Bladder Pressure Measurement Research Articles

A novel human cadaver model to investigate a retrourethral transobturator male sling procedure.

PurposeTo develop a cadaver model for the assessment of a male transobturator male sling (retrourethral transobturator sling [RTS], AdVance™; Boston Scientific, USA) to investigate its effect on a simulated abdominal and retrograde leak point pressures (ALPP, RLPP) and the urethral pressure profile (UPP).Materials and MethodsThree fresh frozen human male cadaver specimens were obtained. A suprapubic tube was inserted into the bladder and connected to a digital manometer to measure bladder pressure. Manual suprapubic pressure was then applied to generate an increase in intraabdominal pressure and measure a simulated ALPP. Subsequent measurements of RLPP and UPP were recorded. All measurements were undertaken prior to and following insertion of a RTS.ResultsThe placement of the RTS consistently increased the simulated ALPP for all three cadaver specimens when compared to baseline measures. No leaks occurred at simulated ALPP's of 170 cm H2O for specimen 1, 160 cm H2O for specimen 2, and 170 cm H2O for specimen 3. There was minimal or no change in the RLPP's and UPP's following insertion of the RTS when compared to respective baseline.ConclusionsA model using fresh unfixed cadavers that incorporates a simulated measurement of ALPP is feasible for male stress urinary incontinence surgical intervention investigations.

Emptying cystometry: A feasibility and validation pilot study on female patients

To assess the feasibility and the accuracy of emptying cystometry in order to simplify the manometric follow-up of overactive detrusor in neurological patients under anticholinergic or botulinum toxin injections. Female patients with a stable detrusor underwent both a conventional cystometry and sequential measurements of bladder pressure during emptying (emptying cystometry). At the end of the standard cystometry, a CH12 urinary catheter was introduced in the bladder and was connected to a three-way stopcock. The second way of the stopcock permitted the emptying. The third way of the stopcock was connected to a vertical graduated tube to measure the bladder pressure each 50mL during the bladder emptying. Eleven female patients were included (mean age: 59.4years). Nine patients (82%) had neurogenic bladder. Mean cystometric capacity was 439mL (SD: 35mL). During the emptying cystometry, 8 to 10 measures were taken (mean: 9.4). The mean detrusor pressure was 1.7cmH2O (SD 2.1) for the filling cystometry and 2.3cmH2O (SD: 2.7) for the emptying cystometry. The agreement between the detrusor pressure between the two cystometries was good with intra-class correlation coefficient at 0.66 [0.48-0.77]-and the correlation was high (r=0.7; P<0.000001). In a small, selected sample of patients, emptying cystometry provides similar results of detrusor pressure to filling cystometry. This technique could constitute a home monitoring of bladder pressures in a selected population of patients with intermittent catheterization in whom a manometric follow-up of detrusor overactivity is required. 4.

‘Identifying Brain Networks Controlling Micturition and Continence in Mouse’

