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Shim J, Oh MM. Updates of Overactive Bladder in Pediatrics. Int Neurourol J 2023; 27:3-14. [PMID: 37015720 PMCID: PMC10073000 DOI: 10.5213/inj.2244228.114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Accepted: 01/09/2023] [Indexed: 04/06/2023] Open
Abstract
Overactive bladder (OAB) is clinically defined as urinary urgency with or without urinary incontinence. It is associated with daytime frequency or constipation and has a prevalence of approximately 5%-12% among 5- to 10-year-olds. The appropriate functional exchange between the pontine micturition center, periaqueductal gray matter, and prefrontal cortex is important for proper micturition control. Several studies on pediatric cases observed a link between OAB and neuropsychiatric problems, such as anxiety, depression, and attention deficit, and treatment of these comorbidities improved patient symptoms. In this review, we present the pathophysiology of OAB, its associated conditions, and aspects related to updates in OAB treatment, and we propose a step-by-step treatment approach following this sequence: behavioral therapy, medical treatment, and invasive treatment. Although anticholinergic drugs are the mainstay of OAB medical treatment, beta-3 agonists and alpha-blockers are now recommended as a result of significant advancements in pharmacologic treatment in the last 10 years. Electrical stimulation techniques and botulinum toxin are also effective and can be used, especially in conventional treatment-refractory cases.
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Affiliation(s)
- Jisung Shim
- Department of Urology, Korea University College of Medicine, Seoul, Korea
- Institute of Nano, Regeneration, Reconstruction, College of Medicine, Korea University, Seoul, Korea
| | - Mi Mi Oh
- Department of Urology, Korea University College of Medicine, Seoul, Korea
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İbrahimov A, Özkıdık M, Akıncı A, Hajiyev P, Burgu B. Does urination position have an effect on evaluation of lower urinary tract function ın children? A uroflowmetric study. AFRICAN JOURNAL OF UROLOGY 2022. [DOI: 10.1186/s12301-022-00299-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
We aimed to determine whether different urination positions had significant impact on the parameters of uroflowmetry performed by healthy individuals and children with voiding dysfunction.
Methods
The study was conducted with a prospective and comparative design. Children between 5 and 15 years of age who met the inclusion–exclusion criteria of the study were enrolled. Children in the study were divided into two groups. Participants whose voiding dysfunction symptom score was ≥ 9 points were classified in group 1 and the remaining individuals were classified in group 2. Girls urinated in two different positions as sitting and squatting while boys urinated in three different positions as sitting, squatting and standing. Also, habitual urination position was asked and recorded for each individual participated in the study. Uroflowmetry parameters were compared for different urination positions in two groups separately and a p value of ≤ .05 was accepted for statistical significance.
Results
Voided volume, maximum flow rate (Qmax), time to reach Qmax, urination time and postvoid residual volume measured by abdominal ultrasound were recorded in every participant for each urination position in both groups. In group 1, girls with voiding dysfunction presented a significantly higher postvoid residual volume in squatting position compared to sitting position (the p value = 0.02). In group 2, healthy boys presented a significantly higher Qmax in standing position compared to sitting and squatting positions (the p value = 0.01). All participants provided a better uroflowmetry pattern in their habitual urination positions.
Conclusion
Urination position may affect uroflowmetry results; however, its impact on lower urinary tract function requires further research.
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Sexual dimorphic impacts of systemic vincristine on lower urinary tract function. Sci Rep 2022; 12:5113. [PMID: 35332157 PMCID: PMC8948262 DOI: 10.1038/s41598-022-08585-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Accepted: 03/09/2022] [Indexed: 11/20/2022] Open
Abstract
Vincristine (VCR) is one of the most common chemotherapy agents used in pediatric oncology. Despite the well-known VCR-induced peripheral neuropathy, potential impacts of VCR on lower urinary tract (LUT) function remain poorly defined. We investigated the effects of systemic VCR exposure in childhood on LUT function by using juvenile mice treated with VCR (4 mg/kg) or saline and evaluated at 5 weeks later. VCR induced a decreased urinary frequency with increased functional bladder capacity and non-void contractions. There were no changes in detrusor contractility between the groups. VCR exposure caused sexual dimorphic changes; in females, increased intravesical pressure at micturition and downregulations of a major player in bladder afferent firing, Htr3b, in the bladders, and Cav1.2 in the lumbosacral dorsal root ganglia (Ls-DRG), while male mice displayed increases in bladder compliance and detrusor activity, upregulations of IL-2, Trpa1 and Itga1 in the bladders and neuroinflammation-related genes, P2×4, P2×7, IL-2 and CD68 in the Ls-DRG. These results suggest that that systemic VCR exposure caused sensory neuropathy via sex-dimorphic mechanisms, leading to altered LUT function. These changes might clinically present as gender-specific signs or symptoms of LUT dysfunction, and follow-up urological assessment may be of benefit for pediatric cancer patients treated with VCR.
