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Tang G, Liu M, Ding G, Liu S, Chu Y, Cui Y, Wu J. The Efficacy of Cyclooxygenase-2 Inhibitors for the Male Treatment of Lower Urinary Tract Symptoms: A Systematic Review and Meta-Analysis. Am J Mens Health 2023; 17:15579883231176667. [PMID: 37249083 PMCID: PMC10236251 DOI: 10.1177/15579883231176667] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Revised: 04/07/2023] [Accepted: 05/01/2023] [Indexed: 05/31/2023] Open
Abstract
To investigate the potential use of cyclooxygenase-2 (COX-2) inhibitors in the treatment of lower urinary tract symptoms (LUTS) in male patients, we conducted a comprehensive meta-analysis. Our study involved the identification and collection of randomized controlled trials (RCTs) from leading databases including PubMed, MEDLINE, EMBASE, and Cochrane Library. The primary objective of this analysis was to evaluate the effectiveness of COX-2 inhibitors for the treatment of LUTS. Our analysis involved six short-term (within 3 months) RCTs involving 707 patients. We found that COX-2 inhibitor treatment significantly improved the International Prostate Symptom Score (IPSS) of patients (mean difference [MD] = -2.99, 95% confidence interval (CI): -3.65 to -2.33, p < .00001), nocturia frequency (MD = -1.90; 95% CI: -3.18 to -0.61, p = .004), and maximum flow rate (Qmax) (MD = 1.02; 95% CI: 0.06 to 1.98, p = .04). However, no significant differences were found between patients in terms of changes in prostate-specific antigen (PSA) (MD = 0.02; 95% CI: -0.39 to 0.43, p = .92) and total prostate volume (TPV) (MD = -2.93; 95% CI: -6.45 to 0.59, p = .10). Therefore COX-2 inhibitors are an effective treatment for LUTS.
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Affiliation(s)
- Gonglin Tang
- Department of Urology, The Affiliated
Yantai Yuhuangding Hospital of Qingdao University, Yantai, China
| | - Ming Liu
- Department of Urology, The Affiliated
Yantai Yuhuangding Hospital of Qingdao University, Yantai, China
- Second Clinical Medical College,
Binzhou Medical University, Yantai, China
| | - Guixin Ding
- Department of Urology, The Affiliated
Yantai Yuhuangding Hospital of Qingdao University, Yantai, China
| | - Shangjing Liu
- Department of Urology, The Affiliated
Yantai Yuhuangding Hospital of Qingdao University, Yantai, China
| | - Yongli Chu
- Department of Scientific Research, The
Affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai, China
| | - Yuanshan Cui
- Department of Urology, The Affiliated
Yantai Yuhuangding Hospital of Qingdao University, Yantai, China
| | - Jitao Wu
- Department of Urology, The Affiliated
Yantai Yuhuangding Hospital of Qingdao University, Yantai, China
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Sipal T, Akdere H. The relation between the storage symptoms before and after transurethral resection of the prostate, analysis of the risk factors and the prevention of the symptoms with solifenacin. Int Braz J Urol 2020; 46:575-584. [PMID: 32374123 PMCID: PMC7239300 DOI: 10.1590/s1677-5538.ibju.2019.0227] [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: 04/04/2019] [Accepted: 10/13/2019] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE AND HYPOTHESIS We aimed to investigate the reasons of storage symptoms ( SS) after transurethral resection of the prostate (TURP). The hypothesis was that a positive correlation would be identified between preoperative and postoperative SS in patients with undergoing TURP and starting early solifenacin treatment in patients with high preoperative SS would be reasonable. In addition, we aimed to analyze multiple other risk factors for post-TURP SS. MATERIALS AND METHODS A total of 160 patients undergoing TURP were prospectively evaluated and divided into two groups according to their OABS. Those with a score of ≥10 points were Group 1 (G1), and those with < 10 points Group 2 (G2). In addition, patients in each group were randomly further divided into two subgroups: those who were started on 5 mg solifenacin succinate in the early postoperative period (G1/G2 A) and those who were not (G1/G2 B). In additions to SS Preop, perop and at the 3rd-month of postoperatively 14 variable were evaluated. The effects of these factors, surgery and the efficacy of an early medical treatment on the postoperative SS were investigated. LUTS were assessed by International Prostate Symptom Score (IPSS) and SS were assessed by sum of IPSS 2, 4 and 7 questionnaires (Storage, S- IPSS). RESULTS Preoperative IPSS and S-IPSS were significantly higher in G1 (p< 0.001); there was a significant improvement at IPSS, S-IPSS, QoL score, Qmax, and PVR for all groups after surgery. Only preoperative S-IPSS was found to have significant effect on postoperative SS (p< 0.001). There was a significant difference between G1A and G1B but no significant difference between G2A and G2B in terms of SS at postoperatively. In addition to this, prostatic volume was found smaller than non-symptomatic patients in de novo SS patients. CONCLUSION TURP provides significant improvement in both storage and voiding symptoms. The predictive value of the preoperative S-IPSS on postop SS is significant. These results suggest that 5 mg solifenacin succinate treatment in the early postoperative period may be beneficial for patients with high preoperative SS and may not be beneficial in others. Small prostatic volume may bode ill for postoperative SS in the patients with de novo SS.
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Affiliation(s)
- Timucin Sipal
- Depertment of Urology, Cerkezkoy State Hospital, Tekirdag, Turkey
| | - Hakan Akdere
- Depertmen of Urology, Trakya University Medical Faculty, Edirne, Turkey
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Lee JY, Park JM, Na YG, Song KH, Lim JS, Yang SW, Kim GH, Shin JH. Expression of bladder α 1-adrenoceptor subtype after relief of partial bladder outlet obstruction in a rat model. Investig Clin Urol 2020; 61:297-303. [PMID: 32377606 PMCID: PMC7189111 DOI: 10.4111/icu.2020.61.3.297] [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: 06/04/2019] [Accepted: 11/17/2019] [Indexed: 12/03/2022] Open
Abstract
Purpose Many patients with benign prostatic hyperplasia require treatment for persistent storage symptoms, even when the obstruction is successfully relieved by surgery. Previous studies identified a characteristic increase in α1D-adrenoceptor levels in the bladder in a bladder outlet obstruction (BOO) model. Here, we investigated the expression of α1-adrenoceptor subtypes in the bladder after relief of partial BOO (pBOO) in a rat model. Materials and Methods A total of 60 female Sprague–Dawley rats were randomly divided into three groups (sham-operated, pBOO, and pBOO relief groups), and the expression of α1-adrenoceptor subtypes in the urothelium and detrusor muscle tissues was examined by western blot. Results The expression of the α1D-adrenoceptor was significantly higher in the urothelium and detrusor muscle tissue of the pBOO and pBOO relief groups than in the corresponding tissue of the sham-operated group. Additionally, the α1A-adrenoceptor was predominant in the sham-operated group but significantly decreased in the urothelium in the pBOO group. No significant differences were found in α1A-adrenoceptor levels in detrusor muscle or whole bladder. Conclusions Our results showed that α1D-adrenoceptor levels were consistently increased with pBOO, even after relief, suggesting that the α1D-adrenoceptor might be a cause of persistent storage symptoms after relief of pBOO.
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Affiliation(s)
- Ji Yong Lee
- Department of Urology, Chungnam National University Hospital, Chungnam National University School of Medicine, Daejeon, Korea
| | - Jong Mok Park
- Department of Urology, Chungnam National University Hospital, Chungnam National University School of Medicine, Daejeon, Korea
| | - Yong Gil Na
- Department of Urology, Chungnam National University Hospital, Chungnam National University School of Medicine, Daejeon, Korea
| | - Ki Hak Song
- Department of Urology, Chungnam National University Hospital, Chungnam National University School of Medicine, Daejeon, Korea
| | - Jae Sung Lim
- Department of Urology, Chungnam National University Hospital, Chungnam National University School of Medicine, Daejeon, Korea
| | - Seung Woo Yang
- Department of Urology, Chungnam National University Hospital, Chungnam National University School of Medicine, Daejeon, Korea
| | - Gun Hwa Kim
- Drug & Disease Target Team, Division of Bioconvergence Analysis, Korea Basic Science Institute, Cheongju, Korea.,Tunneling Nanotube Research Center, Division of Life Science, Korea University, Seoul, Korea
| | - Ju Hyun Shin
- Department of Urology, Chungnam National University Hospital, Chungnam National University School of Medicine, Daejeon, Korea
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Alexandre EC, Cao N, Mizoguchi S, Saito T, Kurobe M, Gotoh D, Okorie M, Igarashi T, Antunes E, Yoshimura N. Urethral dysfunction in a rat model of chemically induced prostatic inflammation: potential involvement of the MRP5 pump. Am J Physiol Renal Physiol 2020; 318:F754-F762. [PMID: 32036697 DOI: 10.1152/ajprenal.00566.2019] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
Prostate inflammation (PI) is a clinical condition associated with infection and/or inflammation of the prostate. It is a common disease frequently associated to lower urinary tract (LUT) symptoms. The urethra is an understudied structure in the LUT and plays a fundamental role in the urinary cycle. Here, we proposed to evaluate the effect of PI on the urethra tissue. Male Sprague-Dawley rats were used, and PI was induced by formalin injection into the ventral lobes of the prostate. The pelvic urethra at the prostatic level was harvested for histological analysis, contraction (electrical field stimulation and phenylephrine), and relaxation (sodium nitroprusside/MK-571) experiments. Various gene targets [cytochrome c oxidase subunit 2, transforming growth factor-β1, interleukin-1β, hypoxia-inducible factor-1α, α1A-adrenoceptor, inositol 1,4,5-trisphosphate receptor type 1, voltage-gated Ca2+ channel subunit-α1D, neuronal nitric oxide synthase, soluble guanylyl cyclase, phosphodiesterase 5A, protein kinase CGMP-dependent 1, and multidrug resistance-associated protein 5 (MRP5; ATP-binding cassette subfamily C member 5)] were quantified, and cGMP levels were measured. No histological changes were detected, and functional assays revealed decreased contraction and increased relaxation of urethras from the PI group. The addition of MK-571 to functional assays increased urethral relaxation. Genes associated with inflammation were upregulated in urethras from the PI group, such as cytochrome oxidase c subunit 2, transforming growth factor-β1, interleukin-1β, and hypoxia-inducible factor-1α. We also found increased expression of L-type Ca2+ channels and the neuronal nitric oxide synthase enzyme and decreased expression of the MRP5 pump. Finally, cGMP production was enhanced in urethral tissue of PI animals. The results indicate that PI is associated with proinflammatory gene expression in the urethra without histologically evident inflammation and that PI produces a dysfunctional urethra and MRP5 pump downregulation, which results in cGMP accumulation inside the cell. These findings would help to better understand LUT dysfunctions associated with PI and the role of MRP pumps in the control of LUT function.
