Home About us Contact
|
Home About us Contact | ||
|
|
||
Cystometry
Kinds of Cystometry Selected AbstractsThe effect of tamsulosin on the response of the rabbit bladder to partial outlet obstructionNEUROUROLOGY AND URODYNAMICS, Issue 1 2006Robert M. Levin Abstract Aim To determine if tamsulosin treatment prevents or decreases the incidence and severity of outlet obstruction-induced bladder dysfunction in rabbits. Materials and Methods Male New Zealand White rabbits were treated with tamsulosin or vehicle for 4 weeks with treatments initiated 1 week prior to sham or obstruction surgery. Cystometry was done on anesthetized rabbits 21 days after surgery. The bladders were then removed, weighed, and prepared for in vitro whole bladder studies. Responses to 32 Hz field stimulation (FS), carbachol, phenylephrine, and KCl were measured. Results Obstruction resulted in a significant increase in bladder weight, which was unchanged by tamsulosin treatment and a significant increase in micturition pressure in the vehicle-treated group but not in the tamsulosin-treated group. Compliance was significantly decreased in both obstructed groups. The vehicle-treated obstructed rabbits had a very sharp increase in intravesical pressure as the bladder reached capacity; this was not seen in the tamsulosin-treated obstructed rabbits. Tamsulosin did not change the pattern of modifications in contractile responses induced by bladder outlet obstruction. Conclusions In vitro responses of vehicle and tamsulosin-treated obstructed rabbit groups in this study were similar. A greater micturition pressure was found for the vehicle-treated obstructed group than for the tamsulosin-treated obstructed group, which was probably due to decreased urethral resistance in the latter. On a functional basis, the higher compliance at capacity and decreased micturition pressure in the tamsulosin-treated obstructed group would be considered beneficial for bladder function. Neurourol. Urodynam. © 2005 Wiley-Liss, Inc. [source] Clinical and urodynamic features of intrinsic sphincter deficiencyNEUROUROLOGY AND URODYNAMICS, Issue 4 2003Cinzia Pajoncini Abstract Aims A prospective analysis of 92 patients with genuine stress incontinence was performed to identify the clinical and urodynamic features of intrinsic sphincter deficiency (ISD). Methods We divided the patients into two categories: 50 patients affected by pure ISD as they had severe stress incontinence and no urethral mobility; 42 patients suffering from stress urinary incontinence without ISD as they had mild stress incontinence and marked urethral hypermobility. Cystometry was normal in all patients. The presence/absence of ISD was considered the dependent variable and was correlated against the following independent variables: age, vaginal deliveries, menopause, previous urogynecological surgery and/or hysterectomy, supine stress test, irritative and/or obstructive symptoms, Valsalva leak point pressure (VLPP), maximum urethral closure pressure (MUCP), urethral functional length (UFL), and leakage during cystometry. Results The statistical analysis showed close correlations between ISD and age (P,<,0.001), menopausal status (P,<,0.001), previous surgery (P,<,0.0001), supine stress test (P,<,0.0001), leakage during cystometry (P,<,0.001), and UFL (P,<,0.01). The VLPP was below the cut-off value (,60 cm H2O) in 70% of ISD patients (P,<,0.0001), whereas the MUCP in 50% of ISD patients (P,<,0.0001). Multiple logistic analysis showed that lower VLPP, lower MUCP, and previous surgery correlate more significantly with ISD. After backward conditional stepwise logistic regression, the odds ratio of having ISD were VLPP,=,2.3, MUCP,=,7.7, VLPP + MUCP,=,62.8. Conclusions ISD is related to the presence of a more severe clinical picture and case history, but the most significant independent variables are the VLPP and MUCP. Neurourol. Urodynam. 22:264,268, 2003. © 2003 Wiley-Liss, Inc. [source] Type 4 phosphodiesterase inhibitor suppresses experimental bladder inflammationBJU INTERNATIONAL, Issue 10 2008Takeya Kitta OBJECTIVE To evaluate the effects of orally administered YM976, a specific inhibitor of type 4 phosphodiesterase (PDE4), on bladder activity in a rat model with hydrochloric acid (HCl)-induced cystitis (IC), hypothesizing that a PDE4 inhibitor might suppress bladder overactivity and bladder pain responses in bladder-hypersensitive disorders such as IC. MATERIALS AND METHODS Wistar rats with HCl-induced IC were treated with YM976 or vehicle and their voiding observed and assessed by cystometry. The severity of bladder inflammation (BI) was quantified using the BI index (BII), which comprises three factors (oedema, leukocyte infiltration and haemorrhage). Nociceptive neural activity was also examined using an immunohistochemical study of spinal c-fos expression. RESULTS YM976 significantly reduced the number of voids, and the volume per void was significantly higher than in control (vehicle) group. Cystometry showed a significant increase in bladder capacity, voided volume and voiding efficiency, and a decrease in the amplitude of voiding pressure in rats treated with YM976. All BII scores were significantly lower in the YM976 than in the control group. c-fos expression in the spine was less in the YM976 than in the control group. CONCLUSIONS Oral administration of YM976 significantly improved the voiding behaviour and histological damage in rats with IC induced by HCl. These results indicate that PDE4 inhibitor might be effective in relieving bladder symptoms with IC. [source] Reproducibility of same session repeated cystometry and pressure-flow studies in women with symptoms of urinary incontinence,,NEUROUROLOGY AND URODYNAMICS, Issue 3 2010Suzan R. Broekhuis Abstract Aim The aim of this study was to determine the reproducibility of same session repeated urodynamic measurements in women with symptoms of urinary incontinence. Methods Women presenting with symptoms of urinary incontinence underwent standardized urodynamic examination, which consisted of free uroflowmetry and two filling cystometries and pressure-flow studies. Intra-class Correlation Coefficient (ICC) and McNemar tests were used to describe the same session reproducibility. Results Two evaluable urodynamic tests were available in 152 patients. Overall, reproducibility of the urodynamic parameters were good to excellent (ICC range: 0.72,0.93), except for the bladder volume at first sensation of bladder filling (ICC,=,0.46) and the maximum Watt's factor (ICC,=,0.68). The bladder volume at first sensation and the maximum cystometric capacity were systematically higher in the second run (mean difference (95% CI),=,,45 (,73; ,37) and ,3 (,15; 10), respectively). Reproducibility of the diagnosis stress urinary incontinence and/or detrusor overactivity were good to excellent (median ICC,=,0.76, P,=,0.68 and P,=,1.00, respectively). Reproducibility of the volume and amplitude at involuntary detrusor contractions, however, were only poor (ICC,=,0.18 and 0.25, respectively). Conclusions The reproducibility of same session repeated urodynamic measurements in women with symptoms of urinary incontinence was good to excellent. Our results provide the scientific support for guidelines that recommend the omission of repeated filling cystometries and pressure-flow studies in cases where the first test confirms the pathology expected. Neurourol. Urodynam. 