Lower Urinary Tract Function Research Articles

Can we define and characterize the aging lower urinary tract?-ICI-RS 2015.

The prevalence of lower urinary tract (LUT) symptoms increases with age but the etiology is unknown. This article aims to identify research directions that clarify the basis of this association. The initial question is whether biological age is the variable of interest or a time-dependent accumulation of factors that impact on LUT function at rates that differ between individuals. In particular, the accumulation of conditions or agents due to inflammatory states or tissue ischemia is important. Much of the above has been concerned with changes to bladder function and morphology. However, the outflow tract function is also affected, in particular changes to the function of external sphincter skeletal muscle and associated sacral motor nerve control. Nocturia is a cardinal symptom of LUT dysfunction and is more prevalent with aging. Urine production is determined by diurnal changes to the production of certain hormones as well as arterial blood pressure and such diurnal rhythms are blunted in subjects with nocturia, but the causal links remain to be elucidated. Changes to the central nervous control of LUT function with age are also increasingly recognized, whether in mid-brain/brainstem regions that directly affect LUT function or in higher centers that determine psycho-social and emotional factors impinging on the LUT. In particular, the linkage between increasing white matter hyperintensities and LUT dysfunction during aging is recognized but not understood. Overall, a more rational approach is being developed to link LUT dysfunction with factors that accumulate with age, however, the precise causal pathways remain to be characterized. Neurourol. Urodynam. 36:854-858, 2017. © 2017 Wiley Periodicals, Inc.

Effect of a Bicyclic Pyrimidine Derivative (KRP-103), a Novel Selective Tachykinin NK1 Receptor Antagonist, on Bladder Function in Guinea Pigs.

We evaluated the pharmacological characteristics of KRP-103, chemically named as ((2-(4-acetylpiperazin-1-yl)-6-[3,5-bis(trifluorometheyl)-phenylmethyl]-4- (2-methylphenyl)-6,7,8,9-tetrahydro-5H-pyrimido[4,5-b][1,5]oxazocin-5-one), and its effects on lower urinary tract function in guinea pigs. In radioligand binding assay, KRP-103 showed higher selectivity for human NK1 receptor (hNK1R) than for human NK2 receptor (hNK2R) and human NK3 receptor (hNK3R) (Ki for hNK1R, hNK2R and hNK3R=0.126 nM, > 10 000 nM and > 10 000 nM). In distention-induced rhythmic bladder contractions (RBCs) in urethane-anesthetized guinea pigs, intravenous administration of KRP-103 dose-dependently increased the shutdown time of RBCs and slightly decreased the amplitude of RBCs (only about 20%). In acutely spinalized guinea pig cystometory, intraduodenal administration of KRP-103 dose-dependently increased the effective bladder capacity with a minimum effective dose of 1 mg/kg. Furthermore, to clarify the site of action of KRP-103, we evaluated the inhibitory effects of KRP-103 on bladder contractions induced by electrical stimulation (ES) of the central or peripheral cut end of the pelvic nerve (PN). KRP-103 inhibited the bladder contractions induced by ES of the central cut end of PN but not those induced by ES of the peripheral cut end of PN. These results indicate that KRP-103 enhances bladder storage function by inhibiting sensory transmission from the bladder at the level of spinal cord without affecting bladder efferent function, suggesting that KRP-103 may be a suitable therapeutic drug for treatment of overactive bladder.

472 - Evaluation of urologic problems in anorectal malformations and effect of anorectoplasty on lower urinary tract function

472 - Evaluation of urologic problems in anorectal malformations and effect of anorectoplasty on lower urinary tract function

Deep brain stimulation for the control of the lower urinary tract functions

Deep brain stimulation for the control of the lower urinary tract functions

Muro-Neuro-Urodynamics; a Review of the Functional Assessment of Mouse Lower Urinary Tract Function.

