To compare the impact of transurethral resection of prostate （TURP） on symptom scores and maximal flow rates （Qmax） in patients with equivocal bladder outlet obstruction （BOO） and definite BOO and to assess the ...To compare the impact of transurethral resection of prostate （TURP） on symptom scores and maximal flow rates （Qmax） in patients with equivocal bladder outlet obstruction （BOO） and definite BOO and to assess the relationship between the surgical outcomes and degree of preoperative BOO, we prospectively evaluated men with lower urinary tract symptoms and bladder outlet obstruction index （BOO1） greater than 20, who were refractory to conventional medical treatment and underwent TURP. Urodynamic evaluation, International Prostate Symptom Score （IPSS）, uroflowmetry, post-void residual volume （PVR） check and transrectal ultrasound were performed. 20〈B001〈40 was defined as equivocal BOO and BOO1 〉~40 as definite BOO. Changes of IPSS, Qmax, PVR and correlation analysis was performed between the degree of improvement of Qmax, subdomains of I PSS and BOO1. Fifty-four patients showed equivocal BOO and 80 patients showed definite BOO. Preoperatively equivocal BOO group and definite BOO group showed significant differences in maximal bladder capacity and prevalence of detrusor overactivity, whereas no difference was noted in prostate volume. Postoperatively both groups showed improvements in Qmax, obstructive （IPSSO） and irritative （IPSSI） subdomain of IPSS, but the degree of improvement in Qmax and IPSSI subdomain was statistically significantly greater in definite BOO group. The degree of improvement of Qmax and IPSSI showed weak correlation with preoperative BOO1. As a weak correlation was identified between preoperative degree of BOO and outcome of TURP, other factors other than BOO1 such as severity of patients＇ symptoms should be considered in deciding treatment modality.展开更多
Purpose: Large conductance, voltage- and Ca2+-activated K+ (BK) channel is thought to have a central role to regulate urinary bladder smooth muscle functions, and its dysfunction may lead to increase of urination freq...Purpose: Large conductance, voltage- and Ca2+-activated K+ (BK) channel is thought to have a central role to regulate urinary bladder smooth muscle functions, and its dysfunction may lead to increase of urination frequency and overactive bladder. The present study aims to investigate the expression pattern of BK channel subunits in the human urinary bladder, and how it changes in association with bladder outlet obstruction (BOO). Materials and Methods: Human bladders were obtained from 7 controls without prostatic enlargement and lower urinary tract symptoms and 4 BPH patients with clinically diagnosed overactive bladder who were verified by the International Prostate Symptom Score (IPSS) and prostate volume. The expression and location of BK channel protein complex was examined using immunohistochemistry with affinity-purified anti-BKα antibodies. A real-time RT-PCR was used to quantify the expression of each BK channel subunit (α and β1 - 4) gene in the mucosal and muscle layers of human urinary bladder. Results: Immunohistochemical staining for BK-α protein complex was localized in the muscle and submucosal regions of urinary bladder. RT-PCR analysis revealed the presence of α-, β1-, and β4-subunit genes of BK channel in the mucosal layer, α- and β1-subunit in the muscle layer. The expressions of α- and β1-subunit genes in the muscle (α: p = 0.0003, β1: p = 0.0003) and mucosal (α: p = 0.03, β1: p = 0.02) layers significantly decreased in BOO bladders compared with controls. The expression levels of α- and β1-subunit in mucosal layer were statistically correlated with storage score of IPSS (α;r = 0.84, p = 0.002, β1;r = 0.84, p = 0.002), and so were in muscle layer (α;r = 0.934, p 0.0001, β1;r = 0.917, p = 0.00018). Conclusions: BK channels, which are mainly composed of α- and β1-subunits, are expressed in both the mucosal and muscle layers of human urinary bladder. Decreased expression of BK channel in BOO might be implicated in the mechanisms underlying the development of overactive bladder.展开更多
