Urodynamic Changes Research Articles

Urodynamic outcome of parasacral transcutaneous electrical neural stimulation for overactive bladder in children.

ABSTRACTObjective:To evaluate the urodynamic changes immediately after the first session (acute effect) and after the last session of parasacral TENS in children with idiopathic OAB.Materials and methods:We performed urodynamic evaluation immediately before and after the first session of parasacral TENS and immediately after the last session (7 weeks later). Only children with idiopathic isolated OAB were included. Patients with dysfunctional voiding were not included.Results:18 children (4 boys and 14 girls, mean age of 8.7) were included in the first analysis (urodynamic study before and immediately after the first session) and 12 agreed to undergo the third urodynamic study. Urodynamic before and immediately after the first session: There was no change in the urodynamic parameters, namely low MCC, low bladder compliance, presence of IDC, the average number of IDC, or in the maximum detrusor pressure after the first exam. Urodynamic after the last session: The bladder capacity improved in most patients with low capacity (58% vs. 8%). Detrusor overactivity was observed in 11 (92%) before treatment and 8 (76%) after. There was not a significant reduction in the average number of inhibited contractions after TENS (p=0.560) or in the detrusor pressure during the inhibited contraction (p=0.205).Conclusion:There was no change in the urodynamic parameters immediately after the first session of stimulation. After the last session, the only urodynamic finding that showed improvement was bladder capacity.

Long-Term Outcomes of Bladder Neck Reconstruction without Augmentation Cystoplasty in Children

Bladder outlet procedures without augmentation cystoplasty remain controversial. We hypothesized that bladder outlet procedures without augmentation cystoplasty may lead to unfavorable bladder dynamics, upper tract changes and/or continued incontinence. We reviewed long-term urodynamic, upper tract and continence outcomes following bladder outlet procedures without augmentation cystoplasty. We retrospectively reviewed all patients who underwent bladder neck reconstruction/closure/sling without augmentation cystoplasty between 2000 and 2014. Because of variation in length of followup, we calculated the cumulative incidence and proportion of cases of upper tract and urodynamic changes, augmentation cystoplasty and subsequent continence procedures. Preoperative factors were compared between patients with and without adverse outcomes. A total of 109 patients underwent bladder outlet procedures without augmentation cystoplasty at a mean age of 8.5 years. At a mean of 4.9 years of followup 59 patients (54%) had undergone additional continence surgery, 20 (18%) had undergone augmentation cystoplasty, 50 (46%) manifested vesicoureteral reflux or hydronephrosis and 23 (21%) had newly diagnosed or worsening renal scarring. At augmentation cystoplasty 13 of 18 patients (72%) had upper tract changes, 15 (83%) had continued incontinence and 11 (61%) had an end fill pressure of greater than 40 cm H2O. All patients had resolution of these changes after augmentation cystoplasty. Patients who had previously undergone vesicostomy or surgery for vesicoureteral reflux were significantly more likely to undergo a subsequent augmentation cystoplasty or to show upper tract changes. Following bladder outlet procedures without augmentation cystoplasty the estimated 10-year cumulative incidence of augmentation cystoplasty is 30%, continence procedures 70%, upper tract changes greater than 50% and chronic kidney disease 20%. Because of these risks, careful patient selection and close followup are essential if considering a bladder outlet procedure without augmentation cystoplasty.

Changes in urodynamic measurements and bladder neck position after single-incision trans-vaginal mesh for pelvic organ prolapse.

