RESUMEN
ABSTRACT Objective: To identify and describe the protocols and clinical outcomes of urotherapy interventions in children and adolescents with bladder bowel dysfunction. Method: Systematic review carried out in June 2018 on Medical Literature Analysis and Retrieval System Online (MEDLINE), Cumulative Index to Nursing and Allied Health Literature (CINAHL),Excerpta Medica dataBASE (EMBASE), Scientific Electronic Library Online (SciELO), Cochrane Library, and PsycInfo databases. Clinical trials and quasi-experimental studies carried out in the last ten years in children and/or adolescents with bladder and bowel symptoms and application of at least one component of urotherapy were included. Results: Thirteen clinical trials and one quasi-experimental study were included, with moderate methodological quality. The heterogeneity of the samples and of the methodological design of the articles prevented the performance of a meta-analysis. The descriptive analysis through simple percentages showed symptom reduction and improvement of uroflowmetry parameters. The identified urotherapy components were: educational guidance, water intake, caffeine reduction, adequate voiding position, pelvic floor training, programmed urination, and constipation control/management. Conclusion: This review indicates positive results in terms of symptom reduction and uroflowmetry parameter improvement with standard urotherapy as the first line of treatment for children and adolescents with bladder bowel dysfunction. It is recommended that future studies bring contributions regarding the frequency, number, and time of urotherapy consultations.
RESUMO Objetivo: Identificar e descrever os protocolos e desfechos clínicos das intervenções de uroterapia em crianças e adolescentes com disfunção vesical e intestinal. Método: Revisão sistemática realizada em junho de 2018 nas bases Medical Literature Analysis and Retrieval System Online (MEDLINE), Cumulative Index to Nursing and Allied Health Literature (CINAHL), Excerpta Medica dataBASE (EMBASE), Scientific Electronic Library Online (SciELO), Cochrane Library e PsycInfo. Foram incluídos ensaios clínicos e estudos quase-experimentais dos últimos 10 anos, em crianças e/ou adolescentes com sintoma urinário e intestinal e aplicação de no mínimo um componente de uroterapia. Resultados: 13 ensaios clínicos e 1 estudo quase-experimental foram incluídos, sendo a qualidade metodológica moderada. A heterogeneidade da amostra e de delineamento metodológico dos artigos impediu a realização de meta-análise. A análise descritiva por meio de percentual simples demonstrou redução dos sintomas e melhora dos parâmetros de urofluxometria. Os componentes de uroterapia identificados foram: orientação educacional, ingestão hídrica, redução de cafeína, posicionamento adequado para eliminação, treinamento do assoalho pélvico, micção programada e controle/manejo da constipação. Conclusão: Esta revisão sinaliza resultados positivos em termos de redução de sintomas e melhora nos parâmetros de urofluxometria com aplicação de uroterapia padrão como primeira linha de tratamento nos casos de crianças e adolescentes com disfunção vesical e intestinal. Recomenda-se que estudos futuros tragam contribuições no que tange a frequência, número e tempo para as consultas de uroterapia.
Asunto(s)
Humanos , Masculino , Femenino , Niño , Adolescente , Trastornos Urinarios/terapia , Enfermedades de la Vejiga Urinaria/terapia , Enfermedades Gastrointestinales/terapia , Estreñimiento/terapia , Encopresis/terapiaRESUMEN
A significant workforce shortage of urologists available to serve the US population has been projected to occur over the next decade. Accordingly, much of the management of urologic patients will need to be assumed by other specialties and practitioners. Since primary care physicians are often first evaluate common urologic complaints, it makes sense that these physicians are in an excellent position to intervene in the management of these patients when appropriate. One of the most common complaints in urology is voiding dysfunction. The incidence of voiding dysfunction increases with age, with conservative estimates showing that over 50% of elderly patients suffer. Despite this high prevalence and its negative impact on quality of life, however, few seek or receive treatment, as many do not readily disclose these impactful yet personal symptoms. We sought to summarize the typical presentation, evaluation, assessment and therapeutic options for both male and female patients presenting with voiding dysfunction.
