Combined Diagnostic Modalities Improve Detection of Detrusor External Sphincter Dyssynergia

Introduction. The diagnosis of detrusor-external sphincter dyssynergia (DESD) is a clinically relevant finding during urodynamic testing. However, there is no consensus regarding diagnostic specifics of electromyography (EMG) or voiding cystourethrography (VCUG). We evaluated the concordance of the two modalities most commonly used in clinical practice for the diagnosis of DESD. Methods. Patients were prospectively evaluated by a single urodynamicist at an academic center and retrospectively re-evaluated by an independent urodynamicist for agreement. DESD was determined by increased patch EMG activity or a dilated bladder neck/proximal urethra on VCUG during detrusor contraction. Minimal acceptable criterion for agreement was set at 70%. Results. Forty-six patients were diagnosed with DESD with both modalities available. Of these 46 patients, 25 were diagnosed by both tests, 11 by VCUG alone and 10 by patch EMG alone. Binomial testing demonstrated the proportion of agreement was 54% (95% CI 39% to 68%). Conclusion. We found significant disagreement between the two modalities, similar to previously reported findings using needle EMG, and we expand the applicability of our data to the majority of clinicians who use patch EMG electrodes. This further supports the idea that the combined use of EMG and VCUG for diagnosis can identify more cases of DESD than either modality alone

The South African guidelines on enuresis-2017

Introduction: Enuresis (or Nocturnal Enuresis) is defined as discreet episodes of urinary incontinence during sleep in children over 5 years of age in the absence of congenital or acquired neurological disorders. Recommendations: Suggestions and recommendations are made on the various therapeutic options available within a South African context. These therapeutic options include; behavioural modification, pharmaceutical therapy [Desmospressin (DDAVP), Anticholinergic (ACh) Agents, Mirabegron (beta 3-adrenoreceptor agonists), and Tricyclic Antidepressants (TCA)], alternative treatments, complementary therapies, urotherapy, alarm therapy, psychological therapy and biofeedback. The role of the Bladder Diary, additional investigations and Mobile Phone Applications (Apps) in enuresis is also explored. Standardised definitions are also outlined within this document. Conclusion: An independent, unbiased, national evaluation and treatment guideline based on the pathophysiological subcategory is proposed using an updated, evidence based approach. This Guideline has received endorsement from the South African Urological Association, Enuresis Academy of South Africa and further input from international experts within the field

Edukasi Dan Terapi Latihan Untuk Mengurangi Nyeri Lutut Pada Lansia Dengan Kondisi Osteoarthritis

Nyeri lutut atau osteoarthritis knee merupakan suatu kondisi degeneratif kronis yang paling banyak menyumbang gangguan pada lansia akibat adanya peradangan pada jaringan disekitar lutut. Usia adalah predictor terkuat Osteoarthritis lutut. Gejala klinis OA yaitu kekakuan sendi, nyeri sendi dan disfungsi sendi, namun masalah utama bagi sebagian besar pasien adalah rasa sakit atau nyeri pada sendi. Kegiatan pengabdian dilakukan dengan maksud memberikan dan meningkatkan pemahaman kepada komunitas lansia di Desa Soak Batok Kecamatan Indralaya Utara Kabupaten Ogan Ilir yang berjumlah kurang lebih 11 orang dengan kondisi nyeri pada sendi lutut. Penyuluhan digunakan sebagai metode kegiatan pengabdian dengan media promosi kesehatan berupa leaflet yang di lengkapi dengan keterangan gambar latihan. Materi dan demo praktek terapi latihan untuk mengurangi keluhan nyeri lutut dapat diterima dan dipahami dengan baik. Selama berjalannya kegiatan dilakukannya sesi diskusi atau tanya jawab seputar kondisi nyeri lutut yang dialami oleh lansia  untuk menambah pengetahuan lansia terhadap kondisi nyeri lutut

Long term partial bladder outlet obstruction induced contractile dysfunction in male rabbits: A role for rho-kinase

Aims: In this study we examined the expression of Rho-kinase (ROK) isoforms in rabbit detrusor smooth muscle during the progression of partial bladder outlet obstruction and correlated them with the time course of obstruction. Methods: Detrusor samples were obtained from bladders after 1, 2, 4, and 8 weeks of obstruction and also sham operated control rabbits. Contractile responses to field stimulation (FS) and also the smooth muscle (SM) to collagen ratio were determined in isolated bladder strips. Reverse transcriptase-polymerase chain reaction, sodium dodecyl sulfate-polyacrylamide gel electrophoresis and Western blotting were used to determine the relative levels of ROK isoform expression at the mRNA and protein levels. Results: Bladder weight increased gradually and contractile responses were reduced significantly over the course of obstruction. The smooth muscle/collagen ratio increased significantly during the course of obstruction. The expression of ROK alpha increased significantly to approximately the same extent in 1-4-week obstructed groups and increased further in the 8-week obstructed group, both at the mRNA and protein levels. In contrast, there was a significant decrease in the expression of ROK beta in the obstructed groups, which gradually decrease during the course of 1-4-week obstruction period and are slightly upregulated at the decompensated stage at 8-week obstruction. Conclusions: The change in the isoforms of ROK may be part of the molecular mechanism for bladder compensation following partial bladder outlet obstruction