Increase In Bladder Compliance Research Articles

Bovine Bladder Compliance Increases with Normal Fetal Development

In this study we characterized the elastic properties of the normal bovine bladder throughout fetal life, the newborn period and into adulthood. The elasticity of the bladder was measured with a novel circularly clamped bladder testing system. Pressurization of a circularly clamped bladder tissue sample caused the tissue to deflect upward repetitively in the shape of a spherical cap. If the centerline deflection is much larger than the tissue thickness, the elastic modulus, considered the inverse of compliance, can be determined using linear regression techniques.The results of our analyses showed that the elastic modulus decreases in direct proportion with increasing gestational age. These data suggest that during normal development of the bovine fetal bladder there is a progressive change from a rather stiff noncompliant bladder characterized by a high elastic modulus to a compliant bladder with a lower elastic modulus. Moreover, the increase in compliance appears in the developmental period when urine production first occurs. These observations suggest that volume work may be a significant event in the normal development process of the bovine bladder and results in an increase in bladder compliance. Conversely, the poorly compliant fetal bladder may explain some of the transient dilatations of the upper urinary tract which have been documented in utero. Finally, from the newborn period to the mature adult bovine we documented a relatively modest increase in the elastic modulus or decrease in bladder compliance which may reflect the normal aging process.

Type III Collagen Decreases in Normal Fetal Bovine Bladder Development

In normal fetal bovine bladder development we have shown that compliance increases at approximately the same time that urine production first occurs. The late first trimester fetal bladders are relatively stiff with a progressive increase in bladder compliance peaking in the newborn period. From the newborn period through adulthood, we documented a relatively modest decrease in bladder compliance, which may result from the normal aging process. To account for these changes, we have used the bovine model to perform biochemical analyses of the major structural collagens that are found in the bladder (types I and III). These results show that the per cent of type III collagen decreases in the developing bladder from the end of the first trimester until the newborn period. Comparing the newborn bladder to that of a mature adult, we documented a relatively modest increase in the amount of type III collagen. We demonstrated that the ratio of type III-to-type I collagen parallels the normal compliance changes in the developing fetal and mature bovine bladder.

Bladder Compliance after Posterior Sacral Root Rhizotomies and Anterior Sacral Root Stimulation

To evaluate the effects of central detrusor denervation on bladder compliance, we studied 27 patients with complete suprasacral spinal cord injury in whom intradural posterior sacral root rhizotomies from S2 to S5 in combination with implantation of an intradural Finetech-Brindley bladder stimulator were performed. All patients initially presented with detrusor hyperreflexia. A majority of these patients had a decreased bladder compliance 5 days postoperatively followed by a rapid increase in bladder compliance thereafter. All patients showed persistent detrusor areflexia after long-term followup. In 2 patients incomplete posterior sacral rhizotomies appeared to be performed. These patients had low bladder compliance, so that secondary posterior sacral root rhizotomies at the level of the conus medullaris were done. Intradural rhizotomies of all posterior sacral root components from S2 to S5 in combination with implantation of an anterior sacral root stimulator is a safe and effective procedure in spinal cord injury patients.

ELECTRICAL STIMULATION OF SACRAL ROOTS FOR MICTURITION AFTER SPINAL CORD INJURY

In patients with suprasacral spinal cord injury, electrical stimulation of the sacral anterior nerve roots can produce micturition with low residual volumes of urine and reduced urinary tract infection. Voiding pressures can be maintained at acceptable levels by selective peripheral neurotomy and myotomy or, more commonly, by an intermittent pattern of stimulation. Occasionally, external sphincterotomy is required. The procedure is usually combined with division of the sacral posterior roots, which increases bladder capacity and continence; this also increases bladder compliance, which may be protective for the upper urinary tracts. A reduction in constipation usually is observed, and some patients are able to defecate with the aid of electrical stimulation. Penile erection is produced in a substantial proportion of male patients. The procedure has now been applied in about 700 patients with spinal cord injury, some of whom have been followed for nearly 15 years. The nerves do not appear to be damaged by long-term stimulation, and technical faults with the equipment are now uncommon.

Voiding dysfunction in patients with spastic paraplegia: Urodynamic evaluation and response to continuous intrathecal baclofen

Patients with hereditary spastic paraplegia (HSP), a degenerative central nervous system disorder characterized by progressive lower extremity spasticity, frequently experience symptoms of voiding dysfunction. Urodynamic evaluation of patients with HSP has not been reported, and the etiology of voiding dysfunction remains unexplained. We present our evaluation of three men (ages 42-62 years) with this rare syndrome. Urgency of urination was a uniform and dominant complaint, and two patients regularly experienced urge incontinence. Other symptoms included frequency (n = 3), nocturia (n = 3), and diminished force of stream (n = 1). Postvoid residual volumes were less than 25 ml in all patients. On urodynamic evaluation the two patients with urge incontinence displayed cystometric evidence of involuntary detrusor contractions. Pelvic floor EMG recordings suggested detrusor-sphincter dyssynergia (DSD). In addition, one patient exhibited markedly diminished bladder compliance (1.0 ml/cm H2O) and capacity (50 ml). All patients reported marked symptomatic improvement when treated with continuous intrathecal baclofen. Evaluation during baclofen treatment revealed increases in bladder compliance and capacity, with apparent resolution of DSD in one patient. Voiding symptoms in these patients most likely arise from a neurogenic etiology; however, a contributory role for chronic outlet obstruction from striated muscle spasticity may also exist.

