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PubMed1994

[Voiding dysfunctions in patients with lumbar spinal canal stenosis].

We studied on subjective and objective findings of 69 patients with lumbar spinal canal stenosis. Of the patients 51 (73.9%) had not only orthopedical symptoms but also urological complaints of mostly emptying disorders such as protracted and retardated dysuria and urinary retention, 14 (20.3%) no urological symptom and four (5.8%) urological complaint alone. Cystometrographic findings investigated from all of the patients revealed normoactive detrusor in 34 (49.3%) of them, underactive or acontractile detrusor in 28 (40.6%) and overactive detrusor 7 (10.1%). Eighteen of the patients underwent a surgical treatment for the lumbar spinal canal stenosis. All of seven patients with normoactive detrusor had a good micturition and four of nine with underactive or acontractile detrusor and one of two with overactive detrusor required clean intermittent catheterization (CIC) even after the surgeries. Pre and post surgical urodynamic studies demonstrated that the seven patients resulted in normoactive in four and overactive in three, the nine underactive in six and overactive in three and the two overactive and underactive in one, respectively. It was suggested from the results that the bladder of a patient with limbar spinal canal stenosis could become more irritable state after the surgery than before the therapy.

Adult↗
PubMed2004

Protective effect of an oral endothelin converting enzyme inhibitor on rat detrusor function after outlet obstruction.

PURPOSE: Endothelin (ET)-1, one of the most potent vasoconstrictors known, is converted from its less potent precursor big ET by the endothelin converting enzyme (ECE). In vitro studies suggest that ET has an important role in smooth muscle growth after bladder outlet obstruction (BOO). We investigated the effect of an orally administered ECE inhibitor by cystometry in conscious rats with and without BOO. MATERIAL AND METHODS: BOO was produced in female rats by a standardized method and the animals were divided into 2 groups. One group received the ECE inhibitor WO-03028719 and the remaining animals received vehicle daily by oral gavage. Five sham operated animals served as controls and were treated with WO-03028719. Two weeks after surgery cystometry was performed. RESULTS: BOO led to a significant increase in bladder weight in vehicle treated animals and a nonsignificant increase in the treatment group. Micturition interval and volume increased in each obstructed group. Micturition pressure was significantly decreased in the vehicle group but unchanged in the BOO treatment group. Residual urine occurred in 4 of 11 BOO vehicle animals but not in the sham operated or BOO treatment group. Spontaneous nonvoiding bladder contractions occurred in 37% of BOO treatment animals but in 82% of the BOO vehicle group. Voiding contractions were markedly prolonged in the BOO vehicle group, while they were normal in the BOO treatment group. CONCLUSIONS: ECE inhibition did not prevent an increase in bladder weight after BOO but it appeared to have a beneficial effect on detrusor function and decrease detrusor overactivity in conscious rats.

Administration, Oral↗
PubMed2002

Influence of central serotonergic mechanisms on lower urinary tract function.

The effects of serotonergic drugs on the central nervous system control of the lower urinary tract have revealed possible approaches for the treatment of detrusor overactivity and urinary incontinence. Studies in animals of the distribution of serotonergic nerves and receptors and the changes in voiding function induced by serotonin (5-hydroxytryptamine [5-HT]) receptor agonists and antagonists, as well as 5-HT reuptake inhibitors, form a basis for the development of such treatments. In rats and cats, spinal reflex circuits involved in voiding function exhibit a dense serotonergic innervation, multiple 5-HT receptors, and sensitivity to various drugs that affect serotonergic transmission. Although there is some evidence in the rat for serotonergic facilitation of voiding, most experiments in rats and cats indicate that activation of the central serotonergic system by 5-HT reuptake inhibitors, as well as by 5-HT1A and 5-HT2 receptor agonists, depresses reflex bladder contractions and increases the bladder volume threshold for inducing micturition. These data indicate that activation of the central serotonergic system can suppress voiding by enhancing efferent control of the urethral outlet and inhibiting the parasympathetic excitatory input to the urinary bladder. The 5-HT receptors and reuptake mechanisms, therefore, represent targets for the development of new treatments of detrusor overactivity and urinary incontinence.

