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Artykov M, Ozcelebi E, Sara MY, Gudeloglu A, Iskit AB, Aki FT. In vitro effects of β3-adrenoceptor agonist mirabegron on the human ureter. Neurourol Urodyn 2024. [PMID: 38660954 DOI: 10.1002/nau.25483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2024] [Revised: 04/02/2024] [Accepted: 04/15/2024] [Indexed: 04/26/2024]
Abstract
INTRODUCTION This study aimed to investigate the effect of mirabegron, a β3-adrenoceptor agonist with widespread clinical use for treating overactive bladder disease, on isolated healthy human ureter strips. MATERIALS AND METHODS This was a prospective study employing a series of in vitro organ bath experiments using ureteral tissues of kidney grafts from 10 healthy donors. The ureteral strips were subjected to cumulative mirabegron concentrations (10-9-10-4.5 M). Effects on frequency or amplitude of spontaneous, 10 mM KCl- or EFS-induced contractions were evaluated. RESULTS Mirabegron decreased the frequency of spontaneous ureteric contraction in a concentration-dependent manner. Statistically significant decrease in the frequency of spontaneous contraction was observed at 10-8-10-4.5 M. In 10 mM KCl medium, statistically significant change in frequency was observed at 10-9-10-4.5 M. Statistically significant decrease in the amplitudes of spontaneous contraction was observed at 10-7-10-4.5 M. In a 10 mM KCl medium, statistically significant change in amplitudes was observed at 10-8-10-4.5 M. CONCLUSIONS Mirabegron reduced the amplitude and frequency of human ureter activity in in vitro organ bath studies. This effect was achieved in a dose-dependent manner on isolated tissue strips. Although monotherapy with mirabegron remains uncertain, this study has the potential to elucidate the mechanism underlying the effectiveness of mirabegron, particularly in combination therapy for ureteral stones.
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Affiliation(s)
- Meylis Artykov
- Department of Urology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Esin Ozcelebi
- Department of Pharmacology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Mehmet Yildirim Sara
- Department of Pharmacology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Ahmet Gudeloglu
- Department of Urology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Alper Bektas Iskit
- Department of Pharmacology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Fazil Tuncay Aki
- Department of Urology, Hacettepe University Faculty of Medicine, Ankara, Turkey
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Samir M, Awad AF, Maged WA. Does mirabegron have a potential role as a medical expulsive therapy in the treatment of distal ureteral stones? A prospective randomized controlled study. Urologia 2024; 91:136-140. [PMID: 37776033 DOI: 10.1177/03915603231204081] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/01/2023]
Abstract
BACKGROUND The existence of β3 receptors in the bladder and ureter was documented in many studies on animals and humans, it was documented that relaxation of the lower ureteral segment is achieved by the stimulation of these receptors. Our aim was to assess the efficacy and safety of mirabegron as a medical expulsive therapy (MET) for distal ureteral stones in comparison with silodosin and placebo. METHODS One hundred eighty patients with distal ureteral stone of 5-10 mm size were included in our study. They were divided into three groups, and each one consisted of 60 patients. Group I was given silodosin 8 mg, group II mirabegron 50 mg and group III placebo once daily. The treatment was prescribed for all the cases till stone expulsion or a maximum duration of 4 weeks. Primary outcome was the stone expulsion rate (SER). While secondary outcomes were stone expulsion time, side effects of the used drugs, hospital visits number for pain, and amount of analgesic taken. RESULTS We found that the SER was significantly higher in silodosin than mirabegron and placebo groups (61%, 38.6%, and 36.7%, respectively) (p = 0.013). Also, the stone expulsion interval was significantly shorter in silodosin than mirabegron and control groups (p < 0.001). While hospital visits number for pain, and amount of analgesic taken were comparable. There was no difference between the studied medications in terms of the adverse effects except for retrograde ejaculation (silodosin = 63.3%, mirabegron = 0%, and placebo = 0%; p < 0.001). CONCLUSION Mirabegron has no medical expulsive effect. While silodosin improves SER and stone expulsion time. However, retrograde ejaculation was its main side effect and occurred in 63.3% of the male patients. Therefore, more research is needed to discover a more tolerable MET.
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Hennenberg M, Michel MC. Adrenoceptors in the Lower Urinary Tract. Handb Exp Pharmacol 2023. [PMID: 37455288 DOI: 10.1007/164_2023_678] [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: 07/18/2023]
Abstract
Adrenoceptors importantly contribute to the physiological regulation of lower urinary tract (LUT) function and have become a target of several clinically successful treatments for major LUT diseases. In the bladder dome, β-adrenoceptor subtypes are found in multiple cell types and mediate relaxation of detrusor smooth muscle, perhaps partly indirectly by acting on afferent nerves and cells of the mucosa. β3-adrenoceptor agonists such as mirabegron and vibegron are used to treat overactive bladder syndrome. In the bladder trigone and urethra, α1-adrenoceptors cause contraction and thereby physiologically contribute to bladder outlet resistance. α1-adrenoceptors in the prostate also cause contraction and pathophysiologically elevate bladder outlet resistance leading to voiding dysfunction in benign prostatic hyperplasia. α1-adrenoceptor antagonist such as tamsulosin is widely used as a first-line option to treat LUT symptoms in men, but it remains unclear to which extent and how smooth muscle relaxation contributes to symptom relief.
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Affiliation(s)
- Martin Hennenberg
- Department of Urology, University Hospital, LMU Munich, Munich, Germany
| | - Martin C Michel
- Department of Pharmacology, University Medical Center, Johannes Gutenberg University, Mainz, Germany.
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Li Z, Cui Y, Chai Y, Zhang Y. The efficacy and safety of mirabegron in treating ureteral stent-related symptoms: A systematic review and meta-analysis. Low Urin Tract Symptoms 2021; 14:27-34. [PMID: 34363321 DOI: 10.1111/luts.12405] [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: 06/18/2021] [Revised: 07/08/2021] [Accepted: 07/18/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVES This meta-analysis aimed to assess the efficacy and safety of mirabegron in treating ureteral stent-related symptoms. METHODS MEDLINE, EMBASE, and the Cochrane Controlled Trials Register were searched to identify randomized controlled trials (RCT) of mirabegron in treating ureteral stent-related symptoms. We conducted a systematic review and meta-analysis based on the eligible RCT. RESULTS Five RCT including 546 patients and comparing mirabegron with placebo or blank control were involved in the present research. Regarding efficacy, mirabegron was superior to controls in urinary symptom score (P = .0006) and general health score (P < .0001) of the Ureteral Stent Symptom Questionnaire, total International Prostate Symptom Score (P < .00001), quality of life (P < .0001), analgesic use (P = .008), and readmission or visit to hospital due to discomfort (P = .001). Safety assessments including adverse events (P = .40) suggested that mirabegron was well tolerated. CONCLUSIONS The present meta-analysis shows that mirabegron is an effective and safe treatment for relieving ureteral stent-related symptoms with a low occurrence of adverse events.
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Affiliation(s)
- Zhouyue Li
- Department of Urology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Yuanshan Cui
- Department of Urology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,Department of Urology, Yantai Yuhuangding Hospital Affiliated to Medical College of Qingdao University, Yantai, China
| | - Yumeng Chai
- Department of Urology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Yong Zhang
- Department of Urology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
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Lim I, Sellers DJ, Chess-Williams R. Current and emerging pharmacological targets for medical expulsive therapy. Basic Clin Pharmacol Toxicol 2021; 130 Suppl 1:16-22. [PMID: 33991399 DOI: 10.1111/bcpt.13613] [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: 02/26/2021] [Revised: 05/04/2021] [Accepted: 05/08/2021] [Indexed: 11/28/2022]
Abstract
The primary goals of medical expulsive therapy are to increase the rate of stone expulsion along the ureter to avoid ureteral obstruction and reduce ureteral colic and thus avoid the need for surgical and more invasive interventions. This review focussed on the findings from in vivo and in vitro animal and human studies that have investigated the pharmacological mechanisms controlling ureteral motility and their translation to current and potentially new clinically used drugs for increasing the rate of stone expulsion along the ureter. The complicated contractility profile of the ureter, which alters with age, tissue segment region, orientation and species contributes to the difficulty of interpreting studies on ureteral pharmacology, which translates to the complexity of discovering ideal drug targets for medical expulsive therapy. Nevertheless, the current drug classes clinically used for patients with stone lodgement include α1 -adrenoceptor antagonists, calcium channel blockers and NSAIDS, whilst there are promising targets for drug development that require further clinical investigations including the phosphodiesterase type 5 enzyme, β-adrenoceptors and 5-HT receptors.
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Affiliation(s)
- Iris Lim
- Centre for Urology Research, Faculty of Health Science & Medicine, Bond University, Gold Coast, QLD, Australia
| | - Donna J Sellers
- Centre for Urology Research, Faculty of Health Science & Medicine, Bond University, Gold Coast, QLD, Australia
| | - Russ Chess-Williams
- Centre for Urology Research, Faculty of Health Science & Medicine, Bond University, Gold Coast, QLD, Australia
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Solakhan M, Bayrak O, Bulut E. Efficacy of mirabegron in medical expulsive therapy. Urolithiasis 2018; 47:303-307. [PMID: 30078089 DOI: 10.1007/s00240-018-1075-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2018] [Accepted: 08/01/2018] [Indexed: 12/29/2022]
Abstract
To show the efficacy of mirabegron for medical expulsive treatment, in patients had intramural located distal ureteral stone. A 80 patients had intramural ureteral stone were assessed retrospectively between April 2017 and January 2018. Mirabegron 50 mg/day + diclofenac 100 mg/day (group 1, n = 40), and only diclofenac 100 mg/day (group 2, n = 40) were administered to patients, consecutively. Age, gender, stone size, laterality, and severity of hydronephrosis were recorded. Spontaneous stone expulsion rates (SER), stone expulsion time, and the number of daily colic episodes were evaluated. In the group 1, one (2.5%) patient was excluded due to nasopharyngitis, and one (2.5%) patient was excluded due to 5 mmHg systolic blood pressure increase. In addition, four (10%) patients in group 1, and six (15%) patients in group 2, who did not attend follow-up examinations, were excluded from the study. There was not any statistically significant difference between the two groups in terms of age, gender, stone location, severity of hydronephrosis, stone size (p = 0.736, p = 0.310, p = 0.467, p = 0.801, p = 0.761, consecutively). Spontaneous expulsion ratios were calculated as 73.52% in group 1, and 47.05% in group 2 (p = 0.026). However, there was not any statistically significant difference in terms of stone expulsion time (p = 0.979). SER for patients had ≤ 6 mm stones was higher in group 1 (87.5 vs 52.49%, p = 0.031). In addition, group 2 patients had more pain episodes (1.02 ± 0.52 vs. 1.29 ± 0.57, p = 0.049). In the current study, mirabegron has been shown to be an efficient, safe and a new treatment modality, with lower side effect profile for the intramural located distal ureteral stones.
