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      Do functional changes occur in the bladder due to bladder outlet obstruction? ‐ ICI‐RS 2018

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          Studies on bladder dysfunction (BD), more specifically functional‐urodynamic changes in the bladder as a result of bladder outlet obstruction (BOO) have been summarized for this TT. Based on available, but limited evidence from human studies a three‐stage model can be hypothesized to characterize BOO‐induced bladder remodeling: hypertrophy, compensation (increased detrusor contractility during the voiding phase, often in combination with filling phase detrusor overactivity) followed by the phase of decompensation [detrusor underactivity]. The time between the start of compensation and eventual decompensation seems to be determined by age of onset, severity, and type of obstruction and clinical mitigating factors such as vascular and metabolic problems. Understanding the relative contributions of these factors may allow the development of personalized timelines and probabilities for these obstructed patients.

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          Most cited references 43

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          Ultrasound Elastography: Review of Techniques and Clinical Applications

          Elastography-based imaging techniques have received substantial attention in recent years for non-invasive assessment of tissue mechanical properties. These techniques take advantage of changed soft tissue elasticity in various pathologies to yield qualitative and quantitative information that can be used for diagnostic purposes. Measurements are acquired in specialized imaging modes that can detect tissue stiffness in response to an applied mechanical force (compression or shear wave). Ultrasound-based methods are of particular interest due to its many inherent advantages, such as wide availability including at the bedside and relatively low cost. Several ultrasound elastography techniques using different excitation methods have been developed. In general, these can be classified into strain imaging methods that use internal or external compression stimuli, and shear wave imaging that use ultrasound-generated traveling shear wave stimuli. While ultrasound elastography has shown promising results for non-invasive assessment of liver fibrosis, new applications in breast, thyroid, prostate, kidney and lymph node imaging are emerging. Here, we review the basic principles, foundation physics, and limitations of ultrasound elastography and summarize its current clinical use and ongoing developments in various clinical applications.
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            The effect of atherosclerosis-induced chronic bladder ischemia on bladder function in the rat.

            To develop a rat model of atherosclerosis-induced chronic bladder ischemia and investigate the effect of chronic bladder ischemia on voiding behavior and bladder function. Adult male rats were divided into three groups. The arterial injury (AI) group underwent endothelial injury of the iliac arteries and received a 2% cholesterol diet. The sham group underwent sham operation and received a 2% cholesterol diet. The control group received a regular diet. After 8 weeks, a metabolic cage study and cystometry were performed without anesthesia. Bladder blood flow was measured using a laser Doppler blood flowmeter. Histological examination of the iliac arteries and the bladder was performed. The bladder was also processed for immunohistochemical staining of oxidative stress markers. The metabolic cage study showed that in the AI group, voiding frequency significantly increased while voided volume significantly decreased. Cystometry showed that the frequency of reflex bladder contractions was significantly higher in the AI group. Filling-induced decrease in bladder blood flow was the greatest in the AI group. Histological study showed that in the AI group alone, atherosclerotic occlusion occurred in the iliac arteries as well as in the downstream bladder microvessels. Oxidative stress marker positive cells were more prevalent in the AI bladder than in the other bladders. Combined with a high-cholesterol diet, endothelial injury of iliac arteries induced arterial occlusive disease in the downstream vessels and consequent bladder ischemia in rats. This model of chronic bladder ischemia showed detrusor overactivity manifested as an increase in voiding frequency. Copyright © 2011 Wiley Periodicals, Inc.
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              Increase in detrusor wall thickness indicates bladder outlet obstruction (BOO) in men.

              Detrusor wall thickness decreases continuously while the bladder fills to 50% of its capacity and then remains constant until 100%. Therefore, detrusor wall measurements were performed in patients when the bladder was filled to maximum capacity only. Mean detrusor wall thickness for unobstructed (n = 14), equivocal (n=23) and obstructed patients (n=33) were 1.33, 1.62 and 2.4 mm, respectively (P <0.001). With increasing CHESS letters and CHESS numbers, the thickness of the detrusor wall increased as well (P< 0.001). The positive predictive value of detrusor wall measurement (95.5% for a cut-off value greater than or equal to 2 mm) was superior to all other predictors investigated. The thickness of the detrusor wall increases depending on the extent of BOO. Both constrictive and compressive BOO lead to an increase in detrusor wall thickness. BOO is found in 95.5% of men with a detrusor wall thickness greater than or equal to 2 mm. Measuring the thickness of the detrusor wall can be used as a screening test to detect BOO.

                Author and article information

                Neurourol Urodyn
                Neurourol. Urodyn
                Neurourology and Urodynamics
                John Wiley and Sons Inc. (Hoboken )
                06 July 2019
                December 2019
                : 38
                : Suppl 5 ( doiID: 10.1002/nau.v38.S5 )
                : S56-S65
                [ 1 ] Department of Urology University Medical Centre Utrecht Utrecht The Netherlands
                [ 2 ] Department of Urology Bristol Urological Institute Bristol United Kingdom
                [ 3 ] Department of Urology Moinhos de Vento Hospital Porto Alegre Brazil
                [ 4 ] Department of Experimental Medicine and Surgery, Department of Surgery, Policlinico Tor Vergata University of Rome “Tor Vergata” and Urology Unit Rome Italy
                [ 5 ] Bristol Urological Institute Southmead Hospital Bristol United Kingdom
                [ 6 ] Department of Urology Maastricht University Medical Centre Maastricht The Netherlands
                [ 7 ] Department of Urology Guy's and St Thomas’ NHS Trust London United Kingdom
                Author notes
                [* ] Correspondence Ruud Bosch, Department of Urology, University Medical Centre Utrecht, Utrecht 855500, 3508GA, The Netherlands.

                Email: jlhbosch@

                © 2019 The Authors. Neurourology and Urodynamics Published by Wiley Periodicals, Inc.

                This is an open access article under the terms of the License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.

                Page count
                Figures: 2, Tables: 2, Pages: 10, Words: 5382
                Review Article
                Review Articles
                Custom metadata
                December 2019
                Converter:WILEY_ML3GV2_TO_JATSPMC version:5.7.3 mode:remove_FC converted:17.12.2019


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