Are blood vessels a target to treat lower urinary tract dysfunction?

Abstract

Bladder dysfunction is common in the general population (Stewart et al. 2010) and even more so among patients seeing a physician for any reason (Goepel et al. 2002). It often manifests as lower urinary tract symptoms (LUTS), a term originally coined to describe voiding and storage symptoms in men with benign prostatic hyperplasia (BPH) but now more universally used to describe any type of voiding and storage symptoms in both sexes. Studies into possible causes of urinary bladder dysfunction have long focused on detrusor smooth muscle cells (Turner and Brading 1999). More recently, it became clear that several other types of cells and organs contribute to regulating detrusor smooth muscle function. These include the urothelium (Andersson and McCloskey 2014; Michel 2015), afferent nerves (Michel and Igawa 2015; Yoshimura et al. 2014b), and the central and autonomic nervous systems (Fowler and Griffiths 2010; Yoshimura et al. 2014a). Alterations in any of these may at least partly be responsible for detrusor dysfunction and, accordingly, be potential targets for the treatment of bladder dysfunction. As highlighted by an article in this issue of Naunyn-Schmiedeberg's Archives of Pharmacology (Bayrak et al. 2015), there is an additional suspect, the bladder vasculature. This article will discuss the currently available experimental and clinical evidence for a role of the vasculature in causing bladder dysfunction, and how existing and emerging treatments may modulate bladder function by acting on blood vessels. Due to a similarity in concept, data on prostate perfusion will also be discussed to some extent.

Frequency of common complications during treatment of patients with benign prostate hyperplasia

“…These calculi are secondary, mainly due to infection, with a basis that lies in the urinary tract. 6,[10][11][12][13][14][15][16][17][18][19][20] The bladder calculi were not verified in the patients presented in this study. Given that there were not many patients with a large amount of post-voiding RU and with long-term urinary infection due to the inclusion of adequate antibiotic therapy, as well as a limited time of this study, it is believed that this is the reason why this complication did not occur.…”

“…The causes of acute retention are complex: hyperdensity of detrusor muscle fibres, congestion and prostate infarction, sphincter spasm. 6,[10][11][12][13][14][15][16][17][18][19][20] According to one study performed in 300 patients, 231 (77 %) had different forms of retention during of BPH. Complete retention as the first sign of BPH, occurred in 52 (17.6 %) patients.…”

Where will the next generation of medical treatments for overactive bladder syndrome come from?

“…More recently proposed targets include P2X3 receptors, various members of the transient receptor potential family including TRPV1, TRPV4, TRPA1, TRPM4 and TRPM8, and components of the endocannabinoid system, such as fatty acid amide hydrolase . Furthermore, accumulating evidence from animal and patient studies points to a role of atherosclerosis as a predisposing or even causative factor in the development of OAB . However, these also have not proceeded to clinical trials.…”

“…41 Furthermore, accumulating evidence from animal and patient studies points to a role of atherosclerosis as a predisposing or even causative factor in the development of OAB. 42,43 However, these also have not proceeded to clinical trials. Apparently, ligands for none of these potential targets appear to be in clinical development by major pharmaceutical companies.…”

Naunyn-Schmiedeberg’s Archives of Pharmacology under new editorship: change and continuity

“…Martin introduced several new features into the journal such as theme issues (Gomsyan and Szallasi 2015;Hsu et al 2015), comprehensive non-clinical single compound reviews (Modjtahedi et al 2014;Michel et al 2015a), editorials (Michel et al 2015b;Seifert 2015a), debates (Seifert 2014;Gao and Vanhoutte 2014), letters to the editor (Michel-Reher and Michel 2015), and meeting reports (Friebe et al 2015;Heifetz et al 2015;, stimulating scientific exchange. Papers in these sections are downloaded very frequently.…”