ABSTRACT
Purpose@#We aimed to develop urodynamic criteria to improve the accuracy of the diagnosis of bladder outlet obstruction (BOO) and detrusor underactivity (DU) in women with lower urinary tract symptoms (LUTS). @*Methods@#Initially, in a group of 68 consecutive women with LUTS and increased postvoid residual (PVR) who had undergone urodynamic investigations, we examined the level of agreement between the operating physician’s diagnosis of BOO or DU and the diagnosis according to urodynamic nomograms/indices, including the Blaivas-Groutz (B-G) nomogram, urethral resistance factor (URA), bladder outlet obstruction index (BOOI), and bladder contractility index (BCI). Based on the initial results, we categorized 160 women into 4 groups using the B-G nomogram and URA (group 1, severe-moderate BOO; group 2, mild BOO and URA≥20; group 3, mild BOO and URA<20; group 4, nonobstructed) and compared the urodynamic parameters. Finally, we redefined women as obstructed (groups 1+2) and nonobstructed (groups 3+4) for subanalysis. @*Results@#The agreement between the B-G nomogram and physician’s diagnosis was poor in the mild obstruction zone (κ=0.308, P=0.01). By adding URA (cutoff value=20), excellent agreement was reached (κ=0.856, P<0.001). Statistically significant differences were found among the 4 groups (analysis of variance) in maximum flow rate (Qmax) (P<0.0001), voided volume (VV) (P=0.042), PVR (P=0.032), BOOI (P<0.0001), and BCI (P<0.0001), with a positive linear trend for Qmax and VV and a negative linear trend for PVR and BOOI moving from groups 1 to 4. In the subanalysis, all parameters showed statistically significant differences between obstructed and nonobstructed women, except BCI (Qmax, P=0.0001; VV, P=0.0091; PVR, P=0.0005; BOOI, P=0.0001). @*Conclusions@#The combination of the B-G nomogram with URA increased the accuracy of diagnosing BOO among women with LUTS. Based on this combination, most women in the mild obstruction zone of the B-G nomogram would be considered underactive rather than obstructed.
ABSTRACT
Purpose@#Preclinical data increasingly support an impact of low-intensity extracorporeal shockwave therapy (Li-ESWT) on the bladder. We investigated the molecular effects of Li-ESWT on the bladder of a streptozotocin-induced diabetic rat model. @*Methods@#Fifteen 8-week-old male Wistar rats were randomized into 3 groups: a control group (n=5), a group of diabetic rats without treatment (diabetes mellitus [DM], n=5) and a group of diabetic rats treated with Li-ESWT (DM-ESWT, n=5). A single intraperitoneal dose of streptozotocin (60 mg/kg) was used to induce diabetes. Twenty days after diabetes induction, each rat in the DM-ESWT group received 300 shockwaves with an energy flux density of 0.09 mJ/mm2. Sessions were repeated 3 times/week for 2 weeks, followed by a 2-week washout period. Total RNA from bladder tissue was extracted, cDNA was synthesized, and quantitative real-time polymerase chain reaction was performed to analyze the expression pattern of transient receptor potential vanilloid 1 (Trpv1), interleukin-1β (Il1b), and the muscarinic receptors M1, M2, and M3 (Chrm1, Chrm2, and Chrm3). @*Results@#The expression of Trpv1, Il1b, and Chrm2 genes was significantly different between the 3 groups (P=0.002, P<0.0001, and P=0.011, respectively; 1-way analysis of variance). In the DM group, the expression of all genes was higher than in the control group, but statistical significance was observed only for Trpv1 and Il1b (P=0.002 and P<0.0001, respectively). Li-ESWT significantly reduced the expression of Il1b and Chrm2 (P=0.001 and P=0.011, respectively), whereas a nonsignificant tendency for reduced expression was noted for Trpv1 (P=0.069). @*Conclusions@#The induction of diabetes was associated with increased expression of genes related to mechanosensation, inflammation/ischemia, and contraction in the rat bladder. Li-ESWT reduced the expression of IL1b, Chrm2, and to a lesser extent Trpv1 toward the control levels, suggesting the therapeutic potential of this treatment modality for diabetic cystopathy.
