December 15, 2012

Effects of intravesical electrical stimulation therapy on urodynamic patterns for children with spina bifida: A 10-year experience.

Effects of intravesical electrical stimulation therapy on urodynamic patterns for children with spina bifida: A 10-year experience.:
Effects of intravesical electrical stimulation therapy on urodynamic patterns for children with spina bifida: A 10-year experience.
J Pediatr Urol. 2012 Nov 21;
Authors: Choi EK, Hong CH, Kim MJ, Im YJ, Jung HJ, Han SW
Abstract

OBJECTIVE: Intravesical electrical stimulation (IVES) has been performed for various purposes in children with a neurogenic bladder. We evaluated the results of IVES on urodynamic study parameters in children with spina bifida. METHODS: We retrospectively analyzed the cases of 88 children who received IVES between August 1999 and May 2010 and whose comparative urodynamic data were available before and after treatment. According to the pre-IVES urodynamic study, children were divided into 3 groups: detrusor overactivity, detrusor underactivity and acontractile detrusor. We investigated the changes in detrusor function, bladder capacity and detrusor-sphincter dyssynergia. RESULTS: In the group showing detrusor overactivity, the bladder had a synergic pattern in 41.7%, and normal detrusor function was observed in 16.7% of them. Bladder capacity increased after IVES therapy, especially in those who started therapy before 18 months of age (p = 0.019). Detrusor-sphincter dyssynergia was resolved in 55.6%. In the acontractile detrusor group, detrusor contraction ability increased in 48%, but bladder capacity did not. CONCLUSIONS: Appropriate candidates for this treatment need to be carefully selected.


PMID: 23177928 [PubMed - as supplied by publisher]

November 30, 2012

Bladder dysfunction changes from underactive to overactive after experimental traumatic brain injury.

Bladder dysfunction changes from underactive to overactive after experimental traumatic brain injury.:
Bladder dysfunction changes from underactive to overactive after experimental traumatic brain injury.
Exp Neurol. 2012 Nov 21;
Authors: Jiang HH, Kokiko-Cochran ON, Li K, Balog B, Lin CY, Damaser MS, Lin V, Cheng JY, Lee YS
Abstract

Although bladder dysfunction is common after traumatic brain injury (TBI), few studies have investigated resultant bladder changes and the detailed relationship between TBI and bladder dysfunction. The goal of this study was to characterize the effects of TBI on bladder function in an animal model. Fluid-percussion injury was used to create an animal model with moderate TBI. Female Sprague-Dawley rats underwent TBI, sham TBI or were not manipulated (naïve). All rats underwent filling cystometry while bladder pressure and external urethral sphincter electromyograms were simultaneously recorded 1day, 1week, 2weeks, and 1month after injury. One day after injury, 70% of the animals in the TBI group and 29% of the animals in the sham TBI group showed no bursting activity during urination. Compared to naïve rats, bladder function was mainly altered 1day and 1week after sham TBI, suggesting the craniotomy procedure affected bladder function mostly in a temporary manner. Compared to either naïve or sham TBI, bladder weight was significantly increased 1month after TBI and collagen in the bladder wall was increased. Bladder function in the TBI group went from atonic 1day post-TBI to overactive 1month post-TBI, suggesting that TBI significantly affected bladder function.


PMID: 23178579 [PubMed - as supplied by publisher]

October 29, 2012

Lower urinary tract symptoms of neurological origin in urological practice.

Lower urinary tract symptoms of neurological origin in urological practice.:
Lower urinary tract symptoms of neurological origin in urological practice.
Clin Auton Res. 2012 Oct 26;
Authors: Magari T, Fukabori Y, Ogura H, Suzuki K
Abstract

PURPOSE: The present study aimed to reveal the neurological origin of lower urinary tract symptoms (LUTS) in routine urological examination. METHODS: We retrospectively analyzed 70 cases to identify cases in which the neurologist and/or urologist suspected the relation between neurological diseases and LUTS. The compromised neurological areas were categorized into brain and spinal cord based on the appearance time of LUTS and presence/absence of disease specificity. We classified the lesion site based on the imaging result and the neurologic finding. We compared LUTS appearance time: from LUTS appearance till the first visit to urologist (first visit urologist) and from the aforementioned visit till the neurological diagnosis confirmation (neurological diagnosis). Finally, we conducted a detailed investigation of the surgical cases, as well as those with urodynamic studies (UDS) performed prior to the neurological examination. RESULTS: The neurological diseases involved 31 cases (44 %) of multiple system atrophy, 11 (16 %) of multiple sclerosis, and 4 (6 %) of Parkinson's disease. Associated symptoms comprised gait disturbance (38) and lower limb dysesthesia (20), while no associated symptoms were observed in 13 (19 %). Both the periods proved significantly shorter for spinal cord disease. Urological surgeries were performed in 10 cases (14 %). UDS findings revealed 10 cases of decrease in bladder compliance, and 15 of detrusor underactivity; no normal cases were observed. CONCLUSIONS: Consideration of detailed medical history, enforcement of UDS, and closer cooperation between urologists and neurologists are required to ascertain early and correct diagnosis, and to avoid unnecessary surgery.


PMID: 23099558 [PubMed - as supplied by publisher]

October 18, 2012

Aging and recurrent urinary tract infections are associated with bladder dysfunction in type 2 diabetes.

Aging and recurrent urinary tract infections are associated with bladder dysfunction in type 2 diabetes.:
Related Articles
Aging and recurrent urinary tract infections are associated with bladder dysfunction in type 2 diabetes.
Taiwan J Obstet Gynecol. 2012 Sep;51(3):381-6
Authors: Lin TL, Chen GD, Chen YC, Huang CN, Ng SC
Abstract

OBJECTIVE: The objective of this study was to demonstrate the diversity of urodynamic findings and temporal effects on bladder dysfunction in diabetes as well as to evaluate the predisposing factors that attenuate the storage and voiding function of diabetic women.

