Urinary Bladder Pressure Research Articles

Clinical Observations in Patients With Open Abdomens Managed With Negative Pressure Therapy Using a Perforated Foam Dressing: A Limited Case Series With Brief Literature Review

Introduction. Emergency laparotomy has become an increasingly more frequent and expensive general surgery procedure in terms of cost and resource utilization. Primary fascial closure at the index procedure may not be feasible in many patients, requiring use of the open abdomen (OA) technique. Patients with OA are most often managed with temporary abdomen closure (TAC). Open abdomen negative pressure therapy (OA-NPT) has been shown to be an effective TAC technique, which facilitates re-exploration, protects visceral organs, mitigates fascial retraction, prevents loss of abdominal domain, and provides effective volumetric abdominal fluid management. Objective. This study assessed the clinical use and outcomes of a next-generation perforated polyurethane foam dressing that has been developed for use with OA-NPT. Materials and Methods. The authors evaluated a next-generation OA-NPT foam dressing to provide TAC in 4 patients who required OA management. Two surgeons at different facilities exercised their independent surgical discretion in selecting the patients who would receive the next generation OA-NPT foam dressing. Surgical interventions to resolve the underlying pathology were completed using the OA technique. Postoperatively, all patients had intermittent urinary bladder pressures recorded as an indirect method for approximating intra-abdominal pressure (IAP) and to monitor clinical evidence of intra-abdominal hypertension (IAH) or abdominal compartment syndrome. Results. In these patients, primary fascial closure was achieved and no appreciable increase in IAP was noted. No gastrointestinal complications related to the next generation perforated OA-NPT foam dressing were noted. Conclusions. Based on the authors' clinical assessment of the 4 patients who required OA management, the new, perforated OA-NPT foam dressing was effective in providing increased medial tension and contraction without an appreciable increase in IAP.

An Evaluation of Parylene Thin Films to Prevent Encrustation for a Urinary Bladder Pressure MEMS Sensor System.

Recent developments in urological implants have focused on preventive strategies to mitigate encrustation and biofilm formation. Parylene, a conformal, pinhole-free polymer coating, has gained attention due to its high biocompatibility and chemical resistance, excellent barrier properties, and low friction coefficient. This study aims to evaluate the effectiveness of parylene C in comparison to a parylene VT4 grade coating in preventing encrustation on a urinary bladder pressure MEMS sensor system. Additionally, silicon oxide (SiOx) applied as a finish coating was investigated for further improvements. An in vitro encrustation system mimicking natural urine flow was used to quantify the formation of urinary stones. These stones were subsequently analyzed using Fourier transform infrared spectrometry (FTIR). Encrustation results were then discussed in relation to coating surface chemical properties. Parylene C and VT4 grades demonstrated a very low encrustation mass, making them attractive options for encrustation prevention. The best performance was achieved after the addition of a hydrophilic SiOx finish coating on parylene VT4 grade. Parylene-based encapsulation proved to be an outstanding solution to prevent encrustation for urological implants.

The Persistency Index: a novel screening tool for identifying myofascial pelvic floor dysfunction in patients seeking care for lower urinary tract symptoms

