in this experimental. The mechanisms of the effect of oil preparation on the urodynamics and the prospect of clinical use was discussed.

Comprehensive urodynamics: Being devoted to clinical urologic practice

As a combined electrophysiological system for evaluating the lower urinary tract(LUT), comprehensive urodynamics(UDS) aims at duplicating patient's micturition process, either normal or abnormal, and further seeking for possible causative origin, either neurogenic or non-neurogenic, in order to guide treatment. Through thorough analysis, some so-called cutoff values, for example, bladder outlet obstruction(BOO) degree or dyssynergic degree between the detrusor and sphincter, could be gained; however, in most cases, their qualitative description, such as stress urinary incontinence, idiopathic detrusor underactivity(DUA), detrusor overactivity(IDO), low compliance, and idiopathic sphincter overactivity(ISO), is more preferable and important. In aged neurologically intact male patients with symptoms of the LUT(LUTS) including benign prostatic hyperplasia, a combined UDS system, which coupled BOO with compliance, was constructed. The patients may be categorized into one of the seven subgroups, including equivocal or mild BOO with sphincter synergia with or without IDO(pattern A), equivocal or mild BOO with ISO(B), classic BOO with sphincter synergia(C) or ISO(D), BOO with only low compliance(E), BOO with both DUA and low compliance(F), and potential BOO with DUA(G). This new system can be used to optimize diagnosis and treatment according to a derived guideline diagram.

The Aging Bladder in Females Evaluated by Urodynamics

Aim: To determine whether bladder functions deteriorate with age. Methods: Data contained in electronic medical record (INFOMED?) were used in this institutional retrospective review. Analysis was done on the urodynamic studies in women over 18 years old conducted between May 2011 and November 2015. Patients with previous history of pelvic surgery or radiotherapy, neurological disease, vaginal prolapse greater than grade I, congenital urogenital malformations, urinary obstructive disease, diabetes, or the use of any medication that could interfere with bladder function were excluded from the analysis. The urodynamic parameters analyzed were the Maximum Cystometric Capacity (MCC), Voiding Volume (VV), Maximum Flow (Qmax), Bladder Compliance (BC), Detrusor Pressure at Maximum Flow (PdetQmax), Bladder Contractility Index (BCI), Bladder Voiding Efficiency (BVE) and Post-Void Residual Urine Volume (PVR). Patients were further stratified in five groups according to age (A—18 to 40;B—41 to 50;C—51 to 60;D—61 to 70;E—over 70 years old). Results: Out of 3103 urodynamic studies analyzed, 719 were eligible for the study. The average age of patients was 49.3 (+13.2) years old and in all evaluated parameters, statistically significant correlation between age and decline of bladder function was obtained (p Conclusions: This study showed a decline in bladder storage function (reduction in MCC and BC) and in bladder emptying function (reduction in Qmax, PdetQmax, VV, BCI and BVE with an increase in PVR) with age.

Autonomic Dysreflexia Severity between Urodynamics and Cystoscopy in Patients with Spinal Cord Injury above T6

Objective: The objective is to evaluate autonomic dysreflexia (AD) severity between urodynamics and cystoscopy in patients with spinal cord injury (SCI) above thoracic 6 (T6). Design: It is a cross-sectional survey. Subject and methods: The study was carried out in 22 patients with SCI above T6 who underwent both procedures of urodynamics and cystoscopy;all patients developed episodes of AD. The systolic blood pressure (SBP) and diastolic blood pressure (DBP) were measured and recorded at the beginning and during the various stages of the two examinations. AD was defined as a rise in SBP above 20 mm Hg. Results: There was no significant difference in SBP and DBP at baseline before urodynamics and cystoscopy. Both urodynamics and cystoscopy triggered episodes of AD. The volume of water instilled during cystoscopy was typically standard and smaller (150 mL) in comparison with urodynamics, where volume varied depending on cystometric bladder capacity (the mean bladder volume in our study was 234.86 ± 139.06 mL). The SBP was significantly different between cystoscopy and urodynamics (49.23 ± 23.07 mm Hg and 35.14 ± 15.75 mm Hg, respectively;P = 0.023). Conclusions: Although bladder distension during cystoscopy was less than that in urodynamics, the severity of AD was more pronounced during cystoscopy. It is recommended that monitoring of cardiovascular parameters during these procedures should be routinely performed.

