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Lv R, Li M, Chen X, Li S, Cao N, Gu B. Serotonin (5-HT) 2A/2C receptor agonist 2,5-dimethoxy-4-iodophenyl-2-aminopropane hydrochloride improves detrusor sphincter dyssynergia by inhibiting L-type voltage-gated calcium channels in spinal cord injured rats. CNS Neurosci Ther 2024; 30:e14890. [PMID: 39097910 PMCID: PMC11298198 DOI: 10.1111/cns.14890] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2024] [Revised: 06/11/2024] [Accepted: 07/17/2024] [Indexed: 08/06/2024] Open
Abstract
AIMS To explore the role of voltage-gated calcium channels (VGCC) in 5-HT2A/2C receptor agonist 2,5-dimethoxy-4-iodophenyl-2-aminopropane hydrochloride's improvement of spinal cord injury (SCI) induced detrusor sphincter dyssynergia and the expressions of the 5-hydroxy tryptamine (5-HT) 2A receptors and VGCCs in lumbosacral cord after SCI. METHODS Female Sprague-Dawley rats were randomized into normal control group and SCI group (N = 15 each). Cystometrogram (CMG), simultaneous CMG, and external urethral sphincter electromyography (EUS-EMG) were conducted in all groups under urethane anesthesia. Drugs were administered intrathecally during CMG and EUS-EMG. Rats were euthanized and L6-S1 spinal cord were acquired for immunofluorescence. RESULTS In SCI rats, intrathecal administration of 2,5-dimethoxy-4-iodophenyl-2-aminopropane hydrochloride or L-type VGCC blocker, nifedipine, could significantly increase voiding volume, voiding efficiency, and the number of high-frequency oscillations. They could also prolong EUS bursting activity duration on EUS-EMG. Moreover, the effect of 2,5-dimethoxy-4-iodophenyl-2-aminopropane hydrochloride can be eliminated with the combined administration of L-type VGCC agonist, (±)-Bay K 8644. No significant differences were observed in CMG after intrathecal administration of T-type VGCC blocker TTA-P2. Additionally, immunofluorescence of the lumbosacral cord in control and SCI rats showed that the 5-HT2A receptor and Cav1.2 immunolabeling-positive neurons in the anterior horn of the lumbosacral cord were increased in SCI rats. CONCLUSIONS Our study demonstrated that 5-HT2A/2C agonist 2,5-dimethoxy-4-iodophenyl-2-aminopropane hydrochloride may improve SCI-induced DSD by inhibiting the L-type voltage-gated calcium channel in lumbosacral cord motoneurons.
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Affiliation(s)
- Rong Lv
- Department of UrologyShanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of MedicineShanghaiChina
| | - Mingzhuo Li
- Department of UrologyShanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of MedicineShanghaiChina
| | - Xun Chen
- Department of UrologyShanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of MedicineShanghaiChina
| | - Shengtian Li
- Bio‐X Institutes, Key laboratory for the Genetics of Developmental and Neuropsychiatric Disorders (Ministry of Education), Shanghai Key Laboratory of Psychotic Disorders, Brain Science and Technology Research CenterShanghai Jiao Tong UniversityShanghaiChina
| | - Nailong Cao
- Department of UrologyShanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of MedicineShanghaiChina
| | - Baojun Gu
- Department of UrologyShanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of MedicineShanghaiChina
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Li M, Xu M, Zhou H, Pan Y, Liu X. The association between different levels of depression and overactive bladder: A cross-sectional study of the 2005-2018 National Health and Nutrition Examination Survey. Neurourol Urodyn 2024. [PMID: 39032101 DOI: 10.1002/nau.25563] [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: 05/10/2024] [Revised: 07/05/2024] [Accepted: 07/10/2024] [Indexed: 07/22/2024]
Abstract
BACKGROUND There is growing evidence of a possible correlation between depression and overactive bladder (OAB). However, few studies have classified depression according to its severity. Whether there is an association between different levels of depression and OAB symptoms remains unclear. METHODS Participants with complete information about depression, OAB, and covariates in the National Health and Nutrition Examination Survey (NHANES) 2005-2018 were included in this study. Depression symptoms were assessed by the Patient Health Questionnaire-9. OAB symptoms were evaluated by the Overactive Bladder Symptom Score. Weighted multivariate logistic regression models were applied to analyze the relationship between depression and OAB. RESULTS A total of 30 359 participants were included in this study, consisting of 6245 OAB patients and 24 114 non-OAB participants. The multivariate logistic regression suggested depression independently correlated with OAB (odds ratio [OR] = 2.764, 95% confidence interval [CI] = 2.429-3.146, p < 0.001). Further, mild (OR = 2.355, 95% CI = 2.111-2.627, p < 0.001), moderate (OR = 3.262, 95% CI = 2.770-3.841, p < 0.001), and moderately severe to severe depression (OR = 3.927, 95% CI = 3.246-4.752, p < 0.001) were all associated with OAB. Additionally, depression was also correlated with urgency urinary incontinence (OR = 2.249, 95% CI = 1.986-2.548, p < 0.001) and nocturia (OR = 2.166, 95% CI = 1.919-2.446, p < 0.001). CONCLUSION This study indicated different levels of depression, even mild depression, were independent risk factors for OAB. Given the frequent coexistence and potential interactions between depression and OAB, clinicians should be aware of the importance of assessing both physical and psychological symptoms in these patients. Early diagnosis and holistic treatment may improve the treatment outcomes, particularly for those suffering from both conditions.
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Affiliation(s)
- Muwei Li
- Department of Urology, Tianjin Medical University General Hospital, Tianjin, China
| | - Mingming Xu
- Department of Urology, Tianjin Medical University General Hospital, Tianjin, China
| | - Hang Zhou
- Department of Urology, Tianjin Medical University General Hospital, Tianjin, China
| | - Yang Pan
- Department of Urology, Tianjin Medical University General Hospital, Tianjin, China
| | - Xiaoqiang Liu
- Department of Urology, Tianjin Medical University General Hospital, Tianjin, China
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Zhang Y, Wu X, Liu G, Feng X, Jiang H, Zhang X. Association between overactive bladder and depression in American adults: A cross-sectional study from NHANES 2005-2018. J Affect Disord 2024; 356:545-553. [PMID: 38642902 DOI: 10.1016/j.jad.2024.04.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Revised: 03/12/2024] [Accepted: 04/08/2024] [Indexed: 04/22/2024]
Abstract
BACKGROUND AND AIM Overactive bladder (OAB) and depression are both common disorders and there is research suggesting an association between the two, but there is a lack of studies with large samples. The aim of this study is to investigate the association between OAB and depressive symptoms. METHODS We used data from the National Health and Nutrition Examination Survey (NHANES) database for the period 2005 to 2018. OAB was characterized by the Overactive Bladder Symptom Score (OABSS, score > 3) and depression was diagnosed by the Patient Health Questionnaire (PHQ-9, score ≥ 10). There were three models employed in our analysis: (1) Crude model was unadjusted; (2) Model 1 was adjusted for age, sex, race/ethnicity, educational level, and marital status; (3) Model 2 was adjusted for factors in Model 1 plus the remained potential covariates. We used survey-weighted logistic regression models to assess the association between OAB and depression. Subsequently, subgroup analyses and smoothed curve analyses were used to evaluate the reliability of the findings. RESULTS Finally, a total of 6612 participants were included in our study, consisting of 1005 participants with diagnosis of OAB and 5607 participants without diagnosis of OAB. After adjusting for all covariates, there was a significant positive association between OAB and depression (OR: 2.89, 95 % CI: 1.91, 4.37). The severity of OAB was also positively associated with depression. Compared to participants without OAB, the fully adjusted ORs for depression were 2.76 (95 % CI: 1.64, 4.65) for those with mild OAB, 3.79 (95 % CI: 1.68, 8.55) for those with moderate OAB, and 5.21 (95 % CI: 1.39, 19.53) for those with severe OAB. CONCLUSIONS This study revealed a strong association between OAB and depression and a progressive increase in the risk of depression as the severity of OAB (mild, moderate, and severe) increased. Therefore, it is important for clinicians to recognize the assessment of OAB symptoms in patients who are at risk for or have developed depressive symptoms, as well as the mental health of patients with OAB.
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Affiliation(s)
- Yuyang Zhang
- Department of Urology, The First Affiliated Hospital of Anhui Medical University, Anhui Province, China; Institute of Urology, The First Affiliated Hospital of Anhui Medical University, Anhui Province, China; Anhui Province Key Laboratory of Urological and Andrological Diseases Research and Medical Transformation, Anhui Medical University, Anhui Province, China
| | - Xu Wu
- Department of Urology, The First Affiliated Hospital of Anhui Medical University, Anhui Province, China; Institute of Urology, The First Affiliated Hospital of Anhui Medical University, Anhui Province, China; Anhui Province Key Laboratory of Urological and Andrological Diseases Research and Medical Transformation, Anhui Medical University, Anhui Province, China
| | - Guodong Liu
- Department of Urology, The First Affiliated Hospital of Anhui Medical University, Anhui Province, China; Institute of Urology, The First Affiliated Hospital of Anhui Medical University, Anhui Province, China; Anhui Province Key Laboratory of Urological and Andrological Diseases Research and Medical Transformation, Anhui Medical University, Anhui Province, China
| | - Xingliang Feng
- Department of Urology, The Third Affiliated Hospital of Soochow University, Changzhou, Jiangsu, China.
| | - Hui Jiang
- Department of Urology, Peking University First Hospital Institute of Urology, Peking University Andrology Center, Beijing, China.
| | - Xiansheng Zhang
- Department of Urology, The First Affiliated Hospital of Anhui Medical University, Anhui Province, China; Institute of Urology, The First Affiliated Hospital of Anhui Medical University, Anhui Province, China; Anhui Province Key Laboratory of Urological and Andrological Diseases Research and Medical Transformation, Anhui Medical University, Anhui Province, China.
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Zhang D, Yan Z, He J, Yao Y, Liu K. The exposure to volatile organic compounds associate positively with overactive bladder risk in U.S. adults: a cross-sectional study of 2007-2020 NHANES. Front Public Health 2024; 12:1374959. [PMID: 38912261 PMCID: PMC11190323 DOI: 10.3389/fpubh.2024.1374959] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Accepted: 05/27/2024] [Indexed: 06/25/2024] Open
Abstract
Objective The aim of this study was to comprehensively investigate the potential relationship between blood volatile organic compounds (VOCs) and overactive bladder (OAB) risk. Methods A total of 11,183 participants from the 2007-2020 National Health and Nutrition Examination Survey (NHANES) were included in this cross-sectional study. We used multivariate logistic regression models to investigate the relationship between nine blood VOCs and OAB risk. Restricted cubic spline (RCS) analysis was used to investigate the dose-response relationship between blood VOCs and OAB. In addition, the overall association of blood VOCs with OAB risk was assessed by weighted quantile sum (WQS) regression model. Finally, we conducted subgroup analyses to explore the findings in different high-risk populations. Results After adjusting for potential confounders, logistic regression analysis revealed that blood 2,5-dimethylfuran (aOR = 2.940, 95% CI: 1.096-7.890, P = 0.032), benzene (aOR = 1.460, 95% CI: 1.044-2.043, P = 0.027) and furan (aOR = 9.426, 95% CI: 1.421-62.500, P = 0.020) were positively independent associated with the risk of OAB. And dose-response risk curves indicated that 2,5-dimethylfuran, benzene and furan in the blood were linearly positive associated with OAB risk. WQS regression analysis showed that exposure to mixed blood VOCs increased the risk of OAB (OR = 1.29, 95% CI: 1.11-1.49), with furans having the greatest weight. In subgroup analyses, we found that OAB was more susceptible to blood VOCs in young and middle-aged, male, non-hypertensive, and alcohol-drinking populations. Conclusions The results of this study indicate that high exposure to VOCs is independently and positively associated with OAB risk in U.S. adults, particularly 2,5-dimethylfuran, benzene, and furan. In addition, age, gender, hypertension and alcohol consumption may influence the association. Our study provided novel epidemiologic evidence to explore the potential role of environmental pollutants in OAB.
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Affiliation(s)
| | | | | | - Yunmin Yao
- Department of Urology, The Fifth People's Hospital of Wujiang District, Suzhou, China
| | - Kai Liu
- Department of Urology, The Fifth People's Hospital of Wujiang District, Suzhou, China
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Giorgioni G, Bonifazi A, Botticelli L, Cifani C, Matteucci F, Micioni Di Bonaventura E, Micioni Di Bonaventura MV, Giannella M, Piergentili A, Piergentili A, Quaglia W, Del Bello F. Advances in drug design and therapeutic potential of selective or multitarget 5-HT1A receptor ligands. Med Res Rev 2024. [PMID: 38808959 DOI: 10.1002/med.22049] [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: 12/21/2023] [Revised: 03/14/2024] [Accepted: 05/03/2024] [Indexed: 05/30/2024]
Abstract
5-HT1A receptor (5-HT1A-R) is a serotoninergic G-protein coupled receptor subtype which contributes to several physiological processes in both central nervous system and periphery. Despite being the first 5-HT-R identified, cloned and studied, it still represents a very attractive target in drug discovery and continues to be the focus of a myriad of drug discovery campaigns due to its involvement in numerous neuropsychiatric disorders. The structure-activity relationship studies (SAR) performed over the last years have been devoted to three main goals: (i) design and synthesis of 5-HT1A-R selective/preferential ligands; (ii) identification of 5-HT1A-R biased agonists, differentiating pre- versus post-synaptic agonism and signaling cellular mechanisms; (iii) development of multitarget compounds endowed with well-defined poly-pharmacological profiles targeting 5-HT1A-R along with other serotonin receptors, serotonin transporter (SERT), D2-like receptors and/or enzymes, such as acetylcholinesterase and phosphodiesterase, as a promising strategy for the management of complex psychiatric and neurodegenerative disorders. In this review, medicinal chemistry aspects of ligands acting as selective/preferential or multitarget 5-HT1A-R agonists and antagonists belonging to different chemotypes and developed in the last 7 years (2017-2023) have been discussed. The development of chemical and pharmacological 5-HT1A-R tools for molecular imaging have also been described. Finally, the pharmacological interest of 5-HT1A-R and the therapeutic potential of ligands targeting this receptor have been considered.