Objective: Detrusor hyperactivity with impaired contractility (DHIC) is not an uncommon bladder disorder, and is often difficult to treat. Therefore, using a rat model featuring both urinary frequency and residual uri...Objective: Detrusor hyperactivity with impaired contractility (DHIC) is not an uncommon bladder disorder, and is often difficult to treat. Therefore, using a rat model featuring both urinary frequency and residual urine, we investigated whether an anticholinergic agent (solifenacin) or a β3-agonist (mirabegron) is more suitable to combine with distigmine to treat DHIC. Methods: The partial bladder outlet obstruction (BOO) rat model was used. Rats were treated for 2 weeks: BOO/Solifenacin group was treated with 0.1 mg/kg solifenacin (n = 8), BOO/Mirabegron group was treated with 1 mg/kg mirabegron (n = 8), BOO/- group was not drug-treated but was given distilled water (n = 8), and the control group was also given distilled water (n = 8). Then the urethral ligature was removed under urethane anesthesia, and continuous cystometry was performed to evaluate bladder function. Baseline measurements were taken, then distigmine was administered to all groups, and cystometry was performed again to measure changes in bladder function. Results: Residual volumes increased in the BOO/- group, and the detrusor contractions were more frequent than that of the control group. Solifenacin treatment did not influence changes, except for threshold pressure, to any cystometric measurements. However, mirabegron treatment decreased the residual volume and residual volume rate;it also decreased detrusor contraction frequency similar to measurements obtained from the control group. Distigmine treatment enhanced detrusor contractions, which resulted in less residual volume, and decreased detrusor contraction frequency in the BOO model. Conclusions: The combination of distigmine and mirabegron was determined to be a better treatment than the combination of distigmine and solifenacin for DHIC.展开更多
Urinary retention in women is rare and is more frequently described as case reports or small case series. The female/male ratio is 1:13 with about 3 cases per 100,000 women every year We report a case of a 12-year old...Urinary retention in women is rare and is more frequently described as case reports or small case series. The female/male ratio is 1:13 with about 3 cases per 100,000 women every year We report a case of a 12-year old female student. She presented with progressive weight loss, worsening lower urinary tract symptoms with distended lower abdomen of 10 weeks duration. Physical examination revealed a mobile tender firm pelvic mass, 18 centimeters (cm) × 16 cm in size. Laboratory and imaging studies showed obstructive nephropathy and uropathy respectively. She was worked up and had uneventful exploratory laparotomy with right salpingo-oophorectomy, urinary bladder diverticulectomy and pelvic lymphadenectomy. Histopathology of the pelvic mass showed ovarian dysgerminoma with lymph node metastasis. She responded very well to chemotherapy and resumed her school activities. Bladder outlet obstruction is relatively rare in females and in the index patient, ovarian dysgerminoma is the cause leading to obstructive nephropathy and uropathy.展开更多
Objective To explore the effect of doxazosin on rabbit bladder compliance after partial bladder outlet ob- struction. Methods A total of 40 male New Zealand white rabbits were randomized into 4 groups,with 10 rabbits ...Objective To explore the effect of doxazosin on rabbit bladder compliance after partial bladder outlet ob- struction. Methods A total of 40 male New Zealand white rabbits were randomized into 4 groups,with 10 rabbits in each group. Partial bladder outlet展开更多
Objective: To compare the efficacy of bladder neck incision (BNI) with transurethral resection of prostate (TURP) in the treatment of patients with urinary obstruction caused by benign prostatic hyperplasia (BPH) on t...Objective: To compare the efficacy of bladder neck incision (BNI) with transurethral resection of prostate (TURP) in the treatment of patients with urinary obstruction caused by benign prostatic hyperplasia (BPH) on the basis of short term follow up of 4 months. Patient and Methods: The study was conducted in Department of General Surgery in Maulana Azad Medical College, New Delhi. 