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Fanciulli A, Stankovic I, Avraham O, Jecmenica Lukic M, Ezra A, Leys F, Goebel G, Krismer F, Petrovic I, Svetel M, Seppi K, Kostic V, Giladi N, Poewe W, Wenning GK, Gurevich T. Early Screening for the Parkinson Variant of Multiple System Atrophy: A 6-Item Score. Mov Disord Clin Pract 2024. [PMID: 38659282 DOI: 10.1002/mdc3.14048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2023] [Revised: 03/22/2024] [Accepted: 04/03/2024] [Indexed: 04/26/2024] Open
Abstract
BACKGROUND A 4-item score based on ≥2 features out of orthostatic hypotension, overactive bladder, urinary retention and postural instability was previously shown to early distinguish the Parkinson-variant of multiple system atrophy (MSA-P) from Parkinson's disease (PD) with 78% sensitivity and 86% specificity. OBJECTIVES To replicate and improve the 4-item MSA-P score. METHODS We retrospectively studied 161 patients with early parkinsonism [ie, ≤2 years disease duration or no postural instability, aged 64 (57; 68) years, 44% females] and a diagnosis of clinically established MSA-P (n = 38) or PD (n = 123) after ≥24 months follow-up. RESULTS The 4-item MSA-P score had a 92% sensitivity and 78% specificity for a final MSA-P diagnosis. By including dopaminergic responsiveness and postural deformities into a 6-item score (range: 0-6), reaching ≥3 points at early disease identified MSA-P patients with 89% sensitivity and 98% specificity. CONCLUSIONS The 6-item MSA-P score is a cost-effective tool to pinpoint individuals with early-stage MSA-P.
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Affiliation(s)
| | - Iva Stankovic
- Neurology Clinic, University Clinical Center of Serbia, Belgrade, Serbia
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Omer Avraham
- Movement Disorders Unit, Neurological Institute, Tel-Aviv Medical Center, Tel-Aviv, Israel
- School of Medicine, Sagol School of Neuroscience, Tel-Aviv University, Tel-Aviv, Israel
| | - Milica Jecmenica Lukic
- Neurology Clinic, University Clinical Center of Serbia, Belgrade, Serbia
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Adi Ezra
- Movement Disorders Unit, Neurological Institute, Tel-Aviv Medical Center, Tel-Aviv, Israel
| | - Fabian Leys
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Georg Goebel
- Institute of Medical Statistics and Informatics, Medical University of Innsbruck, Innsbruck, Austria
| | - Florian Krismer
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Igor Petrovic
- Neurology Clinic, University Clinical Center of Serbia, Belgrade, Serbia
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Marina Svetel
- Neurology Clinic, University Clinical Center of Serbia, Belgrade, Serbia
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Klaus Seppi
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
- Department of Neurology, Provincial Hospital of Kufstein, Kufstein, Austria
| | - Vladimir Kostic
- Neurology Clinic, University Clinical Center of Serbia, Belgrade, Serbia
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Nir Giladi
- Movement Disorders Unit, Neurological Institute, Tel-Aviv Medical Center, Tel-Aviv, Israel
- School of Medicine, Sagol School of Neuroscience, Tel-Aviv University, Tel-Aviv, Israel
- Sagol School of Neuroscience, Tel-Aviv University, Tel-Aviv, Israel
| | - Werner Poewe
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Gregor K Wenning
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Tanya Gurevich
- Movement Disorders Unit, Neurological Institute, Tel-Aviv Medical Center, Tel-Aviv, Israel
- School of Medicine, Sagol School of Neuroscience, Tel-Aviv University, Tel-Aviv, Israel
- Sagol School of Neuroscience, Tel-Aviv University, Tel-Aviv, Israel
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Sapouna V, Zikopoulos A, Thanopoulou S, Zachariou D, Giannakis I, Kaltsas A, Sopheap B, Sofikitis N, Zachariou A. Posterior Tibial Nerve Stimulation for the Treatment of Detrusor Overactivity in Multiple Sclerosis Patients: A Narrative Review. J Pers Med 2024; 14:355. [PMID: 38672982 DOI: 10.3390/jpm14040355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2024] [Revised: 03/26/2024] [Accepted: 03/26/2024] [Indexed: 04/28/2024] Open
Abstract
Bladder dysfunction, particularly neurogenic detrusor overactivity (DO), poses a substantial challenge in multiple sclerosis (MS) patients, detrimentally impacting their quality of life (QoL). Conventional therapies often fall short, necessitating alternative approaches like posterior tibial nerve stimulation (PTNS) for effective management. This narrative review critically examines the application of PTNS in treating DO among MS patients, aiming to provide a comprehensive synthesis of its efficacy, underlying mechanisms, and clinical outcomes. By evaluating a spectrum of studies, including randomized controlled trials and long-term follow-up research, the review elucidates PTNS's role in enhancing bladder control and ameliorating symptoms of urgency and incontinence, thereby improving patient well-being. Despite its potential, the review acknowledges the limited scope of existing research specific to MS-induced neurogenic DO and calls for further investigation to optimize PTNS protocols and understand its long-term benefits. Highlighting PTNS's minimal invasiveness and favorable safety profile, the review advocates for its consideration as a viable third-line treatment option in MS-related bladder dysfunction management. Through this analysis, the review contributes to the broader narrative of seeking effective, patient-centered therapeutic strategies for MS-related complications, underscoring the importance of personalized care in improving patient outcomes.
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Affiliation(s)
- Vaia Sapouna
- Department of Urology, EV PRATTEIN Rehabilitation Centre, 38222 Volos, Greece
| | - Athanasios Zikopoulos
- Department of Urology, Faculty of Medicine, School of Health Sciences, University of Ioannina, 45110 Ioannina, Greece
| | - Sofia Thanopoulou
- Department of Urology, EV PRATTEIN Rehabilitation Centre, 38222 Volos, Greece
| | - Dimitrios Zachariou
- Department of Urology, EV PRATTEIN Rehabilitation Centre, 38222 Volos, Greece
| | - Ioannis Giannakis
- Department of Urology, Faculty of Medicine, School of Health Sciences, University of Ioannina, 45110 Ioannina, Greece
| | - Aris Kaltsas
- Third Department of Urology, Attikon University Hospital, School of Medicine, National and Kapodistrian University of Athens, 12462 Athens, Greece
| | - Bou Sopheap
- Department of Urology, Cambodia-China Friendship Preah Kossamak Hospital, Phnom Penh 120406, Cambodia
| | - Nikolaos Sofikitis
- Department of Urology, Faculty of Medicine, School of Health Sciences, University of Ioannina, 45110 Ioannina, Greece
| | - Athanasios Zachariou
- Department of Urology, Faculty of Medicine, School of Health Sciences, University of Ioannina, 45110 Ioannina, Greece
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Rana S, Alom F, Martinez RC, Fuller DD, Mickle AD. Acute ampakines increase voiding function and coordination in a rat model of SCI. eLife 2024; 12:RP89767. [PMID: 38451184 PMCID: PMC10962400 DOI: 10.7554/elife.89767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/08/2024] Open
Abstract
Neurogenic bladder dysfunction causes urological complications and reduces the quality of life in persons with spinal cord injury (SCI). Glutamatergic signaling via AMPA receptors is fundamentally important to the neural circuits controlling bladder voiding. Ampakines are positive allosteric modulators of AMPA receptors that can enhance the function of glutamatergic neural circuits after SCI. We hypothesized that ampakines can acutely stimulate bladder voiding that has been impaired due to thoracic contusion SCI. Adult female Sprague-Dawley rats received a unilateral contusion of the T9 spinal cord (n = 10). Bladder function (cystometry) and coordination with the external urethral sphincter (EUS) were assessed 5 d post-SCI under urethane anesthesia. Data were compared to responses in spinal-intact rats (n = 8). The 'low-impact' ampakine CX1739 (5, 10, or 15 mg/kg) or vehicle (2-hydroxypropyl-beta-cyclodextrin [HPCD]) was administered intravenously. The HPCD vehicle had no discernible impact on voiding. In contrast, following CX1739, the pressure threshold for inducing bladder contraction, voided volume, and the interval between bladder contractions were significantly reduced. These responses occurred in a dose-dependent manner. We conclude that modulating AMPA receptor function using ampakines can rapidly improve bladder-voiding capability at subacute time points following contusion SCI. These results may provide a new and translatable method for therapeutic targeting of bladder dysfunction acutely after SCI.
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Affiliation(s)
- Sabhya Rana
- Department of Physical Therapy, University of FloridaGainesvilleUnited States
- McKnight Brain Institute, University of FloridaGainesvilleUnited States
- Breathing Research and Therapeutics CenterGainesvilleUnited States
| | - Firoj Alom
- Department of Physiological Sciences, College of Veterinary Medicine, University of FloridaGainesvilleUnited States
- Department of Veterinary and Animal Sciences, University of RajshahiRajshahiBangladesh
| | - Robert C Martinez
- Department of Physical Therapy, University of FloridaGainesvilleUnited States
- McKnight Brain Institute, University of FloridaGainesvilleUnited States
- Breathing Research and Therapeutics CenterGainesvilleUnited States
| | - David D Fuller
- Department of Physical Therapy, University of FloridaGainesvilleUnited States
- McKnight Brain Institute, University of FloridaGainesvilleUnited States
- Breathing Research and Therapeutics CenterGainesvilleUnited States
| | - Aaron D Mickle
- McKnight Brain Institute, University of FloridaGainesvilleUnited States
- Department of Physiological Sciences, College of Veterinary Medicine, University of FloridaGainesvilleUnited States
- Department of Veterinary and Animal Sciences, University of RajshahiRajshahiBangladesh
- J. Crayton Pruitt Family Department of Biomedical Engineering, College of Engineering, University of FloridaGainesvilleUnited States
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El-Hajj VG, Daller C, Fletcher-Sandersjöö A, Gharios M, Bydon M, Söderman M, Jabbour P, Edström E, Elmi-Terander A, Arnberg F. The negative impact of treatment delays on the long-term neurological outcomes of spinal dural arteriovenous fistulas: a longitudinal cohort study. Neurosurg Focus 2024; 56:E14. [PMID: 38427990 DOI: 10.3171/2023.12.focus23703] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Accepted: 12/27/2023] [Indexed: 03/03/2024]
Abstract
OBJECTIVE Dural arteriovenous fistulas are rare vascular malformations that affect the brain and spinal cord. Spinal dural arteriovenous fistulas (sdAVFs) are the most frequently encountered vascular malformation affecting the spinal cord. The object of this study was to evaluate the impact of treatment delays on the long-term neurological outcomes of either open surgical or interventional treatment of sdAVFs. METHODS In this retrospective, population-based cohort study, the authors examined consecutive patients with diagnosed sdAVFs at a tertiary care center between 2005 and 2020. Patients were assessed using the Aminoff-Logue disability scale (ALS) at various time points including symptom onset, primary care visit, first specialist outpatient visit, as well as both short and long-term follow-ups. The postoperative long-term ALS gait and bladder grades constituted the primary outcomes of the study. RESULTS Among the 34 patients included in the study, the median age was 65 years, and there was a male predominance (71%). Most lesions were in the lumbar region (47%). Significant worsening in ALS gait and bladder grades was observed preoperatively, followed by postoperative improvements (p < 0.05). There was no difference in outcomes between surgical and endovascular treatments. Older age (OR 1.10, 95% CI 1.03-1.17, p = 0.007), worse preoperative ALS gait grades (OR 5.12, 95% CI 2.18-12.4, p < 0.001), and longer time from first specialist outpatient visit to first treatment (OR 1.00, 95% CI 1.00-1.01, p = 0.040) were independently associated with worse long-term gait outcomes. Only the preoperative ALS bladder score was a predictor of worse long-term bladder function (OR 92.7, 95% CI 28.0-306.7, p < 0.001). CONCLUSIONS Both surgical and endovascular treatments for sdAVFs led to significant neurological improvements. However, treatment delays were associated with less favorable long-term outcomes. Prompt diagnosis and early intervention prior to symptom progression may enhance recovery and help to preserve neurological function.
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Affiliation(s)
| | - Cornelia Daller
- 1Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- 2Department of Neuroradiology, Karolinska University Hospital, Stockholm, Sweden
- 8Department of Neurosurgery, University Hospital Salzburg, Paracelsus Medical University Salzburg, Austria; and
- 9Department of Neurosurgery, University Hospital St. Pölten, Karl-Landsteiner University of Health Sciences, St. Pölten, Austria
| | | | - Maria Gharios
- 1Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Mohamad Bydon
- 3Department of Neurological Surgery, Mayo Clinic, Rochester, Minnesota
| | - Michael Söderman
- 1Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- 2Department of Neuroradiology, Karolinska University Hospital, Stockholm, Sweden
| | - Pascal Jabbour
- 4Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | - Erik Edström
- 1Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- 5Capio Spine Center Stockholm, Löwenströmska Hospital, Stockholm, Sweden
- 6Department of Medical Sciences, Örebro University, Örebro, Sweden
| | - Adrian Elmi-Terander
- 1Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- 5Capio Spine Center Stockholm, Löwenströmska Hospital, Stockholm, Sweden
- 6Department of Medical Sciences, Örebro University, Örebro, Sweden
- 7Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | - Fabian Arnberg
- 1Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- 2Department of Neuroradiology, Karolinska University Hospital, Stockholm, Sweden
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Gomes A, Zapata LF, Galarreta CI, Henderson R, Hoyt E, Swee S, Bird LM. Substantial incidence of bladder dysfunction in patients with VACTERL association: Implications for surveillance. Am J Med Genet A 2024; 194:320-327. [PMID: 37822287 DOI: 10.1002/ajmg.a.63443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Revised: 09/29/2023] [Accepted: 10/03/2023] [Indexed: 10/13/2023]
Abstract
VACTERL association is defined as the nonrandom co-occurrence of a minimum of three of the following six key components: Vertebral anomalies, Anal atresia, Cardiac malformations, Tracheo-Esophageal fistula, Renal anomalies, and Limb abnormalities. Patients presenting with two components may also belong in the same spectrum. Additional components have been associated with VACTERL defects, including single umbilical artery, tethered spinal cord (TSC), and genital malformations. We observed a significant proportion of patients with bladder dysfunction (often called neurogenic bladder in the medical record) when reviewing a cohort of patients with VACTERL defects at our clinical center. Our finding calls attention to bladder dysfunction as an additional VACTERL phenotypic component. The prevalence of bladder dysfunction is greatest in those with genital anomalies, anorectal malformations, sacral dysplasia, renal anomalies, and TSC. We propose that patients with two or more VACTERL malformations be monitored for symptoms of bladder dysfunction if one or more of the identified risk factors are present until the achievement of urinary continence.
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Affiliation(s)
- Adriana Gomes
- Division of Dysmorphology/Genetics, Department of Pediatrics and Rady Children's Hospital San Diego, University of California, San Diego, La Jolla, California, USA
| | - Laura Forero Zapata
- Division of Dysmorphology/Genetics, Department of Pediatrics and Rady Children's Hospital San Diego, University of California, San Diego, La Jolla, California, USA
| | - Carolina I Galarreta
- Medical Genetics and Metabolism Department, Valley Children's Hospital, Madera, California, USA
| | - Riley Henderson
- Creighton University School of Medicine, Omaha, Nebraska, USA
| | - Erin Hoyt
- Pediatric Resident PGY-3 Valley Children's Healthcare, Madera, California, USA
| | - Steven Swee
- Division of Extended Studies, University of California, San Diego, La Jolla, California, USA
| | - Lynne M Bird
- Division of Dysmorphology/Genetics, Department of Pediatrics and Rady Children's Hospital San Diego, University of California, San Diego, La Jolla, California, USA
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6
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Ge Y, AlObaidi AS, Kuchel GA, Bartley JM, Smith PP, He W, Hu X. Dysfunctional Bladder Morphology and Functional Impairments Are Identified in the Alzheimer's Disease APPNL-G-F/NL-G-F Murine Model. J Alzheimers Dis 2024; 97:395-408. [PMID: 38160353 DOI: 10.3233/jad-230547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2024]
Abstract
BACKGROUND While symptoms related to lower urinary tract dysfunction (LUTD) are common in individuals with Alzheimer's disease (AD), pathophysiological links between AD and LUTD remain unclear. OBJECTIVE This study aimed to investigate whether AD neuropathology would cause autonomic dysfunction along the spinal cord-bladder axis, which could result in alterations in bladder muscle kinetics. METHODS We utilized APPNL-G-F/NL-G-F knock-in (APP KI) and APPwt/wt (wild-type) mice at two different ages, 4- and 10-month-old, to investigate how AD impacts bladder tissue function by immunohistochemistry, western blotting, and pharmacomyography. RESULTS We showed that the mucosal layer partially separated from the detrusor in 10-month-old APP KI mouse bladders. Although there was no detectable amyloid deposition in the APP KI bladder, we found amyloid plaques in APP KI lumbar spinal cord. Further immunoblot analysis revealed that tyrosine hydroxylase protein levels were significantly reduced in both 4- and 10-month-old bladder tissues, suggesting reduction of norepinephrine synthesis in APP KI mouse bladders. In contrast, the level of β2 adrenergic receptor was increased in 4-month-old but not 10-month-old APP KI bladders. In bladder strips, the adrenergic agonist isoproterenol induced increased relaxation in 4- but not 10-month-old APP KI bladders. With 10 Hz electrical field stimulation, 10-month-old APP KI bladder strips were more responsive than wild-type controls, with no differences observed in 4-month-old APP KI bladders. CONCLUSIONS APP KI mice exhibit LUTD, which is likely arising from amyloid pathology in the spinal cord, and results in maturational declines in presynaptic activity combined with compensatory postsynaptic upregulation.
