Urethral Pressure Measurements Research Articles

Comparison of Air-charged Catheter and Water-filled Catheter in Female Urethral Pressure Profile

ObjectivesTo compared the maximum urethral pressure (Pura@max) and functional urethral length (FUL) obtained with water‐filled catheters and air‐charged catheters during female urethral pressure profile (UPP) in a retrospective study. Subjects and methodsOne hundred and five female patients were enrolled in our investigation. At Beijing Chao-Yang Hospital, patients who had lower urinary tract dysfunction underwent UPP using a modified UPP equipment. In one UPP, both a water-filled catheter (WFC) and an air-charged catheter (ACC) were employed simultaneously. The paired t-test was used to compare the differences between the two systems. Bias and correlations between the two systems were analyzed according to the American Clinical and Laboratory Standardization Institute (CLSI) EP9-A3 recommendations. ResultThere were 105 female participants in this study. The patients were 55.5±14.2 years old on average. By using the ACC and WFC systems, the mean functional urethral length (FUL) was determined to be 39.7±16.2mm and 33.9±13.9mm, respectively. The FUL findings of two systems differed significantly from one another (P<0.01), and a linear fit with R2=0.94 indicates a strong linear correlation. The findings of the maximum urethral pressure (Pura@max) measurements made by the ACC and WFC systems, respectively, were 134.3±39.1cmH2O and 99.2±27.6cmH2O, are substantially different (P<0.01), and the linear fit R2=0.67. The Pura@max of two systems did not linearly correlate with one another. Conclusion：For UPP, air-charged catheters often provide higher readings than water-filled catheters, and there is a significant difference in the readings between the two systems. The pressure values derived from the two systems do not correlate, although the FUL does have a significant linear correlation. Results from the ACC and WFC cannot be used interchangeably.

The use of autologous skeletal muscle-derived cells as a sling in the treatment of stress-induced urinary incontinence: An experimental study in dogs

PurposeThis is an experimental preclinical study testing the applicability of autologous skeletal muscle-derived cells as a treatment of SUI in a canine model.MethodsTen mongrel dogs were included in this study. Skeletal muscle was harvested for biopsy in 4 dogs. One month later, incontinence was induced in 8 dogs through urethrolysis. Biopsied muscle cells were incubated and expanded for 8 weeks. Muscle-derived cells were collected and covered with a polyglycolic acid (PGA) scaffold immersed in culture medium and coated with Matrigel to be used as a sling, which was placed suburethrally in 8 dogs; 4 had cell seeding, and 4 had scaffolds only. Urethral pressure (UP) measurements were performed at baseline and 2 &amp;amp; 6 weeks after sling insertion. The urethra was harvested 4 weeks after sling insertion for histopathology.ResultsOne month, a statistically significant increase of mean urethral pressure values compared to baseline was observed in all dogs with a scaffold inserted. The increase ranged from 5 to 40 cmH2O. Histopathology showed significant periurethral proliferation of skeletal muscles in 4 dogs with cell-seeded scaffolds. These levels were the maximum levels in dogs # 1 &amp;amp; 2. This was not the case in the 4 dogs that had slings only.ConclusionBased on the outcome of this preliminary experience, the use of skeletal muscle-seeded PGA scaffolds seems to be an easy and reproducible procedure which preserves histological differentiation and integrity in a canine model

Diagnostic value of urethral pressure profile for female bladder neck obstruction using air-charged catheters

