Urethral Occlusion Research Articles

(189) Modified Mini-jupette Sling for Climacturia During IPP Placement

Abstract Introduction Climacturia, the inadvertent leak of urine during orgasm, is a well-known complication following radical prostatectomy and can cause significant patient/partner bother. The Mini-Jupette sling treats climacturia during placement of an inflatable penile prosthesis (IPP) but requires an extended corporotomy with a complex closure. Our modified Mini-Jupette technique utilizes a standard corporotomy and places the sling inferior as opposed to integrated into the corporotomy. Additionally, we perform an intraoperative drip test for urethral occlusion, which eliminates the need for guessing on sling tension. Corset sutures can then be utilized intraoperatively or in future revision surgeries in the event of sling loosening or recurrent climacturia. Objective To visually demonstrate the modified mini-jupette technique and intraoperative drip test. Methods An IPP surgical candidate with climacturia was identified. Intraoperative video of the Mini-Jupette technique was recorded using an overhead camera. The Mini-Jupette sling is placed with four vertical Ethibond (00) sutures placed inferior to the corporotomy stay sutures. The drip test is set up by retracting the catheter to the distal urethra and connecting it to a bedside irrigation system set 60cm above the patient. Stoppage of fluid flow during IPP inflation indicates that the sling is appropriately occluding the urethra. Results Successful demonstration of a modified Mini-Jupette technique and intraoperative drip test without complications. Conclusions Our modified Mini-Jupette and intraoperative drip test provide a reasonable alternative to the standard Mini-Jupette technique. Disclosure Any of the authors act as a consultant, employee or shareholder of an industry for: Coloplast.

The Effect of Duration of Stress Urinary Incontinence on developing Signs of Bladder Outlet Obstruction in Urodynamic Study

Background: Stress urinary incontinence is a frequent urological disease in women; it has a great influence on an individual’s wellbeing and places a significant economic strain on any health service. The placement of urodynamic diagnostic tests in the evaluation route is an important clinical research concern in this field. Objective: to find out whether the duration of stress urinary incontinence is associated with the finding of bladder outlet obstruction in urodynamic study or not. Subjects and Methods: A descriptive study. With enrolled female patients had symptomatic Stress urinary incontinence as their primary complain. All the included patients were assessed thoroughly by history taking and physical examination and relevant clinical tests and investigation in addition to urodynamic evaluation consisted of multi-channel urodynamics measuring abdominal, vesical and detrusor pressures simultaneously. Results: 140 females were suffering from stress incontinence. Urodynamic study showed maximum urine flow rate (Q max) mean of (20.45±9.86) ml/second, the maximum post void volume was 500ml with 36.89ml was the mean of post void residual volume, and 90.83cm water was the mean of urethral occlusion pressure. The mean of duration have positive relationship with age category but without statically significant. Ninety-eight patients have Q max flow more than 25ml/sec with mean duration 6.04 without any statically significant (p=0.872). 37 patients were having >0 ml post void volume with mean duration more than other patients that didn’t have post void volume but without statically significant (p=0.257). All patients with urethral pressure less than 120 cm had long duration mean than others but without statically significant (p=0.335). also, no statistical significance association between mean of duration and sphincter pelvic floor electromyogram (EMG). Conclusion: there was no catechistically significant relationship between the urodynamic findings and the duration neither of stress urinary incontinence nor between the urodynamic findings and the age of the patients.

Astragaloside IV Protects Detrusor from Partial Bladder Outlet Obstruction-Induced Oxidative Stress by Activating Mitophagy through AMPK-ULK1 Pathway.

