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G Monfort - One of the best experts on this subject based on the ideXlab platform.
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Persistent urination disorders after treatment of posterior urethral valve: incidence and semiology
Archives de pediatrie : organe officiel de la Societe francaise de pediatrie, 1997Co-Authors: J M Guys, B Meyrat, J Siméoni-alias, M Coquet, G MonfortAbstract:Micturition disorders were studied retrospectively in a series of 165 children over a period of 15 years. Among patients without lesions of the upper tract at the time of diagnosis (group A, n = 131), 18 (14%) had persistent nocturnal and Diurnal Enuresis: one urethral stenosis and six vesicoureteric reflux required surgery; three experienced persistent pollakiuria and Enuresis. Among patients with upper urinary tract damage at the time of diagnosis (group B, n = 34), seven presented with recurrent urinary tract infection, five with nocturnal and Diurnal Enuresis and three with urolithiasis. In the long term, only 52% of them had normal renal function and two were successfully transplanted. Micturition disorders following treatment of posterior urethral valves are frequent and usually related to the so-called valve bladder syndrome. Iatrogenic complications and mortality rate have dramatically decreased during the recent years but long-term renal function impairment remains the most critical problem.
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Les troubles mictionnels persistant après traitement d'une valve de l'urètre postérieur: incidence et sémiologie
Archives de Pédiatrie, 1997Co-Authors: J M Guys, B Meyrat, J Siméoni-alias, M Coquet, G MonfortAbstract:Micturition disorders were studied retrospectively in a series of 165 children over a period of 15 years. Among patients without lesions of the upper tract at the time of diagnosis (group A, n = 131), 18 (14%) had persistent nocturnal and Diurnal Enuresis: one urethral stenosis and six vesicoureteric reflux required surgery; three experienced persistent pollakiuria and Enuresis. Among patients with upper urinary tract damage at the time of diagnosis (group B, n = 34), seven presented with recurrent urinary tract infection, five with nocturnal and Diurnal Enuresis and three with urolithiasis. In the long term, only 52% of them had normal renal function and two were successfully transplanted. Micturition disorders following treatment of posterior urethral valves are frequent and usually related to the so-called valve bladder syndrome. Iatrogenic complications and mortality rate have dramatically decreased during the recent years but long-term renal function impairment remains the most critical problem.
Fumihiko Ikoma - One of the best experts on this subject based on the ideXlab platform.
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Lower urinary tract problems in patients with Enuresis.
European urology, 1998Co-Authors: Hiroki Shima, Yoshinori Mori, Michio Nojima, Iwai Miyamoto, Hirofumi Chokyu, Fumihiko IkomaAbstract:Two hundred and thirty-eight children (170 males, and 68 females) with nocturnal Enuresis were retrospectively studied for lower urinary tract problems. Surgical correction of subclinical organic obstruction in the lower urinary tract was evaluated for the improvement of bed-wetting. One hundred and fifty-five micturating cystourethrography (MCU), and 89 urodynamic studies were performed. Optic internal urethrotomy was done in a boy, and meatoplasty in a girl for urethral 'ring' stenosis (URS). Nocturnal Enuresis was found in 153 cases and nocturnal Enuresis associated with daytime Enuresis in 67 cases. Vesicoureteral reflux was found in 30, URS in 42, and posterior urethral valve in 3 cases on MCU. Detrusor instability was recognized in 39.4% of 38 cases of nocturnal Enuresis associated with daytime Enuresis and in 25.0% of 51 cases of nocturnal Enuresis. Surgery brought 73.8% improvement of bed-wetting in 42 cases. Surgical correction of subclinical obstruction in the lower urinary tract might contribute to the earlier resolution of bed-wetting in children with nocturnal and/or Diurnal Enuresis.
