Detrusor Instability Research Articles

Comparing the incidence of postoperative painful bladder spasm between malecot catheter and 3-way Foley catheter: a clinical trial.

In this study, the effect of Pezzer (as a Pezzer catheter) and three-way Foley catheters, used for suprapubic catheterization after open prostatectomy, was investigated in terms of early incidence of painful bladder spasms. In this single-blind clinical trial study, 160 patients diagnosed with LUTS/BPH were placed in two groups of 80 Pezzer catheter (Pezzer(size 28)) and three-way Foley catheters (size 24) for suprapubic catheterization. The evaluated variables in this study are age, prostate weight, narcotics dose, Spasm frequency, International Prostate Symptom Score (IPSS), visual analogue scale (VAS), catheterization period. The frequency of spasm in Foley group was significantly lower (4.4±7.26 vs. 6.28±4.4; P value=0.000). There was no significant difference between the two groups regarding the frequency of dysuria (P value=0.3). The findings of our study showed that despite slightly favourable results in using suprapubic Foley catheter compared to Pezzer catheters in patients with open prostatectomy in terms of pain and spasm frequency, there was no significant difference between the use of these two types of catheters.

It is not the best option to perform transurethral enucleation of the prostate immediately after biopsy in patients with histological inflammation.

This study seeks to investigate the impact of histopathological evidence of histological prostatic inflammation (PI) on the surgical outcomes of patients with benign prostatic hyperplasia (BPH) undergoing transurethral bipolar enucleation of the prostate (BiLEP) after biopsy. We conducted a prospective study in which data were collected from 112 patients with BPH who underwent BiLEP immediately after prostate biopsy at the Department of Urology in our hospital between October 2020 and October 2023. This cohort included 52 patients with histopathological prostatic inflammation (BPH + PI group) and 60 patients with simple BPH (BPH group). Baseline characteristics, surgical details, International Prostate Symptom Score (IPSS), quality of life (QoL), post-void residual volume (PVR), maximum flow rate (Qmax), International Index of Erectile Function-5 (IIEF-5), postoperative pathology results, and surgical complications were compared between the two groups. The study findings indicate that in patients with BPH who underwent BiLEP, various parameters in the BPH + PI group including operation time, intraoperative flushing volume, hemoglobin drop value, postoperative white blood cells, postoperative C-reactive protein, and average pain score at 3 days postoperatively were significantly higher compared to those in the BPH group (p < 0.01). In addition, the IPSS and IIEF-5 scores of the BPH + PI group were significantly worse before surgery and at 2 weeks postoperatively compared to the BPH group (p < 0.01); however, no significant differences were observed between the two groups at 1 and 3 months postoperatively (p > 0.05). At 2 weeks postoperatively, the BPH + PI group exhibited significantly worse outcomes in terms of QoL, PVR, and Qmax compared to the BPH group (p < 0.01). However, there were no statistically significant differences between the two groups at 1 and 3 months postoperatively (p > 0.05). The incidence rates of postoperative complications, such as fever, prostatic capsule perforation, urinary tract irritation, bladder spasm, acute epididymitis, urinary tract infection, and urethral stricture, were higher in the BPH + PI group compared to the BPH group (p < 0.05). Nevertheless, there was no significant difference in the overall complication rates between the two groups (p > 0.05). There were no statistically significant differences observed between the two groups in postoperative irrigation volume, extubation time, hospitalization time, proportion of secondary operations, proportion of bladder injury, and proportion of urinary incontinence (p > 0.05). However, the proportion of reported prostate cancer after surgery in the BPH + PI group was significantly higher than that in the BPH group (p < 0.05). Histopathological prostatic inflammation does not have a significant impact on the long-term efficacy of BiLEP surgery immediately after biopsy. However, it does prolong surgery time, increase surgery-related complications, and influence short-term surgical outcomes and patient treatment experience. Therefore, it may be advisable to administer a course of anti-inflammatory treatment before performing BiLEP in such patients. Nevertheless, further high-quality studies are necessary to validate this approach.

