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Xiao Y, Tang Y, Wang J, Yin S, Bai Y, Cui J, Yang Y, Huang K, Wang J. Cardiovascular health assessed by the new life's essential 8 and the prevalence of urinary incontinence in adults. BMC Public Health 2024; 24:2136. [PMID: 39107742 PMCID: PMC11304804 DOI: 10.1186/s12889-024-19604-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Accepted: 07/26/2024] [Indexed: 08/10/2024] Open
Abstract
OBJECTIVE To explore the association between cardiovascular health (CVH) measured by Life's Essential 8 (LE8) and the prevalence of urinary incontinence (UI). METHOD A cross-section study was conducted using data from the National Health and Nutrition Examination Survey 2007-2012. 22,609 people aged ≥ 20 years with complete information on LE8 metrics and UI questionnaires were enrolled. Participants were divided into three groups (low: < 50, moderate: ≥ 50 and < 80, high: ≥ 80) based on the cut-off of LE8. Weighted proportions, multivariable logistic regression analysis and stratified logistic regression were performed to examine the association between LE8 and the prevalence of three types of UI separately (stress UI (SUI), urge UI (UUI), mixed UI (MUI)) by confounding factors adjusted. Spline smooth was conducted to find whether a linear relationship existed. In addition, sensitive analyses were also conducted to observe the stability. RESULT A total of 22,609 adults were involved in the study, and participants were divided into three groups (low 42.2 ± 6.3, moderate 66.1 ± 8.1, high 86.8 ± 5.1) according to the cut-off points of LE8. The multivariable logistic regression suggested that LE8 is inversely associated with the prevalence of SUI (OR = 0.98, 95%CI 0.98 to 0.99), UUI (OR = 0.98, 95%CI 0.98 to 0.99), and MUI (OR = 0.98, 95%CI 0.97 to 0.98) in the fully-adjusted model. Compared with the low group, people with high scores of LE8 had a lower prevalence of SUI (OR = 0.45, 95%CI 0.37 to 0.55), UUI (OR = 0.49, 95%CI 0.40 to 0.60), and MUI (OR = 0.41, 95%CI 0.30 to 0.55). The result of the sensitive analysis showed the robustness of the main analysis. CONCLUSION The prevalence of UI (SUI, UUI, or MUI) is inversely associated with the LE8 score, which suggests that maintaining a good CVH with a higher LE8 score is accompanied by lower prevalence rates of UUI, SUI, and MUI.
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Affiliation(s)
- Yunfei Xiao
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Guoxue Alley, No. 37, Chengdu, Sichuan, P.R. China
| | - Yaxiong Tang
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Guoxue Alley, No. 37, Chengdu, Sichuan, P.R. China
| | - Jiahao Wang
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Guoxue Alley, No. 37, Chengdu, Sichuan, P.R. China
| | - Shan Yin
- Department of Urology, Affiliated Hospital of North Sichuan Medical College, Nanchong, China
| | - Yunjin Bai
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Guoxue Alley, No. 37, Chengdu, Sichuan, P.R. China
| | - Jianwei Cui
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Guoxue Alley, No. 37, Chengdu, Sichuan, P.R. China
| | - Yaqing Yang
- Department of Respiratory and Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, China
| | - Ke Huang
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Guoxue Alley, No. 37, Chengdu, Sichuan, P.R. China
| | - Jia Wang
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Guoxue Alley, No. 37, Chengdu, Sichuan, P.R. China.
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Gao D, Zhang C, Chen Q, Cao Z, Li P, Zhou G, Xu H, Xu B, Wang Z. Association between dietary fatty acids and urinary incontinence. Heliyon 2024; 10:e28595. [PMID: 38571581 PMCID: PMC10988052 DOI: 10.1016/j.heliyon.2024.e28595] [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: 12/03/2022] [Revised: 03/18/2024] [Accepted: 03/21/2024] [Indexed: 04/05/2024] Open
Abstract
Background Dietary nutrient intake contributes to urination; however, the association between dietary nutrient intake, especially that of fat, and urinary incontinence (UI) is not well understood. The most common types of UI include stress UI (SUI) and urgency UI (UUI). Objective To investigate the potential effect(s) of dietary fat intake on UI and explore its mechanism of action in relation to body mass index (BMI). Methods A cross-sectional survey of data from 15,121 individuals (20-85 years of age) from the National Health and Nutrition Examination Survey (2001-2008), a random population-based sample, was performed. Data regarding dietary nutrient intake were collected through 24 h dietary recall interviews. UI and covariate data were collected through in-person interviews. UI was assessed according to the American Urological Association Symptom Index. The odds ratio (OR) for SUI and UUI were calculated using multivariate logistic regression analysis. The mediation effect was estimated using observational mediation analysis. Results Higher total fat intake was positively associated with increased odds for developing UI (OR 1.44 [95% confidence interval (CI) 1.08-1.93]). Females who consumed more saturated fatty acids (SFA), monounsaturated fatty acids (MUFA), and polyunsaturated fatty acids (PUFA) were more likely to develop SUI. BMI partially explained the association between total fat, SFA, MUFA, and PUFA and SUI; the proportions of the mediation effect of BMI were 14.7%, 13.0%, 18.7%, and 16.3%, respectively. Conclusions Results of this study emphasize the key role of dietary fat intake in the prevalence of UI. Higher fat intake was positively associated with UI and BMI partially mediated the effect of fat intake on SUI.
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Affiliation(s)
- Dajun Gao
- Department of Urology, Shanghai Ninth People's Hospital, Shanghai, 200011, China
| | - Caoxu Zhang
- The Core Laboratory in Medical Center of Clinical Research, Department of Molecular Diagnostics and Endocrinology, Shanghai Ninth People's Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Qi Chen
- Department of Urology, Shanghai Ninth People's Hospital, Shanghai, 200011, China
| | - Zhi Cao
- Shanghai Changhai Hospital, Shanghai, China
| | - Peizhang Li
- Department of Urology, Shanghai Ninth People's Hospital, Shanghai, 200011, China
| | | | - Huan Xu
- Department of Urology, Shanghai Ninth People's Hospital, Shanghai, 200011, China
| | - Bin Xu
- Department of Urology, Shanghai Ninth People's Hospital, Shanghai, 200011, China
| | - Zhong Wang
- Department of Urology, Shanghai Ninth People's Hospital, Shanghai, 200011, China
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Jhang JF, Jiang YH, Kuo HC. Discriminating Different Bladder and Bladder Outlet Dysfunctions by Urinary Biomarkers in Women with Frequency–Urgency Syndrome. Biomedicines 2023; 11:biomedicines11030673. [PMID: 36979652 PMCID: PMC10045187 DOI: 10.3390/biomedicines11030673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Revised: 02/22/2023] [Accepted: 02/22/2023] [Indexed: 02/25/2023] Open
Abstract
Objectives: To investigate the role of urinary biomarkers in discriminating different bladder and bladder outlet dysfunctions in women with frequency–urgency syndrome. Materials and Methods: Urine samples collected from 146 women with frequency–urgency syndrome and 34 controls were investigated. All patients were included in previous clinical trials of functional urology studies and underwent a videourodynamic study. Patients with frequency–urgency syndrome were subdivided into idiopathic detrusor overactivity (IDO), neurogenic detrusor overactivity (NDO), dysfunctional voiding (DV), and hypersensitive bladder (HSB) subgroups. Urine samples were collected before any treatment, and urinary inflammatory proteins (interleukin- (IL-) 1β, IL-2, IL-6, IL-8, tumor necrosis factor-α (TNF-α), and vascular endothelial growth factor (VEGF)), neurogenic proteins (nerve growth factor (NGF), brain-derived neurotrophic factor (BDNF), and prostaglandin E2 (PGE2)), and oxidative stress biomarkers (8-isoprostane, total antioxidant capacity (TAC), and 8-hydroxydeoxyguanosine (8-OHdG)) were measured and compared between the different OAB subgroups and controls. Results: Of the 146 patients, 31 had IDO, 41 had NDO, 45 had DV, and 29 had HSB. The control group included 34 women. The patients with HSB had lower urinary TAC and IL-2 levels than the controls. The patients with IDO, NDO, and DV had significantly higher urinary TNF-α levels than those with HSB. The patients with IDO and NDO showed an increase in the urinary 8-isoprostane levels, whereas the patients with IDO had higher urinary IL-2, NGF, and BDNF levels than those with NDO. The other urinary inflammatory biomarkers did not show enough significant differences to discriminate between the different bladder and bladder outlet dysfunctions. Conclusions: The urinary levels of inflammatory, neurogenic, and oxidative stress biomarkers varied widely among the patients with bladder and bladder outlet dysfunction. This study’s results provide evidence that women with frequency–urgency syndrome and different urodynamic subtypes have varying bladder inflammation and oxidative stress conditions, which might have an impact on treatment outcomes.
