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Cho KJ, Kim JC. Novel pharmacotherapeutic avenues for bladder storage dysfunction in men. Expert Opin Pharmacother 2024:1-10. [PMID: 38651268 DOI: 10.1080/14656566.2024.2346278] [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: 02/21/2024] [Accepted: 04/18/2024] [Indexed: 04/25/2024]
Abstract
INTRODUCTION Bladder storage dysfunction is associated with low quality of life in men and remains a challenging field in pharmacotherapy because of low persistence followed by patient-perceived lack of efficacy and adverse effects. The persistent desire for the development of novel pharmacotherapy is evident, leading to numerous research efforts based on its pathophysiology. AREAS COVERED This review describes the pathophysiology, current pharmacotherapeutic strategies, and emerging novel drugs for male bladder storage dysfunction. The section on emerging pharmacotherapy provides an overview of current research, focusing on high-potential target molecules, particularly those being evaluated in ongoing clinical trials. EXPERT OPINION As pharmacotherapies targeting alpha-adrenergic, beta-adrenergic, and muscarinic receptors - the current primary targets for treating male bladder storage dysfunction - have demonstrated insufficient efficacy and side effects, researchers are exploring various alternative molecular targets. Numerous targets have been identified as central to regulating bladder afferent nerve activity, and their pharmacological effects and potential have been evaluated in animal-based experiments. However, there is a limited number of clinical trials for these new pharmacotherapies, and they have not demonstrated clear superiority over current treatments. Further research is needed to develop new effective pharmacotherapies for bladder storage dysfunction in men.
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Affiliation(s)
- Kang Jun Cho
- Department of Urology, Bucheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Joon Chul Kim
- Department of Urology, Bucheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
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Bschleipfer T. [Case-based presentation of the S2e guideline on the diagnosis and treatment of benign prostatic hyperplasia]. Urologie 2024:10.1007/s00120-024-02327-1. [PMID: 38597947 DOI: 10.1007/s00120-024-02327-1] [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] [Subscribe] [Scholar Register] [Accepted: 03/05/2024] [Indexed: 04/11/2024]
Abstract
Benign prostatic hyperplasia (BPH) is the most common disease of the lower urinary tract in men. The prevalence increases continuously with increasing age and a chronic progressive course is to be expected. In order to reduce the morbidity of affected patients and to improve their quality of life, the expert panel Benign Prostatic Hyperplasia (BPH) of the German Society of Urology (DGU) has written a new version of the evidence-based "S2e guideline on the diagnosis and treatment of BPH". Using a current patient case, the contents of the new S2e guideline are illustrated, from diagnosis to the decision-making process for a suitable treatment choice. The case presented here shows the possible complexity and difficulty that can arise in the diagnosis of BPH, the need for further diagnostic steps and the finding of a suitable therapy in order to fulfill the patient's wishes, if possible.
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Affiliation(s)
- Thomas Bschleipfer
- Klinik für Urologie und Kinderurologie, REGIOMED Klinikum Coburg, Ketschendorfer Straße 33, 96450, Coburg, Deutschland.
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Yu WR, Jiang YH, Jhang JF, Kuo HC. Urine biomarker could be a useful tool for differential diagnosis of a lower urinary tract dysfunction. Tzu Chi Med J 2024; 36:110-119. [PMID: 38645782 PMCID: PMC11025593 DOI: 10.4103/tcmj.tcmj_221_23] [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: 09/01/2023] [Revised: 09/18/2023] [Accepted: 10/04/2023] [Indexed: 04/23/2024] Open
Abstract
A precision diagnosis of lower urinary tract dysfunctions (LUTD) such as bladder outlet obstruction, detrusor overactivity (DO), interstitial cystitis/bladder pain syndrome (IC/BPS), dysfunctional voiding (DV), or detrusor underactivity (DU) needs invasive videourodynamic study. Exploring non-invasive tools to help screening LUTD is necessary for clinicians in their daily practice. This article reviews recently clinical studies of using urinary inflammatory proteins and oxidative stress biomarkers in the identification of specific LUTD among men and women with lower urinary tract symptoms (LUTS). Some important findings have been reported: (1) Using urine chemokines CXCL-1 and interleukin-8 (IL-8), we may discriminate overactive bladder (OAB) symptoms in women between DO and urinary tract infection. (2) Urinary levels of oxidative stress biomarkers such as 8-hydroxydeoxyguanosine (8-OHdG) and 8-isoprostane have a potential being used as a tool to identify women with mixed DO and stress urinary incontinence. (3) Urine levels of total antioxidant capacity (TAC), and prostaglandin E2 (PGE2) are positively correlated with voiding detrusor pressure in patients with DU. (4) Urine levels of brain-derived neurotrophic factor (BDNF) and PGE2 were significantly higher in the DU patients with detrusor function recovery. (5) Women with DV had higher urinary levels of tumor necrosis factor-alpha (TNF-α) and 8-OHdG, and urinary IL-2 level was significantly lower. (6) Urine level of 8-isoprostane was higher in the patients with idiopathic DO and neurogenic DO. (7) Higher urine cytokine levels of monocyte chemoattractant protein-1 (MCP-1), regulated on activation, normal T-cell expressed and secreted (RANTES), CXCL-10, IL-7, and eotaxin-1 in patients with IC/BPS than controls. (8) The urine levels of IL-8, CXCL-10, BDNF, IL-6, and RANTES were significantly higher in patients with Hunner's IC than non-Hunner's IC. (9) Male patients with IC/BPS had a significantly higher level of eotaxin, MCP-1, TNF-α, 8-OHdG, and TAC. Combining a higher eotaxin and a higher TNF-α can provide a satisfactory diagnostic value in discriminating IC/BPS from other LUTD in men. These studies provide evidence that measurement of cluster of urine biomarkers could be used as a diagnostic tool to differentiate different LUTD in patients with similar LUTS.
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Affiliation(s)
- Wan-Ru Yu
- Department of Nursing, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan
- Institute of Medical Sciences, Tzu Chi University, Hualien, Taiwan
| | - Yuan-Hong Jiang
- Department of Urology, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation and Tzu Chi University, Hualien, Taiwan
| | - Jia-Fong Jhang
- Department of Urology, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation and Tzu Chi University, Hualien, Taiwan
| | - Hann-Chorng Kuo
- Department of Urology, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation and Tzu Chi University, Hualien, Taiwan
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Chuang MS, Ou YC, Cheng YS, Wu KY, Wang CT, Huang YC, Kao YL. Surgical Outcomes and Predictive Factors in Patients With Detrusor Underactivity Undergoing Bladder Outlet Obstruction Surgery. Int Neurourol J 2024; 28:59-66. [PMID: 38569621 PMCID: PMC10990765 DOI: 10.5213/inj.2346252.126] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Accepted: 01/08/2024] [Indexed: 04/05/2024] Open
Abstract
PURPOSE This study was conducted to evaluate the efficacy of bladder outlet surgery in patients with detrusor underactivity (DU) and to identify factors associated with successful outcomes. METHODS We conducted a retrospective review of men diagnosed with DU in urodynamic studies who underwent bladder outlet surgery for lower urinary tract symptoms between May 2018 and April 2023. The International Prostate Symptom Score (IPSS) questionnaire, uroflowmetry (UFM), and multichannel urodynamic studies were administered. Successful treatment outcomes were defined as either an IPSS improvement of at least 50% or the regaining of spontaneous voiding in patients urethral catheterization prior to surgery. RESULTS The study included 93 male patients. Men diagnosed with significant or equivocal bladder outlet obstruction (BOO) experienced significant postoperative improvements in IPSS (from 20.6 to 6.0 and from 17.4 to 6.5, respectively), maximum urine flow rate (from 5.0 mL/sec to 14.4 mL/sec and from 8.8 mL/sec to 12.2 mL/sec, respectively) and voiding efficiency (from 48.8% to 86.0% and from 61.2% to 85.1%, respectively). However, in the group without obstruction, the improvements in IPSS and UFM results were not significant. The presence of detrusor overactivity (odds ratio [OR], 3.152; P=0.025) and preoperative urinary catheterization (OR, 2.756; P=0.040) were associated with favorable treatment outcomes. Conversely, an unobstructed bladder outlet was identified as a negative prognostic factor. CONCLUSION In men with DU accompanied by equivocal or significant BOO, surgical intervention to alleviate the obstruction may enhance the IPSS, quality of life, and UFM results. However, those with DU and an unobstructed bladder outlet face a comparatively high risk of treatment failure. Preoperative detrusor overactivity and urinary catheterization are associated with more favorable surgical outcomes. Consequently, active deobstructive surgery should be considered for patients with DU who are experiencing urinary retention.
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Affiliation(s)
- Ming-Syun Chuang
- Department of Urology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Yin-Chien Ou
- Department of Urology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Yu-Sheng Cheng
- Department of Urology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Kuan-Yu Wu
- Department of Urology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Chang-Te Wang
- Department of Urology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Yuan-Chi Huang
- Department of Urology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Yao-Lin Kao
- Department of Urology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
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Geng J, Zhang X, Zhang Y, Meng X, Sun J, Zhou B, Ma J. TGFβ2 mediates oxidative stress-induced epithelial-to-mesenchymal transition of bladder smooth muscle. In Vitro Cell Dev Biol Anim 2024:10.1007/s11626-024-00864-9. [PMID: 38409639 DOI: 10.1007/s11626-024-00864-9] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2023] [Accepted: 02/05/2024] [Indexed: 02/28/2024]
Abstract
Bladder outlet obstruction (BOO) is the primary clinical manifestation of benign prostatic hyperplasia, the most common urinary system disease in elderly men, and leads to associated lower urinary tract symptoms. Although BOO is reportedly associated with increased systemic oxidative stress (OS), the underlying mechanism remains unclear. The elucidation of this mechanism is the primary aim of this study. A Sprague-Dawley rat model of BOO was constructed and used for urodynamic monitoring. The bladder tissue of rats was collected and subjected to real-time reverse transcription-quantitative polymerase chain reaction (RT-qPCR), histological examination, and immunohistochemical staining. Through bioinformatics prediction, we found that transforming growth factor β2 (TGFβ2) expression was upregulated in rats with BOO compared with normal bladder tissue. In vitro analyses using primary bladder smooth muscle cells (BSMCs) revealed that hydrogen peroxide (H2O2) induced TGFβ2 expression. Moreover, H2O2 induced epithelial-to-mesenchymal transition (EMT) by reducing E-cadherin, an endothelial marker and CK-18, a cytokeratin maker, and increasing mesenchymal markers, including N-cadherin, vimentin, and α-smooth muscle actin (α-SMA) levels. The downregulation of TGFβ2 expression in BSMCs using siRNA technology alleviated H2O2-induced changes in EMT marker expression. The findings of the study indicate that TGFβ2 plays a crucial role in BOO by participating in OS-induced EMT in BSMCs.
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Affiliation(s)
- Jingwen Geng
- Medical Research Center, The Second Affiliated Hospital of Zhengzhou University, Zhengzhou, 450014, Henan, China
| | - Xiaofan Zhang
- Medical Research Center, The Second Affiliated Hospital of Zhengzhou University, Zhengzhou, 450014, Henan, China
| | - Yansong Zhang
- Medical Research Center, The Second Affiliated Hospital of Zhengzhou University, Zhengzhou, 450014, Henan, China
| | - Xiaojia Meng
- Medical Research Center, The Second Affiliated Hospital of Zhengzhou University, Zhengzhou, 450014, Henan, China
| | - Jinqi Sun
- Clinical Laboratory, The Second Affiliated Hospital of Zhengzhou University, Zhengzhou, 450014, Henan, China
| | - Bo Zhou
- Medical Research Center, The Second Affiliated Hospital of Zhengzhou University, Zhengzhou, 450014, Henan, China
| | - Jun Ma
- Clinical Laboratory, The Second Affiliated Hospital of Zhengzhou University, Zhengzhou, 450014, Henan, China.
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Gavi F, Ragonese M, Fettucciari D, Bientinesi R, Gandi C, Campetella M, Marino F, Racioppi M, Sacco E, Foschi N. Efficacy of transurethral botulinum toxin A injections for bladder outlet obstruction: A systematic review and meta-analysis. Urologia 2024:3915603241228166. [PMID: 38372240 DOI: 10.1177/03915603241228166] [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] [Indexed: 02/20/2024]
Abstract
INTRODUCTION Botulinum toxin A (BoNT-A) injections in the prostate gland have been used as a minimally invasive option for treating bladder outlet obstruction (BOO). However, the efficacy of transurethral BoNT-A injections for BOO is not well established in the literature. The aim of this study is to collect evidence on the efficacy of transurethral BoNT-A injections for the treatment of BOO. MATERIALS AND METHODS This systematic review and meta-analyses was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) statement. A systematic literature search was performed till December 2022. The study population consisted of adult patients diagnosed with BOO, who underwent transurethral injections of BoNT-A for the treatment of BOO. EVIDENCE SYNTHESIS Out of 883 records, we identified seven studies enrolling 232 participants, of which only one nonrandomized controlled trial was found. Four prospective studies and two retrospective studies. Three studies included patients with lower urinary tract symptoms (LUTS) and benign prostatic hyperplasia (BPH) and were included in the meta-analysis. Three studies included patients with urethral sphincter hyperactivity. One study included patients with primary bladder neck disease (PBND). All studies showed significant improvements from baseline in maximum urinary flow rate (Qmax), International Prostate Symptom Score (IPSS), and postvoid residual (PVR) at 3 and 6 months. The adverse events were mild in all studies. Hematuria, UTI, and urinary retention were reported across all studies. CONCLUSION In conclusion, transurethral BoNT-A injections have been shown to improve LUTS, QoL, and urodynamic parameters of individuals with BOO at 3 and 6 months after injections, and no serious adverse effects have been reported. However, data on the long-term benefits of this treatment are scarce, and more prospective, randomized studies with larger samples examining various injection techniques, dosages, and extended follow-up of recurrent injections are needed.
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Affiliation(s)
- Filippo Gavi
- Postgraduate School of Urology, Università Cattolica del Sacro Cuore, Rome, Italy
- Department of Urology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Mauro Ragonese
- Department of Urology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Daniele Fettucciari
- Postgraduate School of Urology, Università Cattolica del Sacro Cuore, Rome, Italy
- Department of Urology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Riccardo Bientinesi
- Department of Pathology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, University of Sacred Heart, Rome, Italy
| | - Carlo Gandi
- Department of Urology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Marco Campetella
- Urology Department, Isola Tiberina-Gemelli Isola Hospital, Catholic University Medical School, Rome, Italy
| | - Filippo Marino
- Postgraduate School of Urology, Università Cattolica del Sacro Cuore, Rome, Italy
- Department of Urology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Marco Racioppi
- Department of Pathology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, University of Sacred Heart, Rome, Italy
| | - Emilio Sacco
- Urology Department, Isola Tiberina-Gemelli Isola Hospital, Catholic University Medical School, Rome, Italy
| | - Nazario Foschi
- Department of Urology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
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Lo TS, Harun F, Alzabedi A, Chiung HK, Jhang LS, Hsieh WC. Voiding Dysfunction in Patients With Advanced Pelvic Organ Prolapse and Bladder Outlet Obstruction Following Pelvic Reconstructive Surgery: Urodynamic Profile and Predictive Risk Factors. J Minim Invasive Gynecol 2024; 31:102-109. [PMID: 37952873 DOI: 10.1016/j.jmig.2023.11.003] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Revised: 10/22/2023] [Accepted: 11/07/2023] [Indexed: 11/14/2023]
Abstract
STUDY OBJECTIVE To determine the outcome of voiding function 1 year after pelvic reconstructive surgery (PRS) in women with bladder outlet obstruction (BOO). DESIGN Retrospective cohort study. SETTING Tertiary referral hospital. PATIENTS A total of 1894 women underwent PRS for advanced pelvic organ prolapse (POP) stages 3 to 4 with urodynamic findings of BOO. INTERVENTIONS PRS. MEASUREMENTS The primary outcome measured was the resumption of normal voiding function, defined clinically with multichannel urodynamic testing at 1 year postoperatively. The secondary outcomes were to identify the different risk factors for persistence voiding dysfunction (VD) 1 year after PRS. MAIN RESULTS A total of 431 women with Pelvic Organ Prolapse Quantification stages 3 and 4, urodynamic study of maximum urinary flow rate ≤15 mL/s, and detrusor pressure at maximum flow ≥20 cm H2O were included. Resumption of normal voiding function was found in 91% (n = 392 of 431), whereas 9% (n = 39 of 431) remained to have VD 1 year postoperatively. Those with persistent VD, 20.5% (n = 8 of 39) remained having urodynamic diagnosis of BOO. Univariate and multivariate logistic regression revealed factors associated with postoperative VD were pre-operative maximal cystometric capacity ≥500 mL and postvoid residual volume ≥200 mL. CONCLUSION VD may persist in women with BOO after PRS, particularly in those with preoperative maximal cystometric capacity of >500 mL and postvoid residual volume >200 mL.
