Bladder (San Francisco, Calif.)最新文献

This article reviewed brain mechanism of the lower urinary tract (LUT). Among autonomic nervous systems, LUT is unique in terms of afferent pathophysiology; bladder sensation is perceived soon after the storage phase and throughout the voiding phase. Within the brain, this is measured in experimental animals by the firing of single neurons and in humans by evoked potentials/functional neuroimaging. The evidence indicates that sphincter information goes up to the precentral motor cortex and other brain areas, and bladder information goes up to the insular cortex (IC)/anterior cingulate (ACG) and further to the prefrontal cortex (PFC). Another LUT-specific phenomenon is efferent pathophysiology: detrusor overactivity (exaggerated micturition reflex) occurs in brain diseases such as stroke (focal disease) and dementia with Lewy bodies (diffuse diseases, may overlap with each other). With the turning off and on of the brain-switch of micturition (at the periaqueductal gray [PAG]), there is a bladder-inhibitory PFC-IC/ACG-hypothalamus-PAG pathway, with interconnections via the PFC with a PFC-nigrostriatal D1 dopaminergic pathway and a PFC-cerebellar pathway. Brain diseases that affect these areas may cause a loss of the brain's inhibition of the micturition reflex, leading to detrusor overactivity. This has a significant clinical impact on patients and requires appropriate management.

Reducing the recurrence rate in patients with low-risk non-muscle invasive bladder cancer patients is a critical concern in the urologic community. The gold standard treatment is single instillation (SI) of intravesical chemotherapy after transurethral resection of bladder tumor (TURBT), but unfortunately, it is underused. Continuous bladder irrigation (CBI) after TURBT is an alternative strategy to SI for the prevention of bladder tumor implantation and recurrence. The aim of this review was to present the evidence that supports CBI after TURBT when SI is not possible.

Objectives: To evaluate the utility and safety of pelvic floor muscle exercises in combination with a wireless percutaneously implantable microstimulator device (NuStim^®) for the treatment of stress urinary incontinence.

Methods: In this prospective self-controlled pilot trial, three patients aged 35-75 years with incontinence symptoms were treated by pelvic floor muscle exercises plus implantation of NuStim^® from June 2017 to March 2019. The patients received 25 weeks of pelvic floor training, during which the patients' incontinence was quantitatively assessed by a 1-h pad test. Self-reported scores were used to rate the effect of treatment in terms of the quality of daily life, with pelvic floor muscle strength evaluated on the modified Oxford scale at each follow-up visit.

Results: All three patients (2 males and 1 female) completed the trial without dropouts. The results showed that their incontinence symptoms were alleviated, as measured by a decrease in the normalized weight of the 1-h pad test, which presented a significant linear trend (P = 0.0021). An intragroup analysis revealed that all participants achieved statistically significant improvement in terms of the 1-h pad test score at 25 weeks as compared with pre-training findings. Nonetheless, no significant difference was found between the results of the other follow-up points and the baseline before treatment (P = 0.058). Comparison of the secondary outcome variable scores in each participant showed no significant difference at the conclusion of the study.

Conclusions: Use of the NuStim^® during pelvic floor muscle exercises resulted in significant improvement in incontinence symptoms. The device was shown to be useful and safe as an adjunct to the pelvic floor training for the treatment of stress urinary incontinence.

Objectives: To verify the safety and effectiveness of a novel micro-implantable wireless nerve stimulation device in healthy adult beagles and evaluate the feasibility of using the device in clinical practice.

Methods: The stimulator was experimentally implanted into the quadriceps femoris of three adult beagles. The animals were subjected to training on daily basis for 14 days, and the threshold test was administered once a week. At the end, we analyzed the images of light microscopy and electron microscopy.

Results: The implantation was easy to perform and the whole stimulation system worked stably and reliably. The stimulation threshold was stable. During the process, the stimulator did not move or cause damage to adjacent tissues. The whole system showed a good biocompatibility with recipient animals. The stimulator could induce muscular contraction and enhance the motor function of muscles.

Conclusions: The preliminary results showed that the stimulator could be safely implanted into animal body, with good tissue compatibility, stability and reliability. In addition, it also worked well in eliciting muscle contraction. It promises to be used for the treatment of stress urinary incontinence in future.

The botulinum neurotoxin type A (BoNT/A) is a neurotoxin produced by Clostridium botulinum. It causes botulism and represents the most powerful natural poison. In urological practice, the indications for BoNT/A therapy include neurogenic detrusor overactivity (NDO), idiopathic overactive bladder (OAB) or idiopathic detrusor overactivity (IDO), detrusor-sphincter dyssynergia (DSD), interstitial cystitis/bladder pain syndrome (IC/BPS), urinary tract infections (UTI), benign prostatic hyperplasia (BPH), and, more recently, chronic prostatic pain (CPP). BoNT/A is not only conducive to the treatment of muscle spasticity but also effectively works on hyperalgesia associated with various disorders of the lower urinary tract, thanks to its anti-nociceptive properties. While Botox^® (Allergan Inc., Irvine, CA) is currently being used across the globe, we have been using Chinese BoNT/A for many years for the treatment of DSD, NDO, idiopathic OAB, IC/BPS, BPH and UTI. Our experience showed that Chinese BoNT/A was as good as other BoNT/A products in terms of efficacy, safety, and tolerability. In this study, we explored the current and potential applications of Chinese BoNT/A in urology, and reviewed the background information regarding the toxin.

Objectives: To summarize some key steps of functional improvement in robotic intracorporeal studer's orthotopic neobladder (RISON) of males, especially for nerve-spring technique. We also presented the result of 1-year follow-up aimed to illustrate its functional trifecta outcomes.

