丹参酮ⅡA对骶上脊髓损伤后神经源性膀胱大鼠尿动力学的影响

目的 :观察丹参酮ⅡA对骶上脊髓损伤后神经源性膀胱大鼠尿动力学的影响,并探讨其可能的机制。方法:将40只SD雌性大鼠随机分为4组,每组10只,分别为对照组(Sham组)、模型组(SCI组)、丹参酮ⅡA组(TⅡA组)、甲泼尼龙组(MP组)。Sham组仅切除椎板,予尾静脉注射生理盐水1ml/d,连续7d;其他3组采用改良Allen法建立脊髓损伤后神经源性膀胱动物模型(用NYU脊髓打击器选择25mm高度打击T9节段脊髓背侧),SCI组造模成功后予尾静脉注射生理盐水1ml/d,连续7d;TⅡA组造模成功后予尾静脉注射丹参酮ⅡA磺酸钠注射液20mg/kg/d,连续给药7d;MP组造模成功后予尾静脉注射甲泼尼龙30mg/kg,仅给药1次。术后2周,每组大鼠取8只行尿动力学检查,记录膀胱内压力变化曲线并行相关参数测量;心脏灌注固定后取材T9节段脊髓组织并分离双侧L6-S1背根神经节,HE染色观察脊髓组织的结构并使用Image Pro-Plus(IPP)6.0病理分析软件测量脊髓背侧出血灶的面积占正常脊髓组织的比例,分离L6-S1背根神经节(dorsal root ganglion,DRG)后用TUNEL法(terminal deoxynucleotidyl transferase-mediated d UTP nick end labeling assay)标记凋亡细胞,用IPP 6.0测得各组大鼠DRG中凋亡细胞的累积光密度(integrated optical density,IOD)并进行统计分析。结果:(1)术后2周,各损伤组与Sham组比较膀胱基础压、最大排尿压和排尿阈均显著升高(P0.05);TⅡA组、MP组与SCI组相比膀胱内基础压力明显下降(P0.05),最大排尿压和排尿阈差异无统计学意义(P0.05);TⅡA组与MP组比较差异无统计学意义(P0.05)。损伤各组与Sham组相比,残余尿量明显增加,排尿量明显减小,排尿效率显著降低(P0.05);TⅡA组、MP组与SCI组相比残余尿量明显减小,排尿量明显增加,排尿效率显著提高(P0.05);TⅡA组残余尿量较MP组明显下降,同时TⅡA组排尿效率较MP组显著升高(P0.05)。损伤各组与Sham组相比收缩间期明显减小,无排尿性收缩明显增加(P0.05);TⅡA组、MP组与SCI组相比,收缩间期明显增加,无排尿性收缩明显减少(P0.05);TⅡA组、MP组相比收缩间期无显著性差异(P0.05),但TⅡA组较MP组无排尿性收缩明显减少(P0.05)。(2)术后2周,损伤各组脊髓背侧出血灶面积占正常组织面积的比例分别为:SCI组0.048±0.001,TⅡA组0.006±0.003,MP组0.012±0.001,TⅡA组、MP组与SCI组比较损伤面积占比显著减小(P0.05),TⅡA组和MP组比较差异无统计学意义(P0.05)。(3)术后2周,Sham组凋亡细胞IOD为0.67±0.37,SCI组为2.92±0.35,TⅡA组为1.81±0.27,MP组为2.16±0.18,损伤各组IOD与Sham组相比明显升高(P0.05),TⅡA组和MP组IOD与SCI组相比显著减小(P0.05),TⅡA组和MP组相比差异无统计学意义(P0.05)。结论:丹参酮ⅡA可以改善脊髓损伤后神经源性膀胱大鼠的尿动力学评价指标,改善膀胱功能并减少膀胱传入神经元细胞凋亡,其作用与甲泼尼龙相近,为脊髓损伤后神经源性膀胱的治疗提供了新的思路。     

非神经源性逼尿肌膀胱颈协同失调

报告５例原发性膀胱颈功能障碍患者表现为排尿时膀胱颈开放不良，病变为逼尿肌膀胱颈协同失调，可命名为非神经源性逼尿肌膀胱颈协同失调。提示其诊断标准：（１）有下尿路功能性梗阻；（２）排尿时膀胱颈开放不良，膀胱内压－膀胱颈内压梯度异常；（３）无影响膀胱尿道功能的神经系疾患。同时对此症的发病机理和治疗选择进行了讨论。     