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Affiliation(s)
- Tsia-Shu Lo
- Division of Urogynecology, Department of Obstetrics and Gynecology, Linkou, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan, Taiwan (Drs. Lo, Chiung, Jhang, and Hsieh); Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Keelung Medical Center, Keelung, Taiwan (Dr. Lo); Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Taipei, Medical Center, Taipei, Taiwan (Dr. Lo); Chang Gung University, School of Medicine, Taoyuan, Taiwan (Dr. Lo).
| | - Fazlin Harun
- Department of Obstetrics and Gynecology, Women and Children Hospital (Hospital Tunku Azizah) Kuala Lumpur, Malaysia, (Dr. Harun)
| | - Aisha Alzabedi
- Women Health Center, International Medical Center Hospital, Jeddah, Saudi Arabia (Dr. Alzabedi)
| | - Huan-Ka Chiung
- Division of Urogynecology, Department of Obstetrics and Gynecology, Linkou, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan, Taiwan (Drs. Lo, Chiung, Jhang, and Hsieh)
| | - Lan-Sin Jhang
- Division of Urogynecology, Department of Obstetrics and Gynecology, Linkou, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan, Taiwan (Drs. Lo, Chiung, Jhang, and Hsieh)
| | - Wu-Chiao Hsieh
- Division of Urogynecology, Department of Obstetrics and Gynecology, Linkou, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan, Taiwan (Drs. Lo, Chiung, Jhang, and Hsieh)
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Vale L, Cruz F, Charrua A. Detrusor Overactivity After Partial Bladder Outlet Obstruction Is Associated With High Urinary Adenosine Triphosphate Levels in Female Wistar Rats. Int Neurourol J 2024; 28:34-39. [PMID: 38461854 DOI: 10.5213/inj.2346196.098] [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: 08/25/2023] [Accepted: 10/23/2023] [Indexed: 03/12/2024] Open
Abstract
PURPOSE Bladder outlet obstruction (BOO) commonly causes detrusor overactivity (DO). In this study, a post hoc analysis of previous obtained data, we investigate if DO occurring in initial phases of BOO is associated with changes in urinary adenosine triphosphate (ATP) levels. METHODS Adult female Wistar rats were submitted to partial BOO (pBOO) or to sham obstruction. Cystometry was performed at 3 or 15 days after pBOO and saline voided was collected for ATP determination. Normality was tested using Shapiro-Wilk test. The mean frequency of voiding contractions (VCs) of the sham-operated animals at 15 days after surgery, plus or minus 3 standard deviations, was used to represent the normal range. Statistical analyses were performed using the chi-square and Mann-Whitney tests. RESULTS DO was indicated by a VC frequency greater than or equal to 0.9 VCs/min. DO was observed in 63% of animals at 3 days and in 33% at 15 days following pBOO. ATP levels were significantly higher in rats with DO compared to those without DO. CONCLUSION The DO phenotype, occurring in the initial phases of BOO, is associated with comparatively high urinary ATP levels.
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Affiliation(s)
- Luís Vale
- Departmento de Biomedicina-Unidade de Farmacologia e Terapêutica, Faculdade de Medicina da Universidade do Porto, Porto, Portugal
- Serviço de Urologia, Centro Hospitalar Universitário São João, Porto, Portugal
| | - Francisco Cruz
- Serviço de Urologia, Centro Hospitalar Universitário São João, Porto, Portugal
- Departmento de Cirurgia e Fisiologia-Faculdade de Medicina da Universidade do Porto, Porto, Portugal
- Translational Neurourology group, IBMC-Instituto de Biologia Molecular e Celular, Universidade do Porto, Porto, Portugal
- I3S-Instituto de Investigação e Inovação em Saúde, Universidade do Porto, Porto, Portugal
| | - Ana Charrua
- Translational Neurourology group, IBMC-Instituto de Biologia Molecular e Celular, Universidade do Porto, Porto, Portugal
- I3S-Instituto de Investigação e Inovação em Saúde, Universidade do Porto, Porto, Portugal
- Departmento de Biomedicina-Unidade de Biologia Experimental, Faculdade de Medicina da Universidade do Porto, Porto, Portugal
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Gao X, Jin X, Wang W, Di X, Peng L, Li H, Liao B, Wang K. β-Adrenoceptors regulate urothelial inflammation and zonula occludens in the bladder outlet obstruction model. Int Immunopharmacol 2024; 127:111371. [PMID: 38103410 DOI: 10.1016/j.intimp.2023.111371] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Revised: 11/23/2023] [Accepted: 12/10/2023] [Indexed: 12/19/2023]
Abstract
BACKGROUND The purpose of this study was to evaluate the effects of β-adrenoceptors (ADRBs) on the urothelial inflammation and zonula occludens (ZO) in a rat PBOO model and in an in vitro model. METHODS The PBOO model was established by ligating the bladder neck of rats. Twenty rats were divided into 4 groups: sham operation, PBOO + normal saline, PBOO + ADRB2 agonist, PBOO + ADRB3 agonist. PBOO rats were with treated with ADRBs agonists for 3 weeks. Human urothelial cells (HUCs) were subjected to ADRBs agonist treatment or hydrostatic pressure in an in vitro model. RESULTS In the PBOO group, there was a significant increase in the expression of MCP-1, IL-6 and RANTES compared to the sham group. By contrast, there was a post-PBOO decline in the expression of ZO-1 and ZO-2 in the urothelium. ADRB2 or ADRB3 agonists exhibited downregulated inflammatory cytokine expression and increased ZO expression in the PBOO model. The regulation of inflammation and ZO by ADRB2 and ADRB3 agonists in an in vitro model was found consistent with that in the PBOO model. Moreover, RhoA and ROCK inhibitors suppressed the expression of hydrostatic pressure-induced inflammatory cytokines. Additionally, RhoA agonist reversed the inhibitory effect of ADRBs agonists on the inflammatory secretion from HUCs. CONCLUSIONS ADRB2 and ADRB3 agonists increased ZO protein expression in HUCs in a rat PBOO model and in an in vitro model. Furthermore, ADRB2 and ADRB3 agonists inhibited the secretion of inflammatory cytokines from HUCs by regulating the RhoA/ROCK signaling pathways.
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Affiliation(s)
- Xiaoshuai Gao
- Department of Urology and Institute of Urology (Laboratory of Reconstructive Urology), West China Hospital, Sichuan University, Chengdu, Sichuan, PR China
| | - Xi Jin
- Department of Urology and Institute of Urology (Laboratory of Reconstructive Urology), West China Hospital, Sichuan University, Chengdu, Sichuan, PR China
| | - Wei Wang
- Department of Urology and Institute of Urology (Laboratory of Reconstructive Urology), West China Hospital, Sichuan University, Chengdu, Sichuan, PR China
| | - Xingpeng Di
- Department of Urology and Institute of Urology (Laboratory of Reconstructive Urology), West China Hospital, Sichuan University, Chengdu, Sichuan, PR China
| | - Liao Peng
- Department of Urology and Institute of Urology (Laboratory of Reconstructive Urology), West China Hospital, Sichuan University, Chengdu, Sichuan, PR China
| | - Hong Li
- Department of Urology and Institute of Urology (Laboratory of Reconstructive Urology), West China Hospital, Sichuan University, Chengdu, Sichuan, PR China
| | - Banghua Liao
- Department of Urology and Institute of Urology (Laboratory of Reconstructive Urology), West China Hospital, Sichuan University, Chengdu, Sichuan, PR China.
| | - Kunjie Wang
- Department of Urology and Institute of Urology (Laboratory of Reconstructive Urology), West China Hospital, Sichuan University, Chengdu, Sichuan, PR China.
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Wishahi M, Hassan S, Kamal N, Badawy M, Hafiz E. Is bladder outlet obstruction rat model to induce overactive bladder (OAB) has similarity to human OAB? Research on the events in smooth muscle, collagen, interstitial cell and telocyte distribution. BMC Res Notes 2024; 17:22. [PMID: 38212840 PMCID: PMC10785408 DOI: 10.1186/s13104-023-06681-9] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Accepted: 12/28/2023] [Indexed: 01/13/2024] Open
Abstract
BACKGROUND Cellular and cytoskeletal events of overactive bladder (OAB) have not been sufficiently explored in human bladder due to different limitations. Bladder outlet obstruction (BOO) had been induced in different animal models with different methods to induce (OAB). Similarity of the animal models of BOO to the human OAB is postulated but has not been confirmed. The interstitial cells of Cajal (ICCs), and telocytes (TCs) are an important players in smooth muscles conductivity, they had not been well investigated in the previous BOO models. Objectives are to investigate the morphological pattern of cellular, cytoskeleton and telocytes distribution in BOO rat model and to match the events in two time periods and compare it to the findings in real-world human OAB. METHODS Female Sprague-Dawley rats (Rattus norvegicus) were randomly divided into: sham (n = 10), BOO 6 W (n = 10), BOO 8 W (n = 10). Operative procedure to Induce BOO was done under anesthesia with intraperitoneal Ketamine administration. The Effect of induction of BOO was evaluated after 6 and 8 weeks. The rats were anesthetized, and the urinary bladder was removed, while the rat was unconscious under anaesthesia it was transferred to the inhalation anaesthesia cage for euthanasia, rats were sacrificed under light anesthesia using isoflurane. Care of animals, surgical procedure, and euthanasia adhered to Guide for the Care and Use of Laboratory Animals, and AVMA Guidelines for the Euthanasia of Animals. The retrieved bladder was processed for examination with histopathology, immunohistochemistry (IHC), and transmission electron microscopy (EM). RESULTS Histological examination of the bladder shows thinner urothelium, condensation of collagen between muscle bundles. IHC with c-kit shows the excess distribution of ICCs between smooth muscle bundles. EM shows frequent distribution of TCs that were situated between collagen fibers. Finings in BOO 6 W group and BOO 8 W group were comparable. CONCLUSION The animal model study demonstrated increased collagen/ smooth muscle ratio, high intensity of ICCs and presence of TCs. Findings show that a minimally invasive procedure to induce BOO in rats had resulted in an OAB that has morphological changes that were stable in 6 & 8 weeks. We demonstrated the distribution of TCs and ICCs in the rat animal model and defined them. The population of TCs in the BOO rat model is described for the first time, suggests that the TCs and ICCs may contribute to the pathophysiology of OAB. Similarity of animal model to human events OAB was demonstrated. These findings warrant further study to define the role of TCs in OAB. CLINICAL TRIAL REGISTRY The study does not require a clinical trial registration; it is an experimental animal study in basic science and does not include human subjects.
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Affiliation(s)
- Mohamed Wishahi
- Department of Urology, Theodor Bilharz Research Institute, P.O. 30, Warrak El-Hadar, Cairo, Imbaba, Giza, 12411, Egypt.
| | - Sarah Hassan
- Department of Pathology and Electron microscopy, Theodor Bilharz Research Institute, Cairo, Egypt
| | - Nabawya Kamal
- Department of Anesthesia, Theodor Bilharz Research Institute, Cairo, Egypt
| | - Mohamed Badawy
- Department of Urology, Theodor Bilharz Research Institute, P.O. 30, Warrak El-Hadar, Cairo, Imbaba, Giza, 12411, Egypt
| | - Ehab Hafiz
- Department of Pathology and Electron microscopy, Theodor Bilharz Research Institute, Cairo, Egypt
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Chapelle C, Lavallée E, Vallée M, Descazeaud A. Bicentric retrospective study comparing the postoperative outcomes of patients treated surgically for bladder stones with or without concomitant surgery for BPH. World J Urol 2024; 42:13. [PMID: 38189811 DOI: 10.1007/s00345-023-04699-z] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Accepted: 10/10/2023] [Indexed: 01/09/2024] Open
Abstract
PURPOSE To compare the postoperative outcomes of male patients who underwent bladder stone (BS) removal, with or without concomitant benign prostatic hyperplasia (BPH) surgery. PATIENTS AND METHODS All men aged > 50 years who underwent BS removal at two French university hospitals between 2009 and 2018 were retrospectively reviewed. Four binary outcome criteria were identified during the follow-up: early postoperative complications, stone recurrence, subsequent surgery for BS or BPH, and late surgical complications. A composite score ranging from 0 to 4 was calculated by combining the four criteria. RESULTS A median follow-up period of 42 months was observed in 179 patients. Of these, 107 patients were in the "concomitant surgical treatment" (CST) group and 72 in the bladder "stone removal alone" (SRA) group. The CST group presented higher baseline post-void residual volume (105 vs. 30 ml, p = 0.005). Patients who underwent CST had a significantly lower rate of BS recurrence (12% vs. 39%; p = 0,001) and underwent fewer subsequent surgeries (14% vs. 44%; p < 0.001). There was no significant difference in the early (51% vs. 35%, p = 0,168) and late (26% vs. 17%, p = 0,229) complications rates between the two groups. A better composite score was observed in the CST than in the SRA, but the difference was not significant (3.07 vs. 2.72, p = 0.078). CONCLUSION As CST increases morbidity and decreases the risk of reoperation, each situation should be considered, taking into account patient choice and comorbidities.
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Affiliation(s)
- Caroline Chapelle
- CHU La Milétrie, Service d'Urologie Et de Transplantations Rénales, CHU de Poitiers, 2 Rue de La Milétrie, 86021, Poitiers, France.
| | - Etienne Lavallée
- Service de Chirurgie Urologique CHU de Québec - Hôtel-Dieu de Québec, 11 Côte du Palais, Québec, QC, G1R 2J6, Canada
| | - Maxime Vallée
- CHU La Milétrie, Service d'Urologie Et de Transplantations Rénales, CHU de Poitiers, 2 Rue de La Milétrie, 86021, Poitiers, France
| | - Aurélien Descazeaud
- Service de Chirurgie Urologique, CHU de Limoges, 2, Avenue Martin-Luther-King, 87042, Limoges, France
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12
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Kwun-Chung Cheng B, Kar-Kei Yuen S, Castellani D, Wroclawski ML, Zhao H, Chiruvella M, Chua WJ, Tiong HY, Tanidir Y, Rosette JDL, Rijo E, Misrai V, Krambeck A, Elterman DS, Somani BK, Yuen-Chun Teoh J, Gauhar V. Defining minimal invasive surgical therapy for benign prostatic obstruction surgery: Perspectives from a global knowledge, attitude, and practice survey. Asian J Urol 2024; 11:55-64. [PMID: 38312819 PMCID: PMC10837660 DOI: 10.1016/j.ajur.2022.02.011] [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: 08/09/2021] [Accepted: 02/10/2022] [Indexed: 11/24/2022] Open
Abstract
Objective To scrutinize the definitions of minimal invasive surgical therapy (MIST) and to investigate urologists' knowledge, attitudes, and practices for benign prostatic obstruction surgeries. Methods A 36-item survey was developed with a Delphi method. Questions on definitions of MIST and attitudes and practices of benign prostatic obstruction surgeries were included. Urologists were invited globally to complete the online survey. Consensus was achieved when more than or equal to 70% responses were "agree or strongly agree" and less than or equal to 15% responses were "disagree or strongly disagree" (consensus agree), or when more than or equal to 70% responses were "disagree or strongly disagree" and less than or equal to 15% responses were "agree or strongly agree" (consensus disagree). Results The top three qualities for defining MIST were minimal blood loss (n=466, 80.3%), fast post-operative recovery (n=431, 74.3%), and short hospital stay (n=425, 73.3%). The top three surgeries that were regarded as MIST were Urolift® (n=361, 62.2%), Rezum® (n=351, 60.5%), and endoscopic enucleation of the prostate (EEP) (n=332, 57.2%). Consensus in the knowledge section was achieved for the superiority of Urolift®, Rezum®, and iTIND® over transurethral resection of the prostate with regard to blood loss, recovery, day surgery feasibility, and post-operative continence. Consensus in the attitudes section was achieved for the superiority of Urolift®, Rezum®, and iTIND® over transurethral resection of the prostate with regard to blood loss, recovery, and day surgery feasibility. Consensus on both sections was achieved for EEP as the option with the better symptoms and flow improvement, lower retreatment rate, and better suitable for prostate more than 80 mL. Conclusion Minimal blood loss, fast post-operative recovery, and short hospital stay were the most important qualities for defining MIST. Urolift®, Rezum®, and EEP were regarded as MIST by most urologists.
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Affiliation(s)
| | - Steffi Kar-Kei Yuen
- S. H. Ho Urology Centre, Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China
| | - Daniele Castellani
- Department of Urology, University Hospital “Ospedali Riuniti” and Polytechnic University of Marche Region, Ancona, Italy
| | - Marcelo Langer Wroclawski
- Hospital Israelita Albert Einstein, Sao Paulo, SP, Brazil
- BP—A Beneficencia Portuguesa de Sao Paulo, Sao Paulo, SP, Brazil
- Faculdade de Medicina do ABC, Santo Andre, SP, Brazil
| | - Hongda Zhao
- S. H. Ho Urology Centre, Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China
| | | | - Wei-Jin Chua
- Department of Urology, National University Hospital, Singapore
| | - Ho-Yee Tiong
- Department of Urology, National University Hospital, Singapore
| | - Yiloren Tanidir
- Department of Urology, Marmara University School of Medicine, Istanbul, Turkey
| | - Jean de la Rosette
- Department of Urology, Medipol Mega University Hospital, Istanbul Medipol University, Istanbul, Turkey
| | - Enrique Rijo
- Department of Urology, Hospital Quiron Barcelona, Barcelona, Spain
| | - Vincent Misrai
- Department of Urology, Clinique Pasteur, Toulouse, France
| | - Amy Krambeck
- Department of Urology, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Dean S. Elterman
- Division of Urology, Department of Surgery, University Health Network, University of Toronto, Toronto, Canada
| | - Bhaskar K. Somani
- Department of Urology, University Hospital Southampton NHS Trust, Southampton, UK
| | - Jeremy Yuen-Chun Teoh
- S. H. Ho Urology Centre, Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China
| | - Vineet Gauhar
- Department of Urology, Ng Teng Fong General Hospital, NUHS, Singapore
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13
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Kapadia SF, Saha A, Bhatt D, Srivastava P, Mehta S, Kumar S, Vala KB. Eyes sees what mind knows-a very rare cause of hydroureteronephrosis in a 12-year-old boy: Questions. Pediatr Nephrol 2023; 38:3619-3620. [PMID: 37219639 DOI: 10.1007/s00467-023-06014-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 04/24/2023] [Accepted: 04/25/2023] [Indexed: 05/24/2023]
Affiliation(s)
- Shahenaz F Kapadia
- Institute of Kidney Diseases and Research Centre and Institute of Transplantation Sciences, Ahmedabad, India
| | - Anshuman Saha
- Institute of Kidney Diseases and Research Centre and Institute of Transplantation Sciences, Ahmedabad, India
| | - Disha Bhatt
- Institute of Kidney Diseases and Research Centre and Institute of Transplantation Sciences, Ahmedabad, India
| | | | - Shruti Mehta
- Institute of Kidney Diseases and Research Centre and Institute of Transplantation Sciences, Ahmedabad, India
| | - Suresh Kumar
- Institute of Kidney Diseases and Research Centre and Institute of Transplantation Sciences, Ahmedabad, India
| | - Kinnari B Vala
- Institute of Kidney Diseases and Research Centre and Institute of Transplantation Sciences, Ahmedabad, India.
