RESUMO
Urinary incontinence due to urethral sphincter mechanism incompetence (USMI) affects up to 20% of bitches that undergo spaying surgery. Amitriptyline is a tricyclic antidepressant whose urinary retention is a reported side effect. This study aimed to assess the efficacy and safety of amitriptyline when compared to estriol orally. Fifteen bitches with a clinical diagnosis of post-spaying UI were evaluated during 60 days in a non-blinded randomized clinical trial. All patients were enrolled after clinical evaluation consisting of anamnesis, physical examination, and complementary exams (complete blood count, biochemical parameters, urinalysis, and abdominal ultrasound). The amitriptyline (AMT) group consisted of 8 bitches, which received the initial dose of 1 mg/kg every 12 h, whereas the estriol (EST) group consisted of 7 bitches which were initially treated with 1 mg/animal every 24 h. Patients underwent clinical evaluation at 7 days, and then at 21 and 60 days of treatment to assess safety and efficacy, as well as adjustments of dose when necessary. A urinary incontinence scale was used to assess the level of incontinence and therapeutic response to treatment. During the period of the study, estriol was fully effective in 71% of cases and amitriptyline in 62%. Both drugs proved safe in the medical treatment of USMI, with adverse effects such as somnolence (AMT, n = 5/8) and male attraction (EST, n = 1/7). The results support the amitriptyline recommendation as a substitute for estriol in USMI treatment.
Assuntos
Doenças do Cão , Enurese , Incontinência Urinária , Feminino , Masculino , Animais , Cães , Amitriptilina/uso terapêutico , Ovariectomia/veterinária , Doenças do Cão/diagnóstico , Incontinência Urinária/tratamento farmacológico , Incontinência Urinária/veterinária , Incontinência Urinária/diagnóstico , Enurese/etiologia , Enurese/veterináriaRESUMO
INTRODUCTION: Stress urinary incontinence (SUI) is one of the health problems with more impact on patients' lives. The aim of the present work was to develop a therapy for SUI using tissue engineering by isolation and culture of autologous myoblasts (CAM) followed by endoscopic implantation. We also evaluated the efficacy of this therapy in a rabbit model of incontinence after sphincterotomy. MATERIALS AND METHODS: We used healthy male New Zealand rabbits. The animals were first bled to obtain platelet-poor plasma (PPP) and biopsied for myoblast isolation. Post-sphincterotomy, they were divided into two groups: the treatment group (including animals that received CAM resuspended in PPP) and the control group (including animals receiving only PPP). The leak-point pressure (LPP) was used to measure continence in both groups at different time points. The results were evaluated with hierarchical linear regression models. Histological evaluation of the rabbits' sphincters was also performed at the end of follow-up. RESULTS: No statistically significant differences were observed between the baseline LPP values of each group. The post-sphincterotomy values of both groups were below 50% of the baseline value, which was a mandatory condition for incontinence. The post-implantation values of the treatment group were higher than 50% of the baseline value, which led us to assume continence recovery. A statistically significant difference was observed in the LPP values between the two treatment groups (p=0.003). Histological study revealed interconnected islands formed by muscle fibers in the treatment group, and connective tissue surrounding the urethral lumen and inflammatory infiltrate in the control group. DISCUSSION AND CONCLUSIONS: The implantation of CAM significantly improved LPP values in the treatment group, and the improvement remained throughout the evaluation period. It may be associated with the consistency of the implant and its stability at the injection site. Longer follow-up studies and human clinical investigations are required to consider CAM implantation as an alternative treatment for stress urinary incontinence.
Assuntos
Incontinência Urinária por Estresse , Incontinência Urinária , Coelhos , Humanos , Masculino , Animais , Incontinência Urinária por Estresse/cirurgia , Uretra/cirurgia , Uretra/patologia , Mioblastos/patologia , Engenharia TecidualRESUMO
AIMS: To determine if a continuous administration of leuprolide acetate (LA), a synthetic agonist for the gonadotrophin-releasing hormone receptor, facilitates the recovery of urinary function in spinal cord injured male rats. MAIN METHODS: Male Wistar rats were randomized into spinal cord injury (SCI; n = 7), SCI with continuous administration of LA for two weeks via implantation of a subcutaneous osmotic pump (SCI + LA; n = 7), Sham SCI (SH-SCI; n = 6) or no surgery (Intact; n = 6) groups. Micturition, hind-limb nociception and locomotor behaviors were analyzed before and after surgical procedures on days 7, 14, 21 and 28. After behavioral studies, electromyography of the external urethral sphincter (EUS-EMG) and cystometric (CMG) studies were performed in all groups. KEY FINDINGS: SCI significantly decreased frequency of voids and CMG parameters (p < 0.001), abolished the bursting activity of the EUS during CMG, significantly increased hind limb sensory threshold and decreased locomotor performance in comparison to the other groups (p < 0.001). Continuous LA treatment significantly increased the frequency of voids and improved CMG parameters (p < 0.001), exhibiting bursting EUS activity during CMGs, and enhanced locomotor performance in comparison to SCI rats (p < 0.001). SIGNIFICANCE: SCI severely affected behavioral and functional micturition processes, including sensory and locomotor functions. Systemic and uninterrupted treatment with LA improves the recovery of micturition behavior and the synergistic function of the EUS. Furthermore, sensory and locomotor responses were also improved in SCI rats. This procedure may have a therapeutic potential to facilitate urinary function recovery in patients with SCI.
