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To critically analyse the relationship of bladder pain syndrome (BPS/IC), as defined, to the posterior fornix syndrome, "PFS" predictably co-occurring bladder urgency, frequency, nocturia, chronic pelvic pain, emptying symptoms/retention, caused by uterosacral ligament (USL) laxity and cured by USL repair. The starting and end points of this paper are the questions, "Are there arguments that BPS/IC can, in some cases, be linked to PFS?" And if so, "To what extent?" We used the criteria required by Ueda for proper diagnosis: "understanding symptoms, detecting abnormal findings and verifying them as a cause of the symptoms." Literature, diagnostic and surgical, indicate that chronic pelvic pain "of unknown origin" can be caused by unsupported visceral pelvic plexuses because of weak USLs; these cause fire of afferent impulses, which the brain mistakenly interprets as coming from the end-organ itself (i.e., genitourinary pain, lower urinary tract symptoms). The same lax USLs can also weaken the pelvic muscles which contract to stretch the vagina to support the urothelial stretch receptors from below: these may prematurely fire off afferent impulses to activate micturition at lower bladder volumes, interpreted as urgency. A speculum placed in the vagina can relieve pain and urgency by mechanically supporting the vaginal wall and USLs, thus predicting an eventual cure by USL repair. There is need to evaluate what percentage of women with known BPS/IC also pass the criteria for PFS. Identifying a significant percentage of BPS/IC women with the causative relation between PFS pathogenesis and BPS/ IC may open a new way of diagnosing and treating BPS/IC in some women. [ABSTRACT FROM AUTHOR]

Purpose: This study investigated the sensations reported during filling cystometry in patients with spinal cord lesions (SCLs) of different levels and completeness. Methods: In this retrospective cohort study, information was gathered on patients' age and sex, cause of SCL, American Spinal Injury Association Impairment Scale (AIS), and lower urinary tract-related sensations in daily life. Filling cystometry (videourodynamics) was performed following the International Continence Society Good Urodynamic Practice Guidelines. In addition to bladder filling sensations (first sensation of bladder filling, first desire to void, strong desire to void), other sensations, such as detrusor overactivity related sensation and pain, were noted. Results: In total, 170 patients were included (age, 45±17 years; 114 males and 56 females, 92 with complete and 78 with incomplete SCL). The test was done 6±4 years post-SCL. Sensation was reported by 57% of all patients. Half of the patients with complete SCL (46 of 92) had sensation, while 36% of those with incomplete SCL (28 of 78) reported no sensation. Bladder awareness was not predictable by the AIS. The filling sensations reported were equivalent to those given in the terminology of ICS. Pain was seldom present (6%, 10 of 170), and detrusor overactivity contraction was felt by 45 of 78 (58%). Very few patients used sensory information for bladder management at home. Conclusions: After SCL, most patients retained the ability to be aware of the lower urinary tract, and were assessable and gradable during urodynamic testing. The filling sensations were not different from those described in healthy individuals, but the number and sequence of the sensations were altered in a minority of patients. Pain and a sensation of unstable contractions gave additional important information. As different sensations relate to different spinal afferent pathways, the sensory evaluation during cystometry provided additional important information on the spinal cord's condition. [ABSTRACT FROM AUTHOR]

The pelvic floor biomechanics and sphincter functioning are essential for understanding pelvic floor dysfunction and the pathophysiology of the pelvic organs. The pelvic floor consists of muscles, fascial connections and ligaments. The Integral Theory Paradigm (ITP) explains the musculoskeletal entity of the sphincter mechanism and the pathophysiology of pelvic organ function. The ITP explains the pelvic floor function determined by 3 directional muscle forces: forward, backwards and downward-acting muscle vector forces that form an anterior and posterior resultant. The resultant equilibrium is essential for urinary continence, voiding and defecation. Loose ligaments disturb the equilibrium of the pelvic floor's muscular function with consequences for the organ function's continence, evacuation, and sensory perception. [ABSTRACT FROM AUTHOR]

Purpose: This work represents the efforts of the SIU-ICUD workgroup on this topic and comprehensive literature search of English language manuscripts regarding urologic surgery in spinal cord injury using key words of urologic surgery and spinal cord injury. Articles were compiled, and recommendations in the chapter are based on group discussion and intensive communication. The purpose is to review what has been published during the last decades on urological surgery for neurogenic bladder after spinal cord injury.Methods: Surgical techniques applied in spinal cord injured patients for neurogenic bladder dysfunction have been reviewed and the published material evaluated.Results: There are several techniques that can be used to treat neurogenic dysfunctions and symptoms in refractory cases where conservative treatment failed. The number of publications is small as are the number of patients with spinal cord injury in which they have been performed. The choice of techniques proposed to the patients depends on the exact functional pathology in bladder, bladder neck and urethral sphincter. The final informed choice will be made by the patient.Conclusion: There are surgical urological techniques available to treat neurologic dysfunctions in spinal cord injured patients. [ABSTRACT FROM AUTHOR]

Objective:A thorough clinical assessment including physical examination is crucial in a diagnostic work-up, including in patients with chronic pelvic pain syndrome (CPPS). This study investigated the prevalence of pain areas and the mechanosensitivity of peripheral nerves in patients with CPPS and compared the findings with a healthy control group. Materials and methods:Healthy volunteers and patients diagnosed with CPPS were assessed with physical examinations and neurodynamic testing. Results:The CPPS group (n = 26) and the control group (n = 28) showed no statistical differences between males and females for age and body mass index (Mann–WhitneyU test). The patients in the CPPS group were significantly older and had a significantly higher weight compared to controls. Healthy volunteers did not show any pain area or mechanosensitivity of the examined peripheral nerves of the lumbosacral plexus. Patients with CPPS showed a variety of pain from different musculoskeletal origins. Neurodynamic testing demonstrated significant mechanosensitivity in at least one nerve of the lumbosacral plexus in 88% of the patients with CPPS, suggesting minor nerve injuries. Pudendal nerve mechanosensitivity was found in 85% of patients, while 42% had multiple nerves involved. Unilateral or bilateral pudendal channel palpatory pain was present in 62% of the CPPS group and not in controls. Conclusions:This study shows musculoskeletal pain and a high prevalence of minor nerve injuries in CPPS patients, indicating the presence of abnormal impulse generation sites that can help in understanding the clinical picture in CPPS patients and guiding their treatment. [ABSTRACT FROM AUTHOR]