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Lower urinary tract problems in patients with Enuresis
European Urology, 1998Co-Authors: Hiroki Shima, Yoshinori Mori, Michio Nojima, Iwai Miyamoto, Hirofumi Chokyu, Fumihiko IkomaAbstract:Objective(s): Two hundred and thirty-eight children (170 males, and 68 females) with nocturnal Enuresis were retrospectively studied for lower urinary tract problems. Surgical correction of subclinical organic obstruction in the lower urinary tract was evaluated for the improvement of bed-wetting. Methods: One hundred and fifty-five micturating cystourethrography (MCU), and 89 urodynamic studies were performed. Optic internal urethrotomy was done in a boy, and meatoplasty in a girl for urethral ‘ring’ stenosis (URS). Results: Nocturnal Enuresis was found in 153 cases and nocturnal Enuresis associated with daytime Enuresis in 67 cases. Vesicoureteral reflux was found in 30, URS in 42, and posterior urethral valve in 3 cases on MCU. Detrusor instability was recognized in 39.4% of 38 cases of nocturnal Enuresis associated with daytime Enuresis and in 25.0% of 51 cases of nocturnal Enuresis. Surgery brought 73.8% improvement of bed-wetting in 42 cases. Conclusions: Surgical correction of subclinical obstruction in the lower urinary tract might contribute to the earlier resolution of bed-wetting in children with nocturnal and/or Diurnal Enuresis.
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Congenital lower urinary tract obstruction and Enuresis in children
The Japanese Journal of Urology, 1991Co-Authors: Yoshinori Mori, Keizou Taguchi, Shouzou Hosokawa, Hideari Ihara, Hiroki Shima, Kenji Shimada, Masaaki Arima, Fumihiko IkomaAbstract:We reviewed enuretic children among patients with congenital lower urinary tract obstructions experienced in the Department of Urology, Hyogo College of Medicine during 16 years from 1974 to 1989. Among 612 patients with congenital lower urinary tract obstructions, 139 (22.7%) had Enuresis nocturna and/or diurna. The incidence of Enuresis was 24.7% with posterior urethral valve (77 cases), 50.0% with anterior urethral valve (6 cases), 23.8% with congenital bulbar urethral stenosis in boys (303 cases) and 19.9% with congenital distal urethral stenosis in girls (226 cases). Diurnal Enuresis was more common in Enuresis associated with congenital lower urinary tract obstructions than in usual Enuresis. In urodynamic examinations, more than half of enuretic children with congenital lower urinary obstructions showed hyperactive detrusor activity. Treatment of congenital lower urinary tract obstructions through operation resulted in cure or amelioration of Enuresis in about 80% of the patients. Enuresis associated with lower urinary tract obstruction or neurogenic bladder is sometimes called complicated Enuresis and it is an important role of a urologist to differentiate complicated Enuresis from simple Enuresis.
Donna Mc Tavish - One of the best experts on this subject based on the ideXlab platform.
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Terodiline
Drugs, 1990Co-Authors: Heather D. Langtry, Donna Mc TavishAbstract:Synopsis Terodiline has both anticholinergic and calcium antagonist properties and, as a result, effectively reduces abnormal bladder contractions caused by detrusor instability. When administered to adult patients with urge incontinence (generally as a 25mg twice-daily dose) terodiline reduces Diurnal and nocturnal micturition frequency and incontinence episodes. In studies also assessing cystometric parameters, bladder volume at first urge and bladder capacity are increased. Children with Diurnal enures is respond similarly to a daily 25 m g dose. Several studies have shown that terodiline 50 mg/day is preferred by patients when compared with emepronium 600 mg/day or flavoxate 600 mg/day, and tends to reduce voluntary micturition frequency and episodes of incontinence more effectively than these drugs. Terodiline is well tolerated in short and long term (up to 3.5 years) studies. Anticholinergic effects are most commonly reported; other adverse effects occur equally during terodiline and placebo treatment. Thus, terodiline is effective and well tolerated in patients with urge incontinence or neurogenic bladder dysfunction, and will claim an important place in the treatment of such patients in light of the limitations of alternative therapies. Overview of Pharmacological Properties In vitro studies in isolated animal and human detrusor muscle have shown that terodiline possesses anticholinergic activity at concentrations of 5 μmol/L or less: it inhibits carbachol-induced muscle contractions in a concentration-dependent manner. An interaction between terodiline and muscarinic receptors has also been demonstrated in vitro . In addition, at higher concentrations terodiline inhibits calcium-induced contractions in depolarised rabbit aorta and pregnant human uterus, and reduces potassium-induced contraction in isolated rabbit detrusor muscle, indicating a calcium antagonist effect. Unlike verapamil and nifedipine, terodiline showed specific calcium antagonism in bladder tissue. Terodiline exhibits local anaesthetic and spasmolytic activity which may also contribute to its overall clinical efficacy. After oral administration, terodiline is rapidly absorbed: a mean absolute bioavailability of 92% and a mean peak plasma concentration of 32 μg/L were reached 4 hours after a 12.5mg dose in healthy volunteers. Steady-state terodiline concentrations are dose related, and are achieved after 10 to 14 days of administration because of its slow elimination (mean elimination half-life is about 60 hours but this increases to about 130 hours in elderly inpatients). Terodiline is extensively metabolised, mainly via hydroxylation, with only 15% of a dose excreted unchanged in urine. The major metabolite in humans is parahydroxyterodiline; this