Bladder attack: transient bladder ischemia leads to a reversible decrease in detrusor compliance

Tracey, Andrew; Anele, Uzoma A.; Vince, Randy; Speich, John E.; Klausner, Adam P.; Ratz, Paul H.

doi:10.21037/tau.2019.11.12

Cited by 3 publications

(5 citation statements)

References 23 publications

(33 reference statements)

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“…Temporary ischemia and flow return to basal levels after drainage in male Sprague Dawley rats, as a result of acute urine retention (Shimizu S, 2009). Transient bladder ischemia is believed to cause a temporary reduction in detrusor compliance (Tracey AT, 2019). In this particular instance, the patient is experiencing chronic urine retention as a result of multiple sclerosis (MS).…”

Section: Resultsmentioning

confidence: 99%

Low-Intensity Shockwave Treatment for Neurogenic Bladder With Chronic Urine Retention - Case Report

Tosev,

Vladeva,

Geil-Bierschenk

et al. 2024

MEDIS

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We present a case of neurogenic bladder accompanied by chronic urine retention in a patient diagnosed with multiple sclerosis (MS). This condition was effectively managed by low-intensity shockwave therapy (Li-ESWT). Low-intensity focused shockwave therapy (Li-ESWT) is becoming increasingly important in the treatment of urological problems. This case study investigates the feasibility and efficacy of using Li-ESWT to reduce post-void residual volume in persons with neurogenic bladder, representing the first examination of its sort. Bladder dysfunction (BD) frequently occurs in patients who have been diagnosed with multiple sclerosis (MS). Bladder dysfunction (BD) can occur due to the impairment of nerve impulses in the central nervous system regions involved for regulating bladder function and managing the contractions of the urinary sphincters, which is caused by the lesions associated with multiple sclerosis (MS). Urinary retention can cause various symptoms, including insufficient bladder emptying, urinary incontinence, frequent urinary tract infections, urosepsis resulting in the development of kidney abscesses due to localised kidney infection, and reduced kidney function. Optimal bladder function is essential for individuals with MS, as it plays a critical role in preserving kidney health, preventing urinary tract infections and incontinence, reducing the frequency of MS episodes, and improving their overall well-being. A 31-year-old woman was referred to our urology office with a chronic urinary tract infection caused by a neurogenic bladder with a significant volume of residual urine. A kidney abscess formation was identified as a complication. Li-ESWT, which stands for low-intensity extracorporeal shockwave therapy, was used as a part of a multimodal strategy to treat the urinary bladder. This treatment was delivered off-label. The therapy was given on a weekly basis for a period of 6 weeks. The procedure included administering 2500 shocks at a rate of four pulses per second, with an energy flux density (EFD) of 0.25 millijoules per square millimetre. The EFD (Energy Flux Density) used in our study exceeded 0.32 mJmm2,4, the fR (frequency rate) was set at 8 Hz (pulses per second), the treatment sessions consisted of 12 cycles of Li-ESWT (Low-Intensity Extracorporeal Shockwave Therapy), and a total of 3000 shocks were administered. At the intervals of one week, three months, six months, nine months, and twelve months following the administration of Li-ESWT and tadalafil 2.5 mg, the post-void residual (PVR) volume was consistently below 50 ml. The Li-ESWT treatment effectively reduced the post-void residual urine volume.Low-intensity extracorporeal shockwave therapy (Li-ESWT) can safely and efficiently decrease the amount of urine left in the bladder after voiding in individuals with neurogenic bladder caused by multiple sclerosis (MS). We have effectively demonstrated that Li-ESWT is a feasible and safe treatment for chronic urine retention, resulting in a decrease of post-void residual (PVR) volume from 200 ml to 50 ml. In the future, Li-ESWT has the potential to be advanced as a more efficacious alternative therapy for individuals experiencing chronic urinary retention. Further investigation is necessary to confirm the effectiveness of ESWT in addressing the neurogenic bladder.

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Section: Resultsmentioning

confidence: 99%

Low-Intensity Shockwave Treatment for Neurogenic Bladder With Chronic Urine Retention - Case Report

Tosev,

Vladeva,

Geil-Bierschenk

et al. 2024

MEDIS

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“…Additionally, acute ischemia in detrusor strips has been shown to increase the tone of the detrusor muscle, which is reversed with reperfusion. Interestingly, this increase in muscle tone was shown to be blocked with anticholinergics, which has been theorized to suggest a relationship between acute ischemia and increase local acetylcholine release (25).…”

Section: Discussionmentioning

confidence: 95%

“…This has been seen most well known in cardiac models, but has also been used in gastrointestinal models as well as pulmonary models (29)(30)(31)(32)(33). Recently this model has been used in the Urologic world to model bladder physiology and to be better understand (19)(20)(21)25,34,35). In previous porcine strip studies, it has been shown that the lamina propria also contracts, in conjunction with the detrusor muscle.…”

