RESUMO
INTRODUCTION AND HYPOTHESIS: The mid-urethral sling (MUS) is considered the gold standard for stress urinary incontinence (SUI). Nevertheless, this procedure is not excluded from postsurgical complications, which can be challenging for most clinicians. Hence, one of the main concerns about this procedure is late postoperative voiding dysfunction (LDS), defined as obstructive symptoms 6 weeks after surgery. Primary medical management regularly includes expectant management and rehabilitation, including the mid-urethral cut sling (MUCS) as an alternative when it fails. This video provides an anatomical illustration and detailed description of the surgical steps of the J-cut of the lateral sling. MATERIALS AND METHODS: We set up a step-by-step surgical process and provided some advice for MUCS in a video; this material included how to position the sling, dissect, isolate the synthetic material, release adhesions and make a lateral cut of the MUS. Additionally, a case series of 30 patients from our institution is described to confirm the effectiveness of MUCS to manage delayed voiding dysfunction syndrome. RESULTS: MUCS in LDS was beneficial for our patients. Obstructive symptoms improved clinically from 75% to 100%, and urgency-related symptoms decreased from 57.9% to 26.3%, evidencing 20% SUI post-MUCS surgery. CONCLUSIONS: The lateral cut of the mid-urethral tape should be considered a surgical alternative for the resolution of post-sling late voiding dysfunction syndrome in patients who do not improve with expectant management.
Assuntos
Slings Suburetrais , Incontinência Urinária por Estresse , Humanos , Masculino , Período Pós-Operatório , Slings Suburetrais/efeitos adversos , Síndrome , Uretra , Incontinência Urinária por Estresse/etiologia , Incontinência Urinária por Estresse/cirurgia , Procedimentos Cirúrgicos Urológicos/métodosRESUMO
BACKGROUND: Mesh-related complications resulting from pelvic organ prolapse (POP) reconstruction operations may be a devastating experience leading to multiple and complex interventions. OBJECTIVES: The aim of the study was to describe the experience and time frame of management of mesh-related complications in women treated for POP or stress urinary incontinence in a tertiary center. METHODS: 1,530 cases of mesh-related complications were accessed regarding their clinical presentation, number of surgeries, and timeline of surgical treatments to treat multiple clinical complaints until the ultimate operation where all the meshes were removed in a single tertiary center. RESULTS: The studied population revealed to be a highly referred one with only 10.2% of the cases implanted at our center. Clinical presentation varied widely with 48.7% referring pain as the chief complaint, while 31.3% complained of voiding dysfunctions, 2.5% reported genital prolapses, 2.2% complained of vaginal problems, and 1.2% noted intestinal problems as the main clinical complaint. Only 4.8% of the cases presented mesh erosion at examination; 57.8% of the cases required more than 1 operation to address the mesh-related problems. Sixty-eight cases had more than 10 operations up to complete removal. Three clusters of patients could be identified: (i)-those from whom the mesh was promptly removed after clinical problems emerged, (ii) those with slowly evolving problems, and (iii) those with escalating problems despite treatment attempts. CONCLUSIONS: Mesh-related complications after pelvic floor reconstruction are an evolving disease with diverse clinical presentation. The identified time-related problems and the multiple failed attempts to treat their complications warrant attention with continuous monitoring of these patients and aggressive removal of the mesh if the clinical complaint cannot be swiftly managed.
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Prolapso de Órgão Pélvico , Incontinência Urinária por Estresse , Feminino , Humanos , Prolapso de Órgão Pélvico/cirurgia , Próteses e Implantes , Reoperação , Telas Cirúrgicas/efeitos adversos , Resultado do Tratamento , Incontinência Urinária por Estresse/complicações , Incontinência Urinária por Estresse/cirurgiaRESUMO
AIM: The aim of this study is to describe the prevalence and type of female voiding dysfunction (FVD) in patients with overactive bladder (OAB) who were studied by urodynamics and its relationship with voiding symptoms. METHODS: This is a cross-sectional study of female adult patients with OAB syndrome who underwent UDS in a University Hospital in Chile between January 2015 and April 2020. FVD was defined either as bladder outlet obstruction (BOO) or detrusor underactivity (DU). BOO was established if the Solomon-Greenwell BOO index was higher than 18. DU was diagnosed when the invasive maximum flow rate (Qmax) was ≤15 ml/sec, detrusor pressure at Qmax (Pdet@Qmax) was ≤20 cmH2 O and postvoid residual (PVR) was greater than 10%. Urodynamic data and clinical features were compared between groups. RESULTS: Two hundred and ninety-nine UDS were selected and analyzed. Bladder outlet obstruction was diagnosed in 59 patients (19.7%), whereas DU was found in 10 patients (3.3%). In the multivariate analysis, the logistic regression to predict BOO demonstrated that night-time frequency, the presence of detrusor overactivity and a higher PVR were independent predictors of BOO. Instead, for DU, the only independent predictor was a smaller voided volume in the pressure-flow study. CONCLUSION: Female voiding dysfunction was found in 23% of patients with overactive bladder. BOO is more frequent than DU, and should be suspected in patients with higher night-time frequency, presence of detrusor overactivity and a high PVR. Instead, DU should be suspected in patients with a smaller voided volume.
