Incont Pelvic Floor Dysfunct 2009; 3(Suppl 1):3-4
The Role of Urothelial Dysfunction in Pathogenesis of Overactive Bladder
Yao-Chi Chuang, M.D.
Department of Urology, Chang Gung Memorial Hospital, Kaohsiung Medical Center, Chang Gung University College of Medicine, Kaohsiung, Taiwan
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Received: February 10, 2009 Accepted: March 2, 2009
Address correspondence to: Dr. Yao-Chi Chuang, Department of Urology, Chang Gung
Memorial Hospital, Kaohsiung Medical Center, 123, Ta-Pei Road, Niao Song Hsiang,
Kaohsiung, Taiwan
E-mail: [email protected]
P
Y. C. Chuang
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1. Birder LA, de Groat WC: Mechanisms of disease: Involvement of
the urothelium in bladder dysfunction. Nat Clin Pract Urol 2007; 4:
46-54.
2. Apostolidis A, Dasgupta P, Fowler CJ: Proposed mechanism for
the efficacy of injected Botulinum toxin in the treatment of human
detrusor overactivity. Eur Urol 2006; 49:644-650.
3. Hsu CC, Chuang YC: Mechanisms of action of botulinum toxin a on
lower urinary tract. JTUA 2008; 19:77-82.
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