Assuntos
Traumatismos da Medula Espinal , Micção , Animais , Masculino , Ratos , Leuprolida/farmacologia , Ratos Wistar , Medula Espinal , Traumatismos da Medula Espinal/tratamento farmacológico , UretraRESUMO
Ovariohysterectomy (OHE) is the most performed elective surgery in veterinary medicine. Although this procedure brings benefits both to the animal and public health, acquired urinary incontinence is a possible complication resultant from it. The aim of this study was to determine the prevalence of urinary incontinence and evaluate size, breed, and time of surgery as risk factors in a population of spayed female dogs in the Hospital de Clínicas Veterinárias da Universidade Federal do Rio Grande do Sul, in the year of 2013, through the use of a multiple-choice screening instrument. Identified estimated prevalence was 11.27% and main risk factors were as follows: large size (OR = 7.12 IC95% = 1.42 - 35.67), Rottweiler breed (OR = 8.92; IC95% = 5.25 - 15.15), Pit-bull breed (OR = 4.14; IC95% = 2.19 - 7.83), and Labrador breed (OR = 2.73; IC95% = 1.53 - 4.87). Time of surgery was not considered a risk factor for urinary incontinence in this population (OR = 1.45; IC95% = 0.86 - 2.40). Even though most owners reported a small impact on their relationship with the animal, urinary incontinence hazard should be addressed before spaying.(AU)
A ovário-histerectomia (OHE) é a cirurgia eletiva mais realizada em medicina veterinária. Embora seja um procedimento que beneficie a saúde pública e do animal, a incontinência urinária adquirida é uma complicação possível resultante desse procedimento. O objetivo deste estudo foi determinar a prevalência de incontinência urinária e avaliar porte, raça e momento da castração como fatores de risco em uma população de cadelas castradas no HCV/UFRGS, no ano de 2013, através do uso de um instrumento de triagem de múltipla escolha. A prevalência estimada foi de 11,27% e os principais fatores de risco foram: grande porte (OR = 7,12 IC95% = 1,42 - 35,67), raça Rottweiler (OR = 8,92; IC95% = 5,25 - 15,15), raça Pitbull (OR = 4,14; IC95% = 2,19 - 7,83) e raça Labrador (OR = 2,73; IC95% = 1,53 - 4,87). O tempo da cirurgia não foi considerado fator de risco para incontinência urinária nessa população (OR = 1,45; IC95% = 0,86 - 2,40). Embora a maioria dos proprietários tenha relatado um pequeno impacto no relacionamento com o animal, a possibilidade de incontinência urinária deve ser devidamente discutida antes da castração.(AU)
Assuntos
Animais , Feminino , Cães , Uretra/patologia , Incontinência Urinária/etiologia , Incontinência Urinária/veterinária , Ovariectomia/veterinária , Castração/veterinária , Histerectomia/veterináriaRESUMO
Resumen ANTECEDENTES: El síndrome de Fowler es poco común, con predominio en mujeres jóvenes; se caracteriza por una actividad anormal, con contracciones repetidas en el esfínter uretral externo, en ausencia de enfermedad neurológica. CASO CLÍNICO: Paciente de 51 años, acudió a consulta por prolapso de órganos pélvicos con sensación de masa en la vagina y dificultad para orinar. En la videourodinamia se apreció una onda intermitente, con hipoactividad del detrusor y micción no coordinada, sin incontinencia, hallazgos característicos del síndrome de Fowler. Se le indicó terapia de aprendizaje de relajación del esfínter para coordinar la micción, posteriormente neuromodulación sacra. Durante el seguimiento se observó mejor coordinación y satisfacción después de orinar. CONCLUSIONES: La micción es un proceso complejo, que implica la integridad de la vía urinaria inferior y adecuado sinergismo con el sistema nervioso central, autónomo y somático. La falla en alguna de estas estructuras podría ocasionar un patrón miccional obstructivo.
