BACKGROUND Prostate cancer is a major disease impacting men’s health worldwide.Peplau,who is known as“the mother of psychiatric society,”developed an interpersonal relationship theory for nursing.Implementation of ...BACKGROUND Prostate cancer is a major disease impacting men’s health worldwide.Peplau,who is known as“the mother of psychiatric society,”developed an interpersonal relationship theory for nursing.Implementation of this theory in practice has been shown to positively impact patients’quality of life and reduce adverse symptoms after surgery.AIM To investigate the effects of a nursing model based on Peplau’s interpersonal relationship theory combined with bladder function training on patients with prostate cancer.METHODS Eighty-nine patients with prostate cancer who underwent transurethral resection of the prostate(TURP)participated in this study.These patients were admitted to The First Affiliated Hospital of Soochow University or Dushu Lake Hospital Affiliated to Soochow University between January 2020 and April 2021.Patients were randomized into either the Peplau nursing group(n=44)or a routine nursing group(n=45).The routine nursing group received routine care and bladder function training,while the Peplau care group received care that integrated concepts from the Peplau interpersonal relationship theory as well as bladder function training.The urinary incontinence symptoms of the two groups were recorded,and the respective International Prostate Symptom Scores(IPSS),Functional Assessment of Chronic Illness Therapy-Spiritual Well-Being(FACIT-Sp)scores,and quality of life(QOL)scores for each group were compared before and after three months of nursing intervention.RESULTS During the intervention period,the duration of urinary incontinence,frequency,number and amount of urinary incontinence were significantly greater in the routine nursing group compared to the Peplau care group(P<0.05).The indicators of the routine nursing group were 7.13±2.42 days,8.23±2.75 times,and 1.24±0.42 L,while those of the Peplau care group were 4.74±1.85 d,4.21±1.26 times,and 0.56±0.11 L,respectively.After three months of intervention,the mean IPSS score of the routine nursing group was significantly reduced(P<0.05),while the mean FACIT-Sp and QOL scores were significantly increased(P<0.05).The mean IPSS score in the Peplau nursing group was significantly lower compared to the routine nursing group,while the FACIT-Sp and QOL scores were higher(P<0.05).CONCLUSION A nursing model based on Peplau’s interpersonal relationship theory combined with bladder function training can significantly improve prostate function and urinary symptoms,resulting in the restoration of physiological function and improvement in the QOL of patients with prostate cancer following TURP.展开更多
We examined the effect of androgens on bladder blood flow （BBF）, bladder function and histological changes in castrated male rats. Male Wistar rats were classified into unoperated group （control group）, groups cas...We examined the effect of androgens on bladder blood flow （BBF）, bladder function and histological changes in castrated male rats. Male Wistar rats were classified into unoperated group （control group）, groups castrated at the age of 8weeks （group 8wPC） and groups castrated at the age of 4weeks （group 4wPC）. Each rat was used at the age of 20weeks. BBF was measured using fluorescent microspheres. Bladder cystometry was performed without anesthesia or restraint; the bladder was first irrigated with saline and then with 0.25% acetic acid （AA） solution. Maximum voiding pressure and voiding interval were measured. The bladder and lilac artery were histologically examined for differences in smooth muscle and quantity of collagen fiber to analyze the effect of castration on the smooth muscle content. No differences were noted in BBF following castration. The voiding intervals for all groups were shortened （P 〈 0.001） following AA irrigation. No significant difference was noted in the maximum voiding pressure. Histological changes were observed in bladder and lilac artery. Smooth muscle/collagen ratio at the bladder was lower in groups 8wPC and 4wPC compared to the control group （P 〈 0.01）, while that at the lilac artery was decreased in group 4wPC compared to the control group （P〈 0.001）. In conclusion, our findings indicate that castration does not alter BBF, but leads to histological changes in the bladder as well as its associated blood vessels.展开更多
