As a common clinical syndrome,voiding dysfunction is complicated in etiology,involved in a variety of diseases and associated with multi-disciplines of medicine.Either medication or surgery has not obtained the favora...As a common clinical syndrome,voiding dysfunction is complicated in etiology,involved in a variety of diseases and associated with multi-disciplines of medicine.Either medication or surgery has not obtained the favorable effect on it.Integrated the theories of traditional Chinese medicine and Western medicine and based on the pathogenesis of the disease,the acupoint specificity and neuromodulatory effects,Professor Wei-bin GAO suggested"selecting the acupoints along the affected areas"The acupoints located near to the lumbar,sacral and abdominal regions are dominated and stimulated with electroacupuncture at different electric waves.In treatment,electric stimulation with disperse and dense waves was adopted.The bone conduction theory of dense-wave electric field was proposed.The same neuromodulation is presented in different diseases such as neurogenic bladder,pediatric enuresis,senile nocturia,benign prostatic hyerplasia,and postpartum of postoperative urination disorders.Hence,the same therapeutic method is adoptable to different diseases with the basic acupoint composition modified.展开更多
Background Parkinson＇s disease （PD） is an extrapyramidal neurological disorder.Urinary symptoms are frequently present in patients affected by PD.Symptoms such as urgency,frequency,nocturia,and urge incontinence si...Background Parkinson＇s disease （PD） is an extrapyramidal neurological disorder.Urinary symptoms are frequently present in patients affected by PD.Symptoms such as urgency,frequency,nocturia,and urge incontinence significantly impact the patient＇s quality of life.We attempted to investigate the urodynamic changes and treatment of male PD patients with voiding dysfunction by means of a review.Methods Comprehensive urodynamic examinations were performed in 141 male patients with PD associated with voiding dysfunction.Appropriate treatments were given to subgroups that were divided based on test results,and the changes in urodynamic parameters as well as the treatment efficacy were observed.Results Detrusor hyperreflexia without bladder outlet obstruction （BOO） was observed in 35 patients,who exhibited significant improvements in the international prostate symptom score （IPSS）,maximum flow rate （Qmax）,bladder volume at the first desire to void,post-void residual （PVR）,and bladder compliance.Detrusor hyperreflexia associated with BOO was observed in 59 patients.The patients exhibited significant improvements in IPSS,Qmax,PVR,and bladder compliance.Detrusor dysfunction without BOO was observed in 19 patients,for whom the IPSS and the bladder volume at the first desire to void were improved after treatment.Detrusor dysfunction with BOO was found in 28 patients,with no significant improvement in the urodynamic parameters after the treatment.Conclusions Urodynamic examination is recommended for male Parkinson＇s disease patients with voiding dysfunction.Early and effective treatment can improve the bladder function and quality of life of these patients.展开更多
OBJECTIVE： To study the effect of acupuncture on rabbit bladder with urodynamic indexes. METHODS： New Zealand male rabbits were divid ed into control group, model group, treatment group 1 treated by acupuncture at S...OBJECTIVE： To study the effect of acupuncture on rabbit bladder with urodynamic indexes. METHODS： New Zealand male rabbits were divid ed into control group, model group, treatment group 1 treated by acupuncture at Shenshu （BL 23） and treatment group 2 treated by acupuncture at Zhongji （CV 3）. The urine dynamic parameters through the urethral catheter were detected in each group in order： fluctuation of pressure at fill ing phase of urinary bladder and flow rate in urina tion phase, which were used as quantification in dexes of urinary bladder function. The urinary blad der abnormal model was prepared by administra tion of cholinergic stimulant; Regulatory effects of acupuncture at Shenshu （BL 23） and Zhongji （CV 3） on the abnormal state of the urinary bladder were respectively observed. RESULTS： 1） In the filling phase of urinary bladder and in the urination phase, the intravesical pres sure wave in infilling （IPWI） and intravesical dis charge rate （IDR） could be respectively recorded. 2） IPWI and IDR could become abnormality by neo stigmine methyl sulfate [stability type IPWh the con trol group （n=20, 80%） vs the model group （n=15, 14.3%）, P〈0.01; IDR and time regression equation： the control group （n=20, y=24.3 0.878x） vs the model group （n=15, y=40.0 5.15x）, P〈0.01]. 