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Objective To explore the effective method of the prevention and cure of unstable bladder after transurethral resection of prostate(TURP).Methods Ninety patients with benign prostatic hyperplasia(BPH)undergoing TURP under epidural anesthesia were randomly divided into 3 groups(with 30 patients in each group):treatment group,control group I and control group II.Tolterodine combined with diciofenac sodium/lidecaine hydrechloride injection were used after operation in treatment group.Control group I was only given tolterodine,and control group II was only given diclofenac sodium/lidocaine hydrochloride injection.Observed the incidence times and continuous time of unstable bladder after operation in three groups.Results Three cases(10.0%)happened to unstable bladder in treatment group and they were I degree,14 cases(46.7%)happened to unstable bladder in control group I,8 cases were I degree,5 cases were II degree,1 case was III degree;16 cases(53.3%)happened to unstable bladder in control group II,8 cases were I degree,6 cases were II degree,1 case was III degree,1 case was IV degree.There was obvious significance either between treatment group and control group I(P = 0.003)or between treatment group and control group II(P = 0.001).Conclusion Tolterodine combined with diclofenac sodium/ lidocaine hydrochloride injection have obvious effect on preventing the incidence of unstable bladder after TURP,it is easy to perform and can be used widely.
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Nocturnal enuresis is the second most common chronic health problem in children following allergy. The prevalence of nocturnal enuresis in different age groups is about the same in all parts of the world. It can be stated that nocturnal enuresis is a clinical problem for the child and the family as well when the child is wetting the bed at least one night every month. With this definition, about 10% of 7-year-old children have nocturnal enuresis. Historically, a remarkable progress has been made in the mid-eighties. Previously, bedwetting was looked upon as a trivial condition, hardly worthy of serious medical assessment and management. In 1985, however, a study from Aarhus in Denmark drew a strong attention to bedwetting in the medical community worldwide by suggesting that nocturnal enuresis may be caused by nocturnal polyuria, which in turn depends on an insufficient production of antidiuretic hormone (vasopressin) during the sleeping hours. Since then, nocturnal enuresis has turned out to be an unexpectedly fruitful area for research, producing hundreds of scientific reports. Regarding its pathophysiology, it is becoming clear that two thirds of children with nocturnal enuresis have nocturnal polyuria due to an inadequate vasopressin secretion during sleep. In addition, ongoing studies suggest that there may be bladder problems (unstable bladder) or arousal disorder underlying nocturnal enuresis. Nocturnal enuresis should be taken seriously by physicians and needs intervention when the child expresses a desire to sleep dry, usually around 5 years of age.
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Criança , Humanos , Nível de Alerta , Dinamarca , Frutas , Hipersensibilidade , Enurese Noturna , Poliúria , Prevalência , Bexiga Urinária , VasopressinasRESUMO
PURPOSE: Unstable bladder has been known to be one of the reasons for the genesis and persistance of primary vesicoureteral reflux(VUR) in children. And treatment of unstable bladder by anticholinergic agent may contribute to the resolution of primary VUR. We evaluated the effect of an anticholinergic agent(oxybutynin) on the resolution of primary VUR in children with different toilet training and voiding functions. METHODS: 152 children with persistant primary VUR after one year of follow up were randomly assigned to the oxybutynin group(n=59, oxybutynin 0.2 mg/kg twice daily) and the control group(n=93, no oxybutynin) at Ewha Womans University Mok-Dong Hospital from October 1996 to April 2002. The resolution rate of the VUR and the difference according to the status of toilet training and voiding dysfunction were analyzed. Statistical analysis was done by the Chi-square test and a P-value of less than 0.05 was considered as significant. RESULTS: VUR was resolved in 49.2%, improved in 20.3% and not changed in 30.5% in the oxybutynin group(n=59) which was not significantly different to 45.2%, 16.1%, 38.7% in the control group(n=93), respectively. In the non-toilet trained young children, VUR was resolved in 50.0%, improved in 23.5% and not changed in 26.5% in the oxybutynin group(n=34) which was not significantly different to 44.2%, 19.2%, 36.6% in the control group(n=52), respectively. In the toilet trained older children, VUR was resolved in 48.0%, improved in 16.0% and not changed in 36.0% in the oxybutynin group(n=25) which was not significantly different to 46.3%, 12.2%, 41.5% in the control group(n=41), respectively. In the toilet trained older children with no voiding dysfunction, VUR was resolved in 33.3%, improved in 11.1% and not changed in 55.6% in the oxybutynin group(n=9) which was not significantly different to 53.6 %, 10.7%, 35.7% in the control group(n=28), respectively. In the toilet trained older children with voiding dysfunction, VUR was resolved in 56.3%, improved in 18.7% and not changed in 25.0% in the oxybutynin group(n=16), which looked higher than 30.7%, 15.4%, 53.9% in the control group(n=13), respectively, but these were not significantly different either. CONCLUSION: Oxybutynin was not effective in the resolution of primary VUR in non-toilet trained young children and toilet trained older children. Oxybutynin showed slightly higher tendency of reflux resolution in toilet-trained older children with voiding dysfunction but the difference was not statistically significant. Judicious use of oxybutynin is required in selected older children with VUR and voiding dysfunction.