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Affiliation(s)
- Yingying Ge
- Department of Neuroscience, University of Connecticut School of Medicine, Farmington, CT, USA
| | - Alya S AlObaidi
- Department of Neuroscience, University of Connecticut School of Medicine, Farmington, CT, USA
- Center on Aging, UConn Health, Farmington, CT, USA
| | | | - Jenna M Bartley
- Center on Aging, UConn Health, Farmington, CT, USA
- Department of Immunology, University of Connecticut School of Medicine, Farmington, CT, USA
| | - Phillip P Smith
- Department of Neuroscience, University of Connecticut School of Medicine, Farmington, CT, USA
- Center on Aging, UConn Health, Farmington, CT, USA
| | - Wanxia He
- Department of Neuroscience, University of Connecticut School of Medicine, Farmington, CT, USA
| | - Xiangyou Hu
- Department of Neuroscience, University of Connecticut School of Medicine, Farmington, CT, USA
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7
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Liu X, Wang J, Ren L, Ling Q. Bladder Replacement Therapy. Bladder (San Franc) 2023; 10:e21200010. [PMID: 38022707 PMCID: PMC10668601 DOI: 10.14440/bladder.2023.869] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Revised: 09/15/2023] [Accepted: 10/09/2023] [Indexed: 12/01/2023] Open
Abstract
The bladder, as a vital organ of the urinary system, facilitates urine storage and micturition. The bladder can store urine under low pressure, sense volume changes, and coordinate with the urethral sphincter to ensure autonomous and efficient urination and bladder emptying. However, irreversible bladder damage may result from various conditions, such as nerve injuries, aging, or metabolic syndrome, compromising its normal physiological functions and necessitating various interventions for anatomical and functional bladder replacements. This review aimed to summarize advances on anatomical and functional bladder replacements.
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Affiliation(s)
| | | | | | - Qing Ling
- Department and Institute of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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8
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Yates A. Intermittent self-catheterisation: the gold standard for individuals with bladder dysfunction. Br J Community Nurs 2023; 28:550-556. [PMID: 37930854 DOI: 10.12968/bjcn.2023.28.11.550] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2023]
Abstract
Intermittent self-catheterisation (ISC) has long been identified as the 'gold standard' for drainage of the bladder for individuals with bladder dysfunction. This article will outline identification of appropriate individuals, the types of intermittent self-catheters available, outline how it can improve quality of life for sufferers of bladder dysfunction, outline the complications that may occur and finally, suggest why it should be recommended as the 'gold standard' if it is taught and done correctly.
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Affiliation(s)
- Ann Yates
- Director of Continence Services Cardiff and Vale UHB
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9
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Suzuki N, Okuyama M, Kamiya K. Effects and Limitations of Naldemedine for Opioid-Induced Urinary Retention: A Case Report. J Palliat Med 2023; 26:1593-1595. [PMID: 37347929 DOI: 10.1089/jpm.2023.0269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/24/2023] Open
Abstract
A 78-year-old man with postoperative recurrence of esophageal cancer was admitted to the hospital due to chest pain and dyspnea. Oral short-acting opioids provided some relief, but chest pain persisted and worsened, leading to the initiation of a transdermal fentanyl patch. However, the patient developed opioid-induced urinary retention, which was treated with a naldemedine, a medication used for opioid-induced constipation and urinary retention. Opioid switching led to recurrent urinary retention, requiring placement of a urinary catheter. The patient ultimately required continuous deep sedation for refractory symptoms and died several days later.
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Affiliation(s)
- Naoki Suzuki
- Department of Palliative Medicine, Yamagata Prefectural Central Hospital, Yamagata, Japan
| | - Megumi Okuyama
- Department of Palliative Medicine, Yamagata Prefectural Central Hospital, Yamagata, Japan
| | - Kohei Kamiya
- MY Wells Community Care Workshop, Inc., Yamagata, Japan
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10
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Öztürk YD, Elmas AT, Tabel Y. Uroflowmetry parameters in healthy children between 5 and 15 years old. Low Urin Tract Symptoms 2023; 15:231-237. [PMID: 37614060 DOI: 10.1111/luts.12499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Revised: 07/22/2023] [Accepted: 08/07/2023] [Indexed: 08/25/2023]
Abstract
OBJECTIVES Uroflowmetry (UFM) is the first-line noninvasive screening test employed in the diagnosis of lower urinary tract dysfunction (LUTD). The purpose of this study was to determine normal UFM values in healthy Turkish children among our local population. METHODS A total of 100 healthy girls and 62 healthy boys aged 5-15 years, who applied to İnönü University Turgut Özal Medical Center Pediatrics Polyclinic between February 2021 and January 2022, were included in the present study. The UFM parameters, including maximum flow rate (Qmax), average flow rate (Qavg), voided volume (VV), time to maximum flow, and voiding time, were measured using the Inoflow Smart System UFM Device and the resulting urine flow curve was recorded. The children were compared in terms of the UFM parameters based on their gender and age groups (5-10 years and 11-15 years). RESULTS The mean Qmax value in healthy female children aged 5-15 years (21.8 ± 8.6 mL/s) was significantly higher than in male children (17.98 ± 6.1 mL/s) (p = .003). VV, Qmax, and Qavg values of the children in the 11-15 age group were significantly higher than those in the age group of 5-10 years (p > .05 for each). VV, Qmax, and Qavg values were directly proportional to age (p = .0001, for each). CONCLUSIONS We believe that this study adds to the limited knowledge base regarding normal flow patterns in healthy children.
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Affiliation(s)
| | - Ahmet Taner Elmas
- Department of Pediatric Nephrology, Faculty of Medicine, University of İnönü, Malatya, Turkey
| | - Yılmaz Tabel
- Department of Pediatric Nephrology, Faculty of Medicine, University of İnönü, Malatya, Turkey
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11
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Wang Y, Wang X, Liang S, Cai W, Chen L, Hu Y, Hao F, Ren W. Predictive value of risk factors for bladder dysfunction in Chinese patients with type 2 diabetes mellitus: A case-control study. Neurourol Urodyn 2023; 42:1712-1721. [PMID: 37674463 DOI: 10.1002/nau.25278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Revised: 08/16/2023] [Accepted: 08/28/2023] [Indexed: 09/08/2023]
Abstract
OBJECTIVE To analyze risk factors associated with bladder dysfunction in patients with type 2 diabetes mellitus (T2DM) and to construct a prediction model for early prediction of diabetic bladder dysfunction (DBD). METHODS We included hospitalized patients with T2DM from the endocrinology department of Shenzhen Hospital, Southern Medical University, Shenzhen, China, from January 2019 to 2022. Factors associated with DBD in bivariate analysis with a p < 0.05 were included in a multivariate logistic regression analysis. Multivariate logistic regression analysis was used to determine independent risk factors and to construct a prediction model. The prediction model was presented as the model formula. The receiver operating characteristic (ROC) curve was used to evaluate the predictive value of the above risk factors and the prediction model for DBD. The model was internally verified by Boostrap resampling 1000 times. RESULTS Two hundred and eleven patients were included in this study, and they were divided into the DBD group (n = 101) and the non-DBD group (n = 110). Eight variables showed significant significance in the bivariate analysis, including age, diabetic peripheral neuropathy (DPN), glycated hemoglobin (HbA1c), urinary microalbumin (mALB), red blood cell count (RBC), white blood cell count (WBC), absolute neutrophil count (ANC), percentage of monocyte (Mono%). Furthermore, multivariate logistic regression analysis revealed that age (OR [95% CI]: 1.077 [1.042-1.112]), p < 0.001; DPN (OR [95% CI]: 2.373 [1.013-5.561]), p = 0.047; HbA1c (OR [95% CI]: 1.170 [1.029-1.330]), p = 0.017 and ANC (OR [95% CI]: 1.234 [1.059-1.438]), p = 0.007 were independent risk factors for the DBD. The prediction model formula was Logit (p) = -6.611 + 0.074 age + 0.864 DPN + 0.157 HbA 1 c + 0.078 ANC. The area under the ROC curve (AUC) for the four risk factors were 0.676, 0.582, 0.618, and 0.674, respectively. The prediction model predicted DBD with higher accuracy than the individual risk factors, AUC = 0.817 (95% CI: 0.757-0.877), and the sensitivity and specificity were 88.1% and 50.0%, respectively. The model internal validation results showed that the AUC = 0.804 (95% CI: 0.707-0.901), and the calibration curve is close to the ideal diagonal line. CONCLUSIONS Age, DPN, HbA1c, and ANC were risk factors for DBD. The prediction model constructed based on the four risk factors had a good predictive value for predicting the occurrence of DBD.
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Affiliation(s)
- Ying Wang
- Department of Nursing, Shenzhen Hospital, Southern Medical University, Shenzhen, Guangdong, China
- School of Nursing, Southern Medical University, Guangzhou, Guangdong, China
| | - Xiufen Wang
- Department of Nursing, Shenzhen Hospital, Southern Medical University, Shenzhen, Guangdong, China
- School of Nursing, Southern Medical University, Guangzhou, Guangdong, China
- Department of the Third Pulmonary Disease, The Third People's Hospital of Shenzhen, Shenzhen, Guangdong, China
| | - Surui Liang
- Department of Nursing, Shenzhen Hospital, Southern Medical University, Shenzhen, Guangdong, China
| | - Wenzhi Cai
- Department of Nursing, Shenzhen Hospital, Southern Medical University, Shenzhen, Guangdong, China
- School of Nursing, Southern Medical University, Guangzhou, Guangdong, China
| | - Ling Chen
- Department of Nursing, Shenzhen Hospital, Southern Medical University, Shenzhen, Guangdong, China
- School of Nursing, Southern Medical University, Guangzhou, Guangdong, China
| | - Yingjie Hu
- Department of Nursing, Shenzhen Hospital, Southern Medical University, Shenzhen, Guangdong, China
- School of Nursing, Southern Medical University, Guangzhou, Guangdong, China
| | - Fengming Hao
- Department of Nursing, Shenzhen Hospital, Southern Medical University, Shenzhen, Guangdong, China
- School of Nursing, Southern Medical University, Guangzhou, Guangdong, China
| | - Wei Ren
- Department of Nursing, Shenzhen Hospital, Southern Medical University, Shenzhen, Guangdong, China
- School of Nursing, Southern Medical University, Guangzhou, Guangdong, China
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Topoliova K, Harsanyi S, Danisovic L, Ziaran S. Tissue Engineering and Stem Cell Therapy in Neurogenic Bladder Dysfunction: Current and Future Perspectives. Medicina (Kaunas) 2023; 59:1416. [PMID: 37629705 PMCID: PMC10456466 DOI: 10.3390/medicina59081416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Revised: 07/21/2023] [Accepted: 07/31/2023] [Indexed: 08/27/2023]
Abstract
Tissue engineering (TE) is a rapidly evolving biomedical discipline that can play an important role in treating neurogenic bladder dysfunction and compensating for current conventional options' shortcomings. This review aims to analyze the current status of preclinical and clinical trials and discuss what could be expected in the future based on the current state of the art. Although most preclinical studies provide promising results on the effectiveness of TE and stem cell therapies, the main limitations are mainly the very slow translation of preclinical trials to clinical trials, lack of quality research on neurogenic preconditions of neurogenic bladder dysfunction outside of the spinal cord injury and varying therapeutic methods of the existing research that lacks a standardized approach.
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Affiliation(s)
- Katarina Topoliova
- National Institute of Rheumatic Diseases, Nabrezie I. Krasku 4, 921 12 Piestany, Slovakia; (K.T.); (S.H.); (S.Z.)
- Department of Urology, Faculty of Medicine, Comenius University in Bratislava, Limbova 5, 833 05 Bratislava, Slovakia
| | - Stefan Harsanyi
- National Institute of Rheumatic Diseases, Nabrezie I. Krasku 4, 921 12 Piestany, Slovakia; (K.T.); (S.H.); (S.Z.)
- Institute of Medical Biology, Genetics and Clinical Genetics, Faculty of Medicine, Comenius University in Bratislava, Sasinkova 4, 811 08 Bratislava, Slovakia
| | - Lubos Danisovic
- National Institute of Rheumatic Diseases, Nabrezie I. Krasku 4, 921 12 Piestany, Slovakia; (K.T.); (S.H.); (S.Z.)
- Institute of Medical Biology, Genetics and Clinical Genetics, Faculty of Medicine, Comenius University in Bratislava, Sasinkova 4, 811 08 Bratislava, Slovakia
- Regenmed Ltd., Medena 29, 811 02 Bratislava, Slovakia
| | - Stanislav Ziaran
- National Institute of Rheumatic Diseases, Nabrezie I. Krasku 4, 921 12 Piestany, Slovakia; (K.T.); (S.H.); (S.Z.)
- Department of Urology, Faculty of Medicine, Comenius University in Bratislava, Limbova 5, 833 05 Bratislava, Slovakia
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13
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Yu WR, Jiang YH, Jhang JF, Kuo HC. Use of Urinary Biomarkers in Discriminating Interstitial Cystitis/Bladder Pain Syndrome from Male Lower Urinary Tract Dysfunctions. Int J Mol Sci 2023; 24:12055. [PMID: 37569430 PMCID: PMC10419079 DOI: 10.3390/ijms241512055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Revised: 07/15/2023] [Accepted: 07/25/2023] [Indexed: 08/13/2023] Open
Abstract
To analyze the urinary biomarkers in men with lower urinary-tract symptoms (LUTS) and identify interstitial cystitis/bladder pain syndrome (IC/BPS) from the other lower urinary-tract dysfunctions (LUTDs) by the levels of characteristic urinary biomarkers. In total, 198 men with LUTS were prospectively enrolled and urine samples were collected before intervention or medical treatment. Videourodynamic studies were routinely performed and the LUTDs were diagnosed as having bladder-outlet obstruction (BOO) such as bladder-neck dysfunction, benign prostatic obstruction, or poor relaxation of external sphincter (PRES); and bladder dysfunction such as detrusor overactivity (DO), hypersensitive bladder (HSB), and IC/BPS. Patients suspicious of IC/BPS were further confirmed by cystoscopic hydrodistention under anesthesia. The urine samples were investigated for 11 urinary inflammatory biomarkers including eotaxin, IL-6, IL-8, CXCL10, MCP-1, MIP-1β, RANTES, TNF-α, NGF, BDNF, and PGE2; and 3 oxidative stress biomarkers 8-OHdG, 8-isoprostane, and TAC. The urinary biomarker levels were analyzed between LUTD subgroups and IC/BPS patients. The results of this study revealed that among the patients, IC/BPS was diagnosed in 48, BOO in 66, DO in 25, HSB in 27, PRES in 15, and normal in 17. Patients with BOO had a higher detrusor pressure and BOO index than IC/BPS, whereas patients with IC/BPS, BOO, and DO had a smaller cystometric bladder capacity than the PRES and normal subgroups. Among the urinary biomarkers, patients with IC/BPS had significantly higher levels of eotaxin, MCP-1, TNF-α, 8-OHdG, and TAC than all other LUTD subgroups. By a combination of different characteristic urinary biomarkers, TNF-α, and eotaxin, either alone or in combination, had the highest sensitivity, specificity, positive predictive value, and negative predictive value to discriminate IC/BPS from patients of all other LUTD subgroups, BOO, DO, or HSB subgroups. Inflammatory biomarker MCP-1 and oxidative stress biomarkers 8-OHdG and TAC, although significantly higher in IC/BPS than normal and PRES subgroups, did not have a diagnostic value between male patients with IC/BPS and the BOO, DO, or HSB subgroups. The study concluded that using urinary TNF-α and eotaxin levels, either alone or in combination, can be used as biomarkers to discriminate patients with IC/BPS from the other LUTD subgroups in men with LUTS.
