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1.
Urologiia ; (5): 132-135, 2019 Dec.
Artigo em Russo | MEDLINE | ID: mdl-31808648

RESUMO

Three basic theories of the development of an overactive bladder that have experimental and clinical evidences have been described, including neurogenic, myogenic, and urothelial. Based on the results of the literature analysis, the authors suggested the existence of detrusor ischemic disease as a result of compressive impairment of its blood flow due to incomplete or short-term relaxation under overactivity or hydraulic compression of the vessels by excessive urine volume in case of hypoactive bladder.


Assuntos
Isquemia/fisiopatologia , Doenças da Bexiga Urinária/etiologia , Doenças da Bexiga Urinária/terapia , Bexiga Urinária/irrigação sanguínea , Hemodinâmica , Humanos , Contração Muscular/fisiologia , Fluxo Sanguíneo Regional/fisiologia , Bexiga Urinária/fisiopatologia , Obstrução do Colo da Bexiga Urinária/complicações , Micção/fisiologia , Urodinâmica/fisiologia , Urotélio
2.
Can Assoc Radiol J ; 70(3): 254-263, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-30922786

RESUMO

PURPOSE: The aim of study is to assess the role of dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) and correlation with tumour angiogenesis in evaluation of urinary bladder cancer. MATERIAL AND METHODS: The study included 81 patients with recent presumed diagnosis of bladder tumour or who came for follow up after management of histopathologically proven bladder cancer. All had DCE-MRI with time-signal intensity curve. The radiologic results then correlated with the histopathologic results using both haematoxylin and eosin stain and immuno-histochemical staining for localization and evaluation of CD34 immunoreactivity as a detector for the microvessel density (MVD) and tumour angiogenesis. RESULTS: Seventy-one cases were pathologically proven to be malignant: 41 cases (58%) showed type III time-signal intensity curve (descending); 22 cases (31%) showed type II (plateau); and 8 cases (11%) showed type I (ascending) curve. The sensitivity of DCE-MRI in stage T1 bladder tumour was 80%; in stage T2, it was (90.9%); and in stage T3, it was (96.9%). Overall accuracy of DCE-MRI in tumour staging was 89.5% and P = .001 (significant). Values more than the cutoff value = 76.13 MVD are cystitis with sensitivity (90%), specificity (91%), and P value is .001, which is statistically highly significant. CONCLUSION: There is a strong positive association between DCE-MRI (staging and washout slope of the time-signal intensity curve) with histopathologic grade, tumour stage, and MVD in bladder cancer. So, DCE-MRI can be used as reliable technique in preoperative predictions of tumour behavior and affect the planning of antiangiogenetic therapy.


Assuntos
Meios de Contraste , Aumento da Imagem/métodos , Imagem por Ressonância Magnética/métodos , Neovascularização Patológica/diagnóstico por imagem , Neoplasias da Bexiga Urinária/diagnóstico por imagem , Neoplasias da Bexiga Urinária/patologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Neovascularização Patológica/patologia , Sensibilidade e Especificidade , Bexiga Urinária/irrigação sanguínea , Bexiga Urinária/diagnóstico por imagem , Bexiga Urinária/patologia , Adulto Jovem
3.
J Urol ; 202(2): 290-300, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-30865573

RESUMO

PURPOSE: We systematically characterized gene expression, inflammation and neovascularization in patients with interstitial cystitis/bladder pain syndrome to obtain biological evidence supporting diagnosis and classification. MATERIALS AND METHODS: We sequenced RNA obtained from bladder mucosal biopsies of 33 patients with 3 subtypes of interstitial cystitis/bladder pain syndrome, including Hunner lesions in 12, no Hunner lesions in 11 but with glomerulations and neither Hunner lesions nor glomerulations in 10, and 9 controls. Differentially expressed genes of each subtype were searched to identify subtype specific biological pathways and candidate genes important for pathogenesis. Candidate genes were validated by quantitative polymerase chain reaction and immunohistochemistry. Digital immunohistochemical quantification was performed to assess subepithelial lymphoplasmacytic cell and microvessel density. Relationships between candidate gene over expression and symptom severity were explored. RESULTS: Patients with Hunner lesions showed a distinct gene expression profile associated with significant up-regulation of biological processes involving immune responses and infection, and an increase in subepithelial lymphoplasmacytic cell and microvessel density. Over expression of 2 candidate genes, VEGF and BAFF, correlated with symptom severity. Meanwhile, the gene expression profiles of patients with the 2 subtypes without Hunner lesions were similar to those of controls. No difference in biological pathways or subepithelial lymphoplasmacytic cell and microvessel density were detected between these 2 subtypes and controls. CONCLUSIONS: Interstitial cystitis/bladder pain syndrome with Hunner lesions shows distinct genomic and histological features associated with immune responses and infection. In addition, VEGF and BAFF are potential disease biomarkers and therapeutic targets. This subtype should be considered separate from the syndrome.