29:428,431, 2010. © 2009 Wiley-Liss, Inc. [source] Electrical stimulation of sacral dermatomes in multiple sclerosis patients with neurogenic detrusor overactivity,NEUROUROLOGY AND URODYNAMICS, Issue 4 2007M.V. Fjorback Abstract Aims Transcutaneous electrical stimulation of the dorsal penile/clitoral nerve (DPN) has been shown to suppress detrusor contractions in patients with neurogenic detrusor overactivity (NDO). However, the long-term use of surface electrodes in the genital region may not be well tolerated and may introduce hygienic challenges. The aim of this study was to assess whether electrical stimulation of the sacral dermatomes could suppress detrusor contractions in multiple sclerosis (MS) patients with NDO, hereby providing an alternative to DPN stimulation. Materials and Methods A total of 14 MS patients (8 M, 6 F) with low bladder capacity (<300 ml) and a recent urodynamic study showing detrusor overactivity incontinence participated in the study. Three successive slow fill cystometries (16 ml/min) were carried out in each patient. The first filling served as control filling where no stimulation was applied. In the second and third filling electrical stimulation of either the DPN or sacral dermatomes was applied automatically whenever the detrusor pressure exceeded 10 cmH2O. Results The control filling showed detrusor overactivity in 12 of the 14 patients. In 10 of the 12 patients one or more detrusor contractions could be suppressed with DPN stimulation. Electrical stimulation of the sacral dermatomes failed to suppress detrusor contractions in all patients. Conclusions Although therapeutic effects may be present from stimulation of the sacral dermatomes, we were unable to demonstrate any acute effects during urodynamics. For this reason stimulation of the sacral dermatomes is not an option in a system that relies on the acute suppression of a detrusor contraction. Neurourol. Urodynam. 26:525,530, 2007. © 2007 Wiley-Liss, Inc. [source] Non-neurogenic urinary retention (Fowler's syndrome) in two sistersNEUROUROLOGY AND URODYNAMICS, Issue 7 2006Simon Podnar Abstract Aims To report for the first time occurrence of obstructed voiding due to excessive activity of the urethral sphincter (US) muscle in two sisters with polycystic ovaries (Fowler's syndrome). Methods In both patients precise micturition history was obtained. In addition, clinical neurological and gynecological examinations, cystometry, urethral pressure profile measurements, gynecological ultrasound, measurement of gonadotropic hormone levels, and concentric needle electromyography (EMG) of the US muscle were performed. Results Both sisters reported symptoms of severely obstructed voiding. Clinical examination, and filling cystometries were normal. Urethral pressures were increased (99,134 cm water). The first sister was not able to void, and the urinary flow was slow and intermittent in the second on voiding studies. Profuse complex repetitive discharges and decelerating burst activity were found on concentric needle EMG of the US in both of them. Both sisters had increased LH/FSH ratio (2.96 and 2.64), and ultrasonographic abnormalities compatible with polycystic ovaries. Conclusions Diagnosis of Fowler's syndrome was made in both sisters. Due to very low incidence rate of this syndrome (0.2/100.000 per year), we think that it is highly unlikely to find it in two sisters just by chance. We suggest that the probable explanation is a genetic predisposition to polycystic ovaries, with which this condition has been shown to be associated. Neurourol. Urodynam. 25:739,741, 2006. © 2006 Wiley-Liss, Inc. [source] Changes of bladder activity and glycine levels in the lumbosacral cord after partial bladder outlet obstruction in ratsINTERNATIONAL JOURNAL OF UROLOGY, Issue 9 2008Minoru Miyazato Objectives: We investigated the time course of changes in bladder activity as well as in spinal and serum levels of glutamate and glycine after partial bladder outlet obstruction (BOO) in rats. Methods: A total of 36 female rats were divided into six groups: sham operation (control); 3 days, 14 days, and 28 days after BOO; 3 days and 28 days after relief of BOO. Under urethane anesthesia, isovolumetric cystometry was carried out in each group. Then, spinal and serum levels of glutamate and glycine were measured. Results: The interval between bladder contractions was shorter in all of the groups compared with the control group. The amplitude and duration of bladder contractions was decreased at 3 days, 14 days, and 28 days after BOO, and at 3 days after relief of BOO. Spinal and serum glutamate levels showed no changes. However, the spinal glycine level was decreased at 14 days and 28 days after BOO, and at 28 days after relief of BOO. Serum glycine level was also decreased at 28 days after BOO and 28 days after relief of BOO. Conclusions: Detrusor overactivity during the chronic phase of partial BOO is partly caused by a decrease of glycinergic neuronal activity in the lumbosacral cord. A 3-day period of BOO produces detrusor overactivity, which might be due to an irreversible decrease of spinal glycinergic neuronal activity. [source] Intrathecal glutamate promotes glycinergic neuronal activity and inhibits the micturition reflex in urethane-anesthetized ratsINTERNATIONAL JOURNAL OF UROLOGY, Issue 12 2006KATSUHIRO ASHITOMI Objectives: In order to clarify the role of glutamate in the micturition reflex and in glutamatergic and glycinergic neuronal activity, we examined the effects of intrathecal (IT) injection of glutamate or MK-801 (an N- methyl-D-aspartate receptor antagonist) on bladder activity and on the glutamate and glycine levels in the lumbosacral cord of female rats with or without acute lower thoracic spinal cord injury (SCI). Methods: Under urethane anesthesia, isovolumetric cystometry was performed in rats with or without SCI before and after IT injection of glutamate or MK-801 at the lumbosacral cord level. The glutamate and glycine levels of the whole