Bladder Fullness Research Articles

Comparing transabdominal and transvaginal cervical length measurements at mid‐trimester fetal anomaly scan: The impact of bladder fullness and lower uterine contractions

Comparing transabdominal and transvaginal cervical length measurements at mid‐trimester fetal anomaly scan: The impact of bladder fullness and lower uterine contractions

Improving neurological deficits secondary to transverse myelitis using epidural spinal cord stimulation: illustrative cases.

Epidural spinal cord stimulation (eSCS) is canonically used for the treatment of intractable, chronic pain. Recent efforts have successfully utilized eSCS to improve neurological deficits in patients with spinal cord injury. However, there is a paucity of literature on the use of eSCS for demyelinating conditions, with no prior case reports examining eSCS among patients with transverse myelitis (TM). Two patients with TM underwent eSCS and experienced improvements in motor function and bladder symptoms. The first patient exhibited enhanced motor strength in both lower extremities and no longer experienced leg spasms, increasing exercise capacity and decreasing their fall risk. The patient had reduced incontinence pad usage due to a regained ability to sense bladder fullness. The second patient also experienced improved motor scores, leading to enhanced motor functionality and independence. Furthermore, the patient observed reductions in urinary tract infections post-eSCS. Neither patient reported substantial improvement in bowel function following stimulation. Improvements in motor functionality and bladder functioning are well-documented as factors that improve quality of life among paraplegic patients. Given the findings of the present case report, larger cohort studies examining the use of eSCS for demyelinating conditions, including TM, are warranted. https://thejns.org/doi/10.3171/CASE24152.

Urothelium-derived prostanoids enhance contractility of urinary bladder smooth muscle and stimulate bladder afferent nerve activity in the mouse.

The transitional epithelial cells (urothelium) that line the lumen of the urinary bladder form a barrier between potentially harmful pathogens, toxins, and other bladder contents and the inner layers of the bladder wall. The urothelium, however, is not simply a passive barrier, as it can produce signaling factors, such as ATP, nitric oxide, prostaglandins, and other prostanoids, that can modulate bladder function. We investigated whether substances produced by the urothelium could directly modulate the contractility of the underlying urinary bladder smooth muscle. Force was measured in isolated strips of mouse urinary bladder with the urothelium intact or denuded. Bladder strips developed spontaneous tone and phasic contractions. In urothelium-intact strips, basal tone, as well as the frequency and amplitude of phasic contractions, were 25%, 32%, and 338% higher than in urothelium-denuded strips, respectively. Basal tone and phasic contractility in urothelium-intact bladder strips were abolished by the cyclooxygenase (COX) inhibitor indomethacin (10 µM) or the voltage-dependent Ca2+ channel blocker diltiazem (50 µM), whereas blocking neuronal sodium channels with tetrodotoxin (1 µM) had no effect. These results suggest that prostanoids produced in the urothelium enhance smooth muscle tone and phasic contractions by activating voltage-dependent Ca2+ channels in the underlying bladder smooth muscle. We went on to demonstrate that blocking COX inhibits the generation of transient pressure events in isolated pressurized bladders and greatly attenuates the afferent nerve activity during bladder filling, suggesting that urothelial prostanoids may also play a role in sensory nerve signaling.NEW & NOTEWORTHY This paper provides evidence for the role of urothelial-derived prostanoids in maintaining tone in the urinary bladder during bladder filling, not only underscoring the role of the urothelium as more than a barrier but also contributing to active regulation of the urinary bladder. Furthermore, cyclooxygenase products greatly augment sensory nerve activity generated by bladder afferents during bladder filling and thus may play a role in perception of bladder fullness.

Effect of Dietary Choline Consumption on the Development of Urinary Urgency Incontinence in a Longitudinal Cohort of Women.

