Urodynamic Analysis Research Articles

Urodynamic analysis of the effect of electroacupuncture at different acupoints on the bladder after spinal cord injury.

Guanyuan (CV4), Zhongji (CV3) and Sanyinjiao (SP6) are the most frequently used acupoints for treating neurogenic bladder after spinal cord injury (SCI). However, there has been no investigation to clarify the differences in effects of these acupoints in different types of neurogenic bladder. The study was structured with a randomized, two-phase cross over design with a washout period. A routine urodynamic examination was performed first, then, in the order of grouping, electroacupuncture was performed on CV4, CV3,and SP6, respectively，and urodynamic examination was performed to observe the changes of urodynamic indexes in real time. When undergoing electroacupuncture at CV4, CV3, and SP6 in patients with neurogenic detrusor overactivity (DO), the bladder volume at the first occurrence of DOand maximum cystometric capacity increased (p < 0.05), but maximum detrusor pressure (Pdetmax) at DO decreased (p < 0.05), and the changes using CV4 and CV3 was more significantly than using SP6 (p < 0.05). And in patients with in neurogenic detrusor underactivity, there were no significant changes in maximum urinary flow rate and Pdetmax during urination (p > 0.05). The immediate relief effect of electroacupuncture at CV4, CV3on DO was greater than at SP6.

Pelvic Floor Muscle Exercises can Effectively Improve Urinary Incontinence after Radical Prostatectomy: Systematic Review and Meta-Analysis Based on Randomised Controlled Trials.

This study aims to assess the effect of pelvic floor muscle exercise (PFME) on urinary incontinence after radical prostatectomy. PubMed, Web of Science, Embase, Cochrane Library, China National Knowledge Infrastructure (CNKI), VIP and other domestic and foreign databases were searched for published literature until December 2023 on the effect of pelvic muscle exercise on urinary incontinence in patients after radical prostatectomy. The retrieved literatures were screened, and data were extracted. After evaluating the quality of the literatures, RevMan 5.4 software was used for meta-analysis. This work included nine articles consisting of 1208 sufferers with urinary incontinence after radical prostatectomy. The forest plot showed that patients in the experimental group had better postoperative outcomes at 1 month (Relative Risk (RR) = 3.38, 95% confidence interval (CI) (1.83; 6.25)), 3 months (RR = 1.99, 95% CI (1.67; 2.38)) and 6 months (RR = 1.34, 95% CI (1.20; 1.49)). The incidence of urinary incontinence was statistically significant compared with the control group (p < 0.05). Patients in the experimental group 12 months after surgery (RR = 1.13, 95% CI (0.99; 1.23)) showed no significant difference in the incidence of urinary incontinence compared with the control group (p > 0.05). PFME can significantly increase the recovery rate of urinary incontinence in sufferers with prostate cancer at 1, 3 and 6 months after radical surgery but have no significant improvement at 12 months. Urodynamic analysis may be needed for patients with long-term urinary incontinence.

Targeting Thbs1 reduces bladder remodeling caused by partial bladder outlet obstruction via the FGFR3/p-FGFR3 pathway.

Partial bladder outlet obstruction (pBOO) may lead to bladder remodeling, including fibrosis and extracellular matrix (ECM) deposition. Despite the extensive research on the mechanisms underlying pBOO, potential therapeutic targets for the treatment of pBOO require further research. Dysregulated expression of thrombospondin-1 (Thbs1) has been reported in various human fibrotic diseases; however, its relationship with pBOO remains unclear. Investigate the effects of Thbs1 on bladder remodeling caused by pBOO. We established a pBOO model in Sprague-Dawley rats and performed urodynamic analyses to estimate functional changes in the bladder, validated the histopathological changes in the bladder by using haematoxylin-eosin and Masson's trichrome staining, identified key target genes by integrating RNA sequencing(RNA-seq) and bioinformatics analyses, validated the expression of related factors using Western blot analysis and RT-qPCR, and used immunofluorescence staining to probe the potential interaction factors of Thbs1. Urodynamic results showed that pressure-related parameters were significantly increased in rats with pBOO. Compared with the sham group, the pBOO group demonstrated significant increases in bladder morphology, bladder weight, and collagen deposition. Thbs1 was significantly upregulated in the bladder tissues of rats with pBOO, consistent with the RNA-seq data. Thbs1 upregulation led to increased expression of matrix metalloproteinase (MMP) 2, MMP9, and fibronectin (Fn) in normal human urinary tract epithelial cells (SV-HUC-1), whereas anti-Thbs1 treatment inhibited the production of these cytokines in TGF-β1-treated SV-HUC-1. Further experiments indicated that Thbs1 affected bladder remodeling in pBOO via the fibroblast growth factor receptor 3 (FGFR3) pathway. Thbs1 plays a crucial role in bladder remodeling caused by pBOO. Targeting Thbs1 might alleviate ECM damage. Mechanistically, Thbs1 may function via the FGFR signaling pathway by regulating the FGFR3 receptor, identified as the most relevant disease target of pBOO, and FGF2 may be a mediator. These findings suggest that Thbs1 plays a role in BOO development and is a therapeutic target for this condition.

