108 results on '"Urinary Bladder, Underactive"'
Search Results
2. Can Acupoint Low Intensity Shockwave Therapy Improve Bladder Voiding Efficiency
- Author
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Jing-Dung, SHEN, Director of Urology
- Published
- 2024
3. Previously Implanted Pudendal Nerve Stimulation
- Author
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National Institutes of Health (NIH) and Timothy Bruns, Associate Professor of Biomedical Engineering, Medical School
- Published
- 2023
4. Pudendal Nerve Mapping Towards Improved Neuromodulation for Urinary Retention
- Author
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National Institutes of Health (NIH) and Timothy Bruns, Associate Professor of Biomedical Engineering
- Published
- 2023
5. The Treatment Efficacy of Prolotherapy in Bladder Voiding Dysfunction
- Author
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Jing-Dung, SHEN, Senior Urologist
- Published
- 2023
6. Amplifying Sensation in Underactive Bladder (AMPLIFY)
- Published
- 2023
7. Superficial Peroneal Nerve Neuromodulation for Non-Obstructive Urinary Retention
- Author
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Society of Urodynamics, Female Pelvic Medicine & Urogenital Reconstruction, University of North Carolina, Chapel Hill, and Michael Pintauro, Resident Physician
- Published
- 2023
8. Efficacy and Safety of Low-Dose Intravesical OnabotulinumtoxinA Injections in Female Patients With Detrusor Overactivity With Detrusor Underactivity
- Author
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Hyun Seok Na, Chung Lyul Lee, Jae Sung Lim, Ki Hak Song, Ju Hyun Shin, Jong Mok Park, and Ji Yong Lee
- Subjects
urinary bladder, overactive ,urinary bladder, underactive ,botulinum toxins, type a ,Diseases of the genitourinary system. Urology ,RC870-923 - Abstract
Purpose We assessed the effectiveness and safety of using intravesical onabotulinumtoxinA (onabotA; BOTOX) injection with a low dose (75 units) for treating urinary storage symptoms in patients with detrusor overactivity with detrusor underactivity (DODU) compared to using the standard 100 units of onabotA in patients with overactive bladder (OAB). Methods This ambidirectional study included 121 female patients who received intravesical onabotA injections at our hospitals. A total of 87 patients with OAB and 34 patients with DODU were reviewed using a 3-day voiding diary, uroflowmetry, and questionnaires including the International Prostate Symptom Score (IPSS), Overactive Bladder Symptom Score, and Patient Perception of Bladder Condition. Patients were evaluated at baseline, within 2 weeks of treatment, and beyond 3 months after treatment. Results Questionnaire scores of the DODU group demonstrated significant improvement in the short term, with a subsequent decline, but an overall improvement compared to baseline in the long term. Notably, the DODU group exhibited enhanced IPSS voiding scores after the treatment. In the OAB group, most questionnaire scores, excluding the IPSS voiding score, showed significant posttreatment improvement, which was sustained to some extent in the long term. Voiding diary parameters related to storage symptoms were enhanced in both groups. The maximum and mean flow rates decreased in the OAB group but increased in the DODU group, particularly in the short term (P=0.000). The postvoid residual volume increased in both groups after posttreatment, with a mitigated change in the long term. Safety assessments revealed manageable adverse events in both groups with comparable frequencies. Conclusions Low-dose intravesical onabotA for DODU demonstrated a relatively shorter duration of efficacy than OAB. Nonetheless, the treatment improved both storage and voiding symptoms in patients with DODU without significant adverse effects.
- Published
- 2024
- Full Text
- View/download PDF
9. Codesign of an Optical Device to Measure Urine Flow and Volume
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South Tees Hospitals NHS Foundation Trust and John S. Young, Professor of Translational Healthcare
- Published
- 2022
10. Extracoporeal Shock Wave Therapy (ESWT) for the Treatment of Detrusor Underactivity/ Underactive Bladder (DU/UAB)
- Published
- 2022
11. A Study of ASP8302 in Participants With Underactive Bladder
- Published
- 2022
12. Urinary retention after lipoabdominoplasty: case report
- Author
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Taisa Szolomicki, Caio Engelbrecht de Souza, Semer Ali Mahmoud, Michell Fayad André Haddad, Osvaldo Saldanha Filho, and Osvaldo Saldanha
- Subjects
urinary retention ,lipoabdominoplasty ,urinary bladder, underactive ,postoperative complications ,analgesics, opioid ,Surgery ,RD1-811 - Abstract
Introduction: Postoperative urinary retention may predispose to permanent bladder damage. Risk factors include type of anesthesia, type of surgery, and use of anticholinergics, analgesics, and opioids. Once the lesion is established, complementary urodynamic tests are essential for etiological diagnosis and treatment. The objective of this study is to report a case of a patient with urinary retention in the postoperative period of lipoabdominoplasty. Case Report: 27-year-old female patient, without comorbidities or use of continuous medication. She underwent lipoabdominoplasty and evolved postoperatively with urinary retention and bladder distention, diagnosed as detrusor contractility and sensitivity deficit in the urodynamic study. She was maintained in outpatient follow-up with the surgical team and Urology, with a progressive reduction in urinary catheter use and complete removal in eight months of follow-up. Discussion: The objective of aesthetic plastic surgery is to improve the physical appearance of the body. It is subject to complications like other surgical procedures, and pain seems to be the most frequent. Urinary retention may be secondary to the use of opioids, and its diagnosis in the postoperative period of lipoabdominoplasty still has some obstacles. Plication of the rectus muscle diastasis, liposuction, and the use of a compressive abdominal belt make it difficult to identify a possible bladder distention. An episode of bladder overdistention can result in significant morbidity. Conclusion: The present report demonstrated the good evolution of a patient who developed urinary retention in the postoperative period of lipoabdominoplasty. The main diagnostic hypothesis was that it was secondary to the use of opioids.
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- 2023
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13. Delta Q Value to Discriminate Detrusor Underactivity From Bladder Outlet Obstruction
- Author
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Ahmed Maher Gamil Ahmed Higazy, principle investigator
- Published
- 2022
14. Autologous Muscle Derived Cells for Underactive Bladder
- Author
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Jason Gilleran, Principal Investigator
- Published
- 2022
15. DU and BOO in Women With and Without Symptoms of VD
- Published
- 2021
16. A Comparative Analysis of Portable Bladder Scanner to Determine Age/ Volume Specific Accuracy in 0-6 Years of Children
- Published
- 2021
17. Effects of Intravesical Electrical Stimulation on Urinary Adenosine Triphosphate and Nitric Oxide in Rats With Detrusor Underactivity Induced By Bilateral Pelvic Nerve Crush Injury: The Possible Underlying Mechanism
- Author
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Han Deng, Limin Liao, Xing Li, Qinggang Liu, Xuesheng Wang, and Zhonghan Zhou
- Subjects
urinary bladder, underactive ,intravesical electrical stimulation ,bilateral pelvic nerve crush ,adenosine triphosphate ,nitric oxide ,Diseases of the genitourinary system. Urology ,RC870-923 - Abstract
Purpose To explore the effect of intravesical electrical stimulation (IVES) on urinary adenosine triphosphate (ATP) and nitric oxide (NO) in rats with detrusor underactivity (DU) induced by bilateral pelvic nerve crush (bPNC), and to determine the underlying peripheral mechanism. Methods Twenty-four female Sprague-Dawley rats were equally divided into 3 groups: sham; bPNC; and IVES. Rats in the IVES group began to receive IVES treatment 10 days after bPNC (20 minutes per day for 14 consecutive days). After the 14th IVES, rat urine was collected and cystometry was performed. The serum creatinine, blood urea nitrogen, and urinary ATP and NO levels were measured, and a routine urinalysis was performed. Results The maximum cystometric capacity (MCC), maximum changes in bladder pressure during filling (∆FP), and postvoid residual urine (PVR) in the IVES group were significantly lower than the bPNC group, and the maximum changes in bladder pressure during voiding (∆VP) was significantly higher than the bPNC group. Compared with the sham group, the MCC, ∆FP and PVR were significantly increased, and the maximum voiding pressure (MVP) and ∆VP were significantly decreased in the bPNC group. After bPNC, urinary ATP was significantly decreased, and urinary NO was significantly increased. In IVES-treated rats, urinary ATP was significantly higher than the bPNC group, and NO was significantly lower than the bPNC group. In addition, the ATP-to-NO ratio of the rats in the bPNC group was significantly lower than the sham and IVES groups. Correlation analysis showed that the ATP and NO were not correlated with the MCC, ∆FP, MVP, ∆VP, and PVR. Conclusions Promoting the release of urothelial ATP and inhibiting the release of urothelial NO may be one of the peripheral mechanisms underlying IVES in the treatment of DU. Specifically, IVES may shift the balance between excitation and inhibition toward excitation.
