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Detrusor Contractility (detrusor + contractility)
Selected AbstractsData from frequency-volume charts versus maximum free flow rate, residual volume, and voiding cystometric estimated urethral obstruction grade and detrusor contractility grade in men with lower urinary tract symptoms suggestive of benign prostatic hyperplasiaNEUROUROLOGY AND URODYNAMICS, Issue 5 2002Ger E.P.M. van Venrooij Abstract Aims To examine associations of data from frequency-volume charts with maximum free flow rate, residual volume, and voiding cystometric estimated urethral obstruction grade and detrusor contractility in men with lower urinary tract symptoms suggestive of benign prostatic hyperplasia (BPH). Methods The 160 men included in the study met the criteria of the International Scientific 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 were evaluated. Pressure-flow studies were performed as well. Results Increasing residual volume was related to a decrease of maximum voided volume and to a decrease of maximum free flow rate. Cystometric capacity was little affected by residual volume. Low contractility did not result in high residual volume. A marked decrease in voided volumes with increasing obstruction grade was observed, due to a decrease of cystometric capacity and an increase of residual volume. Detrusor contractility was little associated with voided volumes. A higher voiding frequency was related to a higher fluid intake. However, increased standardized frequency (number of voidings per 1,000 mL) was associated with a substantial reduction of fluid intake. Conclusions Infravesical obstruction is the most important factor influencing voided volumes, cystometric capacity, and residual urine volume. Frequency of voiding was not influenced significantly because patients with small voided volumes minimized their fluid intake. Neurourol. Urodynam. 21:450,456, 2002. © Wiley-Liss, Inc. [source] Recent Advances in Intravesical Treatment of Overactive BladderLUTS, Issue 1 2009Hann-Chorng KUO The traditional medication for overactive bladder (OAB) is antimuscarinic agent, which targets muscarinic receptors. Recent investigations have revealed that muscarinic receptors are present in the urothelium and suburothelial sensory fibers, as well as in the detrusor. Urothelial dysfunction and abnormality of sensory receptor expression or transmitter release in suburothelial nerves could contribute to OAB refractory to antimuscarinics. Intravesical treatment to inhibit abnormal receptor expression or transmitter release in the sensory nerve terminals in the suburothelial space might provide beneficial therapeutic effects in the treatment of OAB. Intravesical resiniferatoxin (RTX) instillation and intravesical botulinum toxin A (BoNT-A) injection are two promising treatment alternatives for refractory OAB. RTX at a high dose may cause undesired adverse events, such as hematuria, bladder pain or autonomic dysreflexia. RTX at a low concentration can decrease sensory urgency without influencing detrusor contractility; multiple instillations of low-dose RTX may be required to achieve adequate desensitization of OAB. BoNT-A, however, has a beneficial effect on detrusor contractility and causes large post-void residual after injection in some patients. Therefore, careful dosage and injection site adjustment is mandatory to achieve satisfactory results using intravesical therapy. [source] Short-term effect of a single levodopa dose on micturition disturbance in Parkinson's disease patients with the wearing-off phenomenonMOVEMENT DISORDERS, Issue 5 2003Tomoyuki Uchiyama MD Abstract We investigated the short-term effects of a single dose of levodopa (L -dopa) on micturition function in PD patients with wearing-off phenomenon. Eighteen PD patients who had median Hoehn and Yahr scores of 5 during the off phase and 3 during the on phase were recruited. We carried out urodynamic studies before and about 1 hour after the patients had taken 100 mg of L -dopa with dopa-decarboxylase inhibitor (DCI). After taking the L -dopa/DCI, urinary urgency and urge incontinence aggravated, whereas voiding difficulty was alleviated in all 12 patients. When compared to the baseline assessment, urodynamic study results after taking 100 mg of L -dopa/DCI showed aggravated detrusor hyperreflexia; decreased maximum bladder capacity (P = 0.006); an increased maximum Watts Factor value (P = 0.001), reflecting the detrusor power on voiding; an increased Abrams-Griffiths number (P = 0.042), reflecting urethral obstruction on voiding; decreased residual urine volume (P = 0.025); and increased static urethral closure pressure (P = 0.012). One hundred milligrams of L -dopa/DCI worsened detrusor hyperreflexia, producing worsened urinary urgency and urge incontinence during the storage (bladder-filling) phase. It also increased detrusor contractility much more than it did urethral