Radiofrequency Sacral Rhizotomy for the Management of Intolerable Neurogenic Bladder in Spinal Cord Injured Patients

OBJECTIVE: To investigate the effect of radiofrequency (RF) sacral rhizotomy of the intolerable neurogenic bladder in spinal cord injured patients. METHOD: Percutaneous RF sacral rhizotomy was performed on 12 spinal cord injured patients who had neurogenic bladder manifested with urinary incontinence resisted to an oral and intravesical anticholinergic instillation treatment. Various combinations of S2, S3, and S4 RF rhizotomies were performed. The urodynamic study (UDS) was performed 1 week before RF rhizotomy. The voiding cystourethrogram (VCUG) and voiding diaries were compared 1 week before and 4 weeks after therapy. Total volume of daily urinary incontinence (ml/day) and clean intermittent catheterization (ml/time) volume of each time were also monitored. RESULTS: After RF sacral rhizotomy, bladder capacity increased in 9 patients and the amount of daily urinary incontinence decreased in 11 patients. The mean maximal bladder capacity increased from 292.5 to 383.3 ml (p<0.05) and mean daily incontinent volume decreased from 255 to 65 ml (p<0.05). Bladder trabeculation and vesicoureteral reflux findings did not change 4 weeks after therapy. CONCLUSION: This study revealed that RF sacral rhizotomy was an effective method for neurogenic bladder with uncontrolled incontinence using conventional therapy among spinal cord injured patients.

The Effects of Botulinum Toxin A on the Detrusor Muscle in Rats / 대한비뇨기과학회지

PURPOSE: There is little data on the effects of botulinum toxin A (BoTx A) on detrusor muscle published in the literature. An experimental study was conducted to investigate the effect of BoTx A on the detrusor muscle in rats. MATERIALS AND MTHODS: Sprague-Dawley rats were used to make the detrusor muscle strip (length: 8mm, width: 2mm). An isometric force transducer in the physiologic salt solution was used to measure the contraction and relaxation of this muscle strip. A contraction was induced by acetylcholine (ACh) and electrical field stimulation (40V, 20Hz, 3sec), and relaxation was induced by verapamil and sodium nitroprusside. The BoTx A concentration was 0.1U/ml. The relaxation and contraction of the detrusor muscle in the BoTx A-treated group were analyzed and compared with those in the control group. RESULTS: The time to the maximum contraction induced by electrical field stimulation was lengthened and the time of recovery to the basal state after terminating electrical field stimulation was also increased by BoTx A (p<0.05). However, the contractile reaction induced by ACh and the relaxing reaction induced by verapamil and sodium nitroprusside after maintaining the maximum contraction induced by ACh 10 4M was not influenced by BoTx A. CONCLUSIONS: The results of this experimental study suggest that the time delay of the maximum contraction induced by electrical field stimulation occurred by blocking ACh release at the neuronal endings and the time delay of the recovery to the basal state after terminating electrical field stimulation occurred by reducing cholinesterase activity.

The Effects of Botulinum Toxin A on the Detrusor Muscle in Rats / 대한비뇨기과학회지

PURPOSE: There is little data on the effects of botulinum toxin A (BoTx A) on detrusor muscle published in the literature. An experimental study was conducted to investigate the effect of BoTx A on the detrusor muscle in rats. MATERIALS AND MTHODS: Sprague-Dawley rats were used to make the detrusor muscle strip (length: 8mm, width: 2mm). An isometric force transducer in the physiologic salt solution was used to measure the contraction and relaxation of this muscle strip. A contraction was induced by acetylcholine (ACh) and electrical field stimulation (40V, 20Hz, 3sec), and relaxation was induced by verapamil and sodium nitroprusside. The BoTx A concentration was 0.1U/ml. The relaxation and contraction of the detrusor muscle in the BoTx A-treated group were analyzed and compared with those in the control group. RESULTS: The time to the maximum contraction induced by electrical field stimulation was lengthened and the time of recovery to the basal state after terminating electrical field stimulation was also increased by BoTx A (p<0.05). However, the contractile reaction induced by ACh and the relaxing reaction induced by verapamil and sodium nitroprusside after maintaining the maximum contraction induced by ACh 10 4M was not influenced by BoTx A. CONCLUSIONS: The results of this experimental study suggest that the time delay of the maximum contraction induced by electrical field stimulation occurred by blocking ACh release at the neuronal endings and the time delay of the recovery to the basal state after terminating electrical field stimulation occurred by reducing cholinesterase activity.

