Neuroendocrine control of urine-marking behavior in male rats

Sexually experienced Wistar male rats were used to investigate (a) urine voiding in the presence of nearby estrous females and the control of such voiding by (b) steroid hormones and (c) peripheral nerves supplying the genitourinary system. The first experiment showed that males always have a low rate of urine voiding that is significantly increased when a receptive female is around. Thus, it is suggested that an airborne scent from the female stimulates the olfactory system of males, triggering urine emission to transmit sex-related messages, i.e., male rats display the well-known urine-marking behavior of mammals. The number of urine marks and sniffing to females decreased after castration, and were restored after exogenous treatment with testosterone or estradiol. The proposed hypothesis is that airborne scents from the female activate the aromatization process in nuclei of the olfactory pathway of the male, evoking a cascade of neuronal responses that finish in urine marking. Peripheral nerves supplying the genitourinary system are the viscerocutaneous branch of the pelvic nerve (Vc) and the hypogastric (Hg). Data showed that both nerves are important for the central control of urine storage and voiding. Transection of Vc almost blocked urine marking, while Hg lesion increased the number of marks. Thus, it is discussed that Vc is the most important nerve in charge of voiding the bladder, and that Hg is important for continence.     

The ability of periurethralEscherichia colito grow in a voiding system is a key for the dominance ofE. colicystitis

The generally accepted concept of the pathogenesis of cystitis is that bacteria on the periurethra migrate via the urethra to the bladder urine. To explore whyEscherichia coliis the dominant organism isolated from cystitis, we examined two potential mechanisms that might account for the dominance ofE. colias the etiologic agent in cystitis in prepubertal, non-sexually active girls. First, the frequency of carriage of aerobic bacteria on the periurethra of two populations— healthy girls and girls after their first episode of cystitis was determined. Second, the survival capability of periurethral bacteria in urine under voiding conditions was examined. Two voids were simulated over 6 h by 10⁻²dilution. A control was run in broth instead of urine. We found that Gram-positive bacteria, particularly coagulase-negative staphylococci, were much more common on the periurethra thanE. coli.E. colidid grow well in urine in anin vitrovoiding system whereas most Gram-positive bacteria did not. Growth in urine despite voiding may be the key reason for the dominance ofE. coliin cystitis.     

A signal-processing system for real-time ultrasonic measurement of urine flow parameters.

An application of a signal-processing system to the urethra is described which allows for real-time measurement of the average velocity of the urine at a particular location along the urethra during voiding through measurement of the average frequency in ultrasonic return from scatterers in the flowing urine. In addition, this comparatively simple system provides, without additional instrumentation, the relative urethral cross-sectional area at this location and the relative urine flow rate as functions of time throughout the voiding period. Tests indicate its potential as a valuable transcutaneous diagnostic aid in the detection, study, and treatment of various disorders and diseases of the lower urinary system. The key element of the system is a circuit having a voltage transfer function magnitude proportional to the square root frequency.     

Screening for urinary tract infection with the Sysmex UF-1000i urine flow cytometer

The diagnosis of urinary tract infection (UTI) by urine culture is time-consuming and can produce up to 60 to 80% negative results. Fast screening methods that can reduce the necessity for urine cultures will have a large impact on overall turnaround time and laboratory economics. We have evaluated the detection of bacteria and leukocytes by a new urine analyzer, the UF-1000i, to identify negative urine samples that can be excluded from urine culture. In total, 1,577 urine samples were analyzed and compared to urine culture. Urine culture showed growth of ≥10(3) CFU/ml in 939 samples (60%). Receiver operating characteristics (ROC) curves and ROC decision plots were been prepared at three different gold standard definitions of a negative urine culture: no growth, growth of bacteria at <10(4) CFU/ml, and growth of bacteria at <10(5) CFU/ml. Also, the reduction in urine cultures and the percentage of false negatives were calculated. At the most stringent gold standard definition of no growth, a chosen sensitivity of 95% resulted in a cutoff value of 26 bacteria/μl, a specificity of 43% and a reduction in urine cultures of only 20%, of which 14% were false negatives. However, at a gold standard definition of <10(5) CFU/ml and a sensitivity of 95%, the UF-1000i cutoff value was 230 bacteria/μl, the specificity was 80%, and the reduction in urine cultures was 52%, of which 0.3% were false negatives. The applicability of the UF-1000i to screen for negative urine samples strongly depends on population characteristics and the definition of a negative urine culture. In our setting, however, the low workload savings and the high percentage of false-negative results do not warrant the UF-1000i to be used as a screening analyzer.     