Abstract BACKGROUND: Fowler's syndrome is a rare phenomenon mainly in young women in reproductive age with abnormal, repeated contractions in the external urethral sphincter without a neurological disease. CLINICAL CASE: 51-year-old woman with pelvic organ prolapse, symptoms of vaginal bulge and difficult micturition. A videourodynamic study was done showing intermittent waveform, detrusor hypoactivity and uncoordinated micturition without incontinence, suggestive of Fowler's syndrome. The patient underwent therapy for sphincter relaxation and sacral neuromodulation with good response. In the follow up with clinical improvement, referring being satisfied after micturition. CONCLUSIONS: Micturition is a complex process that needs integrity of the lower urinary tract and synergy between this and the central nervous system, autonomous and somatic. Failure in any of these structures can result in an obstructive pattern.
RESUMO
AIMS: Investigate the effect of a novel cell-based therapy with skeletal muscle-derived mononuclear cells (SMDMCs) in a rat model of stress urinary incontinence. METHODS: Male Wistar-Kyoto rats' hind limb muscles were enzymatically dissociated, and SMDMCs were isolated without needing expansion. The cell population was characterized. Twenty female rats underwent urethrolysis. One week later, 10 rats received periurethral injection of 106 cells (SMDMC group), and 10 rats received saline injections (Saline group). Ten rats underwent sham surgery (Sham group). Four weeks after injection, animals were euthanized and the urethra was removed. The incorporation of SMDMCs in the female urethra was evaluated with fluorescence in situ hybridization for the detection of Y-chromosomes. Hematoxylin and eosin, Masson's trichrome staining, and immunohistochemistry for actin and myosin were performed. The muscle/connective tissue, actin and myosin ratios were calculated. Morphological evaluation of the urethral diameters and fractional areas of the lumen, mucosa, and muscular layer was performed. RESULTS: SMDMCs population was consistent with the presence of muscle cells, muscle satellite cells, perivascular cells, muscle progenitor cells, and endothelial cells. SMDMCs were incorporated into the urethra. A significant decrease in the muscle/connective tissue ratio was observed in the Saline group compared with the SMDMC and Sham groups. The proportions of actin and myosin were significantly decreased in the Saline group. No differences were observed in the morphometric parameters. CONCLUSIONS: SDMSC were incorporated into the rat urethra and promoted histological recovery of the damaged urethral sphincter, resulting in decreased connective tissue deposition and increased muscle content.
Assuntos
Terapia Baseada em Transplante de Células e Tecidos/métodos , Fibras Musculares Esqueléticas/citologia , Incontinência Urinária por Estresse/terapia , Animais , Feminino , Masculino , Ratos , Ratos Sprague-Dawley , Resultado do Tratamento , Uretra/fisiologiaRESUMO
AIMS: The objective of this study was to evaluate the similarities and differences of the urethral morphological and functional changes following external urethral sphincter EUS injury in male and female rats. METHODS: 30 female and 30 male age-matched Wistar rats were used in the experiments. Half of them underwent electrocauterization of the surrounding tissues lateral to the urethra at the level of the (EUS) and the others, a sham operation. At 2, 6, and 16 weeks after surgeries they underwent anesthetized cystometry, measurement of leak point pressure (LPP) and their urethras were harvested for morphological analyses. RESULTS: There were no differences in cystometric parameters between sex-time-matched animals, ensuring normal bladder function in the manipulated animals. The mean LPP in male and female rats was lower compared with sham animals. Age-time-matched sham operated male rats exhibited a higher LPP compared with female rats. The reduction in LPP comparing electrocauterized and sham time-matched animals was more pronounced in male rats than in female rats. Electrocauterization produced urethral collagen deposition and nerve damage in both male and female animals. Muscle atrophy and disruption also occurred, being more evident in female rats. CONCLUSIONS: The urethras of male and female rats exhibited a similar morphological and functional response to electrocauterization. The time-course evaluation revealed that the male animal model is as reliable, reproducible and long-lasting as the female model. Intact males had a higher LPP than female rats and the nerve injury led to a more drastic impairment of this mechanism.
