RESUMEN
OBJECTIVE: To analyze the benefit of voiding chain cystourethrography (VCC) [placing a radiographic opaque chain into the urethra and bladder and asking the patient to void under fluoroscopy] in the urodynamic evaluation of female bladder outlet obstruction (BOO). MATERIALS AND METHODS: Females with post anti-incontinence operation voiding dysfunction who underwent urodynamic evaluation augmented with VCC and later had urethrolysis were identified. Six diagnostic criteria for obstruction were applied to each patient: (1) VCC ( obstructed: chain was angulated and could not be voiding out) (2) Video urodynamic study (VUDS) (detrusor contraction combined with radiographic obstruction) (3) maximum flow (Qmax) ≤ 15 cc/sec, detrusor pressure (pDet)@ Qmax ≥ 20 cm H20 (4) Qmax ≤ 11 cc/sec, pDet@ Qmax ≥ 25 cm H20 (5) Qmax ≤ 12 cc/sec, pDet@ Qmax ≥ 25 cm H20 (6) Blaivas-Groutz (B-G) nomogram. Urethrolysis results were reviewed. Agreement in assessment of BOO criteria was assessed by estimating the proportion of pair-wise agreements along with an exact binomial 95% confidence interval (CI) and by estimating kappa along with a 95 % CI. RESULTS: Twenty-one patients were identified. Twenty of the 22 urethrolyses (91%) were clinically successful. Diagnosis of BOO was most common for VCC (86 %) and then B-G Nomogram (67 %). Agreement with the VCC was relatively poor for each of the five other methods (14% -62%) with the video urodynamic study (VUDS) being the best. Three patients with successful urethrolysis were diagnosed only by the VCC. All of kappa values regarding agreement with the VCC were low; the highest value of 0.15 was observed for VUDS. CONCLUSION: VCC may augment selection criteria for urethrolysis.
Asunto(s)
Marcadores Fiduciales , Uretra/diagnóstico por imagen , Obstrucción del Cuello de la Vejiga Urinaria/diagnóstico , Vejiga Urinaria/diagnóstico por imagen , Urodinámica/fisiología , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Persona de Mediana Edad , Radiografía , Valores de Referencia , Reproducibilidad de los Resultados , Uretra/cirugía , Obstrucción del Cuello de la Vejiga Urinaria/diagnóstico por imagen , Incontinencia Urinaria/cirugíaRESUMEN
Objective To analyze the benefit of voiding chain cystourethrography (VCC) [placing a radiographic opaque chain into the urethra and bladder and asking the patient to void under fluoroscopy] in the urodynamic evaluation of female bladder outlet obstruction (BOO). Materials and Methods Females with post anti-incontinence operation voiding dysfunction who underwent urodynamic evaluation augmented with VCC and later had urethrolysis were identified. Six diagnostic criteria for obstruction were applied to each patient: (1) VCC ( obstructed: chain was angulated and could not be voiding out) (2) Video urodynamic study (VUDS) (detrusor contraction combined with radiographic obstruction) (3) maximum flow (Qmax) ≤ 15 cc/sec, detrusor pressure (pDet)@ Qmax ≥ 20 cm H20 (4) Qmax ≤ 11 cc/sec, pDet@ Qmax ≥ 25 cm H20 (5) Qmax ≤ 12 cc/sec, pDet@ Qmax ≥ 25 cm H20 (6) Blaivas-Groutz (B-G) nomogram. Urethrolysis results were reviewed. Agreement in assessment of BOO criteria was assessed by estimating the proportion of pair-wise agreements along with an exact binomial 95% confidence interval (CI) and by estimating kappa along with a 95% CI. Results Twenty-one patients were identified. Twenty of the 22 urethrolyses (91%) were clinically successful. Diagnosis of BOO was most common for VCC (86%) and then B-G Nomogram (67%). Agreement with the VCC was relatively poor for each of the five other methods (14%-62%) with the video urodynamic study (VUDS) being the best. Three patients with successful urethrolysis were diagnosed only by the VCC. All of kappa values regarding agreement with the VCC were low; the highest value of 0.15 was observed for VUDS. Conclusion VCC may augment selection criteria for urethrolysis. .
