bluuebunny/crossref_metadata_2025 huggingface dataset:
Directional differences in urethral pressure recordings: Contributions from the stiffness and weight of the recording catheter
Authors: Plevnik Stanislav , Janež Janez , Vrtašnik Peter , Brown Malcolm
Published: March 2007

The difference between urethral pressures measured along the anterior wall and those measured along the posterior wall was found to increase markedly as the stiffness of the catheter was increased and to increase by a greater amount if the weight of the catheter was increased. A method of grading the stiffness of catheters is proposed and the use of stiff catheters in past reports of urethral measurements is discussed.
Superimposition of urethral closure pressure profiles using urethral electric conductance measurements
Authors: Plevnik Stanislav , Vrtačnik Peter , Janež Janez
Published: March 2007

The external urethral meatus (EUM) was located on the urethral closure pressure profile by simultaneous measurement of the urethral electric conductance profile. The EUM was further used as a reference point for accurate superimposition of urethral closure pressure profiles.
An electronic monitoring system for voiding events
Authors: Fernie G. R. , Griggs G. , Holliday P. J. , Jewett M. A. S.
Published: March 2007

This report describes a new electronic monitoring system for recording voiding events.
Calcium antagonist affinity for adrenergic and cholinergic receptors in rabbit urinary bladder
Authors: Malkowicz S. Bruce , Wein Alan J. , Levin Robert M.
Published: March 2007

Calcium antagonists have the ability to relax vesical smooth muscle in vitro and in vivo. The presumed mechanism of action is through the inhibition of calcium translocation, yet these agents have also been shown to bind to several different pharmacological receptors. By employing radioligand binding assays, the affinity of verapamil and diltiazem for several receptor populations in the rabbit detrusor was studied. Verapamil and diltiazem displayed binding affinities for receptor populations in the following order: alpha1‐ and alpha2‐ adrenergic > muscarinic cholinergic > beta‐adrenergic. In all instances verapamil affinity was greater than that of diltiazem. The relatively high Ic50's for both muscarinic and beta receptors indicate that the interactions of verapamil and diltiazem with these receptors are of little physiological significance.
The role of urodynamic testing in the evaluation of subtle neurologic lesions
Authors: Blaivas Jerry G. , Salinas Jesús M. , Katz Gary P.
Published: March 2007

Seventy‐five patients with equivocal neurologic findings were prospectively evaluated to determine the presence or absence of “neurogenic bladder.” All were referred by neurologists or neurosurgeons because of their inability to make a definitive diagnosis of neurologic impairment of bladder function. On the basis of sophisticated urodynamic studies, a definite diagnosis of “neurogenic bladder dysfunction” was made in 23% of the patients. In 40%, the findings were equivocal, and in 37%, “neurogenic bladder” was excluded.
Intrinsic neuromuscular defects in the neurogenic bladder: IV. Loss of somatomotor and preservation of autonomic innervation of the male feline rhabdosphincter following bilateral sacral ventral rhizotomy
Authors: Atta Mohamed A. , Elbadawi Ahmad
Published: March 2007

Innervation of the male feline rhabdosphincter was studied ultrastructurally 1 and 2 weeks following bilateral sacral ventral rhizotomy. In all samples, there was virtual loss of myelinated axons, degeneration and loss of the axonal element of all motor end‐plates, and preservation of autonomic nonrnyelinated (cholinergic, adrenergic, and probable copcptidergic) axons, as well as their nonspecialized surface contacts with myofibers of the rhabdosphincter. These observations provide solid evidence for the existence of both somatomotor and autonomic cholinergic innervation of the male feline rhabdosphincter and indicate that its potential neural control shortly after somatic denervation is exercised exclusively by autonomic axonlmyofiber surface contacts.
Bladder compliance and detrusor activity during the collection phase
Authors: Coolsaet Bo
Published: March 2007

The bladder wall is composed of passive (collagen, elaftin) and active (smooth muscle) elements. Some of the smooth muscle cells have properties of “pacemakers” in that they show spontaneous activity at rest. Moreover, when these cells are stretched, the resting membrane potentials decrease and the frequency of action potentials increase. It has been further demonstrated that both in vitro muscle strips and in vivo bladder preparations show spontaneous activity which may generate both tonic and phasic changes in bladder wall forces. The rate and duration of stretch both affect the force that the cell can generate. Thus, the filling pressureivolume curve obtained by systometry represents an interaction between the active and passive elements of the bladder wall. Since the cystornetric curve is time dependent, it is impossible to compare cystometrograms unless this time dependency is taken into account. With these principles in mind it is possible to standardize the terminology for characterizing detrusor activity during the collection phase as outlined in this report.
Subthreshold detrusor instability
Authors: Coolsaet B. L. R. A. , Blok C. , Van Venrooij G. E. P. M. , Tan B.
Published: March 2007

At the present time there is a paucity of clinical information on subthreshold (less than 15 cm of water) detrusor instability. In this study of 334 women with stress and/or urge incontinence, it was calculated that subthreshold detrusor instability resulted in urinary incontinence in 10% and urgency and frequency in 85%.
Detrusor instability and bladder outlet obstruction
Authors: Abrams Paul
Published: March 2007

Detrusor instability is found in a high percentage of children with voiding disorders and in elderly patients both with and without bladder outlet obstruction. An assumption that outlet obstruction leads to detrusor instability has arisen largely from the findings that prostatectomy results in a marked reduction in the incidence of instability. However, studies have shown that the incidence of instability is related to age both by virtue of a decreasing incidence in childhood and an increasing incidence in later life. In later life the increase reflects advancing age and is not related to the severity of any coexisting outlet obstruction. The reduction in instability following prostatectomy may be due to an interruption of sensory afferent impulses due to resection of prostatic, urethral, and bladder neck nerve tissues.

