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Bou Kheir G, Verbakel I, Vande Walle J, Wyndaele M, Sinha S, Arlandis S, Raes A, Abrams P, Wein A, Hervé F, Everaert K. Exploring lifelong overactive bladder: Transitions, evidence, and clinical implications; A modified Delphi process. Neurourol Urodyn 2024; 43:1040-1057. [PMID: 38289322 DOI: 10.1002/nau.25307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Accepted: 10/09/2023] [Indexed: 02/01/2024]
Abstract
INTRODUCTION Overactive bladder (OAB) is a prevalent urological condition characterized by urinary urgency, with or without urgency urinary incontinence, accompanied by increased daytime frequency and nocturia. However, the current definition of OAB lacks a specified time frame, hindering our understanding of the temporal aspects and transitions that occur within the OAB spectrum. METHODS A modified Delphi study was conducted in three rounds, involving a panel of international experts in functional urology, urogynaecology, geriatrics, transitional medicine, and pediatric urology. The study took place between February 2023 and June 2023 and employed two sequential rounds of online surveys, followed by a final hybrid group discussion session in June 2023. RESULTS The Delphi process resulted in a consensus definition of lifelong OAB as a persistent and continuous condition that may manifest differently from birth and evolve over time, with varying levels of clinical perception. The course of its progression is influenced by transition periods and modifying factors, mainly anatomical, hormonal, and psychosocial/stressors. Three main transition periods were identified: achievement of daytime continence, adulthood to elderly, and transition to frail elderly. The panel also considered the therapeutic and diagnostic implications of lifelong OAB, as well as future research prospects in terms of importance and feasibility. CONCLUSIONS Future longitudinal research is needed to develop this concept and further identify transitions and temporal dynamics.
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Affiliation(s)
- George Bou Kheir
- Department of Urology, ERN Accredited Centrum, Ghent University Hospital, Ghent, Belgium
| | - Irina Verbakel
- Department of Urology, ERN Accredited Centrum, Ghent University Hospital, Ghent, Belgium
| | - Johan Vande Walle
- Department of Paediatric Nephrology and Rheumatology, ERknet Center, Ghent University Hospital, Ghent, Belgium
| | - Michel Wyndaele
- Department of Urology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Sanjay Sinha
- Department of Urology, Apollo Hospital, Hyderabad, Telangana, India
| | - Salvador Arlandis
- Urology Department, La Fe University and Polytechnic Hospital, Valencia, Spain
| | - Ann Raes
- Department of Internal Medicine and Pediatrics, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Paul Abrams
- Bristol Urological Institute, Southmead Hospital, Bristol, UK
| | - Alan Wein
- Department of Urology, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - François Hervé
- Department of Urology, ERN Accredited Centrum, Ghent University Hospital, Ghent, Belgium
| | - Karel Everaert
- Department of Urology, ERN Accredited Centrum, Ghent University Hospital, Ghent, Belgium
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Qasemi A, Aminian A, Erfanian A. Real-time prediction of bladder urine leakage using fuzzy inference system and dual Kalman filtering in cats. Sci Rep 2024; 14:3879. [PMID: 38365925 PMCID: PMC10873426 DOI: 10.1038/s41598-024-53629-5] [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: 06/30/2023] [Accepted: 02/02/2024] [Indexed: 02/18/2024] Open
Abstract
The use of electrical stimulation devices to manage bladder incontinence relies on the application of continuous inhibitory stimulation. However, continuous stimulation can result in tissue fatigue and increased delivered charge. Here, we employ a real-time algorithm to provide a short-time prediction of urine leakage using the high-resolution power spectrum of the bladder pressure during the presence of non-voiding contractions (NVC) in normal and overactive bladder (OAB) cats. The proposed method is threshold-free and does not require pre-training. The analysis revealed that there is a significant difference between voiding contraction (VC) and NVC pressures as well as band powers (0.5-5 Hz) during both normal and OAB conditions. Also, most of the first leakage points occurred after the maximum VC pressure, while all of them were observed subsequent to the maximum VC spectral power. Kalman-Fuzzy method predicted urine leakage on average 2.2 s and 1.6 s before its occurrence and an average of 2.0 s and 1.1 s after the contraction started with success rates of 94.2% and 100% in normal and OAB cats, respectively. This work presents a promising approach for developing a neuroprosthesis device, with on-demand stimulation to control bladder incontinence.
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Affiliation(s)
- Amirhossein Qasemi
- Department of Biomedical Engineering, School of Electrical Engineering, Iran Neural Technology Research Center, Iran University of Science and Technology (IUST), Tehran, Iran
| | - Alireza Aminian
- Department of Biomedical Engineering, School of Electrical Engineering, Iran Neural Technology Research Center, Iran University of Science and Technology (IUST), Tehran, Iran
| | - Abbas Erfanian
- Department of Biomedical Engineering, School of Electrical Engineering, Iran Neural Technology Research Center, Iran University of Science and Technology (IUST), Tehran, Iran.
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Kwon J, Kim DY, Cho KJ, Hashimoto M, Matsuoka K, Kamijo T, Wang Z, Karnup S, Robertson AM, Tyagi P, Yoshimura N. Pathophysiology of Overactive Bladder and Pharmacologic Treatments Including β3-Adrenoceptor Agonists -Basic Research Perspectives. Int Neurourol J 2024; 28:12-33. [PMID: 38461853 DOI: 10.5213/inj.2448002.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2023] [Accepted: 01/10/2024] [Indexed: 03/12/2024] Open
Abstract
Overactive bladder (OAB) is a symptom-based syndrome defined by urinary urgency, frequency, and nocturia with or without urge incontinence. The causative pathology is diverse; including bladder outlet obstruction (BOO), bladder ischemia, aging, metabolic syndrome, psychological stress, affective disorder, urinary microbiome, localized and systemic inflammatory responses, etc. Several hypotheses have been suggested as mechanisms of OAB generation; among them, neurogenic, myogenic, and urothelial mechanisms are well-known hypotheses. Also, a series of local signals called autonomous myogenic contraction, micromotion, or afferent noises, which can occur during bladder filling, may be induced by the leak of acetylcholine (ACh) or urothelial release of adenosine triphosphate (ATP). They can be transmitted to the central nervous system through afferent fibers to trigger coordinated urgency-related detrusor contractions. Antimuscarinics, commonly known to induce smooth muscle relaxation by competitive blockage of muscarinic receptors in the parasympathetic postganglionic nerve, have a minimal effect on detrusor contraction within therapeutic doses. In fact, they have a predominant role in preventing signals in the afferent nerve transmission process. β3-adrenergic receptor (AR) agonists inhibit afferent signals by predominant inhibition of mechanosensitive Aδ-fibers in the normal bladder. However, in pathologic conditions such as spinal cord injury, it seems to inhibit capsaicin-sensitive C-fibers. Particularly, mirabegron, a β3-agonist, prevents ACh release in the BOO-induced detrusor overactivity model by parasympathetic prejunctional mechanisms. A recent study also revealed that vibegron may have 2 mechanisms of action: inhibition of ACh from cholinergic efferent nerves in the detrusor and afferent inhibition via urothelial β3-AR.
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Affiliation(s)
- Joonbeom Kwon
- Department of Urology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
- Leaders Urology Clinic, Daegu, Korea
| | - Duk Yoon Kim
- Department of Urology, Catholic University of Daegu School of Medicine, Daegu, Korea
| | - Kang Jun Cho
- Department of Urology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
- Department of Urology, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Mamoru Hashimoto
- Department of Urology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Kanako Matsuoka
- Department of Urology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Tadanobu Kamijo
- Department of Urology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Zhou Wang
- Department of Urology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Sergei Karnup
- Department of Pharmacology and Chemical Biology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Anne M Robertson
- Department of Mechanical Engineering and Materials Science, University of Pittsburgh School of Bioengineering, Pittsburgh, PA, USA
| | - Pradeep Tyagi
- Department of Urology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Naoki Yoshimura
- Department of Urology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
- Department of Pharmacology and Chemical Biology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
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Vale L, Cruz F, Charrua A. Detrusor Overactivity After Partial Bladder Outlet Obstruction Is Associated With High Urinary Adenosine Triphosphate Levels in Female Wistar Rats. Int Neurourol J 2024; 28:34-39. [PMID: 38461854 DOI: 10.5213/inj.2346196.098] [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: 08/25/2023] [Accepted: 10/23/2023] [Indexed: 03/12/2024] Open
Abstract
PURPOSE Bladder outlet obstruction (BOO) commonly causes detrusor overactivity (DO). In this study, a post hoc analysis of previous obtained data, we investigate if DO occurring in initial phases of BOO is associated with changes in urinary adenosine triphosphate (ATP) levels. METHODS Adult female Wistar rats were submitted to partial BOO (pBOO) or to sham obstruction. Cystometry was performed at 3 or 15 days after pBOO and saline voided was collected for ATP determination. Normality was tested using Shapiro-Wilk test. The mean frequency of voiding contractions (VCs) of the sham-operated animals at 15 days after surgery, plus or minus 3 standard deviations, was used to represent the normal range. Statistical analyses were performed using the chi-square and Mann-Whitney tests. RESULTS DO was indicated by a VC frequency greater than or equal to 0.9 VCs/min. DO was observed in 63% of animals at 3 days and in 33% at 15 days following pBOO. ATP levels were significantly higher in rats with DO compared to those without DO. CONCLUSION The DO phenotype, occurring in the initial phases of BOO, is associated with comparatively high urinary ATP levels.
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Affiliation(s)
- Luís Vale
- Departmento de Biomedicina-Unidade de Farmacologia e Terapêutica, Faculdade de Medicina da Universidade do Porto, Porto, Portugal
- Serviço de Urologia, Centro Hospitalar Universitário São João, Porto, Portugal
| | - Francisco Cruz
- Serviço de Urologia, Centro Hospitalar Universitário São João, Porto, Portugal
- Departmento de Cirurgia e Fisiologia-Faculdade de Medicina da Universidade do Porto, Porto, Portugal
- Translational Neurourology group, IBMC-Instituto de Biologia Molecular e Celular, Universidade do Porto, Porto, Portugal
- I3S-Instituto de Investigação e Inovação em Saúde, Universidade do Porto, Porto, Portugal
| | - Ana Charrua
- Translational Neurourology group, IBMC-Instituto de Biologia Molecular e Celular, Universidade do Porto, Porto, Portugal
- I3S-Instituto de Investigação e Inovação em Saúde, Universidade do Porto, Porto, Portugal
- Departmento de Biomedicina-Unidade de Biologia Experimental, Faculdade de Medicina da Universidade do Porto, Porto, Portugal
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Watanabe S, Kinno K, Takeuchi Y, Sawada Y, Sekido N. Association between voiding lower urinary tract symptoms and findings on dynamic magnetic resonance imaging with regard to pelvic organs and their supportive structures. Low Urin Tract Symptoms 2024; 16:e12506. [PMID: 37866821 DOI: 10.1111/luts.12506] [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: 07/20/2023] [Revised: 09/25/2023] [Accepted: 10/09/2023] [Indexed: 10/24/2023]
Abstract
OBJECTIVES Pelvic organ prolapse (POP) causes voiding lower urinary tract symptoms (vLUTS). In the present study, we investigated the association between vLUTS and pelvic organ mobility (POM), including relevant supportive structures, on dynamic magnetic resonance imaging (dMRI). METHODS We included 118 patients who had POP of stage II or less before straining and stage III or more when straining during dMRI. The presence of vLUTS and overactive bladder (OAB) was determined by a voiding subscore of the International Prostate Symptom Score (vIPSS) ≥5 and the OAB symptom score, respectively. POM was measured by dMRI before and during straining, and patients with and without vLUTS as well as patients with and without vLUTS and/or OAB were compared. p < .05 was considered to be statistically significant. RESULTS According to vIPSS, 42 patients (35.6%) had vLUTS. On dMRI, patients with vLUTS showed a significantly more ventral position and/or movement of the bladder and cervix. Moreover, patients with vLUTS and OAB had significantly more ventral movement of the uterine cervix and a larger strain on imaginary uterosacral and cardinal ligaments than those without these symptoms. In addition, patients with vLUTS and OAB had significantly higher vIPSS than those with vLUTS alone. CONCLUSIONS vLUTS may be associated with the proximity of the bladder and cervix to the pubic bone and consequent compression of the urethra by the prolapsed organs. vLUTS with OAB might indicate more advanced lower urinary tract dysfunction than vLUTS alone.
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Affiliation(s)
- Shoutarou Watanabe
- Department of Urology, Toho University Ohashi Medical Center, Meguro City, Tokyo, Japan
| | - Kurenai Kinno
- Department of Urology, Toho University Ohashi Medical Center, Meguro City, Tokyo, Japan
- Department of Urology, Yotsuya Medical Cube, Chiyoda City, Tokyo, Japan
| | - Yasuharu Takeuchi
- Department of Urology, Toho University Ohashi Medical Center, Meguro City, Tokyo, Japan
| | - Yoshitomo Sawada
- Department of Urology, Toho University Ohashi Medical Center, Meguro City, Tokyo, Japan
| | - Noritoshi Sekido
- Department of Urology, Toho University Ohashi Medical Center, Meguro City, Tokyo, Japan
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Wang J, Ren L, Liu X, Liu J, Ling Q. Underactive Bladder and Detrusor Underactivity: New Advances and Prospectives. Int J Mol Sci 2023; 24:15517. [PMID: 37958499 PMCID: PMC10648240 DOI: 10.3390/ijms242115517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Revised: 10/20/2023] [Accepted: 10/22/2023] [Indexed: 11/15/2023] Open
Abstract
Underactive bladder (UAB) is a prevalent but under-researched lower urinary tract symptom that typically occurs alongside detrusor underactivity (DU). Unlike UAB, DU is a urodynamic diagnosis which the International Continence Society (ICS) defines as "a contraction of reduced strength and/or duration, resulting in prolonged bladder emptying and/or a failure to achieve complete bladder emptying within a normal time span". Despite the widespread prevalence of UAB/DU, there are significant gaps in our understanding of its pathophysiological mechanisms, diagnosis, and treatment compared with overactive bladder (OAB) and detrusor overactivity (DO). These gaps are such that clinicians regard UAB/DU as an incurable condition. In recent years, the understanding of UAB has increased. The definition of UAB has been clarified, and the diagnostic criteria for DU have been considered more comprehensively. Meanwhile, a number of non-invasive diagnostic methods have also been reported. Clinical trials involving novel drugs, electrical stimulation, and stem cell therapy have shown promising results. Therefore, this review summarizes recent reports on UAB and DU and highlights the latest advances in their diagnosis and treatment.
