Bladder Storage Research Articles

Role of corticotropin-releasing factor on bladder function in rats with psychological stress

Stress-related peptide corticotropin-releasing factor (CRF) and CRF-related peptides are distributed in the peripheral viscera such as the bladder. We investigated the contribution of psychological stress (PS) and CRF on bladder function. Male rats received sham stress (SS) or PS using a communication box method for 120 min every day for 7 days. One group of rats received the intraperitoneal CRF-R1 antagonist antalarmin for 7 days during stress exposure. Mean voided volume per micturition was significantly lower in PS rats compared to SS rats, which was antagonized by antalarmin treatment. Increases in plasma and bladder CRF, and mRNA expressions of bladder CRF, CRF-R1, and M2/3 muscarinic receptors, were found in PS rats. CRF did not influence bladder contraction in itself; however, stress increased the response of muscarinic contraction of bladder strips. These changes were antagonized by antalarmin treatment. In conclusion, PS reinforces M3 receptor-mediated contractions via CRF-R1, resulting in bladder storage dysfunction.

Nicotine‐induced hypoxia in rat urothelium deteriorates bladder storage functions

To measure the effects of nicotine on lower urinary tract symptoms (LUTS), bladder blood flow, and the urothelial markers hypoxia-inducible factor 1α (HIF1α), uroplakin III (UPIII), and aquaporin 3 (AQP3). Ten-week-old female Sprague Dawley rats were subcutaneously injected with 2 mg/kg nicotine (n = 17) or vehicle (control, n = 18) twice daily for 13 days. Some nicotine-treated rats (n = 10) were injected daily with 1 mg/kg tadalafil for the last 6 days of nicotine treatment. One day before cystometry, the bladders of some nicotine-treated and control rats were instilled with 0.08% acetic acid. Urinary frequency and volume were measured 1 day after treatment. Blood flow in the bladder neck was measured, and the urothelia were immunochemically assayed for HIF1α, UPIII, and AQP3. Following acetic acid treatment, both voiding interval and micturition volume of the nicotine-treated rats were significantly lower than controls. Nicotine-treated rats had lower blood flow than controls, and the urothelial expression of HIF1α was higher than controls. Simultaneously, the expressions of UPIII and AQP3 were decreased. Tadalafil treatment increased bladder blood flow, and nicotine-treated rats had increased voiding interval and micturition volume. Further, the expression of HIF1α decreased, and both UPIII and AQP3 levels increased. Nicotine-treated rats stimulated by intravesicular acetic acid instillation exhibited deterioration of bladder storage functions. Changes in tissue markers in the nicotine-treated rats were consistent with hypoxia and loss of urothelial function. Restoration of blood flow reversed the nicotine effects. Nicotine may induce LUTS through reduced bladder blood flow and urothelial hypoxia.

Somatic and psychological triggers for bladder storage symptoms among men and women.

To determine the prevalence of somatic and psychological triggers for bladder storage symptoms among men and women who have not been diagnosed with overactive bladder (OAB) and to determine their impact on individuals' quality of life (QoL). Randomly selected male and female volunteers were screened for the presence of bladder storage symptoms and their impact on their QoL using the UDI-6 and IIQ-7 questionnaires. They were also asked about somatic and psychological triggers for these symptoms using the validated SOPSETO questionnaire. Individuals who had previously been diagnosed with or treated for OAB, prostatic hypertrophy, neurological disease or cancer were excluded. Sixty-six women and 40 men were included. There was a significantly higher prevalence of urinary urgency (41% vs. 19%, p = 0.021), urge urinary incontinence (22% vs. 0%, p = 0.002) and stress urinary incontinence (30% vs. 3%, p = 0.001) among women than men. Total UDI-6 (17± 15 vs. 9± 8, p = 0.04) and IIQ-7 (21± 10 vs. 15± 4, p = 0.02) scores were also higher among women than men. Of the total 34 triggers evaluated, 18 were ranked significantly higher among women than among men. There was a good correlation between the SOPSETO and the UDI-6 and IIQ-7 scores primarily in women (r = 0.46, p < 0.0001; r = 0.69, p < 0.0001) but also in men (r = 0.44, p = 0.009; r = 0.39, p = 0.02). Women who have not been diagnosed with OAB report bladder storage symptoms more frequently than men. Somatic and psychological triggers are more likely to stimulate these symptoms in women than in men and might add burden to their QoL.

