bluuebunny/crossref_metadata_2025 huggingface dataset:
Post‐prostatectomy incontinence: Part II. The results of treatment based on urodynamic evaluation
Authors: Leach Gary E. , Yun Scott K.
Published: March 2007

One hundred seven men with post‐prostatectomy incontinence, were initially evaluated with in‐depth urodynamics. Fifty‐four of these men underwent treatment based on urodynamic findings and were available for follow‐up ranging from 12 to 84 months (mean 40 months). Treatment included anticholinergic therapy for patients with bladder dysfunction, artificial sphincter placement for those with only pure sphincteric insufficiency, or anticholinergics followed by an artificial sphincter in those with combined bladder dysfunction and sphincteric insufficiency.

Excellent objective responses were obtained after therapy based on urodynamic findings. Forty‐seven (87%) of the 54 treated men became “socially continent” (using two pads or less per day). Prior to treatment, 38 men used pads for incontinence with a mean of five pads per day, and the other 16 wore external catheters. With therapy based on urodynamic findings, no patients required an external catheter, and the mean number of pads used per day decreased to one.

Urodynamic evaluation followed by appropriate treatment based on urodynamic findings is effective in significantly improving or eliminating post‐prostatectomy incontinence. © 1992 Wiley‐Liss, Inc.
Telemetric electromyographic monitoring in elderly incontinent men
Authors: O'Donnell Pat , Hanish Harve M.
Published: March 2007

Urinary incontinence is a serious social, psychological, economic, and medical problem for elderly people. However, the pathophysiology of incontinence in the elderly is unclear. Previous studies have shown an irregular occurrence of incontinence events regarding incontinence volume, time between episodes, and residual urine volume. In this study, telemetric monitoring of external anal electromyography (EMG), rectus abdominis EMG, bladder pressure, and incontinence detection were done. Involuntary detrusor contractions occurred which were associated with an increase in sphincteric EMG activity and followed by either continence or incontinence. A fall in sphincteric EMG activity was associated with incontinence, while a fall in detrusor pressure was associated with continence. A detrusorsphincter activity interaction appears to exist during involuntary detrusor contractions which may result in either continence or incontinence, depending upon whether the detrusor or the sphincter activity is predominant. The irregular detrusor‐sphincter activity represents a possible etiology of the irregular occurrence of urinary incontinence patterns in elderly patients. © 1992 Wiley‐Liss, Inc.
Continuous monitoring of micturition pattern in nonhuman primates: Technique
Authors: Ghoniem Gamal M. , Shoukry Mohamed Shafik , Walker Cedric F. , Bernice Kaack M.
Published: March 2007

A complete system for continuous monitoring of micturition pattern in nonhuman primates is described and was tested using female rhesus monkeys. The system consists of modified standard animal cages, load cell transducers continuously activated and linked to a Grass polygraph. Potential problems or sources of error are described and overcome. The limitations are described; however, the system is proven to be reliable, durable, and accurate. © 1992 Wiley‐Liss, Inc.
SEAPI QMM incontinence classification system
Authors: Raz Shlomo , Erickson Deborah R.
Published: March 2007

Outcome of therapy for many incontinent patients is persistently difficult to assess in spite of a large published literature. One problem is that each institution describes patient populations and outcomes based on its own system, thus, valid comparisons between institutions cannot be made. To help to resolve this problem we are proposing a standardized classification system for incontinence. The system is analogous to the TNM system for tumor staging. Each letter of SEAPI QMM represents an aspect of incontinence, and each factor is assigned a number grade. Zero represents no symptom, problem, or abnormality while 1, 2, and 3 represent mild, moderate, or severe problems, respectively. This proposed system does not cover every aspect of urinary incontinence, however it can be used as a base for further development of a uniform method to grade and stage urinary incontinence. © 1992 Wiley‐Liss, Inc.
Resistance to forced opening of the resting urethra in healthy females assessed by experimental simulation of urine ingression
Authors: Thind Peter , Lose Gunnar , Colstrup Hans
Published: March 2007

Forced urethral dilation simulates the ingression of urine and hence leakage. The maximum urethral pressure response to a given dilation denotes the bladder pressure required in that specific opening. Urethral dilation was performed by inflation of a balloon. The pressure response increased by increasing rate and size of the dilation. The pressure response was analyzed at the bladder neck, in the high pressure zone, and in the distal urethra and showed no difference between the three sites of measurement. The bladder pressure required to open a specific urethral segment at a given rate and to a given size can be determined. Leakage prerequisites an opening of the entire urethra which results in a response to dilation all along its length. Consequently, any opening implies a bladder pressure for a certain period of time and exceeding the urethral pressure. In healthy women an opening process due to a rise in the bladder pressure will be restricted at the bladder neck. However, if the bladder pressure exceeds the urethral pressure for certain period of time leakage will occur. © 1992 Wiley‐Liss, Inc.
Pelvic floor reeducation and body posture correction for treatment of female urinary incontinence: Results of comprehensive pre‐ and post‐treatment urodynamic testing
Authors: Bemelmans B. L. H. , Hankel M. , Jacobs C. H. G. M. , Van Kerrebroeck Ph. E. V. , Worm G. , Debruyne F. M. J.
Published: March 2007

