Vesical Pressure Research Articles

Bladder attack: transient bladder ischemia leads to a reversible decrease in detrusor compliance.

The deleterious effects of chronic ischemia on bladder function have been extensively studied; however, evaluation and characterization of the effects of acute ischemia and hypoxia are lacking. The present study examined pig and human detrusor smooth muscle (DSM) strips, in combination with an isolated perfused working pig bladder model to evaluate the relationship between transient ischemia and bladder function. Organ bath and myographic studies were performed using pig and human DSM strips exposed to starvation/hypoxia conditions. Analogous conditions were then recreated in the ex vivo bladder preparation. Filled bladders were then treated with intravascular carbachol to induce contraction and subsequent void. An intravesical transducer continuously monitored changes in bladder pressure, while a tissue pO2 monitor analyzed changes in oxygenation. After 120 min in starved/hypoxic conditions, both pig and human DSM strips demonstrated significantly increased resting tone, with a greater than two-fold increase in force over control. This was effectively blocked with atropine. DSM strips also demonstrated significantly weaker contractions; however, contractile force was nearly recovered following 15-min exposure to replete/oxygenated buffer. In the ex vivo bladder preparation, filling under ischemic conditions yielded a 225% increase in end-fill vesical pressures (Pves) compared to controls. End-fill Pves returned to baseline with reperfusion during a subsequent filling cycle. Transient ischemia/hypoxia leads to an acute increase in tone in both DSM strips and ex vivo pig bladder. Remarkably, the effect is reversible with re-perfusion and may be blocked with anticholinergics, suggesting a relationship between acute ischemia and increased local acetylcholine release.

Can rectal catheters be avoided during paediatric urodynamic studies?

ABSTRACTObjective: To determine if the interpretation of urodynamic studies (UDS) in children without a rectal catheter may be similar to multi-channel studies, as UDS in children are challenging and can sometimes be difficult to interpret.Patients and methods: In this retrospective pilot study, 115 paediatric pressure–flow studies were included. A blinded investigator was given two sets of UDS traces. The first set had the vesical trace of all children and the second set had the multi-channel trace. The agreement between the interpretations of both the sets was tested by Cohen’s κ, and sensitivity, specificity, and predictive values were expressed with 95% confidence intervals (CIs). The voiding pattern was compared and Pearson’s correlation coefficient was used to analyse the pressure at maximum urinary flow (Qmax).Results: The most common indications for UDS were neurogenic bladder and posterior urethral valves. The interpretation of compliance and detrusor overactivity by single-channel analysis had a positive predictive value of 92.1% (95% CI 84.7–96.1%) and 89.4% (95% CI 78.3–95.6%), respectively, and a negative predictive value of 100% and 97.1% (95% CI 89.5–99.2%) respectively, in comparison to multi-channel analysis. Children with underactive detrusor were identified reliably by analysing the straining pressure pattern and flow curve. Amongst children who voided, the pressure at Qmax showed a moderate correlation (Pearson’s coefficient = 0.53) between the two groups.Conclusion: Rectal catheters may be avoided in a carefully selected group of children undergoing UDS who only need filling phase assessment.Abbreviations: DO: detrusor overactivity; EBC: expected bladder capacity; Pabd: abdominal pressure; Pdet: detrusor pressure; PUV: posterior urethral valve; (N)(P)PV: (negative) (positive) predictive value; Pves: vesical pressure; Qmax: maximum urinary flow rate; UDS: urodynamic studies; UI: urinary incontinence

Automated quantification of low amplitude rhythmic contractions (LARC) during real-world urodynamics identifies a potential detrusor overactivity subgroup.

