Search

Purpose: To compare the diagnostic ability of traditional radiographic urethrography and magnetic resonance urethrography (MRU) for iatrogenic bladder outlet obliteration (BOO), and explore the efficacy and complications of laparoscopic modified Y-V plasty for patients selected based on MRU evaluation., Methods: 31 patients with obliteration segments ≤ 2 cm and no false passages or diverticula based on MRU evaluation from eight centers in China were included. Obliteration segments were measured preoperatively by MRU and conventional RUG/VCUG and compared with intra-operative measurements. Surgical effects were evaluated by uroflow rates, urethrography, or cystoscopy at 1, 3, 6, and 12 months post-operation and then every 12 months. Postoperative urinary continence was assessed by 24-h urine leakage (g/day)., Results: The results showed that MRU measured the length of obliteration more accurately than RUG/VCUG (MRU 0.91 ± 0.23 cm, RUG/VCUG 1.72 ± 1.08 cm, Actual length 0.96 ± 0.36 cm, p < 0.001), and clearly detected false passages and diverticula. Laparoscopic Y-V plasty was modified by incisions at 5 and 7 o'clock positions and double-layer suture with barbed sutures. All operations were successfully completed within a median time of 75 (62-192) minutes and without any complications. Urethral patency and urinary continence rates were 90.3% (28/31) and 87.1% (27/31), respectively. Three recurrences were cured by direct visual internal urethrotomy. Four patients had stress urinary incontinence after catheter removal 14 days post-operation, with urine leakage of 80-120 g/day, not relieved during follow-up., Conclusions: Laparoscopic modified Y-V plasty based on MRU evaluation is a promising approach for iatrogenic BOO, with a high patency rate and a low incontinence rate., (© 2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

The aim of this study is to investigate the feasibility and efficacy of a novel biomimetic poly-l-lactide (PLLA) nanofiber membrane in repairing anterior urethral strictures from both preclinic and clinic. Biomimetic PLLA membrane was fabricated layer by layer according to the structure of human extracellular matrix. Microstructure, tensile strength, and suture retention strength were fully assessed. Before the clinical application, the safety and toxicology test of the biomimetic PLLA membrane was performed in vitro and in experimental animals. The patients underwent urethroplasty used dorsal onlay or lateral onlay technique. Then, they were followed up for 1 month, 3 months, 6 months, and then annually after the surgery. The mechanical experiments showed well property for application. Biomimetic PLLA membrane was safe according to the in vitro and animal studies. Then, a total of 25 patients (mean age 48.96 years) were included in the study from September 2016 to December 2018. After a mean follow-up of 33.56 months, 20 patients successfully treated with biomimetic PLLA membrane. Five patients (2 bulbar and 3 penile) suffered postoperational urethral stricture recurrence. None of infection or urinary fistula or any other adverse events related to the use of biomimetic PLLA membrane were observed during the follow-up period for all patients. The preliminary result confirmed the feasibility and efficacy of the biomimetic PLLA membrane as a novel material for anterior urethral repair. The long-term effects with more patients should be investigated in further studies., Competing Interests: Kunxue Deng, Jing Zhang, and Haitao Zhang are the employees of Medprin Regenerative Medical Technologies Co. Ltd. (Guangzhou, China), which is provider of the biomimetic poly‐l‐lactide (PLLA) nanofiber membrane. The other authors declare no competing interests., (© 2022 The Authors. Bioengineering & Translational Medicine published by Wiley Periodicals LLC on behalf of American Institute of Chemical Engineers.)

Lower urinary tract (LUT) dysfunction is the most common complication of diabetes mellitus (DM). An involvement of the 5-HT 2A receptor in spinal micturition control has been demonstrated in urethane anaesthetized DM rats in which i.v. administration of the 5-HT 2A/2C receptor agonist 2,5-methoxy-4-iodoamphetamine (DOI), stimulated high frequency oscillations (HFOs) and improved micturition. However, the mechanisms involved in these effects are not completely understood. The present work showed that 5-HT 2A and -2C receptors were upregulated in lumbosacral cord motoneurons, and the number of serotonergic paraneurons were downregulated in the urethra in DM group. The importance of the downregulation of urethral paraneurons in DM remains to be elucidated but may be related to the reduced urethral sensation caused by the disease. We suggest that targets of 5-HT receptor agonists for improvement of voiding function may be found both in the LUT and lumbosacral spinal cord., (Copyright © 2019 Elsevier B.V. All rights reserved.)

