Publications by authors named "Limin Liao"

76 Publications

Current Applications and Future Directions of Bioengineering Approaches for Bladder Augmentation and Reconstruction.

Front Surg 2021 18;8:664404. Epub 2021 Jun 18.

Department of Urology, China Rehabilitation Research Center, Rehabilitation School of Capital Medical University, Beijing, China.

End-stage neurogenic bladder usually results in the insufficiency of upper urinary tract, requiring bladder augmentation with intestinal tissue. To avoid complications of augmentation cystoplasty, tissue-engineering technique could offer a new approach to bladder reconstruction. This work reviews the current state of bioengineering progress and barriers in bladder augmentation or reconstruction and proposes an innovative method to address the obstacles of bladder augmentation. The ideal tissue-engineered bladder has the characteristics of high biocompatibility, compliance, and specialized urothelium to protect the upper urinary tract and prevent extravasation of urine. Despite that many reports have demonstrated that bioengineered bladder possessed a similar structure to native bladder, few large animal experiments, and clinical applications have been performed successfully. The lack of satisfactory outcomes over the past decades may have become an important factor hindering the development in this field. More studies should be warranted to promote the use of tissue-engineered bladders in clinical practice.
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http://dx.doi.org/10.3389/fsurg.2021.664404DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8249581PMC
June 2021

Intermediate-term results of a prospective, multicenter study on remote programming sacral neuromodulation for refractory overactive bladder.

Transl Androl Urol 2021 May;10(5):1966-1975

Urology Department, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences Beijing, China.

Background: To evaluate the efficacy and safety of a novel remote programming sacral neuromodulation (SNM) system (BetterStim system) in the treatment of patients with refractory overactive bladder (OAB) for 3 years.

Methods: A total of 8 centers in China enrolled 84 patients with OAB. Following test stimulation 70 patients underwent implantation using BetterStim. All patients returned for follow-up at 3 and 6 months postoperatively. After that, the visits were conducted by telephone. Outcomes of voiding diaries, the overactive bladder symptom score (OABSS), questionnaires regarding OAB-related quality of life (OAB-qol), and adverse events (AEs) were evaluated at each visit. The clinical therapeutic success was defined as ≥50% improvement from baseline in any of the voiding diary variables or average voids/day return to normal voiding (<8 voids/day). The analysis is a modified Completers analysis.

Results: At the 36-month follow-up, the success rate was 79% for overall OAB symptoms, 69% for urge urinary incontinence (UUI) and 42% for urgency frequency (UF). The average number of voids/day decreased from 29.2±14.9 at baseline to 17.6±11.2 at 3 years, the average volume/void increased from 94.7±54.2 to 151.4±80.8 mL, the urgency reduced from 3.0±1.4 to 1.8±1.7 (all P<0.001). For patients with urge incontinence, mean leaking episodes/day decreased from 8.1±7.6 at baseline to 2.1±3.5 at three years (P<0.05). The devices were explanted in 8 (11.4%) patients. There were no remote programming-related AEs or device-related serious AEs that occurred.

Conclusions: The Intermediate-term results demonstrated that BetterStim SNM system with remote programming is safe and effective for patients with refractory OAB.
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http://dx.doi.org/10.21037/tau-21-43DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8185673PMC
May 2021

Regional activity and functional connectivity in brain networks associated with urinary bladder filling in patients with tethered cord syndrome.

Authors:
Yi Gao Limin Liao

Int Urol Nephrol 2021 Jun 21. Epub 2021 Jun 21.

Department of Urology, China Rehabilitation Research Centre, No 10. Jiaomen Beilu, Fengtai District, Beijing, 100068, China.

Purpose: Abnormal neural activities can be revealed by resting-state functional magnetic resonance imaging using analyses of regional activity and functional connectivity of brain networks. This study was designed to demonstrate functional network alterations in patients with detrusor overactivity.

Materials And Methods: In this study, we recruited 36 patients with tethered cord syndrome who had detrusor overactivity and 34 normal controls. We used regional homogeneity and seed-based functional connectivity computational methods to reveal resting-state brain activity features associated with patients.

Results: Compared with normal controls, patients with tethered cord syndrome showed regional abnormalities, mainly in the bilateral frontal cortex, anterior and midcingulate cortex, and temporal lobes. When these regions were defined as seeds, we demonstrated widespread modification in brain networks. The brain-bladder network was not positively connected with the cognitive control network. Both altered regional activity and changed functional connectivity were found in the brain-bladder network.

Conclusion: Patients with NDO, activated areas in the frontal lobe and anterior cingulate gyrus decreased significantly and have fewer brain activation areas in the caudate nucleus and hypothalamus (limbic system). In functional connectivity work, we found a small positive correlation in different regions of frontal lobe. This study helped us better to understand the characteristics of neural network modifications in patients with tethered cord syndrome.
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http://dx.doi.org/10.1007/s11255-021-02880-0DOI Listing
June 2021

Abnormal functional connectivity within the prefrontal cortex in interstitial cystitis/bladder pain syndrome (IC/BPS): A pilot study using resting state functional near-infrared spectroscopy (rs-fNIRS).

Neurourol Urodyn 2021 Aug 15;40(6):1634-1642. Epub 2021 Jun 15.

School of Rehabilitation, Capital Medical University, Beijing, China.

Purpose: To investigate the abnormalities of functional connectivity (FC) within the prefrontal cortex (PFC) of patients with interstitial cystitis/bladder pain syndrome (IC/BPS) based on resting state functional near-infrared spectroscopy (rs-fNIRS) data using FC matrix analysis.

Materials And Methods: Ten patients with IC/BPS (females, 9; mean age, 56.9 ± 12.432 years) and 15 age- and gender-matched healthy controls (HC) (females, 12; mean age, 55.067 ± 7.46 years) participated in this rs-fNIRS study. Two rs-fNIRS scans were performed (when the bladder was empty and when the desire to void was strong). The Pearson's correlation coefficient between the time series of the 22 channels was calculated to obtain a 22 × 22 FC matrix for each subject. A two-sample t-test (p < .05) was performed to compare group differences in the FC matrix between patients with IC/BPS and HC.

Results: FC was significantly decreased within the PFC in the IC/BPS group based on a two-sample t-test (p < .05) compared with HC. FC decreased in a wider range of brain regions during the strong desire to void state (4 brain regions and 28 edges) when compared with the empty bladder state (3 brain regions and 18 edges).

Conclusion: FC abnormalities in IC/BPS patients may lead to frontal lobe disorders involved in processing sensory integration, motivation drive, emotional control, and decision-making whether to urinate, leading to urinary control dysfunction manifested as typical clinical IC/BPS symptoms. Our results may provide new insight into the pathogenesis of IC/BPS and new brain biomarkers for diagnosis.
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http://dx.doi.org/10.1002/nau.24729DOI Listing
August 2021

Risk Factors Predicting Upper Urinary Tract Damage in Patients With Myelodysplasia: Data Analysis of 637 Cases From a Single Center.

Int Neurourol J 2021 May 14. Epub 2021 May 14.

Department of Urology, China Rehabilitation Research Center, Rehabilitation School of Capital Medical University, Beijing, China.

