Urodynamic Examination Research Articles

Komplikationsmanagement nach Band- und Netzimplantationen

Tension-free alloplastic slings (TFAS) have revolutionized surgery for female stress urinary incontinence for more than 15 years. The procedure is easy to perform, minimally invasive with short operation time in an ambulatory setting, and has proven efficacy comparable to the gold standard procedure of retropubic colposuspension.Possible TFAS complications are potentially underestimated with respect to prevalence and manageability. We report our experience with major complications following TFAS and mesh implantation in patients referred to our interdisciplinary continence center. Patient history, risk factors, and preoperative diagnostics were analyzed for development of individualized treatment strategies. Overcorrections with formation of postvoid residual (PVR) can occur in retropubic TFAS as well as in transobturator TFAS. However, the most prevalent and challenging complication is de novo urgency. Major complications like urethrovaginal fistula, sling arrosions of the urethra, bladder, and vagina as well as infected gangrene and complete urethral loss requiring urinary diversion were seen at a frequency suggesting underrepresentation of these complications in the literature. The large amount of implanted artificial mesh material used for pelvic organ prolapse (POP) correction represents a particular challenge in cases of dyspareunia or persisting pelvic pain.Complication management has to be based on cystoscopic, urodynamic, and physical examination findings to be individualized to each patient and must take potential risks of recurrent incontinence or persisting complaints into account.To prevent TFAS or mesh complications, every patient should have tried all conservative treatment options and should be completely evaluated (including urodynamics) preoperatively. Artificial meshes should only be used in cases of prolapse recurrence or in otherwise inoperable patients. Postoperative urodynamics may help to document treatment success and to identify and quantify complications.

Urinary Incontinence in French Women: Prevalence, Risk Factors, and Impact on Quality of Life

BackgroundThe lack of epidemiologic data on the prevalence of female urinary incontinence (UI) attending general practitioners (GPs) in France led us to conduct a cross-sectional study in our country. ObjectivesTo determine the prevalence of UI and to assess its impact on the quality of life (QoL). Design, setting, and participantsThis cross-sectional study of women aged >18 yr was conducted by attending GPs between June 2007 and July 2007. MeasurementsThe main outcome measures were urinary symptoms, functional impairment, International Consultation on Incontinence Questionnaire–Short Form score, and medical care seeking. Results and limitationsOverall, 241 GPs enrolled 2183 women seen during 1 d. The prevalence of UI was 26.8% (n=584) and increased with age, body mass index (BMI), and number of children delivered (p<0.0001). Among women with UI, 496 were included in a cross-sectional survey: 45.2% (n=224) had stress UI, 42.1% (n=209) had mixed UI, and 10.9% (n=53) had urge UI, while 2% (n=10) had UI of indeterminate type. Overall, 288 of 496 women (51.8%) stated that UI had a negative impact on their QoL; this effect remained mostly mild or moderate, and only 197 of 496 women (39.7%) had asked for medical help. Longer duration of symptoms, higher frequency of comorbid urinary symptoms, and altered QoL were most frequent among women with mixed UI (p<0.001). Misclassification may have occurred because the diagnosis of UI was based on self-reported data rather than on clinical or urodynamic examinations. ConclusionsUI symptoms were found in almost one in four women attending GPs. Clinical and functional UI impairment were associated with age, BMI, and parity. UI caused distress to women, but only those who were severely affected sought help. The results emphasize the need for policy development for UI prevention and management in France.

Vesical Sequelae of Transverse Myelitis. Long-Term Urodynamics Observations in Adult Patients