Clinical and urodynamic impact of detrusor overactivity in women with overactive bladder

ObjectiveTo evaluate the clinical and urodynamic differences associated with the presence or absence of detrusor overactivity (DO) in women with overactive bladder (OAB) referred to Functional Urology and Urodynamic Units in Spain. Material and methodsObservational, cross-sectional, multicenter and prospective study conducted in Spain in women with clinical diagnosis of OAB, who had been referred to urodynamic study (UDS) of which centralized reading was performed. Patients completed the 3-day bladder diary (DM3d) with the PPIUS scale (Patient Perception of Intensity of Urgency Scale), the B-SAQ (Bladder control Self-Assessment Questionnaire) and the OABq-SF (Overactive Bladder Questionnaire Short Form). The questionnaires and UDS variables of women with OAB, with or without DO, were compared using the Mann-Whitney test (continuous variables) and the chi-square test (χ2) (categorical variables). ResultsA total of 247 women with OAB were evaluated, and 103 of them had DO. According to the presence or absence of DO, significant differences were observed in the number of episodes of urge urinary incontinence (UUI), urinary frequency, nocturia, mean micturition volume and number of pads (p<0.05 for all comparisons). A higher percentage of patients with OAB and DO presented reduced bladder capacity, urgency, urge urinary incontinence (UUI) and lower volume for first voiding desire, strong desire to void and maximum cystomanometric capacity in UDS compared with patients without DO (p<0.05 for all comparisons). The only significant differences between both groups were regarding the B-SAQ symptoms scale (p=0.011). ConclusionsThe presence of DO in women with OAB is related to a more severe alteration of the bladder storage phase.

Suo Quan Wan Protects Mouse From Early Diabetic Bladder Dysfunction by Mediating Motor Protein Myosin Va and Transporter Protein SLC17A9.

Objective: To investigate the effects of Suo Quan Wan (SQW), a traditional Chinese herbal formula, on the overactive bladder (OAB) of type 2 diabetes mellitus (T2DM) mouse models, particularly on its function of mediating the gene and protein expression levels of myosin Va and SLC17A9.Materials and Methods: After 4 weeks high-fat diet (HFD) feeding, C57BL/6J mice were injected with streptozotocin (100 mg/kg) for four times. After 3 weeks, the diabetic mice were treated with SQW for another 3 weeks. Voided stain on paper assay, fasting blood glucose (FBG) test, and oral glucose tolerance test (OGTT) were conducted. Urodynamic test, tension test [α,β-methylene ATP, electrical-field stimulation (EFS), KCl, and carbachol] and histomorphometry were also performed. Western blot analysis and qPCR assays were used to quantify the expression levels of myosin Va and SLC17A9.Results: The diabetic mice exhibited decreased weight but increased water intake, urine production, FBG, and OGTT. No significant changes were observed after 3 weeks SQW treatment. Urodynamic test indicated that the non-voiding contraction (NVC) frequency, maximum bladder capacity (MBC), residual volume (RV), and bladder compliance (BC) were remarkably increased in the diabetic mice, whereas the voided efficiency (VE) was decreased as a feature of overactivity. Compared with the model mice, SQW treatment significantly improved urodynamic urination with decreased NVC, MBC, RV, and BC, and increased VE. Histomorphometry results showed that the bladder wall of the diabetic mice thickened, and SQW effectively attenuated the pathological alterations. The contract responses of bladder strips to all stimulators were higher in the DSM strips of diabetic mice, whereas SQW treatment markedly decreased the contraction response for all stimuli. Moreover, the protein and gene expression levels of myosin Va and SLC17A9 were up-regulated in the bladders of diabetic mice, but SQW treatment restored such alterations.Conclusion: T2DM mice exhibited the early phase of diabetic bladder dysfunction (DBD) characterized by OAB and bladder dysfunction. SQW can improve the bladder storage and micturition of DBD mice by mediating the protein and gene expression levels of myosin Va and SLC17A9 in the bladder, instead of improving the blood glucose level.

