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Djurhuus JC, Olsen LH. Lost in transition. J Pediatr Urol 2024:S1477-5131(24)00100-1. [PMID: 38433080 DOI: 10.1016/j.jpurol.2024.02.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2024] [Accepted: 02/12/2024] [Indexed: 03/05/2024]
Affiliation(s)
| | - L Henning Olsen
- Department of Clinical Medicine, Aarhus University, DK 8200, Aarhus, Denmark.
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Djurhuus JC, Olsen LH. Editorial commentary to clinical utility and interrater reliability of video urodynamics in children with isolated fibrolipoma of filum terminale. J Pediatr Urol 2023; 19:532-533. [PMID: 37422428 DOI: 10.1016/j.jpurol.2023.06.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Accepted: 06/01/2023] [Indexed: 07/10/2023]
Affiliation(s)
| | - L Henning Olsen
- Department Clinical Medicine, Aarhus University, Aarhus, Denmark.
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Olsen LH, Djurhuus JC. Comment on: "Cost comparison of intra-detrusor injection of botulinum toxin versus augmentation cystoplasty for refractory Neurogenic Detrusor Overactivity in Children". J Pediatr Urol 2022; 18:323-324. [PMID: 35370093 DOI: 10.1016/j.jpurol.2022.02.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Accepted: 02/15/2022] [Indexed: 11/15/2022]
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Djurhuus JC, Wu HY, Fossum M. A conversation on how animal experimental studies allies with translational medicine. J Pediatr Urol 2021; 17:622-629. [PMID: 34420875 DOI: 10.1016/j.jpurol.2021.07.029] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Accepted: 07/28/2021] [Indexed: 11/30/2022]
Abstract
Basis science research in pediatric urology studies physiological questions in animal models to provide new data on how to treat patients. We sat down with Jens-Christian Djurhuus to discuss both practical and philosophical questions on how to best perform basic science research. Initial questions such as "What type of questions are best studied in animal models?" and "Which animal model should I use?" help us answer the basic question of "What is a good research topic?". To take advantage of his experience leading a research team, we went on to discuss "How do you lead a research team?" and "How do we make sure that basic science research translates to clinical practice?". As research funding becomes scarce, we thank Professor Djurhuus for his insights on how to focus basic science research on relevant topics that are easily translatable to the care of children.
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Affiliation(s)
| | - His-Yang Wu
- Brown University, Division of Urology, Providence, RI, USA
| | - Magdalena Fossum
- Department of Pediatric Surgery, Copenhagen University Hospital Rigshospitalet. Copenhagen, Denmark; Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden.
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Lu Y, Fog-Poulsen K, Nørregaard R, Djurhuus JC, Olsen LH. Gender-dependent bladder response to one-day bladder outlet obstruction. J Pediatr Urol 2021; 17:170.e1-170.e10. [PMID: 33487568 DOI: 10.1016/j.jpurol.2020.12.026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Revised: 11/22/2020] [Accepted: 12/28/2020] [Indexed: 12/15/2022]
Abstract
BACKGROUND Development of bladder fibrosis, loss of compliance, and voiding dysfunction are among the severe consequences of various lower urinary conditions, for example, bladder outlet obstruction (BOO), neurogenic bladder, and radiotherapy to the pelvic area. The bladder remodelling results in significant changes in bladder function and architecture, and may ultimately be deleterious for kidney function. The molecular signals underlying pathologic bladder remodelling, as well as the impact of gender, remain poorly understood. OBJECTIVE To investigate the bladder remodelling after one day BOO, whether the remodelling is different between different bladder sections, and whether genders may affect the remodelling. STUDY DESIGN Thirty male and 30 female C57BL/6NRj mice were randomly divided into Control, Sham and BOO groups with ten mice per group. A 24-h total urethral obstruction was performed at the proximal urethra. Histological changes were observed via H&E, trichrome and immunohistochemistry staining. Harvested bladders were divided into upper and lower sections for analysis. Protein and gene expression were detected by Western blotting and qPCR. RESULTS No significant changes in bladder wall thickness were observed following BOO, while increased bladder mass after BOO was found in female mice only. We detected FN and ⍺-SMA upregulation in the male upper bladder segment. Female BOO mice bladders showed increased α-SMA expression in both bladder segments, but no difference of FN was observed in either bladder segments. BOO-induced upregulation of TGF-β and Gremlin were detected in both male and female bladders, while downregulation of BMP-7 was detected only in male bladders. Furthermore, phosphorylation of both SMAD2/3 and SMAD1/5/9 were increased in male bladders following BOO, whereas female mice exhibited increased pSMAD2/3 in the upper and increased pSMAD1/5/9 in the lower bladder segment. CONCLUSIONS Our data indicate that some specific proteins and growth factors were detected as early alterations of tissue which may lead to fibrosis. In addition, the males tended to have more pronounced response than females. However, the causes and consequences of the findings need to be further investigated.
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Affiliation(s)
- Yutao Lu
- Department of Clinical Medicine, Aarhus University, Aarhus N, Denmark.
| | | | - Rikke Nørregaard
- Department of Clinical Medicine, Aarhus University, Aarhus N, Denmark
| | | | - L Henning Olsen
- Department of Clinical Medicine, Aarhus University, Aarhus N, Denmark; Department of Urology, Aarhus University Hospital, Aarhus N, Denmark
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Djurhuus JC. Preclinical studies of testicular ischemia-reperfusion treatment. J Pediatr Urol 2021; 17:168. [PMID: 33495100 DOI: 10.1016/j.jpurol.2020.10.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Revised: 10/23/2020] [Accepted: 10/24/2020] [Indexed: 11/17/2022]
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Djurhuus JC. Biomarkers and their future use in clinical diagnostics and treatment. J Pediatr Urol 2019; 15:399. [PMID: 31350175 DOI: 10.1016/j.jpurol.2019.05.040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2019] [Accepted: 05/22/2019] [Indexed: 11/24/2022]
Affiliation(s)
- J C Djurhuus
- Department of Clinical Medicine, Aarhus University, Denmark.
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Kaspersen AE, Hasenkam JM, Leipziger JG, Djurhuus JC. [Introduction on how to write a scientific abstract]. Ugeskr Laeger 2019; 181:V02190103. [PMID: 31124438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
In this review, a guide on how to write a scientific abstract is given. When junior researchers submit an abstract for a conference or a manuscript for a journal, a well-written abstract is the key to acceptance and publication. Being able to catch the interest of the reader, while keeping the length to a minimum, is an art, which can be learned by practice.
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Djurhuus JC. Commentary to 'Association Between Urodynamic Parameters and Urine NGAL Concentrations in Children with Neuropathic Bladders'. J Pediatr Urol 2019; 15:156-157. [PMID: 30853439 DOI: 10.1016/j.jpurol.2019.01.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2019] [Accepted: 01/15/2019] [Indexed: 11/27/2022]
Affiliation(s)
- J C Djurhuus
- Aarhus University, Department of Clinical Medicine, Aarhus University Hospital, Brendstrupgaardsvej 100, 8200 Aarhus n, Denmark.
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Hashim H, Blanker MH, Drake MJ, Djurhuus JC, Meijlink J, Morris V, Petros P, Wen JG, Wein A. International Continence Society (ICS) report on the terminology for nocturia and nocturnal lower urinary tract function. Neurourol Urodyn 2019; 38:499-508. [PMID: 30644584 DOI: 10.1002/nau.23917] [Citation(s) in RCA: 133] [Impact Index Per Article: 26.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2018] [Accepted: 11/27/2018] [Indexed: 11/07/2022]
Abstract
INTRODUCTION The terminology for nocturia and nocturnal lower urinary tract function is reviewed and updated in a clinically and practically-based consensus report. METHODS This report has been created by a Working Group under the auspices and guidelines of the International Continence Society (ICS) Standardisation Steering Committee (SSC). All relevant definitions were updated on the basis of research over the last 16 years since the publication of the first nocturia standardization document in 2002. An extensive process of 16 rounds of internal and external reviews was involved to examine each definition exhaustively, with decision-making by collective opinion (consensus). RESULTS A clinically-based terminology report for nocturia and nocturnal lower urinary tract function, encompassing five key definitions divided into signs and symptoms has been developed. Clarity and user-friendliness have been key aims to make it interpretable by healthcare professionals and allied healthcare practitioners involved in the care of individuals with nocturnal lower urinary tract function. CONCLUSION A consensus-based terminology report for nocturia and nocturnal lower urinary tract function has been produced to aid clinical practice and research.
