Voiding Pressure Research Articles

Posterior Urethral Valves: Primary Voiding Pressures and Kidney Function in Infants

We evaluated whether high voiding pressures in patients with posterior urethral valves are associated with reduced kidney function. A total of 25 children younger than 12 months with posterior urethral valves underwent urodynamic evaluation within 15 days of valve ablation between 1994 and 2007. Six patients underwent primary urodynamics before and 19 after valve ablation. A total of 17 patients underwent repeat studies after 1 month and 1 year. Maximum detrusor pressures during voiding and cystometric bladder capacity were compared with kidney function tests. Maximum detrusor pressures during voiding was compared with a control group and data from other studies of male infants. At presentation median cystometric bladder capacity was 22 ml (range 5 to 125) and maximum voiding pressure was 112 cm H(2)O (40 to 331). There was no statistical difference in bladder capacity and voiding pressures before and after valve ablation. Also, patients with and without vesicoureteral reflux had similar bladder capacities and voiding pressures. There was no association between primary voiding pressures and serum creatinine levels or kidney split function during the first year of life. Primary voiding pressures were about the same as in a control group and in previous studies of males who were healthy, who had reflux or whose status was post-pyelonephritis. Voiding pressures had decreased and bladder capacity had increased significantly at 1-year followup. Voiding pressures in infants with posterior urethral valves are as high as but not higher than other male infants. High voiding pressures postnatally are not associated with reduced kidney function.

Bladder outlet obstruction in male cystinuria mice

Cystinuria is the most common inherited cause of urinary tract stones in children. It can lead to obstructive uropathy, which is a major cause of renal failure. Genetic studies have identified two genes, SLC3A1 and SLC7A9, to be directly involved in cystine stone formation. Slc3a1 knockout male mice develop cystine stones in the bladder and, to a lesser extent, in the kidney. Slc3a1 knockout female mice also develop cystinuria, but they do not form stones. The specific aim of this study was to characterize bladder function in cystinuria mice. Eight control (4 male, 4 female) and 16 Slc3a1 knockout (9 male, 7 female) mice of mixed strain background (C57B/129, age 4-5 months) were evaluated. Each mouse was anesthetized and the bladder dome catheterized for cystometry. Immediately following cystometry, the bladder was excised, weighed, and separated into three full thickness strips for contractile studies. Bladders from cystinuria male mice had significantly increased weight, all of them had stones, decreased compliance, and decreased contractile responses to field stimulation, ATP, carbachol, and KCl. Compared with controls, female knockout mice showed normal bladder weight, decreased voiding pressure, slightly decreased compliance, and slightly decreased contractile responses. These studies clearly demonstrate that the bladder stones that developed in the male cystinuria mice resulted in a partial outlet obstruction. Although the female cystinuria mice did not have bladder stones, bladder function was mildly impaired; presumably by the presence of cystine crystals.

Urodynamic Changes and Initial Results of the AdVance Male Sling

To present the urodynamic changes and early results associated with the AdVance male sling. The AdVance male sling is a treatment option for postprostatectomy incontinence (PPI), with the goal of eliminating urinary incontinence without affecting voiding parameters. A concern of any procedure in treating men with PPI is whether the treatment induces obstruction and causes retention. Data were prospectively collected from 13 patients undergoing AdVance male sling placement for PPI. Urodynamic testing was performed at baseline and repeated at 6 months postoperatively. A 24-hour pad test and the Incontinence Quality of Life questionnaire were completed preoperatively and at 3 and 6 months postoperatively. The median age at the procedure was 63.3 years (range 44.7-74.7). The mean preoperative and 6-month postoperative patient-reported pad use was 4.52 and 1.04, respectively (2-tailed t test, P = .0009). The 24-hour pad test, performed preoperatively and at 6 months postoperatively, yielded a pad weight of 779.3 and 67.6 g, respectively (P = .03). The Valsalva leak point pressure improved significantly (P = .032), but the detrusor voiding pressure, postvoid residual urine volume, and maximal and average flow rates remained relatively unchanged. At 3 and 6 months postoperatively, the Incontinence Quality of Life scores had improved significantly compared with the preoperative scores (P <.01). These results are encouraging, because this series has demonstrated a significant improvement in patient-reported pad use, 24-hour pad test weights, and Valsalva leak point pressure without signs of obstruction. The improvement in incontinence was accompanied without any changes in the other voiding parameters and with significant improvement in the quality-of-life measures. Ongoing studies with longer follow-up are pending to compare their results with these promising early results.

