Urethral Pressure Research Articles

Electroacupuncture for postpartum sexual dysfunction with urinary incontinence: A prospective case series study电针治疗产后性功能障碍伴尿失禁：前瞻性病例系列研究

ObjectiveTo observe the clinical therapeutic effect of electroacupuncture on postpartum sexual dysfunction associated with urinary incontinence. MethodsThe prospective case-series study was adopted. A total of 36 patients with postpartum sexual dysfunction associated with urinary incontinence were included consecutively. Electroacupuncture was applied to Shènshū (肾俞BL23), Huìyáng (会阳BL35), Pángguāngshū (膀胱俞BL28), Shíqīzhuī (十七椎EX-B8), Cìliáo (次髎BL32), Zhōngliáo (中髎BL33), Qìhăi (气海CV6), Guānyuán (关元CV4), Zhōngjí (中极CV3), Qūgŭ (曲骨CV2), Shuĭdào (水道ST28), Zĭgōng (子宫EX-CA1), Zúsānlĭ (足三里ST36) and Sānyīnjiāo (三阴交SP6), once daily, 6 times a week. The treatment for 2 weeks was as one phase and it should be completed in one menstrual cycle. For the cases without menstrual cycle recovery, the treatment should be given for any two weeks in one menstrual cycle and for those with menstrual cycle recovery, the treatment should avoid the menstrual period. Totally, the treatment lasted for 3 menstrual cycles. Before and after treatment, the scores of postpartum female sexual dysfunction diagnostic scale (PFSDDS), sexual intercourse pain assessment scale (SIPAS) and pelvic floor muscle strength test (PFMST), as well as the results of urodynamic examination (UE) were observed before and after treatment in the patients. ResultsAfter treatment, the scores of PFSDDS, SIPAS and PFMST were all increased as compared with those before treatment separately, presenting the statistical significance (all P < 0.05). Regarding UE, after treatment, the maximum bladder capacity, detrusor pressure at maximum flow, maximum flow rate and maximal urethral closure pressure were increased and postvoiding residual urine volume was reduced obviously as compared with the values before treatment, respectively, indicating the statistical differences (all P < 0.05). ConclusionElectroacupuncture has the significant effect on postpartum sexual dysfunction associated with urinary incontinence.

Characterization of bilateral, pudendal nerve-evoked, urethral rhabdosphincter contractions in anesthetized cats

Pudendal (PUD) efferent activity contracts urethral rhabdosphincters to resist urine leakage. This study evaluates the potential for PUD nerve stimulation to provide benefit for urinary incontinence. Acute responses of the urethral rhabdosphincter to modulation of current amplitude, pulse duration (PD), and frequency of stimulation were examined. Urethral pressure was measured using a microtip catheter in chloralose-anesthetized, male cats with or without acute spinalization at T10. Stimulation was applied from an external pulse generator coupled to cuff electrodes placed around left and right PUD nerves in the ischiorectal fossa, central to its branching. Bladder pressure clamp techniques were used for testing effects of stimulation on time and rate of leakage during PUD stimulation. Single pulses (0.1 ms) produced single transient increases in urethral pressure that peaked at 50 ms and diminished to 50% of peak at 90 ms. Threshold current was 88 ± 30μA with maximal responses occurring with 50% increases in current. Peak pressures increased with increasing PDs between 40–180μs. Summation, tetany, peak pressures, and fatigue of responses to increasing stimulation frequencies during 2 min periods of stimulation are described. Stimulation under pressures that are typical during bladder filling or during bladder contractions (30–40 cm H2O) prevented leakage up to an hour in some animals, increased the median time to leak from 0.3 min to 56.0 min, and decreased the median rate of leakage from 1.44 ml/min to 0.04 ml/min when leakage did occur in less than hour. During rapid elevations in bladder pressure to simulate a Valsalva-like bladder pressure (120 cm H2O), PUD stimulation increased the median time to leak from 9 s to 93 s and decreased the median rate of leakage from 5.5 ml/min to 3.4 ml/min. These results support future studies of bilateral PUD stimulation in a clinically-relevant, animal model of urinary incontinence.