Assuntos
Cistite Intersticial/classificação , Cistite Intersticial/genética , Perfilação da Expressão Gênica , Adulto , Idoso , Idoso de 80 Anos ou mais , Biópsia , Cistite Intersticial/patologia , Feminino , Expressão Gênica , Humanos , Masculino , Pessoa de Meia-Idade , Membrana Mucosa , Neovascularização Patológica , Análise de Sequência de RNA , Bexiga Urinária/irrigação sanguínea
4.
Neurourol Urodyn ; 38(4): 1135-1141, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30843277

RESUMO

AIM: Bladder pain syndrome (BPS) is a complex disease which causes cognitive, behavioral, sexual, and emotional problems. Vascular factors related to bladder blood supply may be one of the etiologic cause of BPS. This study aims to investigate the bladder blood flow and internal iliac artery resistive indices of patients with BPS. METHODS: A total of 30 female patients with the diagnosis of BPS and 30 female as control group were enrolled in the study. Bilateral internal iliac arterial blood flow distal to uterine arteries were examined as the primary source of vesical arterial blood supply. Peak systolic velocities, end diastolic velocities, resistive indices, and flow volumes of internal iliac arteries were measured by color Doppler ultrasonography in a single-blind fashion. RESULTS: The blood flows volume of the right and left internal iliac arteries during empty and full bladder were significantly lower at BPS group compared with control (P < 0.05). Although the difference was not significant, the mean resistive index of right and left internal iliac arteries were lower at the control group ( P > 0.05). Aging decreased the bladder blood volume and both BPS and control group internal iliac artery blood volume decreased by aging. The decrease was more significant at the control group, but the internal iliac artery blood volume was still lower at patients with BPS compared with the control group. CONCLUSION: Arterial blood flow of bladder was lower at patients with BPS compared with the control group. The decrease in the vascular supply of bladder might be one of the related factors for the BPS etiology.


Assuntos
Cistite Intersticial/etiologia , Bexiga Urinária/irrigação sanguínea , Adulto , Velocidade do Fluxo Sanguíneo/fisiologia , Cistite Intersticial/diagnóstico por imagem , Feminino , Humanos , Artéria Ilíaca/diagnóstico por imagem , Pessoa de Meia-Idade , Método Simples-Cego , Ultrassonografia Doppler em Cores , Bexiga Urinária/diagnóstico por imagem
5.
World J Urol ; 37(10): 2175-2182, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-30560299

RESUMO

PURPOSE: To evaluate the efficacy and outcome of superselective vesical arterial embolization in the management of severe intractable hematuria secondary to hemorrhagic cystitis. MATERIALS AND METHODS: We retrospectively reviewed the medical records of nine patients with severe intractable hematuria treated with superselective vesical artery embolization at our institution between March 2003 and February 2015. There were six males and three females with a mean age of 56.1 years. Seven patients had transitional cell carcinoma (TCC) of urinary bladder and had undergone transurethral resection of bladder tumor and pelvic radiotherapy. One patient had synchronous renal pelvis and bladder TCC. One patient had aortoarteritis and was receiving cyclophosphamide therapy and another patient had carcinoma cervix post-pelvic radiotherapy. Following the failure of conservative management, superselective vesical artery catheterization and embolization was performed with 300-500-µ PVA particles in all patients. Coil embolization of inferior gluteal artery followed by particle embolization of vesical arteries was done in one patient in whom superior, inferior vesical and inferior gluteal arteries were arising as a trifurcation. RESULTS: The technical success rate was 100% with complete cessation of hematuria within 48 h in all patients. No significant complications were noted, except for post-embolization syndrome in one patient, which improved on symptomatic treatment. During a mean follow-up period of 14.45 months (ranging from 3-28 months), one patient had mild recurrent hematuria (at 2 months) which resolved spontaneously. CONCLUSIONS: Superselective vesical artery embolization is a safe and effective procedure in controlling intractable life-threatening hematuria in a select group of patients who have failed conventional treatment protocols. This procedure may be considered as the treatment of choice since it usually obviates the need for emergency surgery in these severely ill patients.


Assuntos
Cistite/complicações , Embolização Terapêutica/métodos , Hematúria/etiologia , Hematúria/terapia , Hemorragia/complicações , Artérias , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Bexiga Urinária/irrigação sanguínea
6.
Neurourol Urodyn ; 37(8): 2827-2832, 2018 11.
Artigo em Inglês | MEDLINE | ID: mdl-30106191