Of the conservative treatment modalities for stress urinary incontinence in females, the effectiveness of electric pelvic floor stimulation and exercise programs for reeducation of pelvic floor muscles are generally accepted and recognized. This prospective study reports on the analysis of subjective and objective pre‐ and post‐treatment parameters in 12 selected female patients with stress incontinence who were enrolled in a physiotherapeutical training program consisting of acute intrarectal electrostimulation, pelvic floor exercises, and body posture correction (Mensendieck). Patients' symptom scores, performance status of pelvic floor muscles, body posture alterations as well as standard urodynamic parameters (maximal urethral closing pressure, functional urethral length, and maximum cystometric capacity), and telemetric ambulatory urodynamic parameters (pad‐weighing test, urethral relaxations) were analyzed. This study shows the advantageous effect of pelvic floor reeducation and body posture correction for the treatment of female low‐urethral‐resistance urinary incontinence. A remarkable finding was the coalescence of genuine stress incontinence, proven on standard urodynamic investigation, and urethral instability on telemetric ambulatory urodynamic investigation in 10 of 12 patients (83%). This was very well treated by the training program. Pathophysiology of low‐urethral‐resistance urinary incontinence and the mode of action of the training program are discussed. © 1992 Wiley‐Liss, Inc.
Urinary flow curve patterns and their prognostic value in males over the age of 50 years
Authors: Balslev Jørgensen J. , Klarskov P. , Thorup Andersen J. , Jensen K.M.‐E. , Mogensen P.
Published: March 2007

Flow curves from two groups of men over the age of 50 years were compared. One group consisted of 112 initially asymptomatic men, controlled with history, uroflowmetry, and symptom score over a 7‐year period. The other group consisted of 85 men treated for benign prostatic hyperplasia. Five flow curve patterns were defined, and each flow curve was classified according to the definitions. A significant difference was found comparing untreated and treated males, as 78% of the flow curves in the untreated group were type 1 or 2 and 16% were type 3 or 4 compared to 56% and 37%, respectively, in the treated group. The risk of need of operation in the initially asymptomatic group as a whole was 17% over a 7‐year period versus 25% to 44% if the initial flow curve was type 3 or 5, i.e., severely abnormal. Analysis of the influence of age on flow curve pattern revealed a significant shift from “normal” to “abnormal” as age advanced.

In conclusion, flow curve patterns, reflecting the voiding process, shifts from normal to abnormal even in subjectively normal men as age advances. At the same time the flow curve seems to be of some prognostic value as to need of operative treatment in voiding problems.
Prospective urodynamic evaluation of the efficacy of prostatic balloon dilatation
Authors: Ganabathi Kumaresan , Roskamp Deborah , Foote Jenelle , Zimmern Philippe E. , Leach Gary E.
Published: March 2007

In order to evaluate the ability of transurethral prostatie balloon dilatation (TUPBD) to effectively treat prostatic obstruction, 18 men (aged 53–77 years) with obstructive small prostate glands were evaluated with symptom scores and urodynamic studies before and 6 and 12 months after TUPBD utilizing the endoscopically placed Advanced Surgical Intervention 75F balloon.

After TUPBD, 81% of men reported some improvement in their symptoms with statistical significance (P <.05) at 6 and 12 months after the procedure. The mean non‐invasive peak flow rate did not change significantly after TUPBD. Although the mean maximum voiding pressure (Pv max) and the maximum detrusor pressure at peak flow (Pq max) were reduced at 6 and 12 months postoperatively, the changes were found to be statistically insignificant (P >.05). In addition, the use of Abrams and Griffiths pressure‐flow nomogram revealed a “non‐obstructive” pressure‐flow study in only one patient at 6 and 12 after TUPBD.

Although TUPBD results in some symptomatic improvement, on pressure‐flow analysis the majority of men remain obstructed at 6 and 12 months after the procedure.
Prevalence of hand‐washing urinary incontinence in healthy subjects in relation to stress and urge incontinence
Authors: Kondo A. , Saito M. , Yamada Y. , Kato T. , Hasegawa S. , Kato K.
Published: March 2007

Hand‐washing urinary incontinence is involuntary urine loss in response to washing hands, hearing the sound of running water, or exposing oneself to cold wind in the winter season. The prevalence of this incontinence in relation to stress and urge incontinence was studied in healthy community‐dwelling subjects of 1,636 females and 3,010 males. The afflication rate of both genders was 3% for those in their 50s and younger and 16% for those in their 60s and older, which was significantly different (P < 0.01). Females (10%) suffered more from this incontinence compared to males (5%) (P < 0.01). The prevalence of this incontinence was approximately the same as that of stress and urge incontinence in each gender except females' stress incontinence, which was 3 times more than the other two. Seventytwo percent of subjects with hand‐washing incontinence also had either urge incontinence, stress incontinence, or both.
Dopamine D‐1 receptor‐mediated inhibition of micturition reflex by central dopamine from the substantia nigra
Authors: Yoshimura Naoki , Yoshida Osamu , Sasa Masashi , Takaori Shuji
Published: March 2007