Objective: The aim of this study was to investigate the influence of the type of current and the frequency of impulses of electrical stimulation on the contraction of pelvic muscles with different fibre content.Materials and methods: Electrical stimulation of complete muscles from Wistar rats was performedin vitrowith a biphasic square wave current and with a bipolar mid-frequency current at frequencies between 2 and 100 Hz. The parameters of the resulting isometric contraction were determined.Results: The iliococcygeus and pubococcygeus, both with mainly fast-twitch muscle fibres, showed maximal contraction with a biphasic current with square wave pulses at 50 Hz and 60 Hz. The best result in the soleus, with mainly slow-twitch fibres, was with 33 Hz. The mid-frequency current needed a higher intensity to reach lower contraction values but was more effective at the very low frequencies.Conclusions: Current type and frequency of electrical impulses change the electrically induced contraction in pelvic muscles substantially. This should be taken into account when designing and evaluating specific electrical stimulation of pelvic floor muscles aiming at improving either fast contraction or support, or both. From these data, optimal stimulation programmes may be proposed for mainly slow and mainly fast pelvic floor muscles, which need to be evaluated in a clinical setting. [ABSTRACT FROM PUBLISHER]

Objectives. The aim of this study was to evaluate the prevalence of lower urinary tract symptoms and quality of life in patients with chronic pelvic pain syndrome (CPPS). Materials and methods. The McGill Pain Questionnaire, Dutch Leiden/Leuven Version (MPQ-DLV), Pain Disability Index (PDI), National Institutes of Health Chronic Prostatitis Symptom Index (NIH-CPSI), Interstitial Cystitis Symptom Index (ICSI) and Pelvic Pain and Urinary/Frequency Symptom Scale (PUF) were used, based on their specific properties, to assess the symptoms and impact on the quality of life. Total scores and domains were compared for gender. Results. The studied group ( N = 35; 18 male, 17 female) showed a good distribution in gender for age [Mann-Whitney U test (MW-U) p = 0.4] and body mass index (MW-U p = 0.2). The MPQ-DLV showed significantly higher scores for pain in women for Pain Rating Index - Affective (MW-U p = 0.030) and Total (MW-U p = 0.031), and Visual Analogue Scale for Pain - Most (MW-U p = 0.005). Women were less sexually active (PUF-SA) (chi-squared test p = 0.021) and had a significantly higher disability (PDI-T) (MW-U p = 0.005) and MPQ - Quality of Life (MW-U p = 0.003). The urinary symptoms showed similar results for gender (chi-squared test p > 0.05). Conclusions. A wide variety of symptoms and a negative impact on quality of life were shown. No differences in lower urinary tract symptoms were found between genders. Women were less sexually active than men. Chronic pelvic pain had a significantly higher negative impact on the level of quality of life in women than in men. [ABSTRACT FROM AUTHOR]

Chronic pelvic pain syndrome (CPPS) presents with a variety of symptoms affecting multiple systems. There is no universal treatment that can be given to all patients with CPPS. The results of treatment depend greatly on an accurate diagnosis. A thorough clinical assessment, including a 'four-step plan', should include paying special attention to the musculoskeletal system. This assessment is not difficult to perform and provides valuable information on possible muscular problems and neuropathy. [ABSTRACT FROM AUTHOR]

Background: For the evaluation of sensory innervation, normative data are necessary as a comparison. Aims: To compare our current perception thresholds (CPTs) with normative data from other research. Methods: Healthy volunteers were assessed for 2000, 250, and 5 Hz CPTs of the median and pudendal nerve and data were compared with other studies. Results: Normative data in the studied group n = 41 (male: 21; female: 20) for the median nerve, 2 kHz, 250 Hz, and 5 Hz were respectively: 241.85 ± 67.72 (140-444); 106.27 ± 39.12 (45-229); 82.05 ± 43.40 (13-271). Pudendal nerve CPTs 250 Hz were: 126.44 ± 69.46 (6-333). For men 2 kHz: 349.95 ± 125.76 (100-588); 5 Hz: 132.67 ± 51.81 (59-249) and women 2 kHz: 226.20 ± 119.65 (64-528); 5 Hz: 92.45 ± 44.66 (35-215). For the median nerve no statistical differences for gender were shown. For the pudendal nerve, only 250 Hz showed no difference for gender ( t-test: 0.516). Comparison of our data with CPTs of other normative data showed no agreement for the pudendal nerve. For the median nerve only 2 kHz showed agreement in three studies and for 5 Hz with one study. Conclusion: Comparing normative data of multiple studies shows a variety of results and poor agreement. Therefore, referring to normative data of other studies should be handled with caution. [ABSTRACT FROM AUTHOR]

The article examines on the lack of clinical practice and the design of clinical trials for assessing treatment response and non-response in patients with overactive bladder (OAB). It states that the study conducted a systematic review of several articles published between January 1, 2005 and August 8, 2013 in patients with neurogenic detrusor overactivity, conditions other than OAB, or OAB symptoms. It also provides an overview of the results and conclusions of the study.

What's known on the subject? and What does the study add? Clean intermittent catheterization (CIC) is considered the method of choice for bladder emptying when neurological or non-neurological causes make normal voiding impossible or incomplete. The outcome is overall good, also in the long-term. There is neither one best technique nor one best material, as both depend greatly on patients' individual anatomic, social and economic possibilities. The most frequent complication is urinary tract infection (UTI). Studies differ in the definition criteria for UTI, methods for evaluation, CIC techniques, frequency of urine analysis, prophylaxis and patients studied. The study provides a literature review and shows that most studies do not have a high level of evidence. There are various risk factors for UTI and phenotyping them helps to assess prognosis by considering what can happen if treatment is not initiated. The study concludes, that the role of biofilms in CIC deserves more attention and that diagnosis should be made on urine sample obtained with catheterization, because symptoms are often less reliable. It also concludes that treatment in those who catheterize for a long time is only necessary for symptomatic infections. The study identifies the following areas for further research: prevention of UTI in patients performing CIC; the use of special catheter types; and the role of frequency of catheterization, prophylactic antibiotics and preservation of natural defence mechanisms in the lower urinary tract. OBJECTIVE To review the factors related to urinary tract infection (UTI), the most prevalent complication in patients who perform clean intermittent catheterization (CIC)., METHODS We conducted a literature search then a group discussion to gather relevant information on aspects of UTI to guide future research and to help provide clearer recommendations for the prevention of UTI in patients performing CIC., RESULTS UTI is a major complication of CIC, the incidence of which varies widely in the literature owing to differences in methodology and definitions., Phenotyping the risk factors for UTI helps to assess prognosis by considering what can happen if treatment is not initiated. The role of biofilms in CIC deserves more attention., Diagnosis is made using the urine sample obtained by catheterization. Because of neurological or other deficiencies in patients performing CIC, symptoms are less reliable. Thorough evaluation for the source of signs and symptoms should be made before attributing them to UTI., There have been many different proposals for the prevention of UTI in patients performing CIC, but most need more research. The role of the type of catheter is unclear but further exploration of special catheter types might be worthwhile., Treatment in those who perform CIC for a long time is best reserved for symptomatic infections., CONCLUSIONS Several mechanisms are relevant in UTI related to CIC., As UTI is prevalent, more research into its prevention is needed. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the reproducibility of a standardized technique of current perception threshold measurements with square wave and sine wave current, with monopolar and bipolar electrodes in a cohort of patients with overactive bladder (OAB) and healthy volunteers. Methods: We enrolled 6 female nulliparous healthy volunteers and 11 female patients with OAB. Current perception threshold measurements of the bladder were performed using several techniques. The same sequence was used for all 3 measurements performed at weekly intervals to assess the reproducibility. An intraclass correlation coefficient >0.75 was considered as very good reproducibility. Results: All the different stimulation forms were well tolerated by all participants and all experienced stimulation at 2.5-Hz and 95-Hz square wave current. The results with sine wave current showed less uniform results. The intraclass correlation showed the greatest reproducibility with bipolar stimulation at a current of 95 Hz. Sine wave current at 5 Hz and 250 Hz showed low reproducibility. Bipolar stimulation had significantly lower thresholds than monopolar stimulation (P < .0001). No significant differences were found between the healthy subjects and the patients with OAB for the 4 settings. Conclusion: In the healthy volunteers and patients with OAB, the determination of the current perception threshold in the bladder using a standardized method is feasible and well tolerated, with both bipolar and monopolar stimulation. In our study, square wave current showed strong reproducibility at weekly intervals at 2.5 Hz and 95 Hz. However, sinusoid current gave weak reproducibility. [ABSTRACT FROM AUTHOR]

