Urodynamic Analysis Research Articles

MP19-18 THE ROLE OF MATRIX METALLOPROTEINASES AND THEIR TISSUE INHIBITORS IN THE OBSTRUCTED BLADDER SECONDARY TO BENIGN PROSTATIC HYPERPLASIA: ANALYSIS OF EXPRESSION OF 8 GENES

You have accessJournal of UrologyBenign Prostatic Hyperplasia: Basic Research1 Apr 2014MP19-18 THE ROLE OF MATRIX METALLOPROTEINASES AND THEIR TISSUE INHIBITORS IN THE OBSTRUCTED BLADDER SECONDARY TO BENIGN PROSTATIC HYPERPLASIA: ANALYSIS OF EXPRESSION OF 8 GENES Yuri A. Ferreira, Joao A. Barbosa, Marco A. Nunes, Sabrina T. Reis, Nayara I. Viana, Katia R. Leite, Miguel Srougi, and Alberto A. Antunes Yuri A. FerreiraYuri A. Ferreira More articles by this author , Joao A. BarbosaJoao A. Barbosa More articles by this author , Marco A. NunesMarco A. Nunes More articles by this author , Sabrina T. ReisSabrina T. Reis More articles by this author , Nayara I. VianaNayara I. Viana More articles by this author , Katia R. LeiteKatia R. Leite More articles by this author , Miguel SrougiMiguel Srougi More articles by this author , and Alberto A. AntunesAlberto A. Antunes More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2014.02.719AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Long-term Bladder outlet obstruction secondary to Benign Prostatic Hyperplasia (BPH) can cause functional and morphological abnormalities in the bladder, such as increased collagen deposition and loss of compliance, leading to urinary storage and voiding symptoms. The mechanisms determining extracellular matrix deposition and the role of Matrix Metalloproteinases (MMPs) and their inhibitors in this process are not fully elucidated. The objective of this study was to evaluate gene expression of collagen, MMPs and their inhibitors in patients with poor bladder compliance. METHODS We performed a prospective and controlled analysis of 43 patients with BOO due to BPH who underwent TURP from 2011 to 2012. The control group was comprised of 4 bladder specimens from patients younger than 60 years who underwent radical prostatectomy with IPSS < 8 and prostate volume < 30 grams. All patients underwent urodynamic analysis pre and post operatively after 6 months. A biopsy of the bladder muscle was performed at the end of TURP for analysis of collagen, metalloproteinases and TIMPs gene expressions. For this purpose we used the quantitative real time polymerase chain reaction method (qRT-PCR). RESULTS All subjects within the BPH group had BOO diagnosed on urodynamic preoperatively per Schaffer criteria. MMPs 2 and 9, TIMP-1 and type I collagen were down-regulated in subjects with long-term bladder outlet obstruction due to BPH. MMP-1 and TIMP-2 were significantly up-regulated in patients such abnormalities. (Figure 1). Type III collagen was statistically more expressed among patients with non-inhibited bladder contractions (NIC) as compared to patients without (p=0.04), and MMP-2 was more expressed among patients with increased sensitivity (p=0.06). CONCLUSIONS Down-regulation of Matrix metalloproteinases and up-regulation of inhibitors may be involved with collagen deposition in the setup of bladder outlet obstruction. Up-regulation of MMP-1 and down-regulation of TIMP-1 found in this study could be due to different responses of humans and animals, and should be further studied. Type III collagen may be involved in the pathogenesis on NIC. © 2014FiguresReferencesRelatedDetails Volume 191Issue 4SApril 2014Page: e195 Advertisement Copyright & Permissions© 2014MetricsAuthor Information Yuri A. Ferreira More articles by this author Joao A. Barbosa More articles by this author Marco A. Nunes More articles by this author Sabrina T. Reis More articles by this author Nayara I. Viana More articles by this author Katia R. Leite More articles by this author Miguel Srougi More articles by this author Alberto A. Antunes More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Correlation between detrusor pressure and transurethral resection of prostate outcome

Objective To assess the long-term outcome of transurethral resection of the prostate (TURP) in men with different maximum detrusor pressure (Pdet.max).Methods 113 neurologically intact men diagnosed with BPH and undergone surgical intervention in our department were enrolled between Feb.2009 and May 2012.All patients had completed the International Prostate Symptom Score (IPSS) and quality-of-life (QOL) questionnaires and had undergone a full urodynamic analysis before surgery.The outcomes were assessed at 24 months postoperatively using the IPSS score,QOL score,and maximum urinary flow rate (Qmax).Results After 24 months follow-up,3 cases in the poor symptom improvement group could not void.The average Pdet.max of these three patients was (15.7±5.1) cmH2O,which was statistically significantly lower than that of the other three groups [(102.7±39.3),(95.9±42.8),(77.0±27.4) cmH2O] (P＜0.05).Nine cases in the poor functional improvement group whose average Pdet.was (32.5± 16.6) cmH2O,which was statistically significantly lower than that of the other three groups [(115.2±36.3),(87.5±28.7),(75.5±46.9) cmH2O] (P＜0.05).Conclusions Urodynamic analysis plays an important role in judging the efficacy of TURP.Patients with a Pdet.max less than 32.5 cmH2O may not have an objectively successful result from surgery treatment. Key words: Benign prostatic hyperplasia; Urodynamics; Maximum detrusor pressure; Transurethral resection of prostate; Detrusor underactivity