We examined the role of dopamine derived from the pars compacta of the substantia nigra (SN) in the micturition reflex using a‐chloralose anesthetized cats. Repetitive stimuli applied to the SN suppressed rhythmic contractions of the urinary bladder induced by continuous infusion of saline into the bladder. SN stimulation‐induced inhibition of rhythmic contractions of the urinary bladder was antagonized by intracerebroventricular administration of haloperidol, a non‐selective dopamine receptor antagonist, and SCH 23390, a dopamine D‐1 receptor antagonist. The intracerebroventricular administration of SCH 23390 alone increased the frequency of bladder contractions induced by its distension. In addition, rhythmic contractions of the urinary bladder induced by its distension were in hibited by intracerebroventricular administration of dopamine, a non‐selective dopamine receptor agonist, and SKF 38393, a dopamine D‐1 receptor agonist, but were not affected by quinpirole, a dopamine D‐2 receptor agonist. However, the bladder contraction induced by stimulation of the locus coeruleus, remained unaffected during SN stimulation. These findings suggest that central dopamine derived from the pars compacta of the SN inhibits the micturition reflex via dopamine D‐1 receptors probably in the afferent pathway form the sacral spinal cord to the locus coeruleus, although the possibility that it acts on the efferent pathways originating in areas other than locus coeruleus could not completely be excluded.
Energetics of detrusor contraction: Effects of outlet obstruction
Authors: Lin Alex Tong‐Long , Shiao Ming‐Shi , Chen Ching‐Ju , Chang Luke S. , Chen Ming‐Tsun , Yang Chin‐Hua , Levin Robert M.
Published: March 2007

Previous studies demonstrated that the ability of the urinary bladder to empty was impaired after mild outlet obstruction. One contributing factor may be the derangement of intracellular energy metabolism. The primary objective of the current study is to examine the energentics of detrusor contraction in normal and obstructed rabbit urinary bladders. Mild bladder outlet obstruction was induced in male rabbits; after 2 weeks of partial outlet obstruction, three muscle strips were isolated from the bladder body of each obstructed and control rabbit. One of these strips was frozen at unstimulated state, while the remaining two strips were stimulated with 500 m̈M bethanechol and frozen separately either at maximal phasic (peak) contraction or during plateau (tonic) contraction. Tissue content of adenine nucleotides (ATP, ADP, AMP), NAD (nicotinamide adenine dinucleotide), creatine, and creatine phosphate were determined using reverse phase high performance liquid chromatography (HPLC).

The results can be summarized as follows: 1) The tissue content of creatine phosphate of the unstimulated control bladder was significantly higher than in the obstructed bladders. The tissue content of all other compounds were similar. 2) In the normal bladder strips, bethanechol stimulation induced a significant net decrease only in the tissue content of creatine phosphate during the plateau phase of contraction. 3) In the obstructed bladder strips, bethanechol stimulation induced a decrease in both ATP and creatine phosphate during the plateau phase of the response. The decrease in creatine phosphate was of a significantly greater magnitude than the decrease of creatine phosphate observed in normal strips. In addition, AMP content was significantly increased during both peak and plateau contraction.

These observations show that mild bladder outlet obstruction results in changes in the energy metabolism of detrusor contraction, which indicates that the obstructed bladder is unable to maintain proper tissue levels of high energy phosphates which are necessary for adequate detrusor contraction.
Relationship of fluid intake to voluntary micturition and urinary incontinence in geriatric patients
Authors: Griffiths Derek J. , Mccracken Peter N. , Harrison Gloria M. , Ann Gormley E.
Published: March 2007

The aim of this study was to investigate, in a group of geriatric inpatients with established incontinence, the relationships among urine loss, voided volumes, frequency of voiding, and fluid intake. The investigated included 128 patients: 76 women and 52 men, with a median age of 79 years. One‐half had significant cognitive impairment. Patients underwent 24‐hr monitoring of fluid intake, urine loss, and voiding, as well as conventional videourodynamic testing. Diurnal and nocturnal voiding frequencies were significantly but relatively weakly related to fluid intake. Diurnal and nocturnal voided volumes were more closely related, however, to the fluid intake. There was a strong and easily interpretable relationship among nocturnal voided volume, nocturia, cystometric bladder capacity, and evening fluid intake. Sixty of 128 patients had urodynamically proven urge incontinence, and this group was studied separately. They were more cognitively impaired and had significantly greater urine loss and smaller fluid intake than was true of the other incontinent patients. Urine loss was significantly related to fluid intake in this group. Nocturnal urine loss increased by an average of 28 ml/dl of evening fluid intake and decreased by 17 ml/dl voided at night. These results suggest that nocturnal toileting and evening fluid restriction may reduce nocturnal urine loss by a small but useful amount in carefully selected older patients with severe urge incontinence. © 1993 Wiley‐Liss, Inc.
Time‐series analysis of urethral electrical conductance measurements in the assessment of unstable urethral pressure: Results in normal patients and in those with genuine stress incontinence
Authors: Ramsay Ian N. , Hilton Paul , Cox Trevor F.
Published: March 2007

