Measurement of detrusor wall thickness in women with overactive bladder by transvaginal and transabdominal sonography

Introduction and hypothesis  

Women with overactive bladder (OAB) might have a greater detrusor wall thickness (DWT) suggestive of detrusor overactivity (DO).     

Urinary levels of glycosaminoglycans in patients with idiopathic detrusor overactivity

Introduction and hypothesis  

We assessed whether urinary excretion of glycosaminoglycans (GAGs) may be affected by a condition of detrusor overactivity (DO).     

Urodynamically diagnosed detrusor hypocontractility: should transurethral resection of the prostate be contraindicated?

Background  

Patients with benign prostatic hyperplasia (BPH) suffering from hypocontractile detrusor were generally regarded unsuitable for surgery. This prospective study is to evaluate the efficacy of transurethral resection of the prostate (TURP) on BPH patients diagnosed detrusor hypocontractility on urodynamic study (UDs).     

Triple therapy in refractory detrusor overactivity: a preliminary study

Purpose  

To evaluate in a prospective study the impact of the “three-drug therapy” (antimuscarinic, alpha-blocker and tricyclic antidepressants) on the treatment of refractory detrusor overactivity (DO).     

Role of botulinum toxin-A in refractory idiopathic overactive bladder patients without detrusor overactivity

Background  

To evaluate the efficacy of intradetrusor botulinum toxin-A (BTX-A) in idiopathic overactive bladder patients (OAB) refractory to anti-muscarinic therapy, without detrusor overactivity (DOA) on urodynamics.     

Objective differences between overactive bladder patients with and without urodynamically proven detrusor overactivity

Introduction and hypothesis  

This paper aims to determine if there are differences between female overactive bladder (OAB) patients with and without urodynamic detrusor overactivity (DO).     

Ultrasound measurement of bladder wall thickness in different forms of detrusor overactivity

Introduction and hypothesis  

Aims of this study were to compare the ultrasound measurement of bladder wall thickness (BWT) in women with different urodynamic diagnosis and to correlate BWT to the different urodynamic findings of detrusor overactivity (DO).     

Five-year cost analysis of intra-detrusor injection of botulinum toxin type A and augmentation cystoplasty for refractory neurogenic detrusor overactivity

Purpose  

Treatment options for antimuscarinic refractory neurogenic detrusor overactivity (NDO) are botulinum toxin type A injections (BTX-A) and augmentation cystoplasty (AC). We estimated initial and cumulative 5-year costs of these treatments.     

Systematic review of the accuracy of ultrasound as the method of measuring bladder wall thickness in the diagnosis of detrusor overactivity

Introduction and hypothesis  

A systematic review was carried out to study the hypothesis that bladder wall thickness (BWT) on ultrasound is accurate in diagnosing detrusor overactivity (DO).     

Preoperative voiding detrusor pressures do not predict stress incontinence surgery outcomes

Introduction and hypothesis

The aim of this study was to determine whether preoperative voiding detrusor pressures were associated with postoperative outcomes after stress incontinence surgery.

Methods

Opening detrusor pressure, detrusor pressure at maximum flow (p _det Q_max), and closing detrusor pressure were assessed from 280 valid preoperative urodynamic studies in subjects without advanced prolapse from a multicenter randomized trial comparing Burch and autologous fascia sling procedures. These pressures were compared between subjects with and without overall success, stress-specific success, postoperative detrusor overactivity, and postoperative urge incontinence using independent sample t tests.

Results

There were no clinically or statistically significant differences in mean preoperative voiding detrusor pressures in any comparison of postoperative outcomes.

Conclusions

We found no evidence that preoperative voiding detrusor pressures predict outcomes in women with stress predominant urinary incontinence undergoing Burch or autologous fascial sling procedures.     

Intravesical oxybutynin protects the vesical wall against functional and smooth muscle changes in rabbits with detrusor overactivity

Introduction and hypothesis  

The aim of this study was to evaluate the protective effect of intravesical oxybutynin on the bladder wall of rabbits with detrusor overactivity and partial bladder outlet obstruction (PBOO).     