Urodynamic analysis and treatment of male Parkinson's disease patients with voiding dysfunction

Background Parkinson's disease (PD) is an extrapyramidal neurological disorder. Urinary symptoms are frequently present in patients affected by PD. Symptoms such as urgency, frequency, nocturia, and urge incontinence significantly impact the patient's quality of life. We attempted to investigate the urodynamic changes and treatment of male PD patients with voiding dysfunction by means of a review. Methods Comprehensive urodynamic examinations were performed in 141 male patients with PD associated with voiding dysfunction. Appropriate treatments were given to subgroups that were divided based on test results, and the changes in urodynamic parameters as well as the treatment efficacy were observed. Results Detrusor hyperreflexia without bladder outlet obstruction (BOO) was observed in 35 patients, who exhibited significant improvements in the international prostate symptom score (IPSS), maximum flow rate (Qmax), bladder volume at the first desire to void, post-void residual (PVR), and bladder compliance. Detrusor hyperreflexia associated with BOO was observed in 59 patients. The patients exhibited significant improvements in IPSS, Qmax, PVR, and bladder compliance. Detrusor dysfunction without BOO was observed in 19 patients, for whom the IPSS and the bladder volume at the first desire to void were improved after treatment. Detrusor dysfunction with BOO was found in 28 patients, with no significant improvement in the urodynamic parameters after the treatment. Conclusions Urodynamic examination is recommended for male Parkinson's disease patients with voiding dysfunction. Early and effective treatment can improve the bladder function and quality of life of these patients.

Chronic lower urinary tract symptoms in young men without symptoms of chronic prostatitis: urodynamic analyses in 308 men aged 50 years or younger.

PurposeWe investigated the etiologies of lower urinary tract symptoms (LUTS) and compared urodynamic characteristics between different diagnostic groups in young men with chronic LUTS.Materials and MethodsWe reviewed the medical records of 308 men aged 18 to 50 years who had undergone a urodynamic study for chronic LUTS (≥6 months) without symptoms suggestive of chronic prostatitis.ResultsThe men's mean age was 40.4 (±10.1) years and their mean duration of symptoms was 38.8 (±49.2) months. Urodynamic evaluation demonstrated voiding phase dysfunction in 62.1% of cases (primary bladder neck dysfunction [PBND] in 26.0%, dysfunctional voiding [DV] in 23.4%, and detrusor underactivity [DU]/acontractile detrusor [AD] in 12.7%) and a single storage phase dysfunction in 36.4% of cases (detrusor overactivity [DO] in 13.3%, small cystometric capacity in 17.9%, and reduced bladder sensation in 5.2%). Most of the demographic characteristics and clinical symptoms did not differ between these diagnostic groups. Whereas 53.9% of patients with voiding dysfunction had concomitant storage dysfunction, 69.6% of those with storage dysfunction had concomitant voiding dysfunction. Men with DV or DU/AD exhibited lower maximum cystometric capacity than did those with normal urodynamics. Low bladder compliance was most frequent among patients with PBND (10.0%, p=0.025). In storage dysfunctions, men with DO exhibited higher detrusor pressure during voiding than did those with other storage dysfunctions (p<0.01).ConclusionsBecause clinical symptoms are not useful for predicting the specific urodynamic etiology of LUTS in this population, urodynamic investigation can help to make an accurate diagnosis and, potentially, to guide appropriate treatment.

Comparison of urodynamic findings in patients with upper and lower cervical spinal cord injury

Retrospective study. To analyze the neurogenic bladder characteristics and treatment approaches in patients with upper and lower cervical spinal cord injury (SCI) in order to make proper and reasonable decisions to the relevant patients. Rehabilitation center in Ankara, Turkey. Ninety patients with cervical SCI were included. The urodynamic analyses of the patients were conducted retrospectively by using the urodynamic laboratory records. The patients were divided into two groups as the upper cervical SCI (UCSCI) group (C1-C5) and lower cervical SCI (LCSCI) group (C6-C8). In this study, 82 male (91.1%) and 8 (8.9%) female patients were included. There were 51 UCSCI patients with the mean age of 34.2 ± 16.1 years and 39 LCSCI patients with the mean age of 30.4 ± 12.5 years. Detrusor overactivity and preservation of the bladder-filling sensation were significantly more frequent in the UCSCI group than in the LCSCI group (P=0.048, P=0.000 respectively). Moreover, there were statistically significant differences between the groups regarding the bladder-emptying methods, residual volume and the frequency of anticholinergic and alpha blocker use (all P<0.05). No significant difference was found between the groups regarding the frequency of autonomic dysreflexia, detrusor hypocompliancy and the bladder-storage and -emptying disorders (all P>0.05). Our results demonstrate that there are differences in the upper and lower SCI cases in terms of neurogenic bladder characteristics and treatment approaches.

