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Urinary frequency [keywords]
- Protective effect of preserved bladder-filling sensation on upper urinary tract in patients with spinal cord injury. [JOURNAL ARTICLE]
- Neurol Sci 2014 Apr 19.
In this study the possible preventive effect of bladder-filling sensation (BFS) on upper urinary tract deterioration (UUTD) in spinal cord injury (SCI) patients was investigated. Eighty-four (60 males, 24 females) patients with SCI who underwent neurourological assessment and urodynamic examinations because of neurogenic lower urinary tract dysfunction and were prescribed appropriate bladder management and were under follow-up and whose disease duration was at least 3 years were included in the study. Bladder-filling sensation was categorised as "absent", "partially preserved" or "preserved", and as "normal" (preserved) and "abnormal" (partially preserved, absent). Presence of hydronephrosis, renal stones, and chronic pyelonephritis in any renal USG or IVP performed during the follow-up period were accepted as criteria of UUTD. The frequencies of UUTD for BFS subgroups were determined and compared. Mean age and mean disease duration were 38.4 ± 13.0 years and 72.2 ± 36.2 months. The frequency of UUTD was 31/84 (36.9 %) in the study population. The frequencies of UUTD were 0/8 (0 %), 22/53 (41.5 %) and 9/23 (39.1 %) for "preserved" "partially preserved" and "absent" BFS subgroups, respectively (p = 0.074). There was a statistically significant difference between normal BFS [0/8 (0 %)] and abnormal BFS [31/76 (40.8 %)] subgroups (p = 0.024). According to the results of our study preserved (normal) bladder-filling sensation has protective effect on upper urinary tract in patients with SCI.
- Quality of life in patients treated for penile cancer. [JOURNAL ARTICLE]
- J Urol 2014 Apr 17.
To assess the impact of primary surgery (penile-sparing surgery versus (partial) penectomy), and lymphadenectomy on sexuality and health-related quality of life (HRQOL).We invited patients surgically treated for penile cancer in the Netherlands Cancer Institute between 2003 and 2008 (N=147) to complete the International Index of Erectile Function (IIEF-15), the Short Form-36 Health Survey (SF-36), the Impact of Cancer questionnaire (IOCv2), and questions about urinary function. We evaluated the impact of primary surgery type and lymphadenectomy on these outcomes. We also compared the patients' SF-36 scores with those of an age- and sex-matched normative sample from the general Dutch population.Ninety patients (62%) returned a completed questionnaire. Type and extent of surgery was not associated significantly with most of the study outcomes assessed. However, men who underwent (partial) penectomy reported significantly more problems than those who had had penile-sparing surgery with orgasm (p=0.031;ES=0.54), appearance concerns (p=0.008;(ES)=0.61), life interference (p=0.032;ES=0.49), and urinary function (83% versus 43%, p<0.0001). Men who underwent lymphadenectomy reported significantly more life interference (p=0.037;ES=0.50). The patient sample scored significantly better than the normative sample on the SF-36 physical component (p=0.044) and bodily pain subscale (p<0.001).Few differences were observed in sexuality and HRQOL as a function of primary surgery and lymphadenectomy. However, (partial) penectomy and lymphadenectomy are associated with more problems with orgasm, body image, life interference and urination. Additional longitudinal studies are warranted to evaluate individual changes over time in these outcomes.
- Inhibition of Peripheral Fatty Acid Amide Hydrolase Depresses Activities of Bladder Mechanosensitive Nerve Fibers of the Rat. [JOURNAL ARTICLE]
- J Urol 2014 Apr 15.
