SEARCH · PubMed Health

Results for “overactive bladder”

Explore indexed PubMed citations for clinical trials, systematic reviews and public health research. Read source abstracts and follow each citation to its original PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 1,333 records · Page 74Linked to original sources

PubMed2006

Oxybutynin in detrusor overactivity.

Oxybutynin has been used for the management of detrusor overactivity for over 30 years and has withstood medical scrutiny and the test of time throughout the world. Although several agents in the class of bladder relaxants have only recently been studied, oxybutynin's effectiveness in reducing urinary frequency and urge urinary incontinence is unquestioned in the medical literature. Oxybutynin is extremely safe and effective in almost every population including children, the elderly, and those who have neurogenic bladder. With more preparations available and more dosing flexibility than any other anticholinergic medication on the market, oxybutynin remains the "gold standard" for first-line therapy for patients who have detrusor overactivity.

Humans↗

PubMed2006

Detection of neurogenic detrusor contractions from the activity of the external anal sphincter in cat and human.

AIMS: Individuals with spinal cord injury or neurological disorders may develop bladder contractions at low volumes (neurogenic detrusor overactivity), which can lead to significant health problems. Present devices can inhibit unwanted contractions through continuous electrical stimulation of sensory nerves, but do not enable conditional stimulation only at the onset of bladder contractions. The objectives of this study were to determine the relationship between the electrical activity of external anal sphincter (EAS) and bladder pressure during neurogenic detrusor contractions and to determine whether EAS activity could be used to detect the onset of bladder contractions. METHODS: Bladder pressure and EAS electromyogram (EMG) were recorded in nine adult male cats. Retrospective clinical data consisting of bladder pressure and EAS EMG from 41 spinal cord injured individuals with neurogenic detrusor overactivity were analyzed. A CUSUM algorithm was used to detect the onset of bladder contractions from the EAS EMG. RESULTS: EAS EMG activity increased at the onset of bladder contractions in six cats (dyssynergic) and decreased (synergic) in three cats. The onset of bladder contractions was detected within 3 sec of the start of the contraction for both the synergic and dyssynergic data sets. The onset of bladder contractions was detected within 1 sec of the start of the bladder contraction for both synergic and dyssynergic human subjects. CONCLUSIONS: Recordings of the EAS EMG can be used to detect robustly the onset of neurogenic detrusor contractions. The EAS EMG is a suitable signal to control closed-loop inhibitory electrical stimulation to maintain urinary continence.

Anal Canal↗

PubMed2006

The functional effects of a c-kit tyrosine inhibitor on guinea-pig and human detrusor.

OBJECTIVE: To describe the effect of a specific c-kit receptor inhibitor (imatinib mesylate) on human detrusor strips in vitro and guinea-pig cystometry in vivo, and to show histological data suggesting differences in the distribution of interstitial cells of Cajal (ICC)-like cells in 'normal' and overactive human detrusor, as these cells have been identified as possible mediators of spontaneous activity and excitability in bladder smooth muscle. MATERIALS AND METHODS: Specimens of human detrusor were stained immunohistochemically with a c-kit antibody. Human detrusor strips were mounted in a superfused organ-bath apparatus, and smooth muscle contraction was evoked with carbachol and electrical field stimulation in the presence and absence of imatinib mesylate. Also, guinea-pig urodynamic studies were conducted before and after i.v. administration of imatinib mesylate, and changes in bladder variables and spontaneous activity were recorded. RESULTS: Imatinib mesylate (10(-6)M) inhibited evoked smooth muscle contraction and spontaneous activity in overactive human detrusor, with less effect on normal human tissue. Imatinib mesylate (10(-5)M) improved bladder capacity, compliance, voided volumes, urinary frequency, and reduced contraction thresholds and spontaneous activity during guinea-pig cystometry. c-kit labelling showed significantly more ICC-like cells in overactive human detrusor than in normal specimens. CONCLUSION: c-kit receptor blockers have inhibitory effects on guinea-pig and overactive human detrusor, possibly via c-kit receptors on bladder ICC-like cells. This and the possibility that there are more ICC-like cells in overactive bladder suggest that the c-kit receptor may provide a novel target for treating detrusor overactivity.

Animals↗

PubMed2000

Botulinum-A toxin for treating detrusor hyperreflexia in spinal cord injured patients: a new alternative to anticholinergic drugs? Preliminary results.

