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Castellan P, Ferretti S, Litterio G, Marchioni M, Schips L. Management of Urinary Incontinence Following Radical Prostatectomy: Challenges and Solutions. Ther Clin Risk Manag 2023; 19:43-56. [PMID: 36686217 PMCID: PMC9851058 DOI: 10.2147/tcrm.s283305] [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: 07/28/2022] [Accepted: 01/06/2023] [Indexed: 01/15/2023] Open
Abstract
Urinary incontinence is a common and debilitating problem in patients undergoing radical prostatectomy. Current methods developed to treat urinary incontinence include conservative treatments, such as lifestyle education, pelvic muscle floor training, pharmacotherapy, and surgical treatments, such as bulking agents use, artificial urinary sphincter implants, retrourethral transobturator slings, and adjustable male sling system. Pelvic floor muscle exercise is the most common management to improve the strength of striated muscles of the pelvic floor to try to recover the sphincter weakness. Antimuscarinic drugs, phosphodiesterase inhibitors, duloxetine, and a-adrenergic drugs have been proposed as medical treatments for urinary incontinence after radical prostatectomy. Development of new surgical techniques, new surgical tools and materials, such as male slings, has provided an improvement of outcomes after UI surgery. Such improvement is still ongoing, and the uptake of new devices might lead to even better outcomes after UI surgery.
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Affiliation(s)
| | - Simone Ferretti
- Department of Medical, Oral and Biotechnological Sciences, G. d’Annunzio University of Chieti, Urology Unit, Chieti, Italy,Correspondence: Simone Ferretti, Department of Medical, Oral and Biotechnological Sciences, G. d’Annunzio University of Chieti, Urology Unit, Chieti, Italy, Tel +393278733805, Fax +390871357756, Email
| | - Giulio Litterio
- Department of Medical, Oral and Biotechnological Sciences, G. d’Annunzio University of Chieti, Urology Unit, Chieti, Italy
| | - Michele Marchioni
- Department of Urology, ASL02 Abruzzo, Chieti, Italy,Department of Medical, Oral and Biotechnological Sciences, G. d’Annunzio University of Chieti, Urology Unit, Chieti, Italy
| | - Luigi Schips
- Department of Urology, ASL02 Abruzzo, Chieti, Italy,Department of Medical, Oral and Biotechnological Sciences, G. d’Annunzio University of Chieti, Urology Unit, Chieti, Italy
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2
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Sheng Y, Zhang S, Ling J, Hu C, Zhang Z, Lv H. Oxybutynin nanosuspension gel for enhanced transdermal treatment for overactive bladder syndrome. Pharm Dev Technol 2022; 27:459-468. [DOI: 10.1080/10837450.2022.2078983] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Yuze Sheng
- Department of Pharmaceutics, School of Pharmacy, China Pharmaceutical University, 211198, Nanjing, China
| | - Shuang Zhang
- Department of Pharmaceutics, School of Pharmacy, China Pharmaceutical University, 211198, Nanjing, China
| | - Jiawei Ling
- Department of Pharmaceutics, School of Pharmacy, China Pharmaceutical University, 211198, Nanjing, China
| | - Chenlu Hu
- Department of Pharmaceutics, School of Pharmacy, China Pharmaceutical University, 211198, Nanjing, China
| | - Zhenhai Zhang
- Affiliated Hospital of Integrated Traditional Chinese and Western Medicine, Nanjing University of Chinese Medicine, 210023, Nanjing, China
- Jiangsu Province Academy of Traditional Chinese Medicine, 210028, Nanjing, China
| | - Huixia Lv
- Department of Pharmaceutics, School of Pharmacy, China Pharmaceutical University, 211198, Nanjing, China
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Guzelsoy M, Gunes A, Coban S, Turkoglu AR, Onen E, Ocakoglu G, Karadag M. Frequency of overactive bladder (OAB) and the factors affecting it in patients with obstructive sleep apnea syndrome (OSAS). Urologia 2022; 90:58-67. [PMID: 35188003 DOI: 10.1177/03915603221078263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE To investigate the prevalence of overactive bladder (OAB) in patients with obstructive sleep apnea syndrome (OSAS) and the factors affecting it. MATERIALS AND METHODS A total of 255 patients were included in this prospectively designed study. Among all patients, 166 were male, 89 were female; 213 patients were married and 42 were single. All patients underwent polysomnography. All patients completed the OAB-V8 form. OSAS was diagnosed via polysomnography. OAB was diagnosed via OABV8. The participants were evaluated as patients with and without OAB and those with and without OSAS. SPSS for Windows version 18.0 software was used for the statistical analysis and the level of significance was set at α = 0.05. RESULTS The prevalence of OAB was high among the OSAS patients (66.3%, n = 136). Age, body mass index, waist circumference, marital status, oxygen desaturation index (ODI4) ⩾4%, apneahypopnea index (AHI), the number and duration of decreases in O2 saturation below 90%, wake after sleep onset (WASO) duration, and groups, and OSAS severity were different in the OAB group (p < 0.05). Duration and number of O2 saturation <90%, and ODI4 are higher in the OSAS group and OAB group (p < 0.05). In multivariate logistic regression analysis, AHI, WASO, age, and marital status were the factors influencing OAB. CONCLUSION OAB is seen at a high rate in OSAS patients. Hypoxia is the main basis for both diseases and probably it is the common pathway. AHI, WASO, age, and marital status can provide valuable information to physicians for predicting OAB.
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Affiliation(s)
- Muhammet Guzelsoy
- Department of Urology, Bursa Yuksek Ihtisas Education and Research Hospital, University of Health Sciences, Bursa, Turkey
| | - Aygul Gunes
- Department of Neurology, Bursa Yuksek Ihtisas Education and Research Hospital, University of Health Sciences, Bursa, Turkey
| | - Soner Coban
- Department of Urology, Bursa Yuksek Ihtisas Education and Research Hospital, University of Health Sciences, Bursa, Turkey
| | - Ali Riza Turkoglu
- Department of Urology, Bursa Yuksek Ihtisas Education and Research Hospital, University of Health Sciences, Bursa, Turkey
| | - Efe Onen
- Department of Urology, Bursa Yuksek Ihtisas Education and Research Hospital, University of Health Sciences, Bursa, Turkey
| | - Gokhan Ocakoglu
- Department of Biostatistics, Uludag University, Faculty of Medicine, Bursa, Turkey
| | - Mehmet Karadag
- Department of Pulmonary Diseases, Uludag University, Faculty of Medicine, Bursa, Turkey
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Salehi-Pourmehr H, Ghojazadeh M, Jahantabi E, Hajebrahimi S. Diagnostic value of nerve growth factor in detrusor overactivity: a study on women with mixed urinary incontinence. Int Urol Nephrol 2021; 53:1557-1562. [PMID: 33866484 DOI: 10.1007/s11255-021-02864-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Accepted: 04/11/2021] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Urinary incontinence has a profound impact on women's quality of life. Studies have shown that changes in urinary protein levels could be a potential diagnostic biomarker in some urological diseases. The aim of present study is to determine the diagnostic value of nerve growth factor (NGF) in women with mixed urinary incontinence (MUI) as a diagnostic biomarkers of detrusor overactivity (DO). METHODS Seventy women aged between 20 and 75 years with MUI were enrolled in this prospective study. All participants underwent urodynamic study. Urine NGF levels were measured using an ELISA method. NGF level was compared between groups using Mann-Whitney U test. Receiver Operator Characteristic (ROC) analysis was employed to evaluate the diagnostic performance of urinary NGF. RESULTS The results showed that the median (min, max) of NGF in patients with DO was significantly higher in comparing to its level in women without DO [184.10 (31, 346.60) pg/ml vs. 151.80 (21, 210.70)], respectively (P = 0.035). Using receiver-operator characteristics analysis, the threshold urinary NGF value of 102.00 pg/ml provided a sensitivity of 88% and specificity of 40% in diagnosing DO, PPV of 39.1%, and NPV of 88.2%, positive likelihood ratio 2.18 and negative likelihood ratio of 0.45 (P = 0.02). CONCLUSION Based on high sensitivity and low specificity, we can conclude that NGF can be a good tool for ruling out the OAB when the test is negative. However, the future investigations are needed to expand the observed correlation in larger groups of women with DO.
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Affiliation(s)
- Hanieh Salehi-Pourmehr
- Research Center for Evidence-Based Medicine, Iranian EBM Centre: A Joanna Briggs Institute (JBI) Center of Excellence, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Morteza Ghojazadeh
- Research Center for Evidence-Based Medicine, Iranian EBM Centre: A Joanna Briggs Institute (JBI) Center of Excellence, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Elham Jahantabi
- Urology Department, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Sakineh Hajebrahimi
- Research Center for Evidence-Based Medicine, Iranian EBM Centre: A Joanna Briggs Institute (JBI) Center of Excellence, Tabriz University of Medical Sciences, Tabriz, Iran.
- Urology Department, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran.
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Hokanson JA, Langdale CL, Milliken PH, Sridhar A, Grill WM. Effects of intravesical prostaglandin E 2 on bladder function are preserved in capsaicin-desensitized rats. Am J Physiol Renal Physiol 2021; 320:F212-F223. [PMID: 33283648 PMCID: PMC7948121 DOI: 10.1152/ajprenal.00302.2020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2020] [Revised: 11/23/2020] [Accepted: 12/01/2020] [Indexed: 11/22/2022] Open
Abstract
Prostaglandin E2 (PGE2) instilled into the bladder generates symptoms of urinary urgency in healthy women and reduces bladder capacity and urethral pressure in both humans and female rats. Systemic capsaicin desensitization, which causes degeneration of C-fibers, prevented PGE2-mediated reductions in bladder capacity, suggesting that PGE2 acts as an irritant (Maggi CA, Giuliani S, Conte B, Furio M, Santicioli P, Meli P, Gragnani L, Meli A. Eur J Pharmacol 145: 105-112, 1988). In the present study, we instilled PGE2 in female rats after capsaicin desensitization but without the hypogastric nerve transection that was conducted in the Maggi et al. study. One week after capsaicin injection (125 mg/kg sc), rats underwent cystometric and urethral perfusion testing under urethane anesthesia with saline and 100 µM PGE2. Similar to naïve rats, capsaicin-desensitized rats exhibited a reduction in bladder capacity from 1.23 ± 0.08 mL to 0.70 ± 0.10 mL (P = 0.002, n = 9), a reduction in urethral perfusion pressure from 19.3 ± 2.1 cmH2O to 10.9 ± 1.2 cmH2O (P = 0.004, n = 9), and a reduction in bladder compliance from 0.13 ± 0.020 mL/cmH2O to 0.090 ± 0.014 mL/cmH2O (P = 0.011, n = 9). Thus, changes in bladder function following the instillation of PGE2 were not dependent on capsaicin-sensitive pathways. Further, these results suggest that urethral relaxation/weakness and/or increased detrusor pressure as a result of decreased compliance may contribute to urinary urgency and highlight potential targets for new therapies for overactive bladder.