Purpose: To determine the risk factors predicting upper urinary tract (UUT) damage using a grading system for upper urinary tract dilation (UUTD) and a descriptive system for all urinary tract dysfunction (AUTD) in patients with myelodysplasia.

Methods: Six hundred thirty-seven patients with myelodysplasia were evaluated at our center from January 2008 to November 2019. Clinical data, ultrasonography, magnetic resonance urography (MRU), and video-urodynamics (VUDS) parameters were collected. Univariate and multivariate analyses were used to determine the risk factors predicting UUT damage.

Results: Three hundred eighty-three males and 254 females were included. The average course of lower urinary tract symptoms (LUTS) was 14.08±7.07 years (range, 3-31 years). The urodynamic diagnoses of all patients were as follows: detrusor overactivity (DO), 26.8%; detrusor underactivity (DU), 6.44%; and acontractile detrusor (AcD), 66.72%%. UUT damage was determined in 66.56% of the patients. Of the patients, 28.73 % had vesicoureteral reflux (VUR) during filling (bilateral, n=50; unilateral, n=133) on fluoroscopy during VUDS testing. Two hundred thirty-four patients had UUTD (bilateral, n=203; unilateral, n=31). The occurrence of hydronephrosis based on ultrasonography was closely related to ipsilateral VUR (P<0.05). Absent of bladder sensation, long-term course of LUTS, decreased maximum cystometric capacity (MCC) and bladder compliance (BC), and increased post-void residual urine (PVR) were shown to be independent risk factors in logistic regression analysis.

Conclusions: This retrospective study using UUTD and AUTD systems indicated that patients with myelodysplasia have a high incidence of UUT damage. Absence of bladder sensation, long-term course of LUTS, decreased MCC and BC, and increased PVR were independent risk factors predicting UUT damage.
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http://dx.doi.org/10.5213/inj.2040468.234DOI Listing
May 2021

Lower Urinary Tract Function in Patients with Inflammatory Encephalomyelopathy: Characteristics of Urodynamics, Neurological Deficits and Magnetic Resonance Imaging.

Urology 2021 May 12. Epub 2021 May 12.

Department of Urology, China Rehabilitation Research Center; Department of Urology of Capital Medical University. Electronic address:

Objective: To report the clinical data in a large population of patients affected by inflammatory encephalomyelopathy.

Material And Methods: We retrospectively reviewed the medical history, imaging studies and urodynamic findings in a series of 87 consecutive patients with inflammatory encephalomyelopathy. Age at disease onset ranged from 3 to 76 years with an average of 35.4 years. The type of bladder dysfunction, neurological impairment and spinal magnetic resonance imaging were assessed. Upper urinary tract was evaluated. The urological complications and subsequent management were reported.

Results: The mean follow-up was 3.0 years (range from 0.5 to 6.6 yrs). Initial evaluation revealed detrusor overactivity in 53 patients (61.1%), detrusor underactivity in 34 patients (39.1%), detrusor leak point pressure greater than 40 cm water and decreased compliance in 29.9% of patients. At the latest follow-up, a total of 64 patients (73.6%) had persistent bladder dysfunction requiring treatment, mainly presenting as urinary incontinence and incomplete bladder emptying. Around 18.8% patients (13/69) experienced upper urinary tract changes. The location of spinal lesions may correspond with the type of bladder dysfunction. Higher abnormal sensory levels are associated with poor bladder recovery.

Conclusion: Persistent bladder dysfunction is common in inflammatory encephalomyelopathy and tend to change with the progression of disease. Evaluation must be instituted at early onset of the disease and ongoing surveillance should be offered through the entire disease process. Management can be tailored individually to the urodynamic findings for optimal preservation of bladder and renal function.
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http://dx.doi.org/10.1016/j.urology.2021.03.047DOI Listing
May 2021

Sacral Neuromodulation in Patients With Neurogenic Lower Urinary Tract Dysfunction: A Multicenter Retrospective Study From China.

Neuromodulation 2021 Apr 28. Epub 2021 Apr 28.

Department of Urology, China Rehabilitation Research Centre, School of Rehabilitation, Capital Medical University, Beijing, China.

Objectives: This retrospective study aimed to determine the effectiveness of sacral neuromodulation (SNM) on neurogenic lower urinary tract dysfunction (NLUTD) and analyze the predictive factors.

Materials And Methods: From January 2012 to January 2020, 152 subjects with NLUTD from four medical centers in China received SNM test stimulation. Subjects were assessed via bladder diaries, postvoid residual volumes (PRVs) and neurogenic bowel dysfunction (NBD) scores before and during the testing period. Patients who showed a minimum 50% improvement in symptoms through the SNM test phase were eligible for permanent SNM implantation.

Results: The pooled success rate for chronic urinary retention was 31.0% (40/129), which was significantly lower (p < 0.05) than the rates for frequency-urgency (64.8%, 59/91), urinary incontinence (65.2%, 30/46), and NBD score (61.7%, 82/133). The results of the risk factor analysis showed that the urinary storage symptom was a statistically significant positive predictor (p = 0.001).

Conclusions: In conclusion, SNM is an effective and reliable method for treating NLUTD, especially in patients with urinary storage symptoms. Although not all of the symptoms in every patient can be resolve, SNM still might be a superior choice together with other treatment procedures.
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http://dx.doi.org/10.1111/ner.13383DOI Listing
April 2021

Frequency-Dependent Effects on Bladder Reflex by Saphenous Nerve Stimulation and a Possible Action Mechanism of Tibial Nerve Stimulation in Cats.

Int Neurourol J 2021 Jun 4;25(2):128-136. Epub 2021 Feb 4.

Department of Urology, Rehabilitation School of Capital Medical University, China Rehabilitation Research Center, Beijing, China.

Purpose: The present study determined the effects of saphenous nerve stimulation (SNS) at different stimulation frequencies on bladder reflex and explored a possible action mechanism of tibial nerve stimulation (TNS) on bladder activity in cats.

Methods: Two bipolar nerve cuff electrodes were implanted on the saphenous nerve and the contralateral tibial nerve in 13 cats, respectively. Multiple cystometrograms were obtained to determine the effects of single SNS at different frequencies and that of combined SNS and TNS on the micturition reflex by infusing normal saline.

Results: SNS at 1 Hz significantly reduced the bladder capacity (BC) to 59.8%±7.7% and 59.3%±5.8% of the control level at the intensity threshold (T) and 2T, respectively (P<0.05), while that at 20 Hz significantly increased the BC to 130.6%±4.2% of the control level at 6T (P<0.05). The TNS and SNS at 20 Hz did not significantly change the BCs at 1T (P>0.05), while combined stimulation at 1T significantly increased the BC to 122.7%±1.9% of the control level and induced an inhibitory effect which was similar to that TNS at 2T.

Conclusion: The current study revealed that SNS reduced and increased BC depending on different stimulation frequencies. The combined SNS and TNS maximized the clinical efficacy at a low intensity. Also, SNS may be a potential therapeutic mechanism of TNS.
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http://dx.doi.org/10.5213/inj.2040304.152DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8255824PMC
June 2021

The Effect of Sacral Neuromodulation in Ambulatory Spina Bifida Patients with Neurogenic Bladder and Bowel Dysfunction.

