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1.
Am J Physiol Regul Integr Comp Physiol ; 318(2): R428-R434, 2020 02 01.
Artigo em Inglês | MEDLINE | ID: mdl-31913685

RESUMO

Nonobstructive urinary retention (NOUR) is a medical condition without an effective drug treatment, but few basic science studies have focused on this condition. In α-chloralose-anesthetized cats, the bladder was cannulated via the dome and infused with saline to induce voiding that could occur without urethral outlet obstruction. A nerve cuff electrode was implanted for tibial nerve stimulation (TNS). The threshold (T) intensity for TNS to induce toe twitch was determined initially. Repeated (6 times) application of 30-min TNS (5 Hz, 0.2 ms, 4-6T) significantly (P < 0.05) increased bladder capacity to 180% of control and reduced the duration of the micturition contraction to 30% of control with a small decrease in contraction amplitude (80% of control), which resulted in urinary retention with a low-voiding efficiency of 30% and a large amount of residual volume equivalent to 130% of control bladder capacity. This NOUR condition persisted for >2 h after the end of repeated TNS. However, lower frequency TNS (1 Hz, 0.2 ms, 4T) applied during voiding partially reversed the NOUR by significantly (P < 0.05) increasing voiding efficiency to 60% and reducing residual volume to 70% of control bladder capacity without changing bladder capacity. These results revealed that tibial nerve afferent input can activate either an excitatory or an inhibitory central nervous system mechanism depending on afferent firing frequencies (1 vs. 5 Hz). This study established the first NOUR animal model that will be useful for basic science research aimed at developing new treatments for NOUR.


Assuntos
Estimulação Elétrica , Nervo Tibial/fisiopatologia , Bexiga Urinária/inervação , Retenção Urinária/etiologia , Micção , Urodinâmica , Animais , Gatos , Modelos Animais de Doenças , Terapia por Estimulação Elétrica , Feminino , Masculino , Fatores de Tempo , Retenção Urinária/fisiopatologia , Retenção Urinária/terapia
2.
Urology ; 136: 88-94, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31794815

RESUMO

OBJECTIVE: To determine whether the presence of detrusor overactivity (DO) is associated with the 12-week and 12-month clinical outcomes of selective bladder denervation (SBD) in women with refractory overactive bladder (OAB). METHODS: Prospective single institutional study of refractory OAB females who underwent a urodynamic study and were categorized according to DO status (DO- vs DO+) prior to receiving SBD. RESULTS: Among the 23 patients, 10 were DO- and 13 were DO+. Both groups reported improvement at 12 weeks on the 24-hour pad weight test, in urgency urinary incontinence (UUI) and urgency. At 12 months, both groups still reported improvement in urgency, but only the DO- group reported reduction on the pad weight test and only the DO+ group maintained improvement in the UUI rate. Clinical success (≥50% reduction in UUI) was achieved by all DO- and by 69% of DO+ patients at 12 weeks, and by 60% of DO- and 92% of DO+ patients at 12 months. Treatment benefit (Treatment Benefit Scale ≤2) was reported in 90% of DO- and 85% of DO+ patients at 12 weeks, and in 60% of DO- and 85% of DO+ patients at 12 months. When directly comparing both group outcomes, the only significant difference was the greater reduction of UUI in the DO- group at 12 weeks (-9.0 vs -6.5; P = .045). CONCLUSION: Refractory OAB females appear to be effectively treated by SBD regardless of baseline DO status. DO status does not seem to be associated with the 12-week and 12-month outcomes of SBD.


Assuntos
Denervação/métodos , Bexiga Urinária Hiperativa/complicações , Bexiga Urinária/inervação , Bexiga Urinária/fisiopatologia , Idoso , Feminino , Humanos , Pessoa de Meia-Idade , Estudos Prospectivos , Resultado do Tratamento , Procedimentos Cirúrgicos Urológicos/métodos
3.
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
4.
Urology ; 134: 237-242, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31539508

RESUMO

OBJECTIVE: To determine if targeted and modulated radiofrequency ablation (RFA) of the urinary bladder using our novel ablation device (Denerblate) reduces bladder nerve density, potentially leading to a novel strategy for the management of overactive bladder. METHODS: Fifteen pigs were divided into 4 groups: control (n = 3), 1-week (n = 4), 4-week (n = 4) and 12-week (n = 4) survival times. Denerblate was deployed on the trigone area of the bladder. Three 240-second cycles of modulated RFA were applied with 30 seconds between cycles. At the end of each survival term, urinary bladders were harvested for histopathologic evaluation. Nerve count and density were manually calculated. RESULTS: All procedures were successfully completed, and all animals survived to the desired time points. Mean nerve density (nerves/mm2) was highest in the control and 1-week survival group compared to the 4-week and 12-week groups, both of which demonstrated significant diminishment. Nerve density in the bladder neck at control, 1 week, 4 weeks, and 12 weeks were 1.8, 1.35, 0.87, and 0.12, respectively (P <.001). Nerve density in the bladder trigone area at control, 1 week, 4 weeks, and 12 weeks were 1.5, 0.98, 0.65, and 0.112, respectively (P <.001). Epithelial heat injury was observed in 14.3% at 1 week, 10.7% at 4 weeks, but completely resolved by 12 weeks. CONCLUSION: In the porcine model, modulated RFA delivered by our novel device reduced nerve density in the bladder neck and trigone by 88.6% and 88.9% at 12 weeks without evidence of lasting epithelial injury.


