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Objective:To explore the central mechanism of overactive bladder (OAB) using the resting-state functional magnetic resonance imaging (rs-fMRI). Methods:From October, 2019 to January, 2021, 13 patients with OAB aged (46.9 ±13.4) years were enrolled. Under urodynamic monitoring, rs-fMRI scans were performed in these subjects under empty bladder and strong desire to void. Matlab 2016, SPM 12 and DPABI software were used to process and analyze these obtained image data, six brain regions related to bladder control: right superior frontal gyrus (X = 3, Y=24, Z = 48), right anterior cingulate gyrus (X = 12, Y = 33, Z = 3), left postcentral gyrus (X = -18, Y = -26, Z = 48), right supplementary motor area (X = 3, Y = -12, Z = 63), left insular (X = -42, Y = -12, Z = -3) and right insular (X = 3, Y = -12, Z = 63),were extracted as the regions of interest to analyze the functional connection with the whole brain. Results:The functional connection of the right superior frontal gyrus with the right middle frontal gyrus increased, while the connection with the right cuneus decreased. The connection of the right anterior cingulate gyrus with the right superior temporal gyrus increased, while the connection with the left posterior cingulate gyrus decreased. The connection of the left postcentral gyrus with the right cuneus decreased. The functional connection of the right supplementary motor area with the left cuneus, the connection of the right insular with the medial superior frontal gyrus, and the connection of the left insular with the inferior parietal lobule increased. Conclusion:The functional connections between the brain areas related to continence and other brain regions involved in bladder control changes in patients with OAB. These changes may be one of the potential pathogenic mechanisms of OAB.
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Objective:To identify the small-world network property of brain functional network provoked by a strong desire to void in healthy women. Methods:From 2017 to 2018, 21 healthy women were enrolled, and scanned with resting-state functional magnetic resonance imaging under the empty bladder and strong desire to void, respectively. Brain connection matrix was established with Pearson's correlation analysis, and the differences in topologic properties between the two conditions were identified with paired t-test and Bonferroni correction. The small-world parameters, named clustering coefficient (Cp), characteristic path length (Lp), global efficiency (Eglob), local efficiency (Eloc) and nodal efficiency (Enodal) were calculated. Results:There were two women dropped down because of head moving. For the other 19 women, the brain connection presented a small-world network property under the both conditions. Compared with the empty bladder, Cp, Lp, and Eloc decreased, and Eglob increased under the strong desire to void (P < 0.05); while Enodal increased in left inferior frontal gyrus and superior frontal gyrus; right cingulate gyrus, middle occipital gyrus and middle temporal gyrus; and bilateral gyrus rectus and inferior parietal lobes; and decreased in bilateral fusiform gyrus, calcarine fissure and surrounding, and lingual gyrus (P < 0.05). Conclusion:Brain functional network presents a small-world network property under both empty bladder and a strong desire to void. The regulation of lower urinary tract function involves the coordination of multiple brain regions.
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Objective:To explore the clinical characteristics of urination disorders in multiple system atrophy (MSA). Methods:The clinical data and imaging urodynamic examination of twelve MSA patients with severe urination disorders from June, 2013 to March, 2021 were retrospectively analyzed. Results:Among twelve cases, there were eight cases with acontractile detrusor, one case with detrusor overactivity, one case with detrusor-sphincter dyssynergia, one case with filling detrusor hyperactivity and voiding-phase dyssynergia (DO+DSD), and one case with normal urodynamics. Conclusion:The clinical symptoms of MSA are complex, and the early diagnosis is difficult. Electrophysiological and MRI examinations can be helpful for diagnosis.
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Objective:To investigate the effect of pelvic floor muscle training on detrusor overactivity in patients with spinal cord injury. Methods:From August, 2019 to August, 2020, 17 patients with incomplete spinal cord injury were randomly divided into control group (n = 8) and experimental group (n = 9). Both groups accepted tolterodine tartrate 4 mg a day orally for twelve weeks, while the experimental group accepted pelvic floor muscle training. They were measured urodynamic indexes, and assessed with Neurogenic Bladder Symptom Scale and Patient Perception of Bladder Condition before and after treatment. Results:All the urodynamic indexes and scores of the scales improved in both groups after treatment (t > 3.674, |Z| > 2.646, P < 0.05), while the indexes of maximum bladder volume, first contraction pressure volume of detrusor, leakage point pressure of detrusor, maximum contraction pressure of detrusor and neurogenic bladder symptom score improved more in the experimental group than in the control group (|t| > 2.194, P < 0.05). Conclusion:Pelvic floor muscle training based on medicine can release the detrusor overactivity in patients with spinal cord injury.
