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Petereit C, Porath K, Rackow S, Kernig K, Hakenberg OW, Köhling R, Kirschstein T. Age-dependent effects of the β 3 adrenoceptor agonist CL316,243 on human and rat detrusor muscle strips. Pflugers Arch 2024; 476:243-256. [PMID: 37993748 DOI: 10.1007/s00424-023-02877-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Revised: 10/19/2023] [Accepted: 10/30/2023] [Indexed: 11/24/2023]
Abstract
Motility of detrusor smooth muscle includes adrenergic relaxation and cholinergic contraction. Since the latter may be deregulated in overactive bladder (OAB) pathophysiology, anticholinergics are the standard therapy but occasionally less tolerated due to side effects such as dry mouth and constipation. β3 adrenoceptor agonists also alleviate OAB symptoms by relaxing the detrusor muscle. Their age dependence, however, is far from understood. To address this issue, we induced contractions with KCl (60 mM) and carbachol (from 10 nM to 100 μM) in the presence of the β3 adrenoceptor agonist CL316,243 (from 0.1 to 10 μM) in both human and rat muscle strips. Our results confirmed that both contractions were attenuated by β3 adrenoceptor activation in both species, but with differing age dependence. In humans, specimens from mid-life subjects showed a significantly more pronounced effect of CL316,243 in attenuating carbachol-induced contractions than those from aged subjects (Cohen's d of maximal attenuation: 1.82 in mid-life versus 0.13 in aged) without altering EC50. Conversely, attenuation of KCl responses by CL316,243 increased during ageing (Spearman correlation coefficient = -0.584, P<0.01). In rats, both KCl- and carbachol-induced contractions were significantly more attenuated by CL316,243 in samples from adolescent as compared to aged samples. Immunohistochemistry in human detrusor sections proved β3 adrenoreceptor abundance to remain unaltered during ageing. In conclusion, our findings suggest differential age-dependent changes in human β3 adrenoceptor-dependent attenuation of detrusor contraction in terms of electromechanical versus pharmacomechanical coupling; they may help understand the differential responsiveness of OAB patients to β3 agents.
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Affiliation(s)
- Charlotte Petereit
- Oscar Langendorff Institute of Physiology, University of Rostock, Gertrudenstrasse 9, 18057, Rostock, Germany
| | - Katrin Porath
- Oscar Langendorff Institute of Physiology, University of Rostock, Gertrudenstrasse 9, 18057, Rostock, Germany
| | - Simone Rackow
- Oscar Langendorff Institute of Physiology, University of Rostock, Gertrudenstrasse 9, 18057, Rostock, Germany
| | - Karoline Kernig
- Department of Urology, University of Rostock, Rostock, Germany
| | | | - Rüdiger Köhling
- Oscar Langendorff Institute of Physiology, University of Rostock, Gertrudenstrasse 9, 18057, Rostock, Germany
- Center of Transdisciplinary Neurosciences Rostock (CTNR), University of Rostock, Rostock, Germany
| | - Timo Kirschstein
- Oscar Langendorff Institute of Physiology, University of Rostock, Gertrudenstrasse 9, 18057, Rostock, Germany.
- Center of Transdisciplinary Neurosciences Rostock (CTNR), University of Rostock, Rostock, Germany.
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Justo AFO, Suemoto CK. The modulation of neuroinflammation by inducible nitric oxide synthase. J Cell Commun Signal 2022; 16:155-158. [PMID: 35031946 DOI: 10.1007/s12079-021-00663-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Accepted: 12/07/2021] [Indexed: 10/19/2022] Open
Abstract
The accumulation and propagation of misfolded proteins in the brain is a pathological hallmark shared by many neurodegenerative diseases, such as the depositions of β-amyloid and hyperphosphorylated tau proteins in Alzheimer's disease. Initial evidence shows the role of nitric oxide synthases in the development of neurodegenerative diseases. A recent, in an exciting paper (Bourgognon et al. in Proc Natl Acad Sci USA 118, 1-11, 2021. 10.1073/pnas.2009579118) it was shown that the inducible nitric oxide synthase plays an important role in promoting oxidative and nitrergic stress leading to neuroinflammation and consequently neuronal function impairments and decline in synaptic strength in mouse prion disease. In this context, we reviewed the possible mechanisms of nitric oxide synthase in the generation of neurodegenerative diseases.
