Urodynamic evaluation and electrical and pharmacologic neurostimulation. The rat model

Contribution of pudendal nerve injury to stress urinary incontinence in a male rat model

Urinary incontinence is a common complication following radical prostatectomy, as the surgery disturbs critical anatomical structures. This study explored how pudendal nerve (PN) injury affects urinary continence in male rats. In an acute study, leak point pressure (LPP) and external urethral sphincter electromyography (EMG) were performed on six male rats with an intact urethra, the urethra exposed (UE), the PN exposed (NE), and after PN transection (PNT). In a chronic study, LPP and EMG were tested in 67 rats 4 days, 3 weeks, or 6 weeks after sham PN injury, PN crush (PNC), or PNT. Urethras were assessed histologically. Acute PNT caused a significant decrease in LPP and EMG amplitude and firing rate compared to other groups. PNC resulted in a significant reduction in LPP and EMG firing rate 4 days, 3 weeks, and 6 weeks later. EMG amplitude was also significantly reduced 4 days and 6 weeks after PNC. Neuromuscular junctions were less organized and less innervated after PNC or PNT at all timepoints compared to sham injured animals. Collagen infiltration was significantly increased after PNC and PNT compared to sham at all timepoints. This rat model could facilitate preclinical testing of neuroregenerative therapies for post-prostatectomy incontinence.

Locomotor Exercise Enhances Supraspinal Control of Lower-Urinary-Tract Activity to Improve Micturition Function after Contusive Spinal-Cord Injury

The recovery of lower-urinary-tract activity is a top priority for patients with spinal-cord injury. Historically, locomotor training improved micturition function in both patients with spinal cord injury and animal models. We explore whether training augments such as the supraspinal control of the external urethral sphincter results in enhanced coordination in detrusor-sphincter activity. We implemented a clinically relevant contusive spinal-cord injury at the 12th thoracic level in rats and administered forced wheel running exercise for 11 weeks. Awake rats then underwent bladder cystometrogram and sphincter electromyography recordings to examine the micturition reflex. Subsequently, pseudorabies-virus-encoding red fluorescent protein was injected into the sphincter to trans-synaptically trace the supraspinal innervation of Onuf's motoneurons. Training in the injury group reduced the occurrence of bladder nonvoiding contractions, decreased the voiding threshold and peak intravesical pressure, and shortened the latency of sphincter bursting during voiding, leading to enhanced voiding efficiency. Histological analysis demonstrated that the training increased the extent of spared spinal-cord tissue around the epicenter of lesions. Compared to the group of injury without exercise, training elicited denser 5-hydroxytryptamine-positive axon terminals in the vicinity of Onuf's motoneurons in the cord; more pseudorabies virus-labeled or c-fos expressing neurons were detected in the brainstem, suggesting the enhanced supraspinal control of sphincter activity. Thus, locomotor training promotes tissue sparing and axon innervation of spinal motoneurons to improve voiding function following contusive spinal-cord injury.

Fadolmidine - Favourable adverse effects profile for spinal analgesia suggested by in vitro and in vivo models

Fadolmidine is an α₂-adrenoceptor full agonist developed for spinal analgesia with a local mode of action. The purpose of this study was to demonstrate the safety of fadolmidine on known α₂-adrenoceptor-related effects: kidney function, urodynamics and cardiovascular variables. Furthermore, the binding affinity of fadolmidine for the 5-HT₃ receptor prompted functional studies on 5-HT₃. According to the binding affinity data, fadolmidine demonstrated partial agonism on the 5-HT₃ receptor in transfected cells and in guinea pig ileum preparation. However, intravenous (IV) fadolmidine did not produce any 5-HT₃-related hemodynamic effects in anaesthetised rats. In urodynamic studies, intrathecal (IT) fadolmidine interrupted volume-evoked voiding cycles and induced overflow incontinence at high concentrations in anaesthetised rats; however, at the analgesic dose range, the effects were mild. The effects of fadolmidine on kidney function were studied in conscious rats after IV and IT dosing. While IT fadolmidine increased dose-dependent urine output, sodium ion concentration, IV doses increased only sodium ion concentration The effects of IT fadolmidine on heart rate (HR), mean arterial pressure (MAP) and sedation were evaluated in the home cage and in the open field using a telemetry system. In resting conditions, fadolmidine decreased HR dose-dependently and increased initial MAP, whereas in actively moving rats, there were no effects at analgesic doses. The results suggest that at anticipated analgesic clinical doses, IT fadolmidine provides analgesia without significant adverse effects on sedation, MAP or HR and with only modest effects on kidney function and urodynamics.

