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