The objective of this study was to determine whether differences in the cumulative dietary intake of choline, is associated with the risk of developing urge urinary incontinence (UUI). This was an analysis within the Nurses' Health Study (NHS) I and II. The main exposure was the cumulative daily intake for each choline-containing compound obtained from a detailed daily food frequency questionnaire. The primary outcome was UUI, defined as urine loss with a sudden feeling of bladder fullness or when a toilet is inaccessible, occurring >1/month. Cox proportional hazards regression models were used to calculate multivariate-adjusted relative risks and 95% confidence intervals (CIs) for the association between total choline and choline derivatives and risk of UUI. Fixed effects meta-analyses of results from NHSI and NHSII were performed for postmenopausal women only to obtain a pooled estimate of the impact of choline consumption on UUI. There were 33,273 participants in NHSI and 38,732 in NHSII who met all the criteria for inclusion in the analysis. The incidence of UUI was 9.41% (n=3,139) in NHSI and 4.25% (n=1,646) in NHSII. After adjusting for confounders choline was not found to be associated with UUI in postmenopausal women. However, in premenopausal women, relative to the lowest quartile, the highest quartile of consumption of total choline (aRR = 0.79, 95% CI: 0.64-0.99), free choline (aRR = 0.74, 95% CI: 0.58-0.94), and phosphocholine (aRR = 0.77, 95% CI: 0.61-0.96) were associated with a reduced risk of UUI. Increased dietary choline consumption was associated with a reduced risk of UUI among premenopausal women.

Overactive bladder ‘symptoms’ or ‘complaints’ in young and elderly patients or healthy volunteers?

Objective:The overactive bladder symptom complex is multifactorial and heterogeneously influenced by genetic and environmental factors. The role of ageing is not exactly known. Our objective is to evaluate age-related differences in bladder sensations in healthy volunteers and overactive bladder patients. Methods:68 patients with an overactive bladder, diagnosed by their urologist using the International Continence Society criteria, and 66 healthy volunteers were included: 41 patients and 20 volunteers were ≥60 years old. Subjects filled out sensation-related bladder diaries, for 2 periods of 3 days. Results:To obtain the following results, 6160 voids were assessed. Both young and older healthy volunteers experienced storage symptoms. However, older volunteers experienced more symptoms than younger ones. The healthy aged experienced more nocturia and voided 34% more often over 6 days, compared to the young people. They experienced more urge at a lower mean voided volume too. Younger OAB patients perceived their bladder to be ∼25% fuller at 100 ml compared to younger volunteers, older patients experienced a similar mean bladder fullness sensation to their healthy peers. Fourteen healthy older volunteers experienced voids with urge 3 (need to void now), however at a higher mean voided volume compared to the older OAB patients. They both experienced the same amount of nocturia. Conclusions:Storage symptoms are widespread throughout the population in a continuum of frequency and severity of symptoms. Ageing healthy volunteers shift on this continuum, from never having any urinary complaints towards experiencing (a severity of) symptoms that fit within the ICS definition of OAB. Hence, there is an important distinction between storage symptoms and storage complaints.

Proof-of-Concept of Microwave-Based Bladder State Detection Using Realistic Pelvic Models.

Goal: Urinary incontinence (UI) affects a significant proportion of the population and is associated with negative physical and psychological side-effects. Microwave-based technologies may have the potential to monitor bladder volume, providing a proactive, low-cost and non-invasive tool to support individuals with UI. Methods: Studies to date on microwave bladder monitoring have been limited to highly simplified computational and experimental scenarios. In this work, we study the most realistic models to date (both male and female), which incorporate dielectrically and anatomically representative tissues of the pelvic region. Results: We examine the ability of detecting bladder fullness through both reflection and transmission-based parameters and, for the first time, study the effect of urine permittivity. As a proof-of-concept of bladder state detection, we further investigate reconstructing differential radar images of the bladder with two different volumes of urine. Conclusions: The results indicate that there is strong potential for monitoring and detecting the bladder state using microwave measurements.

An evidence-based approach to the recovery of bladder and bowel function after pediatric spinal cord injury

