Age-associated determinants decompensation of the bladder in the conditions of prostate hyperplasia

Introduction. In conditions of long-term infravesical obstruction caused by prostate hyperplasia (РН), 15-30% of patients eventually experience decompensation of detrusor function. At the same time, the details of the adaptive transformation of the vascular bed of the bladder, as well as its correlation with the structural remodeling of this organ, which determine the decompensation of the lower urinary tract in conditions of chronic urinary retention, are still unclear. Aim. To study the role of vascular and age-related factors in the depletion of the compensatory reserve of detrusor in long-term РН in elderly and senile people. Material and methods. Autopsy material from 25 men who did not have urological pathology, from 25 men who had РН without signs of decompensation of the bladder and biopsy material from 25 patients operated on for РН in the decompensation stage were examined. The age of all persons ranged from 60 to 80 years. Control – 10 men aged 20-30 years, who died as a result of injuries. Histological sections of the areas of the bladder were stained with hematoxylin-eosin, according to Mason and Hart. Results. In conditions of long-term РН, the functioning of a locally hypertrophic detrusor occurs against the background of age-related atrophic-sclerotic changes in it, the cause of which is: atherosclerosis of large arteries, as well as hyalinosis of small arteries and arterioles, characteristic of arterial hypertension. The «working capacity» of the bladder under these conditions is provided by the activity of regulatory muscle formations in the arterial and venous basins, with the help of which the necessary level of oxygenation is achieved. However, progressive age-related changes in the cardiovascular system over time lead to an increase in chronic ischemia. Sclerotic changes develop in the regulatory structures of the arteries and veins. As a result, there is a gross diffuse sclerosis of the detrusor with atrophy of the muscle fibers. Conclusions. Decompensation of detrusor in РН is a consequence of earlier vascular decompensation, the morphological markers of which are: arteriosclerosis, phlebosclerosis and sclerosis of regulatory structures.

Clinical characteristics and outcome of high-pressure chronic urinary retention: A systematic review

Background: Although not infrequent, publications on high-pressure chronic urinary retention (HPCR) are limited. Lack of awareness of this condition can lead to delayed diagnosis and suboptimal treatment. This systematic review aimed to describe the clinical characteristics and outcome of HPCR. Methods: Keywords were searched in PubMed, Scopus, EMBASE, LILACS, Cochrane-CENTRAL, APAMED Central and Google Scholar. Relevant articles were added from the list of references of eligible articles. Studies describing any two of the characteristic features related to HPCR were included. Qualitative analysis was performed using the available data. Results: Eight prospective studies with 271 patients ( Mage=66.4 years, range 14–89 years; 263 males) were identified. The commonest presentation was tense painless palpable bladder (99.6%). Late-onset nocturnal enuresis was reported in 68.4%, and resistant hypertension was reported in 41.6%. Elevated levels of serum creatinine were identified in 43–81%. Benign prostatic hyperplasia (64.1%) was the commonest aetiology followed by prostatic malignancy (22.6%). A satisfactory response was seen following the definitive treatment of the underlying aetiology. Initial bladder decompression reversed adverse cardiovascular changes and improved renal function but resulted in post-obstructive diuresis. Heterogeneity of the reported data in available studies was a major limitation. Conclusions: Late-onset nocturnal enuresis, a tense painless and non-tender palpable bladder and treatment-resistant hypertension are important clinical findings which would raise the suspicion of HPCR in the clinical setting. Urinary tract ultrasonography showing upper-tract dilatation and raised serum creatinine support the diagnosis. Definitive treatment targeting the underlying aetiology following careful decompression of the bladder showed satisfactory outcomes. Level of evidence: Level 2a(-).

Innovative option for removal of encrusted, incarcerated longstanding indwelling Foleys catheter

Encrustation of indwelling Foley’s catheter is one of the common complication associated with long term indwelling catheter, encrusted catheter are often incarcerated and difficult to remove. Many methods have been evolved to remove stuck urethral catheter but each has its own complications. Here we have described a case of 90 year old male patient with chronic indwelling (7 months) Foley urethral catheter, who presented with chronic urinary retention. After initial bladder drainage with 8 Fr feeding tube by the side of catheter. Massive encrustation was fragmented by performing laser cyst lithotripsy with 6/7.5 Fr semi rigid ureter scope and 30 Watt Holmium laser. Catheter was removed intact and stone fragments evacuated. Post-operative recovery was uneventful. Surgical removal with minimally invasive technique should be treatment of choice for encrusted and stucked urethral catheter. Traditional technique of performing suprapubic cystostomy for removal of Foleys catheter are associated with various complications and should be reserved for hospital with limited facilities.

An overview of sacral neuromodulation: a treatment for patients with symptoms of lower urinary tract dysfunction

This article provides an introduction to patient selection for, and the processes involved in, sacral neuromodulation (SNM) device implantation as a treatment for urinary symptoms. SNM has been an option to treat lower urinary tract dysfunction for more than 20 years and is a treatment for both overactive bladder syndrome (OAB) and female non–obstructed chronic urinary retention (FCUR). It is recognised by the National Institute for Health and Care Excellence as a therapeutic option for OAB and FCUR. SNM has its place in the pathway for the treatment of both conditions and, in the correctly assessed patient, can be the last option before considering major surgical intervention.