Maximum Intravesical Pressure Research Articles

Early effects of adipose-derived stem cell sheets against detrusor underactivity in a rat cryo-injury model

AimsThis study investigated the effects of adipose-derived stem cell sheets on a rat model of detrusor underactivity. Main methodsAdipose-derived stem cell sheets were prepared from the subcutaneous adipose tissue of male Lewis rats. Female Lewis rats were assigned into four groups: control, sham operation, cryo-injury, and cryo-injury+sheet (n = 8 per group). Rats in the cryo-injury+sheet group were implanted with ASC sheets 3 days after cryo-injury induction and underwent cystometry 7 days later. Subsequently, reverse transcription-polymerase chain reaction (RT-PCR) and histopathological examinations were performed. Cell sheets expressing the green fluorescent protein were prepared and transplanted to confirm the viability and differentiation of the sheets. Fluorescence was confirmed using a fluorescence stereomicroscope on days 3, 7, 14, 21, and 28 after sheet implantation, and tissue immunostaining was performed. Key findingsCystometry showed that sheet implantation improved the maximum intravesical pressure (P = 0.009) and the residual urine volume (P = 0.011). Furthermore, RT-PCR indicated that the mRNA levels of the angiogenic factors vascular endothelial growth factor and hepatocyte growth factor were significantly higher in the cryo-injury+sheet group than in the cryo-injury group (P = 0.045, P = 0.037, respectively). Histologically, sheet implantation resulted in an improvement in inflammation and increased the number of blood vessels. Green fluorescent protein-positive cells fused with von Willebrand factor-positive cells and differentiated into blood vessels 7 days after sheet implantation. SignificanceAdipose-derived stem cell sheets transplanted into the bladder of cryo-injured rats differentiated into blood vessels and restored bladder contractile function 7 days after transplantation.

MP49-19 TIME COURSE CHANGES IN VOIDING INTERVAL IN RATS WITH FOCAL CEREBRAL INFARCTION INDUCED BY PHOTOCHEMICALLY-INDUCED THROMBOSIS

You have accessJournal of UrologyCME1 May 2022MP49-19 TIME COURSE CHANGES IN VOIDING INTERVAL IN RATS WITH FOCAL CEREBRAL INFARCTION INDUCED BY PHOTOCHEMICALLY-INDUCED THROMBOSIS Yuya Ota, Yasue Kubota, Yuji Hotta, Mami Matsumoto, Nayuka Matsuyama, Taiki Kato, Takashi Hamakawa, Tomoya Kataoka, Kazunori Kimura, Kazunobu Sawamoto, and Takahiro Yasui Yuya OtaYuya Ota More articles by this author , Yasue KubotaYasue Kubota More articles by this author , Yuji HottaYuji Hotta More articles by this author , Mami MatsumotoMami Matsumoto More articles by this author , Nayuka MatsuyamaNayuka Matsuyama More articles by this author , Taiki KatoTaiki Kato More articles by this author , Takashi HamakawaTakashi Hamakawa More articles by this author , Tomoya KataokaTomoya Kataoka More articles by this author , Kazunori KimuraKazunori Kimura More articles by this author , Kazunobu SawamotoKazunobu Sawamoto More articles by this author , and Takahiro YasuiTakahiro Yasui More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002624.19AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The Photochemically-induced thrombosis (photothrombosis), which is easy to implement and minimally invasive, can create focal cerebral infarcts in the superficial layers of the cerebrum. Using this, we aimed to establish a new rat model of increases in urinary frequency after focal cerebral infarction, characterized by its simplicity, nonlethal nature, and high reproducibility. METHODS: A total of 90 11-week-old female Wistar-ST rats were assigned to the sham or photothrombosis-treated (PT) group. Photothrombosis was used to induce focal infarcts in the prefrontal and anterior cingulate cortices, which are involved in lower urinary tract control. A fiber optic cable delivering a light source was placed stereotactically onto the skull 1 mm anterior to the bregma on the midline. Rose Bengal solution (30 mg/mL/kg) was injected into the tail vein, and the skull was irradiated. Neurological, cystometric, and immunohistochemical evaluation of the brain were performed preoperatively and on postoperative days 1, 7, 14, and 28. RESULTS: Cystometric analysis indicated that micturition intervals significantly shortened in photothrombosis-treated rats compared with that in the sham group on Days 1 and 7 (P < 0.01), and prolonged after 14 days, with no difference between the groups (Figure A). Baseline pressure, micturition threshold pressure, and maximum intravesical pressure did not differ between the groups. Neurological evaluation revealed that only motor disturbances in the hind limbs improved with time in the PT group. Immunopathological evaluation revealed an accumulation of activated microglia, and subsequent increase in reactive astrocytes, at the peri-infarct zone after photothrombotic stroke. Throughout the study, all postphotothrombosis rats showed cerebral infarction in the prefrontal cortex and anterior cingulate cortex; no rats showed fatal cerebral infarction. CONCLUSIONS: This novel photothrombosis model, combining non-lethality and high reproducibility, observed changes in micturition status. This photothrombosis method may be able to contribute to the understanding of neural control of urinary function by regulating the number and volume of the infarcted areas. Source of Funding: GSK Japan Research Grant 2019 © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e861 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Yuya Ota More articles by this author Yasue Kubota More articles by this author Yuji Hotta More articles by this author Mami Matsumoto More articles by this author Nayuka Matsuyama More articles by this author Taiki Kato More articles by this author Takashi Hamakawa More articles by this author Tomoya Kataoka More articles by this author Kazunori Kimura More articles by this author Kazunobu Sawamoto More articles by this author Takahiro Yasui More articles by this author Expand All Advertisement PDF DownloadLoading ...