Hyaluronic acid improves pain symptoms more than bladder storage symptoms in women with interstitial cystitis

ObjectiveIntravesical hyaluronic acid (HA) therapy is one of acceptable methods to treat bladder pain and storage symptoms (i.e., urgency, frequency and nocturia) of interstitial cystitis/bladder pain syndrome (IC/BPS). We aim to assess the impacts of intravesical HA on bladder pain and storage symptoms, respectively, and to investigate their associated factors in patients with IC/BPS. Materials and methodsIn this prospective, multicenter study, 103 women with refractory IC/BPS undergoing a standard protocol of intravesical HA therapy were enrolled. A pain Visual Analog Scale (VAS) and the Interstitial Cystitis Symptom and Problem Index (ICSI & ICPI) were used to assess symptoms and bother associated with IC/BPS. The Scaled Global Response Assessment (GRA) was used to evaluate patients' perception of overall changes in bladder pain and storage symptoms, respectively, after treatment. ResultsMean age of participants was 43.6 ± 11.8 years. The average duration of symptoms was 5.1 ± 5.0 years. Significant improvements in pain VAS, ICSI and ICPI scores were observed after treatment. However, patients reported significantly different rates of moderate/marked improvement in bladder pain and storage symptoms (73.8% vs. 47.6%; P < 0.001) on the GRA, respectively. “Lower pain VAS score” and “reduced functional bladder capacity” were found to be the factors that adversely affected the treatment responses of bladder pain and storage symptoms, respectively, after repeated statistical analyses. ConclusionBladder instillation of HA seemed more efficient in improving bladder pain than storage symptoms associated with IC/BPS. The persistence of bladder storage symptoms after treatment might result from a reduced functional bladder capacity.

Urogenital symptoms in mitochondrial disease: overlooked and undertreated.

Background and purposeBowel symptoms are well documented in mitochondrial disease. However, data concerning other pelvic organs is limited. A large case–control study has therefore been undertaken to determine the presence of lower urinary tract symptoms (LUTS) and sexual dysfunction in adults with genetically confirmed mitochondrial disease.MethodsAdults with genetically confirmed mitochondrial disease and control subjects were recruited from a specialist mitochondrial clinic. The presence and severity of LUTS and their impact on quality of life, in addition to sexual dysfunction and bowel symptoms, were captured using four validated questionnaires. Subgroup analysis was undertaken in patients harbouring the m.3243A>G MT‐TL1 mitochondrial DNA mutation. A subset of patients underwent urodynamic studies to further characterize their LUTS.ResultsData from 58 patients and 19 controls (gender and age matched) were collected. Adults with mitochondrial disease had significantly more overactive bladder (81.5% vs. 56.3%, P = 0.039) and low stream (34.5% vs. 5.3%, P = 0.013) urinary symptoms than controls. Urodynamic studies in 10 patients confirmed that bladder storage symptoms predominate. Despite high rates of LUTS, none of the patient group was receiving treatment. Female patients and those harbouring the m.3243A>G MT‐TL1 mutation experienced significantly more sexual dysfunction than controls (53.1% vs. 11.1%, P = 0.026, and 66.7% vs. 26.3%, P = 0.011, respectively).ConclusionsLower urinary tract symptoms are common but undertreated in adult mitochondrial disease, and female patients and those harbouring the m.3243A>G MT‐TL1 mutation experience sexual dysfunction. Given their impact on quality of life, screening for and treating LUTS and sexual dysfunction in adults with mitochondrial disease are strongly recommended.

Radiographic abnormalities, bladder interventions, and bladder surgery in the first decade of life in children with spina bifida.

Spina bifida (SB) patients are at increased risk for hydronephrosis, bladder storage and emptying problems, and renal failure that may require multiple bladder surgeries. We retrospectively reviewed patients born with SB 2005-2009, presenting to our institution within 1year of birth. Outcomes at 8-11years old included final renal/bladder ultrasound (RBUS) results, clean intermittent catheterization (CIC) use, anticholinergic use, surgical interventions, and final renal function. We excluded those without follow-up past age 8 and/or no RBUS or fluoroscopic urodynamic images (FUI) within the first year of life. Imaging was independently reviewed by four pediatric urologists blinded to radiologists' interpretation and initial findings compared with final outcomes. Of 98 children, 62 met inclusion criteria (48% male, 76% shunted). Median age at last follow-up was 9.6years. Upon initial imaging, 74% had hydronephrosis (≥ SFU grade 1), decreasing to 5% at 10years (p < 0.0001). Initially, 9% had ≥ SFU grade 3 hydronephrosis, decreasing to 2% (p = 0.13). CIC and anticholinergic use increased from 61% and 37% to 87% and 86%, respectively (p = 0.001 and p < 0.0001, respectively). With follow-up, 55% had surgical intervention and 23% had an augmentation. Of children with a serum creatinine/cystatin-C at 8-11years old, one had confirmed chronic kidney disease (stage 2). Despite initial high incidence of hydronephrosis, this was low grade and resolved in the first decade of life. Additionally, the 8-11-year incidence of kidney disease and upper tract changes was low due to aggressive medical management.

