Interpretation
Patients in this study displayed an unchanged Vv after TOT. Because the
Vv was the difference between the pre-emptied volume and maximal bladder
capacity, this result implies an un-modified volume threshold
triggering/initiating a voiding, i.e., our TOT protocol exhibits little
effect on the sensory afferents, namely the pelvic and the hypogastric
nerves,27 and integration centers regulating voiding
activity. Moreover, rather than the pudendal nerve innervating the
urethra, the motor impulse provoking bladder contractions is also mainly
transmitted by the pelvic and the hypogastric
nerves.27 We thereby suggest our TOT procedure
exhibits trivial damage on the afferent/efferent pathways and the
centers mediating voiding activity. Thereby, the post-operative effects
in this study could be attributed to the biomechanical modifications
occurring in the bladder itself.
We propose two possible causes could underlie the TOT-associated Pv
increment. First, below the failure threshold, detrusor could adapt
itself to an inotropic situation following enhanced outlet
resistance.28 Alternatively, the bladder is inherently
to develop higher tension to the enhanced outlet resistance for its
length-tension relationship is distinctive and relatively linear,29 nevertheless, the precise mechanisms wait for final
proof