In children, instability is likely to represent delayed maturation of cerebral control over the micturition reflex, or to be due to neurological disease such as meningomyelocele.

More data are required for all groups of patients, both children and adults, to determine the influence of the relief of obstruction on the incidence of instability. Furthermore, additional data are required on the incidences of instability and obstruction in the “normal” population.
The surgical treatment of detrusor instabiiity
Authors: Mundy A. R.
Published: March 2007

The surgical treatment of detrusor instability is still in its infancy. At the present time there are two main types: operations designed to ablate the nerve supply and those designed to circumvent the problem by enlarging the bladder sufficiently such that the unstable contractions are either ineffectual or occur at such a large volume that they are clinically insignificant. The former approach is rarely successful, except possibly in patients over the age of 55 years; the latter seems to be effective in the majority of patients, but the data should still be considered to be preliminary. Hydrodistension of the bladder is ineffective.
A comparison of spontaneous and intubated urinary flow in female patients
Authors: Lose G. , Thunedborg P. , Jørgensen L. , Colstrup H.
Published: March 2007

In 60 female patients with lower urinary tract disorders the natural urinary flow was compared with the flow obtained with two 5 F urethral catheters in place. For the group as a whole there was no significant decrease in the intubated maximum flow rate whereas the intubated average flow decreased significantly. Among patients with a spontaneous flow rate of < 15 ml/sec no effect of the catheters was observed; actually the maximum flow rate increased significantly, which, however, may be due to increased voided volume.

The transurethral technique for pressure‐flow studies offers a simple method for the assessment of detrusor contractility and for the identification of patients with infravesical obstruction. It can be performed without further invasion in conjunction with routine cystometry studies. Therefore this technique is recommended in the routine urodynamic workup in females with lower urinary tract disorders.
The one‐hour pad‐weighing test: Reproducibility and the correlation between the test result, the start volume in the bladder, and the diuresis
Authors: Lose Gunnar , Gammelgaard Jens , Jørgensen Tine J.
Published: March 2007

To evaluate the reproducibility of the one‐hour pad‐weighing test as proposed by the ICS and to study the association between the test results, the initial volume in the bladder, and the diuresis, 18 females with stress or mixed incontinence underwent two separate tests. Bladder volumes were estimated by transabdominal ultrasonic scanning.

A significant intra‐individual variation in the test results was found. In about 50% of the patients the classification of the degree of leakage changed from one test to the other. This variation could be explained by variation in the fluid load on the bladder during the test, ie, the initial volume and the diuresis. For scientific purposes the one‐hour pad‐weighing test in its present design is not precise enough to allow reliable quantitation of urinary incontinence.
A computer‐based program for a neuro‐urology unit in a department of urology
Authors: Simon D. , Levy E. , Servadio C. , Nissenkorn I.
Published: March 2007

A computer‐based record program for a Neuro‐Urology Unit and its practical applications are described.

The advantages of the system are the following: “handy” day‐to‐day medical recording with instant access to medical records, accurate entry of followup notes, systematic analysis of urodynamic examination results, and upon completion of examinations, immediate issue of a typed medical report.

The medical information collected is easily accessible for research purposes by the same system.
Functional voiding disorders in females
Authors: Paviakis Aristidis , Wheeler John S. , Krane Robert J. , Siroky Mike B.
Published: March 2007

One hundred fifty‐nine female patients with persistent and unexplained voiding symptoms were referred for urodynamic study. Sixty percent had frequency, and nearly half of these reported incontinence. Twenty‐five percent had obstructive symptoms, and half of these had urinary retention. Symptoms were long standing (mean 12.3 years) especially in those with detrusor hyperreflexia (DH). Also, a history of childhood enuresis was elicited in 50% of patients with DH. A psychosocial disturbance or psychosomatic illness was present in 70% of our patients. Urodynamic studies revealed DH in 44.5%, detrusor areflexia (DA) in 44.5 %, and normal studies in 11 %. Rapid pharmacologic testing using bethanechol (n = 67) and/or diazepam (n = 13) was performed in patients with DA as an aid in determining the etiology. The role of urodynamic testing in evaluating and treating functional voiding disorders in adult female patients is discussed.
A study of the myelinated fibres in the branches of the pelvic plexus
Authors: Donker P. J.
Published: March 2007