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- 2022
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18. Exploratory Study of TAC-302 in Detrusor Underactivity Patients With Overactive Bladder.
- Published
- 2020
19. Detrusor Underactivity: Presentation and Urodynamic Characteristics
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Istishari Urology Center and Fadi Sawaqed, Assistant Professor
- Published
- 2020
20. Urodynamics for Prostate Surgery Trial; Randomised Evaluation of Assessment Methods (UPSTREAM)
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University of Bristol, University of Aberdeen, Newcastle University, Royal Devon and Exeter NHS Foundation Trust, and University of Sheffield
- Published
- 2020
21. Prevalence of Detrusor Underactivity and Bladder Outlet Obstruction in Female Without Cystocele
- Published
- 2019
22. Detrusor Underactivity and Bladder Outlet Obstruction in Women With Cystocele
- Published
- 2019
23. Frequency-Dependent Effects on Bladder Reflex by Saphenous Nerve Stimulation and a Possible Action Mechanism of Tibial Nerve Stimulation in Cats
- Author
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Xing Li, Xiaoping Wan, Zhaoxia Wang, Yanan Liang, Zhuo Jia, Xu Zhang, and Limin Liao
- Subjects
urinary bladder, overactive ,saphenous nerve ,tibial nerve stimulation ,urinary bladder, underactive ,Diseases of the genitourinary system. Urology ,RC870-923 - Abstract
Purpose The present study determined the effects of saphenous nerve stimulation (SNS) at different stimulation frequencies on bladder reflex and explored a possible action mechanism of tibial nerve stimulation (TNS) on bladder activity in cats. Methods Two bipolar nerve cuff electrodes were implanted on the saphenous nerve and the contralateral tibial nerve in 13 cats, respectively. Multiple cystometrograms were obtained to determine the effects of single SNS at different frequencies and that of combined SNS and TNS on the micturition reflex by infusing normal saline. Results SNS at 1 Hz significantly reduced the bladder capacity (BC) to 59.8%±7.7% and 59.3%±5.8% of the control level at the intensity threshold (T) and 2T, respectively (P0.05), while combined stimulation at 1T significantly increased the BC to 122.7%±1.9% of the control level and induced an inhibitory effect which was similar to that TNS at 2T. Conclusions The current study revealed that SNS reduced and increased BC depending on different stimulation frequencies. The combined SNS and TNS maximized the clinical efficacy at a low intensity. Also, SNS may be a potential therapeutic mechanism of TNS.
- Published
- 2021
- Full Text
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24. BOO and DU and Their Clinical and Urodynamic Findings in Women With ≥Stage II Cystocele
- Published
- 2018
25. Management of Urinary Incontinence With Underactive Bladder: A Review
- Author
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Kang Jun Cho and Joon Chul Kim
- Subjects
urinary incontinence ,urinary bladder, underactive ,therapeutics ,Diseases of the genitourinary system. Urology ,RC870-923 - Abstract
Urinary incontinence is caused by storage function failure, while underactive bladder (UAB) is caused by a decline in detrusor contractility and voiding dysfunction. As the treatment mechanisms for incontinence and UAB are contrary to each other, it is difficult to treat both incontinence and UAB, and the patient’s quality of life can be further degraded. Conventional midurethral sling (MUS), such as transobturator tape or retropubic MUS, introduces a risk of postoperative voiding dysfunction in stress urinary incontinence with UAB. However, there have been several reports about the efficacy and safety of conventional MUS. Adjustable sling procedures, such as transobturator adjustable tape or the Remeex system, have better outcomes than conventional MUS because they control tension both during and after surgery. When voiding dysfunction occurs after incontinence treatment with UAB, voiding symptoms can be improved by various therapeutic modalities. Clean intermittent catheterization is recommended for patients with significant increased postvoid residual volumes or urinary retention. Although pharmacotherapy such as with alpha-blockers or parasympathomimetics can be considered for UAB, there is insufficient evidence of their effect on incontinence with UAB. Future therapies, such as stem cell therapy or gene therapy, may be used to treat incontinence with UAB. The possibility of management urgency urinary incontinence that related to detrusor hyperactivity with impaired contractility using sacral neuromodulation has been suggested. Further research is needed to establish evidence for the efficacy and safety of treatments for incontinence with UAB and improve patient quality of life.
- Published
- 2020
- Full Text
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26. Efficacy and Safety of Low-Dose Intravesical OnabotulinumtoxinA Injections in Female Patients With Detrusor Overactivity With Detrusor Underactivity.
- Author
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Na HS, Lee CL, Lim JS, Song KH, Shin JH, Park JM, and Lee JY
- Abstract
Purpose: We assessed the effectiveness and safety of using intravesical onabotulinumtoxinA (onabotA; BOTOX) injection with a low dose (75 units) for treating urinary storage symptoms in patients with detrusor overactivity with detrusor underactivity (DODU) compared to using the standard 100 units of onabotA in patients with overactive bladder (OAB)., Methods: This ambidirectional study included 121 female patients who received intravesical onabotA injections at our hospitals. A total of 87 patients with OAB and 34 patients with DODU were reviewed using a 3-day voiding diary, uroflowmetry, and questionnaires including the International Prostate Symptom Score (IPSS), Overactive Bladder Symptom Score, and Patient Perception of Bladder Condition. Patients were evaluated at baseline, within 2 weeks of treatment, and beyond 3 months after treatment., Results: Questionnaire scores of the DODU group demonstrated significant improvement in the short term, with a subsequent decline, but an overall improvement compared to baseline in the long term. Notably, the DODU group exhibited enhanced IPSS voiding scores after the treatment. In the OAB group, most questionnaire scores, excluding the IPSS voiding score, showed significant posttreatment improvement, which was sustained to some extent in the long term. Voiding diary parameters related to storage symptoms were enhanced in both groups. The maximum and mean flow rates decreased in the OAB group but increased in the DODU group, particularly in the short term (P=0.000). The postvoid residual volume increased in both groups after posttreatment, with a mitigated change in the long term. Safety assessments revealed manageable adverse events in both groups with comparable frequencies., Conclusion: Low-dose intravesical onabotA for DODU demonstrated a relatively shorter duration of efficacy than OAB. Nonetheless, the treatment improved both storage and voiding symptoms in patients with DODU without significant adverse effects.
- Published
- 2024
- Full Text
- View/download PDF
27. An automatic diagnostic system for the urodynamic study applying in lower urinary tract dysfunction.
- Author
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Ding Z, Zhang W, Wang H, Ke H, Su D, Wang Q, Bian K, Su F, and Xu K
- Subjects
- Humans, Urinary Bladder, Algorithms, Machine Learning, Urodynamics, Urinary Bladder, Underactive
- Abstract
Objective: To establish an automatic diagnostic system based on machine learning for preliminarily analysis of urodynamic study applying in lower urinary tract dysfunction (LUTD)., Methods: The eight most common conditions of LUTDs were included in the present study. A total of 527 eligible patients with complete data, from the year of 2015 to 2020, were enrolled in this study. In total, two global parameters (patients' age and sex) and 13 urodynamic parameters were considered to be the input for machine learning algorithms. Three machine learning approaches were applied and evaluated in this study, including Decision Tree (DT), Logistic Regression (LR), and Support Vector Machine (SVM)., Results: By applying machine learning algorithms into the 8 common LUTDs, the DT models achieved the AUC of 0.63-0.98, the LR models achieved the AUC of 0.73-0.99, and the SVM models achieved the AUC of 0.64-1.00. For mutually exclusive diagnoses of underactive detrusor and acontractile detrusor, we developed a classification model that classifies the patients into either of these two diseases or double-negative class. For this classification method, the DT models achieved the AUC of 0.82-0.85 and the SVM models achieved the AUC of 0.86-0.90. Among all these models, the LR and the SVM models showed better performance. The best model of these diagnostic tasks achieved an average AUC of 0.90 (0.90 ± 0.08)., Conclusions: An automatic diagnostic system was developed using three machine learning models in urodynamic studies. This automated machine learning process could lead to promising assistance and enhancements of diagnosis and provide more useful reference for LUTD treatment., (© 2023. The Author(s), under exclusive licence to Springer Nature B.V.)
