Detrusor instability and low compliance may represent different levels of disturbance in peripheral feedback control of the micturition reflex

Petros, Peter

doi:10.1002/(sici)1520-6777(1999)18:2<81::aid-nau3>3.0.co;2-z

Cited by 45 publications

(71 citation statements)

References 20 publications

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“…5E). Premature micturition is associated with myogenic changes and indicates an unstable but not low-compliant detrusor in overactive bladder (24,28). Electrical coupling of BSMC allows transmission of stimuli to adjacent cells and consequently enhances the reactivity of the bladder to weaker stimulation (10,13).…”

Section: Discussionmentioning

confidence: 99%

Basic fibroblast growth factor causes urinary bladder overactivity through gap junction generation in the smooth muscle

Imamura¹,

Negoro²,

Kanematsu³

et al. 2009

American Journal of Physiology-Renal Physiology

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Overactive bladder is a highly prevalent clinical condition that is often caused by bladder outlet obstruction (BOO). Increased coupling of bladder smooth muscle cells (BSMC) via gap junctions has been hypothesized as a mechanism for myogenic bladder overactivity in BOO, although little is known about the regulatory system underlying such changes. Here, we report the involvement of basic fibroblast growth factor (bFGF) and connexin 43, a bladder gap junction protein, in bladder overactivity. BOO created by urethral constriction in rats resulted in elevated bFGF and connexin 43 levels in the bladder urothelium and muscle layer, respectively, and muscle strips from these bladders were more sensitive than those from sham-operated controls to a cholinergic agonist. In vitro bFGF treatment increased connexin 43 expression in cultured rat BSMC via the ERK 1/2 pathway. This finding was supported by another in vivo model, where bFGF released from gelatin hydrogels fixed on rat bladder walls caused connexin 43 upregulation and gap junction formation in the muscle layer. Bladder muscle strips in this model showed increased sensitivity to a cholinergic agonist that was blocked by inhibition of gap junction function with α-glycyrrhetinic acid. Cystometric analyses of this model showed typical features of detrusor overactivity such as significantly increased micturition frequency and decreased bladder capacity. These findings suggest that bFGF from the urothelium could induce bladder hypersensitivity to acetylcholine via gap junction generation in the smooth muscle, thereby contributing to the myogenic overactivity of obstructed bladders.

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Section: Discussionmentioning

confidence: 99%

Basic fibroblast growth factor causes urinary bladder overactivity through gap junction generation in the smooth muscle

Imamura¹,

Negoro²,

Kanematsu³

et al. 2009

American Journal of Physiology-Renal Physiology

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show abstract

“…In a 1993 experiment, the sequence of events in a group of patients who had urodynamically diagnosed detrusor overactivity (DO) and who lost urine with a provocative hand-washing test was found to be identical with what occurs during normal micturition, a sensation of urgency, followed by urethral relaxation, detrusor contraction, and urine loss [18]. In a 1999 experiment, a low compliance bladder was deemed consistent with a partially controlled prematurely activated micturition reflex, which worked via a chaotically (non-linear) controlled neurological feedback system [19]. In the same experiment, it was found possible, in some patients, to temporarily control DO with gentle support of the stretch receptors “S”, Fig.…”

Section: Part 1 the Dynamic Anatomy Of Normal Functionmentioning

confidence: 99%

REVIEW ARTICLES The Integral System

Petros

2011

cejurol3/2011

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The Integral System is a total care management system based on the Integral Theory which states ‘prolapse and symptoms of urinary stress, urge, abnormal bowel & bladder emptying, and some forms of pelvic pain, mainly arise, for different reasons, from laxity in the vagina or its supporting ligaments, a result of altered connective tissue’. Normal functionThe organs are suspended by ligaments against which muscles contract to open or close the their outlet tubes, urethra and anus. These ligaments fall naturally into a three-zone zone classification, anterior, middle, and posterior.DysfunctionDamaged ligaments weaken the force of muscle contraction, causing prolapse and abnormal bladder and bowel symptomsDiagnosisA pictorial diagnostic algorithm relates specific symptoms to damaged ligaments in each zone.TreatmentIn mild cases, new pelvic floor muscle exercises based on a squatting principle strengthen the natural closure muscles and their ligamentous insertions, thereby improving the symptoms predicted by the Theory. With more severe cases, polypropylene tapes applied through “keyhole” incision using special instruments reinforce the damaged ligaments, restoring structure and function. Problems that can be potentially addressed by application of the Integral System Urinary stress incontinenceUrinary urge incontinenceAbnormal bladder emptyingFacal incontinence and “obstructed evacuation” (“constipation”)Pelvic pain, and some types of vulvodynia and interstitial cystitisOrgan prolapse ConclusionsOrgan prolapse and symptoms are related, and both are mainly caused by laxity in the four main suspensory ligaments and perineal body. Restoration of ligament/fascial length and tension is required to restore anatomy and function.

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“…This creates a``spasm'' of the detrusor, something we observed during video studies on micturition [Petros and Bush, 1998]. It follows from this that each phasic pressure variation observed in urethral and bladder tracings also indicates the threshold point for activation of mechanisms attempting to control the micturition re¯ex [Petros, 1999]. It follows from this that each phasic pressure variation observed in urethral and bladder tracings also indicates the threshold point for activation of mechanisms attempting to control the micturition re¯ex [Petros, 1999].…”

mentioning

confidence: 79%

“…These parameters are natural derivatives from a musculoelastic external micturition control mechanism activated by the posterior striated muscles of the pelvic¯oor [Petros, 1999]. Such a system approach potentially addresses the major defect of conventional urodynamics, that it captures only a singular``snapshot'' of what is really a complex ongoing non-linear process.…”

mentioning

confidence: 99%

Comment on ?finite element models?a template for future urodynamics: Comparison of different computer models of the neural control system of the lower urinary tract,? Neurourol Urodynam (2000) 19:289-310

Petros

2001

Neurourol. Urodyn.

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Detrusor instability and low compliance may represent different levels of disturbance in peripheral feedback control of the micturition reflex

Cited by 45 publications

References 20 publications

Basic fibroblast growth factor causes urinary bladder overactivity through gap junction generation in the smooth muscle

Basic fibroblast growth factor causes urinary bladder overactivity through gap junction generation in the smooth muscle

REVIEW ARTICLES The Integral System

Comment on ?finite element models?a template for future urodynamics: Comparison of different computer models of the neural control system of the lower urinary tract,? Neurourol Urodynam (2000) 19:289-310

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