lumbosacral cord were measured after IT injection of glutamate or MK-801 in both groups. Results: In intact rats, IT glutamate (100 µg) prolonged the interval between bladder contractions and decreased the amplitude of contractions. IT MK-801 (3,100 µg) also prolonged the interval between bladder contractions and decreased the amplitude in intact rats. In SCI rats, cystometry demonstrated the disappearance of bladder contractions, and the glycine level in the lumbosacral cord was elevated. In intact rats, IT glutamate (0.3,100 µg) increased the glycine level in the lumbosacral cord. On the other hand, IT MK-801 (3,100 µg) decreased both glutamate and glycine levels in intact and SCI rats. Conclusions: These results suggest that glutamatergic neurons have stimulatory projections to both glutamatergic and glycinergic neurons in the lumbosacral cord, and that glutamatergic neurons inhibit the micturition reflex by stimulating glycinergic neurons. [source] Urodynamic findings in children with cerebral palsyINTERNATIONAL JOURNAL OF UROLOGY, Issue 8 2005M IHSAN KARAMAN Abstract Aim: More than one-third of children with cerebral palsy are expected to present with dysfunctional voiding symptoms. The voiding dysfunction symptoms of the cerebral palsy patients in the present study were documented. Methods: Of the study group, 16 were girls and 20 were boys (mean age: 8.2 years). Children with cerebral palsy were evaluated with urodynamics consisting of flow rate, filling and voiding cystometry, and electromyography findings of the external urethral sphincter to determine lower urinary tract functions. Treatment protocols were based on the urodynamic findings. Anticholinergic agents to reduce uninhibited contractions and to increase bladder capacity were used as a treatment. Clean intermittent catheterization and behavioral modification were used for incomplete emptying. Results: Of the children, 24 (66.6%) were found to have dysfunctional voiding symptoms. Daytime urinary incontinence (47.2%) and difficulty urinating (44.4%) were the most common symptoms. Urodynamic findings showed that neurogenic detrusor overactivity (involuntary contractions during bladder filling) with a low bladder capacity was present in 17 (47.2%) children, whereas detrusor,sphincter dyssynergia was present in four patients (11%). The mean bladder capacity of patients with a neurogenic bladder was 52.2% of the expected capacity. Conclusions: The present study concluded that voiding dysfunction was seen in more than half of the children with cerebral palsy, which is a similar result to other published studies. We propose that a rational plan of management of these patients depends on the evaluation of the lower urinary tract dysfunction with urodynamic studies. These children benefit from earlier referral for assessment and treatment. [source] Incomplete emptying and urinary retention in multiple-system atrophy: When does it occur and how do we manage it?MOVEMENT DISORDERS, Issue 6 2006Takashi Ito MD Abstract Neurogenic urinary retention can be a major cause of morbidity in multiple-system atrophy (MSA). However, the timing of its appearance has not been entirely clear, and neither have the medical and surgical modalities for managing patients. We present the data obtained from our uroneurological assessment and therapeutic interventions at various stages of MSA. We recruited 245 patients with probable MSA. We measured postvoid residuals (PVR) and performed EMG cystometry in all patients. The grand average volume of PVR was 140 mL (range, 0,760) in our patients. The average PVR volume was 71 mL in the first year, increasing to 129 mL in the second year and 170 mL by the fifth year. The percentages of patients with complete urinary retention, acontractile detrusor, and detrusor,sphincter dyssynergia (DSD) also increased. The increase in PVR resulted in a decrease in functional bladder capacity, together with an increase in detrusor overactivity and neurogenic sphincter EMG. Clean intermittent self-catheterization (CISC) was introduced in most patients. Bladder-oriented therapy (cholinergic agents) had a limited value, whereas urethra-oriented therapy benefited patients with DSD (surgery) for up to 2 years, but syncope occurred in a subset of patients (,-blockers). MSA patients present with large PVR by the second year of illness, and that large PVR secondarily causes urinary frequency. CISC is the recommended treatment for most patients. Urethra-oriented medication and surgery benefit patients who would have difficulty performing CISC, although careful consideration of the short-term efficacy and potential adverse effects of these alternatives is mandatory. © 2006 Movement Disorder Society [source] Urodynamic findings in female diabetic patients with and without overactive bladder symptoms,,NEUROUROLOGY AND URODYNAMICS, Issue 3 2010Chen-Hsun Ho Abstract Aims The purpose was to analyze urodynamic findings in female diabetic patients with OAB symptoms. Methods Data from 94 female diabetic patients who underwent urodynamic studies in evaluation of various LUTS were retrospectively reviewed. Urodynamic findings, demographic data, and clinical symptoms were compared between patients with and without OAB. Results Among the 94 subjects analyzed, 34 (36.2%) were diagnosed as OAB. Demographic data were similar between the patients with and without OAB. In the OAB group, patients had significantly higher storage symptom scores and marginally higher voiding symptom scores. On cystometry, the OAB group had a higher percentage of increased bladder sensation (41.2% vs 11.7%, P,=,0.001) and detrusor overactivity (29.4% vs 10.0%, P,=,0.023). The OAB group had lower peak flow rate (16.2,±,5.9 vs 19.3,±,6.3 ml/s, P,=,0.023), greater PVR volume (60.3,±,29.4 vs 45.0,±,25.1 ml, P,=,0.009), and lower bladder voiding efficiency (BVE, 75.2,±,2.8 vs 81.5,±,2.9%, P,<,0.001). On pressure-flow studies, the OAB group had a higher percentage of BOO (26.5% vs 6.7%, P,=,0.008). Conclusions Our study shows that the most frequent urodynamic finding of OAB in female diabetic patients is increased bladder sensation, followed by detrusor overactivity. Compared to those without OAB, female diabetic patients with OAB are more likely to have impaired voiding function, characterized by lower peak flow rate, greater PVR volume, lower BVE, and a higher percentage of BOO. In these patients, BOO not only causes voiding difficulty but may also contribute to the development of OAB. Neurourol. Urodynam. 