Association of lower urinary tract symptoms and chronic ischaemia of the lower urinary tract in elderly women and men: assessment using colour Doppler ultrasonography

Pinggera, Germar-Michael; Mitterberger, Michael; Steiner, Eberhard; Pallwein, Leo; Frauscher, Ferdinand; Aigner, Friedrich; Bartsch, Georg; Strasser, Hannes

doi:10.1111/j.1464-410x.2008.07587.x

Cited by 133 publications

(133 citation statements)

References 29 publications

(48 reference statements)

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“…Belenky et al [27] found that detrusor RI significantly increased in patients with LUTS and BPO compared to those without BPO. In a study using color Doppler ultrasound, decreased perfusion of the bladder neck and prostate was observed in the elderly with LUTS [14]. In rat chronic bladder ischemia models, β 3 -adrenoreceptor agonist mirabegron and coenzyme Q-10 were reported to have protective effects on bladder function [28,29].…”

Section: Discussionmentioning

confidence: 99%

“…Even if older women are less prone to the development of bladder outlet obstruction, sometimes they may have LUTS. These observations suggest that the pathophysiological basis of LUTS is independent of gender and associated with age-related changes in vascular and neural structures of the lower urinary tract, and the urothelium or smooth muscle [14]. Vascular diseases common in the elderly may cause LUTS by chronic bladder ischemia [20].…”

Section: Discussionmentioning

confidence: 99%

“…In addition, it has been found that prostatic RI is positively correlated with IPSS and negatively with Q max in patients with LUTS/BPH [12,13]. In subsequent studies, α-blocker therapy has been found to improve the decreased bladder blood flow in patients with LUTS/BPH [14,15]. In the present study, the effects of both medical and surgical therapies on bladder and prostatic RIs were evaluated in patients with LUTS/BPH.…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Effects of Medical Therapy or Surgery on Prostatic and Bladder Resistive Indices in Patients with Benign Prostatic Hyperplasia

Bulut¹,

Özden²,

Aktaş³

et al. 2014

Urol Int

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Introduction: The effects of medical therapy or surgery on bladder and prostatic resistive indices (RIs) in patients with lower urinary tract symptoms suggestive of benign prostatic hyperplasia (LUTS/BPH) were evaluated in the present study. Patients and Methods: A total of 124 consecutive LUTS/BPH patients who were candidates for medical therapy (alfuzosin 10 mg once daily, n = 66) or surgery (transurethral prostatectomy (TUR-P), n = 58) were prospectively included. Baseline assessment of patients was performed with the International Prostate Symptom Score (IPSS), maximum urinary flow rate (Q_max), and prostatic and bladder RIs measured using power Doppler imaging (PDI). All patients were re-evaluated 3 months after treatment measuring the same parameters. Results: Following medical therapy, mean IPSS (17.2 ± 5.1 vs. 8.3 ± 5.3, p = 0.0001), postvoiding residual (PVR) urine (80.0 ± 80.5 vs. 40.3 ± 38.6, p = 0.0001), and prostatic RI (0.73 ± 0.1 vs. 0.70 ± 0.1, p = 0.0001) were decreased, Q_max (13.7 ± 4.2 vs. 16.9 ± 5.9, p = 0.0001) was increased, and bladder RI remained unchanged (0.70 ± 0.1 vs. 0.70 ± 0.1, p = 0.68). Mean IPSS (25.3 ± 5.6 vs. 6.0 ± 4.5, p = 0.0001), PVR urine volume (134.5 ± 115.5 vs. 35.7 ± 25.9, p = 0.0001), and prostatic (0.78 ± 0.1 vs. 0.67 ± 0.04, p = 0.0001) and bladder RIs (0.72 ± 0.1 vs. 0.64 ± 0.04, p = 0.005) were decreased, and Q_max (8.0 ± 4.5 vs. 17.2 ± 8.2, p = 0.0001) was increased after TUR-P. Conclusions: Our results demonstrated that TUR-P decreased both prostatic and bladder RIs, while α-blocker therapy did not change bladder RI in the early posttreatment period in LUTS/BPH patients.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Effects of Medical Therapy or Surgery on Prostatic and Bladder Resistive Indices in Patients with Benign Prostatic Hyperplasia

Bulut¹,

Özden²,

Aktaş³

et al. 2014

Urol Int

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“…The vascular supply to the human genitourinary tract, including the bladder, prostate, urethra and penis, is primarily derived from the iliac arteries, and atherosclerotic obstructive changes distal to the aortic bifurcation will have consequences for the distal vasculature and for lower urinary tract blood flow [Yamaguchi et al 2014]. Pinggera and colleagues [Pinggera et al 2008b] found that elderly patients with LUTS had a significant decrease in bladder blood flow in comparison with asymptomatic young individuals. These studies suggest that arterial occlusive disease and concomitant chronic bladder ischemia may produce bladder dysfunction, including detrusor overactivity (DO).…”

