247 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
- Author
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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.
- Published
- 2023
- Full Text
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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.
- Published
- 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
- Author
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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)
- Author
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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
- View/download PDF
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.)
- Published
- 2024
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28. Myogenic Underactive Bladder and Heart Failure Resemblance: A Novel Role for SGLT2 Inhibition?
- Author
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Gabriel Faria-Costa, Ana Charrua, Carlos Martins-Silva, Adelino Leite-Moreira, and Tiago Antunes-Lopes
- Subjects
Heart Failure ,Urology ,Urinary Bladder, Underactive ,Humans - Abstract
The heart and bladder share physiological biomechanical determinants of contraction. Heart failure (HF) and myogenic underactive bladder (mUAB) also share similarities in their pathophysiology. In both cases there is muscle injury that is directly linked to disease stage. In the final stage, both myocardium and detrusor show marked fibrosis and lower contractility. While HF has an established pharmacological treatment, there are still no effective drugs for mUAB. This mini-review explores the similarities between HF and mUAB and suggests that, as in HF, SGLT2 inhibitors may also have a beneficial role in mUAB. PATIENT SUMMARY: To date, there is no treatment for underactive bladder caused by problems with the bladder muscle (mUAB). We review similarities between this condition and heart failure and hypothesize that a recent drug class with striking results in heart failure might also have a beneficial role in mUAB.
- Published
- 2022
29. Efficacy of TAC-302 for patients with detrusor underactivity and overactive bladder: a randomized, double-blind, placebo-controlled phase 2 study
- Author
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Masaki Yoshida, Momokazu Gotoh, Osamu Yokoyama, Hidehiro Kakizaki, Tomonori Yamanishi, and Osamu Yamaguchi
- Subjects
Male ,Urodynamics ,Treatment Outcome ,Double-Blind Method ,Urinary Bladder, Overactive ,Urology ,Urinary Bladder, Underactive ,Humans ,Urination ,Female - Abstract
Purpose This multicenter, randomized, double-blind, placebo-controlled phase 2 study evaluated the efficacy and safety of TAC-302, a novel drug that restores neurite outgrowth, in patients with detrusor underactivity (DU) and overactive bladder (OAB). Methods After 2–4 weeks of observation, patients were randomized 2:1 to receive oral TAC-302 200 mg or placebo twice daily for 12 weeks. The primary endpoint was detrusor contraction strength, estimated by bladder contractility index (BCI) for males and projected isovolumetric pressure 1 (PIP1) for females. Secondary endpoints included changes in bladder voiding efficiency (BVE) and safety. Results Seventy-six patients were included (TAC-302, n = 52; placebo, n = 24). The mean (standard deviation [SD]) BCI for males was 64.6 (16.6) at baseline and 75.2 (21.1) at week 12 (p n = 27), and 61.3 (16.6) and 60.5 (16.7) (p = 0.82) with placebo (n = 11). The respective mean (SD) PIP1 for females was 18.8 (6.6) and 29.4 (9.4) (p n = 15), and 20.6 (7.5) and 25.5 (9.6) (p = 0.14) with placebo (n = 7). TAC-302 significantly increased BCI in males and BVE in both sexes. TAC-302 efficacy on OAB was not clearly shown. The incidences of adverse events (AEs), serious AEs, and AEs leading to dose interruption were similar between groups; no adverse drug reactions occurred. Conclusion Considering the significant effects on BCI in males and BVE in both sexes, TAC-302 may benefit patients with DU. Registration ClinicalTrials.gov Identifier NCT03175029 registered 6/5/2017.