In a 20‐year‐old human female specimen the nerves to the pelvic organs were dissected and analysed. The gross anatomy of the branches of the pelvic plexus was described. The composition of these nerves was studied and the sizes and distribution of the diameter of a great part of the myelinated nerve fibres were measured and analysed. It was confirmed that the ventral roots S2 and S3 contain many nonmyelinated nerve fibres. There are direct connections between the sacral sympathetic chain and the pelvic plexus. They contain myelinated fibres with sizes as large as 11 μm. There are two different groups of fibres which supply the bladder, one on the dorsal side, mainly nonmyelinated (postganglic sympathetic?), and another group to the lateral side which contains many thin myelinated fibres (parasympathetic preganglionic?). The pelvic plexus and its branches are fixed to the vagina and the rectum. Surgical interventions in this area and perhaps also childbirth can damage the nerve supply to the bladder and the urethra. The functional disturbances of the bladder after such interventions can depend on what group of nerve fibres is most seriously damaged. The large number of thick myelinated fibres which reach the ventro lateral side of the urethra makes it highly probable that these fibres innervate the intrinsic striated urethral musculature. The large number of nonmyelinated nerve fibres in the nerves to the m. levator ani probably innervate smooth muscle tissue which is found in the fasciae of the pelvic floor.
Effect of naloxone on detrusor‐sphincter dyssynergia in the chronic spinal cat
Authors: Galeano César , Jubelin Bruno , Biron Linda , Guenette Lilianne
Published: March 2007

Naloxone, an opioid peptide antagonist, has been reported to facilitate voiding in neurologic bladder disorders, but its effects on the neural micturition reflex arc are poorly understood. We studied the effect of naloxone in 34 male adult cats, spinalized at C5‐C6 level 7 to 119 days previously. Each cat served as its own control.

The following tests were performed: Urethral pressure profiles, cystosphincterograms with the urethro‐vesical junction opened and closed and mechanograms of the detrusor, and the circular and longitudinal urethral muscles. The study included (1) the effects of anesthesia of the bladder and pelvic nerve, as well as that of the urethral and pudendal nerves; (2) the action of naloxone; and (3) the action of oxymorphone.

Our results demonstrated that naloxone (1) increased somatic (osteotendinous and nociceptive) reflexes and aggravated spasticity; (2) increased vegetative micturitional and sexual reflexes, in particular the urethra‐urethral contraction reflex, aggravating the spasmodic contractions of the external sphincter; and (3) increased the frequency and intensity of the mass reflex. In consequence, we suggest that naloxone is contraindicated in cases of spinal cord lesions with detrusor‐sphincter dyssynergia syndrome.
Is sympathetic control of the urethra mediated through vasomotor action?
Authors: Downie John W. , Lautt W. Wayne
Published: March 2007

The suggestion that the sympathetic nervous influence on urethral smooth muscle activity is mediated through vasomotor control was tested directly by using an arterial long circuit in pentobarbital‐anesthetized cats. Hypogastric nerve stimulation produced a frequency‐dependent contraction of the bladder and constriction of the urethra but had no influence on the resistance of the isolated vascular circuit. Altering the speed of the pump that controlled circuit flow to either increase or decrease vascular circuit pressure had no influence on urethral perfusion pressure. It was concluded that the hypogastric nerve induces urethral constriction directly and not by vasomotor action. Furthermore, short‐term alterations in vascular status are not reflected in changes in urethral tension.
Experimental models of urinary bladder outlet obstruction
Authors: Levin Robert M. , Wein Alan J.
Published: March 2007

Urinary bladder obstruction has been the subject of numerous clinical and experimental studies. The most common experimental model for outlet obstruction requires the surgical creation of a bladder outlet obstruction and then determining the effects after specific periods of time. These studies have demonstrated that the bladder responds to obstruction with rapid and significant changes in bladder structure and function. Although much important information comes from experimental surgical obstruction, this model is not appropriate for the study of the initial effects of outlet obstruction. The in‐vitro whole bladder model (rabbit) can be utilized to study the initial effects of outlet obstruction on the physical characteristics of bladder emptying. This model has the advantage of one being able to have complete control of the type and magnitude of obstruction.
Direct static measurement of obstruction
Authors: Regnier Claude H.
Published: March 2007

The measurement of related values of pressure and cross‐sectional area along the urethra provides, on theoretical grounds, the means to detect local areas of obstruction. A probe was developed to make such measurements and was used in a preliminary study on tubes of known mechanical properties; it enabled the differentiation of elastic from nonelastic tubes, based on values of the “hydrostatic compliance.” The results obtained are discussed and compared to alternative techniques used for the measurement of urethral compliance that have been developed for and applied clinically on females.
Effect of varying size of urethral catheters upon flow and resistance measurements
Authors: Reid R. E. , Chandrasekar D. , Pugach R. , Laor E. , Tolia B. M. , Freed S. Z.
Published: March 2007

The effect of urethral catheters upon voiding parameters has been studied in eight patients. Each patient was studied sequentially with catheter sizes 3 1/2, 5, 8, and 10 F. Catheter free flow measurements are done before and after instrumentation. No significant changes were seen with varying catheter sizes if there was no clinical obstruction (two patients). In six patients with bladder outlet obstruction, flow diminished and resistance measurements increased with increasingly larger catheters.
Videourodynamics and differential pressures in the evaluation of infravesical obstruction
Authors: Lockhart J. L. , Weinstein D. A. , Hamady G.
Published: March 2007