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Affiliation(s)
- Mehmet Solakhan
- Department of Urology, Bahcesehir University School of Medicine, Istanbul, Turkey.
| | - Omer Bayrak
- Department of Urology, Gaziantep University School of Medicine, Gaziantep, Turkey
| | - Ersan Bulut
- Department of Urology, Bulent Ecevit University School of Medicine, Zonguldak, Turkey
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Pressure matters 2: intrarenal pressure ranges during upper-tract endourological procedures. World J Urol 2018; 37:133-142. [PMID: 29915944 DOI: 10.1007/s00345-018-2379-3] [Citation(s) in RCA: 65] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2018] [Accepted: 06/12/2018] [Indexed: 01/24/2023] Open
Abstract
PURPOSE To perform a review on the latest evidence related to intrarenal pressures (IRPs) generated during upper-tract endourology, and present different tools to maintain decreased values, to decrease complication rates. METHODS A literature search was performed using PubMed, restricted to original English-written articles, including animal, artificial model and human studies. Different keywords were: percutaneous nephrolithotomy, PCNL, ureteroscopy, URS, RIRS, irrigation flow, irrigation pressure, intrarenal pressure, intrapelvic pressure and renal-pelvic pressure. RESULTS IRPs reported during retrograde intrarenal surgery (RIRS), PCNL, miniPCNL, and microPCNL range 40.8-199.35, 3-40.8, 10-45 and 15.37-41.21 cm H2O, respectively. By utilizing ureteral access sheaths (UASs) IRPs usually remain lower than 30 cm H2O at an irrigation pressure (IP) of ≤ 100 cm H2O but could increase to > 40 cm H2O at an IP of 200 cm H2O. By utilizing the minimally invasive PCNL system, IRPs remain low at 20 cm H2O even at high IPs. Utilizing endoluminal isoproterenol during RIRS, could reduce IRP increases with a rate of 27-107%, and maintain low IRPs values, usually below 50 cm H2O. CONCLUSIONS Increased IRP values have been reported during RIRS and UASs constitute the most efficient tool for decreasing them. IRPs during mini-PCNL can be decreased utilizing the vacuum-cleaner and purging effects but might remain uncontrolled during micro- and ultra-mini PCNL. Intraluminal pharmacological treatment could play a role in IRP decrease, with isoproterenol being the most studied agent.
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Osther PJS. Risks of flexible ureterorenoscopy: pathophysiology and prevention. Urolithiasis 2017; 46:59-67. [PMID: 29151117 DOI: 10.1007/s00240-017-1018-6] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2017] [Accepted: 11/11/2017] [Indexed: 11/26/2022]
Abstract
Currently, indications for flexible ureterorenoscopy (fURS) are expanding, mainly due to technological advancements. Although data from clinical series definitely presents fURS as a safe procedure, serious complications including sepsis and ureteral lesions do occur. These complications seem to be a result of the unique elements of fURS, ureteral access and irrigation, pushing normal upper urinary tract physiology into pathophysiological processes, including intrarenal/pyelo-veneous backflow and ureteral contractions, potentially resulting in septic, haemorrhagic and ureteral lesional complications. Knowledge on normal upper urinary tract physiology are crucial for understanding how these harmful effects of fURS may be avoided or minimized. The pathophysiology of intrarenal pressure increases and ureteral access will be discussed as a basis for understanding preventive measures. Role of antibiotics, ureteral access sheaths, safty guidewires, pain medication, prestenting and pharmacologic modulation of pyeloureteral dynamics are reviewed from a pathophysiological perspective.
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Affiliation(s)
- Palle J S Osther
- Urological Research Center, Department of Urology, Lillebaelt Hospital, Beridderbakken 4, 7100, Vejle, Denmark.
- Department of Regional Health Research, Faculty of Health Sciences, University of Southern Denmark, Vejle, Denmark.
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Xu YF, Liang ZJ, Kuang ZJ, Chen JJ, Wu J, Lu XE, Jiang WW, Fan PL, Tang LY, Li YT, Huang P, Cao HY. Effect of Suo Quan Wan on the bladder function of aging rats based on the β-adrenoceptor. Exp Ther Med 2017; 13:3424-3432. [PMID: 28587421 PMCID: PMC5450672 DOI: 10.3892/etm.2017.4394] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2015] [Accepted: 02/07/2017] [Indexed: 01/01/2023] Open
Abstract
Suo Quan Wan (SQW) has been used to treat lower urinary tract symptoms (LUTS) in elderly patients for hundreds of years in China. β-adrenoceptors (β-ARs), particularly β3-adrenoceptor (β3-AR), was reported to be important in the bladder dysfunction of the elderly. The present study was conducted to explore the effect of β-AR, and particularly the β3-adrenoceptor, in aging rat bladder function in vitro and to test the therapeutic effect of SQW on LUTS in an aging rat model based on the β3-adrenoceptor. Briefly, the bladder detrusor muscles of young (age, 3 months) and aging (age, 15 months) female rats were separated. A β-AR non-selective agonist, isoprenaline (ISO), subtype β3-AR agonist (BRL37344A) and β3-AR antagonist (SR59230A) were used to define the tension change of detrusor muscles between young and aging rats in vitro. For blank controls, 12 young rats were marked, and 48 aging female rats were randomly divided into four groups as follows: Model, SQW high, SQW middle and SQW low. Following oral administration of SQW for 6 weeks in aging rats, urodynamic and bladder detrusor tests were used to evaluate the therapeutic effect of SQW. The expression of β3-AR mRNA was investigated using reverse transcription-quantitative polymerase chain reaction. Using ISO and BRL37344A in vitro, maximum relaxation (Emax), intrinsic activity (IA), and log (50% effective concentration) (PD2) were significantly decreased in aging rats compared with that in young rats (P<0.05). Significant changes were also observed in the β3-AR antagonist experiment, which blocked ISO-induced relaxation, with significant decreases observed in Emax, IA and PD2, and a significant increase observed in PA2 for the aging rats compared with the young controls (P<0.05). SQW was demonstrated to enhance bladder control, storage and contraction ability. Furthermore, SQW was able to increase the sensitivity and expression of β3-AR in an aging rat. In conclusion, the decrease in β3-AR sensitivity in aging rats and the expression resulted in bladder detrusor dysfunction. In addition, the therapeutic effect of SQW against LUTS relies on the former's effect on the urethral sphincter, bladder detrusor and β3-AR.
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Affiliation(s)
- Yi-Fei Xu
- Department of Chinese Medicine Pharmacology, School of Chinese Materia Medica, Guangzhou University of Chinese Medicine, Guangzhou, Guangdong 510006, P.R. China
| | - Zhi-Jian Liang
- Department of Chinese Medicine Pharmacology, School of Chinese Materia Medica, Guangzhou University of Chinese Medicine, Guangzhou, Guangdong 510006, P.R. China
| | - Zhao-Jin Kuang
- Department of Chinese Medicine Pharmacology, School of Chinese Materia Medica, Guangzhou University of Chinese Medicine, Guangzhou, Guangdong 510006, P.R. China
| | - Jie-Jun Chen
- Center for Drug Non-Clinical Evaluation and Research, Guangzhou General Pharmaceutical Research Institute, Guangzhou, Guangdong 510240, P.R. China
| | - Jun Wu
- Department of Chinese Medicine, School of Chinese Medicine, Shandong College of Traditional Chinese Medicine, Yantai, Shandong 264199, P.R. China
| | - Xiang-E Lu
- Department of Traditional Chinese Medicine, Institute of Traditional Chinese Medicine, Guangdong Pharmaceutical University, Guangzhou, Guangdong 510006, P.R. China
| | - Wei-Wen Jiang
- Department of Chinese Medicine Pharmacology, School of Chinese Materia Medica, Guangzhou University of Chinese Medicine, Guangzhou, Guangdong 510006, P.R. China
| | - Ping-Long Fan
- Department of Chinese Medicine Pharmacology, School of Chinese Materia Medica, Guangzhou University of Chinese Medicine, Guangzhou, Guangdong 510006, P.R. China
| | - Li-Yao Tang
- Department of Chinese Medicine Pharmacology, School of Chinese Materia Medica, Guangzhou University of Chinese Medicine, Guangzhou, Guangdong 510006, P.R. China
| | - Yi-Tao Li
- Department of Chinese Medicine Pharmacology, School of Chinese Materia Medica, Guangzhou University of Chinese Medicine, Guangzhou, Guangdong 510006, P.R. China
| | - Ping Huang
- Department of Chinese Medicine Pharmacology, School of Chinese Materia Medica, Guangzhou University of Chinese Medicine, Guangzhou, Guangdong 510006, P.R. China
| | - Hong-Ying Cao
- Department of Chinese Medicine Pharmacology, School of Chinese Materia Medica, Guangzhou University of Chinese Medicine, Guangzhou, Guangdong 510006, P.R. China
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Abstract
PURPOSE OF REVIEW Indications for ureterorenoscopy are expanding without hard scientific evidence to support its efficacy. Therefore, it is extremely important to focus on potential harmful effects of the procedure itself. This review explores how physiology of the upper urinary tract reacts to ureterorenoscopy, potentially translating into harmful effects, and how such pathophysiological processes may be minimized. RECENT FINDINGS Complications to ureterorenoscopy and postoperative pain seem to be related to intrarenal pressure and/or access. Mean intrarenal pressures in the range of 60-100 mmHg during ureterorenoscopy without access sheaths have been measured, thus by far exceeding the threshold for intrarenal backflow, potentially resulting in septic complications. Intrarenal pressure may be reduced by use of ureteral access sheaths, which, however, may cause ureteral damage due to the limited size of the ureter and strain-induced ureteral contractions (peristalsis). Different receptor types modulate this peristaltic activity. β-receptor agonists have been investigated in animal and human trials for the purpose of relaxing the ureter. In randomized, placebo-controlled trials in pigs and humans, usage of the β-receptor agonist isoproterenol in the irrigation fluid has shown a potential for reducing both intrarenal pressure and ureteral tone during ureterorenoscopy. SUMMARY Upper urinary tract physiology has unique features that may be pushed into pathophysiological processes by the unique elements of ureterorenoscopy: access and irrigation. Pharmacological ureteral relaxation during ureterorenoscopy deserves further attention with regard to reducing complications and postoperative pain.