Urology 2021 Jul 6;153:345-350. Epub 2021 Feb 6.

Department of Urology, China Rehabilitation Research Center, Beijing China; Department of Urology, Capital Medical University, Beijing China.

Objective: To assess the effect of sacral neuromodulation (SNM) in ambulatory spina bifida patients with neurogenic bladder and bowel dysfunction.

Materials And Methods: We retrospectively reviewed the records of 29 ambulatory spina bifida patients with neurogenic bladder and bowel dysfunction who underwent SNM testing from July 2012 to January 2020. Clinical data and video-urodynamic parameters were collected and compared using the t-test and the chi-square test. The potential risk factors were considered by logistic regression analysis. P < .05 was considered significant.

Results: In the test phase, 21 patients (72.4%) achieved successful improvement of at least 1 symptom. The success rate for chronic urinary retention (26.09%) was significantly lower (P <.05) than that for urgency-frequency syndrome (58.82%) and urinary incontinence (56.25%). The mean neurogenic bowel dysfunction score decreased from 13.3±6.29 to 6.9±5.09 (P <.0001). The urodynamic evaluation showed a significant improvement in the mean maximum cystometric capacity, compliance, and maximum detrusor pressure (P <.05). Implantation was performed in 16 cases (55.17%). The analysis of the risk factors showed that chronic urinary retention was a statistically significant variable (P <.05). No complications were reported in the test phase. The average follow-up time was 41.19±33.06 months. Two patients changed to intermittent catheterization, and 2 patients changed to augmentation cystoplasty.

Conclusion: SNM is effective for neurogenic bladder and bowel dysfunction in patients with ambulatory spina bifida, especially in those without chronic urinary retention. And SNM can also significantly improve the urodynamic parameters of these patients during the storage period.
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http://dx.doi.org/10.1016/j.urology.2020.11.075DOI Listing
July 2021

Responses of functional brain networks to bladder control in healthy adults: a study using regional homogeneity combined with independent component analysis methods.

Int Urol Nephrol 2021 May 1;53(5):883-891. Epub 2021 Feb 1.

School of Rehabilitation, Capital Medical University, Department of Urology of Capital Medical University, Beijing, China.

Objective: A functional magnetic resonance imaging (fMRI) study was performed during urodynamic examination in healthy adults to determine the responses of functional brain networks to bladder control during urine storage.

Methods: The brain imaging was performed in empty and full bladder states during urodynamic examination. First, we used independent component analysis (ICA) to obtain several resting state network masks, then the brain regions with significantly different regional homogeneity (ReHo) values between the two states were determined using a paired t test (p < 0.05; Gaussian random field correction [GRF]: voxel p < 0.01 and cluster p < 0.05) and presented in their corresponding resting state network (RSN) masks.

Results: Data sets obtained from the remaining 20 subjects were analyzed after motion correction. Nine RSNs were identified by group-ICA, including the salience network (SN), default mode network (DMN), central executive network (CEN), dorsal attention network (dAN), auditory network (AN), sensorimotor network (SMN), language network (LN), visual network (VN), and cerebellum network (CN). The ReHo values were significantly increased (p < 0.05, GRF corrected) within the SN, DMN, and CEN in the full bladder state compared with the empty bladder state.

Conclusion: Significant changes within the three functional brain networks were demonstrated when the bladder was full, suggesting that SN provides bladder sensation and DMN may provide self-reference, self-reflection, and decision-making about whether to void after assessment of the external environment, while CEN may provide support related to episodic memory, which provides new insight into the processing of bladder control and could serve as a premise to further explore the pathologic process underlying bladder dysfunction.
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http://dx.doi.org/10.1007/s11255-020-02742-1DOI Listing
May 2021

The Video-Urodynamic and Electrophysiological Characteristics in Patients With Traumatic Spinal Cord Injury.

Int Neurourol J 2021 Jan 27. Epub 2021 Jan 27.

Department of Urology, China Rehabilitation Research Centre, Rehabilitation School of Capital Medical University, Beijing, China.

Purpose: To investigate the video-urodynamic and pelvic floor electrophysiological characteristics in patients with traumatic spinal cord injury.

Methods: This retrospective reviewed the clinical records, urodynamic and pelvic floor electrophysiological data of 647 patients with traumatic spinal cord injury (SCI) and out of spinal shock. Patients were classified based on American Spinal Injury Association (ASIA) Impairment Scale and urodynamic findings.

Results: Of the 647 patients, detrusor overactivity (DO) with or without detrusor sphincter dyssynergia (DSD) was found in 79.5%, 61%, 35.2%, 35%, and 19.2% of patients with cervical, thoracic (T1-9), thoracic (T10-12), lumbar, and conical cauda injury, respectively. Other patients manifested detrusor areflexia (DA). Patients with DO and/or DSD had a longer duration of SCI at each injury level than patients with DA. In suprasacral injury patients with DA, 63.0% (58/92) had a normal bulbocavernosus reflex (BCR) response. Compared with patients without bladder sensation, bladder capacity during urine leakage was far higher in those with bladder sensation. The manifestation of BCR and somatosensory-evoked potential (SEP) was associated with the level of injury.

Conclusions: This study showed a significant correlation between the level of SCI and video-urodynamic findings, but clinical examination cannot by predict bladder function; urodynamic testing is also necessary. In addition, the role of BCR and SEP for guiding bladder management is limited. Moreover, bladder sensation is important for urinary control in patients with traumatic SCI.
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http://dx.doi.org/10.5213/inj.2040376.188DOI Listing
January 2021

Influence of patient sex on the effectiveness of sacral neuromodulation: A cohort study from China.

Int J Surg 2020 Dec 17;84:13-17. Epub 2020 Oct 17.

Department of Urology, West China Hospital, Sichuan University, Chengdu, 610000, China.

Background: Sacral neuromodulation (SNM) has been widely used to treat lower urinary tract dysfunction. Studies have shown a higher conversion rate among female patients than among male patients. However, the influence of gender on the clinical effectiveness of SNM remains unclear. We aimed to confirm whether patients of both genders show similar benefits after SNM treatment.

Materials And Methods: Clinical data of patients with lower urinary tract symptoms associated with pelvic floor dysfunction (overactive bladder, neurogenic bladder, interstitial cystitis/painful bladder syndrome, idiopathic urinary retention) treated with SNM in 10 medical centres in China between January 2012 and December 2016 were retrospectively collected. The patients were classified by gender. Variations in objective (voiding diary) and subjective scores in the baseline, testing, and last follow-up periods were compared. Data were analysed using statistical measures.

Results: The study included 203 patients (93 males, 110 females). There were no statistical differences in baseline information between the two groups, both groups showed improvement over time. Unsatisfactory improvement was observed in the quality of life and sexual life scores of both groups over the entire treatment period (all p>0.05). Although there was a difference in the maximum voiding volume between the groups at baseline, no difference was observed at the last follow-up (p = 0.004, p = 0.044, p = 0.124), unlike in the average volume where a difference was noted at the last follow-up (p = 0.085, p = 0.964, p = 0.031). While there were no differences in quality of life, sexual life, or pelvic pain and urinary urgency frequency scores at baseline, a significant difference was observed at the last follow-up, and the degree of improvement was less among female patients (p = 0.836, p = 0.131, p = 0.015; p = 0.294, p = 0.265, p = 0.013; p = 0.299, p = 0.087, p = 0.015).

