Changes of bladder morphology and function and effect on upper urinary tract dilatation at different time after lumbosacral nerve transecting in rats / 中华泌尿外科杂志

Objective:To investigate the changes in the morphology, structure and function of the bladders and their effects on the upper urinary tract dilatation(UUTD) after lumbosacral nerve transecting in rats.Methods:A total of 45 female SD rats were included, randomly divided into 3 groups with 15 rats in each group. Two groups were performed bilateral lumbar 6(L6) and cauda equina nerve shearing to establish neurogenic bladder(NB) model, which were nerve transected for 4 weeks(NB-4W) group and nerve transected for 12 weeks(NB-12W) group. Another group was performed bilateral L6 nerves and cauda equine exposing but not transecting, which was sham-operation (Sham) group. Cystometry and renal ultrasound examination were performed and rats in each group were killed to collect the kidney and bladder tissues in NB-4W group at 4 weeks, in Sham group and NB-12W group at 12 weeks after operation. HE, Masson staining, immunohistochemical staining and western blot were used to detect histological changes, expression of transforming growth factor-β1(TGF-β1) and α-smooth muscle actin(α-SMA).Results:All rats in NB-4W and NB-12W group showed acontractile detrusor. In the NB-4W and NB-12W group, the maximum cystometric capacity [(5.84±0.33) ml and (3.13±0.35) ml], the detrusor leak point pressure [(25.41±0.86) cm H 2O and (27.36±2.04) cm H 2O] (1 cm H 2O = 0.098 kPa), were significantly higher than those in the Sham group [(0.98±0.14) ml, (7.13±0.90) cm H 2O, both P<0.05]. Compliance in NB-4W group [(0.28±0.21) ml/cm H 2O] and NB-12W group [(0.17±0.12) ml/cm H 2O] were significantly lower than that of the Sham group [(0.34±0.26) ml/cm H 2O], and the compliance of NB-12W group was lower than that of NB-4W group significantly (all P<0.05). HE staining of the bladder showed that the inflammatory cell infiltration was obvious in the NB-4W and NB-12W group. Bladder collagen volume fractions in NB-4W group [(30.5±1.5) %] and NB-12W group [(45.2±3.8) %] were both higher than that of Sham group [(20.7±2.2) %, both P<0.05]. The expression of TGF-β1 and α-SMA in the bladder tissue of NB-4W group were higher than those of sham group, and that of NB-12W group were higher than NB-4W group. In NB-4W group and NB-12W group, 3 (20.0 %) and 7 (46.7 %) rats were found hydronephrosis, respectively. Additionally, HE staining showed that the degree of renal tubule injury and the number of inflammatory cell infiltration in the NB-4W and NB-12W group were higher than those in the Sham group. Masson staining showed that the volume fraction of collagen in kidneys of NB-4W and NB-12W group were (13.1±1.4) % and (21.6±1.9) %, respectively, which were significantly higher than that in sham operation group [(4.6±0.7) %, both P<0.05]. Conclusions:Bilateral L6 + cauda equina nerve transecting can induce NB with hydronephrosis in parts of rats. The degree of bladder fibrosis gradually increased with the time of nerve transection, and the incidence and severity of UUTD also increased with the time of nerve transection.

Caracterización clínica de las disfunciones de piso pélvico en mujeres chilenas sintomáticas que consultan en un hospital universitario / Clinical characterization of pelvic floor dysfunctions in symptomatic Chilean women who visit an academic hospital

INTRODUCCIÓN: La prevalencia de las disfunciones de piso pélvico (DPP) puede llegar hasta un 25%, y esta incrementando con los años. El objetivo de este estudio es mostrar las características clínicas de pacientes sintomáticas sometidas a cistometría simple en el Hospital La Florida, entre diciembre del 2015 y marzo 2020. MÉTODOS: Es un estudio retrospectivo transversal. Se evaluaron los datos de todos los resultados de cistometrías simples de pacientes derivadas por sintomatología de piso pélvico entre los años 2015 y 2020. RESULTADOS: Se evaluaron 1.211 cistometrías simples. El motivo de derivación más frecuente fue prolapso de órganos pélvicos + incontinencia de orina (IO) (39.6%). 13.5% tuvieron resultado normal. 58% presentó test de esfuerzo positivo. 22.5% tenían prueba de estrés con vejiga vacía positiva. 17.6% presentó IO oculta. 21.9% de IO mixta. De las pacientes derivadas por vejiga hiperactiva o IO mixta, en el 14.2% se constató la presencia de contracciones no inhibidas y en el 34.8% la presencia de urgencia. CONCLUSIONES: Nuestro estudio aporta información sobre las DPP en la mujer chilena en un hospital universitario.

