Effects of Bladder Function by Early Tamsulosin Treatment in a Spinal Cord Injury Rat Model

OBJECTIVE: To investigate the effects of early tamsulosin treatment on changes in bladder characteristics after a spinal cord injury. METHODS: We divided 45 rats into three groups: the control (CON) group, the spinal cord injury (SCI) group, and the SCI+tamsulosin treatment (SCI+TAM) group. Spinal cord transection was performed in the SCI and SCI+TAM groups. Tamsulosin was injected for 7 days in the SCI+TAM group. Intravesical and intra-abdominal catheters were implanted before cord injury. Basal pressure (BP), maximal vesical pressure (MVP), micturition volume (MV), and voiding interval time (VIT) were measured at 7 days after SCI. The bladder was then removed and used for an in vitro organ bath study and Western blot analysis. The percentage changes in contractility from baseline after acetylcholine alone, pretreatment with a muscarinic 2 (M2) receptor blocker (AQ-RA741), and pretreatment with a M3 receptor blocker (4-DAMP) were compared among the groups. Western blot analyses were performed to determine expression levels of pERK1/2 and rho-kinase. RESULTS: In cystometry, MVP, BP, MV, and VIT showed changes in the SCI and SCI+TAM groups versus the CON group (p<0.05). In the organ bath study, acetylcholine-induced contractility in the three groups differed significantly (p<0.05). Additionally, acetylcholine-induced contractility with 4-DAMP pretreatment was reduced significantly in the SCI+TAM group versus the SCI group. In Western blotting, pERK1/2 expression was stronger (p<0.05) and rho-kinase expression was weaker in the SCI+TAM group than the SCI group (p<0.05). CONCLUSION: These results suggest that the bladder contraction due to acetylcholine after SCI can be decreased by tamsulosin in the acute stage and this involves changes in pERK1/2 and rho-kinase.

Long-term Results of the Gittes Procedure for Treatment of Stress Urinary Incontinence / 대한비뇨기과학회지

PURPOSE: We evaluated the long-term outcome of the Gittes procedure for treatment of stress urinary incontinence. MATERIALS AND METHODS: A total of 84 women had Gittes bladder neck suspension carried out for the treatment of anatomic stress urinary incontinence. Long term (mean 51.4 months) results were evaluated using a questionnaire. RESULTS: Of the 58 patients assessed, 25 (43.1%) reported cure of stress urinary incontinence, 19 (32.8%) reported improvement, 12 (20.7%) were the same and 2 (3.4%) were worse after Gittes bladder neck suspension. Thirty-seven (63.8%) replied 'satisfactory' for the Gittes bladder neck suspension. Overall success rate was estimated as 62.1%. Depending on follow-up periods success rate was declined with time and by 5 years the success rate was 67.2%. CONCLUSIONS: Although the Gittes procedure was quick and easy to perform and was well tolerated with minimal complications, long term follow-up study of Gittes bladder neck suspension showed a declining success rate with time. Therefore it may not be a satisfactory procedure for the management of anatomic stress urinary incontinece in women.

Comparative Analysis of Transurethral Resection of the Prostate and Side Firing Laser Prostatectomy(VLAP) / 대한비뇨기과학회지

PURPOSE: Side firing laser prostatectomy(VLAP) is now considered as alternative promise of transurethral resection of the prostate(TURP). This study was designed to compare VLAP to conventional TURP in the efficacy and safety. MATERIALS AND METHODS: There was no significant differences in preoperative clinical characteristics between the TURP group and VLAP group. To evaluate the effectiveness and safety of VLAP, we compared the results of transurethral resection of prostate(TURP, n=115) to laser prostatectomy(VLAP, n=45) in international prostate symptom score(IPSS), maximal flow rate(Qmax), post-voiding residual urine at preoperative, after 1 month, 6 months and 12 months postoperatively. For the VLAP procedure, Nd: YAG was used. Patient was treated with 600micrometer internal reflector fiber covered by crystal glass cadding(SideTrackTM). RESULTS: There was no statistically significant difference in the results between TURP group and VLAP group. TURP group; IPSS of preoperative, after 1 month, 6 months, 12 months was 23.8, 9.0, 9.1, 9.0 and Qmax was 7.8ml/s, 17.0ml/s, 17.1ml/s, 17.6ml/s and residual urine was 159.3ml, 52.7ml, 40.0ml, 34.6ml. VLAP group; IPSS of preoperative, after 1 month, 6 months, 12 months was 22.8, 9.7, 9.8, 9.3 and Qmax was 8.1ml/s, 16.0ml/s, 16.7ml/s, 17.1ml/s and residual urine was 135.7ml, 46.8ml, 34.5ml, 28.1ml. Postoperative period of catheter indwelling and hospitalization was shorter in VLAP group than TURP group(3.7+/-2.0 days vs 5.3+/-1.9 days, 4.5+/-1.6 days vs 6.8+/-3.5 days). CONCLUSIONS: VLAP has no siginificant complications such as postoperative bleeding, TURP syndrome. VLAP would be recommended as following: 1) prostate weight is smaller, 2) physical status is poor, 3) anticoagulant treatment, 4) when patient wants more safe treatment. We had a good results by means of VLAP. The good results come from the use of internal reflecting type laser fiber. These results suggest that VLAP is considered the most promising alternative to TURP.

Clinical Significance of Apoptosis in Transitional Cell Carcinoma of the Bladder and It's Correlation with Expression of Mutnant p53 Protein / 대한비뇨기과학회지

PURPOSE: The significance of constitutive apoptosis in the development and progression of transitional ceil carcinoma of the bladder has yet to be investigated. The wild type p53 gene is known to play a significant role in apoptosis. Therefore, mutation of p53 gene, which correlates closely with p53 protein overexpression, would be predicted to limit apoptosis. We evlauated the prognostic significance of apoptosis and the relationship between apoptosis and mutant p53 overexpression in transitional cell carcinoma of bladder. MATERIALS AND METHODS: The extent of apoptosis was determined by TUNEL(terminal deoxynucleotidyl transferase mediated biotinylated deoxyuridine-triphosphate nick end labeling) stain in 64 paraffin embedded tissue of primacy transitional cell carcinoma specimens. Also, the level of p53 overexpression was determined immunohistochemically on the same tissue. RESULTS: Although the incidence of apoptosis increased with increasing tumor grade, the difference in indices between grade II and grade III failed to reach statistical significance. The mean apoptotic index(AI) of grade I tumors was significantly lower than that of grade III tumors(p=0.0023). The apoptotic index was not related to p53 overexpression, T(tumor)-category, growth type of tumors and also there was no significant difference in disease-free survival between the bladder tumors with high as opposed to low apoptotic index. CONCLUSIONS: The results show that AI is related to histological grade in transitional cell bladder tumor, while AI hardly has any independent prognostic significance.