Conclusion: SNM treatment elicited a similar effect on patients of both gender; however, a significant difference was observed regarding patient satisfaction with the treatment. Further preoperative patient education, especially, for female patients with interstitial cystitis/painful bladder syndrome may improve patient satisfaction.
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http://dx.doi.org/10.1016/j.ijsu.2020.10.007DOI Listing
December 2020

Inhibitory effects of a minimally invasive implanted tibial nerve stimulation device on non-nociceptive bladder reflexes in cats.

Int Urol Nephrol 2021 Mar 28;53(3):431-438. Epub 2020 Sep 28.

Department of Urology, China Rehabilitation Research Center, Rehabilitation School of Capital Medical University, Beijing, 100068, China.

Objective: The present study investigated the inhibitory effects of a novel minimally invasive implanted tibial nerve stimulation device on non-nociceptive bladder reflexes in cats.

Materials And Methods: A wireless minimally invasive implanted nerve stimulator was implanted adjacent to the left tibial nerve in seven cats. Multiple cystometrograms (CMGs) were obtained to determine the inhibitory effects of tibial nerve stimulation (TNS) at different frequencies and intensities on the micturition reflex by infusing normal saline (NS).

Results: TNS at 6 Hz did not significantly change the bladder capacity (BC) compared to the control level at the intensity threshold (T), while TNS significantly (P < 0.05) increased the BC to 158.89 ± 20.57% of the control level at 2 T. When stimulated at 15 Hz, TNS did not significantly (P > 0.05) change the BCs at 1 T and 2 T.

Conclusions: The minimally invasive implanted TNS device was shown to be effective in inhibiting the micturition reflex under physiologic conditions. Further studies are warranted to determine the inhibitory effects of TNS on nociceptive bladder reflexes.
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http://dx.doi.org/10.1007/s11255-020-02666-wDOI Listing
March 2021

Brain functional network alterations caused by a strong desire to void in healthy adults: a graph theory analysis study.

Neurourol Urodyn 2020 09;39(7):1966-1976

Rehabilitation School of Capital Medical University, Department of Urology of Capital Medical University, Beijing, China.

Purpose: This resting-state functional magnetic resonance imaging (fMRI) study determined the functional connectivity (FC) changes and topologic property alterations of the brain functional network provoked by a strong desire to void in healthy adults using a graph theory analysis (GTA).

Materials And Methods: Thirty-four healthy, right-handed subjects filled their bladders by drinking water. The subjects were scanned under an empty bladder and a strong desire to void states. The Pearson's correlation coefficients were calculated among 90 brain regions in the automated anatomical labeling (AAL) atlas to construct the brain functional network. A paired t test (P < .05, after false discovery rate [FDR] correction) was used to detect significant differences in the FC, topologic properties (small-world parameters [gamma, sigma], C, L, E, E, and E) between the two states in all subjects.

Results: Both the two states showed small-world network properties. The clustering coefficient (C) and local efficiency (E) in the whole brain network decreased, while the FC within the default mode network (DMN) increased during the strong desire to void compared with the empty bladder state. Moreover, an increased nodal efficiency (E) was detected in the basal ganglia (BG), DMN, sensorimotor-related network (SMN), and visual network (VN).

Conclusion: We detected FC changes and topologic property alterations in brain functional networks caused by a strong desire to void in healthy and suggest that the micturition control may be a process dominated by DMN and coordinated by multiple sub-networks (such as, BG, SMN, and VN), which could serve as a baseline for understanding the pathologic process underlying bladder dysfunction and be useful to improve targeted therapy in the future.
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http://dx.doi.org/10.1002/nau.24445DOI Listing
September 2020

Brain functional connectivity during storage based on resting state functional magnetic resonance imaging with synchronous urodynamic testing in healthy volunteers.

Brain Imaging Behav 2021 Jun;15(3):1676-1684

Department of Urology of Beijing Boai Hospital at China Rehabilitation Research Centre, Rehabilitation School of Capital Medical University, No 10. Jiaomen Beilu, Fengtai District, Beijing, 100068, China.

The aim of the study was to elucidate the correlation between spatially distinct brain areas with a full bladder from the perspective of functional connectivity using resting-state functional magnetic resonance imaging (rs-fMRI) with simultaneous urodynamic testing in healthy volunteers. The brain regions with full and empty bladders were reported via rs-fMRI using a 3 T magnetic resonance system. Then, we identified brain regions that are activated during bladder filling by calculating the amplitude of low-frequency fluctuation (ALFF) values using brain imaging software (DPABI and SPM8) and empirically derived six regions of interest (ROI) from analysis of activation were used as seeds for resting-state functional connectivity (rs-FC) analysis with the rest of the brain to examine differences in the two conditions. Statistical analysis was performed with a paired t-test and statistical significance was defined as a P < 0.01. Twenty-two healthy volunteers (11 men and 11 women) 35-64 years of age were enrolled. The rs-fMRI scans of 22 healthy volunteers were analyzed. After motion correction, two subjects were excluded. Meaningful data were obtained on 20 of these subjects. Compared with an empty bladder, functional connection enhancement was noted mainly in the right inferior orbitofrontal cortex and bilateral calcarine gyrus, the left lingual gyrus, left fusiform gyrus, left superior occipital gyrus, right insula, right inferior temporal gyrus, superior parietal lobe, left insula, right lingual gyrus, right fusiform gyrus, left parahippocampal gyrus, right inferior temporal gyrus, superior parietal lobe, left calcarine gyrus, bilateral lingual gyrus, prefrontal cortex, including the middle frontal gyrus and superior frontal gyrus, the right middle temporal gyrus, bilateral posterior cingulate cortex, and right precuneus. The decrease in functional connection was mainly located in the right inferior orbitofrontal cortex, prefrontal cortex, including the superior frontal gyrus, orbitofrontal cortex, and anterior cingulate cortex, the left inferior orbitofrontal cortex, right insula, middle occipital gyrus, angular gyrus, inferior frontal gyrus, right insula, middle temporal gyrus, inferior parietal lobe, middle occipital gyrus, supplementary motor area, superior frontal gyrus, left insula, bilateral posterior cingulate cortex, bilateral precuneus, middle occipital gyrus, and right middle temporal lobe. There were significant changes in the functional connectivity of the brain between full and empty bladders in healthy volunteers, which suggests that the central neural processes involved in storage needs brain areas with integrated control. These findings are strong evidence for physicians to consider brain responses in urine storage and offer the provision of some normative data.
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http://dx.doi.org/10.1007/s11682-020-00362-yDOI Listing
June 2021

[Application and progress of neuromodulation in lower urinary tract dysfunction].

Sheng Wu Yi Xue Gong Cheng Xue Za Zhi 2020 Apr;37(2):211-218

Department of Urology of Capital Medical University, Beijing 100069, P.R.China;China Rehabilitation Research Center, Capital Medical University, Beijing 100068, P.R.China.

