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This study was conducted to provide evidence that elastograms of two different devices and different manufacturers using the same technical approach provide the same diagnoses. A total of 110 breast lesions were prospectively analysed by two experts in ultrasound, using the strain elastography function from two different manufacturers (Hitachi HI-RTE, Hitachi Medical Systems, Wiesbaden, Germany; and Siemens eSie Touch, Siemens Medical Systems, Erlangen, Germany). Results were compared with the histopathologic results. Applying the Bowker test of symmetry, no statistically significant difference between the two elastography functions of these two devices was found (p = 0.120). The Cohen's kappa of k = 0.591 showed moderate strength of agreement between the two elastograms. The two examiners yielded moderate strength of agreement analysing the elastograms (Hitachi HI-RTE, k = 0.478; Siemens eSie Touch, k = 0.441). In conclusion, evidence is provided that elastograms of the same lesion generated by two different ultrasound devices equipped with a strain elastography function do not significantly differ.

Vector Network Analyzer Settings for TD Measurements. Gating: The unwanted time domain responses will be reduced by the gate, but not totally removed. Even the most simple impulse response does not appear at a single point in time, but can spread out and have side lobe ripples that cannot be completely eliminated by gating.

Aims The working group initiated by the ICS Standardisation Steering Committee has updated the International Continence Society Standard "Good Urodynamic Practice" published in 2002. Methods On the basis of the manuscript: "ICS standard to develop evidence-based standards," a new ICS Standard was developed in the period from December 2013 to December 2015. In July, a draft was posted on the ICS website for membership comments and discussed at the ICS 2015 annual meeting. The input of ICS membership was included in the final draft before ICS approval and subsequent peer review (for this journal). Results This evidence-based ICS-GUP2016 has newly or more precisely defined more than 30 terms and provides standards for the practice, quality control, interpretation, and reporting of urodynamics; cystometry and pressure-flow analysis. Furthermore, the working group has included recommendations for pre-testing information and for patient information and preparation. On the basis of earlier ICS standardisations and updating according to available evidence, the practice of uroflowmetry, cystometry, and pressure-flow studies are further detailed. Conclusion ICS-GUP2016 updates and adds on to ICS-GUP2002 to improve urodynamic testing and reporting both for individual care and scientific purposes.

Background: Imatinib is a tyrosine kinase inhibitor of BCR-ABL, ABL, PDGFR-α and -β, KIT, and DDR. In solid tumors, it inhibits proliferation and invasiveness and facilitates higher intratumoral cytotoxic drug concentrations. Vinorelbine has good tolerability and efficacy in metastatic breast cancer (MBC). This study evaluates the safety and efficacy of imatinib and vinorelbine in combination. Methods: In a prospective, open-label, phase I/II trial, 400 mg imatinib p.o. daily (corrected from 600 mg) was combined with an escalating dose of vinorelbine i.v. weekly in four dose levels of 10, 15, 20, and 25 mg/m2 (each n ≥ 5) to treat patients with MBC (expressing PDGFR-α and/or -β, and/or KIT). The last patient of each level was treated for >28 days, before enrolment for the next dose level started. Study endpoints were feasibility and tolerability, incidence of hematological and nonhematological toxicity, and clinical efficacy (data cutoff: November 18, 2011). A total of 33 patients have been enrolled, and all dose levels have been fully recruited. One patient is still on study medication. A translational subprotocol is ongoing. Results: All 33 included patients are evaluable for safety (32 within the ITT population). Eleven patients were excluded early from the study (progressive disease, toxicity, and withdrawal of consent). Twenty-two patients participated in the study for >28 days (‘ITT >28'). Within the ITT population, the response rate [complete response (CR) and partial response (PR)] was 9.4% (n = 3), the clinical benefit rate (CBR; CR+PR+stable disease) 50% (n = 16), and the median time to progression (TTP) 155 days. A total of 21.3% of the patients were on study medication for >6 months, and 15.2% for >12 months (mean 140 days, range 15-643). Within ‘ITT >28', the response rate was 13.6%, CBR 72.7%, and median TTP 176 days. The response was independent of the receptor status (PDGFR-α, -β, and KIT). Toxicities were as follows (safety population): 21.6% severe leukopenia, 9.1% severe neutropenia (with 1 febrile neutropenia), 1 case of bowel perforation, 36% diarrhea (3% severe), 84.8% nausea (severe 15.2%), 48.5% vomiting (severe 9.1%), 27.3% infections (severe 6.1%), 12.1% peripheral neuropathy (severe 9.1%), and 36.4% dyspnea (3% severe). Four patients on trial died (nondrug-related). Conclusion: The combination of imatinib and vinorelbine in MBC appeared to be feasible and tolerable. A CBR of 50% (ITT) in pretreated patients suggests that this combination may be active. Although toxicities were frequent, they appeared to be manageable.