Animals↗
PubMed2004

The impact of radical prostatectomy on patient well-being: a prospective urodynamic study focused on detrusor function.

Prostate cancer is common in aged men and radical prostatectomy is established as a therapeutic measure. However, to date there is little information about its impact on voiding function. We conducted a prospective clinical study to elucidate the impact of radical prostatectomy on voiding function in 17 patients with prostate cancer, by urological evaluation including filling and voiding cystometry (pressure flow study). The patients who were estimated as having weak detrusor function including very weak detrusor function at 3 months postoperatively had significantly more frequent urinary incontinence compared with the others (p < 0.05). Of 8 patients who showed urinary incontinence for more than 3 months, 7 (88%) patients developed weak detrusor function at 3 months after operation, but 4 of them were estimated as having normal detrusor function preoperatively. These patients revealed reduced maximum flow rate and significantly increased quality of life score compared with the other patients (p < 0.05). An initially reduced bladder compliance disclosed a tendency to a rapid return to normal with time after surgery. Detrusor overactivity itself and neoadjuvant antiandrogen therapy were not related to prolonged postoperative urinary incontinence. The present study indicates that caution is required when administering medication that could potentially affect detrusor function, regardless of the type of preoperative detrusor function, in patients with persistent urinary incontinence or a reduced urinary stream. Particular emphasis is laid on the importance of urodynamic assessment of post-prostatectomy detrusor function and appropriate management modalities based on the results.

Aged↗
PubMed2005

Variability of detrusor overactivity on repeated filling cystometry in men with urge symptoms: comparison with spinal cord injury patients.

OBJECTIVE: To investigate the variation in urodynamic variables during repeated filling cystometry and the impact that the variability had on the observed incidence of detrusor overactivity, to evaluate the correlation of detrusor overactivity with the symptoms of urge in men with lower urinary tract symptoms (LUTS), and to compare the variability of detrusor overactivity in men with LUTS to that in men with spinal cord injury (SCI). PATIENTS AND METHODS: Sixty men with LUTS and 35 with neurogenic bladders after SCI were assessed. Investigations included the International Prostate Symptom Score (IPSS), Madsen-Iversen Symptom Score (MSS), uroflowmetry, filling cystometry and pressure-flow, in three successive studies. RESULTS: In men with LUTS, a significant decrease in the number and pressure of involuntary detrusor contractions (IDCs) in consecutive cystometries resulted in a reduction of observed detrusor overactivity from 72% to 63% and 48%, in the three studies. Urgency scores were significantly lower in men who became 'stable' than in those who remained 'unstable' throughout the three studies. In men with SCI, cystometric variables and detrusor overactivity remained consistent over sequential studies. CONCLUSION: Urodynamic detrusor overactivity is affected by repeated cystometry. In men with LUTS, two populations with detrusor overactivity were identified; one group adapted to repeated filling while another had persistent IDCs and greater urgency scores. The latter group had bladder behaviour similar to that of men with neurogenic bladders secondary to SCI. These findings might be important in explaining the cause of symptoms, initiating further investigation, and predicting the outcome of therapy.

Adolescent↗
PubMed2004

Spontaneous activity and electrical coupling in human detrusor smooth muscle: implications for detrusor overactivity?