Mild moxibustion for the prevention and treatment of bladder spasms after transurethral resection of the prostate

Objective: To observe the therapeutic effect of mild moxibustion on preventing and treating bladder spasms after transurethral resection of the prostate. Method: The control group patients were given routine perioperative care, while the experimental group patients were given mild moxibustion on Taixi, Zhongji, Qihai, and Shenque points in addition to routine perioperative care. Result: The frequency of bladder spasms, degree of pain, and degree of bladder spasms in the experimental group were significantly better than those in the control group, and the differences were statistically significant (P&lt;0.05). Conclusion: Mild moxibustion is safe and reliable in preventing and treating bladder spasms after transurethral resection of the prostate.

Construction of early warning classification of risk in bladder spasm and its intervention plans guided by the rate adjustment card of continuous bladder irrigation after transurethral resection of the prostate (TURP): development and usability study

Construction of early warning classification of risk in bladder spasm and its intervention plans guided by the rate adjustment card of continuous bladder irrigation after transurethral resection of the prostate (TURP): development and usability study

Peripheral muscle force balance/imbalance in neurological binary control of bladder function and dysfunction.

Bladder control is not from the bladder itself but from muscles and ligaments outside of it. Bladder control is binary, either closed or open. Control is exerted cortically, directly and via a peripheral pelvic mechanism comprising three reflex pelvic muscles which contract (variously) against pubourethral ligaments (PULs) anteriorly and uterosacral ligaments (USLs) posteriorly. Directed efferent impulses from the cortex close the urethra, open it, and stretch the vagina in opposite directions to prevent urothelial impulses inappropriately activating micturition (urge incontinence). Normally, the opposite muscles are equivalent in force, and balance at the bladder neck. Weak PULs weaken the forward closure force: the posterior forces become relatively more powerful; balance shifts behind bladder neck; the posterior urethral wall is pulled open like a trapdoor, and urine is lost on effort (stress urinary incontinence). Weak USLs weaken the posterior muscle forces; the balance of forces shifts forwards, and the urethra is closed relatively more tightly by slow-twitch forward muscle vector forces (pubococcygei), which stretch each side of the distal vagina forwards to compress the posterior urethral wall; in consequence, the weakened posterior muscle forces cannot easily open the posterior urethral wall; the bladder has to contract against a relatively unopened urethra, perceived as "obstructed micturition". Nor can weakened posterior forces stretch the vagina sufficiently to support the urothelial stretch receptors from below; these may fire off excess afferent impulses to cause urgency. As bladder control is strictly binary, in women with urgency, control swings between open and closed modes. This condition is known as an "unstable bladder", which is defined symptomatically as "overactive bladder", and urodynamically as "detrusor overactivity". In summary, bladder control is binary, either closed or open. How the cortex integrates and computes multiple inputs determines the type of closure, opening or unstable control which is experienced by the patient.

Evaluation of an Opioid-free Pathway for Perineal Reconstructive Surgery: A 1-year Pilot Study

ObjectiveTo evaluate the impact of a standardized perioperative pain management pathway on postoperative opioid prescribing practices following male perineal reconstructive surgery at our institution. MethodsPatients undergoing perineal reconstructive surgery (urethroplasty, artificial urinary sphincter, urethral sling) by a single surgeon from July 2022 to June 2023 were prospectively followed. A standardized nonopioid pathway was implemented in the perioperative period. Intraoperative local anesthetic included liposomal bupivacaine mixed with 0.25% bupivacaine. Opioids are administered in the recovery room at the discretion of anesthesiology providers. As of July 2022, our standard practice does not include a postoperative opioid prescription unless pain is poorly controlled in the recovery area. Postoperative communication encounters and opioid prescriptions were tracked through the electronic health record in order to assess the efficacy of an opioid-free pathway. Results67 patients met criteria during the study period, 64/67 performed in an outpatient setting. 6/67 (9%) patients were prescribed an opioid postoperatively; 4 related to post-surgical pain, and 2 related to chronic pain. No refills were prescribed. Of the 26 patients who received an opioid in the recovery area, 2 (7.6%) were prescribed an opioid at discharge. 15/67 (22%) patients had a communication encounter related to pain within 30 days, most commonly related to bladder spasm management. Only 2 of these encounters resulted in an electronic opioid prescription. ConclusionAn opioid-free pathway is appropriate for opioid naïve men undergoing perineal reconstructive surgery. When necessary, electronic opioid prescribing should be employed following discharge for breakthrough pain.