Transverse myelitis is a rare autoimmune inflammatory disease often secondary to viral infection of the spinal cord; it frequently has vesico-sphynteric complications. Between January 2000 and December 2005 we performed urodynamic examination on 13 consecutive patients (7 females and 6 males) with previous diagnosis of transverse myelitis. Mean age was 54.5 years; transverse myelitis had been diagnosed a mean of 6.3 years earlier; etiology of myelitis was viral infection in 5 cases, autoimmune in 3 cases, insect bite in 1 case, unknown in 4 cases. The neurological sequelae included paraparesis in 3 cases and tetraparesis in 2 cases. Symptoms: dysuria 46%, slow stream 15%, pollakiuria 23%, urgency 30%; urge incontinence 38%, stress incontinence 15%. 3 patients performed 4 clean intermittent catheterisms (CIC), 2 patients 2 CICs. Eight patients had maximum cystometric capacity above 350 mL, the others had a mean capacity of 223 mL. Four patients showed no bladder sensitivity. Voluntary micturitional reflex was observed in 4 patients. Detrusor overactivity was diagnosed in 9 patients, 10 patients had mean residual post-micturition (RPM) of 218 mL, 2 patients showed detrusor-sphincter dyssynergia, 2 patients were found to be obstructed at pressure-flow study. Urodynamic follow-up is indicated in these patients with or without neurological complications (possibility of detrusor overactivity, urinary retention, detrusor-sphincter dyssynergia); the follow-up personalizes the diagnosis and therapy, and prevents complications.

Radiation exposure during videourodynamic examinations in children with meningomyelocele

Purpose In children with meningomyelocele, repeated urodynamic examinations are recommended from birth on. These are often proceeded fluoroscopicly (videourodynamic, VUD) e.g. to verify a reflux. Guidelines are vague about the frequency of required VUDs en no data exist about the effective dose, children are exposed to. To evaluate the radiation exposure in children during VUD evaluations and, based on these data, to discuss the commensurability of repeated VUD examinations in children this study was initiated. Material and methods Prospective study from a university hospital with 30 participating children between 0 and 16 years. Age, gender, dose area product, kV, mA, number of images, abdominal diameter and the field area (with affected organs) was measured and the effective dose calculated. Comparison of radiation exposure during videourodynamics with other radiologic pediatric procedures taken from the literature. Results 7 children were examinated for the first time, 23 underwent a control. No significant difference in age, abdominal diameter, time of fluoroscopy, kV and mA was found between the groups. In average, 7 fluoroscopic images were taken; significant more images were done in patients, examinated for the first time. The over all mean effective dose per child and examination was found to be 0,203 mSv. Conclusions Radiation exposure per VUD is moderate. Due to the need of repeated exposures and the vulnerability of children to irradiation, an explicit advice about the frequency of required VUD should be given in the guidelines to avoid unnecessary exposure. Generally, fluoroscopic images should be taken according to the ALARA principle.

Effects of inhibitory rTMS on bladder function in Parkinson's disease patients

Patients affected by Parkinson's disease (PD) may present with lower urinary tract (LUT) dysfunction characterized by involuntary detrusor overactivity. We evaluated possible impact of a 2-week course of low frequency 1 Hz repetitive transcranial magnetic stimulation (rTMS) on LUT behavior in eight advanced PD patients complaining of urinary disturbances. We tested the effects of rTMS measuring urodynamic examination and the International Prostate Symptoms Score (IPSS) questionnaire, used for evaluation of subjective LUTS. rTMS was able to improve temporarily LUT behavior in PD patients, increasing bladder capacity and the first sensation of filling phase. Moreover, a reduction of IPSS score was noticed, due to an improvement on filling phase symptoms. The beneficial effects assessed with the IPSS lasted for up to 2 weeks after the end of the stimulation. rTMS seems to be an effective, noninvasive alternative treatment for PD patients with urinary disturbances.

Electromotive drug‐administration: A pilot study for minimal‐invasive treatment of therapy‐resistant idiopathic detrusor overactivity

