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urinary retention [keywords]
- Effect of dietary supplementation with resveratrol on nutrient digestibility, methanogenesis and ruminal microbial flora in sheep. [JOURNAL ARTICLE]
- J Anim Physiol Anim Nutr (Berl) 2014 Oct 15.
Two experiments were conducted to evaluate the effect of resveratrol on methanogenesis and microbial flora in Dorper × thin-tailed Han cross-bred ewes. In experiment 1, ten ewes (67.2 ± 2.24 kg BW) were assigned to two dietary treatments, a basal diet and a basal diet supplemented with resveratrol (0.25 g/head·day), to investigate the effect of resveratrol on nutrient digestibility and nitrogen balance. In experiment 2, six ewes (64.0 ± 1.85 kg BW) with ruminal cannulae were assigned to the identical dietary treatments used in experiment 1 to investigate supplementary resveratrol on ruminal fermentation and microbial flora using qPCR. The results showed that supplementary resveratrol improved the digestibility of organic matter (OM; p < 0.001), nitrogen (N; p = 0.007), neutral detergent fibre (NDF; p < 0.001) and acid detergent fibre (ADF; p < 0.001). The excretion of faecal N was reduced (p = 0.007), whereas that of urinary N increased (p = 0.002), which led to an unchanged N retention (p = 0.157). Both CO2 and CH4 output scaled to digestible dry matter (DM) intake decreased from 602.5 to 518.7 (p = 0.039) and 68.2 to 56.6 (p < 0.001) respectively. Ruminal pH (p = 0.341), ammonia (p = 0.512) and total volatile fatty acid (VFA) (p = 0.249) were unaffected by resveratrol. The molar proportion of propionate increased from 13.1 to 17.5% (p < 0.001) while that of butyrate decreased from 11.0 to 9.55% (p < 0.001). The ratio of acetate to propionate (A/P) decreased from 5.44 to 3.96 (p < 0.001). Supplementary resveratrol increased ruminal population of Fibrobacter succinogenes, Ruminococcus albus and Butyrivibrio fibrisolvens (p < 0.001) while decreased protozoa and methanogens. In conclusion, dietary resveratrol inhibited methanogenesis without adversely affecting ruminal fermentation.
- Postpartum urinary retention after vaginal delivery: Assessment of risk factors in a case-control study. [Journal Article]
- J Turk Ger Gynecol Assoc 2014; 15(3):140-3.
To assess the obstetrics risk factors for postpartum urinary retention after vaginal delivery.Of 234 women with a vaginal delivery, 19 (8.1%) women who had postpartum urinary retention were cases, and 215 (91.9%) women who did not were controls. Postpartum urinary retention was defined as the presence of postvoid residual bladder volume ≥150 mL or the inability to void within 6 hours after vaginal delivery. Logistic regression analysis identified risk factors for urinary retention.Prolonged duration of the second stage of labor (OR=0.46, 95% CI for OR=0.06-3.67, p<0.001), presence of episiotomy (OR=0.07, 95% CI for OR=0.01-0.68, p=0.022) and perineal laceration (OR=97.09, 95% CI for OR=7.93-1188.93, p<0.001), and birth weight of >4000 g for the newborn (OR=0.04, 95% CI for OR=0.01-0.20, p<0.001) were found as independent risk factors for postpartum urinary retention after vaginal delivery.Postpartum urinary retention after vaginal delivery is a relatively common condition. Awareness of risk factors, including prolonged second stage of labor, episiotomy, perineal lacerations, and macrosomic birth, may allow us to take the necessary precautions against this complication.
- [Sacral neuromodulation: Results of a monocentric study of 93 patients.] [JOURNAL ARTICLE]
- Prog Urol 2014 Oct 10.
Sacral nerve stimulation (NMS) is a therapeutic alternative for the treatment of urinary functional disorders as diverse as overactive bladder (OAB), urinary retention or pelvic pain syndromes. With the increasing use of NMS, we must deal with the postoperative management of this therapy.We report the results, postoperative adverse events and their management in our center.This is a retrospective single-center single-operator study of 93 patients who were tested for NMS between January 2005 and December 2013.Of the 93 patients, 78 had a definitive implantation of the device for OAB (n=44), urinary retention (n=11), pain, interstitial cystitis (n=12), bladder hyperactivity and pain (n=8) or dysuria (n=3). The average follow-up was 38.86 months (2.06 to 88.3±28.9). Among patients with OAB, 75% had a clinical improvement greater than or equal to 50%, 11.3% were considered as cured. Among patients with urinary retention, 63.5% were improved. Painful patients were improved for 58.3% of them, 2 were considered as cured. We reported 3 early postoperative complications (2 local infections, 1 hematoma), and adverse events in 49 patients (multiple visits for parameter settings, revision of the device [n=38], explantation [n=14]).Our results confirm the long-term effectiveness of NMS for the treatment of refractory overactive bladder, urinary retention, chronic pelvic pain, vesico-uretral dyssynergies. Studies are still needed to improve the selection of ideal candidates, identify prognostic factors and reduce the rate of complications and revisions.4.