Urethral dysfunction due to alloxan-induced diabetes. Urodynamic evaluation and action of sildenafil citrate

PURPOSE

To evaluate the effect of diabetes mellitus and of sildenafil citrate on female urethral function.

METHODS

Twenty nine female rats were divided into four groups: G1 - (n=9), normal rats; G2 - (n=6), normal rats treated with sildenafil citrate; G3 - (n=9) rats with alloxan-induced diabetes; G4 - (n=5) rats with alloxan-induced diabetes treated with sildenafil citrate. Under anesthesia, urodynamic evaluation was performed by cystometry and urethral pressure simultaneously.

RESULTS

A significant increase in urethral pressure was observed during micturition.

CONCLUSION

Sildenafil citrate can partially reduced urethral pressure in diabetic female rats.

Long-term recording of external urethral sphincter EMG activity in unanesthetized, unrestrained rats

The external urethral sphincter muscle (EUS) plays an important role in urinary function and often contributes to urinary dysfunction. EUS study would benefit from methodology for longitudinal recording of electromyographic activity (EMG) in unanesthetized animals, but this muscle is a poor substrate for chronic intramuscular electrodes, and thus the required methodology has not been available. We describe a method for long-term recording of EUS EMG by implantation of fine wires adjacent to the EUS that are secured to the pubic bone. Wires pass subcutaneously to a skull-mounted plug and connect to the recording apparatus by a flexible cable attached to a commutator. A force transducer-mounted cup under a metabolic cage collected urine, allowing recording of EUS EMG and voided urine weight without anesthesia or restraint. Implant durability permitted EUS EMG recording during repeated (up to 3 times weekly) 24-h sessions for more than 8 wk. EMG and voiding properties were stable over weeks 2-8. The degree of EUS phasic activity (bursting) during voiding was highly variable, with an average of 25% of voids not exhibiting bursting. Electrode implantation adjacent to the EUS yielded stable EMG recordings over extended periods and eliminated the confounding effects of anesthesia, physical restraint, and the potential for dislodgment of the chronically implanted intramuscular electrodes. These results show that micturition in unanesthetized, unrestrained rats is usually, but not always, associated with EUS bursting. This methodology is applicable to studying EUS behavior during progression of gradually evolving disease and injury models and in response to therapeutic interventions.

External urethral sphincter motor unit recruitment patterns during micturition in the spinally intact and transected adult rat

In the rat, external urethral sphincter (EUS) activation during micturition consists of three sequential phases: 1) an increase in tonic EUS activity during passive filling and active contraction of the bladder (guarding reflex), 2) synchronized phasic activity (EUS bursting) associated with voiding, and 3) sustained tonic EUS activity that persists after bladder contraction. These phases are perturbed following spinal cord injury. The purpose of the present study was to characterize individual EUS motor unit (MU) patterns during micturition in the spinally intact and transected adult rat. EUS MU activity was recorded from either the L5 or L6 ventral root (intact) or EUS muscle (transected) during continuous flow cystometry in urethane-anesthetized adult female Sprague-Dawley rats. With the use of bladder pressure threshold and timing of activation, four distinct patterns of EUS MU activity were identified in the intact rat: low threshold sustained, medium/high threshold sustained, medium/high threshold not sustained, and burst only. In general, these MUs displayed little frequency modulation during active contraction, generated high-frequency bursts of action potentials during EUS bursting, and varied in terms of the duration of sustained tonic activity. In contrast, three general patterns of EUS MU activity were identified in the transected rat: low threshold, medium threshold, and high threshold. These MUs exhibited considerable frequency modulation during active contraction of the bladder, no bursting behavior and little to no sustained firing. The prominent frequency modulation of EUS MUs is likely due to the enhanced guarding reflex seen in EUS whole muscle electromyogram recordings in transected rats (D'Amico SC, Schuster IP, Collins WF 3rd. Exp Neurol 228: 59–68, 2011). In addition, EUS MU recruitment in transected rats more closely followed predictions by the size principle than in intact rats. This may reflect the influence of local synaptic circuits or intrinsic properties of EUS motoneurons that are active in intact rats but attenuated or absent in transected rats.