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Affiliation(s)
- Alberto Fernando Oliveira Justo
- Physiopathology in Aging Laboratory, Department of Internal Medicine, University of São Paulo Medical School, Avenida Doutor Arnaldo, 455, Pacaembu, São Paulo, Brazil.
| | - Claudia Kimie Suemoto
- Physiopathology in Aging Laboratory, Department of Internal Medicine, University of São Paulo Medical School, Avenida Doutor Arnaldo, 455, Pacaembu, São Paulo, Brazil.,Division of Geriatrics, Department of Internal Medicine, University of São Paulo Medical School, São Paulo, Brazil
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Afonso PPL, Afonso ML, Barbosa GR, Justo AFO. Hospitalization due to mental and behavioral disorders caused by use of alcohol and psychoactive substances among older adults and elderly people in Brazil: a cross-sectional study. SAO PAULO MED J 2022; 140:229-236. [PMID: 35293935 PMCID: PMC9610256 DOI: 10.1590/1516-3180.2021.0115.r1.22062021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Accepted: 06/22/2021] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND It has been estimated that 17% of individuals aged 50 years or older suffer from addiction to legal or illegal drugs. Use of alcohol and psychoactive substances has been correlated with several diseases, e.g. psychiatric conditions and cardiovascular and sexual dysfunctions. OBJECTIVE To discuss the Brazilian profile of mental and behavioral disorders caused by use of alcohol and psychoactive substances among older adults and elderly people, over the period from 2008 to 2019. DESIGN AND SETTING Cross-sectional study conducted among Brazilians aged 50 years or older. METHODS Hospitalization due to mental and behavioral disorders caused by use of alcohol and psychoactive substances was assessed through data obtained from the National Health System Department of Informatics (Departamento de Informática do Sistema Único de Saúde, DATASUS). RESULTS Decreasing and steady trends of hospitalization due to mental and behavioral disorders caused by use of alcohol among both men and women at all ages were observed. Similar trends were reported for all age ranges among men and women aged 60 years and older. In contrast, a slight increase was seen among women aged 50 to 59 years. CONCLUSION These data are crucial for qualifying mental healthcare for older adults and elderly people and for planning mental health services.
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Affiliation(s)
- Pedro Paulo Luciano Afonso
- MD. Resident of Psychiatry, Department of Psychiatry, Hospital Municipal do Campo Limpo, São Paulo (SP), Brazil.
| | - Mariana Luciano Afonso
- PhD. Psychologist, Assistant Professor, Department of Medicine, Universidade Cidade de São Paulo (UNICID), São Paulo (SP), Brazil
| | - Gabriela Rodrigues Barbosa
- MSc. Biomedical Scientist and Doctoral Student, Department of Medicine, Universidade Federal de São Paulo (UNIFESP), São Paulo (SP), Brazil.
| | - Alberto Fernando Oliveira Justo
- PhD. Biomedical Scientist and Associate Researcher, Department of Medicine, Universidade Federal de São Paulo (UNIFESP), São Paulo (SP), Brazil.
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Lau HH, Su TH, Huang WC. Effect of aging on lower urinary tract symptoms and urodynamic parameters in women. Taiwan J Obstet Gynecol 2021; 60:513-516. [PMID: 33966738 DOI: 10.1016/j.tjog.2021.03.022] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/06/2020] [Indexed: 10/21/2022] Open
Abstract
OBJECTIVE Lower urinary tract symptoms (LUTS) are common in women. However, due to multifactorial etiologies, it is difficult to determine the prevalence, and functional changes with age. The aim of this study is to assess the effect of age on female LUTS, urethral and bladder function after their midlife. MATERIALS AND METHODS This was an observational cohort study conducted at a tertiary referral medical center. Women who visited for bothersome LUTS, valid quality of life questionnaires, and urodynamic tests were recruited into the this study. Patients The patients were divided into four groups (<50, 50-59, 60-69, and >69 years). All LUTS, and urodynamic parameters were reviewed, and compared between groups. RESULTS A total of 364 women were enrolled and analyzed. The urodynamic tests showed the that maximal cystometric bladder capacity, the average and maximal urine flow rate, and pressure of detrusor contractility at maximal urine flow rate were all significantly decreased with age. Besides, the voiding time, and post-voiding residual urine volume significantly increased with age. For urethral competence, the maximal urethral closure pressure deteriorated with age. All storage symptoms did not change with age, except for nocturnal enuresis. However, the effect of age on some voiding symptoms significantly increased with age, including straining to void, hesitancy, and intermittency. CONCLUSIONS Lower urinary tract symptoms, bladder and urethral functions change with age, particularly voiding function. Physicians should be aware of the aging process when counseling and before implementing management strategies, particularly for older people.