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Affiliation(s)
- Eduardo C Alexandre
- Department of Urology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania.,Department of Pharmacology, Faculty of Medical Sciences, University of Campinas, Campinas, São Paulo, Brazil
| | - Nailong Cao
- Department of Urology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Shinsuke Mizoguchi
- Department of Urology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Tetsuichi Saito
- Department of Urology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Masahiro Kurobe
- Department of Urology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Daisuke Gotoh
- Department of Urology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Meri Okorie
- Department of Urology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Taro Igarashi
- Department of Urology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Edson Antunes
- Department of Pharmacology, Faculty of Medical Sciences, University of Campinas, Campinas, São Paulo, Brazil
| | - Naoki Yoshimura
- Department of Urology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
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5
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Tamalunas A, Magistro G, Grimm T, Jokisch JF, Westhofen T, Schott M, Stief CG, Weinhold P. [Benign prostatic enlargement: symptoms, diagnostics and therapy]. MMW Fortschr Med 2019; 161:50-57. [PMID: 31037703 DOI: 10.1007/s15006-019-0017-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Affiliation(s)
- Alexander Tamalunas
- Urologische Klinik und Poliklinik, Campus Großhadern, Klinikum der Universität München, Ludwig-Maximilians-Universität München, Marchioninistr. 15, D-81377, München, Deutschland.
| | - Giuseppe Magistro
- Urologische Klinik und Poliklinik, Campus Großhadern, Klinikum der Universität München, Ludwig-Maximilians-Universität München, Marchioninistr. 15, D-81377, München, Deutschland
| | - Tobias Grimm
- Urologische Klinik und Poliklinik, Campus Großhadern, Klinikum der Universität München, Ludwig-Maximilians-Universität München, Marchioninistr. 15, D-81377, München, Deutschland
| | - Jan-Friedrich Jokisch
- Urologische Klinik und Poliklinik, Campus Großhadern, Klinikum der Universität München, Ludwig-Maximilians-Universität München, Marchioninistr. 15, D-81377, München, Deutschland
| | - Thilo Westhofen
- Urologische Klinik und Poliklinik, Campus Großhadern, Klinikum der Universität München, Ludwig-Maximilians-Universität München, Marchioninistr. 15, D-81377, München, Deutschland
| | - Melanie Schott
- Urologische Klinik und Poliklinik, Campus Großhadern, Klinikum der Universität München, Ludwig-Maximilians-Universität München, Marchioninistr. 15, D-81377, München, Deutschland
| | - Christian G Stief
- Urologische Klinik und Poliklinik, Campus Großhadern, Klinikum der Universität München, Ludwig-Maximilians-Universität München, Marchioninistr. 15, D-81377, München, Deutschland
| | - Philipp Weinhold
- Urologische Klinik und Poliklinik, Campus Großhadern, Klinikum der Universität München, Ludwig-Maximilians-Universität München, Marchioninistr. 15, D-81377, München, Deutschland
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Hwang EC, Gandhi S, Jung JH, Imamura M, Kim MH, Pang R, Dahm P. Naftopidil for the treatment of lower urinary tract symptoms compatible with benign prostatic hyperplasia. Cochrane Database Syst Rev 2018; 10:CD007360. [PMID: 30306544 PMCID: PMC6516835 DOI: 10.1002/14651858.cd007360.pub3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND Benign prostatic hyperplasia (BPH) is a common condition in ageing men that may cause lower urinary tract symptoms (LUTS). Treatment aims are to relieve symptoms and prevent disease-related complications. Naftopidil is an alpha-blocker (AB) that has a high affinity for the A1d receptor that may have advantages in treating LUTS in this setting. This is an update of a Cochrane Review first published in 2009. Since that time, several large randomised controlled trials (RCTs) have been reported, making this update relevant. OBJECTIVES To evaluate the effects of naftopidil for the treatment of LUTS associated with BPH. SEARCH METHODS We performed a comprehensive search using multiple databases (the Cochrane Library, MEDLINE, Embase, Scopus, LILAC, and Web of Science), trials registries, other sources of grey literature, and conference proceedings with no restrictions on the language of publication or publication status up to 31 May 2018 SELECTION CRITERIA: We included all parallel RCTs. We also included cross-over design trials. DATA COLLECTION AND ANALYSIS Two review authors independently classified and abstracted data from the included studies. We performed statistical analyses using a random-effects model and interpreted them according to the Cochrane Handbook for Systematic Reviews of Interventions. Primary outcomes were urological symptom scores, quality of life (QoL) and treatment withdrawals for any reason; secondary outcomes were treatment withdrawals due to adverse events, acute urinary retention, surgical intervention for BPH, and cardiovascular and sexual adverse events. We considered outcomes measured up to 12 months after randomisation as short term, and later than 12 months as long term. We rated the certainty of the evidence according to the GRADE approach. MAIN RESULTS We included 22 RCTs with 2223 randomised participants across four comparisons for short-term follow-up. This abstract focuses on only two of four comparisons for which we found data since two comparators (i.e. propiverine and Eviprostat (phytotherapy)) are rarely used. One study comparing naftopidil to placebo did not report any relevant outcomes and was therefore excluded. There were no trials that compared to combination therapy with naftopidil or any 5-alpha reductase inhibitors (5-ARIs) to combination therapy with other ABs and any 5-ARIs.All included studies were conducted in Asian countries. Study duration ranged from four to 12 weeks. Mean age was 67.8 years, prostate volume was 35.4 mL, and International Prostate Symptom Score was 18.3. We were unable to perform any of the preplanned subgroup analyses based on age and baseline symptom score.Naftopidil versus tamsulosinBased on 12 studies with 965 randomised participants, naftopidil may have resulted in little or no difference in urological symptom score (mean difference (MD) 0.47, 95% confidence interval (CI) -0.09 to 1.04 measured on a scale from 0 to 35 with higher score representing increased symptoms), QoL (MD 0.11, 95% CI -0.09 to 0.30; measured on a scale from 0 to 6 with higher scores representing worse QoL), and treatment withdrawals for any reason (risk ratio (RR) 0.92, 95% CI 0.64 to 1.34; corresponding to 7 fewer per 1000 participants, 95% CI 32 fewer to 31 more). Naftopidil may have resulted in little to no difference in sexual adverse events (RR 0.54, 95% CI 0.24 to 1.22); this would result in 26 fewer sexual adverse events per 1000 participants (95% CI 43 fewer to 13 more). We rated the certainty of evidence as moderate for urological symptom score and low for the other outcomes.Naftopidil versus silodosinBased on five studies with 652 randomised participants, naftopidil may have resulted in little or no difference in the urological symptom scores (MD 1.04, 95% CI -0.78 to 2.85), QoL (MD 0.21, 95% CI -0.23 to 0.66), and treatment withdrawals for any reason (RR 0.80, 95% CI 0.52 to 1.23; corresponding to 26 fewer per 1000 participants, 95% CI 62 fewer to 32 more). We rated the certainty of evidence as low for all these outcomes. Naftopidil likely reduced sexual adverse events (RR 0.15, 95% CI 0.06 to 0.42; corresponding to 126 fewer sexual adverse events per 1000 participants, 95% CI 139 fewer to 86 fewer). We rated the certainty of evidence as moderate for sexual adverse events. AUTHORS' CONCLUSIONS Naftopidil appears to have similar effects in the urological symptom scores and QoL compared to tamsulosin and silodosin. Naftopidil has similar sexual adverse events compared to tamsulosin but has fewer compared to silodosin.
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Affiliation(s)
- Eu Chang Hwang
- Chonnam National University Medical School, Chonnam National University Hwasun HospitalDepartment of UrologyHwasunKorea, South
| | | | - Jae Hung Jung
- Yonsei University Wonju College of MedicineDepartment of Urology20 Ilsan‐roWonjuGangwonKorea, South26426
- Yonsei University Wonju College of MedicineInstitute of Evidence Based Medicine20 Ilsan‐roWonjuGangwonKorea, South26426
| | - Mari Imamura
- University of AberdeenAcademic UrologyHealth Sciences BuildingForesterhillAberdeenUKAB25 2ZD
| | - Myung Ha Kim
- Yonsei University Wonju College of MedicineYonsei Wonju Medical LibraryWonjuKorea, South
| | - Ran Pang
- Guang An Men Hospital, China Academy of Chinese Medical SciencesDepartment of UrologyNo.5 Bei Xian Ge Street, Xicheng DistrictBeijingChina100053
| | - Philipp Dahm
- Minneapolis VA Health Care SystemUrology SectionOne Veterans DriveMail Code 112DMinneapolisMinnesotaUSA55417
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Phosphodiesterase type 4 inhibition enhances nitric oxide- and hydrogen sulfide-mediated bladder neck inhibitory neurotransmission. Sci Rep 2018; 8:4711. [PMID: 29549279 PMCID: PMC5856743 DOI: 10.1038/s41598-018-22934-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2017] [Accepted: 03/02/2018] [Indexed: 01/01/2023] Open
Abstract
Nitric oxide (NO) and hydrogen sulfide (H2S) play a pivotal role in nerve-mediated relaxation of the bladder outflow region. In the bladder neck, a marked phosphodiesterase type 4 (PDE4) expression has also been described and PDE4 inhibitors, as rolipram, produce smooth muscle relaxation. This study investigates the role of PDE4 isoenzyme in bladder neck gaseous inhibitory neurotransmission. We used Western blot and double immunohistochemical staining for the detection of NPP4 (PDE4) and PDE4A and organ baths for isometric force recording to roflumilast and tadalafil, PDE4 and PDE5, respectively, inhibitors in pig and human samples. Endogenous H2S production measurement and electrical field stimulation (EFS) were also performed. A rich PDE4 and PDE4A expression was observed mainly limited to nerve fibers of the smooth muscle layer of both species. Moreover, roflumilast produced a much more potent smooth muscle relaxation than that induced by tadalafil. In porcine samples, H2S generation was diminished by H2S and NO synthase inhibition and augmented by roflumilast. Relaxations elicited by EFS were potentiated by roflumilast. These results suggest that PDE4, mainly PDE4A, is mostly located within nerve fibers of the pig and human bladder neck, where roflumilast produces a powerful smooth muscle relaxation. In pig, the fact that roflumilast increases endogenous H2S production and EFS-induced relaxations suggests a modulation of PDE4 on NO- and H2S-mediated inhibitory neurotransmission.
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Mizoguchi S, Mori K, Wang Z, Liu T, Funahashi Y, Sato F, DeFranco DB, Yoshimura N, Mimata H. Effects of Estrogen Receptor β Stimulation in a Rat Model of Non-Bacterial Prostatic Inflammation. Prostate 2017; 77:803-811. [PMID: 28181685 PMCID: PMC5968815 DOI: 10.1002/pros.23320] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2016] [Accepted: 01/24/2017] [Indexed: 12/30/2022]
Abstract
BACKGROUND There is increasing evidence showing that chronic non-bacterial prostatic inflammation is involved in the pathogenesis of benign prostatic hyperplasia (BPH) and male lower urinary tract symptoms (LUTS). It has also been reported that estrogen receptor β (ERβ) could have an immunoprotective role in prostatic tissue. Therefore, we investigated the effect of ERβ-activation on not only prostatic inflammation, but also bladder overactive conditions in a rat model with nonbacterial prostatic inflammation. METHODS Male Sprague-Dawley rats (8 weeks, n = 15) were divided into three groups: sham-saline group (n = 5), formalin-vehicle group (n = 5), and formalin-treatment group (n = 5). The sham-saline group had sham operation and 50 μl normal saline injected into each ventral lobe of the prostate. The formalin-vehicle group had 50 μl 5% formalin injection into bilateral ventral lobes of the prostate. The formalin-treatment group was treated with 3α-Adiol (a selective ERβ agonist precursor) at a dose of 3 mg/kg daily from 2 days before induction of prostatic inflammation, whereas formalin-vehicle rats received vehicle (olive oil). In each group, conscious cystometry was performed on day 28 after intraprostatic formalin injection or sham treatment. After cystometry, the bladder and prostate were harvested for evaluation of mRNA expression and histological analysis. RESULTS In cystometric investigation, the mean number of non-voiding contractions was significantly greater and voiding intervals were significantly shorter in formalin-vehicle rats than those in sham-saline rats (P < 0.05). In RT-qPCR analysis, mRNA expression of NGF, P2X2, and TRPA1 receptors was significantly increased in the bladder mucosa, and mRNA expression of TNF-α, iNOS and COX2 in the ventral lobes of prostate was significantly increased in formalin-vehicle rats compared with sham-saline rats (P < 0.05). In addition, relative mRNA expression ratio of ERβ to ERα (ERβ/ERα) in the ventral lobes of prostate was significantly decreased in formalin-vehicle rats compared with sham-saline rats (P < 0.05). These changes were ameliorated by 3α-Adiol administration in formalin-treatment rats. CONCLUSIONS These results indicate that ERβ activation by 3α-Adiol administration, which normalized the ERβ/ERα expression ratio in the prostate, can improve not only prostatic inflammation, but also bladder overactivity. Therefore, ERβ agonists might be useful for treating irritative bladder symptoms in patients with symptomatic BPH associated with prostatic inflammation. Prostate 77:803-811, 2017. © 2017 Wiley Periodicals, Inc.