Background: Mouse urodynamic tests are fundamental to understanding normal lower urinary tract (LUT) function. These experiments also contribute to our understanding of neurological dysfunction, pathophysiological processes, and potential mechanisms of therapy.Objectives: Systematic assessment of published evidence on urodynamics, advantages and limitations of different urodynamic measurements in mice, and consideration of potential implications for the clinical field.Methods: A search using specific search-terms for urodynamic studies and mice was conducted on PubMed (from inception to 1 July 2016).Results: We identified 55 studies examining or describing mouse neuro-urodynamics. We summarize reported features of mouse urodynamic function deriving from frequency-volume chart (FVC) measurements, voiding spot assays, filling cystometry, and pressure-flow studies. Similarly, an influence of the diurnal cycle on voiding is observed in mice and should be considered when interpreting rodent urodynamic studies, especially FVC measurements and voiding spot assays. Anaesthesia, restraint conditions, or filling rate influence mouse neuro-urodynamics. Mouse cystometric studies have observed intravesical pressure oscillations that accompany urine flow, attributed to high frequency opening and closing of the urethra. This characterization is not seen in other species, except rats. In contrast to human clinical urodynamics, the terminology of these examinations has not been standardized although many rodent urodynamic studies have been described.Conclusion: Mice have many anatomical and physiological similarities to humans and they are generally cost effective, and allow investigation of the effects of aging because of their short lifespan. There are some differences between mouse and human urodynamics. These must be considered when interpreting LUT function in mice, and translational value of murine disease models.

The Long-Term Effect of Radical Prostatectomy on Erectile Function, Urinary Continence, and Lower Urinary Tract Symptoms: A Comparison to Age-Matched Healthy Controls.

Introduction. To analyze the impact of radical prostatectomy (RPE) on erectile function and lower urinary tract function in comparison to age-matched healthy men. Materials and Methods. Patients who underwent radical retropubic prostatectomy completed questionnaires containing the IIEF-5, the Bristol female LUTS questionnaire, and the International Prostate Symptom Score (IPSS). Results. Patients after RPE were included (n = 363). Age-matched healthy men (n = 363) were included. The mean IIEF-5 of patients aged 61–70 yrs after RPE was 10.4 ± 6.6 versus 18.8 ± 5.3 in the control cohort; the respective values for men aged 71–80 yrs after RPE were 7.2 ± 6.5 versus 13.6 ± 7.7 in the control cohort. Urinary incontinence after RPE was reported in 41.9% (61–70 years) and 37.7% (71–80) versus 7.5% and 15.1% in the control cohort. The mean IPSS of patients after RPE aged 61–70 yrs was 5.0 ± 4.4 versus 5.5 ± 4.9 in the control cohort; the respective values for men aged 71–80 yrs were 6.0 ± 4.9 versus 7.5 ± 5.7 in the healthy cohort. Conclusions. The negative effect of radical prostatectomy on erectile and urinary incontinence remains substantial. The physiologically declining erectile and lower urinary tract function with ageing reduces the difference between healthy men and those after surgery. Healthy men have a higher IPSS presumably due to the presence of bladder outlet obstruction.

AB287. SPR-14 High fat diet leads to impaired mitochondrial respiration, increased hydrogen peroxide emission and greater nerve-mediated purinergic contraction in mouse bladder

ObjectiveChronic high fat diet (HFD) is associated with the development of metabolic syndrome and type 2 diabetes, known risk factors for lower urinary tract symptoms, overactive bladder, and incontinence. HFD induced increases in oxidative stress and impaired mitochondrial integrity is a possible mechanism underlying this pathology. Our objectives were to determine bladder function following long-term HFD and characterize mitochondrial oxidant emission and respiratory function. We hypothesized that chronic HFD would lead to increased cholinergic mediated contraction and impaired mitochondrial respiration.MethodsMale C57BL/6J mice were maintained on a control diet (CD: 4% fat, 60% carbohydrates, 26% protein) or a HFD (45% fat, 35% carbohydrates, 20% protein) from 6 weeks of age for 20 weeks. A week prior to sacrifice, lower urinary tract function was assessed via void spot assay. Animals were euthanized and bladders and visceral fat depots were collected and weighed. Bladders were denuded of urothelium, cut into 8×2 mm strips and placed in tissue baths. Increasing concentrations of carbachol (cholinergic mediated) contraction and adrenergic relaxation to norepinephrine (NE) were measured. Electric field stimulated (EFS) contractions with and without atropine (cholinergic antagonist) were assessed. A separate group of bladders were denuded, homogenized and mitochondria quantified via citrate synthase activity. High-resolution respirometry measured oxygen consumption of individual electron transport chain complexes. Mitochondrial hydrogen peroxide (H2O2) emission was measured fluorimetrically using Amplex Ultra Red. Data were compared using a student t-test.ResultsHFD mice had a greater number of voids (P<0.005) and a larger void area (P<0.005). Blood glucose was greater in HFD (CD: 85±6.1; HFD: 139±5.9) as were body and overall visceral fat weights (P<0.0005). In contrast, HFD did not impact bladder weight. HFD did not change detrusor cholinergic contraction or adrenergic relaxation. However, detrusor contraction to EFS was markedly increased with HFD in both the presence and absence of atropine. Cholinergic inhibition blunted EFS contraction to a greater extent in CD bladders (CD: 75.7%±2.65; HFD: 42.3%±2.82, P<0.05) indicating that HFD had shifted EFS contraction to greater purinergic release. Citrate synthase activity indicated similar amounts of intact mitochondria. HFD resulted in a decreased respiratory capacity across 4 of 6 mitochondrial complexes investigated (P<0.05). Complex I and Complex II in state 4 conditions were unchanged. Additionally, mitochondrial H2O2 emission was increased in HFD bladders (CD: 11.4 pmols/min/mg ±0.53; HFD: 18.6±0.66, P<0.05).ConclusionsProlonged HFD leads to increased urinary frequency and volume, increased detrusor purinergic EFS contraction and mitochondrial dysfunction including decreased respiratory capacity and increased H2O2 emission. Further investigation of the role of mitochondrial dysfunction and resulting detrusor dysfunction following HFD is merited.Funding Source(s)None