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Shao Y, Wei H, Sha M, Sun F, Lu J, Xia S. Verapamil Inhibits the Pelvic Pressure Increase Corresponding to Flow Perfusion in the Porcine Percutaneous Renal Puncture Model. Urol Int 2016; 97:429-433. [PMID: 27115398 DOI: 10.1159/000443967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2015] [Accepted: 12/28/2015] [Indexed: 11/19/2022]
Abstract
PURPOSE To estimate the effects of verapamil on pelvic pressure and investigate the possible systemic side effects in the porcine model during the procedure of increasing perfusion rates. MATERIALS AND METHODS In the experimental group, the pelvic pressure was recorded with increasing perfusion rates of the renal pelvis (0, 2, 4, 6, 8, 10, 14 and 20 ml/min) in response to intraluminal administration of increasing concentrations of verapamil (0, 0.1, 1, 10 and 100 µg/ml) in isotonic saline. In the isotonic saline group, the pressure flow study was also done by increasing perfusion rates of the renal pelvis per animal using isotonic saline without verapamil. RESULTS Perfusion with 1, 10 and 100 µg/ml verapamil caused a decrease in pelvic pressure as a response to increasing flow rates, whereas perfusion with 0.1 µg/ml verapamil did not obviously inhibit the increase of pelvic pressure at all perfusion rates compared with other concentrations. Importantly, the mean systolic blood pressure and mean heart rate were stable despite the increase of flow rates and verapamil concentrations. In the isotonic saline group, perfusion with isotonic saline resulted in an increase in the pelvic pressure with an increase in flow rates each time. CONCLUSIONS Endoluminal administration of verapamil reduces pelvic pressure significantly without any untoward systemic cardiovascular side effects.
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Affiliation(s)
- Yi Shao
- Department of Urology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, PR China
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12
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Abstract
Background Irrigation and instrumentation during ureterorenoscopic procedures may cause increased pressure in the renal pelvis (PP) with potential harmful adverse effects. In order to assess the pressure increases during ureterorenoscopy, we measured the intraluminal renal pelvic pressure during retrograde intrarenal stone surgery (RIRS). Methods Twelve patients admitted for RIRS were included. Irrigation rate was standardized to 8 ml/min. A ureteral catheter was retrogradely placed in the renal pelvis for PP measurements. PP was measured one time per second during insertion of the Storz Flex-X2 ureteroscope and during stone treatment. Results Baseline PP was mean 10(±4.0) mmHg. During simple ureterorenoscopy, PP was mean 35(±10) mmHg. During stone management the average PP was 54(±18) mmHg and pelvic pressure peaks up to 328 mmHg occurred. In a 5-min standardized period of simple ureterorenoscopy, 83 pressure peaks >50 mmHg were measured in average per patient (range 2–238). Forced irrigation with a 20 ml syringe resulted in pressure peaks up to 288 mmHg. Conclusion Very high pelvic pressures are obtained during flexible ureterorenoscopy. Taking into consideration that the threshold for pyelovenous backflow is around 30 mmHg, it is concerning that PPs >300 mmHg are not uncommon during these procedures. Methods to monitor and lower the PP during ureterorenoscopy, therefore, are considered of importance.
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Affiliation(s)
- Helene Jung
- Department of Urology, Urological Research Center, Lillebaelt Hospital, University of Southern Denmark, Fredericia, Denmark
| | - Palle J S Osther
- Department of Urology, Urological Research Center, Lillebaelt Hospital, University of Southern Denmark, Fredericia, Denmark
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Rat β3-adrenoceptor protein expression: antibody validation and distribution in rat gastrointestinal and urogenital tissues. Naunyn Schmiedebergs Arch Pharmacol 2014; 387:1117-27. [DOI: 10.1007/s00210-014-1039-4] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2014] [Accepted: 08/18/2014] [Indexed: 12/31/2022]
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Abstract
Urine differs greatly in ion and solute composition from plasma and contains harmful and noxious substances that must be stored for hours and then eliminated when it is socially convenient to do so. The urinary tract that handles this output is composed of a series of pressurizable muscular compartments separated by sphincteric structures. With neural input, these structures coordinate the delivery, collection, and, ultimately, expulsion of urine. Despite large osmotic and chemical gradients in this waste fluid, the bladder maintains a highly impermeable surface in the face of a physically demanding biomechanical environment, which mandates recurring cycles of surface area expansion and increased wall tension during filling, followed by rapid wall compression during voiding. Afferent neuronal inflow from mucosa and submucosa communicates sensory information about bladder fullness, and voiding is initiated consciously through coordinated central and spinal efferent outflow to the detrusor, trigonal internal sphincter, and external urethral sphincter after periods of relative quiescence. Provocative new findings suggest that in some cases, lower urinary tract symptoms, such as incontinence, urgency, frequency, overactivity, and pain may be viewed as a consequence of urothelial defects (either urothelial barrier breakdown or inappropriate signaling from urothelial cells to underlying sensory afferents and potentially interstitial cells). This review describes the physiologic and anatomic mechanisms by which urine is moved from the kidney to the bladder, stored, and then released. Relevant clinical examples of urinary tract dysfunction are also discussed.
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Affiliation(s)
- Warren G Hill
- Laboratory of Voiding Dysfunction, Department of Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts
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15
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Michel MC. Editorial Comment from Dr Michel to Expression and functional role of β 3-adrenoceptors in the human ureter. Int J Urol 2013; 20:1015. [DOI: 10.1111/iju.12108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Martin C Michel
- Department of Pharmacology; Johannes Gutenberg University; Mainz; Germany
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Matsumoto R, Otsuka A, Suzuki T, Shinbo H, Mizuno T, Kurita Y, Mugiya S, Ozono S. Expression and functional role of β3-adrenoceptors in the human ureter. Int J Urol 2013; 20:1007-14. [DOI: 10.1111/iju.12093] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2012] [Accepted: 12/26/2012] [Indexed: 12/01/2022]
Affiliation(s)
- Rikiya Matsumoto
- Department of Urology; Hamamatsu University School of Medicine; Hamamatsu; Japan
| | - Atsushi Otsuka
- Department of Urology; Hamamatsu University School of Medicine; Hamamatsu; Japan
| | - Takahisa Suzuki
- Department of Urology; Hamamatsu University School of Medicine; Hamamatsu; Japan
| | | | - Takuji Mizuno
- Department of Urology; Iwata City Hospital; Iwata; Japan
| | - Yutaka Kurita
- Department of Urology; Enshu Hospital; Hamamatsu; Japan
| | - Soichi Mugiya
- Department of Urology; Hamamatsu University School of Medicine; Hamamatsu; Japan
| | - Seiichiro Ozono
- Department of Urology; Hamamatsu University School of Medicine; Hamamatsu; Japan
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Miniaci MC, Bucci M, Santamaria R, Irace C, Cantalupo A, Cirino G, Scotto P. CL316,243, a selective β3-adrenoceptor agonist, activates protein translation through mTOR/p70S6K signaling pathway in rat skeletal muscle cells. Pflugers Arch 2013; 465:509-16. [DOI: 10.1007/s00424-012-1213-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2012] [Revised: 12/19/2012] [Accepted: 12/23/2012] [Indexed: 02/04/2023]
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Origin of Motion in the Human Ureter: Mechanics, Energetics and Kinetics of the Myosin Molecular Motors. Urologia 2012; 79:123-9. [DOI: 10.5301/ru.2012.9110] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/15/2012] [Indexed: 11/20/2022]
Abstract
Background Ureteral peristalsis is the result of coordinated mechanical motor performance of longitudinal and circular smooth muscle layer of the ureter wall. The main aim of this study was to characterize in smooth muscle of proximal segments of human ureter, the mechanical properties at level of muscle tissue and at level of myosin molecular motors. Methods Ureteral samples were collected from 15 patients, who underwent nephrectomy for renal cancer. Smooth muscle strips longitudinally and circularly oriented from proximal segments of human ureter were used for the in vitro experiments. Mechanical indices including the maximum unloaded shortening velocity (Vmax), and the maximum isometric tension (P0) normalized per cross-sectional area, were determined in vitro determined in electrically evoked contractions of longitudinal and circular smooth muscle strips. Myosin cross-bridge (CB) number per mm2 (Ψ) the elementary force per single CB (Ψ) and kinetic parameters were calculated in muscle strips, using Huxley's equations adapted to nonsarcomeric muscles. Results Longitudinal smooth muscle strips exhibited a significantly (p<0.05) faster Vmax (63%) and a higher P0 (40%), if compared to circular strips. Moreover, longitudinal muscle strips showed a significantly higher unitary force (Ψ) per CB. However, no significant differences were observed in CB number, the attachment (f1) and the detachment (g2) rate constants between longitudinal and circular muscle strips. Conclusions The main result obtained in the present work documents that the mechanical, energetic and unitary forces per CB of longitudinal layer of proximal ureter are better compared to the circular one; these preliminary findings suggested, unlike intestinal smooth muscle, a major role of longitudinal smooth muscle layer in the ureter peristalsis.
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Wanajo I, Tomiyama Y, Yamazaki Y, Kojima M. Ureteral Selectivity of Intravenous β-Adrenoceptor Agonists in Pig Model of Acute Ureteral Obstruction: Comparison of KUL-7211, a Selective β2/β3 Agonist, With Isoproterenol, Terbutaline, and CL-316243. Urology 2011; 77:1266.e1-6. [DOI: 10.1016/j.urology.2010.12.045] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2010] [Revised: 12/25/2010] [Accepted: 12/25/2010] [Indexed: 10/18/2022]
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Abstract
Within the urinary tract, β-adrenergic receptors (AR) are found largely on smooth muscle cells but are also present, at least in the bladder, in the urothelium and on afferent nerves. Our understanding of β-AR subtype expression and function is hampered by a lack of well-validated tools, particularly with regard to β(3)-AR. Moreover, the β-AR subtypes involved in a specific function may differ between species. In the ureter, β-AR can modulate pacemaker activity and smooth muscle tone involving multiple subtypes. In the human bladder, β-AR promote urine storage. Bladder smooth muscle relaxation primarily involves β(3)-AR, and the agonists selective for this subtype are in clinical development to treat bladder dysfunction. While prostate and urethra also express β-AR, the overall physiological role in these tissues remains unclear.
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Affiliation(s)
- Martin C Michel
- Department of Pharmacology and Pharmacotherapy, Academic Medical Center, Meibergdreef 15, 1105 AZ, Amsterdam, The Netherlands.
