1/9. An urodynamic study of emepronium bromide in bladder dysfunction.The effect of emepronium bromide in 13 patients, most of whom had uninhibited bladders, has been studied urodynamically. Under the influence of this drug, the detrusor pressure and the urinary flow was reduced, and abdominal straining during during micturition was commonly recorded. The bladder capacity increased considerably, but all subjects developed residual urine. The effect of emepronium bromide on the bladder capacity seemed to last for a longer period than the effect on the detrusor pressure.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |
2/9. Polysomnographic and urodynamic changes in a case of obstructive sleep apnea syndrome with enuresis.A 53-year-old female patient with obstructive sleep apnea syndrome was reported. She had complained of enuresis as well as a 15-year history of snoring, but she had no complaint of sleep and awake disturbance. Polysomnographic study showed repeated obstructive apnea and hypopnea with an apnea/hypopnea index of 52.6, and severe oxygen desaturation during sleep. On cystometography during sleep, the changing amplitude of the spike wave corresponds to the changes of respiratory efforts against a closed upper airway. The patient was treated successfully with imipramine and acetazolamide for the obstructive sleep apnea and enuresis. apnea/hypopnea index, nocturnal oxygen desaturation, and sleep architecture were improved, and enuresis completely disappeared. Cystometrography during sleep showed that the average amplitude of the spike wave tended to be low. Percentage urinary volume during sleep compared with 24 h volume was significantly reduced. We considered that the enuresis was mainly related to increased intra-abdominal pressure produced by respiratory efforts and enhanced nocturnal urine production.- - - - - - - - - - ranking = 0.5keywords = pressure (Clic here for more details about this article) |
3/9. Bedwetting--not always what it seems: a sign of sleep-disordered breathing in children.ISSUES AND PURPOSE: nocturnal enuresis (bedwetting) can linger long into childhood. Sleep research has documented that nocturia and bedwetting are symptoms of obstructive sleep apnea (OSA) in adults and that bedwetting is predictive of OSA in children. CONCLUSIONS: Nocturnal polyuria is a cardiovascular response to negative pressure breathing (inspiration against a closed glottis), which is characteristic of OSA. PRACTICE IMPLICATIONS: Evidence of nocturnal polyuria and sleep-disordered breathing are important signs of OSA, a serious but treatable condition.- - - - - - - - - - ranking = 0.5keywords = pressure (Clic here for more details about this article) |
4/9. Isolated retrovesical cyst hydatid in a child: an unusual presentation of echinococcosis.echinococcosis is the most widespread, serious human cestode infection in the world. Isolated retrovesical cyst hydatid is extremely rare in children and mostly causes symptoms because of its pressure on adjacent organs. We report on the case of an 8-year-old girl with an isolated retrovesical cyst hydatid. Final diagnosis was established after histological examination, whereas imaging techniques failed to establish the diagnosis.- - - - - - - - - - ranking = 0.5keywords = pressure (Clic here for more details about this article) |
5/9. Spinning top urethra and lower urinary tract dysfunction in a young female.Spinning top urethra (STU) denotes a particular urethral configuration that is a dilated posterior urethra mainly seen in young girls or women. STU deformity arises secondary to detrusor instability, leading to a rise the intravesical pressure against a closed sphincter. We describe a case of spinning top urethra in a 30-year-old woman who presented with lower urinary tract symptoms and left flank pain.- - - - - - - - - - ranking = 0.5keywords = pressure (Clic here for more details about this article) |
6/9. Management of the uninhibited bladder by selective sacral neurectomy.The authors report the treatment of incontinence due to uninhibited bladder contractions by selective sacral neurectomy in nine patients, four without evidence of neurological disease. A detailed and objective analysis of bladder and urethral function, together with quantitation of clinical features, was made before and after operation. Seven patients were either cured or greatly improved. The overall increase in bladder capacity and reduction of uninhibited activity were statistically significant. The resting urethral sphincter pressure was unchanged, but the contractility of the voluntary external sphincter was slightly impaired. Criteria for such neurectomies are discussed.- - - - - - - - - - ranking = 0.5keywords = pressure (Clic here for more details about this article) |