Crucial role of TRPC1 and TRPC4 in cystitis-induced neuronal sprouting and bladder overactivity.

PurposeDuring cystitis, increased innervation of the bladder by sensory nerves may contribute to bladder overactivity and pain. The mechanisms whereby cystitis leads to hyperinnervation of the bladder are, however, poorly understood. Since TRP channels have been implicated in the guidance of growth cones and survival of neurons, we investigated their involvement in the increases in bladder innervation and bladder activity in rodent models of cystitis.Materials and MethodsTo induce bladder hyperactivity, we chronically injected cyclophosphamide in rats and mice. All experiments were performed a week later. We used quantitative transcriptional analysis and immunohistochemistry to determine TRP channel expression on retrolabelled bladder sensory neurons. To assess bladder function and referred hyperalgesia, urodynamic analysis, detrusor strip contractility and Von Frey filament experiments were done in wild type and knock-out mice.ResultsRepeated cyclophosphamide injections induce a specific increase in the expression of TRPC1 and TRPC4 in bladder-innervating sensory neurons and the sprouting of sensory fibers in the bladder mucosa. Interestingly, cyclophosphamide-treated Trpc1/c4−/− mice no longer exhibited increased bladder innervations, and, concomitantly, the development of bladder overactivity was diminished in these mice. We did not observe a difference neither in bladder contraction features of double knock-out animals nor in cyclophosphamide-induced referred pain behavior.ConclusionsCollectively, our data suggest that TRPC1 and TRPC4 are involved in the sprouting of sensory neurons following bladder cystitis, which leads to overactive bladder disease.

Bladder dysfunction in a transgenic mouse model of multiple system atrophy

Multiple system atrophy (MSA) is an adult-onset neurodegenerative disorder presenting with motor impairment and autonomic dysfunction. Urological function is altered in the majority of MSA patients, and urological symptoms often precede the motor syndrome. To date, bladder function and structure have never been investigated in MSA models. We aimed to test bladder function in a transgenic MSA mouse featuring oligodendroglial α-synucleinopathy and define its applicability as a preclinical model to study urological failure in MSA. Experiments were performed in proteolipid protein (PLP)-human α-synuclein (hαSyn) transgenic and control wild-type mice. Diuresis, urodynamics, and detrusor strip contractility were assessed to characterize the urological phenotype. Bladder morphology and neuropathology of the lumbosacral intermediolateral column and the pontine micturition center (PMC) were analyzed in young and aged mice. Urodynamic analysis revealed a less efficient and unstable bladder in MSA mice with increased voiding contraction amplitude, higher frequency of nonvoiding contractions, and increased postvoid residual volume. MSA mice bladder walls showed early detrusor hypertrophy and age-related urothelium hypertrophy. Transgenic hαSyn expression was detected in Schwann cells ensheathing the local nerve fibers in the lamina propria and muscularis of MSA bladders. Early loss of parasympathetic outflow neurons and delayed degeneration of the PMC accompanied the urological deficits in MSA mice. PLP-hαSyn mice recapitulate major urological symptoms of human MSA that may be linked to αSyn-related central and peripheral neuropathology and can be further used as a preclinical model to decipher pathomechanisms of MSA.

Comparison of Lower Urinary Tract Symptoms Between Women with Detrusor Overactivity and Impaired Contractility, and Detrusor Overactivity and Preserved Contractility

We compared symptoms in women with detrusor overactivity with impaired contractility and women with detrusor overactivity who had preserved contractility. The study included 359 consecutive women with detrusor overactivity who underwent multichannel urodynamics at our department between 2009 and 2011. The women were divided into 2 groups, including 151 (42%) with detrusor overactivity and impaired contractility, and 208 (58%) with detrusor overactivity and preserved contractility. We compared the 2 groups. Women with detrusor overactivity and impaired contractility were older (mean ± SD age 73.2 ± 17.3 vs 54.1 ± 20.7 years) with a higher frequency of diabetes mellitus (49% vs 31%, each p <0.001). The prevalence of previous urinary retention and recurrent cystitis was significantly higher in women with impaired contractility (7% vs 1%, p <0.01 and 22% vs 7%, p <0.001, respectively). Mean post-void residual urine was greater in the group with impaired contractility (89 ± 42 vs 21 ± 18 ml) and the mean maximal flow rate was lower (11 ± 6 vs 23 ± 5 ml per second, each p <0.001). The frequency of storage symptoms was similar in the 2 groups. However, voiding symptoms were more common in women with impaired contractility, including a slow stream in 69% vs 42%, an intermittent stream in 72% vs 26%, hesitancy in 35% vs 22%, straining in 84% vs 26%, terminal dribbling in 73% vs 42% and incomplete emptying in 71% vs 49% (p <0.001). Women with detrusor overactivity and impaired contractility are older than women with detrusor overactivity and preserved detrusor contractility. Urinary retention and recurrent cystitis are more frequent in women with detrusor overactivity and impaired contractility, and voiding symptoms are significantly more common.

