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urinary retention [keywords]
- 5-Alpha-reductase inhibitors in diseases of the prostate. [JOURNAL ARTICLE]
- Curr Opin Endocrinol Diabetes Obes 2014 Sep 27.
To summarize the history of the use of 5-alpha-reductase inhibitors in the treatment of urologic diseases and discuss the current practices and indications for therapy.5-Alpha-reductase inhibitors (5-ARIs) are indicated in the treatment of benign prostatic hyperplasia (BPH) with obstructive urinary symptoms to reduce symptoms, reduce the risk of acute urinary retention, and reduce the risk of needing surgical management for this condition. These drugs have also been employed in the treatment of recurrent and refractory hematuria of prostatic origin because of their effect on the androgen-mediated angiogenic pathways in the prostate. Data support the use of 5-ARIs for this indication, though this is off-label use. There is no role for the use of 5-ARIs in primary prostate cancer chemoprevention and they may increase the risk of developing high-grade prostate cancer. Current investigations are underway to determine the efficacy of 5-ARIs in the secondary treatment of localized prostate cancer as adjunctive therapy, which may decrease the likelihood of prostate cancer progression and increase the likelihood that patients will remain on active surveillance.5-ARIs have significantly impacted the medical treatment of urologic disease, in particular BPH, and prostatic hematuria. Their use in the secondary treatment of prostate cancer is currently under investigation.
- Ultrasonography and clinical outcomes following surgical anti-incontinence procedures (Monarc vs Miniarc). [JOURNAL ARTICLE]
- Eur J Obstet Gynecol Reprod Biol 2014 Sep 16.:91-97.
To evaluate the ultrasound morphology and its clinical outcome among women who had undergone Miniarc™ vs Monarc™ in the treatment of stress urinary incontinence (SUI).This was a prospective study on 140 patients with USI and undergone either Miniarc or Monarc surgery. From March 2010 to December 2011, patients with clinically SUI and urodynamic stress incontinence (USI) were included in the study. Objective cure of SUI was defined as no urinary leakage on provocative filling cystometry and 1-h pad test of <2g. Subjective cure of SUI was the negative response to UDI-6. Introital ultrasound at one-year explored the sling and bladder neck's position, mobility, sling tension, percentile of urethra where the sling was located and urethral kinking.Postoperative data was available from 130 women. The ultrasound objective data for successful treatment post-operative follow-up was available from 119 women (46 Monarc, 73 Miniarc), the rest failed to follow-up. A bladder perforation was diagnosed in the Monarc group and 15 cases (7.1% of Monarc and 16.3% of Miniarc, p=0.082) of urinary retention was reported due to over-tensioning of the sling, majority of cases came from the Miniarc group. At rest and during Valsalva, analogous distances of the bladder neck and sling as well as the center of the urethral core were similar for both procedures. In both groups, shortest (Us) and longest diameters (Ul) of the urethral core were comparable at Valsalva which was significantly shorter and longer, respectively, compared to the values at rest. Sling position and percentage of urethral kinking were similar. Statistical analysis failed to detect any significant difference between the two groups with regards to the objective and subjective cure (p>0.05).In conclusion, a Miniarc and Monarc exhibit similar mechanism of action with comparable subjective and objective clinical outcomes. Majority of urethral impingement was noted in the Miniarc group. A higher maximum urethral closure pressure (MUCP), longer resting Ul, and shorter resting Us suggested these observations. Postoperative ultrasonographic evaluation may give a promising future perspective for the evaluation of sling tension.
- Surgery for stress urinary incontinence due to presumed sphincter deficiency after prostate surgery. [JOURNAL ARTICLE]
- Cochrane Database Syst Rev 2014 Sep 27.:CD008306.
