216 ORIGIN AND MODULATION OF SPONTANEOUS ACTIVITY IN THE BLADDER TRIGONE

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Sexual dysfunction in women with hypothyroidism and subclinic hypothyroidism Atış R.G.1, Altuntaş Y.2, Dalkılınç A.3, Aydın A.4, Çaşkurlu T.1, Ergenekon E.3 Göztepe Training and Research Hospital, Dept. of Urology, Istanbul, Turkey, 2Şişli Etfal Training and Research Hospital, Dept. of Internal Medicine, Istanbul, Turkey, 3Şişli Etfal Training and Research Hospital, Dept. of Urology, Istanbul, Turkey, 4Şişli Etfal Training and Research Hospital, Dept. of Obstetrics and Gynecology, İstanbul, Turkey

1

Introduction & Objectives: Hypothyroidism is a common hormonal disorder in women that may affect the phases of female sexual function. We investigated sexual function in patients with primary hypothyroidism and subclinic hypothyroidism. Material & Methods: A total of 25 women with primary hypothyroidism, 25 women with subclinic hypothyroidism and 20 age matched voluntary healthy women controls were included in the study. All the subjects were evaluated with a detailed medical and sexual history, including a female sexual function index (FSFI) questionnaire for sexual status and the Beck Depression Inventory (BDI) for psychiatric assessment. The levels of serum thyroid stimulating hormone (TSH), thyroid hormones (free T3, free T4), prolactin, free testosterone, estradiol, follicle-stimulating hormone, luteinizing hormone, lipid profile, blood glucose were measured. Results: The mean prolactin levels for hypothyroidic and subclinic hypothyroidic patients were found to be significantly higher than the levels for controls (p=0.0001), whereas other serum hormone levels were not different among groups. Female sexual dysfunction (FSD) was diagnosed in 14 of 25 patients ( 56%) in hypothyroidic group and in 8 of 25 patients (32%) in subclinic hypothyroidic group, while only 3 of 20 healthy women (15%) had (p = 0.015). The median total FSFI score was 23.9 in the hypothyroidic group, 27.8 in the subclinic hypothyroidic group, and 32.30 in the control group (p<0.0001). When the subscores of each domain of FSFI were evaluated, desire (p=0.002), arousal (p=0.018), lubrication (p=0.035), orgasm (p=0.04), satisfaction (p=0.014) and pain (p=0.001) domain scores were significantly lower in women with hypothyroidism and also subclinic hypothyroidism as compared to control group. The mean BDI score for hypothyroidic patients was significantly greater than the score for subclinic hypothyroidic patients and the controls (p = 0.012). The FSFI score showed a significant negative correlation with the serum TSH (r=-0.47, p=0.001), prolactin (r=-0.41, p=0.0017), and cholesterol levels (r=-0.34, p=0.042) and also the BDI score (r =-0.39, p= 0.003). Conclusions: A significant percent of women with hypothyroidism and subclinic hypothyroidism had sexual dysfunction. Hyperprolactinemia, hypercholesterolemia and depression were associated with FSD in hypothyroidism. Different than hypothyroidism depression was not associated with subclinic hypothyroidism.

P14 FURTHER MECHANISMS FOR MICTURITION DYSFUNCTION AND TREATMENT Wednesday, 18 March, 14.30-16.00, Room C4

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Abnormal brain responses to bladder filling in Fowler’s syndrome and effect of sacral neuromodulation (SNM) Kavia R.B.C.1, Dasgupta R.1, Critchley H.D.2, Fowler C.J.1, Griffiths D.J.3 University College London, Dept. of Uro-Neurology, London, United Kingdom, 2University of Sussex, Dept. of Psychiatry, Brighton, United Kingdom, 3University of Pittsburgh, Div. of Geriatric Medicine, Pittsburgh Pa, United States of America 1

Introduction & Objectives: Young women with urinary retention due to Fowler’s syndrome have little bladder sensation and are unable to contract the detrusor. EMG recorded from the striated urethral sphincter shows a specific abnormality of a type expected to cause impaired muscle relaxation. Maximum urethral closure pressure (MUCP) is elevated. SNM does not alter the sphincter abnormality but does result in a return of the sensation and ability to micturate. The aims of this study were to use functional magnetic resonance imaging (fMRI) to determine, in women with this syndrome, brain responses to bladder filling before and after SNM. Material & Methods: Six female volunteers aged 18 – 39 y, with proven Fowler’s syndrome and successful response to temporary SNM, were included. All had preliminary measurement of MUCP. They were then scanned pre- and post-SNM in a 1.5T scanner. On each occasion two measurement sessions were performed, one with near-empty bladder and the other with the bladder filled until strong desire to void or discomfort. After structural imaging, the whole brain was scanned (once per 3.24 s, 280 total scans) using an fMRI pulse sequence to produce a signal representing regional neuronal activity. During scanning, 50 ml saline was repeatedly infused or withdrawn from the bladder over a period of 7 s, thus mimicking repeated bladder filling. A pushbutton was used to report changes in desire to void. Images were preprocessed and analysed using Statistical Parametric Mapping (SPM2). The difference between fMRI signals during infusion and withdrawal was used to indicate response to bladder filling. Results: Brain responses to bladder infusion and sensation (judged by number of button presses) depended on both bladder volume (near-empty or full) and SNM status (pre- or post-SNM). PreSNM and with near-empty bladder, sensation was weak and responses were almost exclusively negative (withdrawal > infusion) rather than the normal positive activations. However the periaqueductal grey, which receives ascending afferents from the spinal cord, was activated by infusion. With full bladder and post-SNM, sensation improved and limited activation was observed in some parts of the cortex, although many responses were still abnormal. Abnormality of response was correlated with higher MUCP (reflecting a more severe disorder). Conclusions: Brain responses to bladder infusion in subjects with Fowler’s syndrome are highly abnormal and these correlate with the severity of sphincter abnormality, confirming an association with the syndrome. After successful SNM treatment, the reliability of bladder sensation is improved and brain responses to bladder infusion are partially normalized. One possible interpretation is that, in Fowler’s syndrome, abnormal urethral afferents result in suppression of the cerebral control network, thus reducing bladder sensation and contractility.

