Changes In Bladder Compliance Research Articles

Urodynamic evaluation of patients with localized prostate cancer before and 4\xa0months after robotic radical prostatectomy

Radical prostatectomy can alter the anatomy of the urinary bladder. We aimed to evaluate bladder function before and 4 months after radical prostatectomy using the urodynamic test and overactive bladder (OAB) symptom score. Among 70 prospectively enrolled patients, 61 patients completed the study. In the urodynamic test, bladder capacity and compliance did not change, the frequency of involuntary detrusor contraction decreased, the maximum flow rate and bladder outlet obstruction index improved, and the maximum urethral closure pressure (MUCP) deteriorated. Further evaluation of urodynamic parameters according to changes in symptoms was made. Although change in bladder compliance was correlated with changes in OAB symptoms, not the relative change of bladder compliance but the relative change in the MUCP was reliable factor when OAB symptoms were deteriorated. In general, prostatectomy did not deteriorate the condition of the detrusor; rather, change in the MUCP could be responsible for postprostatectomy OAB.

Long-Term Efficacy of Mirabegron Add-On Therapy to Antimuscarinic Agents in Patients With Spinal Cord Injury.

ObjectiveTo evaluate the long-term efficacy of mirabegron add-on therapy in patients with spinal cord injury (SCI) based on an urodynamic study.MethodsThis retrospective study involved a chart audit of individuals with SCI who underwent two consecutive urodynamic studies between April 1, 2015 and April 1, 2018. After adding 50 mg of mirabegron once a day to the pre-existing antimuscarinic therapy for a period of, at least 6 months, the following variables were analyzed: change in cystometric capacity, change in bladder compliance, change in maximal detrusor pressure, change in reflex volume, and presence of significant leakage during filling cystometry.ResultsA total of 31 participants with a mean age of 41±15 years were included in the analysis. A significant increase in cystometric capacity (mean, 362 to 424 mL; p=0.03), reflex volume (mean, 251 to 329 mL; p=0.02), and bladder compliance (median, 12 to 18 mL/cmH2O; p=0.04) was observed. The presence of leakage during filling cystometry was significantly reduced (29% to 10%; p=0.03). Likewise, a non-significant decrease in the change in maximal detrusor pressure was observed (mean, 31 to 27 cmH2O; p=0.39).ConclusionAdding mirabegron to conventional antimuscarinics further improved urodynamic parameters in patients with chronic SCI, and sustained efficacy was observed in long-term use.

Urodynamic characteristics of lower urinary tract of patients with idiopathic overactive bladder.

Aims:The aims of this study were to determine the frequency and clinical significance of individual urodynamic signs, which revealed on the basis of the results of comprehensive urodynamic examination of patients with the idiopathic overactive bladder (IOAB), to produce definitions of these features, and to describe any necessary remedial action.Materials and Methods:To identify the most common features and artifacts, we conducted a combined urodynamic examination of 137 patients with IOAB (105 women and 32 men). Age, comorbidities, and urodynamic parameters were analyzed to determine the association between bladder sensation and contractility.Results:It was found that most patients suffer from the same type of bladder function impairment, often related to the decrease in the average effective capacity of the bladder, frequent urination, urgency urination, and urgent urinary incontinence events. Imperative nature of urination in patients with IOAB leads to the reduction maximum cystometric capacity in 75.9% of patients, increased bladder sensitivity threshold in 70.8%, detrusor overactivity in 35.8%, change in bladder compliance in 43.1%, and urethral instability in 24.8% of patients.Conclusions:Decreased ability of the bladder to accumulate and hold the urine under the normal or low intravesical pressure and frequent association of bladder instability with signs of obstructive urination are major peculiarities of the impaired urodynamics of the lower urinary tract in patients with IOAB.