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- 2024
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28. EP2 and EP3 receptors as therapeutic targets for underactive bladder/detrusor underactivity due to diabetic cystopathy in a type 1 diabetic rat model.
- Author
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Sekido, Noritoshi, Otsuki, Takeya, Kida, Jun, Mashimo, Hiroko, Wakamatsu, Daisuke, Okada, Hiroki, and Matsuya, Hidekazu
- Subjects
- *
HYPOKINESIA , *BLADDER , *PEOPLE with diabetes , *DRUG carriers , *DRUG administration - Abstract
Objectives: Diabetic cystopathy (DC) is recognized as one of the major etiologies of underactive bladder (UAB)/detrusor underactivity (DU). Although DC was first reported about three decades ago, there is a distinct lack of effective pharmacological management methods for UAB/DU due to DC with a robust certainty of evidence. In this study, we investigated whether EP2 and EP3 receptors are promising targets of pharmacological management of UAB/DU due to DC. Methods: We used streptozotocin (STZ)‐induced diabetic Sprague‐Dawley rats with postvoid residual urine (PVR) greater than 0.1 mL. Sixteen weeks after induction of diabetes, we performed awake single cystometry after oral administration of the vehicle, an α‐blocker (tamsulosin [TAM], 0.1 and 0.3 mg/kg), a cholinesterase inhibitor (distigmine [DIS], 0.3 and 1.0 mg/kg), or an EP2/3 dual agonist (ONO‐8055, 0.01 and 0.03 mg/kg). We compared cystometric parameters after administration of the vehicle and drugs using a paired t test. P <.05 was considered to be statistically significant. Results: Compared with the vehicle, TAM significantly decreased maximum intravesical pressure during voiding (Pmax), while DIS significantly increased it. However, neither drug significantly affected PVR or the residual urine rate (RUR). On the other hand, ONO‐8055 significantly decreased PVR and tended to decrease RUR, although it did not significantly affect Pmax. Conclusion: The present study was unable to demonstrate that stimulation of EP2 and EP3 receptors caused major improvements in UAB/DU due to DC. However, this equivocal result could arise from inherent limitations of the STZ‐induced diabetic rat as a UAB/DU model. [ABSTRACT FROM AUTHOR]
- Published
- 2020
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29. Screening for Zinner Syndrome in Patients With a Congenitally Solitary Kidney: Lessons Learned.
- Author
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Bearrick EN and Husmann DA
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- Male, Infant, Newborn, Humans, Child, Preschool, Seminal Vesicles surgery, Urinary Bladder, Solitary Kidney complications, Urinary Bladder, Underactive, Cysts complications, Cysts surgery
- Abstract
Purpose: We determined if serial screening ultrasounds are beneficial in evaluating for the development of Zinner syndrome in males with a congenital solitary kidney., Materials and Methods: All patients included had their congenital solitary kidney diagnosed at <20 years of age and had to be ≥20 at their last visit. Individuals were seen annually, with pelvic ultrasounds to screen for mesonephric duct cysts obtained at birth and every year of age, divisible by 5., Results: At a median follow-up of 38 years of age (range 20-57), 17% (20/121) developed Zinner syndrome, with 60% (12/20) developing clinical symptoms. The yield for screening ultrasound studies was significantly higher in patients ≤20 years of age at 3.5% (12/340), compared to 0.33% (1/296) in patients >20 years of age ( P = .004). Serial ultrasounds reveal the onset of lower urinary tract and cyst-related pain symptoms are associated with the growth of the seminal vesicle cyst to ≥5 cm ( P = .0198). Of symptomatic patients, 75% (8/12) had abnormal uroflows. Complete urodynamic studies revealed findings consistent with bladder outlet obstruction in 38% (3/8), equivocal for obstruction in 24% (2/8), and detrusor underactivity in 38% (3/8). Cyst excision effectively resolved voiding symptoms that were obstructive in etiology but failed to resolve symptoms in patients with detrusor underactivity., Conclusions: Serial ultrasound evaluations reveal that cyst growth to ≥5 cm in size is highly related to the onset of clinical symptoms, with the resolution of voiding symptoms by cyst excision directly associated with urodynamic findings.
- Published
- 2023
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30. Re: Yuan Chi Shen, Chien Hsu Chen, Michael B. Chancellor, Yao-Chi Chuang. Prospective, Randomized, Double-blind, Placebo-controlled, Pilot Study of Extracorporeal Shock Wave Therapy for Detrusor Underactivity/Underactive Bladder. Eur Urol Focus. In press. https://doi.org/10.1016/j.euf.2022.11.011.
- Author
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Usmani A, Misra A, and Pratap Singh U
- Subjects
- Humans, Pilot Projects, Prospective Studies, Urinary Bladder, Randomized Controlled Trials as Topic, Extracorporeal Shockwave Therapy, Urinary Bladder, Underactive
- Published
- 2023
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31. Safety And Efficacy Of Solifenacin In Men With Overactive Bladder (OAB) And Detrusor Underactivity
- Published
- 2008
32. Transcriptomics Reveals Molecular Features of the Bilateral Pelvic Nerve Injury Rat Model of Detrusor Underactivity.
- Author
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Wang J, Ren L, Liu X, Xu W, Liu M, Hu P, Wang T, Liu J, and Ling Q
- Subjects
- Animals, Rats, Transcriptome, Gene Expression Profiling, RNA-Seq, Cell Cycle, Urinary Bladder, Underactive, Peripheral Nervous System Diseases
- Abstract
The pathogenesis of detrusor underactivity (DU) is unclear, and the available therapeutic effects are unsatisfactory. We propose to find key molecules and pathways related to DU based on transcriptome sequencing. A rat model of bilateral pelvic nerve injury (BPNI) was established. Bladder tissues from the sham-operated group, 3 and 28 days after BPNI mapping, were taken for urodynamics, histopathology, and RNA-seq. An enrichment analysis of the screened differential expression genes was performed. Three days after BPNI, the results showed urodynamic features of overflow incontinence, while there was a recovery at 28 days after the operation. Masson staining revealed collagen deposition accompanied by progressive thickening of the smooth muscle layer as DU progressed. RNA-seq results suggested that a total of 1808 differentially expressed genes (DEGs) differed among the groups. RNA-seq and subsequent analysis confirmed that the cell cycle and immune response were significantly activated 3 days after BPNI, while extracellular matrix remodeling occurred 28 days after BPNI. Partial DEGs and pathways were verified by qRT-PCR. Validation of key proteins involved in cell cycle, inflammation, and fibrosis was performed by immunohistochemical staining and western blot, respectively. These molecular expression patterns at different time points after BPNI injury provide valuable insights into the search for therapeutic targets for DU.
