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PubMed2002

P2X receptors and their role in female idiopathic detrusor instability.

PURPOSE: It is clear from previous studies that adenosine triphosphate is released as a contractile co-transmitter with acetylcholine from parasympathetic nerves supplying the mammalian bladder but the physiological significance of ligand gated purinergic P2X receptors in human bladder innervation has not been adequately investigated. We examined the role of these receptors in female patients with idiopathic detrusor instability. MATERIALS AND METHODS: Female patients with idiopathic detrusor instability were recruited for cystoscopy and bladder biopsy with ethics approval. Control tissue was obtained from age and sex matched patients with a urodynamically proved stable bladder. We obtained 4 bladder biopsies per patient from the posterior wall. Samples were analyzed in an organ bath for functional studies of the detrusor muscle to assess the purinergic contribution to its contraction. In addition, we performed quantitative analysis using reverse transcriptase-polymerase chain reaction and immunohistochemical localization of P2X receptors. RESULTS: In patients with idiopathic detrusor instability detrusor P2X2 receptors were significantly elevated, while other P2X receptor subtypes were significantly decreased. A purinergic component of nerve mediated contractions was not detected in control female bladder biopsy specimens but there was a significant component in unstable bladder specimens. It was particularly prominent at stimulation frequencies of 2 to 16 Hz. which are likely to be most relevant physiologically. Approximately 50% of nerve mediated contractions were purinergic in idiopathic detrusor instability cases. CONCLUSIONS: In patients with idiopathic detrusor instability there is abnormal purinergic transmission in the bladder, which may explain symptoms. This pathway may be a novel target for the pharmacological treatment of overactive bladder.

Adult↗

PubMed2005

Correlation between symptoms and urodynamic findings in Thai female patients with urinary incontinence.

OBJECTIVE: To determine the accuracy of a urinary incontinence questionnaire in the diagnosis of various types of urinary incontinence classified according to the results of multichannel urodynamic testing. MATERIAL AND METHOD: Between May 2000 and April 2004, 129 women with symptoms of urinary incontinence were interviewed using a urinary incontinence questionnaire consisting of 12 urinary symptoms questions. Various patient demographic and other descriptive data were also collected. All patients underwent multichannel urodynamic testing, and classified using the International Continence Society criteria. Descriptive data and patient symptoms were tested for statistical association with the types of urinary incontinence. Sensitivity and specificity were used to measure the accuracy of the symptoms in distinguishing between the various urodynamic conditions. RESULTS: Of the 12 questions, only three questions (two stress incontinence symptoms and one overactive bladder symptom) were significantly associated with the urodynamic diagnoses of genuine Stress Urinary Incontinence (SUI) and Detrusor Overactivity (DO). The sensitivity and specificity for distinguishing between genuine SUI and DO from other urodynamic diagnoses or between each other were relatively low. CONCLUSION: Symptoms of urinary incontinence were not sufficient to predict types of urinary incontinence. Therefore, the authors suggest that urodynamic testing is still essential in the diagnosis and management of female urinary incontinence.

Diagnostic Techniques, Urological↗

PubMed1997

Tolterodine--a new bladder-selective antimuscarinic agent.

