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PubMedDate not supplied

[May the Blaivas and Groutz nomogram substitute videourodynamic studies in the diagnosis of female lower urinary tract obstruction?].

OBJECTIVES: To compare the results of the Blaivas and Groutz nomogram in the diagnosis of female urinary obstruction with videourodynamic tests. METHODS: We performed a transverse study in a series of 52 female patients with ages between 20 and 81 years (mean age: 48.7 years; standard deviation: 14.4 years) and functional lower urinary tract symptoms referred for videourodynamic studies. All patients underwent free flowmetry and voiding videourodynamic study. From the scores of free flowmetry and maximum detrusor pressure in the detrusor pressure/voiding flow test of the urodynamic study they were classified in one of four categories following the Blaivas and Groutz nomogram. Following urodynamic data they were classified into three categories: absence of obstruction, bladder neck obstruction and urethral obstruction. The nomogram results were compared with the videourodynamic data using the Pearson chi-square statistical test. The diagnostic sensitivity and specificity of the nomogram were also determined. RESULTS: The Blaivas and Groutz nomogram showed a significant association with the videourodynamic data (p = 0.000). Its diagnostic sensitivity for obstruction was 100%, but its specificity was only 67.5%. The percentage of diagnostic discrepancies was maximal in the mild obstruction, where one third of the patients were obstructed following the videourodynamic data. CONCLUSIONS: The Blaivas and Groutz nomogram is a sensitive method for the diagnosis of obstruction, but its specificity is low so that it has the tendency to overdiagnose the presence of obstruction in the female patient.

Adult↗
PubMed2002

Presence of the eggshell sign in obstructive uropathy.

OBJECTIVES: To analyze the relationship between hydronephrosis due to urinary tract obstruction and the presence of the sonographic eggshell sign, which is a recently described crescent of increased echogenicity at the caliceal/parenchymal interface and possibly an indicator of raised intrarenal pressure. METHODS: All patients presenting between 1996 and 1999 for surgical management of pelviureteral junction obstruction or congenital posterior urethral obstruction had films reviewed for the presence of the eggshell sign. RESULTS: Of 94 patients, 40 presented postnatally and 54 had hydronephrosis detected on the antenatal ultrasound scan. Of the postnatal group, 16 (40%) had urethral obstruction, of whom 4 (25%) displayed the eggshell sign; in the 24 with pelviureteral junction obstruction, the echogenic pericaliceal crescent was seen in 5 (20.8%). Of the 54 in the prenatal group, 8 (15.4%) were found to have urethral obstruction, 5 (62.5%) of whom demonstrated the eggshell sign. Of the 46 prenatally diagnosed patients with pelviureteral junction obstruction, 31 (70.5%) displayed the eggshell sign before birth; we were unable to satisfactorily review 2 patients' ultrasound scans. CONCLUSIONS: Antenatally diagnosed hydronephrosis due to significant urinary tract obstruction seems to be related to the appearance of the eggshell sign on ultrasonography, particularly in those patients with pelviureteral junction obstruction. Those patients without significant caliceal distension and those with renal dysplasia or severe hydronephrosis with low-pressure kidneys were less likely to display the eggshell sign. Although the association with other causes of hydronephrosis is unknown, we believe these figures support the need for further investigation of the eggshell sign as a marker of raised intrarenal pressure to possibly provide another data point in the sonographic evaluation of congenital hydronephrosis.

Humans↗
PubMed1989

[Echotomographic evaluation of the anterior urethra].

A simple method of sonographic (US) evaluation of penile and bulbous urethra is reported. Twenty-three dysuric patients were examined. They were divided into 2 groups according to their pathology. The US patterns of normal urethra were evaluated in 10 patients (first group) with no obstructive lesions. Urethral and periurethral structures were examined in 13 patients (second group) with urethral obstructive pathology. All patients underwent conventional cystourethrography. The diagnostic parameters considered were urethral gauge and thickness, echogenicity of the urethral wall, and Cowper's glands. US evaluation of obstructive lesions provided the same findings as conventional radiological techniques. Moreover, US allowed the evaluation of both thickness and echogenicity of the urethral wall, and of normal/injured Cowper's glands.

