Detrusor Muscle Research Laboratory
Operating since 1992, the Pelvic Floor Unit and Detrusor Muscle Laboratory make up the Department of Urogynaecology. The Detrusor Muscle Laboratory is led by Professor Kate Moore, with close collaboration from the laboratories of: Dr Lu Liu (UNSW), Professor Russ Chess-Williams (Bond University) and Dr Kylie Mansfield (University of Wollongong). The Post Doctoral Research Associate is Dr Ying Cheng.
Bladder overactivity occurs in 17% of the population; the incidence rises with increasing age. Patients suffer from debilitating symptoms of urgency (ie. strong desire to urinate), frequency (urinating 8 or more times a day) to urge incontinence (ie. uncontrollable urine leakage). Current treatments are often ineffective and have limiting side effect such as dry mouth, blurred vision and constipation. The lack of satisfactory treatment is due to inadequate understanding of the physiological mechanisms that govern bladder function. We seek to understand this cause of urinary incontinence (detrusor overactivity), our major research interests are:
Mechanisms of ATP release: ATP is an important and ubiquitous signalling molecule for bladder function. Stretch is a major stimulus for ATP release in the bladder. Bladder stretch is mimicked by the Urodynamic test (a routine bladder function test) by injecting saline into a patient’s bladder. Injected saline (bladder washing) is then collected for a simple ATP assay using a luminescence ATP Assay kit and a luminometer (Turner BioSystem).
Gene expression of vanilloid receptors (TRPV1), muscarinic receptors, tachykinin receptors (NK), ATP gated ion channels (P2x) in mucosa and muscle cells, to address whether the level of certain molecule(s) has been altered in detrusor overactivity patients.
Molecular mechanism: Stimuli such as stretch, receptor agonists and antagonists, can be applied on tissue or cell culture to identify whether the response has been altered in detrusor overactivity patients.
A possible role of subclinical infection in patients with urge incontinence has been largely ignored until recently. Our studies have shown high prevalence of bacterial presence in exfoliated urothelial cells collected from urine specimens in overactive bladder patients using Cytospin and Wright stain light microscopy. We have demonstrated the presence of intracellular bacteria in urothelial cells of detrusor overactivity patients using 3D high-resolution confocal technology
Therefore, we have postulated that there might be an association of overactive bladder with bladder inflammation due bacterial presence in bladder, especially low grade bacterial cystitis, which is normally undetectable with routine microbiology methods and threshold. This has led to our current random controlled clinical trial: antibiotics treatment for refractory urge incontinence.
Since inflammation plays an important role in overactive bladder, we further investigate inflammatory factors, both pro- and anti-inflammatory cytokines, in urine samples of women with or without bladder dysfunction.
We have also set up an intracellular bacterial colonization model using urothelial cell culture in our laboratory, this model allows researchers to further investigate the capability of bacterial isolates from patients to form intracellular bacterial colonization.
Pelvic Floor Unit Research
A wide range of clinical research projects are conducted in the Pelvic Floor Unit. For example, we study outcome measures used to determine the severity of incontinence. These include a wide range of questionnaires.
We study the long term outcomes of a variety of conditions eg. we have published an 8 year follow-up study of patients with urge incontinence, and are about to publish a 6 year follow-up study of women with prolapse of the vagina (rectocele), a 9 year follow-up of the results of one operation for prolapse, an 8 year follow-up of vaginal ring pessaries and a 6 year follow-up of one operation for stress incontinence.
From time to time we conduct trials of new pharmaceutical agents for the treatment of urge incontinence, patients who have not responded to standard tablets are invited to join these studies and we often advertise them in the local newspaper.
We investigate ways to optimise current treatments eg. we have published a study of a technical variation of the performance of a standard operation for stress incontinence (called the TVT operation, which can be performed with or without an intra-operative cough test).
We also study the costs of incontinence from a variety of perspectives.
The role of low grade infection in women with Refractory Overactive Bladder is currently the subject of a Randomised Controlled Trial.
We work closely with our local Colorectal Surgeon and run a Perineal Tear Clinic for women who have had tears of their pelvic floor muscle during labour – we are studying the outcome of this clinic to predict which factors are associated with negative long term outcomes for women.
Prof Moore’s Awards
- Awarded Prize for ” Woman in Science” for 2017 at St George Hospital ($2,000)
- Prize for the best Scientific Abstract, ($US1000) International Continence Society, Florence, October 2003
- President’s Award – 2003 – Continence Foundation of Australia – For extraordinary efforts in producing the Australian and New Zealand Continence Journal.
Prizes and Grants Awarded to Trainees and MD/PhD candidates who worked with Prof Moore
- Dr Lucy Bates, Continence Foundation of Australia 2016 – Research Prize $AU500
- Dr Lucy Bates, St George & Sutherland Symposium 2016 Young Investigator Award $AU1,000
- Dr Nevine Te West, UGSA 2016 Auckland 1st Prize – Scientific Talk, Quantitative liquid chromatography mass spectrometry of serum oestriol levels in new/chronic users of vaginal oestriol cream. $AU500
- Dr Nevine Te West, Australian Rheumatology Association 2015 – Best Clinical Presentation – Pelvic Floor Dysfunction in Female Sjogren’s Syndrome: An 8 Year Audit $AU350
- Dr Nevine Te West, St George & Sutherland Medical Symposium 2015, 2nd Prize Clinical Presentation Pelvic Floor Dysfunction in Female Sjogren’s Syndrome: An 8 Year Audit $AU500
- Dr Nevine Te West, St George & Sutherland Medical Symposium 2015 Bladder Diathermy for recurrent UTI – Best Clinical Poster $AU500
- Li A, Cheng Y, Moore KH. Intracellular Bacterial Cystitis in Refractory Urge Incontinence; What is the Role of Inflammatory Cytokines? St George & Sutherland Symposium 2015 and 7th Urogenital & Gastrointestinal Symposium Adelaide 2015 – Best Poster Prize $AU100
- Ognenovska K, Cheng Y, Mansfield KJ, Moore KH. The Correlation of the Clinical Symptoms of Refractory Detrusor Overactivity with Urothelial Cell-Associated Bacteria. St George & Sutherland Symposium 2015 $AU500
- Dr J McKenna, Prize for Best Presentation, AGES ASM 2014 $AU750
- Dr V Wong, UGSA Annual scholarship March 2012-March 2013, $AU5000 (Competitive)
- Dr F Bahadory, Prize for best poster 2012, St George Hospital Medical Symposium. Gene expression of neurochemical receptors in procine bladder and cultured cells: comparison in urothelium, myofibroblasts and detrusor, $AU500
- P Sadananda, ICS Young Investigators Award 2011 $EUR1,000
- Dr Colin Walsh, UNSW International Research Scholarship 2009, $AU36,000
- Dr Emmanuel Karantanis, Prize for best clinical research paper 2009, the Continence Foundation of Australia, $AU500
- Dr Kylie Mansfield, Best Basic Science Poster 2005, International Continence Society, Montreal, $US1,000
- Dr Peter Dietz, Christopher Kohlenberg Memorial medal 2003, NSW/QLD Annual Scientific Meeting, $AU500
- Dr Emmanuel Karantanis, Dean’s Scholarship 2002-2003, Faculty of Medicine UNSW, $AU18,000 per annum for 2 years
- Dr Ray O’Sullivan, Prize for best clinical research paper 2000,George Hospital Annual Medical Symposium, $AU1,000
- Dr Andrew Foote, Mayne Nicholas Scholarship for Urogynaecology Fellowship 1996, $AU45,000
- Dr Andrew Foote, Crown Street Medal 1997, $AU500