Assuntos
Denervação/instrumentação , Ablação por Radiofrequência/instrumentação , Bexiga Urinária/inervação , Animais , Modelos Animais , Suínos , Bexiga Urinária Hiperativa/cirurgia
5.
Pol J Vet Sci ; 22(2): 427-430, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31269360

RESUMO

Combined retrograde tracing and double-labelling immunofluorescence were used to investigate the distribution and chemical coding of neurons in aorticoerenal (ARG) and testicular (TG) ganglia supplying the urinary bladder apex (UBA) in the juvenile male pig (n=4, 12 kg. body weight). Retrograde fluorescent tracer Fast Blue (FB) was injected into the wall of the bladder apex under pentobarbital anesthesia. After three weeks all the pigs were deeply anesthetized and transcardially perfused with 4% buffered paraformaldehyde. TG and ARG were collected and processed for double-labelling immunofluorescence. The presence of tyrosine hydroxylase (TH) or dopamine beta-hydroxylase (DBH), neuropeptide Y (NPY), somatostatin (SOM), galanin (GAL), nitric oxide synthase (NOS) and vesicular acetylcholine transporter (VAChT) were investigated. The cryostat sections were examined with a Zeiss LSM 710 confocal microscope equipped with adequate filter blocks. The TG and ARG were found to contain many FB-positive neurons projecting to the UBA (UBA-PN). The UBA-PN were distributed in both TG and ARG. The majority were found in the left ganglia, mostly in TG. Immunohistochemistry disclosed that the vast majority of UBA-PN were noradrenergic (TH- and/or DBH-positive). Many noradrenergic neurons also contained immunoreactivity to NPY, SOM or GAL. Most of the UBA-PN were supplied with varicose VAChT-, or NOS- IR (immunoreactive) nerve fibres. This study has revealed a relatively large population of differently coded ARG and TG neurons projecting to the porcine urinary bladder. As judged from their neurochemical organization these nerve cells constitute an important element of the complex neuro-endocrine system involved in the regulation of the porcine urogenital organ function.


Assuntos
Aorta/inervação , Gânglios/citologia , Rim/inervação , Suínos , Testículo/inervação , Bexiga Urinária/inervação , Animais , Gânglios/fisiologia , Masculino
6.
J Clin Neurosci ; 68: 342-343, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31331745

RESUMO

The periaqueductal grey area and sensory thalamus are thought to be important nuclei involved in the supraspinal bladder control network. Deep brain stimulation of the periqueductal grey area has been shown to increase bladder capacity in the human. In a single patient, we have recorded local field potential signals from implanted deep brain stimulation electrodes within the sensory thalamus during filling cystometry with periaqueductal grey area deep brain stimulation in the ON and OFF states. In the OFF stimulation state, we demonstrate correlations between bladder volume and oscillations in the high gamma frequency band in the sensory thalamus. Stimulation of the periaqueductal grey area abolishes this correlated activity in the gamma frequency band and also suppresses oscillations within the sensory thalamus in the alpha frequency band. These findings support the involvement of the sensory thalamus in the afferent limb of bladder-related brain networks. They also suggest that periaqueductal grey area deep brain stimulation may disrupt the normal processing of afferent signals within the sensory thalamus which may be related to the effect of stimulation on bladder capacity.


Assuntos
Estimulação Encefálica Profunda , Substância Cinzenta Periaquedutal/fisiologia , Tálamo/fisiologia , Bexiga Urinária/inervação , Bexiga Urinária/fisiologia , Humanos , Masculino , Pessoa de Meia-Idade , Membro Fantasma/terapia
7.
Probl Endokrinol (Mosk) ; 65(1): 46-49, 2019 05 14.
Artigo em Russo | MEDLINE | ID: mdl-31091050

RESUMO

We describe clinical presentation of Wolfram syndrome and follow-up data in a child. Diagnostics of Wolfram syndrome takes time because clinical symptoms develop not at the time of disease manifestation, but usually several years later. The sequence of manifestations also varies. According to the literature, sensorineural hearing loss occurs in the 2nd decade, and bladder atony develops only by the 3rd decade. In the presented case, initial manifestations of bladder innervation disorders in the form of its dysfunction developed as early as the first year, and sensorineural hearing loss formed by the 4th year of the disease. As in other studies, the patient developed optic disc atrophy within the first year after diabetes onset. This clinical case confirms variability in the clinical symptoms of Wolfram syndrome. The sequence in which the disease picture develops (in this case, there was an incomplete form of syndrome - the absence of diabetes insipidus) does not always coincide with the classic course of syndrome, which complicates timely diagnosis.


