The Central Autonomic Network and Regulation of Bladder Function

The autonomic nervous system (ANS) is involved in the regulation of physiologic and homeostatic parameters relating particularly to the visceral organs and the co-ordination of physiological responses to threat. Blood pressure and heart rate, respiration, pupillomotor reactivity, sexual function, gastrointestinal secretions and motility, and urine storage and micturition are all under a degree of ANS control. Furthermore, there is close integration between the ANS and other neural functions such as emotion and cognition, and thus brain regions that are known to be important for autonomic control are also implicated in emotional functions. In this review we explore the role of the central ANS in the control of the bladder, and the implications of this for bladder dysfunction in diseases of the ANS

Transcutaneous electrical nerve stimulation: an effective treatment for refractory non-neurogenic overactive bladder syndrome?

Purpose: To assess the effect of transcutaneous electrical nerve stimulation (TENS) for treating refractory overactive bladder syndrome (OAB). Patients and methods: A consecutive series of 42 patients treated with TENS for refractory OAB was prospectively investigated at an academic tertiary referral centre. Effects were evaluated using bladder diary for at least 48h and satisfaction assessment at baseline, after 12weeks of TENS treatment, and at the last known follow-up. Adverse events related to TENS were also assessed. Results: Mean age of the 42 patients (25 women, 17 men) was 48years (range, 18-76). TENS was successful following 12weeks of treatment in 21 (50%) patients, and the positive effect was sustained during a mean follow-up of 21months (range, 6-83months) in 18 patients. Following 12weeks of TENS treatment, mean number of voids per 24h decreased significantly from 15 to 11 (p<0.001) and mean voided volume increased significantly from 160 to 230mL (p<0.001). In addition, TENS completely restored continence in 7 (39%) of the 18 incontinent patients. Before TENS, all 42 patients were dissatisfied or very dissatisfied; following 12weeks of TENS treatment, 21 (50%) patients felt satisfied or very satisfied (p<0.001). No adverse events related to TENS were noted. Conclusions: TENS seems to be an effective and safe treatment for refractory OAB warranting randomized, placebo-controlled trial

More than skin deep: body representation beyond primary somatosensory cortex

The neural circuits underlying initial sensory processing of somatic information are relatively well understood. In contrast, the processes that go beyond primary somatosensation to create more abstract representations related to the body are less clear. In this review, we focus on two classes of higher-order processing beyond somatosensation. Somatoperception refers to the process of perceiving the body itself, and particularly of ensuring somatic perceptual constancy. We review three key elements of somatoperception: (a) remapping information from the body surface into an egocentric reference frame (b) exteroceptive perception of objects in the external world through their contact with the body and (c) interoceptive percepts about the nature and state of the body itself. Somatorepresentation, in contrast, refers to the essentially cognitive process of constructing semantic knowledge and attitudes about the body, including: (d) lexical-semantic knowledge about bodies generally and one’s own body specifically, (e) configural knowledge about the structure of bodies, (f) emotions and attitudes directed towards one’s own body, and (g) the link between physical body and psychological self. We review a wide range of neuropsychological, neuroimaging and neurophysiological data to explore the dissociation between these different aspects of higher somatosensory function

Practical Clinical Andrology

This open access book offers a valuable resource for understanding the correct pathways in the context of sexual disorders, couple reproduction, gender identity dysphoria, conditions for which patients commonly ask for consultation and treatment. Based on clinical evidence, international guidelines and experts experience, practical clinical management strategies are presented for each condition. Each clinical care pathway is based on updated algorithm, level of evidence, photos and video-clips that describes the clinical presentations and the best practice management through diagnostic tools and medical or surgical treatment. Leading experts from the most important center of excellence in the field of sexual medicine joined to cover the field of andrology in its entirety, each of them dealing with a single topic from the top of their recognized experience and providing a complete and update textbook that will help urologists and other physicians in their daily clinical practice. This book is thought to be a practical and valuable reference for urologists, gynecologists, endocrinologists, psychiatrics and psychologists, and residents who are not specialty trained in andrology. It is designed for both young fellows training in different specialties and coming into contact with andrological issues for the first time and also more experienced clinicians and surgeons requiring updated guidelines and clear advice on the most controversial issues. This book will represent an invaluable quick consulting tool, updated in its scientific contents and rich in tables, images and video-clips

Efectividad del mini sling vs sling transobturatriz en el tratamiento de la incontinencia urinaria de esfuerzo

Objetivo: Demostrar que el mini sling suburetral anclado en una sola rama del pubis, es más efectivo en el tratamiento de la incontinencia urinaria de esfuerzo que la inserción de un sling transobturatriz. Material y Métodos: Se llevó a cabo un estudio de tipo cohorte retrospectivo. La población de estudio estuvo constituida por 66 pacientes con incontinencia urinaria de esfuerzo según criterios de inclusión y exclusión establecidos distribuidos en dos grupos: expuestos a técnica mini sling o sling transoburatriz. Resultados: La frecuencia de dolor genital postoperatorio fue significativamente menor el grupo usuario de la técnica mini sling suburetral respecto a la técnica sling Transobturatriz (p<0.05). La frecuencia de continencia urinaria postoperatoria fue significativamente mayor el grupo usuario de la técnica mini sling suburetral respecto a la técnica sling Transobturatriz (p<0.05). La frecuencia de extrusión de malla y la frecuencia de dificultad de micción postquirúrgica no tuvieron diferencias significativas entre los usuarios de la técnica mini sling suburetral o de la técnica sling Transobturatriz (p>0.05). Conclusiones: El mini sling suburetral anclado en una sola rama del pubis, es más efectivo en el tratamiento de la incontinencia urinaria de esfuerzo, que la inserción de un sling transobturatriz.Objective: To demonstrate that the suburethral mini sling anchored in a single branch of the pubis is more effective in the treatment of stress urinary incontinence than the insertion of a transobturator sling. Material and Methods: A retrospective cohort study was carried out. The study population consisted of 66 patients with stress urinary incontinence according to established inclusion and exclusion criteria divided into two groups: exposed to mini sling technique or transobturator sling. Results: The frequency of postoperative genital pain was significantly lower in the user group of the suburethral mini sling technique compared to the Transobturator sling technique (p <0.05). The frequency of postoperative urinary continence was significantly higher in the user group of the suburethral mini sling technique compared to the Transobturator sling technique (p <0.05). The frequency of mesh extrusion and the frequency of difficulty of postoperative urination did not differ significantly between users of the suburethral mini sling technique or the Transobturator sling technique (p> 0.05). Conclusions: The suburethral mini sling anchored in a single branch of the pubis is more effective in the treatment of stress urinary incontinence than the insertion of a transobturator sling.Tesi