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Michel MC, Ochodnicky P, Summers RJ. Tissue functions mediated by beta(3)-adrenoceptors-findings and challenges. Naunyn Schmiedebergs Arch Pharmacol 2010; 382:103-8. [PMID: 20517594 PMCID: PMC2904903 DOI: 10.1007/s00210-010-0529-2] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2010] [Accepted: 05/18/2010] [Indexed: 11/26/2022]
Abstract
As β3-adrenoceptor agonists metamorphose from experimental tools into therapeutic drugs, it is vital to obtain a comprehensive picture of the cell and tissue functions mediated by this receptor subtype in humans. Human tissues with proven functions and/or a high expression of β3-adrenoceptors include the urinary bladder, the gall bladder, and other parts of the gastrointestinal tract. While several other β3-adrenoceptor functions have been proposed based on results obtained in animals, their relevance to humans remains uncertain. For instance, β3-adrenoceptors perform an important role in thermogenesis and lipolysis in rodent brown and white adipose tissue, respectively, but their role in humans appears less significant. Moreover, the use of tools such as the agonist BRL 37344 and the antagonist SR59230A to demonstrate functional involvement of β3-adrenoceptors may lead in many cases to misleading conclusions as they can also interact with other β-adrenoceptor subtypes or even non-adrenoceptor targets. In conclusion, we propose that many responses attributed to β3-adrenoceptor stimulation may need re-evaluation in the light of the development of more selective tools. Moreover, findings in experimental animals need to be extended to humans in order to better understand the potential additional indications and side effects of the β3-adrenoceptor agonists that are beginning to enter clinical medicine.
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Affiliation(s)
- Martin C. Michel
- Department of Pharmacology and Pharmacotherapy, Academic Medical Center, University of Amsterdam, Meibergdreef 15, 1105 AZ Amsterdam, Netherlands
| | - Peter Ochodnicky
- Department of Pharmacology and Pharmacotherapy, Academic Medical Center, University of Amsterdam, Meibergdreef 15, 1105 AZ Amsterdam, Netherlands
| | - Roger J. Summers
- Drug Discovery Biology, Monash Institute of Pharmaceutical Sciences, Monash University, 399 Royal Parade, Parkville, 3052 Australia
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Abstract
The pyeloureteral function is to transport urine from the kidneys into the ureter toward the urinary bladder for storage until micturition. A set of mechanisms collaborates to achieve this purpose: the basic process regulating ureteral peristalsis is myogenic, initiated by active pacemaker cells located in the renal pelvis. Great emphasis has been given to hydrodynamic factors, such as urine flow rate in determining the size and pattern of urine boluses which, in turn, affect the mechanical aspects of peristaltic rhythm, rate, amplitude, and baseline pressure. Neurogenic contribution is thought to be limited to play a modulatory role in ureteral peristalsis. The myogenic theory of ureteral peristalsis can be traced back to Engelmann (1) who was able to localize the peristaltic pressure wave's origin in the renal pelvis and suggested that the ureteral contraction impulse passes from one ureteral cell to another, the whole ureter working as a functional syncitium. Recent studies of ureteral biomechanics, smooth muscle cell electrophysiology, membrane ionic currents, cytoskeletal components and pharmacophysiology much improved our understanding of the mechanism of how the urine bolus is propelled, how this process is disturbed in pathological states, and what could be done to improve it.
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Affiliation(s)
- F Osman
- Department of Urology and Clinical Experimental Research Department, Semmelweis University, Budapest, Hungary.
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Holst U, Rawashdeh YF, Andreasen F, Christian Djurhuus J, Mortensen J. Endoluminal pelvic perfusion with norepinephrine causes only minor systemic effects and diminishes the increase in pelvic pressure caused by perfusion. ACTA ACUST UNITED AC 2009; 39:443-8. [PMID: 16303718 DOI: 10.1080/00365590500221469] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
OBJECTIVE To evaluate the effect of endoluminal norepinephrine (NE) on transport pressures of the normal upper urinary tract of the pig and on plasma levels of NE in relation to possible systemic effects. MATERIAL AND METHODS Six anaesthetized pigs weighing approximately 39 kg were studied. Transparenchymally, two 6-F catheters were introduced into the renal pelvis bilaterally to measure pressure and perfusion. Ultrasonic flow probes recorded renal arterial blood flow, and a transurethral 10-F catheter drained the bladder and monitored diuresis. In all six animals, the bilateral pelvic pressure response was examined at increasing perfusion rates (2, 4, 6, 8, 10 and 15 ml/min) and with increasing doses of NE (0, 5, 50 and 100 microg/ml). Arterial blood samples were analysed for NE, epinephrine and blood glucose. The systemic blood pressure, heart rate and electrocardiogram were registered. RESULTS At all the investigated concentrations, endoluminal NE significantly diminished the increase in pelvic pressure caused by pelvic perfusion at all flow rates. At the lowest concentration of NE, no significant increase in the plasma level of NE was observed and the blood pressure did not increase. During perfusion with 50 and 100 microg/ml NE, plasma levels of NE increased significantly from 487+/-398 to 1798+/-910 and 2961+/-2093 pg/ml, respectively. This was accompanied by significant rises in mean systolic blood pressure from a baseline value of 95+/-10 mmHg to 111+/-20 and 118+/-23 mmHg, respectively. Heart rate, renal arterial blood flow and plasma levels of epinephrine and glucose did not change. CONCLUSIONS Endoluminal NE diminished the increase in pelvic pressure caused by pelvic perfusion even at concentrations too low to cause significant changes in NE plasma levels or systemic effects. Very high NE concentrations in the perfusion fluid caused increased plasma levels and a modest but significant increase in blood pressure. Administration of endoluminal NE may be useful in upper urinary tract stone treatment and endoscopy.
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Affiliation(s)
- Uffe Holst
- Department of Surgery, Haderslev Sygehus, Haderslev, Denmark
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Jakobsen JS, Jung HU, Gramsbergen JB, Osther PJ, Walter S. Endoluminal isoproterenol reduces renal pelvic pressure during semirigid ureterorenoscopy: a porcine model. BJU Int 2009; 105:121-4. [PMID: 19558558 DOI: 10.1111/j.1464-410x.2009.08678.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To investigate the effects on the pressure-flow relation of renal pelvic pressure during semirigid ureterorenoscopy and endoluminal perfusion of isoproterenol (ISO) 0.1 microg/mL, with emphasis on local effects and cardiovascular side-effects, as topically administered ISO effectively and dose-dependently causes relaxation of the upper urinary tract in pigs with no concomitant cardiovascular side-effects. MATERIALS AND METHODS In anaesthetized female pigs (60 kg), 16 macroscopically normal upper urinary tract systems were subjected to ureterorenoscopy. Via a subcostal incision a 6-F catheter was placed in the renal pelvis for pressure measurements, and a semirigid ureteroscope (7.8 F) was inserted retrogradely in the renal pelvis, through which the pelvis was perfused. The blood pressure and heart rate were recorded. The increase in renal pelvic pressure was examined with increasing flow rates (0, 4, 8, 12, 16, 25 and 33 mL/min) with saline alone or saline + ISO 0.1 microg/mL. Perfusion was initiated on the left side, with randomization for adding ISO or not. Thereafter perfusion was done on the right side as a control in each pig. The surgeons were unaware of whether ISO was added or not. RESULTS The mean (sd) baseline pelvic pressures in the saline and ISO group were 28 (7.1) and 25 (9.8) mmHg, respectively, with no significant difference (P = 0.079). Endoluminal perfusion with ISO significantly inhibited the pelvic pressure increase to perfusion at all perfusion rates. The pressure-flow relation was linear; the maximum relaxation (27%) was obtained at 4 mL/min, from 52 to 38 mmHg during saline alone and ISO 0.1 microg/mL perfusion, respectively. The mean blood pressure did not change significantly (P = 0.330). The mean (sd) heart rate in the saline and ISO group were 109 (4.5) and 97 (2.1) beats/min, respectively (P < 0.001), i.e. a markedly greater rate in the saline than in the ISO group. CONCLUSION The pressure-flow relation during semirigid ureterorenoscopy was linear. ISO 0.1 microg/mL in saline significantly reduced the pressure-flow relation during semirigid ureterorenoscopy in this porcine model. ISO might be a potential additive to the irrigation fluid during upper urinary tract endoscopic procedures, minimizing pressure increases due to irrigation and manipulation.
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Affiliation(s)
- Jørn S Jakobsen
- Department of Urology L, University Hospital of Southern Denmark, Odense, Denmark
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Rajpathy J, Aswathaman K, Sinha M, Subramani S, Gopalakrishnan G, Kekre NS. Anin vitrostudy on human ureteric smooth muscle with the α1-adrenoceptor subtype blocker, tamsulosin. BJU Int 2008; 102:1743-5. [DOI: 10.1111/j.1464-410x.2008.08022.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Mortensen J, Holst U, Jakobsen JS, Andreasen F. Endoluminal Norepinephrine Inhibits Smooth Muscle Activity of the Pig Pyeloureter by Stimulation of β-Adrenoceptors without Side Effects. Basic Clin Pharmacol Toxicol 2008; 103:455-60. [DOI: 10.1111/j.1742-7843.2008.00297.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Raynal G, Bellan J, Saint F, Tillou X, Petit J. [Ureter drugs]. Prog Urol 2008; 18:152-9. [PMID: 18472067 DOI: 10.1016/j.purol.2008.02.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2007] [Accepted: 02/15/2008] [Indexed: 11/28/2022]
Abstract
Many improvements have been made recently in the field of the ureteral smooth muscle pharmacology. After a brief summary on physiological basis, we review what is known about effects on ureter of different drugs class. In a second part, we review clinical applications for renal colic analgesia, calculi expulsive medical therapy, ESWL adjuvant treatment and preoperative treatment before retrograde access. There are now sufficient data on NSAID and alpha-blockers. beta-agonists, especially for beta3 selective ones, and topical drugs before retrograde access are interesting and should be further evaluated.
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Affiliation(s)
- G Raynal
- Service d'urologie et transplantation, CHU d'Amiens, hôpital Sud, boulevard Laennec, 80054 Salouel cedex, France.