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Affiliation(s)
- Hashim Hashim
- Bristol Urological Institute, Bristol, United Kingdom
| | - Marco H Blanker
- University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Marcus J Drake
- University of Bristol and Bristol Urological Institute, Bristol, United Kingdom
| | | | - Jane Meijlink
- International Painful Bladder Foundation, The Netherlands
| | | | - Peter Petros
- University of New South Wales, Sydney, Australia
| | - Jian Guo Wen
- First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Alan Wein
- University of Pennsylvania, Philadelphia, Pennsylvania
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Abstract
IMPORTANCE Data on the long-term risk of urologic and nonurologic cancer after hematuria diagnosis are sparse. Such data can improve understanding of hematuria and cancer and can provide insight into the clinical course of patients with hematuria. OBJECTIVE To assess the risk of urologic or nonurologic cancer after a hospital-based diagnosis of hematuria. DESIGN, SETTING, AND PARTICIPANTS This cohort study used population-based, nationwide health care databases covering all hospitals in Denmark. The data set included records of all adults (n = 134 173) with an inpatient, outpatient, or emergency department diagnosis of hematuria. The study was conducted from January 1, 1995, to December 31, 2013. Follow-up ended on December 31, 2013. Data analysis was performed from January 16, 2017, to September 18, 2018. MAIN OUTCOMES AND MEASURES Cumulative risk of cancer was computed, and observed cancer incidence was compared with incidence expected in the general population, using standardized incidence ratios. RESULTS Of the 134 173 patients included, 52 367 (39.0%) were women, 81 806 (61.0%) were men, and the median (interquartile range) age was 59 (44-72) years. Within 3 months after hematuria diagnosis, 2647 patients (1.9%) received an invasive bladder cancer diagnosis, 1077 (0.8%) a noninvasive bladder cancer diagnosis, 569 (0.4%) a kidney cancer diagnosis, and 908 (1.1%) a prostate cancer diagnosis. The 3-month cumulative incidence (or absolute risk) of any cancer diagnosis was 4.81% (95% CI, 4.70%-4.93%), the 1-year risk was 6.65% (95% CI, 6.51%-6.78%), and the 5-year risk was 12.34% (95% CI, 12.15%-12.53%). The cumulative incidence of bladder cancer only increased from 1.20% (95% CI, 1.11%-1.30%) after 1 year to 1.36% (95% CI, 1.26%-1.46%) after 5 years of follow-up in women and from 2.93% (95% CI, 2.82%-3.05%) to 3.31% (95% CI, 3.19%-3.44%) in men. For noninvasive bladder cancer, the standardized incidence ratio in the 1 year to less than 5 years of follow-up was 5.39 (95% CI, 4.58-6.30) in patients without initial cystoscopy and was 0.16 (95% CI, 0.04-0.42) in patients with cystoscopy within 3 months after hospital-based diagnosis of hematuria. For kidney cancer, the standardized incidence ratio in the 1 year to less than 5 years of follow-up was 2.63 (95% CI, 2.15-3.18) in patients without cystoscopy and 1.20 (95% CI, 0.87-1.61) in patients with cystoscopy within 3 months after hospital-based diagnosis of hematuria. After 1 year, the risk of gynecologic and colorectal cancers was as expected or even lower, whereas the risk of hematologic malignant neoplasms remained slightly elevated. CONCLUSIONS AND RELEVANCE Increased risk of bladder and kidney cancers even more than 1 year after hospital-based hematuria diagnosis, as well as the slightly elevated risk of invasive bladder cancer after 5 years, may indicate that it is a marker of greater cancer risk; these findings could inform follow-up recommendations for hematuria.
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Affiliation(s)
- Mette Nørgaard
- Department of Clinical Epidemiology, Institute of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Katalin Veres
- Department of Clinical Epidemiology, Institute of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Anne Gulbech Ording
- Department of Clinical Epidemiology, Institute of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark
| | | | - Jørgen Bjerggaard Jensen
- Department of Urology, Institute of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Henrik Toft Sørensen
- Department of Clinical Epidemiology, Institute of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark
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Wen JG, Djurhuus JC, Rosier PF, Bauer SB. ICS educational module: Cystometry in children. Neurourol Urodyn 2018; 37:2306-2310. [PMID: 30203421 DOI: 10.1002/nau.23729] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2018] [Accepted: 05/16/2018] [Indexed: 12/19/2022]
Affiliation(s)
- Jian G. Wen
- Pediatric Urodynamic Centre; the First Affiliated Hospital of Zhengzhou University; Zhengzhou China
- Department of Pediatric Surgery; the First Affiliated Hospital of Xinxiang Medical University; Weihui China
| | | | - Peter F.W.M. Rosier
- Department of Urology; University Medical Centre Utrecht; Utrecht The Netherlands
| | - Stuart B. Bauer
- Department of Urology; Boston Children's Hospital; Boston Massachusetts
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Graugaard-Jensen C, Hvistendahl GM, Frøkiær J, Bie P, Djurhuus JC. Oral Contraceptives and Renal Water Handling: A diurnal study in young women. Physiol Rep 2018; 5:5/23/e13547. [PMID: 29233909 PMCID: PMC5727291 DOI: 10.14814/phy2.13547] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2017] [Revised: 11/17/2017] [Accepted: 11/21/2017] [Indexed: 11/24/2022] Open
Abstract
To test the hypothesis that use of oral contraceptives (OC) changes diurnal variation in fluid balance mechanisms including blood pressure, secretion of vasopressin and oxytocin, and renal water and electrolyte excretion. Fifteen naturally cycling (NC) women in mid‐follicular phase and 11 long‐term OC users were included in a 24‐h standardized inpatient study for measurements of vasopressin, oxytocin, sodium, and osmolality in plasma as well as urinary excretion of electrolytes, aquaporin‐2, and prostaglandin E2. Blood pressure and heart rate were monitored noninvasively. Plasma vasopressin showed circadian rhythm (P = 0.02) and were similar in both groups (P = 0.18) including nighttime increases (P < 0.001). There was no circadian rhythm in plasma oxytocin within (P = 0.84) or between groups (P = 0.22). OC users had significantly lower plasma osmolality (Δosm: 3.05 ± 0.29 mosm/kg, P = 0.04) and lower plasma sodium (ΔNa+: 0.91 ± 0.09 mmol/l, P = 0.05). The two groups showed similar nighttime decreases in diuresis (1.08 ± 0.04 mL/(kg·h), P < 0.001) and increases in urine osmolality (109 ± 9 mosm/kg, P = 0.02), but similar rates of excretion of Aquaporin‐2, prostaglandin E2 and sodium. Nighttime decreases in mean arterial pressure of approximately 13% were significant in both groups (P < 0.001), but 24‐h average mean arterial pressure was significantly higher in OC users than in controls (+4.7 ± 0.4 mmHg, P = 0.02). Packed cell volumes were similar between groups (P = 0.54). OC does not change the diurnal patterns of renal fluid excretion, but resets the osmoreceptors for vasopressin release and leads to a significant increase in arterial blood pressure.
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Affiliation(s)
| | | | - Jørgen Frøkiær
- Department of Clinical Physiology and Nuclear Medicine, University Hospital of Aarhus, Aarhus N, Denmark
| | - Peter Bie
- Institute of Molecular Medicine, University of Southern Denmark, Odense, Denmark
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Jakobsen LK, Trelborg KF, Kingo PS, Hoyer S, Andersson KE, Djurhuus JC, Norregaard R, Olsen LH. Aquaporin expression in the fetal porcine urinary tract changes during gestation. Physiol Res 2018; 67:283-292. [PMID: 29303600 DOI: 10.33549/physiolres.933545] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
The expression of aquaporins (AQPs) in the fetal porcine urinary tract and its relation to gestational age has not been established. Tissue samples from the renal pelvis, ureter, bladder and urethra were obtained from porcine fetuses. Samples were examined by RT-PCR (AQPs 1-11), QPCR (AQPs positive on RT-PCR), and immunohistochemistry. Bladder samples were additionally examined by Western blotting. RNA was extracted from 76 tissue samples obtained from 19 fetuses. Gestational age was 60 (n=11) or 100 days (n=8). PCR showed that AQP1, 3, 9 and 11 mRNA was expressed in all locations. The expression of AQP3 increased significantly at all four locations with gestational age, whereas AQP11 significantly decreased. AQP1 expression increased in the ureter, bladder and urethra. AQP9 mRNA expression increased in the urethra and bladder, but decreased in the ureter. AQP5 was expressed only in the urethra. Immunohistochemistry showed AQP1 staining in sub-urothelial vessels at all locations. Western blotting analysis confirmed increased AQP1 protein levels in bladder samples during gestation. Expression levels of AQP1, 3, 5, 9 and 11 in the urinary tract change during gestation, and further studies are needed to provide insights into normal and pathophysiological water handling mechanisms in the fetus.
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Affiliation(s)
- L K Jakobsen
- Department of Clinical Medicine, Department of Urology, Aarhus University, Aarhus N, Denmark.
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Lu YT, Tingskov SJ, Djurhuus JC, Nørregaard R, Olsen LH. Can bladder fibrosis in congenital urinary tract obstruction be reversed? J Pediatr Urol 2017; 13:574-580. [PMID: 29037864 DOI: 10.1016/j.jpurol.2017.08.013] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2017] [Accepted: 08/22/2017] [Indexed: 02/06/2023]
Abstract
A variety of conditions exists in adults and children in which functional or anatomical urinary tract obstructions cause bladder fibrosis, which reduces the bladder's ability to store and empty urine. Current surgical procedures include removal of the obstructions to facilitate bladder emptying or prompt prenatal or postnatal spinal closure to prevent further neurogenic damage. Bladder fibrosis may occur, and it can get worse if a flow hindrance persists or deteriorates. Anti-fibrotic therapeutic strategies that target a variety of factors have been developed in animal models, but currently there are no anti-fibrotic therapies available for clinical use. This review examines the pathogenesis of bladder fibrosis that is caused by congenital obstructions of the lower urinary tract, and it focuses on the principal signalling factors and potential treatment modalities.