IntroductionBladder dysfunction and associated complications of the urinary system negatively impact the quality of life in children living with spinal cord injury (SCI). Pediatric lower urinary tract deficits include bladder over-activity, inefficient emptying, decreased compliance, and incontinence. Recent evidence in adults with SCI indicates significant improvements in bladder capacity and detrusor pressure following participation in an activity-based recovery locomotor training (ABR-LT) rehabilitative program. Additionally, anecdotal self-reports from parents in our Pediatric NeuroRecovery Program reference changes in bladder function, ranging from awareness of bladder fullness to gains in voluntary control while undergoing ABR-LT. Case presentationIn a within-subjects repeated measures study, we investigated the effect of ABR-LT on bladder function in three children (ages: 2.5, 3, and 6 years) who sustained upper motor neuron SCI. Each child received at least 60 sessions of ABR-LT (5x/week) for 12–14 weeks. Bladder function was assessed via urodynamics and the Common Data Elements questionnaires. Awareness of bladder filling during cystometry was present in all children and detrusor leak point pressure (LPP) was reduced post-ABR-LT relative to pre-training. A decrease in LPP after locomotor training was observed in all three participants. One out of the three participants had substantial improvements in bladder capacity post-ABR-LT and experienced less bowel incontinence following training. DiscussionLike our evidence in adults, the changes in bladder function suggest an interaction between lumbosacral networks regulating spinal reflex control of bladder filling, voiding, and afferent input (including potential descending supraspinal commands) and those activated by ABR-LT. Locomotor training may be associated with increased bladder capacity, enhanced perception of bladder filling, and decreased LPP as well as improvements in bowel control in pediatric SCI. This research suggests that children and adolescents with traumatic SCI could experience dynamic improvements in bladder and bowel function with the aid of various therapies. Studies assessing the durability of training on the recovery of bladder and bowel dysfunction in children with SCI are needed.

Decoding bladder state from pudendal intraneural signals in pigs.

Neuroprosthetic devices used for the treatment of lower urinary tract dysfunction, such as incontinence or urinary retention, apply a pre-set continuous, open-loop stimulation paradigm, which can cause voiding dysfunctions due to neural adaptation. In the literature, conditional, closed-loop stimulation paradigms have been shown to increase bladder capacity and voiding efficacy compared to continuous stimulation. Current limitations to the implementation of the closed-loop stimulation paradigm include the lack of robust and real-time decoding strategies for the bladder fullness state. We recorded intraneural pudendal nerve signals in five anesthetized pigs. Three bladder-filling states, corresponding to empty, full, and micturition, were decoded using the Random Forest classifier. The decoding algorithm showed a mean balanced accuracy above 86.67% among the three classes for all five animals. Our approach could represent an important step toward the implementation of an adaptive real-time closed-loop stimulation protocol for pudendal nerve modulation, paving the way for the design of an assisted-as-needed neuroprosthesis.

Three-year Follow-up of a Single Incision Sling Procedure Performed Under Local Anesthesia in an Office Setting

To assess the 3-year success of placing a single-incision midurethral sling (SIMS) using the Dynamic Intraoperative Standing Sling Technique (DISST) in an office setting under local anesthesia. This is a prospective case series of 20 women who underwent in-office SIMS procedure by the DISST from July 2019 to February 2020. This is an extension of our pilot study (11) and all 20 patients were evaluated at a mean follow-up of 34.3months. Success was defined as a composite score of objective success (negative standing cough test at bladder fullness), subjective success based on the modified PGI-I score of "very much better" or "much better," and no retreatment for stress urinary incontinence. Secondary objectives were adverse events, de novo overactivity of the bladder, recurrent urinary tract infections, voiding dysfunction, pain/dyspareunia, and influence on sexual function. The composite success rate was 95% (95% CI [75.1, 99.9]) at the 36-month follow-up. The significant improvement in MESA scores was maintained over the study period. There were no cases of de novo urgency, mesh exposure, postop voiding dysfunction or recurrent urinary tract infections. There were no cases of de novo dyspareunia. SIMS placed by the DISST technique under local anesthesia in an office setting has shown sustained efficacy over a 3-year period with no decrease in cure. Subjects remained dry and reported excellent improvement in symptoms and quality of life at the 36-month follow-up visit.

A Multielectrode Nerve Cuff for Chronic Velocity Selective Recording in a sheep model.

Supra-sacral spinal cord injury (SCI) causes loss of bladder fullness sensation and bladder over-activity, leading to retention and incontinence respectively. Velocity selective recording (VSR) of nerve roots innervating the bladder might enable identification of bladder activity. A 10-electrode nerve cuff for sacral nerve root VSR was developed and tested in a sheep model during acute surgeries and chronic implantation for 6 months. The cuff performed well, with 5.90±1.90 kΩ electrode, and <~800 Ω tissue impedance after 189 days implantation with a stable device and tissues. This is important information for assessing the feasibility of chronic VSR.Clinical Relevance-This demonstrates the manufacturing and performance of a neural interface for chronic monitoring of bladder nerve afferents with applications in urinary incontinence and retention management following SCI.