Objective: to observe the effect of multidisciplinary cooperative intervention on the recovery of bladder function after radical hysterectomy. Methods: 96 patients with extensive total hysterectomy received in our dep...Objective: to observe the effect of multidisciplinary cooperative intervention on the recovery of bladder function after radical hysterectomy. Methods: 96 patients with extensive total hysterectomy received in our department from July 2019 to December 2020 were taken as observation objects and divided into two groups. The first group used routine nursing intervention and the second group used multidisciplinary cooperation intervention on the basis of the first group. The nursing effect and bladder dysfunction score of the two groups were compared, with 48 patients in each group. Results: (1) the infection rate of urinary system in the first group was significantly higher than that in the second group. The indwelling time of urinary catheter in the second group was longer than that in the second group. There was a difference between the two groups (P < 0.05). (2) The score of bladder dysfunction before and one month after operation in the first group was higher than that in the second group, with difference between the two groups (P < 0.05). Conclusion: multidisciplinary cooperative intervention is effective for patients with extensive total hysterectomy and is recommended.展开更多
Objective: to discuss the effect of laparoscopic radical prostatectomy for prostate cancer in patients with prostate cancer, and explore the effect of this treatment method on the improvement of bladder function. Meth...Objective: to discuss the effect of laparoscopic radical prostatectomy for prostate cancer in patients with prostate cancer, and explore the effect of this treatment method on the improvement of bladder function. Methods: 80 cases of prostate cancer patients received treatment in our hospital were selected as the object of the study, and then they were divided into equal groups, respectively as the control group and observation group. In the grouping study, patients in the control group were treated with open radical prostatectomy, while patients in the observation group were treated with laparoscopic radical prostatectomy. At the end of the study, the clinical indicators and improvement of bladder function of patients in the two groups were compared. Results: the clinical indicators and bladder function improvement data of the control group were compared for reference, and the observation group had significant advantages, P<0.05. Conclusion: in patients with prostate cancer treated by laparoscopic radical prostatectomy, clinical indicators and bladder function are improved, which has a positive impact on the improvement of prognosis and quality of life of patients.展开更多
We investigated the impact and predictive value of bladder function in patients with benign prostatic hyperplasia(BPH)on the efficacy of transurethral prostatectomy.Symptomatic,imaging,and urodynamic data of patients ...We investigated the impact and predictive value of bladder function in patients with benign prostatic hyperplasia(BPH)on the efficacy of transurethral prostatectomy.Symptomatic,imaging,and urodynamic data of patients who underwent transurethral prostatectomy at West China Hospital of Sichuan University(Chengdu,China)from July 2019 to December 2021 were collected.Follow-up data included the quality of life(QoL),International Prostate Symptom Score(IPSS),and IPSS storage and voiding(IPSS-s and IPSS-v).Moreover,urinary creatinine(Cr),nerve growth factor(NGF),brain-derived neurotrophic factor(BDNF),and prostaglandin estradiol(PGE2)were measured in 30 patients with BPH and 30 healthy participants.Perioperative indicators were determined by subgroup analyses and receiver operating characteristic(ROC)curve analysis.Among the 313 patients with BPH included,patients with severe micturition problems had more improvements but higher micturition grades postoperatively than those with moderate symptoms.Similarly,good bladder sensation,compliance,and detrusor contractility(Dc)were predictors of low postoperative IPSS and QoL.The urinary concentrations of BDNF/Cr,NGF/Cr,and PGE2/Cr in patients were significantly higher than those in healthy participants(all P<O.oo1).After evaluation,only DC was significantly related to both urinary indicators and postoperative recovery of patients.Patients with good DC,as predicted by urinary indicators,had lower IPSS and IPSS-v than those with reduced DC at the 1st month postoperatively(both P<0.05).In summary,patients with impaired bladder function had poor recovery.The combined levels of urinary BDNF/Cr,NGF/Cr,and PGE2/Cr in patients with BPH may be valid predictors of preoperative bladderfunction and postoperative recovery.展开更多