Aims Bladder outlet obstruction (BOO) and the consequent low contractility of detrusor are the leading causes of voiding dysfunction. In this study, we aimed to evaluate the pharmacological activity of astragaloside IV (AS-IV), an antioxidant biomolecule that possess beneficial effect in many organs, on detrusor contractility and bladder wall remodeling process. Methods Partial BOO (pBOO) was created by urethral occlusion in female rats, followed by oral gavage of different dose of AS-IV or vehicle. Cystometric evaluation and contractility test were performed. Bladder wall sections were used in morphology staining, and bladder tissue lysate was used for ELISA assay. Primary smooth muscle cells (SMCs) derived from detrusor were used for mechanism studies. Results Seven weeks after pBOO, the bladder compensatory enlarged, and the contractility in response to electrical or chemical stimuli was reduced, while AS-IV treatment reversed this effect dose-dependently. AS-IV also showed beneficial effect on reversing the bladder wall remodeling process, as well as reducing ROS level. In mechanism study, AS-IV activated mitophagy and alleviated oxidative stress via an AMPK-dependent pathway. Conclusion Out data suggested that AS-IV enhanced the contractility of detrusor and protected the bladder from obstruction induced damage, via enhancing the mitophagy and restoring mitochondria function trough an AMPK-dependent way.

MP52-04 COMPARATIVE URODYNAMIC STUDY IN CADAVER OF URETHRAL PRESSURE PROFILOMETRY BETWEEN THE UROMEMS ARTIFICIAL URINARY SPHINCTER AND THE AMS80TM

You have accessJournal of UrologyCME1 May 2022MP52-04 COMPARATIVE URODYNAMIC STUDY IN CADAVER OF URETHRAL PRESSURE PROFILOMETRY BETWEEN THE UROMEMS ARTIFICIAL URINARY SPHINCTER AND THE AMS80TM Aurelien Beaugerie, Florence Poinard, Anne Denormandie, Juliette Cotte, Christine Reus, Pierre Mozer, and Emmanuel Chartier-Kastler Aurelien BeaugerieAurelien Beaugerie More articles by this author , Florence PoinardFlorence Poinard More articles by this author , Anne DenormandieAnne Denormandie More articles by this author , Juliette CotteJuliette Cotte More articles by this author , Christine ReusChristine Reus More articles by this author , Pierre MozerPierre Mozer More articles by this author , and Emmanuel Chartier-KastlerEmmanuel Chartier-Kastler More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002627.04AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The Artificial Urinary Sphincter (AUS) is currently the standard of care for men with severe Stress Urinary Incontinence (SUI). It's also a treatment option for SUI in women in Europe. Urethral occlusion pressure transmitted by the cuff to the urethra is determined by the Pressure Regulating Balloon (PRB), that cannot be adjusted after implantation. Low pressure will affect functional result on continence, excessive pressure could lead to urethral erosion. The UroMems AUS is an implantable device with a cuff and a Control Unit (CU) which embeds an automatic pump and electronic components. This allows to wirelessly set the device occlusive pressure, thereby personalizing the therapy. The objective of this study is to compare on cadavers the range of urethral occlusion pressure covered by the UroMems AUS compared to the AMS800™(Boston Scientific). METHODS: This study was conducted on 6 cadavers, 3 males and 3 females. Each cadaver was implanted with an AMS800 occlusive cuff, around the bulbous urethra by perineal approach in males, and around the bladder neck by median incision in females. For each cadaver, the cuff was successively connected to the 3 different AMS800 PRB: 51-60 cmH2O, 61-70 cmH2O and 71-80 cmH2O. For each PRB, Urethral Pressure Profilometry (UPP) was done with a Goby™ urodynamic system (Laborie). The AMS800 PRB was then replaced by the UroMems CU. After device calibration, UPP was done for set pressures ranging from 10 to 150 cmH2O by increments of 10 cmH2O. The main outcome of the study was Maximal Urethral Closing Pressure (MUCP). A study correlation was performed between CU set pressure and MUCP. RESULTS: Cuff size were 4; 4; 4,5 cm for males and 5; 5; 5,5 cm for females. With AMS800 PRB, mean MUCP was 58 cmH2O IC95%[53; 62], 66 cmH2O [65; 68], and 76 cmH2O [70; 81] for the 51-60 cmH2O, 61-70 cmH2O and 71-80 cmH2O PRB respectively. With the UroMems CU, mean MUCP range was from 23 [16; 30] to 120 [108;131] cmH2O for a set pressure range of 10 to 150 cmH2O respectively, as shown in Figure 1. There was a significant correlation between the CU set pressure and the MUCP for both males (r=0,99, p<0,01) and females (r=0,97, p<0,01). CONCLUSIONS: In male and female cadavers, the UroMems CU provides a range of MUCP from 23 to 120 cmH2O, which covers MUCP obtained with the 3 different AMS800 PRB. Source of Funding: N/A © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e887 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Aurelien Beaugerie More articles by this author Florence Poinard More articles by this author Anne Denormandie More articles by this author Juliette Cotte More articles by this author Christine Reus More articles by this author Pierre Mozer More articles by this author Emmanuel Chartier-Kastler More articles by this author Expand All Advertisement PDF DownloadLoading ...

