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Hennenberg M, Michel MC. Adrenoceptors in the Lower Urinary Tract. Handb Exp Pharmacol 2023. [PMID: 37455288 DOI: 10.1007/164_2023_678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/18/2023]
Abstract
Adrenoceptors importantly contribute to the physiological regulation of lower urinary tract (LUT) function and have become a target of several clinically successful treatments for major LUT diseases. In the bladder dome, β-adrenoceptor subtypes are found in multiple cell types and mediate relaxation of detrusor smooth muscle, perhaps partly indirectly by acting on afferent nerves and cells of the mucosa. β3-adrenoceptor agonists such as mirabegron and vibegron are used to treat overactive bladder syndrome. In the bladder trigone and urethra, α1-adrenoceptors cause contraction and thereby physiologically contribute to bladder outlet resistance. α1-adrenoceptors in the prostate also cause contraction and pathophysiologically elevate bladder outlet resistance leading to voiding dysfunction in benign prostatic hyperplasia. α1-adrenoceptor antagonist such as tamsulosin is widely used as a first-line option to treat LUT symptoms in men, but it remains unclear to which extent and how smooth muscle relaxation contributes to symptom relief.
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Affiliation(s)
- Martin Hennenberg
- Department of Urology, University Hospital, LMU Munich, Munich, Germany
| | - Martin C Michel
- Department of Pharmacology, University Medical Center, Johannes Gutenberg University, Mainz, Germany.
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Ding N, Liu J, Liu J, Zhao M, Liu L, Liu H, Yan J, Song W, Wen J, Zu S, Zhang X, Xu Y. The enhancing effect of 5-HT on phasic contractions of human isolated distal ureter and the mechanisms mediating these effects. Eur J Pharmacol 2023; 949:175715. [PMID: 37059373 DOI: 10.1016/j.ejphar.2023.175715] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Revised: 04/07/2023] [Accepted: 04/11/2023] [Indexed: 04/16/2023]
Abstract
5-Hydroxytryptamine (5-HT) can enhance human ureteral contractions. However, the mediating receptors have not been clarified. This study sought to further characterize the mediating receptors using several selective antagonists and agonists. Human distal ureters were obtained from 92 patients undergoing cystectomy. The mRNA expression levels of 5-HT receptors were examined using RT-qPCR experiments. The phasic contractions of ureter strips, either spontaneous or evoked with neurokinin, were recorded in an organ bath. Among the 13 5-HT receptors, 5-HT2A and 5-HT2C receptors showed the highest mRNA expression levels. 5-HT (10-7-10-4 M) increased the frequency and baseline tension of phasic contractions in a concentration-dependent manner. However, a desensitization effect was observed. The 5-HT2C receptor selective antagonist, SB242084 (10,30,100nM), shifted the 5-HT concentration-response curves (frequency and baseline tension) rightward with a pA2 value of 8.05 and 7.75, respectively. 5-HT2C receptor selective agonist, vabicaserin, increased contraction frequency with an Emax of 35% of 5-HT. 5-HT2A receptor selective antagonist, volinanserin (1,10,100 nM), only reduced baseline tension with a pA2 of 8.18. The selective antagonists of 5-HT1A,1B, 1D, 2B, 3, 4, 5, 6, and 7 had no antagonism. Blockade of voltage-gated sodium channels, α1-adrenergic receptors, adrenergic neurotransmission, and neurokinin-2 receptors using tetrodotoxin, tamsulosin, guanethidine, and Men10376, respectively, and desensitization of sensory afferents using capsaicin (100 μM), significantly reduced 5-HT effects. We conclude that 5-HT enhanced ureteral phasic contractions mainly by activating 5-HT2C and 5-HT2A receptors. Sympathetic nerve and sensory afferents partly contributed to 5-HT effects. 5-HT2C and 5-HT2A receptors could be promising targets for ureteral stone expulsion.
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Affiliation(s)
- Ning Ding
- Department of Urology, The Second Hospital of Shandong University, Jinan, China
| | - Jiaxin Liu
- Department of Urology, The Second Hospital of Shandong University, Jinan, China; Department of Kidney Transplantation, The Second Hospital of Shandong University, Jinan, China
| | - Jianing Liu
- Department of Kidney Transplantation, The Second Hospital of Shandong University, Jinan, China
| | - Mengmeng Zhao
- Department of Urology, The Second Hospital of Shandong University, Jinan, China
| | - Lei Liu
- Department of Urology, The Second Hospital of Shandong University, Jinan, China
| | - Hanwen Liu
- Department of Urology, The Second Hospital of Shandong University, Jinan, China
| | - Jieke Yan
- Department of Kidney Transplantation, The Second Hospital of Shandong University, Jinan, China
| | - Wei Song
- Department of Urology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
| | - Jiliang Wen
- Department of Urology, The Second Hospital of Shandong University, Jinan, China
| | - Shulu Zu
- Department of Urology, The Second Hospital of Shandong University, Jinan, China
| | - Xiulin Zhang
- Department of Urology, The Second Hospital of Shandong University, Jinan, China
| | - Yang Xu
- Department of Urology, The Second Hospital of Shandong University, Jinan, China.
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Moss AL, Acutt EV, Ullal T, Applegate TJ, Hackett ES. Ureteropyeloscopic removal of a nephrolith from a 19 year old Hanoverian gelding. Vet Surg 2022; 51 Suppl 1:O53-O59. [PMID: 35535970 DOI: 10.1111/vsu.13815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Revised: 03/07/2022] [Accepted: 03/27/2022] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To describe the ureteropyeloscopic removal of a nephrolith in a horse. ANIMALS A 19 year old Hanoverian gelding with history of urolithiasis requiring surgical intervention. STUDY DESIGN Case report METHODS: The horse presented with signs of abdominal straining and stranguria. A proximal urethral calculus was palpable externally within the perineal urethra. Perineal urethrostomy (PU) at the location of the urethral calculi was performed to remove the urethral obstruction. Left nephrolithiasis was then treated by endoscopic retrieval, inserting the endoscope through the PU. The procedures were performed over 2 consecutive days, with the horse standing and sedated. Medical therapy included antimicrobial and anti-inflammatory treatment. RESULTS The ureteropyeloscopic removal of a nephrolith from the left renal pelvis was completed. No complications were appreciated following the procedure, and the horse was able to return to athletic activity within 2 weeks. The horse had no further clinical signs referable to urinary dysfunction 7 months later. CONCLUSION Ureteropyeloscopic removal of a nephrolith from the renal pelvis is technically feasible in the equine patient and preserves function of the affected kidney. The availability of a treatment that maintains renal function is a distinct benefit over unilateral nephrectomy, particularly when treating a condition that frequently involves both kidneys.