INTRODUCTION: Prevalence of pelvic floor dysfunctions (PFD) can be as high as 25%, and it is increasing over the years. The objective if this study is to show the clinical characteristics of symptomatic patients undergoing simple cystometry at La Florida Hospital, between December 2015 and March 2020. METHODS: This is a cross-sectional study. The data of all simple cystometries of patients derived for pelvic floor symptoms between 2015 and 2020 were evaluated. RESULTS: 1211 simple cystometries were evaluated. The most frequent reason for referral was pelvic organ prolapse + urinary incontinence (UI) (39.6%). 13.% had a normal result. 58% presented positive stress test. 22.% had a positive empty stress test. 17.6% had occult UI. 21.9% mixed UI. Of the patients referred by overactive bladder or mixed UI, 12.2% had detrusor contractions and 34.8% had urgency. CONCLUSIONS: Our study provides information on PFD in Chilean women in a university hospital. .

Synergistic Activities of Abdominal Muscles Are Required for Efficient Micturition in Anesthetized Female Mice / 대한배뇨장애요실금학회지

PURPOSE: To characterize the electromyographic activity of abdominal striated muscles during micturition in urethane-anesthetized female mice, and to quantitatively evaluate the contribution of abdominal responses to efficient voiding. METHODS: Cystometric and multichannel electromyographic recordings were integrated to enable a comprehensive evaluation during micturition in urethane-anesthetized female mice. Four major abdominal muscle domains were evaluated: the external oblique, internal oblique, and superior and inferior rectus abdominis. To further characterize the functionality of the abdominal muscles, pancuronium bromide (25 μg/mL or 50 μg/mL, abdominal surface) was applied as a blocking agent of neuromuscular junctions. RESULTS: We observed a robust activation of the abdominal muscles during voiding, with a consistent onset/offset concomitant with the bladder pressure threshold. Pancuronium was effective, in a dose-dependent fashion, for partial and complete blockage of abdominal activity. Electromyographic discharges during voiding were significantly inhibited by applying pancuronium. Decreased cystometric parameters were recorded, including the peak pressure, pressure threshold, intercontractile interval, and voiding duration, suggesting that the voiding efficiency was significantly compromised by abdominal muscle relaxation. CONCLUSIONS: The relevance of the abdominal striated musculature for micturition has remained a topic of debate in human physiology. Although the study was performed on anesthetized mice, these results support the existence of synergistic abdominal electromyographic activity facilitating voiding in anesthetized mice. Further, our study presents a rodent model that can be used for future investigations into micturition-related abdominal activity.

Urodynamic characteristics of awake rats under retrained versus freely moving condition: Using a novel model / 华中科技大学学报（医学）（英德文版）

Urodynamic investigation in conscious rats is widely employed to explore functional bladder disorders of various etiologies and pathogeneses. Rats can be placed in restraining cages or wide cabinets where they are allowed to move freely during cystometry. However, the requirements of special devices hampered the application of urodynamic test in freely moving rats, and whether the restraint has any effects on urodynamic parameters in conscious rats remains obscure. In the present study, we described a novel approach for urodynamic investigation in both restrained and freely moving conscious rats. In addition, we for the first time systematically compared the urodynamic parameters of rats in the two conditions. With the current method, we successfully recorded stable and repeatable intravesical pressure traces and collected expected reliable data, which supported the idea that the restraint does not affect the activity of the micturition reflex in rats, provided sufficient and appropriate measures could be applied during cystometry. Fewer technique problems were encountered during urodynamic examination in restrained rats than in freely moving ones. Taken together, conscious cystometry in rats placed in restraining cages with proper managements is a reliable and practical approach for evaluating the detrusor activity and bladder function.