Inhibitory Effect of Purinergic Antagonists to the Electrically Stimulated Contraction of Canine Detrusor Muscle / 대한비뇨기과학회지

Cholinergic neurotransmission plays a major role in the postganglionic nerve evoked contractile response of the urinary bladder, but there is atropine-resistant contraction that is not completely blocked by atropine and may be related with nonadrenergic-noncholinergic (NANC) neurotransmission. Among the NANC neurotransmission, adenosine triphosphate(ATP) is an important transmitter in purinergic neurotransmission which is known to many vertebrates including human beings. The aim of this study is to determine the role and existence of purinergic neurotransmission in the canine detrusor muscle. In vitro contractile responses to electrical stimulation after pretreatment with atropine were measured in the presence of purinergic antagonist such as theophylline, b, r-methylene ATP and verapamil. Field stimulation( frequency 0.5-40 Hz; pulse width l ms; 10V square wave) produced a contraction that was abolished by tetrodotoxin( 0.1uM) and reduced by 42.5% after atropine ( 10uM) pretreatment. The contractile response was reduced by 44.1%, 30.3% and 60.1 % after the treatment of theophylline( 1uM, 10uM and 100uM) in the presence of atropine, 11.1%, 22.7% and 30.3% after the treatment of b, r-methylene ATP ( 5uM, 50uM and 500uM) and 17.6%, 39.4% and 60.1 % after the treatment of verapamil( 0.1u M, 1uM and 10uM) at 20 Hz frequency. These reduced contractile responses were statistically significant (p <0.05), especially in higher concentration, and relatively frequency-dependent and verapamil decreased the contractile response most significantly. These data demonstrate that purinergic neurotransmission is related to the contraction of canine detrusor muscle. On the other hand contractile responses were persisted after pretreatment of higher dose antagonist, which suggests that another mechanism such as peptidergic mechanism be related to the contraction of canine detrusor muscle.

Effect of Nitric Oxide Generated by Photolysis on the Rat Detrusor / 대한비뇨기과학회지

The mechanism underlying the bladder relaxation during filling is not fully understood. Nitric oxide played an important role in mediation of relaxation in between vascular and various types of non-vascular smooth muscle. Theoretically, an increased activity of nitric oxide-releasing inhibitory nerves to the detrusor could be a factor keeping the bladder relaxed during the filling phase. The role of nitric oxide in detrusor muscle is still not fully characterized. The objective of this study was to determine the effect and action mechanism of nitric oxide in the rat detrusor. In this experiment, nitric oxide was generated by photolysis using a long wavelength UV lamp ( 366nm) under nitric oxide, NO2-carrying molecules( streptozotocin, NG-nitro-L-arginine). This study were consisted of in vitro examination using Polygraph(Grass Model 79E, Quincy, MA, U.S.A.), radioimmunoassay for guanosine 3', 5'-cyclic monophosphate and nitrite assay to identify the production of nitric oxide. Nitric oxide was generated by photolysis from nitric oxide and NO-containing compounds. The longer UV irradiated and the stronger photo energy of light source, the more produced the amount of nitric oxide. The relaxation induced by nitric oxide-containing compound ( streptozotocin) is much more than that by NO2-containing compound(NG-nitro-L-arginine). Nitric oxide was a potent but labile relaxing substance to the rat detrusor strip. The maximal relaxation under streptozotocin treatment and 60 second UV irradiation was approximately 70.0 % comparing to carbachol induced contraction. That relaxation was significantly inhibited by pyrogallol, methylene blue treatment. The photo-induced nitric oxide directly activated soluble form of guanylate cyclase resulting in increased concentration of guanosine 3' 5'-cyclic monophosphate in detrusor strips. From the above results. it was confirmed that nitric oxide relaxed the detrusor muscle, which means that L-arginine/nitric oxide pathway may be present in the mechanism of relaxation. Therefore, new therapeutic approach using exogenous nitric oxide will be an attractive modality in treating functional voiding disturbances such as detrusor hyperreflexia and bladder instability.

