Continence Reports最新文献

Female urethral strictures and urethral diverticula are rare as individual entities and exceedingly rare in combination. To our knowledge, there has not been a report of the use of diverticulum sac tissue for simultaneous female urethral stricture repair. We present a novel procedure with an inverted U-shaped approach with urethral diverticulectomy, then we were able to use the urethral diverticula sac tissue for repair of the stricture. Ultimately, the procedure was successful and the patient is doing well at 10 months postoperatively.

Existence of vesicovaginal fistula is known since ancient days and has been considered related to tedious labour. It continues to be a health care issue in those communities where obstetrician and midwifery care are scarce. Initial descriptions of surgical treatment started within the XV century, but the first detailed description of a curative technique was made in 1852. Urethral and perineal fistula are also known since ancient days related to the treatment of urethral stricture or bladder stones in males. The implementation of anaesthesia and antisepsis have been a great aid to the advancement of surgery and relief to urinary fistula patients all over the world.

Today urgency, according to the International Continence Society, is defined as “the complaint of a sudden compelling desire to pass urine, which is difficult to defer”. The overactive bladder (OAB) is a symptom syndrome defined as the presence urgency with or without urgency incontinence accompanied by frequency and nocturia in the absence of infection or any other obvious aetiology. Treatment is primarily behavioural regulation with reduction in fluid intake, timed voiding, bladder training and pelvic floor muscle training. Pharmacologic treatment of urgency and urgency incontinence is oral medical treatment, e.g. anticholinergics or beta-3 agonists. In resistant cases, the patient will be offered treatment with injection of botulinum toxin A in the submucosa of the bladder. In ancient time, concise definitions were lacking and reports on treatment of urinary incontinence are therefore often a mismatch between treatment modalities of different types of urinary incontinence. This non-systematic review outlines the history of how urinary incontinence were evaluated in western medicine, emphasizing the pharmacologic treatment of urgency incontinence.

Evolutionary medicine can help to better understand the basis of pelvic floor disorders. Some evidences of the anthropological literature are reviewed, with emphasis on the paleontological clues and phylogenetic comparison of cephalo-pelvic relations in Homo and non-human primates, is undertaken to elucidate the origin of pelvic floor disturbances in humans. Labor difficulties inherent to bipedal gait and the encephalization process could have started several million years ago with Australopithecus and appear undeniable since Homo heidelbergensis, the precursor of Neanderthals. The mechanisms involved in modern human delivery with fetal rotation into the birth canal could be exclusive of Homo sapiens. Among pre-bipedal non-human primates only squirrel monkey can suffer severe dystocia and spontaneous pelvic organ prolapse. Better understanding of the evolutionary changes regarding the human pelvis and the pelvic floor could help us to better understand pelvic floor disorders and the interventions to avoid this highly prevalent ailment.

Medieval medicine established the basis of western sanitary knowledge. In an early period, the medical model was monastic and based mainly on botany. In High Middle Age (1000–1300 AD) classical Greek, Roman and Arabic sources were rescued by manuscript copiers, compilers and translators, especially in the Medical School of Salerno and in Toledo. The Arab and Hebrew knowledge was fundamental for this information recovery, that promoted the creation of the first medical universities in Europe (Montpelier, Bologna, Paris, Oxford, Salamanca) that spread the medical knowledge in Late Middle Ages. A non-systematic review is undertaken to analyze how urinary signs and symptoms were evaluated in medieval medicine, with emphasis in uroscopy and in the description in medical treatises of urinary symptoms; including incontinence, dysuria and retention, and their remedies in the form of oils, syrups and electuaries to restore the humoral balance

Purpose:

While intradetrusor botulinum neurotoxin (BoNT) injection is a well-established treatment of neurogenic detrusor overactivity, its administration in individuals with complex genitourinary (GU) reconstruction can be difficult. The objective of this report is to highlight our institution’s experience with challenges and practical solutions in delivering BoNT to this unique patient population.