Twenty‐five patients were investigated for infravesical obstruction using videourodynamics and a modified differential pressure technique. Clinical symptoms correlated 86%, 71%, and 56% with urethral resistance, differential pressures, and fluoroscopy, respectively. We believe that differential bladder‐posterior urethral pressure (Pves‐Pura) recorded in erect position and with a fixed catheter is a valuable technique to investigate males suspected to have bladder neck‐prostatic obstruction.
Endourodynamics: Another valuable dimension in clinical urodynamics
Authors: Loughlin Kevin R. , Yalla Subbarao V.
Published: March 2007

Using a custom‐made (10.5‐F) fiberoptic endoscope, we have carried out endoscopy‐aided urodynamic studies in several male and female patients. Our preliminary observations in more than 25 subjects have suggested that additional endoscopic observations during urodynamic studies can help in determining the accuracy of the urethral locations, especially the bladder neck and prostatic urethra, where pressures are being monitored during voiding. Fluid bridge tests, micturitional total urethral pressure determinations without yaw, and voiding cystourethroscopy can be performed with this clinical investigational tool. Although we understand its usefulness, we have also described its limitations.
Management of striated sphincter dyssynergia
Authors: Madersbacher H.
Published: March 2007

Therapy of striated sphincter dyssynergia becomes mandatory as soon as the increase of outflow‐resistance causes high detrusor voiding pressure, noncompensated bladder emptying, vesico‐uretero‐renal reflux, or reflux into the male adnexa. Pharmacotherapy of striated sphincter dyssynergia so far is disappointing, the local approach for relieving sphincter spasticity by neurectomy of the pudendal nerve was abandoned at least in men because of an over 50% rate of erectile impotence. The concept of a “reversible sphincterotomy” is fascinating but not yet ready for clinical use. Nowadays, two methods are common for managing striated sphincter dyssynergia: intermittent catheterization (IC) and transurethral sphincterotomy. IC is the method of choice if a poorly sustained and lowpressure detrusor is present and if the patient stays dry in between, with or without anticholinergic medication. Otherwise, transurethral sphincterotomy by means of an anteromedian incision is the alternative. Both methods are not ideal and have definite disadvantages: IC needs instrumentation; sphincterotomy is destructive. Therefore, especially in females, a trial to empty the bladder by anal stretch is advisable and should be undertaken before other therapeutic measures are considered. A new way to achieve compensated bladder emptying is the implantation of an anterior sacral root stimulator, which also provides continence, if the relevant posterior sacral roots are out. The results so far are excellent, but further observation is necessary to prove its long‐term effects.

The optimal therapy for clinically relevant striated sphincter dyssynergia can only chosen on the basis of a careful workup and with regards to the patient's personal and social situation.
Clinical characteristics of Pseudo‐dyssynergia
Authors: Siroky Mike B.
Published: March 2007

Pseudo‐dyssynergia is distinguished from true vesico‐sphincter dyssynergia by the voluntary, as opposed to reflex, nature of the sphincteric contraction. Pseudo‐ dyssynergia (PSD) occurs clinically in association with functional voiding disorders, neurologic disorders and local disorders of the bladder. The diagnosis of PSD depends on the demonstration that dyssynergic contractions of the pelvic floor occur during micturition and that these contractions can be voluntarily suppressed by the patient. Treatment of PSD is based on a combination of pharmacologic, psychologic and educative techniques which are individually discussed.
Voiding patterns and urinary control after repair of giant vesicovaginal and vesicourethrovaginal fistulas and neourethral construction
Authors: Bissada Nabil K. , Morcos Rafik R.
Published: March 2007

Twenty‐six patients, 10 with giant vesicovaginal fistulas and 16 with vesicourethrovaginal fistulas, who underwent fistula repair (12) or fistula repair and neourethral construction (14) were evaluated 1 to 6 months postoperatively for adequacy of their urinary storage and evacuation.

The ten patients with giant vesicovaginal fistulas and two patients with giant vesicourethrovaginal fistulas, in whom the urethral involvement was minimal, were managed solely by repair of their fistulas. Eleven of these 12 patients (92%) are continent and one has mild stress urinary incontinence. Of the 11 continent patients, nine have normal voiding and two void by straining. Five patients with extensive urethral involvement were managed initially by fistula repair that did not alleviate their incontinence. Fourteen patients with vesicourethrovaginal fistula and extensive urethral involvement were managed by simultaneous or nonsimultaneous fistula repair and neourethral construction. Ten of these patients (71 %) became continent. Continence rate was better in those who had no suprapublic operations prior to neourethral construction. In spite of attainment of continence in the majority of these patients, those with extensive urethral involvement did not regain normal evacuation function.
Bladder neck obstruction in women
Authors: Diokno Ananias C.
Published: March 2007

Bladder neck obstruction in women is uncommon. It should be suspected in patients with chronic symptoms of obstruction and irritation, and with signs including bladder trabeculation, diverticula, and vesicoureteric reflux. Accurate diagnosis can be established using the simultaneous pressure‐flow fluoroscopy study. A specific surgical approach to correct the bladder neck obstruction may be justified with proper urodynamic documentation.
Sacral stimulation for neurogenic bladder outlet obstruction
Authors: Talalla Andrew , Bloom Joseph W.
Published: March 2007