Age-Dependent Effects of Oxytocin and Oxytocin Receptor Antagonists on Bladder Contractions: Implications for the Treatment of Overactive Bladder Syndrome.

Overactive bladder (OAB) is an age-related disorder characterised by unstable bladder contractions resulting in disruptive lower urinary tract symptoms (LUTS), thus creating a profound impact on an individual's quality of life. The development of LUTS may be linked to the overexpression of oxytocin receptors (OXTRs) within the bladder detrusor muscle, resulting in increased baseline myogenic tone. Thus, it is hypothesised that targeting OXTRs within the bladder using oxytocin antagonists may attenuate myogenic tone within the bladder, thereby providing a new therapeutic avenue for treating OAB. Organ bath contractility and immunohistochemistry techniques were conducted on bladder tissue sourced from young rats (7-8 weeks and 10-12 weeks) and older rats (4-5 months and 7-9 months). Organ bath studies revealed that oxytocin (OT) significantly increased bladder contractions, which were significantly attenuated by [β-Mercapto-β,β-cyclopentamethylenepropionyl1, O-Me-Tyr2, Orn8]-Oxytocin) (1 µM) (**** p < 0.0001) and atosiban (10 µM) in both young and older rats (** p < 0.01); in contrast, cligosiban (1 µM and 10 µM) did not inhibit OT-induced contractions in both young and older rats (p ≥ 0.05). Interestingly, cligosiban (1 µM and 10 µM) significantly reduced the frequency of spontaneous contractions within the bladder of both young (*** p < 0.001) and older rats (**** p < 0.0001), while atosiban (10 µM) only demonstrated this effect in older rats (** p < 0.01). Furthermore, immunohistochemistry (IHC) analysis revealed significant colocalization of nuclear-specific oxytocin receptors (OXTRs) in the contractile (smooth muscle) cells within young (** p < 0.01) and older rats (* p < 0.05), indicating OT may be a key modulator of bladder contractility.

Incidence and Determinants of Catheter-Related Bladder Spasms Following Transurethral Resection of the Prostate; A Prospective Review of 80 Cases.

Bladder spasms due to involuntary contraction of the bladder occur frequently following Transurethral resection of the prostate (TURP). They may be aggravated by the presence of a catheter, blood clots, preoperative overactive bladder, or preoperative ingestion of bladder stimulants like caffeine. These bladder spams are painful, associated with peri-catheter leakage of urine, increased post-operative bleeding, and often refractory to postoperative analgesia. The incidence and risk factors for the occurrence of bladder spasms following TURP need to be reviewed and validated to ensure adequate patient counseling and possible lifestyle modification before surgery. We conducted a prospective review of the determinants of bladder spasms in our patients following TURP. The study population was patients with benign prostatic obstruction scheduled for TURP between March 2022 and April 2023. Monopolar transurethral resection of the prostate was done using a continuous flow resectoscope. The primary endpoint of the study was occurrences of bladder spasms postoperatively before the trial without a catheter. Pain perception during the spasms was assessed using a visual analog scale. Clinical data were collected and analyzed to determine their association with the occurrence of bladder spasms postoperatively using regression analysis. Sub-group analysis was also done to correlate significant variables with the severity of pain in patients with spasms. The mean age of the 80 patients reviewed was 66.9 ±8 years. Bladder spasms were seen in 41(51.2%) of the patients. The presence of overactive bladder (OAB) symptoms and the use of bladder stimulants were statistically significant determinants with a p-value of 0.003 and 0.026 respectively. The age of the patient, preoperative indwelling catheter, prostate volume, and resection time were not statistically determinant variables in the occurrence of bladder spasms post-operatively. 61% had severe pains and 39% had mild pains. There was no significant correlation between the presence of OAB or the use of bladder stimulants with the severity of pains in patients with bladder spasms after TURP. Half of the patients are likely to have bladder spasms after TURP. The risk of having these spasms is higher in patients with preoperative OAB or patients who are exposed to bladder stimulants. The severity of spasms is however independent of these risk factors.

A nomogram model for the occurrence of bladder spasm after TURP in patients with prostate enlargement based on serum prostacyclin and 5-hydroxytryptamine and clinical characteristics.