Does urodynamics predict voiding after benign prostatic hyperplasia surgery in patients with detrusor underactivity?

Objective:We sought to determine if urodynamic study(UDS)predicted voiding outcomes in men with detrusor underactivity(DU)and benign prostatic enlargement(BPE)who underwent photovaporization of the prostate(PVP).Methods:Between September 2010 and July 2015,106 male patients with BPE and DU were identified.All patients underwent PVP.Urinary retention was noted by the preoperative necessity for an indwelling or intermittent catheter.Data collection included comorbidities,quality of life(QoL)scores,prostate volume,prostate-specific antigen(PSA),UDS and perioperative outcomes.UDS parameters included volume at first desire to void,volume at first urge to void,volume of severe urge,volume at capacity,compliance,detrusor contractions,maximum urinary flow rate(Qmax),and postvoid residual(PVR).Results:A total of 106 men were included in this analysis,who had urinary retention with a Foley catheter or clean intermittent catheterization(CIC)at the time of surgery.At baseline we found patients who voided had a detrusor pressure at Qmax(Pdet@Qmax)of 10.05±6.45 cmH2O compared to 16.78±12.17 cmH2O in those who did not void(p=0.071).Postoperatively,96(90.6%,mean age 76.9±26.2 years)of patients voided successfully while 10(9.4%,mean age 80.52±9.61 years)of patients remained in urinary retention.Mean baseline Qmax was 4.895±5.452 mL/s and 2.900±3.356 mL/s(p=0.087)in those who voided and did not respectively.PVR was 319.23±330.62 mL in those who voided and 276.88
263.27 mL(p=0.344)in those who did not void.No UDS parameter predicted who would void postoperatively or improvements in QoL.Conclusions:The patients with DU and BPE might be able to successfully void after undergoing PVP regardless of UDS findings.All men who voided had improved international prostate symptom score and QoL scores compared to baseline and these parameters were durable up to 12 months.

Comparation of the predictive value between ultrasonography and urodynamics for the efficacy of transurethral resection of prostate in benign prostatic hyperplasia patients

Background Transurethral resection of prostate （TURP） has been widely used as a golden standard therapy of benign prostatic hyperplasia for over 40 years. However, not all patients achieved favorable outcome postoperatively. Since the level of bladder outlet obstruction and the dysfunction of detrusor （overactive and underactive） were both found to affect surgical efficacy, urodynamics was recommended as routine preoperative examination in selecting proper surgical candidates by International Continence Society in spite of its invasiveness and high cost. The aim of this research was to compare the predictive value between ultrasonography and urodynamics for TURP efficacy and determine if preoperative urodynamic test could be replaced by ultrasonography.Methods Two hundred and seventy-one patients took part in the retrospective analysis. All the subjects had preoperative evaluation of symptoms, life quality, and combined examination of ultrasonography and urodynamics. Surgical efficacy was measured according to the recovery of international prostate symptom score, quality of life score, and maximal flow rate 6 months after TURP. Fisher’s linear discriminant analysis was applied to establish the predictive models of surgical efficacy by choosing parameters from ultrasonography or urodynamics as independent factors. Receiver’s operating characteristic curve was then plotted to compare the values between the models.Results Sensitivity, specificity, positive and negative predictive value of models consisting of parameters from both ultrasonography and urodynamics were favorable. Corresponding models of ultrasonography and urodynamics were found to have non-significant difference in area under curve （P〉0.05）.Conclusions Preoperative ultrasonography has as strong value as urodynamics does in predicting surgical outcome of patients undergone TURP and might take the place of urodynamics in selecting surgical candidates. Further prospective analysis with larger popularity and longer period of follow up should be launched to verify the result of this research.

