Men With Severe Lower Urinary Tract Symptoms Are at Increased Risk of Depression / 대한배뇨장애요실금학회지

PURPOSE: Lower urinary tract symptoms (LUTS) comprise a set of common, bothersome symptoms in middle-aged and elderly men. Recent research suggests that depressive symptoms may influence the symptoms of benign prostatic hyperplasia (BPH). We performed a community-based cross-sectional study to evaluate the correlation between LUTS and depression. METHODS: The survey was conducted in a rural community during four periods in August 2009, 2010, 2011, and 2012. Two validated questionnaires were used to examine LUTS and depressive symptoms. These included the International Prostate Symptom Score/quality of life (IPSS/QoL) and the Korean version of the Center for Epidemiological Studies-Depression scale (CES-D-K). Patients were categorized in the depressive symptom group if their CES-D-K score was >16 points. RESULTS: A total of 711 men were included in this study. Thirty-five participants (4.92%) were found to have depressive symptoms. There was a positive correlation between depressive symptoms and LUTS severity (P<0.001). As compared to the mild LUTS group, the odds ratio (OR) of depression was 2.868 (95% confidence interval [CI], 1.293-6.362; P for trend<0.001) in the moderate LUTS group, and 4.133 (95% CI, 1.510-11.313; P for trend<0.001) in the severe LUTS group. In a model considering multiple variables such as age, education level, smoking, and exercise, the OR in the moderate LUTS group was 2.534 (1.125-5.708, 95% CI, P for trend=0.005), while that in the severe LUTS group was 3.910 (95% CI, 5.708-11.154; P for trend=0.005). In addition, depression was related to voiding symptoms. CONCLUSIONS: Men with severe LUTS are at higher risk of depression than those with less severe urinary symptoms. The severity of voiding symptoms worsens depression. More aggressive urological diagnosis and treatment is needed in patients with severe LUTS, due to the impact on depressive symptoms and QoL.

Brain and Skin Metastasis From Urothelial Carcinoma of the Bladder

Brain and skin metastasis from urothelial carcinoma of the bladder is rare. There have been few case reports of the clinical course of patients with metastatic urothelial carcinoma of the brain and skin. In the present case, a 60-year-old man had undergone radical cystectomy with an ileal conduit owing to urothelial carcinoma (T1N0M0). The patient developed dizziness 9 years later and a solitary brain tumor was discovered in his left cerebellar hemisphere. The tumor was totally resected and the mass was verified to be metastatic urothelial carcinoma. One year after the metastasectomy of the brain lesion, multiple erythematous nodular lesions developed on his abdominal skin. The skin lesions were excised and verified to be metastatic urothelial carcinoma. This report describes this case of urothelial carcinoma of the bladder that metastasized to the brain and abdominal skin.

Fate of Abstracts Presented at the Annual Meeting of the Korean Urological Association

PURPOSE: The acceptance rate for journal publication of the abstracts presented at the annual Korean Urological Association (KUA) meeting, the time to publication, and the effect of abstract characteristics on the publication pattern were analyzed and compared with data for abstracts from other major urological meetings. MATERIALS AND METHODS: A total of 1,005 abstracts listed in the abstract books of the 2006 (58th) and 2007 (59th) annual KUA meetings were analyzed, and their subsequent publication as listed in PubMed or KoreaMed between August 2006 and August 2011 was evaluated. RESULTS: A total of 41.59% of abstracts were published as full-length reports. Abstracts on sexual dysfunction, neurourology, prostate cancer, basic research, and benign prostatic hyperplasia showed the highest publication rates (54%, 52.27%, 48%, 47.56%, and 45%, respectively). It took 19.01+/-12.83 months on average for abstracts to be published in a journal, whereas it took 25.24+/-14.64 months and 17.51+/-11.89 months for publication in foreign and Korean journals, respectively (p<0.001). CONCLUSIONS: Approximately 40% of studies presented as abstracts at the KUA meeting are subsequently published as full-length articles. The KJU is the most targeted journal. The mean time to publication is 1.5 years, and publication seems to be influenced by the study subject.