RESUMO

AIM: The mechanisms leading to the development of detrusor overactivity (DO) are still relatively poorly understood, however, animal studies suggest that atherosclerosis and reduced blood flow to the bladder may be one etiological pathway. Thus, the aim of this study was to evaluate signs of atherosclerosis in a large cohort of women with detrusor overactivity, using two precise measures of atherosclerotic vascular impairment, Ankle Brachial Index (ABI), and Brachial-ankle Pulse Wave Velocity (baPWV). METHODS: A prospective cohort study measuring ABI and baPWV of women with DO and controls was conducted. The ABI and baPWV were measured using an automated oscillometric blood pressure machine, to evaluate the degree of atherosclerosis in patients with DO and controls. Associations between ABI and baPWV and important confounding variables were assessed by a linear regression model. RESULTS: Ninety-eight women with DO, and 98 controls without any symptoms of DO were studied. Multivariate analysis showed an increase in left baPWV of approximately 96 cm/s units of velocity (95%CI 20.65-172.05, P = 0.01) is predicted significantly by the presence or absence of detrusor overactivity (as well by independent factors of age, diastolic blood pressure and body mass index). A similar effect was seen for right baPWV. CONCLUSIONS: On linear regression modeling, the presence of DO was a strong predictor for an increased PWV when controlling for age, BMI and diastolic blood pressure (DBP), thus supporting the hypothesis that atherosclerosis may contribute to the etiology of DO.


Assuntos
Aterosclerose/diagnóstico , Velocidade do Fluxo Sanguíneo/fisiologia , Pressão Sanguínea/fisiologia , Bexiga Urinária Hiperativa/complicações , Bexiga Urinária/irrigação sanguínea , Idoso , Idoso de 80 Anos ou mais , Índice Tornozelo-Braço , Aterosclerose/complicações , Aterosclerose/fisiopatologia , Índice de Massa Corporal , Feminino , Humanos , Pessoa de Meia-Idade , Estudos Prospectivos , Análise de Onda de Pulso , Bexiga Urinária/fisiopatologia , Bexiga Urinária Hiperativa/fisiopatologia
7.
J Physiol ; 596(16): 3531-3552, 2018 08.
Artigo em Inglês | MEDLINE | ID: mdl-29873405

RESUMO

KEY POINTS: In the bladder suburothelial microvasculature, pericytes in different microvascular segments develop spontaneous Ca2+ transients with or without associated constrictions. Spontaneous Ca2+ transients in pericytes of all microvascular segments primarily rely on the cycles of Ca2+ uptake and release by the sarco- and endoplasmic reticulum. The synchrony of spontaneous Ca2+ transients in capillary pericytes exclusively relies on the spread of depolarizations resulting from the opening of Ca2+ -activated chloride channels (CaCCs) via gap junctions. CaCC-dependent depolarizations further activate L-type voltage-dependent Ca2+ channels as required for the synchrony of Ca2+ transients in pericytes of pre-capillary arterioles, post-capillary venules and venules. Capillary pericytes may drive spontaneous Ca2+ transients in pericytes within the suburothelial microvascular network by sending CaCC-dependent depolarizations via gap junctions. ABSTRACT: Mural cells in the microvasculature of visceral organs develop spontaneous Ca2+ transients. However, the mechanisms underlying the integration of these Ca2+ transients within a microvascular unit remain to be clarified. In the present study, the origin of spontaneous Ca2+ transients and their propagation in the bladder suburothelial microvasculature were explored. Cal-520 fluorescence Ca2+ imaging and immunohistochemistry were carried out on mural cells using mice expressing red fluorescent protein (DsRed) under control of the NG2 promotor. NG2(+) pericytes in both pre-capillary arterioles (PCAs) and capillaries developed synchronous spontaneous Ca2+ transients. By contrast, although NG2-DsRed also labelled arteriolar smooth muscle cells, these cells remained quiescent. Both NG2(+) pericytes in post-capillary venules (PCVs) and NG2(-) venular pericytes exhibited propagated Ca2+ transients. L-type voltage-dependent Ca2+ channel (LVDCC) blockade with nifedipine prevented Ca2+ transients or disrupted their synchrony in PCA, PCV and venular pericytes without dis-synchronizing Ca2+ transients in capillary pericytes. Blockade of gap junctions with carbenoxolone or Ca2+ -activated chloride channels (CaCCs) with 4,4'-diisothiocyanato-2,2'-stilbenedisulphonic acid disodium salt prevented Ca2+ transients in PCA and venular pericytes and disrupted the synchrony of Ca2+ transients in capillary and PCV pericytes. Spontaneous Ca2+ transients in pericytes of all microvascular segments were abolished or suppressed by cyclopiazonic acid, caffeine or tetracaine. The synchrony of Ca2+ transients in capillary pericytes arising from spontaneous Ca2+ release from the sarco- and endoplasmic reticulum appears to rely exclusively on CaCC activation, whereas subsequent LVDCC activation is required for the synchrony of Ca2+ transients in pericytes of other microvascular segments. Capillary pericytes may drive spontaneous activity in the suburothelial microvascular unit to facilitate capillary perfusion.


