bluuebunny/crossref_metadata_2025 huggingface dataset:
The frequency/volume chart in genuine stress incontinent women
Authors: Larsson Gregor , Victor Arne
Published: March 2007

Urinary incontinence is a major health problem. Simple methods of investigation are thus of great interest. For example, the frequency/volume chart is in common use, but the efficiency of this instrument in characterizing different conditions of incontinence does not seem to have been scrutinized.

In this study the frequency/volume charts of 81 genuine stress incontinent women are compared to those of 151 women without complaints from the lower urinary tract. The total voided volume, the frequency of micturition, the largest single voided volume, and the variability of voided volumes are all shown to be statistically different in the genuine stress incontinent material from that of the normal material. If this is of importance from a differential diagnostic viewpoint is uncertain, as the overlap between the materials for all parameters is great.
Effects of acid‐base changes on rabbit urinary bladder contractility
Authors: Tong Yat‐Ching , Wein Alan J. , Levin Robert M.
Published: March 2007

Alterations in the pH of the in vitro bathing medium can effect intracellular pH and thus alter the contractile response of smooth muscle preparations to various forms of stimulation. The mucosal surface of the urinary bladder provides a barrier to most solutes within the bladder. The purpose of this study was to determine if alterations in the intravesical pH would affect the contractile response to field stimulation.

The in vitro whole rabbit bladder model was used to study the effect of changing intravesical pH on bladder contractility. Contrary to previous studies on isolated muscle strips, the results of the present study show that under different pH conditions (pH 4.0–8.0), no significant changes were observed in intravesical pressure generation with field stimulation, nor in the rate of the pressure generation. An intact bladder mucosa appears to be an effective barrier against the physiological effects of altered intravesical pH on bladder smooth muscle contraction.
Pressure measurements during pelvic floor muscle contractions: The effect of different positions of the vaginal measuring device
Authors: Bø Kari
Published: March 2007

The purpose of the present investigation was to assess whether different positions of the vaginal measuring device affect the pressure readings during pelvic floor muscle (PFM) contraction.

Twelve women with stress urinary incontinence (SUI) participating in a PFM exercise program, volunteered for the study. The diagnosis of SUI was based on urodynamic investigation and pad test. The mean age of the women was 40.9 years (24–50).

The women performed three PFM contractions with a vaginal balloon placed in four different positions: 1) against the vaginal vault and in the posterior fornix, 2) in the proximal upper third of the vagina, 3) with the middle of the balloon 3.5 cm from the introitus vagina and 4) with half of the balloon outside the introitus vagina.

The results demonstrated significant differences between recordings from the four vaginal positions: position 1, median pressure 5 cm H2O; position 2, 9 cm H2O; position 3, 15 cm H2O; and position 4, 8 cm H2O.

It is concluded that the position of the vaginal device affects the results. This may be one important factor which could explain the variability of vaginal pressure recordings during PFM contractions. For most women the highest pressure was recorded in position 3. © 1992 Wiley‐Liss, Inc.
New method of measuring uroflow in the rat bladder
Authors: Chancellor Michael B. , Blaivas Jerry G. , Levin Robert M. , Kaplan Steven A. , Otter Mark W. , Schussler George
Published: March 2007

Urodynamic evaluation of bladder function requires the simultaneous measurement of detrusor pressure and uroflow. Although the rat is a common animal model to study several bladder dysfunctions, including partial outlet obstruction, one of the major problems is that the bladder capacity has been too small for the measurement of uroflow. We have developed a new method of measuring uroflow in the rat that is sensitive at low bladder volumes. The method is based on the change in conductance of the gap between two silver electrodes in a measuring chamber as the chamber fills with saline during voiding. An AC voltage supply drives a current through the saline. As the saline level rises in the chamber the conductance increases, with a corresponding increase in current flow. A linear correlation between time rate of change of electrical current and fluid flow rate exists over a wide range of values and suggests that this new rat flowmeter is both accurate and reproducible. © 1992 Wiley‐Liss, Inc.
Continuous monitoring of micturition pattern in nonhuman primates: Similarities to humans
Authors: Shoukry Mohamed Shafik , Ghoniem Gamal M.
Published: March 2007

Most experimental urodynamic studies have been carried out in animals under anesthesia. This study is performed on awake, unrestrained, upright animal models phylogenetically similar to humans. Five female rhesus monkeys were monitored for their micturition pattern using the system described in Part I. The voiding frequency, physiologic diuresis, and the early voiding correspond well to those of humans. A peak flow nomogram was constructed based on 357 urinations. It depicts a non‐linear relation of peak flow to increasing voided volume. The nomogram is similar in pattern to those developed for humans.

