Impaired Bladder Contractility Research Articles

The examination of detrusor underactivity in multiple system atrophy.

The urinary dysfunction in multiple system atrophy (MSA) is characterized by large post-void residuals (PVR) due to impaired bladder contractility. However, the evaluations of bladder contractility are not well validated in MSA. Because the bladder contractility index can be generally represented as Pdet Qmax (detrusor pressure at maximum urinary flow rate) + kQmax (maximum urinary flow rate), we aim to examine which "k" value is suitable for representing bladder contractility concerning its correlations to PVR and voided percentage (VOID%). We retrospectively reviewed 133 patients with MSA (74 males, 59 females, mean disease duration 3.2 years) who underwent an urodynamic study. We calculated bladder contractility using the formula PIPk = Pdet Qmax + kQmax by increasing the "k" value from 0.1 to 10 by increments of 0.1. We calculated the correlations between each PIPk (k = 0.1-10.0) and PVR and VOID%. The correlational coefficients between PIPk and VOID% were larger than those between PIPk and PVR. The correlational coefficients between PIPk and VOID% reached a plateau level at a "k" value >5.0 in male patients, suggesting that currently used formulas such as Pdet Qmax + 5Qmax for males might be appropriate for male MSA patients. However, the correlational coefficients between PIPk and VOID% reached a plateau level in female patients when the "k" values were >6.0, which might overestimate bladder contractility in female patients. Although currently used formulas such as Pdet Qmax + 5Qmax might be appropriate for male MSA patients, formulas for female patients need further evaluation.

Changes of proapoptotic and antiapoptotic genes affect sensitivity to apoptotic stimuli in impaired contractility due to long term bladder outlet obstruction.

The normal biological process that necessitates cell removal greatly depends on apoptosis. Long term bladder outlet obstruction (BOO) causes damaged smooth muscle cells to undergo apoptosis. However, smooth muscle cell apoptosis that BOO causes is not well known in impaired bladder contractility. Therefore, we designed this study to investigate whether long-term BOO could induce apoptosis activities and to obtain an expression profile of apoptosis related genes. We used 10 Sprague-Dawley six-week-old female rats. We separated them equally into two groups: a sham intervention group (group 1) and an eight-week BOO group (group 2). We conducted cystometric evaluation eight weeks following BOO onset, with processing of bladder tissue for PCR array. Every array comprised 84 genes, which were established to contribute to an apoptosis response, cell differentiation and metabolism, and 12 sequences were established for the regulation of loading and the quality of cDNA. We performed real-time PCR. Changes in gene expression presented as a fold increase/decrease. Alterations of more than two-fold constituted the cut-off determining expression. Group 2 had a greater bladder weight and Impaired bladder contractility. Immunofluorescent staining with CAS3, TUNEL showed increased in the BOO group. In comparison to group 1, group 2 exhibited an at least two-fold upregulation in five genes, the Bcl-2 (15.1), Birc5 (5.8), Cd40lg (7.5), Il10 (16.2), and Naip2 (13.2). They also demonstrated at least a two-fold downregulation in the PRLR (-18.1) gene. Genes Bcl2ald, Circ5, Cd40lg, Il10, Naip2, and PRLR were among the genes with activity against apoptosis. TNF, STAT3 and TP53 mediated the effect that genes had on one another. This study demonstrated that the relative ratios of pro- and antiapoptotic genes determine bladder cell sensitivity cells to apoptotic stimuli in impaired contractility caused by long term BOO. Although we cannot confirm whether this finding is the result of the decompensated phase of the bladder or the process, the gene expression profiles could explain molecular mechanisms of apoptosis in impaired bladder contractility caused by long-term BOO with further studies.

Enhanced Hypoxia-Associated Genes in Impaired Contractility From Bladder Outlet Obstruction.

BackgroundHypoxia damages the bladder wall and contributes to the initiation of bladder dysfunction. The change of hypoxia is not well known in impaired bladder contractility caused by long-term bladder outlet obstruction (BOO). We aimed to find out whether hypoxia of bladder tissue is present and what signaling mechanisms are involved in the decompensated bladder in BOO.MethodsTwenty 6-week-old female Sprague-Dawley rats were divided into 2 groups, 10 rats each: group 1, sham operation; group 2, BOO for 8 weeks. Eight weeks after the onset of BOO, we did cystometric evaluation and processed polymerase chain reaction (PCR) array for hypoxia pathway using bladder tissues. The PCR array consists of 84 genes known to be involved in the hypoxic response, cell differentiation, and metabolism. We did quantitative PCR (qPCR) and immunohistochemical staining of bladder tissue for hypoxia.ResultsEight genes were at least 2-fold upregulated and 3 genes were at least 2-fold downregulated in BOO group, compared with the sham operation group. The up-regulated genes (fold change) belonging to the hypoxia-inducible factor (HIF) 1 interactor included Cdkn2a (11.0), and the down-regulated genes belonging to HIF and co-transcription factors included Hif3a (−39.6) and Per1 (−5.1) by BOO. Genes influenced each other by means of TGFβ1, TNF, and TP53.ConclusionHypoxia genes were increased in impaired contractility because of long-term BOO. The gene expression profiles could explain the molecular mechanisms of hypoxia in impaired contractility because of long-term BOO.