Assuntos
Síndrome de Wolfram/diagnóstico , Adolescente , Audição , Humanos , Masculino , Disco Óptico/patologia , Bexiga Urinária/inervação , Bexiga Urinária/fisiopatologia
8.
J Urol ; 202(3): 612-616, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31042110

RESUMO

PURPOSE: Reaugmentation cystoplasty rates vary in the literature but have been reported as high as 15%. It is likely that bladders augmented with detubularized and reconfigured bowel are less likely to require reaugmentation. We assessed the incidence of reaugmentation among patients with spina bifida at 2 high volume reconstruction centers. MATERIALS AND METHODS: We retrospectively reviewed medical records of patients with spina bifida who underwent enterocystoplasty before age 21 years (1987 to 2017). Those who did not undergo augmentation with a detubularized and reconfigured bowel segment were excluded from analysis. Data on demographic and surgical variables were collected. Reaugmentation was the main outcome. One analysis was performed using the entire cohort and another analysis was restricted to patients with ileocystoplasty performed in the last 15 years (2002 to 2017). Survival analysis was used. RESULTS: A total of 289 patients were identified. Enterocystoplasty was performed in patients at a median age of 8.1 years (median followup 11.3, IQR 5.2-14.9). Most initial augmentations were performed using ileum (93.4%), followed by sigmoid (6.2%). Seven patients underwent reaugmentation, including 6 with initial augmentation using ileum and 1 with initial augmentation using sigmoid. On survival analysis risk of reaugmentation was 1.1% at 5 years and 3.3% at 10 years after the original surgery. All reaugmentations occurred within the first 9 years of followup. In the more contemporary cohort (162, median followup 7.0 years) only 1 patient underwent reaugmentation at 2.0 years. CONCLUSIONS: The risk of reaugmentation after enterocystoplasty with a detubularized and reconfigured bowel in the spina bifida population is lower than that reported in initial series.


Assuntos
Procedimentos Cirúrgicos do Sistema Digestório/efeitos adversos , Procedimentos Cirúrgicos Reconstrutivos/efeitos adversos , Disrafismo Espinal/complicações , Bexiga Urinaria Neurogênica/cirurgia , Procedimentos Cirúrgicos Urológicos/efeitos adversos , Anastomose Cirúrgica/efeitos adversos , Anastomose Cirúrgica/métodos , Anastomose Cirúrgica/estatística & dados numéricos , Criança , Pré-Escolar , Colo Sigmoide/cirurgia , Procedimentos Cirúrgicos do Sistema Digestório/métodos , Procedimentos Cirúrgicos do Sistema Digestório/estatística & dados numéricos , Feminino , Humanos , Íleo/cirurgia , Masculino , Procedimentos Cirúrgicos Reconstrutivos/métodos , Procedimentos Cirúrgicos Reconstrutivos/estatística & dados numéricos , Reoperação/estatística & dados numéricos , Estudos Retrospectivos , Medição de Risco , Resultado do Tratamento , Bexiga Urinária/inervação , Bexiga Urinária/cirurgia , Bexiga Urinaria Neurogênica/etiologia , Procedimentos Cirúrgicos Urológicos/métodos , Procedimentos Cirúrgicos Urológicos/estatística & dados numéricos
9.
Andrologia ; 51(8): e13302, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31074030

RESUMO

Chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) is the prostate gland inflammation characterised as genitourinary pain in the pelvic region. The rat experimental autoimmune prostatitis (EAP) was achieved to mimic CP/CPPS. The expressions of transient receptor potential vanilloid 1 (TRPV1) in the prostate, bladder and spinal dorsal root ganglion (DRG) were analysed by Western blotting. Tropomyosin receptor kinase A (TrkA) and nerve growth factor (NGF) in the DRG were also analysed by Western blotting. Measurements of inflammatory cytokines were carried out according to the instructions of the corresponding kits. The expressions of TRPV1 in the prostate, bladder and DRG in the EAP group were significantly higher than those in the control group. The expressions of NGF and TrkA in the DRG in the EAP group were significantly higher than those in the control group. The levels of serum TNF-α and IL-1ß in the EAP group were significantly higher than those in the control group. We conclude that CP/CPPS may participate in the pathological activation of neurons in the L5-S1 segment of DRG by activating NGF-TrkA pathway and cause pelvic organ cross-sensitisation by upregulating the expression of TRPV1 in the prostate, bladder and DRG.


