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Eljamal K, Kajioka S, Maki T, Ushijima M, Kawagoe K, Lee K, Sasaguri T. New mouse model of underactive bladder developed by placement of a metal ring around the bladder neck. Low Urin Tract Symptoms 2020; 13:299-307. [PMID: 33089671 DOI: 10.1111/luts.12359] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Revised: 09/30/2020] [Accepted: 10/04/2020] [Indexed: 01/22/2023]
Abstract
OBJECTIVE To develop a new mouse model of underactive bladder (UAB) caused by chronic bladder outlet obstruction (BOO). METHODS BOO was created in 6-week-old male C57BL/6 mice using surgery to loosely place a silver jump ring around the bladder neck of each mouse. Micturition behavior (assessed with a metabolic cage) and cystometry were used to evaluate bladder function at 8 and 16 weeks after BOO. Following completion of the functional studies, the bladders of the mice were excised, weighed, and subjected to histological analysis. RESULTS Micturition behavior analysis showed that mice subjected to BOO for 16 weeks had a lower frequency of micturition (7.3 ± 1.1 vs 12.5 ± 3.0 times/d, P < .05) and volume per void (106.0 ± 0.1 vs 133.9 ± 3.2 μL, P < .05) than mice subjected to BOO for 8 weeks. Cystometry revealed that mice subjected to BOO for 16 weeks had lower baseline pressure (8.4 ± 0.6 vs 14.0 ± 0.7 cmH2 O, P < .01) and micturition pressure (13.9 ± 1.1 vs 42.8 ± 1.7 cmH2 O, P < .05) than mice subjected to BOO for 8 weeks. BOO caused progressive increases in bladder mass and collagen deposition over time. CONCLUSIONS We successfully established a novel mouse model of UAB using surgery to place a silver jump ring loosely on the bladder neck. BOO initially induced bladder overactivity but subsequently resulted in UAB due to deterioration of detrusor smooth muscle contractility and progressive deposition of collagen in the bladder wall.
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Affiliation(s)
- Kareman Eljamal
- Department of Clinical Pharmacology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Shunichi Kajioka
- Department of Clinical Pharmacology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.,Department of Urology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Tomoko Maki
- Department of Urology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Miho Ushijima
- Department of Urology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Kentaro Kawagoe
- Department of Urology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Ken Lee
- Department of Urology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Toshiyuki Sasaguri
- Department of Clinical Pharmacology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
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Does detrusor underactivity affect the results of transurethral resection of prostate? Int Urol Nephrol 2020; 53:199-204. [PMID: 33074461 DOI: 10.1007/s11255-020-02669-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2020] [Accepted: 09/25/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE We aimed to evaluate the outcome of transurethral resection of the prostate (TURP) in patients with benign prostatic hyperplasia (BPH) and diagnosed to have weak detrusor contractility by urodynamic study. METHODS A prospective study of 32 male patients had BPH candidate for TURP diagnosed to have impaired detrusor contractility by preoperative urodynamic study. We studied the postoperative outcome after TURP regarding international prostate symptoms score (IPSS), maximum flow rate (Qmax), post-voiding residual urine (PVR), the patients need for catheter, and urodynamic pressure flow study (PFS) parameters (maximum detrusor contractility, bladder contractility index (BCI), maximum bladder capacity and compliance) after 6 month follow-up. RESULTS Twenty-one cases presented with urethral catheter because of chronic or refractory retention. Twenty patients voided preoperatively during PFS with mean detrusor pressure (Pdet) at Qmax 23.97 ± 25.54 cmH2O and the mean BCI was 51.04 ± 23.86, while twelve patients did not void with mean maximum Pdet 21.75 ± 7.34. After 6 month follow-up, there was significant improvement in IPSS, Qmax, and detrusor contractility (Pdet at Qmax and BCI) postoperatively in all patients, and there was no significant postoperative improvement of post-voiding residual urine (p value 0.92). Finally, 11 patients voided normally without RU, 7 patients needed timed triple voiding with crede maneuver and small RU, and 14 patients needed CIC. CONCLUSIONS There were significant improvements in IPSS, detrusor contractility, and urine flow after TURP in patients with BPH and weak bladder contractility, although the risk of postoperative urine retention in approximately 43% of cases and needed CIC.
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Yoshida M, Sekido N, Matsukawa Y, Yono M, Yamaguchi O. Clinical diagnostic criteria for detrusor underactivity: A report from the Japanese Continence Society working group on underactive bladder. Low Urin Tract Symptoms 2020; 13:13-16. [PMID: 33029933 DOI: 10.1111/luts.12356] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Revised: 09/09/2020] [Accepted: 09/22/2020] [Indexed: 11/27/2022]
Abstract
Detrusor underactivity (DU) is a common bladder dysfunction that causes lower urinary tract symptoms (LUTS) in both men and women. Currently DU can only be diagnosed by an invasive urodynamic test. Underactive bladder (UAB) is the symptom-based correlate of DU, as is the case with overactive bladder (OAB) and detrusor overactivity (DO). The International Continence Society (ICS) consensus group has recently proposed a working definition of UAB as a symptom syndrome suggestive of DU. However, a symptom complex of UAB is shared by LUTS attributable to bladder outlet obstruction (BOO). Thus, UAB is not specific for DU, leading to difficulties in determining a therapeutic target (DU or BOO) in the initial management of UAB. Under these circumstances, a consensus group was formed under the auspices of the Japanese Continence Society (JCS) and diagnostic criteria were produced to potentially identify patients likely to have DU, without a pressure/flow study-based diagnosis. Certain symptoms and several noninvasive test parameters have been reported as clinical predictors of DU, and were suggested to discriminate DU from BOO. Of these predictive factors, the more commonly used parameters were used to develop clinical diagnostic criteria for DU. This article presents the clinical diagnostic criteria for DU proposed by the JCS consensus group and aims to summarize the background discussion by the group.
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Affiliation(s)
- Masaki Yoshida
- Department of Urology, National Center for Geriatrics and Gerontology, Obu, Japan
| | - Naritoshi Sekido
- Department of Urology, Toho University Medical Center Ohashi Hospital, Tokyo, Japan
| | - Yoshihisa Matsukawa
- Department of Urology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Makoto Yono
- Department of Clinical Pharmacology and Urology, Nishi-Kumamoto Hospital, SOUSEIKAI, Kumamoto, Japan
| | - Osamu Yamaguchi
- Department of Chemical Biology and Applied Chemistry, School of Engineering, Nihon University, Koriyama, Japan
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Sawaqed F, Abughosh Z, Suoub M. The Prevalence of Detrusor Underactivity and its Symptoms Co-relation with Urodynamic Study Findings in Patients with Lower Urinary Tract Symptoms. Res Rep Urol 2020; 12:415-422. [PMID: 33062620 PMCID: PMC7522515 DOI: 10.2147/rru.s264237] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2020] [Accepted: 08/03/2020] [Indexed: 11/23/2022] Open
Abstract
Purpose This study determines the prevalence and clinical presentation of detrusor underactivity (DU) and its urodynamic characteristics in adult patients with lower urinary tract symptoms (LUTS). Patients and Methods This retrospective study has reviewed the symptoms and urodynamic study (UDS) findings of 283 patients with LUTS. Chi-square analysis was used to present the prevalence of UDS characteristics in both sexes. Results Out of records of 206 patients included in this study, fifty-one (24.76%) patients were diagnosed with DU based on bladder contractility index. Storage lower urinary tract symptoms were the most prevalent characteristic presentation in both sexes as compared to the difficulty in voiding, recurrent urine retention, and urinary incontinence. Bladder outlet, sphincter EMG findings, and degree of DU were significantly correlated with gender. Conclusion DU is a prevalent and sophisticated bladder pathology rather than a simple one. It requires more attention from the urologists, and evaluations, including UDS, to differentiate it from other pathologies.
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Affiliation(s)
- Fadi Sawaqed
- Section of Urology, Department of Special Surgery, Faculty of Medicine, Mu'tah University, Karak, Jordan
| | - Zeid Abughosh
- Istishari Urology Center, Istishari Hospital, Amman, Jordan
| | - Mohammed Suoub
- Section of Urology, Department of Special Surgery, Faculty of Medicine, Mu'tah University, Karak, Jordan
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Shin JH, Ryu CM, Ju H, Yu HY, Song S, Hong KS, Chung HM, Park J, Shin DM, Choo MS. Therapeutic Efficacy of Human Embryonic Stem Cell-Derived Multipotent Stem/Stromal Cells in Diabetic Detrusor Underactivity: A Preclinical Study. J Clin Med 2020; 9:jcm9092853. [PMID: 32899334 PMCID: PMC7563486 DOI: 10.3390/jcm9092853] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2020] [Accepted: 08/31/2020] [Indexed: 01/23/2023] Open
Abstract
Mesenchymal stem/stromal cell (MSC) therapy is a promising approach for treatment of as yet incurable detrusor underactivity (DUA), which is characterized by decreased detrusor contraction strength and/or duration, leading to prolonged bladder emptying. In the present study, we demonstrated the therapeutic potential of human embryonic stem cell (ESC)-derived multipotent MSCs (M-MSCs) in a diabetic rat model of DUA. Diabetes mellitus (DM) was induced by intraperitoneal injection of streptozotocin (STZ) (50 mg/kg) into 8-week-old female Sprague-Dawley rats. Three weeks later, various doses of M-MSCs (0.25, 0.5, and 1 × 106 cells) or an equivalent volume of PBS were injected into the outer layer of the bladder. Awake cystometry, organ bath, histological, and gene expression analyses were evaluated 1 week (short-term) or 2 and 4 weeks (long-term) after M-MSC transplantation. STZ-induced diabetic rats developed DUA, including phenotypes with significantly longer micturition intervals, increased residual urine amounts and bladder capacity, decreased micturition pressure on awake cystometry, and contractile responses to various stimuli in organ bath studies. Muscle degeneration, mast cell infiltration, fibrosis, and apoptosis were present in the bladders of DM animals. A single local transplantation of M-MSCs ameliorated DUA bladder pathology, including functional changes and histological evaluation, and caused few adverse outcomes. Immunostaining and gene expression analysis revealed that the transplanted M-MSCs supported myogenic restoration primarily by engrafting into bladder tissue via pericytes, and subsequently exerting paracrine effects to prevent apoptotic cell death in bladder tissue. The therapeutic efficacy of M-MSCs was superior to that of human umbilical cord-derived MSCs at the early time point (1 week). However, the difference in efficacy between M-MSCs and human umbilical cord-derived MSCs was statistically insignificant at the later time points (2 and 4 weeks). Collectively, the present study provides the first evidence for improved therapeutic efficacy of a human ESC derivative in a preclinical model of DM-associated DUA.
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Affiliation(s)
- Jung Hyun Shin
- Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, Seoul 05505, Korea; (J.H.S.); (J.P.)
| | - Chae-Min Ryu
- Department of Biomedical Sciences, Asan Medical Center, University of Ulsan College of Medicine, Seoul 05505, Korea; (C.-M.R.); (H.J.); (H.Y.Y.); (S.S.)
| | - Hyein Ju
- Department of Biomedical Sciences, Asan Medical Center, University of Ulsan College of Medicine, Seoul 05505, Korea; (C.-M.R.); (H.J.); (H.Y.Y.); (S.S.)
| | - Hwan Yeul Yu
- Department of Biomedical Sciences, Asan Medical Center, University of Ulsan College of Medicine, Seoul 05505, Korea; (C.-M.R.); (H.J.); (H.Y.Y.); (S.S.)
| | - Sujin Song
- Department of Biomedical Sciences, Asan Medical Center, University of Ulsan College of Medicine, Seoul 05505, Korea; (C.-M.R.); (H.J.); (H.Y.Y.); (S.S.)
| | - Ki-Sung Hong
- Department of Stem Cell Biology, School of Medicine, Konkuk University, Seoul 05029, Korea; (K.-S.H.); (H.-M.C.)
| | - Hyung-Min Chung
- Department of Stem Cell Biology, School of Medicine, Konkuk University, Seoul 05029, Korea; (K.-S.H.); (H.-M.C.)
| | - Juhyun Park
- Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, Seoul 05505, Korea; (J.H.S.); (J.P.)
| | - Dong-Myung Shin
- Department of Biomedical Sciences, Asan Medical Center, University of Ulsan College of Medicine, Seoul 05505, Korea; (C.-M.R.); (H.J.); (H.Y.Y.); (S.S.)