Abstract: Context: Effective symptom reduction has the potential to significantly improve health-related quality of life (HRQoL) in patients with overactive bladder (OAB), particularly those experiencing urgency urinary incontinence (UUI). Objective: To assess the evidence for flexible therapy with fesoterodine for patients with OAB, focussing on UUI. Evidence acquisition: A nonsystematic search performed in 2010 was used to identify relevant literature regarding fesoterodine therapy. Evidence synthesis: Antimuscarinic medications are the first-line pharmacotherapy for OAB, and tolterodine has been the treatment of choice for many patients. However, optimal efficacy may be difficult to achieve because of tolterodine''s limited dosing options. Fesoterodine, a nonselective oral antimuscarinic with the same active metabolite as tolterodine, provides an alternative option. After oral administration, fesoterodine is rapidly and extensively converted into 5-hydroxymethyl tolterodine by ubiquitous, nonspecific plasma esterases, thus bypassing the hepatic cytochrome P450 pathway that mediates the metabolism of tolterodine. The superiority of fesoterodine 8mg over tolterodine extended release (ER) 4mg for the effective relief of UUI episodes and other OAB symptoms and improvements in HRQoL has been demonstrated in two superiority-design, head-to-head, randomised, placebo-controlled, clinical trials in patients with OAB and UUI. The majority of patients achieved dryness with fesoterodine 8mg, a significantly higher percentage than with tolterodine ER 4mg. Clear dose-response relationships have been defined for fesoterodine in OAB patients for many outcomes, including UUI episodes, mean voided volume, continent days per week and self-reported treatment response. The dose-response magnitude for improving UUI episodes was larger in patients with greater UUI severity. Flexible dosing with fesoterodine appears to be well tolerated, with no unexpected safety signals during long-term treatment and high rates of patient-reported treatment satisfaction. Conclusions: Flexible dosing with fesoterodine 4mg and 8mg allows for maximisation of treatment efficacy for a broad spectrum of patients with OAB. [Copyright &y& Elsevier]

OBJECTIVE To assess changes in overactive bladder (OAB) symptoms and patient-reported outcomes in a post hoc analysis in which subjects from a 12-week, open-label, flexible-dose fesoterodine study were stratified according to whether they opted for dose escalation. PATIENTS AND METHODS Subjects with OAB (eight or more micturitions and three or more urgency episodes per 24 h) who reported dissatisfaction with tolterodine within 2 years of screening received fesoterodine 4 mg once daily for 4 weeks, with an optional dose increase to 8 mg after week 4 based on discussion of efficacy and tolerability between the subject and investigator. Subjects completed 5-day diaries, the Patient Perception of Bladder Condition (PPBC) and Urgency Perception Scale (UPS) at baseline and weeks 4 and 12, and the Overactive Bladder Questionnaire (OAB-q) at baseline and week 12. Subjects rated treatment satisfaction at week 12. RESULTS Dose escalation to 8 mg at week 4 was chosen by 255 (50%) of 513 subjects. At baseline, subjects who opted for dose escalation at week 4 (escalators) had significantly higher means for all diary variables except urgency urinaryincontinence (UUI) episodes, significantly greater OAB-q Symptom Bother scores and significantly lower OAB-q health-related quality of life (HRQL) scores (all P < 0.05) compared to subjects who did not opt for dose escalation (non-escalators). There was no significant difference in the percentage of escalators (51%) and non-escalators (48%) who reported at least one UUI episode on baseline diary. At week 4 (before the decision to escalate was made), all outcomes were significantly improved vs baseline among both groups (all P < 0.0001), although non-escalators had significantly greater improvements in all diary variables and in PPBC and UPS scores than escalators (all P < 0.05), and the 5-day diary-dry rate (i.e. the percentage of subjects with at least one UUI episode on baseline diary and no UUI episodes on week 4 diary) was significantly higher ( P = 0.0016) among non-escalators (62%) than among escalators (42%). At week 12, all outcomes were again significantly improved vs baseline among both groups (all P < 0.0001). There were no significant differences between non-escalators and escalators in week 12 improvements for most diary variables, UPS scores, OAB-q Symptom Bother scores, the diary-dry rate (68% vs 60%) or the percentage of subjects who reported treatment satisfaction (82% vs 78%). However, escalators still had significantly greater improvements from baseline in urgency episodes, PPBC scores and OAB-q total HRQL and Coping domains ( P < 0.05). Adverse event rates were similar between non-escalators and escalators. Dry mouth was the most frequently reported adverse event; most cases were mild. CONCLUSION Flexible-dose fesoterodine significantly improved OAB symptoms and patientreported outcomes in subjects who chose to remain on the initial 4-mg dose, as well as in the 50% of subjects who escalated to the 8-mg dose after 4 weeks. Non-escalators had significantly fewer OAB symptoms at baseline and significantly greater improvements than escalators before dose escalation. Escalators showed increased symptom relief after dose escalation; improvements in most outcomes were similar among non-escalators and escalators by week 12. Flexible-dose fesoterodine was well tolerated, with similar adverse-event profiles observed in the escalator and nonescalator groups. These results may help clinicians to identify patients more likely to require fesoterodine 8 mg to achieve maximum relief of OAB symptoms and thus facilitate dose escalation in these patients. [ABSTRACT FROM AUTHOR]

