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Rahnama'i MS, Bagheri A, Jahantabi E, Salehi-Pourmehr H, Mostafaei H, Schurch B, Javan Balegh Marand A, Hajebrahimi S. Long-term follow-up of intravesical abobotulinumtoxinA (Dysport®) injections in women with idiopathic detrusor overactivity. Asian J Urol 2024; 11:93-98. [PMID: 38312815 PMCID: PMC10837662 DOI: 10.1016/j.ajur.2022.02.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 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: 05/05/2021] [Accepted: 02/08/2022] [Indexed: 10/14/2022] Open
Abstract
Objective Only a few numbers of studies have been published on the use of abobotulinumtoxinA (Dysport®) in idiopathic detrusor overactivity (IDO). This study reported the long-term follow-up of women with IDO who were treated with intravesical Dysport® injections. Methods Two hundred and thirty-six patients with IDO who had failed first-line conservative and antimuscarinic therapy received 500-900 units of Dysport® between April 2014 and July 2015. All patients were followed up for 5 years after their initial injection and interviewed on the phone. Results A total of 236 women with IDO aged from 18 years to 84 years (mean±standard deviation: 49.6±15.9 years) were included in our study. The median follow-up time for patients was 36.5 (range: 10-70) months, and the median recovery time after injection was 18.5 (range: 0-70) months. A total of 83 (35.2%) patients stated that they had subjective improvement of their symptoms whereas 84 (35.6%) patients did not report any improvement in symptoms. The initial International Consultation on Incontinence Questionnaire Overactive Bladder mean score was 6.9 (standard deviation 3.4). There was a positive association between the median recovery time and the components of the International Consultation on Incontinence Questionnaire Overactive Bladder questionnaire. Conclusion In a sub-population of overactive bladder patients with IDO who have failed first-line therapy, a single intravesical Dysport® injection can resolve patient symptoms completely or reduce the symptoms to an acceptable level that can be controlled with antimuscarinics or re-injection on demands.
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Affiliation(s)
| | - Amin Bagheri
- Research Center for Evidence-based Medicine, Iranian EBM Centre: A Joanna Briggs Institute (JBI) Center of Excellence, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Elham Jahantabi
- Urology Department, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Hanieh Salehi-Pourmehr
- Research Center for Evidence-based Medicine, Iranian EBM Centre: A Joanna Briggs Institute (JBI) Center of Excellence, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Hadi Mostafaei
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | | | | | - Sakineh Hajebrahimi
- Research Center for Evidence-based Medicine, Iranian EBM Centre: A Joanna Briggs Institute (JBI) Center of Excellence, Tabriz University of Medical Sciences, Tabriz, Iran
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2
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Javan Balegh Marand A, Baars C, Heesakkers J, van den Munckhof E, Ghojazadeh M, Rahnama'i MS, Janssen D. Differences in the Urinary Microbiome of Patients with Overactive Bladder Syndrome with and without Detrusor Overactivity on Urodynamic Measurements. Life (Basel) 2023; 13:life13051199. [PMID: 37240844 DOI: 10.3390/life13051199] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [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: 04/04/2023] [Revised: 05/10/2023] [Accepted: 05/16/2023] [Indexed: 05/28/2023] Open
Abstract
INTRODUCTION It has been hypothesized that the urinary microbiome might play an important role in OAB. Studies have been conducted on the association between OAB symptoms and the microbiome, although a possible causality still has to be determined. MATERIAL AND METHODS In this study, 12 female patients, ≥18 years of age, with 'OAB DO+' and 9 female patients with 'OAB DO-' were included. Patients were excluded if they met one of the following exclusion criteria: bladder tumors and previous bladder operations; sacral neuromodulation; injection of Botox in the bladder; and TOT or TVT operations. Urine samples were collected and stored with patient informed consent and with the approval of the Hospital Ethical Review Board (Arnhem-Nijmegen). All OAB patients underwent urodynamics before collecting urine samples, and the diagnosis of detrusor overactivity was confirmed by two individual urologists. In addition, samples from 12 healthy controls who did not undergo urodynamic evaluation were analyzed. The 16S rRNA V1-V2 region amplification and gel electrophoresis were used to determine the microbiota. RESULTS 12 of the OAB patients had DO shown on their urodynamic studies; the remaining 9 patients had a normoactive detrusor on their urodynamic measurements. Overall, there were no substantial differences among the demographic characteristics of the subjects. The samples were classified as the following: 180 phyla, 180 classes, 179 orders, 178 families, 175 genera, and 138 species. The least commonly observed phyla were Proteobacteria, with an average presence of 10%, followed by Bacteroidetes with 15%, Actinobacteria with 16%, and Firmicutes with 41%. Most of the sequences could be classified according to the genus level for each sample. DISCUSSION Significant differences were observed in the urinary microbiome of patients with overactive bladder syndrome who have detrusor overactivity on urodynamics compared to OAB patients without detrusor overactivity and matched controls. OAB patients with detrusor overactivity have a significantly less diverse microbiome and show a higher proportion of Lactobacillus, particularly Lactobacillus iners. The results imply that the urinary microbiome could be involved in the pathogenesis of a specific phenotype of OAB. The urinary microbiome could be a new starting point to study the causes and treatments of OAB.
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Affiliation(s)
- Aida Javan Balegh Marand
- Department of Urology, Maastricht University Medical Centre (MUMC+), 6229 HX Maastricht, The Netherlands
| | - Cléo Baars
- Department of Urology, Radboud University, 6525 GA Nijmegen, The Netherlands
| | - John Heesakkers
- Department of Urology, Maastricht University Medical Centre (MUMC+), 6229 HX Maastricht, The Netherlands
| | - Ellen van den Munckhof
- Research Center for Evidence-Based Medicine, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz 5165665811, Iran
| | - Morteza Ghojazadeh
- Viroclinics-DDL Diagnostic Laboratory, 2288 ER Rijswijk, The Netherlands
| | | | - Dick Janssen
- Department of Urology, Radboud University, 6525 GA Nijmegen, The Netherlands
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Abstract
Due to the COVID-19 pandemic, major congresses and many teaching
opportunities as well as the usual visits from medical advisors of
pharmaceutical firms have been postponed and canceled. The major
trials of prostate cancer in the last 5 years in each state are
shortly discussed providing a panoramic overview of the available
evidence and data on prostate cancer treatment. Apalutamide,
enzalutamide, and darolutamide have proven to have clinical benefits
when added to androgen deprivation therapy for patients with
nonmetastatic castration-resistant prostate cancer. In patients in the
metastatic hormone-sensitive setting, next to docetaxel, abiraterone,
enzalutamide, and apalutamide have been shown to significantly improve
overall survival and progression-free survival in comparison to
standard hormone therapy. In addition, docetaxel abiraterone and
enzalutamide are widely used in the metastatic setting. For
second-line therapy of metastasized prostate cancer patients who have
received either docetaxel or abiraterone or enzalutamide, olaparib,
cabazitaxel, radium, and lutetium therapy have been shown to be
beneficial in selected patient groups.