ObjectiveLower urinary tract symptoms (LUTS) are extremely common and enormously debilitating. A significant component of LUTS is due to failure of nervous control of bladder function, or otherwise failure of neural pathways to compensate for bladder dysfunction. It remains however unclear how the brain controls bladder filling and voiding and how the micturition reflex is inhibited at times when voiding is undesirable. Prior studies have shown that the pontine micturition center (PMC, aka Barrington's nucleus) directly controls voiding. PMC neurons provide direct innervation of sacral spinal cord nuclei that control bladder contraction and sphincter relaxation. Here we identify the neurochemical identity of PMC neurons that contribute to micturition control as well as identify a network of afferent neurons, spanning several forebrain and brainstem regions, which directly modulates these PMC neurons to influence voiding behavior.MethodsMicro‐injections of adeno‐associated viruses (AAVs), modified Rabies virus, Cholera Toxin b (CTb) or Diphtheria Toxin a (dtA), were placed into anatomically defined regions of the mouse brain, enabling highly selective expression of proteins in target neuron populations. A novel non‐invasive assay; micturition video thermography (MVT), was used to track voiding behavior in awake‐behaving mice. MVT was combined with telemetric measurement of bladder pressure, urethral sphincter EMG and optogenetic stimulation or inhibition. Following MVT these manipulations were repeated whilst recording cystometry, in either the awake or anesthetized state.ResultsStimulating PMCCRH neurons using Gq DREADDs produced urinary frequency in awake‐behaving mice and on the anesthetized cystometrogram (CMG). Conversely, selective ablation of neurons in the PMC using dtA resulted in urinary retention, and delayed or eliminated the CMG voiding reflex. To identify the input connections controlling PMC neurons, we used CTb and modified Rabies virus. Afferents to PMCCRH neurons were found in the vlPAG, the preoptic area, the lateral hypothalamic area, and other sites. Monosynaptic connectivity was confirmed for select sites using electrophysiological recordings. To test the functional consequence of afferent neuron activity, we light‐stimulated their axon terminals within the PMC and observed micturition events within seconds (glutamatergic/excitatory afferents) or increased inter‐void intervals (GABAergic/inhibitory afferents). Finally, we recorded Ca2+‐dependent fluorescence changes in distinct neuron populations to study the timing of neuronal activity with respect to detrusor contraction and voiding.ConclusionsOur results taken together, identify a network of neurons that can control urinary voiding and continence by acting on PMC neurons. We have demonstrated necessity of select afferent sites for voiding, and the effects of removing their modulatory input for continence. This information helps us with a detailed understanding of how forebrain, brainstem and spinal inputs converge to control bladder filling and voiding, and hence the neurologic mechanisms of LUTS in mice and humans. As we define the brain pathways controlling normal micturition, we will evaluate how they are altered in settings of abnormal micturition, such as brain degeneration and prostatic enlargement.Support or Funding InformationNational Institutes of Health (NIH); R01 DK113030‐01This abstract is from the Experimental Biology 2018 Meeting. There is no full text article associated with this abstract published in The FASEB Journal.

Real-time, autonomous bladder event classification and closed-loop control from single-channel pressure data.

Urinary incontinence, or the loss of bladder control, is a debilitating condition affecting millions worldwide, which significantly reduces quality of life. Neuromodulation of lower urinary tract nerves can be used to treat sensations of urgency in many subjects, including those with Spinal Cord Injury (SCI). Event driven, or conditional stimulation has been investigated as a possible improvement to the state-of-the-art open-loop stimulation systems available today. However, this requires a robust, adaptive, and noise-tolerant method of classifying bladder function from real-time bladder pressure measurements. Context-Aware Thresholding (CAT) has been previously shown to work well on prerecorded single contraction urodynamic data. In this work, for the first time, we present real-time detection of multiple serial bladder contractions using urodynamic recordings from human subjects with SCI and Neurogenic Detrusor Overactivity (NDO). CAT demonstrated a high degree of accuracy and noise tolerance on prerecorded data from 15 human subjects, with a mean accuracy of 92% and average false positive rate of 0.3 false positives per contraction. Analysis of event detection latencies showed that CAT identified and responded to events 1.4 seconds faster than the original human experimenter. Finally, we present a case study in which CAT was used live for real-time autonomous, closed-loop bladder control in a single human subject with SCI and NDO, successfully inhibiting four consecutive unwanted bladder contractions and increasing bladder capacity by 40%.

Study of the occurrence of intra-abdominal hypertension and abdominal compartment syndrome in patients of blunt abdominal trauma and its correlation with the clinical outcome in the above patients.

