Leak Point Research Articles

Effect of a 5-HT2c receptor agonist on urethral closure mechanisms in female rats.

The serotonin (5-HT2c) receptor is known to be involved in the mechanism of urethral closure in a model of stress incontinence. Lorcaserin (Belviq®) has received Food and Drug Administration approval for the treatment of obesity. However, it is unclear whether this selective 5-HT2c receptor agonist enhances urethral closure in stress urinary incontinence (SUI) models. Therefore, we investigated whether lorcaserin could enhance urethral closure in female rats with vaginal distention (VD). Normal female rats and rats with stress incontinence induced by VD were tested. We evaluated the effect of a single dose of lorcaserin (0.03, 0.3, or 0.9 mg/kg with cumulative administration) on the urethral pressure amplitude during electrical stimulation (A-URE) and on the urethral baseline pressure (UBP). The manual compression-induced leak point pressure (LPP) was also measured. In VD rats, a single intravenous injection of lorcaserin (0.3 and 0.9 mg/kg) significantly increased both A-URE and LPP compared to saline (P < 0.05). In normal rats, intravenous lorcaserin (0.3 and 0.9 mg/kg) also significantly increased A-URE and LPP compared to saline (P < 0.05). The changes of A-URE and LPP, which are parameters of active urethral closure, were significantly larger in normal rats than in VD rats. We showed that lorcaserin can activate the external urethral sphincter and pelvic floor muscles, suggesting an influence on active closure mechanisms. 5-HT2c receptors agonists may have dual effects in patients with SUI, not only by reducing obesity but also by enhancing active urethral closure.

PD36-11 INCONTINENT ILEOVESICOSTOMY FOR NEUROGENIC BLADDER DYSFUNCTION: LONG TERM CLINICAL AND URODYNAMIC PATIENT OUTCOMES

You have accessJournal of UrologyUrodynamics/Lower Urinary Tract Dysfunction/Female Pelvic Medicine: Neurogenic Voiding Dysfunction II1 Apr 2018PD36-11 INCONTINENT ILEOVESICOSTOMY FOR NEUROGENIC BLADDER DYSFUNCTION: LONG TERM CLINICAL AND URODYNAMIC PATIENT OUTCOMES Mihir Shah, Ali Syed, Alana Murphy, Akhil Das, and Patrick Shenot Mihir ShahMihir Shah More articles by this author , Ali SyedAli Syed More articles by this author , Alana MurphyAlana Murphy More articles by this author , Akhil DasAkhil Das More articles by this author , and Patrick ShenotPatrick Shenot More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2018.02.1734AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Ileovesicostomy is useful in patients with severe lower urinary tract dysfunction who are unwilling or unable to perform intermittent catheterization or are refractory to medical therapy. We evaluated the long term urodynamic outcomes changes in bladder management in a series of patients treated with ileovesicostomy for neurogenic bladder dysfunction. METHODS We retrospectively reviewed the charts of 19 men and 12 women with a mean age of 44.9 years who underwent incontinent ileovesicostomy at our institution between 1992 and 2002. Mean follow-up was 156 months (range 126-183 months). We compared detrusor leak point (DLPP) preoperatively and postoperatively and determined long-term urinary tract management. RESULTS Two male patient underwent conversion of the incontinent ileovesicostomy to ileocystoplasty using the same segment of bowel and now manage their bladder by intermittent catheterization. These patients were excluded from analysis. Three female patient underwent conversion to ileal conduit at a mean of 2.1 years after initial ileovesicostomy due to urethral incontinence. DLPP was less than 20 cm H2O in all of these patients. Urodynamic study (UDS) was performed in the remaining 26 patients with at least one UDS performed a minimum of ten years after initial ileovesicostomy. Initial DLPP in this cohort was 68 ± 21 cm H2O. With an extended follow-up of greater than ten years, DLPP on last follow-up was 12 ± 4 cm H2O. Of these 26 patients, intermittent catheterization is utilized at least once daily due to stasis with recurrent UTI (6/26 patients) and UTI with mild hydronephrosis in (2/26 patients). All of these patients have functioning ileovesicostomy with a DLPP of less than 20 cm H2O. CONCLUSIONS In this series of patients with ileovesicostomy, nearly 40% of patients will require the addition of intermittent catheterization after ten years despite low pressure drainage of the bladder through a functioning ileovesicostomy. We hypothesize that complications such as recurrent urinary tract infections are in part related to urinary stasis within the bladder and that although low pressure storage is achieved, there remains a significant residual urine within the bladder. © 2018FiguresReferencesRelatedDetails Volume 199Issue 4SApril 2018Page: e730 Advertisement Copyright & Permissions© 2018MetricsAuthor Information Mihir Shah More articles by this author Ali Syed More articles by this author Alana Murphy More articles by this author Akhil Das More articles by this author Patrick Shenot More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Outcome of rolled fortified vaginal flap operation on female patients with intrinsic sphincteric deficiency: 2-year follow-up.

