Detrusor Contraction Strength Research Articles

Multi-omic analysis revealed the therapeutic mechanisms of Alpinia oxyphylla fructus water extract against bladder overactivity in spontaneously hypertensive rats

ObjectiveAlpinia oxyphylla fructus without impurities and shells is called “Yi-Zhi-Ren” (YZR) in Chinese, and traditionally used to alleviate enuresis. The aim of this study was to investigate the effects and underlying mechanisms of YZR in the treatment of overactive bladder (OAB) in spontaneously hypertensive rats (SHR), a vascular disorder-related OAB model. MethodsA 3-week administration of YZR water extract (p.o.) was done, followed by urodynamics to measure bladder parameters. Changes in bladder structure were observed through H&E staining and Masson's staining. An integrated approach involving network pharmacology, transcriptomics and metabolomics was employed to elucidate the potential mechanisms of YZR, and the key proteins involved in the mechanisms were validated by Western blotting. Additionally, network pharmacology was used to predict the relationship between YZR's active components and validated proteins. ResultsYZR treatment significantly improved the bladder storage parameters, tightened the detrusor layer, reduced inflammatory infiltration, and decreased collagen proportion in the SHR bladder. These results indicated that YZR water extract can alleviate OAB symptoms and improve bladder structure. Integrated analysis suggested that YZR may affect extracellular matrix-receptor interaction and calcium signaling pathway. Western blotting results further confirmed that the reduction in key proteins, such as TGFβ1, p-SMAD3, collagen III, Gq and PLCβ1, involved in collagen synthesis and calcium signaling pathways after YZR treatment. Network pharmacology predicted that sitosterol, chrysin, and nootkatone were potential components responsible for YZR's therapeutic effect on OAB. ConclusionYZR's mechanisms of action in treating OAB involved the TGFβ1-SMAD3 signaling pathway-related collagen synthesis and Gq-PLCβ1 calcium signaling pathway, which are associated with detrusor contraction frequency and strength, respectively.

Efficacy of TAC-302 for patients with detrusor underactivity and overactive bladder: a randomized, double-blind, placebo-controlled phase 2 study

PurposeThis multicenter, randomized, double-blind, placebo-controlled phase 2 study evaluated the efficacy and safety of TAC-302, a novel drug that restores neurite outgrowth, in patients with detrusor underactivity (DU) and overactive bladder (OAB).MethodsAfter 2–4 weeks of observation, patients were randomized 2:1 to receive oral TAC-302 200 mg or placebo twice daily for 12 weeks. The primary endpoint was detrusor contraction strength, estimated by bladder contractility index (BCI) for males and projected isovolumetric pressure 1 (PIP1) for females. Secondary endpoints included changes in bladder voiding efficiency (BVE) and safety.ResultsSeventy-six patients were included (TAC-302, n = 52; placebo, n = 24). The mean (standard deviation [SD]) BCI for males was 64.6 (16.6) at baseline and 75.2 (21.1) at week 12 (p < 0.001) with TAC-302 (n = 27), and 61.3 (16.6) and 60.5 (16.7) (p = 0.82) with placebo (n = 11). The respective mean (SD) PIP1 for females was 18.8 (6.6) and 29.4 (9.4) (p < 0.001) with TAC-302 (n = 15), and 20.6 (7.5) and 25.5 (9.6) (p = 0.14) with placebo (n = 7). TAC-302 significantly increased BCI in males and BVE in both sexes. TAC-302 efficacy on OAB was not clearly shown. The incidences of adverse events (AEs), serious AEs, and AEs leading to dose interruption were similar between groups; no adverse drug reactions occurred.ConclusionConsidering the significant effects on BCI in males and BVE in both sexes, TAC-302 may benefit patients with DU.RegistrationClinicalTrials.gov Identifier NCT03175029 registered 6/5/2017.

Dropped abdominal pressure at void in women.