MATERIAL AND METHODS: In this prospective study, 181 women with type 2 diabetes mellitus (DM) and lower urinary tract dysfunction underwent complete urogynecological evaluations and urodynamic studies. The patients' histories of DM and the treatment agents used were documented from chart records and interviews. The urodynamic diagnoses were recategorized into two groups for comparison, namely overactive detrusor (detrusor overactivity and/or increased bladder sensation as well as mixed incontinence) and voiding dysfunction (detrusor hyperactivity with insufficient contractility and detrusor underactivity with poor voiding efficiency) in order to evaluate the temporal effect of DM on diabetic bladder dysfunction.

RESULTS: The development of bladder dysfunction showed a trend involving time-dependent progression, beginning with storage problems (i.e. advancing from urodynamic stress incontinence to detrusor overactivity and/or increased bladder sensation) and eventually led to impaired voiding function. The duration of DM relative to the urodynamic diagnoses of these women was longer in women with voiding dysfunction (6.8 ± 2.8 years with urodynamic stress incontinence, 7.3 ± 6.5 years with detrusor overactivity and/or increased bladder sensation, and 10.4 ± 8.3 years with women with voiding dysfunction). Notwithstanding these findings, stepwise logistic regression analysis indicated that age and recurrent urinary tract infections were the two independent factors associated with developing voiding dysfunction.

CONCLUSION: The urodynamic study revealed a temporal effect on bladder function, and women with diabetic voiding dysfunction were found to have had a longer duration of DM than women with an overactive detrusor. However, aging and recurrent urinary tract infections are the two independent factors that contribute to impaired voiding function and diabetic bladder dysfunction.


PMID: 23040921 [PubMed - in process]

September 24, 2012

Maximum Isometric Detrusor Pressure to Measure Bladder Strength in Men With Postprostatectomy Incontinence.

Maximum Isometric Detrusor Pressure to Measure Bladder Strength in Men With Postprostatectomy Incontinence.:
Related Articles
Maximum Isometric Detrusor Pressure to Measure Bladder Strength in Men With Postprostatectomy Incontinence.
Urology. 2012 Sep 15;
Authors: Elliott CS, Comiter CV
Abstract

OBJECTIVE: To describe the use of isovolumetric detrusor pressure (Piso) in men with postprostatectomy incontinence and compare the rates of detrusor underactivity using Piso versus other common measurements/surrogates of bladder strength. METHODS: We evaluated 62 men referred to our institution during a 3-year period for workup of postprostatectomy incontinence. During videourodynamic evaluation, the maximum Piso was measured using a mechanical stop test-with the examiner gently occluding the penile urethra during volitional voiding. Statistical analysis was performed to evaluate the effect of patient variables on Piso. RESULTS: The mean Piso was 54.6 ± 25.4 cm H(2)O. The Piso was <50 cm H(2)O in 40%. Isometric strength did not significantly correlate with age, interval since radical prostatectomy, abdominal leak point pressure, maximal urethral closure pressure, or pad use. The bladder contractility index and other approximations of detrusor underactivity were not predictive of low isometric pressure. CONCLUSION: Detrusor underactivity is relatively common in men with postprostatectomy incontinence, with 40% demonstrating a Piso <50 cm H(2)O. Our data do suggest, however, that the use of common bladder contractility nomograms, such as the bladder contractility index, might not be appropriate in this population.


PMID: 22990061 [PubMed - as supplied by publisher]

July 24, 2012

Clinical symptoms are not reliable in the diagnosis of lower urinary tract dysfunction in women.

Clinical symptoms are not reliable in the diagnosis of lower urinary tract dysfunction in women.:
Related Articles
Clinical symptoms are not reliable in the diagnosis of lower urinary tract dysfunction in women.
J Formos Med Assoc. 2012 Jul;111(7):386-91
Authors: Kuo HC
Abstract

BACKGROUND/PURPOSE: The pathophysiology of female lower urinary tract symptoms (LUTS) may involve bladder, urethral, and pelvic floor dysfunctions. This study analyzed the relationship between clinical symptoms and lower urinary tract dysfunctions (LUTD) in women.

METHODS: A total of 1605 consecutive women were included. LUTS were classified as storage, voiding, pain, and postmicturition symptoms. All patients underwent videourodynamic study (VUDS) and the final diagnosis of LUTD was made based on VUDS findings. Patients were stratified into three major disorder groups: sensory, motor, and bladder outlet disorders. The main symptoms and associated symptoms were used for analysis in varying LUTD.

RESULTS: Normal tracing was found in 272 patients (16.9%), sensory bladder disorders in 459 (28.6%), motor bladder disorders in 560 (34.9%), and bladder outlet disorders were found in 314 patients (19.6%). Frequent urination was the main symptom in patients with normal, bladder oversensitivity, interstitial cystitis, and idiopathic detrusor overactivity (DO). In patients with voiding dysfunction due to detrusor underactivity, bladder neck dysfunction and urethral stricture, dysuria was the most common symptom. However, 707 (44%) of overall women had both storage and voiding symptoms. DO was present in 533 women and in 149 (66%) of 212 with bladder outlet obstruction. However, DO was only found in 42.5% of women with urgency and in 69.4% of women with urgency incontinence based on reported LUTS.

CONCLUSION: Storage and voiding symptoms are common in women with LUTD. The differential diagnosis of LUTD in women cannot be based on LUTS alone.


PMID: 22817816 [PubMed - in process]

June 21, 2012

The passive and active contractile properties of the neurogenic, underactive bladder.

The passive and active contractile properties of the neurogenic, underactive bladder.:
The passive and active contractile properties of the neurogenic, underactive bladder.
BJU Int. 2012 Jun 19;
Authors: Young JS, Johnston L, Soubrane C, McCloskey KD, McMurray G, Eccles R, Fry CH
Abstract

