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J J Wyndaele - One of the best experts on this subject based on the ideXlab platform.
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Urological Neurology and Urodynamics THE NORMAL PATTERN OF PERCEPTION OF Bladder Filling DURING CYSTOMETRY STUDIED IN 38 YOUNG HEALTHY VOLUNTEERS
1998Co-Authors: J J WyndaeleAbstract:Purpose: The normal pattern of sensation during the tonic phase of cystometric Bladder Filling was evaluated in a group of young healthy volunteers. Materials and Methods: A total of 38 healthy volunteers 19 to 28 years old described the sensations they perceived while sitting during medium fill cystometry after the Bladder was filled through a urethral catheter with saline at body temperature. Results: Of the subjects 4 had unstable Bladder contractions that corresponded with some sensations reported, and 34 with a stable Bladder perceived a first sensation of Filling, first desire to void and strong desire to void. Each sensation was easily distinguishable from the others. Bladder volumes at the different sensations as well as detrusor pressures strongly correlated with each other. Conclusions: Although sensations reported during cystometric Bladder Filling are subjective, they have a normal pattern. Since these sensations are easily distinguished from each other and occur at interrelated volumes, they probably correspond with specific physiological mechanisms as suggested previously. Therefore, evaluation of these sensations could provide additional relevant information during urodynamics. It has been described previously that Bladder distension can evoke sensations, particularly those related to stretch and distension, of varying quality and origin.13 Adequate sensory input is the prerequisite for conscious Bladder control,4 and pathological Bladder sensation may cause serious symptoms and complications.S.6 Therefore, the evaluation of sensation is clinically useful. Sensations reported during urodynamic investigations are subjective and investigators might be cautious about their diagnostic value. Although some technical investigations are currently used to evaluate objectively sensory innervation of the lower urinary tract,7 they do not involve the perception of sensations, such as desire to void and of full Bladder, which guide daily urinary behavior. Bladder Filling sensation was studied in a group of healthy volunteers to determine the value of this investigative technique.
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the normal pattern of perception of Bladder Filling during cystometry studied in 38 young healthy volunteers
The Journal of Urology, 1998Co-Authors: J J WyndaeleAbstract:AbstractPurpose: The normal pattern of sensation during the tonic phase of cystometric Bladder Filling was evaluated in a group of young healthy volunteers.Materials and Methods: A total of 38 healthy volunteers 19 to 28 years old described the sensations they perceived while sitting during medium fill cystometry after the Bladder was filled through a urethral catheter with saline at body temperature.Results: Of the subjects 4 had unstable Bladder contractions that corresponded with some sensations reported, and 34 with a stable Bladder perceived a first sensation of Filling, first desire to void and strong desire to void. Each sensation was easily distinguishable from the others. Bladder volumes at the different sensations as well as detrusor pressures strongly correlated with each other.Conclusions: Although sensations reported during cystometric Bladder Filling are subjective, they have a normal pattern. Since these sensations are easily distinguished from each other and occur at interrelated volumes, ...
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is impaired perception of Bladder Filling during cystometry a sign of neuropathy
BJUI, 1993Co-Authors: J J WyndaeleAbstract:Summary— The sensation of Bladder Filling during cystometry was evaluated in 627 consecutive patients. The groups of patients with various patterns of impaired sensation included significantly more patients with confirmed neuropathy than did the group whose perception of Bladder Filling was normal. When sensation was absent, or only 1 of 3 types was reported by patients without known neuropathy, further investigation revealed abnormal afferent innervation of the lower urinary tract in 35%. These data suggest the need for further neurological evaluation in such patients.
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A clinical study on subjective sensations during Bladder Filling
International Urogynecology Journal, 1991Co-Authors: J J WyndaeleAbstract:Subjective sensations during the tonic phase of a Bladder Filling during cystometry were determined in 649 patients with incontinence and/or micturition problems of neurogenic and non-neurogenic origin. In this study 354 patients perceived three distinct sensations: a ‘first sensation of Filling’ at 40% of Bladder capacity, a ‘first desire to void’ at 75% of Bladder capacity and a ‘strong desire to void’ at maximum cystometric capacity; 184 patients had one or two different sensations. Volume seemed more important than intravesical pressure in eliciting the sensations. In the distinction by the patient between the three consecutive sensations, both changes in intensity of volume perception and the existence of a specific neurological pathway for each sensation might play a role. Sensations appeared earlier during Filling when asymtomatic urinary tract infection was present. These data give additional information about the subjective proprioception of Bladder Filling.
