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Kamo I, Nagata H, O'Connell G, Kato T, Imanishi A, Kuno M, Okanishi S, Yoshikawa K, Nishiyama Y. Increasing Effects of Selective 5-Hydroxytryptamine Type 2C Receptor Stimulation on Evoked Momentary Urethral Closure in Female Rats and Humans. J Pharmacol Exp Ther 2021; 378:60-68. [PMID: 33837045 DOI: 10.1124/jpet.121.000573] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Accepted: 04/05/2021] [Indexed: 11/22/2022] Open
Abstract
Under healthy conditions, more than one urethra-closing reflex, including both bladder afferent-independent and -dependent actions, function during momentary elevation of intravesical (bladder) pressure to prevent urinary incontinence. In the current study, the effects of a novel selective 5-hydroxytryptamine type 2C (5-HT2C) receptor agonist, TAK-233, on evoked momentary urethra-closing functions were investigated in female rats and humans to elucidate 5-HT2C receptor functions. In anesthetized female rats, TAK-233 dose-dependently and significantly increased urethral resistance during sneezing in rats with distended vaginas and bilaterally transected pelvic nerves. The drug also dose-dependently and significantly increased urethral resistance during momentary intravesical pressure elevation by electrical stimulation of abdominal muscles in rats with a transected spinal cord at the T8-T9 level and intact pelvic nerves. The increased effects observed during electrical stimulation were abolished by either an intravenously administered selective 5-HT2C receptor antagonist, SB 242084, or bilateral transection of the pelvic nerves or somatic nerves innervating the external urethral sphincter and pelvic floor muscles. In the spinal cord-transected and pelvic nerve-intact rats, TAK-233 enlarged the urethra-closing responses induced by both passive and abrupt intravesical pressure elevation, measured by a microtip transducer located in the middle urethra. Additionally, the effects of TAK-233 on the stimulus threshold of urethral contractile responses induced by transcranial magnetic stimulation were investigated in healthy female volunteers. The drug dose-dependently and significantly lowered this stimulus threshold, indicating an increased sensitivity of the response. These results demonstrate that 5-HT2C receptor stimulation enhances the evoked momentary urethra-closing functions in both female rats and humans. SIGNIFICANCE STATEMENT: 5-hydroxytryptamine (serotonin) type 2C (5-HT2C) receptor stimulation by TAK-233 enhanced urethral resistance in rats during an evoked momentary event in which the bladder afferent-independent or -dependent reflex functions via striated muscle-mediated mechanisms. The increases in sensitivity of transcranial magnetic stimulation-evoked urethral contractile responses in healthy female subjects indicates that this mechanism also functions in humans. The evoked momentary conditions activating these reflexes provide a suitable model to demonstrate the effects of 5-HT2C receptor stimulation.
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Affiliation(s)
- Izumi Kamo
- Research (I.K., A.I., M.K., K.Y.), Formerly, Japan Development Center (H.N., T.K.), Formerly, Pharmaceutical Research Division (S.O.), and Takeda Development Center Japan (Y.N.), Takeda Pharmaceutical Company Ltd., Fujisawa and Osaka, Japan; and Formerly, Takeda Development Center Europe Ltd., London, United Kingdom (G.O.)
| | - Hiroshi Nagata
- Research (I.K., A.I., M.K., K.Y.), Formerly, Japan Development Center (H.N., T.K.), Formerly, Pharmaceutical Research Division (S.O.), and Takeda Development Center Japan (Y.N.), Takeda Pharmaceutical Company Ltd., Fujisawa and Osaka, Japan; and Formerly, Takeda Development Center Europe Ltd., London, United Kingdom (G.O.)
| | - Gale O'Connell
- Research (I.K., A.I., M.K., K.Y.), Formerly, Japan Development Center (H.N., T.K.), Formerly, Pharmaceutical Research Division (S.O.), and Takeda Development Center Japan (Y.N.), Takeda Pharmaceutical Company Ltd., Fujisawa and Osaka, Japan; and Formerly, Takeda Development Center Europe Ltd., London, United Kingdom (G.O.)
| | - Takuya Kato
- Research (I.K., A.I., M.K., K.Y.), Formerly, Japan Development Center (H.N., T.K.), Formerly, Pharmaceutical Research Division (S.O.), and Takeda Development Center Japan (Y.N.), Takeda Pharmaceutical Company Ltd., Fujisawa and Osaka, Japan; and Formerly, Takeda Development Center Europe Ltd., London, United Kingdom (G.O.)
| | - Akio Imanishi
- Research (I.K., A.I., M.K., K.Y.), Formerly, Japan Development Center (H.N., T.K.), Formerly, Pharmaceutical Research Division (S.O.), and Takeda Development Center Japan (Y.N.), Takeda Pharmaceutical Company Ltd., Fujisawa and Osaka, Japan; and Formerly, Takeda Development Center Europe Ltd., London, United Kingdom (G.O.)
| | - Masako Kuno
- Research (I.K., A.I., M.K., K.Y.), Formerly, Japan Development Center (H.N., T.K.), Formerly, Pharmaceutical Research Division (S.O.), and Takeda Development Center Japan (Y.N.), Takeda Pharmaceutical Company Ltd., Fujisawa and Osaka, Japan; and Formerly, Takeda Development Center Europe Ltd., London, United Kingdom (G.O.)
| | - Satoshi Okanishi
- Research (I.K., A.I., M.K., K.Y.), Formerly, Japan Development Center (H.N., T.K.), Formerly, Pharmaceutical Research Division (S.O.), and Takeda Development Center Japan (Y.N.), Takeda Pharmaceutical Company Ltd., Fujisawa and Osaka, Japan; and Formerly, Takeda Development Center Europe Ltd., London, United Kingdom (G.O.)
| | - Kyoko Yoshikawa
- Research (I.K., A.I., M.K., K.Y.), Formerly, Japan Development Center (H.N., T.K.), Formerly, Pharmaceutical Research Division (S.O.), and Takeda Development Center Japan (Y.N.), Takeda Pharmaceutical Company Ltd., Fujisawa and Osaka, Japan; and Formerly, Takeda Development Center Europe Ltd., London, United Kingdom (G.O.)
| | - Yuya Nishiyama
- Research (I.K., A.I., M.K., K.Y.), Formerly, Japan Development Center (H.N., T.K.), Formerly, Pharmaceutical Research Division (S.O.), and Takeda Development Center Japan (Y.N.), Takeda Pharmaceutical Company Ltd., Fujisawa and Osaka, Japan; and Formerly, Takeda Development Center Europe Ltd., London, United Kingdom (G.O.)
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2
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Transecting the hypogastric nerve to uncover the bladder-inhibitory pathways involved with saphenous nerve stimulation in anesthetized rats. Auton Neurosci 2020; 226:102672. [DOI: 10.1016/j.autneu.2020.102672] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Revised: 02/07/2020] [Accepted: 04/02/2020] [Indexed: 01/03/2023]
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3
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Verification and Defined Dosage of Sodium Pentobarbital for a Urodynamic Study in the Possibility of Survival Experiments in Female Rat. BIOMED RESEARCH INTERNATIONAL 2020; 2020:6109497. [PMID: 32626750 PMCID: PMC7306087 DOI: 10.1155/2020/6109497] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/29/2020] [Revised: 05/24/2020] [Accepted: 05/30/2020] [Indexed: 11/18/2022]
Abstract
Objectives To evaluate the effects of pentobarbital dosages on lower urinary tract function and to define an appropriate dosage of sodium pentobarbital that would be suitable for urodynamic studies in which recovery from anesthesia and long term survive were needed for subsequent experiment. Methods Twenty-four 8-week-old, female, virgin, Sprague-Dawley rats (200-250 g) were used in this study. Rats in study groups received gradient doses of pentobarbital intraperitoneally, and those in the control group received urethane intraperitoneally. External urethral sphincter electromyography (EUS-EMG) was recorded simultaneously during cystometry and leak point pressure tests. The toe-pinch reflex was used to determine the level of anesthesia. Results Micturition was normally induced in both the urethane group and 32 mg/kg pentobarbital group. However, in groups of 40 mg/kg or 36 mg/kg pentobarbital, micturition failed to be induced; instead, nonvoiding contractions accompanied by EUS-EMG tonic activity were observed. There were no significant differences in leak point pressure or EUS-EMG amplitude or frequency between the urethane and 32 mg/kg pentobarbital groups. Conclusions This study confirmed significant dose-dependent effects of pentobarbital on lower urinary tract function and 32 mg/kg pentobarbital as an appropriate dosage for recovery urodynamic testing, which enable the achievement of expected essential micturition under satisfactory anesthesia in female rats.
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4
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Kwon J, Suzuki T, Takaoka EI, Shimizu N, Shimizu T, Takai S, Yoshikawa S, de Groat WC, Yoshimura N. Analysis of continence reflexes by dynamic urethral pressure recordings in a rat stress urinary incontinence model induced by multiple simulated birth traumas. Am J Physiol Renal Physiol 2019; 317:F781-F788. [PMID: 31313954 DOI: 10.1152/ajprenal.00197.2019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
The present study evaluated real-time changes in urethral pressure during the storage phase using a rat model with stress urinary incontinence (SUI) induced by simulated multiple birth traumas and investigated the relationship between urethral continence function and dynamic parameters associated with the changes in urethral pressure. Sprague-Dawley rats were divided into the following two groups: the sham group, which underwent three catheterizations of the vagina without distension at 2-wk intervals, and the vaginal distension (VD) group, which underwent three VDs at 2-wk intervals. After transection of the T8-T9 spinal cord, simultaneous bladder and urethral pressure recordings were performed during intravesical pressure elevation. Urodynamic parameters such as leak point pressure (LPP), urethral baseline pressure (UBP), maximum urethral pressure (MUP), the MUP-UBP differential (dUP) during intravesical pressure elevation, the bladder pressure when urethral contraction begins (Puc), and the bladder pressure at bladder neck opening (Pno) were then measured and compared. Compared with the sham group, LPP, UBP, dUP, MUP, Puc, and Pno were significantly decreased in the VD group. Pressure differences between LPP and Pno and between LPP and UBP (LPP-UBP) were also significantly different in the two groups. However, difference values of LPP and MUP or Pno and UBP were not altered after VD. Our new methods of simultaneous recordings of dynamic changes in bladder and urethral pressures are useful to fully evaluate the functional alterations in urethral continence function in the SUI model induced by multiple VDs. Moreover, LPP-UBP values, which correspond to the difference between Valsalva LPP and maximum urethral closure pressure in clinical urodynamics, would be useful to evaluate the impaired urethral continence function after simulated birth traumas in animal models.
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Affiliation(s)
- Joonbeom Kwon
- Department of Urology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania.,Department of Urology, Daegu Fatima Hospital, Daegu, Republic of Korea
| | - Takahisa Suzuki
- Department of Urology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Ei-Ichiro Takaoka
- Department of Urology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Nobutaka Shimizu
- Department of Urology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Takahiro Shimizu
- Department of Urology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Shun Takai
- Department of Urology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Satoru Yoshikawa
- Department of Urology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - William C de Groat
- Department of Pharmacology and Chemical Biology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Naoki Yoshimura
- Department of Urology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania.,Department of Pharmacology and Chemical Biology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
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Ishigami T, Ueshima K, Ukai M, Asai N, Takamatsu H, Yokono M, Takeda M, Masuda N. Effect of ASP2205 fumarate, a novel 5-HT 2C receptor agonist, on urethral closure function in rats. J Pharmacol Sci 2019; 139:333-339. [PMID: 30871873 DOI: 10.1016/j.jphs.2019.02.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Revised: 02/07/2019] [Accepted: 02/20/2019] [Indexed: 01/10/2023] Open
Abstract
The pharmacological profile of ASP2205 fumarate (ASP2205), a novel 5-HT2C receptor agonist, was evaluated in vitro and in vivo. ASP2205 showed potent and selective agonistic activity for the human 5-HT2C receptor, with an EC50 of 0.85 nM in the intracellular Ca2+ mobilization assay. Rat 5-HT2C receptor was also activated by ASP2205 with an EC50 of 2.5 nM. Intraduodenal administration (i.d.) of ASP2205 (0.1-1 mg/kg) significantly elevated the leak point pressure (LPP) in anesthetized rats in a dose-dependent manner. This ASP2205 (0.3 mg/kg i.d.)-induced LPP elevation was inhibited by SB242084 (0.3 mg/kg i.v.), a selective 5-HT2C receptor antagonist. Urethral closure responses induced by intravesical pressure loading in rats were enhanced by ASP2205 (0.3 mg/kg i.v.), which was abolished by pretreatment with SB242084 (0.3 mg/kg i.v.) and bilateral transection of the pudendal nerve. In contrast, ASP2205 (0.3 mg/kg i.v.) did not change the resting urethral pressure in rats. These results indicate that ASP2205 can enhance the pudendal nerve-mediated urethral closure reflex via the 5-HT2C receptor, resulting in the prevention of involuntary urine loss.