"Dropped pabd at void" occurs when pabd decreases below the previous resting pressure during voiding time. We sought clinical factors associated with this phenomenon and evaluated whether its correction modifies the urodynamic diagnosis. Retrospective cross-sectional study of non-neurological consecutive symptomatic women. The following definitions were used: "dropped pabd at void": decrease in pabd at Qmax ≥ 5 cmH2O; bladder outflow obstruction (BOO) (pdetQmax ≥ 25 cmH2O + Qmax ≤ 12 ml/s and female BOO index (pdetQmax - 2.2*Qmax) > 18; "low detrusor contraction strength": PIP1 (pdetQmax + Qmax) < 30. In patients with "dropped pabd at void", pdetQmax was corrected. A total of 360 women were analyzed. Ninety-five percent of the women had a variation in pabd at Qmax between -13 and 53 cmH2O. "Dropped pabd at void"was found in 100 women (27.8%). History of stress urinary incontinence (SUI) surgery was significantly higher (p = 0.016) and symptoms of mixed urinary incontinence were significantly lower (p = 0.030) in patients with "dropped pabd at void". On multivariate analysis only the history of SUI surgery maintained its significance (OR = 1.787 [95% CI: 1.058, 3.017], p = 0.030). When correcting pdetQmax in women with "dropped pabd at void", 2 or 5 patients lost BOO diagnosis (depending on how it was diagnosed) and 7 patients gained a "low detrusor contraction strength"diagnosis. Approximately one-quarter of women had "dropped pabd at void", which was associated with a history of SUI surgery. Correction of pdetQmax would lead to a 2.5% to 3.33% diagnostic modification.

Therapeutic Efficacy of Human Embryonic Stem Cell-Derived Multipotent Stem/Stromal Cells in Diabetic Detrusor Underactivity: A Preclinical Study.

Mesenchymal stem/stromal cell (MSC) therapy is a promising approach for treatment of as yet incurable detrusor underactivity (DUA), which is characterized by decreased detrusor contraction strength and/or duration, leading to prolonged bladder emptying. In the present study, we demonstrated the therapeutic potential of human embryonic stem cell (ESC)-derived multipotent MSCs (M-MSCs) in a diabetic rat model of DUA. Diabetes mellitus (DM) was induced by intraperitoneal injection of streptozotocin (STZ) (50 mg/kg) into 8-week-old female Sprague-Dawley rats. Three weeks later, various doses of M-MSCs (0.25, 0.5, and 1 × 106 cells) or an equivalent volume of PBS were injected into the outer layer of the bladder. Awake cystometry, organ bath, histological, and gene expression analyses were evaluated 1 week (short-term) or 2 and 4 weeks (long-term) after M-MSC transplantation. STZ-induced diabetic rats developed DUA, including phenotypes with significantly longer micturition intervals, increased residual urine amounts and bladder capacity, decreased micturition pressure on awake cystometry, and contractile responses to various stimuli in organ bath studies. Muscle degeneration, mast cell infiltration, fibrosis, and apoptosis were present in the bladders of DM animals. A single local transplantation of M-MSCs ameliorated DUA bladder pathology, including functional changes and histological evaluation, and caused few adverse outcomes. Immunostaining and gene expression analysis revealed that the transplanted M-MSCs supported myogenic restoration primarily by engrafting into bladder tissue via pericytes, and subsequently exerting paracrine effects to prevent apoptotic cell death in bladder tissue. The therapeutic efficacy of M-MSCs was superior to that of human umbilical cord-derived MSCs at the early time point (1 week). However, the difference in efficacy between M-MSCs and human umbilical cord-derived MSCs was statistically insignificant at the later time points (2 and 4 weeks). Collectively, the present study provides the first evidence for improved therapeutic efficacy of a human ESC derivative in a preclinical model of DM-associated DUA.

Clinical Epidemiology: Detrusor Voiding Contraction Maximum Power, Related to Ageing

ObjectiveTo report clinical epidemiology of detrusor (bladder) muscle contraction maximum related to ageing in patients referred with signs and symptoms of lower urinary tract dysfunction. Study Design and SettingOne thousand three hundred and eight urodynamic pressure-flow measurements were analyzed in retrospective. Standard measures of detrusor muscle voiding contraction strength were compared for gender and ranked by age (range 20-90 years). ResultsA decline in maximum detrusor contraction strength was observed when the results were ranked according to age. Detrusor muscle maximum voiding contraction was on average 30% less powerful in older women and 12% less powerful in the aged men, when compared to the younger. This is transversal data—interpreted in a longitudinal manner—and from persons referred to specialist care with (the full spectrum of) signs and symptoms of lower urinary tract dysfunction. Therefore these results are relevant for clinical epidemiology but not definitely generalizable to (symptom-free) population level. ConclusionsClinical epidemiologic evaluation of patients referred with lower urinary tract symptoms, found lower detrusor maximum contraction strength in higher-age cohorts, both for women as for men. The maximum detrusor strength difference in association with age was larger in women than in men.