Efficacy of Holmium laser enucleation of the prostate in men with impaired bladder contractility: A review

Introduction: Since Holmium laser enucleation of the prostate (HoLEP) was introduced in the 1990s as an endoscopic deobstructing modality for benign prostatic hyperplasia (BPH), several reports have concluded that HoLEP has compared favourably to transurethral resection of prostate (TURP) in relieving Bladder Outlet Obstruction (BOO). However, there has been no consensus regarding the efficacy of surgical management of men with Detrusor Underactivity (DU) and BOO. Methods: We performed a literature search of PubMed, Google Scholar, Scopus, and Web of Science databases. All studies that provided data on the effectiveness of HoLEP in men with BOO and DU were assessed. Data collected included the number of patients, median follow-up, International Prostate Symptom Score (IPSS), Qmax, post-void residual (PVR) and catheter dependency pre- and post-intervention. Results: Nine studies were identified in the literature with a follow-up range between 6 and 60 months. Only one prospective study was identified where investigators performed urodynamic studies (UDSs) before and after the intervention. In addition to a significant improvement of voiding parameters, they reported partial recovery of detrusor muscle contractility in approximately 80% of patients. Furthermore, all other studies reported an improvement in all outcome parameters and proved the efficacy of HoLEP in patients with DU and BOO. Conclusion: The current literature underpins the efficacy of HoLEP in patients with impaired bladder contractility. However, current research is limited and the majority of the published data are retrospective in nature. Therefore, more well-conducted prospective randomised studies are needed to reinforce high-level evidence for this hypothesis. Level of evidence: Not applicable.

Участие Р2-рецепторов в сократительной активности мочевого пузыря пациентов с доброкачественной гиперплазией предстательной железы

AIM to study the role of P2 receptors in impaired bladder contractility in patients with lower urinary tract obstruction. MATERIALS AND METHODS in pharmacological studies, tissue samples from the bladder wall of 30 patients were used, obtained during planned surgical interventions for benign prostatic hyperplasia (transvesical simple prostatectomy without placement of cystostomy tube). Based on these tissue, isolated smooth muscle specimens were prepared. Their mechanical activity and the efficiency of ligands of purine P2 and other receptors were evaluated. With this aim, the following P2-receptor agonists were used: adenosine triphosphoric acid (ATP), adenosine diphosphoric acid (ADP), uridine-5'-triphosphoric acid (UTP), alpha, beta-methylene-ATP, 2-methylthio-ADP, as well as antagonists of P2-disulfonate receptors acid (PPADS), suramin, NF023, MRS2500. In addition, the efficiency of ligands of other receptors, including carbacholine, epinephrine, histamine, serotonin, atropine was evaluated. RESULTS the most effective agonist was alpha-beta-methylene-ATP, while ATP and 2-methylthio-ADP were significantly less active. In our experiments, ADP and UTP did not show an effect on human bladder. The influence of P2 receptor agonists was inhibited by P2 receptor antagonists PPADS and suramin, as well as MRS2500, although to a lesser extent. Carbacholine caused a strong concentration-dependent contractile response of the bladder, which was inhibited by atropine. Histamine resulted in mild bladder contractions only at high concentrations. Epinephrine and serotonin did not cause significant changes in the contractile activity of the bladder. CONCLUSION The main subtype of P2 receptors involved in the contractile activity of the human bladder is P2X1 receptors. P2Y1 receptors also have some influence on the contraction, while other subtypes of P2 receptors are not detected by pharmacological methods.

Video-urodynamic characteristics of lower urinary tract dysfunctions in patients with chronic brain disorders.

