Neuroimaging Study Investigating the Supraspinal Control of Lower Urinary Tract Function in Man With Orthotopic Ileal Neobladder

Introduction: Recent studies employing functional imaging methodology have revealed reference brain regions of urinary tract function, namely, the midbrain periaqueductal gray matter, thalamus, and cingulate and prefrontal cortices. The orthotopic ileal neobladder is a desirable method for urinary diversion after radical cystectomy, but its supraspinal control remains unknown. We aimed to evaluate brain activity while maintaining urinary urgency and voluntary urinary control in male subjects with ileal orthotopic neobladders by performing functional MRI (fMRI) during a block design experiment.Materials and Methods: Patients were recruited at the Sun Yat-sen Memorial Hospital of the Sun Yat-sen University from October 2017 to May 2019. Two tasks were performed during fMRI scanning: (1) repeated infusion and withdrawal of sterile saline solution into and out of the neobladder to simulate urgency; and (2) repeated contraction of the pelvic floor muscle with a full neobladder to induce inhibition of micturition since the subjects were asked not to urinate. The obtained data were visualized and statistically analyzed.Results: Sixteen subjects were recruited in the study, and data were obtained from 10 subjects: mean age 60.1 years, average postoperative time 20.2 months, and daytime continence rate 100%. The parahippocampus, frontal lobe, vermis, and anterior cingulate cortex were activated with large bladder volumes, and the thalamus and caudate nucleus were deactivated during voluntary urinary control.Conclusion: A complex supraspinal program is involved during ileal orthotopic neobladder control, which is significantly different from that with normal bladders, in which the original intestine visceral volume sensation is preserved.

The Advantages of DiLEP Operation in the Treatment of BPH Patients and the Observation of Postoperative Urinary Control Effect

Objective: To evaluate the efficacy of Semiconductor laser trefoil enucleation of the prostate (DiLEP) in the treatment of patients with benign prostatic hyperplasia (BPH). Methods: 120 BPH patients scheduled for prostate surgery in our hospital were randomly divided into two groups: study group (DiLEP treatment) and control group (transurethral plasma bipolar resection of the prostate treatment), with 60 cases in each one. Surgical process indicators, postoperative rehabilitation indicators, Qmax before and after surgery, post-void residual volume (PVR), international prostate symptom score (IPSS), hemoglobin (Hb), urinary control and surgical complications for two groups were compared. Results: The operation time, intraoperative blood loss, bladder irrigation time, urinary catheter indwelling time and hospital stay in the study group were lower than those in the control group (P<0.05). The weight of resected tissue in the study group was higher than that in the control group (P <0.05). The difference in Qmax, PVR, IPSS scores and Hb between the study group and the control group before operation and one month after operation had no statistical significance (P>0.05). The Qmax and Hb scores in the study group were higher than those in the control group (P<0.05), while the PVR and IPSS scores were lower than those in the control group (P<0.05); five days and two weeks after operation, the urinary control rates in the study group were all higher than that in the control group (P<0.05); one month after operation, the difference in the urinary control rates between the two groups had no statistical significance (P>0.05); the difference in the surgical complication rate between the study group and the control group had no stastiscal significance (P>0.05). Conclusion: DiLEP is beneficial for early recovery of urodynamics in patients with BPH, with less trauma and faster recovery of urinary control after surgery.

Modified completely intrafascial radical cysprostatectomy for bladder cancer: a single-center, blinded, controlled study

Background We have proposed a modified, completely intrafascial radical cysprostatectomy (RC) to treat bladder cancer patients with the aim of preserving the patients’ post-surgical urinary control and erectile function. This study aimed to evaluate the oncological and functional outcomes of this innovation relatively to that with the conventional technique. Methods A retrospective, single-center, blinded, and controlled study was conducted using the medical data of patients since the past 5 years from the hospital database. A total of 44 patients were included, including 20 who received complete intrafascial cysprostatectomy and 24 who received conventional interfascial surgeries. The patients’ continent and sexual information of 1-year follow-up after the surgery were extracted. The oncological and functional outcomes of the 2 groups were compared and analyzed. Results The demographics parameters of the 2 groups showed no significant difference. The results of follow-up of the oncological outcomes did not reveal any significant difference between the completely intrafascial group and the conventional interfascial group in terms of the positive surgical margins, local recurrences, and distant metastasis. Patients following neobladder diversion in the intrafascial group showed a faster recovery of the urinary control, with a 76.9% (10/13) daytime continent rate at 3-month, as well as 46.2% (6/13) and 58.3% (7/12) nighttime continent rates at 3-month and 6-month, respectively. Regarding the sexual functions, our results revealed significant advantages in favor of completely intrafascial technique on the post-surgical International Index of Erectile Function (IIEF)-5 score at 3-, 9-, and 12-month follow-up relative to that with the conventional interfascial process. Thus, the IIEF score of patients in the intrafascial group was 11.4 ± 3.5 at 3-month, 14.1 ± 3.6 at 9-month, and 15.2 ± 3.8 at 12-month follow-up after the cystectomy, which was significantly greater than that of the patients in the control group. Conclusions Our novel data illustrated that the modified completely intrafascial technique could result in a better sexual function and faster continence recovery for patients following RC, without any compromise in the cancer control. Thus, this technique could be considered as an alternative extirpative technique for bladder cancer treatment in a clinical setting.

