bluuebunny/crossref_metadata_2025 huggingface dataset:
Pressure variations in the female urethra measured by the infusion technique: Is it an artifact?
Authors: Colstrup Hans , Lose Gunnar , Jørgensen Lisbeth
Published: March 2007

The aim of this study was to investigate the possibility that pressure variation in the female urethra, as registered by the Brown‐Wickham technique, is an artifact due to infusion of fluid into the urethra. Sixteen women with various lower urinary tract disorders underwent pressure registration in the urethral high pressure zone for 5 minutes using the infusion method, followed by pressure registration using a water column pressure head. In nine patients, well‐defined pressure variations were observed during infusion; similar stepwise pressure decreases were found in these patients using the water column method. Because the stepwise decreases with the latter method can be due only to genuine relaxations of the urethral wall, obtaining similar patterns with these two techniques indicates that the infusion method is reliable in detecting urethral pressure variations.
Evidence for local neural modulation of sympathetic influences on the feline bladder
Authors: Rudy Delbert C. , Downie John W.
Published: March 2007

It is known that resting conditions of bladder volume and pressure influence the response of the cat bladder in situ to sympathetic nerve stimulation. We observed that this was also true when the bladder was decentralized by cutting the sacral spinal roots, the hypogastric nerves, and one sympathetic chain. Under these conditions, elevating intravesical pressure by means of a reservoir of large surface area connected to the bladder resulted in an enhancement of the beta‐adrenoceptor‐mediated dilatory component of the response to stimulation of either the sympathetic chain or the hypogastric nerves. In order to test whether this enhancement was the result of mechanical or end‐organ effects, the change in response to ia isoprenaline was also evaluated. Although the response to isoprenaline was modestly (2‐fold) increased at intravesical pressures of 20–30 cm H2O, the increase in response to hypogastric nerve stimulation (8.5‐fold) was significantly greater. The increase in response to sympathetic chain stimulation was intermediate, but only one chain was stimulated. Thus, end‐organ or physical factors have some influence on the dilatory response. However, there must be another modulatory component that exerts an effect on the neurally mediated dilatation but not on that produced by isoprenaline. This modulation appears to be activated by bladder distension and to be directed at the nerves, either on their terminals or at the intramural or plexus ganglia. Candidate mechanisms are humoral compounds (e.g., eicosanoids) or a local neural network.
Endocrine influences on the detrusor of male and female cats
Authors: Theobald Robert J. , Zepp E. A. , Westhoff Rebecca
Published: March 2007

The effects of ATP, adenosine (ADS), β,γ‐methylene ATP (APPCP), norepinephrine (NE), and hypogastric nerve stimulation (HGS) on urinary bladder responsiveness have been studied in male and female cats. Recent studies indicated binding sites for estradiol and testosterone in the urinary tract of animals. Other studies have demonstrated that estrogen alters the effects of certain agonists in urinary tract smooth muscle, although the mechanism of this effect is not known. The present study was designed to determine if differences occurred in the response of bladder smooth muscle in male vs. female cats to various stimuli and if surgical or drug pretreatment alters the response.

The results of these experiments indicate differences between the response of the urinary bladder in female and male cats to various stimuli and that various pretreatments can alter the detrusor response to selected stimuli. In particular, detrusor of female cats was less responsive to most stimuli than detrusor of male cats, including stimuli that induced inhibition of pelvic‐nerve‐evoked bladder contractions (such as norepinephrine) and stimuli which induced bladder contractions (such as ATP). Also, gonadectomy altered the response of the detrusor making it more responsive to purine inhibitory stimuli, while having a mixed effect on detrusor responsiveness to excitatory stimuli. Pretreatment of cats with a gonadotropin‐releasing hormone antagonist also altered detrusor responsiveness, both inhibitory and excitatory agonists in a variable manner, increasing the magnitude of most responses. In addition to the above‐stated differences, the data also proved to underscore some similarities in the response of male and female cats to adrenergic and cholinergic stimuli. These studies imply that sex hormones influence detrusor response to certain purinergic stimuli and that alteration of sex hormone levels by surgery or medication can impact lower urinary tract function.
Detrusor overactivity
Authors: Coolsaet Bo L. R. A. , Elhilali Mostafa M.
Published: March 2007

Detrusor pressure is only a partial reflection of bladder wall force. In order to better standardize the results of clinical studies, bladder wall activity has to be taken into account by relating detrusor pressures to volume levels.