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Affiliation(s)
- James A Hokanson
- Department of Biomedical Engineering, Duke University, Durham, North Carolina
| | | | | | - Arun Sridhar
- Galvani Bioelectronics, Stevenage, United Kingdom
| | - Warren M Grill
- Department of Biomedical Engineering, Duke University, Durham, North Carolina
- Department of Electrical and Computer Engineering, Duke University, Durham, North Carolina
- Department of Neurobiology, Duke University, Durham, North Carolina
- Department of Neurosurgery, Duke University, Durham, North Carolina
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6
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Cost Effectiveness of Sacral Neuromodulation and OnabotulinumtoxinA in Managing Refractory Idiopathic Overactive Bladder. Urology 2020; 149:1-10. [PMID: 33227305 DOI: 10.1016/j.urology.2020.11.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Revised: 10/28/2020] [Accepted: 11/09/2020] [Indexed: 11/22/2022]
Abstract
Little information from clinical and modelled studies are available on cost effectiveness of OnabotulinumtoxinA and SNM for the treatment of idiopathic overactive bladder. We aimed to summarize the evidence in this regard from different healthcare systems. Seven studies from 5 countries were reviewed. Some modelled studies with a 10-year time frame showed that sacral neuromodulation became dominant long-term; others suggested OnabotulinumtoxinA was more cost effective at <5 years. There was considerable heterogeneity in the base case/sensitivity analysis and statistical modelling among the studies. Clinical studies with longer term follow-up will help determine cost effectiveness more accurately.
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7
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Overactive Bladder in Women: an Update for Primary Care Physicians. CURRENT BLADDER DYSFUNCTION REPORTS 2020. [DOI: 10.1007/s11884-020-00574-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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8
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Characterizing the Health-Related Quality of Life Burden of Overactive Bladder Using Disease-Specific Patient-Reported Outcome Measures: A Systematic Literature Review. Adv Ther 2019; 36:548-562. [PMID: 30715686 PMCID: PMC6824512 DOI: 10.1007/s12325-019-0880-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2018] [Indexed: 01/29/2023]
Abstract
Introduction The objective was to identify the most commonly used patient-reported outcome (PRO) instruments for overactive bladder (OAB), determine which are the most useful for measuring burden in OAB and characterize the findings of recent studies that have employed PRO instruments to assess OAB symptoms and the effects of treatment. Methods A systematic search of OAB literature published between January 2006 and November 2017 using Medline/PubMed and EMBASE databases. Results Of 3425 abstracts and 500 full-text articles reviewed, 58 studies (both clinical trials and observational studies) were included in the review. The most commonly used PRO instruments were the OAB Questionnaire (OAB-q; 64%), followed by the King’s Health Questionnaire (KHQ; 31%) and the Patient Perception of Bladder Condition (PCBC; 21%). Synthesis of data from studies using the OAB-q showed that OAB treatment with antimuscarinics, mirabegron and onabotulinumtoxinA all improve health-related quality of life (HRQoL) and symptoms beyond the benefits observed with placebo. The OAB-q could detect dose–response relationships in some studies and demonstrated there were no significant differences across therapies from different drug classes. Conclusion The HRQoL burden of OAB and response to treatment can be reliably measured by PRO instruments, and the OAB-q is the most commonly used instrument in OAB, particularly in clinical trials of OAB interventions. These data will be useful to provide benchmarks of burden levels for PRO scores obtained among those on contemporary therapies for comparison with outcomes from patients managed with emerging treatments. Funding Astellas Pharma Global Development, Inc. Electronic supplementary material The online version of this article (10.1007/s12325-019-0880-8) contains supplementary material, which is available to authorized users.
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9
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Calogero AE, Burgio G, Condorelli RA, Cannarella R, La Vignera S. Lower urinary tract symptoms/benign prostatic hyperplasia and erectile dysfunction: from physiology to clinical aspects. Aging Male 2018; 21:261-271. [PMID: 29374992 DOI: 10.1080/13685538.2018.1430758] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
Erectile dysfunction, prostatic hyperplasia and lower urinary tract symptoms hare important pathogenetic links. Endothelial dysfunction and hormonal alterations represent the main aspects. The present article examines the anatomical, physiological, and pathophysiological characteristics of this association, finalizing the text to an interpretation of the clinical management of these patients based on these functional considerations.
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Affiliation(s)
- Aldo E Calogero
- a Department of Clinical and Experimental Medicine, Policlinico "G. Rodolico", University of Catania , Catania , Italy
| | - Giovanni Burgio
- a Department of Clinical and Experimental Medicine, Policlinico "G. Rodolico", University of Catania , Catania , Italy
| | - Rosita A Condorelli
- a Department of Clinical and Experimental Medicine, Policlinico "G. Rodolico", University of Catania , Catania , Italy
| | - Rossella Cannarella
- a Department of Clinical and Experimental Medicine, Policlinico "G. Rodolico", University of Catania , Catania , Italy
| | - Sandro La Vignera
- a Department of Clinical and Experimental Medicine, Policlinico "G. Rodolico", University of Catania , Catania , Italy
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Tamburro FR, Castellan P, Neri F, Berardinelli F, Bada M, Sountoulides P, Giuliani N, Finazzi Agrò E, Schips L, Cindolo L. Onabotulinumtoxin-A improves health status and urinary symptoms in subjects with refractory overactive bladder: Real-life experience. Urologia 2018; 85:163-168. [DOI: 10.1177/0391560318759258] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objective: Onabotulinumtoxin-A has been approved for wet overactive bladder refractory to anticholinergics in randomised controlled trials; however, data from real-life practice are scarce. This study was designed to assess the efficacy of intravesical onabotulinumtoxin-A injections, focusing on health status, urinary symptoms and subjective satisfaction. Methods: Data from consecutive patients with overactive bladder-refractory to anticholinergics treated with onabotulinumtoxin-A were prospectively collected and analysed. Standard doses (100–150 U) were used, followed by repeat sessions when clinical benefits diminished. Efficacy and safety of repeat onabotulinumtoxin-A administrations were assessed at 12-week post-injection. Clinical parameters evaluated were: change in the magnitude and frequency of incontinence, urgency and nocturia episodes, change in the number of pads used and procedural complications. Quality of life was evaluated using the 36-Item Short-Form Health Survey, Overactive Bladder Screener and Treatment Benefit Scale questionnaires. Results: Consecutive overactive bladder-refractory to anticholinergics patients ( n = 22) (median duration of oral therapy: 10 months) were enrolled. No intraoperative complications occurred, but two urinary retention cases were recorded. Forty-five percent of patients (10/22) were re-treated (median duration of perceived benefits: 18 months, range: 8–55 months). The number of urinary incontinence, frequency and nocturia episodes, and pads used went from 3.6, 11.3, 2.7 and 2.4 preoperatively to 1.0, 5.8, 0.7 and 0.7 postoperatively ( p < 0.005). Quality of life (36-Item Short-Form Health Survey) was significantly improved and symptom scores (Overactive Bladder Screener) were reduced, from 34.5 to 17.1 at week 12 ( p < 0.05). Eighty-seven percent of patients indicated improvement/great improvement in their condition (Treatment Benefit Scale). Conclusion: Intradetrusor injections of onabotulinumtoxin-A in patients with overactive bladder-refractory to anticholinergics significantly improved health status and urinary symptoms, with high subjective satisfaction.
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Affiliation(s)
- Fabiola R Tamburro
- Department of Urology, ASL02 Abruzzo, ‘S.Pio da Pietrelcina’ Hospital, Vasto, Italy
| | - Pietro Castellan
- Department of Urology, ASL02 Abruzzo, ‘S.Pio da Pietrelcina’ Hospital, Vasto, Italy
| | - Fabio Neri
- Department of Urology, ASL02 Abruzzo, ‘S.Pio da Pietrelcina’ Hospital, Vasto, Italy
| | | | - Maida Bada
- Department of Urology, ASL02 Abruzzo, ‘S.Pio da Pietrelcina’ Hospital, Vasto, Italy
- Department of Urology, G. d’Annunzio University of Chieti-Pescara, Chieti, Italy
| | | | - Nicola Giuliani
- Department of Urology, ASL02 Abruzzo, ‘S.Pio da Pietrelcina’ Hospital, Vasto, Italy
| | | | - Luigi Schips
- Department of Urology, ASL02 Abruzzo, ‘S.Pio da Pietrelcina’ Hospital, Vasto, Italy
- Department of Urology, G. d’Annunzio University of Chieti-Pescara, Chieti, Italy
| | - Luca Cindolo
- Department of Urology, ASL02 Abruzzo, ‘S.Pio da Pietrelcina’ Hospital, Vasto, Italy
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Xu D, Huang L, Gao J, Li J, Wang X, Wang K. Effects of an education program on toileting behaviors and bladder symptoms in overactive bladder patients with type 2 diabetes: A randomized clinical trial. Int J Nurs Stud 2018; 87:131-139. [PMID: 30096579 DOI: 10.1016/j.ijnurstu.2018.07.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2018] [Revised: 06/22/2018] [Accepted: 07/02/2018] [Indexed: 01/28/2023]
Abstract
BACKGROUND Overactive bladder is more common in patients with type 2 diabetes than in those without diabetes. Many patients with diabetes adopt unhealthy toileting behaviors to empty their bladder that may contribute to the onset or worsening of overactive bladder. OBJECTIVE To investigate whether an education program targeting toileting behaviors is effective for helping overactive bladder patients with type 2 diabetes in terms of adopting healthy toileting behaviors, improving bladder symptoms, and enhancing quality of life. DESIGN The study was a parallel, pragmatic, open-label randomized trial. SETTINGS The trial was conducted in a hospital-based endocrinology outpatient department in Jinan, China. PARTICIPANTS A total of 104 patients were randomly assigned to a 6-week education program or a control group. METHODS Primary outcomes included toileting behaviors and bladder symptoms, including dry/wet overactive bladder and severity of urgency. Secondary outcomes were overactive bladder-specific and general quality of life. The patients were reassessed on the outcome variables at the end of the intervention and at 3 months and 6 months following the intervention. The analysis followed the intent-to-treat principle. To account for the longitudinal data with repeated measures, group comparisons for continuous outcomes were evaluated using linear mixed models. Group differences in binary outcomes were examined using mixed-effects logit models. RESULTS Compared with the control group, the education program group showed significant changes in three unhealthy toileting behaviors: premature voiding (-0.7, p < 0.001), place preference for voiding (-0.5, p = 0.007), and delayed voiding (-0.2, p = 0.011). The program significantly relieved the bladder symptoms (-2.2, p < 0.001) and decreased the probability of having wet overactive bladder (-0.3, p < 0.001) and the severity of urgency (-0.4, p < 0.001). It also significantly improved the overactive bladder-specific quality of life by 10.8 points (p = 0.001). Regarding patients' general quality of life, the physical aspect was enhanced by 3.0 points (p = 0.049); however, no effect on the mental well-being aspect was observed. CONCLUSIONS Among overactive bladder patients with type 2 diabetes, the 6-week education program targeting toileting behaviors resulted in the adoption of healthy toileting behaviors, relief of bladder symptoms and improvement in quality of life in the 6 months following the intervention compared with routine care alone. The education program was highly successful and may represent an effective, acceptable, feasible, and safe intervention for improving bladder health and quality of life during diabetes care, given that the toileting behavioral changes were maintained during the 6-month follow-up period.
