September 17, 2013

Statin-Associated Underactive Bladder




Keywords:

  • bladder;
  • statin;
  • underactive bladder;
  • urinary retention

Abstract


Statins are widely used to treat hypercholesterolemia but can lead to side-effects. We present a case of statin-associated permanent urinary retention in a 69-year-old woman. Oral Cerivastatin was prescribed 2 months prior to the onset of retention. With the discontinuation of Cerivastatin, the patient reported modest improvement in symptoms. The findings of this case support the potential risk of permanent bladder smooth muscle damage due to statin that may lead to underactive bladder and urinary retention.

May 30, 2013

The other bladder syndrome: underactive bladder.

The other bladder syndrome: underactive bladder.:
The other bladder syndrome: underactive bladder.
Rev Urol. 2013;15(1):11-22
Authors: Miyazato M, Yoshimura N, Chancellor MB
Abstract

Detrusor underactivity, or underactive bladder (UAB), is defined as a contraction of reduced strength and/or duration resulting in prolonged bladder emptying and/or a failure to achieve complete bladder emptying within a normal time span. UAB can be observed in many neurologic conditions and myogenic failure. Diabetic cystopathy is the most important and inevitable disease developing from UAB, and can occur silently and early in the disease course. Careful neurologic and urodynamic examinations are necessary for the diagnosis of UAB. Proper management is focused on prevention of upper tract damage, avoidance of overdistension, and reduction of residual urine. Scheduled voiding, double voiding, al-blockers, and intermittent self-catheterization are the typical conservative treatment options. Sacral nerve stimulation may be an effective treatment option for UAB. New concepts such as stem cell therapy and neurotrophic gene therapy are being explored. Other new agents for UAB that act on prostaglandin E2 and EP2 receptors are currently under development. The pharmaceutical and biotechnology industries that have a pipeline in urology and women's health may want to consider UAB as a potential target condition. Scientific counsel and review of the current pharmaceutical portfolio may uncover agents, including those in other therapeutic fields, that may benefit the management of UAB.


PMID: 23671401 [PubMed - in process]

May 7, 2013

Longitudinal observational cohort study about detrusor underactivity as a risk factor for bladder neck contracture after retropubic radical prostatectomy: preliminary results.

Longitudinal observational cohort study about detrusor underactivity as a risk factor for bladder neck contracture after retropubic radical prostatectomy: preliminary results.:
Longitudinal observational cohort study about detrusor underactivity as a risk factor for bladder neck contracture after retropubic radical prostatectomy: preliminary results.
Int Urol Nephrol. 2013 Apr 17;
Authors: Mucciardi G, Galì A, Inferrera A, Di Benedetto A, Macchione L, Mucciardi M, Magno C
Abstract

OBJECTIVES: To evaluate the association between preoperative detrusor underactivity (DU) and symptomatic bladder neck contracture (BNC) in patients undergoing radical retropubic prostatectomy (RRP), in order to identify a possible new risk factor in the etiopathogenic mechanisms of BNC after RRP. METHODS: A total of 100 prostate cancer patients underwent RRP after preoperative complete urodynamic examination. Detrusor contractility was evaluated by bladder contractility index (BCI), power at maximum flow (WF-Qmax), and maximum velocity of detrusorial contraction (MVDC). Follow-up included uroflowmetry with bladder post-voiding volume evaluation at 3 and 6 months after surgery and repeated urodynamic examination at 12 months. Statistical evaluation was performed using the Student's t test (P < 0.01). RESULTS: The mean patient age was 65.6 ± 5.4 years, and pathological stage ranged from T2a to T2c. A total of 40 patients (40 %) presented normal detrusor contractility, 47 (47 %) mild DU, and 13 (13 %) severe DU. Detrusor overactivity (DO) was observed in 12 patients (12 %), small cystometric capacity in 10 (10 %), low compliance in 16 (16 %), DO plus DU (mild or severe) in 6 (6 %), and DO plus small cystometric capacity together with low compliance in 5 (5 %). Normal urodynamics were observed in 38 patients (38 %). Overall BNC incidence was 12. All patients with BNC presented preoperative DU; none presented DO or low bladder compliance. DU severity and BNC occurrence were significantly correlated (P < 0.01) for all 3 urodynamic parameters (BCI, WF-Qmax, and MVDC). CONCLUSIONS: We identify DU as a possible novel risk factor for BNC formation after radical prostatectomy that may contribute to its development.


PMID: 23591720 [PubMed - as supplied by publisher]

April 30, 2013

Overactive bladder and underactive bladder: A symptom syndrome or urodynamic diagnosis?

Overactive bladder and underactive bladder: A symptom syndrome or urodynamic diagnosis?:
Overactive bladder and underactive bladder: A symptom syndrome or urodynamic diagnosis?
Neurourol Urodyn. 2013 Apr;32(4):305-307
Authors: Chapple C
PMID: 23592009 [PubMed - as supplied by publisher]

March 18, 2013

Investigation into neurogenic bladder in arthrogryposis multiplex congenita.

Investigation into neurogenic bladder in arthrogryposis multiplex congenita.:
Investigation into neurogenic bladder in arthrogryposis multiplex congenita.
J Pediatr Urol. 2013 Mar 10;
Authors: Arantes de Araújo L, Ferraz de Arruda Musegante A, de Oliveira Damasceno E, Barroso U, Badaro R
Abstract

OBJECTIVE: During the follow-up of children who had been diagnosed with arthrogryposis multiplex congenita (AMC), it was noted that some were experiencing dysfunctional voiding. Further investigation into these cases led to a diagnosis of neurogenic bladder. Few studies have investigated the relationship between AMC and neurogenic bladder, this being the first to describe the clinical characteristics of neurogenic bladder among these patients. METHODS: A series of 26 cases were obtained from the electronic medical records of patients with AMC who were admitted to Hospital Sarah in Salvador between 1994 and 2007. The patients had all been diagnosed with neurogenic bladder through clinical symptoms, lower urinary tract exams, and urodynamic findings. RESULTS: There was urinary incontinence in 21 patients (81%), and 50% had a history of urinary tract infections. Renal function was altered in 4 patients (15%) and normal in 22 (85%). In the urodynamic study, 14 patients (64%) had detrusor overactivity and 6 (27%) had underactivity. CONCLUSION: Patients with AMC may show changes in the urinary tract, including neurogenic bladder. It is mandatory to study these symptomatic children with urinary disorders.