The 15 cm H2O threshold level is misleading. Tonic and phasic pressure changes have to be clearly distinguished. Standardization of technique can be improved by using diuresis cystometry.

Urethral mobility and dysfunction have to be further investigated in relation to detrusor activity.

Detrusor overactivity may be caused by factors which also cause stress incontinence and is therefore no contra‐indication for culposuspension. The occurrence of detrusor overactivity after culposuspension cannot be predicted. It can be treated pharmacologically and in case of resistance to therapy by an augmentation cystoplasty such as a CLAM operation. Investigation of the urethra is therefore more important than a cystometrogram prior to a culposuspension. A technique is described.

Genuine stress incontinence is not a useful urodynamic diagnosis.

In the aging male, detrusor overactivity is more frequent, with or without obstruction. In patients with benign prostatic hypertrophy and detrusor overactivity resistant to treatment, prostatectomy would be acceptable therapy.
Surgical treatment of anatomical stress incontinence
Authors: Siegel Andrew L. , Raz Shlomo
Published: March 2007

The condition Stress Incontinence may be classified as (a) anatomical (AI) and (b) due to intrinsic sphincter damage (ID). While anatomical incontinence is due to anatomical malposition of a normal sphincteric unit in intrinsic damage, the sphincteric unit is abnormal (damaged from multiple surgery, radiation, neurologic disease, etc). The goal of surgery for AI is to reposition the bladder neck and urethra in a high, fixed retropubic position without obstruction. With improvements in the surgical techniques and a better understanding of the anatomical landmarks a clear trend has evolved in recent years toward vaginal approach. Important principles of the vaginal approach include mobilization or the urethra and bladder neck, precise placement of the suspension sutures in sturdy tissue (endopelvic fascia), fingertip guidance of a ligature carrier through the retropubic space, cystoscopy control and tying the sutures without tension. The advantages are simplicity, less morbidity and providing equal or better results than the abdominal approach. AI is only a symptom of pelvic prolapse and concomitant pathology like rectocele, enterocele and uterine prolapse should be addressed at the time of surgical repair. The pathophysiology, classification and different modalities of treatment for anatomical incontinence are discussed.
Anterior sacral root stimulator (Brindley): Experiences especially in women with neurogenic urinary incontinence
Authors: Madersbacher H. , Fischer J. , Ebner A.
Published: March 2007

Six women and one man with complete (or almost complete) suprasacral lesions and with unbalanced reflex bladder and otherwise uncontrollable reflex incontinence received a radiolinked anterior sacral root stimulator using the intradural approach. At the same time the relevant posterior sacral roots were cut to abolish spontaneous reflex detrusor contractions. All patients were able to empty the bladder with physiologic detrusor pressure, with no or minimal residual urine, and they achieved urinary continence. Pre‐ and postoperative urodynamic findings are given as well as the intra‐operative details. The aims of this procedure, balanced voiding and urinary continence, were achieved in all seven patients; follow‐up in this series ranged from 6 months to 2 years. Our findings confirm the excellent results reported by Brindley and others with 155 implantations of an anterior sacral root stimulator worldwide. In our series so far no technical problems — either with the implant or with the external stimulation unit — have occurred; exact setting of the electric stimulation parameters provides physiologic detrusor pressures, and although micturition is achieved by poststimulus voiding, no increase of trabeculation could be observed. Achievement of urinary continence depends on the effect of the rhizotomy of the relevant sacral posterior roots performed at the same time intradurally. Further observation time will be necessary to prove its effectiveness in the long run. Even with these arguments in mind the results so far justify the implantation of an anterior sacral root stimulator together with a posterior root rhizotomy, especially in female patients with unbalanced reflex bladder together with reflex urinary incontinence which cannot be managed otherwise.
Abdominal approach for implantation of the A.S. 800 artificial urinary sphincter in females
Authors: Light J. Keith
Published: March 2007

