Urodynamic effects of electrical stimulation of the detrusor spastic bladder after spinal cord injury / 中华物理医学与康复杂志

Objective To observe the clinical effect of surface electrical stimulation on bladder spasm among patients with spinal cord injury,and compare it with that of therapy combining electrical stimulation with bladder function training.Methods Forty-two patients with bladder spasm after spinal cord injury were randomly divided into an experimental group (n=21) and a control group (n=21).Patients in the experimental group were further divided into three subgroups:patients with cervical spinal injury (n =7),thoracic spinal injury (n =9) and lumbar spinal injury (n =5).Both the experimental group and control group were given normal bladder function recovery exercise,while the experimental group was given the extra electrical stimulation on the surface of the sacral nerve.Urodynamic tests including the maximum detrusor pressure,bladder capacity,residual urine volume and bladder compliance were conducted for both groups before the treatment,after the first and the second 18-days of treatment and during a follow-up visit 2 months after the intervention.Results After the first course of treatment,significant differences were found in all measurements in the experimental group and most measurements of the control group except for the residual urine volume.Significant differences were found in all measurements after the second course of treatment compared to those after the first course in both groups.After the two courses of treatment and during the follow-up visit the average residual urine volume of the experiment group was significantly better than that of the control group.After the second course of treatment the average maximum detrusor pressure and bladder compliance of the experimental group were significantly better than those of the control group.Conclusion Surface electrical stimulation significantly improves the urodynamics and bladder function of patients with bladder spasm after spinal cord injury and its therapeutic effect is greater for patients with cervical and thoracic spinal injury than for those with lumber spinal injury.

The Clinical Significance of Detrusor Contraction Duration as a Predicting Parameter for Evaluaing Bladder Outlet Obstruction with Lower Urinary Symptoms in Men / 대한비뇨기과학회지

PURPOSE: Recently, detrusor contraction duration (DCD) has been suggested to be a useful urodynamic parameter for differentiating bladder outlet obstruction. Therefore, we studied the relationship between DCD and bladder outlet obstruction to determine whether DCD is a useful parameter for characterizing bladder outlet obstruction with lower urinary tract symptoms in men. MATERIALS AND METHODS: The urodynamic records of 212 consecutive male patients with lower urinary tract symptoms subdivided into 4 groups as bladder outlet obstruction (BOO), detrusor underactivity (DU), detrusor instability (DI), and normal (NL). DCD was defined as the contraction time elapsed between the first rise in detrusor pressure from baseline to the time at which detrusor pressure returned to baseline at the end of voiding. The correlations of DCD with other urodynamic parameters were assessed. RESULTS: DCD was significantly increased in patients with BOO and DU groups compared to other groups (DI, NL) (p<0.05). However, DCD were only weakly correlated with other urodynamic obstructive parameters in the BOO groups. CONCLUSIONS: Since DCD may also depend on detrusor contractility and bladder volume, DCD alone cannot be used as obstructive parameters to diagnose bladder outlet obstruction. However, considering the fact that the bladder outlet obstruction can be easily differentiated from the decreased detrusor contractility with other urodynamic parameters, DCD seems to be useful proxy for evaluating bladder outlet obstruction.

Changes of Detrusor Contractility after Partial Bladder Outlet Obstruction and Relief of Obstruction in Rat: Long-term Evaluation

PURPOSE: The contraction of the bladder is biphasic in nature consisting of an initial phasic contraction followed by a prolonged tonic contraction that is responsible for evacuating the bladder. Previous study demonstrated that the relief of bladder outlet obstruction induced recovery of the ability to initiate contraction, but emptying ability was not recovered within a certain period of time. This study was designed to determine the ability of recovery in tonic contraction and changes of contraction to pharmacologic stimulation through longterm evaluation after relief of obstruction. MATERIALS AND METHODS: Forty eight female rats were used in this investigation. Normal bladder was used as control and experimental groups were classified into 6 weeks obstruction group and 3, 6, 9, 12 weeks groups after relief of obstruction. The phasic and tonic contractile response to field stimulation(2, 4, 8, 16, 32Hz) and the response to bethanechol(3x10-5M), ATP(1mM) and KCl(120mM) were estimated by polygraph. RESULTS: The weight of bladder increased in obstruction group and gradually decreased after relief of obstruction. The phasic and tonic contractile response to all frequency of stimulation were decreased in obstruction group and recovered after relief of obstruction. In low frequency of stimulation, the ratio of tonic to phasic contractile response was decreased in obstruction group and recovered from 9 weeks after relief of obstruction. The contractile response to bethanechol was decreased in obstruction group and rapidly recovered after relief of obstruction. However, there were no change in contractile response to ATP in all group. The contractile response to KCl was decreased in obstruction group, but there were no change after relief of obstruction. CONCLUIONS: These results indicate that the emptying ability is recovered slowly but not enough and the contractile response to cholinergic stimulation is rapidly recovered after relief of obstruction. Further study will be needed for response to ATP and KCl.