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Criança , Feminino , Humanos , Seguimentos , Treinamento no Uso de Banheiro , Bexiga Urinária , Refluxo VesicoureteralRESUMO
PURPOSE: Unstable bladder has been known to be one of the reasons for the genesis and persistance of primary vesicoureteral reflux(VUR) in children. And treatment of unstable bladder by anticholinergic agent may contribute to the resolution of primary VUR. We evaluated the effect of an anticholinergic agent(oxybutynin) on the resolution of primary VUR in children with different toilet training and voiding functions. METHODS: 152 children with persistant primary VUR after one year of follow up were randomly assigned to the oxybutynin group(n=59, oxybutynin 0.2 mg/kg twice daily) and the control group(n=93, no oxybutynin) at Ewha Womans University Mok-Dong Hospital from October 1996 to April 2002. The resolution rate of the VUR and the difference according to the status of toilet training and voiding dysfunction were analyzed. Statistical analysis was done by the Chi-square test and a P-value of less than 0.05 was considered as significant. RESULTS: VUR was resolved in 49.2%, improved in 20.3% and not changed in 30.5% in the oxybutynin group(n=59) which was not significantly different to 45.2%, 16.1%, 38.7% in the control group(n=93), respectively. In the non-toilet trained young children, VUR was resolved in 50.0%, improved in 23.5% and not changed in 26.5% in the oxybutynin group(n=34) which was not significantly different to 44.2%, 19.2%, 36.6% in the control group(n=52), respectively. In the toilet trained older children, VUR was resolved in 48.0%, improved in 16.0% and not changed in 36.0% in the oxybutynin group(n=25) which was not significantly different to 46.3%, 12.2%, 41.5% in the control group(n=41), respectively. In the toilet trained older children with no voiding dysfunction, VUR was resolved in 33.3%, improved in 11.1% and not changed in 55.6% in the oxybutynin group(n=9) which was not significantly different to 53.6 %, 10.7%, 35.7% in the control group(n=28), respectively. In the toilet trained older children with voiding dysfunction, VUR was resolved in 56.3%, improved in 18.7% and not changed in 25.0% in the oxybutynin group(n=16), which looked higher than 30.7%, 15.4%, 53.9% in the control group(n=13), respectively, but these were not significantly different either. CONCLUSION: Oxybutynin was not effective in the resolution of primary VUR in non-toilet trained young children and toilet trained older children. Oxybutynin showed slightly higher tendency of reflux resolution in toilet-trained older children with voiding dysfunction but the difference was not statistically significant. Judicious use of oxybutynin is required in selected older children with VUR and voiding dysfunction.
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Criança , Feminino , Humanos , Seguimentos , Treinamento no Uso de Banheiro , Bexiga Urinária , Refluxo VesicoureteralRESUMO
Objective: To establish a rabbit unstable bladder and Partial Bladder Outlet Obstruction (BOO) model, and to study on urodynamic changes. Methods: 30 male New Zealand rabbits were divided into control group and operative group. After 8 weeks, urodynamic changes were determined after they were anaesthetized by ketamine and droperidol. Results: Prominent changes of Main urodynamic parameters were found between the operative group and control group. The incidence rate of unstable bladder was 60%. Conclusion: The method of establishing rabbit model of Partial BOO is successful. It provides a platform for the study on the changes of pathology and pathophysiology of human chronic partial BOO and treatment of this kind of diseases.