Electromotive drug-administration (EMDA) represents a minimal-invasive method of intravesical instillation of therapeutic agents. We examined the therapeutic effect of EMDA in patients suffering from therapy-resistant idiopathic detrusor overactivity (IDO) with respect to urodynamics, micturition charts and quality of life (Kings Health Questionnaire). Patients suffering from urge syndrome with and without urge incontinence and non-responding to oral anticholinergic drugs underwent EMDA therapy (2000 mg lidocaine-HCl 4% (50 ml), 2 mg epinephrine [1:1000] (2 ml), 40 mg dexamethason-21-dihydrogen phosphat (10 ml) in a total volume of 100 ml). Over a 27 months period, 84 patients (median age 63.1 years; 72 female, 12 male) with urge syndrome and urodynamically-proven idiopathic detrusor overactivity (IDO) were treated with EMDA. Following urodynamic measurements, quality of life (QoL) was evaluated using Kings Health Questionnaire (KHQ) and a micturition chart over 48 h, EMDA was performed once in four weeks for a period of three months. Patients continued to document drinking and micturition data during this time. Before each EMDA session urodynamic examination and KHQ were repeated. All treated patients suffered from urge syndrome (25.6% OAB wet, 20.0% OAB dry and 54.4% mixed urinary incontinence). Mean daytime frequency (DF) was 14.1 +/- 7.7 per day and nocturia (N) 5.1 +/- 5.1 per night before EMDA. After two EMDA sessions, daytime frequency (DF) decreased to 9.4 +/- 6.2 per day (P < 0.0001) and 2.5 +/- 2.4 per night (P = 0.035). The use of pads could be lowered from 4.5 +/- 4.1 per 24 h to 1.8 +/- 2.4 (P < 0.0074). The first desire to void volume (FDV) assessed by urodynamics started at 94.0 +/- 60.5 ml before treatment and changed to 142.2 +/- 79.6 ml (P = 0.0064) after two sessions. Strong desire to void volume (SDV) was noticed at 155.6 +/- 84.8 ml filling of the bladder; after two EMDA sessions at 199.5 +/- 97.3 ml (P = 0.001). Uninhibited detrusor contractions (UIC) were seen in all patients before treatment and were reduced to 46.4% after two EMDA sessions (P < 0.001). Maximal cystometric bladder capacity (MCBC) increased from 192.3 +/- 106.6 ml to 239.6 +/- 114.9 ml (P = 0.018). Patient-documented bladder capacity (BC) as micturition volume increased from 186.0 +/- 108.7 ml to 234.2 +/- 134.2 ml (P = 0.043). A reduction of impact of Quality of Life (QoL) was observed from 11.8 +/- 0.4 to 7.0 +/- 0.3 (P < 0.001) during treatment. A fraction of 53.6% (45/84) of all patients reported a completely withdrawal of symptoms and 28.6% (24/84) indicated a remarkable reduction. Only 10.7% (9/84) of patients did not continue therapy after two sessions. EMDA significantly improves urodynamic parameters, QoL and pad usages in patients with urge syndrome and therapy-resistant IDO. Therefore we offer EMDA therapy as an alternative treatment modality to the standard approaches.

Better Compliance Contributes to Better Nocturnal Continence With Orthotopic Ileal Neobladder Than Ileocolonic Neobladder After Radical Cystectomy for Bladder Cancer

To investigate, in a randomized controlled study, the degree of continence after the creation of orthotopic ileocolonic and ileal neobladders after cystectomy and to explore a possible mechanism for the difference in continence between these 2 types of orthotopic neobladder. From 2003 to 2007, 71 male patients underwent orthotopic lower urinary tract reconstruction with either an ileocolonic or ileal neobladder after radical cystectomy. The degrees of continence and voiding patterns were individually evaluated using urodynamic examinations and a detailed patient questionnaire. The abnormal upper tract was evaluated using intravenous urography and ultrasonography. Complete daytime continence was achieved in 90.9% and 89.4% of the patients and functional nocturnal continence 48.5% and 76.3% of patients in the ileocolonic neobladder and ileal neobladder groups, respectively. The urodynamic data showed that the initial volume of both the ileocolonic and the ileal neobladder appeared to not be significantly different statistically, although the compliance of the ileocolonic neobladder was lower than that of the ileal neobladder (P < .05). No difference was found in the parameters such as flow rate, urethral profile length, maximal urethral pressure, or neobladder neck pressure between the 2 neobladder types. Although the ileocolonic and ileal neobladders can both achieve a large initial volume, the ileal neobladder has an advantage in the aspect of obtaining satisfactory nocturnal continence because of its greater compliance compared with that of the ileocolonic neobladder.