Objective: To evaluate the measurements of urethral pressure profile (UPP) using air-charged catheters (ACC) in women with bladder neck obstruction and to preliminarily analyze the diagnostic value of UPP based on ACC for female bladder neck obstruction. Methods: Retrospective inclusion of 63 female patients with bladder neck obstruction diagnosed in the Department of Urology of Beijing Chao-yang Hospital from September 2020 to December 2021 were included as the observation group, and 45 female patients who came to the hospital due to lower urinary tract symptoms with non-bladder neck obstruction during the same period were selected as the control group. All patients received urodynamic examination and UPP examination based on ACC, and urethral pressure measurements [M (Q1, Q3)] were compared between the two groups and analyzed the predictive value of the relevant measurements for female bladder neck obstruction. Results: The age of the observation group was 61 (47, 67) years and body mass index (BMI) was 24.1 (21.6, 27.9) kg/m2, the age of the control group was 65 (58, 71) years and BMI was 25.0 (22.8, 27.6) kg/m2. The urethral pressure at the bladder neck and urinary sphincter position in the observation group were higher than control group[104.00 (83.00, 124.00) cmH2O (1 cmH2O=0.098 kPa) vs 42.00 (31.00, 65.50) cmH2O, 125.0 (107.0, 154.0) cmH2O vs 99.0 (77.0, 124.0) cmH2O, P<0.001]. The results of the receiver operating characteristic (ROC) curve showed that the area under the curve (AUC) of urethral pressure at the bladder neck position had the highest predictive value for female bladder neck obstruction (AUC: 0.946, 95%CI: 0.886-0.981, sensitivity: 87.3%, specificity: 91.1%), and the results of interaction point plot showed that the cut-off value was 72 cmH2O. The cut-off value of urethral pressure at the bladder neck position was used as positive cut-off value to predict female patients with bladder neck obstruction. Sixty-three patients with bladder neck obstruction were detected by UPP measurement using ACC in 59 cases (59/63, 93.7%) and the Kappa value was 0.774 (95%CI: 0.654-0.894), indicating that UPP had high consistency with pressure-flow study. Conclusions: UPP examination based on ACC can show the pressure values of the bladder neck and urethral sphincter position. When the urethral pressure of the bladder neck position is greater than 72 cmH2O, it is helpful for the diagnosis of female bladder neck obstruction and has guiding significance for the diagnosis and treatment of this disease.

The potential involvement of MRP5 pump in urethral dysfunction in streptozotocin-induced diabetic rats.

To examine the effects of i.v. administration of MK-571, a MRP4/5 pump inhibitor, on urethral function in the urethane-anesthetized rat, and the changes of urethral multidrug resistance protein 5 (MRP5) pump in streptozotocin (STZ)-induced diabetes mellitus (DM) rats. Isovolumetric cystometry and urethral perfusion pressure (UPP) measurements were carried out in normal control (NC) group and 8week DM groups under urethane anesthesia. When stable rhythmic bladder contractions were showed, UPP parameters were recorded after successive administration of various dose of MK-571. Additionally, urethral cyclic guanosine monophosphate (cGMP) protein level was evaluated by ELISA, and changes of MRP5 pump and neurogenic nitric oxide synthase (nNOs) in the urethra were examined with immunohistochemical staining and Western blot analysis. In NC group, UPPnadir was significantly decreased but UPP change increased after administration of MK-571, while no significant differences in UPP parameters were observed in 8-week DM group. Furthermore, urethral MRP5 protein level was up-regulated, whereas urethral cGMP and nNOS protein levels were down-regulated in 8-week DM group. MK-571 could not restore NO-mediated urethral relaxation dysfunction in DM rats, which may be attributed to the up-regulation of urethral MRP5 pump, and thus decrease of intracellular cGMP concentration in the urethra. These novel results would be useful for a better understanding of DM-related lower urinary tract dysfunction LUT (LUTD). Also, they could be helpful to study the importance of MRP pumps in the control of urethral relaxation mechanisms under physiological and pathological states.

The Mode of Action of Adjustable Transobturator Male System (ATOMS): Intraoperative Urethral Pressure Measurements

(1) Background: The Adjustable Transobturator Male System (ATOMS) device is increasingly used to treat post-prostatectomy incontinence as it enhances residual urinary sphincteric function and allows continence recovery or improvement by dorsal compression of the bulbar urethra through a fixed transobturator mesh passage. The mode of action and the profile of the patients with best results are not totally understood. (2) Methods: Intraoperative urethral pressure measurements at different filling levels of the ATOMS device show increased urethral resistance and enhanced residual sphincteric activity. We evaluated whether the pattern of urethral pressure change secondary to serial progressive intraoperative filling of the cushion can predict postoperative results after ATOMS placement. (3) Results: The regression analysis showed a significant direct relationship between cushion volume and intraurethral pressure (p = 0.000). The median intraurethral pressure at atmospheric pressure was 51 ± 22.7 cm H2O, and at atmospheric pressure plus 4 mL was 80 ± 23.1 cm H2O). Cluster analyses defined a group of patients (n = 6) formed by patients with a distensible urethra and 100% continence after adjustment in contrast to another group (n = 3) with rigid urethras and 33% continence after adjustment. (4) Conclusions: As a part of its continence mechanism, the ATOMS device leads to continence by increasing intraurethral pressure owing to the stretching effect on the urethral wall caused by cushion filling that increases urethral resistance.

Association of intrinsic sphincter deficiency with urine flow acceleration measurement.