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Affiliation(s)
| | | | - Hann-Chorng Kuo
- Correspondence: ; Tel.: +886-3-8561825 (ext. 2117); Fax: +886-3-8560794
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Planta D, Gerwinn T, Salemi S, Horst M. Neurogenic Lower Urinary Tract Dysfunction in Spinal Dysraphism: Morphological and Molecular Evidence in Children. Int J Mol Sci 2023; 24:ijms24043692. [PMID: 36835106 PMCID: PMC9959703 DOI: 10.3390/ijms24043692] [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: 01/09/2023] [Revised: 02/09/2023] [Accepted: 02/10/2023] [Indexed: 02/15/2023] Open
Abstract
Spinal dysraphism, most commonly myelomeningocele, is the typical cause of a neurogenic lower urinary tract dysfunction (NLUTD) in childhood. The structural changes in the bladder wall in spinal dysraphism already occur in the fetal period and affect all bladder wall compartments. The progressive decrease in smooth muscle and the gradual increase in fibrosis in the detrusor, the impairment of the barrier function of the urothelium, and the global decrease in nerve density, lead to severe functional impairment characterized by reduced compliance and increased elastic modulus. Children present a particular challenge, as their diseases and capabilities evolve with age. An increased understanding of the signaling pathways involved in lower urinary tract development and function could also fill an important knowledge gap at the interface between basic science and clinical implications, leading to new opportunities for prenatal screening, diagnosis, and therapy. In this review, we aim to summarize the evidence on structural, functional, and molecular changes in the NLUTD bladder in children with spinal dysraphism and discuss possible strategies for improved management and for the development of new therapeutic approaches for affected children.
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Affiliation(s)
- Dafni Planta
- Division of Pediatric Urology, University Children’s Hospital Zurich, 8032 Zurich, Switzerland
- Children’s Research Center, University Children’s Hospital Zurich, 8032 Zurich, Switzerland
| | - Tim Gerwinn
- Division of Pediatric Urology, University Children’s Hospital Zurich, 8032 Zurich, Switzerland
- Children’s Research Center, University Children’s Hospital Zurich, 8032 Zurich, Switzerland
| | - Souzan Salemi
- Laboratory for Urologic Oncology and Stem Cell Therapy, Department of Urology, University Hospital Zurich, 8091 Zurich, Switzerland
| | - Maya Horst
- Division of Pediatric Urology, University Children’s Hospital Zurich, 8032 Zurich, Switzerland
- Children’s Research Center, University Children’s Hospital Zurich, 8032 Zurich, Switzerland
- Correspondence:
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Mossa AH, Abdaem J, Cammisotto P, Campeau L. Deleterious impact of nerve growth factor precursor (proNGF) on bladder urothelial and smooth muscle cells. Cell Signal 2021; 81:109936. [PMID: 33529756 DOI: 10.1016/j.cellsig.2021.109936] [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: 11/10/2020] [Revised: 01/28/2021] [Accepted: 01/28/2021] [Indexed: 12/21/2022]
Abstract
The nerve growth factor precursor (proNGF) activates p75NTR receptor and promotes cell death in different tissues, yet this pathophysiological effect is not fully described in the bladder. The aim of this study was to identify the biological effect of proNGF/p75NTR activation on urothelial and smooth muscle (SM) cells of rodents' bladder. Cell viability was assessed by MTT assay which showed a significant reduction in urothelial viability after 24 h of incubation with proNGF in culture medium [5 or 10 nM], an effect not seen in SM cells. Western blot analysis on cellular protein extracts showed increased expression of the transmembrane TNF-α and activation of RhoA in urothelial cells exposed to proNGF with no evidence of a nuclear translocation of NF-κB assessed by western blotting on nuclear extracts and immunofluorescence. The activation of p75NTR-death domain related pathways in urothelial cells such as TNF-α or RhoA had a downstream effect on NO release and the junctional protein occludin, as estimated respectively by colorimetric and western blotting. On the other hand, proNGF did not induce TNF-α or RhoA expression in SM cells, but induced a significant NF-κB nuclear translocation. ProNGF had a different impact on SM as evidenced by a significant dose- and time-dependent increase in SM proliferation and migration examined by MTT test and cell migration assay. Together, our results indicate that activation of proNGF/p75NTR axis induces degenerative changes to the urothelial layer impacting its barrier and signaling integrity, while promoting adaptive proliferative changes in detrusor SM cells that can interfere with the contractile phenotype essential for proper bladder function.
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Affiliation(s)
- Abubakr H Mossa
- Lady Davis Institute, McGill University, 3755, Chemin de la cote-Ste-Catherine, Montreal, QC H3T 1E2, Canada
| | - Jacob Abdaem
- School of Medicine, McGill University, 3605 Rue de la Montagne, Montréal, QC H3G 2M1, Canada
| | - Philippe Cammisotto
- Lady Davis Institute, McGill University, 3755, Chemin de la cote-Ste-Catherine, Montreal, QC H3T 1E2, Canada
| | - Lysanne Campeau
- Lady Davis Institute, McGill University, 3755, Chemin de la cote-Ste-Catherine, Montreal, QC H3T 1E2, Canada; Urology Department, Jewish General Hospital, 3755, Chemin de la cote-Ste-Catherine, Montreal, QC H3T 1E2, Canada.
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Deng C, Peng Q, Hu X, Gao L, Xu J, Su J, Xia X, Liu F, Li M. RETRACTED ARTICLE: Urinary nerve growth factor: a biomarker for overactive bladder in children? A meta-analysis and trail sequential analysis. Pediatr Surg Int 2019; 35:1033. [PMID: 30783750 DOI: 10.1007/s00383-019-04447-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/25/2019] [Indexed: 11/29/2022]
Affiliation(s)
- Changkai Deng
- Department of Pediatric Surgery, Chengdu Women's and Children's Central Hospital of Chongqing Medical University, No. 1617, Riyue Avenue, Qinyang District, Chengdu, China.
| | - Qiang Peng
- Department of Pediatric Surgery, Chengdu Women's and Children's Central Hospital of Chongqing Medical University, No. 1617, Riyue Avenue, Qinyang District, Chengdu, China
| | - Xianliang Hu
- Department of Pediatric Surgery, Chengdu Women's and Children's Central Hospital of Chongqing Medical University, No. 1617, Riyue Avenue, Qinyang District, Chengdu, China
| | - Li Gao
- Department of Pediatric Surgery, Chengdu Women's and Children's Central Hospital of Chongqing Medical University, No. 1617, Riyue Avenue, Qinyang District, Chengdu, China
| | - Juan Xu
- Department of Pediatric Surgery, Chengdu Women's and Children's Central Hospital of Chongqing Medical University, No. 1617, Riyue Avenue, Qinyang District, Chengdu, China
| | - Jing Su
- Department of Pediatric Surgery, Chengdu Women's and Children's Central Hospital of Chongqing Medical University, No. 1617, Riyue Avenue, Qinyang District, Chengdu, China
| | - Xue Xia
- Department of Pediatric Surgery, Chengdu Women's and Children's Central Hospital of Chongqing Medical University, No. 1617, Riyue Avenue, Qinyang District, Chengdu, China
| | - Feng Liu
- Department of Urology Surgery, Children's Hospital of Chongqing Medical University, Chongqing, China
| | - Maoxian Li
- Department of Pediatric Surgery, Chengdu Women's and Children's Central Hospital of Chongqing Medical University, No. 1617, Riyue Avenue, Qinyang District, Chengdu, China
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7
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Deng C, Zhang W, Peng Q, Hu X, Li M, Gao L, Xu J, Su J, Xia X. Urinary nerve growth factor: a biomarker for detrusor overactivity in children? A meta-analysis and trail sequential analysis. Pediatr Surg Int 2019; 35:1027-1032. [PMID: 30729304 DOI: 10.1007/s00383-019-04448-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/25/2019] [Indexed: 12/19/2022]
Abstract
PURPOSE Based on, previously, a systematic review, urinary nerve growth factor (NGF) has emerged as one potentially noninvasive biomarker for detrusor overactivity (DO) in adults. We performed this systematic review to explore if NGF is a biomarker for DO in children. METHODS A literature search was conducted in PubMed, Embase, Web of science, and Cochrane Library. Copies of all relevant articles were retrieved for quality assessment and data abstraction by two reviewers. Primary outcome was pooled standardized mean difference (SMD) for NGF/Cr (NGF normalized to urine creatinine) level between DO group and controls. RESULTS Three case-control studies published from 2012 to 2016 were included with 74 patients and 70 controls. Children with DO had a significant higher baseline urinary NGF/Cr level compared to controls (SMD = 2.48, 95%CI = 0.85-4.10, P < 0.01). After treatment, the level of NGF/Cr decreased significantly compared to baseline level at 6th month time points (SMD = 0.94, 95%CI = 0.03-1.86, P = 0.04). We calculated the required information size to 99 patients for comparison of urinary NGF/Cr level between DO and controls by trail sequential analysis (TSA). CONCLUSION Based on this systematic review, NGF/Cr may be a noninvasive biomarker for DO in children in the future. However, based on TSA, more original studies are needed to clarify the role of NGF/Cr in the biomarker effect.