Comparison of Outcome of Transurethral Resection of Prostate Between Patients With Preoperative Low or Normal and High Voiding Pressure

Objective: T0 compare the outcome of Transurethral Resecton of Prostate between Patients with Preoperative Low or Normal and High Voiding Pressure.&#x0D; Methods: This hospital based prospective observational study was conducted in the Department of Urology of Dhaka Medical college Hospital from July 2008 to June 2010 on male patients aging &gt;59 years having Lower urinary tract symptoms (LUTS) attending to urology OPD&amp; IPD were evaluated by history, physical examination including DRE and necessary investigations like USG of KUB and prostate with MCC &amp; PVR, Q max, IPSS score to identify the potential candidates for TURP. Potential participants were counseled for urodynamic study. Who fulfilled the selection criteria included in this study in outpatient basis or admitted in the urology ward and numbered chronologically and performed urodynamic study and then patients underwent TURP, after 12 weeks of completion of TURP again a follow-up urodynamic study performed in all patients to compare the outcome between two groups. Sample size was 65, high pressure voiding group were 36 in number and Normal or low pressure voiding group were 29 in number. Data were collected on variables of interest using a structural data collection format. Data were processed and analyzed using SPSS (Statistical package for social science) software program. The test of significant employed to analyze the data was descriptive statistics and Student’s t-test, Paired and unpaired t- test, Fisher exact test. Probability value (P value &lt; 0.05) was considered significant.&#x0D; Results: In this study the age ranges were 59 and 88 years and mean age was 70.7 ± 6.7 years. the maximum urinary flow rate, residual urine volume and maximum intravesical pressure 3 months after transurethral prostatic resection were significantly better in patients with high detrusor pressure compared to those with normal/low normal/low detrusor pressure (15.9±0.7 vs. 21.3±2.2ml/sec, p&lt;0.001, 18.1±11.8 vs. 2.9±0.7 ml, p&lt;0.001 and 48.3±6.2 vs. 71.9±15.2 cmH2O, p&lt;0.001 respectively).The maximum urinary flow rate ( Q max ), residual urine volume, maximum intravesical pressure and detrusor pressure at peak urinary flow rate and also IPSS score were significantly improved 3 months after operation in both groups, more improvement was observed in preoperative high voiding pressure group. Post-voiding residual urine is a clear indication of poor outcome, and also the maximum urinary flow rate, maximum intravesical pressure and detrusor pressure at peak urinary flow rate all factors may precipitate decompensation of bladder and in low voiding pressure group decompensation of bladder occurs more than the high voiding pressure group as the preoperative and postoperative residual urine develops more in low voiding pressure group.&#x0D; Conclusion: The high voiding pressures (detrusor pressure) may influence in good postoperative outcome and helps in resolution of a significant outflow obstruction, there are good urodynamic reasons for avoiding unwanted TURP rather it could be justified by using urodynamic study which may predict outcome of TURP. So, we may assess properly the patient for prostatectomy by urodynamic study. As if we do this type of evaluation before TURP it may reduce the unwanted operation.&#x0D; Bangladesh Journal of Urology, Vol. 21, No. 2, July 2018 p 111-119

EP2 and EP3 receptors as therapeutic targets for underactive bladder/detrusor underactivity due to diabetic cystopathy in a type 1 diabetic rat model.