BackgroundIntra-abdominal pressure (IAP) measurements have been identified as essential for diagnosis and management of both intra-abdominal hypertension (IAH) and Abdominal compartment syndrome (ACS). It has gained prominent status in ICUs worldwide. We aimed to evaluate the utility of measurement of rise in bladder pressure to assess IAP levels in blunt abdominal trauma (BAT) patients.Patients and methodsThirty patients of BAT with solid organ injuries were included in this study. Intra-abdominal pressure was measured through a Foleys bladder catheter throughout their stay. Bladder pressure was compared with clinical parameters like mean arterial pressures(MAP), respiratory rate(RR), serum creatinine(SC) and abdominal girth(AG) and also with outcome in terms of intervention whether operative(OI) or non-operative(NOI).ResultsBladder pressure showed significant correlation with MAP (R = −0.418; P = 0.022), AG (R = 0.755; P = 0.000), SC (R = 0.689; P = 0.000) and RR (R = 0.537; P = 0.002). Bladder pressure (R = 0.851; P = 0.000), SC (R = 0.625; P = 0.000), MAP (R = −0.350; P = 0.058) and maximum AG difference (R = 0.634; P = 0.000) showed significant correlation with intervention. In total, 17 patients (56 %) required intervention, 9 patients (30 %) underwent NOI (pigtailing or aspiration) while 8 (27 %) needed OI. More than 3 derailed parameters were associated with 100 % intervention (Mean 3.47, SD-1.23). High APACHE III score on admission (>40) was associated with increased intervention (p = 0.001). Intervention correlates well with Grade of injury (p = 0.000) and not with number of organs injured (p = 0.061). Blood transfusion of 2 or more units of blood was associated with increased intervention (p = 0.000).ConclusionIncreased bladder pressure and other clinical parameters (MAP, SC, RR and change in AG) correlates well with intervention. Elevated bladder pressure correlates well with other clinical parameters in patients with BAT. Bladder pressure, SC, MAP, RR and AG difference can be used to determine the group of patients that can be managed conservatively and those that would benefit with minimal intervention or exploration. During Non-operative management (NOM) of patients with BAT and multiple solid organ injuries, IAP monitoring may be a simple and objective guideline to suggest further intervention whether NOI or OI. Although routine bladder pressure measurements will result in unnecessary monitoring of large number of patients it is hoped that patients with IAH can be detected early and subsequent ACS with morbid abdominal exploration can be prevented. However the criterion for non-operative failure and the point of decompression needs further refinement to prevent an increase of nontherapeutic operations.

The Bladder Pill: Developments Toward Bladder Pressure Measurement in Wake Mini-pigs

This work presents progress on development of the “Bladder pill”, a pressure monitoring implant for urological diagnosis. The device, measuring as little as 5x30mm, uses resonant inductive coupling for wireless powering and communication via an omnidirectional “3-D” receiving coil. The transmitting coil along with the battery-powered control and data logging circuitry is integrated into an external belt suitable for in-vivo testing in mini-pigs. All circuitry is realized using low cost off-the-shelf components, including the pressure sensor which is decapsulated to allow potting in PDMS. Powering and communication is successfully achieved at a distance up to 12cm orthogonally from the belt with data rates exceeding 10kbps and pressure sampling rate of 10Hz with < 2.5W power input. Finally, the results of a preliminary test involving a measurement of bladder contractions and voiding in anaesthised mini-pigs are presented and discussed.

Urodynamic studies in children: Standardized transurethral video-urodynamic evaluation

The aim was too demonstrate standardized video-urodynamic study (VUDS) in children using a transurethral catheter and pressure transducers. Data necessary to obtain urodynamic evaluation of bladder sphincter function were gathered by concomitant measurement of bladder, urethral, and abdominal pressure. A 7F transurethral triple-lumen water-filled catheter was used for measuring the bladder and sphincter pressures and a water-filled 8F catheter connected to a pressure transducer was inserted into the rectum for pressure measurement. Cystometry was combined with fluoroscopy, providing simultaneous voiding cystourethrography information. Detrusor activity, bladder sensation, capacity, and compliance were measured during filling cystometry. Voiding cystometry consisted of recording pressures in the bladder sphincter and abdomen with simultaneous urinary flow measurement. Transurethral VUDS was safely and easily performed in a clinical setting adapted to children. A good and reproducible UDS is mandatory for correct therapeutic decisions. A standardized study associated with fluoroscopic assessment is presented in this video.

Wireless Implantable Pressure Monitor for Conditional Bladder Neuromodulation.