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Affiliation(s)
- Wan-Ru Yu
- Department of Nursing, Hualien Tzu Chi Hospital, Buddhist Tzu Chi General Hospital, Hualien 970, Taiwan;
- Institute of Medical Sciences, Tzu Chi University, Hualien 970, Taiwan
| | - Yuan-Hong Jiang
- Department of Urology, Hualien Tzu Chi Hospital and Tzu Chi University, Buddhist Tzu Chi Medical Foundation, 707, Section 3, Chung Yang Road, Hualien 970, Taiwan; (Y.-H.J.); (J.-F.J.)
| | - Jia-Fong Jhang
- Department of Urology, Hualien Tzu Chi Hospital and Tzu Chi University, Buddhist Tzu Chi Medical Foundation, 707, Section 3, Chung Yang Road, Hualien 970, Taiwan; (Y.-H.J.); (J.-F.J.)
| | - Hann-Chorng Kuo
- Department of Urology, Hualien Tzu Chi Hospital and Tzu Chi University, Buddhist Tzu Chi Medical Foundation, 707, Section 3, Chung Yang Road, Hualien 970, Taiwan; (Y.-H.J.); (J.-F.J.)
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Wada N, Abe N, Miyauchi K, Makino S, Kakizaki H. High-Fat and High-Sucrose Diet Leads to Skeletal Muscle Loss and Bladder Dysfunction in Rat. Res Rep Urol 2023; 15:305-313. [PMID: 37425652 PMCID: PMC10327923 DOI: 10.2147/rru.s406808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Accepted: 04/29/2023] [Indexed: 07/11/2023] Open
Abstract
Purpose In this study, we investigated skeletal muscle loss and bladder dysfunction caused by high-fat/high-sucrose (HFS) diet. Methods Twelve-week-old Sprague-Dawley (SD) female rats were fed on normal (Group N) or HFS (Group HFS) diet for 12 weeks. We conducted urodynamic investigation and pharmacologic in vitro. In addition, we measured gastrocnemius and tibialis muscle weight and protein concentration. The hypoxia-inducible factor (HIF)-1α and 8-hydroxy-2'-deoxyguanosine (8-OHdG) in the bladder were assayed. Results The urodynamic investigations revealed the significantly shorter intercontraction intervals and lower maximal voiding pressure in Group HFS than in Group N. Furthermore, the absolute and relative weights of the gastrocnemius muscle were found to be significantly lower in Group HFS than in Group N. The protein concentration of the gastrocnemius muscle was also significantly lower in Group HFS than in Group N. The absolute and relative weights of the bladder were also significantly lower in Group HFS than in Group N. The contractile responses of the bladder strips to electrical field stimulation and carbachol were significantly lower in Group HFS than in Group N. The HIF1α and 8OHdG in the bladder muscle were significantly higher in Group HFS than in Group N. The HFS diet reduced bladder capacity and contractility along with the loss of the gastrocnemius muscle. Conclusion HFS diet promotes bladder dysfunction similar to detrusor hyperreflexia with impaired contractility.
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Affiliation(s)
- Naoki Wada
- Department of Renal and Urologic Surgery, Asahikawa Medical University, Asahikawa, Japan
| | - Noriyuki Abe
- Department of Renal and Urologic Surgery, Asahikawa Medical University, Asahikawa, Japan
| | - Kotona Miyauchi
- Department of Renal and Urologic Surgery, Asahikawa Medical University, Asahikawa, Japan
| | - Shogo Makino
- Department of Renal and Urologic Surgery, Asahikawa Medical University, Asahikawa, Japan
| | - Hidehiro Kakizaki
- Department of Renal and Urologic Surgery, Asahikawa Medical University, Asahikawa, Japan
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Janardanan S, Nigam A, Moschonas D, Perry M, Patil K. Urinary Bladder Diverticulum: A Single-Center Experience in the Management of Refractory Lower Urinary Symptoms Using a Robotic Platform. Cureus 2023; 15:e42354. [PMID: 37621793 PMCID: PMC10445242 DOI: 10.7759/cureus.42354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/24/2023] [Indexed: 08/26/2023] Open
Abstract
Introduction Urinary bladder diverticulum (UBD) is commonly seen in urological practice and, in most cases, does not need treatment specifically directed towards it. However, it can give rise to symptoms that are not distinct from this finding. This makes the evaluation and management of this complex patient group challenging. We present our experience with robotic bladder diverticulectomy (RBD) for acquired bladder diverticulum to assess the outcomes and safety of this procedure when patient symptoms have failed to respond to either medical or surgical treatment directed at other associated contributing factors. Methods We retrospectively collected data on all patients who underwent RBD for persistent lower urinary tract symptoms (LUTS) at Royal Surrey County Hospital, Guildford, between 2016 and 2021, including baseline characteristics, urodynamic findings, intraoperative and postoperative outcomes, and a six-month follow-up. Patients who were diagnosed with cancer in the diverticulum, associated pathology that may contribute to their symptoms, or who had concomitant procedures at the time of RBD were excluded from this study. Results We had six patients who underwent RBD; the median age and body mass index (BMI) were 63.8 years (range 48-73) and 27.1 kg/m2 (range 24-32), respectively. The most common presenting symptoms were refractory LUTS and recurrent urinary tract infections (UTIs). The urodynamic evaluation revealed varying findings like bladder outlet obstruction (BOO), poor compliance, and equivocal readings in these patients. All patients reported incomplete bladder emptying and double voiding, with half practicing clean intermittent self-catheterization (CISC). Diverticulum size averaged 9.4 cm (range 8.5-12). The median operative time and blood loss were 166 mins (range 150-180) and 75 mls (range 50-100), respectively. The average length of stay was 1.6 days (range 1-3). Three patients developed UTIs within a month after surgery, requiring a course of oral antibiotics. Post-void residual (PVR) measured an average of 32.6 mls (range 0-161) postoperatively compared to a preoperative average of 249 mls (range 125-400), showing a two-tailed p-value of 0.016. The International Prostate Symptom Score (IPSS) score for these patients showed an average of 27.83 (range 24-31) preoperatively compared to the postoperative average of eight (range 7-12), showing a two-tailed p-value of 0.0001. Final histology showed no malignancy, and all patients reported symptom improvement, with none requiring CISC after surgery. Conclusion RBD is a safe and effective procedure in carefully selected patients with refractory LUTS and UTIs showing good postoperative and functional outcomes. The presence of a large diverticulum can have a complex effect on bladder dynamics. In the era of robotic surgery and enhanced recovery, discussion about diverticulectomy should be encouraged after proper evaluation and counseling for patients who have failed to improve with other measures of treatment for their symptoms.
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Affiliation(s)
- Sarosh Janardanan
- Department of Urology, Ashford and St Peter's National Health Services Foundation Trust, Chertsey, GBR
- Department of Urology, Royal Surrey County Hospital, Guildford, GBR
| | - Anurag Nigam
- Department of Urology, Royal Surrey County Hospital, Guildford, GBR
| | | | - Matthew Perry
- Department of Urology, Royal Surrey County Hospital, Guildford, GBR
| | - Krishna Patil
- Department of Urology, Royal Surrey County Hospital, Guildford, GBR
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16
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Msheik A, Abbass D, Bayram M, Awde A, Al Mokdad Z. Cervical Myelocystocele: A One-in-50,000 Congenital Abnormality of the Spinal Cord. Cureus 2023; 15:e37278. [PMID: 37168187 PMCID: PMC10165719 DOI: 10.7759/cureus.37278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/08/2023] [Indexed: 05/13/2023] Open
Abstract
Neural tube defects are a group of birth defects that affect the development of the spinal cord and brain. Myelomeningocele is a type of neural tube defect that results in the protrusion of the spinal cord and meninges through a defect in the vertebral column. While myelomeningocele is a relatively rare condition, cervical myelomeningocele is extremely uncommon. The condition can lead to various neurological problems and atrophies and is typically diagnosed in the first trimester of pregnancy using an ultrasound examination. Surgical intervention is typically recommended to repair the affected vertebral column. In this report, we describe the case of a four-month-old baby boy who was diagnosed with a cervical myelocystocele and successfully treated surgically. The patient had an excellent postoperative status, and this case highlights the importance of early diagnosis and intervention in the management of this rare condition.
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Affiliation(s)
- Ali Msheik
- Neurological Surgery, Zahraa Hospital University Medical Center, Beirut, LBN
- Neurological Surgery, Lebanese University Faculty of Medical Sciences, Hadath, LBN
| | - Daniel Abbass
- Neurological Surgery, Al Rassoul Al-Aazam Hospital, Beirut, LBN
| | - Mohamad Bayram
- Neurological Surgery, Al Rassoul Al-Aazam Hospital, Beirut, LBN
| | - Ahmad Awde
- Neurosurgery, Endovascular Neurosurgery, Al Rassoul Al-Aazam Hospital, Beirut, LBN
| | - Zeinab Al Mokdad
- Medical Sciences, Public Health, Lebanese University Faculty of Medical Sciences, Hadath, LBN
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17
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Girard BM, Campbell SE, Vizzard MA. Stress-induced symptom exacerbation: Stress increases voiding frequency, somatic sensitivity, and urinary bladder NGF and BDNF expression in mice with subthreshold cyclophosphamide (CYP). Front Urol 2023; 3:1079790. [PMID: 37811396 PMCID: PMC10558155 DOI: 10.3389/fruro.2023.1079790] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/10/2023]
Abstract
Symptom exacerbation due to stress is prevalent in many disease states, including functional disorders of the urinary bladder (e.g., overactive bladder (OAB), interstitial cystitis/bladder pain syndrome (IC/BPS)); however, the mechanisms underlying the effects of stress on micturition reflex function are unclear. In this study we designed and evaluated a stress-induced symptom exacerbation (SISE) mouse model that demonstrates increased urinary frequency and somatic (pelvic and hindpaw) sensitivity. Cyclophosphamide (CYP) (35 mg/kg; i.p., every 48 hours for a total of 4 doses) or 7 days of repeated variate stress (RVS) did not alter urinary bladder function or somatic sensitivity; however, both CYP alone and RVS alone significantly (p ≤ 0.01) decreased weight gain and increased serum corticosterone. CYP treatment when combined with RVS for 7 days (CYP+RVS) significantly (p ≤ 0.01) increased serum corticosterone, urinary frequency and somatic sensitivity and decreased weight gain. CYP+RVS exposure in mice significantly (p ≤ 0.01) increased (2.6-fold) voiding frequency as we determined using conscious, open-outlet cystometry. CYP+RVS significantly (p ≤ 0.05) increased baseline, threshold, and peak micturition pressures. We also evaluated the expression of NGF, BDNF, CXC chemokines and IL-6 in urinary bladder in CYP alone, RVS alone and CYP+RVS mouse cohorts. Although all treatments or exposures increased urinary bladder NGF, BDNF, CXC and IL-6 content, CYP+RVS produced the largest increase in all inflammatory mediators examined. These results demonstrated that CYP alone or RVS alone creates a change in the inflammatory environment of the urinary bladder but does not result in a change in bladder function or somatic sensitivity until CYP is combined with RVS (CYP+RVS). The SISE model of CYP+RVS will be useful to develop testable hypotheses addressing underlying mechanisms where psychological stress exacerbates symptoms in functional bladder disorders leading to identification of targets and potential treatments.
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Affiliation(s)
- Beatrice M Girard
- The Larner College of Medicine at The University of Vermont, Department of Neurological Sciences, Burlington, VT, 05405
| | - Susan E Campbell
- The Larner College of Medicine at The University of Vermont, Department of Neurological Sciences, Burlington, VT, 05405
| | - Margaret A Vizzard
- The Larner College of Medicine at The University of Vermont, Department of Neurological Sciences, Burlington, VT, 05405
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18
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Zang Y, Bai M, Wang L, Zhang M, Li L. Effects of acupuncture and pelvic floor muscle training on bladder dysfunction after spinal cord injury: A meta-analysis. Medicine (Baltimore) 2023; 102:e33048. [PMID: 36897726 PMCID: PMC9997793 DOI: 10.1097/md.0000000000033048] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Accepted: 01/31/2023] [Indexed: 03/11/2023] Open
Abstract
OBJECTIVE We aimed to systematically review and quantify the association between acupuncture and pelvic floor muscle exercise and bladder dysfunction rehabilitation in individuals with spinal nerve injury. METHODS A meta-analysis was conducted using an evidence-based nursing analysis method based on clinical evidence. China National Knowledge Infrastructure, PubMed, VIP database, Wan Fang database, Cochrane Library, and other databases were searched by computer from January 1, 2000 to January 1, 2021. The literature was searched for clinical randomized controlled trials on acupuncture stimulation, pelvic floor muscle function training, and bladder function recovery training after spinal cord nerve injury. Two reviewers independently used The Cochrane Collaboration recommended randomized controlled trial risk of bias assessment tool to evaluate the quality of the literature. Then, the meta-analysis was performed using RevMan 5.3 software. RESULTS A total of 20 studies were included, with a total sample size of 1468 cases, including 734 patients in the control group and 734 patients in the experimental group. The results of our meta-analysis showed that acupuncture treatment [OR = 3.98, 95% CI (2.77, 5.72), Z = 7.49, P < .001] and pelvic floor muscle treatment [OR = 7.63, 95% CI (4.47, 13.04), Z = 7.45, P < .001] was statistically significant. CONCLUSION Acupuncture and pelvic floor muscle exercise are effective intervention and treatment methods, which have obvious effects on rehabilitation treatment of bladder dysfunction after spinal nerve injury.
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Affiliation(s)
- Y.T. Zang
- The Second Affiliated Hospital of Inner Mongolia Medical University, Hohhot, China
| | - M.J. Bai
- School of Nursing, Inner Mongolia Medical University, Hohhot, China
| | - L. Wang
- School of Nursing, Inner Mongolia Medical University, Hohhot, China
| | - M.X. Zhang
- Ordos Institute of Applied Technology, Ordos, China
| | - L. Li
- The Second Affiliated Hospital of Inner Mongolia Medical University, Hohhot, China
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O'Leary BD, Keane DP. Effect of the length of the second stage of labor on pelvic floor dysfunction. Am J Obstet Gynecol MFM 2023; 5:100795. [PMID: 36334722 DOI: 10.1016/j.ajogmf.2022.100795] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Revised: 10/12/2022] [Accepted: 10/28/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND Pelvic floor dysfunction refers to any combination of incontinence, overactive bladder, pelvic organ prolapse, and sexual dysfunction. Pelvic floor dysfunction affects approximately 25% to 30% of women and is linked to parity and age. Some obstetrical risk factors have been highlighted, though the second stage of labor has not been as thoroughly investigated. Allowing a longer second stage has been suggested as a method of reducing the rates of cesarean delivery in nulliparous women, though it has also been linked to pelvic floor injuries. OBJECTIVE This study aimed to determine the effect of the length of the second stage of labor on self-reported pelvic floor dysfunction. STUDY DESIGN This was a single-center prospective cohort study in a tertiary referral obstetrical unit. Nulliparous women attending routine antenatal clinics were recruited to complete the Australian Pelvic Floor Questionnaire during pregnancy and again 3 months after delivery. The primary outcome in this study was the effect of the length of the second stage of labor on total pelvic floor scores when analyzed using multiple regression. The models were adjusted for the mother's age, mother's body mass index, length of the second stage of labor, fetal birthweight, mode of delivery, and perineal trauma. The secondary outcomes included the comparison of maternal, obstetrical, and functional pelvic floor outcomes based on the mode of delivery and the length of the second stage of labor. RESULTS Among the 295 women who were recruited, the length of the second stage of labor and body mass index were associated with self-reported bladder dysfunction on multiple regression, whereas maternal age was protective. Compared with those with 60 to 120 minutes or <60 minutes of second stage of labor, women with that longer than 120 minutes had higher rates of stress incontinence (85.7% [>120 minutes] vs 41.7% [60-120 minutes] or 52.5% [<60 minutes], P=.001), urinary urgency (89.3% [>120 minutes] vs 39.6% [60-120 minutes] or 53.8% [<60 minutes], P<.001), and fecal incontinence (10.7% [>120 minutes] vs 0% [60-120 minutes] or 1.2% [<60 minutes], P=.027). There were no differences in the rates of sexual activity or dyspareunia. Women delivering vaginally had higher rates of stress incontinence (57.6% vs 38.0%, P=.006) than those undergoing cesarean delivery, though there were no differences in other pelvic floor symptoms or pelvic floor scores. CONCLUSION A prolonged second stage of labor is associated with more self-reported bladder dysfunction at 3 months postnatal in primiparous women. Women with a longer second stage of labor should be informed about the risk of short-term bladder dysfunction, though the prevalence of long-term sequelae is unknown.