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Affiliation(s)
- Gianfabio Giorgioni
- Medicinal Chemistry Unit, School of Pharmacy, University of Camerino, Camerino, Italy
| | - Alessandro Bonifazi
- Medicinal Chemistry Section, Molecular Targets and Medications Discovery Branch, National Institute on Drug Abuse - Intramural Research Program, National Institutes of Health, Baltimore, Maryland, USA
| | - Luca Botticelli
- Pharmacology Unit, School of Pharmacy, University of Camerino, Camerino, Italy
| | - Carlo Cifani
- Pharmacology Unit, School of Pharmacy, University of Camerino, Camerino, Italy
| | - Federica Matteucci
- Medicinal Chemistry Unit, School of Pharmacy, University of Camerino, Camerino, Italy
| | | | | | - Mario Giannella
- Medicinal Chemistry Unit, School of Pharmacy, University of Camerino, Camerino, Italy
| | | | - Alessia Piergentili
- Medicinal Chemistry Unit, School of Pharmacy, University of Camerino, Camerino, Italy
| | - Wilma Quaglia
- Medicinal Chemistry Unit, School of Pharmacy, University of Camerino, Camerino, Italy
| | - Fabio Del Bello
- Medicinal Chemistry Unit, School of Pharmacy, University of Camerino, Camerino, Italy
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Smith AL, Berry A, Brubaker L, Cunningham SD, Gahagan S, Low LK, Mueller M, Sutcliffe S, Williams BR, Brady SS. The brain, gut, and bladder health nexus: A conceptual model linking stress and mental health disorders to overactive bladder in women. Neurourol Urodyn 2024; 43:424-436. [PMID: 38078701 PMCID: PMC10872494 DOI: 10.1002/nau.25356] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Revised: 09/28/2023] [Accepted: 11/25/2023] [Indexed: 02/06/2024]
Abstract
OBJECTIVE A small, but growing literature links stressors and mental health disorders (MHDs) across the life course to overactive bladder (OAB) and urinary incontinence symptoms. Mechanisms by which stressors and MHDs may impact bladder health are not fully understood, limiting novel prevention and treatment efforts. Moreover, potential biopsychosocial mechanisms involving the brain and gut have not been considered in an integrated, comprehensive fashion. METHODS Members of the prevention of lower urinary tract symptoms Research Consortium developed conceptual models to inform research on biopsychosocial mechanisms through which stress and MDHs may impact bladder health among girls and women, focusing on brain and gut physiology. RESULTS Two conceptual models were developed-one to explain central (brain-based) and peripheral (gut-based) mechanisms linking stressors and MHDs to OAB and bladder health, and one to highlight bidirectional communication between the brain, gut, and bladder. Traumatic events, chronic stressors, and MHDs may lead to a maladaptive stress response, including dysregulated communication and signaling between the brain, gut, and bladder. Gut bacteria produce molecules and metabolites that alter production of neurotransmitters, amino acids, short-chain fatty acids, and inflammatory immune response molecules that mediate communication between the gut and brain. Microbiota signal neurogenesis, microglia maturation, and synaptic pruning; they also calibrate brain-gut-bladder axis communication through neurotransmission and synaptogenesis, potentially influencing bladder symptom development. Life course trajectories of risk may be prevented or interrupted by central and peripheral resources for neuropsychological resilience. CONCLUSIONS Depicted pathways, including brain-gut-bladder communication, have implications for research and development of novel prevention and treatment approaches.
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Affiliation(s)
- Ariana L. Smith
- Division of Urology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | - Amanda Berry
- Division of Urology, Children’s Hospital of Philadelphia, Philadelphia, PA
| | - Linda Brubaker
- Department of Obstetrics, Gynecology, and Reproductive Sciences, UC San Diego School of Medicine, University of California San Diego, La Jolla, California
| | - Shayna D. Cunningham
- Department of Public Health Sciences, University of Connecticut School of Medicine, Farmington, CT
| | - Sheila Gahagan
- Department of Pediatrics, UC San Diego School of Medicine, University of California, San Diego CA
| | - Lisa Kane Low
- Department of Health Behavior and Biological Sciences, School of Nursing, University of Michigan
| | - Margaret Mueller
- Department of Ob/Gyn, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Siobhan Sutcliffe
- Division of Public Health Sciences, Department of Surgery, Washington University in St. Louis, St. Louis, MO
| | - Beverly R. Williams
- Department of Medicine, Division of Gerontology, Geriatrics and Palliative Care, University of Alabama at Birmingham (UAB) and Birmingham/Atlanta Geriatric Research, Education, and Clinical Center, Department of Veterans Affairs
| | - Sonya S. Brady
- Division of Epidemiology & Community Health, University of Minnesota School of Public Health, Minneapolis, MN
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Lin CY, Li K, Thalluri R, Lee YS. Upregulated 5-HT 1A Receptors Regulate Lower Urinary Tract Function in Rats after Complete Spinal Cord Injury. J Neurotrauma 2023; 40:845-861. [PMID: 36762948 PMCID: PMC10162122 DOI: 10.1089/neu.2022.0329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/11/2023] Open
Abstract
Spinal cord injury (SCI) above the lumbosacral level often leads to dysfunction of the lower urinary tract (LUT) including detrusor hyper-reflexia, wherein bladder compliance is low, baseline pressures are increased, and filling is accompanied by numerous non-voiding contractions (NVCs) referred to as neurogenic detrusor overactivity. Here, we investigate the expression levels of the serotonin 1A (5-HT1A) receptor in segments both rostral and caudal to the injured site, as well as the effects on micturition of blocking 5-HT1A receptor using pharmacological interventions in spinally intact rats or T8 complete SCI rats. The activities of detrusor and external urethral sphincter (EUS) were assessed with the rats in a conscious condition. Adult female rats were divided into two groups: (1) sham control (T8 laminectomy only) and (2) T8 complete spinal cord transection. The observation period was 2 months after the original SCI. In Western blot analyses, we identified significant upregulation of the 5-HT1A receptor in the T10-L2 and L6/S1 segments after chronic complete SCI. In pharmacological studies, a dose-response study of the 5-HT1A receptor antagonist, WAY100635, indicated alterations in detrusor and EUS activities in spinally intact rats. Interestingly, blocking the 5-HT1A receptor alone resulted in inhibitory effects on NVCs with a reduced number and decreased amplitude, but in an increased interval between NVCs in SCI rats. In addition, the duration of EUS bursting was also significantly increased by WAY100635. These inhibitory effects of WAY100635 on NVCs were diminished by subsequent application of a beta-adrenergic blocker (propranolol). The reduction of NVCs observed by WAY100635 may be the result of blocking the constitutive activities of the 5-HT1A receptor but activating the beta-adrenergic sympathetic pathway, which in turn relaxes bladder activity. Together, the neuroplasticity of the 5-HT1A receptor can be a potential therapeutic target for treatment of bladder dysfunction after SCI.
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Affiliation(s)
- Ching-Yi Lin
- Department of Neurosciences, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Kevin Li
- Department of Neurosciences, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Rajaa Thalluri
- Department of Neurosciences, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Yu-Shang Lee
- Department of Neurosciences, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio, USA
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Ren J, Yu T, Tian Y, Luo G. Comparative effectiveness of interventions for managing urological postoperative catheter-related bladder discomfort: a systematic review and network meta-analysis. BMC Urol 2023; 23:29. [PMID: 36869313 PMCID: PMC9985303 DOI: 10.1186/s12894-023-01195-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Accepted: 02/20/2023] [Indexed: 03/05/2023] Open
Abstract
BACKGROUND Catheter-related bladder discomfort (CRBD) is a common postoperative bladder pain syndrome. Many drugs and interventions for managing CRBD have been studied, but their comparative effectiveness remains controversial. We made a study to assess the comparative effectiveness of interventions included Ketorolac, Lidocaine, Chlorpheniramine, Gabapentin, Magnesium, Nefopam, Oxycodone, Parecoxib, Solifenacin, Tolterodine, Bupivancaine, Dexmedetomidine, Hyoscine N-butyl bromide, Ketamine, Penile nerve block on urological postoperative CRBD. METHODS We performed a network meta-analysis via Aggregate Data Drug Inormation System software included 18 studies with 1816 patients and assessed the risk of bias by Cochrane Collaboration tool. The incidence of moderate to severe CRBD at 0, 1, and 6 h after surgery and the incidence severe CRBD at 1 h after surgery were compared. RESULT The number of best rank is 0.48(Nefopam) and 0.22(Nefopam) in the incidence of moderate to severe CRBD at 1 h and incidence severe CRBD at 1 h. More than half of studies at unclear or high risk of bias. CONCLUSION Nefopam reduced the incidence of CRBD and prevented severe events, but limited by the small number of studies for each intervention and heterogeneous patients.
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Affiliation(s)
- Jingwen Ren
- Department of Urology, Guizhou Province People's Hospital, Guiyang, China
| | - Ting Yu
- Evidence-Based Nursing Center, West China Hospital, Sichuan University/West China School of Nursing, Sichuan University, Chengdu, China
| | - Ye Tian
- Department of Urology, Guizhou Province People's Hospital, Guiyang, China.
| | - Guangheng Luo
- Department of Urology, Guizhou Province People's Hospital, Guiyang, China.
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Jung J, Kim A, Yang SH. The Innovative Approach in Functional Bladder Disorders: The Communication Between Bladder and Brain-Gut Axis. Int Neurourol J 2023; 27:15-22. [PMID: 37015721 PMCID: PMC10072998 DOI: 10.5213/inj.2346036.018] [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: 02/03/2023] [Accepted: 02/21/2023] [Indexed: 04/06/2023] Open
Abstract
Functional bladder disorders including overactive bladder and interstitial cystitis may induce problems in many other parts of our body such as brain and gut. In fact, diagnosis is often less accurate owing to their complex symptoms. To have correct diagnosis of these diseases, we need to understand the pathophysiology behind overlapped clinical presentation. First, we focused on reviewing literatures that have reported the link between bladder and brain, as the patients with bladder disorders frequently accompanied mood disorders such as depression and anxiety. Second, we reviewed literatures that have described the relationship between bladder and gut. There exist many evidences of patients who suffered from both bladder and intestinal diseases, such as irritable bowel syndrome and inflammatory bowel disease, at the same time. Furthermore, the interaction between brain and gut, well-known as brain-gut axis, might be a key factor that could change the activity of bladder and vice versa. For example, the affective disorders could alter the activity of efferent nerves or autonomic nervous system that modulate the gut itself and its microbiota, which might cause the destruction of homeostasis in bladder eventually. In this way, the communication between bladder and brain-gut axis might affect permeability, inflammation, as well as infectious etiology and dysbiosis in bladder diseases. In this review, we aimed to find an innovative insight of the pathophysiology in the functional bladder disorders, and we could provide a new understanding of the overlapped clinical presentation by elucidating the pathophysiology of functional bladder disorders.
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Affiliation(s)
- Jiwon Jung
- Department of Biomedical Engineering, College of Life Science and Biotechnology, Dongguk University, Seoul, Korea
| | - Aram Kim
- Department of Urology, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Korea
| | - Seung-Hoon Yang
- Department of Biomedical Engineering, College of Life Science and Biotechnology, Dongguk University, Seoul, Korea
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Initiating daily acute intermittent hypoxia (dAIH) therapy at 1-week after contusion spinal cord injury (SCI) improves lower urinary tract function in rat. Exp Neurol 2023; 359:114242. [PMID: 36240880 DOI: 10.1016/j.expneurol.2022.114242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2022] [Revised: 09/15/2022] [Accepted: 10/05/2022] [Indexed: 11/07/2022]
Abstract
Spinal cord injury (SCI) above the level of the lumbosacral spinal cord produces lower urinary tract (LUT) dysfunction, resulting in impairment of urine storage and elimination (voiding). While spontaneous functional recovery occurs due to remodeling of spinal reflex micturition pathways, it is incomplete, indicating that additional strategies to further augment neural plasticity following SCI are essential. To this end, acute intermittent hypoxia (AIH) exposure has been proposed as a therapeutic strategy for improving recovery of respiratory and other somatic motor function following SCI; however, the impact of AIH as a therapeutic intervention to improve LUT dysfunction remains to be determined. Therefore, we examined the effects of daily AIH (dAIH) on both spontaneous micturition patterns and reflex micturition event (rME) behaviors in adult female Sprague-Dawley rats with mid-thoracic moderate contusion SCI. For these experiments, dAIH gas exposures (five alternating 3 min 12% O2 and 21% O2 episodes) were delivered for 7 consecutive days beginning at 1-week after SCI, with awake micturition patterns being evaluated weekly for 2-3 sessions before and for 4 weeks after SCI and rME behaviors elicited by continuous infusion of saline into the bladder being evaluated under urethane anesthesia at 4-weeks after SCI; daily normoxia (dNx; 21% O2 episodes) served as a control. At 1-week post-SCI, both an areflexic phenotype (i.e., no effective voiding events) and a functional voiding phenotype (i.e., infrequent voiding events with large volumes) were observed in spontaneous micturition patterns (as expected), and subsequent dAIH, but not dNx, treatment led to recovery of spontaneous void frequency pattern to pre-SCI levels; both dAIH- and dNx-treated rats exhibited slightly increased void volumes. At 4-weeks post-SCI, rME behaviors showed increased effectiveness in voiding in dAIH-treated (compared to dNx-treated) rats that included an increase in both bladder contraction pressure (delta BP; P = 0.014) and dynamic voiding efficiency (P = 0.018). Based on the voiding and non-voiding bladder contraction behaviors (VC and NVC, respectively) observed in the BP records, bladder dysfunction severity was classified into mild, moderate, and severe phenotypes, and while rats in both treatment groups included each severity phenotype, the primary phenotype observed in dAIH-treated rats was mild and that in dNx-treated rats was moderate (P = 0.044). Taken together, these findings suggest that 7-day dAIH treatment produces beneficial improvements in LUT function that include recovery of micturition pattern, more efficient voiding, and decreased NVCs, and extend support to the use of dAIH therapy to treat SCI-induced LUT dysfunction.