Prenatal myelomeningocele repair: Do bladders better?

Prenatal myelomeningocele (MMC) repair has been proven to significantly reduce the need for hydrocephalus shunting and improve lower-extremity motor outcomes. The aim of this study was to evaluate the effect of prenatal MMC repair on the urological outcome. All patients who underwent fetal MMC repair at our institution are followed prospectively. Assessments include medical history, renal and bladder ultrasound, voiding cystourethrogram and urodynamic study, need for clean intermittent catheterization (CIC) and anticholinergics, and the occurrence of urinary tract infections (UTI). Of the 30 patients who underwent prenatal MMC closure from December 2010 to December 2015, eight patients with a postnatal follow-up of at least 2 years were included in this study and compared with eight patients after postnatal MMC repair. The level of the bony spinal defect was similar in both groups. Urological evaluation at 2 years revealed normal bladder function in 50% after prenatal repair. Neurogenic bladder dysfunction requiring CIC and anticholinergic therapy was seen in 50% in the prenatal and in 100% in the postnatal group. Significant bladder wall thickening was found in 37.5% and 87.5%, respectively. Febrile UTIs occurred in 37.5% in the prenatal and 62.5% in the postnatal group during the observation period. Our data suggest a positive effect of prenatal MMC closure on lower urinary tract function. The long-term significance of these results remains unclear. Therefore, continued close monitoring of renal and bladder function are mandatory.

Effect of orchiectomy and testosterone replacement on lower urinary tract function in anesthetized rats.

Lower urinary tract (LUT) symptoms (LUTS), including frequency, urgency, incomplete voiding, and slow stream, are common in both men and women with advancing age. The most common cause for LUTS in aging men is benign prostatic hyperplasia. Some studies have also revealed an inverse association of serum testosterone levels with LUTS; however, the underlying mechanisms by which gonadal hormones affect the LUT have not been clarified. In the present study, we examined the effect of orchiectomy and testosterone replacement on LUT function in adult male Sprague-Dawley rats. Six weeks after bilateral orchiectomy or sham operations and 3 wk after injection of long-acting testosterone undecanoate (100 mg/kg im), transvesical cystometry and external urethral sphincter electromyogram (EUS EMG) recordings were performed under urethane anesthesia. The micturition reflex was elicited in both sham and orchiectomized animals. In orchiectomized rats, volume threshold for inducing micturition decreased by 47.6%; however, contraction amplitude, duration, and voiding efficiency were similar in sham and orchiectomized rats. The active period during EUS EMG bursting was lengthened during micturition in orchiectomized animals. Testosterone treatment, which normalized plasma testosterone levels, reversed these changes but also increased the duration of EUS EMG bursting. Orchiectomy also reduced mean voiding flow rate estimated from the duration of EUS EMG bursting, an effect that was not reversed by testosterone. The results indicate that orchiectomy affects both the active and passive properties of the bladder and urethra, and that many, but not all, of the changes can be reversed by testosterone.

