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Relationship between Lower Urinary Tract Dysfunction and Clinical Features in Chinese Parkinson's Disease Patients. PARKINSONS DISEASE 2019; 2019:6820937. [PMID: 30949327 PMCID: PMC6425341 DOI: 10.1155/2019/6820937] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/09/2018] [Revised: 12/20/2018] [Accepted: 01/15/2019] [Indexed: 01/11/2023]
Abstract
Background Lower urinary tract (LUT) dysfunction is very common in Parkinson's disease (PD) patients. However, the number of studies conducted on LUT dysfunction and its related factors in Chinese PD patients is very limited, and there is no international consensus concerning the results. Methods This cross-sectional study enrolled 100 Chinese PD patients. The patients were classified based on their overactive bladder symptom score (OABSS) and then assigned to either a PD with overactive bladder (PD-OAB) group or a PD with no overactive bladder (PD-NOAB) group. A binary logistic regression analysis was performed to identify the accompanying factors for overactive bladder (OAB). Next, correlations between the OABSS and patient sex, age, age of onset, disease duration, MDS-UPDRS-III, H-Y stage, PD subtype, treatment, education, and nonmotor symptoms were analyzed to identify factors correlated with LUT dysfunction. Results Eighty nine (89%) of the PD patients suffered from LUT dysfunction, and OAB was diagnosed in 45 (45%) of those PD patients. The most common lower urinary tract (LUT) symptom in the PD patients was nighttime frequency (86%), followed by urgency (50%), urge incontinence (34%), and daytime frequency (17%). Patients in the PD-OAB group had an older age and age of onset, were at a more advanced Hoehn–Yahr stage, and had more severe motor symptoms and nonmotor symptoms, including worse cognition, and a greater incidence of REM sleep behavior disorder (RBD). A binary logistic regression analysis showed that a lower Frontal Assessment Battery (FAB) score, higher H-Y stage, and RBD accompanied with a higher prevalence of OAB in PD patients. A multiple linear regression analysis showed that the OABSS was significantly influenced by the FAB score, H-Y stage, RBD, and age. Conclusions The FAB score, H-Y stage, and RBD are accompanying factors for OAB. A higher OABSS in PD patients was related to a lower FAB score for frontal lobe executive dysfunction, a higher H-Y stage for severity of motor disorders, RBD, and an older age.
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Ahn J, Saltos TM, Tom VJ, Hou S. Transsynaptic tracing to dissect supraspinal serotonergic input regulating the bladder reflex in rats. Neurourol Urodyn 2018; 37:2487-2494. [PMID: 29999191 DOI: 10.1002/nau.23762] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2018] [Accepted: 06/15/2018] [Indexed: 12/12/2022]
Abstract
AIMS This study was designed to determine specific cell groups of the raphe nuclei (RN) that give rise to supraspinal serotonergic projections regulating the bladder reflex. METHODS Anesthetized rats underwent surgery to open the abdomen and expose the bladder. A total of 6 µL transsynaptic neuronal tracer pseudorabies virus (PRV-152), encoding for green fluorescent protein (GFP), was injected into the bladder detrusor. After 72 or 96 h, animals were perfused and the brain was dissected for processing transverse and sagittal sections. Subsequently, fluorescent immunohistochemistry for GFP and Serotonin (5-hydroxytryptamine [5-HT]) was performed in the brain sections. Under the microscope, each RN subset was characterized individually from caudal to rostral according to the atlas. GFP+ or GFP/5-HT double labeled neurons in each subset were quantified for statistical analysis. RESULTS At 72-h post-infection, very few GFP+ or GFP/5-HT double-labeled neurons appeared in the brainstem and beyond. In contrast, many labeled neurons were found at these levels after 96 h. Quantitative analysis showed that the majority of infected 5-HT+ neurons were located in the pallidus, obscurus, and magnus nuclei. Conversely, very few infected neurons were found in other raphe subsets, that is the pontis, median, dorsal, or linear nuclei. Overall, the raphe magnus had the highest number of GFP-labeled and GFP/5-HT double-labeled cells. CONCLUSIONS The caudal subsets of RN, especially the raphe magnus, are the main sources of serotonergic input to the lower spinal cord controlling bladder activity.