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Affiliation(s)
- Takao Ishigami
- Institute for Drug Discovery Research, Astellas Pharma Inc, 21, Miyukigaoka, Tsukuba-shi, Ibaraki, 305-8585, Japan.
| | - Koji Ueshima
- Institute for Drug Discovery Research, Astellas Pharma Inc, 21, Miyukigaoka, Tsukuba-shi, Ibaraki, 305-8585, Japan
| | - Masashi Ukai
- Institute for Drug Discovery Research, Astellas Pharma Inc, 21, Miyukigaoka, Tsukuba-shi, Ibaraki, 305-8585, Japan
| | - Norio Asai
- Institute for Drug Discovery Research, Astellas Pharma Inc, 21, Miyukigaoka, Tsukuba-shi, Ibaraki, 305-8585, Japan
| | - Hajime Takamatsu
- Institute for Drug Discovery Research, Astellas Pharma Inc, 21, Miyukigaoka, Tsukuba-shi, Ibaraki, 305-8585, Japan
| | - Masanori Yokono
- Institute for Drug Discovery Research, Astellas Pharma Inc, 21, Miyukigaoka, Tsukuba-shi, Ibaraki, 305-8585, Japan
| | - Masahiro Takeda
- Institute for Drug Discovery Research, Astellas Pharma Inc, 21, Miyukigaoka, Tsukuba-shi, Ibaraki, 305-8585, Japan
| | - Noriyuki Masuda
- Institute for Drug Discovery Research, Astellas Pharma Inc, 21, Miyukigaoka, Tsukuba-shi, Ibaraki, 305-8585, Japan
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de Vries AM, Venema PL, Heesakkers JPFA. Midurethral support is also necessary for reflex closure of the urethra. Neurourol Urodyn 2018; 37:2965-2972. [DOI: 10.1002/nau.23807] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2018] [Accepted: 06/09/2018] [Indexed: 11/08/2022]
Affiliation(s)
- Allert M. de Vries
- Department of Urology; Radboud University Medical Centre; Nijmegen The Netherlands
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7
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Kullmann FA, McDonnell BM, Wolf-Johnston AS, Lynn AM, Giglio D, Getchell SE, Ruiz WG, Zabbarova IV, Ikeda Y, Kanai AJ, Roppolo JR, Bastacky SI, Apodaca G, Buffington CAT, Birder LA. Inflammation and Tissue Remodeling in the Bladder and Urethra in Feline Interstitial Cystitis. Front Syst Neurosci 2018; 12:13. [PMID: 29706873 PMCID: PMC5908978 DOI: 10.3389/fnsys.2018.00013] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2018] [Accepted: 03/28/2018] [Indexed: 01/21/2023] Open
Abstract
Interstitial cystitis/bladder pain syndrome (IC/BPS) is a debilitating chronic disease of unknown etiology. A naturally occurring disease termed feline interstitial cystitis (FIC) reproduces many features of IC/BPS patients. To gain insights into mechanisms underlying IC/BPS, we investigated pathological changes in the lamina propria (LP) of the bladder and proximal urethra in cats with FIC, using histological and molecular methods. Compared to control cat tissue, we found an increased number of de-granulated mast cells, accumulation of leukocytes, increased cyclooxygenase (COX)-1 expression in the bladder LP, and increased COX-2 expression in the urethra LP from cats with FIC. We also found increased suburothelial proliferation, evidenced by mucosal von Brunn’s nests, neovascularization and alterations in elastin content. Scanning electron microscopy revealed normal appearance of the superficial urethral epithelium, including the neuroendocrine cells (termed paraneurons), in FIC urethrae. Together, these histological findings suggest the presence of chronic inflammation of unknown origin leading to tissue remodeling. Since the mucosa functions as part of a “sensory network” and urothelial cells, nerves and other cells in the LP are influenced by the composition of the underlying tissues including the vasculature, the changes observed in the present study may alter the communication of sensory information between different cellular components. This type of mucosal signaling can also extend to the urethra, where recent evidence has revealed that the urethral epithelium is likely to be part of a signaling system involving paraneurons and sensory nerves. Taken together, our data suggest a more prominent role for chronic inflammation and tissue remodeling than previously thought, which may result in alterations in mucosal signaling within the urinary bladder and proximal urethra that may contribute to altered sensations and pain in cats and humans with this syndrome.
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Affiliation(s)
- F Aura Kullmann
- Department of Medicine, School of Medicine, University of Pittsburgh, Pittsburgh, PA, United States
| | - Bronagh M McDonnell
- Department of Medicine, School of Medicine, University of Pittsburgh, Pittsburgh, PA, United States
| | - Amanda S Wolf-Johnston
- Department of Medicine, School of Medicine, University of Pittsburgh, Pittsburgh, PA, United States
| | - Andrew M Lynn
- Department of Medicine, School of Medicine, University of Pittsburgh, Pittsburgh, PA, United States
| | - Daniel Giglio
- Department of Pharmacology and Chemical Biology, School of Medicine, University of Pittsburgh, Pittsburgh, PA, United States
| | - Samuel E Getchell
- Department of Medicine, School of Medicine, University of Pittsburgh, Pittsburgh, PA, United States
| | - Wily G Ruiz
- Department of Medicine, School of Medicine, University of Pittsburgh, Pittsburgh, PA, United States
| | - Irina V Zabbarova
- Department of Medicine, School of Medicine, University of Pittsburgh, Pittsburgh, PA, United States
| | - Youko Ikeda
- Department of Medicine, School of Medicine, University of Pittsburgh, Pittsburgh, PA, United States
| | - Anthony J Kanai
- Department of Medicine, School of Medicine, University of Pittsburgh, Pittsburgh, PA, United States.,Department of Pharmacology and Chemical Biology, School of Medicine, University of Pittsburgh, Pittsburgh, PA, United States
| | - James R Roppolo
- Department of Pharmacology and Chemical Biology, School of Medicine, University of Pittsburgh, Pittsburgh, PA, United States
| | - Sheldon I Bastacky
- Department of Pathology, School of Medicine, University of Pittsburgh, Pittsburgh, PA, United States
| | - Gerard Apodaca
- Department of Medicine, School of Medicine, University of Pittsburgh, Pittsburgh, PA, United States
| | - C A Tony Buffington
- Department of Medicine and Epidemiology, University of California, Davis, Davis, CA, United States.,Department of Veterinary Clinical Sciences, The Ohio State University, Columbus, OH, United States
| | - Lori A Birder
- Department of Medicine, School of Medicine, University of Pittsburgh, Pittsburgh, PA, United States.,Department of Pharmacology and Chemical Biology, School of Medicine, University of Pittsburgh, Pittsburgh, PA, United States
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8
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Ouchi M, Kitta T, Kanno Y, Higuchi M, Togo M, Moriya K, Shinohara N. Effect of a 5-HT2c receptor agonist on urethral closure mechanisms in female rats. Neurourol Urodyn 2018; 37:2382-2388. [DOI: 10.1002/nau.23586] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2018] [Accepted: 03/20/2018] [Indexed: 01/08/2023]
Affiliation(s)
- Mifuka Ouchi
- Department of Renal and Genitourinary Surgery; Graduate School of Medicine; Hokkaido University; Sapporo Japan
- School of Rehabilitation Sciences; Health Sciences University of Hokkaido; Tobetsu Japan
| | - Takeya Kitta
- Department of Renal and Genitourinary Surgery; Graduate School of Medicine; Hokkaido University; Sapporo Japan
| | - Yukiko Kanno
- Department of Renal and Genitourinary Surgery; Graduate School of Medicine; Hokkaido University; Sapporo Japan
| | - Madoka Higuchi
- Department of Renal and Genitourinary Surgery; Graduate School of Medicine; Hokkaido University; Sapporo Japan
| | - Mio Togo
- Department of Renal and Genitourinary Surgery; Graduate School of Medicine; Hokkaido University; Sapporo Japan
| | - Kimihiko Moriya
- Department of Renal and Genitourinary Surgery; Graduate School of Medicine; Hokkaido University; Sapporo Japan
| | - Nobuo Shinohara
- Department of Renal and Genitourinary Surgery; Graduate School of Medicine; Hokkaido University; Sapporo Japan
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9
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Kullmann FA, Chang HH, Gauthier C, McDonnell BM, Yeh JC, Clayton DR, Kanai AJ, de Groat WC, Apodaca GL, Birder LA. Serotonergic paraneurones in the female mouse urethral epithelium and their potential role in peripheral sensory information processing. Acta Physiol (Oxf) 2018; 222:10.1111/apha.12919. [PMID: 28719042 PMCID: PMC5963688 DOI: 10.1111/apha.12919] [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] [Received: 05/08/2017] [Revised: 06/19/2017] [Accepted: 07/13/2017] [Indexed: 01/01/2023]
Abstract
AIM The mechanisms underlying detection and transmission of sensory signals arising from visceral organs, such as the urethra, are poorly understood. Recently, specialized ACh-expressing cells embedded in the urethral epithelium have been proposed as chemosensory sentinels for detection of bacterial infection. Here, we examined the morphology and potential role in sensory signalling of a different class of specialized cells that express serotonin (5-HT), termed paraneurones. METHODS Urethrae, dorsal root ganglia neurones and spinal cords were isolated from adult female mice and used for immunohistochemistry and calcium imaging. Visceromotor reflexes (VMRs) were recorded in vivo. RESULTS We identified two morphologically distinct groups of 5-HT+ cells with distinct regional locations: bipolar-like cells predominant in the mid-urethra and multipolar-like cells predominant in the proximal and distal urethra. Sensory nerve fibres positive for calcitonin gene-related peptide, substance P, and TRPV1 were found in close proximity to 5-HT+ paraneurones. In vitro 5-HT (1 μm) stimulation of urethral primary afferent neurones, mimicking 5-HT release from paraneurones, elicited changes in the intracellular calcium concentration ([Ca2+ ]i ) mediated by 5-HT2 and 5-HT3 receptors. Approximately 50% of 5-HT responding cells also responded to capsaicin with changes in the [Ca2+ ]i . In vivo intra-urethral 5-HT application increased VMRs induced by urethral distention and activated pERK in lumbosacral spinal cord neurones. CONCLUSION These morphological and functional findings provide insights into a putative paraneurone-neural network within the urethra that utilizes 5-HT signalling, presumably from paraneurones, to modulate primary sensory pathways carrying nociceptive and non-nociceptive (mechano-sensitive) information to the central nervous system.
