Myung-Soo Choo

Effects of flexible-dose fesoterodine on overactive bladder symptoms and treatment satisfaction: an open-label study.

Aims:  To evaluate the efficacy and tolerability of flexible‐dose fesoterodine in subjects with overactive bladder (OAB) who were dissatisfied with previous tolterodine treatment.

Tolterodine: As effective but better tolerated than oxybutynin in Asian patients with symptoms of overactive bladder

Background: This double‐blind, multicenter study compared the efficacy and tolerability of tolterodine (Pharmacia, Los Angeles, USA) with that of oxybutynin (Alza, Palo Alto, USA) in Asian patients with overactive bladder.

Health-related quality of life and sexual function in women with stress urinary incontinence and overactive bladder

Background:  We evaluated the impact of stress urinary incontinence (SUI) and overactive bladder (OAB) on health‐related quality of life (HRQOL) and sexual function.

Characterization of iridium film as a stimulating neural electrode

Iridium films having near-bulk properties were formed by electron-beam evaporation with simultaneous bombardment of Ar ion beam. The charge-injection capabilities of Ir film were investigated, and the detrusor pressure induced by S2 stimulation with Ir-coated Pt electrode was measured and compared with the uncoated Pt electrode. The charge densities of Ir film were continuously increased with increase in the number of cycles in 0.1 M H2SO4 due to the accumulation of the iridium oxide phase. The iridium oxide formed contained nano-pores, and oxides had different dielectric properties. The Ir film could inject various amounts of charge in physiological solution under the identical stimulating condition depending on the degree of activation in 0.1 M H2SO4. S2 stimulation by Ir-coated Pt electrode caused more efficient bladder contraction of the male dog than the uncoated Pt electrode under the identical stimulus condition.

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

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.

The efficacy of transurethral resection of the prostate in the patients with weak bladder contractility index.

OBJECTIVES We evaluated the effect of transurethral resection of the prostate (TUR-P) in men with weak bladder contractility who were unresponsive to medical treatment. METHODS Among the patients who underwent TUR-P for lower urinary tract symptoms at our institution, we reviewed the records of consecutive 71 patients who had preoperative urodynamic evaluations. According to the bladder outlet obstruction index and the bladder contractility index, the patients were divided into 2 groups: group A (25 patients) with unobstructed and weak bladder contractility, and group B (46 patients) with obstructed and/or normal bladder contractility. We investigated the differences of International Prostate Symptom Score (IPSS), quality of life (QoL), maximum flow rate (Q(max)), postvoid residuals (PVR), and the patient subjective satisfaction between the 2 groups after the TUR-P. RESULTS Mean follow-up period after TUR-P was 19 months (range 12 to 55 months). After the TUR-P, the IPSS/QoL, and PVR were significantly improved in group A and all parameters in group B. Patients in group B showed a more significant improvement with regard to the IPSS and they were more satisfied after the TUR-P than group A. CONCLUSIONS There were significant improvements in IPSS/QoL and PVR after TUR-P in patients with weak bladder contractility and more than 60% were satisfied with the results of the surgery. TUR-P is considered an optional procedure for the treatment of men with weak bladder contractility who are unresponsive to medical treatment.

Prevalence of urinary incontinence in Korean women: results of a National Health Interview Survey

ObjectivesWe determined the prevalence and types of urinary incontinence (UI) in Korean women and analyzed their attitude toward treatment.MethodsThis national survey was conducted as part of the Korean National Health Interview Survey to evaluate the prevalence of UI in Korean women between April and June 2005. In 13,345 Korean households, 13,484 women aged 19 years or older were interviewed by census takers. The subjects were asked about the type of UI that they had experienced and their treatment. UI was classified as “stress,” “urge,” “mixed” (stress and urge), or “other.”ResultsThe overall prevalence of UI in the subjects was 24.4%. Of those women, 48.8% reported stress UI only; 7.7%, urge UI only; 41.6%, mixed UI; and 1.9%, other type of UI. The prevalence of UI increased with age. Only 12.6% of the women with UI had sought medical care, and only 0.8% had undergone surgery for UI. Self-reported depression was higher in women with UI than in those without that disorder, and UI was more prevalent in women who were married, unemployed, and undereducated. According to national population data estimated by weighted UI numbers, about 4.2 million Korean women aged 19 years or older have experienced UI.ConclusionsThe prevalence of UI among women aged 19 years or older in Korea was 24.4%, and stress UI was the most prevalent type. Many women with UI did not seek medical treatment for that condition.

Urodynamic interpretation of changing bladder function and voiding pattern after radical prostatectomy: a long-term follow-up

Study Type – Diagnostic (exploratory cohort)
Level of Evidence 2b

Urinary urgency outcomes after propiverine treatment for an overactive bladder: the ‘Propiverine study on overactive bladder including urgency data’

Study Type – Therapy (RCT)
Level of Evidence 1b

Mesenchymal Stem Cell Therapy Alleviates Interstitial Cystitis by Activating Wnt Signaling Pathway

Interstitial cystitis (IC) is a syndrome characterized by urinary urgency, frequency, pelvic pain, and nocturia in the absence of bacterial infection or identifiable pathology. IC is a devastating disease that certainly decreases quality of life. However, the causes of IC remain unknown and no effective treatments or cures have been developed. This study evaluated the therapeutic potency of using human umbilical cord-blood-derived mesenchymal stem cells (UCB-MSCs) to treat IC in a rat model and to investigate its responsible molecular mechanism. IC was induced in 10-week-old female Sprague-Dawley rats via the instillation of 0.1 M HCl or phosphate-buffered saline (PBS; sham). After 1 week, human UCB-MSC (IC+MSC) or PBS (IC) was directly injected into the submucosal layer of the bladder. A single injection of human UCB-MSCs significantly attenuated the irregular and decreased voiding interval in the IC group. Accordingly, denudation of the epithelium and increased inflammatory responses, mast cell infiltration, neurofilament production, and angiogenesis observed in the IC bladders were prevented in the IC+MSC group. The injected UCB-MSCs successfully engrafted to the stromal and epithelial tissues and activated Wnt signaling cascade. Interference with Wnt and epidermal growth factor receptor activity by small molecules abrogated the benefits of MSC therapy. This is the first report that provides an experimental evidence of the therapeutic effects and molecular mechanisms of MSC therapy to IC using an orthodox rat animal model. Our findings not only provide the basis for clinical trials of MSC therapy to IC but also advance our understanding of IC pathophysiology.