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Affiliation(s)
- Yu Tao Lu
- Department of Clinical Medicine, University of Aarhus, Aarhus, Denmark
| | | | | | - Rikke Nørregaard
- Department of Clinical Medicine, University of Aarhus, Aarhus, Denmark
| | - L Henning Olsen
- Department of Clinical Medicine, University of Aarhus, Aarhus, Denmark; Department of Urology, Aarhus University Hospital, Aarhus, Denmark.
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Ervandian M, Djurhuus JC, Høyer M, Graugaard-Jensen C, Borre M. Long-term urodynamic findings following radical prostatectomy and salvage radiotherapy. Scand J Urol 2017; 52:20-26. [DOI: 10.1080/21681805.2017.1354067] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Maria Ervandian
- Department of Urology, Aarhus University Hospital, Aarhus, Denmark
| | | | - Morten Høyer
- Department of Oncology, Aarhus University Hospital, Aarhus, Denmark
- Danish Centre for Particle Therapy, Aarhus University Hospital, Aarhus, Denmark
| | | | - Michael Borre
- Department of Urology, Aarhus University Hospital, Aarhus, Denmark
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Badawi JK, Bosch R, Djurhuus JC, Hanna-Mitchell AT. Is testosterone important in LUT function in men and women? ICI-RS 2015. Neurourol Urodyn 2017; 36:859-862. [PMID: 28444714 DOI: 10.1002/nau.23041] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2015] [Accepted: 05/02/2016] [Indexed: 12/20/2022]
Abstract
AIM This review article is a collaborative report based upon the Authors' presentations and Group discussion on the role of testosterone (T) in the male and female lower urinary tract (LUT) which took place at the 6th International Consultation on Incontinence Research Society's (ICI-RS) annual meeting, in Bristol, UK (September 8-10, 2015). METHODS It comprises overviews and opinions on both the current state of knowledge of the role of T in LUT function and dysfunction in both sexes. RESULTS Results from animal studies suggest that T treatment may be beneficial for disorders of the LUT in women including urinary incontinence and pelvic organ prolapse. The need for clinical studies to evaluate the effect of T treatment in peri- and post-menopausal women, taking into account the type of applied androgen, the application form, timing and dosage, is especially emphasized. In males, findings on the impact of T on the male external urethral sphincter underscores that there is still much to learn about its role in male LUT physiology. The important topic of the use of T therapy in the treatment of enuresis in the young, both sexes, is also discussed. The importance of understanding the steroidogenic pathways linking T with estradiol is discussed as being of paramount importance in researching the unique actions of T in the LUT. CONCLUSION The overall conclusion is that further research into the role of T in LUT function and dysfunction across genders and age groups (young to old) is extremely important. Neurourol. Urodynam. 36:859-862, 2017. © 2017 Wiley Periodicals, Inc.
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Affiliation(s)
- Jasmin Katrin Badawi
- Department of Urology, University Hospital Mannheim, Medical Faculty of the Ruprechts-Karls-University of Heidelberg, Mannheim, Germany
| | - Ruud Bosch
- Department of Urology, University Medical Center Utrecht, Utrecht, The Netherlands
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Kirschner-Hermanns R, Anding R, Rosier P, Birder L, Andersson KE, Djurhuus JC. Fundamentals and clinical perspective of urethral sphincter instability as a contributing factor in patients with lower urinary tract dysfunction--ICI-RS 2014. Neurourol Urodyn 2016; 35:318-23. [PMID: 26872575 PMCID: PMC4760427 DOI: 10.1002/nau.22815] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2015] [Accepted: 06/08/2015] [Indexed: 01/02/2023]
Abstract
Aims Urethral pathophysiology is often neglected in discussions of bladder dysfunction. It has been debated whether “urethral sphincter instability,” referred to based on observed “urethral pressure variations,” is an important aspect of overactive bladder syndrome (OAB). The purpose of this report is to summarize current urethral pathophysiology evidence and outline directions for future research based on a literature review and discussions during the ICI‐RS meeting in Bristol in 2014. Methods Urethral pathophysiology with a focus on urethral pressure variation (UPV) was presented and discussed in a multidisciplinary think tank session at the ICI_R meeting in Bristol 2014. This think tank session was based on collaboration between physicians and basic science researchers. Results Experimental animal studies or studies performed in clinical series (predominantly symptomatic women) provided insights into UPV, but the findings were inconsistent and incomplete. However, UPV is certainly associated with lower urinary tract symptoms (likely OAB), and thus, future research on this topic is relevant. Conclusions Future research based on adequately defined clinical (and urodynamic) parameters with precisely defined patient groups might shed better light on the cause of OAB symptoms. Further fundamental investigation of urethral epithelial–neural interactions via the release of mediators should enhance our knowledge and improve the management of patients with OAB. Neurourol. Urodynam. 35:318–323, 2016. © 2016 The Authors. Neurourology and Urodynamics published by Wiley Periodicals, Inc.
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Affiliation(s)
- Ruth Kirschner-Hermanns
- Neuro-Urologie, University Clinic Friedrich-Wilhelms-University Bonn and Neurologic Rehabilitation Center Godeshoehe, Germany
| | - Ralf Anding
- Neuro-Urologie, University Clinic Friedrich-Wilhelms-University Bonn and Neurologic Rehabilitation Center Godeshoehe, Germany
| | - Peter Rosier
- Department of Urology, University Medical Centre Utrecht, the Netherlands
| | - Lori Birder
- Departments of Medicine and Pharmacology and Chemical Biology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Karl Erik Andersson
- Faculty of Health Sciences, Institut for Klinisk Medicin, Aarhus Universitet, Denmark.,AIAS, Aarhus Institute of Advanced Studies, Aarhus University, Denmark
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Borch L, Rittig S, Kamperis K, Mahler B, Djurhuus JC, Hagstroem S. No immediate effect on urodynamic parameters during transcutaneous electrical nerve stimulation (TENS) in children with overactive bladder and daytime incontinence-A randomized, double-blind, placebo-controlled study. Neurourol Urodyn 2016; 36:1788-1795. [PMID: 27868230 DOI: 10.1002/nau.23179] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2016] [Accepted: 10/30/2016] [Indexed: 11/08/2022]
Abstract
AIM To evaluate the immediate effect on natural fill urodynamic parameters and bladder function during transcutaneous electrical nerve stimulation (TENS) in children with overactive bladder (OAB) and daytime urinary incontinence (DUI). MEETHODS In this double-blind, placebo-controlled study, 24 children with severe OAB and DUI (mean age 8.5 ± 1.2 years) underwent 48-h natural fill urodynamics. After 24 h of baseline investigation, the children were randomized to either active continuous TENS (n = 12) or placebo TENS (n = 12) over the sacral S2-S3 outflow. The urodynamic recordings were analyzed manually for three different bladder contraction patterns resulting in a void. The number of bladder contractions not leading to a void was also calculated. Maximum voided volume (MVV) and average voided volume (AVV) were identified for both the baseline and the intervention day. RESULTS We found that TENS had no immediate objective effect on bladder capacity. The difference (before minus after treatment) in MVV/EBC in the active TENS group = 0.03 ± 0.23 versus placebo TENS group = -0.01 ± 0.10 (P = 0.61). Also, there was no significant difference in the proportion of different bladder contraction types between the two groups. TENS did not significantly influence the number of bladder contractions not leading to a void. Results are presented as mean ± SD. CONCLUSION There is no immediate objective effect of TENS on bladder activity assessed by natural fill urodynamics in children with OAB and DUI.
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Affiliation(s)
- Luise Borch
- Department of Pediatrics, Center for Child Incontinence, Aarhus University Hospital, Aarhus, Denmark
| | - Soeren Rittig
- Department of Pediatrics, Center for Child Incontinence, Aarhus University Hospital, Aarhus, Denmark
| | - Konstantinos Kamperis
- Department of Pediatrics, Center for Child Incontinence, Aarhus University Hospital, Aarhus, Denmark
| | - Birgitte Mahler
- Department of Pediatrics, Center for Child Incontinence, Aarhus University Hospital, Aarhus, Denmark
| | | | - Soeren Hagstroem
- Department of Pediatrics, Aalborg University Hospital, Aalborg, Denmark
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Djurhuus JC. Retrospective clinical studies. J Pediatr Urol 2016; 12:221. [PMID: 27329868 DOI: 10.1016/j.jpurol.2016.05.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2016] [Accepted: 05/04/2016] [Indexed: 10/21/2022]
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Svensson E, Horváth-Puhó E, Thomsen RW, Djurhuus JC, Pedersen L, Borghammer P, Sørensen HT. Does vagotomy reduce the risk of Parkinson's disease: The authors reply. Ann Neurol 2015; 78:1012-3. [DOI: 10.1002/ana.24518] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2015] [Accepted: 09/06/2015] [Indexed: 11/10/2022]
Affiliation(s)
- Elisabeth Svensson
- Department of Clinical Epidemiology; Institute of Clinical Medicine, Aarhus University Hospital; Aarhus Denmark
| | - Erzsébet Horváth-Puhó
- Department of Clinical Epidemiology; Institute of Clinical Medicine, Aarhus University Hospital; Aarhus Denmark
| | - Reimar W Thomsen
- Department of Clinical Epidemiology; Institute of Clinical Medicine, Aarhus University Hospital; Aarhus Denmark
| | | | - Lars Pedersen
- Department of Clinical Epidemiology; Institute of Clinical Medicine, Aarhus University Hospital; Aarhus Denmark
| | - Per Borghammer
- Institute of Clinical Medicine, Aarhus University; Aarhus Denmark
- Department of Nuclear Medicine & PET Center; Aarhus University Hospital; Aarhus Denmark
| | - Henrik Toft Sørensen
- Department of Clinical Epidemiology; Institute of Clinical Medicine, Aarhus University Hospital; Aarhus Denmark
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Mahler B, Kamperis K, Ankarberg-Lindgren C, Djurhuus JC, Rittig S. The effect of puberty on diurnal sodium regulation. Am J Physiol Renal Physiol 2015; 309:F873-9. [PMID: 26336163 DOI: 10.1152/ajprenal.00319.2014] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2014] [Accepted: 08/26/2015] [Indexed: 11/22/2022] Open
Abstract
The aim of this study was to investigate the impact of sex and puberty stage on circadian changes in sodium excretion, sodium-regulating hormones, and hemodynamics. Thirty-nine healthy volunteers (9 prepuberty boys, 10 prepuberty girls, 10 puberty boys, and 10 puberty girls) were included. They all underwent a 24-h circadian in-patient study under standardized conditions regarding activity, diet, and fluid intake. Blood samples were drawn every 4 h, and the urine was collected in fractions. Blood pressure and heart rate were noninvasively monitored. Atrial natriuretic peptide (ANP), angiotensin II, aldosterone, and renin were measured in blood. Children in puberty had lower plasma levels of renin (P<0.05) and angiotensin II (P<0.05) and a 26% reduction in filtered sodium without changes in sodium excretion compared with prepuberty children. A circadian rhythm in sodium excretion, the renin-angiotensin system, ANP, and blood pressure was found with a midnight ANP peak (P<0.001), a nighttime decrease in hemodynamic parameters (P<0.001), an increase in plasma renin (P<0.001) and angiotensin II (P<0.001), and a decrease in sodium excretion (P<0.001) mainly on the basis of increased sodium reabsorption (P<0.001). The timing of the changes did not depend on sex or puberty group. There is a circadian rhythm of sodium excretion and sodium regulation in 7- to 15-yr-old children. This rhythm is similar in boys and girls. As an important new finding, puberty changes the plasma levels of renin and angiotensin II without changing the amount of sodium excreted or the day to night sodium excretion ratio.