Computational Tools for the Investigation of the Male Lower Urinary Tract Functionality in Health and Disease

PurposeThis paper aims to show the potentialities of computational bioengineering in the field of lower urinary tract pathophysiology. Engineering methods allow the investigation of urine flow in healthy and pathologic conditions and the analysis of urethral occlusion by means of artificial urinary sphincters.MethodsComputational models of bladder and urethra were developed and exploited to investigate the lower urinary tract physiology in health and in disease. Average male morphometric configurations were assumed, together with typical properties of both biological tissues and fluids. The reliability of the models was assessed by the mutual comparison of results and the investigation of data from experimental and clinical activities.ResultsThe developed models allowed to analyze typical situations, such as the micturition in health and in disease, and the lumen occlusion by external devices. The models provided information that clinical and experimental tests barely provide, as the occurrence of turbulent phenomena within urine flow, the shear stresses at the lumen wall, the external pressure that is strictly required to occlude the lumen.ConclusionsThe methods of bioengineering allow broadening and deepening the knowledge of the lower urinary tract functionality. More in detail, modeling techniques provide information that contributes to explain the occurrence of pathological situations, and allows to design and to optimize clinical-surgical procedures and devices.

Evaluation of non-invasive tests as diagnostic tools in assessment of bladder outlet obstruction severity in men with anterior urethral stricture.

IntroductionThe aim of this article was to evaluate non-invasive tests, which were typically used in preoperative diagnosis of male patients with anterior urethral strictures in the assessment of the urethral resistance caused by urethral occlusion.Material and methodsA total of 63 adult males with confirmed urethral stricture and aged below 55 years old were enrolled in the study. Data obtained from non-invasive tests such as uroflowmetry (UF), ultrasound examination (USG), and questionnaires such as from The International Prostatic Symptom Score (IPSS), and The Patient-Reported Outcome Measure for Urethral Stricture Surgery (USS-PROM) were analyzed.ResultsAmong all analyzed non-invasive tests, bladder wall thickness (BWT) showed the highest correlation with the degree of urethral occlusion described as percentage of preserved urethral lumen (r = -0.70; p <0.0001). UF variables presented medium degree of correlation, with maximum flow rate (Qmax) as the best parameter (p = 0.45; p = 0.0005). Results from both questionnaires did not show any correlation with the severity of the urethral stricture. Multiple linear regression analysis showed that only BWT was an independent predictor in detection degree of urethral occlusion.ConclusionsUF and USG seem to be useful additional diagnostic tools in assessment severity of urethral occlusion in men suffering from anterior urethral stricture. Among them, USG had the highest correlation with degree of urethral occlusion.

Pelvic Floor Muscle Training in Radical Prostatectomy and Recent Understanding of the Male Continence Mechanism: A Review.

Pelvic floor muscle training (PFMT) is recommended as part of supportive care for patients with prostate cancer. It can assist in reducing treatment-related symptoms such as urinary incontinence. This literature review aims to discuss recent innovative findings on the pathophysiology of the male continence mechanism and implications for PFMT in radical prostatectomy. CINAHL, Embase, Web of Science, Emcare and PsycINFO were searched until January 2020. Nurses providing supportive care for patients undergoing radical prostatectomy can engage in-clinic in the instruction and recommendation of pre- and postoperative PFMT and delivering guidance on home-based programs to promote motor learning. Optimal postoperative urinary incontinence outcomes are suggested to be promoted by preoperative PFMT. Training focused on the urethral and anterior pelvic floor muscle complex has been shown to facilitate mid urethral occlusion required for continence. Prescription of PFMT should be individualised, focusing on skill acquisition and motor learning, which is in line with recent knowledge developments in male pelvic floor anatomy.