Patients with myofascial pelvic floor dysfunction often present with lower urinary tract symptoms, such as urinary frequency, urgency, and bladder pressure. Often confused with other lower urinary tract disorders, this constellation of symptoms, recently termed myofascial urinary frequency syndrome, is distinct from other lower urinary tract symptoms and optimally responds to pelvic floor physical therapy. A detailed pelvic floor myofascial examination performed by a skilled provider is currently the only method to identify myofascial urinary frequency syndrome. Despite a high influence on quality of life, low awareness of this condition combined with no objective diagnostic testing leads to the frequent misdiagnosis or underdiagnosis of myofascial urinary frequency syndrome. This study aimed to develop a screening measure to identify patients with myofascial urinary frequency syndrome (bothersome lower urinary tract symptoms secondary to myofascial pelvic floor dysfunction) from patient-reported symptoms. A population of patients with isolated myofascial urinary frequency syndrome was identified by provider diagnosis from a tertiary urology practice and verified by standardized pelvic floor myofascial examination and perineal surface pelvic floor electromyography. Least Angle Shrinkage and Selection Operator was used to identify candidate features from the Overactive Bladder Questionnaire, Female Genitourinary Pain Index, and Pelvic Floor Distress Index predictive of myofascial urinary frequency syndrome in a pooled population also containing subjects with overactive bladder (n=42), interstitial cystitis/bladder pain syndrome (n=51), and asymptomatic controls (n=54) (derivation cohort). A simple, summated score of the most discriminatory questions using the original scaling of the Pelvic Floor Distress Index 5 (0-4) and Genitourinary Pain Index 5 (0-5) and modified scaling of Female Genitourinary Pain Index 2b (0-3) had an area under the curve of 0.75. As myofascial urinary frequency syndrome was more prevalent in younger subjects, the inclusion of an age penalty (3 points added if under the age of 50 years) improved the area under the curve to 0.8. This score was defined as the Persistency Index (possible score of 0-15). The Youden Index was used to identify the optimal cut point Persistency Index score for maximizing sensitivity and specificity. Using a development cohort of 215 subjects, the severity (Pelvic Floor Distress Index 5) and persistent nature (Female Genitourinary Pain Index 5) of the sensation of incomplete bladder emptying and dyspareunia (Female Genitourinary Pain Index 2b) were the most discriminatory characteristics of the myofascial urinary frequency syndrome group, which were combined with age to create the Persistency Index. The Persistency Index performed well in a validation cohort of 719 patients with various lower urinary tract symptoms, including overactive bladder (n=285), interstitial cystitis/bladder pain syndrome (n=53), myofascial urinary frequency syndrome (n=111), controls (n=209), and unknown diagnoses (n=61), exhibiting an area under the curve of 0.74. A Persistency Index score ≥7 accurately identified patients with myofascial urinary frequency syndrome from an unselected population of individuals with lower urinary tract symptoms with 80% sensitivity and 61% specificity. A combination of the Persistency Index with the previously defined Bladder Pain Composite Index and Urge Incontinence Composite Index separated a population of women seeking care for lower urinary tract symptoms into groups consistent with overactive bladder, interstitial cystitis/bladder pain syndrome, and myofascial urinary frequency syndrome phenotypes with an overall diagnostic accuracy of 82%. Our study recommends a novel screening method for patients presenting with lower urinary tract symptoms to identify patients with myofascial urinary frequency syndrome. As telemedicine becomes more common, this index provides a way of screening for myofascial urinary frequency syndrome and initiating pelvic floor physical therapy even before a confirmatory pelvic examination.

INTRAABDOMINAL PRESSURE CHANGE UNDER ABDOMINAL SURGERY

Abstract. Statement of the problem. Intraabdominal hypertension (IAH) recognized as important consequence of surgery intraabdominal or on abdominal wall.
 For a pity there are no signs to predict the possibility of such a dangerous complication.
 Aim of study: to find out changes of intraabdominal pressure (IAP) corresponding to different kind of abdominal surgeries.
 Material and methods. IAP had been measured in 15 patients before, immediately after, and 1, and 3-4 days since open surgery. Also, IAP had been measured in 5 patients before and after laparoscopic surgeries.
 IAP was measured by urinal bladder way.
 Results and discussion. Before surgery IAP was find at level 10 cm Н2О or higher in 3 patients, but not higher than 15 cm in none of them.
 There was not estimated direct connection between IAP and diagnosis. Of 2 patients with large incisional hernia and abdominal wall defect 243 cm2 and 832 cm2 in size IAP before surgery was stated as 3 and 14 cm Н2О, respectively, while in the latter there were no any little of compression.
 There was no firm interconnection between anesthesia mode and IAP
 Immediately after surgery IAP became equal to 10 cm Н2О or higher in 13 patients, of them in 4 it was 20 cm Н2О or higher. On the next day after surgery IAP leveled to 10 cm Н2О or higher in 7 patients, of them in 3 it was 20 cm Н2О or higher. One of the latter died, all other patients survived.
 In all patients operated in laparoscopic way IAP measured through intrabladder catheter was 7-11 cm Н2О lower than those on insufflator manometer.
 Conclusions. IAP assay via urinary bladder pressure estimating is not the IAP measurement but indicator of urinary bladder tone.
 As high IAP in many cases correspond to patient’s grave condition and even death it is of importance to study the real reason of this indicator.

