PURPOSE: To evaluate the therapeutic effect of human embryonic stem cell (hESC)-derived multipotent mesenchymal stem cells (M-MSCs) on ketamine-induced cystitis (KC) in rats. METHODS: To induce KC, 10-week-old female rats were injected with 25-mg/kg ketamine hydrochloride twice weekly for 12 weeks. In the sham group, phosphate buffered saline (PBS) was injected instead of ketamine. One week after the final injection of ketamine, the indicated doses (0.25, 0.5, and 1×106 cells) of M-MSCs (KC+M-MSC group) or PBS vehicle (KC group) were directly injected into the bladder wall. One week after M-MSC injection, the therapeutic outcomes were evaluated via cystometry, histological analyses, and measurement of gene expression. Next, we compared the efficacy of M-MSCs at a low dose (1×105 cells) to that of an identical dose of adult bone marrow (BM)-derived MSCs. RESULTS: Rats in the KC group exhibited increased voiding frequency and reduced bladder capacity compared to rats of the sham group. However, these parameters recovered after transplantation of M-MSCs at all doses tested. KC bladders exhibited markedly increased mast cell infiltration, apoptosis, and tissue fibrosis. Administration of M-MSCs significantly reversed these characteristic histological alterations. Gene expression analyses indicated that several genes associated with tissue fibrosis were markedly upregulated in KC bladders. However the expression of these genes was significantly suppressed by the administration of M-MSCs. Importantly, M-MSCs ameliorated bladder deterioration in KC rats after injection of a low dose (1×105) of cells, at which point BM-derived MSCs did not substantially improve bladder function. CONCLUSIONS: This study demonstrates for the first time the therapeutic efficacy of hESC-derived M-MSCs on KC in rats. M-MSCs restored bladder function more effectively than did BM-derived MSCs, protecting against abnormal changes including mast cell infiltration, apoptosis and fibrotic damage.
Adult ; Animals ; Apoptosis ; Bone Marrow ; Cystitis ; Female ; Fibrosis ; Gene Expression ; Human Embryonic Stem Cells ; Humans ; Ketamine ; Mast Cells ; Mesenchymal Stromal Cells ; Multipotent Stem Cells ; Pelvic Pain ; Rats ; Urinary Bladder

PURPOSE: To determine the baseline clinical characteristics associated with dose escalation of solifenacin in patients with overactive bladder (OAB). METHODS: We analyzed the data of patients with OAB (micturition frequency > or =8/day and urgency > or =1/day) who were treated with solifenacin and followed up for 24 weeks. According to our department protocol, all the patients kept voiding diaries, and OAB symptom scores (OABSS) were monitored at baseline and after 4, 12, and 24 weeks of solifenacin treatment. RESULTS: In total, 68 patients (mean age, 60.8+/-10.0 years) were recruited. The dose escalation rate by the end of the study was 41.2%, from 23.5% at 4 weeks and 17.6% at 12 weeks. At baseline, the dose escalator group had significantly more OAB wet patients (53.6% vs. 20.0%) and higher total OABSS (10.2+/-2.4 vs. 7.9+/-3.5, P=0.032) than the nonescalator group. OAB wet (odds ratio [OR], 4.615; 95% confidence interval [CI], 1.578-13.499; P<0.05) and total OABSS (OR, 1.398; 95% CI, 1.046-1.869; P<0.05) were found to be independently associated with dose escalation. CONCLUSIONS: Patients who have urgency urinary incontinence and high total OABSS have a tendency for dose escalation of solifenacin.
Elevators and Escalators ; Humans ; Muscarinic Antagonists ; Solifenacin Succinate ; Urinary Bladder, Overactive* ; Urinary Incontinence

PURPOSE: We compared the effectiveness of the retropubic tension-free vaginal tape (TVT) and the transobturator inside-out tape (TVT-O) in treating symptoms of overactive bladder (OAB) in women with stress urinary incontinence (SUI). METHODS: Women with urodynamic SUI and OAB (mean urgency episodes > or =1 and frequency > or =8/24 hours on a 3-day voiding diary) were assigned to the TVT or TVT-O group. Preoperative measures were based on a urodynamic study, 3-day voiding diary, the Bristol Female Lower Urinary Tract Symptoms questionnaire (BFLUTS(SF)), and the urgency perception scale (UPS). At 12 postoperative months, the 3-day voiding diary, symptoms questionnaire, patient satisfaction, and standing stress test were assessed. The primary endpoint was change in the number of urgency episodes/24 hours from baseline to 12 months. RESULTS: In this group of 132 women, 42 received TVT and 90 received TVT-O. The mean urgency episodes/24 hours decreased from 6.3+/-5.5 to 1.6+/-3.2 in the TVT group and from 5.1+/-4.4 to 1.8+/-3.0 in the TVT-O group. The mean percent change was significantly greater after TVT than after TVT-O (73% vs. 60%, P=0.049). All subscales of BFLUTS(SF) and UPS were significantly improved using either method, with significantly greater improvement seen in the quality of life (QoL) domain after TVT (P=0.002). There were no significant differences in the cure and satisfaction rates between the two groups. CONCLUSIONS: Intervention with the TVT or the TVT-O significantly improved symptoms of OAB in women with SUI and OAB. Urgency and QoL significantly improved after TVT compared with that after TVT-O.
Exercise Test ; Female ; Humans ; Lower Urinary Tract Symptoms ; Patient Satisfaction ; Quality of Life ; Suburethral Slings ; Urinary Bladder, Overactive ; Urinary Incontinence ; Urodynamics