Diabetic cystopathy (DC) is recognized as one of the major etiologies of underactive bladder (UAB)/detrusor underactivity (DU). Although DC was first reported about three decades ago, there is a distinct lack of effective pharmacological management methods for UAB/DU due to DC with a robust certainty of evidence. In this study, we investigated whether EP2 and EP3 receptors are promising targets of pharmacological management of UAB/DU due to DC. We used streptozotocin (STZ)-induced diabetic Sprague-Dawley rats with postvoid residual urine (PVR) greater than 0.1 mL. Sixteen weeks after induction of diabetes, we performed awake single cystometry after oral administration of the vehicle, an α-blocker (tamsulosin [TAM], 0.1 and 0.3 mg/kg), a cholinesterase inhibitor (distigmine [DIS], 0.3 and 1.0 mg/kg), or an EP2/3 dual agonist (ONO-8055, 0.01 and 0.03 mg/kg). We compared cystometric parameters after administration of the vehicle and drugs using a paired t test. P < .05 was considered to be statistically significant. Compared with the vehicle, TAM significantly decreased maximum intravesical pressure during voiding (Pmax), while DIS significantly increased it. However, neither drug significantly affected PVR or the residual urine rate (RUR). On the other hand, ONO-8055 significantly decreased PVR and tended to decrease RUR, although it did not significantly affect Pmax. The present study was unable to demonstrate that stimulation of EP2 and EP3 receptors caused major improvements in UAB/DU due to DC. However, this equivocal result could arise from inherent limitations of the STZ-induced diabetic rat as a UAB/DU model.

Urodynamic findings during the filling phase in neurogenic bladder patients with or without vesicoureteral reflux who have undergone sacral neuromodulation.

To assess the urodynamic findings during the filling phase in neurogenic bladderpatients with or without vesicoureteral reflux (VUR) who underwent sacral neuromodulation (SNM). We retrospectively reviewed the records of 19 patients with neurogenic lower urinary tract dysfunction (NLUTD) who underwent SNM at our center from July 2018 to July 2019. Clinical data and video-urodynamic parameters were collected. VUR grading systems were used to evaluate upper urinary tractfunction. The mean test duration was 24 ± 8.2 days. The urodynamic evaluation showed a significant increase in the mean maximum cystometric capacity (136.3 ± 118.2 vs216.5 ± 137.8 mL; P = .0071) and compliance (8.7 ± 8.52 vs18.3 + 16.47 mL/H2 O; P = .016), as well as a decrease in maximum intravesical pressure (57 ± 39.23 vs36.58 ± 31.16 H2 O; P = .0064). In the voiding phase, none of the patients had automatic urination at the baseline and testing phases. In 8 of 19 patients who had detrusor overactivity (DO), the DO disappeared (four patients) or was delayed (four patients). The VUR in 3 of 12 ureter units disappeared. The grade of VUR or the volume before VUR improved in 8 ureter units, and the remaining 1 did not change significantly. An implant was performed in 16 cases. After permanent implantation, all patients needed intermittent catheterization to empty the bladder. This retrospective study indicates that SNM can improve the urinary storage function of the bladder in appropriate patients with NLUTD. For patients with VUR, SNM can cure or reduce VUR by improving DO and bladder compliance.

Abdominal compartment syndrome monitoring in neonates with an acute abdomen – A pilot, retrospective, observational study

BackgroundAbdominal compartment syndrome (ACS) is a pathological increase of the intra-abdominal pressure (IAP) with dysfunction of one or more organs. There is lack of clarity in neonates regarding what intravesical pressure (IVP) value, a surrogate marker for IAP, indicates the need for intervention for ACS. MethodsThe medical records at a Children's Hospital NICU were reviewed to identify all neonates that had IVP/s monitored over a 10-year period (2008–2017). Demographic parameters, IVPs, and important clinical outcomes were obtained. Associations between IVP monitoring and clinical outcomes were explored. ResultsForty-six neonates had IVP monitoring, with 4 (8%) being diagnosed with ACS requiring further operative intervention. There was no significant correlation between IVP and need for surgery. There was a significant positive correlation between the maximum IVP and the need for total parenteral nutrition (rs = 0.350, p = 0.017), ventilator support (rs = 0.321, p = 0.034) and length of stay (rs = 0.362, p = 0.016) and between a diagnosis of ACS and neonatal mortality (rs = 0.299, p = 0.044). ConclusionsIVP monitoring and raised IVP did not correlate with the need for surgical intervention. Raised IVP was associated with neonatal morbidity and maybe neonatal mortality. A large, prospective, observational study is required to evaluate the role of IVP monitoring in ACS and its associated outcomes. Level of EvidenceIII.