Tolterodine is a new muscarinic receptor antagonist intended for the treatment of urinary urge incontinence and other symptoms related to an overactive bladder. The aim of the present study was to compare the antimuscarinic properties of tolterodine with those of oxybutynin, in vitro and in vivo. Tolterodine effectively inhibited carbachol-induced contractions of isolated strips of urinary bladder from guinea pigs (K(B) 3.0 nM; pA2 8.6; Schild slope 0.97) and humans (K(B) 4.0 nM; pA2 8.4; Schild slope 1.04) in a concentration-dependent, competitive manner. The affinity of tolterodine was similar to that derived for oxybutynin (K(B) 4.4 nM; pA2 8.5; Schild slope 0.89) in the guinea-pig bladder. Tolterodine (21-2103 nmol/kg (0.01-1 mg/kg); intravenous infusion) was significantly more potent in inhibiting acetylcholine-induced urinary bladder contraction than electrically-induced salivation in the anaesthetised cat. In contrast, oxybutynin displayed the opposite tissue selectivity. Radioligand binding data showed that tolterodine bound with high affinity to muscarinic receptors in urinary bladder (K(i) 2.7 nM), heart (K(i) 1.6 nM), cerebral cortex (K(i) 0.75 nM) and parotid gland (K(i) 4.8 nM) from guinea pigs and in urinary bladder from humans (K(i) 3.3 nM). Tolterodine and oxybutynin were equipotent, except in the parotid gland, where oxybutynin bound with 8-times higher affinity (K(i) 0.62 nM). Binding data on human muscarinic m1-m5 receptors expressed in Chinese hamster ovary cells showed that oxybutynin, in contrast to tolterodine, exhibits selectivity (10-fold) for muscarinic m3 over m2 receptors. The K(B) value determined for oxybutynin (4.4 nM) in functional studies on guinea-pig bladder correlated better with the binding affinity at muscarinic M2/m2 receptors (K(i) 2.8 and 6.7 nM) than at muscarinic M3/m3 receptors (K(i) 0.62 and 0.67 nM). The tissue selectivity demonstrated for tolterodine in vivo cannot be attributed to selectivity for a single muscarinic receptor subtype. However, the combined in vitro and in vivo data on tolterodine and oxybutynin may indicate either that muscarinic M3/m3 receptors in glands are more sensitive to blockade than those in bladder smooth muscle, or that muscarinic M2/m2 receptors contribute to bladder contraction.

Adult↗

PubMed2005

Piboserod (SB 207266), a selective 5-HT4 receptor antagonist, reduces serotonin potentiation of neurally-mediated contractile responses of human detrusor muscle.

The aim of this study is to evaluate the potency of piboserod (SB 207266), a selective 5-HT(4) receptor antagonist, at inhibiting the 5-HT(4)-mediated potentiating effect of serotonin (5-HT) on the neurally-mediated contractile responses of human detrusor strips to electrical field stimulations (EFS). Strips of human detrusor muscle were mounted in Krebs-HEPES buffer under a resting tension of 500 mg and EFS (20 Hz, 1 ms duration at 300 mA for 5 s) was applied continuously at 1 min intervals. After stabilization of the EFS-induced contractions, concentration-response curves to 5-HT (0.1 nM-100 microM) were constructed in the absence or presence of 1 or 100 nM of piboserod. The experiments were performed in the presence of methysergide (1 microM) and ondansetron (3 microM) to block 5HT(1)/5HT(2) and 5-HT(3) receptors, respectively. 5-HT potentiated the contractile responses to EFS of human bladder strips in a concentration-dependent manner, with a maximum mean of 60.0+/-19.9% of the basal EFS-evoked contractions. Piboserod did not modify the basal contractions but concentration-dependently antagonized the ability of 5-HT to enhance bladder strip contractions to EFS. In presence of 1 and 100 nM of piboserod, the maximal 5-HT-induced potentiations were reduced to 45.0+/-7.9 and 38.7+/-8.7%, respectively. A mean apparent antagonist dissociation constant value (K(B)) of 0.56+/-0.09 nM was determined. These data show the ability of piboserod to antagonize with high potency the enhancing properties of 5-HT on neurally-mediated contractions of isolated human bladder strips. Therefore, the 5-HT(4) receptor might represent an attractive pharmacological target for the treatment of overactive bladder.

Electric Stimulation↗

PubMed2005

Synthesis and antimuscarinic properties of quinuclidin-3-yl 1,2,3,4-tetrahydroisoquinoline-2-carboxylate derivatives as novel muscarinic receptor antagonists.