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Affiliation(s)
- Shinsuke Mizoguchi
- Department of Urology, Oita University Graduate School of Medicine, Yufu, Japan
| | - Kenichi Mori
- Department of Urology, Oita University Graduate School of Medicine, Yufu, Japan
- Department of Urology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Zhou Wang
- Department of Urology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
- Department of Pharmacology and Chemical Biology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Teresa Liu
- Department of Pharmacology and Chemical Biology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Yasuhito Funahashi
- Department of Urology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Fuminori Sato
- Department of Urology, Oita University Graduate School of Medicine, Yufu, Japan
| | - Donald B. DeFranco
- Department of Pharmacology and Chemical Biology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Naoki Yoshimura
- Department of Urology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
- Department of Pharmacology and Chemical Biology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
- Correspondence to: Naoki Yoshimura, MD, PhD, Department of Urology, University of Pittsburgh School of Medicine, Suite 700 Kaufmann Medical Building, 3471 Fifth Avenue, Pittsburgh, PA 15213.
| | - Hiromitsu Mimata
- Department of Urology, Oita University Graduate School of Medicine, Yufu, Japan
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9
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Wallukat G, Jandrig B, Kunze R, Wendler JJ, Müller J, Schostak M, Schimke I. Autoantibodies Directed Against the Endothelin A Receptor in Patients With Benign Prostatic Hyperplasia. Prostate 2017; 77:458-465. [PMID: 27882567 DOI: 10.1002/pros.23284] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2016] [Accepted: 11/09/2016] [Indexed: 12/16/2022]
Abstract
BACKGROUND Over-stimulation of G-protein coupled receptors (GPCRs) such as α1-adrenergic, muscarinic, endothelin, and AT1 receptors is considered to drive benign prostatic hyperplasia (BHP) which is often associated with lower urinary tract syndrome (LUTS). However, in addition to physiologic GPCR ligands, there is a new class of autoantibodies called functional autoantibodies that target the same GPCRs (GPCR-AABs) for over-stimulation, thus, presenting pathogenic potency. We hypothesize that patients with BPH/LUTS could carry GPCR-AABs representing potential targets for treatment. METHODS GPCR-AABs were identified, quantified, and characterized in the serum from 20 patients (aged 55-82 years, median 71 years) with BPH using the bioassay of spontaneously beating cultured neonatal rat cardiomyocytes. RESULTS A sum of 60% of the patients were positive for agonistic autoantibodies directed against the endothelin A receptor (ETA-AABs). ETA-AABs were associated with the IgG 1 subclass, targeted an epitope located on the second extracellular receptor loop and their agonistic activity could be neutralized by the aptamer BC007. CONCLUSIONS Agonistic ETA-AABs could-via uncontrolled over-boarding endothelin A receptor stimulation-contribute to the pathogenesis of BPH/LUTS. The in vitro demonstrated ETA-AAB neutralization by the aptamer BC007 could open the door for a new treatment strategy in patients with BPH/LUTS. Prostate 77:458-465, 2017. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
| | - Burkhard Jandrig
- Universitätsklinik für Urologie und Kinderurologie, Otto von Guericke Universität, Magdeburg, Germany
| | | | - Johann J Wendler
- Universitätsklinik für Urologie und Kinderurologie, Otto von Guericke Universität, Magdeburg, Germany
| | | | - Martin Schostak
- Universitätsklinik für Urologie und Kinderurologie, Otto von Guericke Universität, Magdeburg, Germany
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10
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Elshazly MA, Sultan MF, Aboutaleb HA, Salem SM, Aziz MS, Abd Elbaky TM, Elsherif EA, Gawish MM, Alajrawi FT, Elgadi FAA, Thaher AH, Shebl MA, Allam AM, Kehinde E. Vitamin D deficiency and lower urinary tract symptoms in males above 50 years of age. Urol Ann 2017; 9:170-173. [PMID: 28479770 PMCID: PMC5405662 DOI: 10.4103/0974-7796.204192] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Context: Lower urinary tract symptoms (LUTSs) in elderly males are usually related to benign prostatic hyperplasia (BPH) in the majority of cases. It is estimated that BPH affects half of men above the age of 50 years. Recently, a relationship between Vitamin D deficiency and LUTS in elderly males has been reported. Aims: The aim of this study was to analyze Vitamin D levels in males aged above 50 years presenting with LUTS. Settings and Design: This is a prospective case–control study. Patients and Methods: This was a case–control study in which males above 50 years of age who presented with LUTS (Group A) were compared with a control group (Group B) without LUTS. Both groups were investigated regarding Vitamin D level, prostate-specific antigen (PSA), International Prostatic Symptoms Score (IPSS), prostate size, flow rate, serum calcium levels, and abdominal ultrasonography. Statistical Analysis Used: Statistical software package (SPSS Inc., Chicago, IL, USA) was used for the statistical analyses, performing t-test for quantitative data to compare between the two groups. Pearson's correlation coefficient “r” test was calculated between two quantitative, continuous variables in Group A. P <0.05 was considered statistically significant. Results: A total of 150 patients were studied. There were 70 and 80 patients in Groups A and B, respectively. The mean age of Group A patients was 60.32 ± 11.93 years versus 58.12 ± 10.55 years for Group B patients (P > 0.05). The mean value of Vitamin D level was 40.82 ± 29.46 nmol/L in Group A and 70.25 ± 22.42 nmol/L in Group B (P < 0.001). The mean value of prostate size was 50.12 ± 23.24 g in Group A and 30.68 ± 4.90 g in Group B (P < 0.001). The mean serum calcium level was 2.4 ± 0.14 mmol/L and 2.50 ± 0.15 mmol/L in Groups A and B, respectively (P < 0.001). The mean value of PSA in Group A was 2.24 ± 1.95 ng/ml versus 2.11 ± 0.45 ng/ml in Group B (P < 0.001). The mean value of IPSS in Group A was 13.38 ± 5.32 ml/s versus 3.41 ± 2.42 ml/s in Group B. The mean value of Q max in uroflowmetry in Group A was 11.5 ± 2 ml/s versus 15.4 ± 1 ml/s in Group B. Conclusions: Men older than 50 years of age with LUTS have lower levels of Vitamin D compared to men without LUTS.
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Affiliation(s)
| | - Mohamed Farag Sultan
- Department of Urology, Faculty of Medicine, Menoufia University, Shibin Elkom, Egypt
| | | | - Shady Mohamed Salem
- Department of Urology, Faculty of Medicine, Menoufia University, Shibin Elkom, Egypt
| | | | | | | | | | - Feras Tarek Alajrawi
- Department of Urology, Farwaniya Hospital, Kuwait University, Kuwait City, Kuwait
| | | | - Awad Husein Thaher
- Department of Urology, Farwaniya Hospital, Kuwait University, Kuwait City, Kuwait
| | - Mohamed Ahmed Shebl
- Department of Occupational Health and Community Medicine, Faculty of Medicine, Menoufia University, Shibin ElKom, Egypt
| | - Adel Mohamed Allam
- Department of Urology, Faculty of Medicine, Menoufia University, Shibin Elkom, Egypt
| | - Elija Kehinde
- Department of Urology, Faculty of Medicine, Kuwait University, Kuwait City, Kuwait
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11
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Andersson KE, Boedtkjer DB, Forman A. The link between vascular dysfunction, bladder ischemia, and aging bladder dysfunction. Ther Adv Urol 2016; 9:11-27. [PMID: 28042309 DOI: 10.1177/1756287216675778] [Citation(s) in RCA: 82] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
The vascular supply to the human bladder is derived mainly from the superior and inferior vesical arteries, the latter being directly connected to the internal iliac artery. Aging is associated with an impairment of blood vessel function and changes may occur in the vasculature at the molecular, cellular and functional level. Pelvic arterial insufficiency may play an important role in the development of bladder dysfunctions such as detrusor overactivity (DO) and the overactive bladder syndrome. Chronic ischemia-related bladder dysfunction may progress to bladder underactivity and it would be desirable to treat not only lower urinary tract symptoms (LUTS) induced by chronic ischemia, but also the progression of the morphological bladder changes. Studies in experimental models in rabbits and rats have shown that pelvic arterial insufficiency may result in significant bladder ischemia with reduced bladder wall oxygen tension. In turn, this will lead to oxidative stress associated with upregulation of oxidative stress-sensitive genes, increased muscarinic receptor activity, ultrastructural damage, and neurodegeneration. The phosphodiesterase type 5 (PDE5) inhibitor tadalafil, the α1-adrenoceptor (AR) blocker silodosin, the β3-AR agonist mirabegron, and the free radical scavenger melatonin, exerted a protecting effect on urodynamic parameters, and on functional and morphological changes of the bladder demonstrable in vitro. Since the agents tested are used clinically for relieving LUTS, the results from the animal models seem to have translational value, and may be of relevance for designing clinical studies to demonstrate if the drugs may prevent progression of ischemia-related functional and morphological bladder changes.
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Affiliation(s)
- Karl-Erik Andersson
- Institute of Clinical Medicine, Department of Obstetrics and Gynecology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, DK 8200 Aarhus N, Denmark
| | | | - Axel Forman
- Department of Gynecology and Obstetrics, Aarhus University Hospital, Denmark
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12
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Andersson KE. Potential Future Pharmacological Treatment of Bladder Dysfunction. Basic Clin Pharmacol Toxicol 2016; 119 Suppl 3:75-85. [DOI: 10.1111/bcpt.12577] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2015] [Accepted: 12/23/2016] [Indexed: 12/16/2022]
Affiliation(s)
- Karl-Erik Andersson
- Institute for Regenerative Medicine; Wake Forest University School of Medicine; Winston Salem NC USA
- Aarhus Institute for Advanced Sciences (AIAS); Aarhus University; Aarhus Denmark
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13
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Tarhan H, Ekin RG, Can E, Cakmak O, Yavascan O, Mutlubas Ozsan F, Helvaci M, Zorlu F. C-reactive protein levels in girls with lower urinary tract symptoms. J Pediatr Urol 2016; 12:105.e1-4. [PMID: 26497919 DOI: 10.1016/j.jpurol.2015.09.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2015] [Accepted: 09/04/2015] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Daytime lower urinary tract (LUT) conditions are identified as daytime incontinence problems for children in whom any cause of neuropathy and uropathy has been excluded. C-reactive protein (CRP) is a common marker of acute or chronic inflammation and infection. Increased CRP levels have been detected in the studies conducted on adults diagnosed with overactive bladders and interstitial cystitis. OBJECTIVE This study aimed to investigate the role of serum CRP levels in girls suffering from daytime LUT conditions. STUDY DESIGN Out of the 752 patients who presented to the outpatient clinics with lower urinary tract symptoms, 709 were excluded due to: being boys, having previous urinary tract surgery, an active urinary tract infection, a neurological anomaly, a urinary system anomaly, having rheumatic disease, any chronic disease, any febrile infection over the past week, a history of constipation, and enuresis nocturna. Forty-three girls with LUT conditions and aged 8-10 years were included in the study as the patient group. Forty girls who attended the urology outpatient clinic without LUT conditions, or active urinary tract infections and any chronic disease requiring follow-up constituted the control group. Under the control of the parents, all subjects were asked to fill out 3-day voiding diaries. The voiding diaries identified frequency, urgency, urgency urinary incontinence, and functional bladder capacity data. All subjects also completed a dysfunctional voiding scoring system (DVSS). The serum CRP levels of all subjects were measured. RESULTS There was a significant difference in serum CRP levels and DVSS between the patient group and the control group (P = 0.001, P = 0.001). The mean serum CRP levels showed a significant increase when frequency and urgency scores were ≥8, the urge incontinence score was ≥2 and the DVS score DVSS was ≥14 in the voiding diaries of the patient group (Table). DISCUSSION Lower urinary tract dysfunction is defined as a condition involving abnormalities of filling and/or emptying of the bladder. This frequently encountered problem constitutes >40% of all pediatric urology outpatient visits. The relationship between LUT conditions and serum CRP in both genders has been detected. However, it is believed that to our knowledge, this is the first study looking at the relationship between daytime LUTS and increased CRP levels in children. The most important limitations of the study were: having a small number of patients, and the sample consisting of only one gender and a specific age group. CONCLUSION The serum CRP levels were significantly higher in the girls with daytime LUT conditions than in the control group. Also, the CRP levels significantly increased as DVSS, frequency, urgency, and urge incontinence scores increased.
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Affiliation(s)
- H Tarhan
- Department of Urology, Tepecik Training and Research Hospital, Izmir, Turkey.
| | - R G Ekin
- Department of Urology, Tepecik Training and Research Hospital, Izmir, Turkey.
| | - E Can
- Department of Urology, Tepecik Training and Research Hospital, Izmir, Turkey.
| | - O Cakmak
- Department of Urology, Tepecik Training and Research Hospital, Izmir, Turkey.
| | - O Yavascan
- Department of Pediatrics, Tepecik Training and Research Hospital, Izmir, Turkey.
| | - F Mutlubas Ozsan
- Department of Pediatrics, Tepecik Training and Research Hospital, Izmir, Turkey.
| | - M Helvaci
- Department of Pediatrics, Tepecik Training and Research Hospital, Izmir, Turkey.
| | - F Zorlu
- Department of Urology, Tepecik Training and Research Hospital, Izmir, Turkey.
