Morphologic Relationship between the Pontine Micturition Center and the Sympathetic Center in the Spinal Cord of the Rat

To study whether the sympathetic nerves coordinate with the parasympathetic nerves during micturition in the rat. We used antegrade neural tracing with biotinylated dextran amine (BDA) injected into the pontine micturition center (PMC) to label the terminals in the L6-S1 cord. Preganglionic parasympathetic neurons (PPNs) in the L6-S1 segment were labelled by retrograde transport of Fluorogold (FG) from the major pelvic ganglion (MPG).We detected retrograde neurons in L6-S1 using retrograde transport of horseradish peroxidase (HRP) from the intermediolateral cell column (IML) of the L1-L2 segment where sympathetic preganglionic neurons (SPNs) are located. Immunohistochemical methods showed that PPNs were identified to be choline acetyltransferase-immunoreactive (ChAT-IR). HRP-labelled neurons were not ChAT-IR and located dorsal to PPNs. BDA-labelled terminals were located mainly in the bilateral IML of L6-S1, some of which had synaptic contact with the HRP-labelled neurons. In addition, there were some wheat germ agglutinin-horseradish peroxidase (WGA-HRP) labelled terminals in the ipsilateral IML of the L1-L2 segment after WGA-HRP was microinjected into SPN. We conclude that PMC may control the preganglionic neurons of sympathetic nerves through the interneurons located dorsal to PPNs.

Influence of Intravesical Lower pH on the Micturition Reflex Threshold in the Rat

Aims: To investigate whether intravesical lower pH induces a micturition threshold reflex change of anaesthetized rats. Methods: Thirteen female rats, anaesthetized by a-chloralose and paralyzed by pancurone bromide were used for the experiments. The micturition threshold volume was determined by repeated cystometry. Simultaneously bladder afferent activities in four and efferent activities in seven rats were recorded from the exposed pelvic nerve to the bladder. Results: Cystometry with acidic saline at pH 3 and 4 induced a significant decrease in micturition threshold volume. The mean value of these groups of test showed that bladder compliance, micturition threshold pressure and maximal micturition contraction pressure were decreased significantly comparing with the controls. There were no changes in all other parameters recorded from afferent and efferent, e.g. afferent threshold volume, afferent or efferent activity at the micturition threshold and their peak activity at the micturition contraction. Conclusions: Acidic solution provoked sensitivity but reduced the force of the contractility to the urinary bladder. The effect was presented without a detectable change in the firing properties of bladder Ad mechanoreceptor afferents. It is proposed that proton sensitive bladder receptors with unmyelinated afferent were stimulated by the acidic solution and that the micturition reflex was facilitated by afferent inflow from such receptors. The findings were clinically important in choosing the medium for urodynamic examination.

Refex seizures induced by micturition: a case report

Background Refex seizures(RS)induced by micturition are extremely rare,and the clinical and electroencephalogram features of RS are not widely known among clinicians.In particular,the origin of the epileptic area is still unclear.Case presentation An 8-year-old girl who had generalized tonic-clonic seizures was diagnosed with RS induced by micturition based on the clinical manifestation and EEG recordings.We also reviewed the clinical and EEG characteristics of RS induced by micturition in literature by searching the databases of PubMed and MEDLINE using keywords“micturition refex seizure”,“refex seizure induced by micturition”,and“micturition induced seizure”by January 2022.We speculate that the mechanism of micturition-induced RS may involve excessive neuronal excitation in regions that participate in micturition.Conclusions The RS in this patient was considered to be induced by micturition.Awareness should be raised to this rare form of RS among practitioners.

Leuprolide acetate induces structural and functional recovery of injured spinal cord in rats

Gonadotropin-releasing hormone（Gn RH） and its synthetic analog leuprolide acetate, a Gn RH agonist, have neurotrophic properties. This study was designed to determine whether administration of leuprolide acetate can improve locomotor behavior, gait, micturition reflex, spinal cord morphology and the amount of microglia in the lesion epicenter after spinal cord injury in rats. Rats with spinal cord compression injury were administered leuprolide acetate or saline solution for 5 weeks. At the 5th week, leuprolide acetate-treated rats showed locomotor activity recovery by 38%, had improvement in kinematic gait and exhibited voiding reflex recovery by 60%, as compared with the 1st week. By contrast, saline solution-treated rats showed locomotor activity recovery only by 7%, but voiding reflex did not recover. More importantly, leuprolide acetate treatment reduced microglial immunological reaction and induced a trend towards greater area of white and gray matter in the spinal cord. Therefore, leuprolide acetate has great potential to repair spinal cord injury.