Lower urinary tract symptoms (LUTS) are classified into three groups: storage, voiding, and post-micturition symptoms. The most popular causes of LUTS are benign prostatic hyperplasia (BPH) and overactive bladder (OAB). Although BPH is a pathologic term, clinically, we use this when patients have LUTS due to benign prostatic enlargement and obstruction. OAB is defined as urgency, with or without urge incontinence, usually with frequency and nocturia. Currently alpha1-adrenoceptor antagonists are the most common drug treatment for BPH, and are thought to act by relaxing the prostatic smooth muscle. They are all effective for the treatment of LUTS/BPH. 5alpha-reductase inhibitors, such as fiansteride and dutasteride, are another treatment option for BPH symptoms, which reduce the prostatic volume by inducing epithelial atrophy. Long-term combination therapy with alpha-1-blockers and 5alpha-reductase inhibitors reduces the risk of the overall clinical progression of BPH significantly more than does treatment with either drug alone. Antimuscarinics are the mainstay for the treatment of OAB. Antimuscarinics competitively block muscarinic receptors of all subtypes but with variations in selectivity for the different subtypes. When they are used for the treatment of OAB, they are active during the storage phase of the bladder, with little or no effect on voiding contractions. Desmopressin acetate is a synthetic analogue of Arginin vasopressin, which has been proven effective for the treatment of nocturnal polyuria in LUTS.
Atrophy ; Azasteroids ; Contracts ; Deamino Arginine Vasopressin ; Dutasteride ; Humans ; Lower Urinary Tract Symptoms ; Muscarinic Antagonists ; Muscle, Smooth ; Nocturia ; Polyuria ; Prostatic Hyperplasia ; Receptors, Muscarinic ; Urinary Bladder ; Urinary Bladder, Overactive ; Urinary Incontinence, Urge ; Vasopressins

PURPOSE: We assessed the long-term effects of the tension-free vaginal tape (TVT) procedure for stress urinary incontinence (SUI) on voiding, storage, and patient satisfaction. MATERIALS AND METHODS: This retrospective study examined the records of 134 patients who had undergone the TVT procedure for SUI and were followed up for more than 5 years. Voiding function was evaluated by measuring maximum urinary flow rate (MFR), post-void residual urine volume (PVR), and storage function by using a voiding diary. Patients were asked to describe their satisfaction with the operation. RESULTS: MFR was lower at 1 month compared with the preoperative level, but had recovered to preoperative levels by 5 years postoperatively. However, some patients with >50%, 25-50%, and <25% decreases in the MFR at 1 month postoperatively showed a decrease in the MFR of >50% at 5 years. PVR increased over the 5 postoperative years. Of the patients with urgency and urgency incontinence, 43.8% and 48.1% showed improvement, respectively, whereas new patients developed postoperatively. Thus, the total number of patients with urgency or urgency incontinence remained similar over the 5 years. In those with a changed voiding pattern, patient satisfaction was negatively affected by de novo urgency and urgency incontinence and decreased MFR. CONCLUSIONS: Any obstructive effect of the TVT procedure diminished over time in most patients, although a decrease in the MFR was sustained in some patients. With regard to overactive bladder symptoms, some patients were cured and some patients complained of de novo symptoms. The most major factor affecting patient satisfaction was de novo urgency.
Female ; Humans ; Patient Satisfaction ; Retrospective Studies ; Suburethral Slings ; Urinary Bladder, Overactive ; Urinary Incontinence

PURPOSE: In the surgical treatment of pelvic organ prolapse(POP), treatment failure and re-operation rates are relatively high when conventional mesh-free surgical methods are employed. Recently, a transvaginal prolapse repair method using surgical mesh has come into broad usage. The principal objective of this study was to report on the clinical efficacy and safety of transvaginal mesh repair of genital prolapses using the Prolift(TM) system. MATERIALS AND METHODS: We included 31(mean age 61.1 years) patients who had undergone pelvic organ prolapsed treatment with the Prolift(TM) system. The evaluation included a medical history, physical examination including Pelvic Organ Prolapse staging system(POP-Q), a urodynamic study, and a Pelvic Floor Distress Inventory(PFDI). An anatomic cure after intervention was defined as stage 0 and an improvement was defined as stage I. Anatomic failures were defined as stage II or higher. The patients were monitored at 4, 12 and 52 weeks postoperatively, and the mean follow-up period was 13.7 months. RESULTS: Preoperative anterior vaginal wall prolapse to the POP-Q was stage II in 13, III in 14, IV in 4, uterine or vaginal vault prolapse stage II in 3, III in 6, IV in 1 and posterior vaginal wall prolapse stage II in 3, and stage III in 7. Anterior, posterior and total repair were performed in 21(67.8%), 1(3.2%), and 9(29.0%) patients, respectively. 90.3%(28/31) of the patients had been anatomically cured upon follow-up examination, and 93.5%(29/31) reported being satisfied with the result of the operation. Pre-and postoperative urinary symptoms, as well as prolapse symptoms as evaluated by PFDI, were improved significantly. CONCLUSIONS: Pelvic floor surgery using the Prolift(TM) system appears to be both effective and safe.
Follow-Up Studies ; Humans ; Pelvic Floor ; Pelvic Organ Prolapse ; Physical Examination ; Prolapse ; Surgical Mesh ; Treatment Failure ; Urodynamics