(445) A Full Bladder Is Not Needed To Grade Male Stress Incontinence For Prosthesis Patient Selection

Abstract Introduction Stress urinary incontinence (SUI) resulting from prostate surgery can have devastating consequences in men’s quality of life. Patient selection is crucial for successful treatment of SUI with urethral sling or artificial urinary sphincter (AUS). The ideal SUI evaluation tool for determining severity and guiding surgical treatment remains unknown. The Male Stress Incontinence Grading Scale (MSIGS) uses a standing cough test to provide a simple, non-invasive assessment of post-prostatectomy SUI severity, and can facilitate procedure selection. However, uncertainty remains as to whether MSIGS underestimates SUI severity if performed with insufficiently full bladder, increasing the risk of treatment failure. Objective We present our sling and AUS outcomes using the MSIGS for selection. We assessed bladder fullness with random bladder scans (BS) at the time of evaluation to determine if emptier bladder carries increased risk of failure. Methods We conducted a retrospective chart review of male patients undergoing sling and AUS placement. MSIGS and BS were documented at initial evaluation. Additional collected data included age, pads per day (PPD) pre- and post-surgery, post-operative MSIGS, and need for revision or conversion. Success and failure groups were defined as the post-operative use of ≤1 PPD or &amp;gt;1 PPD, respectively. Descriptive and comparative statistics were performed using SAS software. Results From April 2017 to September 2021, 40 male patients underwent sling and 43 naïve AUS placement. Average age was 71.9 for slings and 70.3 for AUS. 80/83 had prior prostatic surgery. Average follow up was 12.5 months. 34/40 slings had complete SUI resolution or reduction of pad use to no more than one PPD vs 40/43 of AUS (85 vs 93%, p=0.4). 4 sling patients (10%) had persistence or recurrence of SUI, of whichone patient underwent AUS placement. MSIGS scores were similar between sling success (83% patients grade 0, 3% grade 1, 14% grade 2) and failure groups (67% grade 0, 33% grade 1). 73% of AUS patient mostly had MSIGS scores 3 or 4. BS was available for 35 sling and 25 AUS patients. Average was 18.5cc in the sling failure group (range 17-161) and 38cc in the sling success, (17-161), with 32% of success patients having a BS of 0cc, and 80% of &amp;lt;60cc. Average BS for AUS patients was 45cc (14-224). 10 patients with BS 0 and 7 patients with BS&amp;lt;30cc demonstrated MSIGS 4 on exam. Conclusions MSIGS is a non-invasive, reliable test to assess SUI severity. Our preliminary data suggests that a full bladder at time of assessment is not necessary to accurately select patients for male sling vs AUS, with high rate of success and patient satisfaction. Disclosure No

MP46-20 EVALUATION OF URODYNAMIC OUTCOMES AND INCONTINENCE SPECIFIC HEART-RELATED QUALITY OF LIFE IN PATIENTS TREATED WITH ROBOT-ASSISTED RADICAL CYSTECTOMY WITH INTRACORPOREAL Y-MODIFIED NEOBLADDER THE BORDEAUX NEOBLADDER