Incontinence after prostatectomy for benign or malignant disease is a well-known and often a feared outcome. Although small degrees of incidental incontinence may go virtually unnoticed, larger degrees of incontinence can have a major impact on a man's quality of life.Conceptually, post-prostatectomy incontinence may be caused by sphincter malfunction or bladder dysfunction, or both. Most men with post-prostatectomy incontinence (60% to 100%) have stress urinary incontinence, which is involuntary urinary leakage on effort or exertion, or on sneezing or coughing. This may be due to intrinsic sphincter deficiency and may be treated with surgery for optimal management of incontinence. Detrusor dysfunction is more common after surgery for benign prostatic disease.To determine the effects of surgical treatment for urinary incontinence related to presumed sphincter deficiency after prostate surgery for:- men with lower urinary tract symptoms (LUTS) secondary to benign prostatic hyperplasia (BPH) - transurethral resection of prostate (TURP), photo vaporisation of the prostate, laser enucleation of the prostate or open prostatectomy - and- men with prostate cancer - radical prostatectomy (retropubic, perineal, laparoscopic, or robotic).We searched the Cochrane Incontinence Group Specialised Register, which contains trials identified from Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, MEDLINE in process, ClinicalTrials.gov, and handsearching of journals and conference proceedings (searched 31 March 2014); MEDLINE (January 1966 to April 2014); EMBASE (January 1988 to April 2014); and LILACS (January 1982 to April 2014). We handsearched the reference lists of relevant articles and conference proceedings. We contacted investigators to locate studies.Randomised or quasi-randomised trials that include surgical treatments of urinary incontinence after prostate surgery.Two authors independently screened the trials identified, appraised quality of papers, and extracted data.Only one study with 45 participants met the inclusion criteria. Men were divided in two sub-groups (minimal or total incontinence) and each group was randomised to artificial urethral sphincter (AUS) implantation or Macroplastique injection. Follow-up ranged from six to 120 months. In the trial as a whole, the men treated with AUS were more likely to be dry (18/20, 82%) than those who had the injectable treatment (11/23, 46%) (odds ratio (OR) 5.67, 95% confidence interval (CI) 1.28 to 25.10). However, this effect was only statistically significant for the men with more severe ('total') incontinence (OR 8.89, 95% CI 1.40 to 56.57) and the CIs were wide. There were more severe complications in the group undergoing AUS, and the costs were higher. AUS implantation was complicated in 5/22 (23%) men: the implant had to be removed from one man because of infection and in one man due to the erosion of the cuff, in one man the pump was changed due to mechanical failure, in one man there was migration to the intraperitoneal region, and one man experienced scrotal erosion. In the injectable group, 3/23 (13%) men had a complication: one man treated with Macroplastique injection had to be catheterised because of urinary retention and two men developed urinary tract infections.The evidence available at present was of very low quality because we identified only one small randomised clinical trial. Although the result was favourable for the implantation of AUS in the group with severe incontinence, this result should be considered with caution due to the small sample size and uncertain methodological quality of the study found.
- The Potential effect of G915C polymorphism in regulating TGF-β1 transport into Endoplasmic Reticulum for cytokine production. [Journal Article]
- Bioinformation 2014; 10(8):487-90.
The TGF-β1 cytokine concentration is known to be higher in nephritis with implied Lupus Nephritis severity. The production of TGF-β1 cytokine is associated with G915C polymorphism. Therefore, it is of interest to study G915C polymorphism. The G915C polymorphism changes codon 25 which encodes arginine into proline in the signal peptide of TGF-β1. The amino acid substitution affects signal peptide properties that may inhibit the transport of TGF-β1 into the endoplasmic reticulum and eventually decline the cytokine production. Hence, the effect of G915C polymorphism on the properties of the signal peptide, the ability of TGF-β1 transport into the endoplasmic reticulum and the concentrations of urinary TGF-β1 in Lupus Nephritis patients was studied. The arginine substitution into proline decreased the polarity of the signal peptide for TGF-β1. The increased hydrophobicity with increased binding energy of the signal peptide for TGF-β1 to Signal Recognition Particle (SRP) and translocon is shown. This implies decreased protein complex stability in potentially blocking the transport of TGF-β1 into the endoplasmic reticulum. This transport retention possibly hampers the synthesis and maturation of TGF-β1 leading to decreased cytokine production.
- Hospital admissions after transrectal ultrasound-guided biopsy of the prostate in men diagnosed with prostate cancer: A database analysis in England. [JOURNAL ARTICLE]
- Int J Urol 2014 Sep 26.
To investigate the complication rate within 30 days after transrectal ultrasound-guided biopsy of the prostate in England, and to examine associated risk factors.A population-based study was carried out using the English cancer registry linked to administrative hospital data. We included men aged 45 years and older diagnosed with prostate cancer between 2000 and 2008. A complication was considered to have occurred if men had been admitted to hospital as a result of urological causes (urinary tract infection/sepsis, hematuria and urinary retention) within 30 days of the transrectal ultrasound-guided biopsy of the prostate. Multivariable logistic regression was carried out to estimate odds ratios, reflecting the impact of risk factors on the complication rate.Of the 198 361 included men, 69% were aged between 65 and 84 years. The 30-day complication rate was 3.7% (1.1% for urinary tract infection/sepsis, 1.4% for hematuria and 1.3% for urinary retention). The most important risk factors were age above 85 years (odds ratio 3.85, 95% confidence interval 3.18-4.67, compared with age below 55 years) and three or more comorbidities (odds ratio 3.50, 95% confidence interval 3.17-5.87, compared with no comorbidity). The overall complication rate increased over time (odds ratio 1.20, 95% confidence interval 1.08-1.34, 2008 compared with 2000), as did the complication rate as a result of urinary tract infection/sepsis (odds ratio 1.72, 95% confidence interval 1.41-2.10, 2008 compared with 2000).There has been an increase in the complication rate after transrectal ultrasound-guided biopsy of the prostate in England between 2000 and 2008, predominantly as a result of infections. Age and comorbid conditions seem to represent the two most important risk factors for occurrence of post-biopsy complications.