PMID: 23491981 [PubMed - as supplied by publisher]

March 13, 2013

Unravelling the underactive bladder: a role for TRPV4?

Unravelling the underactive bladder: a role for TRPV4?:
Unravelling the underactive bladder: a role for TRPV4?
BJU Int. 2013 Feb;111(2):353-4
Authors: Everaerts W, De Ridder D
PMID: 23476938 [PubMed - in process]

February 17, 2013

[External sphincterotomy using bipolar vaporisation in saline. First results].

[External sphincterotomy using bipolar vaporisation in saline. First results].:
Related Articles
[External sphincterotomy using bipolar vaporisation in saline. First results].
Prog Urol. 2012 Jul;22(8):462-6
Authors: Even L, Guillotreau J, Mingat N, Castel-Lacanal E, Braley E, Malavaud B, Marque P, Rischmann P, Gamé X
Abstract

OBJECTIVES: The aim of this study was to assess the feasibility, efficacy and tolerance of external urethral sphincter vaporization in saline for treating detrusor-sphincter dyssynergia.

MATERIAL: Between 2009 and 2011 a monocentric prospective study of ten men mean age 58±9 years with neurogenic detrusor-sphincter dyssynergia was carried out. Preoperative evaluation included kidney ultrasound scan, 24-hour creatinine clearance, urodynamics, retrograde and voiding urethrocystography and an at least 6 months temporary stent sphincterotomy. Postoperative assessment was composed of an ultrasound scan post-void residual volume measurement when the urethral catheter were removed and 1 year after the procedure, a retrograde and voiding urethrocystography at 3 months and a flexible cystoscopy at 1 year.

RESULTS: At the catheter removal, eight patients emptied their bladder at completion, a supra-pubic catheter was temporary left in one case and a patient had a permanent urinary retention. For a mean follow-up of 22±11 months, eight patients emptied their bladder at completion and two had a complete urinary retention related to a detrusor underactivity. An orchitis occurred in one case 1 month after the procedure and an urethral stricture in four cases in 12.75±5.68 months on average.

CONCLUSION: External urethral sphincter vaporisation saline was feasible and efficient for treating detrusor-sphincter dyssynergia but was associated with a high risk of urethral stricture.


PMID: 22732581 [PubMed - in process]

Re: prevalence and clinical features of detrusor underactivity among elderly with lower urinary tract symptoms: a comparison between men and women.

Re: prevalence and clinical features of detrusor underactivity among elderly with lower urinary tract symptoms: a comparison between men and women.:
Re: prevalence and clinical features of detrusor underactivity among elderly with lower urinary tract symptoms: a comparison between men and women.
J Urol. 2013 Jan;189(1):227
Authors: Griebling TL
PMID: 23235235 [PubMed - in process]

January 3, 2013

Usefulness of total bladder capacity and post-void residual urine volume as a predictor of detrusor overactivity with impaired contractility in stroke patients.

Usefulness of total bladder capacity and post-void residual urine volume as a predictor of detrusor overactivity with impaired contractility in stroke patients.:
Usefulness of total bladder capacity and post-void residual urine volume as a predictor of detrusor overactivity with impaired contractility in stroke patients.
Exp Ther Med. 2012 Dec;4(6):1112-1116
Authors: Lee SH, Lee JG, Min GE, Lee HL, Lee CH, Yoo KH
Abstract

Detrusor overactivity (DO) with impaired contractility (DOIC) is a mixed pattern of involuntary contraction and increased post-void residual urine volume (PVR) which occurs in stroke patients. Urodynamic study results obtained from patients with detrusor abnormalities and stroke were analyzed to identify the associations between various urodynamic parameters and DOIC. Between August 2003 and November 2010, 127 patients were selected from 178 patients undergoing urodynamic study due to urinary symptoms. Stroke patients were divided into three groups: the DO, DOIC and detrusor underactivity (DU) groups. The significance of differences between the three groups was analyzed using the Kruskal-Wallis test and receiver operating characteristic (ROC) curves were used to calculate the accuracy of the urodynamic study result factors to distinguish between the three groups. The average total bladder capacity (TBC) was 219.15±98.30 ml in the DO, 330.25±115.75 ml in the DOIC and 486.00±111.48 ml in the DU (P<0.001) group. The average PVR was 22.64±20.85 ml in the DO, 146.87±95.09 ml in the DOIC and 425.33±136.70 ml in the DU (P<0.001) group. A ROC curve of DO and DOIC revealed that TBC and PVR were significantly different between the DOIC and DO groups. The area under the curve (AUC) of TBC was 0.812 (P<0.001) and that of PVR was 0.987 (P<0.001). A ROC curve of DOIC and DU revealed that TBC and PVR were significantly different between the DOIC and DU groups. The AUC of TBC was 0.813 (P<0.001) and that of PVR was 0.929 (P<0.001). In the urodynamic study of stroke patients with urinary symptoms, TBC and PVR may provide useful information for treating patients who cannot undergo urodynamic study.


PMID: 23226784 [PubMed - as supplied by publisher]