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Affiliation(s)
- Changkai Deng
- Department of Pediatric Surgery, Chengdu Women's and Children's Central Hospital of Chongqing Medical University, No.1617, Riyue Avenue, Qinyang District, Chengdu, China.
| | - Wei Zhang
- Department of Pediatric Surgery, Chengdu Women's and Children's Central Hospital of Chongqing Medical University, No.1617, Riyue Avenue, Qinyang District, Chengdu, China
| | - Qiang Peng
- Department of Pediatric Surgery, Chengdu Women's and Children's Central Hospital of Chongqing Medical University, No.1617, Riyue Avenue, Qinyang District, Chengdu, China
| | - Xianliang Hu
- Department of Pediatric Surgery, Chengdu Women's and Children's Central Hospital of Chongqing Medical University, No.1617, Riyue Avenue, Qinyang District, Chengdu, China
| | - Maoxian Li
- Department of Pediatric Surgery, Chengdu Women's and Children's Central Hospital of Chongqing Medical University, No.1617, Riyue Avenue, Qinyang District, Chengdu, China
| | - Li Gao
- Department of Pediatric Surgery, Chengdu Women's and Children's Central Hospital of Chongqing Medical University, No.1617, Riyue Avenue, Qinyang District, Chengdu, China
| | - Juan Xu
- Department of Pediatric Surgery, Chengdu Women's and Children's Central Hospital of Chongqing Medical University, No.1617, Riyue Avenue, Qinyang District, Chengdu, China
| | - Jing Su
- Department of Pediatric Surgery, Chengdu Women's and Children's Central Hospital of Chongqing Medical University, No.1617, Riyue Avenue, Qinyang District, Chengdu, China
| | - Xue Xia
- Department of Pediatric Surgery, Chengdu Women's and Children's Central Hospital of Chongqing Medical University, No.1617, Riyue Avenue, Qinyang District, Chengdu, China
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Mizoguchi S, Wolf-Johnson AS, Ni J, Mori K, Suzuki T, Takaoka E, Mimata H, DeFranco DB, Wang Z, Birder LA, Yoshimura N. The role of prostaglandin and E series prostaglandin receptor type 4 receptors in the development of bladder overactivity in a rat model of chemically induced prostatic inflammation. BJU Int 2019; 124:883-891. [PMID: 31166645 DOI: 10.1111/bju.14845] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
OBJECTIVES To evaluate, using a rat model of non-bacterial prostatic inflammation, the prostaglandin production and expression profiles of E-series prostaglandin (EP) receptor subtypes, which are reportedly implicated in the development of overactive bladder, in the bladder mucosa, and to investigate the effect of EP receptor type 4 (EP4) blockade on bladder overactivity after prostatic inflammation. METHODS Male Sprague-Dawley rats were used. Prostatic inflammation was induced by formalin injection (5%; 50 μL per lobe) into the bilateral ventral lobes of the prostate. At 10 days after induction of prostatic inflammation or vehicle injection, bladder tissues from the deeply anaesthetized rats were harvested and separated into mucosal and detrusor layers. Then, prostaglandin E2 (PGE2) concentrations and protein levels of PGE2 receptors (EP1-4) in the bladder mucosa and detrusor were measured by ELISA and Western blotting, respectively. In separate groups of control and formalin-treated rats, awake cystometry was performed to evaluate the changes in bladder activity after prostatic inflammation. In addition, the effect of intravesical administration of a selective EP4 antagonist (ONO-AE3-208; 30 μm) on bladder activity was evaluated in control rats and rats with prostatic inflammation. RESULTS PGE2 concentration and protein levels of EP4, but not other EP receptor subtypes, in the bladder mucosa and detrusor layers were significantly increased in formalin-injected rats vs vehicle-injected control rats. In cystometry, rats with prostatic inflammation exhibited a significant decrease in intercontraction intervals (ICIs) compared with control rats. Intravesical application of ONO-AE3-208 (30 μm), but not vehicle application, significantly increased ICIs in rats with prostatic inflammation, whereas ONO-AE3-208 at this concentration did not significantly affect any cystometric values in control rats. CONCLUSIONS Because intravesical administration of an EP4 antagonist effectively improved bladder overactivity after prostatic inflammation, EP4 activation, along with increased PGE2 production in the bladder mucosa, seems to be an important contributing factor to bladder overactivity induced by prostatic inflammation. Thus, blockade of EP4 in the bladder could be a therapeutic approach to male lower urinary tract symptoms attributable to benign prostatic hyperplasia with prostatic inflammation.
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Affiliation(s)
- Shinsuke Mizoguchi
- Department of Urology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.,Department of Urology, Oita University Graduate School of Medicine, Yufu, Japan
| | - Amanda S Wolf-Johnson
- Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Jianshu Ni
- Department of Urology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Kenichi Mori
- Department of Urology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.,Department of Urology, Oita University Graduate School of Medicine, Yufu, Japan
| | - Takahisa Suzuki
- Department of Urology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Eiichiro Takaoka
- Department of Urology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Hiromitsu Mimata
- Department of Urology, Oita University Graduate School of Medicine, Yufu, Japan
| | - Donald B DeFranco
- Department of Pharmacology and Chemical Biology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Zhou Wang
- Department of Urology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.,Department of Pharmacology and Chemical Biology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Lori A Birder
- Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.,Department of Pharmacology and Chemical Biology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Naoki Yoshimura
- Department of Urology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.,Department of Pharmacology and Chemical Biology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
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9
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Molecular Characteristics of Underactive Bladder. CURRENT BLADDER DYSFUNCTION REPORTS 2019. [DOI: 10.1007/s11884-019-00512-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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10
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Bray R, Cacciatore S, Jiménez B, Cartwright R, Digesu A, Fernando R, Holmes E, Nicholson JK, Bennett PR, MacIntyre DA, Khullar V. Urinary Metabolic Phenotyping of Women with Lower Urinary Tract Symptoms. J Proteome Res 2017; 16:4208-4216. [PMID: 28937771 DOI: 10.1021/acs.jproteome.7b00568] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Lower urinary tract symptoms (LUTS), including urinary incontinence, urgency and nocturia, affect approximately half of women worldwide. Current diagnostic methods for LUTS are invasive and costly, while available treatments are limited by side effects leading to poor patient compliance. In this study, we aimed to identify urine metabolic signatures associated with LUTS using proton nuclear magnetic resonance (1H NMR) spectroscopy. A total of 214 urine samples were collected from women attending tertiary urogynecology clinics (cases; n = 176) and healthy control women attending general gynecology clinics (n = 36). Despite high variation in the urine metabolome across the cohort, associations between urine metabolic profiles and BMI, parity, overactive bladder syndrome, frequency, straining, and bladder storage were identified using KODAMA (knowledge discovery by accuracy maximization). Four distinct urinary metabotypes were identified, one of which was associated with increased urinary frequency and low BMI. Urine from these patients was characterized by increased levels of isoleucine and decreased levels of hippurate. Our study suggests that metabolic profiling of urine samples from LUTS patients offers the potential to identify differences in underlying etiology, which may permit stratification of patient populations and the design of more personalized treatment strategies.