Urodynamic analysis of W shape orthotopic ileal neobladder following radical cystectomy

Objective To evaluate the urodynamic parameters of shape orthotopic ileal neobladder during a 36-month follow-up post-operatively.Methods Forty-five consecutive patients underwent radical cystectomy and W shape ileal neobladder substitution for muscle-invasive bladder cancer were recruited.Follow-up and urodynamic evaluation were performed at 12 and 36 months after surgery.Cystourethrography,ultrasonography,IVU and renal function test were performed during the follow-up.Results Of the 45 patients,3 were dead during the follow-up because of cancer-related causes.When comparing to the 12-and 36-month urodynamic parameters,Qmax,MCC,compliance,end-filling pressure,peak flow pressure and PVR respectively were 15.6 ± 2.3 ml/s and 14.9 ± 1.9 ml/s,588.0 ± 264.6 ml and 561.0 ±197.4 ml,27.6±8.4 ml/cm H2O and 29.5 ±1.7 ml/cm H2O,24.4 ±5.2 cm H2O and 33.0 ±6.8 cmH2O,60.7 ±18.0 cm H2O and 79.9 ±28.2 cm H2O,83.5±24.4 ml and 80.4 ±26.8 ml.At early and late evaluation,daytime continence rate was 90％ and 94％,night continence rate was 48％ and 74％.Conclusions Orthotopic shape ileal neobladder was proven to maintain an adequate capacity and low pressure during a 36-month period of follow-up.The urodynamic results support this urinary diversion as a valid treatment option for muscle-invasive bladder cancer. Key words: Urodynamic; Bladder neoplasmas; Ileal neobladder

Resistive Index of Prostate Capsular Arteries: A Newly Identified Parameter to Diagnose and Assess Bladder Outlet Obstruction in Patients with Benign Prostatic Hyperplasia

We evaluated the association of the resistive index of the prostate capsular arteries and bladder outlet obstruction severity in men with benign prostatic hyperplasia. A total of 74 patients histologically diagnosed with benign prostatic hyperplasia were ultimately enrolled in this prospective study. Urodynamics were performed by a urologist to determine bladder outlet obstruction. Baseline parameters measured in patients with benign prostatic hyperplasia were the prostate capsular artery resistive index, International Prostate Symptom Score, quality of life score, total prostate and transition zone volume, and the transition zone index. ROC curves were produced to calculate the ROC AUC and evaluate the diagnostic performance of the prostate capsular artery resistive index, International Prostate Symptom Score, obstructive symptoms, total prostate and transition zone volume, and the transition zone index for bladder outlet obstruction. Significant difference between patients with and without bladder outlet obstruction was observed in the resistive index, which showed the highest coefficient with the degree of obstruction (r = 0.712, p <0.0001). At a cutoff of 0.69 the resistive index distinguished patients with and without bladder outlet obstruction with 78% sensitivity and 86.4% specificity. The prostate capsular artery resistive index had the maximum AUC of 0.823. The prostate capsular artery resistive index is significantly higher in patients with benign prostatic hyperplasia related bladder outlet obstruction than in those without such obstruction. The resistive index might serve as a novel indicator to diagnose and assess bladder outlet obstruction in patients with benign prostatic hyperplasia.

2027 URODINAMYC FINDINGS AFTER PROSTATIC ARTERY EMBOLIZATION FOR TREATMENT OF URINARY RETENTION RELATED TO BENIGN PROSTATIC HYPERPLASIA