- Boronate affinity-assisted MEKC separation of highly hydrophilic urinary nucleosides using imidazolium-based ionic liquid-type surfactant as pseudostationary phase. [JOURNAL ARTICLE]
- Electrophoresis 2014 Sep 25.
In this work we extend our investigations regarding the separation of urinary nucleosides by MEKC with the ionic liquid (IL)-type surfactant 1-tetradecyl-3-methylimidazolium bromide (C14 MImBr). We study the impact of the addition of alkyl- and arylboronic acids (in the presence of C14 MImBr micelles) on the separation of these highly hydrophilic metabolites and investigate the mechanism of interaction between the negatively charged nucleosides (the negative charge is acquired either due to deprotonation of the amidic group or complexation with boronate) and the positively charged pseudostationary phase (PSP). This interaction is not only due to electrostatic (Coulombic) forces, but also due to hydrophobic interaction of the alkyl or aryl group of the boronate, which forms a complex with the cis-diol group of the nucleoside. In this case, alkylboronates can act as a co-surfactant, which increases the partitioning coefficient of the analytes into the micelles. In the presence of an alkylboronate in the BGE (employing only 20 mmol L(-1) C14 MImBr), the retention factors of the studied analytes are increased considerably when compared to a BGE without this additive. It is shown that the concept of one-site hydrophobically assisted ion-exchange can be applied to describe the observed retention behaviour. The high selectivity of boronates towards cis-diol containing compounds can be used to adjust selectively the migration behaviour of members of this compound class. Via addition of an alkylboronic acid to the BGE the separation selectivity is fine-tuned so that interferences from matrix components can be avoided in real sample analysis. This article is protected by copyright. All rights reserved.
- Dutasteride plus Tamsulosin fixed-dose combination first-line therapy versus Tamsulosin Monotherapy in the treatment of benign prostatic hyperplasia: a budget impact analysis in the Greek healthcare setting. [JOURNAL ARTICLE]
- BMC Urol 2014 Sep 26; 14(1):78.
The purpose of this study was to explore the budget impact of dutasteride plus tamsulosin fixed-dose combination (DUT + TAM FDC) versus tamsulosin monotherapy, in the treatment of patients with benign prostatic hyperplasia (BPH) from the perspective of the Greek healthcare insurance system.A Microsoft Excel-based model was developed to estimate the financial consequences of adopting DUT + TAM FDC within the Greek healthcare setting. The model, compared six mutually exclusive health states in two alternative treatment options: current standard of care and the introduction of DUT + TAM FDC in the market. The model used clinical inputs from the CombAT study; data on resource use associated with the management of BPH in Greece were derived from expert panel, and unit cost data were derived from official reimbursement tariffs. A payer perspective was taken into account. As patient distribution data between public and private sectors are not available in Greece two scenarios were investigated, considering the whole eligible population in each scenario. A 4 year time horizon was taken into account and included treatment costs, number of transurethral resections of the prostate (TURPs) and acute urinary retention (AUR) episodes avoided.The clinical benefit from the market adoption of DUT + TAM FDC in Greece was 1,758 TURPs and 972 episodes of AUR avoided cumulatively in a four year period. The increase in total costs from the gradual introduction of DUT + TAM FDC to the Greek healthcare system ranges from [euro sign]1.3 million in the first year to [euro sign]5.8 million in the fourth year, for the public sector, and [euro sign]1.2 million to [euro sign]4.0 million, for the private sector. This represents an increase of 1.91% to 7.94% for the public sector and 1.10% 3.29% in the private sector, during the 4-year time horizon.Budget impact analysis (BIA) results indicated that the gradual introduction of DUT + TAM FDC, would increase the overall budget of the disease, however providing better clinical outcomes. DUT + TAM FDC drug acquisition cost is partly offset by the reduction in the costs associated with the treatment of the disease.
- A randomized controlled study to evaluate the efficacy of tamsulosin monotherapy and its combination with mirabegron on patients with overactive bladder induced by benign prostatic obstruction. [JOURNAL ARTICLE]
- J Urol 2014 Sep 21.