- Published
- 2023
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33. A Preclinical Study of Human Embryonic Stem Cell-Derived Mesenchymal Stem Cells for Treating Detrusor Underactivity by Chronic Bladder Ischemia
- Author
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Jisun Lim, Hwan Yeul Yu, Ki-Sung Hong, Dong-Myung Shin, Juhyun Park, Chae-Min Ryu, Jung Hyun Shin, Seungun Lee, HongDuck Yun, Jinbeom Heo, Hyung-Min Chung, and Myung-Soo Choo
- Subjects
Male ,medicine.medical_specialty ,Embryonic stem cells ,Angiogenesis ,media_common.quotation_subject ,Human Embryonic Stem Cells ,Urinary Bladder ,Ischemia ,Urology ,Vimentin ,Multipotent mesenchymal stem cells ,Urination ,Article ,Rats, Sprague-Dawley ,Urinary Bladder, Underactive ,Medicine ,Animals ,Humans ,media_common ,biology ,medicine.diagnostic_test ,business.industry ,Mesenchymal stem cell ,Cystometry ,Chronic bladder ischemia ,Mesenchymal Stem Cells ,General Medicine ,medicine.disease ,Detrusor underactivity ,Muscle atrophy ,Rats ,Disease Models, Animal ,biology.protein ,medicine.symptom ,Stem cell ,business - Abstract
Background The therapeutic effects of human embryonic stem cell-derived multipotent mesenchymal stem cells (M-MSCs) were evaluated for detrusor underactivity (DUA) in a rat model with atherosclerosis-induced chronic bladder ischemia (CBI) and associated mechanisms. Methods Sixteen-week-old male Sprague–Dawley rats were divided into five groups (n = 10). The DUA groups underwent 30 bilateral repetitions of endothelial injury to the iliac arteries to induce CBI, while the sham control group underwent a sham operation. All rats used in this study received a 1.25% cholesterol diet for 8 weeks. M-MSCs at a density of 2.5, 5.0, or 10.0 × 105 cells (250 K, 500 K, or 1000 K; K = a thousand) were injected directly into the bladder 7 weeks post-injury, while the sham and DUA group were treated only with vehicle (phosphate buffer solution). One week after M-MSC injection, awake cystometry was performed on the rats. Then, the bladders were harvested, studied in an organ bath, and prepared for histological and gene expression analyses. Results CBI by iliac artery injury reproduced voiding defects characteristic of DUA with decreased micturition pressure, increased micturition interval, and a larger residual volume. The pathological DUA properties were improved by M-MSC treatment in a dose-dependent manner, with the 1000 K group producing the best efficacy. Histological analysis revealed that M-MSC therapy reduced CBI-induced injuries including bladder fibrosis, muscular loss, and apoptosis. Transplanted M-MSCs mainly engrafted as vimentin and NG2 positive pericytes rather than myocytes, leading to increased angiogenesis in the CBI bladder. Transcriptomes of the CBI-injured bladders were characterized by the complement system, inflammatory, and ion transport-related pathways, which were restored by M-MSC therapy. Conclusions Single injection of M-MSCs directly into the bladder of a CBI-induced DUA rat model improved voiding profiles and repaired the bladder muscle atrophy in a dose-dependent manner. Graphical abstract
- Published
- 2021
34. Detrusor underactivity causes neurogenic voiding dysfunction in a rat bilateral accessory nerve-injury model
- Author
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Kazunori Kimura, Tomoya Kataoka, Yuji Hotta, Ryoya Kawata, and Kotomi Maeda
- Subjects
0301 basic medicine ,Male ,medicine.medical_specialty ,Contraction (grammar) ,Mrna expression ,Accessory Nerve Injuries ,Urinary Bladder ,Urology ,Gene Expression ,Isometric exercise ,RM1-950 ,urologic and male genital diseases ,03 medical and health sciences ,chemistry.chemical_compound ,0302 clinical medicine ,Isometric Contraction ,Urinary Bladder, Underactive ,Medicine ,Animals ,Receptors, Cholinergic ,RNA, Messenger ,Rats, Wistar ,Urinary Bladder, Neurogenic ,Neurotransmitter ,Accessory nerve injury ,Acetylcholine receptor ,Pharmacology ,Neurotransmitter Agents ,business.industry ,Detrusor contractility ,Detrusor underactivity ,female genital diseases and pregnancy complications ,Voiding dysfunction ,Disease Models, Animal ,030104 developmental biology ,chemistry ,Molecular Medicine ,Cholinergic ,Rat ,Carbachol ,Therapeutics. Pharmacology ,business ,030217 neurology & neurosurgery - Abstract
We aimed to investigate detrusor function in a previously developed rat neurogenic voiding dysfunction model that we have developed previously. We performed sham or bilateral accessory nerve injury (BACNI) surgeries on ten-week-old male Wistar/ST rats. One week after surgery, we evaluated detrusor contractility in the bladder using isometric tension and mRNA expression assays. Cholinergic contraction was attenuated in the injury model, whereas carbachol-evoked contraction was enhanced, and mRNA expression of the cholinergic receptor increased. These findings suggest that there was a reduction in neurotransmitter release causing detrusor underactivity.
- Published
- 2021
35. Therapeutic effect of Low intensity Extracorporeal Shock Wave Therapy (Li-ESWT) on diabetic bladder dysfunction in a rat model
- Author
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Yung-Shun Juan, Fang-Hsiang Tang, Jhen-Hao Jhan, Yung-Chin Lee, Kun-Ling Lin, Cheng-Yu Long, Tusty-Jiuan Hsieh, and Hsun-Shuan Wang
- Subjects
Extracorporeal Shockwave Therapy ,medicine.medical_specialty ,media_common.quotation_subject ,Urinary Bladder ,Urology ,bladder dysfunction ,low intensity extracorporeal shock wave ,Urination ,Streptozocin ,Diabetes Mellitus, Experimental ,Diabetes Complications ,03 medical and health sciences ,0302 clinical medicine ,Diabetes mellitus ,Urinary Bladder, Underactive ,medicine ,Animals ,Humans ,media_common ,Urinary continence ,medicine.diagnostic_test ,business.industry ,Urinary Bladder, Overactive ,Therapeutic effect ,Cystometry ,General Medicine ,Streptozotocin ,medicine.disease ,Rats ,Urethra ,medicine.anatomical_structure ,Erectile dysfunction ,diabetes mellitus ,030211 gastroenterology & hepatology ,Female ,business ,medicine.drug ,Research Paper - Abstract
Objectives: Low intensity extracorporeal shock wave therapy (Li-ESWT) has proven to be effective and safe for the treatment of various urological disorders including erectile dysfunction and chronic pelvic pain syndrome. In this study, we elucidated the therapeutic effect and possible mechanisms of Li-ESWT on diabetic bladder dysfunction (DBD) in a rat model. Materials and Methods: In all, thirty-two female Sprague-Dawley rats were divided into three groups: normal control (NC), diabetes mellitus (DM) control, and DM Li-ESWT. The two DM groups were given high fat diets for one month, followed by 2 intraperitoneal injections of streptozotocin (STZ) 30 mg/kg separated by one week. Body weight and fasting blood glucose were monitored every week. Only rats with fasting blood glucose 140 mg/dL or more were considered diabetic and used in the subsequent portions of the study. The Li-ESWTs were applied toward the pelvis of the rats twice a week for 4 weeks with energy flux density (EFD) 0.02 mJ/mm2, 500 shocks, at 3Hz. All rats underwent plasma insulin tolerance test, conscious cystometry, leak-point pressure (LPP) assessment, and immunohistochemical studies. Results: DM groups had significantly lower insulin sensitivity and higher body weight. Conscious cystometry also revealed voiding dysfunctions. In the DM Li-ESWT group, the rats had significantly improved voiding functions that were reflected in longer micturition intervals and higher LPP compared to DM control. Immunofluorescence in DM control groups showed increased tyrosine hydroxylase (TH) expression and decreased neuronal nitric oxide synthase (nNOS) expression in the longitudinal urethral smooth muscles. Besides, rats had dilations and deformities of suburothelium capillary network of the bladder, revealing the deterioration of the nerve function of the urethra and destruction of the vascularization of the bladder. However, the DM Li-ESWT group exhibited recovery of the nerve expression of the urethra and vascularization of bladder. Conclusions: Li-ESWT ameliorates the bladder dysfunction and urinary continence in the DBD rat model, reflected in restoration of the nerve expression of the urethra and the vascularization of the bladder. Non-invasive Li-ESWT could be an alternative therapeutic option for DBD.
