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Sample records for bladder outflow obstruction

  1. Surgical therapy for benign prostatic hypertrophy/bladder outflow obstruction

    PubMed Central

    Thiruchelvam, Nikesh

    2014-01-01

    Monopolar transurethral resection of the prostate (TURP) with endoscopic electrocautery remains the gold standard surgical technique for benign prostatic hypertrophy (BPH) by which all new procedures are compared. We reviewed the current literature, and international urological guidelines and consensus opinion on various surgical options for BPH and present a brief overview of alternative techniques including bipolar TURP, transurethral incision of the prostate, transurethral vaporization of the prostate, laser prostatectomy (with holmium, thulium and potassium titanyl phosphate greenlight lasers) and open prostatectomy (with mention of new techniques including laparoscopic and robotic prostatectomy). Emerging, experimental and less established techniques are also described including endoscopic heat generation (transurethral microwave thermotherapy, radiofrequency transurethral needle ablation of the prostate, high intensity focused ultrasound, hot water induced thermotherapy, pulsed electromagnetic radiofrequency), injection therapy (transurethral ethanol ablation and botulinum toxin) and mechanical devices (intraprostatic stents and urethral lift devices). Despite a plethora of surgical options, none have realistically improved outcomes in the long-term compared with TURP. Improvements have been made on improving surgical morbidity and time in hospital. Questions remain in this area, including what specific elements of bladder outflow obstruction (BOO) result in damage to the urinary tract, how does BPH contribute to BOO and how much prostate volume reduction is necessary to relieve BOO or lower urinary tract symptoms. Given these unanswered questions and the multitude of procedures available, it is clear that appropriate counselling is necessary in all men who undergo BPH surgery. PMID:24744521

  2. Sham versus transurethral microwave thermotherapy in patients with symptoms of benign prostatic bladder outflow obstruction

    SciTech Connect

    Ogden, C.W.; Reddy, P.; Johnson, H.; Ramsay, J.W.; Carter, S.C. . Dept. of Urology)

    1993-01-02

    Transurethral microwave thermotherapy (TUMT) is a single-session, minimally invasive outpatient treatment for patients with symptoms of benign prostatic bladder outflow obstruction. The authors designed a prospective randomized trial to identify any placebo response. Patients with a Madsen symptom score over 8 for at least 6 months were eligible for study. Patients with renal dysfunction, upper urinary tract disease, co-existing bladder disease and malignant prostatic change were excluded. 43 patients were studied: 21 were randomized to receive a sham treatment and 22 to thermotherapy. The thermotherapy group showed a 70% decrease in the mean Madsen score, a 53% increase in flow-rate, and 92% decrease in residual urine volume. No Significant change was seen in these mean indices in the sham group. There was no difference in the main complication of transient hematuria between the two groups. However, there was a 22% frequency of acute retention in the TUMT group. The results show a little significant placebo component to the subjective and objective improvement that occurs in patients who have received TUMT.

  3. Functional and molecular evidence for Kv7 channel subtypes in human detrusor from patients with and without bladder outflow obstruction.

    PubMed

    Svalø, Julie; Sheykhzade, Majid; Nordling, Jørgen; Matras, Christina; Bouchelouche, Pierre

    2015-01-01

    The aim of the study was to investigate whether Kv7 channels and their ancillary β-subunits, KCNE, are functionally expressed in the human urinary bladder. Kv7 channels were examined at the molecular level and by functional studies using RT-qPCR and myography, respectively. We found mRNA expression of KCNQ1, KCNQ3-KCNQ5 and KCNE1-5 in the human urinary bladder from patients with normal bladder function (n = 7) and in patients with bladder outflow obstruction (n = 3). Interestingly, a 3.4-fold up-regulation of KCNQ1 was observed in the latter. The Kv7 channel subtype selective modulators, ML277 (activator of Kv7.1 channels, 10 μM) and ML213 (activator of Kv7.2, Kv7.4, Kv7.4/7.5 and Kv7.5 channels, 10 μM), reduced the tone of 1 μM carbachol pre-constricted bladder strips. XE991 (blocker of Kv7.1-7.5 channels, 10 μM) had opposing effects as it increased contractions achieved with 20 mM KPSS. Furthermore, we investigated if there is interplay between Kv7 channels and β-adrenoceptors. Using cumulative additions of isoprenaline (β-adrenoceptor agonist) and forskolin (adenylyl cyclase activator) in combination with the Kv7 channel activator and blocker, retigabine and XE991, we did not find interplay between Kv7 channels and β-adrenoceptors in the human urinary bladder. The performed gene expression analysis combined with the organ bath studies imply that compounds that activate Kv7 channels could be useful for treatment of overactive bladder syndrome. PMID:25692982

  4. Giant bladder diverticulum in Ehlers-Danlos syndrome type I causing outflow obstruction.

    PubMed

    Burrows, N P; Monk, B E; Harrison, J B; Pope, F M

    1998-05-01

    We describe a 16-year-old patient with Ehlers-Danlos syndrome (EDS) type I and recurrent urinary retention caused by giant bladder diverticulum and review the literature on this association. PMID:9861737

  5. Female Bladder Outlet Obstruction.

    PubMed

    Hoffman, Daniel S; Nitti, Victor W

    2016-04-01

    The non-specific symptoms the patients express upon the presentation of female bladder outlet obstruction make it a challenge to diagnose. There are subtle differences between the obstructed patient and those whose bladders are underactive and/or fail to mount a detrusor contraction. These disparities can be extracted through a thorough history and examination. At times, the clinician may utilize nomograms, non-invasive uroflow, and urodynamics with the addition of fluoroscopy to establish the diagnosis of obstruction. Management of the obstruction depends on the nature of the condition, whether functional or anatomical. The increase in the number of sling procedures performed to treat stress urinary incontinence has resulted in a rise in the number of iatrogenic obstructions. The temporal relationship between surgery and obstruction is the key to identifying the problem. PMID:26902625

  6. The novel β3-adrenoceptor agonist mirabegron reduces carbachol-induced contractile activity in detrusor tissue from patients with bladder outflow obstruction with or without detrusor overactivity.

    PubMed

    Svalø, Julie; Nordling, Jørgen; Bouchelouche, Kirsten; Andersson, Karl-Erik; Korstanje, Cees; Bouchelouche, Pierre

    2013-01-15

    β(3)-Adrenoceptors are major players in detrusor relaxation and have been suggested as a new putative target for the treatment of overactive bladder syndrome. We determined the effects of mirabegron (YM178), a novel β(3)-adrenoceptor agonist, on carbachol-induced tone in isolated human detrusor preparations from patients with bladder outflow obstruction (BOO) with and without detrusor overactivity (DO), and from patients with normal bladder function. We compared the effects to those of isoprenaline, a non-selective β-adrenoceptor agonist. Detrusor specimens were obtained from patients with benign prostatic hyperplasia undergoing cystoscopy and from patients undergoing radical prostatectomy/cystectomy (in total 33 donors). Detrusor contractility was evaluated by organ bath studies and strips were incubated with carbachol (1μM) to induce and enhance tension. Both mirabegron and isoprenaline reduced carbachol-induced tone in tissues from all groups. Isoprenaline decreased tension with higher potency than mirabegron in normal, BOO and BOO+DO detrusor strips with pIC(50) values of 7.49 ± 0.16 vs. 6.23 ± 0.26 (P=0.0002), 6.89 ± 0.34 vs. 6.04 ± 0.31 (P=0.01), and 6.57 ± 0.20 vs. 5.41 ± 0.08 (P<0.0001, n=4), respectively. The maximal relaxant effect of isoprenaline and mirabegron in the normal, BOO and BOO+DO detrusor was 37.7 ± 14.4% and 36.1 ± 23.3%, 14.4 ± 12.2% vs. 33.4 ± 21.0% and 18.3 ± 10.0% vs. 28.3 ± 12.2% (n=4, P>0.05), respectively. Mirabegron and isoprenaline reduced carbachol-induced tone in both normal bladders and obstructed bladder with and without DO. Isoprenaline had higher potency than mirabegron, but the efficacy of mirabegron effect was the same as that of isoprenaline. PMID:23246623

  7. Beta adrenergic modulation of spontaneous microcontractions and electrical field-stimulated contractions in isolated strips of rat urinary bladder from normal animals and animals with partial bladder outflow obstruction.

    PubMed

    Gillespie, J I; Rouget, C; Palea, S; Granato, C; Korstanje, C

    2015-07-01

    Spontaneous microcontractions and electrical field stimulation (EFS)-evoked contractions in isolated rat bladder strips from normal and from 6 weeks partial bladder outflow obstruction (pBOO) animals were studied to identify the potential site of action for the β3-adrenoceptor (AR) agonist mirabegron in detrusor overactivity in rats. For this, effects of the β-AR agonist isoprenaline and mirabegron were tested in presence or absence of selective antagonists for β-AR subtypes, namely CGP-20712A for β1-AR, ICI-118,551 for β2-AR, and L-748,337 for β3-AR. In detrusor strips from both normal and obstructed animals, EFS-induced contractions were weakly affected by isoprenaline and even less so by mirabegron. In contrast, microcontraction activity was more potently reduced by isoprenaline (pIC50 7.3; Emax ±85 %), whereas mirabegron showed a small effect. In pBOO strips, concentration response curves for isoprenaline and mirabegron at inhibition of EFS and spontaneous microcontractions were similar to those in normal strips. Isoprenaline-induced inhibition of microcontractions and EFS was antagonized by the β1-AR antagonist, but not by the β2- and β3-AR antagonists. In the context of β3-AR-mediated bladder functions for mirabegron in other experiments, the current data question a role for effects at spontaneous microcontractions, or neurogenic detrusor stimulation in the mode of action for mirabegron in vivo, since functional bladder effects for mirabegron are reported to occur at much lower concentrations. PMID:26047780

  8. Hepatic venous outflow obstruction: Three similar syndromes

    PubMed Central

    Bayraktar, Ulas Darda; Seren, Soley; Bayraktar, Yusuf

    2007-01-01

    Our goal is to provide a detailed review of veno-occlusive disease (VOD), Budd-Chiari syndrome (BCS), and congestive hepatopathy (CH), all of which results in hepatic venous outflow obstruction. This is the first article in which all three syndromes have been reviewed, enabling the reader to compare the characteristics of these disorders. The histological findings in VOD, BCS, and CH are almost identical: sinusoidal congestion and cell necrosis mostly in perivenular areas of hepatic acini which eventually leads to bridging fibrosis between adjacent central veins. Tender hepatomegaly with jaundice and ascites is common to all three conditions. However, the clinical presentation depends mostly on the extent and rapidity of the outflow obstruction. Although the etiology and treatment are completely different in VOD, BCS, and CH; the similarities in clinical manifestations and liver histology may suggest a common mechanism of hepatic injury and adaptation in response to increased sinusoidal pressure. PMID:17461490

  9. Effects of mild bladder outlet obstruction on rabbit bladder structure and function.

    PubMed

    Kuo, H C

    1995-09-01

    Mild bladder outlet obstruction was created in 42 New Zealand white rabbits by placing a 5-mm inner diameter polyethylene tube around the urethra. Periods of obstruction lasted for 1 day (7 rabbits), 3 days (7 rabbits), 1 week (7 rabbits), 2 weeks (6 rabbits), 4 weeks (7 rabbits), 6 weeks (4 rabbits) and 8 weeks (4 rabbits). Whole bladder functional study was performed in control (5 rabbits) and the obstructed bladders. The obstructed bladders increased in weight two-to threefold. There was no significant difference in bladder weight after different periods of obstruction. Electric stimulation showed a diminished response after 3 days of obstruction. Pharmacologic stimulation with 500 microM carbachol revealed a decreased response after obstruction, but intravesical pressure returned to the control level at 6 and 8 weeks of obstruction. However, the bladder weight and the expelling function of the obstructed bladders remained the same as on day 1 of obstruction. Histologic study of control and obstructed bladders revealed that: 1) dense submucosal fibrous tissue developed after 3 days of obstruction, 2) detrusor muscle hypertrophy and hyperplasia were noted with intermuscular collagenous fiber deposition after 2 weeks of obstruction, 3) trabeculation of the bladder wall with hyperplasia of muscular bundles was noted after 2 weeks of obstruction, 4) acute edematous and inflammatory reaction were apparent after 3 days and 1 week of obstruction, but resolved later and 5) degenerative changes of muscular cells were noted at 8 weeks of obstruction. The results show that despite apparent morphologic changes after outlet obstruction, no significant difference was observed in bladder expelling between short-term and long-term infravesical mild outlet obstruction. The bladder contractile apparatus appears to have a compensatory ability after mild outlet obstruction. PMID:8696170

  10. Muscular (hypertrophic) subaortic stenosis (hypertrophic obstructive cardiomyopathy): the evidence for true obstruction to left ventricular outflow.

    PubMed Central

    Wigle, E. D.; Henderson, M.; Rakowski, H.; Wilansky, S.

    1986-01-01

    The clinical and haemodynamic significance of the subaortic pressure gradient in patients with muscular (hypertrophic) subaortic stenosis (hypertrophic obstructive cardiomyopathy) has long been debated. In this report we summarize the evidence which indicates that true obstruction to left ventricular outflow exists in these patients. Rapid left ventricular ejection, through an outflow tract narrowed by ventricular septal hypertrophy, results in Venturi forces causing systolic anterior motion of the anterior (or posterior) mitral leaflets. Mitral leaflet-septal contact results in obstruction to outflow and the accompanying mitral regurgitation. The time of onset of mitral leaflet-septal contact determines the magnitude of the pressure gradient and the severity of the mitral regurgitation, as well as the degree of prolongation of left ventricular ejection time and the percentage of left ventricular stroke volume that is ejected in the presence of an obstructive pressure gradient. Early and prolonged mitral leaflet-septal contact results in a large pressure gradient, significant mitral regurgitation, as well as dramatic prolongation of the ejection time and a large percentage of left ventricular stroke volume being obstructed. Late and short mitral leaflet-septal contact results in little haemodynamic perturbation. Hypertrophic cardiomyopathy patients with obstructive pressure gradients are significantly more symptomatic than those without. Thus the obstructive pressure gradients in hypertrophic cardiomyopathy are of clinical as well as haemodynamic significance. To deny the existence of obstruction to outflow in patients with muscular subaortic stenosis is to deny these patients appropriate medical and surgical therapy. PMID:3774688

  11. Assessment of local structural disorders of the bladder wall in partial bladder outlet obstruction using polarized light imaging.

    PubMed

    Alali, Sanaz; Aitken, Karen J; Schröder, Annette; Gribble, Adam; Bagli, Darius J; Vitkin, I Alex

    2014-02-01

    Partial bladder outlet obstruction causes prominent morphological changes in the bladder wall, which leads to bladder dysfunction. In this paper, we demonstrate that polarized light imaging can be used to identify the location of obstruction induced structural changes that other imaging modalities fail to detect. We induced 2-week and 6-week partial outlet obstruction in rats, harvested obstructed bladders, then measured their retardances while distended to high pressures and compared them to controls. Our results show that the retardance of the central part of the ventral side (above the ureters) closer to the urethra can be used as a potential metric of the distending bladder obstruction. PMID:24575354

  12. Urethral duplication with unusual cause of bladder outlet obstruction

    PubMed Central

    Venkatramani, Vivek; George, Arun Jacob Philip; Chandrasingh, J.; Panda, Arabind; Devasia, Antony

    2016-01-01

    A 12-year-old boy presented with poor flow and recurrent urinary tract infections following hypospadias repair at the age of 3 years. The evaluation revealed urethral duplication with a hypoplastic dorsal urethra and patent ventral urethra. He also had duplication of the bladder neck, and on voiding cystourethrogram the ventral bladder neck appeared hypoplastic and compressed by the dorsal bladder neck during voiding. The possibility of functional obstruction of the ventral urethra by the occluded dorsal urethra was suspected, and he underwent a successful urethro-urethrostomy. PMID:27127361

  13. Dynamic left ventricular outflow tract obstruction: underestimated cause of hypotension and hemodynamic instability

    PubMed Central

    2014-01-01

    Left ventricular outflow tract obstruction, which is typically associated with hypertrophic cardiomyopathy, is the third most frequent cause of unexplained hypotension. This underestimated problem may temporarily accompany various diseases (it is found in even <1% of patients with no tangible cardiac disease) and clinical situations (hypovolemia, general anesthesia). It is currently assumed that left ventricular outflow tract obstruction is a dynamic phenomenon, the occurrence of which requires the coexistence of predisposing anatomic factors and a physiological condition that induces it. The diagnosis of left ventricular outflow tract obstruction should entail immediate implementation of the therapy to eliminate the factors that can potentially intensify the obstruction. Echocardiography is the basic modality in the diagnosis and treatment of left ventricular outflow tract obstruction. This paper presents four patients in whom the immediate implementation of bedside echocardiography enabled a rapid diagnosis of left ventricular outflow tract obstruction and implementation of proper treatment. PMID:26674265

  14. Bladder outlet obstruction number: a good indicator of infravesical obstruction in patients with benign prostatic enlargement?

    PubMed

    Aganovic, Damir; Spahovic, Hajrudin; Prcic, Alden; Hadziosmanovic, Osman

    2012-08-01

    The objective of our study was to evaluate bladder outlet obstruction number (BOON) in order to predict infravesical obstruction in patients with benign prostatic enlargement (BPE). Two hundred patients with proven BPE from daily urological practice at the Urology Department of the Sarajevo University Clinical Centre were covered by a prospective study in period 2009-2011. All patients completed International Prostatic Symptom Score, their mean voided volume urine was determined from frequency-volume chart and their prostate volume was determined by transabdominal ultrasound. Subsequently, the patients had free uroflowmetry and they underwent complete urodynamic studies. BOON was calculated using the formula: prostate volume (cc)-3 x Qmax (ml/s)-0.2 x mean voided volume (ml). A satisfactory area under the curve (AUC) was obtained for the prediction of obstruction according to bladder outlet obstruction index, Schaefer obstruction class nomogram and group specific urethral resistance factor , with AUC of 0.83 (p<0.001). Following the comparison of different cut-off values of BOON according to the obstruction, the BOON >-20 has been found to be the most accurate obstruction indicator (sensitivity 76.5% and specificity 68.2%), with posttest probability of 77%. The BOON may be used in daily urological practice as a valid, non-invasive indicator of infravesical obstruction in patients with BPE, with a possibility of correct classification of obstruction in approximately 75% of the cases. Transabdominal ultrasound has shown to be applicable to the BOON formula in determining prostate volume. PMID:22938540

  15. Pirfenidone attenuates bladder fibrosis and mitigates deterioration of bladder function in a rat model of partial bladder outlet obstruction.

    PubMed

    Duan, Liu Jian; Qi, Jun; Huang, Tao; Gu, Xin; Xu, Ding; Kong, Xiang Jie; Qian, Xiao Qiang

    2015-09-01

    To investigate the effects of pirfenidone (PFD) on the attenuation of bladder remodeling, and the associated functional changes caused by partial bladder outlet obstruction (pBOO), the present study performed surgery on adult male Sprague‑Dawley rats produce a model of pBOO. The rats in the pBOO group were administered a placebo and, in the CMC group, PFD mixed with the placebo was administered orally at 500 mg/kg body weight each day for 5 weeks, from 1 week after surgery. The rat bladders were harvested for biochemical analysis following cystometry at the end of the 6 week period. The histopathology was determined using Masson's trichrome staining. The mRNA and protein levels of pro‑fibrotic growth factors and extracellular matrix subtypes were assessed. pBOO debilitated bladder function and caused the parameters from cystometry to increase significantly compared with those in the control group (P<0.05), which were mitigated significantly following PFD treatment (P<0.05). In terms of the histology, the rats in the pBOO group exhibited significant increases in bladder weight, muscle hypertrophy and deposition of collagens, which were suppressed by PFD treatment (P<0.05). Based on the biochemical analysis, significant increases in the mRNA levels of collagen subtypes and growth factors, and protein levels of profibrotic growth factors and α‑smooth muscle actin in the bladders of rats in the pBOO group were reduced following PFD treatment. PFD prevented bladder remodeling and attenuated bladder fibrosis and, therefore, mitigated the deterioration of bladder function during the initial stage of pBOO. PMID:25997537

  16. Bladder outlet obstruction treated with transurethral ultrasonic aspiration

    NASA Astrophysics Data System (ADS)

    Malloy, Terrence R.

    1991-07-01

    Fifty-nine males with bladder outlet obstruction were treated with transurethral ultrasonic aspiration of the prostate. Utilizing a 26.5 French urethral sheath, surgery was accomplished with a 10 French, 0-700 micron vibration level ultrasonic tip with an excursion rate of 39 kHz. Complete removal of the adenoma was accomplished, followed by transurethral electrocautery biopsies of both lateral lobes to compare pathologic specimens. One-year follow-up revealed satisfactory voiding patterns in 57 of 59 men (96%). Two men developed bladder neck contractures. Pathologic comparisons showed 100% correlation between aspirated and TUR specimens (56 BPH, 3 adeno-carcinoma). Forty-sevel men were active sexually preoperatively (6 with inflatable penile prostheses). Post ultrasonic aspiration, 46 men had erectile function similar to preoperative levels with one patient suffering erectile dysfunction. Forty men (85%) had antegrade ejaculation while 7 (15%) experienced retrograde or retarded ejaculation. No patients were incontinent.

  17. Botulinum toxin: An emerging therapy in female bladder outlet obstruction

    PubMed Central

    Pradhan, Aditya A.

    2009-01-01

    Introduction: We evaluated the utility of botulinum toxin in functional female bladder outlet obstruction. Materials and Methods: A total of 7 consecutive female patients with bladder outlet obstruction were included. Patients with neurogenic bladder were excluded. All were previously treated with periodic dilations. Diagnosis was based on symptomatology, cystometry, and micturating cystograms. A total of 2 patients had been in chronic retention with residual volumes more than 400 ml. All were managed with an injection of botulinum toxin, 100 units in 2 ml of saline injected with a flexible cystoscopic needle. The site of the injection was deep submucosally, 0.5 ml in each quadrant at the level of the most prominent narrowing seen endoscopically. All the procedures were done as day care procedures under local anaesthesia. After the procedure, no catheter was placed. Patients were followed up for changes in IPSS scores and post void residual urine measurements. In all cases, multiple injections were used. Results: The follow-up period ranged from 48–52 weeks. The IPSS reduced by an average of 12 points. Post void residual urine reduced by 62%. Improvements commenced 4.85 days (average) after the procedure and lasted for an average of 16.8 weeks (range: 10.8–28 weeks). Discussion: There is a gradual improvement in symptoms over time and the maximal effect occurred at 10–14 days. The duration of improvement was approximately 16.8 weeks. All patients were satisfied by the degree of improvement felt. Conclusions: Botulinum toxin proved successful in improving the voiding characteristics. It possibly acts at the zone of hypertonicity at the bladder neck or midurethra. The only disadvantage is the high cost of the drug. PMID:19881122

  18. 5-Hydroxytryptamine-induced bladder hyperactivity via the 5-HT2A receptor in partial bladder outlet obstruction in rats.

    PubMed

    Sakai, Takumi; Kasahara, Ken-ichi; Tomita, Ken-ichi; Ikegaki, Ichiro; Kuriyama, Hiroshi

    2013-04-01

    We investigated the effects of partial bladder outlet obstruction (BOO) on the function and gene expression of 5-hydroxytryptamine (5-HT) receptor subtypes in rat bladder. Isometric contractions of the isolated bladders from sham-operated control and BOO rats were examined. The contractile responses to 5-HT were significantly increased in BOO rat bladder strips, while the responses to KCl, carbachol, or phenylephrine were not different from the control. The 5-HT-induced hypercontraction in BOO rat bladder strips was inhibited by ketanserin, a 5-HT(2A) receptor antagonist. The contractile responses to 5-HT in bladder strips were not affected by urothelium removal from the intact bladder. The gene expression of 5-HT receptor subtypes in the bladders was analyzed by RT-PCR. The mRNA expression of the 5-HT(2A), 5-HT(2B), 5-HT(2C), 5-HT(4), and 5-HT(7) receptors was detected in both the control and BOO rat bladders. Quantitative RT-PCR analysis showed there was a significant increase of 5-HT(2A) receptor mRNA in the BOO rat bladder compared with the control bladder. On the other hand, the gene expression of the 5-HT(4) receptor was not changed in the BOO rat bladder. These results suggest that the increased contractile responses to 5-HT in BOO rat bladder may be partly caused by 5-HT(2A) receptor upregulation in the detrusor smooth muscles. PMID:23344575

  19. Work Capacity of the Bladder During Voiding: A Novel Method to Evaluate Bladder Contractile Function and Bladder Outlet Obstruction

    PubMed Central

    Liu, Ning; Man, Li-Bo; He, Feng; Huang, Guang-Lin; Zhou, Ning; Zhu, Xiao-Fei

    2015-01-01

    Background: Work in voiding (WIV) of the bladder may be used to evaluate bladder status throughout urination rather than at a single time point. Few studies, however, have assessed WIV owing to the complexity of its calculations. We have developed a method of calculating work capacity of the bladder while voiding and analyzed the associations of bladder work parameters with bladder contractile function and bladder outlet obstruction (BOO). Methods: The study retrospectively evaluated 160 men and 23 women, aged >40 years and with a detrusor pressure at maximal flow rate (Pdet Qmax) of ≥40 cmH2O in men, who underwent urodynamic testing. The bladder power integration method was used to calculate WIV; WIV per second (WIV/t) and WIV per liter of urine voided (WIV/v) were also calculated. In men, the relationships between these work capacity parameters and Pdet Qmax and Abrams-Griffiths (AG) number were determined using linear-by-linear association tests, and relationships between work capacity parameters and BOO grade were investigated using Spearman's association test. Results: The mean WIV was 1.15 ± 0.78 J and 1.30 ± 0.88 J, mean WIV/t was 22.95 ± 14.45 mW and 23.78 ± 17.02 mW, and mean WIV/v was 5.59 ± 2.32 J/L and 2.83 ± 1.87 J/L in men and women, respectively. In men, WIV/v showed significant positive associations with Pdet Qmax (r = 0.845, P = 0.000), AG number (r = 0.814, P = 0.000), and Schafer class (r = 0.726, P = 0.000). Conversely, WIV and WIV/t showed no associations with Pdet Qmax or AG number. In patients with BOO (Schafer class > II), WIV/v correlated positively with increasing BOO grade. Conclusions: WIV can be calculated from simple urodynamic parameters using the bladder power integration method. WIV/v may be a marker of BOO grade, and the bladder contractile function can be evaluated by WIV and WIV/t. PMID:26668148

  20. Changes in Aquaporin 1 Expression in Rat Urinary Bladder after Partial Bladder Outlet Obstruction: Preliminary Report

    PubMed Central

    Kim, Sun-Ouck; Song, Seung Hee; Ahn, Kuyoun; Kwon, Dongdeuk; Ryu, Soo Bang

    2010-01-01

    Purpose Aquaporins (AQPs) are membrane proteins that facilitate water movement across biological membranes. AQPs are also called water channels, and they have recently been reported to be expressed in rat and human urothelium. The purposes of this study were to investigate the effect of bladder outlet obstruction (BOO) on the rat urothelium and AQP1 expression in rat urothelium. Materials and Methods Female Sprague-Dawley rats (230-240 g each, n=20) were divided into 2 groups: the sham group (the Con group, n=10) and the partial BOO group (the BOO group, n=10). The BOO group underwent a partial BOO. The expression and cellular localization of AQP1 were determined by performing Western blotting and immunohistochemistry on the rat urinary bladder. Results AQP1 immunoreactivity in both the control and the BOO groups was localized in the capillaries, arterioles, and venules of the lamina propria of the urinary bladder. The protein expression of AQP1 was significantly increased in the BOO group. Conclusions This study showed that BOO causes a significant increase in the expression of AQP1. This may imply that AQP1 has a functional role in the detrusor instability that occurs in association with BOO. PMID:20428433

  1. Benefits of mesenchymal stem cells after partial bladder outlet obstruction

    PubMed Central

    Al-Saikan, Bader; Ding, Jie; Tredget, Edward; Metcalfe, Peter

    2016-01-01

    Introduction: Partial bladder outlet obstruction (pBOO) results in significant morbidity and mortality in the pediatric and adult populations. Mesenchymal stem cells (MSC) have been widely studied in many organ systems for the treatment and prevention of fibrotic and inflammatory conditions. Therefore, we hypothesize that systemic administration of MSC will demonstrate short-term biochemical, histological, and urodynamic benefits in an animal model for pBOO. Methods: After University ethics approval, 5 × 106 green fluorescent protein GFP-labeled MSC were intravenously injected concurrently with pBOO in adult Sprague-Dawley rats. Five groups (n=3/group) were analyzed: a) unobstructed controls; b) pBOO for seven days with intravenous MSC (7d+MSC); c) pBOO for seven days without intravenous MSC (7d-MSC); d) pBOO for 14 days with intravenous MSC (14d+MSC), e) pBOO for 14 days without MSC (14d–MSC). Urodynamics were performed at the end of the experimental period and bladders were weighed. Immunohistochemistry was performed for GFP detection and reverse transcription polymerase chain reaction (RT-PCR) to detect mRNA of: TGF-B, HIF-1a, RhoA, GRP-78, lumican, and decorin. Results: All animals remained healthy. GFP was detected in all treatment groups. MSC treatment resulted in a significant decrease in bladder capacity (0.91 cc vs. 2.15 cc, p=0.04). Treatment also resulted in significant decreases in mRNA levels of: TGF-B, HIF-1a, Rho-A, and GRP-78. Conclusions: Systemic treatment with MSC was well tolerated and resulted in MSC accumulation after pBOO. Despite our low numbers, we were able to successfully demonstrate short-term urodynamic improvements and widespread, significant decreases in inflammatory mediators. We believe that this decreased inflammatory cascade will help prevent long-term detrusor deterioration. PMID:26858780

  2. Adjustable passive stiffness in mouse bladder: regulated by Rho kinase and elevated following partial bladder outlet obstruction.

    PubMed

    Speich, John E; Southern, Jordan B; Henderson, Sheree; Wilson, Cameron W; Klausner, Adam P; Ratz, Paul H

    2012-04-15

    Detrusor smooth muscle (DSM) contributes to bladder wall tension during filling, and bladder wall deformation affects the signaling system that leads to urgency. The length-passive tension (L-T(p)) relationship in rabbit DSM can adapt with length changes over time and exhibits adjustable passive stiffness (APS) characterized by a L-T(p) curve that is a function of both activation and strain history. Muscle activation with KCl, carbachol (CCh), or prostaglandin E(2) at short muscle lengths can increase APS that is revealed by elevated pseudo-steady-state T(p) at longer lengths compared with prior T(p) measurements at those lengths, and APS generation is inhibited by the Rho Kinase (ROCK) inhibitor H-1152. In the current study, mouse bladder strips exhibited both KCl- and CCh-induced APS. Whole mouse bladders demonstrated APS which was measured as an increase in pressure during passive filling in calcium-free solution following CCh precontraction compared with pressure during filling without precontraction. In addition, CCh-induced APS in whole mouse bladder was inhibited by H-1152, indicating that ROCK activity may regulate bladder compliance during filling. Furthermore, APS in whole mouse bladder was elevated 2 wk after partial bladder outlet obstruction, suggesting that APS may be relevant in diseases affecting bladder mechanics. The presence of APS in mouse bladder will permit future studies of APS regulatory pathways and potential alterations of APS in disease models using knockout transgenetic mice. PMID:22205227

  3. Bladder outlet obstruction causes up-regulation of nicotinic acetylcholine receptors in bladder-projecting pelvic ganglion neurons.

    PubMed

    Chung, Hyun-Chul; Lee, Choong-Ku; Park, Kwang-Hwa; Jeong, Seong-Woo

    2015-03-30

    Pelvic ganglion (PG) neurons relay sympathetic and parasympathetic signals to the lower urinary tract, comprising the urinary bladder and bladder outlet, and are thus essential for both storage and voiding reflexes. Autonomic transmission is mediated by activation of the nicotinic acetylcholine receptor (nAChR) in PG neurons. Previously, bladder outlet obstruction (BOO), secondary to benign prostatic hyperplasia, was found to increase soma sizes of bladder-projecting PG neurons. To date, however, it remains unknown whether these morphological changes are accompanied by functional plasticity in PG neurons. In the present study, we investigated whether BOO alters acetylcholine receptor (nAChR) transcript expression and current density in bladder PG neurons. Partial ligation of the rat urethra for six weeks induced detrusor overactivity (DO), as observed during cystometrical measurement. In rats exhibiting DO, membrane capacitance of parasympathetic bladder PG neurons was selectively increased. Real-time PCR analysis revealed that BOO enhanced the expression of the transcripts encoding the nAChR α3 and β4 subunits in PG neurons. Notably, BOO significantly increased ACh-evoked current density in parasympathetic bladder PG neurons, whereas no changes were observed in sympathetic bladder and parasympathetic penile PG neurons. In addition, other ligand-gated ionic currents were immune to BOO in bladder PG neurons. Taken together, these data suggest that BOO causes upregulation of nAChR in parasympathetic bladder PG neurons, which in turn may potentiate ganglionic transmission and contribute to the development of DO. PMID:25625357

  4. Unruptured Sinus of Valsalva Aneurysm Obstructing the Left Ventricular Outflow Tract: An Uncommon Presentation in Childhood.

    PubMed

    Murli, Lakshmi; Shah, Prashant; Sekar, Prem; Surya, Karthik

    2016-01-01

    Congenital aneurysms of the sinus of Valsalva are uncommon abnormalities that are usually silent and slowly progressive without symptoms of cardiac dysfunction unless catastrophic rupture occurs. However, in rare cases, unruptured aneurysms can produce symptoms resulting from compression of adjacent structures, ventricular outflow tract obstruction, heart block, and coronary and valvular insufficiency. We report a case of a single unruptured sinus of Valsalva aneurysm producing left ventricular outflow tract obstruction in an 8-year-old boy who presented with chest pain on exertion. PMID:26694306

  5. Giant Urinary Bladder and Bilateral Giant Hydronephrosis due to Bladder Neck Obstruction: One Case Report and Literature Review

    PubMed Central

    Tazi, Mohammed Fadl; Riyach, Omar; Ahallal, Youness; Mellas, Soufiane; Khallouk, Abdelhak; El Fassi, Mohammed Jamal; Farih, Moulay Hassan

    2012-01-01

    Bilateral hydronephrosis secondary to urinary obstruction leads to a buildup of back pressure in the urinary tract and may lead to impairment of renal function. Cases of giant hydronephrosis are rare and usually contain no more than 1-2 litres of fluid in the collecting system. Here, we report a rarely seen case with giant urinary bladder and bilateral giant hydronephrosis due to bladder neck obstruction which contains 4000 mL fluid in the collecting system of the kidney mimicking an ascites in an adult male. PMID:22606637

  6. Intracardiac tumor causing left-ventricular outflow-tract obstruction in a newborn.

    PubMed

    Jordan, Christopher P; Costello, John P; Endicott, Kendal M; Reyes, Christine; Hougen, Thomas J; Cummings, Susan D; Nath, Dilip S

    2016-07-01

    The following report describes the case of newborn girl with an asymptomatic systolic murmur, which on imaging revealed a nearly obstructive mass in the left-ventricular outflow tract. The mass was resected and found to be consistent with a rhabdomyoma. Here, we describe the pathologic and clinical characteristics of this tumor. PMID:27358535

  7. Reoperation for left ventricular outflow tract obstruction after repair of atrioventricular septal.

    PubMed

    Overman, David M

    2014-01-01

    Left ventricular outflow tract obstruction (LVOTO) is an important source of morbidity and mortality after repair of atrioventricular septal defect (AVSD). The intrinsic anatomy of the left ventricular outflow tract in AVSD is complex and predisposes to the development of LVOTO. LVOTO after repair of AVSD usually involves multiple levels and sources of obstruction, and surgical intervention must address each component of the obstruction. This includes fibromuscular obstruction, septal hypertrophy, and valve related sources of obstruction. Special attention is also directed to the anterolateral muscle bundle of the left ventricle, a well defined but under recognized feature of the left ventricular outflow tract in AVSD. It is present in all patients with AVSD, and resection of a hypertrophic anterolateral muscle bundle of the left ventricle should be incorporated in all operations for LVOTO after repair of AVSD. LVOTO after repair of AVSD has several unique features that must be taken into consideration to maximize outcome after surgical intervention. These include anatomic factors, technical aspects of surgical intervention, and proper selection of the operation used for relief of LVOTO. PMID:24725716

  8. Effect of αlipoic acid and silymarin on bladder outlet obstruction.

    PubMed

    Yildirim, Abidin; Başeskioğlu, Barbaros; Temel, Halide E; Erkasap, Nilüfer; Yenilmez, Aydin; Uslu, Sema; Ozer, Caner; Ozkurt, Mete; Dönmez, Turgut

    2013-02-01

    The aim of the present study was to determine whether the treatment of obstructed rat bladders with αlipoic acid (ALA) and silymarin reverses the biochemical and physiological responses to bladder outlet obstruction (BOO). A total of 32 adult Sprague Dawley rats were divided into four groups (n=8 per group): sham (placebo surgery) animals with no treatment (group 1); control animals with surgically induced BOO (group 2); obstructed rats treated with ALA (group 3); and obstructed rats treated with silymarin (group 4). Histological evaluation, bladder weights, collagen structure, TdT-mediated biotin nick end-labeling (TUNEL), inducible nitric oxide sentase (iNOS) mRNA levels, malondialdehyde (MDA) levels and tumor necrosis factor (TNF) levels were investigated. The ALA-treated group had similar bladder weights, collagen levels and TUNEL positivity and decreased iNOS levels compared with the control group, while the silymarin group exhibited further differences. Serum MDA and TNF-α levels were both decreased in the ALA and silymarin groups. ALA treatment reduced the increased oxidative stress and bladder inflammation caused by BOO and may contribute to the protection of bladder function. PMID:23403734

  9. Upregulation of heme oxygenase and collagen type III in the rat bladder after partial bladder outlet obstruction.

    PubMed

    Inaba, Mitsuhiko; Ukimura, Osamu; Yaoi, Takeshi; Kawauchi, Akihiro; Fushiki, Shinji; Miki, Tsuneharu

    2007-01-01

    The objective of the study was to evaluate possible changes of the gene expression and localization of the enzymes, heme oxygenase and nitric oxide synthase (NOS), with reference to increase of collagen type III in response to the partial obstruction of the bladder. Following initial obstruction, whole rat bladders were removed for real-time quantitative reverse transcription-polymerase chain reaction (RT-PCR) and immunohistochemistry. Real-time RT-PCR demonstrated significantly enhanced expression of HO (p < 0.01) and collagen type III (p < 0.001) gene on postoperative day 14. Enhanced expression of NOS gene was seen only on postoperative day 4 (p < 0.01). Immunohistochemistry revealed that immunoreactivity to HO-1 had much in common in neural cells and fibers, although immunoreactivity to HO-2 and iNOS was relatively weak. This study suggested gene expression of HO, especially HO-1, was more dramatically changed than NOS, and was upregulated simultaneously with increase of collagen type III after obstruction. HO systems could be involved in the pathogenesis of bladder dysfunction related to increase of collagen type III after obstruction. PMID:17406140

  10. Mir-29 repression in bladder outlet obstruction contributes to matrix remodeling and altered stiffness.

    PubMed

    Ekman, Mari; Bhattachariya, Anirban; Dahan, Diana; Uvelius, Bengt; Albinsson, Sebastian; Swärd, Karl

    2013-01-01

    Recent work has uncovered a role of the microRNA (miRNA) miR-29 in remodeling of the extracellular matrix. Partial bladder outlet obstruction is a prevalent condition in older men with prostate enlargement that leads to matrix synthesis in the lower urinary tract and increases bladder stiffness. Here we tested the hypothesis that miR-29 is repressed in the bladder in outlet obstruction and that this has an impact on protein synthesis and matrix remodeling leading to increased bladder stiffness. c-Myc, NF-κB and SMAD3, all of which repress miR-29, were activated in the rat detrusor following partial bladder outlet obstruction but at different times. c-Myc and NF-κB activation occurred early after obstruction, and SMAD3 phosphorylation increased later, with a significant elevation at 6 weeks. c-Myc, NF-κB and SMAD3 activation, respectively, correlated with repression of miR-29b and miR-29c at 10 days of obstruction and with repression of miR-29c at 6 weeks. An mRNA microarray analysis showed that the reduction of miR-29 following outlet obstruction was associated with increased levels of miR-29 target mRNAs, including mRNAs for tropoelastin, the matricellular protein Sparc and collagen IV. Outlet obstruction increased protein levels of eight out of eight examined miR-29 targets, including tropoelastin and Sparc. Transfection of human bladder smooth muscle cells with antimiR-29c and miR-29c mimic caused reciprocal changes in target protein levels in vitro. Tamoxifen inducible and smooth muscle-specific deletion of Dicer in mice reduced miR-29 expression and increased tropoelastin and the thickness of the basal lamina surrounding smooth muscle cells in the bladder. It also increased detrusor stiffness independent of outlet obstruction. Taken together, our study supports a model where the combined repressive influences of c-Myc, NF-κB and SMAD3 reduce miR-29 in bladder outlet obstruction, and where the resulting drop in miR-29 contributes to matrix remodeling and

  11. Mir-29 Repression in Bladder Outlet Obstruction Contributes to Matrix Remodeling and Altered Stiffness

    PubMed Central

    Ekman, Mari; Bhattachariya, Anirban; Dahan, Diana; Uvelius, Bengt; Albinsson, Sebastian; Swärd, Karl

    2013-01-01

    Recent work has uncovered a role of the microRNA (miRNA) miR-29 in remodeling of the extracellular matrix. Partial bladder outlet obstruction is a prevalent condition in older men with prostate enlargement that leads to matrix synthesis in the lower urinary tract and increases bladder stiffness. Here we tested the hypothesis that miR-29 is repressed in the bladder in outlet obstruction and that this has an impact on protein synthesis and matrix remodeling leading to increased bladder stiffness. c-Myc, NF-κB and SMAD3, all of which repress miR-29, were activated in the rat detrusor following partial bladder outlet obstruction but at different times. c-Myc and NF-κB activation occurred early after obstruction, and SMAD3 phosphorylation increased later, with a significant elevation at 6 weeks. c-Myc, NF-κB and SMAD3 activation, respectively, correlated with repression of miR-29b and miR-29c at 10 days of obstruction and with repression of miR-29c at 6 weeks. An mRNA microarray analysis showed that the reduction of miR-29 following outlet obstruction was associated with increased levels of miR-29 target mRNAs, including mRNAs for tropoelastin, the matricellular protein Sparc and collagen IV. Outlet obstruction increased protein levels of eight out of eight examined miR-29 targets, including tropoelastin and Sparc. Transfection of human bladder smooth muscle cells with antimiR-29c and miR-29c mimic caused reciprocal changes in target protein levels in vitro. Tamoxifen inducible and smooth muscle-specific deletion of Dicer in mice reduced miR-29 expression and increased tropoelastin and the thickness of the basal lamina surrounding smooth muscle cells in the bladder. It also increased detrusor stiffness independent of outlet obstruction. Taken together, our study supports a model where the combined repressive influences of c-Myc, NF-κB and SMAD3 reduce miR-29 in bladder outlet obstruction, and where the resulting drop in miR-29 contributes to matrix remodeling and

  12. HIF-mediated metabolic switching in bladder outlet obstruction mitigates the relaxing effect of mitochondrial inhibition.

