| 1. |
- Ehrén, Ingrid, et al.
(författare)
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Cognitive challenges in persons with spina bifida : Bearing on urological dysfunctions?
- 2020
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Ingår i: Neurourology and Urodynamics. - : John Wiley & Sons. - 0733-2467 .- 1520-6777. ; 39:8, s. 2139-2145
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Tidskriftsartikel (refereegranskat)abstract
- AIM: To evaluate if adult persons with spina bifida (SB) who have urinary tract complications have cognitive difficulties that can be identified by neuropsychological tests.METHODS: All individuals with SB ≥ 18 years of age registered at a regional outpatient clinic (n = 219) were invited, of which, 154 persons were included. Neuropsychological assessment of their cognitive status was performed with Wechsler Adult Intelligence Scale®-Fourth Edition: Coding, Block design, Arithmetic's, FAS (word generation), Rey Auditory Verbal Test for learning, and delayed recall 30 min. Bladder and bowel function were assessed with questions used by the Nordic Spinal Cord Injury Registry (NSCIR) in structured interviews, by questionnaires, and by chart reviews.RESULTS: Average neuropsychological test results for this SB population was shown to be approximately 1 SD under the median for the general population. The Coding test showed significantly lower test results as compared with the whole SB group in persons with urinary tract complications, especially urinary tract infections, reduced kidney function, dependent emptying of the bladder, and the bowel and accidental bowel leakage. The Arithmetic's test showed a significant difference between subgroups in all parameters except reduced kidney function whereas the other neuropsychological tests were significantly correlated with some but not all urological parameters.CONCLUSION: We propose neuropsychological testing with primarily two tests to find those persons with SB who, due to cognitive challenges, might need extra support to minimize urological complications.
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| 2. |
- Ehren, Ingrid
(författare)
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Nitric oxide, formation and effects in the urogenital tract
- 1996
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The aim of the thesis was to study the formation and effects of nitric oxide (NO) in the human urinary tract and in the male reproductive organs. In the human upper and lower urinary tract NO synthase activity was studied via the formation of radiolabeled L-citrulline from L-arginine. In the human upper urinary tract NO synthase activity was found in the renal pelvis and exogenous NO inhibited spontaneous rhythmic and tonic contractions in both the isolated renal pelvis and the ureter suggesting that NO is a modulator of renal myogenic pacemaker-induced peristalsis. In the human lower urinary tract NO synthase activity was high in the prostatic urethra, intermediate in the bladder neck and low in the detrusor which is in good agreement with the nerve-induced smooth muscle responses and the guanylate cyclase activity. The results suggests that NO is the major mediator for neurogenic dilatation of the bladder neck and urethra during the micturition reflex. Estrogen and progesterone were shown to induce Ca2+-dependent NO synthase activity in the female guinea-pig urinary bladder suggesting that estrogen substitution, which reduces irritative bladder symptoms in elderly women, may act by increasing the Ca2+-dependent NO synthase activity in the lower urinary tract. Irritative bladder symptoms may be caused by various inflammatory conditions in the lower urinary tract. Since NO synthesis is increased during inflammation in several tissues we measured the luminal NO concentration in air from the human urinary bladder with chemiluminescence technique to study weather increased NO production is at hand in patients with inflammatory conditions in the lower urinary tract. Elevated levels of luminal NO concentrations were found in urinary bladders with inflammation due to interstitial cystitis and irradiation cystitis. The analysis of NO in air from the urinary bladder may be a simple diagnostic method to identify patients with cystitis. In the human male reproductive tract NO synthase activity was high, with the highest activity in the seminal vesicle, prostate and vas deferens. NADPH-diaphorase staining showed a prominent staining of the secretory cells in the vas deferens, seminal vesicle, prostate and urethra but also in the testis and epididymis of man and guinea-pig. NO synthase activity in the secretory epithelium of the guinea-pig seminal vesicle was 6 times higher than in the muscle coat, suggesting that the major part of the NO synthase activity is localized in the secretory cells. NO synthase inhibitors blocked the secretion of fructose induced by carbachol and nerve stimulation, respectively. Furthermore, a NO donor increased the fructose secretion. The results suggests that NO formation is a functional step in the secretory response to muscarinic stimulation of the glandular cells of the seminal vesicle. In conclusion, these findings suggest that NO is the mediator for neurogenic dilatation of the bladder neck and urethra during the micturition reflex. NO is also suggested as a cellular mediator of secretion in the male reproductive tract indicating an important role of NO in male fertility. Analysis of NO in air from the urinary bladder may be a simple method to identify patients with cystitis.