Schwann cell transplantation is considered one of the most promising cell-based therapy to repair injured spinal cord due to its unique growth-promoting and myelin-forming properties.A the Food and Drug Administration...Schwann cell transplantation is considered one of the most promising cell-based therapy to repair injured spinal cord due to its unique growth-promoting and myelin-forming properties.A the Food and Drug Administration-approved Phase I clinical trial has been conducted to evaluate the safety of transplanted human autologous Schwann cells to treat patients with spinal cord injury.A major challenge for Schwann cell transplantation is that grafted Schwann cells are confined within the lesion cavity,and they do not migrate into the host environment due to the inhibitory barrier formed by injury-induced glial scar,thus limiting axonal reentry into the host spinal cord.Here we introduce a combinatorial strategy by suppressing the inhibitory extracellular environment with injection of lentivirus-mediated transfection of chondroitinase ABC gene at the rostral and caudal borders of the lesion site and simultaneously leveraging the repair capacity of transplanted Schwann cells in adult rats following a mid-thoracic contusive spinal cord injury.We report that when the glial scar was degraded by chondroitinase ABC at the rostral and caudal lesion borders,Schwann cells migrated for considerable distances in both rostral and caudal directions.Such Schwann cell migration led to enhanced axonal regrowth,including the serotonergic and dopaminergic axons originating from supraspinal regions,and promoted recovery of locomotor and urinary bladder functions.Importantly,the Schwann cell survival and axonal regrowth persisted up to 6 months after the injury,even when treatment was delayed for 3 months to mimic chronic spinal cord injury.These findings collectively show promising evidence for a combinatorial strategy with chondroitinase ABC and Schwann cells in promoting remodeling and recovery of function following spinal cord injury.展开更多
Objective: To evaluate the results of a self-designed bladder controller for restoring micturition function in paraplegic dogs.Methods: The spinal cords of 4 dogs were transected above the cone. Electrodes were implan...Objective: To evaluate the results of a self-designed bladder controller for restoring micturition function in paraplegic dogs.Methods: The spinal cords of 4 dogs were transected above the cone. Electrodes were implanted in S2 bilaterally and connected to the subcutaneous receivers for external activation. Microsurgical technique was employed to perform dorsal rhizotomy of S1-3 intradurally. The dogs were stimulated daily to observe micturition. Urodynamic testing and vesicography were performed. Results: All the dogs acquired micturition under the control of electric stimulation, with urine volume 80-140 ml per time. The mode of micturition was post-stimulus voiding. Vesicography revealed that the bladder was filled well and the bladder neck was open in the micturition course of electric stimulation. Residual urine volume was 15-20 ml. Urodynamic testing found that the bladder pressure and intraurethral pressure increased simultaneously, but when the intraurethral pressure was greater than the bladder pressure, no micturition occurred. The pressure decreased to baseline rapidly and the bladder pressure decreased slowly between two bursts. Micturition occurred when the bladder pressure was greater than the intraurethral pressure.Conclusions: The self-designed bladder controller together with a sacral deafferentation procedure can restore micturition function of paraplegic dogs.展开更多
Background and Objective: Functional paraganglioma of the urinary bladder (FPUB) is a rare tumor. Misdiagnosis of FPUB before operation can lead to serious intraoperative consequences. In this article, we reported our...Background and Objective: Functional paraganglioma of the urinary bladder (FPUB) is a rare tumor. Misdiagnosis of FPUB before operation can lead to serious intraoperative consequences. In this article, we reported our experience in preoperative diagnosis and surgical treatment of FPUB. Methods: Clinical data of nine patients with FPUB treated between June 1985 and January 2009 at Peking Union Medical College Hospital were analyzed. Results: All patients underwent urinary catecholamine (CA) detection, B-ultrasound, CT and/or MRI scan; 5 underwent