    PubMed

    Ekman, Mari; Uvelius, Bengt; Albinsson, Sebastian; Swärd, Karl

    2014-05-01

    Prior work demonstrated increased levels of hypoxia-inducible factor-1α (HIF-1α) in the bladder following outlet obstruction, associated with bladder growth and fibrosis. Here we hypothesized that HIF induction in outlet obstruction also switches energetic support of contraction from mitochondrial respiration to glycolysis. To address this hypothesis, we created infravesical outlet obstruction in female Sprague-Dawley rats and examined HIF induction and transcriptional activation. HIF-1α increased after 6 weeks of outlet obstruction as assessed by western blotting and yet transcription factor-binding site analysis indicated HIF activation already at 10 days of obstruction. Accumulation HIF-2α and of Arnt2 proteins were found at 10 days, providing an explanation for the lack of correlation between HIF-1α protein and transcriptional activation. HIF signature targets, including Slc2a1, Tpi1, Eno1 and Ldha increased in obstructed compared with sham-operated bladders. The autophagy markers Bnip3 and LC3B-II were also increased at 6 week of obstruction, but electron microscopy did not support mitophagy. Mitochondria were, however, remodeled with increased expression of Cox4 compared with other markers. In keeping with a switch toward glycolytic support of contraction, we found that relaxation by the mitochondrial inhibitor cyanide was reduced in obstructed bladders. This was mimicked by organ culture with the HIF-inducer dimethyloxalylglycine, which also upregulated expression of Ldha. On the basis of these findings, we conclude that HIF activation in outlet obstruction involves mechanisms beyond the accumulation of HIF-1α protein and that it results in a switch of the energetic support of contraction to anaerobic glycolysis. This metabolic adaptation encompasses increased expression of glucose transporters and glycolytic enzymes combined with mitochondrial remodeling. Together, these changes uphold contractility when mitochondrial respiration is limited. PMID

  13. Reversal of muscle hypertrophy in the rat urinary bladder after removal of urethral obstruction.

    PubMed

    Gabella, G; Uvelius, B

    1994-08-01

    We studied the ultrastructure of the bladder musculature after first inducing hypertrophy by means of urethral obstruction and subsequently removing the obstruction. With hypertrophy the bladder musculature increases ten-fold or more in volume; after de-obstruction approximately 4/5 of the hypertrophic muscle weight and volume is lost within six weeks. In spite of this very large decrease in muscle mass there is no degeneration of muscle cells or nerve endings or of other cell types in the de-obstructed bladder either at 5 days or at 6 weeks. The individual muscle cells are smaller in size than in the hypertrophic bladder but still larger than control muscle cells. The decrease in muscle cell size is more substantial than the decrease in muscle cell surface. There are no lysosomes or other signs of intracellular degradation in any cells of the muscle layer. The musculature contains a very large amount of intercellular material, mainly collagen. This study documents the great plasticity of the musculature in the reduction of muscle mass after de-obstruction. However, some of the fine structural features are almost as different from the controls as in the hypertrophic muscle. PMID:8082124

  14. Pregnancy in Hypertrophic Cardiomyopathy with Severe Left Ventricular Outflow Tract Obstruction

    PubMed Central

    Shin, Jaeouk; Kim, Minsu; Lee, Junsoo; Kim, Sihun; Kim, Myeonggun; Hwang, Hyunjung; Moon, Jeonggeun; Shin, Mi-Seung

    2016-01-01

    Hypertrophic obstructive cardiomyopathy (HOCM) patients with severe left ventricular outflow tract (LVOT) obstruction (those with a gradient of > 100 mm Hg) are at the highest risk of hemodynamic deterioration during pregnancy. Complications of HOCM include sudden cardiac death, heart failure, and arrhythmias. Physiological changes during pregnancy may induce these complications, affecting maternal and fetal health conditions. Therefore, close monitoring with appropriate management is essential for the well-being of both mother and fetus. We report on the case of a 27-year-old female patient with severe LVOT obstruction HOCM, pressure gradient (PG) of 125 mm Hg at resting, and 152 mm Hg induced by the Valsalva maneuver at 34 weeks gestation. This case showed how close monitoring using echocardiography and proper management during the course of pregnancy resulted in successful delivery in the patient with extremely high PG HOCM. PMID:27358709

  15. Urinary bladder matrix promotes site appropriate tissue formation following right ventricle outflow tract repair

    PubMed Central

    Remlinger, Nathaniel T; Gilbert, Thomas W; Yoshida, Masahiro; Guest, Brogan N; Hashizume, Ryotaro; Weaver, Michelle L; Wagner, William R; Brown, Bryan N; Tobita, Kimimasa; Wearden, Peter D

    2013-01-01

    The current prevalence and severity of heart defects requiring functional replacement of cardiac tissue pose a serious clinical challenge. Biologic scaffolds are an attractive tissue engineering approach to cardiac repair because they avoid sensitization associated with homograft materials and theoretically possess the potential for growth in similar patterns as surrounding native tissue. Both urinary bladder matrix (UBM) and cardiac ECM (C-ECM) have been previously investigated as scaffolds for cardiac repair with modest success, but have not been compared directly. In other tissue locations, bone marrow derived cells have been shown to play a role in the remodeling process, but this has not been investigated for UBM in the cardiac location, and has never been studied for C-ECM. The objectives of the present study were to compare the effectiveness of an organ-specific C-ECM patch with a commonly used ECM scaffold for myocardial tissue repair of the right ventricle outflow tract (RVOT), and to examine the role of bone marrow derived cells in the remodeling response. A chimeric rat model in which all bone marrow cells express green fluorescent protein (GFP) was generated and used to show the ability of ECM scaffolds derived from the heart and bladder to support cardiac function and cellular growth in the RVOT. The results from this study suggest that urinary bladder matrix may provide a more appropriate substrate for myocardial repair than cardiac derived matrices, as shown by differences in the remodeling responses following implantation, as well as the presence of site appropriate cells and the formation of immature, myocardial tissue. PMID:23974174

  16. Left ventricular outflow track obstruction and mitral valve regurgitation in a patient with takotsubo cardiomyopathy

    PubMed Central

    Wu, Yin; Fan, WuQiang; Chachula, Laura; Costacurta, Gary; Rohatgi, Rajeev; Elmi, Farhad

    2015-01-01

    Introduction Takotsubo cardiomyopathy (TCM) can be complicated by left ventricular outflow tract (LVOT) obstruction and severe acute mitral regurgitation (MR), leading to hemodynamic instability in an otherwise benign disorder. Despite the severity of these complications, there is a paucity of literature on the matter. Because up to 20–25% of TCM patients develop LVOT obstruction and/or MR, it is important to recognize the clinical manifestations of these complications and to adhere to specific management in order to reduce patient morbidity and mortality. We report the clinical history, imaging, treatment strategy, and clinical outcome of a patient with TCM that was complicated with severe MR and LVOT obstruction. We then discuss the pathophysiology, characteristic imaging, key clinical features, and current treatment strategy for this unique patient population. Case report A postmenopausal woman with no clear risk factor for coronary artery disease (CAD) presented to the emergency department with chest pain after an episode of mental/physical stress. Physical examination revealed MR, mild hypotension, and pulmonary vascular congestion. Her troponins were mildly elevated. Cardiac catheterization excluded obstructive CAD, but revealed severe apical hypokinesia and ballooning. Notably, multiple diagnostic tests revealed the presence of severe acute MR and LVOT obstruction. The patient was diagnosed with TCM complicated by underlying MR and LVOT obstruction, and mild hemodynamic instability. The mechanism of her LVOT and MR was attributed to systolic anterior motion of the mitral valve (SAM), which the transesophageal echocardiogram clearly showed during workup. She was treated with beta-blocker, aspirin, and ACE-I with good outcome. Nitroglycerin and inotropes were discontinued and further avoided. Conclusions Our case illustrated LVOT obstruction and MR associated with underlying SAM in a patient with TCM. LVOT obstruction and MR are severe complications of TCM

  17. Combined uterine and urinary bladder rupture: an unusual complication of obstructed labor in a primigravida

    PubMed Central

    Takai, Idris Usman; Abubakar, Abdulkadir

    2016-01-01

    Background Combined uterine and urinary bladder rupture following prolonged obstructed labor is indeed a momentous uro-obstetric emergency. The urinary bladder involvement is distinctly rare in the absence of factors that predispose the bladder to be adherent to the lower uterine segment and is quite unusual in a primigravida. Objective To report a rare case of uterine rupture involving urinary bladder secondary to a prolonged obstructed labor in a primigravida from a low resource setting. Case A 17-year-old married unbooked primigravida who presented with a 3-day history of spontaneous onset of labor at term that was initially managed at home and later in a primary health care center where she had fundal pressure and oxytocin augmentation, respectively. The labor was complicated by combined uterine and urinary bladder rupture with sepsis. She was resuscitated and had exploratory laparotomy with uterine and urinary bladder repair. The postoperative period was uneventful and she was followed-up at the gynecology and family planning clinics. Conclusion There is a need for community reawakening on the inherent risks of teenage pregnancy, bad obstetric practices, and unsupervised pregnancy, labor, and delivery, particularly in the rural settings as in the index patient. A high index of suspicion and prompt appropriate intervention will reduce the sequel of morbidity and occasional mortality from this predicament. PMID:27499647

  18. Latent Left Ventricular Outflow Tract Obstruction Due to Accessory Mitral Valve in a 12-Year-Old Boy

    PubMed Central

    Yun, Kyung Won; Park, Yong Hyun; Lee, Sang Hyun; Kim, Jeong Su; Kim, June Hong; Chun, Kook Jin

    2016-01-01

    Accessory mitral valve (AMV) is a rare congenital anomaly which can cause left ventricular outflow tract (LVOT) obstruction. Patients with isolated AMV usually present with exertional dyspnea, chest pain, or syncope during the first ten years of life. In patients with AMV, detection of latent LVOT obstruction can be clinically challenging. We here present a case of AMV causing latent LVOT obstruction in an adolescent, which was diagnosed by echocardiography with dobutamine provocation and finally treated by successful surgical resection. PMID:27471367

  19. Dynamic outflow tract obstruction in congenitally corrected transposition of the great arteries.

    PubMed

    Zurick, Andrew O; Menon, Venu

    2010-08-01

    Congenitally corrected transposition of the great arteries (CCTGA) is a rare form of congenital heart disease, constituting 0.5% of all congenital heart defects. The incidence of left ventricle (non-systemic ventricle) outflow tract obstruction ranges between 44 and 57%. Herein, we present the case of a 45 year old woman with CCTGA with progressively worsening dyspnea who had been referred for surgical correction of severe systemic ventricle (morphologic right ventricle) atrio-ventricular valve (tricuspid valve) regurgitation. Cardiac magnetic resonance imaging (CMR) and transesophageal imaging (TEE) demonstrated severe systemic ventricle (morphologic right ventricle) contractile dysfunction, as well as dynamic non-systemic ventricle (morphologic left ventricle) outflow tract obstruction due to systolic anterior motion (SAM) of the non-systemic ventricle (morphologic left ventricle) atrio-ventricular valve (mitral valve) with a large membranous ventricular septal aneurysm that protrudes into the outflow tract of the non-systemic ventricle (morphologic left ventricle). Ultimately, our patient was felt to be too high-risk for surgical correction and a course of medical therapy has been pursued. PMID:20191324

  20. Effect of Left Ventricular Outflow Tract Obstruction on Left Atrial Mechanics in Hypertrophic Cardiomyopathy

    PubMed Central

    Williams, Lynne K.; Chan, Raymond H.; Carasso, Shemy; Durand, Miranda; Misurka, Jimmy; Crean, Andrew M.; Ralph-Edwards, Anthony; Gruner, Christiane; Woo, Anna; Lesser, John R.; Maron, Barry J.; Maron, Martin S.; Rakowski, Harry

    2015-01-01

    Left atrial (LA) volumes are known to be increased in hypertrophic cardiomyopathy (HCM) and are a predictor of adverse outcome. In addition, LA function is impaired and is presumed to be due to left ventricular (LV) diastolic dysfunction as a result of hypertrophy and myocardial fibrosis. In the current study, we assess the incremental effect of outflow tract obstruction (and concomitant mitral regurgitation) on LA function as assessed by LA strain. Patients with HCM (50 obstructive, 50 nonobstructive) were compared to 50 normal controls. A subset of obstructive patients who had undergone septal myectomy was also studied. Utilising feature-tracking software applied to cardiovascular magnetic resonance images, LA volumes and functional parameters were calculated. LA volumes were significantly elevated and LA ejection fraction and strain were significantly reduced in patients with HCM compared with controls and were significantly more affected in patients with obstruction. LA volumes and function were significantly improved after septal myectomy. LVOT obstruction and mitral regurgitation appear to further impair LA mechanics. Septal myectomy results in a significant reduction in LA volumes, paralleled by an improvement in function. PMID:26788503

  1. Non-uniform changes in membrane receptors in the rat urinary bladder following outlet obstruction.

    PubMed

    Zeng, Jianwen; Ekman, Mari; Jiang, Chonghe; Uvelius, Bengt; Swärd, Karl

    2015-09-01

    The aim of the present study was to investigate the expression and distribution of membrane receptors after bladder outlet obstruction (BOO). Partial bladder outlet obstruction (BOO) was induced in female rats and bladders were harvested after either 10 days or 6 weeks of BOO. The expression of different receptors was surveyed by microarrays and corroborated by immunohistochemistry and western blotting. A microarray experiment identified 10 membrane receptors that were differentially expressed compared to sham-operated rats including both upregulated and downregulated receptors. Four of these were selected for functional experiments on the basis of magnitude of change and relevance to bladder physiology. At 6 weeks of BOO, maximal contraction was reduced for neuromedin B and vasopressin (AVP), consistent with reductions of receptor mRNA levels. Glycine receptor-induced contraction on the other hand was increased and receptor mRNA expression was accordingly upregulated. Maximal relaxation by the β3-adrenergic receptor agonist CL316243 was reduced as was the receptor mRNA level. Immunohistochemistry supported reduced expression of neuromedin B receptors, V1a receptors and β3-adrenergic receptors, but glycine receptor expression appeared unchanged. Western blotting confirmed repression of V1a receptors and induction of glycine receptors in BOO. mRNA for vasopressin was detectable in the bladder, suggesting local AVP production. We conclude that changes in receptor expression following bladder outlet obstruction are non-uniform. Some receptors are upregulated, conferring increased responsiveness to agonist, whereas others are downregulated, leading to decreased agonist-induced responses. This study might help to select pharmacological agents that are effective in modulating lower urinary tract symptoms in BOO. PMID:26004535

  2. Autonomic nervous system activity assessment by heart rate variability in experimental bladder outlet obstruction.

    PubMed

    Dobrek, Łukasz; Baranowska, Agnieszka; Skowron, Beata; Thor, Piotr J

    2013-01-01

    A syndrome with urgency, with or without associated urine incontinence and usually accompanied by higher urinary frequency and nocturia has been named "overactive bladder; OAB". OAB is an entity with complex pathophysiology, involving both myogenic and neurogenic (afferent / efferent bladder innervation) disturbances. OAB symptoms accompany benign prostatic hypertrophy--BPH ("obstructive OAB"). The aim of the study was to estimate the autonomic nervous system activity (ANS) in the experimental bladder outlet obstruction (BOO) which was an animal model of the human BPH. The study was conducted using 30 female rats, divided into two groups: BOO animals (n=15), with surgically induced BOO (by partial ligation of the proximal urethra) and control ones (n=15), which underwent sham procedure (without urethral ligation). Two weeks after the surgery, in both groups, ANS activity was estimated using time- and spectral analysis of the heart rate variability recordings. The bladder overactivity in BOO animals was confirmed using urodynamic recordings and bladder histological assessment, juxtaposed against the results of the control group. The key finding of our study was the development of autonomic disturbances in bladder outlet obstruction (BOO) rats. Our study revealed that BOO animals were characterised by diminished rMSSD and spectral HRV parameters: TP, LF and HF, in comparison with the control group. The normalised nLF and nHF parameters did not differ significantly in both groups, although slight changes in the nLF (increased) and nHF (decreased) were noted in BOO group. The absolute VLF value was almost the same in both studied populations, however, the percentage part of this component in the appropriate HRV spectrum differed considerably in both studied groups. In BOO animals, VLF percentage amounted to about 90%, whereas in control animals this parameter reached only about 53% of the total power spectrum. Thus, to sum up, our findings suggest autonomic imbalance

  3. Combined usage of Ho:YAG laser with monopolar resectoscope in the treatment of bladder stone and bladder outlet obstruction

    PubMed Central

    Wu, Jian Hui; Yang, Kuo; Liu, Qian; Yang, Shi Qiang; Xu, Yong

    2014-01-01

    Objective: Bladder stones in elderly men are commonly associated with bladder outlet obstruction, and many different treatment modalities have been presented for both these conditions. To evaluate the effectiveness and safety of a novel method concerning spontaneous usage of both monopoplar transurethral resection of the prostate and Holmium Laser cystolithotripsy, we compared the transurethral use of resectoscope and cystoscope lithotripsy approaches retrospectively. Methods: Patients data of one hundred and nine male patients with benign prostatic hyperplasia (BPH) and bladder stone(s) were analyzed retrospectively. Two groups of patients were compared: Group I was treated with combination of transurethral holmium laser cystolithotripsy (HLC) and transurethral resection of the prostate (TURP) using the 24F resectoscope, and group II used 22F cystoscope and 24F resectoscope for treating both these conditions. Result: We reviewed the records of 109 patients undergoing transurethral cystolithotripsy with holmium laser and simultaneous TURP. The mean bladder stone size were 3.6±1.5 cm in Group-I and 3.7±1.1 cm (mean 3.8) in Group-II (p>0.05). The mean operation time of Group-I and Group-II was 49.0±22.5 minutes and 79.0±28.5 minutes, respectively (p<0.05). Stone fragments were removed completely and TURP procedures were done successfully in all of the patients. Mild hematuria was found more frequently in Group-II (22.2%), and four (7.4%) patients had urethral stricture in the same group during the late follow-up. Conclusion: Combination of transurethral laser cystolithotripsy and TURP using the same 24F resectooscope is an effective, safe and economical treatment for bladder stones in BPH patients. It is minimally invasive and involves and has lower complication rates and shorter hospital stay. However, this combined approach should be taken in the treatment of calculus within 4 or 5 centimeters. PMID:25097543

  4. Unruptured Sinus of Valsalva Aneurysm with Right Ventricular Outflow Tract Obstruction and Supracristal Ventricular Septal Defect: A Rare Case

    PubMed Central

    Sadiq, Muhammad Athar; Ahmad, Wan Azman Wan; Supuramaniam, Chitra; Watson, Timothy; Abidin, Imran Zainal; Chee, Kok Han

    2015-01-01

    Unruptured right sinus of Valsalva aneurysm that causes severe obstruction of the right ventricular outflow tract is extremely rare. We describe the case of a 47-year-old woman who presented with exertional dyspnea. Upon investigation, we discovered an unruptured right sinus of Valsalva aneurysm with associated right ventricular outflow tract obstruction and a supracristal ventricular septal defect. To our knowledge, only 2 such cases have previously been reported in the medical literature. Although treatment of unruptured sinus of Valsalva aneurysm remains debatable, surgery should be considered for extremely large aneurysms or for progressive enlargement of the aneurysm on serial evaluation. Surgery was undertaken in our patient because there was clear evidence of right ventricular outflow tract obstruction, right-sided heart dilation, and associated exertional dyspnea. PMID:26504442

  5. Late renal failure due to prostatic outflow obstruction: a preventable disease.

    PubMed

    Sacks, S H; Aparicio, S A; Bevan, A; Oliver, D O; Will, E J; Davison, A M

    1989-01-21

    Nineteen patients presenting with late renal failure due to prostatic outflow obstruction (mean age 68.7 years; mean serum creatinine concentration 1158 mumol/l) were identified from the admission records of two renal units. As late renal failure secondary to prostatic enlargement is preventable case records were analysed retrospectively in an attempt to identify aspects of management in which preventive efforts might be of value. Delays in referral were common, with a mean of 2.8 years between the onset of prostatic symptoms and time of referral, six patients being referred who had had symptoms for more than three years. Four of five patients who had had a prostatectomy were known to be in renal failure at the time of operation but were not referred until 2-13 years later, when prostatic symptoms had recurred and there was evidence of progressive nephropathy with dilatation of the upper urinary tract. Two patients died on admission and eight (47% of survivors) required long term dialysis, most patients (80%) requiring some dialysis support during the initial period. These findings suggest that progressive nephropathy caused by prostatic outflow obstruction might, in part, be averted by more adequate screening of renal function in men with untreated prostatism and closer follow up of patients with uraemia at the time of prostatectomy. PMID:2466506

  6. Sulforaphane Ameliorates Bladder Dysfunction through Activation of the Nrf2-ARE Pathway in a Rat Model of Partial Bladder Outlet Obstruction

    PubMed Central

    Liu, Chong; Xu, Huan; Fu, Shi; Chen, Yanbo; Chen, Qi; Cai, Zhikang; Zhou, Juan; Wang, Zhong

    2016-01-01

    Purpose. We evaluated the effect of sulforaphane (SFN) treatment on the function and changes of expression of Nrf2-ARE pathway in the bladder of rats with bladder outlet obstruction (BOO). Materials and Methods. A total of 18 male Sprague-Dawley rats at age of 8 weeks were divided into 3 groups (6 of each): the sham operated group, the BOO group, and the BOO+SFN group. We examined histological alterations and the changes of oxidative stress markers and the protein expression of the Nrf2-ARE pathway. Results. We found that SFN treatment could prolong micturition interval and increase bladder capacity and bladder compliance. However, the peak voiding pressure was lower than BOO group. SFN treatment can ameliorate the increase of collagen fibers induced by obstruction. SFN treatment also increased the activity of SOD, GSH-Px, and CAT compared to the other groups. The level of bladder cell apoptosis was decreased in BOO rats with SFN treatment. Moreover, SFN could reduce the ratio of Bax/Bcl-2 expression. Furthermore, SFN could activate the Nrf2 expression with elevation of its target antioxidant proteins. Conclusions. The sulforaphane-mediated decrease of oxidative stress and activation of the Nrf2-ARE pathway may ameliorate bladder dysfunction caused by bladder outlet obstruction. PMID:27433291

  7. Sulforaphane Ameliorates Bladder Dysfunction through Activation of the Nrf2-ARE Pathway in a Rat Model of Partial Bladder Outlet Obstruction.

    PubMed

    Liu, Chong; Xu, Huan; Fu, Shi; Chen, Yanbo; Chen, Qi; Cai, Zhikang; Zhou, Juan; Wang, Zhong

    2016-01-01

    Purpose. We evaluated the effect of sulforaphane (SFN) treatment on the function and changes of expression of Nrf2-ARE pathway in the bladder of rats with bladder outlet obstruction (BOO). Materials and Methods. A total of 18 male Sprague-Dawley rats at age of 8 weeks were divided into 3 groups (6 of each): the sham operated group, the BOO group, and the BOO+SFN group. We examined histological alterations and the changes of oxidative stress markers and the protein expression of the Nrf2-ARE pathway. Results. We found that SFN treatment could prolong micturition interval and increase bladder capacity and bladder compliance. However, the peak voiding pressure was lower than BOO group. SFN treatment can ameliorate the increase of collagen fibers induced by obstruction. SFN treatment also increased the activity of SOD, GSH-Px, and CAT compared to the other groups. The level of bladder cell apoptosis was decreased in BOO rats with SFN treatment. Moreover, SFN could reduce the ratio of Bax/Bcl-2 expression. Furthermore, SFN could activate the Nrf2 expression with elevation of its target antioxidant proteins. Conclusions. The sulforaphane-mediated decrease of oxidative stress and activation of the Nrf2-ARE pathway may ameliorate bladder dysfunction caused by bladder outlet obstruction. PMID:27433291

  8. Overexpression of Aquaporin-1 and Caveolin-1 in the Rat Urinary Bladder Urothelium Following Bladder Outlet Obstruction

    PubMed Central

    Song, Seung Hee; Park, Kwangsung; Kwon, Dongdeuk

    2013-01-01

    Purpose This study was designed to investigate the effect of detrusor overactivity induced by partial bladder outlet obstruction (BOO) on the expression of aquaporin 1 (AQP1) and caveolin 1 (CAV1) in the rat urinary bladder, and to determine the role of these molecules in detrusor overactivity. Methods Female Sprague-Dawley rats were divided into control (n=30) and experimental (n=30) groups. The BOO group underwent partial BOO, and the control group underwent a sham operation. After 4 weeks, an urodynamic study was performed to measure the contraction interval and contraction pressure. The expression and cellular localization of AQP1 and CAV1 were determined by western blot and immunofluorescence experiments in the rat urinary bladder. Results In cystometrograms, the contraction interval was significantly lower in the BOO group (2.9±1.5 minutes) than in the control group (6.7±1.0 minutes) (P<0.05). Conversely, the average contraction pressure was significantly higher in the BOO group (21.2±3.3 mmHg) than in the control group (13.0±2.5 mmHg) (P<0.05). AQP1 and CAV1 were coexpressed in the capillaries, arterioles, and venules of the suburothelial layer. AQP1 and CAV1 protein expression was significantly increased in the BOO rats compared to the control rats (P<0.05). Conclusions Detrusor overactivity induced by BOO causes a significant increase in the expression of AQP1 and CAV1, which were coexpressed in the suburothelial microvasculature. This finding suggests that AQP1 and CAV1 might be closely related to bladder signal activity and may have a functional role in BOO-associated detrusor overactivity. PMID:24466464

  9. Functional and Anatomic Esophagogastic Junction Outflow Obstruction: Manometry, Timed Barium Esophagram Findings, and Treatment Outcomes.

    PubMed

    Clayton, Steven B; Patel, Rupal; Richter, Joel E

    2016-06-01

    Little is known about the clinical features, radiology and manometry findings, and treatment outcomes of patients with functional and mechanical esophagogastic junction outflow obstruction (EGJOO). Between November 2011 and February 2015, a total of 1443 high-resolution manometries were reviewed and 49 patients (3.4%) met the manometric criteria for EGJOO. Then, we performed a retrospective chart review, collecting data from manometric studies, timed barium esophagram findings (TBEs), endoscopic reports, and clinical records. Twenty-seven patients had functional EGJOO and 22 patients had an anatomic esophageal obstruction. Common causes of anatomic EGJOO included strictures (36% of patients) and hiatal hernias (31% of patients). There were no differences between groups in manometric or radiographic metrics. Each group had increased basal lower esophageal sphincter and intrabolus pressures, compared with individuals without EGJOO, and most patients had abnormal findings on TBE analysis. Two patients with functional EGJOO progressed to type 3 achalasia. We conclude that patients diagnosed with EGJOO based on manometry findings can have anatomic obstruction or functional EGJOO; high-resolution manometry and TBE do not distinguish between disease causes. PMID:26792374

  10. Simple Modification of the Bladder Outlet Obstruction Index for Better Prediction of Endoscopically-Proven Prostatic Obstruction: A Preliminary Study

    PubMed Central

    Han, Jang Hee; Yu, Ho Song; Lee, Joo Yong; Kim, Joohan; Kang, Dong Hyuk; Kwon, Jong Kyu; Choi, Young Deuk; Cho, Kang Su

    2015-01-01

    Purpose The bladder outlet obstruction index (BOOI), also known as the Abrams-Griffiths (AG) number, is the most widely used index for predicting BOO. However, the obstructed prostatic urethra determined by the BOOI is often inconsistent with endoscopically-proven obstruction. We assessed abdominal straining pattern as a novel parameter for improving the prediction of BOO. Materials and Methods We retrospectively reviewed the pressure-flow studies (PFS) and cystourethroscopy in 176 BPH/LUTS patients who were unresponsive to medical therapy. During PFS, some groups of patients tried to urinate with abdominal straining, which can increases intravesical pressure and underestimate BOOI theoretically. Accordingly, the modified BOOI was defined as (PdetQmax+ΔPabd)-2Qmax. Results Ultimately, 130 patients were eligible for the analysis. In PFS, ΔPabd (PabdQmax-initial Pabd) was 11.81±13.04 cmH2O, and it was 0–9 cmH2O in 75 (57.7%), 10–19 cmH2O in 23 (17.7%) and ≥20 cmH2O in 32 (24.6%) patients. An endoscopically obstructed prostatic urethra in 92 patients was correctly determined in 47 patients (51.1%) by the original BOOI versus 72 patients (78.3%) based on the modified BOOI. Meanwhile, an “unobstructed” urethra according to the original BOOI was present in 11 patients (12.0%), whereas according to the modified BOOI, only 2 (2.1%) would be labeled as “unobstructed”. In receiver operating characteristic curves, the area under the curve was 0.906 using the modified BOOI number versus 0.849 in the original BOOI (p<0.05). Conclusions The change in abdominal pressure was correlated with endoscopically-proven obstruction. Our simple modification of the BOOI on the basis of this finding better predicted bladder outlet obstruction and, therefore, should be considered when evaluating BOO in patients with LUTS/BPH. PMID:26505196

  11. Large bowel obstruction resulting from bladder transitional cell carcinoma metastasis: a common cancer presenting in an uncommon manner

    PubMed Central

    Rohloff, Matthew; VandenBerg, Todd; MacMath, Terry

    2015-01-01

    Transitional cell carcinoma (TCC) and large bowel obstructions are both common disease processes typically considered unrelated. Presented below is the case of a 49-year-old male with a large bowel obstruction caused by a bladder TCC metastasis. One year prior to large bowel obstruction presentation, the patient had a T2, Grade III TCC of the bladder with no nodal involvement or metastasis, which was removed via radical cystoprostatectomy. This case serves as a reminder that cancer, despite common pathogenesis patterns, can present in atypical ways. PMID:26197806

  12. Large bowel obstruction resulting from bladder transitional cell carcinoma metastasis: a common cancer presenting in an uncommon manner.

    PubMed

    Rohloff, Matthew; VandenBerg, Todd; MacMath, Terry

    2015-01-01

    Transitional cell carcinoma (TCC) and large bowel obstructions are both common disease processes typically considered unrelated. Presented below is the case of a 49-year-old male with a large bowel obstruction caused by a bladder TCC metastasis. One year prior to large bowel obstruction presentation, the patient had a T2, Grade III TCC of the bladder with no nodal involvement or metastasis, which was removed via radical cystoprostatectomy. This case serves as a reminder that cancer, despite common pathogenesis patterns, can present in atypical ways. PMID:26197806

  13. Primary Cardiac Synovial Sarcoma Originating From the Mitral Valve Causing Left Ventricular Outflow Tract Obstruction.

    PubMed

    Prifti, Edvin; Veshti, Altin; Ikonomi, Majlinda; Demiraj, Aurel

    2015-10-01

    An 11-year-old boy was admitted with complaints of syncope and convulsion. Echocardiogram revealed a mass measuring 2 × 4 cm related to the mitral subvalvular apparatus. The mass, which appeared to be attached to the anterolateral papillary muscle, protruded into the left ventricular outflow tract causing intermittent obstruction. The patient underwent surgical excision of the mass. Pathology confirmed the diagnosis of primary synovial sarcoma. At six months following the operation, a small mass measuring 1 × 1 cm was detected in the left ventricle. The patient underwent reoperation consisting of radical resection of the subvalvular apparatus and mitral valve replacement. Histology confirmed that the mass was cardiac synovial sarcoma. One year after surgery, the patient is doing well. PMID:26467881

  14. Refractory Hypotension after Liver Allograft Reperfusion: A Case of Dynamic Left Ventricular Outflow Tract Obstruction

    PubMed Central

    Essandoh, Michael; Otey, Andrew Joseph; Dalia, Adam; Dewhirst, Elisabeth; Springer, Andrew; Henry, Mitchell

    2016-01-01

    Hypotension after reperfusion is a common occurrence during liver transplantation following the systemic release of cold, hyperkalemic, and acidic contents of the liver allograft. Moreover, the release of vasoactive metabolites such as inflammatory cytokines and free radicals from the liver and mesentery, compounded by the hepatic uptake of blood, may also cause a decrement in systemic perfusion pressures. Thus, the postreperfusion syndrome (PRS) can materialize if hypotension and fibrinolysis occur concomitantly within 5 min of reperfusion. Treatment of the PRS may require the administration of inotropes, vasopressors, and intravenous fluids to maintain hemodynamic stability. However, the occurrence of the PRS and its treatment with inotropes and calcium chloride may lead to dynamic left ventricular outflow tract obstruction (DLVOTO) precipitating refractory hypotension. Expedient diagnosis of DLVOTO with transesophageal echocardiography is extremely vital in order to avoid potential cardiovascular collapse during this critical period. PMID:26909349

  15. [Accessory mitral tissue responsible for left ventricular outflow obstruction. Reports of 7 cases].