There are four anatomical sites at which functional electrical stimulation may be applied to the sacral neural outflow to achieve voiding of urine in patients with neurogenic bladder dysfunction: the micturition centres of the conus medullaris; the sacral anterior nerve roots; the mixed sacral nerves in their intraspinal, extradural course; and the pelvic nerves. This paper reviews the surgical and physiological advantages and disadvantages of each of these stimulation sites.
Detrusor inhibition induced by stimulation of pudendal nerve afferents
Authors: Vodusek David B. , Light J. Keith , Libby James M.
Published: March 2007

A critical analysis of therapeutic vesicoinhibitory electrical stimulation is presented based on a study of ten patients with suprasacral spinal cord lesions and detrusor hyperreflexia. The detrusor contraction was either completely abolished, or the threshold of the contraction significantly increased, with electrical stimulation delivered to the dorsal nerves of penis (or clitoris) via surface electrodes. A current strength of 0.09 to 3.5 times the bulbocavernosus reflex threshold was used.
Treatment of micturitional disorders in the Shy‐Drager syndrome with oxybutynin chloride and self intermittent catheterization
Authors: Politi P. , Sandri S. D. , Marino V. , Fanciullacci F. , Catanzaro F. , Zanollo A.
Published: March 2007

Patients with Shy‐Drager syndrome complain of frequency, urgency, and urge incontinence associated with urinary retention. We report our experience with three cases. Urodynamic evaluation showed detrusor hyperreflexia with low amplitude detrusor contractions. Symptoms have been well controlled by means of oxybutynin chloride and intermittent self catheterization.
Effect of opiate dependence on erectile function in primates
Authors: Levin Robert M. , Strong George , Brenman Henry , Hayes Lynn , Memberg William , O'Brien C. P. , Ternes Joe W. , Wein Alan
Published: March 2007

Thirteen nonhuman primates (Macaca mulatta and Madada fascicularis) were placed and maintained on opiates (six on morphine, seven on hydromorphone). Eight nondependent opiate naive primates were used as controls. Noninvasive transrectal electronic stimulation using a Biosonics MEGS

Registered trademark and devices by Biosonics, Inc. Philadelphia, Patents pending.

unit was employed to produce erection in all primates. This device has been previously demonstrated to produce consistant, full erections in the species of monkeys employed in these studies. The opiate‐dependent monkeys were tested both after being maintained on the opiates for 150 days, and following a 30‐day washout period (opiate free).

The results clearly demonstrate that opiate dependence did not alter the erectile response to rectal stimulation, thus the dependence did not negatively affect the neural or cardiovascular components of the erectile system. Analysis of the results demonstrated although there were no difference between species, there was a significant acquisition effect for the transrectal stimulation procedure.
The effect of tonic immobility on urethral pressure and vesical capacity
Authors: Germain L. , Galeano C. , Elhilali M. M.
Published: March 2007

Tonic immobility (TI) is a behavioral response to a sudden constraint and inversion in the rabbit. TI is characterized by a long‐lasting immobilization, abolition of righting reflex, leg tremors, and waxy flexibility of the extremities. However, during TI autonomic functions do not seem significantly altered. We have used TI as a method to obviate the effect of anesthesia when recording urodynamic parameters during filling of the bladder. Our results suggest that, indeed, autonomic functions related to the filling phase of the micturition cycle are not altered by TI.
An integrated software package for urodynamic research and clinical applications
Authors: Saini Vasant D. , Thiede Henry A.
Published: March 2007

A software package running on popular microcomputers (such as the IBM‐PC) has been developed to support computerized urodynamics studies. It lends itself to research as well as to clinical applications. Specifically, it provides: (1) recording and storage of urodynamics and EMG waveforms directly from the instrumentation into a microcomputer; (2) archiving and cataloging of these waveforms along with episodes and events; (3) display and analysis of raw and processed waveforms and data by means of an interactive graphics system; and (4) relational data base management for entry, management, storage, statistical analysis, and report generation of clinical data and other information along with urodynamic results. These four software modules are fully integrated, ie, results produced by one module can be automatically incorporated into others. Specifically, the relational data base manager organizes urodynamic results as well as a wide variety of other clinical information into a single integrated data base for purposes such as query, report generation, and statistical analysis. This package has been found to greatly simplify the handling and processing of the voluminous data typically generated in urodynamics work‐ups, as well as provide for clinical and research‐oriented analysis and report generation in a flexible and accurate manner.
Detrusor properties related to prostatism
Authors: Coolsaet Bo , Blok Cees
Published: March 2007

Urodynamic testing of 211 patients with prostatism symptoms showed that symptoms were related to detrusor instability, low detrusor strength, or low detrusor speed in the absence of obstruction in 72 patients and in combination with outlet obstruction in 139 patients. Detrusor instability is not related to the degree of outlet obstruction; detrusor strength does not increase with increasing outlet resistance; and detrusor speed is decreased in the obstructed group. BPH, as an obstructive entity, is overdiagnosed.
Intrinsic neuromuscular defects in the neurogenic bladder. VI. Myofiber ultrastructure in the somatically denervated male feline rhabdosphincter
Authors: Elbadawi Ahmad , Atta Mohamed A.
Published: March 2007