- Published
- 2021
36. Prevalence of detrusor underactivity and bladder outlet obstruction in women with cystocele and changes in voiding function after cystocele repair
- Author
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Ting-Chen Chang, Sheng-Mou Hsiao, Pei-Chi Wu, and Ho-Hsiung Lin
- Subjects
medicine.medical_specialty ,Urology ,Cystocele repair ,03 medical and health sciences ,Bladder outlet obstruction ,0302 clinical medicine ,Enuresis ,Lower urinary tract symptoms ,Urinary Bladder, Underactive ,Prevalence ,Medicine ,Nocturia ,Humans ,Pressure transmission ratio ,lcsh:R5-920 ,business.industry ,General Medicine ,medicine.disease ,Detrusor underactivity ,Urinary Bladder Neck Obstruction ,Urodynamics ,030220 oncology & carcinogenesis ,Detrusor pressure ,030211 gastroenterology & hepatology ,Female ,medicine.symptom ,Bladder diary ,business ,lcsh:Medicine (General) ,Cystocele ,Urinary bladder outlet obstruction - Abstract
Purpose: To evaluate the prevalence of detrusor underactivity (DU) and bladder outlet obstruction (BOO) in women with high-grade cystocele and the impacts of cystocele repair. Methods: Between November 2010 and September 2018, women with ≥stage II cystocele were included. DU (detrusor pressure at maximum flow rate (PdetQmax)
- Published
- 2020
37. Sacral neuromodulation in patients with detrusor underactivity: Is biological sex an indicator
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Rahmi Onur, Sona Tayebi, Hanieh Salehi‐Pourmehr, Elham Jahantabi, Marie‐Aimee Perrouin‐Verbe, Changiz Naseri, Sakineh Hajebrahimi, Hashim Hashim, and ONUR A. R., Tayebi S., Salehi-Pourmehr H., Jahantabi E., Perrouin-Verbe M., Naseri C., Hajebrahimi S., Hashim H.
- Subjects
Adult ,Male ,Internal Diseases ,Sacrum ,BLADDER OUTLET OBSTRUCTION ,detrusor underactivity ,Urology ,Electric Stimulation Therapy ,Sağlık Bilimleri ,İç Hastalıkları ,Clinical Medicine (MED) ,sacral neuromodulation ,Young Adult ,UROLOGY & NEPHROLOGY ,Urinary Bladder, Underactive ,Health Sciences ,Humans ,Klinik Tıp (MED) ,ÜROLOJİ VE NEFROLOJİ ,Retrospective Studies ,Internal Medicine Sciences ,Klinik Tıp ,underactive bladder ,Dahili Tıp Bilimleri ,etrusor underactivity ,Middle Aged ,Urinary Retention ,CLINICAL MEDICINE ,CONTRACTILITY ,Tıp ,Treatment Outcome ,Nefroloji ,Nephrology ,outcome ,Medicine ,Female ,Neurology (clinical) - Abstract
Objectives This study aimed to report sacral neuromodulation (SNM) outcomes in detrusor underactivity (DU). Methods A multicentric, multinational, retrospective case series was conducted between March 2017 and June 2021 in three different referral centers. Initial test phase stimulation included either a percutaneous nerve evaluation (PNE) or an advanced lead evaluation test phase (ALTP) before permanent SNM implantation. The test phases were performed under local anesthesia, either in the outpatient (PNE) or operating room (ALTP), in the prone position, which was implanted in the third or fourth sacral foramina under fluoroscopic guidance. Patients with favorable response to the initial test phase during the first 2 weeks underwent the implantable pulse generator (IPG) implantation (Medtronic neurostimulation generator device InterStim (TM)). Favorable response was defined as >= 50% improvement in symptoms, frequency of clean intermittent catheterization (CIC) and/or decrease in postvoid residual (PVR), increase in voided volume, or improvement in bladder voiding efficiency (BVE) based on the bladder diary. Results Fifty-eight patients were recruited with a mean age of 39.95 +/- 15.28 years. Among the 58 cases, 36 (62.1%) patients responded to the initial stage. Of these, 12 patients (30.8%) with non-neurogenic etiology and nine patients (52.9%) with neurologic etiology did not respond to the initial test phase; thus, they did not undergo full implantation (p = 0.141). Voided volume, PVR, and the median maximum flow rate (Qmax) improved significantly (p < 0.001) in both sexes; however, there was no statistical difference between both genders. Most female cases (78.3%), and nearly half of the men (51.4%), responded to the test phase and were candidates for the IPG phase. Among the 35 cases who underwent IPG, 27 patients (72.2% of males, and 77.8% of females; p = 0.700) had a favorable response to IPG. 46.6% of patients had a successful outcome at the end of the study. Conclusion This multicentric study showed that SNM effectively and safely provided symptom improvement in refractory DU in males similar to females which is an important finding as previously it has been suggested that SNM works better in nonobstructive urinary retention in women and not in women.
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- 2022
38. Implications of underactive bladder syndrome for nocturia:Do we need urodynamic assessment?
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Ifeoma Offiah, Marcus J. Drake, and Andrew Gammie
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Urodynamics ,Lower Urinary Tract Symptoms ,Urology ,Urinary Bladder ,Urinary Bladder, Underactive ,Humans ,Nocturia ,Syndrome ,urologic and male genital diseases ,female genital diseases and pregnancy complications - Abstract
Nocturia is a common urological symptom defined by the International Continence Society (ICS) as “the number of times urine is passed during the main sleep period. Having woken to pass urine for the first time, each urination must be followed by sleep or the intention to sleep. This should be quantified using a bladder diary” [ [1] ]. The prevalence of nocturia is high in both genders and increases with age. Nocturia or nocturnal polyuria can be caused by wide-ranging nonurological factors, such as cardiovascular disease, obstructive sleep apnoea, polypharmacy, or learnt behaviour. These mainly contribute to an increase in the rate of urine production. Alongside these, factors impairing the reservoir function of the bladder need to be considered. Underactive bladder (UAB) is characterized by a slow urinary stream, hesitancy, and straining to void, with or without a feeling of incomplete bladder emptying, sometimes with storage symptoms [ [2] ]. UAB has a varied phenotype, and for many patients with UAB the storage symptoms can be prominent and problematic. Urgency and increased daytime frequency are present in a large proportion of patients, meaning that overactive bladder syndrome (OAB) commonly coexists with UAB.
- Published
- 2022
39. Wireless, Fully Implantable and Expandable Electronic System for Bidirectional Electrical Neuromodulation of the Urinary Bladder.
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Lee JH, Jang TM, Shin JW, Lim BH, Rajaram K, Han WB, Ko GJ, Yang SM, Han S, Kim DJ, Kang H, Lim JH, Lee KS, Park E, and Hwang SW
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- Animals, Urinary Bladder, Urinary Bladder, Underactive
- Abstract
Current standard clinical options for patients with detrusor underactivity (DUA) or underactive bladder─the inability to release urine naturally─include the use of medications, voiding techniques, and intermittent catheterization, for which the patient inserts a tube directly into the urethra to eliminate urine. Although those are life-saving techniques, there are still unfavorable side effects, including urinary tract infection (UTI), urethritis, irritation, and discomfort. Here, we report a wireless, fully implantable, and expandable electronic complex that enables elaborate management of abnormal bladder function via seamless integrations with the urinary bladder. Such electronics can not only record multiple physiological parameters simultaneously but also provide direct electrical stimulation based on a feedback control system. Uniform distribution of multiple stimulation electrodes via mesh-type geometry realizes low-impedance characteristics, which improves voiding/urination efficiency at the desired times. In vivo evaluations using live, free-moving animal models demonstrate system-level functionality.
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- 2023
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40. Detrusor underactivity is associated with metabolic syndrome in aged primates.
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Biscola NP, Bartmeyer PM, Christe KL, Colman RJ, and Havton LA
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- Aged, Animals, Female, Humans, Macaca mulatta, Quality of Life, Urinary Bladder, Urodynamics physiology, Urinary Bladder, Underactive, Metabolic Syndrome complications
- Abstract
Lower urinary tract (LUT) dysfunction is prevalent in the elderly population, and clinical manifestations include urinary retention, incontinence, and recurrent urinary tract infections. Age-associated LUT dysfunction is responsible for significant morbidity, compromised quality of life, and rising healthcare costs in older adults, but its pathophysiology is not well understood. We aimed to investigate the effects of aging on LUT function by urodynamic studies and metabolic markers in non-human primates. Adult (n = 27) and aged (n = 20) female rhesus macaques were evaluated by urodynamic and metabolic studies. Cystometry showed detrusor underactivity (DU) with increased bladder capacity and compliance in aged subjects. Metabolic syndrome indicators were present in the aged subjects, including increased weight, triglycerides, lactate dehydrogenase (LDH), alanine aminotransferase (ALT), and high sensitivity C-reactive protein (hsCRP), whereas aspartate aminotransferase (AST) was unaffected and the AST/ALT ratio reduced. Principal component analysis and paired correlations showed a strong association between DU and metabolic syndrome markers in aged primates with DU but not in aged primates without DU. The findings were unaffected by prior pregnancies, parity, and menopause. Our findings provide insights into possible mechanisms for age-associated DU and may guide new strategies to prevent and treat LUT dysfunction in older adults., (© 2023. This is a U.S. Government work and not under copyright protection in the US; foreign copyright protection may apply.)