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Shimizu T, Shimizu S, Higashi Y, Saito M. Psychological/mental stress-induced effects on urinary function: Possible brain molecules related to psychological/mental stress-induced effects on urinary function. Int J Urol 2021; 28:1093-1104. [PMID: 34387005 DOI: 10.1111/iju.14663] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Accepted: 07/13/2021] [Indexed: 11/30/2022]
Abstract
Exposure to psychological/mental stress can affect urinary function, and lead to and exacerbate lower urinary tract dysfunctions. There is increasing evidence showing stress-induced changes not only at phenomenological levels in micturition, but also at multiple levels, lower urinary tract tissues, and peripheral and central nervous systems. The brain plays crucial roles in the regulation of the body's responses to stress; however, it is still unclear how the brain integrates stress-related information to induce changes at these multiple levels, thereby affecting urinary function and lower urinary tract dysfunctions. In this review, we introduce recent urological studies investigating the effects of stress exposure on urinary function and lower urinary tract dysfunctions, and our recent studies exploring "pro-micturition" and "anti-micturition" brain molecules related to stress responses. Based on evidence from these studies, we discuss the future directions of central neurourological research investigating how stress exposure-induced changes at peripheral and central levels affect urinary function and lower urinary tract dysfunctions. Brain molecules that we explored might be entry points into dissecting the stress-mediated process for modulating micturition.
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Affiliation(s)
- Takahiro Shimizu
- Department of Pharmacology, Kochi Medical School, Kochi University, Nankoku, Kochi, Japan
| | - Shogo Shimizu
- Department of Pharmacology, Kochi Medical School, Kochi University, Nankoku, Kochi, Japan
| | - Youichirou Higashi
- Department of Pharmacology, Kochi Medical School, Kochi University, Nankoku, Kochi, Japan
| | - Motoaki Saito
- Department of Pharmacology, Kochi Medical School, Kochi University, Nankoku, Kochi, Japan
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Abstract
PURPOSE OF REVIEW This review will be covering dysfunctional voiding, its diagnosis, and treatment options. This will focus primarily on dysfunctional voiding rather than all lower urinary tract dysfunction and we will focus on some of the newer findings and progress within this disease. RECENT FINDINGS Dysfunctional voiding is the inappropriate sphincter and pelvic floor constriction during voiding in an otherwise neurologically normal child. This has a wide spectrum of symptoms and can lead to a number of complications such as chronic kidney disease and poor quality of life if not appropriately addressed. Dysfunctional voiding is diagnosed with a careful examination and history with further imaging including a renal ultrasound and uroflowmetry to confirm the diagnosis. Urotherapy and biofeedback are the first and second-line treatments respectively and lead to significant improvement or cure in the majority of patients. For refractory patients, additional therapy options include use of α-blockers, botulinum injection, and electroneurostimulation, though the majority of the literature surrounding the use of these therapies consists of small studies with heterogenous causes of voiding dysfunction. SUMMARY Dysfunctional voiding is a common urologic complaint that has many excellent options for improving the patient's voiding issues and should be considered in patients with voiding dysfunction.