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Affiliation(s)
- F. A. Kullmann
- Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - H. H. Chang
- Department of Urology, University of Southern California, Los Angeles, CA, USA
| | - C. Gauthier
- Department of Biological Sciences, University of Pittsburgh, Pittsburgh, PA, USA
| | - B. M. McDonnell
- Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - J.-C. Yeh
- Department of Urology, University of Southern California, Los Angeles, CA, USA
| | - D. R. Clayton
- Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - A. J. Kanai
- Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
- Department of Pharmacology and Chemical Biology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - W. C. de Groat
- Department of Pharmacology and Chemical Biology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - G. L. Apodaca
- Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
- Department of Cell Biology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - L. A. Birder
- Department of Medicine, 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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10
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Yoshikawa S, Sumino Y, Kwon J, Suzuki T, Kitta T, Miyazato M, Yoshimura N. Effects of multiple simulated birth traumas on urethral continence function in rats. Am J Physiol Renal Physiol 2017; 313:F1089-F1096. [PMID: 28768663 DOI: 10.1152/ajprenal.00230.2017] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2017] [Revised: 07/17/2017] [Accepted: 07/25/2017] [Indexed: 11/22/2022] Open
Abstract
Multiple vaginal parities have been reported to be an important risk factor for stress urinary incontinence (SUI). Simulated birth trauma with single vaginal distention (VD) has been used to induce the SUI condition in animals; however, the effect of multiple simulated birth traumas on the urethral continence function has not been well characterized. Therefore, we examined the effects of multiple VDs on urethral functions in vivo and the changes in gene expressions of several molecules in the urethra using female SD rats, which were divided into three groups; sham, VD-1 (single VD), and VD-3 groups (3 times of VDs every 2 wk). Two weeks after the final VD, leak point pressure (LPP) and urethral responses during sneezing were evaluated. Also, changes in mRNA levels of urethral molecules were quantified with RT-PCR. The VD-1 group did not show any change in LPP with only a tendency of decrease in amplitudes of the urethral responses during sneezing (A-URS); however, the VD-3 group showed a significant decrease in LPP and urethral responses such as baseline urethral pressure and A-URS accompanied with SUI episodes during sneezing. Nicotinic receptor subtypes and transforming growth factor (TGF)-β1 were significantly increased in both VD-1 and VD-3 groups while TNF receptor (TNFR)-1, IL-6, collagens, and matrix metalloproteinases-9 were significantly increased only in the VD-3 group. These data indicate that rats with multiple simulated birth traumas exhibit profound impairment of the urethral continence function and that these functional changes are associated with those in cytokines, extracellular matrix molecules, and nicotinic receptor subtypes in the urethra.
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Affiliation(s)
- Satoru Yoshikawa
- Department of Urology, University of Pittsburgh, Pittsburgh, Pennsylvania; and
| | - Yasuhiro Sumino
- Department of Urology, University of Pittsburgh, Pittsburgh, Pennsylvania; and
| | - Joonbeom Kwon
- Department of Urology, University of Pittsburgh, Pittsburgh, Pennsylvania; and
| | - Takahisa Suzuki
- Department of Urology, University of Pittsburgh, Pittsburgh, Pennsylvania; and
| | - Takeya Kitta
- Department of Urology, University of Pittsburgh, Pittsburgh, Pennsylvania; and
| | - Minoru Miyazato
- Department of Urology, University of Pittsburgh, Pittsburgh, Pennsylvania; and
| | - Naoki Yoshimura
- Department of Urology, University of Pittsburgh, Pittsburgh, Pennsylvania; and .,Department of Pharmacology and Chemical Biology, University of Pittsburgh, Pittsburgh, Pennsylvania
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11
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Alexandre EC, de Oliveira MG, Campos R, Kiguti LR, Calmasini FB, Silva FH, Grant AD, Yoshimura N, Antunes E. How important is the α 1-adrenoceptor in primate and rodent proximal urethra? Sex differences in the contribution of α 1-adrenoceptor to urethral contractility. Am J Physiol Renal Physiol 2017; 312:F1026-F1034. [PMID: 28298357 DOI: 10.1152/ajprenal.00013.2017] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2017] [Revised: 03/09/2017] [Accepted: 03/09/2017] [Indexed: 12/28/2022] Open
Abstract
Urethral smooth muscle (USM) contributes to urinary continence by contracting during the urine storage phase, which is mainly mediated by activation of postjunctional α1-adrenoceptors. Males and females show differences in the functioning of the lower urinary tract and the most common urinary tract symptoms (LUTS). LUTS in men typically occur in association with bladder outlet obstruction, whereas in women urinary urge-incontinence symptoms are more common. Therefore, this study aimed to evaluate sex differences in α1-adrenoceptor subtype expression and their importance in proximal urethra contraction in the mouse (C57BL6/J) and marmoset (Callithrix jacchus). Contractile responses to phenylephrine, norepinephrine, potassium chloride (KCl), and electrical-field stimulation (EFS) were evaluated. Phenylephrine, norepinephrine, KCl, and EFS produced markedly greater contractions in male mice and marmoset USM compared with females. The sex differences remained unchanged by Nω-nitro-l-arginine (l-NAME; nitric oxide synthase inhibitor), atropine (muscarinic receptor antagonist), and PPADS (P2X1-purinoceptor antagonist). Additionally, selective α1A (but not α1B- and α1D-)-adrenoceptor antagonists significantly reduced phenylephrine-induced USM contractions. qRT-PCR for α1A-, B-, and D-adrenoceptor subtypes revealed a marked presence of the α1A-adrenoceptor subtype in male USM, but not females. Male mouse urethra also exhibited a higher tyrosine hydroxylase mRNA expression. Histomorphometric analysis showed a greater USM area in male than female mice. In conclusion, male mouse and marmoset proximal USM shows strong α1A- adrenoceptor-induced contractions and abundant α1A-adrenoceptor expression, whereas α1A-adrenoceptor-mediated mechanisms are much less important in females. The differential expression of α1-adrenoceptors in the proximal urethra may contribute to the higher incidence of urinary incontinence in women and obstructed voiding in men.
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Affiliation(s)
- Eduardo C Alexandre
- Department of Pharmacology, Faculty of Medical Sciences, University of Campinas (UNICAMP), Campinas, São Paulo, Brazil;
| | - Mariana G de Oliveira
- Department of Pharmacology, Faculty of Medical Sciences, University of Campinas (UNICAMP), Campinas, São Paulo, Brazil
| | - Rafael Campos
- Department of Pharmacology, Faculty of Medical Sciences, University of Campinas (UNICAMP), Campinas, São Paulo, Brazil
| | - Luiz R Kiguti
- Department of Pharmacology, Faculty of Medical Sciences, University of Campinas (UNICAMP), Campinas, São Paulo, Brazil
| | - Fabiano B Calmasini
- Department of Pharmacology, Faculty of Medical Sciences, University of Campinas (UNICAMP), Campinas, São Paulo, Brazil
| | - Fábio H Silva
- Department of Pharmacology, Faculty of Medical Sciences, University of Campinas (UNICAMP), Campinas, São Paulo, Brazil
| | - Andrew D Grant
- Wolfson Centre for Age-Related Diseases, King's College London, London, United Kingdom; and
| | - Naoki Yoshimura
- Department of Urology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Edson Antunes
- Department of Pharmacology, Faculty of Medical Sciences, University of Campinas (UNICAMP), Campinas, São Paulo, Brazil
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Kadekawa K, Yoshimura N, Majima T, Wada N, Shimizu T, Birder LA, Kanai AJ, de Groat WC, Sugaya K, Yoshiyama M. Characterization of bladder and external urethral activity in mice with or without spinal cord injury--a comparison study with rats. Am J Physiol Regul Integr Comp Physiol 2016; 310:R752-8. [PMID: 26818058 DOI: 10.1152/ajpregu.00450.2015] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2015] [Accepted: 01/21/2016] [Indexed: 11/22/2022]
Abstract
To clarify the lower urinary tract function in mice, we compared bladder and urethral activity between rats and mice with or without spinal cord injury (SCI). Female Sprague-Dawley rats and C57BL/6N mice were divided into five groups:1) spinal intact (SI) rats,2) SI mice,3) pudendal nerve transection (PNT) SI mice,4) spinal cord injury (SCI) rats, and 5) SCI mice. Continuous cystometry (CMG) and external urethral sphincter (EUS)-electromyogram (EMG) analyses were conducted under an awake, restrained condition. During voiding bladder contractions, SI animals exhibited EUS bursting with alternating active and silent periods, which, in rats but not mice, coincided with small-amplitude intravesical pressure oscillations in CMG recordings. In SI mice with bursting-like EUS activity, the duration of active periods was significantly shorter by 46% (32 ± 5 ms) compared with SI rats (59 ± 9 ms). In PNT-SI mice, there were no significant differences in any of cystometric parameters compared with SI mice. In SCI rats, fluid elimination from the urethra and the EUS bursting occurred during small-amplitude intravesical pressure oscillations. However, SCI mice did not exhibit clear EUS bursting activity or intravesical pressure oscillations but rather exhibited intermittent voiding with slow large-amplitude reductions in intravesical pressure, which occurred during periods of reduced EUS activity. These results indicate that EUS pumping activity is essential for generating efficient voiding in rats with or without spinal cord injury. However, EUS bursting activity is not required for efficient voiding in SI mice and does not reemerge in SCI mice in which inefficient voiding occurs during periods of reduced tonic EUS activity.
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Affiliation(s)
- Katsumi Kadekawa
- Department of Urology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania; Southern Knights' Laboratory, Okinawa, Japan; Okinawa Kyodo Hospital, Okinawa, Japan; and
| | - Naoki Yoshimura
- Department of Urology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania; Department of Pharmacology and Cell Biology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania;
| | - Tsuyoshi Majima
- Department of Urology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Naoki Wada
- Department of Urology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Takahiro Shimizu
- Department of Urology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Lori A Birder
- Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania; and
| | - Anthony J Kanai
- Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania; and
| | - William C de Groat
- Department of Pharmacology and Cell Biology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | | | - Mitsuharu Yoshiyama
- Department of Pharmacology and Cell Biology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania; Department of Urology, University of Yamanashi Graduate School of Medical Sciences, Chuo, Japan
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IGF-1 as an Important Endogenous Growth Factor for Recovery from Impaired Urethral Continence Function in Rats with Simulated Childbirth Injury. J Urol 2016; 195:1927-35. [PMID: 26767520 DOI: 10.1016/j.juro.2015.12.087] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/27/2015] [Indexed: 11/22/2022]
Abstract
PURPOSE We examined the functional role of endogenous IGF-1 (insulin-like growth factor-1) in the recovery phase of stress urinary incontinence induced by simulated childbirth trauma using an IGF-1 receptor inhibitor. MATERIALS AND METHODS Simulated birth trauma was induced by vaginal distension in female Sprague Dawley® rats. The IGF-1 receptor antagonist JB-1 (10 and 100 μg/kg per day) or vehicle was continuously delivered from 1 day before vaginal distension for 7 days using subcutaneous osmotic pumps. Seven, 14 and 21 days after vaginal distension the effect of JB-1 treatment was examined by functional analyses, including leak point and urethral baseline pressure, and urethral responses during passive increments in intravesical pressure, as well as molecular analyses in urethral tissues, including phosphorylation of Akt, apoptotic changes and peripheral nerve density using Western blot and immunohistochemistry. RESULTS On functional analyses vehicle treated rats with vaginal distension had significantly decreased leak point and urethral baseline pressure, and urethral responses at 7 days, which recovered to the normal level 14 and 21 days after vaginal distension. In the JB-1 treated vaginal distension group leak point and urethral baseline pressure, and urethral responses were still significantly reduced 21 days after vaginal distension. On molecular analyses JB-1 treatment increased apoptotic cells, induced a significant decrease in phosphorylated Akt and prolonged the decrease of peripheral nerve density in urethral tissues. CONCLUSIONS Suppression of endogenous IGF-1 activity delayed recovery from stress urinary incontinence induced by simulated childbirth trauma in rats. Thus, IGF-1 is likely to be an important endogenous mediator for functional recovery from childbirth related stress urinary incontinence. This suggests that IGF-1 could be an effective target for treating stress urinary incontinence in women.
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Furuta A, Suzuki Y, Kimura S, Asano K, Egawa S, Yoshimura N. Noradrenergic Mechanisms Controlling Urethral Smooth and Striated Muscle Function in Urethral Continence Reflex in Rats. Low Urin Tract Symptoms 2015; 7:155-61. [PMID: 26663731 DOI: 10.1111/luts.12065] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2014] [Revised: 04/16/2014] [Accepted: 05/07/2014] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To investigate the role of noradrenergic pathways in the urethral continence reflex during abdominal compression in rats. METHODS Under urethane anesthesia, urethral baseline pressure (UBP) and urethral pressure response (UPR) during momentary abdominal compression using a 100 g weight was measured using a transurethral microtransducer-tipped catheter placed at the middle urethra in Sprague-Dawley female rats. Following intravenous (i.v.) application of hexamethonium or α-bungarotoxin to block urethral smooth or striated muscle function, respectively, the effects of terazosin, an α1 -adrenoceptor (AR) antagonist (0.3 mg/kg, i.v.), medetomidine, an α2 -AR agonist (0.3 mg/kg, i.v.) or nisoxetine, a norepinephrine reuptake inhibitor (1 mg/kg, i.v.) followed by terazosin on UBP and UPR were examined. RESULTS After hexamethonium pretreatment, terazosin did not alter UBP or UPR, whereas medetomidine significantly decreased UPR by 28% without UBP changes. Nisoxetine significantly increased UPR by 64%, which was eliminated by terazosin, but UBP was not altered by nisoxetine. After α-bungarotoxin pretreatment, UBP and UPR were significantly decreased by terazosin or medetomidine. Nisoxetine induced significant increases in UBP and UPR by 16 and 15%, respectively, which were antagonized by terazosin. CONCLUSION These results suggest that: the baseline activity and reflex contraction of urethral smooth muscle are decreased by α1 -AR inhibition or α2 -AR stimulation; the reflex contraction of urethral striated muscle is decreased by α2 -AR stimulation, but not by α1 -AR inhibition; and nisoxetine increases baseline and reflex activity of smooth muscle in addition to striated muscle reflex activity by α1 -AR stimulation. These findings will be useful to understand nerve-mediated urethral closure mechanisms.