It is well established that urethral pressure variations occur in patients with or without urinary incontinence, but to what extent they contribute to a patient's symptoms remains unclear. Previous work has suggested that in stress incontinent patients, a rise in bladder neck electrical conductance (BNEC) occurs simultaneously with a fall in urethral pressure, and that this represents bladder neck opening. Six patients with genuine stress incontinence (gsi), and six normal controls underwent simultaneous urethral pressure and BNEC measurements, the results being subjected to time‐series analysis, to determine whether the previous finding could be confirmed statistically, and to establish whether a similar association was present in normal women. All six patients with gsi and five of the normal patients had unstable urethral pressure. Estimated cross‐correlation of differenced data for the two parameters showed a significant negative correlation at zero time lag in three patients with gsi and two of the control group. There was no significant correlation between the two parameters in the other seven patients. We conclude that the previous finding of a correlation between urethral pressure variation and BNEC, suggesting bladder neck opening occurs as urethral pressure falls in patients with gsi is confirmed, but appeared to be present in only 50% of patients; the finding is just as likely in normal patients, and therefore whilst it may be of relevance to the severity of symptoms, could not be held to have any aetiological significance. © 1993 Wiley‐Liss, Inc.
Role of adrenoceptors in the proximal urethral function of female and male rabbits using an in vivo model of isovolumetric pressure generation
Authors: Yamaguchi Takanori , Kitada Shinichiro , Osada Yukio
Published: March 2007

The role of alpha‐1 and alpha‐2 adrenoceptors in the contractile response of the proximal urethra to agonists and antagonists was studies in female and male New Zealand White rabbits. The response pattern for alpha‐1 agonists showed a sharp rise, while that for alpha‐2 agonists showed a gradual increase to a maximum pressure. The duration of the response of alpha‐2 agonists was significantly longer than that of alpha‐1 agonists. A difference in the response between alpha‐1 and alpha‐2 would be produced mainly through different receptor functions. The magnitude of the response of alpha‐1 adrenoceptors in the male rabbits was almost twice that of the female rabbits. In contrast, the response of alpha‐2 in the male rabbits was less than that of the female rabbits. Our experimental findings indicate that alpha‐2 stimulation mediates a slow and prolonged response that is essential for urinary continence in female rabbits. © 1993 Wiley‐Liss, Inc.
A model of the mechanics of smooth muscle reservoirs applied to the intestinal bladder
Authors: Coldinq‐Jørqensen Morten , Steven Kenneth
Published: March 2007

A model of the mechanics of smooth muscle reservoirs was derived from the stress‐strain relation in smooth muscle strips. The model was applied to the intestinal bladder reservoir but may also be applied to natural reservoirs such as the bladder. The relation between reservoir volume and pressure was calculated at different values of smooth muscle tone and was found to accord with clinical results. The muscle tone of the bowel when measuring off the bowel to construct the reservoir was found to have a profound influence on its ultimate volume. Stiffening of a part of the reservoir wall as a result of edema or fibrosis will cause a substantial decrease in functional capacity, both directly as a result of a reduced expansion of the diseased part and indirectly by enhancing the stretching of the adjacent normal wall. The pressure rise produced by a slow peristaltic contraction was calculated to depend both upon the strength of contraction and on the degree of reservoir filling: Almost no pressure rise will occur in the near empty reservoir, while the highest pressure rise was calculated to occur at a volume of about 300 ml. If only a part of the reservoir contracts, more filling is needed before the pressure increases and the maximum pressure will be reached at a substantially higher volume. Localized contractions will stretch the resting reservoir wall and so activate stretch receptors, which may cause a desire to void, resulting in reduced functional capacity. © 1993 Wiley‐Liss, Inc.
Regulation of the bladder neck closure by lumbar splanchnic nerves at ejaculation in the dog
Authors: Ando Masao , Kihara Kazunori , Sato Kenji , Sato Tatsuo , Oshima Hiroyuki
Published: March 2007

To clarify the role of canine thoracolumbar splanchnic nerves for bladder neck closure during ejaculation, these nerves of adult male mongrel dogs were exposed under anesthesia using ketamine hydrochloride and pentobarbital, and electrical stimulation and anatomical dissection studies were performed. Bladder neck closure by the stimulation of each sympathetic nerve was monitored with a 10 Fr silicon catheter equipped with pressure‐sensitive rubber balloon placed at the bladder neck. The dissection study revealed that canine thoracolumbar splanchnic nerves consisted of two nerve groups: one branching from the sympathetic trunks at thoracic and L1 ganglia, reaching caudal mesenteric plexus (CMP) through the anterior wall of the aorta, the other branching from the sympathetic trunks at level L2–L5 ganglia, reaching CMP through the posterior side of the bilateral spermatic arteries. The former were designated intermesenteric splanchnic nerves, the latter lumbar splanchnic nerves. No bladder neck closure was observed by electrical stimulation of the distal end of severed intermesenteric splanchnic nerves or of the sympathetic trunks at the lumbopelvic level among 10 dogs examined. At least one lumbar splanchnic nerve generated the closure in all 10 dogs and generally, a few lumbar splanchnic nerves, generated the closure. The results indicate that bladder neck closure during ejaculation is generated by lumbar splanchnic nerves regardless of their branching levels from lumbar sympathetic ganglia, but not by either intermesenteric splanchnic nerves or pelvic sympathetic trunks. © 1993 Wiley‐Liss, Inc.
Reproducibility of pressure transmission ratios in stress incontinent women
Authors: Richardson David A. , Ramahi Alfida
Published: March 2007