In the course of continuing efforts to develop potent and bladder-selective muscarinic M3 receptor antagonists, quinuclidin-3-yl 1-aryl-1,2,3,4-tetrahydroisoquinoline-2-carboxylate derivatives and related compounds were designed as conformationally restricted analogues of quinuclidin-3-yl benzhydrylcarbamate (8). Binding assays with rat muscarinic receptor subtypes revealed that the quinuclidin-3-yl 1-aryl-1,2,3,4-tetrahydroisoquinoline-2-carboxylate derivatives showed high affinities for the M3 receptor, and selectivity for the M3 receptor over the M2 receptor. Of these derivatives, (+)-(1S,3'R)-quinuclidin-3'-yl 1-phenyl-1,2,3,4-tetrahydroisoquinoline-2-carboxylate monohydrochloride (9b) exhibited almost the same inhibitory activity against bladder contraction to that of oxybutynin (1), and more than 10-fold selectivity for bladder contraction versus salivary secretion, demonstrating that 9b may be useful for the treatment of symptoms associated with overactive bladder without having side effects such as dry mouth.

Animals↗

PubMed1997

Voiding dysfunction in patients with spinal cord lesions at the thoracolumbar vertebral junction.

Neurogenic voiding dysfunction invariably follows a complete spinal cord lesion. With spinal shock urodynamic investigation will show an areflexic bladder if the sacral spinal cord has been damaged, otherwise, if the lesion involves the suprasacral cord, an overactive bladder will result. There are some exceptions to this rule, particularly in those with lesions of the thoracolumbar vertebral junction, where the sacral cord is located, it may be difficult to predict urodynamic dysfunction merely on the basis of the vertebral body involved. 46 patients with a complete SCI neurological lesion at the thoraco-lumbar vertebral junction underwent a neurourological evaluation including multi-channel urodynamic studies. Overall in 20 to 36% of the patients the urodynamic pattern was different from what one would have expected considering the anatomical level of the vertebral body involved. Urodynamic study is confirmed as an essential tool in the correct diagnostic and therapeutic approach to the voiding dysfunction in these type of patients.

Adolescent↗

PubMed2001

[Genital and sphincter disorders].

Symptomatic bladder dysfunction occurs at some time in most patients with multiple sclerosis. Detrusor hypereflexia and sphincter dyssynergia are the main dysfunctions. Anticholinergic medication is currently the most effective and the most common treatment of overactive bladder with reduced bladder capacity and uninhibited detrusor contractions. Desmopressin, surgery, permanent indwelling catheter or external device are used in some cases. Nevertheless essential to bladder management is understanding to what extent the patient has incomplete emptying while complaining predominantly of symptoms of detrusor overactivity: frequency and urgency, with or without urge incontinence. Intravesical capsaicin and botulinum toxin injected into the detrusor seems promising means of treating intractable bladder hyperreflexia. If the post-micturition residual volume is raised, intermittent self-catheterization is the most adequate method to achieve bladder emptying of patients with MS. Physical and cognitive disability as well as patients motivation can reduce their ability to perform catheterization. In such situation, alphablockers show moderate efficacy and botulinum toxin urethral sphincter injection or surgical solution may be discussed. Disturbed anorectal physiology is common in MS, but there are as yet few specific treatments. The efficacy of oral sildenafil for treatment of neurogenic erectile failure increases the range of treatment available for men with sexual dysfunction. In women, mechanical remedies, treatment of motor and sensory loss are effective for dyspareunia. Patients of both sexes are likely to welcome to discuss their problem, and counselling or psychotherapy may be of use.

Combined Modality Therapy↗

PubMed2005

A developing view of the origins of urgency: the importance of animal models.