Evaluation of autologous composite colo-peritoneal grafts in the repair of experimental urinary bladder defects in dogs

Background: Urinary bladder (UB) defects are most often associated with embryologic development and pelvic trauma. The cause of the defects could be congenital abnormalities or various aetiologies connected with modern life, including road traffic accidents, assault (gunshot injuries) and occupational hazards (neoplasia). industrial, and criminal activities. Medical treatment for these defects is mostly limited thereby necessitating surgical intervention. This study was aimed at finding alternative reconstruction tissue for restoring bladder storage and voiding capability. Materials and Methods: The surgical procedure was aseptically performed under general anesthesia. The dorsal aspect of the urinary bladder served as the recipient site, while sero-muscular colonic pedicle flap of the descending colon along with free peritoneal sheath formed a composite tissue (donor), colo-peritoneal pedicle graft. The surgical procedure included preparation of the colonic pedicle flap, preparation of free peritoneal flap, formation of composite colo-peritoneal graft, preparation of urinary bladder graft bed, and colo-peritoneo-cystoplasty. The dogs were evaluated in the post-operative period by physical examination, urinalysis, and cystography within the duration of 14 weeks. Results: Cystographic evaluations performed on the 2nd, 10th, and 14th weeks post surgery revealed gradual transition of the urinary bladder architecture at the point of graft with clear delineation and minimal blurring at initial assessment, which gradually disappeared later. Complications observed were straining and constipation, which responded positively following appropriate interventions. Post surgical urinalysis showed transient changes in specific gravity and urine pH values, but returned to pre surgical level after day 18 post surgery. Post surgical proteinuria was observed for the first 7 days, but disappeared on day 12. Hematuria occurred within the first 16 days post surgery. Conclusion: It was concluded that autologous composite colo-peritoneal tissue graft was successfully formed and effectively used in the repair of urinary bladder defects in the dogs. This surgical management intervention could be evaluated in human subjects with similar urinary bladder defects.

Most recent findings of curative drugs for lower urinary tract symptoms in clinical practice

As Japan enters into an aging society, aged patients with chief complaint of lower urinary tract symptoms (LUTS) have increased. The most common cause of LUTS in men older than 50 years is benign prostatic hyperplasia (BPH). In particular, LUTS associated with overactive bladder (OAB) symptoms was reported to have a significant negative impact on patient quality of life (QOL). In clinical practice, monotherapy with α1-blockers or PDE5 inhibitors is widely employed for the initial management of BPH accompanied by OAB (BPH/OAB). However, storage symptoms may persist in some patients. In patients with residual OAB symptoms despite α1-blocker or PDE5 inhibitor monotherapy, the addition of an anticholinergic agent or a β3-adrenergic receptor (β3-AR) agonist is recommended by the BPH guidelines. Although both agents have been shown to effectively improve OAB symptoms and bladder storage functions, it remains unclear which type of add-on therapy, anticholinergic agents or β3-AR agonists, is most effective for alleviating OAB symptoms and storage functions. Recently, detrusor underactivity (DU) is also considered to be a common cause of non-neurogenic LUTS in men. DU has been reported to be present in 9%-48% of men undergoing urodynamic evaluation for non-neurogenic LUTS. DU can lead to adverse health effects, in addition to significant burden and decreased QOL. Thus, development of a safe and effective treatment for patients with LUTS induced by DU is an urgent issue at present. In this paper, we will introduce most recent findings of curative drugs for LUTS, especially BPH/OAB and DU in clinical practice.

Роль фезотеродина в лечении синдрома гиперактивного мочевого пузыря

The muscarinic receptors have been used as target in treatment of overactive bladder (OAB) for a long time. These patients have complaints of urgency, increased urinary frequency and nocturia, sometimes with urinary incontinence (involuntary urine leakage which is associated with abrupt and strong desire to void). Fesoterodine is a prodrug that is structurally and functionally associated with tolterodine and it is the novel drug for OAB treatment. As a result of fesoterodine cleavage by non-specific esterase, the active metabolite 5-hydroxymethyl tolterodine (5-HMT) is formed. Like other antimuscarinic drugs, fesoterodine allows to improve bladder storage function (reducing the frequency of urination) and urgency. For assessing an improvement of the quality of life after treatment by fesoterodine the KHQ questionnaire was used.

