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.:
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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]