S. De Wachter

Bladder Compliance What Does it Represent: Can We Measure it, and is it Clinically Relevant?

To report the conclusion of the Think Thank 8 on Compliance Discussions during the second ICI‐RS meeting in 2010.

On the nature of bladder sensation: The concept of sensory modulation

Going to the toilet is an essential everyday event. Normally, we do not give much thought to the sensations and factors that trigger voiding behavior: we just go. For many people, this apparently simple task is complicated and dominates their life. They have strong sensations and sudden desires to void, often resulting in incontinence. It is therefore important that we understand the origins for this functional change and identify means to alleviate it.

How should bladder sensation be measured?: ICI‐RS 2011

Disturbed bladder sensations, or in broader terms, sensory dysfunctions are increasingly recognized as key elements in the origin and manifestation of symptom syndromes of urinary dysfunction. Adequate assessment of bladder sensation is crucial to improve our understanding of the pathophysiology and treatment of urinary dysfunction. This manuscript summarizes the discussions of a think tank on “How to measure bladder sensation” held at the ICI‐RS meeting in 2011.

Changes in voiding behavior in a mouse model of Alzheimer's disease

Besides cognitive decline and behavioral alteration, urinary incontinence often occurs in patients suffering from Alzheimer’s disease (AD). To determine whether the transgenic mouse model of AD, APP/PS1 (APPSL/PS1M146L) mouse, shows alteration of the urinary bladder function and anxiety, as for patients with AD, we examined the urinary marking behavior in relation to affective behavior. At 18 months of age voiding behavior of APP/PS1 and wild type (WT) mice was assessed by using a modified filter paper assay in combination with video tracing, with the cage divided into a center and corner zones. Anxiety-related behavior and locomotion were respectively tested in an elevated zero maze (EZM) and an open field (OF). The APP/PS1 mice urinated more in the center zone than the WT mice. The total volume of markings was significantly lower in the APP/PS1 mice. In both groups, the average volume of a marking in the corner zone was larger than in the center zone. In the EZM, the APP/PS1 mice spent less time in the open arms of the arena, considered as anxiogenic zones, than the WT mice. During the OF task, the APP/PS1 mice covered a longer distance than the WT mice. These findings show that the APP/PS1 mice have a different voiding behavior compared to the WT mice, i.e., urinating with small volumes and voiding in the center of the cage, and suggest that increased locomotor activity and anxiety-related behaviors are factors in the change in voiding pattern in the APP/PS1 mouse.

Three month clinical results with a rechargeable sacral neuromodulation system for the treatment of overactive bladder

The primary aim of the RELAX‐OAB study is to confirm the safety and efficacy of the Axonics r‐SNM System, a miniaturized, rechargeable SNM system.

2 Three and six month results from a randomized, controlled clinical trial of an intravesical pressure-attenuation balloon system for the treatment of female stress urinary incontinence (SUI)

• The reduction in transient spikes in intravesical pressure is accomplished by insertion of a free-floating, non-occlusive intravesical balloon filled with compressible gas. Since gas is highly compressible relative to most liquids, it can act as a hydraulic “shock-absorber.” This fundamental mechanism of action has been published previously, including a prospective, randomized, single blind, multi-center study on a different patient population.1 Placement • A sheath is placed through the urethra, and cystoscopy is performed. The deflated balloon is pre-inserted inside the tip of a 19 French (Fr) delivery system and inserted into the bladder through the sheath, inflated and released.

Sacrale neuromodulatie voor nietobstructieve urineretentie met een voorgeschiedenis van blaasoverdistensie groter dan 1500 cc

Resultaten Twintig patiënten met de natte vorm van iOAB, die eerder BoNTA-behandelingen hadden ondergaan, werden geïncludeerd: 17 (85%) patiënten hadden onvoldoende baat van de eerste of daaropvolgende BoNTA-behandelingen bemerkt. De overige 3 patiënten waren succesvol behandeld met BoNTA, maar waren ontevreden over het herhaaldelijk moeten ondergaan van de behandeling en wilden graag gescreend worden voor behandeling met SNM. Het gemiddelde interval tussen de laatste BoNTA-behandeling en de start van de SNM-teststimulatie bedroeg 23 maanden (range: 7-53). Bij 14 patiënten (70%) was de teststimulatie succesvol (tabel 5.1). Uit de mictiedagboeken bleek dat de episoden van urineverlies, de mate van urineverlies, de frequentie en de urgentie met > 50% waren afgenomen, in vergelijking met de dagboeken van voor de teststimulatie. Bij 5 patiënten was er zelfs sprake van > 90% afname van de episoden van urineverlies. Alle 14 patiënten ondergingen een definitieve implantatie van een neuromodulator. Een jaar na implantatie waren 11 patiënten (79%) tevreden met de SNM-behandeling.

Reply from authors; Re: P. Petros:“Urgency: An All or None Phenomenon”†‡

The purpose of themanuscript “Urgency: An All or None Phenomenon” was to stimulate the reader to think about urgency and the possible pathophysiological mechanisms behind it. As suggested in the review and suggested by Petros there are indeed arguments to support the view that urgency can be modulated, for example, by digitally supporting the bladder base1 or by different other interventions including as pelvic floor training.2 The reasonwhyonlypart of the affectedpatients respond to these interventions is not always clear andmaypoint to thepresenceofdifferent formsofurgency, ordifferentperceptions of urgency. There are indeed arguments that point to the existence of peripheral forms of OAB which may include detrusor overactivity, and central forms which show changed brain activity without concomitant detrusor overactivity.3 Considering the complexity in brain responses towards bladder filling, it is therefore not surprising that even in one individual the perception of urge and urgency can change on a day-to-day basis. The complexity in underlying mechanism further increases in the presence of anatomical abnormalities such as anterior or posterior compartment prolapses. As suggested above by Petros, different hypotheses can be proprosed thatmay explain the observations in someof thepatientswithurgency.However, the existence of OAB patients that fail different treatment modalities do suggest a diversity in underlying mechanisms. Further studieswill guide our views onurinary urgency andhow to deal with it.