Emotions and Warfare: The Social Dynamics of Close-Range Fighting

Emotions play a central role in warfare. Nearly all soldiers who encounter combat zones experience intense emotional reactions. Some of these emotions are negative, such as fear, panic, anger, rage, or shame, while others are more positive, including pride, elation, joy, or exhilaration. These emotional responses are usually characterized by physiological and psychological changes that affect the bodies and minds of soldiers facing close-range fighting encounters. Researchers have documented a number of physiological effects that accompany intense emotional reactions on the battlefield, including hormonal increases, heavy breathing, increased heart rate, dilation of the pupils, and the loss of urinary control, among others. These similarities in biological responses have led some scholars to make generalizations about the inherent uniformity of emotional reactions on the battlefield. However, recent studies indicate that emotional dynamics in the combat zone are more complex and flexible. In particular, much contemporary historical, sociological, and anthropological scholarship shows that the emotional responses of soldiers are highly variable and context-dependent. Although some physiological reactions are present in many battlefield situations, they too, like psychological effects, tend to be specific to time and place. In other words, there are pronounced historical and cultural differences in the emotional responses of soldiers in combat zones. Facing the same realities of the close-range fighting, soldiers tend to display different emotional reactions and these reactions are more variable as the cultural and historical contexts change. Military organizations have become aware that emotions are central to the behavior of soldiers on the battlefield and they continue to devise new methods to control and shape the emotional reactions of soldiers.

Comparison of open and intracorporeal modified ureterosigmoidostomy (Mainz II) after laparoscopic radical cystectomy with bladder cancer

Objective To compare perioperative and oncologic outcomes of open modified ureterosigmoidostomy urinary diversion (OMUUD) and intracorporeal modified ureterosigmoidostomy urinary diversion (IMUUD) following laparoscopic radical cystectomy (LRC). Patients and methods We retrospectively reviewed our single institutional collected database patients undergoing LRC from October 2011 to October 2019. The perioperative characteristics were compared between OMUUD and IMUUD, and overall survival (OS) and progression-free survival (PFS) were evaluated by the Kaplan-Meier method. Results Overall, 84 patients were included. OMUUD and IMUUD were performed in 63 (75%) and 21 (25%) patients, respectively. IMUUD patients demonstrated shorter postoperative length of stay (16.24 ± 3.91 days vs. 18.98 ± 7.41 days, P = 0.033), similar operation time (498.57 ± 121.44 vs. 462.24 ± 99.71, P = 0.175), similar estimated blood loss [400 (200–475) ml vs. 400 (200–700) ml, P = 0.095], and similar overall complication rate within 30 days (19.05% vs. 25.40%, P = 0.848) and 90 days (23.81% vs. 17.46%, P = 0.748). Complete urinary control rate was 87.3% (55/63) in the OMUUD group. In IMUUD, the complete urinary control rate was 90.5% (19/21). There was no significant difference in OS (χ2 = 0.015, P = 0.901) and PFS (χ2 = 0.107, P = 0.743) between the two groups. Conclusion IMUUD postoperative recovery is faster; other perioperative outcomes and oncology results are not significantly different with OMUUD. It is indicated that IMUUD can be utilized safely and effectively in the urinary diversion after LRC.

Comparison of Open and Intracorporeal Modified Ureterosigmoidostomy (Mainz Ⅱ) After Laparoscopic Radical Cystectomy with Bladder Cancer

