Acta Cirurgica Brasileira.docx
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ActaCirurgicaBrasileira
ActaCirurgicaBrasileira
Print ISSN 0102-8650
ActaCir.Bras. vol.23 suppl.1 SãoPaulo 2008
doi:
10.1590/S0102-86502008000700011
11-EXPERIMENTALRESEARCH
ORIGINALARTICLE
MODELS,BIOLOGICAL
Comparisonoftwoexperimentalmodelsofurodynamicevaluationinfemalerats1
Comparaçãodedoismodelosexperimentaisparaavaliaçãourodinâmicaemratas
AnaBeatrizGomesdeSouzaI;HayltonJorgeSuaidII;CarlaAdelinoSuaidIII;SilvioTucciJrII;AdautoJoséColognaIV;AntonioCarlosPereiraMartinsV
IFellowMasterdegree,DivisionofUrology,DepartmentofSurgeryandAnatomy,RibeirãoPretoFacultyofMedicine,UniversityofSãoPaulo,Brazil
IIPhD,AssociatedProfessor,DivisionofUrology,DepartmentofSurgeryandAnatomy,RibeirãoPretoFacultyofMedicine,UniversityofSãoPaulo,Brazil
IIIFellowMasterdegree,DepartmentofNeurology,RibeirãoPretoFacultyMedicine,UniversityofSãoPaulo,Brazil
IVMD,PhD,DivisionofUrology,DepartmentofSurgeryandAnatomy,RibeirãoPretoFacultyofMedicine,UniversityofSãoPaulo,Brazil
VFullProfessorandHead,DivisionofUrology,DepartmentofSurgeryandAnatomy,RibeirãoPretoFacultyofMedicine,UniversityofSãoPaulo,Brazil
ABSTRACT
PURPOSE:
Urodynamicstudiesinsmallanimalscanbeperformedthroughurethralsoundingorcystostomy.
OBJECTIVE:
Tocomparethetwomethodsofurodynamicevaluationinfemalerats.
METHODS:
Tenfemaleratsweighingonaverage250g,underanesthesiawithurethane(1,25mg/kg)weresubmittedinthreerepeatstoanurethalcatheterof0,64mminexternaldiameterforcystometricmeasurementsofvesiclepressure(VP1)andcontractiontime(CT1).Thecatheterwasextractedataconstantvelocityof0.05cm/minuteuntilcompleteexteriorizationanddeterminationsofmaximalurethralpressure(UP1)andfunctionalurethrallength(FUL1).ThiswasfollowedbyacystostomywithcatheterPE50andanewdeterminationofthevesicalpressure(VP2).Afterbladderdenervation,anewcystometricrecordindirectlyinferedthemaximumurethralclosurepressure(UP2).Thepeakurethalpressure(UP3)andthefunctionalurethrallength(FUL2)weredeterminedinanotherurethralsounding.Thepressureregistrationsystemconsistedofacontinuousinfusionpumpregulatedtoaflowof0.1ml/minuteconnectedbothtothecystostomycatheter(PE-50)ortheurethalcatheter(0.64mm)andthepolygraphNarco-Biosystem.StatisticalanalysisemployedtheWilcoxonnon-parametrictest
RESULTS:
MeanVP1=48,2mmHg(11,8SD);MeanVP2=38,2mmHg(9,0SD)"p"(VP1XVP2)=0,0039.MeanCT1=30,2s(21,5SD);MeanCT2=20,0s(7SD)p(CT1XCT2)=1,28.MeanUP1=47,2mmHg(6,5SD);MeanUP2=21,3mmHg(6,6SD),meanUP3=40,7mmHg(13,3SD)p(UP1XUP2)=0,002;"p"(UP1XUP3)=0,084;p(UP2XUP3)=0,002.MeanFUL1=14,2mm(1,9SD);MeanFUL2=14,1mm(1,9SD);p(FUL1XFUL2)=0,64.