A comparison of urodynamic findings between patients with complete and incomplete traumatic spinal cord injuries

Objective: To compare urodynamic findings between patients with complete and incomplete traumatic spinal cord injuries (SCI) and to determine whether it is important to test with urodynamic study in patients with incomplete SCI. Design: Retrospective study Setting: Ankara Physical Medicine and Rehabilitation Training and Research Hospital, Ankara, Turkey Participants: A total of 66 patients with 36 complete and 30 incomplete traumatic SCI were included in the study, from July 2012 to September 2014. Interventions: Urodynamic study Outcome Measures: Maximum cystometric capacity (MCC) , vesicle pressure at MCC, detrusor function (detrusor overactivity or not), bladder complience, bladder storage and emptying disorders, post-void residual volume (PVR) and bladder emptying method were recorded. It was also recorded whether the patients used anticholinergic drugs before urodynamic study. Results: In urodynamic findings MCC, vesicle pressure at MCC, PVR, there was no statistically significant difference between complete and incomplete traumatic SCI patients. Also there was no statistically significant difference in low-compliance of detrusor frequency and bladder storage and emptying disorder frequency. Clean intermittent catheterization (CIC) was the most commonly recommended method after urodynamic studies in both groups of patients with SCI. Conclusions: In urodynamic study findings, there was no statistical difference between complete and incomplete traumatic SCI patients. The present study demonstrate that even if patients with incomplete SCI appear to be functionally better than the patients with complete SCI, urodynamic studies should still be performed in patients with incomplete SCI to identify bladder characteristics and to identify appropriate treatment.

Atherosclerosis as a predictor of transient exacerbation of overactive bladder symptoms after robot-assisted laparoscopic radical prostatectomy.

To assess whether atherosclerosis is involved in the development of overactive bladder and the function of lower urinary tract after robot-assisted radical prostatectomy. The present cohort consisted of 80 consecutive participants. The preoperative cardio-ankle vascular index was used to evaluate the presence of atherosclerosis. The present cohort was split into two groups, the atherosclerotic group, whose cardio-ankle vascular index was ≥9.0, and the control group, whose index was <9.0. The overactive bladder symptom score and lower urinary tract function were compared for 12months after surgery. The total score of the questionnaire was significantly higher at 6 and 9months after surgery in the atherosclerosis group (P=0.04, P=0.03, respectively). Both the urgency and urgency incontinence subscores of the questionnaire showed a parallel tendency to that of the total score after surgery. At 3months after surgery, there was a significant increase in the prevalence of de novo overactive bladder in the atherosclerosis group (P=0.04). At 9 and 12months after surgery, there was a significant decrease of voided volume in the atherosclerotic group (P<0.01, P=0.04, respectively). Atherosclerosis delays the improvement in both overactive bladder symptoms and storage function postoperatively, and it is involved in the transient increase in the prevalence of de novo overactive bladder. Atherosclerosis might be a predictor of the development of overactive bladder after robot-assisted radical prostatectomy.

Recent advances in imaging and understanding interstitial cystitis.

Interstitial cystitis/bladder pain syndrome (IC/BPS) is a debilitating condition associated with intense pelvic pain and bladder storage symptoms. Since diagnosis is difficult, prevalence estimates vary with the methodology used. There is also a lack of proven imaging tools and biomarkers to assist in differentiation of IC/BPS from other urinary disorders (overactive bladder, vulvodynia, endometriosis, and prostatitis). Current uncertainty regarding the etiology and pathology of IC/BPS ultimately impacts its timely and successful treatment, as well as hampers future drug development. This review will cover recent developments in imaging methods, such as magnetic resonance imaging, that advance the understanding of IC/BPS and guide drug development.

