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L B Robinson - One of the best experts on this subject based on the ideXlab platform.
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Nonobstructive posterior urethral widening (spinning top urethra) in boys with Bladder Instability.
Radiology, 1992Co-Authors: H. M. Saxton, M Borzyskowski, L B RobinsonAbstract:Seven boys between the ages of 5 and 10 years with symptoms of urinary frequency and urgency and daytime wetting were studied with urodynamics and were shown to have Bladder Instability and a dilated posterior urethra. In two the dilatation occurred predominantly during Bladder filling. Unstable contractions caused filling of the posterior urethra, and leakage was prevented by voluntary contraction of the distal urethral sphincter; with voiding, the urethra showed a more normal appearance. In the remaining five, there were similar changes during filling, but dilatation persisted during voiding. In six the measured urine flow rate was normal, and none showed any evidence of anatomic obstruction. The mechanism of urethral distention appears to be similar to that previously shown in girls with spinning top urethra: Unstable contractions resisted by voluntary sphincter contraction cause posterior urethral dilatation. Boys with dilated posterior urethras who have urinary frequency and urgency and daytime wetting and normal urine flow rates should be assumed to have Bladder Instability.
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nonobstructive posterior urethral widening spinning top urethra in boys with Bladder Instability
Radiology, 1992Co-Authors: H. M. Saxton, M Borzyskowski, L B RobinsonAbstract:Seven boys between the ages of 5 and 10 years with symptoms of urinary frequency and urgency and daytime wetting were studied with urodynamics and were shown to have Bladder Instability and a dilated posterior urethra. In two the dilatation occurred predominantly during Bladder filling. Unstable contractions caused filling of the posterior urethra, and leakage was prevented by voluntary contraction of the distal urethral sphincter; with voiding, the urethra showed a more normal appearance. In the remaining five, there were similar changes during filling, but dilatation persisted during voiding. In six the measured urine flow rate was normal, and none showed any evidence of anatomic obstruction. The mechanism of urethral distention appears to be similar to that previously shown in girls with spinning top urethra: Unstable contractions resisted by voluntary sphincter contraction cause posterior urethral dilatation. Boys with dilated posterior urethras who have urinary frequency and urgency and daytime wetti...
B Jacobsson - One of the best experts on this subject based on the ideXlab platform.
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recognition of Bladder Instability on voiding cystourethrography in infants with urinary tract infection
The Journal of Urology, 2001Co-Authors: M Bachelard, G Verkauskas, M Bertilsson, Jodal U U Sillen, B JacobssonAbstract:Purpose: We evaluate voiding cystourethrography as a method for identifying Bladder Instability in infants.Materials and Methods: Cystometry was combined with voiding cystourethrography in 79 male and 64 female infants with first time urinary tract infection. Bladder wall irregularity, elongation of Bladder shape, and filling of the posterior urethra were transient radiological signs occurring during Bladder filling and were considered to reflect Bladder Instability. A pediatric radiologist looked for these signs on all 480 films exposed during Bladder filling. The results were correlated to simultaneous detrusor pressure recordings. The analysis was repeated independently by a urologist to evaluate the reliability of the radiological signs used.Results: The sensitivity and specificity were both 90% in the evaluation of radiological signs of Bladder Instability. Filling of the posterior urethra was the least frequently reported radiological sign, which was seen at 53% of unstable contractions. However, wh...