What's known on the subject? and What does the study add? Detrusor underactivity is highly prevalent, particularly in the elderly. It is assumed to result from detrusor failure, although detrusor contractility is often derived from urodynamics studies. Given that detrusor pressure and force are not proportional and urodynamics cannot identify the basis of the pathology, we produced a neurogenic animal model with a highly-compliant bladder and studied detrusor muscle properties, aiming to increase our understanding of the underlying pathology. Highly compliant bladders were characterized by reduced passive wall stiffness and stretched detrusor muscle strips exhibited an enhanced rate of relaxation. These detrusor strips displayed spontaneous contractions that were of greater amplitude (expressed as a ratio of bladder wall stiffness) than those of strips from sham-operated animals; spontaneous contractions increased in amplitude when stimulated by an agonist. These data imply that compliance is not the result of a reduction of detrusor contractility; we hypothesize that altered matrix properties reduce the magnitude with which force can be generated to void the bladder. OBJECTIVE: •  To characterize passive and active changes in detrusor activity in a highly compliant bladder. MATERIALS AND METHODS: •  Bladders from adult female Sprague-Dawley rats were used 5 weeks after lower thoracic (T8) spinal cord transection or a sham-operation. •  Passive wall properties were assessed by pressure-volume relationships from whole bladders and the tensile response of bladder strips after a rapid (<0.5 s) stretch. •  Active properties were assessed from the frequency and amplitude of spontaneous contractions of bladder strips, and their response to the inotropic TRPV4 agonist GSK1016790A. RESULTS: •  Passive bladder wall stiffness of SCT bladders was significantly reduced compared to that of the sham-operated control group (N= 6 and 8, respectively) and SCT bladder strips relaxed more quickly than those from sham-operated rats. •  The frequency of spontaneous contractions was reduced in SCT rats, and their amplitude, expressed as a ratio of bladder wall stiffness, was greater than in sham-operated rats. •  GSK1016790A (0.1 µm) significantly increased amplitude in strips from both sham-operated and SCT groups. CONCLUSIONS: •  There is no evidence of contractile failure in a highly-compliant bladder. The observations of reduced passive bladder wall stiffness and an enhanced rate of stress relaxation lead to the conclusion that increased compliance is marked by altered matrix properties that dissipate muscle force, thereby generating low pressures. •  Contractile agonists may be effective for improving bladder function in detrusor underactivity.


PMID: 22712666 [PubMed - as supplied by publisher]

June 7, 2012

Prevalence and Clinical Features of Detrusor Underactivity among Elderly with Lower Urinary Tract Symptoms: A Comparison between Men and Women.

Prevalence and Clinical Features of Detrusor Underactivity among Elderly with Lower Urinary Tract Symptoms: A Comparison between Men and Women.:
Prevalence and Clinical Features of Detrusor Underactivity among Elderly with Lower Urinary Tract Symptoms: A Comparison between Men and Women.
Korean J Urol. 2012 May;53(5):342-8
Authors: Jeong SJ, Kim HJ, Lee YJ, Lee JK, Lee BK, Choo YM, Oh JJ, Lee SC, Jeong CW, Yoon CY, Hong SK, Byun SS, Lee SE
Abstract

PURPOSE: To identify the prevalence and clinical features of detrusor underactivity (DU) in elderly men and women presenting with lower urinary tract symptoms (LUTS).

MATERIALS AND METHODS: We reviewed 1,179 patients aged over 65 years who had undergone a urodynamic study for LUTS with no neurological or anatomical conditions. DU was defined as a bladder contractility index <100 and a maximal flow rate (Qmax) ≤12 ml/s combined with a detrusor pressure at Qmax ≤10 cmH(2)O for men and women, respectively.

RESULTS: Of the patients, 40.2% of men and 13.3% of women were classified as having DU (p<0.001). Types of clinical symptoms were not significantly different between patients with and without DU. In men, whereas the prevalence of bladder outlet obstruction (BOO) was constant across the age spectrum, the prevalence of DU and detrusor overactivity (DO) increased with age, and 46.5% of men with DU also had DO or BOO. In women, the prevalence of DU also increased with age, and the trend was more remarkable in women aged over 70 years. DU was accompanied by DO or urodynamic stress urinary incontinence (USUI) in 72.6% of the women with DU. Women with DU were found to have lower cystometric capacity and exhibited a greater incidence of reduced compliance than did women without DU.

CONCLUSIONS: DU was a common mechanism underlying LUTS in the elderly population, especially in men. One half of the men and three quarters of the women with DU also had other pathologies such as DO, BOO, or USUI.


PMID: 22670194 [PubMed - in process]

June 4, 2012

Persistent vesicourethral dysfunction following radical surgery for rectal carcinoma: urodynamic features and potential abatement with modified sphincterotomy (radical transurethral resection of the prostate).

Persistent vesicourethral dysfunction following radical surgery for rectal carcinoma: urodynamic features and potential abatement with modified sphincterotomy (radical transurethral resection of the prostate).:
Related Articles
Persistent vesicourethral dysfunction following radical surgery for rectal carcinoma: urodynamic features and potential abatement with modified sphincterotomy (radical transurethral resection of the prostate).
Int J Urol. 1998 Jan;5(1):39-43
Authors: Mitsui T, Shinno Y, Kobayashi S, Matsuura S, Shibata T, Ameda K, Koyanagi T
BACKGROUND: Vesicourethral function returns after radical rectal surgery during the first year but rarely progresses after 1 year. We examined the urodynamics of patients whose voiding dysfunction remained after 1 year, and treated several with a modified sphincterotomy procedure similar to radical transurethral resection of the prostate. METHODS: We analyzed the urodynamic features of vesicourethral dysfunction in 16 male patients with persistent voiding dysfunction for more than 1 year following radical surgery for rectal carcinoma. Seven patients elected to undergo radical transurethral resection of prostate (radical TUR-P) for the relief of their persistent voiding dysfunction. RESULTS: The mean bladder volume at the first desire to void was 210 mL, the mean maximal bladder capacity was 343 mL, and the mean vesical compliance (Cves) was 27.1 mL/cm H2O. All patients demonstrated either vesical denervation supersensitivity (Vds) or uninhibited contraction. The mean maximal urethral closure pressure was 43.9 cm H2O, and urethral denervation supersensitivity was found in 77.8% (7/9), and sphincter dyssynergia in 66.7% (6/9) of patients. After radical TUR-P, 5 patients became free from the use of self-catheterization, 1 patient had a reduced residual urine rate, and 1 patient was unchanged, but no patient noted a change in urinary control. CONCLUSION: Urethral dysfunction after radical rectal surgery was caused by failure of the bladder to empty along with an underactive detrusor. Radical TUR-P was effective in restoring voiding function in a selected group of these patients.
PMID: 9535599 [PubMed - indexed for MEDLINE]

May 29, 2012

Vasoactive intestinal polypeptidergic innervation of human urinary bladder in normal and pathological conditions.

