Assessment Of Urinary Function Research Articles

Effect of partial preservation versus complete preservation of Denonvilliers’ fascia on postoperative urogenital function in male patients with low rectal cancer (PREDICTION): protocol of a multicentre, prospective, randomised controlled clinical trial

IntroductionTotal mesorectal excision (TME) has been the gold standard for the surgical treatment of mid-low rectal cancer, but traditional TME removal of Denonvilliers’ fascia (DVF) is too low and is...

Time of return of neurologic function after spinal anesthesia for total knee arthroplasty: mepivacaine vs bupivacaine in a randomized controlled trial.

BackgroundMepivacaine as an intermediate-length spinal anesthetic for rapid recovery in total knee arthroplasty (TKA) has not been fully described. We compared spinal mepivacaine vs bupivacaine for postoperative neurologic function in patients undergoing primary TKA.MethodsThirty-two patients undergoing primary TKA were enrolled. Primary outcome measure was return of motor and sensory function. Secondary outcome measures included assessment of urinary function, pain via visual analog scale (VAS) scores, opioid usage, distance walked and pain with physical therapy, time to discharge readiness, and complications.ResultsPatients with mepivacaine spinal anesthetic had faster return of sensory function (164 ± 38.6 vs 212 ± 54.2 minutes, P = .015), return of motor function (153 ± 47.4 vs 200 ± 45.2 minutes, P = .025), and time to straight leg raise (148 ± 43.5 vs 194 ± 50.8 minutes, P = .023). The mepivacaine group experienced significantly fewer episodes of urinary retention and shorter time to urination (344 ± 154.4 vs 416 ± 96.3 minutes, P = .039). Patients exhibited slightly higher VAS pain scores in the postanesthesia care unit (1.0 ± 1.7 vs 2.7 ± 2.3, P = .046) with no difference in opioid consumption. There were no differences in VAS scores or opioid use on the inpatient ward. Patients achieved discharge readiness 71 minutes faster in the mepivacaine group. There was no need to convert to general anesthesia or transient nerve symptoms in either group.ConclusionsPatients undergoing TKA with mepivacaine spinal anesthetic had a reliably more rapid neurologic recovery after TKA compared to bupivacaine.

Palliation of urinary obstruction from advanced prostate cancer with SBRT.

246 Background: In patients with advanced prostate cancer (PCa), urinary obstruction (UO) can lead to urinary retention requiring indwelling or suprapubic catheterization, which negatively impacts quality of life. Palliative options for UO from advanced PCa include surgical and medical treatment. Surgical intervention, including prostatectomy, pelvic exenteration and TURP, may confer undue risk to patients with advanced disease. Medical palliation may require months to take effect. Stereotactic Body Radiotherapy (SBRT) is a non-invasive technique that delivers high-dose and highly conformal radiation in ≤5 fractions, often used to treat PCa and metastatic disease. Here, we reviewed the utility of SBRT to treat UO from advanced PCa. Methods: A retrospective review of patients undergoing SBRT for UO was completed at a single institution between 2011 and 2017. Stage, PSA at diagnosis and time of treatment were recorded. Assessment of urinary function by IPSS/SHIM and documentation of catheterization were reviewed at consultation andsubsequent follow-up. Results: A total of 3 patients were treated with SBRT to the prostate for the palliation of urinary obstruction. Patient ages were 67, 57 and 52 years, and all had high risk, stage IV disease, Gleason 4+4 or 4+5, T3 or T4, with regional nodal, bony or visceral metastases. All patients required indwelling catheterization for an average 4 months prior to SBRT. Two patients were treated with whole pelvis irradiation after SBRT. In those who received subsequent pelvic irradiation, the SBRT doses to the prostate were 19 Gy in 2 fractions. The patient treated with SBRT monotherapy received 38 Gy in 4 fractions. Catheters were successfully removed in all 3 patients, one at the completion of radiation, and the others within 4 weeks of completion. With follow-up ranging from 1.2 to 6 years, no patients required re-catheterization, and there were no reports of grade ≥3 acute or long-term toxicity. Conclusions: SBRT is an effective treatment to palliate UO from locally advanced PCa, leading to removal of urinary catheters and presumed improved in quality of life. Further investigation is required to establish the optimal dose and fractionation of palliative SBRT for UO from PCa.

