Clinical Effects of Formulated Food of Peucedanum japonicum Extract and Saw Palmetto Extract in Male Patients with Lower Urinary Tract Symptoms.

OBJECTIVES: To evaluate changes over time in subjective symptom scores and urination parameters before and after oral administration of formulated food containing a combination of Peucedanum japonicum (P. japonicum) extract and saw palmetto extract (SPE) in male patients with lower urinary tract symptoms (LUTS). METHODS: This study was conducted in an open label manner on male patients with untreated LUTS. The urination state of patients was evaluated before and after administration of food formulated with P. japonicum extract and SPE for 4 weeks, based on urodynamic parameters and subjective symptom scores (International Prostate Symptom Score [IPSS and IPSS-QOL], Overactive Bladder Symptom Score [OABSS], Overactive Bladder Questionnaire [OAB-q], and International Index of Erectile Function [IIEF]). RESULTS: After the administration of food formulated with these extracts, the following results were obtained: (i) Subjective findings: The IPSS-QOL score improved significantly; both parameters related to nocturia, i.e., frequency of nighttime urination and OABSS-2, improved significantly; other ratings for subjective symptoms slightly improved. (ii) Objective findings: Residual urine volume decreased significantly, and blood prostate specific antigen (PSA) and urinary 8-OHdG levels decreased slightly after the treatment. (iii) Other findings: Blood pressure decreased slightly. No adverse drug reactions were reported. (iv) Patient impressions: 75% of patients gave a rating of "Good" or higher, with 15 out of 20 patients wanting to continue treatment after the end of 4-week administration period. CONCLUSIONS: Food formulated with P. japonicum extract and SPE may be useful to decrease frequency of nighttime urination and residual urine volume in male patients with LUTS.

Bladder outlet obstruction induced expression of prostaglandin E2 receptor subtype EP4 in the rat bladder: a possible counteractive mechanism against detrusor overactivity.

PURPOSE: Prostaglandins have been implicated as endogenous modulators of bladder function under physiological and pathological conditions. We examined how the expression of each EP receptor subtype changed in association with bladder outlet obstruction and focused on the functional role of EP4 receptor subtype in the bladder with outlet obstruction. MATERIALS AND METHODS: We assessed the gene expression of EP receptor subtypes by reverse transcriptase-polymerase chain reaction. EP4 protein localization was determined by immunohistochemistry. The effect of the selective EP4 agonist ONO-AE1-329 on 50 mM KCl induced contraction of rat bladder strips was examined in vitro. Continuous infusion cystometrograms were done to examine the effect of intravesical perfusion of ONO-AE1-329 on the micturition reflex in urethane anesthetized rats. RESULTS: EP4 receptor genes were largely expressed in bladders with outlet obstruction but absent in controls. EP4 receptor proteins were clearly detected in obstructed bladder detrusor smooth muscle and epithelium. ONO-AE1-329 (100 µM) significantly relaxed KCl induced contraction of bladder strips from rats with bladder outlet obstruction. A significant correlation was found between the relaxant effect of ONO-AE1-329 and whole bladder weight. In rats with bladder outlet obstruction intravesical infusion of 10 µM ONO-AE1-329 significantly increased bladder capacity without changing micturition pressure while it had no effect in controls. CONCLUSIONS: Activation of the EP4 receptors expressed in bladders with outlet obstruction may suppress detrusor muscle contraction and afferent activity. This might be a compensatory mechanism to counteract the deterioration of storage function in bladders with outlet obstruction.

Amiloride-sensitive ion channels in urinary bladder epithelium involved in mechanosensory transduction by modulating stretch-evoked adenosine triphosphate release.

OBJECTIVES: To examine the possibility that mechanosensitive ion channels, including epithelial Na+ channels (ENaC), are implicated in mechanosensory transduction of the rat urinary bladder. METHODS: Cystometry with continuous infusion was performed to investigate the effect of intravesically perfused amiloride (a blocker of ENaC) on micturition reflex in urethane-anesthetized female rats. Bladder strips with or without epithelium suspended in organ bath were subjected to varying degrees of mechanical stretch (up to 50%). A luciferin-luciferase assay was used to quantify the change of stretch-evoked adenosine triphosphate (ATP) release by amiloride. The ENaC gene expression was assessed by reverse transcriptase-polymerase chain reaction. The expression and localization of ENaC proteins was examined using immunofluorescent staining. RESULTS: The intravesical perfusion of 1 mM amiloride significantly reduced the frequency of reflex voiding during bladder filling. This effect of amiloride was reversible by washing out the drug. The peak amplitude of micturition pressure was not affected by amiloride. The stretch-evoked ATP release, most of which (more than 90%) came from epithelial layer, was greatly diminished by 1 mM amiloride (from 443 to a 22% increase from basal level at 50% stretch of the original length). The alpha, beta, and gamma-ENaC subunit proteins and genes were expressed in the rat bladder epithelium. CONCLUSIONS: The amiloride-sensitive mechanosensitive channel, including ENaC, expressed in the rat bladder epithelium might be involved in the mechanosensory transduction mechanism by controlling stretch-evoked ATP release.

Prevalence and impact on generic quality of life of urinary incontinence in Japanese working women: assessment by ICI questionnaire and SF-36 Health Survey.

OBJECTIVES: To examine the prevalence of urinary incontinence (UI) and the relationship between UI and generic quality of life (QOL) in working women. METHODS: Of 7229 female hospital nurses in Japan, 3734 (51.7%) responded to a self-administered postal questionnaire that included the Rand Medical Outcomes Study 36-item Health Survey (SF-36) and the International Consultation on Incontinence questionnaire (ICIQ) for evaluating symptoms and health-related QOL. RESULTS: The overall prevalence of UI in Japanese working women aged 20 to 64 years (mean 35.2) was 16.7%. The main type of incontinence was stress UI (73%). Its prevalence increased with age and reached a plateau at age 45 to 49 years (34.7%). The ICIQ score also correlated significantly with age. Generic QOL, especially physical functioning, role-physical, social functioning, and role-emotional, was significantly impaired by UI. A comparison of subjects with and without UI revealed that the differences in the physical and mental component summary scores of the SF-36 were largest in the age groups of 25 to 29 and 55 to 59 years, respectively. The correlations of the ICIQ score with the physical and mental component scores were most significant in the age groups of 25 to 29 and 45 to 49 years, respectively. The impact of mixed UI on QOL showed a greater tendency than that of stress or urge UI. CONCLUSIONS: The prevalence of UI showed an age-related increase, with a peak at 45 to 49 years old. The impact of UI on physical health was great in individuals in their 20s, but its impact on mental health increased in the older age groups.