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- Torffvit, Ole, et al.
(författare)
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Lack of association between cystopathy and progression of diabetic nephropathy in insulin-dependent diabetes mellitus
- 1997
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Ingår i: Scandinavian Journal of Urology and Nephrology. - : Informa UK Limited. - 0036-5599 .- 1651-2065. ; 31:4, s. 365-369
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Tidskriftsartikel (refereegranskat)abstract
- Whether an association exists between cystopathy and progression of diabetic nephropathy has never been clarified. The aim of the present study was to measure the degree of cystopathy in relation to the rate of progression of diabetic nephropathy. To that end, 17 insulin-dependent diabetic patients with diabetic nephropathy but without voiding symptoms were investigated urodynamically. The median age of the patients was 45 years (range 27-67 years), diabetes duration 23 years (range 14-44 years) and the serum creatinine level was 162 mumol/L (median, range 65-449 mumol/L) at the time of the study. The progression rate of diabetic nephropathy was analysed retrospectively by measuring changes in yearly mean values of Log10 serum creatinine for a period of 13 years (3-15 years) before the investigation. The progression rate was 0.028 mumol/L/year (median). Patients with a progression rate above and below the median rate were considered to be rapid (n = 8) and slow (n = 9) progressors, respectively. More women than men had a rapid progression rate of nephropathy. Rapid progressors were found to have smaller volume or residual urine (90 vs 165 ml; p < 0.05), larger volume voided (440 vs 270 ml; p < 0.05), lower opening pressure (18 vs 48 cm H2O; p < 0.05) and lower pressure at maximum flow (37 vs 64 cm H2O; p < 0.05) compared to slow progressors. However, these variables were not related to the progression rate of nephropathy (MANOVA). Furthermore, these results should be interpreted with caution because of the natural gender differences in pressure conditions. In conclusion, rapid progression of diabetic nephropathy does not seem to be associated with dysfunction of the urinary bladder measured with cystometry and pressure flow.
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| 6. |
- Crayton, Robert, et al.
(författare)
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Exogenously Administered Opioids Contract the Female Rat Intrinsic Urethral Sphincter In Vivo
- 2010
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Ingår i: Neurourology and Urodynamics. - : Wiley. - 0733-2467. ; 29:5, s. 777-782
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Tidskriftsartikel (refereegranskat)abstract
- Background and objective: Previous studies have reported immunoreactive opioid nerve fibers in the detrusor and lower urinary tract sphincters. However, there is a paucity of in vivo studies demonstrating the direct effect of endogenous opioids in these structures. In the present study, we investigated the contractile actions of intra-arterially administered exogenous Dynorphin-A, Met-enkephalin, Leu-enkephalin, morphine, and the opioid antagonist naltrexone on the female rat intrinsic urethral sphincter in vivo. Methods: Intraurethral pressure was recorded by a catheter placed at the maximum pressure zone of the intrinsic urethral sphincter in anesthetized female Sprague-Dawley rats. The effects of different opioids were studied and expressed as means and as percentages of pressure change (cmH(2)O) of the baseline intraurethral pressure. Results: Dynorphin-A, Met-enkephalin, and Leu-enkephalin evoked rapid, long-lasting contractile effects on the female rat urethra. The greatest intraurethral pressure increase was evoked by Dynorphin-A (89.2 +/- 15.3%). For Met-enkephalin, intraurethral pressure increased by 70.2 +/- 21.8% and for Leu-enkephalin, the pressure increase was 60.6 +/- 20%. Morphine, however, evoked inconsistent intraurethral pressure changes, increasing the urethral pressure in three subjects and lowering the pressure in the remaining six subjects. The opioid antagonist naltrexone reduced the intraurethral pressure by a mean of -19.0 +/- 5.8%. Conclusion: Results of the present study suggest that endogenous opioids by their contractile action on the intrinsic urethral sphincter may play a role in the control of continence in rats, additional to cholinergic and noradrenergic pathways. Neurourol. Urodynam. 29:777-782, 2010. (C) 2010 Wiley-Liss, Inc.
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| 7. |
- Gravas, S, et al.
