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Bosch R, Abrams P, Averbeck MA, Finazzi Agró E, Gammie A, Marcelissen T, Solomon E. Do functional changes occur in the bladder due to bladder outlet obstruction? - ICI-RS 2018. Neurourol Urodyn 2019; 38 Suppl 5:S56-S65. [PMID: 31278801 PMCID: PMC6915908 DOI: 10.1002/nau.24076] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Accepted: 05/27/2019] [Indexed: 01/24/2023]
Abstract
Studies on bladder dysfunction (BD), more specifically functional‐urodynamic changes in the bladder as a result of bladder outlet obstruction (BOO) have been summarized for this TT. Based on available, but limited evidence from human studies a three‐stage model can be hypothesized to characterize BOO‐induced bladder remodeling: hypertrophy, compensation (increased detrusor contractility during the voiding phase, often in combination with filling phase detrusor overactivity) followed by the phase of decompensation [detrusor underactivity]. The time between the start of compensation and eventual decompensation seems to be determined by age of onset, severity, and type of obstruction and clinical mitigating factors such as vascular and metabolic problems. Understanding the relative contributions of these factors may allow the development of personalized timelines and probabilities for these obstructed patients.
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Affiliation(s)
- Ruud Bosch
- Department of Urology, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Paul Abrams
- Department of Urology, Bristol Urological Institute, Bristol, United Kingdom
| | | | - Enrico Finazzi Agró
- Department of Experimental Medicine and Surgery, Department of Surgery, Policlinico Tor Vergata, University of Rome "Tor Vergata" and Urology Unit, Rome, Italy
| | - Andrew Gammie
- Bristol Urological Institute, Southmead Hospital, Bristol, United Kingdom
| | - Tom Marcelissen
- Department of Urology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Eskinder Solomon
- Department of Urology, Guy's and St Thomas' NHS Trust, London, United Kingdom
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Chen L, Yang Y, Yang J, He P, Amend B, Stenzl A, Hu J, Zhang Y, Wang Z. Suture causing urethral meatus stricture: A novel animal model of partial bladder outlet obstruction. Neurourol Urodyn 2018; 37:2088-2096. [PMID: 29953650 DOI: 10.1002/nau.23427] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2017] [Accepted: 09/15/2017] [Indexed: 11/08/2022]
Abstract
AIMS Open surgery is the most commonly used methodological approach for generating a partial bladder outlet obstruction (pBOO) animal model. Surgical suturing closing a part of the urethral meatus induces comparable pathophysiological changes in bladder and renal functions, but the optimum degree of obstruction that closely mimics the clinical pathology of pBOO has not been elucidated. We investigated the optimum obstruction level by performing a comprehensive time-dependent analysis of the stability and reliability of this novel animal model. METHODS Six- to eight-week-old female BALB/c mice were divided into three groups according to the degree of urethral meatus stricture (UMS). Non-operated mice served as controls, and a pBOO model generated using the traditional method served as a positive control. A cystometric evaluation and long-term studies were performed to evaluate the validity and reliability of this novel animal model. An additional 35 mice were used to investigate the protein expression levels and histopathological features 24 h and 14 days postoperatively, respectively. RESULTS The characteristic cystometry features in the UMS group revealed increased changes in pressure-related parameters compared with the control. The 1/3 UMS model is an optional pBOO animal model because the cystometric evaluation and histopathological studies revealed a striking resemblance between the 1/3 UMS model and the model generated using the traditional open-surgery method. CONCLUSIONS The minimally invasive UMS model required less time and produced minimal alterations in pathophysiologically relevant processes compared with the traditional surgery model. Suturing to cause UMS produced effective and repeatable patterns in bladder function investigations in mice.