Evaluation of lower urinary system symptoms and neurogenic bladder in children with cerebral palsy: relationships with the severity of cerebral palsy and mental status

Aim: This study aimed to evaluate lower urinary system symptoms, to determine bladder type in children with cerebral palsy (CP), and to determine the relationship between bladder type, and the severity of CP and mental status of the children. Materials and Methods: The study included 41 children with CP. Subjects were first asked to provide information concerning lower urinary system symptoms. Urodynamic examination was performed in 41 children with CP. The severity of CP was determined according to the Gross Motor Functional Classification System (GMFCS). The Stanford-Binet Intelligence Scale was used to determine intelligence quotients (IQ). After urodynamic examination, subjects were divided into 2 groups based on bladder type: neurogenic detrusor overactivity (NDO) and normal bladder (NB) groups. Results: One or more lower urinary system symptoms were observed in 78% of the subjects. NDO was observed in 30 subjects (73.2%), while NB was observed in 11 (26.8%), based on urodynamic study. While there was an almost statistically significant difference in terms of IQ scores (P = 0.053) between the NDO and NB groups, there was not a statistical difference in terms of GMFCS distribution. Conclusion: The incidences of urinary system symptoms and neurogenic bladder are high in the CP population. Multiple factors, such as the effects on IQ, bladder functions, and mobility caused by cerebral lesions, may cause urinary dysfunction.

Transurethral Incision of the Bladder Neck Using KTP in the Treatment of Bladder Neck Obstruction in Women

Objectives: To study the results and complications of the potassium-titanyl-phosphate (KTP, green) laser during transurethral incision of the bladder neck in the treatment of female voiding dysfunction due to bladder neck obstruction. Methods: A total of 40 women (43–79 years of age) with obstruction were identified. Patients with neurogenic, traumatic, or iatrogenic causes of obstruction were excluded. Preoperative investigations included a full urodynamic examination and urethrocystoscopy. Transurethral bladder neck incision with KTP was performed in all patients. Urodynamic results, clinical improvements in voiding symptoms, and volume of bleeding were assessed. Results: Of the 40 patients, 12 had chronic urinary retention and 28 had difficult micturition. The most common findings on urodynamic study were a high voiding pressure plus low flow rate and high urethral pressure. After treatment, the lower urinary tract symptoms were resolved or improved in all patients. Urodynamic study revealed decreased voiding pressure, post-void residual urine volume, and increased maximal flow rate. Conclusions: Transurethral incision of the bladder neck is effective in relieving voiding difficulties owing to anatomic or functional bladder neck obstruction in women. KTP has great efficacy in the treatment of female voiding dysfunction due to bladder neck obstruction.

Qualité de vie après cure d’incontinence urinaire d’effort : comparaison de trois techniques

Objectives To assess the health-related quality of life (Contilife ®) after three surgical anti-incontinence procedures (Tension-Free Vaginal Tape [TVT], Transobturator Vaginal Tape [TOT], and Transobturator Vaginal Tape [TVT-O]). Patients and methods We performed a prospective analysis of 90 women (30 TVT, 30 TOT, 30 TVT-0) with genuine stress incontinence pre- and postoperatively at 18 months. The objective cure rate was determined by clinical and urodynamic examination and the subjective cure rate by the Contilife ® questionnaire. Results Prior to surgery, patients complained more of effort activities, followed by global well-being. Postoperatively, all domains improved significantly without statistical difference between the three groups and 90% of the patients would advise the intervention to one of their friends. Discussion and conclusion Surgical outcomes vary greatly depending on the methodology of the study. Health-related quality of life seems paramount to decide time of surgery and to evaluate postoperatory results. We have chosen the Contilife ® questionnaire because of its scientific and clinical validity, reliability, responsiveness and linguistic validation. These results confirm that TVT/TOT/TVT-O procedures are a safe and effective surgical method and that they significantly improved health-related quality of life.

Curative effect and histocompatibility evaluation of reconstruction of traumatic defect of rabbit urethra using extracellular matrix