- Published
- 2022
30. 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
- Full Text
- View/download PDF
31. Clinical and Urodynamic Findings Before and After Surgical Repair of Pelvic Organ Prolapse in Women With Lower Urinary Tract Symptoms. A Prospective Observational Study
- Author
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Ahmed M. Tawfeek, Tarek Osman, Hany Hamed Gad, Mohamed Elmoazen, Dana Osman, and Ahmed Emam
- Subjects
Adult ,Urodynamics ,Urinary Incontinence ,Lower Urinary Tract Symptoms ,Urinary Incontinence, Stress ,Urology ,Urinary Bladder, Underactive ,Humans ,Female ,Prospective Studies ,Middle Aged ,Pelvic Organ Prolapse - Abstract
To investigate the association between urodynamic findings and lower urinary tract symptoms (LUTS) before and after surgical treatment of pelvic organ prolapse (POP).Seventy-four patients with stage II or more anterior POP associated with LUTS and eligible for surgical repair of POP were included in this prospective study. All cases had clinical evaluation and urodynamic testing (UDS) before and 6 months after surgical repair of POP.Mean age was 45 ± 9 years. Mean BMI was 28 ± 6 kg/mPatients had significant improvement in LUTS after POP surgery with or without an anti-incontinence procedure. Detrusor underactivity was associated with persistence of voiding LUTS. Meanwhile, preoperative DO and post-void residual urine volume were of limited prognostic value.
- Published
- 2022
32. Urodynamic Curve Patterns may Predict Female Bladder Outlet Obstruction and Detrusor Underactivity
- Author
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Bülent Çetinel, Bülent Önal, Berin Selçuk, Günay Can, Uğur Aferin, and Ömer Yıldırım
- Subjects
Urinary Bladder Neck Obstruction ,Urodynamics ,Urology ,Urinary Bladder ,Urinary Bladder, Underactive ,Humans ,Female ,Retrospective Studies - Abstract
To search for independent predictors for distinguishing bladder outlet obstruction (BOO) and detrusor underactivity (DU) in female patients with voiding difficulty.A retrospective patient file review was performed of 918 female patients with lower urinary tract symptoms. After exclusion criteria, 148 patients with voiding difficulty were eligible for the study. Patients were classified as having BOO and DU based on urodynamic BOO and DU definitions. The symptoms, patient characteristics, the patterns of free urine flow, and detrusor voiding pressure curves were compared between 2 groups.Of 148 patients with a median age of 53 (18-86), 42 (28,4%), 37 (25%), 69 (46,6%) patients had a urodynamic diagnosis of BOO, DU, and unclassified P/F study respectively. Multivariate logistic regression analysis results showed that the symptom of weak urine stream [P = .015 OR = 7.07 CI(1,47-34,0)], the negative provocative stress test [P = .038 OR = 7.32 CI(1,12-47,83)], the continuous detrusor voiding pressure and the prolonged/tailed shaped free urine flow curve patterns [P.001 OR = 2,99 CI(1,66-5,38)] were the independent predictors of BOO. Sensitivity and specifity values for prolonged/tailed to predict BOO were 82.5 and 60% respectively.The continuous detrusor voiding pressure and the prolonged/tailed shaped free urine flow curve patterns were found to be useful independent predictors for distinguishing BOO from DU in female patients with voiding difficulty. In addition, the symptom of weak urine stream, and the negative provocative stress test may be of beneficial use.
- Published
- 2022
33. Coexisting overactive–underactive bladder and detrusor overactivity–underactivity in pelvic organ prolapse
- Author
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Matteo Frigerio, Marta Barba, Alice Cola, Federico Spelzini, Rodolfo Milani, and Stefano Manodoro
- Subjects
Urodynamics ,Urinary Bladder, Overactive ,Urinary Bladder, Underactive ,Humans ,Obstetrics and Gynecology ,Female ,General Medicine ,Pelvic Organ Prolapse ,Retrospective Studies - Abstract
The coexisting overactive-underactive bladder (COUB) syndrome could be related to the increased urethral resistance caused by severe pelvic organ prolapse (POP). We aimed to evaluate the clinical and urodynamic findings of patients with COUB and/or detrusor overactivity-underactivity (DOU) in a cohort of patients scheduled for POP surgery and the possible risk factors of COUB after surgery.This retrospective study analyzed all patients who underwent POP repair between 2008 and 2013, excluding women with a history of pelvic floor surgery. Patients were divided into COUB and non-COUB according to baseline symptoms and into DOU and non-DOU based on urodynamic findings. A multivariate model was performed to identify risk factors for COUB symptoms after surgery.A total of 533 women underwent POP surgery. Preoperatively, patients with COUB had more severe anterior compartment prolapse (Pelvic Organ Prolapse Quantification staging system Aa point, P = 0.008) and more frequently had overactive bladder compared with controls (P = 0.023). The rate of COUB decreased significantly after surgery. Preoperative opening detrusor pressure resulted as the only independent predictor of postoperative COUB symptoms (P = 0.034).POP is a valid pathogenetic model for COUB development. POP repair induced a significant decrease in COUB symptoms with low opening detrusor pressure resulting as the only independent predictor of postoperative COUB.