Stress urinary incontinence (SUI) is common in patients with pelvic organ prolapse. This study hypothesized that SUI may be persistent, de novo, or even cured in women after Elevate™ mesh repair alone and that SUI is associated with urodynamic changes and bladder neck position. This secondary analysis included a study cohort of 100 women who underwent Elevate repair. All of them underwent multi-channel urodynamic measurements, 1-h pad test, and bead chain urethrocystography to measure the bladder neck position pre-operatively and at 3 months post-surgery. Fifty-five women with pelvic organ prolapse were continent and 45 had concomitant SUI. Of the 55 continent women, 19 (35%) had de novo SUI after mesh repair surgery and 5 (9%) subsequently underwent anti-incontinence surgery. Of the 45 incontinent women, 11 (24%) became dry after mesh repair without additional anti-incontinence surgery. Of the remaining 34 (76%) with persistent SUI, 15 (33%) underwent subsequent anti-incontinence surgery. Patients with de novo and persistent SUI had a greater decrease in maximal urethral closure pressure (MUCP) after mesh repair (p = 0.03 and 0.01 respectively). Those cured of SUI also had decreased MUCP (p = 0.12), but the bladder neck position while straining was significantly more elevated after mesh repair (p < 0.01) compared with those with persistent SUI. Elevate mesh reinforcement significantly decreases post-operative MUCP, which is associated with SUI, but can elevate the bladder neck position. Correcting a hyper-mobile urethra is associated with treatment of the concomitant SUI.

The role of urodynamic studies in the diagnosis and treatment of patients with spina bifida.

Aim:Spina bifida (SB) is a congenital deformity that is frequently seen in infancy. Surgical treatment and clinical follow-up of patients with the diagnosis of SB are important to provide education to the patients and their relatives, to increase patient survival, to ensure that they have a more comfortable life. Neuro-urological problems are highly important for the patients in terms of both social and medical.Materials and Methods:The medical records of patients who underwent surgery for SB and tethered cord syndrome at our clinic in the past year were retrospectively evaluated. The results of urodynamic studies of the patients were evaluated. The results of patients who underwent control urodynamic studies during the follow-up period were compared with the previous results, and their clinical courses were determined.Results:The most frequent urodynamic changes in patients were hyperactive detrusor activity and detrusor sphincter dyssynergy preoperatively.Conclusion:A significant improvement was observed when the results of postoperative urodynamic studies were evaluated in patients who underwent surgery for tethered cord.

MP19-16 HUMAN ADIPOSE TISSUE DERIVED STEM CELLS (HADSCS) PREVENTS FIBROSIS AND BLADDER DYSFUNCTION IN A RAT MODEL OF URETHRAL STRICTURE