Assuntos
Gânglios Espinais/patologia , Prostatite/patologia , Canais de Cátion TRPV/metabolismo , Animais , Vacina contra Difteria, Tétano e Coqueluche/administração & dosagem , Vacina contra Difteria, Tétano e Coqueluche/imunologia , Modelos Animais de Doenças , Gânglios Espinais/citologia , Humanos , Injeções Intraperitoneais , Masculino , Fator de Crescimento Neural/metabolismo , Neurônios/patologia , Próstata/imunologia , Próstata/inervação , Próstata/patologia , Prostatite/imunologia , Ratos , Ratos Sprague-Dawley , Receptor trkA/metabolismo , Transdução de Sinais , Regulação para Cima , Bexiga Urinária/inervação , Bexiga Urinária/patologia
10.
J Urol ; 202(4): 812-818, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31075056

RESUMO

PURPOSE: We investigated longer term urological outcomes in patients enrolled in the Management of Myelomeningocele Study (MOMS). MATERIALS AND METHODS: Women who participated in the original trial were asked for consent for followup for their child at age 6 years or older in a single comprehensive study visit to a MOMS center. Participating children underwent urological and radiologic procedures to provide objective evidence of current bladder functioning. Primary urological outcome was defined as any among need for clean intermittent catheterization, vesicostomy, urethral dilatation or augmentation cystoplasty. RESULTS: A total of 156 children were evaluated, with a mean age of 7.4 years. Overall 62% vs 87% in the prenatal and postnatal surgery groups, respectively, were placed on clean intermittent catheterization (RR 0.71, 95% CI 0.58-0.86, p <0.001). Voiding status was significantly different between the groups (p <0.001) as 24% in the prenatal group vs 4% in the postnatal group (RR 5.8, 95% CI 1.8-18.7) were reported to be voiding volitionally. Augmentation cystoplasty, vesicostomy and urethral dilation did not differ between the 2 groups. Aside from a larger post-void residual urodynamic catheterization volume, there were no other statistical differences in videourodynamic data or findings on renal/bladder ultrasound. CONCLUSIONS: Prenatal closure of myelomeningocele resulted in less reported clean intermittent catheterization at school age and the mechanism for this is unclear. Although most children are in diapers or on clean intermittent catheterization, parental reports showed children who underwent prenatal closure may be more likely to void volitionally than the postnatal group. Despite these findings, urological outcomes alone should not be the sole impetus to perform in utero closure in children with spina bifida.


Assuntos
Terapias Fetais/métodos , Meningomielocele/cirurgia , Procedimentos Neurocirúrgicos/métodos , Cuidado Pós-Natal/métodos , Procedimentos Cirúrgicos Reconstrutivos/métodos , Transtornos Urinários/terapia , Criança , Feminino , Terapias Fetais/estatística & dados numéricos , Seguimentos , Humanos , Cateterismo Uretral Intermitente/estatística & dados numéricos , Masculino , Meningomielocele/complicações , Meningomielocele/diagnóstico , Cuidado Pós-Natal/estatística & dados numéricos , Gravidez , Procedimentos Cirúrgicos Reconstrutivos/estatística & dados numéricos , Resultado do Tratamento , Bexiga Urinária/diagnóstico por imagem , Bexiga Urinária/inervação , Bexiga Urinária/fisiopatologia , Transtornos Urinários/diagnóstico por imagem , Transtornos Urinários/etiologia
11.
Urologe A ; 58(6): 634-639, 2019 Jun.
Artigo em Alemão | MEDLINE | ID: mdl-31139864

RESUMO

BACKGROUND: Sacral neuromodulation (SNM) has been used in the treatment of refractory overactive bladder syndrome, nonobstructive urinary retention and faecal incontinence for almost 40 years now. It is not to be confused with the sacral anterior root stimulation which is exclusively used for bladder dysfunction due to spinal paraplegia. MECHANISM OF ACTION: The principles of SNM are yet to be fully understood. Nevertheless, there is proof of modulating the activity of several micturition-associated, afferent neurons in the spine, brainstem and cerebrum. Thus, premature detrusor contractions are suppressed, the desire to void is delayed and detrusor-sphincter coordination improves. TECHNIQUES OF IMPLANTATION AND STIMULATION: Motor reactions are an important indicator of correct electrode placement. The implantation procedure consists of two stages with an initial trial phase to determine the best possible treatment response through an external generator before implanting the whole stimulating device. Yearly check-up examinations are recommended; wireless adjustments allow for long-lasting symptom reduction. INDICATION AND OUTCOME: Success rates in the treatment of the refractory overactive bladder syndrome and the non-obstructive urinary retention lie above 70% and can still be perceived as sufficient after 5 years of ongoing SNM therapy. There is also profound evidence of SNM being an effective option for patients with faecal incontinence or chronic obstipation. CONTRAINDICATIONS AND RISKS: Children, pregnant women and patients in need of frequent MRI examinations are usually not eligible for SNM therapy. Infection of the implant, technical failure (including lead displacement and battery depletion) and pain in the implantation site are important adverse effects which might require surgical revision. CONCLUSIONS: The indications for SNM in the German health care system can be expected to be expanded upon the chronic pelvic pain syndrome, erectile dysfunction and additional gastrointestinal conditions. Technical progress will continue to improve the risk-benefit ratio of SNM.