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Endoluminal isoproterenol irrigation decreases renal pelvic pressure during flexible ureterorenoscopy: a clinical randomized, controlled study. Eur Urol 2008; 54:1404-13. [PMID: 18403102 DOI: 10.1016/j.eururo.2008.03.092] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2007] [Accepted: 03/21/2008] [Indexed: 11/21/2022]
Abstract
OBJECTIVES Irrigation during ureterorenoscopic procedures causes increased pelvic pressure (PP), which may lead to intrarenal backflow with potential harmful consequences. This study aims to investigate PP response to intraluminal administration of isoproterenol (beta-agonist; ISO) during flexible ureterorenoscopy. METHODS Twelve patients admitted for retrograde intrarenal stone surgery (RIRS) were included. Patients were randomized to (1) irrigation with saline (n=6) or (2) irrigation with ISO 0.1 microg/mL (n=6). Irrigation rate was standardized to 8 mL/min. A ureteral catheter was retrogradely placed in the renal pelvis for PP measurements. PP, heart rate (HR), and mean arterial pressure (MAP) were also measured. RESULTS Baseline PP was 12.1+/-4mm Hg in the saline group and 10.3+/-4mm Hg in the ISO group (p=0.44). In the saline group, PP increased to a mean 33+/-12 mm Hg during ureterorenoscopy. In the ISO group, PP was a mean 19+/-3mm Hg (p=0.029). During endoscopy, PP peaks as high as 328 mm Hg were noted during saline irrigation. The number of pressure peaks above 50mm Hg was minimized dramatically during ISO irrigation (p=0.035). No systemic side effects to ISO irrigation were observed. CONCLUSION For the first time, a randomized, controlled human study demonstrates that pharmacologic modulation of the ureter is possible during upper urinary tract endoscopy. The ability to relax ureteral tone during endoscopy may have clinical advantages.
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Jung HU, Frimodt-Møller PC, Osther PJ, Mortensen J. Pharmacological effect on pyeloureteric dynamics with a clinical perspective: a review of the literature. ACTA ACUST UNITED AC 2007; 34:341-50. [PMID: 17019613 DOI: 10.1007/s00240-006-0069-x] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2006] [Accepted: 08/31/2006] [Indexed: 11/26/2022]
Abstract
We searched to review experimental and clinical trials concerning the capabilities of impacting on the ureteric and pelvic activity by means of pharmacological stimulation. Ureteropyeloscopy may cause high renal pelvic pressure. The normal pressure is in the range of 5-15 mmHg whereas pressure of 410 mmHg has been measured during endoscopy. The threshold pressure for intrarenal reflux is about 35 mmHg. Studies in animals have revealed that high renal pelvic pressures may cause permanent damage to the renal parenchyma. Furthermore, it has been demonstrated that elevated pressures may entail an increased risk of several complications related to endourological procedures including bleeding, perforation and infection. In other words, means by which intrarenal pressure could be lowered during endourological procedures might be beneficial with respect to clinical outcomes. In vitro experiments support the existence of different receptors in the ureter and renal pelvis. The ureteric and pelvic responses to the corresponding neurotransmitters have been determined. It seems that alpha-adrenergic and cholinergic agents are stimulating whereas beta-adrenergic agents inhibit ureteric activity. The effect may depend on the mode of administration. Drugs exerting advantageous effects in the pyeloureter may cause undesirable systemic side effects when administered intravenously. In animal studies, renal pelvic pressure can be significantly lowered by topical administration of beta-adrenergic agonists without systemic side effects. In vivo human studies are necessary to clarify the exact dose-response relationship and the degree of urothelial absorption of a drug before clinical use may be adopted.
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Affiliation(s)
- Helene U Jung
- Department of Urology, Fredericia and Kolding Hospitals, Dronningensgade 97, 7000 Fredericia, Denmark.
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Jung HU, Jakobsen JS, Mortensen J, Osther PJ, Djurhuus JC. Irrigation with isoproterenol diminishes increases in pelvic pressure without side-effects during ureterorenoscopy: a randomized controlled study in a porcine model. ACTA ACUST UNITED AC 2007; 42:7-11. [PMID: 17853047 DOI: 10.1080/00365590701520073] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
OBJECTIVE Recently, we showed that endoluminally administered isoproterenol (ISO) inhibits muscle function of the pyeloureter in swine. This may be of value in managing increases in pelvic pressure during upper urinary tract endoscopy. The purpose of this study was to examine the effect of endoluminally administered ISO on increases in pelvic pressure and cardiovascular function during flexible ureterorenoscopy. MATERIAL AND METHODS The study was performed in anaesthetized female pigs. In terms of endoscopic procedures, the pigs were randomized as follows: Group 1, irrigation with 0.1 microg/ml ISO added to saline (n=12); and Group 2, irrigation with saline (n=10). A 5-Fr catheter was retrogradely placed in the renal pelvis and an 8-Fr catheter in the bladder for pressure measurements. Flexible ureterorenoscopy was performed with constant irrigation at a perfusion rate of 8 ml/min. Pelvic, bladder and blood pressure and heart rate were registered continuously. RESULTS Mean baseline pelvic pressure was identical in both groups: 12+/-2.3 mmHg in Group 1 and 14+/-3.6 mmHg in Group 2 (p=0.26). During ureterorenoscopy, mean pelvic pressure increased to 26+/-2.3 mmHg in Group 1 and to 38+/-3.1 mmHg in Group 2. Hence ISO reduced the pressure increase due to ureterorenoscopy by 42% (p<0.001). Pelvic pressure seemed to be independent of bladder pressure, which showed no difference between the two groups (p=0.067). Blood pressure and heart rate showed no significant differences between the two groups: p=0.425 and p=0.166, respectively. CONCLUSIONS ISO (0.1 microg/ml) added to irrigation fluid significantly reduces the increase in pelvic pressure during ureterorenoscopy in pigs, without concomitant side-effects.
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Affiliation(s)
- H U Jung
- Departments of Urology, Fredericia and Kolding Hospitals, Dronningensgade 97, Fredericia, Denmark.
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Itoh Y, Kojima Y, Yasui T, Tozawa K, Sasaki S, Kohri K. Examination of alpha 1 adrenoceptor subtypes in the human ureter. Int J Urol 2007; 14:749-53. [PMID: 17681068 DOI: 10.1111/j.1442-2042.2007.01812.x] [Citation(s) in RCA: 82] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
AIM Urinary stone disease is a common condition affecting up to 12% of the population. Speedy elimination of ureterolithiasis in the lower part of ureters is reported with the alpha 1-blocker. This study was carried out to characterize the alpha 1 adrenoceptors (AR) subtype gene and protein expression in the proximal, medial, and distal regions of the human ureter with the aim of facilitating stone expulsion. METHODS The study was carried out on 20 volunteers. Proximal, medial and distal ureter specimens were obtained as discarded tissues after nephroureterectomy for renal pelvic or ureteral carcinoma. Proximal ureter specimens were obtained as discarded tissues after nephrectomy for renal carcinoma. Using ureter samples, real-time reverse transcription polymerase chain reaction (RT-PCR) and immunohistochemical staining were performed. RESULTS The alpha 1d subtype mRNA was highly expressed in each ureteral region, accounting for about 54% of the total AR Messenger Ribonucleic Acid. In the proximal and medial ureter, the distribution of ARs was alpha 1d > or = alpha 1a > alpha 1b as well as that of the total ureter. The distal ureter expressed the highest amount of alpha 1d ARs. The alpha 1d subtype expression tended to be high compared with the alpha 1a subtype expression. In the distal ureter, the distribution of ARs was alpha 1d > alpha 1a > alpha 1b. Immunohistochemical staining revealed that expressions of alpha 1a-AR and alpha 1d-AR were higher than that of alpha 1b-AR. CONCLUSIONS According to our results, we should try the alpha 1d AR antagonist for the conservative expulsive therapy of distal ureteral stones in the highest region of alpha 1d subtype distribution.
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Affiliation(s)
- Yasunori Itoh
- Department of Nephro-urology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Aichi, Japan.
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Canda AE, Turna B, Cinar GM, Nazli O. Physiology and pharmacology of the human ureter: basis for current and future treatments. Urol Int 2007; 78:289-98. [PMID: 17495484 DOI: 10.1159/000100830] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
INTRODUCTION This article sets out to be a review regarding agents that affect contraction and relaxation of the ureter in order to establish a basis for current and future treatments for upper urinary tract obstruction. MATERIAL AND METHODS A complete review of the English literature using MEDLINE was performed between 1960 and 2007 on ureter physiology and pharmacology with special emphasis on signal transduction mechanisms involved in the contractile regulation of the human ureter. RESULTS Activation of muscarinic and adrenergic receptors increases the amplitude of ureteral contractions. The sympathetic nerves modulate the contractions by alpha-adrenoceptors and relaxation by beta-adrenoceptors. The purinergic system is important in sensory/motor functions and ATP is an important non-adrenergic non-cholinergic (NANC) agent causing contraction. Nitric oxide (NO) is a major inhibitory NANC neurotransmitter causing relaxation. Serotonin causes contraction. Prostaglandin-F(2)alpha contracts whereas prostaglandin-E(1)/E(2) relaxes the ureter. Phosphodiesterases (PDE) and the Rho-kinase pathway have recently been identified in the human ureter. PDE-IV inhibitors, K(+) channel openers, calcium antagonists, alpha(1)-adrenoceptor antagonists and NO donors seem to be promising drugs in relieving obstruction and facilitating stone passage. CONCLUSIONS Further understanding of the ureteral function and pharmacology may lead to the discovery of promising new drugs that could be useful in relieving ureteral colic, facilitating spontaneous stone passage, preparing the ureter for ureteroscopy as well as acting adjunctive to extracorporeal shock-wave lithotripsy.