Effects of electroacupuncture on urodynamics,intramedullary apoptosis and bidirectional regulation of neurotrophic factors in neurogenic bladder rats after supersacral spinal cord injury

Objective:To observe the effects of electroacupuncture on urodynamics and intramedullary apoptosis related factor B cell lymphoma gene-2(Bcl-2),Bcl-2 related protein X(Bax)and brain-derived neurotrophic factor(BDNF)in neurogenic bladder rats after supersacral spinal cord injury.Methods:A total of 60 female SD rats,SPF grade,were randomly selected,12 rats in the blank group and 12 rats in the sham operation group,and the remaining 36 rats were made models.Of these 36 rats,24 rats meeting the model standard were randomized into the model group and electroacupuncture group,with 12 rats in each group.The neurogenic bladder models after supracacral spinal cord injury were prepared by the Hassan Shaker spinal cord transection method,via combining the previous model study experience.At the end of spinal shock stage,"Dazhui(大椎GV14)""Zhongji(中极CV 3)""Ciliao(次髎BL 32)",and"Sanyinjiao(三阴交SP 6)"were selected for electroacupuncture.Observation on the histomorphological changes of bladder detrusor and spinal cord in rats was conducted by HE staining.The apoptosis rate of spinal cord cells was measured by TUNEL assay.The maximum bladder volume and compliance were measured by urodynamics test.The protein expressions of Bcl-2,Bax,and BDNF in spinal cord tissues were measured by Western blot assay.The expressions of Bcl-2,Bax,and BDNF mRNA were measured by RT-PCR assay.Results:(1)The results of HE staining showed that compared with the blank group and sham operation group,in the model group the bladder epithelial cell structure was destroyed,the detrusor muscle fibers proliferated,and there were severe bleeding changes,the spinal cord tissue was disordered,the structure was destroyed,the cell space was enlarged,and accompanied by a large number of inflammatory cell infiltration and cystic cavity formation.Compared with the model group,in the electroacupuncture group,the intact bladder epithelial cells increased,the detrusor muscle fiber proliferation decreased,the bleeding changes decreased,the complete structural area of spinal cord tissues increased,the cell space decreased,the levels were clearer,and the cystic cavity decreased.(2)The results of TUNEL assay indicated that the TUNEL positive rate of spinal cord cells in the model group was significantly higher than that in the blank group and sham group(both P<0.05).Compared with the model group,the TUNEL positive rate of spinal cord cells in the electroacupuncture group was significantly reduced(P<0.05).(3)The results of urodynamics test suggested that compared with the blank group and sham operation group,the maximum bladder volume and compliance of the model group were significantly reduced(all P<0.05).Compared with the model group,the maximum bladder volume and compliance were significantly increased in the electroacupuncture group(both P<0.05).(4)The results of Western blot assay indicated that,compared with the blank group and sham operation group,in the model group the protein contents of Bcl-2 and BDNF were significantly reduced(all P<0.05),while the protein content of Bax in the model group was significantly increased(both P<0.05).(5)The results of RT-PCR assay indicated that,compared with blank group and sham operation group,in the model group the intramedullary Bcl-2 and BDNF mRNA were significantly reduced(all P<0.05),and Bax mRNA was significantly increased(both P<0.05).Conclusion:Electroacupuncture at"GV14""CV3""BL32",and"SP6"can promote the repair of bladder detrusor,improve the maximum bladder volume and compliance of bladder,promote morphological repair of bladder detrusor,reduce spinal cord cell apoptosis rate,thus to restore the function of bladder.This is maybe related with the electroacupuncture’s two-way regulatory mechanism of increased expression of protein and gene of Bcl-2 and BDNF and decreased expression of protein and gene of Bax in spinal cord tissues.