Comparison of clinical effects between microscopic surgery and conventional surgery in children with penile hypospadias and difference analysis of postoperative urodynamics.

To compare and analyze the clinical effects of microscopic surgery and conventional surgery in children with penile hypospadias and the differences in postoperative urodynamic indexes. It was a clinical comparative study. A total of 80 children with penile hypospadias admitted to Beijing Children's Hospital Affiliated to Capital Medical University Baoding Hospital from July 2018 to September 2022 were selected and randomly divided into two group. The experimental group were treated with microscopic urethroplasty, while the control group were treated with traditional urethroplasty. The operative effect, operation time, total intraoperative blood loss, postoperative hospital stay and incidence of surgical complications were compared and analyzed between the two groups. All the children were followed up for two years, and the changes in urodynamic parameters including maximum urine flow rate (Qmax), average urine flow rate (Qavc), urine flow time (FT), peak time (TQmax) and residual urine (PVR) were compared before, two weeks after, six months after and two years after surgery. The efficacy of the experimental group was significantly higher than that of the control group (p=0.013). The intraoperative blood loss and postoperative hospital stay in the experimental group were significantly better than those in the control group (p=0.000). The incidences of urinary leakage and urethral stricture in the experimental group were lower than those in the control group (p<0.05). The Qmax level in the experimental group was higher than that in the control group at six months and two years after surgery, while the FT level was lower than that of the control group (p<0.05). Microscopic surgery is a method with significant clinical value in the treatment of penile hypospadias.

A Velocity-Based Approach to Noninvasive Methodology for Urodynamic Analysis.

To date, invasive urodynamic investigations have been used to define most terms and conditions relating to lower urinary tract symptoms. This invasiveness is almost totally due to the urethral catheter. In order to remove this source of discomfort for patients, the present study investigated a noninvasive methodology able to provide diagnostic information on bladder outlet obstruction or detrusor underactivity without any contact with the human body. The proposed approach is based on simultaneous measurements of flow rate and jet exit velocity. In particular, the jet exit kinetic energy appears to be strongly related to bladder pressure, providing useful information on the lower urinary tract functionality. We developed a new experimental apparatus to simulate the male lower urinary tract, thus allowing extensive laboratory activities. A large amount of data was collected regarding different functional statuses. Experimental results were compared successfully with data in the literature in terms of peak flow rate and jet exit velocity. A new diagram based on the kinetic energy of the exit jet is proposed herein. Using the same notation as a Schäfer diagram, it is possible to perform noninvasive urodynamic studies. A new noninvasive approach based on the measurement of jet exit kinetic energy has been proposed to replace current invasive urodynamic studies. A preliminary assessment of this approach was carried out in healthy men, with a specificity of 91.5%. An additional comparison using a small sample of available pressure-flow studies also confirmed the validity of the proposed approach.

Voiding dynamics of pelvic organ prolapse: Large scale comparative study.

To determine the voiding dynamics of the patients with pelvic organ prolapse (POP). A retrospective patient file review was performed of 877 female patients with lower urinary tract symptoms. After exclusion criteria 373 female patients were eligible for the study. Two patient groups w/wo prolapse were identified. The symptoms, patient characteristics, patterns of free urine flow, and detrusor voiding pressure curves were compared between two groups. A comparison of the urodynamic findings between the subgroups (mild/moderate, severe, and w/o prolapse) was made and shown on a scatter plot graphics of Pdet Qmax versus Qmax as well. A total of 373 patients with median age 54 (18-92), 189 (51%) had varying degrees and forms of POP while 184 (49%) did not have any prolapse (p < 0.003). Logistic regression analysis results showed that older age [p = 0.023, odds ratio (OR) = 1.01, confidence interval (CI): (1.00-1.03)], weaker pelvic floor muscle strength [p = 0.032, OR = 1.67, CI: (1.04-2.69)], more frequent symptom of hesitancy [p = 0.003 OR = 2.15 CI: (1.29-3.58)], prolonged-tailed shaped curve pattern of free urine flow [p = 0.027 OR = 1.97 CI: (1.08-3.58)], and higher Pdet Qmax (22 cmH2 O) values [p = 0.002, OR = 1.02, CI: (1.00-1.03)] were the independent different features of the patients with prolapse. Subgroup urodynamic analysis showed significantly lower free flowmetry Qmax and higher Pdet Qmax values in patients with severe prolapse. Prolonged/tailed-shaped curve pattern of free urine flow was significantly more frequent in patients with prolapse. Voiding dynamics of the patients with prolapse were significantly different from the patients' w/o prolapse. They had higher Pdet Qmax values, more frequent symptom of hesitancy, and prolonged shaped free flow curve pattern. Free flow Qmax values were lower in patients with severe prolapse.