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Affiliation(s)
- M S Rahnama'i
- Department of Urology, Maastricht University, Maastricht, The Netherlands.,Department of Urology, University Hospital RWTH Aachen, Aachen, Germany
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Marand AJB, Bach C, Janssen D, Heesakkers J, Ghojazadeh M, Vögeli TA, Salehi-Pourmehr H, Mostafae H, Hajebrahimi S, Rahnama'i MS. Lower urinary tract signs and symptoms in patients with COVID-19. BMC Infect Dis 2021; 21:706. [PMID: 34311703 PMCID: PMC8312200 DOI: 10.1186/s12879-021-06394-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [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: 01/28/2021] [Accepted: 06/28/2021] [Indexed: 11/28/2022] Open
Abstract
Background The type of pneumonia that is caused by the new coronavirus (SARS-CoV-2) has spread across the world in a pandemic. It is not clear if COVID-19 patients have any lower urinary tract signs or symptoms. Methods The effect of COVID-19 on lower urinary tract function was studied in a prospective multi-centre, observational study including 238 patients who were admitted with symptoms caused by COVID-19 to the university hospital of Aachen in Germany and Tabriz in Iran. Results None of the patients reported to have any lower urinary tract symptoms. SARS-CoV-2 was found in the urine of 19% of the tested patients. The mortality rate in COVID-19 infected patients with microscopic haematuria together with white blood cells in their urine, was significantly increased from 48 to 61% in the Tabriz cohort (p-value = 0.03) and from 30 to 35% in the Aachen cohort (p-value =0.045). Furthermore, in the group of patients with SARS-CoV-2 urine PCR, the mortality rate rose from 30 to 58%. (p-value =0.039). Conclusion Patients admitted with COVID-19 did not report to have any lower urinary tract symptoms, even those patient who had a positive Urine SARS-CoV-2 PCR. In addition, hematuria, WBC in urine as well as SARS- CoV-2 presence in urine, were found to be strong negative prognostic factors in admitted COVID-19 patients.
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Affiliation(s)
- Aida Javan Balegh Marand
- Uniklinik RWTH Aachen, Pauwelsstrasse 30, 52074, Aachen, Germany.,Radboud University, Nijmegen, The Netherlands.,Society of Urological Research and Education (SURE), Heerlen, The Netherlands
| | - Christian Bach
- Uniklinik RWTH Aachen, Pauwelsstrasse 30, 52074, Aachen, Germany
| | | | | | - Morteza Ghojazadeh
- Research Center for Evidence-Based Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
| | | | - Hanieh Salehi-Pourmehr
- Research Center for Evidence-Based Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
| | | | - Sakineh Hajebrahimi
- Research Center for Evidence-Based Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Mohammad Sajjad Rahnama'i
- Uniklinik RWTH Aachen, Pauwelsstrasse 30, 52074, Aachen, Germany. .,Radboud University, Nijmegen, The Netherlands.
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5
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Ataei J, Bach C, Javan A, Vögeli TA, Grafe C, Rahnama'i MS. The Scientific Value of Abstracts on Prostate Cancer Presented at the European Association of Urology Congresses. Front Surg 2021; 8:683359. [PMID: 34212000 PMCID: PMC8239171 DOI: 10.3389/fsurg.2021.683359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 03/20/2021] [Accepted: 05/20/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Scientific congresses are an important medium for presenting recent clinical findings. Publication of abstracts allows wider dissemination. Objectives: To determine the publication rates of prostate cancer abstracts presented at the annual congress of the European Association of Urology (EAU). Design, Setting, and Participants: All abstracts with the term prostate cancer or carcinoma presented at the congress of the European Association of Urology from 2015 to 2018 were analyzed. We captured their publication rate, journal impact factor and time to publication. Moreover, we formulated a scoring system to determine the grade of discrepancy between the conclusions mentioned in the congress abstract and published abstract. Results: A total of 834 abstracts presented at EAU annual meeting included prostate cancer or carcinoma in their title. We recorded a publication rate of 56.8% with 474 of the 834 abstracts being published with a mean time of 12.5 months. Conclusion: Approximately, 57% of the prostate cancer abstracts presented at the EAU congress are published in peer reviewed journals. This acceptance rate indicates the high distribution and dissemination of these abstracts.
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Affiliation(s)
- Jasmin Ataei
- Department of Urology, Uniklinik Rheinisch-Westfälische Technische Hochschule (RWTH) Aachen, Aachen, Germany
| | - Christian Bach
- Department of Urology, Uniklinik Rheinisch-Westfälische Technische Hochschule (RWTH) Aachen, Aachen, Germany
| | - Aida Javan
- Department of Urology, Uniklinik Rheinisch-Westfälische Technische Hochschule (RWTH) Aachen, Aachen, Germany
| | - Thomas-Alexander Vögeli
- Department of Urology, Uniklinik Rheinisch-Westfälische Technische Hochschule (RWTH) Aachen, Aachen, Germany
| | - Christina Grafe
- Department of Urology, Uniklinik Rheinisch-Westfälische Technische Hochschule (RWTH) Aachen, Aachen, Germany
| | - Mohammad Sajjad Rahnama'i
- Department of Urology, Uniklinik Rheinisch-Westfälische Technische Hochschule (RWTH) Aachen, Aachen, Germany
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6
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Rahnama'i MS, Bach C, Schulze-Hagen M, Kuhl CK, Vögeli TA. Can the predictive value of multiparametric MRI for prostate cancer be improved by a liquid biopsy with SelectMDx? Cancer Rep (Hoboken) 2021; 4:e1396. [PMID: 33931984 PMCID: PMC8714534 DOI: 10.1002/cnr2.1396] [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] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2020] [Accepted: 03/29/2021] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND SelectMDx is a urinary biomarker test for determining prostate cancer risk. AIM In a group of patients with a biopsy proven prostate cancer (PCa) who had undergone a multi parametric Magnetic Resonance Imaging (mpMRI) and urinary biomarker test with SelectMDx, we studied the additive value of SelectMDx to mpMRI and correlated that to the radical prostatectomy histology. METHODS AND RESULTS Thirty-nine consecutive patients with a positive prostate biopsy were included in the study. They all had mpMRI and SelectMDx and underwent a radical prostatectomy. Overall, the mpMRI showed a PIRADS ≤3 lesion in seven cases out of the 39 patients. Significant lesions (PIRADS ≥4) were found in 32 cases (82%), that is, in 17 cases a PIRADS 5 lesion and in 15 cases a PIRADS 4 lesion. The mpMRI missed significant PCa in seven cases (18%) who had a PIRADS ≤3 lesion but had a significant PCa on final histology after RP. In our study, the positive predictive values of mpMRI were 97% and that of the SelectMDx was 100%. CONCLUSION In this real-life selected group of consecutive patients with a confirmed positive PCa biopsy and available mpMRI, the liquid biopsy test with SelectMDx, did not provide an additional information about the PCa clinical significance. The addition of SelectMDx was only found valuable in those patients who had a very high-risk PCa (ie, GS ≥8) who had a positive SelectMDx test outcome despite of a negative mpMRI outcome.