Modulation of urinary frequency via type 1 lysophosphatidic acid receptors: Effect of the novel antagonist ASP6432 in conscious rats

Bladder dysfunctions associated with benign prostatic hyperplasia are not sufficiently alleviated by current pharmacotherapies. Lysophosphatidic acid (LPA) is a phospholipid with diverse biological effects. LPA modulates prostate and urethral contraction via the type 1 LPA (LPA1) receptor, suggesting the potential of the LPA1 receptor as a therapeutic target. However, the role of LPA and the LPA1 receptor in bladder function has not been studied in vivo. We investigated the effects of LPA and the novel LPA1 receptor antagonist ASP6432 (potassium 1-(2-{[3,5-dimethoxy-4-methyl-N-(3-phenylpropyl)benzamido]methyl}− 1,3-thiazole-4-carbonyl)− 3-ethyl-2,2-dioxo-2λ6-diazathian-1-ide) on the micturition reflex in conscious rats using cystometry. Intravenous infusion of LPA decreased the micturition interval and threshold pressure with no apparent changes in baseline pressure or maximum intravesical pressure. ASP6432 inhibited the LPA-induced decrease in MI. In contrast, ASP6432 had no effect on the LPA-induced decrease in threshold pressure. Similarly, ASP6432 had no effect on either baseline pressure or maximum intravesical pressure. We also evaluated the effect of ASP6432 on the urinary frequency induced by the nitric oxide synthase inhibitor L-Nω-nitro arginine methyl ester (L-NAME). Intravenous L-NAME administration decreased the micturition interval. ASP6432 dose-dependently reversed the L-NAME-induced decrease in micturition interval. Our findings demonstrate for the first time that LPA causes bladder overactivity in rats. ASP6432 inhibited the LPA- and L-NAME-induced decrease in micturition interval, suggesting a significant role for the LPA1 receptor in regulating the functional capacity of the bladder. Our results also suggest the potential of ASP6432 as a novel therapy for the treatment of bladder dysfunction associated with lower urinary tract diseases.

Nerve coaptation on bladder function recovery in rats with end-to-side neurorrhaphy

Objective To investigate the effect of end-to-side nerve coaptation on bladder function recovery in rats with neurogenic bladder. Methods Forty male Sprague-Dawley (SD) rats [mean weight (240-280) g] were randomly divided into end-to-side nerve coaptation group (ETS group, n=15), no coaptation group (NC group, n=15) and blank control group (BC group, n=10). In the ETS group, the left ventral root (VR) and dorsal root (DR) of L6 and S1 were transected, and the distal stump of L6VR was sutured to the lateral face of L4VR. In the NC group, the left VR and DR of L6 and S1 were transected, but coaptation was not performed. In the BC group, no operation was performed. Four months later, bladder function was evaluated by cystometry and electrical stimulation. Results When the spinal nerves were stimulated, the increased maximum intravesical pressure was (34.9±3.1) mmHg (1 mmHg=0.133 kPa) in BC group and (18.3±2.1) mmHg in ETS group. The difference was statistically significant (t=15.317, P 0.05], and that in the ETS and BC groups was greater than in the NC group [(18.8±1.7) mmHg; t=9.446, P<0.01; t=11.504, P<0.01]. Conclusion The bladder can be reinnervated and the bladder function can be partially improved by end-to-side nerve coaptation in rats. Key words: Neurogenic bladder; End-to-side nerve coaptation; Urodynamic; Rats

Mapping and neuromodulation of lower urinary tract function using spinal cord stimulation in female rats

Spinal cord epidural stimulation (SCS) represents a form of neuromodulation for the management of spasticity and pain. This technology has recently emerged as a new approach for potentially augmenting locomotion and voiding function in humans and rodents after spinal cord injury. However, the effect of SCS on micturition has not been studied extensively. Here, SCS was first applied as a direct stimulus onto individual segmental levels of the lumbar spinal cord in rats to map evoked external urethral sphincter (EUS) electromyography activity and SCS-induced voiding contractions. SCS of L2-3 inhibited EUS tonic activity, and SCS on L3 (L3/SCS) inhibited EUS tonic activity and elicited EUS bursting. In contrast, SCS of L1 and L4-6 evoked EUS tonic contractions, which resembled the urethral guarding reflex during bladder storage. Next, the effects of a bilateral pelvic nerve crush (PNC) injury on urodynamic function were examined at 14 days post-operatively. The PNC injury resulted in decreased voiding efficiency and maximum intravesical pressure, whereas the post-voiding residual volume was increased, suggestive of an underactive bladder. Finally, L3/SCS was performed to induce a voiding contraction and enable voiding in rats with a PNC injury. Voiding efficiency was significantly increased, and the residual volume was decreased by L3/SCS in rats after the PNC injury. We conclude that L3/SCS may be used to induce micturition reflexes in a partially filled bladder, reduce urethral resistance, and augment bladder emptying after PNC injury.