TRPV1 enhances the afferent response to P2X receptor activation in the mouse urinary bladder

Both TRPV1 and P2X receptors present on bladder sensory nerve fibres have been implicated in mechanosensation during bladder filling. The aim of this study was to determine possible interactions between these receptors in modulating afferent nerve activity. In wildtype (TRPV1+/+) and TRPV1 knockout (TRPV1−/−) mice, bladder afferent nerve activity, intravesical pressure, and luminal ATP and acetylcholine levels were determined and also intracellular calcium responses of dissociated pelvic DRG neurones and primary mouse urothelial cells (PMUCs). Bladder afferent nerve responses to the purinergic agonist αβMethylene-ATP were depressed in TRPV1−/− mice (p ≤ 0.001) and also in TRPV1+/+ mice treated with the TRPV1-antagonist capsazepine (10 µM; p ≤ 0.001). These effects were independent of changes in bladder compliance or contractility. Responses of DRG neuron to αβMethylene-ATP (30 µM) were unchanged in the TRPV1−/− mice, but the proportion of responsive neurones was reduced (p ≤ 0.01). Although the TRPV1 agonist capsaicin (1 µM) did not evoke intracellular responses in PMUCs from TRPV1+/+ mice, luminal ATP levels were reduced in the TRPV1−/− mice (p ≤ 0.001) compared to wildtype. TRPV1 modulates P2X mediated afferent responses and provides a mechanistic basis for the decrease in sensory symptoms observed following resiniferatoxin and capsaicin treatment for lower urinary tract symptoms.

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

ObjectiveTo investigate phasic changes during filling cystometry that most accurately represent detrusor properties, regardless of other factors affecting detrusor contractility.MethodsSeventy-eight patients (59 males, 19 females; mean age, 48.2 years) with spinal cord injuries were enrolled. Urodynamic studies were performed using a normal saline filling rate of 24 mL/min. We calculated bladder compliance values of the detrusor muscle in each of three filling phase intervals, which divided the filling cystometrogram into three phases referable to the cystometric capacity or maximum cystometric capacity. The three phases were sequentially delineated by reference to the pressure-volume curve reflecting bladder filling.ResultsBladder compliance during the first and second phases of filling cystometry was significantly correlated with overall bladder compliance in overactive detrusors. The highest coefficient of determination (r2=0.329) was obtained during the first phase of the pressure-volume curve. Bladder compliance during all three phases was significantly correlated with overall bladder compliance of filling cystometry in underactive detrusors. However, the coefficient of determination was greatest (r2=0.529) during the first phase of filling cystometry.ConclusionPhasic bladder compliance during the early filling phase (first filling phase) was the most representative assessment of overall bladder compliance during filling cystometry. Careful determination of early phase filling is important when seeking to acquire reliable urodynamic data on neurogenic bladders.

Autologous Cell Seeded Biodegradable Scaffold for Augmentation Cystoplasty: Phase II Study in Children and Adolescents with Spina Bifida

Augmentation cystoplasty using gastrointestinal segments in children/adolescents with medically refractory neurogenic bladder is associated with significant complications. We evaluated an autologous cell seeded biodegradable scaffold (Tengion®) for bladder augmentation as an alternative to traditional enterocystoplasty in this population. A phase II prospective study was performed in children with neurogenic bladder due to spina bifida requiring enterocystoplasty for detrusor pressure 40 cm H2O or greater despite maximum antimuscarinic medication. Following open bladder biopsy, urothelial and smooth muscle cells were grown ex vivo and seeded onto a biodegradable scaffold to form a regenerative augment as the foundation for bladder tissue regeneration. Bladder neck sling was the only concomitant surgical procedure permitted. Bladders were cycled postoperatively to promote regeneration. Primary and secondary outcomes at 12 months included change in bladder compliance, bladder capacity and safety. Long-term assessment was done with similar outcomes at 36 months. Compliance improved in 4 patients at 12 months and in 5 patients at 36 months, although the difference was not clinically or statistically significant. There was no clinical or statistical improvement in bladder capacity at 12 or 36 months in any patient. Adverse events occurred in all patients, and most were easily treated. Two patients had low cell growth following bladder biopsy, of whom 1 withdrew from the study and 1 underwent a second biopsy. Serious adverse events of bowel obstruction and/or bladder rupture occurred in 4 patients. Our autologous cell seeded biodegradable scaffold did not improve bladder compliance or capacity, and our serious adverse events surpassed an acceptable safety standard.

