Benign prostatic hyperplasia (BPH) is a common disease in the elderly population and holmium laser enucleation of the prostate (HoLEP) is an important method for its management. However, postoperative complications of HoLEP affects the patients' quality of life as well as the outcome of surgery. Based on the ten-year clinical practice and multi-center data analysis, the author puts forward the concept of "postoperative urethral recovery" for BPH patients receiving HoLEP, which involves postoperative pain recovery, urination recovery, urine control recovery, sexual function recovery, and a postoperative recovery system aiming at the acceleration of recovery.
Aged ; Holmium ; Humans ; Laser Therapy ; adverse effects ; methods ; Lasers, Solid-State ; adverse effects ; Male ; Pain, Postoperative ; Postoperative Period ; Prostatectomy ; adverse effects ; methods ; Prostatic Hyperplasia ; surgery ; Quality of Life ; Recovery of Function ; Sexual Behavior ; Treatment Outcome ; Urethra ; physiology ; Urination

PURPOSE: We compared bladder and urethral functions following radical prostatectomy (RP) between men with and without urinary incontinence (UI), using a large-scale database from SNU-experts-of-urodynamics-leading (SEOUL) Study Group. MATERIALS AND METHODS: Since July 2004, we have prospectively collected data on urodynamics from 303 patients with lower urinary tract symptoms (LUTS) following RP at three affiliated hospitals of SEOUL Study Group. After excluding 35 patients with neurogenic abnormality, pelvic irradiation after surgery, or a history of surgery on the lower urinary tract, 268 men were evaluated. We compared the urodynamic findings between men who had LUTS with UI (postprostatectomy incontinence [PPI] group) and those who had LUTS without UI (non-PPI group). RESULTS: The mean age at an urodynamic study was 68.2 years. Overall, a reduced bladder compliance (< or =20 mL/cmH2O) was shown in 27.2% of patients; and 31.3% patients had idiopathic detrusor overactivity. The patients in the PPI group were older (p=0.001) at an urodynamic study and had a lower maximum urethral closure pressure (MUCP) (p<0.001), as compared with those in the non-PPI group. Bladder capacity and detrusor pressure during voiding were also significantly lower in the PPI group. In the logistic regression, only MUCP and maximum cystometric capacity were identified as the related factor with the presence of PPI. CONCLUSIONS: In our study, significant number of patients with LUTS following RP showed a reduced bladder compliance and detrusor overactivity. PPI is associated with both impairment of the urethral closuring mechanism and bladder storage dysfunction.
Aged ; Humans ; Male ; Middle Aged ; Prospective Studies ; Prostatectomy/*adverse effects/methods ; Urethra/*physiopathology ; Urinary Bladder/*physiopathology ; Urinary Bladder, Overactive/complications ; Urinary Incontinence/*etiology/physiopathology ; Urodynamics/physiology

OBJECTIVETo observe the relaxant effect of Aike Mixture (AKM) on isolated bladder and prostatic urethral smooth muscle of rabbits.

METHODSThe isolated bladder and prostatic urethral smooth muscle from male rabbits were placed in a Magnus bath and smooth muscle contraction was measured using a biological signal acquisition and analysis system. The effects of AKM in combination with methoxyamine, carbachol and CaCl2 on the contractile tension of muscle strips were determined by cumulative dosing.

RESULTSAKM dose-dependently reduced contractile tension of bladder trigone smooth muscle (r=0.831, P<0.05), reduced contractile wave amplitude (r=0.837, P<0.05) and decreased contractile frequency (r=-0.917, P<0.01). AKM significantly inhibited the increases in smooth muscle contraction induced by methoxyamine, carbachol and CaCl2.

CONCLUSIONAKM dose-dependently inhibited the contraction of rabbit isolated bladder and prostatic urethral smooth muscle by antagonizing α1-adrenergic receptors and M-cholinergic receptors.