Psychotropic Drugs and Their Effects on Lower Urinary Tract Function: an Update

A psychotropic drug is defined as a drug “capable of affecting the mind, emotions, and behavior; denoting drugs used in the treatment of mental illnesses” (Medical Dictionary for the Health Professions and Nursing 2012). Use of these drugs can lead to urinary dysfunction, but it is often difficult to delineate whether urinary dysfunction is a direct/indirect result of drug use or secondary to an unrelated concurrent condition. This situation can therefore result in diagnostic or management dilemmas for urologists, psychiatrists, and primary care physicians. This article reviews the literature published in the last 3 years, and provides an update on the desirable and undesirable effects of psychotropic drugs on lower urinary function. Duloxetine is an antidepressant with efficacy in the treatment of stress urinary incontinence. In addition, duloxetine and desipramine have been proposed in the treatment of overactive bladder. Laboratory research into potential therapies which target the role of neurotrophins in lower urinary tract function is in progress. Narcotic analgesia, several antipsychotics, antidepressant, anticonvulsant, and stimulant medications are associated with urinary retention. Several antidepressants have been associated with nocturnal enuresis. Furthermore, ketamine is known to induce storage symptoms, with reduction in bladder capacity. Lower urinary tract symptom (LUTS)-causing drugs are associated with polypharmacy, and elderly patients are particularly susceptible to adverse events due to pharmacotherapy. Awareness of psychotropic drug side effects and rationalization of their use is important to avoid undesirable outcomes. When patients with bothersome LUTS who are on psychotropic drugs fail to benefit from simple first-line treatments for LUTS, clinicians should be mindful that the psychotropic drug may indeed be the cause of LUTS and seek to liaise with the patient’s psychiatrist or primary care physician to discuss reasonable alternatives.

Linkage of Lower Urinary Tract Symptoms to Sleep Quality in Elderly Men with Nocturia: A Community Based Study Using Home Measured Electroencephalogram Data

We objectively investigated the relationship between sleep quality/efficiencyand factors associated with micturition using at-home electroencephalogram assessment. Participants were recruited from among those enrolled in the Fujiwara-kyo Study, a community based longitudinal evaluation that began in Nara Prefecture, Japan, in 2007. Included participants were men at least 65 years old who woke up in the middle of the night/early morning at least 3times per week with the urge to void. We evaluated lower urinary tract symptoms using the I-PSS and subjective sleep quality using the Pittsburgh Sleep Quality Index. Uroflowmetry and 3-day frequency volume charting measurementswere also obtained. Electroencephalogram recordings were obtained during sleep to evaluate objective sleep quality. Final analysis included data from 47 participants. I-PSS-quality of life score and slow wave sleep time were independent predictors of good subjective sleep quality as determined by Pittsburgh Sleep Quality Index scores. Nocturnal urinary volume was an independent predictor of greater sleep efficiency. Maximum flow rate was an independent predictor of longer slow wave sleep time. In elderly men with nocturia, sleep quality is associated with lowerurinary tract function. Higher subjective sleep quality is associated with longer slow wave sleep time and less severe lower urinary tract symptoms. Higher objective sleep quality is further associated with a higher urinary flow rate and lower nocturnal urinary volume.

Cardiovascular response during urodynamics in individuals with spinal cord injury.

Retrospective chart review. To establish the frequency and severity of autonomic dysreflexia (AD) during urodynamics among individuals with chronic spinal cord injury (SCI) and to investigate the possible effect of the number of years since SCI on the severity of AD. SCI outpatient clinic. A retrospective chart review was undertaken of individuals with SCI who were seen at an outpatient clinic and could potentially develop an episode of AD (T6 and above). Data regarding age, gender, urodynamic examination, lower urinary tract function, cardiovascular parameters and SCI were collected. In addition, information on signs and symptoms of AD were retrieved. A total of 76 individuals with SCI were examined with blood pressure (BP) monitoring. The majority had cervical SCI (79%). The mean age was 47.8±13.9 years. The median duration after SCI was 51.5 months. During urodynamics, a total of 48 (63.2%) individuals showed an increase in systolic BP>20 mm Hg, meeting the criteria for AD. Indicators for higher incidences of AD were cervical SCI, being >2 years after SCI, the presence of detrusor sphincter dyssynergia (DSD) and low bladder compliance. AD was more severe in individuals with complete (American Spinal Cord Association (ASIA) impairment scale (AIS) A) injuries, worse with greater time after SCI. Individuals with cervical SCI, DSD, poor bladder compliance or >2 years after SCI were associated with a higher possibility of developing AD during urodynamics. Furthermore, AD was more severe in complete (AIS A) individuals and was exacerbated with time after injury.