Conditional neuromodulation in which neurostimulation is applied or modified based on feedback is a viable approach for enhanced bladder functional stimulation. Current methods for measuring bladder pressure rely exclusively on external catheters placed in the bladder lumen. This approach has limited utility in ambulatory use as required for chronic neuromodulation therapy. We have developed a wireless bladder pressure monitor to provide real-time, catheter-free measurements of bladder pressure to support conditional neuromodulation. The device is sized for submucosal cystoscopic implantation into the bladder. The implantable microsystem consists of an ultra-low-power application specific integrated circuit (ASIC), micro-electro-mechanical (MEMS) pressure sensor, RF antennas, and a miniature rechargeable battery. A strategic approach to power management miniaturizes the implant by reducing the battery capacity requirement. Here we describe two approaches to reduce the average microsystem current draw: switched-bias power control and adaptive rate transmission. Measurements on human cystometric tracings show that adaptive transmission rate can save an average of 96% power compared to full-rate transmission, while adding 1.6% RMS error. We have chronically implanted the wireless pressure monitor for up to 4 weeks in large animals. To the best of our knowledge these findings represent the first examples of catheter-free, real-time bladder pressure sensing from a pressure monitor chronically implanted within the bladder detrusor.

Bladder Pressure Measurements in Patients Admitted to a Medical Intensive Care Unit

Intra-abdominal hypertension is identified as an independent risk factor for death. However, this pathophysiological state is not always considered in patients in medical intensive care units and is frequently underdiagnosed. Serial bladder pressure measurements were recorded in patients admitted to the medical intensive care units to determine the frequency of intra-abdominal hypertension. This study included 53 patients with a mean age of 59.0 ± 17.7 years. The average admission intra-abdominal pressure was 10.0 ± 5.4 mm Hg with a range of 0 to 28 mm Hg. Eleven patients (21%) had an initial pressure reading above normal (>12 mm Hg). Peak airway pressures were higher, and PaO2/FiO2 ratios were lower in patients with an initial pressure >12 mm Hg. Bladder pressure measurements provide an easy method to estimate intra-abdominal pressures and provide an additional tool for the physiologic assessment of critically ill patients.

Application of the urinary bladder pressure measurement evaluation system in the nursing of diabetic neurogenic bladder

Objective To observe the application effect of the urinary bladder pressure measurement evaluation system in the nursing of diabetic neurogenic bladder .Methods Fifty patients with diabetic neurogenic bladder two days after hospitalization from March 2011 to August 2013 were chosen .The change of bladder pressure and volume , the bladder safe capacity and maximum capacity , the starting activity state of detrusor, the state of sphincter, and the coordination ability of detrusor/sphincter were measured by the urinary bladder pressure meter .The nursing plan were made and carried out according to the results of measures .The residual urine volumes of bladder and the urination function changes were compared before and after the intervention .Results The cases of urinary incontinence （ high compliance small capacity bladder ） and the urinary retention （ high compliance large capacity bladder ） were respectively 9 and 40 cases.The cases of residual urine volumes of bladder more than 200 ml were decreased from 20 cases to 5 cases after the training of bladder , and the cases of patients with moderate and severe disorder of urination function were decreased from 22 cases to 7 cases after the training, and the differences were found before and after the training （U=4.73, 5.51, respectively;P〈0.01）.The case of low compliance small capacity bladder was one case , and was needed to the treatment of surgery .Conclusions Application of the urinary bladder pressure measurement evaluation system in the nursing of diabetic neurogenic bladder is safe and feasible , and can reduce the residual urine volumes of bladder , and improve the urination function . Key words: Nursing care; Urinary bladder pressure measurement evaluation system; Diabetic neurogenic bladder

Implanted electronic siren to alarm for bladder full with urine.

A Device to detect for the bladder which is full with urine is designed. The device can measure bladder pressure. The pressure signals are processed. When the pressure exceeds 40cm water column, Pressure signal exceeds a fixed voltage. At the same time, Oscillator sends a signal and the signal transmits to the body surface. The receiver accepts the oscillating signal. Then, the alarm alerts. Liquid pressure sensor is used to measure bladder pressure. Signal transmits through a pig bladder to pigskin to verify the feasibility of the program.

