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Detection of neuronal activity associated with function of lower urinary tract with use of functional magnetic resonance imaging
Holý, Petr ; Zachoval, Roman (advisor) ; Hanuš, Tomáš (referee) ; Mašata, Jaromír (referee)
of the thesis Considerable research attention has been paid to the neural regulation of the lower urinary tract (LUT) in past three decades. The aim of this work is mapping of a brain activity by functional magnetic resonance imaging (fMRI) using refined scanning protocol with synchronously performed urodynamics. We aimed to detect neural activity associated with pelvic floor muscle (PF) contractions, filling of urinary bladder and miction. In addition we evaluated using fMRI brain activity associated with urinary bladder filling in patients with a complete spinal cord injury (SCI). We hypothesized activation of brainstem and forebrain areas in receiving information from the vagal nerves. Adjustments of urodynamic system enabled successful implementation of synchronous filling cystometry with fMRI evaluation of cortical activity. We concluded that synchronous urodynamic examination is a novel feasible method that facilitates and enhance interpretation of fMRI data acquired. The main clusters of brain activation during PF contractions were observed in the medial surface of the frontal lobe (primary motor area) and supplementary motor area (SMA). We detected neural activity associated with filling of urinary bladder and miction in middle and inferior frontal gyrus, angular gyrus, posterior and...
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Quality of life after urogynecologic surgery Comparation of change of quality of life after urogynecologic surgery in relation to anatomy of the pelvis foor
Drahorádová, Petra ; Mašata, Jaromír (advisor) ; Zachoval, Roman (referee) ; Naňka, Ondřej (referee)
Introduction: Stress urinary incontinence is a common problem which affects a high percentage of women. Anti-incontinent surgery has played an important role in the treatment of stress urinary incontinence. Burch colposuspension was considered a gold standard in anti-incontinence surgery, with good long-term results. However, over the past decade this procedure has been largely replaced by the application of various types of TVTs (tensionfree vaginal tapes). In our study we have focused on comparing developments in the quality of life and the occurrence of complications in a long-term follow-up after TVT, TVT O and colposuspension. For subjective assessment of urinary incontinence we have chosen a validated specialized Incontinence Quality of Life questionnaire (I-QoL). The aim of our study was to monitor the trends with quality of life after TVT, TVT O and colposuspension procedures and to establish whether the occurrence of complications affects the quality of life (QoL) and compare of the quality of life among anti-incontinence procedures and longterm subjective and objective outcome. Methods: The study included 215 women who underwent a TVT, TVT O or Burch procedure between 1.6.2002 - 31.5.2005. Women were completely urogynecologic examined and urodynamic stress incontinence was documented....
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Treatment of neurogenic detrusor overactivity using botulinum toxin A
Šámal, Vladimír ; Morávek, Petr (advisor) ; Zachoval, Roman (referee) ; Krhut, Jan (referee)
2. Summary Treatment of neurogenic detrusor overactivity using botulinum toxin A Introduction: The treatment of neurogenic detrusor overactivity (NDO) is still a serious medical, social and economic problem. Using onabotulinumtoxinA (onaBTA) is the first choice in patients who are refractory to standard anticholinergic therapy or with the occurrence of serious adverse events from this treatment. The standard way of applying onaBTA is intramural injection into the detrusor of the urinary bladder. Aim: To evaluate the effectiveness of the NDO treatment with submucosal applications of onaBTA with regard to the complex mechanism of the action of onaBTA on the urinary bladder. Methods: A randomized, prospective open-label study was performed. The study population consisted of patients with neurogenic detrusor overactivity due to spinal cord injury. A total of 23 patients, in which urinary incontinence persisted due to NDO despite anticholinergic therapy, were included. After randomization, patients were treated with 300 U onaBTA applied in 30 injection sites, sparing bladder trigone. In group A the treatment was carried out using submucosal applications and in group B with intramural application into the detrusor. The length of the study was 12 weeks. Urodynamic examination was performed before and after the...
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Concurrent possibilities of minimallyinvasive surgical treatment of kidney tumours
Eret, Viktor ; Hora, Milan (advisor) ; Zachoval, Roman (referee) ; Minčík, Ivan (referee)
Minimally invasive surgery in the treatment of kidney tumours has developed since the beginning of the nineties. A lot of specialized or top laparoscopic urological centres so-called "centres of excellence" have been created since the first laparoscopic radical nephrectomy (LRN). These centres have thanks to the centralization of kidney tumour patients sufficient cohorts for evaluation of operative data, operative technique and oncological results. A lot of large studies have been published so far, showing comparable oncological results with open nephrectomy and advantages of miniinvasivity ( shorter hospitalization time, less analgesia requirements, better recovery and cosmetics). LRN is considered a standard of care in the treatment of cT1-2 (≤ 8cm) renal tumours in patients who are not candidates for nephron- sparing surgery. In our department in Plzeň, we have been performing LRN since January 2003. The majority of procedures has been performed by transperitoneal approach. The first LRN in the Czech Republic was done in April 1998 within XII. Conference of Czech Urologic Society by guesting prof. Clayman. We prefer transperitoneal to extraperitoneal approach in our department. The transperitoneal approach provides a larger working space, better anatomical and topographical orientation.We perform...