These findings suggest that the rhesus monkey is one of the best animal models to study the function of lower urinary tract. © 1992 Wiley‐Liss, Inc.
Bladder function in patients with myotonic dystrophy
Authors: Bernstein Inge Thomsen , Andersen Birgitte Bo , Andersen Jens Thorup , Arlien‐øborg Peter
Published: March 2007

Ten patients with a clinically and neurophysiologically established diagnosis of myotonic dystrophy underwent urodynamic evaluation of the lower urinary tract. Eighty percent of the patients had urinary complaints by history, but we were not able to identify a homogeneous bladder dysfunction pattern by voiding and incontinence chart, flowmetry, cystometry, or sphincter electromyography. © 1992 Wiley‐Liss, Inc.
Early molecular response to rabbit bladder outlet obstruction
Authors: Buttyan Ralph , Jacobs Benjamin Z. , Blaivas Jerry G. , Levin Robert M.
Published: March 2007

Partial obstruction of the rabbit bladder outlet induces a rapid hypertrophy characterized by increased bladder weight and smooth muscle content in addition to increased collagen deposition. In experiments designed to examine the genetic basis of this response, we evaluated the expression of a multitude of gene products in the rabbit bladder during the first 48‐hr period following placement of a urethral cuff blocking the rabbit bladder outlet by 90%. Individual bladders were obtained from unoperated rabbits, from sham‐operated rabbits and from rabbits at 2, 6, 10, 24, and 48 hr after obstruction. Poly (A)+ mRNA was extracted from each of these tissues and Northern blots made from the RNAs were hybridized repeatedly with a series of probes. Corrected densitometry was utilized to assign a value to each transcript and to follow the change in expression of a given gene product over time.

Although several of the gene products we analyzed for were undetectable or unchanged over this brief period, we were able to detect a substantial sustained increase in the 4.5 kb mRNA encoding basic fibroblast growth factor (bFGF) initiated by 2 hr after obstruction. Later, at 6–24 hr, we measured transient induction of transcripts encoding c‐myc, heat shock 70K (hsp‐70), Ha‐, and N‐ras. In contrast, the constitutively‐expressed 2.4 kb transcript for transforming growth factor‐β (TGF‐β) transiently declined to 50% of control levels at 24 hr following obstruction. In summary, our results provide a picture of tissue in transition, with synthesis of certain growth‐stimulating and stress‐response products (bFGF, myc, ras, and hsp‐70) increasing and a growth‐inhibitory substance (TGF‐β) decreasing. © 1992 Wiley‐Liss, Inc.
Effect of different anaesthetics, routes of catheterisation, age, and filling rate on the urodynamics of the guinea‐pig
Authors: Macneil H. F. , Williams J. H. , Brading A. F.
Published: March 2007

This study compared the effects of two anaesthetic regimens, ketamine 66 mg/kg with xylazine 2.5 mg/kg and urethane 1.25 g/kg, on the urodynamic parameters of the guineapig. In addition, the effects of advancing age, different filling rates (0.25 and 0.5 ml/min) and different routes of cannulation of the bladder (urethral and suprapubic) upon urodynamic parameters were studied.

There was a larger cystometric capacity under urethane than with ketamine and xylazine anaesthesia in both young and old animals.

Older animals had a larger cystometric capacity under ketamine and xylazine anaesthesia and a higher pressure threshold (Pthreshold) for micturition under urethane.

The higher filling rate, 0.5 ml/min, caused a higher Pthreshold under ketamine and xylazine anaesthesia.

There was a significantly higher voiding pressure with the urethral catheter in place, than with a suprapubic catheter alone. There was also a lower Pthreshold when recording with a suprapubic catheter than with a urethral catheter under ketamine and xylazine anaesthesia (5.4 vs. 1.8 cm H2O).

Interpretation of the results from anaesthetised small animal models should take into account the age of the animal, the anaesthetic used and the route by which the various parameters are measured. © 1992 Wiley‐Liss, Inc.
Membrane electrical properties of guinea pig bladder smooth muscle with growth
Authors: Seki Narihito , Karim Omer M. A. , Mostwin Jacek L.
Published: March 2007

The effect of growth on bladder membrane electrical properties was studied in guinea pigs. The electrical activity of the smooth muscle membrane in dertusor muscle strips from immature (6–8 wk) and mature (22–24 wk) guinea pigs was investigated using an intracellular microelectrode technique. The parameters measured included resting membrane potential, membrane time constant, and the action potential (AP) kinetics. The results of this study can be summarized as follows: 1) Bladder weight increased with animal growth. 2) Growth did not affect the detrusor smooth muscle resting membrane potential or membrane time constant. 3) The configuration of the detrusor muscle AP (amplitude, after hyperpolarization, and overshoot potential) and indices of AP kinetics (maximum velocities of depolarization and repolarization) were similar in immature and mature animals. The AP duration, however, showed slight prolongation in the mature adult group. These results indicate that, in the guinea pig, the passive and active electrical properties of the detrusor smooth muscle membrane do not change significantly with growth. © 1992 Wiley‐Liss, Inc.
Bladder functional recovery following acute overdistension
Authors: Kang Jianshe , Wein Alan J. , Levin Robert M.
Published: March 2007