Continuous uroflow cystometry in the urethane-anesthetized mouse

PURPOSE

In vivo animal cystometry represents an accepted methodology for the study of lower urinary tract physiology. A particular advantage of the mouse model is the availability of genetically modified strains, offering the possibility of linking individual genes to relevant physiological events. However, small voided volumes complicate the ability to obtain reliable pressure-flow data by gravimetric methods, due to non-continuous drop formation and release during voiding. We investigated the feasibility of a simple non-gravimetric continuous urine collection system during cystometry under urethane anesthesia, and compared urethane-anesthetized with awake cystometry.

METHODS

Cystometry was performed in awake and urethane-anesthetized female mice using a suprapubic tube. A simple, novel non-gravimetric method of urine collection was used in urethane-anesthetized animals to assess voided volume and permit flow rate calculations. Pressure and time-related variables were compared between groups.

RESULTS

Voided urine collection appears to be complete and continuous in this model. Mean voided volume was 0.09 ± 0.020 ml, with an average flow rate of 0.029 ± 0.007 ml/sec. Urethane anesthesia delayed cystometric pressure/volume responses. However, micturition reflexes were intact and otherwise comparable between groups. Female mice void with pulsatile pressurization previously described in rats.

CONCLUSION

Suprapubic voiding cystometry using a simple and reliable urine collection method under urethane anesthesia is feasible in mice, permitting the integration of voided volumes with pressure and time data. The inclusion of volume and flow data enhances the usefulness of the mouse model for in vivo assessment of detrusor and potentially sphincteric performance.

Comparison of the effects of complete and incomplete spinal cord injury on lower urinary tract function as evaluated in unanesthetized rats

In rats, phasic external urethral sphincter (EUS) activity (bursting) is postulated to be crucial for efficient voiding. This has been reported to be lost after spinal cord transection (txSCI), contributing to impaired function. However, anesthesia may confound evaluating EUS activity. We therefore evaluated urodynamic parameters in unanesthetized, restrained rats and compared the effects of txSCI to that of a clinically relevant, incomplete, contusive injury (iSCI) on lower urinary tract function. Adult female rats were subjected to txSCI or standardized iSCI at the T8 vertebral level. As expected, all injured rats were initially unable to void but developed a reflex bladder with time, with iSCI rats recovering more rapidly than txSCI rats. LUT function was evaluated urodynamically at 2 and 6 weeks after injury. In response to infusion of saline into the bladder, controls consistently exhibited coordinated contraction of the bladder and activation of the EUS in a phasic pattern and had a high voiding efficiency (86.4+/-2.5%). Voiding efficiency of iSCI rats was reduced to approximately 57% and txSCI rats to approximately 32%. However, two different patterns of EUS activity during voiding were present in both txSCI and iSCI groups at both time points: (1) rats with phasic EUS activity, similar to controls and (2) those that only exhibited tonic EUS activity during voiding. The former had more normal voiding efficiencies. Thus, phasic EUS activity and the improved voiding efficiency associated with it can occur and can be detected in unanesthetized rats after both incomplete and complete SCI.

Functional reinnervation of the rat lower urinary tract after cauda equina injury and repair

Conus medullaris and/or cauda equina forms of spinal cord injury commonly result in a permanent loss of bladder function. Here, we developed a cauda equina injury and repair rodent model to investigate whether surgical implantation of avulsed lumbosacral ventral roots into the spinal cord can promote functional recovery of the lower urinary tract. Adult female rats underwent sham surgery (n = 6), bilateral L5-S2 ventral root avulsion (VRA) injury (n = 5), or bilateral L5-S2 VRA followed by an acute implantation of the avulsed L6 and S1 ventral roots into the conus medullaris (n = 6). At 12 weeks after operation, the avulsed group demonstrated urinary retention, absence of bladder contractions and external urethral sphincter (EUS) electromyographic (EMG) activation during urodynamic recordings, increased bladder size, and retrograde death of autonomic and motoneurons in the spinal cord. In contrast, the implanted group showed reduced urinary retention, return of reflexive bladder voiding contractions coincident with EUS EMG activation, anatomical reinnervation of the EUS demonstrated by retrograde neuronal labeling, normalization of bladder size, and a significant neuroprotection of both autonomic and motoneurons. In addition, a positive correlation between motoneuronal survival and voiding efficiency was observed in the implanted group. Our results show that implantation of avulsed lumbosacral ventral roots into the spinal cord promotes reinnervation of the urinary tract and return of functional micturition reflexes, suggesting that this surgical repair strategy may also be of clinical interest after conus medullaris and cauda equina injuries.