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Objective:To apply contrast-enhanced ultrasound in renal function evaluation for patients with spinal cord injury complicated with hydronephrosis. Methods:From October, 2015 to November, 2018, 23 patients with spinal cord injury complicated with hydronephrosis and renal disfunction (spinal cord injury group) and 19 cases of normal kidneys (control group) accepted contrast-enhanced ultrasonography and the image was analyzed with software. The region of interest (ROI) in the renal cortex, and the time intensity curve was drawn. Logistic regression was performed with time to initial peak (TTP), peak intensity (DPI), slope of ascending time (A), area under the curve (AUC) as the independent variable and renography as the dependent variable. The data was analyzed with ROC. Results:There was no significant difference in serum creatinine and ureophil between two groups (P > 0.05). TTP was longer (t = 5.068, P < 0.001), and A and AUC were lower (t > 3.784, P < 0.01) in the spinal cord injury group than in the control group. AUC was the factor related to renography (P < 0.01). The smaller the AUC was, the greater the likelihood of kidney damage was. The sum of sensitivity and specificity was 1.759 and the corresponding AUC was 982.518 dBS. Conclusion:Contrast-enhanced ultrasound can evaluate renal function of patients with spinal cord injury complicated with hydronephrosis. The decrease in AUC of the time-intensity curve indicates that the renal function is impaired.
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Urodynamics is able to reproduce the patient's lower urinary tract symptoms and to explain patient's bladder problems objectively. Currently, the most commonly used urodynamic manometry catheter is water filled catherters, which is widely recognized due to its economic and healthy advantages. However, air bubbles and patient's activities can affect the quality and speed of signal transduction, interfering the explanation of the pressure results. The air-filled catheters are easy to operate, and the measures are unaffected by air bubbles and patient's activities, which have gradually begun to be used in urodynamic study in some areas. However, there are several differences between them in terms of fluid mechanics principle, zero set and detailed operations which directly and indirectly lead to the different pressure results. The researches on air-filled catheters at home and abroad are still not perfect. This article gave a detailed comparison between them based on the present studies from the following aspects: the essential structure, the developing history, the fluid mechanics principle, the zero pressure point setting, the frequency response, the cystometrogram, the urethral pressure profile, the conversion algorithm, and the urinary tract infection after the investigation, etc.
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The technical review for clinical trials of implantable sacral nerve stimulation system needs to focus on the basic principles of trials, clinical institutition and design elements of clinical trial protocols.
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@#Electrical stimulation is a common technology to treat neurogenic bladder dysfunction secondary to supersacral spinal cord injury. This paper reviews the historical development of this treatment and current status.