ABSTRACT
Purpose@#We aimed to develop urodynamic criteria to improve the accuracy of the diagnosis of bladder outlet obstruction (BOO) and detrusor underactivity (DU) in women with lower urinary tract symptoms (LUTS). @*Methods@#Initially, in a group of 68 consecutive women with LUTS and increased postvoid residual (PVR) who had undergone urodynamic investigations, we examined the level of agreement between the operating physician’s diagnosis of BOO or DU and the diagnosis according to urodynamic nomograms/indices, including the Blaivas-Groutz (B-G) nomogram, urethral resistance factor (URA), bladder outlet obstruction index (BOOI), and bladder contractility index (BCI). Based on the initial results, we categorized 160 women into 4 groups using the B-G nomogram and URA (group 1, severe-moderate BOO; group 2, mild BOO and URA≥20; group 3, mild BOO and URA<20; group 4, nonobstructed) and compared the urodynamic parameters. Finally, we redefined women as obstructed (groups 1+2) and nonobstructed (groups 3+4) for subanalysis. @*Results@#The agreement between the B-G nomogram and physician’s diagnosis was poor in the mild obstruction zone (κ=0.308, P=0.01). By adding URA (cutoff value=20), excellent agreement was reached (κ=0.856, P<0.001). Statistically significant differences were found among the 4 groups (analysis of variance) in maximum flow rate (Qmax) (P<0.0001), voided volume (VV) (P=0.042), PVR (P=0.032), BOOI (P<0.0001), and BCI (P<0.0001), with a positive linear trend for Qmax and VV and a negative linear trend for PVR and BOOI moving from groups 1 to 4. In the subanalysis, all parameters showed statistically significant differences between obstructed and nonobstructed women, except BCI (Qmax, P=0.0001; VV, P=0.0091; PVR, P=0.0005; BOOI, P=0.0001). @*Conclusions@#The combination of the B-G nomogram with URA increased the accuracy of diagnosing BOO among women with LUTS. Based on this combination, most women in the mild obstruction zone of the B-G nomogram would be considered underactive rather than obstructed.
ABSTRACT
Purpose@#Preclinical data increasingly support an impact of low-intensity extracorporeal shockwave therapy (Li-ESWT) on the bladder. We investigated the molecular effects of Li-ESWT on the bladder of a streptozotocin-induced diabetic rat model. @*Methods@#Fifteen 8-week-old male Wistar rats were randomized into 3 groups: a control group (n=5), a group of diabetic rats without treatment (diabetes mellitus [DM], n=5) and a group of diabetic rats treated with Li-ESWT (DM-ESWT, n=5). A single intraperitoneal dose of streptozotocin (60 mg/kg) was used to induce diabetes. Twenty days after diabetes induction, each rat in the DM-ESWT group received 300 shockwaves with an energy flux density of 0.09 mJ/mm2. Sessions were repeated 3 times/week for 2 weeks, followed by a 2-week washout period. Total RNA from bladder tissue was extracted, cDNA was synthesized, and quantitative real-time polymerase chain reaction was performed to analyze the expression pattern of transient receptor potential vanilloid 1 (Trpv1), interleukin-1β (Il1b), and the muscarinic receptors M1, M2, and M3 (Chrm1, Chrm2, and Chrm3). @*Results@#The expression of Trpv1, Il1b, and Chrm2 genes was significantly different between the 3 groups (P=0.002, P<0.0001, and P=0.011, respectively; 1-way analysis of variance). In the DM group, the expression of all genes was higher than in the control group, but statistical significance was observed only for Trpv1 and Il1b (P=0.002 and P<0.0001, respectively). Li-ESWT significantly reduced the expression of Il1b and Chrm2 (P=0.001 and P=0.011, respectively), whereas a nonsignificant tendency for reduced expression was noted for Trpv1 (P=0.069). @*Conclusions@#The induction of diabetes was associated with increased expression of genes related to mechanosensation, inflammation/ischemia, and contraction in the rat bladder. Li-ESWT reduced the expression of IL1b, Chrm2, and to a lesser extent Trpv1 toward the control levels, suggesting the therapeutic potential of this treatment modality for diabetic cystopathy.