60 men with proven clinical diagnosis of BPH of size 30 grams and less presenting with symptoms of bladder outlet obstruction (BOO) were randomised prospectively to undergo either of the two operative modalities. Preoperatively size of the prostate, symptom scoring (IPSS), peak flow rate (Qmax) were assessed. Postoperatively and during 4 months follow up the following data were collected—operative time, catheterisation period, hospital stay, blood loss, Qmax and IPSS. Results: Preoperative parameters in both the groups showed no statistically significant differences with respect to prostate size, Qmax and IPSS Scoring. At 4 months follow up Qmax increased from (6.35 ± 4.49) to (16.41 ± 2.28) in TURP group and (4.51 ± 3.57) to (15.95 ± 2.58) in BNI group. IPSS decreased from 18.70 to 5.7 in TURP group and 18.90 to 6.00 in BNI group. All differences were statistically significant. There was a statistically significant difference in operative time, blood loss, hospital stay, catheterisation timing favouring BNI. Conclusion: TURP and BNI are equally effective in providing symptomatic improvement. BNI has an upper hand in reference to operative time, hospital stay, duration of catheterisation and blood loss.展开更多
Objective Bladder outlet obstruction(BOO)results in significant fibrosis in the chronic stage and elevated bladder pressure.Piezo1 is a type of mechanosensitive(MS)channel that directly responds to mechanical stimuli....Objective Bladder outlet obstruction(BOO)results in significant fibrosis in the chronic stage and elevated bladder pressure.Piezo1 is a type of mechanosensitive(MS)channel that directly responds to mechanical stimuli.To identify new targets for intervention in the treatment of BOO-induced fibrosis,this study investigated the impact of high hydrostatic pressure(HHP)on Piezo1 activity and the progression of bladder fibrosis.Methods Immunofluorescence staining was conducted to assess the protein abundance of Piezo1 in fibroblasts from obstructed rat bladders.Bladder fibroblasts were cultured under normal atmospheric conditions(0 cmH_(2)O)or exposed to HHP(50 cmH_(2)O or 100 cmH_(2)O).Agonists or inhibitors of Piezo1,YAP1,and ROCK1 were used to determine the underlying mechanism.Results The Piezo1 protein levels in fibroblasts from the obstructed bladder exhibited an elevation compared to the control group.HHP significantly promoted the expression of various pro-fibrotic factors and induced proliferation of fibroblasts.Additionally,the protein expression levels of Piezo1,YAP1,ROCK1 were elevated,and calcium influx was increased as the pressure increased.These effects were attenuated by the Piezo1 inhibitor Dooku1.The Piezo1 activator Yoda1 induced the expression of pro-fibrotic factors and the proliferation of fibroblasts,and elevated the protein levels of YAP1 and ROCK1 under normal atmospheric conditions in vitro.However,these effects could be partially inhibited by YAP1 or ROCK inhibitors.展开更多
Summary： We performed a retrospective, case-control study to evaluate whether the urine flow acceleration （UFA, mL/s2） is superior to maximum uroflow （Qmax, mL/s） in diagnosing bladder outlet obstruction （BOO） ...Summary： We performed a retrospective, case-control study to evaluate whether the urine flow acceleration （UFA, mL/s2） is superior to maximum uroflow （Qmax, mL/s） in diagnosing bladder outlet obstruction （BOO） in patients with benign prostatic hyperplasia （BPH）. In this study, a total of 50 men with BPH （age： 58±12.5 years） and 50 controls （age： 59±13.0 years） were included. A pressure-flow study was used to determine the presence of BOO according to the recommendations of Incontinence Control Society （ICS）. The results showed that the UFA and Qmax in BPH group were much lower than those in the control group [（2.05±0.85） vs. （4.60±1.25） mL/s2 and （8.50±1.05） vs. （13.00±3.35） mL/s] （P〈0.001）. Accol;ding to the criteria （UFA〈2.05 mL/s2, Qmax〈10 mL/s）, the sensitivity and specificity of UFA vs. Qmax in diagnosing BOO were 88%, 75% vs. 81%, 63%. UFA vs. Omax, when compared with the results of P-Q chart （the kappa values in corresponding analysis）, was 0.55 vs. 0.35. The pros- tate volume, post void residual and detrusor pressure at Qmax between the two groups were 28.6±9.8 vs. 24.2±7.6 mL, 60.4±1.4 vs. 21.3±2.5 mL and 56.6±8.3 vs. 21.7±6.1 cmHzO, respectively （P〈0.05）. It was concluded that the UFA is a useful urodynamic parameter, and is superior to Qmax in diagnosing BOO in patients with BPH.展开更多