Animals ; Calcium Chloride ; pharmacology ; Carbachol ; pharmacology ; Drugs, Chinese Herbal ; pharmacology ; Hydroxylamines ; pharmacology ; In Vitro Techniques ; Male ; Muscle Contraction ; drug effects ; Muscle, Smooth ; drug effects ; physiology ; Neuromuscular Agents ; pharmacology ; Prostate ; drug effects ; physiology ; Rabbits ; Receptors, Adrenergic, alpha-1 ; metabolism ; Receptors, Muscarinic ; metabolism ; Urethra ; drug effects ; physiology ; Urinary Bladder ; drug effects ; physiology

The most promising treatment for stress urinary incontinence can be a cell therapy. We suggest human amniotic fluid stem cells (hAFSCs) as an alternative cell source. We established the optimum in vitro protocol for the differentiation from hAFSCs into muscle progenitors. These progenitors were transplanted into the injured urethral sphincter and their therapeutic effect was analyzed. For the development of an efficient differentiation system in vitro, we examined a commercial medium, co-culture and conditioned medium (CM) systems. After being treated with CM, hAFSCs were effectively developed into a muscle lineage. The progenitors were integrated into the host urethral sphincter and the host cell differentiation was stimulated in vivo. Urodynamic analysis showed significant increase of leak point pressure and closing pressure. Immunohistochemistry revealed the regeneration of circular muscle mass with normal appearance. Molecular analysis observed the expression of a larger number of target markers. In the immunogenicity analysis, the progenitor group had a scant CD8 lymphocyte. In tumorigenicity, the progenitors showed no teratoma formation. These results suggest that hAFSCs can effectively be differentiated into muscle progenitors in CM and that the hAFSC-derived muscle progenitors are an accessible cell source for the regeneration of injured urethral sphincter.
Amniotic Fluid/*cytology ; Animals ; Biological Markers/metabolism ; Cell Differentiation ; Cell Lineage ; Cell Transformation, Neoplastic ; Cells, Cultured ; Coculture Techniques ; Female ; Gene Expression Regulation ; Humans ; Immunohistochemistry ; Mice ; Mice, Inbred ICR ; Regeneration ; *Stem Cell Transplantation ; Stem Cells/*cytology/metabolism ; Urethra/physiology ; Urinary Incontinence, Stress/pathology/*therapy ; Urodynamics

BACKGROUNDEfficient cell adhesion and proliferation is a central issue in cell-based tissue engineering, which offers great promise for repair of urethral defects or strictures. This study evaluated the adhesion and growth of rabbit uroepithelium on a surface-modified three-dimensional poly-L-lactic acid (PLLA) scaffold.

METHODSUrethral mucosa were harvested from male New Zealand rabbits and the urothelium were dissociated and then cultured. Immunocytochemistry on cultured uroepithelium for pancytokeratin and uroplakin II and TE-7 confirmed pure populations. After in vitro proliferation, cells were seeded onto a surface-modified urethral scaffold with non-knitted filaments. The morphology and viability of the cells were examined by immunohistochemical and fluorescence staining. Inverted and scanning microscopes were used to document cell growth and adhesion.

RESULTSThree to five days after primary culture, the uroepithelial cells gradually became confluent, assuming a cobblestone pattern. The filaments of the urethral scaffold had excellent biocompatibility and allowed growth of the uroepithelium, without affecting viability. The uroepithelial cells adhered to and grew well on the scaffold. After 3 - 7 days, the cells grew vigorously and meshes of the scaffold were full of uroepitheliums.

CONCLUSIONSThe surface-modified urethral scaffold with non-knitted filaments allows the growth of uroepithelium and can serve as a carrier for the tissue engineering of urethra.

Absorbable Implants ; Animals ; Cells, Cultured ; Epithelial Cells ; physiology ; Lactic Acid ; Male ; Polyesters ; Polymers ; Rabbits ; Tissue Engineering ; methods ; Urethra ; cytology

OBJECTIVETo assess the biocompatibility of a urethral acellular matrix graft (UAMG) and evaluate its effect in repairing urethral defect in rabbit models.

METHODSThe UAMG was prepared and its structural features were observed using optical and electron microscopy. In vitro cultured rabbit bladder smooth muscle cells were seeded on UAMG and the cell proliferation was observed. The cytotoxicity of the aqueous extract of the UAMG against the cells was evaluated by MTT assay, and its biocompatibility was assessed by implanting the grafts subcutaneously on the back of the rabbits. In 24 male rabbits, a 2-cm urethral defect was induced and repaired with UAMG (experimental group, n=12) or left untreated (control group, n=12). In both groups, the rabbits were sacrificed 2, 4, 8 and 12 weeks after the operation for histological and immunohistochemical examination of the tissue regeneration.