Investigation of interaction phenomena between lower urinary tract and artificial urinary sphincter in consideration of urethral tissues degeneration.

Lower urinary tract dysfunction pertains to symptoms related to the lower urinary tract (LUT), with consequent incontinence. Artificial urinary sphincters (AUS) are adopted to obtain continence conditions, mainly in male subjects, via urethral occlusion by applying pressure load, mostly operating on the basis of an empirical approach. Considering the frequent access of elderly patients to this surgical practice, tissue degradation related to aging phenomena must be investigated. Computational models of the LUT structures and the AUS systems have been designed to evaluate tissues mechanical stimulation and degenerative phenomena for reciprocal interaction. Virtual solid models of the LUT have been developed starting from biomedical images, as histological/morphometrical data. Segmentation procedures have been exploited to provide the three-dimensional reconstruction, and subsequent discretization techniques led to the finite element model. Contemporarily, a finite element model of a typical AUS device was developed. Numerical analyses have been performed to analyze interaction phenomena between AUS and LUT. Different conditions were investigated, modifying both loading conditions, as intraluminal pressure and AUS action, and urethral tissues properties. Particular attention was devoted to tissues parameters, aiming to evaluate the influence of tissues degeneration because of aging and/or pathologies.

Conformation and mechanics of the polymeric cuff of artificial urinary sphincter.

The surgical treatment of urinary incontinence is often performed by adopting an Artificial Urinary Sphincter (AUS). AUS cuff represents a fundamental component of the device, providing the mechanical action addressed to urethral occlusion, which can be investigated by computational approach. In this work, AUS cuff is studied with reference to both materials and structure, to develop a finite element model. Materials behavior is investigated using physicochemical and mechanical characterization, leading to the formulation of a constitutive model. Materials analysis shows that AUS cuff is composed by a silicone blister joined with a PET fiber-reinforced layer. A nonlinear mechanical behavior is found, with a higher stiffness in the outer layer due to fiber-reinforcement. The cuff conformation is acquired by Computer Tomography (CT) both in deflated and inflated conditions, for an accurate definition of the geometrical characteristics. Based on these data, the numerical model of AUS cuff is defined. CT images of the inflated cuff are compared with results of numerical analysis of the inflation process, for model validation. A relative error below 2.5% was found. This study is the first step for the comprehension of AUS mechanical behavior and allows the development of computational tools for the analysis of lumen occlusion process. The proposed approach could be adapted to further fluid-filled cuffs of artificial sphincters.