Are prostatic calculi independent predictive factors of lower urinary tract symptoms？

We determined the correlation between prostatic calculi and lower urinary tract symptoms （LUTS）,as well as the predisposing factors of prostatic calculi. Of the 1 527 patients who presented at our clinic for LUTS,802underwent complete evaluations,including transrectal ultrasonography,voided bladder-3 specimen and international prostatic symptoms score （IPSS）. A total of 335 patients with prostatic calculi and 467 patients without prostatic calculi were divided into calculi and no calculi groups,respectively. Predictive factors of severe LUTS and prostatic calculi were determined using uni/multivariate analysis. The overall IPSS score was 15.7±9.2 and 14.1±9.1 in the calculi and no calculi group,respectively （P = 0.013）. The maximum flow rate was 12.1±6.9 and 14.2±8.2 mL s^（-1） in the calculi and no calculi group,respectively （P = 0.003）. On univariate analysis for predicting factors of severe LUTS,differences on age （P = 0.042）,prostatic calculi （P = 0.048） and prostatitis （P = 0.018） were statistically significant. However,on multivariate analysis,no factor was significant. On multivariate analysis for predisposing factors of prostatic calculi,differences on age （P〈0.001） and prostate volume （P = 0.001） were significant. To our knowledge,patients who have prostatic calculi complain of more severe LUTS. However,prostatic calculi are not an independent predictive factor of severe LUTS. Therefore,men with prostatic calculi have more severe LUTS not only because of prostatic calculi but also because of age and other factors. In addition,old age and large prostate volume are independent predisposing factors for prostatic calculi.

New pharmacological approaches against chronic bowel and bladder problems in paralytics

Spinal cord injury(SCI) leads generally to an irreversible loss of sensory functions and voluntary motor control below injury level. Cures that could repair SCI and/or restore voluntary walking have not been yet developed nor commercialized. Beyond the well-known loss of walking capabilities, most SCI patients experience also a plethora of motor problems and health concerns including specific bladder and bowel dysfunctions. Indeed, chronic constipation and urinary retention, two significant life-threatening complications, are typically found in patients suffering of traumatic(e.g., falls or car accidents) or non-traumatic SCI(e.g., multiple sclerosis, spinal tumors). Secondary health concerns associated with these dysfunctions include hemorrhoids, abdominal distention, altered visceral sensitivity, hydronephrosis, kidney failure, urinary tract infections, sepsis and, in some cases, cardiac arrest. Consequently, individuals with chronic SCI are forced to regularly seek emergency and critical care treatments when some of these conditions occur or become intolerable. Increasing evidence supports the existence of a novel experimental approach that may be capable of preventing the occurrence or severity of bladder and bowel problems. Indeed, recent findings in animal models of SCI have revealed that, despite paraplegia or tetraplegia, it remains possible to elicit episodes of micturition and defecation by acting pharmacologically or electrically upon specialized lumbosacral neuronal networks, namely the spinal or sacral micturition center(SMC) and lumbosacral defecation center(LDC). Daily activation of SMC and LDC neurons could potentially become, new classes of minimally invasive treatments(i.e., if orally active) against these dysfunctions and their many lifethreatening complications.

Bacterial Urinary Tract Infections among Males with Lower Urinary Tract Obstruction at Komfo Anokye Teaching Hos-pital, Kumasi, Ghana