Assuntos
Uretra/lesões , Incontinência Urinária por Estresse/etiologia , Animais , Colágeno/metabolismo , Modelos Animais de Doenças , Eletrocoagulação , Feminino , Fibrose , Masculino , Atrofia Muscular/etiologia , Atrofia Muscular/patologia , Atrofia Muscular/fisiopatologia , Regeneração Nervosa , Traumatismos dos Nervos Periféricos/etiologia , Traumatismos dos Nervos Periféricos/patologia , Traumatismos dos Nervos Periféricos/fisiopatologia , Pressão , Ratos Wistar , Fatores Sexuais , Fatores de Tempo , Uretra/inervação , Uretra/metabolismo , Uretra/fisiopatologia , Incontinência Urinária por Estresse/metabolismo , Incontinência Urinária por Estresse/patologia , Incontinência Urinária por Estresse/fisiopatologia , UrodinâmicaRESUMO
Incontinência urinária (IU) pode ocorrer após castração de cadelas, quando há diminuição nos níveis circulantes de hormônios esteroides e aumento nos de gonadotrofinas, além de alteração funcional no esfíncter uretral. Para determi- nar a ocorrência da IU em cadelas castradas no Hospital Veterinário da Universidade Anhembi-Morumbi, os prontuá- rios de cadelas esterilizadas no período 2002-2009 foram analisados de agosto de 2010 a março de 2011. Foi feito conta- to telefônico com os proprietários para investigar um possível desenvolvimento de IU após a castração. Nesse período, foram contatados osproprietários de 227 cadelas. Destas, 73 (32,2%) vieram a óbito sem sintoma de IU pós-castração, 146 (64,3%) não apresentaram IU e oito (3,5%) desenvolveram IU no período de 3,8 ± 1,6 anos após castração.(AU)
Urinary incontinence (UI) can occur in bitches after spaying due to a functional alteration in the urethral sphincter. which may be caused by a number of different causes among which a decrease in the blood levels of steroidal hormones or an increase in gonadotropin in order to determine the occurrence of UI in spayed bitches at the Veterinary Hospital, University Anhembi-Morumbi, the medical records of spayed bitches in the period 2002-2009 were examined from August 2010 to March 2011. The owners of 227 bitches were contacted by telephone to search for development of UI after spaying. Of these, 73 (32.2%) died with no symptom of UI, 146 (64.3%) did not develop UI, and eight (3.5%) de- veloped UI in the period of 3.8 ± 1.6 years after castration.(AU)
Assuntos
Animais , Incontinência Urinária/fisiopatologia , Ovário/anatomia & histologia , Hormônios , Castração , CãesRESUMO
Incontinência urinária (IU) pode ocorrer após castração de cadelas, quando há diminuição nos níveis circulantes de hormônios esteroides e aumento nos de gonadotrofinas, além de alteração funcional no esfíncter uretral. Para determi- nar a ocorrência da IU em cadelas castradas no Hospital Veterinário da Universidade Anhembi-Morumbi, os prontuá- rios de cadelas esterilizadas no período 2002-2009 foram analisados de agosto de 2010 a março de 2011. Foi feito conta- to telefônico com os proprietários para investigar um possível desenvolvimento de IU após a castração. Nesse período, foram contatados osproprietários de 227 cadelas. Destas, 73 (32,2%) vieram a óbito sem sintoma de IU pós-castração, 146 (64,3%) não apresentaram IU e oito (3,5%) desenvolveram IU no período de 3,8 ± 1,6 anos após castração.
Urinary incontinence (UI) can occur in bitches after spaying due to a functional alteration in the urethral sphincter. which may be caused by a number of different causes among which a decrease in the blood levels of steroidal hormones or an increase in gonadotropin in order to determine the occurrence of UI in spayed bitches at the Veterinary Hospital, University Anhembi-Morumbi, the medical records of spayed bitches in the period 2002-2009 were examined from August 2010 to March 2011. The owners of 227 bitches were contacted by telephone to search for development of UI after spaying. Of these, 73 (32.2%) died with no symptom of UI, 146 (64.3%) did not develop UI, and eight (3.5%) de- veloped UI in the period of 3.8 ± 1.6 years after castration.
Assuntos
Animais , Hormônios , Incontinência Urinária/fisiopatologia , Ovário/anatomia & histologia , Castração , CãesRESUMO
OBJECTIVE: The aim of the study was to develop a new durable animal model (using rabbits) for anatomical-functional evaluation of urethral sphincter deficiency. MATERIALS AND METHODS: A total of 40 New Zealand male rabbits, weighting 2.500 kg to 3.100 kg, were evaluated to develop an incontinent animal model. Thirty-two animals underwent urethrolysis and 8 animals received sham operation. Before and at 2, 4, 8 and 12 weeks after urethrolysis or sham operation, it was performed cystometry and leak point pressure (LPP) evaluation with different bladder distension volumes (10, 20, 30 mL). In each time point, 10 animals (8 from the study group and 2 from the sham group) were sacrificed to harvest the bladder and urethra. The samples were evaluated by H&E and Masson's Trichrome to determine urethral morphology and collagen/smooth muscle density. RESULTS: Twelve weeks after urethrolysis, it was observed a significant decrease in LPP regardless the bladder volume (from 33.7 ± 6.6 to 12.8 ± 2.2 cmH2O). The histological analysis evidenced a decrease of 22% in smooth muscle density with a proportional increase in the collagen, vessels and elastin density (p < 0.01). CONCLUSIONS: Transabdominal urethrolysis develops urethral sphincter insufficiency in rabbits, with significant decrease in LPP associated with decrease of smooth muscle fibers and increase of collagen density. This animal model can be used to test autologous cell therapy for stress urinary incontinence treatment.