Aims To better target a behavioral approach for urge urinary incontinence (UUI) and enhance its efficacy by (1) identifying predictors of response to biofeedback-assisted pelvic muscle training (BFB), and (2) determining factors that mediate response. Methods BFB (four biweekly visits) was administered to 183 women > 60 years (mean = 73.6). Before and after intervention, all underwent comprehensive evaluation and videourodynamic testing. Postulated predictors and mediators from four urodynamic domains, specified a priori, were correlated with reduction in UUI frequency. Results Median UUI frequency decreased from 3.2/day to 1/day (P =0.0001). UUI improved by ≥50% in 55% of subjects and by 100% in 13% of subjects. Frequent UUI predicted poor response (P

Aims To report interpatient, intrapatient, and study site variability of urodynamic study (UDS) parameters in patients with overactive bladder (OAB). Methods Fifty-eight patients with OAB participated in a randomized, double-blind, placebo-controlled, urodynamic trial of an experimental OAB drug. Patients underwent 3 serial cystometries (CMGs) at three times: screening, pre-dose, and 4-hr postdose. This post hoc analysis describes intrapatient, interpatient, and site variability for the 6 CMGs prior to administration of study drug. Sites were given standard procedures for equipment calibration and UDS technique. Instilled volumes and pressures were recorded at first sensation of filling, first desire to void (FDV), strong desire to void (SDV), and maximum cystometric capacity (MCC). Results The UDS volume endpoint with the smallest observed within-patient variability based on coefficient of variation (%CV) was MCC (%CV 24). Pressure measurements of all bladder sensations had larger within-patient variability than volume (MCC %CV 105). The between-patient variability was greater than within-patient variability for all bladder sensation volumes. Between-patient MCC variability for the 6 pre-treatment CMGs ranged from %CV of 50 to 58, whereas the within-patient %CV for MCC was 21–23. Excellent reproducibility was observed for bladder volume for MCC (intraclass correlation coefficients, range: 0.80–0.84). The between-site variability was large, as demonstrated by the mean volumes by site for MCC (132–397 ml). Conclusions MCC was the most reproducible sensation. Pressure measurements were substantially more variable than volume. Between-patient variability was substantially greater than within-patient variability. The observed intersite variability suggests that despite detailed instructions, sensations may not have been measured in a consistent manner across sites. Neurourol. Urodynam. Neurourol. Urodynam. 30: 1565–1569, 2011. © 2011 Wiley Periodicals, Inc.

We investigated the relationship between experimental neuroimaging and self-reported urinary incontinence measures.We evaluated 14 functionally independent, community dwelling women older than 60 years with moderate to severe urgency urinary incontinence. All underwent detailed clinical assessment (3-day bladder diary, 24-hour pad test and quality of life assessment), urodynamic testing and functional brain scanning. Brain activity during reported urgency was assessed using a method that combines functional magnetic resonance imaging with simultaneous urodynamic monitoring during repeat bladder filling/emptying cycles. We used the statistical parametric mapping program SPM2 (http://www.fil.ion.ucl.ac.uk/spm/spm2.html) to correlate brain activity with relevant clinical covariates, including the number of urgency incontinent episodes, amount of urine leakage and psychological burden as assessed by the Urge Impact Scale questionnaire.Activity in rostral and subgenual anterior cingulate gyrus, insula, inferior frontal gyrus, orbitofrontal cortex, dorsal and posterior cingulate gyrus, parahippocampus, cuneus and parts of parietotemporal lobe correlated positively with daytime incontinence frequency and urine loss. Different brain regions correlated with the psychological burden and the associations were inverse, that is precuneus/cuneus and posterior cingulate gyrus, and superior temporal, supramarginal and transverse gyrus.As provoked by bladder filling, regional brain activity in the setting of self-reported urgency correlates significantly with incontinence severity in daily life and the associated psychological burden. Thus, observations made under experimental conditions correlate with patient real-life experience and suggest neural correlates of urgency incontinence symptoms that could serve as potential targets for future investigations.

