Clinical Outcome in Male Patients With Detrusor Overactivity With Impaired Contractility

Shuo Liu,Lewis Chan,Vincent Tse 대한배뇨장애요실금학회 2014 International Neurourology Journal Vol.18 No.3

Purpose: To review the clinical outcomes of patients with voiding dysfunction who have detrusor overactivity with impaired contractility (DOIC) diagnosed with urodynamic studies. Methods: Urodynamic reports from 2005 to 2009 were reviewed, and 54 male patients had findings consistent with DOIC. Patients with acontractile or neuropathic bladders were excluded. Clinical outcomes were obtained from patient records. Results: Of 54 men, 8 presented with voiding symptoms, 17 had storage symptoms, and 29 had mixed symptoms. Twenty-two had a previous transurethral resection of the prostate. The median follow-up was 12 months. Four patients received no intervention. Two patients were taught intermittent self-catheterization. Five patients underwent surgery to reduce outlet resistance and all reported improvement. Forty-three patients were started on pharmacotherapy; symptomatic improvement was reported by 9 of 16 patients commenced on anticholinergics alone, 6 of 16 on alpha-blockers alone, and 4 of 5 treated with a combination of alpha-blockers and anticholinergics. Eleven patients experienced no difference on pharmacotherapy and 2 reported deterioration. One patient developed acute urinary retention (18 months after commencing treatment with alpha-blockers). No patient had urosepsis. Conclusions: Anticholinergics and alpha-blockers appear to be safe in patients with DOIC. The risk of urinary retention and sepsis is low. The majority of patients report symptomatic benefit from either drugs or surgical treatment.

Zeolite Synthesis from a Charge Density Perspective: The Charge Density Mismatch Synthesis of UZM-5 and UZM-9

Park, Min Bum,Jo, Donghui,Jeon, Him Chan,Nicholas, Christopher P.,Lewis, Gregory J.,Hong, Suk Bong American Chemical Society 2014 Chemistry of materials Vol.26 No.23

<P>A charge density model of aluminosilicate zeolite synthesis is presented. This model has been applied to the charge density mismatch (CDM) synthesis of UZM-5 and UZM-9 zeolites at 150 and 100 °C, respectively, using the same synthesis mixture that includes tetraethylammonium (TEA<SUP>+</SUP>), tetramethylammonium (TMA<SUP>+</SUP>), and Na<SUP>+</SUP> ions as structure-directing agents (SDAs). It allows a seamless description of the contributions of both the hydroxide and SDA components of the CDM barrier to zeolite synthesis. The syntheses are described as temperature-driven confrontations with the CDM barrier, resulting in disproportionation to solution and solid products with diverging charge densities. The presence of the CDM barrier and this tunable disproportionation in charge density, along with the suitable choice of SDA concentrations, allows a flexible and cooperative participation of SDAs, as the synthesis medium initially forms aluminosilicate networks that maximize Coulombic stabilization under the conditions at hand. The UZM-5 synthesis at 150 °C is characterized by much higher fractional Si and Al yields (0.85 Si and 0.94 Al vs 0.30 Si and 0.70 Al) and a higher Si/Al ratio (ca. 7 vs 3) compared to UZM-9 synthesis at 100 °C. Unlike the latter case, TEA<SUP>+</SUP> plays an important role in the nucleation of UZM-5. However, TMA<SUP>+</SUP> was found to be essential for the nucleation of both zeolites. While Na<SUP>+</SUP> is required to crystallize UZM-9, the nucleation rate of UZM-5 is about twice as fast in the absence of Na<SUP>+</SUP>. On the other hand, the crystal growth rate of this small-pore zeolite is over 10 times faster with Na<SUP>+</SUP> present, giving a considerably larger crystallite size.</P><P><B>Graphic Abstract</B> <IMG SRC='http://pubs.acs.org/appl/literatum/publisher/achs/journals/content/cmatex/2014/cmatex.2014.26.issue-23/cm501919d/production/images/medium/cm-2014-01919d_0003.gif'></P><P><A href='http://pubs.acs.org/doi/suppl/10.1021/cm501919d'>ACS Electronic Supporting Info</A></P>

Eight-Year Experience With Botulinum Toxin Type-A Injections for the Treatment of Nonneurogenic Overactive Bladder: Are Repeated Injections Worthwhile?

Shannon HK Kim,David Habashy,Sana Pathan,Vincent Tse,Ruth Collins,Lewis Chan 대한배뇨장애요실금학회 2016 International Neurourology Journal Vol.20 No.1