ObjectivesDetrusor overactivity (DO) is characterized by non-voiding detrusor smooth muscle contractions during the bladder filling phase and often contributes to overactive bladder. In some patients DO is observed as isolated or sporadic contractions, while in others DO is manifested as low amplitude rhythmic contractions (LARC). The aim of this study was to develop an objective method to quantify LARC frequencies and amplitudes in urodynamic studies (UDS) and identify a subgroup DO of patients with LARC.MethodsAn automated Fast Fourier Transform (FFT) algorithm was developed to analyze a 205-second region of interest of retrospectively collected “real-world” UDS ending 30 seconds before voiding. The algorithm was designed to identify the three largest rhythmic amplitude peaks in vesical pressure (Pves) in the 1.75–6 cycle/minute frequency range. These peak Pves amplitudes were analyzed to determine whether they were 1) significant (above baseline Pves activity) and 2) independent (distinct from any in abdominal pressure (Pabd) rhythm).Results95 UDS met criteria for inclusion and were analyzed with the FFT algorithm. During a blinded visual analysis, a neurourologist/urodynamicist identified 52/95 (55%) patients as having DO. The FFT algorithm identified significant and independent (S&I) LARC in 14/52 (27%) patients with DO and 0/43 patients (0%) without DO, resulting in 100% specificity and a significant association (Fischer’s exact test, p<0.0001). The average slowest S&I LARC frequency in this DO subgroup was 3.20±0.34 cycles/min with an amplitude of 8.40±1.30 cm-H2O. This algorithm can analyze individual UDS in under 5 seconds, allowing real-time interpretation.ConclusionsAn FFT algorithm can be applied to “real-world” UDS to automatically characterize the frequency and amplitude of underlying LARC. This algorithm identified a potential subgroup of DO patients with LARC.

Minimally invasive measurement of vesical pressure for diagnosis of infravesical obstruction.

This study was focused on the clinical test of an improved and portable version of a previously described urethral connector (UC), designed for minimally invasive measurement of vesical pressure and diagnosis of infravesical obstruction in men. The conventional pressure-flow study (PFS) and the test with the new version of UC were applied to individuals reporting lower urinary tract symptoms (LUTS), who were then classified as obstructed or non-obstructed/equivocal based on the bladder outlet obstruction index (BOOI) from PFS data. Two-way analysis of variance was used to compare the values of urine flow rate and vesical pressure between methods and diagnoses. Vesical pressure and urine flow values were not significantly different between methods (P > 0.05), while the former was greater in the group classified as obstructed. The present results showed that the UC test can support the diagnosis of infravesical obstruction in a comparable way as that of the conventional urodynamic method, however with the advantages of simplicity and minimal invasiveness, having thus the potential to be an alternative method for long term follow-up of individuals reporting LUTS.

Effects of vesical and perfusion pressure on perfusate flow, and flow on vesical pressure, in the isolated perfused working pig bladder reveal a potential mechanism for the regulation of detrusor compliance.

Although there is evidence that deficits in bladder blood flow negatively impact bladder function, the effects of vesical, and perfusion pressures on bladder perfusion (perfusate flow), and of perfusate flow on vesical pressure, remain poorly understood. The present study used the isolated perfused working pig bladder model to examine the relationships between blood flow, and vesical and perfusion pressures. Vesical arteries of pig bladders obtained from a local slaughterhouse were cannulated and perfused with Krebs-Henseleit solution at different pressures, and with carbachol to cause bladder contraction. The urethra of each bladder was cannulated to permit filling (10 mL/min), isovolumetric contraction and emptying. A ureter was cannulated with a pressure sensor to monitor vesical pressure. When at rest (50 mL vesical volume), bladder vesical pressure was 8.06 ± 1.5 mmHg and perfusate flow driven by a pressure gradient of 105 mmHg was 22.5 ± 2 mL/min (58.9 ± 7.8 mL/min-100 g). During filling, vesical pressure increased and flow decreased, but not necessarily in-parallel. Perfusate flow decreased transiently during isovolumetric contraction, and flow increased during emptying. A reduction in perfusion pressure from ∼105 to ∼40 mmHg reduced flow from ∼70 to ∼20 mL/min-100g, and reduced flow correlated with reduced vesical pressure. Perfusate flow is dependent on bladder perfusion pressure, and not necessarily reciprocally dependent on vesical pressure. Vesical pressure is highly sensitive to the level of perfusate flow, which supports the hypothesis that vesical pressure is dependent on the level of detrusor smooth muscle contractile activity (tone), and that compliance is dependent on bladder perfusion.