Loss of bladder control (urge incontinence) is common in elderly; the cause is usually unknown. Functional imaging has revealed the brain network controlling responses to bladder filling. Age-related changes in this network might predispose to urge incontinence. We sought such changes in 10 continent, healthy women aged 30-79 years who underwent fMRI while fluid (approximately 20 ml) was repeatedly infused into and withdrawn from the bladder. Data were collected in 4 measurement blocks with progressively increasing bladder volumes and were analyzed by SPM2, using the contrast infuse-withdraw to quantify response to bladder infusion. Effective connectivity was examined by physiophysiological interaction (PhPI; see interpretation in Supplementary Material), with right insula (RI) and dorsal anterior cingulate cortex (dACC) as seed regions. Dependence on age and bladder volume (= block number) was assessed. Bladder infusion evoked expected activations. Activation decreased with age in bilateral insula and dACC. PhPI revealed connectivity with RI and dACC in regions that included bilateral putamen and R pontine micturition center. Interaction (connectivity) tended to increase with age in regions including L insula, L paracentral lobule and PAG. Consistent with a special role in maintaining continence, medial prefrontal cortex (mPFC) showed a trend to deactivation on bladder infusion that became more prominent in old age, and a trend to negative interaction (connectivity) that weakened significantly with age. Thus, with increasing age, weaker signals in the bladder control network as a whole and/or changes in mPFC function or connecting pathways may be responsible for the development of urge incontinence.

Aims: To investigate the test-retest reproducibility and variability of urethral resistance and detrusor contractility with-in a session in men with lower urinary tract symptoms, an

This paper reports on the currently available information regarding urethral dysfunction as presented during the scientific session of the 2006 Society for Urodynamics and Female Urology meeting in Atlanta, GA. Anatomic studies of the urethral sphincter complex contribute to our understanding of the continence mechanism, particularly as it relates to sex differences and the effect of androgens. It is important to understand biomechanical concepts of load and stress as they relate to the demonstration of incontinence on urodynamic studies. Urethral imaging complements our ability to accurately diagnose clinical problems. The pharmacologic components of urethral pressure are also discussed. Continued advances in our understanding of urethral dysfunction will guide improved diagnosis and treatment of these disorders.

To explore the interaction between bladder compliance (BC) and bladder outflow obstruction (BOO) in men with benign prostatic hyperplasia (BPH) using cross-sectional and longitudinal studies.A total of 181 men with BPH were recruited, and 100 of them were followed for one year. Cystometry was performed in a standing or a sitting position with 30 mL/min infusion. BC was manually corrected and defined. Obstruction coefficient (OCO), linear passive urethral resistance relation and international continence society (ICS) nomogram were used to diagnose BOO. The obstructed parameters were compared between the reduced BC group and the non-reduced group. BC was compared between the first investigation at the beginning of study and the second investigation at the end of study during the one-year follow-up period.The group with reduced BC had increased OCO and linear passive urethral resistance relation. BC was significantly lower in the obstructed group (55.7 mL/cm water) than that in unobstructed and equivocal one (74.9 mL/cm water, P0.01). BC gradually reduced with the increased obstructed grade. There was a significantly weak negative correlation between BC and OCO (r = -0.132, P0.01). Over the one-year follow-up period in the longitudinal study, BC for all men changed from 54.4 to 48.8 mL/cm water (P0.05), and BC for the group with BOO fell from 58.4 +/- 70.1 to 46.5 +/- 38.7 mL/cm water (P0.05).In men with BPH, a significant systematic decrease occurred in BC in the obstructed group and a significant systematic increase with urethral resistance occurred in the low BC group. A longitudinal study of the tendency of BC reduction in a group with BOO is necessary in the future.