Bladder Function Recovery in Rats With Traumatic Spinal Cord Injury After Transplantation of Neuronal-Glial Restricted Precursors or Bone Marrow Stromal Cells

We investigated functional recovery of the lower urinary system in rats with spinal cord injury after transplanting neuronal restricted precursors/glial restricted precursors or neural cells derived from bone marrow stromal cells into the injured area of the spinal cord. A total of 30 rats underwent experimentation in 4 groups, including group 1--sham operation, group 2--spinal cord injury plus neuronal restricted precursor/glial restricted precursor transplantation, group 3--spinal cord injury plus bone marrow stromal cell transplantation and group 4--spinal cord injury control. All rats in the 4 groups were investigated urodynamically and sacrificed on day 28 after transplantation. The cells transplanted into the injured spinal cord underwent histological investigation. Transplanted cells (neuronal and glial restricted precursors, and bone marrow stromal cells) were found to maintain a presence in the injured spinal cord area. Baseline pressure, maximum capacity, mean uninhibited contraction amplitude, mean voiding pressure, voided volume and post-void residual volume were significantly better in groups 2 and 3 than in group 4, while baseline pressure in group 2 was better than that in group 3. We found no significant difference among the groups according to mean uninhibited contraction frequency. Although neuronal/glial restricted precursor transplanted rats seemed to have more improvement, all rats in groups 2 and 3 showed some significant improvement in lower urinary system function. On the other hand, the level of this improvement was far from complete functional recovery.

Glycogen Deposition in Obstructed Human Bladder

Purpose In an animal model of urethral obstruction glycogen deposition in the bladder muscle was found to be a marker for previous increased voiding pressure and decreased compliance [de Jong et al. Neurourol Urodynam 2008; 27: 454-60]. Here we measured if also in the human bladder glycogen deposition marks adaptation to increased pressure in the filling phase by comparing two groups: normal leak-point pressure + normal compliance (Vesico Ureteral Reflux) and high leak-point pressure + low compliance (MyeloMeningoCele). Material and Methods Rest material was obtained from patients undergoing a ureter reimplantation (VUR group, n = 8) or an augmentation (MMC group, n = 16). Glycogen deposition was scored from 0 to 3 on periodate acid Schiffs (PAS) stained sections. Bladder function was assessed with video urodynamics yielding: CAPacity (ml), COMpliance (from 0,good, to 2, bad), INStability (0,absent, to 2, severe), Leak Point Pressure (cm water). Significance of difference was tested with a student t-test. Results Group PAS Cap COM INS LPP VVR group 1.6 ± 0.3 217 ± 47 0.29 ± 0.17 0.13 ± 0.13 17 ± 3 MMC group 2.5 ± 0.12 83 ± 11 1.19 ± 0.15 0.8 ± 0.23 64 ± 5 p -value Discussion In Guinea pigs glycogen deposition in the bladder muscle marks adaptation to prolonged periods of increased bladder pressure. This marker function has now been confirmed for the human bladder. As glycogen is deposited in response to ischemia this suggests the increased pressure is linked with ischemic conditions. Next to extrinsic conditions like an obstruction downstream this intrinsic bladder condition might be involved in the continuing loss of bladder function that, often unexplained, occurs in patients with structural/functional obstruction. This opens new venues for monitoring bladder function (bladder wall blood supply and saturation) and new angles of treatment (maintaining proper bladderwall saturation).

The effect of intravesical electrical stimulation on bladder function and synaptic neurotransmission in the rat spinal cord after spinal cord injury

