Detrusor Contraction Research Articles

Time-dependent arachidonic acid metabolism and functional changes in rats bladder tissue after suprasacral spinal cord injury

BackgroundA critical aspect affecting the quality of life in Traumatic spinal cord injury (TSCI) patients is bladder dysfunction. Metabolities in arachidonic acid are crucial lipid signaling molecules involved innumerous physiological processes. In this study, We are the first use eicosanoid metabolomics detrusor contraction examine, to assess the effect of the arachidonic acid metabolic in bladder dysfunction following TSCI. In additon, we explore the time of inflammatory and function changes in bladder tissue. MethodsAdult male Sprague-Dawley rats were subjected to improved Weight Drop method surgeries. Detrusor contraction examination, urodynamic examination, eicosanoid metabolomics, transmission electron microscopy, Elisa and histological staining were performed to assess the change of inflammatory, metabolic and function variation over time after TSCI. ResultsFollowing TSCI, before the variations of bladder function, inflammatory changes including the increase of inflammatory factors, mitochondrial damage, and slight lipid peroxidation, occurred in bladder tissue. And the inflammatory changes gradually decreases over time. However, From the third day after TSCI, secondary lesions appeared in bladder tissue. Not only did inflammation-related indexes increase again, the degree of mitochondrial damage and lipid peroxidation increased, but also the contractility of detrusor began to change significantly. We also found that the content of metabolites in arachidonic acid metabolic pathway and the degree of detrusor contractility change showed a strong correlation. In addition, we found that rats had moved beyond the spinal shock stage on the seventh day after TSCI. ConclusionAltogether, we are the first to demonstrate that abnormal arachidonic acid metabolism plays an important role in bladder dysfunction after TSCI. We also demonstrate that 3d is a critical juncture for changes in rat bladder tissue, which indicates it is an important juncture in the treatment of neurogenic bladder.

Cough-Induced Detrusor Overactivity—Outcome after Conservative and Surgical Treatment

Background/Objectives: The most common variant of mixed urinary incontinence is stress-induced urge urinary incontinence with the correlating urodynamic findings of cough-induced detrusor overactivity (CIDO). This prospective study assessed the clinical outcomes and leakage improvement among patients with CIDO following conservative or surgical treatment. Methods: We included patients with CIDO treated at our tertiary referral center from January 2018 to July 2021 in this prospective cohort study. The detection of a detrusor contraction after a cough was diagnosed as CIDO by urodynamic multichannel testing. All the patients in our study received personalized care, with behavioral therapy and anticholinergic/betamimetic treatment as a first step. If leakage persisted, patients were given a choice between pelvic floor muscle exercises (PFMEs), periurethral bulking or a midurethral sling. The primary outcome was the mean difference in urine leakage in the pad test before and six months after treatment. Results: Thirty-five patients met the inclusion criteria for CIDO and all presented a positive pad test at baseline (mean: 27 g). All 35 patients participated in behavioral therapy and anticholinergic/betamimetic treatment. Twenty-two patients (62.9%) underwent PFME, twelve patients (34.2%) received periurethral bulking, and nine patients (25.7%) received a midurethral sling. After all the treatments, our cohort showed a significant improvement in the pad test (mean: 5.7 g, p < 0.001). The result was more favorable after periurethral bulking than the midurethral sling (p < 0.001). Conclusions: This study shows the effectiveness of conservative treatment as a first step. In cases needing further treatment, bulking agents may be superior to PFME and midurethral propylene slings, offering new perspectives in the field of urogynecology and urinary incontinence.

Is it Possible to Regenerate the Underactive Detrusor? Part 2 Electrical Stimulation Therapies, Treatment of Bladder Outlet Obstruction, Constipation, and Pelvic Floor Disorders ICI-RS 2024.

Detrusor muscle weakness is commonly noted on urodynamics in patients with refractory voiding difficulty. No clinical therapy has been proven to augment the strength of a detrusor contraction. This subject was discussed at a think-tank at the International Consultation on Incontinence-Research Society (ICI-RS) held in Bristol, June 2024. The discussions of the think-tank are being published in two parts. This second part discusses the role of electrical stimulation therapies, treatment of bladder outlet obstruction, constipation, and pelvic floor disorders, in the enhancement of strength of a detrusor contraction. Electrical stimulation therapies, specifically sacral neuromodulation, have long been used in the salvage of patients with refractory nonobstructive voiding dysfunction. Clinical improvements can be noted in men following bladder outlet resistance reduction surgery especially, though not limited to those with demonstrable obstruction. Some patients may also show improvement with pelvic floor relaxation therapies and constipation care. However, there is a lack of high-quality urodynamic data to demonstrate an improvement in the strength of a detrusor contraction with these therapies. The think-tank recommends standards for future clinical studies examining treatments aimed at improving an underactive detrusor. Studies need to examine whether clinical improvement following treatment of patients with an underactive detrusor is associated with improvement in strength of the detrusor contraction. New therapeutic options should apply specified standards for assessing and reporting the impact on detrusor contraction.

