Search

Although attachment security has been associated with children's rule-compatible conduct, the mechanism through which attachment influences early regard for rules is not well established. We hypothesized that effortful control would mediate the link between security and indicators of children's emerging regard for rules (discomfort following rule violations, internalization of parents' and experimenter's rules, few externalizing behaviors). In a longitudinal study, the Attachment Q-Set was completed by parents, effortful control was observed, and Regard for Rules was observed and rated by parents. The proposed model fit the data well: Children's security to mothers predicted their effortful control, which in turn had a direct link to a greater Regard for Rules. Children's security with fathers did not predict effortful control. The mother-child relationship appears particularly important for positive developmental cascades of self-regulation and socialization. [ABSTRACT FROM AUTHOR]

Background: No current standardized set of pelvic floor muscle (PFM) outcome measures have been specifically tested for their applicability in a general female chronic pelvic pain (CPP) population. We aimed to compare PFM function between a randomly selected population‐based sample of women with CPP and age‐matched pain‐free controls using multiple standardized intravaginal examination measures recommended by the International Continence Society. Methods: This was a cross‐sectional, population‐based and controlled study with randomly selected participants among women in Denmark. We reported blinded findings from a set of standardized vaginal PFM examination manoeuvres in 50 female participants (24 with CPP, 26 pain free). A preliminary pilot study ensured the intra‐ and intertester reliability of the test procedure. PFM outcomes were resting tone, relaxation capacity, strength, surface electromyographic activity and mechanosensitivity. Statistical analyses included unpaired t‐tests, Fisher's exact tests and Mann–Whitney tests. Results: The examination protocol was a reliable and predictable clinical measurement of associated PFM dysfunction in female CPP. Women with CPP had higher PFM resting tone and decreased maximal PFM strength and relaxation capacity compared with pain‐free controls. Enhanced PFM pressure‐pain sensitivity measured by palpometry during examination was also associated to CPP. Conclusion: This controlled, single‐blinded study with randomly selected participants provides new population‐based information regarding associated PFM dysfunction in women with CPP using multiple intravaginal examination methods. However, to identify women with CPP who will benefit from a physiotherapeutic specialized intervention, future prospective randomized controlled trials using these reliable and predictive outcomes are needed. [ABSTRACT FROM AUTHOR]

Highlights: [•] A cross-sectional study of female chronic pelvic pain (CPP) in Denmark. [•] The prevalence of CPP was 11% in women ≥18 years; 13.6% in women aged 18–49 years. [•] CPP of a moderate to severe intensity was prevalent in 6.2% of the included women. [•] Four factors independently associated with female CPP were identified. [•] Factors were age ≤49 years, country of birth, former pelvic trauma and pelvic surgery. [Copyright &y& Elsevier]

Abstract: Background and purpose: Chronic pelvic pain (CPP) is a debilitating condition among women with a major impact on health-related quality of life, work productivity and health care utilisation. The exact prevalence of chronic pelvic pain is not known, but 3.8% is commonly suggested. Musculoskeletal dysfunction is frequently cited as a possible aetiology. Physiotherapy is therefore recommended as one treatment modality. The aim of this systematic review was to source and critically evaluate the evidence for an effect of physiotherapy on pain, physical activity and quality of life in the treatment of female CPP. Methods: Electronic databases, conference proceedings, text books and clinical guidelines were searched for quantitative, observational, and prospective clinical intervention studies of female chronic pelvic pain where physiotherapy was a sole or significant component of the intervention. Trial inclusion, data extraction according to predefined criteria and risk of bias assessment were performed by two independent authors. Methodological quality of the included clinical intervention studies was assessed using The Cochrane Collaboration''s tool for assessing risk of bias. Review Manager (RevMan) version 5.0 was used for data analysis. Effect estimates (relative risk, mean difference and mean change) with 95% confidence intervals were calculated for the above outcomes. For significant outcomes the numbers needed to treat were calculated. Results: The search strategy identified 3469 potential articles. Of these, 11 articles, representing 10 studies, met the inclusion criteria. There were 6 randomised clinical trials, 1 cohort study and 3 case series. Methodological quality was dependent on study type. Accordingly, level of evidence was judged higher in randomised clinical trials than in the other study types. Physiotherapy treatments varied between studies and were provided in combination with psychotherapeutic modalities and medical management. This did not allow for the ‘stand-alone’ value of physiotherapy to be determined. Heterogeneity across the studies, with respect to participants, interventions, outcome measures and times of follow-up, prevented meta-analysis. Narrative synthesis of the results, based on effect estimates and clinically relevant pain improvement, disclosed some evidence to support an effect of multidisciplinary intervention and Mensendieck somatocognitive therapy on female chronic pelvic pain. Conclusion: Chronic pelvic pain in women is a major health care problem with no specific therapies and poor prognosis. There seems to be some evidence to support the use of a multidisciplinary intervention in the management of female chronic pelvic pain. Somatocognitive therapy is a new approach that appears to be promising and randomised clinical trials are underway in order to establish its evidence base. Implications: Based on the findings of this review, recommendations for physiotherapy in chronic pelvic pain clinical guidelines, textbooks and narrative reviews should be interpreted with caution due to the lack of a sufficient evidence base. Only small and largely non-randomised studies have been undertaken of physiotherapeutic interventions and this greatly limits the available evidence on which to base clinical practice. High quality randomised clinical trials are therefore urgently needed. [Copyright &y& Elsevier]

