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Post WM, Ruiz-Zapata AM, Grens H, de Vries RBM, Poelmans G, Coenen MJH, Janssen DAW, Heesakkers JPFA, Oosterwijk E, Kluivers KB. Genetic variants and expression changes in urgency urinary incontinence: A systematic review. Neurourol Urodyn 2020; 39:2089-2110. [PMID: 32949220 PMCID: PMC7692907 DOI: 10.1002/nau.24512] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Revised: 08/17/2020] [Accepted: 09/04/2020] [Indexed: 12/12/2022]
Abstract
Aim To perform a systematic review summarizing the knowledge of genetic variants, gene, and protein expression changes in humans and animals associated with urgency urinary incontinence (UUI) and to provide an overview of the known molecular mechanisms related to UUI. Methods A systematic search was performed on March 2, 2020, in PubMed, Embase, Web of Science, and the Cochrane library. Retrieved studies were screened for eligibility. The risk of bias was assessed using the ROBINS‐I (human) and SYRCLE (animal) tool. Data were presented in a structured manner and in the case of greater than five studies on a homogeneous outcome, a meta‐analysis was performed. Results Altogether, a total of 10,785 records were screened of which 37 studies met the inclusion criteria. Notably, 24/37 studies scored medium‐high to high on risk of bias, affecting the value of the included studies. The analysis of 70 unique genes and proteins and three genome‐wide association studies showed that specific signal transduction pathways and inflammation are associated with UUI. A meta‐analysis on the predictive value of urinary nerve growth factor (NGF) levels showed that increased urinary NGF levels correlate with UUI. Conclusion The collective evidence showed the involvement of two molecular mechanisms (signal transduction and inflammation) and NGF in UUI, enhancing our understanding of the pathophysiology of UUI. Unfortunately, the risk of bias was medium‐high to high for most studies and the value of many observations remains unclear. Future studies should focus on elucidating how deficits in the two identified molecular mechanisms contribute to UUI and should avoid bias.
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Affiliation(s)
- Wilke M Post
- Department of Obstetrics and Gynecology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Alejandra M Ruiz-Zapata
- Department of Obstetrics and Gynecology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Hilde Grens
- Department of Obstetrics and Gynecology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Rob B M de Vries
- Department for Health Evidence, SYRCLE, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Geert Poelmans
- Department of Human Genetics, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Marieke J H Coenen
- Department of Human Genetics, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Dick A W Janssen
- Department of Urology, Radboud University Medical Center, Nijmegen, The Netherlands
| | | | - Egbert Oosterwijk
- Department of Urology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Kirsten B Kluivers
- Department of Obstetrics and Gynecology, Radboud University Medical Center, Nijmegen, The Netherlands
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Pontes-Júnior J, Nunes RLV, dos Reis ST, de Oliveira LCN, Viana N, Leite KRM, Bruschini H, Srougi M. Adhesion molecules of detrusor muscle cells are influenced by a hypercholesterolemic diet or bladder outlet obstruction in a Wistar rat model. BMC Urol 2013; 13:50. [PMID: 24139451 PMCID: PMC3817818 DOI: 10.1186/1471-2490-13-50] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2012] [Accepted: 10/09/2013] [Indexed: 01/20/2023] Open
Abstract
Background Cell adhesion molecules (CAMs) are essential for maintaining tissue integrity by regulating intercellular and cell to extracellular matrix interactions. Cadherins and catenins are CAMs that are located on the cell membrane and are important for adherens junction (AJ) function. This study aims to verify if hypercholesterolemic diet (HCD) or bladder outlet obstruction (BOO) promotes structural bladder wall modifications specific to alterations in the expression of cadherins and catenins in detrusor muscle cells. Methods Forty-five 4-week-old female Wistar rats were divided into the following three groups: group 1 was a control group that was fed a normal diet (ND); group 2 was the BOO model and was fed a ND; and group 3 was a control group that was fed a HCD (1.25% cholesterol). Initially, serum cholesterol, LDL cholesterol and body weight were determined. Four weeks later, groups 1 and 3 underwent a sham operation; whereas group 2 underwent a partial BOO procedure that included a suture tied around the urethra. Six weeks later, all rats had their bladders removed, and previous exams were repeated. The expression levels of N-, P-, and E-cadherin, cadherin-11 and alpha-, beta- and gamma-catenins were evaluated by immunohistochemistry with a semiquantitative analysis. Results Wistar rats fed a HCD (group 3) exhibited a significant increase in LDL cholesterol levels (p=0.041) and body weight (p=0.017) when compared to both groups that were fed a normal diet in a ten-week period. We found higher β- and γ-catenin expression in groups 2 and 3 when compared to group 1 (p = 0.042 and p = 0.044, respectively). We also observed Cadherin-11 overexpression in group 3 when compared to groups 1 and 2 (p = 0.002). Conclusions A HCD in Wistar rats promoted, in addition to higher body weight gain and increased serum LDL cholesterol levels, overexpression of β- and γ-catenin in the detrusor muscle cells. Similar finding was observed in the BOO group. Higher Cadherin-11 expression was observed only in the HCD-treated rats. These findings may be associated with bladder dysfunctions that occur under such situations.