Can urodynamic diagnosis of dysfunctional voiding/external sphincter nonrelaxation be made on two-channel pressure-flow study without video-urodynamics, electromyography, or urethral pressure profilometry? Plateau detrusor pattern in perspective.

urodynamic diagnosis of dysfunctional voiding/external-sphincter nonrelaxation (DV/EUSD) needs assistance of specialized testing namely urethral pressure profilometry (UPP), electromyography (EMG), and/or videofluoroscopy (VUDS). We aimed to find a predictive model based on standard pressure-flow study without need for specialized testing. In this retrospective study (2017-2021), clinical and urodynamic data of adult men and women presenting with voiding dysfunction was collected. Mandatory inclusion criteria were availability of all-(1) findings of clinical examination and neurological status, (2) a valid filling cystometry and pressure-flow study (with active detrusor contraction), (3) a final clinic-urodynamic diagnosis. Voiding cystourethrography (VCUG) was performed to confirm the location of obstruction. Data of 218 participants (178♂, 40♀) was eligible. Plateau detrusor contraction pattern was observed in 89.0% of men and 86% of women with DV/EUSD; whereas only 7.5% men and no women with other obstructions demonstrated this pattern. Forward likelihood Logistic regression analysis revealed presence of plateau pattern, lower bladder outlet obstruction index (BOOI), and smaller difference between Pdetmax and PdetQmax highly predictive of presence of DV/EUSD in men as per the following equation-Y = -9.900 + (0.085 × BOOI) + (0.123 × pdetmax - pdetQmax) + (4.061 × detrusor pattern). A kattan-type nomogram was constructed based on the above equation. In women, presence of plateau pattern alone was highly predictive of DV/EUSD. Diagnosis of DV/EUSD can be accurately predicted using parameters of three-channel urodynamics (plateau pattern, BOOI, Pdetmax-pdetQmax) minimizing need for specialized testing.

Prediction of Postradical Prostatectomy Urinary Incontinence Through the Combination of the Urethral Pressure Profile With Electromyography of the Urethral Sphincter.

PurposeWe tested the hypothesis that the urethral pressure profile, in combination with electromyography of the urethral sphincter, may be useful as a predictor of urinary incontinence after radical prostatectomy (RP). The aim of this study was to assess whether the combination of these tests resulted in an improved tool for the prediction of post-RP urinary incontinence.MethodsPatients with indications for RP were included. The urethral pressure profile, including prostatic and sphincter components for maximum urethral closure pressure (MUCP) and functional urethral length, was recorded in combination with needle electromyography of the urethral sphincter. The mean and maximum amplitude of waves were measured twice: 1 month before RP and 6 months after the procedure. The 1-hour pad test was conducted in parallel with other tests. Patients completed the International Consultation on Incontinence Questionnaire - Short Form (ICIQ-SF). The relationship of the results of the tests with post-RP urinary incontinence was studied. Age, urodynamic parameters, pathologic stage, and surgical technique were recorded for analysis as potential confounding factors.ResultsNineteen patients were included within the 1-year study period. Their mean age was 63 years. According to the 1-hour pad test and ICIQ-SF, 42.1% of the sample had urinary incontinence after RP. Prostate MUCP with the mean and during-stress amplitude of waves predicted post-RP urinary incontinence with a sensitivity of 87.5% (P=0.002) in our model. Age, urodynamic parameters, pathological stage, and surgical technique were not related to incontinence after surgery.ConclusionsThe combination of the urethral pressure profile (prostatic MUCP) and electromyography of the urethral sphincter might be a useful prognostic predictor of post-RP urinary incontinence.

Diagnostic Value of the Maximum Urethral Closing Pressure in Women With Overactive Bladder Symptoms and Functional Bladder Outlet Obstruction.