Pathophysiological aspects of bladder dysfunction: a new hypothesis for the prevention of 'prostatic' symptoms

This article reviews the literature on the pathophysiology of male lower urinary tract symptoms (LUTS) with the intention of developing a new preventive intervention for this bothersome disease. Traditionally, male voiding dysfunction has been thought to arise from bladder outlet obstruction (BOO) caused by prostatic enlargement. Many years of research, however, have shown that a clear relationship between the size of the prostate and the occurrence or severity of symptoms is doubtful. Because of its crucial role in urination, it is increasingly being accepted that the clinical manifestation of voiding dysfunction relies on the functional behaviour of the bladder. Several animal studies have shown that bladder performance can be improved by increasing urine output. Contrary to alterations observed in pathologic situations, an increased urine output provides a physiologic stimulus for animal bladder function improvement. We hypothesise that a trained bladder should be less susceptible to the harmful effects of ageing and obstruction. Future symptoms may thus be prevented. In humans an increased urine output can be achieved by drinking additional water, which could be an adequate preventive intervention.     

Urinary tract anomalies and dysfunctional voiding: a spectrum dictated by the influence of amniotic pressure upon fetal urodynamics

The etiologic basis of urinary tract anomalies and dysfunctional voiding largely remain unknown. However, the travel of urine from renal pelvis into the amniotic cavity under the pressures exerted by amniotic fluid satisfactorily explains the etiologic basis. Amniotic pressure is affected by the changes in maternal intraabdominal pressure. The intraabdominal pressure of the fetus is also dictated by the amniotic pressure. Amniotic pressure compresses the urethra throughout the length, and may increase both bladder leak point pressure and urethral resistance. Furthermore, the urine is propelled against amniotic pressure. These factors closely simulate outflow obstruction. Since the pressure within the bladder with minimal urine content reflects the intraabdominal pressure, intravesical pressure is also elevated during fetal life. Additionally, elevated intravesical pressures impair ureteral drainage. The compressive effect exerted by fetal intraabdominal pressure upon ureters, further elevate the pressure within the renal pelvis. While forwarding the urine against these pressures may result in anomalies of the urinary tract, the increased work load of the detrusor may act as a state of injury that forms the basis of dysfunctional voiding.     

Evaluation of preservative fluid for urine collected for culture.

Immediate culture or refrigeration of urine is recommended, but not always practical. Therefore, we evaluated the Becton-Dickinson Urine Culture Kit containing a boric acid-glycerol-sodium formate preservative in a study of 1,000 clinical urine specimens. Each specimen was cultured a total of four times by the surface streak technique with a 0.001-ml calibrated loop. After an initial reference culture (culture 1), a portion of urine was poured into a clean nonsterile paper cup, aspirated into a urine transport tube, and recultured immediately (culture 2). The original specimen cup was refrigerated for 18 to 24 h (culture 3), and the urine transport tube was held at room temperature for 18 to 24 h (culture 4) before repeat cultures. Eighty-eight of the initial reference cultures were positive (pure growth of greater than 10(5) bacteria per ml). Eighty-two (93.2%) of the 88 specimens positive on the reference culture were also positive after refrigeration or holding at room temperature in the transport tube for 24 h. There was one false-positive culture from refrigerated urine but none from the transport tube. Mixing of urine in a nonsterile container did not introduce detectable contamination. We conclude that the Becton-Dickinson Urine Culture Kit maintains a stable bacterial population in urine for up to 24 h as reliably as refrigeration. Urine for culture may be collected in a nonsterile container if it is immediately aspirated into the transport tube so that contaminants are not allowed to multiply.     