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14
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Kapadia SF, Saha A, Bhatt D, Srivastava P, Mehta S, Kumar S, Vala KB. Eyes sees what mind knows-a very rare cause of hydroureteronephrosis in a 12-year-old boy: Answers. Pediatr Nephrol 2023; 38:3621-3623. [PMID: 37227521 DOI: 10.1007/s00467-023-06015-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 04/24/2023] [Accepted: 04/25/2023] [Indexed: 05/26/2023]
Affiliation(s)
- Shahenaz F Kapadia
- Institute of Kidney Diseases and Research Centre and Institute of Transplantation Sciences, Ahmedabad, India
| | - Anshuman Saha
- Institute of Kidney Diseases and Research Centre and Institute of Transplantation Sciences, Ahmedabad, India
| | - Disha Bhatt
- Institute of Kidney Diseases and Research Centre and Institute of Transplantation Sciences, Ahmedabad, India
| | | | - Shruti Mehta
- Institute of Kidney Diseases and Research Centre and Institute of Transplantation Sciences, Ahmedabad, India
| | - Suresh Kumar
- Institute of Kidney Diseases and Research Centre and Institute of Transplantation Sciences, Ahmedabad, India
| | - Kinnari B Vala
- Institute of Kidney Diseases and Research Centre and Institute of Transplantation Sciences, Ahmedabad, India.
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Blanco Fernández R, González Rodríguez I, Fernández-Pello Montes S, Sánchez Verdes P, Miranda García P, Suárez Sal PJ, Alonso Calvar L, Rodríguez Villamil L. Holmium laser enucleation of the prostate (HoLEP) as same-day surgery: A safe and feasible option. Actas Urol Esp 2023; 47:457-461. [PMID: 37369301 DOI: 10.1016/j.acuroe.2023.05.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Revised: 05/02/2023] [Accepted: 05/03/2023] [Indexed: 06/29/2023]
Abstract
OBJECTIVE To study the feasibility of holmium laser enucleation (HoLEP) performed as a same-day surgery. MATERIAL AND METHODS Prospective observational study including 25 patients submitted to HoLEP. Patients were discharged the same day if they met the established criteria. RESULTS The mean age of the patients was 65.1 years and prostate volume was 45.8cc. All patients were discharged the same day of surgery. The overall complication rate at 30 days was 12% (Clavien I 100%). The rate of re-hospitalization was 0%. Patient satisfaction rate with the day surgery pathway was 95%. CONCLUSIONS The initial analysis of our results suggests that outpatient HoLEP is a safe and effective alternative with low rate of complications. According to satisfaction rates, patients prefer the day surgery pathway for the performance of HoLEP.
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Affiliation(s)
- R Blanco Fernández
- Departamento de Urología, Hospital Universitario de Cabueñes, Gijón, Asturias, Spain.
| | - I González Rodríguez
- Departamento de Urología, Hospital Universitario de Cabueñes, Gijón, Asturias, Spain
| | | | - P Sánchez Verdes
- Departamento de Urología, Hospital Universitario de Cabueñes, Gijón, Asturias, Spain
| | - P Miranda García
- Departamento de Anestesiología y Reanimación, Hospital Universitario de Cabueñes, Gijón, Asturias, Spain
| | - P J Suárez Sal
- Departamento de Urología, Hospital Universitario de Cabueñes, Gijón, Asturias, Spain
| | - L Alonso Calvar
- Departamento de Urología, Hospital Universitario de Cabueñes, Gijón, Asturias, Spain
| | - L Rodríguez Villamil
- Departamento de Urología, Hospital Universitario de Cabueñes, Gijón, Asturias, Spain
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16
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Shi Y, Cao T, Xu J, Cui D, Wang X, Zhu Y, Ruan Y, Han B, Xia S, Chen Y, Guo W, Jing Y. Simultaneous thulium laser resection of the prostate and transperineal prostate biopsy in clinically diagnosed metastatic prostate cancer with bladder outlet obstruction. Lasers Med Sci 2023; 38:188. [PMID: 37596454 DOI: 10.1007/s10103-023-03848-5] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Accepted: 08/03/2023] [Indexed: 08/20/2023]
Abstract
Metastatic prostate cancer (mPCa) patients complicated with bladder outlet obstruction (BOO) are often referred to a urologist. Androgen deprivation therapy (ADT) combined with indwelling catheter usually be the initial management. To retrospectively analysis the safety and efficacy of simultaneous thulium laser resection of the prostate (TmLRP) and transperineal prostate biopsy in metastatic prostate cancer with bladder outlet obstruction. From January 2016 to December 2021, 67 clinically diagnosed mPCa with BOO patients were included in this study. All patients were preoperatively assessed with international prostate symptom score (IPSS), QoL, serum prostate-specific antigen (PSA), prostate volume evaluation by transrectal ultrasound, postvoid residual urine volume (PVR), and maximum flow rate (Qmax). Preoperative and perioperative parameters at 1-, 3-, and 6-month follow-up were also evaluated. All complications were recorded. Simultaneous TmLRP and transperineal prostate biopsy had obvious advantages for clinically diagnosed mPCa patients with BOO, including short overall operation time (52 ± 23.3 min), little hemoglobin decrease (0.6 ± 0.7 g/l), and short hospital stay (average 3.8 days). In addition, simultaneous TmLRP and transperineal prostate biopsy also brought them significant improvement on IPSS, QoL score, Qmax, and PVR volume (P < 0.001) at 1-, 3-, and 6-month follow-up after operation compared to preoperative parameters. Complications were in a low incidence. Simultaneous TmLRP and transperineal prostate biopsy is a bloodless operation with immediate effect and little perioperative complication. Importantly, it is a promising technology in the diagnosis and treatment of clinically diagnosed mPCa patients with BOO.
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Affiliation(s)
- Youwei Shi
- Department of Urology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200080, China
| | - Tianyu Cao
- Department of Urology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200080, China
| | - Junhao Xu
- Department of Urology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200080, China
| | - Di Cui
- Department of Urology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200080, China
| | - Xiaohai Wang
- Department of Urology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200080, China
| | - Yiping Zhu
- Department of Urology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200080, China
| | - Yuan Ruan
- Department of Urology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200080, China
| | - Bangmin Han
- Department of Urology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200080, China
| | - Shujie Xia
- Department of Urology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200080, China
| | - Yuee Chen
- Department of Urology, Nanping First Hospital Affiliated to Fujian Medical University, Fujian, 353006, China.
| | - Wenhuan Guo
- Department of Pathology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200011, China.
| | - Yifeng Jing
- Department of Urology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200080, China.
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Oelke M, Abt SD, Becher KF, Dreikorn K, Madersbacher S, Magistro G, Michel MC, Muschter R, Reich O, Rieken M, Salem J, Schönburg S, Höfner K, Bschleipfer T. [Diagnostic work-up of benign prostatic hyperplasia : The German S2e-guideline 2023 part 1]. Urologie 2023:10.1007/s00120-023-02142-0. [PMID: 37401972 DOI: 10.1007/s00120-023-02142-0] [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] [Subscribe] [Scholar Register] [Accepted: 06/07/2023] [Indexed: 07/05/2023]
Abstract
BACKGROUND Lower urinary tract symptoms (LUTS) suggestive of benign prostatic hyperplasia (BPH; in German guidelines: benign prostatic syndrome [BPS]) is the most frequent urological disease in men and can result in a considerable deterioration of quality-of-life. BPS can be associated with LUTS, benign prostatic enlargement (BPE), and bladder outlet obstruction (BOO) or benign prostatic obstruction (BPO), respectively. The expert group on BPS of the German Society of Urology has re-evaluated the tests for the assessment of BPH and provides evidence-based recommendations. OBJECTIVES Presentation and evidence-based rating of tests for the assessment of patients with BPS. MATERIALS AND METHODS Summary and overview of chapters 5, 6, and 8 of the latest long version of the German S2e guideline on BPS. RESULTS The diagnostic work-up should clarify (1) whether the complaints of the patient are caused by BPS, (2) how relevant the complaints are and whether treatment is necessary, (3) whether complications of the lower or upper urinary tract already exist, and (4) which treatment will be most suitable. Baseline assessment should be done in all BPS patients and include history, measurement of LUTS and quality-of-life, urinalysis, serum prostate-specific antigen, post-void residual, ultrasound of the lower urinary tract, including measurements of prostate volume, intravesical prostatic protrusion and detrusor wall thickness, and ultrasound of the upper urinary tract. Additional tests can follow when questions remain unanswered after baseline assessment. These optional tests include bladder diaries, uroflowmetry, serum creatinine, urethrocystoscopy, other noninvasive tests for the determination of BOO/BPO such as penile cuff test, condom catheter method and near-infrared spectroscopy, and other imagining tests such as X‑ray and MRI investigations. CONCLUSIONS The updated German S2e guideline summarizes evidence-based recommendations on the diagnostic work-up, including the assessment of the BPS components BPE, LUTS, and BOO/BPO.
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Affiliation(s)
- Matthias Oelke
- Klinik für Urologie, Urologische Onkologie und Roboter-assistierte Chirurgie, St. Antonius-Hospital GmbH, Möllenweg 22, 48599, Gronau, Deutschland.
| | - S Dominik Abt
- Klinik für Urologie, Spitalzentrum Biel, Biel, Schweiz
| | - Klaus F Becher
- Klinik für Rehabilitation, Klinik Wartenberg Professor Dr. Selmair GmbH & Co. KG, Wartenberg, Deutschland
| | | | | | - Giuseppe Magistro
- Klinik für Urologie, Asklepios Westklinikum GmbH, Hamburg, Deutschland
| | - Martin C Michel
- Abteilung Pharmakologie, Johannes Gutenberg Universität, Mainz, Deutschland
| | - Rolf Muschter
- Urologische Abteilung, ALTA Klinik, Bielefeld, Deutschland
| | - Oliver Reich
- Urologische Privatpraxis Prof. Dr. Oliver Reich, München, Deutschland
| | | | - Johannes Salem
- CUROS urologisches Zentrum, Klinik LINKS VOM RHEIN, Köln, Deutschland
- Klinik für Urologie und Kinderurologie, Universitätsklinikum, Medizinische Hochschule Brandenburg Theodor Fontane, Brandenburg a.d. Havel, Deutschland
| | - Sandra Schönburg
- Universitätsklinik und Poliklinik für Urologie, Martin-Luther Universität Halle-Wittenberg, Halle (Saale), Deutschland
| | - Klaus Höfner
- Klinik für Urologie, Evangelisches Krankenhaus, Oberhausen, Deutschland
| | - Thomas Bschleipfer
- Klinik für Urologie und Kinderurologie, Regiomed Klinikum, Coburg, Deutschland
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Okeke CJ, Jeje EA, Obi AO, Ojewola RW, Ogunjimi MA, Tijani KH. Correlation between bladder wall thickness and uroflowmetry in West African patients with benign prostatic enlargement. Niger J Clin Pract 2023; 26:986-991. [PMID: 37635584 DOI: 10.4103/njcp.njcp_850_22] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/29/2023]
Abstract
Background Pressure flow urodynamic study remains the gold standard for the diagnosis of bladder outlet obstruction; however, their use is limited by their relative unavailability in our environment, cost, and invasiveness. Measurement of bladder wall thickness (BWT) by transabdominal ultrasonography is a promising tool that can be used to diagnose bladder outlet obstruction in our environment where pressure-flow urodynamic study is not readily available. Objective The study aimed to correlate BWT with uroflowmetry and to establish a BWT cut-off in patients with lower urinary tract symptoms (LUTS) due to benign prostatic enlargement. Materials and Methods This was a prospective one-year study of patients with LUTS due to benign prostatic enlargement. The patients were divided into obstructed and non-obstructed groups with Q- max of 10 ml/s serving as the cut-off value. Receiver Operator Curve (ROC) was used to evaluate the performance of BWT in diagnosing BOO. Statistical significance was set at P < 0.05. Results The mean BWT and Q-max were 4.53 ± 2.70 mm and 15.06 ± 9.43 ml/s. There was a negative correlation between BWT and Q-max (r = -0.452, P = 0.000), Q-average (r = -0.336, P = 0.000), and voided volume (r = -0.228, P = 0.046). A BWT cut-off of 5.85 mm was found to be the best threshold to differentiate obstructed from non-obstructed patients with a sensitivity and specificity of 70 and 88.2 percent respectively. Conclusion Bladder wall thickness showed an inverse relationship with maximum flow rate with high sensitivity and specificity. This non-invasive test can be used as a screening tool for BOO in our setting, where the pressure flow urodynamic study is not readily available.
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Affiliation(s)
- C J Okeke
- Department of Urology, Epsom and St Helier University Hospitals NHS Trust, Surrey, London, United Kingdom
| | - E A Jeje
- Department of Surgery/College of Medicine, University of Lagos, Idi-Araba Surulere, Lagos, Nigeria
| | - A O Obi
- Alex-Ekwueme Federal University Teaching Hospital/Department of Surgery, Ebonyi State University Abakaliki Ebonyi State, Nigeria
| | - R W Ojewola
- Department of Surgery/College of Medicine, University of Lagos, Idi-Araba Surulere, Lagos, Nigeria
| | - M A Ogunjimi
- Department of Surgery/College of Medicine, University of Lagos, Idi-Araba Surulere, Lagos, Nigeria
| | - K H Tijani
- Department of Surgery/College of Medicine, University of Lagos, Idi-Araba Surulere, Lagos, Nigeria
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Mazeaud C, Hernandez N, Gonzalez RR. Role of Bladder Functional Testing Prior to Surgeries for Benign Prostatic Obstruction. Curr Urol Rep 2023:10.1007/s11934-023-01165-6. [PMID: 37289378 DOI: 10.1007/s11934-023-01165-6] [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] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/24/2023] [Indexed: 06/09/2023]
Abstract
PURPOSE OF REVIEW There is no consensus on preoperative functional testing prior to surgeries for benign prostatic obstruction causing lower urinary tract symptoms (LUTS). RECENT FINDINGS Surgical management offers definite benefits, but the results are not always satisfactory. The urodynamic study (UDS) is the gold standard for assessing bladder outlet obstruction (BOO) which is the best predictor of surgical success. Yet, it is not recommended by our urologic societies as standard testing prior to surgery. In this narrative review of the literature, we report recent findings and controversies regarding the benefits and downside of UDS, and the use of other less-invasive approaches to achieve this goal. The lack of strong evidence for or against performing UDS was surprising. Prospective UDS data may not predict surgical outcomes if there is no consensus on criteria that directs surgical intervention. However, confirming the presence of BOO and characterizing the bladder function to identify detrusor over- and underactivity may help counselling and setting patient's post-operative expectations. Urocuff, a non-invasive testing offers promising results to address this problem with a less-invasive assessment of BOO. We emphasize better pre-operative characterization of patients to confirm BOO and better define subgroups to improve surgical decision-making.
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Affiliation(s)
- Charles Mazeaud
- Department of Urology, Houston Methodist Hospital, Houston, TX, USA
- Department of Urology, Nancy University Hospital, IADI-UL-INSERM (U1254), Nancy, France
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Olaoluwa HA, Polenakovik H, Hakim J. The andes of bladder stones: Gigantic bladder calculi in a patient with bladder outlet obstruction and hyperparathyroidism. Urol Case Rep 2023; 48:102416. [PMID: 37215057 PMCID: PMC10193164 DOI: 10.1016/j.eucr.2023.102416] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Accepted: 05/02/2023] [Indexed: 05/24/2023] Open
Abstract
60-year-old man with known chronic urinary retention (CUR) managed with clean intermittent catheterization (CIC); He presented with difficulty with CIC. A KUB revealed 13 cm in conglomeration bladder stones. Routine preoperative bloodwork revealed calcium >12 and a subsequent PTH was also elevated. Osteoporosis was confirmed on DEXA. Sestamibi parathyroid scan had increased uptake within one parathyroid gland. The patient underwent open suprapubic 92 gm prostatectomy with evacuation of 254 gm calcium phosphate bladder stones; this was followed by removal of the offending parathyroid gland. On follow up, the patient was voiding well with normalization of other symptoms related to hyperparathyroidism.
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Affiliation(s)
| | - Hari Polenakovik
- Wright State University Boonshoft School of Medicine, Dayton, OH, USA
- Department of Infectious Disease, Dayton VA Medical Center, Dayton, OH, USA
| | - Jonathan Hakim
- Wright State University Boonshoft School of Medicine, Dayton, OH, USA
- Department of Urology, Dayton VA Medical Center, Dayton, OH, USA
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21
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Alenezi SAAD, Zahir M, Alenezi J. Embryonal rhabdomyosarcoma of the prostate in a young male: A rare case report. Int J Surg Case Rep 2023; 106:108228. [PMID: 37086503 PMCID: PMC10154731 DOI: 10.1016/j.ijscr.2023.108228] [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: 03/20/2023] [Revised: 04/12/2023] [Accepted: 04/14/2023] [Indexed: 04/24/2023] Open
Abstract
INTRODUCTION AND IMPORTANCE Embryonal rhabdomyosarcoma (ERMS) of the prostate is a rare disease, and it has a poor prognosis. Mostly patient come with late stage thus with delayed diagnosis and worse outcomes. CASE PRESENTATION a 35-year-old Bangladeshi male presented with bladder outlet obstruction in an intermittent pattern. Patient was not complaining from any other urological symptoms, there was no hematuria or dysuria, even no constitutional symptoms, no history of weight loss, no anorexia or night rigors, also there was no history of fever. Patients have an only previous history of spinal screw without any other medical illnesses. Patient came to casualty with frequent visits without any inflammatory markers elevation even with normal biochemical labs. O/E he found to have a prostatic mass on PR examination of which patient admitted to urology department and underwent diagnostic cystoscopy which showed cauliflower mass at the prostatic urethra. Biopsies retrieved and showed embryonal rhabdomyosarcoma (RMS) of the prostate under the histopathological examination. CLINICAL DISCUSSION Embryonal rhabdomyosarcoma (ERMS) mostly care a poor prognosis and modalities vary according to the presentation and the stage. However distant metastasis is common at the time of presentation. CONCLUSION embryonal rhabdomyosarcoma of the prostate is a rare and aggressive tumor with a low survival rate in adults. However, more clinical data needed for a better outcome.