818 NOCTURNAL BLADDER EMPTYING: IT PROTECTS NOT ONLY THE UPPER TRACTS OF PATIENTS WITH HIGH PRESSURE BLADDERS, BUT ALSO IMPROVES BLADDER DYNAMICS AS WELL

You have accessJournal of UrologyPediatrics: Bladder Dysfunction - Myelodysplasia, Voiding Dysfunction, Enuresis1 Apr 2011818 NOCTURNAL BLADDER EMPTYING: IT PROTECTS NOT ONLY THE UPPER TRACTS OF PATIENTS WITH HIGH PRESSURE BLADDERS, BUT ALSO IMPROVES BLADDER DYNAMICS AS WELL Shannon N. Nees, Andrew J. Combs, and Kenneth I. Glassberg Shannon N. NeesShannon N. Nees New York, NY More articles by this author , Andrew J. CombsAndrew J. Combs New York, NY More articles by this author , and Kenneth I. GlassbergKenneth I. Glassberg New York, NY More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2011.02.637AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Since first reported by Koff et al in 2002, nocturnal bladder emptying (NBE) has been increasingly recognized as beneficial in protecting the upper tracts of patients with high urine output and defective, poorly compliant bladders. While subsequent reports have documented improvement in renal function and hydronephrosis in these patients, none has documented what urodynamic changes, if any, occur in these bladders as a result of NBE. We report our experience with changes in urodynamic parameters following the addition of NBE to the patient's treatment regimen. METHODS All 15 patients treated with NBE because of persistent abnormal storage pressures despite maximum dose anticholinergic therapy were prospectively assessed urodynamically just prior to and while on NBE. Changes in VUR and hydronephrosis were also assessed. RESULTS Patient demographics and changes in bladder compliance, detrusor storage pressures and detrusor overactivity are reported in Table 1. Bladder compliance improved significantly in 12 (80%), including normalization in 8 (53%); those with HS and PUV had the greatest improvement in compliance on NBE. Detrusor overactivity resolved in 4/7 (57%). Bladder capacity was initially low (<75% expected) in 6 and high (>125%) in 5. On NBE, 9/11 (82%) had normalization of capacity. In patients with available follow up imaging, hydronephrosis improved or resolved in 44%; 2 patients with grades 4 and 5 VUR both decreased to grade 1. When NBE was discontinued by 1 patient he reverted from normal back to severe loss of compliance. CONCLUSIONS Overnight catheter drainage of the bladder not only serves to protect and improve the upper tracts as previously reported but has a direct, beneficial effect on bladder function as well. Patients with impaired detrusor compliance should not be categorized as refractory to non-surgical therapy and in need of bladder augmentation without first having NBE added to their treatment regimen as it has been our experience that the vast majority of patients show dramatic urodynamic improvement on NBE irrespective of the underlying pathology. What is not clear is how long these patients will need to be on NBE nor the long term implications of such management. © 2011 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 185Issue 4SApril 2011Page: e329 Peer Review Report Advertisement Copyright & Permissions© 2011 by American Urological Association Education and Research, Inc.MetricsAuthor Information Shannon N. Nees New York, NY More articles by this author Andrew J. Combs New York, NY More articles by this author Kenneth I. Glassberg New York, NY More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Intravesical Oxybutynin for Children With Poorly Compliant Neurogenic Bladder: A Systematic Review

Children with neurogenic bladder and poor bladder compliance are usually treated with bladder catheterization and oral anticholinergic medication. They may become nonresponders to the drug or present with severe side effects. We evaluated the effectiveness and tolerability of intravesical oxybutynin in children with poorly compliant neurogenic bladder. We conducted a search of MEDLINE, EMBASE, CINAHL, SciELO, dissertations/theses in ProQuest, LILACS, the Cochrane Library, protocol registries and the gray literature. Two reviewers independently assessed study quality and extracted data. Eight studies (2 prospective, 6 retrospective) assessed the effectiveness and side effects of intravesical oxybutynin in children with neurogenic bladder. A total of 297 children started treatment, of whom 22% (66 patients) discontinued therapy, with 9% (28) quitting due to systemic side effects. Mean change in bladder compliance (primary outcome) was reported in only 2 studies (+7.4 and +7.5 ml/cm H(2)O). The pooled mean change in pressure at maximum bladder capacity was -16.4 cm H(2)O (95% CI -22.8 to -10.0). Incontinence improved significantly in most studies, with "dry and improved" rates ranging from 61% to 83%. The funnel plot of pressure at maximum bladder capacity suggested no publication bias. Adjunctive intravesical oxybutynin therapy increased mean maximum bladder capacity and decreased bladder pressure in children with neurogenic bladder. However, identified studies offered a low level of evidence, with most being poorly reported retrospective case series with potential biases. Although the incidence of side effects was lower with the intravesical route, side effects are still possible and should be discussed with patients and families. The evidence available is insufficient to recommend this therapy. Research of more sound study design such as a randomized controlled trial should be conducted to assess the efficacy and side effects of intravesical oxybutynin in children.