You have accessJournal of UrologyBenign Prostatic Hyperplasia: Surgical Therapy and New Technology II1 Apr 20122027 URODINAMYC FINDINGS AFTER PROSTATIC ARTERY EMBOLIZATION FOR TREATMENT OF URINARY RETENTION RELATED TO BENIGN PROSTATIC HYPERPLASIA Alberto A. Antunes, Francisco Carnevale, Eduardo Muracca, Joaquim Motta_leal_Filho, Sabrina Reis, Luciana Cerri, Ronaldo Baroni, Antônio Marcelino, Geraldo Campos Freire, Giovanni Cerri, and Miguel Srougi Alberto A. AntunesAlberto A. Antunes Sao Paulo, Brazil More articles by this author , Francisco CarnevaleFrancisco Carnevale Sao Paulo, Brazil More articles by this author , Eduardo MuraccaEduardo Muracca Sao Paulo, Brazil More articles by this author , Joaquim Motta_leal_FilhoJoaquim Motta_leal_Filho Sao Paulo, Brazil More articles by this author , Sabrina ReisSabrina Reis Sao Paulo, Brazil More articles by this author , Luciana CerriLuciana Cerri Sao Paulo, Brazil More articles by this author , Ronaldo BaroniRonaldo Baroni Sao Paulo, Brazil More articles by this author , Antônio MarcelinoAntônio Marcelino Sao Paulo, Brazil More articles by this author , Geraldo Campos FreireGeraldo Campos Freire Sao Paulo, Brazil More articles by this author , Giovanni CerriGiovanni Cerri Sao Paulo, Brazil More articles by this author , and Miguel SrougiMiguel Srougi Sao Paulo, Brazil More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2012.02.2190AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Prostatic artery embolization (PAE) has emerged as an option for treatment of lower urinary tract symptoms (LUTS) related to benign prostatic hyperplasia (BPH). Here we describe the urodynamic findings after PAE in 11 patients with urinary retention due to BPH. METHODS We performed a prospective study including 11 patients with acute urinary retention (AUR) due to BPH who were waiting for surgical treatment. Patients underwent physical examination, PSA measurement, transrectal US and MRI. International Prostate Symptom Score (IPSS), QoL and urodynamic testing were used to assess the outcome. PAE was performed under local anesthesia through the femoral artery. Urodynamic analysis were performed after a median 12 months (1–15) follow-up period. Ages ranged from (59 to 78, median 68.5 years) and prostate size ranged from 30-90 grams (median 72 grams). RESULTS Twelve PAE procedures using 300-500ìm Embosphere® Microspheres were performed in 11 patients, and clinical success (catheter removal and symptoms improvement) was 91% (10/11 patients). Patients urinated spontaneously from 4-25 days (mean, 12.1) after catheter removal. Urodynamic findings after PAE showed that maximum bladder capacity and maximum flow rates improved significantly. Bladder complacence and post-void residual (PVR) volume improved with marginally significant results. An overactive bladder was found in 63 and 45% of cases pre and post-PAE respectively (table). Bladder outlet obstruction index (BOOI) showed values > 40 in 100% of cases pre-embolization. After PAE, only 36% of cases were > 40, 27% were between 20 and 40, and 36% were < 20 (graphic). CONCLUSIONS PAE is an effective method for treatment of AUR due to BPH. Most urodynamic parameters are improved after treatment and a BOOI < 40 can be observed in 76% of cases. © 2012 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 187Issue 4SApril 2012Page: e818 Advertisement Copyright & Permissions© 2012 by American Urological Association Education and Research, Inc.MetricsAuthor Information Alberto A. Antunes Sao Paulo, Brazil More articles by this author Francisco Carnevale Sao Paulo, Brazil More articles by this author Eduardo Muracca Sao Paulo, Brazil More articles by this author Joaquim Motta_leal_Filho Sao Paulo, Brazil More articles by this author Sabrina Reis Sao Paulo, Brazil More articles by this author Luciana Cerri Sao Paulo, Brazil More articles by this author Ronaldo Baroni Sao Paulo, Brazil More articles by this author Antônio Marcelino Sao Paulo, Brazil More articles by this author Geraldo Campos Freire Sao Paulo, Brazil More articles by this author Giovanni Cerri Sao Paulo, Brazil More articles by this author Miguel Srougi Sao Paulo, Brazil More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Effects of phosphate glass fiber–collagen scaffolds on functional recovery of completely transected rat spinal cords

Phosphate-based glass fibers (PGFs), due to characteristics such as biodegradability and directionality, could be effective as spatial cues for axonal outgrowth following nerve injury. In the present study, PGF-containing cylindrical scaffolds of 1.8mm diameter and 3mm length were developed and implanted into the gap between the proximal and distal stumps following complete transection of rat spinal cords at T9. The PGF-free collagen scaffolds were implanted into the transected spinal cords of the control group. The open-field Basso, Beattie and Bresnahan locomotor scale revealed that the locomotor function of the experimental group was better than in the control group from 8 to 12weeks after implantation, and urodynamic analysis revealed additional improvements in the experimental group in some parameters. Twelve weeks after implantation, some axon growth from the proximal and distal stumps to the scaffold was observed in the experimental group but not in the control group. Macrophages surrounded the injured thoracic spinal cord at 1 and 4weeks after implantation; however, 6h after implantation, the pro-inflammatory cytokines did not differ between the control and experimental groups. Anterograde corticospinal tract (CST) tracing with biotinylated dextran amine showed that, in the experimental group, some CST outgrowths could reach the lumbar enlargement. By 12weeks, the mRNA levels of brain-derived neurotrophic factor in the bladder had increased more in the experimental group than in the controls. We conclude that PGFs can have a beneficial effect on functional recovery following complete transection of the thoracic spinal cord in rats.