For those patients with refractory lower urinary tract dysfunction who are not well treated by traditional therapy such as behavior therapy and drug therapy, neuromodulation technologies have gradually become alternative treatments. Several neuromodulation technologies are also used in animal experimental and clinical scientific research by more and more scholars, in order to find more effective methods and mechanisms of treatment of lower urinary tract dysfunction. This article introduces the principle and advantages of common neuromodulation technologies, which focuses on the application in lower urinary tract dysfunction treatment, and analyzes the direction and the broad prospect of neuromodulation.
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http://dx.doi.org/10.7507/1001-5515.201911078DOI Listing
April 2020

Urodynamic findings during the filling phase in neurogenic bladder patients with or without vesicoureteral reflux who have undergone sacral neuromodulation.

Neurourol Urodyn 2020 06 13;39(5):1410-1416. Epub 2020 Apr 13.

Department of Urology, China Rehabilitation Research Center, Beijing, China.

Aims: To assess the urodynamic findings during the filling phase in neurogenic bladder patients with or without vesicoureteral reflux (VUR) who underwent sacral neuromodulation (SNM).

Methods: We retrospectively reviewed the records of 19 patients with neurogenic lower urinary tract dysfunction (NLUTD) who underwent SNM at our center from July 2018 to July 2019. Clinical data and video-urodynamic parameters were collected. VUR grading systems were used to evaluate upper urinary tract function.

Results: The mean test duration was 24 ± 8.2 days. The urodynamic evaluation showed a significant increase in the mean maximum cystometric capacity (136.3 ± 118.2 vs 216.5 ± 137.8 mL; P = .0071) and compliance (8.7 ± 8.52 vs18.3 + 16.47 mL/H O; P = .016), as well as a decrease in maximum intravesical pressure (57 ± 39.23 vs 36.58 ± 31.16 H O; P = .0064). In the voiding phase, none of the patients had automatic urination at the baseline and testing phases. In 8 of 19 patients who had detrusor overactivity (DO), the DO disappeared (four patients) or was delayed (four patients). The VUR in 3 of 12 ureter units disappeared. The grade of VUR or the volume before VUR improved in 8 ureter units, and the remaining 1 did not change significantly. An implant was performed in 16 cases. After permanent implantation, all patients needed intermittent catheterization to empty the bladder.

Conclusions: This retrospective study indicates that SNM can improve the urinary storage function of the bladder in appropriate patients with NLUTD. For patients with VUR, SNM can cure or reduce VUR by improving DO and bladder compliance.
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http://dx.doi.org/10.1002/nau.24354DOI Listing
June 2020

The prevalence of urinary incontinence in men and women aged 40 years or over in China, Taiwan and South Korea: A cross-sectional, prevalence-based study.

Low Urin Tract Symptoms 2020 Sep 23;12(3):223-234. Epub 2020 Mar 23.

Department of Urology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan.

Objectives: To assess prevalence of urinary incontinence (UI), including urgency UI (UUI), stress UI (SUI) and mixed UI (MUI) in individuals aged ≥40 years in China, Taiwan and South Korea.

Method: This was a post hoc analysis of a cross-sectional, questionnaire-based internet survey. Participants were asked questions relating to urinary symptoms, health-related quality of life (HRQoL) and mental health (using the HRQoL 12-item short form health survey mental health and physical domains, and the Hospital Anxiety and Depression Scale), visits to healthcare professionals (HCPs) for any reason or for urinary symptoms, treatments for urinary symptoms and treatment satisfaction.

Results: Of 8284 survey participants, 1818 (22%) reported any UI (men 17.3%, women 26.4%). MUI was the most prevalent (overall 9.7%, men 6.8%, women 12.6%) followed by SUI (overall 7.9%, men 5.1%, women 10.7%) and UUI (overall 4.3%, men 5.5%, women 3.2%). HRQoL, anxiety and depression scores were poor in all participants with UI; MUI was associated with the worst scores. Of the participants with UI, 46.9% visited HCPs for urinary symptoms (highest proportion [62.7%] among participants with MUI). Approximately 80% of participants with UI followed treatment, with prescribed medicine being the most common form (38.1%). Over half of participants (59.6%) were somewhat, very, or extremely satisfied with their treatment. MUI was associated with least satisfaction.

Conclusion: UI was associated with substantial problems, including an adverse impact on HRQoL. Medication failed to satisfy many individuals with UI. Efforts to educate the public and physicians about the impact of UI could improve diagnosis and treatment rates.
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http://dx.doi.org/10.1111/luts.12308DOI Listing
September 2020

Analysis of the Correlation Between the Clinical Effect of Sacral Neuromodulation and Patient Age: A Retrospective Multicenter Study in China.

Neuromodulation 2020 Dec 20;23(8):1189-1195. Epub 2020 Mar 20.

Department of Urology, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China.

Objectives: This study aimed to evaluate whether patients stratified by age have the same level of benefits after a sacral neuromodulation (SNM) procedure for refractory lower urinary tract dysfunction.

Materials And Methods: This retrospective study comprised 211 patients with refractory lower urinary tract dysfunction who had been treated with SNM and recruited from multiple medical centers across China. Patients were grouped according to age: <40 (n = 58), 40-64 (n = 94), and > 64 (n = 59) years. Data were compared using voiding diaries and subjective scores pre-operatively, post-implantation of a stage I tined lead, and during a short-term follow-up period postimplantation of a stage II implanted pulse generator.

Results: In all groups, voiding diary data and subjective scores improved significantly over different periods. Residual urine improved in the 40-64 and > 64-year-old age groups. Quality of life scores improved in the <40-year-old age group. Voiding diary data among age groups varied at baseline; however, average urinary frequency did not differ at the last follow-up. Urgency and sexual life scores differed at baseline and these differences had resolved at the last follow-up. O'Leary-Sant and Pelvic Pain and Urgency/Frequency Symptoms Scale scores did not differ at baseline; however, significant differences were observed at the last follow-up.

Conclusions: SNM success is unrelated to age, and age alone should not be considered a limiting factor in SNM. For older patients, an overactive bladder appears a better indication for SNM treatment; however, further studies are required to confirm this finding.
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http://dx.doi.org/10.1111/ner.13130DOI Listing
December 2020

Urinary continence outcomes of four years of follow-up and predictors of early and late urinary continence in patients undergoing robot-assisted radical prostatectomy.

BMC Urol 2020 Mar 18;20(1):29. Epub 2020 Mar 18.

Department of Urology, Medical College of People's Liberation Army, Chinese People's Liberation Army General Hospital, No. 28 Fuxing Road, Haidian District, Beijing, 100853, China.

Background: The robot-assisted radical prostatectomy (RARP) has been widely applied in recent years; however, only a few studies are reported about long-term urinary continence after surgery. The present study aimed to examine the outcomes of continence rates (CRs) and determine the risk and protective factors of urinary continence in patients with prostate cancer (PCa) undergoing RARP.