PurposeOveractive bladder (OAB) is observed in women with functional bladder outlet obstruction (FBOO), as are lower urinary tract symptoms (LUTS). Therefore, we evaluated the urodynamic characteristics of women with storage LUTS and FBOO diagnosed by urodynamic studies (UDS).MethodsWomen (n=108) with storage LUTS and FBOO diagnosed by UDS were included in this study. The urodynamic characteristics of women with FBOO were compared with those of women with OAB (n=34) and stress urinary incontinence (SUI, n=78). FBOO was defined as a maximum flow rate (Qmax) < 15 mL/sec, combined with detrusor pressure at a Qmax (PdetQmax) > 20 cm H2O in a pressure-flow study. The UDS included uroflowmetry, postvoid residual volume determination, a cystometrogram, and a pressure-flow study.ResultsWomen with FBOO who had storage symptoms showed a higher PdetQmax and maximum urethral closing pressure (MUCP) than women with OAB and SUI. Interstitial cystitis/bladder pain syndrome (IC/BPS) was observed in 17.6% of women with FBOO. MUCP was significantly higher in women with BOO than in women with BOO and IC/BPS (115.6±27.4 and 96.6±14.1 cm H2O, P=0.00). The receiver operating characteristic curve analysis showed that the cutoff values of MUCP in women with FBOO compared to women with OAB and SUI were 87 cm H2O (sensitivity=81.5%, specificity=73.5%) and 36 cm H2O (sensitivity=92.6%, specificity=84.4%), respectively. The cutoff value of MUCP in women with FBOO compared to women with FBOO and IC/BPS was 92 cm H2O (sensitivity=85.4%, specificity=78.9%).ConclusionsMUCP could have predictive value for identifying FBOO in women with complex LUTS.

Influence of background characteristics in responders of regenerative therapy by periurethral injection of adipose-derived regenerative cells for male stress urinary incontinence.

To determine if the male responders with post-prostatectomy incontinence in the ADRESU study, which is a clinical trial of regenerative therapy by periurethral injection of adipose-derived regenerative cells, are influenced by any background characteristics. Briefly, autologous adipose-derived regenerative cells isolated from abdominal adipose tissue and a mixture of adipose-derived regenerative cells with fat tissue were transurethrally injected into the rhabdosphincter and submucosal space of the urethra, respectively. Sixteen out of 43 patients (37.2%) responded to treatment (responders) and exhibited improvement in the urine leakage volume, defined as >50% reduction from baseline determined by the 24-hour pad test at 52 weeks of treatment (or last visit within 52 weeks). Background data such as age, body weight, method of prostatectomy, baseline frequency of leaks, number of leaks, number of pad changes, International Consultation on Incontinence Questionnaire-Short Form, King's Health Questionnaire, urodynamic urethral function including functional profile length and maximum urethral closure pressure, and abdominal leak point pressure were collected and compared between responders and nonresponders. None of the background factors influenced improvement in the responders as compared with the nonresponders. However, a significant between-group difference in the rates of decrease in urine leakage volume was noted in patients of younger age (<70 years), compared with those of older age (≥70 years) from 2 to 26 weeks of treatment. A greater decrease in urine leakage volume was noted in the younger patient group than in the older patient group.

Overactive bladder (OAB): a failed concept needing revision to accommodate an external anatomical control system.