3） Ab normal IPWI＇s could be normalized respectively by acupuncture at Shenshu （BL 23） and Zhongji （CV 3） [the stability type IPWl wave： the model group （n= 2, 14.3%） vs the treatment group 1 （n=3, 30%）, P〉 0.05; the instability type IPWl wave： the model group （n=13, 85.7%） in vs the treatment group 2 （n=6, 60%）, P〉0.05]; 4） Abnormal IDR also could be turned to normality by acupuncture at Shenshu （BL 23） and Zhongji （CV 3）, respectively [IDR and the time regression equation： the model group （n=15, y=40.0 5.15x） vs the treatment group 1 （n=10, y= 18.9 0.499x）, P〈0.01; the model group （n=15, y= 40.0 5.15x） vs the treatment group 2 （n=10, y= 17.5 0.251x）, P〈0.01]. CONCLUSION： 1） Urodynamic indexes can be used for study of mechanism of acupuncture effects; 2） The effect of acupuncture in the bladder filling phase is smaller than that in the urination phase; 3） Acupuncture has a very obvious effect on intravesi cal discharge rate.展开更多
Prostatitis comprises of a group of syndromes that affect almost 50% of men at least once in their lifetime and makeup the majority of visits to the Urology Clinics.After much debate, it has been divided into four dis...Prostatitis comprises of a group of syndromes that affect almost 50% of men at least once in their lifetime and makeup the majority of visits to the Urology Clinics.After much debate, it has been divided into four distinct categories by National Institutes of Health namely(1) acute bacterial prostatitis;(2) chronic bacterial prostatitis;(3) chronic prostatitis/chronic pelvic pain syndrome(CP/CPPS) which is further divided into inflammatory and non-inflammatory CP/CPPS; and(4)asymptomatic inflammatory prostatitis. CP/CPPS has been a cause of great concern for both patients and physicians because of the lack of presence of thoroughinformation about the etiological factors along with the difficult-to-treat nature of the syndrome. For the presented manuscript an extensive search on PubM ed was conducted for CP/CPPS aimed to present an updated review on the evaluation and treatment options available for patients with CP/CPPS. Several diagnostic criteria's have been established to diagnose CP/CPPS, with prostatic/pelvic pain for at least 3 mo being the major classifying symptom along with the presence of lower urinary tract symptoms and/or ejaculatory pain. Diagnostic tests can help differentiate CP/CPPS from other syndromes that come under the heading of prostatitis by ruling out active urinary tract infection and/or prostatic infection with uropathogen by performing urine cultures, Meares-Stamey Four Glass Test, Preand Post-Massage Two Glass Test. Asymptomatic inflammatory prostatitis is confirmed through prostate biopsy done for elevated serum prostate-specific antigen levels or abnormal digital rectal examination. Researchers have been unable to link a single etiological factor to the pathogenesis of CP/CPPS, instead a cluster of potential etiologies including atypical bacterial or nanobacterial infection, autoimmunity, neurological dysfunction and pelvic floor muscle dysfunction are most commonly implicated. Initially monotherapy with anti-biotics and alpha adrenergic-blockers can be tried, but its success has only been observed in treatment nave population. Other pharmacotherapies including phytotherapy, neuromodulatory drugs and anti-inflammatories achieved limited success in trials. Complementary and interventional therapies including acupuncture, myofascial trigger point release and pelvic floor biofeedback have been employed. This review points towards the fact that treatment should be tailored individually for patients based on their symptoms. Patients can be stratified phenotypically based on the UPOINT system constituting of Urinary, Psychosocial, Organ-specific, Infectious, Neurologic/Systemic and symptoms of muscular Tenderness and the treatment algorithm should be proposed accordingly. Treatment of CP/CPPS should be aimed towards treating local aswell as central factors causing the symptoms. Surgical intervention can cause significant morbidity and should only be reserved for treatment-refractory patients that have previously failed to respond to multiple drug therapies.展开更多