PURPOSE: We evaluated the efficacy of botulinum-A toxin injections into the detrusor muscle in patients with spinal cord injury, detrusor hyperreflexia and urge incontinence resistant to anticholinergic drugs. The purpose of treatment was to suppress incontinence episodes and increase functional bladder capacity. MATERIALS AND METHODS: Included in our prospective nonrandomized study done at 2 clinics were 31 patients with traumatic spinal cord injury who emptied the bladder by intermittent self-catheterization. These patients had severe detrusor hyperreflexia and incontinence despite a high dose of anticholinergic medication. Pretreatment evaluation included a clinical examination and complete urodynamic investigation. Under cystoscopic control a total of 200 to 300 units of botulinum-A toxin were injected into the detrusor muscle at 20 to 30 sites (10 units per ml. per site), sparing the trigone. Clinical and urodynamic followup was planned for 6, 16 and 36 weeks after treatment. Patients were asked to decrease their intake of anticholinergic drugs during week 1 after treatment. RESULTS: Of the 21 patients 19 underwent a complete examination 6 weeks after the botulinum-A toxin injections, and 11 at 16 and 36 weeks. At the 6-week followup complete continence was restored in 17 of 19 cases in which anticholinergic medication was markedly decreased or withdrawn. Less satisfactory results in 2 cases were associated with an insufficient dose of 200 units botulinum-A toxin. After the injections overall mean reflex volume and mean maximum cystometric bladder capacity plus or minus standard deviation significantly increased from 215.8 +/- 90.4 ml. to 415.7 +/- 211.1 (p <0.016) and 296.3 +/- 145.2 to 480.5 +/- 134.1 (p <0.016), respectively. There was also a significant decrease after treatment in mean maximum detrusor voiding pressure from 65.6 +/- 29.2 cm. water to 35 +/- 32. 1 (p <0.016). Mean post-void residual urine volume catheterized at the end of the urodynamic examination increased significantly from a mean of 261.8 +/- 241.3 ml. to 490.5 +/- 204.8 (p <0.016). Moreover, autonomic dysreflexia associated with bladder emptying that manifested as a hypertensive crisis during voiding disappeared after treatment in the 3 patients with tetraplegia. Satisfaction was high in all successfully treated patients and no side effects were observed. Ongoing improvement in urodynamic parameters and incontinence was already present in all patients reevaluated at 16 and 36 weeks. CONCLUSIONS: Botulinum-A toxin injections into the detrusor seem to be a safe and valuable therapeutic option in spinal cord injured patients with incontinence resistant to anticholinergic medication who perform clean intermittent self-catheterization. Successfully treated patients become continent again and may withdraw from or markedly decrease anticholinergic drug intake. A dose of 300 units botulinum-A toxin seems to be needed to counteract an overactive detrusor. The duration of bladder paresis induced by the toxin is at least 9 months, when repeat injections are required.

Adolescent↗

PubMed1977

Studies of enuresis. VIII. Detrusor and sphincter instability caused by overactivity of integral voiding reflexes.

Ninety-one children with nocturnal enuresis or enuresis plus daytime urgency incontinence were studied by cystometry. Seventy-two per cent of the girls and 62 per cent of the boys had evidence of bladder instability. Sixty-eight children in whom abnormalities were found on preliminary voiding urodynamics or voiding cystourethrography also underwent calibration and endoscopic examination under anesthesia. An atropine-suppression test was also performed preoperatively in some children with a markedly unstable bladder demonstrated on preoperative cystometry. In the majority of children tested suppression of bladder instability with atropine was demonstrable. Voluntary detrusor sphincter dyssynergia was demonstrated in a majority of the children with daytime urgency incontinence. Sixty-five per cent of the boys and 81 per cent of the girls were treated for urethral obstructive lesions suspected to be of functional urodynamic significance. Postoperative cystometry showed marked improvement in bladder stability in 57 per cent of the girls and 63 per cent of the boys treated for suspected urethral obstructive pathology. The anticholinergic suppression test was found to have no significant predictive value relative to the cause or surgical curability of bladder instability. The pathophysiologic significance of overactivity of integral voiding reflexes 6 through 11 is described.