The artificial urinary sphincter has been used with success in female patients with neuropathic bladder dysfunction and resultant urinary incontinence as the device has reliably substituted for the nonfunctioning sphincteric mechanism in these patients. A combination of augmentation cystoplasty to create a low pressure reservoir with the artificial urinary sphincter was successful in restoring continence in 92% of pediatric patients with meningomyelocele where other measures had failed. Use of the artificial urinary sphincter in patients with severe, recurrent stress incontinence is likewise highly successful in restoring continence. The potential disadvantage to the sling procedure of having to perform prolonged self‐intermittent catheterization is avoided. Careful preoperative urodynamic evaluation is essential, however, to ensure that a stable bladder with no outlet obstruction is present. The abdominal approach to insert the artificial urinary sphincter avoids the potential of vaginal contamination with subsequent device infection. The operative technique to successfully accomplish this is fully described. The vascularity of the trigonovaginal septum is crucial for success with this approach. Conditions such as previous radiotherapy and excessive atrophy adversely affect the ultimate success of the operation because of decreased tissue perfusion. This applies whether the vaginal or abdominal approach is used to insert the device.

Careful attention to preoperative evaluation and surgical technique will result in a high degree of success.
Techniques and results in the implantation of the artificial urinary sphincter in women with type III stress urinary incontinence by a vaginal approach
Authors: Appell Rodney A.
Published: March 2007

Thirty‐four women with type III stress urinary incontinence underwent implantation of the artificial urinary sphincter (AUS) for control of urination using the AMS #800TM device via a combined vaginal and minimal retropubic approach. The deliberate opening of the vagina facilitates placement of the sphincteric cuff in its proper position and serves to prevent urethral or bladder neck damage without increasing the risks of cuff infection or erosion. Results show no erosions, no detrusor instability, four patients on intermittent self‐catheterization, and three patients requiring repeat surgery for mechanical problems. These results indicate that the AUS is a viable alternative in the management of this difficult group of incontinent women and that implanting surgeons should not fear entering the vagina during implantation, but should deliberately do so to facilitate surgical placement of the cuff while protecting the urinary organs and reducing operating room time.
Interference pattern in perineal muscles: I. A quantitative electromyographic study in normal subjects
Authors: Aanestad Ø. , Flink R. , Stålberg E.
Published: March 2007

The electromyographic pattern (EMG) in two perineal muscles, the external anal sphincter muscle and the puborectalis muscle, was examined in 30 normal subjects consisting of women aged 24–77 years, using a concentric needle electrode. The interference pattern in the two muscles was recorded at rest and at maximal voluntary activation and analyzed with a computerized technique. The number of turns and the mean amplitudes in the interference pattern were measured and the recorded differences between the two investigated muscles as well as the differences compared to other striated extremity muscles are discussed. This technique (T/A analysis) has been shown to differentiate between neurogenic and myopathic changes in a weak muscle, and it is proposed that the technique could be useful in characterizing disturbances in perineal muscles in patients with micturition or defaecation dysfunctions.
Quantification of urethral function based on Griffiths' model of flow through elastic tubes
Authors: Spángberg Anders , Terió Heikki , Engberg Anders , Ask Per
Published: March 2007

Griffiths' model of flow‐through elastic tubes makes it possible to relate the elastic properties of the flow‐controlling zone to the pressure/flow relation of the urethra. In this work the pressure function p(A) = Pmo + Kn An, where A is cross‐sectional area, Pmo the minimal opening pressure, and Kn and n parameters describing urethral distensibility, describes the elastic properties of the flow‐controlling zone. By curve‐fitting in the pressure/flow plot, the three parameters pmo, Kn, and n can be estimated analytically. Using this model it is possible to identify three different biomechanical changes that may cause obstruction. First, pmo may be elevated. Second, the urethra can be distended to a certain area only, corresponding to high values of Kn and n. Third, the urethra can be distended but a higher‐than‐normal pressure increase above Pmo is needed, Kn is high, and n is low. With this model it is possible to quantify urethral function for both scientific and clinical purposes.
Pubovesical ligament: A separate structure from the urethral supports (“pubo‐urethral ligaments”)
Authors: DeLancey John O. L.
Published: March 2007

The position and mobility of the vesical neck influences not only continence but also the initiation of micturition. During an examination of urethral topography, there appeared to be two structures running from the region around the vesical neck to the pelvic walls which might influence vesical neck function. These structures, the urethral supports (“pubo‐urethral ligaments”) and pubovesical ligaments, have previously been considered to be synonymous terms for a single structure. To investigate this disparity, 1,500 serial histologic sections from eight normal cadavers were examined, 28 cadavers were dissected, and whole pelvis cross sections from an embalmed cadaver were studied.

