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Upper urinary tract damage secondary to voiding dysfunction is an important reason for the end stage of renal diseases. We evaluated clinical manifestations and outcomes of various treatments, and analyzed underlying mechanism in order to improve guidance for their therapy. Two hundred seventy one patients suffering from upper urinary tract damage caused by voiding dysfunction diseases from Jan. 1999 to Oct. 2009 were enrolled and data of urodynamics, urinary imaging and renal functions before and after treatments were retrospectively analyzed. Bladder pressure was over 40 cm H[2]O in 78.2% of the patients, and among them, the average pressures for the first voiding desire was 42.3 +/- 6.0 cm H[2]O with the maximum bladder pressure of 67.3 +/- 5.8cmH[2]O in 271 patients. In 157 patients the residual urine bladder volume was 100ml, but smaller and moderate residual urine volume was occurring in 37.9% of the upper urinary tract damage patients, which implied that residual urine is not an appropriate indicator. 89.3% of the patients exhibited bladder outlet obstruction and 95.2% of those suffered moderate to severe LUTS. After the relief of obstruction treatment and resulting intravesical pressure reduction, 264 patients showed a good recovery and in 202 of them hydronephrosis have disappeared and their renal function returned to normal, due to reduced bladder pressure. We found that high bladder pressure is the main reason of upper urinary tract damage caused by voiding dysfunction. Thus, attention should be paid in order to achieve and maintain reduced bladder pressure below the safety line
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Objective To investigate the therapeutic effect of post-traumatic complex posterior urethral stricture in the male patients.Methods Clinical data of 479 male patients with post-traumatic complex posterior urethral stricture were reviewed.One-stage resection of the stenosis and end-to-end anastomosis was performed in 422 patients and scrotal flap with blood pedicle posterior urethroplasty in 57.Results The mean operation time was 115 minutes(range,90-140 minutes).The mean blood loss was 225 ml(range,100-300 ml).No intraoperative blood transfusion was needed.The mean follow-up time was 15 months(range,12-24 months).Among the 422 patients performed end-to-end anastomosis,386 patients had good voiding and 36 had dysuria because of the formation of anastomotic stoma valve(21 patients)or stricture ring(15 patients).The problem was resolved by transurethral valve/stricture ring resection.Among 57 patients undergone posterior urethroplasty,45 patients had good voiding nine patients were found with anterior urethra-skin tube anastomotic stoma stricture,of which four patients were treated by urethral dilatation and five by endourethrotomy; three patients were found with posterior urethra-skin tube anastomotic stoma stricture,of which one patient was treated by urethral dilation and two by endourethrotomy.Conclusions One-stage resection of the stenosis and end-to-end anastomosis is the main treatment for post-traumatic complex posterior urethral stricture.If the condition of the patients does not allow the end-to-end anastomosis,posterior urethroplasty can be an alternative.
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BACKGROUND: Muscarine receptor plays a key role in adjusting contraction of detrusor muscle cell, and M3R, isoforms of its receptor, can mediate contraction of detrusor muscle cell directly. Ca2+ is the direct factor in stimulating contraction of detrusor muscle cell. Of several 10 kinds of Ca2+conjugable receptors protein, Ca2+ conjugated with different receptor proteins can adjust various reactions.OBJECTIVE: To investigate the effect of Ca2+-calmodulin (Ca2+-CaM) on contraction of M3R-mediated detrusor muscle cell.DESIGN: Compared observation .on the basis of detrusor muscle cell.SETTING: Ourological Center of Southwest Hospital of the Third Military Medical University of Chinese PLA.MATERIALS: The experiment was completed at Central Laboratory of Southwest Hospital of the Third Military Medical University of Chinese PLA. Healthy Wistar rats were selected in this study.METHODS: The primary cultured detrusor muscle cells were divided into experimental group and control group. Cells were inoculated in 6-well plate, and 10-4 mmol/L carbachol and M2R antagonist were added to cells of the experimental group during 70% confluence to block M3R and M2R respectively. Ca2+ concentration and CaM activity were detected by Ca2+ test kit and CaM test kit respectively.MAIN OUTCOME MEASURES: Changes of [Ca2+]I concentration and CaM activity of cells in both groups.RESULTS: The mean channel fluorescence values (log) of [Ca2+]I and CaM were higher in the experimental group than those in the control group(3.26±0.38, 2.06±0.12; 2.87±0.34, 2.14±0.24, P ＜ 0.05).CONCLUSION: Results in this study suggest that Ca2+-CaM participates in adjusting contraction of M3R-mediated detrusor muscle cells through signal transduction.