Actions of potassium channel openers in rat detrusor urinae

This study was performed to investigate the action of potassium channel openers on the mechanical activity of detrusor muscle isolated from rats. Detrusor muscle strips, 15 mm in length, were myographied isometrically in an isolated organ bath. P 1060, RP 49356 and BRL 38277, potassium channel activators, reduced the basal tone and diminished the phasic activity of detrusor concentration-dependently. P 1060, RP 49356 and BRL 38227 suppressed the maximal responses to bethanechol and shifted the concentration-response curves of bethanechol-induced contraction to the right. RP 49356 and BRL 38227 reduced the contraction by low (20 mM) concentration of potassium. P 1060, however, diminished the high (80 mM) and low (20 mM) concentration of potassium-induced contraction. Glibenclamide, an inhibitor of ATP-dependent potassium channel, antagonized the suppressive action of P 1060, RP 49356 and BRL 38227 on the basal tone. Apamin or procaine did not antagonize it significantly. Based on these results, it is suggested that the relaxation of detrusor muscle strip caused by P 1060, RP 49356 and BRL 38227 may predominantly involve opening of the same potassium channel, i.e., the ATP-dependent potassium channel.

The recovery of the destusor muscle function in acute urinary retention patients due to benign prostatic hyperplasia / 대한비뇨기과학회지

We studied 33 patients with acute urinary retention due to benign prostatic hyperplasia for evaluating the recovery of the detrusor muscle function and its affecting factors through the serial urodynamic studies prospectively. And ninety nine patients were studied for risk factors of acute urinary retention retrospectively. Among the 33 patients studied prospectively, detrusor contraction at immediate decompression was observed in 20 cases(60.7%) and was not observed in 13 cases (39.3%), and there was statistically significant difference in the retained volume and duration of retention between two groups. In 10 cases of non-contraction group at immediate decompression, serial urodynamic studies showed that detrusor contraction recovered within 2 days in 4 cases, but in 6 cases no detrusor contraction was found upto 5 days. Overall, detrusor function recovered in 80% or patients within 2 days. Among the patients studied for risk factors, hesitancy and interruption were the most common symptoms whereas urgency and urge incontinence were the least common. In conclusion, it is thought that acute urinary retention due to benign prostatic hyperplasia is resulted from temporary or permanent loss of detrusor muscle function due to overdistension, and the degree of retention duration and retained volume expressly affect the severity of loss of detrusor muscle function. The risk of acute urinary retention is higher in benign prostatic hyperplasia patients with obstructive symptoms rather than irritative symptoms.

Existance of cholinergic and purinergic receptor on the detrusor muscle of rat urinary bladder / 영남의대학술지

This study was aimed at investigation of the stimulatory innervations on the rat urinary bladder. Detrusor muscle strips of 15 mm long were suspended in isolated muscle chambers containing 1 ml of PSS maintained at 37℃ and aerated with 95% O²/5% Co². Isometric myography was performed, and the results were as followings: Muscle strips showed “on-contraction” by electric field stimulation (EFS) frequency-dependently. The EFS-induced contraction was not affected by hexamethonium, a ganglion blocker, but abolished by tetrodotoxin, a nerve conduction blocker. Physostigmine, a cholinesterase inhibitor enhanced the EFS-induced contraction which was inhibited by hemicholinium, an inhibitor of choline uptake at the cholinergic nerve ending. Such an EFS-induced contraction was antagonized by atropine only partially, and the atropine-resistant portion was completely abolished by the desensitization of purinergic receptors by prolonged incubating of the strips in the presence of high concentration of ATP. Bethanechol, a cholinergic agonist, elicited concentration-dependent contraction. Adenosine triphosphate (ATP), a purinergic agonist, induced a weak but concentration-dependent contraction of short duration. Bethanechol-induced contraction was not affected by ATP-desensitization, and ATP-induced contraction was not affected by tetrodotoxin. These results suggest that there are at least two main stimulatory components of innervations in the detrusor muscle, cholinergic muscarinic and purinergic; and those receptors are independent each other.