Intrinsic sphincter deficiency (ISD) is associated with an inability to maintain mucosal coaptation either at rest or in the presence of stress resulting from damage to muscles or nerves that maintain tonus. The purpose of our trial was to determine the role of urodynamic measurements of flow such as maximum flow rate, flow time, and acceleration speed of flow to assess the urethral resistance on prediction of stress incontinence and ISD. Our study was based on a retrospective analysis of urodynamic records of female patients performed for urinary incontinence. Mean flow rate, maximum flow rate, detrusor pressure at maximum flow, vesical pressure at maximum flow, maximum detrusor pressure, and flow rate at maximum detrusor pressure measurements were extracted from the voiding phase of urodynamic charts. The slope of the maximum flow was used to calculate acceleration of flow (Qacc). The urodynamic records of 142 women were reviewed and Qacc was measured. The mean age of the ISD group was 53.3 ± 12.5 (24-78) and of the non-ISD group 53.7 ± 12.5 (35-74). The mean Qacc (30.3 ± 16.1° [mL/s2 ]) in the ISD group was significantly higher than in the non-ISD group (21.6 ±9.6° [mL/s2 ]). Urodynamic bladder capacity of the non-ISD group (432.3 ± 90.4 mL) was higher than the ISD group (389.2 ± 109) (P = .01). The Valsalva leak point pressure and maximum urethral closure pressure measurements in assessing urethral function are not useful for predicting incontinence surgery failure. We demonstrated that Qacc is higher in ISD stress incontinent women than stress incontinent women. Qacc may demonstrate urethral resistance and tonus in a more reliable manner.

MP48-03 THE EFFECTS OF L-ARGININE ON URETHRAL FUNCTION IN STREPTOZOTOCIN-INDUCED AND INSULIN-TREATED DIABETIC RATS

You have accessJournal of UrologyUrodynamics/Lower Urinary Tract Dysfunction/Female Pelvic Medicine: Neurogenic Voiding Dysfunction (MP48)1 Apr 2020MP48-03 THE EFFECTS OF L-ARGININE ON URETHRAL FUNCTION IN STREPTOZOTOCIN-INDUCED AND INSULIN-TREATED DIABETIC RATS Nailong Cao, Baojun Gu*, Eduardo C Alexandre, Daisuke Gotoh, Masahiro Kurobe, Shinsuke Mizeguchi, and Naoki Yoshimura Nailong CaoNailong Cao More articles by this author , Baojun Gu*Baojun Gu* More articles by this author , Eduardo C AlexandreEduardo C Alexandre More articles by this author , Daisuke GotohDaisuke Gotoh More articles by this author , Masahiro KurobeMasahiro Kurobe More articles by this author , Shinsuke MizeguchiShinsuke Mizeguchi More articles by this author , and Naoki YoshimuraNaoki Yoshimura More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000000903.03AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Normal lower urinary tract (LUT) function is dependent on the coordination between bladder and urethra, which is sensitive to a host of disorders, including diabetes mellitus (DM). Although STZ-induced diabetic rat model has been extensively used as a rodent model of the LUT dysfunction, it’s not a good physiological condition for diabetic patients. Our purpose is therefore to establish a physiological DM animal model with low dose insulin treatment, and examine the effects of L-arginine on urethral function in this animal model. METHODS: Thirty female Sprague-Dawley rats were divided into three groups. DM was initially induced by i. p. injection of STZ (65 mg/kg), and then received subcutaneous implantation of insulin under the mid dorsal skin. Isovolumetric cystometry and urethral perfusion pressure (UPP) measurements were performed under urethane anesthesia. L-arginine (100 mg/kg), was administered intravenously. Subsequently, N-nitro-L-arginine methyl ester hydrochloride (L-NAME) (50 mg/kg) was injected intravenously to inhibit NO synthase activity. The changes of urethral function among different groups in vitro were tested by organ bath. RESULTS: In vivo study, UPP nadir was only decreased by L-arginine both in Normal control (NC) and insulin-treated DM groups, but inhibited by L-NAME in all the groups (Fig.1). Furthermore, 5 out of 6 DM rats showed a similar detrusor-sphincter dyssynergia pattern after L-NAME (Fig.1). In vitro study, the ratio, namely urethral relaxation difference divided by relaxation before L-NAME administration, was significantly decreased in DM group (Fig.2). CONCLUSIONS: Low dose insulin can protest against diuresis-induced bladder overdistention and increase urethral relaxation, and this may be attributed to the protection of NO synthase and urethral NO sensitivity, but the longer effects should be further explored. Source of Funding: NIH (U54 DK112079 and R01 DK115476) © 2020 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 203Issue Supplement 4April 2020Page: e695-e695 Advertisement Copyright & Permissions© 2020 by American Urological Association Education and Research, Inc.MetricsAuthor Information Nailong Cao More articles by this author Baojun Gu* More articles by this author Eduardo C Alexandre More articles by this author Daisuke Gotoh More articles by this author Masahiro Kurobe More articles by this author Shinsuke Mizeguchi More articles by this author Naoki Yoshimura More articles by this author Expand All Advertisement PDF downloadLoading ...