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14
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Lee YC, Juan YS, Liu CC, Bao BY, Wang CJ, Wu WJ, Huang CN, Huang SP. The association of endothelial nitric oxide synthase (eNOS) G894T gene polymorphism with responsiveness to a selective α1-blocker in men with benign prostatic hyperplasia related lower urinary tract symptoms. BJU Int 2016; 118:313-9. [DOI: 10.1111/bju.13468] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Affiliation(s)
- Yung-Chin Lee
- Department of Urology; Kaohsiung Medical University Hospital; Kaohsiung Taiwan
- Department of Urology; Faculty of Medicine; Kaohsiung Medical University; Kaohsiung Taiwan
| | - Yung-Shun Juan
- Department of Urology; Kaohsiung Medical University Hospital; Kaohsiung Taiwan
- Department of Urology; Faculty of Medicine; Kaohsiung Medical University; Kaohsiung Taiwan
- Department of Urology; Kaohsiung Municipal Hsiao-Kang Hospital; Kaohsiung Taiwan
| | - Chia-Chu Liu
- Department of Urology; Kaohsiung Medical University Hospital; Kaohsiung Taiwan
- Department of Urology; Faculty of Medicine; Kaohsiung Medical University; Kaohsiung Taiwan
- Department of Health; Executive Yuan; Pingtung Hospital; Pingtung Taiwan
| | - Bo-Ying Bao
- Department of Pharmacy; China Medical University; Taichung Taiwan
- Sex Hormone Research Center; China Medical University Hospital; Taichung Taiwan
- Department of Nursing; Asia University; Taichung Taiwan
| | - Chii-Jye Wang
- Department of Urology; Kaohsiung Medical University Hospital; Kaohsiung Taiwan
- Department of Urology; Faculty of Medicine; Kaohsiung Medical University; Kaohsiung Taiwan
| | - Wen-Jeng Wu
- Department of Urology; Kaohsiung Medical University Hospital; Kaohsiung Taiwan
- Department of Urology; Faculty of Medicine; Kaohsiung Medical University; Kaohsiung Taiwan
| | - Chun-Nung Huang
- Department of Urology; Kaohsiung Medical University Hospital; Kaohsiung Taiwan
- Department of Urology; Faculty of Medicine; Kaohsiung Medical University; Kaohsiung Taiwan
| | - Shu-Pin Huang
- Department of Urology; Kaohsiung Medical University Hospital; Kaohsiung Taiwan
- Department of Urology; Faculty of Medicine; Kaohsiung Medical University; Kaohsiung Taiwan
- Graduate Institute of Medicine; College of Medicine; Kaohsiung Medical University; Kaohsiung Taiwan
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15
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Sun F, Crisóstomo V, Báez-Díaz C, Sánchez FM. Prostatic Artery Embolization (PAE) for Symptomatic Benign Prostatic Hyperplasia (BPH): Part 2, Insights into the Technical Rationale. Cardiovasc Intervent Radiol 2016; 39:161-9. [PMID: 26563245 DOI: 10.1007/s00270-015-1238-5] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2015] [Accepted: 10/19/2015] [Indexed: 12/11/2022]
Abstract
Rationale of prostatic artery embolization (PAE) in the treatment of symptomatic benign prostatic hyperplasia is conventionally believed to include two parts: shrinkage of the enlarged prostate gland as a result of PAE-induced ischemic infarction and potential effects to relax the increased prostatic smooth muscle tone by reducing the number and density of α1-adrenergic receptor in the prostate stroma. This review describes new insights into the likely mechanisms behind PAE, such as ischemia-induced apoptosis, apoptosis enhanced by blockage of androgens circulation to the embolized prostate, secondary denervation following PAE, and potential effect of nitric oxide pathway immediately after embolization. Studies on therapeutic mechanisms in PAE may shed light on potentially new treatment strategies and development of novel techniques.
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Affiliation(s)
- Fei Sun
- Jesús Usón Minimally Invasive Surgery Centre, Carretera N-521, km. 41.8, 10071, Cáceres, Spain.
| | - Verónica Crisóstomo
- Jesús Usón Minimally Invasive Surgery Centre, Carretera N-521, km. 41.8, 10071, Cáceres, Spain.
| | - Claudia Báez-Díaz
- Jesús Usón Minimally Invasive Surgery Centre, Carretera N-521, km. 41.8, 10071, Cáceres, Spain.
| | - Francisco M Sánchez
- Jesús Usón Minimally Invasive Surgery Centre, Carretera N-521, km. 41.8, 10071, Cáceres, Spain.
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16
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Lai H, Tan B, Liang Z, Yan Q, Lian Q, Wu Q, Huang P, Cao H. Effect of the Chinese traditional prescription Suo Quan Wan on TRPV1 expression in the bladder of rats with bladder outlet obstruction. Altern Ther Health Med 2015; 15:424. [PMID: 26627190 PMCID: PMC4666052 DOI: 10.1186/s12906-015-0898-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2015] [Accepted: 10/05/2015] [Indexed: 12/16/2022]
Abstract
Background Suo Quan Wan (SQW) is a Chinese traditional prescription that has been used in clinical treatment of lower urinary tract symptoms for centuries. However, scientific basis of SQW efficacy and mechanism is still needed. This study investigated the effect of SQW on bladder function and transient receptor potential vanilloid 1 (TRPV1) expression in the bladder of rats with bladder outlet obstruction (BOO). The induced changes in bladder function in overactive bladder (OAB) rat model were observed following different periods of outlet obstruction to obtain an appropriate rat model. Methods This study was carried out in two parts. In the first part, female Sprague–Dawley rats received sham operations or partial BOO operations. Two, four, and six weeks later, the OAB model groups and control were subjected to urodynamic tests to measure differences in bladder functions. Once the appropriate rat model was obtained, the second part of the experiment was performed. The rat model was recreated and treated with SQW. Urodynamic assessment was conducted, and the bladders of the rats were then removed. Immunofluorescence staining, real-time PCR, and Western blot were performed to localize and quantify the expression of TRPV1 in the bladder. Results Results of the first part indicated that at 2 and 4 weeks, the OAB model group exhibited significant differences in urodynamic parameters, including bladder pressure, maximum voiding pressure, and maximum bladder capacity, compared with the sham group. At 4 and 6 weeks, the OAB model group exhibited significant differences in residual volume (RV) and non-voiding contraction frequency. Six-week OAB model group showed much more RV but less voiding efficiency when compared with 6-week sham group or 2—and 4-week OAB model group. Rats that underwent BOO exhibited similarities with the compensated state before four weeks and may have entered decompensated state at six weeks. Studies conducted with 4-week OAB model were appropriate. In part two of the experiment, unstable bladder in the OAB model group recovered bladder stability after SQW treatment, accompanied by improved bladder hypertrophy, as well as corrected urodynamic parameters. Expression of TRPV1 mRNA and proteins in the bladder was significantly greater in the OAB model group than that in the control group, which subsequently decreased significantly with SQW treatment in BOO-induced rats. Conclusions SQW can modulate the expression of TRPV1 in accordance with the recovery of bladder function. Electronic supplementary material The online version of this article (doi:10.1186/s12906-015-0898-7) contains supplementary material, which is available to authorized users.
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17
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Kullmann FA, Birder LA, Andersson KE. Translational Research and Functional Changes in Voiding Function in Older Adults. Clin Geriatr Med 2015; 31:535-48. [PMID: 26476114 PMCID: PMC4865381 DOI: 10.1016/j.cger.2015.06.001] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Age-related LUT dysfunctions result from complex processes controlled by multiple genetic, epigenetic, and environmental factors and account for high costs of health care. This article discusses risk factors that may play a role in age-related LUT dysfunction and presents available data comparing structural and functional changes that occur with aging in the bladder of humans and animal models. A better understanding of factors and mechanisms underlying LUT symptoms in the older population may lead to therapeutic interventions to reduce these dysfunctions.
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Affiliation(s)
- Florenta Aura Kullmann
- Renal-Electrolyte Division, Medicine Department, University of Pittsburgh School of Medicine, 3500 Terrace Street, A1220 Scaife Hall, Pittsburgh, PA 15261, USA
| | - Lori Ann Birder
- Renal-Electrolyte Division, Medicine Department, University of Pittsburgh School of Medicine, 3500 Terrace Street, A1207 Scaife Hall, Pittsburgh, PA 15261, USA; Pharmacology and Chemical Biology, University of Pittsburgh School of Medicine, 200 Lothrop Street, Pittsburgh, PA 15213, USA
| | - Karl-Erik Andersson
- Department of Urology, Institute for Regenerative Medicine, Wake Forest Baptist Medical Center, Wake Forest University School of Medicine, Medical Center Boulevard, Winston Salem, NC 27157, USA; AIAS, Aarhus Institute of Advanced Studies, Aarhus University, Høegh-Guldbergs Gade 6B, Building 1632, Aarhus C 8000, Denmark.
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18
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Andersson KE. Drug therapy of overactive bladder--what is coming next? Korean J Urol 2015; 56:673-9. [PMID: 26495067 PMCID: PMC4610893 DOI: 10.4111/kju.2015.56.10.673] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2015] [Accepted: 09/03/2015] [Indexed: 01/25/2023] Open
Abstract
After the approval and introduction of mirabegron, tadalafil, and botulinum toxin A for treatment of lower urinary tract symptoms/overactive bladder, focus of interest has been on their place in therapy versus the previous gold standard, antimuscarinics. However, since these agents also have limitations there has been increasing interest in what is coming next - what is in the pipeline? Despite progress in our knowledge of different factors involved in both peripheral and central modulation of lower urinary tract dysfunction, there are few innovations in the pipe-line. Most developments concern modifications of existing principles (antimuscarinics, β3-receptor agonists, botulinum toxin A). However, there are several new and old targets/drugs of potential interest for further development, such as the purinergic and cannabinoid systems and the different members of the transient receptor potential channel family. However, even if there seems to be good rationale for further development of these principles, further exploration of their involvement in lower urinary tract function/dysfunction is necessary.
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Affiliation(s)
- Karl-Erik Andersson
- Institute for Regenerative Medicine, Wake Forest University School of Medicine, Winston Salem, NC, USA. ; Aarhus Institute for Advanced Sciences, Aarhus University, Aarhus, Denmark
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Caretta N, Vigili de Kreutzenberg S, Valente U, Guarneri G, Pizzol D, Ferlin A, Avogaro A, Foresta C. Hypovitaminosis D is associated with lower urinary tract symptoms and benign prostate hyperplasia in type 2 diabetes. Andrology 2015; 3:1062-7. [DOI: 10.1111/andr.12092] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2015] [Revised: 06/24/2015] [Accepted: 07/16/2015] [Indexed: 01/30/2023]
Affiliation(s)
- N. Caretta
- Department of Medicine; Section of Endocrinology and Centre for Human Reproduction Pathology; University of Padova; Padova Italy
| | - S. Vigili de Kreutzenberg
- Department of Medicine; Section of Diabetes and Metabolic Diseases; University of Padova; Padova Italy
| | - U. Valente
- Department of Medicine; Section of Endocrinology and Centre for Human Reproduction Pathology; University of Padova; Padova Italy
| | - G. Guarneri
- Department of Medicine; Section of Diabetes and Metabolic Diseases; University of Padova; Padova Italy
| | - D. Pizzol
- Department of Medicine; Section of Endocrinology and Centre for Human Reproduction Pathology; University of Padova; Padova Italy
| | - A. Ferlin
- Department of Medicine; Section of Endocrinology and Centre for Human Reproduction Pathology; University of Padova; Padova Italy
| | - A. Avogaro
- Department of Medicine; Section of Diabetes and Metabolic Diseases; University of Padova; Padova Italy
| | - C. Foresta
- Department of Medicine; Section of Endocrinology and Centre for Human Reproduction Pathology; University of Padova; Padova Italy
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20
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Wang CC, Liao CH, Kuo HC. Clinical guidelines for male lower urinary tract symptoms associated with non-neurogenic overactive bladder. UROLOGICAL SCIENCE 2015. [DOI: 10.1016/j.urols.2014.12.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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21
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Kunit T, Gratzke C, Schreiber A, Strittmatter F, Waidelich R, Rutz B, Loidl W, Andersson KE, Stief CG, Hennenberg M. Inhibition of smooth muscle force generation by focal adhesion kinase inhibitors in the hyperplastic human prostate. Am J Physiol Renal Physiol 2014; 307:F823-32. [DOI: 10.1152/ajprenal.00011.2014] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Smooth muscle contraction may be critical for lower urinary tract symptoms (LUTS) in patients with benign prostate hyperplasia and requires stable anchorage of the cytoskeleton to the cell membrane. These connections are regulated by focal adhesion kinase (FAK). Here, we addressed the involvement of FAK in the regulation of smooth muscle contraction in hyperplastic human prostate tissues. Prostate tissues were obtained from radical prostatectomy. Expression of FAK and focal adhesion proteins was assessed by Western blot analysis and immunohistochemical stainings. Effects of the FAK inhibitors PF-573228 and Y-11 on contraction of prostate strips were examined in the organ bath. Expression of FAK and focal adhesion proteins (integrin-5α, paxilin, and c-Src) was detected by Western blot analysis in prostate samples. By double immunofluorescence staining with calponin and pan-cytokeratin, expression of FAK was observed in stromal and epithelial cells. Immunoreactivity for FAK colocalized with integrin-5α, paxilin, talin, and c-Src. Stimulation of prostate tissues with the α1-adrenergic agonist phenylephrine increased the phosphorylation state of FAK at Tyr397 and Tyr925 with different kinetics, which was blocked by the α1-adrenoceptor antagonist tamsulosin. Norepinephrine and phenylephrine induced concentration-dependent contractions of prostate strips. Both FAK inhibitors PF-573228 and Y-11 significantly inhibited norepinephrine- and phenylephrine-induced contractions. Finally, PF-573228 and Y-11 inhibited contractions induced by electric field stimulation, which was significant at the highest frequency. In conclusion, α1-adrenergic smooth muscle contraction or its regulation involves FAK in the human prostate. Consequently, FAK may be involved in the pathophysiology of LUTS and in current or future LUTS therapies.