Ordinary somatic striated muscle with purely somatomotor innervation undergoes atrophy with fibrosis when completely denervated. On this basis, it has been suggested that vesical outlet “obstruction” in voiding dysfunction resulting from lower‐motor neural lesions is due to fibrosis of a denervated rhabdosphincter. We have shown previously that: (1) this sphincter has natural triple somatomotor/autonomic, cholinergic/autonomic adrenergic innervation of its myofibers; and (2) following its somatomotor denervation by bilateral sacral ventral rhizotomy, its myofibers lose somatomotor innervation and eventually acquires a purely autonomic innervation that includes autonomic re‐innervation of their sole plates. The present study was conducted in 16 adult male cats to define the structural changes in myofibers of the somatically denervated rhabdosphincter. Samples of the sphincter, obtained 1, 2, 4, 6, and 10 weeks after bilaterial sacral ventral rhizotomy, were processed and studied by electron microscopy. In all samples, there was a combination of ultrastructurally normal, degenerative, and regenerative myofiber profiles. Degenerative profiles were most frequent in the 1‐week, and regenerative profiles in the 6–10 weeks samples. No atrophic myofibers or interstitial fibrosis were observed in any sample. It is concluded that the somatically denervated male feline rhabdosphincter, unlike ordinary somatic striated muscle, maintains its structural integrity through myofiber regeneration and by not undergoing fibrosis. The somatically denervated rhabdosphincter, with its eventual purely autonomic re‐innervation, therefore, can play an important role in lowermotor neurogenic dysfunctions that needs further investigation.
Urodynamic action of clonidine in the chronic spinal cat
Authors: Galeano César , Jubelin Bruno , Carmel Michel , Ghazal Georges
Published: March 2007

Spinalization produces a central micturition dysreflexia characterized by weak vesical contraction reflexes and by an exaggerated urethro‐urethral contraction reflex, causing the peripheral syndromes of underactive detrusor and detrusor‐sphincter dys‐synergia. We explored the action of catecholaminergic drugs of central action on these micturitional dysfunctions.

Twenty‐four male cats were spinalized by transection of the spinal cord at C5–C6 level and studied 1–18 weeks later. Cystosphincterograms were performed without using anesthetic drugs. Pves, Pura, the EMG of the external sphincter, the EMG of the extensor hindleg muscles, and urine emission were studied. The responses of the spinal vesicovesical contraction, urethro‐vesical contraction, and urethro‐urethral contraction reflexes were explored. Clonidine (0.02–0.06 mg/kg intravenously [IV], intraperitoneally [IP], or per os), phentolamine (0.7–1 mg/kg, IV), and yohimbine (0.4–1 mg/kg, IV) were administered.

Clonidine, at doses of 0.02 mg/kg, IV or IP, or higher, produced the following effects: (1) it significantly increased the intensity and duration of Pves waves; (2) it inhibited the spasms of the external sphincter; (3) it induced voiding; (4) it reduced spasticity; (5) it reinforced the vesico‐vesical contraction reflex; (6) it antagonized the exaggeration of the urethro‐urethral contraction reflex; (7) it corrected totally or partially the underactive detrusor and detrusor‐sphincter dys‐synergia. Taken orally (0.02–0.03 mg/kg) the urodynamic effect of clonidine was not significant; higher doses produced vomiting and other adverse effects. The action of clonidine was blocked by yohimbine but not by phentolamine.

These results suggest that the absence of the descending noradrenergic pathways plays a role in the physiopathology of neurogenic bladder dysfunctions in chronic spinalized cats.
Changes in ureteral peristaltic activity induced by various stimuli
Authors: Theobald Robert J.
Published: March 2007

The interaction between the urinary bladder, the kidneys, and ureters is an area of interest to many investigators. Several investigators have suggested the existence of a feedback control system which would regulate urine production by the kidney and urine transport by the upper tract system. In certain conditions, such as urinary bladder outlet obstruction, this system would adjust the production and flow of urine as the situation dictates. The present study was designed to investigate the effects of changes in detrusor pressure, electrical stimulation of the pelvic nerves and the hypogastric nerves, and drugs on ureteral peristaltic activity and on renal nerve electricial activity. Cats anesthetized with alpha chloralose were monitored for changes in ureteral peristaltic frequency or spontaneous firing in renal nerves during changes in detrusor pressure, pelvic and hypogastric nerve stimulation, or drug administration.

Increases in detrusor pressure decreased ureteral activity, while pelvic nerve and hypogastric nerve stimulation had little effect on renal nerve firing or ureteral peristaltic activity. Attempts were made to elicit changes in ureteral activity by the administration of acetylcholine, adenosine, adenosine nucleotides, and substance P. Acetylcholine increased and the purines decreased ureteral peristaltic frequency. Atropine and theopylline were used to antagonize the effects of drugs on ureteral peristaltic frequency. Theophylline antagonized only the adenosine responses.