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Affiliation(s)
- José Pontes-Júnior
- Laboratory of Medical Investigation - LIM 55, Urology Department, University of São Paulo Medical School, São Paulo, Brazil.
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Blatt AH, Brammah S, Tse V, Chan L. Transurethral prostate resection in patients with hypocontractile detrusor--what is the predictive value of ultrastructural detrusor changes? J Urol 2012; 188:2294-9. [PMID: 23083643 DOI: 10.1016/j.juro.2012.08.010] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2012] [Indexed: 11/30/2022]
Abstract
PURPOSE Men with detrusor failure and chronic urinary retention have a lower voiding success rate and higher postoperative morbidity following transurethral prostatectomy than those with bladder outlet obstruction. Current investigations, including urodynamics, may be unable to predict the response to surgical treatment. We identified ultrastructural features on detrusor biopsy that correlated with the postoperative voiding outcome in patients with a hypocontractile detrusor undergoing transurethral prostatectomy. MATERIALS AND METHODS Detrusor biopsies were obtained from 17 patients with urodynamic evidence of bladder outlet obstruction or a hypocontractile detrusor undergoing transurethral prostatectomy and from 5 controls. Specimens were examined by transmission electron microscopy. Ten individual detrusor ultrastructural features were analyzed. Findings were compared with preoperative and postoperative clinical parameters. RESULTS Failure to void after transurethral prostatectomy was significantly associated with the ultrastructural features of variation in muscle cell size, muscle cell shape, collagenosis and abnormal fascicles. These 4 features were significantly associated with each other, defining a distinctive pattern of detrusor failure. For transurethral prostatectomy failure the sensitivity, specificity, and positive and negative predictive values of all 4 features together were 60%, 91%, 75% and 84%, respectively. Three or 4 features on detrusor biopsy predicted voiding failure. CONCLUSIONS Detrusor ultrastructural analysis is highly predictive of voiding outcome following transurethral prostatectomy in patients with detrusor failure. Patients with ultrastructural features previously described as part of the myohypertrophy pattern do not have a primary diagnosis of bladder outlet obstruction but rather detrusor failure secondary to bladder outlet obstruction.
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Affiliation(s)
- Alison H Blatt
- Concord Repatriation General Hospital, Sydney, New South Wales, Australia.
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Adherence junctions and cadherin-11 in normal and overactive human detrusor smooth muscle cells. J Urol 2011; 185:1946-51. [PMID: 21421233 DOI: 10.1016/j.juro.2010.12.030] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2010] [Indexed: 11/22/2022]
Abstract
PURPOSE We investigated whether analysis of adherence junctions in human detrusor could be used as a diagnostic tool to determine detrusor overactivity. MATERIALS AND METHODS We characterized the protein composition of adherence junctions in the human bladder using cadherin-11 since our group previously found that cadherin-11 could be an integral structural protein of adherence junctions. We obtained a total of 46 biopsies from 23 patients categorized into 4 groups, including 5 who were normal, and 6 each with neurogenic disease with detrusor overactivity, bladder outlet obstruction with detrusor overactivity and idiopathic detrusor overactivity. Specimens were processed to study cadherin-11 expression using combined immunohistochemical and immunogold electron microscopy techniques. Cadherin-11 expression was semiquantitatively analyzed and correlated to muscle fascicle structure and collagen in the extracellular spaces. RESULTS Immunogold labeling showed highly specific cadherin-11 expression at adherence junctions in detrusor smooth muscle cells. During immunohistochemical staining a wide variety of cadherin-11 expression and fascicle structure was found in the same specimen. No correlation was noted between detrusor overactivity and cadherin-11 expression. However, cadherin-11 seemed to be down-regulated with intercellular space widening and collagenosis. CONCLUSIONS Cadherin-11 is an integral structural protein of the adherence junction. Defects in the overactive detrusor are highly punctate. Quantitative analysis of adherence junctions using biopsy cannot replace urodynamic evaluation as a predictor of detrusor overactivity in the human bladder.
