Effect of Mirabegron combined with Silodosin on detrusor hyperactivity with impaired contractile / 中国康复理论与实践

@#Objective To observe the clinical effect of Mirabegron combined with Silodosin on detrusor hyperactivity with impaired contractile (DHIC).Methods From September, 2019 to December, 2021, 40 patients with DHIC in the Department of Urology of Beijing Bo'ai Hospital were selected and randomly divided into control group and experimental group, with 20 cases in each group. The control group took Silodosin only, and the experimental group took Mirabegron in addition, for four weeks. The urinary diary, residual urine volume, Overactive Bladder Symptom Score (OABSS) and quality of life (QOL) score were compared before and after treatment.Results A total of 18 patients in the control group and 19 in the experimental group finished the trial. After treatment, the number of night urination per day, the residual urine volume and QOL score improved in the control group (P<0.01); the number of urination per 24 hours, the number of night urination per day, the volume per urination, the residual urine volume, the daily urgency score, the OABSS score and QOL score improved in the experimental group (P<0.01). The number decrease of urination per 24 hours, the volume decrease of per urination, the daily urgency score decrease, the OABSS score decrease and QOL score decrease were more in the experimental group than in the control group (P<0.01). The adverse reactions included palpitations, increased heart rate, dyspareunia, increased blood pressure, gastric discomfort, postural hypotension, and retrograde ejaculation, and there was no significant difference between two groups (P > 0.05).Conclusion The efficacy of Mirabellone combined with Silodosin on DHIC is better than Silodosin only, and there was no significant increase in drug-related adverse effects.

Establish the urodynamic classification of male patients with benign prostatic obstruction and analysis of the effect of transurethral resection of the prostate on different classifications / 中华泌尿外科杂志