Underactive bladder(UAB)is a voiding disorder which generates disabling lower urinary tract symptoms(LUTS)due to the inability to produce an effective voiding contraction sufficient to empty the bladder.The underlying...Underactive bladder(UAB)is a voiding disorder which generates disabling lower urinary tract symptoms(LUTS)due to the inability to produce an effective voiding contraction sufficient to empty the bladder.The underlying abnormality,that is usually appreciated when performing urodynamic studies,has been defined by the International Continence Society(ICS)as detrusor underactivity(DUA).DUA is a common yet under-researched bladder dysfunction.The prevalence of DUA in different patient groups suggests that multiple aetiologies are implicated.Currently there is no effective therapeutic approach to treat this condition.An improved understanding of the underlying mechanisms is needed to facilitate the development of new advances in treatment.The purpose of this review is to discuss the epidemiology,pathophysiology,common causes and risk factors potentially leading to DUA;to aid in the appropriate diagnosis of DUA to potentially improve treatment outcomes.展开更多
Background： Work in voiding （WIV） of the bladder may be used to evaluate bladder status throughout urination rather than at a single time point. Few studies, however, have assessed WIV owing to the complexity of it...Background： Work in voiding （WIV） of the bladder may be used to evaluate bladder status throughout urination rather than at a single time point. Few studies, however, have assessed WIV owing to the complexity of its calculations. We have developed a method of calculating work capacity of the bladder while voiding and analyzed the associations of bladder work parameters with bladder contractile function and bladder outlet obstruction （BOO）. Methods： The study retrospectively evaluated 160 men and 23 women, aged 〉40 years and with a detrusor pressure at maximal flow rate （PdetQmax） of ≥40 cmH2O in men, who underwent urodynamic testing. The bladder power integration method was used to calculate WIV; WIV per second （WIV/t） and WIV per liter of urine voided （WIV/v） were also calculated. In men, the relationships between these work capacity parameters and PdetQmax and Abrams-Griffiths （AG） number were determined using linear-by-linear association tests, and relationships between work capacity parameters and BOO grade were investigated using Spearman＇s association test. Results： The mean WIV was 1.15 ± 0.78 J and 1.30 ± 0.88 J, mean WIV/t was 22.95 ± 14,45 mW and 23.78 ± 17.02 mW, and mean WIV/v was 5.59 ± 2.32 J/L and 2.83 ± 1.87 J/L in men and women, respectively. In men, WIV/v showed significant positive associations with PdetQmax （r = 0.845, P = 0.000）, AG number （r = 0.814, P = 0.000）, and Schafer class （r = 0.726, P = 0.000）. Conversely, WIV and WIV/t showed no associations with PdetQmax or AG number. In patients with BOO （Schafer class 〉 II）, WIV/v correlated positively with increasing BOO grade. Conclusions： WIV can be calculated from simple urodynamic parameters using the bladder power integration method. WIV/v may be a marker of BOO grade, and the bladder contractile function can be evaluated by WIV and WIV/t.展开更多
We aimed to develop and validate a clinical nomogram predicting bladder outlet obstruction(BOO)solely using routine clinical parameters in men with refractory nonneurogenic lower urinary tract symptoms(LUTS).A total o...We aimed to develop and validate a clinical nomogram predicting bladder outlet obstruction(BOO)solely using routine clinical parameters in men with refractory nonneurogenic lower urinary tract symptoms(LUTS).A total of 750 eligible patient ≥50 years of age who had previously not responded(International Prostate Symptom Score[IPSS]improvement<4 points)to at least three different kinds of LUTS medications(including a-blocker)for the last 6 months were evaluated as subcohorts for nomogram development(n=570)and for split-sample validation(n=180).BOO was defined as Abrams-Griffiths number^40,or 20-39.9 with a slope of linear passive urethral resistance ratio>2 cmH20 ml^-1 s^-1.A stepwise multivariable logistic regression analysis was conducted to determine the predictors of BOO,and^-coefficients of the final model were selected to create a clinical nomogram.The final multivariable logistic regression model showed that age,IPSS,maximum urinary flow rate,postvoid residual volume,total prostate volume,and transitional zone index were significant for predicting BOO;these candidates were used to develop the final nomogram.The discrimination performance of the nomogram was 88.3%(95%Cl:82.7%-93.0%,P<0.001),and the nomogram was reasonably we 11-fitted to the ideal line of the calibration plot.Independe nt split-sample validation revealed 80.9%(95%Cl:75.5%-84.4%,P<0.001)accuracy.The proposed BOO nomogram based solely on routine clinical parameters was accurate and validated properly.This nomogram may be useful in determining further treatment,primarily focused on prostatic surgery for BOO,without impeding the detection of possible BOO in men with LUTS that is refractory to empirical medications.