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Kuijpers KAJ, Heesakkers JPFA, Jansen CFJ, Schalken JA. Cadherin-11 is expressed in detrusor smooth muscle cells and myofibroblasts of normal human bladder. Eur Urol 2007; 52:1213-21. [PMID: 17292535 DOI: 10.1016/j.eururo.2007.01.052] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2006] [Accepted: 01/12/2007] [Indexed: 10/23/2022]
Abstract
OBJECTIVES It has recently been found that detrusor smooth muscle cells and myofibroblasts are coupled via gap junctions. However, gap junctions cannot account for strong physical interaction between cells, which has prompted the search for intercellular adhesion molecules. Cadherin-11 is a candidate for such a molecule, since it mediates the interaction of dermal myofibroblasts in contractile wound granulation tissue. We therefore hypothesised that the physical adhesion between detrusor smooth muscle cells and myofibroblasts is mediated by cadherin-11. The aim of this study was to test this hypothesis. METHODS Bladder biopsies from eight radical cystectomy specimens were snap-frozen, sectioned, and stained for E-cadherin; cadherin-11; alpha-catenin; beta-catenin; gamma-catenin; and smooth muscle cell/myofibroblast markers connexin-43, vimentin, desmin, smooth muscle actin, and smoothelin. Specimens were analysed by using binocular epifluorescent and confocal laser-scanning microscopy. RESULTS Specific positive membranous expression of all adhesion complex molecules except E-cadherin was detected in detrusor suburothelial tissue. All biopsies showed a similar punctate pattern of expression for cadherin-11 within bundles of smooth muscle cells and a suburothelial layer of cells. Cadherin-11 was specifically located at the cell membrane, in distinct linear domains. CONCLUSIONS To our knowledge this is the first time evidence has been provided for cadherin-mediated smooth muscle and suburothelial myofibroblast cell-cell interaction in the human bladder. Cadherin-11 most probably plays an important role in the intercellular physical coupling of detrusor smooth muscle cells and also of myofibroblasts.
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Affiliation(s)
- Kamiel A J Kuijpers
- Department of Urology, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands.
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Taylor JA, Kuchel GA. Detrusor Underactivity: Clinical Features and Pathogenesis of an Underdiagnosed Geriatric Condition. J Am Geriatr Soc 2006; 54:1920-32. [PMID: 17198500 DOI: 10.1111/j.1532-5415.2006.00917.x] [Citation(s) in RCA: 139] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Urinary incontinence and other lower urinary tract symptoms exert a major influence on the health and independence of frail older people. Detrusor underactivity (DU) is defined as a contraction of reduced strength and/or duration, resulting in prolonged bladder emptying and/or a failure to achieve complete bladder emptying within a normal time span. DU may influence the clinical presentation and impede the therapy of disorders as common and as disparate as detrusor overactivity, urinary retention, and benign prostatic hyperplasia. Urodynamically, nearly two-thirds of incontinent nursing home residents exhibit DU. The clinical diagnosis of DU when present alone or in association with other bladder conditions such as detrusor overactivity (detrusor hyperactivity with impaired contractility (DHIC)) is challenging, because symptoms lack adequate precision. A catheterized and increasingly noninvasive ultrasound-based postvoid residual assessment allows a bedside diagnosis of retention and may suggest the presence of DU in individuals (mostly women) with a low likelihood of bladder outlet obstruction (BOO). Nevertheless, it cannot differentiate primary DU from retention secondary to BOO. The management of individuals with DHIC remains unsatisfactory, because antispasmodic anticholinergic medications may worsen retention, whereas bethanechol does not improve bladder emptying. Human detrusor biopsies reveal axonal degeneration, muscle loss, and fibrosis in DU. Animal studies suggest that multiple risk factors, including retention itself, lack of estrogen, infection, inflammation, and aging, may contribute to DU. Priority areas for future research include efforts to facilitate clinical nonurodynamic diagnosis of probable DU plus translational research designed to address the pathogenesis of this complex multifactorial geriatric syndrome.