Lower urinary tract dysfunction (LUTD) is common in patients with chronic brain disorders. This study investigated the video-urodynamic study (VUDS) findings of LUTD in patients with chronic brain disorders, including cerebrovascular accident (CVA), Parkinson's disease (PD), and early dementia. A total of 169 patients with a history of chronic brain disorders, including 84 with CVA, 55 with PD, and 30 with early dementia were enrolled. All patients had a comprehensive chart review, including brain disorder subtype, the period from diagnosis to VUDS, the VUDS parameters, and final LUTD. The mean age of patients was 69.2 ± 10.5 years, and the interval from brain insult to VUDS was 61.3 ± 49.7 months. Urodynamic detrusor overactivity (DO) was noted in 73.4% of patients, detrusor underactivity in 10.1%, and detrusor overactivity with detrusor underactivity in 16.6%. Bladder outlet obstruction (BOO) was noted in 60.9% of patients, including bladder neck dysfunction in 21.3%, urethral sphincter dysfunction in 42%, and prostatic obstruction in 10.1% of male patients. Urethral sphincter dysfunction was noted in 60% of patients with PD, 32.1% with CVA, and 36.7% with dementia (p = 0.004). A low mean maximum flow rate increased post-void residual volume, and poor voiding efficiency was common in these patients, without significant differences among the subgroups. Real-world VUDSs revealed that patients with chronic brain disorders not only had a high prevalence of DO but also impaired bladder contractility and a high rate of BOO at the level above the bladder neck and urethral sphincter.

MP63-07 LONG-TERM PROGNOSIS OF LOWER URINARY TRACT FUNCTION AFTER ROBOT-ASSISTED RADICAL PROSTATECTOMY IN PATIENTS WITH PREOPERATIVELY LOW BLADDER CONTRACTILITY

You have accessJournal of UrologyUrodynamics/Lower Urinary Tract Dysfunction/Female Pelvic Medicine: Non-neurogenic Voiding Dysfunction II (MP63)1 Sep 2021MP63-07 LONG-TERM PROGNOSIS OF LOWER URINARY TRACT FUNCTION AFTER ROBOT-ASSISTED RADICAL PROSTATECTOMY IN PATIENTS WITH PREOPERATIVELY LOW BLADDER CONTRACTILITY Junya Hata, Yu Endo, Akihisa Hasegawa, Yuki Harigane, Syunta Makabe, Kei Yaginuma, Kanako Matsuoka, Akihumi Onagi, Tomoyuki Koguchi, Yuichi Sato, Hidenori Akaihata, Masao Kataoka, Soichiro Ogawa, and Yoshiyuki Kojima Junya HataJunya Hata More articles by this author , Yu EndoYu Endo More articles by this author , Akihisa HasegawaAkihisa Hasegawa More articles by this author , Yuki HariganeYuki Harigane More articles by this author , Syunta MakabeSyunta Makabe More articles by this author , Kei YaginumaKei Yaginuma More articles by this author , Kanako MatsuokaKanako Matsuoka More articles by this author , Akihumi OnagiAkihumi Onagi More articles by this author , Tomoyuki KoguchiTomoyuki Koguchi More articles by this author , Yuichi SatoYuichi Sato More articles by this author , Hidenori AkaihataHidenori Akaihata More articles by this author , Masao KataokaMasao Kataoka More articles by this author , Soichiro OgawaSoichiro Ogawa More articles by this author , and Yoshiyuki KojimaYoshiyuki Kojima More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002103.07AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Our previous study reported that preoperative bladder contractility index (BCI) was a predictive factor of postoperative detrusor underactivity (DU) at 1 month after robot-assisted radical prostatectomy (RARP). This result suggested that a preoperative decrease in reserve capacity of bladder function might contribute to the postoperative DU at a relatively early phase after RARP. However, the long-term prognosis of lower urinary tract function (voiding and storage function) in patients with reduced bladder contractility remained unclear. In the current prospective study, we analyzed time-dependent changes in lower urinary tract function and symptoms in patients who underwent RARP. METHODS: One hundred fifteen patients (mean age 66.6±5.0 years) who underwent RARP at our institution were enrolled in this study. Urodynamic studies (UDS) were performed before RARP in all of these patients. The patients were divided into two groups: impaired bladder contractility group (patients with BCI <100: impaired group; n=45) and preserved bladder contractility group (patients with BCI >100: preserved group; n=70). In both groups, lower urinary tract function, including maximum flow rate (Qmax), voiding volume and post-void residual volume, and lower urinary tract symptoms, including International Prostatic Symptom Score (IPSS), Quality of Life score and Overactive Bladder Symptom Score (OABSS) were evaluated at 1, 3, 6, 9 and 12 months after RARP. Furthermore, to determine the risk factors for lower BCI, we performed univariate and multivariate logistic regression analysis using patient parameters, including age, body mass index, prostate weight, diabetes and LDL-cholesterol. RESULTS: Qmax at 1, 3, 9 and 12 months after RARP were significantly lower in the impaired group than the preserved group (p<0.05, respectively). Voiding volume at 3 months after RARP was also significantly lower in the impaired group than the preserved group (p<0.01). In addition, IPSS voiding scores at 1, 3, 6, 9 and 12 months after RARP were significantly higher in the impaired group than the preserved group (p<0.05, respectively). On the other hand, no significant difference was observed in the 1-hour pad test and OABSS between impaired and preserved groups throughout the testing period. High LDL-cholesterol was identified as a risk factor for low BCI preoperatively (p=0.03, odds ratio 1.02). CONCLUSIONS: Low preoperative bladder contractility was associated with prolonged deterioration of voiding function. The results also suggested that dyslipidemia might be associated with a decrease in bladder contractility. Source of Funding: None © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e1104-e1104 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Junya Hata More articles by this author Yu Endo More articles by this author Akihisa Hasegawa More articles by this author Yuki Harigane More articles by this author Syunta Makabe More articles by this author Kei Yaginuma More articles by this author Kanako Matsuoka More articles by this author Akihumi Onagi More articles by this author Tomoyuki Koguchi More articles by this author Yuichi Sato More articles by this author Hidenori Akaihata More articles by this author Masao Kataoka More articles by this author Soichiro Ogawa More articles by this author Yoshiyuki Kojima More articles by this author Expand All Advertisement Loading ...

