The Experts below are selected from a list of 117 Experts worldwide ranked by ideXlab platform
Sohier Elneil - One of the best experts on this subject based on the ideXlab platform.
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Urinary retention in women and sacral neuromodulation
International Urogynecology Journal, 2010Co-Authors: Sohier ElneilAbstract:The remit of this article is to provide an overview of urinary retention in women, taking into account the predisposing factors, aetiology, investigations and treatments. The information presented is based on a widespread search of the English literature using multiple library sites on the internet and on personal experience. Urinary retention occurs when there is Impaired Bladder Emptying, resulting in a high post-void urinary residual. It is often associated with restricted voiding. The aetiology is manifold and thus the symptomatic patient may present to the urologist, gynaecologist, neurologist or physician. Once the problem is identified, and predisposing factors excluded (e.g. opiates), the patient has to be investigated fully. In the Department of Uro-Neurology at the National Hospital for Neurology and Neurosurgery in the UK, we advocate the use of urethral sphincter assessments, including urethral pressure studies, ultrasound volume assessment and electromyography. This article will take a detailed look at all aspects of assessing these patients. In those in whom diagnosis is reached, sacral neuromodulation (SNM) is the treatment of choice. As a modality, SNM has its supporters but also its detractors. Thus, it is essential that all patients are fully counselled before undergoing this surgery. Urinary retention in women is still poorly understood. This article serves to demystify the issues raised in having this condition, by looking closely at the currently known science. It is clear that some patients may be diagnosed with Fowler’s syndrome and may thus be more treatable by SNM than others, but this still leaves a significant proportion of patients with no diagnosis and no satisfactory therapy. A great deal of work still needs to be done on the understanding of the pathogenesis, the provision of more distinct investigations and the development of better treatment modalities.
Karl-erik Andersson - One of the best experts on this subject based on the ideXlab platform.
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The many faces of Impaired Bladder Emptying.
Current opinion in urology, 2014Co-Authors: Karl-erik AnderssonAbstract:PURPOSE OF REVIEW Impaired Bladder Emptying is a common clinical problem for which currently no effective drug treatment is available. There has been an increasing interest in the condition, and the present review updates the terminology issues, common causes, and potential future pharmacological treatment possibilities. RECENT FINDINGS Impaired Bladder Emptying can be described in many ways, but general agreement on the terminology has not yet been reached. The disorder can have many underlying causes, including aging, Bladder outflow obstruction, diabetes mellitus, and neurogenic disturbances. There is no effective pharmacological treatment, and to what extent drug treatment of the associated morbidities (e.g., diabetes mellitus, Parkinson's disease, and multiple sclerosis) also can improve Impaired Bladder Emptying has only been investigated to a limited extent. SUMMARY Impaired Bladder Emptying may be caused by a spectrum of pathophysiologically defined disorders. To describe the condition, underactive Bladder (UAB) can be used as a general term, covering detrusor underactivity as the urodynamic diagnosis, and the UAB syndrome for its symptomatic manifestations. In order to understand UAB, identification of the underlying cause(s) is necessary. Effective pharmacologic therapy is lacking and further basic research is needed to find targets for treatment.
Hishaam N Ismael - One of the best experts on this subject based on the ideXlab platform.
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reactivity of diabetic urinary Bladder to the cholinesterase inhibitor neostigmine
Urology, 2014Co-Authors: Seham Mustafa, Hishaam N IsmaelAbstract:Objective To examine the effects of neostigmine, an acetylcholinesterase inhibitor that has been used to treat Impaired Bladder Emptying on diabetic rat urinary Bladder smooth muscle. Methods Rat urinary detrusor muscle strips were suspended in organ baths containing Krebs' solution for isometric tension recording. Streptozotocin-diabetic (12 weeks) Bladder tissue activity compared with control was assessed by using electrical field stimulation (EFS) in the presence and absence of the cholinesterase inhibitor, neostigmine. Results EFS-induced contractions; a major part of it is cholinergic in origin. Neostigmine significantly enhanced EFS-induced contractions in diabetic strips than control at all frequencies. Neostigmine caused concentration-dependent contractions of control and diabetic Bladder tissues, which were completely abolished by atropine. Carbachol-induced Bladder contraction was significantly reduced in diabetes. Conclusion In diabetes mellitus, cholinesterase modulation (increase) may play a role in the development of inadequate Bladder contraction, seen in later stage diabetic Bladder dysfunction.
Gommert Van Koeveringe - One of the best experts on this subject based on the ideXlab platform.
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Prediction of sacral neuromodulation treatment success in men with Impaired Bladder Emptying-time for a new diagnostic approach.
Neurourology and urodynamics, 2016Co-Authors: Kevin Rademakers, Jamie Drossaerts, Philip Van Kerrebroeck, Matthias Oelke, Gommert Van KoeveringeAbstract:Introduction Detrusor underactivity (DU) is currently a topic that receives major attention within functional urology. Urologists are often confronted with men who present with voiding dysfunction without Bladder outlet obstruction (BOO) or after desobstructive or neuromodulation treatment. Their Impaired Bladder Emptying is suspected to be related to failure of detrusor contractile function. Earlier research indicated that patients with non-obstructive urinary retention (NOR), for example, detrusor underactivity (DU), have a lower success rate after sacral neuromodulation (SNM) compared to patients treated with SNM for storage dysfunction. However, predicting factors for treatment success in the NOR group have not yet been defined. Methods and evidence The aim of this study was to assess whether the use of the new BOO-contractility (Maastricht-Hannover) nomogram can identify and predict SNM non-responders. Our results in 18 men showed that only 20% of patients below the 10th percentile, but 86% of men between the 10 and 25th percentiles of the nomogram can be treated successfully with SNM. All successfully treated patients voided without needing self- catheterisation. Conclusions This pilot study showed for the first time that SNM treatment response in male patients with Impaired Bladder Emptying can be predicted with the BOO-contractility (Maastricht-Hannover) nomogram. Men below the 10th percentile are likely to be treatment non-responders, whereas the majority of men above the 10th percentile are responders. Neurourol. Urodynam. 36:808-810, 2017. © 2016 Wiley Periodicals, Inc.
Michael B Chancellor - One of the best experts on this subject based on the ideXlab platform.
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Differential diagnosis and treatment of Impaired Bladder Emptying.
Reviews in urology, 2004Co-Authors: Naoki Yoshimura, Michael B ChancellorAbstract:Although much attention is paid to urinary incontinence, the condition of incomplete Bladder Emptying is becoming more common with the aging of the US population and the widespread use of anticholinergic drugs to treat overactive Bladder. This disorder can often be silent until end-stage presentation of overflow incontinence. In this article, we review the pathophysiologic conditions of the Bladder and urethra that can cause Impaired Bladder Emptying and discuss how to evaluate and screen the patient with a Bladder that does not empty. In addition, we provide an overview of treatment options available for Impaired Bladder Emptying and consider the research that is under way to find the best therapies for the failing Bladder.