Materials and Methods:

We performed a retrospective review of our institution’s database of adults with congenital neurogenic lower urinary tract dysfunction (NLUTD) with history of complex GU reconstruction who received intradetrusor BoNT injections performed by a single surgeon between 2016 and 2023. In patients with multiple injections, the most recent procedure was used as the index case for analysis.

Results:

A total of 17 patients were included, with a mean age of 27 years (range 21–46). The most common diagnosis was myelomeningocele (n=13), followed by sacral agenesis (n=2), Williams syndrome (n=1), and urethral atresia (n=1). The most common GU reconstruction was augmentation cystoplasty (n=11). 75% (12/16) of the patients had a continent catheterizable channel (CCC) and 31% (5/16) had undergone prior bladder neck reconstruction or closure.

Conclusion:

Additional considerations and instruments are required for safe and effective BoNT injections in individuals with congenital NLUTD and reconstruction. Adequate preparation by the staff and the provider may be needed. Our recommendation generally favors the utilization of a flexible cystoscope or a rigid scope with a smaller sheath size to minimize trauma to the CCC, bladder neck, or urethra. Additionally, it is advisable to consider reconstituting BoNT in higher concentrations to enable the administration of fewer injections. Furthermore, performing these procedures in the operating room under anesthesia allows for the development of a well-considered strategy prior to any attempts in the office setting We hope that this manuscript sparks discussion between pediatric urologists and adult urologist to expand our knowledge on strategies needed for delivering BoNT to individuals with complex and restricting GU surgeries.

Introduction:

Advice for women with pelvic organ prolapse (POP) often includes lying down to decrease the effects of gravity on the pelvic floor. The aim of this study was to compare pelvic floor morphometry before and after 30 min of supine lying in women with symptomatic POP.

Methods:

Pelvic floor morphometry was assessed in vaginally parous, premenopausal women with symptomatic POP $\ge$ stage 1. The modified Pelvic Organ Prolapse Quantification system was used in supine to assess points Ba (anterior vaginal wall), Bp (posterior vaginal wall), and C (cervix). Transperineal ultrasound imaging was used in supine and standing to assess the following measures at rest and bearing down: bladder neck position, bladder position, rectal ampulla position, levator plate angle, anorectal angle, levator anteroposterior distance, and levator hiatal area. Measures taken before and after 30 min of supine lying were compared.

Results:

Twenty-one women (median (range) age: 39 (29–50) years) with varied stages of POP (33% stage 1, 57% stage 2, and 10% stage 3) were included. Most measures of pelvic floor morphometry were unchanged after 30 min of supine lying compared to before lying. Participants had greater resting levator hiatal area in supine and levator anteroposterior distance at rest and bearing down in supine after lying down (p $\le$ 0.001), suggesting reduced pelvic floor muscle activity.

Conclusion:

Findings suggest that a 30-min period of supine lying does not improve support of the pelvic organs.

Emptying an overfilled bladder has been a severe medical problem in mankind since ancient times. This review presents highlights the main historical milestones in the development and use of urine catheters. Some of the most famous designers and makers are also commented. Besides, the historic role of urinals, both as sanitary elements and sometimes as therapeutic devices for male incontinence, is presented.

Tuberculosis has become an infrequent disease in Western society, hence has tuberculosis of the bladder. However, when tuberculosis was prevalent, urogenital tuberculosis and tuberculosis of the bladder could be the consequence if untreated, and were responsible for severe bladder dysfunction. Before antibiotic treatment became available, chronic bladder tuberculosis caused irreversible damage and often necessitated bladder reconstruction or even cystectomy. The specific antibiotic treatment of tuberculosis eradicated bladder dysfunction caused by tuberculosis. We aim to review the history of urogenital tuberculosis and the consequent dysfunction of the bladder based on existing literature.

Periurethral injection of bulking agents is a technique used to treat urinary incontinence due to stress incontinence, preferably caused by intrinsic sphincter deficiency. The variety of the nature of existing bulking agents leads to different success rates and complications. This case report describes the formation of pseudo-abscesses after periurethral injections with a bioresorbable implant consisting of synthetic polycaprolactone microspheres suspended in a carboxymethylcellulose gel carrier.