    PubMed

    Arnaud-Crozat, E; Nottin, R; Chambran, P; Serraf, A; Verrier, J F; Detroux, M; Lacour-Gayet, F; Planche, C; Langlois, J; Binet, J P

    1990-09-01

    The authors report the medico-surgical experience of Marie Lannelongue hospital of a rare condition: accessory mitral valve tissue. Seven patients aged 2 to 28 years (average: 8.7 years) had left ventricular outflow obstruction due to accessory mitral valve tissue. The diagnostic was not obvious clinically and was based on the association of echocardiographic and angiographic data. This condition was associated with another intra-cardiac malformation in 6 of the 7 patients. Surgical treatment included resection of the accessory mitral valve tissue by an aortic or combined aorto-left atrial approach, together with correction of the associated intracardiac abnormality. The postoperative results were excellent with the regression of the ventriculo-aortic pressure gradient and the physiological integrity of the mitral valve. PMID:2122834

  16. Compensatory Paracrine Mechanisms That Define The Urothelial Response to Injury in Partial Bladder Outlet Obstruction

    SciTech Connect

    Bassuk, James; Lendvay, Thomas S.; Sweet, Robert; Han, Chang-Hee; Soygur, Tarkan; Cheng, Jan-Fang; Plaire, J. Chadwick; Charleston, Jay S.; Charleston, Lynne B.; Bagai, Shelly; Cochrane, Kimberly; Rubio, Eric; Bassuk, James A.; Fuchs, Elaine

    2007-06-21

    Diseases and conditions affecting the lower urinary tract are a leading cause of dysfunctional sexual health, incontinence, infection, and kidney failure. The growth, differentiation, and repair of the bladder's epithelial lining are regulated, in part, by fibroblast growth factor (FGF)-7 and -10 via a paracrine cascade originating in the mesenchyme (lamina propria) and targeting the receptor for FGF-7 and -10 within the transitional epithelium (urothelium). The FGF-7 gene is located at the 15q15-q21.1 locus on chromosome 15 and four exons generate a 3.852-kb mRNA. Five duplicated FGF-7 gene sequences that localized to chromosome 9 were predicted not to generate functional protein products, thus validating the use of FGF-7-null mice as an experimental model. Recombinant FGF-7 and -10 induced proliferation of human urothelial cells in vitro and transitional epithelium of wild-type and FGF-7-null mice in vivo.To determine the extent that induction of urothelial cell proliferation during the bladder response to injury is dependent on FGF-7, an animal model of partial bladder outlet obstruction was developed. Unbiased stereology was used to measure the percentage of proliferating urothelial cells between obstructed groups of wild-type and FGF-7-null mice. The stereological analysis indicated that a statistical significant difference did not exist between the two groups, suggesting that FGF-7 is not essential for urothelial cell proliferation in response to partial outlet obstruction. In contrast, a significant increase in FGF-10 expression was observed in the obstructed FGF-7-null group, indicating that the compensatory pathway that functions in this model results in urothelial repair.

  17. Results of aortoventriculoplasty in 21 consecutive patients with left ventricular outflow tract obstruction.

    PubMed

    Rastan, H; Abu-Aishah, N; Rastan, D; Heisig, B; Koncz, J; Björnstad, P G; Beuren, A J

    1978-05-01

    Results of aortoventriculoplasty (AVP) are reported in 21 patients with various types of left ventricular outflow tract obstruction (LVOTO). The concept of AVP is based on creating a surgical aortoseptal defect which is patched to provide the largest possible outflow tract to the left ventricle. Lesions consisted of isolated diffuse fibromuscular subaortic stenosis in six patients, diffuse subaortic stenosis and associated other cardiovascular anomalies in five, hypoplastic aortic anulus in two, idiopathic hypertrophic subaortic stenosis (IHSS) in two, and stenosis of a previously implanted aortic valvular prosthesis in three patients. Ten patients had had at least one unsuccessful previous surgical attempt to relieve the LVOTO. The coexisting mitral incompetence in IHSS disappeared after AVP alone. Immediate postoperative hemodynamic results were excellent in all cases. Postoperative death in five patients was due to advance myocardial failure in two, brain damage in one, transection of a dominant septal artery in one, and severe acidosis with renal failure in the last case. However, in the last 16 patients (17 operations) the only death (5.8 percent) was that caused by uncontrollable acidosis. Follow-up results indicate that 16 patients are clinically doing well, and hemodynamic studies in 14 patients are rated as excellent or good from 1 to 25 months postoperatively. It is concluded that AVP is an effective operation for managing all types of LVOTO and can be used routinely with an acceptably low mortality rate. PMID:565445

  18. [Demonstration of obstruction of blood outflow from the left and right ventricles in idiopathic hypertrophic subaortic stenosis].

    PubMed

    Makhkamova, M N

    1985-12-01

    A comparative assessment of the value of routine clinical and intracardiac investigation procedures for the diagnosis of idiopathic hypertrophic subaortic stenosis (IHSS) was carried out in 12 patients with simultaneous obstructions of the left- and right-ventricular blood outflow pathways caused by hypertrophy of the interventricular septum. It is suggested that electrocardiographic and roentgenologic evidence of overloaded right and left compartments of the heart signals are indicative of the need for simultaneous catheterization and angiocardiography of the right and left compartments that can detect right-ventricular obstruction in the IHSS patients. Intravital diagnosis of the obstruction makes possible complete correction of the defect, whereas an isolated removal of the left-ventricular obstruction is not successful in the presence of an obstruction in the right ventricle. PMID:2936921

  19. Persistent overexpression of SERCA2a affects bladder functions under physiological conditions, but not in bladder outlet obstruction-induced sub-acute pathological conditions.

    PubMed

    Yamada, Atsushi; Torimoto, Kazumasa; Obata, Koji; Hirayama, Akihide; Fujimoto, Kiyohide; Takaki, Miyako

    2014-01-01

    A functional impairment of the bladder and heart in a decompensated state caused by a pressure overload is accompanied by a decrease in the sarcoplasmic reticulum Ca(2+)-ATPase (SERCA2). The beneficial effects of SERCA2 overexpression in preserving cardiac functions have been previously reported. The aim of the present study was to investigate the effects of overexpressed SERCA2 on bladder functions under physiological and pathological conditions using partial bladder outlet obstruction (BOO) in SERCA2a transgenic Wistar rats (TG). Bladder cystometry and western blot analysis were performed using the wild-type Wistar rats (WT), TG, and BOO models (WTBOO and TGBOO). Persistent overexpression of SERCA2 induces reduced bladder compliance without hypertrophy in TG. BOO induces reduced bladder compliance and hypertrophy in WT and TG in the sub-acute phase, but persistent overexpression of SERCA2a in TG does not aggravate the bladder compliance and hypertrophy. In conclusion, SERCA2a overexpression affects bladder functions under physiological conditions, but not in BOO-induced sub-acute pathological conditions. PMID:24037709

  20. Cystometric parameters and the activity of signaling proteins in association with the compensation or decompensation of bladder function in an animal experimental model of partial bladder outlet obstruction.

    PubMed

    Choi, Bo-Hwa; Jin, Long-Hu; Kim, Khae-Hawn; Kang, Sung-An; Kang, Ju-Hee; Yoon, Sang-Min; Park, Chang-Shin; Lee, Tack

    2013-12-01

    We conducted this study to determine whether the degree of detrusor contractility is associated with the compensation or decompensation of bladder function depending on the residual volume (RV) during the first two weeks after the onset of partial bladder outlet obstruction (BOO). Moreover, we also examined whether the degree of the phosphorylation and expression of signaling proteins [AMP-activated kinase (AMPK), extracellular signal‑regulated protein kinases 1 and 2 (ERK1/2) and protein kinase C (PKC)] is associated with the prevalence of compensation or decompensation of bladder function. Twenty-seven female Sprague-Dawley (SD) rats were randomly assigned to either the sham-operated group (n=7) or the group with partial bladder outlet obstruction (BOO) (n=20). We then measured cystometric parameters from three reproducible micturition cycles and averaged the results for a comparison between the two groups. Based on a cut-off value of a mean RV% of 25%, we subdivided our experimental animals into two subgroups: the subgroup with bladder compensation (mean RV%, <25%) and the subgroup with bladder decompensation (mean RV%, >25%). Our results indicated that the degree of detrusor overactivity (DO) was associated with the compensation or decompensation of bladder function depending on the RV during the first two weeks after the onset of BOO in an animal experimental model of partial BOO. Moreover, we also demonstrate that AMPK and ERK1/2 are involved in the compensation or decompensation of bladder function. Furthermore, our results suggest that PKC is not involved in two-phase bladder contraction. Alterations in the activities of signaling proteins, such as AMPK and ERK1/2 may prove to be helpful in the treatment of patients with voiding difficulty. PMID:24085268

  1. [Obstructive pyelonephritis caused by ureteral orifice catheterization with a bladder catheter].

    PubMed

    Arnaud, P; Carpentier, X; Pedulla, F; Sandid, M; Pernin, F

    2014-12-01

    This article reports a rare case of acute pyelonephritis secondary to left ureteral obstruction by a bladder catheter. The patient was 93years old man hospitalized in the hospital emergency department with a 39°C fever and pyuria from an indwelling catheter. Blood test found hyperleukocytosis, inflammatory syndrome and acute renal failure. Diagnosis was confirmed by non-contrast abdominal CT scan showing distal part of the catheter inside left ureteral orifice with ureterohydronephrosis. Treatment consisted in replacing the catheter by a three-way catheter for irrigation and parenteral antibiotics therapy. Clinico-biological evolution was successful and a urinary tract CT scan could be realized at day 9. The left upper urinary tract function was recovered. With a short review of the literature we propose to describe the different procedures to manage those obstructions. PMID:25288585

  2. Absence of Canonical Smad Signaling in Ureteral and Bladder Mesenchyme Causes Ureteropelvic Junction Obstruction

    PubMed Central

    Tripathi, Piyush; Wang, Yinqiu; Casey, Adam M.

    2012-01-01

    Obstruction of the ureteropelvic junction (UPJ) is a common congenital anomaly frequently associated with ureteral defects. To study the molecular mechanisms that modulate ureteral development, we inactivated Smad4, the common Smad critical for transcriptional responses to TGF-β and Bmp signaling, in the ureteral and bladder mesenchyme during embryogenesis. Loss of canonical Smad signaling in these tissues caused bilateral UPJ obstruction and severe hydronephrosis beginning at embryonic day 17.5. Despite a reduction in quantity of ureteral smooth muscle, differentiation proceeded without Smad4, producing a less severe phenotype than Bmp4 mutants; this finding suggests that at least some Bmp4 functions in ureteral smooth muscle may be Smad-independent. The absence of canonical Smad signaling in the ureteral mesenchyme, but not in the urothelium itself, led to urothelial disorganization, highlighting the importance of mesenchymal support for epithelial development. Transcript profiling revealed altered expression in known Bmp targets, smooth muscle-specific genes, and extracellular matrix-related genes in mutant ureters before the onset of hydronephrosis. Expression of the Bmp target Id2 was significantly lower in Smad4 mutants, consistent with the observation that Id2 mutants develop UPJ obstruction. In summary, Smad4 deficiency reduces the number and contractility of ureteral smooth muscle cells, leading to abnormal pyeloureteral peristalsis and functional obstruction. The subsequent bending and luminal constriction of the ureter at the UPJ marks the transition from a functional obstruction to a more intractable physical obstruction, suggesting that early intervention for this disease may prevent more irreversible damage to the urinary tract. PMID:22282597

  3. Mesenchymal stem cells overexpressing hepatocyte growth factor (HGF) inhibit collagen deposit and improve bladder function in rat model of bladder outlet obstruction.

    PubMed

    Song, Yun Seob; Lee, Hong Jun; Doo, Seung Hwan; Lee, Sun Ju; Lim, Inja; Chang, Kyu-Tae; Kim, Seung U

    2012-01-01

    Bladder outlet obstruction (BOO) caused by collagen deposit is one of the most common problems in elderly male. This study was performed to examine the capability of human mesenchymal stem cells (MSCs) overexpressing hepatocyte growth factor (HGF) to inhibit collagen deposition in rat model of bladder outlet obstruction (BOO). HGF is known for its antifibrotic effect and the most promising agent for treating bladder fibrosis. BM3.B10 stable immortalized human MSC line (B10) was transduced to encode human HGF with a retroviral vector was prepared (B10.HGF). Two weeks after the onset of BOO, B10, and B10.HGF cells were injected into the rat's bladder wall. After 4 weeks, bladder tissues were harvested and Masson's trichrome staining was performed. Transgene expression in HGF-expressing B10 cells was demonstrated by reverse transcriptase polymerase chain reaction and immunohistochemical staining, and the high levels of HGF secreted by B10.HGF cells was confirmed by ELISA. The mean bladder weight in BOO rats was 5.8 times of the normal controls, while in animals grafted with B10.HGF cells, the weight was down to four times of the control [90.2 ± 1.6 (control), 89.9 ± 2.8 (sham), 527.9 ± 150.9 (BOO), 447.7 ± 41.0 (BOO + B10), and 362.7 ± 113.2 (BOO + B10.HGF)]. The mean percentage of collagen area increased in BOO rats, while in the animals transplanted with B10.HGF cells, the collagen area decreased to the normal control level [12.2 ± 1.3, (control), 12.8 ± 1.1 (sham), 26.6 ± 2.7 (BOO), 19.9 ± 6.0 (BOO + B10), and 13.3 ± 2.1 (BOO + B10.HGF)]. The expression of collagen and TGF-b protein increased after BOO, while the expression of HGF and c-met protein increased in the group with B10.HGF transplantation after BOO. Intercontraction interval decreased after BOO, but it recovered after B10.HGF transplantation. Maximal voiding pressure (MVP) increased after BOO, and it recovered to levels of the normal control after transplantation of B10.HGF cells. Residual

  4. Aneurysm of the Membranous Septum Causing Outflow Obstruction of the Venous Ventricle in Corrected Transposition of the Great Arteries

    PubMed Central

    Gunawan, Antonius; Krajcer, Zvonimir; Leachman, Robert D.

    1982-01-01

    A 58 year-old man with clinical and hemodynamic evidence of subpulmonic stenosis was admitted to our hospital. Angiography revealed corrected transposition of the great arteries and an aneurysm of membranous ventricular septum (AVS) that protruded into the venous outflow tract, causing severe subpulmonic obstruction during systole. The diagnosis was confirmed at surgery, and successful repair of the aneurysm was performed. This was an unusual case because the AVS caused such severe obstruction that the venous ventricular pressure was elevated to a value equal to the systemic level. Images PMID:15226819

  5. Bladder outlet obstruction triggers neural plasticity in sensory pathways and contributes to impaired sensitivity in erectile dysfunction.

    PubMed

    Malykhina, Anna P; Lei, Qi; Chang, Shaohua; Pan, Xiao-Qing; Villamor, Antonio N; Smith, Ariana L; Seftel, Allen D

    2013-05-15

    Lower urinary tract symptoms (LUTS) and erectile dysfunction (ED) are common problems in aging males worldwide. The objective of this work was to evaluate the effects of bladder neck nerve damage induced by partial bladder outlet obstruction (PBOO) on sensory innervation of the corpus cavernosum (CC) and CC smooth muscle (CCSM) using a rat model of PBOO induced by a partial ligation of the bladder neck. Retrograde labeling technique was used to label dorsal root ganglion (DRG) neurons that innervate the urinary bladder and CC. Contractility and relaxation of the CCSM was studied in vitro, and expression of nitric oxide synthase (NOS) was evaluated by Western blotting. Concentration of the sensory neuropeptides substance P (SP) and calcitonin gene-related peptide was measured by ELISA. Partial obstruction of the bladder neck caused a significant hypertrophy of the urinary bladders (2.5-fold increase at 2 wk). Analysis of L6-S2 DRG sections determined that sensory ganglia received input from both the urinary bladder and CC with 5-7% of all neurons double labeled from both organs. The contractile responses of CC muscle strips to KCl and phenylephrine were decreased after PBOO, followed by a reduced relaxation response to nitroprusside. A significant decrease in neuronal NOS expression, but not in endothelial NOS or protein kinase G (PKG-1), was detected in the CCSM of the obstructed animals. Additionally, PBOO caused some impairment to sensory nerves as evidenced by a fivefold downregulation of SP in the CC (P ≤ 0.001). Our results provide evidence that PBOO leads to the impairment of bladder neck afferent innervation followed by a decrease in CCSM relaxation, downregulation of nNOS expression, and reduced content of sensory neuropeptides in the CC smooth muscle. These results suggest that nerve damage in PBOO may contribute to LUTS-ED comorbidity and trigger secondary changes in the contraction/relaxation mechanisms of CCSM. PMID:23535456

  6. The use of ultrasound-estimated bladder weight in diagnosing bladder outlet obstruction and detrusor overactivity in men with lower urinary tract symptoms

    PubMed Central

    Housami, Fadi; Drake, Marcus; Abrams, Paul

    2009-01-01

    Objectives: Measurement of bladder weight using ultrasound estimates of bladder wall thickness and bladder volume is an emerging clinical measurement technique that may have a role in the diagnosis of lower urinary tract dysfunction. We have reviewed available literature on this technique to assess current clinical status. Methods: A systematic literature search was carried out within PubMed and MedLine to identify relevant publications. These were then screened for relevance. Preliminary results from our clinical experiments using the technique are also included. Results: We identified 17 published papers concerning the technique which covered clinical studies relating ultrasound-estimated bladder wall thickness to urodynamic diagnosis in men, women, and children together with change in response to treatment of bladder outlet obstruction. The original manual technique has been challenged by a commercially available automated technique. Conclusion: Ultrasound-estimated bladder weight is a promising non-invasive technique for the categorization of storage and voiding disorders in both men and women. Further studies are needed to validate the technique and assess accuracy of diagnosis. PMID:19468439

  7. Initial experience using the Palmaz Corinthian stent for right ventricular outflow obstruction in infants and small children.

    PubMed

    Turner, D R; Rodriguez-Cruz, E; Ross, R D; Forbes, T J

    2000-12-01

    The original Palmaz balloon expandable stent has been used extensively for the treatment of vascular stenoses in older children and young adults. Placement of the Palmaz stent in infants and small children, however, is limited by stent inflexibility, large delivery sheath size, and concerns about creating fixed obstructions after the placement of small diameter stents in growing patients. New Palmaz Corinthian stents were placed through 6 French sheaths in four high-risk patients with postoperative right ventricular outflow obstruction. Patients were not considered candidates for surgical repair. Median patient age and weight were 17 months (range 5-32 months) and 7.7 kg (range 4.6-11.1 kg), respectively. Median fluoroscopy time was 58.2 min (range 55.2-172 min). No complications were encountered. In each case, successful stent placement was achieved, and surgery with cardiopulmonary bypass was avoided. Palmaz Corinthian stents are more flexible, require a smaller delivery sheath, have equal or increased radial strength, and can be maximally expanded to a greater cross sectional area when compared to the original Palmaz stent. These characteristics make the Palmaz Corinthian stent a reasonable alternative for use in a select group of infants and small children who are not candidates for surgical repair of postoperative right ventricular outflow obstruction. PMID:11108677

  8. Effect of silodosin, a selective α(1A)-adrenoceptor antagonist, on voiding behavior and bladder blood flow in a rat model of bladder outlet obstruction.

    PubMed

    Goi, Yoshiaki; Tomiyama, Yoshitaka; Yokoyama, Ayaka; Tatemichi, Satoshi; Maruyama, Kazuyasu; Kobayashi, Mamoru; Yamaguchi, Osamu

    2015-10-01

    This study was performed to investigate the effects of silodosin (selective α1A-adrenoceptor antagonist) on bladder blood flow (BBF) and bladder function in a rat model of bladder outlet obstruction (BOO) and to determine the expression of α1-adrenoceptor subtype mRNA in human and rat bladder microvessels. BOO was produced by partial ligature of the proximal urethra, which was maintained for 2 weeks. The BOO rats received either silodosin at a rate of 0.3mg/kg/day or vehicle subcutaneously via an osmotic pump for 2 weeks after BOO surgery. A metabolic cage study was performed in conscious animals. BBF was measured using a Laser Speckle Blood Flow Imager. Urinary levels of 8-hydroxy-2'-deoxyguanosine (8-OHdG) and nerve growth factor (NGF) were measured. Immunohistological examinations of nerve distribution and NGF expression in the rat bladder were conducted. The expression of each α1-adrenoceptor subtype mRNA in human and rat bladder microvessels was determined by in situ hybridization. Silodosin ameliorated the increase in voiding frequency and decrease in mean voided volume in BOO rats in the metabolic cage study. Silodosin also abrogated the decrease in BBF in BOO rats. The levels of 8-OHdG and NGF in BOO rats were significantly decreased by administration of silodosin. Silodosin prevented the decrease in nerve distribution and increase in NGF expression. Human and rat bladder microvessels showed expression of all α1-adrenoceptor subtype mRNAs. The results presented here suggest that silodosin improves voiding behavior in rat models with BOO by inducing recovery of BBF. PMID:26189024

  9. AB116. Role of the novel herbal formulation (WSY-1075) in a refractory detrusor overactivity due to bladder outlet obstruction

    PubMed Central

    Bae, Woong Jin; Bashraheel, Fahad; Choi, Sae Woong; Kim, Su Jin; Kim, Sae Woong

    2016-01-01

    Objective To evaluate whether a new herbal formula (WSY-1075) could prevent partial bladder outlet obstruction induced overactive bladder and to investigate its anti-oxidant and anti-inflammatory effects. Methods Twenty four male Sprague-Dawley rats were used in the study. The experimental group was partially obstructed via perineal ligation. After 2 weeks, the rats were randomly divided into one of three treatment groups: control (n=8), oxybutynin (3 mg/kg) (n=8), and WSY-1075 (400 mg/kg) (n=8). After 4 weeks of treatment, ligations were removed and cystometrograms were performed twice a week apart. The pro-inflammatory cytokine levels, anti-oxidant effects and histological findings were also noted. Results The use of oxybutynin and WSY-1075 showed significantly increased bladder compliance and diminished non-voiding contractions. Treatment with Oxybutynin and WSY-1075 significantly decreased pro-inflammatory cytokine levels. The levels of superoxide dismutase increased in the WSY-1075 group, which confirmed the anti-oxidant effect of WSY-1075. Conclusions WSY-1075 may be effective in treating detrusor overactivity do not respond to resolution of bladder outlet obstruction.

  10. The influence of piroxicam, a non-selective cyclooxygenase inhibitor, on autonomic nervous system activity in experimental cyclophosphamide-induced hemorrhagic cystitis and bladder outlet obstruction in rats.

    PubMed

    Dobrek, Łukasz; Baranowska, Agnieszka; Skowron, Beata; Thor, Piotr J

    2014-01-01

    Signs and symptoms of secondary overactive bladder (OAB) are observed both in course of infravesical obstruction of urine outflow in patients with benign prostatic hyperplasia, and as a result of development of hemorrhagic cystitis (HC) following administration of cyclophosphamide (CP). Non-steroidal antiinflammatory drugs (NSAIDs) alleviate symptoms of bladder overactivity reducing local synthesis of prostaglandins (PGs), but precise effects of those agents on functions of the autonomic nervous system (ANS) in course of OAB remain unknown. The purpose of this study was to evaluate the effect of piroxicam-induced prostaglandins (PGs) synthesis block on activity of the ANS in two experimental models of secondary OAB: bladder outlet obstruction (BOO) and cyclophosphamide-induced HC (CP-HC), by heart rate variability analysis (HRV). The experiment was performed on a group of rats with surgically induced 2-week BOO, and on a group of rats that were administered CP five times, with corresponding control groups. Study animals were given piroxicam (PRX) i.p. in two doses: 2 and 10 mg/kg b.w. In the BOO model, PRX in both doses revealed a trend for reduction of value of all non-normalized components of HRV. The lower PRX dose caused an increased nHF value, and PRX administered in the dose of 10 mg/kg b.w. caused an increase of the nLF value. In the CP-HC model, the lower PRX dose caused a trend for an increase of values of all non-normalized components, and the higher dose--for their decrease. Both doses of PRX in that model caused increase of the nLF value. Inhibition of PGs synthesis caused changes of ANS function in both models of OAB. Both in BOO and in CP-HC, PGs seem to be ANS-activating factors, responsible for maintenance of a high parasympathetic activity. In both models, inhibition of PGs synthesis with PRX administered at the dose of 10 mg/kg b.w. lead to functional reconstruction of ANS, with marked sympathetic predominance. That may contribute to reduction of

  11. Effect of detrusor overactivity on the expression of aquaporins and nitric oxide synthase in rat urinary bladder following bladder outlet obstruction

    PubMed Central

    Kim, Sun-Ouck; Choi, Dongjune; Song, Seung Hee; Ahn, Kyu Youn; Kwon, Dongdeuk; Park, Kwangsung; Ryu, Soo Bang

    2013-01-01

    Background: Aquaporins (AQPs) have recently been reported to be expressed in rat and human urothelium. Nitric oxide (NO) is thought to play a role in the bladder overactivity related to bladder outlet obstruction (BOO). The purpose of this study is to investigate the effect of BOO on the expression of AQP2-3 and nitric oxide synthase (NOS) isoforms in rat urothelium. Methods: Female Sprague-Dawley rats (230–240 g, n = 60) were divided into 2 groups. The control group (n = 30) and the partial bladder outlet obstruction (BOO) group (n = 30). After 4 weeks, we performed a urodynamic study to measure the contraction interval and contraction pressure. The expression and cellular localization of AQP2-3, endothelial nitric oxide synthase (eNOS) and neuronal nitric oxide synthase (nNOS) were determined by Western blot and immunohistochemistry. Results: On the cystometrogram, the estimated contraction interval time (minutes, mean ± SE) was significantly lower in the BOO group (3.0 ± 0.9) than in the control group (6.3 ± 0.4; p < 0.05). AQP2 was localized in the cytoplasm of the epithelium, whereas AQP3 was found only in the cell membrane of the epithelium. The protein expression of AQP2-3, eNOS and nNOS was significantly increased in the BOO group. Conclusion: Detrusor overactivity induced by BOO causes a significant increase in the expression of AQP2-3, eNOS, and nNOS in rat urinary bladder. This may imply that the AQPs and NOS isoforms have a functional role in the bladder dysfunction that occurs in association with BOO. PMID:23766828

  12. Increased susceptibility of estrogen-induced bladder outlet obstruction in a novel mouse model.

    PubMed

    Tam, Neville Ngai-Chung; Zhang, Xiang; Xiao, Hong; Song, Dan; Levin, Linda; Meller, Jarek; Ho, Shuk-Mei

    2015-05-01

    Disorders of the prostate and lower urinary tract are common in elderly men. We investigated the role of metallothionein-1 (MT1) in prostate carcinogenesis by generating a prostate-specific, MT1-expressing mouse. Unexpectedly, genomic analyses revealed that a 12.1-kb genomic region harboring several conserved noncoding elements was unintentionally deleted, upstream of the transgene integration site in the mouse, which we named it 12.1ΔMT1. Male 12.1ΔMT1 mice chronically treated with testosterone (T) plus 17β-estradiol (E2) to induce prostate cancer exhibited no evidence of precancerous or cancerous lesions. Instead, most of them exhibited a bladder outlet obstruction (BOO) phenotype not observed in treated wild-type (WT) mice. Thus, we hypothesized that 12.1ΔMT1 is a novel model for studying the hormonal requirement for BOO induction. Adult male 12.1ΔMT1 and WT mice were treated with T, E2, bisphenol A (BPA), T+E2, or T+BPA for up to 6 months. Histologic and immunohistochemical analysis of the prostate, bladder, and urethra were performed. No significant prostate pathologies were observed in WT or 12.1ΔMT1 mice treated with any of the hormone regimens. As expected, prostatic regression occurred in all E2-treated animals (WT and 12.1ΔMT1). Of great interest, despite a small prostate, 100% of E2-treated 12.1ΔMT1 mice, but only 40% of E2-treated WT mice, developed severe BOO (P<0.01). In contrast, T+E2 treatment was less effective than E2 treatment in inducing severe BOO in 12.1ΔMT1 mice (68%, P<0.05) and was completely ineffective in WT animals. Similarly, T, BPA, and T+BPA treatments did not induce BOO in either WT or 12.1ΔMT1 mice. The BOO pathology includes a thinner detrusor wall, narrowing of bladder neck and urethral lumen, and basal cell hyperplasia in the bladder body and urethra. These findings indicate that 12.1ΔMT1 mice exhibit enhanced susceptibility to E2-induced BOO that is independent of prostate enlargement but that is attenuated by the

  13. Structural and functional changes in gap junctional intercellular communication in a rat model of overactive bladder syndrome induced by partial bladder outlet obstruction

    PubMed Central

    ZHOU, FENGHAI; LI, HAIYUAN; ZHOU, CHUAN; LV, HAIDI; MA, YULEI; WANG, YANGMIN; SONG, BO

    2016-01-01

    The aim of the present study was to investigate the association between connexin (Cx)43 levels and alterations in gap junctional mediation of intercellular communication in overactive bladder syndrome (OAB), and to examine the effects of connexin inhibitor on this condition. Adult female Wistar rats with OAB following partial bladder outlet obstruction (PBBO) (OAB group, n=37) and sham-operated rats (control group, n=17) were studied. The ultrastructure of the rat detrusor was observed by transmission electron microscopy and the protein expression levels of Cx43 were analyzed using western blot analysis. Furthermore, bladder detrusor cells in both groups were cultured and cells in the OAB group were randomly divided into ten groups. In nine of these groups, 18-β glycyrrhetinic acid (18β-GA) was administered at various doses and durations. All groups were compared using fluorescence redistribution after photobleaching and a laser scanning confocal microscope. Cystometry demonstrated that gap junctions were an abundant mechanism among adjacent cells, and Cx43 protein expression levels were increased in the OAB group following 6 weeks of obstruction, as compared with the control group. Mean fluorescence recovery rates in the OAB group were significantly increased, as compared with the control group (P<0.01). Mean fluorescence recovery rates were noted following 18β-GA administration. These results suggested that upregulation of Cx43 induces structural and functional alterations in gap junctional intercellular communication following PBOO, and connexin inhibitors may be a novel therapeutic strategy for the clinical treatment of OAB. PMID:27284295

  14. Review of invasive urodynamics and progress towards non-invasive measurements in the assessment of bladder outlet obstruction

    PubMed Central

    Griffiths, C. J.; Pickard, R. S.

    2009-01-01

    Objective: This article defines the need for objective measurements to help diagnose the cause of lower urinary tract symptoms (LUTS). It describes the conventional techniques available, mainly invasive, and then summarizes the emerging range of non-invasive measurement techniques. Methods: This is a narrative review derived form the clinical and scientific knowledge of the authors together with consideration of selected literature. Results: Consideration of measured bladder pressure urinary flow rate during voiding in an invasive pressure flow study is considered the gold standard for categorization of bladder outlet obstruction (BOO). The diagnosis is currently made by plotting the detrusor pressure at maximum flow (pdetQmax) and maximum flow rate (Qmax) on the nomogram approved by the International Continence Society. This plot will categorize the void as obstructed, equivocal or unobstructed. The invasive and relatively complex nature of this investigation has led to a number of inventive techniques to categorize BOO either by measuring bladder pressure non-invasively or by providing a proxy measure such as bladder weight. Conclusion: Non-invasive methods of diagnosing BOO show great promise and a few have reached the stage of being commercially available. Further studies are however needed to validate the measurement technique and assess their worth in the assessment of men with LUTS. PMID:19468436

  15. Left ventricular outflow tract obstruction in complete transposition of the great arteries with intact ventricular septum. A cross sectional echocardiography study.

    PubMed Central

    Robinson, P J; Wyse, R K; Macartney, F J

    1985-01-01

    The roles of posterior bulging of the interventricular septum (septal bulge) and of systolic septal mitral apposition in patients with simple transposition of the great arteries are not known. Cross sectional echocardiograms of 40 such patients were reviewed (after exclusion of those with fixed left ventricular outflow tract obstruction) and haemodynamic findings were compared with long and short axis measurements within the left ventricle. There was no significant correlation between the degree of septal bulge and systolic gradient across the left ventricular outflow tract, but septal bulge correlated weakly with systolic right ventricular pressure and inversely with pulmonary arteriolar resistance index. Systolic left ventricular outflow gradient was inversely related to the minimum systolic distance between the anterior mitral leaflet and interventricular septum. No patients without complete systolic apposition of the anterior mitral leaflet and interventricular septum had a left ventricular outflow gradient greater than 20 mm Hg. Conversely, even when cross sectional echocardiography showed apparently total obstruction of the left ventricular outflow tract at some time in systole there was often no significant gradient detected during haemodynamic study. In the short axis cuts closeness of the papillary muscles to the interventricular septum or to each other was unrelated to systolic gradient. This study shows that (a) cross sectional echocardiography can identify fixed obstruction of the left ventricular outflow tract in simple transposition of the great arteries; (b) the degree of septal bulge, unless complicated by fibrous thickening of the anterior mitral leaflet and interventricular septum, is unrelated to the gradient across the left ventricular outflow tract; (c) the absence of systolic septal/mitral apposition excludes a significant gradient at that site across the left ventricular outflow tract; and (d) papillary muscle geometry is unrelated to dynamic

  16. Impairment of ATP hydrolysis decreases adenosine A1 receptor tonus favoring cholinergic nerve hyperactivity in the obstructed human urinary bladder.

    PubMed

    Silva-Ramos, M; Silva, I; Faria, M; Magalhães-Cardoso, M T; Correia, J; Ferreirinha, F; Correia-de-Sá, P

    2015-12-01

    This study was designed to investigate whether reduced adenosine formation linked to deficits in extracellular ATP hydrolysis by NTPDases contributes to detrusor neuromodulatory changes associated with bladder outlet obstruction in men with benign prostatic hyperplasia (BPH). The kinetics of ATP catabolism and adenosine formation as well as the role of P1 receptor agonists on muscle tension and nerve-evoked [(3)H]ACh release were evaluated in mucosal-denuded detrusor strips from BPH patients (n = 31) and control organ donors (n = 23). The neurogenic release of ATP and [(3)H]ACh was higher (P < 0.05) in detrusor strips from BPH patients. The extracellular hydrolysis of ATP and, subsequent, adenosine formation was slower (t (1/2) 73 vs. 36 min, P < 0.05) in BPH detrusor strips. The A(1) receptor-mediated inhibition of evoked [(3)H]ACh release by adenosine (100 μM), NECA (1 μM), and R-PIA (0.3 μM) was enhanced in BPH bladders. Relaxation of detrusor contractions induced by acetylcholine required 30-fold higher concentrations of adenosine. Despite VAChT-positive cholinergic nerves exhibiting higher A(1) immunoreactivity in BPH bladders, the endogenous adenosine tonus revealed by adenosine deaminase is missing. Restoration of A1 inhibition was achieved by favoring (1) ATP hydrolysis with apyrase (2 U mL(-1)) or (2) extracellular adenosine accumulation with dipyridamole or EHNA, as these drugs inhibit adenosine uptake and deamination, respectively. In conclusion, reduced ATP hydrolysis leads to deficient adenosine formation and A(1) receptor-mediated inhibition of cholinergic nerve activity in the obstructed human bladder. Thus, we propose that pharmacological manipulation of endogenous adenosine levels and/or A(1) receptor activation might be useful to control bladder overactivity in BPH patients. PMID:26521170

  17. Relationship of basal-septal fibrosis with LV outflow tract obstruction in hypertrophic cardiomyopathy: insights from cardiac magnetic resonance analysis.

    PubMed

    Nakamura, Takashi; Iwanaga, Yoshitaka; Yasuda, Masakazu; Kawamura, Takayuki; Miyaji, Yuki; Morooka, Hanako; Miyazaki, Shunichi

    2016-04-01

    Myocardial fibrosis is frequently observed and may be associated with the prognosis in patients with hypertrophic cardiomyopathy (HCM); however, the clinical pathophysiological features, particularly in terms of fibrosis, of hypertrophic obstructive cardiomyopathy (HOCM) remain unclear. This study aimed to determine a role of local fibrosis in HOCM using cardiac magnetic resonance (CMR). 108 consecutive HCM patients underwent CMR. HOCM was defined as a left ventricular outflow tract (LVOT) pressure gradient ≥30 mmHg at rest. Myocardial mass and fibrosis mass by late gadolinium-enhancement CMR (LGE-CMR) were calculated and the distribution/pattern was analyzed using the AHA 17-segment model. LV ejection fraction (LVEF) was significantly higher in patients with HOCM (n = 19) than in those with nonobstructive HCM (n = 89) (P < 0.05). Both total myocardial and fibrosis masses in LV were similar in the two groups (P = 0.385 and P = 0.859, respectively). However, fibrosis in the basal septum was significantly less frequent in the HOCM group than in the nonobstructive HCM group (P < 0.01). The LVOT pressure gradient was significantly higher in the basal-septal non-fibrosis group than in the fibrosis group (23.6 ± 37.3 vs. 4.8 ± 11.4 mmHg, P < 0.01). Multivariate analysis revealed that basal-septal fibrosis was an independent negative predictor of LVOT obstruction in addition to the local wall thickness and LVEF as positive predictors in HCM patients. In conclusion, a significant association was observed between LVOT obstruction and basal septal fibrosis by LGE-CMR in HCM patients. In addition to negative impact of basal-septal fibrosis, basal-septal hypertrophy and preserved global LV contractility may be associated with the pathophysiological features of LVOT obstruction. PMID:26589516

  18. Dynamic left ventricular outflow tract obstruction secondary to hypovolemia in a German Shepard dog with splenic hemangiosarcoma.

    PubMed

    Aoki, Takuma; Sunahara, Hiroshi; Sugimoto, Keisuke; Ito, Tetsuro; Kanai, Eiichi; Neo, Sakurako; Fujii, Yoko; Wakao, Yoshito

    2015-09-01

    Dynamic left ventricular outflow tract obstruction (DLVOTO) is a common condition in cats and humans. In this case report, a dog is described with DLVOTO secondary to severe intra-abdominal hemorrhage caused by a hemangiosarcoma. The dog was a 9-year-old, 35.7-kg, spayed female German Shepard dog that presented with a history of tachypnea and collapse. A Levine II/VI systolic murmur was present at the heart base. Abdominal ultrasonography revealed a splenic mass and a large amount of ascites. Echocardiography showed a reduced left ventricular diameter and an increased aortic velocity caused by systolic anterior motion (SAM) of the mitral valve apparatus. The heart murmur and the SAM were resolved after treatment including a splenectomy and a blood transfusion. PMID:25924797

  19. Dynamic left ventricular outflow tract obstruction secondary to hypovolemia in a German Shepard dog with splenic hemangiosarcoma

    PubMed Central

    AOKI, Takuma; SUNAHARA, Hiroshi; SUGIMOTO, Keisuke; ITO, Tetsuro; KANAI, Eiichi; NEO, Sakurako; FUJII, Yoko; WAKAO, Yoshito

    2015-01-01

    Dynamic left ventricular outflow tract obstruction (DLVOTO) is a common condition in cats and humans. In this case report, a dog is described with DLVOTO secondary to severe intra-abdominal hemorrhage caused by a hemangiosarcoma. The dog was a 9-year-old, 35.7-kg, spayed female German Shepard dog that presented with a history of tachypnea and collapse. A Levine II/VI systolic murmur was present at the heart base. Abdominal ultrasonography revealed a splenic mass and a large amount of ascites. Echocardiography showed a reduced left ventricular diameter and an increased aortic velocity caused by systolic anterior motion (SAM) of the mitral valve apparatus. The heart murmur and the SAM were resolved after treatment including a splenectomy and a blood transfusion. PMID:25924797

  20. The paracrine effects of mesenchymal stem cells stimulate the regeneration capacity of endogenous stem cells in the repair of a bladder-outlet-obstruction-induced overactive bladder.