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Affiliation(s)
- Alexandra L Moss
- College of Veterinary Medicine and Biomedical Sciences, Colorado State University, Fort Collins, Colorado, USA
| | - Elizabeth V Acutt
- College of Veterinary Medicine and Biomedical Sciences, Colorado State University, Fort Collins, Colorado, USA
| | - Tarini Ullal
- College of Veterinary Medicine and Biomedical Sciences, Colorado State University, Fort Collins, Colorado, USA
| | - Tanya J Applegate
- College of Veterinary Medicine and Biomedical Sciences, Colorado State University, Fort Collins, Colorado, USA
| | - Eileen S Hackett
- College of Veterinary Medicine and Biomedical Sciences, Colorado State University, Fort Collins, Colorado, USA.,College of Veterinary Medicine, Cornell University, Ithaca, New York, USA
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Kolupayev SM, Heletka OO, Lisova MA. FEATURES OF THE APPLICATION OF COMBINED EXPULSIVE THERAPY IN THE COMPLEX TREATMENT OF PATIENTS WITH URETERAL STONES. BULLETIN OF PROBLEMS BIOLOGY AND MEDICINE 2022. [DOI: 10.29254/2077-4214-2022-3-166-209-215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Zhang X, Liu X, Ye Q, Wang X, Chen J, Wang Z, Zhao P, Tao B, Xu G, Xu W, Wu K, Xiao Y, Yang L, Tian J, Wang J, Dong Z, Wang Z. Acupuncture versus Lornoxicam in the Treatment of Acute Renal Colic: A Randomized Controlled Trial. J Pain Res 2021; 14:3637-3648. [PMID: 34876848 PMCID: PMC8643168 DOI: 10.2147/jpr.s339006] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Accepted: 11/13/2021] [Indexed: 12/15/2022] Open
Abstract
Objective To compare the analgesic efficacy and safety of acupuncture and lornoxicam in acute renal colic (ARC). Design, Setting, Participant A randomized, double-blind, parallel-controlled, single-centered trial was conducted at Susong County People’s Hospital from October 2019 to November 2020. Eighty-four patients with ARC were randomly divided into lornoxicam group (Group L) and acupuncture group (Group A). Group A was treated with acupuncture at Sanyinjiao (SP6), Yinlingquan (SP9) and normal saline, and Group L was treated with sham acupuncture at SP6, SP9 and lornoxicam. Main Outcome Measures Visual analogue scale (VAS) scores and adverse reactions such as nausea and dizziness were recorded within 5, 10, 15, 20 and 40 minutes after treatment. The main outcome of this study was the short-term effective (STE) rate, the secondary outcome was the onset time, and the safety index was incidence of adverse reactions. Results A total of 80 patients completed this study, including 41 patients (21 males and 20 females) in Group L and 39 patients (21 males and 18 females) in Group A. Group A exhibited lower scores versus group L after treatment (P < 0.05). The overall STE of group L was 61.00% (25/41), significantly lower than group A [84.62% (33/39)] (P < 0.001). There was no difference in the incidence of adverse reactions between group A [2.6% (1/39)] and group L [7.3% (3/41)] (P = 0.616). The ordered logistic regression analysis showed patients receiving acupuncture therapy are more likely to be cured [OR = 2.887, 95% CI: (1.190, 7.000), P = 0.019]. Conclusion Acupuncture at SP6, SP9 and intramuscular injection of lornoxicam can effectively and safely relieve ARC, but the former has faster and better analgesic effect. Moreover, the incidence of adverse reactions was similar between the two treatments. This acupuncture therapy is recommended as a complementary therapy for ARC.
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Affiliation(s)
- Xiaohua Zhang
- Institute of Urology, Lanzhou University Second Hospital; Key Laboratory of Gansu Province for Urological Diseases; Gansu Nephro-Urological Clinical Center, Lanzhou, Gansu Province, People's Republic of China
| | - Xinguo Liu
- Department of Urology, Susong County People's Hospital, Susong, Anhui Province, People's Republic of China
| | - Qiongxiang Ye
- Department of Urology, Susong County People's Hospital, Susong, Anhui Province, People's Republic of China
| | - Xunbao Wang
- Department of Urology, Susong County People's Hospital, Susong, Anhui Province, People's Republic of China
| | - Jinjun Chen
- Department of Urology, Susong County People's Hospital, Susong, Anhui Province, People's Republic of China
| | - Zhiyong Wang
- Department of Urology, Susong County People's Hospital, Susong, Anhui Province, People's Republic of China
| | - Pengfei Zhao
- Department of Urology, Susong County People's Hospital, Susong, Anhui Province, People's Republic of China
| | - Baozhou Tao
- Department of Urology, Susong County People's Hospital, Susong, Anhui Province, People's Republic of China
| | - Guoping Xu
- Department of Urology, Susong County People's Hospital, Susong, Anhui Province, People's Republic of China
| | - Wanfeng Xu
- Department of Urology, Susong County People's Hospital, Susong, Anhui Province, People's Republic of China
| | - Kan Wu
- Department of Urology, Susong County People's Hospital, Susong, Anhui Province, People's Republic of China
| | - Yao Xiao
- Department of Pediatrics, Lanzhou University Second Hospital, Lanzhou, Gansu Province, People's Republic of China
| | - Li Yang
- Institute of Urology, Lanzhou University Second Hospital; Key Laboratory of Gansu Province for Urological Diseases; Gansu Nephro-Urological Clinical Center, Lanzhou, Gansu Province, People's Republic of China
| | - Junqiang Tian
- Institute of Urology, Lanzhou University Second Hospital; Key Laboratory of Gansu Province for Urological Diseases; Gansu Nephro-Urological Clinical Center, Lanzhou, Gansu Province, People's Republic of China
| | - Juan Wang
- Institute of Urology, Lanzhou University Second Hospital; Key Laboratory of Gansu Province for Urological Diseases; Gansu Nephro-Urological Clinical Center, Lanzhou, Gansu Province, People's Republic of China
| | - Zhilong Dong
- Institute of Urology, Lanzhou University Second Hospital; Key Laboratory of Gansu Province for Urological Diseases; Gansu Nephro-Urological Clinical Center, Lanzhou, Gansu Province, People's Republic of China
| | - Zhiping Wang
- Institute of Urology, Lanzhou University Second Hospital; Key Laboratory of Gansu Province for Urological Diseases; Gansu Nephro-Urological Clinical Center, Lanzhou, Gansu Province, People's Republic of China
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Liu J, Zhao M, Chen Z, Xu Y, Guo L, Wang S, Li Y, Shi B, Zhang X, Jin XD. TRPM3 channel activation inhibits contraction of the isolated human ureter via CGRP released from sensory nerves. Life Sci 2021; 268:118967. [PMID: 33417951 DOI: 10.1016/j.lfs.2020.118967] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Revised: 12/18/2020] [Accepted: 12/21/2020] [Indexed: 11/29/2022]
Abstract
AIMS Sensory nerve activation modulates ureteral contractility by releasing neuropeptides including CGRP and neurokinin A (NKA). TRPM3 is a recently discovered thermosensitive channel expressed in nociceptive sensory neurons, and plays a key role in heat nociception and chronic pain. The aim of this study is to examine the role of TRPM3 activation in human ureter motility. MAIN METHOD Human proximal ureters were obtained from fourteen patients undergoing nephrectomy. Spontaneous or NKA-evoked contractions of longitudinal ureter strips were recorded in an organ bath. Ureteral TRPM3 expression was examined by immunofluorescence. KEY FINDINGS Spontaneous contractions were observed in 60% of examined strips. TRPM3 activation using pregnenolone sulphate (PS) or CIM0216 (specific TRPM3 agonists) dose-dependently reduced the frequency of spontaneous and NKA-evoked contractions, with IC50s of 241.7 μM and 4.4 μM, respectively. The inhibitory actions of TRPM3 agonists were mimicked by CGRP (10 to 100 nM) or a cAMP analogue (8-Br-cAMP; 1 mM). The inhibitory actions of TRPM3 agonists (300 μM PS or 30 μM CIM0216) were blocked by pretreatment with primidone (TRPM3 antagonist; 30 μM), tetrodotoxin (sodium channel blocker; 1 μM), olcegepant (CGRP receptor antagonist; 10 μM), or H89 (non-specific PKA inhibitor; 30 μM). TRPM3 was co-expressed with CGRP in nerves in the sub-urothelial and intermuscular regions of the ureter. SIGNIFICANCE TRPM3 channels expressed on sensory terminals of the human ureter involve in inhibitory sensory neurotransmission and modulate ureter motility via the CGRP-cAMP-PKA signal pathway. Targeting TRPM3 may be a pharmacological strategy for promoting the ureter stone passage.
