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  • Hashim, Hashim, et al. (författare)
  • Desmopressin, as a "Designer-Drug," in the Treatment of Overactive Bladder Syndrome
  • 2009
  • Ingår i: Neurourology and Urodynamics. - : John Wiley & Sons Inc.. - 0733-2467 .- 1520-6777. ; 28:1, s. 40-46
  • Tidskriftsartikel (refereegranskat)abstract
    • Aims: This study looked at whether oral desmopressin, by decreasing kidney urine production, would prolong bladder filling-time thereby increasing the time to reach maximum capacity, thus reducing overactive bladder (OAB) symptoms, and providing an alternative method of treatment to OAB sufferers. Methods: An investigator-initiated, 2-week, multi-national, multi-centre, "proof-of-concept," phase IIb, double-blind, placebo-controlled, prospective, randomized, cross-over study was conducted using 0.2 mg of oral desmopressin in adults suffering with OAB. Patients were included in the trial period if they had >= 4 voids in the first 8-hr of the day after rising, excluding the first morning void. The primary endpoint was evaluation of effectiveness of desmopressin in increasing the time to the first OAB symptom episodes during the first 8-hr following treatment. Results: Time to first void was 8-min later on the drug than on placebo (P = 0.27). However, the drug led to one less void (3.2 vs. 4.2) in the same period (P < 0.001). There was an increase in the time to first urgency episode with a decrease in the number of urgency episodes in the drug days compared to placebo (P < 0.003). There was a subjective improvement in frequency and urgency and overall quality-of-life as measured by the ICIQ-OAB. Twenty-seven people reported adverse events which were all mild, headache being the commonest and no hyponatremia was recorded. Conclusions: Antidiuresis, using oral desmopressin tablets, is a novel, feasible and safe (short-term basis) method of treatment for adults with OAB, and could be considered in the armamentarium of drugs available for the treatment of OAB. Neurourol. Urodynam. 28:40-46, 2009. (C) 2008 Wiley-Liss, Inc.
  • Hedlund, Petter (författare)
  • Cannabinoids and the Endocannabinoid System in Lower Urinary Tract Function and Dysfunction
  • 2014
  • Ingår i: Neurourology and Urodynamics. - : Wiley-Blackwell. - 0733-2467 .- 1520-6777. ; 33:1, s. 46-53
  • Tidskriftsartikel (refereegranskat)abstract
    • AimsTo review knowledge on cannabinoids and the endocannabinoid system in lower urinary tract function and dysfunction. MethodsReview of MEDLINE using defined search terms, and manual analysis. Articles published in English were included. Results and DiscussionComponents of the endocannabinoid systemcannabinoid (CB) receptor types 1 and 2, anandamide, and fatty acid amide hydrolase (FAAH), which degrades anandamide and related fatty-acid amideshave been located to lower urinary tract tissues of mice, rats, monkeys, and humans. Studies have located CB receptors in urothelium and sensory nerves and FAAH in the urothelium. CB receptor- and FAAH-related activities have also been reported in the lumbosacral spinal cord. Data on supraspinal CB functions in relation to micturition are lacking. Cannabinoids are reported to reduce sensory activity of isolated tissues, cause antihyperalgesia in animal studies of bladder inflammation, affect urodynamics parameters reflecting sensory functions in animals models, and appear to have effects on storage symptoms in humans. FAAH inhibitors have affected sensory bladder functions and reduced bladder overactivity in rat models. Cannabinoids may modify nerve-mediated functions of isolated lower urinary tract tissues. ConclusionsEvidence suggests components of the endocannabinoid system are involved in regulation of bladder function, possibly at several levels of the micturition pathway. It is unclear if either CB receptor has a dominant role in modification of sensory signals or if differences exist at peripheral and central nervous sites. Amplification of endocannabinoid activity by FAAH inhibitors may be an attractive drug target in specific pathways involved in LUTS.