    PubMed

    Song, Miho; Heo, Jinbeom; Chun, Ji-Youn; Bae, Hee Sook; Kang, Jeong Wook; Kang, Hyunsook; Cho, Yong Mee; Kim, Seong Who; Shin, Dong-Myung; Choo, Myung-Soo

    2014-03-15

    Overactive bladder (OAB), which is characterized by the sudden and uncomfortable need to urinate with or without urinary leakage, is a challenging urological condition. The insufficient efficacy of current pharmacotherapies that uses antimuscarinic agents has increased the demand for novel long-term/stable therapeutic strategies. Here, we report the superior therapeutic efficacy of using mesenchymal stem cells (MSCs) for the treatment of OAB and a novel therapeutic mechanism that activates endogenous Oct4(+) primitive stem cells. We induced OAB using bladder-outlet-obstruction (BOO) in a rat model and either administered a single transplantation of human adipose-derived MSCs or daily intravenous injections of solifenacin, an antimuscarinic agent, for 2 weeks. Within 2 weeks, both the MSC- and solifenacin-treated groups similarly demonstrated relief from BOO-induced detrusor overactivity, hypertrophic smooth muscle, and neurological injuries. In contrast with the solifenacin-treated groups, a single transplantation of MSCs improved most OAB parameters to normal levels within 4 weeks. Although the transplanted human MSCs were hardly engrafted into the damaged bladders, the bladder tissues transplanted with MSCs increased rat sequence-specific transcription of Oct4, Sox2, and Stella, which are surrogate markers for primitive pluripotent stem cells. In addition, MSCs enhanced the expression of several genes, responsible for stem cell trafficking, including SDF-1/CXCR4, HGF/cMet, PDGF/PDGFR, and VEGF/VEGFR signaling axis. These changes in gene expression were not observed in the solifenacin-treated group. Therefore, we suggest the novel mechanisms for the paracrine effect of MSCs as unleashing/mobilizing primitive endogenous stem cells, which could not only explain the long-term/stable therapeutic efficacy of MSCs, but also provide promising new therapies for the treatment of OAB. PMID:24192209

  1. Targeted Laser Ablation of the Zebrafish Larval Heart Induces Models of Heart Block, Valvular Regurgitation, and Outflow Tract Obstruction

    PubMed Central

    Matrone, Gianfranco; Maqsood, Sana; Taylor, Jonathan; Mullins, John J.; Tucker, Carl S.

    2014-01-01

    Abstract Mammalian models of cardiac disease have provided unique and important insights into human disease but have become increasingly challenging to produce. The zebrafish could provide inexpensive high-throughput models of cardiac injury and repair. We used a highly targeted laser, synchronized to fire at specific phases of the cardiac cycle, to induce regional injury to the ventricle, atrioventricular (AV) cushion, and bulbus arteriosus (BA). We assessed the impact of laser injury on hearts of zebrafish early larvae at 72 h postfertilization, to different regions, recording the effects on ejection fraction (EF), heart rate (HR), and blood flow at 2 and 24 h postinjury (hpi). Laser injury to the apex, midzone, and outflow regions of the ventricle resulted in reductions of the ventricle EF at 2 hpi with full recovery of function by 24 hpi. Laser injury to the ventricle, close to the AV cushion, was more likely to cause bradycardia and atrial–ventricular dysfunction, suggestive of an electrical conduction block. At 2 hpi, direct injury to the AV cushion resulted in marked regurgitation of blood from the ventricle to the atrium. Laser injury to the BA caused temporary outflow tract obstruction with cessation of ventricle contraction and circulation. Despite such damage, 80% of embryos showed complete recovery of the HR and function within 24 h of laser injury. Precision laser injury to key structures in the zebrafish developing heart provides a range of potentially useful models of hemodynamic overload, injury, and repair. PMID:25272304

  2. Diagnosing Bladder Outlet Obstruction Using Non-invasive Decorrelation-Based Ultrasound Imaging: A Feasibility Study in Healthy Male Volunteers.

    PubMed

    Arif, Muhammad; Idzenga, Tim; van Mastrigt, Ron; de Korte, Chris L

    2015-12-01

    A feasibility study on the applicability of an ultrasound decorrelation method to urinary flow imaging was carried out in 20 healthy male volunteers, to provide a basis for a non-invasive approach to diagnose bladder outlet obstruction. Each volunteer voided five times in a flow meter in standing position. During each voiding, ultrasound radiofrequency frames were acquired transperineally at different flow rates. The results indicated that the decrease in correlation (decorrelation) of ultrasound radiofrequency signals had no unique relation with flow rate, but decreased distinctively with urinary flow velocity. In most of the healthy volunteers, the decorrelation was small because of the low flow velocity. However, because of the different flow velocities in volunteers, the variation in slope between volunteers was statistically significant. Therefore, it is probably possible to use the decorrelation method to differentiate between healthy persons and patients with obstruction. PMID:26403699

  3. Sodium Tanshinone IIA Sulfonate Ameliorates Bladder Fibrosis in a Rat Model of Partial Bladder Outlet Obstruction by Inhibiting the TGF-β/Smad Pathway Activation.

    PubMed

    Jiang, Xiaoxiao; Chen, Yaping; Zhu, Haitao; Wang, Bo; Qu, Ping; Chen, Renfu; Sun, Xiaoqing

    2015-01-01

    Transforming growth factor (TGF)-β1 is known to play a pivotal role in a diverse range of biological systems including modulation of fibrosis in several organs. The precise role of TGF-β/Smad signaling in the progression of bladder fibrosis secondary to partial bladder outlet obstruction (PBOO) is yet to be conclusively. Using a rat PBOO model, we investigated TGF-β1 expression and exaimined whether sodium tanshinone IIA sulfonate (STS) could inhibit TGF-β/Smad signaling pathway activation and ameliorate bladder fibrosis. Forty-eight female Sprague-Dawley rats were randomly divided into three groups: sham operation group (n = 16), PBOO operation without STS treatment group (n = 16) and PBOO operation with STS treatment group (n = 16). Thirty-two rats underwent the operative procedure to create PBOO and subsequently received intraperitoneal injections of STS (10 mg/kg/d; n = 16) or vehicle (n = 16) two days after the surgery. Sham surgery was conducted on 16 rats, which received intraperitoneal vehicle injection two days later. In each of the three groups, an equal number of rats were sacrificed at weeks 4 and 8 after the PBOO or sham operation. The TGF-β/Smad signaling pathway was analyzed using western blotting, immunohistochemical staining and reverse transcriptase polymerase chain reaction (RT-PCR). One-way analysis of variance was conducted to draw statistical inferences. At 4 and 8 weeks, the expression of TGF-β1 and phosphorylated Smad2 and Smad3 in STS-treated PBOO rats was significantly lower than in the PBOO rats not treated with STS. Alpha smooth muscle actin (α-SMA), collagen I and collagen III expression at 4 and 8 weeks post PBOO was lower in STS-treated PBOO rats when compared to that in PBOO rats not treated with STS. Our findings indicate that STS ameliorates bladder fibrosis by inhibiting TGF-β/Smad signaling pathway activation, and may prove to be a potential therapeutic measure for preventing bladder fibrosis secondary to PBOO operation

  4. Sodium Tanshinone IIA Sulfonate Ameliorates Bladder Fibrosis in a Rat Model of Partial Bladder Outlet Obstruction by Inhibiting the TGF-β/Smad Pathway Activation

    PubMed Central

    Wang, Bo; Qu, Ping; Chen, Renfu; Sun, Xiaoqing

    2015-01-01

    Transforming growth factor (TGF)-β1 is known to play a pivotal role in a diverse range of biological systems including modulation of fibrosis in several organs. The precise role of TGF-β/Smad signaling in the progression of bladder fibrosis secondary to partial bladder outlet obstruction (PBOO) is yet to be conclusively. Using a rat PBOO model, we investigated TGF-β1 expression and exaimined whether sodium tanshinone IIA sulfonate (STS) could inhibit TGF-β/Smad signaling pathway activation and ameliorate bladder fibrosis. Forty-eight female Sprague-Dawley rats were randomly divided into three groups: sham operation group (n = 16), PBOO operation without STS treatment group (n = 16) and PBOO operation with STS treatment group (n = 16). Thirty-two rats underwent the operative procedure to create PBOO and subsequently received intraperitoneal injections of STS (10 mg/kg/d; n = 16) or vehicle (n = 16) two days after the surgery. Sham surgery was conducted on 16 rats, which received intraperitoneal vehicle injection two days later. In each of the three groups, an equal number of rats were sacrificed at weeks 4 and 8 after the PBOO or sham operation. The TGF-β/Smad signaling pathway was analyzed using western blotting, immunohistochemical staining and reverse transcriptase polymerase chain reaction (RT-PCR). One-way analysis of variance was conducted to draw statistical inferences. At 4 and 8 weeks, the expression of TGF-β1 and phosphorylated Smad2 and Smad3 in STS-treated PBOO rats was significantly lower than in the PBOO rats not treated with STS. Alpha smooth muscle actin (α-SMA), collagen I and collagen III expression at 4 and 8 weeks post PBOO was lower in STS-treated PBOO rats when compared to that in PBOO rats not treated with STS. Our findings indicate that STS ameliorates bladder fibrosis by inhibiting TGF-β/Smad signaling pathway activation, and may prove to be a potential therapeutic measure for preventing bladder fibrosis secondary to PBOO operation

  5. Summary of Clinical Experience of Modified Double Root Translocation in the Management of Complete Transposition of Great Arteries With Left Ventricular Outflow Tract Obstruction.

    PubMed

    Yang, Bin; Xu, Jing; Zhou, Zhiming; Wang, Ke; Chen, Jianchao; Chen, Hongling; Wen, Meng; Liang, Qiaoru

    2016-07-27

    To summarize the therapeutic effects of modified double root translocation (MDRT) in the management of congenital heart disease-transposition of great arteries (TGA) with ventricular septum defect (VSD) and left ventricular outflow tract obstruction (LVOTO). From May 2013 to March 2015, we treated 6 patients (4 males, 2 females, aged from 1 year and 8 months old to 5 years old) with complete transposition of great arteries with left ventricular outflow tract obstruction, SaO2 54 ± 7.3%; the outflow velocity of the left ventricular or pulmonary valve measured by Doppler was 4.46 ± 0.15 m/s, and the Nakata index was 217 ± 32 cm(2)/m(2). We carried out a double root translocation operation on these 6 patients.One patient developed low cardiac output syndrome 4 hours after the operation. Extracorporeal membrane oxygenation (ECMO) was performed, but the patient died of multiple organ failure. The other 5 patients all recovered and were discharged from the hospital. During the 3-month to 2-year follow-up period, these 5 patients all demonstrated NYHA Class I or NYHA Class II LVEF (65 ± 2.7) %; 4 had mild pulmonary regurgitation, 1 moderate pulmonary regurgitation; 3 no aortic regurgitation, and 2 micro aortic regurgitation, SaO2 99 ± 0.4%.Modified double root translocation is an effective treatment method in the management of complete transposition of great arteries with left ventricular outflow tract obstruction. PMID:27396558

  6. Relaxant and contractile responses of detrusor muscle strips obtained from bladder outlet-obstructed rats treated with doxazosin enantiomers.

    PubMed

    Wang, Miao; Ren, Xue-Jiao; Zhao, Qing-Hua; Lin, Li-Xin; Wang, Xue; Zhao, Yan; Ren, Lei-Ming

    2011-12-01

    (-)Doxazosin, one of (±)doxazosin enantiomers, was speculated to have a pharmacological enantioselectivity between the cardiovascular system and the urinary system by comparison with (+)doxazosin. Therefore, to evaluate the potential benefits of (-)doxazosin in the treatment of benign prostate hyperplasia, we compared the effects of the 3 agents, using rat mesenteric artery preparations and obstructed bladder strips. Concentration-response curves for carbachol (contractile response) and isoprenaline (relaxant response) in detrusor muscle strips of the bladder outlet obstruction (BOO) rats were shifted to the left, with significant increases in the Emax values, and significant decreases in the EC50 values by comparison with the sham-operated rats (P < 0.05, n = 10). The enhanced responses in detrusor muscle strips of the BOO rats treated with (±)doxazosin and its enantiomers at 3 mg·(kg body mass)(-1)·day(-1) for 2 weeks returned to normal levels, and the 3 agents inhibited the enhanced responses to carbachol and isoprenaline to the same extent. On the other hand, the 3 agents uncompetitively inhibited the vasoconstrictive response curves for NA in the rat isolated mesenteric artery, and the pKB value of (-)doxazosin at vascular α1-adrenoceptors was significantly smaller (P < 0.05, n = 6) than that of (+)doxazosin or (±)doxazosin. In conclusion, although (-)doxazosin inhibits vascular functional α1-adrenoceptors more weakly than (+)doxazosin, both agents equally ameliorate the enhanced responses in detrusor muscle of BOO rats, suggesting that the chiral carbon atom in the molecular structure of doxazosin does not affect its beneficial effects in the bladder smooth muscle of BOO rats. PMID:22115277

  7. MiR-133 modulates TGF-β1-induced bladder smooth muscle cell hypertrophic and fibrotic response: implication for a role of microRNA in bladder wall remodeling caused by bladder outlet obstruction.

    PubMed

    Duan, Liu Jian; Qi, Jun; Kong, Xiang Jie; Huang, Tao; Qian, Xiao Qiang; Xu, Ding; Liang, Jun Hao; Kang, Jian

    2015-02-01

    Bladder outlet obstruction (BOO) evokes urinary bladder wall remodeling significantly, including the phenotype shift of bladder smooth muscle cells (BSMCs) where transforming growth factor-beta1 (TGF-β1) plays a pivotal role given the emerging function of modulating cellular phenotype. miR-133 plays a role in cardiac and muscle remodeling, however, little is known about its roles in TGF-β1-induced BSMC hypertrophic and fibrotic response. Here, we verified BOO induced bladder wall remodeling and TGF-β1 expression mainly located in bladder endothelium. Furthermore, we uncovered miR-133a/b expression profile in BOO rats, and then explored its regulated effects on BSMCs' phenotypic shift. Our study found that miR-133 became down-regulated during rat bladder remodeling. Next, we sought to examine whether the expression of miR-133 was down-regulated in primary BSMCs in response to TGF-β1 stimulation and whether forced overexpression of miR-133 could regulate profibrotic TGF-β signaling. We found that stimulation of BSMCs with exogenous TGF-β1 of increasing concentrations resulted in a dose-dependent decrease of miR-133a/b levels and transfection with miR-133 mimics attenuated TGF-β1-induced α-smooth muscle actin, extracellular matrix subtypes and fibrotic growth factor expression, whereas it upregulated high molecular weight caldesmon expression compared with the negative control. Also, downregulation of p-Smad3, not p-Smad2 by miR-133 was detected. Additionally, miR-133 overexpression suppressed TGF-β1-induced BSMC hypertrophy and proliferation through influencing cell cycle distribution. Bioinformatics analyses predicted that connective tissue growth factor (CTGF) was the potential target of miR-133, and then binding to the 3'-untranslated region of CTGF was validated by luciferase reporter assay. These results reveal a novel regulator for miR-133 to modulate TGF-β1-induced BSMC phenotypic changes by targeting CTGF through the TGF-β-Smad3 signaling pathway

  8. Effects of Spinal and Peripheral Injection of α1A or α1D Adrenoceptor Antagonists on Bladder Activity in Rat Models with or without Bladder Outlet Obstruction

    PubMed Central

    Kim, Jae Heon; Shim, Ji Sung; Kang, Seung Chul; Shim, Kang Soo; Park, Jae Young; Moon, Du Geon; Lee, Jeong Gu

    2011-01-01

    Purpose Antagonists of α1-adrenergic receptors (α1ARs) relax prostate smooth muscle and relieve voiding and storage symptoms. Recently, increased expression of α1ARs with change of its subtype expression has been proved in bladder outlet obstruction (BOO). To search for the evidence of changes in α1ARs subtype expression and activity in the peripheral and spinal routes, the effects of spinal and peripheral administration of tamsulosin (an α1A/D-selective AR), naftopidil (an α1A/D-selective AR), and doxazosin (non-selective AR) on bladder activity were investigated in a rat model with or without BOO. Methods A total of 65 female Sprague-Dawley rats were divided into the BOO surgery group (n=47) and the sham surgery group (n=18). After 6 weeks, cystometry was assessed before and after intrathecal and intra-arterial administrations of tamsulosin, naftopidil, and doxazosin. Results After intra-arterial administrations of all three drugs, bladder capacity (BC) was increased and maximal intravesical pressure (Pmax) was decreased in both BOO and the sham rat models (P<0.05). After intrathecal administration of all three drugs, BC was increased and Pmax was decreased in only the BOO group. The episodes of involuntary contraction in the BOO rat models were decreased by intra-arterial administration (P=0.031). The increase of BC after intrathercal and intra-arterial administrations of α1ARs was significantly greater in the BOO group than in the sham group (P=0.023, P=0.041). In the BOO group, the increase of BC and decrease in Pmax were greater by intra-arterial administration than by intrathecal administration (P=0.035). There were no significant differences of the degrees of changes in the cystometric parameters among the three different α1ARs. Conclusions Up-regulations of the α1ARs in BOO were observed by the greater increases of BC after α1AR antagonist administrations in the BOO group than in the sham group. However, there were no subtype differences of the

  9. Testosterone and 17β-estradiol induce glandular prostatic growth, bladder outlet obstruction, and voiding dysfunction in male mice.

    PubMed

    Nicholson, Tristan M; Ricke, Emily A; Marker, Paul C; Miano, Joseph M; Mayer, Robert D; Timms, Barry G; vom Saal, Frederick S; Wood, Ronald W; Ricke, William A

    2012-11-01

    Benign prostatic hyperplasia (BPH) and bladder outlet obstruction (BOO) are common in older men and can contribute to lower urinary tract symptoms that significantly impact quality of life. Few existing models of BOO and BPH use physiological levels of hormones associated with disease progression in humans in a genetically manipulable organism. We present a model of BPH and BOO induced in mice with testosterone (T) and 17β-estradiol (E(2)). Male mice were surgically implanted with slow-releasing sc pellets containing 25 mg T and 2.5 mg E(2) (T+E(2)). After 2 and 4 months of hormone treatment, we evaluated voiding patterns and examined the gross morphology and histology of the bladder, urethra, and prostate. Mice treated with T+E(2) developed significantly larger bladders than untreated mice, consistent with BOO. Some mice treated with T+E(2) had complications in the form of bladder hypertrophy, diverticula, calculi, and eventual decompensation with hydronephrosis. Hormone treatment caused a significant decrease in the size of the urethral lumen, increased prostate mass, and increased number of prostatic ducts associated with the prostatic urethra, compared with untreated mice. Voiding dysfunction was observed in mice treated with T+E(2), who exhibited droplet voiding pattern with significantly decreased void mass, shorter void duration, and fewer sustained voids. The constellation of lower urinary tract abnormalities, including BOO, enlarged prostates, and voiding dysfunction seen in male mice treated with T+E(2) is consistent with BPH in men. This model is suitable for better understanding molecular mechanisms and for developing novel strategies to address BPH and BOO. PMID:22948219

  10. AB259. TRPV1 receptor associated with detrusor overactivity induced by partial bladder outlet obstruction in rats

    PubMed Central

    Zhang, Zhaocun; Zhu, Yanfeng; Chen, Jun; Jiang, Xuewen; Shang, Zhenhua; Shi, Benkang

    2016-01-01

    Background To investigate the role of TRPV1 in the pathological process of DO induced by partial bladder outlet obstruction (pBOO). Methods In 40 female Wistar rats, pBOO was achieved by partial urethral ligation and urodynamic analysis was taken to filter the DO rats six weeks later. Urinary bladder and dorsal root ganglia (DRG) were removed and RT-PCR, Western Blot and IHC were performed to investigate the expression and location of TRPV1 in control and DO rats. Effect of different concentrations of TRPV1 agonist, as well as TRPV1 antagonist, was also evaluated with isolated detrusor strips. Results Forty female Wistar rats received pBOO surgery and 24 of them developed DO. Expression of TRPV1 mRNA and protein in urinary bladder and dorsal root ganglia (DRG) significantly increased in pBOO induced OAB rats. While that did not significantly change after de-urothelial treatment both in OAB and control rats. Immunohistochemistry observed linear TRPV1-reactive staining mainly in suburothlial and muscular layer. In isolated detrusor strips studies, the amplitude and frequency of contractions of DO tissues were significantly higher than that of control ones (P<0.05). Capsaicin significantly increased the amplitude but not frequency of detrusor intrinsic contractility and this effect was enhanced in OAB conditions. All changes induced by capsaicin were blocked by capsazepine pre-incubated. Conclusions In pBOO induced DO rats, over-expressed TRPV1 was involved in DO pathological process by directly sensitizing bladder afferent fibers or indirectly enhancing detrusor intrinsic properties.

  11. Congenital giant cardiac tumor with severe left-ventricular inflow and outflow obstruction and arrhythmia treated with pulmonary artery banding and long-term amiodarone infusion

    PubMed Central

    Takeuchi, Daiji; Hiramatsu, Takeshi; Nakanishi, Toshio

    2012-01-01

    We report a congenital giant cardiac tumor that occupied the majority of left ventricular cavity with severe left ventricular inflow and outflow obstruction. The hemodynamics were similar to univentricular physiology. He was treated with prostaglandins and bilateral pulmonary artery banding. He had frequent supraventricular tachycardia associated with ventricular pre-excitation that was controlled by long-term administration of intravenous amiodarone. The patient died due to sepsis after 3 months. PMID:22529609

  12. Assessment of noninvasive predictors of bladder outlet obstruction and acute urinary retention secondary to benign prostatic enlargement

    PubMed Central

    Abdel-Aal, Ashraf; El-Karamany, Tarek; Al-Adl, Ahmed Mahmoud; Abdel-Wahab, Osama; Farouk, Hesham

    2011-01-01

    Purpose To prospectively compare the diagnostic accuracy of intravesical prostatic protrusion (IPP), detrusor wall thickness (DWT), prostate volume (PV) and serum prostate specific antigen (PSA) levels for detecting bladder outlet obstruction (BOO) and predicting acute urinary retention (AUR) secondary to benign prostatic obstruction. Patients and methods In all, 135 men who presented with lower urinary tract symptoms due to benign prostatic enlargement were enrolled in the study; among them, 50 presented with AUR. Thirty normal men in the same age group were included and represented a control group for normative data. Their evaluation included a digital rectal examination, International Prostate Symptom Score and quality-of-life question, uroflowmetry and serum total PSA assay. Transabdominal ultrasonography was used to measure the PV, IPP DWT and post-void residual urine volume. Pressure-flow urodynamic studies were used as the reference standard test for BOO, differentiating obstructed from unobstructed bladders. DWT, IPP, PV and total PSA level served as index tests. To compare the usefulness of the various indices, the area under the curve (AUC) of receiver-operator characteristic curves was calculated for each index. Results According to presentation and urodynamic studies, patients were classified into three groups: Group 1 (no BOO), 50 patients with a BOO index (BOOI) of <40; group 2 (BOO), 35 with a BOOI of >40; and group 3 (AUR), 50 who presented with AUR. The IPP, DWT, PV and PSA levels differed significantly between obstructed and unobstructed patients, with a significant correlation with the BOOI. The AUC for IPP, DWT, PSA and PV were 0.885, 0.783, 0.745 and 0.678, respectively. The IPP threshold at 8 mm provided the best diagnostic accuracy (80%) for detecting BOO, followed by combined DWT and IPP (77.6%). Between patients with and without AUR, there was a highly significant difference in IPP, DWT and PSA; a combined IPP threshold of >8 mm and DWT

  13. Left lobe graft poses a potential risk of hepatic venous outflow obstruction in adult living donor liver transplantation.

    PubMed

    Kitajima, Toshihiro; Kaido, Toshimi; Iida, Taku; Yagi, Shintaro; Fujimoto, Yasuhiro; Ogawa, Kohei; Mori, Akira; Okajima, Hideaki; Imamine, Rinpei; Shibata, Toshiya; Uemoto, Shinji

    2016-06-01

    Hepatic venous outflow obstruction (HVOO) is a critical complication after living donor liver transplantation (LDLT). This study aimed to evaluate the incidence of HVOO and the risk factors for HVOO in adults. From 2005 to 2015, 430 adult LDLT patients (right lobe [RL] graft, 270 patients; left lobe [LL] graft, 160 patients) were enrolled and divided into no HVOO (n = 413) and HVOO (n = 17) groups. Patient demographics and surgical data were compared, and risk factors for HVOO were analyzed. Furthermore, the longterm outcomes of percutaneous interventions as treatment for HVOO were assessed. HVOO occurred in 17 (4.0%) patients. The incidence of HVOO in patients receiving a LL graft was significantly higher than in those receiving a RL graft (8.1% versus 1.5%; P = 0.001). The body weight and caliber of hepatic vein anastomosis in the HVOO group were significantly lower compared with the no HVOO group (P = 0.02 and P = 0.008, respectively). Multivariate analysis revealed that only LL graft was an independent risk factor for HVOO (OR, 4.782; 95% CI, 1.387-16.488; P = 0.01). Among 17 patients with HVOO, 7 patients were treated with single balloon angioplasty, and 9 patients who developed recurrence were treated with repeated interventions. Overall, 6 patients underwent stent placement: 1 at the initial procedure, 3 at the second procedure for early recurrence, and 2 following repeated balloon angioplasty (≥3 interventions). These 6 patients experienced no recurrence. Overall graft survival was not significantly different between the HVOO and no HVOO groups (P = 0.99). In conclusion, the use of a LL graft was associated with HVOO, and percutaneous interventions were effective for treating adult HVOO after LDLT. Liver Transplantation 22 785-795 2016 AASLD. PMID:26785423

  14. Assessing the contribution of thrombospondin-4 induction and ATF6α activation to endoplasmic reticulum expansion and phenotypic modulation in bladder outlet obstruction

    PubMed Central

    Krawczyk, Katarzyna K.; Ekman, Mari; Rippe, Catarina; Grossi, Mario; Nilsson, Bengt-Olof; Albinsson, Sebastian; Uvelius, Bengt; Swärd, Karl

    2016-01-01

    Phenotypic modulation of smooth muscle cells is a hallmark of disease. The associated expansion of endoplasmic reticulum (ER) volume remains unexplained. Thrombospondin-4 was recently found to promote ATF6α activation leading to ER expansion. Using bladder outlet obstruction as a paradigm for phenotypic modulation, we tested if thrombospondin-4 is induced in association with ATF6α activation and ER expansion. Thrombospondin-4 was induced and ATF6α was activated after outlet obstruction in rodents. Increased abundance of spliced of Xbp1, another ER-stress sensor, and induction of Atf4 and Creb3l2 was also seen. Downstream of ATF6α, Calr, Manf, Sdf2l1 and Pdi increased as did ER size, whereas contractile markers were reduced. Overexpression of ATF6α, but not of thrombospondin-4, increased Calr, Manf, Sdf2l1 and Pdi and caused ER expansion, but the contractile markers were inert. Knockout of thrombospondin-4 neither affected bladder growth nor expression of ATF6α target genes, and repression of contractile markers was the same, even if ATF6α activation was curtailed. Increases of Xbp1s, Atf4 and Creb3l2 were similar. Our findings demonstrate reciprocal regulation of the unfolded protein response, including ATF6α activation and ER expansion, and reduced contractile differentiation in bladder outlet obstruction occurring independently of thrombospondin-4, which however is a sensitive indicator of obstruction. PMID:27581066

  15. Assessing the contribution of thrombospondin-4 induction and ATF6α activation to endoplasmic reticulum expansion and phenotypic modulation in bladder outlet obstruction.

    PubMed

    Krawczyk, Katarzyna K; Ekman, Mari; Rippe, Catarina; Grossi, Mario; Nilsson, Bengt-Olof; Albinsson, Sebastian; Uvelius, Bengt; Swärd, Karl

    2016-01-01

    Phenotypic modulation of smooth muscle cells is a hallmark of disease. The associated expansion of endoplasmic reticulum (ER) volume remains unexplained. Thrombospondin-4 was recently found to promote ATF6α activation leading to ER expansion. Using bladder outlet obstruction as a paradigm for phenotypic modulation, we tested if thrombospondin-4 is induced in association with ATF6α activation and ER expansion. Thrombospondin-4 was induced and ATF6α was activated after outlet obstruction in rodents. Increased abundance of spliced of Xbp1, another ER-stress sensor, and induction of Atf4 and Creb3l2 was also seen. Downstream of ATF6α, Calr, Manf, Sdf2l1 and Pdi increased as did ER size, whereas contractile markers were reduced. Overexpression of ATF6α, but not of thrombospondin-4, increased Calr, Manf, Sdf2l1 and Pdi and caused ER expansion, but the contractile markers were inert. Knockout of thrombospondin-4 neither affected bladder growth nor expression of ATF6α target genes, and repression of contractile markers was the same, even if ATF6α activation was curtailed. Increases of Xbp1s, Atf4 and Creb3l2 were similar. Our findings demonstrate reciprocal regulation of the unfolded protein response, including ATF6α activation and ER expansion, and reduced contractile differentiation in bladder outlet obstruction occurring independently of thrombospondin-4, which however is a sensitive indicator of obstruction. PMID:27581066

  16. Use of triple ultra-high-pressure balloons for obstructed right ventricular outflow conduits in adults can be safe and effective.

    PubMed

    Fujimoto, Kazuto; Sugiyama, Hisashi; Yazaki, Satoshi

    2015-04-01

    To date, no transcatheter valve has been approved for placement in the pulmonary position in Japan. Consequently, percutaneous balloon dilatation may be advised for stenotic right ventricular outflow lesions; however, technical difficulties persist, particularly in adults. We describe the acute haemodynamic changes and outcome of balloon dilatation of right ventricular outflow obstruction using triple ultra-high pressure balloons. This is the first report of such a technical development, which seems to be safe and effective. A total of three adult patients, aged 25, 29, and 37 years, with severe conduit obstruction were referred for balloon dilatation. A triple ultra-high-pressure balloon technique was used in the three patients after unsuccessful double-balloon dilatation, or for highly calcified lesions, which were expected to require ultra-high pressure for effective relief. Following balloon dilatation, the pressure gradient decreased from 24, 30, 65 to 3, 25, 30 mmHg, respectively. There were no procedural complications except slightly increased pulmonary regurgitation. Balloon dilatation using a triple ultra-high pressure balloon technique can be a safe and effective palliative procedure for conduit obstruction in adult patients. PMID:24905445

  17. Enterolith causing bladder outlet obstruction in patient with imperforate anus. A rare case presentation.

    PubMed

    Hussain, Mudassir; Muhammad, Shah; Khan, Muhammad Arsalan; Manzoor, Muhammad

    2015-12-01

    Imperforate anus is a rare anomaly associated with defects commonly referred to as vertebral defects, anal atresia, cardiac defects, tracheo-oesophageal fistula, renal anomalies and limb abnormalities (VACTERL). With modern surgical procedures the overall outcome is excellent. Permanent colostomy which is required in some cases of this disease can result in some rare complications such as enteroliths formation, as illustrated in the case we are presenting here related to a 28-year-old male who reported at urology emergency with features of urinary and acute large bowel obstruction. On investigation he was found to have two enteroliths in his distal loop of sigmoid colostomy. The more distal of the two enteroliths caused urinary retention and hence acute renal failure, and the proximal one caused large bowel obstruction by compressing the proximal loop of colostomy. This case demonstrates that the blind distal sigmoid colostomy loop can grow enteroliths secondary to stasis of its own contents over a long period. PMID:26627524

  18. Increased expression of 5-HT(2A) and 5-HT(2B) receptors in detrusor muscle after partial bladder outlet obstruction in rats.

    PubMed

    Michishita, Mai; Yano, Kazuo; Kasahara, Ken-ichi; Tomita, Ken-ichi; Matsuzaki, Osamu

    2015-01-01

    Serotonin (5-hydroxytryptamine; 5-HT)-induced bladder contraction is enhanced after partial bladder outlet obstruction (pBOO) in rats. We investigated time-dependent changes in bladder contraction and expression of 5-HT(2A) and 5-HT(2B) receptor mRNA in bladder tissue to elucidate the mechanism of this enhancement. On day 3 and 7 after pBOO, contractile responses of isolated rat bladder strips to 5-HT were increased compared with that in sham-operated rats; on day 14, the response had decreased to the same level as that in sham rat bladders. In contrast, carbacholinduced contraction was not enhanced by pBOO at any time point. In sham rats, 5-HT(2A) receptor mRNA was expressed in the urothelium, and 5-HT(2B) receptor mRNA was expressed in the detrusor muscle layer. In pBOO rats, both receptor mRNAs were increased in the detrusor muscle and subserosal layers, but not in the urothelium. The increase of 5-HT(2A) receptor mRNA was maintained from day 3 to day 14 after pBOO, and 5-HT(2B) receptor mRNA was increased on day 7 after pBOO. These results suggested that pBOO induced up-regulation of the 5-HT(2A) and 5-HT(2B) receptors in the detrusor muscle and subserosal layers of the bladder, and such up-regulation may be related to the enhanced bladder contractile response to 5-HT. PMID:26106048

  19. “V-PLASTY”: a novel technique to reconstruct pulmonary valvular and annular stenosis in patients with right ventricular outflow tract obstruction

    PubMed Central

    2013-01-01

    Background The goal of repair of right ventricular outflow tract obstruction with or without Tetralogy of Fallot (TOF) is to eliminate valvular and/or subvalvular obstruction. However, this operation has a high risk of late complication of pulmonary insufficiency. In this study, we aimed to present early period results of our new technique that we call “V-Plasty” developed to prevent pulmonary insufficiency after pulmonary valve reconstruction in selected patients. Methods Between January 2006 and January 2010, we performed V-plasty for pulmonary valve reconstruction in 10 patients. Eight patients (5 males, 3 females) had TOF and 2 patients (1 male, 1 female) had atrial septal defect concomitant with pulmonary valve stenosis. Patient selection for V-plasty reconstruction was made due to the pulmonary valve anatomy and degree of stenosis. The mean follow-up time was 55.7 ± 16.2 months (ranging from 32 to 80 months). Results Functional capacity of the patients improved immediately after the surgery. There were no mortality and re-operation in follow-up period. Patients were followed up with echocardiography one week after the operation, at 1st, 6th, 12th months and annually. There was no pulmonary insufficiency. Conclusions Operative correction of the pulmonary outflow tract obstruction with or without TOF, frequently requires transannular enlargement because of the infundibular and/or annular-valvular obstruction. This conventional technique is usually a reason for late pulmonary insufficiency. In our study, we have not seen pulmonary insufficiency in early term follow-up period. Our early term results are encouraging, but long term follow-up results are needed with large case series. PMID:23537211

  20. Obstructive Form of Hypertrophic Cardiomyopathy-Left Ventricular Outflow Tract Gradient: Novel Methods of Provocation, Monitoring of Biomarkers, and Recent Advances in the Treatment

    PubMed Central

    Dimitrow, Pawel Petkow; Rajtar-Salwa, Renata

    2016-01-01

    Dynamic (latent or/and labile) obstruction of left ventricular outflow (LVOT) was recognized from the earliest clinical descriptions of hypertrophic cardiomyopathy (HCM) and has proved to be a complex phenomenon, as well as arguably the most audible (“visible”) pathophysiological hallmark of this heterogeneous disease. The aim of the current review is focused on two novel issues in a subgroup of obstructive HCM. Firstly, the important methodological problem in HCM is the examination of a subgroup of patients with nonobstructive hypertrophy in resting conditions and hard, but possible provoking obstruction. Recently, investigators have proposed physiological stress test (with double combined stimuli) to disclose such type of patients. The upright exercise is described in the ESC guideline on hypertrophic cardiomyopathy from 2014 and may appear as a candidate for gold standard provocation test. The second novel area of interest is associated with elevated level of signaling biomarkers: hypercoagulation, hemolysis, acquired von Willebrand 2A disease, and enhanced oxidative stress. The accelerated and turbulent flow within narrow LVOT may be responsible for these biochemical disturbances. The most recent advances in the treatment of obstructive HCM are related to nonpharmacological methods of LVOT gradient reduction. This report extensively discusses novel methods. PMID:27247935

  1. Effects of ritobegron (KUC-7483), a novel β3-adrenoceptor agonist, on both rat bladder function following partial bladder outlet obstruction and on rat salivary secretion: a comparison with the effects of tolterodine.

    PubMed

    Maruyama, Itaru; Yonekubo, Saori; Tatemichi, Satoshi; Maruyama, Kazuyasu; Hoyano, Yuji; Yamazaki, Yoshinobu; Kusama, Hiroshi

    2012-01-01

    The objective of this study was to investigate the effects of the β3-adrenoceptor (AR) agonist ritobegron on rat bladder function following partial bladder outlet obstruction and on rat salivary secretion. In addition, the effects of ritobegron were compared with those of the anti-muscarinic agent tolterodine. After a 6-week partial bladder outlet obstruction (BOO), drug effects on bladder functions were evaluated using cystometrography. Effects on carbachol (CCh)-induced salivary secretion were evaluated in urethane-anesthetized rats. Ritobegron significantly decreased the frequency of non-voiding contractions (NVC), while both ritobegron and tolterodine each significantly decreased the amplitude of NVC. Ritobegron had no effect on either the micturition pressure (MP) or the residual volume (RV). In contrast, tolterodine dose-dependently decreased MP and increased RV. Ritobegron had no effect on CCh-induced salivary secretion, whereas tolterodine dose-dependently decreased it. Ritobegron decreased both the frequency and amplitude of NVC, which is similar to its effect on the contractions associated with detrusor overactivity (DO) in patients with an overactive bladder (OAB), without affecting MP, RV, or CCh-induced salivary secretion. Although tolterodine reduced the amplitude of NVC, it also markedly increased RV and significantly inhibited CCh-induced salivary secretion. These results suggest that use of ritobegron, a β3-AR agonist, is unlikely to lead to the residual urine and dry mouth symptoms that are associated with anti-muscarinic drugs, and that ritobegron may hold promise as a safe and effective agent for OAB treatment. PMID:23538508

  2. A rare combination of undiagnosed hypertrophic cardiomyopathy revealed by intraoperative anaphylaxis resulting in acute left ventricular outflow obstruction and cardiac arrest.