Asunto(s)
Prostatismo/terapia , Vejiga Urinaria Hiperactiva/terapia , Trastornos Urinarios/diagnóstico , Trastornos Urinarios/terapia , Cistitis Intersticial/diagnóstico , Cistitis Intersticial/etiología , Cistitis Intersticial/terapia , Femenino , Humanos , Masculino , Prostatismo/diagnóstico , Prostatismo/etiología , Vejiga Urinaria Hiperactiva/diagnóstico , Vejiga Urinaria Hiperactiva/etiología , Vejiga Urinaria de Baja Actividad/diagnóstico , Vejiga Urinaria de Baja Actividad/etiología , Vejiga Urinaria de Baja Actividad/terapia , Incontinencia Urinaria de Esfuerzo/diagnóstico , Incontinencia Urinaria de Esfuerzo/etiología , Incontinencia Urinaria de Esfuerzo/terapia , Trastornos Urinarios/etiologíaRESUMEN
OBJECTIVE: To identify and describe the protocols and clinical outcomes of urotherapy interventions in children and adolescents with bladder bowel dysfunction. METHOD: Systematic review carried out in June 2018 on Medical Literature Analysis and Retrieval System Online (MEDLINE), Cumulative Index to Nursing and Allied Health Literature (CINAHL),Excerpta Medica dataBASE (EMBASE), Scientific Electronic Library Online (SciELO), Cochrane Library, and PsycInfo databases. Clinical trials and quasi-experimental studies carried out in the last ten years in children and/or adolescents with bladder and bowel symptoms and application of at least one component of urotherapy were included. RESULTS: Thirteen clinical trials and one quasi-experimental study were included, with moderate methodological quality. The heterogeneity of the samples and of the methodological design of the articles prevented the performance of a meta-analysis. The descriptive analysis through simple percentages showed symptom reduction and improvement of uroflowmetry parameters. The identified urotherapy components were: educational guidance, water intake, caffeine reduction, adequate voiding position, pelvic floor training, programmed urination, and constipation control/management. CONCLUSION: This review indicates positive results in terms of symptom reduction and uroflowmetry parameter improvement with standard urotherapy as the first line of treatment for children and adolescents with bladder bowel dysfunction. It is recommended that future studies bring contributions regarding the frequency, number, and time of urotherapy consultations.
Asunto(s)
Enfermedades Gastrointestinales/terapia , Enfermedades de la Vejiga Urinaria/terapia , Trastornos Urinarios/terapia , Adolescente , Niño , Estreñimiento/terapia , Encopresis/terapia , Femenino , Humanos , MasculinoRESUMEN
ABSTRACT Objective: To compare standard urotherapy with a combination of urotherapy and biofeedback sessions and to determine the changes that these therapies promote in children with dysfunctional voiding. Patients and Methods: The data of 45 patients who participated in the study from January 2010 to March 2013 were evaluated. All patients underwent urinary system ultrasonography to determine post-void residual urine volumes and urinary system anomalies. All patients were diagnosed using uroflowmetry - electromyography (EMG). The flow pattern, maximum flow rate, and urethral sphincter activity were evaluated in all patients using uroflowmetry - EMG. Each patient underwent standard urotherapy, and the results were recorded. Subsequently, biofeedback sessions were added for all patients, and the changes in the results were recorded and statistically compared. Results: A total of forty - five patients were included, of which 34 were female and 11 were male and the average age of the patients was 8.4 ± 2.44 years (range: 5 - 15 years). After the standard urotherapy plus biofeedback sessions, the post-void residual urine volumes, incontinence rates and infection rates of patients were significantly lower than those with the standard urotherapy (p < 0.05). A statistically significant improvement in voiding symptoms was observed after the addition of biofeedback sessions to the standard urotherapy compared with the standard urotherapy alone (p < 0.05). Conclusions: Our study showed that a combination of urotherapy and biofeedback was more effective in decreasing urinary incontinence rates, infection rates and post - void residual urine volumes in children with dysfunctional voiding than standard urotherapy alone, and it also showed that this combination therapy corrected voiding patterns significantly and objectively.