Purpose: To investigate the efficacy and safety of repeated botulinum toxin type-A (BTX-A) injections for patients with drugrefractory nonneurogenic overactive bladder (NNOAB) and explore factors predictive of outcome. Methods: Data were collected from all patients receiving repeated BTX-A injections for drug-refractory NNOAB between 2004 and 2012. Trigone-sparing injections were administered under sedation with antibiotic prophylaxis. Patient characteristics including age, sex, preoperative urodynamics, injection number, BTX-A dose, complications, and patient global impression of improvement (PGI-I) scores were collected. Correlations between patient factors and outcomes were assessed by using Pearson’s chi-square tests. Results: Fifty-two patients with a mean age of 67.4 years (range, 26–93 years) received 140 BTX-A injections in total; 33 (64%), 15 (29%), and 4 patients (7%) received 2, 3 to 4, and 5 to 8 injections, respectively. Mean follow-up time was 49 months (range, 9–101 months). Nine patients developed urinary tract infection; additionally, 3 patients experienced transient urinary retention. Median PGI-I score was 2 out of 7 (interquartile range [IQR], 2). For 46 patients, the PGI-I score remained stable with the administration of each injection. Pearson chi-square tests revealed that male patients or reduced bladder compliance was associated with a higher (worse) PGI-I score. Median PGI-I scores for men and women were 3 (IQR, 1) and 2 (IQR, 1), respectively; additionally, median PGI-I scores for those with normal bladder compliance and those with reduced bladder compliance were 2 (IQR, 2) and 4.5 (IQR, 1), respectively. Median PGI-I scores and complication rates were the same in the older patient (≥70 years) and younger (<70 years) patient cohorts. Conclusions: Efficacy is maintained with repeated BTX-A injections. Patients including the elderly show a good degree of tolerability with a low complication rate. Male patients or reduced bladder compliance is associated with poorer outcomes.

Alternative splicing converts STIM2 from an activator to an inhibitor of store-operated calcium channels

Rana, Anshul,Yen, Michelle,Sadaghiani, Amir Masoud,Malmersjö,, Seth,Park, Chan Young,Dolmetsch, Ricardo,Lewis, Richard S. The Rockefeller University Press 2015 The Journal of general physiology Vol.146 No.1

Alternative splicing converts STIM2 from an activator to an inhibitor of store-operated calcium channels

Rana, Anshul,Yen, Michelle,Sadaghiani, Amir Masoud,Malmersjö,, Seth,Park, Chan Young,Dolmetsch, Ricardo E.,Lewis, Richard S. The Rockefeller University Press 2015 The Journal of cell biology Vol.209 No.5

<P>Store-operated calcium entry (SOCE) regulates a wide variety of essential cellular functions. SOCE is mediated by STIM1 and STIM2, which sense depletion of ER Ca<SUP>2+</SUP> stores and activate Orai channels in the plasma membrane. Although the amplitude and dynamics of SOCE are considered important determinants of Ca<SUP>2+</SUP>-dependent responses, the underlying modulatory mechanisms are unclear. In this paper, we identify STIM2β, a highly conserved alternatively spliced isoform of STIM2, which, in contrast to all known STIM isoforms, is a potent inhibitor of SOCE. Although STIM2β does not by itself strongly bind Orai1, it is recruited to Orai1 channels by forming heterodimers with other STIM isoforms. Analysis of STIM2β mutants and Orai1-STIM2β chimeras suggested that it actively inhibits SOCE through a sequence-specific allosteric interaction with Orai1. Our results reveal a previously unrecognized functional flexibility in the STIM protein family by which alternative splicing creates negative and positive regulators of SOCE to shape the amplitude and dynamics of Ca<SUP>2+</SUP> signals.</P>

Lower Urinary Tract Functional Assessment of Men Undergoing Radical Prostatectomy: Correlation of Preoperative Clinical and Urodynamic Parameters

Nicholas Faure Walker,Ashan Canagasingham,Danielle Van Diepen,Athina Pirpiris,Vincent Tse,Scott Leslie,Ruban Thanigasalam,Lewis Chan 대한배뇨장애요실금학회 2021 International Neurourology Journal Vol.25 No.2

Purpose: To assess baseline clinical and urodynamic profiles of a contemporary cohort of men undergoing radical prostatectomy (RP) as part of the ROSE (Robotic and Open Surgery for Prostate Cancer: A Prospective, Multi-centre, Comparative Study of Functional and Oncological Outcomes) study. Methods: Men with localized prostate cancer undergoing RP were prospectively recruited to undergo clinical assessment and urodynamic testing prior to surgery as part of a clinical trial. The International Prostate Symptoms Score (IPSS) was used to determine participants’ degree of lower urinary tract symptoms (LUTS). Results: Eighty-five men with a median age of 64.5 years and a median prostate-specific antigen level of 6.3 ng/mL were prospectively recruited. Of patients with complete baseline data, 36 (50.7%), 28 (39.4%), and 7 (9.9%) had mild (IPSS<8), moderate (IPSS 8–19), and severe (IPSS>20) LUTS, respectively. Obstruction was identified in 18 men (29.5%), and 9 (14.8%) showed detrusor underactivity. Of the 15 patients with detrusor overactivity, 12 (80%) reported overactive bladder (OAB). Of men with urodynamic obstruction, 5 (31.3%), 10 (62.5%), and 1 (6.3%) reported mild, moderate, and severe LUTS, respectively. Of men without OAB, 4 (11.8%, P=0.002) showed filling phase abnormalities, 13 (46.4%, P=0.611) had flow rates of <15 mL/sec, and 7 (30.4%, P=0.767) showed obstruction. Of men with mild or no LUTS, 5 (20%, P=0.072) showed obstruction and 4 (16%, P=0.524) showed poor contractility. Conclusion: LUTS and OAB were common in men with localized prostate cancer undergoing RP. Detrusor overactivity and urodynamic filling phase abnormalities were strongly correlated with OAB. IPSS did not show a strong correlation with bladder outflow obstruction or detrusor underactivity. Urodynamic filling abnormalities were found in 11.8% of men without OAB. Symptomatic and functional assessment may therefore have a role in the preoperative counselling of patients and possibly guide postoperative management of LUTS, especially if OAB is present.