- Correspondence: (D.-M.S.); (M.-S.C.); Tel.: +82-2-3010-2086 (D.-M.S.); +82-2-3010-3735 (M.-S.C.); Fax: +82-2-3010-8493 (D.-M.S.); +82-2-477-8928 (M.-S.C.)
| | - Myung-Soo Choo
- Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, Seoul 05505, Korea; (J.H.S.); (J.P.)
- Correspondence: (D.-M.S.); (M.-S.C.); Tel.: +82-2-3010-2086 (D.-M.S.); +82-2-3010-3735 (M.-S.C.); Fax: +82-2-3010-8493 (D.-M.S.); +82-2-477-8928 (M.-S.C.)
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Functional Evaluation of Upper Urinary Tract with Diuretic Mercaptoacetyltriglycine Renal Scans in Patients with Benign Prostatic Obstruction before and after Surgical Intervention: A Pilot Study. BIOMED RESEARCH INTERNATIONAL 2020; 2020:4605683. [PMID: 32851073 PMCID: PMC7436344 DOI: 10.1155/2020/4605683] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Revised: 06/29/2020] [Accepted: 07/04/2020] [Indexed: 11/17/2022]
Abstract
Introduction We investigated which benign prostatic hyperplasia-related lower urinary parameters are related to upper urinary tract obstruction and whether transurethral prostatectomy could improve upper urinary tract obstruction. Materials and Methods Patients with prostate size over 30 g and urodynamically proven bladder outlet obstruction were enrolled in this prospective observational study. Bladder wall thickness and prostate size were measured by ultrasonography. A urodynamic study with laboratory tests including serum creatinine, prostate-specific antigen, and urinalysis was performed. Finally, a diuretic scintigraphy using mercaptoacetyltriglycine was performed. Tests except the urodynamic evaluation were repeated after transurethral prostatectomy. Results In total, 24 patients were enrolled, and 19 patients completed the present study. The mean values of age (yrs), prostate size (mL), bladder thickness (mm), bladder compliance (ΔmL/Δpr), and the bladder outlet obstruction index were 68.42 ± 8.25, 72.29 ± 32.78, 4.42 ± 1.14, 50.17 ± 32.15, and 82.11 ± 34.68, respectively. The mean T1/2 (min) was 17.51 ± 16.34 on the left side and 15.30 ± 11.96 on the right side. Statistical analysis showed that bladder compliance and bladder thickness were preoperatively related to upper urinary tract obstruction (p = 0.001 and p = 0.007, respectively). Diuretic mercaptoacetyltriglycine scan in 19 patients showed improvement 6 months after prostate surgery. Clinically significant proteinuria was associated with upper urinary tract obstruction, and proteinuria was also improved after prostate surgery. Conclusion Storage-phase bladder dysfunction could be a reliable urodynamic factor for the indication of upper urinary tract obstruction in patients with benign prostatic hyperplasia, and upper urinary tract obstruction with subsequent kidney damage could be improved by surgical decompression of benign prostatic obstruction.
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Understanding and Redefining the Role of Urodynamics in Pelvic Floor Disorders. CURRENT BLADDER DYSFUNCTION REPORTS 2020. [DOI: 10.1007/s11884-020-00591-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Geramipour A, Danziger ZC. Sensitivity of urethral flow-evoked voiding reflexes decline with age in the rat: insights into age-related underactive bladder. Am J Physiol Renal Physiol 2020; 318:F1430-F1440. [DOI: 10.1152/ajprenal.00475.2019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
The prevalence of underactive bladder (UAB) increases with age, suggesting a link between age-related processes and lower urinary tract (LUT) symptoms; however, the underlying mechanisms of age-related UAB are poorly understood. Understanding how aging affects LUT reflexes may help in the development of new treatments by identifying mechanistic targets. In this work, we studied the relationship between age and systems-level function of the LUT and tested the hypothesis that aging is related to weakening of reflexes that control voiding. Three groups of anesthetized female rats, young (4–7 mo old), mature (11–14 mo old), and old (18–24 mo old), were used to quantify the effect of aging on LUT reflexes. A double-lumen catheter enabled us to control the bladder volume and urethral flow rate independently, under quasi-isovolumetric bladder conditions. We systematically investigated the reflex bladder contractions evoked by combinations of rates of urethral infusion and bladder fill volumes as a function of age. Urethral infusion with the same flow rate evoked bladder contractions (via the augmenting reflex) in old animals less often than in younger animals. Furthermore, old animals needed more fluid in their bladders (relative to their bladder capacity) before urethra flow-evoked bladder contractions could be triggered at all, suggesting a delay in the switch of the LUT to “voiding mode.” Old rats also showed longer and weaker bladder contractions than young or mature rats. Taken together, this suggests there is an age-related functional weakening and loss of sensitivity in LUT reflexes, which may contribute to age-related UAB symptoms.
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Affiliation(s)
- Arezoo Geramipour
- Department of Biomedical Engineering, Florida International University, Miami, Florida
| | - Zachary C. Danziger
- Department of Biomedical Engineering, Florida International University, Miami, Florida
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Kalil J, D'Ancona CAL. Detrusor underactivity versus bladder outlet obstruction clinical and urodynamic factors. Int Braz J Urol 2020; 46:419-424. [PMID: 32167707 PMCID: PMC7088469 DOI: 10.1590/s1677-5538.ibju.2019.0402] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Accepted: 01/18/2020] [Indexed: 11/21/2022] Open
Abstract
Objectives: Methods: Results: Conclusion:
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Clinical and Urodynamic Predictors of the Q-Tip Test in Women With Lower Urinary Tract Symptoms. Int Neurourol J 2020; 24:52-58. [PMID: 32252186 PMCID: PMC7136438 DOI: 10.5213/inj.1938156.078] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2019] [Accepted: 10/01/2019] [Indexed: 11/08/2022] Open
Abstract
Purpose The Q-tip test is used to measure urethral hypermobility and can predict surgical outcomes. However, certain factors may affect the reliability of this test. Our aim was to identify independent clinical and urodynamic predictors of the results of the Q-tip test. Methods Between January 2014 and June 2019, 176 consecutive women with lower urinary tract symptoms who underwent the Q-tip test and urodynamic studies were included in this retrospective study. Results Multivariable regression analysis revealed that age (regression coefficient, -0.55), point Ba (regression coefficient, 4.1), urodynamic stress incontinence (regression coefficient, 9.9), maximum flow rate (Qmax) (regression coefficient, 0.13), pressure transmission ratio (PTR) at maximum urethral pressure (MUP) (regression coefficient, -0.14), and the score on the fifth question of the Incontinence Impact Questionnaire (IIQQ5; “Has urine leakage affected your participation in social activities outside your home?”; regression coefficient, -4.1) were independent predictors of the Q-tip angle, with a constant of 87.0. The following Spearman rank correlation coefficients were found between the Q-tip angle and the following variables: age, -0.38; point Ba, 0.34; urodynamic stress incontinence, 0.32; Qmax, 0.28; PTR at MUP, -0.28; and IIQQ5, -0.23. A receiver operating characteristic curve (ROC) analysis for the prediction of urodynamic stress incontinence found that the optimum cutoff for PTR at MUP was <81%, with an area under the ROC curve of 0.70. Conclusions Age, point Ba, urodynamic stress incontinence, Qmax, PTR at MUP, and IIQQ5 were independent predictors of the Q-tip angle. However, none of these could be used as effective surrogates for the Q-tip test due to their lack of a sufficient correlation.
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Xing T, Ma J, Jia C, Ou T. Neurogenic lower urinary tract dysfunction predicts prognosis in patients with multiple system atrophy. Clin Auton Res 2020; 30:247-254. [PMID: 32166422 DOI: 10.1007/s10286-020-00678-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2019] [Accepted: 02/28/2020] [Indexed: 12/19/2022]
Abstract
PURPOSE To evaluate whether neurogenic lower urinary tract dysfunction and urodynamic parameters predict the outcomes of patients with multiple system atrophy (MSA). METHODS A retrospective study was performed in patients who were diagnosed with MSA and underwent urodynamic studies simultaneously from September 2014 to July 2018. The urodynamic traces were reviewed by urologists. Detrusor contractility was evaluated by the bladder contractility index (BCI) and Schäfer nomogram. Telephone follow-up was conducted in July 2019 to acquire survival data. Clinical and urodynamic parameters were analyzed for survival using Cox regression analysis. RESULTS Overall, 70 MSA patients were eligible for analysis, and 61 of them underwent urodynamic study within 3 years of initial symptom onset. The parkinsonian subtype of MSA (MSA-P) had a smaller proportion of men as well as longer motor and lower urinary tract symptom durations than the cerebellar subtype (MSA-C). MSA-P also had a lower mean BCI than MSA-C (32.0 ± 27.0 versus 53.6 ± 33.4, p = 0.025). The mean MSA survival time was 5.4 [95% confidence interval (CI) 4.8-6.3] years. Cox regression analysis showed that survival from baseline was correlated only with BCI [hazard ratio (HR) 0.983, 95% CI 0.969-0.997, p = 0.020]. Overall survival was correlated with BCI (HR 0.982, 95% CI 0.966-0.999, p = 0.039) and the presence of urinary incontinence (HR 3.007, 95% CI 0.993-9.220, p = 0.052). CONCLUSION Detrusor contractility can be a prognostic marker in MSA patients. A high BCI value is a protective factor for survival from baseline and overall survival. The presence of urinary incontinence predicts shortened overall survival.
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Affiliation(s)
- Tianying Xing
- Department of Urology, Xuanwu Hospital, Capital Medical University, Beijing, 100045, China
| | - Jinghong Ma
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, 100045, China
| | - Chunsong Jia
- Department of Urology, Xuanwu Hospital, Capital Medical University, Beijing, 100045, China
| | - Tongwen Ou
- Department of Urology, Xuanwu Hospital, Capital Medical University, Beijing, 100045, China.
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Valentini F, Marti B, Robain G, Nelson P. Account for high flow rate-low detrusor pressure voids in female: Contribution of VBN model. Prog Urol 2020; 30:214-218. [DOI: 10.1016/j.purol.2019.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Revised: 09/27/2019] [Accepted: 10/18/2019] [Indexed: 11/28/2022]
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A Modern Comparison of Urodynamic Findings in Diabetic Versus Nondiabetic Women. Female Pelvic Med Reconstr Surg 2020; 26:44-50. [DOI: 10.1097/spv.0000000000000586] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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Smith PP, Valentini F, Mytilekas KV, Apostolidis A, Rademakers K, Cardozo L, Gammie A. Can we improve our diagnosis of impaired detrusor contractility in women? An ICI-RS 2019 proposal. Neurourol Urodyn 2019; 39 Suppl 3:S43-S49. [PMID: 31856370 DOI: 10.1002/nau.24260] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Accepted: 12/10/2019] [Indexed: 11/07/2022]
Abstract
INTRODUCTION Widely accepted consensus terminology and calculations of detrusor contractility in females do not exist but may be useful. We report the output of a proposal session at the International Consultation on Incontinence Research Society meeting 2019, addressing the title topic. METHODS Three formal presentations and a lively discussion addressed several questions including: which is the optimal cutoff value of female bladder voiding efficiency during uroflow to suspect obstruction or detrusor underactivity? Is there a definition of pure underactive and pure obstructed voiding in females? Is there a place to distinguish those relatively obstructed from those relatively underactive females especially in those cases of equivocal obstruction? Current measures of contractility were reviewed for their usefulness in women. RESULTS No recommendation for a specific index or calculation can be made based on current knowledge. "Contractility" may be context-dependent regarding clinical care, clinical prognostication, and physiologic research. CONCLUSIONS This group proposes that context-sensitive definitions of "Contractility" deserve attention by international leadership. Cooperative clinical and physiologic expertise will be needed to achieve this goal. Following initial recommendations based on expert opinion, the development of final definitions and measures of contractility should be iterative, based upon validation studies to be considered as part of the definitional process.