Asunto(s)
Humanos , Masculino , Femenino , Preescolar , Niño , Adolescente , Trastornos Urinarios/terapia , Biorretroalimentación Psicológica , Urodinámica , Resultado del Tratamiento , ElectromiografíaRESUMEN
OBJECTIVE: To compare standard urotherapy with a combination of urotherapy and biofeedback sessions and to determine the changes that these therapies promote in children with dysfunctional voiding. PATIENTS AND METHODS: The data of 45 patients who participated in the study from January 2010 to March 2013 were evaluated. All patients underwent urinary system ultrasonography to determine post-void residual urine volumes and urinary system anomalies. All patients were diagnosed using uroflowmetry - electromyography (EMG). The flow pattern, maximum flow rate, and urethral sphincter activity were evaluated in all patients using uroflowmetry - EMG. Each patient underwent standard urotherapy, and the results were recorded. Subsequently, biofeedback sessions were added for all patients, and the changes in the results were recorded and statistically compared. RESULTS: A total of forty - five patients were included, of which 34 were female and 11 were male and the average age of the patients was 8.4 ± 2.44 years (range: 5 - 15 years). After the standard urotherapy plus biofeedback sessions, the post-void residual urine volumes, incontinence rates and infection rates of patients were significantly lower than those with the standard urotherapy (p < 0.05). A statistically significant improvement in voiding symptoms was observed after the addition of biofeedback sessions to the standard urotherapy compared with the standard urotherapy alone (p < 0.05). CONCLUSIONS: Our study showed that a combination of urotherapy and biofeedback was more effective in decreasing urinary incontinence rates, infection rates and post - void residual urine volumes in children with dysfunctional voiding than standard urotherapy alone, and it also showed that this combination therapy corrected voiding patterns significantly and objectively.
Asunto(s)
Biorretroalimentación Psicológica , Trastornos Urinarios/terapia , Adolescente , Niño , Preescolar , Electromiografía , Femenino , Humanos , Masculino , Resultado del Tratamiento , UrodinámicaRESUMEN
AIMS AND OBJECTIVES: To identify how catheters and lubricants have been used among patients using intermittent urinary catheterisation in rehabilitation. BACKGROUND: The clean intermittent urinary catheterisation technique is an invasive procedure can cause discomfort, pain and urethral traumas. The use of lubricants and lubricated urinary catheters reduces the friction between the catheter and the urethral mucosa, minimising the risks. DESIGN: A descriptive exploratory design was used. METHODS: Quantitative and descriptive study developed at a rehabilitation centre of a University Hospital in the interior of the state of São Paulo, Brazil, at the Intermittent Urinary Catheterisation Outpatient Clinic, between June 2012-December 2014. After ethical approval, the data were collected through an interview with the support of a semistructured questionnaire, held during the nursing consultation. Among the users, patients using intermittent urinary catheterisation were interviewed, over 18 years of age and minors younger than eight years accompanied. Descriptive statistical analysis was applied. RESULTS: Most of 214 (100·0%) patients were interviewed were male, single, young adults and with a primary medical diagnosis of bone marrow injury and myelomeningocele. Most patients perform the urinary catheterisation between four and six times per day. For the procedure, the majority uses polyethylene (polyvinyl chloride) catheter and, as a lubricant, 2·0% lidocaine hydrochloride on the catheter itself. Many mention lack of sensitivity when passing the catheter. CONCLUSION: In the study sample, a risk of urethral traumas was evidenced, related to the inappropriate use of catheters and lubricants. For the patients' safety, the professionals need to acknowledge the importance of the appropriate use of lubricants and lubricated catheters to implement evidence-based practices that mobilise public policies. RELEVANCE TO CLINICAL PRACTICE: The use of evidences demonstrates that the appropriate use of lubricants for intermittent urinary catheterisation is fundamental for patient safety and the performance of the best practices.