You have accessJournal of UrologyStem Cell Research1 Apr 2015MP19-16 HUMAN ADIPOSE TISSUE DERIVED STEM CELLS (HADSCS) PREVENTS FIBROSIS AND BLADDER DYSFUNCTION IN A RAT MODEL OF URETHRAL STRICTURE Fabio Castiglione, Maarten Albersen, Andrea Russo, Trinity J. Bivalacqua, Francesco Montorsi, Steven Joniau, Dirk De Ridder, and Petter Hedlund Fabio CastiglioneFabio Castiglione More articles by this author , Maarten AlbersenMaarten Albersen More articles by this author , Andrea RussoAndrea Russo More articles by this author , Trinity J. BivalacquaTrinity J. Bivalacqua More articles by this author , Francesco MontorsiFrancesco Montorsi More articles by this author , Steven JoniauSteven Joniau More articles by this author , Dirk De RidderDirk De Ridder More articles by this author , and Petter HedlundPetter Hedlund More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2015.02.1008AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES The cure rate of urethrotomy for urethral stricture (US) is lower than 10%. Reduction of high recurrence rates would improve patient comfort and a decrease healthcare costs. We aimed to evaluate if local injection of hADSCs could prevent fibrosis in a rat model of iatrogenic US. METHODS After ethical approval, partial damage of the spongious urethra of male rats was created with a hypodermic needle. Then, TGFβ1 (1μg) was injected into the site of urethral damage. Rats were divided into 3 groups: vehicle (n=7), hADSCs (n=7), and sham (no damage; no TGFβ1, n=7). Vehicle (100μl) or hADSCs (1 million in 100μl) was injected to the site of urethral damage one day later. After 4 weeks, rats were implanted with bladder catheters and underwent awake cystometry. Following euthanasia, penises and bladders were harvested for histology and western blot analysis (WB). RESULTS Vehicle rats exhibited higher (p<0.05) threshold pressure (TP: 23.95 ± 3.4cmH2O), flow pressure (FP: 36.32 ± 2.89 cmH2O) and basal pressure (BP: 14.27 ± 2.39 cmH2O) compared to the hADSCs group (TP: 14.07 ± 1.44; FP: 26.05 ± 3.19; BP: 9.65 ± 0.89 cmH2O) and sham group. Vehicle rats showed lower (p<0.05) threshold compliance (TC: 0.064±0.025 ml/cmH2O) and flow compliance (FC: 0.022 ± 0.010 ml/cmH2O) than hADSCs (TC: 0.23±0.03; FC: 0.061 ± 0.09 ml/cmH2O) and sham group. No differences in these endpoints were detected between ADCS and Sham groups. Maximum micturition pressure was higher in vehicle and hADSCs groups than in the sham rats (p<0.05). By WB, collagen III expression was higher in penises of vehicle rats (2.25±0.25) than in sham (1.49±0.16) and hADSCs groups (1.13±0.27) (p<0.05). No differences were noted in elastin expression between the three groups (p>0.05). Collagen I was more expressed in vehicle and hADSCs groups compared to sham group (p<0.05). Interestingly, the eNOS expression was higher in hADSCs group compared to the other groups (p<0.05). The WB results were corroborated by immunofluorescence analysis. Bladder-to-body weight ratio was higher in vehicle group compared to hADSCs and sham group (p<0.05). By WB, vehicle bladders showed more collagen III than the others groups (p<0.05). No differences were detected in collagen I or elastin expressions between the groups. CONCLUSIONS Local injection of hADSCs seems to prevent fibrosis and counteract urodynamic changes in a male rat model for US. Additional studies are required to understand the role of eNOS in this process. © 2015 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 193Issue 4SApril 2015Page: e221 Advertisement Copyright & Permissions© 2015 by American Urological Association Education and Research, Inc.MetricsAuthor Information Fabio Castiglione More articles by this author Maarten Albersen More articles by this author Andrea Russo More articles by this author Trinity J. Bivalacqua More articles by this author Francesco Montorsi More articles by this author Steven Joniau More articles by this author Dirk De Ridder More articles by this author Petter Hedlund More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Urodynamic changes in mice with experimental autoimmune encephalomyelitis correlate with neurological impairment.

Neurogenic bladder dysfunction is a major issue in Multiple Sclerosis (MS). High intravesical pressure should be treated early. Available therapies are insufficient and there is need for drug development and investigation of pathogenesis. Experimental Autoimmune Encephalomyelitis (EAE) in rodents is a well validated model to study MS. Previous research has shown that these animals develop urinary symptoms. However, from clinical studies, we know that symptoms do not necessarily reflect changes in bladder pressure. This paper aims to provide a complete overview of urodynamic changes in a model for detrusor overactivity in MS. Female C57Bl/6J mice, injected with MOG35-55 and control mice, injected with vehicle (Complete Freund's adjuvant), were monitored daily for neurologic symptoms. Within 1 month after symptom development, mice were used for cystometry or histology of the bladder. Increasing disease score correlated with increased micturition frequency, basal pressure, and average pressure, and with a decrease in functional bladder capacity, voiding amplitude, and maximum pressure. This paper provides a detailed description of bladder function in C57Bl/6J mice with Myelin Oligodendrocyte Glycoprotein peptide (MOG35-55 ) induced EAE. This EAE model induces detrusor overactivity in close relationship to neurological impairment. EAE in mice is a suitable model to study detrusor overactivity in MS. Neurourol. Urodynam. 35:450-456, 2016. © 2015 Wiley Periodicals, Inc.

Evaluation of mouse urinary bladder smooth muscle for diurnal differences in contractile properties.