Objectives: To examine the effect of intrathecal (i.t.) serotonin (5-hydroxytryptamine) 5-HT 7 agonist administration on voiding function in the urethane-anesthetised rat, and the change in 5-HT 7 receptor (5-HT 7 R) expression in the lumbosacral cord Onuf's nucleus after spinal cord injury (SCI)., Materials and Methods: In all, 32 female Sprague-Dawley (SD) rats were equally divided into a spinally intact (SI) group and SCI group (n = 16 each). At 8 weeks after transection, half of the rats underwent continuous cystometry under urethane anaesthesia, and the 5-HT 7 R-selective agonist LP44 was given (i.t.). The remaining rats were used for pseudorabies (PRV) retrograde tracing, immunofluorescence, and Western Blot., Results: LP44 administered i.t. had no effect in the SI rats. In SCI rats, LP44 (1-30 μg/kg) induced significant dose-dependent increases in micturition volume, voiding efficiency, number of high-frequency oscillations per micturition; and decreases in residual volume, bladder capacity, peak bladder pressure, threshold pressure and non-voiding contractions. The 5-HT 7 R antagonist, SB-269970 (10 μg/kg), partially reversed LP44-induced changes. Using PRV retrograde tracing and immunofluorescence, 5-HT 7 Rs were found in the L6-S1 spinal cord Onuf's nucleus in both SI and SCI rats, but the expression was significantly greater in the SCI rats. Western blot showed significantly more 5-HT 7 Rs in the ventral L6-S1 spinal cord in SCI rats., Conclusion: A 5-HT 7 R agonist, given i.t., improved voiding efficiency in urethane-anesthetised SCI rats, and the 5-HT 7 R was significantly up-regulated in the lumbosacral cord Onuf's nucleus. If valid for humans, these findings suggest that the 5-HT 7 R could be a target for therapeutic interventions., (© 2018 The Authors BJU International © 2018 BJU International Published by John Wiley & Sons Ltd.)

Objectives: This study aimed to investigate the effects of ketanserin on micturition mediated via the 5-HT 2A receptor in the motoneuron nucleus of the Lumbosacral cord, as reflected in high frequency oscillations (HFOs) of intravesical pressure and the external urethral sphincter electromyogram (EUS-EMG) in anesthetized male rats. METHODS：: Male Sprague-Dawley rats were used. Cystometry and EUS-EMG were performed in all rats under urethane anesthesia to examine the variations after successive intrathecal (i.t.) administration of various doses of ketanserin into the lumbosacral cord. Immunofluorescence staining and Western blotting were made to observe the distribution of 5-HT2 A and -2C receptors in the lumbosacral cord motor neurons., Results: Compared to the controls, ketanserin-treated rats showed a declined trend of dose-dependent manner in the HFOs, in accordance with the variation of EUS-EMG, while decreased micturition volume, voiding efficiency, and increased post-void residual volume was only observed at the dose of 0.1 mg/kg. The effects of ketanserin on the HFO and EUS-EMG activity were partially or completely reversed by the 5-HT 2A/2C receptor agonist, DOI. Meanwhile, immunofluorescence staining and Western blot analysis showed that immunoreactivity of 5-HT 2A receptor was higher than that of 5-HT 2C, labeling in the lumbosacral cord motoneurons., Conclusions: The intrathecally administrated 5-HT 2A receptor antagonist ketanserin can weaken the EUS bursting activity, decrease HFOs, and reduce voiding efficiency as dose dependently. The effects of ketanserin on micturition may be mainly mediated via the 5-HT 2A receptors in the motoneuron nucleus of the lumbosacral cord., (Copyright © 2018 Elsevier B.V. All rights reserved.)