- Published
- 2022
34. Muscarinic‐3‐receptor positive allosteric modulator ASP8302 in patients with underactive bladder. A randomized controlled trial
- Author
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Jan Willem Olivier van Till, Eri Arita, Kentaro Kuroishi, Richard Croy, Matthias Oelke, Gommert A. van Koeveringe, Christopher R. Chapple, Osamu Yamaguchi, Paul Abrams, MUMC+: MA Urologie (9), MUMC+: MA Urologie (3), Urologie, and RS: MHeNs - R3 - Neuroscience
- Subjects
Adult ,Male ,BETHANECHOL ,Urinary Bladder, Overactive ,DETRUSOR UNDERACTIVITY ,Urology ,Cholinergic Agents ,URINARY-TRACT SYMPTOMS ,underactive bladder ,Receptors, Muscarinic ,Urinary Bladder Neck Obstruction ,Treatment Outcome ,Urinary Incontinence ,Double-Blind Method ,Urinary Bladder, Underactive ,randomized controlled trial ,Humans ,Female ,OBSTRUCTION ,lower urinary tract symptoms ,Neurology (clinical) ,muscarinic receptor M3 ,COMBINATION ,FORM - Abstract
AIM: The aim of this study is to evaluate safety and efficacy of ASP8302, a novel positive allosteric modulator for the muscarinic M3 receptor (M3-PAM), in patients with underactive bladder (UAB).METHODS: A randomized, double-blind, placebo-controlled multicenter study was performed in adult male/female subjects with UAB, defined as incomplete bladder emptying (postvoid residual volume [PVR] > 100 ml) without significant bladder outlet obstruction and/or overactive bladder. Subjects were randomized (1:1) to receive 4-week oral once-daily administration of 100 mg ASP8302 or matching placebo. Primary endpoint was a change from baseline in PVR measured by catheterization after standardized bladder filling (PVRC2 ). Other endpoints included PVR and bladder voiding efficiency (BVE) measured in various ways, uroflowmetry, bladder diary, and questionnaires. Pressure-flow studies were performed in a subgroup.RESULTS: One hundred and thirty-five patients were randomized (ASP8302 group: 65 patients, placebo group: 70 patients). The median change in PVRC2 was -40.0 ml (ASP8302) versus -35.0 ml (placebo) and the difference between groups was -5.0 ml (p = 0.960). In males, functional and symptomatic outcomes improved, for example, maximum urine flow rate (Qmax ) and detrusor pressure at Qmax (Pdet.Qmax ) increased (mean difference in change ASP8302 vs. placebo: 3.8 ml/s, p = 0.031 and 12.7 cm H2 O, p = 0.034, respectively). Urinary incontinence episodes/24 h decreased in males with preexisting incontinence (mean difference: -0.35; p = 0.028). The incidence of adverse events was similar between study groups (ASP8302: 33.3%, placebo: 31.4%). In the included subjects, both baseline urine flow and bladder voiding pressure was low. Compared with PVR, simultaneous BVE measurements were more consistent between various methods (spontaneous vs. standardized bladder filling, catheterization vs. ultrasound [US]).CONCLUSIONS: ASP8302 was safe and well tolerated in patients with UAB identified by nonurodynamic clinical criteria, but it did not show efficacy in the primary endpoint. However, in males it showed improvement of symptoms and functional parameters. BVE (using US) is a more optimal outcome measure than PVR in UAB.
- Published
- 2022
35. Screening for Zinner Syndrome in Patients With a Congenitally Solitary Kidney: Lessons Learned.
- Author
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Bearrick EN and Husmann DA
- Subjects
- 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.
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- 2023
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36. 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.
