A pragmatic approach to the characterization and effective treatment of male patients with postprostatectomy incontinence

Cornu, Jean‐Nicolas; Melot, Charlotte; Haab, F.

doi:10.1097/mou.0000000000000112

Cited by 10 publications

(3 citation statements)

References 47 publications

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“…Despite the paucity of data on the development of urogenital innervation and mechanisms of its remodeling in adulthood, the importance of this area of the nervous system is illustrated by the many clinical problems that arise when the nervous system is perturbed. For example, various types of pelvic surgery performed for tumor removal unavoidably damage nearby nerves, resulting in incontinence and sexual dysfunction (Mauroy et al, 2003 ; Cornu et al, 2014 ; Wit and Horenblas, 2014 ; Laterza et al, 2015 ). Understanding factors that drive growth of these connections during development could identify strategies for their repair in adults.…”

Section: Understanding the Endpoint: Innervation Of The Adult Urinarymentioning

confidence: 99%

Developing a functional urinary bladder: a neuronal context

Keast

Smith-Anttila

Osborne

2015

Front. Cell Dev. Biol.

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The development of organs occurs in parallel with the formation of their nerve supply. The innervation of pelvic organs (lower urinary tract, hindgut, and sexual organs) is complex and we know remarkably little about the mechanisms that form these neural pathways. The goal of this short review is to use the urinary bladder as an example to stimulate interest in this question. The bladder requires a healthy mature nervous system to store urine and release it at behaviorally appropriate times. Understanding the mechanisms underlying the construction of these neural circuits is not only relevant to defining the basis of developmental problems but may also suggest strategies to restore connectivity and function following injury or disease in adults. The bladder nerve supply comprises multiple classes of sensory, and parasympathetic or sympathetic autonomic effector (motor) neurons. First, we define the developmental endpoint by describing this circuitry in adult rodents. Next we discuss the innervation of the developing bladder, identifying challenges posed by this area of research. Last we provide examples of genetically modified mice with bladder dysfunction and suggest potential neural contributors to this state.

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Section: Understanding the Endpoint: Innervation Of The Adult Urinarymentioning

confidence: 99%

Developing a functional urinary bladder: a neuronal context

Keast

Smith-Anttila

Osborne

2015

Front. Cell Dev. Biol.

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“…A variety of clinical disorders originate from the disruption of lower urinary tract innervation. Pelvic surgeries such as prostatectomy [32], hysterectomy [33,34], or colorectal cancer surgery can damage pelvic nerves and lead to subsequent incontinence. Additionally, hyper-innervation of the bladder occurs in chronic cystitis [35,36].…”

Section: Discussionmentioning

confidence: 99%

5-HT3 Signaling Alters Development of Sacral Neural Crest Derivatives That Innervate the Lower Urinary Tract

Buehler

Asher

Deal

et al. 2021

IJMS

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The autonomic nervous system derives from the neural crest (NC) and supplies motor innervation to the smooth muscle of visceral organs, including the lower urinary tract (LUT). During fetal development, sacral NC cells colonize the urogenital sinus to form pelvic ganglia (PG) flanking the bladder neck. The coordinated activity of PG neurons is required for normal urination; however, little is known about the development of PG neuronal diversity. To discover candidate genes involved in PG neurogenesis, the transcriptome profiling of sacral NC and developing PG was performed, and we identified the enrichment of the type 3 serotonin receptor (5-HT3, encoded by Htr3a and Htr3b). We determined that Htr3a is one of the first serotonin receptor genes that is up-regulated in sacral NC progenitors and is maintained in differentiating PG neurons. In vitro cultures showed that the disruption of 5-HT3 signaling alters the differentiation outcomes of sacral NC cells, while the stimulation of 5-HT3 in explanted fetal pelvic ganglia severely diminished neurite arbor outgrowth. Overall, this study provides a valuable resource for the analysis of signaling pathways in PG development, identifies 5-HT3 as a novel regulator of NC lineage diversification and neuronal maturation in the peripheral nervous system, and indicates that the perturbation of 5-HT3 signaling in gestation has the potential to alter bladder function later in life.

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“…In patients undergoing artificial urinary sphincter implantation due to intrinsic sphincter deficiency, there was no correlation between preoperative urodynamic findings and surgical outcomes [55]. Recent evidence indicates that the urodynamic study might not be relevant in all PPUI patients [56].…”

Section: Diagnostic Evaluationmentioning

confidence: 99%

Post-Prostatectomy Urinary Incontinence

Marino,

Rossi,

Sacco

2024

Tertiary Care - Medical, Psychosocial, and Environmental Aspects

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Post-prostatectomy urinary incontinence (PPUI) represents the most bothersome long-term complication of prostatectomy. While the risk of PPUI due to invasive treatments of benign prostatic hyperplasia appears to be low (about 1%), the risk is significantly higher after radical prostatectomy (10–50%). Although both external urethral sphincter deficiency and bladder dysfunctions have been considered responsible for PPUI, sphincter deficiency is the most important determinant. Fortunately, PPUI can be effectively cured by specialized management. The first-line treatment based on pelvic floor muscle training has been shown to accelerate continence recovery. Duloxetine is the only available medical treatment demonstrating clinical efficacy for mild-to-moderate PPUI. However, side effects commonly lead to 15–31% of withdrawal. As a result, in the case of refractory PPUI, more invasive options are recommended including artificial urinary sphincters and male slings. Level 1 evidence has been achieved on the efficacy of these surgical treatments that need to be indicated based on an accurate preoperative workout and shared decision-making.

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A pragmatic approach to the characterization and effective treatment of male patients with postprostatectomy incontinence

Cited by 10 publications

References 47 publications

Developing a functional urinary bladder: a neuronal context

Developing a functional urinary bladder: a neuronal context

5-HT3 Signaling Alters Development of Sacral Neural Crest Derivatives That Innervate the Lower Urinary Tract

Post-Prostatectomy Urinary Incontinence

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