Effect of Electroacupuncture on urodynamics, PACAP-38 and PAC1R of spinal cord in rats with neurogenic bladder

Objective： To investigate the effect and mechanism of electroacupuncture（EA） in the intervention of neurogenic bladder（NB） caused by suprasacral spinal cord injury（SCI）.Methods： The total 60 female Sprague-Dawley（SD） rats were divided into blank group, sham operation group by adopting random number table method, with 12 rats in each group. The remaining rats were made into models through operation, and 24 successful model rats were randomly divided into model group and EA group, with 12 rats in each group. Since the 19 th day after modeling, EA was conducted at ＂Cìliào＂（次髎BL 32）, ＂Zhōngjí＂（中极CV 3）,＂Sānyīnjiāo＂（三阴交SP 6） and ＂Dàzhuī＂（大椎GV 14） in EA group, remaining the needle for 20 min every time. The intervention was performed for once a day, and7 consecutive days were needed. The rest of the three groups were only tied up for the same time. Urodynamics test was conducted after the intervention. The contents of PACAP-38 and PAC1 R of the spinal cord of the injury site were detected by Western blot.Results： Compared with the blank group. there were no significant differences in the bladder capacity,leak point pressure, bladder compliance and PACAP-38 and PAC1 R contents in spinal cord in sham operation group; compared with the sham operation group, the maximum bladder capacity and the bladder compliance in the model group were lower（both P〈0.05）, the leak point pressure was higher（P〈0.05）,the contents of PACAP-38 and PAC1 R were lower（both P〈0.05）; compared with the model group, the maximum bladder capacity and the bladder compliance in the EA group were higher（both P〈0.05）, the leak point pressure was lower（P〈0.05）, the contents of PACAP-38 and PAC1 R were higher（both P〈0.05）.Conclusion： EA at BL 32, CV 3, SP 6 and GV 14 can improve the bladder function of NB rats of suprasacral SCI, and its mechanism may be related to the increase expression of PACAP-38 and PAC1 R protein in the injured spinal cord tissue.

Dynamic Observation of Needling Huiyang(BL 35)on Ambulatory Urodynamics in Unstable Bladder

Objective： Needling lumbosacral acupoints could regulate unstable bladder （USB）. The present study is to observe the ambulatory urodynamics changing of needling Huiyang （BL 35） on USB to provide scientific basis for the relative theory of acupoint and Zang-fu organs, and the rule of acupuncture treatment. Methods： Unstable bladder model were prepared in 80 Wistar rats, and then they were randomly divided into treatment group （n=40） and model group （n=40）. The urodynamics were monitored respectively at 2 h, 6 h, 12 h and 24 h after acupuncture and the results were analyzed. Results： After acupuncture Huiyang （BL 35）, the compliance of bladder were superior to that of model group at 2 h, 6 h and 12 h, respectively （P〈0.05）, and the bladder volume were superior to that of model group at 2 h and 12 h, respectively （P〈0.05）. After acupuncture Huiyang （BL 35）, the compliance and volumn of bladder at 12 h were superior to those at other time （P〈0.05）. Twenty-four hours later, the effect of acupuncture on urodynamics decreased. Conclusion： Needling Huiyang （BL 35） could improve the urodynamics of USB, including improving the compliance of bladder and increasing the volume of bladder. Acupuncture Huiyang （BL 35） had the most effect at 12 h.

Long-term anodal block stimulation at sacral anterior roots promoted recovery of neurogenic bladder function in a rabbit model of complete spinal cord injury

A complete spinal cord injury model was established in experimental rabbits using the spinal cord clip compression method. Urodynamic examination was performed 2 weeks later to determine neurogenic bladder status. The rabbits were treated with anodal block stimulation at sacral anterior roots for 4 weeks. Electrical stimulation of sacral anterior roots improved urodynamic parameters of neurogenic bladder in rabbit models of complete spinal cord injury, effectively promoted urinary function, and relieved urinary retention. Immunohistochemistry results showed that a balance was achieved among expression of muscarinic receptor subunits M2, M3, ATP-gated ion channel P2X3 receptors, and 132-adrenergic receptor, and nerve growth factor expression decreased. These results suggested that long-term sacral anterior root stimulation of anodal block could＇be used to treat neurogenic bladder in a rabbit model of complete spinal cord injury.