To investigate the curative effect and histocompatibility of reconstruction of traumatic urethral defect of rabbit using urethral extracellular matrix (ECM). Urethral ECM was obtained by excision of the urethra in 20 donor rabbits. In experimental group, 20 rabbits were resected a 1.0 cm-1.5 cm segment of the urethra and artificially made a model of traumatic urethral defect, then reconstructed by the urethral extracellular matrix of the same length. The rabbit immunity response was assessed by lymphocyte transformation test and serum TNF-alpha level. The reconstructed urethral segments were stained with hematoxylin-eosin and Van Gieson stain and observed by histological examination postoperatively. The urethrography, urethroscopy and urodynamic examinations were performed. There was no significant difference in stimulative index of lymphocyte transformation between ECM group and control group. The serum TNF-alpha levels of ECM group slightly rose, but the increase was not significant as compared with control group. On postoperative day 10, epithelial cell had migrated from each side and small vessels were found in the extracellular matrix. In the 3rd week, several layers of urothelium covered the whole surface of the matrix tube. In the 6th week, the disorganized arrangements of smooth muscle fibers were firstly observed by Van Gieson staining. In the 24th week, the smooth muscle cells increased and the matrix tube appeared fairly similar to normal urethral wall components. The urethroscopy and urodynamic evaluation revealed that the surface of reconstructed urethra was smooth and emiction was unobstructed. The urethral extracellular matrix might be an ideal and safe biomaterial for the reconstruction of urethral traumatic defect.

Voiding Symptoms and Urodynamic Findings in Patients with Modified Ileal Neobladde

The aim of our study was to find the cause of urinary incontinence and voiding dysfunction in patients undergoing radical cystectomy and orthotopic bladder replacement with modified ileal neobladder (Reddy). Twenty-eight incontinent patients (operated on between 1988 and 2004) were involved in our examination. Based on the complaints of the patients, continence status was evaluated and divided into two groups: group I: partially incontinent (only night-time incontinence) n = 11 (39.3%) and group II: totally incontinent (night-time and daytime incontinence) n = 17 (60.7%). Detailed urodynamic examination (enterocystometry and urethral pressure profile) in addition to involuntary neobladder contractions and capacity detection were carried out on all patients. Furthermore resting pressure and maximal voluntary contraction ability of the sphincter were determined and statistically analyzed in both groups. Significant difference was noticed in resting pressure and maximal voluntary contraction ability of the sphincter among the partially incontinent and totally incontinent patients. Frequency, intensity and duration of involuntary neobladder contractions also showed significant differences between the two groups. Incontinence of neobladder depends not only on the destruction of resting and contraction capability of the urethral sphincter, but also on the presence or absence of involuntary contractions in the wall of the neobladder and decreased capacity of the neobladder.

Editorial Comment

An overactive bladder (OAB) is a lower urinary tract symptom that is frequently found in stroke patients. In this excellent article written by Natsume, the occurrence of detrusor underactivity was considerably high in stroke patients (35% of male and 43% of female patients). In addition, detrusor overactivity with impaired contractility was found in 33% and 20% of male and female patients, respectively. Finally, OAB in patients with underactive detrusor appeared in 67% and 80% of male and female patients, respectively. It is thought that stroke is one of the common etiologic factors for OAB. Therefore, as shown in this article, diagnosis and treatment that depend on only a symptom diagnosis are accompanied by risk. It is important that indices such as residual urine volume should be added in dealing with OAB, even in the level of primary care physicians. It is a fact that there are some shortcomings in this article. Intervals between stroke and urodynamic study were variable, and a reference to a change of detrusor activity with time was not made. In addition, causative diseases for stroke were various, and, the relationship between location of brain lesion and findings of urodynamic examination was not mentioned. An identification of a responsible lesion of detrusor underactivity should be thoroughly investigated at institutions carrying out many urodynamic examinations. From the viewpoint of real life practice, establishment of methods to diagnose a detrusor underactivity non-invasively and accurately would be expected.

Clinical significance of parameters of prostate volume measured by transabdominal ultrasonography in evaluating bladder outlet obstruction

To explore the correlation between the parameters of prostate volume (PV) measured by transabdominal ultrasonography and urodynamic results in diagnosing bladder outlet obstruction (BOO). 112 BPH patients aged 45-85 underwent transabdominal ultrasonography to measure the superior-inferior diameter (R1) anterior-posterior diameter (R2), and left-right diameter (R3). Urodynamic examination was conducted to record the maximum flow rate (Qmax), detrusor pressure at maximum urinary flow rate (Pdet. Qmax), and detrusor pressure at minimum urinary flow rate (Pdet. Qmin), Schafer grading and international prostate symptom score (IPSS) scores were calculated. Correlation analysis was performed. The PV, R1, R2, and R3 were (48 +/- 29) ml, (4.3 +/- 1.0) cm, (3.7 +/- 0.9) cm, and (5.2 +/- 0.8) cm respectively. The Qmax, Pdet. Qmax, Schafer score, and IPSS score were (6.2 +/- 3.2) ml/s, (56 +/- 41) cm H2O, 3.1 +/- 1.8 (0-6) and 23 +/- 2 (15-31) respectively. Logistic regression analysis showed that R1 (OR = 22.662, P = 0.000), PV (OR = 0.946, P = 0.008) , and Qmax (OR = 0.760, P = 0.013) were positively correlated with Schafer grading value. The parameters of PV measured by transabdominal ultrasonography are reliable to diagnose BOO due to BPH.