Objective. To evaluate the cystoscopy and histology of bladder biopsies conducted following the European Society for the Study of Interstitial Cystitis/Painful Bladder Syndrome (ESSIC) recommendations. Material and methods. This prospective study at a referral centre included 50 patients, with >12 on the O'Leary-Sant Interstitial Cystitis Symptom and Problem Indices and >7/10 on a visual analogue scale for average pelvic pain. Cystoscopic findings at hydrodistension and histological examination of biopsies were described as recommended by ESSIC and compared. Results. Performing the tests following ESSIC recommendations proved easy and offered information that permitted comparison between patients. Both cystoscopic and histological findings showed a large variation. There was no correlation between overall cystoscopic severity score and cystoscopic severity grade and the histological findings. There was a significant correlation between the cystoscopic aspect and inflammatory infiltration, mastocyte count in the detrusor muscle and stromal oedema. Maximal bladder capacity was negatively correlated with inflammation, mast cell count, haemorrhages and the overall cystoscopic aspect. In some patients cystoscopy and/or histology were normal. No information was available on patients with less severe symptoms. Conclusions. Bladder pain syndrome (BPS) patients suffering from severe symptoms represent a group with various cystoscopic findings on hydrodistension and bladder histology carried out following ESSIC recommendations. Correlations between cystoscopic findings, maximal bladder capacity and bladder histology were found. For further typing of patients with BPS cystoscopy at hydrodistension and biopsies, may be considered to be mandatory. The use of the ESSIC methodology permits a standardized investigation with results that can be compared between patients. [ABSTRACT FROM AUTHOR]

Abstract: Objectives: To review the up-to-date literature of the mostly used conservative treatment modalities in patients with neurogenic bladder. Methods: material from literature on conservative management in patients with neurogenic bladder was reviewed. Pubmed search results and recent books were consulted. Results: The conservative treatment is in almost all cases the first and will remain the primary choice in the majority of patients with neurogenic bladder. Treatment will depend on the type of underlying disease, on the bladder dysfunction, its natural evolution but also on the patients’ general condition, and the available resources. Behavioural training, catheters, external appliances, drugs and electrical stimulation are presented, their indications and limitations. Conclusions: Conservative treatment is the mainstay in neurogenic bladder management. It offers different methods which permit to successfully treat most symptoms and conditions in this prevalent LUT pathology. [Copyright &y& Elsevier]

Intermittent catheterization (IC) is a more preferable method for bladder drainage than indwelling urethral or suprapubic catheterization. Several complications with IC have been described, however, including urinary tract infection, genital infection, urethral bleeding, urethritis, urethral stricture, and bladder stones. To prevent these complications, patients should be well instructed on the technique and the risks of IC. Indwelling catheterization should be used only exceptionally, under close control and the catheter should be changed with adequate frequency. [ABSTRACT FROM AUTHOR]

OBJECTIVE To evaluate whether a compelling desire to void (CDV) is always perceived suddenly, or whether it can result from the gradual build-up of bladder-filling sensations. PATIENTS AND METHODS The pattern of filling sensations was evaluated during standard cystometric bladder filling in 75 patients who complained of urgency and showed detrusor overactivity during cystometry. Cystometric filling ended when a CDV was reported. The ‘warning volume’ is defined as the difference in volume between the first perception of filling and the volume at CDV. RESULTS Different patterns of bladder-filling sensations were reported. A CDV occurred suddenly, without a preceding sensation in 13% of the patients, whereas 66% reported at least two normal preceding filling sensations before a CDV. The bladder volume at the CDV was significantly smaller in patients that reported no or just one preceding sensation compared with those that reported the normal pattern of two or three sensations ( P < 0.005). The bladder volume at which the first filling perception was reported was not different regardless of whether it was described as a first sensation of filling, a first desire or a CDV ( P = 0.42). The warning volumes were not different between patients with one or no standardized filling sensations ( P = 0.7), but they were significantly smaller than in patients with two or three filling sensations ( P = 0.85). CONCLUSION A CDV can occur suddenly if normal filling sensation is disturbed, but also gradually if normal filling sensation is preserved. In cases of disturbed filling sensation, the volume at CDV and the warning volume are significantly lower. [ABSTRACT FROM AUTHOR]

Thesis and aims: In 45 years, the definitions and practice of the urodynamically based overactive bladder (OAB)/detrusor overactivity (DO) system have failed to adequately address pathogenesis and cure of urinary urge incontinence, frequency and nocturia. Methods: We analysed the OAB syndrome with reference to the Integral Theory paradigm's (ITS) binary feedback system, where OAB in the female is viewed as a prematurely activated, but otherwise normal micturition caused mainly, but not entirely, by ligament damage/laxity. The ITS Clinical Assessment Pathway which details the relationships between structural damage (prolapse), ligaments and dysfunction (symptoms) is introduced. Results: The ITS was able to "better explain" OAB pathophysiology in anatomical terms with reference to the binary model. The phasic patterns diagnostic of "detrusor overactivity" are explained as a struggle for control by the closure and micturition reflexes. The exponentially determined relationship between urethral diameter and flow explains why obstructive patterns occur, why they do not and why urine may leak with no recorded pressure. Mechanically supporting ligaments ("simulated operations") during urodynamic testing can improve low urethral pressure, negative pressure during coughing with SUI and diminish urge sensation or even DO patterns, transforming urodynamics from non-predictive test to accurate predictor of continence surgery results. High cure rates for OAB by daycare repair of damaged ligaments is a definitive test of the binary system's validity. Conclusion: Conceptual progression of OAB to the Integral Theory paradigms's prematurely activated micturition validates OAB component symptoms as a syndrome, explains pathogenesis, and unlocks a new way of understanding, diagnosing, treating and researching OAB. [ABSTRACT FROM AUTHOR]

The pelvic floor functions as a holistic entity. The organs, bladder, bowel, smooth and striated muscles, nerves, ligaments and other connective tissues are directed cortically and reflexly from various levels of the nervous system. Such holistic integration is essential for the system's multiple functions, for example, pelvic girdle stability, continence, voiding/defecation, and sexuality. Pelvic floor dysfunction (PFD) is related to a variety of pelvic pain syndromes and organ problems of continence and evacuation. Prior to treatment, it is necessary to understand which part(s) of the system may be causing the dysfunction (s) of Chronic Pelvic Pain Syndrome (CPPS), pelvic girdle pain, sexual problems, Lower Urinary Tract Symptoms (LUTS), dysfunctional voiding, constipation, prolapse and incontinence. The interpretation of pelvic floor biomechanics is complex and involves multiple theories. Non-surgical treatment of PFD requires correct diagnosis and correctly supervised pelvic floor training. The aims of this review are to analyze pelvic function and dysfunction. Because it is a holistic and entirely anatomically based system, we have accorded significant weight to the Integral Theory's explanations of function and dysfunction. [ABSTRACT FROM AUTHOR]

A letter to the editor is presented in response to the article on the symptoms differences between bladder pain syndrome (BPS) and non-type 3C BPS.