We evaluate the 2-year outcome of the rolled fortified vaginal flap (RFVF) operation for the treatment of stress urinary incontinence (SUI) due to intrinsic sphincteric deficiency (ISD). A prospective study of 20 women suffering from SUI due to ISD was conducted. All patients were subjected to history-taking, clinical examination, cough stress test, and urodynamics. Symptom severity and quality of life (QoL) were assessed using the Arabic version of the International Consultation on Incontinence Questionnaire Urinary Incontinence Short Form (ICIQ-UI-SF). All studied women were followed up for 24months to detect success rate, any postoperative complications, and reveal changes in the quality of life. Mean age was 53 ± 8years. Preoperative Valsalva leak point pressure was 50.1 ± 11.3 cmH2O. After a follow-up period of 24months, only 2 patients (10%) showed mild stress incontinence with mean VLPP 80± 3 cm H2O. Postoperative mean maximum flow rate (Q-max) and mean Pdet-Qmax showed no significant difference from the preoperative results (P = 0.115 and 0.187 respectively). The quality of life domain of the ICIQ-UI-SF decreased significantly from 73.5 ± 12.1% (preoperatively) to 2.6 ± 8.1% (after a 1-year follow-up), P < 0.001 and then showed a slight increase to 4.5 ± 10.6 at 24months' follow-up. The RFVF operation has a success rate of 90% after a 24-month follow-up. It significantly improved the quality of life of women with SUI due to ISD.

Effects of 7-difluoromethy-5, 4'-dimethoxygenistein on stress urinary incontinence model in rats and its mechanisms

To investigate the effects of 7-difluoromethy-5, 4'-dimethoxygenistein (DFMG) on stress urinary incontinence (SUI) model in Sprague Dawley (SD) rats and its possible mechanisms. Methods: SD rat model of SUI was established through simulating pregnancy, birth trauma and ovarian castration. The rats were divided into a normal control group, a SUI group, and a DFMG group at 10 or 20 mg/kg. They were treated with 10 mg/kg normal saline (NS), 10 mg/kg NS, 10 mg/kg DFMG and 20 mg/kg DFMG, respectively, via gastric gavage every other day. Maximal bladder capacity (MBC), leak point pressure (LPP), abdominal leak point pressure (ALPP), hematoxylin-eosin (HE) staining, and Masson staining were performed to detect the index for the model. MiR-26b and its down-stream gene phosphatase and tensin homolog deleted on chromosome 10 (PENT) mRNA in urethral sphincter muscles cells (USMCs) were analyzed by RT-PCR. The protein levels of PENT, phosphatidylinositol 3-kinase (PI3K), protein kinaseB (AKT), B-cell lymphoma 2 (Bcl-2), Bcl-2 associated X protein (Bax), cytochrome C(Cyt-c) and caspase-3 were examined by Western blot. The apoptotic rate of USMCs was determined by flow cytometry (FCM), and the proliferative rate of USMCs was examined by MTT assay. Results: The SD rat model of SUI was successfully established. HE staining and Masson staining showed that the pathological features of urethral sphincter were improved in the DFMG-treated groups compared with the SUI group. The urine dynamics indexes of model rats, such as MBC, LPP and ALPP, were improved (all P﹤0.05). The results of RT-PCR showed that the miR-26b mRNA was up-regulated (P﹤0.05) and PENT mRNA was down-regulated (P﹤0.05) in the DFMG-treated groups compared with the SUI group. Simultaneously, compared with the SUI group, the protein levels of PENT, Bax, Cyt-c and caspase-3 were down-regulated (all P﹤0.05) and the protein levels of PI3K, AKT and Bcl-2 protein were up-regulated (all P﹤0.05), accompanied by the decreased apoptotic rate of USMCs (P﹤0.05) and the increased proliferative rate of USMCs (P﹤0.05) in the DFMG-treated groups. Conclusion: The DFMG can significantly improve the symptoms of urinary dynamics, which might be related to the up-regulation of miR-26b expression and the regulation of PI3/AKT-Bcl-2/ Bax signaling pathways.