Background Only a few reports have currently studied the efficacy of dutasteride in patients with small benign prostatic hyperplasia(BPH).We investigated the efficacy of dutasteride on reducing lower urinary tract sym...Background Only a few reports have currently studied the efficacy of dutasteride in patients with small benign prostatic hyperplasia(BPH).We investigated the efficacy of dutasteride on reducing lower urinary tract symptoms among them.Materials and methods A total of 81 patients with BPH who completed 52weeks of 0.5?mg dutasteride treatment were enrolled.Each patient filled out the International Prostatic Symptom Score(IPSS)and overactive bladder symptom score(OABSS)at baseline and at the 6-and 12-month follow-up visits.Total testosterone,prostate-specific antigen,adenoma/prostate volume(PV),uroflowmetry analysis,and postvoid residual volume were evaluated at baseline and at the 12-month follow-up visit.The enrolled patients were divided into 2 groups according to PV at baseline.The groups were as follows:Group A(PV≥30 mL)and Group B(PV<30 mL).Results Groups A and B had mean PVs of 52.1 and 23.6 mL and mean IPSS scores of 16.7 and 14.4,respectively.Group A had significantly higher OABSS and prostate-specific antigen levels at baseline than Group B,while no significant differences in any other baseline characteristics was observed.After dutasteride treatment,adenoma volume and PV decreased significantly,while testosterone level showed a significant increase in both groups.Group A showed significant improvements in the total IPSS,voiding and storage subscore of the IPSS,OABSS,maximum flow rate,and postvoid residual volume.Group B,on the other hand,also showed significant improvements only in the total IPSS,voiding subscore of the IPSS,and maximum flow rate.Conclusions The present study suggests a possible beneficial effect of dutasteride treatment on the reduction of lower urinary tract symptoms in patients with small and large BPH.However,the effectiveness of dutasteride was limited compared to patients with large BPH(PV≥30 mL).展开更多
Voiding dysfunction,such as urge-frequency syndrome,urge incontinence,stress incontinence and unobstructive urinary retention,is often refractory to pharmacotherapy.Electrical neuromodulation has proved to be benefici...Voiding dysfunction,such as urge-frequency syndrome,urge incontinence,stress incontinence and unobstructive urinary retention,is often refractory to pharmacotherapy.Electrical neuromodulation has proved to be beneficial for these situations.Electroacupuncture pudendal nerve stimulation(EPNS),as one therapy of electrical neuromodulation,is beneficial for voiding dysfunction.The performance and application of EPNS will be introduced in this article.展开更多
Objective： To assess the clinical efficacy of electroacupuncture for treatment of unstable bladder. Methods： Patients were randomly divided into electroacupuncture and control groups and the curative effects were ev...Objective： To assess the clinical efficacy of electroacupuncture for treatment of unstable bladder. Methods： Patients were randomly divided into electroacupuncture and control groups and the curative effects were evaluated according to improvement in clinical symptom and quality of life scores after treatment. Results： The observation indices were significantly lower after than before treatment in both groups （P〈0.05）. There was no significant difference in clinical symptom score between the two groups （P〉0.05）. Quality of life score was significantly decreased in the electroacupuncture group as compared with that in the manipulation group （P〈0.05）. Conclusion： Both treatments improve voiding difficulty. The degree of satisfaction to quality of life is larger in the electroacupuncture group than in the manipulation group. Clinical symptom score tends to be lower in the electroacupuncture group than in the manipulation group.展开更多
基金Supported by Evidence-Based Capacity Building Project of Traditional Chinese Medicine,National Administration of Traditional Chinese Medicine:2019xzzXZJ005。
文摘As a common clinical syndrome,voiding dysfunction is complicated in etiology,involved in a variety of diseases and associated with multi-disciplines of medicine.Either medication or surgery has not obtained the favorable effect on it.Integrated the theories of traditional Chinese medicine and Western medicine and based on the pathogenesis of the disease,the acupoint specificity and neuromodulatory effects,Professor Wei-bin GAO suggested"selecting the acupoints along the affected areas"The acupoints located near to the lumbar,sacral and abdominal regions are dominated and stimulated with electroacupuncture at different electric waves.In treatment,electric stimulation with disperse and dense waves was adopted.The bone conduction theory of dense-wave electric field was proposed.The same neuromodulation is presented in different diseases such as neurogenic bladder,pediatric enuresis,senile nocturia,benign prostatic hyerplasia,and postpartum of postoperative urination disorders.Hence,the same therapeutic method is adoptable to different diseases with the basic acupoint composition modified.