29:424,427, 2010. © 2009 Wiley-Liss, Inc. [source] Reproducibility of same session repeated cystometry and pressure-flow studies in women with symptoms of urinary incontinence,,NEUROUROLOGY AND URODYNAMICS, Issue 3 2010Suzan R. Broekhuis Abstract Aim The aim of this study was to determine the reproducibility of same session repeated urodynamic measurements in women with symptoms of urinary incontinence. Methods Women presenting with symptoms of urinary incontinence underwent standardized urodynamic examination, which consisted of free uroflowmetry and two filling cystometries and pressure-flow studies. Intra-class Correlation Coefficient (ICC) and McNemar tests were used to describe the same session reproducibility. Results Two evaluable urodynamic tests were available in 152 patients. Overall, reproducibility of the urodynamic parameters were good to excellent (ICC range: 0.72,0.93), except for the bladder volume at first sensation of bladder filling (ICC,=,0.46) and the maximum Watt's factor (ICC,=,0.68). The bladder volume at first sensation and the maximum cystometric capacity were systematically higher in the second run (mean difference (95% CI),=,,45 (,73; ,37) and ,3 (,15; 10), respectively). Reproducibility of the diagnosis stress urinary incontinence and/or detrusor overactivity were good to excellent (median ICC,=,0.76, P,=,0.68 and P,=,1.00, respectively). Reproducibility of the volume and amplitude at involuntary detrusor contractions, however, were only poor (ICC,=,0.18 and 0.25, respectively). Conclusions The reproducibility of same session repeated urodynamic measurements in women with symptoms of urinary incontinence was good to excellent. Our results provide the scientific support for guidelines that recommend the omission of repeated filling cystometries and pressure-flow studies in cases where the first test confirms the pathology expected. Neurourol. Urodynam. 29:428,431, 2010. © 2009 Wiley-Liss, Inc. [source] Prevalence and mechanism of bladder dysfunction in Guillain,Barré Syndrome,NEUROUROLOGY AND URODYNAMICS, Issue 5 2009Ryuji Sakakibara Abstract Aim To examine the prevalence and mechanism of urinary dysfunction in GBS. Methods Urinary symptoms were observed and neurological examinations made repeatedly during hospitalization of 65 consecutive patients with clinico-neurophysiologically definite GBS. The patients included 41 men, 24 women; mean age, 41 years old; mean Hughes motor grade, 3; AIDP, 28, AMAN, 37. Urodynamic studies consisted of uroflowmetry, measurement of post-micturition residuals, medium-fill water cystometry, and external anal sphincter electromyography. Results Urinary dysfunction was observed in 27.7% of GBS cases (urinary retention, 9.2%). Urinary dysfunction was related to the Hughes motor grade (P,<,0.05), defecatory dysfunction (P,<,0.05), age (P,<,0.05), and negatively related to serum IgG class anti-ganglioside antibody GalNAc-GD1a (P,<,0.05). Urinary dysfunction was more common in AIDP (39%) than in AMAN (19%). No association was found between antibody titer against neuronal nicotinic acetylcholine receptors and urinary dysfunction. Urodynamic studies in nine patients, mostly performed within 8 weeks after disease onset, revealed post-void residual in 3 (mean 195 ml), among those who were able to urinate; decreased bladder sensation in 1; detrusor overactivity in 8; low compliance in 1; underactive detrusor in 7 (both overactive and underactive detrusor in 5); and nonrelaxing sphincter in 2. Conclusion In our series of GBS cases, 27.7% of the patients had urinary dysfunction, including urinary retention in 9.2%. Underactive detrusor, overactive detrusor, and to a lesser extent, hyperactive sphincter are the major urodynamic abnormalities. The underlying mechanisms of urinary dysfunction appear to involve both hypo- and hyperactive lumbosacral nerves. Neurourol. Urodynam. 28:432,437, 2009. © 2009 Wiley-Liss, Inc. [source] Acute urodynamic effects of percutaneous posterior tibial nerve stimulation on neurogenic detrusor overactivity in patients with Parkinson's disease,NEUROUROLOGY AND URODYNAMICS, Issue 1 2009Sibel Canbaz Kabay Abstract Aims Lower urinary tract dysfunction is often occurs in patients with Parkinson's disease (PD), that is primarily induced by neurogenic detrusor overactivity (NDO) and negatively effect the quality of the patient's life. The aim of this study is to evaluate the acute effects of posterior tibial nerve stimulation (PTNS) on the urodynamic findings in the PD patients with NDO. Methods Thirty-two patients with PD (19 [59.3%] men and 13 [40.6%] women) with NDO were included in the study. Mean age of the patients was 64.2,±,8.7 years (range 44,78). Urodynamic studies before and during PTNS were performed. Electrical stimulation was applied unilaterally from the medial malleolus and posterior to the edge of the tibia by using charge-compensated 200 µsec pulses with a pulse rate of 20 Hz. Mean first involuntary detrusor (1st IDCV) contractions and means maximum cystometric capacity (MCC) before and during PTNS was compared. Results Mean 1st IDCV on standard cystometry was 145.2,±,41.1 (55,265) ml, while it was 244.7,±,51.7 (145,390) ml during PTNS. MCC on standard cystometry was 204.8,±,40.5 (115,320) ml, while it was 301.2,±,51.5 (230,395) ml during stimulation. Mean 1st IDC and mean MCC were significantly improved during PTNS. Conclusions These results have demonstrated the objective acute effect of PTNS on urodynamic parameters. PTNS is acutely effective to suppress detrusor overactivity in PD patients. Neurourol. Urodynam. 28:62,67, 2009. © 2008 Wiley-Liss, Inc. [source] Comparison of sensation-related voiding patterns between continent and incontinent women: A study with a 3-day sensation-related bladder diary (SR-BD),,NEUROUROLOGY AND URODYNAMICS, Issue 6 2008Irina Naoemova Abstract Aim To describe and compare voiding patterns on a 3-day sensation-related bladder diary (SR-BD) in women with urinary incontinence (UI) and healthy volunteers. Methods A total of 251 women (224 incontinent patients and 27 healthy volunteers) who recorded a 3-day SR-BD and underwent standard cystometry participated in the study. Parameters from the 3-day SR-BD were compared between incontinent patients and healthy volunteers. Results Compared to continent women, all groups of incontinent women noted a significantly higher 24 hr voiding frequency, a greater voiding frequency per liter diuresis, a smaller mean voided volume for different degrees of bladder sensation with more voids made with higher intensity of desire to void. The smallest mean voided volumes for different degrees of desire to void and the highest voiding frequency per liter diuresis were observed in the urge incontinence group. Conclusions There were different sensation-related voiding patterns on the 3-day SR-BD from incontinent women and healthy volunteers. All incontinence groups had increased bladder sensation compared to healthy volunteers. The most severe increase of bladder sensation was observed in the patients with urgency incontinence. Neurourol. Urodynam. 