April 29, 2016

Phasic changes in bladder compliance during filling cystometry of the neurogenic bladder.

Phasic changes in bladder compliance during filling cystometry of the neurogenic bladder.
Ann Rehabil Med. 2014 Jun;38(3):342-6
Authors: Kim SY, Ko SH, Shin MJ, Park YJ, Park JS, Lee KE, Ko HY
Abstract
OBJECTIVE: To investigate phasic changes during filling cystometry that most accurately represent detrusor properties, regardless of other factors affecting detrusor contractility.
METHODS: Seventy-eight patients (59 males, 19 females; mean age, 48.2 years) with spinal cord injuries were enrolled. Urodynamic studies were performed using a normal saline filling rate of 24 mL/min. We calculated bladder compliance values of the detrusor muscle in each of three filling phase intervals, which divided the filling cystometrogram into three phases referable to the cystometric capacity or maximum cystometric capacity. The three phases were sequentially delineated by reference to the pressure-volume curve reflecting bladder filling.
RESULTS: Bladder compliance during the first and second phases of filling cystometry was significantly correlated with overall bladder compliance in overactive detrusors. The highest coefficient of determination (r(2)=0.329) was obtained during the first phase of the pressure-volume curve. Bladder compliance during all three phases was significantly correlated with overall bladder compliance of filling cystometry in underactive detrusors. However, the coefficient of determination was greatest (r(2)=0.529) during the first phase of filling cystometry.
CONCLUSION: Phasic bladder compliance during the early filling phase (first filling phase) was the most representative assessment of overall bladder compliance during filling cystometry. Careful determination of early phase filling is important when seeking to acquire reliable urodynamic data on neurogenic bladders.
PMID: 25024957 [PubMed]
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April 27, 2016

Pharmacotherapy in detrusor underactivity: A new challenge for urologists and pharmacologists (from lab to clinic).

Pharmacotherapy in detrusor underactivity: A new challenge for urologists and pharmacologists (from lab to clinic).
Pharmacol Rep. 2016 Mar 19;68(4):703-706
Authors: Juszczak K, Drewa T
Abstract
Higher incidence of functional urinary bladder dysfunction (detrusor overactivity - DO and detrusor underactivity - DU) occurs in elderly people. Effective therapy is widely used in patients with DO, in contrast DU seems to be a serious burden for the older population due to the lack of successful treatment. The aim of the study was to review the potential pharmacological targets in DU treatment in the animal model. This review is based on systemic literature research. The Medline/Pubmed, Scopus, Embase, and Web of Science databases were searched in order to identify original and review articles, as well as editorials relating to underactive bladder, detrusor underactivity. The following Medical Subject Headings (MeSH) terms were used to ensure the sensitivity of the searches: urinary bladder, animal models, humans and therapy. 19 papers met the criteria and were included for this review. 19 papers met the criteria and were included for this review. The pathophysiology of DU and its animal models were described. Moreover, the potential pharmacological targets in DU therapy were discussed, such as bombesin receptors, prostaglandin-, ATP-, NO-, CGRP-, SP-, Dopamine-, NGF-, M2-, and agrin-dependent pathways. In conclusion, due to the lack of effective treatment strategies in DU, further research is necessary. Close cooperation between urologists and pharmacologists should be maintained for optimal research on DU pharmacotherapy.
PMID: 27110877 [PubMed - as supplied by publisher]
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April 25, 2016

The underactive bladder: detection and diagnosis.