Most physiological systems show daily variations in functional output, entrained to the day–night cycle. Humans exhibit a daily rhythm in urinary voiding (micturition), and disruption of this rhythm (nocturia) has significant clinical impact. However, the underlying mechanisms are not well-understood. Recently, a circadian rhythm in micturition was demonstrated in rodents, correlated with functional changes in urodynamics, providing the opportunity to address this issue in an animal model. Smooth muscle cells from mouse bladder have been proposed to express a functional and autonomous circadian clock at the molecular level. In this study, we addressed whether a semi-intact preparation of mouse urinary bladder smooth muscle (UBSM) exhibited measurable differences in contractility between day and night. UBSM tissue strips were harvested at four time points over the diurnal cycle, and spontaneous (phasic) and nerve-evoked contractions were assessed using isometric tension recordings. During the active period (ZT12-24) when micturition frequency is higher in rodents, UBSM strips had no significant differences in maximal- (high K+) or nerve-evoked contractions compared to strips harvested from the resting period (ZT0-12). However, a diurnal rhythm in phasic contraction was observed, with higher amplitudes at ZT10. Consistent with the enhanced phasic amplitudes, expression of the BK K+ channel, a key suppressor of UBSM excitability, was lower at ZT8. Higher expression of BK at ZT20 was correlated with an enhanced effect of the BK antagonist paxilline (PAX) on phasic amplitude, but PAX had no significant time-of-day dependent effect on phasic frequency or nerve-evoked contractions. Overall, these results identify a diurnal difference for one contractile parameter of bladder muscle. Taken together, the results suggest that autonomous clocks in UBSM make only a limited contribution to the integrated control of diurnal micturition patterns.

Pathophysiology of lower urinary tract dysfunction in the older patient

Understanding the pathophysiology of lower urinary tract dysfunction in the elderly is necessary for the adequate management of lower urinary tract dysfunction, as aging causes anatomical and functional changes in the lower urinary tract. While epithelium atrophy of genitourinary organs and detrusor muscle changes occur in elderly women, due to estrogen decline, prostate enlargement may lead to bladder outlet obstruction and wall thickening in elderly men. Urodynamic changes that occur with aging include bladder outlet obstruction, detrusor overactivity and underactivity, decreased bladder compliance, and detrusor hyperactivity with impaired contractility. Moreover, impaired mobility, central nervous system diseases, non-genitourinary comorbidities, and various medications can also influence lower urinary tract function. Among these age-associated multifactorial conditions, adequate differentiation and management of the factors responsible for lower urinary tract dysfunction is of paramount importance in elderly patients.

The Effect of Untethering on Urologic Symptoms and Urodynamic Parameters in Children With Primary Tethered Cord Syndrome

To evaluate urinary system symptoms (USSs) and urodynamic parameters (UPs) before and after untethering in children with primary tethered cord syndrome (pTCS). USSs and UPs of patients undergoing untethering for pTCS during the period January 2008-July 2012 were evaluated preoperatively and at the postoperative third and 12th months. For analysis, patients were separated into 4 groups according to the presence of USSs: group 1, USSs preoperative positive and postoperative negative; group 2, USSs preoperative positive and postoperative positive; group 3, USSs preoperative negative and postoperative positive; group 4, USSs preoperative negative and postoperative negative. Preoperative and postoperative USSs and UPs were compared. Forty patients (average age, 7.2 years, follow-up of 2.8 years) were included. There were 13 patients in group 1, 11 in group 2, 3 in group 3, and 13 in group 4. All patients showed improvement when preoperative and postoperative USSs and UPs were compared. There was no correlation between USSs and UPs, both preoperatively and postoperatively. USSs and UPs at the postoperative third and 12th months were similar. Patients with no USS showed the most significant improvement in UP after untethering. Our study has demonstrated that untethering in patients with pTCS improves urologic symptoms and UPs. However, there is no correlation between improvement in symptoms and urodynamic findings. Urodynamic changes are similar at the postoperative third and 12th months. As the most significant improvement was seen in patients without USSs, it is important that these patients undergo urodynamic studies preoperatively and postoperatively.

Long-term urodynamic evaluation of laparoscopic radical cystectomy with orthotopic ileal neobladder for bladder cancer.