Assuntos
Obstrução do Colo da Bexiga Urinária , Bexiga Urinária Hiperativa , Adulto , Estudos Transversais , Feminino , Humanos , Obstrução do Colo da Bexiga Urinária/epidemiologia , Bexiga Urinária Hiperativa/epidemiologia , Micção , UrodinâmicaAssuntos
Carcinoma , Neoplasias Uretrais , Neoplasias da Bexiga Urinária , Feminino , Humanos , Masculino , Uretra , Neoplasias Uretrais/complicaçõesRESUMO
AIMS: To evaluate the functional and molecular alterations of contractile and relaxant machinery in the bladder and urethra that lead to the underactive bladder (UAB) in old female mice. METHODS: Female young (3-months) and old (18-months) C57BL/6 mice were used. Urodynamic was assessed in awake and anaesthetized mice. Electrical-field stimulation (EFS) and concentration-response curves to contractile and relaxing agents in isolated bladders and urethras were performed. Messenger RNA (mRNA) expressions of muscarinic, adrenergic, and transient receptor potential vanilloid-4 (TRPV4), and of the enzymes tyrosine hydroxylase and neuronal nitric oxide synthase (nNOS) were determined. Bladder cyclic adenosine monophosphate (cAMP) levels were measured. RESULTS: Cystometry in old mice showed incapacity to produce bladder emptying. On filter paper, old mice showed reduced urinary spots. Compared to the young group, bladder contractions induced by EFS and carbachol were lower in old mice. The ß3 -adrenoceptor agonist mirabegron promoted higher bladder relaxation and elevation of cAMP levels in old mice. In old mice urethras, the α1a -adrenoceptor agonist phenylephrine produced higher contractions, but no differences were found for the NO donor sodium nitroprusside-induced relaxations. In old mice, increased mRNA expressions of ß3 - and α1a -adrenoceptors in bladder and urethra were found, respectively, whereas the muscarinic M2 and M3 receptors and ß2 -adrenoceptors did not change between groups. Reduced mRNA expressions of tyrosine hydroxylase and nNOS were found in old mouse urethras. Additionally, TRPV4 expression was reduced in bladder urothelium from old mice. CONCLUSION: Age-associated mouse UAB is the result of autonomic dysfunction at multiple levels leading to the less sensitive and overrelaxed bladder, along with urethral hypercontractility.