Background: Unenhanced multidetector computed tomography (UMDCT) is well established as the procedure of choice for radiologic evaluation of patients with renal colic. The procedure has both clinical and financial consequences for departments of surgery and radiology. However, the financial effect outside the radiology department is poorly elucidated. Purpose: To evaluate the financial consequences outside of the radiology department, a retrospective study comparing the ward occupation of patients examined with UMDCT to that of intravenous urography (IVU) was performed. Material and Methods: A total of 594consecutive patients were admitted for renal colic during two 6-month periods. One hundred seventy-three consecutive patients were examined with IVU in 2000 and 421 with UMDCT in 2005. The only difference between the two groups was the imaging procedure. The duration of hospital stay and pathology findings were registered. Results: In 50% of the patients undergoing UMDCT, a stone was found; a stone was found or suspected in 40% of patients undergoing IVU. Patients undergoing IVU stayed significantly longer in the ward than patients examined by UMDCT (P<0.0001). The new procedure (UMDCT) saved the hospital USD 265,000 every 6 months compared to the use of IVU. Conclusion: Use of UMDCT compared to IVU in patients with renal colic leads to cost savings outside the radiology department. [ABSTRACT FROM AUTHOR]

Discusses means of preventing benign prostatic hyperplasia (BPH) from progressing to acute urinary retention (AUR) and BPH-related surgery. Background on existing treatment procedures; Description of BPH as a progressive disease; Management of BPH by prevention of disease progression.

OBJECTIVES To examine the efficacy and safety of a once-daily formulation of alfuzosin in a pooled analysis of three parallel, randomized, double-blind, placebo-controlled 3-month studies of patients with lower urinary tract symptoms (LUTS) consistent with clinical benign prostatic hyperplasia. PATIENTS AND METHODS Patients were randomized to receive alfuzosin, 10 mg once-daily (473) or placebo (482) for 12 weeks. Primary efficacy criteria were improvements in the International Prostate Symptom Score (IPSS) and peak urinary flow rate (PFR). RESULTS Alfuzosin significantly improved the mean (sd) IPSS, by - 6.0 (5.1) vs - 4.2 (5.7) with placebo (P < 0.005) and the PFR, by + 2.3 (3.8) vs + 1.1 (3.1) ml/s with placebo (P < 0.001), irrespective of prostate size. The significant improvement in LUTS included the irritative and the obstructive subscore of the IPSS and the nocturia criterion; the PFR increased rapidly and significantly, from the first visit (14 days). The quality-of-life score also improved significantly in alfuzosin-treated patients. Alfuzosin was well tolerated; the number of withdrawals for adverse events was comparable in both treatment groups. The most frequently reported adverse event was dizziness (placebo 2.9%, alfuzosin 6.1%). There were no significant changes in blood pressure with alfuzosin compared with placebo, including in elderly and hypertensive patients. Sexual adverse events were rare (abnormal ejaculation, 0.6%). CONCLUSIONS The once-daily formulation of alfuzosin, administered at 10 mg with no dose titration is effective, with a good safety profile, especially in elderly and hypertensive patients. [ABSTRACT FROM AUTHOR]