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7
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Javan Balegh Marand A, Van Koeveringe GA, Janssen D, Vahed N, Vögeli TA, Heesakkers J, Hajebrahimi S, Rahnama'i MS. Urinary Microbiome and its Correlation with Disorders of the Genitourinary System. Urol J 2021; 18:259-270. [PMID: 33550579 DOI: 10.22037/uj.v16i7.5976] [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] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
PURPOSE Until recently, the urine of healthy individuals was assumed to be sterile. However, improvement of bacterial detection methods has debunked this assumption. Recent studies have shown that the bladder contains microbiomes, which are not detectable under standard conditions. In this review, we aimed to present an overview of the published literature regarding the relationship between urinary microbiota and functional disorders of the genitourinary system. METHODS We searched Medline, PubMed, Embase, The Cochrane library and Scopus to identify RCTs published, with MeSH and free keywords including microbiota, bladder pain syndrome, prostatitis, kidney stone disease, and bladder cancer until September 2020. Randomized controlled trials investigating microbiome and lower urinary tract symptoms were included. Non-randomized trials, cross-over trials and pooled studies were excluded. The articles were critically appraised by two reviewers. CONCLUSION The urine microbiome is a newly introduced concept, which has attracted the attention of medical researchers. Since its recent introduction, researchers have conducted many fruitful studies on this phenomenon, changing our perspective toward the role of bacteria in the urinary tract and our perception of the genitourinary system health. RESULT A deeper understanding of the urinary microbiome can help us to develop more efficient methods for restoring the microbiota to a healthy composition and providing symptom relief. Modification of the urinary microbiome without antibiotic use can be a possible venue for future research.
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Affiliation(s)
| | | | - Dick Janssen
- Dept. of Urology, Radboud University, Nijmegen, The Netherlands
| | - Nafiseh Vahed
- Research Center for Evidence-Based Medicine (RCEBM), Tabriz University of Medical Sciences, Tabriz, Iran
| | | | - John Heesakkers
- Dept. of Urology, Radboud University, Nijmegen, The Netherlands
| | - Sakineh Hajebrahimi
- Research Center for Evidence-Based Medicine (RCEBM), Tabriz University of Medical Sciences, Tabriz, Iran
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8
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Khullar V, Digesu GA, Veit-Rubin N, Sahai A, Rahnama'i MS, Tarcan T, Chermansky C, Dmochowski R. How can we improve the diagnosis and management of bladder pain syndrome? Part 2:ICI-RS 2018. Neurourol Urodyn 2020; 38 Suppl 5:S71-S81. [PMID: 31821630 DOI: 10.1002/nau.24245] [Citation(s) in RCA: 6] [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: 05/29/2019] [Accepted: 11/21/2019] [Indexed: 11/12/2022]
Abstract
BACKGROUND This paper summarises the discussion in a think tank at the International Consultation on Incontinence-Research Society (ICI-RS) 2018 about the treatment of bladder pain syndrome. AIMS To review the treatments of bladder pain syndrome from behavioural treatments to surgical interventions. MATERIALS AND METHODS Review the literature in the light of the think tank discussions. RESULTS All guidelines recommend different levels of treatment starting with conservative behavioral treatments then introducing oral treatments followed by intravesical instillations. If these treatments fail then more invasive treatments such as botulinum toxin injections, neuromodulation, or surgery could be suggested. CONCLUSION Unfortunately for all treatments, the numbers are limited and, therefore, the evidence base is not strong. Further suggestions for research are suggested.
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Affiliation(s)
- Vik Khullar
- Department of Urogynaecology, St Mary's Hospital, Imperial College, London, UK
| | - G Alessandro Digesu
- Department of Urogynaecology, St Mary's Hospital, Imperial College, London, UK
| | - Nikolaus Veit-Rubin
- Department of Obstetrics and Gynecology, Medical University of Vienna, Vienna, Austria
| | - Arun Sahai
- Department of Urology, Guy's Hospital, MRC Centre for Transplantation, King's College London, London, UK
| | | | - Tufan Tarcan
- Department of Urology, Marmara University School of Medicine, Istanbul, Turkey.,School of Medicine, Koc University, Istanbul, Turkey
| | - Christopher Chermansky
- Department of Urology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Roger Dmochowski
- Department of Urologic Surgery, Vanderbilt University, Nashville, Tennessee
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9
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Rahnama'i MS, Javan A, Vyas N, Lovasz S, Singh N, Cervigni M, Pandey S, Wyndaele JJ, Taneja R. Bladder Pain Syndrome and Interstitial Cystitis Beyond Horizon: Reports from the Global Interstitial Cystitis/Bladder Pain Society (GIBS) Meeting 2019 Mumbai - India. Anesth Pain Med 2020; 10:e101848. [PMID: 32944561 PMCID: PMC7472163 DOI: 10.5812/aapm.101848] [Citation(s) in RCA: 3] [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: 03/19/2020] [Revised: 04/04/2020] [Accepted: 04/12/2020] [Indexed: 12/12/2022] Open
Abstract
Purpose of the Meeting Bladder pain syndrome/interstitial cystitis is a prevalent but underserved disease. At the Global Interstitial Cystitis/Bladder Pain Syndrome Society (GIBS) meeting, the organization and participants were committed to delivering word-class expertise and collaboration in research and patient care. Under the umbrella of GIBS, leading research scholars from different backgrounds and specialties, as well as clinicians, from across the globe interested in the science and art of practice of Bladder Pain Syndrome (BPS)/Interstitial Cystitis (IC) were invited to deliberate on various dimensions of this disease. The meeting aimed to have global guidelines to establish firm directions to practicing clinicians and patients alike on the diagnosis and treatment of this disease entity. Chronic Pelvic Pain Syndrome (CPPS) is defined by pain in the pelvic area that can have different etiologies. This can be due to urologic, gynecologic, musculoskeletal, gastrointestinal, neurologic, and autoimmune or rheumatologic diseases. At the GIBS meeting held in Mumbai, India, in August 2019, a multidisciplinary expert panel of international urologists, gynecologists, pain specialists, and dietitians took part in a think tank to discuss the development of evidence-based diagnostic and treatment algorithms for BPS/IC. Summary of Presented Findings The diagnosis of BPS/IC is difficult in daily clinical practice. Patients with BPS/IC present with a variety of signs and symptoms and clinical test results. Hence, they might be misdiagnosed or underdiagnosed, and the correct diagnosis might take a long time. A good history and physical examination, along with cystoscopy, is a must for the diagnosis of IC/BPS. For the treatment, besides lifestyle management and dietary advice, oral medication and bladder instillation therapy, botulinum toxin, and sacral neuromodulation were discussed. The innovation in bladder instillation applicators, as well as battery-free neuromodulation through the tibial nerve, was discussed, as well. Recommendation for Future Research As BPS/IC is complex, for many patients, several treatments are necessary at the same time. This was presented at GIBS 2019 as the piano model. In this way, a combination of treatments is tailored to an individual patient depending on the symptoms, age, and patients' characteristics. In the art of medicine, especially when dealing with BPS/IC patients, pressing the right key at the right time makes the difference.