Evaluation for Madigan's prostatectomy in patients with benign prostatic hyperplasia

Aim: To comparatively evaluate the efficacy and post-operative complications of the Madigan's prostatectomy(MPC) and suprapubic prostatectomy (SPPC). Methods: A total of 43 patients with benign prostatic hyperplasiawere divided into two groups: 21 underwent MPC and 22, SPPC. In all the patients, the international prostate symp-tom score (IPSS) and urinary pressure-flow studies were assessed before and 6 months after operation. The InternationalContinence Society (ICS) nomogram, Abrams-Griffiths (AG) number and linear passive urethral resistance relationanalysis (L-PURR) were used to diagnose and grade bladder outlet obstruction (BOO). The IPSS and the urodynamicparameters before and after operation, as well as the advantages and post-operative complications were recorded andcompared. Results: Patients of both the MPC and SPPC groups had a significant improvement in IPSS and urody-namic parameters. Obstruction was relieved in 81.0% of MPC and 86.4% of SPPC patients. MPC has the advantagesof the absence of postoperative hematuria and post-catheter stricture, a shorter period of hospitalization, and lower inci-dence of retrograde ejaculation and erectile dysfunction. Conclusion: Both MPC and SPPC can effectively relieveBOO. MPC has certain advantages and a lower incidence of complications as compared with SPPC. (Asian J Androl2001 Mar; 3: 33-37)

Can intravesical prostatic protrusion predict bladder outlet obstruction even in men with good flow?

Objective:Men with benign prostate hyperplasia(BPH)with good urinary flow may still have bladder outlet obstruction(BOO).Intravesical prostatic protrusion(IPP)has been shown to be able to predict BOO.We aim to investigate the use of IPP to predict BOO in men with good urinary flow.Methods:One hundred and fourteen consecutive men(>50 years old)presenting with lower urinary tract symptoms suggestive of BPH were recruited in 2001 and 2002.They were evaluated with serum prostate specific antigen(PSA),uroflowmetry and transabdominal ultrasound measurement of IPP and prostate volume(PV).Pressure-flow urodynamic studies were performed on all men and BOO was defined by BOO index>40.Men with Qmax
12.0 mL/s were considered to have good flow.Results:Among the 114 men,61 patients had good urinary flow.Their median age,PV and Qmax were 66 years,32.9 mm3 and 14.5 mL/s respectively.14/61(23.0%)patients had BOO and their distribution of IPP were as follows:Grade 1 e 0/20(0%)obstructed,Grade 2 e 6/22(27.3%)and Grade 3 e 8/19(42.1%).Sensitivity of Grade 2/3 IPP for BOO was 100% while specificity of Grade 3 IPP was 76.6%.The area-under-curve(AUC)for IPP was greater than that for PV(0.757 vs.0.696).Conclusion:Even in men with good flow,high grades of IPP were more likely to have BOO and hence,may be a useful adjunct to predict BOO.

Ambulatory urodynamic monitoring of external urethral sphincter behavior in chronic prostatitis patients

Aim: To study the behavior of external urethral sphincter in chronic prostatitis (CP) patient under natural filling.Methods: Twenty-one CP patients and 17 normal volunteers were involved in the study. Both the patients andvolunteers underwent ambulatory urodynamic monitoring (AM) and conventional medium filling cystometry (CMG).Urodec 500 was used for AM and Menuet for CMG. AM findings from CP patients were compared with those fromnormal volunteers, and the results from AM were compared with those from CMG. Results: In AM, the restingand voiding external urethral sphincter (EUS) pressures and maximum urethral closure pressures (MUCP) weresignificantly higher in CP patients [ ( 121.5 ±10.3) and (85.6±3.5) cm water, respectively ] than in normalvolunteers [ (77.6±11.4) and (10.3±1.6) cm water, respectively)]. Conclusion: The behavioral changes ofEUS in CP patients included spasm and instability of EUS, which were demonstrated using AM under natural filling;the findings were also in accord with the results of CMG. (Asian J Androl 1999 Dec; 1: 215 -217)

Survey of spinal cord injury-induced neurogenic bladder studies using the Web of Science

