Changes in Bladder Wall Blood Oxygen Saturation in the Overactive Obstructed Bladder
Department of Urology and Pediatric Urology, Erasmus Medical Centre, Sophia Children's Hospital, Rotterdam, The Netherlands. The Journal of urology
(Impact Factor: 4.47).
09/2011; 186(3):1128-33. DOI: 10.1016/j.juro.2011.04.111
Several studies suggest that hypoxia of the bladder wall contributes to bladder dysfunction but the exact relation between bladder function and blood oxygen saturation, a surrogate marker for hypoxia, is not known. We determined bladder wall blood oxygen saturation in vivo in an animal model of bladder outlet obstruction to establish the exact relation between blood oxygen saturation and bladder function.
In 8 sham operated and 8 urethrally obstructed guinea pigs we measured blood oxygen saturation of the bladder wall by differential path length spectroscopy before surgery and 8 weeks postoperatively. Urodynamic investigations performed during the whole 8-week period provided data on bladder function.
Before surgery and 8 weeks after sham surgery blood oxygen saturation in the bladder wall was between 88% and 95% during filling. It decreased during voiding and returned to greater than 90% within 30 seconds. Eight weeks after obstruction saturation was significantly lower than in the sham operated group during filling and voiding. The decrease was positively related to bladder pressure during filling and voiding, and was more pronounced when overactivity was present. Local bladder contractions occurred without a measurable increase in bladder pressure but were associated with a decrease in saturation.
A normal bladder maintains a high oxygen saturation level during filling. Bladder obstruction compromises this ability, especially when it involves overactivity. Local bladder contractions without a measurable increase in bladder pressure were associated with a decrease in blood saturation.
Available from: JR Scheepe
- "The obstructed bladder is characterized by a significantly lower saturation both during voiding and filling. This decrease in saturation is more pronounced when detrusor overactivity occurs during the filling phase . "
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Blood oxygen saturation (BOS) is decreased in a low-compliant, overactive obstructed bladder. The objective of this study is to determine the effect of Sildenafil (SC) on bladder function and BOS) in an in vivo animal model of bladder outlet obstruction.
Thirty-two guinea pigs; sham operated (n = 8), sham operated + SC (n = 8), urethrally obstructed (n = 8) and urethrally obstructed + SC (n = 8) were studied during an 8 week period. BOS of the bladder wall was measured by differential path-length spectroscopy (DPS) before obstruction, at day 0, and at week 8. The bladder function was evaluated by urodynamic studies every week.
Before surgery and after sham operation all study parameters were comparable. After sham operation, bladder function and BOS did not change. In the obstructed group the urodynamic parameters were deteriorated and BOS was decreased. In the group obstruction + SC, bladder compliance remained normal and overactivity occurred only sporadic. BOS remained unchanged compared to the sham group and was significantly higher compared to the obstruction group.
In an obstructed bladder the loss of bladder function is accompanied by a significant decrease in BOS. Treatment of obstructed bladders with SC yields a situation of high saturation, high bladder compliance and almost no overactivity. Maintaining the microcirculation of the bladder wall might result in better bladder performance without significant loss of bladder function. Measurement of BOS and interventions focussing on tissue microcirculation may have a place in the evaluation / treatment of various bladder dysfunctions.
Available from: onlinelibrary.wiley.com
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ABSTRACT: Ischemia and the accompanied hypoxia significantly impair the function of the urinary bladder, which is further damaged by ischemia/reperfusion (I/R) injury following the re-establishment of the blood supply. Current evidences have confirmed that blood flow of the bladder is decreased by bladder outlet obstruction (BOO) and acute overdistention and that functional impairment of the urinary bladder following chronic BOO and acute overdistention might partly come from tissue ischemia and ischemia/reperfusion injury. Antioxidants, free radical scavengers or substances inhibiting I/R injury may reduce bladder damages caused by BOO or overdistention.
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ABSTRACT: Objective: The current study was carried out to investigate the impact of atherosclerosis on lower urinary tract function in the male patients with lower urinary tract symptoms (LUTS). Patients and methods: This prospective study evaluated 110 male patients aged 55-75 years who were presented with LUTS. All patients underwent general and local investigations. The atherosclerosis was assessed by ultrasound examination of the carotid artery. Patients then were divided into two groups: non-atherosclerosis group (Group 1) and atherosclerosis group (Group 2). The two groups were compared regarding voiding and storage parameters. Results: Mean patient age were 67.9±5.9 years. The average age and number of Group 1 was 65.7±4.3, n=51. The average age and number of Group 2 was 68.7±5.3, n=59. There were no significant differences in age, prostate volume, blood pressure, International Prostate Symptom Score, Voiding symptom score and Storage symptom score between the two groups. Blood serum triglycerides were significantly lower in Group 1 than Group 2 while HDL cholesterol were significantly higher in Group 1 than Group 2 0.97±0.5 and 1.43±0.2mmol/L, versus 1.46±0.7 and 1.28±0.3mmol/L, respectively. Qmax denotes significant decrease in Group 2 compared with Group 1 12.5±6.3 versus 17.6±6.5, respectively (p<0.01). While in post-voiding residual urine, there was a significant increase in Group 2 compared with Group 1 82.2±15.4 versus 51.4±12.7, respectively (p<0.01). Daytime voided urine denotes a significant decrease in Group 2 176±48, compared with Group 1 221.2±79 (p<0.01). Daytime frequency and nocturia, were significantly higher in Group 2, compared with Group 1 8.90±2.8 versus 7.16±3.11, respectively, and 3.1±1.2 versus 1.92±1.12, respectively (p<0.05). Conclusion: The atherosclerosis disease play a significant role in the impairments of both voiding and storage function in male patients with LUTS irrelevant to the age.
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