MP77-06 DETRUSOR HYPERACTIVITY WITH IMPAIRED CONTRACTILITY: URODYNAMIC FINDINGS AND THE NEED FOR MORE PRECISE DEFINITIONS.

You have accessJournal of UrologyUrodynamics/Lower Urinary Tract Dysfunction/Female Pelvic Medicine: Non-neurogenic Voiding Dysfunction II1 Apr 2016MP77-06 DETRUSOR HYPERACTIVITY WITH IMPAIRED CONTRACTILITY: URODYNAMIC FINDINGS AND THE NEED FOR MORE PRECISE DEFINITIONS. Jason K Frankel, Andrew C Boylan, and Phillip P Smith Jason K FrankelJason K Frankel More articles by this author , Andrew C BoylanAndrew C Boylan More articles by this author , and Phillip P SmithPhillip P Smith More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2016.02.1920AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Detrusor hyperactivity with impaired contractility (DHIC) is a vexing clinical problem especially in the elderly. Originally described by Resnick in 1987 as neurogenic detrusor overactivity with a voiding efficiency of <50%, it is often assumed to be the same as the concurrence of ICS-defined detrusor overactivity (DO) and detrusor underactivity (DU). DU describes poor voiding detrusor contraction strength, whereas poor efficiency is a voiding termination problem. We therefore sought to determine if these definitions describe the same populations. METHODS Demographic and cystometric data were abstracted from the electronic urodynamic records of 501 consecutive videourodynamic studies conducted by one urodynamicist. Age, voiding efficiency (VE), Watts Factor (WF) and urodynamic observations from the 414 non-neurogenic patients who attempted voiding were used for this analysis. Records were grouped by DO, DU, VE<50%, VE<50%+DO, and DU+DO. Kruskal-Wallace with Dunn's post-hoc test for multiple comparisons among groups and contingency tables were prepared. RESULTS Distributions are shown in the Figure. 104, 75, and 129 patients were identified with DU, DO, and VE<50%, respectively. Of those, 17 patients fit the ICS definition of DHIC and 18 fit the Resnick definition. DO+DU patients were older than DU, DO and VE<50% groups, but did not differ from VE<50%+DO patients. VE was less in VE<50% and VE<50%+DO groups. Sex distribution and WF did not differ among groups. CONCLUSIONS Current use of DHIC describes an overlapping but different population than the original definition. Neither definition of DHIC was associated with low value of WF, an objective index of voiding contractility. Our results point to the need for a formal definition of DHIC, recognizing likely etiologic subgroupings. Standardization of diagnosis may be a critical first step towards an improved understanding of this common and clinically difficult problem. © 2016FiguresReferencesRelatedDetails Volume 195Issue 4SApril 2016Page: e1017-e1018 Advertisement Copyright & Permissions© 2016MetricsAuthor Information Jason K Frankel More articles by this author Andrew C Boylan More articles by this author Phillip P Smith More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Traces: Making Sense of Urodynamics Testing - Part 10: Evaluation of Micturition via the voiding Pressure Flow Study (Abstract Only): Special Series on Urodynamics

Part 10 of the Traces series focuses on urodynamics evaluation of micturition via the voiding pressure-flow study (VPS). This article reviews techniques for generating a high-quality voiding pressure-flow study and initial interpretation of findings. Part 11 of the Traces series will focus on advanced analysis of the VPS using nomograms that measure the magnitude of urethral resistance (bladder outflow obstruction) and detrusor contraction strength.