7/9. Membrano-bulbo-urethral junction stenosis. Posterior urethra obstruction due to extreme caliber disproportion in the male urethra.OBJECTIVE: Based on 4 cases of infravesical obstruction due to extreme caliber disproportion between the posterior urethra and the penile urethra, a pathophysiological mechanism for this dynamic obstruction is given and endoscopic treatment is described. SUBJECTS: Four cases of membrano-bulbo-urethral junction (MBUJ) stenosis, seen between September 1995 and April 1996, are described. Two boys had previous successful valve resection but still showed extreme ballooning of the posterior urethra. The other 2 boys showed bladder instability on urodynamics and the male variant of the spinning top urethra on voiding cystourethrography (VCUG). RESULTS: All cases were successfully treated by endoscopic incision at the 12 o'clock position of the kink between the posterior and the penile urethra which is seen when the full bladder is expressed. Disproportion in the posterior urethra, seen on VCUG, together with bad urinary flow measured on uroflowmetry raise the suspicion of MBUJ stenosis. CONCLUSION: Although rarely seen, extreme caliber disproportion in the male urethra can cause obstruction. Ballooning of the posterior urethra, caused by urethral valves, bladder instability resisted by voluntary sphincter contraction or congenital posterior urethral dilatation, creates an obstructive kink in the urethra comparable to some obstructions in ureteropelvic junction stenosis. If suspicion of such a form of obstruction arises, cystoscopy during pressure on the full bladder is mandatory in order to see the obstruction, descending as a membrane from the vault of the urethra.- - - - - - - - - - ranking = 0.5keywords = pressure (Clic here for more details about this article) |
8/9. Diurnal and nocturnal enuresis in a 6 year old.Justin is a 6-year-old boy diagnosed with attention-deficit/hyperactivity disorder who presented with daytime and night-time wetting. He had been toilet trained at the age of 3 years but was back in diapers as a result of the enuresis. His bowel movements were normal. The initial evaluation consisted of a urinalysis, urine culture, serum creatinine level, and renal/bladder ultrasound examination. The urine studies were normal. The serum creatinine level was elevated at 1.0 mg/dL. The ultrasound examination revealed bilateral mild hydronephrosis and a thickened bladder wall. A voiding cystourethrogram was ordered to evaluate anatomy, but Justin would not allow a Foley catheter to be inserted, so the procedure, along with cystoscopy, was performed under anesthesia. cystoscopy revealed a highly trabeculated bladder, as is seen in either high-grade obstruction or a neurogenic bladder. The cystogram did not show any obstruction or vesicoureteral reflux. Meanwhile, Justin's symptoms continued to increase to the point at which he was constantly wet, and he no longer made any attempts to void on his own. A spinal magnetic resonance imaging study did not show any occult neurologic lesions. Urodynamic studies revealed a high-pressure bladder, poor emptying, and inappropriate voluntary contraction of the striated, urinary sphincter during micturition. Despite institution of anticholinergic medication, psychotherapy, and behavioral therapy, Justin continued to do poorly. He could not tolerate clean intermittent catheterization, and he eventually required a suprapubic tube for urinary drainage and preservation of his kidneys.- - - - - - - - - - ranking = 0.5keywords = pressure (Clic here for more details about this article) |
9/9. Enuresis and obstructive sleep apnea in adults.adult enuresis is an unusual symptom of obstructive sleep apnea (OSA). Although it is described as a classic symptom of childhood OSA, enuresis is encountered infrequently in adult sleep medicine. Five adults with enuresis associated with sleep apnea presented to our sleep disorders Center. In all five cases, the onset of enuresis was associated with the progression of sleep apnea symptoms. In each case, the enuresis resolved with treatment with nasal continuous positive airway pressure. Current medical literature on the postulated mechanisms of nocturia and enuresis in sleep apnea is reviewed. Based on the experience of the authors and review of the medical literature, one may conclude that severe OSA may lead to new-onset enuresis in adults and that effective treatment of OSA is associated with resolution of enuresis.- - - - - - - - - - ranking = 0.5keywords = pressure (Clic here for more details about this article) |