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BACKGROUND: Urinary incontinence can be divided into stress, urgent and mixed types, they can not be easily distinguished only basing on clinical experience, which often result in misdiagnose or improper treatment OBJECTIVE: To discuss the value of urodynamical inspection, especially stress leak point pressure (SLPP) determination in the diagnose of female stress urinary incontinence.DESIGN: Retrospective paralleled comparison observation.SETTING: Center of General Urology Department, Southern Hospital,Third Military Medical University of Chinese PLA PARTICIPANTS: Totally 120 female patients who received medical treatment in the uropoiesis surgical department of the Southwest hospital due to urinary incontinence between January 1996 and May 2002 were enrolled in this experiment.gle was determined and considered as normal if it was ＜100° and abnormal if ＞ 100°. Urethral tilt angle is judged as normal if ＜ 45° and abnormal if ＞45°; Urethrovesical junction (when static state) was judged as normal if not tion: including fulling urinary bladder pressure measurement, static urethral Cystourethrography classification standard: type Ⅰ refers to posterior urethrovesical angle vanished with urethral tilt angle＜45° and the biggest urethra closure pressure＞20 cmH2O; type Ⅱ: refers to posterior urethrovesical angle vanished with urethral tilt angle＞45° and the biggest urethra closure pressure＜20 cmH2O; type Ⅲ refers to normal posterior urethrovesical angle with urethral tilt angle＜45° and the biggest urethra closure pressure ＞20 cmH2O. SLPP classification standard: typeⅠ: SLPP ＞120 cmH2O; type Ⅱ: SLPP of 90- 120 cmH2O; type Ⅲ: SLPP ＜ 60 cmH2O;type Ⅱ/Ⅲ: SLPP of 60 - 90 cmH2O.compared with that of cystourethrographic classification.RESETS: Totally120 patients all remained in the final result analysis.stress urinary incontinence, 64 cases as symptomatic stress urinary incontinence including 28 cases of unstable bladder and 36 cases of low compliclassification: of the 56 genuine stress urinary incontinence, 20 cases were diagnosed as type Ⅰ; 16 cases as type Ⅱ and 10 cases as type Ⅱ/Ⅲ; 10cases as type Ⅲ. Two classification was proved of 100% consistency in type Ⅰ and Ⅲ, and 94.1% and 90.1% in type Ⅱ and type Ⅱ/Ⅲ respectively, difference was not remarkable (P＞0.05).CONCLUSION: SLPP determination can be used to make accurate classification of female genuine stress urinary incontinence, possessing important instructive significance for the treatment.
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Objective To study the innervation between baldder and rectum.Methods The retrograde fluorescent double labeling method was used.Propidium Iodide(PI)was injected into the right wall of the rectum of male SD rats and Bisbenzimide(Bb)into their right wall of urinary bladder.Results The fluorescent double labeled neurons were found in the right L6-S3 and L1-L3 dorsal root ganglia(DRG).Conclusion DRG cells at L6-S3 and L1-L3 simultaneously innervate the rectum and the urinary bladder,explaining that the abnormal micturition due to chronic constipation may be caused by axis reflex at the level of the peripheral process of DRG cells.
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Objective To study the causes, prophylaxis, and treatment of the severe complications due to transurethral electrovaporization of the prostate (TVP). Methods We analyzed the complications found in 1 910 men with moderate and severe symptoms of prostatism treated with TVP from August 1997 to February 2003 and studied the causes, prophylaxis, and treatment of the severe complications due to TVP. Results Severe complications were found in 78 cases (4.1%). Late mass bleeding in 35 cases (0.18%) was resulted from the abscission of coagulated necrotic tissue of the prostate after TVP. Extraperitoneal water extravasation (hydrocele) in 27 cases (0.14%) was caused by the early incision of the peritoneum in TVP and could be prevented by avoiding early incision of the peritoneum and stopping operation in time. Severe urethral stricture in 9 cases (0.05%) was caused by using thick sheath of cystoscope and cutting the neck of urinary bladder improperly. Urinary bladder explosion in 2 cases (0.01%) was caused by accumulation of air during the process of TVP, but could be protected by removing the air and water in urinary bladder at intervals. Incontinence in 2 cases (0.01%) was resulted from the injured urinary sphincter muscle. Acute renal failure in 3 cases (0.015%) was caused by hypotension. Conclusion Severe complications due to TVP can be prevented and treated. The occurrence rate of severe complications can be decreased by the proper preventive measures and skilled techniques of the operators.