OBJECTIVE：To identify global trends in research on spinal cord injury-induced neurogenic bladder, through a bibliometric analysis using the Web of Science. DATA RETRIEVAL：We performed a bibliometric analysis of studies on spinal cord injury-induced neurogenic bladder using the Web of Science.Data retrieval was performed using key words＂spinal cord injury＂,＂spinal injury＂,＂neurogenic bladder＂,＂neuropathic bladder＂,＂neurogenic lower urinary tract dysfunction＂,＂neurogenic voiding dysfunction＂,＂neurogenic urination disorder＂and ＂neurogenic vesicourethral dysfunction＂. SELECTION CRITERIA：Inclusion criteria：（a）published peer-reviewed articles on spinal cord injury-induced neurogenic bladder indexed in the Web of Science;（b）type of articles：original research articles and reviews;（c）year of publication：no limitation.Exclusion criteria：（a）articles that required manual searching or telephone access;（b）Corrected papers and book chapters. MAIN OUTCOME MEASURES：（1）Annual publication output;（2）distribution according to journals; （3）distribution according to subject areas;（4）distribution according to country;（5）distribution according to institution;and（6）top cited publications. RESULTS：There were 646 research articles addressing spinal cord injury-induced neurogenic bladder in the Web of Science.Research on spinal cord injury-induced neurogenic bladder was found in the Science Citation Index-Expanded as of 1946.The United States,Ireland and Switzerland were the three major countries contributing to studies in spinal cord injury-induced neurogenic bladder in the 1970s.However,in the 1990s,the United States,the United Kingdom,the Netherlands,Germany and Japan published more papers on spinal cord injury-induced neurogenic bladder than Switzerland,and Ireland fell off the top ten countries list.In this century,the United States ranks first in spinal cord injury-induced neurogenic bladder studies,followed by France,the United Kingdom,Germany,Switzerland and Japan.Subject categories including urology, nephrology and clinical neurology,as well as rehabilitation,are represented in spinal cord injury-induced neurogenic bladder studies. CONCLUSION：From our analysis of the literature and research trends,we conclude that spinal cord injury-induced neurogenic bladder is a hot topic that will continue to generate considerable research interest in the future.

Electroacupuncture at points Baliao and Huiyang (BL35) for post-stroke detrusor overactivity

Acupuncture is used extensively in China for the treatment of stroke and other neurological disorders. The National Institutes of Health recommends acupuncture as an adjunctive therapy for stroke recovery. This study included patients with post-stroke detrusor overactivity who were treated in the Department of Neurology, Fourth Hospital of Harbin Medical University, China. Subjects received either electroacupuncture or sham electroacupuncture at points Baliao [including bilateral Shangliao （BL31）, bilateral Ciliao （BL32）, bilateral Zhongliao （BL33）, and bilateral Xialiao （BL34）] and Huiyang （BL35）. Our results showed that electroacupuncture significantly improved cystometric capacity and bladder compliance, decreased detrusor leak point pressure, ameliorated lower urinary tract symptoms, and decreased the risk of upper urinary tract damage. These findings indicate that electroacupuncture at points Bafiao and Huiyang is an effective treatment for post-stroke detrusor overactivity.

Pressure-flow studies in patients with benign prostatic hyperplasia:a study comparing suprapubic and transurethral methods

Aim： To compare the use of the suprapubic puncture method versus the transurethral method in pressure-flow studies in patients with benign prostatic hyperplasia. Methods： Twenty-three men with benign prostatic hyperplasia underwent both suprapubic and transurethral pressure-flow studies during a single session. Standard pressure-flow variables were recorded in all patients with both methods, enabling calculation of obstruction using commonly used grading systems, such as the urethral resistance algorithm, the Abrams-Griffith （AG） number and the Schaefer linear nomogram. Results： There were statistically significant differences between the methods in the mean values of maximum flow rate （P 〈 0.05）, detrusor pressure at the maximum flow （P 〈 0.01）, urethral resistance algorithm （P 〈 0.01）, AG number （P 〈 0.01） and maximum cystic capacity （P 〈 0.01）. Of the men in the study, 10 （43.5%） remained in the same Schaefer class with both methods and 18 （78.3%） in the same AG number area. Using the transurethral method, 12 （52.2%） men increased their Schaefer class by one and 1 （4.3%） by two. There were also differences between the suprapubic and transurethral methods using the AG number： 4 （17.4%） men moved from a classification of equivocal to obstructed and 1 （4.3%） from unobstructed to equivocal. Conclusion： The differences between the techniques for measuring intravesical pressure alter the grading of obstruction determined by several of the commonly used classifications. An 8 F transurethral catheter significantly increases the likelihood of a diagnosis of bladder outlet obstruction when compared with the suprapubic method.