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Affiliation(s)
- Rhiannon Bray
- Department of Urogynaecology, St. Mary's Hospital, Imperial College Healthcare NHS Trust , London W2 1NY, U.K
| | | | - Beatriz Jiménez
- Imperial Clinical Phenotyping Centre, QEQM Building, Imperial College London, Saint Mary's Hospital , London W21NY, U.K
| | - Rufus Cartwright
- Department of Urogynaecology, St. Mary's Hospital, Imperial College Healthcare NHS Trust , London W2 1NY, U.K
| | - Alex Digesu
- Department of Urogynaecology, St. Mary's Hospital, Imperial College Healthcare NHS Trust , London W2 1NY, U.K
| | - Ruwan Fernando
- Department of Urogynaecology, St. Mary's Hospital, Imperial College Healthcare NHS Trust , London W2 1NY, U.K
| | | | | | - Phillip R Bennett
- Queen Charlotte's Hospital, Imperial College Healthcare NHS Trust , London W12 0HS, U.K
| | | | - Vik Khullar
- Department of Urogynaecology, St. Mary's Hospital, Imperial College Healthcare NHS Trust , London W2 1NY, U.K
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11
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Mossa AH, Velasquez Flores M, Cammisotto PG, Campeau L. Succinate, increased in metabolic syndrome, activates GPR91 receptor signaling in urothelial cells. Cell Signal 2017; 37:31-39. [DOI: 10.1016/j.cellsig.2017.05.014] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2017] [Revised: 05/11/2017] [Accepted: 05/24/2017] [Indexed: 12/17/2022]
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12
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Chen SF, Jiang YH, Kuo HC. Urinary biomarkers in patients with detrusor underactivity with and without bladder function recovery. Int Urol Nephrol 2017; 49:1763-1770. [PMID: 28770419 DOI: 10.1007/s11255-017-1666-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2017] [Accepted: 07/21/2017] [Indexed: 02/06/2023]
Abstract
PURPOSE Detrusor underactivity (DU) is frequently encountered in elderly patients. Part of patients with DU might have bladder function recovery after treatment. This study investigated urinary proteins in these DU patients with and without bladder function recovery. METHODS A total of 37 patients with chronic urinary retention and urodynamically proven DU were enrolled. After treatment, 24 DU patients had bladder function recovery whereas 13 had not, after 1-year follow-up. Urine collection at baseline was performed, and the urinary protein including nerve growth factor (NGF), brain-derived neurotrophic factor (BDNF) and prostaglandin E2 (PGE2) were measured by ELISA. Twenty urodynamically normal, 34 detrusor overactivity (DO) and 15 detrusor hyperactivity and inadequate contractility (DHIC) patients served as comparative groups. RESULTS Urinary NGF levels were significantly higher than normal in patients with DU (9.2 ± 20.3 vs 1.85 ± 2.9 pg/ml, p = 0.037). Urinary BDNF level was only significantly higher in patients with DU than that of the control group (153 ± 199 vs 77.4 ± 47.7 pg/ml, p = 0.033) but not in patients with DHIC or DO. Compared with the control group, the urinary BDNF level was significantly higher in DU patients with bladder function recovery (190 ± 239 pg/ml, p = 0.033) but not in patients without recovery (85.8 ± 43.7 pg/ml, p = 0.612). The PGE2 level was significantly higher than the control group in DU patients with bladder function recovery (1290 ± 836 pg/ml, p < 0.0001) but not in patients without recovery (383 ± 237 pg/ml, p = 0.130). CONCLUSION Patients with DU and higher urinary PGE2 and BDNF levels might have a chance to recover bladder function than those with a lower protein level.
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Affiliation(s)
- Sheng-Fu Chen
- Department of Urology, Buddhist Tzu Chi General Hospital and Tzu Chi University, 707, Section 3, Chung-Yang Road, Hualien, Taiwan
| | - Yuan-Hong Jiang
- Department of Urology, Buddhist Tzu Chi General Hospital and Tzu Chi University, 707, Section 3, Chung-Yang Road, Hualien, Taiwan
| | - Hann-Chorng Kuo
- Department of Urology, Buddhist Tzu Chi General Hospital and Tzu Chi University, 707, Section 3, Chung-Yang Road, Hualien, Taiwan.
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Abstract
Urinary incontinence symptoms are highly prevalent among women, have a substantial effect on health-related quality of life and are associated with considerable personal and societal expenditure. Two main types are described: stress urinary incontinence, in which urine leaks in association with physical exertion, and urgency urinary incontinence, in which urine leaks in association with a sudden compelling desire to void. Women who experience both symptoms are considered as having mixed urinary incontinence. Research has revealed overlapping potential causes of incontinence, including dysfunction of the detrusor muscle or muscles of the pelvic floor, dysfunction of the neural controls of storage and voiding, and perturbation of the local environment within the bladder. A full diagnostic evaluation of urinary incontinence requires a medical history, physical examination, urinalysis, assessment of quality of life and, when initial treatments fail, invasive urodynamics. Interventions can include non-surgical options (such as lifestyle modifications, pelvic floor muscle training and drugs) and surgical options to support the urethra or increase bladder capacity. Future directions in research may increasingly target primary prevention through understanding of environmental and genetic risks for incontinence.
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Affiliation(s)
- Yoshitaka Aoki
- Department of Urology, University of Fukui Faculty of Medical Sciences, Fukui, Japan
| | - Heidi W Brown
- Departments of Obstetrics and Gynecology &Urology, University of Wisconsin-Madison School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Linda Brubaker
- Department of Reproductive Medicine, University of California San Diego, San Diego, California, USA
| | - Jean Nicolas Cornu
- Department of Urology, Charles Nicolle Hospital, University of Rouen Normandy, Rouen, France
| | - J Oliver Daly
- Department of Obstetrics and Gynaecology, Western Health, Victoria, Australia
| | - Rufus Cartwright
- Department of Urogynaecology, St Mary's Hospital, London, UK
- Department of Epidemiology and Biostatistics, Imperial College London, Norfolk Place, London W2 1PG, UK
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14
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Corcos J, Przydacz M, Campeau L, Witten J, Hickling D, Honeine C, Radomski SB, Stothers L, Wagg A. CUA guideline on adult overactive bladder. Can Urol Assoc J 2017; 11:E142-E173. [PMID: 28503229 PMCID: PMC5426936 DOI: 10.5489/cuaj.4586] [Citation(s) in RCA: 79] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Affiliation(s)
- Jacques Corcos
- Department of Urology, Jewish General Hospital, McGill University, Montreal, QC, Canada
| | - Mikolaj Przydacz
- Department of Urology, Jewish General Hospital, McGill University, Montreal, QC, Canada
| | - Lysanne Campeau
- Department of Urology, Jewish General Hospital, McGill University, Montreal, QC, Canada
| | | | - Duane Hickling
- Division of Urology, Department of Surgery, The Ottawa Hospital, Ottawa, ON, Canada
| | - Christiane Honeine
- Department of Urology, Jewish General Hospital, McGill University, Montreal, QC, Canada
| | - Sidney B. Radomski
- Division of Urology, Toronto Western Hospital, University of Toronto, University Health Network, Toronto, ON, Canada
| | - Lynn Stothers
- Department of Urological Sciences, University of British Columbia, Vancouver, BC, Canada
| | - Adrian Wagg
- Department of Medicine, University of Alberta, Edmonton, AB, Canada
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15
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Leue C, Kruimel J, Vrijens D, Masclee A, van Os J, van Koeveringe G. Functional urological disorders: a sensitized defence response in the bladder-gut-brain axis. Nat Rev Urol 2016; 14:153-163. [PMID: 27922040 DOI: 10.1038/nrurol.2016.227] [Citation(s) in RCA: 71] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Functional urological and gastrointestinal disorders are interrelated and characterized by a chronic course and considerable treatment resistance. Urological disorders associated with a sizeable functional effect include overactive bladder (OAB), interstitial cystitis/bladder pain syndrome (IC/BPS), and chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS). Poor treatment outcomes might be attributable to untreated underlying psychological and psychiatric disorders, as the co-occurrence of functional urological and gastrointestinal disorders with mood and anxiety disorders is common. The hypothetical bladder-gut-brain axis (BGBA) is a useful framework under which this interaction can be studied, suggesting that functional disorders represent a sensitized response to earlier threats such as childhood adversity or previous traumatic events, resulting in perceived emotional and bodily distress - the symptoms of functional disorders. Psychological and physical stress pathways might contribute to such alarm falsification, and neuroticism could be a risk factor for the co-occurrence of functional disorders and affective conditions. Additionally, physical threat - either from external sources or internal sources such as infection - might contribute to alarm falsification by influencing body-brain crosstalk on homeostasis and, therefore, affecting mood, cognition, and behaviour. Multidisciplinary research and an integrated care approach is, therefore, required to further elucidate and remediate functional urological and gastrointestinal polymorphic phenotypes.
