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Garbas K, Zapała Ł, Ślusarczyk A, Piecha T, Gwara P, Żuk-Łapan A, Piekarczyk H, Zapała P, Radziszewski P. (A)voiding misdiagnosis: prediction of detrusor underactivity vs. bladder outlet obstruction using pre-urodynamic nomogram in male patients with LUTS. Int Urol Nephrol 2024:10.1007/s11255-024-04093-7. [PMID: 38819576 DOI: 10.1007/s11255-024-04093-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2024] [Accepted: 05/23/2024] [Indexed: 06/01/2024]
Abstract
PURPOSE Our study aimed to develop a noninvasive model using a combination of the set of clinical data and uroflowmetry (UFL) to differentiate between detrusor underactivity (DU) and bladder outlet obstruction (BOO) in non-neurogenic male patients with lower urinary tract symptoms (LUTS). METHODS Data from 229 men with LUTS, diagnosed with DU or BOO on a pressure-flow study (PFS), were retrospectively analyzed, including medical history, Core Lower Urinary Tract Symptoms score (CLSS) questionnaire, UFL and PFS. Uni- and multivariate logistic regression were utilized for the prediction analyses. RESULTS Of the cohort, 128 (55.9%) patients were diagnosed with DU. A multivariate logistic regression analysis identified less prevalent nocturia (OR 0.27, p < 0.002), more prevalent intermittency (OR 2.33, p = 0.03), less prevalent weak stream (OR 0.14, p = 0.0004), lower straining points in CLSS (OR 0.67, p = 0.02), higher slow stream points in CLSS (OR 1.81, p = 0.002), higher incomplete emptying points in CLSS (OR 1.31, p < 0.02), lower PVR ratio (OR 0.20, p = 0.03), and present features of fluctuating (OR 2.00, p = 0.05), fluctuating-intermittent (OR 3.09, p < 0.006), and intermittent (OR 8.11, p = 0.076) UFL curve shapes as independent predictors of DU. The above prediction model demonstrated satisfactory accuracy (c-index of 0.783). CONCLUSION Our 10-factor model provides a noninvasive approach to differentiate DU from BOO in male patients with non-neurogenic LUTS, offering a valuable alternative to invasive PFS.
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Affiliation(s)
- Karolina Garbas
- Department of General, Oncological and Functional Urology, Medical University of Warsaw, Lindleya 4, 02-005, Warsaw, Poland.
| | - Łukasz Zapała
- Department of General, Oncological and Functional Urology, Medical University of Warsaw, Lindleya 4, 02-005, Warsaw, Poland
- Urodynamic Lab of Private Hospital "Prostalith", Kielce, Poland
| | - Aleksander Ślusarczyk
- Department of General, Oncological and Functional Urology, Medical University of Warsaw, Lindleya 4, 02-005, Warsaw, Poland
| | - Tomasz Piecha
- Department of General, Oncological and Functional Urology, Medical University of Warsaw, Lindleya 4, 02-005, Warsaw, Poland
| | - Piotr Gwara
- Department of General, Oncological and Functional Urology, Medical University of Warsaw, Lindleya 4, 02-005, Warsaw, Poland
| | - Aleksandra Żuk-Łapan
- Department of General, Oncological and Functional Urology, Medical University of Warsaw, Lindleya 4, 02-005, Warsaw, Poland
| | - Hanna Piekarczyk
- Department of General, Oncological and Functional Urology, Medical University of Warsaw, Lindleya 4, 02-005, Warsaw, Poland
| | - Piotr Zapała
- Department of General, Oncological and Functional Urology, Medical University of Warsaw, Lindleya 4, 02-005, Warsaw, Poland
| | - Piotr Radziszewski
- Department of General, Oncological and Functional Urology, Medical University of Warsaw, Lindleya 4, 02-005, Warsaw, Poland
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Chen KC, Chang ML, Lin CS, Rajneesh CP, Liao CH, You WC, Maa HC, Wu YN. Insight into SLC9A3 deficiency-mediated micturition dysfunction caused by electrolyte imbalance. Biomed Pharmacother 2023; 158:114155. [PMID: 36916397 DOI: 10.1016/j.biopha.2022.114155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Revised: 12/14/2022] [Accepted: 12/21/2022] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Solute carrier family nine isoform 3 (SLC9A3) is an Na+/H+ exchanger that regulates Ca2+ homeostasis. SLC9A3 is largely involved in the transepithelial absorption of Na+/H+ and frequently functions in pair with a Cl-/HCO3- exchanger. OBJECTIVE To investigate the impact and pathophysiological mechanisms of long-term SLC9A3 deficiency on lower urinary tract symptoms (LUTS) in a mouse model MATERIALS AND METHODS: Slc9a3 knockout and wild-type mice (average >6 months) were used. The effects of SLC9A3 depletion on bladder and urethral functions and effectiveness of voiding were assessed using a cystometrogram (CMG). Histology, blood electrolytes, and gene expression were also analyzed. RESULTS The SLC9A3-deficient mice had smaller gross bladders than the wild-type mice. The CMG analysis revealed normal peak micturition pressure, higher threshold pressure, short intercontraction interval, less voided volume, and poor compliance in the SLC9A3-deficient mice, similar to clinical LUTS. Histological analysis revealed loose detrusor muscle and loss of transformability of the urothelium in the SLC9A3-deficient mice. Masson's trichrome analysis revealed severe collagen deposition in the detrusor muscle. Immunofluorescence staining also demonstrated a significant decrease in cytokeratins 5 and 20. Gene and protein expression analyses confirmed that SLC9A3 does not act directly on bladder tissue. Homeostasis was correlated with bladder dysfunction in the SLC9A3-deficient mice. DISCUSSION Fibrosis and collagen deposition in the bladder of the SLC9A3-deficient mice is due to bladder inflammation because of decreased blood flow and deregulated systemic homeostasis. Long-term SLC9A3 depletion causes progressive bladder dysfunction, similar to human LUTS. CONCLUSION Electrolyte imbalance causes SLC9A3 deficiency-mediated progressive micturition dysfunction.
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Affiliation(s)
- Kuo-Chiang Chen
- School of Medicine, College of Medicine, Fu Jen Catholic University, New Taipei City 242062, Taiwan; Department of Urology, Cathay General Hospital, Taipei City 106438, Taiwan
| | - Meng-Lin Chang
- School of Medicine, College of Medicine, Fu Jen Catholic University, New Taipei City 242062, Taiwan; Department of Urology, Fu Jen Catholic University Hospital, Fu Jen Catholic University, New Taipei City 243089, Taiwan
| | - Chun-Sian Lin
- Graduate Institute of Biomedical and Pharmaceutical Science, College of Medicine, Fu Jen Catholic University, New Taipei City 242062, Taiwan
| | | | - Chun-Hou Liao
- School of Medicine, College of Medicine, Fu Jen Catholic University, New Taipei City 242062, Taiwan; Division of Urology, Department of Surgery, Cardinal Tien Hospital, New Taipei City 231403, Taiwan
| | - Wen-Chen You
- School of Medicine, College of Medicine, Fu Jen Catholic University, New Taipei City 242062, Taiwan
| | - Hung-Chune Maa
- School of Medicine, College of Medicine, Fu Jen Catholic University, New Taipei City 242062, Taiwan; Department of Pathology, Cardinal Tien Hospital, New Taipei City 231403, Taiwan.
| | - Yi-No Wu
- School of Medicine, College of Medicine, Fu Jen Catholic University, New Taipei City 242062, Taiwan.
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Fisette-Paulhus I, Gagnon C, Girard-Côté L, Morin M. Genitourinary and lower gastrointestinal conditions in patients with myotonic dystrophy type 1: A systematic review of evidence and implications for clinical practice. Neuromuscul Disord 2022; 32:361-376. [DOI: 10.1016/j.nmd.2022.01.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Revised: 01/13/2022] [Accepted: 01/18/2022] [Indexed: 12/19/2022]
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Santos-Pereira M, Charrua A. Understanding underactive bladder: a review of the contemporary literature. Porto Biomed J 2020; 5:e070. [PMID: 32734011 PMCID: PMC7386537 DOI: 10.1097/j.pbj.0000000000000070] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Accepted: 04/08/2020] [Indexed: 12/15/2022] Open
Abstract
Underactive bladder (UAB) is characterized by prolonged voiding, hesitancy, and slow and/or intermittent stream with or without a sensation of incomplete bladder emptying. The overlap of UAB lower urinary tract symptoms with those of overactive bladder or bladder outlet obstruction, as well as its multifactorial etiology, make UAB study, as well as its diagnosis and management, a very arduous and challenging task. Therefore, despite its incidence and significant impact in the quality of life of both men and women, UAB remains a poorly understood urologic condition with insufficient and ineffective treatment options available. In this review, we will focus on the etiology theories that have been proposed and the animal models available to test those theories.
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Affiliation(s)
- Mariana Santos-Pereira
- Unidade de Biologia Experimental, Departamento de Biomedicina, Faculdade de Medicina da Universidade do Porto, Porto, Portugal
| | - Ana Charrua
- Unidade de Biologia Experimental, Departamento de Biomedicina, Faculdade de Medicina da Universidade do Porto, Porto, Portugal
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