Baseline cystometric parameters in conscious and anesthetized sheep: experimental data and systematic review.

To characterize cystometry in conscious and anesthetized sheep, including bladder response to sacral root electrical stimulation, thereby providing a baseline set of values. Single-fill cystometries were repeated in adult mule ewes both conscious (n = 5) and under general anesthesia (18) using a commercial system. Parameters including bladder capacity, detrusor (bladder) pressure, urethral opening pressure, bladder compliance, number of nonvoiding detrusor contractions, and bladder pressure change in response to electrical stimulation of the sacral roots under general anesthesia are reported. Pubmed, Embase, and Web of Science databases were searched for studies relating to ovine cystometry, and a systematic review was conducted. In awake sheep, mean ± SD bladder capacity was 79.6 ± 32.2 mL, urethral opening pressure was 26.0 ± 10.7 cm H2O, and compliance was 3.5 ± 1.9 mL/cm H2O. Peak detrusor pressures during micturition reached 57.7 ± 28.3 cm H2O. In anesthetized animals, mean bladder capacity (endpoint, 50 cm H2O) was 333 ± 191 mL, and mean bladder compliance was 7.7 ± 4.9 mL/cm H2O. Values for these parameters from our systematic review are presented for comparison and reference. Electrical stimulation of the second and third sacral roots caused a greater increase in detrusor pressure than stimulation of the first and fourth sacral roots. We present a comprehensive set of data for normal cystometry parameters in sheep, including the first report of detrusor response to sacral root stimulation in anesthetized sheep. This report provides a valuable set of baseline values for a potential translational model of value to neurourologic research and may be a useful reference for clinicians.

Therapeutic efficacy and short-term durability of trans-urethral amniotic bladder injections for the treatment of refractory COVID-associated cystitis.

COVID-19-associated cystitis (CAC) may arise following a COVID-19 infection and is characterized by the development of novel or worsening overactive bladder (OAB). CAC is possibly associated with bladder mucosal damage and the release of pro-inflammatory cytokines, resulting in inflammation and fibrosis of the bladder wall. Amniotic membrane (AM) has been shown to possess anti-inflammatory and anti-fibrotic properties and might potentially be beneficial for CAC. This study investigated the safety and efficacy of bladder injections of AM in CAC patients with resistant OAB symptoms. Five CAC patients, with an average age of 73 ± 1.0 years and a median disease duration of 2.4 years, received intra-detrusor injections of 100 mg micronized AM under general anesthesia and were followed for 20 weeks. Key urodynamic measures (involuntary detrusor contraction and maximum cystometric capacity) were determined to evaluate treatment response. Quality of life (QOL) was assessed using the OAB assessment tool, and safety was analyzed. All five patients showed improved urodynamic bladder function and significantly improved QOL improvements. The improvement was evident from 4 weeks post-treatment and sustained until 12 weeks. Symptoms re-surged at 20 weeks. No safety concerns arose during the study. The observed improvements in symptom scores and bladder volume parameters highlighted the promise of AM bladder injections as a viable intervention for CAC patients with refractory OAB symptoms. Comprehensive studies are needed to validate its therapeutic potential, and treatment protocol refinement is warranted to address the observed reduction in efficacy over time.

Effect of biofeedback pelvic floor training on urodynamic study in children with detrusor sphincter dyssynergia