  • Ishizuka, O, et al. (författare)
  • Role of supraspinal serotonin receptors for micturition in normal conscious rats
  • 2002
  • Ingår i: Neurourology and Urodynamics. - : John Wiley & Sons Inc.. - 0733-2467 .- 1520-6777. ; 21:3, s. 225-230
  • Tidskriftsartikel (refereegranskat)abstract
    • Serotonin (5-HT) receptors are widely distributed in the central nervous system, including several areas involved in the control of micturition reflex pathways. However, the roles of the different subtypes of 5-HT receptors are not well known. We studied in normal, conscious rats, the effects on the cystometrogram of intracerebroventricular (i.c.v.) administration of 5-HT, 8-hydroxy-2-(di-N-propylaminotetralin) (8-OH-DPAT; agonist at 5-HT1A receptors), alpha-methol-5-hydroxytryptamine maleate (agonist at 5-HT2 receptors), 2-methyl-5-hydroxytryptamine hydrochloride (agonist at 5-HT3 receptors), and 1-(4-amino-5-chloro-2methoxyphenyl)-3-(1-n-butyl-4piperidinyl)-1-propano ne hydrochloride (RS67506; agonist at 5-HT4 receptors). Female Sprague-Dawley rats, weighing approximately 230 g, were used. A polyethylene catheter was inserted into the bladder through the dome for cystometric investigations. For administration of drugs, a catheter was implanted into the right cerebral ventricle. Three days after implantation of the bladder catheter, continuous cystometry was performed. Administration of 5-HT (6 nmol/kg i.c.v.), 8-OH-DPAT (6 nmol/kg), alpha-methyl-5-hydroxytryptamine maleate (6 nmol/kg), or RS67506 hydrochloride (6 nmol/kg) significantly (P < 0.05) increased micturition pressure and decreased bladder capacity and micturition volume. The effects increased in a dose-dependent manner (18, 60 nmol/kg). Intracerebroventricular administration of 2-methyl-5-hydroxytryptamine hydrochloride (60 nmol/kg) caused no change in the cystometric parameters. The results suggest that in normal conscious rats, at the supraspinal level, 5-HT (via 5-HT1A, 5-HT2, and 5-HT4 receptors) can enhance the micturition reflex induced by bladder filling. Whether this means that 5-HT1A, 5-HT2, and 5-HT4 receptors can be targets for drugs meant for treatment of bladder hyperactivity, should be explored. (C) 2002Wiley-Liss, Inc.
  • Jiang, Chonghe, et al. (författare)
  • Gating of the Micturition Reflex by Tonic Activation of Bladder Cold Receptors in the Cat
  • 2009
  • Ingår i: NEUROUROLOGY AND URODYNAMICS. - : Wiley. - 0733-2467 .- 1520-6777. ; 28:6, s. 555-560
  • Tidskriftsartikel (refereegranskat)abstract
    • Aims: To determine whether C afferents can modify the gating of the A delta micturition reflex in order to identify the neuronal site of interaction of the two afferent systems. Methods: Adult female cats, anaesthetized with a.-chloralose, had their bladder and urethra catherized through a slit in the proximal urethra. Micturition threshold volume was assessed by cystometry and bladder efferent activity recorded simultaneously. The bladder was filled at a slow rate (1.2-3.5 ml/min) with either body-warm saline (control) or menthol solution (0.06 mM) or by cold saline (4 degrees C). Results: Of 14 trial sessions in 5 animals, the threshold volume of the A delta micturition reflex was consistently reduced by menthol infusions from a control median (md) value of 16.8 to 10.2 ml (P andlt; 0.01). The threshold pressure was also somewhat decreased from and 0.7 to 0.5 kPa (P andlt; 0.05), while the peak pressure or pressure slope did no differ in two situations. Similar results were obtained with slow cold infusions into the bladder (nine sessions in three animals). The threshold volume decreased from and 19.8 to 17.4 ml (P andlt; 0.05). The bladder reflex response to slow menthol or cold infusions had the typical features of an A delta micturition reflex in that the efferent activity was largely abolished by the bladder A delta mechanoreceptor unloading. Conclusions: Gradual tonic activation of bladder cold receptors lowers the threshold volume of the ordinary A delta micturition, pointing to a segmental spinal mechanism for the gating of the micturition reflex. Neurourol. Urodyrzam. 28:555-560, 2009.