Pressure transmission ratios (PTR) are obtained during cough pressure profiles (Δ urethral pressure/Δ bladder pressure × 100) and have been extensively used in pre and post operative evaluation of patients with stress urinary incontinence. Sixteen patients with genuine stress were studied to assess the magnitude of PTR variance in incontinent women and how changes in bladder pressure impact on PTR. A marked variation in PTR was seen in individual patients with the coefficient of variation averaging 19.8%. Using linear regression analysis, 5 patients demonstrated a statistically significant relationship between bladder pressure and PTR. Only one of the five patients showed a decrease in pressure transmission with increased cough strength. The differences seen in PTR within individual patients make comparisons of single recordings at different times difficult to interpret.
Complications of teflon injection for stress urinary incontinence
Authors: Kiilholma Pentti J. , Chancellor Michael B. , Makinen Juha , Hirsch Irvin H. , Klemi Pekka J.
Published: March 2007

Four significant complications of Teflon injections for stress urinary incontinence are reported in 22 women and eight men. Three of the complications included periurethral abscess, urethral diverticulum, and periurethral Teflon granuloma with urethral wall prolapse occurred in women. These complications needed surgical excision and further surgery for stress incontinence, in two patients the outcome was good. Among the female patients the cure rate for stress incontinence with Teflon injection was only 18% in the 5‐year follow‐up. One other complication, a Teflon cyst, occurred in a male who had previously undergone radical retropubic prostatectomy. Only two of the eight men (25%) who received Teflon injections had maintained improvement after 1 year.
The dynamic urethral sphincter function in healthy females assessed by rapid dilatations in the resting state: Evaluation of reproducibility
Authors: Thind Peter , Lose Gunnar , Colstrup Hans , Kristensen Jøgen Kvist
Published: March 2007

Recording the pressure response to rapid dilatations enables one to assess urethral sphincter function. The rapid dilatations of the urethra experimentally simulate the ingression of urine. A method that enables standardized dilatations of 2‐mm long urethral segments was used, and the subsequent pressure response was measured. The reproducibility of the urethral pressure response to rapid and standardized dilatations was evaluated by repeating the measurements after 1 week in 10 healthy females. The pressure response showed an acceptable reproducibility. The urethral pressure increase as a response to dilatation is considered to rely on stretching of intra‐ and periurethral fibers. Calculations of strain (change in length divided by the original length) of circularly arranged fibers when the urethra is dilated indicate that the tension (and pressure) bearing layers must be located outside a circular zone with a radius of 4 mm perpendicular to the longitudinal axis of the urethra.
Voiding dysfunction in patients with spastic paraplegia: Urodynamic evaluation and response to continuous intrathecal baclofen
Authors: Bushman Wade , Steers William D. , Meythaler Jay M.
Published: March 2007

Patients with hereditary spastic paraplegia (HSP), a degenerative central nervous system disorder characterized by progressive lower extremity spasticity, frequently experience symptoms of voiding dysfunction. Urodynamic evaluation of patients with HSP has not been reported, and the etiology of voiding dysfunction remains unexplained. We present our evaluation of three men (ages 42–62 years) with this rare syndrome.

Urgency of urination was a uniform and dominant complaint, and two patients regularly experienced urge incontinence. Other symptoms included frequency (n = 3), nocturia (n = 3), and diminished force of stream (n = 1). Postvoid residual volumes were less than 25 ml in all patients. On urodynamic evaluation the two patients with urge incontinence displayed cystometric evidence of involuntary detrusor contractions. Pelvic floor EMG recordings suggested detrusor‐sphincter dyssynergia (DSD). In addition, one patient exhibited markedly diminished bladder compliance (1.0 ml/cm H2O) and capacity (50 ml). AH patients reported marked symptomatic improvement when treated with continuous intrathecal baclofen. Evaluation during baclofen treatment revealed increases in bladder compliance and capacity, with apparent resolution of DSD in one patient. Voiding symptoms in these patients most likely arise from a neurogenic etiology; however, a contributory role for chronic outlet obstruction from striated muscle spasticity may also exist.
Bladder instability in women: A premature activation of the micturition reflex
Authors: Papa Petros P. E. , Ulmsten U.
Published: March 2007

Urethrocystometry was performed during a provocative hand washing test in 163 patients, 115 of whom had a prior history of urge incontinence. Almost invariably, a rise in detrusor pressure, when present, followed a fall in urethral pressure, and both were preceded by urge symptoms. This pattern appears to conform to the concept of “urethral instability”, “detrusor instability” and urge incontinence being different manifestations of a prematurely activated micturition reflex.
Effect of partial outlet obstruction on choline acetyltransferase activity in the rat and rabbit
Authors: Levin Robert M. , Saito Masahiko , Wein Alan J. , Packard David , Cohen Adam , Haugaard Niels
Published: March 2007