Child↗

PubMed2006

Ureteric jet Doppler waveform and bladder wall thickness in children with nocturnal enuresis.

To test the hypothesis that the presence of nocturnal enuresis is related to increased frequency of immature vesicoureteric function, which is further associated with detrusor overactivity, we compared the incidence of immature monophasic ureteric jet in children with and without nocturnal enuresis. The relationship between monophasic ureteric jet Doppler wave form and bladder wall thickness was further explored in the enuresis group. Ultrasound examinations were performed in 511 children suffering from nocturnal enuresis and 266 normal controls. Doppler wave forms of the ureteric jet on each side and the bladder wall thickness after voiding were recorded. Standard urodynamic studies were obtained in 203 enuretic children for correlations with ultrasound findings. There was a significant increase in the incidence of monophasic ureteric jet waveforms in enuretic children when compared with the controls (19.2% versus 6.4% on the right side, 19.2% versus 8.3% on the left side, all p < 0.01). Furthermore, immature monophasic waveforms were more commonly seen in the enuretic group with markedly thickened bladder wall. Enuretic children with bilateral immature ureteric jet waveforms and markedly thickened bladder wall showed multiple significant urodynamic abnormalities (p < 0.05). The above observations could be accounted for by immaturity of both vesicoureteric junction and detrusor muscle.

Adolescent↗

PubMed2003

Clinical diagnosis of bladder outlet obstruction in men with lower urinary tract symptoms: reliability of commonly measured parameters and the role of idiopathic detrusor overactivity.

AIMS: There is no generally accepted consensus how to evaluate patients with lower urinary tract symptoms (LUTS) suggestive of bladder outlet obstruction (BOO). We have tried to determine whether the most frequently used objective variables as prostate volume, IPS-score, maximum flow rate, residual urine volume, functional bladder capacity, and pressure-flow study are reliable for diagnosis of BOO and we investigated the influence of idiopathic detrusor overactivity (IDO) on this condition. METHODS: A total of 153 men with LUTS and suspected BOO were systematically examined with routine investigation including digital rectal examination, transrectal ultrasound (TRUS), post-void residual urine volume measurement, uroflowmetry, and pressure-flow study. All patients completed IPS-score. Patients were divided into groups based on Schäfer's grade of obstruction and incidence of IDO and clinical and urodynamical variables were compared. RESULTS: At baseline, 45.8% of the patients were urodynamically moderately obstructed and 37.9% were found to be severely obstructed. The grade of obstruction did not correlate with age. Prostate volume, post-void residual volume (PVR), and maximum flow rate correlated significantly with the degree of obstruction. The mean IPS-score remained almost unchanged throughout all obstruction groups. The incidence of IDO was 40.5% and increased from 16% in the minor obstruction group to 38.6% and 53.4% in the moderate and severe obstruction group, respectively. The patients with IDO were older, had larger prostates and were more obstructed. There was no impact of IDO on symptomatology of BOO. CONCLUSIONS: These data indicate that IPS-score does not achieve sufficient diagnostic accuracy and its role in the assessment of BOO is limited. The grade of obstruction is more related to prostate volume, PVR, and maximum flow rate. BOO and IDO seem to be related and have numerous mutual interactions.

Aged↗

PubMed2006

Upper and lower urinary tract evaluation of 104 patients with myelomeningocele without adequate urological management.

To evaluate the upper and lower urinary tract and revise the urodynamic parameters on myelomeningocele patients without adequate urological management. 104 myelomeningocele patients without previous adequate urological management were assessed by clinical, urodynamic and imaging evaluation. The urodynamic.data were correlated with the status of the upper urinary tract (UUT). Thirty patients presented with vesico-ureteral reflux. Six patients presented signs of UUT damage without reflux. The cystometry showed detrusor overactivity (DO), poor compliance, increased bladder capacity and normal cystometry in 48, 49, 2 and 1% of the patients, respectively. Detrusor leak point pressure (DLPP) over 40 cm H(2)O was associated with UUT damage. Patients with decrease on functional bladder capacity (FBC) or= 40 cm H(2)O and decrease in FBC <or= 33% are associated with greater UUT damage. DO and poor compliance are predominant and pose similar risk of UUT damage.

Adolescent↗

PubMed2006

Placard-shaped in situ vaginal wall sling for the treatment of stress urinary incontinence.