nailfola microcirculation inspection; 4 underwent 131I-metaiodobenzyl guanidine (MIBG) detection; and 6 underwent 111In-DTPA-Octreotide (OCT) scintiscan. According to the UICC bladder tumor classification, 5 patients had T2, 3 had T3, and 1 had T4 disease. All patients underwent surgical treatment, and 1 received 131I-MIBG therapy. All patients had paroxysmal hypertension and palpitation and six had cold sweat, headache, and dizziness after emphatic urination. The definitive diagnosis was made by histopathologic examination of the removed tumors and was confirmed in 7 cases by the immunohistochemical staining of chromogranin A, Ki-67 and S100 protein. The tumor consisted of discrete aggregates of zellballen cells separated by a network of vascular channels. One patient had metastases in the pelvic lymph nodes, liver and colon. Follow-up ranged from 7 to 289 months (mean, 127.2 ± 34.2). Six of the nine cases reported here were found in the usual locations. One patient had multiple tumors. The catecholamine level was elevated under basal conditions in 8 patients and during endoscopic resection of the tumor in 1 patient; it returned to normal after surgery in 8 patients. Three patients had recurrence and 1 had metastasis following surgery. Conclusions: Early preoperative diagnosis of FPUB is difficult, but it should be suspected in patients with typical tetrad symptoms: headache and micturition syncope, sweating, palpitation and hematuria. In those patients with unresectable multiple tumors, medicine and 131I-MIBG therapy may be helpful for controlling hypertension and delaying disease progression. Advanced classification (≥T3), multifocal tumors and CgA expression are risk factors of recurrence and metastasis.展开更多
Alterations in bladder function with aging are very common and are very likely to represent an increasing healthcare problem in the years to come with the general aging of the population.In this review the authors des...Alterations in bladder function with aging are very common and are very likely to represent an increasing healthcare problem in the years to come with the general aging of the population.In this review the authors describe the prevalence of lower urinary tract symptoms(LUTS)and comment upon potential mechanisms which may be responsible for the increasing prevalence of lower LUTS with increasing age,based on laboratory studies.It is clear that there is a complex interplay between the various components of the neural innervation structure of the bladder in leading to changes with age,which are likely to underpin the LUTS which are seen in the aging bladder.展开更多
AIM: To determine the influence of intra-abdominal pressure(IAP) on respiratory function after surgical repair of ventral hernia and to compare two different methods of IAP measurement during the perioperative period....AIM: To determine the influence of intra-abdominal pressure(IAP) on respiratory function after surgical repair of ventral hernia and to compare two different methods of IAP measurement during the perioperative period. METHODS: Thirty adult patients after elective repair of ventral hernia were enrolled into this prospective study.IAP monitoring was performed via both a balloontipped nasogastric probe [intragastric pressure(IGP), Ci MON, Pulsion Medical Systems, Munich, Germany] and a urinary catheter [intrabladder pressure(IBP), Uno Meter Abdo-Pressure Kit, Uno Medical, Denmark] on five consecutive stages:(1) after tracheal intubation(AI);(2) after ventral hernia repair;(3) at the end of surgery;(4) during spontaneous breathing trial through the endotracheal tube; and(5) at 1 h after tracheal extubation. The patients were in the complete supine position during all study stages.RESULTS: The IAP(measured via both techniques) increased on average by 12% during surgery compared to AI(P < 0.02) and by 43% during spontaneous breathing through the endotracheal tube(P < 0.01). In parallel, the gradient between РаСО2 and Et CO2 [Р(а-et)CO2] rose significantly, reaching a maximum during the spontaneous breathing trial. The PаO2/Fi O2 decreased by 30% one hour after tracheal extubation(P = 0.02). The dynamic compliance of respiratory system reduced intraoperatively by 15%-20%(P < 0.025). At all stages, we observed a significant correlation between IGP and IBP(r = 0.65-0.81, P < 0.01) with a mean bias varying from-0.19 mm Hg(2SD 7.25 mm Hg) to-1.06 mm Hg(2SD 8.04 mm Hg) depending on the study stage. Taking all paired measurements together(n = 133), the median IGP was 8.0(5.5-11.0) mm Hg and the median IBP was 8.8(5.8-13.1) mm Hg. The overall r2 value( n = 30) was 0.76(P < 0.0001). Bland and Altman analysis showed an overall bias for the mean values per patient of 0.6 mm Hg(2SD 4.2 mm Hg) with percentage error of 45.6%. Looking at changes in IAP between the different study stages, we found an excellent concordance coefficient of 94.9% comparing IBP and IGP( n = 117).CONCLUSION: During ventral hernia repair, the IAP rise is accompanied by changes in Р(а-et)CO2 and PаO2/Fi O2-ratio. Estimation of IAP via IGP or IBP demonstrated excellent concordance.展开更多