(författare)
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Seeking evidence that cell kill guided thermotherapy gives results not inferior to those of transurethral prostate resection: Results of a pooled analysis of 3 studies of feedback transurethral microwave thermotherapy
- 2005
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Ingår i: Journal of Urology. - : Ovid Technologies (Wolters Kluwer Health). - 1527-3792 .- 0022-5347. ; 174:3, s. 1002-1006
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Tidskriftsartikel (refereegranskat)abstract
- Purpose: We compared ProstaLund Feedback Treatment(R) (PLFT(R)) to transurethral prostate resection (TURP) in terms of efficacy and safety in a pooled analysis of 3 clinical studies with 1-year followup. Materials and Methods: Overall raw data on 183 patients with PLFT(R) and 65 with TURP were pooled. All studies had identical inclusion criteria, and the efficacy and safety of the method were evaluated using the International Prostate Symptom Score, maximum urine flow (Qmax), responder rate, bother score, prostate volume reduction and adverse events. Results: The response rate was 85.3% and 85.9% in the PLFT(R) and TURP groups, respectively. One-sided 95% CI analysis showed the noninferiority of PLFT(R) vs TURP for this variable. Mean International Prostate Symptom Score was significantly decreased in the PLFT(R) and TURP groups after 12 months (from 20.9 to 6.4 and 20.7 to 7.1, respectively). The 1-sided upper 95% CI of PLFT(R) was within the noninferiority definition compared with that of TURP. The bother score decrease in the PLFT(R) and TURP groups was not significant different (70.9% and 64.0%, respectively). An increase in Qmax from 7.7 to 16.1 ml per second 12 months after PLFT(R) was noted, while the improvement in Qmax in the TURP group was higher (from 7.5 to 18.6 ml per second). The 1-sided lower 95% CI was close (0.76) but it did not attain the predetermined level of noninferiority (0.80). Mean transurethral ultrasound determined volume 12 months after PLFT(R) and TURP was reduced by 32.8% and 58.1%, respectively. A significant correlation between the transurethral ultrasound determined prostate volume reduction and estimated cell kill was found (r = 0.456, p <0.000001). Serious adverse events with causality occurred in 15.4% of patients with TURP compared with 6.0% in those with PLFT(R) (p = 0.035). Conclusions: Combined experience from our pooled analysis indicates that PLFT(R) challenges TURP in terms of efficacy and safety after 1 year of followup.
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- Gunnarsson, Marianne, et al.
(författare)
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Effects of pelvic floor exercises in middle aged women with a history of naïve urinary incontinence: a population based study.
- 2002
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Ingår i: European Urology. - 1873-7560. ; 41:5, s. 556-561
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: To follow the effect of a 4-month pelvic floor exercise (PFE) program in women with naïve urinary incontinence with vaginal electromyography (EMG), pressure and palpation and also to compare the initial findings with symptom-free women of the same age.METHODS: The pelvic floor function expressed with vaginal EMG, pressure and palpation was measured before, during and after 4 months of PFEs in 60 previously untreated incontinent women, 50 of whom completed the study. The patients' perception of the situation and the amount of leakage were estimated before and after PFE. The incontinent group was compared at baseline and after PFE with 28 healthy controls. All women in this study (age 53-63) were randomly recruited from a major population based study.RESULTS: At baseline, the incontinent women had significant reductions of both vaginal EMG activity and pelvic floor muscle condition as estimated by palpation compared to the healthy group. During training a successive, significant increase was seen in both EMG, pressure and palpation and the values eventually exceeded those of the healthy women. The measures reflecting improvement of pelvic floor function thus showed a consistent and progressive pattern. The degree of improvement was higher in those with initial high values in the muscle function tests than in the women with lower initial EMG values, pressures and findings on palpation. No differences were seen between patients with a history of stress incontinence and patients with an urge component, i.e. urge or mixed incontinence. Sixty-four percent of the women were satisfied and wanted no further treatment. The median leakage at pad-test decreased from 5 (range 0-328) to 1 (range 0-126) g/24h. The correlation between the vaginal and the pad-test measurements was weak.CONCLUSION: Women with urinary incontinence have a significant reduction of pelvic floor function as estimated with vaginal EMG and palpation as compared to symptom-free controls. A successive normalization of vaginal EMG, pressure and findings at palpation was seen during the 4-month training period. Incontinence of both stress type and with an urge component can be alleviated in most of the women with PFE. These methods might be useful for routine evaluation of the pelvic neuromuscular disorder present in incontinent women.
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- Huidobro, C, et al.
(författare)
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Evaluation of microwave thermotherapy with histopathology, magnetic resonance imaging and temperature mapping
- 2004
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Ingår i: Journal of Urology. - : Ovid Technologies (Wolters Kluwer Health). - 1527-3792 .- 0022-5347. ; 171:2, s. 672-678
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Tidskriftsartikel (refereegranskat)abstract
- Purpose: Interstitial temperature mapping was used to determine the heat field within the prostate by the Coretherm. (ProstaLund, Lund, Sweden) transurethral microwave thermotherapy device. Gadolinium. enhanced magnetic resonance imaging (MRI) and histopathology were used to determine the extent and pattern of coagulation necrosis following treatment. The cell kill assessment feature of the device was compared with MRI and histopathology. Materials and Methods: A total of 12 patients were treated, including 5 with adenocarcinoma of the prostate and 7 with benign prostatic hyperplasia. Temperature sensors were inserted from the perineum. to map the temperature distribution. The 5 patients with adenocarcinoma underwent prostatectomy and subsequent histopathology 3 to 6 weeks after treatment. MRI and cell kill calculations were performed in all patients. Results: Therapeutic temperatures were found in a bowl-like shape with a wide circumference of highest temperatures at the base of the prostate, and decreasing temperature and circumference toward the apex. Tissue necrosis assessed by histopathology, MRI and cell kill calculations overlapped reasonably well in shape and size. Histopathology showed that the prostatic urethra was destroyed by treatment. Conclusions: Coretherm microwave treatment causes significant tissue necrosis of the prostate, bladder neck and urethral mucosa. The cell kill calculation provides an on-line estimate of the amount of necrosis caused during treatment.
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