ABSTRACT Introduction Detrusor sphincter dyssynergia (DSD) is the urodynamic description of bladder outlet obstruction from detrusor muscle contraction with concomitant involuntary urethral sphincter activation. DSD is associated with neurologic conditions such as spina bifida. It is associated with urinary incontinence (UI), nocturnal enuresis, urgency, intermittency, and recurrent urinary tract infections (UTIs). The Aim of this Study It aims to assess the efficacy of biofeedback (BF) for achieving perineal synergy and improving symptoms in thirty children with refractory DSD who failed to improve with medical treatment in the last 2 to 3 years. Material and Methods Thirty children (20 girls and 10 boys) aged 6–18 years (mean: 9.2 ± 2.2 yrs) with refractory DSD who failed to show improvement after 2–3 years of medical treatment with recurrent UTI and failure to emptying completely their bladder using urodynamic study. After patients understood the concept of BF pelvic floor training were regularly scheduled twice weekly for up to 3 months. Improvement was assessed using interview with parents after 3 months with measurement of manomeric pelvic floor muscles (PFMs) during straining and urodynamic study. Results Seven (23.3%) of the 30 children had daytime UI and 11 (36.7%) had nighttime incontinence. 4/30 (13.3%) children had increased urgency and 5 (16.7%) had straining intermittency and 3% (10%) had Dysuria. After 3 months of BF pelvic floor training 7/30 (23.3%) of children were fully responsive 100% decrease of symptoms, 14/30 (46%) responded more than 90% decrease of their symptoms, 7/30 (23.3%) of children responded partial decrease of symptoms and 2/30 (0 to 49%) decrease of symptoms to BF pelvic floor training. Conclusions BF pelvic floor training is an effective therapeutic option for children with refectory DSD. It improves symptoms of children with DSD with decreased UTIs through decreasing pressure of PFMs during urination.

Nocturia and obstructive sleep apnea in spinal cord injured patients - a cohort study.

To describe the prevalence of nocturia and obstructive sleep apnea (OSA) in a cohort of spinal cord injury (SCI) patients and to describe their association. Additionally, to assess clinical and urodynamic data explaining nocturia and to evaluate the effect of OSA management with continuous positive airway pressure (CPAP). Retrospective analysis of data from patients with SCI followed in a tertiary care rehabilitation center with a specialized sleep and neuro-urology units. All adult SCI patients who underwent urodynamic assessment before polysomnography (PSG) between 2015 and 2023 were eligible. Subjective (nocturia) and objective data (urodynamic data, polysomnography, CPAP built-in software) were collated from the Handisom database (database register no. 20200224113128) and the medical records of SCI patients. Statistical testing used Mann-Whitney test for non-parametric variables, Fisher's exact test for contingency analysis and the Spearman correlation test to assess correlations. A p-value < 0.05 was considered significant. Statistical analyses were performed using GraphPad Prism v9. 173 patients (131 males, 42 females) were included. The majority of patients were paraplegic (n = 111 (64,2%)) and had complete lesions (n = 75 (43,4%)). A total of 100 patients had nocturia (57,5%). The prevalence of OSA (Apnea Hypopnea Index (AHI) ≥ 15/h) in the studied population was 61,9%. No correlation was found between nocturia and OSA. A significant difference was observed between patients with and without nocturia in terms of the presence of neurogenic detrusor overactivity (p = 0,049), volume at the first detrusor contraction (p = 0,004) and the bladder functional capacity (p < 0,001). Nocturia and OSA are highly prevalent in patients with SCI, but no statistical association was found between these two disorders. A prospective study focusing on nocturnal polyuria will be needed to assess the impact of OSA on lower urinary tract symptoms in SCI patients.

Urodynamic and Frequency-Volume Chart Parameters Influencing Anticholinergic Resistance in Patients With Neurogenic Detrusor Overactivity.

Neurogenic detrusor overactivity (NDOA) is characterized by involuntary detrusor muscle contractions during bladder filling in patients with neurological disorders. Anticholinergic therapy is the primary treatment; however, the reasons for treatment resistance in NDOA are not well understood. This study aimed to identify predictors of treatment failure by comparing urodynamic and frequency-volume chart data between patients with NDOA who respond and patients who do not respond to anticholinergic therapy. We reviewed the records of 362 patients presenting with lower urinary tract symptoms and selected 85 who had NDOA and were on anticholinergic therapy. Ultimately, 67 patients were analyzed. We categorized these individuals into responders (group R) and nonresponders (group NR) based on clinical and urodynamic improvements. Three-day frequencyvolume charts and urodynamic study results were retrospectively reviewed. Of the 85 initial patients, 12 refused medication, and 6 were lost to follow-up. Pre- to posttreatment changes differed significantly between groups in the number of urgency urinary incontinence (UUI) episodes per 24 hours (P=0.001), maximum cystometric capacity (mL, P=0.003), NDOA frequency (P=0.004), and bladder compliance (mL/cm H2O, P=0.003). Multivariate analysis revealed that NDOA frequency (P=0.014) and UUI episodes per 24 hours (P=0.002) were significant factors associated with treatment failure. NDOA varies according to underlying neurological conditions. The frequencies of UUI episodes and NDOA in urodynamic studies can predict resistance to initial anticholinergic treatment.

Investigating the Prevalence of Autonomic Neuropathy in Diabetic Patients with Urinary Irritation Symptoms Without a Known Cause.