Aim: To investigate the value of repeat botulinum toxin A (BTX-A) injections in patients with neurogenic detrusor overactivity (NDO)., Methods: We searched the PubMed, EMBASE, and EBSCO databases for articles published until June 2016. Studies that reported the efficacy and safety of repeat BTX-A injections for adult patients with NDO were eligible. The effect size for each outcome was calculated as the standardized mean difference ± standard error and 95% confidence interval, and was graded as small, >0.2; moderate, >0.5; or large, >0.8. The outcomes included maximum cystometric capacity (MCC), maximum detrusor pressure (MDP), reflex volume (RV), bladder compliance (BC), quality of life (QOL), and injection interval. Descriptive reviews were performed for urinary incontinence (UI) and adverse events (AEs)., Results: Eighteen studies involving 1533 patients whose level of evidence ranged from 3 to 4 were included in this study. We noted non-significant changes in MCC, MDP, RV, and BC between the first and last injections. Patients who had received ≤4 injections were found to have stable QOL improvements after the first and last injections, whereas patients who had received ≥5 injections were found to have a significant decrease in QOL after the last injection. No significant differences in injection intervals were noted after repeat BTX-A injections, and the repeat injection failure rate was low., Conclusion: Our study demonstrated that repeat BTX-A injections allow sustained improvements in patients with NDO. The rate of AEs was stable and low. However, additional high-quality, large-scale, and long-term trials are necessary to establish the efficacy and safety of ≥5 repeat BTX-A injections., (© 2017 Wiley Periodicals, Inc.)

Electrical stimulation of peripheral nerves controlling the bladder is an alternative, nondestructive medical treatment for urinary incontinence and retention. In this study, we aimed to identify the most efficient sensory and motor spinal nerve roots involved in the micturition reflex. Unilateral L5-S2 dorsal and ventral roots were electrically stimulated, and bladder reflex contractions were recorded under isovolumetric conditions. Repeated stimulation of the L6 and S1 dorsal roots not only abolished bladder reflex contractions but also induced a poststimulation inhibitory effect, whereas repeated stimulation of the L5 and S2 dorsal roots had no effect. Only the L6 ventral root directly caused bladder contraction when ventral roots L5-S2 were stimulated in sequence. Upon retrograde tracing using pseudorabies virus (PRV), the sacral parasympathetic nucleus of the L6 segment had more PRV-positive cells than the other segments, though the S1 segment of the dorsal root ganglia had the highest density of PRV-positive neurons. These results suggest the L6 ventral root is most efficient in producing detrusor muscle contraction, and the S1 dorsal root best inhibits the micturition reflex., Competing Interests: CONFLICTS OF INTEREST The authors declare no competing financial interests.

Objectives: To investigate whether the voiding dysfunction caused by spinal cord injury (SCI) in rats can be improved by i.v. administration of the serotonin (5-HT) 2A/2C receptor agonist 2,5-dimethoxy-4-iodophenyl-2-aminopropanehydrochloride (DOI), and to discuss whether the mechanism can be ascribed to 5-HT 2A and 5-HT 2C receptor upregulation in lumbosacral cord motoneurons., Materials and Methods: Female Sprague-Dawley rats were divided into two groups (SCI group vs normal control [NC] group). Under urethane anaesthesia, cystometry was performed to examine the variation in urodynamic variables before and after successive intrathecal (i.t.) administration of various doses of DOI into the lumbosacral cord. Changes in 5-HT 2A and - 2C receptors in the lumbosacral cord were also investigated using immunohistochemical staining and Western blot analysis., Results: Compared with NC rats, the SCI rats had higher bladder capacity and post-void residual urine volume, and lower voiding efficiency. After SCI, DOI improved voiding efficiency, probably via external urethral sphincter (EUS) activity. Immunohistochemical staining and Western blot analysis showed that 5-HT 2A and - 2C receptors were upregulated in lumbosacral cord motoneurons., Conclusion: In rats with SCI, DOI can improve voiding efficiency; this may be attributable to 5-HT 2A and - 2C receptor upregulation in lumbosacral cord motoneurons controlling EUS activity., (© 2017 The Authors BJU International © 2017 BJU International Published by John Wiley & Sons Ltd.)