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Affiliation(s)
- Jiaxin Wang
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China; (J.W.)
- Institute of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Lida Ren
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China; (J.W.)
- Institute of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Xinqi Liu
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China; (J.W.)
- Institute of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Jihong Liu
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China; (J.W.)
- Institute of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Qing Ling
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China; (J.W.)
- Institute of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
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Aizawa N, Fujita T. Comparison of the effects of two anesthetics, isoflurane and urethane, on bladder function in rats. J Pharmacol Sci 2023; 152:144-150. [PMID: 37169479 DOI: 10.1016/j.jphs.2023.04.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2023] [Revised: 04/03/2023] [Accepted: 04/11/2023] [Indexed: 05/13/2023] Open
Abstract
We compared the effects of two anesthetics, isoflurane and urethane on bladder function in rats. Arterial pressure, cystometry (CMG), and rhythmic bladder contractions (RBCs) under isovolumetric conditions, mechanosensitive single-unit afferent activities (SAAs), bladder compliance and bladder myogenic microcontractions (bladder microcontractions), and bladder blood flow, and blood and urine biochemical tests were investigated in isoflurane- or urethane-anesthetized female rats. In results of the CMG, 3/8 rats in the isoflurane group and 7/7 rats in the urethane group showed constant bladder neurogenic contractions for micturition, whereas 5/8 rats in the isoflurane group showed unstable contractions or overflow incontinence. The RBCs appeared in the urethane group but not in the isoflurane group, and SAAs in both the Aδ- and C-fibers, bladder compliance, and bladder microcontractions in the isoflurane group were higher than those in the urethane group during bladder distension. The blood biochemical test showed that the serum calcium level was higher in the isoflurane group. The mean arterial pressure and bladder blood flow were not different between the groups. The results showed that urethane anesthesia more retains bladder neurogenic contractions for micturition compared to isoflurane. In contrast, isoflurane anesthesia more retains bladder function during the storage phase compared to urethane.
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Affiliation(s)
- Naoki Aizawa
- Department of Pharmacology and Toxicology, Dokkyo Medical University School of Medicine, Tochigi, Japan.
| | - Tomoe Fujita
- Department of Pharmacology and Toxicology, Dokkyo Medical University School of Medicine, Tochigi, Japan
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Chess-Williams R, Sellers DJ. Pathophysiological Mechanisms Involved in Overactive Bladder/Detrusor Overactivity. CURRENT BLADDER DYSFUNCTION REPORTS 2023. [DOI: 10.1007/s11884-023-00690-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/06/2023]
Abstract
Abstract
Purpose of Review
To examine the latest published findings on the pathophysiological mechanisms involved in the development of overactive bladder (OAB) and detrusor overactivity (DO), and to identify common pathways linked to the risk factors associated with these conditions.
Recent Findings
Evidence is accumulating, both clinical and experimental, that many of the factors linked to the development of OAB/DO, including ageing, bladder outlet obstruction, psychological stress, and obesity are associated with reduced bladder blood flow. This induces local tissue inflammation with cytokine release and enhanced oxidative stress, ultimately resulting in altered detrusor sensitivity, detrusor hypertrophy and fibrosis, together with afferent hypersensitivity. These mechanisms would explain the symptoms of urgency and frequency observed in OAB patients. Although not a characteristic of OAB, undetected low level bacterial infections of the bladder have been proposed to explain the OAB symptoms in patients resistant to standard treatments. In this condition, inflammatory responses without reductions in perfusion activate the inflammatory pathways.
Summary
Evidence is mounting that poor bladder perfusion and local inflammatory responses are central mechanisms involved in the development of OAB/DO. As our understanding of these pathophysiological mechanisms advances, new avenues for drug development will be identified and ultimately treatment may become more individualized depending on the particular pathway involved and the drugs available.
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Son HS, Moon SY, Kwon J, Kim JH. Effect of β3-adrenoceptor agonist on the micromotion of bilateral major pelvic ganglion-excised rat bladder. Neurourol Urodyn 2023; 42:530-538. [PMID: 36633527 DOI: 10.1002/nau.25127] [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: 10/16/2022] [Revised: 12/14/2022] [Accepted: 12/20/2022] [Indexed: 01/13/2023]
Abstract
AIMS Micromotion is an autonomous intramural movement of the bladder, and is believed to be an initial step in the generation of urinary urgency. Therefore, controlling micromotion may be a novel target in overactive bladder (OAB) treatment. However, developing micromotion treatment has been limited by the absence of a standardized animal model. We attempted to create a micromotion animal model and investigated the effectiveness of a β3 -adrenoceptor agonist (CL316,243) on micromotion. METHODS Bilateral major pelvic ganglia (MPGs) were excised in 18 male Sprague-Dawley rats, resulting in an almost completely denervated bladder. On postoperative Day 7, cystometry was performed. Rats were divided into three treatment groups: CL316,243; β3- adrenoceptor antagonist (SR59230A) pretreated CL316,243; and a nonselective antimuscarinic agent (oxybutynin). Changes in micromotion were evaluated after the intra-arterial administration of each agent. RESULTS Low-amplitude oscillations in intravesical pressure (micromotion) were observed 1 week after MPGs excision. Micromotion frequency significantly (p = 0.003) decreased (2.17 ± 3.54 times/5 min) with CL316,243 compared with vehicle (6.33 ± 1.97 times/5 min). Micromotion amplitude also decreased with CL316,243 (1.15 ± 1.93 cmH2 O) compared with vehicle (5.96 ± 5.12 cmH2 O), approaching conventional significance (p = 0.090). No significant decreases in frequency or amplitude were observed with oxybutynin treatment. CONCLUSIONS Systemic administration of the β3 -adrenoceptor agonist CL316,243 effectively controlled micromotion in bilateral MPGs-excised, almost completely denervated rat bladders. This result indicates that β3 -adrenoceptor agonist may affect the bladder directly, suggesting that it might be effective for overall OAB, regardless of the presence or level of neurological deficits. Bilateral MPGs-excised rats are considered a plausible micromotion animal model suitable for future research.
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Affiliation(s)
- Hee Seo Son
- Department of Urology and Urological Science Institute, Yonsei University College of Medicine, Severance Hospital, Seoul, Republic of Korea
| | - Soo Young Moon
- Biomedical Research Center, Korea University Ansan Hospital, Ansan, Republic of Korea
| | - Joonbeom Kwon
- Department of Urology, Daegu Fatima Hospital, Daegu, Republic of Korea
| | - Jang Hwan Kim
- Department of Urology and Urological Science Institute, Yonsei University College of Medicine, Severance Hospital, Seoul, Republic of Korea
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Ravishankar B, Vasdev RMS, Timm GW, Elliott S, Nakib NA, Johnson M, Nelson DE. Objective Quantification of Detrusor Overactivity Using Spectral Measures of Cystometry Data. Urology 2023; 174:206-211. [PMID: 36708933 DOI: 10.1016/j.urology.2023.01.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Accepted: 01/11/2023] [Indexed: 01/26/2023]
Abstract
OBJECTIVE To develop scalable objective methods for differentiating patients with and without detrusor overactivity (DO) using quantitative Fast Fourier Transform (FFT)-based measures and routinely captured cystometry data. METHODS Retrospective cystometry data were collected as prevoid vesical and abdominal pressure signals from 18 DO and 10 SUI (non-DO) cystometry recordings. Data were filtered and divided into two equal-duration segments, Early and Late Fill, representing the first and second halves of filling. FFT was applied, followed by subtraction of abdominal spectra from vesical spectra. Spectral Power (SP) and Weighted Average Frequency (WAF) measures were calculated for each segment spectra within 1-6 cycles min-1. RESULTS Compared to non-DO, the mean SP was significantly higher in DO patients for both Early and Late Fill segments. WAF was significantly lower in DO patients for both segments. Changes in spectral pressures appeared to be linked to the presence of detrusor contractions (DCs) and were especially visible when DCs were present in the Early Fill segments of cystometry. CONCLUSION FFT-based spectral measures derived from routinely captured cystometry data are significantly different between DO and non-DO patients. This preliminary method is clinically scalable and can be further developed to facilitate the detection of DO, classify disease phenotype, and capture therapeutic efficacy.
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Affiliation(s)
- Bhaskar Ravishankar
- Department of Electrical Engineering, University of Minnesota Twin Cities, Minneapolis, MN; Department of Urology, University of Minnesota Twin Cities, Minneapolis, MN
| | - Ranveer M S Vasdev
- Department of Urology, University of Minnesota Twin Cities, Minneapolis, MN; Department of Biomedical Engineering, University of Minnesota Twin Cities, Minneapolis, MN
| | - Gerald W Timm
- Department of Electrical Engineering, University of Minnesota Twin Cities, Minneapolis, MN; Department of Urology, University of Minnesota Twin Cities, Minneapolis, MN
| | - Sean Elliott
- Department of Urology, University of Minnesota Twin Cities, Minneapolis, MN
| | - Nissrine A Nakib
- Department of Urology, University of Minnesota Twin Cities, Minneapolis, MN
| | - Matthew Johnson
- Department of Biomedical Engineering, University of Minnesota Twin Cities, Minneapolis, MN
| | - Dwight E Nelson
- Department of Urology, University of Minnesota Twin Cities, Minneapolis, MN.
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Saxena P, Broemer E, Herrera GM, Mingin GC, Roccabianca S, Tykocki NR. Compound 48/80 increases murine bladder wall compliance independent of mast cells. Sci Rep 2023; 13:625. [PMID: 36635439 PMCID: PMC9837046 DOI: 10.1038/s41598-023-27897-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Accepted: 01/10/2023] [Indexed: 01/13/2023] Open
Abstract
A balance between stiffness and compliance is essential to normal bladder function, and changes in the mechanical properties of the bladder wall occur in many bladder pathologies. These changes are often associated with the release of basic secretagogues that in turn drive the release of inflammatory mediators from mast cells. Mast cell degranulation by basic secretagogues is thought to occur by activating an orphan receptor, Mas-related G protein-coupled receptor B2 (Mrgprb2). We explored the effects of the putative mast cell degranulator and Mrgprb2 agonist Compound 48/80 on urinary bladder wall mechanical compliance, smooth muscle contractility, and urodynamics, and if these effects were mast cell dependent. In wild-type mice, Mrgprb2 receptor mRNA was expressed in both the urothelium and smooth muscle layers. Intravesical instillation of Compound 48/80 decreased intermicturition interval and void volume, indicative of bladder overactivity. Compound 48/80 also increased bladder compliance while simultaneously increasing the amplitude and leading slope of transient pressure events during ex vivo filling and these effects were inhibited by the Mrgprb2 antagonist QWF. Surprisingly, all effects of Compound 48/80 persisted in mast cell-deficient mice, suggesting these effects were independent of mast cells. These findings suggest that Compound 48/80 degrades extracellular matrix and increases urinary bladder smooth muscle excitability through activation of Mrgprb2 receptors located outside of mast cells. Thus, the pharmacology and physiology of Mrgprb2 in the urinary bladder is of potential interest and importance in terms of treating lower urinary tract dysfunction.
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Affiliation(s)
- Pragya Saxena
- Department of Pharmacology and Toxicology, Michigan State University College of Osteopathic Medicine, East Lansing, MI, USA
| | - Eli Broemer
- Department of Mechanical Engineering, Michigan State University, East Lansing, MI, USA
| | - Gerald M Herrera
- Department of Pharmacology, University of Vermont, Burlington, VT, USA
| | - Gerald C Mingin
- Division of Urology, University of Vermont Larner College of Medicine, Burlington, VT, USA
| | - Sara Roccabianca
- Department of Mechanical Engineering, Michigan State University, East Lansing, MI, USA
| | - Nathan R Tykocki
- Department of Pharmacology and Toxicology, Michigan State University College of Osteopathic Medicine, East Lansing, MI, USA.
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Wang L, Deng S, Meng F, Zhang L, Min Z, Li J, Wang J. Comprehensive analysis of global research on overactive bladder: A scientometric approach. Front Surg 2023; 9:1078052. [PMID: 36684181 PMCID: PMC9852494 DOI: 10.3389/fsurg.2022.1078052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Accepted: 11/21/2022] [Indexed: 01/09/2023] Open
Abstract
Background Overactive bladder, a syndrome marked by an urgent need to urinate, is a globally prevalent ailment. Human health and quality of life are seriously affected. Therefore, it is essential to investigate the current progress and trends in this field. Objective No bibliometric analysis of overactive bladder has been conducted. Through the use of bibliometrics and visualization, this study intends to examine the current progress and development trend of this field. Methods Global publications on overactive bladder between January 2004 and August 2022 were extracted from the Web of Science core collection database. A bibliometric and visual analysis was carried out using VOSviewer software and CiteSpace. Results Over the last 20 years, publications have grown rapidly, but after 2019, they started to fall. According to the collaboration network, the United States, Univ Pittsburgh AND NEUROUROLOGY AND URODYNAMICS are the most active countries, institutes AND journals in the field, respectively. All keywords were categorized by the symbiosis analysis into four categories: experimental study, symptoms, clinical use, and quality of life. The most prevalent keyword across all clusters is "overactive bladder." Conclusion Year after year, there have been more publications in the field of overactive bladder research in many countries, and there has been a deeper level of cooperation and exchange. Researchers will still be interested in overactive bladder in the future. Currently, the clinical application of the disease and the safety and effectiveness of medications are being investigated. However, radical innovation in relevant experimental technologies is a significant obstacle in this field.
