Bladder Overdistension Research Articles

Early Removal of Indwelling Catheter and Vaginal Pack After Vaginal Prolapse Surgery: A Retrospective Cohort Study.

After vaginal pelvic organ prolapse (POP) surgery a vaginal pack and indwelling bladder catheter are inserted to reduce blood loss and bladder overdistension. The ideal timing of removal remains unclear. In this study we compared removal of vaginal pack and indwelling catheter 3 h post-surgery with removal the next day. This retrospective cohort study performed in the Netherlands included patients undergoing POP surgery between 1 January 2019 and 31 December 2020. Patients in whom the vaginal pack and catheter were removed the day after surgery (group A) were compared with patients in which the vaginal pack and catheter were removed 3h post-surgery (group B). Both groups were compared regarding urinary retention and the need for re-intervention owing to active blood loss within 6weeks postoperatively. Baseline characteristics, such as age, type of operation and type of anaesthesia in group A (n = 280) and group B (n = 207) were comparable. No significant differences were found regarding complications such as urinary retention (17.2 versus 23.2%; p = 0.255). The rates of re-intervention because of active blood loss and occurrence of infection were also comparable. Removal of the indwelling catheter and vaginal pack 3h after vaginal POP surgery does not lead to more postoperative complications than removal the 1st day after surgery. Therefore, early removal is a feasible and safe alternative to the standard timing of removal the morning after surgery of women undergoing POP surgery. In the future this could help with introducing same-day discharge.

Short-term effects of suprapubic catheterization on detrusor muscle contraction in a rat model of postoperative urinary dysfunction

Catheterization is commonly performed in pelvic surgery to manage postoperative urinary dysfunction. However, little is known about the effects of catheterization on bladder function, although catheterization can drain urine from the bladder. In the present study, we evaluated the short-term effects of catheterization on detrusor muscle contraction in a rat model of postoperative urinary dysfunction due to bilateral accessory nerve injury (BACNI). Ten-week-old male Wistar/ST rats were divided into sham, sham＋catheterization (sham＋C), BACNI, and BACNI＋catherterization (BACNI＋C) groups. The sham＋C and BACNI＋C groups underwent catheter placement in the bladder dome prior to sham or BACNI surgery and intermittent bladder drainage during the observation period. Four hours after surgery, the bladders were excised and subjected to isometric tension study and immunofluorescence staining. Bladder overdistension and overflow urinary incontinence were observed in the BACNI group, not the BACNI＋C group. The contractile responses of the detrusor muscle to 80 mM KCl, carbachol, and electrical field stimulation (EFS) were enhanced in the BACNI group compared to the sham group; the enhanced contractile responses to EFS were improved in the BACNI＋C group. The ratio of the detrusor muscle layer area to the total bladder area increased with increasing interstitial area ratio in the BACNI and BACNI＋C groups, while the total bladder area increased in the sham＋C and BACNI＋C groups. These results suggest that catheterization does not improve the augmentation of detrusor muscle contraction and increase in the detrusor muscle layer area ratio immediately after BACNI and that catheterization causes bladder hypertrophy.

Time-dependent progress of lower urinary tract dysfunction in streptozotocin-induced diabetic rats with or without low-dose insulin treatment.