Assuntos
Terapia por Estimulação Elétrica/métodos , Incontinência Fecal/terapia , Neuroestimuladores Implantáveis , Plexo Lombossacral/fisiopatologia , Dor Pélvica/terapia , Bexiga Urinária Hiperativa , Bexiga Urinária/inervação , Retenção Urinária/terapia , Criança , Incontinência Fecal/etiologia , Incontinência Fecal/fisiopatologia , Feminino , Humanos , Masculino , Dor Pélvica/fisiopatologia , Gravidez , Sacro , Bexiga Urinária Hiperativa/terapia , Bexiga Inativa , Retenção Urinária/etiologia , Retenção Urinária/fisiopatologia
13.
Muscle Nerve ; 60(2): 202-210, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-31095755

RESUMO

INTRODUCTION: With increasing life expectancy, comorbidities become overt in Duchenne muscular dystrophy (DMD). Although micturition problems are common, bladder function is poorly understood in DMD. We studied dystrophin expression and multiple isoform involvement in the bladder during maturation to gain insights into their roles in micturition. METHODS: Dystrophin distribution was evaluated in rat bladders by immunohistochemical colocalization with smooth muscle, interstitial, urothelial, and neuronal markers. Protein levels of Dp140, Dp71, and smooth muscle were quantitated by Western blotting of neonatal to adult rat bladders. RESULTS: Dystrophin colocalized with smooth muscle cells and afferent nerve fibers. Dp71 was expressed two- to threefold higher compared with Dp140, independently of age. Age-related muscle mass changes did not influence isoform expression levels. DISCUSSION: Dystrophin is expressed in smooth muscle cells and afferent nerve fibers in the urinary bladder, which underscores that micturition problems in DMD may have not solely a myogenic but also a neurogenic origin. Muscle Nerve 60: 202-210, 2019.


Assuntos
Distrofina/metabolismo , Músculo Liso/metabolismo , Fibras Nervosas/metabolismo , Neurônios Aferentes/metabolismo , Bexiga Urinária/metabolismo , Animais , Masculino , Músculo Liso/inervação , Distrofia Muscular de Duchenne/complicações , Distrofia Muscular de Duchenne/fisiopatologia , Isoformas de Proteínas/metabolismo , Ratos , Bexiga Urinária/inervação , Transtornos Urinários/etiologia , Transtornos Urinários/fisiopatologia
14.
J Obstet Gynaecol ; 39(6): 788-792, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31006315

RESUMO

The aim of the study is to evaluate the feasibility of early postoperative bladder catheter removal without prior bladder-training exercises after laparoscopic nerve sparing radical hysterectomy (LNSRH). The post-operative bladder catheterisation period of 30 patients who underwent LNSRH at two institutes in Egypt and Italy were prospectively evaluated with postoperative drainage of the bladder through a Foley catheter for two days without performing bladder-training exercise. The median duration for postoperative bladder catheterisation was 3.5 (3-5) days. Within the fifth postoperative day, 82.7% had a PVR urine volume less than 100 ml. None of the patients had PVR urine more than 100 ml more than 10 days after the operation with no need for self-catheterisation. These results support early postoperative bladder catheter removal without prior bladder-training exercises following LNSRH. IMPACT STATEMENT What is already known on this subject? Bladder-training exercise was used routinely following radical hysterectomy (RH) operations before bladder catheter removal. Only two studies reported that these exercises could be omitted, but one study was done on both laparoscopic and open RH patients and the other did not show whether the operation was nerve-sparing and whether it was done by laparoscopy or open technique. What the results of this study add? This study's results support early postoperative bladder catheter removal without prior bladder-training exercises after laparoscopic nerve sparing RH. What the implications are of these findings for clinical practice and/or further research? Excluding the unnecessary procedure of bladder training, which is time- and effort-consuming, after the operation.


