September 12, 2016

The challenges in the diagnosis of detrusor underactivity in clinical practice: A mini-review.

The challenges in the diagnosis of detrusor underactivity in clinical practice: A mini-review.
Arab J Urol. 2016 Sep;14(3):223-7
Authors: Ahmed A, Farhan B, Vernez S, Ghoniem GM
Abstract
OBJECTIVE: To review the current definitions, terminology, epidemiology and aetiology of detrusor underactivity (DU), with specific attention to the diagnostic criteria in use. In addition, we address the relation and the overlap between DU and bladder outlet obstruction (BOO). In this mini-review, we hope to help identify DU patients and facilitate structured clinical evaluation and research.
METHODS: We searched the English literature using ScienceDirect and PubMed for relevant articles. We used the following terms: 'detrusor underactivity', 'underactive bladder', 'post voiding residual', 'post micturition residual', 'acontractile bladder', 'detrusor failure', and 'detrusor areflexia'.
RESULT: DU is one of the most common conditions causing lower urinary tract symptoms (LUTS). Unfortunately, it is also the most poorly understood bladder dysfunction with scant research. To our knowledge there is no clear definition and no non-invasive method to characterise this important clinical condition. DU may result from the normal ageing process; however, it has multiple aetiologies including neurogenic and myogenic dysfunction. In many cases the symptoms of DU are similar to those of BOO and it usually requires invasive urodynamic study (UDS) for diagnosis to differentiate the two diagnoses. A number of diagnostic tests may be used including: UDS testing, the Schafer pressure/flow nomogram, linear passive urethral resistance relation, Watts factor, and the bladder contractility index. Of these, UDS testing is the most practical as it determines both the maximum urinary flow rate and the pressure exerted by the detrusor muscle relative to the maximal flow of urine, allowing for precise characterisation of detrusor function.
CONCLUSION: Currently, the diagnosis of DU is based on invasive urodynamic parameters as defined by the International Continence Society in 2002. There is no consensus for the definition of DU prior to 2002. As there is significant overlap between the symptoms of DU and BOO, it is difficult to diagnose DU clinically.
PMID: 27547465 [PubMed]
VISIT WEBSITE

August 23, 2016

Urothelial ATP signaling: what is its role in bladder sensation?


Urothelial ATP signaling: what is its role in bladder sensation?

Authors: Kentaro Takezawa, Makoto Kondo, Norio Nonomura, Shoichi Shimada

Abstract

AIM

Bladder functional disorders are common health problems; however, their pathologies are poorly understood. Adenosine triphosphate (ATP) released from the urothelium has been suggested to have an essential role in the micturition reflex, and its involvement in bladder functional disorders has been intensively investigated. Here, we review the latest advances in research on urothelial ATP signaling.

METHODS

We reviewed research articles on the role of the urothelium and urothelial ATP release in bladder function.

RESULTS

Mice lacking purinergic receptors have been reported to exhibit marked bladder hyporeflexia. Based on this observation, it was commonly believed, according to the widely held ATP urothelial signaling theory, that stretch-induced urothelial ATP release mediates the sensation of bladder filling via purinergic receptors. However, recent studies employing novel experimental methods and approaches have demonstrated that there are no significant differences in bladder function between wild-type and purinergic receptor knockout mice under physiological conditions. Nonetheless, under pathological conditions, inhibition of purinergic receptors has been shown to improve bladder hyperactivity. Moreover, enhanced urothelial ATP release has been reported in patients with bladder functional disorders.

CONCLUSIONS

Recently, conflicting evidence has led us to question the role of urothelial ATP signaling in normal micturition reflex. In contrast, under pathological conditions, it seems likely that enhanced urothelial ATP signaling mediates bladder hyperactivity. These recent findings suggest that the urothelial ATP signaling pathway is a potential therapeutic target for bladder functional disorders.
VISIT WEBSITE

August 12, 2016

A pilot study of cardiac electrophysiology catheters to map and pace bladder electrical activity.