Efficacy of Alpha Blocker Treatment According to the Degree of Intravesical Prostatic Protrusion Detected by Transrectal Ultrasonography in Patients with Benign Prostatic Hyperplasia

PURPOSE: To analyze the effectiveness of tamsulosin 0.2 mg once daily for 3 months according to the degree of intravesical prostatic protrusion (IPP) in patients with benign prostatic hyperplasia (BPH). MATERIALS AND METHODS: A total of 134 BPH patients over 40 years of age treated with tamsulosin 0.2 mg between January 2007 and January 2009 were enrolled retrospectively. The patients were classified into three groups according to the degree of IPP: below 5 mm (group A), between 5 and 10 mm (group B), and over 10 mm (group C). Prostate volume, prostate-specific antigen (PSA), prostatic urethral length (PUL), and prostatic adenoma urethral length (PAUL) were evaluated before treatment. International Prostate Symptom Score and Quality of Life (IPSS/QoL), maximal urine flow rate (Qmax), and postvoid residual (PVR) volume were measured before treatment, and improvement in the three groups was compared after 3 months. RESULTS: The mean age of the patients was 65.01+/-7.38 years. Mean IPPs were 0.90+/-1.39 mm (group A, n=90), 6.92+/-1.10 mm (group B, n=24), and 16.60+/-4.06 mm (group C, n=20). Prostate volume, PUL, PAUL, PSA, Qmax, and PVR showed significant correlations with IPP (p0.05). Comparison of parameters before and after 3 months showed that medication improved total IPSS and subscores (p<0.001), QoL (p<0.001), Qmax (p<0.001), and PVR (p=0.030) in group A. In group B, it improved total IPSS (p=0.01), irritative subscore (p<0.001), and obstructive subscore (p=0.03). In group C, only total IPSS (p=0.01) and irritative score (p<0.001) were significantly improved. CONCLUSIONS: Tamsulosin may be more effective in improving symptom scores and Qmax in patients with mild IPP than in those with moderate or severe IPP.

Analysis of the Risk Factors for Overactive Bladder on the Basis of a Survey in the Community

PURPOSE: To evaluate the risk factors for overactive bladder (OAB) in a population aged 40 years and over in the community. MATERIALS AND METHODS: We conducted a community-based survey of OAB in a population aged 40 years and over in Guri City and Yangpyeong County, South Korea, by use of the overactive bladder symptom score (OABSS) questionnaire. A total of 926 subjects were included in the final analysis. The definition of OAB was more than 2 points for the urgency score and 3 points for the sum of scores. In addition, the subjects were asked about age, dwelling place, marital status, educational status, behavioral factors (smoking, drinking, etc), and medical history. Categorical variables were analyzed by using the logistic regression model and were adjusted for age by using the logistic regression model. RESULTS: Overall OAB prevalence was 14.1% (130/926), made up of 49/403 males (12.2%) and 81/523 females (15.5%). OAB prevalence increased with age (p<0.0001). Risk factors for OAB were educational status (age-adjusted p=0.0487), stroke (p=0.0414), osteoporosis (p=0.0208), asthma (p=0.0091), rhinitis (p=0.0008), and cataract. Other factors (dwelling place, marital status, smoking, drinking, hypertension, diabetes, hyperlipidemia, myocardial infarction, angina, tuberculosis, atopic dermatitis, hepatitis B, and depression) were not associated with OAB. CONCLUSIONS: The prevalence of OAB in our study was about 14.1% and the risk factors for OAB were educational status, stroke, osteoporosis, asthma, rhinitis, and cataract. Knowledge of these risk factors may help in the diagnosis and treatment of OAB.