To investigate the effects of intravesical electrical stimulation (IVES) on bladder function and synaptic neurotransmission in the lumbosacral spinal cord in the spinalized rat, as the clinical benefits of IVES in patients with increased residual urine or reduced bladder capacity have been reported but studies on the mechanism of IVES have mainly focused on bladder A delta afferents in central nervous system-intact rats. In all, 30 female Sprague-Dawley rats were divided equally into three groups: normal control rats, sham-stimulated spinalized rats and IVES-treated spinalized rats. IVES was started 5 weeks after spinal cord injury (SCI) and was performed 20 min a day for 5 consecutive days. At 7 days after IVES, conscious filling cystometry was performed. Sections from the L6 and S1 spinal cord segments were examined for n-methyl-d-aspartic acid receptor 1 (NMDAR1) subunit and gamma-aminobutyric acid (GABA) immunoactivity. In IVES-treated spinalized rats, the number and maximal pressure of nonvoiding detrusor contractions were significantly less than in sham-stimulated spinalized rats. The mean maximal voiding pressure was also lower in IVES-treated than in sham-stimulated spinalized rats. IVES significantly reduced the interval between voiding contractions compared with the untreated spinalized rats. There was an overall increase in NMDAR1 immunoactivity after SCI, which was significantly lower in IVES-treated spinalized rats. Immunoactivity of GABA after SCI was significantly lower than in the control group and was significantly higher in IVES-treated spinalized rats. Our results suggest that IVES might affect voiding contractions in addition to inhibiting C-fibre activity and that IVES seems to have a more complex effect on the bladder control pathway. For synaptic neurotransmission in the spinal cord, IVES could possibly shift the balance between excitation and inhibition towards inhibition.

SACRAL NEUROMODULATION FOR THE TREATMENT OF REFRACTORY VOIDING DYSFUNCTION IN THE ELDERLY POPULATION

We hypothesized that warm infusion solution should be used for urodynamic studies in children because it more closely simulates normal physiology. Thus, we conducted a prospective randomized study comparing consecutive room temperature (RT) and body temperature (BT) cystometrograms (CMG) in the same child.Subjects underwent identical CMGs using RT and BT saline in random order. Maximum cystometric bladder capacity (CBC), pressure at CBC, uninhibited detrusor contractions, detrusor leak point pressure, maximum flow rate, pressure at maximum flow, maximum voiding pressure, residual urine and pressure specific volumes below 20 and 30 cm water were compared. Data were analyzed using ANOVA, t test, and chi-square.RT and BT CMGs in 44 males and 47 females with a mean age of 8.6 years were compared. Of the children 58 (64%) had spinal dysraphism, 8 (9%) had cerebral palsy, 5 (6%) had posterior urethral valves and 20 (21%) had recurrent urinary tract infection, daytime incontinence or frequency/urgency symptoms. Maximum CBC, pressure at CBC, and pressure specific volumes below 20 and 30 cm water were significantly lower (10% to 15%) during BT cystometry. Maximum flow rate was higher with BT saline. Detrusor leak point pressure, pressure at maximum flow, maximum voiding pressure, and residual urine did not differ. Uninhibited detrusor contractions were more frequent during RT infusions. No gender differences were found. The discrepancies between RT and BT cystometry were most prominent in infants, children with spinal dysraphism and children with large bladders.There is a difference between cystometries performed using RT and BT saline. Capacity, storage variables and detrusor activity are diminished during BT cystometry. Although statistically significant differences were found between consecutive RT and BT CMGs, the magnitude of the difference may not be clinically relevant to change management. As such, we do not believe it is necessary to use warm infusion solution on a systematic basis for urodynamic studies in children. However, for children younger than 2 years when the magnitude was more relevant, the use of warm solution is recommended.

Urodynamic Measurements by Radiotelemetry in Conscious, Freely Moving Beagle Dogs

Urodynamics have been traditionally recorded in anesthetized or conscious animals implanted with a bladder catheter that is used to artificially fill the bladder while measuring intravesicular bladder pressure. Anesthesia alters the urodynamics and in the conscious state this methodology requires that the dogs be tethered/restrained, which evokes stress and limits the period of continuous urodynamic assessment. A more physiological and chronic method of evaluating pharmacological responses on urodynamics is necessary. Adult female beagle dogs were surgically instrumented with radiotelemetry transmitters enabling urodynamic/hemodynamic recordings. Telemetered urodynamics were compared to those measured in anesthetized dogs receiving bladder infusion of saline. The response to diuresis with furosemide (Intervet, Millsboro, Delaware) and the M3 selective antimuscarinic darifenacin (Matrix Laboratories, Hyderabad, India) were evaluated. Saline infused, anesthetized dogs demonstrated lower peak micturition pressure and higher threshold pressure than conscious, freely moving telemetered dogs. In telemetered dogs a single dose of furosemide increased voiding frequency and average urine volume per void. Darifenacin decreased peak voiding pressure without affecting voiding frequency. Telemetry provides the potential to significantly decrease animal use while enabling the continuous monitoring of urodynamics under more physiological conditions without tethering or artificial filling. In addition, this new model facilitates evaluation of the chronic efficacy of new urological therapies.