    PubMed

    Smith, Bradford B; Nickels, Andrew S; Sviggum, Hans P

    2016-06-01

    A 75-year-old female presented for left total hip reimplantation and suffered pulseless electrical activity arrest upon lateral positioning and administering vancomycin. Resuscitation was achieved according to Advanced Cardiac Life Support protocol. Post-event echocardiography showed hypertrophic cardiomyopathy with asymmetrical septal thickening, an under-filled left ventricle, dynamic left ventricular outflow obstruction, and severe mitral regurgitation related to systolic anterior motion of the mitral valve. Laboratory analysis showed a tryptase level of 209 ng/mL. After multispecialty evaluation, it was concluded that the patient's arrest was due to vancomycin anaphylaxis in the setting of previously undiagnosed hypertrophic cardiomyopathy leading to acute left ventricular outflow tract obstruction. After medical optimization of the patient's cardiomyopathy and an evaluation of potential intraoperative allergic triggers, the patient underwent a successful hip reimplantation without incident. This case presents a novel combination of events leading to intraoperative cardiac arrest. Rapid identification and an understanding of the cause(s) of cardiac arrest in this setting are critical for effective perioperative care. PMID:27185714

  3. Continuous positive airway pressure therapy is associated with improvement in overactive bladder symptoms in women with obstructive sleep apnea syndrome

    PubMed Central

    Ipekci, Tumay; Cetintas, Gulgun; Celik, Orcun; Sarac, Sema; Tunckiran, Ahmet; Ilbey, Yusuf Ozlem

    2016-01-01

    Introduction To evaluate the impact of continuous positive airway pressure (CPAP) therapy on overactive bladder (OAB) symptoms in women with obstructive sleep apnea syndrome (OSAS). Material and methods One-hundred and fifty women underwent an overnight polysomnography study between May 2014 and September 2014. Their voiding symptoms were evaluated using the OAB symptom score (OABSS) and International Consultation on Incontinence Questionnaire Short-Form at OSAS diagnosis and approximately 3-months after CPAP therapy. OSAS severity was assessed according to the apnea-hypopnea-index. Results We evaluated 140 women and 111 of them (79.3%) reported symptoms consistent with OAB. There were no statistically significant differences between OSAS severity with a prevalence of OAB (p = 0.92). The prevalence of urinary incontinence (UI) was 35.7% (n = 50) and 39.6% (n = 44) in all patients and patients with OAB, respectively. There were no statistically significant differences between UI with OAB (p = 0.58). Baseline OABSS is comparable between OSAS severity (p = 0.143). After 3-months CPAP therapy, OABSS and ICIQ-SF sum scores were significantly decreased in patients with severe and moderate OSAS (p <0.01), however, change of OABSS sum score was insignificant in patients with mild OSAS (p = 0.44). Conclusions CPAP therapy improves the OAB, OABSS and ICIQ-SF scores in women with severe and moderate OSAS. OSAS-induced OAB may be alleviated following CPAP therapy. PMID:27123331

  4. Prostaglandin-targeting agents and spectral heart rate variability in experimental partial bladder outlet obstruction in rats.

    PubMed

    Dobrek, Ł; Baranowska, A; Skowron, B; Furgała, A; Żurowski, D; Thor, P

    2016-03-01

    The purpose of this study was to determine the activity of the autonomic nervous system (ANS), using spectral analysis of the heart rate variability (HRV) in the model of partial bladder outlet obstruction (PBOO) in rats treated with selected non-steroidal anti-inflammatory drugs (NSAID): piroxicam (PRX) or meloxicam (MLX), and following administration of PGF2a prostaglandin analogue (Enzaprost F5). Neither the use of PGF2a analogue nor of MLX, caused significant changes in the HRV spectrum (except for HRV spectrum total power reduction with MLX). The use of PRX caused reduction of the total power and powers of all components of the HRV spectrum (except for VLF). Moreover, increased nLF and reduced nHF were observed. The obtained results suggest that the total prostaglandin synthesis block with a non-selective cyclooxygenase inhibitor (PRX) results in reduced ANS total activity, with decreased parasympathetic activity and a relative sympathetic predominance. The preferential cyclooxygenase-2 block (MLX) caused reduction of the total ANS activity as well, however with no clear disproportion of any part of the ANS. Therefore, prostaglandin synthesis inhibition and associated decrease of parasympathetic activity may constitute an additional and favourable feature of NSAID pharmacodynamics in the treatment of BPH. PMID:27030625

  5. Intraprostatic injection of botulinum toxin type- A relieves bladder outlet obstruction in human and induces prostate apoptosis in dogs

    PubMed Central

    Chuang, Yao-Chi; Tu, Chieh-Hsien; Huang, Chao-Cheng; Lin, Hsin-Ju; Chiang, Po-Hui; Yoshimura, Naoki; Chancellor, Michael B

    2006-01-01

    Background With the increasing interest with botulinum toxin – A (BTX-A) application in the lower urinary tract, we investigated the BTX-A effects on the canine prostate and also in men with bladder outlet obstruction (BOO) due to benign prostatic hyperplasia (BPH). Methods Transperineal injection into the prostate using transrectal ultrasound (TRUS) was performed throughout the study. Saline with or without 100 U of BTX-A was injected into mongrel dogs prostate. One or 3 months later, the prostate was harvested for morphologic and apoptotic study. In addition, eight BPH patients refractory to α-blockers were treated with ultrasound guided intraprostatic injection of 200 U of BTX-A. Results In the BTX-A treated dogs, atrophy and diffuse apoptosis was observed with H&E stain and TUNEL stain at 1 and 3 months. Clinically, the mean prostate volume, symptom score, and quality of life index were significantly reduced by 18.8%, 73.1%, and 61.5% respectively. Maximal flow rate significantly increased by 72.0%. Conclusion Intraprostatic BTX-A injection induces prostate apotosis in dogs and relieves BOO in humans. It is therefore a promising alternative treatment for refractory BOO due to BPH. PMID:16620393

  6. Non-Invasive Clinical Parameters for the Prediction of Urodynamic Bladder Outlet Obstruction: Analysis Using Causal Bayesian Networks

    PubMed Central

    Kim, Myong; Cheeti, Abhilash; Yoo, Changwon; Choo, Minsoo; Paick, Jae-Seung; Oh, Seung-June

    2014-01-01

    Purpose To identify non-invasive clinical parameters to predict urodynamic bladder outlet obstruction (BOO) in patients with benign prostatic hyperplasia (BPH) using causal Bayesian networks (CBN). Subjects and Methods From October 2004 to August 2013, 1,381 eligible BPH patients with complete data were selected for analysis. The following clinical variables were considered: age, total prostate volume (TPV), transition zone volume (TZV), prostate specific antigen (PSA), maximum flow rate (Qmax), and post-void residual volume (PVR) on uroflowmetry, and International Prostate Symptom Score (IPSS). Among these variables, the independent predictors of BOO were selected using the CBN model. The predictive performance of the CBN model using the selected variables was verified through a logistic regression (LR) model with the same dataset. Results Mean age, TPV, and IPSS were 6.2 (±7.3, SD) years, 48.5 (±25.9) ml, and 17.9 (±7.9), respectively. The mean BOO index was 35.1 (±25.2) and 477 patients (34.5%) had urodynamic BOO (BOO index ≥40). By using the CBN model, we identified TPV, Qmax, and PVR as independent predictors of BOO. With these three variables, the BOO prediction accuracy was 73.5%. The LR model showed a similar accuracy (77.0%). However, the area under the receiver operating characteristic curve of the CBN model was statistically smaller than that of the LR model (0.772 vs. 0.798, p = 0.020). Conclusions Our study demonstrated that TPV, Qmax, and PVR are independent predictors of urodynamic BOO. PMID:25397903

  7. Absence of Bladder Outlet Obstruction Is an Independent Risk Factor for Prostate Cancer in Men Undergoing Prostate Biopsy

    PubMed Central

    Cormio, Luigi; Lucarelli, Giuseppe; Selvaggio, Oscar; Di Fino, Giuseppe; Mancini, Vito; Massenio, Paolo; Troiano, Francesco; Sanguedolce, Francesca; Bufo, Pantaleo; Carrieri, Giuseppe

    2016-01-01

    Abstract The purpose of this study was to investigate the relationship between bladder outlet obstruction (BOO) and the risk of being diagnosed with prostate cancer (PCa). Study population consisted of 2673 patients scheduled for the first prostate biopsy (PBx). All patients underwent uroflowmetry before PBx; those with a peak flow rate (PFR) <10 mL/s were considered to have BOO. The incidence of PCa was 41.3% (1104/2673) in the overall population and 34.1% (659/1905) in patients with serum prostate-specific antigen (PSA) ≤ 10 ng/mL. Univariate and multivariate logistic regression analyses showed that patients with BOO had a significantly (P < 0.0001) lower risk than those without BOO of being diagnosed with PCa (33.1% vs 66.9% in the overall population; 30% vs 70% in patients with PSA ≤ 10 ng/mL). As the presence of BOO was significantly correlated to a large prostate volume, another independent predictor of PBx outcome, we tested whether these parameters could be used to identify, in the subset of patients with PSA≤10 ng/mL, those who could potentially be spared from a PBx. If we would have not biopsied patients with BOO and prostate volume ≥60 mL, 14.5% of biopsies could have been avoided while missing only 6% of tumors. Only 10% of the tumors that would have been missed were high-risk cancers. In conclusion, in men undergoing PBx, the absence of BOO, as determined by a PFR ≥10 mL/s, is an independent risk factor for PCa. Our study provides ground for this simple, noninvasive, objective parameter being used, alone or in combination with prostate volume, in the decision-making process of men potentially facing a PBx. PMID:26886598

  8. [Repeated percutaneous transluminal septal myocardial ablation leads to reduction of left ventricular outflow-tract pressure gradient in hypertrophic obstructive cardiomyopathy: a case report].

    PubMed

    Takeda, Masafumi; Mori, Takao; Ohashi, Yoshitaka; Ichikawa, Shinobu; Terashima, Mitsuyasu; Ejiri, Junya; Awano, Kojiro

    2006-06-01

    A 61-year-old man with hypertrophic obstructive cardiomyopathy was treated twice with percutaneous transluminal septal myocardial ablation (PTSMA). The first procedure improved the left ventricular outflow tract pressure gradient (LVOTG) from 148 to 48 mmHg and the New York Heart Association (NYHA) class from III to II in a week. However, the LVOTG increased to 197 mmHg and the NYHA class worsened to III within 3 months. In spite of medical treatment with beta-blocker, syncope attack occurred suddenly. Repeated PTSMA was performed. Just after the second procedure, the LVOTG did not decrease. However, the LVOTG decreased to 81 mmHg and the NYHA class improved to II with 3 months. The different response of pressure gradient in the acute and chronic phase with repeated PTSMA was interesting. PMID:16800375

  9. Impact of post-transplant flow cytometric panel-reactive antibodies on late-onset hepatic venous outflow obstruction following pediatric living donor liver transplantation.

    PubMed

    Urahashi, Taizen; Mizuta, Koichi; Ihara, Yoshiyuki; Sanada, Yukihiro; Wakiya, Taiichi; Yamada, Naoya; Okada, Noriki

    2014-03-01

    The development of late-onset hepatic venous outflow obstruction (LOHVOO) following pediatric living donor liver transplantation (LDLT) can lead to uncontrollable fibrotic damage in liver grafts, even long-term patency of the graft outflow is achieved with appropriate therapeutic modalities. The aim of this study was to verify our hypothesis that some immunological responses, particularly cellular and/or antibody-mediated rejection (AMR), are associated with LOHVOO, which occurs following damage to liver sinusoidal endothelial cells in zone 3 of liver grafts. One hundred and eighty-nine patients underwent LDLT between May 2001 and December 2010 at our institute. Nine patients (4.8%) were identified as having LOHVOO. The preoperative factors, operative factors, and mortality, morbidity, and survival rates were examined and compared between the groups with and without LOHVOO. No statistical differences were observed between the groups with regard to preoperative factors, technical factors, or postoperative complications. However, FlowPRA reactivity was found to be a statistically significant risk factor for LOHVOO (P=0.006). The patients with both class I- and class II-reactive antibodies also had a significant risk of developing LOHVOO (P=0.03) and exhibited significantly higher retransplant rates. In conclusion, although further studies are needed to clarify this phenomenon, the pathophysiological mechanism underlying the development of LOHVOO after LDLT may be explained by immune-mediated responses that facilitate damage in zone 3 of liver grafts. PMID:24299518

  10. THE INFLUENCE OF MONTELUKAST ON THE ACTIVITY OF THE AUTONOMIC NERVOUS SYSTEM ESTIMATED BY HEART RATE VARIABILITY IN EXPERIMENTAL PARTIAL BLADDER OUTLET OBSTRUCTION IN RATS.

    PubMed

    Dobrek, Łukasz; Skowron, Beata; Baranowska, Agnieszka; Zurowski, Daniel; Thor, Piotr Jan

    2016-01-01

    Due to their paracrine action, leukotrienes released from the urothelium are involved in control of the bladder function. Anti-leukotriene agents appear to exert an ameliorating effect in bladder overactivity. It is unknown, whether their possible, modulatory impact on the autonomic nervous system (ANS) activity may also contribute to the potentially beneficial effect of those compounds. Therefore, our aim was to indirectly estimate the ANS function using the heart rate variability (HRV) study in rats with experimental partial bladder outlet obstruction (PBOO), reflecting human benign prostatic hyperplasia (BPH), treated with leukotriene receptor antagonist - montelukast (MLKT). Twenty rats with surgically induced PBOO lasting for 14 days, divided into two groups: group 1 (10 control subjects) and group 2 (10 MLKT-treated rats; 2 mg/rat/day) were subjected to HRV recordings, preceded by daily urine collection and a subsequent cystectomy with histopathological evaluation of collected bladders. Standard HRV time and spectral parameters were calculated. MLKT-treated animals demonstrated an increase in power of non-normalized LF (low frequency) and HF (high frequency) components with no change of the total HRV power. Moreover, an increase and decrease in normalized nLF and nHF, respectively, were assessed in those animals compared to the control. Additionally, a decrease in daily diuresis measurement was demonstrated in MLKT-treated animals. Montelukast treatment resulted in the functional ANS status re-arrangement, with sympathetic overdrive and parasympathetic withdrawal. Those changes may contribute to alleviation of bladder overactivity symptoms, independently on leukotriene receptors blockade. PMID:27476297

  11. Bladder outlet obstruction

    MedlinePlus

    ... Goldman's Cecil Medicine . 24th ed. Philadelphia, PA: Saunders Elsevier; 2011:chap 125. McNicholas TA, Kirby RS, Lepor ... Campbell-Walsh Urology . 10th ed. Philadelphia, PA: Saunders Elsevier; 2011:chap 92. Andersson K, Wein AJ. Pharmacologic ...

  12. Selective Transurethral Resection of the Prostate Combined with Transurethral Incision of the Bladder Neck for Bladder Outlet Obstruction in Patients with Small Volume Benign Prostate Hyperplasia (BPH): A Prospective Randomized Study

    PubMed Central

    Li, Xin; Pan, Jin-hong; Liu, Qi-gui; He, Peng; Song, Si-ji; Jiang, Tao; Zhou, Zhan-song

    2013-01-01

    Purpose Transurethral resection of the prostate (TURP) has a high failure rate in patients with small volume benign prostate hyperplasia (BPH) with bladder outlet obstruction (BOO). We describe and report the results of an alternative surgical method, selective transurethral resection of the prostate (STURP) in combination with transurethral incision of the bladder neck (TUIBN). Methods Patients were randomized to receive TURP or STRUP+TUIBN in combination with TUIBN. Maximum urinary flow rate (Qmax), voided volume, and post voiding residual volume (PVR) were assessed at baseline and at 1, 3, and 6 months after surgery. Efficacy of treatment was assessed by lower urinary tract symptoms and IPSS. Results Sixty three patients received STRUP+TUIBN and 61 received TURP. Surgical time, amount of prostate tissue resected, and blood loss was the same in both groups (all, p>0.05). The mean duration of follow-up was 9.02 and 8.53 months in patients receiving TURP and STRUP+TUIBN, respectively. At 6 months postoperatively, IPSS was 4.26±1.22 and 4.18±1.47 in patients receiving TURP and STRUP+TUIBN, respectively (p>0.05), and the Qmax in patients receiving STRUP+TUIBN was markedly higher than in those receiving TURP (28.28±6.46 mL/s vs. 21.59±7.14 mL/s; p<0.05). Bladder neck contracture and urinary tract infections were observed in 3 and 5 patients receiving TURP, respectively, and none in STURP. Conclusions STRUP+TUIBN may offer a more effective and safer alternative to TURP for small volume BPH patients. PMID:23691002

  13. Inhibition of collagen deposit in obstructed rat bladder outlet by transplantation of superparamagnetic iron oxide-labeled human mesenchymal stem cells as monitored by molecular magnetic resonance imaging (MRI).

    PubMed

    Lee, Hong Jun; Won, Jong Ho; Doo, Seung Hwan; Kim, Jung Hoon; Song, Ki Young; Lee, Sun Ju; Lim, Inja; Chang, Kyu-Tae; Song, Yun Seob; Kim, Seung U

    2012-01-01

    Bladder outlet obstruction (BOO) caused by collagen deposit is one of the most common problems in elderly males. The present study is to investigate if human mesenchymal stem cells (MSCs) are capable of inhibiting collagen deposition and improve cystometric parameters in bladder outlet obstruction in rats. Human MSCs were labeled with nanoparticles containing superparamagnetic iron oxide (SPION), and transplanted in rat BOO lesion site. Forty 6-week-old female Sprague-Dawley rats were divided into four groups (group 1: control, group 2: sham operation, group 3: BOO, and group 4: BOO rats receiving SPION-hMSCs). Two weeks after the onset of BOO, 1 × 10(6) SPION-hMSCs were injected into the bladder wall. Serial T2-weighted MR images were taken immediately after transplantation of SPION-labeled human MSCs and at 4 weeks posttransplantation. T2-weighted MR images showed a clear hypointense signal induced by the SPION-labeled MSCs. While the expression of collagen and TGF-β protein increased after BOO, the expression of both returned to the original levels after MSC transplantation. Expression of HGF and c-met protein also increased in the group with MSC transplantation. Maximal voiding pressure and residual urine volume increased after BOO but they recovered after MSC transplantation. Human MSCs transplanted in rat BOO models inhibited the bladder fibrosis and mediated recovery of bladder dysfunction. Transplantation of MSC-based cell therapy could be a novel therapeutic strategy against bladder fibrosis in patients with bladder outlet obstruction. PMID:22449414

  14. Impact of partial urethral obstruction on bladder function: time-dependent changes and functional correlates of altered expression of Ca²⁺ signaling regulators.

    PubMed

    Burmeister, David; AbouShwareb, Tamer; D'Agostino, Ralph; Andersson, Karl-Erik; Christ, George J

    2012-06-15

    In animal models of partial urethral obstruction (PUO), altered smooth muscle function/contractility may be linked to changes in molecules that regulate calcium signaling/sensitization. PUO was created in male rats, and urodynamic studies were conducted 2 and 6 wk post-PUO. Cystometric recordings were analyzed for the presence or absence of nonvoiding contractions [i.e., detrusor overactivity (DO)]. RT-PCR and Western blots were performed on a subpopulation of rats to study the relationship between the expression of RhoA, L-type Ca(2+) channels, Rho kinase-1, Rho kinase-2, inositol 1,4,5-trisphosphate, ryanodine receptor, sarco(endo)plasmic reticulum Ca(2+)-ATPase 2 and protein kinase C (PKC)-potentiated phosphatase inhibitor of 17 kDa, and urodynamic findings in the same animal. Animals displayed DO at 2 (38%) and 6 wk (43%) post-PUO, increases were seen in in vivo pressures at 2 wk, and residual volume at 6 wk. Statistical analysis of RT-PCR and Western blot data at 2 wk, during the compensatory phase of detrusor hypertrophy, documented that expression of molecules that regulate calcium signaling and sensitization was consistently lower in obstructed rats without DO than those with DO or control rats. Among rats with DO at 2 wk, linear regression analysis revealed positive correlations between in vivo pressures and protein and mRNA expression of several regulatory molecules. At 6 wk, in the presence of overt signs of bladder decompensation, no clear or consistent alterations in expression of these same targets were observed at the protein level. These data extend prior work to suggest that molecular profiling of key regulatory molecules during the progression of PUO-mediated bladder dysfunction may shed new light on potential biomarkers and/or therapeutic targets. PMID:22442207

  15. Detrusor induction of miR-132/212 following bladder outlet obstruction: association with MeCP2 repression and cell viability.

    PubMed

    Sadegh, Mardjaneh Karbalaei; Ekman, Mari; Krawczyk, Katarzyna; Svensson, Daniel; Göransson, Olga; Dahan, Diana; Nilsson, Bengt-Olof; Albinsson, Sebastian; Uvelius, Bengt; Swärd, Karl

    2015-01-01

    The microRNAs (miRNAs) miR-132 and miR-212 have been found to regulate synaptic plasticity and cholinergic signaling and recent work has demonstrated roles outside of the CNS, including in smooth muscle. Here, we examined if miR-132 and miR-212 are induced in the urinary bladder following outlet obstruction and whether this correlates with effects on gene expression and cell growth. Three to seven-fold induction of miR-132/212 was found at 10 days of obstruction and this was selective for the detrusor layer. We cross-referenced putative binding sites in the miR-132/212 promoter with transcription factors that were predicted to be active in the obstruction model. This suggested involvement of Creb and Ahr in miR-132/212 induction. Creb phosphorylation (S-133) was not increased, but the number of Ahr positive nuclei increased. Moreover, we found that serum stimulation and protein kinase C activation induced miR-132/212 in human detrusor cells. To identify miR-132/212 targets, we correlated the mRNA levels of validated targets with the miRNA levels. Significant correlations between miR-132/212 and MeCP2, Ep300, Pnkd and Jarid1a were observed, and the protein levels of MeCP2, Pnkd and Ache were reduced after obstruction. Reduction of Ache however closely matched a 90% reduction of synapse density arguing that its repression was unrelated to miR-132/212 induction. Importantly, transfection of antimirs and mimics in cultured detrusor cells increased and decreased, respectively, the number of cells and led to changes in MeCP2 expression. In all, these findings show that obstruction of the urethra increases miR-132 and miR-212 in the detrusor and suggests that this influences gene expression and limits cell growth. PMID:25617893

  16. A corticotropin-releasing factor receptor antagonist improves urodynamic dysfunction produced by social stress or partial bladder outlet obstruction in male rats

    PubMed Central

    Wood, Susan K.; McFadden, Kile; Griffin, Tagan; Wolfe, John H.; Zderic, Stephen

    2013-01-01

    Barrington's nucleus, in the pons, regulates micturition through spinal projections to preganglionic parasympathetic neurons. The stress neuropeptide CRF is prominent in these projections and has an inhibitory influence. Social stress in rats causes urinary retention and abnormal urodynamics resembling those produced by partial bladder outlet obstruction (pBOO), and this is associated with CRF upregulation in Barrington's nucleus. Here, we examined the role of CRF in social stress- and pBOO-induced urodynamic dysfunction by assessing the ability of a CRF1 receptor antagonist to alter these effects. Male rats exposed to repeated resident-intruder stress were administered vehicle or a CRF1 antagonist (NBI-30775) daily prior to the stress. Urodynamic function was recorded in the unanesthetized state 72 h after the final stress. NBI-30775 prevented the increased intermicturition interval, micturition volume, and bladder capacity produced by social stress, but not the increase in CRF expression in Barrington's nucleus neurons. The urinary dysfunction was also partly prevented by shRNA targeting of CRF in Barrington's nucleus, suggesting that stress-induced urinary dysfunction results, in part, from CRF upregulation in Barrington's nucleus and enhanced postsynaptic effects in the spinal cord. Finally, NBI-30775 improved urodynamic function of rats that had pBOO of 2-wk duration when administered daily during the second week but did not block the increase in CRF expression in Barrington's nucleus neurons. These findings implicate a role for Barrington's nucleus CRF in stress- and pBOO-induced urodynamic changes and suggest that CRF1 antagonists may be useful therapeutic agents for the treatment of urinary dysfunction. PMID:23552576

  17. A corticotropin-releasing factor receptor antagonist improves urodynamic dysfunction produced by social stress or partial bladder outlet obstruction in male rats.

    PubMed

    Wood, Susan K; McFadden, Kile; Griffin, Tagan; Wolfe, John H; Zderic, Stephen; Valentino, Rita J

    2013-06-01

    Barrington's nucleus, in the pons, regulates micturition through spinal projections to preganglionic parasympathetic neurons. The stress neuropeptide CRF is prominent in these projections and has an inhibitory influence. Social stress in rats causes urinary retention and abnormal urodynamics resembling those produced by partial bladder outlet obstruction (pBOO), and this is associated with CRF upregulation in Barrington's nucleus. Here, we examined the role of CRF in social stress- and pBOO-induced urodynamic dysfunction by assessing the ability of a CRF₁ receptor antagonist to alter these effects. Male rats exposed to repeated resident-intruder stress were administered vehicle or a CRF₁ antagonist (NBI-30775) daily prior to the stress. Urodynamic function was recorded in the unanesthetized state 72 h after the final stress. NBI-30775 prevented the increased intermicturition interval, micturition volume, and bladder capacity produced by social stress, but not the increase in CRF expression in Barrington's nucleus neurons. The urinary dysfunction was also partly prevented by shRNA targeting of CRF in Barrington's nucleus, suggesting that stress-induced urinary dysfunction results, in part, from CRF upregulation in Barrington's nucleus and enhanced postsynaptic effects in the spinal cord. Finally, NBI-30775 improved urodynamic function of rats that had pBOO of 2-wk duration when administered daily during the second week but did not block the increase in CRF expression in Barrington's nucleus neurons. These findings implicate a role for Barrington's nucleus CRF in stress- and pBOO-induced urodynamic changes and suggest that CRF₁ antagonists may be useful therapeutic agents for the treatment of urinary dysfunction. PMID:23552576

  18. Ruptured urinary bladder attributable to urethral compression by a haematoma after vertebral fracture in a bull

    PubMed Central

    2014-01-01

    Background In male cattle, rupture of the urinary bladder is usually associated with urethral obstruction by uroliths. Less common causes include urethral compression or stricture. This case report describes the findings in a young Limousion breeding bull with rupture of the urinary bladder because of urethral compression by a haematoma after coccygeal fracture. Case presentation The bull had been introduced into a 40-head Red-Holstein herd one week before being injured. One week after introduction to the herd, the bull had an acute onset of anorexia and he was referred to the clinic. There was marked abdominal distension, reduced skin turgor and enophthalmus. The serum concentration of urea and creatinine was increased. Ultrasonographic examination revealed severe ascites and abdominocentesis yielded clear yellow fluid with high urea and creatinine concentrations, which supported a diagnosis of uroperitoneum. The bull was euthanatized because of a poor prognosis. Postmortem examination revealed a comminuted fracture of the first two coccygeal vertebrae associated with a massive haematoma that obstructed entire pelvic cavity. The haematoma compressed the urethra thereby preventing outflow of urine, which resulted in a 5-cm tear ventrally at the neck of the bladder. It was assumed that the newly-introduced bull had sustained the vertebral fractures when he was mounted by a cow. Conclusions The present case study serves to expand the differential diagnosis of urinary bladder rupture. Therefore, in addition to obstructive urolithiasis, compression and stricture of the urethra might be considered in male cattle with uroperitoneum. PMID:24666697

  19. Bladder stones

    MedlinePlus

    ... such as: Bladder diverticulum Enlarged prostate Neurogenic bladder Urinary tract infection Almost all bladder stones occur in men. Bladder ... stream Pain, discomfort in the penis Signs of urinary tract infection (such as fever, pain when urinating, and need ...

  20. Transurethral Electrovaporization of Bladder Diverticulum: An Alternative to Open or Laparoscopic Bladder Diverticulectomy

    PubMed Central

    Chandhoke, Ryan A.

    2015-01-01

    Abstract We used transurethral electrovaporization of the diverticular mucosa as the primary treatment for an acquired bladder diverticulum in a female patient. The bladder diverticulum was secondary to bladder outlet obstruction from a previous pubovaginal sling. In comparison to either open or laparoscopic bladder diverticulectomy, transurethral electrovaporization of the bladder diverticulum was effective in significantly reducing the diverticular size while being less invasive, requiring a short operative time, and a quick patient recovery.

  1. Bladder leiomyoma presenting as dyspareunia

    PubMed Central

    Xin, Jun; Lai, Hai-ping; Lin, Shao-kun; Zhang, Qing-quan; Shao, Chu-xiao; Jin, Lie; Lei, Wen-hui

    2016-01-01

    Abstract Introduction: Leiomyoma of the bladder is a rare tumor arising from the submucosa. Most patients with bladder leiomyoma may present with urinary frequency or obstructive urinary symptoms. However, there are a few cases of bladder leiomyoma coexisting with uterine leiomyoma presenting as dyspareunia. We herein report an unusual case of coexisting bladder leiomyoma and uterine leiomyoma presenting as dyspareunia. Case presentation: A 44-year-old Asian female presented to urologist and complained that she had experienced dyspareunia over the preceding several months. A pelvic ultrasonography revealed a mass lesion located in the trigone of urinary bladder. The mass lesion was confirmed on contrast-enhanced computed tomography (CT). The CT scan also revealed a lobulated and enlarged uterus consistent with uterine leiomyoma. Then, the biopsies were then taken with a transurethral resection (TUR) loop and these biopsies showed a benign proliferation of smooth muscle in a connective tissue stroma suggestive of bladder leiomyoma. An open local excision of bladder leiomyoma and hysteromyomectomy were performed successfully. Histological examination confirmed bladder leiomyoma coexisting with uterine leiomyoma. Conclusion: This case highlights a rare presentation of bladder leiomyoma, dyspareunia, as the chief symptom in a patient who had coexisting uterine leiomyoma. Bladder leiomyomas coexisting with uterine leiomyomas are rare and can present with a wide spectrum of complaints including without symptoms, irritative symptoms, obstructive symptoms, or even dyspareunia. PMID:27428187

  2. Impact of venous thromboembolism, venous stasis syndrome, venous outflow obstruction and venous valvular incompetence on quality of life and activities of daily living: a nested case-control study.

    PubMed

    Ashrani, Aneel A; Silverstein, Marc D; Rooke, Thom W; Lahr, Brian D; Petterson, Tanya M; Bailey, Kent R; Melton, L Joseph; Heit, John A

    2010-10-01

    The role of venous stasis syndrome (VSS) mechanisms (i.e. venous outflow obstruction [VOO] and venous valvular incompetence [VVI]) on quality of life (QoL) and activities of daily living (ADL) is unknown. The objective of this study was to test the hypotheses that venous thromboembolism (VTE),VSS,VOO and VVI are associated with reduced QoL and ADL. This study is a follow-up of an incident VTE case-control study nested within a population-based inception cohort of residents from Olmsted County, MN, USA, between 1966 and 1990. The study comprised 232 Olmsted County residents with a first lifetime VTE and 133 residents without VTE. Methods included a questionnaire and physical examination for VSS; vascular laboratory testing for VOO and VVI; assessment of QoL by SF36 and of ADL by pertinent sections from the Older Americans Resources and Services (OARS) and Arthritis Impact Measurement Scales (AIMS2) questionnaires. Of the 365 study participants, 232 (64%), 161 (44%), 43 (12%) and 136 (37%) had VTE, VSS, VOO and VVI, respectively. Prior VTE was associated with reduced ADL and increased pain, VSS with reduced physical QoL and increased pain, and VOO with reduced physical QoL and ADL.VVI was not associated with QoL or ADL. In conclusion,VSS and VOO are associated with worse physical QoL and increased pain. VOO and VTE are associated with impaired ADL. We hypothesize that rapid clearance of venous outflow obstruction in individuals with acute VTE will improve their QoL and ADL. PMID:20926498

  3. Giant bladder diverticulum.

    PubMed

    Tortorelli, Antonio Pio; Rosa, Fausto; Papa, Valerio; Alfieri, Sergio; Doglietto, Giovanni Battista

    2011-03-01

    We present the case of a 73-year-old man affected by progressive and painful abdominal distension and paresthesia/hypoesthesia at the left leg. US and CT-scan revealed the presence in the left retroperitoneum of a large cystic mass without parietal thickening or enhancement after contrast injection. This mass disappeared after positioning a vesical Foley's catheter and a retrograde cystography confirmed the suspected diagnosis of a large bladder diverticulum due to a severe prostatic hypertrophy; the patient underwent an open diverticulectomy and endoscopic prostatic resection. Bladder diverticula can occasionally appear as complex pelvic masses not obviously connected to the bladder, eventually leading to diagnostic confusion; while small size diverticulum resolves with relief of bladder outlet obstruction, open or laparoscopic diverticulectomy is needed in large size diverticulum if symptomatic, even considering the possible tumor harboring. PMID:21229344

  4. Bladder cancer

    MedlinePlus

    Transitional cell carcinoma of the bladder; Urothelial cancer ... In the United States, bladder cancer usually starts from the cells lining the bladder. These cells are called transitional cells. These tumors are classified by the way ...

  5. Bladder Diseases

    MedlinePlus

    ... frequent, urgent urination Bladder cancer Doctors diagnose bladder diseases using different tests. These include urine tests, x- ... National Institute of Diabetes and Digestive and Kidney Diseases

  6. Perinatal obstructive nephropathy.

    PubMed

    Chevalier, Robert L

    2004-04-01

    Significant advances have been made recently in elucidating the cellular consequences of urinary tract obstruction during renal development. Urinary tract obstruction impairs growth and maturation of the kidney, and can also cause renal maldevelopment. This includes a reduction in the number of nephrons, tubular atrophy, and progressive interstitial fibrosis. Apoptosis (programmed cell death) accounts for much of the loss of tubular epithelial cells. Factors contributing to apoptosis include stretching of cells in dilated tubules, altered renal production of growth factors, and infiltration of the renal interstitium by macrophages. Two major controversies remain regarding the surgical management of congenital obstructive nephropathy: first, which fetuses with bladder outlet obstruction should undergo prenatal intervention, and second, which infants should undergo early pyeloplasty for ureteropelvic junction obstruction? Even after successful surgery for congential obstructive nephropathy, all patients should be followed for hypertension, proteinuria, or renal deterioration. PMID:15200251

  7. Bladder stones

    MedlinePlus

    Stones - bladder; Urinary tract stones; Bladder calculi ... Benway BM, Bhayani SM. Lower urinary tract calculi. In: Wein AJ, ed. Campbell-Walsh Urology . 10th ed. Philadelphia, PA: Elsevier Saunders; 2011:chap 89. Sharma R, Dill CE, Gelman DY. Urinary ...

  8. Bladder Health

    MedlinePlus

    ... life (the person’s level of health, comfort, and happiness). In fact, people with bladder problems may have a lower quality of life than people with diabetes, heart disease, or high blood pressure. Bladder problems ...

  9. Neurogenic Bladder

    PubMed Central

    Dorsher, Peter T.; McIntosh, Peter M.

    2012-01-01

    Congenital anomalies such as meningomyelocele and diseases/damage of the central, peripheral, or autonomic nervous systems may produce neurogenic bladder dysfunction, which untreated can result in progressive renal damage, adverse physical effects including decubiti and urinary tract infections, and psychological and social sequelae related to urinary incontinence. A comprehensive bladder-retraining program that incorporates appropriate education, training, medication, and surgical interventions can mitigate the adverse consequences of neurogenic bladder dysfunction and improve both quantity and quality of life. The goals of bladder retraining for neurogenic bladder dysfunction are prevention of urinary incontinence, urinary tract infections, detrusor overdistension, and progressive upper urinary tract damage due to chronic, excessive detrusor pressures. Understanding the physiology and pathophysiology of micturition is essential to select appropriate pharmacologic and surgical interventions to achieve these goals. Future perspectives on potential pharmacological, surgical, and regenerative medicine options for treating neurogenic bladder dysfunction are also presented. PMID:22400020

  10. Bladder Monitor

    NASA Technical Reports Server (NTRS)

    1993-01-01

    Diagnostic Ultrasound Corporation's Bladder Scan Monitor continuously records and monitors bladder fullness and alerts the wearer or caretaker when voiding is required. The sensor is held against the lower abdomen by a belt and connected to the monitor by a cable. The sensor obtains bladder volume data from sound waves reflecting off the bladder wall. The device was developed by Langley Research Center, the Ames Research Center and the NASA Technology Applications Team. It utilizes Langley's advanced ultrasound technology. It is licensed to the ARC for medical applications, and sublicensed to Diagnostics Ultrasound. Central monitoring systems are planned for the future.

  11. Overactive bladder in males

    PubMed Central

    Dmochowski, Roger R.; Gomelsky, Alex

    2009-01-01

    The prevalence of overactive bladder (OAB) symptoms is considerable in both men and women and the impact on quality of life (QOL) is equally substantial. Ironically, despite nearly equal prevalence, OAB symptoms in men are infrequently treated, and often with medical therapies aimed at bladder outlet obstruction (BOO). In this review, we examine the pathophysiology of OAB and its evaluation in the context of benign prostatic hypertrophy and concomitant BOO. We then consider the efficacy and safety of individual therapeutic options for lower urinary tract symptoms in men, focusing on the mainstays of medical therapy: α-adrenergic blockers, 5-α reductase inhibitors, and antimuscarinic agents. Finally, we aim to comment on new therapeutic strategies and targets that may one day be available for the treatment of male OAB. PMID:21789068

  12. The effects of acupuncture on bladder interstitial cells of cajal excitability in rats with overactive bladder.

    PubMed

    Feng, Qi-Fan; Hou, Yuen-Hao; Hou, Wen-Guang; Lin, Zhi-Xian; Tang, Kang-Min; Chen, Yue-Lai

    2013-01-01

    It is well known that acupuncture treatment has an effect on patients with an overactive bladder, but the mechanism of its action remains to be clarified. This study was aimed to investigate the effects of acupuncture on bladder overactivity, and the excitability of interstitial cells of Cajal of the bladder in a rat model of partial bladder outlet obstruction. Electroacupuncture (continuous wave, 30 Hz, 1 mA) was applied to stimulate the Ciliao point (BL32) and the Huiyang point (BL35) of rats for 20 min, 3 days. Results showed that acupuncture suppressed detrusor unstable contraction frequency and decreased detrusor maximum pressure in the bladder filling period. Compared with the normal control rats, HCN2 mRNA and protein expression within the bladder were upregulated and were reversed by electroacupuncture in overactive bladder rats as determined by RT-PCR, western blotting and immunohistochemistry. Moreover, in-vitro cell-cultured OAB rats bladder interstitial cells of Cajal intracellular Ca(2+) concentration were higher than normal control rats, which were lowered after acupuncture treatment. These findings suggest that acupuncture stimulation can suppress bladder overactivity, and regulate the excitability of bladder interstitial cells of Cajal in treatment of overactive bladder myogenic mechanism. PMID:24194780

  13. Neurogenic bladder

    MedlinePlus

    ... on the cause. They often include symptoms of urinary incontinence . Symptoms of overactive bladder: Having to urinate too ... If you are having urinary incontinence, organizations are available for further information and support.