Objectives: To examine time-dependent functional and structural changes of the lower urinary tract in streptozotocin-induced diabetic rats with or without low-dose insulin treatment and explore the pathophysiological characteristics of insulin therapy on lower urinary tract dysfunction (LUTD) caused by diabetes mellitus (DM). Methods: Female Sprague-Dawley rats were divided into five groups: normal control (NC) group, 4 weeks insulin-treated DM (4-DI) group, 4 weeks DM (4-DM) group, 8 weeks insulin-treated DM (8-DI) group and 8 weeks DM (8-DM) group. DM was initially induced by i.p. injection of streptozotocin (65 mg/kg), and then the DI groups received subcutaneous implantation of insulin pellets under the mid dorsal skin. Voiding behavior was evaluated in metabolic cages. The function of bladder and urethra in vivo were evaluated by simultaneous recordings of the cystometrogram and urethral perfusion pressure (UPP) under urethane anesthesia. The function of bladder and urethra in vitro were tested by organ bath techniques. The morphologic changes of the bladder and urethra were investigated using Hematoxylin-Eosin and Masson's staining. Results: Both 4-and 8-weeks diabetic rats have altered micturition patterns, including increased 12-h urine volume, urinary frequency/12 hours and voided volume. In-vivo urodynamics showed the EUS bursting activity duration is longer in 4-DM group and shorter in 8-DM group compared to NC group. UPP change in 8-DM were significantly lower than NC group. While none of these changes were found between DI and NC groups. Organ bath showed the response to Carbachol and EFS in bladder smooth muscle per tissue weights was decreased significantly in 4- and 8-weeks DM groups compared with insulin-treated DM or NC groups. In contrast, the contraction of urethral muscle and maximum urethral muscle contraction per gram of the tissue to EFS stimulation were significantly increased in 4- and 8-weeks DM groups. The thickness of bladder smooth muscle was time-dependently increased, but the thickness of the urethral muscle had no difference. Conclusions: DM-induced LUTD is characterized by time-dependent functional and structural remodeling in the bladder and urethra, which shows the hypertrophy of the bladder smooth muscle, reduced urethral smooth muscle relaxation and EUS dysfunction. Low-dose insulin can protect against diuresis-induced bladder over-distention, preserve urethral relaxation and protect EUS bursting activity, which would be helpful to study the slow-onset, time-dependent progress of DM-induced LUTD.

Neostigmine for postoperative surgical urine retention: A systematic review and meta-analysis.

Postoperative urinary retention (POUR) is a common surgical complication that can result in bladder overdistension, urinary tract infection and an extended hospital stay. Although neostigmine is an effective therapy for POUR, its usage remains controversial. The purpose of this study was to investigate the effectiveness of neostigmine in improving POUR after surgery. PubMed, Embase, Web of Science, and the Cochrane Library databases were reviewed. A methodical search approach was used for data extraction, while meta-analysis and bias analysis employed Review Manager 5.2 and MedCalc. Fourteen studies involving 4196 postoperative patients were included. With an odds ratio (OR) of 1.70, 95% confidence interval (95% CI) of 1.11-2.60 and an overall effect with p < 0.05, our analysis indicated that the patients receiving neostigmine had a greater effective urine retention rate than after other standard therapies. The subgroup analysis showed that neostigmine recipients had reduced residual urine volume (mean difference (MD) = -1.16, 95% CI: -2.05--0.27, overall p < 0.05, and I2 = 90%) and POUR (standardized MD (SMD) = 3.76, 95% CI: 2.19-5.34, overall p < 0.001, and I2 = 99% using a random effects model) as compared to controls. A random-effects model was utilized due to the substantial heterogeneity between trials. The studies were consistent and had no publication bias. Based on the findings of this meta-analysis, neostigmine can be considered an effective POUR treatment.

(288) Risk Factors and Real-World Short-Term Outcomes of a Failed Trial of Void After Rezum in a Multiethnic Population