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Affiliation(s)
- Akira Furuta
- Department of Urology, Jikei University School of Medicine, Tokyo, Japan
| | - Yasuyuki Suzuki
- Department of Urology, Tokyo Rehabilitation Hospital, Tokyo, Japan
| | - Shouji Kimura
- Department of Urology, Jikei University School of Medicine, Tokyo, Japan
| | - Kouji Asano
- Department of Urology, Jikei University School of Medicine, Tokyo, Japan
| | - Shin Egawa
- Department of Urology, Jikei University School of Medicine, Tokyo, Japan
| | - Naoki Yoshimura
- Department of Urology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
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15
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Abstract
This article summarizes anatomical, neurophysiological, pharmacological, and brain imaging studies in humans and animals that have provided insights into the neural circuitry and neurotransmitter mechanisms controlling the lower urinary tract. The functions of the lower urinary tract to store and periodically eliminate urine are regulated by a complex neural control system in the brain, spinal cord, and peripheral autonomic ganglia that coordinates the activity of smooth and striated muscles of the bladder and urethral outlet. The neural control of micturition is organized as a hierarchical system in which spinal storage mechanisms are in turn regulated by circuitry in the rostral brain stem that initiates reflex voiding. Input from the forebrain triggers voluntary voiding by modulating the brain stem circuitry. Many neural circuits controlling the lower urinary tract exhibit switch-like patterns of activity that turn on and off in an all-or-none manner. The major component of the micturition switching circuit is a spinobulbospinal parasympathetic reflex pathway that has essential connections in the periaqueductal gray and pontine micturition center. A computer model of this circuit that mimics the switching functions of the bladder and urethra at the onset of micturition is described. Micturition occurs involuntarily in infants and young children until the age of 3 to 5 years, after which it is regulated voluntarily. Diseases or injuries of the nervous system in adults can cause the re-emergence of involuntary micturition, leading to urinary incontinence. Neuroplasticity underlying these developmental and pathological changes in voiding function is discussed.
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Affiliation(s)
- William C. de Groat
- Department of Pharmacology and Chemical Biology, University of Pittsburgh, School of Medicine Pittsburgh, Pennsylvania
| | - Derek Griffiths
- Department of Medicine (Geriatrics), University of Pittsburgh, School of Medicine Pittsburgh, Pennsylvania
| | - Naoki Yoshimura
- Department of Pharmacology and Chemical Biology, University of Pittsburgh, School of Medicine Pittsburgh, Pennsylvania
- Department of Urology, University of Pittsburgh, School of Medicine Pittsburgh, Pennsylvania
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16
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Abstract
Many urological studies rely on models of animals, such as rats and pigs, but their relation to the human urinary system is poorly understood. Here, we elucidate the hydrodynamics of urination across five orders of magnitude in body mass. Using high-speed videography and flow-rate measurement obtained at Zoo Atlanta, we discover that all mammals above 3 kg in weight empty their bladders over nearly constant duration of 21 ± 13 s. This feat is possible, because larger animals have longer urethras and thus, higher gravitational force and higher flow speed. Smaller mammals are challenged during urination by high viscous and capillary forces that limit their urine to single drops. Our findings reveal that the urethra is a flow-enhancing device, enabling the urinary system to be scaled up by a factor of 3,600 in volume without compromising its function. This study may help to diagnose urinary problems in animals as well as inspire the design of scalable hydrodynamic systems based on those in nature.
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17
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Sumino Y, Yoshikawa S, Mimata H, Yoshimura N. Therapeutic Effects of IGF-1 on Stress Urinary Incontinence in Rats with Simulated Childbirth Trauma. J Urol 2014; 191:529-38. [DOI: 10.1016/j.juro.2013.08.109] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/26/2013] [Indexed: 11/25/2022]
Affiliation(s)
- Yasuhiro Sumino
- Department of Urology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
- Department of Urology, Faculty of Medicine, Oita University, Oita, Japan
| | - Satoru Yoshikawa
- Department of Urology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Hiromitsu Mimata
- Department of Urology, Faculty of Medicine, Oita University, Oita, Japan
| | - Naoki Yoshimura
- Department of Urology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
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18
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Fan WJ, Li YT, Chen JJJ, Chen SC, Lin YS, Kou YR, Peng CW. Sexually dimorphic urethral activity in response to pharmacological activation of 5-HT1A receptors in the rat. Am J Physiol Renal Physiol 2013; 305:F1332-42. [PMID: 24049146 DOI: 10.1152/ajprenal.00261.2013] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
In this study, we examined the possibility that 5-HT1A receptors may underlie sexually dimorphic mechanisms affecting the regulation of urethral functions in anesthetized rats. Simultaneous recordings of intravesical pressure under isovolumetric conditions, external urethral sphincter-electromyography, and urethral perfusion pressure were used to examine the effects of a 5-HT1A receptor agonist [8-hydroxy-2-(di-n-propylamino)tetralin (8-OH-DPAT)] and antagonist (WAY-100635) on bladder and urethral functions. This research also evaluated the effects of 8-OH-DPAT and α-bungarotoxin (a neuromuscular blockade agent) on urethral continence using leak point pressure testing, and the distribution of 5-HT1A receptors in the lower urinary tract was assessed by immunohistochemistry. The serotonergic mechanism that controls the urinary bladder and external urethral sphincter-electromyography activity showed no significant sexual differences, but urethral activity in urethral perfusion pressure and leak point pressure values exhibited some sexual differences. 8-OH-DPAT enhanced urethral pressure during continence in rats of both sexes, but the drug elevated the pressure during voiding in male rats and reduced it in female rats. The distribution of 5-HT1A receptors in the spinal cord also showed some sexual differences. The present study contributes to our understanding of the role of 5-HT1A receptors in physiological and immunohistochemical properties of urethral smooth muscle in rats of different sexes. These findings may be a basis for the future development of pharmacotherapies for stress urinary incontinence in men.
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Affiliation(s)
- Wen-Jia Fan
- Dept. of Physical Medicine and Rehabilitation, School of Medicine, College of Medicine, Taipei Medical Univ., No. 250, Wuxing St., Taipei 11031, Taiwan.
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Corona-Quintanilla DL, Zempoalteca R, Arteaga L, Castelán F, Martínez-Gómez M. The role of pelvic and perineal striated muscles in urethral function during micturition in female rabbits. Neurourol Urodyn 2013; 33:455-60. [PMID: 23636895 DOI: 10.1002/nau.22416] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2012] [Accepted: 04/05/2013] [Indexed: 12/21/2022]
Abstract
AIM To evaluate the role of pelvic and perineal striated muscles on urethral function during micturition. METHODS Pubococcygeus, or both bulbospongiosus and ischiocavernosus muscles were electrically stimulated during the voiding phase of micturition, and bladder and urethral pressure were simultaneously recorded in urethane anesthetized female rabbits. Bladder and urethral function were assessed measuring urodynamic and urethral pressure variables obtained before and during the stimulation of muscles. Two-tail paired t-tests were carried out in order to determine significant differences (P < 0.05) between groups. RESULTS Electric stimulation of the pubococcygeus during voiding decreased voiding efficiency and voided volume, whereas residual volume, the duration of voiding, the interval between bladder contraction and urethral resistance increased. Simultaneously, there was an increase in maximum urethral pressure, as well as an increase in the pressure to return to baseline and in the pressure required to close the urethra. Electrical stimulation of bulbospongiosus and ischiocavernosus muscles increased voiding efficiency, voiding duration, and the maximal pressure in bladder. Meanwhile, the maximal urethral pressure, the time related to the rise of urethral pressure, and the urethral pressure required to close the urethra decreased. CONCLUSIONS The stimulation of pelvic and perineal muscles have opposing roles in urethral function during micturition. Pubococcygeus muscles facilitate urethral closure, while they inhibit bladder contraction. In contrast, bulbospongiosus and ischiocavernosus muscles prevent urethral contraction while they promote bladder contraction.
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Gill BC, Damaser MS, Vasavada SP, Goldman HB. Stress incontinence in the era of regenerative medicine: reviewing the importance of the pudendal nerve. J Urol 2013; 190:22-8. [PMID: 23376143 DOI: 10.1016/j.juro.2013.01.082] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/17/2013] [Indexed: 10/27/2022]
Abstract
PURPOSE Regenerative medicine will likely facilitate improved stress urinary incontinence treatment via the restoration of its neurogenic, myogenic and structural etiologies. Understanding these pathophysiologies and how each can optimally benefit from cellular, molecular and minimally invasive therapies will become necessary. While stem cells in sphincteric deficiency dominate the regenerative urology literature, little has been published on pudendal nerve regeneration or other regenerative targets. We discuss regenerative therapies for pudendal nerve injury in stress urinary incontinence. MATERIALS AND METHODS A PubMed® search for pudendal nerve combined individually with regeneration, injury, electrophysiology, measurement and activity produced a combined but nonindependent 621 results. English language articles were reviewed by title for relevance, which identified a combined but nonindependent 68 articles. A subsequent Google Scholar™ search and a review of the references of the articles obtained aided in broadening the discussion. RESULTS Electrophysiological studies have associated pudendal nerve dysfunction with stress urinary incontinence clinically and assessed pudendal nerve regeneration functionally, while animal models have provided physiological insight. Stem cell treatment has improved continence clinically, and ex vivo sphincteric bulk and muscle function gains have been noted in the laboratory. Stem cells, neurotrophic factors and electrical stimulation have benefited pudendal nerve regeneration in animal models. CONCLUSIONS Most regenerative studies to date have focused on stem cells restoring sphincteric function and bulk but whether a sphincter denervated by pudendal nerve injury will benefit is unclear. Pudendal nerve regeneration appears possible through minimally invasive therapies that show significant clinical potential. Treating poor central control and coordination of the neuromuscular continence mechanism remains another challenge.
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Affiliation(s)
- Bradley C Gill
- Glickman Urological and Kidney Institute and Department of Biomedical Engineering, Cleveland Clinic, Cleveland, Ohio 44195, USA
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21
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Koike Y, Furuta A, Suzuki Y, Honda M, Naruoka T, Asano K, Egawa S, Yoshimura N. Pathophysiology of urinary incontinence in murine models. Int J Urol 2012; 20:64-71. [PMID: 23126617 DOI: 10.1111/j.1442-2042.2012.03225.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2012] [Accepted: 10/03/2012] [Indexed: 12/14/2022]
Abstract
Urethral closure mechanisms under stress conditions consist of passive urethral closure involving connective tissues, fascia and/or ligaments in the pelvis and active urethral closure mediated by hypogastric, pelvic and pudendal nerves. Furthermore, we have previously reported that the active urethral closure mechanism might be divided into two categories: (i) the central nervous control passing onto Onuf's nucleus under sneezing or coughing; and (ii) the bladder-to-urethral spinal reflex under Valsalva-like stress conditions, such as laughing, exercise or lifting heavy objects. There are over 200 million people worldwide with urinary incontinence, a condition that is associated with a significant social impact and reduced quality of life. Therefore, basic research for urinary continence mechanisms in response to different stress conditions can play an essential role in developing treatments for stress urinary incontinence. It has been clinically shown that the etiology of stress urinary incontinence is divided into urethral hypermobility and intrinsic sphincter deficiency, which could respectively correspond to passive and active urethral closure dysfunction. In this review, we summarize the representative stress urinary incontinence animal models and the methods to measure leak point pressures under stress conditions, and then highlight stress-induced urinary continence mechanisms mediated by active urethral closure mechanisms, as well as future pharmacological treatments of stress urinary incontinence. In addition, we introduce our previous reports including sex differences in urethral closure mechanisms under stress conditions and urethral compensatory mechanisms to maintain urinary continence after pudendal nerve injury in female rats.
