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1.
Rev Med Suisse ; 16(692): 907-910, 2020 May 06.
Artigo em Francês | MEDLINE | ID: mdl-32374535

RESUMO

Bladder function is controlled by the autonomic and somatic nervous system in the spinal cord. It is coordinated in the brainstem. Different areas of the brain are involved in the voluntary control of this reflex functioning. Brain lesions often cause an overactive bladder syndrome with increased voiding frequency and urgency. Urinary incontinence, frequently present, may be linked to overactive bladder and associated motor and cognitive disorders. Urinary retention occurs in the acute phase of a hemispherical lesion and following brainstem lesions. The identification, evaluation and treatment of urinary disorders in brain-damaged patients require a global assessment and integrated management taking the other neurological consequences of brain damage into account.


Assuntos
Lesões Encefálicas/complicações , Bexiga Urinária Hiperativa/complicações , Incontinência Urinária/complicações , Lesões Encefálicas/fisiopatologia , Humanos , Reflexo , Bexiga Urinária Hiperativa/fisiopatologia , Incontinência Urinária/fisiopatologia
2.
Expert Opin Drug Metab Toxicol ; 16(2): 103-110, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31918590

RESUMO

Introduction: Overactive bladder (OAB) has a heterogeneous presentation that varies between individuals and by gender. Treatment with antimuscarinic medications is standard first line pharmacotherapy for most patients with OAB. However, gender specific differences in the pharmacokinetics and pharmacodynamics of antimuscarinic therapy are often overlooked and not discussed.Areas covered: This review will explore differences by gender between the presentation and treatment of OAB. We will discuss the differences between sexes in terms of lower urinary tract anatomy, muscarinic receptors, and hormone variation. The effect of antimuscarinics on males and females as well as adherence and persistence patterns will be reviewed in order to fully review all available literature on the gender specific pharmacokinetic and pharmacodynamic considerations for antimuscarinic use in the treatment of OAB.Expert opinion: Despite extensive research into various antimuscarinic formulations and therapeutic regimens for the treatment of OAB, identification of gender specific pharmacokinetic and pharmacodynamics considerations remains scant. As our knowledge and understanding of OAB, muscarinic receptors, and antimuscarinic medications evolve, we will hopefully be better able to understand and implement gender-specific and genomic-sprecific treatment regimens and considerations for improved clinical outcomes.


Assuntos
Antagonistas Muscarínicos/administração & dosagem , Bexiga Urinária Hiperativa/tratamento farmacológico , Animais , Feminino , Humanos , Masculino , Adesão à Medicação , Antagonistas Muscarínicos/farmacocinética , Antagonistas Muscarínicos/farmacologia , Receptores Muscarínicos/efeitos dos fármacos , Receptores Muscarínicos/metabolismo , Fatores Sexuais , Bexiga Urinária Hiperativa/fisiopatologia
3.
Urology ; 135: 38-43, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31600558

RESUMO

OBJECTIVE: To evaluate differences in adverse events (AE) in asymptomatic patients with a positive urine dip (UD) at time of intradetrusor onabotulinumtoxinA (BTX-A) injection vsthose with a defined negative UD. MATERIALS AND METHODS: All intradetrusor BTX-A injections were retrospectively reviewed at a single institution between 2016 and 2018. Exclusion criteria included an indwelling catheter, recent positive urine culture, recent antibiotic course, or absence of UD on the day of injection. A positive UD was defined using 7 different definitions with varying combinations of any level of positive blood, leukocyte esterase, or nitrite. Negative UDs were defined those excluded from the positive UD group. We compared multiple positive UD-defined groups to their respective negative UD cohorts with regards to outcomes and demographics. RESULTS: A total of 212 patients underwent 335 cycles of BTX-A injections over a 2-year period. The average age was 65 years (range: 21-90). The majority received 100 units (73%) of BTX-A for a non-neurogenic diagnosis (73%). The overall rate of AEs, urinary tract infection, and urinary retention was 14.6%, 9%, and 3%, respectively. In all groups, the most common AE was urinary tract infection followed by urinary retention. There were no major Clavien-Dindo-defined complications. There was no statistically significant difference in the total or categorical AE rates between positive and negative UD groups using all 7 definitions of a positive UD (P = .05-1.0). CONCLUSION: These data do not support the practice of obtaining a preprocedure UD in asymptomatic patients undergoing intradetrusor BTX-A injection for any indication; test results are unable to predict outcomes or AEs.


Assuntos
Toxinas Botulínicas Tipo A/efeitos adversos , Fármacos Neuromusculares/efeitos adversos , Bexiga Urinária Hiperativa/tratamento farmacológico , Retenção Urinária/epidemiologia , Infecções Urinárias/epidemiologia , Administração Intravesical , Adulto , Idoso , Idoso de 80 Anos ou mais , Doenças Assintomáticas/terapia , Toxinas Botulínicas Tipo A/administração & dosagem , Feminino , Humanos , Injeções Intramusculares/efeitos adversos , Injeções Intramusculares/métodos , Masculino , Pessoa de Meia-Idade , Fármacos Neuromusculares/administração & dosagem , Estudos Retrospectivos , Bexiga Urinária/efeitos dos fármacos , Bexiga Urinária/fisiopatologia , Bexiga Urinária Hiperativa/fisiopatologia , Retenção Urinária/etiologia , Infecções Urinárias/etiologia , Infecções Urinárias/urina , Urodinâmica/efeitos dos fármacos , Adulto Jovem
4.
J Urol ; 203(2): 413-419, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31518199