Objective To investigate the presence of leukotriene D4 receptors in fura-2-loaded human detrusor smooth muscle cells (DSMCs) by examining the ability of leukotriene D4 to raise intracellular-free Ca2+ concentration ([Ca2+]i), to determine the origin of the leukotriene D4-mediated rise in [Ca2+]i and to investigate whether the specific leukotriene D4 receptor antagonist montelukast inhibits the Ca2+ response induced by leukotriene D4. Materials and methods Detrusor muscle biopsies were obtained from patients with benign noninvasive bladder diseases undergoing cystoscopy. DSMCs were isolated using an explant technique and maintained in culture. Only primary cultures or cells passaged up to three times were used for experiments. DSMCs were characterized with immunohistochemical staining and their identity confirmed by transmission electron microscopy. [Ca2+]i was measured in single DSMCs using the Ca2+ probe fura-2 and fluorescence-ratio microscopy. Results Immunohistochemical staining showed that 80–99% of the cells were positive for smooth muscle α-actin. The ultrastructural features of the cultured cells were those of smooth muscle cells and showed no differentiation in a fibroblastic or myofibroblastic direction. Leukotriene D4 increased the level of [Ca2+]i in a dose-dependent manner. Calcium was mobilized almost exclusively from intracellular Ca2+ stores. There was a dose-dependent inhibition of the increase in [Ca2+]i by montelukast. Conclusion The present study is the first to show the presence of specific leukotriene D4 receptors in human detrusor myocytes. This may have implications for a potential pathophysiological role of leukotriene D4 in patients with interstitial cystitis and other functional or inflammatory bladder disorders. [ABSTRACT FROM AUTHOR]

Objective To test the effect on urinary tract infections (UTIs) in patients needing continuous indwelling catheterization, of a newly designed urine‐collecting system containing an antibacterial device which slowly releases silver ions onto the inner surface of the system. Patients and methods The study comprised a prospective controlled randomized trial; 213 patients fulfilled the inclusion criteria. They were randomized to a urine drainage system (comprising a Unometer 400 metering system or PP 2000N closed urine‐bag system, both from Maersk Medical, Denmark) either with or without the antibacterial device. The efficacy was assessed as the number of UTIs and the time to infection in the 170 patients eligible for analysis. Results There were fewer UTIs in those using the system containing the antibacterial device (19% vs 24%), but the difference was not statistically significant (P < 0.05). Conclusion The potential importance of different infection routes were highlighted, suggesting that modifications to Foley catheters and urine‐collecting systems attempting to prevent UTIs should focus not only on the intraluminal pathway, but on the internal and external pathways of infection. [ABSTRACT FROM AUTHOR]

The increasing number of patients on regular dialysis treatment (RDT) for many years produces a number of problems, one of which is the vascular access procedure. When the internal subcutaneous fistula cannot be used either as the first procedure or after some years of treatment, alternative methods are necessary. We present here clinical experience with the saphenous vein arteriovenous fistula placed on the upper thigh in 8 patients. The function was insufficient with a flow rate of about 125 ml/min and the complication rate was very high with development of 5 haematomas, 1 thrombosis and 1 case of severe oedema. Far more serious, however, was the recording of 2 fatal external bleeding episodes. According to the literature, clinical experience with this procedure is very limited in other centres. From our experience we would not recommend this procedure and from the 2 fatal bleeding episodes we would question the placement of any fistula on the upper thigh unless absolutely necessary. [ABSTRACT FROM AUTHOR]