Objective:To establish the urodynamic classification of middle-aged and elderly men with benign prostatic obstruction(BPO), and to analyze the efficacy of transurethral resection of the prostate(TURP) on various types of patients.Methods:A retrospective analysis of middle-aged and elderly male patients with non-neurogenic lower urinary tract symptoms(LUTS) who underwent urodynamic tests from January 2010 to December 2018, including 793 patients with BPO. Urodynamics examination of detrusor without contraction needs to complete cystoscopy to diagnose BPO. During urodynamic examination, the detrusor uninhibited contraction induced by spontaneous or stimulation during the bladder filling period is diagnosed as overactivity of the bladder detrusor(DO), and the LinPURR chart indicates the detrusor underactivity(DU). Based on the persistence of BPO leading to DO, DU, and decreased bladder compliance, 793 male patients with BPO with LUTS were divided into four types, including type Ⅰ(BPO: n=164, 20.7%), type Ⅱ(BPO combined with DO: n=333, 42.00%), type Ⅲ(BPO combined with DU: n=267, 33.7%), type Ⅳ(BPO combined with decreased bladder compliance: n=29, 3.7%). The preoperative comparison between groups showed that the age of type Ⅰ-Ⅳ gradually increased, and the age of type Ⅰ was significantly smaller than other types [(67.3±8.2)years, (69.7±7.7)years, (71.5±7.9)years, (72.4±7.1)years, P<0.05]. Compared with other types, the type Ⅰ’s IPSS-S[(9.1±3.6)points vs.(10.4±3.1) points, (9.2±3.3) points, (10.4±3.1)points, P<0.05], IPSS-V[(13.5±3.4) points vs. (14.2±3.5)points, (14.0±3.5)points, (14.2±2.9)points, P<0.05], IPSS scores[(22.6±5.4)points, (24.7±4.9)points, (23.1±5.3)points, (24.6±4.7)points, P<0.05] were significantly lower than other groups, the maximum bladder capacity [(332.6±83.2)ml vs.(221.4±80.8)ml, (286.7±108.2)ml, (242.3±103.4)ml, P<0.05], the functional bladder capacity was significantly higher than other types[(215.2±90.0)ml, (148.5±76.0)ml, (154.9±87.2)ml, (121.2±72.9)ml, P<0.05]. Type Ⅱ’s IPSS-S[(10.4±3.1)points vs.(9.1±3.6)points, (9.2±3.3)points, P<0.05], nocturia frequency[(3.7±1.8)times vs.(3.2±1.8)times, (3.2±1.6)times, P<0.05], IPSS score[(24.7±4.9)points vs.(22.6±5.4)points, (23.1±5.3)points, P<0.05], quality of life scores [(4.9±0.9) points, (4.6±0.9)points, (4.6±0.9)points, P<0.05] was significantly higher than type Ⅰ and type Ⅲ ( P<0.05). Type Ⅲ and Ⅳ had higher residual urine than type Ⅱ[(121.3±96.4)ml, (121.3±96.4)ml vs.(71.2±73.5)ml, P<0.05]. Type Ⅳ’s IPSS-S[(10.4±3.1)points vs. (9.1±3.6)points, (9.2±3.3)points, P<0.05], IPSS-V[(14.2±2.9) points vs.(13.5±3.4)points, (14.0±3.5)points, P<0.05], the frequency of nocturia[(3.8±1.9)times vs.(3.2±1.8)times, (3.2±1.6)times, P<0.05] was significantly higher than that of type Ⅰ and type Ⅲ, and the quality of life score was higher than type Ⅰ and type Ⅲ[(4.3±0.8)points vs.(4.7±0.9)points, (4.6±0.9)points, P<0.05]. type Ⅱ and type Ⅳ’s bladder compliance[(21.4±24.2)ml/cmH 2O, (11.0±11.4)ml/cmH 2O vs.(33.9±23.7)ml/cmH 2O, (33.1±32.7)ml/cmH 2O, P<0.05], maximum bladder capacity[(221.4±80.8)ml, (242.3±103.4)ml vs.(332.6±83.2)ml, (286.7±108.2)ml, P<0.05], functional bladder capacity[(148.5±76.0)ml, (121.2±72.9)ml vs.(215.2±90.0)ml, (154.9±87.2)ml, P<0.05] were significantly less than type Ⅰ and type Ⅲ( P<0.05). From November 2016 to November 2018, 60 middle-aged and elderly male patients with confirmed BPO and TURP were selected, including type Ⅰ( n=17, 28.3%), type Ⅱ ( n=23, 38.3%), and Ⅲ type ( n=11, 18.3%), Ⅳ type( n=9, 15.1%). Type IV patients are significantly older than other types ( P<0.05), bladder compliance is significantly worse than other types( P<0.05), the maximum bladder capacity is smaller than other types( P<0.05). The follow-up started 3 months after the operation. The content of the follow-up included IPSS, IPSS-S, IPSS-V, nocturia frequency, undisturbed sleep time, nocturia quality of life score, and life quality score. Results:The IPSS scores of type Ⅰ, type Ⅱ, and type Ⅲ after TURP were significantly improved compared with preoperative(19.8±6.2 vs.3.4±1.8; 21.9±5.2 vs.4.6±2.6; 21.5±6.2 vs.5.7±4.6, P<0.05), type Ⅳ urine storage symptom score (9.1±4.1 vs.4.3±3.7), nocturia frequency(3.6±1.5vs.2.3±1.6), nocturia quality of life score (25.3±6.9 vs.31.4±13.7) Compared with preoperatively, there was no significant improvement( P>0.05). The quality of life score improvement of type Ⅳ patients was significantly lower than that of type Ⅰ, type Ⅱ, and type Ⅲ (10.9±9.1 vs.12.2±9.0, 14.4±5.7, 12.7±5.8, P<0.05). The IPSS score of type Ⅳ patients was significantly higher than that of type Ⅰ(7.0±5.8 vs.3.4±1.8), and the nocturia quality of life score was significantly lower than that of each group (31.4±13.7 vs.37.5±4.2, 38.7±3.5, 37.8±3.8, P<0.05). Conclusions:For middle-aged and elderly men with BPO, we divide them into four types based on the results of urodynamic examinations, type Ⅰ(simple BPO), type Ⅱ(BPO combined with DO), type Ⅲ(BPO combined with DU), type Ⅳ(BPO combined with bladder compliance decline). Type Ⅰ patients have the best bladder function, and TURP has the best effect; type Ⅱ has a high symptom score and poor quality of life, and can benefit after TURP; type Ⅲ bladder function is poor, and surgery should be performed as soon as possible to prevent further deterioration of bladder function; type Ⅳ bladder function is the best poor, IPSS score and quality of life score are high, TURP surgery is not effective.

Effect of Pelvic Floor Muscle Training on Neurogenic Detrusor Overactivity / 中国康复理论与实践

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.

Role of urodynamics in evaluation of lower urinary tract dysfunction in women of pelvic organ prolapse

Background: Utero-vaginal prolapse is a common gynecological disorder, result from weakness of musculoskeletal structure that support the pelvic organ. Although it is not an emergency situation but severely affect the quality of life. Women with utero-vaginal prolapse may present with lower urinary tract dysfunction but association of urological changes with UV prolapse and beneficial effect of surgery on these changes is still debatable. Urodynamic study such as cystometry and uroflowmetry help in better understanding of lower urinary tract dysfunction and assist to plan appropriate surgical management thereby reduce chances of postoperative voiding dysfunction.Methods: A total of 30 women of pelvic organ prolapse with lower urinary tract dysfunction, over a period of one year, were subjected to urodynamic studies after thorough evaluation by history, examination and standardized questionnaire both pre and post operatively and data analysed.Results: In present study, urodynamic study identified urinary dysfunction in 93.34% of women recruited in study. Obstruction was present in 36.67% of women. Detrusor overactivity along with obstruction was seen in 20.00% of women. Urodynamic stress incontinence and urodynamic stress incontinence along with obstruction was identified in 13.33% of women each and detrusor overactivity was observed in 10.00% of women.Conclusions: In present study it was found that, if surgical management of pelvic organ prolapse is planned according to urodynamic study, it will improve urologic profile of patients. To conclude that urodynamic study should be an integral part of diagnostic work up of uterovaginal prolapse patients require larger sample size and at least 6 months follow-up duration after surgery.