Design and Implementation of Urodynamic Monitoring System

In order to assess and diagnose lower urinary tract dysfunction in patients and help patients with lower urinary tract rehabilitation training, an accurate and reliable urodynamic monitoring and automatic voiding system was designed. The system realizes the signal acquisition circuit of bladder pressure, abdominal pressure and urine volume based on the pressure sensor of urinary catheter and the load sensor. Meanwhile, the dynamic waveforms of urinary flow rate, bladder pressure and abdominal pressure are drawn in real time on the software of urodynamic monitoring. Signal processing and analysis of each signal are carried out, and the system performance is verified by building a simulation experiment. The experimental results show that the system is stable, reliable, accurate and meets the expected design goals, which can provide support for subsequent engineering design and clinical applications.

Ultrasound Contrast Stability for Urinary Bladder Pressure Measurement.

The goal of this study was to evaluate ultrasound contrast microbubbles(MB) stability during a typical cystometrogram(CMG) for bladder pressure measurement application using the subharmonic-aided pressure estimation technique. A detailed study of MB stability was required given two unique characteristics of this application: first, bulk infusion of MBs into the bladder through the CMG infusion system, and second, duration of a typical CMG which may last up to 30 min. To do so, a series of size measurement and contrast-enhanced ultrasound imaging studies under different conditions were performed and the effects of variables that we hypothesized have an effect on MB stability, namely, i) IV bag air headspace, ii) MB dilution factor, and iii) CMG infusion system were investigated. The results verified that air volume in intravenous(IV) bag headspace was not enough to have a significant effect on MB stability during a CMG. We also showed that higher MB dosage results in a more stable condition. Finally, the results indicated that the CMG infusion system adversely affects MB stability. In summary, to ensure MB stability during the entire duration of a CMG, lower filling rates(limited by estimated bladder capacity in clinical applications) and/or higher MB dosage(limited by FDA regulations and shadowing artifact) and/or the consideration of alternative catheter design may be needed.

Noninvasive, wireless and real-time bladder pressure monitoring with biomimetic structured devices

Urinary bladder pressure (UBP) is a crucial physiological parameter reflecting urinary incontinence, abdominal pressure and abdominal visceral injury. Realizing the real−time monitoring UBP change helps the development of diagnosing either chronic or severe abdominal diseases. However, current clinic facilities or invasive devices are expensive, complicated to manipulate, low sensitivity, and excruciating to patients. Herein, we propose a noninvasive UBP wireless measurement system using a biomimetic structured piezoresistive sensor and low−power Bluetooth. Our piezoresistive pressure sensor can fully reach a sensitivity of 0.19 kPa−1 in the range of 0−3 kPa and exhibits significant robustness after 1000 cycles. The low−power Bluetooth system could transmit data in real−time to realize an intelligent diagnosis. Our integration system provides an efficient strategy to help clinicians or patients diagnose abdominal impairment in real-time.

Comparison of Intra-abdominal pressure monitoring vs APACHE-II and Ranson’s scoring in predicting the outcome of Acute Pancreatitis

Introduction: Intra-abdominal pressure is important risk factor for predicting mortality and morbidity in the early phase of acute pancreatitis. World Society on the abdominal compartment syndrome defines Intra-abdominal hypertension as a sustained increase in pressure above 12 mm of Hg and abdominal compartment syndrome is a sustained increase in intra-abdominal pressure above 20 mm of Hg with new onset organ failure. However, even values of lower than 15 mm of Hg may cause organ dysfunction. Material and Methods: Intra-abdominal pressure was indirectly determined by measuring urinary bladder pressure with a 16 gauge Foley’s catheter in situ. The bladder was drained completely and the tubing of the collecting bag was clamped and then the catheter will be connected to a saline manometer. Intra-abdominal pressure was measured on day 1st, 3rd, 7th and 14th after controlling the severe pain by analgesics. Result: In our study 50 patient of acute pancreatitis was taken. Patient was categorized in low risk and high risk group according to Ranson’s, APACHE and IAP criteria. It was observed that there is a positive correlation between IAP with APACHE and Ranson’s score, positive predictive value for assessment of mortality (4%), Ranson’s (4%), APACHE scoring (4%). It was observed that as the grade of Ranson’s and APACHE increases in patients of acute pancreatitis, IAP also increases. Similarly for morbidity most of the local complication occurs in moderate to severe grade of IAP 1st day (>15 mm), severe grade of APACHE score (>13) and severe grade of Ranson’s score (>3). Common systemic complication were gastrointestinal (98%), circulatory (52%), respiratory (68%), metabolic (56%), renal (24%), MODS (10%), ARDS (8%), DIC (4%). Most of the systemic complication occurs in moderate to severe grade of IAP 1st day (>15), severe grade of APACHE score (>8) and severe grade of Ranson’s score (>3). Conclusion: IAP measurement is cheap, easy, bedside, minimally invasive prognostic modality, cheaper alternative to Ranson’s and APACHE scoring. Early IAP monitoring can be very useful in assessment of mild to severe acute pancreatitis, hospital stay, determines local and systemic complication.