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Objective:To study Ca~(2 +) changes~( )in detrusor cell of the unstable bladder of rabbit~(,)s partial bladder outlet obstruction. Methods: Thirty male New Zealand White rabbits were divided into 2 groups randomly. In the experiment group the unstable bladder were confirmed by Urodynamics and the sham operated age-matched rabbits acted as the control group eight weeks after operetion. bladder smooth muscle cells were isolated by collagenase digestion. Intracellular Ca~(2+) levels in detrusor cell were observed by confocal laser scanning microscope (CLSM). Results: Intracellular Ca~(2+) concentration significantly increased in the experiment group (Ca~(2+) overload). Conclusion:It was a important pathogeny for the unstable bladder of partial bladder outlet obstruction that pathological changes of Ca~(2+) with the unstable bladder.
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Considerable advances have been made in the understanding of the cellular processes that result in contraction and relaxation of detrusor smooth muscle recently,particularly in the role and modulation of calcium.Several changes in these cellular mechanisms that impair normal function have been observed in detrusor muscle from patients with unstable bladders.Whether these changes represent primary causes of bladder dysfunction or whether they are secondary to bladder dysfunction remains to be determined.Nevertheless,the identification of specific cellular lesions in bladder dysfunction presents a novel approach to identification of drug targets and potential treatment modalities.
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PURPOSE: This study was performed to investigate the changes in nerve growth factor (NGF), and vanilloid receptor subtype 1 (VR1), after the relief of bladder outlet obstruction, and to look at how these changes participate in functional changes of the bladder. MATERIALS AND METHODS: 50 Wistar male rats, weighing approximately 250-300g, were used for this study, and divided into two groups: 10 controls and 40 experimental. The control group consisted of sham operated animals. The experimental group was obstructed for 3 weeks by partial urethral ligation. After 3 weeks, the obstruction was relieved by urethral deligation. Cystometrograms (CMG) were performed 3 weeks after deligation. On the basis of CMG, the experimental group was subdivided into normalised, and unstable, bladder groups. The bladders of each group were dissected out, weighed and immunohistochemical staining for NGF and VR1 analysis, performed. RESULTS: Compared with the control group, bladder weights of the normalised, and unstable, bladder groups were increased (p<0.05). On CMG, there was no significant difference in contraction pressure among the 3 groups. The contraction interval of the unstable bladder group was markedly decreased compared with that of the control and normalised groups. On immunohistochemical staining, contrary to the control and normalised groups, the intensity of staining for NGF in the unstable bladder group increased in the basal layer, submucosa and interfascicular layers. VR1-immunoactive nerve fibre-like structures were seen in the basal and submucosal layers in the unstable bladder group, and there were no VR1-like structures in the muscle layer. However, there were no VR1-like structures any of the layers of the control and normalised groups. CONCLUSIONS: Increased NGF and VR1 may be related to persistent unstable bladder or bladder irritative symptoms after rectifying a bladder outlet obstruction.
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Animais , Humanos , Masculino , Ratos , Ligadura , Fator de Crescimento Neural , Obstrução do Colo da Bexiga Urinária , Bexiga Urinária , Pesos e MedidasRESUMO
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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PURPOSE: Bladder irritative symptoms such as urinary urgency or urge incontinence could be worse even after proper treatments, if accompanying the unstable bladder with lower urinary tract obstruction or female urinary incontinence was not found before treatments. We performed walking cystometrography to detect unstable bladder which could be masked by cystometrography in sitting position. MATERIALS AND METHODS: We evaluated 133 patients who complained of urinary urgency or urge incontinence. Walking cystometrography (Group 2) was done for pa tients who did not show unstable bladder at cystometrography in sitting position (Group 1). Bladder volume at first desire to void, cystometric maximal bladder capacity, and occurrence of unstable bladder of both groups were compared. RESULTS: In cystometrography performed in sitting position (Group 1), unstable bladder was found in 48 (36.1%) out of 133 patients. Among the rest 85 patients, 23 patients (27.1%) showed unstable bladder in walking cystometrography (Group 2). Conse quently, 71 (53.4%) out of 133 patients showed unstable bladder in both groups. Com paring the bladder capacity of these two measuring methods, we could observe that bladder volume at first desire to void and maximal bladder capacity of walking state were smaller than those of sitting position from 187.4 +/- 36.9ml (Group 1) to 138.5 +/- 31.6ml (Group 2), 413.6 +/- 42.5ml (Group 1) to 342.8 +/- 43.2ml (Group 2), respectively (p <0.05). CONCLUSIONS: We expect that the diagnosis of unstable bladder through walking cysto metrography is meaningful when the method is applied to the patients who have urinary urgency or urge incontinence but seem to be normal by conventional cystometrography.