Methods: This retrospective study included 650 patients treated with RARP with perioperative data and at least one year of follow-up from September 2009 to November 2017. Also, the preoperative, intraoperative, and postoperative parameters of the patients were analyzed. Continence was defined as no pad use. Early and late continence was defined as the return of urinary continence within 3 months and beyond 12 months post-surgery, respectively. CRs were examined from 1 to 48 months postoperatively. Logistic regression analysis evaluated the association between the predictive factors and urinary continence in the early and late stages.

Results: No significant difference was detected in the CR from 12 to 48 months postoperatively (P = 0.766). Logistic regression analysis proved that pelvic lymph node dissection (PLND) was a significant risk factor of urinary continence at 1 month. Nerve-sparing (NS) was a significant protective factor of urinary continence at 1, 3, and 6 months. Advanced age was an independent risk factor of urinary continence at 6, 12, and 24 months. Other variables were not statistically significant predictors of urinary continence.

Conclusions: The current results demonstrated that CR gradually improved with time within 1 year and stabilized 1 year after the surgery. PLND, NS, and age were significant determinants of continence in the early and late stages, respectively. These parameters could be used for preoperative identification of patients at high risk and counseling about postoperative expectations for urinary continence.
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http://dx.doi.org/10.1186/s12894-020-00601-wDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7079466PMC
March 2020

Long-term follow-up of neurogenic bladder patients after bladder augmentation with small intestinal submucosa.

World J Urol 2020 Sep 11;38(9):2279-2288. Epub 2019 Nov 11.

Department of Urology, Fengtai District, China Rehabilitation Research Center, 10 JiaomenBeilu, Beijing, 100068, China.

Purpose: To evaluate the long-term effect of using small intestinal submucosa (SIS) for bladder augmentation in patients with neurogenic bladder.

Materials And Methods: A total of 15 patients (age range 14-65 years; mean age 29.6 years) were enrolled in our study. The patients had poor bladder capacity and compliance caused by a neurogenic disorder requiring bladder augmentation. A small intestinal submucosa (SIS) cystoplasty was performed alone or in combination with ureter reimplantation. We prospectively followed the cohort to assess the urodynamics parameters, morphologic changes and patient satisfaction and evaluate the clinical benefit of the SIS procedure in long term. The surgical indications and complications were analyzed.

Results: The duration of follow-up ranged from 4.5 to 8.3 years (mean 6.3 years). Nine patients had expected long-term benefit, leading to an overall success rate of 60%. Two patients experienced immediate failure, and four patients slowed decrease in bladder capacity over time. Compared with the baseline data, there were significant increases in bladder capacity (163.5 ± 80.90-275.6 ± 159.5 ml, p < 0.05) and a significant decrease in maximum detrusor pressure (45.07 ± 29.03-17.60 ± 10.34 cmHO, p < 0.05). Histologic examinations showed a complete conversion of SIS, leaving the urothelial lining and bladder wall containing muscular, vascular, and relatively thick connective tissue. Major complications included vesicoureteral reflux in five patients, bladder stone formation in one patient, and bladder perforation in one patient.

Conclusion: Bladder augmentation with an SIS graft offers a partial long-term success rate in neurogenic bladder patients. This procedure cannot be recommended as a substitute for enterocystoplasty, especially in patients with severe upper urinary tract deterioration and/or bladder fibrosis.
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http://dx.doi.org/10.1007/s00345-019-03008-xDOI Listing
September 2020

Efficacy and safety of botulinum toxin a injection into urethral sphincter for underactive bladder.

BMC Urol 2019 Jul 5;19(1):60. Epub 2019 Jul 5.

Department of Urology, Baotou Central Hospital, Baotou, 014040, China.

Background: The aim of this retrospective study was to evaluate the clinical efficacy and safety of botulinum toxin type A (BTX-A) injection into the urethral sphincter to treat patients with underactive bladder (UAB).

Methods: From September 2012 to December 2018, 35 patients with UAB who presented with dysuria were treated with BTX-A (Prosigne®, Lanzhou Biological Products, Lanzhou, China). All patients were evaluated using the International Continence Society standard for video-urodynamic examination before and 1 month after treatment. The index includes maximum urinary flow rate, detrusor leak point pressure, and maximum urethral pressure. Post-voiding residual urine volume was measured using ultrasound before, one and 3 months post injection.

Results: After 1 month of treatment, the maximum flow rate increased from 2.5 ± 1.1 ml/s to 6.6 ± 1.7 ml/s (P < 0. 05). The maximum urethral pressure decreased from 73.5 ± 5.8 cmHo to 45.6 ± 4.3cmHO (P < 0. 05). The detrusor leak point pressure decreased from 69.9 ± 20.7cmHO to 26.3 ± 7.4cmHO (P < 0. 01). Post-voiding residual urine decreased from 282.8 ± 134.2 ml to 125.0 ± 92.1 ml (P < 0. 01) but increased to 270.1 ± 129.0 ml 3 months post injection. Of the 35 patients, 57.1% (20/35) relied on clean intermittent catheterization (CIC) before injection, but 75.0% (15/20) of them could partly void 1 month after injection, and 25%(5/20) could void without CIC. Eight patients showed hydronephrosis before treatment; in three of them, hydronephrosis decreased slightly, while it resolved in two. All patients were followed for three to 6 months, and the effect lasted for about two to 3 months. No serious adverse events occurred in any patient.

Conclusions: The results suggest that Prosigne® injection into the urethral sphincter is an effective, safe, and inexpensive way to treat UAB.
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http://dx.doi.org/10.1186/s12894-019-0490-4DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6611008PMC
July 2019

Effects of Acute Sacral Neuromodulation at Different Pulse Widths on Bladder Overactivity in Pigs.

Int Neurourol J 2019 Jun 30;23(2):109-115. Epub 2019 Jun 30.

Department of Urology of Capital Medical University; Department of Urology at China Rehabilitation Research Centre, Beijing, China.

Purpose: Sacral nerve stimulation has been used to treat overactive bladder. This study evaluated the effects of stimulation using different pulse widths on the inhibition of bladder overactivity by sacral nerve stimulation (SNM) in pigs.

Methods: Implant-driven stimulators were used to stimulate the S3 spinal nerve in 7 pigs. Cystometry was performed by infusing normal saline (NS) or acetic acid (AA). SNM at pulse widths of 64 μsec to 624 μsec was conducted at the intensity threshold at which observable perianal and/or tail movement was induced. Multiple cystometrograms were performed to determine the effects of different pulse widths on the micturition reflex.

Results: AA-induced bladder overactivity reduced the bladder capacity to 46.9%±7.1% of the NS control level (P<0.05). During AA infusion, SNM at 64 μsec, 204 μsec, and 624 μsec increased the bladder capacity to 126.1%±6.9%, 129.5%±7.3%, and 140.1%±7.6% of the AA control level (P<0.05). No significant differences were found among the results obtained using pulse widths of 64 μsec, 204 μsec, and 624 μsec (P>0.05). The actual intensity threshold varied from 0.7 to 8 V. The mean intensity threshold (T visual) for pulse widths of 64 μs, 204 μs, and 624 μs were 5.64±0.76 V, 3.11±0.48 V, and 2.52±0.49 V. T visual for pulse widths of 64 μsec was larger than the other two T visual for pulse widths of 204 μsec and 624 μsec (P<0.05). No significant differences were found among the T visual for pulse widths of 204 μsec and 624 μsec (P>0.05).

