Hong-Jeng Yu

Stopping smoking might reduce tumour recurrence in nonmuscle-invasive bladder cancer

To evaluate effects of stopping smoking on the outcome of nonmuscle‐invasive bladder cancer, as cigarette smoking is a risk factor for bladder cancer and little is known about whether stopping smoking reduces the risk of recurrence or progression.

Investigation of urodynamic characteristics and bladder sensory function in the early stages of diabetic bladder dysfunction in women with type 2 diabetes.

PURPOSE We studied urodynamic characteristics and bladder sensory function in the early stages of diabetic bladder dysfunction in diabetic women. MATERIALS AND METHODS A total of 86 consecutive type 2 diabetic women with minimal confounders of voiding dysfunction followed at a diabetes clinic were prospectively enrolled and subjected to urodynamic studies. The sensory response of Adelta and C fibers of the bladder was measured by intravesical current perception threshold testing at frequencies of 250 and 5 Hz, respectively. RESULTS Of these 86 women 30 (34.9%) were classified as having detrusor underactivity, 12 (14.0%) presented signs of detrusor overactivity, 11 (12.8%) were referred to as having bladder outlet obstruction and 33 (38.4%) showed normal detrusor function on urodynamics. The normal detrusor function group was the reference group. The detrusor underactivity group showed impaired emptying function and decreased sensation on cystometry and intravesical current perception threshold testing. The detrusor overactivity group showed impaired storage and emptying function but had no significant changes in intravesical current perception threshold values. When the normal detrusor function group and detrusor underactivity group were pooled to perform multivariate analysis, an increase in current perception threshold values was associated with a decrease in bladder voiding efficiency on 5 and 250 Hz current perception threshold testing. CONCLUSIONS Our data provide the electrophysiological evidence that indicates an association between impaired Adelta as well as C fiber bladder afferent pathways and poor emptying function in diabetic women with detrusor underactivity. Diabetes can affect the bladder presumably via peripheral pathogenetic mechanisms to induce detrusor overactivity with impaired contractility.

Hypoxia preconditioning attenuates bladder overdistension‐induced oxidative injury by up‐regulation of Bcl‐2 in the rat

We explored whether hypoxic preconditioning minimizes oxidative injury induced by overdistension/emptying in the rat bladder. For hypoxic preconditioning, female Wistar rats were placed in a hypobaric chamber (380 Torr) 15 h day−1 for 28 days. Overdistension was induced by infusion of two times the threshold volume of saline into the bladder and was maintained for 1 or 2 h, followed by drainage/emptying. During overdistension (ischaemia) and emptying (reperfusion) periods, a bursting increase of reactive oxygen species (ROS) from the bladder was originated from the large numbers of infiltrating leucocytes and scattered resident cells, including urothelial, submucosal, and smooth muscle cells. ROS impaired the voiding function by a reduction of bladder afferent and efferent nerve activity and bethanecol‐ or ATP‐induced detrusor contraction. ROS enhanced pro‐apoptotic mechanisms, including increases in the Bax/Bcl‐2 ratio, CPP32 expression, and poly(ADP‐ribose) polymerase (PARP) fragments with subsequent apoptotic cell formation in the insulted bladders. Hypoxia preconditioning up‐regulated Bcl‐2 expression in the bladder and significantly reduced the levels of ROS and apoptosis detected in the overdistension/emptying bladders and preserved partial voiding function. Bcl‐2 up‐regulation by hypoxia preconditioning contributes protection against overdistension/emptying‐induced oxidative stress and injury in the bladder.

Metabolic Syndrome Components Worsen Lower Urinary Tract Symptoms in Women with Type 2 Diabetes

CONTEXT Diabetic women are more susceptible to develop lower urinary tract symptoms (LUTS), especially overactive bladder (OAB). However, data regarding the effect of components of metabolic syndrome (MS) on this association are conflicting. OBJECTIVE The objective of the study was to examine the potential role of MS in the development of LUTS in diabetic women. DESIGN The study was a prevalence study conducted between 2005 and 2007. SETTING The study was conducted in a university hospital. PARTICIPANTS A total of 518 women with type 2 diabetes aged 50-75 yr were included. They were subgrouped as MS (47.5%) and non-MS (52.5%) groups according to whether they fulfilled the criteria of MS. MAIN OUTCOME MEASURE We used American Urological Association Symptom Index (AUA-SI) to evaluate LUTS and Indevus Urgency Severity Scale to evaluate OAB, respectively. RESULTS Women in the MS group had significantly higher storage and total AUA-SI scores as well as a higher prevalence of LUTS and OAB. Most intriguingly, the number of MS components was strongly associated with the LUTS severity because the AUA-SI scores increased in parallel to the number of components were present. Similar results were found between MS and OAB. Multivariate analysis revealed that peripheral neuropathy, but not MS, significantly predicted LUTS in diabetic women after age adjustment. However, MS remained significantly predictive for LUTS and OAB after additional adjustment for neuropathy. CONCLUSIONS Our results suggest that MS may especially influence LUTS and OAB in diabetic women, probably by compounding the effect of peripheral neuropathy.