Evaluating pseudomotor performance can be a valuable tool for investigating the peripheral autonomic nervous system in diabetic patients. Sudoscan, a simple and non-invasive method for assessing pseudomotor performance, has been developed in recent years. This study aimed to investigate autonomic neuropathy using Sudoscan in diabetic patients with lower urinary tract symptoms (LUTS) of unknown cause. In this cross-sectional study conducted from April 2022 to April 2023, we included 195 patients with type 2 diabetes who were referred to the urology clinic. We extracted demographic, clinical, and laboratory data from the patient files and evaluated urinary symptoms using the International Prostate Symptom Score (IPSS) questionnaire. Patients underwent Sudoscan testing to evaluate autonomic neuropathy in the physical medicine and rehabilitation clinic. To further assess urinary irritative symptoms, patients underwent urodynamic studies (UDS) and ultrasonography. The Sudoscan test results showed that autonomic neuropathy was present in 77 patients (40%), with 43 (22.1%) having moderate and 44 (22.6%) having severe neuropathy. Patients with autonomic neuropathy were found to be older, had longer diabetes durations, higher average blood glucose levels, and higher creatinine levels. Additionally, we found a significant correlation between autonomic neuropathy and signs of high post-void residue on ultrasound and detrusor contraction disorders on UDS (p-value < 0.05). Our study found a higher prevalence of autonomic neuropathy in diabetic patients with LUTS using Sudoscan (40%). Longer diabetes duration and poor glycemic control were associated with an increased risk of autonomic neuropathy linked with LUTS, such as urge incontinence.

Immunomodulatory imide drugs inhibit human detrusor smooth muscle contraction and growth of human detrusor smooth muscle cells, and exhibit vaso-regulatory functions

BackgroundThe immunomodulatory imide drugs (IMiDs) thalidomide, lenalidomide and pomalidomide may exhibit therapeutic efficacy in the prostate. In lower urinary tract symptoms (LUTS), voiding and storage disorders may arise from benign prostate hyperplasia, or overactive bladder. While current therapeutic options target smooth muscle contraction or cell proliferation, side effects are mostly cardiovascular. Therefore, we investigated effects of IMiDs on human detrusor and porcine artery smooth muscle contraction, and growth-related functions in detrusor smooth muscle cells (HBdSMC). MethodsCell viability was assessed by CCK8, and apoptosis and cell death by flow cytometry in cultured HBdSMC. Contractions of human detrusor tissues and porcine interlobar and coronary arteries were induced by contractile agonists, or electric field stimulation (EFS) in the presence or absence of an IMID using an organ bath. Proliferation was assessed by EdU assay and colony formation, cytoskeletal organization by phalloidin staining, ResultsDepending on tissue type, IMiDs inhibited cholinergic contractions with varying degree, up to 50 %, while non-cholinergic contractions were inhibited up to 80 % and 60 % for U46619 and endothelin-1, respectively, and EFS-induced contractions up to 75 %. IMiDs reduced viable HBdSM cells in a time-dependent manner. Correspondingly, proliferation was reduced, without showing pro-apoptotic effects. In parallel, IMiDs induced cytoskeletal disorganization. ConclusionsIMiDs exhibit regulatory functions in various smooth muscle-rich tissues, and of cell proliferation in the lower urinary tract. This points to a novel drug class effect for IMiDs, in which the molecular mechanisms of action of IMiDs merit further consideration for the application in LUTS.

Validation of the area under the Watts factor curve during the voiding cycle as a novel parameter for diagnosing detrusor underactivity in females.

Detrusor underactivity (DU) is a common cause of lower urinary tract symptoms (LUTS). To date, no consensus has been reached on the urodynamic criteria for defining DU. We previously proposed the area under the curve of the Watts factor (WF-AUC) as a new parameter for diagnosing DU. By comparing previously reported five criteria for DU and WF-AUC, we analyzed whether the WF-AUC could assess detrusor contraction in women with LUTS. Using urodynamic data of consecutive 77 women with LUTS, first, we classified DU based on previously reported five criteria. Second, we assessed the potential correlation between multiple parameters and WF-AUC. Third, receiver operating characteristic curve analysis was performed to determine the cutoff value of WF-AUC for diagnosing DU based on previously reported five criteria. Fourth, a linear regression analysis was conducted and compared using multiple criteria and female bladder outlet obstruction index (BOOIf). WF-AUC was positively correlated with the maximum values of WF, bladder contractility index (BCI), and projected isovolumetric pressure 1 (PIP1) with correlation coefficients of 0.63, 0.57, and 0.34, respectively. AUC for diagnosing DU based on previously reported five criteria ranging from 0.773 to 0.896 with different cutoff values of AUC-WF. The Spearman's correlation test revealed that BOOIf was significantly correlated with BCI, but not Wmax, PIP1 and WF-AUC. This study demonstrated the non-inferiority of the WF-AUC compared to previously reported criteria for defining DU. Depending on the cutoff value, the WF-AUC could appropriately evaluate women with DU, regardless of the presence of BOO.