Large uncontrollable detrusor contractions, decreased compliance that increases luminal pressures during filling, and detrusor underactivity are all examples of abnormal bladder function. Studies of the nervous control of lower urinary tract function and measurement of the cellular properties of the component tissues of the bladder wall have been performed to deepen our knowledge of these problems. The resultant data have suggested that lower urinary tract smooth muscle should not be regarded solely as a collection of independent cellular contractile units that are each activated by separate neural inputs, but also as a syncytium of cells. Although this syncytial arrangement may not be as well developed as in other tissues, it should impose a new layer of activity that will affect overall bladder function. Recent studies have addressed this issue through investigation of spontaneous contractile activity, the cellular basis of syncytial function, and their normal and abnormal functional consequences. The results suggest that individual detrusor cells possess membrane properties that may lead to spontaneous activity fluctuations, which can affect adjacent cells and, thus, produce multicellular aberrant responses. It remains unclear whether these responses manifest themselves as dysfunctional activity in the whole bladder defects because the extent of local multicellular abnormalities is not known at present. The data do imply that myogenic defects can contribute to abnormal bladder function and, thus, suggest several new targeted drug models that should be explored.

Animals↗
PubMed2006

Neurogenic bladder dysfunction after sacrococcygeal teratoma resection.

PURPOSE: SCT treatment in newborns consists of surgery and selective chemotherapy. Few reports document urological sequelae using this approach. This review focuses on the urological and neurourological findings following SCT treatment in the newborn period. MATERIALS AND METHODS: We reviewed the records of all infants with SCT resected in early infancy who underwent urodynamic evaluation for bladder dysfunction between 1986 and 2004. The radiological, neurological and urodynamic findings, and postoperative incontinence management were analyzed. RESULTS: We analyzed UDS of 14 patients who presented with urinary infection or incomplete bladder emptying after SCT resection. At the time of UDS an abnormal neurological examination was noted in 5 patients (36%). Detrusor overactivity was seen in 8 patients, underactivity in 2 and normal activity in 4. Abnormal urethral sphincter EMG potentials were observed in 7 of 13 patients (54%). Five of 13 patients (38%) had sphincter dyssynergia during voiding. Consequently, CIC was needed in 11 of the 14 patients (79%) to empty the bladder, of whom 5 also required anticholinergics to improve detrusor compliance and dryness. Only 3 patients voided spontaneously with normal bladder and sphincter function, of whom 2 were toilet trained. Hydronephrosis was seen in 6 patients and reflux was noted in 7 (including 5 of 6 with hydronephrosis). Antireflux surgery was performed in 6 patients, all of whom had up to grade 4 reflux due to recurrent urinary tract infection. One girl with grade 2 reflux had spontaneous resolution. CONCLUSIONS: SCT and its treatment can produce neurourological dysfunction of the lower urinary tract with high grade reflux, and abnormal bladder and urethral function. Complete assessment, including urodynamic studies, is imperative preoperatively and postoperatively. Constant vigilance is required to maintain as near normal bladder function as possible and to prevent upper urinary tract injury.

Adolescent↗
PubMed2004

Control of bladder function by peripheral nerves: avenues for novel drug targets.

The micturition reflex involves afferent nerve activation when the bladder is sufficiently full and subsequent controlled firing of parasympathetic efferent nerves to contract the detrusor muscle as part of the voiding mechanism. Alteration of the sensitivity of afferent activation or loss of control over transmitter release could lead to sensory- or motor-activated incontinence, respectively. The control mechanisms that regulate these 2 activities remain poorly understood. Current opinion is that the sensation of bladder fullness is relayed by afferent nerves in the mucosal layer, which are activated by the release of chemical mediators, such as adenosine triphosphate (ATP), from the urothelium when it is stretched as the bladder fills. This hypothesis supports the concept that other chemical signals that affect bladder sensation (eg, changes in urine composition and agents such as capsaicin) can modulate the sensitivity of the basic system. It has also been proposed that a layer of myofibroblasts immediately below the basal lamina of the urothelium acts as a variable gain regulator of the sensory process between ATP release and afferent excitation. These myofibroblasts are functionally connected to form an electrical syncytium, make close contact with nerves, and respond by generating electrical responses and transient increases in intracellular Ca2+ when exposed to ATP. On the efferent side, using a guinea pig detrusor model, possible modulators of transmitter release have been investigated, including adenosine (the breakdown product of the neurotransmitter ATP). Adenosine reduces the force of nerve-mediated contractions by acting predominantly at presynaptic sites at the nerve-muscle junction via a subtype of an adenosine receptor-the A1 receptor. An additional effect, possibly via A2 receptors, is also present on the detrusor muscle itself. These actions of adenosine are less evident in human detrusor muscle but remain a potential modulatory target. In summary, the cellular and molecular regulation of bladder fullness sensation and efferent transmitter release are becoming better understood and represent potential drug targets for the management of detrusor overactivity.