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Affiliation(s)
- Jiaxin Liu
- The First Affiliated Hospital, College of Medicine, Zhejiang University, China
| | - Mengmeng Zhao
- Department of Urology, The Second Hospital, Cheeloo College of Medicine, Shandong University, China
| | - Zhenghao Chen
- Department of Urology, The Second Hospital, Cheeloo College of Medicine, Shandong University, China
| | - Yang Xu
- Department of Urology, The Second Hospital, Cheeloo College of Medicine, Shandong University, China
| | - Liqiang Guo
- Department of Urology, The Second Hospital, Cheeloo College of Medicine, Shandong University, China
| | - Shaoyong Wang
- Department of Urology, The Second Hospital, Cheeloo College of Medicine, Shandong University, China
| | - Yan Li
- Department of Urology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, China
| | - Benkang Shi
- Department of Urology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, China
| | - Xiulin Zhang
- Department of Urology, The Second Hospital, Cheeloo College of Medicine, Shandong University, China.
| | - Xiao-Dong Jin
- The First Affiliated Hospital, College of Medicine, Zhejiang University, China.
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7
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Goka SQ, Copelovitch L. Medical Expulsive Therapy for Urinary Stone Disease in Children. Indian Pediatr 2020. [DOI: 10.1007/s13312-020-1999-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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8
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Lim I, Chess-Williams R, Sellers D. A porcine model of ureteral contractile activity: Influences of age, tissue orientation, region, urothelium, COX and NO. J Pharmacol Toxicol Methods 2020; 102:106661. [DOI: 10.1016/j.vascn.2019.106661] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Revised: 11/07/2019] [Accepted: 12/03/2019] [Indexed: 10/25/2022]
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9
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Lee CX, Cheah JH, Soule CK, Ding H, Whittaker CA, Karhohs K, Burds AA, Subramanyam KS, Carpenter AE, Eisner BH, Cima MJ. Identification and local delivery of vasodilators for the reduction of ureteral contractions. Nat Biomed Eng 2019; 4:28-39. [PMID: 31792422 DOI: 10.1038/s41551-019-0482-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2018] [Accepted: 10/15/2019] [Indexed: 01/23/2023]
Abstract
Kidney stones and ureteral stents can cause ureteral colic and pain. By decreasing contractions in the ureter, clinically prescribed oral vasodilators may improve spontaneous stone passage rates and reduce the pain caused by ureteral stenting. We hypothesized that ureteral relaxation can be improved via the local administration of vasodilators and other smooth muscle relaxants. Here, by examining 18 candidate small molecules in an automated screening assay to determine the extent of ureteral relaxation, we show that the calcium channel blocker nifedipine and the Rho-kinase inhibitor ROCKi significantly relax human ureteral smooth muscle cells. We also show, by using ex vivo porcine ureter segments and sedated pigs that, with respect to the administration of a placebo, the local delivery of a clinically deployable formulation of the two drugs reduced ureteral contraction amplitude and frequency by 90% and 50%, respectively. Finally, we show that standard oral vasodilator therapy reduced contraction amplitude by only 50% and had a minimal effect on contraction frequency. Locally delivered ureteral relaxants therefore may improve ureter-related conditions.
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Affiliation(s)
- Christopher X Lee
- Harvard-MIT Division of Health Sciences and Technology, Massachusetts Institute of Technology, Cambridge, MA, USA.,David H. Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Jaime H Cheah
- David H. Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Christian K Soule
- David H. Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Huiming Ding
- The Barbara K. Ostrom (1978) Bioinformatics and Computing Facility in the Swanson Biotechnology Center, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Charles A Whittaker
- The Barbara K. Ostrom (1978) Bioinformatics and Computing Facility in the Swanson Biotechnology Center, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Kyle Karhohs
- Broad Institute of Massachusetts Institute of Technology and Harvard, Cambridge, MA, USA
| | - Aurora A Burds
- David H. Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Kriti S Subramanyam
- Harvard-MIT Division of Health Sciences and Technology, Massachusetts Institute of Technology, Cambridge, MA, USA.,David H. Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Anne E Carpenter
- Broad Institute of Massachusetts Institute of Technology and Harvard, Cambridge, MA, USA
| | - Brian H Eisner
- Department of Urology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Michael J Cima
- Harvard-MIT Division of Health Sciences and Technology, Massachusetts Institute of Technology, Cambridge, MA, USA. .,David H. Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA, USA. .,Department of Material Science Engineering, Massachusetts Institute of Technology, Cambridge, MA, USA.
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Excitation-Contraction Coupling in Ureteric Smooth Muscle: Mechanisms Driving Ureteric Peristalsis. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2019; 1124:103-119. [DOI: 10.1007/978-981-13-5895-1_4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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Silodosin: An Update on Efficacy, Safety and Clinical Indications in Urology. Adv Ther 2019; 36:1-18. [PMID: 30523608 DOI: 10.1007/s12325-018-0854-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2018] [Indexed: 12/16/2022]
Abstract
INTRODUCTION Silodosin determines smooth muscle relaxation in bladder and prostate tissues, increases bladder blood flow in conditions of chronic bladder ischemia and regulates the activity of transcriptional factors responsible for stromal growth and prostate hyperplasia. Phase III trials have already demonstrated the efficacy and safety of silodosin in the treatment of patients bothered by lower urinary tract symptoms (LUTS) secondary to benign prostatic hyperplasia (BPH). OBJECTIVE We aimed to describe the rationality for the use of silodosin and to summarize the current literature on the use of Silodosin for the treatment of LUTS. METHODS PubMed and Web of Science were queried with the terms: 'silodosin' in combination (AND) with the terms 'lower urinary tract symptoms', 'LUTS', 'pathophysiology', 'symptoms' OR 'therapy'. Studies published in the last 10 years (2007-2017) in adults and core clinical journals in English were included. RESULTS Silodosin 8 mg once-daily was superior to placebo in improving IPSS total score, voiding subscore, storage subscore and QoL score, and at least as effective as tamsulosin 0.4 mg once-daily in all the efficacy analyses. In addition, studies assessing the effect on urodynamic parameters showed that silodosin determined a higher improvement in the bladder outlet obstruction index compared to other alpha1 adrenergic receptor antagonists. Concerning the safety profile, long-term data (after 9 months of treatment) confirmed the limited effect of silodosin on the cardiovascular and gastrointestinal systems. Although ejaculatory disorders represented the main complaint of patients taking silodosin, the discontinuation rate due to this condition remained low even in a long-term follow-up study (7.5%). Encouraging findings showed that silodosin may be administered as a medical expulsive therapy for promoting spontaneous stone passage of distal ureteral stones < 10 mm, to relieve LUTS in patients who underwent prostate cancer brachytherapy and to increase the likelihood of successful trials without a catheter in patients experiencing acute urinary retention. CONCLUSION Silodosin is one of the drugs approved for the treatment of BPH, being highly effective in improving not only LUTS but also urodynamic parameter impairments secondary to BPH. Moreover, it has shown efficacy as medical expulsive therapy for distal ureteral stones in previous prospective randomized trials. FUNDING Sponsorship for this study and article processing charges were funded by Recordati.
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Roedel M, Ravens U, Kasper M, Wirth MP, Jepps TA, Propping S. Contractile responses in intact and mucosa-denuded human ureter—a comparison with urinary bladder detrusor preparations. Naunyn Schmiedebergs Arch Pharmacol 2018; 391:773-782. [DOI: 10.1007/s00210-018-1505-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2017] [Accepted: 04/17/2018] [Indexed: 11/28/2022]
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Role of rho-kinase (ROCK) in tonic but not phasic contraction in the frog stomach smooth muscle. Life Sci 2018; 198:46-55. [PMID: 29455004 DOI: 10.1016/j.lfs.2018.02.023] [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] [Received: 02/06/2018] [Revised: 02/14/2018] [Accepted: 02/15/2018] [Indexed: 01/17/2023]
Abstract
AIMS Rho/Rho-kinase (ROCK) signaling has extensively been shown to take part in mammalian smooth muscle contractions in response to diverse agents yet its role in the contraction of amphibian smooth muscle has not been investigated. Therefore, we aimed to explore any role of this pathway in the contractions of frog stomach smooth. MAIN METHODS The strips were prepared and suspended in organ baths filled with Ringer solution. Changes in the circular strips of the frog stomach muscle length were recorded isotonically with a force transducer in organ baths. KEY FINDINGS Carbachol (CCh) exerted both phasic and tonic contractions. In contrast, atropin abolished all types of contractions by CCh. The phasic contractions were suppressed by a Ca2+ channel blocker, nifedipine but not by the ROCK inhibitor, Y-27632. However, the tonic contractions were markedly attenuated by Y-27632. Selective M1 receptor blocker, pirenzepin, selective M3 receptor blocker and DAMP had no effects on CCh-elicited contractions. On the other hand, selective M2 receptor blocker, AF-DX suppressed all types of contractile activity by CCh. SIGNIFICANCE These data suggest that M2 receptor activation could mainly mediate CCh-induced phasic and tonic contractions, and ROCK seems to be involved in the CCh-induced tonic but not phasic contractions of the frog stomach smooth muscle.