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Affiliation(s)
- Lu Wang
- Department of Surgery, Beijing Xuanwu TCM Hospital, Beijing, China
| | - Sheng Deng
- Department of Andrology, Shunyi Hospital, Beijing Hospital of Traditional Chinese Medicine, Beijing, China
| | - Fanchao Meng
- Department of Urology Surgery, The Third Affiliated Hospital of Beijing University of Chinese Medicine, Beijing, China
| | - Lun Zhang
- Department of Surgery, Beijing Xuanwu TCM Hospital, Beijing, China
| | - Zhenxing Min
- Department of Surgery, Beijing Xuanwu TCM Hospital, Beijing, China
| | - Jitao Li
- Department of Surgery, Beijing Xuanwu TCM Hospital, Beijing, China,Correspondence: Jisheng Wang Jitao Li
| | - Jisheng Wang
- Department of Andrology, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China,Correspondence: Jisheng Wang Jitao Li
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13
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Frigerio M, Barba M, Cola A, Spelzini F, Milani R, Manodoro S. Coexisting overactive-underactive bladder and detrusor overactivity-underactivity in pelvic organ prolapse. Int J Gynaecol Obstet 2023; 160:256-262. [PMID: 35617299 PMCID: PMC10083922 DOI: 10.1002/ijgo.14288] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2021] [Revised: 03/19/2022] [Accepted: 05/24/2022] [Indexed: 12/16/2022]
Abstract
OBJECTIVE The coexisting overactive-underactive bladder (COUB) syndrome could be related to the increased urethral resistance caused by severe pelvic organ prolapse (POP). We aimed to evaluate the clinical and urodynamic findings of patients with COUB and/or detrusor overactivity-underactivity (DOU) in a cohort of patients scheduled for POP surgery and the possible risk factors of COUB after surgery. METHODS This retrospective study analyzed all patients who underwent POP repair between 2008 and 2013, excluding women with a history of pelvic floor surgery. Patients were divided into COUB and non-COUB according to baseline symptoms and into DOU and non-DOU based on urodynamic findings. A multivariate model was performed to identify risk factors for COUB symptoms after surgery. RESULTS A total of 533 women underwent POP surgery. Preoperatively, patients with COUB had more severe anterior compartment prolapse (Pelvic Organ Prolapse Quantification staging system Aa point, P = 0.008) and more frequently had overactive bladder compared with controls (P = 0.023). The rate of COUB decreased significantly after surgery. Preoperative opening detrusor pressure resulted as the only independent predictor of postoperative COUB symptoms (P = 0.034). CONCLUSION POP is a valid pathogenetic model for COUB development. POP repair induced a significant decrease in COUB symptoms with low opening detrusor pressure resulting as the only independent predictor of postoperative COUB.
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Affiliation(s)
- Matteo Frigerio
- Department of Obstetrics and Gynecology, ASST Monza, Ospedale San Gerardo, Monza, Italy.,Department of Obstetrics and Gynecology, Università degli Studi di Milano-Bicocca, Milan, Italy
| | - Marta Barba
- Department of Obstetrics and Gynecology, ASST Monza, Ospedale San Gerardo, Monza, Italy.,Department of Obstetrics and Gynecology, Università degli Studi di Milano-Bicocca, Milan, Italy
| | - Alice Cola
- Department of Obstetrics and Gynecology, ASST Monza, Ospedale San Gerardo, Monza, Italy.,Department of Obstetrics and Gynecology, Università degli Studi di Milano-Bicocca, Milan, Italy
| | - Federico Spelzini
- Department of Obstetrics and Gynecology, AUSL Romagna, Ospedale Infermi, Rimini, Italy
| | - Rodolfo Milani
- Department of Obstetrics and Gynecology, ASST Monza, Ospedale San Gerardo, Monza, Italy
| | - Stefano Manodoro
- Department of Obstetrics and Gynecology, ASST Santi Paolo e Carlo, Ospedale San Paolo, Milan, Italy
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14
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Kumar SJ, Biswas DA. Anatomical Aspects of Neurogenic Bladder and the Approach in Its Management: A Narrative Review. Cureus 2022; 14:e31165. [DOI: 10.7759/cureus.31165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Accepted: 11/06/2022] [Indexed: 11/07/2022] Open
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15
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Heppner TJ, Hennig GW, Nelson MT, Herrera GM. Afferent nerve activity in a mouse model increases with faster bladder filling rates in vitro, but voiding behavior remains unaltered in vivo. Am J Physiol Regul Integr Comp Physiol 2022; 323:R682-R693. [PMID: 36121145 PMCID: PMC9602904 DOI: 10.1152/ajpregu.00156.2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Storage and voiding functions in urinary bladder are well-known, yet fundamental physiological events coordinating these behaviors remain elusive. We sought to understand how voiding function is influenced by the rate at which the bladder fills. We hypothesized that faster filling rates would increase afferent sensory activity and increase micturition rate. In vivo, this would mean animals experiencing faster bladder filling would void more frequently with smaller void volumes. To test this hypothesis, we measured afferent nerve activity during different filling rates using an ex vivo mouse bladder preparation and assessed voiding frequency in normally behaving mice noninvasively (UroVoid). Bladder afferent nerve activity depended on the filling rate, with faster filling increasing afferent nerve activity at a given volume. Voiding behavior in vivo was measured in UroVoid cages. Male and female mice were given access to tap water or, to induce faster bladder filling rates, water containing 5% sucrose. Fluid intake increased dramatically in mice consuming 5% sucrose. As expected, micturition frequency was elevated in the sucrose group. However, even with the greatly increased rate of urine production, void volumes were unchanged in both genders. Although faster filling rates generated higher afferent nerve rates ex vivo, this did not translate into more frequent, smaller-volume voids in vivo. This suggests afferent nerve activity is only one factor contributing to the switch from bladder filling to micturition. Together with afferent nerve activity, higher centers in the central nervous system and the state of arousal are likely critical to coordinating the micturition reflex.
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Affiliation(s)
- Thomas J. Heppner
- 1Department of Pharmacology, University of Vermont, Burlington, Vermont
| | - Grant W. Hennig
- 1Department of Pharmacology, University of Vermont, Burlington, Vermont
| | - Mark T. Nelson
- 1Department of Pharmacology, University of Vermont, Burlington, Vermont,2Institute of Cardiovascular Sciences, University of Manchester, Manchester, United Kingdom
| | - Gerald M. Herrera
- 1Department of Pharmacology, University of Vermont, Burlington, Vermont
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16
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Frigerio M, Barba M, Marino G, Volontè S, Melocchi T, De Vicari D, Torella M, Salvatore S, Braga A, Serati M, Manodoro S, Cola A. Coexistent Detrusor Overactivity-Underactivity in Patients with Pelvic Floor Disorders. Healthcare (Basel) 2022; 10:healthcare10091720. [PMID: 36141332 PMCID: PMC9498318 DOI: 10.3390/healthcare10091720] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Revised: 09/05/2022] [Accepted: 09/06/2022] [Indexed: 11/30/2022] Open
Abstract
Introduction and Hypothesis: Pelvic floor disorders represent a series of conditions that share, in part, the same etiological mechanisms, so they tend to be concomitant. Recently, awareness of a new lower urinary tract clinical syndrome has risen, namely the coexisting overactive–underactive bladder (COUB). The etiopathogenetic process, prevalence, and related instrumental findings of COUB are not well-established. We aimed to evaluate the prevalence, clinical features, and urodynamic findings of patients with COUB in a large cohort of patients with pelvic floor disorders. Methods: A cohort of 2092 women was retrospectively analyzed. A clinical interview, urogenital examination, and urodynamic assessment were performed by a trained urogynecologist. Based on baseline symptoms, patients were divided into COUB and non-COUB groups, and the degree of concordance between COUB and urodynamic findings, and other parameters related to the clinical aspects of these patients were measured and analyzed. Results: 18.8% of patients were classified as COUB. The association between COUB and patients with coexisting detrusor overactivity–underactivity (DOU) was statistically significant and there were substantial similarities in terms of population characteristics, symptoms, and urodynamic findings. Conclusions: Our study showed a high prevalence of COUB, and a link between this clinical syndrome and DOU was demonstrated. They showed substantial similarities in terms of clinical and urodynamics correlates. Based on these findings, we do think that urodynamic tests can be useful to improve knowledge on COUB and may be of help in the management of this condition.
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Affiliation(s)
- Matteo Frigerio
- San Gerardo Hospital, ASST Monza, 20900 Monza, Italy
- Department of Obstetrics and Gynecology, Milano-Bicocca University, 20900 Monza, Italy
- Correspondence: ; Tel.: +39-2339434; Fax: +39-2339433
| | - Marta Barba
- Department of Obstetrics and Gynecology, Milano-Bicocca University, 20900 Monza, Italy
| | - Giuseppe Marino
- Department of Obstetrics and Gynecology, Milano-Bicocca University, 20900 Monza, Italy
| | - Silvia Volontè
- Department of Obstetrics and Gynecology, Milano-Bicocca University, 20900 Monza, Italy
| | - Tomaso Melocchi
- Department of Obstetrics and Gynecology, Milano-Bicocca University, 20900 Monza, Italy
| | - Desirèe De Vicari
- Department of Obstetrics and Gynecology, Milano-Bicocca University, 20900 Monza, Italy
| | - Marco Torella
- Department of Woman, Luigi Vanvitelli University of Campania, 80138 Naples, Italy
| | - Stefano Salvatore
- Obstetrics and Gynaecology Department, Vita-Salute University and IRCCS San Raffaele Hospital, 20133 Milan, Italy
| | - Andrea Braga
- EOC-Beata Vergine Hospital, 6850 Mendrisio, Switzerland
| | - Maurizio Serati
- Del Ponte Hospital, University of Insubria, 21100 Varese, Italy
| | - Stefano Manodoro
- ASST Santi Paolo e Carlo, San Paolo Hospital, 20132 Milano, Italy
| | - Alice Cola
- San Gerardo Hospital, ASST Monza, 20900 Monza, Italy
- Department of Obstetrics and Gynecology, Milano-Bicocca University, 20900 Monza, Italy
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17
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Petros P, Quaghebeur J, Wyndaele J. Defining urge as an uncontrolled micturition explains pathogenesis, informs cure and helps solve the burgeoning OAB crisis. Neurourol Urodyn 2022; 41:1281-1292. [PMID: 35708305 PMCID: PMC9543998 DOI: 10.1002/nau.24990] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Accepted: 06/02/2022] [Indexed: 11/25/2022]
Abstract
BACKGROUND Parallel with the demographic ageing crisis, is a disabling overactive bladder (OAB) crisis (urgency/frequency/nocturia), 30% prevalence in older women, pathogenesis stated as unknown and, according to some learned societies, incurable. HYPOTHESIS/AIMS To review International Continence Society and Integral System paradigms to test our thesis that OAB per se is not a pathological condition, rather, a prematurely activated uncontrolled micturition; pathogenesis being anatomical damage in a nonlinear feedback control system comprising cortical and peripheral (muscle/ligament) components. METHODS We examined studies from basic science, anatomy, urodynamics, ultrasonic and video xrays, ligament repairs, from which we created a nonlinear binary model of bladder function. We applied a Chaos Theory feedback equation, Xnext = Xc(1 - X) to test our hypothesis against existing concepts and hypotheses for OAB pathogenesis. RESULTS The bladder has ONLY two modes, EITHER closed OR open (micturition). Closure is reflexly controlled cortically and peripherally: muscles contracting against ligaments stretch the vagina to suppress afferent signals to micturate from urothelial stretch receptors. "OAB" can be caused by anatomical damage anywhere in the model, by childbirth or age-weakened ligaments, which can be repaired to cure all three OAB symptoms. Urodynamic "DO" graphs are interpreted anatomically and by the feedback equation. CONCLUSION OAB is in crisis. Our thesis of OAB as an uncontrolled micturition from anatomical defects in the bladder control system provides fresh directions for further development of new treatments, nonsurgical and surgical, to help break the crisis and bring hope and cure to 600 million women sufferers.
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Affiliation(s)
- Peter Petros
- Department of Mechanical EngineeringSchool of Engineering and Mathematical Sciences, The University of Western AustraliaPerthWestern AustraliaAustralia
| | - Jörgen Quaghebeur
- Department of AnatomyFaculty of Medicine and Health Sciences, University of Antwerp Edegem BelgiumAntwerpBelgium
| | - Jean‐Jacques Wyndaele
- Department of AnatomyFaculty of Medicine and Health Sciences, University of Antwerp Edegem BelgiumAntwerpBelgium
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18
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Ikeda Y, Zabbarova I, de Rijk M, Kanai A, Wolf-Johnston A, Weiss JP, Jackson E, Birder L. Effects of vasopressin receptor agonists on detrusor smooth muscle tone in young and aged bladders: Implications for nocturia treatment. CONTINENCE (AMSTERDAM, NETHERLANDS) 2022; 2:100032. [PMID: 35789681 PMCID: PMC9250757 DOI: 10.1016/j.cont.2022.100032] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
PURPOSE The main goal of this study was to determine the effects of arginine vasopressin (AVP) and desmopressin on bladder contractility and to examine whether the effects of these vasopressin receptor (VR) agonists differ in young versus aged animals. These aims were addressed using urinary bladders from young (3 months) and aged (24 month) female Fischer 344 rats that were isolated and dissected into strips for isometric tension recordings. Bladder strips were exposed to AVP and desmopressin through the perfusate, and tension changes recorded. RESULTS In young rat bladders, AVP, an agonist at both vasopressin-1 receptors (V1Rs) and vasopressin-2 receptor (V2Rs), concentration-dependently caused contraction of bladder strips with a sensitivity that was greater in young versus aged bladder strips. Removal of the mucosa did not alter the sensitivity of young bladder strips to AVP yet enhanced the AVP sensitivity of aged bladder strips. The differential sensitivity to AVP between young denuded and aged denuded bladder strips was similar. In contrast to AVP, desmopressin (V2R selective agonist) relaxed bladder strips. This response was reduced by removal of the mucosa in young, but not aged, bladder strips. CONCLUSION These findings support a direct role for VRs in regulating detrusor tone with V1Rs causing contraction and V2Rs relaxation. In aged bladders, the contractile response to V1R activation is attenuated due to release of a mucosal factor that attenuates V1R-induced contractions. Also in aged bladders, the relaxation response to V2R activation is attenuated by lack of release of a mucosal factor that contributes to V2R-induced relaxation. Thus age-associated changes in the bladder mucosa impair the effects of VRs on bladder tone. Because the V2R signaling system is impaired in the older bladder, administering an exogenous V2R agonist (e.g., desmopressin) could counteract this defect. Thus, desmopressin could potentially increase nighttime bladder capacity through detrusor relaxation in concert with decreased urine production, reducing nocturnal voiding frequency.