Partial outlet obstruction of the rabbit bladder induces a rapid and significant increase in bladder mass. This increase in mass is associated with a variety of specific contractile dysfunctions, characterized by a marked decrease in the response to field stimulation (acting through the release of neurogenic transmitters). There is histological evidence indicating that the decrease in the contractile response of isolated strips of rabbit urinary bladder to field stimulation is associated with a degeneration of synaptic membranes within the bladder detrusor (neuropathy). In the current experiments, the effect of partial outlet obstruction in rabbit and rat urinary bladders on choline acetyltransferase activity (ChAT) were determined and correlated with both the level of bladder hypertrophy (increase in mass) and the contractile response to field stimulation. The results can be summarized as follows: In the rabbit, partial outlet obstruction induced a rapid 5‐fold increase in bladder mass over the 7 day period of study. This increase in mass was associated with a decrease in the contractile response of isolated strips of bladder body and base to field stimulation and a decrease in ChAT activity. Interestingly, the rabbit bladder base showed a significantly higher ChAT activity than the bladder body, although the contractile response to muscarinic stimulation was significantly greater in the bladder body than in the base. In the rat, partial outlet obstruction induced a mild 2‐fold increase in bladder mass. No change in ChAT activity was observed in the obstructed bladder. Consistent with this finding, there was no dysfunction in the response to field stimulation in the obstructed rat bladder.
Measurement of total urethral compliance in females with stress incontinence
Authors: Walter James S. , Wheeler John S. , Morgan Chris , Zaszczurynski Paul , Plishka Michael
Published: March 2007

Urodynamic evaluation of stress incontinence has failed to result in consistent diagnostic parameters. Using retrospective female bladder pressure and urine flow data, we evaluated two parameters based on a conductance formula. This formula was derived from fitting a classical fluid dynamic equation to published data of voiding cystourethography. The Area Equivalent Factor‐female at maximal flow represents maximal urethral opening and this value further divided by the pressure is the total urethral compliance. A stress incontinent group had a strong trend toward greater maximal urethral opening and total urethral compliance than a continent group. These parameters may, therefore, have potential in the evaluation and understanding of stress urinary incontinence.
Does it matter, the shape of the bladder?
Authors: Damaser Margot S. , Lehman Steven L.
Published: March 2007

To determine if the pressure‐volume curve of the urinary bladder is dependent on its shape, we compared the pressure‐volume curves of spherical, prolate spheroidal, and oblate spheroidal bladders, all made of the same material. We found that oblate spheroidal bladders are significantly more compliant than either spherical or prolate spheroidal bladders. Since the capacity of normal oblate spheroidal bladders is not larger in vivo than those of any other shape bladder, we have concluded that bladder fullness can not be determined by transmural bladder pressure alone.
A transcutaneous implantable bladder controller
Authors: Sawan M. , Duval F. , Hassouna M. , Li J. S. , Elhilali M. M.
Published: March 2007

We describe a computerized experimental system to investigate the effect of early electrical stimulation of the bladder during the spinal shock phase in paraplegic dogs. This system is composed of two main devices: an external part (or controller) based on a portable microcomputer, and a versatile implant (internal) based on a multichannel CMOS microstimulator. Using a new operative technique, this system enabled us to obtain many favorable results.
Evolution of bladder contraction in course of time after implantation of a sacral anterior root stimulator
Authors: Egon G. , Colombel P. , Isambert J. L. , Guerin J. , Barat M.
Published: March 2007

We reviewed bladder contraction evolution after sacral anterior root stimulator implantation in thirty patients operated on from 1984 to 1991. Two patients underwent a complete denervation with a reinnervation within a maximal time of seventeen months. One patient underwent a lesion, like a neuropraxia with a complete recovery at four months. Five patients have undergone a partial denervation with a recovery of miction by neurostimulation within the time of eighteen months. In three patients, bladder contraction disappeared for various reasons.
Computerized voiding diary
Authors: Rabin Jill M. , McNett Joseph , Badlani Gopal H.
Published: March 2007

An electronic, computerized voiding diary, “Compu‐Void” (patent pending) was developed in order to simplify, augment, and automate patients' recording of bladder symptomatology. A voiding diary as a tool has the potential to provide essential information for a more complete diagnostic and therefore therapeutic picture for each patient. Two major problems with the standard written voiding diary have been a lack of patient compliance and the limited amount of information it garners. Twenty‐five women with various types of voiding dysfunctions were compared to twenty‐five age and parity‐matched control women in order to determine patient preferences of the Compu‐Void when compared to the standard written voiding diary, compliance with each method, and amount and quality of information obtained with each method. Over 90% of subjects and over 70% of control group patients preferred the Compu‐Void over the written diary (P<0.005). The amount and quality of information obtained with Compu‐Void exceeded that obtained with the written method.
Distribution and function of the adrenergic and cholinergic receptors in the fetal calf bladder during mid‐gestational age
Authors: Lee Jeong G. , Macarak Edward , Coplen Douglas , Wein Alan J. , Levin Robert M.
Published: March 2007

Previous studies on the developing fetal bovine bladder demonstrate that compliance is low during early stages of fetal development and increases with fetal age. In addition, the pharmacological response of isolated fetal bovine bladder smooth muscle strips to field stimulation and bethanechol increased in proportion with the gestational age. In the adult bladder (rabbit), the contractile response to autonomic receptor stimulation and the autonomic receptor density showed a parallel gradation in the the bladder between bladder dome and the urethra.