Objectification of the evaluation of a pharmacological test with alpha-adrenergic blocking agents during uroflowmetry

The tactics of treating dysuric disorders are largely determined by the pathophysiological and morpho-clinical basis: infravesical obstruction, impaired bladder contractility, complex neurogenic urination disorders, etc. Among the diseases that most often cause infravesical obstruction in men, the most common pathologies are benign prostatic hyperplasia, prostate cancer, prostate sclerosis, obstructive processes of the bladder neck (contractures, fibrosis), urethral strictures of various etiologies. The use of a comprehensive urodynamic study makes it possible to differentiate the causes of urinary disorders. One of the most common and non-invasive methods used in the urologist’s clinical practice is uroflowmetry. The use of the fuzzy logic algorithm described in the article for making a decision on the presence of obstructive urination allows one to assess the urodynamic situation using the home uroflow monitoring technique. Analytical urodynamics in conjunction with the fuzzy logic block increases the accuracy of describing the examination results, and the introduction of the proposed model into the software simplifies the work with diagnostic urological equipment and increases the efficiency of the examination.

The Postural Tachycardia Syndrome (PoTS) Bladder—Urodynamic Findings

ObjectiveTo evaluate the urodynamics (UDS) of patients with postural tachycardia syndrome (PoTS). MethodsPatients with a confirmed diagnosis of PoTS referred by the department of neuro-cardiology to the neuro-urology were identified and their UDS were retrospectively reviewed. ResultsIn total, 50 patients (47 = 94.0% female) with confirmed PoTS and available UDS were identified. Mean age of females and males was 32.4 and 28.2 years, P = .15. Intermittent self-catheterisation was being used by 15/47 (31.9%) females at assessment. Detrusor overactivity was observed in 6 females (12.8%) (all at end fill and associated with urgency). In total, 14 (29.8%) females had no sensation of filling. No patients had an “unsafe” bladder. In total, 15/47 (31.9%) of women were unable to void with UDS catheters. Straining was reported in 22/35 (68.8%) of females. The female bladder outflow obstruction index = PDetQmax – 2.2(Qmax) was over 5 in 10/28 (35.7%) and over 18 in 5 (17.9%). The bladder contractility index = PDetQmax + 5Qmax was under 100 in 18/28 (28.6%) women. ConclusionThe UDS of patients with “PoTS bladder” often demonstrate a poorly sensate but stable and safe bladder with functional obstruction and impaired bladder contractility that may necessitate straining or intermittent self-catheterisation.

Impact of radical prostatectomy on bladder function as demonstrated on urodynamics study-A systematic review.