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Affiliation(s)
- Dongjuan Xu
- School of Nursing, Shandong University, Jinan, Shandong Province, China; School of Nursing, Purdue University, West Lafayette, IN, United States
| | - Liqun Huang
- School of Nursing, Shandong University, Jinan, Shandong Province, China
| | - Jie Gao
- School of Nursing, Shandong University, Jinan, Shandong Province, China
| | - Jingjing Li
- School of Nursing, Shandong University, Jinan, Shandong Province, China; Department of Surgical Nursing, Ningbo College of Health Science, Ningbo, Zhejiang Province, China
| | - Xiaojuan Wang
- School of Nursing, Shandong University, Jinan, Shandong Province, China; School of Nursing, Zhejiang Chinese Medical University, Hangzhou, Zhejiang Province, China
| | - Kefang Wang
- School of Nursing, Shandong University, Jinan, Shandong Province, China.
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Fuyama M, Ikeda H, Oyake C, Onuki Y, Watanabe T, Isoyama K. Clinical features of, and association of bladder ultrasound and uroflowmetry with, overactive bladder recovery period in children. Pediatr Int 2018; 60:569-575. [PMID: 29654627 DOI: 10.1111/ped.13577] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2017] [Revised: 03/17/2018] [Accepted: 04/03/2018] [Indexed: 01/17/2023]
Abstract
BACKGROUND Overactive bladder (OAB) is a symptomatic syndrome defined by urinary urgency, usually accompanied by increased urination frequency and nocturia, with or without urinary incontinence. The prevalence of pediatric OAB in 5-13 year olds is as high as 16.6%, but the pathophysiology and epidemiology have not been sufficiently elucidated. METHODS We retrospectively reviewed medical records in 117 children with OAB aged between 5 and 15 years during the years 2012-2016. At initial presentation, abdominal ultrasound and uroflowmetry were performed, and behavioral modifications, such as timed voiding, and constipation therapy were initiated. If there was no response after 4 weeks, antimuscarinic treatment was added. We evaluated the clinical features of OAB and factors related to the recovery period, which was defined as the period from the start of behavioral modifications to cure. RESULTS The average recovery period was 11.9 ± 9.73 months. There was no significant difference in the recovery period according to age, gender, percentage of urination frequency, nocturnal enuresis, or constipation. The recovery period was significantly shorter in the group with bladder wall thickness ≥5 mm than with bladder wall thickness <5 mm. Children with a tower-shaped curve on uroflowmetry had a significantly shorter recovery period than those with a bell-shaped curve. CONCLUSIONS Bladder wall thickness and uroflow curve shape are related to the recovery period of pediatric OAB.
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Affiliation(s)
- Masaki Fuyama
- Department of Pediatrics, Showa University, Fujigaoka Hospital, Yokohama, Kanagawa, Japan
| | - Hirokazu Ikeda
- Department of Pediatrics, Showa University, Fujigaoka Hospital, Yokohama, Kanagawa, Japan
| | - Chisato Oyake
- Department of Pediatrics, Showa University, Fujigaoka Hospital, Yokohama, Kanagawa, Japan
| | - Yuta Onuki
- Department of Pediatrics, Showa University, Fujigaoka Hospital, Yokohama, Kanagawa, Japan
| | - Tsuneki Watanabe
- Department of Pediatrics, Showa University, Fujigaoka Hospital, Yokohama, Kanagawa, Japan
| | - Keiichi Isoyama
- Department of Pediatrics, Showa University, Fujigaoka Hospital, Yokohama, Kanagawa, Japan
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Meriaux C, Hohnen R, Schipper S, Zare A, Jahanshahi A, Birder LA, Temel Y, van Koeveringe GA. Neuronal Activation in the Periaqueductal Gray Matter Upon Electrical Stimulation of the Bladder. Front Cell Neurosci 2018; 12:133. [PMID: 29867366 PMCID: PMC5968116 DOI: 10.3389/fncel.2018.00133] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2018] [Accepted: 04/30/2018] [Indexed: 12/27/2022] Open
Abstract
Reflexes, that involve the spinobulbospinal pathway control both storage and voiding of urine. The periaqueductal gray matter (PAG), a pontine structure is part of the micturition pathway. Alteration in this pathway could lead to micturition disorders and urinary incontinence, such as the overactive bladder symptom complex (OABS). Although different therapeutic options exist for the management of OABS, these are either not effective in all patients. Part of the pathology of OABS is faulty sensory signaling about the filling status of the urinary bladder, which results in aberrant efferent signaling leading to overt detrusor contractions and the sensation of urgency and frequent voiding. In order to identify novel targets for therapy (i.e., structures in the central nervous system) and explore novel treatment modalities such as neuromodulation, we aimed at investigating which areas in the central nervous system are functionally activated upon sensory afferent stimulation of the bladder. Hence, we designed a robust protocol with multiple readout parameters including immunohistological and behavioral parameters during electrical stimulation of the rat urinary bladder. Bladder stimulation induced by electrical stimulation, below the voiding threshold, influences neural activity in: (1) the caudal ventrolateral PAG, close to the aqueduct; (2) the pontine micturition center and locus coeruleus; and (3) the superficial layers of the dorsal horn, sacral parasympathetic nucleus and central canal region of the spinal cord. In stimulated animals, a higher voiding frequency was observed but was not accompanied by increase in anxiety level and locomotor deficits. Taken together, this work establishes a critical role for the vlPAG in the processing of sensory information from the urinary bladder and urges future studies to investigate the potential of neuromodulatory approaches for urological diseases.
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Affiliation(s)
- Céline Meriaux
- School for Mental Health and Neuroscience (MHeNS), Maastricht University, Maastricht, Netherlands,European Graduate School of Neuroscience (EURON), Maastricht, Netherlands,*Correspondence: Céline Meriaux
| | - Ramona Hohnen
- School for Mental Health and Neuroscience (MHeNS), Maastricht University, Maastricht, Netherlands,European Graduate School of Neuroscience (EURON), Maastricht, Netherlands
| | - Sandra Schipper
- School for Mental Health and Neuroscience (MHeNS), Maastricht University, Maastricht, Netherlands,European Graduate School of Neuroscience (EURON), Maastricht, Netherlands,Department of Urology, Maastricht University Medical Center, Maastricht, Netherlands
| | - Aryo Zare
- School for Mental Health and Neuroscience (MHeNS), Maastricht University, Maastricht, Netherlands,European Graduate School of Neuroscience (EURON), Maastricht, Netherlands
| | - Ali Jahanshahi
- School for Mental Health and Neuroscience (MHeNS), Maastricht University, Maastricht, Netherlands,European Graduate School of Neuroscience (EURON), Maastricht, Netherlands,Department of Neurosurgery, Maastricht University Medical Center, Maastricht, Netherlands
| | - Lori A. Birder
- Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States
| | - Yasin Temel
- School for Mental Health and Neuroscience (MHeNS), Maastricht University, Maastricht, Netherlands,European Graduate School of Neuroscience (EURON), Maastricht, Netherlands,Department of Neurosurgery, Maastricht University Medical Center, Maastricht, Netherlands
| | - Gommert A. van Koeveringe
- School for Mental Health and Neuroscience (MHeNS), Maastricht University, Maastricht, Netherlands,European Graduate School of Neuroscience (EURON), Maastricht, Netherlands,Department of Urology, Maastricht University Medical Center, Maastricht, Netherlands
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14
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[Botulinium toxin and idiopathic overactive bladder: Multicentric contempory management in Bourgogne]. Prog Urol 2018; 28:173-179. [PMID: 29329897 DOI: 10.1016/j.purol.2017.12.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2017] [Revised: 12/11/2017] [Accepted: 12/12/2017] [Indexed: 11/21/2022]
Abstract
INTRODUCTION Since 2014, OnabotulinumtoxinA Botox® (Allergan, Inc., Irvine, USA) represents a new therapeutic option for second-line treatment of idiopathic overactive bladder. The purpose of the current study was to evaluate practices of surgeons using onabotulinium toxin (BoNTA) in this indication. MATERIAL AND METHODS All urogynecology centers of the country were asked in order to list all patients who were treated since marketing autorisation. Patient symptoms, previous treatments, paraclinic evaluations, data of surgery and the characteristics of the follow up were collected and analyzed. RESULTS Six centers used BoNTA and five have accepted to participate. Ninety-seven patients have been identified. Sixty-eight first injections (70 %) were carried out with the strict frameworf of the marketing autorisation (urinary frequency, urinary urgency, urinary incontinence). All patients had at least two symptoms. In 69 %, Botulinum toxin was a second-line treatment after the failure of tibial neuromodulation or sacral neuromodulation. Urodynamic evaluation was carried out for 91 % of patients. The search for a post-void residual volume was observed for 59 % of patients during the follow up. CONCLUSION In our country, BoNTA injections for idiopathic overactive bladder are mainly effected after tibial neuromodulation or sacral neuromodulation failure. Diagnostic, operating and outcome evaluation practices are still very heterogeneous pleading for a greater standardization of this new therapy in this indication. LEVEL OF EVIDENCE 3.