Abstract Introduction A failed trial of void (TOV) following surgery for benign prostatic hyperplasia (BPH) predisposes patients to have trouble voiding, increases hospital stays and office visits, and increases detrusor muscle injury due to bladder over-distention. Rezum is a minimally invasive surgical therapy that utilizes convective radiofrequency water vapor thermal energy to ablate obstructive lobes of the prostate, resulting in improvement in lower urinary tract symptoms (LUTS) secondary to BPH. Identifying risk factors for a failed Rezum TOV can help identify a group of BPH patients who may need to be counseled preoperatively for an increased risk of postoperative urinary retention and therefore have their period of postoperative catheterization extended. Objective The purpose of the study was to identify risk factors for a TOV following Rezum and assess the impact of a failed TOV on real-world short-term outcomes. Methods A single office, retrospective study was conducted on patients treated with Rezum between December 2017 and October 2019. Patients were included if they had a follow-up for catheter removal after Rezum. Patients were excluded if they were in urinary retention requiring catheterization on the day of the procedure. A urinary catheter was placed in all patients following treatment. Demographic data and outcome measures, including International Prostate Symptom Score (IPSS), quality of life (QoL), International Index of Erectile Function (IIEF)-Erectile and -Orgasmic function, maximum urinary flow rate (Qmax), postvoid residual (PVR), and adverse events were analyzed at baseline, 1-, 3-, and/or 6-months postoperatively. Risk factors were identified through multivariate logistic regression analyses. Results A total of 289 patients were included, with the majority being Asian (36.0%), followed by non-Hispanic Black (28.7%), Hispanic (22.5%), and non-Hispanic White (12.8%). Thirty-five patients (12.1%) failed their TOV while 254 (87.9%) had a successful TOV. All patients were given a TOV after a median of 5 days (4-5). Those who failed their TOV spent a mean of 13.7 days (SD: 13.3) with a catheter. Patients who failed their TOV were more likely to get a urinary tract infection (20.0% vs. 4.7%, p 200 ml failed their TOV (40.0%) when compared to patients with a baseline PVR &amp;lt;200 ml (10.9%, p=0.008). Conclusions Following Rezum, approximately 1 in 8 patients were not able to pass their initial TOV. Baseline PVR was the only independent risk factor for a failed TOV. Nevertheless, all patients experienced significant relief in LUTS with preservation of sexual function. Patients with large baseline PVR, particularly &amp;gt;200 ml, should be counseled on possibly failing their TOV and requiring a catheter for an extended period. These patients should also be counseled on alternative BPH treatment options for which they may be a better candidate for. Disclosure No

Near-Infrared Spectroscopy for Bladder Monitoring: A Machine Learning Approach

Patients living with neurogenic bladder dysfunction can lose the sensation of their bladder filling. To avoid over-distension of the urinary bladder and prevent long-term damage to the urinary tract, the gold standard treatment is clean intermittent catheterization at predefined time intervals. However, the emptying schedule does not consider actual bladder volume, meaning that catheterization is performed more often than necessary, which can lead to complications such as urinary tract infections. Time-consuming catheterization also interferes with patients' daily routines and, in the case of an empty bladder, uses human and material resources unnecessarily. To enable individually tailored and volume-responsive bladder management, we design a model for the continuous monitoring of bladder volume. During our design science research process, we evaluate the model's applicability and usefulness through interviews with affected patients, prototyping, and application to a real-world in vivo dataset. The developed prototype predicts bladder volume based on relevant sensor data (i.e., near-infrared spectroscopy and acceleration) and the time elapsed since the previous micturition. Our comparison of several supervised state-of-the-art machine and deep learning models reveals that a long short-term memory network architecture achieves a mean absolute error of 116.7 ml that can improve bladder management for patients.

Urine Double Trouble: A Case of Voiding Dysfunction Following Gynecologic Surgery

<h3>Study Objective</h3> We present a surgical video that demonstrates postoperative voiding dysfunction following laparoscopic excision of deeply infiltrative endometriosis with rectal involvement. This video highlights the relevant anatomy and physiology involved in postoperative voiding dysfunction. <h3>Design</h3> Surgical Educational Video. <h3>Setting</h3> Tertiary Referral Center at an Academic Residency Program. <h3>Patients or Participants</h3> 37-yo G1P1 with symptomatic deep endometriosis, presenting with a 4cm deeply infiltrative endometriotic rectal nodule. <h3>Interventions</h3> Laparoscopic excision of deeply infiltrative endometriosis and excision of rectal nodule with low anterior bowel resection. <h3>Measurements and Main Results</h3> Excision of deep infiltrating endometriosis within the pararectal fossae and parametria as well as resection of 4 cm rectal endometriotic lesion. Postoperative urinary retention led to bladder overdistension injury and subsequent chronic voiding dysfunction. <h3>Conclusion</h3> Postoperative voiding dysfunction and bladder overdistension is a common postoperative injury that can have long-term consequences. Gynecologic patients may present with multiple risk factors. Understanding the pathophysiology, surgical anatomy, signs and symptoms, and immediate treatment recommendations is important for both the generalist and specialist gynecologist.

A Nurse-Led Voiding Algorithm for Managing Urinary Retention After General Thoracic Surgery.