The use of imaging techniques in understanding lower urinary tract (dys)function.

The ability to store urine in the bladder and to void at an appropriate time depends on several complex mechanisms in the lower urinary tract (LUT) and its neural control. Normal LUT function requires coordination of the urinary bladder, urethra, pelvic floor, efferent and afferent neurons and specific spinal cord and brain areas. These structures can be visualised using different imaging modalities, such as ultrasound, X-ray and magnetic resonance imaging. The supraspinal neural control of the LUT can be studied using functional brain imaging. During the last two decades, the many technological improvements of these imaging techniques have increased our knowledge of voiding dysfunction. Here, we review the different imaging modalities of the LUT and its neural control and discuss their importance for diagnosing and understanding voiding dysfunction.

The relationship between histological prostatitis and lower urinary tract symptoms and sexual function.

ABSTRACTThis prospective analysis assessed the effect of histological prostatitis on lower urinary tract functions and sexual function. The patients were separated into two groups as histologically observed prostatitis (Group A) and no prostatitis (Group B) according to the biopsy outcomes. International prostate symptom score, international index of erectile function-5 scores, maximal and average flow rate, and residual urine volumes were compared statistically between groups. There was no significant difference (P>0.05) in baseline age (t=0.64), body mass index value (t=0.51), prostate volume (t=0.87), prostate-specific antigen levels (t=0.43), maximal (t=0.84) and average flow rate (t=0.59), and post-void residual urine volume (t=0.71). Mean international prostate symptom score in patients with prostatitis was numerically but not significantly higher than that in those without prostatitis (t=0.794, P=0.066). Mean international index of erectile function-5 score in the prostatitis group was significantly lower than that in those without prostatitis (t=1.854, P=0.013). Histological prostatitis notably affected sexual function of patients and may serve as a major risk factor for sexual dysfunction while having little effect on lower urinary tract symptoms.

Associations between lower urinary tract dysfunction and health-related quality of life in children with chronic kidney disease.

AimLittle is known about the health‐related quality of life (HRQoL) of children with lower urinary tract dysfunction (LUTD) and chronic kidney disease (CKD). We investigated LUTD and other possible predictors of impaired HRQoL in children with conservatively treated moderate‐to‐severe CKD or with a kidney transplant.MethodsAll 64 children with CKD or a kidney transplant treated at Karolinska University Hospital, Stockholm, Sweden, between June 2011 and December 2012 were approached and 59 children aged 8–18 were enrolled in the study. Lower urinary tract function was evaluated with voiding history, frequency and volume chart, uroflowmetry and postvoid ultrasound measurements. Self‐reported HRQoL was assessed with validated generic instruments.ResultsThe HRQoL of the study cohort was as good as the general paediatric population, apart from the physical and psychological well‐being dimensions, and was no different to children with other chronic conditions. Urinary incontinence, but not LUTD in general, was associated with impaired HRQoL, as was having a kidney transplant and being female in some dimensions.Conclusion LUTD was common in children with CKD or a kidney transplant but did not affect their general HRQoL. Predictors of impaired HRQoL included incontinence, having had a kidney transplant and being female.

Long-Term Urologic Evaluation Following Spinal Cord Injury

Spinal cord injury (SCI) has significant long-term urologic consequences that impact quality of life (QOL) and can influence life expectancy. Neurogenic bladder, urinary tract infections, and autonomic dysreflexia are common consequences of SCI. It is essential to conduct a focused patient interview to address these consequences. History should include a basic assessment of the patient and symptomatology as per a validated instrument, as well as a detailed urologic diary. The physical examination should include evaluation of the extent of the neurologic injury as per the American Spinal Association Injury (ASIA) scale, the affected system as well as examination maneuvers done in those without neurologic injury. Investigations should include urodynamic testing and cystoscopy. In managing patients with SCI, pharmaceutical agents and intermittent catheterization are utilized normally in an effort to protect the upper urinary tract, achieve and maintain urinary continence, and optimize lower urinary tract function and quality of life (QOL).

