Low-Intensity Extracorporeal Shock Wave Therapy Promotes Bladder Regeneration and Improves Overactive Bladder Induced by Ovarian Hormone Deficiency from Rat Animal Model to Human Clinical Trial

Abstract

Postmenopausal women with ovary hormone deficiency (OHD) are subject to overactive bladder (OAB) symptoms. The present study attempted to elucidate whether low-intensity extracorporeal shock wave therapy (LiESWT) alters bladder angiogenesis, decreases inflammatory response, and ameliorates bladder hyperactivity to influence bladder function in OHD-induced OAB in human clinical trial and rat model. The ovariectomized (OVX) for 12 months Sprague–Dawley rat model mimicking the physiological condition of menopause was utilized to induce OAB and assess the potential therapeutic mechanism of LiESWT (0.12 mJ/mm2, 300 pulses, and 3 pulses/second). The randomized, single-blinded clinical trial was enrolled 58 participants to investigate the therapeutic efficacy of LiESWT (0.25 mJ/mm2, 3000 pulses, 3 pulses/second) on postmenopausal women with OAB. The results revealed that 8 weeks’ LiESWT inhibited interstitial fibrosis, promoted cell proliferation, enhanced angiogenesis protein expression, and elevated the protein phosphorylation of ErK1/2, P38, and Akt, leading to decreased urinary frequency, nocturia, urgency, urgency incontinence, and post-voided residual urine volume, but increased voided urine volume and the maximal flow rate of postmenopausal participants. In conclusion, LiESWT attenuated inflammatory responses, increased angiogenesis, and promoted proliferation and differentiation, thereby improved OAB symptoms, thereafter promoting social activity and the quality of life of postmenopausal participants.

Exploratory Metabolomic Analysis for Characterizing the Metabolic Profile of the Urinary Bladder under Estrogen Deprivation

“…The decrease in bladder weight has also been observed in previous ovariectomy rat and rabbit models, and the reasons may be related to muscle atrophy and collagen fiber substitution [21][22][23][24]. Although this study did not deeply investigate the bladder function, the susceptibility to OAB and UTI caused by the ovariectomy animal model has been widely confirmed [7,[25][26][27]. It is well-known that estrogen receptors are widely distributed in the bladder [28], and obviously, estrogen can to some extent regulate bladder function.…”

Use of the Shock Wave Therapy in Basic Research and Clinical Applications—From Bench to Bedsite

“…These clinical findings have been confirmed in a recently published meta-analysis [27] regarding the therapy of patients with a chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS). Additionally, similar encouraging clinical outcomes of SWT have been reported regarding the therapy of overactive bladder syndrome (OAB) [28,29]. Attenuated inflammatory responses, enhanced angiogenesis protein expression, and the elevated protein phosphorylation of ErK1/2, P38, and Akt along with areversion of mitochondria function dysregulation [30] seems to play a crucial role in these processes.…”

Effects of Therapeutic Platelet-Rich Plasma on Overactive Bladder via Modulating Hyaluronan Synthesis in Ovariectomized Rat

“…Physiological metabolic cage studies for micturition pattern, as previously described [64,76] were performed at the end of the experiment. Rats were placed in individual KDS-TL380 metabolic cages (ADInstruments, Colorado Springs, CO, USA) and maintained for a 24 h familiarization period, and then the micturition frequency and volume of urine output were measured with a cup especially fitted to the MLT0380 transducer (ADInstruments, Colorado Springs, CO, USA).…”