  14. Bladder exstrophy repair

    MedlinePlus

    Bladder birth defect repair; Everted bladder repair; Exposed bladder repair; Repair of bladder exstrophy ... in boys and is often linked to other birth defects. Surgery is necessary to: Allow the child to ...

  15. Left Inguinal Bladder Hernia that Causes Dilatation in the Ureter.

    PubMed

    Ugur, Mustafa; Atcı, Nesrin; Oruc, Cem; Akkucuk, Seckin; Aydogan, Akin

    2016-05-01

    The scrotal bladder hernia is a rare condition that may present as scrotal swelling and urinary system obstruction or infection symptoms. Diagnosis of this condition before the operation decreases the severe complications like bladder injury during operation. In this article, a 75-year-old man presented to our clinic with right inguinal swelling and lower urinary system infection. Inguinal bladder hernia was diagnosed after performing a computed tomography. The hernia was repaired without any complications. PMID:27179171

  16. Surgical Treatment of a 4-Year-Old Child with Hypertrophic Obstructive Cardiomyopathy: Case Report.

    PubMed

    Chen, Jin; Wu, Qingyu; Xu, Zhonghua; Kong, Xiangchen

    2016-01-01

    The incidence of pediatric hypertrophic obstructive cardiomyopathy is low. The lesions usually involve the left ventricle or ventricular septum, leading to either left or right ventricular outflow tract stenosis. However, combined left and right ventricular outflow tract stenosis is rare, and the surgical treatment is limited, especially in children. Surgery to release the obstruction was performed successfully in a 4-year-old child with right and left ventricular outflow tract obstruction together with a hypertrophic cardiomyopathy. The result was excellent. PMID:26913685

  17. Factors impacting bladder underactivity and clinical implications.

    PubMed

    Van Koeveringe, G A; Rademakers, K L J

    2015-06-01

    Lower urinary tract symptoms in the voiding phase can be due to an underactive bladder, but are usually similar to symptoms of infravesical obstruction or dysfunctional voiding. The underactive bladder can be caused by an impaired detrusor contraction but also by a derangement of local and central neuro-cognitive regulatory systems or an impairment of bladder sensation. Potential risk factors of bladder underactivity include: ageing, diabetes, neurogenic disease, cardiovascular disease, obstruction and psychological causes. Comprehensive diagnostic and detection techniques for an underactive detrusor are necessary. To establish the diagnosis and follow up new treatments, useful urodynamic parameters and threshold values have to be determined. As neuro-cognitive regulation plays an important role in the control of voiding, psychological factors have to be taken into account during the assessment in these patients. Ambulatory urodynamic techniques therefore have to be considered. Voiding is determined by the balance of both the detrusor contraction and the resistance of the bladder outlet, a dysfunction in one factor can be compensated by a counter-acting function of the other factor. Therefore, to predict voiding problems in the future, it will be indicated to assess the compensatory capacity of the detrusor contractility, contractile reserve, and the outlet relaxation capacity. If novel treatments and evaluation techniques have become available, it is likely that in the future, many patients that get a TURP now, can be treated by pharmacological agents directed towards increasing the bladder contractility in a balanced combination with medication directed towards lowering the bladder outlet resistance. PMID:25645344

  18. Overactive bladder

    PubMed Central

    Wallace, Karen M.; Drake, Marcus J.

    2015-01-01

    Overactive bladder syndrome is highly prevalent, and increasingly so with aging. It is characterized by the presence of urinary urgency, and can be associated with incontinence, increased voiding frequency, and nocturia. Assessment needs to exclude serious medical disorders that might present with similar symptoms, and a bladder diary is an invaluable part of understanding the presentation. Initial management is conservative, comprising education, bladder training, and advice on fluid intake. Drug therapy options include antimuscarinic medications and beta-3 adrenergic receptor agonists. Persistent overactive bladder syndrome, despite initial therapy, requires a review of the patient’s understanding of conservative management and compliance, and adjustment of medications. For refractory cases, specialist review and urodynamic testing should be considered; this may identify detrusor overactivity or increased filling sensation, and needs to exclude additional factors, such as stress incontinence and voiding dysfunction. Botulinum neurotoxin-A bladder injections can be used in severe overactivity, provided the patient is able and willing to do intermittent self-catheterisation, which is necessary in about 5% of treated patients. Sacral nerve stimulation and tibial nerve stimulation are other approaches. Major reconstructive surgery, such as augmentation cystoplasty, is rarely undertaken in modern practice but remains a possibility in extreme cases. PMID:26918151

  19. Obstructive uropathy

    MedlinePlus

    ... enlarged prostate) Bladder or ureteral cancer Colon cancer Cervical cancer Uterine cancer Any cancer that spreads Scar tissue that occurs inside or outside of the ureters Problems with the nerves that supply the bladder Rarely, the problem occurs ...

  20. Bowel Obstruction.

    PubMed

    Gore, Richard M; Silvers, Robert I; Thakrar, Kiran H; Wenzke, Daniel R; Mehta, Uday K; Newmark, Geraldine M; Berlin, Jonathan W

    2015-11-01

    Small bowel obstruction and large bowel obstruction account for approximately 20% of cases of acute abdominal surgical conditions. The role of the radiologist is to answer several key questions: Is obstruction present? What is the level of the obstruction? What is the cause of the obstruction? What is the severity of the obstruction? Is the obstruction simple or closed loop? Is strangulation, ischemia, or perforation present? In this presentation, the radiologic approach to and imaging findings of patients with known or suspected bowel obstruction are presented. PMID:26526435

  1. Ureteral bladder augmentation.

    PubMed

    Churchill, B M; Aliabadi, H; Landau, E H; McLorie, G A; Steckler, R E; McKenna, P H; Khoury, A E

    1993-08-01

    Virtually all segments of the gastrointestinal tract have been used successfully in augmentation cystoplasty. The complications inherent in enterocystoplasty are well described. Megaureters subtending effete kidneys (poorly or nonfunctioning) provide a novel and excellent source of augmentation material with urothelium and muscular backing, free of the electrolyte and acid base disturbances, and mucus production that plague enterocystoplasty. Augmentation cystoplasty using detubularized, reconfigured, otherwise disposable megaureter, with or without ipsilateral total or partial nephrectomy, was performed in 16 patients (mean age 8.8 years, range 1 to 25) with inadequate and dysfunctional bladders. Postoperative followup varied between 8 and 38 months (mean 22). The overall renal function and radiographic appearance of the remaining upper tracts have remained stable or improved in all patients. Of the 16 patients 15 require intermittent catheterization and 1 voids spontaneously. Ten patients are continent day and night, 5 have improved continence (4 damp at night and 1 stress incontinence) and 1 has failed to gain continence despite good capacity and compliance. Complete postoperative urodynamic evaluations in 12 of 13 patients show good capacity, low pressure bladders with no instability. Complications occurred in 5 patients, including transient urine extravasation in 2, contralateral ureterovesical obstruction in 2 and Mitrofanoff stomal stenosis in 1. Augmentation ureterocystoplasty combines the benefits common to all enterocystoplasties without adding any of the untoward complications or risks associated with nonurothelial augmentations. PMID:8326632

  2. Research Findings on Overactive Bladder

    PubMed Central

    Patra, Phani B.; Patra, Sayani

    2015-01-01

    Several physiopathologic conditions lead to the manifestation of overactive bladder (OAB). These conditions include ageing, diabetes mellitus, bladder outlet obstruction, spinal cord injury, stroke and brain injury, Parkinson's disease, multiple sclerosis, interstitial cystitis, stress and depression. This review has discussed research findings in human and animal studies conducted on the above conditions. Several structural and functional changes under these conditions have not only been observed in the lower urinary tract, but also in the brain and spinal cord. Significant changes were observed in the following areas: neurotransmitters, prostaglandins, nerve growth factor, Rho-kinase, interstitial cells of Cajal, and ion and transient receptor potential channels. Interestingly, alterations in these areas showed great variation in each of the conditions of the OAB, suggesting that the pathophysiology of the OAB might be different in each condition of the disease. It is anticipated that this review will be helpful for further research on new and specific drug development against OAB. PMID:26195957

  3. Intestinal obstruction

    MedlinePlus

    Obstruction of the bowel may due to: A mechanical cause, which means something is in the way ... lung disease Use of certain medicines, especially narcotics Mechanical causes of intestinal obstruction may include: Adhesions or ...

  4. Radiological interventions in malignant biliary obstruction

    PubMed Central

    Madhusudhan, Kumble Seetharama; Gamanagatti, Shivanand; Srivastava, Deep Narayan; Gupta, Arun Kumar

    2016-01-01

    Malignant biliary obstruction is commonly caused by gall bladder carcinoma, cholangiocarcinoma and metastatic nodes. Percutaneous interventions play an important role in managing these patients. Biliary drainage, which forms the major bulk of radiological interventions, can be palliative in inoperable patients or pre-operative to improve liver function prior to surgery. Other interventions include cholecystostomy and radiofrequency ablation. We present here the indications, contraindications, technique and complications of the radiological interventions performed in patients with malignant biliary obstruction. PMID:27247718

  5. Radiological interventions in malignant biliary obstruction.

    PubMed

    Madhusudhan, Kumble Seetharama; Gamanagatti, Shivanand; Srivastava, Deep Narayan; Gupta, Arun Kumar

    2016-05-28

    Malignant biliary obstruction is commonly caused by gall bladder carcinoma, cholangiocarcinoma and metastatic nodes. Percutaneous interventions play an important role in managing these patients. Biliary drainage, which forms the major bulk of radiological interventions, can be palliative in inoperable patients or pre-operative to improve liver function prior to surgery. Other interventions include cholecystostomy and radiofrequency ablation. We present here the indications, contraindications, technique and complications of the radiological interventions performed in patients with malignant biliary obstruction. PMID:27247718

  6. Evaluation and management of outlet obstruction in women without anatomical abnormalities on physical exam or cystoscopy.

    PubMed

    Hickling, Duane; Aponte, Margarita; Nitti, Victor

    2012-10-01

    Bladder outlet obstruction (BOO) in women can be either anatomic or functional. Anatomic causes for BOO are often readily apparent by history and physical exam. On the other hand, causes for functional obstruction, including dysfunctional voiding, primary bladder neck obstruction, and detrusor-external sphincter dyssynergia, are more difficult to establish. Because the appropriate treatment for functional obstruction drastically varies according to etiology, making an accurate diagnosis is paramount. Videourodynamics, interpreted in the context of individual clinical symptoms, remains the diagnostic gold standard in women with functional obstruction. PMID:22872500

  7. Cirrus outflow dynamics

    NASA Technical Reports Server (NTRS)

    Lilly, Douglas K.

    1988-01-01

    In the present analyses of cirrus clouds' deep-convection outflow plumes as dynamically and thermodynamically active systems, the initial outflow is considered as an analog to wake collapse: after a neutrally-buoyant flow intrusion is flattened and stretched by its stratified environment, the initially isotropic turbulence within it is converted to other forms. Dugan et al.'s (1976) analytic and numerical calculations are used to predict the early spread of the outflow. Strong radiative heat flux curvature then leads to maintenance or regeneration of buoyant turbulence in the collapsed outflow plume. The rise of narrow plumes is sufficiently rapid that their mean temperature does not significantly differ from that of their environment.

  8. A case–control study on the association between bladder cancer and prior bladder calculus

    PubMed Central

    2013-01-01

    Background Bladder calculus is associated with chronic irritation and inflammation. As there is substantial documentation that inflammation can play a direct role in carcinogenesis, to date the relationship between stone formation and bladder cancer (BC) remains unclear. This study aimed to examine the association between BC and prior bladder calculus using a population-based dataset. Methods This case–control study included 2,086 cases who had received their first-time diagnosis of BC between 2001 and 2009 and 10,430 randomly selected controls without BC. Conditional logistic regressions were employed to explore the association between BC and having been previously diagnosed with bladder calculus. Results Of the sampled subjects, bladder calculus was found in 71 (3.4%) cases and 105 (1.1%) controls. Conditional logistic regression analysis revealed that the odds ratio (OR) of having been diagnosed with bladder calculus before the index date for cases was 3.42 (95% CI = 2.48-4.72) when compared with controls after adjusting for monthly income, geographic region, hypertension, diabetes, coronary heart disease, and renal disease, tobacco use disorder, obesity, alcohol abuse, and schistosomiasis, bladder outlet obstruction, and urinary tract infection. We further analyzed according to sex and found that among males, the OR of having been previously diagnosed with bladder calculus for cases was 3.45 (95% CI = 2.39-4.99) that of controls. Among females, the OR was 3.05 (95% CI = 1.53-6.08) that of controls. Conclusions These results add to the evidence surrounding the conflicting reports regarding the association between BC and prior bladder calculus and highlight a potential target population for bladder cancer screening. PMID:23497224

  9. Right ventricular obstruction in various types of hypertrophic cardiomyopathy.

    PubMed

    Stierle, U; Sheikhzadeh, A; Shakibi, J G; Langbehn, A F; Diederich, K W

    1987-01-01

    Hypertrophic cardiomyopathy (HCM) is most probably a genetically transmitted disease with different clinical and hemodynamic features. In hypertrophic obstructive cardiomyopathy (HOCM) the obstruction is predominantly in the left ventricular outflow tract (IHSS). In a minority of cases the obstruction is strictly located in midventricle (midventricular obstruction, MO). Hypertrophic nonobstructive cardiomyopathy (HNCM) includes asymmetric septal hypertrophy (ASH) and apical hypertrophy (AH). Right ventricular hypertrophic obstruction (RVHO) is an uncommon type of HCM and is almost always combined with other types of left ventricular HCM. We describe in the present report 1 case of RVHO with IHSS, 2 cases with MO and, to our knowledge, the first case with AH. PMID:3599397

  10. Outflow Propagation in Collapsars: Collimated Jets And Expanding Outflows

    SciTech Connect

    Mizuta, A.; Yamasaki, T.; Nagataki, S.; Mineshige, S.; /Kyoto U., Yukawa Inst., Kyoto /KIPAC, Menlo Park

    2007-06-08

    We investigate the outflow propagation in the collapsar in the context of gamma-ray bursts (GRBs) with 2D relativistic hydrodynamic simulations. We vary the specific internal energy and bulk Lorentz factor of the injected outflow from non-relativistic regime to relativistic one, fixing the power of the outflow to be 10{sup 51}erg s{sup -1}. We observed the collimated outflow, when the Lorentz factor of the injected outflow is roughly greater than 2. To the contrary, when the velocity of the injected outflow is slower, the expanding outflow is observed. The transition from collimated jet to expanding outflow continuously occurs by decreasing the injected velocity. Different features of the dynamics of the outflows would cause the difference between the GRBs and similar phenomena, such as, X-ray flashes.

  11. The Murine Bladder Supports a Population of Stromal Sca-1+/CD34+/lin- Mesenchymal Stem Cells.

    PubMed

    Lilly, Meredith A; Kulkulka, Natalie A; Firmiss, Paula R; Ross, Michael J; Flum, Andrew S; Santos, Grace B Delos; Bowen, Diana K; Dettman, Robert W; Gong, Edward M

    2015-01-01

    Bladder fibrosis is an undesired end point of injury of obstruction and often renders the smooth muscle layer noncompliant. In many cases, the long-term effect of bladder fibrosis is renal failure. Despite our understanding of the progression of this disease, little is known about the cellular mechanisms that lead to a remodeled bladder wall. Resident stem (progenitor) cells have been identified in various organs such as the brain, heart and lung. These cells function normally during organ homeostasis, but become dysregulated after organ injury. Here, we aimed to characterize a mesenchymal progenitor cell population as a first step in understanding its role in bladder fibrosis. Using fluorescence activated cell sorting (FACS), we identified a Sca-1+/ CD34+/ lin- (PECAM-: CD45-: Ter119-) population in the adult murine bladder. These cells were localized to the stromal layer of the adult bladder and appeared by postnatal day 1. Cultured Sca-1+/ CD34+/ lin- bladder cells self-renewed, formed colonies and spontaneously differentiated into cells expressing smooth muscle genes. These cells differentiated into other mesenchymal lineages (chondrocytes, adipocytes and osteocytes) upon culture in induction medium. Both acute and partial obstruction of the bladder reduced expression of CD34 and changed localization of Sca-1 to the urothelium. Partial obstruction resulted in upregulation of fibrosis genes within the Sca-1+/CD34+/lin- population. Our data indicate a resident, mesenchymal stem cell population in the bladder that is altered by bladder obstruction. These findings provide new information about the cellular changes in the bladder that may be associated with bladder fibrosis. PMID:26540309

  12. The Murine Bladder Supports a Population of Stromal Sca-1+/CD34+/lin- Mesenchymal Stem Cells

    PubMed Central

    Lilly, Meredith A.; Kulkulka, Natalie A.; Firmiss, Paula R.; Ross, Michael J.; Flum, Andrew S.; Santos, Grace B. Delos; Bowen, Diana K.; Dettman, Robert W.; Gong, Edward M.

    2015-01-01

    Bladder fibrosis is an undesired end point of injury of obstruction and often renders the smooth muscle layer noncompliant. In many cases, the long-term effect of bladder fibrosis is renal failure. Despite our understanding of the progression of this disease, little is known about the cellular mechanisms that lead to a remodeled bladder wall. Resident stem (progenitor) cells have been identified in various organs such as the brain, heart and lung. These cells function normally during organ homeostasis, but become dysregulated after organ injury. Here, we aimed to characterize a mesenchymal progenitor cell population as a first step in understanding its role in bladder fibrosis. Using fluorescence activated cell sorting (FACS), we identified a Sca-1+/ CD34+/ lin- (PECAM-: CD45-: Ter119-) population in the adult murine bladder. These cells were localized to the stromal layer of the adult bladder and appeared by postnatal day 1. Cultured Sca-1+/ CD34+/ lin- bladder cells self-renewed, formed colonies and spontaneously differentiated into cells expressing smooth muscle genes. These cells differentiated into other mesenchymal lineages (chondrocytes, adipocytes and osteocytes) upon culture in induction medium. Both acute and partial obstruction of the bladder reduced expression of CD34 and changed localization of Sca-1 to the urothelium. Partial obstruction resulted in upregulation of fibrosis genes within the Sca-1+/CD34+/lin- population. Our data indicate a resident, mesenchymal stem cell population in the bladder that is altered by bladder obstruction. These findings provide new information about the cellular changes in the bladder that may be associated with bladder fibrosis. PMID:26540309

  13. Bladder Preservation for Muscle Invasive Bladder Cancer

    PubMed Central

    Mirza, Arafat; Choudhury, Ananya

    2016-01-01

    The standard treatment for muscle invasive bladder cancer (MIBC) has been considered to be radical cystectomy (RC) with pelvic lymphadenectomy. However morbidity and impact on quality of life is significant. Radiotherapy has been used in MIBC patients who choose bladder preservation or who are unfit for RC with comparable outcomes. Evidence from some prospective and large retrospective series supports the use of radiotherapy as an attractive alternative option. In this paper we review the evidence and practice of bladder preservation strategies with radiotherapy for muscle invasive bladder cancer. PMID:27376137

  14. Galaxy Outflows Without Supernovae

    NASA Astrophysics Data System (ADS)

    Sur, Sharanya; Scannapieco, Evan; Ostriker, Eve C.

    2016-02-01

    High surface density, rapidly star-forming galaxies are observed to have ≈50-100 km s-1 line of sight velocity dispersions, which are much higher than expected from supernova driving alone, but may arise from large-scale gravitational instabilities. Using three-dimensional simulations of local regions of the interstellar medium, we explore the impact of high velocity dispersions that arise from these disk instabilities. Parametrizing disks by their surface densities and epicyclic frequencies, we conduct a series of simulations that probe a broad range of conditions. Turbulence is driven purely horizontally and on large scales, neglecting any energy input from supernovae. We find that such motions lead to strong global outflows in the highly compact disks that were common at high redshifts, but weak or negligible mass loss in the more diffuse disks that are prevalent today. Substantial outflows are generated if the one-dimensional horizontal velocity dispersion exceeds ≈35 km s-1, as occurs in the dense disks that have star-formation rate (SFR) densities above ≈0.1 M⊙ yr-1 kpc-2. These outflows are triggered by a thermal runaway, arising from the inefficient cooling of hot material coupled with successive heating from turbulent driving. Thus, even in the absence of stellar feedback, a critical value of the SFR density for outflow generation can arise due to a turbulent heating instability. This suggests that in strongly self-gravitating disks, outflows may be enhanced by, but need not caused by, energy input from supernovae.

  15. Bladder function - neurological control

    MedlinePlus Videos and Cool Tools

    ... with urine, sensory nerves send impulses to the brain indicating that the bladder is full. The sensory ... cord to relay this information. In turn, the brain sends impulses back to the bladder instructing the ...

  16. Bladder Cancer Advocacy Network

    MedlinePlus

    ... future bladder cancer research through the Patient Survey Network. Read More... Don’t Miss the 2016 BCAN ... Click here for more details Bladder Cancer Advocacy Network 4915 St. Elmo Avenue, Suite 202 Bethesda, Maryland ...

  17. Studies of Quasar Outflows

    NASA Technical Reports Server (NTRS)

    Arav, Nahum

    2002-01-01

    The main aim of this research program is to determine the ionization equilibrium and abundances in quasar outflows. Especially in the broad absorption line QSO PG 0946+301. We find that the outflow's metalicity is consistent with being solar, while the abundance ratio of phosphorus to other metals is at least ten times solar. These findings are based on diagnostics that are not sensitive to saturation and partial covering effects in the BALs (Broad Adsorption Lines), which considerably weakened previous claims for enhanced metalicity. Ample evidence for these effects is seen in the spectrum.

  18. How frequent are overactive bladder symptoms in women with urodynamic verification of an overactive bladder?

    PubMed Central

    Yeniel, Ahmet Özgür; Ergenoğlu, Mete Ahmet; Meseri, Reci; Aşkar, Niyazi; İtil, İsmail Mete

    2012-01-01

    Objective To determine the relationship between overactive bladder symptoms and urodynamic verification of overactive bladder. Material and Methods Between June 2011 and November 2011, 159 patients underwent urodynamics (UDS) at our urogynecology unit in the Ege University Hospital. Of these, 95 patients who complained of urgency, did not have any overt neurological diseases, bladder outlet obstruction and did not take any medication affecting the lower urinary tract function were evaluated. SPSS (ver. 15.0) was used to evaluate the data and the chi-square test and t test for independent samples were used for analysis. Results The mean age was found to be 54.5±12. Frequency was the most frequent symptom in women with overactive bladder (OAB) (82.1%), nocturia (57.8%) and (57.8%) urgency urinary incontinence followed in frequency. Detrusor over activity incidence was found to be 38.9%. There was no significant relationship between the presence of detrusor over activity (DOA) and OAB symptoms. Leak at urodynamics was found in 46.3% and there is no significant association with detrusor overactivity. Total bladder capacity was found to be significantly lower in women who had DOA (p=0.000). Conclusion It appears that overactive bladder symptoms do not predict detrusor over activity. Urodynamic investigation is not mandatory in the initial management of women with only OAB symptoms. PMID:24592016

  19. [Obstructive shock].

    PubMed

    Pich, H; Heller, A R

    2015-05-01

    An acute obstruction of blood flow in central vessels of the systemic or pulmonary circulation causes the clinical symptoms of shock accompanied by disturbances of consciousness, centralization, oliguria, hypotension and tachycardia. In the case of an acute pulmonary embolism an intravascular occlusion results in an acute increase of the right ventricular afterload. In the case of a tension pneumothorax, an obstruction of the blood vessels supplying the heart is caused by an increase in extravascular pressure. From a hemodynamic viewpoint circulatory shock caused by obstruction is closely followed by cardiac deterioration; however, etiological and therapeutic options necessitate demarcation of cardiac from non-cardiac obstructive causes. The high dynamics of this potentially life-threatening condition is a hallmark of all types of obstructive shock. This requires an expeditious and purposeful diagnosis and a rapid and well-aimed therapy. PMID:25994928

  20. Outflows and Shock Chemistry

    NASA Astrophysics Data System (ADS)

    Tafalla, M.

    2016-05-01

    Bipolar outflows result from the supersonic ejection of material by a protostar, and constitute one of the most characteristic signposts of stellar birth. They also provide ideal targets to test chemical models, and can serve as templates for more complex systems of galactic and extragalactic astronomy where supersonic interactions between gas components take place.

  1. Metallicity and Quasar Outflows

    NASA Astrophysics Data System (ADS)

    Wang, Huiyuan; Zhou, Hongyan; Yuan, Weimin; Wang, Tinggui

    2012-06-01

    Correlations of the outflow strength of quasars, as measured by the blueshift and asymmetry index (BAI) of the C IV line, with intensities and ratios of broad emission lines, based on composite quasar spectra built from the Sloan Digital Sky Survey, are investigated. We find that most of the line ratios of other ions to C IV increase prominently with BAI. These behaviors can be well understood in the context of increasing metallicity with BAI. The strength of the dominant coolant, C IV line, decreases, and weak collisionally excited lines increase with gas metallicity as a result of the competition between different line coolants. Using Si IV+O IV]/C IV as an indicator of gas metallicity, we present, for the first time, a strong correlation between the metallicity and the outflow strength of quasars over a wide range of 1.7-6.9 times solar abundance. Our result implies that metallicity plays an important role in the formation of quasar outflows, likely by affecting outflow acceleration. This effect may have a profound impact on galaxy evolution via momentum feedback and chemical enrichment.

  2. METALLICITY AND QUASAR OUTFLOWS

    SciTech Connect

    Wang, Huiyuan; Zhou, Hongyan; Wang, Tinggui; Yuan, Weimin

    2012-06-01

    Correlations of the outflow strength of quasars, as measured by the blueshift and asymmetry index (BAI) of the C IV line, with intensities and ratios of broad emission lines, based on composite quasar spectra built from the Sloan Digital Sky Survey, are investigated. We find that most of the line ratios of other ions to C IV increase prominently with BAI. These behaviors can be well understood in the context of increasing metallicity with BAI. The strength of the dominant coolant, C IV line, decreases, and weak collisionally excited lines increase with gas metallicity as a result of the competition between different line coolants. Using Si IV+O IV]/C IV as an indicator of gas metallicity, we present, for the first time, a strong correlation between the metallicity and the outflow strength of quasars over a wide range of 1.7-6.9 times solar abundance. Our result implies that metallicity plays an important role in the formation of quasar outflows, likely by affecting outflow acceleration. This effect may have a profound impact on galaxy evolution via momentum feedback and chemical enrichment.

  3. Neoadjuvant Intravesical Vaccine Therapy in Treating Patients With Bladder Carcinoma Who Are Undergoing Cystectomy

    ClinicalTrials.gov

    2014-12-22

    Bladder Adenocarcinoma; Bladder Squamous Cell Carcinoma; Bladder Urothelial Carcinoma; Recurrent Bladder Carcinoma; Stage I Bladder Cancer; Stage II Bladder Cancer; Stage III Bladder Cancer; Stage IV Bladder Cancer

  4. UPJ obstruction

    MedlinePlus

    ... tissue, infection, earlier treatments for a blockage, or kidney stones. UPJ obstruction is the cause of most urinary ... to permanent loss of kidney function ( kidney failure ). Kidney stones or infection may occur in the affected kidney, ...

  5. Intestinal obstruction

    MedlinePlus

    ... of the major causes of intestinal obstruction in infants and children. Causes of paralytic ileus may include: Bacteria or viruses that cause intestinal infections ( gastroenteritis ) Chemical, electrolyte, or mineral imbalances (such as decreased ...

  6. SVC obstruction

    MedlinePlus

    ... Other causes of superior vena cava obstruction include: Aortic aneurysm (a widening of the artery that leaves the ... nlm.nih.gov/pubmed/17476012 . Read More Abdominal aortic aneurysm Chronic Histoplasmosis Lung cancer - small cell Pericarditis - constrictive ...

  7. INTESTINAL OBSTRUCTION

    PubMed Central

    Cole, Warren H.

    1950-01-01

    Despite improvements in knowledge of the pathologic physiology of intestinal obstruction, the introduction of gastrointestinal decompression, and more effective antibiotics, obstruction remains a serious disease with a high mortality rate. Although the diagnosis is often obscure, it can usually be made with a fair degree of accuracy by the history alone; pain is fairly constant and characteristically is of a cramping type simulated by very few other lesions. Distention is present in low lesions but absent in high lesions; on the contrary, vomiting is minimal in low lesions but prominent in high lesions. Visible peristaltic waves are almost pathognomonic of intestinal obstruction. Increased peristaltic sounds, as noted by auscultation, are extremely helpful in diagnosis; they are absent in paralytic ileus. Although intestinal obstruction is a surgical lesion, it must be remembered that in the type produced by adhesions the obstruction can be relieved by gastrointestinal decompression in 80 to 90 per cent of cases. Operation is usually indicated a short time after relief because of the probability of recurrence. In practically all other types of obstruction decompression is indicated only while the patient is being prepared for operation. Obviously any type of strangulation demands early operation. Strangulation can usually be diagnosed, particularly if it develops while the patient is under observation. Increase in pain, muscle spasm and pulse rate are important indications of development of strangulation. Dehydration and electrolytic imbalance are produced almost universally in high obstruction. Usually, it is unwise to wait until these two deficiencies are corrected before operation is undertaken, but correction must be well under way at the time of operation. Resections should be avoided in the presence of intestinal obstruction, but obviously will be necessary in strangulation. Operative technique must be expert and carried out with minimal trauma. Postoperative

  8. Urinary NGAL Levels Correlate with Differential Renal Function in Patients with Ureteropelvic Junction Obstruction Undergoing Pyeloplasty

    PubMed Central

    Cost, Nicholas G.; Noh, Paul H.; Devarajan, Prasad; Ivancic, Vesna; Reddy, Pramod P.; Minevich, Eugene; Bennett, Michael; Haffner, Christopher; Schulte, Marion; DeFoor, W. Robert

    2014-01-01

    Purpose: Recent investigations described the use of NGAL, a sensitive biomarker for kidney injury, in the setting of ureteropelvic junction obstruction. We prospectively evaluated urinary NGAL levels in the affected renal pelvis and bladder of children with ureteropelvic junction obstruction undergoing unilateral dismembered pyeloplasty. Our hypothesis was that higher NGAL in the kidney and bladder would correlate with decreased ipsilateral differential function. Materials and Methods: We performed a prospective cohort study in patients treated with unilateral dismembered pyeloplasty from 2010 to 2012. Urine was obtained intraoperatively from the bladder and obstructed renal pelvis. A control population of unaffected children was recruited to provide a voided bladder specimen. Bladder NGAL levels were compared between the study and control populations. We tested our study hypothesis by correlating bladder and renal pelvic NGAL levels with the differential renal function of the affected kidney. Results: A total of 61 patients with a median age at surgery of 1.62 years (range 0.12 to 18.7) were enrolled in the study. Median bladder NGAL was 18.6 ng/mg (range 1.4-1,650.8) and median renal pelvic NGAL was 26.2 ng/mg (range 1.2-18,034.5, p = 0.004). Median bladder NGAL was significantly higher than in controls (p = 0.004). The correlation of bladder and renal pelvic NGAL with differential renal function was r = −0.359 (p = 0.004) and r = −0.383 (p = 0.002), respectively. Conclusions: Bladder NGAL is increased in children with ureteropelvic junction obstruction. Renal pelvic and bladder normalized urinary NGAL levels correlate inversely with the relative function of the affected kidney in cases of unilateral ureteropelvic junction obstruction. PMID:23791906

  9. Transurethral resection and degeneration of bladder tumour

    PubMed Central

    Li, Aihua; Fang, Wei; Zhang, Feng; Li, Weiwu; Lu, Honghai; Liu, Sikuan; Wang, Hui; Zhang, Binghui

    2013-01-01

    Introduction: We evaluate the efficacy and safety of transurethral resection and degeneration of bladder tumour (TURD-Bt). Methods: In total, 56 patients with bladder tumour were treated by TURD-Bt. The results in these patients were compared with 32 patients treated by current transurethral resection of bladder tumour (TUR-Bt). Patients with or without disease progressive factors were respectively compared between the 2 groups. The factors included recurrent tumour, multiple tumours, tumour ≥3 cm in diameter, clinical stage T2, histological grade 3, adenocarcinoma, and ureteral obstruction or hydronephrosis. Results: Follow-up time was 48.55 ± 23.74 months in TURD-Bt group and 56.28 ± 17.61 months in the TUR-Bt group (p > 0.05). In patients without progressive factors, no tumour recurrence was found and overall survival was 14 (100%) in the TURD-Bt group; 3 (37.50%) patients had recurrence and overall survival was 5 (62.5%) in the TUR-Bt group. In patients with progressive factors, 8 (19.05%) patients had tumour recurrence, overall survival was 32 (76.19%) and cancer death was 3 (7.14%) in TURD-Bt group; 18 (75.00%) patients had tumour recurrence (p < 0.05), overall survival was 12 (50.00%) (p < 0.01) and cancer death was 8 (33.33%) (p < 0.05) in TUR-Bt group. No significant complication was found in TURD-Bt group. Conclusion: This study suggests that complete resection and degeneration of bladder tumour can be expected by TURD-Bt. The surgical procedure is safe and efficacious, and could be predictable and controllable before and during surgery. We would conclude that for bladder cancers without lymph node metastasis and distal metastasis, TURD-Bt could be performed to replace radical TUR-Bt and preserve the bladder. PMID:24475002

  10. Chronic bladder ischemia and oxidative stress: new pharmacotherapeutic targets for lower urinary tract symptoms.

    PubMed

    Nomiya, Masanori; Andersson, Karl-Erik; Yamaguchi, Osamu

    2015-01-01

    Chronic bladder ischemia is potentially a common cause of lower urinary tract symptoms in the elderly. Epidemiological studies have shown a close association between lower urinary tract symptoms and vascular risk factors for atherosclerosis, and investigations using transrectal color Doppler ultrasonography have shown a negative correlation between decreased lower urinary tract perfusion and International Prostate Symptom Score in elderly patients with lower urinary tract symptoms. Bladder blood flow is also known to decrease in men with bladder outlet obstruction as a result of benign prostatic hyperplasia. Studies in animal models suggest that chronic bladder ischemia and repeated ischemia/reperfusion during a micturition cycle might produce oxidative stress, leading to denervation of the bladder and the expression of tissue-damaging molecules in the bladder wall, which could be responsible for the development of bladder hyperactivity progressing to bladder underactivity. The effects of drugs with different mechanisms of action; for example, α1-adrenoceptor antagonists, phosphodiesterase type 5 inhibitors, free radical scavengers and β3-adrenoceptor agonist, have been studied in animal models of chronic bladder ischemia. The drugs, representing different treatment principles for increasing blood flow and decreasing oxidative stress, showed protective effects not only on urodynamic parameters, but also on negative effects on muscle contractility and on detrimental structural bladder wall changes. Improvement of lower urinary tract perfusion and control of oxidative stress can be considered new therapeutic strategies for treatment of bladder dysfunction induced by chronic ischemia. PMID:25339506

  11. Drugs Approved for Bladder Cancer

    MedlinePlus

    ... Professionals Questions to Ask about Your Treatment Research Drugs Approved for Bladder Cancer This page lists cancer ... in bladder cancer that are not listed here. Drugs Approved for Bladder Cancer Atezolizumab Cisplatin Doxorubicin Hydrochloride ...

  12. Ureteral reimplantation in children with neurogenic bladder.

    PubMed

    Belloli, G P; Musi, L; Campobasso, P; Cattaneo, A

    1979-04-01

    The treatment of urologic complications from myelomeningocele and especially of vesico-renal reflux is a controversial problem. A series of 26 reimplanted ureters in 17 children, with good results in more than 85%, is reported. Ureteroneocystostomy, carried out with a few technical innovation, may represent a useful method for the treatment of vesico-renal reflux and obstruction of the uretero-vesical junction in neurogenic bladder associated with myelomeningocele. This surgical approach leads to the disappearance of the reflux, decrease of dilatation of the upper urinary tract and preservation of renal function in most cases; moreover, infection can be more easily controlled. Ureteral reimplantation should be preceded by periodic urethral dilatation, external transurethral sphincterotomy, and pharmacologic regulation in order to attempt to decrease urethral resistance. After successful surgery, it is possible to try to reeducate the bladder. Reimplantation should be preferred to permanent urinary diversion even if there is gross reflux. PMID:458534

  13. Renal Papillary Necrosis Appearing as Bladder Cancer on Imaging

    PubMed Central

    Dagrosa, Lawrence M.; Gormley, Elizabeth Ann

    2016-01-01

    Abstract A 79-year-old woman with a history of diabetes mellitus and recurrent urinary tract infections (UTIs) presented with acute onset left lower quadrant pain, left-sided back pain, vomiting, and dysuria. Abdominopelvic CT scan revealed left hydroureteronephrosis to the level of the left ureterovesical junction (UVJ) where a bladder mass appeared to be obstructing the left ureteral orifice. The obstruction was ultimately found to be the result of a sloughed renal papilla lodged in the distal ureter, which created an inflammatory mass at the UVJ. Her history of diabetes and frequent UTIs likely predisposed her to the development of renal papillary necrosis (RPN) that resulted in sloughing of a renal papilla, distal ureteral obstruction with subsequent bladder inflammation that mimicked a bladder mass on imaging. RPN is a condition associated with many etiologies and likely represents a common final pathway of several diseases. Although several hypotheses exist, it is primarily thought to be ischemic in nature and is related to the underlying physiology of the renal papillae. We present a case of hydroureteronephrosis and bladder mass secondary to a sloughed renal papilla from RPN.

  14. Bladder exstrophy repair

    MedlinePlus

    ... this case, the newborn is sent home on antibiotics. The bladder, which is outside the abdomen, must be kept moist. It can take months for the bladder to grow to the right size. The infant will be followed closely by a medical team ...