Pharmacological treatment of BPS

Pharmacological treatment of BPS is often considered the first therapeutic approach for patients who experience progression in lower urinary tract symptoms (LUTS).α1-adrenoceptor antagonists are often chosen as the first line pharmacological treatment, due to their rapid onset of action, as well as their significant impact on LUTS and Qmax and post-void residual. Adverse effects appear to be low.With larger prostate volume and LUTS, long term treatment with 5α-reductase inhibitors (5ARIs) significantly improves LUTS and post-void residual. In addition, 5ARIs have a significant impact on the reduction in disease progression.Patients with LUTS who mainly suffer from bladder storage symptoms appear to respond to treatment with muscarinic receptor antagonists and beta-3 agonists. Both of these drug classes significantly improve LUTS, but beta-3 agonists seem to be superior with respect to adverse effects.Treatment with phosphodiesterase-5 inhibitors, which are well established in the treatment of erectile dysfunction (ED) gives significant improvement in LUTS and post-void residual and can therefore be recommended for patients with LUTS and ED.Phytotherapies have low rates of adverse effects, which has made them increasingly popular, but effects on LUTS, Qmax and post-void residual remain to be proven.New substances and therapeutic approaches are continuously expanding the options for pharmacological treatment of BPS. As regards adverse effects, therapeutic schemes can increasingly be customised to a patient profile.

Особенности симптомов нижних мочевыводящих путей у мужчин Московского региона. Результаты эпидемиологического исследования

Voiding disorders in men are manifested by various symptoms associated with impairment of the urinary flow along the urinary tract and worsening of the urinary bladder storage function. There is a considerable lack of data on the prevalence of LUTS, their severity, and correlation with data from objective studies in men in the Russian Federation in general and in the Moscow region in particular. A prospective multicenter epidemiological study "Specific Features of Lower Urinary Tract Symptoms in Men Living in the Moscow Region" was conducted based on data acquired from April 1 to May 31, 2017 by an anonymous survey of 525 men (mean age 64.2+/-9.93 years old), residing in Moscow and presenting with complaints of urination disorders. The respondents answered questions of a specially developed 140-item questionnaire. All demographic and medical information was taken into account, including concomitant diseases and ongoing therapy. The patients filled out the IIEF, I-PSS, QoL, and AMS (Aging Male Screening) questionnaires. Analysis the I-PSS scores showed that symptoms of the emptying phase predominated over the symptoms of the filling phase in all age groups. The most frequent complaints were "frequent urination" and "weak urine stream". Forty and 30% of respondents had moderate and severe LUTS, respectively. The remaining 30% of men had mild LUTS. Prostate volume was significantly greater than that reported in similar studies conducted in Asia, Europe and North America (mean 55.27 cm3). The level of total prostate-specific antigen (PSA) was known in 98.8% of patients over the age of 50 and averaged 3.87+/-4.41 ng/ml. The mean age at the first testing for total PSA in Moscow is 56.7+/-9.0 years. This study is the first epidemiological study of this scale and focus. Its findings can be used to compose a "portrait" of a standard patient and identify patterns that limit the extrapolation of international epidemiological studies to the population of Russian patients. It seems necessary to develop an updated LUTS management strategy, taking into account the identified national characteristics.

Questions to ask a patient with nocturia.

Patients may not raise nocturia as a concern as they mistakenly consider the symptom to be a normal part of ageing. Nocturia is associated with significant morbidity and is likely to be a marker of poor health. This paper provides questions to guide diagnosis, evaluation and individualised treatment of nocturia. Nocturia results from the interplay between nocturnal polyuria,reduced bladder storage and sleep disruption. Changes in the function of the urinary bladder, kidneys, brain and cardiovascular system, and hormone status underlie the development and progression of nocturia. Medications commonly prescribed to older people can affect development or resolution of nocturia. The bother caused to a patient by waking to void relates to disturbance of slow-wave sleep, the physical act of getting out of bed and resulting chronic fatigue. An assessment process that identifies relevant and co-existing causes of an individual's nocturia will facilitate a targeted approach to treatment.

Aquaporin-2 plays an important role in water transportation through the bladder wall in rats.

