ABSTRACT
Objective To build the rat animal model of neurogenic bladder induced by spinal cord injury and investigate the changes of urodynamics and P2X1 receptor expression in bladder detrusor after the spinal shock stage.Methods A total of 40 female Wistar rats were randomly allocated into control group,suprasacral injury group and sacral injury group.Complete spinal cord transection was established by cutting out of dura at T10-L2 in suprasacral injury group.The sacral injury group was done by cutting out of dura at S2-4.Urodynamic monitor was performed on rats after the spinal shock stage(6 weeks after operation).The P2X1 receptor expression in bladder detrusor among the 3 groups was checked by using immunohistochemical method.Results The suprasacral injury group exhibited detrusor hyperreflexia during bladder filling,elevated leak point pressure and compliance.The sacral injury group exhibited detrusor lower reflection,reduced leak point pressure and elevated compliance.The level of P2X1 receptor expression in rats' detrusor of suprasacral injury group was increased,and the level of sacral injury group was reduced.Conclusions Neurogenic bladder induced by spinal cord injury reveals significant changes in urodynamic after the spinal shock stage.The enhancement of the P2X1 receptor expression in detrusor may be one of the mechanisms of detrusor hyperreflexia.
ABSTRACT
<p><b>BACKGROUND</b>The delayed diagnosis of pelvi-ureteric junction (PUJ) disruption in children following blunt abdominal trauma can result in loss of function of the involved kidney. We examined the potential for kidney preservation and the limits of diagnostic delays.</p><p><b>METHODS</b>A retrospective review of 17 cases of PUJ disruption at Beijing Children's Hospital from 1993 to 2009 was done with respect to diagnosis, treatment and follow-up.</p><p><b>RESULTS</b>The interval from trauma to diagnosis of PUJ disruption was (52 ± 52) days. If one case with nephrectomy was excluded, the interval from trauma to diagnosis was (40 ± 20) days. The average time between injury and first treatment was (49 ± 25) days. Pelvi-ureteric reanastomosis and caliceal ureterostomy were performed separately in 11 and 4 patients, respectively. Ileal replacement for ureter injuries was finally performed in one patient. Hydronephrosis of the injured kidney was reduced and the function improved in 15 out of 17 patients (88%). Only one patient received nephrectomy and the nephrectomy rate was 5.9%.</p><p><b>CONCLUSION</b>Differential renal function at the PUJ disruption side can be saved and the rate of nephrectomy reduced by appropriate surgery if the time to diagnosis and first treatment is limited to within two months.</p>