Assuntos
Estudos de Viabilidade , Histerectomia/métodos , Cuidados Pós-Operatórios/métodos , Bexiga Urinária/fisiopatologia , Cateterismo Urinário/métodos , Neoplasias do Colo do Útero/cirurgia , Adulto , Remoção de Dispositivo , Terapia por Exercício , Feminino , Humanos , Laparoscopia/métodos , Pessoa de Meia-Idade , Complicações Pós-Operatórias/prevenção & controle , Bexiga Urinária/inervação , Neoplasias do Colo do Útero/patologia
15.
J Urol ; 202(3): 574-584, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-30958741

RESUMO

PURPOSE: Neurogenic bladder significantly impacts individuals after spinal cord injury. We hypothesized that there would be differences in bladder related symptoms and quality of life for 4 common bladder management methods. MATERIALS AND METHODS: In this prospective observational study we measured neurogenic bladder related quality of life after spinal cord injury. Study eligibility included age 18 years or greater and acquired spinal cord injury. Bladder management was grouped as 1) clean intermittent catheterization, 2) an indwelling catheter, 3) surgery (bladder augmentation, a catheterizable channel or urinary diversion) and 4) voiding (a condom catheter, involuntary leaking or volitional voiding). The primary outcomes were the NBSS (Neurogenic Bladder Symptom Score) and the SCI-QoL Difficulties (Spinal Cord Injury Quality of Life Measurement System Bladder Management Difficulties). Secondary outcomes were the NBSS subdomains and satisfaction with urinary function. Multivariable regression was done to establish differences between the groups, separated by level. RESULTS: Of the 1,479 participants enrolled in the study 843 (57%) had paraplegia and 894 (60%) were men. Median age was 44.9 years (IQR 34.4-54.1) and median time from injury was 11 years (IQR 5.1-22.4). Bladder management was clean intermittent catheterization in 754 cases (51%), an indwelling catheter in 271 (18%), surgery in 195 (13%) and voiding in 259 (18%). In regard to primary outcomes, in cases of paraplegia and tetraplegia an indwelling catheter and surgery were associated with fewer urinary symptoms on the NBSS compared to clean intermittent catheterization while voiding was associated with more symptoms. In paraplegia and tetraplegia cases surgery was associated with fewer bladder management difficulties according to the SCI-QoL Difficulties. In regard to secondary outcomes, surgery was associated with improved satisfaction in individuals with paraplegia or tetraplegia. CONCLUSIONS: In individuals with spinal cord injury fewer bladder symptoms were associated with an indwelling catheter and surgery, and worse bladder symptoms were noted in voiding individuals compared to those on clean intermittent catheterization. Satisfaction with the urinary system was improved after surgery compared to clean intermittent catheterization.


Assuntos
Medidas de Resultados Relatados pelo Paciente , Qualidade de Vida , Traumatismos da Medula Espinal/complicações , Bexiga Urinaria Neurogênica/terapia , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Satisfação do Paciente/estatística & dados numéricos , Estudos Prospectivos , Resultado do Tratamento , Bexiga Urinária/inervação , Bexiga Urinária/fisiopatologia , Bexiga Urinária/cirurgia , Bexiga Urinaria Neurogênica/etiologia , Bexiga Urinaria Neurogênica/fisiopatologia , Bexiga Urinaria Neurogênica/psicologia , Cateterismo Urinário/métodos , Micção/fisiologia , Procedimentos Cirúrgicos Urológicos/métodos , Adulto Jovem
16.
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
17.
Pediatr Surg Int ; 35(9): 1027-1032, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-30729304

RESUMO

PURPOSE: Based on, previously, a systematic review, urinary nerve growth factor (NGF) has emerged as one potentially noninvasive biomarker for detrusor overactivity (DO) in adults. We performed this systematic review to explore if NGF is a biomarker for DO in children. METHODS: A literature search was conducted in PubMed, Embase, Web of science, and Cochrane Library. Copies of all relevant articles were retrieved for quality assessment and data abstraction by two reviewers. Primary outcome was pooled standardized mean difference (SMD) for NGF/Cr (NGF normalized to urine creatinine) level between DO group and controls. RESULTS: Three case-control studies published from 2012 to 2016 were included with 74 patients and 70 controls. Children with DO had a significant higher baseline urinary NGF/Cr level compared to controls (SMD = 2.48, 95%CI = 0.85-4.10, P < 0.01). After treatment, the level of NGF/Cr decreased significantly compared to baseline level at 6th month time points (SMD = 0.94, 95%CI = 0.03-1.86, P = 0.04). We calculated the required information size to 99 patients for comparison of urinary NGF/Cr level between DO and controls by trail sequential analysis (TSA). CONCLUSION: Based on this systematic review, NGF/Cr may be a noninvasive biomarker for DO in children in the future. However, based on TSA, more original studies are needed to clarify the role of NGF/Cr in the biomarker effect.