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.

Protective Effect of Hyaluronic Acid on Cyclophosphamide-Induced Cystitis in Rats

Purpose: We investigated the effect and duration of hyaluronic acid (HA) on the bladder of rats with cyclophosphamide (CYP)-induced cystitis. Materials and Methods: CYP (250 mg/kg) was injected intraperitoneally in female Sprague-Dawley rats to induce cystitis. HA (0.5%) was instilled intravesically. First, the rats were separated into 2 groups for urodynamic study (CYP group, CYP+HA group), and we assessed the inter-contraction interval, maximal voiding pressure (MVP), and pressure threshold of the 2 groups. Second, the rats were separated into 3 groups to assess the duration of effect of HA (CYP group; HA-1 group: HA was instilled 1 day before injection of CYP; HA-3 group: HA was instilled 3 days before injection of CYP), and we assessed the voiding interval for 7 days after confining the rats in metabolic cages. Results: The inter-contraction interval of the CYP+HA group (236.018.3 min) was significantly longer than that of the CYP group (178.013.4 min; p 1.2 vs. 34.02.4 cmH2O, respectively; p=0.56). The pressure threshold of the CYP+HA group (9.90.5 cmH2O) was significantly longer than that of the CYP group (13.20.7 cmH2O; p=0.002). The voiding interval decreased in each of the 3 groups according to the time after cystitis had been induced. The voiding interval was maximally decreased on the second day and returned to the pre-CYP injection level on the fifth day in each group. There was a significant difference in voiding interval among the 3 groups on the second day (p0.05). Conclusions: HA has an effect of increasing the voiding interval in rats with CYP-induced cystitis, and the duration of effect is concluded to be 5 days.

Long-term effects of diabetes mellitus on voiding function in a new model of type 2 diabetes mellitus, the Spontaneously Diabetic Torii (SDT) rat

The spontaneously diabetic Torii (SDT) rat has recently been established as a model of type 2 diabetes mellitus (DM). The usefulness of this rat model for the study of diabetic voiding dysfunction was investigated. Male SDT rats and male Sprague-Dawley (SD) rats were used. Voiding function was evaluated by a metabolic cage study and cystometry. Total voided volume for 24 h, mean voided volume, and urinary frequency for 24 h were significantly greater in SDT rats at the age of 36 weeks. From cystometry mean inter-micturition interval (IMI) was significantly longer in SDT rats at the age of 22 and 36 weeks. In SDT rats mean IMI was significantly longer at the age of 36 weeks than at the age of 22 weeks. Mean voiding pressure was significantly higher in SDT rats at the age of 22 and 36 weeks. In the present study, SDT rats showed typical diabetic voiding dysfunction similar to other diabetic rat models. It was suggested that activity of the bladder afferent pathways is decreased and the urethral relaxation mechanism is impaired in SDT rats. In addition, SDT rats are suitable to study chronic diabetic voiding dysfunction because they survive without insulin treatment for as long as 60 weeks.

Effects of Intravesical Instillation of Antimuscarinics on Bladder Overactivity Induced by Intravesical Instillation of Adenosine Triphosphate in Rats

Purpose: Adenosine triphosphate (ATP) from the urothelium acts as a sensory neurotransmitter and is augmented in many diseases, such as overactive bladder. We investigated the effects of intravesical instillation of oxybutynin on ATP-induced bladder overactivity to determine whether this effect is mediated by effects on urothelial muscarinic receptors. Materials and Methods: Cystometry (at rate of 0.04 ml/min) was performed in female Sprague-Dawley rats (body weight 250 g) under urethane anesthesia (1.2 g/kg). After a 2-hour baseline period, protamine sulfate (10 mg/ml) was instilled for 1 hour, and then ATP (60 mM, pH 6.0) or a mixture of oxybutynin (10−6 M) and ATP (60 mM, pH 6.0) was instilled intravesically. We performed experiments with 4-diphenylacetoxy-N-methylpiperidine methobromide (4-DAMP) and methoctramine by the same methods. Cystometric parameters, such as the intercontraction interval (ICI), pressure threshold (PT), and maximal voiding pressure (MVP), were compared. Results: With intravesical instillation of ATP after protamine sulfate treatment, the ICI was decreased compared with baseline (ICI: baseline, 487.1±64.8 s; protamine, 450.6±56.1 s; ATP, 229.7±35.3 s; p 0.05). Intravesical instillation of ATP decreased MVP and PT significantly compared with baseline, but MVP and PT were not changed significantly with oxybutynin, 4-DAMP, or methoctramine compared with ATP. Conclusions: Bladder overactivity induced by intravesical instillation of ATP was not suppressed by intravesical instillation of antimuscarinics. Suppression of ATP-induced bladder overactivity by intravenous oxybutynin is not mediated by urothelial muscarinic receptors. (Korean J Urol 2009;50:396-400) 󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏

