Mark Nigro

Laboratory variables of bladderautoaugmentation in an animal model

Abstract Objectives Evaluations of the functional, radiologic, and pathologic outcomes of autoaugmentation by two surgical techniques (vesicomyectomy versus vesicomyotomy) were compared. Autoaugmentation or vesicomyotomy is being increasingly considered as a simplified method of bladder augmentation in the hypertonic decreased-capacity bladder. Methods In a series of 35 laboratory sessions, creation of an animal model approximatingthe small-capacity hypertonic bladder was achieved. Sixteen vesicomyotomies and 16 vesicomyectomies were performed on the 32 stabilized one-third reduced bladders. Three stabilized one-third reduced bladders were used as controls. Results Radiologic studies show a large diverticulum. A 17.2% net increase in surface area was achieved, compared with the reduced bladder, at the time of pathologic examination. Functional capacity was increased by 43.5% on urodynamic studies, and leak point pressure was decreased by 48.1 %. Histologic and morphometric examinations of the autoaugmentation area showed a few muscle fibers with serosal deposition of collagen. There was less muscle ingrowth at the periphery of the autoaugmentation site utilizing vesicomyectomy. Conclusions There was no statistical difference between vesicomyotomy and vesicomyectomywith respect to radiologic, pathologic, or urodynamic outcome.

Congenital Obstructive Uropathy and Nodular Renal Blastema

The occurrence of nodular renal blastema and renal dysplasia was determined in a retrospective study of 75 cases of congenital obstructive uropathy. Nodular renal blastema was present in 3 upper pole nephrectomy specimens removed as a consequence of nonfunction owing to ectopic ureterocele; none was dysplastic. A more differentiated type of nodular renal blastema was present in 3 other total nephrectomy specimens, bilateral involvement in a case of posterior urethral valves and unilateral nodular renal blastema associated with ureteral atresia. This subset of differentiated nodular renal blastema was associated with renal dysplasia.

A systematic review and comparison of questionnaires in the management of spinal cord injury, multiple sclerosis and the neurogenic bladder

Validated questionnaires are increasingly the preferred method used to obtain historical information. Specialized questionnaires exist validated for patients with neurogenic disease including neurogenic bladder. Those currently available are systematically reviewed and their potential for clinical and research use are described.

Monitoring of lower urinary tract function in patients with spinal cord injury using near infrared spectroscopy

Background: One of the most important conditions where there is loss of normal bladder function is spinal cord injury (SCI). Currently, evaluation of bladder function is limited to periodic invasive urodynamic testing (UDS). The purpose of this study was to assess the feasibility and usefulness of near-infrared spectroscopy (NIRS) in monitoring bladder function in patients with SCI during bladder filling and emptying and to investigate the correlations of NIRS measures with simultaneous UDS parameters. NIRS is a non-invasive optical method to study tissue oxygenation, hemodynamics and function by monitoring changes in the chromophore concentrations of oxygenated (O2Hb), deoxygenated (HHb) and total hemoglobin (tHb). Methods: 10 adult paraplegic patients with neurogenic bladder dysfunction who were referred for regular urodynamic evaluation were recruited. Changes in O2Hb, HHb and tHb, and tissue saturation index (TSI%) in the detrusor were monitored and recorded by a wireless NIRS system during the urodynamic evaluation. Time points of urgency and urinary leakage were marked and patterns of change in NIRS parameters were compared to standard urodynamic pressure tracings. Results: Strong consistency between changes in NIRS-derived tHb and changes in intravesical pressure were observed during filling across the subjects. During bladder filling a gradual increase in O2Hb and tHb with minimal changes in HHb was observed. Interestingly, a drop in TSI% was detected seconds before strong urgency and urinary leakage. Conclusions: Our preliminary data suggest a relationship between noninvasive NIRS measures and UDS parameters during bladder filling in SCI patients.

Optical diagnosis of lower urinary tract infection: A pilot study in children

UNLABELLED Conventionally, diagnosis of lower urinary tract infection (LUTI) is made on the basis of history, urine microscopy and culture. But there are limitations to this methodology especially in children and special populations where there is difficulty in obtaining a full history and details of clinical symptoms. The aim of this study was to determine if monitoring bladder wall oxygenation as a measure of bladder mucosal inflammation using transcutaneous near-infrared spectroscopy (NIRS) allows detection of the presence or absence of LUTI in children. MATERIALS AND METHODS A convenience sample of children referred to a pediatric urology clinic with an acute LUTI and a control group were studied. Diagnosis was confirmed by history, physical examination, laboratory investigations, and urine culture. Participants had transcutaneous measurement of an absolute measure of tissue oxygen saturation (TSI%) in their bladder wall, and a quadriceps muscle control site, using a spatially resolved (SR) wireless NIRS device. Average measures of bladder wall TSI% (B.TSI%) and quadriceps TSI% (Q.TSI%) and their differences (TSI.diff) were calculated and compared between those with LUTI and controls by performing a two-way repeated analysis of variance. RESULTS Thirty-four patients met the inclusion criteria (LUTI n = 12 and controls n = 22). Comparing LUTI to controls B.TSI% and TSI.diff values were significantly higher in the LUTI group (p < 0.0001), while Q.TSI% values were not significantly different. CONCLUSIONS Optical monitoring of bladder wall oxygenation is feasible in children. In this study a significant difference was evident in a SR NIRS-derived measure of absolute oxygen saturation in the bladder wall between children with UTI diagnosed by conventional testing methods, and those in a control group without infection. SR-NIRS monitoring of bladder wall oxygenation may offer a rapid and non-invasive means of bedside screening for LUTI where history and/or clinical signs are not available or adequate.