Urinary function and health-related quality of life of patients after laparoscopic radical prostatectomy: two methods of assessment for 112 patients with up to six years of follow-up

Background: Wide variation exists between methods of assessment of urinary function following laparoscopic radical prostatectomy (LRP). Objective: To assess post-operative urinary function and quality of life (QOL) after LRP using validated questionnaires and compare these results with subjective assessments obtained during outpatient consultations. Design, setting and participants: Between January 2004 and December 2009, 200 men with organ-confined prostate cancer underwent LRP at our centre. Post-operative urinary function and QOL were evaluated using validated questionnaires (ICIQ-MLUTS and FACT-P). Data regarding urinary function, which were collected at the outpatient clinic (OPC), were also available for these 112 patients. Outcome measurements and statistical analysis: Objective post-operative urinary function obtained from validated questionnaires using univariate and multivariate logistic regression models to evaluate the impact of urinary symptoms on QOL. Results and limitations: Based on the validated questionnaires, 75% (75/112) of patients had low incontinence scores (0 to 8/24) at a mean follow-up of 37 months. On subjective assessment at the OPC, 82% (92/112) of patients were considered dry (pad free). The majority of patients had a high QOL score (109–156), indicating good quality of life. Urinary symptoms’ severity was significantly correlated with QOL, where severe symptoms were associated with lower QOL. A literature search revealed wide discrepancies in the assessment of functional outcomes following LRP rendering comparison between studies extremely difficult. Conclusions: The functional outcomes of LRP vary depending on the assessment used. There continues to be a lack of congruity between the methodologies used in the literature and few studies published have used validated questionnaires.

Editorial Comment

Advances in surgical technique have greatly improved continence outcomes after radical prostatectomy. Unfortunately, severe and/or bothersome urinary incontinence does occur in some patients. In many cases, this can be unpredictable and a source of anxiety for patients contemplating prostate cancer surgery. Although other options have arisen to handle milder forms of postprostatectomy incontinence, artificial urethral sphincters have been a mainstay in the management of patients with the most severe symptoms. 1 Silva L.A. Andriolo R.B. Atallah A.N. et al. Surgery for stress urinary incontinence due to presumed sphincter deficiency after prostate surgery. Cochrane Database Syst Rev. 2011; 4 (CD008306) PubMed Google Scholar Safety and Efficacy of Periurethral Constrictor Implantation for the Treatment of Post–radical Prostatectomy IncontinenceUrologyVol. 79Issue 5PreviewTo assess safety and efficacy of the periurethral constrictor for the treatment of postprostatectomy urinary incontinence. Full-Text PDF ReplyUrologyVol. 79Issue 5PreviewWe truly appreciate your comments. We also believe that results assessment of the device implantation by means of validated questionnaires is needed. Achievement of continence is by itself the most simple and reliable way to define a “success,” but at the same time it risks being an excessively “mechanical” definition with respect to quality of life issues. Indeed, a score obtained from the assessment of urinary function allows for the correct definition of “success,” or not in patients who do not regain complete continence or who become perfectly dry but have an impaired quality of life because of urinary frequency or urgency. Full-Text PDF