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Affiliation(s)
- Thomas Kunit
- Department of Urology, Ludwig-Maximilians University, Munich, Germany
- Krankenhaus der Barmherzigen Schwestern Linz, Linz, Austria; and
| | - Christian Gratzke
- Department of Urology, Ludwig-Maximilians University, Munich, Germany
| | - Andrea Schreiber
- Department of Urology, Ludwig-Maximilians University, Munich, Germany
| | | | | | - Beata Rutz
- Department of Urology, Ludwig-Maximilians University, Munich, Germany
| | - Wolfgang Loidl
- Krankenhaus der Barmherzigen Schwestern Linz, Linz, Austria; and
| | - Karl-Erik Andersson
- Wake Forest Institute for Regenerative Medicine, Wake Forest University School of Medicine, Winston-Salem, North Carolina
| | | | - Martin Hennenberg
- Department of Urology, Ludwig-Maximilians University, Munich, Germany
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Ząbkowski T. Evaluation of the clinical indications, adverse drug reactions, and finasteride use in patients with benign prostatic hyperplasia in Poland. Pharmacol Rep 2014; 66:565-9. [PMID: 24948055 DOI: 10.1016/j.pharep.2014.02.022] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2013] [Revised: 10/24/2013] [Accepted: 02/13/2014] [Indexed: 11/17/2022]
Abstract
BACKGROUND Benign prostatic hyperplasia (LUTS/BPH) is one of the most common urinary disorders in elderly men. The symptoms of the disease include prostate gland enlargement, bladder outlet obstruction, and lower urinary tract symptoms (LUTSs). BPH predisposes patients to bladder infections and bladder stone formation and increases their risk of urinary retention, which in turn causes renal failure. Hence, the disease requires surgical treatment. However, over the recent years, the number of surgical interventions performed in pharmacotherapy has significantly reduced because of the increased efficacy of conservative therapy, including combination treatment mostly with 2 groups of drugs, namely, alpha-1-adrenolitics and other 5-alpha-reductase blockers, with a different pharmacological activity [5]. The aim of this study was to evaluate the clinical indications, adverse drug reactions, and finasteride use in patients with diagnosed BPH in Poland. MATERIALS AND METHODS We conducted a clinical trial from November 2009 to November 2010 that included 5751 patients who were enrolled in 46 urological centres in Poland. The researchers who conducted the clinical trial were urologists from different regions of Poland. The clinical trial involved 6 follow-up visits. The mean age of the patients was 67 years (range, 45-93 years; median, 67.00; SD, 8.507). The inclusion criteria were as follows: LUTSs, finasteride therapy for at least 2 weeks, age>40 years, and BPH. RESULTS Patients self-reported data on LUTSs, the symptom frequency, concurrent diseases, and intensification of urinary system symptoms. In addition, additional examinations were performed, including prostate-specific antigen test, urinary tract ultrasonography with evaluation of residual urine and prostate, and uroflowmetry. The study did not exclude data on the combined treatment with finasteride and alpha-1-adrenolitics. CONCLUSION Finasteride was demonstrated to be effective, as evidenced by the significant decrease in TPV by 40% even after 12 months. It was also found to contribute to the attenuation of LUTSs, improvement in maximum flow rate, decrease in nocturia, and improvement in QoL.
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Affiliation(s)
- Tomasz Ząbkowski
- Urology Clinic of the Military Medical Institute, Warszawa, Poland.
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Zacche MM, Giarenis I, Cardozo L. Phase II drugs that target cholinergic receptors for the treatment of overactive bladder. Expert Opin Investig Drugs 2014; 23:1365-74. [PMID: 24899225 DOI: 10.1517/13543784.2014.925877] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
INTRODUCTION Overactive bladder (OAB) is a term used to describe the symptom syndrome of urgency, with or without urgency incontinence, usually associated with frequency and nocturia. Antimuscarinics are the most widely prescribed class of drugs for OAB, although their systemic adverse effects limit their use in clinical practice as compliance. This has led to developments in the field. AREAS COVERED In this review, the authors describe Phase II drugs that target cholinergic receptors. First, the authors present the new antimuscarinics (tarafenacin and afacifenacin). This is followed by reports on a combination drug (tolenix) containing a muscarinic antagonist (tolterodine) associated with a muscarinic agonist (pilocarpine). Further, the authors discuss the trials of well-known drugs in either new combination therapy (solifenacin and mirabegron) or with new routes of delivery (oxybutynin vaginal ring). Finally, the authors examine the option of targeting nicotinic acetylcholine receptors (dexmecamylamine). EXPERT OPINION Different strategies have been adopted to improve the efficacy and tolerability of therapeutics for OAB. Nicotinic receptors represent a novel therapeutic target; however, it is unlikely that antimuscarinic agents will be replaced as standard first-line therapy in the near future.
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Affiliation(s)
- Martino Maria Zacche
- King's College Hospital, Department of Urogynaecology , Denmark Hill, SE5 9 RS, London , UK
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Soler R, Neto JFN, Füllhase C, Simonetti R. Future Pharmacotherapies for Male Lower Urinary Tract Symptoms. CURRENT BLADDER DYSFUNCTION REPORTS 2014. [DOI: 10.1007/s11884-014-0231-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Zhao YR, Liu WZ, Guralnick M, Niu WJ, Wang Y, Sun G, Xu Y. Predictors of short-term overactive bladder symptom improvement after transurethral resection of prostate in men with benign prostatic obstruction. Int J Urol 2014; 21:1035-40. [PMID: 24825248 DOI: 10.1111/iju.12482] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2013] [Accepted: 04/06/2014] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To investigate the correlation of preoperative overactive bladder symptoms and urodynamic parameters to the improvement of overactive bladder symptoms after transurethral resection of the prostate. METHODS A retrospective study was carried out in 128 patients with urodynamically proven benign prostatic obstruction that underwent transurethral resection of the prostate. All patients had preoperative urgency symptoms. The patients were divided into groups according to overactive bladder symptom severity and preoperative urodynamic parameters (presence and type of detrusor overactivity, degree of obstruction, bladder contractility). The 3-month postoperative changes in overactive bladder symptoms were then compared between the groups. RESULTS Overall, there was a statistically significant improvement in mean overactive bladder symptoms score from 9.6 to 2.7 (P < 0.001). However, patients with preoperative mild overactive bladder symptoms had significantly lower postoperative overactive bladder symptoms scores than those with moderate or severe symptoms (P < 0.05). Patients with preoperative terminal detrusor overactivity had significantly higher overactive bladder symptoms scores compared with patients with phasic and no detrusor overactivity (P < 0.05), and were more likely to have persistent urge incontinence. Preoperative detrusor contractility and severity of obstruction did not affect postoperative overactive bladder symptom improvement. CONCLUSIONS Most patients with benign prostatic obstruction and overactive bladder symptoms experience an improvement in their symptoms after transurethral resection of the prostate. The presence of preoperative terminal detrusor overactivity might be negatively associated with this improvement. The preoperative severity of overactive bladder symptoms, detrusor contractility and degree of bladder outlet obstruction do not appear to have an effect.
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Affiliation(s)
- Yao-Rui Zhao
- Department of Urology, Second Hospital of Tianjin Medical University, Tianjin Institute of Urology, Tianjin, China
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Takezawa K, Kondo M, Kiuchi H, Soda T, Takao T, Miyagawa Y, Tsujimura A, Nonomura N, Shimada S. Combination of bladder ultrasonography and novel cystometry method in mice reveals rapid decrease in bladder capacity and compliance in LPS-induced cystitis. Am J Physiol Renal Physiol 2014; 307:F234-41. [PMID: 24808533 DOI: 10.1152/ajprenal.00043.2014] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Various animal models have been used in research into bladder dysfunction, and in vivo cystometry is a common method to analyze bladder function in animals. However, it is rather difficult to perform reliably in small animals. Transabdominal bladder ultrasonography combined with cystometry in urethane-anesthetized mice have revealed physical inhibition of bladder wall movement by a bladder catheter conventionally placed in the bladder apex. For reliable evaluation of mouse lower urinary tract function, we established a novel cystometry method in which a catheter was placed in the bladder anterior wall, in combination with bladder ultrasonography. This new method allowed the bladder to be well distended (i.e., larger maximum bladder capacity, lower pressure threshold, higher voided volume, and higher bladder compliance compared with conventional methods), which reflected more spontaneous voiding than conventional cystometry methods. We also demonstrated the usefulness of bladder ultrasonography for analysis of mouse bladder function, especially bladder dynamics, maximum bladder capacity, and post-voiding residual volume. We analyzed bladder functional changes in lipopolysaccharide (LPS)-induced cystitis by combining bladder ultrasonography and this new cystometry method. Bladder ultrasonography revealed a rapid decrease in bladder capacity, and cystometry showed a rapid decrease in voided volume due to intravesical LPS instillation. This new cystometry method also revealed a rapid decrease in bladder compliance caused by LPS instillation, which was not detectable by conventional methods. The combination of ultrasonography and the new cystometry method may become a powerful tool for analysis of mouse bladder function and could contribute to the development of new treatments for bladder dysfunction.