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Affiliation(s)
- Yusuke Koike
- Department of Urology, Jikei University School of Medicine, Tokyo, Japan
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22
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Kitta T, Tyagi V, Nanri M, Kiniwa M, Nonomura K, Yoshimura N. Effects of propiverine hydrochloride, an anticholinergic agent, on urethral continence mechanisms and plasma catecholamine concentration in rats. Int Urogynecol J 2012; 24:683-8. [PMID: 22930215 DOI: 10.1007/s00192-012-1924-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2012] [Accepted: 08/07/2012] [Indexed: 10/28/2022]
Abstract
INTRODUCTION AND HYPOTHESIS Anticholinergics are used to treat overactive bladder. Anticholinergic agents such as propiverine hydrochloride reportedly increase plasma catecholamine levels in rats. It is also known that active urethral closure mechanisms prevents stress urinary incontinence (SUI), which is enhanced by central and peripheral noradrenergic system activation. Therefore, we examined the influence of propiverine hydrochloride on urethral anti-incontinence function in rats. METHODS Adult female rats were divided into propiverine and vehicle-treated groups. The propiverine group was given propiverine orally once a day for 2 weeks, after which urethral function and plasma concentrations of catecholamine (dopamine, norepinephrine, epinephrine) were tested. RESULTS Urethral baseline pressure measured by a microtransducer-tipped urethral catheter and leak-point pressure during passive intravesical pressure elevation were significantly increased in the propiverine group compared with the vehicle group. Plasma norepinephrine and epinephrine levels in the propiverine group were also significantly increased. CONCLUSIONS Propiverine treatment that increases plasma catecholamine levels could contribute to improvement of SUI conditions by increasing urethral resistance.
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Affiliation(s)
- Takeya Kitta
- Department of Urology, University of Pittsburgh School of Medicine, Suite 700, Kaufmann Medical Bldg., 3471 Fifth Ave, Pittsburgh, PA 15213, USA
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23
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Peng HY, Lin TB. Spinal pelvic-urethra reflex potentiation. Biomedicine (Taipei) 2012. [DOI: 10.1016/j.biomed.2012.03.001] [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] Open
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Yoshimura N, Miyazato M. Neurophysiology and therapeutic receptor targets for stress urinary incontinence. Int J Urol 2012; 19:524-37. [PMID: 22404481 DOI: 10.1111/j.1442-2042.2012.02976.x] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Stress urinary incontinence is the most common type of urinary incontinence in women. Stress urinary incontinence involves involuntary leakage of urine in response to abdominal pressure caused by activities, such as sneezing and coughing. The condition affects millions of women worldwide, causing physical discomfort as well as social distress and even social isolation. This type of incontinence is often seen in women after middle age and it can be caused by impaired closure mechanisms of the urethra as a result of a weak pelvic floor or poorly supported urethral sphincter (urethral hypermobility) and/or a damaged urethral sphincter system (intrinsic sphincter deficiency). Until recently, stress urinary incontinence has been approached by clinicians as a purely anatomic problem as a result of urethral hypermobility requiring behavioral or surgical therapy. However, intrinsic sphincter deficiency has been reported to be more significantly associated with stress urinary incontinence than urethral hypermobility. Extensive basic and clinical research has enhanced our understanding of the complex neural circuitry regulating normal function of the lower urinary tract, as well as the pathophysiological mechanisms that might underlie the development of stress urinary incontinence and lead to the development of potential novel strategies for pharmacotherapy of stress urinary incontinence. Therapeutic targets include adrenergic and serotonergic receptors in the spinal cord, and adrenergic receptors at the urethral sphincter, which can enhance urethral reflex activity during stress conditions and increase baseline urethral pressure, respectively. This article therefore reviews the recent advances in stress urinary incontinence research and discusses the neurophysiology of urethral continence reflexes, the etiology of stress urinary incontinence and potential targets for pharmacotherapy of stress urinary incontinence.
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Affiliation(s)
- Naoki Yoshimura
- Department of Urology, University of Pittsburgh School of Medicine, Pittsburgh, PA 15213, USA.
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Watanabe T, Maruyama S, Yamamoto T, Kamo I, Yasuda K, Saka Y, Ozaki T, Yuzawa Y, Matsuo S, Gotoh M. Increased urethral resistance by periurethral injection of low serum cultured adipose-derived mesenchymal stromal cells in rats. Int J Urol 2011; 18:659-66. [PMID: 21707765 DOI: 10.1111/j.1442-2042.2011.02795.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
OBJECTIVES To evaluate the effects of a periurethral injection of low serum cultured adipose tissue-derived mesenchymal stromal cells (LASC) and to develop a new autologous cell therapy for stress urinary incontinence. METHODS F344 rats were divided into three groups as based on the periurethral injection of LASC, GAX collagen or vehicle (control). At 2 and 4 weeks after injection, leak point pressure (LPP) was measured before and after transection of the pelvic nerves. For cell tracking, LASC of green fluorescent protein transgenic rats were injected into nude rats. RESULTS At 2 weeks, both the LASC and collagen groups showed significantly higher LPP than the control group. At 4 weeks, the increase in LPP in the LASC group remained, whereas LPP in the collagen group decreased to baseline levels. In the absence of the urethral closure reflex after transection of the pelvic nerves, LPP in the LASC group was significantly higher than that in the other two groups. Histologically, the size of the urethral lumen was smaller in the LASC group than the collagen group. At 4 weeks, most of the LASC were positive for myogenic antigens including α-smooth muscle actin, desmin and calponin I. CONCLUSIONS Periurethral injection of autologous LASC capable of myogenic differentiation made a greater contribution to the increase in urethral resistance than did the conventional collagen bulk injection. Thus, its use for treatment of stress urinary incontinence can be postulated.
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Affiliation(s)
- Tatsuhito Watanabe
- Department of Nephrology, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
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Ko IG, Kim SE, Kim BK, Shin MS, Kim CJ, Yim SJ, Bang YJ, Choi IH, Kim KH. Swimming: effects on stress urinary incontinence and the expression of nerve growth factor in rats following transabdominal urethrolysis. Int Neurourol J 2011; 15:74-81. [PMID: 21811696 PMCID: PMC3138847 DOI: 10.5213/inj.2011.15.2.74] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2011] [Accepted: 05/10/2011] [Indexed: 11/27/2022] Open
Abstract
PURPOSE Stress urinary incontinence (SUI) commonly occurs in women, and it has an enormous impact on quality of life. Surgery, drugs, and exercise have been recommended for the treatment of this disease. Among these, exercise is known to be effective for the relief of symptoms of SUI; however, the efficacy and underlying mechanisms of the effect of exercise on SUI are poorly understood. We investigated the effect of swimming the symptom of SUI in relation to the expression of nerve growth factor (NGF) in rats. METHODS Transabdominal urethrolysis was used to induce SUI, in Sprague-Dawley rats. The experimental groups were divided into the following three groups: sham-operation group, transabdominal urethrolysis-induced group, and transabdominal urethrolysis-induced and swimming group. The rats in the swimming group were forced to swim for 30 minutes once daily starting 2 weeks after SUI induction and continuing for 4 weeks. For this study, determination of abdominal leak point pressure and immunohistochemistry for NGF in the urethra and in the neuronal voiding centers (medial preoptic nucleus [MPA], ventrolateral periaqueductal gray [vlPAG], pontine micturition center [PMC], and spinal cord [L4-L5]) were performed. RESULTS Transabdominal urethrolysis significantly reduced the abdominal leak point pressure, thereby contributing to the induction of SUI. Abdominal leak point pressure, however, was significantly improved by swimming. The expression of NGF in the urethra and in the neuronal voiding centers (MPA, vlPAG, PMC, and L4-L5) relating to micturition was enhanced by the induction of SUI. Swimming, however, significantly suppressed SUI-induced NGF expression. CONCLUSIONS Swimming alleviated symptoms of transabdominal urethrolysis-induced SUI, as assessed by an increase in abdominal leak point pressure. The underlying mechanisms of these effects of swimming might be ascribed to the inhibitory effect of swimming on NGF expression.
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Affiliation(s)
- Il Gyu Ko
- Department of Physiology, Kyung Hee University School of Medicine, Seoul, Korea
| | - Sung Eun Kim
- Department of Physiology, Kyung Hee University School of Medicine, Seoul, Korea
| | - Bo Kyun Kim
- Department of Physiology, Kyung Hee University School of Medicine, Seoul, Korea
| | - Mal Soon Shin
- Department of Physiology, Kyung Hee University School of Medicine, Seoul, Korea
| | - Chang Ju Kim
- Department of Physiology, Kyung Hee University School of Medicine, Seoul, Korea
| | - Sung Jin Yim
- Department of Urology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Yu Jeong Bang
- Gachon University of Medicine and Science, Incheon, Korea
| | - In Ho Choi
- Department of Urology, Gachon University Gil Hospital, Gachon University of Medicine and Science, Incheon, Korea
| | - Khae Hawn Kim
- Department of Urology, Gachon University Gil Hospital, Gachon University of Medicine and Science, Incheon, Korea
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Lara-García M, Alvarado M, Cuevas E, Cortés-sol A, Domínguez A, Tovar A, Pacheco P. The Effects of Castration and Hormone Replacement on the Cross-Sectional Area of Pubococcygeus Muscle Fibers in the Female Rat. Anat Rec (Hoboken) 2011; 294:1242-8. [DOI: 10.1002/ar.21414] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2010] [Accepted: 04/04/2011] [Indexed: 12/23/2022]
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Wang HJ, Chuang YC, Chancellor MB. Development of cellular therapy for the treatment of stress urinary incontinence. Int Urogynecol J 2011; 22:1075-83. [PMID: 21505907 DOI: 10.1007/s00192-011-1432-1] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2011] [Accepted: 04/04/2011] [Indexed: 12/16/2022]
Abstract
Stress urinary incontinence (SUI) is highly prevalent and associated with a reduced quality of life. An intact rhabdosphincter at the mid-urethra is mandatory to maintain urinary continence. Adult stem cell injection therapy for the regenerative repair of an impaired sphincter is currently at the forefront of incontinence research. The implanted cells will fuse with muscle and release trophic factors promoting nerve and muscle integration. Hereby, we review the use of mesenchymal stem cell therapy for SUI and the experience with the development of muscle-derived stem cells.
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Affiliation(s)
- Hung-Jen Wang
- Department of Urology, Chang Gung Memorial Hospital Kaohsiung Medical Center, Chang Gung University College of Medicine, Kaohsiung, Taiwan
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Chen SC, Cheng CL, Fan WJ, Chen JJJ, Lai CH, Peng CW. Effect of a 5-HT1A receptor agonist (8-OH-DPAT) on external urethral sphincter activity in a rat model of pudendal nerve injury. Am J Physiol Regul Integr Comp Physiol 2011; 301:R225-35. [PMID: 21490366 DOI: 10.1152/ajpregu.00260.2010] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Although serotonergic agents have been used to treat patients with stress urinary incontinence, the characteristics of the external urethral sphincter (EUS) activity activated by 5-HT receptors have not been extensively studied. This study examined the effects of the 5-HT(1A) receptor agonist, 8-hydroxy-2-(di-n-propylamino)tetralin (8-OH-DPAT), on the EUS-electromyography and resistance of the urethra in a rat model with bilateral pudendal nerve injury (BPNI). Two measurements were utilized to assess the effects of the drug on bladder and urethral functions: the simultaneous recordings of transvesical pressure under isovolumetric conditions [isovolumetric intravesical pressure (IVP)] and urethral perfusion pressure, and the simultaneous recordings of IVP during continuously isotonic transvesical infusion with an open urethra (isotonic IVP) and EUS-electromyography. This study also evaluated the urethral continence using leak point pressure testing. The urethral perfusion pressure and leak point pressure measurements of BPNI rats reveal that 8-OH-DPAT significantly increased urethral resistance during the bladder storage phase, yet decreased resistance during the voiding phase. The entire EUS burst period was significantly prolonged, within which the average silent period increased and the frequency of burst discharges decreased. 8-OH-DPAT also improved the voiding efficiency, as evidenced by the detection of decreases in the contraction amplitude and residual volume, with increases in contraction duration and voided volume. These findings suggest that 8-OH-DPAT not only improved continence function, but also elevated the voiding function in a BPNI rat model.