Reply

We truly appreciate your comments. We also believe that results assessment of the device implantation by means of validated questionnaires is needed. Achievement of continence is by itself the most simple and reliable way to define a “success,” but at the same time it risks being an excessively “mechanical” definition with respect to quality of life issues. Indeed, a score obtained from the assessment of urinary function allows for the correct definition of “success,” or not in patients who do not regain complete continence or who become perfectly dry but have an impaired quality of life because of urinary frequency or urgency. We also believe that experience from other surgeons is needed to reliably assess the pros and cons related to the procedure. To our knowledge, results of about 120 patients implanted with the periurethral constrictor have been published to date. 1 de O Vilar F. Araújo L.A. Lima S.V. Periurethral constrictor in pediatric urology: long-term followup. J Urol. 2004; 171: 2626-2628 Abstract Full Text Full Text PDF PubMed Scopus (14) Google Scholar , 2 Schiavini J.L. Damião R. de Resende Júnior J.A. et al. Treatment of post-prostate surgery urinary incontinence with the periurethral constrictor: a retrospective analysis. Urology. 2010; 75: 1488-1492 Abstract Full Text Full Text PDF PubMed Scopus (21) Google Scholar However, this seems a small number. Finally, let us report only about an emerging problem, which is the onset of late incontinence (after a period of continence) or worsening preexisting incontinence in long-term survivors submitted to radical prostatectomy. 3 Naselli A. Simone G. Papalia R. et al. Late-onset incontinence in a cohort of radical prostatectomy patients. Int J Urol. 2011; 18: 76-79 Crossref PubMed Scopus (7) Google Scholar They form a new category of patients, including some of the individuals described in our paper, that is gradually increasing. In general, the problem afflicts elderly people, who frequently carry many comorbidities and are poorly compliant in using the scrotal pump to begin to urinate. They probably would benefit greatly from the periurethral constrictor implantation because it is easy to be positioned, allowing a minimally invasive, fast surgery; it does not need a pump; and it is not expensive. We strongly believe this specific topic could be the object of future interesting studies. Editorial CommentUrologyVol. 79Issue 5PreviewAdvances in surgical technique have greatly improved continence outcomes after radical prostatectomy. Unfortunately, severe and/or bothersome urinary incontinence does occur in some patients. In many cases, this can be unpredictable and a source of anxiety for patients contemplating prostate cancer surgery. Although other options have arisen to handle milder forms of postprostatectomy incontinence, artificial urethral sphincters have been a mainstay in the management of patients with the most severe symptoms. Full-Text PDF

Is urinary continence considered in the assessment of older people after a fall in England and Wales? Cross-sectional clinical audit results

Objectives To investigate adherence to the urinary function assessments of the national falls guidelines for England and Wales. Study design Secondary data analysis of the 2006 National Clinical Audit of Falls and Bone Health. Setting Acute hospitals in the UK. Participants Patients aged 65 years and older with a fragility fracture as a result of a fall. Main outcome measures Data were analysed to determine whether patients with fragility fractures received an assessment of urinary function including continence status; whether impairment was detected and if action was taken to prevent continence related falls. Results 63% (2009) of 3184 patients were assessed for urinary continence following a hip fracture and 41% (817) of these identified a problem. 21% (1187) of 5642 patients with nonhip fragility fractures were assessed and a problem was found in 27% (316). Hip fracture patients were more likely ( p < 0.0001) to receive a continence assessment and have problems detected. Only about half of those with problems had any intervention or a referral to a continence service. Admission to hospital for nonhip fracture patients was a strong predictor of being assessed ( p < 0.0001). Conclusion Rates of assessment and action for those with who fall and have continence problems are low despite current national guidelines.

The assessment of urinary function following extended lymph node dissection for colorectal cancer

Aims The aim of the current study is to demonstrate whether the effects of extended systematic lymph-node dissection (ESLND) on urinary dysfunctions differ from those of curative radical surgery (CRS) only for rectal cancer. Methods We present data about our patients who underwent rectal resection for rectal cancer over 5 years. One hundred and seventy patients with rectal cancer were reviewed with respect to surgical procedures and post-operative urinary problems. Results We performed CRS on 146 patients and CRS+ESLND on 24 patients, and analysed the incidence of post-operative urinary dysfunction in both groups. Urinary incontinence rates were 39 and 58%, urinary retention rates were 4 and 16%, for the patients from CRS group and CRS+ESLND group, respectively. Conclusions We conclude that the addition of ESLND to CRS does not increase the frequency of post-operative urinary dysfunction, apart from an increased risk of urinary retention.