  15. Daily Bladder Diary

    MedlinePlus

    ... page you would like to print out: View page 1 of the Bladder Diary View page 2 of the Bladder Diary This content is ... Information Center Phone: 1-800-860-8747 | TTY: 1-866-569-1162 | Email: healthinfo@niddk.nih.gov | Hours: 8:30 a.m. to 5 p.m. Eastern time, M-F

  16. Venous outflow obstruction and portopulmonary hypertension after orthotopic liver transplantation

    PubMed Central

    Aguirre-Avalos, Guadalupe; Covarrubias-Velasco, Marco Antonio; Rojas-Sánchez, Antonio Gerardo

    2013-01-01

    Patient: Female, 54 Final Diagnosis: Suprahepatic inferior vena cava anastomosis stricture Symptoms: Ascites • fatigue • lower limb edema • hepatomegaly Medication: — Clinical Procedure: — Specialty: Transplantology • Critical Care Medicine Objective: Unusual clinical course Background: Suprahepatic inferior vena cava anastomosis stricture is an unusual vascular complication after orthotopic liver transplantation with the “piggyback” technique. Clinical manifestations are dependent upon the severity of the stenosis. Portopulmonary hypertension after orthotopic liver transplantation is a complication that carries high mortality due to cardiopulmonary dysfunction. The pathogenesis of pulmonary vascular disorders after orthotopic liver transplantation remains uncertain. Case Report: We report a case of acute right heart pressure overload after surgical correction of the suprahepatic inferior vena cava anastomotic stricture in a 54-year-old woman who had preexisting pulmonary arterial hypertension associated with portal hypertension after orthotopic liver transplantation. Twenty months posttransplantation, she developed fatigue and progressive ascites. On admission, the patient had hepatomegaly, ascites, and lower limb edema. Symptoms in the patient developed gradually over time. Conclusions: Recurrent portal hypertension by vascular complications is a cause of pulmonary arterial hypertension after orthotopic liver transplantation. Clinical manifestations of suprahepatic inferior vena cava anastomotic stenosis are dependent upon their severity. Sildenafil is an effective drug for treatment of pulmonary arterial hyper-tension after portal hypertension by vascular complications. PMID:24046802

  17. 'Nipped in the Budd': hepatic venous outflow obstruction in evolution.

    PubMed

    Karageorgiou, Haris; Mookerjee, Rajeshwar P; Patani, Neill R; Pachiadakis, Ioannis; Usiskin, Sasha I; Gillams, Alice; Lees, William R; Williams, Roger; Douek, Michael; Jalan, Rajiv

    2005-01-01

    Hepatic venous thrombosis (Budd-Chiari) in evolution is a rare phenomenon and carries a high morbidity and mortality. We describe the case of a 39-year-old Bangladeshi lady who presented with severe abdominal pain secondary to a perforated duodenal ulcer and during her hospital admission developed an asymptomatic Budd-Chiari syndrome (BCS). Our report highlights the important role of an inflammatory focus, and how this process with an associated reactive thrombocytosis may act as a trigger for the development of BCS in an individual with predisposing risk factors. Our patient had been on the contraceptive pill, and was homozygous for the C677T mutation of 5,10-methylenetetrahydrofolate reductase, which results in hyperhomocysteinaemia. These pro-thrombotic risk factors were compounded by the thrombogenic potential of subsequent laparoscopic surgery, and resulted in an evolving thrombus that progressed into the inferior vena cava causing hepatic infarction. A particular feature of this case was the radiological demonstration of complete regression of the thrombus and the hepatic parenchymal changes, upon resolution of the inflammation and normalization of the platelet count. These changes occurred with oral anticoagulation as the only treatment modality, since our patient declined systemic thrombolysis. The demonstration of complete radiological resolution raises the question of how long one should continue oral anticoagulants and, indeed, whether in some instances a conservative approach may be the best management strategy for evolving BCS. PMID:15647643

  18. Technique to avoid left ventricular outflow tract obstruction.

    PubMed

    Gualis, Javier; Castaño, Mario; Martínez-Comendador, Jose Manuel

    2016-06-01

    Preserving the subvalvular mitral valve apparatus during mitral valve replacement is extremely important to minimize progressive postoperative left ventricular remodeling and dysfunction. We describe a simple and reproducible surgical technique that prevents the complications that can occur after total mitral anterior leaflet preservation. PMID:26993109

  19. High Velocity Outflows in Quasars

    NASA Astrophysics Data System (ADS)

    Hamann, Fred; Rodriguez Hidalgo, Paola; Nestor, Daniel

    2006-02-01

    High velocity (HV) outflows are important components of SMBH growth and evolution. The ability of SMBHs to accrete matter and light up as AGN probably requires that outflows are present to carry away angular momentum. Outflows during the luminous AGN phase might also play a critical role in ``unveiling" young dust-enshrouded AGN and in ``polluting" the intergalactic medium with metals at high redshifts. Nonetheless, AGN outflows remain poorly understood. We have begun a program to study a nearly unexplored realm of AGN outflow parameter space: HV winds with v> 10,000 km/s up to v~ 0.2c but small velocity dispersions (narrow absorption lines), such that v/(Delta) v ≫ 1. These extreme outflows have been detected so far in just a few quasars, but they might be ubiquitous if, as expected, the flows subtend a small solid angle as seen from the central engine. Narrow-line HV flows merit specific attention because they pose unique challenges for theoretical models of the wind acceleration, mass loss rates, launch radii, etc. They might also comprise a significant fraction of absorbers previously attributed to unrelated (interveinng) gas or galaxies. We have compiled a list of bright quasars with candidate HV outflow lines (CIV 1550 A) in existing SDSS spectra. We now propose to observe ~50 of these candidates with the 2.1m GoldCam to i) identify/confirm some of the true outflow systems (based on line variability), ii) place a firm lower limit on the fraction of quasars with narrow-line HV outflows, iii) compile a short list of confirmed HV outflow sources for future study, and iv) use the combined SDSS and GoldCam data to measure or constrain basic outflow properties, such as the kinematics, locations, and physical conditions.

  20. Inflammasomes are important mediators of cyclophosphamide-induced bladder inflammation.

    PubMed

    Hughes, Francis M; Vivar, Nivardo P; Kennis, James G; Pratt-Thomas, Jeffery D; Lowe, Danielle W; Shaner, Brooke E; Nietert, Paul J; Spruill, Laura S; Purves, J Todd

    2014-02-01

    Bladder inflammation (cystitis) underlies numerous bladder pathologies and is elicited by a plethora of agents such as urinary tract infections, bladder outlet obstruction, chemotherapies, and catheters. Pattern recognition receptors [Toll-like receptors (TLRs) and Nod-like receptors (NLRs)] that recognize pathogen- and/or damage-associated molecular patterns (PAMPs and/or DAMPs, respectively) are key components of the innate immune system that coordinates the production (TLRs) and maturation (NLRs) of proinflammatory IL-1β. Despite multiple studies of TLRs in the bladder, none have investigated NLRs beyond one small survey. We now demonstrate that NLRP3 and NLRC4, and their binding partners apoptosis-associated speck-like protein containing a COOH-terminal caspase recruitment domain (ASC) and NLR family apoptosis inhibitory protein (NAIP), are expressed in the bladder and localized predominantly to the urothelia. Activated NLRs form inflammasomes that activate caspase-1. Placement of a NLRP3- or NLRC4-activating PAMP or NLRP3-activating DAMPs into the lumen of the bladder stimulated caspase-1 activity. To investigate inflammasomes in vivo, we induced cystitis with cyclophosphamide (CP, 150 mg/kg ip) in the presence or absence of the inflammasome inhibitor glyburide. Glyburide completely blocked CP-induced activation of caspase-1 and the production of IL-1β at 4 h. At 24 h, glyburide reduced two markers of inflammation by 30-50% and reversed much of the inflammatory morphology. Furthermore, glyburide reversed changes in bladder physiology (cystometry) induced by CP. In conclusion, NLRs/inflammasomes are present in the bladder urothelia and respond to DAMPs and PAMPs, whereas NLRP3 inhibition blocks bladder dysfunction in the CP model. The coordinated response of NLRs and TLRs in the urothelia represents a first-line innate defense that may provide an important target for pharmacological intervention. PMID:24285499

  1. Particle Acceleration in Relativistic Outflows

    NASA Technical Reports Server (NTRS)

    Bykov, Andrei; Gehrels, Neil; Krawczynski, Henric; Lemoine, Martin; Pelletier, Guy; Pohl, Martin

    2012-01-01

    In this review we confront the current theoretical understanding of particle acceleration at relativistic outflows with recent observational results on various source classes thought to involve such outflows, e.g. gamma-ray bursts, active galactic nuclei, and pulsar wind nebulae. We highlight the possible contributions of these sources to ultra-high-energy cosmic rays.

  2. Zephyria Outflow Features

    NASA Technical Reports Server (NTRS)

    2004-01-01

    1 October 2004 This Mars Global Surveyor (MGS) Mars Orbiter Camera (MOC) image shows streamlined islands and a small cataract in an outflow channel system in the Zephyria region of Mars, south of Cerberus. The fluids responsible for creating these landforms flowed from the lower left (southwest) toward upper right (northeast). The fluids may have been water and mud or, some Mars scientists have argued, extremely fluid lava. The presence of a small cataract probably argues more strongly for a water and mud origin. This image is located near 3.8oN, 204.7oW. The picture covers an area about 3 km (1.9 mi) wide and is illuminated by sunlight from upper left.

  3. Driving Mechanisms for Molecular Outflows

    NASA Astrophysics Data System (ADS)

    Downes, Turlough P.

    Molecular outflows are observed to be closely associated with star formation. The cumulative momentum and the momentum injection rate in these outflows are important parameters in theories of star formation. The cumulative momentum in an outflow is a measure of the feed-back from star formation on molecular cloud turbulence. The level of turbulence in a cloud also effects the formation of further stars and, indeed, the survival of the cloud itself (e.g. [15]). In addition the rate of injection of momentum is an important constraint for theoretical models of outflows from young stars [10, 18]. Hence, while these outflows are interesting in themselves, it is also critical to understand their origin and behaviour as part of the general study of how stars themselves form.

  4. Origins of Bladder Cancer.

    PubMed

    Czerniak, Bogdan; Dinney, Colin; McConkey, David

    2016-05-23

    Bladder cancer, one of the most frequently occurring human cancers, develops via two tracks referred to as papillary and nonpapillary that correspond to clinically different forms of the disease. Most bladder cancers are chemically induced, with tobacco smoking being the leading risk factor. Recent advances in bladder cancer research have enhanced our understanding of the origin of this disease from urothelial progenitor cells via field effects along papillary/luminal and nonpapillary/basal pathways. Evident from the outset of the disease, the diversity of the luminal and basal pathways, together with cell lineage tracing studies, postulates the origin of molecularly distinct subtypes from different uroprogenitor cells. The molecular mechanisms initiating field effects involve a new class of genes referred to as forerunner (FR) genes that generally map around major tumor suppressors such as RB1. These genes are silenced, predominantly by hypermethylation and less frequently by mutations, and drive the expansion of intraurothelial preneoplastic cells. Different FR genes are involved in various molecular subtypes of bladder cancer and they sensitize the uroprogenitor cells to the development of luminal and basal bladder cancers in animal models. In human bladder cancer, luminal and basal forms have dissimilar clinical behavior and response to conventional and targeted chemotherapeutic manipulations. These new research developments hold the promise of expanding our armamentarium of diagnostic and treatment options for patients with bladder cancer and improving our ability to select patients most likely to respond to a specific therapy. PMID:26907529

  5. Small Bowel Obstruction Due to Suprapubic Catheter Placement.

    PubMed

    Bonasso, Patrick C; Lucke-Wold, Brandon; Khan, Uzer

    2016-07-01

    Suprapubic catheter placement has associated complications such as bowel injury, bladder injury, or bleeding. This case describes the management of an elderly patient who had suprapubic catheter placement complicated by small bowel obstruction. The catheter had continued production of urine. Further patient treatment required abdominal exploration and bowel resection. PMID:27335801

  6. Bladder operated robotic joint

    NASA Technical Reports Server (NTRS)

    Robertson, Glen A. (Inventor)

    1993-01-01

    This invention is a robotic joint which is operated by inflatable bladders and which can be used in applications where it is desired to move or hold an object. A support block supports an elongated plate to which is pivotally attached a finger. A tension strip passes over a lever attached to the finger and is attached at its ends to the support block on opposite sides of the plate. Bladders positioned between the plate and the tension strip on opposite sides of the plate can be inflated by pumps to pivot the finger, with one of the bladders being inflated while the other is being deflated.

  7. Obstructed uterus

    SciTech Connect

    Scott, W.W.; Rosenshein, N.B.; Siegelman, S.S.; Sanders, R.C.

    1981-12-01

    Eleven patients with an obstructed, fluid-filled uterus, due to carcinoma of the uterus or to its treatment by radiation therapy, were examined with computed tomography (CT) and/or ultrasound. It is important to recognize this abnormality to differentiate it from other causes of pelvic mass and to ensure prompt treatment of pyometra, should it develop. Both CT and ultrasound reliably identified this condition and differentiated it from other pelvic masses.

  8. Dynamic LVOT Obstruction and Aortic Stenosis in the Same Patient: A Case of Challenging Doppler Hemodynamics.

    PubMed

    Parker, Matthew W; Kiernan, Francis J

    2015-06-01

    We present a patient with both dynamic left ventricular outflow tract obstruction and valvular aortic stenosis. The aortic valve was calcified, and velocities and gradients measured by continuous-wave Doppler met standard criteria for severe aortic stenosis. The increased subvalvular velocities invalidated assumptions of the simplified Bernoulli equation; correction using the longer form of the Bernoulli equation suggested a lower but still significant gradient. The complex shape of the subvalvular spectral Doppler envelope indicated supranormal systolic function and dynamic left ventricular outflow obstruction. Left heart catheterization with an end-hole catheter was required to determine the subvalvular and valvular components of the obstruction. PMID:25809389

  9. Congenital Urinary Tract Obstruction: The Long View

    PubMed Central

    Chevalier, Robert L.

    2015-01-01

    Maldevelopment of the collecting system resulting in urinary tract obstruction (UTO) is the leading identifiable cause of CKD in children. Specific etiologies are unknown; most cases are suspected by discovering hydronephrosis on prenatal ultrasonography. Congenital UTO can reduce nephron number and cause bladder dysfunction, which contribute to ongoing injury. Severe UTO can impair kidney growth in utero, and animal models of unilateral ureteral obstruction show that ischemia and oxidative stress cause proximal tubular cell death, with later development of interstitial fibrosis. Congenital obstructive nephropathy therefore results from combined developmental and obstructive renal injury. Due to inadequacy of available biomarkers, criteria for surgical correction of upper tract obstruction are poorly established. Lower tract obstruction requires fetal or immediate postnatal intervention, and the rate of progression of CKD is highly variable. New biomarkers based on proteomics and determination of glomerular number by MRI should improve future care. Angiotensin inhibitors have not been effective in slowing progression, although avoidance of nephrotoxins and timely treatment of hypertension are important. Because congenital UTO begins in fetal life, smooth transfer of care from perinatologist to pediatric and adult urology and nephrology teams should optimize quality of life and ultimate outcomes for these patients. PMID:26088076

  10. Congenital urinary tract obstruction: the long view.

    PubMed

    Chevalier, Robert L

    2015-07-01

    Maldevelopment of the collecting system resulting in urinary tract obstruction (UTO) is the leading identifiable cause of CKD in children. Specific etiologies are unknown; most cases are suspected by discovering hydronephrosis on prenatal ultrasonography. Congenital UTO can reduce nephron number and cause bladder dysfunction, which contribute to ongoing injury. Severe UTO can impair kidney growth in utero, and animal models of unilateral ureteral obstruction show that ischemia and oxidative stress cause proximal tubular cell death, with later development of interstitial fibrosis. Congenital obstructive nephropathy, therefore, results from combined developmental and obstructive kidney injury. Because of inadequacy of available biomarkers, criteria for surgical correction of upper tract obstruction are poorly established. Lower tract obstruction requires fetal or immediate postnatal intervention, and the rate of progression of CKD is highly variable. New biomarkers based on proteomics and determination of glomerular number by magnetic resonance imaging should improve future care. Angiotensin inhibitors have not been effective in slowing progression, although avoidance of nephrotoxins and timely treatment of hypertension are important. Because congenital UTO begins in fetal life, smooth transfer of care from perinatologist to pediatric and adult urology and nephrology teams should optimize quality of life and ultimate outcomes for these patients. PMID:26088076

  11. Hypertension following primary bladder closure for vesical exstrophy.

    PubMed

    Husmann, D A; McLorie, G A; Churchill, B M

    1993-02-01

    Since the initiation of staged reconstruction for bladder exstrophy, hypertension has been a known complication of the procedure. The etiology of the elevation in blood pressure was presumably secondary to ureteral dysfunction caused by edema at the ureterovesical junction and secondary renal obstruction. This report details the clinical course of three patients who developed significant hypertension following primary bladder closure with posterior iliac osteotomies and bony immobilization by skin traction. None of the patients had urinary obstruction and all had their hypertension alleviated by removal of the traction. The presumed etiology of the elevated blood pressure within these patients is similar to that experimentally produce by inappropriately applied traction resulting in tension on the sciatic nerve and reflex induced vasoconstriction. The need to maintain appropriately applied traction and the necessity of monitoring the postoperative blood pressure is stressed. PMID:8155094

  12. Ultrasound: Bladder (For Parents)

    MedlinePlus

    ... bladder area and images are recorded on a computer. The black-and-white images show the internal ... the images can be seen clearly on the computer screen. A technician (sonographer) trained in ultrasound imaging ...

  13. Cystocele (Fallen Bladder)

    MedlinePlus

    ... interprets the images. A woman does not need anesthesia. A health care provider can also use a ... completely emptying her bladder. A woman receives local anesthesia. A health care provider may use a voiding ...

  14. Urinary Incontinence: Bladder Training

    MedlinePlus

    ... following ways: Lengthen the amount of time between bathroom trips. Increase the amount of urine your bladder ... Kegel exercises may also help control urges. Scheduled bathroom trips: Some people control their incontinence by going ...

  15. Daily Bladder Diary

    MedlinePlus

    ... bladder diary. If you have Adobe's® Acrobat® Reader Software , you might prefer looking at the Print PDF Version (80 KB) of the diary as the print quality will be much enhanced. Please select which page ...

  16. Auroral arcs and ion outflow

    NASA Astrophysics Data System (ADS)

    Maggiolo, Romain

    2016-04-01

    This presentation provides an overwiew of the chapter "Auroral Arcs and Ion Outflow" from the AGU book "Auroral Dynamics and Space Weather" (eds Y. Zhang and L. J. Paxton). This topic covers a wide range of domains, from auroral acceleration processes, auroral arc morphology and dynamics to global magnetosphere-ionosphere coupling and atmospheric erosion. This presentation mainly focuses on the observational properties of auroral ion outflow. Recent observations about their large-scale spatial distribution and link with auroral forms will be presented. Auroral ion outflow statistical dependence on solar and geomagnetic activity and its modulation by auroral dynamics at the timescale of substorms will also be discussed.

  17. Naftopidil inhibits 5-hydroxytryptamine-induced bladder contraction in rats.

    PubMed

    Sakai, Takumi; Kasahara, Ken-ichi; Tomita, Ken-ichi; Ikegaki, Ichiro; Kuriyama, Hiroshi

    2013-01-30

    Naftopidil is an α(1D) and α(1A) subtype-selective α(1)-adrenoceptor antagonist that has been used to treat lower urinary tract symptoms of benign prostatic hyperplasia. In this study, we investigated the effects of naftopidil on 5-hydroxytryptamine (5-HT)-induced rat bladder contraction (10(-8)-10(-4) M). Naftopidil (0.3, 1, and 3 μM) inhibited 5-HT-induced bladder contraction in a concentration-dependent manner. On the other hand, other α(1)-adrenoceptor antagonists, tamsulosin, silodosin or prazosin, did not inhibit 5-HT-induced bladder contraction. The 5-HT-induced bladder contraction was inhibited by both ketanserin and 4-(4-fluoronaphthalen-1-yl)-6-propan-2-ylpyrimidin-2-amine (RS127445), serotonin 5-HT(2A) and 5-HT(2B) receptor antagonists, respectively. In addition, 1-(2,5-dimethoxy-4-iodophenyl)-2-aminopropane (DOI) and α-methyl-5-HT, 5-HT(2A) and 5-HT(2) receptor agonists, respectively, induced bladder contraction. The 5-HT-induced bladder contraction was not inhibited by N-[2-[4-(2-methoxyphenyl)piperazin-1-yl]ethyl]-N-pyridin-2-yl-cyclohexanecarboxamide (WAY-100635), [1-[2[(methylsulfonyl)amino]ethyl]-4-piperidinyl]methyl-1-methyl-1H-indole-3-carboxylate (GR113808) or (R)-3-[2-[2-(4-methylpiperidin-1-yl)ethyl]pyrrolidine-1-sulphonyl]phenol (SB269970), 5-HT(1A), 5-HT(4) and 5-HT(7) receptor antagonists, respectively. Naftopidil inhibited both the 5-HT(2A) and 5-HT(2) receptor agonists-induced bladder contractions. Naftopidil binds to the human 5-HT(2A) and 5-HT(2B) receptors with pKi values of 6.55 and 7.82, respectively. These results suggest that naftopidil inhibits 5-HT-induced bladder contraction via blockade of the 5-HT(2A) and 5-HT(2B) receptors in rats. Furthermore, 5-HT-induced bladder contraction was enhanced in bladder strips obtained from bladder outlet obstructed rats, with this contraction inhibited by naftopidil. The beneficial effects of naftopidil on storage symptoms such as urinary frequency and nocturia in patients with benign

  18. Neuromodulation in neurogenic bladder

    PubMed Central

    Sanford, Melissa T.

    2016-01-01

    While neuromodulation is a well-established treatment option for patients with non-neurogenic overactive bladder and urinary retention, its applicability to the neurogenic bladder population has only recently been examined more in depth. In this article we will discuss the outcomes, contraindications, and special considerations of sacral and percutaneous tibial nerve stimulation (PTNS) in patients with neurogenic lower urinary tract dysfunction. PMID:26904417

  19. Obstructive sleep apnea - adults

    MedlinePlus

    Sleep apnea - obstructive - adults; Apnea - obstructive sleep apnea syndrome - adults; Sleep-disordered breathing - adults; OSA - adults ... the upper airway for obstructive sleep apnea in adults. Sleep . 2010;33:1408-1413. PMID: 21061864 www. ...

  20. Traumatic injury of the bladder and urethra

    MedlinePlus

    Injury - bladder and urethra; Bruised bladder; Urethral injury; Bladder injury; Pelvic fracture; Urethral disruption ... Types of bladder injuries include: Blunt trauma (such as a blow to the body) Penetrating wounds (such as bullet or stab wounds) The ...

  1. Shining a light on galactic outflows: photoionized outflows

    NASA Astrophysics Data System (ADS)

    Chisholm, John; Tremonti, Christy A.; Leitherer, Claus; Chen, Yanmei; Wofford, Aida

    2016-04-01

    We study the ionization structure of galactic outflows in 37 nearby, star-forming galaxies with the Cosmic Origins Spectrograph on the Hubble Space Telescope. We use the O I, Si II, Si III, and Si IV ultraviolet absorption lines to characterize the different ionization states of outflowing gas. We measure the equivalent widths, line widths, and outflow velocities of the four transitions, and find shallow scaling relations between them and galactic stellar mass and star formation rate. Regardless of the ionization potential, lines of similar strength have similar velocities and line widths, indicating that the four transitions can be modelled as a comoving phase. The Si equivalent width ratios (e.g. Si IV/Si II) have low dispersion, and little variation with stellar mass; while ratios with O I and Si vary by a factor of 2 for a given stellar mass. Photoionization models reproduce these equivalent width ratios, while shock models under predict the relative amount of high ionization gas. The photoionization models constrain the ionization parameter (U) between -2.25 < log (U) < -1.5, and require that the outflow metallicities are greater than 0.5 Z⊙. We derive ionization fractions for the transitions, and show that the range of ionization parameters and stellar metallicities leads to a factor of 1.15-10 variation in the ionization fractions. Historically, mass outflow rates are calculated by converting a column density measurement from a single metal ion into a total hydrogen column density using an ionization fraction, thus mass outflow rates are sensitive to the assumed ionization structure of the outflow.

  2. Nerve Disease and Bladder Control

    MedlinePlus

    ... Research Training & Career Development Grant programs for students, postdocs, and faculty Research at NIDDK Labs, faculty, and ... KB) Alternate Language URL Nerve Disease and Bladder Control Page Content On this page: What bladder control ...

  3. Arteriovenous malformations of the bladder.

    PubMed

    Grunberger, I; DeAsis, A; Torno, R; Godec, C J

    1989-01-01

    We report a rare case of a localized arteriovenous malformation of the bladder mimicking a bladder tumor and presenting with gross hematuria. The mass was successfully resected transurethrally. PMID:2908934

  4. General Information about Bladder Cancer

    MedlinePlus

    ... Research Bladder Cancer Treatment (PDQ®)–Patient Version General Information About Bladder Cancer Go to Health Professional Version ... the PDQ Adult Treatment Editorial Board . Clinical Trial Information A clinical trial is a study to answer ...

  5. Blocking of the Hepatic Vein Outflow by Neointima Covering a Wallstent Across a Membranous Stenosis of the Inferior Vena Cava

    SciTech Connect

    Dutta, Usha; Garg, Pramod K.; Agarwal, Rajeev; Gupta, S. Dutta; Prasad, G. A.; Kaul, Upendra; Tandon, Rakesh K.

    1999-11-15

    A 31-year-old man presented with idiopathic membranous obstruction of the suprahepatic inferior vena cava (IVC) and was treated by balloon dilation and placement of a Wallstent. The patient improved markedly. However, he developed obstruction of the hepatic vein outflow secondary to neointima formation over the stent that covered the hepatic vein ostia. The patient died of liver failure and septicemia. We believe that this is the first report of such a serious complication.

  6. Superficial bladder cancer.

    PubMed

    Hall, R R

    1994-04-01

    Bladder cancer is almost certainly a product of the industrial revolution and the cigarette smoking that has accompanied it. Exposure to a chemical bladder carcinogen such as beta naphthylamine, benzidine, or 4-diphenylaniline can be proved in only a small proportion of patients and only a handful obtain industrial diseases benefit after developing "Prescribed Industrial Disease C23." None the less, the continued use of known carcinogenic substances in British industry for many years after their identification, the wide range of industries with a known or suspected increased risk of bladder cancer, and our ignorance of the carcinogenic potential of many materials used in current manufacturing should be a cause for continuing concern. PMID:8173377

  7. Bladder afferent hyperexcitability in bladder pain syndrome/interstitial cystitis

    PubMed Central

    Yoshimura, Naoki; Oguchi, Tomohiko; Yokoyama, Hitoshi; Funahashi, Yasuhito; Yoshikawa, Satoru; Sugino, Yoshio; Kawamorita, Naoki; Kashyap, Mahendra P; Chancellor, Michael B; Tyagi, Pradeep; Ogawa, Teruyuki

    2014-01-01

    Bladder pain syndrome/interstitial cystitis is a disease with lower urinary tract symptoms, such as bladder pain and urinary frequency, which results in seriously impaired quality of life of patients. The extreme pain and urinary frequency are often difficult to treat. Although the etiology of bladder pain syndrome/interstitial cystitis is still not known, there is increasing evidence showing that afferent hyperexcitability as a result of neurogenic bladder inflammation and urothelial dysfunction is important to the pathophysiological basis of symptom development. Further investigation of the pathophysiology will lead to the effective treatment of patients with bladder pain syndrome/interstitial cystitis. PMID:24807488

  8. Mediterranean outflow mixing and dynamics.

    PubMed

    Price, J F; Baringer, M O; Lueck, R G; Johnson, G C; Ambar, I; Parrilla, G; Cantos, A; Kennelly, M A; Sanford, T B

    1993-02-26

    The Mediterranean Sea produces a salty, dense outflow that is strongly modified by entrainment as it first begins to descend the continental slope in the eastern Gulf of Cadiz. The current accelerates to 1.3 meters per second, which raises the internal Froude number above 1, and is intensely turbulent through its full thickness. The outflow loses about half of its density anomaly and roughly doubles its volume transport as it entrains less saline North Atlantic Central water. Within 100 kilometers downstream, the current is turned by the Coriolis force until it flows nearly parallel to topography in a damped geostrophic balance. The mixed Mediterranean outflow continues westward, slowly descending the continental slope until it becomes neutrally buoyant in the thermocline where it becomes an important water mass. PMID:17732247

  9. Origin of outflows and winds

    NASA Technical Reports Server (NTRS)

    Koenigl, Arieh; Ruden, Steven P.

    1993-01-01

    Recent developments concerning the accretion-outflow connection and the role of magnetic fields are examined. It is argued that the weakly ionized wind most likely represents an MHD outflow driven centrifugally from the disk surfaces or from the boundary between the disk and the star. Specific wind models for each of these alternatives are presented, and it is contended that both provide a natural explanation of the observed correlation between accretion and outflow. The kinematic, thermal, and chemical wind properties predicted by these models are described and their observational implications are considered. It is suggested that the wind characteristics may be reflected in the observed forbidden line and IR continuum emission of T Tauri stars and in the measured abundances of various molecular species.

  10. Mediterranean Outflow Mixing and Dynamics

    NASA Astrophysics Data System (ADS)

    Price, James F.; O'Neil Baringer, Molly; Lueck, Rolf G.; Johnson, Gregory C.; Ambar, Isabel; Parrilla, Gregorio; Cantos, Alain; Kennelly, Maureen A.; Sanford, Thomas B.

    1993-02-01

    The Mediterranean Sea produces a salty, dense outflow that is strongly modified by entrainment as it first begins to descend the continental slope in the eastern Gulf of Cadiz. The current accelerates to 1.3 meters per second, which raises the internal Froude number above 1, and is intensely turbulent through its full thickness. The outflow loses about half of its density anomaly and roughly doubles its volume transport as it entrains less saline North Atlantic Central water. Within 100 kilometers downstream, the current is turned by the Coriolis force until it flows nearly parallel to topography in a damped geostrophic balance. The mixed Mediterranean outflow continues westward, slowly descending the continental slope until it becomes neutrally buoyant in the thermocline where it becomes an important water mass.

  11. Bladder inflammatory transcriptome in response to tachykinins: Neurokinin 1 receptor-dependent genes and transcription regulatory elements

    PubMed Central

    Saban, Ricardo; Simpson, Cindy; Vadigepalli, Rajanikanth; Memet, Sylvie; Dozmorov, Igor; Saban, Marcia R

    2007-01-01

    Background Tachykinins (TK), such as substance P, and their neurokinin receptors which are ubiquitously expressed in the human urinary tract, represent an endogenous system regulating bladder inflammatory, immune responses, and visceral hypersensitivity. Increasing evidence correlates alterations in the TK system with urinary tract diseases such as neurogenic bladders, outflow obstruction, idiopathic detrusor instability, and interstitial cystitis. However, despite promising effects in animal models, there seems to be no published clinical study showing that NK-receptor antagonists are an effective treatment of pain in general or urinary tract disorders, such as detrusor overactivity. In order to search for therapeutic targets that could block the tachykinin system, we set forth to determine the regulatory network downstream of NK1 receptor activation. First, NK1R-dependent transcripts were determined and used to query known databases for their respective transcription regulatory elements (TREs). Methods An expression analysis was performed using urinary bladders isolated from sensitized wild type (WT) and NK1R-/- mice that were stimulated with saline, LPS, or antigen to provoke inflammation. Based on cDNA array results, NK1R-dependent genes were selected. PAINT software was used to query TRANSFAC database and to retrieve upstream TREs that were confirmed by electrophoretic mobility shift assays. Results The regulatory network of TREs driving NK1R-dependent genes presented cRel in a central position driving 22% of all genes, followed by AP-1, NF-kappaB, v-Myb, CRE-BP1/c-Jun, USF, Pax-6, Efr-1, Egr-3, and AREB6. A comparison between NK1R-dependent and NK1R-independent genes revealed Nkx-2.5 as a unique discriminator. In the presence of NK1R, Nkx2-5 _01 was significantly correlated with 36 transcripts which included several candidates for mediating bladder development (FGF) and inflammation (PAR-3, IL-1R, IL-6, α-NGF, TSP2). In the absence of NK1R, the matrix Nkx2

  12. Postmenopausal overactive bladder

    PubMed Central

    2014-01-01

    Bladder storage symptoms have a severe impact on many areas as regards the quality of life including health-related, social, psychological and working functions. Pharmacotherapy of lower urinary tract stores (LUTS) has been developed to optimize neural control of the lower urinary tract in pathologic states. The bladder can be overactive or underactive. Overactive bladder (OAB) is highly prevalent and is associated with considerable morbidity, especially in aging population. Therefore, an effective treatment of OAB must result in a meaningful reduction in urinary symptoms. Pharmacotherapy for the OAB must be individualized based on the degree of bother, medication side-effect profile, concomitant comorbidities and current medication regimen. Antimuscarinic agents will continue to represent the current gold standard for the first-line pharmacological management of OAB. Alternatively to antimuscarinic therapy, β3-adrenergic receptor agonists, due to their efficacy and favorable adverse event profile, are a novel and attractive option of pharmacological treatment of overactive bladder symptoms. A combination of selective antimuscarinic and β3-adrenergic receptor agonists, agents with the different mechanism of action, gives a new treatment option for the patient with OAB according to its harms profile. A number of putative novel therapeutic agents is under clinical evaluations that may ultimately provide alternative or combination treatment options for OAB in the nearest future. PMID:26327873

  13. Molecular outflows in starburst nuclei

    NASA Astrophysics Data System (ADS)

    Roy, Arpita; Nath, Biman B.; Sharma, Prateek; Shchekinov, Yuri

    2016-08-01

    Recent observations have detected molecular outflows in a few nearby starburst nuclei. We discuss the physical processes at work in such an environment in order to outline a scenario that can explain the observed parameters of the phenomenon, such as the molecular mass, speed and size of the outflows. We show that outflows triggered by OB associations, with NOB ≥ 105 (corresponding to a star formation rate (SFR)≥1 M⊙ yr-1 in the nuclear region), in a stratified disk with mid-plane density n0 ˜ 200-1000 cm-3 and scale height z0 ≥ 200(n0/102 cm-3)-3/5 pc, can form molecules in a cool dense and expanding shell. The associated molecular mass is ≥107 M⊙ at a distance of a few hundred pc, with a speed of several tens of km s-1. We show that a SFR surface density of 10 ≤ ΣSFR ≤ 50 M⊙ yr-1 kpc-2 favours the production of molecular outflows, consistent with observed values.

  14. The Geometry of Quasar Outflows

    NASA Astrophysics Data System (ADS)

    Ganguly, Rajib

    2012-10-01

    Quasar outflows are important for understanding the accretion and growth processes of the central black hole, but also potentially play a role in feedback to the galaxy, halting star formation and infall of gas. A big uncertainty lies in the geometry and density of these outflows, especially as a function of ionization and velocity. We aim to tackle this using the archival COS M grating spectra of 266 quasars. We separate the geometry of outflows into two parts: the solid angle subtended around the black hole, and the distance of the outflow from the central engine. Large numbers of quasars with high resolution spectra are required for each aspect of this statistical investigation. First, we will determine which/how many absorption-line systems are intrinsic through both partial covering methods and statistical assessments. Second, we will consider the incidence of intrinsic absorbers as a function of quasar property {e.g., radio-loudness, SED shape, black hole mass, bolometric luminosity}. This will reveal what determines the solid angle. This can only be done at moderate redshifts where quasars with a larger range of properties are observable, and hence requires HST/COS. Third, we will use the wide range of diagnostic lines to constrain the physical conditions of the absorbers. We will target the CIII*1175 complex and apply photoionization models to constrain the densities and ionization parameters. This will provide the largest set yet of intrinsic absorbers with systematic distance constraints. In tandem with the solid angles, this work will inform models regarding the geometry of quasar outflows.

  15. Hot outflows in galaxy clusters

    NASA Astrophysics Data System (ADS)

    Kirkpatrick, C. C.; McNamara, B. R.

    2015-10-01

    The gas-phase metallicity distribution has been analysed for the hot atmospheres of 29 galaxy clusters using Chandra X-ray Observatory observations. All host brightest cluster galaxies (BCGs) with X-ray cavity systems produced by radio AGN. We find high elemental abundances projected preferentially along the cavities of 16 clusters. The metal-rich plasma was apparently lifted out of the BCGs with the rising X-ray cavities (bubbles) to altitudes between twenty and several hundred kiloparsecs. A relationship between the maximum projected altitude of the uplifted gas (the `iron radius') and jet power is found with the form R_Fe ∝ P_jet^{0.45}. The estimated outflow rates are typically tens of solar masses per year but exceed 100 M⊙ yr- 1 in the most powerful AGN. The outflow rates are 10-20 per cent of the cooling rates, and thus alone are unable to offset a cooling inflow. Nevertheless, hot outflows effectively redistribute the cooling gas and may play a significant role at regulating star formation and AGN activity in BCGs and presumably in giant elliptical galaxies. The metallicity distribution overall can be complex, perhaps due to metal-rich gas returning in circulation flows or being blown around in the hot atmospheres. Roughly 15 per cent of the work done by the cavities is expended lifting the metal-enriched gas, implying their nuclear black holes have increased in mass by at least ˜107-109 M⊙. Finally, we show that hot outflows can account for the broad, gas-phase metallicity distribution compared to the stellar light profiles of BCGs, and we consider a possible connection between hot outflows and cold molecular gas flows discovered in recent Atacama Large Millimeter Array observations.