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Affiliation(s)
- A Erdem Canda
- Manisa State Hospital, Urology Clinic, Manisa, Turkey
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Jakobsen JS, Holst U, Jakobsen P, Steen W, Mortensen J. Local and systemic effects of endoluminal pelvic perfusion of isoproterenol: a dose response investigation in pigs. J Urol 2007; 177:1934-8. [PMID: 17437851 DOI: 10.1016/j.juro.2007.01.020] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2006] [Indexed: 10/23/2022]
Abstract
PURPOSE Isoproterenol (Sygehus Apotekerne Danmark, Copenhagen, Denmark) is a beta-adrenergic agonist known to cause upper urinary tract relaxation. We studied the local effect on pelvic pressure and the systemic effects of endoluminal perfusion with isoproterenol in a porcine model. MATERIALS AND METHODS Pigs weighing 40 kg were studied. Catheters were placed in the renal pelvis for pressure measurement and perfusion, and a catheter was used to drain the bladder. Blood pressure and heart rate were recorded. In 6 pigs in group 1 the pelvic pressure increase was examined at increasing flow rates of 0, 2, 5, 8, 10 and 15 ml per minute with saline containing 0, 10(-3), 10(-2), 10(-1), 1 and 10 microg/ml isoproterenol. Blood values of isoproterenol were analyzed. In 6 pigs in group 2 the pelvis was perfused at a flow rate of 8 ml per minute with saline containing 0, 10(-5), 10(-4), 10(-3), 10(-2), 10(-1), 1 and 10 microg/ml isoproterenol. RESULTS In group 1 endoluminal perfusion with isoproterenol inhibited the pelvic pressure increase due to perfusion at all concentrations of isoproterenol. At a perfusion rate of 8 ml per minute the maximal effect (a 78% decrease) was achieved using 0.1 microg/ml isoproterenol without cardiovascular side effects. In group 2 all isoproterenol concentrations caused significant inhibition of the pressure-flow relationship in a dose dependent matter. A 64% decrease in the pressure increase due to saline perfusion was achieved at 0.1 microg/ml isoproterenol without concomitant significant cardiovascular side effects. Isoproterenol was only detected in plasma during perfusion with 1 and 10 microg/ml isoproterenol, which caused significant cardiovascular side effects in the latter case. CONCLUSIONS Isoproterenol significantly inhibits the pressure increase due to perfusion in the normal porcine renal pelvis without concomitant cardiovascular side effects. Isoproterenol is a safe drug in this porcine model and, hence, it is potentially useful during endourological procedures.
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Affiliation(s)
- J S Jakobsen
- Department of Urology L, Odense University Hospital, Odense, Denmark.
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Arrighi N, Bodei S, Zani D, Mirabella G, Peroni A, Simeone C, Sigala S. Alpha1 Adrenoceptors in Human Urinary Tract: Expression, Distribution and Clinical Implications. Urologia 2007. [DOI: 10.1177/039156030707400202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Adrenergic receptors (ARs) are a class of proteins belonging to the G protein-coupled receptor family. Pharmacological and molecular studies allowed dividing ARs into three different categories: α1, α2 and β. In this review, we focused on α1 ARs and α1 AR antagonists, since α 1 ARs play an important role in the pathophysiology of a number of urinary tract (UT) dysfunctions. α1 ARs are widely expressed in human UT; in particular, the three ureter areas (distal, medial and proximal) show different patterns of receptor expression (i.e. distal > medial = proximal), giving the molecular basis for the use of α1 ARs antagonist in the expulsive therapy of distal ureter calculi. Bladder areas are characterized by important differences among trigone, detrusor and neck, the first showing a different pattern of expression compared to the other parts. Further, there are evidences of both density and subtype gender-dependent expressions. α1 ARs expression in prostate and detrusor is a widely investigated area of research, mainly due to the clinical impact of benign prostatic hyperplasia (BPH). Urethra has not been well studied in human, although it plays a role in the control of continence. Studies carried out on α1 AR subtype expression in the UT indicate that, although the presence of each subtype is observed, α1A firstly and then α1D ARs seem to be more expressed than α1B ARs. Thus, drugs that demonstrate high α1A/D AR selectivity have drawn the researchers’ attention. As it relates specifically to the α1 AR antagonists used in the treatment of lower UT symptoms, the concept of uroselectivity has been operationally defined; indeed, in a number of recent publications uroselectivity has been defined as the degree to which a given compound inhibits norepinephrine-induced increase in urinary muscle contractions and/or its propensity to generate unwanted cardiovascular effects, such as decreases in blood pressure.
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Affiliation(s)
| | - S. Bodei
- Istituto di Farmacologia, Dipartimento di Scienze Biomediche e Biotecnologie, Facoltà di Medicina e Chirurgia, Università degli Studi di Brescia
| | - D. Zani
- Divisione Clinicizzata di Urologia
| | | | | | | | - S. Sigala
- Istituto di Farmacologia, Dipartimento di Scienze Biomediche e Biotecnologie, Facoltà di Medicina e Chirurgia, Università degli Studi di Brescia
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Vrydag W, Michel MC. Tools to study beta3-adrenoceptors. Naunyn Schmiedebergs Arch Pharmacol 2007; 374:385-98. [PMID: 17211601 DOI: 10.1007/s00210-006-0127-5] [Citation(s) in RCA: 80] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2006] [Accepted: 11/22/2006] [Indexed: 12/21/2022]
Abstract
Beta(3)-adrenoceptors mediate some of the effects of catecholamines on tissues such as blood vessels or the urinary bladder and are putative targets for the treatment of diseases such as the overactive bladder syndrome. Progress in the understanding of the presence, function, and regulation of beta(3)-adrenoceptors has been hampered by a lack of highly specific tools. "Classical" beta(3)-adrenoceptor agonists such as BRL 37,344 [(R*, R*)-(+/-)-4[2-[(3-chlorophenyl)-2-hydroxyethyl) amino] propyl] phenoxyacetic acid] and CGP 12,177 [(+/-)-4-(3-t-butylamino-2-hydroxypropoxy)benzimidazol-2-one] are only partial agonists in many settings, have limited selectivity over other beta-adrenoceptor subtypes, and may additionally act on receptors other than beta-adrenoceptors. More efficacious and more selective agonists have been reported and, in some cases, are in clinical development but are not widely available for experimental studies. The widely used antagonist SR 59,230 [3-(2-ethylphenoxy)-1-[(1,S)-1,2,3,4-tetrahydronapth-1-ylamino]-2S-2-propanoloxalate] is not selective for beta(3)-adrenoceptors, at least in humans, and may actually be a partial agonist. Radioligands, which are suitable either for the selective labeling of beta(3)-adrenoceptors or for the nonselective labeling of all beta-adrenoceptor subtypes, are also missing. beta(3)- and beta(1)/beta(2) double knockout mice have been reported, but their usefulness for extrapolations in humans is questionable based upon major differences between humans and rodents with regard to the ligand recognition and expression profiles of beta(3)-adrenoceptors. While the common availability of more selective agonists and antagonists at the beta(3)-adrenoceptor is urgently awaited, the limitations of the currently available tools need to be considered in studies of beta(3)-adrenoceptor for the time being.
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Affiliation(s)
- Wim Vrydag
- Department Pharmacology and Pharmacotherapy, Academic Medical Center, University of Amsterdam, 1105 AZ Amsterdam, Netherlands
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Wilson L, Patel AB. Renal colic during sexual intercourse: a unique presentation. ACTA ACUST UNITED AC 2006; 34:225-6. [PMID: 16477426 DOI: 10.1007/s00240-006-0039-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2005] [Accepted: 01/12/2006] [Indexed: 10/25/2022]
Abstract
The average lifetime risk of renal stones has been reported to be in the range of 5-21%, and the majority of patients have recurrent stones (Tiselius et al. in Eur Urol 40:362-371, 2001). The peak incidence is between the fourth and fifth decades, and therefore generally active and working adults are most affected. Stones are usually formed in a calyx, and become symptomatic if they move to obstruct the upper urinary tract. In the majority of cases, there is no specific action which causes stone movement from a non-obstructing to an obstructing position. We present the first ever case report in the literature of an episode of renal colic during sexual intercourse. The role of percussion therapy and postural drainage are well established following shockwave lithotripsy (SWL) to enhance passage of lower pole stone fragments (Brownlee et al. in J Urol 143:1096, 1990), and it may well be the result of similar principles of motion and body positioning which caused the patient to present in this manner.
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Affiliation(s)
- L Wilson
- Great Ormond Street Hospital, London, UK
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Wanajo I, Tomiyama Y, Tadachi M, Kobayashi M, Yamazaki Y, Kojima M, Shibata N. The potency of KUL-7211, a selective ureteral relaxant, in isolated canine ureter: comparison with various spasmolytics. ACTA ACUST UNITED AC 2005; 33:409-14. [PMID: 16133579 DOI: 10.1007/s00240-005-0475-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2004] [Accepted: 04/01/2005] [Indexed: 10/25/2022]
Abstract
We compared the potency of a selective ureteral relaxant KUL-7211 (beta(2)/beta(3)-adrenoceptor agonist; (-)-2-[4-(2-{[(1S,2R)-2-hydroxy-2-(4-hydroxyphenyl)-1-methylethyl]amino}ethyl)phenyloxy]acetic acid) with those of various spasmolytics on contractions in isolated canine ureteral preparations. Drug effects were evaluated on the tonic contraction induced by KCl (80 mM) and on spontaneous, 1x10(-5) M phenylephrine-, and 1x10(-6) M PGF(2alpha)-induced rhythmic contractions in isolated canine ureteral preparations using a functional experimental technique. The potencies (pD(2) value) of the following drugs were compared: KUL-7211, tamsulosin (an alpha(1A/1D)-adrenoceptor antagonist), prazosin (an alpha(1)-adrenoceptor antagonist), verapamil (a Ca(2+)-channel blocker), butylscopolamine (a nonselective muscarinic antagonist), and papaverine (a phosphodiesterase inhibitor). The rank order of relaxing potencies against KCl-induced tonic contraction was KUL-7211 (6.60)>tamsulosin(5.90)>verapamil(5.70)>papaverine(4.88)>prazosin (4.54). The rank order of potencies for reductions in spontaneous rhythmic contractions was KUL-7211 (6.80)>verapamil(6.12)>papaverine(5.05). Conversely, high concentrations of the two alpha-adrenoceptor antagonists (tamsulosin and prazosin) and of butylscopolamine enhanced the spontaneous contractions, although at low concentrations (up to 1x10(-6) M) they had no significant effects. For suppression of spasmogen-induced rhythmic contractions, the rank order of potencies was, against phenylephrine-induced contractions: KUL-7211 (6.95)>tamsulosin(6.26)>prazosin(5.68)>verapamil(5.64)>papaverine (5.03), and against PGF(2alpha)-induced contractions: KUL-7211 (7.05)>verapamil(6.70)>papaverine (5.27). Our results suggest that in dogs, the beta(2)/beta(3)-adrenoceptor agonist KUL-7211 is the most efficacious ureteral relaxant among the spasmolytics tested against various contractions. Possibly, KUL-7211 might be useful for promoting stone passage and relieving ureteral colic in urolithiasis patients.
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Affiliation(s)
- Isao Wanajo
- Central Research Laboratory, Kissei Pharmaceutical Company Ltd., 4365-1, Kashiwabara, Hotaka, Nagano 399-8304, Japan.