Investigating the mechanism underlying urinary continence recovery after radical prostatectomy: effectiveness of a longer urethral stump to prevent urinary incontinence.

To assess the chronological changes in urinary incontinence and urethral function before and after radical prostatectomy (RP), and to compare the findings of pelvic magnetic resonance imaging (MRI) before and after RP to evaluate the anatomical changes. In total, 185 patients were evaluated with regard to the position of the distal end of the membranous urethra (DMU) on a mid-sagittal MRI slice and urethral sphincter function using the urethral pressure profilometry. The patients also underwent an abdominal leak point pressure test before RP and at 10 days and 12 months after RP. The results were then compared with the chronological changes in urinary incontinence. The MRI results showed that the DMU shifted proximally to an average distance of 4 mm at 10 days after RP and returned to the preoperative position at 12 months after RP. Urethral sphincter function also worsened 10 days after RP, with recovery after 12 months. The residual length of the urethral stump and urinary incontinence were significantly associated with the migration length of the DMU at 10 days after RP. The residual length of the urethral stump was a significant predictor of urinary incontinence after RP. This is the first study to elucidate that the slight vertical repositioning of the membranous urethra after RP causes chronological changes in urinary incontinence. A long urethral residual stump reduces urinary incontinence after RP.

Experimental and numerical simulation analysis of R-290 air conditioner leak

Different mass R-290 (propane) leaked into the room from the inside and outside of a split type air conditioner indoor unit, and the refrigerant concentration was measured by infrared gas sensors. A CFD mode for RAC indoor unit including heat exchanger and fan was developed and verified by the test data. Through experiment and simulation, the dispersion characteristics of the refrigerant under different conditions were studied. The influence of installation height, leak point location, airflow rate and angle were tested and analyzed. Using velocity and concentration contours, jet camber resulted from leaked refrigerant and Coanda flow were illustrated clearly. The airflow volume at speed greater than 0.2 m/s could be applied directly to assess the effect of airflow on refrigerant mixing and diffusion.

V30 - Intraoperative evaluation of retrograde leak point pressure (RLPP) during robotic assisted radical prostatectomy (RALP) for proper autologous sling tensioning to improve early urinary continence (EUC): The technique

V30 - Intraoperative evaluation of retrograde leak point pressure (RLPP) during robotic assisted radical prostatectomy (RALP) for proper autologous sling tensioning to improve early urinary continence (EUC): The technique

Clinical outcomes of non-surgical management of detrusor leak point pressures above 40 cm water in adults with congenital neurogenic bladder.