Effect of injury severity on lower urinary tract function after experimental spinal cord injury

Lower urinary tract dysfunction is a serious burden for patients following spinal cord injury. Patients are usually limited to treatment with urinary drainage catheters, which can lead to repeated urinary tract infections and lower quality of life. Most of the information previously obtained regarding lower urinary tract function after spinal cord injury has been in completely transected animals. After thoracic transection in the rat, plasticity of local lumbosacral spinal circuitry establishes a "reflex bladder," which results in partial recovery of micturition, albeit with reduced voiding efficiency. Since at least half of cord-injured patients exhibit neurologically incomplete injury, rat models of clinically relevant incomplete contusion injury have been developed. With respect to lower urinary tract function, recent anatomical and physiological studies have been performed after incomplete thoracic contusion injury. The results show greater recovery of lower urinary tract function that varies inversely with the severity of the initial trauma and is positively correlated with time after injury. Recovery, as measured by coordination of the bladder with the external urethral sphincter, occurs between 1 and 4 weeks after spinal cord injury. It is associated with normalization of: serotonin immunoreactivity and glutamate receptor subunit mRNA expression in the dorsolateral nucleus that innervates the external urethral sphincter muscle, the response to glutamatergic pharmacological probes administered at the lumbosacral spinal cord level, and c-Fos activation patterns in the lumbar spinal cord. Understanding the mechanisms involved in this recovery will provide a basis for enhancing lower urinary tract function in patients after incomplete spinal cord injury.

Abdominal muscle activity during voiding in female rats with normal or irritated bladder

The aims of the present study were to determine in female rats whether abdominal muscle discharges during normal voiding and to describe the effect of bladder irritation on this visceromotor activity. The sensory pathway of this reflex was also determined. Electromyograms (EMGs) indicated that in awake rats, the abdominal muscle was consistently activated during spontaneous voiding and during voiding induced by saline infusion. Similarly, in anesthetized animals, the muscle discharged during urine expulsion. The abdominal EMG activity was not abolished by hypogastric (Hgnx) or sensory pudendal neurectomy (SPdnx). SPdnx dramatically decreased the intercontraction interval and voided volume. Acetic acid infusion reduced the intercontraction interval and increased bladder contraction duration. It also reduced the pressure threshold for evoking the abdominal EMG response and increased the EMG duration and amplitude. Although SPdnx and Hgnx modified some urodynamic parameters, they did not reverse the acetic acid effect on EMG activity. Thus the afferents activating the visceromotor reflex during normal voiding and the increased reflex in response to acetic acid are probably both carried by the pelvic nerve. Abdominal muscle activity induced by bladder distension has been considered to be a pain marker. However, we conclude that in female rats, the abdominal muscle is reflexively activated during physiological urine expulsion. On the other hand, bladder irritation is marked by an exaggeration of this abdominal visceromotor reflex.

Is the rhesus monkey (Macaca mulatta) comparable to humans? Histomorphology of the sphincteric musculature of the lower urinary tract including 3D-reconstruction

The physiology of the muscle systems of the human lower urinary tract is still not known in detail. To study the functional basics of this complex organ system, experiments are often performed in animal models including rhesus monkeys. To apply the results of animal model studies to the humans, a clear knowledge of the comparative anatomy of both species is necessary. However, detailed comparative studies of the lower urinary tract of the rhesus monkey and the humans are lacking. Accordingly, a detailed study on the sphincteric musculature of the lower urinary tract of the rhesus monkey was performed in order to demonstrate anatomical correspondences and differences between both species. The lower urinary tract anatomy was investigated in 18 male and female rhesus monkeys (Macaca mulatta) by serial sections. Immunohistochemical staining methods were used to differentiate striated and smooth musculature. Three-dimensional reconstructions were performed in order to demonstrate the topographical anatomy of the different muscle systems. In both man and male rhesus monkeys, a urethral sphincter muscle exists independent of the pelvic floor musculature, with a smooth and a striated muscular part. A urinary diaphragm (diaphragma urogenitale) does neither exist in the rhesus monkey nor in the human. In contrast to women, a striated muscle encircles the urethra and vagina together in the female rhesus monkey. A vesical sphincter muscle, found in the human bladder outlet, does not exist in the rhesus monkey.

