ABSTRACT
Previous concepts of immune-privileged sites obscured the role of peripheral immune cells in neurological disorders and excluded the consideration of the potential benefits of immunotherapy. Recently, however, numerous studies have demonstrated that the blood-brain barrier in the central nervous system is an educational barrier rather than an absolute barrier to peripheral immune cells. Emerging knowledge of immune-privileged sites suggests that peripheral immune cells can infiltrate these sites via educative gates and that crosstalk can occur between infiltrating immune cells and the central nervous system parenchyma. This concept can be expanded to the testis, which has long been considered an immune-privileged site, and to neurogenic bladder dysfunction. Thus, we propose that the relationship between peripheral immune cells, the brain, and the urologic system should be considered as an additional possible mechanism in urologic diseases, and that immunotherapy might be an alternative therapeutic strategy in treating neurogenic bladder dysfunction.
Subject(s)
Blood-Brain Barrier , Brain , Central Nervous System , Immune System , Immunotherapy , Nervous System Diseases , Testis , Urinary Bladder, Neurogenic , Urologic Diseases , UrologyABSTRACT
Objective To investigate the utility of urodynamic testing in the evaluation of neurogenic vesicoureteral reflux in patients with thoracolumbar spinal cord injury at the T10 to L2 level.Methods Twenty-six patients with thoracolumbar spinal cord injury at the T10 to L2 level and who displayed vesicoureteral reflux were enrolled and divided into a detrusor hyper-reflexia group (n =21) and a detrusor a-reflexia group (n =5)according to their cystourethrograms and urodynamic test results.Their bladder volume,detrusor pressure (Pdet) and compliance were observed and analyzed at the vesicoureteral reflux point and the leak point.Results The bladder volume and compliance of the detrusor hyper-reflexia group at the vesicoureteral reflux point were (122.46 ± 87.89) ml and (5.94 ± 4.96) ml/H2 O respectively,significantly different from the detrusor a-reflexia group (P ＜ 0.01).At the leak point,the average bladder volume of the detrusor hyper-reflexia group was (210.81 ± 69.72)ml,while the average bladder compliance was (9.53 ± 5.43)ml/H2O and the average detrusor pressure was (42.29 ± 9.57)cm H2O.All were significantly different from the detrusor a-reflexia group's averages.Moreover,there was a significant difference in the Pdet between the leak point and the vesicoureteral reflux points in the detrusor hyper-reflexia group.Conclusions Patients with thoracolumbar spinal cord injuries at the T10 to L2 level with neurogenic bladder and detrusor hyper-reflexia have low bladder volumes and compliance,and vesicoureteral reflux tends to occur at an early stage after injury with a destrusor pressure lower than 40 cm H2 O.For patients with detrusor a-reflexia,vesicoureteral reflux and bladder leakage may occur when detrusor pressure is low.
ABSTRACT
Objective To investigate the effectiveness of botulinum toxin A (BTX-A) injection to the external urethral sphincter guided by ultrasound in the treatment of various types of lower urinary tract dysfunction.Methods Twenty-two patients with urinary retention caused by neurological dysfunction (neurogenic bladder) were recruited,of which 18 were men and 4 women.They had various types of lower urinary tract dysfunction including detrusor external sphincter dyssynergia (DESD) in 7,nonrelaxing urethral sphincters in 5,and detrusor underactivity in 10.BTX-A (100 U) was injected into the external urethral sphincter at three different points guided by ultrasound.Clinical effects and urodynamic parameters were compared at baseline and after treatment.Results After treatment the urinary function and urodynamic parameters in each group improved significantly compared with the baseline.Maximum efficacy was observed at the 4th week.In the DESD group,3 patients (43％) had an excellent result and 3 (43％) had significant improvement; in the nonrelaxing sphincter group 3 (60％) had excellent results and 2 (40％) showed significant improvement; in the detrusor underactivity group 5 (50％) had excellent results and 3 (30％) had significant improvement.There were no obvious side effects.Conclusions BTX-A injections guided by ultrasound can accurately locate the external urethral sphincter.It is a simple and repeatable method for the treatment of lower urinary tract dysfunction.
ABSTRACT
Objective To assess clinical and urodynamic results of augmentation enterocystoplasty (AE) in patients with ncurogcnic hladdcr dysfunction (NBD).Methods Retrospectively reviewed our database between 2005-2011 to identify 77 patients who underwent AE ( sigmoid 74 patients,ileum 3 patients).Postoperativc complications,renal function,urodynamics parameters and quality of daily life were evaluated.Results The mean follow-up length was 24 months.Compared with pre-operative condition,the mean bladder capacity significantly increased from (160.6 ± 128.3) to (468.5 ± 60.6) ml (P ＜0.001 ) and the maximum detrusor pressure decreased from ( 31.1 ± 26.4) to ( 10.9 ± 4.5 ) cm H2O ( P =0.002 ).Serum creatinine level decreased from (270.3 ± 113.6 ) to ( 174.4 ± 81.3 ) μmol/(l) ( P =0.00 1 ).There were significant decrease on mean number of incontinence episodes and pads used per day ( P ＜0.01 ).Post-operative complications included metabolic acidosis in two patients (2.6％),adhesive intestinal obstruction in four patients (5.2％),deteriorating renal function in one patients ( 1.2％ ) and recurrence of vesicoureteral reflux in three patients (3.9％).Conclusions The results suggest that AE is safe and effective in treating patients with NBD.Concomitant URI is considerèd on patients with long illness history,vesicoureteral reflux at low intravesical pressures and upper urinary tract dilation.Patients with moderate and severe upper urinary tract deteriorations benefit from this procedure and the benefit can maintain a long time.