Urethral dysfunction and therapeutic effects of a PDE 5 inhibitor (tadalafil) in a rat model of detrusor underactivity induced by pelvic nerve crush injury.

The urethral dysfunction produced by a rat model of peripheral neurogenic detrusor underactivity (DU) using pelvic nerve crush (PNC) injury was characterized and then tested with the administration of tadalafil, a phosphodiesterase type 5 (PDE 5) inhibitor. Ten days after producing PNC rats, awake cystometrograms (CMGs) and isovolumetric cystometrograms with urethral perfusion pressure (IC-UPP) measurements were performed. Also, in control rats, IC-UPP was recorded before and after intravenous atropine administration to determine if the reduction of bladder contraction pressure affects urethral relaxation during voiding. Then, CMG and IC-UPP measurements in PNC rats were recorded after intravenous administration of tadalafil. Lastly, real-time polymerase chain reaction was used to measure transcript levels of neuronal nitric oxide synthases (nNOS), endothelial nitric oxide synthases, and PDE 5 in urethral specimens from PNC and control rats. PNC rats demonstrated the characteristics of DU in CMG. Also, PNC rats exhibited significant decreases in isovolumetric bladder contraction amplitudes and urethral relaxation. Atropine attenuated the amplitude of isovolumetric bladder contractions; however, atropine did not affect urethral relaxation in control rats. Tadalafil decreased postvoid residual and increased voiding efficiency without changing bladder contraction amplitude in PNC rats. Also, tadalafil improved the amplitude of urethral relaxation during bladder contraction in PNC rats. Urethral nNOS transcript levels were upregulated in PNC rats compared to control rats. PNC rats revealed both DU and impaired urethral relaxation. PDE 5 inhibition in PNC rats enhanced urethral relaxation during voiding, resulting in improved voiding efficiency. Thus, urethral dysfunction could be a potential target for the treatment of inefficient voiding associated with neurogenic DU.

Additional value of triple-sensor urethral catheter in demonstrating urethral pressure variations during filling cystometry.

During filling cystometry, urethral pressure variations (UPV) can be observed. The clinical relevance and a clear definition of this phenomenon are still a matterof debate. For further research and definition of UPV, it is important to determine how this condition can best be demonstrated. The purpose of this study is to compare continuous urethral pressure measurements with a single urethral-sensor catheter and a triple urethral-sensor catheter in demonstrating UPV. Seventy-five adult female patients requiring urodynamic investigation enrolled in this prospective study. All patients underwent two series of filling and voiding cystometry. One series was performed with a dual-air balloon sensor urodynamic catheter, the other series with a triple urethral-sensor catheter. UPV were defined as urethral pressure drop exceeding 30 cmH2O. The prevalence of UPV was 37.3% (28 out of 75 patients), more common than detrusor overactivity. The triple urethral-sensor catheter was more sensitive than the single urethral-sensor catheter: In eight patients UPV were demonstrated with both catheters and in 18 patients only in the measurement with the triple urethral-sensor catheter. This difference in detection was significant (P < .001). There is an additional value in measurement with the triple urethral-sensor catheter for demonstration of UPV during filling cystometry. Currently, continuous measurement of urethral pressure during filling cystometry and UPV is not defined within International Continence Society terminology. The single urethral-sensor catheter is useful for a start, however, it demonstrates less than half of all UPV.

In vivo molecular engineering of the urethra for treatment of stress incontinence using novel biomimetic proteoglycans.