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Osther PJS. Risks of flexible ureterorenoscopy: pathophysiology and prevention. Urolithiasis 2017; 46:59-67. [PMID: 29151117 DOI: 10.1007/s00240-017-1018-6] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2017] [Accepted: 11/11/2017] [Indexed: 11/26/2022]
Abstract
Currently, indications for flexible ureterorenoscopy (fURS) are expanding, mainly due to technological advancements. Although data from clinical series definitely presents fURS as a safe procedure, serious complications including sepsis and ureteral lesions do occur. These complications seem to be a result of the unique elements of fURS, ureteral access and irrigation, pushing normal upper urinary tract physiology into pathophysiological processes, including intrarenal/pyelo-veneous backflow and ureteral contractions, potentially resulting in septic, haemorrhagic and ureteral lesional complications. Knowledge on normal upper urinary tract physiology are crucial for understanding how these harmful effects of fURS may be avoided or minimized. The pathophysiology of intrarenal pressure increases and ureteral access will be discussed as a basis for understanding preventive measures. Role of antibiotics, ureteral access sheaths, safty guidewires, pain medication, prestenting and pharmacologic modulation of pyeloureteral dynamics are reviewed from a pathophysiological perspective.
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Affiliation(s)
- Palle J S Osther
- Urological Research Center, Department of Urology, Lillebaelt Hospital, Beridderbakken 4, 7100, Vejle, Denmark.
- Department of Regional Health Research, Faculty of Health Sciences, University of Southern Denmark, Vejle, Denmark.
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Kazama I, Nakajima T. Postrenal acute kidney injury in a patient with unilateral ureteral obstruction caused by urolithiasis: A case report. Medicine (Baltimore) 2017; 96:e8381. [PMID: 29069033 PMCID: PMC5671866 DOI: 10.1097/md.0000000000008381] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
RATIONALE In patients with bilateral ureteral obstruction, the serum creatinine levels are often elevated, sometimes causing postrenal acute kidney injury (AKI). In contrast, those with unilateral ureteral obstruction present normal serum creatinine levels, as long as their contralateral kidneys are preserved intact. However, the unilateral obstruction of the ureter could affect the renal function, as it humorally influences the renal hemodynamics. PATIENT CONCERNS A 66-year-old man with a past medical history of hypertension and diabetes mellitus came to our outpatient clinic because of right abdominal dullness. DIAGNOSES Unilateral ureteral obstruction caused by a radio-opaque calculus in the right upper ureter and a secondary renal dysfunction. INTERVENTIONS As oral hydration and the use of calcium antagonists failed to allow the spontaneous stone passage, extracorporeal shock wave lithotripsy (ESWL) was performed. OUTCOMES Immediately after the passage of the stone, the number of red blood cells in the urine was dramatically decreased and the serum creatinine level almost returned to the normal range with the significant increase in glomerular filtration rate. LESSONS Unilateral ureteral obstruction by the calculus, which caused reflex vascular constriction and ureteral spasm in the contralateral kidney, was thought to be responsible for the deteriorating renal function.
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Affiliation(s)
- Itsuro Kazama
- Department of Physiology, Tohoku University Graduate School of Medicine, Seiryo-cho, Aoba-ku
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Burnstock G. Purinergic Signalling: Therapeutic Developments. Front Pharmacol 2017; 8:661. [PMID: 28993732 PMCID: PMC5622197 DOI: 10.3389/fphar.2017.00661] [Citation(s) in RCA: 263] [Impact Index Per Article: 37.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2017] [Accepted: 09/05/2017] [Indexed: 12/15/2022] Open
Abstract
Purinergic signalling, i.e., the role of nucleotides as extracellular signalling molecules, was proposed in 1972. However, this concept was not well accepted until the early 1990's when receptor subtypes for purines and pyrimidines were cloned and characterised, which includes four subtypes of the P1 (adenosine) receptor, seven subtypes of P2X ion channel receptors and 8 subtypes of the P2Y G protein-coupled receptor. Early studies were largely concerned with the physiology, pharmacology and biochemistry of purinergic signalling. More recently, the focus has been on the pathophysiology and therapeutic potential. There was early recognition of the use of P1 receptor agonists for the treatment of supraventricular tachycardia and A2A receptor antagonists are promising for the treatment of Parkinson's disease. Clopidogrel, a P2Y12 antagonist, is widely used for the treatment of thrombosis and stroke, blocking P2Y12 receptor-mediated platelet aggregation. Diquafosol, a long acting P2Y2 receptor agonist, is being used for the treatment of dry eye. P2X3 receptor antagonists have been developed that are orally bioavailable and stable in vivo and are currently in clinical trials for the treatment of chronic cough, bladder incontinence, visceral pain and hypertension. Antagonists to P2X7 receptors are being investigated for the treatment of inflammatory disorders, including neurodegenerative diseases. Other investigations are in progress for the use of purinergic agents for the treatment of osteoporosis, myocardial infarction, irritable bowel syndrome, epilepsy, atherosclerosis, depression, autism, diabetes, and cancer.
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Affiliation(s)
- Geoffrey Burnstock
- Autonomic Neuroscience Centre, University College Medical SchoolLondon, United Kingdom
- Department of Pharmacology and Therapeutics, The University of Melbourne, MelbourneVIC, Australia
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Weinhold P, Hennenberg M, Strittmatter F, Stief CG, Gratzke C, Hedlund P. Transient receptor potential a1 (TRPA1) agonists inhibit contractions of the isolated human ureter. Neurourol Urodyn 2017; 37:600-608. [DOI: 10.1002/nau.23338] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2017] [Accepted: 05/22/2017] [Indexed: 02/06/2023]
Affiliation(s)
- Philipp Weinhold
- Department of Urology; LMU; Munich Germany
- Department of Clinical and Experimental Pharmacology; Lund Sweden
| | | | | | | | | | - Petter Hedlund
- Department of Clinical and Experimental Pharmacology; Lund Sweden
- Department of Clinical Pharmacology; Linköping Sweden
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Abstract
PURPOSE OF REVIEW Indications for ureterorenoscopy are expanding without hard scientific evidence to support its efficacy. Therefore, it is extremely important to focus on potential harmful effects of the procedure itself. This review explores how physiology of the upper urinary tract reacts to ureterorenoscopy, potentially translating into harmful effects, and how such pathophysiological processes may be minimized. RECENT FINDINGS Complications to ureterorenoscopy and postoperative pain seem to be related to intrarenal pressure and/or access. Mean intrarenal pressures in the range of 60-100 mmHg during ureterorenoscopy without access sheaths have been measured, thus by far exceeding the threshold for intrarenal backflow, potentially resulting in septic complications. Intrarenal pressure may be reduced by use of ureteral access sheaths, which, however, may cause ureteral damage due to the limited size of the ureter and strain-induced ureteral contractions (peristalsis). Different receptor types modulate this peristaltic activity. β-receptor agonists have been investigated in animal and human trials for the purpose of relaxing the ureter. In randomized, placebo-controlled trials in pigs and humans, usage of the β-receptor agonist isoproterenol in the irrigation fluid has shown a potential for reducing both intrarenal pressure and ureteral tone during ureterorenoscopy. SUMMARY Upper urinary tract physiology has unique features that may be pushed into pathophysiological processes by the unique elements of ureterorenoscopy: access and irrigation. Pharmacological ureteral relaxation during ureterorenoscopy deserves further attention with regard to reducing complications and postoperative pain.