Detrusor expulsive strength is preserved, but responsiveness to bladder filling and urinary sensitivity is diminished in the aging mouse

The prevalence of urinary symptoms increases with age and is a significant source of distress, morbidity, and expense in the elderly. Recent evidence suggests that symptoms in the aged may result from sensory dysfunction, rather than abnormalities of detrusor performance. Therefore, we employed a pressure/flow multichannel urethane-anesthetized mouse cystometry model to test the hypothesis that in vivo detrusor performance does not degrade with aging. Secondarily, we sought to evaluate sensory responsiveness to volume using pressure-volume data generated during bladder filling. Cystometric data from 2-, 12-, 22-, and 26-mo-old female C57BL6 mice were compared. All 2- and 12-mo-old mice, 66% of 22-mo-old mice, and 50% of 26-mo-old mice responded to continuous bladder filling with periodic reflex voiding. Abdominal wall contraction with voiding had a minimal contribution to expulsive pressure, whereas compliance pressure was a significant contributor. Maximum bladder pressure, estimated detrusor pressure, detrusor impulse (pressure-time integral), as well as indices of detrusor power and work, did not decrease with aging. Bladder precontraction pressures decreased, compliance increased, and nonvoiding contraction counts did not change with increasing age. Intervoid intervals, per-void volumes, and voiding flow rates increased with age. Calculations approximating wall stress during filling suggested loss of bladder volume sensitivity with increasing age. We conclude that aging is associated with an impaired ability to respond to the challenge of continuous bladder filling with cyclic voiding, yet among responsive animals, voiding detrusor contraction strength does not degrade with aging in this murine model. Furthermore, indirect measures suggest that bladder volume sensitivity is diminished. Thus, changes in homeostatic reserve and peripheral and/or central sensory mechanisms may be important contributors to aging-associated changes in bladder function.

Analysis of the Pressure-Flow Study in Weak Detrusor Patients with Benign Prostatic Hypertrophy.

Pressure-flow study is a method used to evaluate the degree of bladder outlet obstruction and the strength of detrusor contractility during voiding. However, whether or not the operation for benign prostate hyperplasia should be avoided in detrusor underactivity patients remains controversial. To address this, we performed a retrospective analysis of our pressure-flow study data for benign prostate hyperplasia patients. We especially focused on the backgrounds of patients with weak detrusor contractility. Patients (n = 288; average age, 71.5 years) who underwent pressure-flow study to evaluate operative indications between February 2001 and April 2010 were included in this study. We analyzed the relationships between background factors and detrusor contraction strength according to Schäfer's nomogram. Patients with weak detrusor contractility had poor flow (5.81 mL/sec) and low voided volume (141.2 mL) compared to patients with normal (8.77 mL/sec, 202.0 mL) or strong (8.97 mL/sec, 178.3 mL) detrusor contractility. Twenty-six of 74 weak detrusor patients underwent prostate operation. The operated group had high obstruction grade (3.35, P < 0.001), but a low rate of detrusor overactivity (19.2%, P < 0.05), compared to the non-operated group (2.16, 41.7%). The operated group also had high urinary retention rate (38.5%) compared to the non-operation group (18.8%). We performed prostate surgery in patients who had episodes of urinary retention, with outlet obstruction, and with no detrusor overactivity, even in those with weak detrusor contractility. The operation may not be contraindicated for these patients. Pressure-flow study is an important tool to ensure adequate informed consent.