Stress urinary incontinence (SUI), a serious condition which affects ~56% of postmenopausal women, is the involuntary leakage of urine through urethra during physical activity that causes an increase in abdominal pressure. SUI is associated with a decrease in compliance and volume of urethral tissue, likely due to a reduced proteoglycan: collagen ratio in the extracellular matrix and collagen disorganization. Here, we investigated the use of biomimetic proteoglycans (BPGs) to molecularly engineer urethral tissue of New Zealand White rabbits to examine biocompatibility in vivo. BPG concentrations of 50 mg/mL (n = 6, 1 week) and 200 mg/mL (n = 6, 1 week and n = 6, 6 weeks) dissolved in 1× phosphate-buffered saline (PBS) were injected transurethrally using a 9 French cystoscope, and were compared to PBS-injected controls (n = 3, 1 week) and non-injected controls (n = 2, 1 week). Urethral compression pressure measurements confirm BPG injections did not modify normal urethral pressure, as intended. Histological assessment demonstrated biological tolerance of BPGs in urethra and no inflammatory response was detected after 1 and 6 weeks compared to non-injected controls. Confocal imaging of fluorescently-labeled BPG injected urethral specimens demonstrated the integration of BPGs into the interstitial connective tissue and confirmed they were still present after 6 weeks. A general decrease of collagen density was exhibited near injection sites which may be due to increased hydration induced by BPGs. Injection of BPGs is a novel approach that demonstrates potential as molecular treatment for SUI and may be able to reverse some of the degenerative tissue changes of individuals affected by this condition. © 2019 Wiley Periodicals, Inc. J Biomed Mater Res Part B: 00B: 000-000, 2019. © 2019 Wiley Periodicals, Inc. J Biomed Mater Res Part B: Appl Biomater 107B: 2409-2418, 2019.

Urethral Pressure Measurement as a Tool for the Urodynamic Diagnosis of Detrusor Sphincter Dyssynergia.

PurposeTo describe a technique for urodynamic diagnosis of detrusor sphincter dyssynergia (DSD) using urethral pressure measurements and examine potential associations between urethral pressure and bladder physiology among patients with DSD.MethodsMultiple sclerosis (MS) and spinal cord injured (SCI) patients with known DSD diagnosed on videourodynamics (via electromyography or voiding cystourethrography) were retrospectively identified. Data from SCI and MS patients with detrusor overactivity (DO) without DSD were abstracted as control group. Urodynamics tracings were reviewed and urethral pressure DSD was defined based on comparison of DSD and control groups.ResultsSeventy-two patients with DSD were identified. Sixty-two (86%) had >20 cm H2O urethral pressure amplitude during detrusor contraction. By comparison, 5 of 23 (22%) of control group had amplitude of >20 cm H2O during episode of DO. Mean duration of urethral pressure DSD episode was 66 seconds (range, 10–500 seconds) and mean urethral pressure amplitude was 73 cm H2O (range, 1–256 cm H2O). Longer (>30 seconds) DSD episodes were significantly associated with male sex (81% vs. 50%, P=0.013) and higher bladder capacity (389 mL vs. 219 mL, P=0.0004). Urethral pressure amplitude measurements during DSD were not associated with significant urodynamic variables or neurologic pathology.ConclusionsUrethral pressure amplitude of >20 cm H2O during detrusor contraction occurred in 86% of patients with known DSD. Longer DSD episodes were associated with larger bladder capacity. Further studies exploring the relationship between urethral pressure measurements and bladder physiology could phenotype DSD as a measurable variable rather than a categorical observation.

Age-associated urethral dysfunction in urethane-anesthetized rats.

We aimed to investigate the age-associated changes in movement coordination between the urinary bladder and the urethra in rats. A total of 17 female Sprague-Dawley rats were used. The rats were divided into young (3 months old) and middle-aged (12-15 months old) groups. In both groups, isovolumetric cystometry and urethral perfusion pressure (UPP) measurements were performed under urethane anesthesia. After the rhythmic bladder contractions stabilized, L-arginine, a nitric oxide (NO) substrate (100 mg/kg), was administered intravenously in both groups. Subsequently, N-nitro-L-arginine methyl ester hydrochloride (L-NAME) (50 mg/kg) was injected intravenously to inhibit NO synthase activity in both groups. UPP change, defined as UPP nadir minus baseline UPP, was significantly smaller in middle-aged rats (64%) than in young rats (P < 0.05). The mean amplitude of high-frequency oscillations (HFOs) of the external urethral sphincter was also significantly lower (62%) in middle-aged rats than that in young rats (P < 0.05). Urethral contraction during UPP change was also noted in middle-aged rats. This urethral contraction disappeared after L-arginine administration. UPP nadir during bladder contraction was inhibited by L-NAME in both groups. UPP change was greater in middle-aged rats than in young rats, and 3 out of 9 middle-aged rats showed a detrusor-sphincter dyssynergia pattern after L-NAME. The results indicated that aging induces dysfunction in movement coordination between the urinary bladder and the urethra. Thus, age-associated urethral dysfunctions may lead to inefficient voiding with increased post-void residual urine volume, which is often observed in elderly populations.