In 45years, the definitions and practice of the urodynamically based overactive bladder (OAB)/detrusor overactivity (DO) system have failed to adequately address pathogenesis and cure of urinary urge incontinence, frequency and nocturia. We analysed the OAB syndrome with reference to the Integral Theory paradigm's (ITS) binary feedback system, where OAB in the female is viewed as a prematurely activated, but otherwise normal micturition caused mainly, but not entirely, by ligament damage/laxity. The ITS Clinical Assessment Pathway which details the relationships between structural damage (prolapse), ligaments and dysfunction (symptoms) is introduced. The ITS was able to "better explain" OAB pathophysiology in anatomical terms with reference to the binary model. The phasic patterns diagnostic of "detrusor overactivity" are explained as a struggle for control by the closure and micturition reflexes. The exponentially determined relationship between urethral diameter and flow explains why obstructive patterns occur, why they do not and why urine may leak with no recorded pressure. Mechanically supporting ligaments ("simulated operations") during urodynamic testing can improve low urethral pressure, negative pressure during coughing with SUI and diminish urge sensation or even DO patterns, transforming urodynamics from non-predictive test to accurate predictor of continence surgery results. High cure rates for OAB by daycare repair of damaged ligaments is a definitive test of the binary system's validity. Conceptual progression of OAB to the Integral Theory paradigms's prematurely activated micturition validates OAB component symptoms as a syndrome, explains pathogenesis, and unlocks a new way of understanding, diagnosing, treating and researching OAB.

Effect of precise nursing service mode on postoperative urinary incontinence prevention in patients with prostate disease.

BACKGROUNDPatients with benign prostatic disease often experience detrusor morphological changes and dysfunction. In severe cases, it leads to bladder detrusor dysfunction, resulting in dysuria, frequent urination, urgent urination, incomplete urination, and other symptoms including renal function injury. An operation to restore normal urination function and to control postoperative complications, as far as possible, is the most common method for benign prostatic disease. AIMTo observe the effect of precise nursing service mode on postoperative urinary incontinence prevention in patients with prostate disease.METHODSIn total, 130 patients diagnosed with benign prostatic disease, from January 2018 to June 2021, in our hospital, were selected and divided into observation and control groups according to their treatment options. Sixty-five cases in the control group were given routine nursing mode intervention and 65 cases in the observation group received precise nursing service mode intervention. The intervention with the observation group included psychological counseling about negative emotions, pelvic floor exercises, and post-hospital discharge care. The complications of the two groups were counted, and the general postoperative conditions of the two groups were recorded. The urinary flow dynamics indexes of the two groups were detected, and differences in clinical international prostate system score (IPSS) and urinary incontinence quality of life questionnaire (I-QOL) scores were evaluated. RESULTSPostoperative exhaust time (18.65 ± 3.23 h and 24.63 ± 4.51 h), the time of indwelling catheter (4.85 ± 1.08 d and 5.63 ± 1.24 d), and hospitalization time (8.78 ± 2.03 d and 10.23 ± 2.28 d) in the observation group were lower than in the control group. The difference was statistically significant (P < 0.05). After the operation, the maximum urinary flow rate (Qmax) increased (P < 0.05), the residual urine volume (RUV) decreased (P < 0.05), and the maximum closed urethral pressure (MUCP) was not statistically significant (P > 0.05) compared to pre-operation. The Qmax of the observation group was higher than that of the control group, while the RUV was lower than that of the control group. There was no significant difference in MUCP between the observation and control groups (P > 0.05). The I-QOL score of the two groups improved (P < 0.05), and the IPSS decreased (P < 0.05). After the operation, the I-QOL score of the observation group was higher than that of the control group, and the IPSS was lower than that of the control group (P < 0.05). There were no significant differences in the incidence of urethral injury (1.54% and 3.08%), bladder spasm (0.00% and 1.54%), and secondary bleeding (1.54% and 4.62) between the observation and control groups (P > 0.05). CONCLUSIONThe precise nursing service mode can reduce the incidence of postoperative urinary incontinence in patients with prostate disease, thus improving postoperative urodynamics and rehabilitation, and quality of life.