The long-term urodynamics of laparoscopic radical cystectomy with orthotopic ileal neobladder for bladder cancer remain unclear in the clinical setting. The present prospective observational study was conducted between January 2010 and December 2012 to evaluate the 6-month and 12-month follow-up data of urodynamic changes of bladder cancer patients who were initially treated by laparoscopic radical cystectomy with orthotopic ileal neobladder. A total of 53 eligible patients were included, and all patients were followed up for at least 12 months, with a median time of 18 months. During the follow-up period, no patients reported difficulty urinating, and the daily frequency of urination and the urine output were gradually improved with time. Dynamic urodynamic examinations showed that the maximum flow rate (11.4±1.1 vs. 7.3±1.4 ml/sec; P<0.001), residual urine content (22.8±10.5 vs. 40.7±12.7 ml; P<0.001), maximum bladder capacity (373.8±62.2 vs. 229.7±56.3 ml; P<0.001) and maximum bladder pressure during filling (35.8±6.7 vs. 26.4±7.0 cm H2O; P<0.001) at 12 months were all improved significantly compared with that at 6 months after the initial surgical treatment. However, there were no significant differences in maximum bladder pressure during voiding (75.7±24.7 vs. 73.1±24.7 cm H2O; P=0.618) and bladder compliance (26.9±13 vs. 27.4±13.1 cm H2O; P=0.848) at 12 and 6 months after initial surgical treatment. In conclusion, the urodynamics of this orthotopic ileal neobladder gradually improve, and its long-term urine storage and voiding functions are acceptable.

Bladder function in patients with dystonia undergoing deep brain stimulation.

Neurogenic bladder dysfunction is well described in Parkinson's disease and has a major impact on quality of live. In contrast, little is known about the extent of urinary symptoms in other movement disorders such as dystonia and about the role of the basal ganglia in bladder control.. A consecutive series of 11 patients with severe dystonia undergoing deep brain stimulation (DBS) of the globus pallidus internus was prospectively enrolled. Bladder function was assessed by the International Prostate Symptom Score and urodynamic investigation (UDI) before DBS surgery and afterwards in the conditions with and without DBS. In UDI before DBS surgery, detrusor overactivity was found in 36% (4/11) of dystonia patients. With pallidal DBS ON, maximum flow rate significantly decreased, post-void residual significantly increased and detrusor overactivity disappeared.. Pathological urodynamic changes can be found in a relevant percentage of dystonia patients. Pallidal DBS has a relaxing effect on detrusor function indicating a role of the basal ganglia in lower urinary tract control. Thus, a better understanding on how subcortical networks influence lower urinary tract function might open new therapeutic perspectives..

D-004 ameliorates phenylephrine-induced urodynamic changes and increased prostate and bladder oxidative stress in rats.

BackgroundLower urinary tract symptoms (LUTS) in patients with benign prostatic hyperplasia (BPH) mainly depend on alpha1-adrenoreceptors (α1-ADR) stimulation, but a link with oxidative stress (OS) is also involved. D-004, a lipid extract of Roystonea regia fruits, antagonizes ADR-induced responses and produces antioxidant effects. The objective of this study was to investigate whether D-004 produce antioxidant effects in rats with phenylephrine (PHE)-induced urodynamic changes.MethodsRats were randomized into eight groups (ten rats/group): a negative vehicle control and seven groups injected with PHE: a positive control, three treated with D-004 (200, 400 and 800 mg/kg) and three others with tamsulosin (0.4 mg/kg), grape seed extract (GSE) (250 mg/kg) and vitamin E (VE) (250 mg/kg), respectively.ResultsEffects on urinary total volume (UTV), volume voided per micturition (VM), malondialdehyde (MDA) and carbonyl groups (CG) concentrations in prostate and bladder homogenates were study outcomes. While VM and UTV lowered significantly in the positive control as compared to the negative control group, the opposite occurred with prostate and bladder MDA and CG values. D-004 (200-800 mg/kg) increased significantly both VM and UTV, lowered significantly MDA in prostate and bladder homogenates, and reduced GC levels only in the prostate. Tamsulosin increased significantly VM and UTV, but unchanged oxidative variables. GSE and VE unchanged the UTV, whereas VE, not GSE, modestly but significantly attenuated the PHE-induced decrease of VM.ConclusionsSingle oral administration of D-004 (200-800 mg/kg) was the only treatment that ameliorated the urodynamic changes and reduced increased oxidative variables in the prostate of rats with PHE-induced prostate hyperplasia.