Adolescent↗
PubMed1991

Collagen content in the rat urinary bladder following removal of an experimental infravesical outlet obstruction.

A partial urethral obstruction was induced in female rats. After 6 weeks, detrusor weight had increased eightfold and collagen concentration had decreased to about 40% compared to controls. Due to the weight gain, the total amount of detrusor collagen had increased more than threefold. Removal of the obstruction led to a rapid decrease in detrusor weight to 70, 34 and 30%, 2, 4 and 6 weeks postobstruction, although control levels were not reached. Collagen content decreased more slowly than detrusor weight, and for the same groups was 97, 69 and 67% of the value in the obstructed detrusor. This led to a rapid increase in detrusor collagen concentration which already 4 weeks after removal of the obstruction had increased to a level that did not significantly differ from the control value. The discrepancy between decrease in detrusor weight and in collagen content after removal of the obstruction suggests that a large proportion of the collagen synthesized during the period of outlet obstruction remained. Changes in the ratio between muscle and nonmuscle tissue were limited between control, obstructed and nonobstructed bladders. This suggests that the collagen concentration following obstruction and removal of obstruction is to a large extent due to changes in collagen concentration in the interstitial connective tissue rich in collagen.

Animals↗
PubMed1991

Nerve growth factor in the urinary bladder of the adult regulates neuronal form and function.

Urethral obstruction produces increased voiding frequency (0.7 +/- 0.06 to 1.1 +/- 0.08 h-1) and hypertrophy of the urinary bladder (89 +/- 1.7 to 708 +/- 40 mg) with profound increments in the dimensions of afferent (4, 6) and efferent neurons (299 +/- 4.7 to 573 +/- 8.6 microns2) supplying this organ in the rat. We discovered that hypertrophied bladders of rat and human contain significantly more nerve growth factor (NGF) per milligram wet weight, protein, and DNA than normal bladders. The temporal correlation between NGF content, neuronal hypertrophy, and bladder weight was consistent with a role for this growth factor in the neurotrophic effects associated with obstruction. Autoimmunity to NGF abolished the hypertrophy of NGF-sensitive bladder neurons in the pelvic ganglion after obstruction. Relief of urethral obstruction reduced bladder size (349 +/- 78 mg), but neuronal hypertrophy (460.2 +/- 10.2 microns2) and elevated NGF levels were only partially reversed. Bladder hypertrophy (133 +/- 4.3 mg) induced by osmotic diuresis slightly increased ganglion cell area (365.2 +/- 6.1 microns2) and only doubled NGF content of the bladder. These findings provide important new evidence that parenchymal cells in the hypertrophied bladder can synthesize NGF and possibly other molecular messengers that act to alter the size and function of neurons in adult animals and man.

Animals↗
PubMed1986

[Cholinergic and adrenergic innervation of the bladder obstructed by urethral stenosis in the rat].

In the obstructed bladder by urethral stenosis the morphometry studies show a decrease of the cholinergic and adrenergic intrinsic innervation in a different way according the tissue layer and the experimental delay. Adrenergic nerves are more affected than cholinergic ones but they recover more quickly. In the adventitia and the sub-mucosa first affected by the high pressures inside the bladder the density of the autonomous nerves decreases from the first week. The perivascular and muscular nervous fibers are less sensitive and the similar shape of their innervation histogram gives evidence of a tight bond between their adrenergic network. Beside their motor participation the adrenergic terminal fibers may play a role in the cellular trophicity of the muscle.

Adrenergic Fibers↗
PubMed2001

Treatment options for outlet obstruction following anti-incontinence surgery in females.

