家兔阴茎皮肤感觉脊神经来源的电生理研究

目的:探讨家兔阴茎感觉神经来源。方法:健康成年雄性新西兰白兔12只,随机均分为两组:每组6只,A组在左侧脊神经上记录,B组在右侧脊神经上记录。对家兔阴茎施加不同大小的机械刺激,用神经单纤维记录技术,在同侧S1~S4脊神经上记录单纤维放电。结果:通过对家兔阴茎施加各种不同机械刺激,在同侧S2~S3脊神经上能记录到放电,S1、S4脊神经上未能记录到放电。左侧脊神经放电纤维数量分别为:S2:39.67±3.14,S3:21.00±2.19;右侧脊神经放电纤维数量分别为:S2:40.00±3.16,S3:19.67±2.58,左右侧差异无显著性(P>0.05)。结论:家兔阴茎皮肤感觉来源于S2~S3脊神经。     

Frequency-volume charts: a tool to evaluate bladder sensation

AIMS: Bladder sensation is routinely evaluated by cystometric bladder filling and electrical stimulation. These methods require catheterization and stimulate the bladder artificially. In this study, we evaluated whether frequency-volume charts can be used as a non-invasive tool to study bladder sensation during normal daily life. Furthermore the agreement between sensory data obtained from frequency-volume charts and conventional cystometric bladder filling is studied. MATERIALS AND METHODS: Fifteen healthy female students filled out frequency-volume charts at home and scored the grade of perception of bladder fullness at each micturition. They also measured the volume of three voidings after postponing micturition as long as possible. Sensation of bladder filling was finally evaluated during cystometry. RESULTS: On frequency-volume charts, 65% of all voidings was made without desire to void, only 9.5% was with strong desire. Urgent desire to void was not reported except after voluntarily postponing micturition. Higher grades of perception of fullness were associated with significantly higher voided volumes. Mean volumes for the different sensations of fullness on the charts were not significantly different from volumes at different sensations reported during cystometry. CONCLUSIONS: In conclusion, bladder sensation during daily life can be evaluated by scoring the grade of perception of fullness on frequency-volume charts. During life voiding usually occurs without desire to void. The voided volumes at different sensations of fullness are comparable to the volumes at different sensations of filling during cystometry. Therefore, frequency-volume charts with evaluation of perception of fullness may provide an initial non-invasive tool to study bladder sensation.     

家兔阴茎皮肤和阴茎背神经躯体感觉神经元的示踪定位

目的:明确家兔阴茎感觉神经躯体纤维来源及其节段性分布规律。方法:健康成年雄性新西兰家兔8只,随机均分为A、B两组,采用辣根过氧化物酶(HRP)逆行神经示踪技术,A组用微量注射器将50%HRP多点注射于阴茎皮下,B组注射于右侧阴茎背神经近侧断端内,留针时间30 m in,动物存活5 d后,4%多聚甲醛心脏灌注,取出腰骶段脊髓及相应背根神经节(DRG),对躯体传入和传出纤维来源的节段分布进行观察。结果:A组S2~S4节段脊神经节内出现大量HRP阳性标记感觉神经元,以S2和S4为多,呈明显节段性分布,各节段阳性神经元计数分别为:S2(215.0±10.2)、S3(242.2±8.3)、S4(109.7±8.4),组间差异具有统计学意义(P<0.01)。B组同侧S2-S4节段脊髓灰质前角腹外侧部出现部分阳性标记细胞,同侧S2~S4DRG内也出现了大量的HRP阳性细胞。结论:家兔阴茎皮肤感觉神经躯体传入和传出纤维投射来源与阴茎背神经一致,均源自骶髓前角及相应的脊神经节,并呈现明显的节段性分布。     

Assessment of changes in penile sensation by electrophysiological study after radical prostatectomy: A pilot study

Background:To evaluate the changes in penile sensation by electrophysiological tests in patients who underwent radical prostatectomy (RP) and to demonstrate the role of dorsal penile nerve injury in postoperative erectile dysfunction.Materials and methods:Twenty-six volunteer patients who were eligible for RP were included in the study. Preoperative penile sensory electromyography and the International Index of Erectile Function-5 (IIEF-5) questionnaire were done for each patient. Erectile function assessment and electrophysiological evaluation of penile sensation were repeated at postoperative 3rd and 6th months.Results:Postoperative IIEF-5 scores and electromyography values were significantly lower than preoperative findings (p < 0.05). The IIEF-5 scores in the nerve sparing-RP (NS-RP) group were significantly higher than the non-nerve sparing-RP (NNS-RP) group in the postoperative period. Nerve conduction velocity values in the NS-RP group were also higher than the NNS-RP group at the postoperative 3rd and 6th months. However, these changes were not statistically significant (p > 0.05).Conclusions:Patients who underwent RP have decreased penile sensation due to cavernous nerve damage and a possible dorsal penile nerve injury. The decrease of penile sensation may be associated with postoperative erectile dysfunction.     