Urodynamic findings and therapeutic approaches for neurogenic lower urinary tract dysfunction in patients with thoracic spinal cord injury.

To evaluate urodynamic examination results and treatment methods of neurogenic lower urinary tract dysfunction (NLUTD) in patients with traumatic thoracic spinal cord injury (SCI). Ninety-one patients with traumatic thoracic SCI were included in the study. The urodynamic analyses of the patients were conducted retrospectively using their laboratory outcomes. The patients were divided into subgroups according to the sensory innervation of the bladder (T1-10/T11-12), the preservation of sensory functions in the sacral segment (complete lesion/incomplete lesion), and the duration of injury (< 6months/ ≥ 6months) and evaluations in subgroups were carried out. A total of 91 patients (69 males, 22 females) were included in the study. When comparing between the subgroups, the sense of bladder fullness was preserved more in the T11-T12 group with a statistically significant difference (p < 0.001). While storage disorder, the rate of indwelling catheter use during hospitalization, bacterial growth of 105CFU/ml in the urine culture, and anticholinergic drug recommendation after urodynamic examination were higher in the complete lesion group, the rate of spontaneous/catheter-free voiding, the number of patients in which sense of bladder fullness was preserved-partially preserved, and alpha-blocker drug recommendation after urodynamic examination was higher in the incomplete lesion group, with a statistically significant difference in all parameters (all p values < 0.05). Our results demonstrate that there are differences in neurogenic lower urinary tract dysfunction features in subgroups of traumatic thoracic SCI patients. Regular urinary system evaluation and necessary changes in treatment should be carried out in this patient group.

A time-course study of urodynamic analyses in rat models with dopaminergic depletion induced through unilateral and bilateral 6-hydroxydopamine injections

Bladder dysfunction is a common non-motor disorder in Parkinson's disease (PD). This study attempted to determine the bladder dysfunction with disease progression in the PD rat model produced from unilateral/bilateral injections of 6-hydroxydopamine (6-OHDA). Cystometrographic (CMG) and external urethral sphincter electromyographic (EUS-EMG) measurements were scheduled in a time-course manner to determine the disease timing, onset, and severity. Animals were allotted into normal control, unilateral, bilateral 6-OHDA injected groups and subjected to scheduled CMG, EUS-EMG analyses at weeks 1, 2, and 4. The urodynamic results concluded that voiding efficiency (VE) was reduced in both unilateral and bilateral PD rats at all-time points. VE had decreased from 57±11% to 31±7% in unilateral PD rats and in bilateral PD rats, a decreased VE of 20±6% was observed compared to control and unilateral PD rats. The EMG results in unilateral PD rats indicated declines in bursting period (BP) (3.78-2.94s), active period (AP) (93.38-88.75ms), and silent period (SP) (161.62-114.30ms). A sudden reduction was noticed in BP (3.62-2.82s), AP (92.21-86.01ms), and SP (128.61-60.16ms) of bilateral PD rats than in control and unilateral PD rats. Histological evidence exhibited a progressive dopaminergic neurons (DA) depletion in the substantia nigra (SN) region in 6-OHDA lesioned rats. The experimental outcomes strongly implied that significant variations in bladder function and VE decline were due to the depletion of DA neurons in the SN region of the brain.

Modification of bladder thermodynamics in stress urinary incontinence patients submitted to trans-obturator tape: A retrospective study based on urodynamic assessment.

