Difference In Bladder Capacity Research Articles

The potential mechanism of treating IC/BPS with hyperbaric oxygen by reducing vascular endothelial growth inhibitor and hypoxia-inducible factor-1α.

To investigate the roles of vascular endothelial growth inhibitor (VEGI) and hypoxia-inducible factor-1α (HIF-1α) in the treatment of refractory interstitial cystitis/bladder pain syndrome (IC/BPS) with hyperbaric oxygen (HBO). A total of 38 patients were included. They were assessed before and 6 months after HBO treatment. Three-day voiding diaries were recorded, and O'leary-Sant scores, visual analog scale (VAS) scores, quality of life (QoL) scores, pelvic pain, and urgency/frequency (PUF) scores were evaluated. Bladder capacity was assessed by cystoscopy. Bladder mucosa was collected for Western blot, qRT-PCR, and immunofluorescence staining to compare the expression of VEGI and HIF-1α before and after treatment. Compared with before treatment, patients showed significant improvements in 24-h voiding frequency (15.32 ± 5.38 times), nocturia (3.71 ± 1.80 times), O'leary-Sant score (20.45 ± 5.62 points), VAS score (41.76 ± 17.88 points), QoL score (3.03 ± 1.44 points), and PUF score (19.95 ± 6.46 points) after treatment (p < 0.05). There was no significant difference in bladder capacity before and after treatment (p ≥ 0.05). The expression levels of VEGI and HIF-1α protein and mRNA were significantly decreased 6 months after treatment compared with before treatment. Immunofluorescence staining results showed that the double positive expression of VEGI and HIF-1α protein in bladder tissue of IC/BPS patients after HBO treatment quantitatively decreased significantly. This study identified a possible mechanism by which VEGI and HIF-1α expression decreased after HBO treatment due to hypoxia reversal, which improved symptoms in IC/BPS patients.

EFFECTS OF COMBINATION THERAPY WITH VIBEGRON FOR ANTICHOLINERGIC-RESISTANT PEDIATRIC NEUROGENIC BLADDER

(Objective) We report the effectiveness of combination therapy with vibegron in pediatric patients with neurogenic bladder inadequately responding to anticholinergic agents. (Subjects and methods) This retrospective study involved 13 pediatric patients with neurogenic bladder treated with anticholinergics at our department from November 2019 to January 2021 who had an inadequate response and received combination therapy with vibegron. Changes in the volume of urinary incontinence before and after the use of vibegron reported during interviews from the 13 patients were compared. In addition, bladder capacity at the end of examination, bladder capacity at the end of examination/expected bladder capacity (EBC), and bladder compliance were compared using the Wilcoxon signed rank test in 9 patients for whom urodynamics (UDS) or video urodynamics (VUDS) was performed before and after introduction of vibegron. (Results) The 13 patients comprised 8 boys and 5 girls. The median age was 13 years (range, 5-18 years). Underlying diseases included 9 cases of spina bifida, 1 case of Hinman syndrome, 1 case of cervical vertebra injury, 1 case of idiopathic cervical epidural hematoma combined with spina bifida, and 1 case of spinal cord infarction. Eight of the 13 patients experienced decrease in urinary incontinence after the introduction of vibegron. All 9 patients who underwent UDS or VUDS before and after introduction of vibegron displayed significant differences in bladder capacity at the end of the examination, bladder capacity at the end of the examination/EBC, and bladder compliance, indicating improvement. (Conclusion) Combination therapy with vibegron is effective for pediatric patients with neurogenic bladder who have inadequately responded to anticholinergic agents.

Small-Fiber Polyneuropathy Is Prevalent in Patients With Interstitial Cystitis/Bladder Pain Syndrome.

The pathophysiology of interstitial cystitis/bladder pain syndrome (IC/BPS) is imperfectly understood. Recent studies reported that small-fiber polyneuropathy (SFPN) is common in fibromyalgia, a condition commonly comorbid with IC/BPS. The objective of this study was to determine the prevalence of SFPN in a large cohort of IC/BPS patients. Adults diagnosed with IC/BPS scheduled to undergo either therapeutic hydrodistention (n = 97) or cystectomy with urinary diversion (n = 3) were prospectively recruited to this study. A skin biopsy obtained from the lower leg was used for intraepidermal nerve fiber density measurement. Small-fiber polyneuropathy (+/-) status was determined by comparing linear intraepidermal nerve fiber density (fibers/mm2) with normative reference values. Demographic information, medical history, and diagnoses for 14 conditions (both urologic and nonurologic) known to co-occur with IC/BPS were documented from self-report and electronic medical record. In this large cohort of patients with IC/BPS, 31% (31/100) were positive for SFPN. Intraepidermal nerve fiber density was below the median for age and sex in 81% (81/100) of patients. Approximately one-third (31%) of SFPN+ patients reported co-occurring chronic fatigue syndrome, compared with 10.6% of the SFPN- group (P = 0.034). Small-fiber polyneuropathy-positive patients reported significantly fewer allergies than SFPN- patients (37.9% vs 60.6%; P = 0.047). There were no significant differences in bladder capacity or Hunner lesion status between the SFPN+ and SFPN- subgroups. Small-fiber polyneuropathy is a common finding in patients with IC/BPS, and SFPN status is significantly correlated with co-occurring chronic fatigue syndrome and negatively correlated with the presence of allergies in this population.