展开更多
文摘To compare the impact of transurethral resection of prostate （TURP） on symptom scores and maximal flow rates （Qmax） in patients with equivocal bladder outlet obstruction （BOO） and definite BOO and to assess the relationship between the surgical outcomes and degree of preoperative BOO, we prospectively evaluated men with lower urinary tract symptoms and bladder outlet obstruction index （BOO1） greater than 20, who were refractory to conventional medical treatment and underwent TURP. Urodynamic evaluation, International Prostate Symptom Score （IPSS）, uroflowmetry, post-void residual volume （PVR） check and transrectal ultrasound were performed. 20〈B001〈40 was defined as equivocal BOO and BOO1 〉~40 as definite BOO. Changes of IPSS, Qmax, PVR and correlation analysis was performed between the degree of improvement of Qmax, subdomains of I PSS and BOO1. Fifty-four patients showed equivocal BOO and 80 patients showed definite BOO. Preoperatively equivocal BOO group and definite BOO group showed significant differences in maximal bladder capacity and prevalence of detrusor overactivity, whereas no difference was noted in prostate volume. Postoperatively both groups showed improvements in Qmax, obstructive （IPSSO） and irritative （IPSSI） subdomain of IPSS, but the degree of improvement in Qmax and IPSSI subdomain was statistically significantly greater in definite BOO group. The degree of improvement of Qmax and IPSSI showed weak correlation with preoperative BOO1. As a weak correlation was identified between preoperative degree of BOO and outcome of TURP, other factors other than BOO1 such as severity of patients＇ symptoms should be considered in deciding treatment modality.
文摘Purpose: Large conductance, voltage- and Ca2+-activated K+ (BK) channel is thought to have a central role to regulate urinary bladder smooth muscle functions, and its dysfunction may lead to increase of urination frequency and overactive bladder. The present study aims to investigate the expression pattern of BK channel subunits in the human urinary bladder, and how it changes in association with bladder outlet obstruction (BOO). Materials and Methods: Human bladders were obtained from 7 controls without prostatic enlargement and lower urinary tract symptoms and 4 BPH patients with clinically diagnosed overactive bladder who were verified by the International Prostate Symptom Score (IPSS) and prostate volume. The expression and location of BK channel protein complex was examined using immunohistochemistry with affinity-purified anti-BKα antibodies. A real-time RT-PCR was used to quantify the expression of each BK channel subunit (α and β1 - 4) gene in the mucosal and muscle layers of human urinary bladder. Results: Immunohistochemical staining for BK-α protein complex was localized in the muscle and submucosal regions of urinary bladder. RT-PCR analysis revealed the presence of α-, β1-, and β4-subunit genes of BK channel in the mucosal layer, α- and β1-subunit in the muscle layer. The expressions of α- and β1-subunit genes in the muscle (α: p = 0.0003, β1: p = 0.0003) and mucosal (α: p = 0.03, β1: p = 0.02) layers significantly decreased in BOO bladders compared with controls. The expression levels of α- and β1-subunit in mucosal layer were statistically correlated with storage score of IPSS (α;r = 0.84, p = 0.002, β1;r = 0.84, p = 0.002), and so were in muscle layer (α;r = 0.934, p 0.0001, β1;r = 0.917, p = 0.00018). Conclusions: BK channels, which are mainly composed of α- and β1-subunits, are expressed in both the mucosal and muscle layers of human urinary bladder. Decreased expression of BK channel in BOO might be implicated in the mechanisms underlying the development of overactive bladder.