A pilot study of cardiac electrophysiology catheters to map and pace bladder electrical activity.
Neurourol Urodyn. 2016 Aug 5;
Authors: Kelley RS, Vardy MD, Simons G, Chen H, Ascher-Walsh C, Brodman M
Abstract
AIMS: This is a pilot study to evaluate the feasibility of using diagnostic cardiac electrophysiology catheters for recording intrinsic urinary bladder electrical activity and for electrical pacing capture of bladder tissue.
METHODS: During cystoscopy, a curved quadripolar catheter was introduced and contact was made with the right and left halves of the dome and trigone in adult female patients undergoing cystoscopy. Electrical activity was recorded, using a commercially available cardiac electrophysiologic recording system, before and during pacing at 0.5-3.0 Hz.
RESULTS: Apparent spontaneous electrical depolarizations were detected in both the trigone and the dome. The amplitude of these depolarizations was in the microVolt range. During pacing, local electrical capture was noted in the trigone, but not in the dome.
CONCLUSIONS: Spontaneous low-amplitude electrical activity was detected in the bladder through the use of commercially available cardiac electrophysiology equipment. While these low-level signals could represent noise, the voltage, and morphology resemble detrusor muscle action potentials previously seen in animal studies. Pacing induced local electrical capture in the trigone but not the dome.
PMID: 27494644 [PubMed - as supplied by publisher]
VISIT WEBSITE

August 6, 2016

Review of “The Nurse Practitioner in Urology”

Review of “The Nurse Practitioner in Urology”


Hollander, J.B. Int Urol Nephrol (2016). doi:10.1007/s11255-016-1374-0
Urology - Book review

There is a great need in the world for skilled urologic practitioners. Urology physician extenders such as nurse practitioners, physician assistants and specialty trained medical assistants will be needed more and more in order to deliver timely and appropriate care to urologic patients. The office practice manual “The Nurse Practitioner in Urology” is now available and has the potential to become a main resource for office practice in urology. Written by urology nurse practitioners with over 32 years of urologic experience between them, the book serves as a guide for physician extenders in order to provide expert high quality cost effective care for adult urology patients. The book to me is so well written and practical that it may serve as a resource for office urologists themselves. The chapter highlights pertinent pathophysiology, assessment and diagnostics specific to GU conditions and promotes advanced critical thinking for physician extenders specializing in urology. The chapters are written with clinical pearls and practical resources that may be of value not only to physician extenders, but clinicians and patients themselves. In addition to standard outpatient management of both benign and malignant urological conditions, there are chapters on transitioning pediatric urology patients to adult environments, men’s health including low testosterone, erectile dysfunction and infertility, and newer concepts with regard to urinary retention and underactive bladder. The book emphasizes evidence based medicine and the resources necessary to practice in that fashion. The book is user friendly and easy to navigate. “The Nurse Practitioner in Urology” will be a valued asset to all mid-level providers, physician extenders and specialists in the office based practice in urology. I suspect it will be a valued asset to busy state-of-the-art urological offices.

© Springer Science+Business Media Dordrecht 2016

VISIT WEBSITE

July 31, 2016

A cross-sectional study in the USA of the epidemiology and quality of life of underactive bladder symptoms.

A cross-sectional study in the USA of the epidemiology and quality of life of underactive bladder symptoms.
Int Urol Nephrol. 2016 Jul 29;
Authors: Faraj K, Doo F, Boura J, Vereecke A, Chancellor MB
Abstract
PURPOSE: To assess the prevalence, awareness, and quality of life (QOL) impact of symptoms suggestive of underactive bladder (UAB) in the USA.
METHODS: A thirteen-item paper survey was mailed to 25,000 individuals 60 years or older living in the USA. It aimed to collect information relating to demographics, familiarity with UAB, patient urinary symptoms, and QOL concerns.
RESULTS: Nine hundred and seventy-seven survey participants were stratified into four groups based on the number of UAB symptoms (straining, retention, and difficulty emptying) present: zero, one, two, and three. As the number of reported UAB symptoms increased, there was an increase prevalence in nocturia, urge, and urinary frequency (p < 0.0001). Increased UAB symptoms were associated with an increased prevalence of concerns related to urgency, urge incontinence, nocturia, and overall urinary status (p < 0.0001). Urology visits were most common in individuals who reported the most UAB symptoms (p < 0.0001); however, there was no difference among groups with regard to UAB awareness. Women were less likely to report any UAB symptoms (p < 0.0001), symptoms of urge (p = 0.001), retention (p = 0.002), difficulty emptying their bladder (p < 0.0001), a history of catheter use for retention (P = 0.002), and urology visits in the past 3 years (p < 0.0001). This study is limited in its inability to differentiate UAB from disorders that may mimic UAB clinically, based on the survey questions asked.
CONCLUSIONS: Underactive bladder symptoms are common and can have a significant impact on ones QOL, although awareness is still lacking among potentially affected individuals. More must be done to allow one to better differentiate between UAB and conditions that are clinically similar.
PMID: 27473156 [PubMed - as supplied by publisher]
VISIT WEBSITE

July 30, 2016

Phenotyping women with detrusor underactivity by presumed etiology: Is it plausible?