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Affiliation(s)
- Kentaro Takezawa
- Department of Neuroscience and Cell Biology, Osaka University Graduate School of Medicine, Osaka, Japan; and Department of Urology, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Makoto Kondo
- Department of Neuroscience and Cell Biology, Osaka University Graduate School of Medicine, Osaka, Japan; and
| | - Hiroshi Kiuchi
- Department of Urology, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Tetsuji Soda
- Department of Urology, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Tetsuya Takao
- Department of Urology, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Yasushi Miyagawa
- Department of Urology, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Akira Tsujimura
- Department of Urology, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Norio Nonomura
- Department of Urology, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Shoichi Shimada
- Department of Neuroscience and Cell Biology, Osaka University Graduate School of Medicine, Osaka, Japan; and
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Ribeiro AS, Fernandes VS, Martínez‐Sáenz A, Martínez P, Barahona MV, Orensanz LM, Blaha I, Serrano‐Margüello D, Bustamante S, Carballido J, García‐Sacristán A, Prieto D, Hernández M. Powerful Relaxation of Phosphodiesterase Type 4 Inhibitor Rolipram in the Pig and Human Bladder Neck. J Sex Med 2014; 11:930-941. [DOI: 10.1111/jsm.12456] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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Kedia GT, Oelke M, Sohn M, Kuczyk MA, Ückert S. Pharmacologic characterization of human male urethral smooth muscle: an in vitro approach. Urology 2014; 82:1451.e13-9. [PMID: 24295263 DOI: 10.1016/j.urology.2013.08.023] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2013] [Revised: 07/15/2013] [Accepted: 08/09/2013] [Indexed: 10/26/2022]
Abstract
OBJECTIVE To elucidate the functional responses of isolated human urethral smooth muscle to various agents known to exert smooth muscle contraction or relaxation. METHODS Specimens of penile urethra were obtained from male patients who had undergone male-to-female gender reassignment surgery. Using the tissue bath technique, the contraction induced by increasing concentrations (1 nM-10 μM) of norepinephrine, phenylephrine, acetylcholine, carbachol, prostaglandin F2α, endothelin 1, angiotensin II, and oxytocin was measured. In another set-up, the effects of C-type natriuretic peptide (0.1 nM-1 μM), sodium nitroprusside, sildenafil, forskolin, alpha2-antagonist delquamine, and acetylcholine (1 nM/10 nM-10 μM) on the tension induced by norepinephrine were investigated. The production of cyclic guanosine monophosphate (GMP) and cyclic adenosine monophosphate (AMP) was measured by means of specific radioimmunoassays. RESULTS Endothelin 1, oxytocin, prostaglandin F2α, norepinephrine, and phenylephrine induced dose-dependent contraction of the isolated urethral tissue, whereas acetylcholine, carbachol, and angiotensin II had no or only minor contractile effects. The contraction induced by norepinephrine was reversed by the drugs with the following rank order of efficacy: sodium nitroprusside > delquamine > sildenafil > C-type natriuretic peptide > forskolin > acetylcholine. The maximal reversion of tension ranged from 68% (sodium nitroprusside) to 22% (acetylcholine). The relaxing effects of the drugs were paralleled by a several-fold increase in tissue levels of cyclic GMP and cyclic adenosine monophosphate. CONCLUSION The results provide evidence that urethral smooth muscle is under the control of endogenous compounds, such as adrenergic agonists (norepinephrine and phenylephrine), vasoactive peptides, prostagladins, NO/cyclic GMP, and acetylcholine, assumed to influence micturition at the peripheral level.
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Affiliation(s)
- George T Kedia
- Division of Surgery, Department of Urology and Urological Oncology, Hannover Medical School, Hannover, Germany.
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White CW, Short JL, Ventura S. Rho kinase activation mediates adrenergic and cholinergic smooth muscle contractile responses in the mouse prostate gland. Eur J Pharmacol 2013; 721:313-21. [DOI: 10.1016/j.ejphar.2013.09.012] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2013] [Revised: 08/27/2013] [Accepted: 09/04/2013] [Indexed: 12/16/2022]
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Lee RT, Bamberger M, Ellsworth P. Impact of mirabegron extended-release on the treatment of overactive bladder with urge urinary incontinence, urgency, and frequency. Res Rep Urol 2013; 5:147-57. [PMID: 24400246 PMCID: PMC3826934 DOI: 10.2147/rru.s38792] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Overactive bladder is a highly prevalent disorder with a significant impact on quality of life. Antimuscarinic agents are commonly used, but persistence is limited due to unsatisfactory efficacy and/or tolerability. Mirabegron is the first beta-3 adrenoceptor agonist approved for the treatment of overactive bladder syndrome. This paper reviews the pharmacology, mechanism of action, efficacy, and safety of mirabegron. A PubMed search of all English articles pertaining to mirabegron was performed. An alternative to antimuscarinics, mirabegron has a unique mechanism, improves overactive bladder symptoms and quality of life, and has limited adverse effects and few contraindications.
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Affiliation(s)
- Raymond T Lee
- University of Massachusetts Medical School, Worcester, MA, USA
| | - Mitchell Bamberger
- UMass Memorial Medical Center, University of Massachusetts Medical School, Worcester, MA, USA
| | - Pamela Ellsworth
- Division of Urology/Surgery, Warren Alpert Medical School of Brown University, Providence, RI, USA
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Gorgel SN, Sefik E, Kose O, Olgunelma V, Sahin E. The Effect of Combined Therapy with Tamsulosin Hydrochloride and Meloxicam in Patients with Benign Prostatic Hyperplasia Symptoms and Impact on Nocturia and Sleep Quality. Int Braz J Urol 2013; 39:657-62. [DOI: 10.1590/s1677-5538.ibju.2013.05.07] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2013] [Accepted: 09/18/2013] [Indexed: 11/22/2022] Open
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Hennenberg M, Stief CG, Gratzke C. Prostatic α1-adrenoceptors: New concepts of function, regulation, and intracellular signaling. Neurourol Urodyn 2013; 33:1074-85. [DOI: 10.1002/nau.22467] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2013] [Accepted: 06/27/2013] [Indexed: 12/20/2022]
Affiliation(s)
- Martin Hennenberg
- Department of Urology; Ludwig-Maximilians-University; Munich Germany
| | | | - Christian Gratzke
- Department of Urology; Ludwig-Maximilians-University; Munich Germany
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Zhang X, Shen F, Dong L, Zhao X, Qu X. Influence and pathophysiological mechanisms of simvastatin on prostatic hyperplasia in spontaneously hypertensive rats. Urol Int 2013; 91:467-73. [PMID: 23838355 DOI: 10.1159/000350519] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2013] [Accepted: 03/06/2013] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To explore the effects and mechanisms of simvastatin on prostate hyperplasia in spontaneously hypertensive rats (SHRs). METHODS Thirty-six male SHRs were randomly divided into three groups: the 10 and the 20 mg/kg/d simvastatin group and the control group. After 6 weeks the ultra-microscopic prostate structures were observed. The serum levels of interleukin-6 (IL-6), insulin-like growth factor (IGF-1) and angiotensin II (Ang-II) were measured by enzyme-linked immunosorbent assays. The endothelium-derived nitric oxide synthase (eNOS) expression was evaluated with immunohistochemistry. RESULTS Compared to the control group, the 20 mg/kg/d simvastatin group presented with lower absolute (p = 0.005) and relative prostate weight (p = 0.009). The basal cells and columnar cells presented with edema, condensed heterochromatin in interstitial fibroblast nuclei, widened nucleus gaps, and decreased mitochondria and endoplasmic reticulum in the 10 mg/kg/d simvastatin group, these changes were more pronounced in the 20 mg/kg/d simvastatin group. The IL-6 levels in the 10 and 20 mg/kg/d simvastatin groups were lower than those of the controls (p = 0.005 and p = 0.008). The IGF-1 levels of the 20 mg/kg/d simvastatin group were reduced compared to the control group (p = 0.016). CONCLUSIONS Simvastatin can delay and inhibit prostatic hyperplasia and progression in SHR. These actions may be mediated through the suppression of inflammatory and growth factors.
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Affiliation(s)
- Xiangyu Zhang
- Departments of Geriatrics and Urology, Second Xiangya Hospital of Central South University, Changsha, Hunan, P.R. China
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Hennenberg M, Strittmatter F, Schmetkamp H, Rutz B, Walther S, Stief CG, Gratzke C. The cAMP effector EPAC activates Elk1 transcription factor in prostate smooth muscle, and is a minor regulator of α1-adrenergic contraction. J Biomed Sci 2013; 20:46. [PMID: 23815815 PMCID: PMC3712007 DOI: 10.1186/1423-0127-20-46] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2013] [Accepted: 06/19/2013] [Indexed: 11/22/2022] Open
Abstract
Background Prostate smooth muscle tone is regulated by α1-adrenoceptor-induced contraction and cAMP-mediated relaxation. EPAC is an effector of cAMP, being involved in smooth muscle relaxation and cell cycle control outside the lower urinary tract. Here, we investigated the expression and function of EPAC in human prostate tissues from patients undergoing radical prostatectomy. Results mRNA and protein expression of EPAC was detected in all prostate tissues by RT-PCR and Western blot analysis. Immunoreactivity was observed in stromal cells, and colocalized with immunofluorescence for α-smooth muscle actin and calponin. Under normal conditions, noradrenaline- or phenylephrine-induced contraction of prostate strips in the organ bath was not affected by the EPAC activator pCPT (SP-8-pCPT-2′-O-Me-cAMPS.NA) (30 μM). However, when the cyclooxygenase inhibitor indomethacin (50 μM) was added, EPAC activators pCPT and OME (8-CPT-2′-O-Me-cAMP.Na) (30 μM) significantly reduced contractions by low concentrations of phenylephrine. These effects were not observed on noradrenaline-induced contraction. OME and pCPT caused phosphorylation of the transcription factor Elk1 in prostate tissues. Elk1 activation was confirmed by EMSA (electrophoretic mobility shift assay), where OME and pCPT incresed Elk1 binding to a specific DNA probe. Conclusions EPAC activation may reduce α1-adrenergic prostate contraction in the human prostate, although this effect is masked by cyclooxygenases and β-adrenoceptors. A main EPAC function in the human prostate may be the regulation of the transcription factor Elk1.
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Affiliation(s)
- Martin Hennenberg
- Department of Urology, Ludwig-Maximilians University, Munich, Germany
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Shimizu S, Saito M, Oiwa H, Ohmasa F, Tsounapi P, Oikawa R, Dimitriadis F, Martin DT, Satoh I, Kinoshita Y, Tomita S. Olmesartan ameliorates urinary dysfunction in the spontaneously hypertensive rat via recovering bladder blood flow and decreasing oxidative stress. Neurourol Urodyn 2013; 33:350-7. [DOI: 10.1002/nau.22405] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2012] [Accepted: 03/08/2013] [Indexed: 12/25/2022]
Affiliation(s)
- Shogo Shimizu
- Division of Molecular Pharmacology; Tottori University School of Medicine; Yonago Japan
| | - Motoaki Saito
- Division of Molecular Pharmacology; Tottori University School of Medicine; Yonago Japan
| | - Harunori Oiwa
- Division of Molecular Pharmacology; Tottori University School of Medicine; Yonago Japan
| | - Fumiya Ohmasa
- Division of Molecular Pharmacology; Tottori University School of Medicine; Yonago Japan
| | - Panagiota Tsounapi
- Division of Molecular Pharmacology; Tottori University School of Medicine; Yonago Japan
| | - Ryo Oikawa
- Division of Molecular Pharmacology; Tottori University School of Medicine; Yonago Japan
| | - Fotios Dimitriadis
- Division of Molecular Pharmacology; Tottori University School of Medicine; Yonago Japan
| | - Darryl T. Martin
- Department of Urology; Yale University School of Medicine; New Haven, Connecticut
| | - Itaru Satoh
- Division of Molecular Pharmacology; Tottori University School of Medicine; Yonago Japan
| | - Yukako Kinoshita
- Division of Molecular Pharmacology; Tottori University School of Medicine; Yonago Japan
| | - Shuhei Tomita
- Division of Molecular Pharmacology; Tottori University School of Medicine; Yonago Japan
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Kurizaki Y, Ishizuka O, Imamura T, Ichino M, Ishikawa M, Ogawa T, Nishizawa O. Correlation Between Bladder Mucosal Alpha-1D/Alpha-1A Adrenoceptor mRNA Ratio and Lower Urinary Tract Function in Benign Prostatic Obstruction Patients. Low Urin Tract Symptoms 2013; 5:60-4. [PMID: 26663371 DOI: 10.1111/j.1757-5672.2012.00164.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVES Alpha-1 adrenoceptor (AR) antagonists are commonly used as therapeutic agents for patients with benign prostatic obstruction (BPO). Our objective was to investigate the correlation between the ratio of bladder mucosal alpha-1D/alpha-1A adrenoceptor mRNA and lower urinary tract function in BPO patients. METHODS In 20 BPO patients, the expression level of alpha-1 AR mRNAs in the bladder mucosal biopsies was investigated by reverse transcriptase polymerase chain reaction. The subjects were divided into two groups. In Group 1, the ratio of alpha-1D mRNA to alpha-1A mRNA was greater than one. In Group 2, the ratio was less than one. We determined the correlation by Schäfer nomogram between Group 1 and Group 2 patients and lower urinary tract function as determined by a video urodynamic study. RESULTS Two patients were excluded due to inability to void. Another was excluded because the alpha-1D/alpha-1A mRNA ratio was one. On the Schäfer nomogram, six of nine Group 1 cases had obstructions less than IV and normal or weak detrusor contractility. For Group 2, six of eight cases had obstructions more than IV and normal or strong detrusor contractility. CONCLUSION Patients with higher levels of alpha-1D AR mRNA were distinct from those with higher alpha-1A AR mRNA levels with regard to obstruction and detrusor activity. The results suggest that the Schäfer nomogram might be useful in determining which alpha-1 AR antagonists are better for BPO patients suffering from storage symptoms.