Assuntos
Fatores de Crescimento Neural/urina , Bexiga Urinária Hiperativa/urina , Bexiga Urinária/inervação , Biomarcadores/urina , Estudos de Casos e Controles , Criança , Humanos , Urinálise
18.
Cochrane Database Syst Rev ; 2: CD012828, 2019 02 12.
Artigo em Inglês | MEDLINE | ID: mdl-30746689

RESUMO

BACKGROUND: Radical hysterectomy is one of the standard treatments for stage Ia2 to IIa cervical cancer. Bladder dysfunction caused by disruption of the pelvic autonomic nerves is a common complication following standard radical hysterectomy and can affect quality of life significantly. Nerve-sparing radical hysterectomy is a modified radical hysterectomy, developed to permit resection of oncologically relevant tissues surrounding the cervical lesion, while preserving the pelvic autonomic nerves. OBJECTIVES: To evaluate the benefits and harms of nerve-sparing radical hysterectomy in women with stage Ia2 to IIa cervical cancer. SEARCH METHODS: We searched the Cochrane Central Register of Controlled Trials (CENTRAL; 2018, Issue 4), MEDLINE via Ovid (1946 to May week 2, 2018), and Embase via Ovid (1980 to 2018, week 21). We also checked registers of clinical trials, grey literature, reports of conferences, citation lists of included studies, and key textbooks for potentially relevant studies. SELECTION CRITERIA: We included randomised controlled trials (RCTs) evaluating the efficacy and safety of nerve-sparing radical hysterectomy compared to standard radical hysterectomy for women with early stage cervical cancer (stage Ia2 to IIa). DATA COLLECTION AND ANALYSIS: We applied standard Cochrane methodology for data collection and analysis. Two review authors independently selected potentially relevant RCTs, extracted data, evaluated risk of bias of the included studies, compared results and resolved disagreements by discussion or consultation with a third review author, and assessed the certainty of evidence. MAIN RESULTS: We identified 1332 records as a result of the search (excluding duplicates). Of the 26 studies that potentially met the review criteria, we included four studies involving 205 women; most of the trials had unclear risks of bias. We identified one ongoing trial.The analysis of overall survival was not feasible, as there were no deaths reported among women allocated to standard radical hysterectomy. However, there were two deaths in among women allocated to the nerve-sparing technique. None of the included studies reported rates of intermittent self-catheterisation over one month following surgery. We could not analyse the relative effect of the two surgical techniques on quality of life due to inconsistent data reported. Nerve-sparing radical hysterectomy reduced postoperative bladder dysfunctions in terms of a shorter time to postvoid residual volume of urine ≤ 50 mL (mean difference (MD) -13.21 days; 95% confidence interval (CI) -24.02 to -2.41; 111 women; 2 studies; low-certainty evidence) and lower volume of postvoid residual urine measured one month following operation (MD -9.59 days; 95% CI -16.28 to -2.90; 58 women; 2 study; low-certainty evidence). There were no clear differences in terms of perioperative complications (RR 0.55; 95% CI 0.24 to 1.26; 180 women; 3 studies; low-certainty evidence) and disease-free survival (HR 0.63; 95% CI 0.00 to 106.95; 86 women; one study; very low-certainty evidence) between the comparison groups. AUTHORS' CONCLUSIONS: Nerve-sparing radical hysterectomy may lessen the risk of postoperative bladder dysfunction compared to the standard technique, but the certainty of this evidence is low. The very low-certainty evidence for disease-free survival and lack of information for overall survival indicate that the oncological safety of nerve-sparing radical hysterectomy for women with early stage cervical cancer remains unclear. Further large, high-quality RCTs are required to determine, if clinically meaningful differences of survival exist between these two surgical treatments.


Assuntos
Sistema Nervoso Autônomo , Histerectomia/métodos , Tratamentos com Preservação do Órgão/métodos , Complicações Pós-Operatórias/prevenção & controle , Bexiga Urinária/inervação , Transtornos Urinários/prevenção & controle , Neoplasias do Colo do Útero/cirurgia , Intervalo Livre de Doença , Feminino , Humanos , Histerectomia/efeitos adversos , Recidiva Local de Neoplasia , Estadiamento de Neoplasias , Tratamentos com Preservação do Órgão/efeitos adversos , Tratamentos com Preservação do Órgão/mortalidade , Pelve/inervação , Ensaios Clínicos Controlados Aleatórios como Assunto , Transtornos Urinários/etiologia , Neoplasias do Colo do Útero/patologia
19.
Neuroimage ; 191: 481-492, 2019 05 01.
Artigo em Inglês | MEDLINE | ID: mdl-30776530