Serotonergic and noradrenergic facilitation of the visceromotor reflex evoked by urinary bladder distension in rats with inflamed bladders

Bladder inflammation resulting from intravesical administration of zymosan significantly enhances the visceromotor reflex (VMR) evoked by urinary bladder distension (UBD). The present study examined whether intrathecal (i.t.) administration of receptor antagonists to either norepinephrine (NE) or serotonin (5-HT) altered this enhancement effect. I.t. administration of the non-specific 5-HT receptor antagonist methysergide (30 microg), the 5-HT(3) receptor antagonist ondansetron, or the 5-HT(1A) receptor antagonist WAY 100635 eliminated the enhancement effect produced by intravesical zymosan and also tended to reduce electromyographic (EMG) responses to UBD in non-inflamed rats. I.t. administration of either the non-specific NE receptor antagonist phentolamine (30 microg) or the alpha(1) antagonist WB 4101 also eliminated the enhancement effect, whereas i.t. administration of the alpha(2) antagonist yohimbine failed to significantly affect the enhancement effect. The effects of phentolamine and methysergide were not mediated by changes in bladder compliance. This is the first study to demonstrate that bladder hypersensitivity resulting from bladder inflammation is partly mediated by 5-HT and NE facilitatory effects. Based on these and previous findings we conclude that the net nociceptive response to bladder distension under conditions of bladder inflammation represents a complex interaction of facilitatory influences of spinal 5-HT and NE, and inhibitory influences of spinal opioids.

Bladder afferent sensitivity in wild‐type and TRPV1 knockout mice

Understanding bladder afferent pathways may reveal novel targets for therapy of lower urinary tract disorders such as overactive bladder syndrome and cystitis. Several potential candidate molecules have been postulated as playing a significant role in bladder function. One such candidate is the transient receptor potential vanilloid 1 (TRPV1) ion channel. Mice lacking the TRPV1 channel have altered micturition thresholds suggesting that TRPV1 channels may play a role in the detection of bladder filling. The aim of this study was therefore to investigate the role of TRPV1 receptors in controlling bladder afferent sensitivity in the mouse using pharmacological receptor blockade and genetic deletion of the channel. Multiunit afferent activity was recorded in vitro from bladder afferents taken from wild-type (TRPV+/+) mice and knockout (TRPV1-/-) mice. In wild-type preparations, ramp distension of the bladder to a maximal pressure of 40 mmHg produced a graded increase in afferent activity. Bath application of the TRPV1 antagonist capsazepine (10 mum) caused a significant attenuation of afferent discharge in TRPV1+/+ mice. Afferent responses to distension were significantly attenuated in TRPV1-/- mice in which sensitivity to intravesical hydrochloric acid (50 mm) and capsaicin (10 microm) were also blunted. Altered mechanosensitivity occurred in the absence of any changes in the pressure-volume relationship during filling indicating that this was not secondary to a change in bladder compliance. Single-unit analysis was used to classify individual afferents into low-threshold and high-threshold fibres. Low threshold afferent responses were attenuated in TRPV1-/- mice compared to the TRPV1+/+ littermates while surprisingly high threshold afferent sensitivity was unchanged. While TRPV1 channels are not considered to be mechanically gated, the present study demonstrates a clear role for TRPV1 in the excitability of particularly low threshold bladder afferents. This suggests that TRPV1 may play an important role in normal bladder function.

Radiotelemetered urodynamics of obstructed ovine fetal bladders: correlations with ex vivo cystometry and renal histopathology