Gastric and urinary bladder pressures correlate with intra-abdominal pressure in patients with morbid obesity

Intra-abdominal pressure (IAP) affects cardio-respiratory and hemodynamic parameters and can be measured directly or indirectly by measuring gastric or urinary bladder pressure. The aim of this study was to investigate the correlation between IAP, gastric pressure and urinary bladder pressure in patients with morbid obesity, at normal and elevated levels of IAP in two positions. As well, to examine the effects of increasing IAP and patient's position on hemodynamic and respiratory parameters. Twelve patients undergoing laparoscopic bariatric surgery were included. IAP, gastric pressure, and urinary bladder pressure were measured while patients were in the supine position and after 45° anti-Trendelenburg tilt. Mean inspiratory pressure, peak inspiratory pressure, and tidal volume were recorded and assessed. In supine position; directly measured IAP was 9.1 ± 1.8 mmHg, compared to 10 ± 3.6 and 8.9 ± 2.9 mmHg in the stomach and bladder, respectively. Increasing IAP to 15 mmHg resulted in an increased gastric pressure of 17 ± 3.8 mmHg, and urinary bladder pressure of 14.8 ± 3.9 mmHg. Gastric and urinary bladder pressures strongly correlated with IAP (R = 0.875 and 0.847, respectively). With 45° anti-Trendelenburg tilt; directly measured IAP was 9.4 ± 2.2 mmHg, and pressures of 10.8 ± 3.8 mmHg and 9.2 ± 3.8 mmHg were measured in the stomach and the bladder, respectively. Increasing IAP to 15 mmHg resulted in elevating gastric and bladder pressures to 16.6 ± 5.3 and 13.3 ± 4 mmHg, respectively. Gastric and urinary bladder pressures had good correlation with IAP (R = 0.843 and 0.819, respectively). Changing patient position from supine to 45° anti-Trendelenburg position resulted in decreased mean and peak inspiratory pressures, and increased tidal volume. Basal IAP is high in patients with morbid obesity. IAP shows positive correlation to gastric and urinary bladder pressures at both normal and elevated levels of IAP. Anti-Trendelenburg tilt of mechanically ventilated morbidly obese patients resulted in favorable effects on respiratory parameters.Trial Registration: The study was retrospectively registered in the NIH registry. Registration number is pending.

A Study of Intra-abdominal Pressure Measurement Using a New Innovative Technique with Foley's Catheter

Aim: We aimed to study intra-abdominal pressure (IAP) measurement using a new innovative technique with Foley's catheter. Introduction: Intra-abdominal hypertension (IAH) is defined as an IAP equal to or above 12 mmHg (16.31 cm of water) (1 mmHg = 1.3 cm of water) and abdominal compartment syndrome (ACS) is defined as an IAP above 20 mmHg along with organ malfunction. Effect of increased intra-abdominal tension is acute renal failure, pulmonary dysfunction, and decreased blood flow to the gastrointestinal organs. It may cause diaphragm elevation along with an increase in intrathoracic pressure causing pulmonary dysfunction and a decrease in the venous return to the brain leading to intracranial congestion and brain dysfunction. Increased IAP is commonly measured by recording intravesical pressure. In this study, we are using 50 ml of saline for urinary bladder pressure measurement through Foley's catheter. Methods: In this prospective study, we measured IAP by Foley's catheter in the urinary bladder in 250 patients which were admitted to our hospital. In this study, 196 patients were male and 54 patients were female. After establishing normal values in routine patients, the IAP was derived above which the values were considered as IAH. Results: Patients with laparoscopic abdominal surgeries, for example, laparoscopic appendectomy and/or laparoscopic cholecystectomy, obstructed hernia (enterocele) and intestinal obstruction, pancreatic ascites, pneumothorax, alcoholic liver disease with ascites, and chronic obstructive pulmonary disease, had raised IAP as compared to others. The average IAP of our patients who were routine patients was 7–9 cm of water. IAH was considered when values were above 9 cm of water. Conclusion: Our study showed that intravesical pressure measurement is a simple, minimally invasive method that may reliably estimate IAP in patients placed in supine position. When applied clinically, this should alert the clinician to take safety measures to avoid ACS.