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Usmani A, Misra A, and Pratap Singh U
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- Humans, Pilot Projects, Prospective Studies, Urinary Bladder, Randomized Controlled Trials as Topic, Extracorporeal Shockwave Therapy, Urinary Bladder, Underactive
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- 2023
- Full Text
- View/download PDF
37. Treatment outcomes of detrusor underactivity in women based on clinical and videourodynamic characteristics
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Sheng-Fu Chen, Jia-Fong Jhang, Yuan-Hong Jiang, and Hann-Chorng Kuo
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Male ,Urodynamics ,Treatment Outcome ,Urethra ,Nephrology ,Urology ,Urinary Bladder, Underactive ,Humans ,Female ,Botulinum Toxins, Type A ,Retrospective Studies - Abstract
Treatment of voiding dysfunction due to detrusor underactivity (DU) remains challenging. This study sought to determine the characteristics of video urodynamic study (VUDS) in female DU and outcomes after active treatment.A total of 409 female patients with VUDS-proven DU were recruited. All patients received conservative bladder management, with others receiving active treatment, such as oral medication, transurethral incision of bladder neck (TUI-BN), surgery for prolapse, and urethral botulinum toxin A (BoNT-A) injection, according to their VUDS characteristics. Treatment outcomes were then analyzed by different VUDS characteristics.Satisfactory treatment outcomes were noted in 123 patients (30.0%), among whom 35 and 88 had a VE of 90% and 66.7%, respectively. A total of 165 patients (40.3%) had voiding efficiency (VE) of 33.3-66.7%, whereas 121 (29.6%) remained unable to void (12.5%) or had a VE of 33.3% (17.1%). Conservative treatment had the worst outcome. Patients with normal or slightly reduced bladder sensation (49.3%) and those with a post-void residual (PVR) of 250 mL (59.4%) displayed better satisfactory outcome after treatment; while TUI-BN and urethral BoNT-A injection promoted better treatment results. Patients with detrusor acontractility and a PVR of ≥ 500 mL still achieved high VE rates ( 66.7%) after TUI-BN. A 56.3% satisfactory outcome was achieved after TUI-BN, whereas 58.1% satisfactory outcome was noted in those with a tight external sphincter after medical treatment.Female patients with DU exhibited VE improvement after active treatment. Patients with very low detrusor contractility and absent bladder sensation generally exhibited poor treatment outcomes.
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- 2022
38. Clinical features of detrusor underactivity in elderly men without neurological disorders
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Keisuke Kiba, Yasunori Akashi, Yutaka Yamamoto, Akihide Hirayama, Kiyohide Fujimoto, and Hirotsugu Uemura
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Male ,Urinary Bladder Neck Obstruction ,Urodynamics ,Lower Urinary Tract Symptoms ,Neurology ,Urology ,Urinary Bladder, Underactive ,Humans ,Female ,Nervous System Diseases ,Aged ,Retrospective Studies - Abstract
To investigate the clinical features of detrusor underactivity (DU) in elderly men without neurological disorders.A total of 336 men aged ≥50 years without neurogenic disorders who underwent pressure flow studies and who had DU or bladder outlet obstruction (BOO) were reviewed retrospectively. According to the bladder contractility index (BCI) and the BOO index (BOOI), the subjects were classified into the following three groups: (a) pure DU group, BCI 100 and BOOI 40; (b) DU + BOO group, BCI 100 and BOOI ≥ 40; and (c) pure BOO group, BCI ≥ 100 and BOOI ≥ 40. Subjective and objective parameters were compared among the three groups, and the predictors for pure DU were evaluated by multivariate analysis.Of the 336 patients, 205 who met the study criteria were included in the analysis: 63 (30.7%) with pure DU, 48 (23.4%) with DU + BOO, and 94 (45.9%) with pure BOO. The proportion of the pure DU group increased with increasing age. Prostate volume was the lowest in the pure DU group. Frequency, urgency on the International Prostate Symptom Score (IPSS), and the IPSS storage subscore were the lowest in the pure DU group. Multivariate analysis showed that age (odds ratio [OR] 1.114 [95% CI, 1.032-1.203], P = .005), prostate volume (OR 0.968 [95% CI, 0.949-0.987], P = .001), and urgency (OR 0.623 [95% CI, 0.431-0.900], P = .012) were predictors of pure DU.Older age, smaller prostate volume, and less urgency may be clinical features of pure DU.