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Affiliation(s)
- Carsten Leue
- Department of Psychiatry and Psychology, Maastricht University Medical Center (MUMC), P. Debyelaan 25, 6229 HX Maastricht, The Netherlands.,Pelvic Care Centre (PCC) Maastricht, Maastricht University Medical Centre (MUMC), P. Debyelaan 25, 6229 HX Maastricht, The Netherlands.,Neuro-intervention Centre (NIC) Maastricht, Maastricht University Medical Centre (MUMC), P. Debyelaan 25, 6229 HX Maastricht, The Netherlands
| | - Joanna Kruimel
- Division of Gastroenterology-Hepatology, Department of Internal Medicine, Maastricht University Medical Center (MUMC), P. Debyelaan 25, 6229 HX Maastricht, The Netherlands.,Pelvic Care Centre (PCC) Maastricht, Maastricht University Medical Centre (MUMC), P. Debyelaan 25, 6229 HX Maastricht, The Netherlands.,Neuro-intervention Centre (NIC) Maastricht, Maastricht University Medical Centre (MUMC), P. Debyelaan 25, 6229 HX Maastricht, The Netherlands
| | - Desiree Vrijens
- Department of Urology, Maastricht University Medical Centre (MUMC), P. Debyelaan 25, 6229 HX Maastricht, The Netherlands.,Pelvic Care Centre (PCC) Maastricht, Maastricht University Medical Centre (MUMC), P. Debyelaan 25, 6229 HX Maastricht, The Netherlands.,Neuro-intervention Centre (NIC) Maastricht, Maastricht University Medical Centre (MUMC), P. Debyelaan 25, 6229 HX Maastricht, The Netherlands
| | - Adrian Masclee
- Division of Gastroenterology-Hepatology, Department of Internal Medicine, Maastricht University Medical Center (MUMC), P. Debyelaan 25, 6229 HX Maastricht, The Netherlands.,Pelvic Care Centre (PCC) Maastricht, Maastricht University Medical Centre (MUMC), P. Debyelaan 25, 6229 HX Maastricht, The Netherlands.,Neuro-intervention Centre (NIC) Maastricht, Maastricht University Medical Centre (MUMC), P. Debyelaan 25, 6229 HX Maastricht, The Netherlands
| | - Jim van Os
- Department of Psychiatry and Psychology, Maastricht University Medical Center (MUMC), P. Debyelaan 25, 6229 HX Maastricht, The Netherlands.,Neuro-intervention Centre (NIC) Maastricht, Maastricht University Medical Centre (MUMC), P. Debyelaan 25, 6229 HX Maastricht, The Netherlands.,King's College London, King's Health Partners, Department of Psychosis Studies, Institute of Psychiatry, De Crespigny Park, London SE5 8AF, UK
| | - Gommert van Koeveringe
- Department of Urology, Maastricht University Medical Centre (MUMC), P. Debyelaan 25, 6229 HX Maastricht, The Netherlands.,Pelvic Care Centre (PCC) Maastricht, Maastricht University Medical Centre (MUMC), P. Debyelaan 25, 6229 HX Maastricht, The Netherlands.,Neuro-intervention Centre (NIC) Maastricht, Maastricht University Medical Centre (MUMC), P. Debyelaan 25, 6229 HX Maastricht, The Netherlands
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16
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Rachaneni S, McCooty S, Middleton LJ, Parker VL, Daniels JP, Coomarasamy A, Verghese TS, Balogun M, Goranitis I, Barton P, Roberts TE, Deeks JJ, Latthe P. Bladder ultrasonography for diagnosing detrusor overactivity: test accuracy study and economic evaluation. Health Technol Assess 2016; 20:1-150. [PMID: 26806032 DOI: 10.3310/hta20070] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Urodynamics (UDS) has been considered the gold standard test for detrusor overactivity (DO) in women with an overactive bladder (OAB). Bladder ultrasonography to measure bladder wall thickness (BWT) is less invasive and has been proposed as an alternative test. OBJECTIVES To estimate the reliability, reproducibility, accuracy and acceptability of BWT in women with OAB, measured by ultrasonography, in the diagnosis of DO; to explore the role of UDS and its impact on treatment outcomes; and to conduct an economic evaluation of alternative care pathways. DESIGN A cross-sectional test accuracy study. SETTING 22 UK hospitals. PARTICIPANTS 687 women with OAB. METHODS BWT was measured using transvaginal ultrasonography, and DO was assessed using UDS, which was performed blind to ultrasonographic findings. Intraobserver and interobserver reproducibility were assessed by repeated measurements from scans in 37 and 57 women, respectively, and by repeated scans in 27 women. Sensitivity and specificity were computed at pre-specified thresholds. The smallest real differences detectable of BWT were estimated using one-way analysis of variance. The pain and acceptability of both tests were evaluated by a questionnaire. Patient symptoms were measured before testing and after 6 and 12 months using the International Consultation on Incontinence modular Questionnaire Overactive Bladder (short form) (ICIQ-OAB) questionnaire and a global impression of improvement elicited at 12 months. Interventions and patient outcomes were analysed according to urodynamic diagnoses and BWT measurements. A decision-analytic model compared the cost-effectiveness of care strategies using UDS, ultrasonography or clinical history, estimating the cost per woman successfully treated and the cost per quality-adjusted life-year (QALY). RESULTS BWT showed very low sensitivity and specificity at all pre-specified cut-off points, and there was no evidence of discrimination at any threshold (p = 0.25). Extensive sensitivity and subgroup analyses did not alter the interpretation of these findings. The smallest detectable difference in BWT was estimated to be 2 mm. Pain levels following both tests appeared relatively low. The proportion of women who found the test 'totally acceptable' was significantly higher with ultrasonography than UDS (81% vs. 56%; p < 0.001). Overall, subsequent treatment was highly associated with urodynamic diagnosis (p < 0.0001). There was no evidence that BWT had any relationship with the global impression of improvement responses at 20 months (p = 0.4). Bladder ultrasonography was more costly and less effective than the other strategies. The incremental cost-effectiveness ratio (ICER) of basing treatment on the primary clinical presentation compared with UDS was £491,500 per woman successfully treated and £60,200 per QALY. Performing a UDS in those women with a clinical history of mixed urinary incontinence had an ICER of £19,500 per woman successfully treated and £12,700 per QALY compared with the provision of urodynamic to all women. For DO cases detected, UDS was the most cost-effective strategy. CONCLUSION There was no evidence that BWT had any relationship with DO, regardless of the cut-off point, nor any relationship to symptoms as measured by the ICIQ-OAB. Bladder ultrasonography has no diagnostic or prognostic value as a test in this condition. Furthermore, despite its greater acceptability, BWT measurement was not sufficiently reliable or reproducible. TRIAL REGISTRATION Current Controlled Trials ISRCTN46820623. FUNDING This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 20, No. 7. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Suneetha Rachaneni
- School of Clinical and Experimental Medicine, University of Birmingham, Birmingham, UK
| | | | - Lee J Middleton
- Birmingham Clinical Trials Unit, University of Birmingham, Birmingham, UK
| | - Victoria L Parker
- Birmingham Clinical Trials Unit, University of Birmingham, Birmingham, UK
| | - Jane P Daniels
- School of Clinical and Experimental Medicine, University of Birmingham, Birmingham, UK.,Birmingham Clinical Trials Unit, University of Birmingham, Birmingham, UK
| | - Arri Coomarasamy
- School of Clinical and Experimental Medicine, University of Birmingham, Birmingham, UK.,Birmingham Women's NHS Foundation Trust, Birmingham, UK
| | - Tina S Verghese
- School of Clinical and Experimental Medicine, University of Birmingham, Birmingham, UK.,Birmingham Women's NHS Foundation Trust, Birmingham, UK
| | - Moji Balogun
- Birmingham Women's NHS Foundation Trust, Birmingham, UK
| | - Ilias Goranitis
- Health Economics Unit, University of Birmingham, Birmingham, UK
| | - Pelham Barton
- Health Economics Unit, University of Birmingham, Birmingham, UK
| | - Tracy E Roberts
- Health Economics Unit, University of Birmingham, Birmingham, UK
| | - Jonathan J Deeks
- Birmingham Clinical Trials Unit, University of Birmingham, Birmingham, UK.,Public Health, Epidemiology and Biostatistics, University of Birmingham, Birmingham, UK
| | - Pallavi Latthe
- School of Clinical and Experimental Medicine, University of Birmingham, Birmingham, UK.,Birmingham Women's NHS Foundation Trust, Birmingham, UK
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17
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Abstract
PURPOSE OF REVIEW Biomarkers constitute objectively measurable characteristics that can be evaluated as indicators of physiological and pathogenic processes and might be used as diagnostic, prognostic or predictive tools in clinical care. This review examines the availability of biomarkers to treat the dynamic and complex symptoms of overactive bladder (OAB). RECENT FINDINGS OAB biomarkers may contribute to reveal the origin of storage symptoms in otherwise healthy individuals. The research encompassing the changes that occur in the bladder or in the peripheral (and central) nervous system might be determined through blood or urinary molecules (neurotrophins, ATP, prostaglandins, C-reactive protein and cytokines) or the measurement of events occurring in the bladder wall (bladder wall or detrusor wall thickness, oxyhemoglobin and deoxyhemoglobin concentration). These biomarkers might contribute to a better understanding of the pathophysiologic mechanisms underlying OAB. SUMMARY The word biomarker to name all the parameters described above, from bladder wall thickness to urinary molecules, has been introduced to call the attention to a field wherein objective noninvasive parameters were nonexistent. OAB treatment based on a biomarker, in comparison to the treatment based on a diagnosis made from a careful history and exclusion of urinary tract infection, is not supported by current literature.