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Shao Y, Wei H, Sha M, Sun F, Lu J, Xia S. Verapamil Inhibits the Pelvic Pressure Increase Corresponding to Flow Perfusion in the Porcine Percutaneous Renal Puncture Model. Urol Int 2016; 97:429-433. [PMID: 27115398 DOI: 10.1159/000443967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2015] [Accepted: 12/28/2015] [Indexed: 11/19/2022]
Abstract
PURPOSE To estimate the effects of verapamil on pelvic pressure and investigate the possible systemic side effects in the porcine model during the procedure of increasing perfusion rates. MATERIALS AND METHODS In the experimental group, the pelvic pressure was recorded with increasing perfusion rates of the renal pelvis (0, 2, 4, 6, 8, 10, 14 and 20 ml/min) in response to intraluminal administration of increasing concentrations of verapamil (0, 0.1, 1, 10 and 100 µg/ml) in isotonic saline. In the isotonic saline group, the pressure flow study was also done by increasing perfusion rates of the renal pelvis per animal using isotonic saline without verapamil. RESULTS Perfusion with 1, 10 and 100 µg/ml verapamil caused a decrease in pelvic pressure as a response to increasing flow rates, whereas perfusion with 0.1 µg/ml verapamil did not obviously inhibit the increase of pelvic pressure at all perfusion rates compared with other concentrations. Importantly, the mean systolic blood pressure and mean heart rate were stable despite the increase of flow rates and verapamil concentrations. In the isotonic saline group, perfusion with isotonic saline resulted in an increase in the pelvic pressure with an increase in flow rates each time. CONCLUSIONS Endoluminal administration of verapamil reduces pelvic pressure significantly without any untoward systemic cardiovascular side effects.
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Affiliation(s)
- Yi Shao
- Department of Urology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, PR China
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Sandner P, Tinel H, Affaitati G, Costantini R, Giamberardino MA. Effects of PDE5 Inhibitors and sGC Stimulators in a Rat Model of Artificial Ureteral Calculosis. PLoS One 2015; 10:e0141477. [PMID: 26509272 PMCID: PMC4624930 DOI: 10.1371/journal.pone.0141477] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2015] [Accepted: 10/07/2015] [Indexed: 01/13/2023] Open
Abstract
Urinary colics from calculosis are frequent and intense forms of pain whose current pharmacological treatment remains unsatisfactory. New and more effective drugs are needed to control symptoms and improve stone expulsion. Recent evidence suggested that the Nitric Oxide (NO) / cyclic guanosine monophosphate (cGMP) / phosphodiesterase type 5 (PDE5) system may contribute to ureteral motility influencing stone expulsion. We investigated if PDE5 inhibitors and sGC stimulators influence ureteral contractility, pain behaviour and stone expulsion in a rat model of ureteral calculosis. We investigated: a)the sex-specific PDE5 distribution in the rat ureter; b)the functional in vitro effects of vardenafil and sildenafil (PDE5 inhibitors) and BAY41-2272 (sGC stimulator) on induced ureteral contractility in rats and c)the in vivo effectiveness of vardenafil and BAY41-2272, alone and combined with ketoprofen, vs hyoscine-N-butylbromide alone or combined with ketoprofen, on behavioural pain indicators and stone expulsion in rats with artificial calculosis in one ureter. PDE5 was abundantly expressed in male and female rats’ ureter. In vitro, both vardenafil and BAY41-2272 significantly relaxed pre-contracted ureteral strips. In vivo, all compounds significantly reduced number and global duration of “ureteral crises” and post-stone lumbar muscle hyperalgesia in calculosis rats. The highest level of reduction of the pain behaviour was observed with BAY41-2272 among all spasmolytics administered alone, and with the combination of ketoprofen with BAY41-2272. The percentage of stone expulsion was maximal in the ketoprofen+BAY41-2272 group. The NO/cGMP/PDE5 pathway is involved in the regulation of ureteral contractility and pain behaviour in urinary calculosis. PDE5 inhibitors and sGC stimulators could become a potent new option for treatment of urinary colic pain.
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Affiliation(s)
- Peter Sandner
- Bayer Health Care AG – Global Drug Discovery, Department of Cardiology – Pharma Research Center Wuppertal, Wuppertal, Germany
- Institute of Pharmacology, Hannover Medical School, Hannover, Germany
| | - Hanna Tinel
- Bayer Health Care AG – Global Drug Discovery, Department of Cardiology – Pharma Research Center Wuppertal, Wuppertal, Germany
| | - Giannapia Affaitati
- Pathophysiology of Pain Laboratory, Ce.S.I., “G. D’Annunzio” University of Chieti, Chieti, Italy
- Department of Medicine and Science of Aging, “G. D’Annunzio” University of Chieti, Chieti, Italy
| | - Raffaele Costantini
- Institute of Surgical Pathology, “G. D’Annunzio” University of Chieti, Chieti, Italy
| | - Maria Adele Giamberardino
- Pathophysiology of Pain Laboratory, Ce.S.I., “G. D’Annunzio” University of Chieti, Chieti, Italy
- Department of Medicine and Science of Aging, “G. D’Annunzio” University of Chieti, Chieti, Italy
- * E-mail:
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Canda AE, Dogan H, Kandemir O, Atmaca AF, Akbulut Z, Balbay MD. Does diabetes affect the distribution and number of interstitial cells and neuronal tissue in the ureter, bladder, prostate, and urethra of humans? Cent European J Urol 2014; 67:366-74. [PMID: 25667756 PMCID: PMC4310884 DOI: 10.5173/ceju.2014.04.art10] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2014] [Revised: 09/16/2014] [Accepted: 09/19/2014] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION The aim of this study was to investigate and compare the distribution and number of interstitial cells (ICs) and neuronal tissue in the ureter, bladder, prostate, and urethra of human patients with and without diabetes. MATERIAL AND METHODS Human tissue was obtained from patients who had undergone radical cystectomy for bladder cancer (10 diabetic and 11 non-diabetic males). Interstitial cells were stained immunohistochemically with anti-human CD117 (c-kit) rabbit polyclonal antibody, Vimentin, and Connexin-43. Neural tissue was stained with synaptophysin. The number of ICs and neurons was evaluated and compared between the groups (diabetic versus non-diabetic). RESULTS The mean number of c-kit (+) ICs in bladder lamina propria was significantly decreased in diabetics (32.40 ±12.96 versus 57.18 ±25.37, p = 0.036). The mean number of ICs in the detrusor muscle was significantly decreased in diabetics (40.50 ±16.79 versus 64.55 ±22.08, p = 0.013). Between the groups, no significant differences were detected regarding the number of ICs at the level of the ureter, urethra, and prostate. No significant differences were detected regarding the number of nerves in the ureter, bladder, prostate, and urethra of both groups. CONCLUSIONS The number of ICs may be decreased in the lamina propria and detrusor muscle of the human bladder in diabetes. This can be an underlying cause of lower urinary tract (LUT) dysfunction in diabetics. Research into the development of drugs targeting or stimulating IC function in order to prevent diabetic LUT dysfunction is warranted.