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Affiliation(s)
- Youko Ikeda
- University of Pittsburgh, School of Medicine, Renal-Electrolyte division, United States of America
- University of Pittsburgh, School of Medicine, Department of Pharmacology and Chemical Biology, United States of America
| | - Irina Zabbarova
- University of Pittsburgh, School of Medicine, Renal-Electrolyte division, United States of America
| | - Mathijs de Rijk
- Maastricht University, Faculty of Health, Medicine, and Life Sciences, School for Mental Health and Neurosciences, Department of Urology, the Netherlands
| | - Anthony Kanai
- University of Pittsburgh, School of Medicine, Renal-Electrolyte division, United States of America
- University of Pittsburgh, School of Medicine, Department of Pharmacology and Chemical Biology, United States of America
| | - Amanda Wolf-Johnston
- University of Pittsburgh, School of Medicine, Renal-Electrolyte division, United States of America
| | - Jeffrey P. Weiss
- SUNY Downstate Health Sciences University, Department of Urology, United States of America
| | - Edwin Jackson
- University of Pittsburgh, School of Medicine, Department of Pharmacology and Chemical Biology, United States of America
| | - Lori Birder
- University of Pittsburgh, School of Medicine, Renal-Electrolyte division, United States of America
- University of Pittsburgh, School of Medicine, Department of Pharmacology and Chemical Biology, United States of America
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19
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Petros P, Quaghebeur J, Wyndaele JJ. An anatomical pathogenesis of lower urinary tract definitions from the 2002 ICS report symptoms, conditions, syndromes, urodynamics. Neurourol Urodyn 2022; 41:740-755. [PMID: 35170804 PMCID: PMC9306741 DOI: 10.1002/nau.24889] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Revised: 01/21/2022] [Accepted: 01/22/2022] [Indexed: 12/30/2022]
Abstract
AIM To present an anatomical pathogenesis parallel with the 2002 International Continence Society Lower Urinary Tract (LUTS) definitions standardization Report 2002. METHODS Each LUTS section is discussed using the same numbers as the Report. RESULTS Normal function Bladder control is binary, with two reflexes alternating, either closure (dominant) or open (micturition), with the same cortical and peripheral components: three directional muscle forces contracting against pubourethral (PUL) and uterosacral (USL) ligaments for closure, two against uterosacral ligaments for micturition. Dysfunction OAB symptoms reflect a prematurely activated micturition; PUL/USL weakness prevents muscle forces from controlling afferent urothelial emptying signals. Stress urinary incontinence is a consequence of weak PULs allowing posterior muscle forces to open the urethra during effort. Lax USLs weaken contractile force of the posterior urethral opening vectors, so detrusor has to contract against an unopened urethra. This is experienced as "obstructive micturition." CONCLUSIONS Anatomical analysis indicates the ICS definitions are fundamentally sound, except for "OAB" which implies detrusor causation. Minor changes, OAB to "overactivated" bladder allow causation outside of bladder. This construct supports OAB and its component symptoms as a syndrome, as intuited by the Committee, (albeit as a prematurely activated micturition), retains the acronym, explains OAB cure by ligament repair, and incontinence pathogenesis from two post-2002 syndromes which need an addition to the definitions, Posterior Fornix Syndrome (of which OAB is a component) and Tethered Vagina Syndrome, which is the basis for skin-grafting cure of the 30%-50% of women who continue leaking urine massively after successful obstetric fistula closure.
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Affiliation(s)
- Peter Petros
- School of Mechanical and Mathematical Engineering, University of Western Australia, Perth, Australia
| | - Jörgen Quaghebeur
- Department of Urology, University of Antwerp, Edegem, Belgium.,Faculty of Medicine and Health Sciences, University of Antwerp, Wilrijk, Belgium
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20
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Offiah I, Drake MJ, Gammie A. Implications of Underactive Bladder Syndrome for Nocturia. Do We Need Urodynamic Assessment? Eur Urol Focus 2022; 8:86-88. [PMID: 35027332 DOI: 10.1016/j.euf.2021.12.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2021] [Accepted: 12/28/2021] [Indexed: 11/15/2022]
Affiliation(s)
- Ifeoma Offiah
- Department of Urogynaecology, Southmead Hospital, Bristol, UK.
| | - Marcus J Drake
- Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK; Bristol Urological Institute, North Bristol NHS Trust, Bristol, UK
| | - Andrew Gammie
- Bristol Urological Institute, North Bristol NHS Trust, Bristol, UK
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21
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Ravishankar B, Vasdev RMS, Timm GW, Nelson DE. Measurement and Quantification of Cystometric Bladder Pressure Spectra in an in-vivo Sheep Model: A Feasibility Study. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2021; 2021:5005-5010. [PMID: 34892331 DOI: 10.1109/embc46164.2021.9630641] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Cystometry is a standard procedure for the clinical evaluation of lower urinary tract disorders such as detrusor overactivity (DO). The utility of this procedure for DO diagnosis, however, is limited by the use of physician observations of bladder contractions and patient reported filling sensations. Although a number of preclinical and clinical studies have observed and developed methods to characterize bladder pressure dynamics, these techniques have not been scaled for routine clinical application. The goal of this study was to evaluate the feasibility of using an awake large animal model to characterize bladder pressure signals from cystometry as bladder pressure spectra and quantify changes in spectra during bladder filling. Two adult female sheep were trained for quiet catheterization in a minimally supportive sling and underwent multiple awake and limited anesthetized cystometry tests. In each test, bladder pressure was measured during continuous filling or with filling that included periods of no filling (constant volume). A Fast-Fourier Transform (FFT)-based algorithm was then used to quantify changes in pre-voiding bladder pressure spectra. Changes in Spectral Power (SP) and Weighted Average Frequency (WAF) were calculated during filling. To visualize temporal changes in bladder pressure frequencies during filling, Continuous Wavelet Transform (CWT) was also applied to cystometry data. Results showed that a significant increase in SP and decrease in WAF were both associated with bladder filling. However, during awake constant volume tests, SP significantly increased while changes in WAF were nonsignificant. Anesthetized tests demonstrated comparable values to awake tests for WAF while SP was considerably reduced. CWT facilitated visualization of spectral changes associated with SP and WAF as well as apparent non-voiding contractions during awake and anesthetized volume tests.Clinical Relevance-Bladder pressure spectra during cystometry are detectable in sheep and the changes during filling are similar to those observed in human retrospective clinical data. Sheep cystometry may be a valuable testbed for establishing and testing quantitative pressure spectra for use as a clinical diagnostic tool.
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22
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Wang R, Hong M, Huang J, Zhou N, Zhang Y, Xu S, Liu J, Yuan J, Zhang L, Huang L, Huang P, Tan B, Cao HY. Low-Dose Cyclophosphamide Induces Nerve Injury and Functional Overactivity in the Urinary Bladder of Rats. Front Neurosci 2021; 15:715492. [PMID: 34658764 PMCID: PMC8517437 DOI: 10.3389/fnins.2021.715492] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Accepted: 09/08/2021] [Indexed: 11/13/2022] Open
Abstract
Aim: This research aimed to investigate the neurotoxicity of low-dose cyclophosphamide (CYP) on the urinary bladder of rats by in vivo and in vitro studies. Methods: To establish CYP-induced cystitis rat model, rats were treated with three intraperitoneal injections of CYP (25 mg/kg) in a week. During treatment, the up-down method was used to assess the mechanical withdrawal threshold. On day 8, urodynamic test and bladder smooth muscle contractility study, including the contraction of bladder strips to electrical field stimulation (EFS, 2-64 Hz), carbachol (CCh, 10-8-10-5 M) and KCl (120 mM), were performed to evaluate the function of bladder function. Body weight and bladder weight were also recorded. Morphometric analysis using an optical microscope and transmission electron microscope was performed to observe the changes of microstructure and submicrostructure of the bladder. The major pelvic neurons were isolated and treated with acrolein (the main CYP metabolite) to assess apoptosis in vitro. RT-PCR assays were used to quantify the mRNA expression levels of Nlrp6, Asc, Casp11 and Casp1 in bladder tissues and primary neurons. Results: After CYP injections, the body weights decreased, but the bladder weights increased in the model group. The mechanical withdrawal threshold of the cystitis model remained at a low level. The morphometric analysis suggested bladder inflammation and neuroinflammation in the bladder of the cystitis rat model. Urodynamic test revealed that, the amplitude, the pressure baseline, the peak pressure and pressure threshold of model rats significantly increased after CYP treatment. The muscle strips of model rats exhibited significantly higher contractility caused by EFS and CCh than the controls. Apoptotic cells appeared at the highest concentration group (100 μM acrolein) after 6 h of acrolein incubation in apoptosis assay of primary neurons. The mRNA expression levels of Nlrp6 and Casp11 were significantly increased in the cystitis rat model and in the acrolein-treated neurons. Conclusions: Low-dose CYP treatment was confirmed to induce nerve injury, which leading to bladder pain and overactive bladder in female rats, and the up-regulation of Nlrp6 and Casp11 may contribute to these pathological changes.
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Affiliation(s)
- Rui Wang
- School of Pharmaceutical Sciences, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Ming Hong
- School of Pharmaceutical Sciences, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Jingyi Huang
- School of Pharmaceutical Sciences, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Na Zhou
- School of Pharmaceutical Sciences, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Yao Zhang
- School of Pharmaceutical Sciences, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Siyuan Xu
- School of Pharmaceutical Sciences, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Jiaye Liu
- School of Pharmaceutical Sciences, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Junjie Yuan
- School of Pharmaceutical Sciences, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Lusiqi Zhang
- School of Pharmaceutical Sciences, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Linyuan Huang
- School of Pharmaceutical Sciences, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Ping Huang
- School of Pharmaceutical Sciences, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Bo Tan
- School of Basic Medical Sciences, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Hong-Ying Cao
- School of Pharmaceutical Sciences, Guangzhou University of Chinese Medicine, Guangzhou, China.,Dongguan & Guangzhou University of Chinese Medicine Cooperative Academy of Mathematical Engineering for Chinese Medicine, Guangzhou University of Chinese Medicine, Guangzhou, China
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23
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Dodds KN, Travis L, Beckett EAH, Spencer NJ. Identification of a novel distension-evoked motility pattern in the mouse uterus. Am J Physiol Regul Integr Comp Physiol 2021; 321:R317-R327. [PMID: 34287078 DOI: 10.1152/ajpregu.00327.2020] [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: 11/22/2022]
Abstract
The dynamic changes in uterine contractility in response to distension are incompletely understood. Rhythmic, propagating contractions of nonpregnant uterine smooth muscle occur in the absence of nerve activity (i.e., myogenic), events that decline during pregnancy and reemerge at parturition. We therefore sought to determine how myogenic contractions of the nonpregnant uterus are affected by distension, which might provide mechanistic clues underlying distension-associated uterine conditions such as preterm birth. Uteri isolated from nulliparous adult female mice in proestrus were video imaged to generate spatiotemporal maps, and myoelectrical activity simultaneously recorded using extracellular suction electrodes. Motility patterns were examined under basal conditions and following ramped intraluminal distension with fluid to 5 and 10 cmH2O. Intraluminal distension caused pressure-dependent changes in the frequency, amplitude, propagation speed, and directionality of uterine contractions, which reversed upon pressure release. Altered burst durations of underlying smooth muscle myoelectric events were concurrently observed, although action potential spike intervals were unchanged. Voltage-gated sodium channel blockade [tetrodotoxin (TTX); 0.6 µM] attenuated both the amplitude of contractions and burst duration of action potentials, whereas all activity was abolished by L-type calcium channel blockade (nifedipine; 1 µM). These data suggest that myogenic motility patterns of the nonpregnant mouse uterus are sensitive to changes in intraluminal pressure and, at high pressures, may be modulated by voltage-gated sodium channel activity. Future studies may investigate whether similar distension-evoked changes occur in the pregnant uterus and the possible pathophysiological role of such activity in the development of preterm birth.
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Affiliation(s)
- Kelsi N Dodds
- College of Medicine & Public Health, Flinders Health & Medical Research Institute, Flinders University of South Australia, Bedford Park, South Australia, Australia
| | - Lee Travis
- College of Medicine & Public Health, Flinders Health & Medical Research Institute, Flinders University of South Australia, Bedford Park, South Australia, Australia
| | - Elizabeth A H Beckett
- Discipline of Physiology, Adelaide Medical School, The University of Adelaide, Adelaide, South Australia, Australia
| | - Nick J Spencer
- College of Medicine & Public Health, Flinders Health & Medical Research Institute, Flinders University of South Australia, Bedford Park, South Australia, Australia
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Franken J, De Bruyn H, Rietjens R, Segal A, De Ridder D, Everaerts W, Voets T, Vande Velde G. X-ray videocystometry for high-speed monitoring of urinary tract function in mice. SCIENCE ADVANCES 2021; 7:7/30/eabi6821. [PMID: 34301607 PMCID: PMC8302127 DOI: 10.1126/sciadv.abi6821] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Accepted: 06/08/2021] [Indexed: 06/13/2023]
Abstract
Lower urinary tract dysfunction (LUTd) represents a major health care problem with a high, unmet medical need. Design of additional therapies for LUTd requires precise tools to study bladder storage and voiding (dys)function in animal models. We developed videocystometry in mice, combining intravesical pressure measurements with high-speed fluoroscopy of the urinary tract. Videocystometry substantially outperforms current state-of-the-art methods to monitor the urine storage and voiding process, by enabling quantitative analysis of voiding efficiency, urethral flow, vesicoureteral reflux, and the relation between intravesical pressure and flow, in both anesthetized and awake, nonrestrained mice. Using videocystometry, we identified localized bladder wall micromotions correlated with different states of the filling/voiding cycle, revealed an acute effect of TRPV1 channel activation on voiding efficiency, and pinpointed the effects of urethane anesthesia on urine storage and urethral flow. Videocystometry has broad applications, ranging from the elucidation of molecular mechanisms of bladder control to drug development for LUTd.