You have accessJournal of UrologyCME1 Apr 2023MP46-20 EVALUATION OF URODYNAMIC OUTCOMES AND INCONTINENCE SPECIFIC HEART-RELATED QUALITY OF LIFE IN PATIENTS TREATED WITH ROBOT-ASSISTED RADICAL CYSTECTOMY WITH INTRACORPOREAL Y-MODIFIED NEOBLADDER THE BORDEAUX NEOBLADDER Erika Palagonia, Benedetta Bianchi, Marilena Gubbiotti, Valentina Giommoni, Anastasios D. Asimakopoulos, Saba Khorrami, Michele De Angelis, Richard Gaston, and Filippo Annino Erika PalagoniaErika Palagonia More articles by this author , Benedetta BianchiBenedetta Bianchi More articles by this author , Marilena GubbiottiMarilena Gubbiotti More articles by this author , Valentina GiommoniValentina Giommoni More articles by this author , Anastasios D. AsimakopoulosAnastasios D. Asimakopoulos More articles by this author , Saba KhorramiSaba Khorrami More articles by this author , Michele De AngelisMichele De Angelis More articles by this author , Richard GastonRichard Gaston More articles by this author , and Filippo AnninoFilippo Annino More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003292.20AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: To present the urodynamic features of our intracorporeal Y-modified neobladder Bordeaux Neobladder and the incontinence specific health-related quality-of-life (HRQoL) outcomes. METHODS: We performed a prospective evaluation of a series of 26 patients who underwent robot-assisted radical cystectomy with intracorporeal Y-modified orthotropic neobladder reconstruction called the Bordeaux Neobladder, between September 2018 and November 2020 in a high-volume referral center, operated by the same surgeon. All the patients were managed following a modified ERAS protocol. Three months and 1 year after surgery, consenting patients underwent clinical evaluation and multichannel urodynamics. The incontinence quality of life (I-QoL) questionnaire was used to evaluate HRQoL. Continence was classified into day-time and night-time and clinically defined as the use of zero pads. RESULTS: The mean age at surgery was 65.4 years. The mean follow-up was 27 months. Regarding the operative time, the mean time for proximal bladder reconstruction was 192 minutes. Urodynamic outcomes data were collected in 17/23 patients for early evaluation and in 13 patients for early and dilated testing. 2/17 patients had I-II grade of hydronephrosis on the left kidney. No cases of hyperchloremic acidosis were identified in the blood gas analysis. The continence rate was 58.8% (10/17) for the day and 23.5% (4/17) for the night and the mean postoperative of the quality-of-life score was 103.3. The mean maximum bladder capacity was 430 cc (range 200-553) ant the average compliance was 33.1 ml/cm h2o. The mean post-voiding residue was 100 ml (0-310). The first sensation of bladder fullness was perceived at an average volume of 337 cm³. The mean max flow at 3 months was 15 ml/s and at 1 year was 18 ml/s. The rate of clean intermittent self catheterization was 17,6%. We did not observe significant changes in urodynamic outcomes during follow-up. Concerning the parameters of the storage phase, there was only a significant reduction in the volume of the first sensation of bladder fullness. CONCLUSIONS: The initial analysis of both invasive and non-invasive urodynamic parameters shows that the Bordeaux Neobladder has adequate functional characteristics in terms of capacity, post-voiding, residual and compliance. It is associated with a reduced chance of upper urinary tract abnormalities and metabolic complications that improve quality of life. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e641 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Erika Palagonia More articles by this author Benedetta Bianchi More articles by this author Marilena Gubbiotti More articles by this author Valentina Giommoni More articles by this author Anastasios D. Asimakopoulos More articles by this author Saba Khorrami More articles by this author Michele De Angelis More articles by this author Richard Gaston More articles by this author Filippo Annino More articles by this author Expand All Advertisement PDF downloadLoading ...

MP60-11 A PRELIMINARY STUDY OF SEX DIFFERENCES IN PREFRONTAL CORTICAL OXYHEMOGLOBIN CONCENTRATION DURING NATURAL BLADDER FILLING

You have accessJournal of UrologyCME1 Apr 2023MP60-11 A PRELIMINARY STUDY OF SEX DIFFERENCES IN PREFRONTAL CORTICAL OXYHEMOGLOBIN CONCENTRATION DURING NATURAL BLADDER FILLING Gabrielle Grob, Helen Query, Linda S. Burkett, Peter Daniels, Mina P. Ghatas, Michael Shields, Devin Rogers, abigail Kaufmann, Lynn Stothers, Adam P. Klausner, and John E. Speich Gabrielle GrobGabrielle Grob More articles by this author , Helen QueryHelen Query More articles by this author , Linda S. BurkettLinda S. Burkett More articles by this author , Peter DanielsPeter Daniels More articles by this author , Mina P. GhatasMina P. Ghatas More articles by this author , Michael ShieldsMichael Shields More articles by this author , Devin RogersDevin Rogers More articles by this author , abigail Kaufmannabigail Kaufmann More articles by this author , Lynn StothersLynn Stothers More articles by this author , Adam P. KlausnerAdam P. Klausner More articles by this author , and John E. SpeichJohn E. Speich More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003318.11AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Sex differences during bladder filling are poorly understood. Functional near infrared spectroscopy (fNIRS) allows non-invasive measurement of cortical brain oxygenated hemoglobin concentration (O2Hb), which has been shown to increase during bladder filling. The objective of this study was to use fNIRS to compare differences between sexes in cortical O2Hb during natural bladder filling. METHODS: Control participants with no known urologic conditions and a negative urgency screen (ICIq-OAB and OAB-V3 surveys) completed a validated oral hydration protocol. During the protocol, participants recorded real-time sensation of bladder fullness (0-100%) and reported “first desire” to void using a Sensation Meter. Prefrontal cortical fNIRS continuous recording of O2Hb was completed during filling and voiding with a 24 channel template. Matlab was used to analyze data between “first desire” to void and 100% sensation, defined in this study as the period of “elevated urgency.” Channels were sub-divided by cortical regions: right (9), left (9), middle (6). RESULTS: Male (n=4) and female (n=4) participants were enrolled with mean age of 39 years and BMI of 25. There were no differences in age, BMI, race, daily fluid intake or OAB scores between sexes. Mean time between first desire and 100% sensation (minutes) was 12.9±6.01 and did not differ between groups (13.8±7.97 female vs 12.0±4.3 male, p=0.70). The difference in O2Hb throughout high urgency was similar between groups in each of the 24 individual channels, with greatest changes in the lateral prefrontal cortex (figure 1). The association between the change in O2Hb and filling did not differ between sexes (R-squared > 0.5 in 72.9% females and 82.3% males, p=0.27). O2Hb generally increased with a positive slope of the exponential fitted curve in 92% participants and did not differ between sexes by individual participant or in all 24 channels. CONCLUSIONS: We found that prefrontal cortical O2Hb concentration generally increases during natural filling and does not appear to differ between male and female controls. Ultimately, fNIRS might enable objective identification of specific neuroexcitation patterns to allow office-based diagnosis and improved treatment of voiding dysfunction. Source of Funding: NIH R21DK128649 & K12HD108269, VCU Presidential Research Quest Fund © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e847 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Gabrielle Grob More articles by this author Helen Query More articles by this author Linda S. Burkett More articles by this author Peter Daniels More articles by this author Mina P. Ghatas More articles by this author Michael Shields More articles by this author Devin Rogers More articles by this author abigail Kaufmann More articles by this author Lynn Stothers More articles by this author Adam P. Klausner More articles by this author John E. Speich More articles by this author Expand All Advertisement PDF downloadLoading ...