Hypertriglyceridemia Impairs Urethral Spontaneous Tone Through Down-regulation of ANO1 in Mouse Urethral Smooth Muscle Cells

ObjectiveTo investigate the effect of hypertriglyceridemia (HTG) on the Anoctamin 1 (ANO1)-centered signal on urinary incontinence. MethodsFemale mice were fed with high fat diet to set up HTG mice model. ANO1 expression in urethrae were detected by Flow Cytometry and Western Blotting. The habit of micturition was recorded through urine spot test. Urethral Smooth Muscle Myography was used to record the urethral spontaneous tone (STT) and contraction. Patch-clamp Recording confirmed the currents of ANO1 in urethral smooth muscle cells. ResultsHTG mice showed almost abolished STT and significantly decreased contraction induced by EACT. Meanwhile, a change in urination habits was detected in HTG mice which suggested that mice could not hold the urethral pressure. Furthermore, ANO1 expression in single urethral smooth muscle cells from HTG mice decreased almost 30% than that found in cells from normal group. Moreover, EACT (an N-aroylaminothiazole, ANO1 activator) induced decreased intracellular calcium ([Ca2+]i) and currents in single urethral smooth muscle cells from HTG mice. ConclusionThese results suggested that hypertriglyceridemia decreased the STT on urethral motility by down-regulating the expression of ANO1 in urethral smooth muscles. These findings provide a new perspective on the mechanism of urinary incontinence which is common in HTG patients.

A0586 - Comparative urodynamic study in cadaver of urethral pressure profilometry between the UroMems artificial urinary sphincter and the AMS800™

A0586 - Comparative urodynamic study in cadaver of urethral pressure profilometry between the UroMems artificial urinary sphincter and the AMS800™

Stress urinary incontinence is caused predominantly by urethral support failure

Whales are mammals that can dive to depths of > 1000 m without the high water pressure pushing open their mouth or anus. The same is true for the female urethra. The meatus externus and internus are seals that cannot be pushed open by high water pressures. Recent evidence suggests that the female meatus internus is pushed open when the bladder pressure exceeds the urethral pressure. For a relaxed detrusor, this opening is not possible for at least three reasons: the law of elastic collision, Pascal’s law of hydrostatics and the Hagen-Poiseuille law. The three laws do not support that urethral function failure is the predominant cause of stress urinary incontinence (SUI); however, they do support that urethral support failure is. Influential urogynecologists claim the opposite. TVT surgery, according to the integral theory of SUI (IT), has high failure rates because it does not principally prevent the urethra from hanging on a less mobile bladder neck. In the case of a long urethra, the tape is set too distally, and in hypomobile SUI, the use of a tension-free suburethral tape is unwarranted/ineffective, because the proximal urethra is not elevated above its resting position. A successful operation corrects urethral support failure and not urethral function failure.

Urethral Exposure of Mid-urethral Sling: Diagnosis, Management and Functional Outcomes

ObjectiveTo identify symptoms leading to urethral mesh exposure diagnosis, describe the surgical management and evaluate post-operative functional and urodynamic outcomes. Materials and MethodsRetrospective observational monocentric study of 15 patients treated by mid-urethral sling removal for urethral exposure, between December 2005 and February 2021, in a pelviperineology centre. ResultsFifteen patients were included. The mean time to diagnosis of urethral exposure was 43 months. This diagnosis delay was caused by a non-specific symptomatology. Surgical management consisted of partial removal of the eroded mid-urethral sling fragment by vaginal approach in all cases, with low peri-operative morbidity. At 3 months follow-up, 87% of the patients had stress urinary incontinence vs 54% at 2 years. 13 patients had a urodynamic assessment after their mid-urethral sling removal, they all had sphincter insufficiency with a urethral closure pressure lower than 30 cm H2O. Nine patients underwent a second urinary incontinence management procedure, leading to 77% of complete remission and 23% of partial improvement. ConclusionClinical presentation of urethral erosion after mid-urethral sling is heterogeneous. Surgical management is complex; after a good preoperative evaluation, a two-step management strategy including minimally invasive mid-urethral sling removal and treatment of recurrent urinary incontinence leads to good results with 77% of patients cured. Sphincter insufficiency is one of the mechanisms that may explain the high rate of stress urinary incontinence after urethral mesh erosion surgery.