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Objective To establish a brand new model of bladder outflow obstruction (BOO) at single cell level in vitro to offer a more stable and scientific experimental base. Methods Recurrent mechanical stretch generated by vacuum facility was applied to cells attached to flexible membrane of special culture plate, which led to 10%, 20% and 30% elongation of them. Immunocytochemistry was used to analyze the expression of ?-actin (sign of contractile phenotype) and RT-PCR was performed to detect the dynamic changes of mRNA expression of PCNA and Western blotting to protein expression of PCNA and cdk2 kinase. MTT assay was used to observe the changes of proliferation of cells. Results In the case of gradual elongation, the expression of ?-actin rose at first and fell afterwards; the mRNA expression of PCNA and protein expression of PCNA and cdk2 kinase rose gradually. Changes in 30% elongation group were greater than the control (P
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0.05), but changed to be significant after stimulation in the rats stimulated respectively with formalin and saline (P
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0.05), and there was no significant difference in instable contraction occurring at filling period. As compared with those before stimulation, the cervicitis model group had increased basic pressure and per-micturition pressure and significantly decreased micturition pressure, vesical volume and vesical compliance lowered (P0.05), but the changes were significant after stimulation (P
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Objective To investigate the effects of prostatitis on secretory alterations of urethral glands in rats.Methods Twenty adult Sprague-Dawley rats were randomly divided into prostatitis group and control group.The prostatitis group(n=10) was injected with 0.1 ml Freund's complete adjuvant at each lateral lobe while the control group(n=10) with 0.1 ml 0.9% physiological saline.Two weeks later the rats were killed and the urethral glands were harvested for pathologic examination and immunohistochemical staining.Results ① There was a great quantity of lymphcells and mononuclear cells infiltrating the prostate gland in prostatitis group while there was no inflammatory cells in control group.② AB-PAS pathologic examination results in urethral glands showed that the grume area,diameter,optical density in control group were significantly less than those of the prostatitis group(P
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Objective To explore the mechanism of the referred pains in pelvic pain due to chronic prostatitis and the relation between pain due to prostatitis and pelvic floor muscle dysfunction. Methods The retrograde fluorescent double labeling and immunohistochemistry were used. A total of 24 Wistar rats were divided two groups, 12 in each group. In the first group, Propidium Iodide(PI) was injected into the prostate, Bisbenzimide(Bb)into the external anal sphincter. In the second group, PI was injected into the prostate, Bb into genitofemoral, iliohypogastric, ilioinguinal, femoral and lateral femoral cutaneous nerves. Results The fluorescent double labeled cells were found in the L 1 L 2 and L 6～S 3 dorsal root ganglia(DRG) and some of them were confirmed to contain calcitonin gene related peptide(CGRP) and P substance (SP) by immunohistochemistry. Conclusion The findings confirm that the peripheral process of DRG cells dichotomizes into prostate, external anal sphincter and somatic parties, and some of these cells contain CGRP and SP, which indicates the referred pains in pelvic floor may be caused by axon reflex in the peripheral process of DRG cells. Meanwhile, neurogenic inflammation might play an important role in this persistent pain status. Pain due to prostatitis is correlated with pelvic floor muscle dysfunction.
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Objective To establish a stable animal model of bladder outlet obstruction(BOO) and to clarify the effects of BOO on the biomechanical properties of detrusor and the mechanisms. Methods BOO animal model was established by partial ligation of the proximal urethra of male Wistar rats forming, a urethra stricture with internal diameter of 1 mm. The active contraction of detrusor muscle stripes to carbachol was recorded with transfusor and organ bath tube. The compliance and maximum volume of bladder were examined by filling cystometry. Results The bladders demonstrated tropical post obstruction alterations at week 2 after partial ligation of the proximal urethra. The maximum volume (3 3?1 9) ml and bladder wet weight (10 4?2 8) g increased significantly in BOO group as compared with those in sham operation group [(1 6?0 8)ml and (7 2?3 5)g]. The detrusor contractile force of detrusor instability(DI) group was significantly lower than that in the control group. However, the contractile force in detrusor stability (DS) group was higher at week 2 but lower at week 4 after BOO than that in the sham operation group. Conclusion BOO animal model established by partial ligation of the proximal urethra of adult rats is simple and can give high survival rate and good stability, suitable for the studies of bladder outlet obstruction. There are two types of the detrusor contraction after BOO: DI group with impaired contraction and DS group with bidirectional change which was higher at early stage(week 2) but lower at later stage(week 4). The changes of bladder compliance are related to the stability of bladder, decrease in DI but increase in DS.
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Objective To provide experimental basis for further study of the mechanism of urinary storage dysfunction of diabetic cystopathy (DCP). Methods Steptozotocin(STZ) induced and sucrose induced diabetic rats were employed as DCP and diuresis models. Normal rats served as the control. The changes of calcitonin gene related peptide(CGRP) were analyzed by immunocytochemical method and computer assisted image analysis software. Compliance of the whole bladder prepared in vitro was evaluated by bladder irrigation. The messenger molecule cAMP of detrusor relaxation was determined by radioimmunological assay. Results Compared with those in other groups, the CGRP immunoreactive positive nerve fibers and content of this neurotransmitter significantly decreased in the bladder wall, especially in the submucosa. Significantly higher bladder compliance was observed( P
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Objective To investigate the changes of urinary bladder structure and function of aging rats. Methods The aging group and the young adult group were composed of 24 month old rats and 6 month old rats, respectively. The urodynamic changes were studied with filling cystometry, structural changes by Masson stain and image analysis. Results Filling cystometry revealed that the maximum bladder capacity increased in the aging rats. No difference in leak point pressure was found in the two groups. The occurrence rate of the detrusor instability in aging group was higher than that in young adult group. In bladder structure, fibrous tissue increased significantly but smooth muscle decreased significantly in the detrusor of aging rats. Conclusion Aging may lead to changes of rat bladder structure and function, but its mechanism needs to be further studied.