During the last few years, the international community debated urinary tract infection and re-use of catheters when managing neurogenic lower urinary tract dysfunction (NLUTD) among individuals with spinal cord injury (SCI). In this respect, the 2014 Cochrane review by Prieto and colleagues, "Intermittent catheterisation for long-term bladder management," became one of the leading documents that captured the minds and attention of clinicians around the world. Although numerous countries had switched to single-use catheters for management of NLUTD following SCI, the opinion that was expressed in the 2014 Cochrane review had a strong influence on healthcare providers and agencies to recommend re-use of catheters. However, many clinicians have expressed concern regarding the conclusions in the 2014 Cochrane review by Prieto and colleagues. We therefore conducted an independent appraisal of the data and analyses presented in the review. Our appraisal identified crucial discrepancies of data extraction and analyses within the review. In appraisal to that of Prieto and colleagues' review, our analysis revealed a trend to favor single over multiple use of catheters. After addressing our concerns to Cochrane's acting Editor-in-Chief, the most recent version of the 2014 Cochrane review was withdrawn from publication. [ABSTRACT FROM AUTHOR]

Objectives: The ability to perform a correct pelvic floor muscle contraction (PFMC) is necessary to start pelvic floor muscle training after delivery. COMMOV are "c"ontractions of "o"ther "m"uscles (m. rectus abdominus, the gluteal muscles, and the adductors), and other "mov"ements (pelvic tilt, breath holding, and straining) performed in addition to or instead of the PFMC. COMMOV are probably the most common errors in attempt to contract the pelvic floor muscles during the first days after delivery. The aims of this study were to observe the prevalence of COMMOV, to investigate whether COMMOV influence the ability to perform a PFMC, and whether verbal instructions are effective to unlearn the COMMOV postpartum.Study Design: A Prospective Observational Study was performed in women during the first through sixth day postpartum. PFMC and COMMOV were evaluated with visual observation. Women who did not show correct isolated PFMC received verbal instructions and were re-evaluated. Interobserver variability and agreement were calculated. Chi-square, Kappa, Risk Ratio, and McNemar were used.Results: A total of 382 women participated, 2.36 (±1.2) days postpartum. Twohundred sixteen, 57%, CI (52-62%), showed COMMOV. The chance to perform a correct PFMC was 2.65 times higher without COMMOV (p=0.0001). Verbal feedback was effective (57% reduced to 3%) to abandon COMMOV during PFMC.Conclusion: COMMOV are common errors performed during attempts to contract the pelvic floor muscles after delivery. They can reduce the ability to contract the pelvic floor muscles, but can easily been unlearned with visual observation and verbal feedback. [ABSTRACT FROM AUTHOR]

Objective: Pelvic floor muscle training is effective and necessary in the prevention and treatment of pelvic floor dysfunction during pregnancy and after childbirth. But because of the high prevalence of perineal pain observed in women after childbirth, many women and caregivers fear to start pelvic floor muscle training immediately after childbirth. However, it is unknown whether pelvic floor muscle contractions (PFMC) provoke perineal pain in women shortly after childbirth. Therefore, the main objective is to study whether PFMC performed immediately after childbirth is painful or not.Study Design: Observational longitudinal study. Perineal pain was assessed (1-6 days and 9 weeks postpartum) using a visual analogue scale (VAS 0-10) during PFMC and during several activities of daily living (ADL), during micturition and defecation. Descriptive statistics, Wilcoxon and McNemar tests were used.Results: A total of 233 women participated (148 primiparous and 85 multiparous). Immediately postpartum the prevalence and intensity of pain during ADL (73%; VAS 4.9 (±2.3)), micturition (47%; VAS 3.4 (±1.7)) and defecation (19%; VAS 3.6 (±2.2)) were significantly higher (all p<0.000) than during PFMC (8%; VAS 2.2 (±0.9)). At 9 weeks postpartum, 30% experienced perineal pain during sexual intercourse (VAS 4.6 +/- 2.3) and 18% during defecation (VAS 4.7 +/- 2.3), but none during PFMC.Conclusion: Perineal pain is highly prevalent immediately after childbirth during ADL, micturition and defecation, but not during PFMC (only 8%). In case perineal pain occurs during PFMC, the intensity of pain is low (VAS 2). These results show that fear of perineal pain should not discourage women to start pelvic floor muscle training shortly after childbirth. [ABSTRACT FROM AUTHOR]

The article discusses various reports published within the issue, including one by R MacDonald, HA Fink, C Huckabay, M Monga and TJ Wilt on the effectiveness and adverse effects of botulinum toxin in urinary incontinence owing to detrusor overactivity and another by SRM Mateus, PSS Beraldo and TA Horan on the maximal static mouth respiratory pressures in patients with spinal cord lesions and the correlation with the motor level of injury.

The article focuses on the importance of locomotion to everyone's life. The author claims that locomotion is a predominant function that permits the person to move from one place to another, grab and reposition things, and make objects and perform task. It was stated that one predominant activity is the planning and application of physical treatment that will restore the predominant functions. The physiotherapy aims to develop muscle functions for proper activities of daily living.

β 3 -adrenoceptor agonists influence overactive bladder in humans and animal models. However, data is emerging that the mode of action of these drugs is complex. The present study explored the actions of the β 3 -adrenergic agonist mirabegron and the non-selective agonist isoprenaline on the contractile systems in the rat and guinea pig bladder. Intravesical pressure was measured in isolated whole bladders from female adult animals. In both species spontaneous contractile activity was observed. The muscarinic agonist arecaidine produced complex responses consisting of an initial transient pressure rise followed by complex phasic activity. Three contractile elements were identified: intrinsic micro-contractile activity, initial transient response and steady state phasic activity. The intrinsic and steady state activity could be further divided into a baseline pressure with superimposed phasic activity. The effects of isoprenaline and mirabegron were investigated on these elements. In the rat, the micro-contractile activity could be completely inhibited by isoprenaline (full agonist). The arecaidine-induced initial and steady state baseline pressures were partially reduced, while the phasic activity was little affected. In the guinea pig, both the arecaidine-induced baseline pressure and the phasic activity were affected by isoprenaline. Mirabegron didn't produce significant inhibitory effects in any of the contractile elements in either species. These results show that complex contractile systems operate in the rat and guinea pig bladder that can be modulated by β 1 /β 2 -adrenoceptor mechanisms. No evidence was obtained for any β 3 -dependent regulation of contraction. These data support similar data in humans. Therefore the primary site of therapeutic action of β 3 -adrenergic agonists remains unknown. [ABSTRACT FROM AUTHOR]