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Affiliation(s)
- Mohammad Sajjad Rahnama'i
- Urology Department, Uniklinik RWTH Aachen, Germany
- Society of Urological Research and Education (SURE), Heerlen, The Netherlands
- Corresponding Author: University Hospital Aachen, Germany Pauwelsstrasse 30 D52074 Aachen, Germany.
| | - Aida Javan
- Society of Urological Research and Education (SURE), Heerlen, The Netherlands
- Urology Department, Radboud University Nijmegen, Nijmegen, The Netherlands
| | - Navita Vyas
- Pain and Rehab Medicine, Kokilaben Dhirubhai Ambani Hospital and Medical Research Institute, Mumbai, India
| | | | | | | | - Sanjay Pandey
- Kokilaben Dhirubhai Ambani Hospital and Research institute, Mumbai, India
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10
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Gajewski JB, Gammie A, Speich J, Kirschner-Hermanns R, De Wachter S, Schurch B, Korstanje C, Valentini F, Rahnama'i MS. Are there different patterns of detrusor overactivity which are clinically relevant? ICI-RS 2018. Neurourol Urodyn 2019; 38 Suppl 5:S40-S45. [PMID: 31821631 DOI: 10.1002/nau.23964] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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: 11/12/2018] [Revised: 12/09/2018] [Accepted: 01/29/2019] [Indexed: 01/19/2023]
Abstract
INTRODUCTION Different patterns of detrusor overactivity (DO) have been described and included in several standardization terminology documents. However, it is unclear if these different patterns have any clinical significance. METHODS This is a report of the proceedings of Proposal 3: "Are there different patterns of detrusor overactivity which are clinically relevant?" from the annual International Consultation on Incontinence-Research Society (ICIRS) meeting, which took place from 14 to 16 June 2018, in Bristol, UK. RESULTS We have collected and discussed, as a committee, the evidence about different urodynamic (UD) patterns of detrusor overactivity and their potential clinical significance. We reviewed the important previous basic research and clinical studies and compiled summaries. The discussion focused on clinical relevance of different UD patterns of DO and what further research is required. CONCLUSIONS There are several UD definitions of patterns of detrusor overactivity, however the clinical relevance of these definitions remains unclear. Future research should concentrate on defining the pattern of DO in relation to clinical diagnosis, gender, age, and treatment outcomes.
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Affiliation(s)
- Jerzy B Gajewski
- Department of Urology, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Andrew Gammie
- Bristol Urological Institute, Southmead Hospital, Bristol, UK
| | - John Speich
- Department of Mechanical and Nuclear Engineering, College of Engineering, Virginia Commonwealth University, Richmond, Virginia
| | - Ruth Kirschner-Hermanns
- Department of Neuro-Urology, University Hospital of the Rheinische Friedrich-Wilhelms University Bonn, Bonn, Germany.,Department of Urology and Paediatric Urology, Neuro-Urology, Neurological Rehabilitation Center "Godeshoehe e.V.", Bonn, Germany
| | | | - Brigitte Schurch
- Neurourology Unit Department of Neurosciences, University Hospital Lausanne, Lausanne, Switzerland
| | - Cees Korstanje
- Department of Drug Discovery Science & Management, Astellas Pharma Europe BV, Leiden, The Netherlands
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11
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Abstract
The function of the lower urinary tract is mainly storage and voiding of urine, which is coordinated by the nervous system. Various diseases of the nervous system may cause neuro-urological symptoms. Neuro-urological symptoms depend on the localization of the disease and the extension of the neurological lesion. About 80% of multiple sclerosis (MS) patients have neuro-urological symptoms within 10 years after diagnosis. In addition, 10% of MS patients may even present with voiding dysfunction at disease onset. In this review, different types of neuromodulation are discussed. The available studies suggest that sacral neuromodulation (SNM) and percutaneous tibial nerve stimulation (PTNS) may be helpful in the neuromodulation of MS-related overactive bladder symptoms. These techniques may not only decrease the severity of symptoms but also significantly improve the quality of life of affected patients. Exploring the role of implantable tibial nerve stimulation devices in patients with MS could open new doors in the management of urgency and urgency incontinence in this patient group.
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Affiliation(s)
- Mohammad Sajjad Rahnama'i
- Department of Urology, Uniklinik RWTH Aachen, Aachen, Germany/Society of Urological Research and Education (SURE), Heerlen, The Netherlands
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12
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Malde S, Apostilidis A, Selai C, Rahnama'i MS, Marcelissen T, Cardozo L, Lovick T. Botulinum toxin A for refractory OAB and idiopathic urinary retention: Can phenotyping improve outcome for patients: ICI-RS 2019? Neurourol Urodyn 2019; 39 Suppl 3:S104-S112. [PMID: 31692092 DOI: 10.1002/nau.24207] [Citation(s) in RCA: 2] [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: 08/13/2019] [Accepted: 10/20/2019] [Indexed: 12/17/2022]
Abstract
AIMS Botulinum toxin A (BTX-A) is a well-established treatment for refractory idiopathic overactive bladder (OAB). It has also been used with short-term success in treating idiopathic urinary retention. However, efficacy and complication rates are variable and predicting those likely to benefit most from treatment would enable personalization of therapy and optimization of outcomes. At the International Consultation on Incontinence-Research Society (ICI-RS) meeting in 2019 a Think Tank addressed the question of how we can improve the way we phenotype patients undergoing BTX-A treatment. METHODS The Think Tank conducted a literature review and expert consensus meeting focussing on how advances in basic science research of the mechanism of action of BTX-A, as well as assessment of psychological comorbidity, can be translated into clinical practice to improve patient selection for therapy. RESULTS Idiopathic OAB and idiopathic urinary retention are heterogenous conditions encompassing several phenotypes with multiple potential pathophysiological mechanisms. Animal models have demonstrated a central nervous system mechanism of action of intravesically injected BTX-A and this has been confirmed in human functional MRI studies, but whether this tool can be used to predict outcome from treatment remains to be determined. Phenotyping based on psychological comorbidity using validated screening tools should be studied as a way to potentially optimize patient selection for therapy. CONCLUSIONS Advances in basic science research into the mechanism of action of BTX-A have improved our understanding of the pathophysiology of OAB and may lead to novel ways to phenotype patients. Psychological assessment is another way in which phenotyping may be improved. Areas for further research are proposed.