Conclusion: This study indicated that different pulse widths could play a role in inhibiting bladder overactivity. It is not yet certain which pulse widths increased bladder capacity compared with AA levels, to minimize energy consumption and maintain patient comfort during stimulation, 204 μsec may be an appropriate pulse width for SNM.
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http://dx.doi.org/10.5213/inj.1938042.021DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6606932PMC
June 2019

Differences between water-filled and air-charged urodynamic catheters for determining the urethral pressure profile in neurogenic lower urinary tract dysfunction patients.

Neurourol Urodyn 2019 08 18;38(6):1760-1766. Epub 2019 Jun 18.

Department of Urology, China Rehabilitation Research Centre, Rehabilitation School of Capital Medical University, Beijing, China.

Aim: The maximum urethral closure pressure (MUCPs) and functional urethral length (FUL) obtained with water-filled and air-charged catheters during urethral pressure profile (UPP) determination was compared in a single, blind, randomized, and prospective trial.

Methods: Thirty-three males with spinal cord injuries and neurogenic lower urinary tract dysfunction underwent UPP determinations using water-filled and air-charged catheters in random order; the patients were unaware of the catheter sequence. The variability of the same type of catheter and the agreement between the different types of catheters were compared. The Pearson correlation coefficient was used to check the correlation between the catheters and the Bland-Altman method was used to verify the agreement.

Result: The intraclass correlation coefficients for MUCPs and FULs determined using water-filled and air-charged catheters were 0.89, 0.75, 0.94, and 0.78, respectively. The interclass correlation coefficients for MUCPs and FULs between the two catheters were 0.43 and 0.28, respectively. Bland-Altman plots suggested that the values measured by air-charged catheters were significantly higher than water-filled catheters (mean difference, 26.0 and 2.4 cmH O, respectively). There were wide 95% limits of agreement (-54.0 to 106.0 and -0.3 to 5.1 cmH O, respectively) that exceeded the clinical range for differences in MUCP and FUL.

Conclusion: Air-charged catheters usually give higher readings than water-filled catheters for UPP. Agreement between water-filled and air-charged catheters was not good. Nevertheless, the catheter type which is more relevant to the disease requires further study.
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http://dx.doi.org/10.1002/nau.24071DOI Listing
August 2019

Evaluation of sacral neuromodulation system with new six-contact points electrode in pigs.

Neurourol Urodyn 2019 04 7;38(4):1038-1043. Epub 2019 Mar 7.

Department of Urology of Capital Medical University, China Rehabilitation Research Center, Capital Medical University, Beijing, China.

Aims: We investigated the effects of sacral neuromodulation using the new six-contact electrode vs the four-contact electrode in pigs.

Methods: Randomly, a six-contact electrode was implanted in eight pigs in one side of the third sacral (S3) foramen, and a four-contact electrode was implanted in the other side using the same method. Using an external neurostimulator, the number of contact points (sensitive voltage ≤ 2 V) of both electrodes (SacralStim and InterStim systems) was calculated. Cystometry was performed by infusing normal saline or acetic acid. Then sacral neuromodulation with the SacralStim and InterStim systems was induced at a voltage at which we could observe perianal and/or tail movement. Multiple cystometrograms were performed to determine the effects of the two systems on the micturition reflex.

Results: The mean number of sensitive points of six-contact electrodes of the SacralStim system (2.63 ± 0.32) was higher than that of the quadripolar-lead electrodes of the InterStim system (1.38 ± 0.18), and the difference was statistically significant (P < 0.05). Acetic acid-induced bladder overactivity significantly reduced bladder capacity to 54.89% ± 4.7% of the normal saline control level. During acetic acid infusion, sacral neuromodulation with the SacralStim system suppressed bladder overactivity and significantly increased bladder capacity to 70.41% ± 5.4% of the normal saline control level, compared with the acetic acid level ( P < 0.05). Moreover, sacral neuromodulation with the InterStim system also significantly increased bladder capacity to 69.63% ± 5.3% of the normal saline control level, compared with the acetic acid level ( P < 0.05). No significant differences were found in the results obtained using the two systems ( P > 0.05).

Conclusions: The six-contact electrode of the SacralStim system had more sensitive points (<2 V) than that of the quadripolar-lead electrode of InterStim system. Potentially, it has more postimplantation programming options and battery savings manifested by lower voltage will increase the longevity of the stimulator. Further studies of sacral neuromodulation with six-contact electrodes in clinical practice are needed.
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http://dx.doi.org/10.1002/nau.23956DOI Listing
April 2019

Remotely programmed sacral neuromodulation for the treatment of patients with refractory overactive bladder: a prospective randomized controlled trial evaluating the safety and efficacy of a novel sacral neuromodulation device.

World J Urol 2019 Nov 26;37(11):2481-2492. Epub 2019 Feb 26.

Urology Department, Beijing Hospital, National Center of Gerontology, No. 1 DaHua Road, Dong Dan, Beijing, 100730, People's Republic of China.

Purpose: The efficacy and safety of a novel remotely programmed BetterStim sacral neuromodulation (SNM) system was evaluated in patients with refractory overactive bladder (OAB) in a prospective, controlled, multicenter trial.

Methods: A total of 84 patients referred for SNM therapy from October 2015 to January 2018 were studied. Of the patients who qualified for implantation, 37 and 33 were randomly assigned to treatment and control groups, respectively. Patients in the treatment group underwent stimulation upon implantation, while stimulation was delayed in the control group for 3 months. Follow-up visits, consisting of voiding diary outcome, questionnaires regarding overactive bladder symptom score (OABSS) and quality of life were conducted at 1, 3, and 6-month post-implantation.

Results: Compared with the control group, subjects in the treatment group exhibited statistically significant improvement in OAB symptoms at 3 months. The overall success rate was achieved in 72% of the treatment group, compared with 12% of the control group at 3 months. At 6 months, there were no significant differences in key voiding diary variables between the two groups. Further, this study demonstrated sustained improvement in urinary symptom interference in OAB patients. In addition, nearly all patients expressed great satisfaction with the remote-programming methods. No serious adverse events occurred, and device-related adverse events rate was 12.86%.

Conclusion: This clinical study demonstrates subjective and objective success of the BetterStim SNM system. Importantly, our data suggest that remote programming can be safely used as a viable option for the conventional programming with a high degree of patient satisfaction.
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http://dx.doi.org/10.1007/s00345-019-02698-7DOI Listing
November 2019

Effects of bladder shape on accuracy of measurement of bladder volume using portable ultrasound scanner and development of correction method.

Neurourol Urodyn 2019 02 8;38(2):653-659. Epub 2019 Jan 8.

School of Public Health, Yale University, New Haven, Connecticut.

Aims: To compare the accuracy of using a bladder scanner to measure bladder volume through intermittent catheterization (IC) in patients and to introduce the Bladder Deformation Index (BDI) to develop a correction method.

Methods: Bladder volume was assessed by a nurse with the scanner. A second nurse catheterized the patient's bladder. A third nurse measured the urine volume in a 500-mL or 1000-mL graduated cylinder.