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- 2022
39. Safety And Efficacy Of Solifenacin In Men With Overactive Bladder (OAB) And Detrusor Underactivity
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- 2008
40. The effectiveness of parasympathomimetics for treating underactive bladder: A systematic review and meta‐analysis
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Kari A.O. Tikkinen, Vineesha Veer, Paul Glasziou, Justin Clark, Anna Mae Scott, Charlotte Phelps, and Christian Moro
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medicine.medical_specialty ,business.industry ,Urology ,030232 urology & nephrology ,Odds ratio ,Parasympathomimetics ,Urinary Retention ,Underactive bladder ,medicine.disease ,Confidence interval ,3. Good health ,Clinical trial ,03 medical and health sciences ,0302 clinical medicine ,030220 oncology & carcinogenesis ,Meta-analysis ,Internal medicine ,Relative risk ,Urinary Bladder, Underactive ,medicine ,Humans ,Neurology (clinical) ,Adverse effect ,business - Abstract
AIMS Biological rationale suggests that parasympathomimetics (cholinergic receptor stimulating agents) could be beneficial for patients with underactive bladder. However, no systematic review with meta-analysis addressing potential benefits or adverse effects exists. The aim of this review was to assess the effectiveness, both benefits and harms, of using parasympathomimetics for the treatment of underactive bladder. METHODS The protocol was registered in PROSPERO, and searches undertaken in PubMed, Embase, and CENTRAL, including randomized and non-randomized controlled trials of patients with underactive bladder, comparing parasympathomimetic to placebo, no treatment, or other pharmaceuticals. Risk ratios, odds ratios, and mean differences were calculated. RESULTS Twelve trials with 3024 participants were included. There was a significant difference between parasympathomimetics and comparators (favoring parasympathomimetics) in the number of patients with urinary retention (risk ratio 0.55, 95% confidence interval [CI] 0.3-0.98, p = 0.04, low quality of evidence). There was no difference in mean postvoid volume overall (MD -41.4 ml, 95% CI -92.0 to 9.1, p = 0.11, low quality of evidence). There was a significant difference at up to 1 week post-intervention, favoring parasympathomimetics (MD -77.5 ml, 95% CI -90.9 to -64.1, p
- Published
- 2021
41. Correlations between bladder wall thickness and clinical manifestations in female patients with detrusor underactivity and detrusor overactivity–with–detrusor underactivity
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Alex T.L. Lin, Chih-Chieh Lin, Ping-Hsuan Yu, Yu-Hua Fan, and William J.S. Huang
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medicine.medical_specialty ,Bladder walls ,Urinary Bladder, Overactive ,business.industry ,Urinary Bladder ,Taiwan ,Urology ,General Medicine ,Middle Aged ,medicine.disease ,Lower urinary tract symptoms ,Surveys and Questionnaires ,Urinary Bladder, Underactive ,Female patient ,Mann–Whitney U test ,Humans ,Medicine ,Detrusor pressure ,Female ,business ,Wall thickness ,Urgency incontinence ,Aged ,Ultrasonography ,Rank correlation - Abstract
BACKGROUND Among female patients with lower urinary tract symptoms, detrusor underactivity (DU), and detrusor overactivity-with-detrusor underactivity (DO-DU) are two common diagnoses. Here, we investigated the correlations between bladder wall thickness (BWT) and clinical manifestations of the two diagnoses. METHODS From 2011 to 2016, female patients with DU or DO-DU, diagnosed at our institute, were recruited. We analyzed their urodynamic parameters and collected three questionnaires (IPSS, UDI-6, OABSS). Using transabdominal sonography, the BWT was recorded. DU was defined as follows: maximum free flow rate (Qmax) ≤ 15 cc/s; detrusor pressure at maximum flow (PdetQmax) ≤ 20 cmH2O; bladder capacity > 150 cc. DO-DU was defined as follows: Qmax ≤ 15 cc/s; PdetQmax ≤ 20 cmH2O; bladder capacity ≤ 150 cc. The BWTs of the two groups were compared using the Mann-Whitney U test; the correlations among the BWTs and the results of three questionnaires were analyzed using Spearman's rank correlation coefficient. RESULTS Forty-eight female patients with DU and 13 with DO-DU were recruited. Demographic data revealed no differences between the two groups. The mean BWT of the DO-DU patients was significantly larger than that of the DU patients (4.11 vs 3.42 mm; p = 0.001). In the DO-DU group, a high correlation existed between the BWT and some of the UDI-6 items (urgency incontinence: r = 0.831, p = 0.006; incontinence related to activity: r = 0.884, p = 0.002; small amounts of leakage: r = 0.809, p = 0.008). The BWT of the DO-DU patients also exhibited a moderate correlation with the urgency incontinence from the OABSS questionnaire (r = 0.679; p = 0.044). No correlations existed between the BWT of the DU patients and any of the data from the three questionnaires. CONCLUSION The BWT in the DO-DU patients was significantly thicker than that in the DU patients. The DO-DU patients with thicker bladder walls also had higher UDI-6 scores for both urgency and urgency incontinence.