Vasoactive intestinal polypeptidergic innervation of human urinary bladder in normal and pathological conditions.:
Related Articles
Vasoactive intestinal polypeptidergic innervation of human urinary bladder in normal and pathological conditions.
Urol Int. 1988;43(4):205-10
Authors: Van Poppel H, Stessens R, Baert L, Van Damme B, Carton H
Urinary bladder biopsies from 31 multiple sclerosis patients, 9 diabetics, 5 patients after transtrigonal phenolization and 20 control patients were stained for acetylcholinesterase, S100 and vasoactive intestinal polypeptide (VIP). The VIP immunoreactivity was not decreased in all neuropathic bladders and its depletion was not related to cholinergic depletion. There was no correlation between bladder over- or underactivity and VIP content. VIP can act as a modulator of detrusor function in normal conditions. The significance of its depletion in neurogenic bladders needs further elaboration.
PMID: 3188288 [PubMed - indexed for MEDLINE]

May 15, 2012

May 7, 2012

Incontinence of urine due to instability of micturition reflexes: Part I. Detrusor reflex instability.

Incontinence of urine due to instability of micturition reflexes: Part I. Detrusor reflex instability.:
Related Articles
Incontinence of urine due to instability of micturition reflexes: Part I. Detrusor reflex instability.
Urology. 1980 Mar;15(3):229-39
Authors: Mahony DT, Laferte RO, Blais DJ
Micturition reflex instability may result from malfunction of the detrusor reflex or instability of the pudendal nucleus which innervates the pelvic floor muscles and external sphincter. Detrusor instability is the result of sacral micturition reflex center (SMRC) hyperexcitability. This may be caused by underinhibition or overfacilitation of the SMRC, and there are both central and peripheral causes of each. Detrusor hypertrophy may invoke chronic overactivity of the detrusodetrusor facilitative reflex causing SMRC overfacilitation. Similarly, distal urethral stricture and/or chronic urethritis causing chronic overactivity of the urethrodetrusor facilitative reflex is a common cause of SMRC overfacilitation. Pathologic relaxation and weakness of the striated muscles of the pelvic floor and perineum resulting in underactivity of the perineodetrusor inhibitory reflex, is a common cause of SMRC underinhibition. In adult women these factors often coexist. Each may predispose to stress-induced detrusor instability and are often seen in association with, or are confused with, true stress incontinence. The distinguishing characteristics of detrusor hypertonicity and detrusor hyperreflexia are reviewed, and the various mechanisms of pseudostress incontinence and of urgency incontinence are discussed in detail.
PMID: 7189070 [PubMed - indexed for MEDLINE]

April 17, 2012

Can Staccato and Interrupted/Fractionated Uroflow Patterns Alone Correctly Identify the Underlying Lower Urinary Tract Condition?

Can Staccato and Interrupted/Fractionated Uroflow Patterns Alone Correctly Identify the Underlying Lower Urinary Tract Condition?:
Can Staccato and Interrupted/Fractionated Uroflow Patterns Alone Correctly Identify the Underlying Lower Urinary Tract Condition?
J Urol. 2012 Apr 12;
Authors: Wenske S, Combs AJ, Van Batavia JP, Glassberg KI
Abstract

PURPOSE: Worldwide, uroflowmetry without simultaneous electromyography is often the only testing performed during the initial assessment of children with lower urinary tract symptoms. Various alterations in uroflow pattern are thought to indicate particular types of lower urinary tract conditions, specifically staccato uroflow indicating dysfunctional voiding and intermittent/fractionated uroflow indicating detrusor underactivity. We determined how reliable uroflow pattern alone is as a surrogate for simultaneously measured pelvic floor electromyography activity during voiding, and how well staccato and interrupted uroflow actually correlate with the diagnoses they are presumed to represent. MATERIALS AND METHODS: We reviewed uroflow/electromyography studies performed during the initial evaluation of 388 consecutive neurologically and anatomically normal patients with persistent lower urinary tract symptoms. We identified those with staccato, interrupted/fractionated and mixed uroflow based on current International Children's Continence Society guidelines. RESULTS: A total of 69 girls (58.5%) and 49 boys (41.5%) met inclusion criteria. Staccato uroflow was noted in 60 patients, interrupted/fractionated uroflow in 28 and a combination in 30. An active electromyography during voiding confirmed the diagnosis of dysfunctional voiding in 33.3% of patients with staccato, 46.4% with interrupted/fractionated and 50% with mixed uroflow patterns. CONCLUSIONS: Diagnoses based on uroflow pattern appearance without simultaneous electromyography to support them can be misleading, and reliance on uroflow pattern alone can lead to overdiagnoses of either dysfunctional voiding and detrusor underactivity. When assessing patients with uroflow, an accompanying simultaneous pelvic floor electromyography is of utmost importance for improving diagnostic accuracy and thereby allowing for the most the appropriate therapy.


PMID: 22503030 [PubMed - as supplied by publisher]

April 11, 2012

Prevalence of bladder dysfunction, urodynamic findings, and their correlation with outcome in guillain-barre syndrome.

Prevalence of bladder dysfunction, urodynamic findings, and their correlation with outcome in guillain-barre syndrome.:
Prevalence of bladder dysfunction, urodynamic findings, and their correlation with outcome in guillain-barre syndrome.
Neurourol Urodyn. 2012 Apr 6;
Authors: Naphade PU, Verma R, Garg RK, Singh M, Malhotra HS, Shankwar SN
Abstract

AIMS: The micturitional disturbances and related urodynamic studies are infrequently reported in Guillain Barre syndrome (GBS). In the present study, we evaluated patients of GBS for bladder dysfunction and urodynamic abnormalities. We also tried to assess relation between urodynamic findings with disability in patients diagnosed as GBS. METHODS: In this study, 38 patients of GBS were assessed for micturitional disturbances and disability using Hughes motor grade, Overall Disability Sum Score (ODSS), Medical Research Council (MRC) sum score. Urodynamic studies were carried out at baseline and at 2 months. RESULTS: Out of 38 patients, 10 patients had urinary symptoms, 23 patients had urodynamic abnormalities and most common being detrusor underactivity in 15 patients. Other findings were detrusor sphincter dyssynergia in six patients, acontractile bladder in five patients, and detrusor overactivity in three patients. Decreased uroflow rates were seen in 14 patients. Severe disability in the form of Hughes motor grades 4-5, ODSS leg scores 4-7, low MRC scores were significantly more common in patients with urodynamic abnormalities. The axonal variant of GBS patients demonstrated more frequent abnormal urodynamic findings. CONCLUSIONS: Our study revealed fair incidence of micturitional disturbances and urodynamic dysfuctions in GBS. The subclinical bladder involvement was frequently observed, substantiated by urodynamic assessment. The disability, particularly of lower limbs had positive correlation with urodynamic abnormality. Neurourol. Urodynam. © 2012 Wiley Periodicals, Inc.


