We evaluated 60 patients with myelodysplasia using the urethral opening pressure (UOP) which is defined as the total intravesical pressure at the moment when urine passes through the external sphincter by the Crede or the Valsalva maneuver, Twenty nine of the patients showed UOP value greater than 35 cmH 2 0 and 31 below 35 cmH 2 0. In the high pressure group, patients showed a tendency to preserve sphincter activity and had mild paralysis of the lower extremities. In contrast, most of patients in the low pressure group showed an underactive sphincter and severe paralysis of the lower extremities. The incidence of deterioration of the upper urinary tract, vesicoureteral reflux (VUR) and bladder deformity were significantly high in the high pressure group than those in the low pressure group (75.9% vs 16.1 %, 72.4% vs 22.6%, 82.8% vs 29.0%, respectively, P<0.05). During the follow-up period (42 months on average), the voiding methods were changed in 15 patients from the Crede maneuver to clean intermittent catheterization, and total of 12 operations were performed (10 antiVUR operation and two with an ileocystoplasty). Finally, approximately 90% of the patients in both the high and the low pressure groups were evaluated as improved or stable in the upper urinary tract, VUR and bladder deformity after conservative or surgical managements. UOP is considered to be one of the useful parameters to select the high risk patient in the urological management of myelodysplastic patients.
An 81-year-old man was referred to our hospital with a chief complaint of asymptomatic macrohematuria. Cystoscopy revealed bleeding from the right ureteral orifice. Various examinations, including ureteroscopy, failed to find any abnormalities. As gingival bleeding followed the macrochematuria, further examinations of blood coagulatory function were undertaken. Decreased factor VIII coagulant activity accompanied by the presence of factor VIII inhibitor was revealed, leading to a final diagnosis of acquired hemophilia A. Macrohematuria and gingival bleeding immediately disappeared with oral administration of prednisolone at 30 mg per day, and the titer of factor VIII inhibitor decreased to an undetectable level by the 45th day of treatment. We emphasized the importance of blood coagulation testing in the examination of patients with macrohematuria.
These results revealed that upper urinary tract and VUR were relatively controlled, however, bladder deformity was increased in its frequency. To prevent upper urinary tract deterioration, further analysis of sequential changes of urinary tract conditions should be demanded.
To achieve successful pregnancy and delivery in the patient with spina bifida, careful urological and obstetrical observation for the potential complications is needed.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.