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Affiliation(s)
- Shih-Ching Chen
- Dept. of Physical Medicine and Rehabilitation, School of Medicine, College of Medicine, Taipei Medical University, No. 250, Wuxing St., Taipei 11031, Taiwan
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Ueno H, Kuno M, Shintani Y, Kamo I. Role of vasopressin V1A receptor in the urethral closure reflex in rats. Am J Physiol Renal Physiol 2011; 300:F976-82. [DOI: 10.1152/ajprenal.00658.2010] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
An enhanced urethral closure reflex via the spinal cord is related to urethral resistance elevation during increased abdominal pressure. However, with the exception of monoamines, neurotransmitters modulating this reflex are not understood. We investigated whether the vasopressin V1A receptor (V1AR) is involved in the urethral closure reflex in urethane-anesthetized female rats. V1AR mRNA was highly expressed among the vasopressin receptor family in the total RNA purified from lamina IX in the spinal cord L6–S1 segment. In situ hybridization analysis of the spinal L6–S1 segment confirmed that these positive signals from the V1ARs were only detected in lamina IX. Intrathecally injected Arg8-vasopressin (AVP), an endogenous ligand, significantly increased urethral resistance during an intravesical pressure rise, and its effect was blocked by the V1AR antagonist. AVP did not increase urethral resistance in rats in which the pelvic nerves were transected bilaterally. Urethral closure reflex responses to the intravesical pressure rise increased by up to threefold compared with the baseline response after AVP administration in contrast to no increase by vehicle. In addition, intravenously and intrathecally injected V1AR antagonists decreased urethral resistance. These results suggest that V1AR stimulation in the spinal cord enhances the urethral closure reflex response, thereby increasing urethral resistance during an abdominal pressure rise and that V1AR plays a physiological role in preventing urine leakage.
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Affiliation(s)
- Hiroyuki Ueno
- Pharmaceutical Research Division, Takeda Pharmaceutical Company, Limited, Osaka, Japan
| | - Masako Kuno
- Pharmaceutical Research Division, Takeda Pharmaceutical Company, Limited, Osaka, Japan
| | - Yasushi Shintani
- Pharmaceutical Research Division, Takeda Pharmaceutical Company, Limited, Osaka, Japan
| | - Izumi Kamo
- Pharmaceutical Research Division, Takeda Pharmaceutical Company, Limited, Osaka, Japan
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Furuta A, Suzuki Y, Asano K, de Groat WC, Egawa S, Yoshimura N. Urethral compensatory mechanisms to maintain urinary continence after pudendal nerve injury in female rats. Int Urogynecol J 2011; 22:963-70. [PMID: 21445696 DOI: 10.1007/s00192-011-1403-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2010] [Accepted: 02/20/2011] [Indexed: 02/05/2023]
Abstract
INTRODUCTION AND HYPOTHESIS This study was conducted to investigate the urethral compensatory mechanisms to maintain urinary continence after pudendal nerve injury. METHODS In naive, acute pudendal nerve transection (PNT) and 4 weeks after PNT (PNT-4w) female rats, leak point pressures (LPPs) during bladder compression were measured before and after the application of hexamethonium (C6), propranolol, and N (ω)-nitro-L: -arginine-methyl ester (L: -NAME), or terazosin and atropine. Responses to carbachol and phenylephrine of proximal and middle urethral muscle strips from naive and PNT-4w rats were also examined. RESULTS LPPs were significantly decreased in PNT rats but not in PNT-4w rats. LPPs in PNT rats were significantly increased by C6 or L-NAME while LPPs in PNT-4w rats were significantly decreased by C6, or terazosin and atropine. Excitatory responses to carbachol and phenylephrine in the proximal urethral muscle were significantly larger in PNT-4w rats. CONCLUSIONS These results suggest that α(1)-adrenoceptor and muscarinic receptor-mediated contractility is upregulated in the proximal urethra 4 weeks after PNT.
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Affiliation(s)
- Akira Furuta
- Department of Urology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
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Jiang HH, Salcedo LB, Damaser MS. Quantification of neurological and other contributors to continence in female rats. Brain Res 2011; 1382:198-205. [PMID: 21295013 DOI: 10.1016/j.brainres.2011.01.094] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2010] [Revised: 01/14/2011] [Accepted: 01/26/2011] [Indexed: 10/18/2022]
Abstract
Smooth muscle, striated muscle, their central and peripheral innervations and control, and mucosal coaptation contribute to maintenance of continence. We used manual leak point pressure (mLPP) testing and electrical stimulation LPP (eLPP) testing in female rats to quantify the contribution of these factors to urethral resistance, a measure of continence. Abdominal muscles were electrically stimulated to induce leakage for eLPP. A Crede maneuver was applied for mLPP. These were repeated after complete T8 spinal cord injury (SCI) and/or bilateral pudendal nerve transection (PNT). After euthanasia, mLPP was repeated. MLPP was not significantly affected by opening the abdomen, suggesting that intra-abdominal pressure transmission contributes little to continence during slow pressure changes. ELPP was significantly higher than mLPP in intact rats, after PNT, and after SCI+PNT, suggesting that abdominal pressure transmission contributes to continence during rapid increases in intra-abdominal pressure. MLPP decreased significantly after PNT, indicating that urethral striated muscles contribute significantly to continence. ELPP decreased significantly after PNT with and without SCI, suggesting that supraspinal control significantly affects continence during rapid pressure changes, but not during slow pressure changes. MLPP after euthanasia was significantly decreased compared to mLPP after SCI+PNT, suggesting that urethral mucosal seal coaptation and tissue elasticity also contribute to continence. The urethra is a complex organ that maintains continence via a highly organized and hierarchical system involving both the central and peripheral nervous systems.
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Affiliation(s)
- Hai-Hong Jiang
- Biomedical Engineering Dept, Cleveland Clinic, Cleveland, OH 44195, USA; Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH 44195, USA.
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Abstract
PURPOSE OF REVIEW Vaginal childbirth is a significant risk factor for stress urinary incontinence (SUI). Women with SUI demonstrate dysfunction of the pelvic floor and pudendal nerve. Animal models of SUI have been developed to investigate its pathophysiology and for preclinical testing of potential treatments. RECENT FINDINGS Vaginal distension, a method of simulating childbirth injury in animals, produces a reliable decrease in leak point pressure (LPP), a measure of urethral resistance to leakage and quantification of SUI severity in animals. In addition to ischemia and direct tissue damage, vaginal distension causes denervation of the external urethral sphincter (EUS). Pudendal nerve crush produces a similar decrease in LPP, whereas combined PNC and vaginal distension injury delays recovery of LPP compared with either single injury alone. Neurophysiologic studies have elucidated the results of each injury and their combination on pudendal nerve and EUS function. Urethrolysis, electrocautery, and pudendal nerve transection produce more durable functional impairment via both structural damage and denervation. Pubourethral ligament injury eliminates the structural support of the urethra, but its neurologic effects are unknown. SUMMARY Animal models demonstrate a complex interplay between tissue damage and pudendal nerve dysfunction, and provide insight into the importance of neuroregeneration in the recovery of continence.
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Abstract
Stress urinary incontinence (SUI) is a common health problem significantly affecting the quality of life of women worldwide. Animal models that simulate SUI enable the assessment of the mechanism of risk factors for SUI in a controlled fashion, including childbirth injuries, and enable preclinical testing of new treatments and therapies for SUI. Animal models that simulate childbirth are presently being utilized to determine the mechanisms of the maternal injuries of childbirth that lead to SUI with the goal of developing prophylactic treatments. Methods of assessing SUI in animals that mimic diagnostic methods used clinically have been developed to evaluate the animal models. Use of these animal models to test innovative treatment strategies has the potential to improve clinical management of SUI. This chapter provides a review of the available animal models of SUI, as well as a review of the methods of assessing SUI in animal models, and potential treatments that have been tested on these models.
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Affiliation(s)
- Hai-Hong Jiang
- Biomedical Engineering Department, The Cleveland Clinic, 9500 Euclid Ave. ND20, Cleveland, OH 44195, USA
| | - Margot S. Damaser
- Biomedical Engineering Department, The Cleveland Clinic, 9500 Euclid Ave. ND20, Cleveland, OH 44195, USA
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Effect of Treadmill Exercise on Leak-point pressure and Neuronal Activation in Brain of Rats with Stress Urinary Incontinence. Int Neurourol J 2010; 14:141-8. [PMID: 21179331 DOI: 10.5213/inj.2010.14.3.141] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2009] [Accepted: 11/09/2009] [Indexed: 02/02/2023] Open
Abstract
PURPOSE Stress urinary incontinence (SUI) commonly occurs in women, and it causes enormous impact on quality of life. Surgery, drugs, and exercise have been recommended for the treatment of this disease. Among these exercise is also known to be effective for relieving thesymptoms of SUI, however, the efficacy and underlying mechanisms of exercise on SUI are poorly understood. In the present study, we investigated the effect of treadmill exercise on abdominal leak-point pressure and neuronal activity in the medial preoptic nucleus (MPA), ventrolateral periaqueductal gray (vlPAG), and pontine micturition center (PMC) following urethrolysis in rats. MATERIALS AND METHODS Adult female Sprague-Dawley rats, weighing 250±10 g (9 weeks old), were used in this study. After having undergone transabdominal urethrolysis to induce SUI, the rats were divided into three groups (n=6 in each group): a sham operation group, an SUI-induced group, and an SUI-induced and treadmill exercise group. The rats in the exercise group performed treadmill running for 30 min once a day starting 2 weeks after the induction of SUI and continuing for 4 weeks after surgery. For this study, determination of abdominal leak point pressure and immunohistochemistry for c-Fos in the brain were performed. RESULTS Induction of transabdominal urethrolysis significantly reduced the abdominal leak point pressure, thereby contributing to the induction of SUI. In contrast, abdominal leak point pressure was significantly improved by treadmill exercise. The expression of c-Fosin the MPA, vlPAG, and PMC, the brain areas relating to micturition, was enhanced by the induction of SUI, whereas treadmill exercise significantly suppressed SUI-induced c-Fos expression, suggesting that neuronal activation in the micturition centers was suppressed by treadmill exercise. CONCLUSION The present results suggest that treadmill exercise may be an effective therapeutic modality for ameliorating the symptoms of SUI.
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Pan HQ, Lin DL, Strauch C, Butler RS, Monnier VM, Daneshgari F, Damaser MS. Pudendal nerve injury reduces urethral outlet resistance in diabetic rats. Am J Physiol Renal Physiol 2010; 299:F1443-50. [PMID: 20881033 DOI: 10.1152/ajprenal.00341.2009] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Diabetics have voiding and continence dysfunction to which elevated levels of advanced glycation end products (AGE) may contribute. In addition, pudendal nerve injury is correlated with voiding dysfunction and stress incontinence in rats. The aim of this study was to investigate whether pudendal nerve crush (PNC) in diabetic rats alters urinary function. Female virgin Sprague-Dawley rats (144) were divided equally into diabetic, diuretic, and control groups. Half of the animals in each group were subjected to PNC, and the other half to sham PNC. Diabetes was induced 8 wk before PNC or sham PNC by streptozotocin injection (35 mg/kg). Animals underwent conscious cystometry and leak point pressure (LPP) testing 4 or 13 days after PNC or sham PNC. Tissues of half the animals were tested for levels of AGEs. Qualitative histological assessment was performed in the remaining animals. Diabetic rats 4 days after PNC voided significantly greater volume in a shorter time and with significantly less pressure than after sham PNC, suggesting that diabetic rats have a functional outlet obstruction that is relieved by PNC. LPP was significantly reduced 4 days after PNC in diabetic and diuretic animals and returned to normal 13 days after PNC. Diabetic rats with PNC demonstrated increased muscle fiber disruption and atrophy of the external urethral sphincter. AGEs were significantly elevated in diabetic rats. PNC relieves a functional outlet obstruction in diabetic rats. AGEs are elevated in diabetic rats and could play a role in urinary dysfunction and recovery from PNC.