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DeLong M, Gil-Silva M, Hong VM, Babyok O, Kolber BJ. Visceral pressure stimulator for exploring hollow organ pain: a pilot study. Biomed Eng Online 2021; 20:30. [PMID: 33766034 PMCID: PMC7993476 DOI: 10.1186/s12938-021-00870-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Accepted: 03/16/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The regulation and control of pressure stimuli is useful for many studies of pain and nociception especially those in the visceral pain field. In many in vivo experiments, distinct air and liquid stimuli at varying pressures are delivered to hollow organs such as the bladder, vagina, and colon. These stimuli are coupled with behavioral, molecular, or physiological read-outs of the response to the stimulus. Care must be taken to deliver precise timed stimuli during experimentation. For example, stimuli signals can be used online to precisely time-lock the stimulus with a physiological output. Such precision requires the development of specialized hardware to control the stimulus (e.g., air) while providing a precise read-out of pressure and stimulus signal markers. METHODS In this study, we designed a timed pressure regulator [termed visceral pressure stimulator (VPS)] to control air flow, measure pressure (in mmHg), and send stimuli markers to online software. The device was built using a simple circuit and primarily off-the-shelf parts. A separate custom inline analog-to-digital pressure converter was used to validate the real pressure output of the VPS. RESULTS Using commercial physiological software (Spike2, CED), we were able to measure mouse bladder pressure continuously during delivery of unique air stimulus trials in a mouse while simultaneously recording an electromyogram (EMG) of the overlying abdominal muscles. CONCLUSIONS This device will be useful for those who need to (1) deliver distinct pressure stimuli while (2) measuring the pressure in real-time and (3) monitoring stimulus on-off using physiological software.
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Affiliation(s)
- Michael DeLong
- Center for Advanced Pain Studies, Department of Neuroscience, University of Texas at Dallas, 800 W. Campbell Rd., Richardson, TX, 75080, USA
| | - Mauricio Gil-Silva
- Center for Advanced Pain Studies, Department of Neuroscience, University of Texas at Dallas, 800 W. Campbell Rd., Richardson, TX, 75080, USA.,Department of Biological Sciences, Duquesne University, 600 Forbes Avenue, Pittsburgh, PA, 15217, USA
| | - Veronica Minsu Hong
- Center for Advanced Pain Studies, Department of Neuroscience, University of Texas at Dallas, 800 W. Campbell Rd., Richardson, TX, 75080, USA
| | - Olivia Babyok
- Department of Biological Sciences, Duquesne University, 600 Forbes Avenue, Pittsburgh, PA, 15217, USA
| | - Benedict J Kolber
- Center for Advanced Pain Studies, Department of Neuroscience, University of Texas at Dallas, 800 W. Campbell Rd., Richardson, TX, 75080, USA.
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Iguchi N, Carrasco A, Xie AX, Pineda RH, Malykhina AP, Wilcox DT. Functional constipation induces bladder overactivity associated with upregulations of Htr2 and Trpv2 pathways. Sci Rep 2021; 11:1149. [PMID: 33441874 PMCID: PMC7806916 DOI: 10.1038/s41598-020-80794-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Accepted: 12/23/2020] [Indexed: 01/23/2023] Open
Abstract
Bladder and bowel dysfunction (BBD) is a common yet underdiagnosed paediatric entity that describes lower urinary tract symptoms (LUTS) accompanied by abnormal bowel patterns manifested as constipation and/or encopresis. LUTS usually manifest as urgency, urinary frequency, incontinence, and urinary tract infections (UTI). Despite increasing recognition of BBD as a risk factor for long-term urinary tract problems including recurrent UTI, vesicoureteral reflux, and renal scarring, the mechanisms underlying BBD have been unclear, and treatment remains empirical. We investigated how constipation affects the lower urinary tract function using a juvenile murine model of functional constipation. Following four days of functional constipation, animals developed LUTS including urinary frequency and detrusor overactivity evaluated by awake cystometry. Physiological examination of detrusor function in vitro using isolated bladder strips, demonstrated a significant increase in spontaneous contractions without affecting contractile force in response to electrical field stimulation, carbachol, and KCl. A significant upregulation of serotonin receptors, Htr2a and Htr2c, was observed in the bladders from mice with constipation, paralleled with augmented spontaneous contractions after pre-incubation of the bladder strips with 0.5 µM of serotonin. These results suggest that constipation induced detrusor overactivity and increased excitatory serotonin receptor activation in the urinary bladder, which contributes to the development of BBD.