High salt loading induces urinary storage dysfunction via upregulation of epithelial sodium channel alpha in the bladder epithelium in Dahl salt-sensitive rats

We aimed to investigate whether high salt intake affects bladder function via epithelial sodium channel (ENaC) by using Dahl salt-resistant (DR) and salt-sensitive (DS) rats. Bladder weight of DR + high-salt diet (HS, 8% NaCl) and DS + HS groups were significantly higher than those of DR + normal-salt diet (NS, 0.3% NaCl) and DS + NS groups after one week treatment. We thereafter used only DR + HS and DS + HS group. Systolic and diastolic blood pressures were significantly higher in DS + HS group than in DR + HS group after the treatment period. Cystometrogram showed the intercontraction intervals (ICI) were significantly shorter in DS + HS group than in DR + HS group during infusion of saline. Subsequent infusion of amiloride significantly prolonged ICI in DS + HS group, while no intra-group difference in ICI was observed in DR + HS group. No intra- or inter-group differences in maximum intravesical pressure were observed. Protein expression levels of ENaCα in the bladder were significantly higher in DS + HS group than in DR + HS group. ENaCα protein was localized at bladder epithelium in both groups. In conclusion, high salt intake is considered to cause urinary storage dysfunction via upregulation of ENaC in the bladder epithelium with salt-sensitive hypertension, suggesting that ENaC might be a candidate for therapeutic target for urinary storage dysfunction.

Effects of cathodal trans-spinal direct current stimulation on lower urinary tract function in normal and spinal cord injury mice with overactive bladder

Objective. Lower urinary tract (LUT) dysfunction is a monumental problem affecting quality of life following neurotrauma, such as spinal cord injury (SCI). Proper function of the bladder and its associated structures depends on coordinated activity of the neuronal circuitry in the spinal cord and brain. Disconnection between the spinal and brain centers controlling the LUT causes fundamental changes in the mechanisms involved in the micturition and storage reflexes. We investigated the effects of cathodal trans-spinal direct current stimulation (c-tsDCS) of the lumbosacral spine on bladder and external urinary sphincter (EUS) functions. Approach. We used cystometry and electromyography (EMG), in mice with and without SCI. Main results. c-tsDCS caused initiation of the micturition reflex in urethane-anesthetized normal mice with depressed micturition reflexes. This effect was associated with normalized EUS-EMG activity. Moreover, in urethane-anesthetized normal mice with expressed micturition reflexes, c-tsDCS increased the firing frequency, amplitude, and duration of EUS-EMG activity. These effects were associated with increased maximum intravesical pressure (Pmax) and intercontraction interval (ICI). In conscious normal animals, c-tsDCS caused significant increases in Pmax, ICI, threshold pressure (Pthres), baseline pressure (Pbase), and number and amplitude of non-voiding contractions (NVCnumb and Pim, respectively). In conscious mice with severe contusive SCI and overactive bladder, c-tsDCS increased Pmax, ICI, and Pthres, but decreased Pbase, NVCnumb, and Pim. c-tsDCS reduced the detrusor-overactivity/cystometry ratio, which is a measure of bladder overactivity associated with renal deterioration. Significance. These results indicate that c-tsDCS induces robust modulation of the lumbosacral spinal-cord circuitry that controls the LUT.

MP31-18 SPINAL CORD STIMULATION ATTENUATES VISCERAL PAIN-RELATED VISCEROMOTOR REFLEXES IN RODENTS WITH CYCLOPHOSPHAMIDE-INDUCED CYSTITIS

You have accessJournal of UrologyUrodynamics/Lower Urinary Tract Dysfunction/Female Pelvic Medicine: Non-neurogenic Voiding Dysfunction I1 Apr 2017MP31-18 SPINAL CORD STIMULATION ATTENUATES VISCERAL PAIN-RELATED VISCEROMOTOR REFLEXES IN RODENTS WITH CYCLOPHOSPHAMIDE-INDUCED CYSTITIS Jih-Chao Yeh, David A Ginsberg, Larissa V Rodriguez, and Huiyi Harriet Chang Jih-Chao YehJih-Chao Yeh More articles by this author , David A GinsbergDavid A Ginsberg More articles by this author , Larissa V RodriguezLarissa V Rodriguez More articles by this author , and Huiyi Harriet ChangHuiyi Harriet Chang More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2017.02.972AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Interstitial cystitis/bladder pain syndrome (IC/BPS) is a chronic inflammation that results in recurring pain in the bladder and the surrounding pelvic region caused by abnormal excitability of micturition reflexes. Spinal cord stimulation (SCS) is currently in clinical use for the attenuation of neuropathic pain, and has been identified for amelioration of pain in a rodent model of colorectal distention. This study aimed to investigate the potential effect of SCS on attenuation of visceral pain-related visceromotor reflexes (VMR) in rodents with cyclophosphamide-induced cystitis. METHODS Female Sprague-Dawley rats underwent intraperitoneal injection of cyclophosphamide (CYP, n=8) or saline (controls, n=4). 48 hours after CYP or saline injections, all rats underwent surgical preparations under urethane anesthesia. Stimulation wires were placed on the dorsal surface of the spinal segments of L2 and L3 for SCS. A PE-50 tubing was inserted into the bladder to obtain the intravesical pressure (IVP). Two wires are placed in the left external abdominal oblique muscle to record VMR. Before and after SCS (40 Hz, 0.2 ms for 25 min), VMR and maximum intravesical pressure (IVPmax) were obtained during continuous bladder infusion and isotonic bladder distention (IBD). RESULTS During continuous bladder infusion (Fig 1A), the ratio of VMR threshold/IVPmax was significantly decreased in CYP rats indicating early VMR appearance compared to controls. SCS significantly increased the ratio indicating the delayed VMR appearance. During IBD with urethral occlusion, SCS delayed the latency of VMR appearance in CYP rats below the voiding thresholds at 10 and 20 cmH2O. SCS also significantly decreased VMR area under the curve (AUC) in CYP rats (Figs 1B-C). CONCLUSIONS SCS attenuated visceral pain-related VMR in rats with CYP-induced cystitis suggesting a role for SCS in modulating visceral nociception and hyperalgesia. SCS appears to be a potential treatment of IC/PBS. © 2017FiguresReferencesRelatedDetails Volume 197Issue 4SApril 2017Page: e406 Advertisement Copyright & Permissions© 2017MetricsAuthor Information Jih-Chao Yeh More articles by this author David A Ginsberg More articles by this author Larissa V Rodriguez More articles by this author Huiyi Harriet Chang More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Application of data mining techniques to explore predictors of upper urinary tract damage in patients with neurogenic bladder.