Fascial Slings and Bladder Neck Tapering in the Treatment of Male Neurogenic Incontinence

Intractable incontinence in selected male patients with a neurogenic bladder has been treated by increasing bladder compliance with augmentation cystoplasty and increasing urethral resistance with the artificial urinary sphincter. However, there are a number of complications associated with the use of an artificial urinary sphincter. As an alternative, we performed bladder neck tapering and bladder neck slings in 13 men with a neurogenic bladder and an incompetent urethra (10 with spina bifida and 3 with spinal cord injury) undergoing bladder augmentation. Mean patient age was 27 years (range 17 to 40 years) and mean followup was 34.3 months (range 5.5 to 49 months). Postoperatively, there was a 113% increase in mean bladder capacity (from 260 to 550cc) and a 62% decrease in mean bladder pressure at capacity (from 53 to 20cm. water). The earliest 2 patients with a Marlex sling suffered erosions that were treated with transurethral excision. As a result, the 11 subsequent patients had a rectus fascial sling. Nine patients (69.2%) are completely dry on selfcatheterization, 2 (15.4%) required collagen injections for improved continence and 2 failures (15.4%) required additional procedures. The complications in these patients are comparable to, if not better than, the use of an artificial urinary sphincter. We conclude that a fascial sling with bladder neck tapering is an excellent alternative to the artificial urinary sphincter in the treatment of male neurogenic bladder with an incompetent urethra.

Bladder Compliance in Myelodysplastic Children: Does Antireflux Surgery Compromise It?

We studied the impact of antireflux surgery on bladder compliance, which was an important clinical parameter in terms of urinary incontinence and upper tract deterioration, in 20 myelodysplastics (group A). For control groups, 31 myelodysplastic children with or without reflux who were conservatively treated (group B) and 19 non-myelodysplastics who were operated on for primary reflux were investigated. The follow-up period averaged 87 months for group A and 86 months for group B. Initial bladder compliance in group A (5.1 +/- 3.7 ml/cm H2O) and group B (5.9 +/- 4.9 ml/cm H2O) was significantly lower than that in nonmyelodysplastics (29.6 +/- 23.1 ml/cm H2O) (p less than 0.01). Antireflux surgery prevented a significant elevation of bladder compliance in group A (6.9 +/- 5.5 ml/cm H2O), while an increase of bladder compliance was significant in group B (10.7 +/- 8.1 ml/cm H2O) (p less than 0.01). In the nonmyelodysplastic group, bladder compliance slightly decreased postoperatively but remained well within the normal range (26.3 +/- 12.0 ml/cm H2O). There was significant correlation between bladder compliance and bladder trabeculation (p less than 0.01), i.e. the higher the bladder compliance, the more normal-appearing the cystogram. We propose a bladder compliance of 10.0 ml/cm H2O as the lower limit of the normal range. Analysis of the present data has led to the hypothesis that any surgical intervention on or around the urinary bladder will result in a low compliance in myelodysplastic patients. We have found, on the other hand, that those who have a normal cystogram, a large bladder capacity, absence of symptomatic urinary infection, and normal renal function before antireflux surgery have a good chance of obtaining the compliant detrusor muscle postoperatively.

Bladder Function in Rats with Short- and Long-Term Diabetes; Effects of Age and Muscarinic Blockade

The development of alterations in urinary bladder function was studied in rats during six months of streptozotocin-induced diabetes. The results were compared with those obtained in age-matched controls. The bladders from the control rats developed with increasing age an increased micturition volume, a decreased micturition interval, and increased bladder compliance and capacity despite an unaltered bladder weight and unaltered passive and active length-tension relations. The effects of muscarinic blockade were somewhat more pronounced in the older control rats.Following streptozotocin 24 hour diuresis increased rapidly to stabilize within two weeks at a level 15 times higher than the original. This was accomplished initially by an increase in the micturition frequency and then gradually by an increased micturition volume. After six weeks bladder weight had increased more than twofold and did not increase further with time. Despite this both micturition volume and bladder capacity increased from six weeks to six months of diabetes. The diabetic bladders had at low frequencies of stimulation a higher resistance to scopolamine than their age-matched controls. At higher frequencies the resistance to muscarinic blockade showed a similar decrease with age as for the controls. The more pronounced decrease in micturition pressure following atropine treatment in six weeks diabetic rats thus suggests an increased excitation frequency during micturition. No supersensitivity to carbachol was found even after six months of diabetes.