Quality of life impact and treatment seeking of Chinese women with urinary incontinence

The objective of this study was to investigate the quality of life (QOL) impact of urinary incontinence (UI) and to examine its relationship with treatment seeking in adult Taiwanese women. We conducted a cross-section in-person questionnaire interview of 1608 adult women living in the Taipei area. The characteristics and incontinence status were recorded. A short form incontinence impact questionnaire (IIQ-7) was used to evaluate the QOL impact of UI. Multiple logistic regression analysis was used to assess the determinative factors for treatment seeking. The mean IIQ-7 score of the 205 (12.7%) women who reported urinary leakage more than once per month in the preceding 12 months was 5.0 (range: 0–19), which showed a significant correlation with the severity of incontinence (r = 0.59, p < 0.001). Women with mixed type UI had a higher IIQ-7 score compared to those with stress or urge UI. Fifty-five (26.8%) incontinent women had sought medical help. Treatment seeking was highly related to IIQ-7 scores as 75% of incontinent women with an IIQ-7 score > 10 in contrast to 5% of those with an IIQ-7 score ≤ (p < 0.001) had sought medical care. On multiple logistic regression analysis, perceiving UI as a disease and a higher IIQ-7 score were independent factors predicting treatment seeking. We concluded that UI is a common problem that brings substantial QOL impact to Taiwanese women. The IIQ-7 questionnaire may provide a useful measurement to quantitate the degree of QOL impact, which is largely affected by the severity and type of incontinence. Women who perceive UI as a disease and those with a higher degree of QOL impact are more likely to seek medical help. Furthermore, treatment seeking in Taiwanese women with significant UI may be more common than thought as a great majority of women with higher IIQ-7 scores had sought medical help.

Neural mechanisms of impaired micturition reflex in rats with acute partial bladder outlet obstruction

To determine the contribution of neural elements to micturition, we evaluated, in intact rats, the cystometrogram, pelvic afferent nervous activity, pelvic efferent nervous activity and external urethral sphincter-electromyogram activity in the normal and acute partial bladder outlet obstruction states. In the normal state, in response to saline filling, mechanoreceptor-dependent pelvic afferent nervous activity gradually activated and finally triggered a voiding reflex, including four phases of detrusor contractions. Phase 1 was characterized by an initial rising intravesical pressure, Phase 2 was characterized by a series of high-frequency oscillations in intravesical pressure, Phase 3 contraction was characterized by a rebound intravesical pressure and Phase 4 contraction was characterized by a rapid fall in intravesical pressure. In the acute partial bladder outlet obstruction state, Phase 1 contraction rose and high-frequency oscillations fell in Phase 2. This voiding dysfunction is ascribed to the bursting extraurethral sphincter activity being converted to tonic extraurethral sphincter activity. In summary, the suppressed high-frequency oscillations in Phase 2 of the detrusor muscle contraction could be detrimental to efficient voidings in the acute partial bladder outlet obstructed rat.

Bladder Dysfunction in Rats With Metabolic Syndrome Induced by Long-Term Fructose Feeding

PURPOSE We studied the effects of long-term fructose feeding and metabolic perturbations on bladder function in rats. MATERIALS AND METHODS Female Wistar rats were fed a fructose enriched (60%) or control diet for 3 and 6 months. In vitro contractile responses to electrical field stimulation, KCl, carbachol and adenosine triphosphate, and in vivo cystometry were used to evaluate bladder function. Tissue staining and electron microscopy were also performed to evaluate the structural changes in rats subjected to metabolic syndrome. Biochemical and physiological data were compared between fructose fed rats and age matched controls. RESULTS All rats fed a fructose enriched diet for 3 months showed insulin resistance, hyperinsulinemia, hypertriglyceridemia and hypertension. These fructose fed rats showed a decreased contractile response to high concentrations of KCl but not to other parameters tested compared to controls. Eight of the 12 rats (66.7%) showed abnormal cystometry, mainly by increased phasic contractions. In 6-month fructose fed rats contractile responses to electrical field stimulation, KCl and carbachol were decreased significantly. However, responsiveness to high concentrations of adenosine triphosphate was significantly increased. Morphological studies in fructose fed rats showed swollen mitochondria in bladder smooth muscle, increased leukocyte infiltration between interstitial tissue and neutrophil adhesion around the endothelium of vessels. CONCLUSIONS Our data show that a significant proportion of fructose fed rats show time related alterations in bladder biochemical, morphological and functional properties. The proinflammation and myopathy of the bladder induced by metabolic perturbations have important roles in causing bladder dysfunction.

Non-inferiority of silodosin to tamsulosin in treating patients with lower urinary tract symptoms (LUTS) associated with benign prostatic hyperplasia (BPH)

Study Type – Therapy (RCT)

Overactive Bladder Syndrome among Community-Dwelling Adults in Taiwan: Prevalence, Correlates, Perception, and Treatment Seeking

Purpose: We investigated the prevalence, correlates, perception of overactive bladder syndrome (OAB) and doctor-consultation behavior among community adults. Subjects and Methods: This urological survey was part of a government-supported health utilization project conducted in Matsu, Taiwan. Participants (n = 1,827) completed a questionnaire collecting information on OAB, which was defined as urgency with either frequency or nocturia. Results: The age-adjusted prevalence of OAB was 16.9%, including 4.5% with urge incontinence. Age (p = 0.002), diabetes (p = 0.03), and benign prostatic hyperplasia (p < 0.001) in men, whereas diabetes (p = 0.01), hyperlipidemia (p = 0.03), stress incontinence (p < 0.001), and recurrent lower urinary tract infections (p = 0.02) in women were factors independently associated with OAB. Most people with OAB (69.0%) perceived little bother; only 13.0% had consulted doctors for this problem. Conclusion: Symptoms related to OAB are common among community-dwelling adults, yet most perceive it as a minor problem. Our results identify several factors that are significantly associated with OAB.

Changes in endogenous monoamines in aged rats.

1. It has been documented that ageing may alter endogenous neurotransmitters. However, these results are controversial. Thus, in the present study, cerebral cortex and plasma from male Wistar rats aged 8 weeks and 6, 12 or 24 months were used to investigate the changes in monoamines using electrochemical detection.