The effects of acute overstretching on detrusor function are unclear. Based on a new method to catheterize male rat bladder through the whole urethra, three groups (control, shamoperated, and acute bladder overdistension) of male rats were utilized in the present experiment. The contraction generated by in vitro bladders immediately post‐overdistension in response to 2 Hz and 32 Hz stimulation significantly decreased at 0.75 ml and 1.5 ml intravesical volumes respectively; however, by 1 day post‐overdistension the contractile responses increased toward normal. By three days the ability of the bladder to generate pressure completely returned to normal, and the average bladder weight for this group was increased. Similarly, the ability to empty was reduced at 0.75 ml and 1.5 ml immediately following overdistension and recovered fully after 3 days. The ability of the sham‐operated bladders to empty at high intravesical volume was slightly reduced immediately following overdistension, and this was the only pathophysiological change observed in this group. Acute bladder overdistension did not alter intravesical capacity. It is clear that acute over‐distension induced reversible changes in basic bladder function.© 1992 Wiley‐Liss, Inc.
Pelvic floor muscle exercise for the treatment of female stress urinary incontinence: Classification and characterization of responders
Authors: Bø Kari , Larsen Stig
Published: March 2007

The purpose of this study was to classify and characterize responders and non‐responders 10 pelvic floor muscle (PFM) exercise in treatment of female stress urinary incontinence (SUI). Fifty‐two women with SUI, mean age 45.9 years (24–64), participated in a randomized PFM exercise trial for 6 months. Treatment was either intensive exercises (IE) or moderate exercises carried out at home (HE).

Each of five parameters used to measure improvement of SUI (pad test, conversion of a closure pressure [cough] from negative to positive, the patient's own assessment, leakage index, and social activity index) was given one point if present. Respondets to treatment were defined by cumulative score 4 and 5, borderline responders by 2 and 3, and non‐responders by 0 and 1. Classified as responders were 65% in the IE group and 20.6% in the HE group. There were no non‐responders but 35% borderline responders in the IE group.

The responders in the IE group were significantly older, had a longer history of SUI, a higher body mass index (BMI), stronger PFM, more severe SUI measured by leakage and social activity index before treatment, negative closure pressure, lower resting maximum urethral pressure (MUP), and in addition were more motivated for treatment than borderline responders.

The discriminant function classified the responders to treatment by a combination of four initially observed variables: maximum flow rate, PFM strength, duration of SUI symptoms, and score on the leakage index. All patients classified as responders by use of the cumulative score in the HE group were correctly classified by the discriminant function.
Neurogenic bladder in lower motor neuron lesion: Long‐term assessment
Authors: Gajewski J.B. , Awad S.A. , Heffernan L.P.H. , Benstead T.J. , Downie J.W.
Published: March 2007

We have comprehensively investigated 10 patients with lower motor neuron (LMN) lesions (mean duration of lesions: 14 years) who were managed with intermittent catheterization. All patients (9 males and 1 female) underwent complete neurologic examination and, if necessary, extensive electromyographic studies to define the level and completeness of the lesion. The causes of the LMN lesions were traumatic injury (5), congenital (2), inflammation (1), and surgery (2). Patients were arranged into 2 groups. Five patients had complete lesions (no sensory or motor function at sacral level) and 5 had incomplete lesions (some remaining function). All patients were continent between catheterizations. A detailed urodynamic investigation, including cystometrogram (CMG), urethral pressure profile (UPP), voiding cystourethrogram (VCUG), phentolamine (5 mg i.v.), and bethanechol (5 mg s.c.),

Tests, was performed in all patients. Detrusor compliance (DC) at 100 ml was statistically the same in both groups (21.9 ml/cm H2O in complete lesions and 37.2 ml/cm H2O in incomplete lesions) and did not change at all after phentolamine in incomplete lesions (37.2 ml/cm H2O) but was somewhat increased in complete ones (27.5 ml/cm H2O). Bethanechol decreased DC in patients with complete and incomplete lesions (2.9 and 7.1 ml/cm H2O, respectively). Maximal urethral pressure was the same in both groups before and after pharmacological tests. The bladder neck was completely closed (VCUG) in all 5 patients with incomplete lesions in comparison to only 1 from the other group. Phentolamine had only a slight effect on bladder neck in both groups. Bladder compliance is normal in patients with LMN lesions treated with intermittent catheterization and the bladder neck is opened only in complete lesions. This may also account for the absence of incontinence in these patients.
Effects of pregnancy on adrenergic function in the rabbit urinary bladder
Authors: Tong Yat‐Ching , Wein Alan J. , Levin Robert M.
Published: March 2007

Pregnancy induces morphological as well as functional changes in the urinary tract. Urinary frequency, incontinence, and an increase in residual urine are common clinical findings during gestation. Previous studies from this laboratory have shown a decreased cholinergic response and cholinergic receptor density in the urinary bladders of pregnant rabbits.

In the present study, the adrenergic functions of the bladders of pregnant and virgin New Zealand White rabbits were compared using isolated muscle strips. Dose‐response curves showed that the contractile responses to epinephrine (alpha and beta agonist) and methoxamine (alpha agonist) were significantly reduced in tissues from the base and the mid‐segment, but not the body of the pregnant rabbit bladders. No significant difference was observed in the degree of isoproterenol (beta agonist) induced relaxations between the two groups. Thus, the results demonstrated a decreased alpha responsiveness in the midsegment and base of the pregnant bladders.