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Li M, Chen X, Cao N, lv R, Gu B. Improvement of urethral dysfunction by 5‐HT
1A
receptor agonist NLX‐112 in diabetic rats. Neurourol Urodyn 2022; 41:1528-1538. [PMID: 35870169 DOI: 10.1002/nau.24993] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Revised: 04/30/2022] [Accepted: 06/04/2022] [Indexed: 11/07/2022]
Affiliation(s)
- Mingzhuo Li
- Department of Urology Shanghai Jiao Tong University Affiliated Sixth People's Hospital Shanghai China
| | - Xun Chen
- Department of Urology Shanghai Jiao Tong University Affiliated Sixth People's Hospital Shanghai China
| | - Nailong Cao
- Department of Urology Shanghai Jiao Tong University Affiliated Sixth People's Hospital Shanghai China
| | - Rong lv
- Department of Urology Shanghai Jiao Tong University Affiliated Sixth People's Hospital Shanghai China
| | - Baojun Gu
- Department of Urology Shanghai Jiao Tong University Affiliated Sixth People's Hospital Shanghai China
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12
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Voiding and storage symptoms in depression/anxiety. Auton Neurosci 2021; 237:102927. [PMID: 34923228 DOI: 10.1016/j.autneu.2021.102927] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Revised: 09/27/2021] [Accepted: 12/05/2021] [Indexed: 12/11/2022]
Abstract
We here described the frequency and nature of voiding and storage bladder symptoms in depression/anxiety, for which we propose the name "bladder somatic symptom disorder (SSD)" because such symptoms most probably have brain mechanisms. SSD was formerly called as various terms including "somatoform disorder", "medically unexplained physical symptoms", "functional somatic syndrome" and "hysterical neurosis/hysteria". Bladder SSD has the following specific features that are distinguishable from "true" neurologic/organic bladder dysfunction: 1) situation-dependence (close association with life event in some), 2) urodynamically increased bladder sensation/hypersensitivity and 3) absence of neurologic/organic diseases, in addition to 4) other stress symptoms (insomnia, etc.), are key clues to the possibility of bladder SSD. Urodynamics in these patients showed, to a lesser extent, underactive bladder without post-void residual. These findings might reflect the biological changes of the depressive brain; e.g., decreases in serotonin and GABA, and possible increases in CRH. Treatment of bladder SSD can follow that of general depression/anxiety, with the potential addition of anticholinergic or selective beta3 bladder drugs.
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Liberation of Serotonin Is Not Unaffected by Acetylcholine in Rat Hippocampus. Int Neurourol J 2021; 25:S114-119. [PMID: 34844394 PMCID: PMC8654309 DOI: 10.5213/inj.2142350.175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Accepted: 11/20/2021] [Indexed: 11/15/2022] Open
Abstract
Purpose Raised cerebral titers of acetylcholine have notable links with storage symptomatology related to lower urinary tract symptoms. The hippocampus contributes to the normal control of continence in the majority of instances (circuit 3). Owing to synaptic connections with other nerve cells, acetylcholine affects the micturition pathway via the liberation of additional cerebral neurotransmitters. Despite the fact that cerebral serotonin is a key inhibitor of reflex bladder muscle contractions, the influence of acetylcholine on its liberation is poorly delineated. The current research was conducted in order to explore the role of acetylcholine in serotonin liberation from sections of rat hippocampus in order to improve the comprehension of the relationship between cholinergic and serotonergic neurons. Methods Hippocampal sections from 6 mature male Sprague-Dawley rats were equilibrated over a 30-minute period in standard incubation medium so as to facilitate [3H]5-hydroxytryptamine (5-HT) uptake. The cerebral neurotransmitter, acetylcholine, was applied to the sections. Aliquots of drained medium solution were utilized in order to quantify the radioactivity associated with [3H]5-HT liberation; any alterations in this parameter were noted. Results When judged against the controls, [3H]5-HT liberation from the hippocampal sections remained unaltered following the administration of acetylcholine, implying that this agent has no inhibitory action on this process. Conclusions Serotonin liberation from murine hippocampal sections is unaffected by acetylcholine. It is postulated that the bladder micturition reflex responds to acetylcholine through its immediate cholinergic activity rather than by its influence on serotonin release. These pathways are a promising target for the design of de novo therapeutic agents.
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Dinesh AA, Helena Pagani Soares Pinto S, Brunckhorst O, Dasgupta P, Ahmed K. Anxiety, depression and urological cancer outcomes: A systematic review. Urol Oncol 2021; 39:816-828. [PMID: 34503900 DOI: 10.1016/j.urolonc.2021.08.003] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2021] [Revised: 07/25/2021] [Accepted: 08/05/2021] [Indexed: 11/25/2022]
Abstract
PURPOSE The interplay between physical and mental aspects of a cancer diagnosis are well recognised. However, little consensus exists on the impact of depression and anxiety on urological cancer outcomes. Therefore, this systematic review aimed to investigate the relationship between these conditions and functional or oncological outcomes in urological malignancy. MATERIALS AND METHODS A systematic search was conducted using PubMed, Embase, PsycINFO and Global Health databases up to June 2020. Studies evaluating the relationship of anxiety and depression disorders or symptoms on functional and mortality outcomes were included. Outcome measures included validated urinary, sexual, body image questionnaire scores and all-cause or disease-specific mortality. RESULTS Of 3,966 studies screened, 25 studies with a total of 175,047 urological cancer patients were included. Significant anxiety and depressive symptoms and disorders were found to impact functional outcomes in several cancer types. A consistent negative association existed for sexual function in prostate, testicular and penile cancer patients. Additionally, poorer urinary function scores were seen in prostate cancer, with increased body image issues in testicular and prostate cancer. Importantly, both overall and disease-specific mortality outcomes were poorer in bladder and prostate cancer patients. CONCLUSIONS Co-existing depression and anxiety appears to be negatively associated with functional and mortality outcomes in urological cancers. This appears especially evident in male cancers, including prostate and testicular cancer. Although not proving causation, these findings highlight the importance of considering mental wellbeing during follow-up for early recognition and treatment. However, current evidence remains heterogenous, with further studies required exploring patients at risk.
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Affiliation(s)
- Ayushi Anna Dinesh
- MRC Centre for Transplantation, Guy's Hospital Campus, King's College London, King's Health Partners, London, United Kingdom
| | | | - Oliver Brunckhorst
- MRC Centre for Transplantation, Guy's Hospital Campus, King's College London, King's Health Partners, London, United Kingdom
| | - Prokar Dasgupta
- MRC Centre for Transplantation, Guy's Hospital Campus, King's College London, King's Health Partners, London, United Kingdom
| | - Kamran Ahmed
- MRC Centre for Transplantation, Guy's Hospital Campus, King's College London, King's Health Partners, London, United Kingdom; Department of Urology, King's College Hospital, London, United Kingdom.
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Delivery of the 5-HT 2A Receptor Agonist, DOI, Enhances Activity of the Sphincter Muscle during the Micturition Reflex in Rats after Spinal Cord Injury. BIOLOGY 2021; 10:biology10010068. [PMID: 33477834 PMCID: PMC7832846 DOI: 10.3390/biology10010068] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/12/2020] [Revised: 01/10/2021] [Accepted: 01/15/2021] [Indexed: 11/17/2022]
Abstract
Simple Summary Spinal cord injury often disrupts connections between the brain and spinal cord leading to a plethora of health complications, including bladder dysfunction. Spinal cord injured patients are left with symptoms such as a leaky bladder (the inability to hold their urine), frequent urinary tract infections, and potential kidney failure. However, previous studies have shown that manipulation of serotoninergic receptors can improve urinary performance following spinal cord injury. In the current study, we sought to explore how stimulation of a specific serotonergic receptor subtype can significantly enhance bladder function in spinal cord injured rats. To do so, we utilized spinal cord injured female rats that underwent various bladder performance evaluations combined with pharmacological intervention of a specific serotonergic subtype. Additionally, the primary site of action was investigated to determine effects elicited during various administration routes (e.g., directly into the cord, into the femoral vein, or into the skin). Stimulation of this receptor subtype, regardless of delivery route, improved activity of the external urethral sphincter and detrusor-sphincter coordination in spinal cord injured rats. Collectively, the results of these experiments have the potential to provide vital guidance for the development of therapeutic strategies to alleviate urinary dysfunction following spinal cord injury. Abstract Traumatic spinal cord injury (SCI) interrupts spinobulbospinal micturition reflex pathways and results in urinary dysfunction. Over time, an involuntary bladder reflex is established due to the reorganization of spinal circuitry. Previous studies show that manipulation of serotonin 2A (5-HT2A) receptors affects recovered bladder function, but it remains unclear if this receptor regulates the activity of the external urethral sphincter (EUS) following SCI. To elucidate how central and peripheral serotonergic machinery acts on the lower urinary tract (LUT) system, we employed bladder cystometry and EUS electromyography recordings combined with intravenous or intrathecal pharmacological interventions of 5-HT2A receptors in female SCI rats. Three to four weeks after a T10 spinal transection, systemic and central blockage of 5-HT2A receptors with MDL only slightly influenced the micturition reflex. However, delivery of the 5-HT2A receptor agonist, DOI, increased EUS tonic activity and elicited bursting during voiding. Additionally, subcutaneous administration of DOI verified the enhancement of continence and voiding capability during spontaneous micturition in metabolic cage assays. Although spinal 5HT2A receptors may not be actively involved in the recovered micturition reflex, stimulating this receptor subtype enhances EUS function and the synergistic activity between the detrusor and sphincter to improve the micturition reflex in rats with SCI.
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Lin CY, Sparks A, Lee YS. Improvement of lower urinary tract function by a selective serotonin 5-HT 1A receptor agonist, NLX-112, after chronic spinal cord injury. Exp Neurol 2020; 332:113395. [PMID: 32615138 DOI: 10.1016/j.expneurol.2020.113395] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Revised: 06/15/2020] [Accepted: 06/25/2020] [Indexed: 12/20/2022]
Abstract
Spinal cord injury (SCI) above the lumbosacral level results in lower urinary tract dysfunction, including (1) detrusor hyperreflexia, wherein bladder compliance is low, and (2) a lack of external urethral sphincter (EUS) control, leading to detrusor-sphincter dyssynergia (DSD) with poor voiding efficiency. Experimental studies in animals have shown a dense innervation of serotonergic (5-HT) fibers and multiple 5-HT receptors in the spinal reflex circuits that control voiding function. Here, we investigated the efficacy of NLX-112 (a.k.a. befiradol or F13640), in regulating lower urinary tract function after T8 contusive SCI in rats. NLX-112 is a very potent, highly-selective, and fully efficacious 5-HT1A receptor agonist, which has been developed for the treatment of L-DOPA-induced dyskinesia in Parkinson's disease patients. We performed urodynamics tests and external urethral sphincter electromyogram recordings to assess lower urinary tract function while NLX-112 was infused through the femoral vein in rats with chronic complete SCI or contusive SCI. The dose response studies indicated that NLX-112 was able to improve voiding behavior by regulating both detrusor and EUS activity. These included improvements in voiding efficiency, reduction of detrusor hyperactivity, and phasic activity of EUS during the micturition period. In addition, the application of a selective 5-HT1A receptor antagonist, WAY100635, reversed the improved detrusor and EUS activity elicited by NLX-112. In summary, the current data suggest that pharmacological activation of 5-HT1A receptors by NLX-112 may constitute a novel therapeutic strategy to treat neurogenic bladder after SCI.
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Affiliation(s)
- Ching-Yi Lin
- Department of Neurosciences, Lerner Research Institute, Cleveland Clinic, Cleveland, OH 44195, USA
| | - Alexander Sparks
- Department of Neurosciences, Lerner Research Institute, Cleveland Clinic, Cleveland, OH 44195, USA
| | - Yu-Shang Lee
- Department of Neurosciences, Lerner Research Institute, Cleveland Clinic, Cleveland, OH 44195, USA.
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Jurášková M, Piler P, Kukla L, Švancara J, Daňsová P, Hruban L, Kandrnal V, Pikhart H. Association between Stress Urinary Incontinence and Depressive Symptoms after Birth: the Czech ELSPAC Study. Sci Rep 2020; 10:6233. [PMID: 32277088 PMCID: PMC7148365 DOI: 10.1038/s41598-020-62589-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Accepted: 03/05/2020] [Indexed: 11/18/2022] Open
Abstract
The study objectives were to (1) identify risk factors related to stress urinary incontinence (SUI) and postnatal depression (PD) after birth, and (2) investigate both possible directions of association between SUI and PD in population-based sample of Czech mothers. 3,701 nulliparous and multiparous women completed the self-reported questionnaires at 6 weeks and 6 months after birth and were included into the analyses of this prospective cohort study. Unadjusted and adjusted logistic regressions examined relationship between SUI a PD accounting for range of other risk factors. During the first 6 months after birth, 650 mothers (17.6%) developed SUI and 641 (17.3%) displayed signs of PD. The mode of delivery, parity and higher BMI were associated with SUI. The rate of PD symptoms was higher in mothers with positive history of prenatal depression, and in divorced or widowed mothers. Both conditions were associated with worse self-reported health, back pain and stop-smoker status. Initially, SUI at 6 weeks was slightly, but significantly associated with onset of PD at 6 months (OR 1.51, 95% CI 1.02–2.23) while PD at 6 weeks was not significantly related to new cases of SUI at 6 months (OR 1.48, 95% CI 0.91–2.39). After full adjustment these OR reduced to 1.41 and 1.38 (both non-significant), respectively. SUI and PD are common conditions in women postpartum that share some risk factors. Our study suggests that both directions of their relationship are possible although a larger study is needed to confirm our findings.