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Affiliation(s)
- Jemin Ahn
- Department of Neurobiology and Anatomy, Spinal Cord Research Center, Drexel University College of Medicine, Philadelphia, Pennsylvania
| | - Tatiana M Saltos
- Department of Neurobiology and Anatomy, Spinal Cord Research Center, Drexel University College of Medicine, Philadelphia, Pennsylvania
| | - Veronica J Tom
- Department of Neurobiology and Anatomy, Spinal Cord Research Center, Drexel University College of Medicine, Philadelphia, Pennsylvania
| | - Shaoping Hou
- Department of Neurobiology and Anatomy, Spinal Cord Research Center, Drexel University College of Medicine, Philadelphia, Pennsylvania
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Bi B, Shan L, Zhou D. Combined Use of Duloxetine and Olanzapine in the Treatment of Urologic Chronic Pelvic Pain Syndromes Refractory to Conventional Treatment: A Case Report. CLINICAL PSYCHOPHARMACOLOGY AND NEUROSCIENCE : THE OFFICIAL SCIENTIFIC JOURNAL OF THE KOREAN COLLEGE OF NEUROPSYCHOPHARMACOLOGY 2018; 16:122-125. [PMID: 29397676 PMCID: PMC5810449 DOI: 10.9758/cpn.2018.16.1.122] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/12/2016] [Revised: 01/21/2017] [Accepted: 01/23/2017] [Indexed: 12/16/2022]
Abstract
Patients with urologic chronic pelvic pain syndromes (UCPPS) report interstitial cystitis/bladder pain syndrome and/or chronic prostatitis/chronic pelvic pain syndrome. The pathogenesis of these syndromes remains unclear and there is currently no standard treatment. UCPPS is, therefore, often misdiagnosed and its management is complex. The present case report involves a 62-year-old male patient with UCPPS whose main presentation is painful bladder filling and painful urgency refractory to conventional treatment with medication, which was successfully treated with the combined use of duloxetine and olanzapine. The combined use of duloxetine and olanzapine may become a new therapeutic option in the management of UCPPS.
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Affiliation(s)
- Bo Bi
- Department of Psychiatry, First Affiliated Hospital, China Medical University, Shenyang, PR China
| | - Liping Shan
- Department of Urology, Shengjing Hospital of China Medical University, Shenyang, PR China
| | - Die Zhou
- Department of Psychiatry, First Affiliated Hospital, China Medical University, Shenyang, PR China
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Uy J, Yu M, Jiang X, Jones C, Shen B, Wang J, Roppolo JR, de Groat WC, Tai C. Glutamatergic Mechanisms Involved in Bladder Overactivity and Pudendal Neuromodulation in Cats. J Pharmacol Exp Ther 2017; 362:53-58. [PMID: 28428223 DOI: 10.1124/jpet.117.240895] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2016] [Accepted: 04/19/2017] [Indexed: 01/12/2023] Open
Abstract
The involvement of ionotropic glutamate receptors in bladder overactivity and pudendal neuromodulation was determined in α-chloralose anesthetized cats by intravenously administering MK801 (a NMDA receptor antagonist) or CP465022 (an AMPA receptor antagonist). Infusion of 0.5% acetic acid (AA) into the bladder produced bladder overactivity. In the first group of 5 cats, bladder capacity was significantly (P < 0.05) reduced to 55.3±10.0% of saline control by AA irritation. Pudendal nerve stimulation (PNS) significantly (P < 0.05) increased bladder capacity to 106.8 ± 15.0% and 106.7 ± 13.3% of saline control at 2T and 4T intensity, respectively. T is threshold intensity for inducing anal twitching. MK801 at 0.3 mg/kg prevented the increase in capacity by 2T or 4T PNS. In the second group of 5 cats, bladder capacity was significantly (P < 0.05) reduced to 49.0 ± 7.5% of saline control by AA irritation. It was then significantly (P < 0.05) increased to 80.8±13.5% and 79.0±14.0% of saline control by 2T and 4T PNS, respectively. CP465022 at 0.03-1 mg/kg prevented the increase in capacity by 2T PNS and at 0.3-1 mg/kg prevented the increase in capacity by 4T PNS. In both groups, MK801 at 0.3 mg/kg and CP465022 at 1 mg/kg significantly (P < 0.05) increased the prestimulation bladder capacity (about 80% and 20%, respectively) and reduced the amplitude of bladder contractions (about 30 and 20 cmH2O, respectively). These results indicate that NMDA and AMPA glutamate receptors are important for PNS to inhibit bladder overactivity and that tonic activation of these receptors also contributes to the bladder overactivity induced by AA irritation.
