The Clinical Significance of Poor Bladder Compliance
ABSTRACT There is limited data on bladder compliance associated with lower urinary tract dysfunction. The aim of this study was to investigate the decrease in bladder compliance, and the clinical relationship between patterns of increased pressure with neurological disease.
A retrospective analysis was performed in 5,027 patients with voiding dysfunction between June 2002 and April 2008. The patients with poor compliance (PC) were categorized according to the detrusor pattern of increased pressure: group A (gradual increase), group B (terminal increase), and group C (abrupt increase and plateau).
Patients with PC were found in 170 (3.4%) cases (76 males and 94 females) with 46.5% in group A 44.7%, group B, and 8.8% group C. Bladder trabeculation was more prevalent in patients with PC than among those with normal compliance. Group A had the highest correlation with the incidence of spinal cord injury compared to the other groups. Group B had a higher correlation with a history of pelvic irradiation, radical prostatectomy, and tethered cord syndrome compared to the others. Vesicoureteral reflux was more frequently detected in group A and group C. Group C was positively correlated with the presence of detrusor overactivity and nocturnal enuresis.
Poor compliance was correlated with the presence of neurological conditions. The gradual increase of detrusor pressure was associated with the development of spinal cord injury, and the terminal increase had an association with a history of treatment to the pelvic cavity.
SourceAvailable from: Dejan LJ. Marković[Show abstract] [Hide abstract]
ABSTRACT: Background/Aim. Autogenous bone grafting has been the gold standard in clinical cases when bone grafts are required for bone defects in dentistry. The study was undertaken to evaluate multilevel designed carbonated hydroxyapatite (CHA) obtained by hydrothermal method, as a bone substitute in healing bone defects with or without corticosteroid treatment in rats as assessed by histopathologic methods. Methods. Bone defects were created in the alveolar bone by teeth extraction in 12 rats. The animals were initially divided into two groups. The experimental group was pretreated with corticosteroids: methylprednisolone and dexamethasone, intramuscularly, while the control group was without therapy. Posterior teeth extraction had been performed after the corticosteroid therapy. The extraction defects were fulfilled with hydroxyapatite with bimodal particle sizes in the range of 50-250 mu m and the sample from postextocactional defect of the alveolar bone was analyzed pathohystologically. Results. The histopatological investigations confirmed the biologic properties of the applied material. The evident growth of new bone in the alveolar ridge was clearly noticed in both groups of rats. Carbonated HA obtained by hydrothermal method promoted bone formation in the preformed defects, confirming its efficacy for usage in bone defects. Complete resorption of the material's particles took place after 25 weeks. Conclusion. Hydroxyapatite completely meets the clinical requirements for a bone substitute material. Due to its microstructure, complete resorption took place during the observation period of the study. Corticosteroid treatment did not significantly affect new bone formation in the region of postextractional defects.Vojnosanitetski pregled. Military-medical and pharmaceutical review 05/2014; 71(5):462-466. DOI:10.2298/VSP1405462M · 0.27 Impact Factor
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ABSTRACT: BACKGROUND:: In a previous observational study, thoracic epidural analgesia (TEA) after open renal surgery resulted in clinically relevant postvoid residuals (PVRs). This study aimed to investigate the individual contribution of epidurally administrated drugs and surgery in bladder dysfunction. METHODS:: In this single-center, parallel-group, randomized (computer-generated list), double-blind superiority trial, 40 patients undergoing open renal surgery were equally allocated to receive epidural bupivacaine (0.125%) alone or with fentanyl (2 µg/ml). Patients underwent urodynamic investigations before TEA and during TEA preoperatively and postoperatively. Primary outcome was the difference (Δ) in PVR between before TEA and postoperatively during TEA. Secondary outcomes were changes in detrusor pressure at maximum flow rate, bladder compliance, and ΔPVR between different time points. RESULTS:: Median ΔPVR (ml) from baseline to postoperatively was 180 (range, -85 to 645; P = 0.001) in the bupivacaine group and 235 (range, 0-580; P value less than 0.001) in the bupivacaine/fentanyl group, with no difference between groups (95% confidence interval, -167 to 103; P = 0.634). Detrusor pressure at maximum flow rate (cm H2O) from baseline was more pronounced in the bupivacaine/fentanyl than that in the bupivacaine group preoperatively (-10; range, -64 to -2; P value less than 0.001 vs. -3; range, -35 to 13; P = 0.397) (P = 0.045) and postoperatively (-18; range, -64 to 0; P value less than 0.001 vs. -12; range, -34 to 22; P = 0.006) (P = 0.135). Surgery did not affect PVRs, but a decreased bladder compliance was observed in both groups. No adverse events occurred. CONCLUSIONS:: Thoracic epidurally administrated bupivacaine resulted in clinically relevant PVRs based on impaired detrusor function. The addition of fentanyl enhanced this effect without generating greater PVRs. After surgery, the voiding phase was not further impaired; however, bladder compliance was decreased.Anesthesiology 11/2012; 118(1). DOI:10.1097/ALN.0b013e318271606a · 6.17 Impact Factor
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ABSTRACT: PURPOSE: To identify the risk factors for hydronephrosis in patients with neurogenic bladder caused by spina bifida. METHODS: A retrospective analysis of 120 patients with hydronephrosis between January 2005 and 2012 was conducted. The patients were evaluated for the following factors: age, sex, voiding symptoms, experience of using clean intermittent catheterization, history of urinary tract infection (UTI), history of one or more tethered spinal cord release surgery, routine urine examination, serum creatinine, ultrasound for kidneys, ureters, bladder, and urodynamic findings by univariate and logistic regression analyses. RESULTS: Among the 120 patients, 45 (38 %) had unilateral or bilateral hydronephrosis. Univariate analysis indicated that detrusor hyperreflexia, poor compliance (PC), vesicoureteral reflux (VUR), urinary incontinence, high residual urine, and UTI were the significant factors in the incidence of hydronephrosis. Multivariate analysis indicated that PC, VUR, and UTI were the risk factors for hydronephrosis and that detrusor hyperreflexia and urinary incontinence were the protective factors. UTI was the most serious risk factor for hydronephrosis, with an odds ratio of 29.6. Hydronephrosis was not associated with the history of tethered spinal cord release surgery. CONCLUSION: This study revealed the prognostic risk factors for hydronephrosis. The medical history of patients, imaging examination, and urodynamic parameters play key roles in identifying the risk factors for hydronephrosis.International Urology and Nephrology 03/2013; 45(3). DOI:10.1007/s11255-013-0409-z · 1.29 Impact Factor