Influence of regulatory peptides on neurogenic lower urinary tract dysfunction in multiple sclerosis. Data of one center

Objective: Cclinical evaluation of the effectiveness and safety of the effect of the regulatory polypeptide drug on neurogenic overactive bladder (OAB) in patients with multiple sclerosis (MS).Materials and methods: 41 patients with MS and urodynamically confirmed detrusor overactivity were included in a prospective, single-center, simple comparative clinical trial with sequential drug changes. The initial function of the lower urinary tract and its dynamic changes during therapy were studied by filling out a voiding diary and questionnaires using the EDSS, NBSS, SF-Qualiveen, I-QOL questionnaires. The control drug Solifenacin (patient group 1) is a specific competitive antagonist of muscarinic receptors of the M3 subtype, which causes detrusor contraction. The Study Drug (patient group 2) is a complex of regulatory polypeptides that have an organotropic effect on the bladder. Drug administration: control drug for 4 weeks, then an observation period of 4 weeks, after which - taking the Study Drug for 30 days. The results were monitored immediately after the end of taking the Study Drugs, after which they were compared with the initial data. Statistical analysis was carried out by the program “Statistica 10” (StatSoft Inc., USA), using non-parametric data analysis with median analysis, Wilcoxon test and Mann-Whitney U-test search. The results of differences were considered statistically significant if the probability of error was &lt;5% (p&lt;0.05).Results: Vvoiding diary: 14.6% and 24.4% of patients in groups 1 and 2, respectively, were freed from urinary incontinence; from nocturia —- 31.7% and 56.1% of patients for groups 1 and 2, respectively, the frequency of daily urination was normalized in 53.6% and 70.7% of patients in groups 1 and 2, respectively. NBSS questionnaire: decrease in the total questionnaire score by 29.2% and 47.4% for groups 1 and 2, respectively. SF-Qualiveen questionnaire: an increase in the overall assessment score by 42.3% for group 1 versus +66.5% for group 2. I-QOL questionnaire: improvement in quality of life by 56.0% and 80.4% for groups 1 and 2, respectively. The Study Drug has a higher safety profile compared to Solifenacin.Conclusion: Tthe effectiveness of the Study Drug in the correction of neurogenic OAB is higher in comparison with Solifenacin, which is reflected in a decrease in urgency, pollakiuria, the number of episodes of urinary incontinence and a significant improvement in the quality of life of these patients. The Study Drug demonstrates a high safety profile in the study.

Transcutaneous posterior tibial nerve stimulation on demand during multichannel urodynamics: A new approach in the management of overactive bladder

Background:Overactive Bladder Syndrome (OAB) affects individuals across all ages and genders, reducing quality of life. Although Transcutaneous Posterior Tibial Nerve Stimulation (TTNS) is an effective treatment, its acute effects on OAB remain underexplored. Objectives:This study aimed to assess the acute effects of TTNS on OAB through invasive urodynamics (UDI), using an intermittent, on-demand approach; with a focus on urinary urgency as the central axis for its application. Methods:A proof-of-concept trial was conducted involving patients with OAB symptoms and no previous treatment. An initial urodynamic evaluation (UDI DG) identified patients with detrusor overactivity (DO) associated with urgency, who then received on-demand TTNS during a second urodynamic study (UDI TENS). Parameters measured included the number of involuntary detrusor contractions (IDC), episodes of urge urinary incontinence (UUI), and maximum cystometric capacity (MCC). Statistical significance was assessed using Student’s t-test and Wilcoxon test, with a p-value ≤ 0.05 chosen as significance threshold. Results:Of the initial twenty-nine participants, 12 completed the study. UDI DG measurements showed an average of 3.33 ± 1.3 IDCs, 0.67 ± 0.98 UUI episodes, and MCC of 235 ± 79 ml. During UDI TENS results demonstrated a significant reduction in IDCs to 0.08 ± 0.29 (p ≤ 0.001), an absence of UUI episodes, and an increase in MCC to 315 ± 83 ml (p = 0.00012). Conclusions:Our findings suggest that an acute, on-demand TTNS protocol is effective for managing OAB symptoms and improvement of UDI parameters. However, the limited number of participants and absence of a control group highlight the need for further research through larger, controlled studies.