Re: Continuous Urethral Pressure Measurements; Measurement Techniques; Pressure Variations; Clinical Interpretations; and Clinical Relevance. ASystematic Literature Analysis.

No AccessJournal of UrologyUrological Survey1 Oct 2017Re: Continuous Urethral Pressure Measurements; Measurement Techniques; Pressure Variations; Clinical Interpretations; and Clinical Relevance. A Systematic Literature Analysis Alan J. WeinMD, PhD (hon) Alan J. WeinAlan J. Wein More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2017.07.063AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail "Re: Continuous Urethral Pressure Measurements; Measurement Techniques; Pressure Variations; Clinical Interpretations; and Clinical Relevance. A Systematic Literature Analysis." The Journal of Urology, 198(4), p. 750 © 2017 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 198Issue 4October 2017Page: 750 Advertisement Copyright & Permissions© 2017 by American Urological Association Education and Research, Inc.MetricsAuthor Information Alan J. Wein More articles by this author Expand All Advertisement PDF downloadLoading ...

Overactive pelvic floor muscles (OPFM): improving diagnostic accuracy with clinical examination and functional studies.

BackgroundTo identify the functional correlation of overactive pelvic floor muscles (OPFM) with cystoscopic and fluoroscopic urodynamic studies (FUDS), including urethral pressure measurements.MethodsPatients refractory to conservative therapy including bladder retraining, medications and pelvic muscle exercises for a variety of gamut of storage and voiding disorders were evaluated. Prospective data for 201 patients across both genders who underwent flexible cystoscopy and urodynamics for lower urinary tract symptoms (LUTS) refractory to conservative management between 01 Jan 2014 and 01 Jan 2016 was collected. Factors studied included history of LUTS, voiding patterns, physical examination, cystoscopic findings and functional studies, with maximum urethral closing pressure (MUCP).ResultsA total of 201 were patients recruited. The 85 were diagnosed with OPFM based on clinical presentation and presence of pelvic floor tenderness on examination. Significant differences were noted on functional studies with FUDS and urethral pressure measurement. Subjects with pelvic floor tenderness were found to have a higher (MUCP) at 93.1 cm H2O compared to 80.6 cm H2O (P=0.015).ConclusionsThere are distinct characteristics of OPFM on clinical examination and functional studies, in particular MUCP. In patients refractory to conservative treatments, specific urodynamics tests are useful in sub-categorising patients. When OPFM is diagnosed, the impact on patient management is significant, and targeted intervention with pelvic floor physiotherapy is central in the multimodal approach of this complex condition.

Urodynamic studies in children: Standardized transurethral video-urodynamic evaluation

The aim was too demonstrate standardized video-urodynamic study (VUDS) in children using a transurethral catheter and pressure transducers. Data necessary to obtain urodynamic evaluation of bladder sphincter function were gathered by concomitant measurement of bladder, urethral, and abdominal pressure. A 7F transurethral triple-lumen water-filled catheter was used for measuring the bladder and sphincter pressures and a water-filled 8F catheter connected to a pressure transducer was inserted into the rectum for pressure measurement. Cystometry was combined with fluoroscopy, providing simultaneous voiding cystourethrography information. Detrusor activity, bladder sensation, capacity, and compliance were measured during filling cystometry. Voiding cystometry consisted of recording pressures in the bladder sphincter and abdomen with simultaneous urinary flow measurement. Transurethral VUDS was safely and easily performed in a clinical setting adapted to children. A good and reproducible UDS is mandatory for correct therapeutic decisions. A standardized study associated with fluoroscopic assessment is presented in this video.

Continuous urethral pressure measurements; measurement techniques; pressure variations; clinical interpretations; and clinical relevance. A Systematic Literature Analysis.

The clinical relevance of urethral pressure variations (UPV) in the pathophysiology of over active bladder syndrome (OAB) has remained controversial to date. Some studies report an association with OAB and/or detrusor over activity (DO). Recently the International Consultation on Incontinence-Research Society recommended new clinical research to be performed on this subject. We provide a systematic review of the literature to specify this recommendation. Literature search was performed in PubMed, Embase, Web of Science, Cochrane, Central, Cinahl, Academic Science Premier, Science Direct, and Wiley Online using a sensitive search string combination. All authors independently reviewed and scored full text papers and consensus about methodological quality was obtained according to Oxford Level of Evidence (LoE). Four hundred eighty seven abstracts were screened, 25 papers met all predefined inclusion selection criteria. Incidence figures of UPV varied between 2% and 95%. Studies are of poor methodological quality with Oxford LoE scores of 3B and 4. Measurement methods and techniques show a large variety. The above mentioned association of DO/OAB with UPV is however frequently reported. There exists a phenomenon of UPV, apart from DO, which may be a separate entity within OAB syndrome. Large variation in measurement techniques and patient populations hinders fundamental research as well as clinical progress. Clinical relevance of UPV and consequences for treatment therefore are yet to be established. Future prospective research with well-defined patient population and standardised urodynamic measurement techniques is needed. Results of standardized and objective evaluations should be compared to clinical signs and symptoms by validated questionnaires. Neurourol. Urodynam. 36:51-56, 2017. © 2015 Wiley Periodicals, Inc.