With the development of analytical methods, mathematical models based on humoral biomarkers have become more widely used in the medical field. This study aims to investigate the risk factors associated with the occurrence of bladder spasm after transurethral resection of the prostate (TURP) in patients with prostate enlargement, and then construct a nomogram model. Two hundred and forty-two patients with prostate enlargement who underwent TURP were included. Patients were divided into Spasm group (n=65) and non-spasm group (n=177) according to whether they had bladder spasm after surgery. Serum prostacyclin (PGI2) and 5-hydroxytryptamine (5-HT) levels were measured by enzyme-linked immunoassay. Univariate and multivariate logistic regression were used to analyze the risk factors. Postoperative serum PGI2 and 5-HT levels were higher in patients in the Spasm group compared with the Non-spasm group (P<0.05). Preoperative anxiety, drainage tube obstruction, and elevated postoperative levels of PGI2 and 5-HT were independent risk factors for bladder spasm after TURP (P<0.05). The C-index of the model was 0.978 (0.959-0.997), with a χ2 = 4.438 (p = 0.816) for Hosmer-Lemeshow goodness-of-fit test. The ROC curve to assess the discrimination of the nomogram model showed an AUC of 0.978 (0.959-0.997). Preoperative anxiety, drainage tube obstruction, and elevated postoperative serum PGI2 and 5-HT levels are independent risk factors for bladder spasm after TURP. The nomogram model based on the aforementioned independent risk factors had good discrimination and predictive abilities, which may provide a high guidance value for predicting the occurrence of bladder spasm in clinical practice.

Non-Neurogenic ‘Christmas Tree’ Urinary Bladder in A 30-Year-Old Man with Urethral Stricture: A Case Report

condition the urinary bladder appears elongated and pointed with a thickened, trabeculated wall likened to a Christmas tree. It is most commonly the result of neurogenic bladder from detrusor hyperreflexia which most commonly occurs after spinal trauma. Christmas tree bladder also may rarely be seen in cases of bladder neck obstruction of non- neurogenic cause. A 30-year-old male presented with two weeks history of leakage of urine par the perineum. There was prior history of urethral discharge, poor urinary stream, urine dribbling and dysuria. No history of genital trauma, urethral instrumentation or catheterization in past. Attempt at passage of urethral catheter failed. He subsequently had open supra pubic cystostomy. Ultrasonography shows multiple internal echoes in the urine with thickened irregular bladder wall. The upper urinary tract was normal. Combine RUG and VCUG demonstrate short segments strictures at the bulbar and membranous urethra. A track of contrast column was noted from the region of the bulbar stricture to the exterior consistent with urethro-cutaneous fistula. The urinary bladder appears large, elongated superiorly with irregular outline resembling ‘Christmas tree’ configuration.

Acute toxicity outcomes from salvage high-dose-rate brachytherapy for locally recurrent prostate cancer after prior radiotherapy.

Isolated intra-prostatic recurrence of prostate adenocarcinoma after definitive radiotherapy presents a challenging clinical scenario. Salvage options require specialized expertise and pose risks of harm. This study aimed to present the acute toxicity results from using salvage high-dose-rate brachytherapy (sHDR-BT) as treatment in locally recurrent prostate cancer cases. Seventeen consecutive patients treated with sHDR-BT between 2019 and 2022 were evaluated retrospectively. Eligible patients had to have received curative intent prostate radiotherapy previously, and showed evidence of new biochemical failure. Evaluation with American Urological Association (AUA) and Common Terminology Criteria for Adverse Events (CTCAE) symptom assessments were performed for each case. The median (inter-quartile range) age prior to salvage treatment was 68 (66-74) years. The median post-sHDR-BT follow-up time was 20 (13-24) months. At baseline prior to sHDR-BT, 8 (47%) patients had significant lower urinary tract symptoms. The median AUA score prior to sHDR-BT was 7 (3-18). Three (18%) patients reported irregular bowel function and 2 (12%) reported hematochezia prior to sHDR-BT. One-month post-treatment, the median AUA score was 13 (8-21, p = 0.21). Using CTCAE scoring, there were no cases of grade 2+ bowel or rectal toxicity, and no cases of grade 3+ urinary toxicity. Reported grade 2 urinary toxicities included 10 (59%) cases of bladder spasms, 2 (12%) cases of incontinence, 1 (6%) urinary obstruction, and 4 (24%) reports of urinary urgency. All these adverse events were temporary. This study adds to the existing literature by demonstrating that the acute toxicity profile of sHDR-BT is acceptable even without intra-operative magnetic resonance (MR) guidance or image registration. Further study is ongoing to determine long-term efficacy and toxicity of treatment.