This study proposed a decision tree model to screen upper urinary tract damage (UUTD) for patients with neurogenic bladder (NGB). Thirty-four NGB patients with UUTD were recruited in the case group, while 78 without UUTD were included in the control group. A decision tree method, classification and regression tree (CART), was then applied to develop the model in which UUTD was used as a dependent variable and history of urinary tract infections, bladder management, conservative treatment, and urodynamic findings were used as independent variables. The urethra function factor was found to be the primary screening information of patients and treated as the root node of the tree; Pabd max (maximum abdominal pressure, >14 cmH2O), Pves max (maximum intravesical pressure, ≤89 cmH2O), and gender (female) were also variables associated with UUTD. The accuracy of the proposed model was 84.8%, and the area under curve was 0.901 (95%CI=0.844-0.958), suggesting that the decision tree model might provide a new and convenient way to screen UUTD for NGB patients in both undeveloped and developing areas.

Distigmine Bromide Produces Sustained Potentiation of Guinea-Pig Urinary Bladder Motility by Inhibiting Cholinesterase Activity.

Distigmine is a cholinesterase (ChE) inhibitor used for the treatment of detrusor underactivity in Japan. Distigmine's pharmacological effects are known to be long-lasting, but the duration of its effect on urinary bladder contractile function has not been fully elucidated. The present study aimed to determine these effects in relation to the plasma concentrations of distigmine and its inhibition of ChE activities in blood, plasma, and bladder tissue. Intravesical pressures were recorded in anesthetized guinea-pigs for 12 h after the intravenous administration of saline or distigmine (0.01-0.1 mg/kg). Plasma distigmine concentrations were measured by liquid chromatograph-tandem mass spectrometry (LC-MS/MS), while ChE activities were assayed using 5,5'-dithiobis(2-nitrobenzoic acid). Distigmine (0.1 mg/kg) significantly increased the maximum intravesical pressure at micturition reflex for 12 h post-administration. In contrast, plasma distigmine was only detectable for 6 h post-administration in these animals and a one-compartment model calculated an elimination half-life of 0.7 h. However, bladder and blood acetylcholinesterase activities were significantly inhibited for 12 h after distigmine administration, although plasma ChE activities were not affected. The pharmacodynamic effects of distigmine thus persisted after its elimination from the circulation, indicating that it may bind to bladder acetylcholinesterase, producing sustained enzyme inhibition and enhancement of bladder contractility.

Cystometric evaluation of recovery in hypocompliant defunctionalized bladder as a result of long-term dialysis after kidney transplantation.