- Alterations in nerve-evoked bladder contractions in a coronavirus-induced mouse model of multiple sclerosis. [Journal Article]
- PLoS One 2014; 9(10):e109314.
Patients with neurodegenerative diseases such as multiple sclerosis, Parkinson's, and Alzheimer's often present with lower urinary tract symptoms (LUTS, urinary frequency, urgency, nocturia and retention) resulting from damage to the peripheral and central nervous systems. These studies were designed to examine the changes in the function of the bladder that may underlie neurogenic bladder dysfunction using a mouse model of demyelination in the CNS.Bladders from 12 week old male C57BL/6J mice with coronavirus-induced encephalomyelitis (CIE, a chronic, progressive demyelinating disease model of human MS), and age-matched controls, were cut into 5-7 strips and suspended in physiological muscle baths for tension measurement in response to agonists and electric field stimulation (EFS). Experiments were performed on intact and denuded (with mucosa removed) bladder strips.The maximum effect of EFS was not significantly different between CIE and control bladders. Nerve-evoked EFS contractions (tetrodotoxin-sensitive) were blocked by a combination of atropine (cholinergic antagonist) and α,β-methylene ATP (an ATP analog that desensitizes purinergic receptors). In response to EFS, the α,β-methylene ATP-resistant (cholinergic) component of contraction was significantly reduced, while the atropine-resistant (purinergic) component was significantly increased in CIE bladders. Removal of the mucosa in CIE bladders restored the cholinergic component. Bethanechol (muscarinic receptor agonist) potency was significantly increased in CIE bladders.Our data demonstrate a deficit in the nerve-evoked cholinergic component of contraction that is not due to the ability of the smooth muscle to respond to acetylcholine. We conclude that neurodegenerative bladder dysfunction in this model of multiple sclerosis may be due, in part, to pathologic changes in the mucosa that causes suppression of muscarinic receptor-mediated contractile response and augmentation of purinergic response of the underlying muscle. Further studies utilizing CIE mice should help elucidate the pathological changes in the mucosa resulting from demyelination in the CNS.
- Acute Kidney Injury Induced by Systemic Inflammatory Response Syndrome is an Avid and Persistent Sodium-Retaining State. [Journal Article]
- Case Rep Crit Care 2014.:471658.
Acute kidney injury (AKI) is a frequent complication of the systemic inflammatory response syndrome (SIRS), which is triggered by many conditions in the intensive care unit, including different types of circulatory shock. One under-recognized characteristic of the SIRS-induced AKI is its avidity for sodium retention, with progressive decreases in urinary sodium concentration (NaU) and its fractional excretion (FENa). This phenomenon occurs in parallel with increases in serum creatinine, being only transitorily mitigated by diuretic use. In the present case, we report a situation of two consecutive shocks: the first shock is hemorrhagic in origin and then the second shock is a septic one in the same patient. The SIRS and AKI triggered by the first shock were not completely solved when the second shock occurred. This could be viewed as a persistent avid sodium-retaining state, which may be appreciated even during renal replacement therapy (in the absence of complete anuria) and that usually solves only after complete AKI and SIRS resolution. We suggest that decreases in NaU and FENa are major characteristics of SIRS-induced AKI, irrespective of the primary cause, and may serve as additional monitoring tools in its development and resolution.
- General Anesthesia: To catheterize or Not? A Prospective Randomized Controlled Study of Patients Undergoing Total Knee Arthroplasty. [JOURNAL ARTICLE]
- J Arthroplasty 2014 Oct 2.
This study was to investigate whether urinary catheterization could be avoided for patients undergoing total knee arthroplasty (TKA) under general anesthesia with saphenous nerve block. 314 patients from a single surgical team were randomized to receive either an indwelling urinary catheter or no urinary catheter before the surgery. The results revealed that the prevalence of postoperative urinary retention (POUR) was quite low in both groups (5.7% vs 6.4%, P=1). Additionally, the prevalence of urinary tract infection was significantly higher in patients using an indwelling catheter (5.1% vs 0.6%, P=0.036). We also identified age, male gender, ASA grade, benign prostatic hypertrophy, intraoperative intravenous fluid and duration of surgery as the risk factors for POUR in these patients.
- VMAT technique enables concomitant radiotherapy of prostate cancer and pelvic bone metastases. [JOURNAL ARTICLE]
- Acta Oncol 2014 Oct 13.:1-7.