Comparison of Effectiveness of Monopolar and Bipolar Transurethral Resection of the Prostate and Open Prostatectomy in Large Benign Prostatic Hyperplasia

PURPOSE: Transurethral resection of the prostate (TURP) is still considered the gold standard in the treatment of benign prostatic hyperplasia (BPH). However, open prostatectomy is indicated for prostate glands over 75 ml. There have been few reports concerning the use of TURP for large prostate glands over 100 ml. Herein we compared the effectiveness of monopolar TURP, bipolar TURP, and open prostatectomy in prostate glands larger than 100 ml. MATERIALS AND METHODS: We reviewed the data of 48 patients with prostate glands larger than 100 ml. A total of 19, 17, and 12 patients underwent monopolar TURP (group A), bipolar TURP (group B), or open prostatectomy (group C), respectively. Preoperative International Prostate Symptom Score (IPSS), maximal flow rate (Qmax), prostate volume, resected tissue volume, resection velocity, and operative time were documented. Postoperative hemoglobin, serum sodium change, hospital stay, and postoperative 6-month IPSS and Qmax were evaluated. RESULTS: The prostate volumes did not differ significantly among the three groups. Operative time was similar in the two TURP groups, but open prostatectomy required a longer operative time. There was no significant difference in the resected prostate tissue or resection velocity between the two TURP groups. There was a marked decrease in postoperative serum sodium in the monopolar group compared with the other two groups. Among the groups, bipolar TURP required a shorter hospitalization. Postoperative IPSS, quality of life (QoL), and Qmax improved significantly in all groups. CONCLUSIONS: Even for large prostate glands, the results of this study suggest that bipolar TURP is an effective and safe operation owing to the significant improvements in voiding symptoms, shorter hospitalization, and fewer complications such as transurethral resection syndrome.

Analysis of Content Legibility for Smartphones of Websites of the Korean Urological Association and Other Urological Societies in Korea

PURPOSE: We performed an analysis of the smartphone legibility of the websites of the Korean Urological Association (KUA) and other urological societies. MATERIALS AND METHODS: This study was conducted on the websites of the KUA and nine other urological societies. Each website was accessed via iPhone Safari and Android Chrome, respectively, to evaluate the establishment and readability of the mobile web pages. The provision of Really Simple Syndication (RSS) feeds by the websites and whether the websites had Twitter and Facebook accounts were evaluated. In addition, a validation test on the web standards was performed by using the World Wide Web Consortium (W3C(R)) Markup Validation Service, and subsequently the numbers of errors and warnings that occurred were analyzed. RESULTS: When accessed via Safari, two websites were legible, four were somewhat legible, and four were somewhat illegible. When accessed via Chrome, two websites were legible, six were somewhat legible, and two were somewhat illegible. One website provided an RSS feed and two websites managed members via separate Twitter accounts. No website supported mobile web pages. The result of the W3C(R) Markup Validation test on 10 websites showed a mean error rate of 221.6 (range, 13-1,477) and a mean warning rate of 127.13 (range, 0-655). CONCLUSIONS: The smartphone legibility level of the websites of urological societies was relatively low. Improved smartphone legibility and web standard compliance of the websites of urological societies are required to keep up with the popularity of smartphones.

Bladder Reconstruction Using Bovine Pericardium in a Case of Enterovesical Fistula

The use of graft materials in bladder mucosa has been examined in animal models, but debate exists over which materials are effective. Intestine has been used as a substitute in augmentation cystoplasty for patients with neuropathic bladder, but serious adverse effects of the operation have occurred in some instances. We report a case of a successful repair of an enterovesical fistula by use of bovine pericardium. The patient has remained well for 2.5 years. We suggest that bovine pericardium may be a suitable option as a bladder substitute.

Analysis of Prescriptions of Alpha-Blockers and Phosphodiesterase 5 Inhibitors from the Urology Department and Other Departments / 대한배뇨장애요실금학회지