Predictors of exploration in patients at high risk of abdominal compartment syndrome

Context Abdominal compartment syndrome (ACS) is caused when an acute increase in intra-abdominal pressure (IAP) occurs sufficient to impair vascular inflow and thereby compromising the viability of the tissues and organs within the abdomen. Familiarity with the presentation of ACS is mandatory for all clinicians who care for critically ill patients to avoid its high mortality if not recognized and treated. The measurement of IAP is a vital part of clinical management of ACS. Early recognition is important, and the need for surgical decompression may be urgent. Aim The aim was to evaluate the cases at high risk for development of ACS trying to prevent its fatal adverse effects by defining its predictors. Patients and methods This prospective, interventional, non-randomized clinical trial was conducted at Mansoura University and emergency hospitals over the period from February 2016 to February 2019. This study was conducted on patients at high risk of intra-abdominal hypertension. Two groups were included. The first group was managed conservatively, and the second one received decompressive laparotomy depending on clinical parameters, including IAP, and general status. Data were analyzed using SPSS v-24. Results A total of 40 patients who had an increased IAP greater than or equal to 20 cmH2O with several clinical presentations were included. These patients had respiratory distress (90%) and distended tense abdomen, whereas abdominal pain and oliguria were only present in ∼25% of cases. Overall, 20 (50%) patients underwent conservative management, and all these cases passed normally. Moreover, 20 (50%) patients underwent decompressive laparotomy. Univariate and multivariate analyses showed central venous pressure, BMI, urinary bladder pressure, and postoperative organ failure were found to be significant independent risk factors that increased the rate of mortality. The complications of the first group were owing to the primary operation and those of the second of group were owing to the primary operation as well as owing to operative decompression procedure. The mortality of the studied groups was 25% in the second one only, and there was a significant difference between both groups in the hospital stay. Conclusion These results had suggested that early detection of cases with ACS and proper management may be curative, and they could decrease multiorgan dysfunction and mortality in such cases. The avoidance of early abdominal closure, which may be distressing to the patients, could be mandatory in such conditions.

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Comparison between changes in secondary muscle spindle afferent activity and detrusor pressure (measured before the surgery; for the implantation of a sacral anterior root stimulator). Paraplegic 9. A. Activity changes of the afferent fiber SP2(1) following bladder catheter pulling (Figure 37Ba). Approx. mean activity level is represented by a dashed line at 7.5 IIs/0.8s ((APs -1)/0.8s). The activity above the mean is cross-hatched and is proposed to be due to parasympathetic activation. Root vS4. B. Detrusor pressure (pressure difference) changes taken from ‘C’. Note that changes in the detrusor pressure show almost exactly the same time course as do the activated changes of the secondary muscle spindle afferent fiber SP2(1) of ‘A’. Corresponding peaks are correlated by arrows. C. Abdominal pressure (measured as rectal pressure), intravesical pressure (urinary bladder pressure) and detrusor pressure (pressure difference) during retrograde filling before the surgery. One transient detrusor pressure increase, marked ‘B’, is used, after enlargement in ‘B’, to compare with the spindle afferent activity.