Urodynamic Mechanisms Underlying Overactive Bladder Symptoms in Patients With Parkinson Disease / 대한배뇨장애요실금학회지

PURPOSE: To assess the urodynamic findings in patients with Parkinson disease (PD) with overactive bladder symptoms. METHODS: We performed a retrospective chart review of all PD patients who were seen in an outpatient clinic for lower urinary tract symptoms (LUTS) between 2010 and 2017 in a single-institution. Only patients who complained of overactive bladder (OAB) symptoms and underwent a video-urodynamic study for these symptoms were included. We excluded patients with neurological disorders other than PD and patients with voiding LUTS but without OAB symptoms. RESULTS: We included 42 patients (29 men, 13 women, 74.5±8.1 years old). Seven patients (16.7%) had a postvoid residual (PVR) bladder volume >100 mL and only one reported incomplete bladder emptying. Detrusor overactivity (DO) was found in all 42 patients (100%) and was terminal in 19 (45.2%) and phasic in 22 patients (52.4%). Eighteen patients had detrusor underactivity (DU) (42.3%). Later age of PD diagnosis was the only parameter associated with DU (P=0.02). Patients with bladder outlet obstruction (BOO) were younger than patients without BOO (70.1 years vs. 76.5 years, P=0.004), had later first sensation of bladder filling (173.5 mL vs. 120.3 mL, P=0.02) and first involuntary detrusor contraction (226.4 mL vs. 130.4 mL, P=0.009). CONCLUSIONS: DO is almost universal in all patients with PD complaining of OAB symptoms (97.1%). However, a significant percentage of patients also had BOO (36.8%), DU (47%), and increased PVR (16.7%) indicating that neurogenic DO may not be the only cause of OAB symptoms in PD patients.

Efficacy and Safety of OnabotulinumtoxinA in Patients With Neurogenic Detrusor Overactivity Caused by Spinal Cord Injury: A Systematic Review and Meta-analysis / 대한배뇨장애요실금학회지

PURPOSE: OnabotulinumtoxinA (BoNT-A) is a promising therapy for treating neurogenic detrusor overactivity (NDO) in individuals with spinal cord injury (SCI). This systematic review and meta-analysis aimed to carry out an in-depth review and to make an objective estimation of the efficacy and safety of BoNT-A on NDO after SCI. METHODS: The PubMed, Embase, and Cochrane databases were searched for all relevant articles published from 2001 to 2016 that referred to NDO, SCI, and BoNT-A or botulinum toxin A. All data were recorded in an Excel spreadsheet by 2 individual reviewers. Review Manager version 5.3 was used to carry out the meta-analysis. RESULTS: This analysis included 17 studies involving 1,455 patients. Compared with placebo and baseline, BoNT-A was effective in increasing maximum cystometric capacity, volume at first involuntary detrusor contraction, cystometric bladder capacity (all P < 0.00001), compliance (P=0.001), and the number of patients with complete dryness (P=0.0003), and decreasing detrusor pressure, the number of patients with no involuntary detrusor contractions, the maximum flow rate, the incidence of detrusor overactivity (all P < 0.00001), and the number of urinary incontinence episodes (P=0.001). There were no statistically significant differences between doses of 200 U and 300 U or between injections into the detrusor and submucosa. There were no life-threatening adverse events. CONCLUSIONS: BoNT-A is effective and safe in treating NDO after SCI. There were no statistically significant differences between doses of 200 U and 300 U or between injecting into the detrusor and submucosa. However, more high-quality randomized controlled trials are still needed.

Influence of two kinds of botulinum toxin A injection on the symptoms severity, bladder function and quality of life in patients with neurogenic detrusor overactivity combined with urinary incontinence / 中国医师进修杂志