Bacteriological study of renal calculi

The pre-operative urine, pelvic urine, removed calculi and calculus washings were examined bacteriologically in 24 patients undergoing removal of intrarenal calculi. Four of seven patients with struvite calculi had an infected pre-operative midstream urine specimen and six of the seven removed calculi demonstrated significant bacterial growth.Proteus mirabilis was the commonest organism isolated. Of 17 patients with oxalate calculi only one had an infected pre-operative urine culture, but in four cases the removed stones were infected. Quantitative bacteriological culture of the stones and their washings demonstrated that infection is within the stone itself. Pre-operative urine culture failed to predict infection within the stone in 60 % of patients with infected stones. The results suggest that the presence of infected urine together with the presence of renal calculus is indication for removal of the calculus.     

Evaluation of liquid and lyophilized preservatives for urine culture

Culture results of urine specimens transported conventionally (sterile cup) and in a commercial liquid or an investigational lyophilized preservative were compared in a hospital that experiences substantial delays in specimen transport to the laboratory (greater than 40% of specimens received after a delay of greater than or equal to 2 h). At the time of initial plating in the laboratory, 106 of 111 (95.5%) specimens that were positive (greater than or equal to 10(5) CFU of a single organism per ml in pure culture) after conventional transport were also positive in liquid preservative. After a 24-h holding period (cup refrigerated, preserved urine at room temperature), agreement was 91.4% (96 of 105). At the time of initial plating, agreement between results obtained by the conventional method and those obtained by using lyophilized preservative was 96.9% (63 of 65); after 24 h, agreement was 92.4% (61 of 67). Complete inhibition of growth of three Klebsiella pneumoniae isolates was observed in liquid preservative; however, urine processed in the lyophilized preservative did not show inhibition. The proportion of urine cultures showing no change in quantitative growth between the time of initial plating and repeat plating at 24 h was virtually identical for all three processing methods (83.6 +/- 0.9%). After the 24-h holding period, specimens processed in lyophilized preservative were less likely to show diminished quantitative growth than were specimens processed conventionally or in liquid preservative but were more likely to show an increase in growth of greater than or equal to 1 log. Nonetheless, the apparent lack of toxicity of lyophilized preservative may make it preferable to the currently available liquid preservative.     

Effects of N-methyl-d-aspartate (dizocilpine) and α-amino-3-hydroxy-5-methyl-4-isoxazolepropionate (LY215490) receptor antagonists on the voiding reflex induced by perineal stimulation in the neonatal rat

The present study was undertaken to examine the role of alpha-amino-3-hydroxy-5-methyl-4-isoxazolepropionate and N-methyl-D-aspartate glutamate receptors in the regulation of voiding reflexes induced by perineal stimulation in the neonatal rat. Four-, six- and 10-day-old awake rats were used in the experiments and perineal stimulation was applied using the tip of a 1-ml syringe to evoke voiding. Voided volume and residual volume were measured. In 10-day-old rats, LY215490 (3-10 mg/kg, i.p.), a competitive alpha-amino-3-hydroxy-5-methyl-4-isoxazolepropionate receptor antagonist, significantly inhibited reflex voiding, increasing the residual volume 34-53-fold. A 3 mg/kg dose decreased the urine release by 55%, whereas 10 mg/kg totally suppressed the voiding reflex induced by the perineal stimulation. LY215490 (10 mg/kg, i.p.) produced similar effects in four- and six-day-old rats. Dizocilpine (1-3 mg/kg, i.p.), a non-competitive N-methyl-D-aspartate receptor antagonist, also significantly decreased the urine release (62-82%) and increased residual volume (180-230-fold). Combined administration of LY215490 (1 mg/kg, i.p.) and dizocilpine (0.3 mg/kg, i.p.) to 10-day-old rats, in doses that individually had no effect on perineal stimulation-evoked voiding, depressed voided volume by 65%. These results indicate that, in neonatal rats, glutamatergic transmission in the spinal cord has an essential role in reflex micturition induced by perineal stimulation, and that facilitatory interactions between alpha-amino-3-hydroxy-5-methyl-4-isoxazolepropionate and N-methyl-D-aspartate glutamatergic mechanisms are important for voiding, as noted previously in adult rats.     