Surgical outcomes of bladder augmentation: A comparison of three different augmentation procedures

BACKGROUND Augmentation cystoplasty is indispensable in many pediatric diseases,especially neurogenic bladder.Various methods and materials are used to augment the bladder,and these methods are associated with different shortcomings and complications.AIM The present study reported the mid-term outcomes of patients undergoing various bladder augmentation procedures in a single institution,and assessed whether seromuscular cystoplasty lined with urothelium(SCLU)provided better urodynamic results than auto-augmentation(AA).METHODS A retrospective review of 96 patients undergoing various augmentation methods between 2003 and 2018 was performed.The patients were divided into three groups according to the type of augmentation,and their outcomes were compared.All patients developed neurogenic bladder due to myelomeningocele or sacrococcygeal teratoma.The clinical data of all patients were collected.RESULTS The mean ages at surgery in the three groups(standard cystoplasty[SC],SCLU,AA)were 10.8,7.5,and 4.8 years,respectively,with mean follow-ups of 36,61,and 36 mo,respectively.The mean preoperative and postoperative bladder capacities of the SC,SCLU,and AA groups were 174±11.7 vs.387±13.7(P<0.0001),165±12.2 vs.240±14.7(P=0.0002),and 138±16.7 vs.181±9.9(P=0.0360),respectively.Compared with the AA group,the SCLU procedure did not have better postoperative urodynamic parameters.Incontinence was reduced in most patients.The mean times of clean intermittent catheterization per day in the SC,SCLU,and AA groups were 5.6,7.8,and 8.2,respectively.The main complications of the SC group were recurrent urinary tract infections(8%)and bladder calculi(6%).Re-augmentation was done in patients in the SCLU(8)and AA(3)groups.CONCLUSION SC provided sufficient bladder capacity and improved compliance with acceptable complications.After AA and SCLU,the patients acquired limited increases in bladder capacity and compliance with a high rate of re-augmentation.Compared with AA,SCLU did not yield better postoperative urodynamic parameters.

Patients with small prostates and low-grade intravesical prostatic protrusion e A urodynamic evaluation

Abstract Objective:Despite high-grade intravesical prostatic protrusion(IPP)being closely related to bladder outlet obstruction(BOO),up to 21%of patients with low IPP remain obstructed.This study evaluates the characteristics and urodynamic findings of men with small prostates and low IPP.Methods:One hundred and fourteen men aged>50 years old with lower urinary tract symptoms(LUTS)were assessed with symptoms,uroflowmetry,serum prostate-specific antigen(PSA),transabdominal ultrasound measurement of prostate volume(PV),IPP and post-void residual urine(PVRU).All patients underwent pressure flow studies.Patients with PV<30 mL and IPP
10 mm were examined for parameters correlating with BOO or impaired detrusor contractility.Results:Thirty-six patients had PV<30 mL and IPP<10 mm.Nine patients(25.0%)had urodynamic BOO,all with normal bladder contractility.Fourteen patients(38.9%)had poor detrusor contractility and all had no BOO.PV,PVRU and IPP were significantly associated with BOO,with IPP showing greatest positive correlation.Both Qmax and IPP were significantly associated with detrusor contractility.At 5-year follow-up,most patients responded to medical therapy.Only three out of nine patients(33.3%)with BOO eventually underwent surgery,and all had a high bladder neck seen on the resectoscope.Only one patient(7.1%)with poor detrusor contractility eventually required surgery after repeat pressure flow study revealed BOO.Conclusion:In men with small prostates and low IPP,the presence of BOO is associated with higher PV,PVRU and IPP,and most respond well to medical management.BOO can possibly be explained by elevation of the bladder neck by a small subcervical adenoma.

