Factors associated with voiding function in women with lower urinary tract symptoms: A mathematic model explanation

Yang, Jenn Ming; Huang, Wen Chen

doi:10.1002/nau.10086

Cited by 10 publications

(3 citation statements)

References 18 publications

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“…2 In addition, straining at voiding may be pathophysiological or represent a voiding habit that is not necessarily pathologic. 3,4 Studies in humans 2,4,5 have shown that in female subjects with lower urinary tract symptoms, straining at voiding is associated with urodynamic parameters that signify urethral obstruction. When the bladder is full voiding may be autonomous without the contribution of abdominal strain.…”

Section: Introductionmentioning

confidence: 99%

Simultaneous registration of intraabdominal and intravesical pressures during cystometry in conscious rats—Effects of bladder outlet obstruction and intravesical PGE₂

Lee

Andersson

Streng

et al. 2007

Neurourology and Urodynamics

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Aims: A method was developed and evaluated to simultaneously register intraabdominal pressure (IAP) and intravesical pressure (IVP) during cystometry in conscious rats. In addition, IAP and IVP were recorded in rats with experimental detrusor overactivity (DO). Methods: Sprague Dawley rats (n ¼ 24) were used. Six female rats were subjected to partial bladder outlet obstruction for 2 weeks. A catheter was implanted into the bladder to record the IVP, and a balloon-fitted catheter was positioned in the abdominal cavity to record the IAP. PGE 2 was given intravesically to induce DO. Detrusor pressure (DP) was defined as the IVP corrected for IAP. Results: Recorded as increases in IAP, all rats of both sexes exhibited abdominal straining during every void. In controls, a maximal IAP of 6.0 AE 1.4 cmH 2 O (range 3-15 cmH 2 O) was registered (n ¼ 12) at the time of the flow pressure (FP). Intravesical administration of PGE 2 or BOO did not affect the IAP at basal pressure, FP or micturition pressure. Changes in IAP due to movement or non-voiding-related straining were subtracted from IVP to generate DP and to visualize DO after BOO or intravesical PGE 2 . Conclusions: The conscious rat uses abdominal straining during voiding, and maximal IAP is recorded at the onset of urinary flow. Simultaneous registration of IAP and IVP during the micturition cycle in conscious rats is a convenient method for accurate quantification of pressures inside the bladder and for studying ''true'' DO without interference from movement artifacts. Neurourol. Urodynam. 27:88-95, 2008. ß 2007 Wiley-Liss, Inc.

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Section: Introductionmentioning

confidence: 99%

Simultaneous registration of intraabdominal and intravesical pressures during cystometry in conscious rats—Effects of bladder outlet obstruction and intravesical PGE₂

Lee

Andersson

Streng

et al. 2007

Neurourology and Urodynamics

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“…This age bias is to be anticipated considering many abnormalities of the urinary tract are age-related, and in particular urethral function may be altered due to a decline in circulating estrogen after menopause. 13,14 Imaging had a high NPV but poor PPV, indicating that imaging may be useful in contributing to a decision not to perform cystoscopy if normal. Clinical risk factors were less helpful in determining who should have cystoscopy, but in the absence of risk factors and combined with normal imaging studies, no woman had an abnormal cystoscopy in this study.…”

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confidence: 99%

Cystoscopy in women with recurrent urinary tract infection

et al. 2006

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Objective: To investigate if women with recurrent urinary tract infection (UTI) warrant cystoscopy to exclude an abnormality of the lower urinary tract. This is particularly relevant given that non-invasive imaging has often been performed to exclude abnormality. Our further aims were to correlate imaging and risk factors with cystoscopic findings to determine their predictive value in finding pathology. Patients and methods: A database of women undergoing cystoscopy with recurrent UTI has been maintained at our institution for 10 years. We retrospectively examined this and patient records for patient demographics, and investigative and operative data. Results: A total of 118 patients (mean 55 years) having recurrent UTI (mean 4.7 infections/year) were available. There were nine patients (8%) with significant abnormalities at cystoscopy: urethral stricture (six), bladder calculus (one), bladder diverticulum (one) and colovesical fistula (one). The negative predictive value (NPV) of imaging was 99% and significant (P < 0.01). Women with no risk factors for UTI had a NPV of 93% for normal cystoscopy (P > 0.05). The positive predictive value was low for imaging and risk factors in predicting cystoscopy findings. Conclusions: In our study, 8% of women had significant abnormalities detected during cystoscopy with most over 50 years. Women without risk factors for recurrent UTI and with normal imaging could have a cystoscopy omitted. Younger women are less likely to have pathology and this must be factored into decisions to perform cystoscopy.Key words cystoscopy, female, recurrence, urinary tract infections, urological diagnostic techniques. ObjectiveThe current incidence of cystitis amongst premenopausal sexually active women is 0.5-0.7 infections/person year. Further, 20% of women will have a urinary tract infection (UTI) in their lifetime with 3% having recurrent infection. The majority of infections are asymptomatic and clear spontaneously. [1][2][3][4] For definitional purposes, recurrent UTI refers to more than three infections in 1 year.5 Recurrent infections are due to either reinfection or bacterial persistence. Reinfection is recurrent infection with different bacteria from outside the urinary tract. Each infection is a new agent; the urine must show no growth after the preceding infection. Relapse is frequently used interchangeably. 6 Of those having recurrent UTI, up to 99% will have reinfections as opposed to bacterial persistence. 2A small number of women with recurrent UTI will have abnormalities of the urinary tract from kidney to urethra including calculi, urethral stricture and other lesions that may become a nidus for infection or interfere with adequate voiding (Table 1). In such individuals it is important to identify structural abnormalities of the urinary tract responsible for recurrent UTI.2 Thus the basis for radiologic or urologic investigation of women with recurrent UTI is to exclude abnormalities of the genitourinary tract that if uncorrected could result in future morbidity.However, most...