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Affiliation(s)
- Miluše Jurášková
- Department of Rehabilitation Medicine, University Hospital Brno, Jihlavská 20, 602 00, Brno, Czech Republic
| | - Pavel Piler
- RECETOX Centre, Faculty of Science, Masaryk University, Kamenice 5, 625 00, Brno, Czech Republic
| | - Lubomír Kukla
- RECETOX Centre, Faculty of Science, Masaryk University, Kamenice 5, 625 00, Brno, Czech Republic
| | - Jan Švancara
- RECETOX Centre, Faculty of Science, Masaryk University, Kamenice 5, 625 00, Brno, Czech Republic.,Institute of Biostatistics and Analyses, Faculty of Medicine, Masaryk University, Kamenice 3, 625 00, Brno, Czech Republic
| | - Petra Daňsová
- RECETOX Centre, Faculty of Science, Masaryk University, Kamenice 5, 625 00, Brno, Czech Republic.,Institute for Research on Children, Youth and Family, Faculty of Social Studies, Masaryk University, Joštova 10, 602 00, Brno, Czech Republic
| | - Lukáš Hruban
- Department of Gynaecology and Obstetrics, University Hospital Brno, Jihlavská 20, 602 00, Brno, Czech Republic
| | - Vít Kandrnal
- Institute for Research on Children, Youth and Family, Faculty of Social Studies, Masaryk University, Joštova 10, 602 00, Brno, Czech Republic.,Department of Pharmacology, Faculty of Medicine, Masaryk University, Kamenice 753/5, 625 00, Brno, Czech Republic
| | - Hynek Pikhart
- RECETOX Centre, Faculty of Science, Masaryk University, Kamenice 5, 625 00, Brno, Czech Republic. .,Department of Epidemiology & Public Health, University College London, 1-19 Torrington Place, London, WC1E 6BT, United Kingdom.
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Guidelines for the evaluation and treatment of perimenopausal depression: summary and recommendations. Menopause 2019; 25:1069-1085. [PMID: 30179986 DOI: 10.1097/gme.0000000000001174] [Citation(s) in RCA: 98] [Impact Index Per Article: 19.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
There is a new appreciation of the perimenopause - defined as the early and late menopause transition stages as well as the early postmenopause - as a window of vulnerability for the development of both depressive symptoms and major depressive episodes. However, clinical recommendations on how to identify, characterize and treat clinical depression are lacking. To address this gap, an expert panel was convened to systematically review the published literature and develop guidelines on the evaluation and management of perimenopausal depression. The areas addressed included: 1) epidemiology; 2) clinical presentation; 3) therapeutic effects of antidepressants; 4) effects of hormone therapy; and 5) efficacy of other therapies (eg, psychotherapy, exercise, and natural health products). Overall, evidence generally suggests that most midlife women who experience a major depressive episode during the perimenopause have experienced a prior episode of depression. Midlife depression presents with classic depressive symptoms commonly in combination with menopause symptoms (ie, vasomotor symptoms, sleep disturbance), and psychosocial challenges. Menopause symptoms complicate, co-occur, and overlap with the presentation of depression. Diagnosis involves identification of menopausal stage, assessment of co-occurring psychiatric and menopause symptoms, appreciation of the psychosocial factors common in midlife, differential diagnoses, and the use of validated screening instruments. Proven therapeutic options for depression (ie, antidepressants, psychotherapy) are the front-line treatments for perimenopausal depression. Although estrogen therapy is not approved to treat perimenopausal depression, there is evidence that it has antidepressant effects in perimenopausal women, particularly those with concomitant vasomotor symptoms. Data on estrogen plus progestin are sparse and inconclusive.
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Do Lifestyle Factors Affect Lower Urinary Tract Symptoms? Results from the Korean Community Health Survey. Int Neurourol J 2019; 23:125-135. [PMID: 31260612 PMCID: PMC6606931 DOI: 10.5213/inj.1938010.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2019] [Accepted: 03/12/2019] [Indexed: 11/08/2022] Open
Abstract
PURPOSE To evaluate the relationships between lower urinary tract symptoms (LUTS) and lifestyle factors (physical activity, smoking, alcohol consumption, body mass index, and stress) in Korean men. METHODS We analyzed the survey results of South Korean men (n=64,439) who were 40 years of age or older among whom interviews were conducted using questionnaires. Trained interviewers performed face-to-face surveys using computer-assisted personal interviewing, the International Prostate Symptom Score (IPSS), and standard questions. We assessed the relationships of lifestyle factors (physical activity, cigarette smoking, alcohol intake, height, weight, and stress) with LUTS. RESULTS We observed higher IPSS scores in participants who engaged in no exercise (n=46,008 [71.7%], IPSS=3.19±5.36) than in those who engaged in vigorous physical activity (n=10,657 [17.6%], IPSS=2.28±4.15). Former smokers showed higher total, storage, and voiding symptom IPSS scores than current smokers and nonsmokers. Nondrinkers had higher IPSS scores than current alcohol drinkers. In multivariable logistic regression analysis, we detected no relationship between LUTS and current alcohol drinking in the moderate and severe LUTS groups, using the mild LUTS group as a reference (moderate: 0.91; 95% confidence interval [CI], 0.91-0.91; P<0.001, severe: 0.78; 95% CI, 0.78-0.78; P<0.001). Participants with moderate to severe stress showed higher total IPSS scores than those with no or mild stress (3.38±5.77 vs. 2.88±4.90), with significant relationships between stress and LUTS found in the moderate and severe LUTS groups. In logistic regression analysis, stronger relationships were found for storage and voiding symptoms in the moderate and severe stress groups compared to the mild stress group. CONCLUSION A history of smoking, low levels of physical activity, low body mass index, and moderate to severe stress were associated with a greater severity of LUTS. Moderate to severe stress was also related to voiding symptoms. However, there was no association between alcohol intake and LUTS severity.
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In CB, Jeon YT, Oh AY, Jin SJ, Park BS, Choi ES. Effects of Intraoperative Nefopam on Catheter-Related Bladder Discomfort in Patients Undergoing Robotic Nephrectomy: A Randomized Double-Blind Study. J Clin Med 2019; 8:jcm8040519. [PMID: 30995766 PMCID: PMC6518107 DOI: 10.3390/jcm8040519] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Revised: 04/12/2019] [Accepted: 04/12/2019] [Indexed: 11/16/2022] Open
Abstract
Catheter-related bladder discomfort (CRBD) is one of the most difficult symptoms during the postoperative period. Nefopam is a non-narcotic analgesic agent, which also has anticholinergic action. This study was performed to evaluate the effects of nefopam on CRBD in male patients undergoing robotic nephrectomy. A total of 109 male patients were randomly divided into two groups: the control group (n = 55) received 20 mL of normal saline, and the nefopam group (n = 54) received 20 mg of nefopam 1 h before the end of the operation. At postoperative times of 20 min, 1 h, 2 h, and 6 h, the severity of CRBD was measured using an 11-point numeric rating scale, respectively. The severity of CRBD in the nefopam group was significantly lower than that in the control group at 20 min (4.8 ± 1.3 vs. 2.3 ± 1.0, respectively, p = 0.012) and at 1, 2, and 6 h (3.5 ± 1.2, 2.7 ± 0.9, and 2.5 ± 1.0 vs. 4.1 ± 0.8, 1.6 ± 0.8, and 1.3 ± 0.6, respectively, p < 0001). Intraoperative nefopam administration reduced the severity of CRBD in patients undergoing robotic nephrectomy.
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Affiliation(s)
- Chi-Bum In
- Department of Anesthesiology and Pain Medicine, Konyang University Hospital, Daejeon 35365, Korea.
| | - Young-Tae Jeon
- Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Seongnam 13620, Korea.
- Department of Anesthesiology and Pain Medicine, Seoul National University College of Medicine, Seoul 03080, Korea.
| | - Ah-Young Oh
- Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Seongnam 13620, Korea.
- Department of Anesthesiology and Pain Medicine, Seoul National University College of Medicine, Seoul 03080, Korea.
| | - Se-Jong Jin
- Department of Anesthesiology and Pain Medicine, Korea University Ansan Hospital, Gyeonggi-do 15355, Korea.
| | - Byeong-Seon Park
- Department of Anesthesiology and Pain Medicine, Korea University Ansan Hospital, Gyeonggi-do 15355, Korea.
| | - Eun-Su Choi
- Department of Anesthesiology and Pain Medicine, Korea University Ansan Hospital, Gyeonggi-do 15355, Korea.
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Peyronnet B, Mironska E, Chapple C, Cardozo L, Oelke M, Dmochowski R, Amarenco G, Gamé X, Kirby R, Van Der Aa F, Cornu JN. A Comprehensive Review of Overactive Bladder Pathophysiology: On the Way to Tailored Treatment. Eur Urol 2019; 75:988-1000. [PMID: 30922690 DOI: 10.1016/j.eururo.2019.02.038] [Citation(s) in RCA: 180] [Impact Index Per Article: 36.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2018] [Accepted: 02/28/2019] [Indexed: 01/06/2023]
Abstract
CONTEXT Current literature suggests that several pathophysiological factors and mechanisms might be responsible for the nonspecific symptom complex of overactive bladder (OAB). OBJECTIVE To provide a comprehensive analysis of the potential pathophysiology underlying detrusor overactivity (DO) and OAB. EVIDENCE ACQUISITION A PubMed-based literature search was conducted in April 2018, to identify randomised controlled trials, prospective and retrospective series, animal model studies, and reviews. EVIDENCE SYNTHESIS OAB is a nonspecific storage symptom complex with poorly defined pathophysiology. OAB was historically thought to be caused by DO, which was either "myogenic" (urgency initiated from autonomous contraction of the detrusor muscle) or "neurogenic" (urgency signalled from the central nervous system, which initiates a detrusor contraction). Patients with OAB are often found to not have objective evidence of DO on urodynamic studies; therefore, alternative mechanisms for the development of OAB have been postulated. Increasing evidence on the role of urothelium/suburothelium and bladder afferent signalling arose in the early 2000s, emphasising an afferent "urotheliogenic" hypothesis, namely, that urgency is initiated from the urothelium/suburothelium. The urethra has also recently been regarded as a possible afferent origin of OAB-the "urethrogenic" hypothesis. Several other pathophysiological factors have been implicated, including metabolic syndrome, affective disorders, sex hormone deficiency, urinary microbiota, gastrointestinal functional disorders, and subclinical autonomic nervous system dysfunctions. These various possible mechanisms should be considered as contributing to diagnostic and treatment algorithms. CONCLUSIONS There is a temptation to label OAB as "idiopathic" without obvious causation, given the poorly understood nature of its pathophysiology. OAB should be seen as a complex, multifactorial symptom syndrome, resulting from multiple potential pathophysiological mechanisms. Identification of the underlying causes on an individual basis may lead to the definition of OAB phenotypes, paving the way for personalised medical care. PATIENT SUMMARY Overactive bladder (OAB) is a storage symptom syndrome with multiple possible causes. Identification of the mechanisms causing a patient to experience OAB symptoms may help tailor treatment to individual patients and improve outcomes.
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Affiliation(s)
- Benoit Peyronnet
- Department of Urology, University Hospital of Rennes, Rennes, France.
| | - Emma Mironska
- Department of Urology, Sheffield Teaching Hospitals, Sheffield, UK
| | | | - Linda Cardozo
- Department of Urology, St. Antonius Hospital, Gronau, Germany
| | - Matthias Oelke
- Department of Urology, Vanderbilt University, Nashville, TN, USA
| | | | - Gérard Amarenco
- Department of Urogynaecology, King's College Hospital, London, UK
| | - Xavier Gamé
- Department of Urology, University Hospital of Toulouse, Toulouse, France
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Maki PM, Kornstein SG, Joffe H, Bromberger JT, Freeman EW, Athappilly G, Bobo WV, Rubin LH, Koleva HK, Cohen LS, Soares CN. Guidelines for the Evaluation and Treatment of Perimenopausal Depression: Summary and Recommendations. J Womens Health (Larchmt) 2019; 28:117-134. [DOI: 10.1089/jwh.2018.27099.mensocrec] [Citation(s) in RCA: 54] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Affiliation(s)
- Pauline M. Maki
- Department of Psychiatry and Department of Psychology, University of Illinois at Chicago, Chicago Illinois
| | - Susan G. Kornstein
- Department of Psychiatry and Institute of Women's Health, Virginia Commonwealth University, Richmond, Virginia
| | - Hadine Joffe
- Connors Center for Women's Health and Department of Psychiatry, Brigham and Women's Hospital and Dana Farber Cancer Institute/Harvard Medical School, Boston, Massachusetts
| | - Joyce T. Bromberger
- Department of Epidemiology, Department of Psychiatry, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Ellen W. Freeman
- Department of Obstetrics and Gynecology and Department of Psychiatry, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Geena Athappilly
- Edith Nourse Rogers Memorial Veterans Hospital, Bedford Massachusetts; Harvard Medical School, Boston Massachusetts
| | - William V. Bobo
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, Minnesota
| | - Leah H. Rubin
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | | | - Lee S. Cohen
- Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Claudio N. Soares
- Department of Psychiatry, Queen's University School of Medicine, Ontario Canada
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Park M, Jee CH, Kwak KH, Park JM, Kim JH. The effect of preoperative nefopam treatment on postoperative catheter-related bladder discomfort in patients undergoing transurethral bladder tumor resection: a randomized double-blind study. Scand J Urol 2019; 52:389-394. [DOI: 10.1080/21681805.2018.1524929] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- MiHye Park
- Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
- Department of Anesthesiology and Pain Medicine, Kangwon National University School of Graduate Medicine, Chuncheon, South Korea
| | - Chan Hee Jee
- Department of Anesthesiology and Pain Medicine, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, Daegu, South Korea
| | - Kyung-Hwa Kwak
- Department of Anesthesiology and Pain Medicine, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, Daegu, South Korea
| | - Jun-Mo Park
- Department of Anesthesiology and Pain Medicine, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, Daegu, South Korea
| | - Ji Hyo Kim
- Department of Anesthesiology and Pain Medicine, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, Daegu, South Korea
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Ikeda Y, Wolf-Johnston A, Roppolo JR, Buffington CAT, Birder L. Feline Interstitial Cystitis Enhances Mucosa-Dependent Contractile Responses to Serotonin. Int Neurourol J 2018; 22:246-251. [PMID: 30599495 PMCID: PMC6312968 DOI: 10.5213/inj.1836276.138] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2018] [Accepted: 12/13/2018] [Indexed: 11/17/2022] Open
Abstract
PURPOSE To determine whether responses to serotonin are altered in bladder strips from cats diagnosed with a naturally occurring form of bladder pain syndrome/interstitial cystitis termed feline interstitial cystitis (FIC). METHODS Full thickness bladder strips were isolated from aged matched healthy control cats and cats with clinically verified FIC. Bladder strips were mounted in an organ bath and connected to a tension transducer to record contractile activity. A serotonin dose response (0.01-10μM) was determined for each strip with the mucosa intact or denuded. RESULTS Bladder strips from control and FIC cats contracted in response to serotonin in a dose-dependent manner. The normalized force of serotonin-evoked contractions was significantly greater in bladder strips from cats with FIC (n=7) than from control cats (n=4). Removal of the mucosa significantly decreased serotonin-mediated responses in both control and FIC bladder preparations. Furthermore, the contractions in response to serotonin were abolished by 1μM atropine in both control and FIC bladder strips. CONCLUSION The effect of serotonin on contractile force, but not sensitivity, was potentiated in bladder strips from cats with FIC, and was dependent upon the presence of the mucosa in control and FIC groups. As atropine inhibited these effects of serotonin, we hypothesize that, serotonin enhances acetylcholine release from the mucosa of FIC cat bladder strips, which could account for the increased force generated. In summary, FIC augments the responsiveness of bladder to serotonin, which may contribute to the symptoms associated with this chronic condition.
