Læknablaðið : fylgirit - 01.06.2009, Blaðsíða 18

Læknablaðið : fylgirit - 01.06.2009, Blaðsíða 18
2 7 T H CONGR SCAND ASSOC UROL F Y L G I R I T 6 1 cumbersome and that is why these patients must not be neglected. There is often a doctor's delay when these patients seek medical attention for their symptoms. It is therefore of paramount importance that unexpected symptoms after pelvic surgery are thoroughly investigated in order to rule out complications. 27 Vibratory ejaculation in 169 spinal cord injured men and home insemination of their partners J Sanksen1, D Löchner-Ernst2, N Brackett3, D Ohl4, C Lynne3 'Dept ofUrology, Herlev Hospital, University ofCopenhagen, Denmark, 2BC- Unfallklinik Murnau, Murnau, Cermany, 3The Miami Project to Cure Paralysis, University of Miami Miller School ofMedicine, Miami, Florida, USA, 4Dept of Urology, University ofMichigan, Ann Arbor, Michigan, USA sonksen@mail.dk Aim: An ejaculation and impairment of semen quality are commonly found in men after spinal cord injury (SCI). Over the past several decades, clinical treatments and assisted reproductive techniques have been developed allowing SCI men to father children. However, only very few home pregnancies have been reported in the literature. The aim of this study is to present the last 20 years' experience from penile vibratory stimulation (PVS) and vaginal self-insemination at home in SCI men and their partners. The data originate from two European and two American centers. Material and methods: Men with SCI and their healthy female partners seeking treatment for infertility were evaluated for this study. Antegrade ejaculation was induced by PVS and basic semen analysis was performed (WHO criteria). Only men who had motile sperm in the ejaculate were included. The main outcome measures were total motile sperm count, time to pregnancies, numbers of pregnancies and miscarriages. Results: A total of 169 SCl men (rnedian age 32 yrs, range 22- 44) and their partners (median age 29 yrs, range 19-36) met the inclusion criteria and were included in the study. The median total motile sperm count was 31 million (range 1-426). Overall, 73 of the 169 couples (43%) achieved 99 pregnancies with delivery of 90 healthy babies (88 singletons and 1 pair of twins). The median time to pregnancy was 1.2 years (range 0.1-8.2). A total of 10 miscarriages in 9 couples were noted Conclusion: Based on the largest study of its kind to date, it is concluded that PVS combined with vaginal self-insemination may be performed as a viable, inexpensive option for assisted conception in couples in whom the SCI male partner has adequate semen parameters and the female partner is healthy. 28 Effects of repeated botulinum toxin therapy in neurogenic detrusor overactivity V Karadzic, L Malmberg Departmcnt ofUrology, Clinical Sciences, Lund, Sweden violetta.karadzic@skane.se Aim of investigation: Injection therapy with Botulinum toxin A (BTX-A) is increasingly used in patients with neurogenic detrusor overactivity (NDO) who fail conservative treatment. We evaluated the results of repeated therapy. Subjects and methods: Patients with NDO who subjectively had severe urinary incontinence and/or urgency in spite of conservative treatment were included. 19 men and 10 women were screened for treatment with 300 U of BTX-A (Botox®). Causes of neurogenic dysfunction were: Spinal cord injury, MS, cerebrovascular lesion or Parkinson's disease. Results and discussion: Mean number of wet pads per week decreased from 17 before treatment to 7 after. Number of incontinence-free days per week increased from 3 to 5. Eight out of 11 patients who had indwelling catheter due to severe symptoms became catheter-free. Disease specific quality of life significantly increased from I-Qol-score 47 to 70. A similar increment was noticed after re-injection. Median time between treatments was 320 days. No serious adverse events were reported. Two patients with high spinal cord injuries and marked autonomic dysreflexia reported weakness in the arms and shoulders. Conclusions: Repeated detrusor injection treatment with BTX-A seems to be very effective in reducing symptoms of neurogenic detrusor overactivity and, thereby, increasing patient's quality of life. The rate of adverse events is low. Patients with high spinal cord lesions and autonomic dysreflexia should be carefully advised. 29 The very first voidings in life: Urinary flow pattern in premature boys LH Olsen, I Grothe, YF Rawashdeh, TM Jorgensen Paediatric Urology, Dept. Urology, Aarhus University Hospital Skejby, Aarhus, Denmark h-olsen@dadlnct.dk Aim of the study: The voiding of healthy newborn boys shortly after term is dominated by dyscoordinated flow patterns and continues to do so during the first year of life. This study ad- dresses the flow patterns of premature boys. Subjects and Methods: The parents of 29 otherwise healthy pre- mature males accepted to let their child participate in the study. Flow measurements were carried out using an ultrasound flow probe device during a 4-hour observation period. Flow patterns were assessed according to the definitions of the ICCS. Data of 25 boys (median gestational age/weight at birth: 31.3 weeks/1590 g) with 98 micturitions where applicable for analysis. Results are reported as median (range). Results: On examination median age was 10 (3-42) days. Flow patterns were bell-shaped in 48%, interrupted in 44%, staccato in 6% and plateau in 2%. In nine of the 47 bell-shaped curves (19%) some fluctuations occurred though not fulfilling the criteria of staccato. None of the premies with more than one re- corded micturition had bell-shaped curves only. The number of coordinated flows was not correlated to the age (r: 0.016, P=0.6). Subjects voided 0.7 (0.2-3.6) times/hour with a volume of 3.9 (0.6-25.2) mL. Median Qmax was 1.0 (0.3-10.0) mL/s. 18 LÆKNAblaðið 2009/95

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