compound is pharmacologically active but is present in small quantities only. The reduced elimination of terodiline in elderly inpatients resulting in increased serum drug levels for a given dose suggests that a reduced dosage is warranted in these patients. Therapeutic Use Noncomparative studies in patients with urge incontinence have shown that terodiline 37.5 to 50 mg/day reduces the number of day- and night-time voluntary micturitions and episodes of incontinence, and improves bladder volume at first urge and bladder capacity. These changes were noted over treatment periods of up to 3.5 years duration. Furthermore, over 70% of patients preferred terodiline therapy to the pretreatment runin period. Japanese studies have demonstrated similar benefits in patients with idiopathic or neurogenic urinary incontinence using daily doses of 24mg. Compared with placebo, terodiline consistently improves subjective and objective symptoms of urge incontinence. In the largest study, a typical 50mg daily dose administered for 8 weeks was significantly superior to placebo with regard to reducing 24-hour micturition frequency and incontinence episodes, daytime micturitions and average voided volume, and increasing bladder capacity. Similar benefits have been noted in children with Diurnal Enuresis treated with terodiline 25 mg/day; in children with subnormal (
Heather D. Langtry - One of the best experts on this subject based on the ideXlab platform.
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Terodiline
Drugs, 1990Co-Authors: Heather D. Langtry, Donna Mc TavishAbstract:Synopsis Terodiline has both anticholinergic and calcium antagonist properties and, as a result, effectively reduces abnormal bladder contractions caused by detrusor instability. When administered to adult patients with urge incontinence (generally as a 25mg twice-daily dose) terodiline reduces Diurnal and nocturnal micturition frequency and incontinence episodes. In studies also assessing cystometric parameters, bladder volume at first urge and bladder capacity are increased. Children with Diurnal enures is respond similarly to a daily 25 m g dose. Several studies have shown that terodiline 50 mg/day is preferred by patients when compared with emepronium 600 mg/day or flavoxate 600 mg/day, and tends to reduce voluntary micturition frequency and episodes of incontinence more effectively than these drugs. Terodiline is well tolerated in short and long term (up to 3.5 years) studies. Anticholinergic effects are most commonly reported; other adverse effects occur equally during terodiline and placebo treatment. Thus, terodiline is effective and well tolerated in patients with urge incontinence or neurogenic bladder dysfunction, and will claim an important place in the treatment of such patients in light of the limitations of alternative therapies. Overview of Pharmacological Properties In vitro studies in isolated animal and human detrusor muscle have shown that terodiline possesses anticholinergic activity at concentrations of 5 μmol/L or less: it inhibits carbachol-induced muscle contractions in a concentration-dependent manner. An interaction between terodiline and muscarinic receptors has also been demonstrated in vitro . In addition, at higher concentrations terodiline inhibits calcium-induced contractions in depolarised rabbit aorta and pregnant human uterus, and reduces potassium-induced contraction in isolated rabbit detrusor muscle, indicating a calcium antagonist effect. Unlike verapamil and nifedipine, terodiline showed specific calcium antagonism in bladder tissue. Terodiline exhibits local anaesthetic and spasmolytic activity which may also contribute to its overall clinical efficacy. After oral administration, terodiline is rapidly absorbed: a mean absolute bioavailability of 92% and a mean peak plasma concentration of 32 μg/L were reached 4 hours after a 12.5mg dose in healthy volunteers. Steady-state terodiline concentrations are dose related, and are achieved after 10 to 14 days of administration because of its slow elimination (mean elimination half-life is about 60 hours but this increases to about 130 hours in elderly inpatients). Terodiline is extensively metabolised, mainly via hydroxylation, with only 15% of a dose excreted unchanged in urine. The major metabolite in humans is parahydroxyterodiline; this compound is pharmacologically active but is present in small quantities only. The reduced elimination of terodiline in elderly inpatients resulting in increased serum drug levels for a given dose suggests that a reduced dosage is warranted in these patients. Therapeutic Use Noncomparative studies in patients with urge incontinence have shown that terodiline 37.5 to 50 mg/day reduces the number of day- and night-time voluntary micturitions and episodes of incontinence, and improves bladder volume at first urge and bladder capacity. These changes were noted over treatment periods of up to 3.5 years duration. Furthermore, over 70% of patients preferred terodiline therapy to the pretreatment runin period. Japanese studies have demonstrated similar benefits in patients with idiopathic or neurogenic urinary incontinence using daily doses of 24mg. Compared with placebo, terodiline consistently improves subjective and objective symptoms of urge incontinence. In the largest study, a typical 50mg daily dose administered for 8 weeks was significantly superior to placebo with regard to reducing 24-hour micturition frequency and incontinence episodes, daytime micturitions and average voided volume, and increasing bladder capacity. Similar benefits have been noted in children with Diurnal Enuresis treated with terodiline 25 mg/day; in children with subnormal (
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Terodiline. A review of its pharmacological properties, and therapeutic use in the treatment of urinary incontinence.