Bladder dysfunction in subacute combined degeneration

In view of the paucity of studies on micturition disturbance in subacute combined degeneration (SACD), this prospective study reports micturition disturbance in SACD and correlations with urodynamic and MRI findings. SACD was diagnosed by clinical features and low serum B12 level (< 211 pg/ml) and/or megaloblastic bone marrow. Micturition disturbances were categorized into voiding and storage symptoms and scored using the American Urological Association Symptoms (AUAS) score. Spinal MRI and urodynamic studies were carried out. Patients were treated with vitamin B12 1000 microg daily i.m. and outcome was defined at 6 months into complete, partial and poor. Eight patients with SACD aged 53.8 (44-70) years were included; 2 of whom were females. The mean duration of illness was 2.2 (1-120) months. All had walking difficulty, 2 were wheelchair bound and 4 bedridden. Lower limb spasticity and joint position impairment were present in all; ankle reflex was absent and pinprick sensation reduced distally in 4 patients each. T2 hyperintensity in the posterior spinal cord was present in 5 and in subcortical white matter in 2 patients. Five patients had storage, 7 voiding and 4 had both dysfunctions. AUAS score was 14.63 (4-35). On urodynamic study, detrusor areflexia was present in 2, neurogenic detrusor overactivity with high pressure voiding in 3 and normal in 2 patients. The urinary symptoms improved in all (AUAS score 3.67). Repeat urodynamic study in 2 patients, who had detrusor areflexia improved. At 6 mo, 3 patients had complete, 4 partial and 1 poor recovery. Bladder symptoms occur in advanced cases of SACD; both detrusor areflexia and neurogenic detrusor overactivity with high pressure voiding occur and respond to B12 therapy.

Robot-assisted laparoscopic transvesical diverticulectomy and simple prostatectomy.

Acquired bladder diverticula are often associated with bladder outlet obstruction (BOO). The increased voiding pressures required to overcome the BOO attenuate the detrusor and promote formation of diverticula. These patients may develop urinary tract infections, bladder stones, and incomplete bladder emptying. Effective treatment must address both the bladder diverticula and BOO. Reports of laparoscopic bladder diverticulectomy with concurrent transurethral resection of the prostate have demonstrated the feasibility of this minimally invasive approach. However, due to longer operative times and technical difficulty of the procedure, the gold-standard treatment remains the open surgical approach of bladder diverticulectomy and transvesical prostatectomy. With the advent of robotic-assisted laparoscopic surgery, application of open surgical principles is increasingly translated to the minimally invasive laparoscopic approach. We report, to our knowledge, the first case of robot-assisted laparoscopic transvesical diverticulectomy and concurrent transvesical simple prostatectomy.

Sex-related differences in activity of lower urinary tract in response to intravesical acid irritation in decerebrate unanesthetized mice

Sex-related differences in lower urinary tract (LUT) activity responding to intravesical infusion of diluted acetic acid (A/A, pH 3.0) were investigated during cystometrograms in decerebrate unanesthetized mice. A/A produced a decrease of intercontraction intervals in both female and male animals, and the extent of the decrease in male mice was much less than in female mice [19 +/- 5% (P = 0.03) vs. 65 +/- 5% (P = 0.03); n = 6 for each], exhibiting a marked difference between the two groups in response to acid irritation of the LUT (P = 0.002). A/A reduced maximal voiding pressure (MVP) (19 +/- 4%, P = 0.03) but had no effect on pressure threshold for inducing voiding contraction (PT) (P = 0.56) in females, whereas A/A did not change MVP (P = 1.00) but increased PT (16 +/- 4%, P = 0.03) in males. A/A decreased bladder compliances of female and male mice in a similar fashion (44 +/- 10% vs. 24 +/- 7%, P = 0.03 for each). In male mice, A/A produced persistent dribbling of fluid after voiding contraction phase, which was virtually not seen in females. The present study demonstrates the differences between female and male mice in response to noxious stimulation in the LUT: the female bladder is more sensitive to the acid irritation, while the male urethra is more irritable to the noxious stimulus. Identification of mechanisms underlying sex-specific characteristics might be helpful for elucidating pathogenesis of painful bladder syndrome.