Eur Urol Suppl 2009;8(4):174



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The study of prevalence and potential risk factors of sexual dysfunction among women attending a urology clinic Hamidi Madani A., Mirmaramdoust J. Guilan University of Medical Sciences-Razi University Hospital, Dept. of Urology, RashtGuilan, Iran Introduction & Objectives: Female sexual dysfunction (FSD) is a prevalent health problem worldwide. Multiple population-based studies revealed a high prevalence of sexual health concerns in women of all ages which most of their sexual problems are potentially treatable. The aim of this study was to find out an estimation of the prevalence of sexual complaints and related potential risk factors among a specific population of married women attending a urology clinic due to other urologic health problems, because there has been little research carried out on the prevalence and causes of FSD in Iran. Material & Methods: This study was conducted at a urology clinic in Rasht-Iran, and all married women who attended this clinic due to other urologic problems during a 12-month period were included in this study voluntarily, and their sexual complaints were evaluated via Female Sexual Dysfunction Index Questionnaire and the prevalence and potential risk factors of FSD were measured among these women. Results: Although a total of 979 married women aged 18-70 years were eligible for inclusion in this study, the participation rate was 44%. The majority of the responders were younger than 50 years old, educated, and unemployed. According to self-reports, the prevalence of FSD among responders was 41% and the prevalence of women with sexual pain, low sexual arousal, lack of orgasms, sexual dissatisfaction, and lack of lubrication were 67.8%, 60.9%, 59.1%, 52.2%, and 50.4%, respectively. Sexual problems among women who had older age, more children, a higher academic status, a long term marriage, infrequent sexual intercourse, married to an older husband, and who were uneducated about sexual themes at the time of marriage were significantly higher. Of those responders who reported a sexual problem, 52% said that they would like to receive professional help for their complaints. Conclusions: Among responders there was a high level of reported sexual problems with predictable potential risk factors and many people would like help for such problems. These findings suggest that there may be an important burden of potentially reversible female sexual problems in the general population which many of these frequently reported problems are amenable to physical, pharmacological or psychological treatments and it is necessary to promote knowledge and attitudes of spouses and health workers about sexual health subjects. It is evident that recognition of FSD prevalence and its potential risk factors help to clarify the high number of women who could be potentially helped with current and future pharmacologic and psychologic interventions which fortifying the family basis.



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Origin and modulation of spontaneous activity in the bladder trigone Roosen A.1, Wu C.2, Sui G.2, Stief C.G.1, Fry C.H.2 1 Ludwig Maximilians University, Dept. of Urology, Munich, Germany, 2University College London, Institute of Urology, London, United Kingdom

Introduction & Objectives: The trigone provides a fixed, but controlled base to the bladder during filling, and relaxes just before emptying. Unlike dome and urethra, the trigone has a dual cholinergic and adrenergic innervation. Spontaneous activity might enable the trigone to adopt a state of sustained contracture. We assessed the interaction of different excitatory transmitters as well as the origin and modulation of trigonal spontaneity. Material & Methods: Intact muscle strips from the superficial trigone of male guinea-pigs were used for tension experiments and immunofluorescent studies. In isolated trigonal cells, intracellular calcium [Ca2+]i was measured by epifluorescence microscopy using the fluorescent Ca2+-indicator Fura-2. Results: EFS contractions were enhanced by phenylephrine (PE, 3–10µM) by 6.4 ± 0.1-fold of control. PE augmented contractions induced by carbachol (1µm) to 4.0 ± 0.8-fold of control, while corresponding [Ca2+]i levels in single cells did not exceed 1.3 ± 0.2-fold of control. The protein kinase C inhibitor GF 109203X (5 µm) and the Rhokinase inhibitor Y-27632 (5 µm) reduced the PE contracture to 37.3 ± 9.4 and 60.1 ± 12.4 % of control, respectively. Spontaneous activity in trigonal single cells and strips was significantly higher compared to the bladder dome. 0-Ca+-solution and verapamil terminated spontaneity in cells as well as in the intact preparation. Cl--channel blocker niflumic acid was significantly effective in attenuating both single cell [Ca2+]i-transients and muscle contractions. Agonist stimulation (carbachol, phenylephrine) up-regulated the activity. Gap junction labelling (Cx43) was about 5 times denser in the trigonal than in the detrusor smooth muscle. Gap junction blocker 18-ß-GA had a depressing effect on spontaneous contractions in the trigone, but not the bladder dome. Conclusions: Muscarinic and adrenergic receptor activation exerts a strong synergistic effect in the trigone without similar changes to the [Ca2+]i transient, most likely mediated through Ca2+-sensitisation of contractile proteins. Similar to interstitial cells, trigonal smooth muscle cells employ membrane L-type-Ca2+- and Cl--channels to generate pronounced spontaneous activity. Extensive electrical coupling ensures its propagation and, thus, sustained contraction of the trigone during filling.