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Affiliation(s)
- B Mahler
- Department of Pediatrics, Aarhus University Hospital, Aarhus, Denmark;
| | - K Kamperis
- Department of Pediatrics, Aarhus University Hospital, Aarhus, Denmark
| | | | - J C Djurhuus
- The Institute of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - S Rittig
- Department of Pediatrics, Aarhus University Hospital, Aarhus, Denmark
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Svensson E, Horváth-Puhó E, Thomsen RW, Djurhuus JC, Pedersen L, Borghammer P, Sørensen HT. Reply: To PMID 26031848. Ann Neurol 2015; 78:835. [PMID: 26267329 DOI: 10.1002/ana.24500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
- Elisabeth Svensson
- Department of Clinical Epidemiology, Institute of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Erzsébet Horváth-Puhó
- Department of Clinical Epidemiology, Institute of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Reimar W Thomsen
- Department of Clinical Epidemiology, Institute of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark
| | | | - Lars Pedersen
- Department of Clinical Epidemiology, Institute of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Per Borghammer
- Institute of Clinical Medicine, Aarhus University, Aarhus, Denmark
- Department of Nuclear Medicine & PET Center, Aarhus University Hospital, Aarhus, Denmark
| | - Henrik Toft Sørensen
- Department of Clinical Epidemiology, Institute of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark
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Svensson E, Horváth-Puhó E, Thomsen RW, Djurhuus JC, Pedersen L, Borghammer P, Sørensen HT. Vagotomy and subsequent risk of Parkinson's disease. Ann Neurol 2015; 78:522-9. [PMID: 26031848 DOI: 10.1002/ana.24448] [Citation(s) in RCA: 529] [Impact Index Per Article: 58.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2015] [Revised: 05/26/2015] [Accepted: 05/26/2015] [Indexed: 01/03/2023]
Abstract
OBJECTIVE Parkinson's disease (PD) may be caused by an enteric neurotropic pathogen entering the brain through the vagal nerve, a process that may take over 20 years. We investigated the risk of PD in patients who underwent vagotomy and hypothesized that truncal vagotomy is associated with a protective effect, whereas superselective vagotomy has a minor effect. METHODS We constructed cohorts of all patients in Denmark who underwent vagotomy during 1977-1995 and a matched general population cohort by linking Danish registries. We used Cox regression to compute hazard ratios (HRs) for PD and corresponding 95% confidence intervals (CIs), adjusting for potential confounders. RESULTS Risk of PD was decreased in patients who underwent truncal (HR = 0.85; 95% CI = 0.56-1.27; follow-up of >20 years: HR = 0.58; 95% CI: 0.28-1.20) compared to superselective vagotomy. Risk of PD was also decreased after truncal vagotomy when compared to the general population cohort (overall adjusted HR = 0.85; 95% CI: 0.63-1.14; follow-up >20 years, adjusted HR = 0.53; 95% CI: 0.28-0.99). In patients who underwent superselective vagotomy, risk of PD was similar to the general population (HR = 1.09; 95% CI: 0.84-1.43; follow-up of >20 years: HR = 1.16; 95% CI: 0.80-1.70). Statistical precision of risk estimates was limited. Results were consistent after external adjustment for unmeasured confounding by smoking. INTERPRETATION Full truncal vagotomy is associated with a decreased risk for subsequent PD, suggesting that the vagal nerve may be critically involved in the pathogenesis of PD.
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Affiliation(s)
- Elisabeth Svensson
- Department of Clinical Epidemiology, Institute of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Erzsébet Horváth-Puhó
- Department of Clinical Epidemiology, Institute of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Reimar W Thomsen
- Department of Clinical Epidemiology, Institute of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark
| | | | - Lars Pedersen
- Department of Clinical Epidemiology, Institute of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Per Borghammer
- Institute of Clinical Medicine, Aarhus University, Aarhus, Denmark.,Department of Nuclear Medicine and PET Center, Aarhus University Hospital, Aarhus, Denmark
| | - Henrik Toft Sørensen
- Department of Clinical Epidemiology, Institute of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark
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Frøkiaer J, Knudsen L, Mortensen J, Djurhuus JC, Jensen FT. The impact of different urinary flow rates on renoscintigraphy. Contrib Nephrol 2015; 79:74-6. [PMID: 2225871 DOI: 10.1159/000418154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Affiliation(s)
- J Frøkiaer
- Institute of Experimental Clinical Research, University of Aarhus, Denmark
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Wen JG, Lu YT, Cui LG, Bower WF, Rittig S, Djurhuus JC. Bladder function development and its urodynamic evaluation in neonates and infants less than 2 years old. Neurourol Urodyn 2014; 34:554-60. [PMID: 24788785 DOI: 10.1002/nau.22626] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2013] [Accepted: 04/02/2014] [Indexed: 12/19/2022]
Affiliation(s)
- Jian Guo Wen
- Pediatric Urodynamic Centre; First Affiliated Hospital of Zhengzhou University; Zhengzhou P.R. China
| | - Yu Tao Lu
- Pediatric Urodynamic Centre; First Affiliated Hospital of Zhengzhou University; Zhengzhou P.R. China
| | - Lin Gang Cui
- Pediatric Urodynamic Centre; First Affiliated Hospital of Zhengzhou University; Zhengzhou P.R. China
| | - Wendy Fiona Bower
- Department of Epidemiology and Preventive Medicine; School of Public Health, Monash University; Melbourne Australia
| | - Soren Rittig
- Department of Paediatrics; Aarhus University Hospital; Aarhus N Denmark
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Wen L, Wen YB, Wang ZM, Wen JG, Li ZZ, Shang XP, Liu ZS, Jia LH, Qin GJ, Heesakkers J, Corcos J, Djurhuus JC. Risk factors of nocturia (two or more voids per night) in Chinese people older than 40 years. Neurourol Urodyn 2014; 34:566-70. [PMID: 24788681 DOI: 10.1002/nau.22623] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2014] [Accepted: 04/02/2014] [Indexed: 11/11/2022]
Affiliation(s)
- Lu Wen
- Urodynamics Centre; First Affiliated Hospital of Zhengzhou University; Zhengzhou China
- Department of Nephrology; First Affiliated Hospital of Zhengzhou University; Zhengzhou China
- Institute of Clinical Medicine; First Affiliated Hospital of Zhengzhou University; Zhengzhou China
| | - Yi Bo Wen
- Grade 2011 (Seven-Years Clinical Medicine of Zhengzhou University); First Affiliated Hospital of Zhengzhou University; Zhengzhou China
| | - Zhi Min Wang
- Department of Endocrinology; First Affiliated Hospital of Zhengzhou University; Zhengzhou China
| | - Jian Guo Wen
- Urodynamics Centre; First Affiliated Hospital of Zhengzhou University; Zhengzhou China
- Institute of Clinical Medicine; First Affiliated Hospital of Zhengzhou University; Zhengzhou China
- Department of Urology; First Affiliated Hospital of Zhengzhou University; Zhengzhou China
| | - Zhen Zhen Li
- Institute of Clinical Medicine; First Affiliated Hospital of Zhengzhou University; Zhengzhou China
| | - Xiao Ping Shang
- Medical Records Department; First Affiliated Hospital of Zhengzhou University; Zhengzhou China
| | - Zhang Suo Liu
- Department of Nephrology; First Affiliated Hospital of Zhengzhou University; Zhengzhou China
| | - Liang Hua Jia
- Urodynamics Centre; First Affiliated Hospital of Zhengzhou University; Zhengzhou China
| | - Gui Jun Qin
- Department of Endocrinology; First Affiliated Hospital of Zhengzhou University; Zhengzhou China
| | - John Heesakkers
- Department of Urology; Radboud University Medical Centre; Nijmegen The Netherlands
| | - Jacques Corcos
- Department of Surgery/Urology; McGill University; Montreal QC Canada
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Abstract
We investigated the influence of sex and puberty stage on circadian urine production and levels of antidiuretic hormone [arginine vasopressin (AVP)] in healthy children. Thirty-nine volunteers (9 prepuberty boys, 10 prepuberty girls, 10 midpuberty boys, and 10 midpuberty girls) were included. All participants underwent a 24-h circadian inpatient study under standardized conditions regarding Na(+) and fluid intake. Blood samples were drawn every 4 h for measurements of plasma AVP, serum 17-β-estradiol, and testosterone, and urine was fractionally collected for measurements of electrolytes, aquaporin (AQP)2, and PGE2. We found a marked nighttime decrease in diuresis (from 1.69 ± 0.08 to 0.86 ± 0.06 ml·kg(-1)·h(-1), P < 0.001) caused by a significant nighttime increase in solute-free water reabsorption (TcH2O; day-to-night ratio: 0.64 ± 0.07, P < 0.001) concurrent with a significant decrease in osmotic excretion (day-to-night ratio: 1.23 ± 0.06, P < 0.001). Plasma AVP expressed a circadian rhythm (P < 0.01) with a nighttime increase and peak levels at midnight (0.49 ± 0.05 pg/ml). The circadian plasma AVP rhythm was not influenced by sex (P = 0.56) or puberty stage (P = 0.73). There was significantly higher nighttime TcH2O in prepuberty children. This concurred with increased nighttime urinary AQP2 excretion in prepuberty children. Urinary PGE2 exhibited a circadian rhythm independent of sex or puberty stage. Levels of serum 17β-estradiol and testosterone were as expected for sex and puberty stage, and no effect on the AVP-AQP2-TcH2O axis was observed. This study found a circadian rhythm of plasma AVP independent of sex and puberty stage, although nighttime TcH2O was higher and AQP2 excretion was more pronounced in prepuberty children, suggesting higher prepuberty renal AVP sensitivity.