文摘Objective: Detrusor hyperactivity with impaired contractility (DHIC) is not an uncommon bladder disorder, and is often difficult to treat. Therefore, using a rat model featuring both urinary frequency and residual urine, we investigated whether an anticholinergic agent (solifenacin) or a β3-agonist (mirabegron) is more suitable to combine with distigmine to treat DHIC. Methods: The partial bladder outlet obstruction (BOO) rat model was used. Rats were treated for 2 weeks: BOO/Solifenacin group was treated with 0.1 mg/kg solifenacin (n = 8), BOO/Mirabegron group was treated with 1 mg/kg mirabegron (n = 8), BOO/- group was not drug-treated but was given distilled water (n = 8), and the control group was also given distilled water (n = 8). Then the urethral ligature was removed under urethane anesthesia, and continuous cystometry was performed to evaluate bladder function. Baseline measurements were taken, then distigmine was administered to all groups, and cystometry was performed again to measure changes in bladder function. Results: Residual volumes increased in the BOO/- group, and the detrusor contractions were more frequent than that of the control group. Solifenacin treatment did not influence changes, except for threshold pressure, to any cystometric measurements. However, mirabegron treatment decreased the residual volume and residual volume rate;it also decreased detrusor contraction frequency similar to measurements obtained from the control group. Distigmine treatment enhanced detrusor contractions, which resulted in less residual volume, and decreased detrusor contraction frequency in the BOO model. Conclusions: The combination of distigmine and mirabegron was determined to be a better treatment than the combination of distigmine and solifenacin for DHIC.
文摘Urinary retention in women is rare and is more frequently described as case reports or small case series. The female/male ratio is 1:13 with about 3 cases per 100,000 women every year We report a case of a 12-year old female student. She presented with progressive weight loss, worsening lower urinary tract symptoms with distended lower abdomen of 10 weeks duration. Physical examination revealed a mobile tender firm pelvic mass, 18 centimeters (cm) × 16 cm in size. Laboratory and imaging studies showed obstructive nephropathy and uropathy respectively. She was worked up and had uneventful exploratory laparotomy with right salpingo-oophorectomy, urinary bladder diverticulectomy and pelvic lymphadenectomy. Histopathology of the pelvic mass showed ovarian dysgerminoma with lymph node metastasis. She responded very well to chemotherapy and resumed her school activities. Bladder outlet obstruction is relatively rare in females and in the index patient, ovarian dysgerminoma is the cause leading to obstructive nephropathy and uropathy.
文摘Objective To explore the effect of doxazosin on rabbit bladder compliance after partial bladder outlet ob- struction. Methods A total of 40 male New Zealand white rabbits were randomized into 4 groups,with 10 rabbits in each group. Partial bladder outlet
文摘Objective: To compare the efficacy of bladder neck incision (BNI) with transurethral resection of prostate (TURP) in the treatment of patients with urinary obstruction caused by benign prostatic hyperplasia (BPH) on the basis of short term follow up of 4 months. Patient and Methods: The study was conducted in Department of General Surgery in Maulana Azad Medical College, New Delhi. 60 men with proven clinical diagnosis of BPH of size 30 grams and less presenting with symptoms of bladder outlet obstruction (BOO) were randomised prospectively to undergo either of the two operative modalities. Preoperatively size of the prostate, symptom scoring (IPSS), peak flow rate (Qmax) were assessed. Postoperatively and during 4 months follow up the following data were collected—operative time, catheterisation period, hospital stay, blood loss, Qmax and IPSS. Results: Preoperative parameters in both the groups showed no statistically significant differences with respect to prostate size, Qmax and IPSS Scoring. At 4 months follow up Qmax increased from (6.35 ± 4.49) to (16.41 ± 2.28) in TURP group and (4.51 ± 3.57) to (15.95 ± 2.58) in BNI group. IPSS decreased from 18.70 to 5.7 in TURP group and 18.90 to 6.00 in BNI group. All differences were statistically significant. There was a statistically significant difference in operative time, blood loss, hospital stay, catheterisation timing favouring BNI. Conclusion: TURP and BNI are equally effective in providing symptomatic improvement. BNI has an upper hand in reference to operative time, hospital stay, duration of catheterisation and blood loss.