Optical monitoring of testicular torsion using a miniaturized near infrared spectroscopy sensor

Background: Testicular torsion is an acute urological emergency occurring in children and adolescents. Accurate and fast diagnosis is important as the resulting ischemia can destroy the testis. Currently, Doppler ultrasound is the preferred diagnostic method. Ultrasound is not readily available in all centers which may delay surgical treatment. In this study, a rat model was used to examine the feasibility and sensitivity of using spatially-resolved near infrared spectroscopy (SR-NIRS) with a custom-made miniaturized optical sensor probe to detect and study changes in testicular hemodynamics and oxygenation during three degrees of induced testicular torsion, and after detorsion. Methods: Eight anesthetized rats (16 testes) were studied using SR-NIRS with the miniaturized optical probe applied directly onto the surface of the surgically exposed testis during 360, 720 and 1080 degrees of torsion followed by detorsion. Oxygenated, deoxygenated and total hemoglobin and TOI% were studied pre-and post-manipulations. Results: NIRS monitoring reflected acute testicular ischemia and hypoxia on induction of torsion, and tissue reperfusionreoxygenation after detorsion. Testicular torsion at 720 degrees induced the maximum observed degree of hypoxic changes. In all cases, rhythmic changes were observed in the NIRS signals before inducing torsion; these disappeared after applying 360 degrees of torsion and did not reappear after detorsion. Conclusion: This animal study indicates that SR-NIRS monitoring of the testes using a directly applied miniature sensor is a feasible and sensitive method to detect testicular ischemia and hypoxia immediately after torsion occurs, and testicular reperfusion upon detorsion. This study offers the potential for a SR-NIRS system with a miniaturized sensor to be explored further as a rapid, noninvasive, optical method for detecting testicular torsion in children.

Optical monitoring of kidney oxygenation and hemodynamics using a miniaturized near-infrared sensor

Background: Following human renal allograft transplant primary graft dysfunction can occur early in the postoperative period as a result of acute tubular necrosis, acute rejection, drug toxicity, and vascular complications. Successful treatment of graft dysfunction requires early detection and accurate diagnosis so that disease-specific medical and/or surgical intervention can be provided promptly. However, current diagnostic methods are not sensitive or specific enough, so that identifying the cause of graft dysfunction is problematic and often delayed. Near-infrared spectroscopy (NIRS) is an established optical method that monitors changes in tissue hemodynamics and oxygenation in real time. We report the feasibility of directly monitoring kidney the kidney in an animal model using NIRS to detect renal ischemia and hypoxia. Methods: In an anesthetized pig, a customized continuous wave spatially resolved (SR) NIRS sensor was fixed directly to the surface of the surgically exposed kidney. Changes in the concentration of oxygenated (O2Hb) deoxygenated (HHb) and total hemoglobin (THb) were monitored before, during and after renal artery clamping and reperfusion, and the resulting fluctuations in chromophore concentration from baseline used to measure variations in renal perfusion and oxygenation. Results: On clamping the renal artery THb and O2Hb concentrations declined progressively while HHb rose. With reperfusion after releasing the artery clamp O2Hb and THb rose while HHb fell with all parameters returning to its baseline. This pattern was similar in all three trials. Conclusion: This pilot study indicates that a miniaturized NIRS sensor applied directly to the surface of a kidney in an animal model can detect the onset of renal ischemia and tissue hypoxia. With modification, our NIRS-based method may contribute to early detection of renal vascular complications and graft dysfunction following renal transplant.

Long-Term Urologic Evaluation Following Spinal Cord Injury

Spinal cord injury (SCI) has significant long-term urologic consequences that impact quality of life (QOL) and can influence life expectancy. Neurogenic bladder, urinary tract infections, and autonomic dysreflexia are common consequences of SCI. It is essential to conduct a focused patient interview to address these consequences. History should include a basic assessment of the patient and symptomatology as per a validated instrument, as well as a detailed urologic diary. The physical examination should include evaluation of the extent of the neurologic injury as per the American Spinal Association Injury (ASIA) scale, the affected system as well as examination maneuvers done in those without neurologic injury. Investigations should include urodynamic testing and cystoscopy. In managing patients with SCI, pharmaceutical agents and intermittent catheterization are utilized normally in an effort to protect the upper urinary tract, achieve and maintain urinary continence, and optimize lower urinary tract function and quality of life (QOL).

MP20-06 OPTICAL MONITORING OF DETRUSOR TISSUE OXYGEN SATURATION IN ACUTE LOWER URINARY TRACT INFECTION: A CASE CONTROL COMPARISON

RESULTS: MN increased cell activity of MSC in vitro. Bladder histological evaluation revealed polymorphological inflammatory cell infiltration and increase in inflammatory and protect of damaged urothelium(Fig) and cytokines in urine and the tissue and MPO in urine. h-MSC and h-MSC with MN were homing in interstitialis of bladder of nude rats(Fig). Evans blue over absorption in the bladder wall were decreased in MSC and MSC with MN treated rats. These findings, which were associated with urothelial injury and increased permeability. Cystometrogram demonstrated that the intercontraction interval were shorter in MSC and MSC with MN treated rats furhthermore. CONCLUSIONS: MSC and MSC with MN accelerated via multiple cytokines suppressive effects for excess cytokines the repair of damaged urothelium, protected urothelial barrier function and suppressed bladder overactivity and nociception respectively.

Optical diagnosis of acute scrotum in children

Acute scrotum is a urologic condition defined by scrotal pain, swelling, and redness of acute onset. Prompt diagnosis and treatment are necessary to preserve testicular viability. The history and clinical symptoms reported are key to diagnosis and proper treatment, but are not always readily obtained in children, in whom common causes of acute scrotum include testicular torsion, torsion of the appendix testis, and epididymitis. These acute conditions have different causal pathology that mandate specific treatment, hence the importance of early and accurate diagnosis.