Urethral pressure profile during ejaculation in men with spinal cord injury.

Ejaculation is often impaired in men with spinal cord injury (SCI). The aim of this prospective study was to assess sequence of sphincteric events and ejaculation dyssynergia during penile vibratory stimulation (PVS) in SCI men. Simultaneous recordings of bladder, bladder neck, prostate and external urethral sphincter pressures were performed using a microtip catheter with 5 pressure transducers. Between 2017 and 2019, ten men participated in the study for a total of 17 procedures. Antegrade ejaculation was found in three men with upper motor neuron (UMN) lesion. Ejaculation was preceded by a progressive increase in all urethral pressures, reaching sustained (plateau) or intermittent peaks above 220 cm H20. Antegrade ejaculation occurred after intermittent decreases in pressure at the external urethral sphincter level down to 100 cm H20, while the pressure at the bladder neck remained high (up to or above 220 cm H20). PVS was ineffective in eliciting ejaculation in seven men. In the five patients with UMN lesions, PVS elicited an increase in the external urethral sphincter pressure (mean 51 cm H20), while there was no pressure change in the two patients with lower motor neuron lesions. Due to lack of enough retrograde retrieval attempts, the hypothesis of ejaculatory dyssynergia could not be verified.

The Effect of Bioelectric Technology Combined with Acupoint Stimulation on the Collagen Concentration and Prognosis of Patients with Stress Urinary Incontinence

The paper aimed to explore the ability of bioelectric technology combined with acupoint stimulation on the collagen concentration and prognosis of invalid. Between June 2020 and June 2021, the study recruited 400 patients who underwent stress urinary incontinence in urology and reconstructive pelvic surgery. They were divided into the experimental group (bioelectric technology combined with acupoint stimulation, n=200) and control group (simple bioelectric stimulation, n=200) according to the odd-even method of admission order. The recovery status of the collagen concentration was matched between the two groups. The use of bioelectric technology combined with acupoint stimulation helped to improve stress urinary incontinence. The total effective rate of the study group was 92.0 %, which was higher than the control group. After treatment, the levels of abdominal leak point pressure, maximum urethral closure pressure, bladder compliance and collagen increased in the two groups, which were different from those before treatment (p<0.05). The improvement of the experimental group was better (p<0.05). The combination of bioelectric technology and acupoint stimulation in the treatment of stress urinary incontinence could advance the curative effect, increase pelvic floor muscle strength and improve the urodynamic status and the patient’s collagen concentration.

How Does the Urethra Respond to Bladder Filling in Continent and Incontinent Women?

The objective of this study was to describe mean urethral pressure (MUP) during filling cystometry in continent and incontinent women. Incontinent women were recruited from a urogynecology clinic if they answered "sometimes" or "always" to 1 of the items on the Medical, Epidemiologic, and Social Aspects of Aging questionnaire. Participants were categorized by Medical, Epidemiologic, and Social Aspects of Aging scores into stress urinary incontinence (SUI) or urgency urinary incontinence (UUI) groups. Continent women were recruited from the community. Multichannel urodynamics were performed using microtip catheters. Urethral pressure profiles were obtained with an empty bladder and at 100-mL increments during filling. Data were analyzed in SPSS. Continuous variables were compared with independent t test or analysis of variance, categorical variables with the χ2 test, and multivariable comparisons were made with linear regression. Eighty-six women (30 continent, 56 incontinent: 37 SUI, 19 UUI) with a mean ± SD age of 48 ± 15 years and a body mass index (BMI) of 31 ± 9 participated. Sixty-nine percent were White, 43% were postmenopausal, and 80% were parous. Continent women were younger (P < 0.001) and had a lower BMI (P = 0.004). Mean cystometric capacity was higher in women with SUI and continent women than in women with UUI (430 ± 142, 448 ± 101, and 332 ± 160, P = 0.04). Continent women had higher MUP at baseline when controlling for age, BMI, and parity (84 ± 35 cmH2O vs 62 ± 28 cmH2O; aR2 = 0.2, P = 0.02) compared with incontinent women. During filling, MUP in continent women was 20-30 cmH2O higher at all bladder volumes than incontinent women. Mean urethral pressure increased significantly between baseline and 300 mL in continent women (P < 0.005) and women with SUI (P = 0.04), but not in women with UUI (P = 0.48). Continent women have greater baseline MUP and greater increases in MUP during bladder filling than incontinent women.