27:511,514, 2008. © 2007 Wiley-Liss, Inc. [source] Effect of lumbar-epidural administration of tramadol on lower urinary tract function,,NEUROUROLOGY AND URODYNAMICS, Issue 1 2008S.K. Singh Abstract Aims Intrathecal and epidural administration of µ-agonist opioids is associated with urinary retention, a potentially serious adverse-event. In animal studies tramadol has been found not to affect voiding function. We evaluated urodynamic effects of epidural tramadol in humans. Methods Fifteen adults planned for cystoscopy under local-anesthesia underwent urodynamics (UDS) at baseline and 30 min after administration of 100 mg tramadol in lumbar-epidural space. UDS consisted of filling cystometry, pressure-flow study and pelvic floor electromyography (EMG). Subsequently, all underwent cystoscopy and were observed for 6 hr. Results After injection of tramadol, a significant rise was observed in bladder capacity (391.8,±,179.6 ml vs. 432.7,±,208.8 ml; P,=,0.019) and compliance (60.1,±,51.5 ml/cm H2O vs. 83.0,±,63.0 ml/cm H2O; P,=,0.011) without a significant change in filling pressure (22.5,±,13.2 cm H2O vs. 24.1,±,15.1 cm H2O; P,=,0.576). Filling sensations were delayed significantly (P,,,0.05). EMG during filling phase showed a significant fall (P,=,0.027). Peak flow-rate (Qmax), average flow-rate, postvoid residue and detrusor pressure-at-Qmax did not show significant change from baseline (P,>,0.05). Three patients had bladder outlet obstruction which did not worsen after the injection. Guarding reflex was inhibited in seven out of 12 patients who had it at baseline (P,=,0.016). Conclusions Epidural tramadol increases the bladder capacity and compliance and delays filling-sensations, without ill effect on voiding. This seems true even for patients with obstructed outflow; however, due to small number of patients a definite conclusion cannot be derived. These results will guide clinician to avoid catheterization in cases where epidural tramadol is used for postoperative pain. The inhibitory effects of tramadol on EMG activity are intriguing and need further studies. Neurourol. Urodynam. © 2007 Wiley-Liss, Inc. [source] Psychogenic urinary dysfunction: A uro-neurological assessment,NEUROUROLOGY AND URODYNAMICS, Issue 4 2007Ryuji Sakakibara Abstract Aims The diagnosis of psychogenic urinary dysfunction (PUD) is one of exclusion, particularly from urologic and neurologic causes, and is usually accompanied by more obvious psychologic/ psychiatric features. We here describe patients with PUD who were diagnosed in our uro- neurological laboratory. Materials and Methods We reviewed the digitized records of 2,300 urodynamic cases treated in the past 6 years to identify patients who fulfilled the diagnostic criteria of PUD. All 2,300 patients had completed a urinary questionnaire and undergone both electromyography (EMG)-cystometry and a detailed neurological examination. In addition, pressure-flow analysis, neurophysiology tests including sphincter EMG analysis, and MRI of the brain and spinal cord were performed as applicable. Results PUD was seen in 16 cases (0.7%): 6 men, 10 women, mean age 37 years. Lower urinary tract symptoms (LUTS) included overactive bladder (OAB) alone in 5, difficult urination alone in one, and both in 10. LUTS commonly occurred in particular situations, for example, OAB only while riding the train. Some patients showed extremely infrequent toileting. The urodynamic findings were normal except for increased bladder sensation (50%) for OAB and acontractile detrusor (31%) for difficulty. The final diagnosis was conversion reaction in six followed by anxiety in four. Conclusions PUD patients experienced the situational occurrence of OAB and/or difficult urination and, in some patients, extremely infrequent toileting. The main urodynamic abnormalities were increased bladder sensation and acontractile detrusor. However, even in cases suggestive of PUD, a non-PUD pathology behind the symptoms should be explored. Neurourol. Urodynam. 26:518,524, 2007. © 2007 Wiley-Liss, Inc. [source] The molecular basis of urgency: regional difference of vanilloid receptor expression in the human urinary bladder,NEUROUROLOGY AND URODYNAMICS, Issue 3 2007Lu Liu Abstract Aim Treatments targeting vanilloid receptor TRPV1 are effective in some bladder disorders. Our aim was to determine the expression profiles of TRPV1 in regions of human bladder and test the hypothesis that there would be an upregulation of TRPV1 in mucosa of patients with bladder hypersensitivity but not idiopathic detrusor overactivity (IDO). Materials and Methods Women with sensory urgency (SU), interstitial cystitis (IC), and IDO were investigated by videourodynamics and cystoscopy. Control biopsies were used for comparison. Biopsies were dissected into mucosa and muscle, and evaluated for TRPV1 mRNA expression using quantitative competitive RT-PCR (QC-RT-PCR). Results TRPV1 mRNA from SU trigonal mucosa was significantly higher than control trigonal mucosa or SU bladder body mucosa. In contrast, in IDO patients, there was no difference between trigonal mucosa and body mucosa. In IC biopsies, RNA quality was substandard and unable to be used for analysis. The most striking finding was that TRPV1 mRNA expressed in SU trigonal mucosa was significantly inversely correlated with the bladder volume at first sensation of filling during cystometry. No such relationship was seen for IDO trigonal mucosa. No difference was seen in bladder body mucosa from any disease groups compared with age-matched control. Conclusions The symptoms of SU were associated with the increased expression of TRPV1 mRNA in the trigonal mucosa. No upregulation or regional differences of TRPV1 mRNA were seen in IDO patients. TRPV1 may play a role in SU and premature first bladder sensation on filling. Neurourol. Urodynam. 