Human Amniotic Fluid Stem Cell-derived Muscle Progenitor Cell Therapy for Stress Urinary Incontinence

The most promising treatment for stress urinary incontinence can be a cell therapy. We suggest human amniotic fluid stem cells (hAFSCs) as an alternative cell source. We established the optimum in vitro protocol for the differentiation from hAFSCs into muscle progenitors. These progenitors were transplanted into the injured urethral sphincter and their therapeutic effect was analyzed. For the development of an efficient differentiation system in vitro, we examined a commercial medium, co-culture and conditioned medium (CM) systems. After being treated with CM, hAFSCs were effectively developed into a muscle lineage. The progenitors were integrated into the host urethral sphincter and the host cell differentiation was stimulated in vivo. Urodynamic analysis showed significant increase of leak point pressure and closing pressure. Immunohistochemistry revealed the regeneration of circular muscle mass with normal appearance. Molecular analysis observed the expression of a larger number of target markers. In the immunogenicity analysis, the progenitor group had a scant CD8 lymphocyte. In tumorigenicity, the progenitors showed no teratoma formation. These results suggest that hAFSCs can effectively be differentiated into muscle progenitors in CM and that the hAFSC-derived muscle progenitors are an accessible cell source for the regeneration of injured urethral sphincter.

Urodynamic analysis on spinal cord injury patients with urinary voiding dysfunction

Objective To find the differences of bladder and urethra dysfunction between sacral spinal cord injury and Thoracolumbar spinal cord injury.Methods According to the criteria of inclusion and exclusion, we collected 30 patients in the study group.There were 22 males and 8 females, aged 17 -74 ( mean, 47 ) years, with duration between 7 - 36 ( mean, 18) months.There were nineteen cases of thoracolumbar spinal cord injury and 11 cases of sacral spinal cord injury in the study group.We conducted a retrospective analysis of the urodynamic data of the 30 patients in the group.They were divided into a sacral spinal cord injury group and a thoracolumbar spinal cord injury group according to the location of the site of injury.The urodynamic findings of the two groups were comparable.SPSS 16.0 was used to compare the differences between the groups by ANOVA/rank sum test.Results We measured the free flow rate parameters between thoracolumbar and sacral spinal cord injury groups.The maximum free flow rate was ( 13.0 ±5.1 ) vs ( 13.0 ±5.8) ml/s, the free flow rate at 2 s was (6.5 ±5.1 ) vs (6.9 ±6.4) ml/s, the mean free flow rate was (5.4± 2.4) vs ( 3.4 ± 0.5 ) ml/s, urine output volume was ( 279.1 ±131.1 ) vs (450.0 ± 26.6) ml and the residual urine volume was (209.5 ± 180.7 ) vs (434.0 ± 215.0) ml.The residual urine volume and urine output volume of sacral the spinal cord injury group was higher than the thoracic spinal cord injury group (P ＜ 0.05).We also measured the the cystometric parameters.The maximum urinary flow rate was (16.0±23.3) vs (7.1 ±3.3) ml/s, average flow rate was (4.6 ±2.3) vs (3.9 ± 2.3) ml/s, the flow rate after voiding 2 s was (4.6 ± 3.1 ) vs (2.2 ± 3.2) ml/s, urine output volume was (268.4 ± 113.9) vs ( 129.0 ± 97.9) ml, detrusor pressure of maximum flow rate was (58.8 ± 22.0) vs (56.5 ± 14.5) cm H2 O, flow rate of maximum detrusor pressure was (4.8 ± 2.0) vs (4.8 ± 4.4) ml/s,the maximum detrusor pressure was (68.0 ± 31.0) vs (54.6 ± 20.2) cm H2O and the average pressure of voiding period was (47.4 ±20.0) vs (42.6 ± 13.9) cm H2O.The urine output volume of the thoracolumbar spinal cord injury group was lower than sacral spinal cord injury group ( P ＜ 0.05 ).There were no significant differences in bladder sensation and coordination of bladder/urethra between the thoracolumbar spinal cord injury group and the sacral spinal cord injury group (P ＞ 0.05).The incidence of low compliance bladder in the thoracolumbar spinal cord injury patients (4/11) was higher than the sacral spinal injury group, the incidence of high compliance bladder in the sacral spinal cord injury patients (11/19) was higherthan the thoracolumbar group.Conclusions The urodynamics' difference between the sacral spinal cord injury group and thoracolumbar spinal cord injury group was observed in bladder compliance and bladder detrusor contractility changes.Relatively, the incidence of decreased detrusor contractility and high compliance bladder in sacral spinal cord injury patients was higher, and the cidence of detrusor hyperreflexia and low compliance bladder in thoracolumbar spinal cord injury patients was higher. Key words: Urodynamics; Spinal cord injury; Voiding dysfunction

Urinary incontinence following surgery for BPH: the role of aging on the incidence of bladder dysfunction