The effects of long-term medical treatment combined with clean intermittent catheterization in children with neurogenic detrusor overactivity

Objectives  

To assess whether conservative treatment of pediatric patients with neurogenic detrusor overactivity (NDO) results in lower bladder pressure and increased expected bladder volume (EBV), we investigated the clinical and urodynamic effects of long-term intravesical oxybutynin instillation compared with a standard treatment of oral anticholinergic medication in patients with clean intermittent catheterization (CIC).     

The impact of simulated birth trauma and ovariectomy on the gene expression of detrusor muscarinic receptors in female rats

Introduction and hypothesis  

This study aims to investigate the effects of simulated birth trauma and ovariectomy on detrusor muscarinic receptors (M2 and M3), urethral neuronal nitric oxide synthase (nNOS), and estrogen receptor β (ERβ).     

Low concentrations of niflumic acid enhance basal spontaneous and carbachol-induced contractions of the detrusor

Purpose

The urinary bladder expresses Ca²⁺-activated Cl^? channels (CACC), but its physiological role in governing contractility remains to be defined. The CACC modulator niflumic acid (NFA) is widely used despite the variable results arisen from different drug concentrations used. This study was designed to examine the effects of NFA at low concentrations on detrusor strip contractility.

Methods

Rat detrusor strips with mucosa-intact (+MU) and mucosa-denuded (?MU) were prepared in transverse (Tr) and longitudinal (Lg) with respect to the bladder orientation. Isometric force measurements were made at baseline (for spontaneous phasic contractile activity) and during drug stimulation (by carbachol, CCh) with and without NFA.

Results

NFA (1 and 10 μmol/L) pretreatment enhanced CCh-induced contractions more in +MU than ?MU strips with no selectivity on contractile direction. For spontaneous phasic contractions, NFA-treated strips in the Tr direction showed increased phasic amplitude, while phasic frequency was unchanged.

Conclusions

The findings suggest low concentrations of NFA having a potentiating effect on detrusor contractions that was sensitive to the MU and contractile direction.     

Effects of potassium channel modulators on myogenic spontaneous phasic contractile activity in human detrusor from neurogenic patients

OBJECTIVE

To characterize the spontaneous contractile activity (SCA) developed by detrusor from patients with neurogenic detrusor overactivity (NDO) because the alteration of detrusor properties plays a critical role in the pathogenesis of detrusor overactivity, as well as to evaluate the role of K_ATP and K_Ca channels on this SCA because these channels regulate detrusor SCA in many species, including humans without overactive bladder (OAB).

PATIENTS AND METHODS

Human bladder samples were obtained from 44 patients undergoing cystectomy for bladder cancer with no known OAB symptoms and from 38 patients suffering from urodynamically diagnosed NDO. Detrusor strips with or without urothelium/suburothelium were mounted isometrically in organ baths filled with Krebs‐HEPES (37 °C; 95% O₂/5% CO₂). Strips were incubated with 10 µm pinacidil (K_ATP opener) followed by 10 µm glibenclamide (K_ATP blocker). In another set of experiments, strips were incubated with 30 µm NS‐1619 (BK_Ca opener) followed by 100 nm iberiotoxin (BK_Ca blocker) or with 100 nm apamin (SK_Ca blocker).

RESULTS

SCA occurred more frequently with larger amplitude and area under the curve in detrusor strips from NDO patients compared to control patients. The presence of urothelium/suburothelium did not significantly modify SCA in either patient population. Pinacidil markedly inhibited SCA of detrusor strips from control and NDO patients. This effect was reversed by glibenclamide. By contrast, NS‐1619 followed by iberiotoxin did not elicit any significant changes in SCA from NDO patients, contrary to control patients.

CONCLUSIONS

K_ATP and SK_Ca channels regulate SCA of NDO patients’ detrusor strips. By contrast, BK_Ca channels are not involved in the regulation of detrusor SCA in NDO patients, whereas they regulate SCA in control patients. These results should be considered in the development of K⁺ channels openers for the treatment of NDO. Moreover, SCA observed in vitro should be regarded as an in vitro modelling of human NDO.     

Conditional neuromodulation of neurogenic detrusor overactivity using transrectal stimulation in patients with spinal cord injury: A proof of principle study

Aims

A proof of principle study of a novel wearable device to control neurogenic detrusor over‐activity in eight male spinal cord injured subjects using conditional neuromodulation.