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RECOGNITION OF Bladder Instability ON VOIDING CYSTOURETHROGRAPHY IN INFANTS WITH URINARY TRACT INFECTION
The Journal of urology, 2001Co-Authors: M Bachelard, G Verkauskas, M Bertilsson, U. Jodal U. Sillén, B JacobssonAbstract:We evaluate voiding cystourethrography as a method for identifying Bladder Instability in infants. Cystometry was combined with voiding cystourethrography in 79 male and 64 female infants with first time urinary tract infection. Bladder wall irregularity, elongation of Bladder shape, and filling of the posterior urethra were transient radiological signs occurring during Bladder filling and were considered to reflect Bladder Instability. A pediatric radiologist looked for these signs on all 480 films exposed during Bladder filling. The results were correlated to simultaneous detrusor pressure recordings. The analysis was repeated independently by a urologist to evaluate the reliability of the radiological signs used. The sensitivity and specificity were both 90% in the evaluation of radiological signs of Bladder Instability. Filling of the posterior urethra was the least frequently reported radiological sign, which was seen at 53% of unstable contractions. However, when this sign was reported, Instability was usually correctly detected (85%). Evaluation accuracy had improved with increasing numbers of noted signs per film. This accuracy had included 29%, 67% and 91% of unstable contractions that were correctly diagnosed when 1, 2 or 3 signs were noted, respectively. The number of noted signs was positively related to the strength of the unstable detrusor contraction. Urologist evaluations had similar results to the radiologist, although the sensitivity was somewhat lower (79% and 90%, respectively). Unstable detrusor contractions could be identified in infants by evaluation of radiological signs on voiding cystourethrography. Findings of Bladder wall irregularity, elongation of Bladder shape and filling of the posterior urethra indicated unstable detrusor contraction. The more such findings are observed, the stronger the indication.
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URODYNAMIC PATTERN IN INFANTS WITH URINARY TRACT INFECTION
The Journal of urology, 1998Co-Authors: M Bachelard, U. Jodal U. Sillén, Sverker Hansson, G. Hermansson, Ulf Jodal, B JacobssonAbstract:AbstractPurpose: We studied the urodynamic pattern in infants with urinary tract infection and evaluated the influence of the infection.Materials and Methods: Cystometry was combined with voiding cystourethrography (video cystometry) and 90 male and 68 female infants admitted to the hospital with first time urinary tract infection. Evaluation was performed 1 to 30 days (mean 11) and 32 to 78 days (mean 46) after diagnosis in 93 and 65 infants, respectively.Results: Bladder Instability was found in two-thirds of male and female infants. Compared to older children male infants had high voiding detrusor pressure and low Bladder capacity (hypercontractility). Female infants also had increased voiding pressure levels but they were significantly lower than those in male infants. The voiding detrusor pressure was even higher in both sexes when evaluation was delayed after the infection.Conclusions: Infants with urinary tract infection have Bladder Instability and hypercontractility compared to older children. Bl...
H. M. Saxton - One of the best experts on this subject based on the ideXlab platform.
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Nonobstructive posterior urethral widening (spinning top urethra) in boys with Bladder Instability.
Radiology, 1992Co-Authors: H. M. Saxton, M Borzyskowski, L B RobinsonAbstract:Seven boys between the ages of 5 and 10 years with symptoms of urinary frequency and urgency and daytime wetting were studied with urodynamics and were shown to have Bladder Instability and a dilated posterior urethra. In two the dilatation occurred predominantly during Bladder filling. Unstable contractions caused filling of the posterior urethra, and leakage was prevented by voluntary contraction of the distal urethral sphincter; with voiding, the urethra showed a more normal appearance. In the remaining five, there were similar changes during filling, but dilatation persisted during voiding. In six the measured urine flow rate was normal, and none showed any evidence of anatomic obstruction. The mechanism of urethral distention appears to be similar to that previously shown in girls with spinning top urethra: Unstable contractions resisted by voluntary sphincter contraction cause posterior urethral dilatation. Boys with dilated posterior urethras who have urinary frequency and urgency and daytime wetting and normal urine flow rates should be assumed to have Bladder Instability.
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nonobstructive posterior urethral widening spinning top urethra in boys with Bladder Instability
Radiology, 1992Co-Authors: H. M. Saxton, M Borzyskowski, L B RobinsonAbstract:Seven boys between the ages of 5 and 10 years with symptoms of urinary frequency and urgency and daytime wetting were studied with urodynamics and were shown to have Bladder Instability and a dilated posterior urethra. In two the dilatation occurred predominantly during Bladder filling. Unstable contractions caused filling of the posterior urethra, and leakage was prevented by voluntary contraction of the distal urethral sphincter; with voiding, the urethra showed a more normal appearance. In the remaining five, there were similar changes during filling, but dilatation persisted during voiding. In six the measured urine flow rate was normal, and none showed any evidence of anatomic obstruction. The mechanism of urethral distention appears to be similar to that previously shown in girls with spinning top urethra: Unstable contractions resisted by voluntary sphincter contraction cause posterior urethral dilatation. Boys with dilated posterior urethras who have urinary frequency and urgency and daytime wetti...