Assuntos
Sinalização do Cálcio , Cálcio/metabolismo , Capilares/fisiologia , Canais de Cloreto/metabolismo , Microvasos/fisiologia , Pericitos/fisiologia , Bexiga Urinária/fisiologia , Animais , Feminino , Junções Comunicantes , Masculino , Camundongos , Bexiga Urinária/irrigação sanguínea , Veias/fisiologia
8.
J Pediatr Urol ; 14(5): 455-456, 2018 10.
Artigo em Inglês | MEDLINE | ID: mdl-29784454

RESUMO

Stomal prolapse is a known late complication of urinary diversions commonly used in urology. While rare, it can lead to ischemia, necrosis, and obstruction of the stoma, requiring urgent reduction before formal revision can be undertaken. Several measures can be attempted to reduce the prolapse including manual pressure and topical osmotic agents. One method that has not been reported in the urologic literature is the use of hyaluronidase. Herein, we report the first case in the literature of hyaluronidase usage to assist in reduction of an ischemic and obstructed prolapsed incontinent ileovesicostomy after manual compression failed.


Assuntos
Cistostomia , Hialuronoglucosaminidase/uso terapêutico , Ileostomia , Isquemia/prevenção & controle , Complicações Pós-Operatórias/prevenção & controle , Doenças da Bexiga Urinária/prevenção & controle , Bexiga Urinária/irrigação sanguínea , Incontinência Urinária/prevenção & controle , Pré-Escolar , Feminino , Humanos , Prolapso
9.
Neurourol Urodyn ; 37(8): 2425-2433, 2018 11.
Artigo em Inglês | MEDLINE | ID: mdl-29777585

RESUMO

AIMS: Chronic ischemia is a recognized factor in the pathophysiology of underactive bladder (UAB). Although relative ischemia (ie, low blood flow) is known to occur during filling, little is known regarding the pathophysiology that leads to UAB. Therefore, we developed an ex vivo functional porcine model to investigate the role of transient ischemia and whether autoregulation, a mechanism that maintains tissue oxygenation in certain vital organs, also exists in the bladder. METHODS: Using bladders from slaughtered pigs, we prepared an isolated perfused model where we studied the effects of bladder perfusion flow rate on perfusion pressure and tissue oxygenation during the filling phase. Bladders were perfused at an initial flow rate of 20 mL/min and then clamped in a sequentially decreasing stepwise manner down to no flow and back to the initial flow rate. RESULTS: We found a linear relationship between flow rate and perfusion pressure until the flow rate decreased below 5 mL/min at which point the vascular resistance decreased; however, tissue pO2 remained stable after an initial decline. CONCLUSIONS: These findings suggest that there may be an intrinsic autoregulatory mechanism in the bladder that allows it to undergo cyclic episodes of relative ischemia during its normal function. Factors that overcome this mechanism such as complete or chronic ischemia may be critical in the progression to detrusor underactivity and thereby highlight the importance of intervention during the early phases of this disease process.


Assuntos
Vasos Sanguíneos/fisiologia , Bexiga Urinária/irrigação sanguínea , Bexiga Urinária/fisiologia , Animais , Pressão Sanguínea/fisiologia , Modelos Animais de Doenças , Feminino , Homeostase , Técnicas In Vitro , Isquemia/fisiopatologia , Modelos Biológicos , Consumo de Oxigênio/fisiologia , Perfusão , Pressão , Suínos , Bexiga Inativa/fisiopatologia , Resistência Vascular/fisiologia
10.
Urology ; 115: e7-e8, 2018 May.
Artigo em Inglês | MEDLINE | ID: mdl-29548866

RESUMO

Portosystemic collaterals are common sequelae of portal hypertension. These often present as gastroesophageal varices. Ectopic varices can rarely be seen in duodenum, jejunum, rectum, and sites of surgical anastomoses. Bladder varices are extremely rare presenting with recurrent hematuria, with only a few reported cases. We report here a management of an unusual case of hematuria managed with blood transfusion, intravenous terlipressin, and endoscopic N-butyl cyanoacrylate glue injection.


Assuntos
Embolização Terapêutica/métodos , Hematúria/etiologia , Hipertensão Portal/complicações , Bexiga Urinária/irrigação sanguínea , Varizes/etiologia , Varizes/terapia , Anti-Hipertensivos/uso terapêutico , Transfusão de Sangue , Embucrilato/uso terapêutico , Hematúria/terapia , Humanos , Hipertensão Portal/tratamento farmacológico , Cirrose Hepática Alcoólica/complicações , Masculino , Pessoa de Meia-Idade , Terlipressina/uso terapêutico , Adesivos Teciduais/uso terapêutico
12.
Neurourol Urodyn ; 37(1): 123-131, 2018 01.
Artigo em Inglês | MEDLINE | ID: mdl-28605059