PMID: 22488834 [PubMed - as supplied by publisher]

April 5, 2012

A novel animal model of underactive bladder: Analysis of lower urinary tract function in a rat lumbar canal stenosis model.

A novel animal model of underactive bladder: Analysis of lower urinary tract function in a rat lumbar canal stenosis model.:
A novel animal model of underactive bladder: Analysis of lower urinary tract function in a rat lumbar canal stenosis model.
Neurourol Urodyn. 2012 Mar 30;
Authors: Sekido N, Jyoraku A, Okada H, Wakamatsu D, Matsuya H, Nishiyama H
Abstract

AIMS: An animal model of neurogenic underactive bladder (UAB) has not been established. It was reported that a rat lumbar spinal canal stenosis (LCS) model created by cauda equina compression manifested intermittent claudication and allodynia. In this study, we examined the lower urinary tract function of the rat LCS model. METHODS: One small hole was drilled at the fifth lumbar vertebral arch (sham), and a rectangular piece of silicone rubber was inserted into the L5-L6 epidural space (LCS). Before and after surgery, a metabolic cage study was performed. After surgery, awake cystometry (CMG) and an in vitro muscle strip study were performed. Bladder morphology was evaluated by hematoxylin and eosin staining. RESULTS: The LCS rats showed a significant decrease in voided volume and a significant increase in postvoid residual volume and residual urine rate compared with Sham rats. CMG showed that the postvoid residual urine volume and numbers of non-voiding contractions significantly increased, while the voided volume, threshold pressure, and maximum intravesical pressure during voiding significantly decreased. There were no significant differences between sham and LCS rats in response to carbachol. In contrast, there was a significant increase in response to field stimulation, especially at lower frequencies, in LCS rats. LCS rats showed no obvious difference in detrusor morphology. CONCLUSIONS: This rat model requires a relatively simple surgical procedure and has characteristics of neurogenic UAB. It seems to be useful in the pathophysiological elucidation of UAB and might have potential for assessment of pharmacotherapy of UAB. Neurourol. Urodynam. © 2012 Wiley Periodicals, Inc.


PMID: 22473471 [PubMed - as supplied by publisher]

March 24, 2012

Low-frequency electrotherapy for female patients with detrusor underactivity due to neuromuscular deficiency.

Low-frequency electrotherapy for female patients with detrusor underactivity due to neuromuscular deficiency.:
Low-frequency electrotherapy for female patients with detrusor underactivity due to neuromuscular deficiency.
Int Urogynecol J. 2012 Mar 23;
Authors: Xu DF, Zhang S, Wang CZ, Li J, Qu CY, Cui XG, Zhao SJ
Abstract

INTRODUCTION AND HYPOTHESIS: The aim of the study was to assess the efficacy of low-frequency electrotherapy (LFE) for female patients with early-stage detrusor underactivity (DUA) due to neuromuscular deficiency. METHODS: A total of 102 female patients were divided randomly into four groups: LFE-NC (normal compliance), LFE-LC (low compliance), CON (control)-NC and CON-LC. Patients in the LFE-NC and LFE-LC groups received LFE, and those in the CON-NC and CON-LC groups received conservative treatment. Urodynamic evaluation was performed before and after treatment. RESULTS: After treatment, 82 % of the LFE-NC regained detrusor contractility, whereas only 2 (8 %) of the CON-NC had normal detrusor contraction. None of LFE-LC or CON-LC regained detrusor contractility (p < 0.01). The per cent of LFE-NC who relied on catheterization for bladder emptying decreased by 43 % (p < 0.01). Those in the LFE-LC, CON-NC and CON-LC groups decreased by only 4, 12 or 0 % (p > 0.05). CONCLUSIONS: LFE was more effective for DUA patients with normal compliance; these patients benefited from LFE, but DUA patients with low compliance did not.


PMID: 22441580 [PubMed - as supplied by publisher]

March 20, 2012

Risk factors that affect the treatment of interstitial cystitis using intravesical therapy with a dimethyl sulfoxide cocktail.

Risk factors that affect the treatment of interstitial cystitis using intravesical therapy with a dimethyl sulfoxide cocktail.:
Risk factors that affect the treatment of interstitial cystitis using intravesical therapy with a dimethyl sulfoxide cocktail.
Int Urogynecol J. 2012 Mar 17;
Authors: Hung MJ, Chen YT, Shen PS, Hsu ST, Chen GD, Ho ES
Abstract

INTRODUCTION AND HYPOTHESIS: Dimethyl sulfoxide (DMSO) bladder instillation is a standard therapy for interstitial cystitis (IC); however, there are varying degrees of success. We hypothesize that first-line intravesical therapy with a DMSO cocktail will optimize treatment outcome. METHODS: Ninety women with newly diagnosed IC were enrolled consecutively for the treatment. The IC symptom and problem index was used as an outcome measure. RESULTS: Six (6.7%) patients dropped out of the treatment due to intolerable bladder irritation. Fifty-five (65.5%) of the remaining 84 patients, who completed the treatment, experienced ≧50% symptomatic improvement. After a regression analysis, three clinical variables were found to affect treatment adversely, i.e., the presence of advanced cystoscopic glomerulations, microscopic hematuria, and urodynamic detrusor underactivity, respectively. CONCLUSIONS: Our results suggest bladder instillation with a DMSO cocktail may well be considered as first-line therapy for IC patients. However, there exists a subgroup of nonresponders who may have severe disease.


