Urology Journal

ISSN: 1735-1308

2019

Association between Hyposensitivity of C-fiber Afferents at The Proximal Urethra and Storage/voiding Dysfunction in Female Patients with Detrusor Overactivity

Urology Journal, 2019, 5 January 2019 , Page 5515-5515
https://doi.org/10.22037/uj.v16i7.5515

Abstract

Purpose: We examined the associations between urethral sensation and storage/voiding function in female patients with detrusor overactivity (DO) by measuring urethral current perception threshold (CPT).

Materials and Methods: We retrospectively investigated the medical records of 27 consecutive patients with lower urinary tract symptoms who underwent cystometry, uroflowmetry (UFM), and urethral CPT tests from 2000 to 2015. Patients were classified into 2 groups: with/without DO. Seven DO-negative cases were selected as normal controls on cystometrogram (CMG) matching the inclusion criteria: bladder compliance ?12.5 mL/cmH2O, volume <275 mL at first sensation, and no comorbidities possibly influencing micturition. Finally, 17 patients were included. Urethral CPT was evaluated with intraurethral square-wave impulses at 3 Hz to stimulate C-fibers. Urethral loss coefficient (LC), reflecting urethral resistance during voiding, was calculated by curve-fitting a mathematical model to a UFM waveform.

Results: Urge incontinence (UI) was observed in 7 DO-positive patients, but not in those with normal CMG. Urethral CPT and LC were significantly higher in patients with DO than in those with normal CMG. Median urethral CPT significantly increased in patients with both DO and UI than in those without these symptoms (p<0.005). CPT values were correlated with the volume at first sensation (?=0.53, p<0.05) and LC (?=0.59, p<0.05). LC was not calculated in 3 cases due to poor curve-fitting.

Conclusions: In females, urethral C-fiber afferents may become hyposensitive as the detrusor becomes overactive with UI in the storage phase. During voiding, C-fiber hyposensitivity may relate to increased functional resistance of the urethra to urine outflow.
Keywords:
  • current perception test
  • C-fiber
  • cystometry
  • detrusor overactivity
  • female
  • loss coefficient
  • urethra
  • uroflowmetry

References

Merrill L, Gonzalez EJ, Girard BM, Vizzard MA. Receptors, channels, and signalling in the urothelial sensory system in the bladder. Nat Rev Urol. 2016;13:193-204.

de Groat WC, Griffiths D, Yoshimura N. Neural control of the lower urinary tract. Compr Physiol. 2015;5:327-96.

Andersson KE, Wein AJ. Pharmacology of the lower urinary tract: basis for current and future treatments of urinary incontinence. Pharmacol Rev. 2004;56:581-631.

Irwin DE, Milsom I, Hunskaar S, et al. Population-based survey of urinary incontinence, overactive bladder, and other lower urinary tract symptoms in five countries: results of the EPIC study. Eur Urol. 2006;50:1306-14.

Wyndaele JJ. Investigating afferent nerve activity from the lower urinary tract: highlighting some basic research techniques and clinical evaluation methods. Neurourol Urodyn. 2010;29:56-62.

Abrams P, Cardozo L, Fall M, et al. The standardisation of terminology of lower urinary tract function: report from the Standardisation Sub-committee of the International Continence Society. Neurourol Urodyn. 2002;21:167-78.

Knupfer SC, Liechti MD, Gregorini F, De Wachter S, Kessler TM, Mehnert U. Sensory function assessment of the human male lower urinary tract using current perception thresholds. Neurourol Urodyn. 2017;36:469-73.

Kenton K, Lowenstein L, Simmons J, Brubaker L. Aging and overactive bladder may be associated with loss of urethral sensation in women. Neurourol Urodyn. 2007;26:981-4.

Ichiyanagi O, Nagaoka A, Naito S, et al. Possible role of hyposensitivity of C-fiber afferents at the proximal urethra in the development of urge urinary incontinence in patients with detrusor overactivity. Low Urin Tract Symptoms. 2019;11:O21-O7.

Weld KJ, Graney MJ, Dmochowski RR. Differences in bladder compliance with time and associations of bladder management with compliance in spinal cord injured patients. J Urol. 2000;163:1228-33.