Changes of urodynamics in female patients with diabetic cystopathy

Objective To evaluate the changes of urodynamics in female patients with diabetic cystopathy. Methods Fifty six female patients with diabetic cystopathy were enrolled in the study, including 31 cases with diabetic course <15 years (group Ⅰ) and 25 cases with diabetic course ≥15 years (group Ⅱ) . Urodynamic examination was performed in all patients and the urodynamic parameters were compared between two groups. Results The average residual urine volume, the volume of first bladder sensation and the max bladder capacity in groups Ⅰ and Ⅱ were (35±16)ml and (65±24) ml, (220±76)ml and (330±88)ml, (380±92)ml and (580±122)ml, respectively; 3 out 31 and 16 out of 25 patients in groups Ⅰ and Ⅱ showed low compliance. The above indexes between two groups were statistically significant (P<0.01). Conclusion Urodynamics can indicate the severity of functional damage of urinary bladder in patients with diabetic cystopathy. Key words: Urodynamics; Urinary, bladder, nearogenic; Diabetesmellitus; Female

Neuromodulation on Bladder Capacity in Conscious Sheep1

Neuromodulation on Bladder Capacity in Conscious Sheep1

MP76-16 VISCERAL PAIN ASSESSMENT AND URODYNAMIC CHANGES IN TRANSGENIC MICE WITH BLADDER TUMOR

You have accessJournal of UrologyUrodynamics/Incontinence/Female Urology: Non-neurogenic Voiding Dysfunction1 Apr 2014MP76-16 VISCERAL PAIN ASSESSMENT AND URODYNAMIC CHANGES IN TRANSGENIC MICE WITH BLADDER TUMOR Huiyi Chang, Xiaolin Zi, and Gamal Ghoniem Huiyi ChangHuiyi Chang More articles by this author , Xiaolin ZiXiaolin Zi More articles by this author , and Gamal GhoniemGamal Ghoniem More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2014.02.2409AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES The UPII-mutant H-RAS transgenic mouse model of urothelial cancer have been used for preclinically testing novel agents for treatment of urinary bladder cancer. However, visceral pain and the urodynamic changes have not been investigated while the bladder tumor develops in these transgenic mice. Thus, the study examined the visceral pain-related visceromotor reflex (VMR) and cystometric changes in both wild type and transgenic mice. METHODS 2 wild type and 2 UPII-mutant H-RAS transgenic mice were used. A PE-50 tubing was inserted into the bladder dome. Then the tubing was connected to the infusion pump (1.8 mL/hr) and the pressure sensor to obtain the bladder pressure. Left external oblique muscle was exposed and embedded with wires to obtain the VMR during voiding. RESULTS In transgenic mice, the voiding frequency had a significant increase compared to the wild type mice (Fig. 1). The resting pressure and voiding threshold increased in transgenic mice because the bladder tumor made the bladder residual volume increase. The amplitude and duration of VMR had significant increase in transgenic mice compared to wild type mice (Table I). Fig. 1 shows the representative examples of cystometry and VMR from the wild type (A) and transgenic animals (B). Note that the transgenic mouse presented the increased voiding frequency and larger responses of VMR during voiding compared to the wild type mouse. CONCLUSIONS Increase of voiding frequency and resting pressure in transgenic mice showed the similar symptoms of overactive bladder. Increase of visceral pain-related VMR may indicate the transgenic mice suffer from visceral pain while the bladder tumor develops. The study showed that UPII-mutant H-RAS transgenic mouse is a suitable model to investigate the changes of urodynamic recording and the level of visceral pain during the formation of bladder tumor. Statistical analysis of cystomery and visceromotor reflex during voiding obtained from wild type and UPII-mutant H-Ras transgenic mice Wild type Transgenic p value Numbers of voiding cycles 6 6 Cystometry inter-contraction interval s 249±32 151±15 0.0484 * peak bladder amplitude cm H2O 35±4 43±3 0.4617 resting pressure cm H2O 7±1 17±2 0.0008 *** voiding threshold cm H2O 19±2 29±3 0.0175 * Visceromotor reflex normalized amplitude mV 0.14±0.02 0.29±0.05 0.0334 * firing duration s 3.61±0.48 7.74±0.87 0.0144 * © 2014FiguresReferencesRelatedDetails Volume 191Issue 4SApril 2014Page: e888 Advertisement Copyright & Permissions© 2014MetricsAuthor Information Huiyi Chang More articles by this author Xiaolin Zi More articles by this author Gamal Ghoniem More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Urodynamic analysis and treatment of male Parkinson's disease patients with voiding dysfunction