Objective: To investigate the age-related growth variation in prostatic parameters by transrectal ultrasound with a simultaneous evaluation of the transitional zone measurements in different prostate volumes., Methods: A retrospective study of 2001 subjects derived from the outpatient clinic at our institution (Shanghai Jiao Tong University Affiliated Sixth People's Hospital in Shanghai) who were diagnosed with benign prostatic hyperplasia (BPH) and prostatitis was reviewed. All subjects were evaluated by the International Prostatic Symptom Score and transrectal ultrasound of the prostate. Statistical analysis was conducted between prostatic parameters and age., Results: The prostate volume, index, length, and width of transitional zone were the parameters most closely associated with increasing age. Notably, the transitional zone measurements showed a significant difference among individuals greater than 50 years old. Moreover, the fastest increasing rate of prostatic parameters was found to be between the ages of 50 and 69. Additionally, we also discovered that the difference between transitional zone parameters and different prostate volumes varies along with increasing age., Conclusion: These results suggest that transitional zone growth is the main contributor to total prostate growth, especially at the ages of 50-69, which may elucidate the higher incidence of the lower urinary tract symptoms from BPH. In view of the increasing rate of transitional zone and the level of total prostate volume, further research is needed to identify the underlying mechanism for such differences in prostate growth., (Copyright © 2017 Elsevier Inc. All rights reserved.)

Objective: The purpose of this study was to evaluate the long-term efficacy and safety of laser vaporesection using the RevoLix(™) 70 W 2 μm continuous wave (CW) laser in the treatment of benign prostatic hyperplasia (BPH)., Background Data: From January 2008 to December 2008, 162 patients with BPH underwent vaporesection using 2 μm CW laser., Materials and Methods: The International Prostate Symptom Score (IPSS), quality of life (QoL), urinary flow rate (Qmax), post-voiding residual urine volume (PVR), and postoperative complications were observed at baseline and were followed at 3-, 6-, and 12-month intervals (range: 3-60 months)., Results: A total of 146 patients completed the 5-year follow-up. At 60 months postoperatively, the mean Qmax increased from 7.5 to 21.2 mL/sec, the mean PVR decreased from 94.3 to 9.4 mL, the mean IPSS score decreased from 20.4 to 6.6, and the mean QoL score decreased from 4.7 to 1.9. Complications included urinary tract infection (3.4%), urethral stricture rate (2.7%), and recurrent bladder outlet obstruction rate (2.1%). Overall, the reoperation rate was 3.4%, and no transurethral resection (TUR) syndrome or blood transfusion was reported., Conclusions: The 2 μm CW laser is a safe and effective option for the treatment of BPH. At the 5-year follow-up, the long-term clinical efficacy and safety are excellent, with low incidence of complications.

Objectives: To examine the effects of the serotonin (5-HT)2A/2C receptor agonist (2,5-dimethoxy-4-idophenyl)-2-aminopropane hydrochloride (DOI) on micturition in rats with diabetes mellitus (DM)., Methods: Female Sprague-Dawley rats (n = 16) were divided into two groups: rats with Type 1 DM and age-matched control rats. DM was induced by i.p. injection of streptozotocin (65 mg/kg) and detailed cystometrogram (CMG) studies were performed 8 weeks post-injection in all rats under urethane anaesthesia. The selective 5-HT2A antagonist ketanserin was administered after each DOI dose-response curve was plotted. All drugs were administered i.v., Results: Compared with controls, comprehensive urodynamic studies showed that DM rats had a higher bladder capacity and post-void residual urine volume (PVR), and a markedly lower voiding efficiency. In DM rats, DOI (0.01-0.3 mg/kg) induced significant dose-dependent increases in micturition volume and reductions in PVR, resulting in greater voiding efficiency. CMG measurements showed a dose-dependent increase in high-frequency oscillation (HFO) activity, evidenced by an increased duration of HFOs per voiding. This correlated with the improved voiding efficiency. Ketanserin (0.1 mg/kg) partially or completely reversed the DOI-induced changes., Conclusions: The HFOs observed in the present study seem to correlate with external urethral sphincter bursting activity during voiding. Bladder voiding efficiency was reduced in DM rats. The 5-HT2A receptor agonist can enhance HFO activity and improves voiding efficiency, and so may represent a new strategy to improve voiding efficiency after DM in experimental studies., (© 2014 The Authors BJU International © 2014 BJU International Published by John Wiley & Sons Ltd.)