Effect of Warming on Detrusor Muscle Contraction and the Micturition Reflex in Rats / 日本温泉気候物理医学会雑誌

<b>Objectives:</b> To investigate the effect of warming on contraction of the detrusor muscle and the micturition reflex in rats.<BR><b>Methods:</b> Female Sprague-Dawley rats were used in this study. Changes in the contractile response of detrusor smooth muscle strips to 40 mM KCl caused by warming to 40°C and 42°C were evaluated by an isometric tension recording study. The effect of intravesical warming at 40.7±1.0°C on the micturition reflex was evaluated by continuous infusion cystometry in conscious rats.<BR><b>Results:</b> Warming to 40°C and 42°C inhibited 40 mM KCl-induced contractions of detrusor smooth muscle strips by 10% and 15.5%, respectively. Intravesical warming at 40.7±1.0°C decreased the pressure threshold for inducing micturition by 14%, resting pressure by 30%, closing peak pressure by 22%, 2nd phase contraction duration by 36%, bladder contraction duration by 26%, and increased bladder compliance by 17%. Maximal voiding pressure and 1st phase contraction duration were unaltered.<BR><b>Conclusions:</b> Our results demonstrated that warming relaxed the detrusor muscle and increased bladder compliance. This suggests that warming might be useful for treatment of low compliance bladder observed in the neurogenic bladder due to neurological diseases such as spinal cord injury. To clarify the usefulness of warming or hot springs for the treatment of neurogenic bladder, the effect of warming on the body surface on the micturition reflex should be investigated.

Effect of Warming on Detrusor Muscle Contraction and the Micturition Reflex in Rats / 日本温泉気候物理医学会雑誌

Objectives: To investigate the effect of warming on contraction of the detrusor muscle and the micturition reflex in rats. Methods: Female Sprague-Dawley rats were used in this study. Changes in the contractile response of detrusor smooth muscle strips to 40 mM KCl caused by warming to 40°C and 42°C were evaluated by an isometric tension recording study. The effect of intravesical warming at 40.7±1.0°C on the micturition reflex was evaluated by continuous infusion cystometry in conscious rats. Results: Warming to 40°C and 42°C inhibited 40 mM KCl-induced contractions of detrusor smooth muscle strips by 10% and 15.5%, respectively. Intravesical warming at 40.7±1.0°C decreased the pressure threshold for inducing micturition by 14%, resting pressure by 30%, closing peak pressure by 22%, 2nd phase contraction duration by 36%, bladder contraction duration by 26%, and increased bladder compliance by 17%. Maximal voiding pressure and 1st phase contraction duration were unaltered. Conclusions: Our results demonstrated that warming relaxed the detrusor muscle and increased bladder compliance. This suggests that warming might be useful for treatment of low compliance bladder observed in the neurogenic bladder due to neurological diseases such as spinal cord injury. To clarify the usefulness of warming or hot springs for the treatment of neurogenic bladder, the effect of warming on the body surface on the micturition reflex should be investigated.

Excreção urinária de glicosaminoglicanos em crianças com bexiga neurogênica secundária a mielomeningocele / Urinary excretion of glycosaminoglycans in children with neurogenic bladder secondary to myelomeningocele