This study aims to describe the effects of radical prostatectomy (RP) on bladder function by performing a systematic review of urodynamics study findings before and after RP. This systematic review was conducted in accordance with the PRISMA guideline and registered on PROSPERO (CRD42020206844). A systematic search was conducted using PubMed, Cochrane, and Embase. Studies were included if they involved men who underwent RP and had urodynamics study performed preoperatively, postoperatively, or both. Studies that included only subgroups of patients based on symptoms were excluded. Three hundred and four articles were screened, with 20 articles included. A qualitative analysis was performed. The rate of baseline bladder outlet obstruction (BOO) pre-RP was 19%-67%. All six studies with comparative data pre- and postoperatively demonstrated a decrease in the rate of patients with equivocal or clear obstruction. The baseline rates of detrusor overactivity (DO) varied widely from 11% to 61.2%. Six of eight studies with 6 months or more follow-up showed an improvement in the rates of DO ranging from 3.0% to 12.5%. The rate of de novo DO ranged from 0% to 54.5%. Four studies reported an increased rate of impaired bladder contractility and two of three studies showed a worsening rate of impaired bladder compliance following RP. This review is limited by the absence of level I/II studies. Urodynamics study shows that BOO is improved following RP in most patients. RP resolves DO in some patients and cause de novo DO in others. The net effect is a reduced overall rate of DO in most studies. Bladder compliance and contractility may be impaired after RP.

Urinary retention after AdVance™ Sling: A multi-institutional retrospective study.

To identify risk factors for urinary retention following AdVance™ Sling placement using preoperative urodynamic studies to evaluate bladder contractility. A multi-institutional retrospective review of patients who underwent an AdVance Sling for post-prostatectomy stress urinary incontinence from 2007 to 2019 was performed. Acute urinary retention (AUR) was defined as the complete inability to void or elevated post-void residual (PVR) leading to catheter placement or the initiation of intermittent catheterization at the first void trial postoperatively. Bladder contractility was evaluated based on preoperative urodynamics. Of the 391 patients in this study, 55 (14.1%) experienced AUR, and 6 patients (1.5%) had chronic urinary retention with a median follow-up of 18.1 months. In total, 303 patients (77.5%) underwent preoperative urodynamics, and there was no significant difference between average PdetQmax (26.4 vs. 27.4 cmH2 O), Qmax (16.6 vs. 16.2 ml/s), PVR (19.9 vs. 28.1 ml), bladder contractility index (108 vs. 103) for patients with or without AUR following AdVance Sling. Impaired bladder contractility preoperatively was not predictive of AUR. Time to postoperative urethral catheter removal was predictive of AUR (odds ratio, 0.83; 95% confidence interval, 0.73-0.94; p = .003). Chronic urinary retention after AdVance Sling placement is uncommon and acute retention is generally self-limiting. No demographic or urodynamic factors were predictive of AUR. Patients who developed AUR were more likely to have their void trials within 2 days following AdVance Sling placement versus longer initial catheterization periods, suggesting that a longer duration of postoperative catheterization may reduce the occurrence of AUR.

Investigation of the relationship between bladder function and sarcopenia using pressure flow studies in elderly male patients.

Although detrusor underactivity is often encountered in elderly patients, the etiology remains unclear. We have hypothesized that sarcopenia was associated with impaired bladder contractility. Therefore, we have evaluated the relationship between bladder contractility and clinical parameters including sarcopenia markers in elderly male patients. This retrospective, single-centre study included male patients over 65 years of age who underwent a pressure flow study (PFS). We excluded patients with any previous medical histories that could affect bladder function, currently on urinary medication, and with no available data of abdominal CT scan. The psoas muscle area (PMA) (cm2 /m2 ) was measured as a surrogate for psoas muscle mass on computed tomography. PMA, serum CRP, and albumin are known as sarcopenia markers. Correlation and multiple regression analyses were performed to evaluate the association of bladder contractility index (BCI) with the following parameters: age, body mass index (BMI), prostate volume, bladder outlet obstruction index (BOOI), serum C-reactive protein (CRP), serum albumin, and PMA. Out of 558 male patients identified in our PFS database, 119 patients were enrolled. In the correlation analysis, age, prostate volume, serum albumin, BOOI, and PMA significantly correlated with BCI. However, no significant correlation of BCI with CRP or BMI was observed. Multiple linear regression analysis showed that serum albumin, BOOI, and PMA were significantly associated with BCI. We have demonstrated that serum albumin and PMA were significantly positively associated with detrusor contractility. It is possible that sarcopenia is associated with impaired detrusor contractility.