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Affiliation(s)
- B Mahler
- Dept. of Pediatrics, Regionshospitalet Randers, Skovlyvej 1, Randers 8930, Denmark.
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Wen JG, Chang QL, Lou AF, Li ZZ, Lu S, Wang Y, Wang YL, Hu JH, Mao SP, Zhang Y, Xue R, Ren C, Xing L, Zhang GX, Zhang S, Djurhuus JC, Frøkiaer J. Melamine-related urinary stones in 195 infants and young children: clinical features within 2 years of follow-up. Urol Int 2011; 87:429-33. [PMID: 22057293 DOI: 10.1159/000330795] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2011] [Accepted: 06/10/2011] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To summarize the clinical features and follow-up, the effects of melamine-tainted milk powder (MMP) consumption on kidney and body growth in children who suffered from melamine-related urinary stones (MUS) 2 years earlier were checked. MEASUREMENTS Body height and weight, kidney and bladder morphology monitored by ultrasound, urinalysis and renal function were recorded. Plain abdominal radiography was performed for differential diagnosis. The first follow-up was carried out at 15 months and the second 2 years later for patients who showed any abnormality at the first follow-up. Two hundred age- and gender-matched cohorts were included. RESULTS All cases received conservative treatment in hospital. Fifteen months of follow-up was successfully carried out in 167 cases. 91 children had residual MUS at the time of discharge, 58 MUS disappeared completely, 25 dissolved partially, 1 increased in size, and 7 did not change. At 2 years of follow-up, the residual stones all disappeared except for 1 case; the patient who showed a delayed development with regard to height caught up at 24 months of follow-up. CONCLUSIONS Conservative treatment shows a high effectiveness in cases with residual MUS. Consumption of MMP with timely treatment did not demonstrate an evident impact on kidney and bladder although body height is slightly affected in a few cases.
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Affiliation(s)
- Jian Guo Wen
- Urodynamic Center, Department of Urology of the First Affiliated Hospital of Zhengzhou University, Institute of Clinical Medicine of Zhengzhou University, Zhengzhou, China. jgwen @ zzu.edu.cn
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Kamperis K, Hagstroem S, Radvanska E, Rittig S, Djurhuus JC. Excess diuresis and natriuresis during acute sleep deprivation in healthy adults. Am J Physiol Renal Physiol 2010; 299:F404-11. [DOI: 10.1152/ajprenal.00126.2010] [Citation(s) in RCA: 77] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
The transition from wakefulness to sleep is associated with a pronounced decline in diuresis, a necessary physiological process that allows uninterrupted sleep. The aim of this study was to assess the effect of acute sleep deprivation (SD) on urine output and renal water, sodium, and solute handling in healthy young volunteers. Twenty young adults (10 male) were recruited for two 24-h studies under standardized dietary conditions. During one of the two admissions, subjects were deprived of sleep. Urine output, electrolyte excretions, and osmolar excretions were calculated. Activated renin, angiotensin II, aldosterone, arginine vasopressin, and atrial natriuretic peptide were measured in plasma, whereas prostaglandin E2 and melatonin were measured in urine. SD markedly increased the diuresis and led to excess renal sodium excretion. The effect was more pronounced in men who shared significantly higher diuresis levels during SD compared with women. Renal water handling and arginine vasopressin levels remained unaltered during SD, but the circadian rhythm of the hormones of the renin-angiotensin-aldosterone system was significantly affected. Urinary melatonin and prostaglandin E2 excretion levels were comparable between SD and baseline night. Hemodynamic changes were characterized by the attenuation of nocturnal blood pressure dipping and an increase in creatinine clearance. Acute deprivation of sleep induces natriuresis and osmotic diuresis, leading to excess nocturnal urine production, especially in men. Hemodynamic changes during SD may, through renal and hormonal processes, be responsible for these observations. Sleep architecture disturbances should be considered in clinical settings with nocturnal polyuria such as enuresis in children and nocturia in adults.
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Affiliation(s)
- Konstantinos Kamperis
- Institute of Clinical Medicine, University of Aarhus, Aarhus
- Depsrtment of Pediatrics, Aarhus University Hospital, Skejby, Aarhus, Denmark
| | - Soren Hagstroem
- Institute of Clinical Medicine, University of Aarhus, Aarhus
| | - Eva Radvanska
- Institute of Clinical Medicine, University of Aarhus, Aarhus
| | - Soren Rittig
- Depsrtment of Pediatrics, Aarhus University Hospital, Skejby, Aarhus, Denmark
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Rittig S, Kamperis K, Siggaard C, Hagstroem S, Djurhuus JC. Age related nocturnal urine volume and maximum voided volume in healthy children: reappraisal of International Children's Continence Society definitions. J Urol 2010; 183:1561-7. [PMID: 20176383 DOI: 10.1016/j.juro.2009.12.046] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2009] [Indexed: 11/15/2022]
Abstract
PURPOSE We determined normal, age related reference data regarding maximum voided volume and nocturnal urine production using the same methodology as in clinical practice. MATERIALS AND METHODS A total of 62 girls and 86 boys without enuresis (mean +/- SD age 9.64 +/- 2.63 years, range 3 to 15) completed 4 days (2 weekends) of frequency-volume charts and 14 days of home recording of nocturnal urine production. From these recordings maximum voided volume with and without first morning void was derived for each subject. Also, average nocturnal urine volume with and without nocturia was calculated. Percentiles were produced by dividing the population into 1-year age groups. RESULTS Based on 2,836 daytime voids and 1,977 overnight recordings, maximum voided volume and nocturnal urine volume showed a significant linear relationship with age but not with gender. Maximum voided volume with first morning void was significantly higher than without (403 +/- 137 ml vs 281 +/- 112 ml, p <0.0001) and the 50th percentile line of maximum voided volume with first morning void was 80 to 100 ml higher than Koff's formula (30 x [age + 1] ml). Conversely the 50th percentile of maximum voided volume without first morning void was almost identical to Koff's formula. Regarding nocturnal measurements, nocturia was noted on 128 nights (6.5%) and nocturnal urine volume on nights with nocturia was significantly higher than on nights without nocturia (365 +/- 160 ml vs 248 +/- 75 ml, respectively, p <0.0001). The 97.5th nocturnal urine volume percentile line of healthy children deviated markedly from the current International Children's Continence Society definition of nocturnal polyuria, especially at low and high ages. CONCLUSIONS We demonstrate clearly that the universally used formula 30 x (age + 1) ml is indeed valid for a population of healthy Danish children but only if the first morning void is disregarded. Furthermore, we question the validity of the current International Children's Continence Society formula for nocturnal polyuria (nocturnal urine volume greater than 130% of maximum voided volume for age), and instead we propose the formula, nocturnal urine volume greater than 20 x (age + 9) ml.
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Affiliation(s)
- S Rittig
- Department of Pediatrics, Center for Child Incontinence, Skejby, Aarhus, Denmark.