文摘BACKGROUND Prostate cancer is a major disease impacting men’s health worldwide.Peplau,who is known as“the mother of psychiatric society,”developed an interpersonal relationship theory for nursing.Implementation of this theory in practice has been shown to positively impact patients’quality of life and reduce adverse symptoms after surgery.AIM To investigate the effects of a nursing model based on Peplau’s interpersonal relationship theory combined with bladder function training on patients with prostate cancer.METHODS Eighty-nine patients with prostate cancer who underwent transurethral resection of the prostate(TURP)participated in this study.These patients were admitted to The First Affiliated Hospital of Soochow University or Dushu Lake Hospital Affiliated to Soochow University between January 2020 and April 2021.Patients were randomized into either the Peplau nursing group(n=44)or a routine nursing group(n=45).The routine nursing group received routine care and bladder function training,while the Peplau care group received care that integrated concepts from the Peplau interpersonal relationship theory as well as bladder function training.The urinary incontinence symptoms of the two groups were recorded,and the respective International Prostate Symptom Scores(IPSS),Functional Assessment of Chronic Illness Therapy-Spiritual Well-Being(FACIT-Sp)scores,and quality of life(QOL)scores for each group were compared before and after three months of nursing intervention.RESULTS During the intervention period,the duration of urinary incontinence,frequency,number and amount of urinary incontinence were significantly greater in the routine nursing group compared to the Peplau care group(P<0.05).The indicators of the routine nursing group were 7.13±2.42 days,8.23±2.75 times,and 1.24±0.42 L,while those of the Peplau care group were 4.74±1.85 d,4.21±1.26 times,and 0.56±0.11 L,respectively.After three months of intervention,the mean IPSS score of the routine nursing group was significantly reduced(P<0.05),while the mean FACIT-Sp and QOL scores were significantly increased(P<0.05).The mean IPSS score in the Peplau nursing group was significantly lower compared to the routine nursing group,while the FACIT-Sp and QOL scores were higher(P<0.05).CONCLUSION A nursing model based on Peplau’s interpersonal relationship theory combined with bladder function training can significantly improve prostate function and urinary symptoms,resulting in the restoration of physiological function and improvement in the QOL of patients with prostate cancer following TURP.
文摘We examined the effect of androgens on bladder blood flow （BBF）, bladder function and histological changes in castrated male rats. Male Wistar rats were classified into unoperated group （control group）, groups castrated at the age of 8weeks （group 8wPC） and groups castrated at the age of 4weeks （group 4wPC）. Each rat was used at the age of 20weeks. BBF was measured using fluorescent microspheres. Bladder cystometry was performed without anesthesia or restraint; the bladder was first irrigated with saline and then with 0.25% acetic acid （AA） solution. Maximum voiding pressure and voiding interval were measured. The bladder and lilac artery were histologically examined for differences in smooth muscle and quantity of collagen fiber to analyze the effect of castration on the smooth muscle content. No differences were noted in BBF following castration. The voiding intervals for all groups were shortened （P 〈 0.001） following AA irrigation. No significant difference was noted in the maximum voiding pressure. Histological changes were observed in bladder and lilac artery. Smooth muscle/collagen ratio at the bladder was lower in groups 8wPC and 4wPC compared to the control group （P 〈 0.01）, while that at the lilac artery was decreased in group 4wPC compared to the control group （P〈 0.001）. In conclusion, our findings indicate that castration does not alter BBF, but leads to histological changes in the bladder as well as its associated blood vessels.