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Affiliation(s)
- John A Taylor
- Division of Urology, University of Connecticut Health Center, Farmington, Connecticut 06030, USA
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Wagener N, Reitz A, Pfitzenmaier J, Pannek J, Bastian PJ, Büttner R, Müller SC, Hohenfellner M, Haferkamp A. Adherens junctions of the human detrusor. BJU Int 2005; 96:843-7. [PMID: 16153214 DOI: 10.1111/j.1464-410x.2005.05724.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To immunohistochemically identify the protein composition of adherens junctions, which couple smooth muscle cells mechanically, and to confirm their decrease in different bladder dysfunctions, as studies in geriatric bladder dysfunction show fewer such junctions in patients with detrusor overactivity (DO) and bladder outlet obstruction (BOO). MATERIAL AND METHODS Detrusor biopsies were obtained from video-urodynamically evaluated patients with neurogenic DO (NDO, 31 patients), BOO (six patients) and from six patients with stress urinary incontinence (SUI) with stable, unobstructed detrusors (serving as controls). Specimens were fixed, paraffin-embedded, sectioned, stained with a polyclonal pan-cadherin antibody, monoclonal alpha-, beta- and gamma-catenin antibodies, and a monoclonal integrin-beta1 antibody. All antibodies were known to react with proteins of adherens junctions. Two examiners unaware of sample origin evaluated the sections qualitatively and using a semiquantitative scale. The results were correlated with the patient groups. RESULTS Specific immunohistochemical staining of pan-cadherin, alpha-, beta- and gamma-catenin could not be detected in any detrusor smooth muscle compartment, but was present in the urothelium. There was integrin-beta1 reactivity in the basement membranes of bladder smooth muscle cells in 38 of 43 detrusor biopsies. There were no differences among the three groups. CONCLUSION The known proteins of cell-cell adherens junctions are not part of the cell-cell junctions of detrusor smooth muscle. The specific staining of integrin-beta1 indicates either the presence of cell-matrix junctions or of cell-cell junctions within the human detrusor. Further studies are needed to identify the complete protein composition of adherens junctions within smooth muscle cells.
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Affiliation(s)
- Nina Wagener
- Department of Urology, University of Heidelberg, Germany.
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Haferkamp A, Mundhenk J, Bastian PJ, Reitz A, Dörsam J, Pannek J, Schumacher S, Schurch B, Büttner R, Müller SC. Increased Expression of Connexin 43 in the Overactive Neurogenic Detrusor. Eur Urol 2004; 46:799-805. [PMID: 15548450 DOI: 10.1016/j.eururo.2004.08.020] [Citation(s) in RCA: 58] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/24/2004] [Indexed: 11/29/2022]
Abstract
PURPOSE The cellular mechanisms involved in unstable uncontrolled detrusor contractions in the human bladder remain unknown. One hypothesis, based on electron microscopical observations and animal studies, is that gap junctions are present in the human detrusor and are increased in patients with detrusor overactivity. Thus intercellular electrical coupling between adjacent detrusor cells would be increased allowing electrical activity to spead more easily within the detrusor muscle mass and more readily generate significant contractions. The aim of this study was to prove this hypothesis. MATERIAL AND METHODS Detrusor biopsies have been obtained from videourodynamically evaluated patients with neurogenic detrusor overactivity (NDO) (n = 19) [group I] and from patients with stress urinary incontinence (SUI) with stable, non-obstructed detrusors (n = 5) [group II] serving as controls. Specimens were fixed, paraffin embedded, sectioned, stained with a monoclonal connexin 43 antibody and evaluated by two blinded examiners using a semiquantitative scale. Connexin 43 mRNA levels were evaluated using quantitative RT-PCR with primers for connexin 43 and for 18S rRNA. The results were correlated with the patients' groups. RESULTS Connexin 43 could be identified in cross sections of every detrusor biopsy. In all biopsies from patients with NDO a widespread presence of connexin 43 staining was observed, whereas only a limited presence of connexin 43 staining was observed in the specimen from patients with SUI. Connexin 43 mRNA levels within the detrusor were 3.7 fold higher in the NDO group than in the SUI group (p = 0.017). CONCLUSIONS A limited amount of gap junctions seems to be present in every detrusor independently from its urodynamic stability or instability. But there is a significant increase in connexin 43 protein and RNA levels in patients with neurogenic detrusor overactivity underlining their role in intercellular electrical coupling.
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Affiliation(s)
- A Haferkamp
- Department of Urology, University of Bonn, Bonn, Germany.