Surgical Outcome of Bilateral Spinal Decompression through Unilateral Laminotomy for Lumbar Canal Stenosis associated with Long-Term Hemodialysis

Patients undergoing long-term hemodialysis often develop spinal canal stenosis caused by β2-microglobulin amyloid deposition in the synovial joints, the intervertebral discs and the ligamentum flavum. Minimally invasive surgery is essential to treat these patients because of their poor general condition and spinal fragility. Bilateral spinal decompression through unilateral laminotomy is one of the minimally invasive surgical techniques for lumbar canal stenosis. This surgical method can accomplish bilateral nerve root decompression without injury of supra- / inter-spinous ligament complex or contralateral paraspinal muscles. In the present study, lumbar canal stenosis of the seven patients undergoing long-term hemodialysis was treated by this technique, and the surgical outcome was evaluated using the Japanese Orthopedic Association score (JOA score) excluding the assessment of urinary function (highest possible score, 29 points). The JOA score ranged preoperatively from 4 to 22 points (mean, 10.9 points), and was improved postoperatively ranging form 16 to 25 points (mean, 20.7 points). The increase in points was equivalent to that of non-dialyzed patients receiving the same operation for lumbar canal stenosis: preoperative scores ranged from 13 to 21 points (mean, 16.7 points), and postoperative scores ranged from 24 to 29 points (mean, 26.7 points). Patients could walk and start rehabilitation training on the next day after their operation, and the postoperative hospital stay ranged from 17 to 39 days (mean, 25.7 days). The technique of bilateral spinal decompression through unilateral laminotomy provides a less invasive operation with an excellent outcome for lumber canal stenosis associated with long-term hemodialysis.

Effects of Spinal Cord X-irradiation on the Recovery of Paraplegic Rats

Axonal regrowth is limited in the adult CNS, especially in the spinal cord, one of the major sites of traumatic lesions. Pathophysiological changes occurring after spinal cord injury include complex acute, subacute, and late processes. In this study, we assessed whether X-irradiation interferes with the acute/subacute phases, thereby improving the functional recovery of paraplegic animals. Two days after acute compression of adult rat spinal cords, various doses (0, 2, 5, 10, 20 Gy) of X-rays were administered as one single dose to the compression site. The animals were functionally evaluated over the course of 1 month after injury, using the Tarlov scale and the Rivlin and Tator scale. We also designed a “physiological” scale, including an assessment of urinary function and infection, appropriate for the evaluation of spinal-cord-lesioned animals. Behavioral analysis suggested that the high doses, 20 Gy and, to a lesser extent, 5 and 10 Gy, were toxic, as shown by morbidity rate and “physiological” score. The 2-Gy group showed better motor performances than the lesioned nonirradiated (LNI) animals and the 5- and 20-Gy groups. Motor performance in the 5-, 10-, and 20-Gy groups was poorer than that seen in the LNI group. Gliosis was reduced in the 2-Gy group compared to LNI animals, and there was high levels of gliosis in the highly (≥5 Gy) irradiated animals. There was a 23% less lesion-induced syringomyelia in the 2-Gy group than in the other groups (LNI and 5–20 Gy). Thus, low doses of X-rays may interfere with the formation of syringomyelia and glial scar, thereby facilitating the recovery of paraplegic animals. These findings suggest that low-dose irradiation of the lesion site, in association with other therapies, is a potentially promising treatment for improving recovery after spinal cord injury.

Urinary flow rates in hypospadias

Uroflowmetry has been performed on 140 occasions in 90 patients with hypospadias before and after reconstructive surgery. Children with hypospadias tend to have a lower maximum urinary flow rate for volume voided than the general population, lying around the population 5th centile. This is observed before any surgery is performed, and appears from our cross-sectional data to be unaffected by surgery. Uroflowmetry has proved a useful and economical means of gaining an objective assessment of urinary function in this group of patients. Further longitudinal studies to confirm this cross-sectional study would be useful.