RESULTSThe UAMG had a reticular fibrous structure without cell residues. The bladder smooth muscle cells showed normal proliferation on UAMG with normal cell morphology. The rabbits receiving the implants showed no abnormal response, and the UAMGs gradually degraded in vivo with grade 0 or 1 cytotoxcity showing satisfactory cytocompatibility. In the experimental group, new urethral tissues that were histologically compatible with normal urethral tissues were regenerated in the defect area 12 weeks after UAMG implantation.

CONCLUSIONAs a tissue engineered scaffold material for urethral reconstruction, the UAMG possesses good biocompatibility and can induce the regeneration of urethral epithelial cells and smooth muscle cells.

Animals ; Extracellular Matrix ; transplantation ; Male ; Rabbits ; Random Allocation ; Reconstructive Surgical Procedures ; methods ; Regeneration ; physiology ; Tissue Engineering ; methods ; Urethra ; injuries ; surgery

AIMTo report the detection in vitro of secretory inhibitor of platelet microbicidal protein (SIPMP) phenotypes of urethral isolates along with a comparison with isolates from patients with or without chronic bacterial prostatitis (CBP).

METHODSUrethral isolates of Staphylococcus spp. (n=4), diphtheroids (n=28), micrococci (n=15), streptococci (n=21), Enterobacteriaceae (n=9) and Enterococcus faecalis (n=19) from patients with or without CBP were tested. SIPMP production was tested by inhibition of platelet microbicidal protein (PMP) bioactivity against Bacillus subtilis and was expressed as percentage of inhibition of PMP bactericidal activity.

RESULTSA significantly higher proportion of CBP-strains (57.78% vs. 16.67%) reduced PMP-induced killing of Bacillus subtilis than non-CBP strains did (P<0.01). SIPMP levels of staphylococci and Enterococcus faecalis from the CBP group were significantly higher than those of the control group.

CONCLUSIONThese results suggest that SIPMP production is associated with the CBP source. Data from the present study might have significant implications for the understanding of the pathogenesis of CBP.

Blood Bactericidal Activity ; physiology ; Blood Platelets ; metabolism ; Chronic Disease ; Humans ; In Vitro Techniques ; Male ; Phenotype ; Prostatitis ; metabolism ; microbiology ; Urethra ; microbiology ; beta-Thromboglobulin ; antagonists & inhibitors

OBJECTIVETo investigate the curative effect and histocompatibility of reconstruction of traumatic urethral defect of rabbit using urethral extracellular matrix (ECM).

METHODSUrethral ECM was obtained by excision of the urethra in 20 donor rabbits. In experimental group, 20 rabbits were resected a 1.0 cm-1.5 cm segment of the urethra and artificially made a model of traumatic urethral defect, then reconstructed by the urethral extracellular matrix of the same length. The rabbit immunity response was assessed by lymphocyte transformation test and serum TNF-alpha level. The reconstructed urethral segments were stained with hematoxylin-eosin and Van Gieson stain and observed by histological examination postoperatively. The urethrography, urethroscopy and urodynamic examinations were performed.

RESULTSThere was no significant difference in stimulative index of lymphocyte transformation between ECM group and control group. The serum TNF-alpha levels of ECM group slightly rose, but the increase was not significant as compared with control group. On postoperative day 10, epithelial cell had migrated from each side and small vessels were found in the extracellular matrix. In the 3rd week, several layers of urothelium covered the whole surface of the matrix tube. In the 6th week, the disorganized arrangements of smooth muscle fibers were firstly observed by Van Gieson staining. In the 24th week, the smooth muscle cells increased and the matrix tube appeared fairly similar to normal urethral wall components. The urethroscopy and urodynamic evaluation revealed that the surface of reconstructed urethra was smooth and emiction was unobstructed.

CONCLUSIONThe urethral extracellular matrix might be an ideal and safe biomaterial for the reconstruction of urethral traumatic defect.