Beneficial effects of lipidic extracts of saladette tomato pomace and Serenoa repens on prostate and bladder health in obese male Wistar rats

Obesity is associated with increased risk of a number of serious medical conditions, including urological disorders. This study investigated the effect of lipidic extracts of saladette tomato pomace (STP) and Serenoa repens (SR) on the prostate and bladder in a rat obese model induced by high-carbohydrate diet. High-sucrose-fed rats showed higher prostate weight as well as increased contractility and stromal and epithelial hyperplasia in the prostate. Treatment with STP and SR improved contractility and diminished hyperplasia and hypertrophy in the prostate. Obese animals also showed impaired bladder contractility, but neither extract reversed this deterioration. In the histological study, a disarray in the process of smooth muscle cell proliferation with non-parallel fibers was observed; interestingly, treatment with STP and SR led to improvement in this derangement. These findings indicated impaired contractility and hyperplasia in the prostate and bladder of obese rats induced by high sucrose. STP and SR could enhance prostate function by reducing contractility and hyperplasia and improve smooth muscle fiber structure and decrease cell proliferation in the bladder, suggesting their possible health-beneficial effects on lower urinary tract symptoms. © 2017 Society of Chemical Industry.

PD39-02 THE IMPACT OF DETRUSOR UNDERACTIVITY ON PATIENT SATISFACTION AFTER HOLMIUM LASER ENUCLEATION OF THE PROSTATE: A PROSPECTIVE STUDY

You have accessJournal of UrologyUrodynamics/Lower Urinary Tract Dysfunction/Female Pelvic Medicine: Non-neurogenic Voiding Dysfunction III1 Apr 2017PD39-02 THE IMPACT OF DETRUSOR UNDERACTIVITY ON PATIENT SATISFACTION AFTER HOLMIUM LASER ENUCLEATION OF THE PROSTATE: A PROSPECTIVE STUDY Young Ju Lee, Chu Hong Park, Chihyun Ahn, Bum Sik Tae, and Seung-June Oh Young Ju LeeYoung Ju Lee More articles by this author , Chu Hong ParkChu Hong Park More articles by this author , Chihyun AhnChihyun Ahn More articles by this author , Bum Sik TaeBum Sik Tae More articles by this author , and Seung-June OhSeung-June Oh More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2017.02.1729AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Detrusor underactivity is a common clinical problem associated with various lower urinary tract symptoms (LUTS). Impaired bladder contractility can affect the outcome of transurethral prostatectomy. The aim of this study is to evaluate the impact of bladder contractility on outcomes of Holmium laser enucleation of the prostate (HoLEP) in objective and subjective parameters. METHODS From December 2009 to December 2015, 797 patients with LUTS/BPH were prospectively enrolled in the Seoul National University Benign Prostatic Hyperplasia Database Registry, and underwent HoLEP by a single surgeon. Preoperative evaluation included International Prostate Symptom Score (IPSS), Overactive Bladder Symptom Score (OABSS), urgency perception scale (UPS), PSA, postvoid residual volume (PVR) and urodynamic study. At postoperative 6 months, IPSS, OABSS, uroflowmetry, PSA and self-administered questionnaires regarding satisfaction to treatment questions (STQ), overall response assessment (ORA) and willingness to undergo the surgery again question (WUSAQ) were obtained. Bladder contractility was classified as weak, normal and strong according to the bladder contractility index (BCI) of <100, 100-150 and >150. Detrusor underactivity (DUA) was defined as BCI<100. Subjective and objective parameters were compared according to the degree of contractility. RESULTS Among 768 patients, 351 (45.7%) had DUA and 63 (7.9%) had strong contractility. Mean age, preoperative IPSS, QoL, Qmax and prostate volume were 69.3 years, 19.2, 4.2, 9.2mL/sec and 70.8mL, respectively. Patients having stronger bladder contractility tended to be younger, have larger prostate volume, higher preoperative OABSS, UPS, bladder outlet obstruction index and larger PVR with significant tendency according to the contractility. However, preoperative Qmax and IPSS were not different among 3 groups. At postoperative 6 months, Qmax, IPSS voiding and QoL were significantly improved as the degree of contractility increases, whereas OABSS, PVR and UPS were not different among 3 groups. Overall, 93.9% of patients were satisfied after the surgery and 99.0%, 94.2% of patients reported improvements and willingness in ORA and WUSAQ, respectively. Patient satisfaction were not different by the degree of contractility. Multiple logistic regression analysis showed that the history of neurologic disease (OR 0.23; 95% CI 0.10-0.50, p<0.001) was the only risk factor for decreased satisfaction. CONCLUSIONS Patients having DUA tended to have less improvement in voiding symptoms postoperatively than those without DUA. However, patient satisfaction were not affected by the degree of bladder contractility. © 2017FiguresReferencesRelatedDetails Volume 197Issue 4SApril 2017Page: e745 Advertisement Copyright & Permissions© 2017MetricsAuthor Information Young Ju Lee More articles by this author Chu Hong Park More articles by this author Chihyun Ahn More articles by this author Bum Sik Tae More articles by this author Seung-June Oh More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Efficacy of Holmium Laser Enucleation of the Prostate in Patients With Non-neurogenic Impaired Bladder Contractility: Results of a Prospective Trial