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Affiliation(s)
- Sachin Malde
- Department of Urology, Guy's Hospital, London, UK
| | - Apostolos Apostilidis
- 2nd Department of Urology, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Caroline Selai
- Department of Clinical and Movement Neurosciences, UCL Queen Square Institute of Neurology, London, UK
| | - Mohammad Sajjad Rahnama'i
- Department of Urology, Uniklinik Aachen RWTH, Aachen, Germany.,Department of Urology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Tom Marcelissen
- Department of Urology, Uniklinik Aachen RWTH, Aachen, Germany
| | - Linda Cardozo
- Department of Urogynaecology, King's College Hospital, London, UK
| | - Thelma Lovick
- School of Physiology, Pharmacology and Neuroscience, University of Bristol, Bristol, UK
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13
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Khullar V, Chermansky C, Tarcan T, Rahnama'i MS, Digesu A, Sahai A, Veit-Rubin N, Dmochowski R. How can we improve the diagnosis and management of bladder pain syndrome? Part 1: ICI-RS 2018. Neurourol Urodyn 2019; 38 Suppl 5:S66-S70. [PMID: 31578775 DOI: 10.1002/nau.24166] [Citation(s) in RCA: 2] [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: 05/27/2019] [Accepted: 08/05/2019] [Indexed: 12/30/2022]
Abstract
BACKGROUND This paper summarizes the discussion in a think tank at the ICI-RS 2018 about the diagnosis of bladder pain syndrome (BPS). AIMS To review the guidelines, investigations and subtypes of BPS. MATERIALS AND METHODS Review of literature in the light of the think tank discussion. RESULTS All guidelines recommend completing history, physical examination, urine analysis, urine culture, and urine cytology to define the BPS phenotype but there are differences on further investigations. In those guidelines which recommend cystoscopy, the identification of Hunner's lesions (HLs) is recommended as this changes the treatment plan and outcome. CONCLUSION We propose that the differentiation of Hunner's ulcers is an important step in the assessment of these patients. Further suggestions for research are suggested.
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Affiliation(s)
- Vik Khullar
- Department of Urogynaecology, St. Mary's Hospital, Imperial College, London, UK
| | - Christopher Chermansky
- Department of Female Pelvic Medicine and Reconstructive Urology, UPMC Magee-Womens Hospital, Pittsburgh, Pennsylvania
| | - Tufan Tarcan
- Department of Urology, School of Medicine, Marmara University, Istanbul, Turkey.,Department of Urology, School of Medicine, Koç University, Istanbul, Turkey
| | | | - Alex Digesu
- Department of Urogynaecology, St. Mary's Hospital, Imperial College, London, UK
| | - Arun Sahai
- Department of Urology, Guy's Hospital, London, UK.,Department of Urology, MRC Centre for Transplantation, King's College London, London, UK
| | - Nikolaus Veit-Rubin
- Department of Obstetrics and Gynecology, Universitätsklinik für Frauenheilkunde, University of Vienna, Wien, Austria
| | - Roger Dmochowski
- Department of Urologic Surgery, Vanderbilt University, Nashville, Tennessee
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14
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Vale L, Jesus F, Marcelissen T, Rieken M, Geavlete B, Rahnama'i MS, Martens F, Cruz F, Antunes‐Lopes T. Pathophysiological mechanisms in detrusor underactivity: Novel experimental findings. Low Urin Tract Symptoms 2019; 11:92-98. [DOI: 10.1111/luts.12257] [Citation(s) in RCA: 10] [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: 08/29/2018] [Revised: 11/29/2018] [Accepted: 01/07/2019] [Indexed: 01/20/2023]
Affiliation(s)
- Luís Vale
- Faculty of Medicine, University of PortoDepartment of Urology, Hospital São João Porto Portugal
| | - Filipa Jesus
- Faculty of Medicine, University of PortoDepartment of Urology, Hospital São João Porto Portugal
| | - Tom Marcelissen
- Department of UrologyMaastricht University Medical Centre Maastricht The Netherlands
| | - Malte Rieken
- Department of UrologyMedical University of Vienna Vienna Austria
| | - Bogdan Geavlete
- Department of UrologySaint John Emergency Clinical Hospital Bucharest Romania
| | - Mohammad Sajjad Rahnama'i
- Department of UrologyMaastricht University Maastricht The Netherlands
- Department of UrologyUniklinik Aachen RWTH Aachen Germany
| | - Frank Martens
- Department of Urology, Rabdoud University Medical Centre Nijmegen The Netherlands
| | - Francisco Cruz
- Faculty of Medicine, University of PortoDepartment of Urology, Hospital São João Porto Portugal
| | - Tiago Antunes‐Lopes
- Faculty of Medicine, University of PortoDepartment of Urology, Hospital São João Porto Portugal
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15
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Rahnama'i MS, Vrijens DMJ, Hajebrahimi S, van Koeveringe GA, Marcelissen TAT. The discrepancy between European Association of Urology (EAU) guidelines and daily practice in the evaluation and management of nocturia: results of a Dutch survey. World J Urol 2019; 37:2517-2522. [PMID: 30656496 DOI: 10.1007/s00345-019-02638-5] [Citation(s) in RCA: 2] [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: 10/29/2018] [Accepted: 01/10/2019] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND AND OBJECTIVE In addition to the evaluation of voiding symptoms, in the evaluation of patients with nocturia, one should also consider other related causes such as sleep disorders, obstructive sleep apnoea (OSAS), diabetes and heart failure. In this study, we have aimed to assess the current knowledge and implementation of the EAU guidelines regarding nocturia in common urological practice in the Netherlands. SETTING AND PARTICIPANTS In a national cross-sectional survey distributed among 450 urologists and urology residents in the Netherlands, the implementation of the recommendations of the European Association of Urology (EAU) guidelines on nocturia evaluation and management was studied. RESULTS AND LIMITATIONS This survey revealed that only some aspects of the EAU guidelines are applied in the daily clinical practice and that some important parts are not. For example, only a minority asks about alcohol consumption and symptoms suggestive for diabetes or OSAS. In addition, a majority reported to use a bladder diary for 1-3 days instead of for a minimum of 3 days as recommended by the EAU guidelines. In the management of nocturia, a trial of timed diuretic therapy is only reported by a minority, whereas the use of beta-3 antagonists, which is not mentioned in the guidelines, is applied by a large majority. Desmopressin recommended for nocturnal polyuria is prescribed by two-third of Dutch urologists. CONCLUSIONS These observations mandate better education and campaigns to raise the awareness on the EAU-guideline recommendations for nocturia.