obstruction in the voiding phase, producing overall lessening of voiding difficulty and improving voiding efficiency in our PD patients with the wearing-off phenomenon. © 2003 Movement Disorder Society [source] Stop test or pressure-flow study?NEUROUROLOGY AND URODYNAMICS, Issue 3 2004Measuring detrusor contractility in older females Abstract Aims Impaired detrusor contractility is common in older adults. One aspect, detrusor contraction strength during voiding, can be measured by the isovolumetric detrusor pressure attained if flow is interrupted mechanically (a stop test). Because interruption is awkward in practice, however, simple indices or nomograms based on measurements made during uninterrupted voiding are an appealing alternative. We investigated whether such methods, originally developed for males, might be applicable in female subjects, and attempted to identify a single best method. Methods We compared stop-test isovolumetric pressures with estimates based on pressure-flow studies in a group of elderly women suffering from urge incontinence. Measurements were made pre- and post-treatment with placebo or oxybutynin, allowing investigation of test,retest reliability and responsiveness to small changes of contractility. Results Existing methods of estimating detrusor contraction strength from pressure-flow studies, including the Schäfer contractility nomogram and the projected isovolumetric pressure PIP, greatly overestimate the isovolumetric pressure in these female patients. A simple modification provides a more reliable estimate, PIP1, equal to pdet.Qmax,+,Qmax (with pressure in cmH2O and Qmax in ml/sec). Typically PIP1 ranges from 30 to 75 cmH2O in this population of elderly urge-incontinent women. PIP1, however, is less responsive to a small change in contraction strength than the isovolumetric pressure measured by mechanical interruption. Conclusions The parameter PIP1 is simple to calculate from a standard pressure-flow study and may be useful for clinical assessment of detrusor contraction strength in older females. For research, however, a mechanical stop test still remains the most reliable and responsive method. The Schäfer contractility nomogram and related parameters such as DECO and BCI are not suitable for use in older women. Neurourol. Urodynam. 23:184,189, 2004. © 2004 Wiley-Liss, Inc. [source] Perugia urodynamic method of analysis (PUMA): A new advanced method of urodynamic analysis applied clinically and compared with other advanced methodsNEUROUROLOGY AND URODYNAMICS, Issue 3 2003Massimo Porena Abstract Aims The aim of this study is to compare PUMA curves with different pathologic conditions causing bladder dysfunction in 158 men and 83 women. Methods PUMA results in terms of bladder outlet obstruction and detrusor contractility were compared in 92 men with benign prostatic hypertrophy (BPH) and pves,pdet (i.e., pabd,0) with the results of the urodynamics operator's opinion, the provisional International Continence Society method, Abrams and Griffith's diagram, urethral resistence factor (URA), Schäfer's diagram, and Watt factor. PUMA curves correlated reliably with different pathologic conditions such as obstructive BPH, orthotopic bladder, cystocele, the neurological bladder, and bladder diverticulum. Statistical analysis indicated excellent agreement between PUMA and URA; agreement with other methods was good in cases of obstruction and nonobstruction. In doubtful cases, as diagnosed by standard methods, PUMA agreed only with the Abrams and Griffith's diagram. PUMA and Wmax were in good agreement on detrusor con traction force. Agreement between PUMA and Schäfer's diagram was excellent for patients with detrusor hypercontractility and good for patients with detrusor hypocontractility and normocontractility. PUMA is the only method applicable to women. It is easy to perform. When integrated with other diagnostic tests, it provides realistic data for diagnosis, medical or surgical therapy, and outcome. Neurourol. Urodynam. 22:206,222, 2003. © 2003 Wiley-Liss, Inc. [source] Data from frequency-volume charts versus maximum free flow rate, residual volume, and voiding cystometric estimated urethral obstruction grade and detrusor contractility grade in men with lower urinary tract symptoms suggestive of benign prostatic hyperplasiaNEUROUROLOGY AND URODYNAMICS, Issue 5 2002Ger E.P.M. van Venrooij Abstract Aims To examine associations of data from frequency-volume charts with maximum free flow rate, residual volume, and voiding cystometric estimated urethral obstruction grade and detrusor contractility in men with lower urinary tract symptoms suggestive of benign prostatic hyperplasia (BPH). Methods The 160 men included in the study met the criteria of the International Scientific 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 were evaluated. Pressure-flow studies were performed as well. Results Increasing residual volume was related