Phenotyping women with detrusor underactivity by presumed etiology: Is it plausible?
Neurourol Urodyn. 2016 Jul 26;
Authors: Brown ET, Cohn JA, Kaufman MR, Dmochowski RR, Reynolds WS
Abstract
AIMS: Underactive bladder (UAB) is a symptom complex with poorly characterized causation. The aim of this study was to determine if clinical and UDS parameters differed between categories of presumed detrusor underactivity (DU) etiologies.
METHODS: A retrospective review was performed at a single institution from 2011 to 2015 to identify patients with symptoms of UAB. Patients were excluded if they were male, had anti-incontinence, or pelvic organ prolapse (POP) surgery within 1 year, or the UDS did not demonstrate DU as defined within. Subjects were stratified by etiology into four cohorts: cardiovascular disease manifestations (CV), cardiac risk factors (CVR), neurologic (N), or idiopathic (I). Patient demographics, comorbidities, symptomatology, physical exam, and UDS parameters were compared.
RESULTS: A total of 200 patients met inclusion criteria (CV: n = 53 [26.5%], CVR: n = 44 [22%] N: n = 81 [40.5%], I: n = 22 [11%]). Women in the CV cohort were significantly older and more likely to be post-menopausal (P < 0.001). There were no differences between cohorts for BMI (P = 0.48), recurrent UTI (P = 0.63), history of urinary retention (AUR) (P = 0.65), POP (0.49), American Urological Association Symptom Score (AUA-SS) (P = 0.06), presenting symptomatology [urgency, frequency, urgency urinary incontinence, AUR, incomplete emptying, hesitancy, UTI (P = 0.97)], or UDS parameters (first sensation [P = 0.25], normal desire [P = 0.80], strong desire [P = 0.58], capacity [P = 0.11], Qmax [P = 0.50], Pdet at Qmax [P = 0.22], post-void residual [P = 0.82]).
CONCLUSIONS: Though differences were observed between cohorts for age and menopausal status, clinical or urodynamic parameters did not demonstrate distinct differences across presumed categories of etiology, suggesting that the etiology of DU may be multifactorial. Neurourol. Urodynam. © 2016 Wiley Periodicals, Inc.
PMID: 27460338 [PubMed - as supplied by publisher]
VISIT WEBSITE

July 23, 2016

Functional and Molecular Characterization of Hyposensitive Underactive Bladder Tissue and Urine in Streptozotocin-Induced Diabetic Rat.

Functional and Molecular Characterization of Hyposensitive Underactive Bladder Tissue and Urine in Streptozotocin-Induced Diabetic Rat.
PLoS One. 2014;9(7):e102644
Authors: Nirmal J, Tyagi P, Chuang YC, Lee WC, Yoshimura N, Huang CC, Rajaganapathy B, Chancellor MB
Abstract
BACKGROUND: The functional and molecular alterations of nerve growth factor (NGF) and Prostaglandin E2 (PGE2) and its receptors were studied in bladder and urine in streptozotocin (STZ)-induced diabetic rats.
METHODOLOGY/PRINCIPAL FINDINGS: Diabetes mellitus was induced with a single dose of 45 mg/kg STZ Intraperitoneally (i.p) in female Sprague-Dawley rats. Continuous cystometrogram were performed on control rats and STZ treated rats at week 4 or 12 under urethane anesthesia. Bladder was then harvested for histology, expression of EP receptors and NGF by western blotting, PGE2 levels by ELISA, and detection of apoptosis by TUNEL staining. In addition, 4-hr urine was collected from all groups for urine levels of PGE2, and NGF assay. DM induced progressive increase of bladder weight, urine production, intercontraction interval (ICI) and residual urine in a time dependent fashion. Upregulation of Prostaglandin E receptor (EP)1 and EP3 receptors and downregulation of NGF expression, increase in urine NGF and decrease levels of urine PGE2 at week 12 was observed. The decrease in ICI by intravesical instillation of PGE2 was by 51% in control rats and 31.4% in DM group at week 12.
CONCLUSIONS/SIGNIFICANCE: DM induced hyposensitive underactive bladder which is characterized by increased inflammatory reaction, apoptosis, urine NGF levels, upregulation of EP1 and EP3 receptors and decreased bladder NGF and urine PGE2. The data suggest that EP3 receptor are potential targets in the treatment of diabetes induced underactive bladder.
PMID: 25050870 [PubMed - as supplied by publisher]
VISIT WEBSITE