Section: Discussionmentioning

confidence: 99%

Phases of decompensation during acute ischemia demonstrated in an ex vivo porcine bladder model

Swavely¹,

Cullingsworth²,

Nandanan³

et al. 2020

Transl Androl Urol

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Background: The aim of this project was to develop an ex-vivo porcine bladder model to test the effects of increasing durations of acute ischemia on detrusor function.Methods: Porcine bladders were perfused through bilateral vesical arteries at physiologic flow (4 mL/min) and filled through a urethral catheter. Intravesical pressures were continuously recorded using standard urodynamics equipment. Bladder contractions, with simulated voiding, were induced by arterial infusion of KCl at 250 mL. Total, passive, and active pressures were recorded for each contraction and data were normalized to the control fill. Bladders underwent the following perfusion protocol by adjusting the arterial flow rates: Equilibration (4 mL/min), control (4 mL/min), partial ischemia (2 mL/min), global ischemia (0 mL/min) and reperfusion (4 mL/min). Perfusion periods were held for 15 min for one group and 30 min for another group of bladders.Results: Porcine bladders (N=19) including 8 (15 min group) and 11 (30 min group) were used. With 15 min ischemia, passive pressure increased 39% (P=0.03) and the active pressure decreased 23% (P=0.002). Total pressure remained constant, identifying a compensated phase. Values returned to baseline with reperfusion.With 30 min ischemia, passive pressure remained unchanged. However, there was a decrease in total pressure 34% (P<0.001) and active pressure 61% (P<0.001), which incompletely recovered to baseline values, identifying a decompensated phase with incomplete recovery upon reperfusion. Conclusion:In the porcine bladder, 15 min ischemia resulted in a compensated phase and 30 min ischemia resulted in a decompensated phase of detrusor function. This study provides mechanistic insight into the natural history of ischemia-mediated voiding dysfunction.

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“…As previously described (24)(25)(26)(27)(28), bladders for this study were procured from local abattoirs immediately after slaughter. Experiments were performed and granted exempt status after review by the Virginia Commonwealth University institutional care and use committee because the animals were already deceased at time of tissue harvest.…”

Section: Bladder Harvestingmentioning

confidence: 99%

“…An infusion catheter was inserted in the urethra to fill the bladder, which was filled to 250 mL at a rate of 50 mL/min, allowing for sufficient size for image collection (Figure 1A). This volume was selected based on our previously published experiments and those of others (14,(24)(25)(26)(27)(28). During dye infusion, the (25).…”

Section: Filling and Dyingmentioning

confidence: 99%

A preliminary study of bilateral color mapping of pig bladder vasculature demonstrates potential for acute hemi-ischemic events

Cullingsworth¹,

Nandanan²,

Swavely³

et al. 2021

Transl Androl Urol

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Background: Chronic ischemia is a known risk factor for the development of lower urinary tract symptoms (LUTS) and bladder hypocontractility. Less is known, however, about the impact of acute ischemia. Classic teaching suggests that collateral circulation is robust in the bladder and, therefore, loss of a single source of blood flow should have no deleterious effect. This study aims to provide visual evidence that segmental vascular supply is critical for maintaining adequate perfusion to the bladder.Methods: Ex vivo pig bladders were cannulated bilaterally in the superior vesical arteries and perfused using contrasting red and green dye. Images were collected at each step of the perfusion dyeing process and these images were analyzed using a custom program to calculate the average hue of each side. Statistical analysis was performed using Student's t-test. Results:The two halves being perfused by separate arteries showed a statistically significant difference when compared (P<0.05) on both the outer wall (n=9) and in the mucosal layer (n=4). On the outside wall, the average normalized hue of the green halves was 27.5°±14.3°, while the average normalized hue of the red halves was −58.7°±3.1°. In the mucosa, the average normalized hue of the green halves was 34.5°±17.4°, while the average normalized hue of the red halves was −51.5°±3.5°.Conclusions: This study identified a novel color mapping method to study pig bladder vascular supply.The results demonstrated a lack of collateral blood flow, highlighting the possibly of acute hemi-ischemic event. However, further research in the effect of acute ischemia on bladder function is necessary.

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Bladder attack: transient bladder ischemia leads to a reversible decrease in detrusor compliance

Cited by 3 publications

References 23 publications

Low-Intensity Shockwave Treatment for Neurogenic Bladder With Chronic Urine Retention - Case Report

Low-Intensity Shockwave Treatment for Neurogenic Bladder With Chronic Urine Retention - Case Report

Phases of decompensation during acute ischemia demonstrated in an ex vivo porcine bladder model

A preliminary study of bilateral color mapping of pig bladder vasculature demonstrates potential for acute hemi-ischemic events

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