RESUMO

PURPOSE: Intradetrusor botulinum toxin is an established part of the treatment pathway for pediatric patients with neurogenic bladder. We determined the urodynamic effect of single and multiple administrations of abobotulinum toxin A in pediatric patients with neurogenic bladder, and determined the urodynamic efficacy of abobotulinum toxin A in low compliance vs overactive bladders. MATERIALS AND METHODS: We conducted a single center retrospective review of all pediatric patients with neurogenic bladder treated with abobotulinum toxin A. Videourodynamic data on cystometric capacity, maximum neurogenic detrusor overactivity pressure and compliance were gathered before and after the first abobotulinum toxin A administration and after the last administration. Patients were divided into low compliance and overactive bladder groups depending on initial videourodynamics findings. Paired t-test was used to compare videourodynamic outcomes before vs after abobotulinum toxin A injection. The Mann-Whitney U test was used to compare bladder groups. RESULTS: A total of 30 patients were included in the study. Of these patients 15 (50%) received multiple abobotulinum toxin A injections. There were 16 patients (53%) with overactive bladder. Abobotulinum toxin A administration significantly improved cystometric capacity (p <0.0001) and maximum neurogenic detrusor overactivity (p=0.0001). Overall, compliance did not change significantly (p=0.25). There was no significant difference in urodynamic parameters between first and last abobotulinum toxin A injections. Improvement in cystometric capacity (p=0.05) and maximum neurogenic detrusor overactivity (p=0.25) was similar between the low compliance and overactive bladder groups. Compliance significantly improved in the low compliance group vs the overactive bladder group (p=0.016). CONCLUSIONS: Intradetrusor abobotulinum toxin A improves cystometric capacity and maximum neurogenic detrusor overactivity in pediatric patients with neurogenic bladder. This effect is maintained over multiple injections. Compliance is significantly improved in patients with low compliance bladder vs overactive bladder.


Assuntos
Toxinas Botulínicas Tipo A/administração & dosagem , Bexiga Urinaria Neurogênica/tratamento farmacológico , Bexiga Urinaria Neurogênica/fisiopatologia , Bexiga Urinária Hiperativa/tratamento farmacológico , Bexiga Urinária Hiperativa/fisiopatologia , Urodinâmica , Administração Intravesical , Adolescente , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Masculino , Estudos Retrospectivos , Resultado do Tratamento
5.
Urology ; 135: 32-37, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31626856

RESUMO

OBJECTIVE: To ascertain whether a poor response and adverse events (voiding dysfunction and urinary tract infection) were predictable for first time botulinum toxin-A (BTX-A) injections in a patient cohort of refractory idiopathic overactive bladder with detrusor overactivity. METHODS: Patients who received BTX-A injections for the first time between the dates of March 2004-August 2017 were analyzed in this single center study. Urogenital Distress Inventory short form (UDI-6) questionnaires were collected both preinjection and postinjection prospectively. A poor response was defined as a decrease of less than 16.7 on the UDI-6 questionnaire. Additional information was gathered from patient records in a retrospective fashion. Predictors of poor response, voiding dysfunction, and UTI were analyzed with multivariate logistic regression analysis. RESULTS: Seventy-four patients were analyzed. The only predictor of poor response was male gender (OR, 5.45; 95% CI 1.83-16.47; P = .002). Lower maximum urinary flow rates (OR, 0.91; 95% CI, 0.83-0.99; P = .023), male gender (OR, 5.14; 95% CI 1.41-18.72; P = .013), and hysterectomy in females (OR, 4.55; 95% CI, 1.09-18.87; P = .038) were predictors of clean intermittent self catheterisation (CISC). There was an increased risk of UTIs in patients who performed CISC (OR, 5.26; 95% CI 1.38-20.0; P = .015). CONCLUSION: Male gender was associated with a poor response to BTX-A injections and increased risk of CISC. Lower maximum urinary flow rates and women with hysterectomies were at increased risk of requiring CISC postinjection. Performing CISC was associated with increased risk of UTI. These factors could be helpful when counselling or selecting patients.


Assuntos
Toxinas Botulínicas Tipo A/administração & dosagem , Fármacos Neuromusculares/administração & dosagem , Bexiga Urinária Hiperativa/terapia , Administração Intravesical , Toxinas Botulínicas Tipo A/efeitos adversos , Feminino , Humanos , Injeções Intramusculares/métodos , Cateterismo Uretral Intermitente/efeitos adversos , Cateterismo Uretral Intermitente/métodos , Cateterismo Uretral Intermitente/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Fármacos Neuromusculares/efeitos adversos , Prognóstico , Estudos Retrospectivos , Autocuidado/métodos , Autocuidado/estatística & dados numéricos , Fatores Sexuais , Inquéritos e Questionários , Resultado do Tratamento , Bexiga Urinária/efeitos dos fármacos , Bexiga Urinária/fisiopatologia , Bexiga Urinária Hiperativa/diagnóstico , Bexiga Urinária Hiperativa/fisiopatologia , Infecções Urinárias/epidemiologia , Infecções Urinárias/etiologia , Transtornos Urinários/diagnóstico , Transtornos Urinários/epidemiologia , Transtornos Urinários/etiologia
6.
Int Braz J Urol ; 45(6): 1186-1195, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31808407