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Affiliation(s)
- Jan Franken
- Laboratory of Ion Channel Research (LICR), VIB-KU Leuven Centre for Brain and Disease Research, Department of Cellular and Molecular Medicine, KU Leuven, Leuven, Belgium
| | - Helene De Bruyn
- Laboratory of Ion Channel Research (LICR), VIB-KU Leuven Centre for Brain and Disease Research, Department of Cellular and Molecular Medicine, KU Leuven, Leuven, Belgium
| | - Roma Rietjens
- Laboratory of Ion Channel Research (LICR), VIB-KU Leuven Centre for Brain and Disease Research, Department of Cellular and Molecular Medicine, KU Leuven, Leuven, Belgium
| | - Andrei Segal
- Laboratory of Ion Channel Research (LICR), VIB-KU Leuven Centre for Brain and Disease Research, Department of Cellular and Molecular Medicine, KU Leuven, Leuven, Belgium
| | - Dirk De Ridder
- Laboratory of Organ System, Department of Development and Regeneration, KU Leuven, Leuven, Belgium
| | - Wouter Everaerts
- Laboratory of Organ System, Department of Development and Regeneration, KU Leuven, Leuven, Belgium
| | - Thomas Voets
- Laboratory of Ion Channel Research (LICR), VIB-KU Leuven Centre for Brain and Disease Research, Department of Cellular and Molecular Medicine, KU Leuven, Leuven, Belgium.
| | - Greetje Vande Velde
- Biomedical MRI, Department of Imaging and Pathology, KU Leuven, Leuven, Belgium
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Neurophysiological control of urinary bladder storage and voiding-functional changes through development and pathology. Pediatr Nephrol 2021; 36:1041-1052. [PMID: 32415328 DOI: 10.1007/s00467-020-04594-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Revised: 04/24/2020] [Accepted: 04/28/2020] [Indexed: 10/24/2022]
Abstract
The effective storage of urine and its expulsion relies upon the coordinated activity of parasympathetic, sympathetic, and somatic innervations to the lower urinary tract (LUT). At birth, all mammalian neonates lack the ability to voluntary regulate bladder storage or voiding. The ability to control urinary bladder activity is established as connections to the central nervous system (CNS) form through development. The neural regulation of the LUT has been predominantly investigated in adult animal models where comparatively less is known about the neonatal and postnatal neurophysiological development that facilitate urinary continence. Furthermore, congenital neurological or anatomical defects can adversely affect both storage and voiding functions through postnatal development and into adulthood, leading to secondary conditions including vesicoureteral reflux, chronic urinary tract infections, and end-stage renal disease. Therefore, the aim of the review is to provide the current knowledge available on neurophysiological regulation of the LUT through pre- to postnatal development of human and animal models and the consequences of congenital anomalies that can affect LUT neural function.
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Rahnama'i MS, Marcelissen T, Geavlete B, Tutolo M, Hüsch T. Current Management of Post-radical Prostatectomy Urinary Incontinence. Front Surg 2021; 8:647656. [PMID: 33898508 PMCID: PMC8063855 DOI: 10.3389/fsurg.2021.647656] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Accepted: 03/03/2021] [Indexed: 12/16/2022] Open
Abstract
Prostate cancer is the second most common cancer in men worldwide. Radical prostatectomy and radiation beam therapy are the most common treatment options for localized prostate cancer and have different associated complications. The etiology of post prostatectomy incontinence is multifactorial. There is evidence in the literature that anatomic support and pelvic innervation are important factors in the etiology of post-prostatectomy incontinence. Among the many surgical and technical factors proposed in the literature, extensive dissection during surgery, damage to the neurovascular bundle and the development of postoperative fibrosis have a substantial negative impact on the continence status of men undergoing RP. Sparing of the bladder neck and anterior, and possibly posterior, fixation of the bladder-urethra anastomosis are associated with better continence rates. Overactive bladder syndrome (OAB) is multifactorial and the exact role of prostate surgery in the development of OAB is still under debate. There are several variables that could contribute to detrusor overactivity. Detrusor overactivity in patients after radical prostatectomy has been mainly attributed to a partial denervation of the bladder during surgery. However, together with bladder denervation, other hypotheses, such as the urethrovesical mechanism, have been described. Although there is conflicting evidence regarding the importance of conservative treatment after post-prostatectomy urinary incontinence, pelvic floor muscle training (PFMT) is still considered as the first treatment choice. Duloxetin, either alone or in combination with PFMT, may hasten recovery of urinary incontinence but is often associated with severe gastrointestinal and central nervous side effects. However, neither PFMT nor duloxetine may cure male stress urinary incontinence. The therapeutic decision and the chosen treatment option must be individualized for each patient according to clinical and social factors. During the recent years, the development of new therapeutic choices such as male sling techniques provided a more acceptable management pathway for less severe forms of urinary incontinence related to radical prostatectomy. Following this perspective, technological improvements and the emergence of new dedicated devices currently create the premises for a continuously positive evolution of clinical outcomes in this particular category of patients.
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Affiliation(s)
| | - Tom Marcelissen
- Maastricht University Medical Center (MUMC+), Maastricht, Netherlands
| | | | - Manuela Tutolo
- Division of Oncology, Unit of Urology, Urological Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy
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Abstract
OBJECTIVES Detrusor underactivity (DU) is diagnosed using urodynamic testing. We hypothesized that nocturia is associated with detrusor underactivity. METHODS We performed a retrospective chart review of all women who underwent urodynamic testing at our institution between 2016 and 2018. Uroflowmetry and pressure-flow study parameters were compared between women with nocturia (≥2 voids/night) and without nocturia (0-1 void/night). Detrusor underactivity was diagnosed using 3 different criteria: (1) bladder voiding efficiency (BVE) of <90%, (2) bladder contractility index of <100, and (3) a composite of three urodynamic measures (Gammie criteria). RESULTS Of 358 women, 172 (48%) were in the nocturia group and 186 (52%) were in the no nocturia group. On uroflowmetry, median postvoid residual volume was similar (20 mL) in both groups. Median maximum flow rate (15 vs 17 mL/s, P < 0.05) and average flow rate (6 mL/s vs 7 mL/s, P < 0.05) were significantly lower in the nocturia group compared with the no nocturia group. During pressure-flow study, a significantly greater proportion of women with nocturia were unable to void around the catheter (30% vs 27%, P < 0.01). The overall rate of DU varied with the criteria used: BVE (54%), bladder contractility index (41%), and Gammie criteria (7%). The rate of DU using the BVE criteria was significantly higher in the nocturia group (63% vs 48%, P < 0.01), but no significant differences were noted using the other criteria. CONCLUSIONS Nocturia is associated with reduced voiding efficiency in women. The diagnosis of DU using urodynamics is challenging.
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Nagle AS, Cullingsworth ZE, Li R, Carucci LR, Klausner AP, Speich JE. Bladder wall micromotion measured by non-invasive ultrasound: initial results in women with and without overactive bladder. AMERICAN JOURNAL OF CLINICAL AND EXPERIMENTAL UROLOGY 2021; 9:44-52. [PMID: 33816693 PMCID: PMC8012835] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Received: 08/29/2020] [Accepted: 01/11/2021] [Indexed: 06/12/2023]
Abstract
OBJECTIVE Rhythmic contractions of the bladder wall during filling result from the synchronization of bladder wall micromotion and are often observed in the urodynamic tracings of individuals with urinary overactive bladder (OAB). This study's objective was to develop a novel, non-invasive method to measure bladder wall micromotion and to conduct an initial study to test the hypothesis that elevated micromotion is associated with OAB. METHODS This prospective study enrolled women with OAB and asymptomatic volunteers as measured by the ICIQ-OAB survey. After filling the bladder to 40% cystometric capacity, 85 second cine-loops were obtained using a GE Voluson E8 ultrasound system with an 8 MHz curved, abdominal probe. A custom correlation-based texture tracking MATLAB algorithm was used to measure changes in the bladder wall thickness over time and correlate with changes in vesical pressure. Significant bladder wall micromotion was defined as changes in wall thickness with amplitudes higher than 0.1 mm in the frequency range of 1.75-6 cycles/minute as calculated from Fast Fourier Transform (FFT) analysis. The micromotion algorithm was tested on 30 women including 17 with OAB and 13 asymptomatic volunteers. RESULTS Micromotion was identified in 41% of subjects with OAB and 0% of asymptomatic volunteers, indicating a significant association of micromotion with OAB (Fisher's exact test, P=0.010). Micromotion was also found to have a significant association with a clinical diagnosis of detrusor overactivity (Fisher's exact test, P=0.031). Frequencies with elevated micromotion correlated with frequencies of vesical pressure fluctuations. CONCLUSIONS The feasibility of a non-invasive method to measure bladder wall micromotion was demonstrated using transabdominal anatomical motion mode (M-mode) ultrasound. Presence of micromotion was significantly associated with OAB and with urodynamic-identified rhythm.
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Affiliation(s)
- Anna S Nagle
- Department of Mechanical & Nuclear Engineering, Virginia Commonwealth University College of EngineeringRichmond, VA, USA
| | - Zachary E Cullingsworth
- Department of Mechanical & Nuclear Engineering, Virginia Commonwealth University College of EngineeringRichmond, VA, USA
| | - Rui Li
- Department of Mechanical & Nuclear Engineering, Virginia Commonwealth University College of EngineeringRichmond, VA, USA
| | - Laura R Carucci
- Department of Radiology, Virginia Commonwealth University School of MedicineRichmond, VA, USA
| | - Adam P Klausner
- Department of Surgery/Division of Urology, Virginia Commonwealth University School of MedicineRichmond, VA, USA
- Department of Surgery/Division of Urology Hunter Holmes McGuire Veterans Affairs Medical CenterRichmond, VA, USA
| | - John E Speich
- Department of Mechanical & Nuclear Engineering, Virginia Commonwealth University College of EngineeringRichmond, VA, USA
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Urodynamic evaluation of patients with localized prostate cancer before and 4 months after robotic radical prostatectomy. Sci Rep 2021; 11:3632. [PMID: 33574414 PMCID: PMC7878735 DOI: 10.1038/s41598-021-83143-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Accepted: 01/20/2021] [Indexed: 01/01/2023] Open
Abstract
Radical prostatectomy can alter the anatomy of the urinary bladder. We aimed to evaluate bladder function before and 4 months after radical prostatectomy using the urodynamic test and overactive bladder (OAB) symptom score. Among 70 prospectively enrolled patients, 61 patients completed the study. In the urodynamic test, bladder capacity and compliance did not change, the frequency of involuntary detrusor contraction decreased, the maximum flow rate and bladder outlet obstruction index improved, and the maximum urethral closure pressure (MUCP) deteriorated. Further evaluation of urodynamic parameters according to changes in symptoms was made. Although change in bladder compliance was correlated with changes in OAB symptoms, not the relative change of bladder compliance but the relative change in the MUCP was reliable factor when OAB symptoms were deteriorated. In general, prostatectomy did not deteriorate the condition of the detrusor; rather, change in the MUCP could be responsible for postprostatectomy OAB.
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30
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Xu JJ, Yousuf Z, Ouyang Z, Kennedy E, Lester PA, Martin T, Bruns TM. Anesthetic agents affect urodynamic parameters and anesthetic depth at doses necessary to facilitate preclinical testing in felines. Sci Rep 2020; 10:11401. [PMID: 32647241 PMCID: PMC7347647 DOI: 10.1038/s41598-020-68395-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2020] [Accepted: 06/22/2020] [Indexed: 01/23/2023] Open
Abstract
Urodynamic studies, used to understand bladder function, diagnose bladder disease, and develop treatments for dysfunctions, are ideally performed with awake subjects. However, in small and medium-sized animal models, anesthesia is often required for these procedures and can be a research confounder. This study compared the effects of select survival agents (dexmedetomidine, alfaxalone, and propofol) on urodynamic (Δpressure, bladder capacity, bladder compliance, non-voiding contractions, bladder pressure slopes) and anesthetic (change in heart rate [∆HR], average heart rate [HR], reflexes, induction/recovery times) parameters in repeated cystometrograms across five adult male cats. The urodynamic parameters under isoflurane and α-chloralose were also examined in terminal procedures for four cats. Δpressure was greatest with propofol, bladder capacity was highest with α-chloralose, non-voiding contractions were greatest with α-chloralose. Propofol and dexmedetomidine had the highest bladder pressure slopes during the initial and final portions of the cystometrograms respectively. Cats progressed to a deeper plane of anesthesia (lower HR, smaller ΔHR, decreased reflexes) under dexmedetomidine, compared to propofol and alfaxalone. Time to induction was shortest with propofol, and time to recovery was shortest with dexmedetomidine. These agent-specific differences in urodynamic and anesthetic parameters in cats will facilitate appropriate study-specific anesthetic choices.
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Affiliation(s)
- Jiajie Jessica Xu
- Unit for Laboratory Animal Medicine, University of Michigan, Ann Arbor, MI, USA.,Biointerfaces Institute, University of Michigan, Ann Arbor, MI, USA
| | - Zuha Yousuf
- Biointerfaces Institute, University of Michigan, Ann Arbor, MI, USA.,Biomedical Engineering Department, University of Michigan, Ann Arbor, MI, USA
| | - Zhonghua Ouyang
- Biointerfaces Institute, University of Michigan, Ann Arbor, MI, USA.,Biomedical Engineering Department, University of Michigan, Ann Arbor, MI, USA
| | - Eric Kennedy
- Biointerfaces Institute, University of Michigan, Ann Arbor, MI, USA.,Biomedical Engineering Department, University of Michigan, Ann Arbor, MI, USA
| | - Patrick A Lester
- Unit for Laboratory Animal Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Tara Martin
- Unit for Laboratory Animal Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Tim M Bruns
- Biointerfaces Institute, University of Michigan, Ann Arbor, MI, USA. .,Biomedical Engineering Department, University of Michigan, Ann Arbor, MI, USA.
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Soebadi MA, Weydts T, Brancato L, Hakim L, Puers R, De Ridder D. Novel implantable pressure and acceleration sensor for bladder monitoring. Int J Urol 2020; 27:543-550. [PMID: 32266758 DOI: 10.1111/iju.14238] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2019] [Accepted: 03/04/2020] [Indexed: 02/06/2023]
Abstract
OBJECTIVES To test the hypothesis that an implantable sensing system containing accelerometers can detect small-scale autonomous movements, also termed micromotions, which might be relevant to bladder physiology. METHODS We developed a 6-mm submucosal implant containing a pressure sensor (MS5637) and a triaxial accelerometer (BMA280). Sensor prototypes were tested by implantation in the bladders of Gottingen minipigs. Repeated awake voiding cystometry was carried out with air-charged catheters in a standard urodynamic set-up as comparators. We identified four phases of voiding similar to cystometry in other animal models based on submucosal pressure. Acceleration signals were separated by frequency characteristics to isolate linear acceleration from the baseline acceleration. The total linear acceleration was calculated by the root mean square of the three measurement axes. Acceleration activity during voiding was investigated to adjacent 1-s windows and was compared with the registered pressure. RESULTS We observed a total of 19 consecutive voids in five measurement sessions. A good correlation (r > 0.75) was observed between submucosal and catheter pressure in 14 of 19 premicturition traces. The peak-to-peak interval between maximum total linear acceleration was correlated with the interval between submucosal voiding pressure peaks (r = 0.760, P < 0.001). The total linear acceleration was higher during voiding compared with pre- and postmicturition periods (start of voiding/phase 1). CONCLUSIONS To the best of our knowledge, this is the first report of bladder wall acceleration, a novel metric that reflects bladder wall movement. Submucosal sensors containing accelerometers can measure bladder pressure and acceleration.