RESUMO

AIMS: This study investigated the protective effect of human amniotic fluid-derived stem cells (hAFSCs) against bladder overactivity in rat model of atherosclerosis-induced chronic bladder ischemia. METHODS: Adult female Sprague-Dawley rats were divided into six groups: (1) Normal control with a regular diet for 8 weeks, (2) Sham-operation, (3) arterial balloon endothelial injury (AEI) of common iliac artery (AEI only), and post-AEI consecutive hAFSCs treatment for (4) 1 day, (5) 3 days, and (6) 7 days. Groups 2-6 were given 2% cholesterol diet for 8 weeks after operation (sham or AEI). Bladder functions were analyzed by cystometry at 8 weeks in controls and after operation in groups 2-6. Wall morphology of common iliac artery was examined by hematoxylin and eosin stain. Bladder oxidative stress and inflammatory markers were studied by immunohistochemistry of 8-hydroxy-2'-deoxyguanosine (8OHdG), malondialdehyde (MDA), and tumor necrosis factor-alpha (TNF-alpha). RESULTS: Bladder overactivity with decreased voided volumes and intercontraction intervals and increased residual volumes was seen in AEI only group, but improved after hAFSCs treatment for 1, 3, and 7 days. Compared with controls and shams, the wall thickness of iliac artery was increased in AEI only group, but improved after hAFSCs treatment for 3 and 7 days. The expressions of 8OHdG, MDA, and TNF-alpha were increased in AEI only group, but improved after hAFSCs treatment for 1, 3, and 7 days. CONCLUSIONS: Bladder overactivity caused by chronic bladder ischemia can be improved by hAFSCs treatment, probably by acting through down-regulation of oxidative stress and TNF-alpha expressions.


Assuntos
Líquido Amniótico/citologia , Isquemia/terapia , Células-Tronco/citologia , Bexiga Urinária Hiperativa/terapia , Bexiga Urinária/fisiopatologia , Animais , Desoxiguanosina/análogos & derivados , Modelos Animais de Doenças , Feminino , Isquemia/fisiopatologia , Malondialdeído/metabolismo , Estresse Oxidativo/fisiologia , Ratos , Ratos Sprague-Dawley , Resultado do Tratamento , Bexiga Urinária/irrigação sanguínea , Bexiga Urinária Hiperativa/fisiopatologia
13.
Urology ; 111: 238.e7-238.e12, 2018 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-29051005

RESUMO

OBJECTIVE: To investigate the effect of fasudil, a Rho-kinase inhibitor, on chronic ischemia-related bladder dysfunction. MATERIALS AND METHODS: Male Sprague-Dawley rats (16 weeks old) were divided into control, chronic bladder ischemia (CBI), and CBI with fasudil treatment (CBI-Fa) groups. The CBI and CBI-Fa groups underwent balloon endothelial injury of bilateral iliac arteries and received a 2% cholesterol diet for 8 weeks after the procedure to induce CBI. The CBI-Fa group was given oral fasudil (30 mg/kg/day) using zonde for 8 weeks after the procedure. The control group received a regular diet for 8 weeks. After cystometry in a conscious state, rats from each group were euthanized, and the bladders and common iliac arteries were harvested for pharmacologic and histologic examination. RESULTS: Mean wall thickness of the common iliac arteries was significantly greater in the CBI group than in controls. Contractile responses of muscle strips were significantly lower in CBI group rats than in controls. In the CBI group, micturition interval was significantly shorter, and bladder capacity was significantly lower compared with those in controls. In the CBI-Fa group, arterial wall thickening was significantly suppressed compared with the CBI group. Significant improvements in muscle strip contractility and cystometric parameters were seen in the CBI-Fa group compared with the CBI group. CONCLUSION: Our results suggest that chronic treatment with fasudil could prevent neointimal formation in arteries and bladder dysfunction in this rat model. Fasudil may be therapeutically useful in protecting bladder function in chronically ischemic bladders.


Assuntos
1-(5-Isoquinolinasulfonil)-2-Metilpiperazina/análogos & derivados , Isquemia/complicações , Inibidores de Proteínas Quinases/uso terapêutico , Doenças da Bexiga Urinária/etiologia , Doenças da Bexiga Urinária/prevenção & controle , Bexiga Urinária/irrigação sanguínea , Quinases Associadas a rho/antagonistas & inibidores , 1-(5-Isoquinolinasulfonil)-2-Metilpiperazina/uso terapêutico , Animais , Doença Crônica , Modelos Animais de Doenças , Masculino , Ratos , Ratos Sprague-Dawley
14.
Acta Radiol ; 59(8): 932-938, 2018 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-29065701

RESUMO

Background Identification of the source of postpartum hemorrhage (PPH) is important for embolization because PPH frequently originates from non-uterine arteries. Purpose To evaluate the clinical importance of identifying the non-uterine arteries causing the PPH and the results of their selective embolization. Material and Methods This retrospective study enrolled 59 patients who underwent embolization for PPH from June 2009 to July 2016. Angiographic findings and medical records were reviewed to determine whether non-uterine arteries contributed to PPH. Arteries showing extravasation or hypertrophy accompanying uterine hypervascular staining were regarded as sources of the PPH. The results of their embolization were analyzed. Results Of 59 patients, 19 (32.2%) underwent embolization of non-uterine arteries. These arteries were ovarian (n = 7), vaginal (n = 5), round ligament (n = 5), inferior epigastric (n = 3), cervical (n = 2), internal pudendal (n = 2), vesical (n = 1), and rectal (n = 1) arteries. The embolic materials used included n-butyl cyanoacrylate (n = 9), gelatin sponge particles (n = 8), gelatin sponge particles with microcoils (n = 1), and polyvinyl alcohol particles (n = 1). In 13 patients, bilateral uterine arterial embolization was performed. Re-embolization was performed in two patients with persistent bleeding. Hemostasis was achieved in 17 (89.5%) patients. Two patients underwent immediate hysterectomy due to persistent bleeding. One patient experienced a major complication due to pelvic organ ischemia. One patient underwent delayed hysterectomy for uterine infarction four months later. Conclusion Non-uterine arteries are major sources of PPH. Detection and selective embolization are important for successful hemostasis.