A excreção urinária de glicosaminoglicanos (GAG) está alterada em várias patologias do trato urinário; o padrão de excreção pode estar associado com o estado da doença. A excreção urinária de GAG em crianças com bexiga neurogênica (BN) secundária a mielomeningocele (MMC) pode também estar alterada, mas até a presente data não há detalhamento epidemiológico dos pacientes e não se correlacionou o padrão de excreção com grau de disfunção vesical. Analisamos a excreção urinária de um grupo bem definido de crianças de 17 pacientes com MMC, 10 meninos e 7 meninas (média de idade +- DP de 4,6 +- 2,9 anos) foram obtidas durante o exame cistométrico. As amostras do grupo controle foram obtidas de 18 crianças normais, 13 meninos e 5 meninas (6,9 +- 2,2 anos). Todas as crianças não estavam com infecção urinária, tinham função renal normal e não estavam sob tratamento farmacológico. A quantificação do GAG urinário total foi expressa em ug de ácido hexurônico/mg de creatinina e a proporção dos diferentes tipos de GAGs sulfatados foi obtida por eletroforese em gel de agarose. A avaliação cistométrica foi realizada utilizando aparelho de urodinâmica Dynapack modelo MPX816 (Dynamed, São Paulo, Brasil), a partir da qual o escore cistométrico foi calculado de acordo com procedimento recente publicado [14]. Não observamos diferença significativa na excreção urinária de GAG total entre meninos e meninas tanto no grupo com MMC (0,913 +- 0,528 vs 0,867 +- 0,434, p>0,05) como no grupo controle (0,546 +- 0,240 vs 0,699 +- 0,296, p>0,05). Os resultados mostraram também que a excreção de GAG urinário não se correlacionou com a idade tanto no grupo com MMC (r = -0,28, p>0,05) como no grupo controle (r = -0,40, p>0,05). Entretanto, a comparação dos dois grupos mostrou que o grupo com MMC excretava 52% a mais de GAG total que o grupo controle (0,894 +- 0,477 vs 0,588 +- 0,257, p<0,04). Nesses pacientes a excreção de GAG total não se correlacionou com a complacência vesical...

Urinary glycosaminoglycan (GAG) excretion is altered in a number of urinary tract disorders, and the excretion pattern may be associated with disease state and/or outcome. GAG excretion in children with neurogenic bladder secondary to myelomeningocele (MMC) may be affected, but existing data lack more detailed demographics and does not correlate excretion pattern with severity of bladder dysfunction. Here we analyzed GAG excretion in a well defined group of children with MMC and correlated the results with cystometric score. Urine specimens from 17 patients (10 boys, 7 girls) mean age +- SD, 4.6 +- 2.9 years) were obtained during cystometry. Control specimens were from 18 normal children (13 boys, 5 girls) (6.9 +- 2.2 years). All children were free from urinary infection, had normal renal function, and were not under pharmacological treatment. Total urinary GAG was assayed as ug hexuronic acid/mg urinary creatinin e, and sulfated GAGs were determined by agarose gel electrophoresis. Cistometry was done using a Dynapack MPX816 (Dynamed, São Paulo, Brazil), from wich a cystometry score was calculated according to a recent procedure [14]. There were no significant differences in total GAG excretion between male and female individuals in the MMC (0.913 +- 0.528 vs 0.867 +- 0.434, p>0.05) and control (0.546 +- 0.240 vs 0.699+- 0.296, p>0.05) groups. Also, urinary GAG did not correlated with age in the MMC (r = -0.28, p>0.05) and control (r = -0.40, p>0.05) groups. However, MMC patients excreted 52% more GAG than controls (0.894 +- 0.477 vs 0.588 +- 0.257, p<0.04). In these patients, total GAG excretion was not associated with vesical complicance alone (r = -0.18, p>0.05), but was significantly and negatively correlated (r = -0.56, p<0.05) with cystometric score. On average, MMC patients with worst scores (<9) excreted 81% more GAG than those with better scores (>9) (1.157 +- 0.467 vs 0.639 +- 0.133, p<0.04). Chondroitin sulfate prevailed in both groups...

Urodynamic Findings in an Awake Chemical Cystitis Rat Model Observed by Simultaneous Registrations of Intravesical and Intraabdominal Pressures / 대한배뇨장애요실금학회지

PURPOSE: The aim of this study was to investigate the effect of urinary bladder inflammation on bladder function in a rat chemical cystitis model. We also histologically confirmed the effects of inflammation in the detrusor on chronically inflamed bladder in rats. MATERIALS AND METHODS: A total of 13 female Sprague-Dawley rats were used in this study. In seven rats, intravesical instillation of HCl induced chemical cystitis, and the other rats with intravesical instillation of saline were used as the sham. After 2 weeks, cystometrograms were obtained with additional intraabdominal pressure measurements in all unanesthetized, unrestrained rats in metabolic cages. The rats were killed just after cystometry. The bladders were removed and examined histologically for mast cells and inflammatory changes. RESULTS: The rats with acute injury by HCl showed no differences in pressure parameters, including basal pressure, threshold pressure, and maximum bladder pressure, compared with the sham rats. They showed significantly increased bladder capacity, micturition volume, residual volume, and micturition interval compared with the sham group. They also showed an increased frequency of detrusor overactivity compared with the sham group. The percent of detrusor overactivity was 56.3% among the total intravesical pressure rises above 2 cmH2O. The histological findings of the rats with acute injury by HCl were consistent with chemical cystitis. CONCLUSIONS: Overlapping patterns of lower urinary tract symptoms and pelvic pain are common disease characteristics among interstitial cystitis patients. The situation in an animal model of interstitial cystitis is similar, as observed in this study by the histologic and awake cystometric examinations. However, the interstitial cystitis model showed detrusor overactivity during the filling phase without a decrease in bladder capacity and micturition intervals, which differs from the characteristics of overactive bladder patients.