Fatty acid amide hydrolase (FAAH) degrades endocannabinoids and fatty acid amides. FAAH inhibition reduces micturition frequency and counteracts bladder overactivity in rats. We aimed to study the effects of a peripherally active selective FAAH inhibitor (URB937), and CB1- and CB2-receptor antagonist (rimonabant and SR144528) on single-unit afferent activities (SAAs) of the primary bladder afferents in rats.Female Sprague-Dawley rats were anesthetized. SAAs of Aδ- or C-fibers from the L6 dorsal roots were recorded during bladder filling before and after URB937-administration with or without rimonabant or SR144528. Drugs were given intravenously (1mg/kg). Expressions of FAAH, CB1, or CB2, and the sensory marker CGRP in the L6 dorsal root ganglion (DRG) were compared by immunofluorescence.One-hundred and two single afferent fibers (Aδ-fibers: n=48, C-fibers: n=54) were isolated from 57 rats. URB937 decreased C-fiber SAAs to 78 ± 9% and Aδ-fiber SAAs to 67 ± 7%, and increased bladder compliance to 116 ± 3 %. The effects of URB937 on SAAs and bladder compliance were counteracted by rimonabant or SR144528. Rimonabant increased SAAs of both fibers, while SR144528 only SAAs of Aδ-fibers. CGRP-positive L6 DRG neurons expressed strong FAAH, CB1 and CB2 stainings.We show for the first time that inhibition of peripheral FAAH depresses Aδ- and C-fiber activities of primary bladder afferents via CB1- and CB2-receptors. CB antagonists alone exert facilitatory effects on SAAs during bladder filling in rats. The endocannabinoid system may be involved in the physiological control of micturition as regulators of afferent signals.
- Benign perivascular myoid cell tumor (myopericytoma) of the urinary tract: a report of 2 cases with an emphasis on differential diagnosis. [Journal Article]
- Hum Pathol 2014 May; 45(5):1115-21.
Myopericytoma is a benign mesenchymal neoplasm thought to comprise part of a spectrum of perivascular myoid cell neoplasms with myofibroma, angioleiomyoma, and glomus tumor. We describe 2 such neoplasms involving the urinary tract: 1 incidentally identified in the kidney of a 59-year-old woman and 1 in the urinary bladder of a 52-year-old woman who presented with urinary frequency and dysuria. Histologically, the bladder tumor was composed of numerous blood vessels surrounded by plump perivascular myoid cells, as in subcutaneous myopericytoma. The renal tumor showed similar morphology centrally and a symplastic glomus tumor-like growth pattern at the periphery. Immunohistochemically, both tumors were reactive for markers of smooth muscle differentiation, such as smooth muscle actin and caldesmon/calponin but negative for CD34, cathepsin K, and S100 protein. Both patients are free of disease 14 and 39 months after resection, respectively. Our findings broaden the morphologic spectrum of myopericytoma.
- Adiponectin retards the progression of diabetic nephropathy in db/db mice by counteracting angiotensin II. [Journal Article]
- Physiol Rep 2014 Feb 1; 2(2):e00230.
Adiponectin is a multifunctional adipokine with insulin-sensitizing, anti-inflammatory, and vasoprotective properties. Epidemiology studies have, however, shown that high levels of serum adiponectin are associated with kidney disease progression. We, therefore, examined the effect of adiponectin administration on the progression of glomerulosclerosis in the obese diabetic (db/db) mouse, a model of type II diabetes. Recombinant human adiponectin was administered intraperitoneally at a dose of 30 or 150 μg per day from weeks 18 to 20. Rosiglitazone administered by gavage at 20 mg/kg body weight (BW) daily served as a therapeutic control. Untreated uninephrectomized db/db mice developed progressive albuminuria and glomerular matrix expansion, associated with increased expression of transforming growth factor beta 1 (TGFβ1), plasminogen activator inhibitor type 1 (PAI-1), collagen I (Col I), and fibronectin (FN). Treatment with adiponectin at either dose reduced the increases in albuminuria and markers of renal fibrosis seen in db/db mice, without affecting BW and blood glucose. Renal expressions of tumor necrosis factor-α (TNF-α) and monocyte-chemoattractant protein-1 (MCP-1) and urinary TNF-α levels, the markers of renal inflammation, were increased in diabetic mice, whereas adiponectin treatment significantly reduced the levels of these markers. Furthermore, adiponectin obliterated the stimulatory effects of angiotensin II (Ang II), but not the total effect of TGFβ1, on the mRNA expression of PAI-1, Col I, and FN by cultured glomerular mesangial cells. These observations suggest that adiponectin treatment reduces glomerulosclerosis resulting from type II diabetes probably through its anti-inflammatory and angiotensin-antagonistic effects. Thus, adiponectin has therapeutic implications in the prevention of progression of diabetic nephropathy.