Assuntos
Embolização Terapêutica/métodos , Hemorragia Pós-Parto/terapia , Adulto , Angiografia , Artérias Epigástricas/diagnóstico por imagem , Artérias Epigástricas/fisiopatologia , Feminino , Genitália Feminina/irrigação sanguínea , Genitália Feminina/diagnóstico por imagem , Genitália Feminina/fisiopatologia , Humanos , Hemorragia Pós-Parto/diagnóstico por imagem , Nervo Pudendo/irrigação sanguínea , Nervo Pudendo/diagnóstico por imagem , Nervo Pudendo/fisiopatologia , Reto/irrigação sanguínea , Reto/diagnóstico por imagem , Reto/fisiopatologia , Estudos Retrospectivos , Resultado do Tratamento , Bexiga Urinária/irrigação sanguínea , Bexiga Urinária/diagnóstico por imagem , Bexiga Urinária/fisiopatologia , Adulto Jovem
15.
Neurourol Urodyn ; 37(2): 690-698, 2018 02.
Artigo em Inglês | MEDLINE | ID: mdl-28762564

RESUMO

AIMS: This study was initiated to investigate the involvement of neutrophil leukocyte activation in neurogenic inflammation, a process also involved in human urinary pathologies, elicited in the rat urinary bladder by the local administration of capsaicin, the archetypal TRPV1 agonist. The contribution of afferent nerves and sensory neuropeptides to leukocyte activation in the urinary bladder microcirculatory bed was examined. METHODS: Following a 15-min topical application of capsaicin (50 µM), leukocyte-endothelial interactions were examined for an observation period of 45 min with intravital microscopy. Expression of adhesion molecules E-selectin and ICAM-1 implicated in these interactions was assessed by immunohistochemistry. Selective sensory denervation was performed by neonatal treatment with capsaicin. The role of the TRPV1 receptor and two sensory neuropeptides (CGRP and substance P [SP]) were studied using the selective antagonists capsazepine, CGRP8-37 and RP67580, respectively. RESULTS: Capsaicin induced rapid increases in leukocyte rolling and adhesion and increased the expression of E-selectin and ICAM-1 in the postcapillary venules. Sensory chemodenervation via capsaicin and also TRPV1 receptor antagonism effectively prevented these changes. A similar reduction was observed in leukocyte adhesion after topical application of CGRP8-34 or RP67580, but only CGRP8-34 reduced the capsaicin-evoked leukocyte rolling. CONCLUSIONS: Topical application of capsaicin induces early neurogenically mediated cellular microcirculatory inflammatory reactions via the activation of the TRPV1 receptor and the release of CGRP and SP from sensory nerves in the bladder. Co-administration of SP and CGRP receptor antagonists may ameliorate microcirculatory inflammatory changes elicited by capsaicin in the urinary bladder.


Assuntos
Capsaicina/farmacologia , Microcirculação/efeitos dos fármacos , Neutrófilos/efeitos dos fármacos , Bexiga Urinária/efeitos dos fármacos , Animais , Peptídeo Relacionado com Gene de Calcitonina/farmacologia , Capsaicina/análogos & derivados , Masculino , Neurônios Aferentes/efeitos dos fármacos , Ratos , Ratos Sprague-Dawley , Substância P/farmacologia , Bexiga Urinária/irrigação sanguínea
16.
Neurourol Urodyn ; 37(2): 666-672, 2018 02.
Artigo em Inglês | MEDLINE | ID: mdl-28782191

RESUMO

AIMS: To investigate the effect of tadalafil on bladder blood flow and lower urinary tract function in a rat model of diabetes. MATERIALS AND METHODS: We studied female Sprague-Dawley rats and induced diabetes in some using a single intraperitoneal injection of streptozotocin. We divided the rats into nondiabetes (ND), diabetes (D), and diabetes with tadalafil (DT) groups. The rats were raised for an additional 7 weeks after diabetes induction. The DT group received oral tadalafil (2 mg/kg/day) for 7 days before the experiments. At 7 weeks after diabetes induction, we performed cystometry, resected the bladders for immunohistochemistry (hypoxia-inducible factor-1α [HIF-1α] and 8-oxo-2'-deoxyguanosine [8-OHdG] staining), and measured bladder blood supply using a laser blood flow meter. RESULTS: The opening pressure, when the urethra opens and urine flow starts, was significantly lower in the DT group than in the D group (24.9 ± 5.9 vs 43.6 ± 12.3 cmH2 O). The inter-contraction interval was significantly longer in the D group than in the ND and DT groups (1566.2 ± 168.7 vs 702.9 ± 165.2 and 787.4 ± 148.8 s). Immunohistochemistry showed positive staining of the urothelial layer for both HIF-1α and 8-OHdG in the D group, but not in the ND or DT groups. Bladder blood flow was significantly lower in the D group than in the ND or DT groups. CONCLUSIONS: Tadalafil improves bladder blood supply and lower urinary tract function in diabetic rats. Tadalafil may be a promising drug that restores lower urinary tract dysfunction in the early phase of diabetes.