The present studies were designed to determine the distribution of the cholinergic and adrenergic receptors in the urinary bladder of the fetal calf at mid‐gestational age, and to correlate the receptor density with the magnitude of the response to receptor stimulation. Each bladder body was separated into upper, middle, and lower segments. For the functional studies, circular and longitudinal strips were cut from each bladder segment and stimulated with field stimulation (FS), bethanechol, methoxamine, isoproterenol, and KCl. Autonomic receptor assays were performed using 3H‐QNB (muscarinic cholinergic), 3H‐DHE (alpha adrenergic), and 3H‐DHA (beta adrenergic) as ligands. In general, there were no significant differences in receptor density among the three bladder segments. However, the density of muscarinic receptors was significantly greater than the density of alpha‐ or beta‐adrenergic receptors for all bladder segments. The receptor densities correlated very well with the functional response of isolated bladder strips to the specific autonomic agonists. The contractile responses of the strips to FS, bethanechol, and methoxamine were not significantly different among the three different bladder segments. The magnitude of the contractile response to methoxamine was significantly smaller than the response to FS, bethanechol, and KC1 for all bladder segments. Isoproterenol (10 μM) relaxed precontracted bladder strips of all segments to a substantial degree (65–85%).

In conclusion, at mid‐gestation, there were no significant differences in either the autonomic receptor densities or in the functional responses to receptor stimulation among three different segments of the fetal bovine bladder.
Subjective and objective evaluation of patients with prostatism and infravesical obstruction treated with both intraprostatic spiral and transurethral prostatectomy
Authors: Nielsen Kurt K. , Kromann‐Andersen Bjarne , Poulsen Asger L. , Schou Jesper , Nordling Jørgen
Published: March 2007

In order to evaluate the effect of intraprostatic spiral and subsequent transurethral prostatectomy (TURP) on obstructive benign prostatic hyperplasia, 9 men were evaluated with symptom scores and urodynamic studies at inclusion after 4 months of spiral treatment and 4 months after TURP. Six patients in a control group were evaluated at inclusion after an observation period of 4 months and 4 months after TURP.

After treatment with spiral the symptom score decreased in 7 patients, increased in 1. and was unchanged in 1. After the observation period in the control group the symptom score decreased in 4 patients, increased in 1, and was unchanged in 1. After TURP the symptom score decreased even further in all patients, but one. After spiral treatment the urethral resistance decreased in 8 of 9 patients, but according to Abrams and Griffith's [(1979): Br J Urol 51:129–134] definition, only 2 were unobstructed. Five patients in the control group were unchanged obstructed after the observation period, while one was unobstructed. After TURP, the patients in both groups were all unobstructed.

Intraprostatic spirals decrease the severity of symptoms and reduce the urethral resistance, but TURP in the same patient was much more effective. © 1994 Wiley‐Liss, Inc.
Needle emg registration of striated urethral wall and pelvic floor muscle activity patterns during cough, valsalva, abdominal, hip adductor, and gluteal muscle contractions in nulliparous healthy females
Authors: Bø K. , Stien R.
Published: March 2007

The aim of the present study was to describe co‐activity patterns of the striated urethral wall muscle and the pelvic floor muscles (PFM) during contraction of outer pelvic muscles. Six healthy nulliparous physical education students, mean age 19.5 years (19–21) participated in the study. Concentric needle EMG and a Dantec amplifier were used for registrations. EMG activity was continuously recorded with the participants lying in a supine position. EMG was recorded during relaxation, contraction of the PFM. valsalva maneuver, coughing, hip adductor contraction, gluteal muscle contraction, backward tilting of the pelvis, and sit‐ups. The procedure was performed with the needle in the striated muscle of the anterior wall of the urethra and then repeated with the needle set lateral to the urethra in the PFM. The results showed that the striated urethral wall muscle was contracted synergistically during PFM, hip adductor, and gluteal muscle contraction, but not during abdominal contraction. Both hip adduction, gluteal muscle, and abdominal muscle contraction gave synergistic contraction of the PFM. Thus the urethral wall striated muscle and the PFM react differently during abdominal contraction. © 1994 Wiley‐Liss, Inc.
3H‐thymidine uptake by the rat urinary bladder after partial outflow obstruction
Authors: Saito Masahiko , Longhurst Penelope A. , Murphy Miles , Monson Frederick C. , Wein Alan J. , Levin Robert M.
Published: March 2007

Partial outflow obstruction induces marked changes in detrusor contractile function and morphology. One common finding in all experimental animal models of outflow obstruction is a significant increase in bladder mass. It is not clear which tissue compartments undergo hypertrophy, hyperplasia, or both. The present study was designed to evaluate the time‐related changes in 3H‐thymidine uptake and distribution within each tissue compartment induced by partial outflow obstruction using autoradiography.