Assuntos
Envelhecimento/patologia , Sistema Nervoso Autônomo/fisiopatologia , Bexiga Inativa/fisiopatologia , Animais , AMP Cíclico/metabolismo , Estimulação Elétrica , Feminino , Camundongos , Camundongos Endogâmicos C57BL , Contração Muscular/efeitos dos fármacos , Receptores Adrenérgicos/efeitos dos fármacos , Receptores Muscarínicos/efeitos dos fármacos , Uretra/fisiopatologia , Bexiga Urinária/inervação , Bexiga Urinária/fisiopatologia , UrodinâmicaRESUMO
INTRODUCTION: Lower urinary tract dysfunction (LUTD) involves faults in the filling and emptying phases of bladder function in toilet-trained children with no previous infection or any other obvious pathology. Lower urinary tract dysfunction is associated with conditions such as vesicoureteral reflux, recurrent urinary infection, behavioral alterations and decreased quality of life. The literature suggests an association between LUTD and obesity; however, the association between each individual symptom and obesity has yet to be evaluated. OBJECTIVE: To evaluate the association between excess weight and LUTD in children and adolescents in a community-based sample. STUDY DESIGN: This cross-sectional study included 423 children and adolescents aged 5-17 years, and randomly selected in public places and schools between May and July 2015. The participants and their mothers completed the Dysfunctional Voiding Scoring System (DVSS) questionnaire, except for the questions on constipation and with the addition of a question on enuresis. They also completed the Rome III questionnaire, in which two positive responses defined the presence of constipation. Participants were classified as being of normal weight, overweight or obese, which was based on the BMI-for-age indicator. RESULTS: Mean age was 9.7 years (SD 2.9), with girls comprising 50.6% of the sample and adolescents 52.5%. The prevalence of LUTD was 7.1%, with 13.5% of participants being overweight and 12.1% obese (Figure). Constipation was present in 5.9% of participants and enuresis in 10.8%. In the multivariate analysis, three factors were independently and significantly associated with a positive DVSS: age <10 years (ß = 0.76; 95% CI: 0.34-1.18), constipation (ß = 1.79; 95% CI: 0.88-2.70) and obesity (ß = 0.89; 95% CI: 0.25-1.52). DISCUSSION: Only bladder filling symptoms were associated with obesity. This may be explained by the fact that both obese individuals and those with emptying symptoms were shown to have activation alterations in the same brain regions. One limitation of this study was the use of questionnaires alone to diagnose LUTD and constipation. CONCLUSION: Only the bladder-emptying symptoms of LUTD appear to be associated with obesity. This hypothesis may serve as a basis for future studies.
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Sintomas do Trato Urinário Inferior/epidemiologia , Obesidade/complicações , Adolescente , Criança , Constipação Intestinal/epidemiologia , Estudos Transversais , Feminino , Humanos , Masculino , Prevalência , Qualidade de Vida , Fatores de Risco , Inquéritos e QuestionáriosRESUMO
INTRODUCTION: Williams-Beuren syndrome (WBS) is a genetic condition caused by a microscopic deletion in the chromosome band 7q11.23. Individuals with WBS may present with congenital cardiovascular defects, neurodevelopmental disturbances and structural abnormalities of the urinary tract. Lower urinary tract symptoms (LUTS) seem to be frequent in this population, but studies on this topic are scarce and based on small case series. OBJECTIVE: To systematically evaluate the prevalence of lower urinary tract symptoms (LUTS) and the acquisition of bladder control in a large population with WBS. STUDY DESIGN: A cross-sectional study evaluating 87 consecutive patients with WBS; there were 41 girls and 46 boys. Genetic studies confirmed WBS in all patients. Subjects were clinically evaluated with: a history of LUTS obtained from the parents and child, a structured questionnaire of LUTS, a 3-day urinary frequency-volume chart, a quality of life question regarding LUTS, and physical examination. A history regarding the acquisition of bladder control was directly evaluated from the parents. RESULTS: Mean age of patients was 9.0 ± 4.2 years, ranging from 3 to 19 years. Based on the symptoms questionnaire and the frequency-volume chart, 70 patients (80.5%) were symptomatic. The most common symptom was urgency, affecting 61 (70.1%) patients, followed by increased urinary frequency in 60 (68.9%) patients, and urge-incontinence in 53 (60.9%), as shown in Summary Fig. More than half of the children reported nocturnal enuresis, including 61% of the girls and 52% of the boys. Twenty-three patients (25.6%) had a history of urinary tract infections. The mean age for acquisition of dryness during the day was 4.4 ± 1.9 years. Parents of 61 patients (70.1%) acknowledged that LUTS had a significant impact on the quality of life of their children. DISCUSSION: A high prevalence of LUTS was confirmed with a significant negative impact on quality of life in a large population of children and adolescents with WBS. It was shown for the first time that the achievement of daytime bladder control is delayed in children with WBS. Although LUTS are not recognized as one of the leading features of the syndrome, it is believed that it should be considered as a significant characteristic of the clinical diagnosis of WBS. CONCLUSIONS: LUTS are highly prevalent in children and adolescents with WBS and have a significant negative impact on patient's quality of life.