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Affiliation(s)
- M S Rahnama'i
- Department of Urology, Uniklinik RWTH Aachen, Aachen, Germany. .,Department of Urology, Maastricht University, Maastricht, The Netherlands. .,Society of Urological Research and Education (SURE), Heerlen, The Netherlands.
| | - D M J Vrijens
- Department of Urology, Maastricht University, Maastricht, The Netherlands.,Society of Urological Research and Education (SURE), Heerlen, The Netherlands
| | - S Hajebrahimi
- Department of Urology, Research Centre of Evidence Based Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
| | - G A van Koeveringe
- Department of Urology, Maastricht University, Maastricht, The Netherlands.,Maastricht University Medical Centre, Maastricht, The Netherlands
| | - T A T Marcelissen
- Department of Urology, Maastricht University, Maastricht, The Netherlands.,Society of Urological Research and Education (SURE), Heerlen, The Netherlands.,Maastricht University Medical Centre, Maastricht, The Netherlands
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16
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Marcelissen T, Cornu JN, Antunes-Lopes T, Geavlete B, Delongchamps NB, Rashid T, Rieken M, Rahnama'i MS. Management of Idiopathic Overactive Bladder Syndrome: What Is the Optimal Strategy After Failure of Conservative Treatment? Eur Urol Focus 2018; 4:760-767. [PMID: 29807823 DOI: 10.1016/j.euf.2018.05.004] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2018] [Revised: 04/15/2018] [Accepted: 05/11/2018] [Indexed: 11/19/2022]
Abstract
CONTEXT A considerable number of patients affected by the overactive bladder syndrome (OAB) do not respond to pharmacotherapy and bladder training due to unsatisfactory response or intolerability. OBJECTIVE To review the available literature assessing therapeutic effect of the available third-line treatment modalities for OAB. EVIDENCE ACQUISITION PubMed, Medline, and Cochrane databases were searched for all studies comparing outcomes of the available third-line treatment modalities for OAB. EVIDENCE SYNTHESIS Several minimally invasive surgical procedures are available for patients with refractory OAB. These therapies include intravesical botulinum toxin type A, posterior tibial nerve stimulation, and sacral neuromodulation. CONCLUSIONS None of the mentioned therapeutic modalities shows strong superiority over another. If the results of one therapy are not satisfactory, switching to another third-line treatment can be attempted. The treatment algorithm is dependent on several factors, including age, comorbidity, patient preference, surgical expertise, and financial concerns. All these factors should be taken into consideration before initiation of treatment. PATIENT SUMMARY In the management of drug-resistant overactive bladder syndrome, the different minimally invasive treatments that are available are equal. If the results of one therapy are not satisfactory, switching to another treatment can be attempted. The treatment algorithm is dependent on several factors, including age, comorbidity, patient preference, surgical expertise, and financial concerns.
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Affiliation(s)
- Tom Marcelissen
- European Association of Urology (EAU) Young Academic Urologists (YAU), Functional Urology Working Group, The Netherlands; Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Jean-Nicolas Cornu
- European Association of Urology (EAU) Young Academic Urologists (YAU), Functional Urology Working Group, The Netherlands; Service d'urologie, CHU de Rouen, Rouen, France
| | - Tiago Antunes-Lopes
- European Association of Urology (EAU) Young Academic Urologists (YAU), Functional Urology Working Group, The Netherlands; Faculty of Medicine of Porto University, Centro Hospitalar São João, Porto, Portugal; Department of Urology, Centro Hospitalar São João, Porto, Portugal
| | - Bogdan Geavlete
- European Association of Urology (EAU) Young Academic Urologists (YAU), Functional Urology Working Group, The Netherlands; Department of Urology, Saint John Emergency Clinical Hospital, Bucharest, Romania
| | - Nicolas Barry Delongchamps
- European Association of Urology (EAU) Young Academic Urologists (YAU), Functional Urology Working Group, The Netherlands; Department of Urology, Université Paris Descartes, Hôpital Cochin, Service d'Urologie, Paris, France
| | - Tina Rashid
- European Association of Urology (EAU) Young Academic Urologists (YAU), Functional Urology Working Group, The Netherlands; Department of Urology, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - Malte Rieken
- European Association of Urology (EAU) Young Academic Urologists (YAU), Functional Urology Working Group, The Netherlands; Department of Urology, Medical University of Vienna, Vienna, Austria
| | - Mohammad Sajjad Rahnama'i
- European Association of Urology (EAU) Young Academic Urologists (YAU), Functional Urology Working Group, The Netherlands; Maastricht University, Maastricht, The Netherlands; Department of Urology, Uniklinik Aachen RWTH, Aachen, Germany.
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17
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Marcelissen T, Rashid T, Antunes Lopes T, Delongchamps NB, Geavlete B, Rieken M, Cornu JN, Rahnama'i MS. Oral Pharmacologic Management of Overactive Bladder Syndrome: Where Do We Stand? Eur Urol Focus 2018; 5:1112-1119. [PMID: 29625926 DOI: 10.1016/j.euf.2018.03.011] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [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: 12/06/2017] [Revised: 03/08/2018] [Accepted: 03/21/2018] [Indexed: 10/17/2022]
Abstract
Overactive bladder syndrome (OAB) is a prevalent disorder with a significant impact on quality of life. Despite this high prevalence, there is significant underdiagnosis and undertreatment due to several barriers, including embarrassment, poor communication and low patient adherence. Currently, various antimuscarinic are available in the treatment of OAB. The introduction of mirabegron has broadened the therapeutic approach and combination therapy of both agents can be valuable in clinical practice. Yet, patient adherence to most drugs for OAB is still relatively poor. Healthcare providers need to identify and utilise strategies to improve treatment adherence by defining clear treatment goals, implement educational methods and frequently communicate with patients to identify problems with adherence. The elderly population form need special attention as in these patients, anticholinergics should be prescribed with care and adequate knowledge regarding pharmacokinetics and drug interactions in essential. Furthermore, patient expectations should be clearly discussed. In this narrative review, the current advances in oral pharmacotherapy are evaluated and the most important factors involved in the management of OAB are discussed.