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Wu L, Wang M, Maher S, Fu P, Cai D, Wang B, Gupta S, Hijaz A, Daneshgari F, Liu G. Effects of different diets used to induce obesity/metabolic syndrome on bladder function in rats. Am J Physiol Regul Integr Comp Physiol 2023; 324:R70-R81. [PMID: 36374176 PMCID: PMC9799141 DOI: 10.1152/ajpregu.00218.2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Revised: 10/14/2022] [Accepted: 11/09/2022] [Indexed: 11/16/2022]
Abstract
Preclinical and human studies on the relationship between obesity/metabolic syndrome (MetS) and lower urinary tract dysfunction (LUTD) are inconsistent. We compared the temporal effects of feeding four different diets used to induce obesity/MetS, including 60% fructose, 2% cholesterol +10% lard, 30% fructose + 20% lard, or 32.5% lard diet, up to 42 wk, on metabolic parameters and bladder function in male Sprague-Dawley rats. Rats fed a 30% fructose + 20% lard or 32.5% lard diet consumed less food (grams), but only the 32.5% lard diet group took in more calories. Feeding rats a 60% fructose or 30% fructose + 20% lard diet led to glucose intolerance and increased blood pressure. Higher body weight and increased cholesterol levels were observed in the rats maintained on a 2% cholesterol +10% lard diet, whereas exposure to a 32.5% lard diet affected most of the above parameters. Voiding behavior measurement showed that voiding frequency and the total voided volume were lower in the experimental diet groups except for the 30% fructose + 20% lard group. The mean voided volume was lower in the 30% fructose + 20% lard and 32.5% lard groups compared with the control group. Cystometric analysis revealed a decreased bladder capacity, mean voided volume, intermicturition interval, and compliance in the 32.5% lard diet group. In conclusion, experimental diets including 60% fructose, 30% fructose + 20% lard, or 2% cholesterol + 10% lard diet differently affected physiological and metabolic parameters and bladder function to a limited extent, while exposure to a 32.5% lard diet had a greater impact.
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Affiliation(s)
- Liyang Wu
- Department of Surgery, MetroHealth Medical Center, Case Western Reserve University, Cleveland, Ohio
- Department of Urology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Mingshuai Wang
- Department of Surgery, MetroHealth Medical Center, Case Western Reserve University, Cleveland, Ohio
- Department of Urology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
| | - Shaimaa Maher
- Department of Surgery, MetroHealth Medical Center, Case Western Reserve University, Cleveland, Ohio
- Department of Chemistry, Cleveland State University, Cleveland, Ohio
| | - Pingfu Fu
- Department of Population and Quantitative Health Sciences, Case Western Reserve University, Cleveland, Ohio
| | - Dan Cai
- Department of Pathology, MetroHealth Medical Center, Case Western Reserve University, Cleveland, Ohio
| | - Bingcheng Wang
- Department of Medicine, MetroHealth Medical Center, Case Western Reserve University, Cleveland, Ohio
| | - Sanjay Gupta
- Department of Urology, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, Ohio
| | - Adonis Hijaz
- Department of Urology, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, Ohio
| | - Firouz Daneshgari
- Department of Surgery, Case Western Reserve University, Cleveland, Ohio
| | - Guiming Liu
- Department of Surgery, MetroHealth Medical Center, Case Western Reserve University, Cleveland, Ohio
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21
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Kostenko EV. [The use of botulinum toxin type A in symptomatic therapy and medical rehabilitation of patients with multiple sclerosis]. Zh Nevrol Psikhiatr Im S S Korsakova 2023; 123:17-25. [PMID: 37966435 DOI: 10.17116/jnevro202312310117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2023]
Abstract
The review of the current state of the problem of symptomatic therapy and medical rehabilitation (MR) of patients with multiple sclerosis (MS) is presented. The search was conducted in the databases Medline, Web of Science, PubMed and Scopus. Information is given about the most common symptoms of MS, among which sensory and motor disorders, bladder dysfunction, and pain have the greatest impact on the quality of life of patients, their functioning and independence in everyday life. The clinical characteristics of spasticity syndrome in MS and its relationship with quality of life indicators are considered. The features of the use of botulinum therapy (BT) in MS are considered. A high level of effectiveness of the use of BT in the treatment of neurogenic hyperactivity of detrusor and neurogenic bladder (the level of persuasiveness of recommendation A) and spasticity (the level of persuasiveness of recommendation B) is shown. Symptomatic treatment of MS and MR with the use of multidisciplinary programs helps to reduce disability, improve the quality of life of patients. When choosing symptomatic treatment and MR methods, it is customary to focus on the needs of patients.
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Affiliation(s)
- E V Kostenko
- Moscow Centre for Research and Practice in Medical Rehabilitation, Restorative and Sports Medicine, Moscow, Russia
- Pirogov Russian National Research Medical University, Moscow, Russia
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22
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Wabik AM, Skrzypczyk P, Dudek-Warchoł T, Warchoł S, Brzewski M, Pańczyk-Tomaszewska M. Nephrological and urological symptoms in patients with Robinow syndrome - a report of two cases. Pol Merkur Lekarski 2022; 50:302-305. [PMID: 36283013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
UNLABELLED Robinow syndrome is a rare congenital syndrome described in 1969 by Meinhard Robinow. The genetic background is heterogeneous - mutations of DVLI1, DVLI3, WNT5A genes (mild, autosomal dominant inheritance) or ROR2 gene (severe, autosomal recessive inheritance) are responsible for the syndrome. The syndrome is characterized by facial dysmorphism, skeletal defects, short stature, cardiovascular and urinary system abnormalities. CASE REPORT We report nephrological and urological problems in two 4-year-old male patients with Robinow syndrome. The first patient has a horseshoe kidney located mainly on the right side, right vesicoureteral reflux grade II, dysfunctional voiding, buried penis, and retractile testicles. The second patient has recurrent urinary tract infections; diagnostic findings include left kidney duplication, grade II left vesicoureteral reflux, large posterior urethral diverticulum, dysfunctional voiding, buried penis, glanular hypospadias, and bilateral cryptorchidism. CONCLUSIONS Patients with Robinow syndrome require multidisciplinary care, including nephrology-urology care. Nephrological and urological manifestations in children with Robinow syndrome are diverse, and urinary tract defects may be atypical and complex.
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Affiliation(s)
- Anna Maria Wabik
- Medical University of Warsaw, Poland: Department of Pediatrics and Nephrology
| | - Piotr Skrzypczyk
- Medical University of Warsaw, Poland: Department of Pediatrics and Nephrology
| | | | - Stanisław Warchoł
- Medical University of Warsaw, Poland: Department of Pediatric Surgery
| | - Michał Brzewski
- Medical University of Warsaw, Poland: Department of Pediatric Radiology
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23
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Klaus R, Lange-Sperandio B. Chronic Kidney Disease in Boys with Posterior Urethral Valves-Pathogenesis, Prognosis and Management. Biomedicines 2022; 10:biomedicines10081894. [PMID: 36009441 PMCID: PMC9405968 DOI: 10.3390/biomedicines10081894] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Revised: 08/01/2022] [Accepted: 08/03/2022] [Indexed: 02/08/2023] Open
Abstract
Posterior urethral valves (PUV) are the most common form of lower urinary tract obstructions (LUTO). The valves can be surgically corrected postnatally; however, the impairment of kidney and bladder development is irreversible and has lifelong implications. Chronic kidney disease (CKD) and bladder dysfunction are frequent problems. Approximately 20% of PUV patients will reach end-stage kidney disease (ESKD). The subvesical obstruction in PUV leads to muscular hypertrophy and fibrotic remodelling in the bladder, which both impair its function. Kidney development is disturbed and results in dysplasia, hypoplasia, inflammation and renal fibrosis, which are hallmarks of CKD. The prognoses of PUV patients are based on prenatal and postnatal parameters. Prenatal parameters include signs of renal hypodysplasia in the analysis of fetal urine. Postnatally, the most robust predictor of PUV is the nadir serum creatinine after valve ablation. A value that is below 0.4 mg/dl implies a very low risk for ESKD, whereas a value above 0.85 mg/dl indicates a high risk for ESKD. In addition, bladder dysfunction and renal dysplasia point towards an unbeneficial kidney outcome. Experimental urinary markers such as MCP-1 and TGF-β, as well as microalbuminuria, indicate progression to CKD. Until now, prenatal intervention may improve survival but yields no renal benefit. The management of PUV patients includes control of bladder dysfunction and CKD treatment to slow down progression by controlling hypertension, proteinuria and infections. In kidney transplantation, aggressive bladder management is essential to ensure optimal graft survival.
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Sauzeau V, Beignet J, Bailly C. Rac1 as a Target to Treat Dysfunctions and Cancer of the Bladder. Biomedicines 2022; 10:1357. [PMID: 35740379 DOI: 10.3390/biomedicines10061357] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Revised: 06/06/2022] [Accepted: 06/07/2022] [Indexed: 12/28/2022] Open
Abstract
Bladder pathologies, very common in the aged population, have a considerable negative impact on quality of life. Novel targets are needed to design drugs and combinations to treat diseases such as overactive bladder and bladder cancers. A promising new target is the ubiquitous Rho GTPase Rac1, frequently dysregulated and overexpressed in bladder pathologies. We have analyzed the roles of Rac1 in different bladder pathologies, including bacterial infections, diabetes-induced bladder dysfunctions and bladder cancers. The contribution of the Rac1 protein to tumorigenesis, tumor progression, epithelial-mesenchymal transition of bladder cancer cells and their metastasis has been analyzed. Small molecules selectively targeting Rac1 have been discovered or designed, and two of them—NSC23766 and EHT 1864—have revealed activities against bladder cancer. Their mode of interaction with Rac1, at the GTP binding site or the guanine nucleotide exchange factors (GEF) interaction site, is discussed. Our analysis underlines the possibility of targeting Rac1 with small molecules with the objective to combat bladder dysfunctions and to reduce lower urinary tract symptoms. Finally, the interest of a Rac1 inhibitor to treat advanced chemoresistance prostate cancer, while reducing the risk of associated bladder dysfunction, is discussed. There is hope for a better management of bladder pathologies via Rac1-targeted approaches.
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25
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McClurg D, Elders A, Hagen S, Mason H, Booth J, Cunnington AL, Walker R, Deane K, Harari D, Panicker J, Stratton S, McArthur J, Sellers C, Collins M. Stimulation of the tibial nerve-a randomised trial for urinary problems associated with Parkinson's-the STARTUP trial. Age Ageing 2022; 51:6608566. [PMID: 35704616 PMCID: PMC9200143 DOI: 10.1093/ageing/afac114] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Indexed: 11/17/2022] Open
Abstract
Background non-motor symptoms such as bladder dysfunction are common (80%) in people with Parkinson’s increasing the risk for falls with a negative impact on health-related costs and quality of life. We undertook STARTUP to evaluate the clinical and cost-effectiveness of using an adhesive electrode to stimulate the transcutaneous tibial nerve stimulation (TTNS) to treat bladder dysfunction in people with Parkinson’s disease (PD). Study design, materials and methods: STARTUP was a parallel two-arm, multi-centre, pragmatic, double-blind, randomised controlled trial. Each participant attended one clinic visit to complete consent, be randomised using a computer-generated system and to be shown how to use the device. The trial had two co-primary outcome measures: International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form and the International Prostate Symptom Score (IPSS). These were completed at baseline, 6 and 12 weeks. A bladder frequency chart and resource questionnaire were also completed. Results two hundred forty two participants were randomised. About 59% of participants were male, the mean age was 69 years and mean time since diagnosis was 6 years. Questionnaire return rate was between 79 and 90%. There was a statistically significantly lower score in the active group at 6 weeks in the IPSS questionnaire (mean difference (Standard deviation, SD) 12.5 (6.5) vs 10.9 (5.5), effect size −1.49, 95% CI −2.72, −0.25). There was no statistically significant change in any other outcome. Conclusion TTNS was demonstrated to be safe with a high level of compliance. There was a significant change in one of the co-primary outcome measures at the end of the treatment period (i.e. 6 weeks), which could indicate a benefit. Further fully powered RCTs are required to determine effective treatments.
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Affiliation(s)
- Doreen McClurg
- NMAHP RU, Glasgow Caledonian University, Glasgow G4 0BA, UK
| | - Andrew Elders
- NMAHP RU, Glasgow Caledonian University, Glasgow G4 0BA, UK
| | - Suzanne Hagen
- NMAHP RU, Glasgow Caledonian University, Glasgow G4 0BA, UK
| | - Helen Mason
- Yunus Centre for Social Business and Health, Glasgow Caledonian University, Glasgow G4 0BA, UK
| | - Jo Booth
- Scholl of Health & Life Sciences, Glasgow Caledonian University, Glasgow G4 0BA, UK
| | | | | | - Katherine Deane
- School of Nursing Sciences, University of East Anglia, NR4 7TJ, Norwich
| | - Danielle Harari
- Guy's & St Thomas Hospital NHS Foundation Trust, SE1 7EH, London
| | - Jalesh Panicker
- University College London Hospitals NHS Foundation Trust, WC1E 6BT, London
| | - Susan Stratton
- NMAHP RU, Glasgow Caledonian University, Glasgow G4 0BA, UK
| | - Jaclyn McArthur
- Yunus Centre for Social Business and Health, Glasgow Caledonian University, Glasgow G4 0BA, UK
| | - Ceri Sellers
- NMAHP RU, Glasgow Caledonian University, Glasgow G4 0BA, UK
| | - Marissa Collins
- Yunus Centre for Social Business and Health, Glasgow Caledonian University, Glasgow G4 0BA, UK
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Ramasamy R, Hardy CC, Crocker SJ, Smith PP. Cuprizone-mediated demyelination reversibly degrades voiding behavior in mice while sparing brainstem reflex. J Neurosci Res 2022; 100:1707-1720. [PMID: 35596557 DOI: 10.1002/jnr.25065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Revised: 03/30/2022] [Accepted: 04/22/2022] [Indexed: 11/12/2022]
Abstract
Multiple sclerosis (MS) is a chronic, progressively debilitating demyelinating disease of the central nervous system (CNS). Nearly 80% of MS patients experience lower urinary tract dysfunction early in their diagnosis. This significantly affects the quality of life, and in latter stages of disease is a leading cause of hospitalization. Previously, animal models have shown that inflammatory demyelination in the CNS causes profound bladder dysfunction, but the confounding influence of systemic inflammation limits the potential interpretation of the contribution of CNS demyelination to bladder dysfunction. Since the micturition circuit has myelinated neuronal connections in the cortex, brainstem, and spinal cord, we examined alterations in bladder function in the cuprizone model characterized by demyelinating lesions in the cortex and corpus callosum that are independent of T-cell-mediated autoimmunity. Herein, we report that a 4-week dietary cuprizone treatment in C57Bl/6J mice induced alterations in voiding behavior with increased micturition frequency and reduced volume voided, similar to human MS bladder dysfunction. Subsequently, recovery from cuprizone treatment restored normal bladder function. Demyelination and remyelination were confirmed by Luxol Fast Blue staining of the corpus callosum. Additionally, we also determined that an 8-week cuprizone treatment, resulting in chronic demyelination lacking spontaneous remyelination potential, is associated with an exacerbated voiding phenotype. Interestingly, while cuprizone-induced CNS demyelination severely affected conscious (cortical) urinary behavior, the brainstem and spinal cord reflex remained unchanged, as confirmed by urethane-anesthetized cystometry. This is the first study to show that cortical demyelination independent of inflammation can negatively impact urinary function.