Analysis of complications of neurogenic bladder dysfunction in children

Dysfunction of the lower urinary tract is a fairly common consequence of perinatal lesions of the nervous system. Dysfunction of the bladder and muscles of the urogenital diaphragm in this group of children can be accompanied by severe urodynamic disorders and, in some cases, can lead to complications such as chronic recurrent urinary tract infection, vesicoureteral reflux, nephrosclerosis, kidney atrophy, chronic renal failure. Purpose. To study uronephrological complications in children with various forms of neurogenic bladder dysfunction and suggest methods for their prevention and pathogenetic treatment. Material and methods. 67 children with neurogenic bladder dysfunction were examined. All children underwent comprehensive uronephrological and neurological diagnostics using objective neuroimaging, electrophysiological and functional research methods. Results. Complications leading to somatic health disorders in patients were diagnosed. These included chronic cystitis — in 13 (19.4%) patients, chronic pyelonephritis — in 57 (85.1%), vesicoureteral reflux — in 25 (37.3%), chronic renal failure — in 8 (11.9%) children. Therapy for neurogenic bladder dysfunction consisted of basic therapy of the central nervous system lesion, as well as symptomatic therapy aimed at normalizing the functional state of the bladder. In the vast majority of cases of neurogenic bladder dysfunction complications, their relief occurred within a year in the process of curing the underlying disease. In some cases, in children with severe neurological disorders (myelodysplasia, meningoradiculocele), along with medication and physiotherapy, surgical manipulations (periodic bladder catheterization) and surgical interventions (epicystostomy) were performed. Conclusion. In children with detrusor hyperreflexia and mild «high» lesions of the nervous system, clinical symptoms of neurogenic bladder dysfunction were usually noted, worsening only their quality of life. In children with a significant neurological deficit and a rather severe lesion of the lumbosacral spinal cord, complications developed that worsened the somatic health of this group of patients.

Effect of electroacupuncture on urodynamics and Raf/MEK/ERK signaling pathway in spinal cord tissue of rats with detrusor hyperreflexia after suprasacral spinal cord injury.

To observe the effect of electroacupuncture (EA) on urodynamics and Raf/MEK/ERK signaling pathway in spine cord tissue of rats after suprasacral spinal cord injury (SSCI), so as to explore its possible mechanism in improving bladder function in rats with detrusor hyperreflexia after SSCI. Female SD rats were randomly divided into blank, sham operation, model, EA and EA+PD98059 groups, with 12 rats in each group. Thorax (T) 10 spinal cord transection was performed by surgery. Rats in the EA group were given EA (10 Hz/50 Hz, 20 min) at "Ciliao" (BL32), "Zhongji" (CV3), "Sanyinjiao" (SP6) and "Dazhui" (GV14) once daily for 7 d. Rats of the EA+PD98059 group received intraperitoneal injection of PD98059 (5 mg/kg) 2 h before EA intervention. The urodyna-mics was used to measure the base pressure, leak point pressure, maximum pressure, maximum capacity and comp-liance of bladder, and the morphology of bladder detrusor tissue was observed with HE staining. The TUNEL staining was used to detect the cell apoptosis of the spinal cord tissue. The expression levels of exchange protein directly activated by cAMP 2 (Epac2), Rap, phosphorylated rapidly accelerated fibrosarcoma (p-Raf), phosphorylated mitogen-activated extracellular signal-regulated kinase (p-MEK), phosphorylated extracellular signal regulated kinase 1 and 2 (p-ERK1/2), B-cell lymphoma-2 (Bcl-2), and Bcl-2 associated X protein (Bax) were determined by Western blot. Compared with the sham operation group, the base pressure, leak point pressure and maximum pressure of bladder were significantly increased (P<0.01), the maximum bladder capacity and bladder compliance were decreased (P<0.01), the cell apoptosis rate of spinal cord tissue was increased (P<0.01), and the expression levels of Epac2, Rap, p-Raf, p-MEK, p-ERK1/2, and Bcl-2 protein in spinal cord tissue were decreased (P<0.01), while the expression level of Bax protein was increased (P<0.01) in the model group. After the treatment and compared with the model group, the base pressure, leak point pressure and maximum pressure of bladder, the cell apoptosis rate of spinal cord tissue, the expression level of Bax protein were decreased (P<0.05) in the EA group, while the maximum bladder capacity and bladder compliance, the expression levels of Epac2, Rap, p-Raf, p-MEK, p-ERK1/2, and Bcl-2 protein in spinal cord tissue were all increased (P<0.05, P<0.01). In comparison with the EA group, the base pressure, leak point pressure and maximum pressure of bladder, the cell apoptosis rate, the expression level of Bax protein were significantly increased (P<0.05), whereas the maximum bladder capacity, bladder compliance, and the expression levels of p-MEK, p-ERK1/2, and Bcl-2 protein were decreased (P<0.05) in the EA+PD98059 group. Results of HE staining showed disordered transitional epithelial cells and destroyed lamina propria in bladder detrusor tissue, with the infiltration of monocytes in the model group, which was obviously milder in both EA and EA+PD98059 groups, especially in the EA group. EA can improve the bladder function in detrusor hyperreflexia rats after SSCI, which may be related to its effect in up-regulating Epac2 and Rap, activating the Raf-MEK-ERK pathway, and reducing the cell apoptosis of spinal cord tissue.