On‐table urodynamic with ureteric occlusion: A resource for measuring bladder capacity and compliance in the management of patients with gross vesico‐ureteric reflux

To describe a technique for on-table urodynamic with ureteric occlusion (OUUO) and present a case series comparing bladder capacity and pressure measurements performed with and without ureteric occlusion in patients with gross vesico-ureteric reflux (grade ≥ IV VUR) to highlight the clinical utility. We performed OUUO in seven patients who were being considered for surgical management of VUR and/or nephro-ureterectomy. We occluded the refluxing ureters using hysterosalpingogram catheters (HSG, single lumen 5.5 Fr catheter with 1.5 ml balloon), guidewires, and rigid cystoscope. A 6 Fr dual-lumen urodynamic (UD) catheter is then inserted into the bladder to perform OUUO. Bladder capacity and Compliance (C = ∆bladder volume/∆detrusor pressure) are recorded and compared with values obtained at standard UD (without ureteric occlusion). The age range of the seven patients was 2.0-15.5 years. The etiology for the gross VUR were posterior urethral valve (PUV) and neuropathic. The bladder capacity and compliance finding between UD and OUUO findings were comparable in five patients. However, there was a clinically significant difference in bladder capacity (20%-50% decrease) and compliance (50%-90%) between UD and OUUO findings in two out of seven patients. In the presence of gross VUR, OUUO allows for a potentially more accurate assessment of bladder capacity and compliance. OUUO should be considered when planning ureteric opening bulking/reimplantation and nephro-ureterectomy.

The voiding pattern of aterm neonates

Introduction: The concept of voiding patterns in neonates had not been completely understood. The voiding pattern in neonates was physiologically different from that in older children. The brain's development affects voiding patterns in frequency, bladder volume, and post-void residual bladder volume, as the child keeps growing. This study aims to understand the physiological neonates' voiding system in Indonesian newborns.Materials and methods: We evaluate ten normal-born and 12 perinatology-hospitalized aterm neonates without anatomical or physiological urologic abnormalities at RSUP Haji Adam Malik from October to November 2019. We used an observational study, assessing the voiding physiology in newborns, including voiding frequency and urine volume. Infants with a history of urinary tract infection or present bacteriuria confirmed by urine culture were excluded. Voiding volume, frequency, bladder capacity, and residual volume were measured. Results: We collected a total of 22 patients, with 12 patients were perinatology-hospitalized and ten patients were healthy neonates with ten subjects were male, and 12 subjects were female. There was no correlation between voiding frequency and total voiding volume with perinatology-hospitalized, healthy neonates, and sex. (p&gt;0.05). Independent T-test was performed with a p-value for volume, frequency, bladder capacity, and residual volume of 0.225, 0.112, 0.031, and 0.663. We got a significant difference in bladder capacity between healthy neonates and perinatology-hospitalized. No significant differences were noted in other variables. Pearson correlation analysis was performed to determine the correlation between total voiding volume and age of gestation, body weight, length, head circumference, abdominal circumference, and chest circumference. The correlation coefficients were 0.772, 0.869, 0.623, 0.698, 0.079, 0.523 in order, with significant p-value in the age of gestation, body weight, length, head circumference, and chest circumference. There were correlations between total voiding volume and age of gestation, body weight, length, head circumference, and chest circumference. Conclusion: In conclusion, we found there was a significant difference in bladder capacity between healthy neonates and perinatology-hospitalized.

Delaying reclosure of bladder exstrophy leads to gradual decline in bladder capacity

After unsuccessful repair of bladder exstrophy, when to repeat surgical intervention is unclear. One must balance time required for tissue healing with the damaging effects of an exposed urothelium to the environment. The authors aim to study whether a relationship exists between bladder growth/capacity and time till eventual successful closure. An institutional database of exstrophy-epispadias complex patients was queried for failed exstrophy closure with successful repeat reconstruction, at least three consecutive bladder capacity measurements, and measurements obtained at least three months following successful closure. Patients closed successfully in the neonatal period were used as a comparative group. Linear mixed effects models were used to study the effect of time and age on bladder capacity. Forty-seven patients requiring reclosure and 117 who had successful neonatal closures were included. Two models were created. The first linear mixed effects model found that for a given age, the bladder capacity declined approximately 9.6mL per year (p=0.016). The second model found that when time to successful closure was grouped by quartiles, compared to neonates, those in the fourth quartile had significantly decreased bladder capacity of 28.8cc (p=0.042). An interaction model comparing neonates and those requiring reclosure did not demonstrate a significant change in bladder growth rate (p=0.098). A model stratified by quartiles similarly did not find any significant impact to bladder growth rate. From the general linear mixed effects models, the authors conclude when compared to neonates, (1) there was an approximate 9.6cc loss of total bladder capacity per year taken until successful closure, and that (2) those who were delayed the longest had the most significant difference in bladder capacity. This study required stricter inclusion criteria compared to previous publications, and therefore the conclusions that can be drawn regarding bladder growth rates may be more reliable. Future studies will examine the effects of delayed closure on the bladder at the cellular level. There is a demonstrable significant impact on overall bladder capacity with increasing delay to successful reclosure. One should be cautious when prolonging reconstruction of the bladder as these data demonstrate a time dependent decline in overall capacity.