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| 3. |
- Ehrén, Ingrid, et al.
(författare)
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Voiding conditions, renal and bowel function in a cohort of adults with spina bifida
- 2020
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Ingår i: Neurourology and Urodynamics. - : Wiley. - 0733-2467 .- 1520-6777. ; 39:6, s. 1796-1802
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Tidskriftsartikel (refereegranskat)abstract
- AIM: To map voiding patterns, degree of continence, use of drugs for voiding disorders, kidney function and surgical interventions but also the bowel function in a near-total regional cohort of adults with spina bifida aged more than or equal to 18 years.METHODS: All individuals more than or equal to 18 years of age with spina bifida registered at a regional outpatient clinic (n = 219) were invited to participate, of which 196 persons were included. Bladder and bowel function were assessed according to questions used by the Nordic Spinal Cord Injury Registry by structured interviews and questionnaires in combination with review of patient charts including kidney function.RESULTS: Twenty percent of the patients voided spontaneously. Fifty-four percent used clean intermittent catherization (CIC) and of these, 14% had also undergone augmentation of the bladder and/or implantation of an artificial sphincter or sling, 23% had undergone major urological surgery, and 3% had an indwelling catheter. Seventeen percent of patients voiding spontaneously or using CIC reported total continence but as many as 36% reported daily leakage. Anticholinergics was the most common drug, used by 21% in the total cohort. About 13% of the patients had a reduced kidney function but only 1.5% had end stage renal failure. Seventy-three percent had problems emptying the bowel and 18% experienced fecal leakage weekly or even daily.CONCLUSION: We found a large variation in problems with bladder and bowel function in this adult group of persons with spina bifida. A structured customized program for follow-up seems necessary to optimize their health status in these areas.
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| 4. |
- Hosseini, Abolfazl, et al.
(författare)
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Enhanced formation of nitric oxide in bladder carcinoma in situ and in BCG treated bladder cancer
- 2006
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Ingår i: Nitric oxide. - Orlando, Fla. : Academic Press. - 1089-8603 .- 1089-8611. ; 15:4, s. 337-343
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Tidskriftsartikel (refereegranskat)abstract
- The purpose of the study was to analyze endogenous nitric oxide (NO) formation and NO-synthase (NOS) gene expression in the urinary bladder from patients with urinary bladder cancer and to investigate the relationship between local NO formation, treatment with Bacillus Calmette Guerin (BCG) and clinical stage in bladder cancer patients. One hundred and three patients with bladder cancer were studied. Endogenous formation of NO was measured in 72 patients, including 6 patients with BCG treated bladder cancer and 6 tumor free control subjects. iNOS expression was analyzed at transcriptional and protein level in biopsies from 31 patients with bladder cancer by real time polymerase chain reaction (PCR) and Western blot (WB), respectively. Three patients in this group had received BCG treatment. Eight biopsies from normal bladder served as control for PCR and WB analysis. Patients with carcinoma in situ (CIS) had higher iNOS expression (p<0.01) and NO formation (p<0.01) than control subjects and patients with papillary tumors without concomitant CIS. Markedly increased iNOS expression (p<0.05) and NO formation (p<0.001) were also found in patients treated with BCG as compared to the other groups. In conclusion, the presence of elevated NO concentration and iNOS expression in the urinary bladder from BCG treated patients and patients with CIS further supports the notion that NO may be an important factor in bladder cancer biology and that the BCG effect on superficial bladder cancer may partly be due to stimulation of local NO formation.
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