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Affiliation(s)
- Yoshiki Kurizaki
- Department of Urology, Shinshu University School of Medicine, Matsumoto, Japan
| | - Osamu Ishizuka
- Department of Urology, Shinshu University School of Medicine, Matsumoto, Japan
| | - Tetsuya Imamura
- Department of Urology, Shinshu University School of Medicine, Matsumoto, Japan
| | - Midori Ichino
- Department of Urology, Shinshu University School of Medicine, Matsumoto, Japan
| | - Masakuni Ishikawa
- Department of Urology, Shinshu University School of Medicine, Matsumoto, Japan
| | - Teruyuki Ogawa
- Department of Urology, Shinshu University School of Medicine, Matsumoto, Japan
| | - Osamu Nishizawa
- Department of Urology, Shinshu University School of Medicine, Matsumoto, Japan
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Hennenberg M, Miersch J, Rutz B, Strittmatter F, Waidelich R, Stief CG, Gratzke C. Noradrenaline induces binding of Clathrin light chain A to α1-adrenoceptors in the human prostate. Prostate 2013; 73:715-23. [PMID: 23460120 DOI: 10.1002/pros.22614] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2012] [Accepted: 10/15/2012] [Indexed: 12/18/2022]
Abstract
BACKGROUND Binding of clathrins or caveolin to G protein-coupled receptors may induce post-translational modifications of receptor function. Receptor regulation by clathrin requires cofactors ADP-ribosylation factor 6 (ARF6) and adaptin, while dynamin is required for clathrin- and caveolin-dependent mechanisms. OBJECTIVE To investigate the expression and α1-adrenoceptor binding of clathrins, caveolin, and their cofactors in the human prostate. METHODS Prostate tissue was obtained from radical prostatectomy. Expression of clathrin heavy chain (HC), clathrin light chain A and B (LCA, LCB), caveolin-1, ARF6, β-adaptin, and dynamin-2 was studied by RT-PCR, Western blot, immunohistochemistry, and fluorescence staining. Interaction of α1A-adrenoceptors with clathrins and caveolin-1 was studied by coimmunoprecipitation. RESULTS mRNA and protein expression of clathrin HC, LCA, LCB, caveolin-1, dynamin-2, and β-adaptin was detected in prostate tissues of each patient. Immunohistochemistry demonstrated the expression of clathrin HC, LCA, LCB, caveolin, dynamin, and β-adaptin in stromal cells. Immunoreactivity for these proteins colocalized with α-smooth muscle actin and α1A-adrenoceptors in double fluorescence staining. Coimmunoprecipitation demonstrated that α1A-adrenoceptors in prostate tissue interact with clathrin HC and LCB under resting conditions, but not with caveolin-1. Stimulation of prostate tissues with noradrenaline (30 µM) in vitro induced binding of clathrin LCA to α1A-adrenoceptors. CONCLUSIONS The prostatic α1-adrenoceptor population is at least partially bound to clathrin HC and LCB. Upon receptor activation, prostate α1A-adrenoceptors bind clathrin LCA. This points to a new concept of post-translational α1-adrenoceptor regulation in the prostate, which includes receptor interaction with accessory binding partners.
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Affiliation(s)
- Martin Hennenberg
- Department of Urology, Ludwig-Maximilians University, Munich, Germany
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Andersson KE. New developments in the management of overactive bladder: focus on mirabegron and onabotulinumtoxinA. Ther Clin Risk Manag 2013; 9:161-70. [PMID: 23637536 PMCID: PMC3634323 DOI: 10.2147/tcrm.s33052] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
In the last few years, much new information has been generated on the pathophysiology, possible therapeutic targets, and pharmacologic treatment of overactive bladder (OAB). Antimuscarinic drugs are still first-line pharmacologic treatment for OAB and often have good initial response rates, but adverse effects and decreasing efficacy cause long-term compliance problems, prompting a search for new therapeutic alternatives. Mirabegron and onabotulinumtoxinA, two drugs with different mechanisms of action, and with adverse effect profiles different from those of antimuscarinics, were recently approved for treatment of OAB. However, their place in the treatment of this disorder has not yet been established. In this short review, the mechanisms of action, clinical efficacy, and safety profiles of these drugs are discussed and compared with those of the current gold standard, antimuscarinic agents.
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Affiliation(s)
- Karl-Erik Andersson
- Institute of Regenerative Medicine, Wake Forest University School of Medicine, and Department of Urology, Wake Forest Baptist Medical Center, Winston Salem, NC, USA
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The difference of lower urinary tract symptoms between sympathetic hyperactive and hypoactive men. Int Neurourol J 2013; 17:30-3. [PMID: 23610709 PMCID: PMC3627996 DOI: 10.5213/inj.2013.17.1.30] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2013] [Accepted: 03/30/2013] [Indexed: 11/12/2022] Open
Abstract
Purpose Heart rate variability (HRV) is a tool used to measure autonomic nervous function; however, there is no evidence that it can be used to define sympathetic hyperactivity in men with lower urinary tract symptoms (LUTS). We suspected that LUTS would differ between sympathetic hyperactive and hypoactive patients. Therefore, we measured HRV and divided the LUTS patients into two groups, a sympathetic hyperactive group and a sympathetic hypoactive group according to the low frequency/high frequency (LF/HF) ratio and made clinical comparisons between the groups. Methods A total of 43 patients with symptomatic LUTS (International Prostate Symptom Score [IPSS] over 8) and 49 healthy volunteers were enrolled. No subjects had diseases that could affect the autonomic nervous system, such as diabetes or hypertension. Electrocardiographic signals were obtained from subjects in the resting state and HRV indexes were calculated with spectral analyses. We divided the LUTS patients into two groups by an LF/HF ratio of 1.9, which was the median value in the healthy volunteers, and compared the differences in clinical characteristics, IPSS, prostate-specific antigen (PSA), and transrectal ultrasound (TRUS) results. The parameters were compared by independent sample t-test by use of SPSS ver. 19. Results There were no significant differences in age, serum PSA, or volume of the prostate between the 2 LUTS groups. However, analyzing IPSS questionnaires between two groups showed that there were significant differences in mean of Q2 score (frequency) and storage symptom score ([Q2+Q4+Q7]/3) (P<0.05). Conclusions We suggest that an imbalance of autonomic nervous system activity may be a factor that evokes varieties of symptoms in men with LUTS. LUTS patients with hypoactive sympathetic tone may suffer from frequency and storage symptoms.
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Hennenberg M, Strittmatter F, Beckmann C, Rutz B, Füllhase C, Waidelich R, Montorsi F, Hedlund P, Andersson KE, Stief CG, Gratzke C. Silodosin inhibits noradrenaline-activated transcription factors Elk1 and SRF in human prostate smooth muscle. PLoS One 2012; 7:e50904. [PMID: 23226423 PMCID: PMC3511420 DOI: 10.1371/journal.pone.0050904] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2012] [Accepted: 10/25/2012] [Indexed: 11/29/2022] Open
Abstract
Background The transcription factors Elk1 and serum response factor (SRF) are central regulators of cell cycle and phenotype in various cell types. Elk1 is activated by phosphorylation (serine-383), while activation of SRF requires its co-factor, myocardin. Activation of Elk1 and SRF results in binding to specific DNA sequences in promoter regions, and may be induced by adrenergic receptor activation in different organs. Objective To examine the effects of adrenergic stimulation on Elk1 and SRF in the human prostate and the ability of the highly selective α1A-adrenoceptor antagonist, silodosin, on transcription factor activation. Methods Prostate tissue was obtained from patients undergoing radical prostatectomy. Expression of Elk1, SRF, and myocardin was estimated by Western blot and immunohistochemistry. Colocalizations were studied by double immunofluorescence staining. Noradrenaline- (NA-) and phenylephrine- (PE-) induced phosphorylation of Elk1 was assessed by Western blot analysis using a phospho-specific antibody. NA-induced activation of Elk1 and SRF was investigated by electrophoretic mobility shift assay (EMSA). Results Immunoreactivity for Elk1, SRF, and myocardin was observed in stromal cells of tissues from each patient. In fluorescence stainings, SRF colocalized with myocardin and α-smooth muscle actin (αSMA). Stimulation of prostate tissues with PE (10 µM) or NA (30 µM) increased the phosphorylation of Elk1 at serine-383. NA-induced Elk1 activation was confirmed by EMSA, where a NA-induced binding of Elk1 to the DNA sequence TTTGCAAAATGCAGGAATTGTTTTCACAGT was observed. Similarly, NA caused SRF binding to the SRF-specific DNA sequence CCATATTAGGCCATATTAGG. Application of silodosin (3 µM) to prostate tissues reduced the activity of Elk1 and SRF in NA-stimulated tissues. Conclusions Silodosin blocks the activation of the two transcription factors, Elk1 and SRF, which is induced by noradrenaline in the human prostate. A role of α1-adrenoceptors beyond smooth muscle contraction may be considered, which includes a function in transcriptional regulation.
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Affiliation(s)
- Martin Hennenberg
- Department of Urology, Ludwig-Maximilians University Munich, Munich, Germany
| | - Frank Strittmatter
- Department of Urology, Ludwig-Maximilians University Munich, Munich, Germany
| | - Christer Beckmann
- Department of Urology, Ludwig-Maximilians University Munich, Munich, Germany
| | - Beata Rutz
- Department of Urology, Ludwig-Maximilians University Munich, Munich, Germany
| | - Claudius Füllhase
- Department of Urology, Ludwig-Maximilians University Munich, Munich, Germany
| | - Raphaela Waidelich
- Department of Urology, Ludwig-Maximilians University Munich, Munich, Germany
| | | | - Petter Hedlund
- Urological Research Institute, University of San Raffaele, Milan, Italy
| | - Karl-Erik Andersson
- Wake Forest Institute for Regenerative Medicine, Wake Forest University School of Medicine, Winston-Salem, North Carolina, United States of America
| | - Christian G. Stief
- Department of Urology, Ludwig-Maximilians University Munich, Munich, Germany
| | - Christian Gratzke
- Department of Urology, Ludwig-Maximilians University Munich, Munich, Germany
- * E-mail:
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Iacono F, Prezioso D, Illiano E, Ruffo A, Romeo G, Amato B. Observational study: daily treatment with a new compound "Tradamixina" plus serenoa repens for two months improved the lower urinary tract symptoms. BMC Surg 2012; 12 Suppl 1:S22. [PMID: 23173650 PMCID: PMC3499205 DOI: 10.1186/1471-2482-12-s1-s22] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Lower urinary tract symptoms (LUTS) are associated with great emotional costs to individuals and substantial economic costs to society. This study seeks to evaluate the effect of a new natural compound "Tradamixina plus Serenoa Repens" in order to improve lower urinary tract symptoms. METHODS 100 patients (≥ 45 years) who had had LUTS/BPH for >6 mo at screening and with IPSS -The international Prostate symptom scores- ≥ 13 and maximum urinary flow rate (Qmax) ≥ 4 to ≤ 15 ml/s. were recruited. The compound "Tradamixina plus Serenoa Repens" (80 mg of Alga Ecklonia Bicyclis, 100 mg of Tribulus Terrestris and 100 mg of D-Glucosamine and N-Acetyl-D-Glucosamine plus 320 mg of Serenoa Repens) was administered daily for 2 months. At visit and after 60 days of treatment patients were evaluated by means of detailed medical urological history, clinical examination, laboratory investigations (total PSA), and instrumental examination like urolfowmetry. Efficacy measures included IPSS-International Prostate Sympto, BPH Impact Index (BII), Quality-of-Life (QoL) Index. Measures were assessed at baseline and end point (12 wk or end of therapy) and also at screening, 1 and 4 wk for IPSS, and 4 wk for BII. Statistical significance was interpreted only if the results of the preceding analysis were significant at the 0.05 level. RESULTS After 2 months of treatment the change from baseline to week 12 relative to "Tradamixina plus Seronea Repens" in total IPSS and Qol was statistically significant. Differences from baseline in BII were statistically significant for "Tradamixina plus Seronea Repens" above all differences in BII were also significant at 4 wk (LSmean ± SE: -0.8 ± 0.2). In the distribution of subjects over the PGI-I and CGI-I response categories were significant for"Tradamixina plus Seronea Repens" (PGI-I: p = 0.001; CGI-I). We also observed a decrease of total PSA. CONCLUSION The daily treatment with a new compound "Tradamixina plus Serenoa Repens" for 2 months improved the male sexual function , it improved the bother symptoms which affect the patient's quality of life , improved uroflowmetric parameters, and we also observed a decrease of serum PSA level.