- Epidemiology and etiology of benign prostatic hyperplasia and bladder outlet obstruction. [Journal Article]
- Indian J Urol 2014 Apr; 30(2):170-6.
Benign prostatic hyperplasia (BPH) is a histological diagnosis associated with unregulated proliferation of connective tissue, smooth muscle and glandular epithelium. BPH may compress the urethra and result in anatomic bladder outlet obstruction (BOO); BOO may present as lower urinary tract symptoms (LUTS), infections, retention and other adverse events. BPH and BOO have a significant impact on the health of older men and health-care costs. As the world population ages, the incidence and prevalence of BPH and LUTS have increased rapidly. Although non-modifiable risk factors - including age, genetics and geography - play significant roles in the etiology of BPH and BOO, recent data have revealed modifiable risk factors that present new opportunities for treatment and prevention, including sex steroid hormones, the metabolic syndrome and cardiovascular disease, obesity, diabetes, diet, physical activity and inflammation. We review the natural history, definitions and key risk factors of BPH and BOO in epidemiological studies.
- Chronic kidney disease as a risk factor for acute community-acquired infections in high-income countries: a systematic review. [Journal Article]
- BMJ Open 2014; 4(4):e004100.
A systematic review of the association of predialysis chronic kidney disease (CKD) with the incidence of acute, community-acquired infections.We searched the MEDLINE, EMBASE and Cochrane databases (inception to 16 January 2014) for studies analysing the association of predialysis kidney disease with the incidence of acute, community-acquired urinary tract infection (UTI), lower respiratory tract or central nervous system infections or sepsis. Studies were required to include at least 30 participants with and without kidney disease.Community-based populations of adults in high-income countries.Acute, community-acquired UTI, lower respiratory tract or central nervous system infections or sepsis.We identified 14 eligible studies. Estimates from two studies lacked 95% CIs and SEs. The remaining 12 studies yielded 17 independent effect estimates. Only three studies included infections managed in the community. Quality assessment revealed that probable misclassification of kidney disease status and poor adjustment for confounding were common. There was evidence from a few large high-quality studies of a graded association between predialysis CKD stage and hospitalisation for infection. One study found an interaction with age, with a declining effect of CKD on infection risk as age increased. There was evidence of between-studies heterogeneity (I(2)=96.5%, p<0.001) which persisted in subgroup analysis, and thus meta-analysis was not performed.Predialysis kidney disease appears to be associated with increased risk of severe infection. Whether predialysis kidney disease increases the susceptibility to infections and whether age modifies this association remains unclear.
- Control of Urinary Drainage and Voiding. [JOURNAL ARTICLE]
- Clin J Am Soc Nephrol 2014 Apr 17.