Our observations indicate that there are two structures which run from the region around the proximal urethra and vesical neck to attach to the pelvic walls. The pubovesical ligaments are an extension of the detrusor muscle and its adventitia. They attach to the pubic bone and arcus tendineus fasciae pelvis. Their structure suggests that they contract to assist in vesical neck opening but would be poorly suited to provide support for the proximal urethra. The other structures represent the urethral supports (“pubo‐urethral ligaments”) which connect the vagina and periurethral tissues to the muscles of the pelvic diaphragm and to the pelvic fasciae. Their structure appears to be adequate to explain urethral support.

There are, therefore, two structures running from the tissues around the vesical neck to the pelvic walls. The structure of the pubovesical ligament suggests that it could assist in vesical neck opening, and the urethral supports could determine urethral position.
Biochemical characterization of the rabbit urinary bladder: II. Intracellular concentration of nucleotides
Authors: Levin Robert M. , Moore Debra , Ruggieri Michael R. , Haugaard Niels , Wein Alan J.
Published: March 2007

Bladder contraction is mediated by a number of intracellular biochemical reactions including glycolysis, mitochondrial respiration, phosphocreatine kinase, and various ATPases. In order to understand how alterations in intracellular metabolism can affect bladder function (or how alterations in bladder function can affect intracellular metabolism), we must first understand and describe normal bladder metabolism. Using the rabbit as a model for bladder function, the present study compares the intracellular concentrations of a variety of important compounds between the bladder base and body.

The intracellular concentrations of phosphocreatine (PC), creatine, ATP, ADP, and AMP were determined in samples of rabbit urinary bladder body and base. The values for PC and creatine were significantly lower in the bladder base than in the bladder body. Adenine nucleotide concentrations were similar in the two sections.

The concentrations of NAD + NADH, NADP, CTP, CDP, CMP, GTP, GDP, GMP, and UTP, UDP, UMP were also measured. Of these compounds, the concentrations of GTP and UTP in the bladder body were nearly double those in the bladder base. The intracellular concentrations of the other tissue constituents were similar in the two bladder sections.

These studies demonstrate that the bladder is not biochemically homogeneous but that the bladder base and body differ not only functionally but also metabolically.

Experiments in which strips of bladder body were incubated in vitro in oxygenated Tyrode's solution containing glucose showed that the tissue concentrations of PC, ATP, GTP, and UTP decreased substantially following 30 min of incubation, with no further decrease during a subsequent 60‐min incubation.
Effects of short‐term partial bladder outlet obstruction on the rabbit detrusor: An ultrastructural study
Authors: Elbadawi Ahmad , Meyer Sabine , Malkowicz S. Bruce , Wein Alan J. , Levin Robert M. , Atta Mohamed A.
Published: March 2007

