Therapeutic effect of Low intensity Extracorporeal Shock Wave Therapy (Li-ESWT) on diabetic bladder dysfunction in a rat model

Abstract

Objectives: Low intensity extracorporeal shock wave therapy (Li-ESWT) has proven to be effective and safe for the treatment of various urological disorders including erectile dysfunction and chronic pelvic pain syndrome. In this study, we elucidated the therapeutic effect and possible mechanisms of Li-ESWT on diabetic bladder dysfunction (DBD) in a rat model. Materials and Methods: In all, thirty-two female Sprague-Dawley rats were divided into three groups: normal control (NC), diabetes mellitus (DM) control, and DM Li-ESWT. The two DM groups were given high fat diets for one month, followed by 2 intraperitoneal injections of streptozotocin (STZ) 30 mg/kg separated by one week. Body weight and fasting blood glucose were monitored every week. Only rats with fasting blood glucose 140 mg/dL or more were considered diabetic and used in the subsequent portions of the study. The Li-ESWTs were applied toward the pelvis of the rats twice a week for 4 weeks with energy flux density (EFD) 0.02 mJ/mm 2 , 500 shocks, at 3Hz. All rats underwent plasma insulin tolerance test, conscious cystometry, leak-point pressure (LPP) assessment, and immunohistochemical studies. Results: DM groups had significantly lower insulin sensitivity and higher body weight. Conscious cystometry also revealed voiding dysfunctions. In the DM Li-ESWT group, the rats had significantly improved voiding functions that were reflected in longer micturition intervals and higher LPP compared to DM control. Immunofluorescence in DM control groups showed increased tyrosine hydroxylase (TH) expression and decreased neuronal nitric oxide synthase (nNOS) expression in the longitudinal urethral smooth muscles. Besides, rats had dilations and deformities of suburothelium capillary network of the bladder, revealing the deterioration of the nerve function of the urethra and destruction of the vascularization of the bladder. However, the DM Li-ESWT group exhibited recovery of the nerve expression of the urethra and vascularization of bladder. Conclusions: Li-ESWT ameliorates the bladder dysfunction and urinary continence in the DBD rat model, reflected in restoration of the nerve expression of the urethra and the vascularization of the bladder. Non-invasive Li-ESWT could be an alternative therapeutic option for DBD.

Effect of Electroacupuncture on Bladder Dysfunction via Regulation of MLC and MLCK Phosphorylation in a Rat Model of Type 2 Diabetes Mellitus

“…Moreover, this state appeared 1 week after the STZ injection and lasted 3 months. Currently, research on DBD is mostly carried out in the eighth week after the successful establishment of a diabetic rat model [ 40 , 41 ]. Therefore, in this study, STZ–HFD was selected to induce T2DM, and the evaluation was conducted after 8 weeks of feeding.…”

Low-Energy Shock Wave Plus Intravesical Instillation of Botulinum Toxin A for Interstitial Cystitis/Bladder Pain Syndrome: Pathophysiology and Preliminary Result of a Novel Minimally Invasive Treatment

“…Recent animal and human studies have shown that LESW can be applied to treat several different bladder disorders by using therapeutic effects to increase vasculature, reduce inflammation, and facilitate reinnervation. LESW also ameliorates bladder dysfunction and urinary continence in a rat model of diabetic bladder dysfunction, and the results showed that LESW can restore the nerve expression of the urethra and the vascularization of the bladder [ 78 , 79 ]. In a cryoinjury-induced detrusor underactivity rat model, LESW was shown to improve the composition of the bladder wall and hasten functional recovery [ 80 ].…”

Low-Intensity Extracorporeal Shock Wave Therapy Promotes Bladder Regeneration and Improves Overactive Bladder Induced by Ovarian Hormone Deficiency from Rat Animal Model to Human Clinical Trial

“…Clinical application of LiESWT for various urological disorders, such as ED [32][33][34][35][36], IC/BPS [40], diabetes-induced underactive bladder [42,43], OAB [38], and SUI [39], have been recently explored. Gruenwald et al implied the efficacy of LiESWT in severe ED patients who respond poorly to PDE5i therapy and suggested that LiESWT significantly improved erectile rigidity and sexual satisfactions [44].…”