جستجوی مقالات مرتبط با کلیدواژه "urodynamics" در نشریات گروه "پزشکی"

Mixed urinary incontinence (MUI) is one of the most common problems of middle-aged women besides pelvic organ prolapses (POPs), and associated urinary symptoms are common disorders among older women whose treatment is necessary for the improvement of quality of life. This study aimed to evaluate the agreement between the symptoms of patients with MUI and urodynamic findings.

This analytic cross-sectional study was conducted on 170 MUI patients who underwent urodynamic evaluation for confirmation of the presumptive diagnosis. Findings comprise patients with “voiding phase symptoms”, “detrusor overactivity” (DO), “bladder hypersensitivity”, and “stress urinary incontinence” (SUI). The Kappa coefficient was used to evaluate the agreement between the symptoms and urodynamic findings. Sensitivity, specificity, and agreement of symptoms with corresponding urodynamic findings were determined. Univariate logistic regression was used to estimate the predictive value of clinical history compared to urodynamic findings.

According to the results, the mean (SD) age of women was 51.87 (11.20). The mean bladder capacity was 339.6 (134.24), and post-void residual was 35.46 (43.89) ml. We determined a sensitivity of 75%, a specificity of 78.3%, a positive predictive value (PPV) of 86.3%, and a 63.2% negative predictive value (NPV) for SUI symptoms. According to the chi-square test results and Cohen Kappa values, there was no agreement between the symptoms of patients with MUI and bladder hypersensitivity, DO, and SUI. The only agreement was observed between the urinary frequency and voiding phase symptoms (Cohen kappa: 0.124; P value=0.003).

There was no agreement between urodynamic findings and MUI symptoms except for urinary frequency and voiding phase symptoms. Since no comprehensive study has been conducted on the correlation between the symptoms of patients with MUI and urodynamic findings in our setting, the necessity to conduct large clinical studies is recommended. 

Cervical medullary injury is a severe type of spinal cord injury that can lead to neurogenic bladder and neurogenic rectum, which increases the risk of autonomic dysreflexia (AD) in patients. Autonomic dysreflexia is a common group of clinical syndromes characterized by autonomic dysfunction after spinal cord injury in the T6 or higher level. If left untreated, AD can lead to severe complications such as hypertensive crisis, paroxysms, intracranial hemorrhage, and even death. Nursing interventions are crucial in selecting the timing of catheterization for a patient with frequent AD during intermittent catheterization for cervical medullary injury, enhancing the overall quality of care for patients with cervical medullary injury.

This study focused on a tetraplegic patient with a cervical medullary injury who developed AD during intermittent catheterization. The factors influencing AD during intermittent catheterization were explored through a literature review, urodynamics, and a bladder scanner. The nursing interventions implemented included active control of AD, personalized assessment of the risk of abnormal autonomic dysreflexia, prevention, early identification, acute episode management, precise bladder management, and implementation of a personalized care plan. After 31 days of treatment, the number of AD episodes was significantly reduced, leakage was decreased, and urine volume was controlled in the normal range with good results. The key points of care included timely control of urine output, selection of the best catheterization timing, and other health education methods. The nursing interventions played an active and effective role in maintaining normal bladder function, and the patient resumed regular intermittent catheterization.

Nursing interventions are vital in managing patients with cervical medullary injuries who require intermittent catheterization. A comprehensive nursing care plan that includes personalized assessment and management of AD can significantly improve outcomes for these patients and prevent the occurrence of AD, ultimately leading to a better quality of life.

Bladder outlet obstruction (BOO) is a relatively infrequent urologic condition in women, but can cause bothersome symptoms. In this article, transurethral incisions of the bladder neck (TUIBN) and urethra in the treatment of anatomical BOO were assessed.

A total of 23 women who referred with chronic lower urinary tract symptoms, urinary retention, and difficulty in micturition were assessed. Diagnose was made on the basis of urethrocystoscopy, voiding cystourethrography, and urodynamic studies. All patients underwent transurethral incisions of bladder neck contracture or site of observed urethral stenosis at 3- and 9-o'clock positions. Clinical improvements and complications were assessed by follow-up examination and International Prostate Symptom Score (IPSS) and quality of life (QOL) scoring before and after intervention.