Assuntos
Sintomas do Trato Urinário Inferior/epidemiologia , Sintomas do Trato Urinário Inferior/etiologia , Qualidade de Vida , Inquéritos e Questionários , Síndrome de Williams/complicações , Adolescente , Distribuição por Idade , Criança , Pré-Escolar , Estudos Transversais , Feminino , Humanos , Sintomas do Trato Urinário Inferior/fisiopatologia , Masculino , Noctúria/epidemiologia , Noctúria/etiologia , Noctúria/fisiopatologia , Prevalência , Prognóstico , Medição de Risco , Índice de Gravidade de Doença , Distribuição por Sexo , Incontinência Urinária/epidemiologia , Incontinência Urinária/etiologia , Incontinência Urinária/fisiopatologia , Urodinâmica , Síndrome de Williams/diagnósticoRESUMO
As crianças portadoras de disfunções miccionais, sendo de ordem neurológica (bexiga neurogênica) ou funcionais, necessitam de cuidados especiais para evitar a deterioração do sistema urinário inferior e insuficiência renal. Na maioria dos casos de bexiga neurogênica, indica-se, o cateterismo intermitente limpo. Também indicado para as disfunções não neurogênicas quando não se consegue bons resultados com outros tratamentos. São crianças com necessidades especiais de saúde (CRIANES), com mudanças na sua vida cotidiana e necessidade de cuidados especiais. O enfermeiro necessita interagir com as mesmas, de forma que, na fase escolar, possam juntos, planejar e administrar o autocuidado, necessários para facilitar o processo de viver saudável. Objeto de estudo: o autocateterismo intermitente limpo realizado pelo escolar portador de disfunção miccional. Objetivos: descrever as práticas de cuidados concernentes ao autocateterismo intermitente limpo realizado pelo escolar portador de disfunção miccional e analisar os desafios para a realização dessa prática de cuidado por esse escolar nos diversos espaços de socialização. Metodologia: estudo de natureza qualitativa, desenvolvido sob o método criativo sensível, através das dinâmicas de criatividade e sensibilidade Corpo Saber e Mapa Falante. Os participantes da pesquisa foram sete crianças portadoras de disfunção miccional, com idade entre 9-11 anos. O cenário de estudo foi um ambulatório de pediatria, situado em um hospital de ensino e pesquisa no estado do Rio de Janeiro. Os dados foram coletados no período entre fevereiro e março de 2015, e foram analisados a partir da análise de discurso em sua corrente francesa, sendo interpretados à luz do autocuidado de acordo com o conceito de Orem, a Teoria do Desenvolvimento Psicossocial de Erik Erikson e da educação em saúde com as concepções freirianas para a educação. Resultados:através da análise da prática de cuidados desses escolares, evidenciamos a preocupação com a higienização das mãos, da região íntima e do óstio de Mitrofanoff e, cuidados com o esvaziamento completo da bexiga. Quanto aos desafios, foram evidenciados a necessidade do uso de dispositivos para a visualização do meato urinário, dificuldades para a visualização do meato uretral feminino no período matutino, no posicionamento para a realização do autocateterismo, a presença de desconfortos com a sondagem uretral, a irregularidade na frequência do autocateterismo, as dificuldades para brincar em função da realização do autocateterismo, a (in) dependência no autocateterismo e o (des)velamento do autocateterismo nos diversos espaços de socialização. Conclusão: Revelou-se uma consciência ingênua na prática de cuidados, assim como fatores ambientais interferindo no autocuidado e riscos de infecção do trato urinário. Os diversos desafios enfrentados pelos escolares, na realização do autocateterismo, apontam para a necessidade de aproximação com estes de forma dinâmica e criativa, facilitando a exposição de suas dúvidas, medos e anseios, e para a promoção da conscientização crítica e a socialização dos saberes, capacitando-os para o autocuidado. Também na divulgação junto aos órgãos competentes, para a adequação social, com vistas à inclusão destas CRIANES nos diversos espaços de socialização.