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Kjølseth D, Madsen B, Knudsen LM, Peter Nørgaard J, Christian Djurhuus J. Biofeedback Treatment of Children and Adults with Idiopathic Detrusor Instability. ACTA ACUST UNITED AC 2010. [DOI: 10.3109/00365599409181273] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Dorthe Kjølseth
- Urological Department K, Aarhus Municipal Hospital, and Institute of Experimental Clinical Research, University of Aarhus, Aarhus, Denmark
| | - Bodil Madsen
- Urological Department K, Aarhus Municipal Hospital, and Institute of Experimental Clinical Research, University of Aarhus, Aarhus, Denmark
| | - Lis M. Knudsen
- Urological Department K, Aarhus Municipal Hospital, and Institute of Experimental Clinical Research, University of Aarhus, Aarhus, Denmark
| | - Jens Peter Nørgaard
- Urological Department K, Aarhus Municipal Hospital, and Institute of Experimental Clinical Research, University of Aarhus, Aarhus, Denmark
| | - Jens Christian Djurhuus
- Urological Department K, Aarhus Municipal Hospital, and Institute of Experimental Clinical Research, University of Aarhus, Aarhus, Denmark
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Wen JG, Li ZZ, Zhang H, Wang Y, Wang G, Wang Q, Nielsen S, Djurhuus JC, Frøkiaer J. Expression of renal aquaporins is down-regulated in children with congenital hydronephrosis. ACTA ACUST UNITED AC 2009; 43:486-93. [PMID: 19757329 DOI: 10.3109/00365590903127446] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Jian Guo Wen
- Pediatric Urodynamic Center, Pediatric Surgery of First Affiliated Hospital of Zhengzhou University, Institute of Clinical Medicine Universities Henan, PR China
| | - Zhen Zhen Li
- Pediatric Urodynamic Center, Pediatric Surgery of First Affiliated Hospital of Zhengzhou University, Institute of Clinical Medicine Universities Henan, PR China
| | - Hong Zhang
- Pediatric Urodynamic Center, Pediatric Surgery of First Affiliated Hospital of Zhengzhou University, Institute of Clinical Medicine Universities Henan, PR China
- Pathology Department of First Affiliated Hospital of Zhengzhou University, PR China
| | - Yan Wang
- Pediatric Urodynamic Center, Pediatric Surgery of First Affiliated Hospital of Zhengzhou University, Institute of Clinical Medicine Universities Henan, PR China
| | - Guixian Wang
- Pediatric Urodynamic Center, Pediatric Surgery of First Affiliated Hospital of Zhengzhou University, Institute of Clinical Medicine Universities Henan, PR China
- Institute of Clinical Medicine, University of Aarhus, Denmark
| | - Qingwei Wang
- Pediatric Urodynamic Center, Pediatric Surgery of First Affiliated Hospital of Zhengzhou University, Institute of Clinical Medicine Universities Henan, PR China
| | - Søren Nielsen
- Institute of Clinical Medicine, University of Aarhus, Denmark
| | | | - Jørgen Frøkiaer
- Institute of Clinical Medicine, University of Aarhus, Denmark
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Wang G, Ring T, Li C, Kim SW, Wen J, Djurhuus JC, Nielsen S, Frøkiaer J. Unilateral ureteral obstruction alters expression of acid-base transporters in rat kidney. J Urol 2009; 182:2964-73. [PMID: 19846141 DOI: 10.1016/j.juro.2009.08.013] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2009] [Indexed: 11/28/2022]
Abstract
PURPOSE Unilateral ureteral obstruction is a common clinical problem that is often associated with a urinary acidification defect caused by decreased net H(+) secretion and/or HCO(3)(-) reabsorption. To clarify the molecular mechanisms of these defects we examined expression levels of key acid-base transporters along the renal nephron segments and collecting duct. MATERIALS AND METHODS Wistar rats (Møllegard Breeding Centre, Eiby, Denmark) underwent 24-hour unilateral ureteral obstruction, unilateral ureteral obstruction release followed for 4 days or unilateral ureteral obstruction release followed for 4 days plus experimental acidosis induced by NH(4)Cl oral administration. After sacrifice kidneys were processed for immunoblotting and immunohistochemistry. RESULTS Semiquantitative immunoblotting revealed that unilateral ureteral obstruction caused significant mean +/- SE down-regulation of type 3 Na(+)/H(+) exchanger to 53% +/- 9%, electrogenic Na(+)/HCO(3)(-) cotransporter to 60% +/- 9%, type 1 bumetanide sensitive Na(+)-K(+)(NH(4)(+)) -2Cl(-) cotransporter to 64% +/- 7%, electroneutral Na(+)/HCO(3)(-) cotransporter to 43% +/- 4% and anion exchanger (pendrin) to 53% +/- 10% in the obstructed kidney, which was confirmed by immunohistochemistry. After release of unilateral ureteral obstruction down-regulation of these transporters persisted together with marked down-regulation of H(+)-adenosine triphosphatase in the obstructed kidney. In rats with unilateral ureteral obstruction release followed for 4 days with experimental acidosis induced by NH(4)Cl oral administration plasma pH and HCO(3)(-) were dramatically decreased in response to NH(4)Cl for 2 days compared with those in sham operated rats with acid loading, indicating a defect in H(+) excretion and HCO(3)(-) reabsorption after obstruction release. Expression of these transporters did not change in the contralateral nonobstructed kidney of rats with unilateral ureteral obstruction and unilateral ureteral obstruction release followed for 4 days. CONCLUSIONS The expression of renal acid-base transporters is markedly decreased in the obstructed kidney, which may be responsible for the contribution of impaired renal H(+) excretion and HCO(3)(-) reabsorption to the urinary acidification defect in response to unilateral ureteral obstruction.
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Affiliation(s)
- Guixian Wang
- Water and Salt Research Center, University of Aarhus, Aarhus, Denmark
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Affiliation(s)
- Iben Moeller Joensson
- Institute of Clinical Medicine, University of Aarhus, Aarhus, Denmark
- Department of Pediatrics (Neurogastroenterology Unit), Aarhus University Hospital, Skejby, Denmark
| | - Soren Hagstroem
- Institute of Clinical Medicine, University of Aarhus, Aarhus, Denmark
| | - Klaus Krogh
- Department of Hepatology and Gastroenterology V, Aarhus University Hospital, Skejby, Denmark
- Department of Surgery P, Aarhus University Hospital, Skejby, Denmark
| | - Charlotte Siggaard
- Department of Pediatrics (Neurogastroenterology Unit), Aarhus University Hospital, Skejby, Denmark
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Affiliation(s)
- Anne Kruse
- Clinical Institute, University of Aarhus and Department of Pediatrics, Aarhus University Hospital (SR), Skejby, Aarhus, Denmark
| | - Birgitte Mahler
- Clinical Institute, University of Aarhus and Department of Pediatrics, Aarhus University Hospital (SR), Skejby, Aarhus, Denmark
| | - Soren Rittig
- Clinical Institute, University of Aarhus and Department of Pediatrics, Aarhus University Hospital (SR), Skejby, Aarhus, Denmark
| | - Jens Christian Djurhuus
- Clinical Institute, University of Aarhus and Department of Pediatrics, Aarhus University Hospital (SR), Skejby, Aarhus, Denmark
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Hagstroem S, Mahler B, Madsen B, Djurhuus JC, Rittig S. Transcutaneous electrical nerve stimulation for refractory daytime urinary urge incontinence. J Urol 2009; 182:2072-8. [PMID: 19695629 DOI: 10.1016/j.juro.2009.05.101] [Citation(s) in RCA: 67] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2008] [Indexed: 12/14/2022]
Abstract
PURPOSE We studied the effect of transcutaneous electrical nerve stimulation in children with overactive bladder and treatment refractory daytime urinary incontinence. MATERIALS AND METHODS We recruited 27 children 5 to 14 years old with daytime urge incontinence refractory to timer assisted standard urotherapy and anticholinergics who had normal urinalysis, and unremarkable urinary tract ultrasound and physical examination. Study exclusion criteria were bladder underactivity, lower urinary tract obstruction, ongoing defecation disorders, lower urinary tract surgery and previous transcutaneous electrical nerve stimulation. After a 2-week run-in of standard urotherapy the children underwent natural fill ambulatory urodynamics to confirm detrusor overactivity. Subsequently they were randomly allocated to 4 weeks of 2 hours of daily active or placebo S2-S3 transcutaneous electrical nerve stimulation. The severity of incontinence and urgency, and 48-hour bladder diaries were recorded before randomization and during intervention week 4. Children withdrew from anticholinergics throughout the study period. RESULTS Two children were excluded from randomization due to urodynamic signs of lower urinary tract obstruction. After 4 weeks of intervention 8 children (61%) in the active group showed a significant decrease in incontinence severity but this occurred in only 2 (17%) in the sham treated group (p <0.05). The active group had a significantly greater decrease in daily incontinence episodes compared to the sham treated group (p <0.01). Transcutaneous electrical nerve stimulation did not alter maximal and average voided volumes. CONCLUSIONS Sacral transcutaneous electrical nerve stimulation seems superior to placebo for refractory daytime incontinence in children with overactive bladder. This effect does not seem to be a consequence of improved bladder reservoir function.
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Affiliation(s)
- Søren Hagstroem
- Institute of Clinical Medicine, Aarhus University Hospital, Skejby, Aarhus, Denmark.