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Affiliation(s)
- Lin Chen
- Department of Urology, Affiliated Hospital of Chengdu University, Chengdu, China
| | - Yafei Yang
- Department of Urology, Affiliated Hospital of Chengdu University, Chengdu, China.,Zunyi Medical University, Zunyi, China
| | - Jin Yang
- Department of Urology, Affiliated Hospital of Chengdu University, Chengdu, China.,Zunyi Medical University, Zunyi, China
| | - Pinglin He
- Department of Urology, Affiliated Hospital of Chengdu University, Chengdu, China
| | - Bastian Amend
- Department of Urology, University of Tübingen, Tübingen, Germany
| | - Arnulf Stenzl
- Department of Urology, University of Tübingen, Tübingen, Germany
| | - Jianyun Hu
- Department of Urology, Affiliated Hospital of Chengdu University, Chengdu, China
| | - Yamei Zhang
- Central Laboratory, Affiliated Hospital of Chengdu University, Chengdu, China
| | - Zili Wang
- Department of Urology, Affiliated Hospital of Chengdu University, Chengdu, China
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Lo TS, Chua S, Uy-Patrimonio MC, Kao CC, Lin CH. Clinical outcomes of detrusor underactivity in female with advanced pelvic organ prolapse following vaginal pelvic reconstructive surgery. Neurourol Urodyn 2018; 37:2242-2248. [PMID: 29664135 DOI: 10.1002/nau.23576] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2018] [Accepted: 03/07/2018] [Indexed: 12/20/2022]
Affiliation(s)
- Tsia-Shu Lo
- Department of Obstetrics and Gynecology; Chang Gung Memorial Hospital; Keelung Medical Center; Keelung Taiwan Republic of China
- Department of Obstetrics and Gynecology, Division of Urogynecology, Chang Gung Memorial Hospital; Linkou Medical Center; Taoyuan, Linkou Taiwan Republic of China
- Chang Gung University; School of Medicine; Taoyuan Taiwan Republic of China
| | - Sandy Chua
- Fellow, Department of Obstetrics and Gynecology; Division of Urogynecology; Chang Gung Memorial Hospital; Linkou Medical Center; Taoyuan Taiwan Republic of China
- Department of Obstetrics and Gynecology; Cebu Velez General Hospital; Cebu City Philippines
| | - Ma. Clarissa Uy-Patrimonio
- Fellow, Department of Obstetrics and Gynecology; Division of Urogynecology; Chang Gung Memorial Hospital; Linkou Medical Center; Taoyuan Taiwan Republic of China
- Department of Obstetrics and Gynecology; Dr. Pablo O. Torre Memorial Hospital; Bacolod City Philippines
| | - Chuan C. Kao
- Department of Obstetrics and Gynecology; Chang Gung Memorial Hospital; Keelung Medical Center; Keelung Taiwan Republic of China
| | - Chih H. Lin
- Department of Obstetrics and Gynecology; Chang Gung Memorial Hospital; Keelung Medical Center; Keelung Taiwan Republic of China
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Aizawa N, Igawa Y. Pathophysiology of the underactive bladder. Investig Clin Urol 2017; 58:S82-S89. [PMID: 29279880 PMCID: PMC5740034 DOI: 10.4111/icu.2017.58.s2.s82] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2017] [Accepted: 08/22/2017] [Indexed: 01/05/2023] Open
Abstract
Underactive bladder (UAB), which has been described as a symptom complex suggestive of detrusor underactivity, is usually characterized by prolonged urination time with or without a sensation of incomplete bladder emptying, usually with hesitancy, reduced sensation on filling, and slow stream often with storage symptoms. Several causes such as aging, bladder outlet obstruction, diabetes mellitus, neurologic disorders, and nervous injury to the spinal cord, cauda equine, and peripheral pelvic nerve have been assumed to be responsible for the development of UAB. Several contributing factors have been suggested in the pathophysiology of UAB, including myogenic failure, efferent and/or afferent dysfunctions, and central nervous system dysfunction. In this review article, we have described relationships between individual contributing factors and the pathophysiology of UAB based on previous reports. However, many pathophysiological uncertainties still remain, which require more investigations using appropriate animal models.
