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【Objective】 To evaluate the safety and efficacy of transobturator bulbourethral suspension with modified four-armed pelvic sling for post-prostatectomy incontinence (PPI). 【Methods】 The clinical data of 78 male PPI patients treated during Jan.2012 and Dec.2017 in our hospital were collected. The incontinence quality of life (I-QOL) score, daily use of urine pad, 1-hour urine pad test, residual urine volume (RUV), and maximum flow rate (Qmax) were assessed before and after surgery. 【Results】 The total success rate was 79.5%, of which the cure rate was 56.4% and the improvement rate was 23.1%. The preoperative I-QOL score was (54.6±3.9), daily use of urinary pad was (3.6±0.7), and increase in weight of the 1-hour urine pad test was (33.6±5.0) g. Three years after surgery, the I-QOL score was (80.4±5.7), daily use of a urinary pad was (1.9±0.4), and increase in weight of the 1-hour urine pad test was (7.4±1.3) g. Compared to preoperative status, the I-QOL score, daily use of urine pad, and increase in weight of the 1-hour urine pad test 3 years after surgery improved significantly (P<0.05). During the mean follow-up of (61.4±20.5) months, no significant changes in the I-QOL score, daily use of a urinary pad, 1-hour urinary pad test, RUV or Qmax were observed, and no complications occurred. 【Conclusion】 Transobturator bulbourethral suspension with modified four-armed pelvic sling is an effective and safe procedure to treat post-prostatectomy incontinence. The long-term efficacy is satisfactory.
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This article reviewed the current knowledge on time-course manifestation of diabetic urethral dysfunction (DUD), and explored an early intervention target to prevent the contribution of DUD to the progression of diabetes-induced impairment of the lower urinary tract (LUT). In the literature search through PubMed, key words used included “diabetes mellitus,” “diabetic urethral dysfunction,” and “diabetic urethropathy.” Polyuria and hyperglycemia induced by diabetes mellitus (DM) can cause the time-dependent changes in functional and morphological manifestations of DUD. In the early stage, it promotes urethral dysfunction characterized by increased urethral pressure during micturition. However, the detrusor muscle of the bladder tries to compensate for inducing complete voiding by increasing the duration and amplitude of bladder contractions. As the disease progresses, it can induce an impairment of coordinated micturition due to dyssynergic activity of external urethra sphincter, leading to detrusor-sphincter dyssynergia. The impairment of relaxation mechanisms of urethral smooth muscles (USMs) may additionally be attributable to decreased responsiveness to nitric oxide, as well as increased USM responsiveness to α1-adrenergic receptor stimulation. In the late stage, diabetic neuropathy may play an important role in inducing LUT dysfunction, showing that the decompensation of the bladder and urethra, which can cause the decrease of voiding efficiency and the reduced thickness of the urothelium and the atrophy of striated muscle bundles, possibly leading to the vicious cycle of the LUT dysfunction. Further studies to increase our understandings of the functional and molecular mechanisms of DUD are warranted to explore potential targets for therapeutic intervention of DM-induced LUT dysfunction.
Subject(s)
Ataxia , Atrophy , Diabetes Mellitus , Diabetic Neuropathies , Early Intervention, Educational , Hyperglycemia , Lower Urinary Tract Symptoms , Muscle, Smooth , Muscle, Striated , Nitric Oxide , Polyuria , Relaxation , Urethra , Urinary Bladder , Urinary Tract , Urination , UrotheliumABSTRACT
Objective To explore the outcome of modified bladder neck reconstruction in treating the urinary incontinence due to the sphincter dysfunction.Methods Between January 2010 and December 2014,a total of 23 patients,including 16 male and 7 female cases,with incontinence due to sphincter dysfunction had undergone a procedure of modified bladder neck reconstruction.The mean age was 36 years (range 17-61 years).Etiology of incontinence was secondary to pelvic fracture and urethral rupture procedure in 19 patients and other failure procedures in 4 cases.The mean duration of incontinence was 2 years (range 1-5 years).Urodynamic examination was performed in all patients and the mean maximum urethral pressure was 34 cmH2O (range 21-43 cmH2O).The modified bladder neck reconstruction was performed in 23 patients.Under the general anesthesia and vertical bladder incision,triangular mucosal strips,from the bladder neck to ureteral office,were denuded and leaving the central urethral plate,which was 2.0-2.5 cm in width.In order to form a neourethra and bladder neck,the multilayer triangular muscles were sutured interruptedly over a 14-16 F catheter using 2-0 or 3-0 polyglactin.And the anterior wall of the bladder was then closed over the new bladder neck using continuous sutured.Results The 23 patients were followed up for 6 months to 3 years,mean 1.4 years.Continence achieved in 5 patients.Of them,2 patients had difficulty in voiding but corrected by indwelling the catheter for another 2 weeks.Social continence was achieved in 7 patients.Incontinence status was improved in 7 cases and failed in 2 cases.Urodynamic examination was performed in 4 patients and the mean maximum urethral pressure was 64 cmH2O (range 52-72 cmH2O).Conclusions Our study suggested that the modified bladder neck reconstruction was a good procedure for the treatment of urinary incontinence due to sphincter dysfunction,particularly for the incontinence secondary to the traumatic urethral stricture or other operation.