Age is associated with reduced urethral pressure and afferent activity in rat.

Age‐related changes in the lower urinary tract (LUT) can affect the coordination of reflexes and increase the incidence of bladder disorders in elderly. This study examines the age‐related loss of urethral signaling capability by measuring the afferent activity directly. We find that less urethral pressure develops in response to fluid flow in old rats compared to young rats and that pressure and flow evoke less urethral afferent activation. These findings are consistent with our previous study demonstrating that the urethra‐to‐bladder reflex, which is required for efficient voiding, becomes weaker with age. We measured the pudendal afferent response in young (4–7 months) and old (18–24 months) rats to fluid flow in the urethra across a range of flow rates. We used paraffin embedding and hematoxylin and eosin staining to quantify age‐related changes in the sensory branch of the pudendal nerve. Urethral afferent signaling in response to the same urethral flow rates was weaker in older animals. That is, the sensitivity of urethra afferents to flow decreased with age, and higher flow rates were required in older animals to recruit urethra afferents. There was also a reduction in the myelin thickness of pudendal afferents in old rats, which is a possible contributing factor to the sensory activity. Furthermore, the same flow rates evoked less pressure in the urethras of old animals, indicating there is an age‐related change of the urethral tissue that reduces the pressure stimulus to which these afferents respond. These results help characterize the underlying changes in LUT system with age.

Urethral Tissue Reconstruction Using the Acellular Dermal Matrix Patch Modified with Collagen-Binding VEGF in Beagle Urethral Injury Models.

Objectives Urethral tissue reconstruction for hypospadias is challenging for urologists. In this study, bovine acellular dermal matrix (ADM) patch loading with collagen-binding vascular endothelial growth factor (CBD-VEGF) was used to repair the urethral injury in beagles. Methods The safety and effectiveness of the scaffold implantation were carefully evaluated by comparing among the urethral injury control group, ADM implantation group, and ADM modified with CBD-VEGF implantation group during 6 months. Urodynamic examination, urethral angiography, and pathological examination were performed to evaluate the recovery of urethral tissue. Results Stricture, urethral diverticulum, and increased urethral closure pressure were observed in the control group. Fistula was observed in one animal in the ADM group. By contrast, no related complications or other adverse situations were observed in animals treated with ADM patch modified with CBD-VEGF. The average urethra diameter was significantly smaller in the control animals than in scaffold implantation groups. Pathological examination revealed more distribution of proliferative blood vessels in the animals treated with ADM modified with CBD-VEGF. Conclusions Overall, ADM patches modified with CBD-VEGF demonstrated an optimized tissue repair performance in a way to increase tissue angiogenesis and maintain urethral function without inducing severe inflammation and scar formation.

Effects of low-dose insulin or a soluble guanylate cyclase activator on lower urinary tract dysfunction in streptozotocin-induced diabetic rats