Neurogenic bladders (NGB) with detrusor leak point pressures >40 cm H2 O (dLPP > 40) have been associated with deterioration of renal function in children with myelomeningocele. For these children, careful pressure management preserves renal function. However, similar evidence is lacking in adult congenital urology (ACU) patients with NGB. We describe renal functional outcomes of non-surgical management of adults with dLPP > 40 or premicturition detrusor pressure (PMDP) >40 cm H2 O, consisting of close follow-up with urodynamic studies (UDS) and renal ultrasound (RUS), paired with adjustments to clean intermittent catheterization (CIC) frequency, anticholinergics, and addition of onabotulinumtoxinA toxin (BTX) injection. We retrospectively reviewed the UDS of all patients at an ACU clinic from 2011 to 2016. Patients with dLPP/PMDP > 40 cm who elected for non-surgical management were included. We describe their management and renal functional outcomes. A total of 33/42 patients with dLPP/PMDP > 40 elected for non-surgical management. 28/33 (85%) were successfully managed without bladder augmentation or urinary diversion at follow-up of nearly 3 years. The median index dLPP/PMDP was 49 cm H2 O (IQR 44, 63) and final dLPP/PMDP was 28 (IQR 18, 43). There was a significant decrease in dLPP/PMDP and increase in bladder compliance between index and final UDS (P < 0.001). No patients advanced their CKD stage and 6/10 with baseline hydronephrosis had improvement or resolution of hydronephrosis with non-surgical management. A non-surgical protocol for ACU patients with NGB and dLPP/PMDP > 40, utilizing CIC, anticholinergics, and BTX is safe and effective when coupled with coordinated care and close follow-up.

The effect of tramadol on sneeze-induced urethral continence reflex through μ-opioid receptors in the spinal cord in rats.

We examined the efficacy of tramadol on the urethral reflex during sneezing, as well as the role of µ-opioid receptors in the spinal cord, in rats. Forty-one female Sprague-Dawley rats were used. The rats were divided into normal female rats and rats with vaginal distension (VD), which mimics stress urinary incontinence (SUI) in humans. Under urethane anesthesia, the sneeze-induced amplitude of urethral responses (AUR) and baseline pressure (BP) were examined after intravenous injection of tramadol using a microtransducer-tipped catheter in both rat groups. The effect of intrathecal cyprodime, a selective µ-opioid receptor antagonist, following intravenous tramadol injection was examined in normal rats. The tilt leak point pressure (tilt LPP) after intravenous tramadol injection was also evaluated in both groups. In normal rats, tramadol enhanced the AUR and BP by 33.2% and 19.5%, respectively. Tramadol also increased BP by 13.9% in rats with VD, but it did not change AUR. Intrathecal cyprodime alone did not change AUR, but it decreased BP. However, tramadol-provoked increments in AUR were blocked by intrathecal cyprodime, while BP was recovered to the level that it was before administration of cyprodime. Tramadol was associated with a significant elevation in tilt LPP: 24.8% and 19.5% in normal and VD rats, respectively. These findings suggest that tramadol effectively enhances the AUR at the spinal level and BP peripherally. Therefore, stimulation of the spinal µ-opioid receptors may be useful for the treatment of SUI.

Video-urodynamic Improvement of Trigonal BTX-A Injection for Patients with Poor Bladder Compliance Secondary to Spinal Cord Injury

Objective: To evaluate video-urodynamic improvement for trigonal BTX-A injection in patients with neurological poor bladder compliance. Methods: 68 consecutive inpatients with poor bladder compliance secondary to spinal cord injury(SCI) received trigonal injections of BTX-A(300U) into the bladder from June 2014 to February 2017. All were evaluated video-urodynamic outcome included detrusor leak point pressure (DLPP), bladder compliance (BC) and vesicoureteral reflux (VUR) at baseline and 12 weeks post-injection. Results: all outcomes improved significantly compared to baseline. The improvement percentage of DLPP (44.36%) and BC(77.13%). No patient developed unilateral or bilateral VUR. Conclusions: Trigone-including BTX-A injection is safe and effective as the treatment for low BC and does not induce VUR.