RESUMO

INTRODUCTION: This study aimed to evaluate the effects of transobturator tape (TOT) on overactive bladder (OAB) symptoms and quality of life. MATERIALS AND METHODS: Patients with stress-predominant mixed urinary incontinence (MUI) who had undergone TOT procedures were considered candidates for this research. Preoperative assessment included anamnesis, pelvic examination, cough stress test (CST), and validated symptom severity and quality of life (QoL) questionnaires. The primary outcome, improvement and cure rates of OAB symptoms were determined based on the patient's baseline scores in symptom-related questions in OAB-V8. Secondary outcomes included the success rates of SUI, changes in the QoL score and patient satisfaction rates. RESULTS: A total of 104 patients were included in the study. Sixty-two patients underwent TOT placement alone, and 42 patients underwent TOT placement along with prolapse surgery. The mean follow-up period of the patients was 30.47 months range: 13-52 months. At the fi rst-year follow-up, 52 patients (50.0%) and 59 patients (56.7%) reported cure in preoperative urgency and urgency incontinence, respectively. The objective and subjective cure rates were 96.2% and 56.7%, respectively. A total of 80.7% of the cases had a 15-point improvement in QoL scores. CONCLUSIONS: MUS is not only a gold standard treatment in SUI but also presents as a promising treatment modality in stress-dominant MUI. Although the improvement rates of OAB symptoms signifi cantly decrease over time, QoL and patient satisfaction rates remain higher than any other treatment in this patient group at the third-year follow-up.


Assuntos
Qualidade de Vida , Slings Suburetrais , Bexiga Urinária Hiperativa/cirurgia , Incontinência Urinária por Estresse/cirurgia , Incontinência Urinária de Urgência/cirurgia , Adulto , Idoso , Análise de Variância , Feminino , Seguimentos , Humanos , Pessoa de Meia-Idade , Medidas de Resultados Relatados pelo Paciente , Satisfação do Paciente , Período Pós-Operatório , Período Pré-Operatório , Estudos Prospectivos , Estatísticas não Paramétricas , Inquéritos e Questionários , Fatores de Tempo , Resultado do Tratamento , Bexiga Urinária Hiperativa/fisiopatologia , Incontinência Urinária por Estresse/fisiopatologia , Incontinência Urinária de Urgência/fisiopatologia , Adulto Jovem
7.
Nihon Yakurigaku Zasshi ; 154(5): 255-258, 2019.
Artigo em Japonês | MEDLINE | ID: mdl-31735754

RESUMO

Bladder afferent nerves are composed by myelinated Aδ- and unmyelinated C-fibers. During the storage phase of urine, distention of the bladder has long been considered to evoke afferent activity via Aδ-fibers connected in series with the smooth muscle fibers. In contrast, a previous study in cats revealed that more than 90% of C-fibers do not respond to normal bladder distension, being so called 〝silent〟 fibers. However, at least in rats, C-fibers can respond to normal bladder distension like Aδ-fibers, although they may also fulfill a potentially different role in the bladder sensory function in response to abnormal stimuli. The symptoms of overactive bladder (OAB) or interstitial cystitis (IC) are believed to be commonly related to the sensory (afferent) function. In addition, it has been suggested that bladder myogenic microcontractions or micromotions may partly contribute to the development of urgency in OAB related to bladder outlet obstruction (BOO), which is one of cause of benign prostatic hyperplasia (BPH). We have investigated the direct effects of drugs (anticholinergics, ß3-adrenoceptor agonists, α1-adrenoceptor antagonists, PDE type5 inhibitors, etc.) on the bladder afferent function in rodents. In our results, almost all drugs may act on the bladder afferent function, and some of drug (e.g. mirabegron) inhibits the afferent activities through the suppression of the bladder myogenic microcontractions in normal or pathophysiological conditions.


Assuntos
Vias Aferentes/efeitos dos fármacos , Neurônios Aferentes/fisiologia , Bexiga Urinária Hiperativa/fisiopatologia , Bexiga Urinária/inervação , Animais , Gatos , Fibras Nervosas Amielínicas , Ratos , Sensação
8.
Urology ; 134: 84-89, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31585199

RESUMO

OBJECTIVE: To investigate computed tomography (CT) texture analysis of the bladder wall as a predictor of urodynamics findings in adult patient with spina bifida. METHODS: A single-center prospective trial was conducted from March 2015 to March 2017 including all consecutive adult spina bifida patients seen for urodynamic testing. A contrast-enhanced abdominal CT was systematically performed in all patients during the same visit. Texture features of the bladder wall related to the gray-level histogram and gray-level co-occurrence were evaluated on CT images. Multivariate analysis was performed to identify independent predictors of poor bladder compliance and detrusor overactivity among clinical and texture parameters. RESULTS: Fourty patients were included. The Lasso penalized logistic regression analysis identified 2 texture parameters as potential predictors of poor bladder compliance: Skewness (coefficient weight, -1.81) and S.1.1.SumVarnc (coefficient weight, -3.52). Multivariate logistic regression analysis confirmed skewness (odds ratio [confidence interval 95%] = 0.40 [0.14, 0.97], P = .04) as an independent predictor of poor bladder compliance. The Lasso penalized logistic regression analysis identified one texture parameters as potential predictor of detrusor overactivity: Kurtosis (coefficient weight, -3.52), which was confirmed in multivariate logistic regression analysis (odds ratio [confidence interval 95%] = 1.12 [1.01, 1.55], P = .02). CONCLUSION: Our findings demonstrate that CT texture analysis of the bladder wall might be an interesting tool to identify spina bifida patients with high risk urodynamic features.