MP63-07 CHARACTERIZATION OF LOW AMPLITUDE RHYTHMIC CONTRACTIONS DURING URODYNAMICS

You have accessJournal of UrologyUrodynamics/Lower Urinary Tract Dysfunction/Female Pelvic Medicine: Incontinence: Evaluation (Urodynamic Testing)1 Apr 2017MP63-07 CHARACTERIZATION OF LOW AMPLITUDE RHYTHMIC CONTRACTIONS DURING URODYNAMICS Zachary Cullingsworth, Brooks Kelly, William Simmons, Andrew Colhoun, Anna Nagle, Randy Vince, John Speich, and Adam Klausner Zachary CullingsworthZachary Cullingsworth More articles by this author , Brooks KellyBrooks Kelly More articles by this author , William SimmonsWilliam Simmons More articles by this author , Andrew ColhounAndrew Colhoun More articles by this author , Anna NagleAnna Nagle More articles by this author , Randy VinceRandy Vince More articles by this author , John SpeichJohn Speich More articles by this author , and Adam KlausnerAdam Klausner More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2017.02.1959AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Human detrusor smooth muscle (DSM) can exhibit low amplitude rhythmic contractions (LARC) which may contribute to overactive bladder (OAB) in some patients. The aim of this study was to develop an objective method to identify LARC during urodynamics (UD), categorize patients with significant LARC, and potentially begin to characterize a LARC-mediated OAB/detrusor overactivity subtype. METHODS An algorithm was developed to analyze UD filling data in low volume (1st 410 seconds) and high volume (final 410s) regions. Fast Fourier Transform (FFT) analysis identified the frequency (F) in the 1-6 cycle/min range associated with the maximum amplitude of the vesical pressure (Pves) in each region (Fig 1). A patient-specific range of interest corresponding to F ± 0.5 cycles/min was determined. Pves and Pabd amplitudes were analyzed separately to identify both significant (higher than average) and independent (distinct from Pabd) Pves signals. To be significant, Pves amplitude must be > 1.35 standard deviations (SD) above average Pves amplitude. To be independent, the Pabd amplitude must be < 1.35 SD above the average Pabd amplitude. SD of 1.35 was chosen using an iterative process in 0.05 SD increments to identify the maximum number of significant and independent signals. RESULTS This algorithm was used to retrospectively analyze 43 consecutive UD studies which included 25 (14 neurogenic, 11 idiopathic) with detrusor overactivity (58%). The average age of the entire group was 55±2 years and included 14 men and 29 women. FFT analysis identified a significant and independent Pves signal in 12/43 patients (28%) of which 8/12 (67%, 5 neurogenic, 3 idiopathic) had detrusor overactivity. The average age of patients with significant and independent signals was 54±5 years and included 6 men and 6 women. CONCLUSIONS Analysis of LARC during UD testing identified a subset of patients with a significant and independent slow wave frequency in Pves. Further refinements of this technique may help identify subsets of individuals with LARC-mediated OAB/detrusor overactivity. © 2017FiguresReferencesRelatedDetails Volume 197Issue 4SApril 2017Page: e838 Advertisement Copyright & Permissions© 2017MetricsAuthor Information Zachary Cullingsworth More articles by this author Brooks Kelly More articles by this author William Simmons More articles by this author Andrew Colhoun More articles by this author Anna Nagle More articles by this author Randy Vince More articles by this author John Speich More articles by this author Adam Klausner More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

The value of intra-abdominal pressure monitoring through transvesical route in the choice and outcome of management of congenital abdominal wall defects