Short-term effects of suprapubic catheterization on detrusor muscle contraction in a rat model of postoperative urinary dysfunction

Catheterization is commonly performed in pelvic surgery to manage postoperative urinary dysfunction. However, little is known about the effects of catheterization on bladder function, although catheterization can drain urine from the bladder. In the present study, we evaluated the short-term effects of catheterization on detrusor muscle contraction in a rat model of postoperative urinary dysfunction due to bilateral accessory nerve injury (BACNI). Ten-week-old male Wistar/ST rats were divided into sham, sham＋catheterization (sham＋C), BACNI, and BACNI＋catherterization (BACNI＋C) groups. The sham＋C and BACNI＋C groups underwent catheter placement in the bladder dome prior to sham or BACNI surgery and intermittent bladder drainage during the observation period. Four hours after surgery, the bladders were excised and subjected to isometric tension study and immunofluorescence staining. Bladder overdistension and overflow urinary incontinence were observed in the BACNI group, not the BACNI＋C group. The contractile responses of the detrusor muscle to 80 mM KCl, carbachol, and electrical field stimulation (EFS) were enhanced in the BACNI group compared to the sham group; the enhanced contractile responses to EFS were improved in the BACNI＋C group. The ratio of the detrusor muscle layer area to the total bladder area increased with increasing interstitial area ratio in the BACNI and BACNI＋C groups, while the total bladder area increased in the sham＋C and BACNI＋C groups. These results suggest that catheterization does not improve the augmentation of detrusor muscle contraction and increase in the detrusor muscle layer area ratio immediately after BACNI and that catheterization causes bladder hypertrophy.

Intradetrusor Versus Suburothelial Onabotulinum Toxin A in Adults with Neurogenic and Non-neurogenic Overactive Bladder Syndrome: A Meta-Analysis.

This systematic review and meta-analysis aimed to compare the effectiveness and safety of submucosal injection of onabotulinum toxin A (OnabotA) with intradetrusor injection for overactive bladder syndrome (OAB). This systematic review is registered with PROSPERO (CRD42021237964). A licensed librarian surveyed Medline, EMBASE, Scopus, and Google Scholar databases to conduct a comprehensive search. Studies comparing suburothelial and intradetrusor techniques of OnabotA injection for OAB were included, along with clinical and urodynamic variables and complications. The studies were assessed for quality on the basis of Cochrane Collaboration guidelines and evaluated using statistical analysis via a random-effect model and I2 statistic. Data extraction and analysis were conducted using Covidence systematic review platform and Review Manager software. Six studies with 299 patients were included in the systematic review, with four reporting that suburothelial injection of OnabotA was as effective as intradetrusor injection and two reporting intradetrusor injection to be more effective. The meta-analysis found no significant difference between the suburothelial and intradetrusor groups for mean daily catheter or voiding frequency (mean difference: 2.12 [95% confidence interval (CI): -1.61, 5.84]) and the mean number of urgency/urge incontinence episodes (mean difference: 0.08 [95% CI: -1.42, 1.57]). However, a significant heterogeneity was found among the studies. Only the mean volume at first detrusor contraction showed a significant difference, being higher for suburothelial injection (mean difference: 33.39 [95% CI: 0.16, 66.63]). No significant difference was noted for mean compliance, mean bladder capacity, and mean maximum detrusor pressure. Urinary tract infections (UTIs) (p = 0.24) and acute urinary retention (p = 0.92) showed no significant difference between the two groups. The risk of bias varied among the studies. Suburothelial injection of OnabotA is as effective as intradetrusor injection in improving OAB symptoms, and it has similar complication rates. A higher mean volume of the first detrusor contraction was found in a urodynamic study with suburothelial injection.

Opportunity for ICS urodynamic standardization: Sensation, rectal contractions, and involuntary detrusor contractions