Avaliação dos glicosaminoglicanos do tecido periuretral de pacientes com e sem prolapso genital

To characterize and quantify periurethral tissue sulphated glycosaminoglycans (GAGs) in women with and without pelvic organ prolapse. Periurethral tissue was obtained from 35 women who underwent surgery for pelvic organ prolapse, for stress urinary incontinence, or for other gynecological benign conditions. Patients were submitted to a clinical history, physical and urodynamic examination and were divided in two groups according to genital prolapse. The standard biopsy with 1.0 x 1.0 cm was taken from periurethral tissue during surgery and assessed by biochemical methods. The GAGs were obtained by proteolysis and precipitated by trichloroacetic acid. The relative concentration of sulfated GAGs was determined by densitometry of toluidine blue stained gel using a spectrophotometer with a 525 nm wavelength. Data were compared using analysis of variance (ANOVA). In the two groups dermatan sulphate (DS) was the predominant glycosaminoglycan (85%), followed by chondroitin sulphate (CS) and heparan sulphate (HS). Women with pelvic organ prolapse had significantly more total GAGs, DS and HS. Differences in CS were not observed. This study showed altered biochemical characteristics in the extracellular matrix of periurethral tissue and also accumulation of GAGs, DS and CS, in women with pelvic organ prolapse.

Vaginal reconstructive surgery for severe pelvic organ prolapses: A ‘uterine-sparing’ technique using polypropylene prostheses

Objective The Ulmsten's “Integral Theory” for pelvic floor dysfunctions is based on the need to reinforce fascias and ligaments with prostheses to obtain a reconstitution of the pelvic floor's anatomy. In September 2004 we developed a “uterine-sparing” surgical technique to correct such pathologies and in this paper we present results obtained. Primary outcome was to evaluate the technique's efficacy, secondary outcomes the resolution of stress urinary incontinence, postoperative pain (VAS scale), safety and complications. Study design This prospective study included patients affected by stage 3 and 4 uterine-vaginal prolapse who wished to conserve their uterus. Those with (1) minor degrees of severity, (2) unfit for surgery, (3) with a clear indication to hysterectomy (i.e. endometrial cancer), (4) with an elevated operative risk (American Society of Anaesthesiologists—ASA score III and IV), (5) previous vaginal surgeries and (6) with moderate/severe defecation problems were excluded. The technique consisted in a sacrospinous colposuspension with polypropylene mesh. The pelvic status was classified according to the international Pelvic Organ Prolapse staging system (POP-Q). Postoperative pain was scored with the VAS Scale. All patients were given the King's Health questionnaire, the Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire (PISQ-12) and the Wexner questionnaire. Results From September 2004 to November 2006 we treated 80 patients. Polypropylene prostheses (Gynemesh-Soft PS, 10 cm × 15 cm – GyneMesh, Gynecare Ethicon – Somerville, NJ, USA) were used to reconstruct the pubo-cervix or the recto-vaginal fascia. We performed an anterior-central vaginal reconstruction in 35 (43.8%) patients, central-posterior in 25 (31%) and total reconstruction in 20 (25%). The median follow-up was 21 months (range 18–26). The severe pelvic prolapse, evaluated with the POP-Q System, was completely treated in all the patients and no recurrences were observed. The urodynamic examination showed a complete resolution of the stress urinary incontinence in 10 patients (83%). Sexual activities improved in all patients. We recorded three vaginal erosions and one patient complained of a postoperative dyspareunia. Conclusions This pilot study suggests that our technique is safe and effective and can efficiently repair the pelvic organs prolapse, without undergoing hysterectomy and with a low rate of vaginal erosions.