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18
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Hegele A, Knippschild S, Frohme C, Hänze J, Olbert P, Hofmann R. Changes in prostaglandin E2 in patients with idiopathic overactive bladder syndrome after botulinum toxin type A treatment: is there a clinical benefit? BMC Urol 2014; 14:85. [PMID: 25370343 PMCID: PMC4230352 DOI: 10.1186/1471-2490-14-85] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2014] [Accepted: 10/23/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The causality of overactive bladder syndrome (OAB) is still not fully understood. Several studies indicate a significant increase of prostaglandin E2 (PGE2) in patients with OAB. However, in order to clarify whether these compounds can help to objectify the clinical diagnosis, further studies are needed. This prospective study aims to analyze PGE2 blood levels (sPGE2) in patients with OAB before and after botulinum toxin type A (BoNT-A) therapy. METHODS Blood samples were obtained from 56 patients (52y, 18-87) with idiopathic OAB. sPGE2 levels were measured before and 4 weeks after BoNT-A treatment by enzyme linked immunosorbent assay (ELISA). 31 healthy persons with normal bladder function served as control group (59 y, 21-72). sPGE2 was set in relation to clinical data and the severity of OAB (wet/dry). The statistical data analysis was performed by using the non-parametric Mann-Whitney U test and paired t-test. RESULTS Significant higher sPGE2 levels were detected in patients with OAB compared to members of the control group (2750 pg/ml vs. 1674 pg/ml, p < 0.005). Furthermore sPGE2 levels were increased in patients with OAB wet compared to OAB dry (p <0.01). In 30 patients sPGE2 levels decreased significantly after BoNT-A treatment compared to baseline (2995 pg/ml vs. 1486 pg/ml, p <0.005). Patients reported an average drug effect of 9 month (0-19); incontinence pads were needed significantly less frequent (p < 0.05). 3 patients reported no postoperative effect. sPGE2 increased in two patients compared to initial levels, a single patient showed a remotely decreased sPGE2. Six patients were treated repeatedly with BoNT-A after showing an sPGE2 re-rise. CONCLUSIONS sPGE2-level is increased in patients with OAB. We could prove a significant decrease of sPGE2 after BoNT-A treatment. In this small cohort we could demonstrate a correlation between OAB and sPGE2, especially in the non-responder group. The use of sPGE2 as a biomarker in diagnostics and follow-up after therapy seems promising. To what extent sPGE2 can be useful as such needs to be examined prospectively in a larger population.
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Affiliation(s)
- Axel Hegele
- Department of Urology and Pediatric Urology, Philipps University Marburg, Medical School, Marburg, Germany.
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19
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Rahnama'i MS, Van Koeveringe GA, Van Kerrebroeck PE. Rationale for the use of prostaglandins and phosphodiesterase inhibitors in the treatment of functional bladder disorders. Nephrourol Mon 2014; 5:949-54. [PMID: 24693500 PMCID: PMC3955285 DOI: 10.5812/numonthly.14088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2013] [Accepted: 09/11/2013] [Indexed: 12/03/2022] Open
Abstract
In this paper a general discussion of the available data on the role of prostaglandin (PG) and phosphodiesterase is discussed. Functional studies would be a next step to understand the functional meaning of the data described in this paper. The data presented are a basis for further research on selective modulation of the EP1 and EP2 receptor which could be a therapeutic target in functional bladder disorders such as OAB. PDE inhibitors are closer to clinical use, as these drugs have been studied and registered for other indications such as erectile dysfunction in men. Therefore, in vivo studies in human subjects can be conducted on short term. However, from a scientific point of view, it is very important to unravel the exact site of action and role of PDE inhibition with in vitro and in vivo studies as is the case with PG. In this way, a combination of drugs targeting different mechanisms involved in bladder physiology such as PG, cGMP, cAMP, and muscarinic receptors, could reduce side effects and improve efficacy.
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Affiliation(s)
- Mohammad Sajjad Rahnama'i
- Maastricht University Medical Centre (MUMC+), Maastricht, The Netherlands
- Corresponding author: Mohammad Sajjad Rahnama'i, Department of Urology, Maastricht University Medical Centre (MUMC+), P.O.Box: 5800, 6202 AZ Maastricht, The Netherlands. Tel: +31-433875255, Fax: +31-433875259, E-mail:
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20
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Fry CH, Sahai A, Vahabi B, Kanai AJ, Birder LA. What is the role for biomarkers for lower urinary tract disorders? ICI-RS 2013. Neurourol Urodyn 2014; 33:602-5. [PMID: 24436105 DOI: 10.1002/nau.22558] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2013] [Accepted: 12/17/2013] [Indexed: 12/12/2022]
Abstract
AIMS A biomarker is an entity that measures a normal or pathological process, or the response to an intervention. A biomarker must measure exclusively and be sufficiently sensitive to the process of interest. Alternatively, a biomarker may give clues regarding the underlying pathology of the condition and be a useful research or specialist tool. If a biomarker is to be of practical benefit then it must also be economical and practical to use. This article will consider chemical moieties as biomarkers, although in principle physical markers (e.g., bladder wall thickness) could also be defined as such. RESULTS AND CONCLUSIONS The validation of a biomarker for detrusor overactivity (DO) must appreciate the fact that the condition is likely to multifactorial and thus no single entity may be sufficiently selective and sensitive. However, more specific conditions, such as bladder pain associated with DO, may make the biomarker search easier. Several prospective agents including antiproliferative factor (APF) and epidermal growth factors (EGF) are discussed. Several urinary biomarkers, including neurotrophins (NGF, BDNF) and cytokines, and a serum marker, C-reactive protein, are considered as reaching the above criteria. All suffer from relatively poor lack of discrimination, as they all change in response to other, often inflammatory, conditions; BDNF may offer the highest expectations. Urinary ATP has also been proposed as a DO/OAB biomarker but requires further evaluation. Finally genetic markers offer potential to understand more about the pathophysiology of DO/OAB. The increasing availability of genome-wide association studies and micro-RNA assays offer genetic markers as a new generation of biomarkers. Neurourol. Urodynam. 33:602-605, 2014. © 2014 Wiley Periodicals, Inc.