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Sigala S, Dellabella M, Milanese G, Fornari S, Faccoli S, Palazzolo F, Peroni A, Mirabella G, Cunico SC, Spano P, Muzzonigro G. Evidence for the presence of alpha1 adrenoceptor subtypes in the human ureter. Neurourol Urodyn 2005; 24:142-8. [PMID: 15690361 DOI: 10.1002/nau.20097] [Citation(s) in RCA: 127] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
AIM Several studies have proposed a role for alpha1 adrenoceptors (ARs) in ureteral physiology, indicating that they are present in the ureter; however, few studies have been done to identify alpha1 AR subtypes present in this area. Thus, this study was carried out to characterize the alpha1 AR subtype gene and protein expression in proximal, medial, and distal region of the human ureter. METHODS Molecular characterization of alpha1 AR subtypes were analyzed by semi-quantitative RT-PCR. alpha1 AR protein expression was studied by saturation binding curves and by competition binding curves with selective antagonists. Analysis of data was performed using the GraphPad PRISM 4 software. RESULTS Analysis of saturation binding curves revealed a heterogeneous distribution of alpha1 AR binding sites, the B(max) for the distal ureter was indeed 52.5 +/- 5.4 fmol/mg prot, while a lower similar density of alpha1 ARs was demonstrated in the medial (25.2 +/- 1.7 fmol/mg prot) and proximal (23.4 +/- 0.4 fmol/mg prot) ureters. Molecular and pharmacological characterization of alpha1 AR subtypes indicated that each receptor was present, although with differences in terms of the amount expressed. CONCLUSIONS Human ureter was endowed with each alpha1 AR subtype, although alpha1D and alpha1A ARs were prevalent over alpha1B ARs. Radioligand binding results revealed that there were no significant differences in the K(d) between ureteral regions, while a heterogeneous distribution of alpha1 AR binding sites was detected, with the highest density of alpha1 ARs in the distal ureter and a lower similar density in the medial and proximal ureters.
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Affiliation(s)
- Sandra Sigala
- Section of Pharmacology, Department of Biomedical Science and Biotechnology, University of Brescia Medical School, Brescia, Italy.
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Palazzolo F, Sigala S, Dellabella M, Milanese G, Faccoli S, Peroni A, Mirabella G, Cunico SC, Spano P, Muzzonigro G. Evidence for the Presence of α 1 Adrenoceptor Subtypes in the Human Ureter. Urologia 2005. [DOI: 10.1177/039156030507200115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Several studies proposed a role for α1 adrenoceptors (α1 ARs) in the ureteral physiology, indicating that they are present in the ureter; however, few studies have been made to identify α1 AR subtypes present in this area. Thus, this study was carried out to characterize the α1 AR subtype gene and protein expression in proximal, medial and distal region of the human ureter. Methods Molecular characterization of α1 AR subtypes was done by semi-quantitative RT-PCR. The α1 AR protein expression was studied by saturation binding curves using the α1 AR antagonist 125I-HEAT. Analysis of data was performed using the GraphPad PRISM 4 software. Results Analysis of saturation binding curves revealed an heterogeneous distribution of α1 AR binding sites; the Bmax for the distal ureter was indeed 52.5 ±5.4 fmol/mg prot, while a lower similar density of α1 ARs was demonstrated in the medial (25.2 ±1.7 fmol/mg prot) and proximal (23.4 ±0.4 fmol/mg prot) ureters. Molecular characterization of α1 AR subtypes indicated that each receptor was present, although with differences in term of the amount expressed. Conclusions Human ureter was endowed with each α1 AR subtype, although α1D and α1A ARs were prevalent over α1B ARs. Radioligand binding results revealed that there were no significant differences in the Kd between ureteral regions, while an heterogeneous distribution of α1 AR binding sites was detected, with the highest density of α1 ARs in the distal ureter and a lower similar density in the medial and proximal ureter.
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Affiliation(s)
- F. Palazzolo
- Sez. di Farmacologia, Dipartimento di Scienze Biomed. e Biotec., Facoltà di Medicina e Chirurgia
| | - S. Sigala
- Sez. di Farmacologia, Dipartimento di Scienze Biomed. e Biotec., Facoltà di Medicina e Chirurgia
| | - M. Dellabella
- Dip. di Urologia e Div. di Urologia, Azienda Ospedaliera Umberto I-Torrette, Università Politecnica delle Marche, Ancona
| | - G. Milanese
- Dip. di Urologia e Div. di Urologia, Azienda Ospedaliera Umberto I-Torrette, Università Politecnica delle Marche, Ancona
| | - S. Faccoli
- Sez. di Farmacologia, Dipartimento di Scienze Biomed. e Biotec., Facoltà di Medicina e Chirurgia
| | - A. Peroni
- Div. di Urologia, Facoltà di Medicina e Chirurgia, Università degli Studi di Brescia, Brescia
| | - G. Mirabella
- Div. di Urologia, Facoltà di Medicina e Chirurgia, Università degli Studi di Brescia, Brescia
| | - S. Cosciani Cunico
- Div. di Urologia, Facoltà di Medicina e Chirurgia, Università degli Studi di Brescia, Brescia
| | - P.F. Spano
- Sez. di Farmacologia, Dipartimento di Scienze Biomed. e Biotec., Facoltà di Medicina e Chirurgia
| | - G. Muzzonigro
- Dip. di Urologia e Div. di Urologia, Azienda Ospedaliera Umberto I-Torrette, Università Politecnica delle Marche, Ancona
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Wanajo I, Tomiyama Y, Yamazaki Y, Kojima M, Shibata N. PHARMACOLOGICAL CHARACTERIZATION OF β-ADRENOCEPTOR SUBTYPES MEDIATING RELAXATION IN PORCINE ISOLATED URETERAL SMOOTH MUSCLE. J Urol 2004; 172:1155-9. [PMID: 15311061 DOI: 10.1097/01.ju.0000133557.39515.b6] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE We pharmacologically characterized the functional beta-adrenoceptor subtypes mediating porcine ureteral smooth muscle relaxation. MATERIALS AND METHODS The effects of various beta-adrenoceptor agonists and antagonists on KCl induced tonic contractions in isolated porcine ureteral preparations were evaluated using a functional experimental technique. RESULTS The rank order of potency for the catecholamines tested was isoprenaline > adrenaline > noradrenaline. All beta2-adrenoceptor agonists tested (salbutamol, procaterol and terbutaline) attenuated the KCl induced contraction. The 2 beta3-adrenoceptor agonists CL-316243 ((R, R)-5-[2-[[2-(3-chlorophenyl)-2-hydroxyethylamino]propyl]-1,3-benzodioxole-2,2-dicarboxylate], Kissei, Nagano, Japan) and CGP-12177A ((+/-)[4-[3[(1,1-dimethylethyl)amino]-2-hydroxypropoxy]-1,3-dihydro-2 H-benzimidazol-2-one hydrochloride], Funakoshi, Tokyo, Japan) also relaxed the ureter. The beta1-adrenoceptor agonist dobutamine had a relaxing effect on the ureter only at high concentrations (over 1 x 10 M). Isoprenaline induced relaxation was antagonized by the beta2-adrenoceptor antagonist ICI-118,551 ((+/-)-1-[(2,3-dihydro-7-methyl-1 H-inden-4-yl)oxy]-3-[(1-methylethyl)amino]-2-butanol hydrochloride, Sigma, St. Louis, Missouri) but not by the beta1-adrenoceptor antagonist CGP 20712A ((+/-)-2-hydroxy-5-[2-[[2-hydroxy-3-[4-[1-methyl-4-(trifluoromethyl)-1 H-imidazol-2-yl]phenoxy]propyl]amino]ethoxy]-benzamide methanesulphonate, Funakoshi). In the presence of 1x 10 M CGP 20712A plus 1 x 10 M ICI-118,551 the beta3-adrenoceptor antagonist SR 58894A (3-(2-allylphenoxy)-1-[(1 S)-1,2,3,4-tetrahydronaphth-1-ylamino]-(2 S)-2-propanol hydrochloride, Kissei) antagonized isoprenaline induced relaxation. CONCLUSIONS Our results suggest that porcine ureteral smooth muscle is relaxed by beta2 and beta3-adrenergic stimulation, as in humans.
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Affiliation(s)
- Isao Wanajo
- Central Research Laboratory, Kissei Pharmaceutical Co. Ltd., Nagano, Japan
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Banwait KS, Rattan S. Role of nitric oxide in beta3-adrenoceptor activation on basal tone of internal anal sphincter. Am J Physiol Gastrointest Liver Physiol 2003; 285:G547-55. [PMID: 12736154 DOI: 10.1152/ajpgi.00545.2002] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Effects of activation of beta3-adrenoceptor (beta3-AR) have not been determined in the spontaneously tonic smooth muscle of the internal anal sphincter (IAS). The effects of disodium (R,R)-5-[2-[2-3-chlorophenyl)-2-hydroxyethyl]-amino]propyl]-1,3-benzodioxole-2,2-dicarboxylate (CL 316243), a selective beta3-AR agonist, on the basal smooth muscle tone and direct release of nitric oxide (NO) by circular smooth muscle strips of the opossum IAS were determined. We also examined the presence of endothelial nitric oxide synthase (eNOS) protein by Western blot studies. CL 316243 produced a concentration-dependent relaxation of the smooth muscle that remained unmodified by different neurohumoral antagonists. The smooth muscle relaxation by CL 316243 was selectively antagonized by L 748337, a beta3-AR antagonist. Such relaxation was several times longer than by isoproterenol. The effect of CL 316243 was significantly attenuated by a nonselective NOS inhibitor N(omega)-nitro-l-arginine (l-NNA) and by putative inhibitor of eNOS l-N5-(1-iminoethyl)-ornithine dihydrochloride (l-NIO). Inhibitors of iNOS [N-(3-aminomethyl)benzyl acetamide 2HCl] and nNOS [1-[2-(trifluoromethylphenyl)imidazole]] had no effect on this relaxation. Relaxation of the IAS smooth muscle induced by CL 316243 was accompanied by an increased release of NO; this was attenuated by l-NNA and l-NIO. In addition, Western blot studies revealed the presence of eNOS in the circular smooth muscle of the IAS. These data demonstrate potent and protracted IAS smooth muscle relaxation by beta3-AR activation, which is partly transduced via NOS, possibly smooth muscle eNOS. Multiple signal-transduction pathways including NOS activation may explain the characteristic IAS relaxation by beta3-AR activation. The studies may have therapeutic implications in anorectal motility disorders.