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- 2021
42. Dysfunctional voiding behavior and impaired muscle contractility in a rat model of detrusor underactivity
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Johanna L. Hannan, Eric J. Gonzalez, Warren M. Grill, and Michael R. Odom
- Subjects
medicine.medical_specialty ,Carbachol ,Urology ,Bethanechol ,Article ,Contractility ,Urine flow rate ,Urinary Bladder, Underactive ,medicine ,Animals ,medicine.diagnostic_test ,business.industry ,Muscles ,Urinary Bladder Diseases ,Cystometry ,Rats ,Urodynamics ,Atropine ,Urethra ,medicine.anatomical_structure ,Reflex ,Female ,Neurology (clinical) ,business ,medicine.drug - Abstract
AIMS Detrusor underactivity (DU) is an understudied health concern with inadequate clinical management. The pathophysiology of DU is unclear, and current therapies fail to improve symptoms. The current studies characterized voiding function and contractility of bladder and urethral tissues in a novel rat model of DU. METHODS Female obese prone (OP) and obese resistant (OR) rats were fed a 60 kcal% fat diet at 8 weeks old. A subset of rats (n = 4/strain) underwent uroflowmetry biweekly for 18 weeks in metabolic cages. At 40-56 weeks old, rats (n = 9-10/strain) underwent instrumented cystometry under urethane anesthesia. Following cystometry, bladder and urethral tissues (n = 8-9/strain) were harvested for in vitro assessments of contractility in response to carbachol, electric field stimulation, atropine, alpha, beta-methylene ATP, and caffeine. RESULTS OP rats exhibited increased urinary frequency (p = 0.0031), decreased voided volume (p = 0.0093), and urine flow rate (p = 0.0064) compared to OR rats during uroflowmetry. Bethanechol (10 mg/kg) did not alter uroflowmetry parameters. During cystometry, OP rats exhibited decreased bladder emptying efficiency (p
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- 2021
43. 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.
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- 2023
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44. Therapeutic effects of silodosin and urapidil on underactive bladder associated with diabetic cystopathy
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Saori Yonekubo‐Awaka, Motohiro Tezuka, Satoshi Tatemichi, and Hiroo Takeda
- Subjects
Midodrine ,Neurology ,Urology ,Urinary Bladder, Underactive ,Adrenergic alpha-1 Receptor Antagonists ,Diabetes Mellitus ,Animals ,Female ,Streptozocin ,Rats - Abstract
Pharmacological treatment options for underactive bladder (UAB) syndrome are limited. Urapidil is the only alphaChanges in intraurethral pressure (IUP) induced by midodrine (alphaBoth silodosin and urapidil inhibited the midodrine-induced increase in IUP and decreased MBP in a dose-dependent manner. Silodosin had a more substantial effect on the lower urinary tract than on MBP. Twelve weeks after STZ administration, DM rats exhibited UAB-like dysfunction (increased bladder capacity/bladder weight and residual volume and decreased bladder voided efficiency) and decreased BBF. Both drug treatments controlled this dysfunction.Alpha
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- 2022
45. Underactive Bladder Versus Bladder Outlet Obstruction: Don’t Get Tricked!
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Nadir Isameldin Osman and Christopher Chapple
- Subjects
Urinary Bladder Neck Obstruction ,Urodynamics ,Lower Urinary Tract Symptoms ,Urology ,Urinary Bladder, Underactive ,Humans ,Urination - Abstract
It is not possible to diagnose the cause of voiding difficulty on the basis of a history alone. Bladder underactivity and bladder outlet obstruction cause similar voiding symptoms and also can be associated with storage symptoms. In this mini-review, we consider the factors associated with making a symptomatic diagnosis of either underactive bladder or bladder outlet obstruction. PATIENT SUMMARY: There is overlapping of symptoms for different urinary problems. To differentiate between underactive bladder and bladder outlet obstruction as the underlying cause of lower urinary tract symptoms, an invasive urodynamic study of the bladder is often required.