PD70-01 EFFECTS OF WATER AVOIDANCE STRESS ON PERIPHERAL AND CENTRAL RESPONSES DURING BLADDER FILLING IN THE RAT

You have accessJournal of UrologyUrodynamics/Lower Urinary Tract Dysfunction/Female Pelvic Medicine: Basic Research & Pathophysiology III1 Apr 2017PD70-01 EFFECTS OF WATER AVOIDANCE STRESS ON PERIPHERAL AND CENTRAL RESPONSES DURING BLADDER FILLING IN THE RAT Huiyi Harriet Chang, Zhuo Wang, Yunliang Gao, Rong Zhang, Daniel P Holschneider, and Larissa V Rodriguez Huiyi Harriet ChangHuiyi Harriet Chang More articles by this author , Zhuo WangZhuo Wang More articles by this author , Yunliang GaoYunliang Gao More articles by this author , Rong ZhangRong Zhang More articles by this author , Daniel P HolschneiderDaniel P Holschneider More articles by this author , and Larissa V RodriguezLarissa V Rodriguez More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2017.02.3155AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Chronic emotional stress plays a role in the exacerbation and possibly the development of functional lower urinary tract disorders. Chronic water avoidance stress (WAS) in rodents is a model with high construct and face validity to bladder hypersensitivity syndromes, such as interstitial cystitis/bladder painful syndrome (IC/BPS), which manifest as urinary frequency and bladder hyperalgesia, which have been shown to be highly responsive to stress. Given the significant overlap of the brain circuits involved in stress, anxiety, and micturition, we evaluated the effects chronic stress has on bladder function and its effects on regional brain activation during bladder filling. METHODS 16 adult female Wistar-Kyoto rats were randomized to 10-day WAS (n=8) or handled controls (n=8). On day 11, rats were evaluated by visceromotor reflex (VMR) for bladder hyperalgesia. VMR was obtained during isotonic bladder distention (0-40 cmH2O) with urethral occlusion. Cerebral perfusion was assessed during bladder distention (20 cmH2O) using [14C]-iodoantipyrine autoradiography with regional cerebral blood flow-related tissue radioactivity (rCBF) analyzed in 3-D reconstructed brains with statistical parametric mapping. RESULTS At 20 cmH2O, VMR significantly increased in WAS compared to controls. WAS animals compared to controls showed greater activation in cortical regions of the central micturition circuit, with seed analysis showing increased functional connectivity of the cingulate to the parabrachial/Barrington nucleus complex (PBN), of the PBN to the thalamus and somatosensory and retrosplenial cortices, and of posterior insula to anterior secondary motor cortex. CONCLUSIONS The current study demonstrates how stress exacerbation of symptoms seen in the majority of patients with IC/PBS may be centrally mediated and gives us anatomic sites to further evaluate the biological mechanisms by which stress may induce or maintain bladder hyperalgesia and urinary frequency as well as a translational model to evaluate the molecular changes behind the brain differences seen in patients with IC/BPS. Collectively, our physiologic and brain mapping results suggest hypersensitivity during bladder filing in WAS animals, as well as increased engagement of portions of the micturition circuit responsive to urgency and the perception of bladder fullness, including viscerosensory perception and its relay to motor regions coordinating imminent bladder contractions. © 2017FiguresReferencesRelatedDetails Volume 197Issue 4SApril 2017Page: e1349 Advertisement Copyright & Permissions© 2017MetricsAuthor Information Huiyi Harriet Chang More articles by this author Zhuo Wang More articles by this author Yunliang Gao More articles by this author Rong Zhang More articles by this author Daniel P Holschneider More articles by this author Larissa V Rodriguez More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

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 ...

Urethral lumen occlusion by artificial sphincteric devices: a computational biomechanics approach.

The action induced by artificial sphincteric devices to provide urinary continence is related to the problem of evaluating the interaction between the occlusive cuff and the urethral duct. The intensity and distribution of the force induced within the region of application determine a different occlusion process and potential degradation of the urethral tissue, mostly at the borders of the cuff. This problem is generally considered in the light of clinical and surgical operational experience, while a valid cooperation is established with biomechanical competences by means of experimental and numerical investigation. A three-dimensional model of the urethra is proposed aiming at a representation of the phases of the urethral occlusion through artificial sphincters. Different conformations of the cuff are considered, mimicking different loading conditions in terms of force intensity and distribution and consequent deformation caused in soft tissues. The action induced in the healthy urethra is investigated, as basis for an evaluation of the efficacy and reliability of the sphincteric devices. The problem is characterized by coupled nonlinear geometric and material problem and entails a complex constitutive formulation. A heavy computational procedure is developed by means of analyses that operate within an explicit finite element formulation. Results reported outline the overall response of the urethral duct during lumen occlusion, leading to an accurate description of the phenomenon in the different phases.

Deletion of neuropilin 2 enhances detrusor contractility following bladder outlet obstruction.

Chronic urethral obstruction and the ensuing bladder wall remodeling can lead to diminished bladder smooth muscle (BSM) contractility and debilitating lower urinary tract symptoms. No effective pharmacotherapy exists to restore BSM contractile function. Neuropilin 2 (Nrp2) is a transmembrane protein that is highly expressed in BSM. Nrp2 deletion in mice leads to increased BSM contraction. We determined whether genetic ablation of Nrp2 could restore BSM contractility following obstruction. Partial bladder outlet obstruction (pBOO) was created by urethral occlusion in mice with either constitutive and ubiquitous, or inducible smooth muscle-specific deletion of Nrp2, and Nrp2-intact littermates. Mice without obstruction served as additional controls. Contractility was measured by isometric tension testing. Nrp2 deletion prior to pBOO increased force generation in BSM 4 weeks following surgery. Deletion of Nrp2 in mice already subjected to pBOO for 4 weeks showed increased contractility of tissues tested 6 weeks after surgery compared with nondeleted controls. Assessment of tissues from patients with urodynamically defined bladder outlet obstruction revealed reduced NRP2 levels in obstructed bladders with compensated compared with decompensated function, relative to asymptomatic controls. We conclude that downregulation of Nrp2 promotes BSM force generation. Neuropilin 2 may represent a novel target to restore contractility following obstruction.