Introduction Gastroschisis and omphalocele are most common congenital abdominal wall defects (AWDs). Surgical management aims to reduce the evisceration safely, close the defect with a cosmetically acceptable outcome under guidance of intraoperative monitoring of intra-abdominal pressure (IAP). Intravesical pressure monitoring technique recommended by (WSACS) is the most reliable technique for IAP measurement in neonates. Aim The aim of this study is to assess the value of IAP monitoring via vesical pressure measurement in the choice and outcome of management of congenital AWDs. Patients and methods This is a prospective study of 25 cases that suffered congenital anterior AWDs (gastroschisis and omphalocele) admitted to Mansoura University Children Hospital during the period from October 2013 to October 2015. They were all operated upon guided by IVP monitoring during and after repair. Results In our study, 14 (56%) cases presented with gastroschisis and 11 (44%) presented with exomphalos with a median age of 24 h. Males (56%) were slightly more than females (44%). Congenital anomalies were reported in 16 cases (64%). Primary fascial closure was successful in 15 (60%) cases, whereas Silo repair was done in six (24%) cases and skin closure in only four (16%) cases. During the attempts of closure the mean abdominal perfusion pressure was 40.24 ± 5.59, the mean peak inspiratory pressure was 24 ±6.11 and the mean IAP was 22.60± 6.89. Two cases developed intra-abdominal hypertension after abdominal closure (8%) and only one of them needed decompressive laparotomy (4%). Postoperative complications were reported in 15 (60%) cases and mortality occurred in eight (32%) cases. Conclusion Increased IAP secondary to forceful closure of the abdominal defect is associated with the occurrence of complications. IVP monitoring is feasible during closure of AWDs and a threshold of 20cm H2O is appropriate to decide between primary and staged approach. Keywords : congenital abdominal wall defect, intravesical pressure, intra-abdominal hypertension

Valsalva versus straining: There is a distinct difference in resulting bladder neck and puborectalis muscle position.

To assess the effects of the Valsalva manoeuvre versus straining on bladder neck (BN) and puborectalis muscle (PR) position, BN stiffness and pelvic floor muscle (PFM) activation in urinary incontinent women and healthy continent controls. We recruited 17 continent and 85 incontinent women. A Microtip transducer measured urethral and vesical/abdominal pressures. A surface EMG electrode attached to a sponge was placed vaginally at the pelvic floor level. BN and PR movements were assessed with perineal ultrasound. Stiffness was calculated as the increase in vesical pressure per descent of BN and PR during manoeuvres. Women were standing and asked to perform a Valsalva against a closed mouth and glottis and thereafter to relax the PFM and strain as if defecating. To demonstrate a difference of 5 mm in PR descent between Valsalva and straining with a power of 80% and α = 0.05, 24 women were necessary. During Valsalva, 71% of continent and 76% of incontinent women demonstrated PFM activation, whereas during straining significantly fewer women activated the PFM (29% and 32%, respectively). During straining, BN and PR muscle descent was significantly greater and stiffness was lower than during Valsalva in both incontinent and continent women. Valsalva and straining are different tasks with different PFM activation patterns. The PF is stiffer with Valsalva resulting in better BN support whereas straining leads to more PR and BN descent. These terms should not be used interchangeably and women have to be instructed carefully to allow appropriate interpretation of data.

Suburothelial Bladder Contraction Detection with Implanted Pressure Sensor.

AimsManaging bladder pressure in patients with neurogenic bladders is needed to improve rehabilitation options, avoid upper tract damage, incontinence, and their associated co-morbidities and mortality. Current methods of determining bladder contractions are not amenable to chronic or ambulatory settings. In this study we evaluated detection of bladder contractions using a novel piezoelectric catheter-free pressure sensor placed in a suburothelial bladder location in animals.MethodsWired prototypes of the pressure monitor were implanted into 2 nonsurvival (feline and canine) and one 13-day survival (canine) animal. Vesical pressures were obtained from the device in both suburothelial and intraluminal locations and simultaneously from a pressure sensing catheter in the bladder. Intravesical pressure was monitored in the survival animal over 10 days from the suburothelial location and necropsy was performed to assess migration and erosion.ResultsIn the nonsurvival animals, the average correlation between device and reference catheter data was high during both electrically stimulated bladder contractions and manual compressions (r = 0.93±0.03, r = 0.89±0.03). Measured pressures correlated strongly (r = 0.98±0.02) when the device was placed in the bladder lumen. The survival animal initially recorded physiologic data, but later this deteriorated. However, endstage intraluminal device recordings correlated (r = 0.85±0.13) with the pressure catheter. Significant erosion of the implant through the detrusor was found.ConclusionsThis study confirms correlation between suburothelial pressure readings and intravesical bladder pressures. Due to device erosion during ambulatory studies, a wireless implant is recommended for clinical rehabilitation applications.