Section: Introductionmentioning

confidence: 99%

Pharmacological treatment of chronic pelvic ischemia

Andersson

Nomiya

Sawada

et al. 2014

Therapeutic Advances in Urology

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Abstract:Epidemiological studies have shown that lower urinary tract symptoms, including overactive bladder, commonly occur in both men and women, with an age-related increase in both sexes. Vascular endothelial dysfunction and urological symptoms are common in the metabolic syndrome; they also occur during the human ageing process and are independent risk factors for the development of atherosclerosis and hypertension. Pelvic arterial insufficiency may lead to impaired lower urinary tract perfusion and play an important role in the development of bladder dysfunction such as detrusor overactivity and overactive bladder. It seems reasonable, but has not been definitely established clinically, that chronic ischemiarelated bladder dysfunction will progress to bladder underactivity. Studies in experimental models in rabbits and rats have shown that pelvic arterial insufficiency may result in significant bladder ischemia with reduced bladder wall oxygen tension, oxidative stress, increased muscarinic receptor activity, ultrastructural damage, and neurodegeneration. Several types of drug may be able to prevent some of these changes. Even if the α 1 -adrenoceptor blocker, silodosin, the phosphodiesterase type 5 inhibitor, tadalafil, the β 3 -α 1 -adrenoceptor agonist, mirabegron, and the free radical scavenger, melatonin, were unable to prevent the development of neointimal hyperplasia and consequent luminal occlusion in animal models, they all exerted a protecting effect on urodynamic parameters, and on the functional and morphological changes of the bladder demonstrable in vitro. The different mechanisms of action of the drugs suggest that many factors are involved in the pathogenesis of chronic ischemia-induced bladder dysfunction and can be targets for intervention. Since several of the agents tested are used clinically and effectively for relieving lower urinary tract symptoms, the results from animal models of chronic bladder ischemia seem to have translational value. Animal models may be of relevance for designing clinical studies to demonstrate if a certain drug may prevent progression of ischemia-related functional and morphological bladder changes.

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“…The incidence of these effects increases with age (3). Transrectal colour Doppler ultrasound examination showed that bladder blood irrigation in elderly LUTS patients was significantly lower than in younger healthy controls, with no gender differences (4). In addition, α-receptor blocker (α-blocker) was reported to improve the chronic ischaemic conditions and symptoms in Treatment for chronic ischaemia-induced bladder detrusor dysfunction using bone marrow mesenchymal stem cells: An experimental study …”

Section: Introductionmentioning

confidence: 99%

Treatment for chronic ischaemia-induced bladder detrusor dysfunction using bone marrow mesenchymal stem cells: An experimental study

Song

Zhang²,

Zhang³

et al. 2011

Int J Mol Med

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Abstract. The mechanism of ischaemia-induced bladder dysfunction is not entirely clear, but is thought to be a result of the ischaemia-related M-receptor hypersensitivity to acetylcholine. In addition to nerve injury, ischaemia may cause bladder detrusor fibrosis and urethra de-epithelialization. Bladder dysfunctions caused by bladder outlet obstruction (BOO) and aging detrusor were considered to be associated with chronic ischaemia. To date, there has been no effective treatment for the histological and functional changes of the bladder caused by bladder ischaemia. The present study evaluated the feasibility and effectiveness of using bone marrow mesenchymal stem cells in the treatment of chronic ischaemia-induced bladder detrusor dysfunction in an experimental model. Bone marrow mesenchymal stem cells from Sprague-Dawley (SD) rats were injected into the common iliac artery of experimental animals, then bilateral iliac arteries were ligated and doxazosin mesylate was intragastrically administered. Eight weeks later, urodynamic examination and intravesical pressure measurements were performed on experimental animals. Histological changes of the taken bladder from sacrificed SD rats were evaluated by immunohistochemistry and trichrome staining and the images captured were analyzed by a software program. The average intravesical pressure and detrusor contraction power of the ischaemia group was 16.21±5.26 and 17.26±5.72; those of the experimental group were 24.02±10.06 and 25.84±11.99; the average intravesical pressure and detrusor contraction power of the control group was 28.56±4.48 and 29.57±5.01. The average intravesical pressure and detrusor contraction power of the ischaemia group were significantly lower than those of the experimental and control group, while no significant difference was shown between the experimental and control groups. 5-Bromo-2'-deoxyuridine (BrdU) staining for the experimental group was positive. The percentage of the smooth muscle content in the bladder wall was (25.21±6.28)%, (49.38±6.32)% and (48.00±17.39)% for ischaemia, experimental and control group, respectively. The percentage of smooth muscle in the bladder wall of the ischaemia group was significantly lower than that of the experimental and control group, while no significant difference was observed between the experimental and control groups. The number of nerve fibers per high power field of the experimental group was significantly higher than that of the ischaemia group, but lower than the control group. In conclusion, the percentage of smooth muscle content and the number of nerve cells per high power field decreases in ischaemia bladder, with detrusor contractility decreased. Injection of stem cell suspension into the common iliac artery in rats with ischaemic bladder, followed by intragastric administration of doxazosin mesylate, makes transplanted stem cells regenerate in the bladder tissue, increases the percentage of smooth muscle content and nerve cells per high power field in the bladder wall, and improve bladder d...

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Association of lower urinary tract symptoms and chronic ischaemia of the lower urinary tract in elderly women and men: assessment using colour Doppler ultrasonography

Cited by 133 publications

References 29 publications

Effects of Medical Therapy or Surgery on Prostatic and Bladder Resistive Indices in Patients with Benign Prostatic Hyperplasia

Effects of Medical Therapy or Surgery on Prostatic and Bladder Resistive Indices in Patients with Benign Prostatic Hyperplasia

Pharmacological treatment of chronic pelvic ischemia

Treatment for chronic ischaemia-induced bladder detrusor dysfunction using bone marrow mesenchymal stem cells: An experimental study

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