Dilemmas in Management of the Geriatric Bladder.

PURPOSE OF REVIEW: In this article, we will review current dilemmas regarding evaluation and management of the geriatric bladder incorporating concepts of normal changes of aging as well as common lower urinary tract dysfunction. RECENT FINDINGS: Increasing age leads to functional changes in essentially all organ systems including the genitourinary system. Understanding the natural changes with age of the bladder as well as the signs and symptoms of pathologic conditions is paramount to diagnosis and treatment of urologic conditions in the geriatric population. SUMMARY: There are several conundrums in the diagnosis and evaluation of the geriatric bladder including the ability of the bladder to store, empty, as well as sensitivity disturbances. Diagnostic testing and goals of treatment should be individualized for each patient and personalized to consider patient comorbidities, limitations, and expectations.

The use of botulinum toxin for treatment of lower urinary tract symptoms.

In the last decade we have seen the emergence of botulinum toxin (BTX) as a successful treatment of patients with neurogenic and idiopathic detrusor overactivity that are refractory to antimuscarinic medication. The success of BTX in this patient population has led to use BTX in patients with other causes of lower urinary tract symptoms such as benign prostatic hyperplasia (BPH) and urethral sphincter anomalies. Despite this success, the protocol for BTX injection has not yet been standardized. Various studies are on the way in order to determine the best injection protocol for bladder injection of BTX. The use of BTX in patients with BPH is in its early stages. Further large randomized controls trials in patients with BPH are needed to determine the efficacy of BTX in this patient population.

Symbiosis-enhanced gene expression in cnidarian-algal associations: cloning and characterization of a cDNA, sym32, encoding a possible cell adhesion protein.

Mutualistic endosymbioses between two partners are complex associations that are regulated by the genetic interactions of the partners. One important marine symbiosis is that between various cnidarians, such as corals and anemones, and their photosynthetic algal symbionts. We have been interested in characterizing cnidarian host genes that are expressed as a function of the symbiotic state, using the temperate sea anemone Anthopleura elegantissima as a model. In this study, we report on symbiosis-enhanced expression and synthesis of sym32 in anemones. We characterized the full-length sym32 cDNA, obtained by RT-PCR, and demonstrated, by semi-quantitative RT-PCR, that sym32 transcript was much more abundant in symbiotic than in non-symbiotic host anemone RNA. Further, using immunoblots, we determined that an antibody made to a sym32 fusion protein labeled a 32 kD band much more strongly in symbiotic compared to non-symbiotic anemone protein homogenates. Databank searches revealed that the sym32 deduced amino acid sequence shares significant homology with the fasciclin I (Fas I) family of homophilic cell adhesion proteins, present in a variety of organisms ranging from bacteria to humans. This strong homology with the Fas I family suggests that sym32 is involved in regulation of the symbiosis by mediating cell-cell interactions.

A precerebellin-like protein is part of the acute phase response in rainbow trout, Oncorhynchus mykiss.

The acute phase response (APR) has a long evolutionary history, but it remains to be characterized fully in lower vertebrates. To study the acute phase proteins of a teleost, rainbow trout (Oncorhynchus mykiss), we induced an APR by injecting Vibrio bacterin emulsified in FIA. In samples taken over the next 3 weeks, the total plasma protein profile changed consistently as seen in one and two-dimensional SDS PAGE. One 18.1 kD upregulated protein was isolated from 2D gels and an N-terminal sequence obtained. Using reverse transcriptase-PCR, a 700 bp cDNA sequence was amplified. The sequence is 53% similar at the amino acid level with rat precerebellin (regions aa 42-184 from trout and aa 89-224 precerebellin), and 46% similar with the globular portion of the human B chain of the first complement component C1q. However, it lacks the collagen portion of C1q with its characteristic Gly-X-Y repeats. The isolated protein seems to be involved in the inflammatory response but its physiological function is unknown.

Carbonic anhydrase expression and synthesis in the sea anemone Anthopleura elegantissima are enhanced by the presence of dinoflagellate symbionts.

Endosymbiotic dinoflagellates resident within cnidarian hosts are extremely productive primary producers. This high productivity may be due in part to an inorganic carbon transport system, present in host tissue, that accelerates carbon delivery to the algae. The enzyme carbonic anhydrase (CA; EC 4.2.1.1) has been shown to be important in this transport system in a variety of tropical symbiotic cnidarians. This study extends the examination of CA to a temperate anemone, Anthopleura elegantissima, and documents symbiosis-enhanced production of CA at the biochemical and molecular level. Depending on light availability, A. elegantissima can occur naturally with (symbiotic) or without (aposymbiotic) dinoflagellates, making it an ideal study organism for symbiosis-enhanced gene expression. We compared (1) CA activities, (2) quantities of CA using an anti-human CA immunoprobe, and (3) quantities of transcript using a semiquantitative PCR in symbiotic versus aposymbiotic A. elegantissima host tissue. Amounts of activity, enzyme, and transcript were greatly enhanced in symbiotic animals compared with aposymbiotic animals. This is the first direct evidence that the presence of symbionts affects the expression of a host cnidarian gene. In addition, we report a full-length A. elegantissima CA cDNA sequence, obtained from subcloned reverse transcriptase-PCR products, and its relatedness to alpha-CAs from a variety of other metazoa, including higher vertebrates.