Urine differs greatly in ion and solute composition from plasma and contains harmful and noxious substances that must be stored for hours and then eliminated when it is socially convenient to do so. The urinary tract that handles this output is composed of a series of pressurizable muscular compartments separated by sphincteric structures. With neural input, these structures coordinate the delivery, collection, and, ultimately, expulsion of urine. Despite large osmotic and chemical gradients in this waste fluid, the bladder maintains a highly impermeable surface in the face of a physically demanding biomechanical environment, which mandates recurring cycles of surface area expansion and increased wall tension during filling, followed by rapid wall compression during voiding. Afferent neuronal inflow from mucosa and submucosa communicates sensory information about bladder fullness, and voiding is initiated consciously through coordinated central and spinal efferent outflow to the detrusor, trigonal internal sphincter, and external urethral sphincter after periods of relative quiescence. Provocative new findings suggest that in some cases, lower urinary tract symptoms, such as incontinence, urgency, frequency, overactivity, and pain may be viewed as a consequence of urothelial defects (either urothelial barrier breakdown or inappropriate signaling from urothelial cells to underlying sensory afferents and potentially interstitial cells). This review describes the physiologic and anatomic mechanisms by which urine is moved from the kidney to the bladder, stored, and then released. Relevant clinical examples of urinary tract dysfunction are also discussed.
- Tolterodine to relieve urinary symptoms following transurethral resection of the prostate: a double-blind placebo-controlled randomized clinical trial. [Journal Article]
- Korean J Urol 2014 Apr; 55(4):260-4.
To evaluate the effect of tolterodine on early storage symptoms following transurethral resection of the prostate.Seventy patients over 55 years of age who underwent transurethral resection of the prostate owing to benign prostatic hyperplasia were randomly assigned to receive either 2 mg of tolterodine twice daily (treatment group) or matched placebo during a 1-month study period. Before and 1 month after the procedure, they were asked to complete the International Prostate Symptom Score (IPSS) questionnaire and quality of life subscale to assess their symptoms. Also, analgesic use and adverse drug events were determined at follow-up.Of 70 allocated patients, 64 patients (91.4%), including 33 in the treatment group and 31 in the placebo group, completed the study. The mean age of the patients was 67 years. None of the patients' basic clinical characteristics were significantly different. At the end of the follow-up period, the total IPSS and quality of life score had significantly improved in the patients receiving tolterodine compared with those receiving placebo (p=0.001 and p=0.036, respectively). The treatment group compared with placebo demonstrated significant improvements in frequency and urgency but not in nocturia. The amount of consumed painkiller was also significantly lower in the tolterodine group than in the placebo group (p=0.0001). The rate of side effects was not significantly different between the groups.Administering 2 mg of tolterodine twice daily is an effective and well-tolerated regimen to relieve early storage symptoms, quality of life, and the amount of analgesic consumption following transurethral resection of the prostate.
- Laparoscopic-assisted transanal pull-through for Hirschsprung's disease: Comparison between partial and near total laparoscopic mobilization of rectum. [Journal Article]
- J Indian Assoc Pediatr Surg 2014 Apr; 19(2):70-5.
Transanal pull-through with laparoscopic assistance is gaining popularity. How much rectal dissection to do laparoscopically and how much transanally is not clear. Laparoscopic rectal mobilization is akin to open pelvic dissection of Swenson's operation - the most physiological procedure. Through this comparative study, we aim to evolve a technique that maximizes the benefits of Swenson's technique and minimizes the problems of a transanal procedure.Twenty patients (19 boys and one girl, newborn to 6 years) with Hirschsprung's disease (HD) were randomized for laparoscopic-assisted transanal pull-through (LATAPT) either by near complete (Group A) or partial (Group B) laparoscopic mobilization of rectum. Patients were followed up for at least 3 months. Demographic profile; operative details (time taken, blood loss, operative difficulty, and complications); postoperative course (duration of urinary catheter, oral feeding, and hospital stay); and follow-up stooling pattern, consistency, and continence were compared in the two groups.The time taken for laparoscopic mobilization was marginally higher in group A, but the time taken for transanal dissection in this group was significantly less than in group B. All other comparisons showed no significant difference in the two groups. Stool frequency and continence improved with time in both groups.Extent of laparoscopic mobilization of rectum does not appear to be a factor deciding the outcomes. No recommendations could be made in view of the small number of cases. However, it shows that laparoscopic assistance can be used to maximize the benefits of Swenson type of operation and a transanal pull-through.