Protocol for a randomized clinical trial investigating early sacral nerve stimulation as an adjunct to standard neurogenic bladder management following acute spinal cord injury

BackgroundNeurogenic bladder (NGB) dysfunction after spinal cord injury (SCI) is generally irreversible. Preliminary animal and human studies have suggested that initiation of sacral neuromodulation (SNM) immediately following SCI can prevent neurogenic detrusor overactivity and preserve bladder capacity and compliance. We designed a multicenter randomized clinical trial to evaluate the effectiveness of early SNM after acute SCI.Methods/DesignThe scientific protocol comprises a multi-site, randomized, non-blinded clinical trial. Sixty acute, acquired SCI patients (30 per arm) will be randomized within 12 weeks of injury. All participants will receive standard care for NGB including anticholinergic medications and usual bladder management strategies. Those randomized to intervention will undergo surgical implantation of the Medtronic PrimeAdvanced Surescan 97,702 Neurostimulator with bilateral tined leads along the S3 nerve root in a single-stage procedure. All patients will undergo fluoroscopic urodynamic testing at study enrollment, 3 months, and 1-year post randomization. The primary outcome will be changes in urodynamic maximum cystometric capacity at 1-year. After accounting for a 15% loss to follow-up, we expect 25 evaluable patients per arm (50 total), which will allow detection of a 38% treatment effect. This corresponds to an 84 mL difference in bladder capacity (80% power at a 5% significance level). Additional parameters will be assessed every 3 months with validated SCI-Quality of Life questionnaires and 3-day voiding diaries with pad-weight testing. Quantified secondary outcomes include: patient reported QoL, number of daily catheterizations, incontinence episodes, average catheterization volume, detrusor compliance, presence of urodynamic detrusor overactivity and important clinical outcomes including: hospitalizations, number of symptomatic urinary tract infections, need for further interventions, and bowel and erectile function.DiscussionThis research protocol is multi-centered, drawing participants from large referral centers for SCI and has the potential to increase options for bladder management after SCI and add to our knowledge about neuroplasticity in the acute SCI patient.Trial registrationClinicalTrials.gov #NCT03083366 1/27/2017.

Bladder Regeneration Using Multiple Acellular Scaffolds with Growth Factors in a Bladder.

Tissue engineering may become an alternative to current bladder augmentation techniques. Large scaffolds are needed for clinically significant augmentation, but can result in fibrosis and graft shrinkage. The purpose of this study was to investigate the use of multiple scaffolds instead of one large scaffold, to enhance bladder tissue regeneration and bladder capacity. Second, acellular collagen, collagen-heparin, and collagen-heparin scaffolds with growth factors (GFs) were used and the biological activity of the different scaffolds was compared in a large animal model. Scaffolds were made of bovine type I collagen with or without heparin (Ø = 3.2 cm). Collagen-heparin scaffolds were loaded with GFs, vascular endothelial growth factor (VEGF), fibroblast growth factor 2 (FGF2), and heparin-binding epidermal growth factor (HB-EGF). Three identical scaffolds prepared from collagen (COL-group), collagen with heparin (COLHEP-group), or collagen-heparin with growth factors (COLHEPGF-group) were implanted in one porcine bladder. The outcome was compared with sham-operated animals (Sham-group), in which no scaffold was used. Urodynamic evaluation was performed before surgery and 3 months after bladder reconstruction, together with histological evaluation. Survival rate was 92%, 12 animals completed the study, 3 of every group, 1 animal developed peritonitis due to urine leakage and was sacrificed. The regenerated area was largest in the COLHEP-group, and least in the COL-group (p = 0.002). Histological evaluation revealed a normal urothelial layer and good angiogenesis in all groups, and comparable ingrowth of smooth muscle cells. Urodynamics showed no statistically significant differences in bladder capacity and compliance between groups. Bladder capacity and compliance was very high in this animal model, which made it impossible to study the increase due to augmentation. Implantation of multiple collagen-heparin scaffolds in one bladder is feasible in a porcine model, resulting in tissue almost indistinguishable from native tissue involving all cell layers of the bladder. Collagen scaffolds with heparin incorporated resulted in a larger area of regenerated tissue. To reach clinically significant augmentation, multiple larger collagen-heparin scaffolds, with or without GFs, need to be tested to study the largest possible diameter of scaffold and number of used scaffolds still resulting in well-vascularized tissue.