CONCLUSIONS:
Themethodsemployedtoevaluatevesicalandurethralpressuresaredifferent.Thepresenceoftheurethralcathetermaybeanobstructivefactor.Surgicaldenervationuptothebladderneckleveldoesnotcompromiseurethralfunction.
Keywords:
Urodynamics.Pressure.Urethra.Bladder.Cystostomy.
RESUMO
INTRODUÇÃO:
Oestudourodinâmicoemrataspodeserrealizadoatravésdesondagemvesicalporviauretralouporcistostomia.Oobjetivodesteestudofoicompararestesdoismétodos.
MÉTODOS:
Foramutilizadas10ratasdaraçaWistar,pesomédiode250gramas,anestesiadascomuretana(1,25mg/kg).Inicialmentefoirealizadoestudoporsondauretral(0,64mmdediâmetroexterno)paradeterminaçãodapressãovesical(PV1)etempodecontração(TC1),apósistoasondafoitracionadaavelocidadeconstante(0,05cm/m)atésuaexteriorizaçãopelomeatouretral,avaliando-seapressãouretralmáxima(PU1)eocomprimentofuncionaluretral(CFU1).Fez-se,então,acistostomia(sondaPE50)paradeterminaçãodapressãovesical(PV2).Aseguir,realizou-sedesnervaçãocirúrgicadabexigaerealizou-senovoregistrocistométricoparaseinferirapressãouretralindireta(PU2).Logoapós,foipassadasondauretralparadeterminaçãodapressãouretralmáxima(PU3)edocomprimentofuncionaluretral(CFU2).Osistemaderegistrodaspressõesfoiconstituídodeumabombadeinfusãocontínuareguladapara0,1ml/minutoconectadaemYcomocateterdecistostomia(PE-50)oucateteruretral(0,64mm)aumpolígrafoNarco-Bioystem.AanáliseestatísticafoirealizadaatravésdométodonãoparamétricodeWilcoxon.
RESULTADOS:
MédiaPV1=48,2mmHg(11,8SD);MédiaPV2=38,2mmHg(9,0SD)."p"(PV1XPV2)=0,0039.MédiaTC1=30,2s(21,5SD);MédiaTC2=20,0(7SD)p(TC1XTC2)=1,28.MédiaPU1=47,2(6,5SD);MédiaPU2=21,3mmHg(6,6SD),médiaPU3=40,7(13,3SD)p(PU1XPU2)=0,002;"p"(PU1XPU3)=0,084;p(PU2XPU3)=0,002.MédiaCFU1=14,2(1,9SD);MédiaCFU2=14,1(1,9SD);p(CFU1XCFU2)=0,64.
CONCLUSÃO:
Osmétodosdeavaliaçãourodinâmicasãodiferentes.Apresençadocateternauretrapodeserumfatorobstrutivo.Adesnervaçãocirúrgica,atéoníveldocolovesical,nãocomprometeafunçãouretral.
Descritores:
Urodinâmica.Pressão.Uretra.Bexiga.Cistostomia.
Introduction
Urodynamicstudiesareofgreatimportanceinthediagnosisofvesicalandurethraldisorders.InternationalContinenceSociety(ICS)definesitas"thestudyofthephysiologyofthelowerurinarytractandthehydrodynamicsofurinarytransport".1Urodynamicsinsmallanimals(rats)isbasictothephysiopathologyofmicturitionaldisorderstudies,aswellastounderstandtheeffectofseveraldrugsonthelowerurinarytract.Theliteratureconsiderstwodifferentmethodsforthesestudies,oneofthemthroughacystostomycatheter(PE-50)"Y"connectedtoacontinuousinfusionsystemandtoapolygraph.2Inthismethoditispossibletodeterminebladderpressurebehaviorduringthefillingupandemptyingphases.Inaddition,themaximumurethralclosurepressurecanbeindirectlydetermined.Whentheanimalissubmittedtothebladdersurgicaldenervationuptothelevelofthebladderneck,theorganactslikeatruereservoir.Thus,whenthevesicalhydrostaticpressureequalstheurethralone,liquidislostthroughtheurethraandthemaximumurethralclosurepressureisregistered.