Physiologically, a decrease in alpha tone at the bladder base would be advantageous for bladder emptying as the resultant relaxation at the bladder outlet theoretically would alleviate the effect of decreased bladder body contractility as well as any mechanical stress imposed on the urethra by the enlarging uterus.
Sacral spinal cord and root potentials evoked by the stimulation of the dorsal nerve of penis and cord conduction delay for the bulbocavernosus reflex
Authors: Ertekin Cumhur , Mungan Behiye
Published: March 2007

Segmental spinal cord and root potentials in response to stimulations of the dorsal nerve of penis, tibial nerve, and the sural nerve were epidurally recorded in normal subjects. EMG responses from the bulbocavernosus (BC) and the various leg muscles were also recorded in response to bipolar stimulations by the same epidural needle electrodes of the sacral cord and lumbosacral roots.

The afferent conduction velocity from the penis to Th12‐L1 intervertebral level was about 40 m/sec on the average, which is significantly slower than those obtained by the stimulation of the mixed and cutaneous nerves at the lower limb.

The latency of the motor responses of the BC muscle from Th12‐L1 spine levels were found comparatively longer than those of thigh muscles on maximal epidural stimulation in spite of the shorter distances to the BC muscle.

The central conduction delay within the sacral cord of the bulbocavernosus reflex was calculated and found to be about 8.2 msec, while the central conduction time was about 1.1 msec for the Soleus‐H‐Reflex. These findings may suggest that there may be about 5–6 synapsis necessary for the first component of the bulbocavernosus reflex, though some faster oligosynaptic cord linkage may also exist.
Uroflowmetry in the puerperium
Authors: Ramsay Ian N. , Hughes Paul A.F. , Mathers Alan M. , Edgar Torbet T. , Rice Nigel
Published: March 2007

One hundred women underwent uroflowmetry once per day for the first 3 days after delivery, and the results compared to those of 53 nonpregnant controls in an effort to determine 1) whether urinary flow in the puerperium is different to that found without pregnancy, 2) whether uroflow parameters change as the puerperium progresses, and 3) which characteristics of a patient or her labour bear most influence upon the results of uroflowmetry.

Urinary flow in the puerperium was seen to be different from that of the nonpregnant female in that mean flow rates were lower. In addition to this, voided volume, total flow time, and time to peak flow were all significantly increased on day 1, but were comparable on days 2 and 3. Other than for falling voided volumes, uroflow parameters did not alter significantly as the puerperium progressed. Correlation of the variables age, parity, baby weight, length of first and second stage, use of epidural and perineal suturing with the parameters of urinary flow failed to show any significant relationship. © 1993 Wiley‐Liss, Inc.
Urothelial permeability of the isolated whole bladder
Authors: Tammela Teuvo , Wein Alan J. , Monson Frederick C. , Levin Robert M.
Published: March 2007

The urothelium of the bladder presents an effective barrier to the penetration of solutes from the urine into the bladder wall. Previously, we have demonstrated that the dye indigocarmine can be utilized intravesically to study urothelial permeability. In general, intravesical indigocarmine (administered in vivo) will not penetrate the bladder wall unless the urothelium is damaged by overdistension, acetone administration, or mechanical damage. Unfortunately, using in vivo methodologies, one is limited in the study of the effect of specific conditions and permeations on bladder permeability. In the current study an isolated in vitro whole bladder model was developed to quantitatively study the permeability of the bladder urothelium. In these studies, the penetration of indigocarmine into and through the bladder wall was quantitated under various conditions. The in vitro bladder was filled by infusing 1% indigocarmine in saline in a step‐wise manner at the rate of 10 ml in 10 minutes followed by a stabilization period of 10 minutes. Samples were taken from the bath at 20 minutes intervals for spectrophotometrical analysis of the dye. At the end of experiment the bladder was washed in saline for 10 minutes, and stored and extracted in formalin. In general, no indigocarmine penetrated the urothelium until the in vitro capacity was reached and exceeded. At intravesical volumes greater than capacity, the dye concentration in the bath increased very rapidly, even though the integrity of the bladder wall remained intact. In bladders treated with a gentle 50% acetone wash for 1 minute the dye started to penetrate into the bath at intravesical volumes of 25% of capacity and increased rapidly thereafter. Heparin instillations both delayed the onset of dye penetration and reduced the magnitude of the dye penetration. In addition, heparin inhibited dye penetration only at low volumes. Although in vitro anoxia of 60 minutes induced only slight dye penetration into the bath, the dye concentration in the tissue increased substantially indicating that anoxia induced damage to the urothelium.

These results indicate that an intact mucosal layer in the in vitro whole bladder model prevents indigocarmine penetration into and through the bladder wall, as it does in the in vivo bladder. Similar to the in vivo studies, there is a clear quantitative correlation between penetration of the dye and mucosal damage. Filling the bladder to capacity induced no mucosal damage. Only at volumes above capacity was the integrity compromised and permeability increased. The current model can be utilized to study mucosal permeability under controlled intravesical and extravesical conditions, as well as the study of permeability of bladders subjected to specific uropathologies. © 1993 Wiley‐Liss, Inc.
Effects of atropine, glucagon, and bethanechol on urodynamics of continent cecal urinary reservoir before and after complete, partial, and sham detubularizations in dog
Authors: Tammela Teuvo L.J. , Kiilholma Pentti J.A. , Chancellor Michael B.
Published: March 2007