Importance: It needs to be clarified whether trans-obturator tape (TOT)-enhanced urethral resistance could impact the voiding function. Objective: Although TOT has been well-recognized for enhancing urethral resistance to restore continence in stress urinary incontinence (SUI) patients, whether the bladder’s voiding functions adapt to the TOT-enhanced resistance has not been adequately investigated. This study thereby aimed to investigate whether TOT impacts the bladder’s thermodynamic efficacy during the voiding phase. Design: A retrospective analysis of urodynamics performed before and after TOT was assessed. Setting: A tertiary referral hospital in Taiwan. Participants: A total of 26 female SUI patients who underwent urodynamic investigations before and after TOT. Main outcomes and measures: The area enclosed by the pressure-volume loop (Apv), which represents the work performed by the bladder during voiding, in a pressure-volume analysis established by plotting the detrusor pressure versus intra-vesical volume was retrospectively analyzed. Paired Student’s t-tests were employed to assess the difference in values before and after the operation. Significance in difference was set at p < 0.05. Results: TOT increased Apv in 20 of 26 (77%) patients and significantly increased the mean Apv compared to the preoperative control (2.17 ± 0.18 and 1.51 ± 0.13 × 103 cmH2O-ml, respectively p < 0.01). TOT also increased the mean urethral resistance (1.03 ± 0.30 vs. 0.29 ± 0.05 cmH2O-sec/ml, p < 0.01) and mean voiding pressure (25.87 ± 1.72 and 19.30 ± 1.98 cmH2O p < 0.01) but did not affect the voided volume and voiding time. Moreover, the TOT-induced Apv increment showed a moderate correlation with the changes in urethral resistance and voiding pressure (both r > 0.5) but no correlation with changes in voided volume or voiding time. It is remarkable that the TOT-induced urethral resistance increment showed a strong correlation with changes in voiding pressure (r > 0.7). Conclusion and Relevance: The bladder enhances thermodynamic efficacy by adapting the voiding mechanism to increased urethral resistance caused by TOT. Further studies with higher case series and longer follow-ups should assess whether this effect could be maintained over time or expire in a functional detrusor decompensation, to define diagnostic criteria that allow therapeutic interventions aimed at its prevention during the follow-up. Clinical Trial Registration: (clinicaltrials.gov), identifier (NCT05255289)

Stress and Urgency Urinary Incontinence: Clinical-Urodynamic Correlation and Rehabilitation Management in Daily Clinical Practice

(a) To correlate the clinical with the urodynamic diagnosis in a series of patients with UUI (urgency urinary incontinence) and SUI (stress urinary incontinence); (b) establish age, clinical and urodynamic differences; and (c) demonstrate the effectiveness of individualized rehabilitation treatment based on the clinical-urodynamic diagnosis in patients with SUI and UUI in the daily clinical practice of a third-level rehabilitation service. Retrospective study of 60 patients with SUI and UUI. Urodynamic study: (a) free flowmetry; (b) filling cystomanometry; (c) pressure-flow study. Outcome variables: daytime (DUF) and nighttime (NUF) urinary frequency, strength of the pelvic floor muscles (PFM) measured by manometry (maximum and mean pressure), and use of absorbents/day. Rehabilitation treatment: (a) pelvic floor muscle training (PFMT); (b) biofeedback (BFB), transcutaneous neuromodulation of the posterior tibial nerve (TTNM). Age, clinical, and urodynamic differences have been observed between patients with UUI versus SUI. UUI is more frequent in older patients (UUI 67.3 ± 10.19 years vs SUI 58.6 ± 8.54 years), p = 0.0028. Patients with UUI, when compared with patients with SUI, present more episodes of DUF (7.7 ± 5.1 vs 5.5 ± 3.99) and NUF (2.51 ± 1.67 vs 1.46 ± 1.42). Patients with SUI use more absorbents/day than patients with UUI (2.7 ± 1.53 vs 1.37 ± 1.5), p = 0.0243. The urodynamic study (UDS) confirmed the clinical diagnosis in UUI in 64.7%, while in SUI, it was only confirmed in 35.1%. In the urodynamic analysis (free flowmetry), patients with UUI have smaller bladders than patients with SUI (voiding volume in UUI 275.8 ± 178.95 vs 411.03 ± 203.62 in SUI), p = 0.083. The maximum flow (Qmax) is higher in patients with SUI compared to UUI (19.6 ± 7.07 vs 16.06 ± 8.54), p = 0.0836. In filling cystomanometry, the bladders of patients with UUI are smaller than those with SUI (bladder capacity UUI 266.3 ± 52.76 vs 308.6 ± 49.72 ml in SUI), p = 0.023. In SUI, the BFB/PFMT significantly improved DUF, NUF, PFM pressure, and absorbent use. In UUI, the BFB plus TTNM improved DUF, NUF, and the maximum and mean PFM pressure with statistical difference, while the use of absorbents decreased with a tendency to significance. There are age, clinical, manometric, and urodynamic differences in patients with UUI when compared with patients with SUI. UUI occurs in older patients; they present a greater number of daytime and nocturnal urinary frequency episodes and use fewer absorbents than patients with SUI. Patients with UUI evacuate a smaller urine volume have a lower peak flow (in flowmetry) and a lower bladder capacity (in cystomanometry) than patients with SUI. The rehabilitation treatment proposed in daily clinical practice (PFMT/BFB with or without TTNM improves SUI and UUI). In this study, the UDS has shown a greater clinical-urodynamic correlation in UUI than in SUI.