Asunto(s)
Cateterismo Uretral Intermitente/enfermería , Lubricantes/administración & dosificación , Trastornos Urinarios/terapia , Adolescente , Adulto , Instituciones de Atención Ambulatoria , Anestésicos Locales/administración & dosificación , Brasil , Catéteres , Niño , Diseño de Equipo , Humanos , Lidocaína/administración & dosificación , Masculino , Persona de Mediana Edad , Dolor/prevención & control , Encuestas y Cuestionarios , Trastornos Urinarios/enfermería , Adulto JovenAsunto(s)
Terapia Cognitivo-Conductual , Defecación , Trastornos Fóbicos/terapia , Trastornos Urinarios/psicología , Antidepresivos de Segunda Generación/uso terapéutico , Terapia Combinada , Humanos , Masculino , Paroxetina/uso terapéutico , Trastornos Fóbicos/tratamiento farmacológico , Trastornos Urinarios/terapia , Adulto JovenRESUMEN
OBJECTIVE: To compare pelvic floor muscle training and a sham procedure for the treatment of lower urinary tract symptoms and quality of life in women with multiple sclerosis. METHODS: Thirty-five female patients with multiple sclerosis were randomized into two groups: a treatment group (n = 18) and a sham group (n = 17). The evaluation included use of the Overactive Bladder Questionnaire, Medical Outcomes Study Short Form 36, International Consultation on Incontinence Questionnaire Short Form, and Qualiveen questionnaire. The intervention was performed twice per week for 12 weeks in both groups. The treatment group underwent pelvic floor muscle training with assistance from a vaginal perineometer and instructions to practice the exercises daily at home. The sham group received a treatment consisting of introducing a perineometer inside the vagina with no exercises required. Pre- and post-intervention data were recorded. RESULTS: The evaluation results of the two groups were similar at baseline. At the end of the treatment, the treatment group reported fewer storage and voiding symptoms than the sham group. Furthermore, the differences found between the groups were significant improvements in the following scores in the treatment group: Overactive Bladder Questionnaire, International Consultation on Incontinence Questionnaire Short Form, and the General Quality of Life, and Specific Impact of Urinary Problems domains of the Qualiveen questionnaire. CONCLUSIONS: The improvement of lower urinary tract symptoms had a positive effect on the quality of life of women with multiple sclerosis who underwent pelvic floor muscle training, as the disease-specific of quality of life questionnaires demonstrated. This study reinforces the importance of assessing quality of life to judge the effectiveness of a treatment intervention.
Asunto(s)
Terapia por Ejercicio/métodos , Esclerosis Múltiple/complicaciones , Contracción Muscular/fisiología , Diafragma Pélvico/fisiología , Calidad de Vida , Trastornos Urinarios/terapia , Adulto , Análisis de Varianza , Femenino , Humanos , Estudios Prospectivos , Estadísticas no Paramétricas , Encuestas y Cuestionarios , Trastornos Urinarios/fisiopatologíaAsunto(s)
Humanos , Masculino , Adulto Joven , Terapia Cognitivo-Conductual , Defecación , Trastornos Fóbicos/terapia , Trastornos Urinarios/psicología , Antidepresivos de Segunda Generación/uso terapéutico , Terapia Combinada , Paroxetina/uso terapéutico , Trastornos Fóbicos/tratamiento farmacológico , Trastornos Urinarios/terapiaRESUMEN
OBJECTIVE: To determine the prevalence of voiding dysfunction (VD) in patients with persistent vulvovaginitis (PVV), and to evaluate the clinical response of PVV in the treatment of VD. PATIENTS AND METHODS: Girls four years or older who consulted for PVV for at least one month and who did not respond to general measures. A physical examination was performed with visual inspection and colposcopy; vaginal samples for culture and vaginoscopy were carried out. On every patient urodynamic studies were performed. Girls who were diagnosed with VD were treated. A pediatric gynecologist did the follow-up; a successful response was considered when inflammatory symptoms and vaginal discharge ceased. RESULTS: Twenty patients were included, mean age 8.6 years (range: 4.6-14 years); 75% prepubertal symptoms lasted for 1.8 years; 19 (95%) had urodynamia, 10 (52.6%) had an overactive bladder, 8 (42.1%) external bladder sphincter dyssynergia, 1 (5.2%) hypotonic bladder, and 13 (65%) showed improvement. CONCLUSION: VD is an important cause when considering the etiology of PVV.