Objective: To compare perioperative and oncologic outcomes of open modified ureterosigmoidostomy urinary diversion (OMUUD) and intracorporeal modified ureterosigmoidostomy urinary diversion (IMUUD) following laparoscopic radical cystectomy (LRC).Patients and Methods: We retrospectively reviewed our single institutional collected database patients undergoing LRC from October 2011 to October 2019.The perioperative characteristics were compared between OMUUD and IMUUD, and overall survival (OS) and progression-free survival (PFS) were evaluated by Kaplan-Meier method. Results: Overall 84 patients were included. OMUUD and IMUUD were performed in 63 (75%) and 21 (25%) patients respectively. IMUUD patients demonstrated shorter postoperative length of stay (16.24±3.91 d vs. 18.98±7.41 d, P=0.033), similar operation time (498.57±121.44 vs. 462.24±99.71, P=0.175), similar estimated blood loss ［400(200-475) ml vs. 400(200-700) ml, P=0.095］,similar overall complication rate within 30-d (19.05% vs. 25.40%, P=0.848) and 90-d (23.81% vs. 17.46%, P=0.748). Complete urinary control rate of 87.3% (55/63) at OMUUD group. In IMUUD with a complete urinary control rate of 90.5% (19/21).There was no significant in OS (χ2=0.015, P=0.901) and PFS (χ2=0.107, P=0.743) between two groups.Conclusion: IMUUD postoperative recovery is faster, other perioperative outcomes and oncology results are not significantly different with OMUUD. It is indicated that IMUUD can be utilized safely and effectively in the urinary diversion after LRC.

Experience in application of modified sling in treatment of Moderate Stress Urinary Incontinence

Objective: To observe the clinical significance of modified sling in the treatment of moderate stress urinary incontinence (SUI). Methods: From January 2016 to January 2019, eighty patients with moderate urinary incontinence who were hospitalized in our hospital were randomly divided into two groups. 40 patients in the experimental group underwent modified sling transvaginal tension-free mid-urethral suspension. Modification method of the sling: cut the sling to a remaining length of about 6~7cm, properly connect the barbed sutures (V-LOCK) on both sides of the sling, and insert the urinary incontinence sling from the urethra to the obturator membrane, from the obturator membrane to the thigh. The inner skin area is replaced by the V-LOCK line. The 40 patients in the control group were unmodified ordinary slings. The operation time, the local pain of the inner thigh after the operation, and the improvement of postoperative urinary incontinence symptoms were compared and analyzed between the two groups. Results: Both groups of patients were successfully operated. The operation time was 16.36 minutes in the experimental group and 27.18 minutes in the control group. The difference in operation time between the two groups was statistically significant (p=0.00); the catheter was pulled out on the third day after the operation. One patient in the group had urinary effort, four patients still had urinary incontinence symptoms, the remaining 35 patients had good urinary control (effective rate 87.5%), five patients in the control group still had urinary incontinence, two patients had urinary effort, and the remaining 33 patients had urinary control Good, (effective rate 87.5%), there was no significant difference in surgical effectiveness between the two groups (p=0.53); follow-up for 12 to 36 months, no significant long-term complications occurred, the pain score of the inner thigh of the experimental group was significantly lower than that of the control group ,statistically significant (p=0.04). Conclusion: The efficacy of the modified sling in the treatment of moderate SUI is the same as that of the traditional sling, but the operation time is shorter, the operation is simpler, and the local pain is significantly reduced. doi: https://doi.org/10.12669/pjms.36.7.2619 How to cite this:Guo J, An F, Gu D, Yang W. Experience in application of modified sling in treatment of Moderate Stress Urinary Incontinence. Pak J Med Sci. 2020;36(7):---------. doi: https://doi.org/10.12669/pjms.36.7.2619 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

The influence of time of elimination communication on the prevalence of infantile daytime urination control - a survey from Mainland China

Background: Child self-administration of urination is one of the most challenging stages of development in early childhood, and it is also an important manifestation of family development in parenting. But a pilot survey shows that urination control has decreased significantly during the past decade in Mainland China.Whether it is related to delay of elimination communication (EC) is unclear.Methods A cross-sectional study in children (aged 3-10 years) was performed by distributing 10 010 anonymous self-administered questionnaires to parents in Mainland China from March to September 2017. T The questionnaires included sociodemographic data,caregivers’ information,and details about the disposable diapers (DD) usage,EC commencement date.Results A total of 8 629 ( 86.22% ) children were qualified to enter the final statistical analysis.The urinary control rates at 2 years old in children with EC starting before 12 months of age was significantly higher than those who start after 12 months of age ( 70.72 %vs 59.02 %,p<0.001),and significantly higher than those no EC ( 70.72 %vs 42.48 %,p<0.001). In addition,there was no significant difference in the rate of urinary control at 2 years old between the subgroups at different EC start times within 12 months. After 12 months, the urinary control rate at 2 years old of different subgroups decreased with the start time of EC, which were: 59.97% and 54.10%. The results of urinary control rates at several other ages (ie, 0.5 years,1 year,and 1.5 years) are similar to those at 2 years of age. There was no difference between groups of different genders. The later the beginning of EC, the lower the urination control was found . EC helps infants move quite easily into traditional toilet training when they are old enough.Conclusions Infants and young children start EC as soon as possible at the age of 3 to 12 months is conducive to the development of daytime urination control. A later onset of EC may be risk factors for urination control.