Construction of Tissue-Engineered Bladder Scaffolds with Composite Biomaterials.

Various congenital and acquired urinary system abnormalities can cause structural damage to patients’ bladders. This study aimed to construct and evaluate a novel surgical patch encapsulated with adipose-derived stem cells (ADSCs) for bladder tissue regeneration. The surgical patch consists of multiple biomaterials, including bladder acellular matrix (BAM), collagen type I from rat tail, microparticle emulsion cross-linking polylactic-co-glycolic acid (PLGA)-chitosan (CS) with PLGA-sodium alginate (SA), and growth factors. ADSCs were seeded on the surgical patch. Approximately 50% of the bladder was excised and replaced with a surgical patch. Histological, immunohistochemical and urodynamic analyses were performed at the 2nd, 4th, and 8th weeks after surgery, respectively. The PLGA-CS, PLGA-SA or surgical patch showed no cytotoxicity to ADSCs. PLGA-CS cross-linked with PLGA-SA at a ratio of 5:5 exhibited a loose microporous structure and was chosen as the candidate for ADSC seeding. We conducted bladder repair surgery in rats using the patch, successfully presenting urothelium layers, muscle bundles, and vessel regeneration and replacing 50% of the rat’s natural bladder in vivo. Experiments through qualitative and quantitative evaluation demonstrate the application potential of the composite biomaterials in promoting the repair and reconstruction of bladder tissue.

MP07-04 STONE FORMATION BY ANALYSIS OF UROFLOW DYNAMICS IN THE RENAL PELVIS

You have accessJournal of UrologyStone Disease: Basic Research & Pathophysiology (MP07)1 Sep 2021MP07-04 STONE FORMATION BY ANALYSIS OF UROFLOW DYNAMICS IN THE RENAL PELVIS Kengo Kawase, Shuzo Hamamoto, Shota Hattori, Ryosuke chaya, Tomoki Okada, Yutaro Tanaka, Takeru Sugino, Rei Unno, Kazumi Taguchi, Ryosuke Ando, Atsushi Okada, Masanori Nakamura, and Takahiro Yasui Kengo KawaseKengo Kawase More articles by this author , Shuzo HamamotoShuzo Hamamoto More articles by this author , Shota HattoriShota Hattori More articles by this author , Ryosuke chayaRyosuke chaya More articles by this author , Tomoki OkadaTomoki Okada More articles by this author , Yutaro TanakaYutaro Tanaka More articles by this author , Takeru SuginoTakeru Sugino More articles by this author , Rei UnnoRei Unno More articles by this author , Kazumi TaguchiKazumi Taguchi More articles by this author , Ryosuke AndoRyosuke Ando More articles by this author , Atsushi OkadaAtsushi Okada More articles by this author , Masanori NakamuraMasanori Nakamura More articles by this author , and Takahiro YasuiTakahiro Yasui More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000001980.04AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Previous studies have shown that Randall's plaques are uniformly present in all renal papillae. However, we experienced cases in which the kidney stone recurrence occurred in the same position and the same renal calices. Therefore, we focused on the effect of urinary flow caused by the morphology of the renal pelvis. In this study, we used urodynamic analysis to investigate the differences in stone formation related to the morphology of the renal pelvis. METHODS: Study 1: Investigation of the site of intervening kidney stones Among the patients who visited our hospital from June 2018 to August 2019, 177 patients, diagnosed with kidney stones using CT, were included in the study. The sites of interest to the study were the upper, middle, and lower renal calyx. Study 2: A simulation analysis of urine fluid. Overall, three kidneys with no stones (NS group) and three kidneys with stones (S group) were studied. 3D models were created from the renal pelvis images obtained from contrast-enhanced CT, and a simulation analysis was performed using computational fluid dynamics. Study 3: Measurement of urine flow and analysis of flow velocity distribution. The phase-contrast method was used to measure the flow in one kidney of a healthy subject, using MRI. A cut-off value was set based on the measurement results, and the distribution of urine flow velocity was analyzed based on the results of study 2. RESULTS: Study 1: The location of intervening kidney stones in the upper, middle, and lower renal calices tended to be in 22 (12%), 92 (52%), and 63 (36%) patients, respectively. Study 2: No vortex-like stream or stagnation was observed in the renal pelvis in both the NS and S groups. Study 3: The method showed the flow velocity in the renal pelvis to be 820 μm/s. The cut-off values for the PS method were set at 400 μm/s and 800 μm/s. In the NS group, the velocity distribution was uniform, but in the S group, there was a difference in velocity in each renal calice. CONCLUSIONS: There was no vortex-like stream or stagnation in the renal pelvis, but there was a difference in the velocity of urine flow depending on the site. In previous studies of crystal growth, the velocity of solute flow has been reported to affect the growth. Differences in urine flow velocity in the renal pelvis might be involved in stone formation. Source of Funding: The authors declare no conflicts of interest associated with this manuscript © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e140-e140 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Kengo Kawase More articles by this author Shuzo Hamamoto More articles by this author Shota Hattori More articles by this author Ryosuke chaya More articles by this author Tomoki Okada More articles by this author Yutaro Tanaka More articles by this author Takeru Sugino More articles by this author Rei Unno More articles by this author Kazumi Taguchi More articles by this author Ryosuke Ando More articles by this author Atsushi Okada More articles by this author Masanori Nakamura More articles by this author Takahiro Yasui More articles by this author Expand All Advertisement Loading ...