Asunto(s)
Trastornos Urinarios/etiología , Vulvovaginitis/complicaciones , Adolescente , Biorretroalimentación Psicológica , Niño , Preescolar , Colposcopía , Femenino , Humanos , Ácidos Mandélicos/administración & dosificación , Antagonistas Muscarínicos/administración & dosificación , Prevalencia , Estudios Prospectivos , Resultado del Tratamiento , Trastornos Urinarios/terapia , Urodinámica , Vulvovaginitis/terapiaRESUMEN
OBJECTIVE: To compare pelvic floor muscle training and a sham procedure for the treatment of lower urinary tract symptoms and quality of life in women with multiple sclerosis. METHODS: Thirty-five female patients with multiple sclerosis were randomized into two groups: a treatment group (n = 18) and a sham group (n = 17). The evaluation included use of the Overactive Bladder Questionnaire, Medical Outcomes Study Short Form 36, International Consultation on Incontinence Questionnaire Short Form, and Qualiveen questionnaire. The intervention was performed twice per week for 12 weeks in both groups. The treatment group underwent pelvic floor muscle training with assistance from a vaginal perineometer and instructions to practice the exercises daily at home. The sham group received a treatment consisting of introducing a perineometer inside the vagina with no exercises required. Pre- and post-intervention data were recorded. RESULTS: The evaluation results of the two groups were similar at baseline. At the end of the treatment, the treatment group reported fewer storage and voiding symptoms than the sham group. Furthermore, the differences found between the groups were significant improvements in the following scores in the treatment group: Overactive Bladder Questionnaire, International Consultation on Incontinence Questionnaire Short Form, and the General Quality of Life, and Specific Impact of Urinary Problems domains of the Qualiveen questionnaire. CONCLUSIONS: The improvement of lower urinary tract symptoms had a positive effect on the quality of life of women with multiple sclerosis who underwent pelvic floor muscle training, as the disease-specific of quality of life questionnaires demonstrated. This study reinforces the importance of assessing quality of life to judge the effectiveness of a treatment intervention.
Asunto(s)
Adulto , Femenino , Humanos , Terapia por Ejercicio/métodos , Esclerosis Múltiple/complicaciones , Contracción Muscular/fisiología , Diafragma Pélvico/fisiología , Calidad de Vida , Trastornos Urinarios/terapia , Análisis de Varianza , Estudios Prospectivos , Estadísticas no Paramétricas , Encuestas y Cuestionarios , Trastornos Urinarios/fisiopatologíaRESUMEN
AIMS: Evaluate the role of pelvic floor muscle training (PFMT) on the treatment of lower urinary tract dysfunction (LUTD) in multiple sclerosis (MS) patients. METHODS: In this randomized controlled trial, twenty seven female patients with a diagnosis of MS and LUTD complaints were randomized, in two groups: Treatment group (GI) (N = 13) and Sham group (GII) (N = 14). Evaluation included urodynamic study, 24-hr Pad testing, three day voiding diary and pelvic floor evaluation according to PERFECT scheme. Intervention was performed twice a week for 12 weeks in both groups. GI intervention consisted of PFMT with assistance of a vaginal perineometer. GII received a sham treatment consisted on the introduction of a perineometer inside the vagina with no contraction required. RESULTS: At the end of the treatment GI was complaining less about storage and voiding symptoms than GII. Furthermore, differences found between groups were: reduction of pad weight (P = 0.00) (Mean: 87,51 grams initial and 6,03 grams final in GI. 69,46 grams initial and 75,88 grams final in GII), number of pads (P = 0.01) (Mean: 3,61 initial and 2,15 final in GI. 3,42 initial and 3,28 final in GII) and nocturia events (P < 0.00) (Mean: 2,38 initial and 0,46 final in GI. 2,55 initial and 2,47 final in GII) and improvements of muscle power (P = 0.00), endurance (P < 0.00), resistance (P < 0.00) and fast contractions (P < 0.00), domains of PERFECT scheme. CONCLUSIONS: PFMT is an effective approach to treat LUTD in female with MS.