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Affiliation(s)
- Abdullah Erdem Canda
- Yildirim Beyazit University, School of Medicine, Ankara Ataturk Training & Research Hospital, Department of Urology, Ankara, Turkey
| | - Hayriye Dogan
- Ankara Ataturk Training & Research Hospital, Department of Pathology, Ankara, Turkey
| | - Olcay Kandemir
- Ankara Oncology Training & Research Hospital, Department of Pathology, Ankara, Turkey
| | - Ali Fuat Atmaca
- Yildirim Beyazit University, School of Medicine, Ankara Ataturk Training & Research Hospital, Department of Urology, Ankara, Turkey
| | - Ziya Akbulut
- Yildirim Beyazit University, School of Medicine, Ankara Ataturk Training & Research Hospital, Department of Urology, Ankara, Turkey
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Villa L, Buono R, Fossati N, Rigatti P, Montorsi F, Benigni F, Hedlund P. Effects by silodosin on the partially obstructed rat ureter in vivo and on human and rat isolated ureters. Br J Pharmacol 2014; 169:230-8. [PMID: 23373675 DOI: 10.1111/bph.12123] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2012] [Revised: 11/25/2012] [Accepted: 01/16/2013] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND AND PURPOSE α1 -adrenoceptor (-AR) antagonists may facilitate ureter stone passage in humans. We aimed to study effects by the α1 A -AR selective antagonist silodosin (compared to tamsulosin and prazosin) on ureter pressures in a rat model of ureter obstruction, and on contractions of human and rat isolated ureters. EXPERIMENTAL APPROACH After ethical approval, ureters of male rats were cannulated beneath the kidney pelvis for in vivo ureteral intraluminal recording of autonomous peristaltic pressure waves. A partial ureter obstruction was applied to the distal ureter. Mean arterial blood pressure (MAP) was recorded. Approximate clinical and triple clinical doses of the α1 -AR antagonists were given intravenously. Effects by the α1 -AR antagonists on isolated human and rat ureters were studied in organ baths. KEY RESULTS Intravenous silodosin (0.1-0.3 mg kg(-1) ) or prazosin (0.03-0.1 mg kg(-1) ) reduced obstruction-induced increases in intraluminal ureter pressures by 21-37% or 18-40% respectively. Corresponding effects by tamsulosin (0.01 or 0.03 mg kg(-1) ) were 9-20%. Silodosin, prazosin and tamsulosin reduced MAP by 10-12%, 25-26% (P < 0.05), or 18-25% (P < 0.05) respectively. When effects by the α1 A -AR antagonists on obstruction-induced ureter pressures were expressed as a function of MAP, silodosin had six- to eightfold and 2.5- to eightfold better efficacy than tamsulosin or prazosin respectively. Silodosin effectively reduced contractions of both human and rat isolated ureters. CONCLUSIONS AND IMPLICATIONS Silodosin inhibits contractions of the rat and human isolated ureters and has excellent functional selectivity in vivo to relieve pressure-load of the rat obstructed ureter. Silodosin as pharmacological ureter stone expulsive therapy should be clinically further explored.
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Affiliation(s)
- L Villa
- Urological Research Institute, San Raffaele Scientific Institute, Milan, Italy
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23
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Comparative evaluation of efficacy of use of naftopidil and/or celecoxib for medical treatment of distal ureteral stones. Urolithiasis 2014; 42:541-7. [DOI: 10.1007/s00240-014-0708-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2014] [Accepted: 08/05/2014] [Indexed: 01/22/2023]
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Guan NN, Thor A, Hallén K, Wiklund NP, Gustafsson LE. Cascade bioassay evidence for the existence of urothelium-derived inhibitory factor in Guinea pig urinary bladder. PLoS One 2014; 9:e103932. [PMID: 25084114 PMCID: PMC4118989 DOI: 10.1371/journal.pone.0103932] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2014] [Accepted: 07/08/2014] [Indexed: 11/20/2022] Open
Abstract
Our aim was to investigate whether guinea pig urothelium-derived bioactivities compatible with the existence of urothelium-derived inhibitory factor could be demonstrated by in vitro serial bioassay and whether purinergic P1 receptor agonists, nitric oxide, nitrite or prostaglandins might explain observed activities. In a cascade superfusion system, urothelium-denuded guinea pig ureters were used as bioassay tissues, recording their spontaneous rhythmic contractions in presence of scopolamine. Urothelium-intact or -denuded guinea pig urinary bladders were used as donor tissues, stimulated by intermittent application of carbachol before or during the nitric oxide synthase inhibitor NG-nitro-L-arginine methyl ester (L-NAME), the adenosine/P1 nucleoside receptor antagonist 8-(p-sulfophenyl)theophylline (8-PST) or the cyclo-oxygenase inhibitor diclofenac infused to bath donor and bioassay tissues. The spontaneous contractions of bioassay ureters were unaltered by application of carbachol 1-5 µM in the presence of scopolamine 5-30 µM. When carbachol was applied over the urothelium-denuded bladder, the assay ureter contraction rate was unaltered. Introducing carbachol over the everted urothelium-intact bladder significantly inhibited the contraction frequency of the assay ureter, suggesting the transfer of an inhibitory activity from the bladder to the assay ureter. The transmissible inhibitory activity was not markedly antagonized by L-NAME, 8-PST or diclofenac, while L-NAME nearly abolished nitrite release from the urothelium-intact bladder preparations. We suggest that urothelium-derived inhibitory factor is a transmissible entity over a significant distance as demonstrated in this novel cascade superfusion assay and seems less likely to be nitric oxide, nitrite, an adenosine receptor agonist or subject to inhibition by administration of a cyclo-oxygenase inhibitor.
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Affiliation(s)
- Na N. Guan
- Department of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden
| | - Anna Thor
- Section of Urology, Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Katarina Hallén
- Section of Urology, Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - N. Peter Wiklund
- Section of Urology, Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Lars E. Gustafsson
- Department of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden
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Gupta A, Aboumarzouk OM, Jefferies MT, Kynaston HG, Datta S. Calcium channel blockers as medical expulsive therapy for ureteric stones. Hippokratia 2014. [DOI: 10.1002/14651858.cd011162] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- Ameet Gupta
- University Hospital Wales; Department of Urology; Heath Park Cardiff UK CF14 4XW
| | - Omar M Aboumarzouk
- Islamic University of Gaza; Department of Urology; College of Medicine Gaza Palestine
| | - Matthew T Jefferies
- University Hospital Wales; Department of Urology; Heath Park Cardiff UK CF14 4XW
| | - Howard G Kynaston
- University Hospital Wales; Department of Urology; Heath Park Cardiff UK CF14 4XW
| | - Shibs Datta
- University Hospital Wales; Department of Urology; Heath Park Cardiff UK CF14 4XW
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Sfoungaristos S, Kavouras A, Kanatas P, Duvdevani M, Perimenis P. Early hospital admission and treatment onset may positively affect spontaneous passage of ureteral stones in patients with renal colic. Urology 2014; 84:16-21. [PMID: 24685060 DOI: 10.1016/j.urology.2014.01.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2013] [Revised: 12/28/2013] [Accepted: 01/02/2014] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To evaluate the impact of early hospital admission and onset of medical expulsive therapy (MET) in spontaneous passage of ureteral stones causing renal colic. METHODS We recruited 392 patients referred to the emergency room with symptoms of renal colic. All patients received standard MET of oral tamsulosin 0.4 mg at the time of diagnosis. In group A, patients who received MET in <2 hours from the symptom onset were included, whereas group B consisted of patients treated in >2 hours. The association of MET onset and stone-free rates after 6 weeks of follow-up was evaluated. Early MET onset predictive impact on spontaneous stone passage was evaluated as well. RESULTS The stone-free rate in group A and B patients was 71.2% and 59.7% (P=.018), respectively. A significant association was observed between spontaneous calculus elimination and stone size (P≤.001), location within the ureter (P=.007), and the interval between pain onset and pharmaceutical management (P=.018). Patients who received a late-onset MET had an increased risk to develop febrile upper urinary tract infection during the follow-up period (P=.040). In the multivariate analysis, size (P≤.001) and early therapy onset (P=.019) were statistically important predictors for stone-free status after the surveillance period. CONCLUSION Patients with renal colic who admitted to the emergency department earlier since symptom onset may have increased potential to be stone free during the surveillance period.