文摘Objective: to observe the effect of multidisciplinary cooperative intervention on the recovery of bladder function after radical hysterectomy. Methods: 96 patients with extensive total hysterectomy received in our department from July 2019 to December 2020 were taken as observation objects and divided into two groups. The first group used routine nursing intervention and the second group used multidisciplinary cooperation intervention on the basis of the first group. The nursing effect and bladder dysfunction score of the two groups were compared, with 48 patients in each group. Results: (1) the infection rate of urinary system in the first group was significantly higher than that in the second group. The indwelling time of urinary catheter in the second group was longer than that in the second group. There was a difference between the two groups (P < 0.05). (2) The score of bladder dysfunction before and one month after operation in the first group was higher than that in the second group, with difference between the two groups (P < 0.05). Conclusion: multidisciplinary cooperative intervention is effective for patients with extensive total hysterectomy and is recommended.
文摘Objective: to discuss the effect of laparoscopic radical prostatectomy for prostate cancer in patients with prostate cancer, and explore the effect of this treatment method on the improvement of bladder function. Methods: 80 cases of prostate cancer patients received treatment in our hospital were selected as the object of the study, and then they were divided into equal groups, respectively as the control group and observation group. In the grouping study, patients in the control group were treated with open radical prostatectomy, while patients in the observation group were treated with laparoscopic radical prostatectomy. At the end of the study, the clinical indicators and improvement of bladder function of patients in the two groups were compared. Results: the clinical indicators and bladder function improvement data of the control group were compared for reference, and the observation group had significant advantages, P<0.05. Conclusion: in patients with prostate cancer treated by laparoscopic radical prostatectomy, clinical indicators and bladder function are improved, which has a positive impact on the improvement of prognosis and quality of life of patients.
基金This study was supported by grants from the National Natural Science Foundation of China(No.82070784 and No.81702536)grants from the Science&Technology Department of Sichuan Province,China(No.2022JDRC0040 and No.2020YJ0054).
文摘We investigated the impact and predictive value of bladder function in patients with benign prostatic hyperplasia(BPH)on the efficacy of transurethral prostatectomy.Symptomatic,imaging,and urodynamic data of patients who underwent transurethral prostatectomy at West China Hospital of Sichuan University(Chengdu,China)from July 2019 to December 2021 were collected.Follow-up data included the quality of life(QoL),International Prostate Symptom Score(IPSS),and IPSS storage and voiding(IPSS-s and IPSS-v).Moreover,urinary creatinine(Cr),nerve growth factor(NGF),brain-derived neurotrophic factor(BDNF),and prostaglandin estradiol(PGE2)were measured in 30 patients with BPH and 30 healthy participants.Perioperative indicators were determined by subgroup analyses and receiver operating characteristic(ROC)curve analysis.Among the 313 patients with BPH included,patients with severe micturition problems had more improvements but higher micturition grades postoperatively than those with moderate symptoms.Similarly,good bladder sensation,compliance,and detrusor contractility(Dc)were predictors of low postoperative IPSS and QoL.The urinary concentrations of BDNF/Cr,NGF/Cr,and PGE2/Cr in patients were significantly higher than those in healthy participants(all P<O.oo1).After evaluation,only DC was significantly related to both urinary indicators and postoperative recovery of patients.Patients with good DC,as predicted by urinary indicators,had lower IPSS and IPSS-v than those with reduced DC at the 1st month postoperatively(both P<0.05).In summary,patients with impaired bladder function had poor recovery.The combined levels of urinary BDNF/Cr,NGF/Cr,and PGE2/Cr in patients with BPH may be valid predictors of preoperative bladderfunction and postoperative recovery.