AB282. SPR-09 A method to quantify of bladder wall biomechanics using ultrasound imaging in conjunction with urodynamics

ObjectiveOveractive bladder (OAB) is often associated with detrusor over-activity which is characterized by biomechanical changes in the smooth muscle of the bladder wall, but there is no established method to measure these changes in vivo. This study’s goal was to develop a novel method to determine detrusor wall biomechanical parameters during urodynamics through the incorporation of abdominal ultrasound imaging.MethodsIndividuals with OAB underwent ultrasound imaging during filling. Fill rate was 10% cystometric capacity (CCap) as determined by an initial fill. Ultrasound images were obtained using a Philips Epiq 7 machine with a 1–5 MHz abdominal probe to capture midsagittal and transverse images at 1 min intervals. Using image data and vesical pressure (Pves), detrusor wall tension, stress, and compliance were calculated. From each cross−sectional image, luminal and wall areas along with inner perimeters were measured. In the sagittal and transverse planes, wall tension was calculated as Pves*luminal area, wall stress as tension/wall area, and strain as the change in perimeter normalized to the perimeter at 10% CCap. Elastic modulus was calculated as stress/strain in each direction. Patient-reported fullness sensation was continuously recorded.ResultsData from five individuals with OAB showed that detrusor wall tension, volume, and strain had the highest correlation to continuous bladder sensation of all quantities measured. This finding demonstrates that Pves and Pdet measurements during urodynamics may not necessarily reflect the underlying state of detrusor wall tension.ConclusionsThis study demonstrates that detrusor wall tension, stress, strain, and elastic modulus can be calculated by adding ultrasound imaging to standard urodynamics. This technique may be useful in better understanding the biomechanics involved in OAB and other bladder disorders.Funding Source(s)Research funding for this study was provided by the Virginia Commonwealth University Presidential Research Quest Fund and NIH grant R01DK101719.

Urodynamic assessment of short-term effects of pelvic radiotherapy on bladder function in patients with gynecologic cancers.

To determine the short-term effects of adjuvant or primary curative radiotherapy (RT) on the urinary system in women with gynecologic cancer. This is a prospective, concurrent cohort study including 55 patients with gynecologic cancer who were divided into three groups. Group 1 included 10 patients who were administered adjuvant RT following a radical hysterectomy (RH); Group 2 included 36 patients who were administered adjuvant RT following a type 1 hysterectomy and Group 3 included 9 patients who were administered primary curative RT. Urogynecologic assessments were carried out on patients before and six months after the treatment. Compared to pretreatment, no significant differences were observed in any of the three groups after treatment in terms of incontinence, first urge to urinate, normal urge to urinate, severe urge to urinate and changes in residual urine volumes. There was a significant decrease in maximal vesical pressure after treatment in Group 1 and Group 3. The maxi-mum detrusor pressure decreased significantly in Group 1. The post-treatment decline in bladder capacity in Group 1 and Group 2 was also significant. RH and pelvic RT cause lower urinary system dysfunction. Especially patients who receive primary curative RT and patients who are administered RT after RH, where more pelvic denervation occurs, are at higher risk due to high doses of RT.