Role of urothelial nerve growth factor in human bladder function

AIMS: To test whether nerve growth factor (NGF) concentration in human bladder urothelium/suburothelium is related to detrusor overactivity (DO), bladder sensation, detrusor contractility, or other aspects of lower urinary tract function. MATERIALS AND METHODS: Concentration of NGF was measured (using ELISA) in superficial bladder biopsies from 27 women (mean age 52 years, range 22-82) after comprehensive video-urodynamics and bladder diary. Approximately half (12/27) showed clear DO and half did not. RESULTS: There was no evidence for increased NGF concentration in subjects with DO (association negative by Mann-Whitney test, P = 0.23). NGF was not significantly associated with two measures of detrusor contractility (Spearman's r = -0.29, P = 0.17; r = -0.20, P = 0.33); nor with four measures inversely related to sensation: volume at strong desire to void and maximum capacity on cystometry (r = -0.13, P = 0.53; r = -0.23, P = 0.28), and maximum voided volume and mean daytime voided volume on bladder diary (r = -0.29, P = 0.16; r = -0.16, P = 0.44). It was significantly associated with 24-hr urine output on bladder diary (Spearman's r = -0.55, P = 0.004). CONCLUSIONS: Elevated NGF levels in human urothelium/suburothelium are not strongly associated with DO, detrusor contractility or increased bladder sensation. NGF levels are lower in subjects with higher 24-hr urine output. This observation is consistent with a role for NGF in an active process (trafficking) involved in bladder filling.     

Decrease of urinary nerve growth factor levels after antimuscarinic therapy in patients with overactive bladder

OBJECTIVE

To determine urinary nerve growth factor (NGF) levels in patients with overactive bladder (OAB) and after treatment with antimuscarinics.

PATIENTS AND METHODS

Urinary NGF levels were measured in 38 ‘normal’ controls and 70 patients with OAB. Patients were treated with tolterodine 4 mg once daily. Urinary NGF levels were measured by enzyme‐linked immunosorbent assay method and normalized by urinary creatinine levels (NGF/Cr). The urinary NGF/Cr levels and urgency severity scale (USS) were compared at baseline, 1, 2 and 3 months after antimuscarinics, and 1 month after discontinuing treatment.

RESULTS

The urinary NGF/Cr level was very low in normal controls with a mean (sem ) of 0.005 (0.003). Patients with OAB had significantly higher baseline urinary NGF/Cr levels than the controls. Urinary NGF/Cr levels were significantly reduced at 3 months in 50 responders (1.10 [0.26] before vs 0.41 [0.09] after, P = 0.008) but not in the 20 non‐responders (1.38 [0.54] before vs 1.30 [0.46] after, P = 0.879). However, after discontinuing antimuscarinic treatment for 1 month, the urinary NGF/Cr level was elevated in 23 responders at 0.83 (0.33) and in five non‐responders at 2.72 (1.41). The USS scores significantly changed with the change of urinary NGF/Cr levels in responders at different time points. The voided volume increased but maximum urinary flow rate and postvoid residual volume did not increase in responders after 3‐months of antimuscarinic treatment. The limitation of this study was the lack of a control arm for comparison.

CONCLUSIONS

Changes in the urinary NGF levels were associated with the changes of the USS scores after antimuscarinic treatment and discontinued medication. The urinary NGF level could be a potential biomarker for evaluating therapeutic results of antimuscarinics therapy.     

双阴茎畸形阴茎再造术后感觉功能检测(附病例报告一例)

目的了解先天性双阴茎畸形行部分阴茎再造术20年后阴茎感觉功能恢复情况以及使用神经电生理方法评估再造阴茎术后感觉功能恢复的可行性。方法对再造阴茎的温度觉及两点辨别觉进行检测:及使用神经电生理的方法检测再造阴茎的体感诱发电位及阴茎背神经的感觉神经传导速度。结果再造阴茎温度觉及两点分辨觉均恢复良好。阴部诱发电位位于正常范围内,阴茎背神经传导速度小于平均水平。结论这种特殊类型的再造阴茎,经神经吻合后感觉功能基本恢复良好;使用神经电生理方法测定再造阴茎感觉功能恢复是可行的。     