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15
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Is it possible to cure the symptoms of the overactive bladder in women? Int Urol Nephrol 2018; 50:433-439. [DOI: 10.1007/s11255-017-1777-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2017] [Accepted: 12/20/2017] [Indexed: 01/16/2023]
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16
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Niederhauser T, Gafner ES, Cantieni T, Grämiger M, Haeberlin A, Obrist D, Burkhard F, Clavica F. Detection and quantification of overactive bladder activity in patients: Can we make it better and automatic? Neurourol Urodyn 2017; 37:823-831. [DOI: 10.1002/nau.23357] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2017] [Accepted: 06/19/2017] [Indexed: 12/21/2022]
Affiliation(s)
- Thomas Niederhauser
- Institute for Human Centered Engineering; Bern University of Applied Sciences; Biel Switzerland
| | - Elena S. Gafner
- Department of Urology; Bern University Hospital; Bern Switzerland
| | | | | | - Andreas Haeberlin
- ARTORG Center; University of Bern; Bern Switzerland
- Department of Cardiology; Bern University Hospital; Bern Switzerland
| | | | - Fiona Burkhard
- Department of Urology; Bern University Hospital; Bern Switzerland
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17
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Tuncer M, Yazici O, Kafkasli A, Sabuncu K, Salepci B, Narter F, Gungor GA, Yucetas U. Critical evaluation of the overactive bladder and urgency urinary incontinence association with obstructive sleep apnea syndrome in a relatively young adult male population. Neurourol Urodyn 2016; 36:1804-1808. [DOI: 10.1002/nau.23184] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2016] [Accepted: 11/07/2016] [Indexed: 11/09/2022]
Affiliation(s)
- Murat Tuncer
- Dr. Lutfi Kirdar Kartal Training and Research Hospital Urology Clinic; Istanbul Turkey
| | - Ozgur Yazici
- Dr. Lutfi Kirdar Kartal Training and Research Hospital Urology Clinic; Istanbul Turkey
| | - Alper Kafkasli
- Dr. Lutfi Kirdar Kartal Training and Research Hospital Urology Clinic; Istanbul Turkey
| | - Kubilay Sabuncu
- Dr. Lutfi Kirdar Kartal Training and Research Hospital Urology Clinic; Istanbul Turkey
| | - Banu Salepci
- Dr. Lutfi Kirdar Kartal Training and Research Hospital Chest Diseases Clinic; Istanbul Turkey
| | - Fehmi Narter
- Dr. Lutfi Kirdar Kartal Training and Research Hospital Urology Clinic; Istanbul Turkey
| | - Gulten A. Gungor
- Dr. Lutfi Kirdar Kartal Training and Research Hospital Chest Diseases Clinic; Istanbul Turkey
| | - Ugur Yucetas
- Istanbul Training and Research Hospital Urology Clinic; Istanbul Turkey
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Abstract
This study is to determine the effect of foot reflexology on the level of depression in women with OAB. Study findings included in the study showed foot reflexology as a part of OAB treatment relieved urinary and depressive symptoms and had a positive effect on quality of life.
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19
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Wu JW, Xing YR, Wen YB, Li TF, Xie JF, Feng QD, Shang XP, Li YL, Feng JJ, Wang XX, Zhai RQ, He XF, Chen T, Liu XJ, Wen JG. Prevalence of Spina Bifida Occulta and Its Relationship With Overactive Bladder in Middle-Aged and Elderly Chinese People. Int Neurourol J 2016; 20:151-8. [PMID: 27377948 PMCID: PMC4932639 DOI: 10.5213/inj.1630464.232] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2015] [Accepted: 02/22/2016] [Indexed: 11/08/2022] Open
Abstract
PURPOSE To investigate the prevalence of spina bifida occulta (SBO) and its relationship with the presence of overactive bladder (OAB) in middle-aged and elderly people in China. METHODS A cross-sectional community-based survey was carried out at 7 communities in Zhengzhou City, China from December 15, 2013 to June 10, 2014, where residents aged over 40 years were randomly selected to participate. All of the participants underwent lumbosacral radiographic analysis and relevant laboratory tests. A questionnaire including basic information, past medical history and present illness, and the OAB symptom score was filled out by all participants. Chi-square tests and logistic regression were used for data analysis with a P-value of <0.05 denoting statistical significance. RESULTS A total of 1,061 subjects were qualified for the final statistical analysis (58.8±11.7 years; male, 471 [44.4%]; female, 590 [55.6%]). The overall prevalence of SBO was 15.1% (160 of 1,061): 18.3% (86 of 471) in men and 12.5% (74 of 590) in women. Among these subjects, 13.7% (145 of 1,061) had OAB: 13.2% (62 of 471) in men and 14.1% (83 of 590) in women. The results of logistic regression showed that age, SBO, history of cerebral infarction (HCI), and constipation were risk factors for OAB (P<0.05), while sex, history of childhood enuresis (HCE), body mass index (BMI), and diabetes mellitus (DM) were not (P>0.05). In men, age, SBO, and constipation were risk factors for OAB (P<0.05), while HCE, BMI, DM, HCI, and benign prostate hyperplasia were not (P>0.05). In women, age, SBO, and HCI were risk factors for OAB (P<0.05), while HCE, BMI, DM, vaginal delivery, and constipation were not (P>0.05). CONCLUSIONS The prevalence of SBO is high and it is related to OAB in middle-aged and elderly people in China.
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Affiliation(s)
- Jun Wei Wu
- Urodynamic Centre, Department of Urology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- Key-Disciplines Laboratory Clinical-Medicine Henan, Zhengzhou, China
| | - Yu Rong Xing
- Center of Health Examination, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Yi Bo Wen
- Urodynamic Centre, Department of Urology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Tian Fang Li
- Department of Rheumatology & Immunology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Jia Feng Xie
- Urodynamic Centre, Department of Urology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- Key-Disciplines Laboratory Clinical-Medicine Henan, Zhengzhou, China
| | - Quan De Feng
- Urodynamic Centre, Department of Urology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- Key-Disciplines Laboratory Clinical-Medicine Henan, Zhengzhou, China
| | - Xiao Ping Shang
- Medical Record Department, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Yun Long Li
- Urodynamic Centre, Department of Urology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- Key-Disciplines Laboratory Clinical-Medicine Henan, Zhengzhou, China
| | - Jin Jin Feng
- Urodynamic Centre, Department of Urology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- Key-Disciplines Laboratory Clinical-Medicine Henan, Zhengzhou, China
| | - Xin Xin Wang
- Reproductive Medical Centre, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Rong Qun Zhai
- Urodynamic Centre, Department of Urology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- Key-Disciplines Laboratory Clinical-Medicine Henan, Zhengzhou, China
| | - Xiang Fei He
- Urodynamic Centre, Department of Urology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- Key-Disciplines Laboratory Clinical-Medicine Henan, Zhengzhou, China
| | - Tao Chen
- Urodynamic Centre, Department of Urology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- Key-Disciplines Laboratory Clinical-Medicine Henan, Zhengzhou, China
| | - Xin Jian Liu
- Urodynamic Centre, Department of Urology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- Key-Disciplines Laboratory Clinical-Medicine Henan, Zhengzhou, China
| | - Jian Guo Wen
- Urodynamic Centre, Department of Urology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- Key-Disciplines Laboratory Clinical-Medicine Henan, Zhengzhou, China
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20
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Rios LAS, Averbeck MA, Franca W, Sacomani CAR, Almeida FG, Gomes CM. Initial experience with sacral neuromodulation for the treatment of lower urinary tract dysfunction in Brazil. Int Braz J Urol 2016; 42:312-20. [PMID: 27176186 PMCID: PMC4871392 DOI: 10.1590/s1677-5538.ibju.2014.0603] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2015] [Accepted: 10/01/2015] [Indexed: 11/22/2022] Open
Abstract
Objectives: We report on the short-term outcomes of sacral neuromodulation (SNM) for treatment of idiopathic lower urinary tract dysfunction in Brazil (procedures performed before 2014). Materials and Methods: Clinical data and surgical outcomes of patients who underwent SNM staged procedures were retrospective evaluated. Urological assessment included a focused medical history and physical examination, measurement of postvoid residual volumes, urodynamics, and bladder diaries. A successful test phase has been defined by improvement of at least 50% of the symptoms, based on bladder diaries. Results: From January 2011 to December 2013, eighteen consecutive patients underwent test phase for SNM due to refractory overactive bladder (15 patients), non-obstructive chronic urinary retention (2 patients), and bladder pain syndrome/interstitial cystitis (1 patient). All patients underwent staged procedures at four outpatient surgical centers. Mean age was 48.3±21.2 (range 10-84 years). There were 16 women and 2 men. Median follow-up was 3 months. Fifteen patients (83.3%) had a successful test phase and underwent implantation of the pulse generator (IPG). Median duration of the test phase was 7 days (range 5–24 days). Mean age was 45.6±18.19 years in responders versus 61.66±34.44 years in non-responders (p=0.242). Mean operative time (test phase) was 99±33.12 min in responders versus 95±35 min for non-responders (p=0.852). No severe complications were reported. Conclusion: SNM is a minimally invasive treatment option for patients with refractory idiopathic lower urinary tract dysfunction. Our initial experience with staged technique showed that tined-lead electrodes yielded a high rate of responders and favorable clinical results in the short-term follow-up.