CYSTOMANOMETRY – ONE OF THE ASSESSMENT METHODS OF THE URODYNAMIC INDEXES IN PATIENTS WITH INFILTRATIVE CERVICAL CANCER

Aim: To evaluate contractile function of urinary bladder in patients with infiltrative cervical cancer after nerve-sparing radical hysterectomy (NSRH). Patients and Methods: Ninety patients with infiltrative cervical cancer were treated with nerve-sparing radical hysterectomy (n=45, NSRH group), or radical hysterectomy (RHE III) without preservation of pelvic autonomic plexuses (n=45, RHE group). Cystomanometry was carried out using urodynamic apparatus “Uro-Pro” by standard method. Results: Using cystomanometry, we have evaluated the main urodynamic indexes such as pressure upon bladder filling (P1), first vesical tenesmus pressure (P2); change of detrusor pressure upon change of bladder volume (P), volume of urinary bladder (V), and complience of urinary bladder wall (C) at preoperative period and postoperative period in both groups of patients. While at preoperative period P1 indexes did not differ significantly between the groups, after NSRH performance, P1 values were significantly higher than P1 values in the group of patients treated with RHE III (8,29±1,1 cm H2O versus 3,51±0,8 cm H2O (р&lt;0,05)). P2 indexes in patients from both groups before and after surgical treatment differed significantly and were 6,82±0,4 cm H2O and 12,27±1,2 cm H2O (р&lt;0,05) in NSRH group, and 5,44±0,6 cm H2O and 10,62±1,1 cm H2O (р&lt;0,05) in RHE III group. The P value in both patients groups before and after the surgical treatments was significantly different, and demonstrated a gradual elevation of urinary bladder pressure, especially in the patients from RHE III treated group. Urinary bladder volume at preoperative and postoperative periods in NSRH-treated group remained practically unaltered (209,78±14,2 ml and 216,86±14,9 ml (р&gt;0,5) respectively), while in the patients from RHE III-treated group after surgical treatment an urinary bladder volume significantly decreased from 188,4±10,5 ml to 161,9±9,8 ml (р&lt;0,05). An analysis of compliance of urinary bladder wall (C) has shown that after surgical treatment in RHE group C value decreased by 75% while in NSE group this index decreased just by 25%. Conclusions: The data of urodynamic study evidence the better preservation of urinary bladder functions in patients with infiltrative cervical cancer after NSRH than in the patients treated with RHE III.

Urodynamic Evaluation of Female Patients with Metabolic Syndrome

Objective : In this study, our main objective is to show the connection between metabolic syndrome (MetS) and bladder functions by using urodynamic evaluation in female MetS patients. Materials and Methods : 131 female patients referred to our clinic for urodynamic evaluation from April 2014 to December 2014 were included in our study. 85 of these patients were diagnosed with MetS (study group) meanwhile 46 patients did not meet MetS criteria (control group). MetS definitions were taken from National Cholesterol Education Program’s Third Adult Treatment Panel criteria. SPSS 17.0 was used for statistical analysis of data and p<0.05 values were deemed as statistically significant. Results : Urodynamic results of 131 patients were analyzed and patients were divided into study and control groups in accordance with their MetS profile. 85 patients were included in the study group and rest 46 were used as the controls. A statistically significant difference was detected when IPSS results were separated into low, intermediate and severe between study and controls (p=0.007). Moreover, urge-type incontinence was more frequent in MetS patients when compared with control group (p<0.001). However, there was no significant difference between groups in terms of SEAPI scores and IPSS. Patients with MetS had significantly higher detrusor, vesical and abdominal pressure in comparison with control group (p<0.001). No significant difference was found in uninhibited contractions, first urinary sense, strong desire to urinate, Valsalva leak-point pressure (VLPP) and abdominal leak-point pressure (ALPP) parameters between the groups Conclusion : Our results showed that MetS and its components can be associated with neurogenic bladder symptoms due to peripheral neuropathy and urge incontinence. Female patients with MetS have significantly higher post-voiding residue and intravesical pressure in comparison with control group. Further clinical studies with longer and controlled series are necessary for clarification of the metabolic syndrome’s effect on bladder dysfunction on a molecular level.

Development of an Improved Animal Model of Overactive Bladder: Transperineal Ligation versus Transperitoneal Ligation in Male Rats.

PurposeWe compared a transperineal ligation model and a transperitoneal ligation model in male rats to determine which animal model of overactive bladder (OAB) was more useful based on cystometrography, estimations of oxidative stress, and measurements of pro-inflammatory cytokine levels.Materials and MethodsMale rats were randomly divided into three groups (n=15 in each): the control group, the transperineal ligation group, and the transperitoneal ligation group. Four weeks after the ligation procedure, cystometrography was performed and oxidative stress, pro-inflammatory cytokine levels, and histologic changes were evaluated. Oxidative stress was assessed by measuring 8-hydroxy-20-deoxyguanosine and superoxide dismutase, and pro-inflammatory cytokine activity was investigated by measuring levels of interleukin (IL)-6, IL-8, and tumor necrosis factor-α.ResultsThe transperineal model led to results similar to those observed for the transperitoneal model, namely (1) increased voiding frequency and reductions in the non-voiding contraction interval and the maximal vesical pressure, (2) increased levels of oxidative stress markers, (3) increased pro-inflammatory cytokine levels, and (4) fibrotic changes in the bladder tissue.ConclusionsWe suggest that the transperineal procedure can be used as an alternative OAB model in male rats.