Background. Prostate cancer (PCa) patients with metastatic disease often suffer from skeletal pain and urinary retention impairing their quality of life. Prophylactic radiotherapy to bone metastases planned concomitantly with primary PCa radiotherapy could enable more precise control of combined dose in healthy tissues when compared to sequential palliative treatment. Materials and methods. Volumetric modulated arc therapy (VMAT) was planned for 14 PCa patients with primary bone metastases. The bone planning target volume (PTVbone) was contoured together with the PTVs of prostate (pr), pelvic lymph nodes (ln) and seminal vesicles (sv). Another virtual plan was calculated excluding PTVbone for dose volume histogram (DVH) comparison. DVHs were additionally compared to a set of actual VMAT treatment plans of a control cohort of 13 high risk PCa patients treated with PTVpr, PTVsv and PTVln. The prescribed doses varied between 42 and 76 Gy for PTVbone. Results. Recommended healthy tissue tolerances (Quantec) were not exceeded except for one patient's rectum V50Gy value. Rectum doses did not increase significantly due to the inclusion of PTVbone. For bladder, there was a slight increase for V65Gy and V50Gy (2.7% and 7.4%). The DVHs of metastatic and non-metastatic patients were comparable. There were no differences in the PTVpr DVH parameters, while mean PTVln dose increased by 3.7 Gy-4.4 Gy due to the increased treatment volume related to PTVbone. All side effects were < grade 3 during the mean follow-up duration of 25 months. Conclusions. VMAT offers a good optimization tool for adding extra PTVs to the radiotherapy plan. Radiotherapy of bone metastases concomitantly with irradiation of the primary prostate tumor is a safe and well-tolerated approach and deserves to be studied in a randomized setting.
- Prostate sarcoma: report of 2 cases and bibliographic review. [JOURNAL ARTICLE]
- Arch Esp Urol 2014 Oct; 67(8):699-704.
To report two cases of prostate sarcoma and perform a review of the published literature.The first case is a 21 year old patient who presented acute urine retention and lung metastases on diagnosis. He was diagnosed by TURP of rhabdomyosarcoma of the prostate dying 1 month after surgery. The second case was a 33 years old male who presented to the emergency room with anal pain, urinary symptoms, hematochezia and loss of 20 kg over the past 3 months. Abdominal CT scan showed an 11 x 10 x 9 cm mass in the lower pelvis that infiltrated the bladder and rectum, being unable to define its origin. CA 19.9, CEA and PSA were normal. The suspected diagnosis was a prostate sarcoma infiltrating rectum and bladder. A pelvic exenteration was performed with a wet colostomy. The pathologic diagnosis was a high grade sarcoma not clearly identified of the prostate. He was treated with adriamycin as adjuvant chemotherapy, having local recurrence, nodal involvement and multiple pulmonary metastases after 3 months of follow up CONCLUSIONS: Prostate sarcomas are rare tumors. This makes difficult to know their natural history. Their rapid progression and systemic spread, despite multimodal treatment, gives a mean survival of 24 months. Main survival factors are grade, a complete resection of the tumor and a low local stage. There is a need to find new chemotherapy protocols to increase survival rates as it has been shown in extremities sarcomas.
- "A prospective, randomized and controlled trial for the treatment of anterior vaginal wall prolapse: Medium-term follow-up" [JOURNAL ARTICLE]
- J Urol 2014 Oct 8.
To compare the efficacy and safety of the anterior colporrhaphy (AC) with transvaginal polypropylene mesh (PM) insertion for the treatment of anterior vaginal wall prolapse (AVWP) at medium-term follow-up.In this prospective and randomized controlled trial 100 women with AVWP stage ≥ II assessed by the Pelvic Organ Prolapse Quantification System (POP-Q) were randomized to undergo AC (Control group) or mesh insertion (Mesh group). Anatomical outcomes were assessed with POP-Q measurements and POP staging. Subjective outcomes and quality of life (QoL) impact were assessed by ICIQ questionnaires. The safety profile of the procedure was assessed through intraoperative complication rates and throughout follow-up.92 women completed 24-month follow-up (Mesh group 42 vs Control group 50). Point Ba was not significantly different between the groups at baseline, but at 24-month follow-up significantly improved in Mesh group compared to Control group. However, no differences were found between groups when considering two different cure criteria on POP staging and subjective parameters. Asymptomatic mesh exposure on the AVW occurred in 7 patients (16.4%) in the Mesh group. Minor mesh-related complications consisted of mesh exposure, pre-pubic ecchymosis and groin pain, most of them were treated conservatively. Urinary retention was surgically treated.NAZCA TC and AC provided good overall anatomical outcomes for a minimum 24-month follow-up. Vaginal and urinary symptoms as well as QoL impact improved post-operatively in both groups. From patient's perspective, NAZCA TC did not show superior overall outcomes compared to anterior colporrhaphy performed with or without retropubic sling.
- Intermittent self-catheterisation in women: reducing the risk of UTIs. [Journal Article]
- Br J Nurs 2014 Oct 9.:S20-9.
Intermittent self-catheterisation (ISC) is the insertion and removal of a catheter to drain the bladder and is a safe and effective way to preserve renal function. It can be used as a one-off intervention to drain urine post-operatively or to measure residual urine volumes if a bladder scanner is unavailable. ISC can also be used as a long-term option to manage bladder dysfunction, and for some provides an excellent option to maintain independence and improve quality of life. Urinary tract infections are a common complication for women undertaking ISC. This article explores the prevention of urinary tract infections in women undertaking long-term ISC for the management of bladder dysfunction.