Fiber-Optic EFPI Pressure Sensors for &lt;italic&gt;In Vivo&lt;/italic&gt; Urodynamic Analysis

A fiber optic sensing system for pressure measurement in invasive urodynamics is presented and experimentally validated. Probes are based on extrinsic Fabry-Perot interferometry (EFPI) principle, with an all-glass biocompatible design having 0.2-mm thickness. Pressure sensitivity of 1.0-1.6 nm/kPa with high stability and reduced thermal sensitivity has been achieved, leading to 0.3-cmH <sub xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink">2</sub> O pressure accuracy. The EFPI probes have been embedded in medical catheters with 4F size for dual bladder and abdominal pressure measurement throughout the full course of a urodynamic analysis. Pressure traces have been compared with a PICO2000 urodynamic instrument, showing improved accuracy and higher responsivity to local pressure variations. Tests have been carried out in vivo on seven patients; the main highlights are reported, showing the premises for an EFPI-based diagnostic tool.

Diagnostik bei Belastungsinkontinenz des Mannes

Male lower urinary tract symptoms (LUTS) occur more frequently with increasing age. LUTS can either be caused by benign prostatic syndrome (BPS) and consecutive subvesical obstruction as well as detrusor hyperactivity. On the other hand, stress urinary incontinence is mostly seen after surgical intervention in the pelvis like radical prostatectomy. Also high volume centers report persisting incontinence rates of 2-4 % after radical prostatectomy.The diagnostic procedure in men with LUTS is divided in two steps: basic diagnostics, followed by a conservative treatment option, and extended diagnostic procedures including measurement of bladder pressure during filling and voiding. In addition, radiologic examinations, including voiding cystouretherogram, retrograde cystogram, CT scan, MRI scan, are added according to the severity of the symptoms and the scheduled surgical procedure. According to the guidelines of the DGU, EAU, AUA, and ICS, this extended examination is also mandatory prior to any surgical procedure like suburethral tapes, artificial sphincters, and sacral foramen neuronal stimulators.

Iliac venous pressure estimates central venous pressure after laparotomy

BackgroundCentral venous pressure (CVP) is traditionally obtained through subclavian or internal jugular central catheters; however, many patients who could benefit from CVP monitoring have only femoral lines. The accuracy of illiac venous pressure (IVP) as a measure of CVP is unknown, particularly following laparotomy. MethodsThis was a prospective, observational study. Patients who had both internal jugular or subclavian lines and femoral lines already in place were eligible for the study. Pressure measurements were taken from both lines in addition to measurement of bladder pressure, mean arterial pressure, and peak airway pressure. Data were evaluated using paired t-test, Bland-Altman analysis, and linear regression. ResultsMeasurements were obtained from 40 patients, 26 of which had laparotomy. The mean difference between measurements was 2.2 mm Hg. There were no significant differences between patients who had laparotomy and nonsurgical patients (P = 0.93). Bland-Altman analysis revealed a bias of 1.63 ± 2.44 mm Hg. There was no correlation between IVP accuracy and bladder pressure, mean arterial pressure, or peak airway pressure. ConclusionsIVP is an adequate measure of CVP, even in surgical patients who have had recent laparotomy. Measurement of IVP to guide resuscitation is encouraged in patients who have only femoral venous catheter access.