Magnesium ions added to fixatives for processing to Transmission Electron Microscopy (TEM) have been claimed to cause relaxation of detrusor smooth muscle cells [1]. This should facilitate the morphologic evaluation of the tissue. However, magnesium ions are osmotically active and their addition may cause the fixative to become hypertonic to the tissue. To ascertain whether the presence of magnesium ions causes significant changes compared to those found where the osmolarity is raised without the presence of magnesium, human detrusor specimens were fixed in glutaraldehyde to which increasing amounts of MgCl2 or NaCl were added in different concentrations. With the addition of increasing amounts of MgCl2 and NaCl, the osmolarity of the fixative increased, causing significant changes in the morphology and morphometry of the tissue. The intercellular distances increased, the cells shrank and the shape of the cells changed from smooth and rounded to spiky and angulated. With regard to its muscle-relaxing effect, it was not possible to distinguish the specimens fixed in magnesium-containing fixatives from those without. In this study it was not possible to prove any relaxing effect of magnesium ions added to the fixative. On the contrary the magnesium ions caused an increase in the osmolarity, with significant changes in both the morphometry and the morphology of the human detrusor smooth muscle cells. [ABSTRACT FROM AUTHOR]

Prostatic urethral obstruction as defined by urodynamic criteria is only present in about 70% of patients undergoing surgical treatment for benign prostatic hyperplasia (BPH). Infravesical obstruction can only be diagnosed by simultaneous recording of detrusor pressure (intravesical pressure minus abdominal pressure) and urinary flow rate. The interpretation of these recordings should be based upon the pressure-flow relationship. The possible clinical implications of the objective diagnosis of prostatic urethral obstruction in BPH are discussed. [ABSTRACT FROM AUTHOR]

Urinary bladder blood flow as measured by the washout of locally injected Xe and by the simultaneously performed radioactive microsphere reference-sample method was studied in pigs. The washout curves were analyzed according to the initial slope, the corrected initial slope and the total curve. The corrected-initial-slope flow rates were not statistically significantly different from the microsphere whole-wall flow rates. The variability between the methods shown by the test-retest difference revealed only a minor lack of agreement. The bladder blood flow tended to decrease after the intravesical pressure had been increased to 20 cmHO, but the difference was not statistically significant. Washout of locally injected Xe can be used for the evaluation of urinary bladder blood flow in humans and in longitudinal animal studies. The corrected-initial-slope method is recommended for the analysis of washout curves. [ABSTRACT FROM AUTHOR]

With the momentum flux apparatus, momentum flux in the voided urinary stream at maximum flow rate was measured in 117 normal males. A normal area of momentum flux related to maximum flow rate has been delineated. The between-person variation of momentum flux was statistically significantly larger than the withinperson variation evaluated from repeated voidings from two normal persons. These direct measurements of momentum flux have been compared with those predicted from results obtained with the drop spectrometer. The agreement between the two types of measurements is judged satisfactory. [ABSTRACT FROM AUTHOR]

Distensibility of the meatal part of urethra was studied in 67 patients with detrusor hyperreflexia and in 7 patients with organic meatal stenosis using the momentum flux meter. Statistically significantly higher momentum flux values were found in patients with non obstructive detrusor hyperreflexia compared to normal persons-indicating a tighter meatus than normal. The connection between tight meatus and detrusor hyperreflexia is discussed. Also in patients with organic meatal stenosis momentum flux measurements showed a rigid meatus. Because of its high diagnostic specificity, momentum flux measurement may prove valuable as a screening investigation in male patients with suspected detrusor hyperreflexia or distal urethral stenosis. [ABSTRACT FROM AUTHOR]

The momentum flux apparatus was tested for accuracy in vitro. Errors were within an acceptable range for clinical evaluation and research of meatal properties in male patients - provided the stream exit angle was horizontal within 10-15 degrees. Measurements from the apparatus give information about the rigid nozzle or distensible meatus from which the stream is discharged. It is stressed, that great caution has to be exercised in the interpretation of the residual kinetic energy density and of the energy loss during micturition. [ABSTRACT FROM AUTHOR]