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Affiliation(s)
- Youko Ikeda
- Division of Renal-Electrolyte, Department of Medicine, School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
- Department of Pharmacology and Chemical Biology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Amanda Wolf-Johnston
- Division of Renal-Electrolyte, Department of Medicine, School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - James R. Roppolo
- Department of Pharmacology and Chemical Biology, University of Pittsburgh, Pittsburgh, PA, USA
| | | | - Lori Birder
- Division of Renal-Electrolyte, Department of Medicine, School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
- Department of Pharmacology and Chemical Biology, University of Pittsburgh, Pittsburgh, PA, USA
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Cheon YW, Kim SH, Paek JH, Kim JA, Lee YK, Min JH, Cho HR. Effects of nefopam on catheter-related bladder discomfort in patients undergoing ureteroscopic litholapaxy. Korean J Anesthesiol 2018; 71:201-206. [PMID: 29684987 PMCID: PMC5995012 DOI: 10.4097/kja.d.18.27113] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2017] [Revised: 08/02/2017] [Accepted: 08/11/2017] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Patients who undergo urinary catheterization may experience postoperative catheter-related bladder discomfort (CRBD). Previous studies have indicated that drugs with antimuscarinic effects could reduce the incidence and severity of CRBD. Accordingly, this study was carried out to investigate whether nefopam, a centrally acting analgesic with concomitant antimuscarinic effect, reduces the incidence and severity of CRBD. METHODS Sixty patients with American Society of Anesthesiologists physical status I and II and aged 18-70 years who were scheduled to undergo elective ureteroscopic litholapaxy participated in this double-blinded study. Patients were divided into control and nefopam groups, comprising 30 patients each. In the nefopam group, 40 mg nefopam in 100 ml of 0.9% saline was administered intravenously. In the control group, only 100 ml of 0.9% saline was administered. All patients had a urethral catheter and ureter stent inserted during surgery. The incidence and severity of CRBD, numerical rating scale (NRS) score of postoperative pain, rescue pethidine dose, and side effects were recorded in the post-anesthesia care unit after surgery. RESULTS The incidence (P = 0.020) and severity (P < 0.001) of CRBD were significantly different between the control group and the nefopam group. The NRS score of postoperative pain (P = 0.006) and rescue dose of pethidine (P < 0.001) were significantly higher in the control group than in the nefopam group. CONCLUSIONS Intravenous administration of nefopam in patients scheduled to undergo ureteroscopic litholapaxy reduced the incidence and severity of CRBD, NRS score of postoperative pain and analgesic requirements.
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Affiliation(s)
- Yong Woo Cheon
- Department of Anesthesiology and Pain Medicine, Myongji Hospital, Goyang, Korea
| | - Seon Hwan Kim
- Department of Anesthesiology and Pain Medicine, Myongji Hospital, Goyang, Korea
| | - Jin Hyub Paek
- Department of Anesthesiology and Pain Medicine, Myongji Hospital, Goyang, Korea
| | - Jin A Kim
- Department of Anesthesiology and Pain Medicine, Myongji Hospital, Goyang, Korea
| | - Yong Kyung Lee
- Department of Anesthesiology and Pain Medicine, Myongji Hospital, Goyang, Korea
| | - Jin Hye Min
- Department of Anesthesiology and Pain Medicine, Myongji Hospital, Goyang, Korea
| | - Hyung Rae Cho
- Department of Anesthesiology and Pain Medicine, Myongji Hospital, Goyang, Korea
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Jairam R, Drossaerts J, Vrijens D, Leue C, van Kerrebroeck P, van Koeveringe G. Affective symptoms and quality of life in patients with voiding or storage dysfunction: Results before and after sacral neuromodulation: A prospective follow-up study. Neurourol Urodyn 2018; 37:1801-1808. [DOI: 10.1002/nau.23527] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2017] [Accepted: 01/17/2018] [Indexed: 11/10/2022]
Affiliation(s)
- Ranjana Jairam
- Department of Urology; Maastricht University Medical Centre (MUMC+); Maastricht The Netherlands
| | - Jamie Drossaerts
- Department of Urology; Maastricht University Medical Centre (MUMC+); Maastricht The Netherlands
| | - Desiree Vrijens
- Department of Urology; Maastricht University Medical Centre (MUMC+); Maastricht The Netherlands
- Pelvic Care Centre Maastricht; Maastricht University Medical Centre; Maastricht The Netherlands
| | - Carsten Leue
- Pelvic Care Centre Maastricht; Maastricht University Medical Centre; Maastricht The Netherlands
- Departmentof Psychiatry and Psychology, South Limburg Mental Health Research Teaching Network, EURON; Maastricht University Medical Centre; Maastricht The Netherlands
| | - Philip van Kerrebroeck
- Department of Urology; Maastricht University Medical Centre (MUMC+); Maastricht The Netherlands
- Pelvic Care Centre Maastricht; Maastricht University Medical Centre; Maastricht The Netherlands
| | - Gommert van Koeveringe
- Department of Urology; Maastricht University Medical Centre (MUMC+); Maastricht The Netherlands
- Pelvic Care Centre Maastricht; Maastricht University Medical Centre; Maastricht The Netherlands
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de Groat WC. Neurophysiology and Neuroanatomy of the Genitourinary Organs. Neuromodulation 2018. [DOI: 10.1016/b978-0-12-805353-9.00121-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Lai HH, Shen B, Rawal A, Vetter J. The relationship between depression and overactive bladder/urinary incontinence symptoms in the clinical OAB population. BMC Urol 2016; 16:60. [PMID: 27716241 PMCID: PMC5053341 DOI: 10.1186/s12894-016-0179-x] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2016] [Accepted: 09/23/2016] [Indexed: 11/23/2022] Open
Abstract
Background To investigate the relationship between depression and overactive bladder (OAB)/urinary incontinence symptoms among the clinical OAB population. Methods Patients who were diagnosed with overactive bladder (OAB) and age-matched control subjects without OAB were enrolled. Depression symptoms were assessed using the Hospital Anxiety and Depression Scale (HADS-D). OAB/incontinence symptoms were assessed using the validated questionnaires: ICIQ-UI, ICIQ-OAB, UDI-6, IIQ-7, and OAB-q. Results 27.5 % of OAB patients in our study had depression (HADS ≥8), and 12 % of OAB patients had moderate to severe depression (HADS-D ≥11). OAB patients reported significantly higher HADS-D depression scores compared to age-matched controls (5.3 ± 3.9 versus 2.8 ± 3.9, p = 0.004). OAB patients with depression reported more severe incontinence symptoms (ICIQ-UI), greater bother and more impact on quality of life (UDI-6, IIQ-7) compared to OAB patients without depression (p = 0.001, 0.01, <0.001, respectively). However there were no differences in ICIQ-OAB and OAB-q. Among OAB patients, there were positive correlations between the severity of depression symptoms and OAB/incontinence symptoms (p-values <0.001 to 0.035). Conclusions 27.5 % of OAB patients have depression. OAB patients with depression reported more severe urinary incontinence symptoms, greater bother and more impact on quality of life compared to those without depression. Future studies are needed to further examine the mechanistic links between depression and OAB/urinary incontinence.
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Affiliation(s)
- H Henry Lai
- Department of Surgery, Division of Urologic Surgery, Washington University School of Medicine, 4960 Children's Place, Campus Box 8242, St Louis, MO, 63110, USA. .,Department of Anesthesiology, Washington University School of Medicine, 4960 Children's Place, Campus Box 8242, St Louis, MO, 63110, USA.
| | - Baixin Shen
- Department of Surgery, Division of Urologic Surgery, Washington University School of Medicine, 4960 Children's Place, Campus Box 8242, St Louis, MO, 63110, USA
| | - Amar Rawal
- Department of Surgery, Division of Urologic Surgery, Washington University School of Medicine, 4960 Children's Place, Campus Box 8242, St Louis, MO, 63110, USA
| | - Joel Vetter
- Department of Surgery, Division of Urologic Surgery, Washington University School of Medicine, 4960 Children's Place, Campus Box 8242, St Louis, MO, 63110, USA
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The Relationship Between Anxiety and Overactive Bladder or Urinary Incontinence Symptoms in the Clinical Population. Urology 2016; 98:50-57. [PMID: 27450939 DOI: 10.1016/j.urology.2016.07.013] [Citation(s) in RCA: 56] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2016] [Revised: 07/07/2016] [Accepted: 07/12/2016] [Indexed: 12/25/2022]
Abstract
OBJECTIVE To investigate the relationship between anxiety and overactive bladder (OAB) or urinary incontinence symptoms among clinical population. MATERIALS AND METHODS Patients who were diagnosed with OAB and age-matched control subjects without OAB were enrolled. Anxiety symptoms were assessed using the Hospital Anxiety and Depression Scale (HADS-A). OAB or incontinence symptoms were assessed using the International Consultation on Incontinence-Urinary Incontinence Short Form (ICIQ-UI), ICIQ-OAB, Urogenital Distress Inventory Short Form (UDI-6), Incontinence Impact Questionnaire Short Form (IIQ-7), and OAB-q. Other psychosocial factors were also assessed. RESULTS About half of the OAB subjects (48%) had anxiety symptoms, and one quarter of OAB subjects (24%) had moderate to severe anxiety. OAB subjects reported significantly higher anxiety symptoms compared to age-matched controls (HADS-A: 7.5 ± 4.5 vs 3.3 ± 3.6, P < .001). OAB subjects with anxiety reported more severe OAB or incontinence symptoms, and greater bother and impact on quality of life compared to OAB subjects without anxiety (ICIQ-UI, ICIQ-OAB, UDI-6, IIQ-7, OAB-q, P values all <.05). OAB subjects with anxiety also have more psychosocial difficulties (eg, more depression, higher stress levels). Among OAB subjects, there were positive correlations between the severity of anxiety symptoms and the severity of OAB/incontinence symptoms (Spearman's correlation coefficients 0.29 to 0.47, P < .05). OAB subjects with both anxiety and depression reported higher ICIQ-UI and IIQ-7 scores than those who had anxiety but no depression (P = .014, .025 respectively). CONCLUSION OAB patients reported higher anxiety symptoms compared to controls. OAB patients with anxiety reported more severe OAB or incontinence symptoms, worse quality of life, and more psychosocial difficulties compared to OAB patients without anxiety. There are positive correlations between the severity of anxiety symptoms and OAB or incontinence symptoms.
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Sheikholeslami B, Gholami M, Lavasani H, Rouini M. Evaluation of the route dependency of the pharmacokinetics and neuro-pharmacokinetics of tramadol and its main metabolites in rats. Eur J Pharm Sci 2016; 92:55-63. [PMID: 27365222 DOI: 10.1016/j.ejps.2016.06.021] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2016] [Revised: 06/13/2016] [Accepted: 06/25/2016] [Indexed: 12/14/2022]
Abstract
Tramadol hydrochloride is a centrally acting analgesic used for the treatment of moderate-to-severe pain. It has three main metabolites: O-desmethyltramadol (M1), N-desmethyltramadol (M2), and N,O-didesmethyltramadol (M5). Because of the frequent use of tramadol by patients and drug abusers, the ability to determine the parent drug and its metabolites in plasma and cerebrospinal fluid is of great importance. In the present study, a pharmacokinetic approach was applied using two groups of five male Wistar rats administered a 20mg/kg dose of tramadol via intravenous (i.v.) or intraperitoneal (i.p.) routes. Plasma and CSF samples were collected at 5-360min following tramadol administration. Our results demonstrate that the plasma values of Cmax (C0 in i.v. group) and area under the curve (AUC)0-t for tramadol were 23,314.40±6944.85 vs. 3187.39±760.25ng/mL (Cmax) and 871.15±165.98 vs. 414.04±149.25μg·min/mL in the i.v. and i.p. groups, respectively (p<0.05). However, there were no significant differences between i.v. and i.p. plasma values for tramadol metabolites (p>0.05). Tramadol rapidly penetrated the blood-brain barrier (BBB) and blood-cerebrospinal fluid barrier (BCSFB) (5.00±0.00 vs. 10.00±5.77min in i.v. and i.p. groups, respectively). Tramadol and its metabolites (M1 and M2) were present to a lesser extent in the cerebrospinal fluid (CSF) than in the plasma. M5 hardly penetrated the CSF, owing to its high polarity. There was no significant difference between the AUC0-t of tramadol in plasma (414.04±149.25μg·min/mL) and CSF (221.81±83.02μg·min/mL) in the i.p. group. In addition, the amounts of metabolites (M1 and M2) in the CSF showed no significant differences following both routes of administration. There were also no significant differences among the Kp,uu,CSF(0-360) (0.51±0.12 vs. 0.63±0.04) and Kp,uu,CSF(0-∞) (0.61±0.10 vs. 0.62±0.02) for i.v. and i.p. pathways, respectively (p>0.05). Drug targeting efficiency (DTE) values of tramadol after i.p. injection were more than unity for all scheduled time points. Considering the main analgesic effect of M1, it is hypothesized that both routes of administration may produce the same amount of analgesia.