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Burnstock G. Purinergic signalling in the urinary tract in health and disease. Purinergic Signal 2014; 10:103-55. [PMID: 24265069 PMCID: PMC3944045 DOI: 10.1007/s11302-013-9395-y] [Citation(s) in RCA: 121] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2013] [Accepted: 10/24/2013] [Indexed: 12/25/2022] Open
Abstract
Purinergic signalling is involved in a number of physiological and pathophysiological activities in the lower urinary tract. In the bladder of laboratory animals there is parasympathetic excitatory cotransmission with the purinergic and cholinergic components being approximately equal, acting via P2X1 and muscarinic receptors, respectively. Purinergic mechanosensory transduction occurs where ATP, released from urothelial cells during distension of bladder and ureter, acts on P2X3 and P2X2/3 receptors on suburothelial sensory nerves to initiate the voiding reflex, via low threshold fibres, and nociception, via high threshold fibres. In human bladder the purinergic component of parasympathetic cotransmission is less than 3 %, but in pathological conditions, such as interstitial cystitis, obstructed and neuropathic bladder, the purinergic component is increased to 40 %. Other pathological conditions of the bladder have been shown to involve purinoceptor-mediated activities, including multiple sclerosis, ischaemia, diabetes, cancer and bacterial infections. In the ureter, P2X7 receptors have been implicated in inflammation and fibrosis. Purinergic therapeutic strategies are being explored that hopefully will be developed and bring benefit and relief to many patients with urinary tract disorders.
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Affiliation(s)
- Geoffrey Burnstock
- Autonomic Neuroscience Centre, University College Medical School, Rowland Hill Street, London, NW3 2PF, UK,
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Owusu-Ofori K, Learned MK, Mellon WS, Nakada SY. PI3K mediates stretch-induced COX-2 expression during urinary tract obstruction. J Endourol 2013; 27:220-9. [PMID: 22998445 DOI: 10.1089/end.2012.0252] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND AND PURPOSE Stretch-induced cyclooxygenase-2 (COX-2) expression occurs in urothelial cells during urinary tract obstruction (UTO). This increases COX-2-dependent prostanoid synthesis in stretched urothelial cells. These prostanoids then act on afferent neurons and smooth muscle cells in the ureter to amplify nociceptive and contractile responses, respectively. We previously used a unilateral ureteral obstruction (UUO) mouse model and a primary human urothelial cell (HUC) stretch model to describe ureteral COX-2 expression during UTO. The current study was performed to determine whether phosphatidylinositol 3-kinase (PI3K)-dependent signaling pathways are necessary for stretch-induced COX-2 expression in urothelial cells. MATERIALS AND METHODS Adult male CD-1 mice were treated with 25% dimethyl sulfoxide/phosphate buffered saline or PI3K inhibitor LY294002 (3 mg/kg, 30 mg/kg) for 1 hour before performing UUO for up to 4 hours. Obstructed and contralateral mouse ureters were analyzed via immunohistochemistry or Western blotting to assess in vivo stretch-induced COX-2 expression. In addition, HUCs were cyclically stretched (5%-20% displacement, 12 cycles/min) on collagen I-coated stretch plates and assessed for COX-2 expression via Western blotting. RESULTS Histologic analyses of obstructed ureters show that urothelial cells stretch in response to external obstruction, COX-2 expression increases in the stretched urothelial cells, and no infiltrating immune cells were present under the conditions of the study. PI3K inhibitor LY294002 (30 mg/kg) attenuated in vivo stretch-induced COX-2 expression. LY294002 or RNA-interference also attenuated (HUC) stretch-induced COX-2 expression in vitro. Furthermore, the results also show that LY294002 inhibits stretch-induced protein kinase C (PKCζ) activation previously identified upstream of stretch-induced COX-2 expression in HUCs. CONCLUSIONS The results indicate that PI3K is a mediator of stretch-induced COX-2 expression in urothelial cells. Identifying molecules that couple urothelial cell stretch to COX-2 expression may provide targets of drug action for effective therapeutics for UTO.
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Affiliation(s)
- Kwadwo Owusu-Ofori
- Department of Urology, University of Wisconsin-Madison, Madison, Wisconsin 53705, USA.
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Purinergic mechanisms and pain--an update. Eur J Pharmacol 2013; 716:24-40. [PMID: 23524093 DOI: 10.1016/j.ejphar.2013.01.078] [Citation(s) in RCA: 94] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2012] [Revised: 12/11/2012] [Accepted: 01/09/2013] [Indexed: 12/12/2022]
Abstract
There is a brief summary of the background literature about purinergic signalling. The review then considers purinergic mechanosensory transduction involved in visceral, cutaneous and musculoskeletal nociception and on the roles played by P2X3, P2X2/3, P2X4, P2X7 and P2Y₁₂ receptors in neuropathic and inflammatory pain. Current developments of compounds for the therapeutic treatment of both visceral and neuropathic pain are discussed.
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Abstract
The mammalian ureter contains two main cell types: a multilayered water-tight epithelium called the urothelium, surrounded by smooth muscle layers that, by generating proximal to distal peristaltic waves, pump urine from the renal pelvis toward the urinary bladder. Here, we review the cellular mechanisms involved in the development of these tissues, and the molecules that control the process. We consider the relevance of these biologic findings for understanding the pathogenesis of human ureter malformations.
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Affiliation(s)
- Adrian S Woolf
- School of Biomedicine, University of Manchester, Manchester Academic Health Science Centre and Manchester Children's Hospital, Michael Smith Building, Oxford Road, Manchester, M13 9PT, UK.
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Lu JL, Tang QL, De Liu F, Hui JH. Naftopidil and tolterodine in the medical expulsive therapy for intramural ureteral stones: a prospective randomized study. ACTA ACUST UNITED AC 2012; 40:757-62. [DOI: 10.1007/s00240-012-0498-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2012] [Accepted: 08/02/2012] [Indexed: 10/28/2022]
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Origin of Motion in the Human Ureter: Mechanics, Energetics and Kinetics of the Myosin Molecular Motors. Urologia 2012; 79:123-9. [DOI: 10.5301/ru.2012.9110] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/15/2012] [Indexed: 11/20/2022]
Abstract
Background Ureteral peristalsis is the result of coordinated mechanical motor performance of longitudinal and circular smooth muscle layer of the ureter wall. The main aim of this study was to characterize in smooth muscle of proximal segments of human ureter, the mechanical properties at level of muscle tissue and at level of myosin molecular motors. Methods Ureteral samples were collected from 15 patients, who underwent nephrectomy for renal cancer. Smooth muscle strips longitudinally and circularly oriented from proximal segments of human ureter were used for the in vitro experiments. Mechanical indices including the maximum unloaded shortening velocity (Vmax), and the maximum isometric tension (P0) normalized per cross-sectional area, were determined in vitro determined in electrically evoked contractions of longitudinal and circular smooth muscle strips. Myosin cross-bridge (CB) number per mm2 (Ψ) the elementary force per single CB (Ψ) and kinetic parameters were calculated in muscle strips, using Huxley's equations adapted to nonsarcomeric muscles. Results Longitudinal smooth muscle strips exhibited a significantly (p<0.05) faster Vmax (63%) and a higher P0 (40%), if compared to circular strips. Moreover, longitudinal muscle strips showed a significantly higher unitary force (Ψ) per CB. However, no significant differences were observed in CB number, the attachment (f1) and the detachment (g2) rate constants between longitudinal and circular muscle strips. Conclusions The main result obtained in the present work documents that the mechanical, energetic and unitary forces per CB of longitudinal layer of proximal ureter are better compared to the circular one; these preliminary findings suggested, unlike intestinal smooth muscle, a major role of longitudinal smooth muscle layer in the ureter peristalsis.