Although caution should be used when applying animal data to human physiology, if care is taken to differentiate between general principles and complications of detail, particular to the species being examined, then experimentation on animal models can reveal basic phenomena in the bladder that offer clues to the origin of urgency. Recent data from the whole isolated bladder of guinea pigs showed unexpected complexities in autonomous activity during the filling phase of the micturition cycle: small, transient increases in intravesical pressure were associated with propagating waves of contractile activity and localized stretches of bladder wall. This complex, coordinated activity suggests that there are mechanisms within the bladder wall devoted specifically to generating phasic activity. Thus, there appear to be two systems controlling detrusor contractions: one associated with overall contractions similar to the micturition contraction and the other generating phasic activity. The mechanisms generating the phasic activity appear to be the point of complex integration of both excitatory and inhibitory inputs. There is evidence that local activity in the bladder wall generates afferent discharge, which probably contributes to bladder sensations. Animal data suggest a novel motor/sensory system incorporating contractile (motor) events, which cause stretches resulting in activation of afferent nerves (sensory). The motor element of this system appears to be controlled in a highly complex fashion such that the amplitude and frequency of the motor activity can be modulated by a variety of inputs. This raises the possibility that the sensitivity of the system informing the central nervous system, and thus awareness of the bladder's state during the micturition cycle, can be manipulated, possibly via novel drugs targeted at areas involved in overactive bladder, including urgency incontinence.

Animals↗

PubMed2000

Cystometric evaluation of bladder function in non-anesthetized mice with and without bladder outlet obstruction.

PURPOSE: To develop a model for cystometric study of bladder function in the awake mouse, and to characterize urodynamically and immunohistochemically the non-obstructed and infravesically obstructed mouse bladder. MATERIALS AND METHODS: Non-obstructed Balb/CJ mice, and mice with bladder outlet obstruction after surgical, partial ligation of the urethra underwent continuous cystometry as previously described for rats. Bladders were also investigated by immunohistochemistry. RESULTS: During the period of cystometry, reproducible micturition patterns were obtained. Marked differences in the urodynamic parameters between non-obstructed and obstructed mice were revealed. In mice subjected to urethral obstruction, micturition pressure (p <0.05), threshold pressure (p <0.05), bladder capacity (p <0.001), micturition volume (p <0.001), and residual volume (p <0.05) increased significantly. There was no difference in basal pressure or compliance between non-obstructed and obstructed mice. Non-voiding bladder activity was consistently recorded in obstructed mice; both frequency and amplitude increased significantly (p <0.01). Compared with non-obstructed bladders, obstructed bladders showed hypertrophy of the bladder wall and various degrees of "patchy denervation" of the detrusor. When tested in non-obstructed mice capsaicin, prostaglandin E2 (intravesical administration) and apomorphine (subcutaneous administration) induced bladder overactivity. CONCLUSIONS: Continuous cystometry can be reproducibly performed in awake, freely moving non-obstructed mice and mice with bladder outflow obstruction. The changes induced by infravesical obstruction in mice were similar to those previously found in rats. This model may be useful for investigations of genetically modified mice.

Animals↗

PubMed2004

Capsaicin-induced apoptosis and reduced release of reactive oxygen species in MBT-2 murine bladder tumor cells.

Bladder cancer is a common cancer with high risk of recurrence and mortality. Intravesicle chemotherapy after trans-urethral resection is required to prevent tumor recurrence and progression. It has been known that antioxidants enhance the antitumor effect of bacillus Calmette-Guerin (BCG), the most effective intravesical bladder cancer treatment. Capsaicin, the major pungent ingredient in genus Capsicum, has recently been tried as an intravesical drug for overactive bladder and it has also been shown to induce apoptotic cell death in many cancer cells. In this study, we investigated the apoptosis-inducing effect and alterations in the cellular redox state of capsaicin in MBT-2 murine bladder tumor cells. Capsaicin induced apoptotic MBT-2 cell death in a time- and dose-dependent manner. The capsaicin-induced apoptosis was blocked by the pretreatment with Z-VAD-fmk, a broad-range caspase inhibitor, or Ac-DEVD-CHO, a caspase-3 inhibitor. In addition to the caspase-3 activation, capsaicin also induced cytochrome c release and decrease in Bcl-2 protein expression with no changes in the level of Bax. Furthermore, capsaicin at the concentration of inducing apoptosis also markedly reduced the level of reactive oxygen species and lipid peroxidation, implying that capsaicin may enhance the antitumor effect of BCG in bladder cancer treatment. These results further suggest that capsaicin may be a valuable intravesical chemotherapeutic agent for bladder cancers.