Purpose: To investigate the inhibitory effect and possible mechanism of intraurethral stimulation on overactive bladder (OAB) induced by acetic acid irritation. Methods: Cystometry was performed in 13 urethane-anesthetized female rats. Intravesical infusion of 0.5% acetic acid was used to irritate the bladder and induce OAB. Multiple cystometrograms were performed with mirabegron, continuous stimulation, mirabegron plus continuous stimulation, and β3-adrenoceptor antagonist plus continuous stimulation to determine the mechanism underlying the inhibitory effect by intraurethral stimulation. Results: Infusion of acetic acid significantly decreased bladder capacity. Intraurethral stimulation at 2.5 Hz plus mirabegron significantly increased bladder capacity and decreased the nonvoiding contraction count. The changes were strongly inhibited after the β3-adrenoceptor antagonist was administered. Conclusions: Activation of urethral afferent nerves can reverse OAB, which activates C-fiber afferent nerves. This animal study indicates that intraurethral stimulation may interfere with OAB through hypogastric nerve activation and pudendal nerve neuromodulation. [ABSTRACT FROM AUTHOR]

3.Symptom cure rate (brackets) 198 women with POP after surgery [24] The correct caption of Fig. Symptom cure rate (brackets) 198 women with POP after surgery [24] The original article has been corrected. [Extracted from the article]

Objective. For the diagnosis of bladder pain syndrome (BPS), the International Society for the Study of Bladder Pain Syndrome (ESSIC) recommends a specific diagnostic work-up using cystoscopy with hydrodistension and bladder biopsies. This study evaluates the correlation between the histological findings in bladder biopsies handled following ESSIC recommendations, as well as the importance of the histological features in BPS compared with the cystoscopic findings. Material and methods. The study included 15 men and 93 women. All patients underwent cystoscopy with hydrodistension, and at least three deep biopsies including detrusor muscle were taken. For the cell count the Leder stain was used most frequently. A cut-off point of 28 mast cells/mm2 was used for detrusor mastocytosis. Results. Significant correlations were found between urothelial damage and inflammatory infiltrate ( p < 0.001). Detrusor mastocytosis was significantly more elevated in biopsies with normal urinary epithelium (Tukey corrected p < 0.0001) than in biopsies where the urothelium was damaged. No other correlations were found between histological findings or between histological and cystoscopic findings. Conclusion. Both cystoscopy with hydrodistension and histology can be used to illustrate different pathophysiological mechanisms in patients with BPS. These results favour the use of both in the classification of BPS patients. [ABSTRACT FROM AUTHOR]

The study of urinary urgency is challenging for a number of reasons, including our lack of understanding of the normal physiology of urinary sensation and the pathophysiology of abnormal sensation. Issues with nomenclature and lack of agreement about the nature of the experience of normal and abnormal urinary sensation add to this difficulty. Review of published literature and critique. Currently available tools for measurement of urgency include validated questionnaires that describe the severity of urgency and its impact on quality of life, modified bladder diaries, body maps of urgency, and measures of urinary sensation during filling cystometry. All these provide some information about the experience of urinary urgency, but no single measure currently captures its multidimensional nature. Measurement of urgency in clinical practice and indeed the optimal treatment strategy has yet to come of age. [ABSTRACT FROM AUTHOR]

Abstract: Background: The exact mechanisms of action of intravesical electrical stimulation (IVES) are not yet fully understood. Objective: To gain more insight into the underlying mechanism(s) of the direct detrusor response during IVES by transsecting the dorsal roots and the pelvic nerve consecutively at different levels and to determine whether the efficiency of IVES to induce contraction could be enhanced by simultaneous bladder filling and IVES and by changing the bladder-filling grade. Design, Setting, and Participants: Eighteen Sprague-Dawley rats underwent IVES (square-wave pulses at 10Hz, 20-ms pulse duration). Measurements: In seven rats, IVES-induced bladder-pressure development was studied after the bladder nerves were consecutively sectioned bilaterally at four different levels: no lesion, L6 dorsal roots, L6 ventral roots, pelvic nerve, and major pelvic ganglion with surrounding nerves. Bladder-pressure development induced by IVES with simultaneous bladder filling, by bladder filling alone, and by IVES alone was recorded in seven other rats, and bladder-pressure development induced by IVES with different grades of bladder filling was recorded in four rats. Results and Limitations: Contraction during IVES was significantly weaker after consecutive section of more nerves (all p <0.001), but a small contraction (19±17% of baseline) could be elicited even after total decentralization. In the neurologically intact rats, separate stimulation and bladder filling gave contraction strengths similar to those of simultaneous bladder filling and stimulation, but the latter gave contraction after a significantly shorter stimulation time (both p <0.015). Conclusions: IVES-induced contraction is, for the major part, a nerve-mediated process. However, a small bladder-pressure rise was induced by direct bladder-wall stimulation after all nerves were cut. Simultaneous electrical stimulation and bladder filling needed much shorter stimulation times than bladder filling alone or stimulation alone. If confirmed in humans, this could shorten IVES sessions substantially without altering the contractile results and could indicate that summation of afferent potentials from different triggers is possible. [Copyright &y& Elsevier]

OBJECTIVE To evaluate models for chronic urinary incontinence (UI) in the rat. MATERIALS AND METHODS Two models were fully evaluated: one of repeated dilatation of the vagina, simulating birth trauma, the vaginal dilatation (VD) group; the other, with surgical transposition of the urethra to a vertical position, the urethral transposition (UT) group. The VD rats were evaluated by the sneeze test. When negative, vaginal dilatation was repeated in a similar way. The UT group was evaluated by observation of continuous urine leakage. The leak-point pressure (LPP) was measured at study end in all the rats. RESULTS All the VD rats had occasional negative sneeze tests and all had to be dilated again. This resulted in persistent UI on sneeze testing for the entire period. In the UT group, 12 rats leaked continuously during the whole study period; in the other four UI became less at 4, 5, 6, and 7 weeks, respectively. The LPP in the rats with UI was significantly lower than in the respective control groups. CONCLUSIONS These models permit study of chronic stress UI and continuous UI in the rat. Spontaneous recovery of continence was seen mostly in the VD group. [ABSTRACT FROM AUTHOR]