We investigated the role of the bladder wall in permeating water, focusing on aquaporins. Female Sprague-Dawley rats weighing 300 g were used to investigate the role of the bladder wall in saline permeation. Changes in intravesical fluid volume and sodium concentration were measured in the desmopressin acetate hydrate-loaded and control groups 3 h after administration. Bladders were resected to measure aquaporin-1, 2, and 3 gene expression using qRT-PCR. Additionally, the change of aquaporin-2 expression was measured using Western blotting and immunohistochemistry in intravesical aquaporin-2 siRNA-treated and control groups. Although the intravesical fluid volume and sodium concentration significantly decreased from 0 to 3 h (1.00 ± 0.00 vs 0.83 ± 0.08 mL, 157.80 ± 1.30 vs 146.8 ± 1.92 mEq/mL, P < 0.01, respectively in the control group), administration of desmopressin did not affect the extent of volume change. Aquaporin-2 expression was significantly higher in the 3-h distended bladders than in the empty bladder. Aquaporin-2 siRNA treatment suppressed aquaporin-2 expression and the change of intravesical fluid volume from 0 to 3 h (1.00 ± 0.00 and 0.99 ± 0.02 mL), which was related to the suppression of sodium concentration change in comparison with control siRNA treatment (149.6 ± 2.4 vs 143.6 ± 3.67 mEq/mL, P < 0.05). The rat urinary bladder absorbs water and salts under the full-filled condition. Aquaporin-2 plays an important role in the transport of water, accompanied by sodium concentration change. We demonstrated a part of the bladder absorption mechanism, which may lead to development of a new method for regulating bladder storage function.

MP31-04 TAMSULOSIN, OXYBUTYNIN, OR THEIR COMBINATION IN THE TREATMENT OF URETERAL STENT-RELATED SYMPTOMS

You have accessJournal of UrologyStone Disease: Medical & Dietary Therapy II1 Apr 2018MP31-04 TAMSULOSIN, OXYBUTYNIN, OR THEIR COMBINATION IN THE TREATMENT OF URETERAL STENT-RELATED SYMPTOMS Efrain Maldonado-Alcaraz, Jorge Moreno-Palacios, Virgilio Augusto Lopez-Samano, Leon Octavio Torres-Mercado, Jason Damian Landa-Salas, and Carlos Garcia-Cruz Efrain Maldonado-AlcarazEfrain Maldonado-Alcaraz More articles by this author , Jorge Moreno-PalaciosJorge Moreno-Palacios More articles by this author , Virgilio Augusto Lopez-SamanoVirgilio Augusto Lopez-Samano More articles by this author , Leon Octavio Torres-MercadoLeon Octavio Torres-Mercado More articles by this author , Jason Damian Landa-SalasJason Damian Landa-Salas More articles by this author , and Carlos Garcia-CruzCarlos Garcia-Cruz More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2018.02.1033AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES INTRODUCTION: The ureteral stent placement is a routinary urological procedure. The ureteral stent generate discomforts that impact on the quality of life (pain, bladder storage symptoms, work and sexual dysfunction) while the ureteral stent is inside the patient. In 2003 was created a ureteral stent symptom questionnaire that evaluates urinary symptoms, pain, general health, work performance, sexual performance and other problems. Pharmacological therapy is the main treatment to control these symptoms. Based on the physiology of theses symptoms, 2 groups of drugs have been used: anticholinergics and alpha-blockers.OBJECTIVE: Compare the efficacy of tamsulosin, oxybutynin or their combination for the treatment of symptoms related to double J stent (DJS). METHODS Randomized clinical non-blinded trial with three arms (tamsulosin, oxybutynin or combination) to assess the improvement of ureteral related symptoms with DJS with the questionnaire of Ureteral Stent Symptom Questionnaire (USSQ) and the adverse effects of treatment. Evaluations were made at 7 and 21 days after the placement of DJS. The maneuvers were compared using χ2, Kruskall-Wallis, ANOVA and Wilcoxon considering a statistically significant p <0.05. RESULTS 170 patients with CJJ were evaluated. A per-protocol analysis was performed in 142 patients, 53 received tamsulosin (37.4%), 42 oxybutynin (29.6%) and 47 the combination of both (33%). At 7 and 21 days the improvement was similar in all three arms. Using the groups as their own controls, there was improvement in the urinary domain score at 21 days with tamsulosin 29 (9-44) vs. 24 (14-39), p=0.003; oxybutynin 30.5 (18-50) vs. 27 (14-44) p=0.002 and combination 31 (13-56) vs. 23 (13-56), p=0.000.Men with tamsulosin and women with oxybutynin had less general symptoms CONCLUSIONS Tamsulosin, oxybutynin or its combination similarly improve ureteral stent related symptoms and this improvement becomes more noticeable over time. Men are less symptomatic with tamsulosin and women with oxybutyn. © 2018FiguresReferencesRelatedDetails Volume 199Issue 4SApril 2018Page: e412 Advertisement Copyright & Permissions© 2018MetricsAuthor Information Efrain Maldonado-Alcaraz More articles by this author Jorge Moreno-Palacios More articles by this author Virgilio Augusto Lopez-Samano More articles by this author Leon Octavio Torres-Mercado More articles by this author Jason Damian Landa-Salas More articles by this author Carlos Garcia-Cruz More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