Assuntos
Disrafismo Espinal , Tomografia Computadorizada por Raios X/métodos , Bexiga Urinária Hiperativa , Bexiga Urinária , Urodinâmica , Adulto , Feminino , França , Humanos , Masculino , Estudos Prospectivos , Intensificação de Imagem Radiográfica/métodos , Disrafismo Espinal/complicações , Disrafismo Espinal/diagnóstico , Disrafismo Espinal/fisiopatologia , Bexiga Urinária/diagnóstico por imagem , Bexiga Urinária/fisiopatologia , Bexiga Urinária Hiperativa/diagnóstico , Bexiga Urinária Hiperativa/etiologia , Bexiga Urinária Hiperativa/fisiopatologia
9.
Urology ; 134: 97-102, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31499079

RESUMO

OBJECTIVE: To determine whether women overactive bladder symptoms would report more frequent unhealthy toileting behaviors. METHODS: A community-based sample of adult women was electronically recruited to complete the Toileting Behavior Scale and the International Consultation on Incontinence Questionnaire - Overactive Bladder module, as well as clinical and demographic questionnaires. The associations between overactive bladder and toileting behavior subscales were assessed as continuous variables using Spearman's rank correlation and as dichotomous variables with multivariable logistic regression. RESULTS: Of the 6562 adult women included in the analytic sample, 1059 (16.1%) were classified as having overactive bladder. Of the toileting behavior subscales, convenience voiding had the highest, positive association with overactive bladder score (r = 0.301, P < .0001). On multivariable logistic regression, women with overactive bladder (OAB) were more likely to report behaviors of convenience voiding (odds ratio [OR] 1.13, confidence intervals [CI] 1.11-1.15), delayed voiding (OR 1.05, CI 1.02-1.08), straining to void (OR 1.05, CI 1.03-1.07), and position preference (OR 1.13, CI 1.08-1.18). CONCLUSION: OAB symptoms were associated with specific toileting behaviors of convenience voiding, delayed voiding, straining to void, and position preference. Further investigation is needed to determine if toileting behaviors are a risk factor for OAB or a compensatory adaptation to mitigate symptoms.


Assuntos
Sintomas Comportamentais/diagnóstico , Qualidade de Vida , Autocuidado , Bexiga Urinária Hiperativa , Incontinência Urinária de Urgência , Micção , Adulto , Aparelho Sanitário , Estudos Transversais , Feminino , Humanos , Pessoa de Meia-Idade , Fatores de Risco , Autocuidado/métodos , Autocuidado/psicologia , Inquéritos e Questionários , Avaliação de Sintomas/métodos , Avaliação de Sintomas/estatística & dados numéricos , Estados Unidos , Bexiga Urinária Hiperativa/diagnóstico , Bexiga Urinária Hiperativa/epidemiologia , Bexiga Urinária Hiperativa/fisiopatologia , Bexiga Urinária Hiperativa/psicologia , Incontinência Urinária de Urgência/etiologia , Incontinência Urinária de Urgência/psicologia
10.
Expert Opin Investig Drugs ; 28(9): 749-755, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31399015

RESUMO

Introduction: In the lower urinary tract (LUT) several members of the TRP superfamily are involved in nociception and mechanosensory transduction. Animal studies have suggested a therapeutic potential of some of these channels, including TRPV1, TRPV4, TRPM8, TRPA1, and TRPM4, for treatment of bladder over- and underactivity and bladder pain disorders, but translation of this information to clinical application has been slow. Areas covered: An update on and discussion of current information on the potential clinical use of TRP channel agonists/antagonists in the treatment of different types of bladder dysfunction. The electronic databases PubMed and Scopus were used to identify relevant clinical and animal studies. Expert opinion: The therapeutic effect of TRPV1 channel desensitizing agonists (capsaicin, resiniferatoxin, given intravesically) has been convincingly demonstrated in some forms of bladder overactivity. However, so far, the potential of any of the small-molecule TRP channel blockers developed for non-bladder indications and tested in early human trials for safety has not been explored clinically in LUT dysfunction. The adverse effects of hyperthermia and reduction of noxious heat sensation of the first generation TRPV1 blockers have delayed development. Despite lack of translational information, TRP channels remain interesting targets for future LUT drugs.


Assuntos
Canais de Receptores Transientes de Potencial/agonistas , Canais de Receptores Transientes de Potencial/antagonistas & inibidores , Doenças da Bexiga Urinária/tratamento farmacológico , Animais , Desenvolvimento de Medicamentos/métodos , Humanos , Sintomas do Trato Urinário Inferior/tratamento farmacológico , Sintomas do Trato Urinário Inferior/fisiopatologia , Dor/tratamento farmacológico , Dor/etiologia , Canais de Receptores Transientes de Potencial/metabolismo , Doenças da Bexiga Urinária/fisiopatologia , Bexiga Urinária Hiperativa/tratamento farmacológico , Bexiga Urinária Hiperativa/fisiopatologia
11.
Acupunct Med ; 37(6): 321-331, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31433197

RESUMO

BACKGROUND: Overactive bladder is prevalent in adults over 40 years of age and its prevalence increases with age. The use of acupuncture in adults with overactive bladder is increasing globally. However, its effectiveness/efficacy and safety have not yet been confirmed. OBJECTIVE: To determine the effectiveness/efficacy and safety of acupuncture and to identify the pattern of commonly used traditional acupuncture points in the management of overactive bladder in adults. METHODS: Ten electronic English and Chinese language databases were systematically searched and two English together with four Chinese journals relevant to acupuncture were manually searched in libraries for randomised controlled trials (RCTs) of acupuncture for overactive bladder in adults from their inception to March 2017. The Cochrane risk of bias tool was used to assess the methodological quality of the RCTs. RevMan v.5.3 software was employed for data analysis. RESULTS: Seven eligible trials involving 695 participants were included. Meta-analysis showed that acupuncture was comparable to drugs (tolterodine tartrate/solifenacin) in the reduction of micturition episodes over 24 hours (pooled standardised mean difference (SMD) 0.36, 95% CI -0.23 to 0.95; I2=83%), increase in voided volume of each micturition episode (pooled SMD -0.15, 95% CI -0.36 to 0.05; I2=0%), and reduction of overactive bladder symptom score (pooled SMD -0.23, 95% CI -1.30 to 0.85; I2=91%). In addition, acupuncture was not significantly different compared with placebo in the reduction of overactive bladder symptom score (pooled SMD -2.36, 95% CI -5.64 to 0.93; I2=97%). No serious adverse events were reported. CONCLUSIONS: No significant differences in effectiveness or efficacy were found between acupuncture and drug or between verum and sham acupuncture, respectively. Further high-quality studies are required.