Caffeine improves bladder function in diabetic rats via a neuroprotective effect.

Diabetic cystopathy (DCP) is one of the most common complications of diabetes mellitus (DM). A previous study reported that caffeine may improve bladder dysfunction in rats with DM. The aim of the present study was to investigate the mechanisms behind the capacity for caffeine to improve bladder function in rats with DM. Sprague Dawley rats were divided into four groups: control, caffeine, DM and DM plus caffeine treatment (DM + caffeine). Bladder function was measured by urodynamic analyses. The levels of nerve growth factor (NGF), brain-derived neurotrophic factor (BDNF) and calcitonin gene-related peptide (CGRP) in the bladder tissue were detected by ELISA. Apoptosis in the dorsal root ganglion (DRG) was detected by terminal deoxynucleotidyl transferase-mediated dUTP nick end labeling assay. The expression levels of B-cell lymphoma-2 (Bcl-2), Bcl-2-associated X protein (Bax), caspase-3, cleaved caspase-3, caspase-9 and cleaved caspase-9 proteins in the DRG were detected by western blotting. Following treatment with caffeine, the urination time and micturition interval of rats with DM were improved, the bladder wet weight was decreased, and the maximum voiding pressure was increased. Relative to that in the DM group, the expression levels of NGF, BDNF and CGRP in the bladder tissue of DM + caffeine rats increased; cellular apoptosis in the DRG of DM + caffeine rates decreased; and the expression levels of Bcl-2, Bax, cleaved caspase-3 and cleaved caspase-9 proteins in the DRG of DM + caffeine rats were restored to a certain extent. In conclusion, caffeine promotes bladder function in rats with DM through a protective effect on DRG.

Application of adipose‐derived, muscle‐derived, and co‐cultured stem cells for the treatment of stress urinary incontinence in rat models

Based on the recent advancements in cell therapy techniques, we aimed to evaluate the efficacy of transurethral injection of autologous adipose-derived stem cells, muscle-derived stem cells, and co-cultured cells for the rehabilitation of stress urinary incontinence rat models. We hypothesized that the utilization of co-cultured stem cells could result in enhanced therapeutic outcomes attributed to their more comprehensive environment of paracrine factors and cytokines. We performed bilateral pudendal nerve transection surgeries to simulate urinary incontinence in 25 female Wistar rats and employed urodynamic evaluations to confirm the injury. We autologously isolated and cultured adipose-derived mesenchymal stem cells, muscle-derived stem cells, and a mixed culture of the two types, which we subsequently injected into the urethral lumen of the damaged animals. Three weeks after the injection, urodynamic assays, histological staining, and immunohistochemical evaluations were performed to determine the efficacy of the implanted cell cultures in sphincter function improvements or structural modifications. Histological evaluations suggested a regenerative process in the muscular layer of the external sphincter 3 weeks after the injection. Also, immunohistochemical analysis revealed a thickened periurethral striated muscle layer in the co-cultured group. Postinjection urodynamic analysis indicated that the urethral pressure profile significantly increased in the co-cultured group compared with other groups. The outcomes of this investigation indicated that the application of co-cultured adipose-derived and muscle-derived stem cells could be associated with higher therapeutic value in stress urinary incontinence patients compared with singular-cell treatments.