Effects of intrathecal injection of a hyperpolarization‐activated channel (Ih) inhibitor ZD7288 on bladder function in urethane‐anesthetized rats

The role of I(h) channels at the spinal level in the control of bladder function was examined in urethane anesthetized female rats. Bladder activity was recorded via a transurethral catheter under isovolumetric conditions or via an intravesical catheter during continuous infusion cystometry. ZD7288, a selective I(h) channel inhibitor, was administered intrathecally at L6-S1 segmental levels of the spinal cord. Under isovolumetric conditions, intrathecal 0.3 microg of ZD7288 was inactive, whereas 1 and 3 microg abolished bladder activity for 5.6 +/- 1.8 and 20.7 +/- 3.9 min, respectively. Three micrograms also tended to decrease the amplitude of the contractions when they reappeared. During continuous cystometry, an intrathecal injection of ZD7288 at 0.3-3 microg dose-dependently increased the intercontraction intervals by 7.5%, 33.1%, and 57.5% from pre-drug values. A higher dose of ZD7288 (3 microg) tended to increase the pressure threshold for inducing micturition by 16.6% and the maximum voiding pressure by 11.1%. On the other hand, cardiovascular parameters such as heart rate and mean blood pressure were not affected by 0.3-3 microg of intrathecal ZD7288. These results indicate that I(h) channels play an important role in the control of micturition. Because I(h) channel inhibition in the lumbosacral spinal cord reduced the frequency of the micturition reflex without significantly affecting the amplitude of reflex bladder contraction, I(h) channels might preferentially be involved in afferent processing in the spinal cord to control the micturition reflex.

The correlation of voiding variables between non‐instrumented uroflowmetery and pressure‐flow studies in women with pelvic organ prolapse

To (1) correlate peak and maximum flow rates from non-instrumented flow (NIF) and pressure-flow studies (PFS) in women with pelvic organ prolapse (POP); (2) measure the impact of voided volume and degree of prolapse on correlations. We compared four groups of women with stages II-IV POP. Groups 1 and 2 were symptomatically stress continent women participating in the colpopexy and urinary reduction efforts (CARE) trial; during prolapse reduction before sacrocolpopexy, Group 1 (n = 67) did not have and Group 2 (n = 84) had urodynamic stress incontinence (USI). Group 3 (n = 74) and Group 4 participants (n = 73), recruited specifically for this study, had stress urinary incontinence (SUI) symptoms. Group 3 planned sacrocolpopexy. Group 4 planned a different treatment option. Participants completed standardized uroflowmetry and pressure voiding studies. Subjects' median age was 61 years; median parity 3% and 80% had stage III or IV POP. Based on the Blaivas-Groutz nomogram, 49% of all women were obstructed. NIF and PFS peak and average flow rates had low correlations with one another (0.31, P < 0.001 and 0.35, P < 0.001, respectively). When NIF and PFS voided volumes were within 25% of each other, the peak and average flow rate correlations improved (0.52, P < 0.001 and 0.57, P < 0.001, respectively). As vaginal prolapse increased, correlations between NIF and PFS peak and average flow rates decreased. Peak and average flow rates are highly dependent on voided volume in women with prolapse. As the prolapse stage increases, correlations between NIF and PFS variables decrease.

GABAergic mechanism mediated via D1 receptors in the rat periaqueductal gray participates in the micturition reflex: an in vivo microdialysis study