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Affiliation(s)
- Phillip P Smith
- Department of Surgery, University of Connecticut School of Medicine, Farmington, Connecticut
| | - Francoise Valentini
- Service de Médecine Physique et de la Réadaptation, Hôpital Rothschild, Université Pierre-et-Marie-Curie, Paris, France
| | | | - Apostolos Apostolidis
- 2nd Department of Urology, Papageorgiou Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Kevin Rademakers
- Department of Urology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Linda Cardozo
- Department of Urogynaecology, King's College Hospital, London, UK
| | - Andrew Gammie
- Bristol Urological Institute, Southmead Hospital, Bristol, UK
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Osman NI, Pang KH, Martens F, Atunes-Lopes T, Geavlete B, Husch T, Tutolo M, Rahnama’i MS, Marcelissen T. Detrusor Underactivity and Underactive Bladder in Women: What Is New? CURRENT BLADDER DYSFUNCTION REPORTS 2019. [DOI: 10.1007/s11884-019-00531-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Abstract
Purpose of Review
Detrusor underactivity (DU) and its symptom-based correlation, the underactive bladder (UAB), are common problems encountered in urological practice. Whilst DU has been defined for many years, only recently has UAB received a formal definition and there is now accumulating literature based on this condition. In this article, we reviewed the recent literature on the aetiology, pathogenesis, diagnosis and management of DU/UAB in women.
Recent Findings
Detrusor underactivity is diagnosed on urodynamic studies but there still remains a lack of widely recognised and accepted diagnostic criteria. Commencing treatment based on the diagnosis of UAB, with or without a PVR measurement, is perhaps feasible due to the lower occurrence of BOO in women and specific clinical features that may distinguish this group. Prospective studies attempting to correlate UAB with the underlying DU are needed before this approach could be considered.
Summary
Detrusor underactivity/UAB in women requires a separate consideration from men due to the anatomical and functional differences in the lower urinary tracts between both genders and consequent differences in pathologies affecting them. The aetiology of DU remains largely unknown, but is probably multifactorial, including myogenic, neurogenic and vasculogenic factors. There remains a lack of any simple effective drug treatments, whilst apart from sacral neuromodulation for the specific subgroup with non-obstructive urinary retention, no safe and effective surgical treatment is currently available. Often, permanent or intermittent bladder drainage with a catheter is the final solution.
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Tarcan T, Rademakers K, Arlandis S, von Gontard A, van Koeveringe GA, Abrams P. Do the definitions of the underactive bladder and detrusor underactivity help in managing patients: International Consultation on Incontinence Research Society (ICI-RS) Think Tank 2017? Neurourol Urodyn 2019; 37:S60-S68. [PMID: 30133789 DOI: 10.1002/nau.23570] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2018] [Accepted: 02/26/2018] [Indexed: 01/10/2023]
Abstract
AIMS The Think Tank aimed to discuss the pitfalls and advantages of current definitions in terms of research and management of underactive bladder (UAB). UAB broadly defines a symptom complex of bladder emptying problems and does not indicate a specific pathology. Detrusor underactivity (DU) is a urodynamic diagnosis from pressure-flow studies. The correlation of UAB with DU remains to be precisely determined. METHODS The presentations and subsequent discussion, leading to research recommendations during the Think Tank of the International Consultation on Incontinence Research Society in Bristol, 2017, are summarized. RESULTS To develop more specific individualized management strategies, the Think Tank panel proposed (i) that, since defining a single type of index patient to represent all UAB will not fulfill all clinical research needs, several index patients should be defined by phenotyping of patients with UAB, including, children, young men and women, elderly male and female patients with co-existing DU and detrusor overactivity, and neurological patients with UAB; (ii) prospective longitudinal studies to assess the natural history of UAB, in the different target populations, based on different UAB phenotypes, should be initiated; (iii) DU should be precisely defined by urodynamic parameters; and (iv) work to develop validated specific questionnaires combined with non-invasive tests for screening, diagnosis and follow up, needs to be continued. CONCLUSIONS The precise relationship of UAB to DU remains to be defined. Phenotyping patients with UAB/DU, performing prospective trials of natural history, and developing symptom questionnaires and diagnostic investigations will improve our ability to identify and treat UAB/DU.
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Affiliation(s)
- Tufan Tarcan
- Department of Urology, Marmara University School of Medicine, Istanbul, Turkey
| | - Kevin Rademakers
- Department of Urology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Salvador Arlandis
- Department of Urology, La Fe University and Polytechnic Hospital, Valencia, Spain
| | - Alexander von Gontard
- Department of Child and Adolescent Psychiatry, Saarland University Hospital, Homburg, Germany
| | | | - Paul Abrams
- Department of Urology, University of Bristol, Bristol Urological Institute, Bristol, UK
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Matsukawa Y, Yoshida M, Yamaguchi O, Takai S, Majima T, Funahashi Y, Yono M, Sekido N, Gotoh M. Clinical characteristics and useful signs to differentiate detrusor underactivity from bladder outlet obstruction in men with non-neurogenic lower urinary tract symptoms. Int J Urol 2019; 27:47-52. [PMID: 31542892 DOI: 10.1111/iju.14121] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2019] [Accepted: 09/01/2019] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To investigate the clinical characteristics and useful signs to differentiate detrusor underactivity from bladder outlet obstruction in men with non-neurogenic lower urinary tract symptoms. METHODS A total of 638 treatment-naive men with non-neurogenic lower urinary tract symptoms who underwent subjective and objective evaluations were reviewed retrospectively. We divided the patients into detrusor underactivity and bladder outlet obstruction groups based on urodynamic findings, and compared parameters obtained from questionnaires and non-invasive tests. Detrusor underactivity was defined as bladder contractility index ≤100 and bladder outlet obstruction index ≤40, whereas bladder outlet obstruction was defined as bladder contractility index >100 and bladder outlet obstruction index >40. RESULTS Of 638 patients, 145 (22.7%) had detrusor underactivity and 273 (42.8%) had bladder outlet obstruction. Total international prostate symptom score and international prostate symptom score-voiding subscore were significantly higher in the detrusor underactivity group. There were significant differences in prostate volume, intravesical prostatic protrusion, and all uroflowmetry parameters between the two groups. In multivariate logistic regression analysis, lower intravesical prostatic protrusion (cut-off value 8.2 mm), lower bladder voiding efficiency (cut-off value 70%), and the presence of sawtooth and interrupted waveform on uroflowmetry were significant predictive factors for detrusor underactivity. In particular, the incidence of sawtooth and interrupted waveform was significantly higher in the detrusor underactivity group (80%) than in the bladder outlet obstruction group (12.8%), which showed both high sensitivity (80%) and specificity (87.2%) in differentiating detrusor underactivity from bladder outlet obstruction. CONCLUSIONS Sawtooth and interrupted waveform on uroflowmetry can be a useful predictive factor for detrusor underactivity. In addition, lower intravesical prostatic protrusion and bladder voiding efficiency can be of supplementary use.
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Affiliation(s)
- Yoshihisa Matsukawa
- Department of Urology, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan.,UAB Working Group in Japanese Continence Society, Tokyo, Japan
| | - Masaki Yoshida
- UAB Working Group in Japanese Continence Society, Tokyo, Japan.,Department of Urology, National Centre for Geriatrics and Gerontology, Obu, Aichi, Japan
| | - Osamu Yamaguchi
- UAB Working Group in Japanese Continence Society, Tokyo, Japan.,Department of Chemical Biology and Applied Chemistry, Nihon University School of Engineering, Koriyama, Japan
| | - Shun Takai
- Department of Urology, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Tsuyoshi Majima
- Department of Urology, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Yasuhito Funahashi
- Department of Urology, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Makoto Yono
- UAB Working Group in Japanese Continence Society, Tokyo, Japan.,Department of Urology, Nishi-Kumamoto Hospital, SOUSEIKAI Medical Group, Kumamoto, Japan
| | - Noritoshi Sekido
- UAB Working Group in Japanese Continence Society, Tokyo, Japan.,Department of Urology, Toho University Ohashi Medical Center, Tokyo, Japan
| | - Momokazu Gotoh
- Department of Urology, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
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Valentini FA, Marti BG, Robain G, Zimern PE, Nelson PP. Is bladder voiding efficiency useful to evaluate voiding function in women older than 65 years? Prog Urol 2019; 29:567-571. [PMID: 31473103 DOI: 10.1016/j.purol.2019.08.270] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Revised: 08/09/2019] [Accepted: 08/12/2019] [Indexed: 11/28/2022]
Abstract
AIMS The aims of the study were to evaluate the reproducibility of bladder voiding efficiency (BVE) between free flow (FF) and intubated flow(IF) in old women, and to search for a relationship of this index with complaint and urodynamic diagnosis. METHODS Urodynamic tracings of non-neurologic women referred for investigation of various lower urinary tract symptoms (LUTS) were analyzed. Urodynamic study included one FF followed by one cystometry and IF. Post void residual volume (PVR) was measured using a Bladder-scan. Exclusion criteria were voided volume<100ml and prolapse of grade>2. RESULTS One hundred and ninety women met the study criteria. The mean age was 74±6 years [65-96years]. The main complaint was urinary incontinence: stress (26), urge (53) and mixed (56). Forty-four women had various complaints without incontinence. Overall BVE IF (77.6±25.8) was significantly lower than BVE FF (90.4±15.3) (P<.0001). Age sub-groups stratification led similar results. BVE IF was significantly lower than BVE FF in women with incontinence whatever the cause. Urodynamic diagnosis was posed according to the ICS/IUGA recommendations and 2 sub-groups defined according with involvement of detrusor. BVE IF was significantly lower than BVE FF for detrusor dysfunction, except for detrusor overactivity. CONCLUSION In this large cohort of old non-neurologic women studied urodynamically for a variety of LUTS, BVE is higher when evaluated from a FF whatever age and for complaint of urinary incontinence. In addition, a low BVE value from an IF may suggest a detrusor dysfunction. LEVEL OF EVIDENCE 4.
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Affiliation(s)
- F A Valentini
- Sorbonne université and hôpital Rothschild, 75012 Paris, France.
| | - B G Marti
- Sorbonne université and hôpital Rothschild, 75012 Paris, France
| | - G Robain
- Sorbonne université and hôpital Rothschild, 75012 Paris, France
| | - P E Zimern
- UT Southwestern Medical Center in Dallas, 7539 TX, United States
| | - P P Nelson
- Sorbonne université and hôpital Rothschild, 75012 Paris, France
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69
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Dobberfuhl AD, Chen A, Alkaram AF, De EJ. Spontaneous voiding is surprisingly recoverable via outlet procedure in men with underactive bladder and documented detrusor underactivity on urodynamics. Neurourol Urodyn 2019; 38:2224-2232. [DOI: 10.1002/nau.24122] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Accepted: 07/12/2019] [Indexed: 12/12/2022]
Affiliation(s)
- Amy D. Dobberfuhl
- Department of UrologyStanford University School of Medicine Stanford California
| | - Annie Chen
- Department of UrologyStony Brook University Hospital Stony Brook New York
| | - Ahmed F. Alkaram
- Department of Surgery, Section of UrologySalem VA Medical Center Salem Virginia
| | - Elise J.B. De
- Department of UrologyMassachusetts General Hospital Boston Massachusetts
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70
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Fry CH, McCloskey KD. Spontaneous Activity and the Urinary Bladder. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2019; 1124:121-147. [PMID: 31183825 DOI: 10.1007/978-981-13-5895-1_5] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
The urinary bladder has two functions: to store urine, when it is relaxed and highly compliant; and void its contents, when intravesical pressure rises due to co-ordinated contraction of detrusor smooth muscle in the bladder wall. Superimposed on this description are two observations: (1) the normal, relaxed bladder develops small transient increases of intravesical pressure, mirrored by local bladder wall movements; (2) pathological, larger pressure variations (detrusor overactivity) can occur that may cause involuntary urine loss and/or detrusor overactivity. Characterisation of these spontaneous contractions is important to understand: how normal bladder compliance is maintained during filling; and the pathophysiology of detrusor overactivity. Consideration of how spontaneous contractions originate should include the structural complexity of the bladder wall. Detrusor smooth muscle layer is overlain by a mucosa, itself a complex structure of urothelium and a lamina propria containing sensory nerves, micro-vasculature, interstitial cells and diffuse muscular elements.Several theories, not mutually exclusive, have been advanced for the origin of spontaneous contractions. These include intrinsic rhythmicity of detrusor muscle; modulation by non-muscular pacemaking cells in the bladder wall; motor input to detrusor by autonomic nerves; regulation of detrusor muscle excitability and contractility by the adjacent mucosa and spontaneous contraction of elements of the lamina propria. This chapter will consider evidence for each theory in both normal and overactive bladder and how their significance may vary during ageing and development. Further understanding of these mechanisms may also identify novel drug targets to ameliorate the clinical consequences of large contractions associated with detrusor overactivity.