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Objective To study the neurogenic mechanism of urinary bladder dysfunction changes in the aged rats. Methods Wistar rats were divided into aged group (24 month old) and young adult group (6 month old, served as the control group). The reactivity of urinary detrusor strips in the two groups to different concentrations of carbachol, noradrenalin, isoproterenol, adenosine triphosphate (ATP) and atropin, was measured respectively using an in vitro tissue bath technique. Results Compared with the young adult rats, significantly increased relaxation response to high concentration of isoproterenol and contractile response to ATP were found in aged rats. No difference in responses to carbachol, atropin and noradrenalin was found in the aged rats. Conclusion The dysfunction in aging bladder may be related to the purinergic and ? adrenergic response modifications.
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Objective To elucidate the neurological mechanism of the referred pains in pelvic floor associated with the prostate. Methods The rat prostate was electrically stimulated, then the elicited action potentials (AP) of the lumbar and sacral nerves and the compound muscle action potentials from the external sphincter muscle of anus were detected. Results Action potentials from the iliohypogastric, genitofemoral, lateral femoral cutaneous, femoral, sciatic nerves compound muscle action potentials (CMAP) from the anal external sphincter were recorded. Conclusion Electric stimulation of the prostate can induce action potentials of the lumbar and sacral efferent nerves through the spinal reflex, resulting in referred pains in the perineal and pelvic areas due to muscle contraction.
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Objective To study the relationship between muscarinic receptor(MR) subtype density changes and the producing of unstable bladder Methods The rat model of unstable bladder was established and the MR subtype density of control and unstable bladders were defermined by RT-PCR Results There were only m 2RNA and m 3RNA in the detrusor of control and unstable bladders, but no m 1, m 2 and m 3 mRNA, the amount of m 2RNA(1 67?0 42)was larger obviously than m 3RNA(0 64?0 19),the ratio was 2 59∶1 in control group, and the density of both m 2 and m 3 in unstable bladder increased to (2 03?0 65) and(1 53?0 46)respectively, and the increase of m 3 was more significant ( P
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0.05 ).Fifty five patients of HoLEP group (78.6%,55/70) and 58 patients of TURP group(82.9%,58/70) were followed up at the third and sixth month postoperatively.In TURP group,6.9% of the patients(4/58) needed blood transfusion and 3.4%(2/58)developed TURS.In HoLEP group, no one needed blood transfusion or developed TURS. The differences were significant between the 2 groups ( P
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Objective To elucidate the neurological m ec hanism of the referred pains in pelvic floor from prostate and the relationship between pain from prostate and pelvic floor muscle dysfunction. Meth ods The prostate was electrically stimulated,and the elicited action potentials were recorded from iliohypogastric,ilioinguinal,genitofemoral,latera l femoral cutaneous,femoral,sciatic nerves,and compound muscle action potentials (CMAP) were recorded from anal external sphincter. Results Action potentials were elicited principally in the genitofemoral nerve (93 .3%),ilioinguinal nerve (55.5%);the action potentials of the genitofemoral nerve were not influenced by transaction of the cervical spinal cord,whereas they dis appeared immediately after rat death; the action potentials were reduced conside rably after destruction of the lumbosacral sympathetic trunks.CMAPs were elicite d in the anal external sphincter in 93.3% of the rats (14/15). Conc lusions Electrical stimulation of the prostate induced reflex discha rges in the nerves to perineal,pelvic floor areas.It was postulated that the ref lex discharges are related to muscle contraction leading to referred pain in the perineal,pelvic floor areas.Pain from prostate is correlated significantly with pelvic floor muscle dysfunction.
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Objective To detect the gene expressions of collagen types Ⅰ and Ⅲ in obstructive low compliant bladder in rats. Methods The expressions of collagen types Ⅰ and Ⅲ mRNA in rat bladder tissues were detected by in situ hybridization. Results Compared with those in the normal control, the gene expressions of collagen types Ⅰ and Ⅲ in smooth muscle of low compliant bladder were up regulated. Type Ⅲ gene expression was more obvious than type Ⅰ. Conclusion The expressions of collagen types Ⅲ and Ⅰ in obstructive low compliant bladder in rats are up regulated, which is related with low compliant bladder after obstruction.