Children suffering from voiding dysfunction, which stems from a neurological (neurogenic bladder) or a functional disorder, need special care to prevent deterioration of the lower urinary tract and kidney failure. In most cases of neurogenic bladder it is indicated clean intermittent catheterization. Also suitable for non-neurogenic dysfunction when you don`t get good results with other treatments. These are children with special health care needs(CSHCN), with changes in their daily lives. The nurse needs to interact with them, so that, at school age, they can together plan and manage the self-care necessary to facilitate the process of healthy living. Subject: clean intermittent catheterization performed by the children that suffers from voiding dysfunction. Objectives: To describe the practices from care concerning the clean intermittent catheterization performed by the children that suffers from voiding dysfunction and analyze the challenges for the realization of this practice by that children in the various spaces of socialization. Methodology: qualitative study developed under the sensitive creative method, through the dynamics of creativity and sensitivity "Corpo Saber e Mapa Falante". The survey participants were seven children with voiding dysfunction, aged 9-11 years.The study setting was an outpatient pediatric clinic located in a teaching hospital in the state of Rio de Janeiro. Data were collected between February and March 2015 and were analyzed from the speech analysis in its French stream being interpreted in the lightof the self-care according to the Orem concept, the Psychosocial Development Theory of Erik Erikson and of health education with Freirian concepts for education. Results: by analyzing the practice of these children we noted the concern on hands, genitals and the Mitrofanoff ostium hygienization, and, the complete evacuation of the bladder.Regarding the challenges, were highlighted the necessity of devices for visualizing the urinary meatus, difficulties in the visualization of the feminine urethral meatus in the morning, the position to perform the catheterization, the discomfort with the urethral probe, the irregularity in the frequency of catheterization, the difficulties to play due the realization of catheterization, the (in)dependence on autocatheterism and the (un)veiling of autocatheterism in various spaces of socialization. Conclusion: It was revealed an ingenuous consciousness in the practice of cares, as well as environmental factors interfering in the self-care and risk of urinary tract infection.The various challenges faced by the children in performing the catheterization point to the necessity of closer ties in a dynamic and creative way, facilitating the exposure of their doubts, fears and desires, to promote critical awareness and the socialization of knowledge, enabling them for self-care. Also, in the disclosure with the competent organs, to social adaptation, aiming to incorporate such CSHCN in various spaces of socialization.
Assuntos
Humanos , Masculino , Feminino , Pré-Escolar , Criança , Criança , Cateterismo Uretral Intermitente/enfermagem , Enfermagem Pediátrica/métodos , Autocuidado , Transtornos Urinários/enfermagem , Stents/estatística & dados numéricosRESUMO
BACKGROUND AND PURPOSE: Cyclophosphamide induces urotoxicity characterized by the development of cystitis, which involves bladder overactivity and inflammation. Here, we investigated the roles of chemokine receptor 2 (CXCR2) and transient receptor potential vanilloid 1 (TRPV1) channels in a rat model of cyclophosphamide-induced cystitis. EXPERIMENTAL APPROACH: Cystitis induced by cyclophosphamide in rats was assessed by gross morphology, histology and immunohistochemistry of bladder tissue. mRNA for CXCR2 and TRPV1 channels were measured by RT-PCR. Nociceptive responses in paw and abdomen, along with cystometric measures were recorded. KEY RESULTS: Cyclophosphamide, i.p., induced pain behaviour, bladder inflammation and voiding dysfunction. The CXCR2 antagonist, SB225002, the TRPV1 channel antagonist, SB366791 or their combination reduced the mechanical hypersensitivity of paw and abdominal area and nociceptive behaviour after cyclophosphamide. Cyclophosphamide-induced cystitis was characterized by haemorrhage, oedema, neutrophil infiltration and other inflammatory changes, which were markedly decreased by the antagonists. Up-regulation of CXCR2 and TRPV1 mRNA in the bladder after cyclophosphamide was inhibited by SB225002, SB366791 or their combination. Expression of CXCR2 and TRPV1 channels was increased in the urothelium after cyclophosphamide. Bladder dysfunction was shown by increased number of non-voiding contractions (NVCs) and bladder pressures and a reduction in bladder capacity (BC), voided volume (VV) and voiding efficiency (VE). SB225002 or its combination with SB366791 reduced bladder pressures, whereas SB225002, SB366791 or their combination increased BC, VV and VE, and also reduced the number of NVCs. CONCLUSIONS AND IMPLICATIONS: CXCR2 and TRPV1 channels play important roles in cyclophosphamide-induced cystitis in rats and could provide potential therapeutic targets for cystitis.