Transmitters contributing to the voiding contraction in female rats

OBJECTIVES

To assess in detail the contribution of acetylcholine and ATP to the different phases of the voiding contraction, urine flow and rhabdosphincter electromyographic (RB-EMG) activity in rats, using alpha,beta-methylene-ATP (desensitizing purinoceptors) and atropine (blocking muscarinic receptors). These agents and possibly other transmitters contribute to bladder emptying in rats, but how they contribute to the different phases of the micturition cycle, including the intraluminal pressure high-frequency oscillations (IPHFOs) is unclear.

MATERIALS AND METHODS

Adult anaesthetized female Sprague-Dawley rats were used; intravesical pressure, RB-EMG and urine flow from the distal urethra were recorded. After baseline recordings, alpha,beta-methylene-ATP (0.5 mg/kg), atropine (1 mg/kg), or both, were injected intravenously.

RESULTS

Alpha,beta-Methylene-ATP significantly decreased the maximum bladder pressure during the first micturition phase, whereas atropine had little effect; the maximum bladder pressure during the second phase was also reduced. IPHFOs were apparent after both treatments. Atropine significantly reduced the maximum bladder pressure during the third phase. The maximum urinary flow rate was reduced by both alpha,beta-methylene-ATP and atropine; after exposure to both agents together, urinary flow was markedly reduced or stopped, and overflow incontinence developed.

CONCLUSIONS

ATP contributes mainly to the initial and acetylcholine to the later phases of the voiding cycle in the rat. Neither agent abolished the IPHFOs; even after blocking the receptors for one transmitter and in the presence of IPHFOs, the bladder can still empty. However, if both receptors are blocked, overflow incontinence develops, suggesting that even if further transmitters are taking part in the voiding contraction, their physiological significance is questionable.

Afferent bladder nerve activity in the rat: a mechanism for starting and stopping voiding contractions

The objective of this work was to study the relation between afferent bladder nerve activity and bladder mechanics and the mechanisms that initiate and terminate bladder contractions. Bladder nerve activity, pressure and volume were recorded during the micturition cycle in the rat. The highest correlation was found between afferent nerve activity and stress (pressure x volume). Afferent nerve activity depended linearly on stress within 6%, and both slope and offset were independent of the bladder-filling rate. The levels of afferent bladder nerve activity at the onset and cessation of efferent firing to the bladder were highly reproducible with coefficients of variation of <or=17%. We propose a model in which afferent activity is proportional to bladder wall stress, and bladder contraction is initiated when afferent activity exceeds a threshold due to an increasing pressure and volume. The contraction continues until afferent activity drops below a threshold again as a result of a decreasing volume.

The role of the rhabdosphincter in female rat voiding

OBJECTIVES

To obtain information on the mechanisms of female rat micturition using a model in which pressure was measured in the bladder and distal part of the urethra corresponding to the location of the rhabdosphincter, providing information on the role of the sphincter in opening and closing the urethral lumen.

MATERIALS AND METHODS

A micturition reflex was induced in adult anaesthetized (chloral hydrate and urethane) female rats by filling the bladder with saline. Bladder pressure (BP), urethral pressure (UP), electromyography (EMG) of the middle part of the rhabdosphincter, and urinary flow rate in the distal urethra were simultaneously recorded.

RESULTS

There were four phases of the micturition contraction, the second characterized by intraluminal pressure high-frequency oscillations (IPHFOs) of BP. When a non-oscillatory micturition contraction started, the BP increased and exceeded UP for the rest of the micturition contraction. Even though the BP increased during this first phase, the urethral lumen stayed closed. Its opening was indicated by a simultaneous decrease in BP and increase of UP as the fluid flowed from the bladder to the urethra. When the rhabdosphincter closed, as indicated by an EMG-burst of the muscle, the UP declined, bladder pressure increased and the flow ceased. Because of momentary contractions of the rhabdosphincter, the UP and urine flow rate had the same periodicity as the IPHFOs of BP.

CONCLUSIONS

The simultaneous recording of the BP, UP, EMG of the rhabdosphincter and urinary flow rate showed the sequence of events during micturition. The rhabdosphincter acts as an 'on-off' switch, causing interruptions in the urinary flow rate.