Effects of Relief of Bladder Outlet Obstruction on the Detrusor Contractility in Rat / 대한비뇨기과학회지

Contraction of the bladder can be divided into two phases. The initial phase (phasic contraction) is characterized by a rapid increase in pressure that results in a change of bladder shape. This phase is followed immediately by a plateau phase (tonic contraction) that maintains an increase in intravesical pressure that is responsible for evacuating the bladder. This study was designed to determine the effect of relief of bladder outlet obstruction on the phasic and tonic detrusor contractile response to field and pharmacologic stimulation in rat urinary bladder. Forty female rats were used in this investigation. Normal bladder was used as control(n=8) and experimental groups (n=32) were classified into 6 weeks obstruction group and 2, 4, and 6 weeks groups after relief of obstruction. The phasic and tonic contractile response to field stimulation (2, 4, 8, 16, 32 Hz) and bethanechol (3 x -100,000 M) was estimated by polygraph. Following results were obtained. 1) The weight of bladder was increased in obstruction group and gradually decreased after relief of obstruction (p0.05). 4) Detrusor contractile response to bethanechol was rapidly decreased in obstruction group and rapidly recovered after relief of obstruction. And the contractile response in 6 weeks after relief of obstruction was higher than control (p<0.05). As the results of above, we concluded that relief of bladder outlet obstruction induced recovery of the ability to initiate contraction2 However, emptying ability is not recovered within a certain period of time. And further study will be needed.

Measurement of detrusor contractility in patients of benign prostatic hypertrophy with episodes of acute urinary retestion / 대한비뇨기과학회지

Incomplete bladder emptying even after prostatectomy were not uncommonly anticipated in patients with benign prostate hypertrophy (BPH) who had episodes of acute urinary retention. This may be related h impaired contractility of detrusor muscle secondary to decreased blood flow to the bladder and over-stretching of detrusor muscle caused by overdistension of bladder. We measured detrusor contractility in 41 patients with BPH who had episodes of urine retention (Group A) and 77 patients with BPH without urine retention. Also, follow up uroflowmetry were taken for 25 patients of group A and 40 patients of group B in 30-50 days after prostatectomy. Results were as follows; I. On filling cystometry. first sense of fill, urge sense to void, maximum cystometric capacity and compliance were not significantly different between 2 groups and detrusor instability were 23 cases (56%) in group A, 38 cases (49%) in group B. 2. On pressure-flow study, maximum detrusor voiding pressure was 32.5+/-4.13 cmH2O in group A and 50.27+/-2.4 cmH2O in group B (P<0.01). Peak flow rate (Qmax) and voided volume were 4.1 to 0.7 ml/sec, 76.1+/-12.7 ml in group A and 8.6+/-0.65 ml/sec, 176.1+/-16.7 ml in group B respectively (P<0.01, P<0.01). Residual urine was 256.5 1:24.3 ml in group A and 111.6 t 14.7 ml in group B (P<0.01). 3. On postoperative follow up uroflowmetry, voided volume and Qmax were increased compared to preoperative value in group A but still lower than those in group B (P<0.05, P<0.05). 4. The number of patients who didn't show any improvement of voiding symptoms after surgery were 17 on group A and 11 on group B. Impaired detrusor contractility was present in 25 of 41 cases (61%) of group A and 10 of 71 cases (13%) of group B on urodynamic diagnosis. Conclusively, in patients with BPH who had episodes of urine retention, preoperative pressure-flow study to recognize impaired detrusor contractility would be helpful in anticipating incomplete bladder emptying after prostate surgery and considering other forms of ancillary therapy.