The underactive bladder: detection and diagnosis.
F1000Res. 2016;5
Authors: Osman N, Mangera A, Hillary C, Inman R, Chapple C
Abstract
The inability to generate a voiding contraction sufficient to allow efficient bladder emptying within a reasonable time frame is a common problem seen in urological practice. Typically, the symptoms that arise are voiding symptoms, such as weak and slow urinary flow. These symptoms can cause considerable bother to patients and impact upon quality of life. The urodynamic finding of inadequate detrusor contraction has been termed detrusor underactivity (DUA). Although a definition is available for this entity, there are no widely accepted diagnostic criteria. Drawing parallels to detrusor overactivity and the overactive bladder, the symptoms arising from DUA have been referred to as the "underactive bladder" (UAB), while attempts to crystallize the definition of UAB are now ongoing. In this article, we review the contemporary literature pertaining to the epidemiology and etiopathogenesis of DUA as well as discuss the definitional aspects that are currently under consideration. 
PMID: 27081483 [PubMed]
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April 22, 2016

The vexing problem of underactive bladder in children: a viable alternative.

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The vexing problem of underactive bladder in children: a viable alternative.
BJU Int. 2016 May;117(5):712-3
Authors: Bauer SB
PMID: 27079477 [PubMed - in process]

April 11, 2016

Lower Urinary Tract and Sexual Dysfunction in Neurological Patients.

Lower Urinary Tract and Sexual Dysfunction in Neurological Patients.
Eur Neurol. 2014 Jul 2;72(1-2):109-115
Authors: VoduĊĦek DB
Abstract
Background: Lower urinary tract dysfunction (LUTD) and sexual dysfunction (SD) are common in neurological patients due to a combination of lesions affecting relevant neural control, constraints imposed by sensorimotor and cognitive deficits and - particularly for SD - psychosocial consequences of chronic neurological disease. Summary: This review summarizes the etiology, diagnosis and treatment of LUTD and SD in neurological patients. Key Messages: LUTD may lead to serious health problems; both LUTD and SD significantly affect quality of life. Management of patients with spinal cord injury and dysraphism is undertaken in specialized centers according to established guidelines. Treatment of neurological patients with noncomplicated neurogenic LUTD or SD should preferentially be guided by a neurologist. Clinical Impact: For rational treatment of urinary symptoms, an accurate assessment is mandatory; the bladder and the sphincter need to be defined as normal, over- or underactive. Urodynamic testing is the gold standard for functional diagnosis; assessment of residual urine and uroflow are the minimal requirements before considering management. Dysfunction of desire, arousal and orgasm (ejaculation) may be diagnosed by medical history and are amenable to counselling and treatment, which is - in the case of erectile dysfunction - evidence based. Further high-quality studies are necessary to test the best approaches for diagnosing and managing particular types of neurogenic LUTD and SD in the different neurological patient populations. © 2014 S. Karger AG, Basel.
PMID: 24993182 [PubMed - as supplied by publisher]
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April 2, 2016

Detrusor underactivity: Pathophysiological considerations, models and proposals for future research. ICI-RS 2013.

Detrusor underactivity: Pathophysiological considerations, models and proposals for future research. ICI-RS 2013.
Neurourol Urodyn. 2014 May 16;
Authors: van Koeveringe GA, Rademakers KL, Birder LA, Korstanje C, Daneshgari F, Ruggieri MR, Igawa Y, Fry C, Wagg A
Abstract
AIMS: Detrusor underactivity, resulting in either prolonged or inefficient voiding, is a common clinical problem for which treatment options are currently limited. The aim of this report is to summarize current understanding of the clinical observation and its underlying pathophysiological entities.
METHODS: This report results from presentations and subsequent discussion at the International Consultation on Incontinence Research Society (ICI-RS) in Bristol, 2013.
RESULTS AND CONCLUSIONS: The recommendations made by the ICI-RS panel include: Development of study tools based on a system's pathophysiological approach, correlation of in vitro and in vivo data in experimental animals and humans, and development of more comprehensive translational animal models. In addition, there is a need for longitudinal patient data to define risk groups and for the development of screening tools. In the near-future these recommendations should lead to a better understanding of detrusor underactivity and its pathophysiological background. Neurourol. Urodynam. © 2014 Wiley Periodicals, Inc.
PMID: 24839258 [PubMed - as supplied by publisher]
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