PMID: 22426874 [PubMed - as supplied by publisher]

March 15, 2012

Does diabetes mellitus-induced bladder remodeling affect lower urinary tract function?-ICI-RS 2011.

Does diabetes mellitus-induced bladder remodeling affect lower urinary tract function?-ICI-RS 2011.:
Does diabetes mellitus-induced bladder remodeling affect lower urinary tract function?-ICI-RS 2011.
Neurourol Urodyn. 2012 Mar 13;
Authors: Kirschner-Hermanns R, Daneshgari F, Vahabi B, Birder L, Oelke M, Chacko S
Abstract

AIMS: Due to an increase in aging population and changing eating habits diabetes mellitus (DM) type II is a rapidly increasing condition worldwide. Although not so detrimental as other co-morbidities, uropathy contributes to a significantly reduced quality-of-life in those affected. The purpose of this ICS-RS report is to highlight clinical and basic research data to outline directions for further research and possible treatment approaches. METHODS: This report is based on a think tank presentation and discussion at the ICI-RS 2011, original research data and literature research. RESULTS: Clinical and experimental data confirm that detrusor overactivity, both neurogenic and myogenic, and changes in transmitter regulation leading to a hyper- excitability of the detrusor are the major findings in diabetic neuropathic bladders. These findings seem to be related to an earlier stage of DM, whereas detrusor underactivity appears to be linked to later stages of DM. Detrusor smooth muscle cells seem to be modulated directly by hyperglycemia. Data support the theory that hyperglycemia-induced oxidative stress in the detrusor smooth muscle and that micro- and macrovascular events are also responsible for urologic complications of DM. CONCLUSIONS: DM causes bladder remodelling leading to uropathy in a mulitfactorial way. Future research should focus on the effects of DM as a function of time and develop novel animal models looking at defined aspects as well as interaction of different aspects- such as oxidative stress in neurogenic, myogenic and urothelial components and the role of inflammation and hypoxia caused by vascular complications. Neurourol. Urodynam. © 2012 Wiley Periodicals, Inc.


PMID: 22415965 [PubMed - as supplied by publisher]

March 14, 2012

The role of prostanoids in urinary bladder physiology.

The role of prostanoids in urinary bladder physiology.:
The role of prostanoids in urinary bladder physiology.
Nat Rev Urol. 2012 Mar 13;
Authors: Rahnama'i MS, van Kerrebroeck PE, de Wachter SG, van Koeveringe GA
Abstract

Five primary prostanoids are synthesized by the cyclooxygenase enzymes, COX-1 and COX-2: the prostaglandins PGE(2), PGF(2α), PGI(2), PGD(2) and thromboxane A2. High levels of these signaling molecules have been implicated-in both animal models and human studies-in decreased functional bladder capacity and micturition volume and increased voiding contraction amplitude. Thus, inhibition of prostanoid production or the use of prostanoid receptor antagonists, might be a rational way to treat patients with detrusor muscle overactivity. Similarly, prostanoid receptor agonists, or agents that stimulate their production, might have a function in treating bladder underactivity. Although some promising results have been reported, the adverse effects of nonselective cyclooxygenase inhibitors are a major concern that restricts their use in the treatment of functional bladder disorders. Further preclinical and clinical studies are needed before cyclooxygenase inhibitors, prostanoid receptor agonists and antagonists become worthwhile therapeutic tools in this setting.


PMID: 22410675 [PubMed - as supplied by publisher]

March 10, 2012

Urinary disorders associated with bilharziasis. Urodynamic evaluation. Findings in 10 cases.

Urinary disorders associated with bilharziasis. Urodynamic evaluation. Findings in 10 cases.:
Urinary disorders associated with bilharziasis. Urodynamic evaluation. Findings in 10 cases.
Med Trop (Mars). 2011 Dec;71(6):572-4
Authors: Guinet A, Jousse M, Verollet D, Le Breton F, Amarenco G
Abstract

Bilharziasis urinary disorders are characterized by recurent hematuria, overactive bladder symptoms (urgency, frequency and urge incontinence) and sometimes weak stream with or without urinary retention. We report 10 cases of urodynamic assessment. RESULTS: The main urodynamic symptom was overactive detrusor with uninhibited detrusor contraction during the filling phase. Only 1 patient had underactive detrusor leading to urinary retention. Urinary symptoms were secondary to a neurogenic abnormality (spinal lesion) in 2 cases, and to a specific lesion of bladder mucosa in 8 cases. CONCLUSION: Urodynamic investigations are usefull in bilharziasis urinary disorders in order to specify the pathophysiology of urinary symptoms and to point a specific neurogenic (spinal) alteration in the genesis of the urinary symptoms.


PMID: 22393623 [PubMed - in process]

March 1, 2012

Women with pure stress urinary incontinence symptoms assessed by the initial standard evaluation including measurement of post-void residual volume and a stress test: Are urodynamic studies still needed?

Women with pure stress urinary incontinence symptoms assessed by the initial standard evaluation including measurement of post-void residual volume and a stress test: Are urodynamic studies still needed?:

Women with pure stress urinary incontinence symptoms assessed by the initial standard evaluation including measurement of post-void residual volume and a stress test: Are urodynamic studies still needed?