The Effect of tolterodine Via Oral and Intravenous Administrations on Voiding in Awake Spontaneously Hypertensive Rats as an Overactive Bladder Model

PURPOSE: We investigated the effect of oral or intravenous tolterodine on cystometric parameters in awake spontaneously hypertensive rats (SHRs) as a model of overactive bladder (OAB). The aim of our study was to observe the experimental conditions required to reproduce the clinical pharmacological effects of tolterodine, as seen in humans, to decrease bladder pressure or increase bladder capacity. MATERIALS AND METHODS: We studied the effects of the most widely used antimuscarinic drug, tolterodine, on cystometric parameters via two different administrations (oral and intravenous) in awake SHRs. RESULTS: Oral administration of tolterodine 10 mg/kg(-1) body weight in awake rats did not change any cystometric parameters significantly. Intravenous administration of tolterodine 0.3 mg/kg(-1) body weight significantly decreased basal pressure (BP) and micturition pressure (MP), but showed no effect on micturition interval (MI) or bladder capacity (BC). CONCLUSION: Despite a high dose of tolterodine via an oral or an intravenous route, a decrease in BP or MP was the only effect on cystometrographic parameters in awake rats, whereas MI and BC were not significantly affected. Therefore, it is difficult to reproduce in awake rats as an acute response the cystometric increase in the MI that is observed in humans after chronic administration of antimuscarinic agents.

Long term evaluation of functional and morphological bladder alterations on alloxan-induced diabetes and aging: experimental study in rats / Avaliação funcional e morfológica tardia de alterações na bexiga secundárias ao diabetes induzido por aloxano e no envelhecimento: estudo experimental em ratos

PURPOSE: to evaluate structural and functional effects of Alloxan- induced diabetes and aging on bladder of rats. METHODS: evaluations were performed in three groups: A - 8 weeks of age, B - 44 weeks of age, C - 44 weeks of age with alloxan-induced diabetes. Muscle layer thickness, extracellular matrix fibrosis and collagen were quantified on digital images of bladder samples. Cystometric evaluations before surgical vesical denervation (SVD), included maximum cystometric capacity (MCC), maximum bladder pressure (MBP), bladder contraction frequency (VCF), duration of bladder contraction (DC), threshold pressure (TP) and bladder compliance (BC). After SVD, maximum cystometric capacity (MCC), BC and maximum urethral closing pressure (MUCP) were also measured. RESULTS: Reduced extracellular matrix fibrosis concentration and contraction strength were found in the bladders of group C. Before SVD, bladder compliance was not different between groups. Alterations were observed in MCC after SVD. CONCLUSIONS: We did not notice smooth muscle hypertrophy in Alloxan-induced diabetic rats after 44 weeks. There was alteration in the total and relative amount of fibrosis and collagen. The cystometric studies support the idea that this morphological alterations are important to determine the different bladder functional patterns found in the aging and the Alloxan-induced diabetic animals.