Assuntos
Antineoplásicos Alquilantes , Comportamento Animal/efeitos dos fármacos , Ciclofosfamida , Cistite/patologia , Transtornos Hemorrágicos/patologia , Inflamação/patologia , Receptores de Interleucina-8B/metabolismo , Canais de Cátion TRPV/metabolismo , Animais , Cistite/induzido quimicamente , Cistite/tratamento farmacológico , Citocinas/metabolismo , Feminino , Transtornos Hemorrágicos/induzido quimicamente , Transtornos Hemorrágicos/tratamento farmacológico , Hiperalgesia/induzido quimicamente , Hiperalgesia/psicologia , Imuno-Histoquímica , Neutrófilos/metabolismo , Tamanho do Órgão/efeitos dos fármacos , Medição da Dor/efeitos dos fármacos , Peroxidase/metabolismo , Ratos , Reação em Cadeia da Polimerase em Tempo Real , Receptores de Interleucina-8B/antagonistas & inibidores , Canais de Cátion TRPV/antagonistas & inibidores , Bexiga Urinária/patologiaRESUMO
OBJECTIVES: The aims of this study were to compare the impact of urodynamic training on the young urologists after fellowship training as well as on senior urologists who attend regular courses on the management of benign prostatic hyperplasia (BPH) and their capacity to do and interpret urodynamic studies. METHODS: Sixty-four consecutive young urologists admitted to fellowship program on voiding dysfunctions and 110 senior urologists attending to periodical meetings were interviewed before and after the 3-day-courses regarding their ability to set, interpret and do urodynamic studies. They were also questioned on the reasons that led them to attend the courses and how they use the new concepts to manage BPH. A rank of the used parameters to indicate transurethral resection of the prostate (TURP) in BPH patients were scored before and after the course. RESULTS: Fellowship and senior urologists mainly attended the course because of lack of confidence and belief that this urological issue is too important to be disregarded. A significant portion of both groups do not trust third-party examiners. More than 90% of the urologists acquired confidence in interpreting, setting and were able to do the exam after the course. The majority of both groups believed urodynamic study was essential to manage BPH, disregarding volume as the main reason to operate on patients. Many outdated parameters became less important on the decision to operate. CONCLUSIONS: Doctors exposed to intensive or long urodynamic training dramatically changed their perceptions on the utility of this tool and became more attentive it.
RESUMO
O comprometimento físico-mental, emocional, social e econômico associados aos sinais, sintomas e complicações secundárias a doença de Parkinson, especialmente a disfunção miccional, interfere no nível de incapacidade do indivíduo e pode influenciar negativamente a qualidade de vida. O presente estudo tem como objeto de investigação o autocuidado e qualidade de vida de idosas com Parkinson e disfunção miccional e tem como objetivos: determinar os efeitos da disfunção miccional na qualidade de vida de idosas com Doença de Parkinson através do questionário de qualidade e vida e contextualizar a percepção das idosas sob a perspectiva do autocuidado. Trata-se de um estudo quantitativo e qualitativo, exploratório e prospectivo, realizado no período de maio a junho de 2011, incluindo 20 idosas com idade a partir de 60 anos, com disfunção miccional ocasionada pela Doença de Parkinson e após assinarem o Termo de Consentimento Livre e Esclarecido. Na coleta de dados foram utilizados os instrumentos para caracterização sóciodemográfica, avaliação da Qualidade de Vida através do King Health Questionaire e três questões norteadoras que permitiram a livre contextualização das idosas. A análise quantitativa revelou que uma média maior de 50% das idosas mostrou percepção de sua saúde ruim, efeitos negativos e limitantes nas atividades da vida diária e de autocuidado, limitações físico-sociais, emocionais e no padrão de sono/energia. A análise qualitativa foi baseada na análise de conteúdo de Bardin, emergindo cinco categorias dos discursos das idosas: A Doença de Parkinson: o significado de suas vivências; Percepção e repercussão da disfunção miccional na qualidade de vida; Disfunção miccional: sentimentos relacionados à dependência para o autocuidado e Qualidade de vida: estratégias e desafios frente às adversidades. A Doença de Parkinson e a disfunção miccional demonstraram repercussões psicossociais devastadoras, evidenciadas por condições de fragilidade, dependência para o autocuidado e isolamento social impostos pela disfunção miccional. O estudo demonstrou a importância da busca de novas alternativas para melhorar a qualidade de vida de idosas com disfunção miccional ocasionada por Doença de Parkinson enfatizando a relevância das ações de enfermagem para o autocuidado.(AU)