Adenosine↗
PubMed2005

A prospective randomized trial comparing transurethral prostatic resection and clean intermittent self-catheterization in men with chronic urinary retention.

OBJECTIVE: To determine whether a preliminary period of clean intermittent self-catheterization (CISC) before transurethral resection of the prostate (TURP) improves bladder contractility and surgical outcome in men with chronic urinary retention (CUR), and whether pressure-flow studies (PFS) before TURP predict the outcome. PATIENTS AND METHODS: The study was a two-centre, pragmatic and randomized trial. Included were 41 men scheduled for TURP with lower urinary tract symptoms (LUTS), an International Prostate Symptom Score (IPSS) of > 7, benign prostatic enlargement and a persistent postvoid residual urine volume (PVR) of > 300 mL. They had conventional PFS using unphysiological filling. The patients then gave consent and were randomized into two treatment groups; the first had TURP after stabilizing renal function by indwelling catheterization if indicated, and the second was taught CISC. Men in both groups were reviewed at 3 and 6 months after surgery or the start of CISC, by the IPSS, urine culture and assay of plasma creatinine, and upper tract imaging and repeat PFS at 6 months. The primary outcome variables were IPSS, maximum urinary flow rate, voiding and end-filling pressures, and mean PVR; secondary variables included treatment failure, complications and other urodynamic measures. RESULTS: Of the 41 patients, 17 (mean age 67 years, range 52-84) were randomized to immediate TURP and 24 (mean age 69 years, range 55-85) to CISC. There was a significant improvement in IPSS and quality of life at 6 months in both groups (P < 0.001). In the CISC group there was a significant improvement in voiding and end-filling pressures, indicating recovery of bladder function (P < 0.001 for each). Of the 41 men, nine (22%) with voiding pressures of < or = 45 cmH2O had no significant improvement in symptoms or urodynamic variables. Detrusor overactivity was found in 17 (41%) patients, of whom six had upper tract dilatation which resolved after treatment. CONCLUSION: The present results emphasize the usefulness of CISC in ensuring the recovery of bladder function in men with CUR. Measuring the voiding pressure before TURP can predict the surgical outcome. Both CISC and immediate TURP are effective for relieving LUTS and result in a better quality of life. A preliminary period of CISC before TURP for men with CUR and low voiding pressure may be valuable. The presence of upper tract dilatation is associated with high end-void and end-fill bladder pressures, and such men have a good outcome from surgery.

Aged↗
PubMed2003

Urethrovaginal reflux--a common cause of daytime incontinence in girls.