To test the hypothesis that fetal bladder outlet obstruction (BOO) in sheep causes abnormal urodynamics correlating with the initiation of renal pathology, as most boys with posterior urethral valves (PUV) have bladder dysfunction when assessed after birth. Male ovine fetuses at 94 days of gestation were assigned to BOO (four) or sham control (five) groups. In BOO fetuses, radiotelemetry catheters were inserted transurachally and intraperitoneally, and the urethra was partly occluded. In two sham controls catheters were inserted directly through the bladder wall; the remaining three had sham surgery only. Radiotelemetered cystometry was recorded daily where possible. At the end of the experiment (9 days), ex vivo cystometry, bladder contractility studies and renal tract histology were assessed. Ultrasonography showed dilated renal tracts only in BOO fetuses; three of four BOO fetuses had renal cortical cysts. The control fetuses with bladder catheters died in utero, so urodynamics were recorded only in fetuses with BOO. The baseline filling/storage detrusor pressures increased slightly (by a mean of 5 mmHg) during the first 4 days of BOO, thereafter returning to those at the outset. There were marked changes in the patterns of bladder activity from 1 to 9 days. The frequency and duration of 'voiding' increased; as such the higher sustained pressures of emptying activity were progressively extended and the periods of low pressure filling/storage accordingly shortened. The patterns among individual fetuses with BOO were not substantially different, except that the one with the non-cystic kidneys had a more moderate frequency and duration of voiding. Ex vivo compliance and contractility showed no consistent differences in detrusor compliance or contractility between BOO and sham bladders. In this fetal model of PUV, there was a progressive increase in the duration and frequency of sustained elevated 'voiding' pressures, with no change in bladder compliance. Fetal kidneys were sensitive to these altered dynamics, with the formation of cortical cysts by 9 days after initiating BOO.

Persistence of therapeutic effect after repeated injections of botulinum toxin type A to treat incontinence due to neurogenic detrusor overactivity

Objectives To study the effect of repeated botulinum toxin type A injections into the detrusor in patients with neurogenic detrusor overactivity and incontinence to determine the safety of repeated injections, the persistence of the clinical and urodynamic treatment efficacy, and potential changes in bladder compliance. Methods Seventeen patients with neurogenic detrusor overactivity who had received three or more botulinum toxin type A injections into the detrusor were studied. The clinical and urodynamic data were analyzed at baseline (before the first injection), after the first injection, and after the last repeated injection. Results No systemic side effects were observed for the total of 91 injections. The mean number of injections per patient was 5.4 (range 3 to 9). The mean number of incontinence episodes per day decreased from 2.6 at baseline to 0 after the first injection, and remained at 0 after the last injection. The maximal cystometric bladder capacity and reflex volume increased significantly after the first and last injection compared with at baseline. The maximal detrusor pressure decreased significantly after the first and last injection compared with at baseline. No difference in compliance was found from baseline to the first or last injection. Conclusions Repeated injections of botulinum toxin A into the detrusor muscle are a safe and valuable treatment option for neurogenic detrusor overactivity. After repeated injections, the effect on the clinical and urodynamic parameters remained constant. Also, repeated injections did not decrease bladder compliance.

Botulinum Toxin for the Management of Bladder Dysfunction

This review highlights a recent innovation in the medical treatment of detrusor overactivity (DO). Anticholinergics are usually the gold standard to treat bladder overactivity. Adverse effects and lack of efficacy are the two main causes for considering alternative treatments. Until recently, invasive surgery (mainly bladder augmentation) was the only available treatment option for patients with intractable DO. This article considers botulinum toxin type A (BTX-A) injection as an alternative treatment to surgery in patients with DO who do not respond to anticholinergic therapy. To identify papers for inclusion in this review, we searched PubMed with the keywords 'botulinum toxin', 'overactive bladder', 'urinary incontinence' and 'neurogenic bladder' for the years 2000-5. Review articles were not included. Abstracts were cited only if they contained important new information. Experimental animal studies and articles or book chapters related to the use of botulinum toxin for other indications (such as achalasia and cervical dystonia) were analysed with regard to the mechanisms of action of botulinum toxin. From this review, it appears that BTX-A injection into the detrusor muscle is a very effective method for treating urinary incontinence secondary to neurogenic detrusor overactivity (NDO), as well as urinary incontinence due to idiopathic overactive bladder (IDO). In both conditions, the duration of effect seems to be at least 6 months. Overall success rates seem to be similar in both patient populations. For NDO, only one evidence-based medicine level 1 study is available, whereas for IDO, only evidence-based medicine level 3 or 4 studies have been published. Particularly in this latter indication, injection technique and outcome parameters vary from study to study and need to be standardised. Without randomised controlled studies aimed at comparing different techniques and dosages, it remains difficult to decide what technique is optimal for treating patients with IDO who are not willing to perform clean intermittent self-catheterisation (CISC). Therefore, studies that compare different dosages and techniques with the risk of needing CISC in regard to the duration of the effect are mandatory. As more studies of repeated injections have been published, it appears that, at least at medium follow-up, the toxin remains as effective as after the first injection, and there is no evidence of change in bladder compliance or detrusor fibrosis. However, long-term observational studies are necessary to assess these last points. Finally, the commonly reported dose appears to be well tolerated, since few adverse effects have been reported.