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Holm NR, Horn T, Smedts F, Nordling J, de la Rossette J. The detrusor muscle cell in bladder outlet obstruction--ultrastructural and morphometric findings. SCANDINAVIAN JOURNAL OF UROLOGY AND NEPHROLOGY 2004; 37:309-15. [PMID: 12944189 DOI: 10.1080/00365590310014751] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
OBJECTIVE Lower urinary tract symptoms (LUTS) in elderly males are not solely caused by bladder outlet obstruction (BOO) and may be at least partly attributable to detrusor dysfunction. Urodynamically, patients may show instability, hypocontractility, BOO or combinations of these findings. These findings have been related to specific ultrastructural changes in detrusor smooth muscle cells; however, this relationship is controversial. The aim of this study was to correlate ultrastructural findings in patients with BOO with urodynamic parameters. MATERIAL AND METHODS In 25 men with BOO verified by means of a full urodynamic evaluation, including a pressure-flow study, a detrusor biopsy was obtained. Six men without BOO served as controls. Biopsies for electron microscopy were analysed semiquantitatively and morphometrically to determine the presence of muscle cell hypertrophy, variation in intercellular distances, occurrence of abnormal cell junctions and configurations and intracellular changes. RESULTS The only parameter which was found to relate to the degree of obstruction in BOO was an increase in intra- and interfascicular elastin, all other correlations not reaching significance. CONCLUSION This study does not confirm a specific relationship between ultrastructural detrusor smooth muscle features and various types of BOO. Therefore ultrastructural investigation of detrusor smooth muscle cells cannot replace urodynamic evaluation in the classification of LUTS.
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Affiliation(s)
- Nina Raae Holm
- Department of Urology, Herley Hospital, University of Copenhagen, Denmark.
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JOHN HUBERT, WANG XIANG, WEHRLI ERNST, HAURI DIETER, MAAKE CAROLINE. Evidence of Gap Junctions in the Stable Nonobstructed Human Bladder. J Urol 2003. [DOI: 10.1016/s0022-5347(05)64006-2] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- HUBERT JOHN
- From the Clinic of Urology, Zürich University Hospital, Laboratory of Electronmicroscopy I, ETH Zürich and Institute of Anatomy, University of Zürich, Zürich, Switzerland
| | - XIANG WANG
- From the Clinic of Urology, Zürich University Hospital, Laboratory of Electronmicroscopy I, ETH Zürich and Institute of Anatomy, University of Zürich, Zürich, Switzerland
| | - ERNST WEHRLI
- From the Clinic of Urology, Zürich University Hospital, Laboratory of Electronmicroscopy I, ETH Zürich and Institute of Anatomy, University of Zürich, Zürich, Switzerland
| | - DIETER HAURI
- From the Clinic of Urology, Zürich University Hospital, Laboratory of Electronmicroscopy I, ETH Zürich and Institute of Anatomy, University of Zürich, Zürich, Switzerland
| | - CAROLINE MAAKE
- From the Clinic of Urology, Zürich University Hospital, Laboratory of Electronmicroscopy I, ETH Zürich and Institute of Anatomy, University of Zürich, Zürich, Switzerland
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A Qualitative Ultrastructural Study of the Hypocontractile Detrusor. J Urol 2002. [DOI: 10.1097/00005392-200207000-00028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Hindley R, Brierly R, Mclarty E, Harding D, Thomas P. A Qualitative Ultrastructural Study of the Hypocontractile Detrusor. J Urol 2002. [DOI: 10.1016/s0022-5347(05)64844-6] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- R.G. Hindley
- From the Department of Urology, Royal Sussex County Hospital, Eastern Road, Brighton, East Sussex, United Kingdom
| | - R.D. Brierly
- From the Department of Urology, Royal Sussex County Hospital, Eastern Road, Brighton, East Sussex, United Kingdom
| | - E. Mclarty
- From the Department of Urology, Royal Sussex County Hospital, Eastern Road, Brighton, East Sussex, United Kingdom
| | - D.M. Harding
- From the Department of Urology, Royal Sussex County Hospital, Eastern Road, Brighton, East Sussex, United Kingdom
| | - P.J. Thomas
- From the Department of Urology, Royal Sussex County Hospital, Eastern Road, Brighton, East Sussex, United Kingdom
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Affiliation(s)
- Peter L Dwyer
- Department of Urogynaecology, Royal Women's Hospital, Melbourne, Australia.
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14
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Ritchie J, Kuchel GA. A prospective evaluation of the pathogenesis of detrusor instability in women, using electron microscopy and immunohistochemistry. BJU Int 2001; 88:645-6. [PMID: 11678770 DOI: 10.1046/j.1464-4096.2001.2429.x-i5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Brierly RD, Hindley RG, McLarty E, Thomas PJ. A prospective evaluation of the pathogenesis of detrusor instability in women, using electron microscopy and immunohistochemistry. BJU Int 2001; 88:302-3. [PMID: 11488754 DOI: 10.1046/j.1464-410x.2001.2310e.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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