OBJECTIVES: To identify age-associated changes in female lower urinary tract function across a wide age spectrum, controlling for detrusor overactivity (DO). DESIGN: Secondary analysis of a cross-sectional study of DO and aging. Eligible volunteers were stratified by age group and presence of DO. SETTING: Community-based volunteers, evaluated in research laboratory. PARTICIPANTS: Eighty-five ambulatory, nondemented, community-dwelling female volunteers, with and without bladder symptoms suggestive of DO, recruited by advertising, mean age 54 (range 22–90); 75% Caucasian, 21% African American. MEASUREMENTS: Comprehensive assessment included bladder diary, uroflowmetry, and detailed videourodynamics. Predefined urodynamic and diary variables were examined for association with age and DO. Mean values of these variables were calculated for subgroups aged 20 to 39, 40 to 59, and 60 and older (14 subjects ≥70). RESULTS: Maximum urethral closure pressure, detrusor contraction strength, and urine flow rate declined significantly with age (P

Objective: Intravesical pressure measurement is considered to be the gold standard for the assessment of intra-abdominal pressure. However, this method is indirect and depends on a physiologic bladder function. We evaluated a modified piezoresistive technique and a water-capsule technique for direct and continuous intra-abdominal pressure measurement. Design: Experimental study. Setting: Animal research laboratory. Subjects: Eleven male domestic pigs. Interventions: In anesthetized and mechanically ventilated animals, CO2 was insufflated to stepwise increase the intra-abdominal pressure to 30 mm Hg. Pressure was then held constant for 9 hrs followed by decompression. Piezoresistive measurement and water-capsule measurement probes were placed intra-abdominally. Measurements and Main Results: Readings of intravesical pressure measurement, piezoresistive measurement, and watercapsule measurement were taken hourly. Mean difference to insufflator readings, confidence intervals, and limits of agreement were calculated. Differences between applied pressure and intraabdominal pressure readings were assessed using a two-factor analysis of variance. No significant differences between methods could be observed. During stepwise pressure increase, limits of agreements were 3.6 to 3.6 mm Hg. Confidence intervals were 3.4 to 3.5 (intravesical pressure measurement), 1.6 to 1.5 (piezoresistive measurement), and 0.5 to 2.9 mm Hg (watercapsule measurement). In the presence of constantly elevated intra-abdominal pressure, limits of agreement ranged from 8.2 to 8.2 mm Hg. Confidence intervals were 0.4 to 6.2 (intravesical pressure measurement), 0.2 to 2.7 (piezoresistive measurement), and 1.1 to 5.1 mm Hg (water-capsule measurement). Conclusions: Both piezoresistive measurement and water-capsule measurement had smaller confidence intervals than intravesical pressure measurement, indicating higher precision, whereas water-capsule measurement had a significant offset. Piezoresistive measurement could be the most suitable device for continuous direct intra-abdominal pressure monitoring in specific patients. (Crit Care Med 2006; 34:745‐750)

To establish typical value ranges (TVRs) and to outline their role in urodynamic quality control.Five hundred and eighty-two data sets of free flow, filling cystometry, and voiding from 181 males in a strictly quality-controlled study were analyzed for intravesical pressure (Pves), abdominal pressure (Pabd), and detrusor pressure (Pdet) before, at the beginning and end of filling, and after voiding. Cystometric capacity, maximum flow rate (Qmax), voided volume (Vvoid), and compliance were determined. Mean value, standard deviation, median, and various TVRs were calculated. Technical errors related to the TVRs are classified and examples given.TVRs for initial resting Pves, Pabd, and Pdet were 31-42, 28-39, and 0-4 cmH₂O, respectively. Various technical errors are classified as type I: normal initial Pdet, both Pves and Pabd are incorrect; type II: negative initial Pdet; and type III: initial Pdet too high. The incidences of I, II, and III errors were 9.8, 4.5, and 1.4%, respectively. The TVRs for maximum cystometric capacity and compliance were 157-345 mL and 26.7-70.8 mL/cmH₂O; Qmax, Pdet, and Vvoid were 5.5-9 mL/s, 57-92 cmH₂O, and 167-315 mL, respectively; Qmax and Vvoid in free flow were 8-9.2 mL/s and 167-301 mL, respectively. After voiding, two errors were found: type V (Pves and Pdet after voiding still high) and type VI (Pves and Pdet negative).TVRs in urodynamics are indispensable and effective tools for quantitative plausibility checks and quality control. They are sensitive and reliable indicators for correct measurement and a relevant contribution to a collection of normal values.