Sleep Disorders, Comorbidities, Actions, Lower Urinary Tract Dysfunction, and Medications ("Sleep C.A.L.M.") in the evaluation and management of nocturia: A simple approach to a complex diagnosis.

Nocturia arises from a fundamental mismatch between nocturnal urine production, storage capacity, and sleep architecture, which may be driven by abnormalities of the genitourinary tract, but also by sleep disorders, medical diseases, patient actions/lifestyle factors, or medications. This article introduces a novel system for organizing the complex differential diagnosis for nocturia, as proposed by an international collective of practicing urologists, physician specialists, and sleep experts: "Sleep CALM"-Sleep Disorders, Comorbidities, Actions, Lower Urinary Tract Dysfunction, and Medications. Narrative review of current evidence regarding the relevance of each "Sleep CALM" factor to nocturia pathogenesis, evaluation, and management. Nocturia and sleep disorders are highly intertwined and often bidirectional, such that nocturnal awakenings for reasons other than a sensation of bladder fullness should not be used as grounds for exclusion from nocturia treatment, but rather leveraged to broaden therapeutic options for nocturia. Nocturia is an important potential harbinger of several serious medical conditions beyond the genitourinary tract. Urologists should have a low threshold for primary care and medical specialty referral for medical optimization, which carries the potential to significantly improve nocturnal voiding frequency in addition to overall health status. Adverse patient actions/lifestyle factors, lower urinary tract dysfunction, and medication use commonly coexist with disordered sleep and comorbid medical conditions, and may be the primary mediators of nocturia severity and treatment response, or further exacerbate nocturia severity and complicate treatment. "Sleep CALM" provides a memorable and clinically relevant means by which to structure the initial patient history, physical exam, and clinical testing in accordance with current best-practice guidelines for nocturia. Although not intended as an all-encompassing diagnostic tool, the "Sleep CALM" schema may also be useful in guiding individualized ancillary testing, identifying the need for specialty referral and multidisciplinary care, and uncovering first-line treatment targets.