Measurement of dynamic urethral pressures with a high-resolution manometry system in continent and incontinent women.

Female stress urinary incontinence is caused by urethral dysfunction during dynamic conditions, but current technology has limitations in measuring urethral pressures under these conditions. An 8-French high-resolution manometry (HRM) catheter currently in clinical use in gastroenterology may accurately measure urethral pressures under dynamic conditions because it has a 25-millisecond response rate and circumferential pressure sensors along the length of the catheter (ManoScan ESO; Given Imaging, Yoqneam, Israel). We evaluated the concordance, repeatability, and tolerability of this catheter. We measured resting, cough, and strain maximum urethral closure pressures (MUCPs) using HRM and measured resting MUCPs with water-perfusion side-hole catheter urethral pressure profilometry (UPP) in 37 continent and 28 stress-incontinent subjects. Maneuvers were repeated after moving the HRM catheter along the urethral length to evaluate whether results depend on catheter positioning. Visual analog pain scores evaluated the comfort of HRM compared to UPP. The correlation coefficient for resting MUCPs measured by HRM versus UPP was high (r = 0.79, P < 0.001). Repeatability after catheter repositioning was high for rest, cough, and strain with HRM: r = 0.92, 0.89, and 0.89. Mean MUCPs (rest, cough, and strain) were higher in continent than in incontinent subjects (all P < 0.001) and decreased more in incontinent subjects than in continent subjects during cough and strain maneuvers compared to rest. This preliminary study shows that HRM is concordant with standard technology, repeatable, and well tolerated in the urethra. Incontinent women have more impairment of their urethral closure pressures during cough and strain than continent women.

The Effects of Thoracic Epidurally Administered Drugs on Urethral Sphincter Function in Women: A Pooled Analysis

Thoracic epidural analgesia (TEA) has been shown to inhibit detrusor activity in patients undergoing open renal surgery, resulting in clinically relevant post-void residuals. However, the impact of different epidural drug mixtures on urethral sphincter function is not completely elucidated. Pooled analysis of an open observational study and a double-blind randomized trial. Single tertiary centre. Twenty-eight women without lower urinary tract symptoms and post-void residual <100 mL, who underwent open renal surgery with TEA. Pooling results in three groups with different epidural regimens (7 with bupivacaine 0.125%, 8 with bupivacaine 0.125% and fentanyl 2 μg/mL, and 13 with bupivacaine 0.1% plus fentanyl 2 μg/mL and epinephrine 2 μg/mL). All women underwent urethral pressure measurements before TEA and during TEA 2-3 days postoperatively. All patients received a TEA placed at the insertion site interspace T 8-9. Maximum urethral closure pressure at rest decreased significantly during TEA with bupivacaine alone (median 70 cm H2 O [interquartile range 66-76] to 43 [43-65], P = 0.031) and with bupivacaine/fentanyl/epinephrine (75 cm H2 O [68-78] to 56 [52-75], P = 0.028), whereas with bupivacaine/fentanyl, no significant change could be detected (74 [51-88] vs 67 [46-70], P = 0.156). In all groups, functional profile length at rest was not influenced during TEA. TEA with bupivacaine and the addition of fentanyl and epinephrine appears to decrease maximum urethral closure pressure at rest in women. The addition of fentanyl alone to bupivacaine may reduce this effect. Thus, the TEA effect on urethral sphincter function seems to depend on the drug mixture administered.