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Affiliation(s)
- Ramalakshmi Ramasamy
- Department of Neuroscience, University of Connecticut School of Medicine, Farmington, Connecticut, USA.,UConn Center on Aging, University of Connecticut School of Medicine, Farmington, Connecticut, USA
| | - Cara C Hardy
- Department of Neuroscience, University of Connecticut School of Medicine, Farmington, Connecticut, USA.,UConn Center on Aging, University of Connecticut School of Medicine, Farmington, Connecticut, USA
| | - Stephen J Crocker
- Department of Neuroscience, University of Connecticut School of Medicine, Farmington, Connecticut, USA.,UConn Center on Aging, University of Connecticut School of Medicine, Farmington, Connecticut, USA
| | - Phillip P Smith
- Department of Neuroscience, University of Connecticut School of Medicine, Farmington, Connecticut, USA.,UConn Center on Aging, University of Connecticut School of Medicine, Farmington, Connecticut, USA.,Department of Surgery, University of Connecticut School of Medicine, Farmington, Connecticut, USA
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27
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Roman H, Huet E, Bridoux V, Khalil H, Hennetier C, Bubenheim M, Braund S, Tuech JJ. Long term outcomes following surgical management of rectal endometriosis: 7-year follow-up of patients enrolled in a randomized trial. J Minim Invasive Gynecol 2022:S1553-4650(22)00074-7. [PMID: 35181523 DOI: 10.1016/j.jmig.2022.02.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Revised: 02/11/2022] [Accepted: 02/14/2022] [Indexed: 11/20/2022]
Abstract
STUDY OBJECTIVE To compare functional outcomes, recurrence rate and pregnancy likelihood in patients undergoing conservative or radical surgery in patients with deep rectal endometriosis 7 years post-operatively. DESIGN Prospective study in a cohort of patients enrolled in a 2-arm randomized trial from March 2011 to August 2013. SETTING A tertiary referral center. PATIENTS 55 patients with deep endometriosis infiltrating the rectum. INTERVENTIONS Patients underwent either segmental resection or nodule excision by shaving or disc excision, depending on a randomization which was performed preoperatively using sequentially numbered, opaque sealed envelopes. MEASUREMENT AND MAIN RESULTS The primary endpoint was the number of patients experiencing one of the following symptoms: constipation, frequent bowel movements, anal incontinence or bladder dysfunction 24 months postoperatively. Secondary endpoints were values of gastrointestinal and overall quality of life scores. The 7 year-recurrence rates (new deep endometriosis nodule infiltrating the rectum) in the excision vs. the segmental resection arms were 7.4 % vs. 0% (P=.24). One of more symptoms included in the definition of the primary outcomes were recorded in 55.6% vs. 60.7% of patients (P=0.79). However, 51.9% vs. 53.6% of patients considered their bowel movements as normal (P=.99). An intention-to-treat comparison of overall quality of life scores did not find differences between the two groups 7 years postoperatively. At the end of the 7-year study period, 31 of the 37 patients who tried to conceive were successful (83.8%) including: 27 (57.4%) natural conceptions and 20 (42.6%) pregnancies resulting from ART procedures. Pregnancy rate was 82.4% vs. 85% in the two arms (P=.99). A 75.7% live birth rate was recorded. At the end of the follow up there were 15 women with one child (40.5%) and 13 women with 2 children (35.1%). During the 7-year follow- up, the reoperation rate was respectively 37% and 35.7% in each arm, P=0.84). Among the 27 reoperation procedures during the follow up period, 11 were postoperative complications (40.7%), 7 were necessary prior to ART management (25.9%), 8 were for recurrent abdominal or pelvic pain (29.6%) and one for midline ventral hernia following pregnancy (3.7%). CONCLUSIONS Our study did not reveal a significant difference in terms of digestive functional outcomes, recurrence rate, reoperation risk and pregnancy likelihood when conservative and radical rectal surgery for deep endometriosis were compared 7 years postoperatively. Postoperative pregnancy rate observed in our series is high.
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28
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Hobbs KT, Choe N, Aksenov LI, Reyes L, Aquino W, Routh JC, Hokanson JA. Machine Learning for Urodynamic Detection of Detrusor Overactivity. Urology 2022; 159:247-254. [PMID: 34757048 PMCID: PMC8865755 DOI: 10.1016/j.urology.2021.09.027] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Revised: 09/20/2021] [Accepted: 09/22/2021] [Indexed: 01/03/2023]
Abstract
OBJECTIVE To develop a machine learning algorithm that identifies detrusor overactivity (DO) in Urodynamic Studies (UDS) in the spina bifida population. UDS plays a key role in assessment of neurogenic bladder in patients with spina bifida. Due to significant variability in individual interpretations of UDS data, there is a need to standardize UDS interpretation. MATERIALS AND METHODS Patients who underwent UDS at a single pediatric urology clinic between May 2012 and September 2020 were included. UDS files were analyzed in both time and frequency domains, varying inclusion of vesical, abdominal, and detrusor pressure channels. A machine learning pipeline was constructed using data windowing, dimensionality reduction, and support vector machines. Models were designed to detect clinician identified detrusor overactivity. RESULTS Data were extracted from 805 UDS testing files from 546 unique patients. The generated models achieved good performance metrics in detecting DO agreement with the clinician, in both time- and frequency-based approaches. Incorporation of multiple channels and data windowing improved performance. The time-based model with all 3 channels had the highest area under the curve (AUC) (91.9 ± 1.3%; sensitivity: 84.2 ± 3.8%; specificity: 86.4 ± 1.3%). The 3-channel frequency-based model had the highest specificity (AUC: 90.5 ± 1.9%; sensitivity: 68.3 ± 5.3%; specificity: 92.9 ± 1.1%). CONCLUSION We developed a promising proof-of-concept machine learning pipeline that identifies DO in UDS. Machine-learning-based predictive modeling algorithms may be employed to standardize UDS interpretation and could potentially augment shared decision-making and improve patient care.
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Affiliation(s)
- Kevin T. Hobbs
- Division of Urologic Surgery, Duke University Medical Center, Durham, NC
| | - Nathaniel Choe
- Department of Electrical and Computer Engineering, Duke University, Durham, NC
| | - Leonid I. Aksenov
- Division of Urologic Surgery, Duke University Medical Center, Durham, NC
| | - Lourdes Reyes
- Department of Mechanical Engineering and Materials Science, Duke University, Durham, NC
| | - Wilkins Aquino
- Department of Mechanical Engineering and Materials Science, Duke University, Durham, NC
| | - Jonathan C. Routh
- Division of Urologic Surgery, Duke University Medical Center, Durham, NC
| | - James A. Hokanson
- Department of Biomedical Engineering, Medical College of Wisconsin, Milwaukee, WI,Corresponding Author. James Hokanson, PhD, Biomedical Engineering, Translational and Biomedical Research Center, 8701 W Watertown Plank Road, Milwaukee, WI, 53226,
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Milivojevic S, Zelenovic A, Milin-Lazovic J, Radojicic O, Laketic D, Dasic I, Milic N, Radojicic Z. The correlation between the transverse rectal diameter and urodynamic findings in children with neurogenic bowel and bladder dysfunction. Front Pediatr 2022; 10:957123. [PMID: 36245719 PMCID: PMC9557052 DOI: 10.3389/fped.2022.957123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Accepted: 08/30/2022] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND The aim of this study was to examine the correlation between the transverse rectal diameter and urodynamic findings in children with neurogenic bowel and bladder dysfunction. METHODS Between 2014 and 2022, we prospectively evaluated 81 consecutive spina bifida children with neurogenic bowel and bladder dysfunction (35 boys and 46 girls, mean age 9.5 ± 3.4 years). All patients underwent echosonographic measurement of transverse rectal diameter and urodynamic studies. RESULTS We found a strong negative correlation between transverse rectal diameter and maximum bladder capacity (r = -0.682, p < 0.001) and compliance (r = -0.690, p < 0.001). There was also a strong positive correlation between transverse rectal diameter and maximal detrusor pressure (r = 0.650, p < 0.001), leak point pressure (r = 0.793, p < 0.001), and PVR (r = 0.762, p < 0.001). In ROC analysis, transverse rectal diameter demonstrated good performance for distinguishing children with upper urinary tract deterioration, with an AUC of 0.857 (95% CI 0.761-0.953). A transverse rectal diameter ≥40 mm was 83.3% sensitive and 100% specific for the diagnosis of unfavorable urodynamic patterns. CONCLUSION There is a correlation between the transverse rectal diameter and urodynamic findings in children with neurogenic bowel and bladder dysfunction. Ultrasonographically assessed transverse rectal diameter of ≥40 mm may be used as a risk factor for upper urinary tract deterioration (unfavorable urodynamic findings). We suggest the transverse rectal diameter echosonographic measurement use as an integral part of the diagnostic approach in children with neurogenic bowel and bladder dysfunction, as it can help decision-making while waiting for urodynamic testing.
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Affiliation(s)
- Sasa Milivojevic
- Department of Urology, University Children's Hospital, Belgrade, Serbia
| | | | - Jelena Milin-Lazovic
- Institute for Medical Statistics and Informatics, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Ognjen Radojicic
- Clinic for Gynecology and Obstetrics "Narodni Front", Belgrade, Serbia
| | - Darko Laketic
- Institute of Anatomy "Niko Miljanic", Faculty of Medicine, Belgrade, Serbia
| | - Ivana Dasic
- Department of Urology, University Children's Hospital, Belgrade, Serbia
| | - Natasa Milic
- Institute for Medical Statistics and Informatics, Faculty of Medicine, University of Belgrade, Belgrade, Serbia.,Department of Internal Medicine, Mayo Clinic, Rochester, MN, United States
| | - Zoran Radojicic
- Department of Urology, University Children's Hospital, Belgrade, Serbia
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Adamec I, Krbot Skorić M, Habek M. Understanding and managing autonomic dysfunction in persons with multiple sclerosis. Expert Rev Neurother 2021; 21:1409-1417. [PMID: 34654355 DOI: 10.1080/14737175.2021.1994856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Multiple sclerosis (MS) is a chronic demyelinating immune mediated disease of the central nervous system. Autonomic dysfunction (AD) is frequently present in persons with MS (pwMS) and increases with disease duration and progression. AREAS COVERED Cardiovascular, genitourinary, and sudomotor autonomic dysfunction in pwMS are reviewed and managing of these disorders is addressed. EXPERT OPINION AD in pwMS can manifest with a myriad of symptoms including cardiovascular, urogenital, and sweating disorders. These symptoms can significantly impact the quality of life of pwMS with poor tolerance of upright position, difficulties in sexual function, and low endurance of physical activity especially in warm environments. Health professionals involved in care of pwMS should possess basic knowledge of the function of the autonomic nervous system and be informed of the way disorders of the autonomic function may manifest in pwMS in order to provide the proper care.
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Affiliation(s)
- Ivan Adamec
- Department of Neurology, University Hospital Center Zagreb, Referral Center for Autonomic Nervous System Disorders, Zagreb, Croatia
| | - Magdalena Krbot Skorić
- Department of Neurology, University Hospital Center Zagreb, Referral Center for Autonomic Nervous System Disorders, Zagreb, Croatia.,Faculty of Electrical Engineering and Computing, University of Zagreb, Zagreb, Croatia
| | - Mario Habek
- Department of Neurology, University Hospital Center Zagreb, Referral Center for Autonomic Nervous System Disorders, Zagreb, Croatia.,School of Medicine, University of Zagreb, Zagreb, Croatia
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La Valle A, Piccolo G, Maghnie M, d'Annunzio G. Urinary Tract Involvement in Wolfram Syndrome: A Narrative Review. Int J Environ Res Public Health 2021; 18:11994. [PMID: 34831749 DOI: 10.3390/ijerph182211994] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Revised: 11/05/2021] [Accepted: 11/09/2021] [Indexed: 12/18/2022]
Abstract
Wolfram Syndrome (WS) is a rare neurodegenerative disease with autosomal recessive inheritance and characterized by juvenile onset, non-autoimmune diabetes mellitus and later followed by optic atrophy leading to blindness, diabetes insipidus, hearing loss, and other neurological and endocrine dysfunctions. A wide spectrum of neurodegenerative abnormalities affecting the central nervous system has been described. Among these complications, neurogenic bladder and urodynamic abnormalities also deserve attention. Urinary tract dysfunctions (UTD) up to end stage renal disease are a life-threatening complication of WS patients. Notably, end stage renal disease is reported as one of the most common causes of death among WS patients. UTD have been also reported in affected adolescents. Involvement of the urinary tract occurs in about 90% of affected patients, at a median age of 20 years and with peaks at 13, 21 and 33 years. The aim of our narrative review was to provide an overview of the most important papers regarding urological impairment in Wolfram Syndrome. A comprehensive search on PubMed including Wolfram Syndrome and one or more of the following terms: chronic renal failure, bladder dysfunction, urological aspects, and urinary tract dysfunction, was done. The exclusion criteria were studies not written in English and not including urinary tract dysfunction deep evaluation and description. Studies mentioning general urologic abnormalities without deep description and/or follow-up were not considered. Due to the rarity of the condition, we considered not only papers including pediatric patients, but also papers with pediatric and adult case reports
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Matsuoka K, Akaihata H, Hata J, Tanji R, Honda-Takinami R, Onagi A, Hoshi S, Koguchi T, Sato Y, Kataoka M, Ogawa S, Kojima Y. l-Theanine Protects Bladder Function by Suppressing Chronic Sympathetic Hyperactivity in Spontaneously Hypertensive Rat. Metabolites 2021; 11:metabo11110778. [PMID: 34822436 PMCID: PMC8618158 DOI: 10.3390/metabo11110778] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Revised: 11/03/2021] [Accepted: 11/11/2021] [Indexed: 11/16/2022] Open
Abstract
Chronic sympathetic hyperactivity is known to affect metabolism and cause various organ damage including bladder dysfunction. In this study, we evaluated whether l-theanine, a major amino acid found in green tea, ameliorates bladder dysfunction induced by chronic sympathetic hyperactivity as a dietary component for daily consumption. Spontaneously hypertensive rats (SHRs), as an animal model of bladder dysfunction, were divided into SHR-water and SHR-theanine groups. After 6 weeks of oral administration, the sympathetic nervous system, bladder function, and oxidative stress of bladder tissue were evaluated. The mean blood pressure, serum noradrenaline level, and media-to-lumen ratio of small arteries in the suburothelium were significantly lower in the SHR-theanine than in the SHR-water group. Micturition interval was significantly longer, and bladder capacity was significantly higher in the SHR-theanine than in the SHR-water group. Bladder strip contractility was also higher in the SHR-theanine than in the SHR-water group. Western blotting of bladder showed that expression of malondialdehyde was significantly lower in the SHR-theanine than in the SHR-water group. These results suggested that orally administered l-theanine may contribute at least partly to the prevention of bladder dysfunctions by inhibiting chronic sympathetic hyperactivity and protecting bladder contractility.
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Eiselen C, Trajanovska M, Griffith A, Phan T, Goldfeld S, Gibb S, King SK. Audit of enuresis referrals on the waiting list for a tertiary hospital outpatient clinic. J Paediatr Child Health 2021; 57:1645-1650. [PMID: 34041818 DOI: 10.1111/jpc.15582] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Revised: 03/09/2021] [Accepted: 05/15/2021] [Indexed: 11/30/2022]
Abstract
AIM Enuresis, defined as intermittent incontinence occurring exclusively during sleep, affects 4-19% of children, but can be effectively treated using education and alarm-bell therapies. However, delays in treatment are likely to impact upon the quality of life of the child, parents and carers. Poor quality and incomplete referrals are thought to be a major driver of inefficiencies. The aim of this study was to explore characteristics of enuresis referrals on the waiting list for a general medicine clinic at a tertiary paediatric hospital. METHODS An audit was conducted to examine all enuresis referrals on the general medicine outpatient clinic waiting list in February 2019 at The Royal Children's Hospital, Melbourne. Enuresis referrals with an organic cause and those for children less than 5 years of age were excluded. RESULTS Of the 2613 referrals on the general medicine waiting list, 486 of 2613 (19%) were related to enuresis. The median age of patients on the waiting list was 8 years and 65% (315/486) were male. Sufficient detail was provided to determine temporal and disease stratification in 45% (218/486) of referrals; primary versus secondary enuresis, and monosymptomatic versus non-monosymptomatic enuresis. The mean number of days on the waiting list calculated at the time of data extraction (13 February 2019) was 226 (±179) days. CONCLUSIONS The findings from this study suggest that there are long waiting times for enuresis services and referrals often do not contain complete information.