CLINICAL SIGNIFICANCE AND CORRELATION OF INTRA-ABDOMINAL PRESSURE WITH THE OUTCOME OF PERFORATION PERITONITIS

Background: A progressive increase in intra-abdominal pressure (IAP) may cause abdominal compartment syndrome (ACS) with organ dysfunction. However, it remains strangely underdiagnosed.
 Objective: To correlate Intra-abdominal pressure with the outcome in perforation peritonitis patients.
 Methods: An Observational study was done on 50 patients with perforation peritonitis and patients undergoing intervention in the form of either emergency laparotomy or drain placement. The abdominal pressures were indirectly determined by measuring urinary bladder pressure with a Foley's catheter. Pearson correlation was used to see relation between intra- abdominal pressure and outcome of peritonitis. SPSS version 16 (trial) was used for analysis.
 Results: Mean intra-abdominal pressure during time of presentation to the hospital was 26.4±3.8cm H2O. Among various morbidities following operation, surgical site infection was most common (36%) followed by wound dehiscence (30%). There was strong linear correlation between intra-abdominal pressure and factors determining morbidity such as surgical site infection, wound dehiscence, burst abdomen.
 Conclusions: There is a strong correlation of various co morbidities with increased intra-abdominal pressure in patients with perforation peritonitis which was significant statistically.
 Keywords: Intra- Abdominal Pressure, Intravescical pressure, perforation peritonitis, Abdominal Compartment Syndrome.

Effects on urinary retention after spinal cord injury treated with acupuncture at Zhibian (BL 54) and Shuidao (ST 28) with elongated needle

To explore the clinical effects of acupuncture with elongated needle on urinary retention after spinal cord injury. A total of 66 patients with urinary retention after spinal cord injury were randomized into an elongated needle group (34 cases) and a filiform needle group (32 cases). In both of the groups, the routine orthopedic treatment and the bladder function training were adopted. Additionally, in the elongated needle group, the acupuncture at Zhibian (BL 54) and Shuidao (ST 28) was used with the elongated needle. In the filiform needle group, the acupuncture with filiform needle was used at Zhibian (BL 54) and Shuidao (ST 28). In both of the groups, acupuncture treatment was provided once every two days, for 2 months consecutively. Separately, before treatment and after 1, 2 month treatment, the residual urine volume, urodynamic parameters (bladder capacity, peak urinary flow rate and bladder pressure) and safety indicators were observed in the patients of the two groups. The clinical therapeutic effects were compared between the two groups. As compared with the results before treatment, the residual urine volume was reduced obviously (all P<0.01), bladder capacity, peak urinary flow rate and bladder pressure were improved obviously (all P<0.01) after 1, 2 month treatment in the two groups. After 1, 2 month treatment, the residual urine volume in the elongated needle group was lower than the filiform needle group (both P<0.01). The improvements in bladder capacity, peak urinary flow rate and bladder pressure in the elongated needle group were superior to the filiform needle (all P<0.01). The total effective rate was 94.1% (32/34) in the elongated needle group, higher than 71.9% (23/32) in the filiform needle group (P<0.01). During treatment, there was no damage of kidney function, no fainting or broken needle happened in the two groups. Acupuncture with elongated needle achieves the significant effects on urinary retention after spinal cord injury. This therapy is better than acupuncture with filiform needle and safe in operation.

Is intra-bladder pressure measurement a reliable indicator for raised intra-abdominal pressure? A prospective comparative study

BackgroundIntra-abdominal pressure (IAP) can be measured by several indirect methods; however, the urinary bladder is largely preferred. The aim of this study was to compare intra-bladder pressure (IBP) at different levels of IAPs and assess its reliability as an indirect method for IAP measurement.MethodsWe compared IBP with IAP in twenty-one patients undergoing laparoscopic cholecystectomy under general anesthesia. Measurements were recorded at increasing levels of insufflation pressures to approximately 22 mmHg. Pearson’s correlation coefficient was calculated to establish the relationship between the two pressure measurements and Bland-Altman analysis was used to assess the limits of agreement between the two methods of measurements.ResultsThe urinary bladder pressures reflected well the pressures in the abdominal cavity. Pearson correlation coefficient showed a good correlation between the two measurement techniques (r = 0.966, p < 0.0001) and Bland-Altman analysis indicated that the 95% limits of agreement between the two methods ranged from − 2.83 to 2.64. This range is accepted both clinically and according to the recommendations of the World Society of Abdominal Compartment Syndrome (WSACS).ConclusionOur study showed that IBP measurement is a simple, minimally invasive method that may reliably estimates IAP in patients placed in supine position. Measurements for pressures higher than 12 mmHg may be less reliable. When applied clinically, this should alert the clinician to take safety measures to avoid abdominal compartment syndrome (ACS).