Objective To investigate the influence of botulinum toxin A (BTX-A) injection in detrusor muscle region and detrusor muscle combined with bladder triangle region on the symptoms severity, bladder function and quality of life in patients with neurogenic detrusor overactivity (NDO) combined with urinary incontinence. Methods Sixty patients with NDO combined with urinary incontinence were chosen in the period from March 2011 to June 2017. The patients were divided into control group and observation group according to random digits table method with 30 cases each. The patients in control group were treated with detrusor muscle region BTX-A injection, and the patients in observation group were treated with detrusor muscle combined with bladder triangle region BTX-A injection. The number of urinary incontinence for every day, detrusor muscle overactivity (DO) duration, average urine volume, bladder detrusor muscle urine storage period of maximum pressure (Pdetmax), bladder compliance (BC), volume at first involuntary detrusor muscle contraction (VFIDC), quality of life of urinary incontinence (I-QOL) score and incidences of adverse reaction before and after treatment were compared between 2 groups. Results The number of urinary incontinence every day, DO duration, average urine volume, Pdetmax, BC, VFIDC and I-QOL score after treatment in observation group were significantly better than those in control group: (2.84 ± 0.56) times vs. (6.18 ± 1.22) times, (80.05 ± 9.49) s vs. (125.16 ± 12.72) s, (378.57 ± 91.03) ml vs. (255.88 ± 75.95) ml, (30.19 ± 5.47) cmH2O (1 cmH2O=0.098 kPa) vs. (47.33 ± 7.79) cmH2O, (10.04 ± 1.71) ml/cmH2O vs. (8.09 ± 1.32) ml/cmH2O, (249.60 ± 76.19) ml vs. (195.19 ± 60.72) ml and (63.17 ± 9.60) scores vs. (54.46 ± 6.29) scores, and there were statistical differences (P＜0.05). There was no statistical difference in incidence of adverse reaction (P＞0.05). Conclusions Detrusor muscle combined with bladder triangle region BTX-A injection in patients with NDO combined with urinary incontinence relieves the symptoms severity, improves the bladder function and quality of life and not increases the adverse reactions risk.

Efficacy and Adverse Events Associated With Use of OnabotulinumtoxinA for Treatment of Neurogenic Detrusor Overactivity: A Meta-Analysis / 대한배뇨장애요실금학회지

PURPOSE: OnabotulinumtoxinA is used widely for the treatment of neurogenic detrusor overactivity. We conducted a systematic review and meta-analysis to assess its efficacy and safety for neurogenic detrusor overactivity treatment. METHODS: A systematic literature review was performed to identify all published randomized double-blind, placebo-controlled trials of onabotulinumtoxinA for neurogenic detrusor overactivity treatment. MEDLINE, Embase, and the CENTRAL were employed. Reference lists of retrieved studies were reviewed carefully. RESULTS: Six publications involving 871 patients, which compared onabotulinumtoxinA with a placebo were analyzed. Efficacy of onabotulinumtoxinA treatment was shown as a reduction of the mean number of urinary incontinence episodes per day (mean difference, -1.41; 95% confidence interval [CI], -1.70 to -1.12; P<0.00001), maximum cystometric capacity (135.48; 95% CI, 118.22–152.75; P<0.00001), and maximum detrusor pressure (-32.98; 95% CI, -37.33 to -28.62; P<0.00001). Assessment of adverse events revealed that complications due to onabotulinumtoxinA injection were localized primarily to the urinary tract. CONCLUSIONS: This meta-analysis suggests that onabotulinumtoxinA is an effective treatment for neurogenic detrusor overactivity with localized advent events.

The role of TRPV1 receptor in detrusor overactivity induced by partial bladder outlet obstrucion in rats / 中华泌尿外科杂志

Objective To investigate the role of transient receptor potential vanilloid tpye 1 (TRPV1) in the pathological process of detrusor overactivity (DO) induced by partial bladder outlet obstruction (BOO).Methods Between June 2014 and December 2014,40 female Wistar rats received partial urethral ligation and urodynamic analysis 6 weeks after.Urinary bladder and dorsal root ganglion (DRG) were removed and RT-PCR,Western Blot and IHC were performed to investigate the expression and location of TRPV1 in control and DO rats.Effect of different concentrations of TRPV1 agonist,as well as TRPV1 antagonist,was also evaluated with isolated detrusor strips.Results 40 female Wistar rats received BOO surgery and 26 of them developed DO.Immunohistochemistry observed linear TRPV1-reactive staining mainly in sub-urothelial and muscular layer.Expression of TRPV1 mRNA and protein in urinary bladder [(0.18±0.02) vs.(0.36 ±0.03),P＜0.05] and dorsal root ganglia (DRG) [(0.41 ±0.05) vs.(0.66 ±0.04),P ＜ 0.05] significantly increased in BOO induced OAB rats.In isolated detrusor strips studies,the amplitude [(0.26 ±0.05)g vs.(0.69 ±0.11)g,P ＜0.05] and frequency [(5.91 ±0.59) Hz vs.(8.75 ± 0.54) Hz,P ＜ 0.05] of contractions of DO tissues were significantly higher than that of control ones.Capsaicin significantly increased the amplitude but not frequency of detrusor intrinsic contractility and this effect was enhanced in OAB conditions.All changes induced by capsaicin were blocked by capsazepine pre-incubated.Conclusions In BOO induced DO rats,over-expressed TRPV1 was involved in DO pathological process by directly sensitizing bladder afferent fibers or indirectly enhancing detrusor intrinsic properties.