Bladder Regeneration Using a Smart Acellular Collagen Scaffold with Growth Factors VEGF, FGF2 and HB-EGF.

Tissue engineering may become an alternative to current bladder augmentation techniques. Large scaffolds are needed for clinically significant augmentation, but can result in fibrosis and graft shrinkage. The purpose of this study was to investigate whether smart acellular collagen-heparin scaffolds with growth factors (GFs) VEGF, FGF2, and HB-EGF enhance bladder tissue regeneration and bladder capacity in a large animal model of diseased bladder. Scaffolds of bovine type I collagen with heparin and VEGF, FGF2, and HB-EGF measuring 3.2 cm in diameter were prepared. In 23 fetal sheep, a bladder exstrophy was surgically created at 79 days of gestation. One week after birth (at full term), the bladder was reconstructed by primary closure (PC group) or using a collagen-heparin scaffold with GFs (COLGF group) and compared to a historical group reconstructed with a collagen scaffold without GFs (COL group). Functional (video urodynamics) and histological evaluation was performed 1 and 6 months after bladder repair. The overall survival rate was 57%. Cystograms were normal in all animals, except for low-grade reflux in all groups. Urodynamics showed no statistically significant differences in bladder capacity and compliance between groups. Histological evaluation at 1 month revealed increased urothelium formation, improved angiogenesis, and enhanced ingrowth of smooth muscle cells (SMCs) in the COLGF group compared to the COL group. At 6 months, improved SMC ingrowth was found in the COLGF group compared to the COL group; both scaffold groups showed normal urothelial lining and standard extracellular matrix development. Bladder regeneration using a collagen-heparin scaffold with VEGF, FGF2, and HB-EGF improved bladder tissue regeneration in a large animal model of diseased bladder. Larger GF-loaded constructs need to be tested to reach clinically significant augmentation.

Relationship between brain activity and voiding patterns in healthy preterm neonates

It remains controversial as to whether the brain affects voiding control in preterm newborns. Constant bladder volume has previously been thought to induce bladder voiding in neonates, with no influence from the brain. Lately, there has been distinct evidence for an existing connection between the central nervous system and bladder voiding in preterm infants, as the voiding reflex arouses neonatal children. Video electroencephalography (EEG) is useful for recording bioelectrical activity of the cerebral cortex and exploring its relationship with voiding patterns in preterm neonates. The objective was to investigate the relationship between voiding patterns and brain activity in healthy preterm neonates by using video-EEG. Forty-seven healthy preterm neonates (16 females) with a mean postconceptional age (PCA) of 34.1 ± 1.8 weeks were divided according to PCA into three groups: Group I (31-33 weeks, n = 13); Group II (33-35 weeks, n = 14); and Group III (35-37 weeks, n = 20). Video-EEG data from eight cortical regions were recorded from 08:00-12:00, along with 4-hour free voiding patterns and status at voiding (awake/sleep). In Group I, the voiding frequency (VF) was significantly higher and the voiding volume (VV) was significantly lower than in the other groups. There were no significant differences in bladder capacity (BC), bladder capacity/birth weight (BC/BW), postvoiding residual/bladder capacity (PVR/BC), or urinary flow rate (UFR) among the three groups. The Fp1-T3 and Fp2-T4 lead amplitudes significantly differed in Group I and Group II at 5 s before (pre-5), during, and after voiding (post-5). The Fp2-C4 total and theta band lead amplitudes significantly differed across all urination states among the groups. There were no significant differences in electroencephalography frequency among the groups in any urination state. There were no significant differences in BC, BC/BW, PVR/BC, or UFR among the three groups, indicating slow bladder function development in preterm neonates. In this study, the EEG amplitude changed in certain pairs of electrodes. These changes might indicate the degree of bladder sensor maturation along with an increasing PCA. This study further suggests that the brain changes in preterm neonates during quiet sleep voiding prominently occur in the right prefrontal cortex and central region. In preterm neonates, bladder voiding during quiet sleep was accompanied by cortical arousal that might have emanated from a lower center.