Effects of Prostaglandins and Oxytocin on the Contractility of Isolated Detrusor Muscle strips in Rabbit / 대한비뇨기과학회지

The effects of prostaglandins and oxytocin on the contractility of detrusor muscle was investigated in the isolated detrusor muscle strips of rabbit. Contractility was measured on the Physiograph with force transducer by means of Magnus method in the Locke`s solution. The results were summarized as follows. 1. Prostaglandin E, and F2a enhanced the contractility of detrusor muscle and that was more potent in prostaglandin E2. 2. Indomethacin reduced the contractility of detrusor muscle. 3. The effects of prostaglandin E2 and F2a on the contractility of detrusor muscle was not blocked by indomethacin and atropine. 4. Oxytocin enhanced the contractility of detrusor muscle significantly and the patterns of enhancement was similar that of the prostaglandins. 5. Progesterone reduced the contractility but the estrogen didn`t affect the contractility of detrusor muscle. 6. The effect of oxytocin on the contractility of detrusor muscle was not affected by progesterone estrogen and also was not blocked by indomethacin and atropine. From the above results, it was suggested that oxytocin enhance not only the contractility of detrusor muscle but also its action was similar that of prostaglandins.

Effects of Several Autonomic Drugs on the Responses of the Isolated Rabbit Detrusor Muscle Strips to Electrical Stimulation / 대한비뇨기과학회지

Effects of several autonomic drugs on the responses of the isolated rabbit detrusor muscle strips to electrical stimulation were investigated. Electric stimulation of the detrusor muscle strips elicited two different responses; (a) contraction followed by relaxation in 14 cases out of 22 experiments, and (b) contraction only in 8 cases. The contraction responses to electrical stimulation were significantly reduced in the presence of either atropine or regitine, respectively The relaxation response to electrical stimulation was abolished in the presence of propranolol. Addition of norepinephrine evoked one of following three responses: (a) relaxation in 10 cases out of 19 experiments, (b) contraction in 6 cases, and (c) contraction followed by relaxation in 4 cases. The relaxation response to norepinephrine was reversed. in the presence of propranolol, to a contraction response which was then abolished after administration of regitine. The contraction response to norepinephrine was reversed, in the presence of regitine, to a relaxation response which was then abolished after administration of propranolol. Acetylcholine elicited contraction of the isolated detrusor muscle strip, and this was abolished in the presence of atropine These results suggest that the rabbit detrusor muscle is innervated by both cholinergic and adrenergic fibers and that the detrusor muscle contains cholinergic receptors as well as adrenergic a-and b-ones. Contrary to the popular opinion that the detrusor muscle predominantly contains adrenergic b-receptors, it seems likely that the adrenergic receptors differ in predominancy of either a or b which elicits contraction or relaxation, respectively, according to different areas of the muscle.

Effects of Several Autonomic Drugs on the Responses to Electrical Stimulation of the Detrusor Muscle Strips in Amyda Japonica / 대한비뇨기과학회지

A strip of the detrusor muscle of amyda japonica was provided in a bath which contained frog-Ringer's solution and the responses to electrical stimulation were observed by means of an isotonic myograph. The effects of several autonomic drugs on the responses to electrical stimulation of the strip were examined. The following results were obtained. 1. Electrical stimulation of the isolated detrusor muscle strip elicited contraction response and the response showed two peaks at 20 and 80 Hz between 1-200 Hz stimulation frequencies. 2. The responses to electrical stimulation of the detrusor muscle strip was completely abolished in the presence of tetrodotoxin and resumed after washing the bath fluids. 3. The responses to electrical stimulation of the detrusor muscle strip were significantly reduced in the presence of atropine, guanethidine, or regitine. 4. Clonidine did not affect the contraction response to electrical stimulation of the detrusor muscle strip. These results suggest that the detrusor muscle of Amyda japonica is innervated by both cholinergic and adrenergic nerves and it contains adrenergic alpha-receptors and that presynaptic alpha-adrenoceptors known to modify inhibit the release of neurotransmitters from the nerve endings are not involved.

