Urodynamic findings of multiple sclerosis patients at a single institution

Aim: Multiple sclerosis (MS) is a chronic and progressive disease of the central nervous system (CNS). The destructive effect of MS on the urogenital system has been demonstrated in many studies especially in young adults. Urodynamic evaluation is recommended in the diagnosis of urogenital system pathologies for MS patients. Unfortunately, there are not enough studies evaluating the urodynamic examinations of MS patients in our country. In this study, urodynamic findings of patients with MS were evaluated. Material and Method: A total of 58 patients (39 female and 19 male) were included in the study. The urodynamic findings of the patients in the same center between January 2011 and October 2017 were evaluated retrospectively. Urodynamic evaluation was performed with 20 ml of infusion per minute according to the International Continence Society standards. Results: The mean age of the patients was 47.4 +/- 8.8 years. The mean duration of multiple sclerosis was 11.8 +/- 7.4 years. When the features of multiple sclerosis were evaluated, 13 (22.4%) patients had a progressive type, 20 (34.5%) had a secondary progressive type, and 25 (43.1%) had relapsing-remitting (with relapses and remissions). The urodynamic findings of the patients are shown in Table 1. Urodynamic evaluations of patients with urinary incontinence are reported as 'Urge type urinary incontinence' was observed in 30 (83.3%), 'stress type urinary incontinence' in 5 (13.9%) and 'mixed type urinary incontinence' in 1 (2.8%) patient. Discussion: Multiple sclerosis is a common neurological pathology which has different urinary system findings. Detrusor overactivity is the most common urinary manifestation, and patients may also have impaired contractility, detrusor sphincter dyssynergia, urodynamic stress incontinence, and bladder outlet obstruction

EVALUATION OF THE ASSOCIATION OF PIGMENTARY MACULOPATHY IN PRIMARY BLADDER PAIN SYNDROME PATIENTS RECEIVING PENTOSAN POLYSULFATE SODIUM TREATMENT

Objective Primary bladder pain syndrome (PBPS) is characterized with suprapubic pain accompanied by at least one lower urinary tract symptoms including frequent urination, urinary urgency and nocturia for more than 6 weeks. While there are many alternative therapies for the treatment of PBPS, the only approved oral medication is PPS (pentosan polysulfate sodium). As it has been associated with retinal toxicity after its widespread use, this study aims to evaluate the relationship between PPS use and maculopathy. Material and Methods The patients diagnosed with PBPS between 2010 and 2020 who may only benefit from PPS use were included into the study after subgroup and phenotype assessment (urinary and non-ulcerative organspecific subgroups). In our study, patients who had history of degenerative maculopathy or diseases predisposing to maculopathy (age-related macular degeneration, diabetes mellitus, hypertension, chronic vascular disorders, central serous chorioretinopathy, retinal dystrophy, epiretinal membrane, and chronic exposure to hydroxychloroquine) were excluded to prevent possible misdirection. Patients underwent best-corrected visual acuity assessment using Snellen chart, anterior segment and fundus examination using slit lamp biomicroscopy, and intraocular pressure measurement. Color vision test (Ishihara test), posterior segment optical coherence examination and 10-2 visual field test were performed, and color images of the fundus and autofluorescence imaging were obtained. Best-corrected visual acuity, color vision results, macular, choroidal and mean retinal nerve fiber thicknesses, mean deviation of the visual field and fundus findings were recorded. Results Out of 15 patients included into the study, 4 (37.5%) were male and 11 (73.3%) were female. The mean age of the patients was 53.3±11.2 years. During the follow-up, the duration of oral PPS use was found to be 33.01±10.59 months, cumulative oral PPS dose to be 216.02±97.63 g and duration of diagnosis to be 66.64±39.37 months. The mean central macular thickness of the patients was measured to be 254.55±33.11 ?m, and the mean choroidal thickness to be 261.82±34.22 ?m. Mean deviation of the visual field of the patients was found to be -1.89 ±-1.25 dB. The mean retinal nerve fiber thickness was measured to be 98.1±17.62 ?m from the fundus autofluorescence images of the patients. Furthermore, in the present study, the ocular findings of the patients who are at below and above the mean cumulative dose and exposure period were compared. Conclusion This study detected no correlation between longterm PPS use and maculopathy. When forming the patient group; it is crucial to exclude patients with comorbidities such as diabetes mellitus and hypertension, and to form a homogeneous group by phenotype and subgroup assessment. Randomized, prospective, multi-center studies are needed to better assess this correlation