OBJETIVOS: avaliar alterações estruturais e funcionais da bexiga de ratos machos, associadas ao diabetes induzido por aloxano e ao envelhecimento. MÉTODOS: três grupos de animais: A - 8 semanas de idade; B- 44 semanas de idade; C - 44 semanas de idade com diabetes induzido por aloxano, foram avaliados. Realizadas medidas de espessura da camada muscular, fibrose de matriz extracelular e quantidade de colágeno, através de análise de imagem digital dos tecidos. Realizados também testes cistométricos, antes da desnervação vesical cirúrgica (DVC), para avaliar capacidade vesical (CV), intensidade máxima de contração vesical (IMCV) e complacência vesical. Após a DVC, foram avaliadas capacidade vesical após a desnervação (CVAD), complacência vesical (CV) e pressão de perda uretral (PPU). RESULTADOS: não foi observada hipertrofia da camada muscular nas bexigas; houve diminuição da concentração de fibrose da matriz extracelular e diminuição da força contrátil, e aumento da capacidade vesical no grupo C. CONCLUSÕES: a atrofia da camadas muscular da bexiga esta relacionada ao diabetes induzido por aloxano. O envelhecimento, como fenômeno isolado, provoca alterações nos parâmetros funcionais, porém associado ao diabetes, gera alterações na IMCV, CV e CVAD. Existe correlação entre alterações estruturais e funcionais nos animais diabéticos após a desnervação.

Evaluation of Neurogenic Bladder with Newly Developed Natural-fill Cystometric Device : Cases report

We developed a new, affordable, and easy-to-use natural-fill cystometric device to overcome the limitation of conventional cystometry, long been criticized for being unphysiological. The device was composed of one transurethral catheter, one rectal catheter, two digital manometers, and a portable computer. The transurethral and rectal catheters were connected to manometers, which were then connected to the computer. Three persons with neurogenic bladder were recruited for testing the device. To shorten the test duration, we gave patients 500 ml water before the test. As urine filled inside the bladder, the transurethral and rectal catheters transmitted respectively the intravesical and abdominal pressures to the digital manometers. The pressures were stored within the portable computer and turned into graphs indicating pressure changes. The natural-fill cystometry is thought to be a physiological test that is affordable and convenient because of its simple structure and small size.

Comparison between Natural Filling Cystometry and Conventional Retrograde Filling Cystometry in Patients with Stroke

OBJECTIVE: To compare the personally developed natural filling cystometry (NFC) and conventional retrograde filling cystometry (RFC) METHOD: NFC and RFC were performed on 15 patients with stroke. RESULTS: Patients were classified into three groups according to their usual lower urinary tract symptom. Four patients without urinary symptom did not show any detrusor overactivity or detrusor underactivity during NFC or RFC. Of the nine patients with urinary frequency or urgency, five (55.6%) showed detrusor overactivity during NFC and two (22.2%) during RFC. Two patients with straining showed detrusor underactivity during both tests. CONCLUSION: There was no significant difference of cystometric findings between NFC and RFC in case of patients without urinary symptom or with detrusor underactivity, but those patients with urinary symptom that is suspected of detrusor overactivity showed a more frequent detrusor overactivity during NFC than RFC. Therefore, NFC is thought to be a useful tool in evaluating the neurogenic bladder of stroke patients suspected of detrusor overactivity since it can detect detrusor overactivity which were less detectable in RFC.

Video cystometry in newborn with no apparent voiding dysfunction / 中华泌尿外科杂志

Objective To investigate the urodynamic pattern in infants with no apparent lower urinary tract symptoms. Methods Video cystometry with simultaneous perineal EMG recording was performed in 14 infants (10 male and 4 female,age 2 d to 2.5 months) with congenital renal pelvis dilatation who were screened for potential bladder dysfunction and VUR.No abnormal lower urinary tract was observed at examination. Results The post-voiding residual urine volume was (1.2?0.8)ml.The maximum bladder capacity was (33?24)ml,with voiding efficiency being 0.87?0.17.Detrusor instability occurred in 21%(3/14) of the subjects. The intermittent voiding pattern was observed in 64% (9/14) of the subjects and characterized by one or repeated increase in sphincter activity with simultaneous rise in voiding detrusor pressure curve. The maximum voiding detrusor pressure was (74?24)cmH 2O.The peak voiding detrusor pressure induced by dyssynergia could rise up to more than 100 cmH 2O. Conclusions In infants with no apparent lower urinary tract symptoms,bladder instability is uncommon,but the capacity is lower than the expected normal range.The high voiding pressure is induced by detrusor-sphincter dyssynergia.