MP77-09 CHRONIC PSYCHOLOGICAL STRESS LEADS TO BLADDER HYRALGESIA VIA STRESS INDUCED SENSITIZATION OF C FIBERS AND MECHANORECPTORS

You have accessJournal of UrologyUrodynamics/Lower Urinary Tract Dysfunction/Female Pelvic Medicine: Non-neurogenic Voiding Dysfunction II1 Apr 2016MP77-09 CHRONIC PSYCHOLOGICAL STRESS LEADS TO BLADDER HYRALGESIA VIA STRESS INDUCED SENSITIZATION OF C FIBERS AND MECHANORECPTORS Yunliang Gao, Rong Zhang, Huiyi Chang, and Larissa Rodriguez Yunliang GaoYunliang Gao More articles by this author , Rong ZhangRong Zhang More articles by this author , Huiyi ChangHuiyi Chang More articles by this author , and Larissa RodriguezLarissa Rodriguez More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2016.02.1923AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Patients affected by overactive bladder and painful bladder syndrome/interstitial cystitis report symptoms exacerbation when stressed. We have shown that anxiety prone animals exposed to chronic psychological water avoidance stress (WAS) develop sustained bladder hyperalgesia. The bladder cooling reflex (BCR) is a segmental reflex believed to be triggered by cold receptors in bladder wall with C fibers signaling. We aimed to evaluate the chronic stress induces changes in BCR and if C fiber sensitization contributes to stress-induced bladder hypersensitivity. METHODS 22 adult female Wistar-Kyoto rats equally divided to 10-day WAS or handled controls. On day 11, animals were evaluated by cystometrogram (CMG) as well as visceromotor reflex (VMR) for bladder sensitivity and pain to saline infusion. CMG and VMR were obtained during bladder infusion at room temperature (RT) and cold (4 degree C) with an open urethral outlet thus allowing the animal to void. CMG and VMR were also obtained during RT isotonic bladder distention (RT-IBD, 10-40 cmH2O) with urethral occlusion. RESULTS During RT infusion, WAS rats had a significant decreases in pressure threshold (PT) and the ratio of VMR threshold/maximum intravesical pressure (IVPmax). VMR duration significantly increased in WAS. BCR induced a more dramatic significant decline in PT and the ratio of VMR threshold/IVPmax in WAS (Fig.1A). No significant differences were found in contraction duration, inter-contraction interval or the VMR area under the curve (AUC) and duration. At RT-IBD (Fig.1B-C), VMR latency in WAS significantly decreased compared to controls. At 20 cmH2O, VMR AUC in WAS significantly increased compared to controls. CONCLUSIONS Chronic psychological stress induces bladder hypersensitivity, which manifests as earlier voiding and VMR. Prolonged VMR duration in WAS correlates with increased bladder sensitivity during voiding. BCR evokes C fibers activation and suggests that stress induced bladder hypersensitivity in functional voiding disorders mediated in part by afferent sensitization. Earlier VMR appearance at RT-IBD suggests a role for mechanoreceptor sensitivity in stress-induced bladder hypersensitivity. © 2016FiguresReferencesRelatedDetails Volume 195Issue 4SApril 2016Page: e1018-e1019 Advertisement Copyright & Permissions© 2016MetricsAuthor Information Yunliang Gao More articles by this author Rong Zhang More articles by this author Huiyi Chang More articles by this author Larissa Rodriguez More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Fetal Megacystis: Etiologies, Management, and Outcome According to the Trimester