Partial outlet obstruction in rats induced a mild 2‐fold increase in mass over a 14 day period. DNA synthesis increased significantly at 1 day following surgery, and remained increased through 7 days. DNA synthesis returned to control levels by 14 days. Distribution studies (using autoradiography) demonstrated a marked increase in the number of labelled urothelium cells at 1 and 3 days after obstruction. Sham surgery also initiated an increase in the number of labelled cells in the urothelium at 1 day. Although both sham and obstructive surgeries induced substantial increases in the labelling of cells within the connective tissue components, the magnitude of the increase in labelled connective tissue cells of the obstructed bladders was greater than that of the sham group. The number of labelled smooth muscle cells of the obstructed bladder increased significantly at 3, 5, and 7 days. However, there were no changes in smooth muscle incorporation of 3H‐thymidine by the sham groups.

In conclusion, partial outflow obstruction induced time‐dependent increases in bladder wall proliferation. The urothelium and connective tissue were the compartments first affected, followed by smooth muscle. © 1994 Wiley‐Liss, Inc.
Intracellular mechanism of penile erection in monkeys
Authors: Trigo‐Rocha Flavio , Hsu Geng‐Long , Donatucci Craig F. , Martinez‐Piñeiro Luis , Lue Tom F. , Tanagho Emil A.
Published: March 2007

To elucidate the sequence of events between the release of neurotransmitters and cavernous smooth muscle relaxation in erection, we studied the role of the cyclic adenosine monophosphate (cAMP) and cyclic guanosine monophosphate (cGMP) systems. In a well‐established simian model, the effects of specific agonists and antagonists of the intracellular sequence for smooth muscle relaxation and potassium channel openers on the intracavernous pressure were examined.

Sodium nitroprusside (10−3 M), a nitric oxide releaser and thus a stimulant of the cGMP system, caused an increase in the intracavernous pressure from 82 to 115 cm H2O for 7 to 19 min and penile diameter from 24.8 ± 2.28 to 43 ± 4.87 mm. When nitroprusside was injected after methylene blue (10−3 M), a specific antagonist of the enzyme guanylate cyclase, intracavernous pressure rise decreased significantly, but cromakalin, a potassium channel opener, provoked excellent increases after the block. A smaller dose of sodium nitroprusside (10−4 M) caused an increase in intracavernous pressure from 35 to 85 cm H2O for 7 to 11.5 min. When nitroprusside was injected after zaprinast, a phosphodiesterase inhibitor, the increase in pressure ranged from 80 to 116 cm H2O for 15 to 30 min. Prostaglandin E1, an activator of the cAMP system, caused an increase in the intracavernous pressure of 20–80 cm H2O for 5 to 10 min, and an increase in penile diameter from 25 ± 2.22 to 35 ± 3.48 mm. The erectile response to PGE1, but not to cromakalin, was nearly abolished by ethylmaleimide, an adenylate cyclase blocker. The response to nitroprusside was significantly greater (P < 0.05) than to PGE1.

Both systems. cAMP and cGMP, may be involved in cavernous smooth muscle relaxation, and cGMP is probably the predominant intracellular second messenger in penile erection in monkeys. Stimulants of the cGMP system, such as nitric oxide releasers, could represent a more physiological and effective approach in the treatment of erectile dysfunction. © 1994 Wiley‐Liss, Inc.
Dollars and sense: Considerations for experimental model design
Authors: Ghoniem Gamal M. , Vandenberg Todd L.
Published: March 2007

Our recent review indicates that numerous factors are involved in selecting an animal model for the study of human disease processes. These include: anatomic, neurologic, physiologic, and pathologic parameters, concept of discrimination, volume of knowledge available, and costs.

Regarding costs, data was collected from twelve medical research institutions in relation to the eight animals selected for comparative cost analysis: rhesus monkey, cynomolgus monkey, Sprague‐Dawley (S.D.) rat. dog (mongrel), cat (mixed breed), swine (piglet), guinea pig, and rabbit.

Biologically, the choices are vast and depend upon the investigator and the experimental design. Economically, pricing is a substantial constraint that varies widely and is institutionally dependent. Furthermore, within the same institution, costs differ according to the source of funding (e.g., private, federal, state, or institutional). However, if the investigator carefully considers these biologic and economic factors, it is possible to select an appropriate animal model. © 1994 Wiley‐Liss, Inc.
Conscious minipig model for evaluating the lower urinary tract
Authors: Guan Zhichen , Kiruluta George , Coolsaet Bo , Elhilali Mostafa
Published: March 2007

An animal model using minipigs to study urodynamic pressure flow relationships in the conscious animal is described. Port‐catheters were implanted subcutaneously in the hacks of 22 minipigs with access to the bladder (to measure intravesical pressure Pves) and to the peritoneal cavity (to measure abdominal pressure Pabd). The subtracted pressure (Pdet = Pves = Pabd) was recorded during the storage phase following Furosemidc diuresis. Simultaneously, measurement of urinary flow (Q) during voiding was also recorded. Urodynamic studies were performed satisfactorily in all animals, and normal urodynamic profiles in minipigs were established. The minipig model allows reliable and reproducible measurement of pressure‐flow parameters in a conscious state and in the natural posture. © 1994 Wiley‐Liss, Inc.