Untreated postoperative urinary retention (POUR) leads to bladder overdistension. Treatment of POUR involves urinary catheterization, which predisposes patients to catheter-associated urinary tract infections. The hospital's rate of POUR after lobectomy was 21%, exceeding the Society of Thoracic Surgeons' benchmark of 6.4%. Nurses observed that more patients were being catheterized after implementation of a newly revised urinary catheter protocol. To reduce the incidence of POUR by implementing a thoracic surgery-specific nurse-led voiding algorithm. Experts validated the voiding algorithm that standardized postoperative assessment. It was initiated after general thoracic surgery among 179 patients in a thoracic surgery stepdown unit of a large Magnet hospital. After obtaining verbal consent from patients, nurses collected demographic and clinical data and followed the algorithm, documenting voided amounts and bladder scan results. Descriptive statistics characterized the sample and the incidence of POUR. Associations were determined between demographic and clinical factors and POUR status by using the t test and χ2 test. The POUR-positive group and the POUR-negative group were equivalent with regard to demographic and clinical factors, except more patients in the POUR-positive cohort had had a lobectomy (P = .05). The rate of POUR was 8%. Society of Thoracic Surgeons reports revealed a rapid and sustained reduction in the hospital's rates of POUR after lobectomy: from 21% to 3%. The use of this nurse-led voiding algorithm effectively reduced and sustained rates of POUR.

Are Foley Catheters Needed during Hysterectomies? an Appraisal of 426 MIGS Hysterectomies without Bladder Catheterization or Cystoscopy

<h3>Study Objective</h3> The standard technique for hysterectomies has long included the insertion of a Foley catheter to theoretically reduce operative complications of urinary injury. Urinary Tract Infections (UTIs) following Gynecologic procedures have been cited in the literature from 5-28%. One study suggested that 69% of CAUTI (catheter-associated UTI) can be avoided, and for each day of catheterization, infection risk increases significantly. Additionally, avoiding bladder catheterization, thus allowing bladder distention, may assist in correctly identifying the bladder during dissection, reducing intraoperative injury. <h3>Design</h3> This is a retrospective case series of 426 MIGS hysterectomies performed without initial bladder catheterization from 12/2015 - 2/2021 by a single surgeon. <h3>Setting</h3> MIGS hysterectomies including Total Laparoscopic Hysterectomies and Robot Assisted Laparoscopic Hysterectomies. <h3>Patients or Participants</h3> Inclusion criteria included MIGS hysterectomywithout concurrent cystoscopy, prolapse, or urinary incontinence procedures. <h3>Interventions</h3> 20% of participants underwent perioperative catheterization. <h3>Measurements and Main Results</h3> Of the 426 MIGS hysterectomies, 80% were completed without bladder catheterization or cystoscopy and20% (84) underwent perioperative catheterization. Intraoperatively 18.5% (79) underwent straight catheterizations secondary to bladder overdistention, and 1 underwent indwelling catheterization for hemodynamic monitoring. Postoperatively, 1.8% (8) developed postoperative urinary retention with 6 requiring straight catheterization and 2 indwelling catheterization. At postoperative follow up, 15% complained of bladder discomfort, of which 1.6 % (5) were treated for clinical UTI with 3 undergoing a negative culture. A total of 29 patients had a urine culture performed, with only 2 (0.5%) positive. In spite of a mean of uterine size of 274g, 6.3% endometriosis and 26.9% cancer diagnoses, no bladder or ureteral injuries were encountered. <h3>Conclusion</h3> This study reveals that MIGS hysterectomies without routine bladder catheterization or cystoscopy are feasible and can be safely performed without bladder or ureteral injury with a subsequent decrease in the incidence of UTIs. Further prospective research is warranted to evaluate the benefits of hysterectomy without routine foley placement.

Vasovagal reaction secondary to bladder overdistension in a dog undergoing a unique timeline of medical and surgical treatment for Corynebacterium urealyticum encrusting cystitis: a case report