Assuntos
Terapia por Acupuntura , Bexiga Urinária Hiperativa/terapia , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Ensaios Clínicos Controlados Aleatórios como Assunto , Resultado do Tratamento , Bexiga Urinária Hiperativa/fisiopatologia , Micção
12.
Adv Exp Med Biol ; 1124: 121-147, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31183825

RESUMO

The urinary bladder has two functions: to store urine, when it is relaxed and highly compliant; and void its contents, when intravesical pressure rises due to co-ordinated contraction of detrusor smooth muscle in the bladder wall. Superimposed on this description are two observations: (1) the normal, relaxed bladder develops small transient increases of intravesical pressure, mirrored by local bladder wall movements; (2) pathological, larger pressure variations (detrusor overactivity) can occur that may cause involuntary urine loss and/or detrusor overactivity. Characterisation of these spontaneous contractions is important to understand: how normal bladder compliance is maintained during filling; and the pathophysiology of detrusor overactivity. Consideration of how spontaneous contractions originate should include the structural complexity of the bladder wall. Detrusor smooth muscle layer is overlain by a mucosa, itself a complex structure of urothelium and a lamina propria containing sensory nerves, micro-vasculature, interstitial cells and diffuse muscular elements.Several theories, not mutually exclusive, have been advanced for the origin of spontaneous contractions. These include intrinsic rhythmicity of detrusor muscle; modulation by non-muscular pacemaking cells in the bladder wall; motor input to detrusor by autonomic nerves; regulation of detrusor muscle excitability and contractility by the adjacent mucosa and spontaneous contraction of elements of the lamina propria. This chapter will consider evidence for each theory in both normal and overactive bladder and how their significance may vary during ageing and development. Further understanding of these mechanisms may also identify novel drug targets to ameliorate the clinical consequences of large contractions associated with detrusor overactivity.


Assuntos
Células Intersticiais de Cajal/fisiologia , Contração Muscular , Músculo Liso/fisiologia , Bexiga Urinária/fisiologia , Humanos , Bexiga Urinária/fisiopatologia , Bexiga Urinária Hiperativa/fisiopatologia
13.
Urology ; 131: 64-70, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31150692

RESUMO

OBJECTIVE: To investigate the whole-brain functional connectivity strength (FCS) of patients with the overactive bladder syndrome (OAB). METHODS: This study investigates the changes of intrinsic whole brain functional connectivity pattern in OAB using FCS. We acquired resting-state fMRI data from 26 OAB patients and 28 healthy controls. FCS was used to compute the long-range and short-range FCS values for each voxel in the brain of each subject. The long or short-range FCS maps were compared between OAB patients and healthy controls. Pearson's correlation coefficients was also performed between abnormal FCS regions and clinical/psychometric scores in patients. RESULTS: Compared with healthy control subjects, the OAB patients exhibited significantly decreased short-range FCS in the right medial superior frontal gyrus and bilateral anterior cingulate gyrus, and increased short-range FCS in the middle frontal gyrus, the precentral gyrus, and bilateral caudate nucleus. In addition, significantly decreased long-range FCS was found in bilateral middle cingulate gyrus and posterior cingulate gyrus. Furthermore, the abnormal FCS values in the right caudate nucleus showed significantly negative correlation with Self-Rating Depression Scale of OAB patients. CONCLUSION: Patients with OAB have abnormal short-range and long-range FCS in brain regions associated with brain-bladder network. Our study provides new insights into the underlying brain network topology of OAB.


Assuntos
Encéfalo/diagnóstico por imagem , Encéfalo/fisiopatologia , Imagem por Ressonância Magnética , Bexiga Urinária Hiperativa/diagnóstico por imagem , Bexiga Urinária Hiperativa/fisiopatologia , Adulto , Feminino , Humanos , Imagem por Ressonância Magnética/métodos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Descanso , Síndrome
14.
Neuromodulation ; 22(6): 738-744, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31215713

RESUMO

OBJECTIVE: Sacral nerve stimulation (SNS) is an effective treatment for refractory overactive bladder (OAB). However, advanced age is often cited as a reason to avoid SNS in the elderly. This study evaluates the safety and efficacy of SNS for refractory OAB among our octogenarian population. METHODS: A retrospective review from a single institution was performed on all SNS lead placements from December 1998 to June 2017 for refractory OAB. Octogenarians were characterized as 80 years of age or older at the time of Stage I. Efficacy and safety were determined by the rate of progression to Stage II, subsequent need for multimodal therapy, and rate of surgical revision and explantation. All patients were followed for a minimum of 12 months. RESULTS: Of 374 patients in this study, 37 (9.9%) were octogenarians. There was no difference in gender, race, smoking history, or prior OAB treatment regimens between cohorts. The rate of progression to Stage II was 56.8% for octogenarians compared to 60.5% for nonoctogenarians (p = 0.66). The rate of surgical revision, explantation, and need for multimodal therapy did not differ between groups. Subgroup analysis of octogenarians did not reveal any significant differences between successful and nonsuccessful Stage I patients. CONCLUSIONS: The safety and efficacy of SNS was similar between cohorts. This result suggests that SNS is a safe and effective therapy that should be considered among the treatment options for refractory OAB in octogenarian patients. Further studies are needed to determine predictive factors of Stage I success in elderly patients.