2167 MAXIMUM ISOMETRIC DETRUSOR CONTRACTION IN MEN WITH POST-PROSTATECTOMY INCONTINENCE

You have accessJournal of UrologyUrodynamics/Incontinence/Female Urology: Urodynamic Testing1 Apr 20112167 MAXIMUM ISOMETRIC DETRUSOR CONTRACTION IN MEN WITH POST-PROSTATECTOMY INCONTINENCE Christopher Elliott and Craig Comiter Christopher ElliottChristopher Elliott Stanford, CA More articles by this author and Craig ComiterCraig Comiter Stanford, CA More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2011.02.2404AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Detrusor dysfunction in the form of poor contractility has been reported in up to 40% of men following radical prostatectomy, regardless of continence status. However, “true” detrusor contraction strengths have not been measured in these studies. Rather surrogates such as the presence of Valsalva voiding, low detrusor pressures at maximum flow (PdetQmax) or the use of bladder contractility nomograms developed for men with intact prostates have been used. To date the use of isovolumetric contraction pressure (Piso) to measure bladder contractility has not been reported in this population. We present our experience in men with post-prostatectomy incontinence (PPI). METHODS We performed a retrospective review of all men referred to our institution in the last 3 years for PPI evaluation. All men undergoing urodynamic examination during this time (62 of 65) were included for study. Videourodynamic evaluation was performed with a standard seven French urodynamic catheter using concomitant rectal pressure monitoring. A maximum isometric detrusor contraction measurement was obtained using the continuous occlusion test (COT). Statistical analysis was performed using Mann-Whitney and linear regression tests to evaluate the effect of patient variables on Piso. RESULTS Piso was measurable in 60 men with a median value of 60cmH2O (range 0–110). Piso was < 50 cm water in 24/60 (40%). Isometric contractility was higher in men with urodynamic evidence of detrusor overactivity (71.5 vs 47 cm water, p=.010) and in non-Valsalva voiders compared to Valsalva voiders (60 vs 24 cm water, p=.016). Piso was also positively correlated with PdetQmax (p<.001) and detrusor reserve (p<.001); it was negatively correlated with bladder compliance (p=.010). Isometric contraction strength was unrelated to age, time since radical prostatectomy, leak point pressure, pad use, history of pelvic radiation, maximum urinary flow rate or bladder capacity (p>.05 for all). CONCLUSIONS Our data suggest that detrusor contraction strength can be easily measured by the COT in men with PPI. Indeed, 40% of men demonstrated a Piso < 50 cm water. As low contractility is a relative contraindication to sling surgery, bladder contractility should be measured in men prior to incontinence surgery. © 2011 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 185Issue 4SApril 2011Page: e867-e868 Advertisement Copyright & Permissions© 2011 by American Urological Association Education and Research, Inc.MetricsAuthor Information Christopher Elliott Stanford, CA More articles by this author Craig Comiter Stanford, CA More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Voiding dynamics in women with stress urinary incontinence and high‐stage cystocele

The aim of this study was to identify the urodynamic features of women with stress urinary incontinence (SUI) or with high-stage (stage 3 or greater) cystocele (HSC) as compared with symptom-free women. Fifty-six neurologically intact women with SUI and 47 women with HSC but without SUI were prospectively evaluated. All patients underwent full urodynamics, in addition to basic clinical evaluations. The urodynamic parameters of SUI and HSC were compared to the ones obtained from 78 urologically symptom-free normal women over the same period. Patients with HSC, after correction of cystocele using a temporary vaginal pessary, had consistently lower maximum urinary flow rate with a lower detrusor pressure during micturition than the controls or those with SUI. On the other hand, patients with SUI had an equivalent to higher maximum urinary flow rate, normal detrusor contraction strength with a lower detrusor pressure during micturition than the controls. Both maximum Watts factor and bladder contractility index were significantly lower in the whole HSC cohort in comparison to the controls and patients with SUI. The urodynamic characteristics observed among the three groups were all maintained even after adjusting for age. Women with SUI demonstrate voiding with low-pressure, normal contraction strength with an equivalent to high urinary flow rate. Women with HSC demonstrate voiding with low pressures with weak contraction strengths and low urinary flow rates, suggesting a higher prevalence of detrusor underactivity. Chronically decreased or increased urethral resistance might alter voiding dynamics and performance.

Traces: Making Sense of Urodynamics Testing - Part 2: Uroflowmetry (Abstract Only): Special Series on Urodynamics

Uroflowmetry is an electronic recording of urinary flow. It is typically measured by one of two types of transducers. One type measures the weight of urine as it falls into a beaker or container placed on the transducer, and the other uses a spinning disc to measure urinary flow. Uroflowmetry is a non-invasive, comparatively inexpensive study often used to identify voiding abnormalities. Experienced clinicians can use uroflow tracings to differentiate a continuous (normal) flow pattern from abnormal patterns. While uroflowmetry has been found to reliably distinguish normal from abnormal flow patterns, uroflowmetry does not reliably distinguish the underlying cause of voiding abnormalities. Differential diagnosis of poor detrusor contraction strength from bladder outlet obstruction relies on a voiding pressure flow study that combines uroflowmetry with the various pressure studies used to generate a cystometrogram and pelvic floor muscle electromyography.