Introduction and Objectives:The International Continence Society (ICS) has published essential documents standardizing urodynamic technique and reporting. Currently, no consensus exists regarding patient prompts for bladder sensation, particularly in the setting of impaired bladder sensation (e.g. spinal cord injury) (SCI). Similarly, no published standardization exists for the reporting of rectal contractions or duration and amplitude of involuntary detrusor contractions (IDCs). We evaluated current practice patterns among ICS urodynamicists regarding sensation prompts, mention of rectal contractions, and the extent to which involuntary detrusor contractions are described. Methods:A Qualtrics urodynamic testing survey was distributed via email to all ICS members twice over a 2 week period. The survey included 18 questions regarding provider and practice characteristics, urodynamic practice patterns, coaching prompts given to patients regarding sensation during urodynamic testing, and documentation of rectal and involuntary detrusor contractions (IDCs). Data were analyzed using descriptive statistics. Results:Of 2859 ICS members, 614 (21%) returned surveys. Of these, 35 did not perform urodynamic testing and 142 surveys were incomplete. Thus, 437/614 (71%) surveys were included in our analysis. Participants were most commonly fellowship-trained female functional urologists (40%) and practiced in a government service hospital (46.4%). Half of the providers (56%) are present for the study 100% of the time. Most participants instructed patients on how to report sensation during testing (57%). First Sensation (86%), First Desire (85%), Strong Desire (93%), and Urgency (86%) were the parameters most utilized. Various prompts for each of the UDS sensation parameters were reported including repeating ICS definitions and real-life analogies. 45% of respondents altered instructions for patients with impaired sensation (e.g. SCI), 59% commented on the presence or absence of rectal contraction, and 70% characterized the amplitude and duration of involuntary detrusor contractions in their reports. Conclusion:Although most survey participants report they standardize urodynamic instructions, there is no consensus for sensation prompts within ICS urodynamic practice publications. Urodynamic testing practice patterns vary widely among ICS urodynamicists with respect to sensation prompts, modified instructions for those with impaired sensation, and reporting of rectal contractions and involuntary detrusor contractions. Opportunity exists for further standardization of good urodynamic practice in published guidelines.

Is detrusor overactivity with detrusor underactivitylimited to the elderly?

Detrusor overactivity with detrusor underactivity (DO-DU) is classically described in frail institutionalized elderly patients, but we have also observed this diagnosis in younger populations. This research aims to identify the differences between two age groups of DO-DU patients. This study included DO-DU patients from a single center from 2012 to 2023. Patients were divided into two groups: the "Younger" group (aged less than 70 years) and the "Older" group (aged 70 years or older). We separately compared demographics, the number of risk factors considered to affect bladder function, clinical presentations, and urodynamic findings between these two groups in each gender. There were 210 patients included in the analysis, with 50.48% in the younger group and 49.52% in the older group. The median ages of males and females in the younger group were 57 and 62 years, whereas the median ages of males and females in the older group were 76.5 and 76 years. Multiple sclerosis exhibited statistically significant prevalence in the younger patients (7.7% vs. 0%, p = 0.03 in males and 19.9% vs. 4.6% in females). While diabetes mellitus (DM) was more prevalent in the older males (20.0% vs. 4.6%, p = 0.01), transabdominal hysterectomy was more common in the younger females (46.3% vs. 25%, p = 0.04). 69.8% of the younger group and 71.2% of the older group have at least one risk factor that impact their bladder function. There was no statistically significant difference between the two groups across various risk factor categories. The older males reported a higher incidence of urgency (78.3% vs. 58.5%, p = 0.02) and urge incontinence (61.7% vs. 32.3%, p < 0.01), while the younger females reported a higher incidence of straining during voiding on history (46.3% vs. 20.5%, p = 0.01). The younger males exhibited a greater volume of strong desire to void (385vs. 300 mL, p = 0.01), maximal cystometric capacity (410vs. 300 mL, p < 0.01), and a lower highest detrusor overactivity (DO) pressure (37vs. 50.5 cmH2O, p = 0.02). The younger group had a higher postvoid residual (170vs. 85 mL in males, p < 0.01 and 180vs. 120 mL in females, p = 0.02). The voiding efficiency was lower in younger females (40% vs. 60%, p = 0.02). In both ages, the ICS detrusor contraction indexand projected isovolumetric pressure 1were similar. However, without considering risk factors, the older males had the highest DO pressure (57vs. 29 cmH2O, p < 0.01), and the younger males had a higher voiding pressure (PdetQmax) than the older males (28 vs. 20 cmH2O, p = 0.02). DO-DU is not exclusive to elderly patients. It can also be diagnosed in individuals with risk factors regardless of age; therefore, clinicians need a high degree of suspicion, especially in patients who have risk factor(s) for DO and DU. A notable clinical differentiation is that older males diagnosed with DO-DU have a higher incidence of urgency and urge urinary incontinence, while younger females have a higher incidence of straining.