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Itano N, Ferlic E, Nunez-Nateras R, Humphreys MR. Medical Expulsive Therapy in a Tertiary Care Emergency Department. Urology 2012; 79:1242-6. [DOI: 10.1016/j.urology.2011.12.033] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2011] [Revised: 11/04/2011] [Accepted: 12/16/2011] [Indexed: 11/25/2022]
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Yoshida M, Kudoh J, Homma Y, Kawabe K. New clinical evidence of silodosin, an α1A selective adrenoceptor antagonist, in the treatment for lower urinary tract symptoms. Int J Urol 2012; 19:306-16. [DOI: 10.1111/j.1442-2042.2011.02957.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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El-Hefnawy AS, Abed A, Shokeir AA. The Management of a Patient with an Acute Stone Problem. Urolithiasis 2012. [DOI: 10.1007/978-1-4471-4387-1_44] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Targeting the visceral purinergic system for pain control. Curr Opin Pharmacol 2011; 12:80-6. [PMID: 22036885 DOI: 10.1016/j.coph.2011.10.008] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2011] [Accepted: 10/06/2011] [Indexed: 11/24/2022]
Abstract
Experimental evidence is presented to support the hypothesis that purinergic mechanosensory transduction can initiate visceral pain in urinary bladder, ureter, gut and uterus. In general, physiological reflexes are mediated via P2X3 and P2X2/3 receptors on low threshold sensory fibres, while these receptors on high threshold sensory fibres mediate pain. Potential therapeutic strategies are considered for the treatment of visceral pain in such conditions as renal colic, interstitial cystitis and inflammatory bowel disease by purinergic agents, including P2X3 and P2X2/3 receptor antagonists that are orally bioavailable and stable in vivo and agents that modulate ATP release and breakdown.
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Borysova L, Shabir S, Walsh MP, Burdyga T. The importance of Rho-associated kinase-induced Ca2+ sensitization as a component of electromechanical and pharmacomechanical coupling in rat ureteric smooth muscle. Cell Calcium 2011; 50:393-405. [PMID: 21839512 DOI: 10.1016/j.ceca.2011.07.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2011] [Revised: 07/05/2011] [Accepted: 07/07/2011] [Indexed: 01/30/2023]
Abstract
Ureteric peristalsis, which occurs via alternating contraction and relaxation of ureteric smooth muscle, ensures the unidirectional flow of urine from the kidney to the bladder. Understanding of the molecular mechanisms underlying ureteric excitation-contraction coupling, however, is limited. To address these knowledge deficits, and in particular to test the hypothesis that Ca2+ sensitization via activation of the RhoA/Rho-associated kinase (ROK) pathway plays an important role in ureteric smooth muscle contraction, we carried out a thorough characterization of the electrical activity, Ca2+ signaling, MYPT1 (myosin targeting subunit of myosin light chain phosphatase, MLCP) and myosin regulatory light chain (LC20) phosphorylation, and force responses to membrane depolarization induced by KCl (electromechanical coupling) and carbachol (CCh) (pharmacomechanical coupling). The effects of ROK inhibition on these parameters were investigated. We conclude that the tonic, but not the phasic component of KCl- or CCh-induced ureteric smooth muscle contraction is highly dependent on ROK-catalyzed phosphorylation of MYPT1 at T855, leading to inhibition of MLCP and increased LC20 phosphorylation.
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Affiliation(s)
- Lyudmyla Borysova
- Department of Cellular and Molecular Physiology, Institute of Translational Medicine, University of Liverpool, Crown Street, Liverpool L69 3BX, UK
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Comparing efficacy of α1D-receptor antagonist naftopidil and α1A/D-receptor antagonist tamsulosin in management of distal ureteral stones. World J Urol 2011; 29:767-71. [DOI: 10.1007/s00345-011-0739-3] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2011] [Accepted: 07/21/2011] [Indexed: 11/25/2022] Open
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[From lab to clinical activity: adrenergic receptors and human uro-genital tissues]. Urologia 2011; 78:153-60. [PMID: 21786233 DOI: 10.5301/ru.2011.8540] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/26/2011] [Indexed: 11/20/2022]
Abstract
BACKGROUND Nowadays translational medicine is acquiring a more and more important role in connecting laboratory experimental results on human tissues to clinical findings and drug employment. We want to underline the importance of in vitro studies, which have been extensively performed on animal organs, but few studies have been performed on human tissues. Nevertheless, a more accurate result when compared to the in vivo use of drugs can be given only by testing the very same human tissues in a lab. We related clinical treatments of different pathologies with the results obtained in laboratory studying in vitro fragments of human organs extracted during surgery exposed to different mediators and drugs. METHODS Fragments of urethers, bladder (detrusorial muscle and bladder neck muscle fibers), corpora cavernosa, and vas deferens were extracted during demolitive surgery trying not to traumatize the tissue, in order to keep it alive and not to ruin its contractile fibers. The fragments were then put into polisaline solution and, once in the laboratory, fixed on suitable isolated organ support, fixed at one side of the thermostatic pool and on the other side connected to a digital monitoring system. The contractility was then studied after adding different mediators. RESULTS The urethers have shown a stronger response to NE and PGF2a, with a different contractility in their distal part due to a major concentration of alpha-receptors; the bladder neck has also shown a strong contractile response to NE and PGF2a, and is inhibited by alpha-blockers; the bladder detrusor, instead, responds to ACH (acetylcholine) and PGF2a; the vas deferens shows a different type of contractility in the prostatic part compared to the epididimary part when stimulated with noradrenaline and PGF2a; the corpora cavernosa respond to NE and PGF2a. CONCLUSIONS The results obtained after stimulating the fragments can explain and prove the receptorial activity of inner mediators and of commonly used drugs which have, for years, been used empirically; the simplicity and repetitivity of the method can be considered and used not only to research the physiological functioning of different organs, but also the functioning of new drugs before testing them on patients, being more reliable and accurate than tests on animal tissues. This experimental work has shown that using human tissues in testing specific mediators is the most reliable laboratory method.
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Abstract
Within the urinary tract, β-adrenergic receptors (AR) are found largely on smooth muscle cells but are also present, at least in the bladder, in the urothelium and on afferent nerves. Our understanding of β-AR subtype expression and function is hampered by a lack of well-validated tools, particularly with regard to β(3)-AR. Moreover, the β-AR subtypes involved in a specific function may differ between species. In the ureter, β-AR can modulate pacemaker activity and smooth muscle tone involving multiple subtypes. In the human bladder, β-AR promote urine storage. Bladder smooth muscle relaxation primarily involves β(3)-AR, and the agonists selective for this subtype are in clinical development to treat bladder dysfunction. While prostate and urethra also express β-AR, the overall physiological role in these tissues remains unclear.
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Affiliation(s)
- Martin C Michel
- Department of Pharmacology and Pharmacotherapy, Academic Medical Center, Meibergdreef 15, 1105 AZ, Amsterdam, The Netherlands.
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Evaluation of the efficiency of tamsulosin and Rowatinex in patients with distal ureteral stones: a prospective, randomized, controlled study. Int Urol Nephrol 2010; 43:79-83. [DOI: 10.1007/s11255-010-9774-z] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2009] [Accepted: 05/18/2010] [Indexed: 10/19/2022]
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Burnstock G. Purinergic mechanosensory transduction and visceral pain. Mol Pain 2009; 5:69. [PMID: 19948030 PMCID: PMC2789721 DOI: 10.1186/1744-8069-5-69] [Citation(s) in RCA: 95] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2009] [Accepted: 11/30/2009] [Indexed: 02/01/2023] Open
Abstract
In this review, evidence is presented to support the hypothesis that mechanosensory transduction occurs in tubes and sacs and can initiate visceral pain. Experimental evidence for this mechanism in urinary bladder, ureter, gut, lung, uterus, tooth-pulp and tongue is reviewed. Potential therapeutic strategies are considered for the treatment of visceral pain in such conditions as renal colic, interstitial cystitis and inflammatory bowel disease by agents that interfere with mechanosensory transduction in the organs considered, including P2X3 and P2X2/3 receptor antagonists that are orally bioavailable and stable in vivo and agents that inhibit or enhance ATP release and breakdown.
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Affiliation(s)
- Geoffrey Burnstock
- Autonomic Neuroscience Centre, Royal Free and University College Medical School, Rowland Hill Street, London NW3 2PF, UK.
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