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Affiliation(s)
- Christopher H Fry
- School of Physiology, Pharmacology and Neuroscience, University of Bristol, Bristol, UK.
| | - Karen D McCloskey
- School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Belfast, UK
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Al Mousa RT, Al Dossary N, Hashim H. The role of urodynamics in females with lower urinary tract symptoms. Arab J Urol 2019; 17:2-9. [PMID: 31258939 PMCID: PMC6583751 DOI: 10.1080/2090598x.2019.1589931] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2018] [Accepted: 01/31/2019] [Indexed: 01/22/2023] Open
Abstract
Objective: To review the role of urodynamic studies (UDS) in females with lower urinary tract symptoms (LUTS), as LUT dysfunction is a common condition. The role of UDS was and continues to be vital in the assessment of such cases; however, utilisation is still debated amongst clinicians as to when and in which conditions it should be used. Materials and methods: We conducted a literature review using the Medical Literature Analysis and Retrieval System Online (MEDLINE) search engine from year 1990 until August 2018, using the keywords: ‘female urology’, ‘lower urinary tract symptoms’, ‘urodynamic’, ‘incontinence’, ‘overactive bladder’, ‘bladder outlet obstruction’. We also reviewed the latest international guidelines related to the subject including: the International Consultation of Incontinence, American Urological Association, European Urology Association, and International Continence Society. Results: Using >60 reference articles and international guidelines, our review showed that there is a trend of utilisation of UDS in females with LUTS. Conclusion: UDS remains a valuable diagnostic test, which provides vital information to both the surgeon and patient prior to invasive treatment, with minimal morbidity. Abbreviations: DO: detrusor overactivity; LUT(D): lower urinary tract (dysfunction); NLUTD: neurogenic LUTD; OAB: overactive bladder; PdetQmax: detrusor pressure at maximum urinary flow; POP: pelvic organ prolapse; PVR: post-void residual urine volume; Qmax: maximum urinary flow rate; UDS: urodynamic studies; (M)(S)(U)UI: (mixed) (stress) (urgency) urinary incontinence
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Affiliation(s)
- Riyad T Al Mousa
- Department of Urology, King Fahad Specialist Hospital Dammam, Dammam, Saudi Arabia
| | - Nader Al Dossary
- Department of Urology, King Fahad Specialist Hospital Dammam, Dammam, Saudi Arabia
| | - Hashim Hashim
- Bristol Urological Institute, Southmead Hospital, Bristol, UK
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Kim A, Park YJ, Heo KO, Choi WS, Park HK, Paick SH, Choo MS, Kim HG. Novel symptom questionnaire for the differential diagnosis of detrusor underactivity and bladder outlet obstruction in men. Aging Male 2019; 22:150-155. [PMID: 29985721 DOI: 10.1080/13685538.2018.1481941] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
Abstract
OBJECTIVE To develop a questionnaire for the differential diagnosis of detrusor underactivity (DUA) and bladder outlet obstruction (BOO) without performing invasive pressure flow studies. STUDY DESIGN AND METHODS Symptoms of men with DUA were analyzed and compared with those of men with BOO using eight questions from the developing questionnaire. Patients with DUA have a bladder contractility index (PdetQmax+5xQmax) less than 100, whereas those with BOO have a BOO index (PdetQmax-2xQmax) greater than 40 in urodynamic studies (UDS). Men with detrusor overactivity in UDS and neurogenic issues were excluded from the analysis. One urologist reviewed patients' medical records, and responded to eight questions without using information from UDS. Scores in the developing questionnaire were then compared to make a differential diagnosis between DUA and BOO. RESULTS Overall, 318 men who underwent UDS were included. Symptoms were compared in patients diagnosed with DUA without BOO (n = 165) and BOO without DUA (n = 153). Questions 1, 2, 4, 5, 6, and 7 were significantly different between groups. The sensitivity and specificity of the questionnaire were 95.8% and 95.4%, respectively, for predicting DUA in patients with scores greater than 45 points (cutoff value). CONCLUSIONS Men with DUA and BOO may be distinguished using a developing questionnaire without invasive evaluation. Men with scores greater than 45 points would be expected to have DUA but not BOO.
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Affiliation(s)
- Aram Kim
- a Department of Urology , Konkuk University Medical Center, Konkuk University School of Medicine , Seoul , Korea
| | - Young-Jin Park
- a Department of Urology , Konkuk University Medical Center, Konkuk University School of Medicine , Seoul , Korea
| | - Kyung Ok Heo
- b Department of Urology , Asan Medical Center, Ulsan University College of Medicine , Seoul , Korea
| | - Woo Suk Choi
- a Department of Urology , Konkuk University Medical Center, Konkuk University School of Medicine , Seoul , Korea
| | - Hyoung Keun Park
- a Department of Urology , Konkuk University Medical Center, Konkuk University School of Medicine , Seoul , Korea
| | - Sung Hyun Paick
- a Department of Urology , Konkuk University Medical Center, Konkuk University School of Medicine , Seoul , Korea
| | - Myung-Soo Choo
- b Department of Urology , Asan Medical Center, Ulsan University College of Medicine , Seoul , Korea
| | - Hyeong Gon Kim
- a Department of Urology , Konkuk University Medical Center, Konkuk University School of Medicine , Seoul , Korea
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AMPK Alters Detrusor Contractility During Emptying in Normal Bladder and Hypertrophied Bladder with Partial Bladder Outlet Obstruction via CaMKKβ. Int J Mol Sci 2019; 20:ijms20112650. [PMID: 31146414 PMCID: PMC6600286 DOI: 10.3390/ijms20112650] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Revised: 05/28/2019] [Accepted: 05/28/2019] [Indexed: 12/20/2022] Open
Abstract
AMP-activated protein kinase (AMPK) has been implicated in contractility changes in bladders with partial bladder outlet obstruction (PBOO), but the role of AMPK in the contractile response of normal bladder remains unclear. We investigated the phosphorylation of AMPKα and expression of the involved upstream AMPK kinases (AMPKKs) in a model of bladders with PBOO and sought to determine whether the pharmacological inhibition of these two factors affected detrusor contractility in normal bladders, using female Sprague–Dawley rats. Cystometry and Western blot analysis were performed in rats that were subjected to PBOO induction or a sham operation. Cystometry was performed in normal rats that received selective inhibitors of AMPKα and Ca2+/calmodulin-dependent protein kinase kinase (CaMKKβ) (compound C and STO-609, respectively) at doses determined in the experiments. In the PBOO bladders, bladder weight and micturition pressure (MP) were higher and AMPKα phosphorylation (T172) and CaMKKβ expression was significantly reduced. Compound C and STO-609 increased MP. The increased contractile response in bladders with PBOO-induced hypertrophy was related to decreased CaMKKβ/AMPK signaling activity, and the pharmacological inhibition of this pathway in normal bladders increased detrusor contractility, implying a role of CaMKKβ/AMPK signaling in the bladder in the regulation of detrusor contractility.
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Dobberfuhl AD, Shaffer RK, Goodman SN, Chen BH. Urodynamic factors associated with the large capacity bladder and incomplete emptying after prolapse repair (2009-2015). Neurourol Urodyn 2019; 38:1322-1331. [PMID: 30912192 DOI: 10.1002/nau.23982] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2018] [Revised: 02/12/2019] [Accepted: 03/04/2019] [Indexed: 12/20/2022]
Abstract
AIMS To identify the clinical and urodynamic factors associated with the large capacity bladder and incomplete bladder emptying after prolapse repair. METHODS We identified 592 women who underwent anterior and/or apical prolapse repair at our institution from 2009 to 2015. Women were stratified by urodynamic capacity. The primary outcome was incomplete emptying at the longest follow-up (postvoid residual [PVR] > 200 mL). Data were analyzed in the Statistical Analysis System software. RESULTS Two hundred and sixty-six women (mean age, 61 years) had preoperative urodynamic tracings available for review. After surgery, there were 519 PVRs in 239 women recorded at up to 2949 days (mean, 396) and nine time points (median, 2; IQR, 1-3). The receiver operator curve for predicted probability of longest follow-up PVR greater than 200 mL (area under curve = 0.67) identified the 600 mL cutpoint which defined large capacity bladder. Large capacity bladders (capacity, >600 mL [n=79] vs ≤600 mL, [n=160]) had a mean: detrusor pressure at maximum flow (21 vs 22 cm H2 O; P = 0.717), maximum flow rate (19 vs 17 mL/s; P = 0.148), significantly elevated PVR (202 vs 73 mL; P < 0.001), and significantly lower voiding efficiency (VE) (74 vs 82%, P < 0.05). Following prolapse repair, elevated PVR was associated with large capacity (PVR 101 vs 49 mL, P < 0.05). Large bladders had a two- to three-fold risk of longest follow-up PVR greater than 200 mL (14.3%-20.3% [capacity, >600 mL] vs 4.1%-7.0% [capacity, ≤600 mL]). VE was similar after surgery regardless of the capacity (87% vs 88%, P = 0.772). CONCLUSIONS The decision to pursue prolapse repair should be individualized and take into account, the bladder capacity and goals for PVR improvement after surgery.