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Affiliation(s)
| | | | - Wagner Franca
- Universidade Federal de São Paulo, Escola Paulista de Medicina, SP, Brasil
| | | | - Fernando G Almeida
- Universidade Federal de São Paulo, Escola Paulista de Medicina, SP, Brasil
| | - Cristiano Mendes Gomes
- Departamento de Urologia, Faculdade de Medicina da Universidade de São Paulo, SP, Brasil
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21
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Kaufman MR, Chang-Kit L, Raj SR, Black BK, Milam DF, Reynolds WS, Biaggioni I, Robertson D, Dmochowski RR. Overactive bladder and autonomic dysfunction: Lower urinary tract symptoms in females with postural tachycardia syndrome. Neurourol Urodyn 2016; 36:610-613. [PMID: 26859225 DOI: 10.1002/nau.22971] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2015] [Accepted: 01/21/2016] [Indexed: 11/07/2022]
Abstract
AIMS Postural Tachycardia Syndrome (POTS) represents an autonomic disorder predominantly affecting females between 15 and 50 years of age. POTS is a chronic disorder (>6 months) characterized by an excessive heart rate increment on standing (>30 beats/min) in the presence of characteristic symptoms of cerebral hypoperfusion or sympathetic activation. Patients have clinically been noted to describe lower urinary tract symptoms (LUTS), although urologic symptoms have not been methodically assessed in the POTS population. Herein, we present data from a pilot study designed to identify and quantitate overactive bladder (OAB) in patients diagnosed with POTS. METHODS Patients admitted to the Vanderbilt Autonomic Dysfunction Center between June 2009 and October 2010 for evaluation for the potential diagnosis of POTS completed a validated, standardized questionnaire for OAB (OAB-q) at presentation. Symptom score and subscale analyses were conducted. Subscale health related quality of life (HRQL) scores were transformed into a 0-100 scale, with higher scores reflecting superior HRQL. Data are presented as mean ± SD. RESULTS Thirty-two females presented for evaluation of symptoms consistent with POTS. Twenty-nine women were subsequently diagnosed with POTS with 19 of these patients completing the OAB-q questionnaire (65.5% response rate). Average age was 33.5 ± 8.3 years. Symptom severity transformed score was 26.0 ± 16.4, with 13 of 19 patients (68.4%) meeting clinical criteria for diagnosis of probable clinically significant OAB. Nocturia was the most bothersome symptom, followed by increased daytime frequency and urgency. CONCLUSIONS This pilot study describes bothersome lower urinary tract dysfunction in patients presenting with POTS as assessed by patient-reported questionnaire data. Nocturia demonstrated the greatest negative impact on health-related quality of life (HRQL), while social interaction was the least affected HRQL domain. In patients with dysautonomia, this data provides a critical baseline for mechanistic insight into both disease-specific and global pathophysiology of nocturia and OAB. Neurourol. Urodynam. 36:610-613, 2017. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Melissa R Kaufman
- Department of Urologic Surgery, Vanderbilt University, Nashville, Tennessee
| | - Laura Chang-Kit
- Division of Urology, Albany Medical College, Albany, New York
| | - Satish R Raj
- Department of Medicine, Vanderbilt Medical Center, Nashville, Tennessee.,Department of Pharmacology, Vanderbilt Medical Center, Nashville, Tennessee
| | - Bonnie K Black
- Department of Medicine, Vanderbilt Medical Center, Nashville, Tennessee
| | - Douglas F Milam
- Department of Urologic Surgery, Vanderbilt University, Nashville, Tennessee
| | - W Stuart Reynolds
- Department of Urologic Surgery, Vanderbilt University, Nashville, Tennessee
| | - Italo Biaggioni
- Department of Medicine, Vanderbilt Medical Center, Nashville, Tennessee.,Department of Pharmacology, Vanderbilt Medical Center, Nashville, Tennessee
| | - David Robertson
- Department of Medicine, Vanderbilt Medical Center, Nashville, Tennessee.,Department of Pharmacology, Vanderbilt Medical Center, Nashville, Tennessee.,Department of Neurology, Vanderbilt Medical Center, Nashville, Tennessee
| | - Roger R Dmochowski
- Department of Urologic Surgery, Vanderbilt University, Nashville, Tennessee
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Kızılyel S, Karakeçi A, Ozan T, Ünüş İ, Barut O, Onur R. Role of percutaneous posterior tibial nerve stimulation either alone or combined with an anticholinergic agent in treating patients with overactive bladder. Turk J Urol 2015; 41:208-14. [PMID: 26623150 DOI: 10.5152/tud.2015.94210] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To evaluate the efficacy of percutaneous tibial nerve stimulation (PTNS), either alone or combined with an anticholinergic agent, in treating patients with an overactive bladder (OAB) in whom previous conservative treatment failed. MATERIAL AND METHODS In this study, we included a total of 30 female patients with OAB in whom all conventional therapies failed between January 2010 and April 2011. Patients were randomly divided into three groups: Group 1, PTNS group; Group 2, patients receiving an anticholinergic agent; and Group 3, patients receiving both PTNS and anticholinergic agent. PTNS treatment continued for 12 weeks with each session lasting 30 min. RESULTS All parameters of the bladder diary significantly improved in all groups (p<0.05). Similarly, all scores measured by questionnaires (UDI-6, IIQ-7, and OABSS) revealed significant improvements in all groups. When the improvements in symptoms were compared among the groups, there was a statistically significantly higher improvement in groups 1 and 3 than in Group 2. CONCLUSION PTNS is a safe, simple, and minimally invasive treatment modality in patients with OAB, and it may be suggested either alone or in combination with anticholinergics when conventional treatments fail.
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Affiliation(s)
- Sadık Kızılyel
- Department of Urology, Fırat University Faculty of Medicine, Elazığ, Turkey
| | - Ahmet Karakeçi
- Department of Urology, Fırat University Faculty of Medicine, Elazığ, Turkey
| | - Tunç Ozan
- Department of Urology, Fırat University Faculty of Medicine, Elazığ, Turkey
| | - İhsan Ünüş
- Department of Urology, Fırat University Faculty of Medicine, Elazığ, Turkey
| | - Osman Barut
- Department of Urology, Fırat University Faculty of Medicine, Elazığ, Turkey
| | - Rahmi Onur
- Department of Urology, Fırat University Faculty of Medicine, Elazığ, Turkey
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23
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Drossaerts J, Vrijens D, Leue C, Schilders I, Van Kerrebroeck P, van Koeveringe G. Screening for depression and anxiety in patients with storage or voiding dysfunction: A retrospective cohort study predicting outcome of sacral neuromodulation. Neurourol Urodyn 2015; 35:1011-1016. [DOI: 10.1002/nau.22871] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2015] [Accepted: 08/10/2015] [Indexed: 11/09/2022]
Affiliation(s)
- Jamie Drossaerts
- Department of Urology; Maastricht University Medical Centre (MUMC+); The Netherlands
| | - Desiree Vrijens
- Department of Urology; Maastricht University Medical Centre (MUMC+); The Netherlands
- Pelvic Care Centre Maastricht; Maastricht University Medical Centre; Maastricht The Netherlands
| | - Carsten Leue
- Pelvic Care Centre Maastricht; Maastricht University Medical Centre; Maastricht The Netherlands
- Department of Psychiatry and Psychology; South Limburg Mental Health Research and Teaching Network; EURON, Maastricht University Medical Centre; Maastricht The Netherlands
| | - Isabelle Schilders
- Department of Urology; Maastricht University Medical Centre (MUMC+); The Netherlands
| | - Philip Van Kerrebroeck
- Department of Urology; Maastricht University Medical Centre (MUMC+); The Netherlands
- Pelvic Care Centre Maastricht; Maastricht University Medical Centre; Maastricht The Netherlands
| | - Gommert van Koeveringe
- Department of Urology; Maastricht University Medical Centre (MUMC+); The Netherlands
- Pelvic Care Centre Maastricht; Maastricht University Medical Centre; Maastricht The Netherlands
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Durlu-Kandilci NT, Denizalti M, Sahin-Erdemli I. Aging changes agonist induced contractile responses in permeabilized rat bladder. AGE (DORDRECHT, NETHERLANDS) 2015; 37:9807. [PMID: 26153091 PMCID: PMC4497501 DOI: 10.1007/s11357-015-9807-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/18/2015] [Accepted: 06/21/2015] [Indexed: 06/04/2023]
Abstract
Aging alters bladder functions where a decrease in filling, storage and emptying is observed. These changes cause urinary incontinence, especially in women. The aim of this study is to examine how aging affects the intracellular calcium movements due to agonist-induced contractions in permeabilized female rat bladder. Urinary bladder isolated from young and old female Sprague-Dawley rats were used. Small detrusor strips were permeabilized with β-escin. The contractile responses induced with agonists were compared between young and old groups. Carbachol-induced contractions were decreased in permeabilized detrusor from old rats compared to young group. Heparin and ryanodine decreased carbachol-induced contractions in young rats where only heparin inhibited these contractions in olds. Caffeine-induced contractions but not inositol triphosphate (IP3)-induced contractions were decreased in old group compared to youngs. The cumulative calcium response curves (pCa 8-4) were also decreased in old rats. Carbachol-induced calcium sensitization responses did not alter by age where GTP-β-S and GF-109203X but not Y-27632 inhibited these responses. Carbachol-induced contractions decrease with aging in rat bladder detrusor. It can be postulated as IP3-induced calcium release (IICR) is primarily responsible for the contractions in older rats where the decrease in carbachol contractions in aging may be as a result of a decrease in calcium-induced calcium release (CICR), rather than carbachol-induced calcium sensitization.
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Affiliation(s)
- N Tugba Durlu-Kandilci
- Faculty of Pharmacy, Department of Pharmacology, Hacettepe University, 06100, Sıhhiye, Ankara, Turkey,
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OnabotulinumtoxinA intravesical treatment in patients affected by overactive bladder syndrome: best practice in real-life management. Urologia 2015; 82:179-83. [PMID: 26044994 DOI: 10.5301/uro.5000120] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/18/2015] [Indexed: 11/20/2022]
Abstract
PURPOSE We evaluated intradetrusorial OnabotulinumtoxinA (Onabot/A) treatment protocols in patients with idiopathic overactive bladder (OAB), in order to assess the care of patients before, during and after treatment. METHODS In 64 OAB patients injected with Onabot/A, we reviewed the length of the hospital stay, frequency of catheterization, frequency of intraoperative and postoperative complications, and patients' satisfaction to the proposed treatment protocol (as assessed by VAS). We also compared the results of the 3-day voiding diary, uroflowmetry with postvoid residual urine (PVR) and VAS to score the bother of urinary symptoms on quality of life (QoL) before and after treatment. RESULTS Twenty-one patients were firstly treated in an 'inpatient' setting. The mean ± SD duration of hospitalization and catheterization was 39.4 ±12.6 and 37.8 ± 10.6 h, respectively. The mean ± SD VAS values of treatment satisfaction and of bother of urinary symptoms on QoL were 6.3 ± 1.1 and 8.2 ± 1.3, respectively. The mean ± SD PVR value was 74.3 ± 15.2 ml. Frequency of UTIs was 2.4 ± 1.6. Forty-three patients were treated on an outpatient basis; the mean ± SD duration of catheterization, the 'outpatient' stay and the mean ± SD frequency of UTIs were lower than those of patients treated in an inpatient setting. The mean ± SD VAS value to score QoL was high. CONCLUSIONS Intradetrusorial Onabot/A injection is a simple and fast procedure that can be easily carried on in an outpatient setting under local anesthesia, with low rates of intraoperative and postoperative complications.