Urethral obstruction following surgical treatment of stress incontinence can result in a wide spectrum of symptoms ranging from mild urgency to complete retention at its most extreme. Management of these symptoms can be challenging and requires a careful history, pelvic examination, and urodynamics in some instances. In patients refractory to medications or conservative measures, urethrolysis is commonly used to treat the underlying outlet obstruction. The selection of which urethrolysis technique to use can be difficult, as many different methods have been described. In many cases, the choice of technique can be tailored to the original procedure(s) that caused the obstruction. Multiple urethrolysis procedures using a transvaginal approach have been described. One type involves perforation of the endopelvic fascia through a lateral approach. This urethrolysis usually is successful in treating obstruction after needle suspensions and pubovaginal slings, whereas retropubic procedures such as a Marshall-Marchetti-Krantz (MMK) or Burch procedure may require an anterior urethrolysis using a suprameatal approach. In cases where a Burch or MMK was performed and a sling subsequently placed, a combined lateral and anterior approach may be needed to treat the obstruction. In certain cases, a suprapubic approach may be required when the vaginal anatomy was drastically altered or a prior transvaginal urethrolysis failed. Using a urethrolysis technique tailored to the procedure that caused the obstruction, most cases of iatrogenic urethral obstruction should be treatable and result in resumption of normal voiding without producing stress urinary incontinence.

Female↗
PubMed2004

Neodymium:YAG laser incision of congenital obstructive posterior urethral membrane in boys with urinary incontinence and low uroflow.

BACKGROUND AND PURPOSE: Congenital obstructive posterior urethral membrane (COPUM) is associated with sub-clinical lower urinary tract symptoms in boys. Urethral stricture following cystoscopic fulguration of the membrane and a relatively small urethral caliber make the treatment of this condition difficult. METHODS: Fifteen boys (mean age, 10.0 years) with COPUM were treated with neodymium:YAG (Nd:YAG) contact laser incision of the membrane through a cystourethroscope (n = 7) or a ureteroscope (n = 8). RESULTS: Presenting symptoms were bedtime incontinence in 15, frequency/urgency in 10, daytime incontinence in 7, lazy bladder in 3 and urinary tract infection in 2. All patients had an obstructive urinary flow pattern with a maximal flow rate (Q(max)) < 15 mL/s. The mean follow-up period was 10.5 months. After the surgery, the number of wet nights per week reduced > 90%, 50-90% and < 50% in 9 (60%), 5 (33.3%), and 1 (6.7%), respectively. Mean (Q(max)) increased from 11.3 to 14.9 mL/s (p = 0.003). CONCLUSION: Nd:YAG laser incision of COPUM with the aid of a ureteroscope or a cystourethroscope is a safe and effective method for improving urinary flow and bedtime incontinence.

Adolescent↗
PubMed1985

Characterization of magnesium-induced urinary disease in the cat and comparison with feline urologic syndrome.

Aggregates of struvite crystals caused urethral obstruction in a high percentage of cats fed moist and dry diets supplemented with Mg oxide. Some of the diets were associated with cystolith formation as well. The percentage of Mg in the experimental diets was a misleading indicator of Mg intake because of differences between moist and dry diets in their caloric density. Magnesium homeostasis was maintained in cats ingesting large quantities of Mg. Tissue (kidney, muscle, and rib) concentrations of Mg were the same in cats fed high Mg and control diets. Plasma Mg concentration was increased only in cats ingesting the largest amount of Mg. Magnesium homeostasis was maintained by a marked increase in urine Mg excretion. However, urine Mg concentration was not directly related to Mg intake, apparently because of differences between diets in intestinal absorption of Mg. Urethral obstruction of experimental cats was not associated with a transient increase in Mg intake, nor did obstructing cats have higher urine Mg concentrations than did nonobstructing cats fed the same diet. This observation indicates that factor(s) other than urine Mg concentration are important in urethral obstruction. Cats with urethral obstruction due to naturally occurring disease, feline urological syndrome (FUS), had markedly lower urine Mg concentrations than cats fed high Mg diets. This finding refutes the theory that cats develop FUS because of primary Mg hyperabsorptive phenomena or because of a primary urinary leak of Mg. It also indicates that factors other than urine Mg concentration are involved in the genesis of naturally occurring urethral obstruction. Another difference between the natural and the induced disease was related to the character of the urinary precipitates. Experimental diets higher in Mg concentration caused urolith formation, which is uncommon with FUS. Lower Mg diets caused obstruction with aggregates of crystals, but mucus was not observed. However, in the experimental disease induced in the present study, urinary precipitates were predominantly or exclusively struvite, as has been reported in the natural disease. Many similarities were seen between the diet-induced disease and FUS, but factors in addition to Mg intake are involved in the natural disease. The importance of Mg, compared with the undefined factors, remains to be established.