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Affiliation(s)
- Hui Q Pan
- Cleveland Clinic, Cleveland, OH 44195, USA
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Wu HC, Chiu CH, Tung KC, Chen GD, Peng HY, Lin TB. Dopaminergic D2 receptors activate PKA to inhibit spinal pelvic-urethra reflex in rats. Am J Physiol Renal Physiol 2010; 299:F681-6. [PMID: 20554643 DOI: 10.1152/ajprenal.00090.2010] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
To clarify the role of descending dopaminergic innervation in reflexive urethral closure, the impacts of dopaminergic D2 receptor (DR2)-selective agonists and antagonists on repetitive stimulation-induced pelvic-to-urethra spinal reflex potentiation (SRP) were tested using in vivo rat preparations. Pelvic afferent nerve test stimulation (TS; 1 pulse/30 s for 30 min) evoked baseline reflex activity with single spikes in the external urethral sphincter electromyogram (EUSE), whereas, repetitive stimulation (RS; 1 pulse/s for 30 min) induced SRP. Intrathecal application of quinelorane dihydrochloride (Q110; 10, 30, and 100 nM, 10 μl, a selective DR2 agonist) dose dependently inhibited the RS-induced SRP. Pretreatment with L135 (100 nM, 10 μL it, a selective DR2 antagonist) antagonized the Q110-dependent inhibition (100 nM, 10 μl it). Intrathecal AMPA (10 μM, 10 μl, a selective glutamatergic AMPA receptor agonist), and NMDA (10 μM, 10 μl, a selective glutamatergic NMDA receptor agonist) reversed the Q110-dependent inhibition. Intrathecal forskolin (100 nM, 10 μl, a PKA activator) prevented the Q110-dependent inhibition that was reversed by CNQX (10 μM, 10 μl it, a selective glutamate AMPA receptor antagonist) and APV (10 μM, 10 μl it , a selective glutamate NMDA receptor antagonist). Our results suggest that DR2 activation, which inactivates intracellular PKA, may be involved in descending dopaminergic inhibition of NMDA/AMPA receptor-dependent SRP at the lumbosacral spinal cord, which is thought to be involved in reflexive urethral closure.
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Affiliation(s)
| | - Chun-Hsien Chiu
- Department of Veterinary Medicine, College of Veterinary Medicine, National Chung-Hsing University, and
| | - Kwong-Chung Tung
- Department of Veterinary Medicine, College of Veterinary Medicine, National Chung-Hsing University, and
| | - Gin-Den Chen
- Department of Obstetrics and Gynecology, Chung-Shan Medical University Hospital, Chung-Shan Medical University, Taichung; and
| | - Hsien-Yu Peng
- Department of Physiology,
- Department of Urology, China Medical University Hospital, China Medical University,
| | - Tzer-Bin Lin
- Department of Physiology,
- Department of Urology, China Medical University Hospital, China Medical University,
- Department of Obstetrics and Gynecology, Chung-Shan Medical University Hospital, Chung-Shan Medical University, Taichung; and
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Gill BC, Moore C, Damaser MS. Postpartum stress urinary incontinence: lessons from animal models. EXPERT REVIEW OF OBSTETRICS & GYNECOLOGY 2010; 5:567-580. [PMID: 21113428 PMCID: PMC2989536 DOI: 10.1586/eog.10.48] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Postpartum stress urinary incontinence (SUI) is associated with chronic SUI in later life, which is 240% more likely to occur in women who deliver vaginally than those who did not. The etiology of SUI is multifactoral and has been associated with defects in both neuromuscular and structural components of continence. Specifically, clinical studies have demonstrated that pudendal nerve damage occurs during vaginal delivery, supporting the concept that neuromuscular damage to the continence mechanism can result in postpartum SUI. Urethral hypermobility and the loss of pelvic floor support, such as that involved in pelvic organ prolapse, have also been associated with SUI. Animal models provide an opportunity to investigate these injuries, individually and in combination, enabling researchers to gain further insight into their relative contributions to the development of SUI and the effectiveness of potential therapies for it. This article discusses the use of animal models of postpartum SUI in addition to the broad insights into treatment efficacy they provide.
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Affiliation(s)
- Bradley C Gill
- Cleveland Clinic Lerner College of Medicine, Department of Biomedical Engineering, Case Western Reserve University, 10900 Euclid Ave, Cleveland, OH 44195, USA
| | - Courtenay Moore
- Glickman Urological and Kidney Institute, Lerner College of Medicine, Cleveland Clinic, 9500 Euclid Ave, Q10, Cleveland, OH 44195, USA
| | - Margot S Damaser
- Department of Biomedical Engineering, Glickman Urological and Kidney Institute, Lerner College of Medicine, Cleveland Clinic, 9500 Euclid Ave, ND20, Cleveland, OH 44195, USA
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Lee KC, Sharma S, Tuttle JB, Steers WD. Origin and characterization of retrograde labeled neurons supplying the rat urethra using fiberoptic confocal fluorescent microscopy in vivo and immunohistochemistry. J Urol 2010; 184:1550-4. [PMID: 20728104 DOI: 10.1016/j.juro.2010.05.092] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2009] [Indexed: 10/19/2022]
Abstract
PURPOSE Autonomic innervation of urethral smooth muscle may influence urinary continence after prostatectomy. It is unclear whether the cavernous nerves carry fibers that influence continence. Using a retrograde axonal tracer combined with real-time in vivo imaging and ex vivo immunohistochemistry we determined the course and type of neurons supplying urethral smooth muscle distal to the prostate in the rat. MATERIALS AND METHODS We injected the retrograde axonal tracers cholera toxin B fragment-Alexa Fluor 488 and Fast Blue in the distal urethral smooth muscle in 10 rats each. Five days later the cavernous nerves and pelvic ganglion were imaged using fiberoptic confocal fluorescence microscopy (cholera toxin B fragment-Alexa Fluor 488) or harvested for immunohistochemistry (Fast Blue). Dual immunofluorescence of Fast Blue neurons with tyrosine hydroxylase or neuronal nitric oxide synthase was done to characterize neurons as noradrenergic or nitrergic. To ascertain whether the cavernous nerves contain fibers to the urethra that originate in the pelvic ganglia we cut the cavernous nerves with their ancillary branches in 3 rats and imaged them for Fast Blue. RESULTS Fluorescent neurons and axons were detected in cavernous nerves and the pelvic ganglion. Few neurons were seen in rats with cavernous nerve section. Of urethral neurons 53.1% showed neuronal nitric oxide synthase positivity while 40.6% were immunoreactive for tyrosine hydroxylase. About 6.2% of urethral neurons failed to show tyrosine hydroxylase or neuronal nitric oxide synthase immunoreactivity. CONCLUSIONS Most of the autonomic innervation to the urethra beyond the prostatic apex travels in the cavernous nerves. Many nerves may be parasympathetic based on neuronal nitric oxide synthase immunoreactivity. Nerves supplying the urethra outside the cavernous nerves may course posterior to the prostate. Along with afferent fibers, tyrosine hydroxylase immunoreactivity expressing neuron fibers, ie noradrenergic nerves, traveling in the cavernous nerves may increase urethral resistance or regulate the reflex mechanisms controlling continence.
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Affiliation(s)
- Keon-Cheol Lee
- Department of Urology, Inje University School of Medicine, Ilsanpaik Hospital, Goyang-si, Korea
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Proaño AR, Medrano A, Garrido G, Mazza O. [Muscle-derived stem cell therapy for stress urinary incontinence]. Actas Urol Esp 2010; 29 Suppl 1:S36-41. [PMID: 20223129 DOI: 10.1002/nau.20833] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
The knowledge of the urinary effort incontinence (UEI) has increased, giving like result an ample range of different therapeutic options available. The middle urethra and external urethral sphincter are the focus in management of UEI. Stem cells therapy for the regenerative repair of the deficient sphincter has been the leading research of incontinence. Obtaining autologous myoblasts and fibroblasts of skeletal muscle-biopsies, cultivating them and transplanting them after its differentiation, into the external urethral sphincter it warns a new concept in the treatment of the incontinence. Instead of using heterologous materials such as synthetic mesh (slings) or bulking agents (collagen, silicone, etc); we now have the potential to restore function with the use of autologous stem cells.
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Affiliation(s)
- A R Proaño
- División de Urología, Hospital de Clínicas José de San Martín, Universidad de Buenos Aires, Argentina.
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Prantil-Baun R, de Groat WC, Miyazato M, Chancellor MB, Yoshimura N, Vorp DA. Ex vivo biomechanical, functional, and immunohistochemical alterations of adrenergic responses in the female urethra in a rat model of birth trauma. Am J Physiol Renal Physiol 2010; 299:F316-24. [PMID: 20444739 DOI: 10.1152/ajprenal.00299.2009] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Birth trauma and pelvic injury have been implicated in the etiology of stress urinary incontinence (SUI). This study aimed to assess changes in the biomechanical properties and adrenergic-evoked contractile responses of the rat urethra after simulated birth trauma induced by vaginal distension (VD). Urethras were isolated 4 days after VD and evaluated in our established ex vivo urethral testing system that utilized a laser micrometer to measure the urethral outer diameter at proximal, middle, and distal positions. Segments were precontracted with phenylephrine (PE) and then exposed to intralumenal static pressures ranging from 0 to 20 mmHg to measure urethral compliance. After active assessment, the urethra was rendered passive with EDTA and assessed. Pressure and diameter measurements were recorded via computer. Urethral thickness was measured histologically to calculate circumferential stress-strain response and functional contraction ratio (FCR), a measure of smooth muscle activity. VD proximal urethras exhibited a significantly increased response to PE compared with that in controls. Conversely, proximal VD urethras had significantly decreased circumferential stress and FCR values in the presence of PE, suggesting that VD reduced the ability of the proximal segment to maintain smooth muscle tone at higher pressures and strains. Circumferential stress values for VD middle urethral segments were significantly higher than control values. Histological analyses using antibodies against general (protein gene product 9.5) and sympathetic (tyrosine hydroxylase) nerve markers showed a significant reduction in nerve density in VD proximal and middle urethral segments. These results strongly suggest that VD damages adrenergic nerves and alters adrenergic responses of proximal and middle urethral smooth muscle. Defects in urethral storage mechanisms, involving changes in adrenergic regulation, may contribute to stress urinary incontinence induced by simulated birth trauma.
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Jiang HH, Salcedo LB, Song B, Damaser MS. Pelvic floor muscles and the external urethral sphincter have different responses to applied bladder pressure during continence. Urology 2010; 75:1515.e1-7. [PMID: 20206969 DOI: 10.1016/j.urology.2009.11.065] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2009] [Revised: 11/11/2009] [Accepted: 11/24/2009] [Indexed: 11/24/2022]
Abstract
OBJECTIVES To determine the functional innervation of the pelvic floor muscles (PFM) and whether there is PFM activity during an external pressure increase to the bladder in female rats. METHODS Thirty-one female adult virgin Sprague-Dawley rats received an external increase in bladder pressure until urinary leakage was noted while bladder pressure was recorded (leak point pressure [LPP]) under urethane anesthesia. Six of the rats underwent repeat LPP testing after bilateral transection of the levator ani nerve. Another 6 rats underwent repeat LPP testing after bilateral transection of the pudendal nerve. Simultaneous recordings of PFM (pubo- and iliococcygeus muscles), electromyogram (EMG), and external urethral sphincter (EUS) EMG were recorded during cystometry and LPP testing. RESULTS Thirteen rats (42%) showed tonic PFM EMG activity during filling cystometry. Eighteen rats (58%) showed no tonic PFM EMG activity at baseline, but PFM EMG could be activated by pinching the perineal skin. This activity could be maintained unless voiding occurred. The external increase in bladder pressure caused significantly increased EUS EMG activity as demonstrated by increased amplitude and frequency. However, there was no such response in PFM EMG. LPP was not significantly different after levator ani nerve transection, but was significantly decreased after pudendal nerve transection. CONCLUSIONS PFM activity was not increased during external pressure increases to the bladder in female rats. Experimental designs using rats should consider this result. The PFM, unlike the EUS, does not contribute to the bladder-to-urethra continence reflex. PFM strengthening may nonetheless facilitate urinary continence clinically by stabilizing the bladder neck.