Asunto(s)
Adulto , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Persona de Mediana Edad , Marcadores Fiduciales , Uretra , Obstrucción del Cuello de la Vejiga Urinaria/diagnóstico , Vejiga Urinaria , Urodinámica/fisiología , Valores de Referencia , Reproducibilidad de los Resultados , Uretra/cirugía , Obstrucción del Cuello de la Vejiga Urinaria , Incontinencia Urinaria/cirugíaRESUMEN
OBJECTIVE: To explore patient preference for injectable therapy over open surgery in the treatment of urinary incontinence. MATERIAL AND METHODS: Fifty-eight female patients presented for treatment of urinary incontinence. During the initial interview process, they were asked to quantify their preference for injectable therapy over surgery by specifying the lowest success rate they would accept and still try injectable therapy. The results were summarized and assessed in relation to patient age and history of previous urogynecologic surgery. RESULTS: The mean lowest acceptable success rate for all 58 surveyed patients was 34%, with 23 (40%) accepting a success rate of only 10%. Although not statistically significant, the data suggested that older patients may tend to accept lower success rates than younger patients (mean of 39% for patients aged less than 60 years compared to 22% for those aged 80 years or older). There was no difference in response based on history of previous urogynecologic surgery. CONCLUSION: Patients appear willing to accept a relatively low success rate for injectable therapy compared to open surgery.
Asunto(s)
Materiales Biocompatibles/administración & dosificación , Satisfacción del Paciente , Incontinencia Urinaria de Esfuerzo/terapia , Adulto , Factores de Edad , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Inyecciones , Entrevistas como Asunto , Persona de Mediana Edad , Incontinencia Urinaria de Esfuerzo/cirugíaRESUMEN
OBJECTIVE: To explore patient preference for injectable therapy over open surgery in the treatment of urinary incontinence. MATERIAL AND METHODS: Fifty-eight female patients presented for treatment of urinary incontinence. During the initial interview process, they were asked to quantify their preference for injectable therapy over surgery by specifying the lowest success rate they would accept and still try injectable therapy. The results were summarized and assessed in relation to patient age and history of previous urogynecologic surgery. RESULTS: The mean lowest acceptable success rate for all 58 surveyed patients was 34 percent, with 23 (40 percent) accepting a success rate of only 10 percent. Although not statistically significant, the data suggested that older patients may tend to accept lower success rates than younger patients (mean of 39 percent for patients aged less than 60 years compared to 22 percent for those aged 80 years or older). There was no difference in response based on history of previous urogynecologic surgery. CONCLUSION: Patients appear willing to accept a relatively low success rate for injectable therapy compared to open surgery.
Asunto(s)
Humanos , Femenino , Adulto , Persona de Mediana Edad , Anciano de 80 o más Años , Materiales Biocompatibles/administración & dosificación , Satisfacción del Paciente , Incontinencia Urinaria de Esfuerzo/terapia , Factores de Edad , Inyecciones , Entrevistas como Asunto , Incontinencia Urinaria de Esfuerzo/cirugíaRESUMEN
Single system orthotopic ureteroceles often present in adulthood are associated with characteristic radiographic findings. We present the case of a 54 year old woman with 8 months of urgency/frequency and pelvic pain that has the cystoscopic appearance of a bladder tumor. Cystoscopic images, radiographs and intraoperative photos demonstrate the work-up, evaluation, and treatment of this unique single system orthotopic ureterocele containing a calculus. This patient demonstrates the need for cystoscopy accompanied by upper tract imaging in patients with new onset pelvic pain, urgency/frequency, and frequent urinary tract infections.