下大静脈内にair bubbleを認めた気腫性膀胱炎の1例

A 76-year-old diabetic woman was referred to our hospital with an episode of high fever and sub-abdominal pain. Computed tomography (CT) of the pelvis revealed gas accumulation within the lumen and wall of the bladder and CT of the abdomen demonstrated bubbles in the inferior vena cava. She recovered by urinary drainage and antibiotic therapy. Urinary culture revealed Escherichia coli. CT after the therapy didn't demonstrate gas accumulation of the bladder and bubbles in the inferior vena cava. Emphysematous urinary tract infections (UTIs) have the high fatality rate, it seems to be a possibility that venous bubbles with emphysematous UTIs contribute to the high fatality rate such as air embolisms. It was suspected that bacterial injury of the bladder wall and high vesical pressure caused by urinary outlet obstruction such as neurogenic bladder lead gas translocation into the venous system. Six previous cases of emphysematous UTIs (three emphysematous cystitis cases and three emphysematous pyelonephritis cases) with venous bubbles have been reported to this day. Our case is seems to be the fourth case report that venous bubbles with emphysematous cystitis was demonstrated.

Effects of Bladder Function by Early Tamsulosin Treatment in a Spinal Cord Injury Rat Model

ObjectiveTo investigate the effects of early tamsulosin treatment on changes in bladder characteristics after a spinal cord injury.MethodsWe divided 45 rats into three groups: the control (CON) group, the spinal cord injury (SCI) group, and the SCI+tamsulosin treatment (SCI+TAM) group. Spinal cord transection was performed in the SCI and SCI+TAM groups. Tamsulosin was injected for 7 days in the SCI+TAM group. Intravesical and intra-abdominal catheters were implanted before cord injury. Basal pressure (BP), maximal vesical pressure (MVP), micturition volume (MV), and voiding interval time (VIT) were measured at 7 days after SCI. The bladder was then removed and used for an in vitro organ bath study and Western blot analysis. The percentage changes in contractility from baseline after acetylcholine alone, pretreatment with a muscarinic 2 (M2) receptor blocker (AQ-RA741), and pretreatment with a M3 receptor blocker (4-DAMP) were compared among the groups. Western blot analyses were performed to determine expression levels of pERK1/2 and rho-kinase.ResultsIn cystometry, MVP, BP, MV, and VIT showed changes in the SCI and SCI+TAM groups versus the CON group (p<0.05). In the organ bath study, acetylcholine-induced contractility in the three groups differed significantly (p<0.05). Additionally, acetylcholine-induced contractility with 4-DAMP pretreatment was reduced significantly in the SCI+TAM group versus the SCI group. In Western blotting, pERK1/2 expression was stronger (p<0.05) and rho-kinase expression was weaker in the SCI+TAM group than the SCI group (p<0.05).ConclusionThese results suggest that the bladder contraction due to acetylcholine after SCI can be decreased by tamsulosin in the acute stage and this involves changes in pERK1/2 and rho-kinase.

Are the measurements of water-filled and air-charged catheters the same in urodynamics? Response to comments

Dear Editor, We appreciate Dr. Valentini’s interest [1] in our article [2]. Her criticisms of our study are essentially that: (1) The use of two catheters to measure simultaneously intravesical pressure leads to nonphysiological conditions. This, in addition to a possible interaction between the two catheters, may affect the pressures measured. (2) Detrusor pressure should not be compared in the study. (3) Vesical pressure measured by the water-filled catheter is higher than the vesical pressure measured by the air-charged catheter. We address each of these three points below.

Different urodynamic patterns in female bladder outlet obstruction: Can urodynamics alone reach the diagnosis?