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Affiliation(s)
- Kuldip S Banwait
- Department of Medicine, Jefferson Medical College, Thomas Jefferson University, Philadelphia, PA 19107, USA
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Tomiyama Y, Murakami M, Hayakawa K, Akiyama K, Yamazaki Y, Kojima M, Shibata N, Akahane M. Pharmacological profile of KUL-7211, a selective beta-adrenoceptor agonist, in isolated ureteral smooth muscle. J Pharmacol Sci 2003; 92:411-9. [PMID: 12939526 DOI: 10.1254/jphs.92.411] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Abstract
Since, in the human ureter, both beta(2)- and beta(3)-adrenoceptors mediate adrenergic-stimulation-induced relaxation, selective beta(2)-/beta(3)-adrenoceptor agonists might prove clinically useful for relieving ureteral colic and promoting stone passage. We evaluated the beta-adrenoceptor subtype selectivity and ureteral-relaxing efficacy of (-)-2-[4-(2-[[(1S,2R)-2-hydroxy-2-(4-hydroxyphenyl)-1-methylethyl]amin] ethyl)phenyloxy]acetic acid (KUL-7211), a new beta-adrenoceptor agonist, in vitro. In rat isolated organs, its selectivities, for inhibition of spontaneous uterine contraction (mediated via beta(2)-adrenergic stimulation) and inhibition of colonic contraction (via beta(3)-adrenergic stimulation) versus increase in atrial rate (via beta(1)-adrenergic stimulation), were 56.3 and 242.2, respectively. KUL-7211 relaxed 80-mM-KCl-induced tonic contractions in both rabbit (pD(2) value: 5.86 +/- 0.13, whose ureteral relaxation is mediated via beta(2)-adrenergic stimulation) and canine (pD(2) value: 6.52 +/- 0.16, via beta(3)-adrenergic stimulation) isolated ureters in a concentration-dependent manner. These KUL-7211-induced relaxing effects were antagonized by ICI-118,551 (selective beta(2)-adrenoceptor antagonist, pK(B) value: 8.91 +/- 0.24) in the rabbit ureter and by bupranolol (non-selective beta-adernoceptor antagonist, pK(B) value: 6.85 +/- 0.12) in the canine ureter. KUL-7211 also reduced the spontaneous rhythmic contraction in a canine ureteral spiral preparation in a concentration-dependent manner, the pD(2) value being 6.83 +/- 0.20. These data clearly demonstrate that KUL-7211 selectively stimulates both ureteral beta(2)- and beta(3)-adrenoceptors and potently relaxes ureteral smooth muscle. KUL-7211 may be a novel and useful medication for relieving ureteral colic and promoting stone passage in urolithiasis patients.
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Affiliation(s)
- Yoshitaka Tomiyama
- Central Research Laboratory, Kissei Pharmaceutical Co, Ltd, Nagano, Japan.
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Takeda H, Matsuzawa A, Igawa Y, Yamazaki Y, Kaidoh K, Akahane S, Kojima M, Miyata H, Akahane M, Nishizawa O. Functional characterization of beta-adrenoceptor subtypes in the canine and rat lower urinary tract. J Urol 2003; 170:654-8. [PMID: 12853850 DOI: 10.1097/01.ju.0000074622.50255.a8] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE We compared the effect of a beta 3-adrenoceptor (AR) agonist with that of beta 1 and beta 2-AR agonists on the urethra and bladder in the dog and rat. MATERIALS AND METHODS In an in vitro experiment we studied the relaxant effect of subtype selective beta-AR agonists in canine and rat urethral and bladder smooth muscle using an organ bath method. In addition, in urethane anesthetized rats we measured urethral pressure and bladder pressure simultaneously in the presence of the beta 3-agonist CL316243 and the beta 2-agonist procaterol in 4 or 5 animals. RESULTS In the dog the relaxing effects of isoprenaline in the distal urethra were about half those seen in the detrusor and trigone. The rank order of relaxing potency was CL316243 > dobutamine (beta 1-agonist) = procaterol in detrusor and trigone but procaterol > dobutamine = CL316243 in the prostatic and distal urethra. In rat urethral smooth muscle in vitro the corresponding order was procaterol > CL316243 > dobutamine and the maximal relaxation to each agonist was about half that seen in the bladder. In the anesthetized rat procaterol clearly decreased urethral pressure but CL316243 produced only a slight decrease at its maximal dose, although each agonists clearly reduced bladder pressure. The beta 2-antagonist ICI-118551 counteracted the decrease in urethral and bladder pressure induced by procaterol. CONCLUSIONS In rats and dogs a selective beta 3-AR agonist can decrease bladder pressure without affecting urethral pressure.
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Affiliation(s)
- Hiroo Takeda
- Division of Discovery Research, Kissei Pharmaceutical Co., Ltd., Hotaka, Nagano-Prefecture, Japan
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Holst U, Dissing T, Rawashdeh YF, Frokiaer J, Djurhuus JC, Mortensen J. Norepinephrine inhibits the pelvic pressure increase in response to flow perfusion. J Urol 2003; 170:268-71. [PMID: 12796702 DOI: 10.1097/01.ju.0000069824.13258.14] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE We evaluated the effects of norepinephrine on transport pressures in the normal upper urinary tract of the pig during increasing perfusion rates. MATERIALS AND METHODS Anesthetized Danish landrace Yorkshire pigs weighing 38 to 40 kg were studied. Transparenchymally 2, 6Fr catheters were introduced into the left renal pelvis for pressure measurements and perfusion, respectively. An ultrasonic flow probe was inserted around the left renal artery to record blood flow. A 10Fr catheter was placed transurethrally for bladder drainage and the bladder was maintained empty during the entire study. In the 5 group 1 pigs the pelvic pressure increase was examined at increasing perfusion rates of the renal pelvis (2, 4, 6, 8, 10 and 15 ml per minute) in response to endoluminal administration of increasing concentrations of norepinephrine (0, 5, 50 and 100 microg/ml) in saline. In the 5 group 2 pigs the pressure flow study was also done 4 times per animal using isotonic saline. RESULTS Endoluminal norepinephrine had a dose dependent effect on the pressure flow relationship. Perfusion with 5 and 50 microg/ml norepinephrine caused a delayed increase and a decrease in pelvic pressure in response to increasing flow rates, whereas perfusion with 100 microg/ml norepinephrine significantly inhibited and almost eliminated the pressure increase at all perfusion rates compared with saline perfusion. Importantly there were no changes in blood pressure, the heart rate or renal arterial blood flow. In group 2 perfusion with isotonic saline resulted in the same pressure response to increasing flow rates each time. CONCLUSIONS Endoluminal administration of norepinephrine caused a dose dependent inhibition on the pressure phases of the pressure flow relationship of the upper urinary tract in pigs. No systemic changes were observed. These observations may provide a useful adjuvant treatment strategy for upper urinary tract stone treatment and endoscopy.
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Affiliation(s)
- U Holst
- Department of Surgery, Haderslev Sygehus, Haderslev, Denmark
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Tomiyama Y, Murakami M, Akiyama K, Kojima M, Akahane M, Park YC, Kurita T. Modification of ureteral motility and promotion of urine flow around an intraureteral obstruction by CL-316243, phenylephrine, and furosemide in dogs. Neurourol Urodyn 2002; 21:251-7. [PMID: 11948718 DOI: 10.1002/nau.10008] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
The aim of this study was to evaluate the effects of a beta3-adrenoceptor (AR) agonist (CL-316243), an alpha1-AR agonist (phenylephrine), and a loop diuretic (furosemide) on the spontaneous rhythmic contractions of the isolated canine ureter and on an acute ureteral obstruction produced by inflation of a balloon catheter in anesthetized dogs. In the isolated ureter, CL-316243 concentration dependently reduced both the amplitude and frequency of the rhythmic contractions (pD(2): 7.19 +/- 0.33), whereas phenylephrine significantly enhanced both variables (pD(2): 5.26 +/- 0.09) and furosemide reduced them only slightly. In the acute ureteral obstruction model, the intraureteral pressure (IUP) gradually rose to reach a plateau of 58.9 mm Hg after inflation of a balloon catheter within the lower ureter. Intravenous administration of CL-316243 (0.3 microg/kg) significantly reduced the elevated IUP and the resumed urine flow (UF), leading to a sustained reduction in the IUP. In contrast, the IUP continued to increase above the plateau level for 10 minutes after phenylephrine administration (10 microg/kg) and for 30 minutes after furosemide administration (1,000 microg/kg). In the phenylephrine group, the UF resumed when the IUP reached 75.8 mm Hg, and thereafter the IUP gradually decreased in parallel with the increase in the UF. From these results, we conclude that in dogs, CL-316243 reduces the IUP by allowing the UF to resume as a result of a relaxation of ureter at the obstruction site, whereas with phenylephrine, the reduction in the IUP is secondary to a resumption in the UF resulting from an induced contraction of ureter that causes an increase in hydrostatic pressure above the obstruction site.
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Affiliation(s)
- Yoshitaka Tomiyama
- Pharmacology Research and Development, Kissei Pharmaceutical Co. Ltd., Nagano, Japan.
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EFFECTS OF ISOPROTERENOL AND BUTYLSCOPOLAMINE ON THE FRICTION BETWEEN AN ARTIFICIAL STONE AND THE INTRAURETERAL WALL IN ANESTHETIZED RABBITS. J Urol 2001. [DOI: 10.1097/00005392-200109000-00088] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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MIYATAKE RYUICHIRO, TOMIYAMA YOSHITAKA, MURAKAMI MAKOTO, PARK YOUNGCHOL, KURITA TAKASHI. EFFECTS OF ISOPROTERENOL AND BUTYLSCOPOLAMINE ON THE FRICTION BETWEEN AN ARTIFICIAL STONE AND THE INTRAURETERAL WALL IN ANESTHETIZED RABBITS. J Urol 2001. [DOI: 10.1016/s0022-5347(05)65926-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- RYUICHIRO MIYATAKE
- From the Department of Urology, Kinki University School of Medicine, Osaka and Pharmacology Research R&D, Kissei Pharmaceutical Co., Ltd., Nagano, Japan
| | - YOSHITAKA TOMIYAMA
- From the Department of Urology, Kinki University School of Medicine, Osaka and Pharmacology Research R&D, Kissei Pharmaceutical Co., Ltd., Nagano, Japan
| | - MAKOTO MURAKAMI
- From the Department of Urology, Kinki University School of Medicine, Osaka and Pharmacology Research R&D, Kissei Pharmaceutical Co., Ltd., Nagano, Japan
| | - YOUNG-CHOL PARK
- From the Department of Urology, Kinki University School of Medicine, Osaka and Pharmacology Research R&D, Kissei Pharmaceutical Co., Ltd., Nagano, Japan
| | - TAKASHI KURITA
- From the Department of Urology, Kinki University School of Medicine, Osaka and Pharmacology Research R&D, Kissei Pharmaceutical Co., Ltd., Nagano, Japan
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