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- 2023
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41. Loss of resilience contributes to detrusor underactivity in advanced age.
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Ramasamy R, Baker DS, Lemtiri-Chlieh F, Rosenberg DA, Woon E, Al-Naggar IM, Hardy CC, Levine ES, Kuchel GA, Bartley JM, and Smith PP
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- Mice, Animals, Urinary Bladder, Aging physiology, Urinary Bladder, Underactive
- Abstract
Volume hyposensitivity resulting from impaired sympathetic detrusor relaxation during bladder filling contributes to detrusor underactivity (DU) associated with aging. Detrusor tension regulation provides an adaptive sensory input of bladder volume to the brainstem and is challenged by physiological stressors superimposed upon biological aging. We recently showed that HCN channels have a stabilizing role in detrusor sympathetic relaxation. While mature mice maintain homeostasis in the face of stressors, old mice are not always capable. In old mice, there is a dichotomous phenotype, in which resilient mice adapt and maintain homeostasis, while non-resilient mice fail to maintain physiologic homeostasis. In this DU model, we used cystometry as a stressor to categorize mice as old-responders (old-R, develop a filling/voiding cycle) or old-non-responders (old-NR, fail to develop a filling/voiding cycle; fluctuating high pressures and continuous leaking), while also assessing functional and molecular differences. Lamotrigine (HCN activator)-induced bladder relaxation is diminished in old-NR mice following HCN-blockade. Relaxation responses to NS 1619 were reduced in old-NR mice, with the effect lost following HCN-blockade. However, RNA-sequencing revealed no differences in HCN gene expression and electrophysiology studies showed similar percentage of detrusor myocytes expressing HCN (I
h ) current between old-R and old-NR mice. Our murine model of DU further defines a role for HCN, with failure of adaptive recalibration of HCN participation and intensity of HCN-mediated stabilization, while genomic studies show upregulated myofibroblast and fibrosis pathways and downregulated neurotransmitter-degradation pathways in old-NR mice. Thus, the DU phenotype is multifactorial and represents the accumulation of age-associated loss in homeostatic mechanisms., (© 2022. The Author(s), under exclusive licence to Springer Nature B.V.)- Published
- 2023
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42. Induction of detrusor underactivity by extensive vascular endothelial damages of iliac arteries in a rat model and its pathophysiology in the genetic levels
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Myong Kim, Jisun Lim, Chae Min Ryu, Hyein Ju, Dong-Myung Shin, Hwan Yeul Yu, Myung Soo Choo, Jinbeom Heo, Jung Hyun Shin, Hong Duck Yun, Aram Kim, Jae Hoon Lee, and Seungun Lee
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Male ,0301 basic medicine ,Muscle tissue ,medicine.medical_specialty ,Bladder ,media_common.quotation_subject ,Urinary Bladder ,030232 urology & nephrology ,Ischemia ,Urology ,lcsh:Medicine ,Iliac Artery ,Urination ,Article ,Rats, Sprague-Dawley ,03 medical and health sciences ,0302 clinical medicine ,Fibrosis ,Urinary Bladder, Underactive ,Animals ,Medicine ,lcsh:Science ,media_common ,Denervation ,Multidisciplinary ,medicine.diagnostic_test ,business.industry ,Purinergic receptor ,lcsh:R ,Cystometry ,Muscle, Smooth ,Genomics ,medicine.disease ,Pathophysiology ,Rats ,Urodynamics ,030104 developmental biology ,medicine.anatomical_structure ,Gene Expression Regulation ,lcsh:Q ,Endothelium, Vascular ,Bladder disease ,business - Abstract
We tried to establish a reliable detrusor underactivity (DUA) rat model and to investigate pathophysiology of chronic bladder ischemia (CBI) on voiding behavior and bladder function. Adult male rats were divided into five groups. The arterial injury (AI) groups (AI-10, AI-20, AI-30) underwent vascular endothelial damage (VED) of bilateral iliac arteries (with 10, 20, and 30 bilateral repetitions of injury, respectively) and received a 1.25% cholesterol diet. The sham group underwent sham operation and received the same diet. Controls received a regular diet. After 8 weeks, all rats underwent unanesthetized cystometrogram. Bladder tissues were processed for organ bath investigation, immunohistochemistry staining, and genome-wide gene expression analysis. Awake cystometry analysis showed that frequency of voiding contractions and micturition pressure were lower in the AI-30 group than in sham group (p
- Published
- 2019
43. Age is associated with reduced urethral pressure and afferent activity in rat
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Zachary C. Danziger and Arezoo Geramipour
- Subjects
medicine.medical_specialty ,Physiology ,Pudendal nerve ,Urinary system ,Urinary Bladder ,H&E stain ,Urology ,Sensory system ,Stimulus (physiology) ,pudendal afferents activity ,Nerve Fibers, Myelinated ,Rats, Sprague-Dawley ,Myelin ,Urethra ,Physiology (medical) ,Urinary Bladder, Underactive ,Medicine ,Animals ,QP1-981 ,Neurons, Afferent ,business.industry ,aging ,Original Articles ,intraurethral pressure ,Rats ,medicine.anatomical_structure ,Reflex ,Female ,Original Article ,neuropathy ,business - Abstract
Age‐related changes in the lower urinary tract (LUT) can affect the coordination of reflexes and increase the incidence of bladder disorders in elderly. This study examines the age‐related loss of urethral signaling capability by measuring the afferent activity directly. We find that less urethral pressure develops in response to fluid flow in old rats compared to young rats and that pressure and flow evoke less urethral afferent activation. These findings are consistent with our previous study demonstrating that the urethra‐to‐bladder reflex, which is required for efficient voiding, becomes weaker with age. We measured the pudendal afferent response in young (4–7 months) and old (18–24 months) rats to fluid flow in the urethra across a range of flow rates. We used paraffin embedding and hematoxylin and eosin staining to quantify age‐related changes in the sensory branch of the pudendal nerve. Urethral afferent signaling in response to the same urethral flow rates was weaker in older animals. That is, the sensitivity of urethra afferents to flow decreased with age, and higher flow rates were required in older animals to recruit urethra afferents. There was also a reduction in the myelin thickness of pudendal afferents in old rats, which is a possible contributing factor to the sensory activity. Furthermore, the same flow rates evoked less pressure in the urethras of old animals, indicating there is an age‐related change of the urethral tissue that reduces the pressure stimulus to which these afferents respond. These results help characterize the underlying changes in LUT system with age., The prevalence of underactive bladder (UAB) symptoms increases with age; however, the underlying mechanism of age‐related bladder dysfunction is unclear. In this study on rats, we found age‐related reductions of overall urethral sensory outflow, urethral pressure development during fluid flow, and myelin present in urethral afferents, suggesting urethral neuropathy plays a role in UAB.
- Published
- 2021
44. The Efficacy of Transvaginal Ultrasound-Guided BoNT-A External Sphincter Injection in Female Patients with Underactive Bladder.
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Tsai CY, Yeh YH, Tsai LH, and Chou EC
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- Male, Humans, Female, Prospective Studies, Treatment Outcome, Ultrasonography, Interventional, Botulinum Toxins, Type A therapeutic use, Urinary Bladder, Underactive, Neuromuscular Agents therapeutic use, Urinary Bladder Diseases
- Abstract
Owing to the diverse treatment outcomes after a botulinum toxin A (BoNT-A) injection to the external sphincter, this study aimed to develop a new technique: an ultrasound-guided BoNT-A external sphincter injection. This single-center prospective cohort study was conducted at a tertiary medical center in Taichung, Taiwan. From December 2020 to September 2022, 12 women were enrolled. The patients were evaluated for lower urinary tract syndrome using patient perception of bladder condition (PPBC), international prostate symptom score (IPSS), uroflowmetry, post-void residual volume (PVR), cystometry, and external sphincter electromyography. We evaluated the patients the day before surgery and 1 week after the BoNT-A injection. For the patients requiring self-catheterization, we recorded the number of times they required clean intermittent catheterization (CIC) per day before the procedure and 1 month after the procedure. The IPSS, PPBC, and PVR were significantly better after the transvaginal ultrasound-guided BoNT-A external sphincter injection. The number of times the patients required daily CIC was also reduced after the injection. Only one patient developed de novo urge urinary incontinence. Our results demonstrated that a transvaginal ultrasound-guided BoNT-A injection was efficacious and safe in the treatment of underactive bladder.