Study on Estrogen Receptors in Uterine Ligaments of Premenopausal and Postmenopausal Patients With Normal Pelvic Floor

In Brief Objective: To explore the impact of menopause on estrogen receptors α and β (ER α and ER β) in the cardinal and uterosacral ligaments in both premenopausal and postmenopausal patients with clinically normal pelvic floor support. Methods: Cardinal and uterosacral ligament tissue samples were obtained from 12 premenopausal and 8 postmenopausal patients undergoing hysterectomy. No patients had symptoms of pelvic floor disorders as determined through medical history, gynecologic examination, stress test, and urodynamic examination. They had normal menses before menopause and did not take any hormones in the 3 months prior to the study. The ER α and ER β in cardinal and uterosacral ligaments were measured by immunohistochemical staining and Western blotting. Results: ER α stained positively in both cardinal and uterosacral ligaments of all premenopausal and postmenopausal patients with normal pelvic floor. There was no significant difference in ER α positive staining in the cardinal and uterosacral ligament between premenopausal and postmenopausal women (P > 0.05). ER β stained negatively in some part of the cardinal and uterosacral ligaments. Positive staining rate of ER β in the uterine ligament is significantly lower in postmenopausal women than in premenopausal women (P < 0.01). The quantitative positive staining of ER α and ER β in the uterine ligaments is not related to menopausal status. The result of ER α and ER β by Western blotting method was similar to the result of ER α and ER β by immunohistochemical staining. Conclusions: 1) The ER β positive staining in the uterine ligaments is lower than ER α. 2) The positive staining rate of ER β in the uterine ligaments is significantly reduced in postmenopausal women. 3) ER α and ER β show different functional characteristics in uterine ligaments. ER β may play a more important role in occurrence of pelvic floor dysfunction relating to menopause. Estrogen receptor α (ERα) and estrogen receptor β (ERβ) in uterine ligaments are influenced by the patient's menopausal status.

Real‐time flow resistance compensation for urodynamic examinations of the upper urinary tract through single lumen catheters

We developed a special calculation method for the compensation of resistance in urodynamic studies of the upper urinary tract that allows us to use existing single lumen nephrostomy catheters. We integrated a new calibration routine into the setup of our urodynamic equipment. Following the initial calibration procedure using the same size catheter as the previously inserted nephrostomy catheter, our software calculates actual resistance based on actual flowrate and the known linear resistance-flow correlation. Actual resistance and calculated intrapelvic pressure curves are presented in real-time. Using single lumen nephrostomy catheters for pressure-flow studies allows us to consider intrapelvic pressure during the measurement, to adjust filling pressure accordingly. It makes time consuming and sophisticated postprocessing resistance calculation unnecessary and also provides a challenging new method for conventional urodynamic studies of the lower urinary tract.

Bladder wall grafting in rats using salt‐modified and collagen‐coated polycaprolactone scaffolds: Preliminary report

A rat model was used for the evaluation of collagen-coated and salt-modified polycaprolactone (PCL) scaffolds for bladder grafting after hemicystectomy. SD rats underwent partial cystectomy and cystoplasty with collagen-coated and salt-modified polycaprolactone scaffolds. The grafts of the regenerated bladder wall were harvested at different intervals and tissue regeneration was evaluated microscopically. Anatomic and functional characters were evaluated by cystography and urodynamics. At harvesting, after 1 and 2 months, we found good preservation of the bladder shape and volume in all 16 rats receiving PCL cystorrhaphy. No stone formation was observed. Good epithelialization and ingrowth of smooth muscle cells were seen after 2 months grafting. Collagen-coated PCL scaffolds showed considerable encrustation, which appeared to be absorbed and disappear with time. The cystographic and urodynamic examinations revealed intact contour and a well-accommodated bladder with reservoir volume and contractility. In the rat model, we have successfully demonstrated the applicability of collagen coated and salt-modified PCL in reconstruction of the partial cystectomized bladder.

MP-02.11: Analysis of urodynamic study in children with primary monosymptomatic nocturnal enuresis

Urodynamic examinations were widely used to detect lower urinary tract disease. It also yields valuable information in infants and children in several clinical situations. We reported our experience for analysis of urodynamic study in children with primary monosymptomatic enuresis.