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Affiliation(s)
- S A A D Alenezi
- Urology department, Jaber Alahmad Hospital, Kuwait; University of Jordan, Amman, Jordan.
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22
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Pratsinis M, Müllhaupt G, Güsewell S, Betschart P, Zumstein V, Engeler D, Schmid HP, Lamb AD, Abt D. Comparison of traditional outcome measures and self-assessed goal achievement in patients treated surgically for benign prostatic hyperplasia. World J Urol 2023; 41:1125-1131. [PMID: 36795145 DOI: 10.1007/s00345-023-04317-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Accepted: 01/28/2023] [Indexed: 02/17/2023] Open
Abstract
PURPOSE To determine self-assessed goal achievement (SAGA) outcomes in men treated surgically for lower urinary tract symptoms (LUTS) due to benign prostatic obstruction (BPO) and compare them to the traditional outcome measures. METHODS Single-center analysis of prospective database of men undergoing surgical treatment of LUTS/BPO at a single institution between July 2019 and March 2021. We assessed individual goals, traditional questionnaires, and functional outcomes prior to treatment, and at first follow-up after 6-12 weeks. We compared SAGA outcomes 'overall goal achievement' and 'satisfaction with treatment' to subjective and objective outcomes using Spearman's rank correlations (rho). RESULTS A total of sixty-eight patients completed the individual goal formulation prior to surgery. Preoperative goals varied between different treatments and individuals. IPSS correlated with 'overall goal achievement' (rho = - 0.78, p < 0.001) and 'satisfaction with treatment' (rho = - 0.59, p < 0.001). Similarly, the IPSS-QoL was correlated with overall goal achievement (rho = - 0.79, p < 0.001) and satisfaction with treatment (rho = - 0.65, p < 0.001). No correlation was seen between SAGA outcomes and functional outcomes Qmax and PVR. CONCLUSIONS SAGA represents a uniquely patient-specific outcome measure. Our study is, to our knowledge, the first to assess patient-specific goals prior to surgery and examine SAGA outcomes following treatment in men suffering from LUTS/BPO. The correlation of SAGA outcomes with IPSS and IPSS-QoL highlight the importance of this well-established questionnaire. Functional outcomes do not necessarily reflect patient's goals and may rather be considered physician-directed outcomes.
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Affiliation(s)
- Manolis Pratsinis
- Department of Urology, School of Medicine, University of St. Gallen, St. Gallen, Switzerland.
- Department of Urology, University of California, Davis, Sacramento, CA, USA.
| | - Gautier Müllhaupt
- Department of Urology, School of Medicine, University of St. Gallen, St. Gallen, Switzerland
| | - Sabine Güsewell
- Clinical Trials Unit, Cantonal Hospital St. Gallen, St. Gallen, Switzerland
| | - Patrick Betschart
- Department of Urology, School of Medicine, University of St. Gallen, St. Gallen, Switzerland
| | - Valentin Zumstein
- Department of Urology, School of Medicine, University of St. Gallen, St. Gallen, Switzerland
| | - Daniel Engeler
- Department of Urology, School of Medicine, University of St. Gallen, St. Gallen, Switzerland
| | - Hans-Peter Schmid
- Department of Urology, School of Medicine, University of St. Gallen, St. Gallen, Switzerland
| | - Alastair D Lamb
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK
- Department of Urology, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Dominik Abt
- Department of Urology, Spitalzentrum Biel/Centre Hospitalier Bienne, Biel/Bienne, Switzerland
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Iguchi N, Dönmez Mİ, Malykhina AP, Wilcox DT. Anti-fibrotic effect of tocotrienols for bladder dysfunction due to partial bladder outlet obstruction. Investig Clin Urol 2023; 64:189-196. [PMID: 36882179 PMCID: PMC9995959 DOI: 10.4111/icu.20220328] [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: 09/28/2022] [Revised: 12/20/2022] [Accepted: 01/11/2023] [Indexed: 02/16/2023] Open
Abstract
PURPOSE To investigate potential beneficial effects of tocotrienols which have been suggested to inhibit hypoxia-inducible factor (HIF) pathway, on partial bladder outlet obstruction (PBOO)-induced bladder pathology. MATERIALS AND METHODS PBOO was surgically created in juvenile male mice. Sham-operated mice were used as controls. Animals received daily oral administration of either tocotrienols (T3) or soybean oil (SBO, vehicle) from day 0 to 13 post-surgery. Bladder function was examined in vivo by void spot assay. At 2 weeks post-surgery, the bladders were subjected to physiological evaluation of detrusor contractility in vitro using bladder strips, histology by H&E staining and collagen imaging, and gene expression analyses by quantitative PCR. RESULTS A significant increase in the number of small voids was observed after 1 week of PBOO compared to the control groups. At 2 weeks post-surgery, PBOO+SBO mice showed a further increase in the number of small voids, which was not observed in PBOO+T3 group. PBOO-induced decrease in detrusor contractility was similar between two treatments. PBOO induced bladder hypertrophy to the same degree in both SBO and T3 treatment groups, however, fibrosis in the bladder was significantly less prominent in the T3 group than the SBO group following PBOO (1.8- vs. 3.0-fold increase in collagen content compared to the control). Enhanced levels of HIF target genes in the bladders were observed in PBOO+SBO group, but not in PBOO+T3 group compared to the control. CONCLUSIONS Oral tocotrienol treatment reduced the progression of urinary frequency and bladder fibrosis by suppressing HIF pathways triggered by PBOO.
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Affiliation(s)
- Nao Iguchi
- Division of Urology, Department of Surgery, University of Colorado Denver School of Medicine, Aurora, CO, USA
| | - M İrfan Dönmez
- Division of Urology, Department of Surgery, University of Colorado Denver School of Medicine, Aurora, CO, USA.,Division of Pediatric Urology, Department of Urology, Istanbul University Istanbul Faculty of Medicine, Istanbul, Turkey
| | - Anna P Malykhina
- Division of Urology, Department of Surgery, University of Colorado Denver School of Medicine, Aurora, CO, USA
| | - Duncan T Wilcox
- Division of Urology, Department of Surgery, University of Colorado Denver School of Medicine, Aurora, CO, USA.,Department of Pediatric Urology, Children's Hospital Colorado, Aurora, CO, USA.
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Pinsard M, Fauconnier A, D'Halluin F, Broux PL, Guerin S, Gasmi A, Harlicot JP, Lavoue V, Leveque J, Manunta A, Nyangoh Timoh K, Peyronnet B. Comparison of early loosening vs delayed section of mid-urethral slings for postoperative voiding dysfunction. Int Urogynecol J 2023; 34:675-81. [PMID: 35445807 DOI: 10.1007/s00192-022-05095-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Accepted: 01/07/2022] [Indexed: 10/18/2022]
Abstract
INTRODUCTION AND HYPOTHESIS Bladder outlet obstruction (BOO) is a common occurrence after midurethral sling (MUS) insertion and can result in acute or chronic urinary retention or de novo lower urinary tract symptoms (LUTS). However, the management of BOO after MUS is not standardised. The objective of this study was to compare two therapeutic strategies for suspected BOO after MUS. METHODS Patients who had surgical revision for voiding dysfunction with a post-void residual (PVR) ≥100 ml after MUS in five centres between 2005 and 2020 were included in a retrospective study. Patients were divided into two groups: early sling loosening (EL) vs delayed section/excision of the sling (DS). RESULTS Seventy patients were included: 38 in the EL group and 32 in the DS group. The postoperative complication rate was comparable in both groups (10.5% vs 12.5%; p = 0.99). At 3 months, the rate of withdrawal from self-catheterisation was similar in the two groups (92.1% vs 100%; p = 0.25) as was the PVR (57.5 vs 63.5 ml; p = 0.09). After a median follow-up of 9 months, there were significantly more patients with resolved voiding dysfunction in the EL group (63.2% vs 31.3%; p = 0.01). The rate of persistent/recurrent stress urinary incontinence (SUI) was higher in the DS group (21% vs 43.7%; p = 0.04). In multivariate analysis, the main predictive factor of recurrent SUI was DS (OR 2.87, 95% CI 1.01-8.60, p = 0.048). CONCLUSIONS Early loosening of MUS in the case of postoperative voiding dysfunction offers better efficacy than DS of the sling, with a lower risk of recurrent/persistent SUI.
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Jue JS, Eid JF. Safety and efficacy of Rezūm™ in erectile dysfunction patients with and without an inflatable penile prosthesis[[es]]Seguridad y eficacia del sistema Rezūm® en pacientes con disfunción eréctil con y sin prótesis de pene inflable. Actas Urol Esp 2023; 47:87-91. [PMID: 37078849 DOI: 10.1016/j.acuroe.2022.08.018] [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: 02/12/2022] [Accepted: 03/06/2022] [Indexed: 04/21/2023]
Abstract
PURPOSE This study evaluates the safety and efficacy of Rezūm™ in erectile dysfunction (ED) patients with and without an inflatable penile prosthesis (IPP). MATERIALS AND METHODS This was a retrospective review of ED patients who underwent Rezūm™ by a single surgeon over 12 months. Patient age, presence of IPP, number of benign prostatic hyperplasia medications, International Prostate Symptom Score (IPSS), IPSS Quality of Life Index (QOL), uroflowmetry maximum flow rate (Qmax), and uroflowmetry average flow rate (Qavg) before and after Rezūm™ were obtained. Independent two-sample T-tests were used to compare preoperative and postoperative characteristics between patients with and without an IPP. Linear regression was performed to identify factors associated with postoperative Qmax or Qavg. RESULTS A total of 17 patients with ED who underwent Rezūm™ were identified, including 11 patients with an IPP. The median follow-up after Rezūm™ was 65 days. There were no significant differences in baseline demographics and clinical characteristics between patients with and without an IPP. Postoperative Qmax (10.9 mL/s vs 9.8 mL/s, p = 0.04) and Qavg (7.5 mL/s vs 6.0 mL/s, p = 0.03) were significantly higher in patients with an IPP compared to patients without an IPP. There were no factors associated with postoperative Qmax or Qavg on linear regression. Two patients without an IPP went into urinary retention, while no complications occurred in IPP patients. CONCLUSION Rezūm™ is a safe and effective procedure to perform in ED patients, particularly those with an IPP. IPP patients may experience greater increase in uroflowmetry rate compared to ED patients without an IPP.
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Affiliation(s)
- Joshua S Jue
- Department of Urology, Lenox Hill Hospital, Northwell Health, Zucker School of Medicine at Hofstra/Northwell, New York, USA.
| | - Jean-Francois Eid
- Department of Urology, Lenox Hill Hospital, Northwell Health, Zucker School of Medicine at Hofstra/Northwell, New York, USA; Advanced Urological Care, PC, New York, USA
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Thomas AC, Muthucumaru M. Retrograde urethrogram - a novel approach to diagnosing a posterior urethral polyp in a neonate. Pediatr Radiol 2023; 53:558-560. [PMID: 36255454 DOI: 10.1007/s00247-022-05524-2] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Revised: 08/18/2022] [Accepted: 09/22/2022] [Indexed: 11/25/2022]
Abstract
We present a case of antenatally detected fetal megacystis caused by an obstructing posterior urethral polyp. Antenatal and postnatal ultrasounds showed bladder wall thickening and bilateral hydroureteronephrosis, most marked antenatally. A working diagnosis of posterior urethral valves was therefore made. However, further postnatal assessment with a micturating cystourethrogram (MCUG) combined with a retrograde urethrogram identified a pedunculated urethral polyp as the cause. The addition of a retrograde urethrogram as an adjunct to the MCUG in the diagnosis of posterior urethral polyp has not previously been reported, and in this case provided diagnostic confidence of this rare condition, allowing for definitive surgical planning.
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Affiliation(s)
- Ali C Thomas
- Department of Medical Imaging, Royal Hobart Hospital, 48 Liverpool Street, Hobart, Tas, 7007, Australia.
| | - Mathie Muthucumaru
- Department of Paediatric Surgery, Royal Hobart Hospital, Hobart, Australia
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Katz R, Ahmed MSA, Safadi A, Roizman S, Zisman A, Kabha M, Dekel Y, Baniel J, Aharony S. The Butterfly: A Novel Minimally Invasive Transurethral Retraction Device for Benign Hypertrophy of the Prostate. Urol Int 2023; 107:406-412. [PMID: 36720211 PMCID: PMC10129019 DOI: 10.1159/000528415] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [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: 05/08/2022] [Accepted: 11/22/2022] [Indexed: 02/02/2023]
Abstract
INTRODUCTION The Butterfly Prostatic Retraction device is a novel transurethral implant designed to dilate the prostatic urethra and treat lower urinary tract symptoms. We assessed its safety, efficacy and impact on urinary flow, ejaculation, and quality of life. MATERIALS AND METHODS We included 64 men, treated for benign prostate hyperplasia for at least 1 year. All patients had Qmax≤ 13 mL/s and IPSS >12. Insertion of the device was performed via cystoscopy. Follow-up visits were performed at 2 weeks, 1, 3, 6, and 12 months and included uroflowmetry, IPSS, QoL, and sexual function questionnaires. Cystoscopy was performed on 3 and 12 months. RESULTS Patients age was 50-83 years. 28 patients completed a 1-year follow-up with an intact device. Mean Qmax improved by 2 mL/s (25%), IPSS median drop was 10 points (40%), and QoL score was 1.5 points (38%). Sexually active patients reported antegrade ejaculation. On cystoscopy, gradual coverage of the devices with urethral mucosa was observed. In 1 patient, the device was repositioned. In 19 patients, the device was removed. 12 patients returned to alpha-blocker therapy and 7 patients underwent TURP. One patient developed a bulbar urethral stricture. CONCLUSIONS We demonstrated feasibility and good tolerability of the Butterfly device.
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Affiliation(s)
- Ran Katz
- Department of Urology, Ziv Medical Center, Azriell Faculty of Medicine, Bar Ilan University, Safed, Israel
| | - Muhamad Sabih Abu Ahmed
- Department of Urology, Ziv Medical Center, Azriell Faculty of Medicine, Bar Ilan University, Safed, Israel
| | - Ali Safadi
- Department of Urology, Ziv Medical Center, Azriell Faculty of Medicine, Bar Ilan University, Safed, Israel
| | - Shmuel Roizman
- Department of Urology, Shamir Medical Center, Tel Aviv University Faculty of Medicine, Zrifin, Israel
| | - Amnon Zisman
- Department of Urology, Shamir Medical Center, Tel Aviv University Faculty of Medicine, Zrifin, Israel
| | - Maharan Kabha
- Department of Urology, Carmel Medical Center, Technion Faculty of Medicine, Haifa, Israel
| | - Yoram Dekel
- Department of Urology, Carmel Medical Center, Technion Faculty of Medicine, Haifa, Israel
| | - Jack Baniel
- Department of Urology, Rabin Medical Center, Tel Aviv University Faculty of Medicine, Petach Tikva, Israel
| | - Shachar Aharony
- Department of Urology, Rabin Medical Center, Tel Aviv University Faculty of Medicine, Petach Tikva, Israel
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Ding Z, Wang H, Zhang W, Hu H, Wang Q, Xu K. Bladder wall thickness measured by CT can predict bladder outlet obstruction in men: a retrospective cohort study. Int Urol Nephrol 2023; 55:43-9. [PMID: 36103042 DOI: 10.1007/s11255-022-03361-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Accepted: 09/01/2022] [Indexed: 01/05/2023]
Abstract
PURPOSE To evaluate whether bladder wall thickness (BWT) measured by CT can be used to predict bladder outlet obstruction in men with low urinary tract symptoms (LUTS). METHODS From 2015 to 2018, a total of 120 men with lower urinary tract symptoms who underwent both urodynamic studies and CT tests of the lower abdomen or pelvis were involved. Bladder wall thickness values were measured by CT scanning. RESULTS Based on the urodynamic studies, 120 men were categorized into two groups, including 70/120 men (58.3%) in the bladder outlet obstruction (BOO) group and 50/120 men (41.7%) in the non-BOO group. The mean BWT was thicker in the BOO group than in the non-BOO group (3.87 vs. 2.75 mm, p < 0.001). The mean maximum bladder capacity (MBC) was lower in the BOO group than in the non-BOO group (263.42 vs. 308.96 ml, p < 0.001). The mean detrusor pressure at maximum urinary flow rate (PdetQmax) was higher in the patients in the BOO group than in those in the non-BOO group (102.28 vs. 49.25 cmH2O, p < 0.001). The ROC curve showed that BWT was a good predictor with an AUC of 0.855 (95% CI 0.785-0.924, p < 0.001). At the cutoff value of 3.20 mm, the predictive sensitivity of BWT for BOO was 72.9%, and the specificity was 90%. CONCLUSION Increased bladder wall thickness was correlated with bladder outlet obstruction in men with LUTS. Bladder wall thickness measured by CT scans may be a noninvasive parameter to predict bladder outlet obstruction in men with LUTS.
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Hashimoto M, Shimizu N, Fujimoto S, Kuwahara K, Nishimoto M, Adomi S, Banno E, Minami T, Fujita K, Yoshimura K, Hirayama A, Uemura H. The pressure flow study investigation of pathophysiology of post-micturition dribble in male patients. Int Urol Nephrol 2023; 55:69-74. [PMID: 36125621 DOI: 10.1007/s11255-022-03367-2] [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: 08/02/2022] [Accepted: 09/16/2022] [Indexed: 01/05/2023]
Abstract
PURPOSE In this study, we aimed to elucidate the pathophysiology of post-micturition dribble (PMD) through analyzing several variables including pressure flow study (PFS) findings and symptoms questionnaire. METHODS We retrospectively analyzed male patients who visited our department between 2010 and 2020. We used modified international prostate symptom score (m-IPSS), which consists of eight sub-score related to lower urinary tract symptoms (Incomplete Emptying, Frequency, Intermittency, Urgency, Weak Stream, Straining, Nocturia, and PMD) and one question related to quality of life (QOL). Multivariate regression analysis was conducted to evaluate the relationship between PMD and the variables, including age, prostate volume (PV), body mass index, bladder outlet obstruction index (BOOI), bladder contractility index, and bladder voiding efficiency, which were obtained by PFS. RESULTS A total of 143 male patients were analyzed. The patients with PMD showed significantly larger PV and higher BOOI, and worse IPSS total and QOL score than those without PMD. Multivariate regression analysis showed that large PV and BOOI were significantly associated with PMD. In Spearman's correlation analysis, PMD and each m-IPSS sub-score except nocturia had significant positive correlation. Furthermore, Spearman's correlation analysis showed that PMD and QOL had significant strong positive correlation. CONCLUSION PMD was significantly associated with large PV and BOO evaluated by PFS. Furthermore, PMD significantly exacerbated QOL. The severity of PMD and the other m-IPSS sub-score except nocturia could have intercorrelation with each other.