Background Parkinson's disease (PD) is an extrapyramidal neurological disorder. Urinary symptoms are frequently present in patients affected by PD. Symptoms such as urgency, frequency, nocturia, and urge incontinence significantly impact the patient's quality of life. We attempted to investigate the urodynamic changes and treatment of male PD patients with voiding dysfunction by means of a review. Methods Comprehensive urodynamic examinations were performed in 141 male patients with PD associated with voiding dysfunction. Appropriate treatments were given to subgroups that were divided based on test results, and the changes in urodynamic parameters as well as the treatment efficacy were observed. Results Detrusor hyperreflexia without bladder outlet obstruction (BOO) was observed in 35 patients, who exhibited significant improvements in the international prostate symptom score (IPSS), maximum flow rate (Qmax), bladder volume at the first desire to void, post-void residual (PVR), and bladder compliance. Detrusor hyperreflexia associated with BOO was observed in 59 patients. The patients exhibited significant improvements in IPSS, Qmax, PVR, and bladder compliance. Detrusor dysfunction without BOO was observed in 19 patients, for whom the IPSS and the bladder volume at the first desire to void were improved after treatment. Detrusor dysfunction with BOO was found in 28 patients, with no significant improvement in the urodynamic parameters after the treatment. Conclusions Urodynamic examination is recommended for male Parkinson's disease patients with voiding dysfunction. Early and effective treatment can improve the bladder function and quality of life of these patients.

Percutaneous nerve evaluation (PNE) for treatment of non-obstructive urinary retention: urodynamic changes, placebo effects, and response rates.

To evaluate the results of percutaneous nerve evaluation (PNE) implantation in the treatment of non-obstructive urinary retention and report the changes in the urodynamic parameters. Patients with non-obstructive urinary retention or incomplete bladder emptying were included. All patients filled a 7 days voiding diary chart and underwent PNE for one week, and the patient was asked to record the second voiding diary chart and repeat urodynamic study in this period. Then the PNE lead was removed from the S3 foramen, but the connections remained fixed in place for another 3 days to exclude the placebo effects and the third voiding diary chart was completed by the patient. The patient wasn't aware of lead removal. Success was defined as, more than 50% improvement in at least one of the urinary tract symptoms. Forty five patients with a mean age of 37.1 years (ranged 9-83 years) were treated with PNE for refractory, non-obstructive urinary retention. Of study subjects 28 complained from complete urinary retention, and 17 had incomplete emptying. Of participants, 28 (62.2%) demonstrated greater than 50% improvement in the urinary symptoms. Urodynamic data, showed a statistically significant increase in maximum flow rate (8 ± 2.2 mL/sec to 16 ± 3.6 mL/sec, P = .06) and voided volume (35 mL to 187 mL, P = .032) in the responders. Any placebo effects in PNE have not been seen. Patients with complete non obstructive urinary retention were good responders to PNE. The placebo effect in sacral nerve stimulation was negligible.

Urodynamic evaluation after high-intensity focused ultrasound for patients with prostate cancer.

This prospective study assesses the impact of high-intensity focused ultrasound (HIFU) on lower urinary tract by comparing pre- and postoperative symptoms and urodynamic changes. Thirty consecutive patients with clinically organ-confined prostate cancer underwent urodynamic study before HIFU and then at 3–6 months after surgery. Continence status and symptoms were analyzed by means of International Prostate Symptoms Score IPSS and International Index Erectile Function IIEF5. As a result, there were a significant improvement in bladder outlet, maximum flow at uroflowmetry, and reduction in postvoid residual PVR at 6-month follow-up and a concomitant significant reduction of detrusor pressure at opening and at maximum flow. De novo overactive bladder and impaired bladder compliance were detected in 10% of patients at 3 months, with progressive improvement at longer follow-up. Baseline prostate volume and length of the procedure were predictors of 6-month IPSS score and continence status. In conclusion, following HIFU detrusor overactivity, decreased bladder compliance and urge incontinence represent de novo dysfunction due to prostate and bladder neck injury during surgery. However, urodynamic study shows a progressive improvement in all storage and voiding patterns at 6-month follow-up. Patients with high prostate volume and long procedure length suffered from irritative symptoms even at long term.