PURPOSE: To evaluate the efficacy of a simple and economic procedure using a placard-shaped in situ anterior vaginal wall sling for the treatment of stress urinary incontinence, with or without cystocele repair. METHODS: From July 2003 to July 2004, 14 female patients (mean age 45.21 years, range 37-57) were operated upon because of stress urinary incontinence (SUI) with the placard-shaped in situ anterior vaginal wall sling technique. The average follow-up period was 11 months (range 4-14.5 months). Twelve patients were operated primarily with this technique and only two patients had undergone previous surgeries for the treatment of SUI (one patient had had two previous surgeries and the other had had one previous surgery). In all patients urethral hypermobility or/and bladder prolapse were observed. Filling cystometry showed sufficient bladder capacity with no detrusor overactivity. RESULTS: No urinary retention was observed in any patient in the postoperative period. While 11 patients have 100% cure of incontinence, three patients started leakage of urine after 1-2 months after the operation (one patient had been operated upon twice before (and who was diabetic and obese) and two patients were primarily repaired by our technique). In two patients, suprapubic tenderness and redness were observed, and were treated by oral antibiotic and anti-inflammatory drugs. CONCLUSION: The placard technique is simple, cost-effective and has low incidence of urinary retention in the post-operative period. The success rate seems to be satisfactory and it can be applicable to patients who are primary cases of SUI with average body mass index. Yet longer term follow up and larger number of patients are needed before final conclusion can be drawn.

Adult↗

PubMed2004

The role of video-urodynamic studies in managing non-neurogenic voiding dysfunction in children.

OBJECTIVE: To retrospectively evaluate the role of video-urodynamics (VUD) in the diagnosis and management of voiding dysfunction in children. PATIENTS AND METHODS: The records of the 128 children with dysfunctional voiding symptoms were retrospectively evaluated. All patients had a noninvasive screening assessment consisting of a detailed voiding history, ultrasonography and uroflowmetry, and measurement of residual urine. All the patients had also undergone VUD with no selection criteria. The results of VUD were compared retrospectively with the noninvasive screening assessment results. RESULTS: In 84 patients with urge syndrome VUD showed detrusor overactivity in 72 (86%); the bladder configuration and voiding-phase results were normal. Three (3.5%) patients had low-grade reflux. In 38 patients with voiding dysfunction VUD showed an intermittent flow pattern and/or increased electromyographic activity with a "spinning top" deformity of the bladder neck and increased detrusor pressure during voiding. Five (13%) of these children had low-grade reflux. In six infrequent voiders VUD revealed increased bladder capacity with fractionated flow patterns, with concomitantly increased abdominal pressures. There was decreased detrusor pressure during voiding with significant residual urine volume in only two patients; there was no reflux in any of the patients in this group. CONCLUSION: We do not recommend routine VUD in children with non-neurogenic voiding dysfunction, as it does not generally change the management and treatment. A detailed voiding history and physical examination is usually sufficient for a correct diagnosis.

Adolescent↗

PubMed1984

Alpha-adrenergic blockade in the diagnosis of detrusor instability secondary to infravesical obstruction.

Detrusor instability secondary to infravesical obstruction is probably caused by overactive stretch receptors in the bladder wall. Since recent studies have shown that alpha-adrenergic blockade with phenoxybenzamine reduces the intravesical pressure under micturition, we undertook this investigation in order to see if phenoxybenzamine has an effect on detrusor instability caused by infravesical obstruction. We found that the detrusor instability was abolished by phenoxybenzamine, which supports the 'stretch receptor theory'. Further, phenoxybenzamine is probably a good test in the diagnosis of detrusor instability secondary to infravesical obstruction.

Aged↗

PubMed2004

The perspective of a neurologist on treatment-related research in fecal and urinary incontinence.