Kenton K, Lowenstein L, Brubaker L. Tolterodine causes measurable restoration of urethral sensation in women with urge urinary incontinence. Neurourol Urodyn. 2010;29:555-7.

De Laet K, De Wachter S, Wyndaele JJ. Current perception thresholds in the lower urinary tract: Sine- and square-wave currents studied in young healthy volunteers. Neurourol Urodyn. 2005;24:261-6.

Nishimoto K, Yasuda K, Nishikawa K, Yoneda Y, Yamanishi T, Nakatani T. Non-invasive estimation of intraurethral pressure profile from uroflowmetric curve. Int J Urol. 2004;11:885-9.

Nishimoto K, Tashiro K, Yoshida N, et al. Study on the relation of the shape of the uroflowmetrogram and the urethral loss coefficient calculated from the uroflowmetrogram. Hinyokika Kiyo. 2006;52:7-10.

Nishimoto K, Nishio S, Hayahara N. Approximation of uroflowmetrograms using micturition model. Hinyokika Kiyo. 1995;41:27-32.

Wyndaele JJ, Van Meel TD, De Wachter S. Detrusor overactivity. Does it represent a difference if patients feel the involuntary contractions? J Urol. 2004;172:1915-8.

Lee SR, Kim HJ, Kim A, Kim JH. Overactive bladder is not only overactive but also hypersensitive. Urology. 2010;75:1053-9.

Kinn AC, Nilsson BY. Urethral sensitivity in incontinent women. Eur Urol. 2005;48:116-20.

Kessler TM, Studer UE, Burkhard FC. Increased proximal urethral sensory threshold after radical pelvic surgery in women. Neurourol Urodyn. 2007;26:208-12.

Van Meel TD, Wyndaele JJ. Reproducibility of electrical sensory testing in lower urinary tract at weekly intervals in healthy volunteers and women with non-neurogenic detrusor overactivity. Urology. 2012;79:526-31.

Lee WC, Wu HP, Tai TY, Yu HJ, Chiang PH. Investigation of urodynamic characteristics and bladder sensory function in the early stages of diabetic bladder dysfunction in women with type 2 diabetes. J Urol. 2009;181:198-203.

Yokoyama O, Miwa Y, Oyama N, et al. Urethral Sensations are Related to the Development of Detrusor Overactivity. Low Urin Tract Symptoms. 2011;3:59-63.

Snellings AE, Yoo PB, Grill WM. Urethral flow-responsive afferents in the cat sacral dorsal root ganglia. Neurosci Lett. 2012;516:34-8.

Combrisson H, Allix S, Robain G. Influence of temperature on urethra to bladder micturition reflex in the awake ewe. Neurourol Urodyn. 2007;26:290-5.

Peng CW, Chen JJ, Cheng CL, Grill WM. Role of pudendal afferents in voiding efficiency in the rat. Am J Physiol Regul Integr Comp Physiol. 2008;294:R660-72.

Jung SY, Fraser MO, Ozawa H, et al. Urethral afferent nerve activity affects the micturition reflex; implication for the relationship between stress incontinence and detrusor instability. J Urol. 1999;162:204-12.

Shafik A, Shafik AA, El-Sibai O, Ahmed I. Role of positive urethrovesical feedback in vesical evacuation. The concept of a second micturition reflex: the urethrovesical reflex. World J Urol. 2003;21:167-70.

Yoo PB, Horvath EE, Amundsen CL, Webster GD, Grill WM. Multiple pudendal sensory pathways reflexly modulate bladder and urethral activity in patients with spinal cord injury. J Urol. 2011;185:737-43.

Chen JL, Chen CY, Kuo HC. Botulinum toxin A injection to the bladder neck and urethra for medically refractory lower urinary tract symptoms in men without prostatic obstruction. J Formos Med Assoc. 2009;108:950-6.

Schäfer W, Abrams P, Liao L, et al. Good urodynamic practices: uroflowmetry, filling cystometry, and pressure-flow studies. Neurourol Urodyn. 2002;21:261-74.

  • Abstract Viewed: 0 times
  • Just Accepted/5515 Downloaded: 0 times

Download Statastics

Browse