Application of Research-Based Quality Control Circle in Setting a New Management Model and Complete Standardized Care for Continuous Bladder Irrigation After TURP

Objective: To explore the application of research-based quality control circle in setting a new standardized nursing management model for continuous bladder irrigation after transurethral resection of prostate (TURP) surgery, and to provide theoretical basis and evidence-based support for standardizing the nursing management model of continuous bladder irrigation after TURP in the Department of Urology. Methods: A quality control circle was established, focusing on the existing common problems of continuous bladder irrigation. The methods include implementing appropriate measures and other steps, and comparing the incidences of bladder spasms and urinary catheter obstruction, patient satisfaction, nurses’ awareness of relevant knowledge, nurses’ operational satisfaction, number of liquid pours (6000ml per flush), and number of open exposures before and after the activity. Results: Through this quality control circle activity, the incidence of bladder spasms in patients dropped from 42% to 14.3%; the incidence of urinary catheter obstruction dropped from 36% to 12.2%; patient satisfaction increased from 82% to 95.9%; nurses’ knowledge awareness rate increased from 74.2% to 96.8%; nurses’ operational satisfaction increased from 80.6% to 96.8%; the above differences are statistically significant (P &lt; 0.05). Moreover, the number of flushing liquid pours reduced from 5 times to 1 time, and the number of open exposures reduced from 5 times to 0 times. Circle members have improved their application of quality control circle methods, team spirit, and professional knowledge. Conclusion: The research-based quality control circle is suitable for setting a new standardized nursing management model for continuous bladder irrigation after TURP.

Behavioral Training with Nursing Intervention Improves Postoperative Rehabilitation and Nutritional Status of Elderly Patients with Benign Prostatic Hyperplasia

The effect of behavioral training and nursing intervention on the postoperative recovery and nutritional status of elderly patients with benign prostatic hyperplasia was examined. The frequency and duration of bladder spasm episodes and the incidence of adverse effects were lower in the patients receiving research than in the control group (P &lt; 0.05). The self-rating anxiety scale and the self-rating depression scale decreased in both groups after the nursing intervention and were lower in the research group than in the control group (P &lt; 0.05), while the General Quality of Life Assessment Questionnaire scores increased in both groups and were higher in the research group (P &lt; 0.05). Furthermore, the level of satisfaction was significantly higher in the research group than the control group (P &lt; 0.05). Finally, the number of people with good nutritional status was higher in the research group, and the neutrophil-to-lymphocyte ratio was lower than in the control group (P &lt; 0.05). Thus, we recommend behavioral training in nursing for benign prostatic hyperplasia patients in the future to improve their postoperative rehabilitation and nutritional status.