OBJECTIVE: The objective of this study was to estimate the frequency of urethrovaginal reflux as the cause of daytime incontinence in school-age girls, and to study the characteristic symptoms and the effect of simple instructions intended to amend the problem. MATERIAL AND METHODS: Girls with urethrovaginal reflux were identified in a group of 169 girls, aged 7 to 15 years, referred to a specialist clinic because of daytime incontinence. They were evaluated by a noninvasive screening protocol, including a careful history and neurourologic examination, bladder diaries, urine analysis, uroflows, and residual urine determined by ultrasound. Girls with urethrovaginal reflux were instructed by a urotherapist on how to achieve better toilet habits. RESULTS: Urethrovaginal reflux was found in 21 (12.4%) of 169 girls as the sole (19) or contributing (2) cause of their daytime urinary incontinence. They all had a typical history of small leakage 5 to 10 minutes after voidings during the day, confirmed by a specific bladder diary. All were neurologically healthy, and all but 2 had a normal bladder function. The latter 2 girls had residual urine and asymptomatic bacteriuria. At follow-up after median 2 years, all girls were free from postmicturition leakage, but the 2 with residual urine remained daytime incontinent with cystometrically proven phasic detrusor overactivity. CONCLUSIONS: Urethrovaginal reflux is a common cause of urinary incontinence in girls. The diagnosis is easily obtained by an adequate history, completed with a specific bladder diary. The problem is easily resolved by proper voiding instructions.

Adolescent↗
PubMed2005

Concomitant pelvic organ prolapse surgery with TVT procedure.

The aim of this study is to evaluate the efficacy and feasibility of concomitant pelvic reconstructive surgery with tension-free vaginal tape (TVT) procedure to treat pelvic organ prolapse women with urodynamic stress incontinence (USI) or occult USI. Seventy-five women with pelvic organ prolapse and diagnosed as USI or occult USI were enrolled in this study. All patients with USI or occult USI underwent TVT treatment under general anesthesia, combined with transvaginal total hysterectomy (VTH), anterior-posterior colporrhaphy (APC), and/or right sacrospinous ligament suspension (SSS) reconstructive surgeries. The subjective assessment was evaluated by using a visual analog scale (VAS) score and a urinary symptomatic questionnaire. The objective assessment was carried out with a 1-h pad test, cough stress test, and urodynamic examination. Of the 75 patients, 35 patients with grade III uterine prolapse underwent VTH and APC, 30 patients with grade IV uterine prolapse underwent VTH, SSS, and APC, and the other 10 patients who had previous hysterectomy with total vaginal vault prolapse underwent SSS and APC. The mean follow-up interval was 25 months (12-42 months). The mean hospitalization was 5.9 days and the mean catheterization time was 3.8 days. The subjective success rate for the treatment of urine incontinence was 88%, and the objective complete cure rate was 84%. The rate of postoperative complications with persistent urinary urgency, de novo detrusor overactivity, dysfunctional voiding, and tape erosion were 50, 8, 12, and 1.3%, respectively. There were no bladder perforations during the TVT procedure and no perioperative complications requiring conversion to laparotomy. Pelvic organ prolapse women with USI or occult USI can be treated by reconstructive surgeries combined with a TVT procedure to treat and prevent postoperative USI.

Adult↗
PubMed1996

Artificial urinary sphincter in patients with neurogenic bladder dysfunction.

OBJECTIVE: To assess the role of the artificial urinary sphincter (AUS) in the management of sphincter weakness incontinence in neuropathic patients. PATIENTS AND METHODS: Ninety patients (75 male and 15 female, mean age 26 years, range 13-62) with neurogenic bladder dysfunction (71 with congenital and 19 with acquired cord lesions) who underwent implantation of an AUS were reviewed. All patients were followed up for a minimum of one year after the initial implantation of the sphincter (mean 4 years, range 1-10). Pre-operative video-urodynamics demonstrated sphincter weakness incontinence in all patients, with 24 patients having an acontractile-type bladder. Of 66 patients with intermediate-type bladders, 52 underwent cystoplasty. RESULTS: Eighty-three patients (92%) were continent both night and day, three were occasionally damp and controlled by pharmacotherapy, and four had a persistent poor result. Of the 66 patients with detrusor hyper-reflexia, 52 (79%) required a cystoplasty to achieve continence and 14 (21%) were controlled with anti-cholinergic therapy. The re-operation rate was 28% (25/90) and complications included six infections, seven erosions, eight system failures, two pump failures, one sheered tube and one rectal and one bladder perforation. Seventy (78%) of the patients currently perform intermittent catheterization to treat high post-voiding residual urine volumes. CONCLUSIONS: A rate of continence > 90% was achieved in these neurogenic patients after implantation of an AUS and we recommend a simultaneous cystoplasty in patients with detrusor overactivity.