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Affiliation(s)
- Hui-Hsuan Lau
- Department of Medicine, Mackay Medical College, New Taipei, 252, Taiwan; Division of Urogynecology, Department of Obstetrics and Gynecology, Mackay Memorial Hospital, Taipei, 104, Taiwan; Department of Nursing, Mackay Junior College of Medicine, Nursing, and Management, Taipei, Taiwan; Department of Obstetrics and Gynecology, Hsinchu Mackay Memorial Hospital, Hsinchu, Hsinchu, 300, Taiwan
| | - Tsung-Hsien Su
- Department of Medicine, Mackay Medical College, New Taipei, 252, Taiwan; Division of Urogynecology, Department of Obstetrics and Gynecology, Mackay Memorial Hospital, Taipei, 104, Taiwan; Department of Nursing, Mackay Junior College of Medicine, Nursing, and Management, Taipei, Taiwan; Department of Obstetrics and Gynecology, Hsinchu Mackay Memorial Hospital, Hsinchu, Hsinchu, 300, Taiwan
| | - Wen-Chu Huang
- Department of Medicine, Mackay Medical College, New Taipei, 252, Taiwan; Division of Urogynecology, Department of Obstetrics and Gynecology, Mackay Memorial Hospital, Taipei, 104, Taiwan; Department of Nursing, Mackay Junior College of Medicine, Nursing, and Management, Taipei, Taiwan.
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Jiang YH, Kuo HC. High percentage of neurologic deficits in the electrophysiology study of the lower urinary tract in patients with detrusor underactivity and chronic urinary retention. Neurourol Urodyn 2021; 40:883-890. [PMID: 33645850 DOI: 10.1002/nau.24644] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Revised: 01/21/2021] [Accepted: 02/09/2021] [Indexed: 11/08/2022]
Abstract
OBJECTIVES Both detrusor underactivity (DU) and bladder outlet obstruction are the common causes of chronic urinary retention. Some novel treatment approaches focus on modulating micturition reflex and external urethral sphincter (EUS) function. This study used electrophysiologic (EP) studies to investigate the micturition reflex and EUS conditions of chronic urinary retention patients. METHODS Sixty patients with urodynamic DU and chronic urinary retention were studied using (1) bulbocavernous reflex (BCR) by electric stimulation, (2) electromyography (EMG) of the EUS, and (3) nerve conduction velocity (NCV) studies of the pudendal nerve. The EP findings were analyzed in DU patients with different etiologies. RESULTS The BCR was positive in 41.7% of patients. In EMG studies, denervation, reinnervation, and reduced recruitment of the EUS were observed in 21.7%, 71.7%, and 88.3% patients, respectively. Decreased amplitude of pudendal nerve conduction in NCV studies was noted in 73.3% of patients. Patients with sacral neuropathy had a lower BCR positive rate (p = 0.001), a nonsignificant but higher denervation rate (p = 0.059) in EMG studies, and a higher rate of decreased amplitude in NCV (p = 0.011) than those without sacral neuropathy. Excluding patients with sacral neuropathy or diabetes mellitus, a high percentage of neurologic deficits was still detected in EP studies. CONCLUSIONS Chronic urinary retention patients with urodynamic DU not only have bladder dysfunction, but also potential neuropathy in the sacral reflexes, pudendal nerve, or urethral sphincter innervation. The neurologic deficits explored in EP studies may affect the decision-making around the therapy to restore the voiding function in DU.