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- 2022
46. A Preclinical Study of Human Embryonic Stem Cell-Derived Mesenchymal Stem Cells for Treating Detrusor Underactivity by Chronic Bladder Ischemia
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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
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- 2021
47. Detrusor underactivity causes neurogenic voiding dysfunction in a rat bilateral accessory nerve-injury model
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Kazunori Kimura, Tomoya Kataoka, Yuji Hotta, Ryoya Kawata, and Kotomi Maeda
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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.
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- 2021
48. Detrusor underactivity prevalence and risk factors according to different definitions in women attending urogynecology clinic
- Author
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Stefano Manodoro, Stefania Palmieri, Marta Barba, Alice Cola, Gloria D'Alessandro, and Matteo Frigerio
- Subjects
Male ,medicine.medical_specialty ,Clinical variables ,Urology ,Concordance ,030232 urology & nephrology ,Urinary incontinence ,urologic and male genital diseases ,Pelvic Floor Disorders ,Urogynecology ,03 medical and health sciences ,0302 clinical medicine ,Risk Factors ,Instrumental evaluation ,Internal medicine ,Urinary Bladder, Underactive ,Prevalence ,Humans ,Medicine ,Retrospective Studies ,030219 obstetrics & reproductive medicine ,business.industry ,Obstetrics and Gynecology ,female genital diseases and pregnancy complications ,Urodynamics ,Cohort ,Bladder contractility ,Female ,medicine.symptom ,business - Abstract
Introduction and hypothesis There is still no consensus on definitions of detrusor underactivity; therefore, it is difficult to estimate the prevalence. The primary objective of the study was to evaluate the prevalence of detrusor underactivity in a cohort of patients with pelvic floor disorders according to different proposed urodynamics definitions. The secondary objectives were to estimate the association between detrusor underactivity and symptoms, anatomy and urodynamic findings and to build predictive models. Methods Patients who performed urodynamic evaluation for pelvic floor disorders between 2008 and 2016 were retrospectively analyzed. Detrusor underactivity was evaluated according to Schafer’s detrusor factor, Abrams’ bladder contractility index and Jeong cut-offs. The degree of concordance between each method was measured with Cohenʼs kappa, and differences were tested using Student’s t test, Wilcoxon test and Pearson’s chi-squared test. Results The prevalence of detrusor underactivity among a cohort of 2092 women, concerning the three urodynamic definitions, was 33.7%, 37.0% and 4.1%, respectively. Age, menopausal status, voiding/bulging symptoms, anterior and central prolapse, first desire to void and positive postvoid residual were directly related to detrusor underactivity. Conversely, stress urinary incontinence, detrusor pressures during voiding and maximum flow were inversely associated. Final models for detrusor underactivity resulted in poor accuracy for all considered definitions. Conclusions The prevalence of detrusor underactivity varies depending on the definition considered. Although several clinical variables resulted as independent predictors of detrusor underactivity, instrumental evaluation still plays a key role in the diagnosis.