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Objective To investigate the effect of 5-hydroxytryptamine 1A (5-HT1A) receptor agonists to improve micturition function in rats with diabetes mellitus (DM).Methods Fourteen female SD rats with the weight of 250 to 275 g were used.Seven rats were in the DM model group with intraperitoneal injection streptozotocin (STZ,65 mg/kg).Rats in the control group and DM group were anesthetized with urethane (1.3 g/kg) 8 weeks later.A polyethylene (PE)-50 catheter were placed in the left jugular vein for intravenous drug administration.A PE-90 catheter was inserted into the bladder,with the other end connected to a syringe pump for continuous infusion of saline and a pressure transducer for intravesical pressure monitor.Dose-response curves for 8-OH-DPAT were followed by WAY-100635 test.The capacity,residual volume,micturition volume,and EUS-EMG were measured.Results Compared to normal control,DM rats had a higher bladder capacity,residual volume,and a lower voiding efficiency.With increasing dose of 8-OH-DPAT (0.003-1.000 mg/kg,i.v.),the micturition volume increased from (2.15±0.49) ml to (2.85±0.21) ml,the residual volume decreased from (3.40±0.74)ml to (1.82±0.48) ml and voiding efficiency changed from (39.0±9.3)％ to (61.6±6.9)％.Control rats showed little change in cystometic variable.During the micturition,there was a dose-dependent increased phasic EUS activity correlated with the improved voiding efficiency.WAY-100635 (0.300 mg/kg,i.v.) reversed the 8-OH-DPAT-induced changes.Conclusions Both the bladder voiding efficiency and the periodic EUS activity decrease in DM rats.5-HT1A receptor agonist could promote periodic EUS activity and improve voiding efficiency.
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Objective To explore the efficacy of different bulbourethral sling procedures in the treatment of male acquired urinary incontinence.Methods A retrospective study of 105 patients with acquired urinary incontinence was performed.The patients underwent 3 different bulbourethral sling procedures under urodynamic monitoring between October 2000 and June 2013.Mean age was 54 years (range 15-81).Urinary incontinence was secondary to post-prostatectomy in 70 patients and posterior urethroplasty in 35.Preoperatively,10 patients were completely urinary incontinence and 95 patients were stress urinary incontinence.Mean duration of urinary incontinence was 3 years (1-12).The surgical techniques were composite device suspension in 54 patients,pedicled rectus abdominalis muscle and fascial flaps suspension in 10 and transobturator sling in 41.Results The patients were followed up for 3-128 months (mean 54 months).The urethral catheter was left in situ for 5-7 days in 103 patients.Of the 103 patients,5 patients were difficulty in voiding but corrected by indwelling of urethral tube for another 1 week in 4 patients and transurethral bladder neck resecting in 1.In the remainder 2 patients,the maximum urethral pressure was 110 and 158 cm H2O (1 cm H2O=0.098 kPa) at the end of surgery and both patients were able to void on day 14 and 21 respectively and achieved complete continence.In this study,complete continence was achieved with good voiding in 74 patients (70.5％),completed control of urination rate was 81,4％ (57/70) in group of prostate and 48.6％ (17/35) in group of posterior urethroplasty.Twenty-six patients were improved and 5 patients were failed.Conclusion Bulbourethral sling procedure under urodynamic monitoring is an effective option in the treatment of male acquired urinary incontinence,especially for patients of incontinence of post-prostatectomy.
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Objective To investigate the effect of 5-hydroxytryptamine serotonin receptor-1A (5-HT1 A) agonists on micturition dysfunction in rats with chronic spinal cord injury (SCI).Methods Female SD rats weighing 175 -200 g were used.Seven of the rats were modified for a spinal cord injury model (transsection at T10).Eight weeks later,control rats and SCI rats were tested.Rats were anesthetized with urethane ( 1.3 g/kg ).A polyethylene (PE) -50 catheter was placed in the left jugular vein for intravenous drug administration.A PE-90 catheter was inserted through the bladder dome,and the other end of the bladder catheter was connected to a syringe pump for continuous infusion of saline and to a pressure transducer for intravesical pressure monitor.Dose-response curves for 8-OH-DPAT were followed by the WAY-100635 test.The capacity,residual volume,micturition volume,and EUS-EMG were measured.Results With an increasing dose of 8-OH-DPAT,the capacity of the bladder decreased from 33.2 ± 8.3 ml to 22.8 ± 2.4 ml.The micturition volume was increased from 0.14 ± 0.08 ml to 0.38 ± 0.09 ml.The residual volume decreased from 3.68 ± 1.36 ml to 1.84 ± 0.21 ml,and peak intravesical pressure changed from 27.1 ± 3.6 mm Hg to 22.8 ± 2.4 mm Hg.Control rats showed little significant change in the cystometric variable.Effects of 8-OH-DPAT were reversed by WAY-100635.That 8-OH-DPAT induced phasic relaxation occured in spinal cord-injured rats but the control group showed no significant change.ConclusionsThe 5-HTIA/7 receptor agonist 8-OH-DPAT may induce periodic EUS relaxation during voiding in urethane-anesthetized chronic spinal cordinjured rats.And this could result in an increase in micturition volume,a decrease in bladder capacity,and thus an increase in voiding efficiency.