RESUMO

Previous functional neuroimaging studies provided evidence for a specific supraspinal network involved in lower urinary tract (LUT) control. However, data on the reliability of blood oxygenation level-dependent (BOLD) signal changes during LUT task-related functional magnetic resonance imaging (fMRI) across separate measurements are lacking. Proof of the latter is crucial to evaluate whether fMRI can be used to assess supraspinal responses to LUT treatments. Therefore, we prospectively assessed task-specific supraspinal responses from 20 healthy participants undergoing two fMRI measurements (test-retest) within 5-8 weeks. The fMRI measurements, conducted in a 3T magnetic resonance (MR) scanner, comprised a block design of repetitive bladder filling and drainage using an automated MR-compatible and MR-synchronized infusion-drainage device. Following transurethral catheterization and bladder pre-filling with body warm saline until participants perceived a persistent desire to void (START condition), fMRI was recorded during repetitive blocks (each 15 s) of INFUSION and WITHDRAWAL of 100 mL body warm saline into respectively from the bladder. BOLD signal changes were calculated for INFUSION minus START. In addition to whole brain analysis, we assessed BOLD signal changes within multiple 'a priori' region of interest (ROI), i.e. brain areas known to be involved in the LUT control from previous literature. To evaluate reliability of the fMRI results between visits, we applied different types of analyses: coefficient of variation (CV), intraclass correlation coefficient (ICC), Sørensen-Dice index, Bland-Altman method, and block-wise BOLD signal comparison. All participants completed the study without adverse events. The desire to void was rated significantly higher for INFUSION compared to START or WITHDRAWAL at both measurements without any effect of visit. At whole brain level, significant (p < 0.05, cluster corrected, k ≥ 41 voxels) BOLD signal changes were found for the contrast INFUSION compared to START in several brain areas. Overlap of activation maps from both measurements were observed in the orbitofrontal cortex, insula, ventrolateral prefrontal cortex (VLPFC), and inferior parietal lobe. The two highest ICCs, based on a ROI's mean beta weight, were 0.55 (right insular cortex) and 0.47 (VLPFC). Spatial congruency (Sørensen-Dice index) of all voxels within each ROI between measurements was highest in the insular cortex (left 0.55, right 0.44). In addition, the mean beta weight of the right insula and right VLPFC demonstrated the lowest CV and narrowest Bland and Altman 95% limits of agreement. In conclusion, the right insula and right VLPFC were revealed as the two most reliable task-specific ROIs using our automated, MR-synchronized protocol. Achieving high reliability using a viscero-sensory/interoceptive task such as repetitive bladder filling remains challenging and further endeavour is highly warranted to better understand which factors influence fMRI outcomes and finally to assess LUT treatment effects on the supraspinal level.


Assuntos
Encéfalo/anatomia & histologia , Encéfalo/fisiologia , Bexiga Urinária/inervação , Adolescente , Adulto , Feminino , Humanos , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Adulto Jovem
20.
Nature ; 565(7739): 361-365, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-30602791

RESUMO

The fast-growing field of bioelectronic medicine aims to develop engineered systems that can relieve clinical conditions by stimulating the peripheral nervous system1-5. This type of technology relies largely on electrical stimulation to provide neuromodulation of organ function or pain. One example is sacral nerve stimulation to treat overactive bladder, urinary incontinence and interstitial cystitis (also known as bladder pain syndrome)4,6,7. Conventional, continuous stimulation protocols, however, can cause discomfort and pain, particularly when treating symptoms that can be intermittent (for example, sudden urinary urgency)8. Direct physical coupling of electrodes to the nerve can lead to injury and inflammation9-11. Furthermore, typical therapeutic stimulators target large nerve bundles that innervate multiple structures, resulting in a lack of organ specificity. Here we introduce a miniaturized bio-optoelectronic implant that avoids these limitations by using (1) an optical stimulation interface that exploits microscale inorganic light-emitting diodes to activate opsins; (2) a soft, high-precision biophysical sensor system that allows continuous measurements of organ function; and (3) a control module and data analytics approach that enables coordinated, closed-loop operation of the system to eliminate pathological behaviours as they occur in real-time. In the example reported here, a soft strain gauge yields real-time information on bladder function in a rat model. Data algorithms identify pathological behaviour, and automated, closed-loop optogenetic neuromodulation of bladder sensory afferents normalizes bladder function. This all-optical scheme for neuromodulation offers chronic stability and the potential to stimulate specific cell types.


Assuntos
Neurônios/fisiologia , Optogenética/instrumentação , Optogenética/métodos , Bexiga Urinária/inervação , Bexiga Urinária/fisiologia , Tecnologia sem Fio/instrumentação , Algoritmos , Animais , Células Cultivadas , Eletrônica , Feminino , Gânglios Espinais/citologia , Humanos , Neurônios/citologia , Ratos , Ratos Sprague-Dawley , Raízes Nervosas Espinhais/citologia
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