To describe the diagnostic criteria and outcome of fetal megacystis according to the gestational age at diagnosis. A 7-year retrospective study was carried out from 2004 to 2011, including cases of megacystis referred to 2 prenatal fetal medicine units. The following data were collected and analyzed: maternal age, term at diagnosis (gestational weeks), ultrasonographic and magnetic resonance imaging data, karyotype, decision of the multidisciplinary prenatal team, fetopathology in cases of termination of pregnancy or fetal death, final diagnosis at birth after ultrasonography and voiding cystourethrography, and medical and surgical follow-up. Of the 69 fetuses included in this study, 82.6% were males; 26 were diagnosed during the first trimester, 21 during the second, and 22 during the third. During the first trimester, the main etiologies were urethral occlusions and prune-belly syndrome with poor fetal prognosis. Nineteen pregnancies (69%) were terminated for medical reasons including the association with other malformations, poor evolution, or miscarriage. Only 4 children were born alive. The main etiologies of megacystis discovered during the second and third trimesters were vesicoureteral reflux and urethral occlusion. Twenty of 22 fetuses (91%) were born alive when the fetal megacystis was discovered after 27weeks of gestation. Antenatal discovery of megacystis is a complex and challenging prognostic situation. The prognosis depends on the gestational age at discovery. Megacystis is not always associated with obstruction. In a newborn with megacystis, bladder outlet obstruction has to be excluded. Optimal counseling of the involved parents requires a multidisciplinary approach.

Characterization of bulbospongiosus muscle reflexes activated by urethral distension in male rats

The urethrogenital reflex (UGR) is used as a surrogate model of the autonomic and somatic nerve and muscle activity that accompanies ejaculation. The UGR is evoked by distension of the urethra and activation of penile afferents. The current study compares two methods of elevating urethral intraluminal pressure in spinalized, anesthetized male Sprague-Dawley rats (n = 60). The first method, penile extension UGR, involves extracting the penis from the foreskin, so that urethral pressure rises due to a natural anatomical flexure in the penis. The second method, penile clamping UGR, involves penile extension UGR with the addition of clamping of the glans penis. Groups of animals were prepared that either received no additional treatment, surgical shams, or received bilateral nerve cuts (4 nerve cut groups): either the pudendal sensory nerve branch (SbPN), the pelvic nerves, the hypogastric nerves, or all three nerves. Penile clamping UGR was characterized by multiple bursts, monitored by electromyography (EMG) of the bulbospongiosus muscle (BSM) accompanied by elevations in urethral pressure. The penile clamping UGR activity declined across multiple trials and eventually resulted in only a single BSM burst, indicating desensitization. In contrast, the penile extension UGR, without penile clamping, evoked only a single BSM EMG burst that showed no desensitization. Thus, the UGR is composed of two BSM patterns: an initial single burst, termed urethrobulbospongiosus (UBS) reflex and a subsequent multiple bursting pattern (termed ejaculation-like response, ELR) that was only induced with penile clamping urethral occlusion. Transection of the SbPN eliminated the ELR in the penile clamping model, but the single UBS reflex remained in both the clamping and extension models. Pelvic nerve (PelN) transection increased the threshold for inducing BSM activation with both methods of occlusion but actually unmasked an ELR in the penile extension method. Hypogastric nerve (HgN) cuts did not significantly alter any parameter. Transection of all three nerves eliminated BSM activation completely. In conclusion, penile clamping occlusion recruits penile and urethral primary afferent fibers that are necessary for an ELR. Urethral distension without significant penile afferent activation recruits urethral primary afferent fibers carried in either the pelvic or pudendal nerve that are necessary for the single-burst UBS reflex.

Laparoscopic‐Assisted Cystotomy and Cystostomy for Treatment of Cystic Calculus in a Gelding

To report laparoscopic-assisted cystotomy and inguinal cystostomy for treating bladder urolithiasis in a gelding. Clinical report. Twelve-year-old Appaloosa gelding. A laparoscopic approach was used to locate and grasp the bladder, which was exteriorized through an enlarged instrument portal for cystotomy to remove the calculus. During withdrawal, the calculus fragmented into multiple pieces. To avoid urethral occlusion and facilitate elimination of these fragments, an inguinal cystostomy was created. The seromuscular layer of the bladder was circumferentially secured to the abdominal fascia and bladder mucosa margins were sutured to the skin. At 2-year follow-up, the gelding was in good condition with mild urine scald of the left ventral abdomen. Laparoscopic-assisted cystotomy was used for calculus removal and inguinal cystostomy for successful fragment elimination.