Objectives: To explore the added value of a repeated ice water test (IWT) and electrical perception threshold (EPT) measurement in the search for a neurologic cause of idiopathic detrusor overactivity (DOA). Methods: The IWT, if originally negative, was repeated up to three times, and EPT measurements were done in 63 patients with neurologic DOA, 117 patients with idiopathic DOA without outflow obstruction, and 30 women with stress urinary incontinence without DOA. Results: Although the IWT was positive in 46% of the neurologic patients if used once, this percentage became 86% when the IWT was repeated. In nonneurologic patients, one IWT was positive in only 7% and when repeated, the positive test rate increased to 24%. IWT, even repeated, remained negative in the women with stress urinary incontinence. The EPTs were not significantly different between the neurologic and nonneurologic patients with a positive IWT, except after the third instillation. In those with negative IWTs, the EPTs were significantly different between the neurologic and nonneurologic patients, independent of the number of IWTs done. If the EPTs were compared within each group between those with positive and negative IWTs, the difference was not significant at the first IWT. However, the difference became statistically significant after two IWTs for the nonneurologic group and after three IWTs for both groups. Conclusions: Our results have shown that repeating the IWT will increase its positivity. Combining the IWT and EPT will reinforce the results of both tests and can indicate more clearly the possibility of an unsuspected neurologic pathologic finding in patients with idiopathic DOA. [Copyright &y& Elsevier]

Abstract: Objective: Previous studies have revealed that intravesical and systemic administration of oxybutinin suppress pelvic afferent nerves. This study evaluates the efficacy of a selective M3 antimuscarinic, darifenacin, on bladder afferent activity. Methods: Sixteen single bladder afferent fibers were isolated in nine female Sprague-Dawley rats. On the basis of their conduction velocities, they were grouped as Aδ or C fibers. The effect of repeat bladder filling was studied on the mechanosensitive properties of these units. The M3 receptor selective muscarinic antagonist darifenacin (0.1mg/kg) was administered intravenously. Unitary afferent activity was again analyzed 30, 60, 90, and 120min after the drug administration. Results: Seven units corresponded to criteria for Aδ fibers, nine for C fibers. Repeat bladder filling did not change nerve activity in Aδ or C fibers. When nerve activity was expressed as a percent of control activity, afferent sensitivity changed after darifenacin in Aδ fibers: 86±27%, 30min (p >0.05), 69±32%, 60min (p <0.05), 56±36%, 90min (p <0.05), and 61±49%, 120min (p >0.05), and in C fibers: 70±39%, 30min (p <0.05), 57±49%, 60min (p <0.05), 45±42%, 90min (p <0.01), and 47±43%, 120min (p <0.01). Conclusions: In this study we show that darifenacin reduces bladder afferent activity in both Aδ and C fibers. The decrease in afferent spikes in C fibers may be more pronounced than that in Aδ fibers. These results may explain that the efficacy of darifenacin in overactive bladder symptoms is partly due to bladder afferent desensitization. [Copyright &y& Elsevier]

Abstract: Objectives: Teaching intimate physical examinations in medical schools generates practical, didactical and ethical problems. At the University of Antwerp, a unique program with intimate examination assistants (IEA) was implemented for fifth year''s undergraduate students. They learn gynaecological and urological skills in healthy volunteers. Technical, communicative and attitude aspects are taken into account. Methods: Description of the implementation of the project. Assessment of the project by questionnaires, written reflections and round table conferences. Results: The results provide detailed information about the student''s perceptions of each component of the program as well as the perceptions of the IEA''s and the teachers. Conclusion: The multilevel evaluation of the program supports the surplus value of working with IEA''s in medical education. The eye-catcher in this program is the integration of clinical skills with communicative skills and attention for students’ attitude. Practice implications: Working with IEA''s for intimate examinations represents a benefit in medical education by lowering the student''s threshold to perform the intimate physical examination on both men and women during their fulltime clerkships. [Copyright &y& Elsevier]

There are two papers in the paediatric urology section this month. The first, from Belgium, assessed the importance of normalising bladder capacity to the age-expected capacity in children with refractory nocturnal enuresis, and evaluated the long-term results when the children reached adolescence. The second paper from the USA assessed the role of apoptosis and proliferation in children with undescended testes. To assess the importance of normalizing bladder capacity to the age-expected capacity in children with refractory monosymptomatic nocturnal enuresis (MNE), and to evaluate the long-term results when these children grow into adolescence. The study included 34 children with refractory MNE; all were treated > 5 years earlier for their MNE using a combined stepwise approach, consisting of retention control training, oxybutynin and an enuresis alarm. Data were obtained on their enuretic state, night-time voiding behaviour and bladder capacity, from a questionnaire and a voiding chart. Before starting treatment, all patients had a bladder capacity that was too small for their age. After the combined stepwise approach, MNE improved in all patients and 24 (71%) were cured. Although the bladder capacity was increased to the age-expected capacity in 26 (76%), most woke at night to void. Currently, at a mean of 7.7 years after the primary treatment, 28 (82%) of the patients are completely dry at night, of whom 15 (54%) arouse to void for 35% of the nights. Six patients (18%) still have some enuretic episodes. Only those who were dry after primary treatment and remained dry had a normal age-expected increase in bladder capacity. For all others there was a decrease in age-related bladder capacity. In patients with refractory MNE, a combined stepwise approach improves and may even eliminate enuresis, but normal night-time bladder behaviour in adolescence and adulthood is only achieved in some. Furthermore, about a fifth still have some enuretic episodes. [ABSTRACT FROM AUTHOR]

Objective: We previously reported a 70% cure rate for bladder biofeedback in children with primary nocturnal enuresis associated with small bladder capacity and detrusor instability. In this paper we report on bladder capacity and incidence of enuresis after 60 months of follow-up and discuss the role of decreased bladder capacity in nocturnal enuresis. Material and Methods: We prospectively evaluated 21 boys and 3 girls (mean age 10.4 years) treated with bladder biofeedback between October 1993 and July 1995. Baseline bladder capacity and capacity at the end of treatment and at 60 months follow-up were determined from a micturition chart. Results: At the end of primary treatment 17/24 patients had stopped bedwetting. In 4/17 responders and 4/7 non-responders the bladder capacity was <9060307040f normal for age. At 60 months, 4 patients had been lost to follow-up, 15 were dry at night and 4 continued bedwetting. One patient underwent surgery and was excluded from the study. Only 2/15 dry patients but 3/4 patients with persistent nocturnal enuresis had a bladder capacity of <9060340630f normal. Conclusions: Bladder biofeedback can be successfully used to treat children with refractory nocturnal enuresis associated with small bladder capacity and unstable detrusor. Normalization of bladder capacity and continuous growth of the bladder in order to keep the capacity normal would seem to be crucial to the long-term resolution of bedwetting in this select patient population. [ABSTRACT FROM AUTHOR]