PURPOSE: We analyzed the prescriptions of alpha-blockers and phosphodiesterase 5 inhibitors (PDE5Is) in the urology department as well as in other departments of the general hospital. METHODS: We investigated the frequency of prescription of alpha-blockers and PDE5Is from 3 general hospitals from January 1, 2007 to December 31, 2009. For alpha-blockers, data were collected from patients to whom alpha-blockers were prescribed from among patients recorded as having benign prostatic hyperplasia according to the 5th Korean Standard Classification of Diseases. For PDE5Is, data were collected from patients to whom PDE5Is were prescribed by the urology department and by other departments. Alpha-blockers were classified into tamsulosin, alfuzosin, doxazosin, and terazosin, whereas PDE5Is were classified into sildenafil, tadalafil, vardenafil, udenafil, and mirodenafil. RESULTS: Alpha-blockers were prescribed to 11,436 patients in total over 3 years, and the total frequency of prescriptions was 68,565. Among other departments, the nephrology department had the highest frequency of prescription of 3,225 (4.7%), followed by the cardiology (3,101, 4.5%), neurology (2,576, 3.8%), endocrinology (2,400, 3.5%), pulmonology (1,102, 1.6%), and family medicine (915, 1.3%) departments in order. PDE5Is were prescribed to 2,854 patients in total over 3 years, and the total frequency of prescriptions was 10,558. The prescription frequency from the urology department was 4,900 (46.4%). Among other departments, the endocrinology department showed the highest prescription frequency of 3,488 (33.0%), followed by the neurology (542, 5.1%), cardiology (467, 4.4%), and family medicine (407, 3.9%) departments in order. CONCLUSIONS: A high percentage of prescriptions of alpha-blockers and PDE5Is were from other departments. For more specialized medical care by urologists is required in the treatment of lower urinary tract symptoms and erectile dysfunction.

Quality Assessment of Randomized Controlled Trials Published in the Korean Journal of Urology Over the Past 20 Years

PURPOSE: Because low-quality trials may lead to erroneous conclusions, quality assessments are necessary. Thus, in this study, we scrutinized randomized controlled trials (RCTs) published in the Korean Journal of Urology (KJU) to assess their quantity and quality. MATERIALS AND METHODS: Upon extracting RCTs from all articles published in the KJU from 1991 to 2010, assessments were made on the basis of the Jadad scale and the adequacy of allocation concealment. The selections and assessments were performed independently by two researchers, and adjustment of the differences was done by a third-party researcher. In addition, the factors that may affect quality were analyzed. RESULTS: A total of 3,516 original articles were searched and 28 RCTs were extracted. In the 1990s, RCTs constituted only 0.27% of the total original articles, but in the 2000s, RCTs constituted 1.34%. The mean total Jadad score increased from 1.6 points in the 1990s to 1.65 points in the 2000s. However, the percentage of "good quality" trials also increased from 20% to 30.43%. As for adequate allocation concealment, one study was observed in the 2000s. The aspect most lacking was appropriate dropout and double-blinding. Studies with medical interventions or funded or examined by institutional review boards tended to receive higher quality assessments. CONCLUSIONS: Although RCTs consistently increased in both quantity and quality, in future studies, researchers should continue to strive toward achieving adequate allocation concealment and appropriate double-blinding. In addition, researchers must become more interested in receiving external funding and undergoing examination by institutional review boards.

The Role of TURP in the Detection of Prostate Cancer in BPH Patients with Previously Negative Prostate Biopsy

PURPOSE: We aimed to investigate the significance of early detection of transition zone prostate cancer by transurethral resection of prostate (TURP) in benign prostatic hyperplasia (BPH) patients with lower urinary tract symptoms (LUTS) in whom prostate cancer was suspected despite a negative transrectal ultrasonography (TRUS) biopsy result. MATERIALS AND METHODS: From January 2006 to January 2009, a total of 165 patients who underwent TURP were evaluated. The prostate cancer detection rate was compared between patients who underwent TRUS biopsy before TURP (group A) and those who did not (group B). All charts were evaluated retrospectively, including prostate-specific antigen (PSA), digital rectal examination (DRE), TURP results (including resection volume and pathology report), TRUS, and TRUS biopsy results. Group A was subdivided into group A1, who were diagnosed with prostate cancer after TURP, and group A2, who were diagnosed with BPH after TURP. RESULTS: The cancer detection rate showed no significant difference between groups A and B (8.9% vs. 7.5%, p>0.05). The mean PSA levels in groups A1 and A2 were 15.5+/-14.0 ng/ml and 9.1+/-5.1 ng/ml, respectively (p>0.05). In group A1, 40% had an abnormal DRE, compared with 6.7% in group A2 (p<0.05). After TURP, the mean percentage of resected prostatic chips of the prostate cancer group and BPH group were 33.9% and 18.6%, respectively (p=0.001). A positive correlation was found between the detection rate of prostate cancer and PSA (p=0.01). CONCLUSIONS: BPH patients in whom prostate cancer is suspected and who have lower urinary tract symptoms (LUTS) with a previously negative TRUS biopsy result can undergo TURP, which results in immediate improvement in bladder outlet obstruction and early diagnosis of clinically significant transition zone prostate cancer.