小儿神经源性膀胱与上尿路损害

目的：探讨脊髓发育不良致神经源性膀胱造成上尿路损害的尿动力学危险因素,方法：对32例脊髓发育不良患儿行尿动力学和影像学检查。结果：18例（56％）有肾和输尿管积水,其中4例伴IV－V级膀胱输尿管返液,19例逼尿肌漏尿点压力大于等于40cmH2O(1cmH2O=0.098kPa)且膀胱顺应性小于等于40ml/cmH2O的患儿中,17例合并上尿路损害,13例逼尿肌漏尿点压力＜40cmH2O且膀胱顺应性＞40ml/c mH2O的患儿中,仅1例有双侧输尿管扩张,差别有非常显著性意义（P＜0．001）,结论：对脊髓发育不良致神经源性膀胱的患儿应行尿动力学检查,了解逼尿肌漏尿点压力和膀胱顺应性,确定与上尿路损害有关的危险因素,有助于避免上尿路进一步损害。     

女性糖尿病神经源性膀胱治疗体会

目的：分析盐酸坦洛新缓释片配合针灸治疗女性糖尿病神经源性膀胱（DNB）的临床疗效。方法对2009年3月至2012年12月收治的35例女性DNB患者采用口服盐酸坦洛新缓释片配合针灸治疗,观察排尿改善情况、尿流率改善情况及残余尿量变化。结果随访1周,18例疗效显著,11例有效,6例疗效不明显。2周后,11例有效者中5例转为显效,6例疗效不明显中2例转为有效。本组无病例出现体位性低血压反应。结论盐酸坦洛新缓释片配合针灸对治疗女性DNB有较好疗效,副作用也小。     

多节段脊髓平面损伤后大鼠神经源性膀胱模型的制备

目的研制一种具有临床相似性、可调控性、可重复性的脊髓损伤后神经源性膀胱尿道功能障碍动物模型的制模方法。方法采用改良Allen法,将10g重的柯氏针从20cm高以自由落体落下,撞击在动物脊柱背侧的垫片上,造成一定程度的脊髓损伤。结果在脊髓休克期,骶上脊髓损伤(胸腰段)组和骶髓损伤组动物平均每次挤压膀胱排尿量差异无统计学意义(P>0.05),在脊髓休克期后,两组之间差异有统计学意义(P<0.001)。结论改良Allen法具有临床相似性等优点,能为脊髓损伤后神经源性膀胱尿道功能障碍的研究提供理想的动物模型。     

神经源性膀胱尿道功能障碍患者的影像尿动力学研究

目的 探讨各类神经源性膀胱患者的影像尿动力学特点.方法 2002年12月至2008年6月间,我们对1800例神经源性膀胱患者进行了影像尿动力学检查,分析不同神经病变所致膀胱尿道功能障碍的影像学特点.结果 脑卒中患者均未发现上尿路改变和反流,71% 为逼尿肌过度活动(DO),60% 伴括约肌无抑制性松弛,29% 为逼尿肌无反射(DA).脑外伤患者中70% 为DO不伴协同失调.7例帕金森病患者均表现为DO.1170例骶上损伤患者91% 为DO,83% 伴逼尿肌括约肌协同失调(DSD),223例骶髓及以下损伤患者73% 为DA.共有12% 的创伤性脊髓损伤患者出现上尿路积水改变,4% 表现为膀胱输尿管反流.脊髓发育不良患者81% 表现为逼尿肌无反射,86% 膀胱顺应性下降,55% 有上尿路积水改变,31% 出现膀胱输尿管反流.腰椎间盘突出患者92% 为逼尿肌无反射,88% 膀胱顺应性基本正常.糖尿病膀胱患者81% 膀胱感觉减退,76% 排尿期逼尿肌收缩力低下.结论 不同神经病变所致神经源性膀胱尿道功能障碍的特点不同,应根据影像尿动力学检查结果 选择合适的临床治疗方案.     