Re: Noninvasive Methods to Evaluate Bladder Obstruction in Men

Reading this paper leads to some thoughts. Our main concerns are first that from paragraph “Symptoms” to paragraph “Doppler Resistive Index”, this paper looks like the paper of M. Belal and P. Abrams “Noninvasive methods of diagnosing bladder outlet obstruction in men. Part 1: Nonurodynamic approach” J Urol 2006; 176: 22-8 (not referenced by the authors) and second, more important, that the authors have made a mixture between two methods the condom method (paragraph Measurement using External Catheter (MEC)) and the penile cuff method (paragraph Measurement Using Penile Compression (MUCP)). Some results about penile cuff method are included in the paragraph external catheter and vice versa. About external catheter, the authors mention a good accuracy for weak flow rate while the original paper mention a lack of accuracy if the flow rate is lower than 5.4 mL/s (van Mastright et al. Development and application of the condom catheter for non-invasive measurement of bladder pressure. J Urol 2009; 25: 99-104). The description of penile compression given by the authors is (only) that of the cuff deflation (Mc Rae et al NAU 1995; 14: 101-114 and Gleason et al. NAU 1997; 16: 93-100) which is not used today. The penile cuff method currently used is an inflation-deflation method (C.J. Griffiths et al.); after initiation of voiding, a cuff is progressively inflated at a stepwise increment of 10cm H2O to a maximum of 200 cm H2O until interruption of the flow. Thus many measurements are possible. The surge of flow observed when the cuff is deflated allows calculating a PCR index (see next remark). In addition, some non-invasive methods have been forgotten: the Penile Compression and Release (PCR) from M.P. Sullivan et al. (NAU 1995; 14: 481-3 & NAU 2000; 19: 657-669) allowing calculating a PCR index, and the D index of voiding dysfunction from F.A. Valentini et al. (BJU Int 2008; 101: 995-9) obtained from a modelled analysis of free uroflows.

Intra-abdominal hypertension in the critically ill: Interrater reliability of bladder pressure measurement

PurposeIntra-abdominal hypertension is frequently underdiagnosed and defined by intra-abdominal pressure (IAP) 12 mm Hg or higher. Increasing IAP may compromise organ viability and culminate in abdominal compartment syndrome. Bladder pressure measurement is a surrogate for IAP, but measurement properties are unknown in the intensive care unit. Our primary objective was to assess the agreement of bladder pressure measurements in critically ill patients. MethodsWe conducted an observational study examining the correlation of measurement variability of bladder pressure. Four raters (2 nurses and 2 physicians) measured IAP. Patient's age, Acute Physiology and Chronic Health Evaluation II, body mass index, mechanical ventilation parameters, and demographics were collected. ResultsFifty-one patients had bladder pressures measured in quadruplicate, producing 204 measurements. Among 51 patients, the mean age was 61.9 years, Acute Physiology and Chronic Health Evaluation II was 23.8, and body mass index was 27.8 kg/m2. The average bladder pressure was 12.4 (SD, ±6.2) mm Hg. The interrater agreement by intraclass correlation coefficient was 0.745 (95% confidence interval [CI], 0.637-0.825), 0.804 (95% CI, 0.684-0.882), and 0.626 (95% CI, 0.428-0.767) among all raters, physicians, and nurses, respectively. ConclusionsAgreement on bladder pressure was high among 4 clinicians and were not significantly different between physicians and nurses. Given that medical/surgical treatments are considered on bladder pressure values, understanding their reliability is essential to monitor critically ill patients.

Longitudinal leak point pressure measurements in rats using a modified port à cath system

Stress urinary incontinence, defined as involuntary loss of urine secondary to an increase in abdominal pressure, represents one of the most significant urological problems. Several animal models to simulate stress urinary incontinence have been presented, including methods to quantify leak point pressure. We have modified an existing leak point pressure procedure to longitudinally quantify stress urinary incontinence in rats by introducing the port à cath system. Reproducible leak point pressure measurements were carried out over a period of more than 40 days at different bladder volumes. Leak point pressure neither showed a significant relationship with the number of times anesthesia was applied nor a significant change over time. The port à cath system provided a reliable, sensitive device for longitudinal urinary bladder pressure measurements in animals with an implanted bladder catheter. This set-up therefore enables the evaluation of bladder pressure in different models for stress urinary incontinence, such as vaginal distention or pudendal transection over long periods of time within the same animal.