Effects of muscarinic receptor blockade (atropine), stimulation (bethanechol), and bowel smooth muscle relaxant (glucagon) on the Urodynamics of the continent cecal urinary reservoir in a tube form and after complete, partial, and sham detubularizations were studied using dogs. Complete detubularization significantly increased capacity and decreased spontaneous motor activity, whereas the other types of detubularization had no significant effects on them. Neither atropine nor glucagon had influence on the basal pressure, but they increased the capacity and the volume at which the first pressure wave appeared and decreased the wave amplitude. After detubularization glucagon further decreased uninhibited contractions while atropine totally abolished them. The highest capacity and lowest motor activity was gained when atropine or glucagon was given in cases with detubularized pouch demonstrating an additive effect of the detubularization and drug. Also, bethanechol increased the motor activity and decreased the volume in detubularized pouches. It is suggested that when hyperactivity of intestinal reservoir is a problem in a patient with a detubularized cecal pouch, orally administered anticholinergic or bowel smooth muscle relaxing drugs may be useful in management. © 1993 Wiley‐Liss, Inc.
Effect of cromakalim on micturition function in rats
Authors: Smith Amanda B. , Bertelsen Darci L. , Kau Sen T. , Chun Alexa L.
Published: March 2007

Although many studies investigating the effect of cromakalim on bladder contractility exist, thus far, there are no published studies investigating its effect on micturition function in conscious rats. We measured the effect of cromakalim i.v. on urine output, frequency, volume of each micturition, and blood pressure in saline‐diuresed and non‐diuresed rats. In saline‐diuresed rats cromakalim produced significant decreases in urine output (0.1 mg/kg, 32%; 0.3 mg/kg, 46%; 1.0 mg/kg, 68%) and average frequency (0.1 mg/kg, 36%; 0.3 mg/kg, 51%; 1.0 mg/kg, 70%) in the first 3 hours. At 3–6 hours after administration of cromakalim there were rebound increases in both urine output (0.1 mg/kg, 290%; 0.3 mg/kg, 373%; 1.0 mg/kg, 538%), and frequency (0.1 mg/kg, 147%; 0.3 mg/kg, 181%; 1.0 mg/kg, 314%) and by 6–12 hours the effects of cromakalim on micturition function were gone. Mean arterial pressure dropped to 50% of control immediately after cromakalim administration in saline‐diuresed rats and began to return to control levels after 3 hours. Cromakalim produced similar results in non‐diuresed rats. The decrease in urine output 0–3 hours after cromakalim administration may have been a consequence of cromakalim's profound decrease in blood pressure that occurred during that time. © 1993 Wiley‐Liss, Inc.
Detrusor contraction strength in men undergoing prostatectomy
Authors: Robertson Andrew S. , Airey Robert , Griffiths Clive J. , Sharpies Linda , Neal David E.
Published: March 2007

Elective prostatectomy is a frequently performed operation but the outcome may not always be satisfactory. This is probably because a significant number of men, despite subjective symptoms, are not urodynamically obstructed before operation and the preoperative assessment of obstruction is not easy using conventional urodynamic criteria. We have calculated detrusor contraction strength (WF) in men before and after prostatectomy. Our aim was to determine its relationship with symptomatic and urodynamic findings before and after prostatectomy and whether it was associated with clinical outcome.

One hundred and twenty nine men listed for operation because of symptoms and low urinary flow rates were studied by means of urodynamic investigation and symptom scoring both before and 6 months after prostatectomy.

A significant association was found between persistent obstructive symptoms after operation and a low WF before operation (P = 0.01), suggesting that weak detrusor function before operation was the cause of persistent symptoms afterwards. A significant correlation was also found between a high pre‐operative WF and a high post‐operative urinary flow rate; (P = 0.003); men with high detrusor power achieving the better flow rates after operation. Despite this relationship, the overall subjective clinical outcome was not strongly associated with WF and WF was no better than simple measurement of voiding pressure in predicting outcome in a multivariate analysis.

The measurement of detrusor contraction strength provides some insight into the relationship between bladder function and clinical outcome after prostatectomy, but we have found it unable to predict outcome for the individual patient.
Abnormal pedal thermoregulation in interstitial cystitis
Authors: Irwin Paul P. , James Susan , Watts Lynda , Fleming Lamar L. , Galloway Niall T. M.
Published: March 2007

Isolated cold stress tests were used to evaluate the thermoregulatory capacity in the feet of 19 patients with interstitial cystitis (IC) and of 11 healthy volunteer control subjects. Mean pedal skin temperature fell more rapidly in the IC group as compared with controls; significant differences were found at 10‐min (P = 0.002) and 20‐min (P = 0.0008) cooling. Mean skin temperature remained lower in the IC group throughout the study. Sixteen feet (42%) in the IC group and five (22%) of the control feet failed to return to within 2°C of baseline temperature during the 20‐min recovery period. These findings may reflect abnormal vasomotor control in the IC group and, if so, may be indicative of increased spinal sympathetic activity in interstitial cystitis.
Male sexual impotence in diabetes mellitus: vasculogenic versus neurogenic factors
Authors: Benvenuti F. , Boncinelli L. , Vignoli G. C.
Published: March 2007

In an attempt to understand better the role of vascular and neurogenic alterations in the pathophysiology of diabetic impotence, 29 impotent male patients with diabetes mellitus (DM) were investigated by means of doppler ultrasound examination (DUE) of penile arteries, sacral evoked responses (SERs), peripheral nerve conduction studies, and, in most cases, nocturnal penile tumescence monitoring (NPTM).