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Affiliation(s)
- Naoki Aizawa
- Department of Continence Medicine, The University of Tokyo Graduate School of Medicine, Tokyo, Japan
| | - Yasuhiko Igawa
- Department of Continence Medicine, The University of Tokyo Graduate School of Medicine, Tokyo, Japan
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Levin RM, Xia L, Wei W, Schuler C, Leggett RE, Lin ADY. Effects of Ganoderma Lucidum shell-broken spore on oxidative stress of the rabbit urinary bladder using an in vivo model of ischemia/reperfusion. Mol Cell Biochem 2017; 435:25-35. [PMID: 28484937 DOI: 10.1007/s11010-017-3053-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2017] [Accepted: 04/01/2017] [Indexed: 12/12/2022]
Abstract
Oxidative stress plays an important role in specific disease pathophysiology and the aging process. In the history of human kind, many herbs were utilized for disease prevention and anti-aging treatment. However, there are few direct evidences provided by modern laboratory technology. The current study was designed to evaluate Ganoderma Lucidum's (GL) ability to reduce the damage from in vivo ischemia/reperfusion (I/R) using a rabbit model of I/R that has been effectively utilized to prove the effects of drugs and supplements to reduce oxidative stress. Urinary bladder dysfunction secondary to benign prostatic hyperplasia (BPH) is a major affliction of aging men. One of the major etiologies of obstructive bladder dysfunction (OBD) is oxidative stress induced by I/R. Pharmaceutical studies and clinical research have proven that GL is useful in helping to prevent certain types of pathology and also helpful in prolonging human life in part by acting as an antioxidant. Using an in vivo model of I/R, we have investigated the ability of GL to protect bladder function from oxidative damage mediated by I/R. Our studies demonstrated that ischemia followed by reperfusion resulted in a significant decrease in bladder compliance and decreases in the contractile responses to a variety of forms of contractile stimulation. Pretreatment of rabbits with Ganoderma Lucidum prior to subjecting the rabbits to I/R completely inhibited the negative effects of I/R on both the compliance and contractile responses. These results demonstrate that Ganoderma provides excellent protection of bladder function following I/R (oxidative stress).
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Affiliation(s)
- Robert M Levin
- Stratton VA Medical Center, Albany, NY, 12208, USA.
- Albany College of Pharmacy and Health Science, Albany, NY, USA.
| | - Li Xia
- Beijing Tong Ren Tang Chinese Medicine Co., LTD., Beijing, China
| | - Wu Wei
- Beijing Tong Ren Tang Chinese Medicine Co., LTD., Beijing, China
| | | | | | - Alpha D-Y Lin
- Beijing Tong Ren Tang Chinese Medicine Co., LTD., Beijing, China
- The Central-Clinic Hospital, Taipei, Taiwan
- Urology Department, National Yang-Ming University, Taipei, Taiwan
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Abstract
In this review, we have looked at three important areas in understanding male lower urinary tract symptoms. These are improvement in terminology, detrusor underactivity, and nocturia. Benign prostatic hyperplasia leading to bladder outlet obstruction has been covered in a previous review.
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Affiliation(s)
- Arman A Kahokehr
- Department of Urology, Wellington Hospital, Wellington, New Zealand
| | - Peter J Gilling
- Head of School, Bay of Plenty Clinical School, Tauranga, New Zealand
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Development of supported liquid-phase microextraction probes for in vivo PK studies. Bioanalysis 2015; 7:661-70. [PMID: 25871585 DOI: 10.4155/bio.15.7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND A new sample preparation method termed supported liquid-phase microextraction is proposed. With this technique, the extraction phase is a liquid immobilized inside the pores of a membrane coated on a solid support. METHODOLOGY Supported liquid-phase microextraction probes were prepared by coating wires with porous polyacrylonitrile followed by saturation with 1-octanol. The probes were introduced inside hypodermic needles and used for in vivo extraction of oxybutynin from the blood and tissues of rabbits. The linear range of the method was from 0.5 to 500 ng/ml. CONCLUSION The proposed method was successfully applied to monitor the PK profile of oxybutynin. The drug followed a two-compartment model, with a volume of distribution of 14 l/kg and a half-life of 76 min.