The reported incidence of urinary incontinence (UI) due to bladder dysfunction following surgery of BPH is variable. We described the causes of incontinence in a large group of men that developed this unusual complication and analyzed the influence of age on the prevalence of bladder dysfunction. We evaluated a total of 125 patients with urinary incontinence following surgical treatment for BPH: Transurethral resection of the prostate (81 men) and open prostatectomy (44 men). A third group of 21 patients with incontinence following radical prostatectomy was used for comparison. All patients underwent urodynamic analysis. Urethral Sphincter Insufficiency (USI) was defined as involuntary loss of urine induced by Valsalva maneuver in the absence of a detrusor contraction. Bladder dysfunction was defined as detrusor overactivity and/or decreased compliance. Urethral sphincter insufficiency was the most common etiology of urinary incontinence in the three groups of patients. However, bladder dysfunction was observed in 59.3%, 56.8% and 57.1% of patients who underwent transurethral resection, open prostatectomy and radical prostatectomy, respectively. Median patient age was 69 and 75 years for patients with and without bladder dysfunction, respectively. A logistic regression model for the presence of bladder dysfunction showed that age was a statistically significant predictor. Urethral Sphincter insufficiency is the main cause of incontinence following surgery for BPH. Bladder dysfunction may be the isolated cause of incontinence in approximately 25% of patients. The chances of bladder dysfunction rises 5.3% for each year added to patient age. Patients older than 70 years have twice the probability of post procedural incontinence.

1697 THE URODYNAMICS OF VOIDING FUNCTION IN FEMALES: GRADING OF BLADDER OUTFLOW CONDITIONS ON A CONTINUOUS SCALE

You have accessJournal of UrologyUrodynamics/Incontinence/Female Urology: Female Urology1 Apr 20111697 THE URODYNAMICS OF VOIDING FUNCTION IN FEMALES: GRADING OF BLADDER OUTFLOW CONDITIONS ON A CONTINUOUS SCALE Werner Schaefer, Becky Clarkson, Derek Griffiths, Stasa Tadic, and Neil Resnick Werner SchaeferWerner Schaefer Pittsburgh, PA More articles by this author , Becky ClarksonBecky Clarkson Pittsburgh, PA More articles by this author , Derek GriffithsDerek Griffiths Pittsburgh, PA More articles by this author , Stasa TadicStasa Tadic Pittsburgh, PA More articles by this author , and Neil ResnickNeil Resnick Pittsburgh, PA More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2011.02.1888AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Urodynamic criteria for bladder outflow obstruction, BOO, are well accepted in males, but not for females; there are overlapping and contradictory gradings using cut-off values and nomograms. We performed a systematic analysis of urodynamics of female BOO employing the same principles used to analyze pressure-flow (p/Q) plots in men, identify advantages and problems, and to suggest a new concept of grading for clinical use. METHODS Repeated voiding studies with free flow rate (FF) and p/Q studies in 168 females were analyzed using various nomograms (provisional ICS, Schaefer (SCH), Blaivas-Groutz (BG), Salvatore, Lemack & Zimmern, Kuo) (1)), and numbers (BOOI and obstruction coefficient OCO = pdet,Qmax/(40+2Qmax) DECO, (2). We also assess the fit of pressure/flow data to the underlying concepts, and how straining and use of FF affect classification. RESULTS Mean values for p/Q data: Qmax 18 ml/s (higher FF in 63%); Vvoid 417 ml, PVR 88 ml, pdet,Qmax 25 cmH2O. By ICS nomogram 2 were obstructed, 3 equivocal; in BG, 3 were moderately obstructed, 38 mildly obstructed; in SCH nomogram, 5 were Grade II obstructed, 25 Grade I, rest in Grade 0. Mean BOOI = -16 and OCO = 0.35. Combining pressure from the p/Q study with higher FF or flow at straining resulted in higher contractility, DECO 116 to 140. CONCLUSIONS There is agreement that 2–3% may be obstructed. Using a higher flow at straining or FF in combination with pressure (BG) mimics an increase in contractility to unrealistically high values, and will mislead in nomograms with Qmax cut-off. BOOI shows significant variability, with sensitivity to maximum flow and straining, and thus to volume voided. Fit between BOOI and the actual p/Q plot in women is poor with calculated mean opening pressure of -16 cmH2O compared to measured 15.9 cmH2O. For OCO mean calculated opening pressure is 14.9 cmH2O, indicating good agreement. Mean OCO 0.35 is close to BG cut-off for “mild obstruction” and SCH grade I. In addition, OCO enables for the first time realistic grading of outflow conditions in females and males on a continuous scale and is only little affected by straining. In males, flow is usually driven by pdet. This is not generally true in women where the effectiveness of straining demonstrates that flow rate is driven by pves. This needs to be taken into account for voiding analysis in females using an additional Q/pves analysis. References 1 2nd ICI. In: . : 2002: 345. Google Scholar 2 Neurourol Urodyn2000; 19: 484. Google Scholar © 2011 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetailsCited byWein A (2016) Re: Evaluation of Obstructed Voiding in the Female: How Close Are We to a Definition?Journal of Urology, VOL. 195, NO. 4 Part 1, (1041-1041), Online publication date: 1-Apr-2016. Volume 185Issue 4SApril 2011Page: e682-e683 Advertisement Copyright & Permissions© 2011 by American Urological Association Education and Research, Inc.MetricsAuthor Information Werner Schaefer Pittsburgh, PA More articles by this author Becky Clarkson Pittsburgh, PA More articles by this author Derek Griffiths Pittsburgh, PA More articles by this author Stasa Tadic Pittsburgh, PA More articles by this author Neil Resnick Pittsburgh, PA More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Bladder installation of alkaline lidocaine for the treatment of ketamine-associated cystitis