  • Khullar, Vik, et al. (författare)
  • The relationship between BMI and urinary incontinence subgroups: Results from EpiLUTS.
  • 2014
  • Ingår i: Neurourology and urodynamics. - : Wiley. - 1520-6777 .- 0733-2467. ; 33:4
  • Tidskriftsartikel (refereegranskat)abstract
    • AIMS: To evaluate the relationship between body mass index (BMI) and urinary incontinence (UI) in adults ≥40 from the United States, United Kingdom, and Sweden. METHODS: This was a secondary analysis of EpiLUTS-a population-representative, cross-sectional, Internet-based survey conducted to assess the prevalence and HRQL impact of urinary symptoms. UI was evaluated by the LUTS Tool and categorized by subgroups: no UI, urgency urinary incontinence (UUI), stress urinary incontinence (SUI), mixed urinary incontinence (MUI) (UUI + SUI), UUI + other UI (OI), SUI + OI, and OI. Descriptive statistics were used. Logistic regressions examined the relationship of BMI to UI controlling for demographics and comorbid conditions. RESULTS: Response rate was 59%; 10,070 men and 13,178 women were included. Significant differences in BMI were found across UI subgroups. Obesity rates were highest among those with MUI (men and women), SUI + OI (women), UUI and UUI + OI (men). Logistic regressions of each UI subgroup showed that BMI ≥ 30 (obese) was associated with UI in general and MUI (women) and UUI + OI (men). Among women, being obese increased the odds of having SUI and SUI + OI. Women with BMI 25-29.9 (overweight) were more likely to have UI in general and SUI with and without other incontinence (SUI, MUI, and SUI + OI). Being overweight was unrelated to any form of UI in men. CONCLUSIONS: Results were consistent with prior research showing BMI is associated with higher risk of UI. These findings indicate substantial differences in obesity by gender and UI subtype, suggesting different mechanisms for UI other than purely mechanical stress on the bladder. Neurourol. Urodynam. 9999:1-8, 2013. © 2013 Wiley Periodicals, Inc.
  • Kirby, Michael G, et al. (författare)
  • Overactive bladder: Is there a link to the metabolic syndrome in men?
  • 2010
  • Ingår i: Neurourology and urodynamics. - : Wiley. - 1520-6777 .- 0733-2467. ; 29:8, s. 1360-4
  • Tidskriftsartikel (refereegranskat)abstract
    • It is becoming increasingly clear that a variety of metabolic, cardiovascular, and endocrine factors contribute to male pelvic health. In particular, a growing body of evidence suggests a relationship between lower urinary tract symptoms, benign prostatic hyperplasia, overactive bladder, erectile dysfunction, and the metabolic syndrome. This article explores these relationships, focusing on the role of the autonomic nervous system and hyperinsulinemia, together with their implications for urological practice.
  • Lee, Tack, et al. (författare)
  • Simultaneous registration of intraabdominal and intravesical pressures during cystometry in conscious rats-Effects of bladder outlet obstruction and intravesical PGE(2).
  • 2008
  • Ingår i: Neurourology and Urodynamics. - : John Wiley & Sons Inc.. - 0733-2467 .- 1520-6777. ; 27:1, s. 88-95
  • Tidskriftsartikel (refereegranskat)abstract
    • 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 = 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 +/- 1.4 cmH(2)O (range 3-15 cmH(2)O) was registered (n = 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. Copyright 2007 Wiley-Liss, Inc
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