The impaired development of physical, mental, emotional, social and economic aspects associated with the signs, symptoms and secondary complications of Parkinson's disease, especially voiding dysfunction, interferes with the individual's level of disability and can negatively influence the life quality. This study has as a objective of investigation the voiding self-care and quality of life of elderly women with Parkinson's disease and bladder dysfunction. It is a quantitative study with clipping qualitative, exploratory and prospective, conducted from May to June of 2011, including 20 elderly women aged above 60 years with voiding dysfunction caused by Parkinson's disease and after signing the Statement of Informed Consent. Data collection instruments were used for socio-demographic, assessment of quality of life through the King Health Questionnaire and three guiding questions in order to free the context of the elderly. The quantitative analysis revealed that an average greater than 50% of the women showed awareness their bad health, negative and limiting activities of daily living and self-care, physical limitations, social, emotional and pattern of sleep/energy. Qualitative analysis was based on content analysis of Bardin, emerging discourses of the five categories elderly, Parkinson's disease; The meaning of their experiences, perceptions and impact of voiding dysfunction on quality of life; Voiding dysfunction; Feelings related to their dependence to self-care and quality of life; Strategies and challenges in the face of adversity. Parkinson's Disease and voiding dysfunction showed devastating psychosocial effects, as evidenced by conditions of frailty, dependence for self-care and social isolation imposed by voiding dysfunction. The study demonstrated the importance of finding new alternatives to improve the quality of life of elderly women with voiding dysfunction caused by disease Parkinson's emphasis on the importance of nursing actions for self-care. (AU)
Assuntos
Humanos , Feminino , Idoso , Doença de Parkinson , Qualidade de Vida , Micção , Enfermagem , Autocuidado , Incontinência UrináriaRESUMO
PURPOSE: The etiology of obstructive bladder dysfunction includes free radical damage to mitochondria. Feeding rabbits a standardized grape suspension protects the ability of the bladder to contract and empty in part by preventing mitochondrial damage, thus maintaining smooth muscle and mucosal metabolism. The objective of the current study is to determine the direct effect of this grape suspension on the response of mitochondria to the oxidative effects of hydrogen peroxide. MATERIALS AND METHODS: Six male rabbits were anesthetized with sodium pentobarbital and the bladders excised. Four full thickness strips were obtained for contractile studies and the balance separated into smooth muscle and mucosa compartments by blunt dissection. The effect of hydrogen peroxide on the contractile response to field stimulation was quantitated. Each tissue was homogenized and the effects of increasing concentrations of hydrogen peroxide in the presence and absence of grape suspension on citrate synthase activity was determined. RESULTS: Citrate synthase activity was significantly higher in the mucosa than in the muscle. The grape suspension had no effect on control citrate synthase activity. However, the grape suspension provided significant protection of both smooth muscle and mucosal citrate synthase activity. CONCLUSIONS: These studies support the conclusion that the grape suspension provides direct protection of mitochondrial function.
Assuntos
Animais , Masculino , Coelhos , Citrato (si)-Sintase/metabolismo , Peróxido de Hidrogênio/farmacologia , Mitocôndrias/metabolismo , Bexiga Urinária/efeitos dos fármacos , Vitis , Antioxidantes/farmacologia , Peróxido de Hidrogênio/efeitos adversos , Mucosa/efeitos dos fármacos , Mucosa/enzimologia , Contração Muscular/efeitos dos fármacos , Músculo Liso/efeitos dos fármacos , Músculo Liso/enzimologia , Obstrução do Colo da Bexiga Urinária/enzimologia , Bexiga Urinária/enzimologiaRESUMO
OBJETIVOS: O aprendizado do controle esfincteriano é influenciado por fatores fisiológicos, psicológicos e socioculturais. O objetivo deste estudo foi avaliar a prevalência de crianças sem fraldas aos 24 meses e seus fatores associados. MÉTODOS: Um total de 3.281 crianças nascidas no ano de 2004 em Pelotas (RS) foi incluído em um estudo longitudinal. Aos 24 meses, as mães responderam a um questionário domiciliar com questões sociodemográficas, características dos hábitos miccionais e intestinais das crianças, com atenção ao treinamento esfincteriano. Foi empregada a regressão de Poisson para as análises multivariáveis. RESULTADOS: Do total, 24,3 por cento estavam sem fraldas durante o dia, com predomínio do sexo feminino (27,8 versus 21,1 por cento, p < 0,001) e 8,6 por cento sem fraldas durante a noite, também com predomínio do sexo feminino (10,6 versus 6,8 por cento, p < 0,001). As habilidades necessárias ao aprendizado do controle esfincteriano estavam presentes em 85,5 por cento das crianças. Orientação pediátrica ocorreu em 10 por cento das crianças, mais freqüente nas mães mais ricas em relação às mais pobres (22,9 versus 4,8 por cento). Mães mais escolarizadas (13,2 por cento) e mais ricas (14 por cento) retiram as fraldas mais tardiamente; maior número de crianças em casa (risco relativo = 1,32) e indicar a necessidade de ir ao vaso (risco relativo = 11,74) aumentam a probabilidade de retirar as fraldas; tentativa anterior sem sucesso retarda a retirada de fraldas (risco relativo = 0,59). CONCLUSÕES: Embora as habilidades necessárias para a aquisição do controle esfincteriano já estejam presentes aos 24 meses, indicando que um treinamento esfincteriano pode ser iniciado, a maioria das crianças ainda não tinha iniciado esse treinamento. As mães com melhor nível de informação retardam mais esse treinamento.