骶神经调控治疗带状疱疹性骶髓炎所致神经源性膀胱一例报告

带状疱疹性骶髓炎所致神经源性膀胱临床罕见,本院收治1例,男性,年龄86岁,以带状疱疹感染后排尿困难、排便功能异常6个月就诊,行骶神经调控手术。永久刺激器植入术后随诊3个月患者排尿困难症状及粪失禁症状消失,恢复控尿功能。     

糖尿病神经源性膀胱尿道功能障碍的尿动力学改变与治疗

糖尿病神经源性膀胱尿道功能障碍(Neuropathic vesicourethral dysfunction of diabetic。NVUDD)症状多样，因病情发展阶段而不同，主要表现为排尿量、排尿次数改变、排尿困难、残余尿增多与尿潴留，以及上尿路损害及尿道感染。NVUDD作为糖尿病患者的泌尿系统并发症，因诱发尿路逆行感染以及肾脏并发症，给患者的日常工作、生活造成严重的影响。因此，研究NVUDD患者的尿动力学改变，通过治疗促进其改善，是目前的热点课题。本文对之作一概述。     

神经移植术治疗截瘫神经性膀胱的尿动力学观察

目的　评价神经转位移植术治疗陈旧性截瘫神经性膀胱病人的手术效果。　方法　回顾性分析40例胸腰段骨折致截瘫神经性膀胱病人肋间血管神经转位桥接骶神经根35例、尺神经转位吻合阴部神经5例手术前后尿动力学检测结果。　结果　骶根组35例术前最大尿流率(Qmax)均低于正常,术后20例恢复正常（57%）,10例明显改善(28.6%),术前后逼尿肌最大收缩力分别为（60±15cmH     

膀胱腹直肌间置术治疗逼尿肌无反射性神经源性膀胱

目的：评价膀胱腹直肌间置术治疗神经源性膀胱的临床效果。方法：通过尿动力学检查选择逼尿肌无反射性膀胱患者8例,通过手术将膀胱置于腹直肌及其前后鞘之间,观察手术后患者症状、排尿情况及残余尿量的改变。结果：手术后62．5％的患者可自行排尿,症状好转或消失;手术后残余尿量较手术前有显著性减少。结论：膀胱腹直肌间置术是治疗神经源性膀胱的有效方法之一,有利于患者的康复。     

Early predictors of bladder recovery and urodynamics after spinal cord injury

Our purpose was to determine if intact perianal (S4–5) pin sensation (PPS) and bulbocavernosus (S2–4) reflex (BCR) shortly after spinal cord injury (SCI) are predictive of bladder function recovery. Twenty-eight SCI patients (aged 18–68 years, Frankel Classification A–D, spinal injury level C4–T12), admitted within 72 hours of injury, underwent evaluation of initial PPS and BCR. The presence of intact PPS and BCR were correlated with the patient's voiding function and urodynamic evaluation results 1 year postinjury. Of the 28 patients within 72 hours of SCI, PPS was intact in 17 (60%) and absent in 11 (40%), while 15 patients (54%) demonstrated a positive BCR and 13 (46%) did not. One year after SCI, no patient with absent PPS voided unassisted, while of the 17 patients with preserved PPS, 11 (65%) were voiding spontaneously. Of these 11 patients, urodynamic evaluation revealed detrusor areflexia in 1 (9%), normal detrusor function in 2 (18%), and detrusor hyperreflexia in 8 (73%), with 3 of these 8 patients (38%) also demonstrating detrusor-sphincter dyssynergia. At 1 year postinjury, only 2 of 13 patients (15%) with an absent BCR voided spontaneously, while 9 of 15 patients (60%) with an intact BCR were able to void. Although PPS and BCR are moderately sensitive in predicting the return of spontaneous voiding, they cannot predict detrusor hyperreflexia and sphincter dyssynergia. Therefore, urodynamic study remains an essential component of initial urologic evaluation after SCI. Neurourol. Urodynam. 17:25–29, 1998. © 1998 Wiley-Liss, Inc.     

Sexual activity in Korean male patients on clean intermittent catheterization with neurogenic bladder due to spinal cord injury

BACKGROUND: The aim of this study was to assess the sexual function and activity in male patients on clean intermittent catheterization with neurogenic bladder due to spinal cord injury. METHODS: Eighty-nine patients (mean age 37.6 years with a range of 18-66) were included in the study. We requested all subjects to complete a questionnaire including the 5-item version of the International Index of Erectile Function (IIEF-5). RESULTS: Of 89 patients, 60 (67.4%) reported having attempted no sexual intercourse over the past 6 months and 28 (31.5%) presented with IIEF-5 scores less than or equal to 21 points. When subjects were stratified according to the years since injury, 50.0% (16 of 32) with less than 2 years post-injury had no sexual activity, while 77.2 (44 of 57) with 2 years or more post-injury did (P = 0.027). Patients with sexual activity were 40.4% (23 of 57) and 18.8% (6 of 32) in patients who were able and unable to perform self-catheterization, respectively (P = 0.037). Patients with less than 2 years post-injury had 3.3-fold higher risk (odds ratio 3.33; 95% confidence interval 1.01-10.97; P = 0.048) of no sexual activity than those with 2 years or more post-injury on the multivariate model. The other parameters were not appreciably related to sexual activity. CONCLUSION: Our results demonstrate that sexual activity as well as erectile function is poor in this population. In addition, our findings suggest that years since injury may influence sexual activity of patients with spinal cord injury.     

