Elise De

Options for independent bladder management in patients with spinal cord injury and hand function prohibiting intermittent catheterization.

Choosing the appropriate bladder management strategy for the spinal cord injury patient with neurogenic bladder and hand function prohibitive of self catheterization (urethral or stomal) catheterization is complex and based on limited literature. We have catalogued the available data in this review.

Choice of antimuscarinic agents for overactive bladder in the older patient: focus on darifenacin

Overactive bladder (OAB) is a difficult condition to live with and is very costly to the community. OAB affects 16% of the adult population and rises with increasing age. We describe the necessary steps in evaluation and behavioral therapy prior to initiating medical therapy. There are several medications that have been used for the treatment of patients who suffer from OAB. This manuscript discusses the popular agents used for OAB, with a focus on the recent clinical trials on darifenacin.

Citrate synthase, sarcoplasmic reticular calcium ATPase, and choline acetyltransferase activities of specific pelvic floor muscles of the rabbit

There is a clear relationship between the pelvic floor muscles and urinary systems, which relates to urgency, frequency, incontinence, pelvic pain, and bowel complaints. The specific mechanisms which relate these two systems are not clear. Improved understanding of the relation between the pelvic floor muscles and bladder function is clinically relevant in establishing effective treatments to such problems as incontinence, secondary to birth. The following tissues were collected from normal adult female rabbits: pubococcygeus (Pc) and ischiocavernosus/bulbospongiosus (Ic/Bs) pelvic floor muscles. Bladder body muscle and mucosa, bladder base muscle and mucosa, and leg skeletal muscle were also collected. The following enzymatic assays were performed on each tissue: citrate synthase (CS), sarcoplasmic–endoplasmic reticular ATPase (SERCA), and choline acetyltransferase (ChAT). CS and SERCA activities were significantly higher in the Pc compared with the Ic/Bs pelvic floor muscles, whereas the ChAT activity of the Ic/Bs was higher than that of the Pc muscle. Based on our results, the Pc muscle is expected to have a significantly greater capacity to contract and a higher metabolic activity than those of the Ic/Bs muscles. We believe that an understanding of the biochemical activities of these three biomarker enzymes in normal pelvic floor muscles is essential in evaluating the effects of specific experimental dysfunctions created in pelvic floor muscle activity.

Complete eversion of the urinary bladder: presentation, review, and algorithm for management.

BACKGROUND: Complete eversion of the urinary bladder is a rare problem that presents a serious management challenge. Currently no standard treatment recommendations exist for management. We describe our experience with bladder eversion and present an algorithm for treatment. CASE: An elderly, multiparous woman presented with complete bladder eversion after partial colpocleisis. Her bladder was reduced by a combined suprapubic and perineal approach with cystopexy to the anterior abdominal wall. CONCLUSION: Multiparous postmenopausal women appear to be at highest risk for complete bladder eversion. External transurethral reduction is sometimes successful, but most cases require laparotomy.

Combined Diagnostic Modalities Improve Detection of Detrusor External Sphincter Dyssynergia

Introduction. The diagnosis of detrusor-external sphincter dyssynergia (DESD) is a clinically relevant finding during urodynamic testing. However, there is no consensus regarding diagnostic specifics of electromyography (EMG) or voiding cystourethrography (VCUG). We evaluated the concordance of the two modalities most commonly used in clinical practice for the diagnosis of DESD. Methods. Patients were prospectively evaluated by a single urodynamicist at an academic center and retrospectively re-evaluated by an independent urodynamicist for agreement. DESD was determined by increased patch EMG activity or a dilated bladder neck/proximal urethra on VCUG during detrusor contraction. Minimal acceptable criterion for agreement was set at 70%. Results. Forty-six patients were diagnosed with DESD with both modalities available. Of these 46 patients, 25 were diagnosed by both tests, 11 by VCUG alone and 10 by patch EMG alone. Binomial testing demonstrated the proportion of agreement was 54% (95% CI 39% to 68%). Conclusion. We found significant disagreement between the two modalities, similar to previously reported findings using needle EMG, and we expand the applicability of our data to the majority of clinicians who use patch EMG electrodes. This further supports the idea that the combined use of EMG and VCUG for diagnosis can identify more cases of DESD than either modality alone.

Ischemic Etiology of Incontinence in Women: A Theory and A Review

Incontinence in women is a major health problem. In a recent study, incontinence affects more than 10 million Americans, 85% of whom are women. Incontinence can result in an extremely altered life style, and is the main reason that women are admitted to nursing homes. Care for the incontinent patient represents an enormous expense nationally. The emphasis of this review is on the relevance of estrogen-dependent ischemia to urethral smooth muscle tone and tonic � -adrenergic tension in the maintenance of continence in women. Additionally, the role of ischemia in bladder dysfunc- tion will be explored. In general, the relative contribution of smooth muscle tension is greater in females than in males. It is clear from both animal and human data that during bladder filling there is a progressive increase in sympathetic stimula- tion of the urethra resulting in increased � -adrenergic tension.

A prospective randomized double-blind trial of grape juice antioxidants in men with lower urinary tract symptoms.

Many patients take alternative medications for their lower urinary tract symptoms (LUTS) either in addition or as a substitute for traditional therapies, despite a lack of clinical data. Grapes products are hypothesized to improve bladder function due to their antioxidant and membrane‐protective actions. There is increasing evidence that progression of obstructed bladder dysfunction is related to bladder ischemia, reperfusion injury and free radical damage. We prospectively studied a standardized grape product on urinary symptoms.

Biofeedback Treatment for Overactive Bladder

For several decades, biofeedback has been utilized to help patients gain control of urinary problems. First described in the 1950s, pelvic floor muscle training employing biofeedback techniques has re-emerged as many patients seek to improve their urinary symptoms without medications or invasive procedures. Developing evidence and clinical agreement suggest that the pelvic floor musculature plays an important and often overlooked role in the etiology of lower urinary tract symptoms. New techniques involving computerized visual feedback and electrical stimulation or magnetic stimulation seek to improve the efficacy of pelvic floor muscle exercises. However, findings from the literature for increased response to these exercises with intensity of biofeedback programs are conflicting. While they pose few risks or side effects, biofeedback programs are a time-consuming exercise for patients and providers. As we explore the promising role of pelvic floor rehabilitation in treatment of pelvic floor disorders, we must continue to assess the efficacy and cost-effectiveness of biofeedback as an adjunct to pelvic floor muscle exercises.

Urethritis in Women—Considerations Beyond Urinary Tract Infection

Urethritis is a common condition affecting women in the USA. The symptoms, however, are not specific to a unique cause and are shared among a wide variety of urogenital diseases. This article evaluates the current literature and provides tools to the practicing clinician. Infections, particularly urinary tract infection and vaginitis, are common causes. The sexually transmitted infection Chlamydia trachomatis continues to be one of the most common etiologies for urethritis. Newer research provides evidence for the importance of Ureaplasma and Mycoplasma genitalium. Mechanical trauma, vaginal atrophy, chemical and mechanical exposure, and Skene’s gland and other anatomical pathology will also be reviewed. The diagnosis and treatment of urethritis often require the practitioner to treat associated diseases such as chronic pelvic pain syndrome and dyspareunia. Urethritis is intensely symptomatic leading to a pressured office interaction, and it is our intent to provide the tools for a comprehensive approach to female urethritis.