Comparison between Conventional Cystometry and Diuretics Stimulated Filling Cystometry in Neurogenic Bladder after Spinal Cord Injury

OBJECTIVE: To determine whether cystometry performed by bladder filling stimulation using furosemide (DCMG) reveals different findings compared to conventional cystometry (CCMG) in the neurogenic bladder. METHOD: The maximum intravesical pressure (MPves) and compliance of the bladder in CCMG and DCMG were compared in 24 patients with neurogenic bladder after spinal cord injury. The MPves was estimated by urethral leak pressure or intravesical pressure at 600 ml filling. Compliance was calculated from the cystometric bladder capacity and the MPves. For CCMG, the bladder was filled with 32oC normal saline via 10 F urethral catheter at 50 ml/min until the patient leaked or filled 600 ml. Three hours later, 20 mg of furosemide was injected intravenously after intravenous infusion of 300 ml normal saline for DCMG. Ultrasound measuring of filled urine volume was made at least every 5 minutes until defined MPves. RESULTS: Significant differences were found between DCMG and CCMG in hyperreflexic neurogenic bladders with respect to: decrease in MPves (p0.05). CONCLUSION: We have found DCMG provides a more effective and near physiological diagnostic method of detrusor characteristics than CCMG in evaluating both genuine MPves and compliance in patients with hyperreflexic neurogenic bladder.

Influence of Menstrual Cycle on Cystometry / 대한산부인과학회잡지

Alteration in the hormone level associated with menstrual cycle influences the interaction between the urethra and bladder as well as detrusor function, maybe due to the common embryological origin of lower female genital and urinary tract. We tried to investigate the effect of the menstrual cycle on cystometric diagnosis through this retrospective study. 60 women with regular menstruation were enrolled in this study. The study groups were divided into 2 groups, Group I was women whose symptoms were not influenced by the menstrual cycle, Group II was women whose symptoms were adversely affected premenstrually. The majority of normal cystometric diagnosis were made in the luteal phase (Group I: 42.9% vs 4.4%, p<0.05; Group II: 50.0% vs 22.2%, p<0.05). But diagnosis of genuine stress incontinence, detrusor instability, mixed genuine stress incontinence and detrusor instability were frequently made in the follicular phase of mentruation. Normal cystometric diagnosis in the group II were more commom than the group II ( 36.8% vs 19.7%, p<0.05 ). The results of this study reveal that the timing of cystometric evaluation may influence the the detection of a positive diagnosis. In patients whose symptom are influenced by their menstrual cycle, the luteal phase may not be the correct time to make an accurate diagnosis.

The usefulness of rapid injection cystometry in the patients with acutely overdistended bladder / 대한비뇨기과학회지

It is known that if the detrusor integrity is maintained, a single coordinated sustained contractile relaxation curve can be observed on rapid injection cystometry in the paralytic period after overdistention, but there is no study on its clinical significance. This study is to know the diagnostic usefulness of such relaxation curve in assessing the possibility of the voiding function recovery in the paralytic period after overdistention. We performed rapid injection cystometrys in 12 patients who had no contraction and sense on medium injection cystometry until 450ml infusion after non-neurogenic acute urinary retention by various causes, and compared the duration for recovery and the presence or absence of a single coordinated sustained contractile relaxation curve, the bladder volume at the first time of such a relaxation curve and the maximum pressure of contraction curve. The results were as follows; 1. All of 3 patients without a single coordinated sustained contractile relaxation curve did not recover their voiding function until three months after overdistention. 2. All of 9 patients with single coordinated sustained contractile relaxation curve recovered their voiding function within four weeks. 3. In 9 patients who recovered their voiding function, the smaller the bladder volume at the first such relaxation curve, the shorter the duration for recovery(r=0.69767. p=0.036), but there is no relationship between the maximum pressure of contraction curve and the duration for recovery(r=-0.10192, p=0.794). In conclusion, rapid injection cystometry is a useful clinical test to check the possibility of voidingfunction recovery within a few weeks in the paralytic period after acute overdistention.