Clinical characteristics differ considerably between phenotypes of bladder pain syndrome/interstitial cystitis

Bladder pain syndrome/interstitial cystitis (BPS/IC) is one of the most bothersome conditions in urological practice. This syndrome includes a heterogeneous collection of underlying pathological conditions. Compared to the classic IC with a Hunner lesion, now denominated European Society for the Study of Interstitial Cystitis (ESSIC) type 3C, the non-Hunner type of BPS/IC appears different concerning demographic, endoscopic and histological findings, as well as the response to all forms of treatment. The objective of this study was to determine whether there are additional dissimilarities in clinical presentation between the main phenotypes of BPS/IC. In total, 393 BPS/IC patients (210 type 3C and 183 non-Hunner), diagnosed according to National Institute of Diabetes and Digestive and Kidney Diseases and ESSIC criteria, were studied by surveying the clinical records including micturition diaries. In this clinical material, BPS/IC ESSIC type 3C accounted for 55% of cases. Patients with non-Hunner disease were on average 20 years younger at the time of diagnosis. Furthermore, there was a marked and significant difference in bladder capacity under general anaesthesia (p < 0.0001). The findings in the present series, together with previously published reports by this group and by others, confirm the striking differences between the main forms of BPS/IC and underline the indispensability of adequate subtyping in clinical studies.

723 URODYNAMIC IMPROVEMENTS AFTER MEDICAL TREATMENT OF PARTIAL BLADDER OUTLET OBSTRUCTION IN AN ANIMAL MODEL

You have accessJournal of UrologyPediatrics: Basic Research1 Apr 2012723 URODYNAMIC IMPROVEMENTS AFTER MEDICAL TREATMENT OF PARTIAL BLADDER OUTLET OBSTRUCTION IN AN ANIMAL MODEL Conrad Maciejewski, Edward Tredget, and Peter Metcalfe Conrad MaciejewskiConrad Maciejewski Edmonton, Canada More articles by this author , Edward TredgetEdward Tredget Edmonton, Canada More articles by this author , and Peter MetcalfePeter Metcalfe Edmonton, Canada More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2012.02.808AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Partial bladder outlet obstruction (pBOO) is a significant problem in both adult and pediatric urology. Anticholinergic medication remains the gold standard for symptomatic treatment, however its efficacy in prevention of deterioration to end-stage bladder fibrosis has never been proven in an experimental model. Furthermore, a great deal of in-vitro work has demonstrated the involvement of numerous novel signaling pathways, including mTOR / MAPK pathway. Rapamycin is a commonly used immunosuppressant due to its potent suppression of the mTOR pathway. Therefore, we wish to assess the long-term urodynamic effects of oxybutinin and compare it to rapamycin in an animal model. METHODS Following approval from the University of Alberta Animal Care & Use Committee, female Sprague-Dawley rats underwent surgical induction of pBOO. Three experimental groups were used: including control, daily oral oxybutynin (3mg/kg) and daily oral rapamycin (2mg/kg). The rats were maintained and monitored for a period of 12 weeks at which point urodynamics were performed, and organs harvested. RESULTS All animals survived to experimental end points. Treatment with oxybutynin resulted in a 10-fold increase in bladder capacity compared to controls, (3.36 +/- 0.53 cc vs 0.36 +/- 0.08 cc (p<0.01). Similar changes were seen in maximum detrusor pressure with oxybutynin treated animals having a pressure of 46.5 +/- 7.8 cm H2O compared to controls with a mean of 17.3 cm H2O+/- 4.04 (p<0.01). However, no statistically significant differences in bladder capacity or pressure were seen with rapamycin. Bladder weights were significantly different between the groups, with controls weighing 326 +/- 30.5 mg, oxybutynin treated animals weighing 875 +/- 318 mg (p=0.04), and rapamycin treated animals weighing 227 +/- 70 mg (p=0.08). CONCLUSIONS We demonstrate that urodynamic changes after bladder outlet obstruction leading to fibrosis is a pharmacologically alterable process. Daily treatment with oxybutinin results in a huge increase in bladder capacity but pressures remain elevated. Treatment with Rapamycin does not seem to alter urodynamic parameters after 3 months, but results in signicicantly smaller bladders. Further work will determine if this data is related to deterioration to fibrotic changes and progression to the end-stage bladder. © 2012 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 187Issue 4SApril 2012Page: e297 Advertisement Copyright & Permissions© 2012 by American Urological Association Education and Research, Inc.MetricsAuthor Information Conrad Maciejewski Edmonton, Canada More articles by this author Edward Tredget Edmonton, Canada More articles by this author Peter Metcalfe Edmonton, Canada More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Augmentation Cystoplasty and Extracellular Matrix Scaffolds: An Ex Vivo Comparative Study with Autogenous Detubularised Ileum

BackgroundAugmentation cystoplasty (AC) with autogenous ileum remains the current gold standard surgical treatment for many patients with end-stage bladder disease. However, the presence of mucus-secreting epithelium within the bladder is associated with debilitating long-term complications. Currently, decellularised biological materials derived from porcine extracellular matrix (ECM) are under investigation as potential augmentation scaffolds. Important biomechanical limitations of ECMs are decreased bladder capacity and poor compliance after implantation.Methodology/Principal FindingsIn the present ex vivo study a novel concept was investigated where a two-fold increase in ECM scaffold surface-area relative to the resected ileal segment was compared in ovine bladder models after AC. Results showed that bladder capacity increased by 40±4% and 37±11% at 10 mmHg and compliance by 40.4±4% and 39.7±6% (ΔP = 0–10 mmHg) after AC with ileum and porcine urinary bladder matrix (UBM) respectively (p<0.05). Comparative assessment between ileum and UBM demonstrated no significant differences in bladder capacity or compliance increases after AC (p>0.05).ConclusionsThese findings may have important clinical implications as metabolic, infective and malignant complications precipitated by mucus-secreting epithelium are potentially avoided after augmentation with ECM scaffolds.