Evaluating the Procedure for Performing Awake Cystometry in a Mouse Model.

Awake filling cystometry has been used for a long time to evaluate bladder function in freely moving mice, however, the specific methods used, vary among laboratories. The goal of this study was to describe the microsurgical procedure used to implant an intravesical tube and the experimental technique for recording urinary bladder pressure in an awake, freely moving mouse. In addition, experimental data is presented to show how surgery, as well as tubing type and size, affect lower urinary tract function and recording sensitivity. The effect of tube diameter on pressure recording was assessed in both polyethylene and polyurethane tubing with different internal diameters. Subsequently, the best performing tube from both materials was surgically implanted into the dome of the urinary bladder of male C57BL/6 mice. Twelve-hour, overnight micturition frequency was recorded in healthy, intact animals and animals 2, 3, 5, and 7 days post-surgery. At harvest, bladders were assessed for signs of swelling using gross observation and were subsequently processed for pathological analysis. The greatest extent of bladder swelling was observed on day 2 and 3, which correlated with behavioral voiding data showing significantly impaired bladder function. By day 5, bladder histology and voiding frequency had normalized. Based on the literature and evidence provided by our studies, we propose the following steps for in vivo recording of intravesical pressure and voided volume in an awake mouse: 1) Perform the surgery using an operating microscope and microsurgical tools, 2) Use polyethylene-10 tubing to minimize movement artifacts, and 3) Perform cystometry on post-operative day 5, when bladder swelling resolves.

Correlation of intra-abdominal pressure with the outcome of perforation peritonitis

Background: A progressive increase in intra-abdominal pressure (IAP) may cause abdominal compartment syndrome (ACS) with organ dysfunction. Studies have documented the impact of Intra-abdominal hypertension (IAH) on virtually every organ. However, it remains strangely underdiagnosed. Present study was aimed to correlate Intra- abdominal pressure with the outcome in perforation peritonitis patients.Methods: This study was done on 50 patients with perforation peritonitis and patients undergoing intervention in the form of either emergency laparotomy or drain placement. The abdominal pressures were indirectly determined by measuring urinary bladder pressure with a Foley's catheter. Pearson correlation was used to see relation between intra-abdominal pressure and outcome of peritonitis.Results: Mean intra-abdominal pressure during time of presentation to the hospital was 26.7±3.2cm H2O. Among various morbidities following operation, surgical site infection was most common (38%) followed by wound dehiscence (24%). There was weak linear correlation between intra-abdominal pressure and factors determining morbidity such as surgical site infection, wound dehiscence, burst abdomen, prolonged ileus, ARDS and ARF. However, this was not statistically significant.Conclusions: There is weak correlation of various co morbidities with increased intra-abdominal pressure in patients with perforation peritonitis which was not significant statistically.

Clinical efficacy and safety of Qingyi Decoction administered by nasojejunal tube for the treatment of severe acute pancreatitis

Objective To compare the clinical efficacy and safety of Qingyi Decoction (a preparation of Chinese herbal medicine) between two different routes of the administration by using nasogastric tube or nasojejunal tube for treatment of severe acute pancreatitis (SAP). Methods A total of 79 SAP patients enrolled were randomly divided into nasogastric tube group (n=41) and nasojejunal tube group (n=38) according to the random number table method. In addition to the conventional therapy, they were treated with Qingyi Decoction administered by using nasogastric tube or nasojejunal tube. Results After treatment for 14 days, the levels of C-reactive protein (CRP), procalcitonin (PCT) and white blood cell count (WBC), urinary bladder pressure, and APACHE Ⅱ score in nasojejunal tube group were significantly lower than those in nasogastric tube group (P<0.05). The time required for the recovery of bowel sounds, length of abnormal serum amylase persistence, the duration of abdominal pain, the time necessary for mechanical respiratory support in nasojejunal tube group was significantly shorter than those in nasogastric tube group. The blood fungus infection rate and pulmonary fungus infection rate in nasojejunal tube group were significantly lower than those in nasogastric tube group, and 28-day survival rate in nasojejunal tube group was significantly higher than that in nasogastric tube group (P<0.05). Conclusion The nasojejunal tube route for the administration of Qingyi Decoction for the treatment of SAP can effectively alleviate the severity of patient’s condition, shorten the time required for improving clinical symptoms, reduce the incidence of morbidity and mortality, and it is worthy of further popularization in clinical practice. Key words: Severe acute pancreatitis; Nasojejunal tube; Nasogastric tube; Qingyi Decoction; Clinical curative effect