The Results of Urodynamics and Pressure Flow Study of Patients with Neurological Disease in a Single Center for 12 Years: Neurogenic Bladder Etiology

Aim:Generally, urodynamic-pressure flow study (U-PFS) is performed on patients with lower urinary tract symptoms (LUTS) for verifying the diagnosis and evaluating the rate of response for treatment. The aim of the study was to assess the results of the U-PFS of patients according to the etiology of neurological disorders.Materials and Methods:The data of 2,489 patients who underwent U-PFS in our clinic between 2010-2022 were analyzed retrospectively. A total of 535 patients with LUTS and neurogenic disorder were included in the study. Patients were divided into subgroups according to their diagnosis. The patient’s age, gender, and U-PFS data (sensation of first urine, maximum cystometric capacity (MSC), maximum detrusor pressures in the filling phase, presence of urgency, and bladder compliance status) were evaluated and compared according to neurological disorders.Results:Cervical and lumbar disc disorder was found in 204 (38.1%) patients, multiple sclerosis (MS) in 103 (19.2%), and cerebrovascular incidents in 74 (13.8%) patients (SVI), spinal cord injury in 48 (8.9%), polyneuropathy in 43 (8.0%), Parkinson’s disease (PD) in 30 (5.6%), diabetic neuropathy in 18 (3.4%), and operated spine bifida (oSB) in 15 (2.8%) was detected. Detrusor pressures in the filling phase were compared according to neurological disorders, and detrusor pressures were statistically significantly higher in patients with oSB and PD (52.66±40.78 mmHg; 45.30±34.43 mmHg, respectively; p<0.001). When the MSCs were compared, it was observed that the bladder capacity was significantly lower in PD and ASD patients, whereas bladder capacity was relatively increased in lomber and servical disc disorder, spinal cord injury and polyneuropathy patients (respectively 308.71±190.25 mL, 264.81±140.25 mL, 491.90±167.49, 474.52±182.92, 447.67±168.03, p<0.001).Conclusion:These specific patient groups (oSB and spinal cord injury) are hazardous groups for the development of end-stage kidney failure. Clinicians should take into consideration that patients and their relatives have to be informed about possible long-term complications

Evaluation of manufacturing performance

Özet: Küresel rekabet, kısalan ürün yaşam eğrileri ve imalât teknolojilerindeki gelişmeler, imalât firmalarını karmaşık ve belirsiz bir çevre içerisinde rekabet etmeye zorlamıştır. Müşterilerin gereksinimleri ve firmaların bu gereksinimleri karşılama eğilimleri dikkate alındığında, maliyetleri ve pazara giriş süresini düşüren, kalite ve teslimatı arttıran firmaların en yüksek imalat performansını elde edeceği göz ardı edilemeyecek bir gerçektir. Akademik yazın incelendiğinde çeşitli yazarlar tarafından çok sayıda imalat performansı ölçütü önerildiği ve kullanıldığı görülmüştür. Bu çalışmada, imalat performansının değerlendirilmesinde kullanılan boyutların irdelenmesi amaçlanmıştır. Rekabetçi imalat öncelikleri olarak adlandırılan bu ölçütlerle ilgili olarak farklı yazarlar tarafından yapılmış olan çalışmalar incelenmiş ve ilgili çalışmalarda kullanılan ölçütler sunulmuştur. Akademik yazın incelendiğinde dört temel rekabetçi imalat önceliği olduğu görülmüştür. Bunlar maliyet, kalite, teslimat ve esnekliktir. Ancak yakın zamanda yapılan çalışmalarda bu dört unsura ilave olarak başka önceliklere de yer verilmiştir. Bu çalışma ile imalat performansının değerlendirilmesinde kullanılan ve günümüz koşullarında en geçerli olduğu düşünülen tüm göstergelerle ilgili detaylı bir araştırma yapmak ve sonuçları ortaya koymak amaçlanmıştır