1975 LONG-TERM EFFICACY OF SILODOSIN ON THE LOWER URINARY TRACT FUNCTION IN PATIENTS WITH BENIGN PROSTATIC HYPERPLASIA: ASSESSMENT ACCORDING TO PROSTATE SIZE BASED ON PRESSURE-FLOW STUDY

You have accessJournal of UrologyBenign Prostatic Hyperplasia: Medical and Hormonal Therapy1 Apr 20111975 LONG-TERM EFFICACY OF SILODOSIN ON THE LOWER URINARY TRACT FUNCTION IN PATIENTS WITH BENIGN PROSTATIC HYPERPLASIA: ASSESSMENT ACCORDING TO PROSTATE SIZE BASED ON PRESSURE-FLOW STUDY Yoshihisa Matsukawa, Ryohei Hattori, Masashi Kato, Tokunori Yamamoto, and Momokazu Gotoh Yoshihisa MatsukawaYoshihisa Matsukawa Nagoya, Japan More articles by this author , Ryohei HattoriRyohei Hattori Nagoya, Japan More articles by this author , Masashi KatoMasashi Kato Nagoya, Japan More articles by this author , Tokunori YamamotoTokunori Yamamoto Nagoya, Japan More articles by this author , and Momokazu GotohMomokazu Gotoh Nagoya, Japan More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2011.02.2200AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Long-term efficacy of α1-adrenoceptor (AR) antagonist in patients with large prostate is of debate. We prospectively investigated the long-term effect of silodosin on the lower urinary tract function in patients with benign prostate hyperplasia (BPH) according to prostate size, using pressure-flow study(PFS). METHODS Silodosin of 8 mg/day was administered to patients with BPH. The patients were classified into 2 groups according to prostate size; small prostate group (SP) (prostate volume <35ml) and large prostate group (LP) (>= 35 ml). Changes in parameters from baseline to 4 weeks and 1 year after administration were assessed in international prostate symptom score (IPSS), and voiding and storage function as measured by PFS. RESULTS Available data from 102 of enrolled 110 patients were analyzed. At baseline, no significant difference was observed in IPSS between LP (n=50, mean prostate volume: 54.3ml) and SP (n=52, 30.6ml). PFS revealed no significant difference in bladder capacity at first desire to void (FDV) and maximum cystometric capacity (MCC), while detrusor pressure at maximum flow rate (PdetQmax) and bladder outlet obstruction index (BOOI) were significantly higher in LP. The frequency of detrusor overactivity was also significantly higher in LP. At 4 weeks after treatment, both groups showed significant improvement in IPSS with no significant inter-group difference. At 1 year, IPSS further decreased in SP, but increased in LP. In PFS, both groups showed a significant increase in FDV and MCC at 4 weeks and further improvement at 1 year with no significant inter-group difference. Disappearance of detrusor overactivity at 4 weeks and 1 year was observed in 50.0% and 44.1% of LP, and 45.0% and 50.0% of SP, respectively. PFS during the voiding phase at 4 weeks demonstrated a significant decrease in PdetQmax and BOOI regardless of prostate size with no significant inter-group difference. However, although the improvement in PdetQmax and BOOI at 4 weeks was maintained to 1 year in SP, these parameters changed for the worse in LP. CONCLUSIONS Silodosin quickly improves bladder storage function and relieves bladder outlet obstruction, regardless of prostate size. However, in long-term administration, an improvement of bladder outlet obstruction may be reversed in patients with large prostate, despite preservation of an improvement in storage function. © 2011 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 185Issue 4SApril 2011Page: e790-e791 Advertisement Copyright & Permissions© 2011 by American Urological Association Education and Research, Inc.MetricsAuthor Information Yoshihisa Matsukawa Nagoya, Japan More articles by this author Ryohei Hattori Nagoya, Japan More articles by this author Masashi Kato Nagoya, Japan More articles by this author Tokunori Yamamoto Nagoya, Japan More articles by this author Momokazu Gotoh Nagoya, Japan More articles by this author Expand All Advertisement Advertisement PDF DownloadLoading ...