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Affiliation(s)
- Tom Marcelissen
- Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Tina Rashid
- University Hospitals of Leicester National Health Service Trust, Leicester, UK
| | | | | | - Bogdan Geavlete
- Urological Department, Saint John Hospital Bucharest, Bucharest, Romania
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18
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Apostolidis A, Averbeck MA, Sahai A, Rahnama'i MS, Anding R, Robinson D, Gravas S, Dmochowski R. Can we create a valid treatment algorithm for patients with drug resistant overactive bladder (OAB) syndrome or detrusor overactivity (DO)? Results from a think tank (ICI-RS 2015). Neurourol Urodyn 2017; 36:882-893. [DOI: 10.1002/nau.23170] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2016] [Accepted: 09/29/2016] [Indexed: 11/07/2022]
Affiliation(s)
- Apostolos Apostolidis
- 2nd Department of Urology; Aristotle University of Thessaloniki; Thessaloniki Greece
| | | | - Arun Sahai
- Department of Urology; Guy's and St.Thomas’ Hospitals; London UK
| | | | - Ralf Anding
- Department of Neurourology; University Hospital Bonn; Bonn Germany
| | - Dudley Robinson
- Department of Urogynaecology; King's College Hospital; NHS Foundation Trust; London UK
| | - Stavros Gravas
- Department of Urology; University of Thessaly; Larissa Greece
| | - Roger Dmochowski
- Department of Urology; Vanderbilt University; Nashville Tennesse
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19
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Marcelissen TAT, Rahnama'i MS, Snijkers A, Schurch B, De Vries P. Long-term follow-up of intravesical botulinum toxin-A injections in women with idiopathic overactive bladder symptoms. World J Urol 2016; 35:307-311. [PMID: 27272312 DOI: 10.1007/s00345-016-1862-y] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2016] [Accepted: 05/18/2016] [Indexed: 12/24/2022] Open
Abstract
INTRODUCTION Intravesical botulinum toxin (BoNT-A) is a safe and effective treatment for overactive bladder syndrome. There are many reports on the clinical experience with BoNT-A, especially in patients with neurogenic detrusor overactivity. The US Food and Drug Administration has recently approved its use for idiopathic overactive bladder (iOAB). Various studies have reported positive results for iOAB in the short-term. Yet little is known about the results after repeated BoNT-A injections. In this study, we evaluated the long-term results of botulinum toxin (BoNT-A) in women with iOAB. METHODS Patients treated with BoNT-A from 2004 until 2009 were evaluated in a non-academic teaching hospital (Zuyderland MC, Heerlen, the Netherlands). All female patients with a follow-up of >5 years with idiopathic bladder dysfunction were included. All patients received 200 U of onabotulinum toxin-A in 20 intradetrusor injections. In some patients, we applied a dose adjustment for repeated injections. Patients were instructed how to use clean intermittent self-catheterization (CISC) before the treatment. We advised patients to commence CISC if post-void residual exceeded 150 ml. RESULTS A total of 128 women were included. All patients had at least 5-year follow-up after their first injection. The mean follow-up was 97 (60-125) months. The mean age was 67 (46-88) years. Of all patients, 30 % were still on BoNT-A treatment at the last follow-up visit. Of the 70 % that discontinued treatment, 27 % had insufficient effect and 43 % had tolerability issues. Most patients discontinued treatment after the first (79 %) and second (19 %) injections. Only 2 % of patients discontinued treatment after more than two injections during follow-up. CONCLUSION Intravesical BoNT-A is an effective treatment for women with idiopathic OAB. However, in time, almost two-thirds of patients in our study discontinued therapy. Most patients discontinue treatment after one or two injections and mainly due to tolerability issues.
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Affiliation(s)
- T A T Marcelissen
- Department of Urology, Zuyderland Medical Centre, Heerlen, The Netherlands
| | - M S Rahnama'i
- Department of Urology, Zuyderland Medical Centre, Heerlen, The Netherlands.
- Maastricht University, Maastricht, The Netherlands.
| | - A Snijkers
- Maastricht University, Maastricht, The Netherlands
| | - B Schurch
- Service de neuroréhabilitation, CHUV, Lausanne, Switzerland
| | - P De Vries
- Department of Urology, Zuyderland Medical Centre, Heerlen, The Netherlands
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20
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Biallosterski BT, Prickaerts J, Rahnama'i MS, de Wachter S, van Koeveringe GA, Meriaux C. Changes in voiding behavior in a mouse model of Alzheimer's disease. Front Aging Neurosci 2015; 7:160. [PMID: 26379542 PMCID: PMC4548184 DOI: 10.3389/fnagi.2015.00160] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [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: 02/26/2015] [Accepted: 08/04/2015] [Indexed: 11/13/2022] Open
Abstract
Besides cognitive decline and behavioral alteration, urinary incontinence often occurs in patients suffering from Alzheimer's disease (AD). To determine whether the transgenic mouse model of AD, APP/PS1 (APP(SL)/PS1(M146L)) mouse, shows alteration of the urinary bladder function and anxiety, as for patients with AD, we examined the urinary marking behavior in relation to affective behavior. At 18 months of age voiding behavior of APP/PS1 and wild type (WT) mice was assessed by using a modified filter paper assay in combination with video tracing, with the cage divided into a center and corner zones. Anxiety-related behavior and locomotion were respectively tested in an elevated zero maze (EZM) and an open field (OF). The APP/PS1 mice urinated more in the center zone than the WT mice. The total volume of markings was significantly lower in the APP/PS1 mice. In both groups, the average volume of a marking in the corner zone was larger than in the center zone. In the EZM, the APP/PS1 mice spent less time in the open arms of the arena, considered as anxiogenic zones, than the WT mice. During the OF task, the APP/PS1 mice covered a longer distance than the WT mice. These findings show that the APP/PS1 mice have a different voiding behavior compared to the WT mice, i.e., urinating with small volumes and voiding in the center of the cage, and suggest that increased locomotor activity and anxiety-related behaviors are factors in the change in voiding pattern in the APP/PS1 mouse.
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Affiliation(s)
- B T Biallosterski
- Department of Urology, University Hospital Maastricht Maastricht, Netherlands ; Department of Neuro-Urology, School for Mental Health and Neuroscience, Maastricht University Maastricht, Netherlands
| | - J Prickaerts
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University Maastricht, Netherlands
| | - M S Rahnama'i
- Department of Urology, University Hospital Maastricht Maastricht, Netherlands ; Department of Neuro-Urology, School for Mental Health and Neuroscience, Maastricht University Maastricht, Netherlands
| | - S de Wachter
- Department of Urology, University Hospital Maastricht Maastricht, Netherlands ; Department of Urology, University Hospital Antwerpen Edegem, Belgium
| | - G A van Koeveringe
- Department of Urology, University Hospital Maastricht Maastricht, Netherlands ; Department of Neuro-Urology, School for Mental Health and Neuroscience, Maastricht University Maastricht, Netherlands
| | - C Meriaux
- Department of Neuro-Urology, School for Mental Health and Neuroscience, Maastricht University Maastricht, Netherlands
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21
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Rahnama'i MS, Van Koeveringe GA, Van Kerrebroeck PE. Rationale for the use of prostaglandins and phosphodiesterase inhibitors in the treatment of functional bladder disorders. Nephrourol Mon 2014; 5:949-54. [PMID: 24693500 PMCID: PMC3955285 DOI: 10.5812/numonthly.14088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2013] [Accepted: 09/11/2013] [Indexed: 12/03/2022] Open
Abstract
In this paper a general discussion of the available data on the role of prostaglandin (PG) and phosphodiesterase is discussed. Functional studies would be a next step to understand the functional meaning of the data described in this paper. The data presented are a basis for further research on selective modulation of the EP1 and EP2 receptor which could be a therapeutic target in functional bladder disorders such as OAB. PDE inhibitors are closer to clinical use, as these drugs have been studied and registered for other indications such as erectile dysfunction in men. Therefore, in vivo studies in human subjects can be conducted on short term. However, from a scientific point of view, it is very important to unravel the exact site of action and role of PDE inhibition with in vitro and in vivo studies as is the case with PG. In this way, a combination of drugs targeting different mechanisms involved in bladder physiology such as PG, cGMP, cAMP, and muscarinic receptors, could reduce side effects and improve efficacy.