Effect of precise nursing service mode on postoperative urinary incontinence prevention in patients with prostate disease

BACKGROUND Patients with benign prostatic disease often experience detrusor morphological changes and dysfunction.In severe cases,it leads to bladder detrusor dysfunction,resulting in dysuria,frequent urination,urgent urination,incomplete urination,and other symptoms including renal function injury.An operation to restore normal urination function and to control postoperative complications,as far as possible,is the most common method for benign prostatic disease.AIM To observe the effect of precise nursing service mode on postoperative urinary incontinence prevention in patients with prostate disease.METHODS In total,130 patients diagnosed with benign prostatic disease,from January 2018 to June 2021,in our hospital,were selected and divided into observation and control groups according to their treatment options.Sixty-five cases in the control group were given routine nursing mode intervention and 65 cases in the observation group received precise nursing service mode intervention.The intervention with the observation group included psychological counseling about negative emotions,pelvic floor exercises,and post-hospital discharge care.The complications of the two groups were counted,and the general postoperative conditions of the two groups were recorded.The urinary flow dynamics indexes of the two groups were detected,and differences in clinical international prostate system score(IPSS)and urinary incontinence quality of life questionnaire(I-QOL)scores were evaluated.RESULTS Postoperative exhaust time(18.65±3.23 h and 24.63±4.51 h),the time of indwelling catheter(4.85±1.08 d and 5.63±1.24 d),and hospitalization time(8.78±2.03 d and 10.23±2.28 d)in the observation group were lower than in the control group.The difference was statistically significant(P<0.05).After the operation,the maximum urinary flow rate(Qmax)increased(P<0.05),the residual urine volume(RUV)decreased(P<0.05),and the maximum closed urethral pressure(MUCP)was not statistically significant(P>0.05)compared to pre-operation.The Qmax of the observation group was higher than that of the control group,while the RUV was lower than that of the control group.There was no significant difference in MUCP between the observation and control groups(P>0.05).The I-QOL score of the two groups improved(P<0.05),and the IPSS decreased(P<0.05).After the operation,the I-QOL score of the observation group was higher than that of the control group,and the IPSS was lower than that of the control group(P<0.05).There were no significant differences in the incidence of urethral injury(1.54%and 3.08%),bladder spasm(0.00%and 1.54%),and secondary bleeding(1.54%and 4.62)between the observation and control groups(P>0.05).CONCLUSION The precise nursing service mode can reduce the incidence of postoperative urinary incontinence in patients with prostate disease,thus improving postoperative urodynamics and rehabilitation,and quality of life.

The Assessment of Bladder and Urethral Function in Spinal Cord Injury Patients

The correlation between the anatomic site of spinal cord injury and real-time conditions of bladder and urethral function was assessed in order to provide a reasonable basis for the clinical treatment of neurogenic bladder. A total of 134 patients with spinal cord injuries （105 males, 29 females; averaged 34.1 years old） were involved in this retrospective analysis, including urodynamic evaluation, clinical examination and imaging for anatomical position, and Bors-Comarr classification. The associa- tions between the levels of injury and urodynamic findings were analyzed. The results showed that mean follow-up duration was 16.7 months （range 8-27 months）. Complete spinal cord injuries occurred in 21 cases, and incomplete spinal cord injuries in 113 cases. Of the 43 patients with upper motor neuron （UMN） injuries, hyperref/exia and （or） detrusor sphincter dyssynergia were demonstrated in 30 （69.8%）, 31 （72.1%） suffered low bladder compliance （less than 12.5 mL/cmH20）, 28 （65.1%） had high detrusor leak point pressures （greater than 40 cmH20）, and 34 （79.1%） had residual urine. Of the 91 patients with lower motor neuron （LMN） injuries, areflexia occurred in 78 （85.7%）, high compliance in 75 （82.4%）, low leak point pressures in 80 （87.9%）, and residual urine in 87 （95.6%）, respectively. The associations between the anatomical site of spinal cord injury and urodynamic findings were ill defined. In patients with spinal cord injury, this study revealed a significant association between the level of injury and the type of voiding dysfunction. The anatomical site of spinal cord injury can not be predicted in real-time condition of bladder and urethral function. Management of neurogenic bladder in patients with spinal cord injury must be based on urodynamic findings rather than inferences from the neurologic evaluation.