Objective To evaluate the efficacy and safety of intravesical alkalised lidocaine therapy for the treatment of ketamine-associated cystitis. Methods From 2008 to 2009,7 cases of patients (6 males and 1 female; mean age 26 years) were admitted with severe lower urinary tract symptoms (LUTS). Three cases had painful hematuria. All cases had history of abuse ketamine. B ultrasound examination revealed marked thickness of the bladder wall and small bladder capacity. Urodynamic study were performed showing the functional bladder capacities between 20 to 100 ml(average 50 ml),Qmax between 3.7 to 10.8 ml/s, RUV between 0 to 24 ml. Urodynamic analyses showed hypersensitive bladder and decreased bladder compliance. Cystoscopy showed diffuse reddish swelling of the bladder mucosa and hemorrhagic cystitis. All patients were required to withdraw the ketamine and treated with bladder hydrodistention therapy (intravesical alkalised lidocaine with heparin). Results The biopsies of 2 patients showed bladder wall inflammation and fibrosis. LUTS was significantly relieved after bladder installation within 7 days. The functional bladder capacities increased between 150±30 ml,Qmax 11.5±3.8 ml/s. Four cases became asymptomatic. Three recurrent cases after reabused ketamin for 1 to 3 months received same intraversical treatment. All cases were followed up for 2 to 17 months. Conclusion Intravesical hydrodistention therapy with alkalised lidocaine and heparin could be the safe and effective therapy in the treatment of katamine-associated cystitis. Key words: Cyctitis; Ketamine; Lidocaine

UP-1.22: Differential diagnosis of lower urinary tract symptoms in elderly men: a 7-year retrospective analysis of symptoms and urodynamics

The cause and pathogenesis of lower urinary tract symptoms (LUTS) in elderly men is unclear. We analyzed the clinical and urodynamic findings in elderly men with LUTS to search for accurate diagnosis and effective treatments.

Leiomyoma of the bladder presenting as acute urinary retention in a female patient: urodynamic analysis of lower urinary tract symptom; a case report

BackgroundMost bladder tumors are derived from the urothelium. Benign mesenchymal tumors are rare. Leiomyoma of the bladder is the most common benign neoplasm. We present a case of leiomyoma of the bladder presenting with acute urinary retention in a female patient and report on the post-operative change in urodynamic findings. To our knowledge, few cases of this kind have been reported.Case PresentationA 56-year-old woman presented with acute urinary retention. Evaluations including ultrasound, magnetic resonance imaging, cystoscopy, and urodynamics contributed to a diagnosis of leiomyoma of the bladder. Various medications were ineffective for solving her lower urinary tract symptoms; therefore, a transurethral resection was performed. The final pathological report was leiomyoma. After the operation, her symptoms resolved; this improvement was confirmed by an urodynamic analysis. The postoperative urodynamics demonstrated a lower frequency of detrusor overactivity during filling cystometry and an increase in the uroflow rate, with reduced detrusor pressure in a pressure flow study.ConclusionsLeiomyoma of the bladder can cause female outlet obstruction. A review of the literature and disease management is discussed.

Urodynamic analysis in multiple system atrophy: characterisation of detrusor-sphincter dyssynergia

In multiple system atrophy (MSA), parkinsonism and a cerebellar syndrome are associated with autonomic dysfunction. Both bladder neck dysfunction and external sphincter denervation have been implicated in detrusor-sphincter dyssynergia. However, urethral dysfunction may not be adequately reflected by a single global measurement of urethral pressure. Pressure assessment at several levels of the urethra is needed to unravel the mechanisms of bladder-urethra dysfunction. Here, we evaluated the use of multiple sensor pressure transducers to assess bladder-sphincter function in 52 patients with MSA in comparison to patients with Parkinson's disease (PD) who were matched for age and severity in the "off" condition. Urinary dysfunction appeared significantly earlier in MSA (<2 years) than in PD (>5 years). Detrusor under-activity with dysuria was observed in 58% of MSA patients within 4 years and in 76% of patients thereafter. Detrusor-urethral dyssynergia in MSA patients was always better characterized by multiple sensor pressure transducer measurement of bladder and urethral pressure than by a single global measurement. This new approach may prove useful for differential diagnosis of parkinsonian syndromes, and especially MSA.