Intravesical liposomal tacrolimus for hemorrhagic cystitis: a phase 2a multicenter dose-escalation study

BackgroundHemorrhagic cystitis (HC) is an inflammatory disease of the bladder with sustained hematuria for which there is currently no approved drug treatment. We evaluated a liposomal tacrolimus preparation (LP-10) in patients with refractory moderate to severe sterile HC.MethodsThis phase 2a dose-escalation study assessed the safety and efficacy of up to 2 intravesical instillations of LP-10 (2, 4, or 8 mg tacrolimus) in 13 patients with HC. Primary efficacy outcomes were changes from baseline in the number of bleeding sites on cystoscopy, microscopic urine analysis for red blood cells (RBCs), and hematuria on dipstick. Additional efficacy measures included urinary incontinence, frequency, and urgency on a 3-day diary and cystoscopy global response assessment (GRA). Blood samples for pharmacokinetic (PK) assessment were obtained in all patients.ResultsIntravesical LP-10 was well tolerated, with no treatment-related severe or serious adverse events (AEs) and only 3 drug-related AEs (artificial urinary sphincter malfunction, dysuria, and bladder spasms). LP-10 blood levels showed short durations of minimal systemic uptake. Treatment resulted in significant improvements in bleeding on cystoscopy, RBC counts in urine, hematuria on dipstick, and urinary incontinence. Bleeding on cystoscopy and urinary incontinence showed dose-dependent improvements that were more pronounced in the 4 mg and 8 mg dose groups. All dose groups showed a significant improvement in cystoscopy GRA.ConclusionLP-10 was well tolerated, with clinically relevant efficacy seen in improvements in cystoscopic bleeding, hematuria, and urinary incontinence. The benefit-risk profile supports the further clinical development of LP-10 at a tacrolimus dose of 4 mg.

761 Effectiveness of Chemohypothermia with Mitomycin C vs Immunotherapy with BCG in High Risk Non Muscle Invasive Bladder Cancer Patients

Abstract Aim Initial data to compare the effectiveness of Chemohypothermia with Mitomycin C (MMC) and Immunotherapy with Bacillus-Calmette-Guerin (BCG) in High risk Non muscle invasive bladder cancer (NMIBC). Method Sixty six patients who underwent Trans-urethral resection of bladder tumor (TURBT) were divided into two equal groups; hyperthermic intravesical chemotherapy group and BCG group. Six intravesical instillation's (one per week) of 40mg of hyperthermic MMC diluted in 40ml of distill water and heated at 43 C were given to patients for 60 min with HIVEC machine. For BCG group intravesical doses of BCG, once weekly for 6 weeks were administered at concentration of 80mg diluted in 50ml of normal saline. Follow up check cystoscopy at 3 months from initial TURBT was done to check effectiveness of both treatments. Patients were also accessed for side effects during the treatment. Results 28 patients (84.8%) had no recurrence and 5 patients (15.2%) had recurrence in chemohypethermia group while in BCG group 29(87.8%) patients had no recurrence and 4(12.2%) patients had recurrence. 3(9%) patients had bladder spasms, 1(3%) had hematuria, 3(9.1%) had Urinary tract infection (UTI) while 26(78.8%) had no adverse effect in Chemohyperthermia group. In BCG group, 1(3%) had bladder spasm, 4(12.4%) had hematuria, 5(15.2%) had UTI and 23(69.5%) had no adverse effect. Conclusions Chemohyperthermia is safe and efficacious treatment choice in patient suffering from NMIBC with outcomes comparable with BCG treatment and improved side effect profile.

The Effect of Pregnancy on Urinary Symptoms.

Background Urinary incontinence is a condition that causes social, medical, or hygienic problems. The increase in the incidence of stress incontinence, particularly with increasing parity, emphasizes the role of pregnancy on the etiology of incontinence and other urinary symptoms. This study aimed to estimate the effect of pregnancy on urinary incontinence and other urinary symptoms with history and urodynamic data. Methodology This study was conducted at Mustafa Kemal University, Medical Faculty, Obstetrics and Gynecology Department. A total of 72 pregnant primigravid women without any urinary problems were included in the study. Patients with severe chronic disease, neurological disorders, antepartum hemorrhage, multiple pregnancies, younger than 18, and those with physical and mental disabilities were excluded. All patients were initially evaluated in the first trimester and finally in the sixth week of the postpartum period. Demographic and obstetric data, including urological complaints and urodynamic findings, were recorded. Results There were significant increases in nocturia, frequency, dysuria, urgency, and stress urinary incontinence complaints in pregnant women. Urge incontinence was not significantly different after pregnancy. In the postpartum urodynamic studies, nine (12.5%) patients with stress urinary incontinence and six (8.3%) patients with detrusor instability were detected. There was no significant difference between cesarean section and vaginal delivery regarding incontinence. Conclusions According to the study findings, pregnant women who were continent before pregnancy could become incontinent after birth according to urodynamic data. However, long-term studies are needed to determine whether this incontinence is temporary. Additionally, according to our results, cesarean section should not be recommended over vaginal delivery only to prevent incontinence.