Assuntos
Diabetes Mellitus Experimental/fisiopatologia , Sintomas do Trato Urinário Inferior/tratamento farmacológico , Inibidores da Fosfodiesterase 5/farmacologia , Tadalafila/farmacologia , Uretra/efeitos dos fármacos , Bexiga Urinária/efeitos dos fármacos , Animais , Feminino , Sintomas do Trato Urinário Inferior/fisiopatologia , Inibidores da Fosfodiesterase 5/uso terapêutico , Ratos , Ratos Sprague-Dawley , Tadalafila/uso terapêutico , Uretra/fisiopatologia , Bexiga Urinária/irrigação sanguínea , Bexiga Urinária/fisiopatologia
17.
BMC Urol ; 17(1): 64, 2017 Aug 23.
Artigo em Inglês | MEDLINE | ID: mdl-28835278

RESUMO

BACKGROUND: Patients with diabetes experience lower urinary tract symptoms. Cystopathy may evolve into underactive bladder (UAB), depending on the degree and duration of the symptoms. In the present study, we aimed to investigate the effects of silodosin, an alpha1A-adrenoceptor (AR) antagonist, on UAB in a rat model of diabetes mellitus (DM). METHODS: Female Sprague-Dawley rats (6 weeks old) were administered streptozotocin (STZ) (50 mg/kg, i.v.) to establish a DM model. One week after STZ administration, vehicle or silodosin (0.3 or 1 mg/kg/day) was delivered subcutaneously through an osmotic pump. Nine weeks after STZ administration (8 weeks after drug treatment), a catheter was implanted into the bladder under urethane anesthesia. After the measurement of emptied bladder blood flow (BBF), saline was continuously infused into the bladder and intravesical pressure and micturition volume were measured. In another experiment, the bladder was isolated and nerve markers were quantified. RESULTS: A cystometrogram showed that bladder capacity (BC), residual volume (RV), and bladder extension (BC/bladder weight) increased by 7.43, 10.47, and 3.59 times, respectively, in vehicle rats in comparison with normal rats. These findings suggested the occurrence of UAB-like symptoms in this model. Silodosin (1 mg/kg/day) inhibited the increase in BC and RV by 49.0% and 46.8%, respectively, and caused a decrease in BBF of approximately 25.5% (when the difference between normal and vehicle was set as 100%) in STZ rats. The nerve marker expression levels tended to be decreased in the bladders of STZ rats and these effects were ameliorated by silodosin. CONCLUSIONS: The STZ rats showed increased bladder extension and RV, symptoms that were suggestive of UAB, and these symptoms were ameliorated by silodosin. These results suggested that the alpha1A-AR antagonist would be useful for the prevention or treatment of UAB.


Assuntos
Complicações do Diabetes/tratamento farmacológico , Indóis/uso terapêutico , Doenças da Bexiga Urinária/tratamento farmacológico , Bexiga Urinária/irrigação sanguínea , Antagonistas de Receptores Adrenérgicos alfa 1/uso terapêutico , Animais , Diabetes Mellitus Experimental , Feminino , Ratos , Ratos Sprague-Dawley , Fluxo Sanguíneo Regional
18.
Am J Physiol Renal Physiol ; 313(5): F1077-F1083, 2017 Nov 01.
Artigo em Inglês | MEDLINE | ID: mdl-28794066

RESUMO

Urinary tract infection (UTI) is a broad term referring to an infection of the kidneys, ureters, bladder, and/or urethra. Because of its prevalence, frequent recurrence, and rising resistance to antibiotics, UTI has become a challenge in clinical practice. Autosomal-dominant polycystic kidney disease (ADPKD) is the most common monogenic disorder of the kidney and is characterized by the growth of fluid-filled cysts in both kidneys. Progressive cystic enlargement, inflammation, and interstitial fibrosis result in nephron loss with subsequent decline in kidney function. ADPKD patients frequently develop UTI; however, the cellular and molecular mechanisms responsible for the high UTI incidence in ADPKD patients remain virtually unaddressed. Emerging evidence suggests that α-intercalated cells (α-ICs) of the collecting ducts function in the innate immune defense against UTI. α-ICs inhibit bacterial growth by acidifying urine and secreting neutrophil gelatinase-associated lipocalin (NGAL) that chelates siderophore-containing iron. It is necessary to determine, therefore, if ADPKD patients with recurrent UTI have a reduced number and/or impaired function of α-ICs. Identification of the underlying cellular and molecular mechanisms may lead to the development of novel strategies to reduce UTI in ADPKD.