基金supported by grants from the National Natural Science Foundation of China(No.82270812)Medical Innovation and Transformation Incubation Project of Tongji Hospital(No.2022ZHFY11).
文摘Objective Bladder outlet obstruction(BOO)results in significant fibrosis in the chronic stage and elevated bladder pressure.Piezo1 is a type of mechanosensitive(MS)channel that directly responds to mechanical stimuli.To identify new targets for intervention in the treatment of BOO-induced fibrosis,this study investigated the impact of high hydrostatic pressure(HHP)on Piezo1 activity and the progression of bladder fibrosis.Methods Immunofluorescence staining was conducted to assess the protein abundance of Piezo1 in fibroblasts from obstructed rat bladders.Bladder fibroblasts were cultured under normal atmospheric conditions(0 cmH_(2)O)or exposed to HHP(50 cmH_(2)O or 100 cmH_(2)O).Agonists or inhibitors of Piezo1,YAP1,and ROCK1 were used to determine the underlying mechanism.Results The Piezo1 protein levels in fibroblasts from the obstructed bladder exhibited an elevation compared to the control group.HHP significantly promoted the expression of various pro-fibrotic factors and induced proliferation of fibroblasts.Additionally,the protein expression levels of Piezo1,YAP1,ROCK1 were elevated,and calcium influx was increased as the pressure increased.These effects were attenuated by the Piezo1 inhibitor Dooku1.The Piezo1 activator Yoda1 induced the expression of pro-fibrotic factors and the proliferation of fibroblasts,and elevated the protein levels of YAP1 and ROCK1 under normal atmospheric conditions in vitro.However,these effects could be partially inhibited by YAP1 or ROCK inhibitors.
文摘Summary： We performed a retrospective, case-control study to evaluate whether the urine flow acceleration （UFA, mL/s2） is superior to maximum uroflow （Qmax, mL/s） in diagnosing bladder outlet obstruction （BOO） in patients with benign prostatic hyperplasia （BPH）. In this study, a total of 50 men with BPH （age： 58±12.5 years） and 50 controls （age： 59±13.0 years） were included. A pressure-flow study was used to determine the presence of BOO according to the recommendations of Incontinence Control Society （ICS）. The results showed that the UFA and Qmax in BPH group were much lower than those in the control group [（2.05±0.85） vs. （4.60±1.25） mL/s2 and （8.50±1.05） vs. （13.00±3.35） mL/s] （P〈0.001）. Accol;ding to the criteria （UFA〈2.05 mL/s2, Qmax〈10 mL/s）, the sensitivity and specificity of UFA vs. Qmax in diagnosing BOO were 88%, 75% vs. 81%, 63%. UFA vs. Omax, when compared with the results of P-Q chart （the kappa values in corresponding analysis）, was 0.55 vs. 0.35. The pros- tate volume, post void residual and detrusor pressure at Qmax between the two groups were 28.6±9.8 vs. 24.2±7.6 mL, 60.4±1.4 vs. 21.3±2.5 mL and 56.6±8.3 vs. 21.7±6.1 cmHzO, respectively （P〈0.05）. It was concluded that the UFA is a useful urodynamic parameter, and is superior to Qmax in diagnosing BOO in patients with BPH.