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Jock M, Leggett RE, Schuler C, Callaghan C, Levin RM. Effect of partial bladder outlet obstruction and reversal on rabbit bladder physiology and biochemistry: duration of recovery period and severity of function. BJU Int 2014; 114:946-54. [DOI: 10.1111/bju.12687] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Affiliation(s)
- Marley Jock
- Albany College of Pharmacy and Health Sciences; Albany NY USA
| | | | | | | | - Robert M. Levin
- Albany College of Pharmacy and Health Sciences; Albany NY USA
- Stratton VA Medical Center; Albany NY USA
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Oelke M, Rademakers KLJ, van Koeveringe GA. Detrusor contraction power parameters (BCI and W max) rise with increasing bladder outlet obstruction grade in men with lower urinary tract symptoms: results from a urodynamic database analysis. World J Urol 2014; 32:1177-83. [PMID: 25007993 DOI: 10.1007/s00345-014-1358-6] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2013] [Accepted: 06/27/2014] [Indexed: 11/28/2022] Open
Abstract
PURPOSE To investigate to what extent detrusor work during voiding is influenced by bladder outlet obstruction (BOO) in adult men with lower urinary tract symptoms (LUTS). MATERIALS AND METHODS We reviewed data of patients with LUTS suggestive of benign prostatic hyperplasia who received computer-urodynamic investigations as part of their baseline clinical assessment. BOO was defined by the Schäfer classification and detrusor work during voiding was quantified by calculation of the bladder contractility index (BCI) and maximum Watt factor (W max) obtained by pressure-flow analysis. RESULTS A total of 786 men with medians of 64 years, IPSS 16 and prostate volume of 35 ml, were included in the study. A total of 462 patients (58.8 %) had BOO (Schäfer 2-6). Both detrusor contraction power parameters continuously increased with rising BOO grade. Median BCI increased from 73.3 in Schäfer 0 to 188.0 in Schäfer 6, whereas W max increased from 9.6 to 23.4 W/m(2) (p < 0.001). Results of BCI and W max correlated well (p < 0.001). With increasing BOO grade, there was a significant decrease of voiding efficiency (p < 0.001). CONCLUSIONS In adult male LUTS patients, detrusor contraction power parameters-BCI and W max-continuously increase with rising BOO grade. According to our results, it is impossible to determine a single threshold value for detrusor contraction power to diagnose detrusor underactivity in a group of LUTS patients with different BOO grades. The study is limited to men with non-neurogenic LUTS. Future studies should evaluate exact threshold values for BCI and W max in BOO subgroups to adequately define detrusor underactivity and investigate men with other bladder conditions.
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Affiliation(s)
- Matthias Oelke
- Department of Urology, OE 6240, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany,
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van Koeveringe GA, Rademakers KLJ, Birder LA, Korstanje C, Daneshgari F, Ruggieri MR, Igawa Y, Fry C, Wagg A. Detrusor underactivity: Pathophysiological considerations, models and proposals for future research. ICI-RS 2013. Neurourol Urodyn 2014; 33:591-6. [PMID: 24839258 DOI: 10.1002/nau.22590] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2013] [Accepted: 02/20/2014] [Indexed: 12/19/2022]
Abstract
AIMS Detrusor underactivity, resulting in either prolonged or inefficient voiding, is a common clinical problem for which treatment options are currently limited. The aim of this report is to summarize current understanding of the clinical observation and its underlying pathophysiological entities. METHODS This report results from presentations and subsequent discussion at the International Consultation on Incontinence Research Society (ICI-RS) in Bristol, 2013. RESULTS AND CONCLUSIONS The recommendations made by the ICI-RS panel include: Development of study tools based on a system's pathophysiological approach, correlation of in vitro and in vivo data in experimental animals and humans, and development of more comprehensive translational animal models. In addition, there is a need for longitudinal patient data to define risk groups and for the development of screening tools. In the near-future these recommendations should lead to a better understanding of detrusor underactivity and its pathophysiological background. Neurourol. Urodynam. 33:591-596, 2014. © 2014 Wiley Periodicals, Inc.