Ulrich Mehnert - One of the best experts on this subject based on the ideXlab platform.
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is detrusor contraction during rapid Bladder Filling caused by cold or warm water a randomized controlled double blind trial
The Journal of Urology, 2018Co-Authors: Marko Kozomara, Ulrich Mehnert, Burkhardt Seifert, Thomas M. KesslerAbstract:Purpose: We investigated whether detrusor contraction during rapid Bladder Filling is provoked by cold or warm water.Materials and Methods: Patients with neurogenic lower urinary tract dysfunction were included in this randomized, controlled, double-blind trial. At the end of a standard urodynamic investigation patients underwent 2 Bladder Fillings using a 4C ice water test or a 36C warm water test saline solution at a Filling speed of 100 ml per minute. The order was randomly selected, and patients and investigators were blinded to the order. The primary outcome measure was detrusor overactivity, maximum detrusor pressure and maximum Bladder Filling volume during the ice and warm water tests.Results: Nine women and 31 men were the subject of data analysis. Neurogenic lower urinary tract dysfunction was caused by spinal cord injury in 33 patients and by another neurological disorder in 7. Irrespective of test order detrusor overactivity occurred significantly more often during the ice water test than duri...
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PD06-11 REPRODUCIBILITY OF SUPRASPINAL RESPONSES TO AUTOMATED, REPETITIVE Bladder Filling - AN FMRI STUDY
The Journal of Urology, 2016Co-Authors: Matthias Walter, Lorenz Leitner, Lars Michels, Spyros Kollias, Patrick Freund, Martina D. Liechti, Thomas M. Kessler, Ulrich MehnertAbstract:INTRODUCTION AND OBJECTIVES: Recent functional magnetic resonance imaging (fMRI) studies revealed supraspinal networks in response to Bladder Filling involved in perception and processing of Bladder distension. However, reproducibility of blood-oxygenation-level dependent (BOLD) signal changes during Bladder Filling has not been proven yet. Therefore, our aim was to investigate BOLD signal changes in response to Bladder Filling to provide evidence for repeatability using a standardized Filling paradigm, i.e. a magnetic resonance (MR)compatible and MR-synchronized infusion-drainage system. METHODS: 20 right-handed healthy subjects, 10 women and 10 men, mean age 39 years (range 22-54) with no history of urinary urgency and/or urinary incontinence were included. Visit 1: After catheterization and Bladder pre-Filling with body warm saline until persistent desire to void, we performed in a 3T MR scanner automated, repetitive Bladder Filling of 100mL body warm saline over 15s, i.e. block design study. Visit 2: Within 8 weeks from visit 1, a second MR scan was performed in the same manner. Using SPM8, BOLD signal changes during Bladder Filling were compared to rest, i.e. pre-filled condition. For within-group whole-brain (WB) analysis, a voxel-threshold was set at p
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pd06 11 reproducibility of supraspinal responses to automated repetitive Bladder Filling an fmri study
The Journal of Urology, 2016Co-Authors: Matthias Walter, Lorenz Leitner, Lars Michels, Spyros Kollias, Patrick Freund, Martina D. Liechti, Thomas M. Kessler, Ulrich MehnertAbstract:INTRODUCTION AND OBJECTIVES: Recent functional magnetic resonance imaging (fMRI) studies revealed supraspinal networks in response to Bladder Filling involved in perception and processing of Bladder distension. However, reproducibility of blood-oxygenation-level dependent (BOLD) signal changes during Bladder Filling has not been proven yet. Therefore, our aim was to investigate BOLD signal changes in response to Bladder Filling to provide evidence for repeatability using a standardized Filling paradigm, i.e. a magnetic resonance (MR)compatible and MR-synchronized infusion-drainage system. METHODS: 20 right-handed healthy subjects, 10 women and 10 men, mean age 39 years (range 22-54) with no history of urinary urgency and/or urinary incontinence were included. Visit 1: After catheterization and Bladder pre-Filling with body warm saline until persistent desire to void, we performed in a 3T MR scanner automated, repetitive Bladder Filling of 100mL body warm saline over 15s, i.e. block design study. Visit 2: Within 8 weeks from visit 1, a second MR scan was performed in the same manner. Using SPM8, BOLD signal changes during Bladder Filling were compared to rest, i.e. pre-filled condition. For within-group whole-brain (WB) analysis, a voxel-threshold was set at p<0.001 using the false discovery rate (FDR) correction to adjust for multiple comparisons. Differences between both visits were investigated using a paired t test. In addition, regions of interest (ROI) were defined using the Wake Forrest University Pickatlas and included as a mask in order to restrict the voxel-by-voxel statistical analysis (familywise error (FWE)-correction) to pre-specified brain areas. RESULTS: Within-group WB analysis revealed activation in the following brain areas for visit 1: bilateral prefrontal gyrus (PFG); anterior cingulate cortex (ACC), mid and posterior cingulate cortex; left insula; hippocampus; temporal and parietal gyrus; and for visit 2: bilateral PFG; ACC; bilateral insula; bilateral basal ganglia. No statistical differences in BOLD signal changes were detected between both visits. ROI analyses, a more sensitive approach, detected reproducibility of BOLD signal changes in the following areas: PFG, ACC and insula. CONCLUSIONS: This study confirms that automated, repetitive Bladder Filling of body warm saline using a MR-compatible and MRsynchronized infusion-drainage system shows reproducible BOLD signal changes in specific areas, known from previous neuroimaging studies to be involved in supraspinal lower urinary tract control.
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MP12-06 SUPRASPINAL ACTIVITY TO AUTOMATED, REPETITIVE Bladder Filling - AN FMRI STUDY
The Journal of Urology, 2015Co-Authors: Matthias Walter, Lorenz Leitner, Lars Michels, Spyros Kollias, Thomas M. Kessler, Ulrich MehnertAbstract:INTRODUCTION AND OBJECTIVES: Recent fMRI studies revealed supraspinal networks in response to Bladder Filling involved in perception and processing of Bladder distension. However significance of supraspinal network activity and network localizations varied largely due to the different Filling protocols. Therefore, our aim was to standardize Filling paradigms using a MR-synchronized pump system for accurate timing and Filling volume. METHODS: 31 right-handed healthy subjects, 16 women and 15 men, mean age 34 years (range 19e54) with no history of urinary urgency and/or urinary incontinence were included, were prospectively investigated using a 3 Tesla Phillips scanner. After catheterization, Bladder was pre-filled until a persistent desire to void was perceived by each subject. The scan paradigm comprised automated, repetitive Bladder Filling of 100 mL body warm saline over 15sec by using a MRcompatible pump system, i.e. block design study. Neuroimaging data was analyzed with SPM8. Blood-oxygenation-level dependent signal analysis during Bladder Filling was compared to rest, i.e. pre-filled Bladder. Second-level random effects group analysis was corrected for gender, age and total intracranial volume and was performed to account for between-subject variability, i.e. within-group results at P1⁄40.05 familywise error rate (FWE). RESULTS: 3 subjects, 2 women and 1 man, were excluded from further analysis due to excessive head motions. Within-group results from the remaining 28 subjects revealed activation in the following brain regions: bilateral insula, left inferior parietal lobe (BA40) and right frontal inferior operculum (BA44). CONCLUSIONS: Automated, repetitive Bladder Filling of body warm saline elicited robust brain activity on a high significance level in specific areas known to be involved in supraspinal lower urinary tract control.