Purpose: We describe the commonest pathology responsible for lower urinary tract obstruction (LUTO) and associated symptoms such as UTI, etc. among males at the Komfo Anokye Teaching Hospital (KATH) in Kumasi. Materials and Methods: Between January and December 2009, prospective cross sectional hospital based study was conducted involving 103 subjects. Patients with symptoms of LUTO and who were on short admission (up to 48 hours) at the accident and emergency unit of KATH were identified as potential study subjects. All the patients presented with acute retention of urine at the emergency unit of KATH and urethral catheterization was attempted to relieve them of the retention under sterile conditions. Those patients whose initial catheterization failed went through suprapubic cystostomy (suprapubic catheterization). Urine specimens for culture and sensitivity tests were then collected into sterile urine containers immediately after the catheterization (irrespective of type). Ultrasound Scan was requested for all the patients to assist in diagnosing enlargement of the prostate and other associated urological pathologies. Retrograde urethrogram was however, requested for those patients with suprapubic catheterization and which helped in the diagnosis of the urethral stricture. For a particular child, urethral catheter was passed under sterile condition and Micturicting Cysto-Urethrogram (MCUG) was done to assist in diagnosing posterior urethral valve and other conditions. Those subjects whose urinalysis revealed pyuria and positive urine culture and who had voluntarily agreed to enter the study were enrolled. Subjects whose urine culture had multiple bacteria growth that was deemed to be contaminants were excluded from the study. Results: The mean age for males with LUTO was 62 years. The youngest male with LUTO was aged 2 years whilst the maximum age was 93 years. LUTO due to prostatic hyperplasia was found in 79 (76.7%) men;23 (22.3%) had LUTO due to urethral stricture and 1 (1.0%) (youngest male). The mean age of patients that had LUTO due to urethral stricture was approximately 39 years. The youngest patient with LUTO due to urethral stricture aged 22 years whilst the maximum age was 72 years. Microbiological results indicated that Escherichia coli caused 53 (51.5%) of urinary tract infection (UTI) due to LUTO;Klebsiella = 23 (22.3%);Staphylococcus aureus = 14 (14.6%);Pseudomonas spp. = 8 (7.8%) Proteus = 2 (2.0%);Citrobacter = 1 (1.0%) and Salmonella spp. =1 (1.0%). Conclusion: The most common cause of lower urinary tract obstruction (LUTO) in Kumasi, Ghana is prostatic hyperplasia and the commonest causative organism of the associated UTI symptom is Escherichia coli.

Roles of dopaminergic receptors in bladder and erectile function at the spinal level

1 Introduction At the spinal level, the dopaminergic, the α1adrenergic and the neurokinin receptors play definite roles in the micturition control. From the anatomical point of view, the spinal center of micturition is located close to the center of erectile function. Recently, apomorphine is used for the treatment of erectile dysfunction and its mechanism of action is considered to be mainly through the central nervous system. 2 Dopaminergic receptors and bladder function at the spinal level

Fluoxetine,a selective serotonin reuptake inhibitor used clinically,improves bladder function in a mouse model of moderate spinal cord injury

After spinal cord injury,the upward conduction of the spinal cord is lost,resulting in the loss of micturition control,which manifests as detrusor sphincter dyssynergia and insufficient micturition.Studies have shown that serotonergic axons play important roles in the control of the descending urination tract.In this study,mouse models of moderate spinal cord contusions were established.The serotonin agonists quipazine(0.2 mg/kg),8-hydroxy-2-(di-n-propylamino)tetralin(8-OH-DAPT,0.1 mg/kg),buspirone(1 mg/kg),sumatriptan(1 mg/kg),and rizatriptan(50 mg/kg),the serotonin reuptake inhibitors fluoxetine(20 mg/kg)and duloxetine(1 mg/kg),and the dopamine receptor agonist SKF-82197(0.1 mg/kg)were intraperitoneally administered to the model mice 35 days post-injury in an acute manner.The voided stain on paper method and urodynamics revealed that fluoxetine reduced the amount of residual urine in the bladder and decreased bladder and external urethral sphincter pressure in a mouse model of moderate spinal cord injury.However,fluoxetine did not improve the micturition function in a mouse model of severe spinal cord injury.In contrast,the other serotonergic drugs had no effects on the micturition functions of spinal cord injury model mice.This study was ethically approved by the Institutional Animal Care and Use Committee of Jiangsu Province Hospital of Chinese Medicine(approval No.2020DW-20-02)on September 11,2020.

New avenues for reducing intensive care needs in patients with chronic spinal cord injury

Relatively soon after their accident, patients suffering a spinal cord injury(SCI) begin generally experiencing the development of significant, often life-threatening secondary complications. Many of which are associated with chronic physical inactivity-related immune function problems and increasing susceptibility to infection that repeatedly requires intensive care treatment. Therapies capable of repairing the spinal cord or restoring ambulation would normally prevent many of these problems but, as of now, there is no cure for SCI. Thus, management strategies and antibiotics remain the standard of care although antimicrobial resistance constitutes a significant challenge for patients with chronic SCI facing recurrent infections of the urinary tract and respiratory systems. Identifying alternative therapies capable of safe and potent actions upon these serious health concerns should therefore be considered a priority. This editorial presents some of the novel approaches currently in development for the prevention of specific infections after SCI. Among them, brain-permeable small molecule therapeutics acting centrally on spinal cord circuits that can augment respiratory capabilities or bladder functions. If eventually approved by regulatory authorities, some of these new avenues may potentially become clinically-relevant therapies capable of indirectly preventing the occurrence and/or severity of these lifethreatening complications in people with paraplegic or tetraplegic injuries.