Animals↗
PubMed1984

Antenatal diagnosis of renal anomalies with ultrasound. I. Obstructive uropathy.

During a 5-year period, a diagnosis of obstructive uropathy was made in 25 fetuses. Eight of them had unilateral obstruction and 17 were affected bilaterally. The most common condition encountered was urethral obstruction by posterior valves. The site and nature of the obstruction were correctly identified in 22 of the 25 fetuses. Among the 17 who had bilateral obstruction, only three survived. In contrast, only one infant with unilateral obstruction died (of unrelated causes). Oligohydramnios in low-level (urethral) obstruction was a uniformly lethal finding. Relief of urethral obstruction in two fetuses after 20 weeks of gestation did not result in survival of the infant, whereas shunting prior to 20 weeks in one fetus seemed to have a beneficial effect. On the basis of this experience, we suggest that unilateral obstruction would be treated best by conservative management, while in bilateral obstruction invasive treatment may be effective if initiated early in gestation, before significant oligohydramnios occurs.

Female↗
PubMedDate not supplied

Complications associated with perineal urethrostomy in the cat.

Urethral obstruction is a common problem in male cats. The most prevalent location for the obstruction is the penile urethra. Most male cats with urethral obstruction can be effectively treated without surgery. However, some cats with this condition require a perineal urethrostomy. This surgical procedure involves removing the penile urethra and creating a permanent stoma between the skin and pelvic urethra. A variety of medical and management problems can develop early in the course of urethral obstruction. In addition, there are several potential intraoperative and postoperative complications related to the technique of perineal urethrostomy. Most medical problems and surgical complications respond to appropriate treatment.

Animals↗
PubMed1994

Permanent urinary diversion in two Vietnamese pot-bellied pigs by extrapelvic urethral or urethropreputial anastomosis.

Permanent urinary diversion was performed in a Vietnamese pot-bellied pig to bypass apparent urethral obstruction at the level of the urethral recess and in a second pig to correct bleeding from perineal urethrostomy. In the first pig, extrapelvic anastomosis of the penile portion of the urethra to the pelvic portion of the urethra was performed. In the second pig, the penis was amputated and the pelvic portion of the urethra was anastomosed to the preputial epithelium, creating a urethropreputial conduit. Postoperatively, positive-contrast radiography demonstrated continuity of the anastomoses, and both pigs were able to urinate normally. The pig with the urethropreputial anastomosis developed hematuria and nocturia that were controlled by continuous administration of antibiotics and resolved following cleansing of the preputial diverticulum 1 year after surgery. Extrapelvic urinary diversion should be considered for permanent resolution of urethral obstruction in Vietnamese pot-bellied pigs; urethral anastomosis is preferable to urethropreputial anastomosis, because of the greater risk of ascending urinary tract infection associated with urethropreputial anastomosis.

Anastomosis, Surgical↗
PubMedDate not supplied

[Cowper's syringocele in children: report on ten cases].