Aging and overactive bladder may be associated with loss of urethral sensation in women

AIMS: To compare current perception thresholds (CPT) in the urethra and bladder of women with idiopathic overactive bladder to asymptomatic controls. METHODS: Women with > or =1 urge urinary incontinence (UUI) episode per week on 7-day diary, seeking treatment for UUI underwent CPT testing using a Neurometer(R) CPT device (Neurotron, Inc., Baltimore, MD). Testing was done in the urethra and bladder at three frequencies 2,000, 250, and 5 Hz corresponding to A-beta, A-delta, and C fibers, respectively. CPT values from the women with UUI were compared to CPT values from a group of control women without lower urinary tract symptoms. RESULTS: Forty-eight controls without lower urinary tract symptoms and 13 women with UUI were included in the analysis. Women with UUI were significantly older (mean +/- SD age 62 +/- 14 and 44 +/- 15, P < 0.0005) and more likely to be vaginally parous (P = 0.007) than control women. Urethral CPT at 2,000, 250, and 5 Hz were significantly higher in women with UUI than controls, while bladder CPT were not different between groups. Using logistic regression, to control for age and parity, urethral CPT at 5 Hz remained significantly higher in women with UUI than controls (P = 0.013). CONCLUSION: Urethral sensation is significantly higher in older women, suggesting sensory neuropathy in the lower urinary tract increases with age and may contribute to the increase in overactive bladder seen with aging. These data reinforce the role of the urethra in lower urinary tract function.     

局部应用丝裂霉素C对大鼠坐骨神经影响的实验研究

目的：观察局部应用丝裂霉素C（Mitomycin C,MMC）对SD大鼠坐骨神经痛觉、组织形态学、超微结构及运动功能的影响。方法分3次实验,实验1：分别在术后1、2、3、5d 测量热缩足反射潜伏期来评估大鼠坐骨神经的痛觉变化;实验2：分别在手术即刻及术后1、2、3 d,用光镜及电镜结果来评估坐骨神经形态学及超微结构的改变;实验3：术后三天通过斜板实验结果来评估坐骨神经运动功能的变化。结果术后1、2、3、5 d各时间点对照组及MMC组热缩足潜伏期无显著性差异（P〉0.05）。与对照组相比,MMC组之间髓鞘厚度、轴突直径差异无统计学意义（P〉0.05）。术后三天,MMC组与对照组相比,斜板实验结果差异无统计学意义（P〉0.05）。结论局部应用浓度不超过0.7 mg/ml的MMC不会对大鼠坐骨神经的痛觉、组织形态、超微结构和运动功能产生明显影响,0.7 mg/ml为实验大鼠坐骨神经局部应用MMC的相对安全浓度。     

Visualization of the neurovascular bundles and major pelvic ganglion with fluorescent tracers after penile injection in the rat

OBJECTIVE

To evaluate whether fluorescent tracers can consistently label the neurovascular bundles (NVBs) and major pelvic ganglion (MPG) after an intracavernosal penile injection, as the reported incidence of erectile dysfunction (ED) in men after radical prostatectomy (RP) is 55–65% and thus preservation of erectile function, sparing one or both of the NVBs remains one of the most vital factors.

MATERIALS AND METHODS

Male Sprague‐Dawley rats (3 months old) received penile injections (20 µL; seven rats/group) of either deionized water (DW), Fluoro‐Gold (FG), Fast‐Blue (FB), Fluoro‐Ruby (FR) or green fluorescent pseudorabies virus (GF‐PRv). The rats were killed at 2, 3 and 14 days after injection and the NVBs and MPG were harvested and placed directly under fluorescence light. Image analysis was done by computer, coupled to a microscope equipped with a digital camera. Each NVB and MPG were analysed for its staining pattern and consistency.

RESULTS

When compared with the FB, FR and GF‐PRv rats, the FG‐injected rats had better staining of the NVB at 2, 3 and 14 days after injection. Under ×200, FG highlighted the axons of the cavernous nerve (CN) and cell bodies (MPG). This indicates that FG injection into the penis induced the strongest CN labelling (positive staining) at 2 and 3 days after injection as compared with FB‐, FR‐ and GF‐PRv‐injected rats.

CONCLUSION

FG injection into the penis has consistent retrograde staining of the NVBs and MPG after 3 days. Therefore, we predict that FG could potentially be used to improve the identification of the NVB in other models. However, further studies need to be carried out before these tracers can be used in humans.