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Affiliation(s)
- Nao Iguchi
- Division of Urology, Department of Surgery, University of Colorado Denver School of Medicine, 12700 E 19th Avenue, Aurora, CO, 80045, USA
| | - Alonso Carrasco
- Children's Hospital Colorado, 13123 E 16th Avenue, B463, Aurora, CO, 80045, USA
- Children's Mercy Kansas City, 2401 Gillham Rd, Kansas City, MO, 64108, USA
| | - Alison X Xie
- Division of Urology, Department of Surgery, University of Colorado Denver School of Medicine, 12700 E 19th Avenue, Aurora, CO, 80045, USA
| | - Ricardo H Pineda
- Division of Urology, Department of Surgery, University of Colorado Denver School of Medicine, 12700 E 19th Avenue, Aurora, CO, 80045, USA
| | - Anna P Malykhina
- Division of Urology, Department of Surgery, University of Colorado Denver School of Medicine, 12700 E 19th Avenue, Aurora, CO, 80045, USA
| | - Duncan T Wilcox
- Division of Urology, Department of Surgery, University of Colorado Denver School of Medicine, 12700 E 19th Avenue, Aurora, CO, 80045, USA.
- Children's Hospital Colorado, 13123 E 16th Avenue, B463, Aurora, CO, 80045, USA.
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Iguchi N, Dönmez Mİ, Carrasco A, Wilcox DT, Pineda RH, Malykhina AP, Cost NG. Doxorubicin induces detrusor smooth muscle impairments through myosin dysregulation, leading to a risk of lower urinary tract dysfunction. Am J Physiol Renal Physiol 2019; 317:F197-F206. [PMID: 31066574 DOI: 10.1152/ajprenal.00090.2019] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
Cytotoxic chemotherapy is the foundation for the treatment of the wide variety of childhood malignancies; however, these therapies are known to have a variety of deleterious side effects. One common chemotherapy used in children, doxorubicin (DOX), is well known to cause cardiotoxicity and cardiomyopathy. Recent studies have revealed that DOX impairs skeletal and smooth muscle function and contributes to fatigue and abnormal intestinal motility in patients. In this study, we tested the hypothesis that systemic DOX administration also affects detrusor smooth muscle (DSM) function in the urinary bladder, especially when administered at a young age. The effects on the DSM and bladder function were assessed in BALB/cJ mice that received six weekly intravenous injections of DOX (3 mg·kg-1·wk-1) or saline for the control group. Systemic DOX administration resulted in DSM hypertrophy, increased voiding frequency, and a significant attenuation of DSM contractility, followed by a slower relaxation compared with the control group. Gene expression analyses revealed that unlike DOX-induced cardiotoxicity, the bladders from DOX-administered animals showed no changes in oxidative stress markers; instead, downregulation of large-conductance Ca2+-activated K+ channels and altered expression of myosin light-chain kinase coincided with reduced myosin light-chain phosphorylation. These results indicate that in vivo DOX exposure caused DSM dysfunction by dysregulation of molecules involved in the detrusor contractile-relaxation mechanisms. Collectively, our findings suggest that survivors of childhood cancer treated with DOX may be at increased risk of bladder dysfunction and benefit from followup surveillance of bladder function.
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Affiliation(s)
- Nao Iguchi
- Division of Urology, Department of Surgery, University of Colorado Denver School of Medicine , Aurora, Colorado
| | - M İrfan Dönmez
- Division of Urology, Department of Surgery, University of Colorado Denver School of Medicine , Aurora, Colorado.,Children's Hospital Colorado , Aurora, Colorado
| | - Alonso Carrasco
- Children's Hospital Colorado , Aurora, Colorado.,Children's Mercy Kansas City, Kansas City, Missouri
| | - Duncan T Wilcox
- Division of Urology, Department of Surgery, University of Colorado Denver School of Medicine , Aurora, Colorado.,Children's Hospital Colorado , Aurora, Colorado
| | - Ricardo H Pineda
- Division of Urology, Department of Surgery, University of Colorado Denver School of Medicine , Aurora, Colorado
| | - Anna P Malykhina
- Division of Urology, Department of Surgery, University of Colorado Denver School of Medicine , Aurora, Colorado
| | - Nicholas G Cost
- Division of Urology, Department of Surgery, University of Colorado Denver School of Medicine , Aurora, Colorado.,Children's Hospital Colorado , Aurora, Colorado
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