Mapping of spinal cord circuits controlling the bladder and external urethral sphincter functions in the rabbit

AIMS

A primary purpose of this study was to evaluate the rabbit as a model for studying the spinal circuitry controlling the bladder emptying. We aimed to map the locations of the neuronal circuitry controlling the external urethral sphincter (EUS) and the detrusor by stimulating at different spinal cord locations with a microelectrode, while recording the responses from these muscles.

METHODS

Spinal cord microstimulation was performed in the intermediate zone of the gray matter at the L7-S4 spinal cord levels in eight rabbits with empty and full bladders. Bladder activity was measured as intravesical pressure (IVP) changes and EUS activity was measured via electromyographic (EMG) electrodes positioned within the urethra.

RESULTS

Under both bladder conditions, EUS activation was produced from similar locations in the spinal cord comprising a continuous area in the intermediate zone of the S2-S3 spinal cord. This region extended 25 mm in the rostrocaudal dimension, at least 1 mm lateral to the midline, and 0.5-1 mm in the dorsoventral dimension at a depth of 2-3 mm beneath the dorsal surface. No locations in the intermediate zone produced EUS inhibition. The S2-S3 spinal region, stimulation of which produced the strongest EUS activation, also produced modest bladder contractions.

CONCLUSIONS

Overall, the results indicate that spinal cord networks controlling bladder and EUS activation in the rabbit are overlapping and clustered into columns extending rostrocaudally. The lack of spinal locations producing EUS inhibition and large bladder contractions make the rabbit an unattractive model for studies of neuroprosthetic spinal control of micturition.

Different responses to drugs against overactive bladder in detrusor muscle of pig, guinea pig and mouse

Direct comparison of experimental data for drugs commonly used in the treatment of overactive bladder is difficult because of possible species differences. In this study, we compare the effects of atropine, propiverine, oxybutynin and tolterodine in strips of pig, guinea pig and mouse detrusor muscle. In the three species, we observed slight differences in potency of carbachol-induced biphasic contractile responses between the species (guinea pig>pig>mouse). Cumulative concentration-response curves for carbachol were shifted to the right by atropine, propiverine, oxybutynin and tolterodine. However, at higher concentrations of the latter three antagonists, the maximum response to carbachol was also reduced. Therefore, propiverine, oxybutynin and tolterodine must have additional pharmacological actions beyond competitive antagonism at muscarinic receptors. Electric field stimulation (30 Hz) of detrusor strips led to contraction amplitudes, which remained constant over time (210 min) in pig, decreased by 17+/-5% in guinea pig, and increased by 28+/-9% in mouse detrusor muscle. Electric field stimulation-evoked contractions were suppressed to 18% of pre-drug control by high concentrations of atropine (10 microM) in pig, but to a much lesser extent in guinea pig and mouse (to 46% and 70%, respectively). In all three species, a myogenic component of contraction was observed in the presence of tetrodotoxin (1 microM). Compared to atropine, the bladder spasmolytic agents propiverine, oxybutynin and tolterodine also reduced electrically evoked contractions in the three species, though higher concentrations were required. The differences in the reported effects of the spasmolytic agents commonly used for treating overactive bladder suggest that drug action is strongly dependent on the species. Thus, a comparison of drug effects is only feasible in the same animal model and the results cannot easily be transferred to humans.

Altered glutamate receptor function during recovery of bladder detrusor-external urethral sphincter coordination in a rat model of spinal cord injury

Coordination of the bladder detrusor and the external urethral sphincter is a supraspinally controlled reflex that is essential for efficient micturition. This coordination is permanently lost after spinal cord transection but can recover chronically after incomplete spinal cord injury (SCI). As glutamatergic transmission plays a key role in all levels of detrusor-external urethral sphincter coordination, we examined the role of potential alterations in glutamatergic control in its recovery after SCI. Rats were subjected to standardized incomplete contusion injury. Detrusor-external urethral sphincter coordination was evaluated urodynamically at 5 days (subacute) and 8 weeks (chronic) after SCI. Sensitivity of coordinated activation of the external urethral sphincter in response to bladder distension to the alpha -amino-3-hydroxy-5-methyl-4-isoxazoleproprionic acid/kainate antagonist 1,2,3,4-tetrahydro-6-nitro-2,3-dioxo-benzo(f)quinoxaline-7-sulfonamide disodium (NBQX) and to the N-methyl-D-aspartate (NMDA) antagonist R(--3-(2-carboxypiperazine-4-yl)-propyl-1-phosphonic acid (CPP) was determined by intrathecal application at the L6 spinal cord level during urodynamic recordings. We found that while detrusor contractions recovered at 5 days after SCI, coordinated activation of the external urethral sphincter was significantly impaired at 5 days and recovered only by 8 weeks. There was no difference in sensitivity of detrusor-external urethral sphincter coordination to NBQX at the subacute or chronic time points. However, external urethral sphincter response to bladder distension was sensitive to a 50% lower dose of CPP at 5 days compared with uninjured rats or chronic recovered SCI rats. Thus, alterations in NMDA receptor function appeared to be involved in recovery of detrusor-external urethral sphincter coordination after incomplete SCI.