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<p><b>OBJECTIVE</b>To evaluate clinical efficacy of holmium laser enucleation of the prostate in the treatment of benign prostatic hyperplasia (BPH) and overactive bladder (OAB).</p><p><b>METHODS</b>From May 2007 to May 2010, a total of 37 patients diagnosed BPH and OAB were treated by holmium laser enucleation of the prostate. After a mean follow-up of 4.9 months postoperatively, indices such as International Prostate Symptom Score (IPSS), quality of life (QOL) score, maximum flow rate (Qmax), residual urine volume and video urodynamics were monitored and statistically analyzed.</p><p><b>RESULTS</b>The mean preoperative IPSS and QOL score were 29.6 ± 5.2 and 4.3 ± 0.9, and decreased to 4.6 ± 1.2 and 1.2 ± 1.0 postoperative. The mean Qmax was (6 ± 3) ml/s preoperative and increased to (21 ± 5) ml/s postoperative. Preoperative average residual urine volume was (167 ± 11) ml, decreased to (41 ± 18) ml after operation. During follow-up, 86.5% patients' symptoms and quality of life improved continuously, however 13.5% patients existed residual postoperative OAB symptoms.</p><p><b>CONCLUSIONS</b>When BPH with OAB patients exist bladder outlet obstruction, bladder outlet obstruction should be relieved first then OAB symptoms can be relieved in majority of patients, but some patients have residual symptoms.</p>
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Aged , Aged, 80 and over , Humans , Male , Middle Aged , Follow-Up Studies , Lasers, Solid-State , Therapeutic Uses , Prostatic Hyperplasia , General Surgery , Transurethral Resection of Prostate , Methods , Treatment Outcome , Urinary Bladder, Overactive , General SurgeryABSTRACT
<p><b>OBJECTIVE</b>To explore the efficacy of neuromodulation (including sacral neuromodulation and dorsal penile/clitoral nerve neuromodulation) for the treatment to neurogenic bowel dysfunction due to spinal cord injury.</p><p><b>METHODS</b>From January 2006 to April 2008, 9 patients with neurogenic constipation after spinal cord injury underwent the therapy of neuromodulation, 1 patient underwent the therapy of sacral neuromodulation, 8 patients underwent the therapy of dorsal penile/clitoral nerve neuromodulation. The therapeutic efficacy was evaluated and followed up by means of Wexner constipation score.</p><p><b>RESULTS</b>One patient received permanent electrode and neurostimulator implantation and constipation were improved continuously. A significant improvement in the Wexner constipation score was observed compared with the preoperative baseline level (preoperative baseline: median 22; after implantation: median 9). Four patients were effective after the therapy of dorsal penile/clitoral nerve neuromodulation. Wexner constipation score decrease from 19 to 11 after 12 weeks dorsal penile/clitoral nerve neuromodulation. Patients also showed a significant improvement in their symptoms and quality of life during follow up.</p><p><b>CONCLUSIONS</b>Sacral neuromodulation and dorsal penile/clitoral nerve neuromodulation may be effective for some neurogenic constipation. However there are no methods successfully identify the candidate who will be beneficial before the procedure. Good quality research data are needed to evaluate the effects of sacral neuromodulation and dorsal penile/clitoral nerve neuromodulation for these conditions.</p>
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Female , Humans , Male , Constipation , Therapeutics , Electric Stimulation Therapy , Methods , Electrodes, Implanted , Follow-Up Studies , Spinal Injuries , Treatment OutcomeABSTRACT
<p><b>OBJECTIVE</b>To find more evidence for mechanism and treatment of pelvic floor dysfunction (PFD), we observed muscle tension and neuropeptide of pelvic floor muscle in rats after spinal cord injury (SCI).</p><p><b>METHODS</b>30 SD adult female rats were randomly divided into suprasacral cord injury group (SS), spinal cord injury at or below the sacral level group (SC) and normal group; 4 weeks after transection of spinal cord, muscle tension including compliance and excitability, and neuropeptide were observed.</p><p><b>RESULTS</b>Compliances in SC group, SS group and normal group were (16.23 +/- 4.46) g, (13.44 +/- 4.15) g and (14.46 +/- 5.61) g respectively, there were no difference among them (P > 0.05), but their excitability under best initial length were (0.35 +/- 0.19) g, (2.80 +/- 2.12) g and (7.75 +/- 2.98) g according to SC, SS and normal group, excitability under prolonged length were (2.61 +/- 0.73) g, (4.67 +/- 1.16) g, (14.86 +/- 3.79) g respectively. SC and SS group were both lower than normal group (P < 0.05), meanwhile SC group was much lower than SS group (P < 0.05); neuropeptide Y and vasoactive intestinal peptide in SS and SC group were significant lower than normal group, and these two neuropeptides in SC were much lower than SS group (P < 0.05).</p><p><b>CONCLUSIONS</b>Muscular excitability and neuropeptide in pelvic floor muscle are decreased obviously at both below and above sacral cord injury, SCI below sacral cord makes much lower level excitability and neuropeptide. The abnormality in pelvic floor muscle after SCI should be emphasized.</p>
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Animals , Female , Rats , Disease Models, Animal , Muscle Tonus , Physiology , Neuropeptides , Metabolism , Pelvic Floor , Random Allocation , Rats, Sprague-Dawley , Spinal Cord Injuries , Metabolism , Vasoactive Intestinal Peptide , MetabolismABSTRACT
The molecular electronegativity-distance vector (MEDV) was used to describe the chemical structural characterization of 46 components of essential oils in the flower of Rosa banksiae. Various multiple linear regression (MLR) models were created with variable screening by the stepwise multiple regression technique and statistics. The QSRR models of 10 and 6 variables were built by MLR with the correlation coefficients (R) of molecular modeling being 0.906 and 0.903. Cross-validation of the models, which contain selected vectors were performed by leave-one -out procedure (LOO) and the satisfied results with correlation coefficients (Rcv) of 0.904 and 0.903, respectively. The results showed that the models constructed can provide estimation stability and favorable predictive ability.