Urachal Actinomycosis Mimicking a Urachal Tumor

A 26-year-old man presented with lower abdominal discomfort and a palpable mass in the right lower quadrant. An abdominal computed tomography (CT) scan revealed an abdominal wall mass that extended from the dome of the bladder. Fluorine-18 fluorodeoxyglucose (FDG) positron-emission tomography/CT (PET/CT) showed hypermetabolic wall thickening around the bladder dome area that extended to the abdominal wall and hypermetabolic mesenteric infiltration. Differential diagnosis included a urachal tumor with invasion into adjacent organs and chronic inflammatory disease. Partial cystectomy with abdominal wall mass excision was performed, and the final pathologic report was consistent with urachal actinomycosis.

An Anteriorly Positioned Midline Prostatic Cyst Resulting in Lower Urinary Tract Symptoms / 대한배뇨장애요실금학회지

Most prostatic cysts are not symptomatic and are found incidentally. There have been some reports of prostatic cysts presenting as an infravesical obstruction. Our case is the second published report of an anteriorly positioned midline prostatic cyst of the bladder neck. The prostatic cyst in a 41-year-old man presenting with lower urinary tract symptoms was located in the anterior and midline area of the prostate and was protruding into the bladder neck at the precise twelve o'clock position. The cyst obstructed the bladder neck by acting like a checking valve. Transurethral resection of the cyst was performed, and the obstructive symptoms successfully improved.

Efficacy and Safety of Tadalafil 5 mg Administered Once Daily in Korean Men with Erectile Dysfunction: A Prospective, Multicenter Study

PURPOSE: The aim of this study was to evaluate the efficacy of a daily dose of tadalafil 5 mg as well as its safety for the cardiovascular system in men with erectile dysfunction. MATERIALS AND METHODS: This study included a total of 162 men who were administered a daily dose of tadalafil 5 mg between April and December of 2009. A total of 127 men completed the 8-week clinical trial. The International Index of Erectile Function (IIEF)-5, blood pressure, and heart rate were measured before treatment with tadalafil (V1) and 4 (V2) and 8 weeks (V3) after treatment with tadalafil. Adverse effects were assessed at V1, V2, and V3. In cases in which the International Prostate Symptom Score (IPSS) was > or =8 at V1, maximal flow rate (Qmax) and postvoid residual volume (PVR) were measured. RESULTS: The IIEF-5 values were 11.25+/-3.18, 14.56+/-3.79, and 16.91+/-3.56 at V1, V2, and V3, respectively, with significant improvement (V1 vs. V2, p<0.001; V1 vs. V3, p<0.001). The IPSS values were 10.59+/-5.56, 9.07+/-6.06, and 8.15+/-6.10 at V1, V2, and V3, respectively, and the differences were statistically significant (V1 vs. V2, p<0.001; V1 vs. V3, p<0.001). There were no significant differences in blood pressure or heart rate. Adverse effects were observed in 7 men (5.51%) at V2 and in 5 men (3.94%) at V3. CONCLUSIONS: Tadalafil 5 mg administered once-a-day may be effective in improving erectile function. Adverse effects on the cardiovascular system may be minimal. In addition, it is believed that this may also be effective in improving voiding symptoms.

Unusual Foreign Bodies in the Urinary Bladder and Urethra Due to Autoerotism / 대한배뇨장애요실금학회지

Most foreign bodies in the lower genitourinary tract are self-inserted via the urethra as the result of exotic impulses, psychometric problems, sexual curiosity, or sexual practice while intoxicated. Diagnosis of these foreign bodies can be done by clinical history, physical examination, and image studies of the patient. The treatment of foreign bodies is determined by their size, location, shape, and mobility. In most cases, minimally invasive procedures such as endoscopic removal are recommended to prevent bladder and urethral injuries. In some cases, however, surgical treatment should be done if the foreign bodies cannot be removed by the endoscopic procedure or further injuries are expected as a result of the endoscopic procedures. Herein we present 2 cases of self-inserted lower genitourinary foreign bodies with a brief review of the literature.