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Affiliation(s)
- Mohammad Ayodhia Soebadi
- Faculty of Medicine, Airlangga University, Surabaya, Indonesia.,Department of Urology, Dr Soetomo Hospital, Surabaya, Indonesia.,Department of Urology, Airlangga University Hospital, Surabaya, Indonesia.,Laboratory of Experimental Urology, Department of Development and Regeneration, KU Leuven, Leuven, Belgium
| | | | | | - Lukman Hakim
- Faculty of Medicine, Airlangga University, Surabaya, Indonesia.,Department of Urology, Dr Soetomo Hospital, Surabaya, Indonesia.,Department of Urology, Airlangga University Hospital, Surabaya, Indonesia
| | | | - Dirk De Ridder
- Laboratory of Experimental Urology, Department of Development and Regeneration, KU Leuven, Leuven, Belgium
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Mancini V, Tarcan T, Serati M, Wyndaele M, Carrieri G, Abrams P. Is coexistent overactive-underactive bladder (with or without detrusor overactivity and underactivity) a real clinical syndrome? ICI-RS 2019. Neurourol Urodyn 2020; 39 Suppl 3:S50-S59. [PMID: 32032454 DOI: 10.1002/nau.24311] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2019] [Accepted: 01/27/2020] [Indexed: 12/14/2022]
Abstract
AIMS Lower urinary tract symptoms (LUTS) can be classified into symptom syndromes based on which symptoms are predominant. Overactive bladder (OAB) syndrome, a storage dysfunction, and underactive bladder (UAB) syndrome, a voiding dysfunction, are common syndromes, which urodynamic tests may show to be caused by detrusor overactivity (DO) and detrusor underactivity (DU), but can also be associated with other urethro-vesical dysfunctions. Sometimes OAB and UAB can coexist in the same patient and, if so, need a specific approach beyond treatment of the single and apparently opposing syndromes. METHODS During its 2019 meeting in Bristol, the International Consultation on Incontinence Research Society held a literature review and expert consensus discussion focused on the emerging awareness of the coexisting overactive-underactive bladder (COUB). RESULTS The consensus considered whether COUB is the combination of OAB and UAB syndromes, or a real unique clinical syndrome in the same patient, possibly with a common etiology. Definitions, pathophysiology, diagnosis, and treatment were discussed, and high-priority research questions were identified. CONCLUSIONS COUB (with or without urodynamic evidence of DO and DU) may be considered a real clinical syndrome, because it differs from single OAB and UAB, and may not be the combination of both syndromes. Urodynamic tests may be necessary in unclear cases or in cases not responding to initial treatment of the most troublesome symptoms. It is pivotal to define the evolution of the syndrome and the characteristic population, and to recognize predictive or phenotyping factors to develop a specific approach and adequate outcome measures.
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Affiliation(s)
- Vito Mancini
- Department of Urology and Renal Transplantation, University of Foggia, Foggia, Italy
| | - Tufan Tarcan
- Department of Urology, School of Medicine, Marmara University, Istanbul, Turkey.,Department of Urology, Koç University School of Medicine, Istanbul, Turkey
| | - Maurizio Serati
- Department of Obstetrics and Gynecology, Del Ponte Hospital, University of Insubria, Varese, Italy
| | - Michel Wyndaele
- Department of Urology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Giuseppe Carrieri
- Department of Urology and Renal Transplantation, University of Foggia, Foggia, Italy
| | - Paul Abrams
- Bristol Urological Institute, University of Bristol, Bristol, United Kingdom
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Kuo HC, Lee CL, Ong HL. Therapeutic efficacy of mirabegron 25 mg monotherapy in patients with nocturia-predominant hypersensitive bladder. Tzu Chi Med J 2020; 32:30-35. [PMID: 32110517 PMCID: PMC7015015 DOI: 10.4103/tcmj.tcmj_226_18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2018] [Revised: 10/29/2018] [Accepted: 12/11/2018] [Indexed: 11/13/2022] Open
Abstract
Objective: The objective of this study was to evaluate the efficacy of mirabegron 25 mg daily in patients with nocturia-predominant hypersensitive bladder (HSB). Materials and Methods: This study prospectively investigated 219 consecutive patients with nocturia-predominant HSB and treated with mirabegron 25 mg daily from July 2015 to 2016. Patient with nocturia episode decreased by ≥1/night after treatment was considered successful. The subjective symptom score, such as International Prostate Symptom Score (IPSS), Quality of life index, Overactive Bladder Symptom Score (OABSS), Urgency Severity Scale, patient perception of bladder condition (PPBC), and nocturia episodes per night, was assessed before and 1 month after mirabegron treatment and between successful and failed groups. Results: A total of 219 patients, including 51 women and 168 men, were enrolled. The mean age of the population was 72.3 ± 11.0 years. Totally, 58 (26.5%) of the patients had improvement in nocturia at 1 month after treatment. Among them, 14 (27.5%) women and 44 (26.2%) men had improvement in nocturia episodes after treatment (P = 0.858). Compared the clinical data between successful and failed group, the baseline symptom scores were more severe in successful group, including IPSS-storage subscore (4.84 ± 2.09 vs. 4.11 ± 2.19, P = 0.031), OABSS (3.21 ± 0.67 vs. 2.91 ± 1.00, P = 0.037), and nocturia episodes (3.81 ± 0.95 vs. 3.095 ± 1.32, P = 0.000). Multivariate analysis revealed only a higher nocturia episodes (P = 0.046) predict a successful treatment result. Mirabegron 25 mg daily significantly improved PPBC score along the 3 months' follow-up (P < 0.05), and postvoid residual volume did not increase after mirabegron treatment in overall patients. Conclusions: Mirabegron 25 mg daily treatment showed a limited therapeutic effect on nocturia-predominant HSB patients. The patients with higher OAB symptoms predict a successful result.
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Cullingsworth ZE, Klausner AP, Li R, Nagle AS, Carroll AW, Roseman JT, Speich JE. Comparative-fill urodynamics in individuals with and without detrusor overactivity supports a conceptual model for dynamic elasticity regulation. Neurourol Urodyn 2019; 39:707-714. [PMID: 31856359 DOI: 10.1002/nau.24255] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Accepted: 12/06/2019] [Indexed: 12/17/2022]
Abstract
AIMS Dynamic elasticity was previously identified in individuals with overactive bladder (OAB) using comparative-fill urodynamics (UD) and is a biomechanical mechanism for acutely regulating detrusor wall tension. On the basis of this data, a conceptual model of dynamic elasticity regulation mediated through a balance of passive mechanisms and active contractions was constructed. The present study tested this model by determining whether individuals with detrusor overactivity (DO) exhibit less dynamic elasticity than individuals without DO. METHODS Individuals with and without urgency based on International Consultation on Incontinence Questionnaire-OAB surveys were prospectively enrolled in a comparative-fill UD study. An initial fill defined the presence or absence of DO and determined cystometric capacity. Three additional fills were employed with either passive emptying via a catheter or active voiding. To identify dynamic elasticity, average filling pressures (Pves ) were compared for fill 1 (before strain softening), fill 2 (after strain softening), and fill 3 (after active void). A dynamic elasticity index was defined. RESULTS From 28 participants, those without DO showed decreased Pves during filling after strain softening and restored Pves during filling following active voiding, revealing dynamic elasticity. Participants with DO did not show dynamic elasticity. A dynamic elasticity index less than 1.0 cmH2 O/40% capacity was identified in 2 out of 13 participants without DO and 9 out of 15 with DO, revealing a significant association between DO and reduced/absent dynamic elasticity (P = .024). CONCLUSIONS This study supports a conceptual model for dynamic elasticity, a mechanism to acutely regulate detrusor wall tension through a balance of competing active contractile and passive strain mechanisms. Improved understanding of this mechanistic model may help us to identify novel treatment strategies for OAB.
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Affiliation(s)
- Zachary E Cullingsworth
- Department of Mechanical and Nuclear Engineering, College of Engineering, Virginia Commonwealth University, Richmond, Virginia
| | - Adam P Klausner
- Division of Urology, Department of Surgery, Virginia Commonwealth University School of Medicine, Richmond, Virginia
| | - Rui Li
- Department of Mechanical and Nuclear Engineering, College of Engineering, Virginia Commonwealth University, Richmond, Virginia
| | - Anna S Nagle
- Department of Mechanical and Nuclear Engineering, College of Engineering, Virginia Commonwealth University, Richmond, Virginia
| | - Ashley W Carroll
- Department of Obstetrics and Gynecology, Virginia Commonwealth University School of Medicine, Richmond, Virginia
| | - John T Roseman
- Division of Urology, Department of Surgery, Virginia Commonwealth University School of Medicine, Richmond, Virginia
| | - John E Speich
- Department of Mechanical and Nuclear Engineering, College of Engineering, Virginia Commonwealth University, Richmond, Virginia
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Brière R, Versi E, Richard PO, Gratton M, Tu LM. A Preliminary Study on the Impact of Detrusor Overactivity on the Efficacy of Selective Bladder Denervation for the Treatment of Female Refractory Overactive Bladder. Urology 2019; 136:88-94. [PMID: 31794815 DOI: 10.1016/j.urology.2019.08.061] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Revised: 08/23/2019] [Accepted: 08/26/2019] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To determine whether the presence of detrusor overactivity (DO) is associated with the 12-week and 12-month clinical outcomes of selective bladder denervation (SBD) in women with refractory overactive bladder (OAB). METHODS Prospective single institutional study of refractory OAB females who underwent a urodynamic study and were categorized according to DO status (DO- vs DO+) prior to receiving SBD. RESULTS Among the 23 patients, 10 were DO- and 13 were DO+. Both groups reported improvement at 12 weeks on the 24-hour pad weight test, in urgency urinary incontinence (UUI) and urgency. At 12 months, both groups still reported improvement in urgency, but only the DO- group reported reduction on the pad weight test and only the DO+ group maintained improvement in the UUI rate. Clinical success (≥50% reduction in UUI) was achieved by all DO- and by 69% of DO+ patients at 12 weeks, and by 60% of DO- and 92% of DO+ patients at 12 months. Treatment benefit (Treatment Benefit Scale ≤2) was reported in 90% of DO- and 85% of DO+ patients at 12 weeks, and in 60% of DO- and 85% of DO+ patients at 12 months. When directly comparing both group outcomes, the only significant difference was the greater reduction of UUI in the DO- group at 12 weeks (-9.0 vs -6.5; P = .045). CONCLUSION Refractory OAB females appear to be effectively treated by SBD regardless of baseline DO status. DO status does not seem to be associated with the 12-week and 12-month outcomes of SBD.
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Affiliation(s)
| | - Eboo Versi
- Department of Obstetrics, Gynecology, Reproductive Sciences, Rutgers, New Brunswick, NJ
| | - Patrick O Richard
- Division of Urology, Department of Surgery, Faculty of Medicine and Health Sciences, Centre Hospitalier Universitaire de Sherbrooke and Centre de Recherche du CHUS, Sherbrooke, Québec, Canada
| | - Matthieu Gratton
- Division of Urology, Department of Surgery, Faculty of Medicine, CHU de Québec-Université Laval, Québec, Québec, Canada
| | - Le Mai Tu
- Division of Urology, Department of Surgery, Faculty of Medicine and Health Sciences, Centre Hospitalier Universitaire de Sherbrooke and Centre de Recherche du CHUS, Sherbrooke, Québec, Canada.
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Sengupta N, Manchanda R. Spontaneous synaptic drive in detrusor smooth muscle: computational investigation and implications for urinary bladder function. J Comput Neurosci 2019; 47:167-189. [PMID: 31712945 DOI: 10.1007/s10827-019-00731-7] [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: 05/20/2019] [Revised: 09/09/2019] [Accepted: 09/16/2019] [Indexed: 10/25/2022]
Abstract
The detrusor, a key component of the urinary bladder wall, is a densely innervated syncytial smooth muscle tissue. Random spontaneous release of neurotransmitter at neuromuscular junctions (NMJs) in the detrusor gives rise to spontaneous excitatory junction potentials (SEJPs). These sub-threshold passive signals not only offer insights into the syncytial nature of the tissue, their spatio-temporal integration is critical to the generation of spontaneous neurogenic action potentials which lead to focal contractions during the filling phase of the bladder. Given the structural complexity and the contractile nature of the tissue, electrophysiological investigations on spatio-temporal integration of SEJPs in the detrusor are technically challenging. Here we report a biophysically constrained computational model of a detrusor syncytium overlaid with spatially distributed innervation, using which we explored salient features of the integration of SEJPs in the tissue and the key factors that contribute to this integration. We validated our model against experimental data, ascertaining that observations were congruent with theoretical predictions. With the help of comparative studies, we propose that the amplitude of the spatio-temporally integrated SEJP is most sensitive to the inter-cellular coupling strength in the detrusor, while frequency of observed events depends more strongly on innervation density. An experimentally testable prediction arising from our study is that spontaneous release frequency of neurotransmitter may be implicated in the generation of detrusor overactivity. Set against histological observations, we also conjecture possible changes in the electrical activity of the detrusor during pathology involving patchy denervation. Our model thus provides a physiologically realistic, heuristic framework to investigate the spread and integration of passive potentials in an innervated syncytial tissue under normal conditions and in pathophysiology.
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Affiliation(s)
- Nilapratim Sengupta
- Department of Biosciences and Bioengineering, Indian Institute of Technology Bombay, Mumbai, 400076, India
| | - Rohit Manchanda
- Department of Biosciences and Bioengineering, Indian Institute of Technology Bombay, Mumbai, 400076, India.