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Affiliation(s)
- Christopher H Fry
- Department of Biochemistry and Physiology, University of Surrey, Guildford, Surrey, United Kingdom
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21
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Silva-Ramos M, Silva I, Oliveira O, Ferreira S, Reis MJ, Oliveira JC, Correia-de-Sá P. Urinary ATP may be a dynamic biomarker of detrusor overactivity in women with overactive bladder syndrome. PLoS One 2013; 8:e64696. [PMID: 23741373 PMCID: PMC3669404 DOI: 10.1371/journal.pone.0064696] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2013] [Accepted: 04/17/2013] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Nowadays, there is a considerable bulk of evidence showing that ATP has a prominent role in the regulation of human urinary bladder function and in the pathophysiology of detrusor overactivity. ATP mediates nonadrenergic-noncholinergic detrusor contractions in overactive bladders. In vitro studies have demonstrated that uroepithelial cells and cholinergic nerves from overactive human bladder samples (OAB) release more ATP than controls. Here, we compared the urinary ATP concentration in samples collected non-invasively from OAB women with detrusor overactivity and age-matched controls. METHODS Patients with neurologic diseases, history of malignancy, urinary tract infections or renal impairment (creatinine clearance <70 ml/min) were excluded. All patients completed a 3-day voiding diary, a 24 h urine collection and blood sampling to evaluate creatinine clearance. Urine samples collected during voluntary voids were immediately freeze-preserved for ATP determination by the luciferin-luciferase bioluminescence assay; for comparison purposes, samples were also tested for urinary nerve growth factor (NGF) by ELISA. RESULTS The urinary content of ATP, but not of NGF, normalized to patients' urine creatinine levels (ATP/Cr) or urinary volume (ATP.Vol) were significantly (P<0.05) higher in OAB women with detrusor overactivity (n = 34) than in healthy controls (n = 30). Significant differences between the two groups were still observed by boosting urinary ATP/Cr content after water intake, but these were not detected for NGF/Cr. In OAB patients, urinary ATP/Cr levels correlated inversely with mean voided volumes determined in a 3-day voiding diary. CONCLUSION A high area under the receiver operator characteristics (ROC) curve (0.741; 95% CI 0.62-0.86; P<0.001) is consistent with urinary ATP/Cr being a highly sensitive dynamic biomarker for assessing detrusor overactivity in women with OAB syndrome.
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Affiliation(s)
- Miguel Silva-Ramos
- Laboratório de Farmacologia e Neurobiologia, UMIB, Instituto de Ciências Biomédicas Abel Salazar (ICBAS) - Universidade do Porto (UP), Porto, Portugal
- Serviço de Urologia - Centro Hospitalar do Porto (CHP), Porto, Portugal
| | - Isabel Silva
- Laboratório de Farmacologia e Neurobiologia, UMIB, Instituto de Ciências Biomédicas Abel Salazar (ICBAS) - Universidade do Porto (UP), Porto, Portugal
| | - Olga Oliveira
- Laboratório de Farmacologia e Neurobiologia, UMIB, Instituto de Ciências Biomédicas Abel Salazar (ICBAS) - Universidade do Porto (UP), Porto, Portugal
- Serviço de Urologia - Centro Hospitalar do Porto (CHP), Porto, Portugal
| | - Sónia Ferreira
- Laboratório de Farmacologia e Neurobiologia, UMIB, Instituto de Ciências Biomédicas Abel Salazar (ICBAS) - Universidade do Porto (UP), Porto, Portugal
- Serviço de Urologia - Centro Hospitalar do Porto (CHP), Porto, Portugal
| | - Maria Júlia Reis
- Serviço de Química Clínica - Centro Hospitalar do Porto (CHP), Porto, Portugal
| | | | - Paulo Correia-de-Sá
- Laboratório de Farmacologia e Neurobiologia, UMIB, Instituto de Ciências Biomédicas Abel Salazar (ICBAS) - Universidade do Porto (UP), Porto, Portugal
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22
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Gamper M, Viereck V, Eberhard J, Binder J, Moll C, Welter J, Moser R. Local immune response in bladder pain syndrome/interstitial cystitis ESSIC type 3C. Int Urogynecol J 2013; 24:2049-57. [PMID: 23670165 PMCID: PMC3838592 DOI: 10.1007/s00192-013-2112-0] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2013] [Accepted: 04/06/2013] [Indexed: 01/17/2023]
Abstract
INTRODUCTION AND HYPOTHESIS Bladder pain syndrome/interstitial cystitis (BPS/IC) is identified based on subjective symptoms which lead to heterogeneous patient populations. Previous studies using gene expression arrays for BPS/IC with Hunner's lesions [European Society for the Study of Interstitial Cystitis (ESSIC) type 3C], a subtype of the condition discernible by cystoscopy, have revealed characteristic immune responses and urothelial abnormalities. This current study aimed to further characterize this subtype using a gene expression panel. We hypothesized that B-cell activation with high levels of urinary antibody concentration would be found. METHODS Cold-cup bladder biopsies, catheterized urine and blood were collected from 15 BPS/IC ESSIC type 3C patients, 11 non-inflammatory overactive bladder (OAB) patients and eight healthy controls. Gene expression in biopsies was quantified by real-time quantitative polymerase chain reaction (RT-qPCR), immunohistochemistry was performed on bladder tissue and urinary immunoglobulins G and A were quantified by enzyme-linked immunosorbent assay. Statistical analyses included the Kruskal-Wallis test for non-parametric data and post hoc tests identified differences between groups. RESULTS High expression of T- and B-cell markers (CTLA4, CD20, CD79A, IGH@), low expression of urothelial markers (KRT20, UPK1B, UPK3A), focal lymphoid aggregates in the submucosa and high immunoglobulin concentration in urine were found exclusively in BPS/IC ESSIC type 3C patients. Results for OAB were in intermediate ranges between the other two groups and UPK1B even reached significantly lower expression when compared to healthy controls. CONCLUSIONS BPS/IC ESSIC type 3C is characterized by a local adaptive immune response with elevated urinary antibody concentrations. Quantification of urinary immunoglobulin levels could be used for a non-invasive diagnosis of BPS/IC ESSIC type 3C.
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Affiliation(s)
- Marianne Gamper
- IKBT, Institut für Klinische Biomedizinische Forschung Thurgau, Lauchefeld 31, 9548, Matzingen, Switzerland,
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Oelke M, Khullar V, Wijkstra H. Review on ultrasound measurement of bladder or detrusor wall thickness in women: techniques, diagnostic utility, and use in clinical trials. World J Urol 2013; 31:1093-104. [PMID: 23386057 DOI: 10.1007/s00345-013-1030-6] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2012] [Accepted: 01/19/2013] [Indexed: 11/29/2022] Open
Abstract
PURPOSE To provide a narrative review of literature evaluating ultrasound techniques for the measurement of bladder wall hypertrophy in women as an alternative to invasive urodynamic assessment for the diagnosis of lower urinary tract symptoms (LUTS). METHODS A literature review was performed using PubMed and all paper journals of congress abstracts searching for articles on ultrasound measurement of bladder wall thickness (BWT) or detrusor wall thickness (DWT) published between January 1990 and May 2012. Each study was classified with a level of evidence using the Oxford Centre for Evidence-based Medicine classification (2009). RESULTS Ultrasound measurement of bladder wall hypertrophy is not standardised, and techniques vary widely according to anatomical approach, ultrasound frequency and other factors. This review compared transvaginal, translabial/transperineal and suprapubic approaches for ultrasound BWT/DWT measurement. BWT/DWT measurements correlated well with urodynamic diagnoses of detrusor overactivity (DO) using all three ultrasound techniques. BWT values were consistently higher in women with DO than in women with stress incontinence, although threshold values for the differential diagnosis of DO varied between clinical studies (5.0-6.5 mm using transvaginal ultrasound). Few data were available on the use of translabial or suprapubic ultrasound in women. Inter- and intraobserver variability was higher with transperineal and suprapubic ultrasound, and these techniques appear less reliable than transvaginal ultrasound. Studies suggest that BWT is reduced in response to antimuscarinic therapy in women with overactive bladder or DO. CONCLUSIONS Data from clinical trials suggest that transvaginal ultrasound measurement of BWT is a reliable method of diagnosing DO in women with LUTS, and BWT decreases during antimuscarinic therapy.