Brain Response Induced by Peroneal Electrical Transcutaneous Neuromodulation Invented for Overactive Bladder Treatment, as Detected by Functional Magnetic Resonance Imaging

ObjectivesIn this study, we aimed to investigate whether peroneal electrical Transcutaneous Neuromodulation invented for overactive bladder (OAB) treatment elicits activation in brain regions involved in neural regulation of the lower urinary tract. Materials and MethodsAmong 22 enrolled healthy female volunteers, 13 were eligible for the final analysis. Functional magnetic resonance imaging (fMRI) (Siemens VIDA 3T; Erlangen, Germany) was used to compare the brain region activation elicited by peroneal electrical Transcutaneous Neuromodulation with the activation elicited by sham stimulation. Each subject underwent brain fMRI recording during eight 30-second periods of rest, alternating with 30-second periods of passive feet movement using the sham device, mimicking the motor response to peroneal nerve stimulation. Subsequently, fMRI recording was performed during the analogic “off-on” stimulation paradigm using peroneal electrical transcutaneous neuromodulation. Magnetic resonance imaging data acquired during both paradigms were compared using individual and group statistics. ResultsDuring both peroneal electrical Transcutaneous Neuromodulation and sham feet movements, we observed activation of the primary motor cortex and supplementary motor area, corresponding to the cortical projection of lower limb movement. During peroneal electrical Transcutaneous Neuromodulation, we observed significant activations in the brain stem, cerebellum, cingulate gyrus, putamen, operculum, and anterior insula, which were not observed during the sham feet movement. ConclusionsOur study provides evidence that peroneal electrical Transcutaneous Neuromodulation elicits activation of brain structures that have been previously implicated in the perception of bladder fullness and that play a role in the ability to cope with urinary urgency. Our data suggest that neuromodulation at the level of supraspinal control of the lower urinary tract may contribute to the treatment effect of peroneal electrical Transcutaneous Neuromodulation in patients with OAB.

Urodynamic findings and therapeutic approaches for neurogenic lower urinary tract dysfunction in patients with thoracic spinal cord injury.

To evaluate urodynamic examination results and treatment methods of neurogenic lower urinary tract dysfunction (NLUTD) in patients with traumatic thoracic spinal cord injury (SCI). Ninety-one patients with traumatic thoracic SCI were included in the study. The urodynamic analyses of the patients were conducted retrospectively using their laboratory outcomes. The patients were divided into subgroups according to the sensory innervation of the bladder (T1-10/T11-12), the preservation of sensory functions in the sacral segment (complete lesion/incomplete lesion), and the duration of injury (< 6months/ ≥ 6months) and evaluations in subgroups were carried out. A total of 91 patients (69 males, 22 females) were included in the study. When comparing between the subgroups, the sense of bladder fullness was preserved more in the T11-T12 group with a statistically significant difference (p < 0.001). While storage disorder, the rate of indwelling catheter use during hospitalization, bacterial growth of 105CFU/ml in the urine culture, and anticholinergic drug recommendation after urodynamic examination were higher in the complete lesion group, the rate of spontaneous/catheter-free voiding, the number of patients in which sense of bladder fullness was preserved-partially preserved, and alpha-blocker drug recommendation after urodynamic examination was higher in the incomplete lesion group, with a statistically significant difference in all parameters (all p values < 0.05). Our results demonstrate that there are differences in neurogenic lower urinary tract dysfunction features in subgroups of traumatic thoracic SCI patients. Regular urinary system evaluation and necessary changes in treatment should be carried out in this patient group.

&lt;em&gt;Ex Vivo&lt;/em&gt; Analysis of Mechanically Activated Ca&lt;sup&gt;2+&lt;/sup&gt; Transients in Urothelial Cells

Mechanically activated ion channels are biological transducers that convert mechanical stimuli such as stretch or shear forces into electrical and biochemical signals. In mammals, mechanically activated channels are essential for the detection of external and internal stimuli in processes as diverse as touch sensation, hearing, red blood cell volume regulation, basal blood pressure regulation, and the sensation of urinary bladder fullness. While the function of mechanically activated ion channels has been extensively studied in the in vitro setting using the patch-clamp technique, assessing their function in their native environment remains a difficult task, often because of limited access to the sites of expression of these channels (e.g., afferent terminals, Merkel cells, baroreceptors, and kidney tubules) or difficulties applying the patch-clamp technique (e.g., the apical surfaces of urothelial umbrella cells). This protocol describes a procedure to assess mechanically evoked Ca2+ transients using the fluorescent sensor GCaMP5G in an ex vivo urothelial preparation, a technique that could be readily adapted for the study of mechanically evoked Ca2+ events in other native tissue preparations.

Ex Vivo Analysis of Mechanically Activated Ca2+ Transients in Urothelial Cells.