To evaluate the efficacy and safety of add-on treatment with a β3-adrenoceptor agonist (mirabegron) on overactive bladder (OAB) symptoms remaining after α1-blocker (tamsulosin) treatment in men with benign prostatic obstruction (BPO).Patients with BPO having urinary urgency at least once per week and a total OAB symptom score (OABSS) ≥ 3 points after ≥ 8 weeks treatment with tamsulosin were enrolled. They were randomly allocated to receive 0.2 mg of tamsulosin daily or 0.2 mg of tamsulosin and 50 mg of mirabegron daily for 8 weeks. The primary endpoint was the change in the total OABSS. Safety assessments included the change in the post-void residual urine volume (PVR) and adverse events (AEs).From January 2012 through September 2013, a total of 94 patients were randomized. Of these, 76 completed the protocol treatment. In the full analysis set, the change in the total OABSS during the treatment period was significantly greater in the combination group than in the monotherapy group (-2.21 vs. -0.87, p=0.012). The changes in the scores for urinary urgency, daytime frequency, and the International Prostate Symptom Score storage symptom subscore and QOL for 8 weeks were significantly greater in the combination group. The change in PVR was significantly greater in the combination group. Although 6 patients developed AEs in the combination group, urinary retention was observed in only 1 patient.Combined tamsulosin and mirabegron treatment is effective and safe for patients with BPO who have OAB symptoms remaining after tamsulosin monotherapy.
- Measurement of post-void residual urine. [JOURNAL ARTICLE]
- Neurourol Urodyn 2014 Sep 22.
To present the teaching module "Measurement of Post-void residual urine."This module has been prepared by a Working Group of the ICS Urodynamics Committee. The methodology used included comprehensive literature review, consensus formation by the members of the Working Group, and review by members of the ICS Urodynamics Committee core panel.In this ICS teaching module the evidence for and relevance of PVR measurement in patients with lower urinary tract dysfunction (LUTD) is summarized; in short: The interval between voiding and post-void residual (PVR) measurement should be of short duration and ultrasound bladder volume measurement is preferred to urethral catheterization. There is no universally accepted definition of a significant residual urine volume. Large PVR (>200-300 ml) may indicate marked bladder dysfunction and may predispose to unsatisfactory treatment results if for example, invasive treatment for bladder outlet obstruction (BOO) is undertaken. PVR does not seem to be a strong predictor of acute urinary retention and does not indicate presence of BOO specifically. Although the evidence base is limited, guidelines on assessment of LUTS generally include PVR measurement.Measurement of PVR is recommended in guidelines and recommendations on the management of LUTS and urinary incontinence, but the level of evidence for this measurement is not high. This manuscript summarizes the evidence and provides practice recommendations for teaching purposes in the framework of an ICS teaching module. Neurourol. Urodynam. © 2014 Wiley Periodicals, Inc.
- A mechanistic study on urine retention in d-amphetamine addicts. [Journal Article]
- Chin J Physiol 2014 Aug 31; 57(4):171-81.
Chronic amphetamine intake leads to neurogenic bladder and chronic urinary retention. The mechanism underlying persistent urinary retention is unclear. The pelvic-urethral reflex (PUR) is essential for the urethra to develop sufficient resistance to maintain urine continence, an important function of the urinary system. Recent studies on PUR activities have indicated that repetitive/tetanic stimulation of the pelvic afferent fibers induces spinal reflex potentiation (SRP) in PUR activities, which further increases urinary retention. In this study, results showed that test stimulation (TS, 1/30 Hz) evoked a baseline reflex activity, while repetitive stimulation (RS, 1 Hz) induced reflex potentiation in the external urethral sphincter. Intrathecal d-amphetamine (AMPH, 30 μM) did not but higher AMPH concentration (100 μM) induced SRP in TS-induced reflex activity. H89 (10 μM, a protein kinase A inhibitor), but not chelerythrine chloride (CTC, 10 μM, a protein kinase C inhibitor), prevented the 100 μM AMPH-elicited SRP. At 30 μM, forskolin, an activator of adenylyl cyclase, elicited SRP. The co-administration of 10 μM forskolin and 30 μM AMPH induced SRP in TS-induced reflex activity. These results implied that the repetitive/tetanic stimulation of the pelvic afferent fibers could induce SRP in PUR activities, so that the urethra can produce sufficient resistance and played a significant role in urinary retention. Findings in this study demonstrated that amphetamine could induce bladder dysfunction by triggering protein kinase A activation, and provide a practical basis for the development of treatment for amphetamine-associated urinary retention.