Efficacy of different dose of Botulinum toxin A in treatment of patients with neurogenic detrusor overactivity / 局解手术学杂志

Objective To research the efficacy of different dose botulinum toxin A in the treatment of patients with neurogenic detrusor overactivity due to spinal cord injury or multiple sclerosis.Methods The datas of 43 patients with neurogenic detrusor overactivity caused by spinal cord injury or multiple sclerosis which accepted treatment in our hostipal were analyzed.And 38 patients were followed up for 12 weeks,of which 20 cases were treated with 200 U botulinum toxin A,and 18 cases received 100 U botulinum toxin A.The average age of 38 patients was 45.3 years old,and the ratio of famale was higher.The incontinence quality of life(I-QOL)changed from baselin after 6 weeks and 12 weeks was recorded.Resluts The final outcomes showed that the efficacy of botulinum toxin A with 200U was better than that with 100 U according to I-QOL score,and the difference was statistical significance(P <0.05).Conclusion The botulinum toxin A has positive effect on neurogenic detrusor overactivity,and the efficacy of 200 U injection is better than that of 100 U.

Neuromodulation Therapy for Neurogenic Detrusor Overactivity after Spinal Cord Injury (review) / 中国康复理论与实践

Neurogenic detrusor overactivity (NDO) often occurs after spinal cord injury, which often causes urinary tract infection, vesi-coureteral reflux, or even renal failure, and seriously impacts on the patient's quality of life. This paper reviewed the mechanism, the com-mon treatment methods, and neuromodulation theray of NDO after spinal cord injury, and elaborated percutaneous posterior tibial nerve stimulation, pudendal nerve regulation and the sacral neuromodulation respectively.

The urodynamic study of neurogenic bladder with vesicoureteral reflux / 实用医学杂志

Objective In children with neurogenic bladder and secondary vesicoureteral reflux , we ex-plore the differences of urodynamics between the children with and without detrusor overactivity (DO). The study is in order to provide theoretical support for clinical practice. Method From January 2013 to March 2016, 110 children with NB vesicoureteral reflux diagnosed by videourodynamics were recruited. There are 63 boys and 47 girls aged 4-12 years with mean of 7.5 years. According to presence of DO during the filling phase, the patients were divided into DO (n=32) and non-DO groups (n=78). The time of bladder ureter reflux perfusion and detru-sor pressure were recorded for calculation of bladder compliance when the reflux occurs in the two groups. Maximum cystometry capacity and maximum detrusor pressure were recorded for calculation of the bladder compliance at the end of filling in the two groups. According to the reflux flow level, patients were divided into mild reflux (Ⅰ-Ⅱdegrees), severe reflux (Ⅲ-Ⅴdegrees). The difference of reflux side of the two groups and reflux degree were an-alyzed. Result In DO group, bladder capacity and compliance were (107.5 ± 21.3) mL and (5.6 ± 1.8) mL/cmH2O, respectively, when bladder ureter reflux occurs. In non-DO group, the bladder ureter reflux bladder capac-ity and compliance were (124.7 ± 35.6) mL, (6.7 ± 2.3) mL/cmH2O. The two parameters were significantly differ-ent in both groups. In DO and non-DO groups, the detrusor pressure were (21.7 ± 8.3) cmH2O and (19.6 ± 9.2) cmH2O, respectively, which does not have any significant statistical difference. At the end of filling, bladder capac-ity and compliance in DO group were (198.7 ± 36.5) mL, (5.8 ± 1.9) mL/cmH2O. In non-DO group, bladder ca-pacity and compliance were (223.8 ± 40.2) mL and (6.5 ± 1.4)mL/cmH2O. In both group, there are difference. In DO group, there are 20 cases of unilateral reflux (63%) and 12 cases of bilateral reflux (37%). In non-DO group, there are 31 cases of unilateral reflux (40%) and 47 cases of bilateral reflux (60%). The reflux of the two groups are also serious. Conclusion Small bladder capacity and poor bladder compliance are the urodynamic characteris-tics of children with NB and secondary vesicoureteral reflux when DO occurs.

Transurethral resection of the prostate versus transurethral holmium laser enucleation of the prostate for benign prostatic hyperplasia with bladder detrusor overactivity / 中华男科学杂志