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Prostatic cancer and possibilities of prediction of early success of radical prostatectomy
Svačina, Jakub ; Hanuš, Tomáš (advisor) ; Zachoval, Roman (referee)
Classification of adenocarcinoma prostatae is very important for the treatment. I have described the disease, its treatment and classification in the introduction. I have analysed a sample of 52 patients from the Urological Clinic of General Faculty Hospital. Simple statistics was used for comparing and analysing of relation of preoperative classification and postoperative development of PSA. I have compared preoperative and operative Gleason's score. Preoperative Gleason score underscores the operative score. PSA decrease is significantly higher in patients with high initial PSA and in patients with classification T2N0M0. PSA one month after surgery does not differ in patients with classification T1C and T2 and it does not correlate with the preoperative characteristics of patients. The decrease of PSA is perhaps dependent only on the surgical treatment. Effect of operation cannot be predicted by Gleason score and by age. These results are valid only for patients undergoing radical prostractomy
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Problems of renal tumours in patiens with terminal stadium of renal failure
Ürge, Tomáš ; Hora, Milan (advisor) ; Novák, Jaroslav (referee) ; Zachoval, Roman (referee) ; Morávek, Petr (referee)
Objective: Risk of renal carcinoma is minimal 10 x higher in group of patients in terminal stadium of renal failure (end stage kidney disease - ESKD). We have only some information about chromosomal changes in renal tubules, from which rise renal carcinoma, and about pathogenesis of renal carcinoma, which seems to be different from carcinoma in common population. Aim of the study: In clinical part we valorize characteristic signs of renal carcinoma in ESKD by using of statistic methods. In experimental part we can explain pathogenesis of this carcinoma by analysis of selective chromosomal aberations. Material, methods: In 2000 - 2007 were 184 patients with ESKD in care of transplant centre and nephrologic ambulation of Faculty hospital Plze_. In 15 patients we diagnose renal carcinoma. In this group we valorize: age, gender, causation of renal failure and dialysis duration. Age, gender and type of renal carcinoma we confront with carcinoma in common population. In experimental part we valorize numerical aberations in chromosome 7, 17 and Y of tubular epithelium using fluorescent hybridization in situ (FISH). Results: We have 15 patients in average age 55.7 ± 11.5 years, long of during dialyzation was 78 ± 54 months. We do not find dependence between causation of renal failure and genesis of renal...
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Lower urinary tract dysfunctions in patients with diabetes mellitus
Krch, David ; Zachoval, Roman (advisor)
HAVE RIGHTS my diploma ce are dysfunction of the lower urinary disorders diabetic patients. It is one of the chronic complications of long it During diabetes mellitus, and although not one of the complications Nejc astější, its impact quality of life is great. Due to the occurrence of disease stoupajcímu DM population Moreover, concerning the ma ACT OF ROUND, whose importance will be the future NADA le rise. So far, however, stay in and in the shadow of more frequent and due to mortality and important complication of DM, which was one of the reasons why I have given Problem chosen as the ma my diploma RIGHTS ce. In his RIGHTS ci I would like to especially provide a comprehensive overview of the fact u to S not too far studied, the issue of and of course the pay and preventive measures taken against formation this kind of diabetic complications.
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Lower urinary tract dysfunctions in patients with diabetes mellitus
Osdal, Arnfinn ; Zachoval, Roman (advisor)
Diabetes mellitus (DM) is a endocrine metabolic disorder that is associated with many complications and lower urinary tract dysfunction (LUTD) is one of them. In addition LUTD can be caused by many other disorders and sometimes it can be difficult to isolate the cause. Incidence of diabetes is increasing and prevalence is expected to increase worldwide to 300 million people in 2025. The most important causes for diabetes and lower urinary tract abnormalities are diabetic neuropathy caused by hyperglycaemia. Approximately 50% of diabetic patients develop some form of neuropathy. Diabetes can cause LUTD many ways and research have shown many possible mechanisms involved. Among the suggested mechanisms are up-regulation of muscarinic receptors, smooth muscle hypertrophy, increase in myosin light chain phosphorylation and changes of certain calcium sensitive potassiumchannels (MaxiK). The increasing knowledge of pathophysiology and pathogenesis of LUTD made it necessary with a new approach to patients, terminology changes, better definitions and classifications. Among the contributors is European urologic association (EUA). The importance of preventive measures and good treatment in diabetes can not be underestimated. Their role has an increasing importance today and for the future because of its negative...
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