文摘Background Parkinson＇s disease （PD） is an extrapyramidal neurological disorder.Urinary symptoms are frequently present in patients affected by PD.Symptoms such as urgency,frequency,nocturia,and urge incontinence significantly impact the patient＇s quality of life.We attempted to investigate the urodynamic changes and treatment of male PD patients with voiding dysfunction by means of a review.Methods Comprehensive urodynamic examinations were performed in 141 male patients with PD associated with voiding dysfunction.Appropriate treatments were given to subgroups that were divided based on test results,and the changes in urodynamic parameters as well as the treatment efficacy were observed.Results Detrusor hyperreflexia without bladder outlet obstruction （BOO） was observed in 35 patients,who exhibited significant improvements in the international prostate symptom score （IPSS）,maximum flow rate （Qmax）,bladder volume at the first desire to void,post-void residual （PVR）,and bladder compliance.Detrusor hyperreflexia associated with BOO was observed in 59 patients.The patients exhibited significant improvements in IPSS,Qmax,PVR,and bladder compliance.Detrusor dysfunction without BOO was observed in 19 patients,for whom the IPSS and the bladder volume at the first desire to void were improved after treatment.Detrusor dysfunction with BOO was found in 28 patients,with no significant improvement in the urodynamic parameters after the treatment.Conclusions Urodynamic examination is recommended for male Parkinson＇s disease patients with voiding dysfunction.Early and effective treatment can improve the bladder function and quality of life of these patients.
文摘OBJECTIVE： To study the effect of acupuncture on rabbit bladder with urodynamic indexes. METHODS： New Zealand male rabbits were divid ed into control group, model group, treatment group 1 treated by acupuncture at Shenshu （BL 23） and treatment group 2 treated by acupuncture at Zhongji （CV 3）. The urine dynamic parameters through the urethral catheter were detected in each group in order： fluctuation of pressure at fill ing phase of urinary bladder and flow rate in urina tion phase, which were used as quantification in dexes of urinary bladder function. The urinary blad der abnormal model was prepared by administra tion of cholinergic stimulant; Regulatory effects of acupuncture at Shenshu （BL 23） and Zhongji （CV 3） on the abnormal state of the urinary bladder were respectively observed. RESULTS： 1） In the filling phase of urinary bladder and in the urination phase, the intravesical pres sure wave in infilling （IPWI） and intravesical dis charge rate （IDR） could be respectively recorded. 2） IPWI and IDR could become abnormality by neo stigmine methyl sulfate [stability type IPWh the con trol group （n=20, 80%） vs the model group （n=15, 14.3%）, P〈0.01; IDR and time regression equation： the control group （n=20, y=24.3 0.878x） vs the model group （n=15, y=40.0 5.15x）, P〈0.01]. 3） Ab normal IPWI＇s could be normalized respectively by acupuncture at Shenshu （BL 23） and Zhongji （CV 3） [the stability type IPWl wave： the model group （n= 2, 14.3%） vs the treatment group 1 （n=3, 30%）, P〉 0.05; the instability type IPWl wave： the model group （n=13, 85.7%） in vs the treatment group 2 （n=6, 60%）, P〉0.05]; 4） Abnormal IDR also could be turned to normality by acupuncture at Shenshu （BL 23） and Zhongji （CV 3）, respectively [IDR and the time regression equation： the model group （n=15, y=40.0 5.15x） vs the treatment group 1 （n=10, y= 18.9 0.499x）, P〈0.01; the model group （n=15, y= 40.0 5.15x） vs the treatment group 2 （n=10, y= 17.5 0.251x）, P〈0.01]. CONCLUSION： 1） Urodynamic indexes can be used for study of mechanism of acupuncture effects; 2） The effect of acupuncture in the bladder filling phase is smaller than that in the urination phase; 3） Acupuncture has a very obvious effect on intravesi cal discharge rate.