Drugs, 1990Co-Authors: Heather D. Langtry, Donna MctavishAbstract:Terodiline has both anticholinergic and calcium antagonist properties and, as a result, effectively reduces abnormal bladder contractions caused by detrusor instability. When administered to adult patients with urge incontinence (generally as a 25mg twice-daily dose) terodiline reduces Diurnal and nocturnal micturition frequency and incontinence episodes. In studies also assessing cystometric parameters, bladder volume at first urge and bladder capacity are increased. Children with Diurnal Enuresis respond similarly to a daily 25mg dose. Several studies have shown that terodiline 50 mg/day is preferred by patients when compared with emepronium 600 mg/day or flavoxate 600 mg/day, and tends to reduce voluntary micturition frequency and episodes of incontinence more effectively than these drugs. Terodiline is well tolerated in short and long term (up to 3.5 years) studies. Anticholinergic effects are most commonly reported; other adverse effects occur equally during terodiline and placebo treatment. Thus, terodiline is effective and well tolerated in patients with urge incontinence or neurogenic bladder dysfunction, and will claim an important place in the treatment of such patients in light of the limitations of alternative therapies.
Patrick H Mckenna - One of the best experts on this subject based on the ideXlab platform.
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interactive computer games for treatment of pelvic floor dysfunction
The Journal of Urology, 2001Co-Authors: C Anthony D Herndon, Marvalyn Decambre, Patrick H MckennaAbstract:Purpose: We reviewed our experience with a conservative medical program and computer game assisted pelvic floor muscle retraining in patients with voiding dysfunction to substantiate our previous findings that demonstrated improvement and/or cure in a majority of patients, and identify factors that may be associated with unsuccessful treatment.Materials and Methods: All patients presenting with symptoms of dysfunctional voiding enrolled in our pelvic floor muscle retraining were examined. Cases were subjectively evaluated for improvement of nocturnal Enuresis, Diurnal Enuresis, constipation, encopresis and incidence of break through urinary tract infection. Patients in whom our initial conservative approach that included our biofeedback program failed were further treated with medication, and outcomes were reviewed as well. Fisher’s exact test was used for statistical analysis to identify factors that may predict failure with our program.Results: During the last 2 years 134 girls and 34 boys were enrolled...
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pelvic floor muscle retraining for pediatric voiding dysfunction using interactive computer games
The Journal of Urology, 1999Co-Authors: Patrick H Mckenna, C Anthony D Herndon, Susan Connery, Fernando A. FerrerAbstract:AbstractPurpose: We evaluated a new noninvasive outpatient method of pelvic muscle retraining in children using computer game assisted biofeedback.Materials and Methods: All patients in whom voiding dysfunction was confirmed by history, uroflowmetry-electromyography and voiding cystourethrography were enrolled in a pelvic floor muscle retraining program. Patients received a pretreatment, mid treatment and posttreatment survey instrument documenting subjective improvement, including the frequency of Diurnal Enuresis, nocturnal Enuresis, constipation and encopresis. Pretreatment and posttreatment simultaneous uroflowmetry surface electrode electromyography was performed and post-void residual urine volume was determined in all patients.Results: A total of 8 boys and 33 girls 5 to 11 years old (mean age 7.2) completed therapy and were available for evaluation. These patients completed 2 to 11 (average 6) hourly treatment sessions. Followup was 3 to 15 months (average 7). At the midterm evaluation improvement...