Methods: Robotic radical cystectomy with intracorporeal studer's orthotopic neobladder was performed on 33 male patients by the same surgeon from April 2018 to March 2019. Nerve-sparing technique had been used in 11 of the 33 patients. A prospectively maintained dataset was retrospectively searched and the related perioperative and follow-up data were analyzed. The functional trifecta outcomes referred to the freedom from recurrence, urinary continence and sexual function recovery after one year.

Results: A total of 33 males were included in our study. All perioperative information was recorded in detail. Thirty-two cases were confirmed to have negative surgical margin, except one pT3a case. And another case of incidental prostate cancer was diagnosed pathologically. All patients (100%) were recurrence-free one year after the operation. Eleven patients underwent nerve-sparing surgeries, including inter-fascial techniques or intra-fascial techniques. All these patients attained daytime continence (0 pad) at 1 month. With the nighttime continence, nerve-sparing group (2, 2,1) used fewer pads than other 22 cases (3, 3,2) at 1, 6 or 12 month(s) respectively. We defined urinary continence as 0 pad in daytime and no more than 1 pad in nighttime. The median preoperative score of International Index of Erectile Function (IIEF-6) in the 11 cases was 24. The sexual function recovery was defined as IIEF-6 > 20. The final trifecta rate was 54.5% and the median follow-up time lasted 17 months (range, 12 to 22 months).

Conclusions: RISON could be a safe and feasible choice of urinary diversion. Nerve sparing techniques might help the patients achieve a relatively higher functional trifecta rate.

Parkinson's disease (PD), caused by degeneration of dopaminergic neurons, leads to motor and autonomic symptoms. A large proportion of PD patients experience lower urinary tract symptoms (LUTS) and voiding dysfunction, associated with poor quality of life. Deep brain stimulation (DBS) is an adjunctive therapy used in combination with medication for Parkinsonian motor symptoms and is currently being explored to treat PD-related LUTS. This review discusses the current literature on the effects of DBS on lower urinary tract function and whether this modality can be used to modulate PD-related LUTS and voiding dysfunction.

Objective: In a concept of accommodation of detrusor pressure to volume as an autonomous potency of the bladder, a crucial physiological biomechanical role has been attributed to spontaneous contraction activity. This concept is experimentally investigated on pig bladder in vitro.

Methods: Slowly emptying of not-stimulated pig bladders via a flow resistor has been recorded and the effect of spontaneous contractions on the tonic pressure during emptying by expulsion has been studied.

Results: The expulsed volume can be separated in a reduction of elastic volume and of rest volume. Tonic pressure is determined by the elastic volume in combination with elastic compliance. In an accommodated state completely transient superimposed pressure waves affect rest volume not elastic volume. Accommodation of tonic detrusor pressure to bladder volume is based on equilibration between passive elongations and active transient contractions distributed in bladder wall.

Conclusion: Maintenance of a tonic accommodated detrusor pressure to a constant or slowly varying volume, obtained by a process of equilibration between passive elongations and active contractions, can be understood as an autonomous potency of a bladder. The earlier presented concept of active accommodation has been validated by the experiments. The pressure-volume relation of the bladder is fundamentally revised. Total volume V can be virtually separated in an elastic volume V_E and a plastic or rest volume V_R. Both parts change with V and in changing ratio. Tonic pressure marks a border between V_E and V_R.

Malakoplakia is a chronic inflammatory condition that affects multiple systems, most commonly the urogenital tract. Its clinical presentation is often non-specific, but is typically characterized by recurrent urinary tract infections and haematuria. We report a rare case of intravesical malakoplakia mimicking an aggressive transitional cell carcinoma both in its clinical presentation and in its macroscopic appearance on cystoscopy in an 82-year patient, the oldest reported case in the literature. Malakoplakia has been described in the literature as a benign disease process presenting typically in younger patients. This case demonstrates its ability to cause obstructive uropathy and affect elderly patients. Thus, this case serves as a reminder to consider malakoplakia as a differential in the evaluation of suspected bladder malignancy in patients of all ages.

With the advent of artificial intelligence (AI) in biostatistical analysis and modeling, machine learning can potentially be applied into developing diagnostic models for interstitial cystitis (IC). In the current clinical setting, urologists are dependent on cystoscopy and questionnaire-based decisions to diagnose IC. This is a result of a lack of objective diagnostic molecular biomarkers. The purpose of this study was to develop a machine learning-based method for diagnosing IC and assess its performance using metabolomics profiles obtained from a prior study. To develop the machine learning algorithm, two classification methods, support vector machine (SVM) and logistic regression (LR), set at various parameters, were applied to 43 IC patients and 16 healthy controls. There were 3 measures used in this study, accuracy, precision (positive predictive value), and recall (sensitivity). Individual precision and recall (PR) curves were drafted. Since the sample size was relatively small, complicated deep learning could not be done. We achieved a 76%-86% accuracy with leave-one-out cross validation depending on the method and parameters set. The highest accuracy achieved was 86.4% using SVM with a polynomial kernel degree set to 5, but a larger area under the curve (AUC) from the PR curve was achieved using LR with a l ₁-norm regularizer. The AUC was greater than 0.9 in its ability to discriminate IC patients from controls, suggesting that the algorithm works well in identifying IC, even when there is a class distribution imbalance between the IC and control samples. This finding provides further insight into utilizing previously identified urinary metabolic biomarkers in developing machine learning algorithms that can be applied in the clinical setting.