Commentary to “Urinary disorders of Wolfram syndrome. Clinical and urodynamic analysis from 6 observations” from: C. Leroux, M. Grasland, N. Turmel, F. Le Breton, C. Chesnel, C. Hentzen, G. Amarenco; report of six cases in two wolfram syndrome siblings

Commentary to “Urinary disorders of Wolfram syndrome. Clinical and urodynamic analysis from 6 observations” from: C. Leroux, M. Grasland, N. Turmel, F. Le Breton, C. Chesnel, C. Hentzen, G. Amarenco; report of six cases in two wolfram syndrome siblings

Can clinical and urodynamic parameters predict the occurrence of neutralizing antibodies in therapy failure of intradetrusor onabotulinumtoxin A injections in patients with spinal cord injury?

BackgroundThe aim of the study was to clarify whether clinical and/or urodynamic parameters could be used to infer the probability of neutralizing antibody (NAb) formation as a possible cause of therapy failure (non-response, NR) in patients with neurogenic detrusor overactivity (NDO) due to acquired spinal cord injury/disease (SCI/D) treated with intradetrusor botulinum neurotoxin A (BoNT-A) injections.MethodsA retrospective chart review was performed of all patients with SCI/D who underwent both intradetrusor onabotulinumtoxin A injections and the determination of neutralizing antibodies against BoNT-A between January 1, 2002, and December 31, 2018. NR was defined as urodynamically confirmed persistent or reappearing NDO.ResultsA total of 2700 BoNT-A injections in 414 patients were ascertained. In 69 patients with primary NR after the first BoNT-A injection (n = 6) or with secondary NR after more than one BoNT-A injection (n = 63), an antibody analysis was performed. Antibody examination showed 36 (52.2%) negative, 5 (7.2%) borderline and 14 (each 20.3%) each of positive and highly positive values. Subgroup analysis indicated a correlation between NAb formation and the duration of BoNT-A therapy (p = 0.015), the mean number of BoNT-A injections (p = 0.011) and the time interval between BoNT-A applications (< 7 months, p = 0.022). Urodynamic data analysis indicate significant differences with cut-off values of MCC (< 225 ml, p = 0.038) and MDP (> 45 cmH2O, p = 0.040). However, in the regression analysis models, the predictive value for the occurrence of NAb was too low (MCC: ROC AUC 0.62, MDP: ROC AUC 0.52) to distinguish with sufficient certainty between NAb-positive and NAb-negative NR patients.ConclusionsDespite significant correlations, clinical and urodynamic parameters are only partially suitable for predicting antibody formation against BoNT-A.

Dissecting of the paravesical space associated with lower urinary tract dysfunction \u2013 a rat model

To determine the association of opening the paravesical space in relation to its occurrence of de novo SUI in an animal model. Thirty five female Sprague Dawley rats were divided into 5 groups of 7 rats each: Control group, Sham groups(F, H), and Study groups(MF, MH). Groups labeled with “F” had the paravesical space opened, “H” had tissue dissection with no opening of the space, and “M” had mesh implanted inside the vaginal wall. Urodynamic studies, immunohistochemical analysis, and western blot were done at day 40. The mean weight and age of 35 rats were 302.1 ± 25.1 grams and 12.8 ± 1.2 weeks old. No significant differences were noted among the control, Sham F, Sham H, Study MF, and Study MH on the voiding pressure and voided volume. The Sham F and Study MF (opened paravesical space) groups had significantly lower values on leak point pressures (LPP) (p = 0.026; p < 0.001) and shorter voiding intervals (p = 0.032; p = 0.005) when compared to other groups. Immunohistochemical analysis showed IL-1 and TNF-α to be intensely increased for the Study MF group (p = 0.003; p = <0.001). MMP-2 and CD 31 markers were also significantly higher in the Study MH and MF group. NGF expression was significantly increased in the Study MF and Sham F groups. Thus, opening of the paravesical space causes an increased inflammatory reaction, which leads to tissue destruction and lower urinary tract dysfunction, exemplified in the study with low leak point pressure and shortened voiding intervals.