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Affiliation(s)
- Yuan-Hong Jiang
- Department of Urology, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation and Tzu Chi University, Hualien, Taiwan
| | - Hann-Chorng Kuo
- Department of Urology, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation and Tzu Chi University, Hualien, Taiwan
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Vanneste M, Segal A, Voets T, Everaerts W. Transient receptor potential channels in sensory mechanisms of the lower urinary tract. Nat Rev Urol 2021; 18:139-159. [PMID: 33536636 DOI: 10.1038/s41585-021-00428-6] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/08/2021] [Indexed: 01/30/2023]
Abstract
Disruptions to sensory pathways in the lower urinary tract commonly occur and can give rise to lower urinary tract symptoms (LUTS). The unmet clinical need for treatment of LUTS has stimulated research into the molecular mechanisms that underlie neuronal control of the bladder and transient receptor potential (TRP) channels have emerged as key regulators of the sensory processes that regulate bladder function. TRP channels function as molecular sensors in urothelial cells and afferent nerve fibres and can be considered the origin of bladder sensations. TRP channels in the lower urinary tract contribute to the generation of normal and abnormal bladder sensations through a variety of mechanisms, and have demonstrated potential as targets for the treatment of LUTS in functional disorders of the lower urinary tract.
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Affiliation(s)
- Matthias Vanneste
- Laboratory of Ion Channel Research, VIB Center for Brain & Disease Research, Leuven, and Department of Cellular and Molecular Medicine, KU Leuven, Leuven, Belgium
| | - Andrei Segal
- Laboratory of Ion Channel Research, VIB Center for Brain & Disease Research, Leuven, and Department of Cellular and Molecular Medicine, KU Leuven, Leuven, Belgium
| | - Thomas Voets
- Laboratory of Ion Channel Research, VIB Center for Brain & Disease Research, Leuven, and Department of Cellular and Molecular Medicine, KU Leuven, Leuven, Belgium
| | - Wouter Everaerts
- Laboratory of Experimental Urology, Department of Development and Regeneration, KU Leuven, Leuven, Belgium.
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Britto-Júnior J, Fernandes Jacintho F, Campos R, Pinheiro DHA, Figueiredo Murari GM, de Souza VB, Schenka AA, Mónica FZ, Moreno RA, Antunes E, De Nucci G. The basal release of endothelium-derived catecholamines regulates the contractions of Chelonoidis carbonaria aorta caused by electrical-field stimulation. Biol Open 2021; 10:bio.057042. [PMID: 33277238 PMCID: PMC7847266 DOI: 10.1242/bio.057042] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
The contractions of Chelonoidis carbonaria aortic rings induced by electrical field stimulation (EFS) are not inhibited by blockade of the voltage-gated sodium channels by tetrodotoxin but almost abolished by the α1/α2-adrenoceptor antagonist phentolamine. The objective of this study was to identify the mediator(s) responsible for the EFS-induced contractions of Chelonoidis carbonaria aortic rings. Each ring was suspended between two wire hooks and mounted in isolated 10 ml organ chambers filled with oxygenated and heated Krebs-Henseleit's solution. Dopamine, noradrenaline and adrenaline concentrations were analysed by liquid chromatography coupled to tandem mass spectrometry. The contractions caused by dopamine and EFS were done in absence and presence of the nitric oxide (NO) synthesis inhibitor L-NAME, the NO-sensitive guanylyl cyclase inhibitor ODQ, the D1-like receptor antagonist SCH-23390, the D2-like receptor antagonists risperidone, quetiapine, haloperidol, and the tyrosine hydroxylase inhibitors salsolinol and 3-iodo-L-tyrosine. Basal concentrations of dopamine, noradrenaline and adrenaline were detected in Krebs-Henseleit solution containing the aortic rings. The catecholamine concentrations were significantly reduced in endothelium-denuded aortic rings. L-NAME and ODQ significantly potentiated the dopamine-induced contractions. The D2-like receptor antagonists inhibited the EFS-induced contractions of the aortic rings treated with L-NAME, whereas SCH 23390 had no effect. Similar results were observed in the contractions induced by dopamine in L-NAME treated aortic rings. These results indicate that catecholamines released by endothelium regulate the EFS-induced contractions. This may constitute a suitable mechanism by which reptilia modulate specific organ blood flow distribution. This paper has an associated First Person interview with the first author of the article. Summary:Chelonoidis carbonaria aortic rings release endothelium-derived catecholamines that modulate vascular smooth muscle reactivity.