基金supported in part by NIH R01 NS100531,R01 NS103481NIH R21NS130241(to LD)+3 种基金Merit Review Award I01 BX002356,I01 BX003705 from the U.S.Department of Veterans AffairsIndiana Spinal Cord and Brain Injury Research Foundation(No.19919)Mari Hulman George Endowment Funds(to XMX)Indiana Spinal Cord&Brain Injury Research Fund from ISDH(to NKL and LD)。
文摘Schwann cell transplantation is considered one of the most promising cell-based therapy to repair injured spinal cord due to its unique growth-promoting and myelin-forming properties.A the Food and Drug Administration-approved Phase I clinical trial has been conducted to evaluate the safety of transplanted human autologous Schwann cells to treat patients with spinal cord injury.A major challenge for Schwann cell transplantation is that grafted Schwann cells are confined within the lesion cavity,and they do not migrate into the host environment due to the inhibitory barrier formed by injury-induced glial scar,thus limiting axonal reentry into the host spinal cord.Here we introduce a combinatorial strategy by suppressing the inhibitory extracellular environment with injection of lentivirus-mediated transfection of chondroitinase ABC gene at the rostral and caudal borders of the lesion site and simultaneously leveraging the repair capacity of transplanted Schwann cells in adult rats following a mid-thoracic contusive spinal cord injury.We report that when the glial scar was degraded by chondroitinase ABC at the rostral and caudal lesion borders,Schwann cells migrated for considerable distances in both rostral and caudal directions.Such Schwann cell migration led to enhanced axonal regrowth,including the serotonergic and dopaminergic axons originating from supraspinal regions,and promoted recovery of locomotor and urinary bladder functions.Importantly,the Schwann cell survival and axonal regrowth persisted up to 6 months after the injury,even when treatment was delayed for 3 months to mimic chronic spinal cord injury.These findings collectively show promising evidence for a combinatorial strategy with chondroitinase ABC and Schwann cells in promoting remodeling and recovery of function following spinal cord injury.
基金a grant from the National Natural Science Fundation of China(No.30170956).
文摘Objective: To evaluate the results of a self-designed bladder controller for restoring micturition function in paraplegic dogs.Methods: The spinal cords of 4 dogs were transected above the cone. Electrodes were implanted in S2 bilaterally and connected to the subcutaneous receivers for external activation. Microsurgical technique was employed to perform dorsal rhizotomy of S1-3 intradurally. The dogs were stimulated daily to observe micturition. Urodynamic testing and vesicography were performed. Results: All the dogs acquired micturition under the control of electric stimulation, with urine volume 80-140 ml per time. The mode of micturition was post-stimulus voiding. Vesicography revealed that the bladder was filled well and the bladder neck was open in the micturition course of electric stimulation. Residual urine volume was 15-20 ml. Urodynamic testing found that the bladder pressure and intraurethral pressure increased simultaneously, but when the intraurethral pressure was greater than the bladder pressure, no micturition occurred. The pressure decreased to baseline rapidly and the bladder pressure decreased slowly between two bursts. Micturition occurred when the bladder pressure was greater than the intraurethral pressure.Conclusions: The self-designed bladder controller together with a sacral deafferentation procedure can restore micturition function of paraplegic dogs.