To examine the outcomes of men with detrusor underactivity or acontractility undergoing holmium laser enucleation of the prostate (HoLEP). A prospective case series between 2009 and 2012 was performed to examine short-term outcomes of men with urodynamic evidence of detrusor hypocontractility or acontractility because of a non-neurogenic etiology and concurrent benign prostatic obstruction (BPO), undergoing HoLEP. Fourteen patients with detrusor hypocontractility and 19 patients with acontractility and evidence of BPO underwent HoLEP during the study period. Median age was 71.5 and 75 years, respectively. Preoperatively, 5 (35.7%) men with hypocontractility and 19 (100%) men with acontractility had catheter-dependent urinary retention for a median of 3 and 9 months, respectively. At a median follow-up of 24.7 months, all 5 (100%) men with hypocontractility and 18 of 19 (94.7%) men with acontractility were voiding spontaneously without the need for intermittent catheterization. Individuals with hypocontratile bladders had statistically significant improvements in American Urological Association Symptom Index (21.5 vs 3; P = .014), maximum urine flow (Qmax, 10 vs 21 mL/s; P = .001), and postvoid residual (250 vs 53 mL; P = .007) from baseline to postoperative assessments. In patients with an acontractile bladder, 15 of 19 (78.9%) displayed significant return of detrusor contractility, whereas 4 of 19 (21.1%) were voiding exclusively by Valsalva effort on follow-up urodynamic study. Postoperatively, patient satisfaction, as ascertained by American Urological Association Symptom Index, was high for both groups. Intermediate follow-up results indicate that HoLEP is a viable management option for men with BPO and detrusor hypocontractility. Furthermore, detrusor acontractility does not appear to adversely affect postoperative results, with return of spontaneous urination and demonstration of detrusor contractility allowing for efficient voiding, in over 95% of patients.

Functional bombesin receptors in urinary tract of rats and human but not of pigs and mice, an in vitro study

AimsBombesin receptors (BB receptors) and/or bombesin related peptides are expressed in the lower urinary tract, though their function and distribution in different species is largely unknown. This study examines whether BB receptor agonists can contract bladder smooth muscle in rats, mice, pigs and humans. MethodsBladder strips were placed in tissue baths for in vitro contractility. Neuronally evoked contractions were elicited using electric field stimulation (EFS). Effects of the BB receptor agonists, neuromedin B (NMB; BB1 receptor agonist) and gastrin-releasing peptide (GRP; BB2 receptor agonist) on baseline tone and EFS-induced contractions were monitored. ResultsIn rat and human bladder strips, NMB and GRP (10−11–10−6M) increased EFS-induced contractions in a concentration dependent manner. In these species, NMB and GRP also increased baseline tension. In mouse and pig bladder strips, NMB and GRP (10−8–3×10−6M) had no effects on either parameter. ConclusionsThese data suggest that bombesin receptors BB receptor 1 and/or BB receptor 2 increase bladder contractions in rat and human. The site of action of these receptors may be pre- and/or post-synaptic, increasing release of transmitters or enhancing smooth muscle excitability, respectively. Thus, BB1 receptor and/or BB2 receptor may offer therapeutic targets for voiding dysfunction associated with impaired bladder contractility; however, species differences must be considered when studying these receptors.Part of this work was published in an abstract form at the SFN meeting New Orleans, 2012.

Pathophysiology and management of urinary retention in men

Background : Urinary retention is a common problem in the elderly. The incidence increases with age so that a man in his 70s has a 10% chance and a man in his 80s has more than 30% chance of having an episode of acute urinary retention. Inadequate management of the condition can lead to unnecessary morbidity and occasionally mortality. Increasing knowledge over the years of its pathophysiology has greatly improved the management. Thus, the objective of this study is to review the current concepts in the management of urinary retention in men. Materials and Methods: Current literature on the pathophysiology and management of urinary retention in men was reviewed. The PubMed database was searched using the key words; pathophysiology, management, urinary retention, and men. Results: Urinary retention is a common problem in the elderly worldwide; the incidence rises with age, and by the 9th decade of life, a man has more than 30% chance of an episode of retention. There are three main pathophysiologic mechanisms: Increased urethral resistance secondary to bladder outlet obstruction, impaired bladder contractility, and loss of normal bladder sensory or motor innervations. It may be acute, acute-on-chronic, or chronic. It is now generally agreed from urodynamic studies that the traditional slow decompression of the bladder in chronic retention does not serve its aim of gradual reduction of vesical pressure; thus, the current practice is immediate and complete decompression and managing anticipated complications of postobstructive diuresis or hematuria whenever they occur. Conclusion: Advanced age and bladder outlet obstruction secondary to benign prostatic hyperplasia remain the commonest risk factors for urinary retention. Secondary bladder dysfunction in bladder outlet obstruction, detrusor myogenic dysfunction, and alteration of bladder innervations are the major mechanisms. Immediate and complete decompression in both types of retention is the current practice.