Rien J.m. Nijman - One of the best experts on this subject based on the ideXlab platform.
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Vesicoureteral reflux and videourodynamic studies: results of a prospective study.
Urology, 2000Co-Authors: Juriën Willemsen, Rien J.m. NijmanAbstract:Objectives. To study the influence of Bladder Instability on the conservative management and surgical treatment of children with vesicoureteral reflux (VUR), 102 children were included in a prospective study. Methods. During a 5-year period all children suspected to have VUR underwent a videourodynamic study to determine VUR grade and Bladder function. This resulted in a group of 36 boys and 66 girls who were followed up for well over 5 years. Results. Bladder Instability was found in 41 of 102 children (40%). The 102 children were either treated conservatively or surgically. Of the 77 children who were treated conservatively, Bladder Instability was found in 35 patients. In the conservatively treated group with Bladder Instability, reflux resolved in 57%; whereas in those with normal Bladder function, reflux resolved in 67%. Of the 25 patients who were treated surgically, the operation was successful in 91%. Breakthrough infections occurred in 22 girls and 3 boys, including 14 of 41 patients with Bladder Instability (34%) and 11 of 61 patients with normal Bladder function (18%). Conclusions. Bladder Instability is a frequent finding and an important factor in the treatment of children with VUR. To determine if a patient has VUR and Bladder Instability a videourodynamic study has proved to be an easy and efficient diagnostic tool. When Bladder Instability is treated with anticholinergic medication, almost the same results can be expected from conservative treatment as from surgical treatment compared to children with a normal Bladder function. Breakthrough urinary tract infections occur more often in girls and tend to occur more often in children with Bladder Instability.
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Vesicoureteric reflux and videourodynamic studies: Results of a prospective study after three years of follow-up
Urology, 1994Co-Authors: Roelof J. Scholtmeijer, Rien J.m. NijmanAbstract:Objective. To study prospectively the influence of videourodynamic studies on the management of children with vesicoureteric reflux. Methods. One hundred one children with reflux were investigated routinely with videourodynamic studies, as well as renal scans, ultrasound studies, and/or intravenous urograms. The studies were repeated at one, three, and five years. If Bladder Instability was demonstrated, the primary treatment consisted of anticholinergic drugs and antibiotics, regardless of the grade of reflux. In reflux Grades IV and V with Instability and renal scars, surgery was performed. In case of a stable Bladder, reflux Grades I–III received antibacterial treatment, while surgical correction was used for reflux Grades IV and V. Results. The results of three years of follow-up of 101 children are reported. Bladder Instability was found in 39 children. Thirty of them with reflux Grades I–-IV and Instability could be managed with anticholinergic and antibacterial drugs, while 9 needed surgical correction. Conclusions. A voiding cystourethrogram is only sufficient for the detection of reflux but for correct management of these children a (video) urodynamic study is mandatory. After treatment of frequently found Bladder dysfunction, the reflux will disappear in the majority of cases.
Siegfried Mense - One of the best experts on this subject based on the ideXlab platform.
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Mechanisms underlying the pathogenesis of urinary Bladder Instability - new perspectives for the treatment of reflex incontinence.
Restorative neurology and neuroscience, 1999Co-Authors: Peter Callsen-cencic, Siegfried MenseAbstract:The urine storage ability of the urinary Bladder is markedly impaired following inflammation of the urinary Bladder and spinal cord injury because of a hyperexcitability of micturition reflexes. Using two rat models of inflammation-induced Bladder overactivity and detrusor hyper-reflexia following spinal cord injury we investigated changes in the neuronal pathways to the urinary Bladder which may underlie the development of this Instability. Our results suggest that among the factors involved in inflammation-induced Bladder Instability are significant changes in the expression of the neuropeptides substance P, calcitonin gene-related peptide and galanin at the primary afferent level, as well as of the enzyme neuronal nitric oxide synthase (nNOS) at the afferent and postganglionic efferent level. In the lumbar and sacral spinal cord nNOS-immunoreactivity was depleted from dorsal horn neurones in both cystitis and spinal cord injured rats and from preganglionic parasympathetic neurones after spinal cord injury. Distension of the Bladder in chronically spinalized rats elicited c-Fos expression in a significantly greater number of neurones throughout the lumbar and sacral segments than in rats with an intact neuraxis. Thus, under pathological conditions rather complicated changes in the synthesis of neuropeptides and nNOS occur at the primary afferent, spinal cord and postganglionic efferent level that together control the activity of the urinary Bladder. Further mechanisms like unmasking of silent synapses and axonal sprouting in the spinal cord might further contribute to an increase in activity in micturition reflex pathways. Local cooling of the dorsal spinal cord at the level L6/S1 with temperatures between 14 and 20 degrees C proved a simple technique to control the unstable Bladder and restore continence in both inflammation-induced detrusor overactivity and detrusor hyperreflexia following spinal cord injury. The effects of cooling are probably the result of a blockade of synaptic transmission within the dorsal cord which eliminates neuronal overactivity. Thus, local spinal cord cooling could offer a new method to treat Bladder Instability and reflex incontinence.