Amino Acid Chloromethyl Ketones↗

PubMed2006

Case series data to encourage randomized trials of bladder retraining compared to antimuscarinic agents.

PURPOSE: This study was designed to test the power potential of a number of different clinical trial designs that could be deployed to test the efficacy of an antimuscarinic drug against bladder retraining. MATERIALS AND METHODS: This was an observational cohort study. Data were collected prospectively from patients treated for an overactive bladder by antimuscarinic agents with bladder retraining, or by bladder retraining alone. At initiation and at followup data on frequency, incontinence, urgency and urge incontinence were collected. Data from visits up to 16 weeks of treatment were analyzed using the parametric methods.708 patients were studied, 44 males and 664 females, and their mean age was 54 (sd 22). 52 patients used pure bladder retraining and 656 used bladder retraining and an antimuscarinic agent. The drug was oxybutynin, tolterodine or imipramine combined with oxybutynin or tolterodine as combination therapy. RESULTS: A between groups analysis demonstrated that bladder retraining was associated with a greater improvement in urinary frequency compared to antimuscarinic therapy (Z = -4.6, 95% CI of difference -3.3, -1.4, p <0.001) whereas antimuscarinic therapy was associated with a greater improvement in incontinence compared to bladder retraining (Z = -2.6, 95% CI of difference -0.93, -0.27, p = 0.024). The within group change in incontinence episodes in the bladder retraining group did not appear to show an effect (95% CI of change -0.19, 0.43). A subgroup showing greatest DeltaInc was sought. Boxplots of DeltaInc against age group, sex and the grading of symptoms were examined for maximum effect. Female sex, age group of 50 or greater and patients describing urge incontinence demonstrated the greatest DeltaInc. Their mean daily frequency was 11.45 (sd 6.1) and incontinence 1.6 (sd 2.1). A sample with such characteristics would be most sensitive to treatment effect. The bladder retraining group had a higher daily frequency (Z = -3.2, p = 0.001, 95% CI for bladder retraining 10 to 11, 95% CI for antimuscarinic group 10 to 12) and a lower daily incontinence compared to the antimuscarinic group (Z = -3.4, p <0.001, 95% CI of median for bladder retraining 0.75, 0.85, 95% CI of median for antimuscarinic group 0.75, 1.75). CONCLUSIONS: Change in frequency is a poor outcome measure, DeltaInc is significantly superior. An antimuscarinic tested against bladder retraining, using DeltaInc for outcome, would probably compare favorably.

Biofeedback, Psychology↗

PubMed2004

Physiologic role of nitric oxide and nitric oxide synthase in female lower urinary tract.

PURPOSE OF REVIEW: In recent years nitric oxide (NO) has gained increasing recognition as an important neurotransmitter and cell signaling molecule with a broad range of functions in the lower urinary tract. This review discusses recently published data related to the physiologic and pathophysiologic roles of NO and nitric oxide synthase (NOS) in the female lower urinary tract. RECENT FINDINGS: Expression of three isoforms of NOS, namely endothelial NOS, neuronal NOS and inducible NOS, has been identified in various tissues of the lower urinary tract in animals and humans. In addition to its relaxation effects on bladder and urethra, NO also serves as a neurotransmitter in the lower urinary tract. The physiologic roles of NO in overactive bladder, bladder outlet obstruction, diabetic cystopathy, interstitial cystitis, and bladder inflammation have been demonstrated. SUMMARY: NO plays an important role in the micturition process and in disorders of the lower urinary tract. Improved understanding of the pathophysiologic role of NO/NOS system and of the L-arginine-NO-cGMP pathway may allow us to identify suitable therapeutic targets for lower urinary tract disorders. However, there is a need for further investigation to determine the precise function of NO in human lower urinary tract because most work thus far has been done in animal models.