OBJECTIVES: Acquisition of bladder and bowel control is influenced by physiological, psychological and sociocultural factors. The objective of this study was to evaluate the prevalence of children out of diapers by 24 months of age and the factors associated with this finding. METHODS: A total of 3,281 children born in Pelotas, RS, Brazil in 2004 were enrolled on a longitudinal study. At 24 months their mothers were visited at home and replied to a questionnaire containing questions about sociodemographic data and the characteristics of their children's urinary and intestinal evacuation habits, with special attention to toilet training. Multivariate analyses were carried out using Poisson regression. RESULTS: From the total, 24.3 percent were out of diapers during the day, with the female sex predominating (27.8 vs. 21.1 percent, p < 0.001) and 8.6 percent were out of diapers at night, also with the female sex predominating (10.6 vs. 6.8 percent, p < 0.001). The abilities needed to start toilet training were present in 85.5 percent of the children. Guidance was received from a pediatrician in 10 percent of cases, and more frequently among richer mothers than among poorer mothers (22.9 vs. 4.8 percent). Mothers who spent more years in education (13.2 percent) and were from higher social classes (14 percent) took their children out of diapers later; a greater number of children living at home (relative risk = 1.32) and being able to communicate the need to go to the toilet (relative risk = 11.74) both increased the probability of being out of diapers; previous unsuccessful attempts delayed removal of diapers (relative risk = 0.59). CONCLUSIONS: Although the abilities needed for acquisition of bladder and bowel control were already present at 24 months, indicating that toilet training could be started, the majority of children had not yet started this training. Better-informed mothers delayed training the most.
Assuntos
Pré-Escolar , Feminino , Humanos , Lactente , Masculino , Treinamento no Uso de Banheiro , Brasil , Fraldas Infantis , Métodos Epidemiológicos , Fatores SocioeconômicosRESUMO
PURPOSE: To evaluate erectile function (EF) and voiding function following primary targeted cryoablation of the prostate (TCAP) for clinically localized prostate cancer (CaP) in a contemporary cohort. MATERIALS AND METHODS: We retrospectively reviewed all patients treated between 2/2000-5/2006 with primary TCAP. Variables included age, Gleason sum, pre-TCAP prostate specific antigen (PSA), prostate volume, clinical stage, pre-TCAP hormonal ablation, pre-TCAP EF and American Urologic Association Symptom Score (AUASS). EF was recorded as follows: 1 = potent; 2 = sufficient for intercourse; 3 = partial/insufficient; 4 = minimal/insufficient; 5 = none. Voiding function was analyzed by comparing pre/post-TCAP AUASS. Statistical analysis utilized SAS software with p < 0.05 considered significant. RESULTS: After exclusions, 78 consecutive patients were analyzed with a mean age of 69.2 years and follow-up 39.8 months. Thirty-five (44.9 percent) men reported pre-TCAP EF level of 1-2. Post-TCAP, 9 of 35 (25.7 percent) regained EF of level 1-2 while 1 (2.9 percent) achieved level 3 EF. Median pre-TCAP AUASS was 8.75 versus 7.50 postoperatively (p = 0.39). Six patients (7.7 percent) experienced post-TCAP urinary incontinence. Lower pre-TCAP PSA (p = 0.008) and higher Gleason sum (p = 0.002) were associated with higher post-TCAP AUASS while prostate volume demonstrated a trend (p = 0.07). Post-TCAP EF and stable AUASS were not associated with increased disease-recurrence (p = 0.24 and p = 0.67, respectively). CONCLUSIONS: Stable voiding function was observed post-TCAP, with an overall incontinence rate of 7.7 percent. Further, though erectile dysfunction is common following TCAP, 25.7 percent of previously potent patients demonstrated erections suitable for intercourse. While long-term data is requisite, consideration should be made for prospective evaluation of penile rehabilitation following primary TCAP.