Assuntos
Terapia por Estimulação Elétrica/métodos , Plexo Lombossacral/fisiologia , Bexiga Urinária Hiperativa/diagnóstico , Bexiga Urinária Hiperativa/terapia , Idoso , Idoso de 80 Anos ou mais , Estudos de Coortes , Terapia por Estimulação Elétrica/tendências , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Resultado do Tratamento , Bexiga Urinária Hiperativa/fisiopatologia
15.
Actas urol. esp ; 43(5): 221-227, jun. 2019. tab
Artigo em Espanhol | IBECS | ID: ibc-181088

RESUMO

Objetivo: Evaluar las diferencias clínicas y urodinámicas en mujeres con vejiga hiperactiva (VH) referidas a urología funcional y unidades urodinámicas en España, asociadas con la presencia o ausencia de hiperactividad del detrusor (HD). Material y métodos: Estudio observacional, transversal, multicéntrico y prospectivo realizado en España en mujeres con diagnóstico clínico de VH derivadas para estudio urodinámico (EUD) del cual se realizó lectura centralizada. Las pacientes completaron el diario miccional de 3días (DM3d) con la Patient Perception of Intensity of Urgency Scale (PPIUS), el Cuestionario de Autoevaluación del Control de la Vejiga (CACV) y la Overactive Bladder Questionnaire Short Form (OABq-SF). Se compararon los cuestionarios y las variables del EUD de mujeres con VH con y sin HD empleándose el test de Mann-Whitney (variables continuas) y el test de χ2 (variables categóricas). Resultados: Se evaluaron 247 mujeres con VH, de ellas 103 presentaron HD. Según la presencia o no de HD se observaron diferencias significativas en el número de episodios de incontinencia urinaria de urgencia (IUU), frecuencia miccional, nicturia, volumen miccional medio y número de absorbentes (p < 0,05 para todas las comparaciones). En pacientes con VH y HD un mayor porcentaje presenta capacidad vesical reducida, urgencia, IUU y volúmenes menores para el primer deseo miccional, fuerte deseo miccional y capacidad cistomanométrica máxima en EUD vs pacientes sin HD (p < 0,05 para todas las comparaciones). En los cuestionarios solo hubo diferencias en la subescala de síntomas del CACV entre ambos grupos (p = 0,011). Conclusiones: La presencia de HD en mujeres con VH se relaciona con una alteración más severa de la fase de llenado vesical


Objective: To evaluate the clinical and urodynamic differences (associated with the presence or absence of detrusor overactivity [DO]) in women with overactive bladder (OAB) referred to Functional Urology and Urodynamic Units in Spain. Material and methods: Observational, cross-sectional, multicenter and prospective study conducted in Spain in women with clinical diagnosis of OAB, who had been referred to urodynamic study (UDS) of which centralized reading was performed. Patients completed the 3-day voiding diary (DM3d) with the PPIUS scale (Patient Perception of Intensity of Urgency Scale), the B-SAQ (Bladder Self-Assessment Questionnaire) and the OABq-SF (Overactive Bladder Questionnaire Short Form). The questionnaires and UDS variables of women with OAV, with or without DO, were compared using the Mann-Whitney test (continuous variables) and the chi-square test (χ2) (categorical variables). Results: A total of 247 women with OAB were evaluated, and 103 of them had DO. According to the presence or absence of DO, significant differences were observed in the number of episodes of urge urinary incontinence (UUI), urinary frequency, nocturia, mean micturition volume and number of pads (P < .05 for all comparisons). A higher percentage of patients with OAB and DO presented reduced bladder capacity, urgency, urge urinary incontinence (UUI) and lower volume for first voiding desire, strong desire to void and maximum cystomanometric capacity in UDS compared with patients without DO (P < .05 for all comparisons). The only significant differences between both groups were regarding the B-SAQ symptoms scale (P = .011). Conclusions: The presence of DO in women with OAB is related to a more severe alteration of the bladder filling phase


Assuntos
Humanos , Feminino , Pessoa de Meia-Idade , Bexiga Urinária Hiperativa/fisiopatologia , Sintomas do Trato Urinário Inferior/fisiopatologia , Incontinência Urinária de Urgência/fisiopatologia , Incontinência Urinária de Urgência/complicações , Uretra/fisiopatologia , Estudos Transversais , Estudos Prospectivos , Inquéritos e Questionários , Urodinâmica
16.
Int Braz J Urol ; 45(4): 782-789, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31136113

RESUMO

PURPOSE: To evaluate the efficacy and tolerability of mirabegron in females with overactive bladder (OAB) symptoms after surgical treatment for stress urinary incontinence (SUI). MATERIALS AND METHODS: The study was conducted with a prospective, randomized and double-blinded design. 62 patients over the age of 40 who met the inclusion-exclusion criterias of the study were enrolled and randomly divided into two groups as Group A (mirabegron 50mg) and B (solifenacin 5mg). Patients were compared based on efficacy of treatment [Patient Perception of Bladder Condition (PPBC) scale and micturition diaries], safety of treatment (heart rate, systolic and diastolic blood pressure, adverse events), number of micturitions per day, patient's satisfaction status after treatment [Visual Analog Scale(VAS)] and quality of life. RESULTS: The mean age of the population was 48.2±3.8 years and the duration of OAB symptoms was 5.9±2.9 months. Baseline values for the mean number of micturitions, volume voided in each micturition, nocturia episodes, urgency and urgency incontinence episodes were 15.3±0.34, 128±3.88mL, 3.96±1.67, 5.72±1.35 and 4.22±0.69, respectively. After treatment, values for these parameters were 11.7±0.29, 164.7±2.9mL, 2.25±0.6, 3.38±0.71, 2.31±0.49 respectively. Quality of life score, symptom bother score, VAS for treatment satisfaction score, PPBC score after treatment were 66.1±0.85, 43.7±0.77, 4.78±0.14, 4.78±0.14, respectively. There were no significant differences between two groups on any parameter. However, mirabegron showed better tolerability than solifenacin, particularly after 6 months. CONCLUSION: Mirabegron is safe, effective and tolerable in the long-term treatment of females with OAB symptoms after surgery for stress urinary incontinence.