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Affiliation(s)
- Mohammad Sajjad Rahnama'i
- Maastricht University Medical Centre (MUMC+), Maastricht, The Netherlands
- Corresponding author: Mohammad Sajjad Rahnama'i, Department of Urology, Maastricht University Medical Centre (MUMC+), P.O.Box: 5800, 6202 AZ Maastricht, The Netherlands. Tel: +31-433875255, Fax: +31-433875259, E-mail:
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22
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Rahnama'i MS, Van Koeveringe GA, Van Kerrebroeck PE. Overactive bladder syndrome and the potential role of prostaglandins and phosphodiesterases: an introduction. Nephrourol Mon 2013; 5:934-45. [PMID: 24350100 PMCID: PMC3842572 DOI: 10.5812/numonthly.14087] [Citation(s) in RCA: 17] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2013] [Accepted: 09/15/2013] [Indexed: 12/14/2022] Open
Abstract
In this paper, a general introduction is given, presenting the overactive bladder syndrome (OAB) and its impact on the quality of life and economical burden in patients affected. Moreover, the anatomy, physiology and histology of the lower urinary tract are discussed, followed by a brief overview on the possible role of prostaglandin (PG) and phosphodiesterase type 5 (PDE5) in the urinary bladder. The current literature on the role and distribution of PGE2 and its receptors in the urinary bladder is discussed. In both animal models and in human studies, high levels of signaling molecules such as PG and cGMP have been implicated, in decreased functional bladder capacity and micturition volume, as well as in increased voiding contraction amplitude. As a consequence, inhibition of prostanoid production, the use of prostanoid receptor antagonists, or PDE inhibitors might be a rational way to treat patients with detrusor overactivity. Similarly, prostanoid receptor agonists, or agents that stimulate their production, might have a function in treating bladder underactivity.
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Affiliation(s)
- Mohammad Sajjad Rahnama'i
- Maastricht University Medical Centre (MUMC+), Maastricht, The Netherlands
- Corresponding author: Mohammad Sajjad Rahnama'i, Department of Urology, Maastricht University Medical Centre (MUMC+), PO Box 5800, 6202 AZ Maastricht, The Netherlands. Tel: +31-433875255, Fax: +31-433875259, E-mail:
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Rahnama'i MS, van Koeveringe GA, Essers PB, de Wachter SGG, de Vente J, van Kerrebroeck PE, Gillespie JI. Prostaglandin receptor EP1 and EP2 site in guinea pig bladder urothelium and lamina propria. J Urol 2010; 183:1241-7. [PMID: 20096878 DOI: 10.1016/j.juro.2009.11.004] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2009] [Indexed: 01/23/2023]
Abstract
PURPOSE Urothelium has 2 main functions. It is a barrier to urine and has a sensory role. In response to stretch urothelium releases various substances that modulate afferent nerve activity. Recent data on the localization of cyclooxygenase type 1, the enzyme responsible for prostaglandin production, suggests that prostaglandin may have complex local action. MATERIALS AND METHODS The bladders of 7 guinea pigs were stained for prostaglandin receptors type 1 and 2, and costained for vimentin and cyclooxygenase I. RESULTS Prostaglandin receptor type 1 staining was seen in urothelial cells and in the suburothelium. Urothelial staining, which was often punctuate and weak, was detected in all urothelial cell layers, including suburothelial cells. In contrast, strong prostaglandin receptor type 2 staining was seen in the urothelium and in suburothelial cells. Cyclooxygenase I was absent in interstitial cells and umbrella cells with the highest concentration in the basal cell layer. CONCLUSIONS Interstitial cells express prostaglandin receptor types 1 and 2, indicating that they can respond to prostaglandin. Umbrella cells do not express cyclooxygenase I. Cyclooxygenase I was present in basal urothelial cells, making them a possible site of prostaglandin synthesis. Thus, prostaglandin produced by urothelium may target prostaglandin receptor types 1 and 2 in the urothelium and suburothelium. Therefore prostaglandin is hypothesized to have a role in signal regulation in the bladder wall.
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Rahnama'i MS, Wagenvoort JHT, van der Linden CJ. Amoxicillin/clavulanate (Augmentin) resistant Escherichia coli in bacterial peritonitis after abdominal surgery--clinical outcome in ICU patients. Neth J Med 2009; 67:173-176. [PMID: 19581666] [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: 05/28/2023]
Abstract
Bacterial resistance to antimicrobial agents is of great concern to clinicians. Patient outcome after infection is mainly dependent on the sensitivity of the bacterium to the agent used. We retrospectively studied 89 postoperative intensive care unit (ICU) patients with proven Escherichia coli peritonitis and investigated the clinical consequences of the E. coli resistance to amoxicillin/clavulanate. Significantly increased mortality, days of ventilation and ICU stay were noted in the co-amoxicillin/clavulanate resistant group. Furthermore, our results demonstrate that the sensitivity of E. coli to amoxicillin/clavulanate in the postoperative ICU setting has decreased in recent years. We can conclude that the current antibiotic regimen for the empirical treatment of ICU patients with peritonitis, as used in our hospital, needs to be changed. A switch, for instance, to ceftriaxone (Rocephin) in combination with metronidazole and gentamicin, instead of the present regimen of amoxicillin/clavulanate in combination with gentamicin, seems preferable.
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Affiliation(s)
- M S Rahnama'i
- Department of Surgery and Intensive Care Medicine, Atrium Medical Centre, Parkstad, Heerlen, the Netherlands.
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Abstract
OBJECTIVE To find the clinical signs that are the best predictors of hypoxemia (SpO2 =92%) in acute asthma in children. METHODS Color of skin, dyspnea (by single breath counting), alertness, respiratory rate, presence of audible wheeze, wheezing on auscultation, accessory muscle use, nasal flaring, pulse rate, systolic and diastolic blood pressure, pulsus paradoxus and oxygen saturation at room air (by pulse oximetry) were recorded at the time of presentation and one hour after presentation after completion of 3 doses of nebulized salbutamol and budesonide. RESULTS Hypoxemia (SpO2 92% pounds sterling) was seen in 45% children at presentation and 14(28.6%) after one hour. The clinical signs that correlated significantly with hypoxemia at both time points were dyspnea assessed by single breath count (OR 3.3, 95% CI 0.9-12.9), accessory muscle use score > or = 3 (OR 3.0, 95% CI 0.9-15.4) and pulsus paradoxus> 10 (OR 3.0, 95% CI 0.7-13.6). In a multiple logistic regression model accessory muscle score > or = 3 and pulsus paradoxus> 10 were identified as independent predictors of hypoxemia (sensitivity 64.3%, specificity 91%). CONCLUSION Physical assessment in a child with acute exacerbation of asthma should at least include accessory muscle use and pulsus paradoxus, since these predict hypoxemia the best.
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Affiliation(s)
- M S Rahnama'i
- Department of General Practice, Maastricht University, The Netherlands
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