PURPOSE: The interest has been growing in the investigation and management of lower urinary tract symptoms, but their prevalence in the general population has so far been based on the estimates made in selected groups of women in Korea. The object of this study was to determine the prevalence of stress urinary incontinence and bladder irritative symptoms of women in rural region in Korea through a community based survey. Also, we investigated the relationship between age, parity, oral contraception, smoking, menopause and obesity and the prevalence of stress urinary incontinence. MATERIALS AND METHODS: A questionnaire survey was performed in a sample of randomly selected 1162 women aged 30 years and over, in 31 villages in the town of Jeong-Eup, Korea. From February 4th to February 22nd, 1997, trained field workers visited every home and interviewed every eligible individual with the questionnaires, which included data on stress urinary incontinence, bladder irritative symptoms, quality of life, reproductive and menstrual history, and use of oral contraceptives. Among 1162 women, 857 responded to questionnaires, and 827 questionnaires were available for analysis. The response rate was 73.5%. The prevalence of stress urinary incontinence was defined as the proportion of the women in the population surveyed who experienced stress urinary incontinence at least twice a week. We defined diurnal frequency as the episodes of voiding again within 2 hours after initial voiding in the series of 5 consecutive voidings during one month period. The urgency was defined as she found it difficult to hold urination, once or more in the series of 5 consecutive voidings and nocturia twice or more per night. RESULTS: The prevalence of stress urinary incontinence was 20.4%. Only seven(4.1%) women carried a sanitary towel or diaper as protection against urinary leakage. The prevalence of stress incontinence among age groups revealed no significant difference. Statistically significant correlation was noted between obesity and the prevalence of stress incontinence. Diurnal frequency was recorded by 375 women(45.3%); 171(20.6%) experienced this symptom more than three times. Urgency was reported by 268 women(32.4%) and 63(7.6%) were always troubled by this symptom. Nocturia 3 times or more every night was recorded by 341 women(42.2%) and 83(10.0%) had nocturia 5 times or more. The severity of nocturia increased significantly with age. CONCLUSIONS: The prevalence of stress urinary incontinence and irritative symptoms in this study is similar to previous studies performed in other countries while the rate of nocturia is much higher in this study. Although stress urinary incontinence and bladder irritative symptoms are relatively common in this community, only few people are seeking for care of these symptoms. Therefore, it is very important to educate the public and promote awareness of this medical problem in this community.
Contraception ; Contraceptives, Oral ; Female ; Health Personnel ; Humans ; Jeollabuk-do ; Korea ; Lower Urinary Tract Symptoms ; Menopause ; Nocturia ; Obesity ; Parity ; Prevalence* ; Quality of Life ; Surveys and Questionnaires ; Smoke ; Smoking ; Urinary Bladder* ; Urinary Incontinence* ; Urination

PURPOSE: To evaluate the effectiveness of percutaneous transluminal angioplasty (PTA) and pulsed-spraypharmacomechanical thrombolysis (PSPMT) using urokinase for the management of insufficient hemodialysis access. MATERIALS AND METHODS: Between September 1996 and May 1998, 21 insufficient hemodialysis accesses were treated in16 patients (3 artificial arteriovenous fistulae, AVF ; and 13 arteriovenous graft, AVG). PTA and PSPMT were performed in 6 and 15 and 15 cases, respectively, and success and long-term patency rates were evaluated. RESULTS: The overall success rate of PTA and PSPMT for insufficient hemodialysis access was 76.2%(16/21). The success rates of PTA and PSPMT were 83.3%(5/6) and 73.3%(11/15), respectively. the primary patency rates of PSPMT were 69+/-12.8% at 6 months and 38+/-18.6% at 12 months. One of the two initially successful PTAs had been patent for 7months, and the second PTA was performed at that time due to venous stenosis. The other was patent for 15 months throughout the follow-up period. CONCLUSION: PTA and PSPMT are effective primary methods for the treatment of insufficient hemodialysis access ; success and patency rates were high, and the procedures can be performed repeatedly.
Angioplasty* ; Arteriovenous Fistula* ; Constriction, Pathologic ; Follow-Up Studies ; Humans ; Renal Dialysis* ; Transplants* ; Urokinase-Type Plasminogen Activator*

No abstract available.
Liver Cirrhosis* ; Liver*

No abstract available.
Gastric Emptying* ; Hepatitis B, Chronic* ; Hepatitis, Chronic*