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Wang G, Topcu SO, Ring T, Wen J, Djurhuus JC, Kwon TH, Nielsen S, Frøkiaer J. Age-dependent renal expression of acid-base transporters in neonatal ureter obstruction. Pediatr Nephrol 2009; 24:1487-500. [PMID: 19495807 DOI: 10.1007/s00467-009-1193-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2008] [Revised: 03/12/2009] [Accepted: 03/27/2009] [Indexed: 12/22/2022]
Abstract
Congenital obstructive nephropathy accounts for a major proportion of renal insufficiency in infancy and childhood. In an earlier investigation we demonstrated that bilateral complete ureteral obstruction (BUO) in rats is associated with inadequate urinary acidification [Am J Physiol Renal Physiol. 295(2):F497-506, 2008]. The aim of the study reported here was to determine whether this defect is also associated with unilateral ureteral obstruction (UUO), which is clinically more common than BUO. The time-course of the changes in protein expression levels of major renal acid-base transporters was examined at 7 and 14 weeks in rats with neonatally induced partial unilateral ureteral obstruction (PUUO), which was performed within the first 48 h of life. We observed that protein expression of the renal acid-base transporters NHE3, NBC1, NBCn1, pendrin and Na(+)-K(+)-ATPase was increased in both obstructed and non-obstructed kidneys 7 weeks after the induction of neonatal PUUO. This was confirmed by immunocytochemistry. In contrast, 14 weeks after the induction of PUUO, there was a significant downregulation of the renal acid-base transporters NBC1, NBCn1 and Na(+)-K(+)-ATPase in the obstructed kidneys. These time/age-dependent changes in protein expression were associated with parallel changes in renal function resulting in urine acidification in response to exogenous acid loading. In conclusion, these results show that downregulation of protein expression is a time/age-dependent response to PUUO, which could contribute to the decreased net acid excretion and development of metabolic acidosis in neonatal rats with PUUO.
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Affiliation(s)
- Guixian Wang
- The Water and Salt Research Center, University of Aarhus, Aarhus C, Denmark
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Holst U, Rawashdeh YF, Andreasen F, Christian Djurhuus J, Mortensen J. Endoluminal pelvic perfusion with norepinephrine causes only minor systemic effects and diminishes the increase in pelvic pressure caused by perfusion. ACTA ACUST UNITED AC 2009; 39:443-8. [PMID: 16303718 DOI: 10.1080/00365590500221469] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
OBJECTIVE To evaluate the effect of endoluminal norepinephrine (NE) on transport pressures of the normal upper urinary tract of the pig and on plasma levels of NE in relation to possible systemic effects. MATERIAL AND METHODS Six anaesthetized pigs weighing approximately 39 kg were studied. Transparenchymally, two 6-F catheters were introduced into the renal pelvis bilaterally to measure pressure and perfusion. Ultrasonic flow probes recorded renal arterial blood flow, and a transurethral 10-F catheter drained the bladder and monitored diuresis. In all six animals, the bilateral pelvic pressure response was examined at increasing perfusion rates (2, 4, 6, 8, 10 and 15 ml/min) and with increasing doses of NE (0, 5, 50 and 100 microg/ml). Arterial blood samples were analysed for NE, epinephrine and blood glucose. The systemic blood pressure, heart rate and electrocardiogram were registered. RESULTS At all the investigated concentrations, endoluminal NE significantly diminished the increase in pelvic pressure caused by pelvic perfusion at all flow rates. At the lowest concentration of NE, no significant increase in the plasma level of NE was observed and the blood pressure did not increase. During perfusion with 50 and 100 microg/ml NE, plasma levels of NE increased significantly from 487+/-398 to 1798+/-910 and 2961+/-2093 pg/ml, respectively. This was accompanied by significant rises in mean systolic blood pressure from a baseline value of 95+/-10 mmHg to 111+/-20 and 118+/-23 mmHg, respectively. Heart rate, renal arterial blood flow and plasma levels of epinephrine and glucose did not change. CONCLUSIONS Endoluminal NE diminished the increase in pelvic pressure caused by pelvic perfusion even at concentrations too low to cause significant changes in NE plasma levels or systemic effects. Very high NE concentrations in the perfusion fluid caused increased plasma levels and a modest but significant increase in blood pressure. Administration of endoluminal NE may be useful in upper urinary tract stone treatment and endoscopy.
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Affiliation(s)
- Uffe Holst
- Department of Surgery, Haderslev Sygehus, Haderslev, Denmark
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Graugaard-Jensen C, Schmidt F, Frederik Thomsen H, Christian Djurhuus J. Normal voiding patterns assessed by means of a frequency–volume chart. ACTA ACUST UNITED AC 2009; 42:269-73. [DOI: 10.1080/00365590701777715] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
| | - Frank Schmidt
- Institute of Clinical Medicine, University Hospital of Aarhus, Skejby Sygehus, Aarhus, Denmark
| | | | - Jens Christian Djurhuus
- Institute of Clinical Medicine, University Hospital of Aarhus, Skejby Sygehus, Aarhus, Denmark
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Affiliation(s)
- Jens Christian Djurhuus
- International Enuresis Research Center, Skejby Hospital, University Hospital of Aarhus, Aarhus, Denmark
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Andersen HL, Duch BU, Gregersen H, Ledet T, Djurhuus JC. Biomechanical properties of the anterior urethra of the male rabbitA study using impedance planimetry. ACTA ACUST UNITED AC 2009; 38:99-111. [PMID: 15204388 DOI: 10.1080/00365590310020051] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
OBJECTIVE To evaluate the anterior urethra of the male rabbit regarding its luminal cross-sectional area (CSA), CSA distensibility, circumferential tension-strain relation, histology and the collagen content of the tissue. material and methods: Nineteen rabbits were examined with impedance planimetry by distending the urethra at the passage from the spongious to the bulbous part and 1 cm proximally in the bulbous part. Four weeks later, eight rabbits underwent a second examination. After the measurements the urethras were processed for either histology or determination of collagen content. The urethras from six additional rabbits served as controls for histology and collagen content. RESULTS The CSA and the CSA distensibility were smaller at the distal than the proximal distension site. At both sites the CSA distensibility was high at low luminal pressure loads and decreased with increasing pressure. The circumferential tension-strain plot displayed an exponential relation, with a steeper slope distally than proximally. Repeated biomechanical investigation revealed a significantly increased CSA and a decreased slope of the circumferential tension-strain relation at both distension sites. The biomechanical investigation induced abrasion of the epithelium, extravasation of erythrocytes and separation of the collagen fibres, suggesting oedema of the luminal part of the wall. After 4 weeks the epithelium had changed from transitional to stratified, squamous and often keratinized epithelium and the collagen beneath the epithelium formed a dense network instead of wavy lines as seen in the control urethras. The collagen content was larger at the distal than the proximal distension site. No change in collagen content could be demonstrated between the urethras investigated once or twice with impedance planimetry. CONCLUSIONS The non-linear pressure-CSA, pressure-CSA distensibility and circumferential tension-strain relations found at both distension sites demonstrate that the urethra yields readily at low pressures, thus facilitating flow. At higher pressure loads, the tissue becomes less distensible, a property that protects it against over-distension and damage. Impedance planimetry cannot be used to study before-and-after phenomena as the biomechanical investigation changed both the histology and the biomechanical properties of the rabbit urethra.
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Affiliation(s)
- H L Andersen
- Institute of Experimental Clinical Research, University of Aarhus, Denmark.
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Abstract
OBJECTIVE Bladder volume monitors may be useful for surveillance of bladder volume and urine production in urologic patients. Therefore, we designed an ultrasonic bladder volume monitor and evaluated it in vitro using phantoms and in vivo in one male volunteer. The purpose of this study was to perform a more thorough in vivo evaluation of our monitor in urologic patients to investigate biological effects and variance over a wide range of bladder volumes. MATERIAL AND METHODS Thirty urologic patients of either gender were examined using the bladder volume monitor, which is based on seven phased array ultrasonic transducers arranged in a circular pattern to optimize detection of the bladder walls. The monitor was set up to record bladder volume every 30 s during two sequential cystometries with infusion rates of 30 and 60 ml/min. The measured volumes were analyzed using regression analysis to determine volume increments (slopes), offset volume (intercept) and correlation (Pearson's correlation coefficient). RESULTS In the male patients, the median correlation coefficient between the infused and measured volumes was 0.97 and the slope was 0.68 ml/ml, thus warranting a correction factor of approximately 1.47 with no general volume offset. In the female patients, small bladders were generally outside the field of view of the monitor. Consequently, the correlation coefficients and slopes were 0.834 (median) and 0.43 (mean), respectively, whereas volume offsets were generally negative. CONCLUSIONS For examinations in male patients, the performance of the bladder volume monitor was adequate. However, for examinations in female patients, a minor redesign of the transducer unit is necessary to insure proper operation.