Results: Sixty one patients were included and 590 pairs of data were obtained. The mean bladder volume measured using a scanner and IC was (332.3 ± 156.1) mL and (339.1 ± 158.8) mL. The mean absolute difference was 30.8 mL. The correlation coefficient was 0.929. Patients were classified into 2 groups depending on whether they had undergone augmentation cystoplasty. The mean absolute difference was 109.2 and 20.4 mL. The correlation coefficient was 0.712 and 0.981. According to the BDI, bladders can be classified into 3 groups. The mean absolute difference was 21.9, 60.4, and 109.4 mL. The correlation coefficient was 0.970, 0.839, and 0.783. The linear regression equations of Grade I and Grade II were Y = 1.11X + 3.1 and Y = 0.76X + 161.5.

Conclusions: The results showed that bladder shape plays a critical role in accuracy which is inversely associated with BDI. This degree of accuracy is sufficient; especially measurement adjusted using the linear regression equation in patients with high BDI. However, although the preliminary results of the study are promising, a large-scale prospective study should be needed to address the validation of the data in the future.
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http://dx.doi.org/10.1002/nau.23883DOI Listing
February 2019

Results of Sacral Neuromodulation Therapy for Urinary Voiding Dysfunction: Five-Year Experience of a Retrospective, Multicenter Study in China.

Neuromodulation 2019 Aug 4;22(6):730-737. Epub 2019 Jan 4.

Department of Urology, West China Hospital, Sichuan University, Chengdu, P.R. China.

Purpose: This five-year, retrospective, multicenter study evaluated the long-term safety and efficiency of sacral neuromodulation (SNM) in Chinese patients with urinary voiding dysfunction.

Patients And Methods: This is a Chinese national, multicenter, retrospective study that included 247 patients (51.2% female) who received an implantable pulse generator (IPG) (InterStim, Medtronic, Minneapolis, MN, USA) between 2012 and 2016. Success was considered if the initial ≥50% improvement in any of primary voiding diary variables persisted compared with baseline. The results were further stratified by identifying patients who showed >50% improvement and those although showed <50% improvement but still wanted to receive IPG; these data were collected and analyzed for general improvement.

Results: Following test stimulation, 187 patients (43%) declined implantation and 247 (57%) underwent implantation using InterStim®. Among 247 patients, 34 (13.7%) had overactive bladder (OAB), 59 (23.8%) had interstitial cystitis/bladder pain syndrome (IC/BPS), 47 (19%) had idiopathic urinary retention (IUR), and 107 (44.1%) had neurogenic bladder (NB). IPG efficiency rate for OAB, interstitial cystitis/bladder pain syndrome, idiopathic urinary retention, and neurogenic bladder were 42.5, 72.4, 51.6, and 58.8%, respectively. The mean duration of follow-up was 20.1 ± 12.8 months.

Conclusions: SNM appears effective in the long term, with a total IPG implantation rate of approximately 57% (ranging between 42.5 and 72.4% depending on indication). Interstitial cystitis/bladder pain syndrome appear to be the best indication for stage I testing. Chinese neurogenic bladder patients are most inclined to choose SNM. SNM is relatively safe, with low postoperation adverse events of 16.1% and reoperation rate of 3.2% during the follow-up period.
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http://dx.doi.org/10.1111/ner.12902DOI Listing
August 2019

Excitatory and inhibitory effects of stimulation of sacral dorsal root ganglion on bladder reflex in cats.

Int Urol Nephrol 2018 Dec 9;50(12):2179-2186. Epub 2018 Oct 9.

Department of Urology, China Rehabilitation Research Centre, Rehabilitation School of Capital Medical University, No 10. Jiaomen Beilu, Fengtai District, Beijing, 100068, China.

Purpose: To explore the effects of electrical stimulation of the sacral dorsal root ganglion (DRG) on bladder reflexes in α-chloralose-anesthetized cats.

Methods: Bladder activity was recorded under isovolumetric conditions. A pair of hook electrodes was placed in the right S1 and S2 DRGs of 12 adult male cats, which were stimulated over a range of frequencies (0.25-30 Hz) and at threshold intensity.

Results: Stimulation of S1 and S2 DRGs inhibited or evoked bladder contractions under isovolumetric conditions depending on the frequency of stimulation in nine cats. Stimulation at low frequencies (3-7 Hz on S1 or S2 DRG) significantly inhibited isovolumetric rhythmic bladder contractions, while excitatory effects were observed at two frequency ranges, including lower frequencies (0.25-1.5 Hz on S1 DRG and 0.25-1.25 Hz on S2 DRG) and middle frequencies (15-30 Hz on S1 and S2 DRGs).

Conclusions: These results suggest that the sacral DRG might be a potential valuable target for electrical stimulation in the treatment of bladder dysfunction.
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http://dx.doi.org/10.1007/s11255-018-2004-9DOI Listing
December 2018

Epidemiology of lower urinary tract symptoms in a cross-sectional, population-based study: The status in China.

Medicine (Baltimore) 2018 Aug;97(34):e11554

Department of Urology, Beijing Hospital Department of Urology, China Rehabilitation Research Center, Capital Medical University, Beijing, China Astellas Pharma Singapore Pte. Ltd., Singapore Astellas Pharma China, Inc., Beijing, China.

Lower urinary tract symptoms (LUTS) are reported to affect over half of all adults, and they are associated with significantly impaired quality of life (QOL). We performed a population-based study to evaluate the overall prevalence and impact of LUTS including overactive bladder (OAB) in adults aged ≥40 years in China.Adults aged ≥40 years were eligible to participate in this internet-based survey, provided that they had the ability to access the internet, to use a computer and to read the local language. The survey contained questions relating to International Continence Society (ICS) symptom definitions, the International Prostate Symptom Score (IPSS) and the Overactive Bladder Symptom Score (OABSS). The primary study objective was to determine the prevalence of LUTS using the ICS 2002 symptom definition.Among the 4136 respondents, 2080 (50.3%) were men and 1347 (32.6%) were aged ≥60 years. LUTS prevalence according to ICS criteria was 60.3% in men and 57.7% in women. All 3 ICS symptom groups (voiding, storage, and postmicturition) were present in 22.8% of women and 24.2% of men, making this the most common combination of ICS symptom groups. The most bothersome symptoms were terminal dribble and nocturia. According to IPSS scores, 32.9% of participants had at least moderate symptoms. The prevalence of OAB was 23.9%. The presence of LUTS-particularly all 3 ICS symptom groups-was associated with reduced sexual QOL in women, reduced satisfaction with erectile function in men, higher anxiety and depression scores, and reduced health-related QOL (physical health and mental health domains). The overall percentage of participants with LUTS visiting healthcare professionals for urinary symptoms was 38%.In conclusion, LUTS affect the majority of adults aged ≥40 years in China, and prevalence increases with increasing age. LUTS are associated with impaired QOL and mental health, but fewer than half of individuals in China with LUTS seek healthcare for their symptoms. There is therefore a need to improve awareness and treatment of the condition.ClinicalTrials.gov identifier: NCT02618421.
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http://dx.doi.org/10.1097/MD.0000000000011554DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6112902PMC
August 2018
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