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Affiliation(s)
- Hai-Hong Jiang
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio 44195, USA
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Xu DF, Qu CY, Ren JZ, Jiang HH, Yao YC, Min ZL, Zhu YH, Chao L. Impact of tension-free vaginal tape procedure on dysfunctional voiding in women with stress urinary incontinence. Int J Urol 2010; 17:346-52. [PMID: 20202012 DOI: 10.1111/j.1442-2042.2010.02467.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVES To determine the prevalence of dysfunctional voiding (DV) in female stress urinary incontinence (SUI) and its modification after tension-free vaginal tape (TVT) procedure. METHODS Three hundred and sixty women with SUI were enrolled and underwent urodynamics from 2002 to 2008. DV was determined when non-neurogenic detrusor-sphincter dyssynergia occurred during voluntary voiding. It was further quantitatively analyzed using the tense/loose value, a parameter derived from external anal sphincter electromyogram. The distribution of other urodynamic variables was also evaluated. One hundred and fifty patients underwent the TVT procedure and forty of them were studied with urodynamics after surgery during follow up. RESULTS Overall, DV was diagnosed in ninety-nine patients, with a prevalence of 27.5%. The functional profile length in SUI women with DV was significantly shorter than that in SUI women without DV (3.13 +/- 0.76 vs 3.32 +/- 0.65, P = 0.017). After the TVT procedure, the recovery of SUI between cases with and without DV showed no significant difference. The rate of DV state change after the surgery, namely from with to without DV or from without to with DV, significantly differed between the female patients with and without DV (66.7% vs 3.6%, P < 0.05) during follow up. The DV improved after the surgery in SUI women with DV. CONCLUSIONS DV might represent a coexistent finding in women with SUI. The main difference of women with SUI and DV, as compared with those without DV, is a shortened functional profile length. In such cases, TVT procedure can improve DV along with the treatment of SUI.
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Affiliation(s)
- Dan-Feng Xu
- Department of Urology, Changzheng Hospital, Second Military Medical University, Shanghai, China
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Yang Z, Dolber PC, Fraser MO. Differential vulnerabilities of urethral afferents in diabetes and discovery of a novel urethra-to-urethra reflex. Am J Physiol Renal Physiol 2009; 298:F118-24. [PMID: 19864303 DOI: 10.1152/ajprenal.00281.2009] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Urethral reflexes are important regulators of micturition, and impairment of urethral afferent neuronal function may disrupt coordinated bladder and urethral activity, thereby contributing to voiding dysfunction in lower urinary tract disorders. Chemical stimulation by intraurethral irritant solution perfusion was used to determine whether urethral afferent neuronal function is altered in diabetes mellitus (DM). Sprague-Dawley rats were studied 10 wk after streptozotocin injection to induce DM or vehicle alone. Escalating doses of capsaicin (0.1-30 microM) or acetic acid (0.01-1%; AA) were perfused intraurethrally while recording isovolumetric bladder activity, urethral perfusion pressure, and electromyography of the external urethral sphincter (EUS-EMG). Some rats were additionally treated with alpha-bungarotoxin, hexamethonium, or bilateral transection of the sensory branches of the pudendal nerves (PudSNx). Intraurethral capsaicin inhibited bladder contractions in six out of seven control rats but not in any of six DM rats. Low-frequency oscillations (LFOs) of intraurethral pressure were observed in five out of six control rats with capsaicin-induced bladder inhibition. In contrast, intraurethral AA inhibited bladder contractions and enhanced tonic EUS-EMG activity in six out of six control and five out of six DM rats. LFOs occurred in four out of six control and three of five DM rats with AA-induced bladder inhibition. Chemically induced bladder inhibition and LFOs were not prevented by alpha-bungarotoxin but were eliminated by PudSNx and hexamethonium. Finally, LFOs were followed by phasic EUS activity. These findings show that DM affects urethral afferent neurons differentially, compromising those expressing TRPV1 receptors. Urethral smooth muscle LFOs are neurogenically mediated and induce EUS activity, revealing the existence of a hitherto undescribed reflex pathway: a smooth-to-striated muscle urethra-to-urethra reflex.
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Affiliation(s)
- Zhongguang Yang
- Division of Urology, Department of Surgery, Veterans Affairs Medical Center, Durham, North Carolina, USA
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Kamo I, Kaiho Y, Miyazato M, Torimoto K, Yoshimura N. Two kinds of urinary continence reflexes during abrupt elevation of intravesical pressure in rats. Low Urin Tract Symptoms 2009; 1:S40-S43. [PMID: 21151773 DOI: 10.1111/j.1757-5672.2009.00026.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Urethral closure mechanisms during abrupt elevation of intravesical pressure (P(ves)) were investigated. During sneezing, the middle urethral closing response was observed and it still remained after opening the abdomen. The middle urethral response was almost completely abolished after bilateral transection of somatic nerves innervating the external urethral sphincter and the pelvic floor muscles, while bilateral transection of both pelvic nerves and hypogastric nerves had no effects. Somatic nerve transection resulted in fluid leakage from the urethral orifice during sneezing. Passive increments of P(ves) for 120 seconds by elevating a saline reservoir connected to the bladder also induced the middle urethral closing response in rats with spinal cord transection at T8-T9. The response was totally abolished by cutting pelvic nerves bilaterally, and partially reduced after bilateral transection of pudendal nerves, nerves to pelvic floor muscles or hypogastric nerves. Electrical stimulation of abdominal muscles (ESAM) for 1 second elevated P(ves) in a stimulus-dependent manner in the spinal cord-transected rats, and the P(ves) rise was almost lost when the abdomen was opened. The P(ves) inducing fluid leakage from the urethral orifice was lowered in rats when pelvic nerves or somatic nerves were cut bilaterally, while transection of bilateral hypogastric nerves showed smaller effects. These results indicate that at least two kinds of urinary continence reflexes close the middle urethra during abrupt elevation of P(ves); one reflex observed during sneeze is preprogrammed so as to close the urethra automatically irrespective of bladder afferent activity, and the other reflex is triggered by bladder afferent excitation. During momentary stress events such as sneezing (<0.15 seconds) and ESAM (1 second), the striated muscles mainly contribute to the urethral closure, while during events for a relatively long period like passive P(ves) elevation for 120 seconds, both striated and smooth muscles are involved in the prevention of stress urinary incontinence.
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Affiliation(s)
- Izumi Kamo
- Departments of Urology, University of Pittsburgh School of Medicine, Pittsburgh, PA
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Furuta A, Asano K, Egawa S, de Groat WC, Chancellor MB, Yoshimura N. Role of alpha2-adrenoceptors and glutamate mechanisms in the external urethral sphincter continence reflex in rats. J Urol 2009; 181:1467-73. [PMID: 19157445 DOI: 10.1016/j.juro.2008.11.008] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2008] [Indexed: 11/24/2022]
Abstract
PURPOSE We investigated the role of alpha(2)-adrenoceptors and glutamate mechanisms in the urethral continence reflex in response to abdominal pressure increases. MATERIALS AND METHODS Under urethane anesthesia external urethral sphincter electromyogram activity was evaluated in spinal cord transected (T8-T9) female rats during lower abdominal wall compression before and after intravenous application of test drugs. The effects of the N-methyl-D-aspartate glutamate receptor antagonist MK-801 (Sigma) or the alpha(2)-adrenoceptor agonist medetomidine (Tocris Cookson, Ellisville, Missouri) (each 0.03, 0.3 and 3 mg/kg intravenously) on external urethral sphincter activity were examined. A 0.3 mg/kg intravenous dose of the alpha(2)-adrenoceptor antagonist idazoxan (Sigma) was then administered before or after the application of 1 mg/kg MK-801 intravenously. In addition, 0.3 mg/kg idazoxan were administered intravenously following the application of 1 mg/kg of the serotonin/norepinephrine reuptake inhibitor duloxetine (Kemprotec, Middlesbrough, United Kingdom) intravenously. RESULTS MK-801 and medetomidine dose dependently decreased external urethral sphincter activity. Idazoxan significantly increased external urethral sphincter activity by 64% but the increase in activity after idazoxan was abolished by MK-801. On the other hand, idazoxan did not reverse the inhibitory effects of MK-801. In addition, idazoxan significantly potentiated the duloxetine effects on external urethral sphincter activity by 120%. CONCLUSIONS These results indicate that 1) glutamate is a major excitatory neurotransmitter in the urethral continence reflex response to abdominal pressure increases, 2) alpha(2)-adrenoceptor activation suppresses external urethral sphincter activity, probably via presynaptic inhibition of glutamate release and 3) the effects of serotonin/norepinephrine reuptake inhibitors are enhanced by alpha(2)-adrenoceptor inhibition. Therefore, alpha(2)-adrenoceptor antagonists could be beneficial for treating stress urinary incontinence.
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Affiliation(s)
- Akira Furuta
- Department of Urology, Jikei University School of Medicine, Tokyo, Japan
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Pauwels E, De Wachter S, Wyndaele JJ. Evaluation of different techniques to create chronic urinary incontinence in the rat. BJU Int 2008; 103:782-5; discussion 785-6. [PMID: 19007361 DOI: 10.1111/j.1464-410x.2008.08158.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To evaluate models for chronic urinary incontinence (UI) in the rat. MATERIALS AND METHODS Two models were fully evaluated: one of repeated dilatation of the vagina, simulating birth trauma, the vaginal dilatation (VD) group; the other, with surgical transposition of the urethra to a vertical position, the urethral transposition (UT) group. The VD rats were evaluated by the sneeze test. When negative, vaginal dilatation was repeated in a similar way. The UT group was evaluated by observation of continuous urine leakage. The leak-point pressure (LPP) was measured at study end in all the rats. RESULTS All the VD rats had occasional negative sneeze tests and all had to be dilated again. This resulted in persistent UI on sneeze testing for the entire period. In the UT group, 12 rats leaked continuously during the whole study period; in the other four UI became less at 4, 5, 6, and 7 weeks, respectively. The LPP in the rats with UI was significantly lower than in the respective control groups. CONCLUSIONS These models permit study of chronic stress UI and continuous UI in the rat. Spontaneous recovery of continence was seen mostly in the VD group.
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Affiliation(s)
- Elisabeth Pauwels
- Department of Urology, Faculty of Medicine, University Antwerp, Antwerp, Belgium
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Jankowski R, Pruchnic R, Wagner D, Chancellor MB. Regenerative Therapy for Stress Urinary Incontinence. Tzu Chi Med J 2008. [DOI: 10.1016/s1016-3190(08)60032-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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Effects of acupuncture on abdominal leak point pressure and c-Fos expression in the brain of rats with stress urinary incontinence. Neurosci Lett 2008; 439:18-23. [DOI: 10.1016/j.neulet.2008.04.100] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2008] [Revised: 04/29/2008] [Accepted: 04/30/2008] [Indexed: 11/22/2022]
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Bernabé J, Julia-Guilloteau V, Denys P, Chartier-Kastler E, Alexandre L, Peeters M, Giuliano F. Peripheral neural lesion-induced stress urinary incontinence in anaesthetized female cats. BJU Int 2008; 102:1162-7. [PMID: 18549429 DOI: 10.1111/j.1464-410x.2008.07795.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
OBJECTIVES To characterize the effect of acute unilateral and bilateral lesion of the pelvic and pudendal nerves, and nerves innervating the iliococcygeous and pubococcygeous muscles during sneezing in anaesthetized female cats, on intravesical pressure (IVP), urethral pressure (UPs) and external urethral sphincter (EUS) activity. MATERIALS AND METHODS In seven anaesthetized female cats UPs along the urethra (UPs1-4) and IVPs were recorded in the emptied bladder during sneezing before and after unilateral and then bilateral peripheral neural lesions. UPs were measured using microtip transducer catheters with UP4 positioned in the distal urethra where the EUS is located. Urine leakage was also noted, after urethral catheter removal and bladder filling. RESULTS During sneezing, in intact cats, the magnitude of UP4 was larger than those of IVP and UPs1-3. The area under the curve of both anal sphincter and EUS electromyography was increased. There was no urine leakage. After unilateral neural lesions, the mean magnitude of response was similar all along the urethra and in the bladder. The distal UP response was significantly lower than that recorded in intact cats. In addition, there was urine leakage in six of the seven cats. Bilateral neural lesions caused permanent urine leakage and significant decreases in all the UP responses. CONCLUSION In female cats, during sneezing, neurally driven reflex contractions of EUS leading to an increase in distal UP contribute to active urethral closure mechanisms and ensure urinary continence.
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Affiliation(s)
- Jacques Bernabé
- Pelvipharm, Orsay, Raymond Poincaré Hospital, Garches, France
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