ObjectiveTo define the different urodynamic patterns in female bladder outlet obstruction (BOO) and to assess whether urodynamics alone can be relied on for the diagnosis. Patients and methodsThis prospective study included 60 clinically obstructed women and 27 with stress urinary incontinence as a control group. All patients had pressure-flow studies and were divided into four groups. Group A (control group, 27 patients) and group B (22) had a maximum urinary flow rate (Qmax) of >15mL/s and a detrusor pressure at Qmax (PdetQmax) of <30 or >30cm H2O, respectively. Group C (20 patients) and group D (18) had a Qmax of <15mL/s and a PdetQmax of >30 or <30cm H2O, respectively. ResultsThe mean Qmax for groups A, B, C, and D were 21.8, 21.9, 10.8 and 9.9mL/s, respectively, while the mean PdetQmax was 20.8, 40.4, 48.7, and 18.7cm H2O, respectively. The residual urine volume was <100mL in groups A and B but >100mL in groups C and D. When compared with group A, groups B–D had a significant difference in vesical pressure, groups B and C had a significant difference in PdetQmax, while Qmax, the maximum voided volume and residual urine volume were significantly different in groups C and D. Group A was obviously unobstructed, group B might have early obstruction, group C had compensated obstruction, while group D can be considered to have late de-compensated obstruction. ConclusionsBOO in females has three different urodynamic patterns, i.e. early, compensated and late obstruction. However, urodynamics should be combined with the clinical presentation and residual urine volume for an accurate diagnosis.

TRPM8 agonists modulate contraction of the pig urinary bladder

The transient receptor potential melastin-8 (TRPM8) channel is activated by the "cooling" compounds menthol and icilin. Pathophysiologically, it is implicated in the overactive bladder and bladder cooling reflex, but the activity of TRPM8 in normal bladder physiology is poorly understood. We investigated the distribution of TRPM8 channels and the effect of TRPM8 agonists on the contractile function of pig bladder (n = 35) strips and whole bladders. The distribution of TRPM8 was examined by immunohistochemistry. The effect of vesical or intravascular menthol (0.1-0.3 mmol/L) or icilin (50 μmol/L) on carbachol-induced isolated whole bladder contractions was monitored by recording vesical pressure. Strips of denuded detrusor or mucosa were mounted in organ baths to study the effect of TRPM8 agonists on the contractile responses to 10 μmol/L carbachol. TRPM8-like immunoreactivity was detected on pig urothelium. Intravascular menthol (0.3 mmol/L) and icilin (50 μmol/L) significantly decreased the magnitude of carbachol-induced whole bladder contraction, whereas vesical administration significantly increased the response. In detrusor and mucosal strips, both menthol (0.3 mmol/L) and icilin (50 μmol/L) inhibited carbachol-induced contractions. We conclude that the TRPM8 channel is expressed on the urothelium of pig bladder. In the whole organ, exposure of the urothelium to menthol or icilin increases the contractile response to carbachol. Where detrusor muscle is exposed directly to these compounds, the contractile response to carbachol is reduced.

Effect of material properties on predicted vesical pressure during a cough in a simplified computational model of the bladder and urethra.

Stress urinary incontinence is a condition that affects mainly women and is characterized by the involuntary loss of urine in conjunction with an increase in abdominal pressure but in the absence of a bladder contraction. In spite of the large number of women affected by this condition, little is known regarding the mechanics associated with the maintenance of continence in women. Urodynamic measurements of the pressure acting on the bladder and the pressures developed within the bladder and the urethra offer a potential starting point for constructing computational models of the bladder and urethra during stress events. The measured pressures can be utilized in these models to provide information to specify loads and validate the models. The main goals of this study were to investigate the feasibility of incorporating human urodynamic pressure data into a computational model of the bladder and the urethra during a cough and determine if the resulting model could be validated through comparison of predicted and measured vesical pressure. The results of this study indicated that simplified models can predict vesical pressures that differ by less than 5cmH(2)O (<10%) compared to urodynamic pressure measurements. In addition, varying material properties had a minimal impact on the vesical pressure and displacements predicted by the model. The latter finding limits the use of vesical pressure as a validation criterion since different parameters can yield similar results in the same model. However, the insensitivity of vesical pressure predictions to material properties ensures that the outcome of our models is not highly sensitive to tissue material properties, which are not well characterized.