Long‐term effects of repeated intradetrusor botulinum neurotoxin A injections on detrusor function in patients with neurogenic bladder dysfunction

To evaluate the influence of repeated botulinum neurotoxin A (BoNT-A) treatments on detrusor function in patients with neurogenic detrusor overactivity (DOA) due to spinal cord lesions. In a retrospective study, urodynamic evaluations of 27 consecutive patients with neurogenic DOA due to spinal cord lesions who received at least five BoNT-A treatments were analysed. After the first BoNT-A treatment, bladder capacity, reflex volume, continence status and detrusor compliance were significantly improved and maximum detrusor pressure (P(detmax)) was significantly reduced. The mean number of BoNT-A treatments was 7.1. Compared with the results of the first treatment, the incontinence rate (seven patients) and the number of patients with an elevated P(detmax) (five patients) were slightly increased after the final BoNT-A treatment. The long-term success rate was 74%. Every fourth patient needed a major surgical intervention. There was a significant decrease in P(detmax) before BoNT-A treatments, indicating that detrusor contraction strength did not completely recover after treatment. Our study confirmed the long-term efficacy of repeated BoNT-A treatments in patients with neurogenic DOA. However, in long-term follow-up, every fourth patient required surgical interventions. Moreover, our data give the first hint that BoNT-A may lead to impaired detrusor contraction strength, which could influence future treatment options. Prospective studies are necessary to elucidate the impact of repeated BoNT-A treatments on detrusor function and the interactions with future treatment options.

Proposal for a Urodynamic Redefinition of Detrusor Underactivity

We sought a sufficiently comprehensive urodynamic definition of idiopathic detrusor underactivity in men with nonneurological conditions and no obstruction who had mainly voiding lower urinary tract symptoms. In 75 such patients and 40 age matched controls we retrospectively analyzed intrinsic detrusor contraction strength and contraction speed by estimating isovolumetric detrusor pressure and maximum possible detrusor contraction velocity. Bladder emptying efficiency was also determined. Nonparametric statistics were done as data analysis. Detrusor underactivity, defined as lower levels of maximum possible detrusor contraction velocity and/or isovolumetric detrusor pressure than the 25th percentiles of such parameters in controls, was found in all 75 patients. Patients could be divided into group 1-22 with low maximum possible detrusor contraction velocity, low isovolumetric detrusor pressure and bladder emptying efficiency less than 67%, group 2-25 with low maximum possible detrusor contraction velocity, low isovolumetric detrusor pressure and bladder emptying efficiency 67% or greater, and group 3-28 with low maximum possible detrusor contraction velocity, normal isovolumetric detrusor pressure and bladder emptying efficiency 67% or greater. For insignificantly different urethral resistance levels there were significant decreases in maximum possible detrusor contraction velocity in group 3 vs those in controls, and in maximum possible detrusor contraction velocity and isovolumetric detrusor pressure in groups 2 and 1 vs those in group 3. In our patients with detrusor underactivity intrinsic detrusor speed was more compromised than intrinsic strength. The definition of idiopathic detrusor underactivity of a slower and/or weaker bladder with or without poorly sustained micturition contractions proved more effective than a definition of decreased detrusor contraction strength and/or poorly sustained micturition contractions. The decreasing trend in detrusor contractility from group 3 to groups 2 and 1 suggests that our classification of idiopathic detrusor underactivity may reflect the evolution of this condition from an initial stage to obviously impaired voiding function.

Development of Idiopathic Detrusor Underactivity in Women: From Isolated Decrease in Contraction Velocity to Obvious Impairment of Voiding Function

To sequentially assess the evolution of urodynamic parameters in women who could be studied before and after the development of idiopathic detrusor underactivity (DUA). We assessed retrospectively 32 consecutive postmenopausal women seen during the period 1989 to 2006. They had invasive urodynamics (cystometry and pressure/flow study) performed when first referred (time 1) and then after several months (time 2). Group A, 17 women with a history of recurrent acute uncomplicated cystitis, had time 2 assessment performed a median of 24 months after time 1, following the discovery of large postvoid residual urine volumes at follow-up. As controls we took 15 age-matched women (group B), referred to exclude anxiety as the main cause for lower urinary tract symptoms, who proved normal urodynamically at time 1, were then lost at follow-up, and proved still normal urodynamically when reassessed a median of 27 months later (time 2). At time 1, group A showed normal urodynamic findings, except for a reduced detrusor contraction velocity. During the period between times 1 and 2, antimicrobial prophylaxis caused a 17% decrease in acute cystitis recurrences. At time 2, group A showed an obvious DUA, with reduced bladder emptying efficiency, lowered detrusor contraction strength, and a further decrease in detrusor contraction velocity. An isolated decrease in detrusor contraction velocity showed as the early phase of the process leading to obvious DUA in the patients studied. This appeared to be a pathological process rather than a natural evolution due to aging.