MP79-14 NOCTURNAL POLYURIA AND NOCTURNAL BLOOD PRESSURE PATTERNS IN MALE PATIENTS WITH LOWER URINARY TRACT SYMPTOMS

You have accessJournal of UrologyUrodynamics/Lower Urinary Tract Dysfunction/Female Pelvic Medicine: Non-neurogenic Voiding Dysfunction II1 Apr 2018MP79-14 NOCTURNAL POLYURIA AND NOCTURNAL BLOOD PRESSURE PATTERNS IN MALE PATIENTS WITH LOWER URINARY TRACT SYMPTOMS Misato Takayama, So Omori, Daiki Ikarashi, Tomohiko Matsuura, Yoichiro Kato, Mitsugu Kanehira, Ryo Takata, Jun Sugimura, Takaya Abe, and Wataru Obara Misato TakayamaMisato Takayama More articles by this author , So OmoriSo Omori More articles by this author , Daiki IkarashiDaiki Ikarashi More articles by this author , Tomohiko MatsuuraTomohiko Matsuura More articles by this author , Yoichiro KatoYoichiro Kato More articles by this author , Mitsugu KanehiraMitsugu Kanehira More articles by this author , Ryo TakataRyo Takata More articles by this author , Jun SugimuraJun Sugimura More articles by this author , Takaya AbeTakaya Abe More articles by this author , and Wataru ObaraWataru Obara More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2018.02.2682AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Nocturia is the most prevalent symptom of lower urinary tract symptoms (LUTS). The causes of nocturia include bladder storage disorders, nocturnal polyuria, and sleep disorders. Nocturnal polyuria is the largest contributor among these factors. We investigate the prevalence of nocturnal polyuria, their underlying factors, and the patterns of blood pressure variation in patients undergoing treatment for LUTS. METHODS This study was conducted from April 2015 to July 2017.Voided volume, voiding frequency and nocturnal polyuria index were determined using voiding diaries of 242 male patients (65–92years old) undergoing treatment for LUTS, whereas underlying factors were assessed using medical histories and medications. Among 242 patients, 34 (17 each in the nocturnal and non-nocturnal polyuria groups) underwent 24h ambulatory blood pressure monitoring. Measurements and assessments were performed using the portable automatic blood pressure monitor TM-2433 (A&D Company Ltd.) according to the guidelines for the clinical use of 24h ABPM (JCS 2010). Patients whose mean nocturnal blood pressure was lower than diurnal blood pressure by ≥10% and <10% were categorized as dippers, and non-dippers. Moreover, patients whose mean nocturnal blood pressure was higher than their mean diurnal blood pressure were categorized as risers. RESULTS Nocturia and nocturnal polyuria were observed in 194 (81%) and 136 (56.2%) patients, respectively.Among patients with nocturia, 130 patients (67.0%) had nocturnal polyuria, the rate of which increased with increased nocturnal voiding frequency.Significantly higher usage rates of two or more anti-hypertensives (including combinations) were observed in the nocturnal polyuria group than in the non-nocturnal polyuria group (p = 0.0351). Analysis of 24-h blood pressure variation showed that significantly higher non-decreased nocturnal blood pressures (i.e., non-dippers and risers) were observed in the nocturnal polyuria group than in the non-nocturnal polyuria group (p = 0.0365)(Fig1). CONCLUSIONS The nocturnal polyuria group had significantly higher proportions of patients who did not exhibit lowered nocturnal blood pressure, indicating the potential therapeutic value of interventions that lower nocturnal blood pressure to improve nocturnal polyuria. © 2018FiguresReferencesRelatedDetails Volume 199Issue 4SApril 2018Page: e1086 Advertisement Copyright & Permissions© 2018MetricsAuthor Information Misato Takayama More articles by this author So Omori More articles by this author Daiki Ikarashi More articles by this author Tomohiko Matsuura More articles by this author Yoichiro Kato More articles by this author Mitsugu Kanehira More articles by this author Ryo Takata More articles by this author Jun Sugimura More articles by this author Takaya Abe More articles by this author Wataru Obara More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...