For those patients with refractory lower urinary tract dysfunction who are not well treated by traditional therapy such as behavior therapy and drug therapy, neuromodulation technologies have gradually become alternative treatments. Several neuromodulation technologies are also used in animal experimental and clinical scientific research by more and more scholars, in order to find more effective methods and mechanisms of treatment of lower urinary tract dysfunction. This article introduces the principle and advantages of common neuromodulation technologies, which focuses on the application in lower urinary tract dysfunction treatment, and analyzes the direction and the broad prospect of neuromodulation.
Humans ; Transcutaneous Electric Nerve Stimulation ; Urologic Diseases ; physiopathology ; therapy

Lower urinary tract dysfunction-such as urinary incontinence (UI), detrusor overactivity, and benign prostatic hyperplasia-is prevalent in elderly persons. These conditions can interfere with daily life and normal functioning and lead to negative effects on health-related quality of life. UI is one of the most common urologic conditions but is poorly understood elderly persons. The overall prevalence of UI increases with age in both men and women. Elderly persons often neglect UI or dismiss it as part of the normal aging process. However, UI can have significant negative effects on self-esteem and has been associated with increased rates of depression. UI also affects quality of life and activities of daily living. Although UI is more common in elderly than in younger persons, it should not be considered a normal part of aging. UI is abnormal at any age. The goal of this review is to provide an overview of the cause, classification, evaluation, and management of geriatric lower urinary tract dysfunction.
Activities of Daily Living ; Aged ; *Aging/physiology/psychology ; Disease Management ; Female ; Humans ; Male ; Prevalence ; *Quality of Life ; Urinary Tract/*physiopathology ; *Urologic Diseases/classification/epidemiology/etiology/physiopathology/psychology/therapy

No abstract available.
Animals ; Erectile Dysfunction/therapy ; Humans ; Male ; Stem Cell Transplantation/*methods ; Urologic Diseases/*therapy ; Urology/methods/trends

The rapid aging of the world population is major global demographic trend. The number of people with age-related disease has increased substantially due to increased life expectancy in the general population. Major geriatric urological diseases include urinary incontinence, urological cancer, bladder outlet obstruction disorders such as benign prostatic hyperplasia (BPH), sexual dysfunction, and urinary tract infection. BPH is the most common benign tumor in urology. Testosterone is considered to play a major role in the development of BPH. Lower urinary tract symptoms due to BPH are classified as related to either storage or voiding. Evaluation of symptom scores, digital rectal examination, urine analysis, serum prostate specific antigen measurement, uroflowmetry, and post-void residual urine testing are mandatory. In addition, in order to rule out prostatic cancer, other screening and diagnostic procedures are often required. Depending on the condition of the patients, approaches such as watchful waiting, pharmacotherapy with an alpha blocker or 5-alpha reductase inhibitor, or surgery such as transurethral resection of prostate are appropriate.
Aging ; Digital Rectal Examination ; Drug Therapy ; Geriatrics ; Humans ; Hyperplasia* ; Life Expectancy ; Lower Urinary Tract Symptoms ; Mass Screening ; Oxidoreductases ; Prostate* ; Prostate-Specific Antigen ; Prostatic Hyperplasia ; Prostatic Neoplasms ; Testosterone ; Transurethral Resection of Prostate ; Urinary Bladder Neck Obstruction ; Urinary Incontinence ; Urinary Tract Infections ; Urologic Diseases ; Urologic Neoplasms ; Urology ; Watchful Waiting

OBJECTIVE: We determined the efficacy of extracorporeal shock wave lithotripsy (ESWL) monotherapy and compared its cost-effectiveness with percutaneous nephrolithotomy (PCNL) for the management of lower pole renal calculi with a size of 1.0cm to 2.0cm in widest dimension.

MATERIALS AND METHODS: Using the cost estimate data available locally from patient billing charges and average professional fee, efficacy and complication rates data from the literature, the cost-effectiveness for the percutaneous nephrolithotomy and shock wave lithotripsy as primary therapy for lower pole stones were evaluated. We developed a decision analysis model in which a patient in whom primary therapy (either ESWL or PCNL failed was rendered stone-free with secondary ESWL using a trial version add-in software for Microsoft Excel from www.TreePlan.com with some modifications.

RESULTS: The average cost over all outcomes from the decision to perform ESWL in patients with lower pole stones 1.0 to 2.0 cm is Php 53,801.07 and Php 127,019.27 for PCNL. For PCNL to be as cost effective, cost incurred should be lowered to Php 47,746.38

CONCLUSIONS: Extracoporeal shock wave lithotripsy, despite its considerable low efficacy as compared to PCNL as a primary treatment for lower pole stones 1.0 to 2.0 cm, is still more cost-effective.

Human ; Male ; Female ; NEPHROLITHIASIS ; UROLOGIC DISEASES ; KIDNEY DISEASES ; COST-BENEFIT ANALYSIS ; TREATMENT OUTCOME ; LITHOTRIPSY ; NEPHROSTOMY, PERCUTANEOUS ; THERAPEUTICS ; THERAPY

OBJECTIVE: To investigate the efficacy of terpene compound drug (pinene, camphene, borneol, anethole, fenchone and cineol in olive oil) in facilitating spontaneous passage of ureteral calculi

METHODS: Systematic literature search of the MEDLINE, EMBASE, OVID, Science Direct, Proquest, Google scholar, Cochrane Library databases and rference lists of related literature was done without language restriction. Trials on ureterolithiasis medical expulsive therapy (MET) that compare terpene compound drug versus placebo/control group or alpha-blockers were identified. Articles retrieved were critically appraised by two independent reviewers according to Cochrane Collaboration recommendations. Data from included studies were extracted for calculation of risk ratio (RR) and 95% confidence interval (CI). Effect estimates were pooled using Mantel-Haenszel method with random effect model. Inter-study heterogeneity and publication bias were assessed. The PRISMA guidelines for meta-analysis reporting were followed.