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Affiliation(s)
- Carl Eiselen
- Department of Paediatric Surgery, The Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Misel Trajanovska
- Centre for Community Child Health, The Royal Children's Hospital, Melbourne, Victoria, Australia.,Population Health, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - Andrew Griffith
- Department of Paediatric Surgery, The Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Tracey Phan
- Population Health, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - Sharon Goldfeld
- Centre for Community Child Health, The Royal Children's Hospital, Melbourne, Victoria, Australia.,Population Health, Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia
| | - Susan Gibb
- Department of General Medicine, The Royal Children's Hospital, Melbourne, Victoria, Australia.,Infection and Immunity, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - Sebastian K King
- Department of Paediatric Surgery, The Royal Children's Hospital, Melbourne, Victoria, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia.,Department of Gastroenterology and Clinical Nutrition, The Royal Children's Hospital, Melbourne, Victoria, Australia.,Surgical Research, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
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Alghafees MA, Alageel MK, Alqahtani MA, Alghazwani Y. Unsuccessful Progression of Sacral Neuromodulation From the Evaluation to the Implantation Stage: A Single-Center Experience. Cureus 2021; 13:e16912. [PMID: 34513485 PMCID: PMC8412884 DOI: 10.7759/cureus.16912] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/05/2021] [Indexed: 11/05/2022] Open
Abstract
Introduction Over the years, sacral neuromodulation (SNM) has become an established and effective treatment for chronic urinary system retention and incontinence. The process of SNM is performed in two stages, the first is an evaluation phase and the second an implant phase. This study aimed to assess the rate of failure of progression from the evaluation to the implantation stage and the factors predicting the outcome of this commonplace procedure. Materials and methods This retrospective cross-sectional study took place at King Abdulaziz Medical City (KAMC), Riyadh, Saudi Arabia. All the patients who underwent SNM implantation from January 1, 2016 to January 1, 2021 were included. Patients younger than 14 years and patients who had the SNM implantation in a different hospital and were only followed-up at KAMC were excluded. Patient-related information were extracted from the BESTCare system. Frequency and percentage were used for the categorical variables, and the mean, median, and standard deviation to display the continuous variables. Chi-square test and Mann-Whitney U test were used to test for the association of the categorical variables. Results Among 28 patients, 46.4% (n=13) failed to progress from the evaluation phase to the implantation phase. Gender, age, having a co-morbidity, and SNM indication were not significant factors for predicting the outcome of the SNM evaluation phase. Conclusion The observed failure rate was marginally higher than the ones detected in other studies. Although no significant association was detected between evaluation stage failure and the assigned predictors, the results need to be interpreted with caution due to the small population size. Larger multicenter studies need to be done in order to investigate the link between patient characteristics and the efficacy of SNM. Establishing a concrete evidence would further refine the targeted patient population and indications for SNM.
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Affiliation(s)
- Mohammad A Alghafees
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, SAU
| | - Mohammed K Alageel
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, SAU
| | - Meshari A Alqahtani
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, SAU
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Hobbs KT, Krischak M, Tejwani R, Purves JT, Wiener JS, Routh JC. The Importance of Early Diagnosis and Management of Pediatric Neurogenic Bladder Dysfunction. Res Rep Urol 2021; 13:647-657. [PMID: 34513742 PMCID: PMC8421253 DOI: 10.2147/rru.s259307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Accepted: 08/17/2021] [Indexed: 11/23/2022] Open
Abstract
Neurogenic bladder dysfunction is a major source of urologic morbidity in children, especially in those with spina bifida (SB). Complications from progression of bladder dysfunction can include urinary tract infections (UTIs), urinary incontinence, upper tract deterioration, and renal dysfunction or failure. In these children, there has been a recent trend toward proactive rather than expectant management of neurogenic bladder. However, there is a lack of consensus on how to best achieve the three main goals of neurogenic bladder management: 1) preserving kidney function, 2) achieving continence (if desired by the family/individual), and 3) achieving social and functional urologic independence (if appropriate). Hence, our objective was to perform a narrative literature review to evaluate the approaches to diagnosis and management of pediatric neurogenic bladder dysfunction, with special focus on children with SB. The approach strategies vary across a spectrum, with a proactive strategy on one end of the spectrum and an expectant strategy at the other end. The proactive management strategy is characterized by early and frequent labs, imaging, and urodynamic (UDS) evaluation, with early initiation of clean intermittent catheterization (CIC) and proceeding with pharmacotherapy, or surgery if indicated. The expectant management strategy prioritizes surveillance labs and imaging prior to proceeding with invasive assessments and interventions such as UDS or pharmacotherapy. Both treatment strategies are currently utilized and data have historically been inconclusive in demonstrating efficacy of one regimen over the other. We performed a narrative literature evaluating proactive and expectant treatment strategies as they relate to diagnostics and management of Spina Bifida. From the available literature and our practice, a proactive strategy favors greater benefit in preventative management and may decrease risk of renal dysfunction compared with expectant management.
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Affiliation(s)
- K Tyler Hobbs
- Division of Urologic Surgery, Duke University Medical Center, Durham, NC, USA
| | | | - Rohit Tejwani
- Division of Urologic Surgery, Duke University Medical Center, Durham, NC, USA
| | - J Todd Purves
- Division of Urologic Surgery, Duke University Medical Center, Durham, NC, USA
| | - John S Wiener
- Division of Urologic Surgery, Duke University Medical Center, Durham, NC, USA
| | - Jonathan C Routh
- Division of Urologic Surgery, Duke University Medical Center, Durham, NC, USA
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Castro J, Maddern J, Grundy L, Manavis J, Harrington AM, Schober G, Brierley SM. A mouse model of endometriosis that displays vaginal, colon, cutaneous, and bladder sensory comorbidities. FASEB J 2021; 35:e21430. [PMID: 33749885 DOI: 10.1096/fj.202002441r] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Revised: 01/19/2021] [Accepted: 01/25/2021] [Indexed: 01/15/2023]
Abstract
Endometriosis is a painful inflammatory disorder affecting ~10% of women of reproductive age. Although chronic pelvic pain (CPP) remains the main symptom of endometriosis patients, adequate treatments for CPP are lacking. Animal models that recapitulate the features and symptoms experienced by women with endometriosis are essential for investigating the etiology of endometriosis, as well as developing new treatments. In this study, we used an autologous mouse model of endometriosis to examine a combination of disease features and symptoms including: a 10 week time course of endometriotic lesion development; the chronic inflammatory environment and development of neuroangiogenesis within lesions; sensory hypersensitivity and altered pain responses to vaginal, colon, bladder, and skin stimulation in conscious animals; and spontaneous animal behavior. We found significant increases in lesion size from week 6 posttransplant. Lesions displayed endometrial glands, stroma, and underwent neuroangiogenesis. Additionally, peritoneal fluid of mice with endometriosis contained known inflammatory mediators and angiogenic factors. Compared to Sham, mice with endometriosis displayed: enhanced sensitivity to pain evoked by (i) vaginal and (ii) colorectal distension, (iii) altered bladder function and increased sensitivity to cutaneous (iv) thermal and (v) mechanical stimuli. The development of endometriosis had no effect on spontaneous behavior. This study describes a comprehensive characterization of a mouse model of endometriosis, recapitulating the clinical features and symptoms experienced by women with endometriosis. Moreover, it delivers the groundwork to investigate the etiology of endometriosis and provides a platform for the development of therapeutical interventions to manage endometriosis-associated CPP.
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Affiliation(s)
- Joel Castro
- Visceral Pain Research Group, College of Medicine and Public Health, Flinders Health and Medical Research Institute (FHMRI), Flinders University, Bedford Park, SA, Australia.,Hopwood Centre for Neurobiology, Lifelong Health Theme, South Australian Health and Medical Research Institute (SAHMRI), Adelaide, SA, Australia
| | - Jessica Maddern
- Visceral Pain Research Group, College of Medicine and Public Health, Flinders Health and Medical Research Institute (FHMRI), Flinders University, Bedford Park, SA, Australia.,Hopwood Centre for Neurobiology, Lifelong Health Theme, South Australian Health and Medical Research Institute (SAHMRI), Adelaide, SA, Australia
| | - Luke Grundy
- Visceral Pain Research Group, College of Medicine and Public Health, Flinders Health and Medical Research Institute (FHMRI), Flinders University, Bedford Park, SA, Australia.,Hopwood Centre for Neurobiology, Lifelong Health Theme, South Australian Health and Medical Research Institute (SAHMRI), Adelaide, SA, Australia
| | - Jim Manavis
- School of Medicine, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, SA, Australia
| | - Andrea M Harrington
- Visceral Pain Research Group, College of Medicine and Public Health, Flinders Health and Medical Research Institute (FHMRI), Flinders University, Bedford Park, SA, Australia.,Hopwood Centre for Neurobiology, Lifelong Health Theme, South Australian Health and Medical Research Institute (SAHMRI), Adelaide, SA, Australia
| | - Gudrun Schober
- Visceral Pain Research Group, College of Medicine and Public Health, Flinders Health and Medical Research Institute (FHMRI), Flinders University, Bedford Park, SA, Australia.,Hopwood Centre for Neurobiology, Lifelong Health Theme, South Australian Health and Medical Research Institute (SAHMRI), Adelaide, SA, Australia
| | - Stuart M Brierley
- Visceral Pain Research Group, College of Medicine and Public Health, Flinders Health and Medical Research Institute (FHMRI), Flinders University, Bedford Park, SA, Australia.,Hopwood Centre for Neurobiology, Lifelong Health Theme, South Australian Health and Medical Research Institute (SAHMRI), Adelaide, SA, Australia.,Discipline of Medicine, University of Adelaide, Adelaide, SA, Australia
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Christie S, Brookes S, Zagorodnyuk V. Endocannabinoids in Bladder Sensory Mechanisms in Health and Diseases. Front Pharmacol 2021; 12:708989. [PMID: 34290614 PMCID: PMC8287826 DOI: 10.3389/fphar.2021.708989] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Accepted: 06/23/2021] [Indexed: 01/23/2023] Open
Abstract
The recent surge in research on cannabinoids may have been fueled by changes in legislation in several jurisdictions, and by approval for the use of cannabinoids for treatment of some chronic diseases. Endocannabinoids act largely, but not exclusively on cannabinoid receptors 1 and 2 (CBR1 and CBR2) which are expressed in the bladder mainly by the urothelium and the axons and endings of motor and sensory neurons. A growing body of evidence suggests that endocannabinoid system constitutively downregulates sensory bladder function during urine storage and micturition, under normal physiological conditions. Similarly, exogenous cannabinoid agonists have potent modulatory effects, as do inhibitors of endocannabinoid inactivation. Results suggest a high potential of cannabinoids to therapeutically ameliorate lower urinary tract symptoms in overactive bladder and painful bladder syndromes. At least part of this may be mediated via effects on sensory nerves, although actions on efferent nerves complicate interpretation. The sensory innervation of bladder is complex with at least eight classes identified. There is a large gap in our knowledge of the effects of endocannabinoids and synthetic agonists on different classes of bladder sensory neurons. Future studies are needed to reveal the action of selective cannabinoid receptor 2 agonists and/or peripherally restricted synthetic cannabinoid receptor 1 agonists on bladder sensory neurons in animal models of bladder diseases. There is significant potential for these novel therapeutics which are devoid of central nervous system psychotropic actions, and which may avoid many of the side effects of current treatments for overactive bladder and painful bladder syndromes.
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Affiliation(s)
- Stewart Christie
- Discipline of Human Physiology, College of Medicine and Public Health, Flinders Health and Medical Research Institute, Flinders University, Adelaide, SA, Australia
| | - Simon Brookes
- Discipline of Human Physiology, College of Medicine and Public Health, Flinders Health and Medical Research Institute, Flinders University, Adelaide, SA, Australia
| | - Vladimir Zagorodnyuk
- Discipline of Human Physiology, College of Medicine and Public Health, Flinders Health and Medical Research Institute, Flinders University, Adelaide, SA, Australia
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Yeh CH, Chen BH, Tseng XW, Liao CH, Tsai WK, Chiang HS, Wu YN. Intravesical Instillation of Norketamine, a Ketamine Metabolite, and Induced Bladder Functional Changes in Rats. Toxics 2021; 9:toxics9070154. [PMID: 34209184 PMCID: PMC8309735 DOI: 10.3390/toxics9070154] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Revised: 06/20/2021] [Accepted: 06/25/2021] [Indexed: 12/13/2022]
Abstract
This study aimed to determine the mechanism of ketamine-induced cystitis without metabolism. A total of 24 adult male Sprague-Dawley rats were separated into control, ketamine, and norketamine groups. To induce cystitis, rats in the ketamine and norketamine groups were treated with intravesical instillation of ketamine and norketamine by mini-osmotic pump, which was placed in subcutaneous space, daily for 24 h for 4 weeks. After 4 weeks, all rats were subjected to bladder functional tests. The bladders were collected for histological and pathological evaluation. Compared to control, ketamine treatment demonstrated an increase in the bladder weight, high bladder/body coefficient, contractive pressure, voiding volume, collagen deposition, reduced smooth muscle content, damaged glycosaminoglycan layer, and low bladder compliance. Compared to ketamine, norketamine treatment showed more severe collagen deposition, smooth muscle loss, damaged glycosaminoglycan layer, and increased residual urine. Intravesical administration of ketamine and norketamine induced cystitis with different urodynamic characteristics. Norketamine treatment caused more severe bladder dysfunction than ketamine treatment. Direct treatment of the bladder with norketamine induced symptoms more consistent with those of bladder outlet obstruction than ketamine cystitis. Detailed studies of cellular mechanisms are required to determine the pathogenesis of ketamine cystitis.
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Affiliation(s)
- Chung-Hsin Yeh
- School of Medicine, College of Medicine, Fu Jen Catholic University, New Taipei City 242, Taiwan; (C.-H.Y.); (C.-H.L.)
- Division of Urology, Department of Surgery, Shin Kong Wu Ho-Su Memorial Hospital, Taipei City 111, Taiwan
| | - Bo-He Chen
- Graduate Institute of Biomedical and Pharmaceutical Science, Fu Jen Catholic University, New Taipei City 242, Taiwan;
| | - Xiao-Wen Tseng
- Program in Pharmaceutical Biotechnology, College of Medicine, Fu Jen Catholic University, New Taipei City 242, Taiwan;
| | - Chun-Hou Liao
- School of Medicine, College of Medicine, Fu Jen Catholic University, New Taipei City 242, Taiwan; (C.-H.Y.); (C.-H.L.)
- Division of Urology, Department of Surgery, Cardinal Tien Hospital, New Taipei City 231, Taiwan
| | - Wei-Kung Tsai
- Department of Urology, Mackay Memorial Hospital, Taipei City 104, Taiwan;
- Ph.D. Program in Nutrition and Food Science, Graduate Institute of Biomedical and Pharmaceutical Science, Fu Jen Catholic University, New Taipei City 242, Taiwan
- Department of Medicine, Mackay Medical College, New Taipei City 252, Taiwan
- Mackay Junior College of Medicine, Nursing, and Management, Taipei City 252, Taiwan
| | - Han-Sun Chiang
- Graduate Institute of Biomedical and Pharmaceutical Science, Fu Jen Catholic University, New Taipei City 242, Taiwan;
- Division of Urology, Department of Surgery, Cardinal Tien Hospital, New Taipei City 231, Taiwan
- Department of Urology, Fu Jen Catholic University Hospital, New Taipei City 243, Taiwan
- Correspondence: (H.-S.C.); (Y.-N.W.); Tel.: +886-2-29052202 (H.-S.C.); +886-2-29056442 (Y.-N.W.); Fax: +886-2-29017391 (H.-S.C.); +886-2-29056100 (Y.-N.W.)
| | - Yi-No Wu
- School of Medicine, College of Medicine, Fu Jen Catholic University, New Taipei City 242, Taiwan; (C.-H.Y.); (C.-H.L.)
- Correspondence: (H.-S.C.); (Y.-N.W.); Tel.: +886-2-29052202 (H.-S.C.); +886-2-29056442 (Y.-N.W.); Fax: +886-2-29017391 (H.-S.C.); +886-2-29056100 (Y.-N.W.)
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Del Toro Pérez C, Amaya Pascasio L, Arjona Padillo A, Olivares Romero J, Mejías Olmedo MV, Fernández Pérez J, Payán Ortiz M, Martínez-Sánchez P. Neurosonological Findings Related to Non-Motor Features of Parkinson's Disease: A Systematic Review. Brain Sci 2021; 11:776. [PMID: 34208347 DOI: 10.3390/brainsci11060776] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2021] [Revised: 06/07/2021] [Accepted: 06/08/2021] [Indexed: 12/25/2022] Open
Abstract
Non-motor symptoms (NMS) in Parkinson’s disease (PD), including neuropsychiatric or dysautonomic complaints, fatigue, or pain, are frequent and have a high impact on the patient’s quality of life. They are often poorly recognized and inadequately treated. In the recent years, the growing awareness of NMS has favored the development of techniques that complement the clinician’s diagnosis. This review provides an overview of the most important ultrasonographic findings related to the presence of various NMS. Literature research was conducted in PubMed, Scopus, and Web of Science from inception until January 2021, retrieving 23 prospective observational studies evaluating transcranial and cervical ultrasound in depression, dementia, dysautonomic symptoms, psychosis, and restless leg syndrome. Overall, the eligible articles showed good or fair quality according to the QUADAS-2 assessment. Brainstem raphe hypoechogenicity was related to the presence of depression in PD and also in depressed patients without PD, as well as to overactive bladder. Substantia nigra hyperechogenicity was frequent in patients with visual hallucinations, and larger intracranial ventricles correlated with dementia. Evaluation of the vagus nerve showed contradictory findings. The results of this systematic review demonstrated that transcranial ultrasound can be a useful complementary tool in the evaluation of NMS in PD.