All patients were followed for at least 6 months after intervention. Follow-up data were available for 19 (90.5%), 13 (61.9%), and 7 (33.3%) of patients at 12, 24, and 48 months' follow-up, respectively. During the follow-up period, the mean IPSS and QOL significantly changed from 26.84 to 10.74 and 4.76 to 2.32, respectively (P < 0.001). Approximately 66.7% had satisfactory outcomes, 47.7% patients after first, and 19.1% after second TUI. About9.5% patients developed new onset of stress urinary incontinence, one of them had indications of surgical intervention, and thus, symptoms were relieved by mid-urethral sling.

Transurethral incision of bladder neck and urethra seems to be effective in relieving urinary symptoms of anatomical BOO in women. Complications may rarely occur and can be fully managed.

To investigate and compare detrusor overactivity (DO) and bladder filling sensation characteristics in female bladder outlet obstruction (FBOO) patients with or without overactive bladder (OAB) symptoms. One hundred fifty-seven FBOO patients with urodynamic testing were recruited. Pa tients who showed urinary urgency ( ? 6 episodes/3 d), with or without urinary frequency ( ?8 voids/24 h), and urge incontinence ( ? 3 episodes/3 d) were considered to have OAB. The detrusor overactivity (DO) and bladder filling sensation measures including first sensation (FSF), first desire to void (FDV) and strong desire to void (SDV) during filling cystometry were recorded. The associations between urodynamic variables and OAB symp toms were analysed. FBOO patients had a high incidence (79%) of OAB. FBOO patients with OAB symptoms had significantly younger age, higher incidence of DO (19.4% versus 6.1%) (P = .051) and lower bladder volumes of FSF (180.32 ± 83.48 versus 226.18 ± 100.90 mL), FDV (269.00 ± 109.78 versus 330.45 ± 123.95 mL) and SDV (345.56 ± 135.43 versus 422.33 ± 148.40 mL) (P < .05) compared to patients without OAB. In multivariate analyses, both DO (OR = 4.83, 95% CI: 1.02-22.85, P = .047) and lower bladder volumes at FDV(OR = 2.47, 95% CI: 1.03-5.95, P = .044) and SDV (OR = 3.07, 95% CI: 1.25-7.55, P < .014) were still independently associated with OAB, after adjustment for age and other confounding factors. FBOO patients had a high incidence of OAB. Not only DO but also bladder hypersensitivity were independently associated with OAB symptoms in FBOO patients.

This study was designed to investigate the clinical effects of different treatment methods on stress urinary incontinence (SUI) in perimenopausal women, and to evaluate urodynamic characteristics.

Seventy-two menopausal female patients with stress urinary incontinence were included in the Second Affiliated Hospital of Soochow University from January 2016 to July 2017. The cases were divided into 3 groups of 24 each, depending on the treatment received. Group A patients received treatment with electrical stimulation combined with biofeedback; those in group B received conventional pelvic floor muscle exercise therapy; and those in group C did not have any treatment. Relevant clinical parameters of urination were determined including pelvic floor muscle strengths, urine dynamics indexes and ICS quality of life survey scores; results were averaged in each group for comparisons among the three groups before and after the 60-day study period.

After treatment for 60 days, both group A and B patients displayed a clear improvement in their urinary incontinence, pelvic floor muscle strength, leakage times, frequency of urination, urine dynamics index and ICS scores (P0.05).

Both the method of electrical stimulation combined with biofeedback, and conventional pelvic floor muscle exercises could help perimenopausal women with stress urinary incontinence; however, electrical stimulation combined with biological feedback seems to bring about better clinical effects.

The preemptive management of urinary bladder dysfunction in children with spinal dysraphism has contributed to renal cortical loss and scaring leading to end-stage renal disease, however, there is no consensus regarding the management and follow-up of these patients.
The present study has been performed to find the incidence of upper urinary tract deterioration in Iranian newborns suffering from spinal dysraphism.
In a prospective study, neonates born with the diagnosis of spinal dysraphism anomalies referred to the Children’s Medical Center, Tehran University of Medical Sciences, Iran in 2015 and 2016 were enrolled in the study. Patients were classified into synergic, dyssynergic and complete denervation groups based on the urodynamic studies. All were followed for a year.
55 neonates with age range of 1-60 days were enrolled in the study. Five (9.1%) patients of the dyssynergic and complete denervation group, who were treated using clean intermittent catheterization, were complicated with severe febrile urinary tract infection. Hydrocephalus and vesicourethral reflux were seen in 23 (42%) and 16 (29.1%) patients, respectively. Upper urinary tract deterioration was significantly related to the type of urodynamic pattern (P = 0.02). The risk for upper urinary tract deterioration was highest in the dyssynergic group (seven out of 32 patients), while just one out of 12 patients in the complete denervation group and none in the synergic group experienced upper urinary tract deterioration.
This study showed that it may be an acceptable choice to perform urodynamic studies as soon as possible in all newborns diagnosed with spinal dysraphism and categorize them in low and high-risk groups.