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Callaghan CM, Johnson A, Neumann P, Leggett RE, Schuler C, Levin RM. The effect of partial outlet obstruction on calpain and phospholipase-2 activities: analyzed by severity and duration. Mol Cell Biochem 2013; 381:217-20. [PMID: 23737136 DOI: 10.1007/s11010-013-1705-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2013] [Accepted: 05/24/2013] [Indexed: 12/23/2022]
Abstract
In an attempt to better understand the two pathways that lead to bladder decompensation following partial obstruction in rabbits one of which is caused by calcium-activated enzymes and the other by oxidative stress, calpain and phospholipase A2 (PLA2) biochemical assays were conducted to see how bladder decompensation is mediated by these two calcium-activated enzymes. Partial outlet obstructions of varying durations (4, 8, and 12 weeks plus controls) were performed on 32 New Zealand white rabbits. The rabbits were also grouped by severity: control, mild, intermediate, and severe. The activities of Calpain and PLA2 on the muscle tissue of the bladders were analyzed. A stronger correlation was seen between activities and severities as opposed to between activities and durations for both PLA2 and calpain. The activity for PLA2 increased dramatically from control to mild and then stayed constant for both intermediate and severe obstructions. Calpain activity increased steadily from control to mild to intermediate to severe. Based on the increase in levels of the calcium-dependent enzymes, it was clearly shown that calcium levels increased in all stages of bladder decompensation most notably with the mild obstructions. Based on previous studies in which nitrotyrosine and dinitrophenol levels did not increase in mildly obstructed rabbits, the calcium overload pathway may predominate in mild decompensation because cells in mildly obstructed bladders are better able to cope with oxidative stress than increased calcium levels.
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Affiliation(s)
- Connor M Callaghan
- Pharmacy Practice, Albany College of Pharmacy and Health Sciences, Albany, NY 12208, USA
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Callaghan CM, Schuler C, Leggett RE, Levin RM. Effect of severity and duration of bladder outlet obstruction on catalase and superoxide dismutase activity. Int J Urol 2013; 20:1130-5. [PMID: 23418991 DOI: 10.1111/iju.12115] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2012] [Accepted: 01/16/2013] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To study the effects of partial bladder outlet obstruction on the cell's anti-oxidant defense mechanisms, superoxide dismutase and catalase, in order to elucidate how the bladder responds to oxidative stress. METHODS Four groups of eight rabbits were subjected to partial bladder outlet obstruction for 4, 8 and 12 weeks. Eight sham rabbits were used as the control group. The bladders were removed under anesthesia, and the muscle and mucosa were separated, frozen and stored at -80°C for analysis. Superoxide dismutase and catalase assays were carried out on these tissues. The groups were also categorized by severity (mild, intermediate and severe) of decompensation, as well as duration. RESULTS When separated by duration, catalase activity of the mucosa was significantly higher in the control and the 12-weeks obstructed rabbits. This activity was lower than the control in the 4- and 8-weeks obstructed rabbits. When separated by severity, catalase activity of the mucosa was significantly higher and severely decompensated than the muscle in the controls. When separated by duration or severity, superoxide dismutase activity of the muscle was significantly lower than controls for all obstructed rabbits. The activities of both superoxide dismutase and catalase were significantly reduced in the severely decompensated bladder smooth muscle, but not in the 12-weeks obstructed bladder smooth muscle. CONCLUSIONS Partial bladder outlet obstruction has significant effects on the activity of both superoxide dismutase and catalase in the bladder, with variations that are dependent on the severity and duration of the obstruction.
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Affiliation(s)
- Connor M Callaghan
- Department of Pharmacy Practice, Albany College of Pharmacy and Health Sciences, Albany, New York, USA; Department of Research, Stratton VA Medical Center, Albany, New York, USA
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Matsumoto S. Editorial Comment to Partial outlet obstruction in rabbits: Duration versus severity. Int J Urol 2012; 20:114-5. [DOI: 10.1111/j.1442-2042.2012.03199.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Seiji Matsumoto
- Department of Renal and Urologic Surgery; Asahikawa Medical University; Asahikawa; Hokkaido; Japan
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