Asunto(s)
Esclerosis Múltiple/complicaciones , Diafragma Pélvico/fisiopatología , Modalidades de Fisioterapia , Vejiga Urinaria/fisiopatología , Trastornos Urinarios/terapia , Adulto , Brasil , Femenino , Humanos , Pañales para la Incontinencia , Persona de Mediana Edad , Esclerosis Múltiple/fisiopatología , Contracción Muscular , Fuerza Muscular , Nocturia/etiología , Nocturia/fisiopatología , Nocturia/terapia , Factores de Tiempo , Resultado del Tratamiento , Trastornos Urinarios/etiología , Trastornos Urinarios/fisiopatología , Urodinámica , Adulto JovenRESUMEN
As disfunções miccionais incluem a enurese, a urgência miccional, alterações funcionais do detrusor. Existem fatores comportamentais afetando o treinamento no uso de banheiro e há também inibição da maturação do controle urinário normal. O objetivo deste trabalho foi revisar o manejo terapêutico de disfunções urinárias em crianças sem desordens neurológicas e sem compromentimento anatômico. Revisou-se literatura médica atual, enfatizando metanálises, estudos randomizados e controlados, documentos da biblioteca mdigital Cochrene. Entre os tratamentos encontram-se medidas dietéticas, registro das micções, "biofeedback", urofluxometria, eletromiografia, medicamentos, entre outros. Existem poucos estudos controlados, além de dificuldades metodológicas. Os resultados são muito próximos entre si quando comparados, sendo que alguns autores questionam a existência de evidências científicas para estes tratamentos.
Asunto(s)
Masculino , Femenino , Niño , Niños con Discapacidad , Electromiografía , Enuresis , Trastornos Urinarios/diagnóstico , Trastornos Urinarios/terapiaRESUMEN
El Síndrome de Mala Eliminación (SME) comprende la alteración en la evacuación a nivel intestinal y urinario, en distintos grados y formas de presentación clínica. Diversos estudios muestran el origen de esta patología en una alteración a nivel de la musculatura del piso pelviano. El objetivo de esta revisión es entregarle al pediatra una visión general de este concepto, usa cada vez más utilizado en la literatura internacional, destacando la importancia de la sospecha clínica, diagnóstico y manejo precoz. Los resultados de estudios internacionales avalan la necesidad del tratamiento conjunto de la afección urinaria y gastrointestinal, para lograr mayor porcentaje de mejoría. El enfoque conjunto de la incontinencia y la constipación, más la amplia gama de situaciones clínicas que cada uno de ellos conlleva, es el objetivo que persigue introducir este nuevo síndrome.
Asunto(s)
Niño , Humanos , Estreñimiento/diagnóstico , Estreñimiento/terapia , Trastornos Urinarios/diagnóstico , Trastornos Urinarios/terapia , Estreñimiento/etiología , Síndrome , Signos y Síntomas , Diafragma Pélvico/patología , Trastornos Urinarios/etiología , Trastornos de Eliminación/etiología , Incontinencia UrinariaAsunto(s)
Humanos , Femenino , Trastornos Urinarios/terapia , Terapia por Estimulación Eléctrica , PerineoRESUMEN
OBJECTIVE: To report a series of children with lower urinary tract dysfunction (LUTD) whose urge syndrome was treated by electrical stimulation, and their voiding dysfunction by biofeedback; none of the children were using anticholinergic drugs during treatment. PATIENTS AND METHODS: In all, 36 children who presented with symptoms of urinary urgency and/or daily incontinence completed the treatment and were prospectively evaluated. The mean (range) follow-up was 13.8 (4-24) months, and their mean age 7 (3-14) years, 17 children were aged <5 years. The children were divided into two groups: group 1, with urge syndrome treated with superficial parasacral electrical stimulation, and group 2, with voiding dysfunction, treated with biofeedback. RESULTS: In group 1, the mean (range) number of electrical stimulation sessions was 13.1 (4-20). Of the 19 children treated, 12 had a complete clinical improvement, six a significant improvement, and one a mild improvement. In group 2, the mean (range) number of biofeedback sessions was 6 (4-14). Of the 17 children treated, there was complete improvement of symptoms in 10, significant improvement in two and mild improvement in five. Six children who had no resolution of symptoms after biofeedback had salvage therapy with electrical stimulation, after which four had complete improvement of symptoms, and two a 90% and 40% improvement, respectively. Taking the two groups together, after treatment, four children developed isolated episodes of urinary tract infection. Of 21 children with nocturnal enuresis, bed-wetting continued in 13 (62%) after treatment. CONCLUSION: In this short-term follow-up, the nonpharmacological treatment of voiding dysfunction using biofeedback, and of urge syndrome by electrical stimulation, was effective for treating LUTD in children.