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- 2021
49. Uroflowmetry pattern in detrusor underactivity and bladder outlet obstruction in male patients with lower urinary tract symptoms
- Author
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Hiroko Banjo, Noriyuki Abe, Hidehiro Kakizaki, Kotona Miyauchi, Masafumi Kita, Masaki Watanabe, Naoki Wada, Mayumi Ishikawa, and Keigo Takeuchi
- Subjects
Male ,medicine.medical_specialty ,Urology ,030232 urology & nephrology ,03 medical and health sciences ,Bladder outlet obstruction ,0302 clinical medicine ,Lower Urinary Tract Symptoms ,Lower urinary tract symptoms ,Urinary Bladder, Underactive ,medicine ,Humans ,In patient ,Retrospective Studies ,030219 obstetrics & reproductive medicine ,business.industry ,Area under the curve ,medicine.disease ,Voiding time ,Urinary Bladder Neck Obstruction ,Urodynamics ,Neurology ,Male patient ,Bladder contractility ,business - Abstract
Objectives To investigate if uroflowmetry (UFM) curve patterns could differentiate between detrusor underactivity (DU) and bladder outlet obstruction (BOO). Methods A hundred consecutive data sets of male patients who were evaluated using UFM and invasive urodynamics (pressure flow study) were retrospectively collected. DU and BOO were diagnosed according to the bladder contractility index and BOO index. The UFM curve with two or more notches was defined as sawtooth pattern, and the interrupted pattern was defined if several curves with interruptions reducing to zero were noted. We also compared other UFM parameters including maximum and average flow rates (Qmax and Qave), voiding time, time to Qmax, the slope to first peak flow, the number of notches on the curve (sawtooth pattern), the number of curves (interrupted pattern), and the maximum drop on the sawtooth pattern. Results Twenty-five and forty-nine patients were categorized in the BOO group and the DU group, respectively. The incidence of sawtooth pattern was significantly higher in the DU group (57%) than in the BOO group (32%), while the incidence of interrupted pattern was not different between the two groups (36% in the BOO group and 49% in the DU group). There were significant differences in age (area under the curve = 0.75), prostatic volume (0.67), the slope to first peak flow (0.58), the number of notches on the curve (0.61), and the maximum drop (0.76) between the two groups. Conclusions The sawtooth UFM pattern is more common in patients with DU than in those with BOO. New parameters on UFM curve patterns could be helpful to evaluate DU and BOO without invasive urodynamics.
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- 2021
50. High percentage of neurologic deficits in the electrophysiology study of the lower urinary tract in patients with detrusor underactivity and chronic urinary retention
- Author
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Hann-Chorng Kuo and Yuan-Hong Jiang
- Subjects
Male ,medicine.medical_specialty ,Urology ,Pudendal nerve ,Urinary system ,030232 urology & nephrology ,Nerve conduction velocity ,03 medical and health sciences ,Bladder outlet obstruction ,0302 clinical medicine ,Bulbocavernosus reflex ,Urinary Bladder, Underactive ,Humans ,Medicine ,Aged ,Retrospective Studies ,030219 obstetrics & reproductive medicine ,business.industry ,Urinary retention ,Urethral sphincter ,Urinary Retention ,Electrophysiology ,Urinary Bladder Neck Obstruction ,Urodynamics ,Chronic Disease ,Reflex ,Female ,Neurology (clinical) ,medicine.symptom ,business - Abstract
Objectives Both detrusor underactivity (DU) and bladder outlet obstruction are the common causes of chronic urinary retention. Some novel treatment approaches focus on modulating micturition reflex and external urethral sphincter (EUS) function. This study used electrophysiologic (EP) studies to investigate the micturition reflex and EUS conditions of chronic urinary retention patients. Methods Sixty patients with urodynamic DU and chronic urinary retention were studied using (1) bulbocavernous reflex (BCR) by electric stimulation, (2) electromyography (EMG) of the EUS, and (3) nerve conduction velocity (NCV) studies of the pudendal nerve. The EP findings were analyzed in DU patients with different etiologies. Results The BCR was positive in 41.7% of patients. In EMG studies, denervation, reinnervation, and reduced recruitment of the EUS were observed in 21.7%, 71.7%, and 88.3% patients, respectively. Decreased amplitude of pudendal nerve conduction in NCV studies was noted in 73.3% of patients. Patients with sacral neuropathy had a lower BCR positive rate (p = 0.001), a nonsignificant but higher denervation rate (p = 0.059) in EMG studies, and a higher rate of decreased amplitude in NCV (p = 0.011) than those without sacral neuropathy. Excluding patients with sacral neuropathy or diabetes mellitus, a high percentage of neurologic deficits was still detected in EP studies. Conclusions Chronic urinary retention patients with urodynamic DU not only have bladder dysfunction, but also potential neuropathy in the sacral reflexes, pudendal nerve, or urethral sphincter innervation. The neurologic deficits explored in EP studies may affect the decision-making around the therapy to restore the voiding function in DU.
- Published
- 2021
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