文摘Prostatitis comprises of a group of syndromes that affect almost 50% of men at least once in their lifetime and makeup the majority of visits to the Urology Clinics.After much debate, it has been divided into four distinct categories by National Institutes of Health namely(1) acute bacterial prostatitis;(2) chronic bacterial prostatitis;(3) chronic prostatitis/chronic pelvic pain syndrome(CP/CPPS) which is further divided into inflammatory and non-inflammatory CP/CPPS; and(4)asymptomatic inflammatory prostatitis. CP/CPPS has been a cause of great concern for both patients and physicians because of the lack of presence of thoroughinformation about the etiological factors along with the difficult-to-treat nature of the syndrome. For the presented manuscript an extensive search on PubM ed was conducted for CP/CPPS aimed to present an updated review on the evaluation and treatment options available for patients with CP/CPPS. Several diagnostic criteria's have been established to diagnose CP/CPPS, with prostatic/pelvic pain for at least 3 mo being the major classifying symptom along with the presence of lower urinary tract symptoms and/or ejaculatory pain. Diagnostic tests can help differentiate CP/CPPS from other syndromes that come under the heading of prostatitis by ruling out active urinary tract infection and/or prostatic infection with uropathogen by performing urine cultures, Meares-Stamey Four Glass Test, Preand Post-Massage Two Glass Test. Asymptomatic inflammatory prostatitis is confirmed through prostate biopsy done for elevated serum prostate-specific antigen levels or abnormal digital rectal examination. Researchers have been unable to link a single etiological factor to the pathogenesis of CP/CPPS, instead a cluster of potential etiologies including atypical bacterial or nanobacterial infection, autoimmunity, neurological dysfunction and pelvic floor muscle dysfunction are most commonly implicated. Initially monotherapy with anti-biotics and alpha adrenergic-blockers can be tried, but its success has only been observed in treatment nave population. Other pharmacotherapies including phytotherapy, neuromodulatory drugs and anti-inflammatories achieved limited success in trials. Complementary and interventional therapies including acupuncture, myofascial trigger point release and pelvic floor biofeedback have been employed. This review points towards the fact that treatment should be tailored individually for patients based on their symptoms. Patients can be stratified phenotypically based on the UPOINT system constituting of Urinary, Psychosocial, Organ-specific, Infectious, Neurologic/Systemic and symptoms of muscular Tenderness and the treatment algorithm should be proposed accordingly. Treatment of CP/CPPS should be aimed towards treating local aswell as central factors causing the symptoms. Surgical intervention can cause significant morbidity and should only be reserved for treatment-refractory patients that have previously failed to respond to multiple drug therapies.
文摘Background Only a few reports have currently studied the efficacy of dutasteride in patients with small benign prostatic hyperplasia(BPH).We investigated the efficacy of dutasteride on reducing lower urinary tract symptoms among them.Materials and methods A total of 81 patients with BPH who completed 52weeks of 0.5?mg dutasteride treatment were enrolled.Each patient filled out the International Prostatic Symptom Score(IPSS)and overactive bladder symptom score(OABSS)at baseline and at the 6-and 12-month follow-up visits.Total testosterone,prostate-specific antigen,adenoma/prostate volume(PV),uroflowmetry analysis,and postvoid residual volume were evaluated at baseline and at the 12-month follow-up visit.The enrolled patients were divided into 2 groups according to PV at baseline.The groups were as follows:Group A(PV≥30 mL)and Group B(PV<30 mL).Results Groups A and B had mean PVs of 52.1 and 23.6 mL and mean IPSS scores of 16.7 and 14.4,respectively.Group A had significantly higher OABSS and prostate-specific antigen levels at baseline than Group B,while no significant differences in any other baseline characteristics was observed.After dutasteride treatment,adenoma volume and PV decreased significantly,while testosterone level showed a significant increase in both groups.Group A showed significant improvements in the total IPSS,voiding and storage subscore of the IPSS,OABSS,maximum flow rate,and postvoid residual volume.Group B,on the other hand,also showed significant improvements only in the total IPSS,voiding subscore of the IPSS,and maximum flow rate.Conclusions The present study suggests a possible beneficial effect of dutasteride treatment on the reduction of lower urinary tract symptoms in patients with small and large BPH.However,the effectiveness of dutasteride was limited compared to patients with large BPH(PV≥30 mL).
基金supported by Project of Shanghai Municipal Science and Technology Commission(09dZ1974900)Project of Shanghai Municipal Science and Technology Commission(12401904600)Project of Shanghai Municipal Health Bureau(ZYSNXD-CCZDYJ010)
文摘Voiding dysfunction,such as urge-frequency syndrome,urge incontinence,stress incontinence and unobstructive urinary retention,is often refractory to pharmacotherapy.Electrical neuromodulation has proved to be beneficial for these situations.Electroacupuncture pudendal nerve stimulation(EPNS),as one therapy of electrical neuromodulation,is beneficial for voiding dysfunction.The performance and application of EPNS will be introduced in this article.
文摘Objective： To assess the clinical efficacy of electroacupuncture for treatment of unstable bladder. Methods： Patients were randomly divided into electroacupuncture and control groups and the curative effects were evaluated according to improvement in clinical symptom and quality of life scores after treatment. Results： The observation indices were significantly lower after than before treatment in both groups （P〈0.05）. There was no significant difference in clinical symptom score between the two groups （P〉0.05）. Quality of life score was significantly decreased in the electroacupuncture group as compared with that in the manipulation group （P〈0.05）. Conclusion： Both treatments improve voiding difficulty. The degree of satisfaction to quality of life is larger in the electroacupuncture group than in the manipulation group. Clinical symptom score tends to be lower in the electroacupuncture group than in the manipulation group.