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Affiliation(s)
- Mamoru Hashimoto
- Department of Urology, Kindai University Faculty of Medicine, Osaka-Sayama, Osaka, Japan
| | - Nobutaka Shimizu
- Department of Pelvic Floor Center, Kochi Medical School, Kochi University, Nankoku, Kochi, 783-8505, Japan.
| | - Saizo Fujimoto
- Department of Urology, Kindai University Faculty of Medicine, Osaka-Sayama, Osaka, Japan
| | - Ken Kuwahara
- Department of Urology, Kindai University Faculty of Medicine, Osaka-Sayama, Osaka, Japan
| | - Mitsuhisa Nishimoto
- Department of Urology, Kindai University Faculty of Medicine, Osaka-Sayama, Osaka, Japan
| | - Shogo Adomi
- Department of Urology, Kindai University Faculty of Medicine, Osaka-Sayama, Osaka, Japan
| | - Eri Banno
- Department of Urology, Kindai University Faculty of Medicine, Osaka-Sayama, Osaka, Japan
| | - Takafumi Minami
- Department of Urology, Kindai University Faculty of Medicine, Osaka-Sayama, Osaka, Japan
| | - Kazutoshi Fujita
- Department of Urology, Kindai University Faculty of Medicine, Osaka-Sayama, Osaka, Japan
| | - Kazuhiro Yoshimura
- Department of Urology, Kindai University Faculty of Medicine, Osaka-Sayama, Osaka, Japan
| | - Akihide Hirayama
- Department of Urology, Nara Hospital Kindai University Faculty of Medicine, Ikoma, Nara, Japan
| | - Hirotsugu Uemura
- Department of Urology, Kindai University Faculty of Medicine, Osaka-Sayama, Osaka, Japan
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Zhu B, Gao J, Zhang Y, Liao B, Zhu S, Li C, Liao J, Liu J, Jiang C, Zeng J. CircRNA/miRNA/mRNA axis participates in the progression of partial bladder outlet obstruction. BMC Urol 2022; 22:191. [PMID: 36434693 PMCID: PMC9700926 DOI: 10.1186/s12894-022-01132-2] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2022] [Accepted: 10/25/2022] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND More and more evidence showed that circRNA/miRNA/mRNA axis played a vital role in the pathogenesis of some diseases. However, the role of circRNA/miRNA/mRNA axis in partial bladder outlet obstruction (pBOO) remains unknown. Our study aimed to explore the complex regulatory mechanism of circRNA/miRNA/mRNA axis in pBOO. METHODS The pBOO rat model was established, and the bladder tissues were collected for mRNA sequencing. The differentially expressed mRNAs were analyzed by high-throughput sequencing, and the GO and KEGG analysis of the differentially expressed mRNAs were performed. Competing endogenous RNAs (ceRNAs) analysis identified the potential regulation function of circRNA/miRNA/mRNA axis in pBOO. qRT-PCR detected the expression of circRNA/miRNA/mRNA. miRanda software was performed to predict the relationship between circRNA and miRNA, miRNA and mRNA. RESULTS Compared with the sham group, a total of 571 mRNAs were differentially expressed in the pBOO group, of which 286 were up-regulated and 285 were down-regulated. GO analysis showed that the mRNAs were mainly involved in cellular process, single-organism process, and cell, etc. KEGG analysis showed that the enriched signaling pathways were metabolic pathways, cell adhesion molecules (CAMs), and HTLV-I infection, etc. Based on the previous transcriptome data and differentially expressed circRNAs, we drew the ceRNA network regulation diagram. qRT-PCR results confirmed that chr3:113195876|113197193/rno-miR-30c-1-3p/Gata4, chr1:126188351|126195625/rno-miR-153-5p/Diaph3, and chr9:81258380|81275269/rno-miR-135b-5p/Pigr axis may have ceRNA function. miRanda confirmed there have the binding sites of circRNA/miRNA/mRNA axis. CONCLUSIONS CircRNA/miRNA/mRNA axis was involved in the progression of pBOO. Our research on the circRNA/miRNA/mRNA axis revealed new pathogenesis and treatment strategies for pBOO.
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Affiliation(s)
- Baoyi Zhu
- grid.410737.60000 0000 8653 1072Department of Urology, The Sixth Affiliated Hospital of Guangzhou Medical University (Qingyuan People’s Hospital), B24 Yinquan Road, Qingcheng, Qingyuan, 511500 Guangdong People’s Republic of China
| | - Jun Gao
- grid.410737.60000 0000 8653 1072Department of Basic Medical Research, The Sixth Affiliated Hospital of Guangzhou Medical University, Qingyuan, 511518 Guangdong People’s Republic of China
| | - Yuying Zhang
- Department of Child Health Care, Shenzhen Longhua Maternity and Child Health Care Hospital, Shenzhen, 518000 Guangdong People’s Republic of China
| | - Baojian Liao
- grid.410737.60000 0000 8653 1072Department of Urology, The Sixth Affiliated Hospital of Guangzhou Medical University (Qingyuan People’s Hospital), B24 Yinquan Road, Qingcheng, Qingyuan, 511500 Guangdong People’s Republic of China ,grid.9227.e0000000119573309Guangzhou Regenerative Medicine and Health Guangdong Laboratory, Guangdong Provincial Key Laboratory of Stem Cell and Regenerative Medicine, Guangzhou Institutes of Biomedicine and Health, Chinese Academy of Sciences, Guangzhou, 510700 Guangdong People’s Republic of China
| | - Sihua Zhu
- grid.410737.60000 0000 8653 1072Department of Urology, The Sixth Affiliated Hospital of Guangzhou Medical University (Qingyuan People’s Hospital), B24 Yinquan Road, Qingcheng, Qingyuan, 511500 Guangdong People’s Republic of China
| | - Chunling Li
- grid.410737.60000 0000 8653 1072Department of Urology, The Sixth Affiliated Hospital of Guangzhou Medical University (Qingyuan People’s Hospital), B24 Yinquan Road, Qingcheng, Qingyuan, 511500 Guangdong People’s Republic of China
| | - Junhao Liao
- grid.410737.60000 0000 8653 1072Department of Urology, The Sixth Affiliated Hospital of Guangzhou Medical University (Qingyuan People’s Hospital), B24 Yinquan Road, Qingcheng, Qingyuan, 511500 Guangdong People’s Republic of China
| | - Jianjia Liu
- grid.410737.60000 0000 8653 1072Department of Urology, The Sixth Affiliated Hospital of Guangzhou Medical University (Qingyuan People’s Hospital), B24 Yinquan Road, Qingcheng, Qingyuan, 511500 Guangdong People’s Republic of China
| | - Chonghe Jiang
- grid.410737.60000 0000 8653 1072Department of Urology, The Sixth Affiliated Hospital of Guangzhou Medical University (Qingyuan People’s Hospital), B24 Yinquan Road, Qingcheng, Qingyuan, 511500 Guangdong People’s Republic of China
| | - Jianwen Zeng
- grid.410737.60000 0000 8653 1072Department of Urology, The Sixth Affiliated Hospital of Guangzhou Medical University (Qingyuan People’s Hospital), B24 Yinquan Road, Qingcheng, Qingyuan, 511500 Guangdong People’s Republic of China
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Mitsogiannis I, Komninos C, Karakosta A, Papatsoris A, Skolarikos A, Tzelves L. "Glycogen deposition in the detrusor muscle of patients with bladder outlet obstruction (BOO) due to benign prostate hyperplasia (BPH); correlation with the urodynamic parameters.''. World J Urol 2022. [PMID: 36219231 DOI: 10.1007/s00345-022-04181-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Accepted: 10/06/2022] [Indexed: 10/17/2022] Open
Abstract
PURPOSE A prospective case-control study was conducted to evaluate glycogen deposition within the detrusor and its correlation with the urodynamic findings in patients with bladder outlet obstruction (BOO) due to benign prostate hyperplasia (BPH). MATERIAL AND METHODS Data from 50 patients with BPH (Study Group) and 20 controls (Control Group) were analyzed. BOO was confirmed by pressure-flow studies. The main outcome was glycogen deposition within the bladder wall. Bladder tissue biopsies were obtained from all patients, and histological assessment of the detrusor glycogen content was performed using Periodate Acid Schiff's (PAS) stain. The obtained glycogen score ranged from 0 (no staining of glycogen granules) to 3 (staining of glycogen granules within the detrusor adjacent to the urothelium). RESULTS Fifty patients and 20 controls were included. Increased glycogen deposition was observed in 37 (74%) and 2 (10%) patients in the Study and Control Group, respectively (p < 0.01, OR 25.6, 95% CI 5.2-125.8). In the subgroup analysis, no statistically significant difference was found between glycogen deposition score and IPSS, maximum detrusor pressure at maximum flow (PdetQmax) and duration of LUTS. In multivariate logistic regression, history of retention was the only variable which could predict high glycogen deposition (p = 0.019). CONCLUSIONS Our results demonstrate increased detrusor glycogen deposition in patients with BOO due to BPH, but the amount of deposition did not seem to correlate with symptom severity and duration or urodynamic findings.
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Cheng F, Watton PN, Pederzani G, Kurobe M, Takaoka EI, Chapple C, Birder L, Yoshimura N, Robertson AM. A constrained mixture-micturition-growth (CMMG) model of the urinary bladder: Application to partial bladder outlet obstruction (BOO). J Mech Behav Biomed Mater 2022; 134:105337. [PMID: 35863296 PMCID: PMC9835014 DOI: 10.1016/j.jmbbm.2022.105337] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Revised: 04/13/2022] [Accepted: 06/24/2022] [Indexed: 01/14/2023]
Abstract
We present a constrained mixture-micturition-growth (CMMG) model for the bladder. It simulates bladder mechanics, voiding function (micturition) and tissue adaptations in response to altered biomechanical conditions. The CMMG model is calibrated with both in vivo and in vitro data from healthy male rat urinary bladders (cystometry, bioimaging of wall structure, mechanical testing) and applied to simulate the growth and remodeling (G&R) response to partial bladder outlet obstruction (BOO). The bladder wall is represented as a multi-layered, anisotropic, nonlinear constrained mixture. A short time scale micturition component of the CMMG model accounts for the active and passive mechanics of voiding. Over a second, longer time scale, G&R algorithms for the evolution of both cellular and extracellular constituents act to maintain/restore bladder (homeostatic) functionality. The CMMG model is applied to a spherical membrane model of the BOO bladder utilizing temporal data from an experimental male rodent model to parameterize and then verify the model. Consistent with the experimental studies of BOO, the model predicts: an initial loss of voiding capacity followed by hypertrophy of SMC to restore voiding function; bladder enlargement; collagen remodeling to maintain its role as a protective sheath; and increased voiding duration with lower average flow rate. This CMMG model enables a mechanistic approach for investigating the bladder's structure-function relationship and its adaption in pathological conditions. While the approach is illustrated with a conceptual spherical bladder model, it provides the basis for application of the CMMG model to anatomical geometries. Such a mechanistic approach has promise as an in silico tool for the rational development of new surgical and pharmacological treatments for bladder diseases such as BOO.
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Affiliation(s)
- Fangzhou Cheng
- Department of Mechanical Engineering and Materials Science, University of Pittsburgh, Pittsburgh, United States
| | - Paul N Watton
- Department of Mechanical Engineering and Materials Science, University of Pittsburgh, Pittsburgh, United States; Department of Computer Science & Insigneo Institute for in silico Medicine, University of Sheffield, Sheffield, United Kingdom.
| | - Giulia Pederzani
- Department of Computer Science & Insigneo Institute for in silico Medicine, University of Sheffield, Sheffield, United Kingdom
| | - Masahiro Kurobe
- Department of Urology, University of Pittsburgh, Pittsburgh, United States
| | - Ei-Ichiro Takaoka
- Department of Urology, University of Pittsburgh, Pittsburgh, United States
| | - Chris Chapple
- Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, United Kingdom
| | - Lori Birder
- Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, United Kingdom; Department of Medicine, University of Pittsburgh, United States
| | - Naoki Yoshimura
- Department of Urology, University of Pittsburgh, Pittsburgh, United States
| | - Anne M Robertson
- Department of Mechanical Engineering and Materials Science, University of Pittsburgh, Pittsburgh, United States
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Peyronnet B, Lapitan MC, Tzelves L, O'Connor E, Nic An Riogh A, Manso M, Yuhong Yuan C, Arlandis S, Bo K, Costantini E, Farag F, Groen J, Nambiar A, Phé V, van der Vaart H, Imran Omar M, Harding C. Benefits and Harms of Conservative, Pharmacological, and Surgical Management Options for Women with Bladder Outlet Obstruction: A Systematic Review from the European Association of Urology Non-neurogenic Female LUTS Guidelines Panel. Eur Urol Focus 2022; 8:1340-1361. [PMID: 34702649 DOI: 10.1016/j.euf.2021.10.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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: 07/15/2021] [Revised: 09/11/2021] [Accepted: 10/05/2021] [Indexed: 12/16/2022]
Abstract
CONTEXT While the management of bladder outlet obstruction (BOO) in men has been a topic of several systematic reviews and meta-analyses, no such evidence base exists for female BOO. OBJECTIVE The aim of this systematic review was to evaluate the benefits and harms of therapeutic interventions for the management of BOO in women. EVIDENCE ACQUISITION This systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) statement. The study protocol was registered with PROSPERO (CRD42020183839). A systematic literature search was performed and updated by a research librarian in May 2021. The study population consisted of adult female patients diagnosed with BOO, who underwent treatment. EVIDENCE SYNTHESIS Out of 6344 records, we identified 33 studies enrolling 1222 participants, of which only six randomized controlled trials (RCTs) were found. One placebo-controlled crossover randomized trial assessed the role of baclofen in 60 female patients with dysfunctional voiding. The trial met its primary endpoint with a significantly greater decrease in the number of voids per day in the baclofen group (-5.53 vs -2.70; p = 0.001). The adverse events were mild and comparable in both groups (25% vs 20%). One placebo-controlled crossover randomized trial assessed the role of sildenafil in 20 women with Fowler's syndrome. There were significant improvements from baseline in maximum urinary flow rate (Qmax), International Prostate Symptom Score (IPSS), and postvoid residual (PVR), but with no statistically significant difference when compared with placebo. In a large RCT including 197 female patients with functional BOO, the alpha-blocker alfuzosin significantly improved IPSS, Qmax, and PVR compared with baseline, but the differences were not statistically significant compared with the placebo group. Several small single-arm prospective series reported improvement of BOO-related symptoms and voiding parameters with urethroplasty, sling revision, urethral dilation, vaginal pessary, and pelvic organ prolapse repair. CONCLUSIONS Evidence to support the use of conservative, pharmacological, and surgical treatments for BOO is scarce. PATIENT SUMMARY According to the present systematic review of the literature, evidence to support the use of conservative, pharmacological, and surgical treatments for either anatomical or functional bladder outlet obstruction is scarce.
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Affiliation(s)
| | | | - Lazaros Tzelves
- Sismanoglio General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | | | | | | | - Cathy Yuhong Yuan
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | | | - Kari Bo
- Norwegian School of Sport Sciences, Department of Sports Medicine, Oslo and Akershus University Hospital, Lørenskog, Norway
| | | | | | - Jan Groen
- Erasmus Medical Center, Rotterdam, The Netherlands
| | | | - Véronique Phé
- Department of Urology, Assistance Publique-Hôpitaux de Paris, Pitié-Salpetrière Academic Hospital, Sorbonne University, Paris, France
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Long Depaquit T, Michel F, Gaillet S, Savoie PH, Karsenty G. [Home uroflowmetry technics and clinical relevance: A narrative review]. Prog Urol 2022; 32:1531-1542. [PMID: 35961806 DOI: 10.1016/j.purol.2022.07.142] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Revised: 06/12/2022] [Accepted: 07/10/2022] [Indexed: 11/15/2022]
Abstract
INTRODUCTION Urine flowmetry (UF) is a key non-invasive urodynamic test for the evaluation of the voiding phase in patients with lower urinary tract symptoms (LUTS). Traditional free urodynamic testing (FUT) performed on a one-time basis in the office is limited by difficulty in capturing normal voiding and high intrapatient variability in urine flow parameters. Home measurement of urine flow by the patient could be a way to obtain multiple data in real-life conditions, addressing its limitations. The objective of this article was to review the literature on the different techniques of home uroflowmetry (HUF) and their clinical interest in comparison with FUT. MATERIAL AND METHODS A search on the PubMed database using the key words "Urodynamics, Uroflowmetry, non-invasive urodynamics, Ambulatory urodynamics, bladder outlet obstruction, male LUTS" was performed to find articles in English or French that had been published with no time limit and March 2022. The sorting by reading the abstract allowed the selection of all articles describing and/or evaluating a HUF technique that were read entirely according to the same collection grid to propose a narrative synthesis. RESULTS Thirty-one articles were identified, selected, and analyzed. Simple and inexpensive techniques by timing or use of funnels reliably and reproducibly estimate the average and maximum urine flow in relation to the FUT, without providing a complete flow curve. More sophisticated electronic or sonometric methods, some using connected mobile applications, present results that are more consistent with ICS recommendations for flow measurement. With the possibility of studying the average of several values of the maximum urinary flow (Qmax) captured during micturition in physiological conditions, some studies suggest a gain in diagnostic value in the evaluation of the emptying phase and lower urinary tract symptoms in men. However, the literature is sparse, old and the clinical benefits are not yet proven. CONCLUSION There is a wide range of techniques for measuring urine flow in the patient's home, all of which aim to fill the gaps in conventional urine flow measurement. Further studies are needed to demonstrate the acceptability of this type of measurement by patients, the existence of a real clinical benefit, to assess the cost/benefit balance and finally to define a possible place for home uroflowmetry in daily practice, compared with traditional free flowmetry and invasive urodynamics (pressure-flow test).