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Affiliation(s)
- Amy D Dobberfuhl
- Department of Urology, Stanford University School of Medicine, Stanford, California
| | - Robyn K Shaffer
- Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, California
| | - Steven N Goodman
- Department of Health Research and Policy, Stanford University School of Medicine, Stanford, California
| | - Bertha H Chen
- Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, California
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Vale L, Jesus F, Marcelissen T, Rieken M, Geavlete B, Rahnama'i MS, Martens F, Cruz F, Antunes‐Lopes T. Pathophysiological mechanisms in detrusor underactivity: Novel experimental findings. Low Urin Tract Symptoms 2019; 11:92-98. [DOI: 10.1111/luts.12257] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2018] [Revised: 11/29/2018] [Accepted: 01/07/2019] [Indexed: 01/20/2023]
Affiliation(s)
- Luís Vale
- Faculty of Medicine, University of PortoDepartment of Urology, Hospital São João Porto Portugal
| | - Filipa Jesus
- Faculty of Medicine, University of PortoDepartment of Urology, Hospital São João Porto Portugal
| | - Tom Marcelissen
- Department of UrologyMaastricht University Medical Centre Maastricht The Netherlands
| | - Malte Rieken
- Department of UrologyMedical University of Vienna Vienna Austria
| | - Bogdan Geavlete
- Department of UrologySaint John Emergency Clinical Hospital Bucharest Romania
| | - Mohammad Sajjad Rahnama'i
- Department of UrologyMaastricht University Maastricht The Netherlands
- Department of UrologyUniklinik Aachen RWTH Aachen Germany
| | - Frank Martens
- Department of Urology, Rabdoud University Medical Centre Nijmegen The Netherlands
| | - Francisco Cruz
- Faculty of Medicine, University of PortoDepartment of Urology, Hospital São João Porto Portugal
| | - Tiago Antunes‐Lopes
- Faculty of Medicine, University of PortoDepartment of Urology, Hospital São João Porto Portugal
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Uren AD, Cotterill N, Harding C, Hillary C, Chapple C, Lasch K, Stroupe A, Deshpande C, Delbecque L, Van Koeveringe G, Oelke M, Belal M, Bosch R, Blok B, Nitti V, Gotoh M, Takei M, Crawford B, Klaver M, Bongaerts D, Hakimi Z, Kos T, Abrams P. The development of the ICIQ-UAB: A patient reported outcome measure for underactive bladder. Neurourol Urodyn 2019; 38:996-1004. [PMID: 30801826 DOI: 10.1002/nau.23947] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2018] [Revised: 12/04/2018] [Accepted: 01/24/2019] [Indexed: 01/05/2023]
Abstract
AIMS To present the development of the International Consultation on Incontinence Questionnaire-underactive bladder (ICIQ-UAB) as the first patient reported outcome measure for the assessment of the symptoms and impact on the health-related quality of life of UAB developed in-line with the Food and Drug Administration Guidance for Industry. METHODS Draft items were developed following 44 semi-structured concept elicitation interviews in the UK and refined using 36 cognitive interviews. A pilot study was designed to assess the draft ICIQ-UAB's initial psychometric properties with 54 patients recruited from European hospitals. Further concept elicitation interviews were also carried out with 11 patients in the US and 10 patients in Japan. All participants had a prior urodynamic diagnosis of detrusor underactivity. RESULTS The cognitive interviews confirmed the initial items to be understood and interpreted as intended. Pilot testing showed that both internal consistency (Cronbach's α ≥ 0.85) and test-retest reliability (stable patients; intraclass correlation coefficient ≥ 0.88) were high. The interviews in the US and Japan elicited symptoms and impacts that support previous findings in the UK and provided further insight into the experiences of patients in those countries. The developmental ICIQ-UAB was refined using the evidence from all substudies. CONCLUSIONS The validity and reliability of the ICIQ-UAB were supported in a pilot study setting and the wider cultural applicability by the additional interviews in the US and Japan. Following further validation in future clinical trials, the developmental ICIQ-UAB is envisaged as an important tool for the monitoring of future UAB treatment strategies.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Gommert Van Koeveringe
- Department of Urology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Matthias Oelke
- Department of Urology, St. Antonius Hospital, Gronau, Germany
| | - Mohammed Belal
- Department of Urology, Queen Elizabeth Hospital, Birmingham, UK
| | - Ruud Bosch
- Department of Urology, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Bertil Blok
- Department of Urology, Erasmus Medical Centre, Rotterdam, The Netherlands
| | - Victor Nitti
- Department of Urology, NYU Langone Medical Centre, New York, New York
| | - Momokazu Gotoh
- Department of Urology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | | | | | | | | | | | - Ton Kos
- Astellas Pharma Europe B.V, Leiden, The Netherlands
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Rosier PF, ten Donkelaar CS, de Kort LM. Clinical Epidemiology: Detrusor Voiding Contraction Maximum Power, Related to Ageing. Urology 2019; 124:72-77. [DOI: 10.1016/j.urology.2018.10.038] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2018] [Revised: 09/28/2018] [Accepted: 10/22/2018] [Indexed: 12/18/2022]
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Yamany T, Elia M, Lee JJ, Singla AK. Female underactive bladder - Current status and management. INDIAN JOURNAL OF UROLOGY : IJU : JOURNAL OF THE UROLOGICAL SOCIETY OF INDIA 2019; 35:18-24. [PMID: 30692720 PMCID: PMC6334577 DOI: 10.4103/iju.iju_306_18] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Underactive bladder (UAB) is defined by the International Continence Society as a symptom complex characterized by a slow urinary stream, hesitancy, and straining to void, with or without a feeling of incomplete bladder emptying sometimes with storage symptoms. Until recently, the topic has received little attention in the literature probably due to a lack of consistent definitions and diagnostic criteria. We performed a literature review to identify articles related to the diagnosis and management of UAB, specifically in female patients. UAB is a common clinical entity, occurring in up to 45% of females depending on definitions used. Prevalence increases significantly in elderly women and women who live in long-term care facilities. The exact etiology and pathophysiology for developing UAB is unknown, though it is likely a multifactorial process with contributory neurogenic, cardiovascular, and idiopathic causes. There are currently no validated questionnaires for diagnosing or monitoring treatment for patients with UAB. Management options for females with UAB remain limited, with clean intermittent catheterization, the most commonly used. No pharmacotherapies have consistently been proven to be beneficial. Neuromodulation has had the most promising results in terms of symptom improvement, with newer technologies such as stem-cell therapy and gene therapy requiring more evidence before widespread use. Although UAB has received increased recognition and has been a focus of research in recent years, there remains a lack of diagnostic and therapeutic tools. Future research goals should include the development of targeted therapeutic interventions based on pathophysiologic mechanisms and validated diagnostic questionnaires.
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Affiliation(s)
- Tammer Yamany
- Department of Urology, Massachusetts General Hospital, Boston, USA
| | - Marlie Elia
- Georgetown University School of Medicine, Washington, DC, USA
| | - Jason Jihoon Lee
- Department of Urology, Massachusetts General Hospital, Boston, USA
| | - Ajay K Singla
- Department of Urology, Massachusetts General Hospital, Boston, USA
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Osman NI, Esperto F, Chapple CR. Detrusor Underactivity and the Underactive Bladder: A Systematic Review of Preclinical and Clinical Studies. Eur Urol 2018; 74:633-643. [PMID: 30139634 DOI: 10.1016/j.eururo.2018.07.037] [Citation(s) in RCA: 63] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2018] [Accepted: 07/27/2018] [Indexed: 11/30/2022]
Abstract
CONTEXT Detrusor underactivity (DUA) is a common but relatively under-researched bladder dysfunction. Underactive bladder (UAB) is the symptom-based correlate of DUA. Recently, there has been renewed interest in this topic. OBJECTIVE To systematically review and summarise the most recent literature and discuss this in the context of what is already known. EVIDENCE ACQUISITION A systematic review of the literature was performed in December 2017 using Medline and Scopus databases. Separate searches of each database used a complex search strategy including "free text" protocols. Search terms included "underactive bladder", "detrusor underactivity", "acontractile bladder", "detrusor failure", "detrusor areflexia", "atonic bladder", "chronic retention", and "impaired bladder contractility". EVIDENCE SYNTHESIS The initial search retrieved a total of 1690 studies; of these 44 were included in the final analyses. CONCLUSIONS Although there has been an expansion in the literature concerning all aspects of DUA and UAB, knowledge on its epidemiology and aetiopathogenesis is still lacking; there remains a need to develop accurate reproducible diagnostic criteria and effective treatments, in particular drug therapies. PATIENT SUMMARY Recently, there has been renewed interest in underactive bladder with expanding research in this area. The lack of simple, reproducible, noninvasive diagnostic criteria has precluded an accurate estimation of the magnitude of the problem. Recent studies have highlighted the potential role of impaired bladder blood supply in causing bladder underactivity.
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Affiliation(s)
- Nadir I Osman
- Department of Urology, Royal Hallamshire Hospital, Sheffield, UK
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Panicker JN, Anding R, Arlandis S, Blok B, Dorrepaal C, Harding C, Marcelissen T, Rademakers K, Abrams P, Apostolidis A. Do we understand voiding dysfunction in women? Current understanding and future perspectives: ICI-RS 2017. Neurourol Urodyn 2018; 37:S75-S85. [DOI: 10.1002/nau.23709] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2017] [Accepted: 03/05/2018] [Indexed: 12/12/2022]
Affiliation(s)
- Jalesh N. Panicker
- Department of Uro-Neurology; The National Hospital for Neurology and Neurosurgery and UCL Institute of Neurology; Queen Square London United Kingdom
| | - Ralf Anding
- Neurourology; Department of Urology and Pediatric Urology; University Hospital Bonn; Bonn Germany
| | - Salvador Arlandis
- Department of Urology; Hospital Universitario y Politécnico La Fe; Valencia Spain
| | - Bertil Blok
- Department of Urology; Erasmus Medical Center; Rotterdam The Netherlands
| | | | - Chris Harding
- Department of Urology; Freeman Hospital; Newcastle Upon-Tyne United Kingdom
| | - Tom Marcelissen
- Department of Urology; Maastricht University Medical Centre; Maastricht The Netherlands
| | - Kevin Rademakers
- Department of Urology; Maastricht University Medical Centre; Maastricht The Netherlands
| | - Paul Abrams
- Department of Urology; University of Bristol; Bristol United Kingdom
- Department of Teaching and Research, Bristol Urological Institute; International Consultation on Urological Diseases; Bristol United Kingdom
| | - Apostolos Apostolidis
- 2nd Department of Urology; Aristotle University of Thessaloniki; Thessaloniki Greece
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81
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Finazzi-Agro E, Gammie A, Kessler TM, van Koeveringe G, Serati M, Solomon E, de Wachter S, Kirschner-Hermanns R. Urodynamics Useless in Female Stress Urinary Incontinence? Time for Some Sense-A European Expert Consensus. Eur Urol Focus 2018; 6:137-145. [PMID: 30061075 DOI: 10.1016/j.euf.2018.07.031] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2018] [Revised: 07/15/2018] [Accepted: 07/20/2018] [Indexed: 01/08/2023]
Abstract
BACKGROUND Routine use of urodynamics (UDS) for the assessment of female stress urinary incontinence (SUI) appears to be in decline across Europe. The reasons for this trend appear multifactorial, but the implications are of significant concern. OBJECTIVES To achieve an expert consensus viewpoint on the value of UDS in female SUI and current barriers to its use. METHODOLOGY A multidisciplinary group of UDS experts from six European countries was convened, and a modified version of the Delphi method was utilised to reach a consensus viewpoint structured around five key questions. RESULTS Consensus was achieved on all five questions. The group was unanimous that the decline in routine use of UDS is unjustified and misguided, driven by restrictions in funding and accelerated by the publication-and subsequent influence-of two trials that had major limitations. LIMITATIONS The authors comprised a selected group of UDS experts and the analysis is not a formal systematic review. CONCLUSIONS Extensive experience and observational studies have demonstrated the value of UDS for the assessment of female SUI and the dangers of empiric management. This evidence base should not be eclipsed by the findings of two randomised controlled trials that had numerous shortcomings. PATIENT SUMMARY A group of experts were worried that, even though the cause of incontinence varies, doctors seem to be skipping a diagnostic test called urodynamics (UDS) in some patients and just providing treatment-even surgery-without knowing exactly what is wrong. These experts analysed the situation in detail and reached agreement that UDS testing should not be skipped.
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Affiliation(s)
- Enrico Finazzi-Agro
- Department of Experimental Medicine and Surgery, Unit for Functional Urology, Tor Vergata University Hospital, Rome, Italy
| | - Andrew Gammie
- Bristol Urological Institute, Southmead Hospital, Bristol, UK
| | - Thomas M Kessler
- Neuro-urology, Spinal Cord Injury Center & Research, University of Zürich, Balgrist University Hospital, Zürich, Switzerland
| | - Gommert van Koeveringe
- Department of Urology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Maurizio Serati
- Department of Obstetrics and Gynaecology, Urogynaecology Unit, University of Insubria, Varese, Italy.
| | | | - Stefan de Wachter
- Department of Urology, University Hospital Antwerpen, University of Antwerp, Belgium
| | - Ruth Kirschner-Hermanns
- Neuro-urology/Urology, University Clinic, Friedrich Wilhelms University Bonn and Neurological Rehabilitation Centre, Bonn, Germany
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82
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Wen J, Zu S, Chen Z, Daugherty SL, de Groat WC, Liu Y, Yuan M, Cheng G, Zhang X. Reduced bladder responses to capsaicin and GSK-1016790A in retired-breeder female rats with diminished volume sensitivity. Am J Physiol Renal Physiol 2018; 315:F1217-F1227. [PMID: 30019934 DOI: 10.1152/ajprenal.00198.2018] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Literature documents an age-related reduction of bladder sensory function. Transient receptor potential vanilloid (TRPV)1 or TRPV4 channels have been implicated in bladder mechanotransduction. To investigate contributions of TRPV1 or TRPV4 to the age-related reduction of bladder sensory function, bladder responses to capsaicin (CAP; TRPV1 agonist) and GSK-1016790A (GSK; TRPV4 agonist) in retired breeder (RB; 12-15 mo) and young adult (2-3 mo) female rats were compared using multiple methods. Metabolic cage and continuous infusion cystometry [cystometrogram (CMG)] recordings revealed that RB rats exhibit larger bladder capacity and lower voiding frequency. RB rats also have a greater intravesical pressure threshold for micturition; however, the voiding contraction strength was equivalent to that in young rats. CAP (1 μM) or GSK (20 nM) administered intravesically evoked smaller changes in all CMG parameters in RB rats. In vitro, CAP (1 μM) or GSK (20 nM) evoked smaller enhancement of bladder strip contractions, while the muscarinic receptor agonist carbachol (at 100, 300, and 1,000 nM) elicited greater amplitude contractions in RB rats. Patch-clamp recording revealed smaller CAP (100 nM) induced inward currents in bladder primary sensory neurons, and Ca2+ imaging revealed smaller GSK (20 nM) evoked increases in intracellular Ca2+ concentration in urothelial cells in RB rats. These results suggest that RB rats have a decreased bladder sensory function commonly observed in elderly women, and could be used as an animal model to study the underling mechanisms. Reduced functional expression of TRPV1 in bladder afferents or reduced functional expression of urothelial TRPV4 may be associated with the diminished sensory function.