1.1 Anatomy of the lower urinary tract Initially, a brief summary of the anatomy of the lower urinary tract will be presented. The bladder is a hollow muscular organ in pelvis lined by a mucous membrane and covered on its outer aspect partly by peritoneal serosa and partly by fascia (Lich et al. 1978; Dixon and Gosling 1987). The muscularis of the bladder is formed of smooth muscle cells which comprise the detrusor muscle. The detrusor muscle is often described as consisting of three layers, the muscle fibres of the outer and inner layers tending to be orientated longitudinally, while those of the middle layer are circularly disposed. Woodburne (1960) has clearly shown that the musculature of the bladder is a "muscular meshwork". The constituent muscle bundles frequently branch and reunite with one another to form this interlacing meshwork. The bladder is profusely supplied with autonomic nerve fibres which form a dense plexus among the smooth muscle cells (Dixon and Gosling 1987). In the male bladder neck, the smooth muscle cells form a complete circular collar which forms the internal urethral sphincter and extends distally to surround the preprostatic portion of the urethra. In the female bladder neck, muscle bundles extend obliquely or longitudinally into the urethral wall. There is the rich sympathetic innervation in the male bladder neck, while the female bladder neck is well supplied with the parasympathetic innervation (Gosling et al. 1977; Dixon and Gosling 1994). The male urethra is considered in four regional parts: preprostatic, prostatic, membranous and spongiose. In the membranous urethra, muscle coat consists of a relatively thin layer of smooth muscle bundles and a layer of circularly orientated striated muscle fibres forming the external urethral sphincter. In the female urethra, the muscle coat consists of an outer sleeve of striated muscle, which forms the external sphincter together with an inner coat of smooth muscle fibres (Dixon and Gosling 1994).

To report interpatient, intrapatient, and study site variability of urodynamic study (UDS) parameters in patients with overactive bladder (OAB).Fifty-eight patients with OAB participated in a randomized, double-blind, placebo-controlled, urodynamic trial of an experimental OAB drug. Patients underwent 3 serial cystometries (CMGs) at three times: screening, pre-dose, and 4-hr postdose. This post hoc analysis describes intrapatient, interpatient, and site variability for the 6 CMGs prior to administration of study drug. Sites were given standard procedures for equipment calibration and UDS technique. Instilled volumes and pressures were recorded at first sensation of filling, first desire to void (FDV), strong desire to void (SDV), and maximum cystometric capacity (MCC).The UDS volume endpoint with the smallest observed within-patient variability based on coefficient of variation (%CV) was MCC (%CV 24). Pressure measurements of all bladder sensations had larger within-patient variability than volume (MCC %CV 105). The between-patient variability was greater than within-patient variability for all bladder sensation volumes. Between-patient MCC variability for the 6 pre-treatment CMGs ranged from %CV of 50 to 58, whereas the within-patient %CV for MCC was 21-23. Excellent reproducibility was observed for bladder volume for MCC (intraclass correlation coefficients, range: 0.80-0.84). The between-site variability was large, as demonstrated by the mean volumes by site for MCC (132-397 ml).MCC was the most reproducible sensation. Pressure measurements were substantially more variable than volume. Between-patient variability was substantially greater than within-patient variability. The observed intersite variability suggests that despite detailed instructions, sensations may not have been measured in a consistent manner across sites.

Evidence from longitudinal studies in community-dwelling elderly links complaints of urgency and urinary incontinence with structural white matter changes known as white matter hyperintensities (WMH). How WMH might lead to incontinence remains unknown, since information about how they relate to neural circuits involved in continence control is lacking. The aim of this study was to investigate the role of WMH in altered brain activity in older women with urgency incontinence. In a cross-sectional study, we measured WMH, globally and in specific white matter tracts, and correlated them with regional brain activity measured by fMRI (combined with simultaneous urodynamic monitoring) during bladder filling and reported ‘urgency’. We postulated that increase in global WMH burden would be associated with changes (either attenuation or reinforcement) in responses to bladder filling in brain regions involved in bladder control. Secondly, we proposed that such apparent effects of global WMH burden might be specifically related to the burden in a few critical white matter pathways. The results showed that regional activations (e.g. medial/superior frontal gyrus adjacent to dorsal ACG) and deactivations (e.g. perigenual ACG adjacent to ventromedial prefrontal cortex) became more prominent with increased global WMH burden, suggesting that activity aimed at suppressing urgency was augmented. Secondary analyses confirmed that the apparent effect of global WMH burden might reflect the presence of WMH in specific pathways (anterior thalamic radiation and superior longitudinal fasciculus), thus affecting connections between key regions and suggesting possible mechanisms involved in continence control.