Does intraoperative success predict outcome in the treatment of urethral sphincter insufficiency with bulking agent?

Sphincter insufficiency is mostly associated with neurogenic and some structural abnormalities in the pediatric population. As a mini-invasive treatment, urethral bulking agents have been used to treat this problem. The aim was to evaluate if technical success, defined as intraoperative increase in abdominal leak point pressure (ALPP), predicts the outcome of the treatment of sphincter insufficiency with urethral bulking agent. We reviewed all children treated first time with dextranomer/hyaluronic acid (Dx/HA) copolymer (Deflux) for urethral sphincter insufficiency and who intraoperatively had ALPPs measured during 2004-2014. Patient characteristics, change in urinary continence and the duration of the possible response were evaluated in neurogenic and non-neurogenic cases. The median age of the patients was 7.8 years (range 4.1-14.5) at initial treatment and median volume of Dx/HA instilled was 3.5mL (IQR 2-5). Twelve patients had neurogenic disease and 15 had non-neurogenic disease. Median ALPPs before and after the injections were 19 cmH2O (IQR 14-28) and 70 cmH2O (IQR 48-80), p<0.001. Increases in ALPPs were similar in both patient groups (p=0.661) and in 17 patients with any response and 10 patients with no response (p=0.267). In patients with any response the median duration of the response was only 0.8 years (IQR 0.09-2.0). During a median follow-up of 4.9 years (range 1.7-11.8), 15 patients received one to three repeat injections and eight patients went through sling or bladder neck operation (Summary table). During repeat injections, the preoperative ALPPs had returned to the original levels. Currently, 20% are continent or almost continent with one or more Dx/HA injections. In half of the patients with neurogenic bladder, compliance or volume deteriorated slightly in follow-up. Five out of 15 patients who reached puberty become continent spontaneously after failed bladder neck injection. Intraoperative ALPPs increased significantly in most patients during the procedure. However, only 52% of the patients experienced more than 1 month of success after the procedure, and even in those the effect lasted mostly under a year. With one to four injections one-fifth seem to have had a good long-term result. Although the long-term success rate is limited, bulking agent injection allowed the patients with spontaneous voiding to continue it and the injection did not prevent future treatments. Intraoperative increased ALPP does not predict a good long-term outcome after Dx/HA injection. At the end, only a fifth of our patients had good result with one or more Dx/HA injections. A change in bladder behavior is possible after treatment.

Volume at First Leak Is Associated With Sling Failure Among Women With Stress Urinary Incontinence.

Stress urinary incontinence at a low bladder volume is a clinically observed phenomenon that is not well studied with regard to treatment outcomes. The primary aim of our study was to determine if the volume at first leak is associated with sling outcome. This is a retrospective cohort study evaluating whether urodynamic stress urinary incontinence observed at low volumes is associated with sling failure using the Synthetic Derivative database. Sling failure was defined as (1) undergoing a subsequent surgery for stress incontinence (eg, urethral bulking agent, repeat sling) or (2) leakage that was subjectively worse or unchanged from baseline. Sling success was defined as subjective improvement in incontinence or being dry. Intrinsic sphincter deficiency was defined as maximum urethral closure pressure 20 cm H20 or less or abdominal leak point pressure less than 60 cm H20. Outcome data were available for 168 of 206 women who underwent a sling after urodynamic testing from 2006 to 2014. Of the 168 women, 80 were transobturator, 79 were retropubic, 8 lacked data regarding the approach to the midurethral sling, and 1 was an autologous pubovaginal sling. Similar failure rates were seen for transobturator (10%) and retropubic slings (7.6%). Preoperative urodynamic parameters, such as cystometric capacity and intrinsic sphincter deficiency, were similar among failed and successful slings. For every additional 50 mL in bladder volume at first leak (SUIvol), there was a 1.6 increased odds of having a successful sling (odds ratio, 1.576; 95% confidence interval, 1.014-2.450; P = 0.04). There was no statistically significant association between maximum urethral closure pressure, abdominal leak point pressure, body mass index, age, sling type, or whether a prior anti-incontinence procedure had been performed and sling success. Bladder volume at first leak is a strong predictor of sling failure.