Objectives: There are at least three clinically indistinguishable but genetically different types of autosomal dominant pure spastic paraplegia (ADPSP). Lower urinary tract symptoms are often present but have not been described in a homogeneous patient population. In this study lower urinary tract symptoms, cystometrical, and neurophysiological characteristics are described in patients with ADPSP linked to chromosome 2p21-p24.Methods: Lower urinary tract symptoms were recorded at an interview and according to a formalised questionnaire. Eleven patients were clinically evaluated and cystometry, measurements of the cutaneous perception threshold, bulbocavernosus reflex latency, and somatosensory evoked potentials (SSEPs) of the pudendal nerve were performed.Results: All patients experienced urinary urgency or urge incontinence. Rectal urgency and sexual dysfunction were reported by most patients. The cystometrical findings showed a mixed pattern of bladder dysfunction. The SSEPs were normal in all but the bulbocavernosus reflex latency was significantly prolonged in seven patients and the cutaneous perception threshold was raised in five patients.Conclusions: Lower urinary tract symptoms and probably also bowel and sexual dysfunction in patients with ADPSP linked to chromosome 2p21-p24 are due to a combination of somatic and autonomic nervous system involvement which support the proposed multisystem affection in ADPSP linked to chromosome 2p21-p24. [ABSTRACT FROM AUTHOR]

Objective To present and describe the validity and reliability of the International Continence Society-Benign Prostatic Hyperplasia study quality-of-life (ICS QoL) instrument, a new set of questions to assess the impact of lower urinary tract symptoms (LUTS) on quality of life (QoL) in middle-aged and elderly men. Patients and methods The study comprised 1271 consecutive men over the age of 45 years, attending urology departments in 12 countries, with LUTS and possible benign prostatic obstruction who were recruited to the ICS-'BPH' study (the clinic group); 423 ambulant men were recruited from a general practice in the UK to provide a community group. Each individual completed the ICS-'BPH' study questionnaire which includes six items addressing general and specific aspects of QoL (the ICS QoL). Content and construct validity were assessed by interviews with patients and by testing hypotheses within the study groups, e.g. the relationships with age, individual LUTS (as measured on the ICS male questionnaire) and generic health status, as measured by the Short Form (SF-36) and EuroQol instruments. Reliability was assessed by measures of internal consistency and a test-retest analysis. Results The ICS QoL items were easily understood by patients, were completed with low levels of missing data, and address some (but not all) concerns about the impact of LUTS on QoL. The ICS QoL items have good construct validity, showing expected differences between community and clinic samples, and expected relationships with each other and individual LUTS. Items had good test-retest reliability, but their internal consistency was poor, confirming that ICS QoL questions should not be combined into a score. General ICS QoL items were closely related with most domains of the SF-36 and the EuroQol. Conclusion ICS QoL items may be used individually or as a group in research studies or in clinical practice. [ABSTRACT FROM AUTHOR]

Objective To determine the clinical applicability of ultrasound-guided detrusor biopsy from the anterior bladder wall and to assess whether it is as representative and as sufficient for determining detrusor ultrastructure as the traditional transurethral biopsy from the lateral bladder wall. Materials and methods The detrusor structure in 22 biopsies, 11 obtained transabdominally and 11 transurethrally from 11 patients, was evaluated without knowledge of the biopsy method by light and electron microscopy, including morphometric analysis. In addition, several specimens from each of three bladders were evaluated, also 'blindly', for ultrastructural diagnosis of the detrusor in an independent current study of voiding dysfunction in geriatric patients. Results There were no differences in intercellular distances and cell:nucleus ratios between transabdominal and transurethral biopsies in eight of the 11 patients. Furthermore, ultrasound-guided transabdominal biopsies were as representative of the detrusor as were transurethral biopsies. Conclusion The transabdominal approach is recommended as an easy, relatively inexpensive and efficient method of obtaining biopsies of the detrusor for study of its structure in voiding dysfunction. On the other hand, the observations and diagnoses made by 'blind' qualitative study of several specimens from the same bladder were identical. This, together with the similarity of detrusor structure in the transabdominal and transurethral biopsies, strongly supports the idea that such structure is relatively uniform throughout the entire bladder wall. [ABSTRACT FROM AUTHOR]