<p><b>Objective</b>To compare and analyze the effects of transurethral resection of the prostate (TURP) and transurethral holmium laser enucleation of the prostate (HoLEP) in the treatment of benign prostatic hyperplasia (BPH) with bladder detrusor overactivity.</p><p><b>METHODS</b>his study included 51 cases of BPH with bladder detrusor overactivity treated by TURP and another 58 treated by HoLEP. We evaluated the urination of the two groups of patients during the recovery period and at 3 and 6 months postoperatively.</p><p><b>RESULTS</b>There were no statistically significant differences in such baseline data as the blood PSA level, prostate volume, International Prostate Symptom Score (IPSS), and quality of life (QOL) between the two groups of patients, except in effective bladder capacity, which was higher in the TURP than in the HoLEP group (［315±59］ vs ［287±76］ ml, P<0.05). Urine storage symptoms were obviously improved in both of the groups postoperatively, with the storage symptoms score significantly decreased from 12.6±4.9 preoperatively to 7.5±3.9 at 3 months and 6.1±4.2 at 6 months after surgery in the TURP group (P<0.01) and from 13.7±5.7 to 7.9±4.2 and 7.0±5.1 in the HoLEP group (P<0.01). HoLEP manifested significant advantages over TURP in the postoperative urethral catheterization time (［2.7±0.8］ vs ［5.1±1.2］ d, P<0.05), postoperative bladder contracture time (［4.1±1.9］ vs ［5.8±2.4］ d, P<0.05), postoperative hospital stay (［4.4±1.8］ vs ［5.9±2.5］ d, P<0.05), and improvement of the maximum urinary flow rate, which was increased from (7.9±3.7) ml/s preoperatively to (16.8±4.3) ml/s at 3 months after surgery in the HoLEP group and from (8.6±3.2) ml/s to (14.6±4.3) ml/s in the TURP group (P<0.05).</p><p><b>CONCLUSIONS</b>Both TURP and HoLEP can improve bladder function and detrusor overactivity in BPH patients, with similar effects in improving urination at 3 to 6 months after surgery. However, HoLEP has more advantages over TURP during the period of postoperative recovery.</p>

Effect of replication-defective herpes simplex virus mediated kynurenine aminotransferase on detrusor overactivity in rats with spinal cord injury / 中华泌尿外科杂志

Objective To evaluate if replication-defective herpes simplex virus mediated kynurenine aminotransferase Ⅱ (HSV-KAT Ⅱ) could inhibit detrusor overactivity (DO) in rats with spinal cord injury by bladder wall injection.Methods From June 2012 to July 2013,48 male Wistar rats with T10 spinal cord transection (SCT) were randomly divided into normal saline group,HSV group and HSV-KAT Ⅱ group (n=16 each group).Normal saline (40 μl),HSV or HSV-KAT Ⅱ (40 μl,1×107 plaque forming unit viruses) was injected into the rat bladder wall of according group by 1 week after SCT.Three weeks after injection,cystometry was performed and the virus transfected efficiency,expression of KAT Ⅱ in L6-S1 dorsal root ganglia were examined.Results The DO number,DO amplitude,maximum voiding pressure and volume inducing voiding were decreased significantly by 59.6％-61.1％,21.6％-24.2％,30.3％-34.4％ and 44.1％-46.5％ (P＜0.01),while voiding efficiency,the time to first DO were increased significantly by 40.7％-47.7％ and 30.1％-49.0％ (P＜0.01) in the HSV-KAT Ⅱ group compared with normal saline group and HSV group.However,the leaking volumes were no significantly different among the 3 groups (P＞0.05).The relative intensity of KAT Ⅱ protein (0.50±0.13 versus 0.28±0.07,P＜0.05) and mRNA (0.78±0.06 versus 0.51±0.08,P＜0.01) were increased significantly in HSV-KAT Ⅱ group than those in HSV group.Conclusion HSV-KATⅡ bladder wall injection inhibits DO and may improve detrusor-sphincter dyssynergia in rats with spinal cord injury.

Short-Term Effect of Percutaneous Bipolar Continuous Radiofrequency on Sacral Nerves in Patients Treated for Neurogenic Detrusor Overactivity After Spinal Cord Injury: A Randomized Controlled Feasibility Study

OBJECTIVE: To investigate the short-term effects of bipolar radiofrequency applied to sacral nerves to treat neurogenic detrusor overactivity in patients with spinal cord injury. METHODS: Ten patients with spinal cord injury with neurogenic detrusor overactivity were recruited. These subjects were randomized to two groups: intervention (n=5) and control (n=5), members of which received conventional treatment. Voiding diary, International Consultation on Incontinence Questionnaire (ICIQ) and the urinary incontinence quality of life scale (IQOL) data were obtained and an urodynamic study (UDS) was performed before and after intervention. In the intervention group, percutaneous bipolar continuous radiofrequency (CRF) was performed on both the S2 and S3 nerves in each patient. RESULTS: In a comparison of daily frequency and number of urinary incontinence and ICIQ and IQOL scores at baseline and at 1 and 3 months after intervention, all variables achieved a significant effect for time (p0.05). CONCLUSION: Percutaneous bipolar CRF applied to sacral nerves might be an effective therapy for neurogenic overactive bladder that reduces urinary incontinence and improves quality of life.