Cystometry in Normal Korean Adults / 대한비뇨기과학회지

Cystometry has contributed much to our understanding of normal vesical function and is of value in diagnosing the types of nervous system lesion which cause neurogenic vesical dysfunction. Authors performed cystometry on 90 Korean adults using an apparatus, the simple water manometer and the results were compared with those various investigators. Excretory and retrograde intermittent cystometry were performed and there was no significant difference between them. The first voiding desire started at 150~350 cc of fluid by retrograde cystometry and maximum voiding desire at 350~500 cc by retrograde cystometry and excretory cystometry 400~550 cc. The average pressure at the first voiding desire was 6.5cm H2O by retrograde cystometry and excretory cystometry 5.4cm H2O and the maximum voiding desire was 11 cm H2O by retrograde cystometry and excretory cystometry 9.2cm H2O. The maximum voluntary pressure was 40~100 cm H2O.

Cystometry in Normal Korean Males: Preliminary Report / 대한비뇨기과학회지

Cystometry was performed on 34 adult, healthy Korean males and the results were compared with those by various investigators. Retrograde intermittent, cystometry, retrograde continuous cystometry and excretory cystometry were used for this purpose. The instrument used was a simple water cystometer which has been used in our clinic. Effects of concentration and temperature of the fluids on the pressure of the bladder were also studied. Sterile water, normal saline, 5% saline, 10% saline and 20% saline in room temperature were administered for "the concentration study" and sterile water in 37C(degree), 38C, 39C, 40C, 41C, 45C, 35C, 30C, 25C, 23C, 22C, 21C, 20C and 10C were used respectively for "the temperature study". The results of both retrograde intermittent cystometry and retrograde continuous cystometry agreed well and there was no significant difference. In this study the first voiding desire starts at approximately 200-400 cc of fluid and the maximum voiding desire at approximately 350-450 cc of fluid The average pressure of the bladder ranges between 4.0-12.0 cm H20, the pressure at the first voiding desire is approximately 9.7 cm H2O and the pressure at maximum voluntary pressure over 32-130 cm H2O. No significant change in the pressure occurred due to changes in concentrations of the fluid but the maximum bladder capacity decreased as higher and lower concentrations of the fluid were administered. Also, higher and lower temperatures of the fluid did not cause significant changes in the pressure but the maximum bladder capacity decreased slightly.

Experimental Study on Ileocystoplasty: 3. Function of Bladder after ileocystoplasty / 대한비뇨기과학회지

The purpose of ileocystoplasty is to augment bladder capacity and the reconstructed bladder must not only be able to empty but also be able to contain urine in a physiologic manner. Low intravesical pressure with minimum reabsorption of electrolytes is desirable. In previous studies I have described a new reliable technique of ileocystoplasty with a satisfactory clinical application. The purpose of this study was to evaluate the physiologic aspects concerning several different types of ileocystoplasty. METHODS AND RESULTS: Healthy 8 Korean dogs were utilized. The animals weighed from 15 to 20kg. The two layer open flap method of ileocystoplasty was performed in four dogs and the other four dogs received ring plastic type. Intravesical pressure was measured by a water manometer and all measurements were read directly from the manometer tube. In order to obtain standard controls cystometrograms were done in 3 normal dogs. The normal dog bladder was found to respond to increased intravesical fluid and the average bladder capacity was 130cc. The voiding pressure was 28cm in water. The average fluid capacity of the reconstructed bladder was 120cc in two layer open flap method and 150c. c. in ring plastic method. The cystometry 10 minutes after intermuscular injection of 1.0cc. of 1:2000 prostigmin solution disclosed a definite increase in vesical fluid pressure in ring plastic type whereas the two layer open flap type did not show any elevation. Administration of 0.4mg of atropine intramuscularly decreased intravesical pressure in ring plastic type but was not significant in two layer open flap type. Injection of 10cc. of 0.25% pentothal sodium intravenously caused decrease of fluid pressure in both types. Emptying activity of the reconstructed bladder was measured by x-ray retrograde cystogram methods. The opaque medium remained in the ileal loop for 24 hours after onset of voiding in ring plastic type but no opaque medium was seen in the two layer open flap type. Absorption of electrolytes from the bladder after the two layer open flap ileocystoplasty was not altered significantly. The postoperative electrolyte plasma values of potassium and sodium chlorides were within normal limits. Histologic examinations of the ileal bladder 2 months after the open flap ileocystoplasty disclosed varying degrees of non-specific inflammatory reactions. No metaplasia or loss of mucous glands was seen.