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Choudhary M, van Asselt E, van Mastrigt R, Clavica F. Neurophysiological modeling of bladder afferent activity in the rat overactive bladder model. J Physiol Sci 2015; 65:329-38. [PMID: 25782438 PMCID: PMC4477068 DOI: 10.1007/s12576-015-0370-y] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2014] [Accepted: 02/21/2015] [Indexed: 11/06/2022]
Abstract
The overactive bladder (OAB) is a syndrome-based urinary dysfunction characterized by “urgency, with or without urge incontinence, usually with frequency and nocturia”. Earlier we developed a mathematical model of bladder nerve activity during voiding in anesthetized rats and found that the nerve activity in the relaxation phase of voiding contractions was all afferent. In the present study, we applied this mathematical model to an acetic acid (AA) rat model of bladder overactivity to study the sensitivity of afferent fibers in intact nerves to bladder pressure and volume changes. The afferent activity in the filling phase and the slope, i.e., the sensitivity of the afferent fibers to pressure changes in the post-void relaxation phase, were found to be significantly higher in AA than in saline measurements, while the offset (nerve activity at pressure ~0) and maximum pressure were comparable. We have thus shown, for the first time, that the sensitivity of afferent fibers in the OAB can be studied without cutting nerves or preparation of single fibers. We conclude that bladder overactivity induced by AA in rats is neurogenic in origin and is caused by increased sensitivity of afferent sensors in the bladder wall.
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Affiliation(s)
- Mahipal Choudhary
- Department of Urology, Sector FURORE, Erasmus MC, Room EE1630, Dr. Molewaterplein 50, 3015 GE, Rotterdam, The Netherlands,
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Malde S, Dowson C, Fraser O, Watkins J, Khan MS, Dasgupta P, Sahai A. Patient experience and satisfaction with Onabotulinumtoxin A for refractory overactive bladder. BJU Int 2014; 116:443-9. [PMID: 25523401 DOI: 10.1111/bju.13025] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To evaluate the patient experience of our dedicated botulinum toxin A (BTX-A) service using a validated patient-reported experience measure (PREM) and assess patient-reported satisfaction with treatment. MATERIALS AND METHODS The first 100 patients who underwent BTX-A treatment for refractory idiopathic detrusor overactivity (IDO) in our institution were contacted for telephone interview. They had all been assessed, injected and followed up in a dedicated BTX-A clinic. Patients were asked to complete a validated PREM - the Client Satisfaction Questionnaire (CSQ-8) - as well as a questionnaire developed in our department to assess satisfaction with the results of the treatment. Most patients received 200 U OnabotulinumtoxinA (Botox(®) ) via an outpatient local anaesthetic flexible cystoscopy technique. RESULTS Complete data was available for 72 patients. In all, 49 patients were continuing to receive BTX-A treatment while 23 had opted for no further injections. The overall mean (sd) CSQ-8 satisfaction score was 38.3 (3.3), indicating a high level of patient satisfaction with the service offered in our institution. There was a significant difference in total satisfaction scores between those still receiving BTX-A (mean score 29.8) and those who have discontinued treatment (mean score 25.1) (P < 0.01). Overall patient satisfaction with the result of the treatment was high with an overall mean (sd) score of 8.6 (2.0) on a visual analogue scale. Of those who had discontinued BTX-A, most were either using conservative measures only (44%) or had recommenced anticholinergic medications. CONCLUSION Overall patient satisfaction with the dedicated BTX-A service offered in our institution is high and can result in a positive patient experience. The use of PREMs are advocated in order to fully capture the patient's views of the quality of services and treatments they receive.
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Affiliation(s)
- Sachin Malde
- Department of Urology, Guy's and St Thomas' NHS Foundation Trust, King's Health Partners, London, UK
| | - Christopher Dowson
- Department of Urology, Guy's and St Thomas' NHS Foundation Trust, King's Health Partners, London, UK
| | - Olivia Fraser
- Department of Urology, Guy's and St Thomas' NHS Foundation Trust, King's Health Partners, London, UK
| | - Jane Watkins
- Department of Urology, Guy's and St Thomas' NHS Foundation Trust, King's Health Partners, London, UK
| | - Muhammed S Khan
- Department of Urology, Guy's and St Thomas' NHS Foundation Trust, King's Health Partners, London, UK
| | - Prokar Dasgupta
- Department of Urology, Guy's and St Thomas' NHS Foundation Trust, King's Health Partners, London, UK
| | - Arun Sahai
- Department of Urology, Guy's and St Thomas' NHS Foundation Trust, King's Health Partners, London, UK
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Guan NN, Nilsson KF, Wiklund PN, Gustafsson LE. Release and inhibitory effects of prostaglandin D2 in guinea pig urinary bladder and the role of urothelium. Biochim Biophys Acta Gen Subj 2014; 1840:3443-51. [DOI: 10.1016/j.bbagen.2014.09.010] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2014] [Revised: 09/04/2014] [Accepted: 09/05/2014] [Indexed: 12/01/2022]
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Andersson KE, Nomiya M, Yamaguchi O. Chronic Pelvic Ischemia: Contribution to the Pathogenesis of Lower Urinary Tract Symptoms (LUTS): A New Target for Pharmacological Treatment? Low Urin Tract Symptoms 2014; 7:1-8. [PMID: 26663644 DOI: 10.1111/luts.12084] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2014] [Revised: 09/30/2014] [Accepted: 10/05/2014] [Indexed: 11/28/2022]
Abstract
The incidence of lower urinary tract symptoms, including overactive bladder (OAB), is continuing to rise, and is associated with a negative impact on quality of life and a heavy economic burden. A major risk factor for OAB is advancing age. The etiology of OAB is multifactorial and appears to involve myogenic, neurogenic, and urotheliogenic factors. In this article, we review the strengthening preclinical evidence supporting the contribution of chronic pelvic ischemia to the pathogenesis of OAB. In animal models, chronic ischemia induced by arterial injury and a high-fat diet upregulates markers of oxidative stress and proinflammatory cytokines in the urothelium and lamina propria, and leads to increased expression of nerve growth factor. These processes result in increased afferent activity and an increased frequency of micturition, reflecting a state of bladder hyperactivity. In severe, prolonged cases, bladder overactivity may develop into underactivity. Antimuscarinic therapies are the mainstay of OAB treatment, but their usefulness is limited by modest efficacy and troublesome side-effects. Our increasing understanding of the contribution of chronic ischemia to OAB is leading toward novel therapeutic options targeting chronic pelvic ischemia and its morphological, functional, and oxidative consequences. Preclinical trials have demonstrated encouraging results with α1 -adrenoreceptor blockade, phosphodiesterase type 5 inhibition, β3 -adrenoreceptor agonism, free radical scavenging, and stem cell therapy, in preventing morphological, biochemical and functional changes induced by chronic bladder ischemia.
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Affiliation(s)
- Karl-Erik Andersson
- Wake Forest Institute for Regenerative Medicine, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
| | - Masanori Nomiya
- Division of Bioengineering and Lower Urinary Tract Diseases Research, Nihon University School of Engineering, Koriyama, Japan
| | - Osamu Yamaguchi
- Division of Bioengineering and Lower Urinary Tract Diseases Research, Nihon University School of Engineering, Koriyama, Japan
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Park HJ, Won JEJ, Sorsaburu S, Rivera PD, Lee SW. Urinary Tract Symptoms (LUTS) Secondary to Benign Prostatic Hyperplasia (BPH) and LUTS/BPH with Erectile Dysfunction in Asian Men: A Systematic Review Focusing on Tadalafil. World J Mens Health 2013; 31:193-207. [PMID: 24459652 PMCID: PMC3888888 DOI: 10.5534/wjmh.2013.31.3.193] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2013] [Revised: 10/24/2013] [Accepted: 11/07/2013] [Indexed: 01/03/2023] Open
Abstract
This review assesses lower urinary tract symptoms (LUTS) due to benign prostatic hyperplasia (BPH) with or without erectile dysfunction (ED) and related therapies focusing on tadalafil. A literature search was obtained and reviewed for the epidemiology, treatment therapies, pathophysiology, and efficacy and safety of phosphodiesterase type 5 inhibitor (PDE5i) tadalafil in patients with LUTS/BPH. Approximately 42% of men aged 51 to 60 years have BPH. Approximately 90% of men aged 45 to 80 years have LUTS. Occurrence of LUTS increases with age for almost all racial/ethnic groups (range, 32% to 56%) with prevalence of LUTS highest among Hispanic men, then Blacks, Caucasians, and Asians. There is an independent relationship with LUTS/BPH and ED, with approximately 70% of men with LUTS/BPH having ED with severity of one disease often correlating with the other. The European Urological Association guidelines include the use of the PDE5i tadalafil. Tadalafil is the only therapy recommended for treatment of co-existing BPH and ED, while other therapies have unwanted ED side effects. The mode of action of tadalafil may involve different areas of the lower urinary tract such as smooth muscle cell relaxation in the bladder neck, prostate, and urethra, but there may also be resulting modulation of the afferent nerve activity. Tadalafil (5 mg) in Asian men with LUTS/BPH, similar to global studies, is efficacious and safe. Tadalafil (5 mg) improves co-existing LUTS/BPH and ED, independently. Men with LUTS/BPH likely also have ED. Asian men with LUTS/BPH have similar incidence rates, co-existing ED, comorbid diseases, and risks as non-Asian men. Tadalafil can improve co-existing LUTS/BPH and ED.
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Affiliation(s)
- Hyun Jun Park
- Department of Urology, Pusan National University School of Medicine, Yangsan, Korea
| | | | | | | | - Seung Wook Lee
- Department of Urology, Hanyang University Guri Hospital, Guri, Korea
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Dobrek L, Thor P. Heart rate variability in overactive bladder experimental model. Arch Med Sci 2013; 9:930-5. [PMID: 24273581 PMCID: PMC3832811 DOI: 10.5114/aoms.2012.30946] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2011] [Revised: 11/14/2011] [Accepted: 02/02/2012] [Indexed: 12/03/2022] Open
Abstract
INTRODUCTION TWO MAIN PATHOPHYSIOLOGICAL CONCEPTS OF OVERACTIVE BLADDER (OAB) ARE POSTULATED: the neurogenic and myogenic theories. Autonomic nervous system (ANS) dysfunction is also involved in OAB pathophysiology. The purpose of our study was to estimate ANS activity by heart rate variability (HRV) assessment in two OAB experimental models evoked by cyclophosphamide administration: acute (AOAB) and chronic (COAB) overactive ones. MATERIAL AND METHODS In the AOAB model, an i.p. dose of cyclophosphamide was administered (200 mg/kg body weight) while the COAB model received 4 times the i.p. administration of cyclophosphamide (75 mg/kg body weight). In each subject, after urethane anaesthesia (1.2 g/kg body weight), 20-minute ECG recordings (PowerLab) were performed with subsequent HRV analysis. RESULTS Most of the differences in time domain analysis parameters were insignificant, except those concerning SDNN and rMSSD (p < 0.05). In frequency analysis, a power decrease of all standard spectral components was revealed in both OAB groups. In AOAB, TP (1.43 ±1.21 vs. 7.92 ±6.22 in control; p < 0.05) and VLF (0.95 ±1.08 vs. 6.97 ±5.99 in control; p < 0.05) showed significant power decrease, whereas the COAB group was mostly characterized by LF (0.09 ±0.15 vs. 0.34 ±0.33 in control; p < 0.05) and HF (0.25 ±0.29 vs. 0.60 ±0.41 in control; p < 0.05) decrease. CONCLUSIONS The ANS disturbances, found as standard spectral parameter abnormalities, were demonstrated in both AOAB and COAB. When this finding is analysed, together with the lack of statistically significant differences in normalized nLF and nHF powers, the VLF changes seem to play an essential role, probably reflecting the progression in bladder inflammatory changes.