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Affiliation(s)
- Jamie Uy
- Department of Urology (J.U., M.Y., X.J., C.J., B.S., J.W., C.T.), Department of Pharmacology and Chemical Biology (J.R.R., W.C.D., C.T.), and Department of Bioengineering (C.T.),University of Pittsburgh, Pittsburgh, Pennsylvania; and Department of Urology, Qilu Hospital, Shandong University, Jinan, P.R. China (X.J.)
| | - Michelle Yu
- Department of Urology (J.U., M.Y., X.J., C.J., B.S., J.W., C.T.), Department of Pharmacology and Chemical Biology (J.R.R., W.C.D., C.T.), and Department of Bioengineering (C.T.),University of Pittsburgh, Pittsburgh, Pennsylvania; and Department of Urology, Qilu Hospital, Shandong University, Jinan, P.R. China (X.J.)
| | - Xuewen Jiang
- Department of Urology (J.U., M.Y., X.J., C.J., B.S., J.W., C.T.), Department of Pharmacology and Chemical Biology (J.R.R., W.C.D., C.T.), and Department of Bioengineering (C.T.),University of Pittsburgh, Pittsburgh, Pennsylvania; and Department of Urology, Qilu Hospital, Shandong University, Jinan, P.R. China (X.J.)
| | - Cameron Jones
- Department of Urology (J.U., M.Y., X.J., C.J., B.S., J.W., C.T.), Department of Pharmacology and Chemical Biology (J.R.R., W.C.D., C.T.), and Department of Bioengineering (C.T.),University of Pittsburgh, Pittsburgh, Pennsylvania; and Department of Urology, Qilu Hospital, Shandong University, Jinan, P.R. China (X.J.)
| | - Bing Shen
- Department of Urology (J.U., M.Y., X.J., C.J., B.S., J.W., C.T.), Department of Pharmacology and Chemical Biology (J.R.R., W.C.D., C.T.), and Department of Bioengineering (C.T.),University of Pittsburgh, Pittsburgh, Pennsylvania; and Department of Urology, Qilu Hospital, Shandong University, Jinan, P.R. China (X.J.)
| | - Jicheng Wang
- Department of Urology (J.U., M.Y., X.J., C.J., B.S., J.W., C.T.), Department of Pharmacology and Chemical Biology (J.R.R., W.C.D., C.T.), and Department of Bioengineering (C.T.),University of Pittsburgh, Pittsburgh, Pennsylvania; and Department of Urology, Qilu Hospital, Shandong University, Jinan, P.R. China (X.J.)
| | - James R Roppolo
- Department of Urology (J.U., M.Y., X.J., C.J., B.S., J.W., C.T.), Department of Pharmacology and Chemical Biology (J.R.R., W.C.D., C.T.), and Department of Bioengineering (C.T.),University of Pittsburgh, Pittsburgh, Pennsylvania; and Department of Urology, Qilu Hospital, Shandong University, Jinan, P.R. China (X.J.)
| | - William C de Groat
- Department of Urology (J.U., M.Y., X.J., C.J., B.S., J.W., C.T.), Department of Pharmacology and Chemical Biology (J.R.R., W.C.D., C.T.), and Department of Bioengineering (C.T.),University of Pittsburgh, Pittsburgh, Pennsylvania; and Department of Urology, Qilu Hospital, Shandong University, Jinan, P.R. China (X.J.)
| | - Changfeng Tai
- Department of Urology (J.U., M.Y., X.J., C.J., B.S., J.W., C.T.), Department of Pharmacology and Chemical Biology (J.R.R., W.C.D., C.T.), and Department of Bioengineering (C.T.),University of Pittsburgh, Pittsburgh, Pennsylvania; and Department of Urology, Qilu Hospital, Shandong University, Jinan, P.R. China (X.J.)