Diurnal Variation in Urodynamics of Rat

In humans, the storage and voiding functions of the urinary bladder have a characteristic diurnal variation, with increased voiding during the day and urine storage during the night. However, in animal models, the daily functional differences in urodynamics have not been well-studied. The goal of this study was to identify key urodynamic parameters that vary between day and night. Rats were chronically instrumented with an intravesical catheter, and bladder pressure, voided volumes, and micturition frequency were measured by continuous filling cystometry during the light (inactive) or dark (active) phases of the circadian cycle. Cage activity was recorded by video during the experiment. We hypothesized that nocturnal rats entrained to a standard 12:12 light:dark cycle would show greater ambulatory activity and more frequent, smaller volume micturitions in the dark compared to the light. Rats studied during the light phase had a bladder capacity of 1.44±0.21 mL and voided every 8.2±1.2 min. Ambulatory activity was lower in the light phase, and rats slept during the recording period, awakening only to urinate. In contrast, rats studied during the dark were more active, had a lower bladder capacities (0.65±0.18 mL), and urinated more often (every 3.7±0.9 min). Average bladder pressures were not significantly different between the light and dark (13.40±2.49 and 12.19±2.85 mmHg, respectively). These results identify a day-night difference in bladder capacity and micturition frequency in chronically-instrumented nocturnal rodents that is phase-locked to the normal circadian locomotor activity rhythm of the animal. Furthermore, since it has generally been assumed that the daily hormonal regulation of renal function is a major driver of the circadian rhythm in urination, and few studies have addressed the involvement of the lower urinary tract, these results establish the bladder itself as a target for circadian regulation.

Posterior Urethral Valves: Primary Voiding Pressures and Kidney Function in Infants

We evaluated whether high voiding pressures in patients with posterior urethral valves are associated with reduced kidney function. A total of 25 children younger than 12 months with posterior urethral valves underwent urodynamic evaluation within 15 days of valve ablation between 1994 and 2007. Six patients underwent primary urodynamics before and 19 after valve ablation. A total of 17 patients underwent repeat studies after 1 month and 1 year. Maximum detrusor pressures during voiding and cystometric bladder capacity were compared with kidney function tests. Maximum detrusor pressures during voiding was compared with a control group and data from other studies of male infants. At presentation median cystometric bladder capacity was 22 ml (range 5 to 125) and maximum voiding pressure was 112 cm H(2)O (40 to 331). There was no statistical difference in bladder capacity and voiding pressures before and after valve ablation. Also, patients with and without vesicoureteral reflux had similar bladder capacities and voiding pressures. There was no association between primary voiding pressures and serum creatinine levels or kidney split function during the first year of life. Primary voiding pressures were about the same as in a control group and in previous studies of males who were healthy, who had reflux or whose status was post-pyelonephritis. Voiding pressures had decreased and bladder capacity had increased significantly at 1-year followup. Voiding pressures in infants with posterior urethral valves are as high as but not higher than other male infants. High voiding pressures postnatally are not associated with reduced kidney function.

Hereditary phenotypes in nocturnal enuresis

To identify phenotypic characteristics in three large families with autosomal dominant nocturnal enuresis (NE), and to elucidate whether such characteristics persist after cessation of symptoms. From three unrelated NE kindreds (A-C) we included 98 living members of whom 34 either had active NE (>one wet night/month after the age of 5 years) or a history of NE. The family members were interviewed to identify NE type and severity. Subsequently, night-time urine production was recorded for 2 weeks at home and 4 days of frequency-volume charts were completed. There was coexistence of both primary and secondary NE (family A), coexistence of monosymptomatic NE and incontinence (families A and C), pure monosymptomatic NE (family B) and pure day-time incontinence (family C). However, the NE phenotype of family A was characterized by nocturnal polyuria and normal bladder capacity, whereas family C was characterized by normal nocturnal urine production and reduced bladder capacity. Interestingly, there were no differences between former affected and unaffected family members in any of the families for night-time urine production, nocturia frequency, nocturia volumes, day-to-night ratios, or bladder capacity. The clinical phenotype in three large families with hereditary severe NE was heterogeneous within and between families. However, the NE phenotype seemed to differ between two of the families for nocturnal urine production, bladder capacity, and response to desmopressin. These results indicate that the genes responsible for NE in these families are not related directly to the presence of primary vs secondary NE or coexisting day-time problems. However, there might be genetically determined differences in bladder capacity and/or nocturnal urine production.

Glomerulation Observed During Transurethral Resection of the Prostate for Patients With Lower Urinary Tract Symptoms Suggestive of Benign Prostatic Hyperplasia is a Common Finding But No Predictor of Clinical Outcome