Assuntos
Acetanilidas/uso terapêutico , Agonistas de Receptores Adrenérgicos beta 3/uso terapêutico , Tiazóis/uso terapêutico , Bexiga Urinária Hiperativa/tratamento farmacológico , Incontinência Urinária por Estresse/cirurgia , Adulto , Método Duplo-Cego , Feminino , Humanos , Pessoa de Meia-Idade , Antagonistas Muscarínicos/uso terapêutico , Estudos Prospectivos , Qualidade de Vida , Valores de Referência , Reprodutibilidade dos Testes , Succinato de Solifenacina/uso terapêutico , Resultado do Tratamento , Bexiga Urinária Hiperativa/fisiopatologia , Incontinência Urinária por Estresse/fisiopatologia , Escala Visual Analógica
17.
Life Sci ; 226: 107-116, 2019 Jun 01.
Artigo em Inglês | MEDLINE | ID: mdl-30965053

RESUMO

Heart failure (HF) has a strong association with the development of lower urinary tract symptoms, especially overactive bladder (OAB); although this condition remains poorly investigated. In this study, we assess the aortocaval fistula (ACF) model as a novel experimental model of micturition dysfunction, associated with HF, focused on the molecular and functional studies to evaluate the autonomic nervous system and urinary bladder remodeling. Male rats were submitted to ACF for HF induction. Echocardiography, cystometric, histomorphometry and molecular analysis, as well as concentration-response curves to carbachol and ATP and frequency-response curves to electrical field stimulation (EFS) were evaluated in Sham and HF (4- and 12-weeksendpoint) groups. Compared to SHAM, HF groups exhibited progressive increases in the left ventricle (LV) mass and fractional shortening which indicates cardiac dysfunction, although HF was characterized only after 12 weeks by the reduced ejection fraction. For micturition function, HF groups presented increased non-voiding contractions (NVC) and decreased bladder capacity; however, when comparing HF groups, these urinary parameters were significantly impaired over the weeks (12-weeks). The contractile responses induced by CCh, ATP and EFS were greater in detrusor muscle (DSM) from HF rats. mRNA expression for muscarinic receptors (M2 and M3) was higher in DSM only after 12 weeks of ACF, in addition to MMP9 and TGF-beta. Histomorphometric revealed increased urothelium thickness in both HF groups, whereas DSM thickness occurred only after 12 weeks. Thus, the ACF model induced cardiac dyfunction with progressive micturition dysfunction over the weeks, characterized by increased DSM contractile mechanisms as well as extracellular matrix remodeling in the urinary bladder, representing a useful tool to evaluate the OAB associated with HF.


Assuntos
Insuficiência Cardíaca/fisiopatologia , Bexiga Urinária Hiperativa/fisiopatologia , Micção/fisiologia , Animais , Modelos Animais de Doenças , Progressão da Doença , Insuficiência Cardíaca/complicações , Insuficiência Cardíaca/metabolismo , Masculino , Contração Muscular , Ratos , Ratos Sprague-Dawley , Receptores Muscarínicos , Bexiga Urinária , Doenças da Bexiga Urinária , Bexiga Urinária Hiperativa/metabolismo
18.
Eur J Obstet Gynecol Reprod Biol ; 237: 18-22, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31003045

RESUMO

OBJECTIVES: To compare body composition in young overweight women with OAB compared to women without OAB, and to determine the severity of the symptoms of OAB, as well as to investigate the impact of OAB on quality of life. STUDY DESIGN: Cross-sectional study. The sample consisted of 1932 enrolled women classed as overweight (BMI:25-29.9).From this sample, 276 women were recruited. Of these, 206 women with an average age of 30.6 ± 20.4 years and an average BMI of 25.8 ± 3.0 were confirmed to be overweight. We used the Voiding Diary, the Overactive Bladder Questionnaire(OAB-q),and the Incontinence Quality of Life (I-QoL) scale. Body composition was measured using direct segmental multi-frequency bioelectrical impedance analysis, with assessment of: skeletal muscle mass(kg)(SMM), body fat mass (kg)(BFM), body fat percentage (%)(BFP), visceral fat area (cm2/level)(VFA), and waist to hip ratio(WHR). RESULTS: The voiding diary and OAB-q results confirmed OAB in 102 women. There was no significant difference in BMI between groups. The body composition analysis showed significant differences in BFP, VFA, and WHR, with higher values in the OAB group(p < 0.01). SMM, however, was higher in the group without OAB(p < 0.01). Recorded I-QoL scores showed worse parameters in the OAB group(p < 0.001). Women with a body fat percentage above 32% have a 1.95 times greater chance of developing OAB. Odds ratio [OR] = 1.95,(95%CI:1.09-3.52,p < 0.02). CONCLUSION: Body fat percentage, visceral fat area, and waist to hip ratio were significantly higher in overweight women with OAB, compared with women without OAB and a comparable BMI.