The innervation of the pelvic region is complex and includes extensive neurologic pathways. The higher centres' organisation determining the pelvic floor and organs' function remains a challenge understanding the physiological and pain mechanisms. Psychological and emotional factors have a profound influence on the pelvic floor and organ dysfunction such as LUTS. LUTS are associated with stress, depression, and anxiety. Neuroception is a subconscious neuronal system for detecting threats and safety and might explain the permanent disturbance of higher brain centres maintaining functional urological and gastrointestinal disorders and sphincter dysfunction. [ABSTRACT FROM AUTHOR]

Highlights from the article: Further, The National Institute for Health and Care Excellence guidelines [https://www.nice.org.uk/guidance/cg139/chapter/2-Research-recommendations] with regard to the reuse of catheters state that "In order to make an "off-licence" recommendation for the use of these catheters, better quality evidence is needed". 7] In addition, the authors proposed in their "Review of intermittent catheterization and current best practices" (1) the use of a new catheter at every occasion of intermittent catheterization to prevent UTI, (2) to consider a hydrophilic catheter to prevent UTI in the case of traumatic catheterization, and (3) a single-use/closed system to prevent UTI in the case of poor catheterization technique and catheter care.[7] The Infectious Diseases Society of America's guideline from 2009 also concluded that the evidence is poor to moderate for recommending multiple-use catheters instead of sterile single-use catheters with regard to bacteriuria or UTI and that there are insufficient data for recommending a cleaning method for multiple-use catheters.[3].

Objectives To study the prevalence of self-reported lower urinary tract symptoms ( LUTS) in women consulting a Gastroenterology clinic with complaints of functional constipation ( FC), fecal incontinence ( FI) or both, compared with a female control population. Also, to study the influence of FC, FI, or both on self-reported LUTS in women attending a Urology clinic. Patients and Methods We present a retrospective study of data collected through a validated self-administered bladder and bowel symptom questionnaire in a tertiary referral hospital from three different female populations: 104 controls, 159 gastroenterological patients and 410 urological patients. Based on the reported bowel symptoms, patients were classified as having FC, FI, a combination of both, or, no FC or FI. LUTS were compared between the control population and the gastroenterological patients, and between urological patients with and without concomitant gastroenterological complaints. Results were corrected for possible confounders through logistic regression analysis. Results The prevalence of LUTS in the control population was similar to large population-based studies. Nocturia was significantly more prevalent in gastroenterological patients with FI compared with the control population [odds ratio ( OR) 9.1]. Female gastroenterological patients with FC more often reported straining to void ( OR 10.3), intermittency ( OR 5.5), need to immediately re-void ( OR 3.7) and feeling of incomplete emptying ( OR 10.5) compared with the control population. In urological patients, urgency (94%) and urgency urinary incontinence ( UUI, 54% of UI) were reported more often by patients with FI than by patients without gastroenterological complaints (58% and 30% of UI respectively), whereas intermittency ( OR 3.6), need to immediately re-void ( OR 2.2) and feeling of incomplete emptying ( OR 2.2) were reported more often by patients with FC than by patients without gastroenterological complaints. Conclusion As LUTS are reported significantly more often by female gastroenterological patients than by a control population, and as there is a difference in self-reported LUTS between female urological patients with different concomitant gastroenterological complaints, we suggest that general practitioners, gastroenterologists and urologists should always include the assessment of symptoms of the other pelvic organ system in their patient evaluation. The clinical correlations between bowel symptoms and LUTS may be explained by underlying neurological mechanisms. [ABSTRACT FROM AUTHOR]

A prerequisite for conscious bladder control is adequate sensory input to the central nervous system, and it is well established that changes in sensory mechanisms can give rise to disturbances in bladder function. Impulses related to the desire to void are believed to course through the pelvic nerves, and those for sensation of a full bladder course through the pudendal nerves. The sense of imminent micturition most probably resides in the urethra, and the desire to void comes from stretching the bladder wall. In addition, a variety of structures play an important role in terms of urethral closure (such as the urethral epithelium, vasculature and smooth muscle) that are necessary to maintain continence. This overview will discuss mechanisms related in part to the urethra involved in activation of bladder reflexes and sensation with a discussion on the mucosa (urothelium and underlying lamina propria) and underlying cellular structures. [ABSTRACT FROM AUTHOR]

Background aims. Damage to smooth muscle has been the primary cause of dysfunction in diabetic bladders. Major changes in the filling phase of the bladder result in the loss of compliance and incomplete emptying in patients. Methods. Cell-based therapies in the lower urinary tract have shown promising results. We argue that because diabetic bladder dysfunction is primarily a problem arising out of altered smooth muscle cells (SMCs), it would be an interesting approach to introduce healthy SMCs into the bladder wall. Results. Furthering this hypothesis, in this experiment, we were successful in introducing syngeneic, healthy SMCs into diabetic bladders. We attempted a method wherein bladder function can be improved in streptozocin-induced diabetes mellitus. Ex vivo--cultured healthy SMCs were introduced into the diabetic bladders of syngeneic Sprague-Dawley rats during the hypercontractile phase after induction of diabetes. Cystometry, metabolic cage evaluation, organ bath studies and histological analyses were performed on the healthy control, the diabetic and the diabetic group transplanted with SMCs. Conclusions. During the 2-week follow-up period after transplantation, we noticed an increase in contractile response of the bladder correlating to a decrease in residual urine. Cell survival studies revealed a cell survival rate close to 1.5%. [ABSTRACT FROM AUTHOR]

Objective. The aims of this study were to check the possibility of observing readiness signs proposed in the literature (Study 1) and to investigate the interrater reliability of observing readiness signs between different researchers (Study 2). Material and methods. In Study 1, 24 healthy children, recruited in Flemish childcare centres, were observed. Each child was observed for 8 h. In this study a list of readiness signs was used as described in a recent literature review on readiness signs in young, healthy children. In Study 2, two observers independently evaluated an adapted list with readiness signs in another 24 healthy children recruited in a similar setting. SPSS was used to analyse the interrater reliability between these observations, calculating Cohen's kappa per readiness sign. Results. The results of Study 1 show that not all readiness signs are easy to assess. This resulted in a shortened checklist with 20 signs, which can be easily observed in young, healthy children during an 8 h period, and which was used in Study 2. The results of Study 2 show that, for most readiness signs, Cohen's kappa and the agreement between observers varied from good to perfect. Conclusions. This article presents the results of two studies that are the first in a series investigating the use of readiness signs. Further research on readiness signs is being conducted to reach consensus on when to start toilet training based on readiness signs, and to obtain evidence-based guidelines. [ABSTRACT FROM AUTHOR]