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Fry CH, McCloskey KD. Spontaneous Activity and the Urinary Bladder. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2019; 1124:121-147. [PMID: 31183825 DOI: 10.1007/978-981-13-5895-1_5] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
The urinary bladder has two functions: to store urine, when it is relaxed and highly compliant; and void its contents, when intravesical pressure rises due to co-ordinated contraction of detrusor smooth muscle in the bladder wall. Superimposed on this description are two observations: (1) the normal, relaxed bladder develops small transient increases of intravesical pressure, mirrored by local bladder wall movements; (2) pathological, larger pressure variations (detrusor overactivity) can occur that may cause involuntary urine loss and/or detrusor overactivity. Characterisation of these spontaneous contractions is important to understand: how normal bladder compliance is maintained during filling; and the pathophysiology of detrusor overactivity. Consideration of how spontaneous contractions originate should include the structural complexity of the bladder wall. Detrusor smooth muscle layer is overlain by a mucosa, itself a complex structure of urothelium and a lamina propria containing sensory nerves, micro-vasculature, interstitial cells and diffuse muscular elements.Several theories, not mutually exclusive, have been advanced for the origin of spontaneous contractions. These include intrinsic rhythmicity of detrusor muscle; modulation by non-muscular pacemaking cells in the bladder wall; motor input to detrusor by autonomic nerves; regulation of detrusor muscle excitability and contractility by the adjacent mucosa and spontaneous contraction of elements of the lamina propria. This chapter will consider evidence for each theory in both normal and overactive bladder and how their significance may vary during ageing and development. Further understanding of these mechanisms may also identify novel drug targets to ameliorate the clinical consequences of large contractions associated with detrusor overactivity.
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Affiliation(s)
- Christopher H Fry
- School of Physiology, Pharmacology and Neuroscience, University of Bristol, Bristol, UK.
| | - Karen D McCloskey
- School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Belfast, UK
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Mora AG, Furquim SR, Tartarotti SP, Andrade DR, Janussi SC, Krikorian K, Rocha T, Franco-Penteado CF, Priolli DG, Priviero FBM, Claudino MA. Progression of micturition dysfunction associated with the development of heart failure in rats: Model of overactive bladder. Life Sci 2019; 226:107-116. [PMID: 30965053 DOI: 10.1016/j.lfs.2019.04.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Revised: 04/03/2019] [Accepted: 04/05/2019] [Indexed: 10/27/2022]
Abstract
Heart failure (HF) has a strong association with the development of lower urinary tract symptoms, especially overactive bladder (OAB); although this condition remains poorly investigated. In this study, we assess the aortocaval fistula (ACF) model as a novel experimental model of micturition dysfunction, associated with HF, focused on the molecular and functional studies to evaluate the autonomic nervous system and urinary bladder remodeling. Male rats were submitted to ACF for HF induction. Echocardiography, cystometric, histomorphometry and molecular analysis, as well as concentration-response curves to carbachol and ATP and frequency-response curves to electrical field stimulation (EFS) were evaluated in Sham and HF (4- and 12-weeksendpoint) groups. Compared to SHAM, HF groups exhibited progressive increases in the left ventricle (LV) mass and fractional shortening which indicates cardiac dysfunction, although HF was characterized only after 12 weeks by the reduced ejection fraction. For micturition function, HF groups presented increased non-voiding contractions (NVC) and decreased bladder capacity; however, when comparing HF groups, these urinary parameters were significantly impaired over the weeks (12-weeks). The contractile responses induced by CCh, ATP and EFS were greater in detrusor muscle (DSM) from HF rats. mRNA expression for muscarinic receptors (M2 and M3) was higher in DSM only after 12 weeks of ACF, in addition to MMP9 and TGF-beta. Histomorphometric revealed increased urothelium thickness in both HF groups, whereas DSM thickness occurred only after 12 weeks. Thus, the ACF model induced cardiac dyfunction with progressive micturition dysfunction over the weeks, characterized by increased DSM contractile mechanisms as well as extracellular matrix remodeling in the urinary bladder, representing a useful tool to evaluate the OAB associated with HF.
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Affiliation(s)
- A G Mora
- Laboratory of Multidisciplinary Research, São Francisco University Medical School, Bragança Paulista, SP, Brazil
| | - S R Furquim
- Laboratory of Multidisciplinary Research, São Francisco University Medical School, Bragança Paulista, SP, Brazil
| | - S P Tartarotti
- Laboratory of Multidisciplinary Research, São Francisco University Medical School, Bragança Paulista, SP, Brazil
| | - D R Andrade
- Laboratory of Multidisciplinary Research, São Francisco University Medical School, Bragança Paulista, SP, Brazil
| | - S C Janussi
- Laboratory of Multidisciplinary Research, São Francisco University Medical School, Bragança Paulista, SP, Brazil
| | - K Krikorian
- Laboratory of Multidisciplinary Research, São Francisco University Medical School, Bragança Paulista, SP, Brazil
| | - T Rocha
- Laboratory of Multidisciplinary Research, São Francisco University Medical School, Bragança Paulista, SP, Brazil
| | - C F Franco-Penteado
- Hematology and Hemotherapy Center, University of Campinas, Campinas, SP, Brazil; Faculty of Medical Sciences, University of Campinas, Campinas, SP, Brazil
| | - D G Priolli
- Laboratory of Multidisciplinary Research, São Francisco University Medical School, Bragança Paulista, SP, Brazil
| | - F B M Priviero
- Department of Physiology, Medical College of Georgia, Augusta University, Augusta, GA, USA
| | - M A Claudino
- Laboratory of Multidisciplinary Research, São Francisco University Medical School, Bragança Paulista, SP, Brazil.
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Abstract
Overactive bladder syndrome (OAB) negatively affects the quality of life of patients and their interactions with society. Treatment of OAB starts with behavioral modification and then pharmacotherapy using monotherapy with either antimuscarinics or β3 agonists. The third-line more invasive approaches are the next treatment option currently recommended. Both antimuscarinic agents and β3 agonists work through a different molecular pathway. This brings up the potential of having an additive effect when using a combination treatment for patients with OAB. Currently, the potential for using combination therapy to treat OAB in patients who had no improvement with a monotherapy approach before we attempt a more invasive approach is being explored. Several studies have shown the benefits of combination therapy which will be an additional option to the tools to treat OAB.
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40
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Vale L, Jesus F, Marcelissen T, Rieken M, Geavlete B, Rahnama'i MS, Martens F, Cruz F, Antunes‐Lopes T. Pathophysiological mechanisms in detrusor underactivity: Novel experimental findings. Low Urin Tract Symptoms 2019; 11:92-98. [DOI: 10.1111/luts.12257] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2018] [Revised: 11/29/2018] [Accepted: 01/07/2019] [Indexed: 01/20/2023]
Affiliation(s)
- Luís Vale
- Faculty of Medicine, University of PortoDepartment of Urology, Hospital São João Porto Portugal
| | - Filipa Jesus
- Faculty of Medicine, University of PortoDepartment of Urology, Hospital São João Porto Portugal
| | - Tom Marcelissen
- Department of UrologyMaastricht University Medical Centre Maastricht The Netherlands
| | - Malte Rieken
- Department of UrologyMedical University of Vienna Vienna Austria
| | - Bogdan Geavlete
- Department of UrologySaint John Emergency Clinical Hospital Bucharest Romania
| | - Mohammad Sajjad Rahnama'i
- Department of UrologyMaastricht University Maastricht The Netherlands
- Department of UrologyUniklinik Aachen RWTH Aachen Germany
| | - Frank Martens
- Department of Urology, Rabdoud University Medical Centre Nijmegen The Netherlands
| | - Francisco Cruz
- Faculty of Medicine, University of PortoDepartment of Urology, Hospital São João Porto Portugal
| | - Tiago Antunes‐Lopes
- Faculty of Medicine, University of PortoDepartment of Urology, Hospital São João Porto Portugal
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Dewulf K, Weyne E, Gevaert T, Deruyver Y, Voets T, Ridder DD, Everaerts W, Albersen M. Functional and molecular characterisation of the bilateral pelvic nerve crush injury rat model for neurogenic detrusor underactivity. BJU Int 2019; 123:E86-E96. [DOI: 10.1111/bju.14649] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Affiliation(s)
- Karel Dewulf
- Laboratory of Experimental Urology; Department of Development and Regeneration; KU Leuven; Leuven Belgium
| | - Emmanuel Weyne
- Laboratory of Experimental Urology; Department of Development and Regeneration; KU Leuven; Leuven Belgium
| | - Thomas Gevaert
- Laboratory of Experimental Urology; Department of Development and Regeneration; KU Leuven; Leuven Belgium
- Department of Imaging and Pathology; Translational Cell and Tissue Research; KU Leuven; Leuven Belgium
| | - Yves Deruyver
- Laboratory of Ion Channel Research; Department of Cellular and Molecular Medicine; KU Leuven; Leuven Belgium
- TRP Channel Research Platform Leuven (TRPLe); KU Leuven; Leuven Belgium
| | - Thomas Voets
- Laboratory of Ion Channel Research; Department of Cellular and Molecular Medicine; KU Leuven; Leuven Belgium
- TRP Channel Research Platform Leuven (TRPLe); KU Leuven; Leuven Belgium
- VIB Center for Brain& Disease Research; KU Leuven; Leuven Belgium
| | - Dirk De Ridder
- Laboratory of Experimental Urology; Department of Development and Regeneration; KU Leuven; Leuven Belgium
- TRP Channel Research Platform Leuven (TRPLe); KU Leuven; Leuven Belgium
| | - Wouter Everaerts
- Laboratory of Experimental Urology; Department of Development and Regeneration; KU Leuven; Leuven Belgium
- TRP Channel Research Platform Leuven (TRPLe); KU Leuven; Leuven Belgium
| | - Maarten Albersen
- Laboratory of Experimental Urology; Department of Development and Regeneration; KU Leuven; Leuven Belgium
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Chakrabarty B, Bijos DA, Vahabi B, Clavica F, Kanai AJ, Pickering AE, Fry CH, Drake MJ. Modulation of Bladder Wall Micromotions Alters Intravesical Pressure Activity in the Isolated Bladder. Front Physiol 2019; 9:1937. [PMID: 30687132 PMCID: PMC6335571 DOI: 10.3389/fphys.2018.01937] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2018] [Accepted: 12/21/2018] [Indexed: 12/20/2022] Open
Abstract
Micromotions are phasic contractions of the bladder wall. During urine storage, such phasic activity has little effect on intravesical pressure, however, changed motile activity may underlie urodynamic observations such as detrusor overactivity. The potential for bladder motility to affect pressure reflects a summation of the overall movements, comprising the initiation, propagation, and dissipation components of micromotions. In this study, the influence of initiation of micromotions was investigated using calcium activated chloride channel blocker niflumic acid, and the effect of propagation using blockers of gap junctions. The overall bladder tone was modulated using isoprenaline. Isolated tissue strips and whole bladder preparations from juvenile rats were used. 18β-glycyrrhetinic acid was used to block gap junctions, reducing the amplitude and frequency of micromotions in in vitro and ex vivo preparations. Niflumic acid reduced the frequency of micromotions but had no effect on the amplitude of pressure fluctuations. Isoprenaline resulted in a reduction in pressure fluctuations and a decrease in pressure baseline. Using visual video data analysis, bladder movement was visible, irrespective of lack of pressure changes, which persisted during bladder relaxation. However, micromotions propagated over shorter distances and the overall bladder tone was reduced. All these results suggest that phasic activity of the bladder can be characterised by a combination of initiation and propagation of movement, and overall bladder tone. At any given moment, intravesical pressure recordings are an integration of these parameters. This synthesis gives insight into the limitations of clinical urodynamics, where intravesical pressure is the key indicator of detrusor activity.
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Affiliation(s)
- Basu Chakrabarty
- School of Physiology, Pharmacology and Neuroscience, Faculty of Life Sciences, University of Bristol, Bristol, United Kingdom
| | - Dominika A Bijos
- Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom.,Southmead Hospital, Bristol Urological Institute, Bristol, United Kingdom
| | - Bahareh Vahabi
- Department of Applied Sciences, University of West England, Bristol, Bristol, United Kingdom
| | - Francesco Clavica
- ARTORG Center for Biomedical Engineering Research, University of Bern, Bern, Switzerland
| | - Anthony J Kanai
- Department of Medicine, University of Pittsburgh, Pittsburgh, PA, United States
| | - Anthony E Pickering
- School of Physiology, Pharmacology and Neuroscience, Faculty of Life Sciences, University of Bristol, Bristol, United Kingdom.,Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Christopher H Fry
- School of Physiology, Pharmacology and Neuroscience, Faculty of Life Sciences, University of Bristol, Bristol, United Kingdom
| | - Marcus J Drake
- Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom.,Southmead Hospital, Bristol Urological Institute, Bristol, United Kingdom
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Tykocki NR, Heppner TJ, Dalsgaard T, Bonev AD, Nelson MT. The K V 7 channel activator retigabine suppresses mouse urinary bladder afferent nerve activity without affecting detrusor smooth muscle K + channel currents. J Physiol 2018; 597:935-950. [PMID: 30536555 DOI: 10.1113/jp277021] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2018] [Accepted: 12/06/2018] [Indexed: 01/20/2023] Open
Abstract
KEY POINTS KV 7 channels are a family of voltage-dependent K+ channels expressed in many cell types, which open in response to membrane depolarization to regulate cell excitability. Drugs that target KV 7 channels are used clinically to treat epilepsy. Interestingly, these drugs also cause urinary retention, but it was unclear how. In this study, we focused on two possible mechanisms by which retigabine could cause urinary retention: by decreasing smooth muscle excitability, or by decreasing sensory nerve outflow. Urinary bladder smooth muscle had no measurable KV 7 channel currents. However, the KV 7 channel agonist retigabine nearly abolished sensory nerve outflow from the urinary bladder during bladder filling. We conclude that KV 7 channel activation likely affects urinary bladder function by blocking afferent nerve outflow to the brain, which is key to sensing bladder fullness. ABSTRACT KV 7 channels are voltage-dependent K+ channels that open in response to membrane depolarization to regulate cell excitability. KV 7 activators, such as retigabine, were used to treat epilepsy but caused urinary retention. Using electrophysiological recordings from freshly isolated mouse urinary bladder smooth muscle (UBSM) cells, isometric contractility of bladder strips, and ex vivo measurements of bladder afferent activity, we explored the role of KV 7 channels as regulators of murine urinary bladder function. The KV 7 activator retigabine (10 μM) had no effect on voltage-dependent K+ currents or resting membrane potential of UBSM cells, suggesting that these cells lacked retigabine-sensitive KV 7 channels. The KV 7 inhibitor XE-991 (10 μM) inhibited UBSM K+ currents; the properties of these currents, however, were typical of KV 2 channels and not KV 7 channels. Retigabine inhibited voltage-dependent Ca2+ channel (VDCC) currents and reduced steady-state contractions to 60 mM KCl in bladder strips, suggesting that reduction in VDCC current was sufficient to directly affect UBSM function. To determine if retigabine altered ex vivo bladder sensory outflow, we measured afferent activity during simulated transient contractions (TCs) of the bladder wall. Simulated TCs caused bursts of afferent activity that were nearly abolished by retigabine. The effects of retigabine were blocked by co-incubation with XE-991, suggesting specific activation of KV 7 channels on afferent nerves. These results indicate that retigabine primarily affects urinary bladder function by inhibiting TC generation and afferent nerve activity, which are key to sensing bladder fullness. Any direct inhibition of UBSM contractility is likely to be from non-specific effects on VDCCs and KV 2 channels.