26:433,438, 2007. © 2006 Wiley-Liss, Inc. [source] A double-blind, randomized controlled trial of cystometry using saline versus 0.3 M potassium chloride infusion in women with overactive bladder syndrome,,NEUROUROLOGY AND URODYNAMICS, Issue 1 2007Joe Philip Abstract Aim To evaluate the effect of 0.3 M potassium chloride on cystometric parameters by comparing it with normal saline as a filling solution in women with overactive bladder (OAB). Patients and Methods Twenty-three women with significant OAB symptoms underwent consecutive cystometrograms (CMGs) using 0.9% normal saline (NS) and 0.3 M potassium chloride (KCl), the order of which was randomized for each patient. Individual CMGs were performed by separate investigators and both patients and investigators were blinded to the order in which each solution was given and to the results of the other CMG. Results Regardless of the nature of the filling solution, the order in which the CMGs were performed had little influence on either first desire to void (FDV, mean 83.5 ml vs. 117.8 ml for first and second CMGs respectively, P,=,0.10) or on maximum cystometric capacity (Cmax, mean 265.0 ml vs. 264.4 ml, P,=,0.98). KCl produced a significant (24%) reduction in mean Cmax compared to NS (mean 228.6 ml vs. 300.8 ml, P,=,0.001), irrespective of the order of infusion. Conclusion This comparative study using 0.3 M KCl versus NS as filling solutions suggests that intravesical potassium may not simply act on urothelial sensory nerve endings; it may also stimulate detrusor muscle contraction. These findings may influence the interpretation of the potassium sensitivity test in patients with OAB symptoms, particularly in those suspected of having interstitial cystitis. Neurourol. Urodynam. © 2006 Wiley-Liss, Inc. [source] Non-neurogenic urinary retention (Fowler's syndrome) in two sistersNEUROUROLOGY AND URODYNAMICS, Issue 7 2006Simon Podnar Abstract Aims To report for the first time occurrence of obstructed voiding due to excessive activity of the urethral sphincter (US) muscle in two sisters with polycystic ovaries (Fowler's syndrome). Methods In both patients precise micturition history was obtained. In addition, clinical neurological and gynecological examinations, cystometry, urethral pressure profile measurements, gynecological ultrasound, measurement of gonadotropic hormone levels, and concentric needle electromyography (EMG) of the US muscle were performed. Results Both sisters reported symptoms of severely obstructed voiding. Clinical examination, and filling cystometries were normal. Urethral pressures were increased (99,134 cm water). The first sister was not able to void, and the urinary flow was slow and intermittent in the second on voiding studies. Profuse complex repetitive discharges and decelerating burst activity were found on concentric needle EMG of the US in both of them. Both sisters had increased LH/FSH ratio (2.96 and 2.64), and ultrasonographic abnormalities compatible with polycystic ovaries. Conclusions Diagnosis of Fowler's syndrome was made in both sisters. Due to very low incidence rate of this syndrome (0.2/100.000 per year), we think that it is highly unlikely to find it in two sisters just by chance. We suggest that the probable explanation is a genetic predisposition to polycystic ovaries, with which this condition has been shown to be associated. Neurourol. Urodynam. 25:739,741, 2006. © 2006 Wiley-Liss, Inc. [source] Murine in vitro whole bladder model: A method for assessing phenotypic responses to pharmacologic stimuli and hypoxiaNEUROUROLOGY AND URODYNAMICS, Issue 4 2004Joel C. Hutcheson Abstract Aims Recent advances in genetic manipulation have allowed for over expression or deletion of selective genes in mice. This offers urologic investigators new means of understanding bladder function in the context of normal development or the response to outlet obstruction. It is important to correlate any genetic manipulations in mice with specific phenotypic properties such as voiding patterns, or muscle strip physiology. We describe a simple in vivo whole bladder preparation that may be used to study the phenotypic changes in bladder function. Methods Murine bladders were mounted on a 30 gauge needle and mounted in an organ chamber containing a physiologic buffer solution. Passive bladder properties were assessed with cystometry, and active contractile responses were measured in response to electrical field stimulation and agonists. The effects of hypoxia were also studied. Results Compliance in the murine bladder is dependent upon actin myosin interactions, and increased in the presence of calcium free buffer and EGTA. The sarcoplasmic reticulum plays a smaller role in the contraction of murine bladder than in other species. Murine bladder smooth muscle demonstrated a remarkable ability to withstand hypoxia. Conclusions This simple model can be adapted to help study the murine bladder smooth muscle phenotype under highly controlled circumstances. © 2004 Wiley-Liss, Inc. [source] Clinical and urodynamic features of intrinsic sphincter deficiencyNEUROUROLOGY AND URODYNAMICS, Issue 4 2003Cinzia Pajoncini Abstract Aims A prospective analysis of 92 patients with genuine stress incontinence was performed to identify the clinical and urodynamic features of intrinsic sphincter deficiency (ISD). Methods We divided the patients into two categories: 50 patients affected by pure ISD as they had severe stress incontinence and no urethral mobility; 42 patients suffering from stress urinary incontinence without ISD as they had mild stress incontinence and marked urethral hypermobility. Cystometry was normal in all patients. The presence/absence of ISD was considered the dependent variable and was correlated against the following independent variables: age, vaginal deliveries, menopause, previous urogynecological surgery and/or hysterectomy, supine stress test, irritative and/or obstructive symptoms, Valsalva leak point pressure (VLPP), maximum urethral closure pressure (MUCP), urethral functional length (UFL), and leakage during cystometry. Results The statistical analysis showed close correlations between ISD and age (P,<,0.001), menopausal status (P,<,0.001), previous surgery (P,<,0.0001), supine stress test (P,<,0.0001), leakage during cystometry (P,<,0.001), and UFL (P,<,0.01). The VLPP was below the cut-off value (,60 cm H2O) in 70% of ISD patients (P,<,0.0001), whereas the MUCP in 50% of ISD patients (P,<,0.0001). Multiple logistic analysis showed that lower VLPP, lower MUCP, and previous surgery correlate more significantly with ISD. After backward conditional stepwise logistic regression, the odds ratio of having ISD were VLPP,=,2.3, MUCP,=,7.7, VLPP + MUCP,=,62.8. Conclusions ISD is related to the presence of a more severe clinical picture and case history, but the most significant independent variables are the VLPP and MUCP. Neurourol. Urodynam. 