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Affiliation(s)
- T Long Depaquit
- Service d'urologie, HIA Sainte-Anne, 2 boulevard Sainte-Anne BP600, 83000 Toulon, France; Service d'urologie et de transplantation rénale, hôpital de La Conception, AP-HM, Marseille, France; Aix-Marseille université, Marseille, France.
| | - F Michel
- Service d'urologie et de transplantation rénale, hôpital de La Conception, AP-HM, Marseille, France; Aix-Marseille université, Marseille, France
| | - S Gaillet
- Service d'urologie et de transplantation rénale, hôpital de La Conception, AP-HM, Marseille, France
| | - P-H Savoie
- Service d'urologie, HIA Sainte-Anne, 2 boulevard Sainte-Anne BP600, 83000 Toulon, France
| | - G Karsenty
- Service d'urologie et de transplantation rénale, hôpital de La Conception, AP-HM, Marseille, France; Aix-Marseille université, Marseille, France
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Yu WR, Chang WC, Kuo HC. Clinical presentation, videourodynamic characteristics, and treatment outcome in men with interstitial cystitis-like lower urinary tract symptoms. Int Urol Nephrol 2022; 54:2157-2165. [PMID: 35804206 DOI: 10.1007/s11255-022-03294-2] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Accepted: 06/29/2022] [Indexed: 11/25/2022]
Abstract
PURPOSE In men, lower urinary tract symptoms (LUTS) similar to interstitial cystitis/bladder pain syndrome (IC/BPS) are difficult to diagnose, and treatment outcomes are poor. This study investigated clinical characteristics and videourodynamic study (VUDS) parameters, pathophysiology, and treatment outcomes in men with IC-like LUTS. METHODS Men with frequency, urgency, dysuria, and bladder pain initially diagnosed as IC/BPS by ESSIC criteria were assessed to rule out other lower urinary tract diseases (LUTD) by voiding diary, digitorectal examination, urinalysis, VUDS, and cystoscopic hydrodistention. Subsequent treatments for LUTD and specific treatment for IC/BPS were based on VUDS and cystoscopic findings. Clinical VUDS characteristics and treatment outcomes were compared with those of women with IC/BPS. RESULTS Seventy consecutive men (median age 54.5 years) were enrolled. The median maximum bladder capacity under cystoscopic hydrodistention was 650 mL (IQR 495-763) and glomerulation grade was 2 (1.0-2.0). The patients had moderate anxiety and depression severity; 49% had improved treatment outcomes. On VUDS, 42 (60%) patients had variable LUTD, including detrusor overactivity (n = 14), bladder neck dysfunction (n = 15), dysfunctional voiding (n = 3), and poor relaxation of the external sphincter (n = 24); also, 22 (31.4%) had a previous bladder outlet procedure. The self-reported treatment outcome was significantly better for patients with vs. without LUTD (p = 0.014). CONCLUSIONS Men with IC-like LUTS diagnosed as IC/BPS may have bladder outlet dysfunction as well as bladder dysfunction, causing a hypersensitive and painful bladder. The IC-like symptoms in the patients with LUTD might, in part, originated from bladder outlet dysfunction rather than the bladder alone.
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Affiliation(s)
- Wan-Ru Yu
- Department of Nursing, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan
| | - Wei-Chuan Chang
- Department of Medical Research, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan
| | - Hann-Chorng Kuo
- Department of Urology, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation and Tzu Chi University, 707, Section 3, Chung Yang Road, Hualien, Taiwan.
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Riccetto CLZ, Achermann APP, Selegatto IB, Gon LM. Double opposite tape incision for obstructive sling. Int Urogynecol J 2022; 33:2315-2316. [PMID: 35403882 DOI: 10.1007/s00192-022-05180-y] [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: 02/12/2022] [Accepted: 03/26/2022] [Indexed: 10/18/2022]
Abstract
INTRODUCTION AND HYPOTHESIS Stress urinary incontinence affects about 34% of all adult women. The mid-urethral sling (MUS), considered the gold-standard treatment, has widespread use but also potential complications. This study aims to demonstrate a new surgical technique that releases urethral obstruction caused by MUS with urinary continence maintenance. METHODS This video presents a 43-year-old patient with acute urinary retention after a suburethral sling procedure treated with a double opposite tape incision through a "U"-shaped inverted incision at the anterior vaginal wall. RESULTS The patient resumed her usual activities 1 week later with urinary continence. After 6 weeks, she was allowed to resume physical activities and sexual intercourse. At 3-month follow-up, she is still satisfied without urine leakage recurrence. CONCLUSIONS The double opposite tape incision is feasible and effective for urethral loosening after the MUS procedure. Concerned that this is a unique case, further studies are required to compare this technique to other surgical treatment options.
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Affiliation(s)
- Cássio L Z Riccetto
- Urology Division, Department of Surgery, University of Campinas Faculty of Medical Sciences - UNICAMP, Campinas, SP, Brazil.
| | - Arnold Peter Paul Achermann
- Urology Division, Department of Surgery, University of Campinas Faculty of Medical Sciences - UNICAMP, Campinas, SP, Brazil.,Post-graduate Program in Surgical Sciences, University of Campinas, UNICAMP, Campinas, Brazil.,Urocore - Centro de Urologia e Fisioterapia Pélvica, Londrina, PR, Brazil
| | - Ivan B Selegatto
- Urology Division, Department of Surgery, University of Campinas Faculty of Medical Sciences - UNICAMP, Campinas, SP, Brazil
| | - Lucas Mira Gon
- Urology Division, Department of Surgery, University of Campinas Faculty of Medical Sciences - UNICAMP, Campinas, SP, Brazil
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Arlandis S, Bø K, Cobussen-Boekhorst H, Costantini E, de Heide M, Farag F, Groen J, Karavitakis M, Lapitan MC, Manso M, Arteaga SM, Nambiar AK, Riogh ANA, O'Connor E, Omar MI, Peyronnet B, Phé V, Sakalis VI, Sihra N, Tzelves L, van Poelgeest-Pomfret ML, van den Bos TWL, van der Vaart H, Harding CK. European Association of Urology Guidelines on the Management of Female Non-neurogenic Lower Urinary Tract Symptoms. Part 2: Underactive Bladder, Bladder Outlet Obstruction, and Nocturia. Eur Urol 2022; 82:60-70. [PMID: 35181193 DOI: 10.1016/j.eururo.2022.01.044] [Citation(s) in RCA: 2] [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: 01/16/2022] [Accepted: 01/26/2022] [Indexed: 12/24/2022]
Abstract
CONTEXT Female lower urinary tract symptoms (LUTS) are a common presentation in urological practice. Thus far, only a limited number of female LUTS conditions have been included in the European Association of Urology (EAU) guidelines compendium. The new non-neurogenic female LUTS guidelines expand the remit to include these symptoms and conditions. OBJECTIVE To summarise the management of underactive bladder (UAB), bladder outlet obstruction (BOO), and nocturia in females. EVIDENCE ACQUISITION The literature search was updated in September 2021 and evidence synthesis was conducted using modified GRADE approach as outlined for all EAU guidelines. A new systematic review on BOO was carried out by the panel for purposes of this guideline. EVIDENCE SYNTHESIS The important considerations for informing guideline recommendations are presented, along with a summary of all the guideline recommendations. CONCLUSIONS Non-neurogenic female LUTS are an important presentation of urological dysfunction. Initial evaluation, diagnosis, and management should be carried out in a structured and logical fashion on the basis of the best available evidence. This guideline serves to present this evidence to practising urologists and other health care providers in an easily accessible and digestible format. PATIENT SUMMARY This report summarises the main recommendations from the European Association of Urology guideline on symptoms and diseases of the female lower urinary tract (bladder and urethra) not associated with neurological disease. We cover recommendations related to the treatment of underactive bladder, obstruction of the bladder outlet, and nighttime urination.
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Affiliation(s)
- Salvador Arlandis
- Urology Department, La Fe University and Polytechnic Hospital, Valencia, Spain.
| | - Kari Bø
- Department of Sports Medicine, Norwegian School of Sport Sciences, Oslo, Norway
| | | | | | | | - Fawzy Farag
- Department of Urology, Sohag University Hospital, Sohag, Egypt; Department of Urology, East Suffolk and North Essex NHS Foundation Trust, Ipswich, UK
| | - Jan Groen
- Department of Urology, Erasmus Medical Center, Rotterdam, The Netherlands
| | | | - Marie Carmela Lapitan
- College of Medicine, Philippine General Hospital, National Institutes of Health, University of the Philippines Manila, Manila, Philippines
| | - Margarida Manso
- Department of Urology, Centro Hospitalar Universitário São João, Porto, Portugal
| | | | - Arjun K Nambiar
- Department of Urology, Freeman Hospital, Newcastle-upon-Tyne, UK
| | | | | | | | - Benoit Peyronnet
- European Association of Urology, Arnhem, The Netherlands; Department of Urology, University of Rennes, Rennes, France
| | - Veronique Phé
- Department of Urology, AP-HP, Pitié-Salpêtrière Academic Hospital, Sorbonne University, Paris, France
| | - Vasileios I Sakalis
- Department of Urology, Agios Pavlos General Hospital of Thessaloniki, Thessaloniki, Greece
| | - Néha Sihra
- Department of Urology, Guy's and St. Thomas' NHS Foundation Trust, London, UK
| | - Lazaros Tzelves
- Second Department of Urology, National and Kapodistrian University of Athens, Sismanogleio General Hospital, Athens, Greece
| | | | | | - Huub van der Vaart
- Department of Obstetrics and Gynecology, University Medical Center, Utrecht, The Netherlands
| | - Christopher K Harding
- Department of Urology, Freeman Hospital, Newcastle-upon-Tyne, UK; Translational and Clinical Research Institute, Newcastle University, Newcastle-upon-Tyne, UK
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Liu J, Zhou L, Zhao F, Zhou C, Yang T, Xu Z, Wang X, Xu L, Xu Z, Ge Y, Wu R, Jia R. Therapeutic effect of adipose stromal vascular fraction spheroids for partial bladder outlet obstruction induced underactive bladder. Stem Cell Res Ther 2022; 13:68. [PMID: 35139904 PMCID: PMC8826668 DOI: 10.1186/s13287-022-02739-w] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Accepted: 01/23/2022] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Underactive bladder (UAB) is a common clinical problem but related research is rarely explored. As there are currently no effective therapies, the administration of adipose stromal vascular fraction (ad-SVF) provides a new potential method to treat underactive bladder. METHODS Male Sprague-Dawley rats were induced by partial bladder outlet obstruction (PBOO) for four weeks and randomly divided into three groups: rats treated with PBS (Sham group); rats administrated with ad-SVF (ad-SVF group) and rats performed with ad-SVF spheroids (ad-SVFsp group). After four weeks, urodynamic studies were performed to evaluate bladder functions and all rats were sacrificed for further studies. RESULTS We observed that the bladder functions and symptoms of UAB were significantly improved in the ad-SVFsp group than that in the Sham group and ad-SVF group. Meanwhile, our data showed that ad-SVF spheroids could remarkably promote angiogenesis, suppress cell apoptosis and stimulate cell proliferation in bladder tissue than that in the other two groups. Moreover, ad-SVF spheroids increased the expression levels of bFGF, HGF and VEGF-A than ad-SVF. IVIS Spectrum small-animal in vivo imaging system revealed that ad-SVF spheroids could increase the retention rate of transplanted cells in bladder tissue. CONCLUSIONS Ad-SVF spheroids improved functions and symptoms of bladder induced by PBOO, which contributes to promote angiogenesis, suppress cell apoptosis and stimulate cell proliferation. Ad-SVF spheroids provide a potential treatment for the future patients with UAB.
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Affiliation(s)
- Jingyu Liu
- Department of Urology, Nanjing First Hospital, Nanjing Medical University, No. 68 Changle Road, Nanjing, 210006, Jiangsu, People's Republic of China
| | - Liuhua Zhou
- Department of Urology, Nanjing First Hospital, Nanjing Medical University, No. 68 Changle Road, Nanjing, 210006, Jiangsu, People's Republic of China
| | - Feng Zhao
- Department of Urology, Nanjing First Hospital, Nanjing Medical University, No. 68 Changle Road, Nanjing, 210006, Jiangsu, People's Republic of China
| | - Changcheng Zhou
- Department of Urology, Nanjing First Hospital, Nanjing Medical University, No. 68 Changle Road, Nanjing, 210006, Jiangsu, People's Republic of China
| | - Tianli Yang
- Department of Urology, Nanjing First Hospital, Nanjing Medical University, No. 68 Changle Road, Nanjing, 210006, Jiangsu, People's Republic of China
| | - Zhongle Xu
- Department of Urology, Hefei Hospital Affiliated to Anhui Medical University (The Second People's Hospital of Hefei), Hefei, Anhui, People's Republic of China
| | - Xinning Wang
- Department of Urology, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, People's Republic of China
| | - Luwei Xu
- Department of Urology, Nanjing First Hospital, Nanjing Medical University, No. 68 Changle Road, Nanjing, 210006, Jiangsu, People's Republic of China
| | - Zheng Xu
- Department of Urology, Nanjing First Hospital, Nanjing Medical University, No. 68 Changle Road, Nanjing, 210006, Jiangsu, People's Republic of China
| | - Yuzheng Ge
- Department of Urology, Nanjing First Hospital, Nanjing Medical University, No. 68 Changle Road, Nanjing, 210006, Jiangsu, People's Republic of China
| | - Ran Wu
- Department of Urology, Nanjing First Hospital, Nanjing Medical University, No. 68 Changle Road, Nanjing, 210006, Jiangsu, People's Republic of China
| | - Ruipeng Jia
- Department of Urology, Nanjing First Hospital, Nanjing Medical University, No. 68 Changle Road, Nanjing, 210006, Jiangsu, People's Republic of China.
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Chen YZ, Peng L, Zhang C, Xu S, Luo DY. Bladder Sonomorphological Tests in Diagnosing Bladder Outlet Obstruction in Patients with Lower Urinary Tract Symptoms: A Systematic Review and Meta-Analysis. Urol Int 2021; 107:327-335. [PMID: 34903702 DOI: 10.1159/000519102] [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: 05/28/2021] [Accepted: 08/02/2021] [Indexed: 02/05/2023]
Abstract
AIMS We aimed to investigate the accuracy of bladder sonomorphological parameters including detrusor wall thickness (DWT) and ultrasound-estimated bladder weight (UEBW) for diagnosing bladder outlet obstruction (BOO) in patients with lower urinary tract symptoms (LUTS). METHODS A comprehensive search was conducted through databases including PubMed, EMBASE, MEDLINE, Cochrane Library, Medicine, China Knowledge Network (CNKI), China Biomedical Literature Database, Wanfang Database, the Chongqing VIP Chinese Science, and Technology Periodical Database (VIP) to select studies assessing the diagnostic accuracy of DWT and UEBW to diagnose BOO in adults with LUTS. Databases were searched from inception to 2020 without restriction. Study quality was assessed using Quality Assessment of Diagnostic Accuracy Studies-2 (QUADAS-2), and measures of accuracy were calculated using random-effects model. RESULTS The initial search included 84 publications, of which 78 publications were screened, and 16 studies with 1,847 patients finally contained diagnostic data. The results from 10 out of 16 studies assessing DWT showed a pooled sensitivity (SSY) of 0.68 (95% CI, 0.56-0.78) and specificity (SPY) of 0.91 (95% CI, 0.82-0.96) with I2 values of 93%, while 6 studies evaluating UEBW were analyzed with a SSY of 0.88 (95% CI, 0.78-0.93) and SPY of 0.81 (95% CI, 0.67-0.90) with I2 values of 83%. CONCLUSIONS DWT shows high SPY, and UEBW performs high SSY of diagnosing BOO. Further well-designed studies are needed to evaluate the utilization of DWT and UEBW for the diagnosis of BOO.
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Affiliation(s)
- Yuan-Zhuo Chen
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, China
| | - Liao Peng
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, China
| | - Chi Zhang
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, China
| | - Shuai Xu
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, China
| | - De-Yi Luo
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, China
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Tan YG, Teo JS, Kuo TLC, Guo L, Shi L, Shutchaidat V, Aslim EJ, Ng LG, Ho HSS, Foo KT. A Systemic Review and Meta-analysis of Transabdominal Intravesical Prostatic Protrusion Assessment in Determining Bladder Outlet Obstruction and Unsuccessful Trial Without Catheter. Eur Urol Focus 2021; 8:1003-1014. [PMID: 34561198 DOI: 10.1016/j.euf.2021.09.016] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2021] [Revised: 08/09/2021] [Accepted: 09/13/2021] [Indexed: 11/18/2022]
Abstract
CONTEXT Urodynamic study (UDS) provides the most objective assessment of bladder outlet obstruction (BOO) but is impractical to be recommended routinely in outpatient services. Intravesical prostatic protrusion (IPP) had been described to obstruct urinary flow by creating an anatomical ball-valve effect, but there remains a lack of pooled evidence that can objectively correlate with BOO in benign prostatic hyperplasia. OBJECTIVE To update the current evidence on the predictive role of IPP in determining BOO and unsuccessful trial without catheter (TWOC). EVIDENCE ACQUISITION A comprehensive literature search was performed to identify studies that evaluated IPP in diagnosing UDS-determined BOO and TWOC. The search included the PubMed/MEDLINE, EMBASE, and Cochrane Library up to January 2021. An updated systemic review and meta-analysis was performed. EVIDENCE SYNTHESIS A total of 18 studies with 4128 patients were examined. Eleven studies with 1478 patients examined the role of IPP in UDS-determined BOO. The pooled area under the curve (AUC) was 0.83 (95% confidence interval [CI]: 0.79-0.86), and at a cut-off of >10 mm, the sensitivity (Sn) and specificity (Sp) were 0.71 (95% CI: 0.61-0.78) and 0.77 (95% CI: 0.68-0.84), respectively. The probability-modifying plot revealed positive and negative likelihood ratios of 3.34 (95% CI: 2.56-4.36) and 0.35 (95% CI: 0.26-0.45), respectively. Seven studies with 2650 patients examined IPP in predicting unsuccessful TWOC, with a pooled AUC of 0.74 (95% CI: 0.70-0.84), with Sn of 0.51 (95% CI: 0.43-0.60) and Sp of 0.79 (95% CI: 0.73-0.84) at an IPP cut-off of >10 mm. Five studies compared prostate volume (PV) and IPP and revealed a lower AUC of PV at 0.71 (95% CI: 0.67-0.75), which was an inferior parameter in diagnosing BOO (p < 0.001). CONCLUSIONS This systemic review provided evidence that IPP is a reliable clinical parameter that correlates strongly with underlying BOO and unsuccessful TWOC. PATIENT SUMMARY In this review, we comprehensively reviewed all the literature to date on evaluating the clinical utility of intravesical prostatic protrusion (IPP). We have demonstrated that IPP correlates strongly with urodynamic study (UDS)-determined bladder outlet obstruction and failure of trial without catheter (TWOC). Outpatient IPP measurement is a quick, inexpensive, and reproducible clinical parameter that can determine the severity of benign prostatic hyperplasia. The clinical role of IPP in predicting failure of TWOC selects patients who are best treated with aggressive surgical approaches rather than conservative medical therapies. More importantly, IPP can facilitate the discriminatory use of invasive UDS, reserved for patients with a strong suspicion of concomitant detrusor abnormalities.