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Affiliation(s)
- Fabrizio Iacono
- Department of Urology – University Federico II of Naples, Via S. Pansini, 5 – 80131 Naples – Italy
| | - Domenico Prezioso
- Department of Urology – University Federico II of Naples, Via S. Pansini, 5 – 80131 Naples – Italy
| | - Ester Illiano
- Department of Urology – University Federico II of Naples, Via S. Pansini, 5 – 80131 Naples – Italy
| | - Antonio Ruffo
- Department of Urology – University Federico II of Naples, Via S. Pansini, 5 – 80131 Naples – Italy
| | - Giuseppe Romeo
- Department of Urology – University Federico II of Naples, Via S. Pansini, 5 – 80131 Naples – Italy
| | - Bruno Amato
- Department of General, Geriatric, Oncologic Surgery and Advanced Technologies,-University “Federico II” of Naples. Via Pansini, 5 - 80131 – Naples, Italy
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Cho ST, Park EY, Kim JC. Effect of Angiotensin II Receptor Antagonist Telmisartan on Detrusor Overactivity in Rats With Bladder Outlet Obstruction. Urology 2012; 80:1163.e1-7. [DOI: 10.1016/j.urology.2012.05.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2012] [Revised: 04/04/2012] [Accepted: 05/01/2012] [Indexed: 10/28/2022]
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Zhang S, Lv JW, Yang P, Yu Q, Pang J, Wang Z, Guo H, Liu S, Hu J, Li J, Leng J, Huang Y, Ye Z, Wang CY. Loss of dicer exacerbates cyclophosphamide-induced bladder overactivity by enhancing purinergic signaling. THE AMERICAN JOURNAL OF PATHOLOGY 2012; 181:937-46. [PMID: 22796409 DOI: 10.1016/j.ajpath.2012.05.035] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/29/2012] [Accepted: 05/30/2012] [Indexed: 12/23/2022]
Abstract
microRNAs (miRNAs) have regulated the expression and function of genes implicated in many pathological settings, but their impact on the pathoetiological characteristics of overactive bladder (OAB) largely remains unknown. We have generated a mouse model in which adult mice can be induced for detrusor deletion of Dicer, an enzyme essential for miRNA processing. Targeted deletion of Dicer did not lead to a significant change for detrusor functionality under physiological conditions; however, loss of Dicer exacerbated cyclophosphamide-induced OAB, manifested by the higher severity of altered detrusor contractile force and sensitivity, abnormal urodynamics, and enhanced macrophage infiltration. Mechanistic studies revealed that loss of Dicer may impair the expression of miRNAs that are capable of targeting P2x mRNAs. As a result, mice deficient in Dicer manifest enhanced P2X expression in the detrusor on cyclophosphamide treatment, predisposing to the increased risk for OAB development. More important, studies using bladder biopsy samples of patients with OAB also demonstrated similar results as those found in animals. Taken together, our results suggest that miRNAs modulate OAB susceptibility by regulating purinergic signaling, in which the pathogenic insult induces the expression of miRNAs capable of targeting P2X mRNAs to suppress OAB symptoms.
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Affiliation(s)
- Shu Zhang
- The Center for Biomedical Research, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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Horstmann M, Foerster B, Brader N, John H, Maake C. Establishment of a protocol for large-scale gene expression analyses of laser capture microdissected bladder tissue. World J Urol 2012; 30:853-9. [PMID: 22638977 DOI: 10.1007/s00345-012-0881-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2011] [Accepted: 04/26/2012] [Indexed: 10/28/2022] Open
Abstract
PURPOSE Lower urinary tract symptoms (LUTS) can be caused by structural and functional changes in different compartments of the bladder. To enable extensive investigations of individual regions even in small bladder biopsies, we established a combination protocol consisting of three molecular techniques: laser capture microdissection microscopy (LCM), RNA preamplification and quantitative polymerase chain reaction (qPCR). METHODS Urinary bladders of ten mice were resected and frozen immediately or after a delay of 15 min. Cryosections were obtained and smooth muscle was isolated using the LCM technique. Then, RNA was extracted, including protocols with and without DNase digestion as well as with and without the addition of carrier RNA. Extracted RNA was either used for reverse transcriptase (RT)-PCR plus qPCR or for a combination of RNA preamplification and qPCR. RESULTS Our data showed that with RNA preamplification, 10 μg cDNA can be regularly generated from 2.5 ng RNA. Depending on expression levels, this is sufficient for hundreds of pPCR reactions. The efficiency of preamplification, however, was gene-dependent. DNase digestion before preamplification lead to lower threshold cycles in qPCR. The use of partly degraded RNA for RNA preamplification did not change the results of the following qPCR. CONCLUSIONS RNA preamplification strongly enlarges the spectrum of genes to be analyzed in distinct bladder compartments by qPCR. It is an easy and reliable method that can be realized with standard laboratory equipment. Our protocol may lead in near future to a better understanding of the pathomechanisms in LUTS.
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Affiliation(s)
- M Horstmann
- Department of Urology, Kantonsspital Winterthur, Brauerstr. 15, 8401 Winterthur, Switzerland.
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Cohen SA, Parsons JK. Combination Pharmacological Therapies for the Management of Benign Prostatic Hyperplasia. Drugs Aging 2012; 29:275-84. [DOI: 10.2165/11598600-000000000-00000] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
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Arteaga JL, Orensanz LM, Martínez MP, Barahona MV, Martínez-Sáenz A, Fernandes VS, Bustamante S, Carballido J, Benedito S, García-Sacristán A, Prieto D, Hernández M. Endothelin ET(B) receptors are involved in the relaxation to the pig urinary bladder neck. Neurourol Urodyn 2012; 31:688-94. [PMID: 22460263 DOI: 10.1002/nau.22203] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2011] [Accepted: 01/09/2012] [Indexed: 11/10/2022]
Abstract
AIMS The involvement of endothelin receptors in the contraction of the lower urinary tract smooth muscle is well established. There is scarce information, however, about endothelin receptors mediating relaxation of the bladder outlet region. The current study investigates the possible existence of endothelin ET(B) receptors involved in the relaxation of pig bladder neck. METHODS ET(B) receptor expression was determined by immunohistochemistry and urothelium-denuded bladder neck strips were mounted in organ baths for isometric force recording. RESULTS ET(B) -immunoreactivity (ET(B) -IR) was observed within nerve fibers among smooth muscle bundles and urothelium. BQ3020 (0.01-300 nM), an ET(B) receptor agonist, produced concentration-dependent relaxations which were reduced by BQ788, an ET(B) receptor antagonist, and by inhibitors of protein kinase A (PKA) and large (BK(Ca) )- or small (SK(Ca) )-conductance Ca(2+) -activated K(+) channels. Pretreatment with BK(Ca) or SK(Ca) channel inhibitors plus PKA blocking did not cause further inhibition compared with that exerted by inhibiting BK(Ca) or SK(Ca) channels only. BQ3020-induced relaxation was not modified by blockade of either nitric oxide (NO) synthase, guanylyl cyclase, cyclooxygenase (COX) or of intermediate-conductance Ca(2+) -activated-(IK(Ca) ), ATP-dependent-(K(ATP) ), or voltage-gated-(K(v) ) K(+) channels. Under non-adrenergic non-cholinergic (NANC) conditions, electrical field stimulation (0.5-16 Hz) evoked frequency-dependent relaxations, which were reduced by BQ788 and potentiated by threshold concentrations of BQ3020. CONCLUSIONS These results suggest that BQ3020 produces relaxation of the pig bladder neck via activation of muscle endothelin ET(B) receptors, NO/cGMP- and COX-independent-, cAMP-PKA pathway-dependent-mechanisms, and involving BK(Ca) and SK(Ca) channel activation. ET(B) receptors are also involved in the NANC inhibitory neurotransmission.
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Affiliation(s)
- José Luis Arteaga
- Departamento de Fisiología, Facultad de Farmacia, Universidad Complutense de Madrid, Madrid, Spain
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Biomarkers in Overactive Bladder. CURRENT BLADDER DYSFUNCTION REPORTS 2012. [DOI: 10.1007/s11884-011-0112-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
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Vaughan CP, Johnson TM, Goode PS, Redden DT, Burgio KL, Markland AD. Vitamin D and lower urinary tract symptoms among US men: results from the 2005-2006 National Health and Nutrition Examination Survey. Urology 2011; 78:1292-7. [PMID: 22014969 DOI: 10.1016/j.urology.2011.07.1415] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2011] [Revised: 07/27/2011] [Accepted: 07/29/2011] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To evaluate the association of vitamin D levels and lower urinary tract symptoms (LUTS) among US men. MATERIAL AND METHODS Data were analyzed for 2387 men (≥20 years) who participated in the 2005-2006 cycle of the National Health and Nutrition Examination Survey, a cross-sectional survey of the US noninstitutionalized population. LUTS included nocturia, incomplete emptying, hesitancy, and urinary incontinence (UI). Plasma 25-hydroxyvitamin D was categorized as ≥30 ng/mL (normal), 20-30 ng/mL (insufficiency), and <20 ng/mL (deficiency). Other factors included age, race/ethnicity, education, body mass index, self-reported health status, chronic diseases, and prior diagnosis of benign prostatic enlargement and/or prostate cancer (men ≥40 years of age). Prevalence and prevalence odds ratios (POR) were estimated from a multivariable logistic regression analysis using appropriate sampling weights. RESULTS A majority (89%, n = 1241) had vitamin D levels <30 ng/mL, of whom 55% (n = 684) had vitamin D levels <20 ng/mL. Vitamin D levels ranged from 2-56 ng/mL (median 19 ng/mL, mean ± SD 19.9 ± 8.0). Among the 1388 (58%) men with LUTS data and vitamin D levels, 48% (n = 666) had at least 1 LUTS. In multivariable analyses adjusting for age and race norms, vitamin D deficiency was associated with the presence of moderate-severe UI (POR 1.8, 95% CI 1.1, 3.0) and at least 1 LUTS (POR 1.4, 95% CI 1.0, 2.0). CONCLUSION Vitamin D insufficiency and deficiency are highly prevalent among adult men in the US, and vitamin D deficiency is associated with moderate-severe UI and the presence of at least 1 LUTS.
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Affiliation(s)
- Camille P Vaughan
- Department of Veterans Affairs Medical Center, Birmingham, AL 35233, USA
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Serum C-reactive protein levels are associated with residual urgency symptoms in patients with benign prostatic hyperplasia after medical treatment. Urology 2011; 78:1373-8. [PMID: 21962879 DOI: 10.1016/j.urology.2011.04.076] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2011] [Revised: 04/27/2011] [Accepted: 04/29/2011] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Urinary urgency is a common and bothersome symptom in patients with benign prostatic hyperplasia (BPH); this symptom may persist even after medical treatment. Chronic inflammation has been reported to be associated with the pathogenesis of BPH and lower urinary tract symptoms (LUTS). We investigate the association between serum C-reactive protein (CRP) level and residual urgency symptoms in BPH patients after medical treatment. METHODS Two-hundred-five men undergoing stable medical treatment for BPH, defined as a total prostate volume ≥40 mL, were enrolled. Patients with acute infection or those taking nonsteroid antiinflammatory drugs or aspirin were excluded. Uroflowmetry, postvoid residual volume, transrectal ultrasound parameters, serum prostate specific antigen (PSA), and CRP level were measured. A three-day void diary was recorded to identify the presence of urinary urgency. RESULTS The mean serum CRP level was 0.24 mg/dL (range 0.01-2.84), and residual urgency was identified in 90 patients (43.9%). Patients with residual urgency were older and had significantly higher serum CRP levels (0.39 ± 0.54 mg/dL) than those without urgency (0.13 ± 0.20, P <.001). On multivariable logistic regression analysis, men with CRP levels ≥0.3 mg/dL were more likely to have urgency (odds ratio 8.08, 95% confidence interval 3.26-20.0) after adjusting for age, serum PSA level, total prostate volume, and antimuscarinic use. Patients with serum CRP levels ≥0.30 mg/dL had more urgency (82.1%) than those with serum CRP levels <0.30 mg/dL (34.9%). CONCLUSION Serum CRP level is significantly associated with residual urgency in BPH patients after medical treatment. Chronic inflammation may play a role in the occurrence of residual urgency in BPH patients.
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