448 Motor Control of Bladder Function by Nerve Transfer

INTRODUCTION: A normal detrusor muscle is activated by parasympathetic efferents that release acetylcholine to muscarinic receptors to contract and expel urine. Through canine work by our group, the scientific underpinning of a somatic nerve transfer to a visceral target (hybrid synapse) was established. We present the scientific basis of this hybrid nerve transfer and report the first-in-human functional outcome. METHODS: Our patient presented with deteriorating bladder function over 1 year and underwent en bloc resection of a sacral chondrosarcoma in December 2020. The sacral roots from S1 caudally were divided – resulting in loss of bowel and bladder function. Urodynamics demonstrated an acontractile bladder (0 cm H20). In May 2021 bilateral obturator nerve transfers to the vesical branches (to bladder) of the inferior hypogastric plexus (6 months after surgery). Patient bladder function and pelvic visceral sensation were followed with serial urodynamic studies. RESULTS: The patient was asked to adduct the thighs and relax the abdomen to initiate a detrusor (bladder) contraction. This provided definitive activation of the nerve transfer in November 2022 (1.5 years after transfer), which was confirmed in January 2023 (∼20 cm H20). Concomitantly, the filling volume at which “full bladder” was perceived appeared at 6 months and progressed until detected within normal range of bladder volumes. CONCLUSIONS: This is a first-in-human nerve transfer that has clear evidence of visceral sensation recovery (need to void) at normal volumes, and functional detrusor contraction. While bladder pressures produced were not within normal range, we expect transfers earlier after loss of function (e.g. within 6 months instead of 18) will result in greater functional gains.

A study evaluating and comparing the effectiveness of combination therapy – Duloxetine with darifenacin versus darifenacin as monotherapy on perception of symptoms, quality and standard of life in patients suffering with overactive bladder (OAB)

: Overactive bladder is chronic debilitating condition, with physical, psychological, and economical consequences. Urinary vesicle tissue contains muscarinic receptors, M3 is principal mediator of detrusor contraction. Muscarinic receptor antagonists, comprises traditional pharmacological treatment. But due to non-selective inhibition, these agents, probably been related with safety and tolerability concerns. Drugs particular inhibiting sM3 receptor (Darifenacin) have potential to present effective relief while reducing side effects concerned with blockade of M1, M2 and M5 receptors. Duloxetine is Serotonin and nor-epinephrine reuptake inhibitor, leading increased concentration of 5-HT and NE in synaptic cleft, increases stimulation of pudendal motor neurons, thus increasing resting tone and contraction of urethral sphincter.: In present prospective, randomized, parallel group, comparative open label study with 60 OAB patients the combination therapy of Duloxetine with Darifenacin was equated with monotherapy using Darifenacin. The outcome thus analyzed using three different OAB-questionnaires and was statistically compared. : We demonstrated that addition of Duloxetine has shown better result outcome in symptoms as well as quality of life, though the difference of OAB-V8, OABss mean score was non-significant, but for OAB-qSF the reduction (percentage change) in mean score was more in treatment group II as compare to group I (w6:13.82±3.17% vs 12.13±3.24% &amp; W12 29.99±5.40% Vs 25.56±5.17%) , and was statistically significant.(p&amp;#60;0.05).: Duloxetine has synergistic effect to Darifenacin, its ability to increase bladder capacity may be the reason for the improvement OAB symptoms, promising in controlling and treating symptoms either alone or in combination with anti-cholinergic drugs.

Evaluation of risk factors of postpartum urinary retention after vaginal delivery

BackgroundUrinary retention is a condition where a person is unable to urinate even after making sufficient efforts. It can be classified as either acute or chronic, as well as overt or covert. Urinary retention can be caused by various factors such as poor detrusor muscle contraction, a decrease in bladder contractility, anatomical anomalies, impaired neurological coordination while urinating, and disruption of outlet relaxation. The objective of this study was to identify the risk factors of postpartum urinary retention (PPUR) after vaginal delivery. MethodsA cross-sectional study was conducted involving 500 female subjects who were in labor. All data obtained including variables such as age, parity, perineal rupture, episiotomy, history of using assisted vaginal birth during labor, and newborn weight, were compared between female subjects with and without postpartum urinary retention. The data were was analyzed using chi square test and multiple logistic regression analyses as a means to identify risk factors for PPUR. Results Among the 500 patients recruited to our study, 68 (13.6%) had PPUR. Episiotomy and parity were found to be potential risk factors for PPUR (OR=1.84;95% CI = 1.06-3.18 and OR=2.19;95% CI = 1.16-4.12, respectively). Severe perineal rupture was not a risk factor of PPUR (OR= 0.82;95% CI =0.82-5.89). ConclusionThe prevalence of PPUR was quite high. Risk factors identified for PPUR were parity and episiotomy. In clinical practice, healthcare providers should pay more attention to women with these risk factors to prevent PPUR.