Assuntos
Composição Corporal/fisiologia , Gordura Intra-Abdominal/fisiopatologia , Sobrepeso/fisiopatologia , Bexiga Urinária Hiperativa/diagnóstico , Adolescente , Adulto , Estudos Transversais , Feminino , Humanos , Sobrepeso/complicações , Qualidade de Vida , Estudantes , Inquéritos e Questionários , Avaliação de Sintomas , Universidades , Bexiga Urinária Hiperativa/complicações , Bexiga Urinária Hiperativa/fisiopatologia , Adulto Jovem
19.
Am J Physiol Renal Physiol ; 316(6): F1103-F1113, 2019 06 01.
Artigo em Inglês | MEDLINE | ID: mdl-30908933

RESUMO

Neural mechanisms of lower urinary tract symptoms in obstruction-induced bladder overactivity remain unclear. We made the first single unit recordings from different types of spinal afferents to determine the effects of bladder outlet obstruction in guinea pigs. A model of gradual bladder outlet obstruction in male guinea pigs was used to produce overactive bladder. Conscious voiding was assessed in metabolic cages, and micturition was recorded in anesthetized guinea pigs in vivo. Single unit extracellular recordings were made ex vivo from spinal afferent nerves in flat sheet preparations of the bladder. Guinea pigs with partially obstructed bladders showed a significant increase in conscious voiding frequency compared with sham-operated guinea pigs. Also, nonvoiding contractions increased significantly in both frequency and amplitude. Although spontaneous firing of low-threshold bladder afferents was increased, their stretch-induced firing was reduced. The proportion of capsaicin-sensitive low-threshold afferents increased in obstructed bladders. Interestingly, spontaneous and stretch-induced firing were both significantly increased in high-threshold afferents after obstruction. In summary, sensory signaling increased in the obstructed bladder during the filling phase. This is largely mediated by low-threshold stretch-sensitive afferents that are activated by increased local nonvoiding contractions. Increased spontaneous firing by high-threshold afferents also contributes. Our findings revealed a complex effect of bladder outlet obstruction on different types of bladder afferents that needs consideration for potential therapeutic targeting of lower urinary tract symptoms in obstruction-induced bladder overactivity.


Assuntos
Nervos Espinhais/fisiopatologia , Obstrução do Colo da Bexiga Urinária/complicações , Bexiga Urinária Hiperativa/etiologia , Bexiga Urinária/inervação , Urodinâmica , Potenciais de Ação , Vias Aferentes/metabolismo , Vias Aferentes/fisiopatologia , Animais , Modelos Animais de Doenças , Cobaias , Masculino , Mecanorreceptores/metabolismo , Limiar Sensorial , Nervos Espinhais/metabolismo , Obstrução do Colo da Bexiga Urinária/metabolismo , Obstrução do Colo da Bexiga Urinária/fisiopatologia , Bexiga Urinária Hiperativa/metabolismo , Bexiga Urinária Hiperativa/fisiopatologia , Micção
20.
Neurourol Urodyn ; 38(4): 1044-1052, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30869827

RESUMO

AIMS: The main goal of our study was to investigate whether blebbistatin would prevent the cyclophosphamide (CYP)-induced changes in cystometric and inflammatory parameters indicating the development of bladder inflammation and bladder overactivity. As the nature of CYP-induced urotoxicity is inflammatory, we assume that agents presenting an anti-inflammatory potential, such as blebbistatin, are worth special attention. MATERIALS AND METHODS: The experiments were carried out in female Wistar rats. Surgical procedures, cystometric investigations, measurements of bladder edema and urothelium thickness as well as biochemical analyses were performed according to the published literature. RESULTS: As expected, an acute administration of CYP (200 mg/kg, intraperitoneally) induced changes in the cystometric parameters and the levels of the tested biomarkers (ie, interleukin 1-ß, interleukin 6, interleukin 10, tumor necrosis factor-α, nerve growth factor, brain-derived neurotrophic factor, heparin-binding epidermal growth factor-like growth factor, insulin-like growth factor-binding protein 3, C-X-C motif chemokine 10, orosomucoid-1, Tamm-Horsfall protein, hemopexin, and occludin), indicating the development of bladder overactivity and bladder inflammation, respectively. These changes were accompanied by bladder edema and increased urothelium thickness. Intravesical infusion of blebbistatin for 7 days (125 nmol/day) prevented all symptoms of the CYP-induced urotoxicity. CONCLUSIONS: Blebbistatin might be a promising novel agent for the treatment of bladder dysfunctions, like CYP-induced hemorrhage cystitis or bladder overactivity, since it diminished the increased urinary bladder levels of proinflammatory markers and normalized the concentrations of the anti-inflammatory ones. This effect was accompanied by amelioration of bladder edema and permeability, and normalization of both urothelium thickness and values of the cystometric parameters.


Assuntos
Cistite/tratamento farmacológico , Compostos Heterocíclicos de 4 ou mais Anéis/uso terapêutico , Bexiga Urinária Hiperativa/tratamento farmacológico , Bexiga Urinária/efeitos dos fármacos , Administração Intravesical , Animais , Ciclofosfamida , Cistite/induzido quimicamente , Cistite/fisiopatologia , Modelos Animais de Doenças , Feminino , Compostos Heterocíclicos de 4 ou mais Anéis/farmacologia , Ratos , Ratos Wistar , Resultado do Tratamento , Bexiga Urinária/fisiopatologia , Bexiga Urinária Hiperativa/induzido quimicamente , Bexiga Urinária Hiperativa/fisiopatologia
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