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Affiliation(s)
- Lukasz Dobrek
- Pathophysiology Department, Jagiellonian University, Medical College, Cracow, Poland
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Rahnama'i MS, Van Koeveringe GA, Van Kerrebroeck PE. Overactive bladder syndrome and the potential role of prostaglandins and phosphodiesterases: an introduction. Nephrourol Mon 2013; 5:934-45. [PMID: 24350100 PMCID: PMC3842572 DOI: 10.5812/numonthly.14087] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2013] [Accepted: 09/15/2013] [Indexed: 12/14/2022] Open
Abstract
In this paper, a general introduction is given, presenting the overactive bladder syndrome (OAB) and its impact on the quality of life and economical burden in patients affected. Moreover, the anatomy, physiology and histology of the lower urinary tract are discussed, followed by a brief overview on the possible role of prostaglandin (PG) and phosphodiesterase type 5 (PDE5) in the urinary bladder. The current literature on the role and distribution of PGE2 and its receptors in the urinary bladder is discussed. In both animal models and in human studies, high levels of signaling molecules such as PG and cGMP have been implicated, in decreased functional bladder capacity and micturition volume, as well as in increased voiding contraction amplitude. As a consequence, inhibition of prostanoid production, the use of prostanoid receptor antagonists, or PDE inhibitors might be a rational way to treat patients with detrusor overactivity. Similarly, prostanoid receptor agonists, or agents that stimulate their production, might have a function in treating bladder underactivity.
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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+), PO Box 5800, 6202 AZ Maastricht, The Netherlands. Tel: +31-433875255, Fax: +31-433875259, E-mail:
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Gap junction expression and the effects of gap junction inhibitors in overactive bladder models: does ovariectomy have a role? Int Urol Nephrol 2013; 45:1001-8. [PMID: 23779227 DOI: 10.1007/s11255-013-0488-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2013] [Accepted: 06/04/2013] [Indexed: 10/26/2022]
Abstract
PURPOSE In this study, gap junction expression and the effects of estrogen deficiency and gap junction inhibitors were investigated in overactive bladder models which were created by bladder outlet obstruction. METHODS In our study, we created four groups as control, ovariectomy, bladder outlet obstruction (BOO), and ovariectomy + BOO. We investigated the effects of oxybutynin and 18-alpha glycyrrhetinic acid (18-α-GA) which is a gap junction blocker on isolated detrusor strips. Western blot method was used to measure the level of connexin-43 in detrusor. RESULTS Bladder weights were significantly increased in the BOO and ovariectomy + BOO groups (p < 0.05). There was no statistically significant difference in the maximal contraction responses to carbachol between ovariectomy and control groups. In BOO and ovariectomy + BOO groups, contractile responses were significantly prominent with higher doses of carbachol. Oxybutynin-induced relaxant responses of BOO and ovariectomy + BOO groups were significantly higher than control group (p < 0.05). The relaxation effect of 18-a-GA was more effective in the obstruction groups. Among those two groups, the relaxation observed in BOO group was higher than ovariectomy + BOO group in higher doses of 18-a-GA. Connexin-43 expression was increased in BOO group compared with the control group (p = 0.006). Ovariectomy did not change connexin-43 expression alone; however, when combined with BOO, connexin-43 expression decreased significantly (p = 0.023). CONCLUSIONS Ovariectomy had no effect on the gap junctions in the bladder and bladder overactivity alone. Therefore, obstruction is the main factor that increases the amount of gap junctions, and gap junction blockers are thus more effective in obstruction. However, ovariectomy was shown to decrease the expression of gap junctions and relaxation effect of gap junction blockers, when combined with BOO.
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Wen JG, Li JS, Wang ZM, Huang CX, Shang XP, Su ZQ, Lu YT, Suo ZH, Wang Y, Qin GJ, Zhang WX, Heesakkers JP. The prevalence and risk factors of OAB in middle-aged and old people in China. Neurourol Urodyn 2013; 33:387-91. [PMID: 23765684 DOI: 10.1002/nau.22429] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2012] [Accepted: 04/17/2013] [Indexed: 11/12/2022]
Affiliation(s)
- Jian G. Wen
- Urodynamic Center; The First Affiliated Hospital of Zhengzhou University; Zhengzhou China
- Department of Urology; The First Affiliated Hospital of Zhengzhou University; Zhengzhou China
- Institute of Clinical Medicine; The First Affiliated Hospital of Zhengzhou University; Zhengzhou China
| | - Jin S. Li
- Urodynamic Center; The First Affiliated Hospital of Zhengzhou University; Zhengzhou China
- Department of Urology; The First Affiliated Hospital of Zhengzhou University; Zhengzhou China
| | - Zhi M. Wang
- Department of Endocrinology; The First Affiliated Hospital of Zhengzhou University; Zhengzhou China
| | - Chen X. Huang
- Urodynamic Center; The First Affiliated Hospital of Zhengzhou University; Zhengzhou China
- Department of Urology; The First Affiliated Hospital of Zhengzhou University; Zhengzhou China
| | - Xiao P. Shang
- Medical Record Department; The First Affiliated Hospital of Zhengzhou University; Zhengzhou China
| | - Zhi Q. Su
- Urodynamic Center; The First Affiliated Hospital of Zhengzhou University; Zhengzhou China
- Department of Urology; The First Affiliated Hospital of Zhengzhou University; Zhengzhou China
| | - Yu T. Lu
- Urodynamic Center; The First Affiliated Hospital of Zhengzhou University; Zhengzhou China
- Department of Urology; The First Affiliated Hospital of Zhengzhou University; Zhengzhou China
| | - Zhen H. Suo
- Institute of Clinical Medicine; The First Affiliated Hospital of Zhengzhou University; Zhengzhou China
| | - Yan Wang
- Urodynamic Center; The First Affiliated Hospital of Zhengzhou University; Zhengzhou China
- Department of Urology; The First Affiliated Hospital of Zhengzhou University; Zhengzhou China
| | - Gui J. Qin
- Department of Endocrinology; The First Affiliated Hospital of Zhengzhou University; Zhengzhou China
| | - Wei X. Zhang
- Department of Urology; The First Affiliated Hospital of Zhengzhou University; Zhengzhou China
| | - John P. Heesakkers
- Department of Urology; Radboud University, Nijmegen Medical Centre; Nijmegen The Netherlands
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Smith MD, Seth JH, Hanna MG, Panicker JN. Detrusor overactivity in Becker muscular dystrophy. Muscle Nerve 2013; 47:464-5. [PMID: 23382079 DOI: 10.1002/mus.23623] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2012] [Revised: 08/03/2012] [Accepted: 08/06/2012] [Indexed: 11/10/2022]
Abstract
A 20-year-old man with normal motor milestones as an infant but subsequent progressive difficulty in walking in childhood, was genetically confirmed to have Becker muscular dystrophy (BMD) at age 13. He was independent in ambulation and activities of daily living. He was referred to the Department of Uro-neurology for a 5-year history of urinary urgency and incontinence. He would visit the toilet 10 times in the daytime and experience urinary urgency daily, often associated with incontinence. He did not report difficulties initiating voiding, stress incontinence, pain, or hematuria. There was no history of urinary tract infections.
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Frias B, Lopes T, Pinto R, Cruz F, Cruz CD. Neurotrophins in the lower urinary tract: becoming of age. Curr Neuropharmacol 2012; 9:553-8. [PMID: 22654715 PMCID: PMC3263451 DOI: 10.2174/157015911798376253] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2010] [Revised: 07/19/2010] [Accepted: 07/19/2010] [Indexed: 01/23/2023] Open
Abstract
The lower urinary tract (LUT) comprises a storage unit, the urinary bladder, and an outlet, the urethra. The coordination between the two structures is tightly controlled by the nervous system and, therefore, LUT function is highly susceptible to injuries to the neuronal pathways involved in micturition control. These injuries may include lesions to the
spinal cord or to nerve fibres and result in micturition dysfunction. A common trait of micturition pathologies, irrespective of its origin, is an upregulation in synthesis and secretion of neurotrophins, most notably Nerve Growth Factor (NGF) and Brain Derived Neurotrophic Factor (BDNF). These neurotrophins are produced by neuronal and non-neuronal cells and exert their effects upon binding to their high-affinity receptors abundantly expressed in the neuronal circuits regulating
LUT function. In addition, NGF and BDNF are present in detectable amounts in the urine of patients suffering from various LUT pathologies, suggesting that analysis of urinary NGF and BDNF may serve as likely biomarkers to be studied in tandem with other factors when diagnosing patients. Studies with experimental models of bladder dysfunction
using antagonists of NGF and BDNF receptors as well as scavenging agents suggest that those NTs may be key elements in the pathophysiology of bladder dysfunctions. In addition, available data indicates that NGF and BDNF might constitute future targets for designing new drugs for better treatment of bladder dysfunction.