BackgroundCorynebacterium urealyticum urinary tract infections can result in a rarely reported condition called encrusting cystitis whereby plaque lesions form on and within the urinary bladder mucosa. Chronic lower urinary tract signs manifest subsequent to the infection-induced cystitis and plaque-induced decreased bladder wall distensibility. Because of the organism’s multidrug resistance and plaque forming capability, infection eradication can be difficult. While systemic antimicrobial therapy is the mainstay of treatment, adjunctive surgical debridement of plaques has been used with relative paucity in such cases, thereby limiting our understanding of this modality’s indications and success rate. Consequently, this report describes the successful eradication of Corynebacterium urealyticum encrusting cystitis utilizing a unique timeline of medical and surgical treatments. Additionally, this represents the first reported veterinary case of a vasovagal reaction due to bladder overdistension.Case presentationA 6-year-old female spayed Miniature Schnauzer was evaluated for lower urinary tract clinical signs and diagnosed with Corynebacterium urealyticum encrusting cystitis. The infection was persistent despite prolonged courses of numerous oral antimicrobials and urinary acidification. A unique treatment timeline of intravenous vancomycin, intravesical gentamicin, and mid-course surgical debridement ultimately resulted in infection resolution. During surgery, while the urinary bladder was copiously flushed and distended with saline, the dog experienced an acute vasovagal reaction from which it fully recovered.ConclusionsSurgical debridement of bladder wall plaques should be considered a viable adjunctive therapy for Corynebacterium urealyticum encrusting cystitis cases failing to respond to systemic antibiotic therapy. The timing in which surgery was employed in this case, relative to concurrent treatment modalities, may be applicable in future cases of this disease as dictated on a case-by-case basis. If surgery is ultimately pursued, overdistension of the urinary bladder should be avoided, or at least minimized as much as possible, so as to prevent the possibility of a vasovagal reaction.

50week ultrasound imaging and ultrastructural abnormalities of bladder after sugar diuresis and diabetes mellitus in rats.

PurposeTo investigate 50 week ultrasound imaging and ultrastructure changes of bladder in diuresis and diabetes rats.MethodsForty-two healthy male Sprague–Dawley rats were randomly divided into control group, sugar-induced diuresis group and streptozotocin-induced diabetes group. The 24 h drinking and urine volume were calculated from 21 to 31 weeks. Using ultrasound to assess bladders after 49 weeks. Bladders were examined by transmission electron microscope after 50 weeks.ResultsThe drinking and urine volume significantly increased in the diuresis and diabetes groups. The bladder morphology and bladder wall thickness increased in the diuresis and diabetes groups. Bladder stones, bladder overdistension and urinary retention were seen in the diuresis and diabetes groups. Urothelium manifested degeneration, denudation and necrosis in the diuresis and diabetes groups. The mitochondrial vacuolar degeneration in the urothelial cells was seen in the diabetes group. The subepithelial vascular endothelial cells hyperplasia with a narrowed lumen were observed in the diabetes group. Abnormal mitochondria were rarely seen in the control group. The mitochondrial vacuolar degeneration in the detrusor was more severe in the diabetes group than in the diuresis group. The detrusor muscle and axon degeneration were observed in the diuresis and diabetes groups. Two rats in the diuresis group share similarities with diabetes group (2/6).ConclusionLong-term diabetes mellitus can cause increments of urinary bladder morphology and bladder wall thickness, urinary retention and bladder stones. Ultrastructural degeneration of the bladder might be the morphological bases of diabetic cystopathy.Supplementary InformationThe online version contains supplementary material available at 10.1007/s11255-021-02911-w.

Longitudinal experience with Studer neobladders: Outcomes and complications.

This study aims to assess the longer-term functional, anatomical, and metabolic outcomes of patients who underwent Studer neobladder (SNB) urinary diversion. A retrospective review of patients who underwent SNB at a single center from 1995-2017 (n=116) was performed. Demographics, comorbidities, pathological data, and longer-term functional, anatomical, and metabolic outcomes were collected from hospital records. The primary outcome was voiding function of patients at most recent followup. Secondary outcomes included postoperative complications, renal function, nephrolithiasis, infections, and metabolic outcomes. Excluding those with incomplete followup data, 72 patients with a minimum followup of one year were included for analysis. Median followup was 70±11 months, with 52.8% of patients having ≥5 years of followup. Clean intermittent catheterization (CIC) was used by 22.2% of patient at most recent followup, which was mostly necessitated by bladder overdistension, deteriorating renal function, or recurrent urosepsis despite timed voiding. Patients experienced more daytime and nighttime urinary incontinence in the early postoperative setting, which improved over time. Generally, renal function declined over time; poorer long-term renal function was predicted by hydronephrosis within one year (p=0.002). Longer-term followup of SNB reveals significant but manageable complications. Gradual decline in renal function was common. Strict adherence to bladder emptying protocols (e.g., timed voiding or CIC) may reduce incidence of renal deterioration, metabolic disorders, and urinary dysfunction. Early onset (<1 year) of hydronephrosis may indicate a need for intervention to preserve long-term renal function.