CYSTOMANOMETRY – ONE OF THE ASSESSMENT METHODS OF THE URODYNAMIC INDEXES IN PATIENTS WITH INFILTRATIVE CERVICAL CANCER

Aim: To evaluate contractile function of urinary bladder in patients with infiltrative cervical cancer after nerve-sparing radical hysterectomy (NSRH). Patients and Methods: Ninety patients with infiltrative cervical cancer were treated with nerve-sparing radical hysterectomy (n=45, NSRH group), or radical hysterectomy (RHE III) without preservation of pelvic autonomic plexuses (n=45, RHE group). Cystomanometry was carried out using urodynamic apparatus “Uro-Pro” by standard method. Results: Using cystomanometry, we have evaluated the main urodynamic indexes such as pressure upon bladder filling (P1), first vesical tenesmus pressure (P2); change of detrusor pressure upon change of bladder volume (P), volume of urinary bladder (V), and complience of urinary bladder wall (C) at preoperative period and postoperative period in both groups of patients. While at preoperative period P1 indexes did not differ significantly between the groups, after NSRH performance, P1 values were significantly higher than P1 values in the group of patients treated with RHE III (8,29±1,1 cm H2O versus 3,51±0,8 cm H2O (р&lt;0,05)). P2 indexes in patients from both groups before and after surgical treatment differed significantly and were 6,82±0,4 cm H2O and 12,27±1,2 cm H2O (р&lt;0,05) in NSRH group, and 5,44±0,6 cm H2O and 10,62±1,1 cm H2O (р&lt;0,05) in RHE III group. The P value in both patients groups before and after the surgical treatments was significantly different, and demonstrated a gradual elevation of urinary bladder pressure, especially in the patients from RHE III treated group. Urinary bladder volume at preoperative and postoperative periods in NSRH-treated group remained practically unaltered (209,78±14,2 ml and 216,86±14,9 ml (р&gt;0,5) respectively), while in the patients from RHE III-treated group after surgical treatment an urinary bladder volume significantly decreased from 188,4±10,5 ml to 161,9±9,8 ml (р&lt;0,05). An analysis of compliance of urinary bladder wall (C) has shown that after surgical treatment in RHE group C value decreased by 75% while in NSE group this index decreased just by 25%. Conclusions: The data of urodynamic study evidence the better preservation of urinary bladder functions in patients with infiltrative cervical cancer after NSRH than in the patients treated with RHE III.

Electroacupuncture decreases the urinary bladder pressure in patients with acute gastrointestinal injury.

The present study investigates the effects of electroacupuncture (EA) on urinary bladder pressure (UBP) in patients with acute gastrointestinal injury (AGI). Twenty patients with AGI admitted to the First Hospital of Jiaxing intensive care unit from December 2011 to June 2013 were evaluated. Conventional group patients (n = 10) were administered moderate enteral nutritional support, and electroacupuncture group patients (n = 10) were administered enteral nutritional support followed by EA at bilateral Zusanli (ST-36), Shangjuxu (ST-37), Hegu (LI-4), and QuChi (LI-11) acupoints. UBP was then measured every 6 h and the serum creatinine once daily for 7 days. There were no statistically significant patient demographic differences in the study groups (P > 0.05). The initial UBP of both patient groups was ≥12 mmHg. On days 6 and 7, the UBP significantly decreased in the EA group compared to the conventional group (P < 0.05). The serum creatinine concentration on day 7 was significantly lower in the EA group than in the conventional group (P < 0.05). Based on these results, electroacupuncture contributed to gastrointestinal motility recovery in patients with AGI. This procedure may reduce UBP and provide organ-protective effects in AGI patients.