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Affiliation(s)
- Bárbara Frias
- Department of Experimental Biology, Faculty of Medicine of Porto, Alameda Hernâni Monteiro, 4200-319 Porto, Portugal
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Munoz A, Somogyi GT, Boone TB, Ford AP, Smith CP. Modulation of bladder afferent signals in normal and spinal cord-injured rats by purinergic P2X3 and P2X2/3 receptors. BJU Int 2012; 110:E409-14. [PMID: 22540742 DOI: 10.1111/j.1464-410x.2012.11189.x] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
OBJECTIVE To evaluate the role of bladder sensory purinergic P2X3 and P2X2/3 receptors on modulating the activity of lumbosacral neurones and urinary bladder contractions in vivo in normal or spinal cord-injured (SCI) rats with neurogenic bladder overactivity. MATERIALS AND METHODS SCI was induced in female rats by complete transection at T8-T9 and experiments were performed 4 weeks later, when bladder overactivity developed. Non-transected rats were used as controls (normal rats). Neural activity was recorded in the dorsal horn of the spinal cord and field potentials were acquired in response to intravesical pressure steps via a suprapubic catheter. Field potentials were recorded under control conditions, after stimulation of bladder mucosal purinergic receptors with intravesical ATP (1 mm), and after intravenous injection of the P2X3/P2X2/3 antagonist AF-353 (10 mg/kg and 20 mg/kg). Cystometry was performed in urethane-anaesthetised rats intravesically infused with saline. AF-353 (10 mg/kg) was systemically applied after baseline recordings; the rats also received a second dose of AF-353 (20 mg/kg). Changes in the frequency of voiding (VC) and non-voiding (NVC) contractions were evaluated. RESULTS SCI rats had significantly higher frequencies for field potentials and NVC than NL rats. Intravesical ATP increased field potential frequency in control but not SCI rats, while systemic AF-353 significantly reduced this parameter in both groups. AF-353 also reduced the inter-contractile interval in control but not in SCI rats; however, the frequency of NVC in SCI rats was significantly reduced. CONCLUSION The P2X3/P2X2/3 receptors on bladder afferent nerves positively regulate sensory activity and NVCs in overactive bladders.
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Affiliation(s)
- Alvaro Munoz
- Scott Department of Urology, Baylor College of Medicine, Houston, TX 77030, USA
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Nonselective Blocking of the Sympathetic Nervous System Decreases Detrusor Overactivity in Spontaneously Hypertensive Rats. Int J Mol Sci 2012; 13:5048-5059. [PMID: 22606029 PMCID: PMC3344265 DOI: 10.3390/ijms13045048] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2012] [Revised: 04/20/2012] [Accepted: 04/20/2012] [Indexed: 11/23/2022] Open
Abstract
The involuntary dual control systems of the autonomic nervous system (ANS) in the bladder of awake spontaneously hypertensive rats (SHRs) were investigated through simultaneous registrations of intravesical and intraabdominal pressures to observe detrusor overactivity (DO) objectively as a core symptom of an overactive bladder. SHRs (n = 6) showed the features of overactive bladder syndrome during urodynamic study, especially DO during the filling phase. After injection of the nonselective sympathetic blocking agent labetalol, DO disappeared in 3 of 6 SHRs (50%). DO frequency decreased from 0.98 ± 0.22 min−1 to 0.28 ± 0.19 min−1 (p < 0.01), and DO pressure decreased from 3.82 ± 0.57 cm H2O to 1.90 ± 0.86 cm H2O (p < 0.05). This suggests that the DO originating from the overactive parasympathetic nervous system is attenuated by the nonselective blocking of the sympathetic nervous system. The detailed mechanism behind this result is still not known, but parasympathetic overactivity seems to require overactive sympathetic nervous system activity in a kind of balance between these two systems. These findings are consistent with recent clinical findings suggesting that patients with idiopathic overactive bladder may have ANS dysfunction, particularly a sympathetic dysfunction. The search for newer and better drugs than the current anticholinergic drugs as the mainstay for overactive bladder will be fueled by our research on these sympathetic mechanisms. Further studies of this principle are required.
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MENG E, LIN WY, LEE WC, CHUANG YC. Pathophysiology of Overactive Bladder. Low Urin Tract Symptoms 2012; 4 Suppl 1:48-55. [DOI: 10.1111/j.1757-5672.2011.00122.x] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
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Valentini FA, Marti BG, Robain G, Nelson PP. Phasic or terminal detrusor overactivity in women: age, urodynamic findings and sphincter behavior relationships. Int Braz J Urol 2011; 37:773-80. [DOI: 10.1590/s1677-55382011000600014] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/05/2011] [Indexed: 11/21/2022] Open
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An overview of the clinical use of antimuscarinics in the treatment of overactive bladder. Adv Urol 2011; 2011:820816. [PMID: 21687579 PMCID: PMC3114080 DOI: 10.1155/2011/820816] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2011] [Accepted: 04/13/2011] [Indexed: 11/17/2022] Open
Abstract
Overactive bladder is a common and bothersome condition. Antimuscarinic agents, as a class, are the cornerstone of medical treatment of overactive bladder. They offer significant improvements in symptoms and patients' quality of life. Antimuscarinics are generally well tolerated with mild and predictable side effects. Available antimuscarinics have small, yet statistically significant, differences in their efficacy and tolerability profiles. In clinical practice, finding the agent that offers the optimum balance of efficacy and side effects for an individual patient remains the major challenge.
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Ochodnický P, Cruz CD, Yoshimura N, Michel MC. Nerve growth factor in bladder dysfunction: Contributing factor, biomarker, and therapeutic target. Neurourol Urodyn 2011; 30:1227-41. [DOI: 10.1002/nau.21022] [Citation(s) in RCA: 100] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2010] [Accepted: 09/21/2010] [Indexed: 12/11/2022]
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Nicholas R, Young C, Friede T. Bladder symptoms in multiple sclerosis: a review of pathophysiology and management. Expert Opin Drug Saf 2011; 9:905-15. [PMID: 20569078 DOI: 10.1517/14740338.2010.501793] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
IMPORTANCE OF THE FIELD The use of anticholinergic medication in bladder dysfunction such as overactive bladder syndrome (OAB) is widespread. However, the benefits and risks of anticholinergics in multiple sclerosis (MS) are unclear because in MS the damage to normal urinary function is both more diffuse and increases with disease progression, and the risk of CNS side effects is higher. AREAS COVERED IN THIS REVIEW The pathophysiology of urinary dysfunction in MS and the efficacy and side effects of anticholinergics is assessed. The review analyzed randomized controlled trials and observational studies using anticholinergics involving persons with a confirmed diagnosis of MS having urinary symptoms. Finally a pragmatic approach to managing urinary symptoms in MS is discussed. WHAT THE READER WILL GAIN The published data provide limited evidence for the efficacy of anticholinergics in MS. The complexity of treating urinary symptoms in the context of other therapies and the changing neurological background seen in MS is comprehensively analyzed. TAKE HOME MESSAGE Anticholinergics could be helpful in particular phases of MS. However, there is inadequate evidence currently available on the use of anticholinergics in MS, and further research on the management of the MS neuropathic bladder is warranted.
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Affiliation(s)
- Richard Nicholas
- Imperial College Healthcare NHS Trust, Charing Cross Hospital, Department of Neurosciences, London, UK.
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Abstract
Overactive bladder syndrome (OAB) is a symptom-based diagnosis characterised by the presence of urinary urgency. It is highly prevalent and overlaps with the presence of bladder contractions during urine storage, which characterises the urodynamic diagnosis of detrusor overactivity. Animal models are needed to understand the pathophysiology of OAB, but the subjective nature of the symptom complex means that interpretation of the findings in animals requires caution. Because urinary urgency cannot be ascertained in animals, surrogate markers such as frequency, altered toileting areas, and non-micturition contractions have to be used instead. No model can recapitulate the subjective, objective, and related factors seen in the clinical setting. Models used include partial bladder outlet obstruction, the spontaneous hypertensive rat, the hyperlipidaemic rat, various neurological insults and some gene knock-outs. Strengths and weaknesses of these models are discussed in the context of the inherent difficulties of extrapolating subjective symptoms in animals.
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Affiliation(s)
- Brian A Parsons
- Bristol Urological Institute, Southmead Hospital, Bristol, BS10 5NB, UK.
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Long CY, Hsu CS, Wu MP, Liu CM, Chiang PH, Juan YS, Tsai EM. Predictors of improved overactive bladder symptoms after transvaginal mesh repair for the treatment of pelvic organ prolapse. Int Urogynecol J 2010; 22:535-42. [DOI: 10.1007/s00192-010-1312-0] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2010] [Accepted: 10/24/2010] [Indexed: 11/25/2022]
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Abstract
PURPOSE The prevalence of bladder dysfunctions increases with age. In humans it is difficult to separate changes related to exogenous factors from those directly related to the aging process. Some confounding variables can be avoided by studying age related changes in an animal model. We evaluated the impact of age on bladder function in vivo and in vitro, and characterized the corresponding morphological changes. MATERIALS AND METHODS Young (4 to 6 months old) and old (older than 28 to 30 months) male Fischer/Brown Norway rats were used in the study. Cystometric studies were done in conscious, freely moving rats. After cystometry tissue strips from the bladder body were used in in vitro studies of muscarinic receptor activation and electrical field stimulation, and histological examination. RESULTS Old rats had higher bladder weight than young rats but the bladder-to-body weight ratio did not change. We noted significant age related differences in 8 of 10 cystometric parameters. Old rats had increased bladder capacity, post-void residual volume, micturition volume and frequency, baseline and intermicturition pressure, and spontaneous activity but decreased micturition pressure. Bladder strip responses to carbachol and electrical field stimulation were significantly lower in old than in young rats. Histological examination revealed urothelial thinning, lower muscle mass and higher collagen content in the bladders of old vs young rats. CONCLUSIONS Physiological aging alters bladder function in male rats even when external factors remain constant. Thus, in old rats bladder capacity, post-void residual urine and spontaneous activity are higher, and responses to muscarinic receptor stimulation and electrical field stimulation are lower than in young rats. Such changes correspond to findings in aging human bladders, supporting the view that the Fischer/Brown Norway rat is a useful model in which to study age related bladder function changes.
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Palmer MH, Busby-Whitehead J. Relationship Between Heart Failure and Overactive Bladder. CURRENT BLADDER DYSFUNCTION REPORTS 2010. [DOI: 10.1007/s11884-009-0035-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Ratz PH, Speich JE, Klausner AP. COX Inhibitors and Overactive Bladder: The Potential for Future Therapy. CURRENT BLADDER DYSFUNCTION REPORTS 2010. [DOI: 10.1007/s11884-009-0037-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
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Deba A, Palea S, Rouget C, Westfall TD, Lluel P. Involvement of β3-adrenoceptors in mouse urinary bladder function: Role in detrusor muscle relaxation and micturition reflex. Eur J Pharmacol 2009; 618:76-83. [DOI: 10.1016/j.ejphar.2009.07.012] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2009] [Revised: 06/29/2009] [Accepted: 07/09/2009] [Indexed: 12/22/2022]
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