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- 2023
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45. Randomized controlled trial of intravesical electrical stimulation for underactive bladder.
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Liao L, Deng H, Chen G, Chen H, Huang M, Xie K, Wei X, Xu Z, Huang B, Chong T, Chen Q, Xiao H, Huang Z, Jiang H, and Jing H
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- Humans, Quality of Life, Prospective Studies, Single-Blind Method, Treatment Outcome, Electric Stimulation, Urinary Bladder, Underactive, Urinary Bladder Diseases
- Abstract
Aim: To evaluate the efficacy and safety of intravesical electrical stimulation (IVES) performed with a novel device in patients with underactive bladder (UAB)., Patients and Methods: This was a multicentre, prospective, single-blind, randomized controlled clinical trial of patients with UAB in China. Eligible patients were randomly assigned in a 1:1 ratio to receive conventional IVES (n = 38) or IVES with an open circuit (n = 38). The primary efficacy measure was change from baseline in post-void residual urine volume (PVR) after 4 weeks of treatment. Secondary efficacy measures included changes in maximum urinary flow rate (Q
max ), bladder voiding efficiency (BVE), number of 24-h clean intermittent catheterization (CIC) procedures, and Patient Perception of Bladder Condition-Scale (PPBC-S) and American Urological Association Symptom Index Quality of Life (AUA-SI-QoL) scores from baseline after 4 weeks of treatment. Adverse events (AEs) were monitored throughout the trial., Results: In the full analysis set (FAS), the mean (sd) PVR changes in the trial and control groups at 4 weeks were -97.1 (107.5) mL and -10.5 (86.7) mL, respectively (P < 0.01). Similar results were obtained in the per-protocol set (PPS): -102.9 (100.0) mL vs 0.7 (82.5) mL (P < 0.01). In the FAS and PPS, Qmax improved significantly at 4 weeks (P = 0.04 and P = 0.03). In the FAS and PPS, BVE was significantly improved at 4 weeks in the two groups (P < 0.01 and P < 0.01), whereas no significant differences in the number of 24-h CIC procedures, PPBC-S score or AUA-SI-QoL score were observed between the groups. Six possible therapy-related AEs occurred in six patients (four in the trial group and two in the control group; P = 0.67), all of which were urinary tract infections. No severe AEs were reported., Conclusions: The results of this clinical study strongly demonstrate that UAB patients benefit from this novel IVES device. More research is needed to validate the clinical utility of this device., (© 2022 BJU International.)- Published
- 2023
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46. Two types of detrusor underactivity in men with nonneurogenic lower urinary tract symptoms.
- Author
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Matsukawa Y, Naito Y, Ishida S, Matsuo K, Majima T, and Gotoh M
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- Male, Humans, Urinary Bladder, Retrospective Studies, Urodynamics, Urinary Bladder, Underactive, Lower Urinary Tract Symptoms, Urinary Bladder Neck Obstruction, Urinary Incontinence
- Abstract
Aims: To clarify the clinical features of men with nonneurogenic detrusor underactivity (DU) by focusing on storage dysfunction (SD)., Methods: We retrospectively reviewed the clinical and urodynamic data of men with nonneurogenic DU. Patients were divided into two groups according to the presence or absence of SD, such as detrusor overactivity (DO) and reduced bladder compliance (BC). Patient characteristics, lower urinary tract symptoms (LUTS), and urodynamic parameters were compared. DU was defined as bladder contractility index (BCI) ≤ 100 and bladder outlet obstruction index (BOOI) ≤ 40., Results: Of 212 men with DU, 123 (58.0%) had concomitant SD (SD + DU group), and 89 (42.0%) had only DU (DU-only group). Age, prostate volume, and severity of storage symptoms were significantly higher in the SD + DU group. Particularly, >80% of men in the SD + DU group met the diagnostic criteria for overactive bladder in Japan, which was significantly higher than the 26% of men in the DU-only group. The frequency of urinary urgency incontinence (UUI) was also significantly higher in the SD + DU group (65% vs. 12% in DU-only group). In contrast, voiding symptoms, including straining, were more severe in the DU-only group. Regarding the urodynamic parameters, compared to the DU-only group, bladder capacity was significantly smaller and BOOI and BCI were significantly higher in the SD + DU group. However, there was no significant difference in the maximum flow rate and bladder voiding efficiency., Conclusions: Approximately 60% of men with DU had SD, such as DO and/or reduced BC, whereas the remaining 40% had increased bladder capacity without an increase in detrusor pressure during the storage phase. There were significant differences in the storage and voiding symptoms between the groups. It is important to divide patients with DU based on SD to accurately clarify the clinical picture of DU., (© 2022 Wiley Periodicals LLC.)
- Published
- 2023
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47. Promising Effects of a Novel EP2 and EP3 Receptor Dual Agonist, ONO-8055, on Neurogenic Underactive Bladder in a Rat Lumbar Canal Stenosis Model.
- Author
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Sekido, Noritoshi, Kida, Jun, Mashimo, Hiroko, Wakamatsu, Daisuke, Okada, Hiroki, and Matsuya, Hidekazu
- Subjects
BLADDER disease treatment ,PROSTAGLANDIN receptors ,STENOSIS ,LUMBAR vertebrae diseases ,CYCLIC adenylic acid ,LABORATORY rats - Abstract
Purpose We investigated whether the novel EP (prostaglandin E2) receptor agonist ONO-8055 would improve the lower urinary tract dysfunction of neurogenic underactive bladder in a rat lumbar spinal canal stenosis model. Materials and Methods First, we studied the agonistic effect of ONO-8055 on EP receptors in EP receptor expressing CHO (Chinese hamster ovary) cells using the increase in the intracellular calcium level and intracellular cAMP (cyclic adenosine monophosphate) production as indicators of receptor activation. The effects of ONO-8055 on bladder and urethral strips from normal rats were then investigated. Finally, the effects of ONO-8055 on bladder and urethral function in rats with lumbar spinal canal stenosis were evaluated by awake cystometry and intraurethral perfusion pressure, respectively. The effects of tamsulosin and distigmine on urethral pressure were also evaluated. Results ONO-8055 is a highly potent and selective agonist for EP2 and EP3 receptors on CHO cells. While this compound contracted bladder strips, it relaxed urethral strips. Awake cystometry showed that ONO-8055 significantly decreased bladder capacity, post-void residual urine and voiding pressure. Compared with vehicle, tamsulosin and ONO-8055 significantly decreased urethral pressure. Conclusions ONO-8055 decreased post-void residual urine, probably by decreasing bladder capacity. The decrease in voiding pressure probably resulted from the lowered urethral pressure due to relaxation of the urethra. Thus, the novel EP2 and EP3 receptor dual agonist ONO-8055 has the potential to improve neurogenic underactive bladder. [ABSTRACT FROM AUTHOR]
- Published
- 2016
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48. Pathophysiological mechanisms in detrusor underactivity
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Frank Martens, Luís Vale, Filipa Jesus, Mohammad S. Rahnama'i, Tiago Antunes-Lopes, Bogdan Geavlete, Tom Marcelissen, Francisco Cruz, and Malte Rieken
- Subjects
STRUCTURAL BASIS ,BLADDER OUTLET OBSTRUCTION ,detrusor underactivity ,Urology ,Urinary Bladder ,030232 urology & nephrology ,Underactive bladder ,Bioinformatics ,Efferent nerve ,URINARY-TRACT DYSFUNCTION ,Diabetes Complications ,03 medical and health sciences ,Bladder outlet obstruction ,0302 clinical medicine ,Lower urinary tract symptoms ,TERM CALORIC RESTRICTION ,Urinary Bladder, Underactive ,Animals ,Humans ,Medicine ,EPIDEMIOLOGY ,lower urinary tract symptoms ,Pathological ,COMMON ,Afferent Pathway ,pathophysiology ,Afferent Pathways ,030219 obstetrics & reproductive medicine ,business.industry ,Age Factors ,CONTRACTILITY ,medicine.disease ,Pathophysiology ,GERIATRIC VOIDING DYSFUNCTION ,Urinary Bladder Neck Obstruction ,MODEL ,Neurology ,INCONTINENCE ,Etiology ,Nervous System Diseases ,business - Abstract
Underactive bladder (UAB) is a multifactorial symptom complex often related to detrusor underactivity (DU). Although recognized as a common cause of lower urinary tract symptoms and with significant effects on quality of life, UAB/DU is largely underresearched. Herein, we review up-to-date knowledge on the pathophysiological mechanisms of UAB/DU, with an emphasis on the relationship between UAB and bladder outlet obstruction (BOO). Original articles and reviews concerning UAB/DU were identified through a search of the PubMed/Medline and Scopus databases. DU can result from several pathological mechanisms, which can be categorized as idiopathic, neurogenic, myogenic, or functional. The main etiological factors of UAB/DU are aging, diabetes mellitus, neurogenic disorders, and BOO. Although conventional models focus primarily on efferent nerve and myogenic mechanisms, contemporary views highlight the importance of the afferent pathway. Specifically, recent findings in BOO showed that afferent dysfunction, such as altered expression of muscarinic and purinergic P2X(3) receptors or diminished urothelial ATP may play a role in the initial and reversible stages of DU, with potential diagnostic and therapeutic implications.