Postoperative urinary retention: risk factors, bladder filling rate and time to catheterization: an observational study as part of a randomized controlled trial

BackgroundKnowledge of risk factors for postoperative urinary retention may guide appropriate and timely urinary catheterization. We aimed to determine independent risk factors for postoperative urinary catheterization in general surgical patients. In addition, we calculated bladder filling rate and assessed the time to spontaneous voiding or catheterization. We used the patients previously determined individual maximum bladder capacity as threshold for urinary catheterization.MethodsRisk factors for urinary catheterization were prospectively determined in 936 general surgical patients. Patients were at least 18 years of age and operated under general or spinal anesthesia without the need for an indwelling urinary catheter. Patients measured their maximum bladder capacity preoperatively at home, by voiding in a calibrated bowl after a strong urge that could no longer be ignored. Postoperatively, bladder volumes were assessed hourly with ultrasound. When patients reached their maximum bladder capacity and were unable to void, they were catheterized by the nursing staff. Bladder filling rate and time to catheterization were determined.ResultsSpinal anesthesia was the main independent modifiable risk factor for urinary catheterization (hyperbaric bupivacaine, relative risk 8.1, articaine RR 3.1). Unmodifiable risk factors were a maximum bladder capacity < 500 mL (RR 6.7), duration of surgery ≥ 60 min (RR 5.5), first scanned bladder volume at the Post Anesthesia Care Unit ≥250mL (RR 2.1), and age ≥ 60 years (RR 2.0). Urine production varied from 100 to 200 mL/h. Catheterization or spontaneous voiding took place approximately 4 h postoperatively.ConclusionSpinal anesthesia, longer surgery time, and older age are the main risk factors for urinary retention catheterization. Awareness of these risk factors, regularly bladder volume scanning (at least every 3 h) and using the individual maximum bladder capacity as volume threshold for urinary catheterization may avoid unnecessary urinary catheterization and will prevent bladder overdistention with the attendant risk of lower urinary tract injury.Trial registrationDutch Central Committee for Human Studies registered trial database: NL 21058.099.07.Current Controlled Trials database: Preventing Bladder Catheterization after an Operation under General or Spinal Anesthesia by Using the Patient’s Own Maximum Bladder Capacity as a Limit for Maximum Bladder Volume. ISRCTN97786497. Registered 18 July 2011 -Retrospectively registered. The original study started 19 May 2008, and ended 30 April 2009, when the last patient was included.

PENGARUH BLADDER TRAINING TERHADAP PERCEPATAN PENGELUARAN URINE PADA IBU POST SECTIO CAESAREA DENGAN RETENSIO URINE DI RUMAH SAKIT GRANDMED LUBUK PAKAM TAHUN 2020

Urinary retention in women is most likely to occur in the post-caesarean section or after pelvic surgery. According to Stanton, urinary retention is the inability to urinate for 24 hours which requires catheter assistance, where the inability to pass urine is more than 25-50% of the bladder capacity. When urinary retention occurs, non-invasive methods are first attempted such as bladder training using Sitz bath hydrotherapy so that the urinary elimination function can occur spontaneously. If these efforts are unsuccessful, bladder training with catheterization is required by inserting a foley catheter in the bladder for 24 - 48 hours to keep the bladder empty and allow the bladder to regain its normal muscle tone to achieve spontaneous urination.&#x0D; Postoperative urinary retention is the patient's inability to urinate after surgery even though the patient's bladder is full, in most cases, postoperative urine retention does not last long, but in some cases postoperative urinary retention can be prolonged even for days after surgery. especially if properly identified and handled. Postoperative urinary retention can cause several complications such as urinary tract infections, bladder overdistention, detrusor damage and can lead to hydronephrosis and kidney damage which can lead to chronic kidney disease, especially in elderly patients.