Commentary regarding “What is a representative voiding pattern in children with lower urinary tract symptoms? Lack of consistent findings in ambulatory and conventional urodynamics tests”

As conventional urodynamics (CU) had been considered the best tool available for evaluating lower urinary tract (LUT) function when it is required, there are still drawbacks to its representation as the ideal method for investigating LUT function. Ambulatory urodynamics (AU) removes much of the artifact encountered with unphysiologic filling of the bladder but it still has drawbacks because of the reaction from indwelling catheters to measure intravesical and rectal pressures when the individual is upright. As noted by the authors there are few parallels in the findings between these two approaches [1]. For instance, it is currently unexplainable why a degree of consistency in voiding patterns was identified in most CU studies but not so with AU. Perhaps relation to last bowel movement, amount of ingested fluid beforehand, and just the time of day may explain why less consistent voiding patterns were seen in AU studies. The authors have pointed out legitimate limitations to their study. Although this is an admirable start to defining the possible diurnal variation of voiding patterns, additional work is needed to understand why this variation exists. It would be ideal, as technology advances, to insert retrievable devices that could be

MP68-04 CLOCK GENES REGULATE CIRCADIAN RHYTHM OF VNUT EXPRESSION, CONNEXIN26 EXPRESSION AND STRETCH-EVOKED ATP RELEASE IN THE CULTURED UROTHELIAL CELLS

You have accessJournal of UrologyUrodynamics/Lower Urinary Tract Dysfunction/Female Pelvic Medicine: Basic Research & Pathophysiology II1 Apr 2016MP68-04 CLOCK GENES REGULATE CIRCADIAN RHYTHM OF VNUT EXPRESSION, CONNEXIN26 EXPRESSION AND STRETCH-EVOKED ATP RELEASE IN THE CULTURED UROTHELIAL CELLS Tatsuya Ihara, Satoru Kira, Tatsuya Miyamoto, Norifumi Sawada, Hiroshi Nakagomi, Takahiko Mitsui, Hideki Kobayashi, Mitsuharu Yoshiyama, Masayuki Takeda, Yuki Nakamura, Atsuhito Nakao, Eiji Shigetomi, Yohichi Shinozaki, and Shuichi Koizumi Tatsuya IharaTatsuya Ihara More articles by this author , Satoru KiraSatoru Kira More articles by this author , Tatsuya MiyamotoTatsuya Miyamoto More articles by this author , Norifumi SawadaNorifumi Sawada More articles by this author , Hiroshi NakagomiHiroshi Nakagomi More articles by this author , Takahiko MitsuiTakahiko Mitsui More articles by this author , Hideki KobayashiHideki Kobayashi More articles by this author , Mitsuharu YoshiyamaMitsuharu Yoshiyama More articles by this author , Masayuki TakedaMasayuki Takeda More articles by this author , Yuki NakamuraYuki Nakamura More articles by this author , Atsuhito NakaoAtsuhito Nakao More articles by this author , Eiji ShigetomiEiji Shigetomi More articles by this author , Yohichi ShinozakiYohichi Shinozaki More articles by this author , and Shuichi KoizumiShuichi Koizumi More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2016.02.1341AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Clock genes exist in almost all the cells and organs, and the products of Per, Cry, Bmal and Clock have the most important role to regulate circadian rhythm as representative clock genes. It has been known that lower urinary tract function is also regulated by clock genes. We previously reported that the Clock mutant mouse (ClockΔ19/Δ19) showed phenotype of nocturia (NOC) and nocturnal polyuria (NP). We hypothesis that clock genes regulate circadian rhythm of perception of the bladder fullness through the circadian expression of the ATP transmitters such as VNUT and Connexin26 in urothelium, which release ATP after mechanical stretch stimulation and send signals of urine perception to the CNS. In this study, we investigated the circadian rhythm of urine perception in mouse primary urothelial cell cultures (MPUCC), measuring the gene and protein expression of VNUT, Connexin26, and the ATP release after stretch stimulation. METHODS MPUCC isolated from C57BL/6 mice (WT) and C57BL/6 ClockΔ19/Δ19 were used. To reset and synchronize the gene expression rhythms in each cells, 50% horse serum shock (HSS) were added for 2hrs. Samples were collected every 4hrs from 12hrs later after HSS. That time was defined as 0. The expression of major clock genes, VNUT, and Connexin26 in MPUCC was investigated by RT-PCR and Western blot. Released ATP after stretch stimulation was quantified using luciferin-luciferase bioluminescence assay. Statistical analyses were done by one-way ANOVA. RESULTS In addition to major clock genes (e.g. Per2 and Bmal1), the expressions of mRNA and proteins of VNUT and Connexin26, showed circadian rhythm in WT. Meanwhile, these circadian rhythm were disrupted in ClockΔ19/Δ19 mice. ATP release after stretch stimulation showed circadian rhythm in WT, but ClockΔ19/Δ19lost this circadian rhythm. These oscillation changes were almost same as circadian rhythm of VNUT- and Connexin26-mRNA (Fig.1), which indicated that CLOCK could regulate the perception of bladderfullness. CONCLUSIONS Clock genes regulate circadian rhythm of perception of the bladder fullness, and disruption of clock genes could induce NOC and NP. Redressing of abnormalities of clock genes can lead to novel treatment of NOC/NP. © 2016FiguresReferencesRelatedDetails Volume 195Issue 4SApril 2016Page: e890 Advertisement Copyright & Permissions© 2016MetricsAuthor Information Tatsuya Ihara More articles by this author Satoru Kira More articles by this author Tatsuya Miyamoto More articles by this author Norifumi Sawada More articles by this author Hiroshi Nakagomi More articles by this author Takahiko Mitsui More articles by this author Hideki Kobayashi More articles by this author Mitsuharu Yoshiyama More articles by this author Masayuki Takeda More articles by this author Yuki Nakamura More articles by this author Atsuhito Nakao More articles by this author Eiji Shigetomi More articles by this author Yohichi Shinozaki More articles by this author Shuichi Koizumi More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Simultaneous urodynamic and anorectal manometry studies in children: insights into the relationship between the lower gastrointestinal and lower urinary tracts.