22:264,268, 2003. © 2003 Wiley-Liss, Inc. [source] Ascending and descending brainstem neuronal activity during cystometry in decerebrate catsNEUROUROLOGY AND URODYNAMICS, Issue 4 2003Kimio Sugaya Abstract Aims This study was undertaken to examine the distribution of pontomedullary neurons related to micturition or urine storage, as well as the connections between the pontine micturition center (PMC), medullary neurons, and the spinal cord. Methods In decerebrate cats, extracellular recording of the rostral pontine and rostral medullary neurons was performed. Firing of each neuron was quantitated during cystometry. Connections between the PMC, medullary neurons, and the spinal cord (L1) were also examined electrophysiologically. Results Ninety-four neurons showed an increase or decrease of the firing rate during micturition. Units with an antidromic response to L1 stimulation and an increased firing rate were located in the nucleus locus coeruleus alpha (LCa; n,=,8) corresponding to the PMC, and in the medial reticular formation (MRF) of the medulla (n,=,14). Units showing a decreased firing rate were located in the nucleus reticularis pontis oralis (PoO; n,=,26) and in the MRF (n,=,11). The latencies of antidromic and orthodromic responses of the LCa units were longer than those of the PoO units. MRF neurons responded antidromically and/or orthodromically to stimulation of the PMC or L1. Conclusions These results suggest that the pathway concerned with urine storage has a faster spinobulbospinal loop than the micturition reflex pathway and that rostral medullary neurons also play an important role in micturition and urine storage. There may be two descending pathways between the PMC and the spinal cord: both a direct pathway and one by means of medullary neurons. Neurourol. Urodynam. 22:343,350, 2003. © 2003 Wiley-Liss, Inc. [source] Measuring the sensations of urge and bladder filling during cystometry in urge incontinence and the effects of neuromodulationNEUROUROLOGY AND URODYNAMICS, Issue 1 2003Sarah Oliver Abstract Aims: As urge and urgency contribute greatly to a patient's symptoms, it follows that sensory evaluation combined with noninvasive neuromodulation during urodynamics may provide new criteria for improving patient selection for an implantable stimulator. The purpose of this research was to develop and validate an objective measure of bladder sensations during filling cystometry and then to apply this technique to evaluate the effects of neuromodulation on the sensations of urge measured in this way. Methods: In study 1 a new patient-activated keypad device was tested during urodynamics to measure bladder sensations according to a 0,4 scale and validated by using a technique adapted from a standard psychophysical sensory threshold testing method. In study 2 the effects of pudendal afferent nerve stimulation on measured sensations of urge were assessed during cystometry with patients as their own controls. Forty-three patients diagnosed with idiopathic detrusor instability were studied; 10 participated in study 1 and 35 in study 2. Results: The new device gave reliable and repeatable measures of sensations with statistically significant differences in bladder volume at each of the urge levels tested (Wilcoxon matched pairs test). Neuromodulation suppressed urinary urge in 89% of the 35 patients. This effect was associated with a statistically significant increase in bladder volume at all urge levels. Conclusions: A new patient operated key-pad device provided a reliably objective measure of sensations of urge during urodynamics without the need for prompting. Neuromodulation using noninvasive pudendal afferent stimulation suppressed these sensations whilst increasing bladder volume. Neurourol. Urodynam. 22:7,16, 2003. © 2003 Wiley-Liss, Inc. [source] Detrusor instability with equivocal obstruction: A predictor of unfavorable symptomatic outcomes after transurethral prostatectomyNEUROUROLOGY AND URODYNAMICS, Issue 5 2002Rintaro Machino Abstract Aims To elucidate whether preoperative urodynamic findings can predict outcomes of transurethral resection of the prostate (TUR-P). Methods Sixty-two patients with symptomatic benign prostatic hyperplasia were categorized in three different ways based on findings of preoperative pressure-flow study (PFS) and cystometry: urodynamic obstruction (determined by the Abrams-Griffiths nomogram), detrusor instability (DI), and combination of both. Outcomes of TUR-P regarding symptom, function, and quality of life (QOL) were analyzed by changes in the International Prostate Symptom Score (I-PSS), maximum flow rate in uroflowmetry, and QOL index before and after TUR-P, respectively. Overall outcome was defined as success when all of the three categories showed successful improvement. Results Neither urodynamic obstruction alone nor DI alone predicted outcomes of TUR-P. However, symptomatic and overall outcomes were significantly worse in patients who were not obstructed but had DI. Postoperative persistent DI was more frequently noted in patients without clear obstruction (60%) than in those with obstruction (27%). Patients with equivocal obstruction showed less satisfactory symptomatic outcomes of TUR-P when DI was accompanied. Persistent DI might be the principle cause of unfavorable outcomes. Conclusions Preoperative evaluation of DI is of benefit because it enhances predictive value of the PFS. Neurourol. Urodynam. 21:444,449, 2002. © Wiley-Liss, Inc. [source] Biochemical and morphological effects of bladder pumping on the urinary bladder in ratsNEUROUROLOGY AND URODYNAMICS, Issue 5 2002Kimio Sugaya Abstract Aims To study the influence of bladder pumping on the urinary bladder in 44 female rats. Methods Under halothane anesthesia, a urethral catheter was inserted into the bladder of 27 rats, and air (0.4,0.8 mL) was pumped in and out of the bladder at 0.5 cycles/second for a period of 5 minutes. Twenty-four hours after pumping, the bladder was harvested for measurement of the tissue levels of myosin, actin, and nerve growth factor, as well as for electron microscopy. In nine of the 27 rats, cystometry was performed without anesthesia before and 1, 7, 30, and 90 days after bladder pumping. The remaining 17 rats that did not undergo pumping were anesthetized and their bladders were harvested as a control. Results Bladder pumping increased the bladder capacity and decreased the maximum bladder contraction pressure, but did not increase the residual volume. Bladder pumping also increased the tissue level of nerve growth factor and decreased the levels of myosin and actin. Electron microscopy showed degeneration of bladder smooth muscle cells and nerve fibers after bladder pumping, as well as derangement and disruption of collagen fiber bundles in the bladder wall. These functional and morphological effects of pumping disappeared within 90 days. Conclusions Bladder pumping therapy appears to have various effects on the bladder wall collagen fiber bundles, smooth muscle cells, and nerves. Neurourol. Urodynam. 