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“…Abdominal muscle straining during voiding in humans is usually considered to be a symptom of bladder outflow obstruction [ 20 , 21 ]. However, clinical observations have failed to demonstrate a consistent relationship between abdominal straining and micturition in healthy subjects or in those with bladder outlet obstruction, suggesting the possibility of nonpathological muscle activity [ 4 , 22 , 23 ]. The maintenance of abdominal pressure has also been later proven to be an important factor in promoting vesical contraction in humans [ 24 ], as well as in animal investigations that confirmed the function of abdominal musculature in improving voiding efficiency [ 5 , 6 ].…”

Section: Discussionmentioning

confidence: 99%

Synergistic Activities of Abdominal Muscles Are Required for Efficient Micturition in Anesthetized Female Mice

Zhang¹,

Zhang²,

Cruz³

et al. 2018

Int Neurourol J

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PurposeTo characterize the electromyographic activity of abdominal striated muscles during micturition in urethane-anesthetized female mice, and to quantitatively evaluate the contribution of abdominal responses to efficient voiding.MethodsCystometric and multichannel electromyographic recordings were integrated to enable a comprehensive evaluation during micturition in urethane-anesthetized female mice. Four major abdominal muscle domains were evaluated: the external oblique, internal oblique, and superior and inferior rectus abdominis. To further characterize the functionality of the abdominal muscles, pancuronium bromide (25 μg/mL or 50 μg/mL, abdominal surface) was applied as a blocking agent of neuromuscular junctions.ResultsWe observed a robust activation of the abdominal muscles during voiding, with a consistent onset/offset concomitant with the bladder pressure threshold. Pancuronium was effective, in a dose-dependent fashion, for partial and complete blockage of abdominal activity. Electromyographic discharges during voiding were significantly inhibited by applying pancuronium. Decreased cystometric parameters were recorded, including the peak pressure, pressure threshold, intercontractile interval, and voiding duration, suggesting that the voiding efficiency was significantly compromised by abdominal muscle relaxation.ConclusionsThe relevance of the abdominal striated musculature for micturition has remained a topic of debate in human physiology. Although the study was performed on anesthetized mice, these results support the existence of synergistic abdominal electromyographic activity facilitating voiding in anesthetized mice. Further, our study presents a rodent model that can be used for future investigations into micturition-related abdominal activity.

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Factors associated with voiding function in women with lower urinary tract symptoms: A mathematic model explanation

Cited by 10 publications

References 18 publications

Simultaneous registration of intraabdominal and intravesical pressures during cystometry in conscious rats—Effects of bladder outlet obstruction and intravesical PGE₂

Simultaneous registration of intraabdominal and intravesical pressures during cystometry in conscious rats—Effects of bladder outlet obstruction and intravesical PGE₂

Cystoscopy in women with recurrent urinary tract infection

Synergistic Activities of Abdominal Muscles Are Required for Efficient Micturition in Anesthetized Female Mice

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Factors associated with voiding function in women with lower urinary tract symptoms: A mathematic model explanation

Cited by 10 publications

References 18 publications

Simultaneous registration of intraabdominal and intravesical pressures during cystometry in conscious rats—Effects of bladder outlet obstruction and intravesical PGE2

Simultaneous registration of intraabdominal and intravesical pressures during cystometry in conscious rats—Effects of bladder outlet obstruction and intravesical PGE2

Cystoscopy in women with recurrent urinary tract infection

Synergistic Activities of Abdominal Muscles Are Required for Efficient Micturition in Anesthetized Female Mice

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Product

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Simultaneous registration of intraabdominal and intravesical pressures during cystometry in conscious rats—Effects of bladder outlet obstruction and intravesical PGE₂

Simultaneous registration of intraabdominal and intravesical pressures during cystometry in conscious rats—Effects of bladder outlet obstruction and intravesical PGE₂