Effects of L-Arginine on Bladder Function in Bladder Outlet-Obstructed Rats

Nitric oxide (NO) is thought to play an important role in the lower urinary tract. We therefore studied the effects of NO on bladder function in bladder outlet-obstructed rats. Twelve-week-old female Wistar rats had their bladder outlets partially obstructed by ligating the urethra over which a catheter was placed. Micturition parameters and urodynamic parameters were measured in 6 groups of rats: Group I, 1 week after sham operation; Group II, 1 week after surgical induction of bladder outlet obstruction; Group III, 150-mg/kg/day L-arginine injected intraperitoneally for 1 week after surgical induction of bladder outlet obstruction; Group IV, 6 weeks after sham operation; Group V, 6 weeks after surgical induction of bladder outlet obstruction and Group VI, 150-mg/kg/day L-arginine injected intraperitoneally for 6 weeks after surgical induction of bladder outlet obstruction. Moreover, the area density of smooth muscle versus connective tissue was determined in bladder specimens using color assisted computer image analysis in these groups. The number of micturitions per day of the 1- and 6-week obstructed rats significantly increased over that of the sham-operated rats. The number of micturitions per day of the obstructed rats treated with L-arginine for 1 and 6 weeks significantly decreased in comparison to that of the obstructed rats. In the urodynamic study, the maximum detrusor pressure of the obstructed rats for 1 and 6 weeks significantly increased over that of the sham-operated rats. Residual urine volume of the obstructed rats for 1 and 6 weeks significantly increased over that of the sham-operated rats. The maximum detrusor pressure and residual urine volume of the obstructed rats treated with L-arginine for 1 and 6 weeks significantly decreased over those of the obstructed rats. In the histological study, the area density of smooth muscle versus connective tissue of the 1- and 6-week obstructed rats significantly increased over that of the sham-operated rats. Histological changes in the 1- and 6-week obstructed rats were prevented by treatment with L-arginine. These results indicate that L-arginine has a beneficial effect on bladder dysfunction in bladder outlet-obstructed rats. This might be due to L-arginine's influence in increasing NO levels and the rate of blood flow in the obstructed bladder

Comprehensive Investigations of Multiple Factors That Are Related to Refractory Outcome in Urosepsis Patients

Background: Urosepsis is an acute life-threating disease, and some cases show refractory outcome to therapy. In an aging society of developed countries, characteristics of urosepsis are becoming complicated. We performed a comprehensive investigation regarding the clinical and social aspects that are related to refractory outcomes in urosepsis patients. Methods: The patient cohort consisted of 66 patients with urosepsis. Multiple factors from clinical and social aspects were reviewed retrospectively. Two categories of refractory outcomes were defined. One was afebrile resistance (AR); fever continued more than 7 days from the initiation of therapy. Another was discharge resistance (DR); hospitalization continued for more than 30 days. Logistic regression analyses were performed to identify significant factors that are related to the AR or DR. Results: Univariate analysis demonstrated that high score of Eastern Cooperative Oncology Group Performance Status (ECOG PS) (? 2) and Age-adjusted Charlson comorbidity index (CCI) (? 4), high serum C-reactive protein (CRP) level (? 14.9 mg/dL), and low serum albumin level (? 2.26 g/dL) were significantly related to AR. Univariate analysis results also revealed that high score of ECOG PS (? 2), high serum creatinine level (? 1.54 mg/dL) and vasopressor administration were significantly related to DR. Multivariate analyses demonstrated that low serum albumin level (? 2.26g/dL) was the only significant factor that was related to AR. In contrast, high score of ECOG PS (? 2) and high serum creatinine level (? 1.54 mg/dL) were significant factors that were related to DR. Conclusion: It is suggested that evaluating serum albumin levels is essential for the therapeutic first step because hypoalbuminemia was the significant factor that was related to obstruction to antipyresis. It is also suggested that the deterioration of patients’ activities of daily living and renal dysfunction might be the refractory factors for discharge from the hospital, which was the ultimate therapeutic goal