Although glomerulation in the bladder mucosa when the bladder is overdistended is a finding suggestive of interstitial cystitis (IC), it is sometimes observed at transurethral resection of the prostate (TURP) for patients with lower urinary tract symptoms suggestive of benign prostatic hyperplasia (LUTS/BPH). We prospectively investigated the incidence and clinical implications of glomerulation found at TURP. From December 2003 to October 2005, 197 patients aged 50 years or older who were considered to be appropriate candidates to undergo TURP for LUTS/BPH were investigated in this study. Just before beginning resection under spinal anesthesia, the bladder was filled to a water pressure of 80 cm and the capacity was measured. After evacuation of the fluid, careful inspection was conducted for glomerulation during refilling. Before TURP, and 3 and 12 months after TURP, the International Prostate Symptom Score and O'Leary-Sant IC Symptom and Problem Index were determined, and uroflowmetry and measurement of residual urine volume were performed. Glomerulation was observed in 40 of the 197 patients (20.3%). There was no difference in bladder capacity between the glomerulation and nonglomerulation groups, although the glomerulation group was younger with lighter resected weight and a higher baseline IC problem index than the nonglomerulation group. There were no differences in other parameters before, 3, and 12 months after TURP between the 2 groups. Although glomerulation at TURP is a common finding, the clinical implications related to IC are unknown. Glomerulation itself may not be a predictor of the clinical outcome of TURP. Glomerulation observed during transurethral resection of the prostate for patients with lower urinary tract symptoms suggestive of benign prostatic hyperplasia is a common finding but no predictor of clinical outcome.

Reference Ranges for Cystographic Bladder Capacity in Children—With Special Attention to Vesicoureteral Reflux

Linear correlations for cystometric/cystographic bladder capacity with age universally serve as clinical yardsticks in pediatric urology and nephrology. However, these correlations do not account for growth or the range in values, as the relation of cystometric/cystographic bladder capacity with age is nonlinear. Also, vesicoureteral reflux might influence the size of cystometric/cystographic bladder capacity, since small and large bladder capacities have been reported in conjunction with reflux. We decided to use the data sets of the International Reflux Study in Children to construct full reference ranges for cystometric/cystographic bladder capacity and age, for comparison with existing reference ranges in normal children, and to study the relation between bladder capacity and refluxing volume. In the International Reflux Study in Children 386 patients with grade III or IV vesicoureteral reflux were followed with isotope cystography for 10 years. To follow the grade of reflux, x-ray cystography was also used at 60-month intervals. The 386 children, who were 1 month to 12 years old, were randomized into 2 groups-those undergoing surgery and those receiving medical treatment. For both groups data were available on cystometric/cystographic bladder capacity, refluxing volume, reflux grade and reflux outcome. The distribution of cystometric/cystographic bladder capacity vs age is logarithmic, with a wide range between the 5th and 95th percentiles, and a clear nonlinear relation between bladder capacity and age (p < 0.001). Gender has no influence on cystometric/cystographic bladder capacity. No difference in bladder capacity exists between persistence or resolution of vesicoureteral reflux (p < 0.78), between grade III and grade IV reflux (p < 0.94), or between unilateral and bilateral reflux (p < 0.74). Thus, refluxing volume correlated only with reflux grade, not with cystometric/cystographic bladder capacity or age. With or without vesicoureteral reflux values for cystometric/cystographic bladder capacity range widely in children, and correlate logarithmically with age. For clinical decisions the full reference range for age, flanked by the 5th and 95th percentiles, should be used to assess individual values for cystometric/cystographic bladder capacity, rather than linear functions.

The Impact of Late Presentation of Posterior Urethral Valves on Bladder and Renal Function

We retrospectively reviewed the records of patients with late presentation of PUVs, and compared bladder and renal function to that in patients with an early diagnosis of PUVs. We retrospectively reviewed the charts of 36 males (mean age at diagnosis 8.8 years, range 5 to 14) with late presentation of PUVs who were treated at our institution between 1986 and 2004. Of these patients 20 had undergone urodynamic evaluation during followup (mean age 10.65 years, range 5 to 23). We chose as controls 19 age matched children with PUVs who were diagnosed and treated before age 5 years and underwent urodynamic evaluation during followup (mean age at urodynamic evaluation 8.52 years, range 6 to 15). Urodynamic parameters were compared between the 2 patient groups. Renal function in the late presenting cases was also compared to controls. The most common symptoms at presentation were diurnal enuresis (17 patients, 47.2%) poor stream (7, 19.4%) and urinary retention (5, 13.9%). Overall, urodynamic bladder abnormalities were detected in 17 of 20 patients (85%), detrusor overactivity in 3 (15%), significant post-void residual in 9 (45%) and bladder capacity greater than expected for age in 9 (45%). No significant difference in bladder capacity, compliance or post-void residual was demonstrated between the late presenting and control groups. Only detrusor overactivity was significantly lower in the late presenting group (p = 0.013). After a mean followup of 67.03 months age specific creatinine levels were increased in 13 of 27 patients (48.1%), including 7 (25.9%) with ESRD. Renal function was significantly impaired in the late presenting group compared to controls (48.1% vs 13.7%, p = 0.001). We found a significantly lower rate of detrusor overactivity (15%) in patients with late presenting PUVs. Comparison of urodynamic parameters between the early and late presenting groups did not reveal any significant difference. This similar pattern of bladder dysfunction, independent of age at relief of obstruction, may indicate a common pathophysiological etiology for bladder dysfunction in all patients with PUVs. Also, renal function was significantly impaired in the late presenting group in this series.