Long-Term Structural and Functional Effects of Autologous Muscle Precursor Cell Therapy in a Nonhuman Primate Model of Urinary Sphincter Deficiency

We measured the long-term efficacy of autologous muscle precursor cell therapy in premenopausal female nonhuman primates with sustained urinary sphincter deficiency. Urinary sphincter deficiency was created in adult premenopausal female cynomolgus monkeys by selectively cauterizing and then transecting the pudendal innervation to the sphincter complex. The monkeys were then treated (18) or not treated (18) with intra-urinary sphincter injections of 5 million autologous green fluorescent protein labeled skeletal muscle precursor cells. Four untreated, uninjured monkeys served as controls. Maximal urethral pressure measurement and corresponding histological analysis of the structural and cellular components of the sphincter complex were performed up to 12 months after injection. Cell treatment produced sustained (12 months) increases in resting, somatic nerve stimulated and adrenergic nerve stimulated maximal urethral pressure, and a greater percent of sphincter area occupied by muscle as well as a decrease in the sphincter area occupied by collagen compared to the untreated group (each p>0.05). These results were within control values (each p>0.05). By 3 months after injection green fluorescent protein positive cells were found in the skeletal muscle layer, expressing desmin and connexin-43, and in the smooth muscle layer, expressing α-smooth muscle actin and connexin-43, and they were incorporated into the subendothelial vasculature, expressing Von Willebrand factor. Cell injected sphincter tissue contained a mixture of green fluorescent protein positive cells and predominantly green fluorescent protein negative cells. Injected skeletal muscle progenitor cells incorporated into the injured sphincter complex resulted in long-term structural and functional restoration of the injured sphincter complex in this nonhuman primate model.

1578 URETHRAL SPHINCTER FUNCTION IN WOMEN DURING THORACIC EPIDURALLY ANALGESIA: A POOLED ANALYSIS

You have accessJournal of UrologyUrodynamics/Incontinence/Female Urology: Female Urology (I)1 Apr 20131578 URETHRAL SPHINCTER FUNCTION IN WOMEN DURING THORACIC EPIDURALLY ANALGESIA: A POOLED ANALYSIS Livio Mordasini, Tobias Metzger, Thomas M. Kessler, Fiona C. Burkhard, and Patrick Y. Wuethrich Livio MordasiniLivio Mordasini Bern, Switzerland More articles by this author , Tobias MetzgerTobias Metzger Bern, Switzerland More articles by this author , Thomas M. KesslerThomas M. Kessler Zuerich, Switzerland More articles by this author , Fiona C. BurkhardFiona C. Burkhard Bern, Switzerland More articles by this author , and Patrick Y. WuethrichPatrick Y. Wuethrich Bern, Switzerland More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2013.02.3128AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Thoracic epidural analgesia (TEA) has been shown to inhibit detrusor activity in patients undergoing open renal surgery, resulting in relevant postvoid residuals. However, the impact of different epidural drug mixtures on urethral sphincter function is still unknown. METHODS The present study is a pooled analysis of an open observational study and a double-blind randomized trial. Twenty-eight women without lower urinary tract symptoms, who underwent open renal surgery with TEA, were pooled and categorized into three groups with different epidural mixtures (7 with bupivacaine 0.125%, 8 with bupivacaine 0.125% and fentanyl 2 μg/ml and 13 with bupivacaine 0.1% plus fentanyl 2 μg/ml and epinephrine 2 μg/ml). All women underwent urethral pressure measurements at rest before TEA and during TEA 2-3 days postoperatively. All patients received a TEA placed at the insertion site interspace T 8-9. RESULTS Maximum urethral closure pressure (MUCP) at rest decreased significantly during TEA with bupivacaine alone (median 70 cmH2O [range: 60-80] to 43 [19-68], P=0.031) and with bupivacaine/fentanyl/epinephrine (75 cmH2O [range: 33-115] to 56 [24-105], P=0.028), whereas with bupivacaine/fentanyl no significant change could be detected (74 [49-95] vs 67 [38-86], P=0.156). In all groups functional profile length at rest was not influenced during TEA. CONCLUSIONS TEA with bupivacaine decrease MUCP at rest in women. The addition of fentanyl counteracts this effect. If epinephrine, which reduces the fentanyl plasma concentration by half is also added, MUCP is again significantly decreased. The effect of fentanyl is most likely systemic. The observed increase of MUCP may further explain the negative effect of systemic opiods on voiding function. © 2013 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 189Issue 4SApril 2013Page: e648 Peer Review Report Advertisement Copyright & Permissions© 2013 by American Urological Association Education and Research, Inc.MetricsAuthor Information Livio Mordasini Bern, Switzerland More articles by this author Tobias Metzger Bern, Switzerland More articles by this author Thomas M. Kessler Zuerich, Switzerland More articles by this author Fiona C. Burkhard Bern, Switzerland More articles by this author Patrick Y. Wuethrich Bern, Switzerland More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...