The periaqueductal gray (PAG) is critically involved in the micturition reflex, but little is known about the neuronal mechanisms involved. The present study elucidated dynamic changes in dopamine (DA), glutamate and gamma-aminobutyric acid (GABA) in the rat PAG during the micturition reflex, with a focus on dopaminergic modulation using in vivo microdialysis combined with cystometrography. Extracellular levels of DA and glutamate increased, whereas levels of GABA decreased, in parallel with the micturition reflex. Application of a D(1) receptor antagonist into the PAG produced increases in maximal voiding pressure (MVP) and decreases in intercontraction interval (ICI), suggesting that the micturition reflex was facilitated by D(1) receptor blockade. The D(1) receptor antagonist prevented micturition-induced decreases in GABA efflux but had no effect on DA or glutamate. Neither a D(2) receptor antagonist nor a D(1)/D(2) receptor agonist affected these neurochemical and physiological parameters. Micturition-induced inhibition of GABA was not observed in 6-hydroxydopamine (6-OHDA)-lesioned rats, an animal model of Parkinson's disease. 6-OHDA-lesioned rats exhibited bladder hyperactivity evaluated by increases in MVP and decreases in ICI, mimicking facilitation of the micturition reflex induced by D(1) receptor blockade. These findings suggest that the micturition reflex is under tonic dopaminergic regulation through D(1) receptors, in which a GABAergic mechanism is involved. Bladder hyperactivity observed in 6-OHDA-lesioned rats may be caused by dysfunction of GABAergic regulation underlying the micturition reflex. The present findings contribute to our understanding not only of the neurophysiology of the micturition reflex but also of the pathophysiology of lower urinary tract dysfunction in patients with Parkinson's disease.

Effect of eviprostat on bladder overactivity in an experimental cystitis rat model

The purpose of this study was to investigate the effects of eviprostat, a phytotherapeutic drug, on bladder overactivity and inflammation in a cyclophosphamide (CYP)-induced cystitis rat model. Female Sprague-Dawley rats received a single intraperitoneal injection of CYP (200 mg/kg) or saline. After the CYP injection, eviprostat (9, 18 or 54 mg/kg per day) or a vehicle was orally given twice each day. Four days after the CYP injection, bladder function was evaluated by cystometrograms under urethane anesthesia. In a separate group, bladder inflammation was compared between the eviprostat- or vehicle-treated animals. Furthermore, the effects of eviprostat on carbachol-induced muscle contraction were evaluated by an in vitro experiment. The intercontraction interval (ICI) significantly decreased in the CYP-injected rats in comparison to the saline-injected rats. In the CYP-injected group, 18 and 54 mg/kg per day of eviprostat treatment significantly increased the ICI, but did not change the maximum voiding pressure in comparison to the vehicle treatment. In the saline-injected group, no significant changes of any parameters in the cystometrograms were observed between the eviprostat- and vehicle-treated groups. CYP-induced bladder inflammation tended to be lower in the eviprostat-treated group in comparison to the vehicle-treated group. An in vitro experiment revealed that eviprostat failed to inhibit carbachol-induced muscle contraction. The oral administration of eviprostat suppressed CYP-induced bladder overactivity. The effects of eviprostat on the micturition reflex may be irrespective of antimuscarinic action. The present findings raise the possibility that eviprostat could be an effective treatment for bladder overactivity associated with inflammation.

Can Bladder Function Characteristics Be Recognized in a Vcug in Young Children with Vesicoureteral Reflux

PURPOSE The aim of the study was to investigate if bladder function variables could be recognized as radiological signs in the VCUG in children with vesicoureteral reflux (VUR). MATERIAL AND METHODS 116 patients with high-grade VUR had videocystometry at median age 6, 21 and 39 months. X-ray films of the bladder was reviewed for size (big = above the line between the iliac crests, small = below the line between the lower ends of sacroiliac junctions), pathology of the bladder wall (irregular, trabeculated, diverticula) and pathology of the bladder neck / proximal urethra (urethral sphincter closed with filling of the posterior urethra - PUF). RESULTS Bladder volume estimated from the X-ray films (big, normal, small), correlated well to bladder volumes obtained from the urodynamic investigations, with significant difference between the groups (p<0.001). Regression formulas have been constructed for the respective bladder size on X-ray in ml versus age. Small bladders were characteristic for the infant group and big bladders for children after age 1 year. Low age (<1 year) was significantly correlated to pathology of the bladder wall and the presence of PUF both during the filling and voiding phase. Abnormalities of the bladder wall also correlated to low bladder capacity and overactive contractions during filling. PUF during filling significantly correlated to high pressure overactive contractions and PUF during voiding to high voiding pressure. CONCLUSIONS Our observations indicate that bladder capacity could roughly be estimated from x-ray films by using the landmarks suggested in this study. The typical urodynamic pattern for small infants: low bladder capacity, overactivity, high voiding pressure and dyscoordination at voiding was recognised in X-ray films from VCUG.