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Affiliation(s)
| | - Mahdi Gholami
- Department of Toxicology and Pharmacology, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran; Pharmaceutical Sciences Research Centre, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran
| | - Hoda Lavasani
- Biopharmaceutics and Pharmacokinetic Division, Department of Pharmaceutics, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammadreza Rouini
- Pharmaceutical Sciences Research Centre, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran; Biopharmaceutics and Pharmacokinetic Division, Department of Pharmaceutics, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran
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VRIJENS DMJ, DROSSAERTS JMAFL, RADEMAKERS K, SMITS M, DE WACHTER SG, LEUE C, VAN KOEVERINGE GA. Associations of Psychometric Affective Parameters with Urodynamic Investigation for Urinary Frequency. Low Urin Tract Symptoms 2016; 9:166-170. [DOI: 10.1111/luts.12130] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2015] [Revised: 11/26/2015] [Accepted: 12/15/2015] [Indexed: 01/04/2023]
Affiliation(s)
- Desiree M. J. VRIJENS
- Department of Urology; Maastricht University Medical Centre; Maastricht The Netherlands
- Pelvic Care Centre Maastricht; Maastricht University Medical Centre; Maastricht The Netherlands
| | - Jamie M. A. F. L. DROSSAERTS
- Department of Urology; Maastricht University Medical Centre; Maastricht The Netherlands
- Pelvic Care Centre Maastricht; Maastricht University Medical Centre; Maastricht The Netherlands
| | - Kevin RADEMAKERS
- Department of Urology; Maastricht University Medical Centre; Maastricht The Netherlands
| | - Martijn SMITS
- Department of Urology; Maastricht University Medical Centre; Maastricht The Netherlands
| | - Stefan G. DE WACHTER
- Division of Urology, Laboratory of Translational Neurosciences; University of Antwerp; Antwerp Belgium
| | - Carsten LEUE
- Pelvic Care Centre Maastricht; Maastricht University Medical Centre; Maastricht The Netherlands
- Department of Psychiatry; Maastricht University Medical Centre; Maastricht The Netherlands
| | - Gommert A. VAN KOEVERINGE
- Department of Urology; Maastricht University Medical Centre; Maastricht The Netherlands
- Pelvic Care Centre Maastricht; Maastricht University Medical Centre; Maastricht The Netherlands
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Chen SC, Hsieh TH, Fan WJ, Lai CH, Peng CW. Does pharmacological activation of 5-HT1A receptors improve urine flow rate in female rats? Am J Physiol Renal Physiol 2016; 311:F166-75. [PMID: 27147676 DOI: 10.1152/ajprenal.00469.2015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2015] [Accepted: 05/02/2016] [Indexed: 11/22/2022] Open
Abstract
The role of 5-HT1A receptors in regulating voiding functions remains unclear, particularly regarding the urine flow rate (UFR) during voiding. This study examined the effects of 5-HT1A receptors on regulating urethral functions in female rats and investigated underlying modulatory mechanisms. Intravesical pressure (IVP), external urethral sphincter-electromyography (EUS-EMG), and UFR were simultaneously recorded during continuous transvesical infusion to examine the effects of a 5-HT1A receptor agonist (8-OH-DPAT) and antagonist (WAY-100635) on bladder and urethral functions. In addition, this study evaluated the independent roles of urethral striated and smooth muscles in the UFR in rats after a neuromuscular blockade (NMB) treatment and bilateral hypogastric nerve transection. Our results revealed that 8-OH-DPAT significantly increased the maximal UFR but reduced the mean UFR. This discrepancy may be because 8-OH-DPAT markedly increased the maximal UFR during the initial segment of the flow duration and subsequently induced an approximately zero level of long oscillatory waves during the remaining flow duration. Thus the mean UFR was reduced because of the prolonged approximately zero level of the UFR. However, paralyzing the EUS with an NMB agent, 8-OH-DPAT, significantly increased the maximal and mean UFRs because the prolonged zero level of the oscillatory UFR did not continue. These results support the hypothesis that the increased UFR in female rats during voiding is due to the induction of urethral smooth muscle relaxation by 8-OH-DPAT. This paper provides a detailed understanding of the role of 5-HT1A receptors in controlling the UFR in female rats.
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Affiliation(s)
- Shih-Ching Chen
- Department of Physical Medicine and Rehabilitation, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan; Department of Physical Medicine and Rehabilitation, Taipei Medical University Hospital, Taipei, Taiwan
| | - Tsung-Hsun Hsieh
- Department of Physical Therapy and Graduate Institute of Rehabilitation Science, College of Medicine, Chang Gung University, Taoyuan, Taiwan; Graduate Institute of Neural Regenerative Medicine, Taipei Medical University, Taipei, Taiwan; and Neuroscience Research Center, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan, Taiwan
| | - Wen-Jia Fan
- Department of Physical Medicine and Rehabilitation, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Chien-Hung Lai
- Department of Physical Medicine and Rehabilitation, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan; Department of Physical Medicine and Rehabilitation, Taipei Medical University Hospital, Taipei, Taiwan
| | - Chih-Wei Peng
- School of Biomedical Engineering, College of Biomedical Engineering, Taipei Medical University, Taipei, Taiwan; Graduate Institute of Biomedical Materials and Tissue Engineering, College of Biomedical Engineering, Taipei Medical University, Taipei, Taiwan; Department of Physical Medicine and Rehabilitation, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan; Department of Physical Medicine and Rehabilitation, Taipei Medical University Hospital, Taipei, Taiwan;
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Matsumoto-Miyai K, Yamada E, Shinzawa E, Koyama Y, Shimada S, Yoshizumi M, Kawatani M. Serotonergic regulation of distention-induced ATP release from the urothelium. Am J Physiol Renal Physiol 2015; 310:F646-F655. [PMID: 26582760 DOI: 10.1152/ajprenal.00024.2015] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2015] [Accepted: 11/09/2015] [Indexed: 12/14/2022] Open
Abstract
Serotonin [5-hydroxytryptamine (5-HT)] is involved in both motor and sensory functions in hollow organs, especially in the gastrointestinal tract. However, the involvement of 5-HT in visceral sensation of the urinary bladder remains unknown. Because distention-induced ATP release from the urothelium plays an essential role in visceral sensation of the urinary bladder, we investigated the regulation of urothelial ATP release by the 5-HT signaling system. RT-PCR and immunohistochemical analyses of the urothelium revealed specific expression of 5-HT1D and 5-HT4 receptors. The addition of 5-HT did not affect urothelial ATP release without bladder distention, but it significantly reduced distention-induced ATP release by physiological pressure during urine storage (5 cmH2O). The inhibitory effect of 5-HT on distention-elicited ATP release was blocked by preincubation with the 5-HT1B/1D antagonist GR-127935 but not by the 5-HT4 antagonist SB-204070. mRNA encoding tryptophan hydroxylase 1 was detected in the urinary bladder by nested RT-PCR amplification, and l-tryptophan or the selective serotonin reuptake inhibitor citalopram also inhibited ATP release, indicating that 5-HT is endogenously synthesized and released in the urinary bladder. The addition of GR-127935 significantly enhanced the distention-elicited ATP release 40 min after distention, whereas SB-204070 reduced the amount of ATP release 20 min after distention. These data suggest that 5-HT4 facilitates the distention-induced ATP release at an earlier stage, whereas 5-HT1D inhibits ATP release at a later stage. The net inhibitory effect of 5-HT indicates that the action of 5-HT on the urothelium is mediated predominantly by 5-HT1D.
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Affiliation(s)
- Kazumasa Matsumoto-Miyai
- Department of Neurophysiology, Akita University Graduate School of Medicine, Akita, Japan; .,Kansai University of Nursing and Health Sciences, Hyogo, Japan; and.,Department of Neuroscience and Cell Biology, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Erika Yamada
- Department of Neurophysiology, Akita University Graduate School of Medicine, Akita, Japan
| | - Eriko Shinzawa
- Department of Neurophysiology, Akita University Graduate School of Medicine, Akita, Japan
| | - Yoshihisa Koyama
- Department of Neuroscience and Cell Biology, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Shoichi Shimada
- Department of Neuroscience and Cell Biology, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Masaru Yoshizumi
- Department of Neurophysiology, Akita University Graduate School of Medicine, Akita, Japan
| | - Masahito Kawatani
- Department of Neurophysiology, Akita University Graduate School of Medicine, Akita, Japan
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Matsumoto-Miyai K, Yoshizumi M, Kawatani M. Regulatory Effects of 5-Hydroxytryptamine Receptors on Voiding Function. Adv Ther 2015; 32 Suppl 1:3-15. [PMID: 26391372 DOI: 10.1007/s12325-015-0240-2] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2015] [Indexed: 10/23/2022]
Abstract
UNLABELLED A growing body of evidence suggests that 5-hydroxytryptamine (5-HT; serotonin) has both physiological and pathological functions in the lower urinary tract. A wide variety of 5-HT receptor subtypes are variably expressed in different organs, both peripheral and central. On urinary bladder smooth muscle, 5-HT1A, 5-HT2, 5-HT3, and 5-HT7 subtypes could function as postjunctional receptors. Postjunctional 5-HT2 receptors induce detrusor contraction of the bladder body. 5-HT1A is suggested to have a similar effect to 5-HT2, while 5-HT3 might suppress detrusor contraction evoked by direct muscle stimulation. Postjunctional 5-HT7 is reported to induce relaxation of the bladder neck, which might be required for efficient voiding. 5-HT1A, 5-HT2A, 5-HT2C, 5-HT3, 5-HT4, and 5-HT7 subtypes also could act as prejunctional receptors in autonomic excitatory nerve terminals. 5-HT2A, 5-HT2C, 5-HT3, 5-HT4, and 5-HT7 subtypes facilitate the neurogenic contraction of the detrusor by enhancing cholinergic or purinergic transmission, whereas 5-HT1A receptors might inhibit the release of acetylcholine in the detrusor. Furthermore, 5-HT1D could be involved in the suppression of ATP release from the urothelium, aiding visceral sensation of the urinary bladder. In the central pathways controlling the micturition reflex, 5-HT1A, 5-HT2A, and 5-HT7 are involved in regulation of bladder and urethral sphincter activities. Their functions, especially that of 5-HT1A, vary in a species- and site (spinal or supraspinal)- dependent manner. In addition to urinary bladder, 5-HT could be involved in prostate contraction and cell proliferation. Evidence indicates that 5-HT receptor subtypes may be novel therapeutic targets for lower urinary tract symptoms. FUNDING Grants-in-Aid for Scientific Research (C) (KAKENHI 23590707, 24590722, and 26460694) from the Japan Society for the Promotion of Science.
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Imamura T, Ishizuka O, Ogawa T, Minagawa T, Ishikawa M, Hiragata S, Yokoyama H, Nakazawa M, Kurizaki Y, Nishizawa O. Expression of 5-Hydroxytryptamine Receptors in Human Urinary Bladders with Benign Prostatic Hyperplasia. Adv Ther 2015; 32 Suppl 1:29-37. [PMID: 26391373 DOI: 10.1007/s12325-015-0242-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2015] [Indexed: 11/30/2022]
Abstract
INTRODUCTION This study investigated the mRNA expression pattern and distribution of 5-hydroxytryptamine (5-HT) receptors 5-HT2A, 5-HT2B, 5-HT3A, 5-HT4, and 5-HT7 within the urothelium and detrusor of normal bladder tissue and in the urothelium of bladders from patients with benign prostatic hyperplasia (BPH). METHODS Normal urinary bladder specimens were obtained from 13 patients undergoing radical cystectomy due to bladder cancer (normal group) and BPH specimens were obtained from 27 benign prostatic obstruction patients receiving transurethral prostatectomy or retropubic prostatectomy. Receptor subtype mRNA expression was determined by real-time reverse transcription polymerase chain reaction on urothelium, detrusor, and whole mucosal preparations. Receptor distribution was determined by immunohistochemistry. RESULTS In normal tissues, expressions of 5-HT2B and 5-HT7 receptor mRNAs in the urothelium, detrusor, and whole mucosa were greater than the average expression for all receptor subtype mRNAs. 5-HT2B receptor protein was distributed in the apical urothelium and among the detrusor smooth muscle layers. In contrast, the 5-HT7 receptors were within the urothelium middle cell layers and detrusor smooth muscle cells. The expression pattern of each 5-HT receptor subtype mRNA within the BPH urothelium was similar to that in the normal urothelium. The expression level of 5-HT2A receptor mRNA in the BPH group was significantly lower than the normal group; however, the expressions of both 5-HT3A and 5-HT7 mRNAs were significantly higher. The expressions of both 5-HT2B and 5-HT4 mRNAs were not significantly different between the normal and BPH groups. CONCLUSION In normal urinary bladders, the expressions of both 5-HT2B and 5-HT7 mRNAs were higher compared to the 5-HT2A, 5-HT3A, and 5-HT4 mRNAs. The distributions of 5-HT2B and 5-HT7 receptors were different in the urothelium and detrusor layers. The 5-HT3A and 5-HT7 receptor mRNAs in the BPH group were significantly higher compared to the normal urothelium, while the 5-HT2A mRNA was significantly lower. FUNDING Asahi Kasei Pharma Corporation.