This study indicates that there is some interaction between the organs of the cat urinary tract. The results suggest the existence of a vesicoureteral reflex. However, the actual neural pathway for this reflex is still unproven. In addition, the evidence indicates the involvement of purines as neurotransmitters or neuromodulators in this reflex.
Adrenergic influences on the voiding cycle in the decerebrated dog
Authors: Nishizawa Osamu , Fukuda Takashi , Matsuzaki Akira , Moriya Itaru , Satoh Sadamoto , Tsuchida Seigi
Published: March 2007

Adrenergic influences on the voiding cycle were clarified by the modern urodynamic technique of pressure flow electromyogram study in 20 decerebrated dogs. A series of experiments were performed before and after hypogastric nerve transection. Similar experiments were done before and after pharmacologic blockade of α‐ and β‐adrenergic receptors. In the control condition, reflex micturition occurred when a critical degree of filling was reached. After hypogastric nerve transection or administration of phentolamine or propranolol, reflex micturition still occurred. However, hypogastric nerve transection, phentolamine, and propranolot produced significant changes in the values of some urodynamic parameters. It appears that adrenergic function plays a definite role in the voiding cycle of the decerebrated dog by regulation of bladder and ureihral smooth muscle activity.
Glycosaminoglycans on the surface of the human urothelium: A preliminary report
Authors: Holm‐Bentzen Merete , Ammitzbøll Thorkil , Hald Tage
Published: March 2007

Glycosaminoglycans (GAGs) are thought to be present in the mucous surface coat of the human urinary bladder and to play a role in the environmental adaptation of the bladder urothelium. A defective mucous surface coat might be involved in the pathogenesis of painful bladder disease (interstitial cystitis) of unknown etiology. By a new cystoscopic scraping method for obtaining the mucous surface coat of the bladder, we investigated four painful bladder patients and three controls (prostatic hypertrophy). Electrophoretic analysis of the surface coat revealed differences in the biochemical GAG‐composition of the surface coat between patients and controls. This preliminary study suggests the existence of GAGs in the mucous surface coat of the bladder and suggests that qualitative differences in the GAG composition might play a role in painful bladder disease.
Evoked potential of the sacral arc reflex: Technical aspects
Authors: Hassouna Magdy , Lebel Michel , Abdel‐Rahman M. , Elhilali Mostafa
Published: March 2007

The evoked potential of the sacral arc is becoming an important tool in testing the integrity of the sacral arc reflex in various neurologic conditions. We compared several known techniques on 40 patients with normal and diseased spinal cords. The somatic and autonomic components should be tested in each patient, particularly those with peripheral neuropathies. We present some considerations in the procedure of testing that may be of help in detecting subtle neurologic deficits of the sacral arc.
Sympathetic contribution to bladder outlet obstructions: Quantitative analysis of tissue catecholamine content
Authors: Park Young‐Chol , Sugiyama Takahide , Kaneko Shigeo , Kurita Takashi
Published: March 2007

The concentration of noradrenalin in bladder neck and prostate tissue was studied in normal subjects and in patients with bladder neck dysfunction and benign prostatic hypertrophy. The concentration in the bladder neck tissue was high in normal subjects (619.3 ng/g), moderate in patients with bladder neck dysfunction (360.7 ng/g), and low in patients with benign prostatic hypertrophy (75.4 ng/g). The values were statistically different from each other. The sympathetic innervation of the bladder neck is suggested to be diminished in the patients with bladder outlet obstructions compared to normal subjects.
Comparative effects of five different calcium channel blockers on the atropine‐resistant contraction in electrically stimulated rabbit urinary bladder
Authors: Andersson K.‐E. , Fovaeus M. , Morgan E. , McLorie G.
Published: March 2007

The effects of the calcium channel blockers nifedipine, verapamil, diltiazem, flunarizine, and lidoflazin on electrically induced contractions of isolated rabbit detrusor were compared in the absence and presence of muscarinic receptor blockade with scopolamine. All drugs had a depressant effect on the contractions both before and after scopolamine addition, nifedipine being the most potent of the calcium channel blockers. However, only nifedipine showed a significant preference for the nonmuscarinic part of the contraction, which was almost abolished at a concentration of 10−6 M. It is concluded that combined muscarinic receptor and calcium channel blockade is an effective means of inhibiting bladder contraction. Differences between calcium channel blockers may be of importance in this respect.
Urinary disorders in intervertebral disc prolapse
Authors: Sandri S. D. , Fanciullacci F. , Politi P. , Zanollo A.
Published: March 2007

Neurogenic bladder caused by intervertebral disc prolapse (IDP) is a well‐known condition, affecting up to 18% of patients with IDP. We present our results after studying 82 patients, 67 of whom were fully evaluated from a neurourological point of view. Neurological and urological symptoms persisted long after the neurosurgical operation had been performed. The most common finding was that of a normal‐compliance areflexic bladder associated with normal or incomplete denervation of perineal floor muscles. This pattern may be explained either by incomplete damage of the motor visceral (preganglionic, parasympathetic) fibers or by a pure sensory lesion. This explanation is confirmed by the significantly reduced positivity of the betanechol test in these cases compared to the 100% positivity results obtained in cases of low‐compliance areflexic bladder.
Electrophysiologic tests of bladder innervation as indicators of autonomic neuropathy in diabetes mellitus
Authors: Benvenuti F. , Tosto A. , Boncinelli L. , Rizzo M.
Published: March 2007

Electrophysiologic tests of bladder innervation are considered to be sensitive indicators 2of impaired bladder function in patients with diabetes mellitus (DM). A question arose as to whether these tests could also be considered early indicators of neuropathic visceral involvement. As diabetic neuropathy is a condition involving several systems, it seemed worthwhile to investigate subjects with impaired glucose tolerance (IGT) and patients with DM with several diagnostic tools: sacral evoked responses (SERs), urodynamics, peripheral nerve conduction studies, and cardiovascular autonomic function tests.