to a decrease of maximum voided volume and to a decrease of maximum free flow rate. Cystometric capacity was little affected by residual volume. Low contractility did not result in high residual volume. A marked decrease in voided volumes with increasing obstruction grade was observed, due to a decrease of cystometric capacity and an increase of residual volume. Detrusor contractility was little associated with voided volumes. A higher voiding frequency was related to a higher fluid intake. However, increased standardized frequency (number of voidings per 1,000 mL) was associated with a substantial reduction of fluid intake. Conclusions Infravesical obstruction is the most important factor influencing voided volumes, cystometric capacity, and residual urine volume. Frequency of voiding was not influenced significantly because patients with small voided volumes minimized their fluid intake. Neurourol. Urodynam. 21:450,456, 2002. © Wiley-Liss, Inc. [source] Neuronal nitric oxide synthase activity in rat urinary bladder detrusor: participation in M3 and M4 muscarinic receptor functionAUTONOMIC & AUTACOID PHARMACOLOGY, Issue 3 2005B. Orman Summary 1,The aim of this paper was to determine the different signalling cascades involved in contraction of the rat urinary bladder detrusor muscle mediated via muscarinic acetylcholine receptors (muscarinic AChR). Contractile responses, phosphoinositides (IPs) accumulation, nitric oxide synthase (NOS) activity and cyclic GMP (cGMP) production were measured to determine the reactions associated with the effect of cholinergic agonist carbachol. The specific muscarinic AChR subtype antagonists and different inhibitors of the enzymatic pathways involved in muscarinic receptor-dependent activation of NOS and cGMP were tested. 2,Carbachol stimulation of M3 and M4 muscarinic AChR increased contractility, IPs accumulation, NOS activity and cGMP production. All of these effects were selectively blunted by 4-DAMP and tropicamide, M3 and M4 antagonists respectively. 3,The inhibitors of phospholipase C (PLC), calcium/calmodulin (CaM), neuronal NOS (nNOS) and soluble guanylate cyclase, but not of protein kinase C and endothelial NOS (eNOS), inhibited the carbachol action on detrusor contractility. These inhibitors also attenuated the muscarinic receptor-dependent increase in cGMP and activation of NOS. 4,In addition, sodium nitroprusside and 8-bromo-cGMP, induced negative relaxant effect. 5,The results obtained suggest that carbachol activation of M3 and M4 muscarinic AChRs, exerts a contractile effect on rat detrusor that is accompanied by an increased production of cGMP and nNOS activity. The mechanism appears to occur secondarily to stimulation of IPs turnover via PLC activation. This in turn, triggers cascade reactions involving CaM, leading to activation of nNOS and soluble guanylate cyclase. They, in turn, exert a modulator inhibitory cGMP-mediated mechanism limiting the effect of muscarinic AChR stimulation of the bladder. [source] Antimuscarinic drugs in detrusor overactivity and the overactive bladder syndrome: motor or sensory actions?BJU INTERNATIONAL, Issue 3 2006STEVEN M. FINNEY Antimuscarinic drugs are generally thought to exert their therapeutic action on detrusor overactivity by reducing the ability of the detrusor muscle to contract. We review currently available published data to establish whether there is any evidence to support this contention. Using a PubMed data search, only 14 original articles (including two abstracts) were found that contained cystometric data for both filling and voiding phases and where the actions of antimuscarinic drugs have been reported in detail. These articles were separated into three groups dealing with neuropathic patients (three papers), patients with idiopathic overactive bladder (four papers) and a group whose aetiology was unclear (seven papers). Variables relating to bladder function during the filling phase (time of first desire to void, time to first unstable contraction, and bladder capacity) were identified. Similarly, variables relating to voiding were identified and compared (e.g. maximum detrusor pressure and detrusor pressure at maximum flow rate). The antimuscarinic drugs have a clearly significant effect on sensations of urge, time to first sensation to void, maximum bladder capacity, decrease in voiding frequency and reduction in incontinence episodes. However, only one article (studying neuropaths) reported a significant reduction of the variables associated with detrusor contraction. The remaining four studies (idiopaths/not stated), reported no change in bladder contractility with antimuscarinic drugs. Thus the available data do not support the conclusion that antimuscarinic drugs at doses used in current clinical practice exert their therapeutic action by inhibiting detrusor contractility, but they suggest effects on variables associated with sensation. [source] | ||||||||||