Fourteen patients showed isolated alterations of penile vascular supply, four isolated alterations of penile segmental innervation, and seven combined vasculogenic and neurogenic abnormalities; finally, in four patients, DUE, SERs, and NPTM were normal. One patient, in spite of the presence of marked vasculogenic and neurogenic alterations, showed nocturnal penile erections. Results confirm that vascular obstruction, more than nerve damage, plays a primary role in the pathophysiology of diabetic erectile failure, and stress the importance of psychogenic factors. The observation that some patients presented marked involvements of both arterial supply and neurological pathways only a few years, or even 1 year, after the diagnosis of the disease, indicates the need of an early screening of the vascular and neurological status, even in asymptomatic patients.

Furthermore, all patients with altered SERs had peripheral neuropathy; on the other hand, six patients with peripheral neuropathy had normal SERs. This result stresses the diagnostic importance of the electrophysiologic studies of sacral segmental innervation and indicates further that in a comprehensive diagnostic protocol of diabetic impotence the study of SERs should be performed only in patients with peripheral neuropathy.
Fiberoptic microtransducer pressure technology: Uurodynamic implications
Authors: Belville William D. , Swierzewski Stanley J. , Wedemeyer Gary , McGuire Edward J.
Published: March 2007

The FST 200 is a novel commercially available pressure measurement system that combines microtechnology and fiberoptics and is particularly well suited for invasive urodynamic studies. Pressure recording with this system is highly accurate and reproducible. The pressure curves obtained parallel those from standard water cystometry. Being small and portable, the system lends itself to invasive transurethral monitoring in the privacy of an examination room. Additionally, the 5F catheter size allows the performance of leak point pressures and pressure/flow voiding studies with minimal urethral stenting artifact often seen with larger catheters. The technical aspects of this system are presented.
Incidence of abnormal voiding parameters in the immediate postpartum period
Authors: Ramsay Ian N. , Edgar Torbet T.
Published: March 2007

One hundred eighty‐four patients were assessed prospectively by uroflowmetry and post‐micturition ultrasonography on a daily basis in the immediate postpartum period to assess the incidence of abnormal voiding parameters, their predisposing factors, and whether the combination of two screening tests was more helpful than either alone as a screening test of abnormal voiding in the puerperium. The incidence of abnormal voiding parameters was 43%. The majority of these were asymptomatic. Of those patients who had an abnormality, 68% had normal voiding parameters by the time they went home, and all of those who returned for follow‐up had normal parameters. Operative delivery, perineal trauma, and epidural anaesthesia all increased the incidence of abnormal voiding parameters. Residual urine was a feature in 70 of the 79 patients found to be abnormal, and the incidence of an abnormal flow rate was not significantly greater than in the nonpregnant population. This suggests that the addition of uroflowmetry does not confer any benefit over postmicturition assessment of residual urine by ultrasonography in the detection of patients with postpartum voiding dysfunction.
Species differences in cAMP production and contractile response induced by β‐adrenoceptor subtypes in urinary bladder smooth muscle
Authors: Morita Takashi , Ando Masao , Kihara Kazunori , Oshima Hiroyuki
Published: March 2007

The contractile activity of urinary bladder smooth muscle has been shown to be inhibited by β‐adrenoceptor agonists. β‐Adrenoceptor subtypes in the rabbit, canine, and human urinary bladder smooth muscles were studied by measuring changes in contractile forces and in intracellular cAMP concentrations on administration of β‐adrenoceptor agonists. In the rabbit bladder, only β2‐receptors may have functional roles in the detrusor muscle, while both β1 and β2‐receptors may have functional roles in the detrusor muscles of the canine bladder. Only β2‐receptors may have functional roles in the human detrusor muscles, similar to the rabbit detrusor muscles. Thus, species differences may exist in β‐adrenoceptor subtypes in smooth muscles of urinary bladder.
Age‐related changes in the response of the rat urinary bladder to neurotransmitters
Authors: Saito Masahiko , Kondo Atsuo , Gotoh Momokazu , Kato Kumiko , Levin Robert M.
Published: March 2007

The effect of age on the contractile response of the rat urinary bladder to various neurotransmitters was studied using in vitro detrusor strips isolated from female Wistar rats. The contractile responses to 8 neurotransmitters were determined for rat urinary bladders isolated from 3 age groups: 24, 16, and 6 months old. The results can be summarized as follows: 1) There was no age‐dependent change in the maximum response to KCl. 2) The contractile response to norepinephrine, adenosine 5′‐triphosphate (ATP), and serotonin increased with age. 3) The relaxation response to isoproterenol was significantly less in 24‐month‐old rats than in the other 2 age groups. 4) There were no age related changes in the responses to acetylcholine, prostaglandin F2 alpha, and angiotensin II. 5) Vasoactive intestinal polypeptide (VIP) failed to induce any response in the rat bladders of any group. 6) There were no significant differences in the ED50s for the 5 neurotransmitters among the 3 age groups. In summary, significant differences in the response to adrenergic, purinergic, and serotonergic stimulation were found as a function of age, whereas no age related changes in the response to cholinergic or generalized depolarization with KCl were found.
Effects of apomorphine and L‐dopa on the parkinsonian bladder
Authors: Aranda Bernard , Cramer Philippe
Published: March 2007

