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Prognosis of Neurogenic Bladders
Published in Jacques Corcos, Gilles Karsenty, Thomas Kessler, David Ginsberg, Essentials of the Adult Neurogenic Bladder, 2020
Most neurologic lesions disrupt bladder-sphincter function and its central neurologic control. The long-term consequences of these dysfunctions are well elucidated. These consequences determine the patients’ quality of life and mortality rates. Prognosis of neurogenic bladders is considered at two different levels: the functional and the vital. The functional level is the ability to void completely, the degree of continence as well as sexual and fertility issues. At the other end of the spectrum is the vital prognosis which includes renal function, infections, stones, and cancer.
Autonomic Nervous System
Published in Peter Kam, Ian Power, Michael J. Cousins, Philip J. Siddal, Principles of Physiology for the Anaesthetist, 2020
Peter Kam, Ian Power, Michael J. Cousins, Philip J. Siddal
Coordination of function within an organ system is mediated by the autonomic system. When the urinary bladder is filling, sympathetic activity dominates to produce relaxation of the bladder wall, and simultaneously, the internal bladder sphincter contracts. This facilitates filling of the bladder. During micturition, parasympathetic activity dominates and this results in contraction of the bladder wall and relaxation of the sphincter.
Enuresis 1
Published in Quentin Spender, Judith Barnsley, Alison Davies, Jenny Murphy, Primary Child and Adolescent Mental Health, 2019
Quentin Spender, Judith Barnsley, Alison Davies, Jenny Murphy
These alarms work on the principle that when the child starts to wet, the urine completes an electrical circuit and sounds an alarm that wakes the child. The theory as to why this is effective is that the child is conditioned to associate relaxation of the bladder sphincter (and thereby fullness of the bladder) with waking up. The aims of alarm treatment are to: learn to recognise the need to pass urine – even while asleepwake up when the bladder is fullhold on long enough to get to the toilet.
Neoadjuvant and adjuvant treatment in high-risk prostate cancer
Published in Expert Review of Clinical Pharmacology, 2018
Marco Bandini, Nicola Fossati, Giorgio Gandaglia, Felix Preisser, Paolo Dell’Oglio, Emanuele Zaffuto, Armando Stabile, Andrea Gallina, Nazareno Suardi, Shahrokh F. Shariat, Francesco Montorsi, Pierre I. Karakiewicz, Alberto Briganti
Several examined RCTs demonstrated that ADT was undoubtedly associated with important clinical benefits after and before either RP or RT. However, such net benefits seemed to be more pronounced when ADT was associated with RT rather that RP. In fact, RCTs showed improved OS either for neoadjuvant and adjuvant ADT in combination with RT but not when both were combined with RP. On the other hand, the use of neoadjuvant ADT before RP was associated with lower rates of extra-prostatic disease and lymph node invasion, when patients receiving neoadjuvant ADT were compared with patients receiving RP alone. These evidences prompt us to consider neoadjuvant ADT as possible treatment option in selected patients. Specifically, ADT by reducing the tumor burden, may allow conservative approaches during RP such as nerve sparing and bladder sphincter sparing. In consequence, neoadjuvant ADT should be ideally considered in patients with locally advance disease (i.e. T2c, T3 HRPCa) in order to make RP less challenging and consequently to improve functional outcomes.
Pharmacological treatments available for the management of underactive bladder in neurological conditions
Published in Expert Review of Clinical Pharmacology, 2018
Seyedeh-Sanam Ladi-Seyedian, Behnam Nabavizadeh, Lida Sharifi-Rad, Abdol-Mohammad Kajbafzadeh
To date, the exact pathophysiology behind UAB remains unclear and our understanding regarding causes of UAB is limited. However, it presumably occurs in a multifactorial fashion rather than solely a consequence of normal aging [4,18]. In the normal bladder, a complex neuromuscular pathway is responsible for an efficient and sustainable detrusor contraction with coordinated function of bladder sphincter. Disruption at any level of this route could potentially result in UAB (e.g. factors affecting detrusor myocytes, bladder muscle vasculature, afferent pathway, brain circuits, and efferent pathway responsible for micturition) [19]. In majority of cases, it is unlikely to find a specific pathology responsible for UAB. It can also result from drugs side effects or iatrogenic origin [20].
Stem cell applications in regenerative medicine for stress urinary incontinence: A review of effectiveness based on clinical trials
Published in Arab Journal of Urology, 2020
Bara Barakat, Knut Franke, Samer Schakaki, Sameh Hijazi, Viktoria Hasselhof, Thomas-Alexander Vögeli
SUI can be attributed to different causes, with differences in both sexes. In general, mechanical and functional reasons can be considered as causes of SUI. Important factors are myogenic, neurogenic, connective tissue and hormonal changes. In addition, muscle cell density decreases as a result of physiological apoptosis due to a decrease in the muscle cells of the rhabdosphincter, with a total volume of 88% immediately after birth decreasing to ~34% in the 90th year of life [5]. Female SUI often has a multifactorial cause with functional defects of the urinary bladder sphincter and morphological nerve damage. This is in contrast to the almost exclusively postoperative prostate resection or radical prostatectomy (RP)-related UI seen in men. In recent years, placement of transvaginal tension-free transobturator tape and retropubic tension-free vaginal tape have become well-established treatment options. The mid-urethral sling has the advantage of a shorter duration of intervention time. The rate of any re-operation, including mesh removal, was 5.5% (95% Cl 5.4–5.7%) at 5 years and 6.9% (95% Cl 6.7–7.1%) at 9 years [6]. However, the USA Food and Drug Administration (FDA) has repeatedly issued warnings on the use of alloplastic material in the treatment of female UI due to >1000 reported severe adverse events [7]. Consequently, alternative treatments are being sought and although stem cell-based therapy has had numerous setbacks, it may well be a concept for treating these disorders. In the last decade, the use of the patient’s own adult stem cells for lower urinary tract dysfunction has been shown to be a promising, causal therapeutic approach [8].