Management of fresh urine

To obtain an accurate urinalysis result, the process from the sampling to completion of the examination should be carried out as quickly as possible. Management of fresh urine is important for this purpose. While urinalysis should basically be performed immediately after voiding, the sample should be maintained in a refrigerator (4 degrees C) if this is not possible. Adequate preservation of the urine according to the purpose of the test is important.     

Risk factors of voiding dysfunction and patient satisfaction after tension-free vaginal tape procedure

This study was undertaken to identify risk factors for postoperative voiding dysfunction and factors having impact on patient global satisfaction after a tension-free vaginal tape (TVT) procedure. Two hundred and eighty-five women who underwent the TVT procedure for stress urinary incontinence were analyzed to identify risk factors predictive of voiding dysfunction. Postoperative voiding dysfunction was defined as a peak urinary flow rate (PFR) <10 mL/sec (straining voiding, n = 17) or residual urine volume >30% of bladder capacity (incomplete emptying, n = 13). The global satisfaction rate was 91.6%. Voiding dysfunction developed in 29 (10.2%) patients. Among the factors, PFR was only factor of significance for voiding dysfunction. There was no significant difference between patients with and without voiding dysfunction in terms of their satisfaction. But postoperative PFR <10 mL/sec significantly compromised global satisfaction after the surgery. In those patients with a preoperative PFR <20 mL/sec, there were more patients with postoperative PFR <10 mL/sec. Peak urinary flow rate is an important factor for the postoperative voiding dysfunction. The inevitable decline in PFR can compromise patients' satisfaction with the procedure, when their postoperative PFR was <10 mL/sec.     

Microbiological diagnosis of epiglottitis

Forty patients, between July 1977 and April 1982, with clinical diagnosis of epiglottitis were studied for the presence of capsular antigen by counter-immunoelectrophoresis (CIE) and for positive blood culture. Blood culture was positive for Haemophilus influenzae only, in 15 patients. Haemophilus influenzae type b antigen was present in blood and/or urine of 25 patients (blood 14 patients, urine 18 patients). CIE associated with blood culture give conclusive proofs of Haemophilus influenzae etiology in 30 patients.     

Effect of time elapsed since previous voiding on the detection ofChlamydia trachomatis antigens in urine

To determine if the time elapsed since previous voiding affects the sensitivity of an enzyme immunoassay (EIA) to detectChlamydia trachomatis in urine, 882 women and 428 men were tested for chlamydial infection in urethral specimens by isolation in cell culture (women and men) and EIA with blocking confirmation (women only). Of the 36 women (4.1 %) and 38 men (8.9 %) who were positive forChlamydia trachomatis in the urethra, 55.5 % (20/36) and 81.6 % (31/38) respectively were positive in the first void urine (FVU) sediment by confirmed EIA. In women the sensitivity of the EIA performed on FVU was 67.8 % (19/28) if the urine had been in the bladder <3 hours and decreased to 12.5 % (1/8) if longer times had elapsed (odds ratio 13.7; 95 % confidence interval 1.4 to 700.0) with no obvious confounding. In men a weaker association was present (odds ratio 2.7; 95 % confidence interval 0.4 to 22.3). These findings should enable investigators to optimize the analysis of urine to diagnose chlamydial infections.     