Objective To validate the Danish Prostatic Symptom Score (DAN-PSS-1), a self-administered quality-of-life questionnaire comprising 12 questions related to voiding problems and the perceived bother of each individual symptom. Methods Using published results from several comparisons of other symptom scoring systems with DAN-PSS-1, the test-retest reliability, internal consistency, construct and content validity, and responsiveness of the DAN-PSS-1 system were assessed. Results The system was internally consistent (Cronbach's alpha = 0.73), the median test-retest reliability of answers to each question was 83.5% (range 0-99.7%) and the questionnaire was well understood by the patients. The DAN-PSS-1 system demonstrated a high degree of construct validity, correlating with the extensively used Madsen-Iversen score system (Spearman's correlation coefficient, rs= 0.51) and with the patients' answers to questions about how bothersome their symptoms were ( rs= 0.71). The DAN-PSS-1 system discriminated clearly between patients with benign prostatic hyperplasia (BPH) and control subjects (an area under the receiver operating characteristic curve of 0.94). Finally, the DAN-PSS-1 was sensitive to changes following intervention, with scores decreasing from a median of 20 to zero 4 months after patients underwent transurethral prostatectomy and from a median of 11.5 to 7.5 (65%) after patients had received 4 months treatment with an alpha-blocker. Conclusions The DAN-PSS-1 system is reliable, valid and responsive, and therefore can be recommended for assessing the severity of symptoms among patients presenting with lower urinary tract complaints suggestive of BPH and in the follow-up after intervention. [ABSTRACT FROM AUTHOR]

Objective To report the results of a standard evaluation programme performed prior to transurethral resection of the prostate (TURP) for benign prostatic hypertrophy (BPH). Patients and methods all 132 patients with symptoms of prostatism on the waiting list for surgery were invited to attend the hospital to undergo a physical examination, symptom evaluation and routine blood sampling. Of these, 117 attended. If the suspicion of BPH was sustained a transrectal ultrasound examination of the prostate and a urodynamic evaluation, including a pressure-flow study, were performed. Results Urodynamic evaluation was carried out in 80 of the 117 patients who attended the clinic. Infravesical obstruction was present in 61 patients while in 19 (24%) there was no obstruction. An operative procedure to relieve obstruction was performed in 65 patients (49%). Conclusions In a population of patients scheduled for TURP. 24% were found not to have an obstruction. This is in accordance with other reports. As the patients with few symptoms and those who did not have an obstruction were treated conservatively only 49% of the referred cases underwent prostatic surgery. [ABSTRACT FROM AUTHOR]

- Venous impotence can be evaluated by cavernosometry, although this is a controversial issue. We have evaluated various techniques for cavernosometry: with and without intracavernous papaverine, with different dosages and modalities, with different modes of induction flow and at various intracavernous pressures. A standardised technique was tested and retested in 32 impotent men. If pharmacocavernosometry is accepted as the most reliable test and a maintenance flow < 20 ml/min indicates optimal venous occulsion, plain cavernosometry gave 6% false positive and 16% false negative results. Pharmacocavernosometry was found to be highly reproducible with regard to maintenance flow for patients thought to have optimal venous occlusion and for those with supposed leakage. The induction flow was of no diagnostic value. After injection of papaverine the maintenance flow became a reproducible parameter for quantifying venous outflow and could be measured with an intracavernous pressure equivalent to systolic blood pressure to minimise cavernous arterial inflow and increase reproducibility. [ABSTRACT FROM AUTHOR]

- A detailed questionnaire on the occurrence of irritative and obstructive voiding symptoms, incontinence and the number of childbirths was sent out to 600 women aged between 20 and 79 years, randomly selected from the National Register; 432 (72%) returned the questionnaire and 414 (69%) were evaluable. The frequency of obstructive symptoms such as hesitancy, intermittency and decreased stream was low. Diurnal frequency with voiding intervals <3 h were recorded by more than 50% of the women and about 10% voided more frequently than every second hour. Nocturia increased significantly with age; 54 (13.6%) voided at least twice per night. About 40% complained of incontinence but this was troublesome in only 6%; 15.3, 13.3 and 11.5% had stress, urge and mixed incontinence respectively. More than 8% wore nappies or sanitary towels every day to protect against urinary leakage. Although the tendency to wear nappies or sanitary towels increased with age, the increase was not statistically significant. There was a positive correlation between the occurrence of stress incontinence and childbirth in the group as a whole. [ABSTRACT FROM AUTHOR]