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Affiliation(s)
- Tetsuya Imamura
- Department of Lower Urinary Tract Medicine, Shinshu University School of Medicine, Matsumoto, Nagano, Japan.
| | - Osamu Ishizuka
- Department of Lower Urinary Tract Medicine, Shinshu University School of Medicine, Matsumoto, Nagano, Japan
- Department of Urology, Shinshu University School of Medicine, Matsumoto, Nagano, Japan
| | - Teruyuki Ogawa
- Department of Urology, Shinshu University School of Medicine, Matsumoto, Nagano, Japan
| | - Tomonori Minagawa
- Department of Urology, Shinshu University School of Medicine, Matsumoto, Nagano, Japan
| | - Masakuni Ishikawa
- Department of Urology, Shinshu University School of Medicine, Matsumoto, Nagano, Japan
| | - Shiro Hiragata
- Department of Urology, Shinshu University School of Medicine, Matsumoto, Nagano, Japan
| | - Hitoshi Yokoyama
- Department of Urology, Shinshu University School of Medicine, Matsumoto, Nagano, Japan
| | - Masaki Nakazawa
- Department of Urology, Shinshu University School of Medicine, Matsumoto, Nagano, Japan
| | - Yoshiki Kurizaki
- Department of Urology, Shinshu University School of Medicine, Matsumoto, Nagano, Japan
| | - Osamu Nishizawa
- Department of Lower Urinary Tract Medicine, Shinshu University School of Medicine, Matsumoto, Nagano, Japan
- Department of Urology, Shinshu University School of Medicine, Matsumoto, Nagano, Japan
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de Groat WC, Yoshimura N. Anatomy and physiology of the lower urinary tract. HANDBOOK OF CLINICAL NEUROLOGY 2015; 130:61-108. [PMID: 26003239 DOI: 10.1016/b978-0-444-63247-0.00005-5] [Citation(s) in RCA: 91] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Functions of the lower urinary tract to store and periodically eliminate urine are regulated by a complex neural control system in the brain, spinal cord, and peripheral autonomic ganglia that coordinates the activity of smooth and striated muscles of the bladder and urethral outlet. Neural control of micturition is organized as a hierarchic system in which spinal storage mechanisms are in turn regulated by circuitry in the rostral brainstem that initiates reflex voiding. Input from the forebrain triggers voluntary voiding by modulating the brainstem circuitry. Many neural circuits controlling the lower urinary tract exhibit switch-like patterns of activity that turn on and off in an all-or-none manner. The major component of the micturition switching circuit is a spinobulbospinal parasympathetic reflex pathway that has essential connections in the periaqueductal gray and pontine micturition center. A computer model of this circuit that mimics the switching functions of the bladder and urethra at the onset of micturition is described. Micturition occurs involuntarily during the early postnatal period, after which it is regulated voluntarily. Diseases or injuries of the nervous system in adults cause re-emergence of involuntary micturition, leading to urinary incontinence. The mechanisms underlying these pathologic changes are discussed.
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Affiliation(s)
- William C de Groat
- Department of Pharmacology and Chemical Biology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
| | - Naoki Yoshimura
- Department of Pharmacology and Chemical Biology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA; Department of Urology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
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Koutsis G, Evangelopoulos ME, Sfagos C, Markianos M. Neurochemical and neuroendocrine correlates of overactive bladder at first demyelinating episode. Neurourol Urodyn 2015; 35:955-958. [DOI: 10.1002/nau.22834] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2015] [Accepted: 06/30/2015] [Indexed: 01/22/2023]
Affiliation(s)
- Georgios Koutsis
- First Department of Neurology; University of Athens Medical School, Eginition Hospital; Athens Greece
| | | | - Constantinos Sfagos
- First Department of Neurology; University of Athens Medical School, Eginition Hospital; Athens Greece
| | - Manolis Markianos
- First Department of Neurology; University of Athens Medical School, Eginition Hospital; Athens Greece
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Abstract
Spinal cord injury (SCI) results not only in motor and sensory deficits but also in autonomic dysfunctions. The disruption of connections between higher brain centers and the spinal cord, or the impaired autonomic nervous system itself, manifests a broad range of autonomic abnormalities. This includes compromised cardiovascular, respiratory, urinary, gastrointestinal, thermoregulatory, and sexual activities. These disabilities evoke potentially life-threatening symptoms that severely interfere with the daily living of those with SCI. In particular, high thoracic or cervical SCI often causes disordered hemodynamics due to deregulated sympathetic outflow. Episodic hypertension associated with autonomic dysreflexia develops as a result of massive sympathetic discharge often triggered by unpleasant visceral or sensory stimuli below the injury level. In the pelvic floor, bladder and urethral dysfunctions are classified according to upper motor neuron versus lower motor neuron injuries; this is dependent on the level of lesion. Most impairments of the lower urinary tract manifest in two interrelated complications: bladder storage and emptying. Inadequate or excessive detrusor and sphincter functions as well as detrusor-sphincter dyssynergia are examples of micturition abnormalities stemming from SCI. Gastrointestinal motility disorders in spinal cord injured-individuals are comprised of gastric dilation, delayed gastric emptying, and diminished propulsive transit along the entire gastrointestinal tract. As a critical consequence of SCI, neurogenic bowel dysfunction exhibits constipation and/or incontinence. Thus, it is essential to recognize neural mechanisms and pathophysiology underlying various complications of autonomic dysfunctions after SCI. This overview provides both vital information for better understanding these disorders and guides to pursue novel therapeutic approaches to alleviate secondary complications.
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Affiliation(s)
- Shaoping Hou
- Spinal Cord Research Center, Department of Neurobiology & Anatomy, Drexel University College of Medicine, Philadelphia, Pennsylvania
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Chen YB, Huang FS, Fen B, Yin JB, Wang W, Li YQ. Inhibitory effects of endomorphin-2 on excitatory synaptic transmission and the neuronal excitability of sacral parasympathetic preganglionic neurons in young rats. Front Cell Neurosci 2015; 9:206. [PMID: 26074773 PMCID: PMC4446531 DOI: 10.3389/fncel.2015.00206] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2015] [Accepted: 05/12/2015] [Indexed: 01/23/2023] Open
Abstract
The function of the urinary bladder is partly controlled by parasympathetic preganglionic neurons (PPNs) of the sacral parasympathetic nucleus (SPN). Our recent work demonstrated that endomorphin-2 (EM-2)-immunoreactive (IR) terminals form synapses with μ-opioid receptor (MOR)-expressing PPNs in the rat SPN. Here, we examined the effects of EM-2 on excitatory synaptic transmission and the neuronal excitability of the PPNs in young rats (24–30 days old) using a whole-cell patch-clamp approach. PPNs were identified by retrograde labeling with the fluorescent tracer tetramethylrhodamine-dextran (TMR). EM-2 (3 μM) markedly decreased both the amplitude and the frequency of the spontaneous and miniature excitatory postsynaptic currents (sEPSCs and mEPSCs) of PPNs. EM-2 not only decreased the resting membrane potentials (RMPs) in 61.1% of the examined PPNs with half-maximal response at the concentration of 0.282 μM, but also increased the rheobase current and reduced the repetitive action potential firing of PPNs. Analysis of the current–voltage relationship revealed that the EM-2-induced current was reversed at −95 ± 2.5 mV and was suppressed by perfusion of the potassium channel blockers 4-aminopyridine (4-AP) or BaCl2 or by the addition of guanosine 5′-[β-thio]diphosphate trilithium salt (GDP-β-S) to the pipette solution, suggesting the involvement of the G-protein-coupled inwardly rectifying potassium (GIRK) channel. The above EM-2-invoked inhibitory effects were abolished by the MOR selective antagonist D-Phe-Cys-Tyr-D-Trp-Orn-Thr-Pen-Thr-NH2 (CTOP), indicating that the effects of EM-2 on PPNs were mediated by MOR via pre- and/or post-synaptic mechanisms. EM-2 activated pre- and post-synaptic MORs, inhibiting excitatory neurotransmitter release from the presynaptic terminals and decreasing the excitability of PPNs due to hyperpolarization of their membrane potentials, respectively. These inhibitory effects of EM-2 on PPNs at the spinal cord level may explain the mechanism of action of morphine treatment and morphine-induced bladder dysfunction in the clinic.
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Affiliation(s)
- Ying-Biao Chen
- Department of Anatomy, Histology and Embryology, Fujian Medical University Fuzhou, China
| | - Fen-Sheng Huang
- Department of Anatomy, Histology and Embryology and K. K. Leung Brain Research Centre, The Fourth Military Medical University Xi'an, China ; Division of Medical Biophysics, Institute of Neuroscience and Physiology, Göteborg University Göteborg, Sweden
| | - Ban Fen
- Department of Anatomy, Histology and Embryology and K. K. Leung Brain Research Centre, The Fourth Military Medical University Xi'an, China
| | - Jun-Bin Yin
- Department of Anatomy, Histology and Embryology and K. K. Leung Brain Research Centre, The Fourth Military Medical University Xi'an, China
| | - Wei Wang
- Department of Anatomy, Histology and Embryology, Fujian Medical University Fuzhou, China
| | - Yun-Qing Li
- Department of Anatomy, Histology and Embryology, Fujian Medical University Fuzhou, China ; Department of Anatomy, Histology and Embryology and K. K. Leung Brain Research Centre, The Fourth Military Medical University Xi'an, China ; Collaborative Innovation Center for Brain Science, Fudan University Shanghai, China
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Tu H, Cao N, Gu B, Si J, Chen Z, Andersson KE. Serotonin (5-HT)2A/2C receptor agonist (2,5-dimethoxy-4-idophenyl)-2-aminopropane hydrochloride (DOI) improves voiding efficiency in the diabetic rat. BJU Int 2015; 116:147-55. [PMID: 25822577 DOI: 10.1111/bju.12684] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Hongjian Tu
- Department of Urology; Shanghai Jiao Tong University Affiliated Sixth People's Hospital; Shanghai Jiangsu Province China
- School of Medicine; Soochow University; Suzhou City Jiangsu Province China
| | - Nailong Cao
- Department of Urology; Shanghai Jiao Tong University Affiliated Sixth People's Hospital; Shanghai Jiangsu Province China
| | - Baojun Gu
- Department of Urology; Shanghai Jiao Tong University Affiliated Sixth People's Hospital; Shanghai Jiangsu Province China
| | - Jiemin Si
- Department of Urology; Shanghai Jiao Tong University Affiliated Sixth People's Hospital; Shanghai Jiangsu Province China
| | - Zhong Chen
- Department of Urology; Shanghai Jiao Tong University Affiliated Sixth People's Hospital; Shanghai Jiangsu Province China
| | - Karl-Erik Andersson
- Wake Forest Institute for Regenerative Medicine; Wake Forest University School of Medicine; Winston Salem NC USA
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Abud EM, Ichiyama RM, Havton LA, Chang HH. Spinal stimulation of the upper lumbar spinal cord modulates urethral sphincter activity in rats after spinal cord injury. Am J Physiol Renal Physiol 2015; 308:F1032-40. [PMID: 25694482 DOI: 10.1152/ajprenal.00573.2014] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2014] [Accepted: 02/11/2015] [Indexed: 01/01/2023] Open
Abstract
After spinal cord injury (SCI), the neurogenic bladder is observed to develop asynchronous bladder and external urethral sphincter (EUS) contractions in a condition known as detrusor-sphincter dyssnergia (DSD). Activation of the EUS spinal controlling center located at the upper lumbar spinal cord may contribute to reduce EUS dyssynergic contractions and decrease urethral resistance during voiding. However, this mechanism has not been well studied. This study aimed at evaluating the effects of epidural stimulation (EpS) over the spinal EUS controlling center (L3) in combination with a serotonergic receptor agonist on EUS relaxation in naive rats and chronic (6-8 wk) T8 SCI rats. Cystometrogram and EUS electromyography (EMG) were obtained before and after the intravenous administration of 5HT-1A receptor agonist and antagonist. The latency, duration, frequency, amplitude, and area under curve of EpS-evoked EUS EMG responses were analyzed. EpS on L3 evoked an inhibition of EUS tonic contraction and an excitation of EUS intermittent bursting/relaxation correlating with urine expulsion in intact rats. Combined with a 5HT-1A receptor agonist, EpS on L3 evoked a similar effect in chronic T8 SCI rats to reduce urethral contraction (resistance). This study examined the effect of facilitating the EUS spinal controlling center to switch between urine storage and voiding phases by using EpS and a serotonergic receptor agonist. This novel approach of applying EpS on the EUS controlling center modulates EUS contraction and relaxation as well as reduces urethral resistance during voiding in chronic SCI rats with DSD.
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Affiliation(s)
- Edsel M Abud
- Department of Neurobiology and Behavior, University of California, Irvine, California
| | - Ronaldo M Ichiyama
- School of Biomedical Sciences, University of Leeds, Leeds, United Kingdom
| | - Leif A Havton
- Department of Anesthesiology and Perioperative Care, University of California, Irvine, California; Department of Anatomy and Neurobiology, University of California, Irvine, California; Department of Neurology, University of California, Irvine, California; Reeve-Irvine Research Center, University of California, Irvine, California; Department of Neurology, University of California, Los Angeles, California; and
| | - Huiyi H Chang
- Department of Anesthesiology and Perioperative Care, University of California, Irvine, California; Department of Neurology, University of California, Los Angeles, California; and
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Ranson RN, Saffrey MJ. Neurogenic mechanisms in bladder and bowel ageing. Biogerontology 2015; 16:265-84. [PMID: 25666896 PMCID: PMC4361768 DOI: 10.1007/s10522-015-9554-3] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2014] [Accepted: 01/28/2015] [Indexed: 01/18/2023]
Abstract
The prevalence of both urinary and faecal incontinence, and also chronic constipation, increases with ageing and these conditions have a major impact on the quality of life of the elderly. Management of bladder and bowel dysfunction in the elderly is currently far from ideal and also carries a significant financial burden. Understanding how these changes occur is thus a major priority in biogerontology. The functions of the bladder and terminal bowel are regulated by complex neuronal networks. In particular neurons of the spinal cord and peripheral ganglia play a key role in regulating micturition and defaecation reflexes as well as promoting continence. In this review we discuss the evidence for ageing-induced neuronal dysfunction that might predispose to neurogenic forms of incontinence in the elderly.