Anothermethodcitedintheliterature3isrelatedtoperformingtheurodynamicstudyinfemaleratsusingcatheter,0.64mminexternaldiameter,withtwoorifices,thatareintroducedviaurethra,uptothebladderand"Y"connectedtothecontinuousinfusionpumpsystemandthepolygraph.Inthisway,vesiclebehaviorinthemictionalcycleisdetermined.Thecatheter,whenlocatedinurethraandtractionedwithconstantspeeduntilitisexteriortotheurethralmeatus,carriesthroughtherecordoftheurethralpressureprofile(UPP).However,itshouldbeconsideredthatthepresenceofacatheterintheurethramayfunctionasanobstructivefactortothemictionalflowmakingthebladdercontractwithhigherpressures.
Severalexperimental4studiesusedUPPtoevaluatedruginfluenceonurethralfunctionandinstudiesofinfravesicalobstruction.Astudymadein20035usingUPPevaluatedtheeffectofthealpha1antagonistsdrugs,prazosinandphenoxybenzamine,onurethralfunctioninbeagledogs.Itverifiedthereductionofmaximalurethralpressureandthemaximalurethralclosurepressure,40minutesafterdrugadministration.UPPdeterminationturnedouttobeanefficientandsensitivemethodtoevaluatetheeffectofalpha1antagonistsdrugsondogurethra.
Another20066studyverifiedtheeffectofmuscarinicreceptorantagonists(M1toM4)onthephysiologyofthelowerurinarytractofratswhenadministeredbythecerebralintraventricularway.Functionalreactionswereevaluatedthroughcystometryandtheurethralpressureprofile.ResultsindicatedthatintracerebralventricularadministrationofreceptorantagonistsM1andM3inhibitedmictionandthatM2eM4antagonistshadanexcitatoryeffectonthelowerurinarytractinconsciousrats.
Cystometryandtheurethralpressureprofilehadalsobeenusedtostudytheeffectofalpha-blockerdrugsonintra-vesicalobstructioninfemaleratsshowingthatsignificantreductionofbladdercontractionswasnotinhibitedandagreaterurethralrelaxation.7
Theexistenceofthesetwomethodsandtheirwideuseasreportedintheliterature,promptedthedevelopmentofacomparativestudyinordertodetermineiftheywereequivalentornot.Thepresentstudyaimedtocomparevesicalpressuremeasuredbyurethralcathetersorcystostomy.Inaddition,theurethralpressureprofilewascomparedbeforeandafterbladdersurgicaldenervation.
Methods
FemaleRattusnorvegicusalbinus,Wistarlineage,08to12weeksofagewithanaverageweightof205gwereobtainedfromtheCentralAnimalRoomintheRibeiraoPretoCampusoftheUniversityofSaoPaulo.Theywereusedunderanesthesiawithurethane,i.p.inthedosageof1,25mg/kg.
Recordingvesiclepressurethroughanurethralcatheter
Apolyethylenecatheter(0.64mmand0.50mminexternalandinternaldiameters,respectively)containinga0.1mmlateralorifice,1cmfromtheoccludedextremitywasespeciallymanufacturedfortheexperiment.Aftervesicleemptying,thecatheterwasconnectedtoapressuretransducer"Y"connectedtoaNarco-Biosystempolygraphandacontinuousinfusionpumpwithaflowof0,1ml/min.Thefillingupandemptyingpressurealterationswererepeatedlyrecordedforthreeconsecutiveperiodsoftime,witha10minutesintervalbetweenthemeasurements(Figure1).Theanalyzedparameterswere:
maximumbladderpressure(VP1)andtimeofcontraction(CT1).
Urethralpressureprofile
Thepolyethylenecatheter(0.64mminexternaldiameter)wasi
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