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Flowers , Chemistry , Linear Models , Molecular Structure , Oils, Volatile , Chemistry , Plants, Medicinal , Chemistry , Quantitative Structure-Activity Relationship , Regression Analysis , Rosa , ChemistryABSTRACT
<p><b>OBJECTIVE</b>To evaluate the urodynamic characteristics of the chronic impairment of cauda equina caused by lumbar disk herniation.</p><p><b>METHODS</b>Clinical data and urodynamic parameters of 67 male patients with lumbar disk herniation were retrospectively analyzed. Lower urinary obstruction was excluded from the cohort using the Lin-PURR analysis. Patients were divided into group A (normal detrusor function), group B (detrusor underactivity) and group C (detrusor areflexia) according to the detrusor contraction function analyzed in Lin-PURR. Clinical data and urodynamic parameters were analyzed statistically between these groups.</p><p><b>RESULTS</b>The category of the detrusor contraction function had a significant effect on the urodynamic parameters. There were significant differences in the maximum flow rate (Q(max)), maximum pressure (P(max)), pressure at the maximum flow (P(det Qmax)) and post-voiding residual urine (PVR) among group A, B and C. There were significant differences in the first sensation volume of the bladder and the maximum cystometric capacity between group A and C, B and C, but no significance was found between group A and B. There was no significant difference in age, disease duration, and compliance of the bladder among 3 groups.</p><p><b>CONCLUSIONS</b>Urodynamic study is important in exploring the severity of the chronic impairment of cauda equina caused by lumbar disk herniation. Detrusor areflexia and loss of bladder sensory indicate more severe degree of impairment of the cauda equine. Q(max) and PVR are helpful in early diagnosis of the chronic impairment of cauda equina.</p>
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Adult , Aged , Aged, 80 and over , Humans , Male , Middle Aged , Cauda Equina , Chronic Disease , Intervertebral Disc Displacement , Nerve Compression Syndromes , Retrospective Studies , UrodynamicsABSTRACT
<p><b>OBJECTIVE</b>To explore the Video-urodynamic characteristics of various neurogenic bladder.</p><p><b>METHODS</b>A total of 1800 patients with neurogenic bladder were included in our study from December 2002 to June 2008. All patients underwent Video-urodynamic studies. Urodynamic data was collected and analyzed.</p><p><b>RESULTS</b>Urodynamic study showed detrusor overactivity in 71%, of which 60% with uninhibited sphincter relaxation, and acontractile detrusor in 29% stroke patients. No upper urinary tract deterioration was found in all 42 stroke patients. Detrusor overactivity without sphincter dyssynergia was found in 70% patients with head trauma. Seven patients with Parkinson disease showed detrusor overactivity, of which 3 with delayed sphincter relaxation. Detrusor overactivity was found in 91% and detrusor sphincter dyssynergia in 83% supra-sacral spinal cord injured patients. Acontractile detrusor was found in 73% patients with conus medullaris and cauda equina injury. Overall, upper urinary tract changes were found in 12% and vesicoureteral reflux in 4% spinal cord injured patients. Urodynamic study showed acontractile detrusor in 81%, reduced compliance in 86%, upper urinary tract changes in 55% and vesicoureteral reflux in 33% patients with myelodysplasia. Most patients (92%) with protruded lumbar disc showed detrusor areflexia. Normal bladder compliance was found in 88% patients with protruded lumbar disc. Urodynamic study showed reduced bladder sensation in 81% and detrusor under-activity in 76% patients with diabetic urinary bladder disease.</p><p><b>CONCLUSIONS</b>Video-urodynamic study can provide the most detailed information about the bladder dysfunction. It is the most valuable examination before treatment of patients with neurogenic bladder.</p>