Neurourol Urodyn. 2012 Feb 28;

Authors: Jeong SJ, Kim HJ, Lee BK, Rha W, Oh JJ, Jeong CW, Kim JH, Yoon CY, Hong SK, Byun SS, Lee SE

Abstract

AIMS: The significance of preoperative urodynamic studies in women with a "clinically-defined pure stress urinary incontinence (SUI) symptom" has been debated in recent years. We evaluated changes of reliability of pure SUI symptoms for prediction of pure urodynamic SUI (USUI) when the assessment of post-void residual (PVR) volume and a stress test, designated as the initial standard evaluation in the NICE and AUA guidelines, were added to the process for the diagnosis of pure SUI symptoms. METHODS: We reviewed records of 1,019 women aged 30-80 who underwent urodynamic study for incontinence. Criteria for pure SUI symptoms were defined as absence of overactive bladder symptoms and voiding difficulties based on a frequency-volume chart and AUA Symptom Index. We then added assessment of PVR volume and a stress test to the process for clinical diagnosis. RESULTS: Of subjects, 211 (20.7%) could be classified as having a pure SUI symptom. Of these, only 167 (79.1%) had pure USUI and 33 (15.7%) had detrusor overactivity. Eight (3.8%) had detrusor underactivity/bladder outlet obstruction. Sensitivity and specificity of pure SUI symptoms for pure USUI were 28.6% and 89.9%. Addition of assessment of PVR volume and a stress test resulted in an increase of predictive accuracy of only 3.6%. CONCLUSIONS: As one-fifth of women with pure SUI symptoms exhibit the pathophysiologies that could affect the surgical outcomes despite additional use of PVR assessment and a stress test in the clinical diagnostic process, urodynamic evaluation is considered necessary before anti-incontinence surgery in this population. Neurourol. Urodynam. © 2012 Wiley Periodicals, Inc.


PMID: 22374678 [PubMed - as supplied by publisher]

February 1, 2012

[The association between diabetes mellitus and lower urinary tract dysfunctions in women assisted in a reference service].

[The association between diabetes mellitus and lower urinary tract dysfunctions in women assisted in a reference service].:

[The association between diabetes mellitus and lower urinary tract dysfunctions in women assisted in a reference service].

Rev Bras Ginecol Obstet. 2011 Dec;33(12):414-20

Authors: Oliveira EG, Marinheiro LP, Silva KS

Abstract

PURPOSE: to describe lower urinary tract dysfunctions and clinical demographic characteristics of patients with urinary symptoms. This study assessed the prevalence of diabetes mellitus and urodynamic changes in these women.

METHODS: We conducted a cross-sectional, retrospective study on 578 women. The prevalence of diabetes mellitus and urodynamic diagnoses was assessed in patients with lower urinary tract dysfunctions, with their respective 95% confidence intervals. The prevalence ratios of urodynamic alterations were calculated according to the diabetes mellitus diagnoses.

RESULTS: Seventy-seven patients (13.3%) had diabetes and type 2 diabetes was predominant (96.1%). Stress urinary incontinence was the most frequent urodynamic diagnosis (39%) in diabetic patients, followed by detrusor overactivity (23.4%). The prevalence of urodynamic alterations was associated with diabetes (PR=1.31; 95%CI=1.17-1.48). Changes in detrusor contractility (over- or underactivity) were diagnosed in 42.8% diabetic patients and in 31.5% non-diabetic patients.

CONCLUSIONS: Diabetic women had a greater prevalence of urodynamic alterations than the non-diabetic ones. There was no association between diabetes mellitus and detrusor contractility alterations (p=0.80).


PMID: 22282030 [PubMed - in process]

January 28, 2012

How does the urothelium affect bladder function in health and disease?

How does the urothelium affect bladder function in health and disease?:

How does the urothelium affect bladder function in health and disease?

Neurourol Urodyn. 2012 Jan 24;

Authors: Birder L, Ruggieri M, Takeda M, van Koeveringe G, Veltkamp S, Korstanje C, Parsons B, Fry C

Abstract

The urothelium is a multifunctional tissue that not only acts as a barrier between the vesical contents of the lower urinary tract and the underlying tissues but also acts as a sensory organ by transducing physical and chemical stresses to the attendant afferent nervous system and underlying smooth muscle. This review will consider the nature of the stresses that the urothelium can transduce; the transmitters that mediate the transduction process; and how lower urinary pathologies, including overactive bladder syndrome, painful bladder syndrome and bacterial infections, are associated with alterations to this sensory system. In particular, the role of muscarinic receptors and the TRPV channels system will be discussed in this context. The urothelium also influences the contractile state of detrusor smooth muscle, both through modifying its contractility and the extent of spontaneous activity; potential pathways are discussed. The potential role that the urothelium may play in bladder underactivity is introduced, as well as potential biomarkers for the condition that may cross the urothelium to the urine. Finally, consideration is given to vesical administration of therapeutic agents that influence urinary tract function and how the properties of the urothelium may determine the effectiveness of this mode of delivery. Neurourol. Urodynam. © 2012 Wiley Periodicals, Inc.


PMID: 22275289 [PubMed - as supplied by publisher]

Detrusor underactivity is prevalent after radical prostatectomy: a urodynamic study including risk factors.

Detrusor underactivity is prevalent after radical prostatectomy: a urodynamic study including risk factors.:

Detrusor underactivity is prevalent after radical prostatectomy: a urodynamic study including risk factors.

Can Urol Assoc J. 2012 Jan 24;:1-5

Authors: Chung DE, Dillon B, Kurta J, Maschino A, Cronin A, Sandhu JS

Abstract

INTRODUCTION: The objective was to determine the prevalence of, and factors that predict, detrusor underactivity (DU) in patients presenting with incontinence or lower urinary tract symptoms (LUTS) following radical prostatectomy (RP). We also determined the prevalence of bladder outlet obstruction (BOO) and detrusor overactivity (DO) in this population. METHODS: Patients who underwent urodynamics post-RP were identified. Detrusor underactivity was defined as a maximum flow rate (Qmax) of ≤ 15 mL/s and detrusor pressure (Pdet) Qmax <20 cmH20 or maximum Pdet <20 cmH20 during attempted voiding. Abdominal voiding (AV) was defined as sustained increase in abdominal pressure during voiding. Bladder outlet obstruction and DO were identified using the Abrams-Griffiths nomogram and the International Continence Society criteria. Univariate logistic regression was used to determine factors predicting DU. The following factors were analyzed: age, year of RP, procedure type (minimally-invasive surgery [MIS] or open), postoperative radiation, nerve-sparing, clinical stage, biopsy Gleason grade and interval between RP and evaluation. RESULTS: Between 2005 and 2008, 264 patients underwent urodynamics post-RP. Detrusor underactivity was observed in 108 patients (41%; 95% CI 35%, 47%), of whom 48% demonstrated AV. Overall, BOO and DO were present in 17% (95% CI 12%, 22%) and 27% (95% CI 22%, 33%), respectively. On univariate analysis, only MIS RP was predictive of DU (univariate odds ratio 2.05 for MIS vs. open; p = 0.009). CONCLUSIONS: Detrusor underactivity and AV are common in patients presenting for evaluation of incontinence or LUTS following RP. The etiology of DU in this setting is likely related to the surgical approach. Because DU may affect the success of male incontinence treatment with the male sling or artificial urinary sphincter, it is useful to document its presence prior to treatment. More studies are needed to elucidate the influence of DU on treatment success for male urinary incontinence following RP.