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Affiliation(s)
- Richard N Ranson
- Department of Applied Sciences (Biomedical Sciences), Faculty of Health and Life Sciences, Northumbria University, Newcastle upon Tyne, NE1 8ST, UK,
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Vrijens D, Drossaerts J, van Koeveringe G, Van Kerrebroeck P, van Os J, Leue C. Affective symptoms and the overactive bladder - a systematic review. J Psychosom Res 2015; 78:95-108. [PMID: 25499886 DOI: 10.1016/j.jpsychores.2014.11.019] [Citation(s) in RCA: 97] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2014] [Revised: 11/17/2014] [Accepted: 11/20/2014] [Indexed: 12/22/2022]
Abstract
BACKGROUND Overactive bladder syndrome (OAB) is characterised by urgency symptoms, with or without urgency incontinence, usually with frequency and nocturia. Although literature suggest an association between OAB, depression and anxiety, no systematic review has been presented. OBJECTIVE Systematically review the literature on the association of affective conditions with OAB. METHODS Systematic review according to the PRISMA guidelines. This review is registered in the PROSPERO register (CRD4201400664). RESULTS Forty-three articles were included, describing more than 80,000 subjects. Depression and OAB were positively associated in 26 studies, anxiety and OAB in 6 studies. Longitudinal studies reported: a) OAB subjects who developed depression/anxiety or b) depressed/anxious subjects developing OAB, or c) both. The quality of evidence in studies reporting an association between the co-occurrence of OAB and depression was rated level 3 in accordance with the GRADE framework. Evidence reporting on the co-occurrence of anxiety and OAB was rated GRADE level 2. Longitudinal associations between new onset of OAB in depressive subjects was GRADE level 2. Evidence reporting association of OAB with anxiety in longitudinal studies was of GRADE level 1. CONCLUSION To our knowledge, this systematic review is the first to give a comprehensive qualitative overview on the association between OAB and affective symptoms. Many evaluated studies failed to note longitudinal changes and lacked evidence of causality. Still, results revealed an association between OAB and affective symptoms and there is evidence for new onset of OAB in depressive subjects, but further research is necessary to examine the strength of the effect.
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Affiliation(s)
- Desiree Vrijens
- Department of Urology, Maastricht University Medical Centre, Maastricht, The Netherlands; Pelvic Care Centre Maastricht, Maastricht University Medical Centre, Maastricht, The Netherlands.
| | - Jamie Drossaerts
- Department of Urology, Maastricht University Medical Centre, Maastricht, The Netherlands.
| | - Gommert van Koeveringe
- Department of Urology, Maastricht University Medical Centre, Maastricht, The Netherlands; Pelvic Care Centre Maastricht, Maastricht University Medical Centre, Maastricht, The Netherlands.
| | - Philip Van Kerrebroeck
- Department of Urology, Maastricht University Medical Centre, Maastricht, The Netherlands; Pelvic Care Centre Maastricht, Maastricht University Medical Centre, Maastricht, The Netherlands.
| | - Jim van Os
- Department of Psychiatry and Psychology, South Limburg Mental Health Research and Teaching Network, EURON, Maastricht University Medical Centre, Maastricht, The Netherlands; King's College London, King's Health Partners, London, Institute of Psychiatry, United Kingdom.
| | - Carsten Leue
- Pelvic Care Centre Maastricht, Maastricht University Medical Centre, Maastricht, The Netherlands; Department of Psychiatry and Psychology, South Limburg Mental Health Research and Teaching Network, EURON, Maastricht University Medical Centre, Maastricht, The Netherlands.
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Abstract
This article summarizes anatomical, neurophysiological, pharmacological, and brain imaging studies in humans and animals that have provided insights into the neural circuitry and neurotransmitter mechanisms controlling the lower urinary tract. The functions of the lower urinary tract to store and periodically eliminate urine are regulated by a complex neural control system in the brain, spinal cord, and peripheral autonomic ganglia that coordinates the activity of smooth and striated muscles of the bladder and urethral outlet. The neural control of micturition is organized as a hierarchical system in which spinal storage mechanisms are in turn regulated by circuitry in the rostral brain stem that initiates reflex voiding. Input from the forebrain triggers voluntary voiding by modulating the brain stem circuitry. Many neural circuits controlling the lower urinary tract exhibit switch-like patterns of activity that turn on and off in an all-or-none manner. The major component of the micturition switching circuit is a spinobulbospinal parasympathetic reflex pathway that has essential connections in the periaqueductal gray and pontine micturition center. A computer model of this circuit that mimics the switching functions of the bladder and urethra at the onset of micturition is described. Micturition occurs involuntarily in infants and young children until the age of 3 to 5 years, after which it is regulated voluntarily. Diseases or injuries of the nervous system in adults can cause the re-emergence of involuntary micturition, leading to urinary incontinence. Neuroplasticity underlying these developmental and pathological changes in voiding function is discussed.
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Affiliation(s)
- William C. de Groat
- Department of Pharmacology and Chemical Biology, University of Pittsburgh, School of Medicine Pittsburgh, Pennsylvania
| | - Derek Griffiths
- Department of Medicine (Geriatrics), University of Pittsburgh, School of Medicine Pittsburgh, Pennsylvania
| | - Naoki Yoshimura
- Department of Pharmacology and Chemical Biology, University of Pittsburgh, School of Medicine Pittsburgh, Pennsylvania
- Department of Urology, University of Pittsburgh, School of Medicine Pittsburgh, Pennsylvania
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Sakakibara R. Lower urinary tract dysfunction in patients with brain lesions. HANDBOOK OF CLINICAL NEUROLOGY 2015; 130:269-87. [PMID: 26003249 DOI: 10.1016/b978-0-444-63247-0.00015-8] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Stroke and brain tumor are well-known brain diseases. The incidence of lower urinary tract dysfunction (LUTD) in these patients ranges from 14% to 53%, mostly overactive bladder (OAB), and is higher when the frontal cortex is involved. This presumably reflects damage at the prefrontal cortex, cingulate cortex, and other areas that regulate (mainly inhibit) the micturition reflex. White-matter disease (WMD) is a chronic, bilateral form of cerebrovascular disease, leading to a high prevalence of OAB (up to 90%). Since WMD is particularly common in the elderly, WMD may be one of the anatomic substrates for elderly OAB. Traumatic brain injury and normal-pressure hydrocephalus are rather diffuse brain diseases, which cause OAB with a prevalence rate of 60-95%. Recent neuroimaging studies have shown a relationship between LUTD and the frontal cortex in these diseases. Data on other brain diseases, particularly affecting deep brain structures, are limited. Small infarctions, tumors, or inflammatory diseases affecting the basal ganglia, hypothalamus, and cerebellum lead to mainly OAB. In contrast, similar diseases affecting the brainstem lead to either OAB or urinary retention. The latter reflects damage at the periaqueductal gray and the pontine micturition center that directly relay and modulate the micturition reflex. Urinary incontinence (UI) in brain disease can be divided into two types: neurogenic UI (due to OAB) and functional UI (immobility and loss of initiative/cognition). These two types of UI may occur together, but management differs significantly. Management of neurogenic UI includes anticholinergic drugs that do not penetrate the blood-brain barrier easily. Management of functional UI includes behavioral therapy (timed/prompted voiding with physical assistance and bladder/pelvic floor training) and drugs to treat gait as well as cognition that facilitate continence. These treatments will maximize the quality of life in patients with brain diseases.
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Affiliation(s)
- Ryuji Sakakibara
- Department of Neurology, Sakura Medical Center, Toho University, Sakura, Japan.
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Fan WJ, Chen SC, Hsieh TH, Lai CH, Lin YS, Peng CW, Kou YR. Influence of serotonergic mechanisms on the urine flow rate in male rats. Am J Physiol Regul Integr Comp Physiol 2014; 307:R1239-50. [PMID: 25209414 DOI: 10.1152/ajpregu.00160.2014] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
This study extensively examined the role of a 5-HT(1A) receptor in controlling voiding function in anesthetized male rats. A simultaneous recording of the intravesical pressure (IVP), external urethral sphincter (EUS)-electromyography (EMG), and urine flow rate (UFR) during continuous cystometry was used. 8-Hydroxy-2-(di-n-propylamino)-tetralin (8-OH-DPAT), a 5-HT(1A) receptor agonist, significantly improved the voiding efficiency, as detected by increases in the evoked contraction amplitude, EUS burst period, and silent period, and decreases in the volume threshold, pressure threshold, and residual volume. Interestingly, the UFR during voiding was reduced by 8-OH-DPAT, as evidenced by decreases in the maximal UFR and mean UFRs of the voiding period, spike duration, and interspike interval. Conversely, treating rats with WAY-100635, a 5-HT(1A) antagonist, produced effects opposite to those produced by 8-OH-DPAT. These findings suggest that 8-OH-DPAT improved the voiding efficiency by enhancing the detrusor contractile ability and prolonging EUS burst period, which would compensate for the lower UFR, resulting from urethral smooth muscle contractions and longer EUS silent periods during voiding. The present study contributes to our understanding of the role of 5-HT(1A) receptors in controlling the urine flow rate in male rats.
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Affiliation(s)
- Wen-Jia Fan
- Department and Institute of Physiology, National Yang-Ming University, Taipei, Taiwan; Department of Physical Medicine and Rehabilitation, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Shih-Ching Chen
- Department of Physical Medicine and Rehabilitation, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan; Department of Physical Medicine and Rehabilitation, Taipei Medical University Hospital, Taipei, Taiwan
| | - Tsung-Hsun Hsieh
- Graduate Institute of Neural Regenerative Medicine, Taipei Medical University, Taipei, Taiwan; Center for Neurotrauma and Neuroregeneration, Taipei Medical University, Taipei, Taiwan
| | - Chien-Hung Lai
- Department of Physical Medicine and Rehabilitation, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan; Department of Physical Medicine and Rehabilitation, Taipei Medical University Hospital, Taipei, Taiwan
| | - You Shuei Lin
- Department of Physiology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan; and
| | - Chih-Wei Peng
- Department of Physical Medicine and Rehabilitation, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan; Department of Physical Medicine and Rehabilitation, Taipei Medical University Hospital, Taipei, Taiwan; Neuroscience Research Center, Taipei Medical University Hospital, Taipei, Taiwan
| | - Yu Ru Kou
- Department and Institute of Physiology, National Yang-Ming University, Taipei, Taiwan;
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Saribacak A, Altinbaş K, Yilmaz H, Özkan A, Özkan L, Oral T. Affective Temperament Profiles of Overactive Bladder Patients. Noro Psikiyatr Ars 2014; 51:263-266. [PMID: 28360636 DOI: 10.4274/npa.y6889] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2012] [Accepted: 01/05/2013] [Indexed: 12/01/2022] Open
Abstract
INTRODUCTION Overactive bladder (OAB) is generally characterized by urinary urgency with or without incontinence and increased frequency of voiding and nocturia. Although animal studies have demonstrated the relationship between defective serotonergic neurotransmission and OAB, its etiology is still unclarified. Temperament profiles are hypothesized to be related with serotonergic activity and are studied in many psychosomatic disorders. Thus, we assume that OAB is related with a certain type of temperament. METHOD 29 patients, who were admitted to the urology outpatient clinic at Kocaeli University and clinically diagnosed with OAB syndrome, were recruited for the study. Temperament profiles were evaluated with the Temperament Evaluation of Memphis Pisa Paris and San Diego Autoquestionnaire (TEMPS-A). Depressive, hyperthymic, cyclothymic, anxious and irritable temperament scores in patients were compared with those in 25 healthy controls. RESULTS Patient and control groups were similar in terms of age (p=.65), sex (p=.64) and educational level (p=.90). Anxious temperament scores were higher (p=.02) and hyperthymic temperament scores were lower (p=.02) in patients with OAB compared to controls. Depressive, cyclothymic and irritable temperament scores were similar in both groups. There was no significant differences between men and women in both groups in terms of different temperament profile scores. CONCLUSION Hypothetically, there might be an association between anxious temperament and OAB syndrome reflecting serotonergic dysfunction. However, OAB syndrome must be considered from the aspect of the interdependence of psychosomatic implications in a narrow sense and psychosomatic dimensions due to the psychological predisposition in the individual case.
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Affiliation(s)
| | - Kürşat Altinbaş
- Çanakkale Onsekiz Mart University Faculty of Medicine, Department of Psychiatry, Çanakkale, Turkey
| | - Hasan Yilmaz
- Seka State Hospital, Clinic of Urology, Kocaeli, Turkey
| | - Alp Özkan
- Kocaeli University Faculty of Medicine, Department of Urology, Kocaeli, Turkey
| | - Levend Özkan
- Kocaeli University Faculty of Medicine, Department of Urology, Kocaeli, Turkey
| | - Timuçin Oral
- İstanbul Commerce University, Department of Psychology, İstanbul, Turkey
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Sakakibara R, Kishi M, Tsuyusaki Y, Tateno F, Uchiyama T, Yamamoto T. [Neurology and the bladder: how to assess and manage neurogenic bladder dysfunction. With particular references to neural control of micturition]. Rinsho Shinkeigaku 2014; 53:181-90. [PMID: 23524597 DOI: 10.5692/clinicalneurol.53.181] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Bladder dysfunctions are one of the most common features seen in the failure of the autonomic nervous system. Among those, overactive bladder (urinary urgency and frequency) worsens quality of life of the patients, and a large amount of post-voiding residual urine or urinary retention causes urinary tract infection, kidney dysfunction, and may bring renal failure. In the present paper we discussed neural control of micturition and how to assess it. Also, we proposed appropriate management of bladder dysfunction in elderly white matter lesions (a common cause of OAB) and diabetic neuropathy (a usual pathology underlying urinary retention). For OAB, anti-cholinergics are the mainstay, whereas for the pathological post-voiding residual urine or urinary retention, alpha-blockers, cholinergic agents and clean, intermittent self-catheterization are the choice. Treatment of bladder dysfunctions is the important target for maximizing patients' quality of life.
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Affiliation(s)
- Ryuji Sakakibara
- Neurology, Internal Medicine, Sakura Medical Center, Toho University
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Abstract
BACKGROUND The combined symptoms of urinary frequency, urgency, nocturia, and incontinence (overactive bladder) are common symptoms within an elderly population but are also seen in palliative care patients and are most often due to detrusor muscle overactivity. These symptoms can lead to a marked reduction in quality of life and pharmacological management is traditionally with anticholinergic drugs. These medications carry a high risk of side effects and are often poorly tolerated by palliative care patients. Other management approaches, however, such as the use of urisheaths may markedly improve quality of life without adding to symptom burden in patients nearing the end of life. OBJECTIVES This article highlights two cases in palliative care where overactive bladder symptoms prove difficult to manage with anticholinergic drugs. CONCLUSIONS The discussion will give an overview of treatment strategies to help aid the clinician in managing these difficult symptoms in patients with a terminal illness.
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Affiliation(s)
- Abigail Walton
- Palliative Care Department, Hammond Care , Sydney, Australia
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