Adolescent↗
PubMed2006

Transverse myelitis in children: long-term urological outcomes.

PURPOSE: Urological complications are well documented in patients with traumatic spinal cord injury. We examined the long-term urological outcomes in a large population of children affected by transverse myelitis. MATERIALS AND METHODS: We retrospectively reviewed the medical history, imaging studies and urodynamic findings in 22 children with transverse myelitis. Age at disease onset ranged from 3 months to 18 years (average 8.8 years). RESULTS: At a mean followup of 7.1 years 19 patients (86%) had persistent bladder dysfunction and 17 (77%) had persistent bowel dysfunction. Initial evaluation at least 1 month after disease onset revealed detrusor overactivity in 59% of patients, detrusor external sphincter dyssynergia in 41%, low compliance in 47% and detrusor leak point pressure greater than 40 cm water in 12%. Functional motor recovery and absence of lower extremity spasticity did not reflect normal urodynamic findings. Of the 19 patients with imaging available for review 5 (26%) had upper tract changes. One patient had development of chronic renal insufficiency. Low compliance (p = 0.02) and upper tract changes (p = 0.1) were more frequent in patients who started clean intermittent catheterization more than 2 years after disease onset. CONCLUSIONS: Persistent bowel and bladder dysfunction is common in transverse myelitis. Urodynamic abnormalities may be present despite normal neurological examination and absence of urinary symptoms. All pediatric patients with transverse myelitis require baseline renal ultrasound and urodynamic evaluation to guide treatment. Early institution of clean intermittent catheterization appears to preserve bladder compliance and decrease upper tract disease, and should be instituted at disease onset.

Adolescent↗
PubMedDate not supplied

The association of fecal impaction and urinary retention in elderly nursing home patients.

The objective of this study was to examine the association of fecal impaction and urinary retention in an elderly nursing home population. Two-hundred and three nursing home patients with urinary dysfunction (77% female, median age: 85 years (range: 61-104)) underwent an evaluation which included rectal examination, measurement of residual urine, and cystometric studies. Bivariate analyses indicated that fecal impaction was not associated with urinary retention. However, dependency in transfer was directly associated with fecal impaction (OR=2.91; P=0.004), and with urinary retention (OR=3.13; P=0.017). There was no association between detrusor underactivity and fecal impaction. When urinary retention and fecal impaction occurred in the same patient, detrusor overactivity was the most common cystometric finding. Rather than implicating an anatomic or neurologic link between poor bladder emptying and poor bowel emptying, a third factor (e.g. immobility) causing both urinary retention and fecal impaction should be sought.

Journal Article↗
PubMed2005

[Nocturia in female with symptoms of urinary incontinence: analysis of associated clinical and urodynamic variables].

BACKGROUND: There is little information about urodynamic characteristics of females with symptoms of urinary incontinence (UI) and nocturia. METHOD: Descriptive study of 1731 females consecutively referred with symptoms of UI for study and treatment. Urogynaecological history, physical examination and urodynamic study were carried out. Patients with pelvic organ prolapse greater than second degree were excluded. Frequency of nocturia symptom and its relationship with urodynamic, personal and clinical variables were analysed. RESULTS: 743 patients (43%) of those included presented nocturia. Urodynamic diagnoses in patients with nocturia were: stress UI in 262 patients (35.4%); detrusor overactivity in 166 (22.3%); and both in 220 (29.6%). The rest (12.7%) had other diagnoses. Mean (S.D.) bladder capacity of patients with nocturia was less than that of the rest of patients: 459.8 (159.8) vs 530.6 (216.9) ml (p<0.001). Of all the variables associated with nocturia, those which showed independent association were (ExpB; 95%CI): age >65 years (1.88; 1.34-2.63); menopause (2.11; 1.56-2.86); hypertension (1.42; 1.04-1.94) and bladder cistometric capacity less than 300 (1.71; 1.01-2.91) and between 300 and 400 (1.67; 1.17-2.38). The urodynamic diagnosis of Stress UI was associated with the absence of nocturia. CONCLUSION: Nocturia is a frequent symptom among females complaining of urinary incontinence. Its presence is associated to age over 65 years, menopause, hypertension and reduced bladder capacity.