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Affiliation(s)
- Yu Guang Tan
- Department of Urology, Singapore General Hospital, Singapore.
| | | | | | - Liang Guo
- Singapore Clinical Research Institute, Consortium for Clinical Research and Innovation, Singapore; Cochrane, Singapore
| | - Luming Shi
- Singapore Clinical Research Institute, Consortium for Clinical Research and Innovation, Singapore; Cochrane, Singapore; Duke-NUS Medical School, Singapore
| | | | | | - Lay Guat Ng
- Department of Urology, Singapore General Hospital, Singapore
| | | | - Keong Tatt Foo
- Department of Urology, Singapore General Hospital, Singapore
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Pang KH, Campi R, Arlandis S, Bo K, Chapple CR, Costantini E, Farag F, Groen J, Karavitakis M, Lapitan MC, Manso M, Monagas Arteaga S, Nambiar AK, Nic An Ríogh AU, O'Connor EM, Osman NI, Peyronnet B, Phé V, Sakalis VI, Sihra N, Tzelves L, van der Vaart H, Yuan Y, Omar MI, Harding CK. Diagnostic Tests for Female Bladder Outlet Obstruction: A Systematic Review from the European Association of Urology Non-neurogenic Female LUTS Guidelines Panel. Eur Urol Focus 2021; 8:1015-1030. [PMID: 34538750 DOI: 10.1016/j.euf.2021.09.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [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: 07/20/2021] [Revised: 08/09/2021] [Accepted: 09/07/2021] [Indexed: 02/01/2023]
Abstract
CONTEXT Female bladder outlet obstruction (fBOO) is a relatively uncommon condition compared with its male counterpart. Several criteria have been proposed to define fBOO, but the comparative diagnostic accuracy of these remains uncertain. OBJECTIVE To identify and compare different tests to diagnose fBOO through a systematic review process. EVIDENCE ACQUISITION A systematic review of the literature was performed according to the Cochrane Handbook and Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) checklist. The EMBASE/MEDLINE/Cochrane databases were searched up to August 4, 2020. Studies on women ≥18 yr of age with suspected bladder outlet obstruction (BOO) involving diagnostic tests were included. Pressure-flow studies or fluoroscopy was used as the reference standard where possible. Two reviewers independently screened all articles, searched reference lists of retrieved articles, and performed data extraction. The risk of bias was assessed using Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2). EVIDENCE SYNTHESIS Overall, 28 nonrandomised studies involving 10 248 patients were included in the qualitative analysis. There was significant heterogeneity regarding the characteristics of women included in BOO cohorts (ie, mixed cohorts including both anatomical and functional BOO). Pressure-flow studies ± fluoroscopy was evaluated in 25 studies. Transperineal Doppler ultrasound was used to evaluate bladder neck dynamics in two studies. One study tested the efficacy of transvaginal ultrasound. The urodynamic definition of fBOO also varied amongst studies with different parameters and thresholds used, which precluded a meta-analysis. Three studies derived nomograms using the maximum flow rate (Qmax) and voiding detrusor pressure at Qmax. The sensitivity, specificity, and overall accuracy ranges were 54.6-92.5%, 64.6-93.9%, and 64.1-92.2%, respectively. CONCLUSIONS The available evidence on diagnostic tests for fBOO is limited and heterogeneous. Pressure-flow studies ± fluoroscopy remains the current standard for diagnosing fBOO. PATIENT SUMMARY Evidence on tests used to diagnose female bladder outlet obstruction was reviewed. The most common test used was pressure-flow studies ± fluoroscopy, which remains the current standard for diagnosing bladder outlet obstruction in women. TAKE HOME MESSAGE: The available evidence on diagnostic tests for female bladder outlet obstruction is limited and heterogeneous. The most common test used was video-urodynamics, which remains the current standard for diagnosing bladder outlet obstruction in women.
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Affiliation(s)
- Karl H Pang
- Academic Urology Unit, University of Sheffield, Sheffield, UK
| | - Riccardo Campi
- Unit of Urological Robotic Surgery and Renal Transplantation, University of Florence, Careggi Hospital, Florence, Italy; Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Salvador Arlandis
- Urology Department, La Fe University and Polytechnic Hospital, Valencia, Spain
| | - Kari Bo
- Department of Sports Medicine, Norwegian School of Sport Sciences, Oslo, Norway
| | - Christopher R Chapple
- Section of Functional and Reconstructive Urology, Department of Urology, Royal Hallamshire Hospital, University of Sheffield, Sheffield, UK
| | | | - Fawzy Farag
- Department of Urology, Sohag University Hospital, Sohag, Egypt; Department of Urology, East Suffolk and North Essex NHS Foundation Trust, UK
| | - Jan Groen
- Department of Urology, Erasmus MC, Rotterdam, The Netherlands
| | - Markos Karavitakis
- Department of Urology, University General Hospital of Heraklion, Medical School, University of Crete, Heraklion, Crete, Greece
| | - Marie Carmela Lapitan
- College of Medicine/Philippine General Hospital/National institutes of Health, University of the Philippines Manila, Manila, Philippines
| | - Margarida Manso
- Department of Urology, São João University Hospital Center, Porto, Portugal; Faculty of Medicine of Porto, Porto, Portugal
| | | | - Arjun K Nambiar
- Department of Urology, Freeman Hospital, Newcastle-upon-Tyne, UK
| | | | | | - Nadir I Osman
- Section of Functional and Reconstructive Urology, Department of Urology, Royal Hallamshire Hospital, University of Sheffield, Sheffield, UK
| | | | - Véronique Phé
- Department of Urology, Assistance Publique-Hôpitaux de Paris, Pitié-Salpêtrière Academic Hospital, Sorbonne University, Paris, France
| | - Vasileios I Sakalis
- Department of Urology, Agios Pavlos General Hospital of Thessaloniki, Thessaloniki, Greece
| | - Néha Sihra
- Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Lazaros Tzelves
- Second Department of Urology, National and Kapodistrian University of Athens, Sismanogleio General Hospital, Athens, Greece
| | - Huub van der Vaart
- Division Woman & Baby, University Medical Center Utrecht, Utrecht, The Netherlands; Bergman Clinics Women's Health, The Netherlands
| | - Yuhong Yuan
- Division of Gastroenterology, Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Muhammad Imran Omar
- University of Aberdeen, Aberdeen, UK; European Association of Urology, Arnhem, The Netherlands.
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Righetto M, Mancini M, Modonutti D, Calpista A, Beltrami P, Dal Moro F. Patients with renal transplant and moderate-to-severe LUTS benefit from urodynamic evaluation and early transurethral resection of the prostate. World J Urol 2021; 39:4397-4404. [PMID: 34480590 PMCID: PMC8602205 DOI: 10.1007/s00345-021-03799-y] [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: 03/26/2021] [Accepted: 08/02/2021] [Indexed: 11/28/2022] Open
Abstract
Purpose To assess long-term renal function and micturition pattern of males submitted to transurethral resection of the prostate (TURP) for moderate-to-severe lower urinary tract symptoms (LUTS) after renal transplantation (RT). To investigate the role of clinical and urodynamic (UD) parameters for bladder outlet obstruction (BOO) diagnosis in these patients. Methods Retrospective data analysis of ≥ 50 years old patients who underwent RT between 01/2005 and 12/2016. Patients with moderate-to-severe LUTS after RT who underwent a urologic evaluation and a UD study were included. TURP was performed in case of BOO diagnosis. Kidney function and micturition patterns were evaluated before, 3, 12, 24, 36, and 48 months after TURP. Predictors of BOO were assessed at univariable and multivariable logistic regression models. Statistical analysis was performed with STATA16. Results 233 male patients ≥ 50 years underwent RT. 71/233 (30%) patients developed voiding LUTS. 52/71 (73%) patients with moderate-to-severe LUTS underwent UD. TURP was performed in 36/52 (69%) patients, with BOO diagnosis. Median (interquartile range) follow-up was 108 (75–136) months. Maximum flow at flowmetry (Qmax), International Prostate Symptom Score and post-voided residual volume improved significantly after surgery. Serum creatinine decreased and glomerular filtration rate improved significantly at follow-up, especially when TURP was performed ≤ 6 months from RT. At the multivariable model, bladder capacity ≥ 300 mL (OR = 1.74, CI 95% 1.03–3.15, p = 0.043) and detrusor pressure at Qmax (OR = 2.05, CI 95% 1.48–3.02, p = 0.035) were the independent predictors of BOO. Conclusion RT patients with moderate-to-severe LUTS at risk for BOO and graft failure are better identified by UD than clinical parameters. Bladder capacity and voiding pressure are key for the early diagnosis of BOO.
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Affiliation(s)
- Marialaura Righetto
- Department of Surgical, Oncological and Gastroenterological Sciences, University of Padova, Padova, Italy.,Urological Clinic, University Hospital of Padova, Padova, Italy
| | - Mariangela Mancini
- Department of Surgical, Oncological and Gastroenterological Sciences, University of Padova, Padova, Italy. .,Urological Clinic, University Hospital of Padova, Padova, Italy.
| | - Daniele Modonutti
- Department of Surgical, Oncological and Gastroenterological Sciences, University of Padova, Padova, Italy.,Urological Clinic, University Hospital of Padova, Padova, Italy
| | - Arturo Calpista
- Department of Surgical, Oncological and Gastroenterological Sciences, University of Padova, Padova, Italy.,Urological Clinic, University Hospital of Padova, Padova, Italy
| | - Paolo Beltrami
- Department of Surgical, Oncological and Gastroenterological Sciences, University of Padova, Padova, Italy.,Urological Clinic, University Hospital of Padova, Padova, Italy
| | - Fabrizio Dal Moro
- Department of Surgical, Oncological and Gastroenterological Sciences, University of Padova, Padova, Italy.,Urological Clinic, University Hospital of Padova, Padova, Italy
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Wang N, Lu L, Cao QF, Qian S, Ding J, Wang C, Duan H, Shen H, Qi J. Partial inhibition of activin receptor-like kinase 4 alleviates bladder fibrosis caused by bladder outlet obstruction. Exp Cell Res 2021; 406:112724. [PMID: 34237300 DOI: 10.1016/j.yexcr.2021.112724] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Revised: 06/22/2021] [Accepted: 06/29/2021] [Indexed: 12/17/2022]
Abstract
The bladder undergoes profound structural alterations after bladder outlet obstruction (BOO), characterized by hypertrophy of the bladder wall and accumulation of extracellular matrix (ECM). Transforming growth factor-β (TGF-β) has been found to promote fibrosis of the bladder induced by partial bladder outlet obstruction (pBOO). Activin receptor-like kinase 4 (ALK4) is a downstream receptor of the TGF-β superfamily. However, the role of the ALK4-Smad2/3 pathway in the pathogenesis of bladder fibrosis caused by pBOO remains unknown. This study focused on learning the role of ALK4 in the process of bladder fibrosis caused by pBOO. The pBOO mice models showed that ALK4 expression was found to upregulate in the wild-type bladder 6 weeks after pBOO compared to control group. Then, mice with heterozygous knockout of the ALK4 gene (ALK4+/-) were generated. Histological analysis and Western blot (WB) results showed significant suppression of collagen expression in the bladders of ALK4+/- mice after pBOO compared with WT mice. WB also showed that ALK4+/- mice demonstrated significant suppression of phosphorylated Smad2/3 (p-Smad2/3) expression in the bladder 6 weeks after pBOO but not of phosphorylated extracellular signal-regulated kinase, c-Jun N-terminal kinase or protein 38 (p-ERK, p-JNK, p-P38) expression. This effect might have occurred through partial inactivation of the Smad2/3 signaling pathway. In vitro, ALK4 overexpression promoted collagen production in cultured BSMCs and activated the Smad2/3 signaling pathway. Taken together, our results demonstrated that ALK4 insufficiency alleviated bladder fibrosis in a mouse model of pBOO partly by suppressing Smad2/3 activity.
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Affiliation(s)
- Ning Wang
- Department of Urology, Henan Provincial People's Hospital, Zhengzhou University People's Hospital, Henan University People's Hospital, Zhengzhou, Henan, China; Department of Urology, Xin Hua Hospital Affiliated to Shanghai Jiao Tong University, School of Medicine, Shanghai, China
| | - Lu Lu
- Department of Gastrointestinal Surgery, Henan Provincial People's Hospital, Zhengzhou University People's Hospital, Henan University People's Hospital, Zhengzhou, Henan, China
| | - Qi Feng Cao
- Department of Urology, Xin Hua Hospital Affiliated to Shanghai Jiao Tong University, School of Medicine, Shanghai, China
| | - Subo Qian
- Department of Urology, Xin Hua Hospital Affiliated to Shanghai Jiao Tong University, School of Medicine, Shanghai, China
| | - Jie Ding
- Department of Urology, Xin Hua Hospital Affiliated to Shanghai Jiao Tong University, School of Medicine, Shanghai, China
| | - Chen Wang
- Department of Urology, Xin Hua Hospital Affiliated to Shanghai Jiao Tong University, School of Medicine, Shanghai, China
| | - Huangqi Duan
- Department of Urology, Xin Hua Hospital Affiliated to Shanghai Jiao Tong University, School of Medicine, Shanghai, China
| | - Haibo Shen
- Department of Urology, Xin Hua Hospital Affiliated to Shanghai Jiao Tong University, School of Medicine, Shanghai, China.
| | - Jun Qi
- Department of Urology, Xin Hua Hospital Affiliated to Shanghai Jiao Tong University, School of Medicine, Shanghai, China.
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王 钊, 张 朝, 金 黎, 刘 博, 沈 炼, 何 大, 魏 光. [Establishment of an Animal Model of Vesicoureteral Reflux Renal Injury through Partial Bladder Outlet Obstruction]. Sichuan Da Xue Xue Bao Yi Xue Ban 2021; 52:825-831. [PMID: 34622600 PMCID: PMC10408891 DOI: 10.12182/20210960502] [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] [MESH Headings] [Subscribe] [Scholar Register] [Received: 12/25/2020] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To establish an animal model of reflux renal damage through bladder outlet obstruction. METHODS Sixty male C57BL/6 mice aged 6-8 weeks were randomly assigned to a control group, a sham operation group, and a partial bladder outlet obstruction (PBOO) group, with 20 mice in each group. Laparotomy were performed on the PBOO mice under anesthesia in order to separate the bladder necks and to perform guided partial ligation of the bladder neck with a metal rod of 0.3 mm diameter. Mice in the sham operation group had laparotomy and had their bladder necks separated without ligation. The control group did not receive any treatment. 7 days after the surgery, 12 surviving mice were randomly selected from each group to observe the general changes of the bladder, ureter, renal pelvis and kidney. Retrograde urography was performed through the bladder. Kidney tissues were extracted for histopathological analysis. The expression levels of Vimentin, proliferating cell nuclear antigen (PCNA) and α-smooth muscle actin (α-SMA) were examined with Western blot, immunohistochemistry and immunofluorescence staining tests, respectively. RESULTS Compared with the control and sham operation group, the bladder, ureter, and renal pelvis of the mice in the PBOO group were significantly enlarged, vesicoureteral reflux was more obvious, the kidney volume and mass increased ( P<0.001), and renal parenchyma became thinner ( P<0.000 1). Histopathological staining showed glomerular atrophy, renal tubule expansion, tubulointerstitial inflammatory cell infiltration, glomerular basement membrane hyperplasia and obvious interstitial fibrosis. Western blot, immunofluorescence and immunohistochemistry staining showed that the expression levels of Vimentin, PCNA and α-SMA in kidney tissue were elevated ( P<0.000 1). CONCLUSION After PBOO, the bladder, ureter, and kidney of the mice showed obvious morphological alteration and presented reflux renal fibrosis-like damage. This can be used as an animal model to study the pathological alteration mechanism and therapeutic measures of renal fibrosis caused by bladder outlet obstruction.