Categorization of Obstruction Using Noninvasive Pressure Flow Measurements: Sensitivity to Change Following Prostatectomy

We determined whether categorizing men with lower urinary tract symptoms using a noninvasive pressure flow nomogram is sensitive to change following the removal of obstruction. A prospective cohort of men undergoing transurethral prostate resection was recruited, of whom 143 (69%) underwent noninvasive pressure flow study using the penile cuff technique before and 4 months following surgery. Cuff pressure required to interrupt voiding, estimated isovolumetric bladder pressure and maximum flow rate were recorded during a single void. Values were plotted on a nomogram categorizing cases as obstructed (upper left quadrant), not obstructed (lower right quadrant) or diagnosis uncertain (upper right and lower left quadrants). Changes in maximum flow rate, cuff pressure required to interrupt voiding and nomogram position following transurethral prostate resection were then analyzed. Transurethral prostate resection resulted in an improved flow rate for all diagnostic groups, which was highest for obstructed cases with a mean +/- SD increase of 11 +/- 6 ml second(-1) (p <0.01). Men categorized with obstruction and those placed in the upper right quadrant showed significant decreases in cuff pressure required to interrupt voiding following transurethral prostate resection with a mean decrease of -45 +/- 35 and -48 +/- 32 cm H(2)O, respectively (p <0.01). The number of cases classified as not obstructed increased from 28 (19%) preoperatively to 114 (80%) after transurethral prostate resection. Sensitivity to change following the removal of obstruction further validates the usefulness of noninvasive measurement of bladder pressure by the penile cuff test and the categorization of obstruction by the noninvasive nomogram. Decreased isovolumetric bladder pressure following transurethral prostate resection may reflect a return to normal detrusor contraction strength.

Study on the change of bladder wall weight pre and after surgery in patients with benign prostatic hyperplasia

To investigate the changes and its clinical significance of ultrasound evaluated bladder wall weight (UEBW) pre and after surgery in patients with benign prostatic hyperplasia (BPH). The clinical data of 63 patients of benign prostatic hyperplasia and 30 of contrast control were studied. The bladder wall weight was calculated by subtracting the volume of sphere represented by the urine volume inside the bladder from the volume of the sphere representing the whole bladder (sphere with a radius = internal radius + bladder wall thickness). Bladder outlet obstruction (BOO) and bladder function was evaluated by urodynamic studies. Of the 63 patients with BPH, UEBW was (97 +/- 54) g, while the control group was only (41 +/- 14) g. UEBW was found to be significantly correlated with LinPURR grade (R = 0.47, P < 0.01) and positive residual urine volume (R = 0.48, P < 0.01), and it was negatively correlated with Qmax (R = -0.52, P < 0.01) and detrusor contraction strength (presented as WF, R = -0.4, P < 0.05). A significant difference was found between the UEBW pre and after surgery [(99 +/- 50) g vs. (56 +/- 21) g, t = 5.05, P < 0.01)]. UEBW decreased 43.68%, and IPSS score decreased 16.81 point, while Qmax increased 8.38 ml/s. As an non-invasive methods, measurement of bladder wall weight appears to be a useful marker in evaluating status before operation and in monitoring the effect of surgery for patients with BPH.