Diagnosis, Management and Physician Collaboration for Neurogenic Bladder / The Japanese Journal of Rehabilitation Medicine

Neurogenic bladder (NB) is a lower urinary tract dysfunction (LUTD) caused by underlying neural diseases that affect the central nervous system and peripheral nerves. LUTD includes urine storage dysfunction and voiding dysfunction. LUTD causes various lower urinary tract symptoms (LUTS) and has a negative impact on patients' quality of life. In addition, urinary tract infection and upper urinary problems can be associated with LUTD, especially with NB. Thus, the diagnosis and management of NB in patients with underlying neural diseases are very important in patient care. LUTD can be screened by a careful history taking of LUTS and simple, non-invasive measures such as postvoid residual urine measurement and uroflowmetry. A urodynamic study is required for precise evaluation of urine storage function and voiding function. Urine storage dysfunction is predominantly caused by detrusor overactivity (involuntary detrusor contractions during bladder filling) and occasionally caused by sphincter deficiency, while voiding dysfunction is caused by detrusor-sphincter dyssynergia (DSD) and/or impaired detrusor contraction. Urodynamic evaluation is mandatory for proper management of NB. Management of detrusor overactivity includes pharmacotherapy using anticholinergics and selective β3-receptor agonist, and neuromodulation. For refractory cases, surgery such as bladder augmentation can be a treatment option. Pharmacotherapy for voiding dysfunction includes α-blockers for DSD and cholinergic agents for impaired detrusor contraction. However, their efficacy has been limited, and not a few patients with NB need urinary management by clean intermittent catheterization (CIC). The goals of urinary management in patients with NB are to render patients free from significant urinary problems, maintain continence, and provide better quality of life. For this purpose, close collaboration between physicians involved in rehabilitation medicine and urology is very important and should be promoted.

Análise da expressão das metaloproteinases e seus inibidores teciduais no músculo detrusor de pacientes com obstrução infravesical por hiperplasia prostática benigna / Expression of metalloproteinases and their tissue inhibitors in the detrusor muscle of patients with bladder outlet obstruction due to benign prostatic hyperplasia

Introdução: A obstrução infravesical (OIV) de longo prazo secundária a hiperplasia prostática benigna (HPB) pode causar alterações funcionais e morfológicas na bexiga. Um dos principais eventos consiste no aumento da deposição de colágeno e perda de complacência vesical, levando a alteração de armazenamento e esvaziamento urinário. O aumento da deposição de colágeno na matriz extracelular (MEC) da musculatura detrusora é a principal razão para a diminuição da complacência vesical. Na bexiga, assim como em outros órgãos, este fenômeno depende da atividade equilibrada de enzimas proteolíticas, incluindo as metaloproteinases (MMP) e os seus inibidores endógenos (inibidores teciduais de metaloproteinases-TIMPs). Como estes fenômenos são desconhecidos na bexiga obstruída, o objetivo deste estudo foi avaliar a expressão gênica de colágeno, MMPs e seus inibidores na bexiga de pacientes com obstrução infravesical. Material e Métodos: Foi realizada uma análise prospectiva e controlada de 43 pacientes com OIV devido a HPB, que foram submetidos à ressecção transuretral da próstata (RTUP) entre 2011 e 2012. Como grupo controle foram selecionados espécimes de músculo detrusor de 10 pacientes que foram submetidos a prostatectomia radical retropúbica devido adenocarcinoma de próstata. Todos estes pacientes tinham idade menor que 60 anos, tamanho de próstata menor que 30 gramas ao ultra-som e escore internacional de sintomas prostáticos (IPSS) menor que 7. Todos os pacientes foram submetidos a estudo urodinâmico pré e pós operatório (após 6 meses). A biópsia de fragmento de músculo da bexiga foi realizada ao final da RTUP e colocada em solução estabilizadora de RNA para quantificação da expressão de colágenos I e III, metaloproteinases de matriz 1, 2 e 9, e inibidores de MMPs (TIMP1, TIMP2 e RECK) na bexiga de pacientes com HPB. Os genes descritos foram avaliados através da técnica de reação em cadeia da polimerase quantitativa em tempo real (qRT-PCR)....

Introduction: Long-term Bladder outlet obstruction (BOO) secondary to Benign prostatic Hyperplasia (BPH) can cause functional and morphological abnormalities in the bladder, such as increased collagen deposition and loss of compliance, leading to urinary storage and voiding symptoms. A decrease in bladder compliance is known to be correlated with deterioration of renal function. Increased deposition of collagen in the extracellular matrix (ECM) is the primary reason for a decreased compliance. In the bladder, as in other organs, this phenomenon is dependent on the balanced activity of proteolytic enzymes, including matrix metalloproteinases (MMPs) and their endogenous inhibitors, tissue inhibitors of metalloproteinases (TIMPs). The imbalance between MMPs and TIMPs is a key regulator in ECM turnover. Since these mechanisms are unknown in the obstructed bladder, the objective of this study was to evaluate gene expression of collagen, MMPs and their inhibitors in patients with bladder outlet obstruction due to BPH. Material and Methods: We performed a prospective and controlled analysis of 43 patients with BOO due to BPH who underwent transurethral resection of the prostate (TURP) from 2011 to 2012. The control group was comprised of 10 bladder specimens from patients with < 60 years who underwent radical prostatectomy with an International Prostatic Symptom Score (IPSS) < 8 and prostate volume < 30 grams. All patients underwent urodynamic analysis pre and post operatively after 6 months. A biopsy of the bladder muscle was performed at the end of TURP for analysis of collagen, metalloproteinases and TIMPs gene expressions. For this purpose we used the quantitative real time polymerase chain reaction method (qRT-PCR)...