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Affiliation(s)
- Jiliang Wen
- Department of Urology, the Second Hospital of Shandong University, Jinan, Shandong, Peoples Republic of China
| | - Shulu Zu
- Department of Urology, the Second Hospital of Shandong University, Jinan, Shandong, Peoples Republic of China
| | - Zhenghao Chen
- Department of Urology, the Second Hospital of Shandong University, Jinan, Shandong, Peoples Republic of China
| | - Stephanie L Daugherty
- Department of Pharmacology and Chemical Biology, University of Pittsburgh School of Medicine , Pittsburgh, Pennsylvania
| | - William C de Groat
- Department of Pharmacology and Chemical Biology, University of Pittsburgh School of Medicine , Pittsburgh, Pennsylvania
| | - Yuqiang Liu
- Department of Urology, the Second Hospital of Shandong University, Jinan, Shandong, Peoples Republic of China
| | - Mingzhen Yuan
- Department of Urology, the Second Hospital of Shandong University, Jinan, Shandong, Peoples Republic of China
| | - Guanghui Cheng
- Department of Central Research Laboratory, the Second Hospital of Shandong University, Jinan, Shandong, Peoples Republic of China
| | - Xiulin Zhang
- Department of Urology, the Second Hospital of Shandong University, Jinan, Shandong, Peoples Republic of China
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83
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Yang TH, Chuang FC, Kuo HC. Urodynamic characteristics of detrusor underactivity in women with voiding dysfunction. PLoS One 2018; 13:e0198764. [PMID: 29924821 PMCID: PMC6010249 DOI: 10.1371/journal.pone.0198764] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2018] [Accepted: 05/22/2018] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION AND HYPOTHESIS Voiding dysfunction has gained interest due to its high prevalence in the elderly. This study characterized bladder dysfunction in women with voiding dysfunction using video urodynamic studies (VUDS) focused on detrusor underactivity (DU). METHODS We studied 1914 women in which first-line medical treatment failed. Age, comorbidities, and urodynamic parameters were analyzed to determine the association between bladder sensation and contractility. RESULTS VUDS were normal in 2.9% (n = 56) of patients and showed DU in 23.1% (n = 443), detrusor hyperactivity and impaired contractility (DHIC) in 12.0% (n = 231), hypersensitive bladder in 17.0% (n = 325), detrusor overactivity (DO) in 2.6% (n = 49) and bladder outlet obstruction in 42.3% (n = 810). The mean age of patients in the DU and DHIC groups was significantly older than in women with normal VUDS and those with hypersensitive bladders (p<0.01). Decreased bladder sensation and larger cystometric bladder capacity were noted in the DU group compared to the DHIC, HSB, and DO groups. Bladder sensation was negatively associated with the bladder contractility. Bladder contractility index and voiding efficiency were lower in the DU and DHIC groups compared to the normal group. CONCLUSIONS The bladder conditions of women with voiding dysfunction included DU, DHIC, HSB and DO. Bladder contractility index and voiding efficiency were significantly lowest in DU and DHIC groups and lower in HSB and DO groups than normal tracing group. Reduced bladder sensation was noted in DU and negatively associated with detrusor contractility.
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Affiliation(s)
- Tsai-Hwa Yang
- Department of Obstetrics and Gynecology, Chang Gang Memorial Hospital, Kaohsiung, Taiwan
| | - Fei-Chi Chuang
- Department of Obstetrics and Gynecology, Chang Gang Memorial Hospital, Kaohsiung, Taiwan
| | - Hann-Chorng Kuo
- Department of Urology, Buddhist Tzu Chi General Hospital and Tzu Chi University, Hualien, Taiwan
- * E-mail:
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84
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Shao YP, Zhou Q, Li YP, Zhang SC, Xu HW, Wu S, Shen BX, Ding LC, Xue J, Chen ZS, Wei ZQ. Curcumin ameliorates cisplatin-induced cystopathy via activating NRF2 pathway. Neurourol Urodyn 2018; 37:2470-2479. [PMID: 29917258 DOI: 10.1002/nau.23731] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2018] [Accepted: 05/13/2018] [Indexed: 01/12/2023]
Affiliation(s)
- Yun Peng Shao
- Department of Urology; The Second Affiliated Hospital of Nanjing Medical University; Nanjing People's Republic of China
| | - Qiao Zhou
- Department of Reproduction; The affiliated Obstetrics and Gynecology Hospital with Nanjing Medical University, Nanjing Maternity and Child Health Care Hospital; Nanjing People's Republic of China
| | - Yun Peng Li
- Department of Urology; The Second Affiliated Hospital of Nanjing Medical University; Nanjing People's Republic of China
| | - Si Cong Zhang
- Department of Urology; The Second Affiliated Hospital of Nanjing Medical University; Nanjing People's Republic of China
| | - He Wei Xu
- Department of Urology; The Second Affiliated Hospital of Nanjing Medical University; Nanjing People's Republic of China
| | - Shuo Wu
- Department of Urology; The Second Affiliated Hospital of Nanjing Medical University; Nanjing People's Republic of China
| | - Bai Xin Shen
- Department of Urology; The Second Affiliated Hospital of Nanjing Medical University; Nanjing People's Republic of China
| | - Liu Cheng Ding
- Department of Urology; The Second Affiliated Hospital of Nanjing Medical University; Nanjing People's Republic of China
| | - Jun Xue
- Department of Urology; The Second Affiliated Hospital of Nanjing Medical University; Nanjing People's Republic of China
| | - Zheng Sen Chen
- Department of Urology; The Second Affiliated Hospital of Nanjing Medical University; Nanjing People's Republic of China
| | - Zhong Qing Wei
- Department of Urology; The Second Affiliated Hospital of Nanjing Medical University; Nanjing People's Republic of China
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85
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Arab Hassani F, Mogan RP, Gammad GGL, Wang H, Yen SC, Thakor NV, Lee C. Toward Self-Control Systems for Neurogenic Underactive Bladder: A Triboelectric Nanogenerator Sensor Integrated with a Bistable Micro-Actuator. ACS NANO 2018; 12:3487-3501. [PMID: 29630352 DOI: 10.1021/acsnano.8b00303] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Aging, neurologic diseases, and diabetes are a few risk factors that may lead to underactive bladder (UAB) syndrome. Despite all of the serious consequences of UAB, current solutions, the most common being ureteric catheterization, are all accompanied by serious shortcomings. The necessity of multiple catheterizations per day for a physically able patient not only reduces the quality of life with constant discomfort and pain but also can end up causing serious complications. Here, we present a bistable actuator to empty the bladder by incorporating shape memory alloy components integrated on flexible polyvinyl chloride sheets. The introduction of two compression and restoration phases for the actuator allows for repeated actuation for a more complete voiding of the bladder. The proposed actuator exhibits one of the highest reported voiding percentages of up to 78% of the bladder volume in an anesthetized rat after only 20 s of actuation. This amount of voiding is comparable to the common catheterization method, and its one time implantation onto the bladder rectifies the drawbacks of multiple catheterizations per day. Furthermore, the scaling of the device for animal models larger than rats can be easily achieved by adjusting the number of nitinol springs. For neurogenic UAB patients with degraded nerve function as well as degenerated detrusor muscle, we integrate a flexible triboelectric nanogenerator sensor with the actuator to detect the fullness of the bladder. The sensitivity of this sensor to the filling status of the bladder shows its capability for defining a self-control system in the future that would allow autonomous micturition.
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Affiliation(s)
- Faezeh Arab Hassani
- Department of Electrical and Computer Engineering, Faculty of Engineering , National University of Singapore , 4 Engineering Drive 3 , #05-45, Singapore 117583 , Singapore
- Singapore Institute for Neurotechnology , National University of Singapore , 28 Medical Drive , #05-COR, Singapore 117456 , Singapore
- Center for Intelligent Sensors and MEMS , National University of Singapore , 5 Engineering Drive 1 , E6 #05-11F, Singapore 117608 , Singapore
| | - Roshini P Mogan
- Singapore Institute for Neurotechnology , National University of Singapore , 28 Medical Drive , #05-COR, Singapore 117456 , Singapore
| | - Gil G L Gammad
- Singapore Institute for Neurotechnology , National University of Singapore , 28 Medical Drive , #05-COR, Singapore 117456 , Singapore
| | - Hao Wang
- Department of Electrical and Computer Engineering, Faculty of Engineering , National University of Singapore , 4 Engineering Drive 3 , #05-45, Singapore 117583 , Singapore
- Singapore Institute for Neurotechnology , National University of Singapore , 28 Medical Drive , #05-COR, Singapore 117456 , Singapore
- Center for Intelligent Sensors and MEMS , National University of Singapore , 5 Engineering Drive 1 , E6 #05-11F, Singapore 117608 , Singapore
- Hybrid-Integrated Flexible Electronic Systems (HIFES) Program , National University of Singapore , 5 Engineering Drive 1 , E6 #05-4, Singapore 117608 , Singapore
| | - Shih-Cheng Yen
- Department of Electrical and Computer Engineering, Faculty of Engineering , National University of Singapore , 4 Engineering Drive 3 , #05-45, Singapore 117583 , Singapore
- Singapore Institute for Neurotechnology , National University of Singapore , 28 Medical Drive , #05-COR, Singapore 117456 , Singapore
| | - Nitish V Thakor
- Department of Electrical and Computer Engineering, Faculty of Engineering , National University of Singapore , 4 Engineering Drive 3 , #05-45, Singapore 117583 , Singapore
- Singapore Institute for Neurotechnology , National University of Singapore , 28 Medical Drive , #05-COR, Singapore 117456 , Singapore
| | - Chengkuo Lee
- Department of Electrical and Computer Engineering, Faculty of Engineering , National University of Singapore , 4 Engineering Drive 3 , #05-45, Singapore 117583 , Singapore
- Singapore Institute for Neurotechnology , National University of Singapore , 28 Medical Drive , #05-COR, Singapore 117456 , Singapore
- Center for Intelligent Sensors and MEMS , National University of Singapore , 5 Engineering Drive 1 , E6 #05-11F, Singapore 117608 , Singapore
- Hybrid-Integrated Flexible Electronic Systems (HIFES) Program , National University of Singapore , 5 Engineering Drive 1 , E6 #05-4, Singapore 117608 , Singapore
- NUS Graduate School for Integrative Science and Engineering , National University of Singapore , Singapore 117456 , Singapore
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86
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Gammie A, Kaper M, Steup A, Yoshida S, Dorrepaal C, Kos T, Abrams P. What are the additional signs and symptoms in patients with detrusor underactivity and coexisting detrusor overactivity? Neurourol Urodyn 2018; 37:2220-2225. [PMID: 29635760 DOI: 10.1002/nau.23565] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2017] [Accepted: 02/15/2018] [Indexed: 11/07/2022]
Abstract
AIMS This study aimed to determine what difference the inclusion of patients with coexisting detrusor overactivity (DO) makes to the signs and symptoms of patients with detrusor underactivity (DU). METHODS A total of 250 male and 435 female urodynamic tests were analyzed retrospectively. Signs and symptoms which showed a statistically significant difference between DU without DO and DU with DO were identified. RESULTS Males with DO in addition to DU had higher age and number of daily micturitions, and were more likely to report urgency with or without urgency incontinence than males with DU without DO. They also had lower volumes for first desire to void, volume voided, and post void residual urine, lower abdominal pressure at Qmax and were less likely to report a history of retention or reduced bladder filling sensation than males with DU without DO. Females with DO in addition to DU had higher age and BMI, and were more likely to report urgency incontinence, higher day and night pad usage, constipation and have reduced anal tone than females with DU without DO. They also had lower volumes for first desire to void, volume voided, and post void residual urine, and lower abdominal pressure at Qmax than females who had DU without DO. CONCLUSIONS There are differences in signs and symptoms between patients who have DU without DO, compared to patients having DU with DO. This understanding will help future studies investigating treatment options for DU patients.