High-Fat and High-Sucrose Diet Leads to Skeletal Muscle Loss and Bladder Dysfunction in Rat.

In this study, we investigated skeletal muscle loss and bladder dysfunction caused by high-fat/high-sucrose (HFS) diet. Twelve-week-old Sprague-Dawley (SD) female rats were fed on normal (Group N) or HFS (Group HFS) diet for 12 weeks. We conducted urodynamic investigation and pharmacologic in vitro. In addition, we measured gastrocnemius and tibialis muscle weight and protein concentration. The hypoxia-inducible factor (HIF)-1α and 8-hydroxy-2'-deoxyguanosine (8-OHdG) in the bladder were assayed. The urodynamic investigations revealed the significantly shorter intercontraction intervals and lower maximal voiding pressure in Group HFS than in Group N. Furthermore, the absolute and relative weights of the gastrocnemius muscle were found to be significantly lower in Group HFS than in Group N. The protein concentration of the gastrocnemius muscle was also significantly lower in Group HFS than in Group N. The absolute and relative weights of the bladder were also significantly lower in Group HFS than in Group N. The contractile responses of the bladder strips to electrical field stimulation and carbachol were significantly lower in Group HFS than in Group N. The HIF1α and 8OHdG in the bladder muscle were significantly higher in Group HFS than in Group N. The HFS diet reduced bladder capacity and contractility along with the loss of the gastrocnemius muscle. HFS diet promotes bladder dysfunction similar to detrusor hyperreflexia with impaired contractility.

Management of bladder spasms in patients with indwelling urinary catheters: A systematic review

Introduction:Bladder spasms caused by indwelling urinary catheters are a serious burden in patients in all settings. Medication may help, but comes with side effects. Little has been described on non-pharmacological interventions in day-to-day care. This systematic review aims to present an overview of interventions that nurses can apply to reduce bladder spasms in patients with indwelling urinary catheters, when removing the catheter is not an option. Material and methods:A systematic review was conducted, in accordance with PRISMA-guidelines. Terms focusing on urinary catheters and bladder spasms were searched for in EAUN Guidelines, Pallialine (NL), Cochrane, Cinahl, PubMed and Embase. A quality assessment was executed, using a critical review form, resulting in low, good or high quality reports. A best-evidence synthesis was carried out for similar interventions. Strong evidence means consistent findings in more than one high-quality report. Moderate evidence means consistent findings in one good-quality and at least one low-quality report. Insufficient evidence means one report found or inconsistent findings in more than one report. Results:After deduplication of 4.208 records, 2.658 unique records were screened for inclusion criteria, resulting in 20 included reports. The quality assessment identified 15 reports of low, 4 reports of good and 1 report of high quality. The best-evidence synthesis resulted in seven interventions with moderate evidence: reduce balloon size, fixation of catheter, use catheter valve, secure urine bag, treat constipation, increase fluid intake and a balanced, fiber-rich diet. Some interventions were only described in low-quality reports, resulting in low to moderate evidence: avoid bladder irritants, wait 24–48 h, resolve blockage of catheter and tubing, place urine bag lower than bladder. Other found interventions had insufficient evidence. Discussion:Most reports found were of low or good quality. However, many articles advocate for the same interventions, resulting in seven interventions of moderate evidence. Conclusions:Five interventions with low to moderate evidence need to be researched more thoroughly. In conclusion, the following interventions, easily applied by nurses, were found: reduce the balloon size, fixate the catheter, secure the urine bag or use a catheter valve, treat constipation, increase fluid intake and advice a balanced, fiber-rich diet.