21:511,515, 2002. © Wiley-Liss, Inc. [source] Good urodynamic practices: Uroflowmetry, filling cystometry, and pressure-flow studies,,NEUROUROLOGY AND URODYNAMICS, Issue 3 2002Werner Schäfer Abstract This is the first report of the International Continence Society (ICS) on the development of comprehensive guidelines for Good Urodynamic Practice for the measurement, quality control, and documentation of urodynamic investigations in both clinical and research environments. This report focuses on the most common urodynamics examinations; uroflowmetry, pressure recording during filling cystometry, and combined pressure,flow studies. The basic aspects of good urodynamic practice are discussed and a strategy for urodynamic measurement, equipment set-up and configuration, signal testing, plausibility controls, pattern recognition, and artifact correction are proposed. The problems of data analysis are mentioned only when they are relevant in the judgment of data quality. In general, recommendations are made for one specific technique. This does not imply that this technique is the only one possible. Rather, it means that this technique is well-established, and gives good results when used with the suggested standards of good urodynamic practice. Neurourol. Urodynam. 21:261,274, 2002. © 2002 Wiley-Liss, Inc. [source] Data from frequency-volume charts versus filling cystometric estimated capacities and prevalence of instability in men with lower urinary tract symptoms suggestive of benign prostatic hyperplasiaNEUROUROLOGY AND URODYNAMICS, Issue 2 2002Ger E.P.M. van Venrooij Abstract The aim was to examine associations of filling cystometric estimated compliance, capacities, and prevalence of bladder instability with data from frequency-volume charts in a well-defined group of men with lower urinary tract symptoms (LUTS) suggestive of benign prostatic hyperplasia (BPH). Men with LUTS suggestive of BPH were included if they met the criteria of the International Consensus Committee on BPH, i.e., they voided more than 150 mL during uroflowmetry, their residual volume and prostate size were estimated, and they completed frequency-volume charts correctly. From the frequency-volume charts, voiding habits, and fluid intake in the daytime and at night were evaluated. Filling cystometric studies were performed in these men as well. Decreased compliance was an exceptional finding. Cystometric capacity and especially effective capacity (cystometric capacity minus residual volume) corresponded significantly with the maximum voided volume on the frequency-volume charts. Effective capacity was almost twice as high as the average voided volume. Minimum voided volume on frequency-volume charts was not related to filling cystometric data. The presence of instability in the supine or sitting position or in both positions was not significantly associated with smaller voided volumes, higher nocturia, or diuria. Filling cystometric capacities were strongly associated with maximal and mean voided volumes derived from frequency-volume charts. The presence of detrusor instability during filling cystometry did not significantly affect voided volumes, diuria, or nocturia. Neurourol. Urodynam. 21:106,111, 2002. © 2002 Wiley-Liss, Inc. [source] Interactions between prostate volume, filling cystometric estimated parameters, and data from pressure-flow studies in 565 men with lower urinary tract symptoms suggestive of benign prostatic hyperplasiaNEUROUROLOGY AND URODYNAMICS, Issue 5 2001Mardy D. Eckhardt Abstract The aim of this study was to establish the characteristics and to investigate the interactions between prostate volume, degree of obstruction, bladder contractility, the prevalence of residual volume, bladder compliance, bladder capacities, and the prevalence of instability in a large, well-defined group of men with lower urinary tract symptoms (LUTS) suggestive of benign prostatic hyperplasia (BPH). The 565 consecutive men included in this study met the criteria of the International Consensus Committee on BPH and voided more than 150 mL during uroflowmetry. Their residual urine volume and prostate size were estimated, and filling cystometry and pressure-flow studies were performed. Fifty-three percent of the men appeared to have obstruction. We found a positive correlation between prostate volume and Schäfer's obstruction grade, except that mean prostate volume decreased at Schäfer's grades 5 and 6. Significant negative correlations existed between Schäfer's grade and cystometric bladder capacity and effective capacity. Bladder outlet obstruction results in incomplete emptying. Of all men, 26% had a significant residual volume (,>,20% of cystometric capacity). Thirty-nine percent did not have residual volume. Of the 565 men, 46% had an unstable bladder. In particular, patients with an unstable bladder in the sitting and lying positions have a significantly higher Schäfer's grade and contractility grade and a significantly lower cystometric and effective bladder capacity compared with patients without instability. Patients with a residual volume or instability were significantly older. We conclude that in men with LUTS suggestive of BPH, abnormalities of bladder and bladder outlet function vary greatly and have complex mutual interactions. Neurourol. Urodynam. 20:579,590, 2001. © 2001 Wiley-Liss, Inc. [source] BPH with coexisting overactive bladder dysfunction,an everyday urological dilemmaNEUROUROLOGY AND URODYNAMICS, Issue 3 2001Tomas Knutson Abstract The aim of this study was to use a systematic schedule, including urodynamics, to describe the rate of coexisting overactive bladder (OB) in patients with bladder outlet obstruction (BOO) caused by benign prostatic hyperplasia (BPH). We also identified differences between the patients with pure BOO compared with those with BOO combined with OB (BOO,+,OB). One hundred and sixty-two men referred to our clinic due to LUTS were included. Patients with a history that might affect their bladder function were excluded. After cystometry and pressure,flow studies, the patients were divided into pure BOO and BOO,+,OB. Of the 162 men, 55% had pure BOO. BOO,+,OB was found in 45%. Age, s-PSA, voided volume, and obstruction grade differed significantly between the groups. The patients with BOO,+,OB were older, had a higher s-PSA, voided smaller volumes, and were more obstructed. We found no differences in TRUS-volume, Q-max, IPS score, or PVR. There was a strong association between OB and BOO, the percentage of OB increasing with increased obstruction. TRUS-volume, Q-max, IPS score, and PVR did not predict whether the patients had a combined BOO,+,OB or not. These findings indicate that BOO is a progressive disease, which in time causes pronounced obstruction and perhaps in itself contributes to the development of OB. Neurourol. Urodynam. 20:237,247, 2001. © 2001 Wiley-Liss, Inc. [source] | ||||||||||