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Feminino , Humanos , Diagnóstico , Máscaras , Bexiga Urinária , Incontinência Urinária , Incontinência Urinária de Urgência , Sistema Urinário , CaminhadaRESUMO
Objective To study the quantitative changes of gap junction (GJ) in the detrusors of unstable bladder(USB) in rats,and to deduce the functional changes of GJ,which mediates intercellular communication,so as to demonstrate one of the mechanisms of USB. Methods Thirteen Wistar rats, which were identified to have USB by manometry of filling bladder after establishment of bladder outlet obstruction (BOO) model, served as study,ie,USB group.Another 10 healthy female Wistar rats served as control group.The content and distribution of connexin (Cx) 43 of the detrusors, which were taken from these rats,were quantitatively analyzed by Western blot and laser confocal microscopy with a double-label immunohistochemical technique. Results Cx43 protein was expressed in both control and USB group, the relative molecular weight was 43000.The mean gray levels of the detrusor protein bands in USB group and control group were 31.066 and 11.701,respectively;the difference of the values between the 2 groups was significant (P
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Objective To evaluate the application of capsaicin to improve bladder stability after suprapubic prostatectomy for BPH. Methods 40 patients with BPH underwent suprapubic prostatectomy under epidural anesthesia were randomly divided into A?B?C and D groups (n=10 in each group).Capsaicin of 1 mmol/L was instilled into the bladder preoperatively for 30 minutes in group B and group D had 10 ml of 1 mmol/L capsaicin given epidurally.Group A and Group C received saline only. Results The bladder instability was lessened.The time of bladder perfusion clearance,indwelling catheter delivery,duration of cystospasm and number of postoperative cystospasm cases in group B and D reduced significantly as compared with group A and C.The Pdet and volume were improved significantly,the Qmax and residual urine were also improved. Conclusions The intravesical and epidural capsaicin delivery helps to prevent detrusor instability and reduces the pain caused by postoperative cystospasm.It also improves the bladder function deteriorated by BPH.
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Intravesical outlet obstruction in human is one of the most commonly observed conditions in the urologic field and often related to voiding difficulty with unstable bladder. The pathophysiological background for voiding difficulty is unknown and also difficult to investigate in human. We, herein, performed animal study to investigate whether and how short-term infravesical outlet obstruction does affect the function of rat bladder, and to establish the animal model with infravesical outlet obstruction for further studies. Infravesical outlet obstruction was created by placing a silicon sleeve around the bladder neck and proximal urethra of mature female rats. At one week after operation. cystometrical evaluation and isolated detrusor strip study was performed in each rat. The whole bladder weight of obstructed group significantly increased to four times that of control group. In cystometrical investigations, obstructed group showed unstable bladder. Furthermore, the obstructed group showed increased bladder capacity and residual urine volume, compared to those or control group. In isolated detrusor muscle strip study, contractile responses of detrusor muscle to field stimulation. bethanechol and ATP were less prominent in obstructed group than in control group. However. tetrodotoxin could not completely abolish EFS induced detrusor contraction in obstructed group, compared to that in control group. These results indicate that short-term obstructed bladder showed a significant decrease in detrusor contractility as well as abnormal detrusor contraction, which may be resulted from the degeneration of detrusor muscle, although neurogenic cause remains to be further investigated.
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Animais , Feminino , Humanos , Ratos , Trifosfato de Adenosina , Betanecol , Modelos Animais , Pescoço , Silicones , Tetrodotoxina , Uretra , Obstrução do Colo da Bexiga Urinária , Bexiga UrináriaRESUMO
Objective To study the pathogenesis of unstable bladder with partial bladder outlet obstruction through the experiment based research on connexins in both unstable bladder group and cell hypoxia group.Methods Unstable bladder rat models were established and smooth muscle cells were cultured in vitro.Then cell anoxia was induced.RT-PCR and Western blot were used to quantify the connexins.Results The mRNA levels of Cx40,Cx43 and the Cx43 protein expressed in the smooth muscle cells from the unstable bladder group and cell hypoxia groups were all higher than those in the control groups(the sham-operation group and normoxia groups)(P