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Affiliation(s)
- 钊颖 王
- 重庆医科大学附属儿童医院 儿童泌尿生殖发育与组织工程重点实验室 儿童发育疾病研究教育部重点实验室 国家儿童健康与疾病临床医学研究中心 儿童发育重大疾病国家国际科技合作基地 儿科学重庆市重点实验室 (重庆 400014)Key Laboratory of Children Urogenital Development and Tissue Engineering, Key Laboratory of Children's Development and Disorders of the Ministry of Education, National Clinical Research Center for Children's Health and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing Key Laboratory of Pediatrics, Children’s Hospital of Chongqing Medical University, Chongqing 400014, China
| | - 朝霞 张
- 重庆医科大学附属儿童医院 儿童泌尿生殖发育与组织工程重点实验室 儿童发育疾病研究教育部重点实验室 国家儿童健康与疾病临床医学研究中心 儿童发育重大疾病国家国际科技合作基地 儿科学重庆市重点实验室 (重庆 400014)Key Laboratory of Children Urogenital Development and Tissue Engineering, Key Laboratory of Children's Development and Disorders of the Ministry of Education, National Clinical Research Center for Children's Health and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing Key Laboratory of Pediatrics, Children’s Hospital of Chongqing Medical University, Chongqing 400014, China
| | - 黎明 金
- 重庆医科大学附属儿童医院 儿童泌尿生殖发育与组织工程重点实验室 儿童发育疾病研究教育部重点实验室 国家儿童健康与疾病临床医学研究中心 儿童发育重大疾病国家国际科技合作基地 儿科学重庆市重点实验室 (重庆 400014)Key Laboratory of Children Urogenital Development and Tissue Engineering, Key Laboratory of Children's Development and Disorders of the Ministry of Education, National Clinical Research Center for Children's Health and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing Key Laboratory of Pediatrics, Children’s Hospital of Chongqing Medical University, Chongqing 400014, China
| | - 博 刘
- 重庆医科大学附属儿童医院 儿童泌尿生殖发育与组织工程重点实验室 儿童发育疾病研究教育部重点实验室 国家儿童健康与疾病临床医学研究中心 儿童发育重大疾病国家国际科技合作基地 儿科学重庆市重点实验室 (重庆 400014)Key Laboratory of Children Urogenital Development and Tissue Engineering, Key Laboratory of Children's Development and Disorders of the Ministry of Education, National Clinical Research Center for Children's Health and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing Key Laboratory of Pediatrics, Children’s Hospital of Chongqing Medical University, Chongqing 400014, China
| | - 炼桔 沈
- 重庆医科大学附属儿童医院 儿童泌尿生殖发育与组织工程重点实验室 儿童发育疾病研究教育部重点实验室 国家儿童健康与疾病临床医学研究中心 儿童发育重大疾病国家国际科技合作基地 儿科学重庆市重点实验室 (重庆 400014)Key Laboratory of Children Urogenital Development and Tissue Engineering, Key Laboratory of Children's Development and Disorders of the Ministry of Education, National Clinical Research Center for Children's Health and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing Key Laboratory of Pediatrics, Children’s Hospital of Chongqing Medical University, Chongqing 400014, China
| | - 大维 何
- 重庆医科大学附属儿童医院 儿童泌尿生殖发育与组织工程重点实验室 儿童发育疾病研究教育部重点实验室 国家儿童健康与疾病临床医学研究中心 儿童发育重大疾病国家国际科技合作基地 儿科学重庆市重点实验室 (重庆 400014)Key Laboratory of Children Urogenital Development and Tissue Engineering, Key Laboratory of Children's Development and Disorders of the Ministry of Education, National Clinical Research Center for Children's Health and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing Key Laboratory of Pediatrics, Children’s Hospital of Chongqing Medical University, Chongqing 400014, China
- 重庆医科大学附属儿童医院 泌尿外科 (重庆 400014)Department of Urology, Children’s Hospital of Chongqing Medical University, Chongqing 400014, China
| | - 光辉 魏
- 重庆医科大学附属儿童医院 儿童泌尿生殖发育与组织工程重点实验室 儿童发育疾病研究教育部重点实验室 国家儿童健康与疾病临床医学研究中心 儿童发育重大疾病国家国际科技合作基地 儿科学重庆市重点实验室 (重庆 400014)Key Laboratory of Children Urogenital Development and Tissue Engineering, Key Laboratory of Children's Development and Disorders of the Ministry of Education, National Clinical Research Center for Children's Health and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing Key Laboratory of Pediatrics, Children’s Hospital of Chongqing Medical University, Chongqing 400014, China
- 重庆医科大学附属儿童医院 泌尿外科 (重庆 400014)Department of Urology, Children’s Hospital of Chongqing Medical University, Chongqing 400014, China
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Radwan M, Rashed A, Zaghloul T, Elgamasy A, Nagla S, Hagrass A. Evaluation of ultrasonographic predictors of alpha-blocker mono-therapy failure in symptomatic benign prostatic enlargement. Urol Ann 2021; 13:220-225. [PMID: 34421255 PMCID: PMC8343277 DOI: 10.4103/ua.ua_87_20] [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: 06/05/2020] [Accepted: 12/09/2020] [Indexed: 11/30/2022] Open
Abstract
Objectives: Many sonographic parameters for predicting treatment failure for benign prostate enlargement have been described. Patients may take alpha-blockers for a long time at high cost before conversion to surgery. Purpose: Evaluation of the sonographic parameters that predict alpha 1 adrenoreceptor blocker monotherapy outcomes in symptomatic patients with benign prostate enlargement. Patients and Methods: Between June 2016 and July 2019, we prospectively enrolled 750 symptomatic patients with benign prostate enlargement. Trans-rectal ultrasonography was performed, and patients were given Tamsulosin (0.4 mg) oral tablets once daily for 6 months. Treatment outcomes were determined using quality of life, the International Prostatic Symptom Score, and maximum urine flow rate measures. The values of the measured baseline sonographic parameters on treatment outcomes were statistically analyzed. Results: Seven-hundred and fifty patients completed the study, and treatment was ineffective in 225 of them (30%). From the measured prostate and bladder sonographic parameters, intra-vesical prostate growth was only significant. Using a cutoff value of 8.2 mm, the area under the receiver operator characteristic curve for intra-vesical prostatic protrusion was 0.866. Using this cutoff value (with 95% confidence interval), both positive and negative predictive values were 73.3% and 98.18%, respectively. Conclusion: Based on sonographic parameters, only the intravesical prostate protrusion was valid for predicting alpha-blocker monotherapy failure in symptomatic benign prostate enlargement patients. This information helps determine a medical therapeutic plan and the need for surgical intervention.
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Affiliation(s)
| | - Ayman Rashed
- Department of Urology, 6 October University, Tanta, Egypt
| | | | | | - Salah Nagla
- Department of Urology, Tanta University, Tanta, Egypt
| | - Ayman Hagrass
- Department of Urology, Tanta University, Tanta, Egypt
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Wang W, Ai J, Liao B, Xiao K, Lin L, Chen H, Zhou L. The roles of MCP-1/CCR2 mediated macrophage recruitment and polarization in bladder outlet obstruction (BOO) induced bladder remodeling. Int Immunopharmacol 2021; 99:107947. [PMID: 34311189 DOI: 10.1016/j.intimp.2021.107947] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [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: 06/03/2021] [Revised: 06/26/2021] [Accepted: 06/29/2021] [Indexed: 02/08/2023]
Abstract
Bladder outlet obstruction (BOO) can lead to alternation of bladder structure and function, known as bladder remodeling. Macrophage is a heterogeneous cell type and implicated in immunity regulating and tissue repairment. The relationship between macrophage and BOO remains unclear. We determined the pivotal role of macrophage recruitment and polarization in bladder remodeling. Sprague-Dawley rats underwent surgical operation of a BOO for either 1, 3, 6 weeks and were compared with sham-operated rats. The BOO rats in the experimental group were orally administrated with 5 mg/kg RS-504393, a C-C chemokine receptor (CCR2) antagonist, for 6 weeks, and the rats in the control group were treated with vehicle. Bladder tissues were harvested for assays of flow cytometry, quantitative reverse transcription polymerase chain reaction, histological examinations, immunohistochemistry staining and immunofluorescence. After induction of BOO, M1 macrophages were predominantly observed at inflammatory stage while M2 macrophages were mainly found during fibrosis stage. Flow cytometry analysis revealed that the ratio of M1/M2 significantly increased at 3 weeks (P = 0.0013) when compared to the sham-operated group. Interestingly, our results showed that M2 macrophages promoted BOO-induced fibrosis through indirectly secreting TGF-β and directly transforming to collagen-producing myofibroblast. Additionally, RS-504393 treatment significantly decreased the number of M1 and M2 macrophage infiltration in bladder tissue, and bladder fibrosis was attenuated by RS-504393 treatment compared with that in the vehicle-treated rats. In summary, macrophages play a pivotal role in bladder remodeling and targeting MCP-1/CCR2 signaling pathway might be a therapeutic strategy for human bladder fibrosis.
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Affiliation(s)
- Wei Wang
- Department of Urology, Institute of Urology (Laboratory of Reconstructive Urology), West China Hospital, Sichuan University, Chengdu, Sichuan, PR China
| | - Jianzhong Ai
- Department of Urology, Institute of Urology (Laboratory of Reconstructive Urology), West China Hospital, Sichuan University, Chengdu, Sichuan, PR China
| | - Banghua Liao
- Department of Urology, Institute of Urology (Laboratory of Reconstructive Urology), West China Hospital, Sichuan University, Chengdu, Sichuan, PR China
| | - Kaiwen Xiao
- Department of Urology, Institute of Urology (Laboratory of Reconstructive Urology), West China Hospital, Sichuan University, Chengdu, Sichuan, PR China
| | - Lede Lin
- Department of Urology, Institute of Urology (Laboratory of Reconstructive Urology), West China Hospital, Sichuan University, Chengdu, Sichuan, PR China
| | - Huiling Chen
- Department of Urology, Institute of Urology (Laboratory of Reconstructive Urology), West China Hospital, Sichuan University, Chengdu, Sichuan, PR China
| | - Liang Zhou
- Department of Urology, Institute of Urology (Laboratory of Reconstructive Urology), West China Hospital, Sichuan University, Chengdu, Sichuan, PR China.
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Choi JB, Min SK. Complicated urinary tract infection in patients with benign prostatic hyperplasia. J Infect Chemother 2021; 27:1284-1287. [PMID: 34144904 DOI: 10.1016/j.jiac.2021.06.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [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: 01/29/2021] [Revised: 05/15/2021] [Accepted: 06/07/2021] [Indexed: 10/21/2022]
Abstract
Complicated urinary tract infection (UTI) is a symptomatic urinary infection accompanied by functional or structural abnormalities of the genitourinary tract. Benign prostatic hyperplasia (BPH) is a major cause of lower urinary tract obstruction in male patients, and bladder outlet obstruction (BOO) secondary to BPH can lead to UTIs in men. However, no evidence has clearly shown that UTI in the aging male population is associated with either post-void residual urine or BOO. Screening for the presence of bacteriuria is recommended prior to any procedure manipulating the urinary tract, and imaging studies of the upper urinary tract are recommended to identify underlying abnormalities. Recurrent or persistent UTI in men with BPH is an indication for surgical treatment. Asymptomatic bacteriuria should be screened for and treated before transurethral resection of the prostate (TURP). In addition, antibiotic prophylaxis reduced the risk of UTI in patients undergoing TURP. The choice of specific antimicrobial for prophylaxis should be based on local pathogen prevalence and individual antibiotic susceptibility. Patients with severe systemic infections require hospitalization, and empirical therapy should include an intravenous antimicrobial regimen. Further prospective studies are needed to refine the treatment process for complicated UTI in patients diagnosed with BPH.
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Affiliation(s)
- Jin Bong Choi
- Department of Urology, Bucheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Seung Ki Min
- Goldman Urology Clinic, Seoul, Republic of Korea.
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Rubilotta E, Balzarro M, Trabacchin N, Righetti R, D'Amico A, Blaivas JG, Antonelli A. Post-void residual urine ratio: A novel clinical approach to the post-void residual urine in the assessment of males with lower urinary tract symptoms. Investig Clin Urol 2021; 62:470-476. [PMID: 34085789 PMCID: PMC8246021 DOI: 10.4111/icu.20200560] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [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: 11/26/2020] [Revised: 01/03/2021] [Accepted: 02/03/2021] [Indexed: 01/04/2023] Open
Abstract
Purpose To assess the correlation between post-void residual urine ratio (PVR-R) and pathological bladder emptying diagnosed by pressure-flow studies (PFS) in males with lower urinary tract symptoms (LUTS). Materials and Methods PVR-R and PVR urine were evaluated in 410 males underwent PFS for LUTS. PVR-R was the percentage of PVR to bladder volume (voided volume+PVR). Schafer and International Continence Society (ICS) nomograms, Bladder Contractility Index (BCI) were used to diagnose bladder outlet obstruction (BOO) and detrusor underactivity (DUA). We subdivided the cohort in 4 groups: Group I, BOO+/DUA+; Group II, BOO-/DUA+; Group III, BOO+/DUA−; Group IV, BOO−/DUA− (control group). We subdivided the 4 groups according to PVR-R strata: (1) 0%–20%; (2) 21%–40%; (3) 41%–60%; (4) 61%–80%; (5) 81%–100%. Results Group I had a greater median PVR-R (50%) with a >40% in 61.4% of the cohort. Median PVR-R was 16.6% in Group II, 24% in Group III, and 0% in the control Group. According to ICS nomograms and BCI, median PVR-R and PVR were significantly higher (p<0.001) in obstructed and underactive males. PVR-R threshold of 20% allowed to recognize males with voiding disorders with high sensibility, specificity, PPV, and NPV. A PVR-R cut-off of 40% identified males with associated BOO and DUA and more severe voiding dysfunction. Conclusions A higher PVR-R is related to a more severe pathological bladder emptying, and to the association of BOO and DUA. PVR-R may have a clinical role in first assessment of males with LUTS and severe voiding dysfunction.
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Affiliation(s)
| | | | | | - Rita Righetti
- Department of Urology, Mater Salutis Hospital AULSS 9 Scaligera, Legnago, Italy
| | | | - Jerry G Blaivas
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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Mytilekas KV, Oeconomou A, Sokolakis I, Kalaitzi M, Mouzakitis G, Nakopoulou E, Apostolidis A. Defining Voiding Dysfunction in Women: Bladder Outflow Obstruction versus Detrusor Underactivity. Int Neurourol J 2021. [PMID: 33957716 DOI: 10.5213/inj.2040342.171] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Accepted: 11/03/2020] [Indexed: 11/08/2022] Open
Abstract
Purpose We aimed to develop urodynamic criteria for more accurate diagnosis of bladder outlet obstruction (BOO) and detrusor underactivity (DU) in women with lower urinary tract symptoms (LUTS). Methods Initially, in a group of 68 consecutive women with LUTS and increased post-void residual who had undergone urodynamic investigation we examined the level of agreement between operating physician's diagnosis of BOO or DU and diagnosis according to urodynamic nomograms/indices, including the Blaivas-Groutz (B-G) nomogram, Urethral Resistance Association (URA), Bladder Outlet Obstruction Index (BOOI) and Bladder Contractility Index (BCI). Based on the initial results, we categorized 160 women into four groups using B-G nomogram and URA (Group 1: severe-moderate BOO, Group 2: mild BOO and URA≥20, Group 3: mild BOO and URA<20 and Group 4: non-obstructed) and compared urodynamic parameters. Finally, we redefined women as obstructed (group 1+2) and non-obstructed (group 3+4) for sub-analysis. Results The agreement between B-G nomogram and physician's diagnosis was poor in the mild obstruction zone (kappa=0.308, p=0.01). Adding URA (cutoff value 20), an excellent level of agreement was reached (kappa=0.856, p<0.001). Statistically significant differences were found between the four groups (ANOVA) in maximum flow (Qmax) (p<0.0001), voided volume (VV) (p=0.042), post void residual (PVR) (p=0.032), BOOI (p<0.0001) and BCI (p<0.0001) with a positive linear trend for Qmax and VV and negative linear trend for PVR and BOOI from group 1 to 4. In the subanalysis all parameters were statistically different between obstructed and nonobstructive women except BCI (Qmax: p=0.0001, VV: p=0.0091, PVR: p=0.0005, BOOI: p=0.0001). Conclusions The combination of B-G nomogram with the URA parameter increases the accuracy of diagnosing BOO among women with LUTS. Based on this combination, most women in the mild obstruction zone of the B-G nomogram would be considered underactive rather than obstructed.
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Jiang YH, Jhang JF, Hsu YH, Ho HC, Kuo HC. Potential urine biomarkers in bladder outlet obstruction-related detrusor underactivity. Tzu Chi Med J 2021; 34:388-393. [PMID: 36578642 PMCID: PMC9791853 DOI: 10.4103/tcmj.tcmj_298_20] [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: 12/18/2020] [Revised: 12/27/2020] [Accepted: 12/30/2020] [Indexed: 12/31/2022] Open
Abstract
Detrusor underactivity (DU), an important but under-researched issue, is thought to be complex and multifactorial in etiology, pathophysiology, and diagnosis. Bladder outlet obstruction (BOO) is one of the important known etiologies of DU, with significant morphologic and physiologic changes of the urothelium, suburothelium, and detrusor muscle in the urinary bladder. Chronic urinary bladder ischemia and repeated cycles of ischemia and reperfusion injury cause excessive oxidative stress, and it is thought to be responsible for the development of DU. DU might be the late phase or decompensated status of BOO, with the possible mechanisms of afferent nervous dysfunction, increased inflammation, denervation of the detrusor muscle, and myogenic failure. Prostaglandin E2 (PGE2) involves in the physiological detrusor contraction, and might provide the prognostic value for the recoverability of DU. Neurotrophins, including nerve growth factor and brain-derived neurotrophic factor, involve in the neuroplastic changes in many inflammatory bladder diseases, including BOO and DU. Oxidative stress biomarkers, including 8-hydroxy-2-deoxyguanosine, F2-isoprostane, and the involved pro-inflammatory cytokines, have been applied in BOO due to their involvements in chronic bladder ischemia. PGE2, neurotrophins, inflammatory cytokines, and oxidative stress biomarkers are the potential urine biomarkers in BOO-related DU.
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Affiliation(s)
- Yuan-Hong Jiang
- Department of Urology, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation and Tzu Chi University, Hualien, Taiwan
| | - Jia-Fong Jhang
- Department of Urology, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation and Tzu Chi University, Hualien, Taiwan
| | - Yung-Hsiang Hsu
- Department of Pathology, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation and Tzu Chi University, Hualien, Taiwan
| | - Han-Chen Ho
- Department of Anatomy, Tzu Chi University, Hualien, Taiwan
| | - Hann-Chorng Kuo
- Department of Urology, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation and Tzu Chi University, Hualien, Taiwan,Address for correspondence: Dr. Hann-Chorng Kuo, Department of Urology, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, 707, Section 3, Chung-Yang Road, Hualien, Taiwan. E-mail:
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