To evaluate the functional recovery of a pretransplant hypocompliant bladder in patients without neurological disorders, and to determine its relationship with ureteral complications, including vesicoureteral reflux. A total of 61 patients without neurogenic disorders, who underwent video water cystometry pre- and 1 year post-transplantation, were enrolled. Cystometric bladder capacity and maximum intravesical pressure were measured, and compliance was calculated by the elevation in intravesical pressure as a result of an increase in volume. The frequencies of urinary complications, including urinary leakage, pyelonephritis and vesicoureteral reflux, were also evaluated. Pretransplant dialysis duration correlated with pretransplant bladder capacity and compliance (R(2) = 0.421, P < 0.001 and R(2) = 0.418, P < 0.001, respectively). A total of 16 (26.2%) patients had hypocompliant bladders <10 mL/cmH2 O, whereas 10 of the 12 patients (83.3%) with pretransplant dialysis duration of more than 5 years had a pretransplant hypocompliant bladder. Bladder compliance significantly recovered to >20 mL/cmH2 O (21.1-286.0) at 1 year post-transplantation in all 16 patients with a pretransplant hypocompliant bladder. No significant differences were observed for urinary leakage, pyelonephritis or vesicoureteral reflux between patients with and without a pretransplant hypocompliant bladder. Bladder compliance decreases logarithmically pretransplantation according to dialysis duration. Although the ability of the patients to recover varies, dysfunctions associated with a pretransplant hypocompliant bladder recover to normal ranges after renal transplantation. A pretransplant hypocompliant bladder seems not to be associated with the post-transplant prevalence of urinary complications or vesicoureteral reflux.

Urodynamic outcomes of detethering in children: experience with 46 pediatric patients.

Tethered cord syndrome (TCS) manifests with neurological and urological complaints. Surgical detethering is the main treatment for TCS. Children with urological symptoms are required objective pre- and postoperative evaluations in order to predict urological outcome. The aims of this study are to investigate the effects of detethering procedure on the urodynamic tests and to determine the relationship between the changes of urodynamic tests and the patients' age and gender. The data of urodynamic tests in 46 pediatric patients, who underwent surgery for TCS, were retrospectively evaluated. Bladder capacity, post-voiding residual urine volume, maximum intravesical pressure, and bladder compliance of each patient were measured in preoperative period and at the third month after surgery. These parameters were statistically compared, and the correlations of these parameters with age, gender, and etiology of the TCS were also investigated. Bladder capacity and post-voiding residual urine volume were decreased and maximum intravesical pressure and bladder compliance were increased after surgery for TCS. The decrease in bladder capacity was significant in patients older than 10years (p<0.05). The increase in maximum intravesical pressure was also positively correlated with age (p<0.05). But the increase in bladder compliance was negatively correlated with age (p<0.05). Bladder capacity, post-voiding residual urine volume, and bladder compliance are mainly affected by surgery in patients with TCS. From the urological viewpoint, children older than 10years are most likely to benefit from surgery for TCS.

Mineralocorticoid receptor stimulation induces urinary storage dysfunction via upregulation of epithelial sodium channel expression in the rat urinary bladder epithelium

We aimed to evaluate mineralocorticoid receptor (MR) expression in rat bladder and the physiological role of the MR-epithelial sodium channel (ENaC) pathway in controlling bladder function in 10–12-week-old, male Sprague–Dawley rats. First, we examined the mRNA expression of MR and localization of MR and ENaC-α proteins in the urinary bladder. MR mRNA expression was observed in untreated-rat urinary bladders, and MR and ENaC-α proteins were localized in the epithelium. Next, rats were treated with vehicle (controls) or fludrocortisone (an MR agonist) for 3 days, and ENaC-α protein expression levels and bladder function were evaluated on day 4. ENaC-α protein expression was significantly higher in fludrocortisone-treated rats than in controls. In addition, cystometry was performed during intravesical infusion of saline and amiloride (an ENaC inhibitor). While intercontraction intervals (ICIs) during saline infusion were significantly shorter in the fludrocortisone group than in the controls, infusion of amiloride normalized the ICIs in the fludrocortisone group. However, no intra- or inter-group differences in maximum intravesical pressure were observed. Taken together, MR protein is localized in the rat urinary bladder epithelium, and may regulate ENaC expression and bladder afferent input. The MR-ENaC pathway may be a therapeutic target for ameliorating storage symptoms.

Young rats exhibit an age- and sex-dependent bladder response to alpha-antagonists but not beta-agonists