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brain activation in response to Bladder Filling and simultaneous stimulation of the dorsal clitoral nerve an fmri study in healthy women
NeuroImage, 2008Co-Authors: Ulrich Mehnert, Lars Michels, Spyros Kollias, Jonas Svensson, Andre Reitz, Victor Candia, Raimund Kleiser, Brigitte SchurchAbstract:AIMS: Using functional magnetic resonance imaging (fMRI) we investigated the cortical and subcortical representations during Bladder Filling and the effect of simultaneous stimulation of the dorsal clitoral nerve on these cortical and subcortical structures. METHODS: After approval of the local ethics committee, 8 healthy females were included. Prior to scanning, subjects were catheterized and the Bladder was filled until first desire to void occurred. In a block design protocol we performed repetitive manual Bladder Filling (Filling) and emptying of additional 80 ml saline, alternating with rest conditions (REST) of constant Bladder volume. The protocol was repeated with simultaneous stimulation of the dorsal clitoral nerve during the Filling periods (COMBINED). Activation maps were calculated by means for 3 different contrasts: 1) Filling>REST, 2) COMBINED>REST and 3) Filling>COMBINED. RESULTS: A group analysis of contrast 1) showed activation of the right prefrontal and orbitofrontal cortices, the insula bilaterally, the left precuneus, the parietal operculum bilaterally, the cerebellum bilaterally (q(FDR)< or =0.001), the right anterior cingulate gyrus (q(FDR)< or =0.005) and the right anterior mid pons (q(FDR)< or =0.05). Contrast 2) showed activation in the right frontal area, the left insula, the parietal operculum bilaterally and the left cerebellum (q(FDR)< or =0.001). Deactivations were found in the middle frontal gyrus bilaterally and the post- and paracentral gyri bilaterally. Contrast 3) revealed stronger activation during Filling in the bilateral frontal and prefrontal areas, the right anterior cingulated gyrus, and the right putamen (q(FDR)< or =0.05). Only the right insula showed stronger activation during the COMBINED condition. CONCLUSION: Simultaneous dorsal clitoral nerve stimulation during Bladder Filling reduced the activation of certain cortical areas suggesting a neuromodulatory effect of this stimulation on supraspinal centres involved in lower urinary tract control.
A G Visser - One of the best experts on this subject based on the ideXlab platform.
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Bladder Filling variation during radiation treatment of prostate cancer can the use of a Bladder ultrasound scanner and biofeedback optimize Bladder Filling
International Journal of Radiation Oncology Biology Physics, 2006Co-Authors: Marcel R Stam, Lisette P Van Der Vight, Johannes H A M Kaanders, A G VisserAbstract:PURPOSE: To investigate the use of a Bladder ultrasound scanner in achieving a better reproducible Bladder Filling during irradiation of pelvic tumors, specifically prostate cancer. METHODS AND MATERIALS: First, the accuracy of the Bladder ultrasound scanner relative to computed tomography was validated in a group of 26 patients. Next, daily Bladder volume variation was evaluated in a group of 18 patients. Another 16 patients participated in a biofeedback protocol, aiming at a more constant Bladder volume. The last objective was to study correlations between prostate motion and Bladder Filling, by using electronic portal imaging device data on implanted gold markers. RESULTS: A strong correlation between Bladder scanner volume and computed tomography volume (r = 0.95) was found. Daily Bladder volume variation was very high (1 SD = 47.2%). Bladder Filling and daily variation did not significantly differ between the control and the feedback group (47.2% and 40.1%, respectively). Furthermore, no linear correlations between Bladder volume variation and prostate motion were found. CONCLUSIONS: This study shows large variations in daily Bladder volume. The use of a biofeedback protocol yields little reduction in Bladder volume variation. Even so, the Bladder scanner is an easy to use and accurate tool to register these variations.
Edward J Mcguire - One of the best experts on this subject based on the ideXlab platform.
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The interaction of Bladder-Filling behavior and ureteral function
World Journal of Urology, 1990Co-Authors: Edward J McguireAbstract:The interrelationship between Bladder-Filling behavior and ureteral delivery of urine into the Bladder was studied in myelodysplastic children, in a primate neurogenic Bladder-dysfunction model, and in a feline obstructive-uropathy model. All of these studies confirm the observation that intravesical pressure is the most important obstacle to ureteral delivery of urine into the Bladder. Our concepts of ureteral function may need some revision. The findings in the obstructive feline model suggest that we should measure ureteral delivery of urine into the Bladder in relation to intravescial pressure since this method may define ureteral reserve “power” better than either perfusion studies or dynamic renal scans.
Mikel Gray - One of the best experts on this subject based on the ideXlab platform.
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Traces: making sense of urodynamics testing--Part 9: Evaluation of sensations detrusor response to Bladder Filling.