Cystic dilatation of Cowper's gland ducts (Cowper's syringocele) is uncommon in pediatric age. Cowper's syringocele frequently are asymptomatic, sometimes may cause dysuria, pollakiuria and obstructive voiding symptoms. We report ten children with syringocele. Five were observed for recurrent urinary infections, three for obstructive voiding symptoms and two for post-traumatic hematuria and for urinary incontinence. Only three patients with obstructive urethral symptoms were surgically treated. In our opinion careful clinical, radiologic and endoscopic evaluation is necessary in such cases so that unnecessary surgery can be avoided.

Bulbourethral Glands↗
PubMed1998

Experimental bladder instability following bladder outlet obstruction in the female rat.

PURPOSE: In rats, urethral obstruction was previously shown to lead to detrusor instability, but bladder instability in conscious animals has not been well characterized. The present study was designed to describe the consequences of bladder outlet obstruction on urodynamic parameters in the conscious rat. A categorization of different types of bladder instability in conscious rats is described. MATERIALS AND METHODS: Cystometry was performed on conscious animals with chronically implanted lines. Recordings of the micturition pattern and the bladder pressure during the micturition cycle were made from normal female rats and those with instability caused by infravesical outflow obstruction. RESULTS: In control rats, the peak micturition pressure was low (45.6+/-2.5 cm. H2O) and only small pressure fluctuations occurred before or after micturition. Rats with outlet obstruction exhibited bladder hypertrophy, high micturition pressure (95.5+/-6.8 cm. H2O) as well as marked spontaneous activity throughout the micturition cycle. According to the spontaneous activity profile we identified four main patterns of abnormal micturition cycles. CONCLUSION: Urethral obstruction in rats leads to a significant increase in bladder weight and to altered micturition patterns which reveal clear similarities with features of the cystometric profiles performed in men with infravesical outflow obstruction. These modifications are not consistently correlated with an increase in bladder weight.

Animals↗
PubMed1999

Nitric oxide synthase--its distribution and alteration in the intramural ganglia of the urinary bladder in normal and urethra-obstructed guinea pigs.

Nitric oxide (NO) has been proposed to function as an inhibitory neurotransmitter in the lower urinary tract. This study investigates the distribution of NO-containing neurons and its changes following urethral obstruction in the guinea-pig. By using nicotinamide adenine dinucleotide phosphate diaphorase (NADPH-d) histochemistry and NO synthase (NOS) immunohistochemistry, the highest frequency of NO-containing neurons was observed in the bladder base. Double labelling studies showed that 70.9% of NADPH-d reactive neurons co-expressed NOS immunoreactivity. Acetylcholinesterase reactivity was present in the majority of the intramural neurons with 54% of them expressed NOS immunoreactivity. NADPH-d reactivity was colocalized with vasoactive intestinal polypeptide, calcitonin gene-related peptide and substance P immunoreactivities in both neurons and fibres. Colocalization study also revealed that NADPH-d reactive neurons formed a distinct cell population from tyrosine hydroxylase positive neurons. At 12 hours after urethral obstruction, NADPH-d reactivity in the intramural ganglion cells was noticeably enhanced and this was sustained till 24 hours whence some intensely stained neurons appeared to undergo degenerative changes. Neuronal degeneration was more drastic at 48 hours so that the number of NADPH-d positive neurons was significantly reduced. The present study suggests that NO is an important neurotransmitter in the urinary bladder and that it may be involved in the relaxation activity in the bladder base during micturition. It is speculated that the increased NADPH-d reactivity in intramural ganglion cells elicited by urethral obstruction may be responsible for the cell death. It is suggested that the resulting cell loss or bladder denervation may account for the urinary dysfunction such as frequency and urgency of micturition in patients with urethral obstruction.

Acetylcholinesterase↗
PubMed2002

Botulinum toxin urethral sphincter injection resolves urinary retention after pubovaginal sling operation.