Aged↗
PubMed2006

Urodynamic study in the neurogenic bladder dysfunction caused by intervertebral disk hernia.

AIMS: To discuss the clinical significance of urodynamic studies in neurogenic bladder dysfunction caused by intervertebral disk hernia. METHODS: Thirty patients with neurogenic bladder dysfunction caused by intervertebral disk hernia were divided into three groups according to the category of detrusor muscle activity: neurogenic detrusor overactivity without detrusor sphincter dyssynergia (DSD), neurogenic detrusor overactivity with DSD, or detrusor underactivity. The patients were divided into three groups according to the condition of urinary retention and incontinence: urinary retention, urinary incontinence, or neither urinary retention nor urinary incontinence. Also they were divided into three groups according to the location of the intervertebral disk hernia: cervical hernia, thoracic hernia, or lumbar hernia. All patients underwent computer tomography (CT), magnetic resonance imaging (MRI), and urodynamic study. The results were analyzed statistically. RESULTS: There was significant correlation between the category of detrusor muscle activity, bladder compliance (BC, P < 0.05), and the pressure at maximum flow (P(det,Qmax), P < 0.01). There were significant differences in post void residual (PVR), cystometric capacity (CC), and maximum flow rate (Qmax) between the three groups of urinary retention, urinary incontinence, and the group of neither retention nor incontinence (P < 0.05). There was statistical correlation between the location of the intervertebral disk hernia and the urodynamic results. There was significant correlation between the BC (the threshold was 15 ml/cmH(2)O), detrusor pressure (Pdet, the threshold was 40 cmH(2)O), DSD, the location of intervertebral disk hernia, and the upper urinary tract lesion (P < 0.01). CONCLUSIONS: Urodynamic studies are indispensable in the classification, diagnosis, treatment, and prognosis of the neurogenic bladder dysfunction caused by intervertebral disk hernia.

Adult↗
PubMed2006

Suppression of bladder reflex activity in chronic spinal cord injured cats by activation of serotonin 5-HT1A receptors.

The effects of 8-OH-DPAT (5-HT1A receptor agonist) and WAY100635 (5-HT1A receptor antagonist) on reflex bladder activity were investigated in alpha-chloralose anesthetized or conscious chronic spinal cord injured cats. The results were similar in both anesthetized and conscious animals. Cystometrograms revealed that 8-OH-DPAT (0.5 mg/kg, s.c.) significantly increased the bladder volume threshold for eliciting a large amplitude micturition contraction, but only slightly reduced the amplitude of the contractions and did not alter the small amplitude pre-micturition contractions. 8-OH-DPAT also reduced the amplitude of isovolumetric bladder contractions. The inhibitory effect of 8-OH-DPAT was reversed by WAY100635 (0.5 mg/kg) or blocked by pre-treatment with WAY100635. Reflex bladder contractions evoked by tactile stimulation of the perigenital region were not altered by 8-OH-DPAT. These results suggest that the inhibitory effect of 8-OH-DPAT is mediated by an action on interneuronal pathways in the spinal cord or on the C-fiber afferent limb of the spinal micturition reflex and not on bladder smooth muscle or the efferent limb of the reflex pathway. Drugs that activate 5-HT1A receptors might be useful in treating detrusor overactivity after spinal cord injury.

8-Hydroxy-2-(di-n-propylamino)tetralin↗