Mechanically activated ion channels are biological transducers that convert mechanical stimuli such as stretch or shear forces into electrical and biochemical signals. In mammals, mechanically activated channels are essential for the detection of external and internal stimuli in processes as diverse as touch sensation, hearing, red blood cell volume regulation, basal blood pressure regulation, and the sensation of urinary bladder fullness. While the function of mechanically activated ion channels has been extensively studied in the in vitro setting using the patch-clamp technique, assessing their function in their native environment remains a difficult task, often because of limited access to the sites of expression of these channels (e.g., afferent terminals, Merkel cells, baroreceptors, and kidney tubules) or difficulties applying the patch-clamp technique (e.g., the apical surfaces of urothelial umbrella cells). This protocol describes a procedure to assess mechanically evoked Ca2+ transients using the fluorescent sensor GCaMP5G in an ex vivo urothelial preparation, a technique that could be readily adapted for the study of mechanically evoked Ca2+ events in other native tissue preparations.

Comparison of Postural Control of Females with and without Urinary Incontinence: A Case-Control Study.

Background: So far, there is much less information about the effects of urinary incontinence on postural control. Therefore the aim of this study is to investigate the differences in postural control using linear and non-linear analyses of the center of pressure (COP) time-series in anteroposterior (AP) and mediolateral (ML) directions between females with and without stress urinary incontinence (SUI). Methods: This case-control study included 22 continent females and 22 SUI females. In this study, static postural control during four different postural tasks was evaluated using a force plate. All participants performed separate 60-sec standing trials with eyes open in the empty bladder and full bladder conditions. Mean, range, velocity, area circle of COP displacements, and approximate entropy (ApEn) of COP time-series were calculated from the 60-sec standing trials for all participants. The independent sample t-test was also used to compare COP variables between the two groups and paired sample t-test was used to assess changes between the full bladder and empty bladder conditions within each group. The effect size of Cohen's d was used to assess the magnitude of the differences between the two groups. Results: The findings revealed a significant group × task interaction for the mean of ML displacement and ApEn of COP. SUI females showed more AP displacement range in the full bladder (pvalue= 0.020, effect size=0.74) and a higher velocity (empty bladder: p=0.040, effect size=0.63) (full bladder: p=0.020, effect size=0.75) than the continent group. Generally, the SUI females had lower ApEn than the continent females, although the differences were not significant. While the variables of COP were unaffected by bladder fullness in the continent group, the SUI group in full bladder condition experienced more AP range (p=0.030), and area circle (p=0.007) of COP sway in quiet standing. Conclusion: These results provide more support for the hypothesis that postural control can be impaired following SUI, although future investigations on this topic are recommended.

The neurogenic bladder characteristics and treatment approaches in the patients with multiple sclerosis

ObjectivesTo analyze the neurogenic bladder characteristics and the treatment approaches in patients with multiple sclerosis (MS) to facilitate proper and reasonable decisions in relevant patients. DesignRetrospective study. SettingDepartment of Physical Medicine and Rehabilitation, Ankara Training and Research Hospital, Ankara, Turkey. ParticipantsSeventy-five patients diagnosed with MS between 2002 and 2015 were included in the study. InterventionUrodynamic examination. Outcome MeasureThe detrusor type, detrusor compliance, sense of bladder fullness, storage disorder, emptying disorder, voided volume, post-void residual volume, urine culture, emptying method, and medical treatments were recorded. ResultsThe study included 53 females and 22 males with a mean age of 36 ± 10.1 years. Urodynamic examinations indicated that 74.7% of the patients had detrusor overactivity, 74.7% had detrusor hypocompliance, 77.3% had storage dysfunction, and 81.3% had emptying dysfunction. An anticholinergic medication was recommended to 74.7% of the patients, while alpha-adrenergic receptor blockers were recommended to 69.3%. The detrusor hypocompliance was more common in the group with a disease duration of ≥10 years (p = 0.045). The use of external collector systems was more common, and urine culture was more frequently positive for infections in the female patients (p = 0.001 and p = 0.049, respectively). The frequency of normal bladder-filling sensation was higher in women (p = 0.01). The frequencies of detrusor overactivity and storage and emptying disorders, voided and postvoid volumes (mL), and bladder emptying methods were not significantly different among the subgroups (p > 0.05). ConclusionThe study revealed a significant neurogenic bladder dysfunction and an inadequate management of this dysfunction in MS patients. Considering that the symptoms may progress over time, the urinary systems of MS patients should be evaluated periodically, and necessary modifications should be made in their treatments.