Therapeutic effect of adipose-derived regenerative cells on bladder function in rats with underactive bladder.

ABSTRACTWe examined the effect of adipose-derived regenerative cells (ADRC) on bladder functions in a rat model of detrusor underactivity (DU) induced by bladder over-distention.Adult female Sprague Dawley rats were divided into 3 groups: sham group (control); over-distention group; and over-distention with ADRC treatment group. Bladder was over-distended with saline (2.7mL) on day 1, 8, 15 and 22 of the study. ADRCs, which were harvested from male F344 rats, expanded via culture, were injected into the bladder wall at day 15. Cystometry and in vitro organ bath functional studies were performed on day 28. Moreover, histological assessment of the bladder was performed.In cystometry, significant prolongation of the inter-contraction interval (ICI) and decrease of voiding efficiency (VE) were observed in the over-distention group, compared to that in the control group. Significant improvement in ICI and VE was seen in the ADRC treatment group in comparison with the over-distention group. The over-distention group showed significantly weaker bladder contractile responses to carbachol and electrical field stimulation than the control group, while bladder contractile responses were significantly stronger in the ADRC treatment group than that in the over-distention group. The over-distention group showed substantial fibrosis of the bladder compared to the control group, whereas bladder fibrosis was alleviated in the ADRC treatment group.In conclusion, the injection of ADRC into bladder wall improved bladder dysfunction and histological changes induced by bladder over-distention. ADRCs-based regenerative therapy could be novel treatment for DU.

450 - Cystodistension injuries and long-term bladder functional outcomes: A unique case series from medical malpractice

Objectives:Bladder overdistension injuries are rare, but they can have devastating effects on the individual and lead to litigation. We aimed to (a) test the hypothesis that larger distension volum...

Postinjury Bladder Overdistension Deteriorates the Lower Urinary Tract’s Storage Function in Patients with Spinal Cord Injury

Introduction: A recent article has reported that postinjury bladder overdistension (OD) deteriorates lower urinary tract function in the mouse spinal cord injury (SCI) model. However, there have been no reports examining the effect of postinjury bladder OD on lower urinary tract function in human SCI patients. Objective: The aim of the study was to investigate the effect of postinjury bladder OD during the acute bladder-areflexia phase on the subsequent lower urinary tract storage function in patients with SCI. Methods: Thirty-one patients with OD (OD group) and 19 patients without OD (non-OD group) during the acute bladder-areflexia phase were included in the study. All patients were confirmed to be completely paralyzed. Their lower urinary tract function was retrospectively evaluated through urodynamic studies 1, 3, and 5 years after injury. Qualiveen-30 questionnaire was used for the evaluation of quality of life. Results: No significant difference was observed in the maximum cystometric capacity between the OD and non-OD groups in their urodynamic evaluation; however, the maximum bladder pressure was significantly higher, and the bladder compliance was significantly lower in the OD group. The incidence of detrusor overactivity tended to be higher in the OD group, but no significant difference was observed. The use of anti-muscarinics was significantly higher in the OD group. No significant differences were observed in Quali­veen-30 scores between both groups. Conclusions: These results suggest that postinjury bladder OD during the acute phase deteriorates lower urinary tract storage function in patients with SCI during the later phase. Thus, it is assumed that a well-planned regular intermittent catheterization in the early spinal shock phase would be important for control of patients’ subsequent storage function.

Cystodistension injuries and long-term bladder functional outcomes: A unique case series from medical malpractice

Objectives: Bladder overdistension injuries are rare, but they can have devastating effects on the individual and lead to litigation. We aimed to (a) test the hypothesis that larger distension volumes and longer distension times are more likely to generate acontractile bladders, (b) determine prognostic information and (c) guide management protocols aimed at preventing cystodistension injuries. Patients and methods: We report 18 cases of cystodistension injury following acute urinary retention. One author provided expert medical opinion in these cases, where redress was sought in the UK courts through medical malpractice claims. Data were collected retrospectively. Results: The cohort comprised 17 females and 1 male. The mean age was 31 years (range 17–69 years). Precipitating events included six surgical procedures, 11 vaginal deliveries and one episode of back pain. The median retention volume was 1450 mL (range 1000–3800 mL), and the median duration of retention was 1200 minutes (range 470–10,365 minutes). Fourteen patients performed intermittent self-catheterisation (ISC), six requiring this temporarily. No statistically significant association was demonstrated between retention characteristics and long-term functional outcomes of the bladder. Conclusions: This case series demonstrates cystodistension injuries to be unpredictable in their long-term impact. No association between volume and duration of retention and long-term bladder function was found. In the long term, 50% void spontaneously, 33% void spontaneously but require ISC to effect complete bladder emptying and 17% remain catheter dependent. Level of evidence: Level 4