Urodynamic Findings Suggesting Two-Stage Development of Idiopathic Detrusor Underactivity in Adult Men

To assess the evolution of bladder voiding dynamics from the onset of symptoms to the final diagnosis of idiopathic detrusor underactivity (DUA) in men with storage and voiding lower urinary tract symptoms (LUTS) and otherwise normal clinical findings. We retrospectively analyzed the urodynamic findings in two patient groups of 25 men each. Group A, with storage and voiding LUTS and otherwise normal clinical findings, had an inconclusive urodynamic test at time 1 and were re-assessed after a mean (+/- SD) of 17 +/- 5 months for worsened symptom severity (time 2). The control group B was formed by age-matched men with unexplained recurrent urinary tract infections who, when seen by us, showed normal clinical and urodynamic findings. Nonparametric statistics were checked for significant differences between groups A and B and between times 1 and 2 in group A. At time 1, group A had moderately high symptom scores, but the urodynamic findings (normal detrusor contraction strength with a lower detrusor contraction velocity than in group B) seemed to be inconclusive; thus no clear-cut diagnosis was made. At time 2, compared with time 1, group A had higher symptom scores, and the urodynamic findings (lower detrusor contraction strength and shortening velocity, unchanged urethral resistance, lesser voiding efficiency) suggested a diagnosis of idiopathic DUA. Idiopathic DUA would likely imply a two-stage development (ie, would be preceded by a phase of low detrusor contraction velocity occurring even several months before a decrease in detrusor contraction strength).

Relationships Between Micturition Urgency and Involuntary Voiding Dynamics in Men With Urinary Incontinence From Idiopathic Detrusor Overactivity

In men with urinary incontinence from idiopathic detrusor overactivity we determined whether bladder voiding dynamics differs between those with and without urgent micturition. We retrospectively assessed urodynamic findings in 3 groups of 22 men each. Groups 1 and 2 had idiopathic detrusor overactivity with detrusor overactivity incontinence and with micturition urgency in group 1. Group 2 showed no urgency but felt a strong voiding desire just after the onset of involuntary micturition. Control group 3 included nonneurological unobstructed men undergoing urodynamic examination for mixed reasons who proved to be urodynamically normal. Patients with detrusor overactivity and controls were assessed by nonparametric statistics for significant differences in bladder voiding dynamics. Detrusor contraction strength proved to be increased in groups 1 and 2 with the highest levels in group 1. Detrusor contraction velocity had the highest levels in group 1 and it differed insignificantly in groups 2 and 3. Voiding contractions were equally well sustained in groups 1 and 3, and proved to be less well sustained in group 2. Detrusor overactivity involves enhanced detrusor contraction strength levels, particularly in patients who feel urgency. In urgency-free patients with detrusor overactivity detrusor contraction velocity differs insignificantly from that in controls and voiding detrusor contractions proved to be less well sustained than in controls and patients who experienced urgency. This suggests that detrusor contraction velocity may have a role in causing urgency and urgency may have a role in enhancing and sustaining involuntary voiding detrusor contractions in patients with detrusor overactivity.

Variation in Invasive and Noninvasive Measurements of Isovolumetric Bladder Pressure and Categorization of Obstruction According to Bladder Volume

We developed a noninvasive test that provides an estimate of isovolumetric bladder pressure by measuring the pressure required to interrupt voiding using controlled inflation of a penile cuff. We noted variation in serial measurements obtained during a single void and, therefore, we determined whether this represents variation in detrusor contraction strength, as predicted in previous studies, or measurement error. A total of 36 symptomatic men underwent simultaneous invasive and noninvasive pressure flow studies. Corresponding values of isovolumetric bladder pressure and cuff interruption pressure were recorded at each flow interruption and grouped according to bladder volume to calculate measurement error and bias at various points during a void. Individual variation in the 2 measurements across a range of normalized bladder volumes was then examined using ANOVA. Cuff interruption pressure showed a consistent level of accuracy as an estimate of isovolumetric bladder pressure across a range of volumes. There were similar, statistically significant differences in isovolumetric bladder pressure and cuff interruption pressure recorded at specific volume increments with the highest values seen in the mid range and the lowest seen at lower bladder volumes (each p <0.01). When plotting, the maximum recorded value of cuff interruption pressure in each individual on our proposed noninvasive pressure flow nomogram provided the best diagnostic accuracy for obstruction. This study shows that cuff interruption pressure varies in the expected manner with bladder volume and provides a consistent estimate of isovolumetric bladder pressure throughout a void. These data provide important guidance for interpreting noninvasive pressure flow studies and classifying obstruction on the proposed nomogram.