- Published
- 2019
49. Improved bladder contractility after transplantation of human mesenchymal stem cells overexpressing hepatocyte growth factor into underactive bladder from bladder outlet obstruction models of rats
- Author
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Jae Heon Kim, Hee Jo Yang, Sung Sik Choi, Seung U. Kim, Hong J. Lee, and Yun Seob Song
- Subjects
Cell Transplantation ,Physiology ,Apoptosis ,Urine ,urologic and male genital diseases ,Biochemistry ,Rats, Sprague-Dawley ,Animal Cells ,Medicine and Health Sciences ,Blood and Lymphatic System Procedures ,Multidisciplinary ,Cell Death ,Hepatocyte Growth Factor ,Stem Cells ,Stem Cell Therapy ,female genital diseases and pregnancy complications ,Body Fluids ,Urinary Bladder Neck Obstruction ,Physiological Parameters ,Cell Processes ,Medicine ,Female ,Collagen ,Anatomy ,Cellular Types ,Research Article ,Muscle Contraction ,endocrine system ,Bladder ,Science ,Urinary Bladder ,Neovascularization, Physiologic ,Urination ,Surgical and Invasive Medical Procedures ,Mesenchymal Stem Cell Transplantation ,Cell Line ,Urinary Bladder, Underactive ,Animals ,Humans ,Regeneration ,RNA, Messenger ,Clinical Genetics ,Transplantation ,Body Weight ,Biology and Life Sciences ,Proteins ,Mesenchymal Stem Cells ,Renal System ,Cell Biology ,equipment and supplies ,Rats ,Disease Models, Animal ,Collagens ,Stem Cell Transplantation - Abstract
Introduction An underactive bladder can lead to difficulty in voiding that causes incomplete emptying of the bladder, suggesting the need for a new strategy to increase bladder contractility in such patients. This study was performed to investigate whether human mesenchymal stem cells (hMSCs) were capable of restoring bladder contractility in rats with underactive bladder due to bladder outlet obstruction (BOO) and enhancing their effects by overexpressing hepatocyte growth factor (HGF) in hMSCs. Materials and methods The hMSCs were transplanted into the bladder wall of rats. Fifty female Sprague-Dawley rats at six weeks of age were divided into five groups: group 1: control; group 2: sham intervention; group 3: eight-week BOO; group 4: BOO rats transplanted with hMSCs; and group 5: BOO rats transplanted with hMSCs overexpressing HGF. Two weeks after the onset of BOO in groups 4 and 5, hMSCs were injected into the bladder wall. Cystometry evaluation was followed by Masson’s trichrome staining of bladder tissues. Realtime PCR and immunohistochemical staining were performed to determine for hypoxia, apoptosis, and angiogenesis. Results Collagen deposition of bladder increased in BOO but decreased after transplantation of hMSCs. The increased inter-contraction interval and residual urine volume after BOO was reversed after hMSCs transplantation. The decreased maximal voiding pressure after BOO was restored by hMSCs treatment. The mRNA expression of bladder collagen1 and TGF-β1 increased in BOO but decreased after hMSCs transplantation. The decrease in vWF-positive cells in the bladder following BOO was increased after hMSCs transplantation. Caspase 3 and TUNEL-positive apoptosis of bladder cells increased in BOO but decreased after transplantation of hMSCs. These effects were enhanced by overexpressing HGF in hMSCs. Conclusion Transplantation of hMSCs into bladder wall increased the number of micro-vessels, decreased collagen deposition and apoptosis of detrusor muscle, and improved bladder underactivity. The effects were enhanced by overexpressing HGF in hMSCs. Our findings suggest that the restoration of underactive bladder using hMSCs may be used to rectify micturition disorders in patients following resolution of BOO. Further studies are needed before hMSCs can be used in clinical applications.
- Published
- 2021
50. Detrusor overactivity and underactivity. implication for lower urinary tract symptoms related to benign prostate hyperplasia diagnosis and treatment
- Author
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Creta, Massimiliano, Colla' Ruvolo, Claudia, Longo, Nicola, Mangiapia, Francesco, Arcaniolo, Davide, De Sio, Marco, De Nunzio, Cosimo, Imbimbo, Ciro, Mirone, Vincenzo, Fusco, Ferdinando, Creta, Massimiliano, Colla' Ruvolo, Claudia, Longo, Nicola, Mangiapia, Francesco, Arcaniolo, Davide, De Sio, Marco, De Nunzio, Cosimo, Imbimbo, Ciro, Mirone, Vincenzo, and Fusco, Ferdinando
- Subjects
Male ,turp ,Urinary Bladder, Overactive ,Urology ,030232 urology & nephrology ,Prostatic Hyperplasia ,Transurethral Resection of Prostate ,underactive ,overactive ,do ,du ,urinary bladder ,urinary bladder, underactive ,lower urinary tract symptoms ,surgery ,03 medical and health sciences ,0302 clinical medicine ,Treatment Outcome ,Nephrology ,030220 oncology & carcinogenesis ,Humans ,Urologic Surgical Procedures - Abstract
Detrusor underactivity (DUA) and detrusor overactivity (DO) have potential impact on the outcomes of surgery for lower urinary tract symptoms related to benign prostate hyperplasia (LUTS/BPH).We performed a literature search including studies on humans enrolling patients with preoperative urodynamic evidence of DO and/or DUA undergoing LUTS/BPH surgery. Factors that may influence the outcomes of surgery in these patients were evaluated.In patients with DUA mean bladder contractility index improved from +4 to +44.6, mean total International Prostate Symptom Score (IPSS) improved from -3 to -19.5 points, mean maximum urinary flow (Qinfmax/inf) improved from +1.4 to +11.7 mL/s, and mean postvoid residual volume (PVR) improved from -16.5 to -736 mL. Older age, lack of obstruction, concomitant DO, lower detrusor contractility and use of transurethral resection of the prostate (TURP) or photovaporization (PV) instead of Holmium laser enucleation of the prostate (HoLEP) were associated with worse outcomes. In patients with DO, the percentage of DO resolution ranged from 57.1% to 83.3%. Mean total IPSS, Qinfmax/inf, and PVR variations ranged from +0.9 to -15.7 points, from -0.2 mL/s to +14 mL/s, and from -19.6 to -202.5 mL, respectively. Older age, lack of obstruction, terminal DO, low maximum cystometric capacity, early and high amplitude DO, and use of transurethral prostate incision instead of TURP or open adenomectomy were associated with worse outcomes.In patients with DUA or DO, surgery for LUTS/BPH provides overall good results. However, a number of factors can affect these outcomes.
- Published
- 2021
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