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Affiliation(s)
- José Britto-Júnior
- Faculty of Medical Sciences, Department of Pharmacology, University of Campinas (UNICAMP), Campinas 13083-894, Brazil
| | - Felipe Fernandes Jacintho
- Faculty of Medical Sciences, Department of Pharmacology, University of Campinas (UNICAMP), Campinas 13083-894, Brazil
| | - Rafael Campos
- Department of Physiology, Superior Institute of Biomedical Sciences, Ceará State University (UECE), Fortaleza 60714-903, Brazil
| | - David Halen Araújo Pinheiro
- Faculty of Medical Sciences, Department of Pharmacology, University of Campinas (UNICAMP), Campinas 13083-894, Brazil
| | - Guilherme M Figueiredo Murari
- Faculty of Medical Sciences, Department of Pharmacology, University of Campinas (UNICAMP), Campinas 13083-894, Brazil
| | - Valéria B de Souza
- Faculty of Medical Sciences, Department of Pharmacology, University of Campinas (UNICAMP), Campinas 13083-894, Brazil
| | - André A Schenka
- Faculty of Medical Sciences, Department of Pharmacology, University of Campinas (UNICAMP), Campinas 13083-894, Brazil
| | - Fabíola Z Mónica
- Faculty of Medical Sciences, Department of Pharmacology, University of Campinas (UNICAMP), Campinas 13083-894, Brazil
| | - Ronilson Agnaldo Moreno
- Faculty of Medical Sciences, Department of Pharmacology, University of Campinas (UNICAMP), Campinas 13083-894, Brazil
| | - Edson Antunes
- Faculty of Medical Sciences, Department of Pharmacology, University of Campinas (UNICAMP), Campinas 13083-894, Brazil
| | - Gilberto De Nucci
- Faculty of Medical Sciences, Department of Pharmacology, University of Campinas (UNICAMP), Campinas 13083-894, Brazil.,Department of Pharmacology, Institute of Biomedical Sciences, University of São Paulo, São Paulo 05508-060, Brazil
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Wu Y, Qi J, Wu C, Rong W. Emerging roles of the TRPV4 channel in bladder physiology and dysfunction. J Physiol 2021; 599:39-47. [PMID: 33052604 DOI: 10.1113/jp279776] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Accepted: 10/06/2020] [Indexed: 12/17/2022] Open
Abstract
The transient receptor potential vanilloid type 4, TRPV4, is a polymodal cation channel which can be activated by diverse stimuli including mechanical, thermal and chemical cues. In the urinary bladder, TRPV4 is not only abundantly expressed in the urothelium but may also be localized in subepithelium, detrusor smooth muscles and afferent neurons. Emerging evidence indicates that the TRPV4 channel plays a sensory role in the uroepithelium, where it may regulate the release of sensory mediators such as ATP, which in turn modulates afferent nerve activity in response to bladder filling during the urination cycle. TRPV4 may also directly regulate detrusor contractility and the urothelial barrier function. Altered TRPV4 expression has been detected in various pathological bladder conditions. As such, TRPV4 may be a promising therapeutic target for bladder dysfunctions.