Methods

Transrectal stimulation was delivered through the device in response to simultaneously recorded external anal sphincter (EAS) contraction as a marker for neurogenic detrusor overactivity (NDO). The effect of conditional neuromodulation on bladder capacity and maximum detrusor pressure was investigated in addition to reliability of dyssynergic sphincter contraction as a marker for NDO.

Results

Conditional neuromodulation through the novel device showed a statistically significant increase in bladder capacity and reduction in maximum detrusor pressure in six male subjects with spinal cord injury (SCI). EAS activity was a reliable surrogate for detection of NDO.

Conclusions

It has been shown for the first time that conditional neuromodulation can be delivered and triggered via a single biocompatible device placed in the anal canal. The pudendal nerves lying in Alcock's canal were stimulated through the wall of the anal canal, and the dyssynergic activity of the EAS was used to detect NDO and trigger neuromodulation giving significant increases in bladder capacity and reduction in detrusor pressure in six male subjects with SCI.     

Vesico-ureteral reflux in women with idiopathic high-pressure detrusor overactivity: prevalence,bladder function,and effect on the upper urinary tract

Introduction and hypothesis

To assess the prevalence of vesico-ureteral reflux (VUR) and upper urinary tract damage in women with idiopathic high-pressure detrusor overactivity (IHPDO) and to characterize their bladder function.

Methods

A retrospective chart review of women diagnosed with IHPDO (detrusor pressures > 40 cm H₂O during involuntary bladder contractions) from 2007 to 2010 was conducted. Women were assessed for VUR by X-ray voiding cysto-urethrogram. Renal ultrasound or CT urogram, serum BUN/creatinine, and urinalyses were performed if reflux reached the renal pelvices. Cystometric and voiding pressure study data were reviewed for detrusor overactivity pressure and volume, voiding dysfunction, urethral relaxation, compliance, and bladder outlet obstruction.

Results

Sixty-five women were diagnosed with IHPDO, and 50 completed an X-ray voiding cysto-urethrogram. The median (range) detrusor overactivity pressure was 65 (41–251) cm H₂O. Four (8.0 %) women had IHPDO; none had upper urinary tract deterioration. The majority of women exhibited urethral relaxation with voiding, impaired compliance, and bladder outlet obstruction.

Conclusions

Women with IHPDO are at risk of low-grade vesico-ureteral reflux. However, most women with IHPDO are likely protected from reflux by intermittent exposure to high detrusor pressures and the ability to decompress the bladder by urethral relaxation.     

Long‐term effects of repeated intradetrusor botulinum neurotoxin A injections on detrusor function in patients with neurogenic bladder dysfunction

OBJECTIVE

To evaluate the influence of repeated botulinum neurotoxin A (BoNT‐A) treatments on detrusor function in patients with neurogenic detrusor overactivity (DOA) due to spinal cord lesions.

PATIENTS AND METHODS

In a retrospective study, urodynamic evaluations of 27 consecutive patients with neurogenic DOA due to spinal cord lesions who received at least five BoNT‐A treatments were analysed.

RESULTS

After the first BoNT‐A treatment, bladder capacity, reflex volume, continence status and detrusor compliance were significantly improved and maximum detrusor pressure (P_detmax) was significantly reduced. The mean number of BoNT‐A treatments was 7.1. Compared with the results of the first treatment, the incontinence rate (seven patients) and the number of patients with an elevated P_detmax (five patients) were slightly increased after the final BoNT‐A treatment. The long‐term success rate was 74%. Every fourth patient needed a major surgical intervention. There was a significant decrease in P_detmax before BoNT‐A treatments, indicating that detrusor contraction strength did not completely recover after treatment.

CONCLUSIONS

Our study confirmed the long‐term efficacy of repeated BoNT‐A treatments in patients with neurogenic DOA. However, in long‐term follow‐up, every fourth patient required surgical interventions. Moreover, our data give the first hint that BoNT‐A may lead to impaired detrusor contraction strength, which could influence future treatment options. Prospective studies are necessary to elucidate the impact of repeated BoNT‐A treatments on detrusor function and the interactions with future treatment options.