Effect of partial bladder outlet obstruction on detrusor compliance, excitability and contractility in rats

Partial bladder outlet obstruction (PBOO) is believed to change the functions of the detrusor, and can lead to an overactive detrusor (OD). The aim of this study was to investigate changes in bladder compliance, excitability and contractility after PBOO in rats. PBOO was performed for 6 weeks in 20 Wistar rats, 13 of which (OD group) had an OD and seven of which (non-OD group) did not. Simultaneously, 10 rats that underwent sham operations (control group) were also studied. Bladder compliance and cystometric capacity were identified in vivo, but bladder compliance was detected without elimination of bladder capacity. Isolated bladder smooth muscle strip (BSMS) was dissected to determine excitability and contractility. After 6 weeks of PBOO, cystometric capacity and compliance were significantly higher than those in the control group. Compliance was 0.170+/-0.029 and 0.149+/-0.042 ml/cmH2O in the OD and non-OD groups, respectively, compared to 0.037+/-0.017 ml/cmH2O in the control group. The corresponding cystometric capacities were 3.66+/-0.490, 3.08+/-0.590 and 1.14+/-0.225 ml. The excitability in the OD group increased significantly compared to that in the non-OD and control groups. The tension threshold for BSMS contraction was lower in the OD group, and BSMS contracted more frequently at the same tension. The contractility of the BSMS in the OD group decreased significantly compared to that in the non-OD and control groups. PBOO can cause a higher cystometric capacity and compliance. After PBOO, there is a chance that an OD may develop. When this occurs, the detrusor excitability increases and contractility decreases.

Urodynamic changes at 18 months post-therapy in patients treated with external beam radiotherapy for prostate carcinoma

Purpose: To quantify the effect of radiotherapy (RT) on urodynamics at 18 months post-therapy, using urodynamic study, in prostate cancer patients undergoing definitive external beam RT.Methods and Materials: A total of 17 patients with clinically localized prostate cancer were accrued into a single-arm prospective study. Fifteen of 17 patients completed scheduled multichannel video-urodynamic study at baseline as well as 3 and 18 months after RT. Baseline quantitative urodynamic parameters were compared with those at 18 months post-RT to assess the nature and extent of urodynamic change brought about by RT. These quantitative changes were further correlated to the change in self-assessed qualitative urinary function measured by International Prostate Symptom Score (IPSS), Quality of Life assessment index (QoL), and urinary functional inquiry.Results: The statistically significant quantitative changes detected by the urodynamic study at 18 months post-RT were decrease in bladder capacity and bladder volume at first sensation in both the supine and upright position, and reduction in bladder volume at desire to void in the supine position. In our cohort, the mean reduction in bladder capacity was 100 mL in the supine position and 54 mL in the upright position. No statistically significant change was observed with regard to pressure, maximum flow rate, voided volume, or postvoid residual volume. Furthermore, there was no statistically significant change in bladder compliance, bladder instability, or bladder outlet obstruction. No statistically significant change in self-assessed qualitative urological function was observed between baseline and 18 months post-RT, measured by the 3 parameters (IPSS, QoL, and urinary frequency over 24 h).Conclusions: This is the first quantitative study that prospectively evaluated the effect of RT on urodynamics in prostate cancer patients receiving definitive RT. The statistically significant changes at 18 months post-RT were reduction in bladder capacity, reduction in bladder volume at first sensation, and decrease in bladder volume at desire to void. Despite the decrease in these parameters, there was no statistically significant adverse effect of RT on bladder compliance, bladder stability, or bladder outlet flow. This observation corresponded well with no significant change in IPSS, QoL, or urinary frequency over 24 h. Furthermore, these results confirm the notion that most prostate cancer patients generally tolerate RT very well.