A Case of Fournier Gangrene after Penile Methamphetamine Injection / 대한남성과학회지

Fournier gangrene is a fulminant infection of the genitalia, perineum, or abdominal wall. It is a life threatening progressive disease that requires aggressive surgical therapy and broad spectrum antibiotic treatment. We present one case of Fournier gangrene after penile methamphetamine injection.

Assessment of the Quality of Information Concerned with Benign Prostatic Hyperplasia and Prostate Cancer on the Related Korean Internet Web Sites / 대한비뇨기과학회지

PURPOSE: We assessed the quality of information available to patients on benign prostatic hyperplasia(BPH) and prostate cancer on the Korean internet web sites. MATREIALS AND METHODS: This research was undertaken by surfing the internet on the world wide web sites, including naver, nate, daum, yahoo and empas. The key words for the search were 'BPH' and 'prostate cancer'. We evaluated two main themes, and these were aspect of the contents and the technical contents. The aspects of the contents were the content and authorship, and the technical aspects were related to design and efficiency. RESULTS: We evaluated 45 web sites that focused on BPH and 24 web sites that focused on prostate cancer. From among the web sites, 27(60%) of the 45 BPH sites and 16(67%) of the 24 sites gave medical information. Only 14(31%) of the 27 BPH sites and 12(50%) of the 24 prostate cancer sites dealt with full information. The average score of these 43 web sites was only 34.5+/-13.6 of a perfect score of 100. The mean score of the content was 10+/-5.1 of 40 points, authorship was 4.3+/-3.3 of 20 points, design was 10.4+/-3.3 of 20 points and efficiency was 9.8+/-4.6 of 20 points. A total of 28(65%) out of the 43 providers of information were urologists and 23 (82%) out of the 28 were general practitioners. The rate of research on prostatic disease was lower than that for 'hypertension', 'diabetes', 'stroke' and 'hepatitis'. CONCLUSIONS: There is need for more accurate information on prostatic diseases on the Korean internet. It is essential to set up an institution for qualifying the medical information on web sites & evaluating the web sites on the Korean internet.

Assessment of the Quality of Information Concerned with Benign Prostatic Hyperplasia and Prostate Cancer on the Related Korean Internet Web Sites / 대한비뇨기과학회지

PURPOSE: We assessed the quality of information available to patients on benign prostatic hyperplasia(BPH) and prostate cancer on the Korean internet web sites. MATREIALS AND METHODS: This research was undertaken by surfing the internet on the world wide web sites, including naver, nate, daum, yahoo and empas. The key words for the search were 'BPH' and 'prostate cancer'. We evaluated two main themes, and these were aspect of the contents and the technical contents. The aspects of the contents were the content and authorship, and the technical aspects were related to design and efficiency. RESULTS: We evaluated 45 web sites that focused on BPH and 24 web sites that focused on prostate cancer. From among the web sites, 27(60%) of the 45 BPH sites and 16(67%) of the 24 sites gave medical information. Only 14(31%) of the 27 BPH sites and 12(50%) of the 24 prostate cancer sites dealt with full information. The average score of these 43 web sites was only 34.5+/-13.6 of a perfect score of 100. The mean score of the content was 10+/-5.1 of 40 points, authorship was 4.3+/-3.3 of 20 points, design was 10.4+/-3.3 of 20 points and efficiency was 9.8+/-4.6 of 20 points. A total of 28(65%) out of the 43 providers of information were urologists and 23 (82%) out of the 28 were general practitioners. The rate of research on prostatic disease was lower than that for 'hypertension', 'diabetes', 'stroke' and 'hepatitis'. CONCLUSIONS: There is need for more accurate information on prostatic diseases on the Korean internet. It is essential to set up an institution for qualifying the medical information on web sites & evaluating the web sites on the Korean internet.