Animals ; Extracellular Matrix ; immunology ; physiology ; Female ; Immunohistochemistry ; Lymphocyte Activation ; Rabbits ; Reconstructive Surgical Procedures ; methods ; Tumor Necrosis Factor-alpha ; blood ; Urethra ; immunology ; injuries ; surgery

MUCP (Maximal urethral closure pressure) is known to be increased in patients with vaginal wall prolapse due to the mechanical obstruction of the urethra. However, urethral function following reduction has not yet been completely elucidated. Predicting postoperative urethral function may provide patients with important, additional information prior to surgery. Thus, this study was performed to evaluate the relationship between MUCP and functional urethral length (FUL) according to stage and age in anterior vaginal wall prolapse patients. 139 patients diagnosed with anterior vaginal wall prolapse at Yonsei University Medical College (YUMC) from March 1999 to May 2003 who had underwent urethral pressure profilometry following reduction were included in this study. The stage of pelvic organ prolapse (POP) was determined according to the dependent portion of the anterior vaginal wall (Aa, Ba). (By International Continence Society's POP Quantification system) Patients were divided into one of four age groups: patients in their 40s (n=13), 50s (n=53), 60s (n=54), and 70 and over (n=16). No difference in MUCP was found between the age groups. The FUL of patients in their 40s was shorter than that of patient's in their 50s and 60s. Patients were also divided into stages: stage II (n=35), stage III (n=76), and stage IV (n=25). No significant difference in MUCP was found according to stage and FUL. However, a significant difference was noted between stage III and IV as stage IV was longer. Anterior vaginal wall prolapse is known to affect urethral function due to prolapse itself, but according to our study, prolapse itself did not alter urethral function. This suggests that, regardless of age and stage, prolapse corrective surgery does not affect the urethral function.
Adult ; Age Factors ; Aged ; Female ; Humans ; Middle Aged ; Postoperative Complications ; Pressure ; Urethra/*anatomy & histology/*physiology ; Urinary Incontinence, Stress/etiology/physiopathology ; Uterine Prolapse/pathology/*physiopathology/*surgery

To investigate the relationship between the endogenous steroid hormones and the lower urinary tract function in postmenopausal women. Thirty postmeopausal volunteer women who did not have lower urinary tract symptoms or hormone replacement therapy were enrolled in this study. Urodynamic studies included uroflowmetry, multi-channel cystometry, and urethral pressure profilometry were conducted. Gas Chromatography- Mass Spectroscopy (GC-MS) was used to measure the urinary endogenous steroid hormone metabolites. The relationship between the urinary profile of the endogenous steroids and the urodynamic parameters of these patients were investigated. The mean ages of the patients were 60.6 +/- 5.5 years, and the Body Mass Index (BMI) averaged 24.56 +/- 2.23 (kg/m2). Of the progesterone metabolites, pregnandiol was significantly related to the residual volume in the uroflowmetry and the functional urethral length parameters (R=0.98, p=0.000; R= -0.65, p=0.04). Pregnantriol was significantly related to the maximum flow rate, the residual volume in uroflowmetry, the maximum urethral closure pressure and the functional urethral length (R=-0.64, p=0.04; R=0.82, p=0.01; R=0.04, p=0.04; R=- 0.79, p=0.01). In the androgen metabolites, androstenedione, 5-AT, 11- keto Et, 11-betahydroxy Et, THS, and THE were significantly related to the residual volume in uroflowmetry (R=0.92, p=0.001; R=0.84, p=0.008; R=0.99, p=0.000; R=0.72, p=0.03; R=0.97, p=0.000; R=0.85, p=0.00). beta-THF/alpha-THF was significantly related to the maximum flow rate, the residual volume in uroflowmetry, the maximum urethral closure pressure and the functional urethral length (R=-0.76, p=0.02; R=0.67, p=0.04; R=0.74, p=0.02; R=-0.92, p=0.000). alpha-cortol was significantly related to the residual volume in uroflowmetry, the maximum urethral closure pressure and the functional urethral length (R=0.81, p=0.01; R=0.71, p=0.03; R=-0.87, p=0.000). Of the estrogen metabolites, estrone (E1) was significantly related to the normal desire to void (R=0.68, p=0.04) and 17 beta-estradiol/estrone was also significantly related to the normal and strong desire to void (R=-0.70, p=0.03 and R=-0.74, p=0.02, respectively). The urinary progesterone and androgen metabolite concentrations were positively related to the residual volume in uroflowmetry and positively or negatively related to MUCP and FUL. However, the urinary estrone concentration was positively related to the normal desire to void and 17 beta-estradiol/estrone was significantly related to the normal and strong desire to void.
Aged ; Androgens/*metabolism ; Bladder/physiology ; Estrogens/*metabolism ; Female ; Human ; Mass Fragmentography ; Middle Aged ; Postmenopause/*physiology ; Progesterone/metabolism ; Urethra/physiology ; *Urodynamics