Asunto(s)
Biorretroalimentación Psicológica/métodos , Estimulación Eléctrica Transcutánea del Nervio/métodos , Trastornos Urinarios/terapia , Adolescente , Niño , Preescolar , Humanos , Lactante , Proyectos Piloto , Estudios ProspectivosRESUMEN
BACKGROUND: Clinical and experimental evidence suggests that a localized decrease in oxygen brain tissue availability contributes to the neurological deficit in patients with cerebrovascular disease (CVD) who also present with frontal leukoaraiosis (LA) (periventricular hypodensity on CT scan) and lacunar infarcts. In a prospective controlled trial blinded to patients but not to investigators, we tested the effect of HBO2 on this group of patients. METHODS: Selected patients with symptomatic CVD, LA and lacunar infarcts received daily exposures of 45 minutes for 10 days to hyperbaric oxygen (n=18, HBO2 group) or hyperbaric air (n=8, control group). The control group subsequently received HBO2. Scores of conventional scales for motor and cognitive functions were obtained and videotaped before and after exposure. After the exposures, participants were followed on a monthly basis with systematic clinical neurological examination for up to 6 months. Results. There was a statistically significant improvement in all scales for the HBO2 group compared with the placebo group and in the placebo group after receiving HBO2 (p<0.05). Neurological improvement persisted in the majority of patients for up to 6 months. Repetition of the HBO2 protocol in 9 patients in whom symptoms recurred after 6 months resulted in improvement of symptoms. CONCLUSIONS: These data provide evidence consistent with the notion that HBO2 improves neurological function in patients with CVD, lacunar infarcts and frontal LA. Because of the lack of investigator blinding and a relatively small sample size in this study, larger, randomized controlled studies are needed to further test this hypothesis and to further define the role of oxygen therapy for brain repair in chronic brain disease.
Asunto(s)
Enfermedades de los Ganglios Basales/terapia , Trastornos Cerebrovasculares/complicaciones , Trastornos del Conocimiento/terapia , Trastornos Neurológicos de la Marcha/terapia , Oxigenoterapia Hiperbárica , Trastornos Urinarios/terapia , Anciano , Enfermedades de los Ganglios Basales/etiología , Infarto Cerebral/complicaciones , Trastornos del Conocimiento/etiología , Femenino , Trastornos Neurológicos de la Marcha/etiología , Humanos , Leucoaraiosis , Masculino , Persona de Mediana Edad , Oxígeno/metabolismo , Estudios Prospectivos , Método Simple Ciego , Trastornos Urinarios/etiologíaRESUMEN
La neuromodulación mediante estimulación eléctrica de las raíces sacras (EERS) es una alternativa terapéutica no destructiva y reversible, indicada en pacientes con disfunción miccional crónica cuando los tratamientos conservadores han resultado ineficaces o mal tolerados. Esta estimulación logra influir sobre el comportamiento de la vejiga, del esfínter uretral externo y de los músculos del suelo pélvico. La estimulación es de tipo eléctrico y se ejerce mediante salvas de pulsos de corriente aplicada a la tercera raíz sacra (S3). El objetivo primordial de esta técnica es restablecer el patrón de micción normal