Educational Exhibit Abstract No. 314 - Percutaneous alleviation of abdominal compartment syndrome due to hemoperitoneum with simultaneous endovascular bleeding control: a case series

Learning Objectives Surgical decompressive laparotomy is the standard treatment for abdominal compartment syndrome (ACS). We demonstrate the feasibility of simultaneous bleeding control and alleviation of ACS, a method that can obviate the need for major surgical interventions plagued by preventable mortality and morbidity. Background ACS is defined by intrabdominal pressure greater than 20mm Hg with evidence of organ failure or dysfunction. Sequelae of ACS include decreased cardiac output due to IVC compression, decreased pulmonary compliance, renal dysfunction and intestinal and hepatic ischemia. Expeditious decompression of the abdomen is essential to allow reperfusion to vital organs. Decompressive laparotomies have been the mainstay of treatment but carry a mortality of 49%. We present a series of 3 cases of ACS due to massive hemoperitoneum caused by left inferior epigastric artery hemorrhage secondary to paracentesis, hepatic artery bleed after transjugular liver biopsy and hepatic artery injury during cardiac valve repair. All patients presented with clinical evidence of ACS, documented with bladder and direct abdominal pressure measurements. Clinical Findings/Procedure Details In each case, the bleeding artery was identified by selective angiography and embolized with particles - complete arterial occlusion was achieved. Ultrasound was then used to find the largest pocket of blood. After establishing access to the peritoneal space, direct intraperitoneal pressure was measured using an end hole catheter. The same access was then used to place a large bore drainage catheter in each case. Compartment syndrome resolved in each case as evidenced by intrabdominal pressures and patient's clinical status. There were no acute or latent complications as a result of embolization or catheter drainage. Surgery was avoided in all three patients. Conclusion and/or Teaching Points Simultaneous embolization and percutaneous drainage is a feasible and significantly less morbid alternative to surgery in the management of ACS caused by hemoperitoneum.

Excitatory effects of neurokinin 2 and bombesin receptor peptide agonists vivo in urinary tract of rats with voiding dysfunctions

Bladder function was examined in anesthetized and awake adult female Sprague Dawley rats. Voiding dysfunction models included STZ‐induced diabetic (streptozotocin; STZ; 65mg/kg i.p., 9–20 weeks post treatment), polyuria (5% sucrose‐fed; &gt;;3 weeks post treatment) and spinal cord injured (SCI; T8‐T9 cut; acute or 3 days – 6 weeks post SCI) rats. Telemetry transmitters were implanted into polyuria group to measure bladder pressure in freely moving rats. [Lys5,MeLeu9,Nle10]‐NKA(4–10) (LMN‐NKA), a neurokinin 2 receptor (NK2R) agonist, gastrin‐releasing peptide (GRP), a bombesin receptor 2 (BBR2) agonist, and neuromedin B (NMB), a BBR1 agonist, were delivered via jugular vein catheters.In urethrane anesthetized STZ and control rats, LMN‐NKA (0.1–100μg/kg), GRP (0.1–300μg/kg) and NMB (0.1–300μg/kg) dose dependently increased bladder contraction (BC, up to 4x) and micturition frequency. In STZ rats, LMN‐NKA reduced residual volume by half. In acute anesthetized SCI rats, LMN‐NKA (&gt;;10μg/kg) induced urine release (voiding efficiency ~40%). In awake polyuria rats, LMN‐NKA and GRP (1–100μg/kg) induced BC that was often associated with voiding. In awake SCI rats, LMN‐NKA (100μg/kg) and GRP (100, 300μg/kg) triggered voiding in 25 – 80% of rats.Activation of NK2R and BBRs enhanced or triggered voiding in naïve rats and in several models of voiding dysfunction including STZ and SCI rats.

Intraabdominal hypertension and abdominal compartment syndrome in patients admitted to a medical and surgical ICU at a third referral university hospital

Intraabdominal hypertension (IAH), especially abdominal compartment syndrome (ACS), can affect organ function leading to multiple organ failure. Appropriate and prompt management could improve survival. Less recognition of this problem in critically ill patients has been reported. The aim of this study was to study the prevalence, predictive factors and clinical outcome of IAH and ACS in a mixed population of critically ill patients by intermittent measuring bladder pressure during the ICU stay.