AimsTo examine the effects of low-dose insulin or a soluble guanylate cyclase activator (sGC) on lower urinary tract dysfunction (LUTD) in rats with diabetes mellitus (DM). Main methodsFemale Sprague-Dawley rats were divided into non-DM control (N), DM induced by streptozotocin (65 mg/kg), with low-dose insulin (DI), DM with vehicle (D), and DM with sGC (GC) groups. In GC group, BAY 60-2770 (1 mg/kg/day) was orally administered in 6–8 weeks after DM. Voiding assay at 2, 4, and 8 weeks after DM, cystometry, and urethral pressure recordings at 8 weeks of DM were performed. mRNA levels of NO-related markers and cGMP protein levels in the urethra, and ischemia and inflammation markers in the bladder were evaluated by RT-PCR. Key findingsModerate levels of high blood glucose were maintained in Group DI versus Group D. The 24-h voided volume was significantly higher in Group D versus Groups N and DI. Non-voiding contractions were significantly greater, and voiding efficiency and urethral pressure reduction were significantly lower in Group D versus Groups N, DI, and GC. Urethral cGMP levels were significantly lower in Group D versus Groups N and GC. mRNA levels of PDE5 in the urethra and ischemia and inflammation markers in the bladder increased in Group D versus Group N or DI was reduced after sGC treatment. SignificanceDI rats with a lesser degree of bladder and urethral dysfunction might be useful as a slow-progressive DM model. sGC activation could be an effective treatment of LUTD in DM.

Urodynamic Values Role For Females With Different Types Of Urinary Incontinence

Aim — The aim of this study was to analyse how conventional urodynamic values differ between females with specific types of urinary incontinence (UI). Material and Methods — Cross-sectional study enrolled 666 females with UI. Based on patient history and questionnaires they were divided into three groups: stress (SUI), mixed (MixUI) and urgency (UUI). Physical investigation and urodynamics were performed. The continuous factors: age and urodynamic data were evaluated using Multinomial regression and ANOVA test using SUI, MixUI, UUI as outcome groups. Results — Analysing urodynamic parameters significant difference between at least two groups was shown by the cystometric capacity and maximum flow rate: both highest in the SUI group; residual urine, opening detrusor pressure, maximum urethral closure pressure at rest, functional urethral length at rest: all highest in the UUI group. Mainly all urodynamic data showed significant difference between SUI/UUI, and MixUI/UUI groups, while difference between SUI/MixUI were not significant. Conclusions — Most of urodynamic data for MixUI group patients do not differ from SUI group. UDS parameters like: maximum flow rate, residual urine, opening detrusor pressure, maximum urethral closure pressure at rest, functional urethral length at rest can help to distinguish SUI and MixUI groups from UUI group.

Estrogens influence differentially on the pelvic floor muscles activation at somatovisceral reflexes involved in micturition of rabbits.

To determine the estrogen-dependency of the bladder and urethral function and the coordinated activation of pelvic floor muscles (PFM) during micturition. We allocated age-matched female rabbits to control, 1-month ovariectomized (OVX), and OVX plus 2-week estradiol benzoate (EB) groups to record cystometry, urethral pressure, and electromyograms of bulbospongiosus (Bsm), and pubococcygeus muscles (Pcm) simultaneously. We also measured serum estradiol levels and myofiber cross-sectional area. We assessed urodynamic and urethral variables, categorized the Bsm-Pcm activation patterns at storage and voiding phases, and obtained the power spectrum density of muscle activation around the voiding phase. We investigated the influence of ovarian hormones, in general, and the contribution of estrogen, particularly on the functions of the bladder, urethra, and PFM. Statistical significance was set at P < 0.05. Ovarian hormones influence the bladder, urethral, and PFM functions. The urodynamics analyses indicated estrogens contribute to voiding duration and, to a lesser extent, to the time between bladder contractions. Urethral pressure at closure (maximal pressure-to-maximal urethral pressure ratio) improved partially (8%, P < 0.05) in the OVX plus 2-week estradiol benzoate compared with OVX, but urethral resistance increased (∼1.9-fold, P < 0.05) compared with control rabbits. Our findings support that Pcm activity at voiding is estrogen-sensitive, albeit EB administration reduced it at storage resume, which relates to high urethral resistance. Ovariectomy impairs bladder and urethral pressures and Bsm and Pcm activation at micturition in anesthetized rabbits. Estrogen administration partially reverts some of these effects and influences Pcm activation.