Objective: To evaluate the safety and efficacy of the RevoLix 70W 2 micron continuous wave laser vaporesection in the treatment of high-risk patients with benign prostatic hyperplasia (BPH)., Background Data: Forty-six high-risk patients (mean age, 82.6 y old) with BPH underwent 2-μm continuous wave laser vaporesection., Materials and Methods: The operative time, drop in hemoglobin, drop in serum sodium, indwelling catheterization time, operative complications, international prostatic symptom scores (IPSS), quality of life (QoL), urinary flow rate (Qmax), and post voiding residual urine volume (PVR) were observed., Results: All 46 patients recovered without incident. The mean operative time was 68 ± 16.3 min. Occasional venous hemorrhage occurred during the operation, but no arterial hemorrhage was observed. Hemoglobin decreased from preoperative 15.0 g/dL to postoperative 14.3 g/dL, serum sodium decreased from preoperative 142.4 mmol/L to postoperative 141.6 mmol/L. IPSS decreased from preoperative 22 ± 6.2 to postoperative 9 ± 3.3, QoL scores decreased from 5.1 ± 0.7 to 2.1 ± 0.7, Qmax increased from 8.4 ± 5.2 to 21.2 ± 12.3 mL/sec, PVR decreased from 94.2 ± 60.2 to 21.6 ± 6.4 mL. The parameters were significantly different between pre- and postoperative results., Conclusions: The RevoLix 70W 2-μm continuous wave laser vaporesection is safe and effective in the treatment of high-risk patients with BPH.

Objective: To investigate the possibility of urethral reconstruction with colonic mucosa for the treatment of complex longer urethral stricture (>/= 10 cm)., Methods: From October 2000 to September 2001, 6 patients with complex longer urethral stricture were treated with colonic mucosal graft urethroplasty. They had under gone 3 previous unsuccessful urethral repairs on average. Urethral reconstruction with a free graft of colonic mucosa ranged from 10 to 15 cm (mean 12.17 cm). Follow-up included retrograde urethrography, urethroscopy, and uroflowmetry., Results: The patients were followed up 3 - 14 months postoperatively (mean 7.8 months). Meatal stenosis developed in one patient 3 months after operation needed reoperation. The patient voided very well with urinary peak flow 28.7 ml per second duing follow-up for 12 months postoperatively. The other patients voided well with urinary peak flow greater than 15 ml per second. At urethroscopy, colonic mucosa was macroscopically difficult to distinguish from normal original urethral mucosa in 4 patients over 6 months after the operation., Conclusions: Colonic mucosa graft urethroplasty is feasible for the treatment of complex longer anterior urethral stricture. The technique is useful for urethral reconstruction when penial skin and bladder mucosa are not available.

Objective: To explore whether bulbourethral suspension procedure is effective for the treatment of male urinary incontinence of post-prostatectomy and posterior urethroplasty., Methods: Twelve male patients with urinary incontinence undergone bulbourethral suspensive operation were reviewed and analyzed with regard to the operation method, postoperative urinary dynamics and clinical results., Results: Ten patients resumed complete control of urination and 1 was improved. In one patient, postoperative difficulty occurred in voiding but corrected by transurethral bladder neck revision for free passage of urine and continence. Urodynamic study showed that the maximum urethral pressure ranged from 85 to 115 cm H(2)O (mean 98 cm H(2)O, 1 cm H(2)O = 0.098 kPa). The functional urethral length ranged from 3.5 to 4.5 cm (mean 3.75 cm)., Conclusion: Bulbourethral suspension procedure is effective in the treatment of male urinary incontinence after prostatectomy and posterior urethroplasty.