Neurogenic bladder frequently occurs in Parkinson's disease. Detrusor hyperreflexia is a consequence of nigrostriatal dopamine depletion, whereas the cause of hyporeflexia remains unclear. We compared the results of cystometry and urethral profilometry with and without apomorphine (and L dopa) in 12 idiopathic parkinsonians with urinary disorders free of dopaminergic treatment. Whereas hyperreflexic patients improved with apomorphine, and to a lesser extent with L dopa, these drugs had no effect on hyporeflexic patients. These results confirm the role of dopaminergic lesions in the occurrence of bladder hyperreflexia and the possible implication of nondopaminergic lesions in the occurrence of hyporeflexia.
Urodynamic biofeedback training for children with bladder‐sphincter dyscoordination during voiding
Authors: Kjølseth Dorthe , Knudsen Lis Mønster , Madsen Bodil , Nørgaard Jens Peter , Djurhuus Jens Christian
Published: March 2007

Neurologically normal children with recurrent urinary tract infections (UTIs), night‐ and daytime wetting, and urge and painful voiding may have staccato voiding due to pelvic floor contractions.

The immediate effect of non‐invasive urodynamic biofeedback (BF) therapy was assessed using a historical follow‐up study in 31 children aged 5–15 years suffering from urodynamically proven overactive urethra during voiding. A long‐term follow‐up study was performed to investigate whether improvement was maintained.

Twenty‐four children (77.5%) benefited from the treatment. Of these 16 (51.5%) were cured, while 8 (26%) had a pronounced reduction in their symptoms. Although the flow was normalized in 17 (55%) and nearly normalized in 7 (22.5%), there was no significant correlation between subjective and objective criteria of improvement. Similarly, no relationship was found between the initial urodynamic characteristics and the treatment outcome.

During a mean follow‐up time of 4 years (range: 1–7.5 years) two of the initially cured patients relapsed. They were recured with a refresher course. Three had had a single or a few episodes of cystitis in the course of several years. Of the patients with pronounced reduction in their symptoms, three relapsed. A refresher course was attempted in two patients; one was successful.

It can thus be concluded that BF is an effective way of treating this disturbance and the beneficial effect is to a wide degree maintained.
Dimensions of urine loss among older women with genuine stress incontinence
Authors: Nochajski Thomas H. , Burns Patricia A. , Pranikoff Kevin , Dittmar Sharon S.
Published: March 2007

The specific maneuvers that cause women to be incontinent can become important diagnostic aids and major factors in differentiating the effectiveness of the current pharmacological, surgical, and behavioral treatments for urinary incontinence. The purpose of this study was to evaluate whether meaningful dimensions could be identified within the multiple movements that produce urine loss in stress‐incontinent women. The Stress Incontinence Questionnaire (SIQ) was constructed from items derived from a compilation of studies and reports of urinary incontinence experts. An exploratory factor analysis using maximum likelihood method of extraction and a varimax rotation procedure identified four dimensions: active maneuvers, passive maneuvers, planned maneuvers, and unplanned maneuvers. The alpha coefficients for the four identified factors were acceptable and ranged from 0.71 to 0.79, with 8‐week test‐retest correlations for the active (r =.87), passive (r =.87), planned (r =.85), and the unplanned maneuvers (r =.60) all highly significant. The four factors also showed differential patterns of relationships with various gynecologic and urologic measures. These latter findings suggest that the factors identified in this study may be acknowledging different types or components of stress incontinence. In either case, the findings may have implications for treatment approaches to stress incontinence. Further research is needed to substantiate the various components of stress incontinence found in this study and the implications these findings may have for treatment of incontinence.
Inhibiting the hyperreflexic bladder with electrical stimulation in a spinal animal model
Authors: Walter James S. , Wheeler John S. , Robinson Charles J. , Wurster Robert D.
Published: March 2007

Uninhibited bladder contractions are a problem in spinal cord injured patients. Accordingly, methods using electrical stimulation to inhibit the bladder were investigated in chronic spinal cord injured (C6‐T1) male cats. In unanesthetized, restrained animals, spontaneous bladder contractions were observed after the bladder was filled above the micturition threshold. In 3 of the 5 cats studied, this bladder activity could be inhibited with stimulation of either sacral nerves or pudendal nerves. Pudendal nerve stimulation, however, was more selective than sacral nerve stimulation for inhibition with fewer side effects such as leg spasms. Tibial nerve stimulation was ineffective and caused leg spasms and increased bladder activity. Finally, high‐frequency stimulation (1,000 Hz) of the sacral nerves was shown to block bladder contractions in 2 of 3 cats investigated. However, this method had adverse side effects such as leg flexion and secondary bladder contractions. We conclude that pudendal nerve/pelvic floor stimulation at low frequency is a relatively effective method in this model.
Quantification of lower urinary tract function and dysfunction
Authors: van Mastrigt R.
Published: March 2007