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Affiliation(s)
- Andrew Gammie
- Bristol Urological Institute, Southmead Hospital, Bristol, UK
| | - Mathilde Kaper
- Astellas Pharma Europe BV., Leiden, South Holland, The Netherlands
| | - Achim Steup
- Astellas Pharma Europe BV., Leiden, South Holland, The Netherlands
| | - Satoshi Yoshida
- Astellas Pharma Europe BV., Leiden, South Holland, The Netherlands
| | | | - Ton Kos
- Astellas Pharma Europe BV., Leiden, South Holland, The Netherlands
| | - Paul Abrams
- Bristol Urological Institute, Southmead Hospital, Bristol, UK
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87
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Abstract
Underactive bladder (UAB) is an important and complex urological condition resulting from the urodynamic finding of detrusor underactivity. It can manifest in a wide range of lower urinary tract symptoms, from voiding to storage complaints, and can overlap with other conditions, including overactive bladder and bladder outlet obstruction. However, UAB continues to be poorly understood and inadequately researched. In this article, we review the contemporary literature pertaining to recent advances in defining, understanding, and managing UAB.
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Affiliation(s)
- Su-Min Lee
- Bristol Urological Institute, Southmead Hospital, Southmead Road, Bristol, BS10 5NB, UK
| | - Hashim Hashim
- Bristol Urological Institute, Southmead Hospital, Southmead Road, Bristol, BS10 5NB, UK
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88
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Gammie A, Kaper M, Steup A, Yoshida S, Dorrepaal C, Kos T, Abrams P. Signs and symptoms that distinguish detrusor underactivity from mixed detrusor underactivity and bladder outlet obstruction in male patients. Neurourol Urodyn 2018; 37:1501-1505. [PMID: 29356059 DOI: 10.1002/nau.23492] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2017] [Accepted: 12/19/2017] [Indexed: 11/08/2022]
Abstract
AIMS This study aimed to identify signs and symptoms which show differences between men with detrusor underactivity (DU) compared to those with both DU and bladder outlet obstruction (BOO). METHODS One thousand six hundred and twelve urodynamic tests on male patients were analyzed retrospectively. Signs and symptoms which showed a statistically significant difference between patients with DU alone and patients with both DU+BOO were identified. RESULTS In the DU only group, considering only patients without a history of bladder outlet surgery, the number of daytime micturitions was lower, maximum voided volume on the bladder diary was higher, and slow stream was reported less often, whereas urinary tract infections were reported more often than for DU+BOO males. The average urine flow rate and abdominal pressure at maximum flow were greater in the DU males, compared to the DU+BOO males. CONCLUSIONS These data suggest that by combining symptoms, medical history and signs, that could be measured without the need for invasive urodynamics, it may be possible to identify men with DU in a non-invasive way. By doing so, men with DU could be separated from men with both DU+BOO, with sufficient specificity to allow the use of any new non-surgical treatment modalities, such as new and effective medical therapy.
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Affiliation(s)
- Andrew Gammie
- Bristol Urological Institute, Southmead Hospital, Bristol, UK
| | | | - Achim Steup
- Astellas Pharma Europe BV, Leiden, The Netherlands
| | | | | | - Ton Kos
- Astellas Pharma Europe BV, Leiden, The Netherlands
| | - Paul Abrams
- Bristol Urological Institute, Southmead Hospital, Bristol, UK
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89
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Gammie A, Rosier P, Li R, Harding C. How can we maximize the diagnostic utility of uroflow?: ICI-RS 2017. Neurourol Urodyn 2018; 37:S20-S24. [PMID: 29315791 DOI: 10.1002/nau.23472] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2017] [Accepted: 11/20/2017] [Indexed: 11/10/2022]
Abstract
AIMS To gauge the current level of diagnostic utility of uroflowmetry and to suggest areas needing research to improve this. METHODS A summary of the debate held at the 2017 meeting of the International Consultation on Incontinence Research Society, with subsequent analysis by the authors. RESULTS Limited diagnostic sensitivity and specificity exist for maximum flow rates, multiple uroflow measurements, and flow-volume nomograms. There is a lack of clarity in flow rate curve shape description and uroflow time measurement. CONCLUSIONS There is a need for research to combine uroflowmetry with other non-invasive indicators. Better standardizations of test technique, flow-volume nomograms, uroflow shape descriptions, and time measurements are required.
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Affiliation(s)
- Andrew Gammie
- Bristol Urological Institute, Southmead Hospital, Bristol, UK
| | - Peter Rosier
- Urology Hp C04 236, UMC Utrecht, Utrecht, Netherlands
| | - Rui Li
- University of the West of England, Bristol, UK
| | - Chris Harding
- Department of Urology, Freeman Hospital, Newcastle Upon Tyne, UK
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90
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Detrusor underactivity in pelvic organ prolapse. Int Urogynecol J 2017; 29:1111-1116. [DOI: 10.1007/s00192-017-3532-z] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2017] [Accepted: 11/28/2017] [Indexed: 10/18/2022]
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91
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Ladi-Seyedian SS, Nabavizadeh B, Sharifi-Rad L, Kajbafzadeh AM. Pharmacological treatments available for the management of underactive bladder in neurological conditions. Expert Rev Clin Pharmacol 2017; 11:193-204. [DOI: 10.1080/17512433.2018.1411801] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Affiliation(s)
- Seyedeh-Sanam Ladi-Seyedian
- Pediatric Urology and Regenerative Medicine Research Center, Children’s Medical Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Behnam Nabavizadeh
- Pediatric Urology and Regenerative Medicine Research Center, Children’s Medical Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Lida Sharifi-Rad
- Pediatric Urology and Regenerative Medicine Research Center, Children’s Medical Center, Tehran University of Medical Sciences, Tehran, Iran
- Department of Physical Therapy, Children’s Medical Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Abdol-Mohammad Kajbafzadeh
- Pediatric Urology and Regenerative Medicine Research Center, Children’s Medical Center, Tehran University of Medical Sciences, Tehran, Iran
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92
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Ko KJ, Lee CU, Lee KS. Clinical implications of underactive bladder. Investig Clin Urol 2017; 58:S75-S81. [PMID: 29279879 PMCID: PMC5740033 DOI: 10.4111/icu.2017.58.s2.s75] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2017] [Accepted: 07/24/2017] [Indexed: 12/14/2022] Open
Abstract
Underactive bladder (UAB) is a common urologic condition but a complex disease that causes troublesome lower urinary tract symptoms. Currently, management of UAB remains unsatisfactory. Also, many urological diseases can be combined with UAB. In these combined cases, the treatment results may be affected by UAB component. This review focuses on the clinical implications of UAB in patients with common urologic conditions, including bladder outlet obstruction, overactive bladder syndrome and stress urinary incontinence.
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Affiliation(s)
- Kwang Jin Ko
- Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Chung Un Lee
- Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Kyu-Sung Lee
- Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.,Department of Medical Device Management and Research, SAIHST, Sungkyunkwan University, Seoul, Korea
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93
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Yu YD, Jeong SJ. Epidemiology of underactive bladder: Common but underresearched. Investig Clin Urol 2017; 58:S68-S74. [PMID: 29279878 PMCID: PMC5740032 DOI: 10.4111/icu.2017.58.s2.s68] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2017] [Accepted: 09/05/2017] [Indexed: 12/02/2022] Open
Abstract
Detrusor underactivity (DU) or underactive bladder is a common cause of lower urinary tract symptoms (LUTS), but it is still poorly understood and underresearched. Although there has been a proposed definition by International Continence Society in 2002, no widely accepted diagnostic criteria have been established for this entity in clinical practice. Therefore, it has been rare to identify community-based researches on the epidemiology of DU until now. Only certain studies have reported the prevalence of DU in community-dwelling cohorts with significant LUTS using arbitrary urodynamic criteria for DU and these investigations have indicated that DU accounts for 25%–48% and 12%–24% of elderly men and women, respectively. However, these prevalence data based on the urodynamic definition apparently are limited in their extrapolation to the general population. Despite the clinical ambiguity of DU, its clinical effects on quality of life are quite significant, especially in the elderly population. An overall and proper comprehension of epidemiologic studies of DU may be crucial for better insight into DU, relevant decision making, and a more reasonable allocation of health resources. Therefore, researchers should find clues to the solution for the clinical diagnosis of this specific condition of LUTS from contemporary epidemiologic studies and try to develop a possible definition of ‘clinical’ DU from further studies.
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Affiliation(s)
- Young Dong Yu
- Department of Urology, Seoul National University Bundang Hospital, Seoul National University School of Medicine, Seongnam, Korea
| | - Seong Jin Jeong
- Department of Urology, Seoul National University Bundang Hospital, Seoul National University School of Medicine, Seongnam, Korea
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94
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Uren AD, Drake MJ. Definition and symptoms of underactive bladder. Investig Clin Urol 2017; 58:S61-S67. [PMID: 29279877 PMCID: PMC5740031 DOI: 10.4111/icu.2017.58.s2.s61] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2017] [Accepted: 09/22/2017] [Indexed: 12/23/2022] Open
Abstract
Underactive bladder (UAB) is a symptom syndrome reflecting the urodynamic observation of detrusor underactivity (DU), a voiding contraction of reduced strength and/or duration, leading to prolonged or incomplete bladder emptying. An International Continence Society Working Group has described UAB as characterised by a slow urinary stream, hesitancy and straining to void, with or without a feeling of incomplete bladder emptying and dribbling, often with storage symptoms. Since DU often coexists with bladder outlet obstruction, or storage dysfunction (detrusor overactivity or incontinence), the exact contribution of the DU to the presenting complaints can be difficult to establish. The presence of voiding and post voiding lower urinary tract symptoms (LUTS) is implicitly expected in UAB, but a reduced sensation of fullness is reported by some patients, and storage LUTS are also an important factor in many affected patients. These may result from a postvoid residual, but often they do not. The storage LUTS are often the key driver in leading the patient to seek healthcare input. Nocturia is particularly common and bothersome, but what the role of DU is in all the range of influences on nocturia has not been established. Qualitative research has established a broad impact on everyday life as a result of these symptoms. In general, people appear to manage the voiding LUTS relatively well, but the storage LUTS may be problematic.
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Affiliation(s)
- Alan D Uren
- Bristol Urological Institute, Southmead Hospital, Bristol, UK
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95
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Hassani FA, Peh WYX, Gammad GGL, Mogan RP, Ng TK, Kuo TLC, Ng LG, Luu P, Yen S, Lee C. A 3D Printed Implantable Device for Voiding the Bladder Using Shape Memory Alloy (SMA) Actuators. ADVANCED SCIENCE (WEINHEIM, BADEN-WURTTEMBERG, GERMANY) 2017; 4:1700143. [PMID: 29201606 PMCID: PMC5700638 DOI: 10.1002/advs.201700143] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/29/2017] [Revised: 05/09/2017] [Indexed: 05/08/2023]
Abstract
Underactive bladder or detrusor underactivity (DU) is defined as a reduction of contraction strength or duration of the bladder wall. Despite the serious healthcare implications of DU, there are limited solutions for affected individuals. A flexible 3D printed implantable device driven by shape memory alloys (SMA) actuators is presented here for the first time to physically contract the bladder to restore voluntary control of the bladder for individuals suffering from DU. This approach is used initially in benchtop experiments with a rubber balloon acting as a model for the rat bladder to verify its potential for voiding, and that the operating temperatures are safe for the eventual implantation of the device in a rat. The device is then implanted and tested on an anesthetized rat, and a voiding volume of more than 8% is successfully achieved for the SMA-based device without any surgical intervention or drug injection to relax the external sphincter.