Cystitis↗

PubMed2005

Risk factors influencing the complication rates of tension-free vaginal tape-type procedures.

PURPOSE OF REVIEW: Tension-free vaginal tape (TVT)-type procedures are gradually becoming the new gold-standard treatment for female stress urinary incontinence. Studies trying to determine the influence of possible risk factors on complications of TVT surgery are needed in order to achieve more favorable results in the future. This review attempts to summarize the current studies which address the possible risk factors influencing the complication rates of TVT-type procedures. RECENT FINDINGS: Articles published in 2004 and 2005 were included and focused, while the older articles were used for historical purposes and achieving the integrity. Risk factors stated in the literature for immediate, infectious, vaginal and urethral erosion complications are found to be mostly on anectodal and speculative bases. The role of concomitant surgery as a risk factor for complications is conflicting, while preoperative low urine flow and low detrusor contractility for urinary retention, and previous anti-incontinence surgery and old age for de-novo urgency seem to appear as possible risk factors. SUMMARY: Most of the risk factors stated were anecdotal and speculative. No consensus exists on concomitant surgery's being a risk factor for postoperative urinary retention and bladder perforation, while prior anti-incontinence surgery and old age were found to be possible risk factors for postoperative overactive bladder symptoms. Multicentric data collection with well designed parameters under the surveillance of a well known organization is needed in order to identify the risk factors influencing the complications of TVT-type procedures.

Female↗

PubMed1993

The bladder cooling reflex in man--characteristics and sensitivity to temperature.

The ice-water test is a simple supplementary urodynamic test that increases the precision of the diagnosis of overactive bladder subtypes. A similar bladder cooling reflex has recently been characterised in the cat and was found to originate from specific cold receptors in the bladder wall. In the present study, the threshold temperature of the human bladder cooling reflex was determined in patients with positive ice-water tests. Estimated threshold values were somewhat lower than those of the cat but still well above the temperatures required for cold stimulation of nociceptors. As in the cat, the strength of the cooling reflex varied inversely with the bladder temperature. These findings indicate that the human bladder cooling reflex is in principle organised in the same way as that of laboratory animals. The human bladder thus seems to be endowed with cold receptors with excitatory reflex connections to the detrusor.

Adult↗

PubMed2006

Urodynamic studies in the evaluation of young men presenting with lower urinary tract symptoms.

AIM: To evaluate the usefulness of urodynamic study in young men with lower urinary tract symptoms (LUTS). METHODS: We reviewed the charts of 50 men with LUTS aged 50 years and below. Those with neurological diseases, urethral trauma or strictures were excluded. All underwent multichannel urodynamic studies (UDS). The pre- and post-UDS diagnoses and treatment modalities were compared. RESULTS: Mean age was 38.1 years (17-49). The main pre-UDS diagnoses included prostatitis in seven (14%), overactive bladder in seventeen (34%) and benign prostatic hyperplasia in nine (18%). Pre-UDS management ranged from anticholingeric agents for thirteen (26%), alpha-adrenergic antagonists for nine (18%), antibiotics for six (12%). Abnormal UDS were noted in 36 (72%), including detrusor overactivity in 9 (18%), detrusor underactivity/acontractility in 5 (10%) and bladder outlet obstruction in 21 (42%). Fourteen (28%) had primary bladder neck dysfunction and five (10%) had benign prostatic hyperplasia. Post-UDS management included anticholingeric agents for ten (26%), alpha-adrenergic antagonists for seventeen (34%), catheterization for four (10%), behavioral therapy for three (6%), surgery for three (6%). None were prescribed antibiotics. Following UDS, the diagnosis had to be updated in 40 (80%) and concomitant change in management was required in 34 (68%). CONCLUSION: Young men presenting with LUTS have different underlying etiologies. Clinical diagnosis and treatment are often empiric and inaccurate. Urodynamic study is useful in the evaluation of this group of patients as it aids in arriving at an accurate diagnosis and guides treatment therapy.