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Adolescent , Adult , Aged , Aged, 80 and over , Child , Child, Preschool , Female , Humans , Male , Middle Aged , Urinary Bladder, Neurogenic , Diagnosis , UrodynamicsABSTRACT
<p><b>AIM</b>To explore the interaction between bladder compliance (BC) and bladder outflow obstruction (BOO) in men with benign prostatic hyperplasia (BPH) using cross-sectional and longitudinal studies.</p><p><b>METHODS</b>A total of 181 men with BPH were recruited, and 100 of them were followed for one year. Cystometry was performed in a standing or a sitting position with 30 mL/min infusion. BC was manually corrected and defined. Obstruction coefficient (OCO), linear passive urethral resistance relation and international continence society (ICS) nomogram were used to diagnose BOO. The obstructed parameters were compared between the reduced BC group and the non-reduced group. BC was compared between the first investigation at the beginning of study and the second investigation at the end of study during the one-year follow-up period.</p><p><b>RESULTS</b>The group with reduced BC had increased OCO and linear passive urethral resistance relation. BC was significantly lower in the obstructed group (55.7 mL/cm water) than that in unobstructed and equivocal one (74.9 mL/cm water, P <0.01). BC gradually reduced with the increased obstructed grade. There was a significantly weak negative correlation between BC and OCO (r = -0.132, P < 0.01). Over the one-year follow-up period in the longitudinal study, BC for all men changed from 54.4 to 48.8 mL/cm water (P >0.05), and BC for the group with BOO fell from 58.4 +/- 70.1 to 46.5 +/- 38.7 mL/cm water (P>0.05).</p><p><b>CONCLUSION</b>In men with BPH, a significant systematic decrease occurred in BC in the obstructed group and a significant systematic increase with urethral resistance occurred in the low BC group. A longitudinal study of the tendency of BC reduction in a group with BOO is necessary in the future.</p>
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Adult , Aged , Aged, 80 and over , Humans , Male , Middle Aged , Compliance , Cross-Sectional Studies , Longitudinal Studies , Prostatic Hyperplasia , Ureteral Obstruction , Urinary BladderABSTRACT
<p><b>AIM</b>To evaluate the effects of retrospective quality control on pressure-flow data with computer-based urodynamic systems from men with benign prostatic hyperplasia (BPH).</p><p><b>METHODS</b>A total of 582 traces of pressure-flow study from 181 men with BPH was included in the study. For each trace, maximum urinary flow rate (Q(max)) and detrusor pressure at Q(max) (p(det.Qmax)) were, respectively, read from manually smoothed and corrected uroflow and detrusor pressure curves from the computer print-outs. Obstruction coefficient, International Continence Society (ICS) and Schaefer nomograms were used to detect urethral resistance and to diagnose obstruction. The results obtained by manual reading were compared with those from computer-based systems.</p><p><b>RESULTS</b>After manual correction, Q(max) underwent a consistently significant decrease by 1.2 mL/s on average (P < 0.001), and had a change range of 0.5-10.4 mL/s. However, p(det.Qmax) underwent inconsistently intra-individual changes after correction. The obstruction coefficient increased significantly, by an average of 0.07 (P < 0.05). Using the ICS nomogram, the percentage of obstruction increased from 69.8% to 73.9%, and of the non-obstruction decreased from 8.8% to 5.3% (P < 0.05). There were 11% of traces that changed the classifications using the ICS nomogram, and 28.9% that changed the grades for the Schaefer nomogram.</p><p><b>CONCLUSION</b>Systematically significant differences in parameters from pressure-flow study between manual readings and computer recordings were demonstrated. Manual correction resulted in a consistently lower Q(max), a higher urethral resistance, and an aggravating obstruction. Manual readings can correct considerable false diagnoses for obstruction. Retrospective quality control of pressure-flow data with computer-based systems is necessary.</p>