Effect of spinal versus general anesthesia on bladder compliance and intraabdominal pressure during transurethral procedures

Study Objective: To evaluate the influence of spinal versus general anesthesia on bladder compliance and intraabdominal pressure in elderly males undergoing elective transurethral resection of the prostate. Design: Prospective, randomized, open-label study. Setting: Teaching hospital. Patients: 21 ASA physical status I, II, and III patients at least 18 years of age, undergoing transurethral surgery. Interventions: According to a computer-generated randomization schedule, patients were allocated to one of two groups. In Group Spinal (S), 10 mg of hyperbaric tetracaine was administered intrathecally. In Group General Anesthesia (GA), patients received fentanyl intravenous (IV) 1 to 2 μg/kg and propofol IV 1.0 to 2.0 mg/kg for induction of anesthesia. Thereafter, a laryngeal mask airway was inserted and, with spontaneous ventilation, anesthesia was maintained by administering isoflurane (end-tidal 0.7% to 1.2%) and 70% nitrous oxide (N 2O) in oxygen. Intraabdominal pressure and bladder compliance were recorded prior to the induction of anesthesia and immediately before the onset of the surgical procedure. Measurements and Main Results: The two groups were demographically comparable. In Group S, mean bladder compliance was significantly (p = 0.003) higher and mean intraabdominal pressure significantly lower (p = 0.007) when compared to baseline preanesthetic values. In Group GA, mean intraabdominal pressure significantly (p = 0.006) decreased when compared to baseline preanesthetic recordings. Following the induction of general anesthesia, a small change in bladder compliance was noted. However, statistical significance was not reached. Data were analyzed and compared using Student’s t-test (p < 0.05 was considered statistically significant). Conclusion: Both spinal and general anesthesia induced a significant decrease in intraabdominal pressure. While both techniques were associated with an increase in bladder compliance, statistical significance was demonstrated only in the spinal anesthesia treatment group.

Feasibility of urodynamic study (combined cystometry and electromyography of the external urethral sphincter) under general anesthesia in children.

To assess the feasibility of urodynamic study under general anesthesia (GA) we performed electromyography of the external urethral sphincter (EUS-EMG) on 73 children and cystometry (CM) alone on 10 children. Subjects were divided into 3 groups. Those in groups I and II were suspected of having voiding dysfunction with (group I) or without (group II) overt neurospinal defects, while those in group III were thought to be functionally normal. EUS-EMG was performed under light anesthesia following cystourethroscopy to examine structural abnormalities. Atropine sulfate premedication was not used for the anesthetic procedure; muscle relaxants were used only for tracheal intubation. Voiding was observed in 83% of the patients. Among patients who voided, detrusor-external sphincter dyssynergia (DSD) was noted in 7 (38%) group I patients and 6 (19%) group II patients; in group III, voiding was synergic in all patients. In 10 cases, CM alone was carried out both under anesthesia and in the waking state; anesthesia suppressed detrusor hyperreflexia (DH) in all 9 patients but produced no change in bladder compliance. In children with urinary disorders, urodynamic study under GA following cystourethroscopy is a feasible method for assessing EUS function and documenting DSD; DH is not evaluable, however. Stratifying urinary management on the basis of these examinations resulted in satisfactory clinical outcomes.

Bladder Compliance in Myelodysplastic Children: Effect of Anti‐reflux Surgery and Conservative Treatment

Little is known about changes in bladder compliance and bladder capacity in myelodysplastic patients following anti-reflux surgery. A study group of 70 patients was divided as follows: group A included 20 myelodysplastic patients who had been operated on for reflux and whose subsequent treatment was conservative. Group B comprised 31 myelodysplastic patients who had been treated conservatively; a third group of 19 non-myelodysplastic patients, treated by anti-reflux surgery because of primary reflux, formed the control group. The follow-up period for group A averaged 61 months (extending from a urodynamic study 3 months after surgery to the most recent test). In group B the mean follow-up period between the initial test and the latest test was 86 months. Bladder compliance in group A patients did not increase significantly (from 5.5 to 6.9), but patients in group B did show a significant increase (from 5.9 to 10.7). Compliance in the 19 non-myelodysplastic patients decreased only marginally 6 months after surgery (from 29.6 to 26.3). Changes in bladder capacity showed a similar trend. In their most recent test, however, the bladder capacity of group A patients increased to the same volume as that of group B. A high correlation between radiological bladder deformity and bladder compliance was found. We propose a bladder compliance of 10.0 as the lower limit for myelodysplastic patients' preferred range. It was concluded that anti-reflux operations prevent any improvement in bladder compliance (but not in bladder capacity) compared with conservative treatment.