Data di Pubblicazione:
2018
Citazione:
PRIMARY BLADDER NECK OBSTRUCTION: A NEW ETIOPATHOGENESIS / T.c. Camerota ; scientific supervisors: M. Raica - Università Victor-Babes di Timisoara (Romania), M. Mazzanti ; directors of the phd program: I. Sporea, C. Sforza. DIPARTIMENTO DI BIOSCIENZE, Università degli Studi di Milano, 2018 Mar 29. 29. ciclo, Anno Accademico 2016. [10.13130/camerota-tommaso-ciro_phd2018-03-29].
Abstract:
INTRODUCTION
Urinary incontinence and bladder voiding symptoms are extremely frequent in the general population, in both sexes, independently from race and age. The onset of voiding disorders is slow in time; therefore, subjects develop adaptation mechanisms. Patients may lose their reference to normality, considering as physiological what in reality is a pathological condition [Abrams, 2013]. For reasons deeply investigated in this doctoral thesis, it is difficult to collect definitive and reliable epidemiological data on lower urinary tract symptoms and on urinary incontinence in the general population [Burkhard FE, 2016], principally in males.
Urinary continence and micturition strongly depend on the integration of two different functional units of the lower urinary tract: the bladder and the urethral sphincter complex (bladder neck and rabdosphincter). Coordination within the system is guaranteed by neural control at three different levels: peripheral ganglia, spinal cord and brain [Morrison JF, 2005]. This normal physiology of the system is extensively reviewed in the thesis. A crucial step in micturition is represented by the relaxation of the urethral sphincters, which depends both on the disappearance of adrenergic and somatic excitatory inputs and on the activation of a parasympathetic reflex. This neuromuscular integrated system involves not only bladder neck and the urethral sphincters, but also the pelvic diaphragm, which is composed by a complex set of structures: the levator ani muscle, the coccygeal muscle and the surrounding connective tissue and fascias [Ayoub SF, 1979; Wallner C, 2009].
The present doctoral thesis is focused on primary bladder neck obstruction (PBNO), which is an under-investigated niche of pathology characterized by an incomplete relaxation or by an over-activity of the urethral sphincters [Nitti VW, 2005]. This urological disease is quite frequent in the young male, being identified in up to 47-54% of male patients aged 18-45 years with chronic voiding dysfunction symptoms [Kaplan SA, 1996; Nitti VW, 2002]. Unfortunately, symptoms at first presentation are vague ant too often patients are thought to be affected by chronic abacterial prostatitis, chronic pelvic pain syndrome or psychogenic voiding dysfunction. Moreover, PBNO patients in fact may be extremely disturbed by symptoms, and to date and to the best of our knowledge there are still no recognized effective treatments. In our opinion, this reflects the lack in knowledge of etiopathogenetic mechanisms.
AIMS OF THE RESEARCH
In the present research we intended to qualitatively and quantitatively analyse multiple variables in patients diagnosed with PBNO. The first aim of the research was to define whether a correlation between voiding dysfunction and postural or musculoskeletal aspects existed. If so, we were willing to understand if this association was only statistical/epidemiological or if a cause/effect relationship was present. The third aim was to define, if possible, the underlying etiopathogenic mechanism, in order to identify an effective treatment strategy. Finally, aim of this doctoral research was also to analyse the extent to which urological patients needed for rehabilitative medicine and dedicated rehabilitations in the field of Urology. In fact, this topic represents an innovative and challenging subject for the modern medicine, which is increasingly devoted to the patient’s needs. More efforts are needed in this field and, more in general, in functional urology, in order to provide better quality of life to our patients.
MATERIALS AND METHODS
From November 2013 to October 2017 all the patients presented for outpatient urological consultation to the same urologist (Tommaso Ciro Camerota) were prospectiv
Tipologia IRIS:
Tesi di dottorato
Keywords:
primary bladder neck obstruction; functional urology; voiding symptoms; storage symptoms; bladder outlet obstruction diagnosis; pelvic floor muscles hypertonicity; gait analysis
Elenco autori:
T.C. Camerota
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