To compare clinical and urodynamic study (UDS) findings in Iranian women with mixed or stress UI (Urinary Incontinence).
A total of 132 patients with either stress or mixed type of UI were enrolled. After accurate examination, data regarding age, parity, mode of delivery and menopausal state were recorded. Furthermore the presence and severity of UI was evaluated with empty bladder supine stress test (ESST) and cough test in supine and standing positions in all patients. Eligible cases underwent UDS evaluation by an expert urologist using a standardized protocol.
Stress and mixed UI were found in 33 (25%) and 99 (75%) patients respectively. By considering clinical evaluation as gold standard, sensitivity, specificity, positive and negative predictive value of urodynamic study were 83.4%, 30.4%, 43.4% and 80% for detecting stress UI and 96.1%, 35.6%, 34.7%, 96.2% for detecting mixed UI respectively. No correlation was noted between ESST or cough test results and Valsalva leak point pressure (VLPP) values in patients with stress UI, however ESST was correlated with VLPP values in patients with mixed UI.
Despite a relatively high sensitivity, the specificity was low and urodynamic evaluation seems to be of limited value in the assessment of UI in female patients.

To assess the reproducibility of the Valsalva leak point pressure (VLPP) based on urodynamics in females with stress urinary incontinence (SUI).
From October 2008 to December 2009, 65 consecutive women with urodynamically confirmed SUI underwent duplicate VLPP measurements. The intra-individual reproducibility of the VLPP recording obtained by one urologist was determined. The two observations were separated by a 10-min interval.
The differences between the repeated measurements were not significant (initial vs. repeat VLPP, 84.8 ± 19.9 vs. 86.7 ± 20.3 cmH2O; P = .094). Repeated VLPP measurements were reproducible. Defining intrinsic sphincter deficiency (ISD) as VLPP In female SUI, the VLPP is a reproducible method for evaluating urethral resistance. For VLPP

Urinary Tract Infections (UTIs) are common in childhood and are frequently associated with abnormalities of the urinary tract. UTIs are the leading cause of morbidity in patients with neurologic bladder; this causes recurrent UTIs and Chronic Kidney Injury& Disease (CKD) that affects their quality of life. Children with UTIs are mostly neurologically intact, but may have infections as a result of a voiding dysfunction. The present study aimed to examine the relationship between occult bladder dysfunction and recurrent UTIs in our patients. A cross-sectional study was done on 210 children aged 10 months to 15 years presenting with UTI with/without reflux who were admitted to the Nephrology Ward of Mofid Children’s Hospital between April 2011 and September 2013 using convenient sampling. Statistic analyses were conducted using descriptive statistics, Kolmogorov-Smirnov test, Mann Whitney test, Fisher’s Exact test, and odds ratio, and p values <0.05 were considered significant. Of 210 Children 74% were female and 26% were male. 25% had one, 25% had two, 31% had 3, and 19% had more than 3 episodes of UTI. Eighty percent of the female and 56% of the male children had recurrent UTI (P: 0.004, odds ratio: 0.361). Fifty eight percent of the patients had Vesicoureteral Reflux which was bilateral in 34% of them. There was no correlation between UTI and Urinary Reflux (P=0.152, odds ratio=1.591) and also no correlation was detected between urodynamic findings and urinary reflux(P=0.243, odds ratio=1.485). Seventy six percent of the children with recurrent UTI had abnormal urodynamic results. Since many children with recurrent UTI and multiple renal scars have bladder dysfunction, it is recommended that urodynamic studies should be included in the evaluation of every child with recurrent UTI and renal scar.