Neural Mechanisms Underlying Lower Urinary Tract Dysfunction

This article summarizes anatomical, neurophysiological, and pharmacological studies in humans and animals to provide insights into the neural circuitry and neurotransmitter mechanisms controlling the lower urinary tract and alterations in these mechanisms in lower urinary tract dysfunction. The functions of the lower urinary tract, to store and periodically release urine, are dependent on the activity of smooth and striated muscles in the bladder, urethra, and external urethral sphincter. During urine storage, the outlet is closed and the bladder smooth muscle is quiescent. When bladder volume reaches the micturition threshold, activation of a micturition center in the dorsolateral pons (the pontine micturition center) induces a bladder contraction and a reciprocal relaxation of the urethra, leading to bladder emptying. During voiding, sacral parasympathetic (pelvic) nerves provide an excitatory input (cholinergic and purinergic) to the bladder and inhibitory input (nitrergic) to the urethra. These peripheral systems are integrated by excitatory and inhibitory regulation at the levels of the spinal cord and the brain. Therefore, injury or diseases of the nervous system, as well as disorders of the peripheral organs, can produce lower urinary tract dysfunction, leading to lower urinary tract symptoms, including both storage and voiding symptoms, and pelvic pain. Neuroplasticity underlying pathological changes in lower urinary tract function is discussed.

Urinary dysfunction with detrusor hyperactivity in women with Parkinson's disease cannot be blamed as a factor of worsening motor performance / Disfuncao urinaria com hiperatividade detrusora nao e fator de risco para progressao do desempenho motor em mulheres com doenca de Parkinson

Introduction Detrusor hyperactivity is the leading cause of urinary dysfunction in Parkinson's disease (PD). There are few studies correlating PD clinical aspects with this autonomic feature. Methods A cohort of 63 women with PD were prospectively examined for assessment of clinical aspects and disease severity using unified Parkinson's disease rating scale and Hoehn-Yahr scale, respectively. The urologic function was evaluated by the urodynamic study. Two groups were categorized at this time - groups with and without detrusor hyperactivity. After seven years, the same parameters were re-evaluated. Results Progression of the disease on mental scores was found in the group with detrusor hyperactivity. On follow-up, clinical symptoms and severity did not show significant worsening between the groups. Conclusion Detrusor hyperactivity is a frequent urodynamic finding in PD, and even though it is associated with dopaminergic dysfunction, it cannot be blamed as a factor of worsening motor performance, but is probably associated with poor cognitive and mental prognosis. .

Introdução Hiperatividade detrusora (HD) é a principal causa de disfunção urinária na doença de Parkinson e poucos estudos correlacionam aspectos clínicos da doença com este componente autonômico. Métodos Foi avaliada uma coorte de 63 pacientes com DP quanto aos aspectos clínicos e gravidade global da doença utilizando as escalas UPDRS e Hoehn-Yahr. A função urológica foi avaliada através de estudo urodinâmico. Foram então categorizados dois grupos: pacientes com e sem HD. Após sete anos os mesmos parâmetros foram reavaliados. Resultados Houve progressão da doença quanto aos escores mentais no grupo com HD. Na reavaliação dos grupos os sintomas motores não evidenciaram piora significante. Conclusão HD é um achado urodinâmico frequente em pacientes com DP. Embora associada à disfunção dopaminérgica, HD não pode ser considerada fator de risco para piora do desempenho motor, mas provavelmente está associada com pior prognóstico mental e cognitivo. .

Efficacy and Safety of Solifenacin in Neurogenic Detrusor Overactivity / 中国康复理论与实践

Objective To assess the efficacy and safety of solifenacin in patients with neurogenic detrusor overactivity (NDO). Methods 50 patients with NDO received solifenacin 5 mg/d. During the treatment period, the voiding diary, Patient Perception of Bladder Condi-tion-Scale (PPBC-S) and side effects were recorded. Results 2 weeks and 12 weeks later, the volume of the catheterization every time in-creased from (224.2 ± 15.7) ml at baseline to (302.6 ± 23.3) ml and (301.3 ± 21.1) ml (P<0.05);the volume of leakage every day decreased from (753.9±121.7) ml to (444.1±87.1) ml and (449.1±89.2) ml (P<0.05);PPBC-S score decreased from (5.12±0.072) to (4.36±0.073) and (4.36±0.068) (P<0.05). There were 3 cases (6%) with dry mouth, and no patients complained dry eyes and blurred vision. Conclusion Solif-enacin is safe and effective, and can significantly improve the quality of life in patients with NDO.