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Affiliation(s)
- Faezeh Arab Hassani
- Department of Electrical and Computer EngineeringFaculty of EngineeringNational University of Singapore4 Engineering Drive 3, #05‐45Singapore117583Singapore
- Singapore Institute for NeurotechnologyNational University of Singapore28 Medical Dr. #05‐CORSingapore117456Singapore
- Center for Intelligent Sensors and MEMSNational University of Singapore4 Engineering Drive 3Singapore117576Singapore
- Biomedical Institute for Global Health Research and Technology (BIGHEART)Yong Loo Lin School of MedicineNational University of Singapore14 Medical Drive #14‐01Singapore117599Singapore
| | - Wendy Yen Xian Peh
- Singapore Institute for NeurotechnologyNational University of Singapore28 Medical Dr. #05‐CORSingapore117456Singapore
| | - Gil Gerald Lasam Gammad
- Singapore Institute for NeurotechnologyNational University of Singapore28 Medical Dr. #05‐CORSingapore117456Singapore
| | - Roshini Priya Mogan
- Singapore Institute for NeurotechnologyNational University of Singapore28 Medical Dr. #05‐CORSingapore117456Singapore
| | - Tze Kiat Ng
- Raffles Hospital585 North Bridge RoadSingapore188770Singapore
| | | | - Lay Guat Ng
- Singapore General HospitalOutram RoadSingapore169608Singapore
| | - Percy Luu
- Singapore Institute for NeurotechnologyNational University of Singapore28 Medical Dr. #05‐CORSingapore117456Singapore
| | - Shih‐Cheng Yen
- Department of Electrical and Computer EngineeringFaculty of EngineeringNational University of Singapore4 Engineering Drive 3, #05‐45Singapore117583Singapore
- Singapore Institute for NeurotechnologyNational University of Singapore28 Medical Dr. #05‐CORSingapore117456Singapore
- Center for Intelligent Sensors and MEMSNational University of Singapore4 Engineering Drive 3Singapore117576Singapore
| | - Chengkuo Lee
- Department of Electrical and Computer EngineeringFaculty of EngineeringNational University of Singapore4 Engineering Drive 3, #05‐45Singapore117583Singapore
- Singapore Institute for NeurotechnologyNational University of Singapore28 Medical Dr. #05‐CORSingapore117456Singapore
- Center for Intelligent Sensors and MEMSNational University of Singapore4 Engineering Drive 3Singapore117576Singapore
- Biomedical Institute for Global Health Research and Technology (BIGHEART)Yong Loo Lin School of MedicineNational University of Singapore14 Medical Drive #14‐01Singapore117599Singapore
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96
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Blaivas JG, Forde JC, Davila JL, Policastro L, Tyler M, Aizen J, Badri A, Purohit RS, Weiss JP. Surgical treatment of detrusor underactivity: a short term proof of concept study. Int Braz J Urol 2017; 43:540-548. [PMID: 28266820 PMCID: PMC5462147 DOI: 10.1590/s1677-5538.ibju.2016.0405] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2016] [Accepted: 10/25/2016] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVES To compare the surgical outcomes of men with bladder outlet obstruction (BOO) due to benign prostatic obstruction (BPO) to those with detrusor underactivity (DU) or acontractile detrusor (DA). MATERIALS AND METHODS This retrospective, IRB approved study included men who underwent BPO surgery for refractory LUTS or urinary retention. Patients were grouped based on videourodynamic (VUDS) findings: 1) men with BOO, 2) men with DU and 3) men with DA. The primary outcome measure was the Patient Global Impression of Improvement (PGII). Secondary outcome measures included uroflow (Qmax), post-void residual volume (PVR) and the need for clean intermittent catheterization (CIC). RESULTS One hundred and nineteen patients were evaluated: 1) 34 with BOO, 2) 62 with DU and 3) 23 with DA. Subjective success rate (PGII) was highest in the BOO group (97%) and those with DU (98%), while DA patients had a PGII success of 26%, (p<0.0001). After surgery, patients with BOO had the lowest PVR (68.5mL). Fifty-six patients (47%) performed CIC pre-operatively (47% of BOO, 32% of DU and 87% of DA patients). None of the patients in the BOO and DU groups required CIC post operatively compared to16/23 (69%) of patients in the DA group (p<0.0001). CONCLUSIONS BPO surgery is a viable treatment option in men with presumed BOO and DU while DA is a poor prognostic sign in men who do not void spontaneously pre-operatively.
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Affiliation(s)
- Jerry G Blaivas
- Department of Urology, Weill Medical College of Cornell University, New York, NY, USA.,Department of Urology, SUNY Downstate Medical School, Brooklyn, NY, USA.,Institute for Bladder and Prostate Research, New York, NY, USA
| | - James C Forde
- Department of Urology, Weill Medical College of Cornell University, New York, NY, USA.,Institute for Bladder and Prostate Research, New York, NY, USA
| | - Jonathan L Davila
- Department of Urology, SUNY Downstate Medical School, Brooklyn, NY, USA.,Institute for Bladder and Prostate Research, New York, NY, USA
| | - Lucas Policastro
- Department of Urology, SUNY Downstate Medical School, Brooklyn, NY, USA.,Institute for Bladder and Prostate Research, New York, NY, USA
| | - Michael Tyler
- Department of Urology, SUNY Downstate Medical School, Brooklyn, NY, USA.,Institute for Bladder and Prostate Research, New York, NY, USA
| | - Joshua Aizen
- Department of Urology, SUNY Downstate Medical School, Brooklyn, NY, USA.,Institute for Bladder and Prostate Research, New York, NY, USA
| | - Anand Badri
- Department of Urology, SUNY Downstate Medical School, Brooklyn, NY, USA.,Institute for Bladder and Prostate Research, New York, NY, USA
| | - Rajveer S Purohit
- Department of Urology, Weill Medical College of Cornell University, New York, NY, USA.,Department of Urology, SUNY Downstate Medical School, Brooklyn, NY, USA.,Institute for Bladder and Prostate Research, New York, NY, USA
| | - Jeffrey P Weiss
- Department of Urology, SUNY Downstate Medical School, Brooklyn, NY, USA.,Institute for Bladder and Prostate Research, New York, NY, USA
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97
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Aruga S, Kuwana N, Shiroki Y, Takahashi S, Samejima N, Watanabe A, Seki Y, Igawa Y, Homma Y. Effect of cerebrospinal fluid shunt surgery on lower urinary tract dysfunction in idiopathic normal pressure hydrocephalus. Neurourol Urodyn 2017; 37:1053-1059. [PMID: 28892272 DOI: 10.1002/nau.23399] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2017] [Accepted: 07/28/2017] [Indexed: 11/07/2022]
Abstract
AIMS To examine the outcomes of lower urinary tract symptoms (LUTS) and urodynamic test results after cerebrospinal fluid (CSF) shunt surgery in idiopathic normal pressure hydrocephalus (iNPH). METHODS Records of 48 patients (33 men; 15 women), who met the definite iNPH criteria and underwent CSF shunt surgery, were retrospectively analyzed. LUTS and their impact on quality of life (QOL) were evaluated using an all-or-none questionnaire targeting four symptoms, the Overactive Bladder Symptoms Score (OABSS), and the QOL index. Urodynamic investigations included filling cystometry and pressure-flow studies performed before and after surgery. RESULTS Forty-seven (98%) patients complained of LUTS, 41 (87%) patients of whom experienced LUTS improvement after surgery. The OABSS and QOL index, which before surgery were 6.8 ± 0.7 and 4.1 ± 0.4, respectively, significantly decreased to 4.6 ± 0.6 and 3.2 ± 0.3, respectively, after surgery. The maximum cystometric capacity (174.9 ± 13.3 mL to 222.4 ± 14.7 mL) and bladder compliance (35.8 ± 4.4 ml/cmH2 O to 52.1 ± 5.4 ml/cmH2 O) significantly increased after surgery. Detrusor overactivity, which was observed in 37 (77%) patients preoperatively, became undetectable in 7 patients postoperatively. Voiding dysfunction (defined as maximum flow rate <10 mL/s or post-void residual >100 mL) was observed in 29 (60%) patients, 22 (75%) of whom had detrusor underactivity before surgery. None of the voiding urodynamic parameters significantly improved postoperatively. CONCLUSIONS iNPH is often associated with LUTS and both storage and voiding dysfunctions. CSF shunt surgery improved LUTS and storage dysfunction, with limited effects on voiding dysfunction.
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Affiliation(s)
- Seiji Aruga
- Department of Urology, Tokyo Kyosai Hospital, Meguro-ku, Japan
| | - Nobumasa Kuwana
- Department of Neurosurgery, Tokyo Kyosai Hospital, Meguro-ku, Japan
| | | | | | - Naoyuki Samejima
- Department of Neurosurgery, Tokyo Kyosai Hospital, Meguro-ku, Japan
| | - Akira Watanabe
- Department of Neurosurgery, Tokyo Kyosai Hospital, Meguro-ku, Japan
| | - Yojiro Seki
- Department of Neurosurgery, Tokyo Kyosai Hospital, Meguro-ku, Japan
| | - Yasuhiko Igawa
- Department of Continence Medicine, University of Tokyo Graduate school of Medicine, Bunkyo-ku, Japan
| | - Yukio Homma
- Japanese Red Cross Medical Center, Shibuya-ku, Tokyo
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98
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Qualitative Exploration of the Patient Experience of Underactive Bladder. Eur Urol 2017; 72:402-407. [DOI: 10.1016/j.eururo.2017.03.045] [Citation(s) in RCA: 49] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2016] [Accepted: 03/29/2017] [Indexed: 01/27/2023]
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99
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Jeong SJ, Lee JK, Kim KM, Kook H, Cho SY, Oh SJ. How do we diagnose detrusor underactivity? Comparison of diagnostic criteria based on an urodynamic measure. Investig Clin Urol 2017; 58:247-254. [PMID: 28681034 PMCID: PMC5494348 DOI: 10.4111/icu.2017.58.4.247] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2017] [Accepted: 06/09/2017] [Indexed: 11/18/2022] Open
Abstract
PURPOSE To compare several contemporary urodynamic criteria for diagnosing detrusor underactivity (DU) and estimate how well they coincide with each other. MATERIALS AND METHODS From our prospective urodynamic database we identified nonneurogenic lower urinary tract symptoms (LUTS) patients older than 60 years between 2003 and 2014. Patients were reclassified based on four and three contemporary criteria for DU among men and women. Each criterion was compared with the others using the McNemar test. RESULTS Urodynamic data of 4,372 patients (3,357 men and 1,015 women) were analyzed. In men, the prevalence of DU was estimated to be 56%, 17%, 5%, and 10% based on bladder contractility index, Abrams-Griffith number, maximal detrusor pressure at maximal flow rate (PdetQmax) 30, and bladder voiding efficiency (BVE) criteria. In women, 14.9%, 9.6%, and 6.4% of patients were classified as having DU based on maximal flow rate/postvoid residual (Qmax/PVR), PdetQmax 30, and BVE criteria. For individual subjects, all 4 criteria for men were significantly different from each other, while PdetQmax 30 and BVE criteria for women did not differ significantly (p=0.065). Additionally, BVE criterion for men and PdetQmax 30 and BVE criteria for women could distinguish the differences of patient age, free Qmax and free PVR between patient with and without DU. CONCLUSIONS Each urodynamic criterion for men does not coincide with each other in the diagnosis of DU within individual subjects. On the other hand, PdetQmax 30 criteria and BVE criteria for women could be appropriately applied to clinical practice when diagnosing DU in women with LUTS.
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Affiliation(s)
- Seong Jin Jeong
- Department of Urology, Seoul National University College of Medicine, Seoul, Korea.,Department of Urology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Jung Keun Lee
- Department of Urology, Seoul National University College of Medicine, Seoul, Korea.,Department of Urology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Kwang Mo Kim
- Department of Urology, Seoul National University College of Medicine, Seoul, Korea.,Department of Urology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Harim Kook
- Department of Urology, Seoul National University College of Medicine, Seoul, Korea.,Department of Urology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Sung Yong Cho
- Department of Urology, Seoul National University College of Medicine, Seoul, Korea.,Department of Urology, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul, Korea
| | - Seung-June Oh
- Department of Urology, Seoul National University College of Medicine, Seoul, Korea.,Department of Urology, Seoul National University Hospital, Seoul, Korea
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100
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Underactive bladder, detrusor underactivity, definition, symptoms, epidemiology, etiopathogenesis, and risk factors. Curr Opin Urol 2017; 27:293-299. [DOI: 10.1097/mou.0000000000000381] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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