Anaerobic infections of the urinary tract: are they being missed?

Routine anaerobic culture of urine identified the urinary tract as the primary focus of sepsis in a postoperative patient with Bacteroides fragilis septicaemia. Specimens of urine from six other symptomatic patients grew > 10(8) cfu/litre of a Bacteroides species in pure growth. The significance of these isolates is discussed. Multipoint technology and the availability of anaerobic work stations have facilitated anaerobic culture and reduced its cost. The incorporation of anaerobic culture of urine into routine laboratory practice may be clinically valuable and should be considered.     

膀胱组织工程研究进展

膀胱作为储尿排尿器官具有重要的生理功能,许多病理原因导致的膀胱损伤往往需要进行膀胱重建。临床上膀胱重建的金标准是胃肠道代膀胱术,但是胃肠道的结构和功能与膀胱有着本质的区别,导致肠段置换术易产生血尿、排尿困难、结石、肿瘤等并发症。近年来,随着组织工程及再生医学的诞生及发展,为膀胱缺损修复提供了新的思路和技术手段。本文就膀胱组织工程的三个方面--种子细胞、支架材料及生长因子的最新进展进行了综述。     

Effects of tiropramide on the activity of lower urinary tract in dogs and its interpretation]

The rhythmic contractions of urinary bladder under constant volume condition were evoked in decerebrate and de-anesthetized dogs, while various myogenic and nerve-mediated electrical and mechanical activities of smooth muscles were recorded from in vivo pelvic viscera. The vesical rhythmic contractions were transiently and partially blocked by intravenous application of tiropromide. This 'partial' block showed a good contrast to the 'complete' block of identical contractions, which was observed after application of oxybutynin, known as a potent anti-muscarinic drug. The bladder voiding cycles were observed in other decerebrate dogs, while the warmed Ringer solution was infused at a steady rate into the dome of the bladder until principal voiding contraction occurred in cystometric recordings. The initiation of voiding contraction was markedly delayed after intravenous injection of tiropramide. The delay of principal contraction was found to be due to successive appearance of falling waves in cystometric recordings. As a evident contrast, terodiline caused a significant reduction of voiding contraction height and shortening of clonic discharge phase of external urethral sphincters during voiding cycle. It is concluded that tiropramide does not reveal anti-muscarinic action which oxybutynin or terodiline does really show, instead tiropramide acts principally on bladder detrusor itself, especially on its relaxation phase of premature contraction to be prolonged. The evidences were also presented for electrophysiological identification of bladder detrusor and urethral smooth muscle.     

Diagnosis of Bacteriuria and Leukocyturia by Automated Flow Cytometry Compared with Urine Culture

Urinary tract infection (UTI) is a widespread disease, and thus, the most common samples tested in diagnostic microbiology laboratories are urine samples. The “gold standard” for diagnosis is still bacterial culture, but a large proportion of samples are negative. Unnecessary culture can be reduced by an effective screening test. We evaluated the performance of a new urine cytometer, the Sysmex UF-1000i (Dasit), on 703 urine samples submitted to our laboratory for culture. We compared bacteria and leukocyte (WBC) counts performed with the Sysmex UF-1000i to CFU-per-milliliter quantification on CPS agar to assess the best cutoff values. Different cutoff values of bacteria/ml and WBC/ml were compared to give the best discrimination. On the basis of the results obtained in this study, we suggest that when the Sysmex UF-1000i analyzer is used as a screening test for UTI the cutoff values should be 65 bacteria/ml and 100 WBC/ml. Diagnostic performance in terms of sensitivity (98.2%), specificity (62.1%), negative predictive value (98.7%), positive predictive value (53.7%), and diagnostic accuracy (73.3%) were satisfactory. Screening with the Sysmex UF-1000i is acceptable for routine use. In our laboratory, we have reduced the number of bacterial cultures by 43%, speeded up their reporting, and decreased the inappropriate use of antibiotics.The urinary tract is the most common site of infection, and urine culture is the standard diagnostic test for urinary tract infection (UTI). The growing need to enhance the performance of urine culture combined with the need to free up resources by rejecting negative samples quickly and economically has drawn attention to solutions that can be used as screening tests to reduce the number of unnecessary culture tests. In this study, we sought to evaluate and optimize the performance of the Sysmex UF-1000i (Dasit) on 703 urine samples submitted at the same time to bacterial culture analysis.     

