Localized contractions in the normal human bladder and in urinary urgency
Localized contractions in the normal human bladder and in urinary urgency
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DOI：
10.1111/j.1464-410x.2005.05455.x
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发表时间：
2005-05-01
影响因子：
4.5
通讯作者：
van Duyl, WA
中科院分区：
文献类型：
--
作者：
Drake, MJ;Harvey, IJ;van Duyl, WA
目的描述一项观察性研究，以确定是否出现局部活动在正常人膀胱，以及是否有任何对应关系的变化，这种活动和报告的sensations.PATIENTS，SUBJECTS和METHODS的膀胱感觉信息的产生取决于传入刺激膀胱壁内的张力增加。自主膀胱活动在几个物种中是明显的，这通常是局部的和多灶性的，引起局部区域的拉伸。因此，传入活动可能部分是由于膀胱壁的局部扭曲。14例女性患者在充盈期膀胱测压时膀胱感觉增加，与6例无症状女性志愿者进行比较。局部膀胱活动进行了评估的微动检测（MMD）的方法，使用8个电极安装在一个硅橡胶气球;局部位移的电极记录为电阻的变化，这是用来计算每对电极之间的距离的变化。在MMD记录过程中，充盈性膀胱测压感觉增加的女性局部活动的发生率显著高于对照组。与无症状女性相比，局部活动更持久，频率更高。所有9名妇女报告尿急在MMD记录有本地化的收缩活动，而只有4个阶段性的逼尿肌压力增加期间的情节urgent. CONCLUSION通过测量膀胱壁内的本地化收缩，我们建立了一个显着的差异，研究组之间的本地化活动的患病率，但没有客观的差异与传统的尿动力学研究。局部收缩的特征也存在差异，症状组的过度活动与报告的感觉相对应。这些发现表明，膀胱壁的局部扭曲刺激传入活动，和人类逼尿肌可能是功能模块化。
OBJECTIVETo describe an observational study to establish whether localized activity arises in the normal human bladder, and whether there is any correspondence between changes in such activity and reported sensation.PATIENTS, SUBJECTS AND METHODSThe generation of sensory information by the bladder depends on afferent stimulation by increased tension within the bladder wall. Autonomous bladder activity is apparent in several species, which is often localized and multifocal, giving rise to localized areas of stretch. Thus afferent activity may partly result from localized distortions of the bladder wall. Fourteen women patients presenting with increased bladder sensation during filling-phase cystometry were compared with six asymptomatic women volunteers. Localized bladder activity was assessed by the micromotion detection (MMD) method, using eight electrodes mounted on a Silastic balloon; local displacements of the electrodes were recorded as changes in electrical resistance, which were used to compute changes in the distance between each pair of electrodes.RESULTSIn two of the six volunteers, micromotions were seen in the extraperitoneal (ventral) portion of the bladder. Women with increased sensation on filling cystometry had a significantly higher prevalence of localized activity than the control group during MMD recording. The localized activity was more sustained and at a higher frequency than in asymptomatic women. All nine women reporting urinary urgency during MMD recording had localized contractile activity, while only four had phasic increases in detrusor pressure during the episodes of urgency.CONCLUSIONSBy measuring localized contractions within the bladder wall, we established a significant difference in the prevalence of localized activity between the groups studied, but there was no objective difference with conventional urodynamic studies. There was also a difference in the character of the localized contractions, with the exaggerated activity in the symptomatic group corresponding with the reported sensations. These findings suggest that localized distortion of the bladder wall stimulates afferent activity, and that the human detrusor may be functionally modular.