Urologic nursing, 2020Co-Authors: Mikel GrayAbstract:: Part 9 of the Traces series continues the discussion of how urodynamic clinicians generate usable data from a Filling cystometrogram. This article focuses on the question: "What is the detrusor's response to Bladder Filling?" Answering this question requires the clinician to identify and differentiate detrusor contractions from abdominal events, artifacts, or low Bladder wall compliance; documentation of the volume of the contraction; and assessment of its clinical relevance as an overactive or subclinical detrusor contraction.
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Traces: making sense of urodynamics testing--Part 8: Evaluating sensations of Bladder Filling.
Urologic nursing, 2011Co-Authors: Mikel GrayAbstract:: The "Traces" series discusses how the urodynamic clinician generates usable data from a Filling cystometrogram (CMG). Part 8 focuses on the question, "What are the sensations of Bladder Filling?" Recent research suggests that sensations of Bladder Filling wax and wane from consciousness in healthy persons free of bothersome lower urinary tract symptoms. Because of its invasive and atypical nature when compared to daily life, multichannel urodynamics testing cannot reproduce the numerous and complex variables that influence Bladder sensation in the healthy individual, making the evaluation of sensations of Bladder Filling a particularly challenging component of the Filling CMG. Routine assessment of Bladder sensations focuses on identification of three landmarks--first sensation of Bladder Filling, first desire to void, and a strong desire to void. A fourth sensation, Bladder fullness or a compelling desire to void, is recommended. In addition to assessing these sensations, the urodynamic clinician must assess sensations indicating associated disease or disorders affecting lower urinary tract function, including urgency, pain, and atypical sensations. This assessment should be completed in the context of the results of one or more validated instruments used to measure Bladder sensations.
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Traces: making sense of urodynamics testing--Part 6: Evaluation of Bladder Filling/ storage: Bladder wall compliance and the detrusor leak point pressure.
Urologic nursing, 2011Co-Authors: Mikel GrayAbstract:: This article defines the concept of Bladder wall compliance, discusses various means of measuring or assessing compliance, and reviews its clinical relevance. Based on existing evidence, low Bladder wall compliance is attributable to increased detrusor muscle tone during Bladder Filling or changes in the viscoelastic properties of the Bladder wall that impede the Bladder wall's ability to stretch. While one can identify the individual components that compromise compliance, the Filling CMG is only able to detect whole Bladder wall compliance (for example, the combined effects of increased detrusor muscle tone and compromised viscoelastic properties of the Bladder wall). From a clinical perspective, whole Bladder wall compliance is divided into two categories: normal and low. Low Bladder wall compliance is clinically relevant because of its potential to produce upper urinary tract distress, and there is increased risk for febrile urinary tract infections, ureterohydronephrosis, vesicoureteral reflux, renal scarring, compromised urinary tract function, and urinary incontinence because of its direct influence on the Bladder outlet. It may produce pain and pressure in the patient with preserved sensations of Bladder Filling. Low Bladder wall compliance is associated with a variety of clinically relevant disorders, including neurogenic Bladder dysfunction, pelvic irradiation, interstitial cystitis, and radical prostatectomy.
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Traces: making sense of urodynamics testing--Part 5: evaluation of Bladder Filling/storage functions.
Urologic nursing, 2011Co-Authors: Mikel GrayAbstract:: Lower urinary tract function is characterized by two stages: Bladder Filling/ storage and micturition. Natural Bladder Filling tends to be slow, intermittent, and variable, while urodynamics testing employs a continuous, supraphysiologic fill rate. A clear understanding of the typical proportion between Bladder storage and micturition is essential when urodynamics findings are interpreted within a clinical setting. When completing a Filling cystometrogram, the urodynamics clinician must answer five essential questions to generate clinical meaningful results: Bladder capacity, Bladder wall compliance, competence of the urethral sphincter mechanism, sensations of Bladder Filling, and detrusor response to Bladder Filling/storage. While the emphasis of each question differs depending on the patient's lower urinary tract symptoms and specific questions posed by the referring physician, the combined answers to these questions form a comprehensive evaluation of lower urinary tract Filling and storage functions. This article will address how the urodynamic clinician answers the first question, "What is the capacity of this Bladder?