Effects of Several Autonomic Drugs on the Responses to Electrical Stimulation of the Detrusor Muscle Strips in Amyda Japonica / 대한비뇨기과학회지

A strip of the detrusor muscle of amyda japonica was provided in a bath which contained frog-Ringer's solution and the responses to electrical stimulation were observed by means of an isotonic myograph. The effects of several autonomic drugs on the responses to electrical stimulation of the strip were examined. The following results were obtained. 1. Electrical stimulation of the isolated detrusor muscle strip elicited contraction response and the response showed two peaks at 20 and 80 Hz between 1-200 Hz stimulation frequencies. 2. The responses to electrical stimulation of the detrusor muscle strip was completely abolished in the presence of tetrodotoxin and resumed after washing the bath fluids. 3. The responses to electrical stimulation of the detrusor muscle strip were significantly reduced in the presence of atropine, guanethidine, or regitine. 4. Clonidine did not affect the contraction response to electrical stimulation of the detrusor muscle strip. These results suggest that the detrusor muscle of Amyda japonica is innervated by both cholinergic and adrenergic nerves and it contains adrenergic alpha-receptors and that presynaptic alpha-adrenoceptors known to modify inhibit the release of neurotransmitters from the nerve endings are not involved.

The Experimental Study for Effect of Prostaglandin on Detrusor Muscle / 대한비뇨기과학회지

In this investigation, the bladder of guinea pig was longitudinally mounted in the muscle chamber and contracted by electrical field stimulation(EFS). It was purposed to elucidate the physiological significance of prostaglandin(PG) on the neurotransmitter release from nerve ending. 1. The inhibitory response of 5 x 0.0000001 g/ml atropine was significant only by high frequency (p<0.05) However. the curve of frequency-response were shifted to left upward by 5 x 0.00000001 g/ml phentolamine, it were not significant. Because the contraction was completely abolished by 0.00000001 and 0.0000001g/ml tetrodotoxin, it was evident that the responses to electrical stimulation are entirely due to nerve mediated excitation. 2. The curve of frequency-response were significantly shifted to left upward by 5x 0.00000001 and 5x0.0000001 g/ml arachidonic acid(p<0.05). Though the contraction were inhibited by 5x0.0000001g/ml atropine it was not significant. 3. The curves of frequency-response showed dose-response relation by 5x 0.00000001, 5 x0.000000001 and 5x 0.0000000001g/ml PGE2. The contraction was significant only by high frequency in 5x0.0000000001g/ml PGE. and the frequency-response curves were significant in varying frequencies in 5x0.000000001and 5x0.00000001g/ml PGE2(p<0.05). 4. Although the contraction was found by 5x0.0001g/ml aspirin, the curves of frequency-response were not significant. The contraction by 5x 0.0001g/ml aspirin and 5x0.000001/ml arachidonic acid was not significant too.

Responses of the Detrusor Muscle Strips of the Amyda Japonica and the Rabbit to some Autonomic Drugs / 대한비뇨기과학회지

Recent reports suggest that the responses of the detrusor muscle to the hypogastric nerve stimulation and some autonomic drugs may not be identical among various species. In this study, the responses of the isolated detrusor muscle strips of the Amyda Japonica and the rabbit to catecholamines were compared, and the type of the adrenergic-receptors was investigated. The results obtained were as follows : 1. Catecholamines (norepinephrine and epinephrine) evoked only contraction in the isolated detrusor muscle of the Amyda Japonica and relaxation in the preparation of the rabbit. 2. The contraction-response in the Amyda Japonica was blocked in the presence of regitine, an adrenergic alpha-receptor blocking agent. 3. The relaxation-response in the rabbit was abolished by pre-treatment with propranolol, an adrenergic beta-receptor blocking agent. 4. Acetylcholine elicited contraction in both of the isolated detrusor muscle strips of the Amyda japonica and the rabbit, and the response was completely blocked in the presence of atropine. 5. The results described above suggest that catecholamines exert excitatory effect on the detrusor muscle of the Amyda japonica as it contains adrenergic alpha-receptors and inhibitory effect on the same preparation of the rabbit as it contains the adrenergic beta-receptors. Key Word : amyda japonica,alpha receptor, beta receptor.