Assuntos
Inflamação/metabolismo , Lipocalinas/metabolismo , Rim Policístico Autossômico Dominante/metabolismo , Bexiga Urinária/metabolismo , Infecções Urinárias/metabolismo , Animais , Humanos , Inflamação/complicações , Ferro/metabolismo , Bexiga Urinária/irrigação sanguínea , Infecções Urinárias/prevenção & controle , Infecções Urinárias/terapia
19.
Urologiia ; (2): 42-47, 2017 Jun.
Artigo em Russo | MEDLINE | ID: mdl-28631905

RESUMO

AIM: To investigate the nature of morphological alterations in the urinary bladder wall in BPH patients receiving pharmacotherapy to establish treatment time limits. MATERIALS AND METHODS: The study comprised 120 BPH patients who underwent a transvesical adenomectomy. Prior to the surgery, 110 patients received pharmacotherapy (-blockers and 5-reductase inhibitors) lasting from 1-6 months to 5-10 years. Preoperative evaluation included a standard diagnostic algorithm. During the surgery, the urinary bladder wall specimens were taken for morphological examination. Histologic specimens were stained with hematoxylin-eosin and according to van Giesonn, and underwent immunohistochemical examination using desmin, vimentin, CD31, type IV collagen and pancitokeratin monoclonal antibodies. In patients who did not take medications or used them for less than 6 months, the bladder preserved the normal histological structure. Pharmacotherapy lasting 1 to 5 years resulted in microcirculatory alterations characterized by extensive hemorrhages, damage to the endothelium and vessel basal membranes, hypertrophy of the bladder muscle membrane. In patients taking the medications for 6 to 10 years, microcirculatory alterations resulted in the vascular wall sclerosis and thickening, narrowing of the vessel lumen, hypoplasia of the transitional epithelium and muscle layer atrophy. RESULTS: The study findings suggest that prolonged (over 1 year) pharmacotherapy can adversely affect the urinary bladder wall and worsen the results of radical adenomectomy.


Assuntos
Hiperplasia Prostática/tratamento farmacológico , Hiperplasia Prostática/patologia , Bexiga Urinária/patologia , Inibidores de 5-alfa Redutase/uso terapêutico , Antagonistas Adrenérgicos alfa/uso terapêutico , Idoso , Idoso de 80 Anos ou mais , Humanos , Masculino , Microcirculação , Prostatectomia , Hiperplasia Prostática/cirurgia , Fatores de Tempo , Bexiga Urinária/irrigação sanguínea
20.
J Ultrasound Med ; 36(11): 2287-2297, 2017 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-28556470

RESUMO

OBJECTIVES: Time-intensity curves (TICs) of contrast-enhanced ultrasound (CEUS) were analyzed retrospectively to differentiate between low-grade and high-grade bladder urothelial carcinoma, and to investigate correlation with tumor microvessel density (MVD). METHODS: The data of 105 patients with pathologically confirmed bladder urothelial carcinoma (55 low-grade and 50 high-grade) were reviewed. Lesions were examined before surgery using conventional ultrasound and CEUS with TIC analysis. The TIC parameters time from peak to one-half the signal intensity (TPH) and the corresponding descending slope (DS) of the low-grade and high-grade groups were compared, and receiver operating characteristic curves constructed. The MVDs of the resectioned tissue specimens were quantified via immunohistochemistry for CD34. RESULTS: Based on conventional ultrasound, the low-grade and high-grade groups were similar in tumor shape, number, topography, internal echo, height, width, and vascularity. The TPH of the high-grade group was significantly longer than that of the low-grade group, and the DS was lower. The cutoff points of TPH and DS for differentiating low-grade and high-grade bladder urothelial carcinoma were 48.06 seconds and 0.15 dB/seconds, respectively (area under the receiver operating characteristic curve = 0.79 for both). The mean MVDs per high-power field of the low-grade and high-grade groups were 41.39 16.65 and 51.03 20.16, respectively (P = .009). The TPH correlated linearly with MVD (P < .01), as did the DS (P < .01). CONCLUSIONS: Contrast-enhanced ultrasound can be used to differentiate low from high-grade bladder urothelial carcinoma. The TIC parameters of CEUS reflect the MVD of bladder urothelial tumors and may be helpful for evaluating tumor angiogenesis, with implications for clinical diagnosis, treatment, and prognosis.


Assuntos
Meios de Contraste , Aumento da Imagem/métodos , Microvasos/diagnóstico por imagem , Ultrassonografia/métodos , Neoplasias da Bexiga Urinária/irrigação sanguínea , Neoplasias da Bexiga Urinária/diagnóstico por imagem , Adulto , Idoso , Idoso de 80 Anos ou mais , Diagnóstico Diferencial , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Gradação de Tumores , Estudos Retrospectivos , Bexiga Urinária/irrigação sanguínea , Bexiga Urinária/diagnóstico por imagem , Bexiga Urinária/patologia , Neoplasias da Bexiga Urinária/patologia
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