  16. Inguinal hernia containing bladder and ureteroneocystostomy: a rare cause for acute renal graft dysfunction.

    PubMed

    Coelho, Hugo; Nunes, Pedro; Canhoto, Carolina; Temido, Paulo

    2016-01-01

    A 77-year-old man presented with acute graft dysfunction 25 years after a renal transplant in the left iliac fossa. He also had an asymptomatic left inguinal hernia. Renal ultrasound showed a significant pyelocalicial dilation of the kidney graft and the patient was submitted to a percutaneous nephrostomy. An antegrade nephrostogram was performed, which showed a dilated ureter and the bladder included in the left inguinal hernia that caused the obstructive uropathy. Concomitant retrograde cystography also showed a significant portion of the bladder in the hernia sac. The patient was submitted to inguinal hernia repair, which resolved the obstruction. We present a rare and potentially curable cause of obstructive uropathy in a transplant recipient; it is possible to revert graft dysfunction and prevent graft loss if the condition is recognised early. PMID:26912768

  17. Endoscopic Management of Bladder Diverticula.

    PubMed

    Pham, Khanh N; Jeldres, Claudio; Hefty, Thomas; Corman, John M

    2016-01-01

    A 50-year-old man with benign prostatic hyperplasia and urinary retention had a very large diverticulum on the posterior wall of the bladder. The patient was managed with transurethral resection of the prostate and endoscopic fulguration of the bladder diverticulum mucosa using the Orandi technique. There was near-complete resolution of the bladder diverticulum following endoscopic management, obviating the need for bladder diverticulectomy. The patient now empties his bladder, with a postvoid residual < 50 mL and the absence of urinary tract infection after 6-month follow-up. We report the successful treatment of a large bladder diverticulum with endoscopic fulguration to near-complete resolution. This minimally invasive technique is a useful alternative in patients unfit for a more extensive surgical approach. PMID:27601971

  18. Endoscopic Management of Bladder Diverticula

    PubMed Central

    Pham, Khanh N.; Jeldres, Claudio; Hefty, Thomas; Corman, John M.

    2016-01-01

    A 50-year-old man with benign prostatic hyperplasia and urinary retention had a very large diverticulum on the posterior wall of the bladder. The patient was managed with transurethral resection of the prostate and endoscopic fulguration of the bladder diverticulum mucosa using the Orandi technique. There was near-complete resolution of the bladder diverticulum following endoscopic management, obviating the need for bladder diverticulectomy. The patient now empties his bladder, with a postvoid residual < 50 mL and the absence of urinary tract infection after 6-month follow-up. We report the successful treatment of a large bladder diverticulum with endoscopic fulguration to near-complete resolution. This minimally invasive technique is a useful alternative in patients unfit for a more extensive surgical approach. PMID:27601971

  19. Pharmacogenomics in bladder cancer

    PubMed Central

    Dancik, Garrett M.; Theodorescu, Dan

    2014-01-01

    Bladder cancer is a common cancer worldwide. For patients presenting with muscle-invasive disease, the five year survival rate is approximately 50%. Cisplatinum-based combination chemotherapy is recommended in the neoadjuvant setting prior to cystectomy and is also the first line in the metastatic setting. However, the survival benefit of such therapy is modest. The identification of pharmacogenomic biomarkers would enable the rational and personalized treatment of patients by selecting those patients that would benefit most from such therapies sparing others the unnecessary toxicity. Conventional therapies would be recommended for an expected responder while a non-responder would be considered for alternative therapies selected on the basis of the individual’s molecular profile. Although few effective bladder cancer therapies have been introduced in the past 30 years, several targeted therapies against the molecular drivers of bladder cancer appear promising. This review summarizes pharmacogenomic biomarkers that require further investigation and/or prospective evaluation, publicly available tools for drug discovery and biomarker identification from in vitro data, and targeted agents that have been evaluated in preclinical models. PMID:24360659

  20. Obstructive sleep apnea - adults

    MedlinePlus

    Sleep apnea - obstructive - adults; Apnea - obstructive sleep apnea syndrome - adults; Sleep-disordered breathing - adults; OSA - adults ... When you sleep, all of the muscles in your body become more relaxed. This includes the muscles that help keep your ...

  1. Chronic obstructive pulmonary disease

    MedlinePlus

    ... this page: //medlineplus.gov/ency/article/000091.htm Chronic obstructive pulmonary disease To use the sharing features on this page, please enable JavaScript. Chronic obstructive pulmonary disease (COPD) is a common lung disease. Having COPD ...

  2. Contemporary Management of Bladder Cancer

    PubMed Central

    Bell, David; Fradet, Yves

    1991-01-01

    Bladder cancer is currently the fifth most common cancer in Western society, and its incidence appears to be increasing. Important advances have recently occurred in both diagnostic and therapeutic approaches to bladder neoplasms. Presentation is not unique, and physician awareness is important to identify patients who are at risk for bladder neoplasia and consequently require further investigation. A diagnostic approach and contemporary management are discussed. ImagesFigure 1Figure 4 PMID:21229043

  3. [Multiple bladder diverticula caused by occipital horn syndrome].

    PubMed

    Legros, L; Revencu, N; Nassogne, M-C; Wese, F-X; Feyaerts, A

    2015-11-01

    We report on the case of a child who presented with recurrent, multiple, and voluminous bladder diverticula. Bladder diverticula are defined as a herniation of the mucosa through the bladder muscle or the detrusor. Causes are numerous and diverticula can be classified into primary congenital diverticula (para-ureteral - or Hutch diverticula - and posterolateral diverticula); secondary diverticula (resulting from chronic mechanical obstruction or from neurological disease; and diverticula secondary to connective tissue or muscle fragility. The latter is seen in disease entities such as prune belly syndrome, Ehlers-Danlos syndrome, cutis laxa syndrome, OHS (occipital horn syndrome), Menkes disease, and Williams-Beuren syndrome. In this patient, the cause of these diverticula was OHS, a genetic, recessive X-chromosome-linked syndrome, responsible for abnormal tissue caused by a disorder in copper metabolism. This case reminds us of the importance of pushing the diagnostic workup when presented with multiple and/or large bladder diverticula, and in particular to search for rare malformation syndromes after exclusion of an obstacle. PMID:26386812

  4. [Diet in bladder cancer ethiopathogenesis].

    PubMed

    Radosavljević, V; Ilić, M; Janković, S; Djokić, M

    2005-01-01

    The aim of this paper is to show influence of different foods on bladder cancer appearance, as well as possible consequent ways of prevention. Consuption of food rich in animal fat and cholesterol, fried foods, especially several times used cookin oil for frying, processed meat with additives (nitrates, nitrites, azo-colourrs) can influence bladder cancer occurrence. Regularly, continous consumption of fermented milk products, which contains come types of milky--acids bacterias, is considered as protective factor in developing bladder cancer. Reports that fruit and vegetable are protective food items are pretty consistent. Data about mineral intake and bladder cancer are obscure. PMID:16812999

  5. Bladder Cancer and Genetic Mutations.

    PubMed

    Zhang, Xiaoying; Zhang, Yangde

    2015-09-01

    The most common type of urinary bladder cancer is called as transitional cell carcinoma. The major risk factors for bladder cancer are environmental, tobacco smoking, exposure to toxic industrial chemicals and gases, bladder inflammation due to microbial and parasitic infections, as well as some adverse side-effects of medications. The genetic mutations in some chromosomal genes, such as FGFR3, RB1, HRAS, TP53, TSC1, and others, occur which form tumors in the urinary bladder. These genes play an important role in the regulation of cell division which prevents cells from dividing too quickly. The changes in the genes of human chromosome 9 are usually responsible for tumor in bladder cancer, but the genetic mutation of chromosome 22 can also result in bladder cancer. The identification of p53 gene mutation has been studied at NIH, Washington, DC, USA, in urine samples of bladder cancer patients. The invasive bladder cancers were determined for the presence of gene mutations on p53 suppressor gene. The 18 different bladder tumors were evaluated, and 11 (61 %) had genetic mutations of p53 gene. The bladder cancer studies have suggested that 70 % of bladder cancers involve a specific mutation in a particular gene, namely telomerase reverse transcriptase (TERT) gene. The TERT gene is involved in DNA protection, cellular aging processes, and cancer. The Urothelial carcinomas of the bladder have been described in Atlas of genetics and cytogenetics in oncology and hematology. HRAS is a proto-oncogene and has potential to cause cancer in several organs including the bladder. The TSC1 c. 1907 1908 del (E636fs) mutation in bladder cancer suggests that the location of the mutation is Exon 15 with frequency of TSC1 mutation of 11.7 %. The recent findings of BAP1 mutations have shown that it contributes to BRCA pathway alterations in bladder cancer. The discoveries of more gene mutations and new biomarkers and polymerase chain reaction bioassays for gene mutations in bladder

  6. Difficult anesthesia management in a case of living donor liver transplantation with hypertrophic obstructive cardiomyopathy.

    PubMed

    Kondo, Takashi; Kusunoki, Shinji; Kuroda, Masahiko; Kawamoto, Masashi

    2013-12-01

    Liver transplantation with hypertrophic obstructive cardiomyopathy is associated with acute hemodynamic changes, which can exacerbate left ventricular outflow tract obstruction during surgery. Therefore, selection of general anesthetic agents is important, as most can result in hemodynamic instability by reducing systemic vascular resistance and blood pressure. We report successful anesthetic management in a case of living donor liver transplantation with hypertrophic obstructive cardiomyopathy using ketamine, propofol, and fentanyl to avoid vasodilation by anesthetic agents. In addition, landiolol, phenylephrine, and low-dose dopamine were administered to prevent left ventricular outflow tract obstruction, and were found to be effective for improving acute hemodynamic changes during surgery. In the case of this patient, the combination of transesophageal echocardiography and a pulmonary artery catheter was beneficial for intraoperative hemodynamic monitoring. PMID:24597212

  7. Physiological and pathophysiological implications of micromotion activity in urinary bladder function.

    PubMed

    Vahabi, B; Drake, M J

    2015-02-01

    'Micromotions' is a term signifying the presence of localized microcontractions and microelongations, alongside non-motile areas. The motile areas tend to shift over the bladder surface with time, and the intravesical pressure reflects moment-by-moment summation of the interplay between net contractile force generated by micromotions and general bladder tone. Functionally, the bladder structure may comprise modules with variable linkage, which supports presence of localized micromotions (no functional linkage between modules), propagating contractions (where emergence of linkage allows sequential activation) and the shifting of micromotions over time. Detrusor muscle, interstitial cells and intramural innervation have properties potentially relevant for initiating, coordinating and modulating micromotions. Conceptually, such activity could facilitate the generation of afferent activity (filling state reporting) in the absence of intravesical pressure change and the ability to transition to voiding at any bladder volume. This autonomous activity is an intrinsic property, seen in various experimental contexts including the clinical setting of human (female) overactive bladder. 'Disinhibited autonomy' may explain the obvious micromotions in isolated bladders and perhaps contribute clinically in neurological disease causing detrusor overactivity. Furthermore, any process that could increase the initiation or propagation of microcontractions might be anticipated to have a functional effect, increasing the likelihood of urinary urgency and detrusor overactivity respectively. Thus, models of bladder outlet obstruction, neurological trauma and ageing provide a useful framework for detecting cellular changes in smooth muscle, interstitial cells and innervation, and the consequent effects on micromotions. PMID:25154454

  8. Pathophysiology of Overactive Bladder and Urge Urinary Incontinence

    PubMed Central

    Steers, William D

    2002-01-01

    Storage symptoms such as urgency, frequency, and nocturia, with or without urge incontinence, are characterized as overactive bladder (OAB). OAB can lead to urge incontinence. Disturbances in nerves, smooth muscle, and urothelium can cause this condition. In some respects the division between peripheral and central causes of OAB is artificial, but it remains a useful paradigm for appreciating the interactions between different tissues. Models have been developed to mimic the OAB associated with bladder instability, lower urinary tract obstruction, neuropathic disorders, diabetes, and interstitial cystitis. These models share the common features of increased connectivity and excitability of both detrusor smooth muscle and nerves. Increased excitability and connectivity of nerves involved in micturition rely on growth factors that orchestrate neural plasticity. Neurotransmitters, prostaglandins, and growth factors, such as nerve growth factor, provide mechanisms for bidirectional communication between muscle or urothelium and nerve, leading to OAB with or without urge incontinence. PMID:16986023

  9. Obstruction is unimportant in the pathophysiology of hypertrophic cardiomyopathy.

    PubMed Central

    Criley, J. M.; Siegel, R. J.

    1986-01-01

    There has been a longstanding controversy about the significance of intracavitary pressure gradients in hypertrophic cardiomyopathy (HCM). It has been generally assumed that the gradient is the result of an 'obstruction' that impedes left ventricular outflow and which can be relieved by operative intervention. In the first decade after the discovery of HCM (1957-66), the site of 'obstruction' was thought to be a muscular sphincter or contraction ring in the submitral region of the left ventricle, and operations designed to emulate pyloromyectomy (for hypertrophic pyloric stenosis) were developed. Following a challenge to the existence of the 'contraction ring' and an alternative non-obstructive explanation of the pressure gradient, the site of 'obstruction' was translocated to a point of apposition between the anterior mitral leaflet and the interventricular septum, a result of systolic anterior motion (SAM) of the mitral valve. Despite the translocation of the site and mechanism of 'obstruction', the operation for 'relief of obstruction' has not changed significantly. The newer site of 'obstruction' has been challenged on the grounds that the ventricle is not demonstrably impeded in its emptying; when a gradient is provoked, the ventricle empties more rapidly and more completely than it does without a gradient. In addition to a non-obstructive explanation of the gradient, other phenomena thought to be indicative of 'obstruction' can be explained by rapid and complete emptying of the ventricle (cavitary obliteration). Since the morbidity and mortality of symptomatic HCM patients without pressure gradients may exceed that of patients with pressure gradients, it is suggested that 'obstruction' may be unimportant in the pathophysiology of HCM and attention should be focused on abnormal diastolic function and life threatening arrhythmias. Images Figure 4 Figure 8b PMID:3534838

  10. Bladder distention and pyelectasis in the male fetus: causes, comparisons, and contrasts.

    PubMed

    Montemarano, H; Bulas, D I; Rushton, H G; Selby, D

    1998-12-01

    The objective of this paper was to determine if prenatal sonographic findings can accurately differentiate between the causes of bladder distention and pyelectasis in the male fetus. Twenty-one cases were evaluated for the presence of oligohydramnios, posterior urethral dilation, bladder wall thickening, urachal patency, cortical thinning, cortical cysts, and increased renal echogenicity. Postnatal diagnosis included posterior urethral valves (10 cases), prune belly syndrome (four cases), vesicoureteral reflux (four cases), left ureterovesical junction obstruction (one case), and nonrefluxing, nonobstructive megacystis-megaureter (two cases). Oligohydramnios was present in eight of 10 cases of posterior urethral valves and in one of four cases of prune belly syndrome. A dilated posterior urethra was noted in seven of 10 cases of posterior urethral valves and transiently in two of four cases of prune belly syndrome. Bladder wall thickening developed in all cases of posterior urethral valves and was noted in two of four patients with prune belly syndrome. A patent urachus likewise was identified in two of four cases of prune belly syndrome. The presence of oligohydramnios, progressive bladder wall thickening, and dilated posterior urethra was most suggestive of posterior urethral valves, whereas the presence of a patent urachus was most suggestive of prune belly syndrome. The presence of pyelectasis and megacystis without additional amniotic fluid, bladder, urethral, or renal abnormalities was most suggestive of vesicoureteral reflux, ureterovesical junction obstruction, or nonrefluxing, nonobstructive megacystis-megaureter. Owing to the overlap and evolution of these findings, close follow-up evaluation is recommended. PMID:9849946

  11. Immunotherapy for bladder cancer

    PubMed Central

    Fuge, Oliver; Vasdev, Nikhil; Allchorne, Paula; Green, James SA

    2015-01-01

    It is nearly 40 years since Bacillus Calmette–Guérin (BCG) was first used as an immunotherapy to treat superficial bladder cancer. Despite its limitations, to date it has not been surpassed by any other treatment. As a better understanding of its mechanism of action and the clinical response to it have evolved, some of the questions around optimal dosing and treatment protocols have been answered. However, its potential for toxicity and failure to produce the desired clinical effect in a significant cohort of patients presents an ongoing challenge to clinicians and researchers alike. This review summarizes the evidence behind the established mechanism of action of BCG in bladder cancer, highlighting the extensive array of immune molecules that have been implicated in its action. The clinical aspects of BCG are discussed, including its role in reducing recurrence and progression, the optimal treatment regime, toxicity and, in light of new evidence, whether or not there is a superior BCG strain. The problems of toxicity and non-responders to BCG have led to development of new techniques aimed at addressing these pitfalls. The progress made in the laboratory has led to the identification of novel targets for the development of new immunotherapies. This includes the potential augmentation of BCG with various immune factors through to techniques avoiding the use of BCG altogether; for example, using interferon-activated mononuclear cells, BCG cell wall, or BCG cell wall skeleton. The potential role of gene, virus, or photodynamic therapy as an alternative to BCG is also reviewed. Recent interest in the immune check point system has led to the development of monoclonal antibodies against proteins involved in this pathway. Early findings suggest benefit in metastatic disease, although the role in superficial bladder cancer remains unclear. PMID:26000263

  12. Immunotherapy for bladder cancer.

    PubMed

    Fuge, Oliver; Vasdev, Nikhil; Allchorne, Paula; Green, James Sa

    2015-01-01

    It is nearly 40 years since Bacillus Calmette-Guérin (BCG) was first used as an immunotherapy to treat superficial bladder cancer. Despite its limitations, to date it has not been surpassed by any other treatment. As a better understanding of its mechanism of action and the clinical response to it have evolved, some of the questions around optimal dosing and treatment protocols have been answered. However, its potential for toxicity and failure to produce the desired clinical effect in a significant cohort of patients presents an ongoing challenge to clinicians and researchers alike. This review summarizes the evidence behind the established mechanism of action of BCG in bladder cancer, highlighting the extensive array of immune molecules that have been implicated in its action. The clinical aspects of BCG are discussed, including its role in reducing recurrence and progression, the optimal treatment regime, toxicity and, in light of new evidence, whether or not there is a superior BCG strain. The problems of toxicity and non-responders to BCG have led to development of new techniques aimed at addressing these pitfalls. The progress made in the laboratory has led to the identification of novel targets for the development of new immunotherapies. This includes the potential augmentation of BCG with various immune factors through to techniques avoiding the use of BCG altogether; for example, using interferon-activated mononuclear cells, BCG cell wall, or BCG cell wall skeleton. The potential role of gene, virus, or photodynamic therapy as an alternative to BCG is also reviewed. Recent interest in the immune check point system has led to the development of monoclonal antibodies against proteins involved in this pathway. Early findings suggest benefit in metastatic disease, although the role in superficial bladder cancer remains unclear. PMID:26000263

  13. Percutaneous Transhepatic Venous Angioplasty and Stenting in a 9-Month-Old Patient with Hepatic Vein Obstruction After Partial Liver Transplantation

    SciTech Connect

    Rasekhi, A. R.; Nabavizadeh, S. A.; Malek-Hosseini, S. A.; Varedi, P.; Naderifar, M.; Soltani, S.

    2008-09-15

    Hepatic venous outflow obstruction is a rare but serious complication after liver transplantation. We report ultrasound-guided percutaneous transhepatic stent placement in a 9-month-old infant with a left lateral split liver transplantation with near-complete hepatic vein obstruction.

  14. The ionospheric outflow feedback loop

    NASA Astrophysics Data System (ADS)

    Moore, T. E.; Fok, M.-C.; Garcia-Sage, K.

    2014-08-01

    Following a long period of observation and investigation beginning in the early 1970s, it has been firmly established that Earth's magnetosphere is defined as much by the geogenic plasma within it as by the geomagnetic field. This plasma is not confined to the ionosphere proper, defined as the region within a few density scale heights of the F-region plasma density peak. Rather, it fills the flux tubes on which it is created, and circulates throughout the magnetosphere in a pattern driven by solar wind plasma that becomes magnetically connected to the ionosphere by reconnection through the dayside magnetopause. Under certain solar wind conditions, plasma and field energy is stored in the magnetotail rather than being smoothly recirculated back to the dayside. Its release into the downstream solar wind is produced by magnetotail disconnection of stored plasma and fields both continuously and in the form of discrete plasmoids, with associated generation of energetic Earthward-moving bursty bulk flows and injection fronts. A new generation of global circulation models is showing us that outflowing ionospheric plasmas, especially O+, load the system in a different way than the resistive F-region load of currents dissipating energy in the plasma and atmospheric neutral gas. The extended ionospheric load is reactive to the primary dissipation, forming a time-delayed feedback loop within the system. That sets up or intensifies bursty transient behaviors that would be weaker or absent if the ionosphere did not “strike back” when stimulated. Understanding this response appears to be a necessary, if not sufficient, condition for us to gain accurate predictive capability for space weather. However, full predictive understanding of outflow and incorporation into global simulations requires a clear observational and theoretical identification of the causal mechanisms of the outflows. This remains elusive and requires a dedicated mission effort.

  15. Chemoprevention of bladder cancer.

    PubMed

    Kamat, Ashish M; Lamm, Donald L

    2002-02-01

    The data presented herein, although highly supportive for a protective role of various nutrients against bladder cancer, are far from definitive. Many authorities question the validity of current recommendations for nutritional chemoprevention against bladder cancer. The reason for the wide variations reported in epidemiologic studies lies in the nature of observational studies. Dietary studies are limited in their conclusions because the protection afforded by the consumption of a particular nutrient may be multifactorial, with different components of the food exerting potential chemopreventive effects. Furthermore, measuring levels of nutrients in the food intake of populations is confounded by factors that might affect these levels and also the incidence of cancer. For example, vitamin A can come from animal or vegetarian sources. Because animal fat has been identified as a potential carcinogen in man, depending on the source of the vitamin, varying levels of protection might be deduced. In addition, chemoprevention studies using dietary supplements are expected to have mild effects, and large studies would be required to confirm statistical significance. Even with agents such as intravesical chemotherapy, only half the studies achieve statistical significance [29]. Prospective randomized trials with a large sample size, longer follow-up, and an extended duration of treatment are needed to clarify the association between micronutrients and cancer protection. With these caveats in mind, several recommendations can be made. Simple measures, such as drinking more fluids (especially water), can have a profound impact on the incidence of bladder cancer. Vitamins are being extensively studied in chemopreventive trials for different cancers. There is strong evidence for a chemoprotective effect of vitamin A in bladder cancer. The authors recommend 32,000 IU/day of vitamin A initially, with lower doses (24,000 IU) for persons less than 50 kg. Because liver toxicity is a

  16. Ultrafast Outflows: Galaxy-scale Active Galactic Nucleus Feedback

    NASA Astrophysics Data System (ADS)

    Wagner, A. Y.; Umemura, M.; Bicknell, G. V.

    2013-01-01

    We show, using global three-dimensional grid-based hydrodynamical simulations, that ultrafast outflows (UFOs) from active galactic nuclei (AGNs) result in considerable feedback of energy and momentum into the interstellar medium (ISM) of the host galaxy. The AGN wind interacts strongly with the inhomogeneous, two-phase ISM consisting of dense clouds embedded in a tenuous, hot, hydrostatic medium. The outflow floods through the intercloud channels, sweeps up the hot ISM, and ablates and disperses the dense clouds. The momentum of the UFO is primarily transferred to the dense clouds via the ram pressure in the channel flow, and the wind-blown bubble evolves in the energy-driven regime. Any dependence on UFO opening angle disappears after the first interaction with obstructing clouds. On kpc scales, therefore, feedback by UFOs operates similarly to feedback by relativistic AGN jets. Negative feedback is significantly stronger if clouds are distributed spherically rather than in a disk. In the latter case, the turbulent backflow of the wind drives mass inflow toward the central black hole. Considering the common occurrence of UFOs in AGNs, they are likely to be important in the cosmological feedback cycles of galaxy formation.

  17. ULTRAFAST OUTFLOWS: GALAXY-SCALE ACTIVE GALACTIC NUCLEUS FEEDBACK

    SciTech Connect

    Wagner, A. Y.; Umemura, M.; Bicknell, G. V.

    2013-01-20

    We show, using global three-dimensional grid-based hydrodynamical simulations, that ultrafast outflows (UFOs) from active galactic nuclei (AGNs) result in considerable feedback of energy and momentum into the interstellar medium (ISM) of the host galaxy. The AGN wind interacts strongly with the inhomogeneous, two-phase ISM consisting of dense clouds embedded in a tenuous, hot, hydrostatic medium. The outflow floods through the intercloud channels, sweeps up the hot ISM, and ablates and disperses the dense clouds. The momentum of the UFO is primarily transferred to the dense clouds via the ram pressure in the channel flow, and the wind-blown bubble evolves in the energy-driven regime. Any dependence on UFO opening angle disappears after the first interaction with obstructing clouds. On kpc scales, therefore, feedback by UFOs operates similarly to feedback by relativistic AGN jets. Negative feedback is significantly stronger if clouds are distributed spherically rather than in a disk. In the latter case, the turbulent backflow of the wind drives mass inflow toward the central black hole. Considering the common occurrence of UFOs in AGNs, they are likely to be important in the cosmological feedback cycles of galaxy formation.

  18. A rare case of obstructive azoospermia due to compression of the seminal vesicle and ejaculatory duct by a large lower ureteric stone.

    PubMed

    Ranjan, Priyadarshi; Yadav, Abhishek; Kapoor, Rohit; Singh, Ranjana

    2013-03-01

    Male infertility due to obstructive azoospermia is a well-known entity. It is characterised by obstruction to the outflow of sperms either in the epididymis, vas, seminal vesicles or the ejaculatory ducts. We describe a rare case of obstructive azoospermia due to compression of the ejaculatory duct and seminal vesicle by a large lower ureteric stone in a 30-year-old man who had infertility for the past ten years. The patient's azoospermia resolved after removal of the stone. PMID:23546036

  19. Outflows in Sodium Excess Objects

    NASA Astrophysics Data System (ADS)

    Park, Jongwon; Jeong, Hyunjin; Yi, Sukyoung K.

    2015-08-01

    Van Dokkum and Conroy revisited the unexpectedly strong Na i lines at 8200 Å found in some giant elliptical galaxies and interpreted them as evidence for an unusually bottom-heavy initial mass function. Jeong et al. later found a large population of galaxies showing equally extraordinary Na D doublet absorption lines at 5900 Å (Na D excess objects: NEOs) and showed that their origins can be different for different types of galaxies. While a Na D excess seems to be related to the interstellar medium (ISM) in late-type galaxies, smooth-looking early-type NEOs show little or no dust extinction and hence no compelling signs of ISM contributions. To further test this finding, we measured the Doppler components in the Na D lines. We hypothesized that the ISM would have a better (albeit not definite) chance of showing a blueshift Doppler departure from the bulk of the stellar population due to outflow caused by either star formation or AGN activities. Many of the late-type NEOs clearly show blueshift in their Na D lines, which is consistent with the former interpretation that the Na D excess found in them is related to gas outflow caused by star formation. On the contrary, smooth-looking early-type NEOs do not show any notable Doppler components, which is also consistent with the interpretation of Jeong et al. that the Na D excess in early-type NEOs is likely not related to ISM activities but is purely stellar in origin.

  20. Bladder Injury During Cesarean Delivery

    PubMed Central

    Tarney, Christopher M.

    2013-01-01

    Cesarean section is the most common surgery performed in the United States with over 30% of deliveries occurring via this route. This number is likely to increase given decreasing rates of vaginal birth after cesarean section (VBAC) and primary cesarean delivery on maternal request, which carries the inherent risk for intraoperative complications. Urologic injury is the most common injury at the time of either obstetric or gynecologic surgery, with the bladder being the most frequent organ damaged. Risk factors for bladder injury during cesarean section include previous cesarean delivery, adhesions, emergent cesarean delivery, and cesarean section performed at the time of the second stage of labor. Fortunately, most bladder injuries are recognized at the time of surgery, which is important, as quick recognition and repair are associated with a significant reduction in patient mortality. Although cesarean delivery is a cornerstone of obstetrics, there is a paucity of data in the literature either supporting or refuting specific techniques that are performed today. There is evidence to support double-layer closure of the hysterotomy, the routine use of adhesive barriers, and performing a Pfannenstiel skin incision versus a vertical midline subumbilical incision to decrease the risk for bladder injury during cesarean section. There is also no evidence that supports the creation of a bladder flap, although routinely performed during cesarean section, as a method to reduce the risk of bladder injury. Finally, more research is needed to determine if indwelling catheterization, exteriorization of the uterus, and methods to extend hysterotomy incision lead to bladder injury. PMID:24876830

  1. Anodized 20 nm diameter nanotubular titanium for improved bladder stent applications

    PubMed Central

    Alpaslan, Ece; Ercan, Batur; Webster, Thomas J

    2011-01-01

    Materials currently used for bladder applications often suffer from incomplete coverage by urothelial cells (cells that line the interior of the bladder and ureter) which leads to the continuous exposure of the underlying materials aggravating an immune response. In particular, a ureteral (or sometimes called an ureteric or bladder) stent is a thin tube inserted into the ureter to prevent or treat obstruction of urine flow from the kidney. The main complications with ureteral stents are infection and blockage by encrustation, which can be avoided by promoting the formation of a monolayer of urothelial cells on the surface of the stent. Nanotechnology (or the use of nanomaterials) may aid in urothelialization of bladder stents since nanomaterials have been shown to have unique surface energetics to promote the adsorption of proteins important for urothelial cell adhesion and proliferation. Since many bladder stents are composed of titanium, this study investigated the attachment and spreading of human urothelial cells on different nanotextured titanium surfaces. An inexpensive and effective scaled up anodization process was used to create equally distributed nanotubular surfaces of different diameter sizes from 20–80 nm on titanium with lengths approximately 500 nm. Results showed that compared to untreated titanium stents and 80 nm diameter nanotubular titanium, 20 nm diameter nanotubular titanium stents enhanced human urothelial cell adhesion and growth up to 3 days in culture. In this manner, this study suggests that titanium anodized to possess nanotubular surface features should be further explored for bladder stent applications. PMID:21499419

  2. A rare urinary bladder tumour

    PubMed Central

    Haddad-Lacle, Judella Edwina Maria; Haddad, Charles Joseph; Villas, Bruce

    2014-01-01

    This case report describes a 54-year-old man who presented to his primary care physician with low back pain. During his workup, an incidental finding of a bladder mass was diagnosed. He underwent transurethral resection of the bladder tumour and the resulting pathology was consistent with extra nodal marginal zone lymphoma of mucosa-associated lymphoid tissue (MALT lymphoma). Presentation of MALT lymphoma in the urinary bladder is rare. This malignancy is more commonly found in the stomach. The prognosis for this rare tumour is excellent. Our patient showed no sign of recurrence with transurethral excision and radiation alone. PMID:24835803

  3. Underactive Bladder in Older Adults.

    PubMed

    Chuang, Yao-Chi; Plata, Mauricio; Lamb, Laura E; Chancellor, Michael B

    2015-11-01

    Overactive bladder is one of the most common bladder problems, but an estimated 20 million Americans have underactive bladder (UAB), which makes going to the bathroom difficult, increases the risk of urinary tract infections, and even leads to institutionalization. This article provides an overview of UAB in older adults, and discusses the prevalence, predisposing factors, cause, clinical investigations, and treatments. At present, there is no effective therapy for UAB. A great deal of work still needs to be done on understanding the pathogenesis and the development of effective therapies. PMID:26476113

  4. Increased bladder permeability in interstitial cystitis/painful bladder syndrome

    PubMed Central

    Greenwood-Van Meerveld, Beverley; Wisniewski, Amy B.; VanGordon, Samuel; Lin, HsuehKung; Kropp, Bradley P.; Towner, Rheal A.

    2015-01-01

    The definition of interstitial cystitis (IC) has evolved over the years from being a well-defined entity characterized by diagnostic lesion (Hunner’s ulcer) in the urothelium to a clinical diagnosis by exclusion [painful bladder syndrome (PBS)]. Although the etiology is unknown, a central theme has been an association with increased permeability of the bladder. This article reviews the evidence for increased permeability being important to the symptoms of interstitial cystitis/painful bladder syndrome (IC/PBS) and in treating the disorder. Recent work showing cross-communication among visceral organs is also reviewed to provide a basis for understanding IC/PBS as a systemic disorder of a complex, interconnected system consisting of the bladder, bowel and other organs, nerves, cytokine-responding cells and the nervous system. PMID:26751576

  5. Bladder neck contracture

    PubMed Central

    Simhan, Jay; Ramirez, Daniel; Morey, Allen F.

    2014-01-01

    Bladder neck contracture (BNC) is a well-described complication of the surgical treatment of benign and malignant prostate conditions. Nevertheless, etiologies of BNC development are highly dependent on the primary treatment modality undertaken with BNC also occurring after pelvic radiation. The treatment options for BNC can range from simple, office-based dilation procedures to more invasive, complex abdomino-perineal reconstructive surgery. Although numerous strategies have been described, a patient-specific approach is usually necessary in the management of these complex patients. In this review, we highlight various therapeutic maneuvers described for the management of BNC and further delineate a tailored approach utilized at our institution in these complicated patients. PMID:26816768

  6. Diagnosis of upper urinary tract obstruction in children: comparison of diuresis renography and pressure flow studies

    SciTech Connect

    Gonzalez, R.; Chiou, R.

    1985-04-01

    A report is given of the use of diuresis renography and pressure flow studies to diagnose urinary tract obstruction in 41 collecting systems of 33 children. If differential pressures between the renal pelvis and the bladder in excess of 22 cm. water at a flow rate of 10 ml. per minute is accepted as evidence of obstruction and below 15 cm. water is accepted as normal the interpretation of the renogram showing O'Reilly's pattern IIIa as evidence of stasis without obstruction was correct in 74 per cent of the cases. Likewise, the interpretation of O'Reilly's renogram pattern IIIb as showing partial obstruction was correct in only 40 per cent of the cases. Thus, the authors urge caution in the use of the diuresis renogram to diagnose or to rule out upper urinary tract obstruction.

  7. Ct2 Bladder Cancer.

    PubMed

    Soloway, Mark S

    2016-09-01

    The patient is an 80-year-old man who presented with gross hematuria. His past medical history indicates he was a cigarette smoker with 50 pack/years. He was successfully treated for carcinoma of the lung 7 years ago. He received chemotherapy, radiation, and surgery. He has mild COPD but has a good performance status. His laboratory studies do not indicate any abnormalities in terms of renal function. He does not have any significant cardiac disease. He has a medium build. He had prostate cancer and underwent a successful radical prostatectomy 10 years ago. His PSA is undetectable. He has some urinary incontinence and wears two pads/day. He underwent the appropriate investigations for gross hematuria. A CT scan of the abdomen and pelvis was normal with the exception of a 4-cm posterior mass in the bladder. There was no hydronephrosis and no enlarged lymph nodes. He underwent a transurethral resection of a solitary bladder tumor performed by another urologist. The tumor was described as large and sessile. It was located on the posterior wall and was approximately 4 cm. The bimanual examination did not reveal a mass. The pathology report stated that the tumor was a high-grade urothelial carcinoma with invasion into the muscularis propria. There was no lymphovascular invasion. I performed a reTURBT, and at that procedure, I did not identify any obvious tumor but the prior resection site was evident. I resected the prior tumor site quite extensively both in depth and width. The pathology revealed only focal carcinoma in situ. There was ample muscle in the specimen and there was some fat as well. As stated, they were free of any cancer. The patient is receptive to any treatment approach. PMID:27457483

  8. Starburst outflows from nearby galaxies

    NASA Technical Reports Server (NTRS)

    Waller, William H.

    1990-01-01

    Starburst outflows from NGC 5461, 1569 and M82 are discussed. The Sc I galaxy, M101, is reknowned for the kpc-size superassociations of star clusters and HII regions that dominate its spiral arms. NGC 5461 is one of the brightest of these superassociations, rivaling the Large Magellanic Cloud in H alpha luminosity. The NGC 5461 superassociation is dominated by a single unresolved HII region of outstanding luminosity (approx. 1000 Orion nebulae). Detailed examination of corresponding continuum images indicates that only the southern plume has any sort of stellar counterpart. The other plumes are clearly diffuse with no underlying hot stars. An image of NGC 1569 is discussed. Besides showing the peculiar arm noted by Zwicky (1971) and the filamentary extensions to the North and South (as noted by Hodge 1974), this image also reveals two arc-like features of diffuse ionized gas to the South. Both arcs are concentric with the bright center of the galaxy - where the super star clusters, A and B are located. The inner arc (Arc 1) appears to follow the same curve as the SW arm thus suggesting that the two features represent limb-brightened fragments of vast superbubble that was blown out by a central starburst sometime in the past. As the classic starburst galaxy, M82 displays all the luminous hallmarks of intense high-mass star formation and outflow activity. The diffuse H alpha and x ray emitting gas along the minor axis provides especially good evidence for a bipolar outflow of hot gas which is shock heating the swept-up interstellar medium (ISM) to temperatures of approx. 10(exp 4) K. An image shows the H alpha emission within the disk and along the minor axis. Another image shows the same field in the light of near-infrared. Both figures are based on charge coupled device images taken with the McGraw-Hill 1.3 m telescope (Waller 1989). The longer wavelength emission clearly shows a more extended morphology along the major axis. The morphological discrepancy is most

  9. Bright crater outflows: Possible emplacement mechanisms

    NASA Technical Reports Server (NTRS)

    Chadwick, D. John; Schaber, Gerald G.; Strom, Robert G.; Duval, Darla M.

    1992-01-01

    Lobate features with a strong backscatter are associated with 43 percent of the impact craters cataloged in Magellan's cycle 1. Their apparent thinness and great lengths are consistent with a low-viscosity material. The longest outflow yet identified is about 600 km in length and flows from the 90-km-diameter crater Addams. There is strong evidence that the outflows are largely composed of impact melt, although the mechanisms of their emplacement are not clearly understood. High temperatures and pressures of target rocks on Venus allow for more melt to be produced than on other terrestrial planets because lower shock pressures are required for melting. The percentage of impact craters with outflows increases with increasing crater diameter. The mean diameter of craters without outflows is 14.4 km, compared with 27.8 km for craters with outflows. No craters smaller than 3 km, 43 percent of craters in the 10- to 30-km-diameter range, and 90 percent in the 80- to 100-km-diameter range have associated bright outflows. More melt is produced in the more energetic impact events that produce larger craters. However, three of the four largest craters have no outflows. We present four possible mechanisms for the emplacement of bright outflows. We believe this 'shotgun' approach is justified because all four mechanisms may indeed have operated to some degree.

  10. Augmentation cystoplasty in neurogenic bladder.

    PubMed

    Çetinel, Bülent; Kocjancic, Ervin; Demirdağ, Çetin

    2016-09-01

    The aim of this review is to update the indications, contraindications, technique, complications, and the tissue engineering approaches of augmentation cystoplasty (AC) in patients with neurogenic bladder. PubMed/MEDLINE was searched for the keywords "augmentation cystoplasty," "neurogenic bladder," and "bladder augmentation." Additional relevant literature was determined by examining the reference lists of articles identified through the search. The update review of of the indications, contraindications, technique, outcome, complications, and tissue engineering approaches of AC in patients with neurogenic bladder is presented. Although some important progress has been made in tissue engineering AC, conventional AC still has an important role in the surgical treatment of refractory neurogenic lower urinary tract dysfunction. PMID:27617312