Children with urinary incontinence (UI) have associated functional constipation (FC) and fecal incontinence (FI). The physiology between lower urinary tract (LUT) and anorectum in children has not been elucidated. Observe the effect of rectal distention (RD) on LUT function, and bladder filling and voiding on anorectal function. Children with voiding dysfunction referred to Boston Children's Hospital were prospectively enrolled in combined urodynamic (UDS) and anorectal manometry (ARM). Anorectal and urodynamic parameters were simultaneously measured. Patients underwent two micturition cycles, first with rectal balloon deflated and second with it inflated (RD). Lower urinary tract and anorectal parameters were compared between cycles. Ten children (seven UI, four recurrent UTIs, nine FC ± FI) were enrolled. Postvoid residual (PVR) increased (p = 0.02) with RD. No differences were observed in percent of bladder filling to expected bladder capacity, sensation, and bladder compliance with and without RD. Bladder and abdominal pressures increased at voiding with RD (p < 0.05). Intra-anal pressures decreased at voiding (p < 0.05), at 25% (p = 0.03) and 50% (p = 0.06) of total volume of bladder filling. The PVR volume increased with RD. Stool in the rectum does not alter filling cystometric capacity but decreases the bladder's ability to empty predisposing patients with fecal retention to UI and UTIs. Bladder and abdominal pressures increased during voiding, demonstrating a physiological correlate of voiding dysfunction. Intra-anal pressures decreased during bladder filling and voiding. This is the first time intra-anal relaxation during bladder filling and voiding has been described.

Calidad de vida, función del tracto urinario y salud sexual en cirugía de reasignación de sexo hombre a mujer

The aim of this study is to thoroughly report on surgical outcomes, quality of life (QoL), lower urinary tract function, sexual health and sexual desire from four patients who underwent male to female (MTF) sex reassignment surgery (SRS) using the Sava Perovic technique, between 2011 and 2015 in the San Ignacio Teaching Hospital, Bogotá, Colombia. Two questionnaires designed by a multidisciplinary group of experts in sex reassignment surgery and gender dysphoria were used to assess lower urinary tract function and sexual health. It was found that the 4 MTF transexuals who underwent SRS had a good QoL, their lower urinary tract function was not compromised, and none of them referred to any kind of incontinence. The sexual health results were not as promising as in QoL and lower urinary tract function, despite saying they were happy with the surgical outcomes and were able to reassume their life.