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Objective To evaluate the efficacy of bladder hydredistention and resiniferatoxin(RTX)on treating female interstitial cystitis(IC).Methods A total of 16 patients with IC were included.All patients received cystoscopie hydrodistention and RTX under anesthesia.The O'Leary-Sant Interstitial Cystitis Symptom Index(ICSI),Problem Index(ICPI),voiding frequency and the maximum bladder capacity were recorded before and after the therapy.Results All patients were followed up for 1 or 6 months.Fourteen of 16patients'symptoms were relieved,2 patients symptoms disappeared or significantly relieved.Conclusion Bladder hydrodistention and RTX effectively relieve symptoms and improve quality of life in patients with IC in the short term.
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Objective To examine the feasibility of using the serous-lined tunnel technique for orthotopic neobladder, continent cutaneous diversion and ureteral replacement by the intestinal segment. Methods In 31 patients of orthotopic ileal neobladder, the serous-lined tunnel techniques were used for antirefluxing ureteral implantation: In 13 patients of continent ileal pouch, the techniques were adopted for continent-valve construction and for uretersl implantation: In 3 patients (with lower ureteric cancer), the same techniques were applied for constructing the ileal ureters with a proximal antirefluxing mechanism. Results With a mean follow-up of 27 mon( 12-132 mon), 88 ureters implanted into ileal neobladders or continent pouches functioned well with neither obstruction nor reflux: 12 in 13 continent valves functioned well with no incontinence. 3 patients with ileal ureters showed no ileo-ureteric reflux and had reduced hydronephrosis comparing to that of before surgery.Conclusions Ureteral reimplantation and continent valve formation achieved by adopting the serouslined tunnel technique provide satisfactory results. The versatility of the technique is obvious in the present experience and the creative application of the serous-lined tunnel technique should be possible in urinary reconstruction.
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Objective To study the testicular breeding function and p63 expression in seminiferous tubules in androgen receptor(AR)knockout mice.Methods Eight AR knockout mice selected by Cre-lox and 8 Wistar male mice were studied.Testicular breeding function was determined by Makler score and p63 was detected by immunohistochemistry. Results Seminiferous tubules inner diameter deflated in AR knockout group than in Wistar group(60.0±1.5 μm vs 92.05±2.0μm,P＜0.01),peri-tube membrane thickened(4.0±0.7 μm vs 2.85=0.9 μm,P＜0.01),the number of cell layer decreased(2.0±0.3 vs 4.0±0.2,P＜0.01),generative eell maturation arrested(3.0±1.2 score vs 5.05±0.5 score,P＜0.01),Makler score was lower(8.0±0.3 vs 16.0±0.5,P＜0.01).p63 expression was lower in AR knockout group than in Wistar group and the expression was located at the stage of spermatogenous cell and spermatocyte.Conclusion Testicular breeding sperm function is damaged in AR knockout mice,lower expression of p63 mainly affects early differentiation in generative cells.
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500 mg,frequency was reduced in rats treated with tamsulosin (P500 mg,and the combined ?1a/?1dAR antagonist tamsulosin reduces urinary frequency more than the ?1aAR selective antagonist 5MU.This finding supports the hypothesis that the ?1dAR is important in mediating irritative symptoms.
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Objective To investigate the effect of bladder activity by 5-hydroxytryptamine serotonin receptor agonists with chronic spinal cord injury(SCI). Methods Intact cats and SCI cats were catheterized through the bladder dome for saline-filling cystometry.Dose-response curves for i.v.8-OH-DPAT and GR-46611 were followed in three cases each by WAY-100635.Threshold volume,capacity,residual volume,micturition volume,and arterial pressure were measured. Results Intact cats showed few significant changes in cystometric variable.SCI cats responded to both 8-OH-DPAT and GR-46611 with dose-dependent increases in threshold volume,capacity,and residual volume.Effects of 8-OH-DPAT but not GR-46611 were largely reversed by WAY-100635. Conclusions Both 5-HT_ 1A and 5-HT_ 1B/1D agonists may offer a promising means of reducing bladder hyperactivity and increasing bldder capacity in patients with chronic SCI.