In the IGT group SERs were found to be within normal limits in all subjects, whereas cardiac parasympathetic function tests were frequently found to be altered, suggesting autonomic involvement even in the presymptomatic period of the disease. In the DM group prolonged latencies of SERs were not constantly associated with urodynamic bladder dysfunctions, suggesting a difference between neurons involved in SERs and neurons actually involved in pelvic parasympathetic innervation of the urinary bladder. Furthermore the alterations of the single diagnostic tests of autonomic neuropathy appeared to be scattered among the patients without any evident relationship between one another or with the duration and the type of the disease. Results do not suggest that electrophysiologic tests of bladder innervation are early indicators of widespread autonomic neuropathic involvement.
Diuresis cystometry versus filling cystometry: The diagnostic value of diuresis cystometry in patients with frequency, urgency, and/or urge incontinence complaints
Authors: Van Venrooij Ger E. P. M. , Kamphuis Eddy T. , Wolfhagen Maurice J. H. M.
Published: March 2007

Filling cystometry was performed in 16 asymptomatic patients. Cystometry under high diuretic conditions (diuresis cystometry) was also performed in 37 asymptomatic patients.

It appeared that diuresis cystometry is not more complicated than filling cystometry. The prevalence of detrusor instability in the asymptomatic groups is independent of the type of cystometry.

Diuresis cystometry was performed in 36 patients with frequency, urgency, and/or urge incontinence, in whom the prevalence of instability during filling cystometry was comparable with that found in the asymptomatic patients. It appeared that the prevalence of instability in the symptomatic group is significantly higher than in the asymptomatic group during diuresis cystometry. This difference is even much higher with respect to the prevalence of detrusor instability with pressure rises of more than 15 cm H2O.
Changes in the nervous control of the rat urinary bladder induced by outflow obstruction
Authors: Mattiasson Anders , Ekstrom Jörgen , Larsson Bengt , Uvelius Bengt
Published: March 2007

The influence of bladder outflow obstruction on the peripheral nervous control of the detrusor was investigated in female rats. The obstruction was performed by means of partial urethral ligation. The influence of exogenously applied drugs and electrical field stimulation was investigated after obstruction for 6 weeks. The content of noradrenaline and choline acetyltransferase was also determined as well as the density of alpha‐adrenoceptors. A significant decrease of the contractile response to alpha‐adrenoceptor stimulation was found in the obstructed bladders when compared to normal controls. Also the density of alpha‐adrenoceptors decreased in the obstructed bladders. The concentrationresponse relationship to carbachol remained unchanged, and neither were any changes seen in the relation between the cholinergic and noncholinergic components of the electrically induced, nerve‐mediated contractile response. A rightward shift of the frequencyresponse curve for the obstructed bladders was found with 50% of the maximum response occurring at 13 Hz compared to 4 Hz in the control preparations. The total amount of both noradrenaline and choline acetyltransferase had increased after 6 weeks of obstruction, but owing to the pronounced degree of hypertrophy of the bladder wall the concentrations were only approximately 30% of those in the control bladders, which also was the case after 1 and 3 weeks of obstruction.

It is concluded that changes in the peripheral nervous control of the rat bladder seem to occur secondary to outflow obstruction, but also that some of the changes observed might be due to factors unrelated to innervation and receptor‐mediated functions. Whether the decreased alpha‐adrenoceptor mediated influence seen in the presence of obstruction might reflect a generally decreased adrenergic influence in the obstructed bladder remains to be established.
Intrinsic neuromuscular defects in the neurogenic bladder. VII. Neurohistochemistry of the somatically denervated male feline rhabdosphincter
Authors: Atta Mohamed A. , Elbadawi Ahmad
Published: March 2007

We have shown previously by electron microscopy that somatomotor denervation of the male feline rhabodsphincter by bilateral sacral ventral rhizotomy leads to early loss of cholinergic axons innervating its end‐plates, and to its eventual purely autonomic reinnervation by cholinergic and adrenergic axons. The present study was conducted to find out if these ultrastructural changes can be demonstrated histochemically, and whether any histochemical changes can be observed in the denervated side of the rhabodsphincter following unilateral sacral ventral rhizotomy. The material used included four normal, ten bilaterally rhizotomized, and nine unilaterally rhizotomized male cats. Specimens of the rhabdosphincter were obtained at various intervals after operation, and processed‐together with normal material‐for acetylcholinesterase in cholinergic autonomic nerves and motor end‐plates, and norepinephrine in adrenergic nerves. Two weeks after bilateral sacral rhizotomy, there were no detectable changes in either cholinergic or adrenergic elements. Eight to ten weeks postoperatively, however, there was considerable reduction or loss of staining of motor end‐plates, plus an obvious increase in the adrenergic nerve population. No changes in either cholinergic or adrenergic elements were observed 4–10 weeks after unilateral sacral ventral rhizotomy. It is concluded that neurohistochemistry is of value in detecting long‐term but not short‐term changes in the somatically denervated rhabdosphincter, and is of no value in revealing any changes that may occur in the denervated side of a unilaterally rhizotomized rhabdosphincter.