Bladder function in a cannabinoid receptor type 1 knockout mouse

To evaluate bladder function in an established cannabinoid type 1 (CB1) receptor knockout (KO) mouse model via organ-bath (in vitro) and urodynamic (cystometric; in vivo) experiments. In all, 20 8-week-old female wildtype (WT) mice (C57BL/6) and 20 age-matched CB1 KO mice were used. Six mice from each group were used for the organ-bath experiments, where the contractile responses of bladder tissue strips after carbachol exposure (carbachol concentration response curve [CCRC]; myogenic contraction) and during electrical field stimulation (EFS; neurogenic contraction) were assessed. In all, 14 mice per group were used for cystometric experiments without any anaesthesia, in which standard urodynamic variables were assessed 3 days after bladder catheterisation. The CCRCs of bladder strips from CB1 KO mice were similar to those of WT mice. However, during EFS the bladder strips from the CB1 KO mice had significantly lower contractile responses than WT preparations, indicating that in CB1 KO mice the neuronal component of bladder contraction was different. In cystometric experiments the CB1 KO mice had a higher micturition frequency (shorter mean [sem] inter-micturition interval of 3.24 [0.29] vs 7.32 [0.5] min), a lower bladder capacity (0.09 [0.01] vs 0.18 [0.01] mL) and micturition volume (0.07 [0.01] vs 0.14 [0.01] mL), a lower bladder compliance (0.007 [0.001] vs 0.02 [0.002] mL/cmH2 O), and higher spontaneous bladder activity (5.1 [0.5] vs 2.6 [0.6] cmH2 O) than WT mice (all P < 0.05, Student's t-test). In WT mice, systemic administration of rimonabant (SR141716), a CB1 receptor antagonist, resulted in urodynamic changes similar to those seen in the CB1 KO mice. In vitro, bladder strips from CB1 KO mice responded to muscarinic receptor stimulation similarly as the WT controls, but were less responsive to electrical stimulation of nerves. In vivo, CB1 KO mice had a higher micturition frequency and more spontaneous activity than WT mice. The present findings suggest that CB1 receptors are involved in peripheral and central nervous control of micturition.

Changes of urodynamics and P2X1 receptor expression in bladder detrusor of rats with neurogenic bladder induced by spinal cord injury after the spinal shock stage

Objective To build the rat animal model of neurogenic bladder induced by spinal cord injury and investigate the changes of urodynamics and P2X1 receptor expression in bladder detrusor after the spinal shock stage. Methods A total of 40 female Wistar rats were randomly allocated into control group, suprasacral injury group and sacral injury group. Complete spinal cord transection was established by cutting out of dura at T10-L2 in suprasacral injury group. The sacral injury group was done by cutting out of dura at S2-4. Urodynamic monitor was performed on rats after the spinal shock stage(6 weeks after operation). The P2X1 receptor expression in bladder detrusor among the 3 groups was checked by using immunohistochemical method. Results The suprasacral injury group exhibited detrusor hyperreflexia during bladder filling, elevated leak point pressure and compliance. The sacral injury group exhibited detrusor lower reflection, reduced leak point pressure and elevated compliance. The level of P2X1 receptor expression in rats' detrusor of suprasacral injury group was increased, and the level of sacral injury group was reduced. Conclusions Neurogenic bladder induced by spinal cord injury reveals significant changes in urodynamic after the spinal shock stage. The enhancement of the P2X1 receptor expression in detrusor may be one of the mechanisms of detrusor hyperreflexia. Key words: Spinal cord injury; Neurogenic bladder; Animal model; Urodynamics; P2X1 receptor