Effectiveness and quality of life 10 years after transobturator suburethral tape surgery for stress urinary incontinence.

We aimed to measure the effectiveness and quality of life (QoL) 10 years after transobturator suburethral tape surgery. We carried out a prospective observational study of 42 women assessed 10 years after surgical intervention with the transobturator technique. The main outcome measures were subjective and objective cure or improvement, complications, and changes in QoL. The median abdominal leak point pressure had been 92 (82-113) mL H2 O prior to surgery. Thirty-six women (85.7%) remained cured (negative cough test) and 13 (31%) reported urine leakage during physical activity, percentages which were similar to those at a previous assessment at the 5th year. Urgency urinary incontinence was reported by 18 women (42.9%), 16 of whom required the use of anticholinergic drugs. Nineteen women had undergone some form of surgical pelvic reconstruction concomitantly with the TOT procedure, four of whom presented with relapse. The QoL tests indicated that cure and improvement persisted in 85.7% (n = 36, Urogenital Distress Inventory-6) and 92.9% (n = 39, Incontinence Impact Questionnaire-7) of the 42 evaluable women, respectively. Rates of objective and subjective effectiveness remained stable after 10 years of surgery and QoL did not deteriorate significantly during that interval. The increase in urgency incontinence needs to be further investigated.

Clinical Evaluation of Urinary Incontinence.

Pelvic organ prolapse is the downward descent of the pelvic floor organs and has a prevalence of 3%–6% and can even reach to 50% if defined by a vaginal examination. The anatomical concepts of pelvic diaphragm, lateral attachment of vagina to arcus tendineus fascia pelvis, and intrinsic and extrinsic sphincter control mechanisms are elaborated. The anatomic and physiological mechanisms of autonomic and voluntary control of continence are discussed. The clinical and urodynamic tests and their implications in guiding the management are explained. Finally, uroflowmetry, cystometry, urethral pressure profile, postvoid urine measurement, leak point pressure (LPP) test, video urodynamic tests, and electromyography studies of pelvic floor are discussed as an integral part of the assessment.

Sonographic evaluation of bladder wall thickness in women with lower urinary tract dysfunction.

ObjectiveTo investigate the correlation between bladder wall thickness (BWT) measured by ultrasonography and lower urinary tract dysfunction (LUTD) in patients with lower urinary tract symptoms (LUTS).MethodsForty-eight women with LUTS who underwent urodynamic study and BWT by ultrasonography as outpatients were studied. We assessed LUTS during a medical examination by interview. The thinnest part of the bladder wall was measured by a transabdominal ultrasonography. We excluded patients who had visited another hospital previously because we did not know what treatment they had received, including medications, behavioral therapy, or other treatments. We constructed receiver operating characteristic (ROC) curves for diagnosis of LUTD and also determined reliable BWT criteria by calculating the area under the curve. Statistical analyses were performed using the Kolmogorov-Smirnov method and Student's t-test.ResultsThe mean age, body mass index, and duration of symptoms were 59.9±9.7 years, 26.06±3.4 kg/m2, and 53.4±38.2 months, respectively. Urodynamic study parameters (Valsalva leak point pressure, maximal urethral closure pressure, functional length, and postvoid residual volume) were lower in patients with BWT <3 mm; however, these differences were not significant. Patients with BWT ≥3 mm developed a hypoactive bladder (P=0.009) and intrinsic sphincter deficiency (ISD) (P=0.001) at a significantly higher rate. According to the ROC analysis, the best BWT cut-off value was 3 mm for overactive bladder diagnosis.ConclusionsWomen with LUTD showed higher BWT values (≥3 mm), especially patients with hypoactive bladder and ISD. Sonographic evaluation of BWT is an easy, fast, and noninvasive method for possible diagnostic tool for LUTD.