Der Aufschluss und der Betrieb von Tagebauen greift zwangslaufig und zum Teil erheblich in den unmittelbaren Bereich des Tagebaues, aber auch in das umgebende Umfeld ein. Diese Eingriffe haben Auswirkungen insbesondere auf die dort lebenden Menschen, die Natur, die Landschaft und den Boden sowie den Wasserhaushalt. Hierbei konnen sowohl Oberflachengewasser als auch das die Braunkohlefloze uber- und unterlagernde Gebirge beeinflusst werden, welches bei den Braunkohlentagebauen in Deutschland ausschlieslich aus zum Teil wassererfullten Lockergesteinen besteht. Aber auch die Besiedlung, deren aktuelle Zeugnisse und vorlaufende Spuren in Form von Bauund Bodendenkmalern, die Verkehrs- und Versorgungswege sowie die Nachbarschaft im Allgemeinen konnen vom Tagebau betroffen sein. Dies gilt umso mehr fur die grosdimensionierten Braunkohlentagebaue in Deutschland.

Aim: To evaluate the effects of retrospective quality control on pressure-flow data with computer-based urodynamic systems from men with benign prostatic hyperplasia (BPH). Methods: A total of 582 traces of pressure-flow study from 181 men with BPH was included in the study. For each trace, maximum urinary flow rate (Qmax) and detrusor pressure at Qmax (pdet.Qmax) were, respectively, read from manually smoothed and corrected uroflow and detrusor pressure curves from the computer print-outs. Obstruction coefficient, International Continence Society (ICS) and Schaefer nomograms were used to detect urethral resistance and to diagnose obstruction. The results obtained by manual reading were compared with those from computer-based systems. Results: After manual correction, Qmax underwent a consistently significant decrease by 1.2 mL/s on average (P < 0.001), and had a change range of 0.5–10.4 mL/s. However, pdet.Qmax underwent inconsistently intra-individual changes after correction. The obstruction coefficient increased significantly, by an average of 0.07 (P < 0.05). Using the ICS nomogram, the percentage of obstruction increased from 69.8% to 73.9%, and of the non-obstruction decreased from 8.8% to 5.3% (P < 0.05). There were 11% of traces that changed the classifications using the ICS nomogram, and 28.9% that changed the grades for the Schaefer nomogram. Conclusion: Systematically significant differences in parameters from pressure-flow study between manual readings and computer recordings were demonstrated. Manual correction resulted in a consistently lower Qmax, a higher urethral resistance, and an aggravating obstruction. Manual readings can correct considerable false diagnoses for obstruction. Retrospective quality control of pressure-flow data with computer-based systems is necessary. (Asian J Androl 2007 Nov; 9: 771–780)

The regions of the supraspinal network that controls urinary bladder behavior are well known, but little is known about their interconnections. We tested the feasibility of using physiophysiological interaction to explore the effective connections of the network and to seek disease-related differences in connectivity. This was a secondary analysis of fMRI data obtained from women aged 26 - 85 years, 11 with urge urinary incontinence and 10 with normal bladder function. In each subject, fMRI BOLD images were obtained during a period with full bladder and strong bladder sensation (without detrusor overactivity) while repeatedly infusing and withdrawing a small amount of liquid in and out of the bladder. Regions of interest included right insula (RI) and anterior cingulate gyrus (ACG), both consistently involved in bladder control. Other regions effectively connected to them were identified by significant correlation between their fMRI signal and the interaction RIxACG. Among normal subjects, many regions involved in bladder control were effectively connected with RI/ACG, including frontotemporal and sensorimotor cortex, forebrain, midbrain and pontine regions. The sign of the correlation with RIxACG was near-uniformly positive, perhaps suggesting mainly inhibitory connections. Among urge-incontinent subjects the effective connectivity was shifted to a parieto-temporal complex, while the sign of the correlation was predominantly negative, perhaps consistent with excitation (recruitment) of accessory pathways in an attempt to maintain bladder control. Thus, physiophysiological interaction yields potentially important information about the connectivity of the bladder control network and its changes in disease.