RESULTS: Five trials (total of 344 subjects) of adequate methodological quality were included. Pooled effect estimates from homogenous studies showed that compared to placebo/ control group, patients treated with terpene compound drug had significantly higher ureteral calculi expulsion rate (pooled RR: 1.34; 95% CI 1.12, 1.61). Analysis of studies that compare terpene compound drug with alpha-blockers showed no significant difference (pooled RR: 0.79; 95% CI 0.59, 1.06), although significant inter-study heterogeneity was noted. Only minor gastrointestinal adverse effect was reported on terpene compound drug use.

CONCLUSIONS: The results suggest that terpene compound drug as MET is effective in promoting passage of ureterolithiasis. High quality large-scale RCTs comparing alpha-blockers and terpene compound drug are warranted to make a more definitive conclusion.

Human ; Male ; Female ; TERPENES-adverse effects,therapy,TREATMENT OUTCOME ; UROLOGIC DISEASES ; URETERAL DISEASES ; Ureteral Calculi

Because sex hormones influence the lower urinary tract, menopause can cause several urinary diseases including overactive bladder, stress urinary incontinence and recurrent urinary tract infection. However, the results of many clinical studies have indicated that menopausal hormone replacement therapy is not effective for the treatment of previous diseases, especially via the oral route. Although estrogen vaginal cream or pessary is an effective treatment for overactive bladders and can prevent recurrent urinary tract infection, its beneficial effects only last for the duration of the treatment. If patients with previous mentioned urologic disease have other local symptoms and conditions, such as atrophic vaginitis and dyspareunia, local estrogen replacement therapy will be helpful in relieving the local symptoms. However, the potential for breast cancer or return of withdrawal of bleeding, patient's age, adverse effect of systemic administration, estrogen-progesterone combination therapy, and effectiveness among other treatment modalities must be considered before a treatment decision can be made. In this article, we will review the current issues on the relationship among urinary tract and sex hormone and menopause, and the effectiveness of menopausal hormone replacement therapy for the treatment of overactive bladders, stress urinary tract incontinence and recurrent urinary tract infection.
Atrophic Vaginitis ; Breast Neoplasms ; Dyspareunia ; Estrogen Replacement Therapy ; Estrogens ; Female ; Gonadal Steroid Hormones ; Hemorrhage ; Hormone Replacement Therapy ; Humans ; Menopause ; Pessaries ; Urinary Bladder ; Urinary Bladder, Overactive ; Urinary Incontinence ; Urinary Tract ; Urinary Tract Infections ; Urologic Diseases ; Vaginal Creams, Foams, and Jellies

The present paper serves as a review of the associations between lower urinary tract symptoms (LUTS) and erectile dysfunction (ED), with a focus on common and combined pathways for treatment. LUTS and ED are common conditions seen in general urologic practice. Research has started to establish epidemiologic and pathophysiologic links between the two conditions and a strong association confirmed across multiple studies. Men seeking care for one condition should always be interviewed for complaints of the other condition. Proposed common pathways include alpha-1 adrenergic receptor imbalance, Rho-kinase overactivity, endothelial cell dysfunction and atherosclerosis-induced ischemia. Medical therapy has replaced surgery as the first-line treatment for LUTS in most patients, with the incorporation of alpha-adrenergic receptor antagonists (alpha-ARAs) and 5-alpha-reductase inhibitors (5-ARIs) into everyday practice. Treatment with alpha-ARAs contributes to some improvement in ED, whereas use of 5-ARIs results in worsened sexual function in some patients. Phosphodiesterase-5 (PDE-5) inhibitors have revolutionized the treatment of ED with a simple oral regimen, and new insights demonstrate a benefit of combined use of PDE-5 inhibitors and alpha-ARAs. The mechanisms of action of these medications support these observed benefits, and they are being studied in the basic science and clinical settings. In addition, novel mechanisms for therapy have been proposed based on clinical and research observations. The minimally invasive and surgical treatments for LUTS are known to have adverse effects on ejaculatory function, while their effects on erectile function are still debated. Much remains to be investigated, but it is clear that the associations between LUTS and ED lay the foundation for future therapies and possible preventative strategies.
5-alpha Reductase Inhibitors ; Adrenergic alpha-Antagonists ; therapeutic use ; Atherosclerosis ; complications ; Endothelium, Vascular ; Erectile Dysfunction ; etiology ; therapy ; Humans ; Male ; Phosphodiesterase Inhibitors ; therapeutic use ; Prostatic Hyperplasia ; complications ; surgery ; Receptors, Adrenergic, alpha ; physiology ; Urologic Diseases ; etiology ; therapy ; rho-Associated Kinases ; metabolism

Diethylstilbestrol ; therapeutic use ; Disease Progression ; Endocrine Disruptors ; therapeutic use ; Female ; Humans ; Urologic Diseases ; drug therapy ; pathology

Integrative traditional Chinese and Western urinary surgery is a subject with good prospect and special superiority of combined TCM with Western medicine. In the past decade, great achievements have been obtained by virtue of endeavor from the integrative urinary surgical workers, they set up a good foundation for the development and academic improvement of the cause in our nation.
Animals ; Combined Modality Therapy ; Diagnosis, Differential ; Drugs, Chinese Herbal ; therapeutic use ; Female ; Humans ; Integrative Medicine ; methods ; Male ; Medicine, Chinese Traditional ; Phytotherapy ; Urologic Diseases ; diagnosis ; drug therapy ; surgery