文摘Underactive bladder(UAB)is a voiding disorder which generates disabling lower urinary tract symptoms(LUTS)due to the inability to produce an effective voiding contraction sufficient to empty the bladder.The underlying abnormality,that is usually appreciated when performing urodynamic studies,has been defined by the International Continence Society(ICS)as detrusor underactivity(DUA).DUA is a common yet under-researched bladder dysfunction.The prevalence of DUA in different patient groups suggests that multiple aetiologies are implicated.Currently there is no effective therapeutic approach to treat this condition.An improved understanding of the underlying mechanisms is needed to facilitate the development of new advances in treatment.The purpose of this review is to discuss the epidemiology,pathophysiology,common causes and risk factors potentially leading to DUA;to aid in the appropriate diagnosis of DUA to potentially improve treatment outcomes.
文摘Background： Work in voiding （WIV） of the bladder may be used to evaluate bladder status throughout urination rather than at a single time point. Few studies, however, have assessed WIV owing to the complexity of its calculations. We have developed a method of calculating work capacity of the bladder while voiding and analyzed the associations of bladder work parameters with bladder contractile function and bladder outlet obstruction （BOO）. Methods： The study retrospectively evaluated 160 men and 23 women, aged 〉40 years and with a detrusor pressure at maximal flow rate （PdetQmax） of ≥40 cmH2O in men, who underwent urodynamic testing. The bladder power integration method was used to calculate WIV; WIV per second （WIV/t） and WIV per liter of urine voided （WIV/v） were also calculated. In men, the relationships between these work capacity parameters and PdetQmax and Abrams-Griffiths （AG） number were determined using linear-by-linear association tests, and relationships between work capacity parameters and BOO grade were investigated using Spearman＇s association test. Results： The mean WIV was 1.15 ± 0.78 J and 1.30 ± 0.88 J, mean WIV/t was 22.95 ± 14,45 mW and 23.78 ± 17.02 mW, and mean WIV/v was 5.59 ± 2.32 J/L and 2.83 ± 1.87 J/L in men and women, respectively. In men, WIV/v showed significant positive associations with PdetQmax （r = 0.845, P = 0.000）, AG number （r = 0.814, P = 0.000）, and Schafer class （r = 0.726, P = 0.000）. Conversely, WIV and WIV/t showed no associations with PdetQmax or AG number. In patients with BOO （Schafer class 〉 II）, WIV/v correlated positively with increasing BOO grade. Conclusions： WIV can be calculated from simple urodynamic parameters using the bladder power integration method. WIV/v may be a marker of BOO grade, and the bladder contractile function can be evaluated by WIV and WIV/t.
文摘We aimed to develop and validate a clinical nomogram predicting bladder outlet obstruction(BOO)solely using routine clinical parameters in men with refractory nonneurogenic lower urinary tract symptoms(LUTS).A total of 750 eligible patient ≥50 years of age who had previously not responded(International Prostate Symptom Score[IPSS]improvement<4 points)to at least three different kinds of LUTS medications(including a-blocker)for the last 6 months were evaluated as subcohorts for nomogram development(n=570)and for split-sample validation(n=180).BOO was defined as Abrams-Griffiths number^40,or 20-39.9 with a slope of linear passive urethral resistance ratio>2 cmH20 ml^-1 s^-1.A stepwise multivariable logistic regression analysis was conducted to determine the predictors of BOO,and^-coefficients of the final model were selected to create a clinical nomogram.The final multivariable logistic regression model showed that age,IPSS,maximum urinary flow rate,postvoid residual volume,total prostate volume,and transitional zone index were significant for predicting BOO;these candidates were used to develop the final nomogram.The discrimination performance of the nomogram was 88.3%(95%Cl:82.7%-93.0%,P<0.001),and the nomogram was reasonably we 11-fitted to the ideal line of the calibration plot.Independe nt split-sample validation revealed 80.9%(95%Cl:75.5%-84.4%,P<0.001)accuracy.The proposed BOO nomogram based solely on routine clinical parameters was accurate and validated properly.This nomogram may be useful in determining further treatment,primarily focused on prostatic surgery for BOO,without impeding the detection of possible BOO in men with LUTS that is refractory to empirical medications.