Acquired urinary incontinence in the bitch: Update and perspectives from human medicine. Part 1: The bladder component, pathophysiology and medical treatment

Micturition disorders are commonly encountered in veterinary medicine and can be divided into two main categories, namely, urinary incontinence and urinary retention. Various pathologies can affect the bladder and/or urethral contractility causing symptoms of urinary incontinence. In this first part of a three-part review, the different causes of urinary incontinence, the physiology of the lower urinary tract and impaired bladder contractility are reviewed. Since urinary incontinence due to overactive bladder syndrome or detrusor atony is described in both dogs and humans, the different therapeutic targets in the treatment of impaired bladder contractility in human and veterinary medicine are discussed.

Partial outlet obstruction of the rabbit urinary bladder induces selective protein oxidation

Oxidation of proteins is presumed to contribute to contractile dysfunction associated with partial outlet obstruction (PBOO) of the urinary bladder. The objective of this study was to determine the acute and chronic effects of PBOO on protein oxidation in urinary bladder detrusor smooth muscle (DSM) and mucosa, and to correlate these findings with in vitro contractile function. Urinary bladders of New Zealand White (NZW) rabbits were obstructed for 1, 3, 7 and 14 days. Proteins were extracted from the bladder tissues and protein carbonyl formation was assessed using immunoblot assays. In vitro contractile response to field stimulation (32 Hz) and carbachol was evaluated in whole bladder strips at the same time points. Significant elevations in oxidation of DSM proteins were observed in the MW range of 29-65 kDa after 3 days and 14 days of obstruction. No changes in the oxidative status of mucosal proteins were detected as a result of short or long term obstruction. The intermediate filament protein, desmin (53-55 kDa) was detected in obstructed DSM samples in the same MW range as oxidized proteins. A significant decrease in contractile response to field stimulation and carbachol was observed after 1 day and 3-days respectively, and continued to deteriorate through 14 days. The increase in protein oxidation at 14-days of obstruction correlates with impaired bladder contractility, suggesting that oxidatively modified proteins may contribute to the contractile and biochemical dysfunction associated with PBOO.

Using Caveolin-1 Knockout Mouse to Study Impaired Detrusor Contractility and Disrupted Muscarinic Activity in the Aging Bladder

Objectives The caveolin-1 knockout mouse has been proposed as an animal model to study impaired bladder contractility and detrusor overactivity. This study investigated the effects of aging on detrusor contraction in wild type and caveolin-1 knockout mice. Methods Young (3-month-old) and old (1-year-old) male caveolin-1 knockout mice and their age-matched male wild type littermates (controls) were used. Longitudinal bladder strips were stimulated electrically (20 Hz) and pharmacologically using 1 to 10 μM carbachol (a nonsubtype selective cholinergic receptor agonist), 10 μM α,β-methylene adenosine triphosphate (a purinergic receptor agonist), and 100 mM potassium (a depolarizing agent). Isometric bladder strip contractions were compared between the young wild type and knockout groups and between the old wild type and knockout groups. Results The bladder strips from the 1-year-old knockout mice exhibited a 40% to 42% decrease in electrical neural contractions and carbachol-evoked contractions compared with the 1-year-old wild type controls ( P <0.05). Even though the bladder strips from the 3-month-old knockout mice demonstrated a smaller decrease (29% to 32%) in electrical neural contractions and carbachol-evoked contractions compared with their age-matched controls, the trend did not reach statistical significance ( P >0.05). The postjunctional cholinergic pathway was specifically disrupted in caveolin-1 knockout animals because no difference was found in contractility between the knockout and wild type mice (young or old) when the bladders were stimulated by α,β-methylene adenosine triphosphate or potassium. The differences in cholinergic contractility between the knockout and wild type mice became significantly greater as the animals aged from 3 months old (young bladders) to 1 year old (aged bladders). Conclusions The male caveolin-1 knockout mouse provides a much-needed animal model for the study of impaired detrusor contractility in the aging bladder.