Comparison Study of Urinary Retention Incidence in Assisted Vaginal Delivery Case with and without 24-Hour Catheterization

Background: Urinary retention is a condition commonly seen after vaginal delivery, especially in the highrisk cases, such as assisted vaginal delivery, grade 3-4th perineal rupture, or another high risk. Urinary retention caused by unsynchronized between the contraction of the bladder detrusor. Urinary catheterization is one of the preventions of urinary retention. It gives a time for perineal trauma to relieve and no longer edema, so that urethra can be fully relaxed. Therefore, 24-hour catheterization expected to prevent bladder overdistention. It also prevents the bladder from becoming atonia. Objective: This research aims to study the incidence of urinary retention in assisted vaginal delivery with and without 24-hour catheterization. Method: This study used randomized control trials that compared two groups with 24-hour catheterization and without 24-hour catheterization. This study was conducted on 40 women in each group who experienced assisted vaginal birth at Dr Soetomo Hospital, Indonesia. Result: Six women (15%) experienced urinary retention with 24-hour catheterization and six women (15%) had urinary retention without catheterization. There was no significant difference in the incidence of urinary retention with 24-hour catheterization and without 24-hour catheterization (p-value = 1.00). Also, there was no significant interference of urinary retention in the normal and prolonged second stage of labor (p-value = 0.736), and there was no significant risk factor contributing to urinary retention. Conclusion: No significant difference in urinary retention occurred in assisted vaginal delivery with and without 24-hour catheterization

Changes in Apoptosis-Related Proteins in The Urothelium of Rat Bladder Following Partial Bladder Outlet Obstruction and Subsequent Relief.

Partial bladder outlet obstruction (PBOO) induces sustained bladder over-distension, leading to ischemia/reperfusion (I/R)-related oxidative damage of the urothelium via apoptosis. The present study aimed to investigate the sequential course of apoptosis in the urothelium of rat bladder and identify the changes in apoptosis-related proteins during PBOO and subsequent relief. Materials and Methods: The study was conducted using 60 female Sprague-Dawley rats divided into three groups: sham-operated, PBOO only, and PBOO plus subsequent relief. PBOO was induced for 2 weeks, and then the obstruction was relieved by removal of the ligature. The urothelium was assessed by a histological analysis, and expression levels of apoptosis-related proteins were detected by quantitative PCR and immunoblotting. Terminal deoxynucleotidyl transferase-mediated dUTP-biotin nick end labeling (TUNEL)-positive cells were significantly increased in the PBOO only group when compared with the sham-operated group, and decreased in the PBOO relief group when compared with the PBOO group (P < 0.001). From the quantitative PCR and the western blot analyses, expression of Bax, caspase-3, P38, and Jnk was significantly increased in the PBOO group (P < 0.001). However, expression of Erk, Bcl-2 significantly decreased in the PBOO group (P < 0.001). The expression of Erk and Bcl-2 significantly increased in the PBOO relief group when compared with the PBOO group (P < 0.001). In comparison to the sham-operated group, expression levels of survivin significantly increased in both the PBOO and PBOO plus relief groups (P < 0.001). In addition, the expression levels were significantly different between the PBOO and PBOO plus relief groups (P < 0.001). PBOO induced apoptosis of urothelium is related to alterations in the MAPK signaling pathways and apoptosis-related protein change. These results may also suggest that the pro-survival Erk signaling cascade and the expression survivin are activated in response to ischemic bladder injury and associated with initiation of bladder restoration in PBOO and subsequent relief. However, the mechanism of survivin as anti-apoptotic protein in ischemic bladder injuries remains unclear.