Possible action of the proximal rhabdosphincter muscle in micturition of the adult male rat

Micturition requires high bladder pressure and simultaneous opening of the urethra. In adult male rat, a rhabdosphincter (RB) is known to be electrically active when the bladder pressure is high. This indicates a closure rather than an opening of the urethra, which is inconsistent with the requirements of optimal urodynamics. In order to solve this problem, we simultaneously recorded electromyogram (EMG) of the proximal RB, bladder pressure, and flow rate. Micturition was evoked by an increased volume of saline in the bladder. A computer-based recording device was used with minimal filtering. The EMG was recorded with a monopolar flexible suction electrode. The suction electrode records action potentials resembling those obtained with a microelectrode technique. During the early high-frequency intraluminal pressure oscillation period (IPHFO), the increase of pressure initially associated with a decrease of potential of the RB. When the first flow peak appeared, the relationship of the bladder pressure and RB single EMG activities changed. The increasing pressure coincided with the positive potential wave (depolarisation). It was interrupted by a transient negative polarity period called transient repolarisation (TRP) coinciding with a flow rate peak, thus indicating an opening of the RB lumen. After the TRP, the depolarisation continued. Additional experiments employing different methods are needed for positive identification of the TRP mechanism.

Coordination of the bladder detrusor and the external urethral sphincter in a rat model of spinal cord injury: effect of injury severity

Recovery of urinary tract function after spinal cord injury (SCI) is important in its own right and may also serve as a model for studying mechanisms of functional recovery after injury in the CNS. Normal micturition requires coordinated activation of smooth muscle of the bladder (detrusor) and striated muscle of the external urethral sphincter (EUS) that is controlled by spinal and supraspinal circuitry. We used a clinically relevant rat model of thoracic spinal cord contusion injury to examine the effect of varying the degree of residual supraspinal connections on chronic detrusor-EUS coordination. Urodynamic evaluation at 8 weeks after SCI showed that detrusor contractions of the bladder recovered similarly in groups of rats injured with a 10 gm weight dropped 12.5, 25, or 50 mm onto the spinal cord. In contrast, the degree of coordinated activation of the EUS varied with the severity of initial injury and the degree of preservation of white matter at the injury site. The 12.5 mm SCI resulted in the sparing of 20% of the white matter at the injury site and complete recovery of detrusor-EUS coordination. In more severely injured rats, the chronic recovery of detrusor-EUS coordination was very incomplete and correlated to decreased innervation of lower motoneurons by descending control pathways and their increased levels of mRNA for glutamate receptor subunits NR2A and GluR2. These results show that the extent of recovery of detrusor-EUS coordination depends on injury severity and the degree of residual connections with brainstem control centers.