Propagation of the Electrical Impulse in Reversible Unilateral Ureteral Obstruction as Determined at High Electrophysiological Resolution

We investigated the propagation of electrical impulses in a reversible, complete or partial unilateral ureteral obstruction model in vivo. In Wistar rats the left mid ureter was completely (8) or partially (7) occluded and released after 24 hours. We recorded electrical activity of the left and right ureter before, during and after obstruction at different stages up to 2 weeks after obstruction using a high resolution, 64 extracellular electrode probe. Complete obstruction in the left proximal ureter caused an immediate increase in frequency from a mean ± SEM of 14.8 ± 1.3 to 18.6 ± 1.7 per minute (p <0.05), followed by a 1.4 ± 0.9 per minute decrease (p <0.001). Within the first 2 days after reversal velocity gradually decreased from 1.82 ± 0.12 to 0.79 ± 0.17 cm per second (p <0.001). Release of obstruction gradually restored frequency and velocity, which returned to baseline at 2 weeks. Generally the alterations in rats with complete and partial obstruction were similar but they were less marked in those with partial obstruction. Distal to the obstruction site the impulses disappeared (38%) or propagated retrograde (43%) at some stage in the post-obstruction period. These abnormal impulse propagations also gradually disappeared in the post-obstruction stage. After complete or partial ureteral obstruction there were immediate, significant changes in the propagation of electrical impulses in the proximal and distal left ureter, which were generally less marked after partial than after complete obstruction. Reversal of obstruction resulted in the gradual disappearance of this abnormality in 2 weeks.

Novel Artificial Urinary Sphincter in the Canine Model: The Tape Mechanical Occlusive Device

To assess the functionality, occlusive efficiency, and biocompatibility of a novel artificial urinary sphincter, the tape mechanical occlusive device (TMOD), after implantation in a live canine model, as well as its occlusive efficiency and sizing parameters in human cadavers. Three female canines underwent implantation of the TMOD at the level of the bladder neck. Functionality was assessed starting at 2 weeks after implantation and continued for ≤9 weeks. The TMODs were activated at 2 weeks and then deactivated for 3, 30-minute sessions daily to permit voiding. The urethral occlusion pressures and biocompatibility for systemic toxicity and the local tissue response were examined. Additionally, the TMOD was inserted in 3 male cadavers to determine the sizing parameters and to assess the urethral occlusion pressures using pressure profilometry. In the canine model, the urethral occlusion pressures increased from a range of 9-42 cm H(2)O with the TMOD deactivated to a range of 57-82 cm H(2)O with the TMOD activated. Pathologic examination revealed unremarkable pseudocapsular tissues surrounding the device. No histologic or structural evidence of systemic toxicity was observed. Sizing parameters similar to those of other urologic implants were confirmed in the male cadavers, and the urethral occlusion pressures increased from 24 to 30 cm H(2)O with the device deactivated to 61-105 cm H(2)O with the device activated. The TMOD meets the current standards for an artificial urinary sphincter in terms of functionality, biocompatibility, and achieving desired occlusion pressures following chronic implantation. Additional testing in male canines followed by early human clinical trials is being contemplated.

Étiologies et pronostic des mégavessies de diagnostic prénatal selon l’âge de découverte. Étude rétrospective sur six années

Objectives The purpose of this study is to describe the diagnosis, the care and the prognosis of the fetuses with an antenataly diagnosed megacystis. Patients and methods Six year retrospective study about 46 cases of megacystis (26 diagnosed during 1st trimester; 14 during 2nd trimester; 9 during 3rd trimester) referred in the prenatal fetal medicine unit of the Femme–Mère-Enfant hospital in Lyon (France). Results The main aetiology is urethral occlusion, particularly for megacystis discovered during the 1st and the 2nd trimesters. Twenty-two terminations of pregnancy were performed (47.8%) and 6 pregnancies arrested spontaneously (13%). Eighteen children were born alive, but 2 died in neonatal period. Finally, 16 children survived (34.8%). Chromosomal abnormalities are frequent (22%). Discussion and conclusion Antenatal discovery of a megacystis is a complex situation, and often of poor fetal prognosis. It requires a multidisciplinary approach to allow the concerned couple to be determined on the best care of this pregnancy.