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Romero-Maroto J, Martinez-Cayuelas L, Gómez-Pérez L, Sarrió-Sanz P, Olarte Barragán E, López-López AI. Long-term effectiveness and safety of bladder augmentation in spina bifida patients. Neurourol Urodyn 2021; 40:1576-1584. [PMID: 34082472 DOI: 10.1002/nau.24713] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Revised: 05/13/2021] [Accepted: 05/13/2021] [Indexed: 11/10/2022]
Abstract
AIMS To establish the long-term efficacy and safety of bladder augmentation in spina bifida patients. MATERIAL AND METHODS Sixteen patients were operated on using the Bramble technique. Preoperative and postoperative evaluation included clinical history, blood tests, urine cultures, cystography, pyelography, ultrasound, and filling cystometry. In the final review a standardized quality of life questionnaire was applied. RESULTS Median follow-up was 20 years (15-26). Kidney function was stabilized except for one case that required a kidney transplant. Hydronephrosis disappeared or improved (p = 0.03). Vesicoureteral reflux grades I-II was cured without reimplantation and grades III-IV responded better with reimplantation than without (p = 0.03). Quality of life improved in all patients, with all stating they would undergo the procedure again. After surgery, 94% of the patients exhibited diurnal continence but 25% exhibited nocturnal incontinence. Pressure at capacity decreased and bladder capacity increased (p < 0.001). One patient presented ureteral fistula with another presenting hemorrhage. Both required immediate surgical review. Late complications included urinary sphincter cuff erosion, renal lithiasis, four instances of bladder lithiasis and repeated pyelonephritis in one 24-year-old patient. All required surgery. The mean of urinary infections fell, from 2.5 per year (0.7) to 1 (0.5) (p = 0.03). CONCLUSION Augmentation cystoplasty (AC) maintains its efficacy and improves quality of life in the long term. However, serious surgical complications can ensue, along with minor or major subsequent complications. This should be considered before surgery and makes lifelong monitoring of patients necessary.
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Affiliation(s)
- Jesús Romero-Maroto
- Department of Pathology and Surgery, Universidad Miguel Hernández, Elche, Spain
| | | | - Luis Gómez-Pérez
- Department of Pathology and Surgery, Universidad Miguel Hernández, Elche, Spain.,Department of Urology, San Juan University Hospital, Alicante, Spain
| | - Pau Sarrió-Sanz
- Department of Urology, San Juan University Hospital, Alicante, Spain
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Wu YH, Chueh KS, Chuang SM, Long CY, Lu JH, Juan YS. Bladder Hyperactivity Induced by Oxidative Stress and Bladder Ischemia: A Review of Treatment Strategies with Antioxidants. Int J Mol Sci 2021; 22:ijms22116014. [PMID: 34199527 PMCID: PMC8199707 DOI: 10.3390/ijms22116014] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Accepted: 05/28/2021] [Indexed: 02/07/2023] Open
Abstract
Overactive bladder (OAB) syndrome, including frequency, urgency, nocturia and urgency incontinence, has a significantly negative impact on the quality-of-life scale (QoL) and can cause sufferer withdrawal from social activities. The occurrence of OAB can result from an imbalance between the production of pro-oxidants, such as free radicals and reactive species, and their elimination through protective mechanisms of antioxidant-induced oxidative stress. Several animal models, such as bladder ischemia/reperfusion (I/R), partial bladder outlet obstruction (PBOO) and ovarian hormone deficiency (OHD), have suggested that cyclic I/R during the micturition cycle induces oxidative stress, leading to bladder denervation, bladder afferent pathway sensitization and overexpression of bladder-damaging molecules, and finally resulting in bladder hyperactivity. Based on the results of previous animal experiments, the present review specifically focuses on four issues: (1) oxidative stress and antioxidant defense system; (2) oxidative stress in OAB and biomarkers of OAB; (3) OAB animal model; (4) potential nature/plant antioxidant treatment strategies for urinary dysfunction with OAB. Moreover, we organized the relationships between urinary dysfunction and oxidative stress biomarkers in urine, blood and bladder tissue. Reviewed information also revealed the summary of research findings for the effects of various antioxidants for treatment strategies for OAB.
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Affiliation(s)
- Yi-Hsuan Wu
- Graduate Institute of Clinical Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 80708, Taiwan; (Y.-H.W.); (K.-S.C.)
- Department of Urology, College of Medicine, Kaohsiung Medical University, Kaohsiung 80708, Taiwan;
- Department of Urology, Kaohsiung Municipal Hsiao-Kang Hospital, Kaohsiung 80661, Taiwan
| | - Kuang-Shun Chueh
- Graduate Institute of Clinical Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 80708, Taiwan; (Y.-H.W.); (K.-S.C.)
- Department of Urology, College of Medicine, Kaohsiung Medical University, Kaohsiung 80708, Taiwan;
- Department of Urology, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung 80145, Taiwan
| | - Shu-Mien Chuang
- Department of Urology, College of Medicine, Kaohsiung Medical University, Kaohsiung 80708, Taiwan;
| | - Cheng-Yu Long
- Department of Obstetrics and Gynecology, Kaohsiung Medical University Hospital, Kaohsiung 80708, Taiwan;
- Regenerative Medicine and Cell Therapy Research Center, Kaohsiung Medical University, Kaohsiung 80708, Taiwan
| | - Jian-He Lu
- Emerging Compounds Research Center, Department of Environmental Science and Engineering, College of Engineering, National Pingtung University of Science and Technology, Pintung 91201, Taiwan;
| | - Yung-Shun Juan
- Graduate Institute of Clinical Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 80708, Taiwan; (Y.-H.W.); (K.-S.C.)
- Department of Urology, College of Medicine, Kaohsiung Medical University, Kaohsiung 80708, Taiwan;
- Department of Urology, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung 80145, Taiwan
- Regenerative Medicine and Cell Therapy Research Center, Kaohsiung Medical University, Kaohsiung 80708, Taiwan
- Correspondence: ; Tel.: +886-7-3121101; Fax: +886-7-3506269
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Salman L, Shmueli A, Aharony S, Pardo A, Chen R, Wiznitzer A, Gabbay-Benziv R. Postpartum voiding dysfunction following vaginal versus caesarean delivery. J OBSTET GYNAECOL 2021; 42:256-260. [PMID: 34027805 DOI: 10.1080/01443615.2021.1907553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
In this prospective study, we evaluated postpartum voiding dysfunction stratified by mode of delivery - vaginal delivery versus elective caesarean delivery (CD). We recruited nulliparous women carrying singleton gestation at term admitted to delivery room or elective CD. Pre-labour voiding function was assessed by recording the post-voiding residual volume (PVRV) using a bladder scan. PVRV evaluation was repeated at least 12 hours following delivery and before discharge. PVRVs were considered abnormal if ≥150 mL. PVRVs were compared between vaginal and CD. Overall, 54 women were included. Of them, 34 (63%) delivered vaginally and 20 (37%) had an elective CD. Postpartum mean PVRVs were significantly higher compared to pre-labour PVRVs (215 vs. 133 mL, p<.001). Abnormal postpartum PVRV was significantly higher in vaginal delivery compared to CD (73.5% vs. 45%, p<.05). In conclusion, delivery adversely affects voiding function. Vaginal delivery is associated with more severe voiding dysfunction compared to elective CD.Impact StatementWhat is already known on this subject? Delivery is associated with voiding dysfunction. While most studies on postpartum voiding dysfunction were related to vaginal delivery, little is known on the effect of mode of delivery (vaginal versus caesarean delivery (CD)) on voiding dysfunction.What the results of this study add? In this study, we found that postpartum post-voiding residual volume is significantly higher than the pre-labour PVRV in women delivered vaginally. In addition, postpartum PVRV was significantly higher in women delivered vaginally compared to elective CD.What the implications are of these findings for clinical practice and/or further research? This study implicates that women with vaginal delivery are more prone to voiding dysfunction compared to elective CD. However, larger observational studies are warranted to confirm these results and evaluate whether this difference still exists beyond the post-partum period.
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Affiliation(s)
- Lina Salman
- Helen Schneider Hospital for Women, Rabin Medical Center, Petah Tikva, Israel.,The Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Anat Shmueli
- Helen Schneider Hospital for Women, Rabin Medical Center, Petah Tikva, Israel.,The Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Shachar Aharony
- The Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Urology Service, Rabin Medical Center, Petah Tikva, Israel
| | - Anat Pardo
- Helen Schneider Hospital for Women, Rabin Medical Center, Petah Tikva, Israel.,The Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Rony Chen
- Helen Schneider Hospital for Women, Rabin Medical Center, Petah Tikva, Israel.,The Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Arnon Wiznitzer
- Helen Schneider Hospital for Women, Rabin Medical Center, Petah Tikva, Israel.,The Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Rinat Gabbay-Benziv
- Hillel Yaffe Medical Center, Hadera, Israel.,The Rappaport Faculty of Medicine, Technion, Haifa, Israel
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Turner AC, Powers SA, Odom MR, Pak ES, Ashcraft KA, Koontz BF, Hannan JL. Impact of prostatic radiation therapy on bladder contractility and innervation. Neurourol Urodyn 2021; 40:1470-1478. [PMID: 34015163 DOI: 10.1002/nau.24705] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Revised: 05/03/2021] [Accepted: 05/06/2021] [Indexed: 11/10/2022]
Abstract
AIMS To determine the effect of prostatic radiation therapy (RT) on bladder contractility and morphology, and axon, or neuron profiles within the detrusor and major pelvic ganglia (MPG) in male rats. METHODS Male Sprague-Dawley rats (8 weeks) received a single dose of prostatic RT (0 or 22 Gy). Bladders and MPG were collected 2- and 10-weeks post-RT. Detrusor contractile responses to carbachol and electrical field stimulation (EFS) were measured. Bladders were stained with Masson's trichrome, and antibodies for nonspecific neuronal marker, cholinergic nerve marker choline acetyltransferase (ChAT), and alpha-smooth muscle actin. MPG gene expression was assessed by quantitative polymerase chain reaction for ubiquitin carboxy-terminal hydrolase L1 (Uchl1) and Chat. RESULTS At 2 weeks post-RT, bladder smooth muscle, detrusor cholinergic axon profiles, and MPG Chat gene expression were increased (p < .05), while carbachol and EFS-mediated contractions were decreased (p < .05). In contrast, at 10 weeks post-RT, nerve-mediated contractions were increased compared with control (p < .05), while bladder smooth muscle, detrusor cholinergic axon profiles, MPG Chat expression, and carbachol contractions had normalized. At both 2- and 10-weeks post-RT, there was no change in detrusor nonspecific axon profiles and MPG Uchl1 expression. CONCLUSION In a rat model, RT of the prostate and MPG was associated with early changes in MPG Chat gene expression, and bladder cholinergic axon profiles and smooth muscle content which resolved over time. After RT recovery, bladder contractility decreased early and increased by 10 weeks. Long-term changes to the MPG and increased bladder cholinergic axons may contribute to RT-induced bladder dysfunction in prostate cancer survivors.
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Affiliation(s)
- Alexander C Turner
- Department of Physiology, Brody School of Medicine, East Carolina University, Greenville, North Carolina, USA
| | - Shelby A Powers
- Department of Physiology, Brody School of Medicine, East Carolina University, Greenville, North Carolina, USA.,Department of Psychiatry & Behavioral Sciences, Duke University, Durham, North Carolina, USA
| | - Michael R Odom
- Department of Physiology, Brody School of Medicine, East Carolina University, Greenville, North Carolina, USA.,Division of Urology, Department of Surgery, Duke University, Durham, North Carolina, USA
| | - Elena S Pak
- Department of Physiology, Brody School of Medicine, East Carolina University, Greenville, North Carolina, USA
| | - Kathleen A Ashcraft
- Department of Radiation Oncology, Duke University, Durham, North Carolina, USA
| | - Bridget F Koontz
- Department of Radiation Oncology, Duke University, Durham, North Carolina, USA
| | - Johanna L Hannan
- Department of Physiology, Brody School of Medicine, East Carolina University, Greenville, North Carolina, USA
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Jeng PH, Huang TR, Wang CC, Chen WL. Clinical Relevance of Urine Flow Rate and Exposure to Polycyclic Aromatic Hydrocarbons. Int J Environ Res Public Health 2021; 18:ijerph18105372. [PMID: 34070005 PMCID: PMC8157826 DOI: 10.3390/ijerph18105372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/18/2021] [Revised: 05/13/2021] [Accepted: 05/15/2021] [Indexed: 01/06/2023]
Abstract
Background: Polycyclic aromatic hydrocarbon (PAH) metabolites have received increasing attention because several of these organic substances are highly carcinogenic or mutagenic. Exposure to PAHs is associated with many harmful health effects; however, we are not aware of any study that has explored the exposure to PAHs and urinary conditions in the general population. The present work aimed to investigate the correlation among PAH and urine flow rate (UFR). Method: Cross-sectional data from the National Health and Nutrition Examination Survey (NHANES) 2009–2012 were used in our study. A total of 4172 participants and a total of nine PAH metabolites were examined. The UFR was measured as the amount of urine excreted in a period of time (mL/h). Several covariates were adjusted in linear regression models. Result: After adjusting for variables, the PAH metabolites in urine showed a significant correlation with UFR. Dose-dependent associations between PAH metabolites in the urine and UFR were also found. Higher quartiles of PAH metabolites in urine exhibited higher regression coefficients. Conclusion: Our study highlighted that PAH metabolites in urine had a strong association with decreased UFR in the US adult population. These findings support the possibility that PAH exposure is related to bladder dysfunction. Further prospective studies are warranted.
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Affiliation(s)
- Po-Hsuan Jeng
- Department of General Medicine, School of Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei 114, Taiwan; (P.-H.J.); (T.-R.H.)
- Department of Surgery, Division of Urology, Tri-Service General Hospital, Taipei 114, Taiwan
| | - Tien-Ru Huang
- Department of General Medicine, School of Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei 114, Taiwan; (P.-H.J.); (T.-R.H.)
- Department of Otolaryngology-Head and Neck Surgery, Tri-Service General Hospital, Taipei 114, Taiwan
| | - Chung-Ching Wang
- Department of Family and Community Medicine, Division of Family Medicine, School of Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei 114, Taiwan;
| | - Wei-Liang Chen
- Department of Family and Community Medicine, Division of Family Medicine, School of Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei 114, Taiwan;
- Department of Family and Community Medicine, Division of Geriatric Medicine, School of Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei 114, Taiwan
- Correspondence: ; Tel.: +886-2-87923311 (ext. 16567)
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45
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Chen L, Lv L, Zhang L, Gao Z, Liu Y, Wang S, Zhou N, Xia Y, Cui J, Jiang X, Zhang X, Li Y, Shi B. Metformin ameliorates bladder dysfunction in a rat model of partial bladder outlet obstruction. Am J Physiol Renal Physiol 2021; 320:F838-F858. [PMID: 33645317 DOI: 10.1152/ajprenal.00625.2020] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Accepted: 02/23/2021] [Indexed: 12/12/2022] Open
Abstract
Alteration of bladder morphology and function was the most important consequence of bladder outlet obstruction (BOO). Using a rat model of partial BOO (pBOO), we found that rats treated with metformin showed lower baseline pressures with a reduced inflammatory reaction in the early phase (2 wk) after pBOO. The NLR family pyrin domain containing 3 inflammasome pathway was inhibited in pBOO rat bladders with treatment of metformin in the early phase. Metformin reduced the activity of NLR family pyrin domain containing 3 in primary urothelial cells. In the chronic phase (9 wk after pBOO), metformin treatment ameliorated bladder fibrosis and improved the reduced compliance. Treatment with metformin suppressed the activation of Smad3 and compensated the diminished autophagy in 9-wk pBOO rat bladders. Autophagy was inhibited with upregulation of profibrotic proteins in primary fibroblasts from chronic pBOO bladders, which could be restored by administration of metformin. The antifibrotic effects of metformin on fibroblasts were diminished after silencing of AMP-activated protein kinase or light chain 3B. In summary, this study elucidates that oral administration of metformin relieves inflammation in the bladder during the early phase of pBOO. Long-term oral administration of metformin can prevent functional and histological changes in the pBOO rat bladder. The current study suggests that metformin might be used to prevent the development of bladder dysfunction secondary to BOO.NEW & NOTEWORTHY The present study in a rat model showed that oral administration of metformin alleviated inflammation following partial bladder outlet obstruction in the early phase and ameliorated bladder fibrosis as well as bladder dysfunction by long-term treatment. Our study indicated that metformin is a potential drug to inhibit bladder remodeling and alleviate bladder dysfunction. Clinical trials are needed to validate the effect of metformin on the bladder dysfunction and bladder fibrosis in the future.
