Relation between bladder filling and anal sphincter reflexes

The effect of bladder filling on the threshold of the perianally elicited anal reflex and the anal reflex elicited by peripheral stimulation of the lower limbs has been studied in seven patients with hyperactive bladder and detrusor-sphincter dyssynergia and in seven normal controls. No changes were found in the perinally elicited reflex, while the minimal peripheral stimulus necessary for eliciting a reflex changed in both groups but in opposite directions. These observations show that the different anal reflexes use different spinal pathways and that the central control of the interaction between detrusor and sphincters is exerted on the pathway used by the peripheral reflex. These findings, moreover, call for a thorough standardization of the conditions of investigation.     

Risk factors for febrile urinary tract infection in children with myelodysplasia treated by clean intermittent catheterization

OBJECTIVE: To identify the factors involved in the incidence of febrile urinary tract infection (UTI) in a retrospective study of children with myelodysplasia who were treated by clean intermittent catheterization. METHODS: A total of 76 myelodysplastic children were included in the present study. Any factors, including urodynamic parameters and urinary tract abnormalities, that may have been associated with the incidence of febrile UTI were evaluated using both a univariate analysis and a multiple logistic regression analysis. RESULTS: Of the 76 patients, 19 (25%) had one or more episodes of febrile UTI. A univariate analysis showed low bladder compliance (<10 mL/cmH2O), detrusor overactivity, bladder trabeculation and the presence of vesico-ureteral reflux (VUR) to be significant factors in the incidence of febrile UTI. The presence of detrusor overactivity and a low bladder compliance, in addition to the presence of VUR, were found to be significant factors for the incidence of febrile UTI using a multivariate analysis. CONCLUSION: These results demonstrate that, in addition to VUR, urodynamics linked to bladder storage function disorder appear to be directly correlated with the cause of febrile UTI in children with myelodysplasia.     

Long-Term Study on the Effects of Visual Biofeedback and Muscle Training as a Therapeutic Modality in Pelvic Floor Dyssynergia and Slow-Transit Constipation

PURPOSE: Biofeedback training has been shown as an effective therapeutic measure in patients with pelvic floor dyssynergia, at least in the short term. Long-term effects have received less attention. Moreover, its effects in patients with slow-transit constipation have been scarcely investigated. This study was designed to assess in an objective way the medium- and long-term effects of biofeedback and muscle training in patients with pelvic floor dyssynergia and slow-transit constipation. METHODS: Twenty-four patients (14 with pelvic floor dyssynergia and 10 with slow transit) meeting the Rome II criteria for constipation, and unresponsive to conventional treatments, entered the study. Clinical evaluation and anorectal manometry were performed basally and three months after a cycle of electromyographic biofeedback and muscle training; moreover, a clinical interview was obtained one year after biofeedback. Patients with slow-transit constipation also had colonic transit time reassessed at one year. RESULTS: Clinical variables (abdominal pain, straining, number of evacuations/week, use of laxatives) all significantly improved in both groups at three-month assessment; anorectal manometric variables remained unchanged, apart from a significant decrease of sensation threshold in the pelvic floor dyssynergia group and of the maximum rectal tolerable volume in the slow-transit constipation group. At one-year control, 50 percent of patients with pelvic floor dyssynergia still maintained a beneficial effect from biofeedback, whereas only 20 percent of those complaining of slow-transit constipation did so. Moreover, the latter displayed no improvement in colonic transit time. CONCLUSIONS: In our experience, patients with pelvic floor dyssynergia are likely to have continued benefit from biofeedback training in the time course, whereas its effects on slow-transit constipation seems to be maximal in the short-term course.     

Correlation between lower urinary tract symptoms and urethral function in benign prostatic hyperplasia

AIM: To examine the potential correlation between urethral function and lower urinary tract symptoms (LUTS) in men with benign prostatic hyperplasia (BPH). METHODS: Thirty-one patients with clinical BPH, who were confirmed to have benign prostatic enlargement (BPE) of 20 ml or more, were enrolled into the study. A mark-sheet questionnaire was used for obtaining the LUTS history. Multichannel pressure-flow urodynamic studies were performed and external urethral sphincter pressure (PEUS), intravesical pressure (PVES), and bladder neck pressure (PBN) were recorded both at maximum cystometric capacity and during voiding with 5-microtip transducers, for the purpose of detecting BPE-specific urodynamic findings at different levels within the urethra. RESULTS: There was a positive correlation between hesitancy and detrusor bladder neck dyssynergia (DBND) (P = 0.0011) and between incomplete emptying and low PBN at maximum cystometric capacity (P = 0.0425). The hesitancy proved to have no correlation with bladder neck opening time (TBNO). CONCLUSION: Urodynamic evaluation of urethral function was beneficial for attributing LUTS to clinical BPH. Among various parameters, DBND was the most specific to clinical BPH, suggesting it to be a situation where a steep rise in PBN or prostatic urethral pressure remains greater than the increasing PVES, resulting in sustained difficulty in opening the bladder neck and subsequently the subjective sensation of hesitancy.     

Effect of bilateral hypogastric nerve transection on voiding dysfunction in rats with spinal cord injury

We determined if bilateral section of the hypogastric nerves (HGN), which provide the major sympathetic input to the urinary bladder neck/proximal urethra, could improve voiding by reducing urethral resistance in conscious, female spinal-cord-injured (SCI) rats 2-3 weeks after T(7-9) transection of the spinal cord. Cystometry was performed in animals with HGN intact and with HGN sectioned bilaterally 1-2 h before the experiment. Residual volume (RV), volume threshold for inducing micturition (VT), maximal voiding pressure, and bladder compliance were significantly lower (71, 35, 33, and 31%, respectively) in SCI rats with sectioned HGN than in rats with intact HGN, whereas voided volume (VV), pressure threshold for micturition, and bladder contraction duration (BCD) in the two groups were similar. Voiding efficiency (VE) in the HGN-sectioned group was 36% greater than that in the HGN-intact group. Antagonists for AMPA and NMDA glutamatergic receptors (LY215490 and MK-801, respectively) were administered to rats with sectioned HGN, to determine if activity in the HGN contributes to the previously reported inhibitory effects of these drugs, on voiding function after SCI. MK-801 (3 mg/kg iv) significantly reduced VV (75%) and VE (85%) and increased RV (8-fold), VT (87%), and bladder compliance (60%), whereas LY215490 (10 mg/kg iv) significantly increased VT and BCD by 15 and 19%, respectively. It is concluded that bilateral section of HGN reduces voiding dysfunction in the SCI rat but does not alter the effects of AMPA and/or NMDA glutamatergic receptor antagonists on the micturition reflex in the SCI rat. Thus the effects of these drugs are not dependent on changes in activity of sympathetic axons in the HGN.