Therapeutic Potential of Human Adipose-Derived Stem Cell Exosomes in Stress Urinary Incontinence – An in Vitro and in Vivo Study

Background/Aims: To evaluate whether local injection of exosomes derived from human adipose-derived stem cells (hADSCs) facilitates recovery of stress urinary incontinence (SUI) in a rat model. Methods: For the in vitro study, a Cell Counting Kit-8 (CCK-8) array and proteomic analysis were performed. For the in vivo study, female rats were divided into four groups: sham, SUI, adipose-derived stem cell (ADSC), and exosomes (n = 12 each). The SUI model was generated by pudendal nerve transection and vaginal dilation. Vehicle, hADSCs, or exosomes were injected into the peripheral urethra. After 2, 4, and 8 weeks, the rats underwent cystometrography and leak point pressure (LPP) testing, and tissues were harvested for histochemical analyses. Results: The CCK-8 experiment demonstrated that ADSC-derived exosomes could enhance the growth of skeletal muscle and Schwann cell lines in a dose-dependent manner. Proteomic analysis revealed that ADSC-derived exosomes contained various proteins of different signaling pathways. Some of these proteins are associated with the PI3K-Akt, Jak-STAT, and Wnt pathways, which are related to skeletal muscle and nerve regeneration and proliferation. In vivo experiments illustrated that rats of the exosome group had higher bladder capacity and LPP, and had more striated muscle fibers and peripheral nerve fibers in the urethra than rats of the SUI group. Both urethral function and histology of rats in the exosome group were slightly better than those in the ADSC group. Conclusions: Local injection of hADSC-derived exosomes improved functional and histological recovery after SUI.

Autologous and heterotopic transplantation of adipose stromal vascular fraction ameliorates stress urinary incontinence in rats with simulated childbirth trauma.

IntroductionAutologous transplantation of adipose stromal vascular fraction (SVF) is a cost-effective and technically accessible option for cell therapy. Clinical study of SVF transplantation for male stress urinary incontinence (SUI) is underway, but the effectiveness remains unknown for female SUI, majority of which is caused by childbirth trauma.MethodsVaginal Distension (VD) rats were generated as in vivo model for female SUI. To quantitate the severity of SUI, leak point pressure (LPP) was measured by placing a bladder catheter. There was a characteristic waveform of LPP with two-peaks, and we counted the second peak as an LPP value. Adipose SVF was separated from inguinal fat and delivered into external urethral sphincter (EUS) through transperineal injection. LPP was measured 7 or 14 days after SVF transplantation. Tissue damage and collagen synthesis around the EUS were visualized by Masson's trichrome and eosin staining. Antibody against α-smooth muscle actin (α-SMA) was used to stain smooth muscle or activated stromal cells. Donor SVF cells were distinguished from recipient EUS tissue by tracking with GFP transgene.ResultsVD procedure decreased the frequency at which the normal LPP waveform appeared and lowered the LPP value. SVF injection normalized the waveform as well as the level of LPP. VD disrupted histological structure of EUS and SVF failed to differentiate into striatal muscles. Instead, SVF increased α-SMA positive cells and collagen synthesis but the phenomena depended on VD stimulus. GFP tracking indicated that the transplanted SVF cells persisted for four weeks and synthesized α-SMA protein simultaneously.ConclusionsAutologous transplantation of adipose SVF displayed bulking effects through collagen synthesis. However, such heterotopic activation was dependent on tissue damage.

Urethral function and histopathology in aged female rats as a stress urinary incontinence model.