Previous studies have suggested that the onset of alpha- (α) and beta- (β) adrenergic receptor activity is delayed in young animals. The use of alpha1- (α1-) antagonists for dysfunctional voiding, and beta3- (β3-) agonists for overactive bladder in younger children may not be indicated if maturation is required before bladder and urethral adrenergic receptors are active. To determine the sex- and age-dependent responses of the bladder and external urethral sphincter (EUS) to α- and β-adrenergic agents in neonatal and young adult rats. A total of 72 naïve Sprague-Dawley rats (36 female, 36 male) and 15 bladder-reduced (BR) female Sprague-Dawley rats underwent cystometry and EUS electromyography at 3, 6, and 9 weeks of life. Following administration of WAY 100,635 (0.3 mg/kg, serotonergic receptor antagonist), the non-selective α-agonist phenylephrine (0.3 mg/kg), α-antagonist phentolamine (1-3 mg/kg), β-agonist isoprenaline (3 mg/kg) and β-antagonist propranolol (3 mg/kg) were delivered intravenously. The maximum intravesical pressure (IVP), pressure threshold (PT), intermicturition interval (IMI), contraction duration (CD), burst amplitude and burst frequency were compared after each drug. The α-antagonist phentolamine lowered the IVP in 9-week-old males without lowering the PT. In contrast, the β-agonist isoprenaline lowered the IVP in both males and females of all ages, also without affecting the PT. Isoprenaline was also effective at shortening the CD in females, suggesting more effective bladder emptying. The α-agonist phenylephrine increased the IVP in 3-week-old and 6-week-old females and 3-week-old males, but this effect was blocked by pretreatment with phentolamine. The β-antagonist propranolol increased the PT in both males and females, and shortened the IMI in females, which was consistent with retention. Phenylephrine increased the burst duration in 9-week-old naïve females, while isoprenaline increased the burst amplitude and duration in 9-week-old BR females. In the neonatal rat, both α- and β-adrenergic receptors actively regulate bladder function by 3 weeks of life, but the desired effect of decreasing IVP by α-antagonists was delayed until 9 weeks in male rats. In contrast, β-agonists were effective at decreasing IVP in both male and female rats of all ages, which suggests that they are better agents for enhancing bladder emptying in female and young male rats.

127. Does reduction in number of injection sites of abobotulinumtoxinA impact efficacy in neurogenic detrusor overactivity (NDO) in the spinal cord‒injured (SCI) rat model?

Spinal cord injury (SCI) induces plasticity within neural pathways innervating the lower urinary tract (LUT), with the recruitment of nociceptive “silent” C-fibers leading to the development of an abnormal autonomic micturition reflex and emergence of neurogenic detrusor overactivity (NDO), thereby greatly compromising bladder filling during the micturition cycle. In SCI patients, botulinum toxin A has been evaluated for the treatment of refractory NDO and have been reported to decrease urinary incontinence frequency and maximum intravesical pressure while increasing bladder capacity and compliance Onabotulinum (Ona) toxin A intradetrusor injections is registered as a second-line treatment to treat NDO in humans. Injection protocol remains variable among clinical studies. Hovever approved Ona label recommends 30 injection points in the bladder wall. The main objective of this study was to determine the effect of reducing the number of injection sites by comparing the effect of 4 versus 8 injection sites with abobotulinum toxin A (aboBoNTA) in the SCI rat, a relevant model of NDO METHODS Experimental design Nineteen days post-SCI, rats received intradetrusor injections in 4 or 8 sites of saline or aboBoNTA 22.5U. Two days after injections, effect of aboBoNTA on urodynamic clinically relevant parameters was determined by analysis of variance test versus aggregated saline groups (ASG). Four experimental groups were considered: saline (NaCl 0.9%) 4 sites (12.5µl total volume, n=12; S-4sites), saline 8 sites (25µl total volume, n=11; S-8sites), aboBoNTA 4 sites (12.5µl total volume, 5.6U per site, n=20; aboBoNTA-4sites) and aboBoNTA 8 sites (25µl total volume, 2.8U per site, n=20; aboBoNTA-8sites).

Does an “Overactive to Underactive Bladder Transition” Phenomenon Exist in a Rat Lumbar Spinal Canal Stenosis Model?

Purpose: To investigate the association between the maximum cystometric capacity (MCC) and other cystometric parameters in lumbar canal stenosis (LCS) rats. Material and Methods: One small hole was drilled at the fifth lumbar vertebral arch (Sham), and a rectangular piece of silicone rubber was then placed in the epidural space (LCS) of Wister rats. Two weeks after surgery, awake cystometry was performed. LCS rats were divided into three groups: Group A (n = 5, MCC 1.81 mL). Cystometric parameters were investigated in sham and LCS groups. Results: MCC did not significantly correlate to the frequency of non-voiding contractions (NVCs), voided volume (VV), or maximum intravesical pressure during voiding (Pmax), but significantly positively correlated to postvoid residual urine volume (PVR) and residual urine rate (RUR) (Spearman’s correlation coefficients (ρ) = 0.8973 (p < 0.0001) and 0.4915 (p = 0.0068), respectively). Compared with the sham rats, LCS rats in each group revealed significantly smaller VV, larger RUR, and lower Pmax. On the other hand, among LCS rats, VV, RUR, and Pmax were not significantly different. The frequency of NVCs in each LCS group was not significantly different from that in sham-operated rats (Tukey-Kramer’s HSD test). However, a Jonckheere-Terpstra trend test revealed a significant trend toward higher NVCs in the order of sham, Groups C, B, and A (p = 0.036). Conclusions: LCS rats showed the same degree of detrusor underactivity regardless of MCC. NVCs did not significantly increase in LCS rats with decreased MCC, but the trend toward higher NVCs with smaller MCC was significant.