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Krarup PM, Stolle LB, Rawashdeh YF, Skott O, Djurhuus JC, Froekiaer J. Regional changes in renal cortical glucose, lactate and urea during acute unilateral ureteral obstruction. ACTA ACUST UNITED AC 2009; 41:47-53. [PMID: 17366102 DOI: 10.1080/00365590600795305] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
OBJECTIVE Acute unilateral ureteral obstruction (UUO) leads to changes in kidney function and metabolism. Microdialysis offers the possibility of topical analysis of changes in kidney metabolism. We applied microdialysis to the porcine kidney and evaluated its impact on gross kidney function. Furthermore, we investigated regional variations in renal interstitial fluid (RIF) glucose, lactate and urea during acute UUO. MATERIAL AND METHODS Eight anesthetized pigs were used. Microdialysis probes were inserted in the upper, middle and lower thirds of the left renal cortex and perfused with Ringer's chloride at a rate of 0.3 microl/min. Dialysates were fractionated for 30-min periods. Bilateral intrapelvic pressure, urinary output, urinary osmolality, the excretion fractions of sodium and potassium, renal blood flow and the glomerular filtration rate were measured. Subsequently, left-sided graded ureteral obstruction was initiated, using the kidney's own urine production as a counter-pressure. RESULTS The application of three microdialysis probes did not have any impact on kidney function. Ureteral obstruction decreased RIF glucose in the upper and lower thirds of the kidney, but not in the middle third. RIF lactate did not change. Interstitial urea increased in all regions of the kidney, but most markedly in the upper and lower poles. CONCLUSIONS Microdialysis is of potential value for assessing the renal interstitial milieu under different pathophysiological conditions. Ureteral obstruction resulted in regional differences in cortical metabolites, predominantly affecting the upper and lower poles.
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Kristiansen NK, Ringgaard S, Nygaard H, Djurhuus JC. Effect of Bladder Volume, Gender and Body Position on the Shape and Position of the Urinary Bladder. ACTA ACUST UNITED AC 2009; 38:462-8. [PMID: 15841778 DOI: 10.1080/00365590410018693] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
OBJECTIVE The optimal design of bladder volume-monitoring equipment, e.g. regarding transducer design and software algorithms, depends greatly on the shape and position of the bladder or on potential changes due to body position and bladder volume. The purpose of this study was to study the influence of body position, bladder volume and gender on the shape and position of the bladder. MATERIAL AND METHODS MRI scans of 11 young volunteers were performed during changes in posture. Images were recorded in the transverse and frontal planes and repeated four to six times through the bladder-filling cycle from empty to full. The position of the bladder midpoint was measured in the three planes. Moreover, to account for shape, the compactness of the cross-section of the bladder was calculated based on its perimeter and area. The effect of body position and gender was analyzed using repeated-measures ANOVA and the independent samples t-test, respectively. RESULTS No significant effect of body position on bladder position or shape was found. Gender was shown to have a significant impact on both the position and shape of the bladder: the female bladder was positioned more caudally and was less compact in the transverse plane than the male bladder. Furthermore, there was significant cranial-dorsal movement of the bladder during filling. CONCLUSION No significant changes in the position or shape of the bladder were observed during changes in body position in young subjects, regardless of bladder volume or gender. However, changes in both parameters were found due to bladder filling.
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Abstract
OBJECTIVE To describe normal natural fill urodynamics in young men during normal and increased fluid intake. MATERIAL AND METHODS Thirty healthy males aged 21-32 years volunteered for an ambulatory urodynamic 24 h investigation with a suprapubic catheter. The recorded micturition data were: frequency (f), voided volume (VV), voiding time, maximal flow rate (Qmax) and time to Qmax. The number of sensed and not-sensed bladder contractions, duration and time in relation to voiding were also recorded. During the recording day subjects were randomized to normal (30 ml/kg body weight per day) or larger (60 ml/kg body weight per day) fluid intake. RESULTS As expected there was a larger urine production and an increased voiding frequency in the fluid-loaded group (p<0.0001). The detrusor pressure (Pdet) Qmax was significantly higher in the fluid-loaded group (73 cmH2O, range 57-94) than in the normal fluid intake group (60 cmH2O, range 45-86) (p=0.003). No other urodynamic data differed significantly between the two groups. When comparing the ambulatory urodynamic data with previously obtained home flowmetry recordings from the same volunteers differences were only found in voiding frequency. The majority of participants had detrusor contractions, felt and unfelt, during the filling phase. Three types of detrusor activity during voiding phase could be described: type 1, with one micturition contraction, type 2, with several small contractions before micturition, and type 3, with large prolonged contractions leading to micturition. CONCLUSIONS Ambulatory urodynamics in normal young men showed a large interindividual variation. Bladder contractions during filling were frequently recorded, and premicturition contractions were consistently found. The data found in this study were similar to previous home flow recordings in the same group.
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Affiliation(s)
- F Schmidt
- Institute of Experimental Clinical Research, Skejby, University of Aarhus, Denmark.
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Wang G, Topcu SO, Djurhuus JC, Nielsen S, Frokiaer J. Age dependent protein expression of renal acid‐base transporters in rats with congenital ureter obstruction. FASEB J 2009. [DOI: 10.1096/fasebj.23.1_supplement.1012.10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Guixian Wang
- Institute of Clinical experimentAarhus UniversityAarhusDenmark
- The Water and Salt Research CenterAarhus UniversityAarhusDenmark
| | - Sukru Oguzkan Topcu
- Institute of Clinical experimentAarhus UniversityAarhusDenmark
- The Water and Salt Research CenterAarhus UniversityAarhusDenmark
| | - Jens Christian Djurhuus
- Institute of Clinical experimentAarhus UniversityAarhusDenmark
- The Water and Salt Research CenterAarhus UniversityAarhusDenmark
| | - Soren Nielsen
- Institute of Clinical experimentAarhus UniversityAarhusDenmark
- The Water and Salt Research CenterAarhus UniversityAarhusDenmark
| | - Jorgen Frokiaer
- Institute of Clinical experimentAarhus UniversityAarhusDenmark
- The Water and Salt Research CenterAarhus UniversityAarhusDenmark
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Hagstroem S, Rittig N, Kamperis K, Mikkelsen MM, Rittig S, Djurhuus JC. Treatment outcome of day-time urinary incontinence in children. ACTA ACUST UNITED AC 2009; 42:528-33. [PMID: 18609267 DOI: 10.1080/00365590802098367] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
OBJECTIVE To analyse retrospectively the efficacy of day-time incontinence treatment in a secondary referral centre and consider characteristics of responders to the different therapeutic interventions. MATERIAL AND METHODS All children treated for day-time urinary incontinence at the authors' clinics from 2000 to 2004 were included. Children with ongoing urinary tract infections were excluded. Before treatment, children filled out registrations of incontinence episodes and 48h frequency-volume charts. Faecal disorders were treated before urinary incontinence. All children were subjected to standard urotherapy and were secondarily recommended a timer-watch. If standard urotherapy had no effect, anticholinergics were added. RESULTS The study included 240 children with day-time urinary incontinence. Of these, 45 had faecal problems and 17% obtained urinary continence when these were successfully treated. In total, 126 (55%) became dry on standard urotherapy. Of the 60 children who had a timer-watch in addition to standard urotherapy, 70% became dry. Of the 62 children who had anticholinergics in addition to standard urotherapy, 81% became continent. Fifteen (6%) did not achieve continence and another 11 patients were lost to follow-up. Children who became dry solely on standard urotherapy had a significantly lower voiding frequency (p<0.05), larger voided volumes as a percentage of those expected for age (p<0.01) and fewer incontinence episodes per week (p<0.05) than children needing anticholinergics. CONCLUSIONS Most children achieve day-time continence solely on standard urotherapy. Children who need anticholinergics to achieve dryness seem to be those with more severe bladder reservoir function abnormalities and symptoms.
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Wen JG, Wang GX, Chen Y, Ringgaard S, Vinter-Jensen L, Jørgensen TM, Li Z, Stødkilde-Jørgensen H, Nielsen S, Djurhuus JC, Frøkiaer J. Long-term EGF treatment partially prevents reduction of renal blood flow in response to neonatally induced partial unilateral ureteral obstruction. Nephron Clin Pract 2009; 111:e51-9. [PMID: 19142026 DOI: 10.1159/000191105] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2007] [Accepted: 09/30/2008] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND/AIMS To investigate the effects of long-term epidermal growth factor (EGF) treatment on kidney growth, renal blood flow (RBF), AQP2 expression and urine output in newborn rats with partial unilateral ureteral obstruction (PUUO). METHODS PUUO (n = 29) and sham-operated control (CON) (n = 26) was created in 2-day-old rats. Fifteen PUUO and 14 CON rats were treated with EGF beginning from the second day after operation to 8 weeks of age. Total kidney volume (TKV) and RBF were measured by MRI at weeks 4 and 8, respectively. Urine volume and osmolality, plasma osmolality, and free water clearance were measured. Renal AQP2 expression was determined using semiquantitative immuno-blotting. RESULTS PUUO induced a severe hydronephrosis and RBF reduction in the obstructed kidney which was attenuated in EGF-treated rats. Body weight, urine output and free water clearance increased, osmolality and the osmolar clearance decreased significantly in EGF-treated rats, despite unchanged AQP2 levels. CONCLUSIONS Long-term EGF treatment attenuated the obstruction- induced RBF reduction. Body weight, urine output increased, and urine osmolality decreased in both control and PUUO rats treated with EGF. Solute-free water clearance increased in PUUO rats which seem to be independent of AQP2 expression.
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Affiliation(s)
- Jian Guo Wen
- Institute of Clinical Medicine, Aarhus University, Aarhus, Denmark
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Wen JG, Li ZZ, Zhang H, Wang Y, Wang G, Wang Q, Nielsen S, Djurhuus JC, Frøkiaer J. Expression of renal aquaporins is down-regulated in children with congenital hydronephrosis. ACTA ACUST UNITED AC 2009. [DOI: 10.1080/00365590903127446] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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