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Affiliation(s)
- Yanyuan Wu
- Department of Urology, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
- Department of Anatomy and Physiology, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Jun Qi
- Department of Urology, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Changhao Wu
- School of Biosciences and Medicine, University of Surrey, Guildford, UK
| | - Weifang Rong
- Department of Urology, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
- Department of Anatomy and Physiology, Shanghai Jiaotong University School of Medicine, Shanghai, China
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Nishikawa N, Chakrabarty B, Kitney D, Jabr R, Kanai A, Fry C. Stretch- and carbachol-induced ATP release from bladder wall preparations of young and aged mice. Neurourol Urodyn 2020; 39:1644-1652. [PMID: 32531080 DOI: 10.1002/nau.24426] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Revised: 05/28/2020] [Accepted: 05/31/2020] [Indexed: 12/19/2022]
Abstract
AIMS Bladder wall stretch increases tissue tension and releases adenosine 5'-triphosphate (ATP) as part of a transduction process to sense bladder filling. Aging is associated with bladder fibrosis to produce a stiffer bladder wall: this may augment ATP release and contribute to age-dependent urgency. Muscarinic agonists also release ATP and present a potential target for antimuscarinic agents, but its age-dependency is unknown. This study aimed, in young and old mice, to: (a) quantify the relationship between bladder wall stiffness and stretch-dependent ATP release and; (b) characterize muscarinic agonist-dependent release. METHODS ATP release from young (9-12 weeks) and aged (24 months) mouse bladder wall was measured in vitro, with a luciferin-luciferase assay, after stretch or carbachol exposure. Bladder wall stiffness, measured simultaneously during stretch, was compared to histological proportions of connective tissue and detrusor muscle. RESULTS With young mice, stretch-activated ATP release required an intact mucosa and was positively associated with wall stiffness. ATP release by carbachol was about four-fold greater compared to stretch. With aged mice: ATP release varied a hundred-fold and no association with stiffness; carbachol release diminished; connective tissue and mucosa thickness increased. CONCLUSIONS With young mice, stretch, or muscarinic agonists potently induce bladder wall ATP release. Stretch-dependent release is proportional to bladder wall stiffness, independent of the extent of stretch. With aged mice dependence of stretch-activated ATP release with stiffness was lost. The huge variability of release suggests that aged mice do not form a homogenous cohort and may underlie the heterogeneity in bladder filling sensations.
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Affiliation(s)
- Nobuyuki Nishikawa
- The School of Physiology, Pharmacology & Neuroscience, University of Bristol, Bristol, UK.,School of Biosciences and Medicine, University of Surrey, Guildford, UK
| | - Basu Chakrabarty
- The School of Physiology, Pharmacology & Neuroscience, University of Bristol, Bristol, UK
| | - Darryl Kitney
- The School of Physiology, Pharmacology & Neuroscience, University of Bristol, Bristol, UK.,School of Biosciences and Medicine, University of Surrey, Guildford, UK
| | - Rita Jabr
- School of Biosciences and Medicine, University of Surrey, Guildford, UK
| | - Anthony Kanai
- School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Christopher Fry
- The School of Physiology, Pharmacology & Neuroscience, University of Bristol, Bristol, UK
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Osman NI, Pang KH, Martens F, Atunes-Lopes T, Geavlete B, Husch T, Tutolo M, Rahnama’i MS, Marcelissen T. Detrusor Underactivity and Underactive Bladder in Women: What Is New? CURRENT BLADDER DYSFUNCTION REPORTS 2019. [DOI: 10.1007/s11884-019-00531-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Abstract
Purpose of Review
Detrusor underactivity (DU) and its symptom-based correlation, the underactive bladder (UAB), are common problems encountered in urological practice. Whilst DU has been defined for many years, only recently has UAB received a formal definition and there is now accumulating literature based on this condition. In this article, we reviewed the recent literature on the aetiology, pathogenesis, diagnosis and management of DU/UAB in women.
Recent Findings
Detrusor underactivity is diagnosed on urodynamic studies but there still remains a lack of widely recognised and accepted diagnostic criteria. Commencing treatment based on the diagnosis of UAB, with or without a PVR measurement, is perhaps feasible due to the lower occurrence of BOO in women and specific clinical features that may distinguish this group. Prospective studies attempting to correlate UAB with the underlying DU are needed before this approach could be considered.
Summary
Detrusor underactivity/UAB in women requires a separate consideration from men due to the anatomical and functional differences in the lower urinary tracts between both genders and consequent differences in pathologies affecting them. The aetiology of DU remains largely unknown, but is probably multifactorial, including myogenic, neurogenic and vasculogenic factors. There remains a lack of any simple effective drug treatments, whilst apart from sacral neuromodulation for the specific subgroup with non-obstructive urinary retention, no safe and effective surgical treatment is currently available. Often, permanent or intermittent bladder drainage with a catheter is the final solution.
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