文摘Background and Objective: Functional paraganglioma of the urinary bladder (FPUB) is a rare tumor. Misdiagnosis of FPUB before operation can lead to serious intraoperative consequences. In this article, we reported our experience in preoperative diagnosis and surgical treatment of FPUB. Methods: Clinical data of nine patients with FPUB treated between June 1985 and January 2009 at Peking Union Medical College Hospital were analyzed. Results: All patients underwent urinary catecholamine (CA) detection, B-ultrasound, CT and/or MRI scan; 5 underwent nailfola microcirculation inspection; 4 underwent 131I-metaiodobenzyl guanidine (MIBG) detection; and 6 underwent 111In-DTPA-Octreotide (OCT) scintiscan. According to the UICC bladder tumor classification, 5 patients had T2, 3 had T3, and 1 had T4 disease. All patients underwent surgical treatment, and 1 received 131I-MIBG therapy. All patients had paroxysmal hypertension and palpitation and six had cold sweat, headache, and dizziness after emphatic urination. The definitive diagnosis was made by histopathologic examination of the removed tumors and was confirmed in 7 cases by the immunohistochemical staining of chromogranin A, Ki-67 and S100 protein. The tumor consisted of discrete aggregates of zellballen cells separated by a network of vascular channels. One patient had metastases in the pelvic lymph nodes, liver and colon. Follow-up ranged from 7 to 289 months (mean, 127.2 ± 34.2). Six of the nine cases reported here were found in the usual locations. One patient had multiple tumors. The catecholamine level was elevated under basal conditions in 8 patients and during endoscopic resection of the tumor in 1 patient; it returned to normal after surgery in 8 patients. Three patients had recurrence and 1 had metastasis following surgery. Conclusions: Early preoperative diagnosis of FPUB is difficult, but it should be suspected in patients with typical tetrad symptoms: headache and micturition syncope, sweating, palpitation and hematuria. In those patients with unresectable multiple tumors, medicine and 131I-MIBG therapy may be helpful for controlling hypertension and delaying disease progression. Advanced classification (≥T3), multifocal tumors and CgA expression are risk factors of recurrence and metastasis.
文摘Alterations in bladder function with aging are very common and are very likely to represent an increasing healthcare problem in the years to come with the general aging of the population.In this review the authors describe the prevalence of lower urinary tract symptoms(LUTS)and comment upon potential mechanisms which may be responsible for the increasing prevalence of lower LUTS with increasing age,based on laboratory studies.It is clear that there is a complex interplay between the various components of the neural innervation structure of the bladder in leading to changes with age,which are likely to underpin the LUTS which are seen in the aging bladder.
文摘AIM: To determine the influence of intra-abdominal pressure(IAP) on respiratory function after surgical repair of ventral hernia and to compare two different methods of IAP measurement during the perioperative period. METHODS: Thirty adult patients after elective repair of ventral hernia were enrolled into this prospective study.IAP monitoring was performed via both a balloontipped nasogastric probe [intragastric pressure(IGP), Ci MON, Pulsion Medical Systems, Munich, Germany] and a urinary catheter [intrabladder pressure(IBP), Uno Meter Abdo-Pressure Kit, Uno Medical, Denmark] on five consecutive stages:(1) after tracheal intubation(AI);(2) after ventral hernia repair;(3) at the end of surgery;(4) during spontaneous breathing trial through the endotracheal tube; and(5) at 1 h after tracheal extubation. The patients were in the complete supine position during all study stages.RESULTS: The IAP(measured via both techniques) increased on average by 12% during surgery compared to AI(P < 0.02) and by 43% during spontaneous breathing through the endotracheal tube(P < 0.01). In parallel, the gradient between РаСО2 and Et CO2 [Р(а-et)CO2] rose significantly, reaching a maximum during the spontaneous breathing trial. The PаO2/Fi O2 decreased by 30% one hour after tracheal extubation(P = 0.02). The dynamic compliance of respiratory system reduced intraoperatively by 15%-20%(P < 0.025). At all stages, we observed a significant correlation between IGP and IBP(r = 0.65-0.81, P < 0.01) with a mean bias varying from-0.19 mm Hg(2SD 7.25 mm Hg) to-1.06 mm Hg(2SD 8.04 mm Hg) depending on the study stage. Taking all paired measurements together(n = 133), the median IGP was 8.0(5.5-11.0) mm Hg and the median IBP was 8.8(5.8-13.1) mm Hg. The overall r2 value( n = 30) was 0.76(P < 0.0001). Bland and Altman analysis showed an overall bias for the mean values per patient of 0.6 mm Hg(2SD 4.2 mm Hg) with percentage error of 45.6%. Looking at changes in IAP between the different study stages, we found an excellent concordance coefficient of 94.9% comparing IBP and IGP( n = 117).CONCLUSION: During ventral hernia repair, the IAP rise is accompanied by changes in Р(а-et)CO2 and PаO2/Fi O2-ratio. Estimation of IAP via IGP or IBP demonstrated excellent concordance.