The role of the mucosa in modulation of evoked responses in the spinal cord injured rat bladder

Aims

Mounting evidence indicates that a variety of factors released from the urothelium or suburothelium can modulate smooth muscle activity. Although the relationship between the mucosa and smooth muscle has been investigated, little is known about the pathophysiologic changes in detrusor‐mucosa interactions in neurogenic bladders. The goal of the study was to determine the impact of the mucosa on evoked responses in spinal cord injured (SCI) bladders.

Methods

Urinary bladders were obtained from 6wk SCI rats or age‐matched uninjured controls. Ex vivo isometric tension studies were performed and muscarinic receptor expression was measured in bladder tissue with and without mucosa.

Results

The magnitude and area of nerve evoked responses in SCI tissue with mucosa was higher than without mucosa. The duration and decay time of nerve‐evoked responses were longer in SCI than control tissue irrespective of the mucosa. The level of the muscarinic M₂ receptor was decreased in the mucosa of SCI bladders.

Conclusions

Detrusor‐mucosa interactions are substantially altered in the neurogenic bladder. After spinal cord injury, an excitatory modulation of smooth muscle contraction by the mucosa emerges, and could be targeted via intravesical treatment in the context of neurogenic bladder dysfunction.     

Early sacral neuromodulation ameliorates urinary bladder function and structure in complete spinal cord injury minipigs

Aims

To determine the effects of early sacral neuromodulation (SNM) and pudendal neuromodulation (PNM) on lower urinary tract (LUT) function, minipigs with complete spinal cord injury (cSCI) were analyzed. SNM and PNM have been proposed as therapeutic approaches to improve bladder function, for example after cSCI. However, further evidence on efficacy is required before these methods can become clinical practice.

Methods

Eleven adults, female Göttingen minipigs with cSCI at vertebral level T11-T12 were included: SNM (n = 4), PNM (n = 4), and SCI control (SCIC: n = 3). Tissue from six healthy minipigs was used for structural comparisons. Stimulation was started 1 week after cSCI. Awake urodynamics was performed on a weekly basis. After 16 weeks follow-up, samples from the urinary bladder were taken for analyses.

Results

SNM improved bladder function with better capacities and lower detrusor pressures at voiding and avoided the emergence of detrusor sphincter dyssynergia (DSD). PNM and untreated SCI minipigs had less favorable outcomes with either DSD or constant urinary retention. Structural results revealed SCI-typical fibrotic alterations in all cSCI minipigs. However, SNM showed a better-balanced distribution of smooth muscle to connective tissue with a trend towards the reduced progression of bladder wall scarring.

Conclusion

Early SNM led to an avoidance of the emergence of DSD showing a more physiological bladder function during a 4 month follow-up period after cSCI. This study might pave the way for the clinical continuation of early SNM for the treatment of neurogenic LUT dysfunction after SCI.

     

光感基因调控技术对大鼠骶上脊髓损伤后膀胱尿动力学和肌电图的影响

目的观察光感基因调控技术对大鼠骶上脊髓损伤所致神经源性膀胱功能的影响。方法 50只大鼠经尿流动力学检查无异常后进行随机分组,并采用T10脊髓完全横断建立脊髓损伤动物模型,分为假手术对照组、脊髓损伤无蓝光刺激组和脊髓损伤蓝光刺激组。2周后进行膀胱尿动力学、肌电图测定。结果脊髓损伤蓝光刺激组大鼠膀胱逼尿肌肌条舒缩曲线大部分可见规律性变化,波形均匀一致;同时膀胱最大容量增加,内压降低,顺应性升高;而脊髓损伤无蓝光刺激组无上述变化。结论光感基因可以调节骶上脊髓完全性损伤后膀胱逼尿肌的收缩功能,对神经源性膀胱功能恢复有重要意义。