Characteristics of Detrusor Overactivity Induced by Intravesical Instillation of Adenosine 5'-Triphosphate / 대한비뇨기과학회지

PURPOSE: The bladder urothelium releases adenosine 5'-triphosphate(ATP) with mechanical stretch, which increases in a pathologic state such as a neurogenic bladder. We investigated the characteristics of detrusor overactivity induced by the intravesical instillation of ATP. MATERIALS AN METHODS: Under urethane anesthesia, cystometry was performed on female Sprague-Dawley rats. After pretreatment with protamine sulfate(PS, 10mg/ml), ATP(60mM, pH 6.0) was continuously infused intravesically. The effects of intravenous injection of pyridoxalphosphate-6-azophenyl-2',4'-disulphonic acid(PPADS) on ATP-induced detrusor overactivity were studied. Changes in cystometric parameters including parameters of each voiding phase, including bladder pressure increase rate(slope; Ph1slope), maximal bladder pressure(Ph1MBP, Ph2MBP, Ph3MBP), mean bladder pressure(Ph2meanBP) and variation of intraluminal pressure high-frequency oscillations(IPHFOs) were analysed. RESULTS: With the intravesical instillation of ATP after PS pretreatment, the intercontraction interval(ICI) decreased significantly(544.2+/-167.2s vs 222.3+/-170.8s, p=0.001), maximal voiding pressure(MVP) decreased significantly(31.3+/-4.7cmH2O vs 25+/-2.9cmH2O, p=0.001), and pressure threshold (PT) decreased significantly(4.0+/-1.3cmH2O vs 1.4+/-0.8cmH2O, p=0.001). Changes in the ICI, MVP & PT induced by intravesical instillation of ATP were reversed by intravenous injection of PPADS. Ph1slope, Ph1MBP, Ph2MBP, Ph2meanBP and Ph3MBP were decreased, but IPHFOs were not affected by intravesical application of ATP. Conclusions: Intravesical instillation of ATP in female rats induced detrusor overactivity, which may be mediated by acting on the urine storage phase.

Characteristics of Detrusor Overactivity Induced by Intravesical Instillation of Adenosine 5'-Triphosphate / 대한비뇨기과학회지

PURPOSE: The bladder urothelium releases adenosine 5'-triphosphate(ATP) with mechanical stretch, which increases in a pathologic state such as a neurogenic bladder. We investigated the characteristics of detrusor overactivity induced by the intravesical instillation of ATP. MATERIALS AN METHODS: Under urethane anesthesia, cystometry was performed on female Sprague-Dawley rats. After pretreatment with protamine sulfate(PS, 10mg/ml), ATP(60mM, pH 6.0) was continuously infused intravesically. The effects of intravenous injection of pyridoxalphosphate-6-azophenyl-2',4'-disulphonic acid(PPADS) on ATP-induced detrusor overactivity were studied. Changes in cystometric parameters including parameters of each voiding phase, including bladder pressure increase rate(slope; Ph1slope), maximal bladder pressure(Ph1MBP, Ph2MBP, Ph3MBP), mean bladder pressure(Ph2meanBP) and variation of intraluminal pressure high-frequency oscillations(IPHFOs) were analysed. RESULTS: With the intravesical instillation of ATP after PS pretreatment, the intercontraction interval(ICI) decreased significantly(544.2+/-167.2s vs 222.3+/-170.8s, p=0.001), maximal voiding pressure(MVP) decreased significantly(31.3+/-4.7cmH2O vs 25+/-2.9cmH2O, p=0.001), and pressure threshold (PT) decreased significantly(4.0+/-1.3cmH2O vs 1.4+/-0.8cmH2O, p=0.001). Changes in the ICI, MVP & PT induced by intravesical instillation of ATP were reversed by intravenous injection of PPADS. Ph1slope, Ph1MBP, Ph2MBP, Ph2meanBP and Ph3MBP were decreased, but IPHFOs were not affected by intravesical application of ATP. Conclusions: Intravesical instillation of ATP in female rats induced detrusor overactivity, which may be mediated by acting on the urine storage phase.