Effect of anesthetics on reflex micturition in the chronic cannula-implanted rat

It is well known that urethane is a suitable anesthetic for acute studies and has been extensively recommended for investigations related to micturition physiology. This is mainly because of the capability of urethane anesthesia to spare reflex micturition as well as its easily established long-lasting and stable anesthetic level. However, urethane anesthesia is usually restricted to acute experiments due to its potential toxicity. This study searched for an alternative to urethane that would be suitable for studies in which recovery from anesthesia was needed. The list of administered drugs was as follows: pentobarbital, thiobutabarbital, ketamine-acepromazine, ketamine-diazepam, tiletamine-zolazepam, fentanyl-droperidol, alphaxalone-alphadolone, propofol, isoflurane, methoxyflurane, azaperone, tribromoethanol, and buprenorphine. Among these drugs, only tiletamine-zolazepam spared the reflex micturition contractions. However, the duration of this anesthesia was too short (approximately 30 minutes) to complete the necessary testing and additional dosing of the anesthetic generally obliterated the micturition reflex. On the other hand, rats given i.v. urethane infusion (10% solution in 0.9% saline, 3.2-4.0 mg/kg/min, total dose 0.56-1.03 g/kg) maintained a stable anesthesia that permitted both reflex micturition and stereotaxic procedures. Rats moved spontaneously 3-16 hours after cessation of i.v. urethane anesthesia and completely recovered in 2 days without significant after-effects. Bladder function was normal. No pathological changes were seen 1 week later. The present results suggest that urethane is the most suitable anesthetic for acute and chronic physiological experiments that require demonstration of reflex micturition. Neurourol. Urodynam. 19:87-99, 2000.

Pudendal nerve stimulation induces urethral contraction and relaxation

In this study we measured urethral pressure changes in response to efferent pudendal nerve stimulation in rats. All other neural pathways to the urethra were transected, and the urethra was continuously perfused. We found fast twitch-like contractions, superimposed on a slow relaxation. The amplitude of the twitches was independent of the stimulation frequency below 26 Hz, whereas the relaxation depended highly on this frequency. The twitches were caused by striated urethral muscles, and the relaxation was caused by smooth muscles. Both were mediated by acetylcholine. We calculated the effective urethral relaxation as the absolute relaxation multiplied by the time fraction between the twitches. Maximum effective relaxation occurred at 8-10 Hz, exactly the frequency of spontaneous oscillations during bladder voiding in rats. Although the oscillatory sphincter contractions in rats during voiding may be needed in other mechanisms for efficient voiding, our data suggest that they may be a side effect of the actual purpose: urethral relaxation.

Threshold for efferent bladder nerve firing in the rat

In this study, the mechanism involved in the initiation of voiding was investigated. Bladder pressure and bladder and urethral nerve activity were recorded in the anesthetized rat. Bladder nerve activity was resolved into afferent and efferent activity by means of a theoretical model. The beginning of an active bladder contraction was defined as the onset of bladder efferent firing at a certain time (t0). From t0 onward, bladder efferent activity increased linearly during deltat seconds (rise time) to a maximum. The pressure at t0 was 1.0 +/- 0.4 kPa, the afferent nerve activity at t0 was 2.0 +/- 0.6 microV (53 +/- 15% of maximum total nerve activity), and deltat was 11 +/- 13 s. Between contractions the afferent activity at t0 was never exceeded. Urethral afferent nerve activity started at bladder pressures of 2.1 +/- 1.1 kPa. Therefore, we concluded that urethral afferent nerve activity does not play a role in the initiation of bladder contractions; voiding contractions presumably are initiated by bladder afferent nerve activity exceeding a certain threshold.

Urinary bladder response to hypogastric nerve stimulation after bilateral resection of the pelvic nerve or spinal cord injury in rats

BACKGROUND

We examined the mechanism of urinary bladder motility return after bladder areflexia induced by interruption of the sacral parasympathetic outflow to the urinary bladder following damage to the sacral cord or pelvic nerves in the rat.

METHODS

The L6 and S1 nerve bundles were resected near the vertebrae, and bilateral pelvic nerve resections (PNR) performed. Spinal cord injury (SCI) was performed by means of a legion generator at the T12 vertebra. Thirty days after PNR and SCI, cystometrograms were recorded under anesthesia.

RESULTS

In all rats subjected to PNR or SCI, overflow incontinence continued, yet some rats subjected to SCI recovered within 2 weeks after the operation. Cystometrograms showed that repetitive bladder contractions appeared in rats subjected to SCI irrespective of hypogastric nerve (HGN) innervation, while bladder contractions did not appear in rats subjected to PNR. Electrical stimulation of the HGN induced higher bladder pressure elevation in rats who underwent PNR than in rats subjected to SCI.

CONCLUSIONS

These results suggest that the generation of repetitive bladder contractions induced by bladder distention after bladder areflexia requires the presence of intact pelvic nerves that transmit sacral cord-originating excitatory information to the bladder. However, the HGN system and functioning pelvic nerve ganglia are not involved in this process. Also, the connection from the preganglionic HGN to the postganglionic parasympathetic nerves in the pelvic plexus did not form after PNR.