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de Groat WC, Tai C. Impact of Bioelectronic Medicine on the Neural Regulation of Pelvic Visceral Function. Bioelectron Med 2015; 2015:25-36. [PMID: 26491706 PMCID: PMC4610375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023] Open
Abstract
Neuromodulation elicited by electrical stimulation of peripheral or spinal nerves is a U.S. Food and Drug Administered (FDA)-approved therapy for treating disorders of the pelvic viscera, including urinary urgency, urgency-frequency, nonobstructive urinary retention and fecal incontinence. The technique is also being tested experimentally for its efficacy in treating interstitial cystitis, chronic constipation and pelvic pain. The goal of neuromodulation is to suppress abnormal visceral sensations and involuntary reflexes and restore voluntary control. Although detailed mechanisms underlying the effects of neuromodulation are still to be elucidated, it is generally believed that effects are due to stimulation of action potentials in somatic afferent nerves. Afferent nerves project to the lumbosacral spinal cord, where they release excitatory neurotransmitters that activate ascending pathways to the brain or spinal circuits that modulate visceral sensory and involuntary motor mechanisms. Studies in animals revealed that different types of neuromodulation (for example, stimulation of a sacral spinal root, pudendal nerve or posterior tibial nerve) act by releasing different inhibitory and excitatory neurotransmitters in the central nervous system. In addition, certain types of neuromodulation inhibit visceral smooth muscle by initiating reflex firing in peripheral autonomic nerves or excite striated sphincter muscles by initiating reflex firing in somatic efferent nerves. This report will provide a brief summary of (a) neural control of the lower urinary tract and distal bowel, (b) clinical use of neuromodulation in the treatment of bladder and bowel dysfunctions,
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Affiliation(s)
- William C de Groat
- Department of Pharmacology and Chemical Biology, University of Pittsburgh Medical School, Pittsburgh, Pennsylvania, United States of America
| | - Changfeng Tai
- Department of Pharmacology and Chemical Biology, University of Pittsburgh Medical School, Pittsburgh, Pennsylvania, United States of America
- Department of Urology, University of Pittsburgh Medical School, Pittsburgh, Pennsylvania, United States of America
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Sacco E, Bientinesi R. Innovative pharmacotherapies for women with overactive bladder: where are we now and what is in the pipeline? Int Urogynecol J 2014; 26:629-40. [PMID: 25377296 DOI: 10.1007/s00192-014-2557-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2014] [Accepted: 10/18/2014] [Indexed: 12/12/2022]
Abstract
INTRODUCTION AND HYPOTHESIS The impressive prevalence of overactive bladder (OAB) and the relevant limitations of current treatments urge the need for novel therapeutic approaches. METHODS A systematic literature and web search was performed to identify investigational drugs that entered the early and late phases of clinical development for women with OAB symptoms. RESULTS Approved pharmacological therapies for OAB (antimuscarinics, beta-3 agonists, and botulinum toxin) are evolving with the development of alternative administration methods, combination strategies, and novel compounds, expected to improve effectiveness, bladder selectivity, and dose flexibility. A wealth of investigational compounds, developed with both public and companies' indoor nonclinical disease-oriented studies, entered the early and late stages of clinical development in the last decade. Most non-anticholinergic compounds in ongoing clinical trials target central and peripheral neurotransmitter receptors involved in neurological modulation of micturition, nonadrenergic-noncholinergic mechanisms, cyclic nucleotide metabolism, different subtypes of ion channels or peripheral receptors of prostaglandins, vanilloids, vitamin D3, and opioids. Fascinating advances are ongoing also in the field of genetic therapy. CONCLUSIONS New pharmaceutical formulations and drug combinations are expected to be available in the next decade in order to overcome the limitations of current drugs for OAB. Although proof-of-concept, patient-oriented studies yielded disappointing results for several tentative drugs, a lot of clinical research is ongoing that is expected to provide clinicians with novel therapeutic agents in the near future.
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Affiliation(s)
- Emilio Sacco
- Department of Urology, "Agostino Gemelli" Hospital, Catholic University Medical School, Rome, Italy,
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