Afferent innervation is important in sensing the degree of bladder fullness and in forming the input limb to involuntary detrusor contractions in neurogenic and probably also non-neurogenic detrusor overactivity. It is likely that homologous mechanisms are involved in control of the bowel. Accumulating evidence now suggests that in conditions of bladder hypersensitivity as well as non-neurogenic detrusor overactivity, there is up-regulation of unmyelinated nerve fibers expressing both the vanilloid receptor and purinergic receptors. The development of a selective neurotoxin that could successfully "deafferent" the bladder would have major therapeutic consequences. Women who respond best to neuromodulation through sacral nerve stimulation are those with a primary disorder of sphincter relaxation and a very large capacity without sensations of urgency or a hyperactive sphincter. For these women, neuromodulation may counteract the inhibitory effects of overactive sphincter afferents on the detrusor, and determination of the central nervous system level at which this response occurs may provide an explanation for the paradoxical finding that both urge incontinence and urinary retention are responsive to this intervention. Experimental evidence suggests that the "procontinence" reaction consists of an inhibitory effect on the detrusor and presumably the lower rectum resulting from contraction of the pelvic floor and the anal or urethral sphincter. Development of methods of enhancing the inhibitory reflex effect could lead to improved voluntary control of micturition and defecation for patients with neurogenic bladder overactivity or spinal cord lesions.

Fecal Incontinence↗

PubMed2006

Efficacy, tolerability and safety of propiverine hydrochloride in children and adolescents with congenital or traumatic neurogenic detrusor overactivity--a retrospective study.

OBJECTIVES: Anticholinergic treatment combined with intermittent catheterisation is the cornerstone of the conservative treatment strategy in children with neurogenic detrusor overactivity, which in most cases is due to congenital causes. Efficacy, tolerability and safety of propiverine hydrochloride were evaluated retrospectively in these children. METHODS: At four specialized outpatient clinics, all children's records were scrutinized for first-line propiverine hydrochloride treatment, or second- or third-line treatment after failure of a non-selective alpha-blocker (phenoxybenzamine) and/or other anticholinergics (oxybutynin, trospium chloride). The primary efficacy outcomes were urodynamic parameters, with clinical symptoms as secondary outcomes. Statistical analysis was performed by paired t-tests (significance level p < 0.05). RESULTS: Altogether 74 children and adolescents (40 boys, 34 girls; age range 11 months-19 years) were treated with propiverine hydrochloride (average duration 2 years and approximately 4 months; individual dose range 5-75 mg). The primary efficacy outcome parameters improved significantly: maximum cystometric capacity 161.2 [standard deviation (SD) 97.3] to 252.2 ml (SD 117.2), p < 0.001; maximum detrusor pressure 43.8 (SD 39.2) to 27.1 cm H(2)O (SD 26.4), p = 0.002; bladder compliance 7.6 (SD 6.4) to 17.0 ml/cm H(2)O (SD 16.2), p < 0.001. Phasic detrusor overactivity was abolished by 63%; incontinence resolved by 54%. One patient spontaneously reported a typical anticholinergic adverse event, which resolved after dose reduction. No safety concerns were documented. CONCLUSIONS: Propiverine hydrochloride is effective in neurogenic detrusor overactivity in children and adolescents, even in some of those cases unresponsive to other anticholinergics. The low incidence rate (<1.5%) of adverse events evidences a favourable risk-benefit profile of propiverine hydrochloride, considering in particular the total documented treatment and surveillance period of 171 patient years and nine months.

Adolescent↗

PubMed2005

Effects of M274773, a neurokinin-2 receptor antagonist, on bladder function in chronically spinalized rats.