Refinement Surgical Technique, and Perioperative and Functional Outcomes in Patients With Robotic Intracorporeal Hautmann Orthotopic Neobladder

ObjectiveTo illustrate our refinement technique for robotic intracorporeal orthotopic Hautmann neobladder with adherence to open surgical principles and evaluate perioperative and functional outcomes. Patients and MethodsRobot-assisted radical cystectomy with intracorporeal Hautmann orthotopic neobladder was performed by the same surgeon in 40 patients with bladder cancer from November 2017 to March 2019. Baseline demographics, pathologic data, 90-day complications, and functional outcomes at both 6 and 12 months were evaluated with questionnaire and urodynamic analysis. ResultsMedian follow-up was 14 months (range 4-20). Median operative time was 320 (230-500) minutes, and the estimated blood loss was 300 (100-2000) mL. No conversion to the open technique was reported. The overall 90-day complication rate was 45%, and the high-grade complication rate was only 10%. The daytime satisfactory continence rate was 90% at both 6 months (30 patients) and 12 months (20 patients), while the night-time satisfactory continence rate was 76.7% and 80.0% at 6 months and 12 months, respectively. One patient underwent clean intermittent catheterization. The cohort had minimal postvoid residual volume, normal compliance, and a mean capacity of 328.7 cm3 (range 170-500) at 6 months postoperatively. ConclusionOur preliminary data indicate that robotic intracorporeal Hautmann neobladder configuration is a feasible surgical technique and can achieve a low pressure and sufficient capacity for satisfactory early voiding patterns. Refinement of the stepwise process can effectively decrease the time of the operation. Long-term functional and oncological outcomes remain to be evaluated with longer follow-up and more cases.

Uroflowmetry and Altitude Hypoxia: A Report from Healthy Italian Trekkers and Nepali Porters During Himalayan Expedition.

Hypoxia alters micturition, which influences bladder function by involving different neurological and humoral systems. In this study we assessed the mid-term effects of altitude hypoxia on uroflowmetry in healthy male lowlander native Nepali porters and Italian trekkers, four each, who coattended a Himalayan expedition. All the participants completed a 19-day trek along a demanding route with ascent and descent at the Kanchenjunga Mountain. They underwent micturition and urodynamic analysis twice, at low altitude of 665ma.s.l. and high altitude of 4,750ma.s.l. Statistical comparisons considered the altitude effects (low vs. high) and ethnicity (Italian vs. Nepali). Food consumption was recorded, and water and energy intake were calculated. We found trends of borderline significance in the mean urinary flow rate (Qmean) (p=0.058; effect size η2 p=0.478) and in Qmax to the advantage of the Nepali. There was no evidence of differences when comparing time to Qmax and urine volume at Qmax and Qmean for altitude or altitude × ethnicity. In addition, there was a lonely female participant, who, analyzed as a case report, showed increased Qmean at high altitude. Older age mitigated while energy intake potentiated the ethnic differences noted in uroflowmetry. We conclude that altitude hypoxia rather inappreciably affects micturition in healthy men. However, a trend for possible ethnic differences raises worthy of note perspectives on adaptive ability of micturition. Also, dietary intake and age should be considered as confounding elements when evaluating micturition.

Urodynamic analysis of the impact of diabetes mellitus on bladder function.

To analyze sequential changes of diabetic cystopathy based on urodynamic data in patients with diabetes mellitus. Participants included male diabetes patients who underwent a pressure flow study at Nagoya University Graduate School of Medicine, Nagoya, Japan, from April 2005 to October 2016. Patients with a previous history of lower urinary tract dysfunction were excluded. Bladder dysfunction was categorized into four urodynamic patterns: (i) normal; (ii) detrusor overactivity with normal detrusor contractility; (iii) detrusor hyperreflexia/impaired contractility; and (iv) detrusor underactivity. The urodynamic patterns were evaluated according to the presence of diabetic retinopathy and nephropathy, which was correlated to diabetes mellitus duration. Furthermore, the association of clinical factors with voiding function, as well as sensory function, was investigated. A total of 57 patients were enrolled. Detrusor overactivity with normal detrusor contractility patterns was seen only in cases with neither diabetic retinopathy nor diabetic nephropathy, whereas the prevalence of detrusor hyperreflexia/impaired contractility pattern was highest in cases with diabetic retinopathy. Detrusor underactivity pattern was found with the highest frequency in cases with both diabetic retinopathy and diabetic nephropathy. On multivariate analysis, the existence of diabetic retinopathy was only significantly correlated with bladder contractility index. Furthermore, multivariate analysis showed that first desire volume and maximum cystometric capacity were significantly positively correlated with post-void residual urine volume, and also negatively correlated with voiding efficiency independent of bladder contractility index. Diabetes patients have diverse progressive bladder dysfunction according to the diabetes stage. An optimal screening program is necessary to detect and manage diabetic cystopathy at an early stage.