The management of prolonged urinary retention following pubovaginal sling surgery typically involves transvaginal urethrolysis for anatomical urethral obstruction. Brubaker [1] recently reported on urethral sphincter abnormalities as a cause of postoperative urinary retention following either Burch suspension or pubovaginal sling procedure. We report a case of functional urethral obstruction and detrusor acontractility following pubovaginal sling surgery that was successfully treated by botulinum A toxin urethral sphincter injection.

Aged↗
PubMedDate not supplied

Effect of therapy on susceptibility to urinary tract infection in male cats with indwelling urethral catheters.

Indwelling urinary catheters with a closed urine collection system were maintained in 30 male cats for 3 days after induction of irritant cystitis. All cats received subcutaneous fluids during the 3 days the catheters were in place. The effects of four different treatment regimens on urinary tract infection rates, incidence of urethral obstruction, and development of urinary tract lesions over a 10-day period were compared with results in a nontreated group. Treatments were 1) amoxicillin for 5 days PO; 2) prednisolone for 5 days PO; 3) both amoxicillin and prednisolone for 5 days PO; and 4) dimethylsulfoxide (DMSO) for 3 days intravesicularly. Euthanasia was done before the end of the 10-day experimental period if the cats had two bouts of urethral obstruction or if the cats became uremic for causes unrelated to urethral obstruction. Seven cats were euthanatized before the conclusion of the experiment. These cats had been treated with prednisolone, prednisolone and amoxicillin, or DMSO. All cats that received amoxicillin alone or no therapy survived the 10-day period. Mortality was due to repeated urethral obstruction or to uremia associated with pyelonephritis or papillitis. Urinary tract infection rate was similar in all groups. The group treated with prednisolone alone had the highest incidence of renal infection. Inflammatory lesions in the lower urinary tract were similar in all groups. In conclusion, persistent urinary tract infection often develops in cats with cystitis after indwelling urethral catheterization even when closed systems of urine drainage are used.(ABSTRACT TRUNCATED AT 250 WORDS)

Amoxicillin↗
PubMed1997

Cytokine gene expression during experimental Escherichia coli pyelonephritis in mice.

PURPOSE: We studied nine inflammatory and immunoregulatory cytokines in acute pyelonephritis and urethral obstruction in mice to better understand the processes underlying kidney inflammation and scarring. MATERIALS AND METHODS: Experimental acute pyelonephritis was established in Bki NMRI outbred mice by bladder inoculation of Escherichia coli, followed by 6 h urethral obstruction. The numbers of cytokine mRNA expressing cells for interleukin-1 (IL-1), IL-4, IL-6, IL-10, IL-12, tumor necrosis factor alpha (TNF-alpha), TNF-beta, transforming growth factor beta (TGF-beta) and interferon gamma (IFN-gamma) were determined in the kidneys and spleens from the infected, non-infected but obstructed and untouched mice using in situ hybridization with radio-labelled oligonucleotide probes at 12 h, 48 h and 6 d after release of the urethral obstruction. RESULTS: Kidney cell expression of IL-1, IL-6 and TNF-alpha mRNA was observed already at 12 h and persisted on day 6 in the infected animals. A significant proinflammatory cytokine response occurred also in the non-infected obstructed animals, albeit later and at lower levels. A marked increase of IL-4, IL-10, TGF-beta and IFN-gamma mRNA producing cells was also found in the kidneys of these two groups again with higher levels in the infected animals. Very high numbers of splenocytes expressing mRNA for IL-1 were observed especially in the infected animals. A high proportion of splenocytes further expressed mRNA for IL-6, TNF-alpha, IL-4, IL-10, IFN-gamma and TGF-beta, again with highest numbers in the infected group of animals. CONCLUSIONS: The present study extends previous knowledge about the local and systemic cytokine expression profiles during acute pyelonephritis and after urethral obstruction. Of particular interest was the marked kidney cell expression of mRNA for TGF-beta, presumed to be important both for obstructive and post-infectious renal scarring.

Acute Disease↗