PURPOSE: Increased afferent nerve activity may have an important role in the pathogenesis of neurogenic detrusor overactivity. We tested the efficacy of the neuokinin-2 receptor antagonist M274773 ((S)-N-[2-(3,4-Dichlorophenyl)-4-[4-(2-oxoperhydro-pyrimidin-l-yl) piperidino]butyl]-N-methylbenzamide dihydrochloride) on neurogenic detrusor overactivity after spinal cord injury in rats. MATERIALS AND METHODS: Included in this study were 48 adult Sprague-Dawley rats (Charles River, Montreal, Quebec, Canada). Six animals served as normal controls, while 32 underwent spinal cord transection at the 10th thoracic vertebra. Two weeks after spinal cord injury 6 animals underwent filling cystometrography to confirm neurogenic detrusor overactivity, while another 12 served as paraplegic controls. The remaining 24 paraplegic animals were used to test the drug and they were divided into 2 equal groups of 12. Group 1 received the drug at a dose of 0.3 mg/kg daily, while group 2 received a dose of 0.6 mg/kg daily. Each paraplegic control and treatment group was further subdivided into 2 subgroups of 6 rats each. In subgroup 1 filling cystometrography was done 3 weeks after spinal cord injury, while in subgroup 2 it was done 4 weeks after spinal cord injury. RESULTS: Three weeks after spinal cord injury neurogenic detrusor overactivity developed in all paraplegic control animals with a mean bladder capacity +/- SD of 0.7 +/- 0.2 ml and a mean voiding pressure of 59 +/- 14.2 cm H2O. Neurogenic detrusor overactivity resolved in 50% and 83% of the animals that received M274773 for 1 week at doses of 0.3 and 0.6 mg/kg daily, respectively. Mean cystometric bladder capacity was 1.2 +/- 0.5 vs 1.3 +/- 0.4 ml and mean voiding pressure was 46.1 +/- 10.8 vs 40 +/- 9.9 cm H2O in animals that received 0.3 vs 0.6 mg/kg daily, respectively. The drug produced better urodynamic results when given for 2 weeks rather than 1 week. CONCLUSIONS: M274773 is effective for neurogenic detrusor overactivity after spinal cord injury in the rat. It may provide an alternative clinical treatment option for neurogenic detrusor overactivity and urgency/frequency syndrome. This new neurokinin-2 selective antagonist has time and dose response effects, which further suggests the potential for clinical application.

Animals↗

PubMed2007

Intravesical atropine compared to oral oxybutynin for neurogenic detrusor overactivity: a double-blind, randomized crossover trial.

PURPOSE: We tested the efficacy and side effect profiles of intravesical atropine compared to oxybutynin immediate release when used by individuals with multiple sclerosis. MATERIALS AND METHODS: We performed a study to determine the most effective dose of atropine. Eight participants used increasing doses of intravesical atropine during a 12-day period. Bladder diary data showed that the instillation of 6 mg atropine 4 times daily was most effective for increasing bladder capacity (voided/catheter volumes). We then did a randomized, double-blind crossover trial. Participants received 14 days of treatment with oral oxybutynin or with intravesical atropine, followed by 14 days of alternative treatment. Participants recorded a bladder diary and rated side effects and quality of life. The primary outcome variable was bladder capacity. RESULTS: A total of 57 participants with multiple sclerosis completed the study. Average change in bladder capacity was higher in the atropine arm. The mean +/- SD oxybutynin change was 55.5 +/- 67.2 ml, the mean atropine change was 79.6 +/- 89.6 ml and the mean difference between arms was 24.1 ml (95% CI -0.4, 49.7; p = 0.053). Changes in incontinence events and voiding frequency were not statistically different between the arms. Changes in total side effect and dry mouth scores were significantly better in the atropine treatment arm. CONCLUSIONS: Intravesical atropine was as effective as oxybutynin immediate release for increasing bladder capacity and it was probably better with less antimuscarinic side effects. We recommend that intravesical atropine should be made available to patients with neurogenic detrusor overactivity and voiding problems requiring intermittent catheterization as an alternative to oral therapy, which often has troublesome side effects.

Administration, Intravesical↗

PubMed2006

The impact of late presentation of posterior urethral valves on bladder and renal function.

PURPOSE: We retrospectively reviewed the records of patients with late presentation of PUVs, and compared bladder and renal function to that in patients with an early diagnosis of PUVs. MATERIALS AND METHODS: We retrospectively reviewed the charts of 36 males (mean age at diagnosis 8.8 years, range 5 to 14) with late presentation of PUVs who were treated at our institution between 1986 and 2004. Of these patients 20 had undergone urodynamic evaluation during followup (mean age 10.65 years, range 5 to 23). We chose as controls 19 age matched children with PUVs who were diagnosed and treated before age 5 years and underwent urodynamic evaluation during followup (mean age at urodynamic evaluation 8.52 years, range 6 to 15). Urodynamic parameters were compared between the 2 patient groups. Renal function in the late presenting cases was also compared to controls. RESULTS: The most common symptoms at presentation were diurnal enuresis (17 patients, 47.2%) poor stream (7, 19.4%) and urinary retention (5, 13.9%). Overall, urodynamic bladder abnormalities were detected in 17 of 20 patients (85%), detrusor overactivity in 3 (15%), significant post-void residual in 9 (45%) and bladder capacity greater than expected for age in 9 (45%). No significant difference in bladder capacity, compliance or post-void residual was demonstrated between the late presenting and control groups. Only detrusor overactivity was significantly lower in the late presenting group (p = 0.013). After a mean followup of 67.03 months age specific creatinine levels were increased in 13 of 27 patients (48.1%), including 7 (25.9%) with ESRD. Renal function was significantly impaired in the late presenting group compared to controls (48.1% vs 13.7%, p = 0.001). CONCLUSIONS: We found a significantly lower rate of detrusor overactivity (15%) in patients with late presenting PUVs. Comparison of urodynamic parameters between the early and late presenting groups did not reveal any significant difference. This similar pattern of bladder dysfunction, independent of age at relief of obstruction, may indicate a common pathophysiological etiology for bladder dysfunction in all patients with PUVs. Also, renal function was significantly impaired in the late presenting group in this series.