Computer software was developed that interprets urodynamic voiding studies in terms of urinary bladder contractility and urethral resistance. The software was successfully applied in a large number of clinical studies.
A critical comparison of methods proposed for quantification of bladder outlet obstruction
Authors: Kranse Ries , van Mastrigt Ron
Published: March 2007

Performance studies of parameters for bladder outlet obstruction in BPH patients before and after a TURP in terms of sensitivity and specificity can easily be criticized because in roughly 25% of the patients it is not clear if the clinical symptoms are related to increased outlet obstruction or impaired bladder contractility. This abstract presents objective alternatives.
Learning procedure in a neural control model for the urinary bladder
Authors: Bastiaanssen Erica H. C. , Vanderschoot Jan , van Leeuwen Johan L.
Published: March 2007

A continuous neural network coupled to a dynamical model of the urinary bladder is defined. The neural network is trained to control the bladder model to track a prescribed volume fluctuation, by adjusting weights and time constants. The gradients of the error in the output neurons of the neural network are unknown. Therefore, the learning procedure discussed here minimizes the error functional without using gradient descent.
Incontinence pads: Predicting their leakage performance using laboratory tests
Authors: Cottenden Alan , Ledger David
Published: March 2007

An international multi‐centre project was performed to discover which laboratory tests best predict the leakage performance of incontinence pads. A combination of absorption capacity and absorption time measurements along with the presence/absence of pad shaping and elastication produced impressive correlations with clinical performance.
Effect of transurethral resection of the prostate on detrusor instability and urge incontinence in elderly males
Authors: Gormley E. A. , Griffiths D. J. , McCracken P. N. , Harrison G. M. , McPhee M. S.
Published: March 2007

Detrusor instability is common in men with evidence of outflow obstruction due to benign prostatic hypertrophy and typically reverses in about two thirds of patients after transurethral resection of the prostate (TURP). It is also common among the elderly without outflow obstruction and may lead to urge incontinence. To determine whether TURP has an effect on detrusor instability and urge incontinence in elderly men, or whether these abnormalities are due to other age‐associated changes, 12 males (mean age 80 years) with urge incontinence or frequency and urgency of micturition, and symptomatic benign prostatic hypertrophy, were studied by 24‐hour monitoring of incontinence and videourodynamic examination, before and after TURP; 7/12 patients were significantly cognitively impaired.

Preoperatively, all patients showed detrusor instability, which reversed postoperatively in only one patient, a significantly smaller proportion than that consistently reported in younger patients. Preoperatively, 11/12 patients were incontinent. After TURP, 8/11 patients had an improvement in the amount of incontinence, by up to 458 g in 24 hours. Those who improved had been urodynamically more severely obstructed preoperatively. Those with the most improvement were also cognitively impaired.

We conclude that, in the geriatric population, detrusor instability and urge incontinence may be the result of age‐associated changes and not secondary to obstruction. Detrusor instability is likely to persist following TURP. Preoperative urodynamic assessment of obstruction in the incontinent male with benign prostatic hypertrophy may be useful since the severity of incontinence responds well to TURP if there is marked obstruction. Cognitive impairment should not be a deterrent to operation.
Neurophysiological evaluation in detrusor instability
Authors: Del Carro U. , Riva D. , Comi G. C. , Locatelli T. , Magnani G. , Levati N. , Viganó R. , Sambruni I. , Canal N.
Published: March 2007

Different and complex neuronal systems are involved in the control of continence. Detrusor overactivity has been divided by the International Continence Society into two functional subgroups: a) detrusor instability and b) detrusor hypereflexia. Only in the latter group has neurological damage been shown, but pathophysiological mechanisms are still unknown. In order to complete a full investigation of sensory and motor pathways 12 female patients affected by idiopathic detrusor instability (mean age 60.2 years; range 49–73) and 13 age‐matched healthy women were studied. All patients were submitted to a subtracted cistometrogram (CMG), anal sphincter electromyography (EMG) with a bipolar coaxial needle, sacral reflex analysis after stimulation of the dorsal nerve of the clitoris, tibial and pudendal somatosensory evoked potentials, motor evoked potentials after magnetic cortical coil stimulation, and recording from anal sphincter and abductor brevis hallucis muscles. All patients had normal neurophysiological tests, and no significant differences between patients and controls could be seen. Our data confirms the absence of both clinical and subclinical damage of central sensory or motor pathways in detrusor instability; an alteration of suprasegmental mechanisms cannot be excluded.
New concepts in relation to urge and detrusor activity
Authors: Coolsaet Bo L. R. A. , Van Duyl Wim A. , Van Os‐Bossagh Pooran , De Bakker Hans V.
Published: March 2007

Investigations of micromotion characteristics of bladder wall strips and pressure wave phenomena in total bladders in vitro and in vivo indicate that micromotion phenomena occur in the bladder wall. Local contractions can occur without an increase in tension or pressure, because other parts are in antiphase. Local contractions stretch surrounding tissues, which can stimulate fast stretch receptors. Synchronisation of these micromotion phenomena appears to be possible. Hence, above threshold levels urge can theoretically occur, even in the absence of a pressure increase. This hypothesis could explain the weak relation between urge and pressure. The distinction between motor and sensory urge could be artifactual based on a misunderstanding of fundamental bladder wall processes.