Asunto(s)
Persona de Mediana Edad , Humanos , Femenino , Neoplasias de la Vejiga Urinaria/diagnóstico , Dolor Pélvico/diagnóstico , Ureterocele/diagnóstico , Cistoscopía , Diagnóstico Diferencial , Tomografía Computarizada por Rayos X , Ureterocele/cirugíaRESUMEN
Single system orthotopic ureteroceles often present in adulthood are associated with characteristic radiographic findings. We present the case of a 54 year old woman with 8 months of urgency/frequency and pelvic pain that has the cystoscopic appearance of a bladder tumor. Cystoscopic images, radiographs and intraoperative photos demonstrate the work-up, evaluation, and treatment of this unique single system orthotopic ureterocele containing a calculus. This patient demonstrates the need for cystoscopy accompanied by upper tract imaging in patients with new onset pelvic pain, urgency/frequency, and frequent urinary tract infections.
Asunto(s)
Dolor Pélvico/etiología , Ureterocele/diagnóstico , Neoplasias de la Vejiga Urinaria/diagnóstico , Cistoscopía , Diagnóstico Diferencial , Femenino , Humanos , Persona de Mediana Edad , Tomografía Computarizada por Rayos X , Ureterocele/complicaciones , Ureterocele/cirugíaRESUMEN
We report the case of a postmenopausal woman with a synchronous obstructing intrinsic endometrioma of the left ureter and a coexistent periurethral leiomyoma. Endometriosis in postmenopausal women is a rare clinical entity usually associated with exogenous estrogen use. Urethral leiomyomas are also rare, with only 40 cases reported in the literature. Ovarian hormones are believed to influence the growth of leiomyomas. We report the genitourinary presentation of 2 separate disease entities with known hormonal influence in a postmenopausal woman receiving estrogen replacement therapy. We believe the patient's hormonal milieu affected the development of her concurrent pathology.
Asunto(s)
Femenino , Humanos , Persona de Mediana Edad , Endometriosis/epidemiología , Leiomioma/epidemiología , Enfermedades Ureterales/epidemiología , Neoplasias Uretrales/epidemiología , Imagen por Resonancia Magnética , UreteroscopíaAsunto(s)
Incontinencia Urinaria de Esfuerzo/cirugía , Procedimientos Quirúrgicos Urológicos/métodos , Adulto , Anciano , Anciano de 80 o más Años , Humanos , Persona de Mediana Edad , Polipropilenos/uso terapéutico , Valor Predictivo de las Pruebas , Presión , Pronóstico , Estudios Prospectivos , Encuestas y Cuestionarios , Resultado del Tratamiento , Incontinencia Urinaria de Esfuerzo/diagnóstico , Incontinencia Urinaria de Esfuerzo/fisiopatología , Urodinámica , Procedimientos Quirúrgicos Urológicos/instrumentaciónAsunto(s)
Doxiciclina/uso terapéutico , Infecciones Urinarias/tratamiento farmacológico , Adulto , Anciano , Anciano de 80 o más Años , Antibacterianos/uso terapéutico , Femenino , Humanos , Leucoplasia/complicaciones , Persona de Mediana Edad , Dolor Pélvico/tratamiento farmacológico , Dolor Pélvico/etiología , Resultado del Tratamiento , Infecciones Urinarias/complicaciones , Infecciones Urinarias/diagnósticoRESUMEN
We report the case of a postmenopausal woman with a synchronous obstructing intrinsic endometrioma of the left ureter and a coexistent periurethral leiomyoma. Endometriosis in postmenopausal women is a rare clinical entity usually associated with exogenous estrogen use. Urethral leiomyomas are also rare, with only 40 cases reported in the literature. Ovarian hormones are believed to influence the growth of leiomyomas. We report the genitourinary presentation of 2 separate disease entities with known hormonal influence in a postmenopausal woman receiving estrogen replacement therapy. We believe the patient's hormonal milieu affected the development of her concurrent pathology.