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Affiliation(s)
- Nathan R Tykocki
- Department of Pharmacology, University of Vermont, Burlington, VT, 05405, USA
| | - Thomas J Heppner
- Department of Pharmacology, University of Vermont, Burlington, VT, 05405, USA
| | | | - Adrian D Bonev
- Department of Pharmacology, University of Vermont, Burlington, VT, 05405, USA
| | - Mark T Nelson
- Department of Pharmacology, University of Vermont, Burlington, VT, 05405, USA.,Institute of Cardiovascular Sciences, University of Manchester, Manchester, UK
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Abstract
PURPOSE OF REVIEW Post-prostatectomy overactive bladder (OAB) is a common and challenging condition to manage. The aim of the present report was to review the recent evidences regarding OAB symptoms that develop in men after prostatectomy and how to manage them. RECENT FINDINGS The prevalence of OAB after radical prostatectomy may range from 15.2 to 37.8%. Recent studies have highlighted the role of the urethrogenic mechanism (facilitation of the urethrovesical reflex due to stress urinary incontinence (SUI)) in the genesis of post-prostatectomy OAB in a significant proportion of patients. Several other pathophysiological factors such as iatrogenic decentralization of the bladder, defunctionalized bladder due to severe SUI, detrusor underactivity, or bladder outlet obstruction might be involved. The evaluation should aim to identify the underlying mechanism to tailor the treatment, which could range from SUI surgery, to fixing a urethral stricture, improving bladder emptying or using the conventional spectrum of OAB therapies. There is a paucity of data for OAB therapies specific to post-prostatectomy patients, with the exception of solifenacin, tolterodine, and botulinum toxin. There is currently no data on how preoperative management or surgical technique may prevent post-prostatectomy OAB.
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Shared Pathophysiology of Detrusor Overactivity and Detrusor Underactivity. CURRENT BLADDER DYSFUNCTION REPORTS 2018. [DOI: 10.1007/s11884-018-0490-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Andersson KE, Choudhury N, Cornu JN, Huang M, Korstanje C, Siddiqui E, Van Kerrebroeck P. The efficacy of mirabegron in the treatment of urgency and the potential utility of combination therapy. Ther Adv Urol 2018; 10:243-256. [PMID: 30034543 PMCID: PMC6048625 DOI: 10.1177/1756287218781255] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2017] [Accepted: 04/29/2018] [Indexed: 01/23/2023] Open
Abstract
Urgency is the prevalent and most bothersome symptom of overactive bladder (OAB) and the treatment of urgency is the primary objective in the management of OAB. Urgency has a major impact on other symptoms of OAB and culminates in an increased frequency of micturition and reduced volume voided, which may contribute to shorter intervals between the need to void. Antimuscarinic agents and mirabegron, a β3-adrenoceptor agonist, constitute the main oral pharmacotherapeutic options for the treatment of urgency and other OAB symptoms. The reduction of urgency and other OAB symptoms significantly improve health-related quality of life. This review will explore the distinct mechanisms of action and effects of antimuscarinic agents and mirabegron, in relation to their effect on the pathophysiology of urgency. The review will also provide an overview of the various validated measurements of urgency and the numerous clinical trials regarding antimuscarinic agent monotherapy, mirabegron monotherapy, or combination treatment with mirabegron added on to the antimuscarinic agent solifenacin. A narrative review of the literature relating to pathophysiology of urgency, the validated measurements of urgency, and clinical trials relating to the pharmacological treatment of urgency. Antimuscarinic agent monotherapy, mirabegron monotherapy, or combination treatment with mirabegron added on to the antimuscarinic agent solifenacin statistically significantly reduce the symptoms of urgency compared with placebo. Combination therapy with mirabegron added on to solifenacin also statistically significantly reduces the symptoms of severe urgency compared with antimuscarinic agent monotherapy. A critique of the clinical benefits of combination therapy is also provided. Combination therapy provides an alternative treatment in patients with OAB that includes urgency who respond poorly to first-line monotherapy and who may otherwise often move on to more invasive treatments.
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Affiliation(s)
- Karl-Erik Andersson
- Institute for Regenerative Medicine, Wake Forest University School of Medicine, Winston-Salem, NC, USA Aarhus Institute for Advanced Sciences (AIAS), Aarhus University, Aarhus, Denmark
| | - Nurul Choudhury
- Astellas Pharma Europe Ltd., 2000 Hillswood Drive, Chertsey, Surrey, KT16 0RS, UK
| | - Jean-Nicolas Cornu
- Department of Urology, Rouen University Hospital and University of Rouen, Rouen, France
| | - Moses Huang
- Astellas Pharma Europe Ltd., Chertsey, Surrey, UK
| | - Cees Korstanje
- Astellas Pharma Europe Research and Development, Leiden, The Netherlands
| | - Emad Siddiqui
- Astellas Pharma Medical and Development, Leiden, The Netherlands
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Colaco M, Osman NI, Karakeçi A, Artibani W, Andersson KE, Badlani GH. Current concepts of the acontractile bladder. BJU Int 2018; 122:195-202. [PMID: 29633516 DOI: 10.1111/bju.14236] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
The acontractile bladder (AcB) is a urodynamic-based diagnosis wherein the bladder is unable to demonstrate any contraction during a pressure flow study. Although it is often grouped with underactive bladder, it is a unique phenomenon and should be investigated independently. The purpose of the present review was to examine the current literature on AcB regarding its pathology, diagnosis, current management guidelines, and future developments. We performed a review of the PubMed database, classifying the evidence for AcB pathology, diagnosis, treatment, and potential future treatments. Over the 67 years covered in our review period, 42 studies were identified that met our criteria. Studies were largely poor quality and mainly consisted of retrospective review or animal models. The underlying pathology of AcB is variable with both neurological and myogenic aetiologies. Treatment is largely tailored for renal preservation and reduction of infection. Although future developments may allow more functional restorative treatments, current treatments mainly focus on bladder drainage. AcB is a unique and understudied bladder phenomenon. Treatment is largely based on symptoms and presentation. While cellular therapy and neuromodulation may hold promise, further research is needed into the underlying neuro-urological pathophysiology of this disease so that we may better develop future treatments.
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Affiliation(s)
- Marc Colaco
- Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Nadir I Osman
- Academic Urology Unit, Royal Hallamshire Hospital, Sheffield, UK
| | | | - Walter Artibani
- Urologic Clinic, University Hospital, Ospedale Policlinico, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
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Abstract
Underactive bladder (UAB) is an important and complex urological condition resulting from the urodynamic finding of detrusor underactivity. It can manifest in a wide range of lower urinary tract symptoms, from voiding to storage complaints, and can overlap with other conditions, including overactive bladder and bladder outlet obstruction. However, UAB continues to be poorly understood and inadequately researched. In this article, we review the contemporary literature pertaining to recent advances in defining, understanding, and managing UAB.
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Affiliation(s)
- Su-Min Lee
- Bristol Urological Institute, Southmead Hospital, Southmead Road, Bristol, BS10 5NB, UK
| | - Hashim Hashim
- Bristol Urological Institute, Southmead Hospital, Southmead Road, Bristol, BS10 5NB, UK
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49
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Guo M, Chang P, Hauke E, Girard BM, Tooke K, Ojala J, Malley SM, Hsiang H, Vizzard MA. Expression and Function of Chemokines CXCL9-11 in Micturition Pathways in Cyclophosphamide (CYP)-Induced Cystitis and Somatic Sensitivity in Mice. Front Syst Neurosci 2018; 12:9. [PMID: 29681802 PMCID: PMC5897511 DOI: 10.3389/fnsys.2018.00009] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2018] [Accepted: 03/20/2018] [Indexed: 12/13/2022] Open
Abstract
Changes in urinary bladder function and somatic sensation may be mediated, in part, by inflammatory changes in the urinary bladder including the expression of chemokines. Male and female C57BL/6 mice were treated with cyclophosphamide (CYP; 75 mg/kg, 200 mg/kg, i.p.) to induce bladder inflammation (4 h, 48 h, chronic). We characterized the expression of CXC chemokines (CXCL9, CXCL10 and CXCL11) in the urinary bladder and determined the effects of blockade of their common receptor, CXCR3, at the level urinary bladder on bladder function and somatic (hindpaw and pelvic) sensation. qRT-PCR and Enzyme-Linked Immunoassays (ELISAs) were used to determine mRNA and protein expression of CXCL9, CXCL10 and CXCL11 in urothelium and detrusor. In urothelium of female mice treated with CYP, CXCL9 and CXCL10 mRNA significantly (p ≤ 0.01) increased with CYP treatment whereas CXC mRNA expression in the detrusor exhibited both increases and decreases in expression with CYP treatment. CXC mRNA expression urothelium and detrusor of male mice was more variable with both significant (p ≤ 0.01) increases and decreases in expression depending on the specific CXC chemokine and CYP treatment. CXCL9 and CXCL10 protein expression was significantly (p ≤ 0.01) increased in the urinary bladder with 4 h CYP treatment in female mice whereas CXC protein expression in the urinary bladder of male mice did not exhibit an overall change in expression. CXCR3 blockade with intravesical instillation of AMG487 (5 mg/kg) significantly (p ≤ 0.01) increased bladder capacity, reduced voiding frequency and reduced non-voiding contractions in female mice treated with CYP (4 h, 48 h). CXCR3 blockade also reduced (p ≤ 0.01) hindpaw and pelvic sensitivity in female mice treated with CYP (4 h, 48 h). CXC chemokines may be novel targets for treating urinary bladder dysfunction and somatic sensitization resulting from urinary bladder inflammation.
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Affiliation(s)
- Michael Guo
- Department of Neurological Sciences, The Robert Larner, M.D. College of Medicine, The University of Vermont, Burlington, VT, United States
| | - Phat Chang
- Department of Neurological Sciences, The Robert Larner, M.D. College of Medicine, The University of Vermont, Burlington, VT, United States
| | - Eric Hauke
- Department of Neurological Sciences, The Robert Larner, M.D. College of Medicine, The University of Vermont, Burlington, VT, United States
| | - Beatrice M Girard
- Department of Neurological Sciences, The Robert Larner, M.D. College of Medicine, The University of Vermont, Burlington, VT, United States
| | - Katharine Tooke
- Department of Neurological Sciences, The Robert Larner, M.D. College of Medicine, The University of Vermont, Burlington, VT, United States
| | - Jacqueline Ojala
- Department of Neurological Sciences, The Robert Larner, M.D. College of Medicine, The University of Vermont, Burlington, VT, United States
| | - Susan M Malley
- Department of Neurological Sciences, The Robert Larner, M.D. College of Medicine, The University of Vermont, Burlington, VT, United States
| | - Harrison Hsiang
- Department of Neurological Sciences, The Robert Larner, M.D. College of Medicine, The University of Vermont, Burlington, VT, United States
| | - Margaret A Vizzard
- Department of Neurological Sciences, The Robert Larner, M.D. College of Medicine, The University of Vermont, Burlington, VT, United States
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Vaughan CP, Markland AD, Smith PP, Burgio KL, Kuchel GA. Report and Research Agenda of the American Geriatrics Society and National Institute on Aging Bedside-to-Bench Conference on Urinary Incontinence in Older Adults: A Translational Research Agenda for a Complex Geriatric Syndrome. J Am Geriatr Soc 2018; 66:773-782. [PMID: 29205261 PMCID: PMC5906179 DOI: 10.1111/jgs.15157] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
The American Geriatrics Society, with support from the National Institute on Aging and other funders, held its ninth Bedside-to-Bench research conference, entitled "Urinary Incontinence in the Older Adult: A Translational Research Agenda for a Complex Geriatric Syndrome," October 16 to 18, 2016, in Bethesda, Maryland. As part of a conference series addressing three common geriatric syndromes-delirium, sleep and circadian rhythm disturbance, and urinary incontinence-the series highlighted relationships and pertinent clinical and pathophysiological commonalities between these conditions. The conference provided a forum for discussing current epidemiology, basic science, and clinical and translational research on urinary incontinence in older adults; for identifying gaps in knowledge; and for developing a research agenda to inform future investigative efforts. The conference also promoted networking involving emerging researchers and thought leaders in the field of incontinence, aging, and other fields of research, as well as National Institutes of Health program personnel.
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Affiliation(s)
- Camille P Vaughan
- Geriatric Research, Education, and Clinical Center, Department of Veterans Affairs Birmingham/Atlanta, Atlanta, Georgia, Birmingham, Alabama
- Division of General Medicine and Geriatrics, Department of Medicine, Emory University, Atlanta, Georgia
| | - Alayne D Markland
- Geriatric Research, Education, and Clinical Center, Department of Veterans Affairs Birmingham/Atlanta, Atlanta, Georgia, Birmingham, Alabama
- Division of Gerontology, Geriatrics, and Palliative Care, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| | - Phillip P Smith
- Division of Urology, University of Connecticut Health Center, Farmington, Connecticut
- UConn Center on Aging, University of Connecticut Health Center, Farmington, Connecticut
| | - Kathryn L Burgio
- Geriatric Research, Education, and Clinical Center, Department of Veterans Affairs Birmingham/Atlanta, Atlanta, Georgia, Birmingham, Alabama
- Division of Gerontology, Geriatrics, and Palliative Care, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| | - George A Kuchel
- UConn Center on Aging, University of Connecticut Health Center, Farmington, Connecticut
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