Adolescent↗

PubMed1999

Effects of intravesical administration of the K+ channel opener, ZD6169, in conscious rats with and without bladder outflow obstruction.

PURPOSE: To investigate the urodynamic effects of the new K(ATP) channel opener, ZD6169, given intravesically, in rats with and without bladder outflow obstruction. MATERIALS AND METHODS: Female, conscious Sprague-Dawley rats, normal or with bladder hypertrophy and overactivity secondary to bladder outflow obstruction, were given ZD6169 intravesically (10 or 100 ng./ml.), and intra-arterially (1 mg./kg.). Continuous cystometry was performed. RESULTS: In normal and obstructed rats, intravesical ZD6169 had similar, dose-dependent effects on bladder function. In obstructed rats, ZD6169 (100 ng./ml.) significantly decreased micturition pressure (17%), and increased bladder capacity (32%), micturition volume (18%), residual volume (145%), and inter-contraction interval (71%). There was a marked decrease in both frequency (40%) and amplitude (43%) of the spontaneous bladder activity. When given intra-arterially in obstructed rats ZD6169 increased bladder capacity (19%) and residual volume (47%) and decreased amplitude (51%), but not frequency, of the spontaneous bladder activity. CONCLUSIONS: In both normal and obstructed rats, intravesical ZD6169, at the investigated doses, significantly affected bladder function. In obstructed rats, the drug markedly reduced bladder overactivity. If the results have clinical validity, intravesical ZD6169 may offer an alternative way of treating bladder overactivity in selected patients.

Administration, Intravesical↗

PubMed2004

Differential diagnosis and treatment of impaired bladder emptying.

Although much attention is paid to urinary incontinence, the condition of incomplete bladder emptying is becoming more common with the aging of the US population and the widespread use of anticholinergic drugs to treat overactive bladder. This disorder can often be silent until end-stage presentation of overflow incontinence. In this article, we review the pathophysiologic conditions of the bladder and urethra that can cause impaired bladder emptying and discuss how to evaluate and screen the patient with a bladder that does not empty. In addition, we provide an overview of treatment options available for impaired bladder emptying and consider the research that is under way to find the best therapies for the failing bladder.

Journal Article↗

PubMed2005

Relationship between nigrostriatal dopaminergic degeneration, urinary symptoms, and bladder control in Parkinson's disease.

Patients with Parkinson's disease (PD) often have lower urinary tract symptoms (LUTS). Studies have indicated a correlation between dopaminergic degeneration and LUTS and presence of overactive bladder. We evaluated 18 patients with Parkinson's disease using single-photon emission computerized tomography (SPECT) imaging of the dopamine transporter with [(123)I]-FP-CIT, and bladder symptoms were assessed using questionnaires and full urodynamic evaluation both in medicated state and after cessation. Bladder symptoms correlated with age, stage and severity of disease but not with uptake of the ligand in the striatum. Patients with bladder symptoms had a significant lower uptake in the striatum compared with patients without LUTS. In patients with severe bladder dysfunction, LUTS correlated with putamen/caudate ratio. The specific binding of the ligand did not correlate with urodynamics parameters or any change in these after wash-out. Our findings suggest that the presence of LUTS is associated with the degeneration of the total number of nigrostriatal dopaminergic neurones, whilst the severity of bladder dysfunction is correlated with the relative degeneration of the caudate nucleus. The effects of medication on bladder control, as evaluated by urodynamics are believed to involve structures outside the basal ganglia.

Adult↗