PMID: 22277630 [PubMed - as supplied by publisher]

January 21, 2012

Is There Any Role for Urodynamic Study in Children with High-grade Vesicoureteral Reflux?

Is There Any Role for Urodynamic Study in Children with High-grade Vesicoureteral Reflux?:

Is There Any Role for Urodynamic Study in Children with High-grade Vesicoureteral Reflux?

Urology. 2012 Jan 12;

Authors: Karami H, Razi A, Mazloomfard MM, Javanmard B

Abstract

OBJECTIVE: To determine the clinical symptoms and urodynamic characteristics among children with primary high-grade vesicoureteral reflux (VUR). MATERIALS AND METHODS: We prospectively studied clinical symptoms and urodynamic parameters in 147 consecutive patients ≤12 years old with idiopathic high-grade VUR referred to our hospital. RESULTS: Of 147 patients with high-grade VUR, 139 cases with mean age of 5.3 years met our inclusion criteria (88.5% females, 11.5% males). The most common symptom was recurrent urinary tract infection (57%) and urgency (59%) followed by enuresis (31.6%) and frequency (26.6%). Normal urodynamic findings were observed in 23% of patients. Overactive bladder (74%), high-end filling pressure (72.7%), low-compliance bladder (56%), and low bladder capacity (51%) were the most common urodynamic reports in this study. Other urodynamic findings were underactive bladder (1.5%), hypersensitive bladder (1.5%), hyposensitive bladder (3%), and high capacity bladder (2.2%). CONCLUSION: Proper management of VUR is very important because of its harmful potential effects on kidney function in children. With regard to the issue that most children with grade III and higher VUR had overactive bladder, high-end filling pressure, and other urodynamic disorders in their urodynamic study, it seems that these urodynamic disorders could be the basic cause of reflux.


PMID: 22245307 [PubMed - as supplied by publisher]

January 15, 2012

Neuropathic bladder dysfunction in patients with ossification of the posterior longitudinal ligament.

Neuropathic bladder dysfunction in patients with ossification of the posterior longitudinal ligament.:
Related Articles

Neuropathic bladder dysfunction in patients with ossification of the posterior longitudinal ligament.

Int J Urol. 1998 Nov;5(6):540-5

Authors: Miyata M, Mizunaga M, Taniguchi N, Kaneko S, Yachiku S, Atsuta Y

BACKGROUND: Ossification of the posterior longitudinal ligament (OPLL) may cause neuropathic bladder dysfunction due to spinal cord involvement. OPLL, unlike a traumatic spinal cord lesion, progresses insidiously and sometimes affects longer cord segments. As the manifestation of bladder dysfunction may depend on the development of OPLL, we studied the relationship between bladder function and roentgenographic changes in the spinal canals of OPLL patients. PATIENTS AND METHODS: Eighteen surgical candidates (11 males and 7 females, 34 to 85 years old) were studied urodynamically. Sixteen underwent CO2-filling cystometry, uroflowmetry and measurement of their residual urine volume. Cystometry was omitted in the remaining 2 patients. The vertical extent of OPLL and the degree of stenosis in the spinal canal was estimated by x-ray films and CT. RESULTS: The cystometric study revealed detrusor hyperreflexia in 2 patients and areflexic or underactive detrusors in 5 patients. Intermittent flows or considerable amounts of residual urine were also observed in the arefilexia/underactive group. Uroflowmetry showed a normal flow with little residual urine in both patients in whom cystometry was omitted. Bladder sensation was maintained in all patients. The occurrence of abnormal detrusor activity had no relationship to the degree of canal stenosis, while the occurrence of an areflexic or underactive detrusor correlated with the vertical extent of OPLL. CONCLUSION: Although detrusor hyperreflexia is common in an upper spinal cord lesion, attention should also be paid to the development of detrusor underactivity in patients with a wide vertical extent of OPLL.

PMID: 9855121 [PubMed - indexed for MEDLINE]

January 2, 2012

[Studies on neurogenic bladder due to human T-lymphotropic virus type-I associated myelopathy (HAM)]

[Studies on neurogenic bladder due to human T-lymphotropic virus type-I associated myelopathy (HAM)]:
Related Articles

[Studies on neurogenic bladder due to human T-lymphotropic virus type-I associated myelopathy (HAM)]

Nippon Hinyokika Gakkai Zasshi. 1994 Jul;85(7):1106-15

Authors: Imamura A

Fifty cases of untreated human T-cell lymphotropic virus type I (HTLV-I) associated myelopathy (HAM) were evaluated by urodynamic studies to clarify the nature of urinary disturbance and to find out suitable urological treatment. Both irritative and obstructive symptoms coexisted in the HAM patients. 38% of the patients experienced only urinary symptoms throughout the affected period. A main cause of frequency was detrusor hyperreflexia at filling phase, which was found in 58% of the patients. However, decreased effective bladder capacity due to large amount of residual urine was possibly an another cause of frequency. Detrusor sphincter dyssynergia was the main cause of difficulty of urination, but in some cases underactive detrusor at voiding phase was also the cause of difficulty of urination. Hydronephrosis was observed in only 5 kidneys, although as many as 30 out of 46 cases (65.2%) showed bladder deformity. 17 cases (34%) had urinary tract infection at first visit. As the activity of daily living was deteriorated, the mean volume of residual urine, incidence of detrusor hyperreflexia and detrusor sphincter dyssynergia were all increased. Medical treatment was effective to relieve subjective symptoms, but urodynamic examination did not necessarily review improvement. Intermittent catheterization was needed and successful in 64% of all cases. Patients with HAM must be carefully followed up by urologists.

PMID: 8078228 [PubMed - indexed for MEDLINE]