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Affiliation(s)
- Matthias Oelke
- Department of Urology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany,
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Abstract
A biomarker is an indicator of a particular disease. It is generally used to define the presence (diagnostic biomarker), severity, progression (prognostic biomarker) of a condition and/or its response to a specific treatment (predictive biomarker). Biomarkers can be specific cells, enzymes, hormones, genes or gene products, which can be detected and measured in parts of the body such as blood, urine or tissue. Therefore, biomarkers have been suggested to play an important role in both the clinical assessment and the management of patients, as well as in the research setting. Recently, interest has gathered in urinary biomarkers as a tool to assess overactive bladder (OAB), potentially playing a role in the diagnosis, disease progression and monitoring response to treatment. Urinary biomarkers identified so far include nerve growth factor (NGF), brain-derived neurotrophic factor (BDNF), prostaglandins, cytokines and C-reactive protein. The aim of this review was to review the published literature on biomarkers in OAB. A literature review using Pub Med, clinicaltrials.gov and the controlled trials online registries was performed from 1970 up to June 2012. The search keywords were: the International Continence Society (ICS) definition of "OAB", "nerve growth fac- tor" (NGF), "brain derived growth factor" (BDNF), "prostaglandins," "cytokines," "genetic biomarkers" and "C reactive protein".The results were limited for fully published English-language articles. The search was then subsequently expanded to include urinary biomarkers in interstitial cystitis and bladder pain where relevant. Each of the studies/articles was reviewed, interpreted and discussed to consider the role of urinary biomarkers in OAB. Using the search criteria, a total of 20 studies (animal and human) that investigated the role of urinary biomarkers in OAB were identified. Full text versions of these articles were obtained and reviewed. Studies on NGF suggested that urinary levels were higher in OAB patients and decreased with antimuscarinic and botulinum toxin treatment. BDNF studies have demonstrated raised levels in OAB and also increased levels in situations of acute bladder inflammation. The role of urinary prostaglandins, cytokines and CRP does not appear to be specific to the OAB disease process according to the current available evidence. Based on the evidence so far NGF and BDNF appear to be the most promising biomarkers in OAB. Although still in their infancy these neurotrophic factors could potentially diagnose OAB, replacing urodynamics and aiding in monitoring disease progression and response to treatment in addition to clinical symptoms.
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Zhang S, Lv JW, Yang P, Yu Q, Pang J, Wang Z, Guo H, Liu S, Hu J, Li J, Leng J, Huang Y, Ye Z, Wang CY. Loss of dicer exacerbates cyclophosphamide-induced bladder overactivity by enhancing purinergic signaling. THE AMERICAN JOURNAL OF PATHOLOGY 2012; 181:937-46. [PMID: 22796409 DOI: 10.1016/j.ajpath.2012.05.035] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/29/2012] [Accepted: 05/30/2012] [Indexed: 12/23/2022]
Abstract
microRNAs (miRNAs) have regulated the expression and function of genes implicated in many pathological settings, but their impact on the pathoetiological characteristics of overactive bladder (OAB) largely remains unknown. We have generated a mouse model in which adult mice can be induced for detrusor deletion of Dicer, an enzyme essential for miRNA processing. Targeted deletion of Dicer did not lead to a significant change for detrusor functionality under physiological conditions; however, loss of Dicer exacerbated cyclophosphamide-induced OAB, manifested by the higher severity of altered detrusor contractile force and sensitivity, abnormal urodynamics, and enhanced macrophage infiltration. Mechanistic studies revealed that loss of Dicer may impair the expression of miRNAs that are capable of targeting P2x mRNAs. As a result, mice deficient in Dicer manifest enhanced P2X expression in the detrusor on cyclophosphamide treatment, predisposing to the increased risk for OAB development. More important, studies using bladder biopsy samples of patients with OAB also demonstrated similar results as those found in animals. Taken together, our results suggest that miRNAs modulate OAB susceptibility by regulating purinergic signaling, in which the pathogenic insult induces the expression of miRNAs capable of targeting P2X mRNAs to suppress OAB symptoms.
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Affiliation(s)
- Shu Zhang
- The Center for Biomedical Research, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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Justewicz DM, Shokes JE, Reavis B, Boyd SA, Burnette TB, Halberstadt CR, Spencer T, Ludlow JW, Bertram TA, Jain D. Characterization of the human smooth muscle cell secretome for regenerative medicine. Tissue Eng Part C Methods 2012; 18:797-816. [PMID: 22530582 DOI: 10.1089/ten.tec.2012.0054] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
Smooth muscle cells (SMC) play a central role in maintaining the structural and functional integrity of muscle tissue. Little is known about the early in vitro events that guide the assembly of 'bioartificial tissue' (constructs) and recapitulate the key aspects of smooth muscle differentiation and development before surgical implantation. Biomimetic approaches have been proposed that enable the identification of in vitro processes which allow standardized manufacturing, thus improving both product quality and the consistency of patient outcomes. One essential element of this approach is the description of the SMC secretome, that is, the soluble and deposited factors produced within the three-dimensional (3D) extracellular matrix (ECM) microenvironment. In this study, we utilized autologous SMC from multiple tissue types that were expanded ex vivo and generated with a rigorous focus on operational phenotype and genetic stability. The objective of this study was to characterize the spatiotemporal dynamics of the first week of organoid maturation using a well-defined in vitro-like, 3D-engineered scale model of our validated manufacturing process. Functional proteomics was used to identify the topological properties of the networks of interacting proteins that were derived from the SMC secretome, revealing overlapping central nodes related to SMC differentiation and proliferation, actin cytoskeleton regulation, and balanced ECM accumulation. The critical functions defined by the Ingenuity Pathway Analysis included cell signaling, cellular movement and proliferation, and cellular and organismal development. The results confirm the phenotypic and functional similarity of the SMC generated by our platform technology at the molecular level. Furthermore, these data validate the biomimetic approaches that have been established to maintain manufacturing consistency.
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Affiliation(s)
- Dominic M Justewicz
- Department of Bioprocess Research & Development, Tengion, Inc., 3929 Westpoint Blvd., Suite G, Winston-Salem, NC 27103, USA.
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Hsiao SM, Lin HH, Kuo HC. The role of serum C-reactive protein in women with lower urinary tract symptoms. Int Urogynecol J 2012; 23:935-40. [PMID: 22422219 DOI: 10.1007/s00192-012-1715-1] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2011] [Accepted: 02/09/2012] [Indexed: 01/01/2023]
Abstract
INTRODUCTION AND HYPOTHESIS Some lower urinary tract dysfunction (LUTD) subtypes may be associated with low-grade inflammation. This study aimed to investigate the role of serum C-reactive protein (CRP) levels in women with lower urinary tract symptoms (LUTS). METHODS A total of 197 consecutive women with non-stress urinary incontinence (non-SUI) LUTS and 18 healthy women without LUTS (normal controls) were enrolled. LUTS include urinary storage, voiding, and post-micturition symptoms. Patients with previous bladder or urethral surgery, active urinary tract infections, or possible neurogenic lesions were excluded. Serum CRP levels were measured before any treatment was given. Patients were stratified to LUTD subgroups based on a 3-day voiding diary, uroflowmetry, and selective videourodynamic studies. RESULTS Median CRP levels were significantly higher in women with overactive bladder (OAB) wet (i.e., with urgency incontinence, n = 30, 0.12 mg/dl) than those in women with bladder oversensitivity (n = 68, 0.075 mg/dl, P = 0.008) and the control group (0.055 mg/dl, P = 0.032). Further analysis revealed that body mass index and maximum flow rate were two independent factors that affected CRP levels. The area under the receiver-operating characteristic curve for using CRP to predict OAB wet was 0.55, and the most predictive cutoff point for CRP was 0.15 mg/dl (sensitivity 43.5 %, specificity 72.7 %). CONCLUSIONS High serum CRP levels were found in women with OAB wet, and they were related to lower maximum urinary flow rates and higher body mass indices in non-SUI LUTD. However, serum CRP is not a suitable biomarker for discriminating between subtypes of non-SUI LUTD.
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Affiliation(s)
- Sheng-Mou Hsiao
- Department of Obstetrics and Gynecology, Far Eastern Memorial Hospital, Banqiao, New Taipei, Taiwan
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