Stress urinary incontinence (SUI) is a common disease condition in elderly women, suggesting that its etiology may be linked to aging. To investigate the hypothesis that urethral dysfunction and histopathological changes are possible contributors to SUI in elderly women, several parameters of urethral function, as well as histological parameters, were compared between young and aged rats. Virgin female rats were examined at 3 different ages, namely 3, 12, and 24 months, corresponding to young, middle-aged, and aged rats, respectively. Urethral function was assessed by measuring the leak point pressure (LPP), pudendal nerve stimulation (PNS)-induced elevation in urethral pressure, and phenylephrine-induced increase in urethral perfusion pressure (UPP). Histopathological assessments were performed following hematoxylin and eosin (HE), Masson's trichrome, and immunofluorescence staining of urethral tissue. LPP of aged rats was significantly reduced compared to that of both young and middle-aged rats. PNS-induced elevation in urethral pressure in aged rats was also significantly lower than that in young rats. In contrast, there were no significant differences in the phenylephrine-induced increase in UPP between young and aged rats. Connective tissue area in the external urethral sphincter (EUS) layer was increased in aged rats, whereas the smooth muscle layer was histologically similar to that in young rats. The number of EUS fibers was significantly reduced in aged rats, whereas the cross-sectional area of EUS fibers increased from differed compared with young rats. We have demonstrated age-related changes in EUS function and morphology in the rat urethra, which are considered to be etiological risk factors for SUI in humans.

The establishment of a neurogenic bladder model through spinal nerve transection in rats

Objective To establish a neurogenic bladder (NB) model through spinal nerve transection in rats and to evaluate the model with video-urodynamic. Methods Twenty five female Sprague-Dawley (SD) rats [mean weight (200-220) g, 8 weeks old] were randomly divided into NB group (n=15) and Sham group (n=10). In NB group rats, the bilateral lumbar 6(L6)and sacral 1(S1)spinal nerves were transected in dura. In Sham group rats, only laminectomy was performed. Video-urodynamic assessment was carried out one month postoperatively. Results The voiding dysfunction was observed in NB group rats, which showed full lower abdomen and discharged more urine by squeezing the increased bladder. The Sham group showed no significant abnormality. The video-urodynamic showed detrusor areflexia of rats in the NB group. The maximum bladder capacity (MBC) and bladder compliance (BC) increased significantly in NB group than those of Sham group [MBC: (3.97±0.90) ml vs. (1.03±0.21) ml; BC: (0.203±0.068) ml/cmH2O vs. (0.037±0.01) ml/cmH2O)] (t=10.070, P=0.000; t=7.616, P=0.000). However, the detrusor leak point pressures (DLPP) decreased significantly in NB group than those of Sham group [DLPP: (20.64±5.03) cmH2O vs. (27.88±3.94) cmH2O] (t=3.746, P=0.001). Simultaneous images showed that the bladder volume of the rats in the NB group was increased as rugby compared with Sham group. Conclusion This procedure of spinal nerve transaction can be used to establish NB rat model with acontractile detrusor. Key words: Neurogenic bladder; Spinal nerve; Urodynamic; Rat

Resistivity profiles of Perth soil in Australia in leak-detection test

The use of a suitable leak-detection system for the prevention and mitigation of pollution due to lining system failures is integral to the proper management of landfill facilities. This paper briefly summarises various methods of leak detection that are currently being practised. The details of a newly developed leak-detection technique are also presented. The tests were conducted to evaluate the performance of the new technique by use of controlled leakage. The resulting resistivity profiles for Perth soil in Australia were obtained at 10 min. This method is found to be effective in detecting and locating liner leakage issues within 30 min from the instant when the defect develops. The electrical resistivity decreases with an increase in the leakage duration. The resistivity was found to increase with an increase in the distance/depth from the leak point. Installation of this innovative detection system below liners can enable the various waste containment facilities, such as landfills and leachate ponds, to monitor the lining systems and in case of failures, to take timely action for hazard mitigation. Results presented in this study can be useful for further development of sensors for leakage detection in lining systems.