Aim: To identify age-related changes in the normal brain/bladder control system, and differences between urge incontinence in younger and older women, as shown by brain responses to bladder filling; and to use age, bladder volume, urge incontinence and detrusor overactivity (DO) as probes to reveal control system function. Functional MRI was used to examine regional brain responses to bladder infusion in 21 females (26–85 years): 11 “cases” with urge incontinence and DO (proven previously) and 10 normal “controls”. Responses and their age dependence were determined at small and large bladder volumes, in whole brain and in regions of interest representing right insula and anterior cingulate (ACG). In “controls”, increasing bladder volume/sensation led to increasing insular responses; with increasing age, insular responses became weaker. In younger “cases”, ACG responded abnormally strongly at large bladder volumes/strong sensation. Elderly “cases” showed strong ACG responses even at small bladder volume but more moderate responses at larger volumes; if DO occurred, pontine micturition center (PMC) activation did not increase. Conclusion: Among normal “controls”, increasing age leads to decreased responses in brain regions involved in bladder control, including right insula, consistent with its role in mapping normal bladder sensations. Strong ACG activation occurs in urge-incontinent “cases” and may be a sign of urgency, indicating recruitment of alternative pathways when loss of bladder control is feared. Easier ACG provocation in older “cases” reflects lack of physiological reserve or different etiology. ACG responses seem associated with PMC inhibition: reduced ACG activity accompanies failure of inhibition (DO).

Aims To determine normative data for lower urinary tract function in asymptomatic continent women without detrusor overactivity (DO) across the age span. Methods Healthy female volunteers aged ≥20 years were recruited from the community. Comprehensive assessment included bladder diary, physical examination, uroflowmetry, and videourodynamics. Continent women without history of frequent urgency and without DO were selected. Data on bladder storage, voiding and urethral sphincter function, urine output and frequency are presented for pre-, peri-, and postmenopausal women. Results Twenty-four asymptomatic women (mean age 50.2 years, range 22–80 years) met the inclusion criteria, including 7 pre- (29.2 years), 7 peri- (48.8 years), and 10 postmenopausal (66.0 years) women. For all subjects, maximum single voided volume in bladder diary was 500 ml and maximum cystometric capacity was 580 ml (median values). Strong desire to void (SDV) was reported at 287, 366, and 425 ml for pre-, peri-, and postmenopausal groups, respectively. The maximum flow rate was 25, 32, and 23 ml/sec in uroflowmetry and 23, 24, and 18 ml/sec in pressure-flow study, respectively. Median post-void residual volume (PVR) was below 20 ml in all groups. At maximum flow rate subjects voided with detrusor pressures of 29, 26, and 24 cm H2O, respectively. Maximum urethral closure pressure was 94, 74, and 42 cm H2O, respectively. Conclusions We provide normative data on bladder function in asymptomatic, continent, pre-, peri-, and postmenopausal women without DO. Neurourol. Urodynam. 26:356–361, 2007. © 2007 Wiley-Liss, Inc.

To identify age-associated changes in female lower urinary tract function across a wide age spectrum, controlling for detrusor overactivity (DO).Secondary analysis of a cross-sectional study of DO and aging. Eligible volunteers were stratified by age group and presence of DO.Community-based volunteers, evaluated in research laboratory.Eighty-five ambulatory, nondemented, community-dwelling female volunteers, with and without bladder symptoms suggestive of DO, recruited by advertising, mean age 54 (range 22-90); 75% Caucasian, 21% African American.Comprehensive assessment included bladder diary, uroflowmetry, and detailed videourodynamics. Predefined urodynamic and diary variables were examined for association with age and DO. Mean values of these variables were calculated for subgroups aged 20 to 39, 40 to 59, and 60 and older (14 subjectsor =70).Maximum urethral closure pressure, detrusor contraction strength, and urine flow rate declined significantly with age (P.001, P.001, P=.006, respectively), regardless of whether DO was present. Most elderly individuals continued to empty their bladder almost completely, with normal voiding frequency. Mean number of nocturnal voids was less than one in all age groups. Bladder capacity did not decrease with age (mean 522 mL in oldest group) but was smaller in subjects with DO. Bladder sensation diminished significantly with age (P.001) but was stronger in subjects with DO.Female bladder and urethral function appear to deteriorate throughout adult life, whether DO is present or not. Specifically, detrusor contractility, bladder sensation, and urethral pressure decline. The common belief that bladder capacity shrinks with age may be related to DO rather than to aging itself.