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Mechanisms underlying the pathogenesis of urinary Bladder Instability - new perspectives for the treatment of reflex incontinence.
Restorative neurology and neuroscience, 1999Co-Authors: Peter Callsen-cencic, Siegfried MenseAbstract:The urine storage ability of the urinary Bladder is markedly impaired following inflammation of the urinary Bladder and spinal cord injury because of a hyperexcitability of micturition reflexes. Using two rat models of inflammation-induced Bladder overactivity and detrusor hyper-reflexia following spinal cord injury we investigated changes in the neuronal pathways to the urinary Bladder which may underlie the development of this Instability. Our results suggest that among the factors involved in inflammation-induced Bladder Instability are significant changes in the expression of the neuropeptides substance P, calcitonin gene-related peptide and galanin at the primary afferent level, as well as of the enzyme neuronal nitric oxide synthase (nNOS) at the afferent and postganglionic efferent level. In the lumbar and sacral spinal cord nNOS-immunoreactivity was depleted from dorsal horn neurones in both cystitis and spinal cord injured rats and from preganglionic parasympathetic neurones after spinal cord injury. Distension of the Bladder in chronically spinalized rats elicited c-Fos expression in a significantly greater number of neurones throughout the lumbar and sacral segments than in rats with an intact neuraxis. Thus, under pathological conditions rather complicated changes in the synthesis of neuropeptides and nNOS occur at the primary afferent, spinal cord and postganglionic efferent level that together control the activity of the urinary Bladder. Further mechanisms like unmasking of silent synapses and axonal sprouting in the spinal cord might further contribute to an increase in activity in micturition reflex pathways. Local cooling of the dorsal spinal cord at the level L6/S1 with temperatures between 14 and 20 °C proved a simple technique to control the unstable Bladder and restore continence in both inflammation-induced detrusor overactivity and detrusor hyperreflexia following spinal cord injury. The effects of cooling are probably the result of a blockade of synaptic transmission within the dorsal cord which eliminates neuronal overactivity. Thus, local spinal cord cooling could offer a new method to treat Bladder Instability and reflex incontinence.
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ABOLITION OF CYSTITIS-INDUCED Bladder Instability BY LOCAL SPINAL CORD COOLING
The Journal of urology, 1998Co-Authors: Peter Callsen-cencic, Siegfried MenseAbstract:AbstractPurpose: The efficacy of lumbosacral spinal cord cooling for the suppression of reflex urinary incontinence was evaluated in a rat model of cystitis-induced Bladder Instability.Materials and Methods: In female Sprague-Dawley rats, overactivity of the detrusor muscle was induced by inflammation of the urinary Bladder. Isovolumetric intravesical pressure, urethral perfusion pressure and electromyographic (EMG) activity of the external urethral sphincter (EUS) were recorded simultaneously during repetitive local cooling (-2C or +15C) and rewarming (to 37C) of the dorsal L6/S1 spinal cord segments.Results: Mustard oil-induced inflammation led to a marked Instability of the urinary Bladder without affecting urethral outlet functions. Local cooling of the dorsal lumbosacral spinal cord with temperatures of −2C as well as +15C completely abolished Bladder voiding contractions in rats with an inflamed Bladder as well as in non-inflamed control animals. Cooling had little effect on the EMG activity of the ...