Adolescent↗

PubMed1993

Structural basis of geriatric voiding dysfunction. IV. Bladder outlet obstruction.

Several aspects of the pathogenesis of voiding dysfunction in bladder outlet obstruction remain unresolved. The structural basis of obstructive versus nonobstructive dysfunction was investigated in a prospective ultrastructural/urodynamic study of 35 elderly subjects of comparable age. Detrusor structure was examined by electron microscopy, with blinded clinical and urodynamic information. Seven detrusor specimens were segregated by a distinctive myohypertrophy, structural pattern, which matched with 6 male and 1 female subjects 72 to 96 years old (mean age 83) who had urodynamically proved outlet obstruction. This pattern was characterized by widely separated muscle cells with reduction of intermediate cell junctions, collagenosis, that is abundant collagen plus some elastic fibers, in the markedly widened spaces between individual muscle cells and abundant profiles characteristic of enlarged, hypertrophic muscle cells. Superimposed degeneration of muscle cells and axons in 6 specimens matched those of 5 men and 1 woman who had impaired detrusor contractility. In 3 specimens there were also abundant protrusion junctions and ultra-close abutments; these matched those of 2 men and 1 woman with obstruction plus detrusor overactivity. Observations on the degree of bladder trabeculation in the entire population of 35 subjects are presented. It is concluded that bladder outlet obstruction is associated with changes in detrusor structure that can account for the resultant voiding dysfunction. Features of the myohypertrophy pattern, with or without superimposed degeneration, can explain overall weakness of the obstructed detrusor despite hypertrophy of its cells. Protrusion junctions and abutments probably mediate electrical coupling of muscle cells leading to involuntary contractions in the overactive (unstable) obstructed detrusor. Excessive deposits of elastic fibers (hyperelastosis) between widely separated muscle cells and in interstitium are suggested as the probable structural basis for increased bladder distensibility and chronic retention.

Age Factors↗

PubMed1997

The ice-water test in detrusor hyper-reflexia and bladder instability.

OBJECTIVES: To determine: (i) the outcome of the ice-water test (IWT) in patients with an overactive detrusor and to define the sensitivity of the test in differentiating bladder instability from detrusor hyper-reflexia: and (ii) to investigate any differences in sensitivity to the IWT with detrusor hyper-reflexia caused by suprapontine and spinal pathologies. PATIENTS AND METHODS: Of 130 consecutive patients with urinary symptoms who underwent a urodynamic evaluation and IWT, 80 had detrusor overactivity; of these 60 had detrusor hyper-reflexia and 20 had bladder instability. The patients with detrusor hyper-reflexia were further subdivided into two groups, suprapontine or spinal, based on the site of the neurological lesion. RESULTS: The overall sensitivity of the test in patients with detrusor hyper-reflexia was 65% and the specificity 85%. In patients with a spinal pathology causing detrusor hyper-reflexia, the test was positive in 70%, while 46% with suprapontine causes of detrusor hyper-reflexia had a positive test. CONCLUSIONS: Although 65% of the patients with detrusor hyper-reflexia and known neurological disease had a positive IWT, so did 15% of the patients with no neurological disease and bladder instability. Patients with suprapontine pathology had a lower sensitivity than those with infrapontine pathology, but this was not statistically significant. The relatively larger number of false-negative tests in patients with a suprapontine pathology is one reason why the test is insufficiently sensitive to discriminate between detrusor hyper-reflexia and bladder instability.

Adolescent↗