Comparison of the B-D urine culture kit with a standard culture method and with the MS-2.

A total of 100 random clinical urine specimens were divided and used to compare Becton, Dickinson & Co. B-D Urine Culture Kit-treated urine (BDU) with refrigerated urine (RU). Each RU-BDU pair was cultured with the standard calibrated loop-plate method and also screened with the Abbott Laboratories MS-2 system at 0, 5, and 24 h. An additional 158 positive urine specimens containing greater than 10(5) CFU/ml were tested by standard culturing and MS-2 at 0 and 24 h. In addition, growth curves were run for Escherichia coli containing RU-BDU pairs at 0 and 24 h, and MS-2 detection time frequencies were analyzed. Culture results showed few changes in colony counts at 0 and 5 h for RU and BDU specimens. At 24 h, there were decreased colony counts for 7.0% of RU and 17.7% of BDU specimens. MS-2 results showed detection rates at 0 h of 100% for RU and 82.9% for BDU specimens and at 24 h of 91.1% for RU and 63.3% for BDU specimens. The organisms most frequently missed at 24 h were E. coli, Pseudomonas aeruginosa, and Staphylococcus epidermidis. Growth curve analysis showed a 1-h delay of logarithmic growth in BDU specimens. MS-2 detection time analysis showed delayed positive reports owing to be extended detection time for BDU specimens. The B-D Urine Culture Kit is a convenient transport system; however, some difficulty in recovering organisms at 24 h with the standard culture method and increased difficulty with the MS-2 system were recognized.     

Is the occurrence of storage and voiding dysfunction affected by menopausal transition or associated with the normal aging process?

OBJECTIVES: To evaluate whether the increasing occurrence of urinary and voiding dysfunction is independently influenced by the transition from pre- to postmenopause or by the interactive and additive effects of age-associated changes in bladder and urethral function. DESIGN: Of the 1,584 women randomly sampled from a community-based health population, 1,253 (79.1%) were successfully interviewed. The participants were asked to reply to the Bristol Female Urinary Tract Symptoms Questionnaire regarding various storage symptoms and voiding dysfunction. The chi2 test and Cochran-Armitage trend test were used for analysis. RESULTS: The prevalence of storage symptoms such as frequency, urgency, nocturia, and urge incontinence in premenopausal and menopausal groups was 18.0% versus 29.8%, 9.8% versus 20.7%, 21.2% versus 38.2%, and 6.8% versus 15.7%, respectively (all P < 0.05). In premenopausal and menopausal groups, the prevalence of hesitancy, poor stream, incomplete emptying, voiding with abdominal straining, discontinuous urine flow, and dribbling was also significantly different (17.2% v 22.9%, 17.8% v 25.7%, 12.7% v 21.9%, 4.9% v 11.6%, 16.2% v 24.5%, and 9.4% v 17.6%, respectively; all P < 0.05). However, the occurrences of various storage symptoms, namely, frequency, urgency, nocturia, and urge incontinence, as well as voiding symptoms such as incomplete emptying, discontinuous urine flow, and dribbling, were also significantly associated with the normal aging process (P < 0.05). CONCLUSIONS: Our results imply that the increasing occurrences of storage and voiding dysfunctions are not only affected by pre- and postmenopausal transition but are also closely associated with aging changes.