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Affiliation(s)
- Lipeng Chen
- Department of Urology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
- Key Laboratory of Urinary Precision Diagnosis and Treatment in Universities of Shandong, Jinan, China
| | - Linchen Lv
- Department of Urology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
- Key Laboratory of Urinary Precision Diagnosis and Treatment in Universities of Shandong, Jinan, China
| | - Lekai Zhang
- Department of Urology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
- Key Laboratory of Urinary Precision Diagnosis and Treatment in Universities of Shandong, Jinan, China
| | - Zhengdong Gao
- Department of Urology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
- Key Laboratory of Urinary Precision Diagnosis and Treatment in Universities of Shandong, Jinan, China
| | - Yaxiao Liu
- Department of Urology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
- Key Laboratory of Urinary Precision Diagnosis and Treatment in Universities of Shandong, Jinan, China
- Laboratory of Basic Medical Sciences, Qilu Hospital, Cheeloo College of Medicine, Jinan, China
| | - Shuai Wang
- Department of Urology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
- Key Laboratory of Urinary Precision Diagnosis and Treatment in Universities of Shandong, Jinan, China
| | - Nan Zhou
- Department of Urology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
- Key Laboratory of Urinary Precision Diagnosis and Treatment in Universities of Shandong, Jinan, China
| | - Yangyang Xia
- Department of Urology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
- Key Laboratory of Urinary Precision Diagnosis and Treatment in Universities of Shandong, Jinan, China
| | - Jianfeng Cui
- Department of Urology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
- Key Laboratory of Urinary Precision Diagnosis and Treatment in Universities of Shandong, Jinan, China
| | - Xuewen Jiang
- Department of Urology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
- Key Laboratory of Urinary Precision Diagnosis and Treatment in Universities of Shandong, Jinan, China
| | - Xiulin Zhang
- Department of Urology, Second Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Yan Li
- Department of Urology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
- Key Laboratory of Urinary Precision Diagnosis and Treatment in Universities of Shandong, Jinan, China
| | - Benkang Shi
- Department of Urology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
- Key Laboratory of Urinary Precision Diagnosis and Treatment in Universities of Shandong, Jinan, China
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Maurya VP, Singh Y, Srivastava AK, Das KK, Bhaisora KS, Sardhara J, Behari S. Spinal Dermoid and Epidermoid Cyst: An Institutional Experience and Clinical Insight into the Neural Tube Closure Models. J Neurosci Rural Pract 2021; 12:495-503. [PMID: 34295103 PMCID: PMC8289537 DOI: 10.1055/s-0041-1724229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Objectives
The spinal dermoid and epidermoid cysts (SDECs) are rare entities comprising less than 1% of pediatric intraspinal tumors. The present study aims to extrapolate the clinicoradiological data, in order to identify the most plausible neural tube closure model in human and provide a retrospective representation from our clinical experience.
Materials and Methods
We collected the details of all histologically proven, newly diagnosed primary SDECs who underwent excision over the past 20 years. Secondary or recurrent lesions and other spinal cord tumors were excluded. Surgical and follow-up details of these patients as well as those with associated spinal dysraphism were reviewed. Clinical and radiological follow-up revealed the recurrence in these inborn spinal cord disorders.
Results
A total of 73 patients were included retrospectively, having a mean age of 22.4 ± 13.3 years, and 41 (56.2%) cases fell in the first two decades of life. Twenty-four (32.9%) dermoid and 49 (67.1%) epidermoid cysts comprised the study population and 20 of them had associated spinal dysraphism. The distribution of SDECs was the most common in lumbosacral region (
n
= 30) which was 10 times more common than in the sacral region (
n
= 3). Bladder dysfunction 50 (68.5%) and pain 48 (65.7%) were the most common presenting complaints. During follow-up visits, 40/48 (83.3%) cases showed sensory improvement while 11/16 (68.7%) regained normal bowel function. There was no surgical mortality with recurrence seen in eight till the last follow-up.
Conclusions
The protracted clinical course of the spinal inclusion cysts mandates a long-term follow-up. The results of our study support the multisite closure model and attempt to provide a retrospective reflection of neural tube closure model in humans by using SDECs as the surrogate marker of neural tube closure defect.
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Affiliation(s)
- Ved P Maurya
- Department of Neurosurgery, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Yashveer Singh
- Department of Neurosurgery, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Arun K Srivastava
- Department of Neurosurgery, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Kuntal K Das
- Department of Neurosurgery, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Kamlesh S Bhaisora
- Department of Neurosurgery, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Jayesh Sardhara
- Department of Neurosurgery, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Sanjay Behari
- Department of Neurosurgery, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
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Lee YC, Hsieh TJ, Tang FH, Jhan JH, Lin KL, Juan YS, Wang HS, Long CY. Therapeutic effect of Low intensity Extracorporeal Shock Wave Therapy (Li-ESWT) on diabetic bladder dysfunction in a rat model. Int J Med Sci 2021; 18:1423-1431. [PMID: 33628099 PMCID: PMC7893573 DOI: 10.7150/ijms.55274] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2020] [Accepted: 01/06/2021] [Indexed: 12/14/2022] Open
Abstract
Objectives: Low intensity extracorporeal shock wave therapy (Li-ESWT) has proven to be effective and safe for the treatment of various urological disorders including erectile dysfunction and chronic pelvic pain syndrome. In this study, we elucidated the therapeutic effect and possible mechanisms of Li-ESWT on diabetic bladder dysfunction (DBD) in a rat model. Materials and Methods: In all, thirty-two female Sprague-Dawley rats were divided into three groups: normal control (NC), diabetes mellitus (DM) control, and DM Li-ESWT. The two DM groups were given high fat diets for one month, followed by 2 intraperitoneal injections of streptozotocin (STZ) 30 mg/kg separated by one week. Body weight and fasting blood glucose were monitored every week. Only rats with fasting blood glucose 140 mg/dL or more were considered diabetic and used in the subsequent portions of the study. The Li-ESWTs were applied toward the pelvis of the rats twice a week for 4 weeks with energy flux density (EFD) 0.02 mJ/mm2, 500 shocks, at 3Hz. All rats underwent plasma insulin tolerance test, conscious cystometry, leak-point pressure (LPP) assessment, and immunohistochemical studies. Results: DM groups had significantly lower insulin sensitivity and higher body weight. Conscious cystometry also revealed voiding dysfunctions. In the DM Li-ESWT group, the rats had significantly improved voiding functions that were reflected in longer micturition intervals and higher LPP compared to DM control. Immunofluorescence in DM control groups showed increased tyrosine hydroxylase (TH) expression and decreased neuronal nitric oxide synthase (nNOS) expression in the longitudinal urethral smooth muscles. Besides, rats had dilations and deformities of suburothelium capillary network of the bladder, revealing the deterioration of the nerve function of the urethra and destruction of the vascularization of the bladder. However, the DM Li-ESWT group exhibited recovery of the nerve expression of the urethra and vascularization of bladder. Conclusions: Li-ESWT ameliorates the bladder dysfunction and urinary continence in the DBD rat model, reflected in restoration of the nerve expression of the urethra and the vascularization of the bladder. Non-invasive Li-ESWT could be an alternative therapeutic option for DBD.
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Affiliation(s)
- Yung-Chin Lee
- Department of Urology, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.,Department of Urology, Kaohsiung Municipal Siaogang Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.,Department of Urology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.,Regenerative Medicine and Cell Therapy Research Center, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Tusty-Jiuan Hsieh
- Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Fang-Hsiang Tang
- Department of Obstetrics and Gynecology, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.,Graduate Institute of Clinical Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.,Department of Obstetrics and Gynecology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Jhen-Hao Jhan
- Department of Urology, Kaohsiung Municipal Siaogang Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.,Department of Urology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.,Graduate Institute of Clinical Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Kun-Ling Lin
- Department of Obstetrics and Gynecology, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.,Graduate Institute of Clinical Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.,Department of Obstetrics and Gynecology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Yung-Shun Juan
- Department of Urology, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.,Department of Urology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.,Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.,Department of Urology, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Hsun-Shuan Wang
- Department of Urology, Kaohsiung Municipal Siaogang Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.,Department of Urology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.,Regenerative Medicine and Cell Therapy Research Center, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Cheng-Yu Long
- Regenerative Medicine and Cell Therapy Research Center, Kaohsiung Medical University, Kaohsiung, Taiwan.,Department of Obstetrics and Gynecology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.,Department of Obstetrics and Gynecology, Kaohsiung Municipal Siaogang Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
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Amesty MV, García-Vaz C, Espinosa L, Martínez-Urrutia MJ, López-Pereira P. Long-Term Renal Transplant Outcome in Patients With Posterior Urethral Valves. Prognostic Factors Related to Bladder Dysfunction Management. Front Pediatr 2021; 9:646923. [PMID: 34046373 PMCID: PMC8144517 DOI: 10.3389/fped.2021.646923] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Accepted: 04/12/2021] [Indexed: 02/01/2023] Open
Abstract
Introduction: To obtain a successful renal transplant (RT) outcome in patients with posterior urethral valves (PUV), it is necessary to accomplish an adequate bladder dysfunction treatment. Our aim was to determine prognostic factors related to bladder dysfunction management in long-term RT outcome in patients with PUV. Methods: A retrospective review of patients with PUV who received a first RT after 1985 in our institution with at least 5 years of follow-up was performed. Variables analyzed included prenatal diagnosis, age of diagnosis, initial presentation and management, bladder dysfunction treatment, other surgical treatments, pre-transplant dialysis, age of transplantation, type of donor, immunosuppression regimen, vascular and urological complications, rejections episodes, and graft survival. Results: Fifty-one patients were included in the analysis. Prenatal diagnosis was done in 37.3%. Median age of diagnosis was 0.30 (0-88) months. Initial presentation was vesicoureteral reflux (VUR) in 78% and obstructive ureterohydronefrosis in 35.3%. Initial management was valve ablation (29.4%), pyelo-ureterostomy (64.7%), and vesicostomy (5.9%). In 33.3%, a type of bladder dysfunction treatment was performed: 21.6% bladder augmentation (BA), 15.7% Mitrofanoff procedure, 17.6% anticholinergic drugs, and 27.5% clean intermittent catheterization (CIC). Pre-transplant dialysis was received by 66.7%. Transplantation was performed at 6.28 ± 5.12 years, 62.7% were cadaveric and 37.3% living-donor grafts. Acute rejection episodes were found in 23.6%. Urological complications included recurrent urinary tract infections (UTIs) (31.4%); native kidneys VUR (31.4%); graft VUR (45.1%); and ureteral obstruction (2%). Vascular complications occurred in 3.9%. Mean graft survival was 11.1 ± 6.9 years. Analyzing the prognostic factor that influenced graft survival, patients with had CIC or a Mitrofanoff procedure had a significant better long-term graft survival after 10 years of follow-up (p < 0.05), despite of the existence of more recurrent UTIs in them. A better graft survival was also found in living-donor transplants (p < 0.05). No significant differences were observed in long-term graft survival regarding native kidneys or graft VUR, BA, immunosuppression regimen, or post-transplant UTIs. Conclusion: Optimal bladder dysfunction treatment, including CIC with or without a Mitrofanoff procedure, might result in better long-term graft survival in patients with PUV. These procedures were not related to a worse RT outcome in spite of being associated with more frequent UTIs.
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Affiliation(s)
| | - Claudia García-Vaz
- Department of Preventive Medicine and Public Health, Hospital Universitario La Paz, Madrid, Spain
| | - Laura Espinosa
- Department of Pediatric Nephrology, Hospital Universitario La Paz, Madrid, Spain
| | | | - Pedro López-Pereira
- Department of Pediatric Urology, Hospital Universitario La Paz, Madrid, Spain
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49
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Praveen Rajneesh C, Liou JC, Hsieh TH, Chin HY, Peng CW. Efficacy of Deep Brain Stimulation on the Improvement of the Bladder Functions in Traumatic Brain Injured Rats. Brain Sci 2020; 10:E850. [PMID: 33198259 DOI: 10.3390/brainsci10110850] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Revised: 11/07/2020] [Accepted: 11/11/2020] [Indexed: 12/25/2022] Open
Abstract
Objective: Traumatic brain injuries (TBIs) are a prime public health challenge with a high incidence of mortality, and also reflect severe economic impacts. One of their severe symptoms is bladder dysfunction. Conventional therapeutic methods are not effective in managing bladder dysfunction. Henceforth, a research endeavor was attempted to explore a new therapeutic approach for bladder dysfunction through deep brain stimulation (DBS) procedures in a TBI animal model. Methods: TBI in this animal model was induced by the weight-drop method. All rats with an induced TBI were housed for 4 weeks to allow severe bladder dysfunction to develop. Subsequently, an initial urodynamic measurement, the simultaneous recording of cystometric (CMG) and external urethral sphincter electromyography (EUS-EMG) activity was conducted to evaluate bladder function. Further, standard DBS procedures with varying electrical stimulation parameters were executed in the target area of the pedunculopontine tegmental nucleus (PPTg). Simultaneously, urodynamic measurements were re-established to compare the effects of DBS interventions on bladder functions. Results: From the variable combinations of electrical stimulation, DBS at 50 Hz and 2.0 V, significantly reverted the voiding efficiency from 39% to 69% in TBI rats. Furthermore, MRI studies revealed the precise localization of the DBS electrode in the target area. Conclusions: The results we obtained showed an insightful understanding of PPTg-DBS and its therapeutic applications in alleviating bladder dysfunction in rats with a TBI. Hence, the present study suggests that PPTg-DBS is an effective therapeutic strategy for treating bladder dysfunction.
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Pikov V, McCreery DB, Han M. Intraspinal stimulation with a silicon-based 3D chronic microelectrode array for bladder voiding in cats. J Neural Eng 2020; 17. [PMID: 33181490 PMCID: PMC8113353 DOI: 10.1088/1741-2552/abca13] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2020] [Accepted: 11/12/2020] [Indexed: 12/31/2022]
Abstract
Objective. Bladder dysfunction is a significant and largely unaddressed problem for people living with spinal cord injury (SCI). Intermittent catheterization does not provide volitional control of micturition and has numerous side effects. Targeted electrical microstimulation of the spinal cord has been previously explored for restoring such volitional control in the animal model of experimental SCI. Here, we continue the development of the intraspinal microstimulation array technology to evaluate its ability to provide more focused and reliable bladder control in the feline animal model. Approach. For the first time, a mechanically robust intraspinal multisite silicon array was built using novel microfabrication processes to provide custom-designed tip geometry and 3D electrode distribution. Long-term implantation was performed in eight spinally intact animals for a period up to 6 months, targeting the dorsal gray commissure area in the S2 sacral cord that is known to be involved in the coordination between the bladder detrusor and the external urethral sphincter. Main results. About one third of the electrode sites in the that area produced micturition-related responses. The effectiveness of stimulation was further evaluated in one of eight animals after spinal cord transection (SCT). We observed increased bladder responsiveness to stimulation starting at 1 month post-transection, possibly due to supraspinal disinhibition of the spinal circuitry and/or hypertrophy and hyperexcitability of the spinal bladder afferents. Significance. 3D intraspinal microstimulation arrays can be chronically implanted and provide a beneficial effect on the bladder voiding in the intact spinal cord and after SCT. However, further studies are required to assess longer-term reliability and safety of the developed intraspinal microstimulation array prior to eventual human translation.
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Affiliation(s)
- Victor Pikov
- Medipace Inc, Pasadena, California, UNITED STATES
| | - Douglas B McCreery
- Neural Engineeiring Laboratory, Huntington Medical Research Institute, 734 Fairmount Avenue, Pasadena CA 91105, USA, Pasadena, California, 91105, UNITED STATES
| | - Martin Han
- Biomedical Engineering, University of Connecticut at Storrs , 260 Glenbrook Rd., Unit 3247, Storrs, Connecticut, 06269-3247, UNITED STATES
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