It has been shown previously that partial bladder outlet obstruction in the rabbit results in changes in detrusor contractility and biochemical profile [Malkowicz et al., 1986]. The present study was conducted in the same animal model to define the nature and evolution of concomitant structural neuromuscular changes in the detrusor, as the basis for its altered function following partial outlet obstruction. Twenty‐five New Zealand White rabbits, including three normal controls, were used. The bladder was excised in 15 rabbits at various intervals 1–14 days postoperatively. In the remaining seven rabbits, the obstruction was relieved after 7 days, and the bladders were excised 14 or 28 days later. Multiple samples of the midbody detrusor were obtained from each specimen and processed for electron microscopy by standard techniques. Changes were observed in the smooth muscle, interstitial, and neural compartments. The muscular changes included a combination of muscle cell degeneration and regeneration, and widening of intercellular spaces with deposition of basal lamina‐like material. Both degenerative and regenerative muscle cell profiles were uncommon in the control and 1 day obstructed samples, frequent in the 3–7 day obstructed samples, and less frequent in the 14 day obstructed samples. The spaces between individual muscle cells appeared to become increasingly wider in the 3–14 day obstructed samples. The ultrastructure of smooth muscle in samples from both deobstructed groups was similar to controls, except for thickened basal laminae of muscle cells and consistently widened intercellular spaces. The interstitial compartment appeared to become progressively exaggerated with increasing deposits of collagen and elastin in the 3–14 day obstructed samples; these changes persisted in samples from both deobstructed groups. In regard to the neural compartment, degeneration of both cholinergic and adrenergic nerves with loss of neuroeffector junctions was observed in the 3–7 day obstructed samples; axonal regeneration was seen with re‐establishment of the junctions in the 14 day obstructed and both deobstructed groups. It is concluded that partial bladder outlet obstruction in the rabbit results in partially reversible neuromuscular changes in the detrusor, which can explain the resultant alterations in detrusor contractility and biochemical profile.
Role of ischemia in structural changes in the rabbit detrusor following partial bladder outlet obstruction: A working hypothesis and a biomechanical/structural model proposal
Authors: Elbadawi Ahmad , Meyer Sabine , Regnier Claude H.
Published: March 2007

Multidisciplinary studies of the partially obstructed detrusor in a rabbit model have shown that important changes in its structure and functional behavior evolve with time and initially are probably related to rapid changes in smooth muscle. This report presents a working hypothesis on the basis of and the reasons for obstructive structural changes in the detrusor, and their bearing on its function, from a biomechanical viewpoint. In this report, the concept that detrusor changes following short‐term bladder outlet obstruction evolve through an ischemic, an adaptive, and a “recovery” phase will be proposed. In addition, a simple “chain” model will be presented in an attempt to define the possible mechanical correlates of each of these phases with respect to both the structure and function of the detrusor in each.
Morphometry of the obstructed detrusor: I. Review of the issues
Authors: Elbadawi Ahmad , Meyer Sabine
Published: March 2007

Qualitative and quantitative ultrastructural studies on the rabbit detrusor following partial bladder outlet obstruction indicate the necessity of morphometry in evaluating structure of the dysfunctional detrusor. This report presents a review of the issues involved in such morphometry, as a prelude to presentation of a comprehensive protocol for this purpose in a subsequent report. In the present report, obstructive changes in the structure of smooth muscle are reviewed, the parameters that should be evaluated are defined, the limitations of detrusor morphometry are presented, and the guidelines for a meaningful morphometric protocol for use in future studies on the dysfunctional detrusor are outlined.
Morphometry of the obstructed detrusor: II. Principles of a comprehensive protocol
Authors: Meyer Sabine , Elbadawi Ahmad
Published: March 2007

Morphologic studies on the obstructed detrusor have revealed several structural neuromuscular changes that must be evaluated quantitatively by morphometry to be functionally meaningful and clinically relevant. The peculiar structural organization of the detrusor poses important limitations to methods of morphometry that have withstood the test of time in other visceral smooth muscle systems, particularly the intestine. Because of this, conclusions in the literature about structure of the obstructed detrusor based on standard methods of morphometry are in many instances open to question. What is needed for scientifically credible morphometry of the detrusor is a comprehensive protocol that takes into consideration its peculiar structural organization and outlines the most appropriate methods for its processing and study within the context of the morphometric parameters to be evaluated. The principles of such a protocol will be presented in this report after a review of standard methods of morphometry and their applicability to the detrusor.
Successful use of electroejaculation in two multiple sclerosis patients including report of a pregnancy utilizing intrauterine insemination
Authors: Ohl Dana A. , Grainger Ronald , Bennett Carol J. , Randolph John F. , Seager Stephen W. J. , McCabe Marcianna
Published: March 2007

We report two males with multiple sclerosis who were infertile as a result of failure to ejaculate. Electroejaculation was successfully used to recover semen with motile sperm from both men, and the sperm was used for artificial insemination. One pregnancy was achieved by intrauterine insemination, and a healthy male baby was born.
Urodynamics in enuretics II: A pressure/flow study
Authors: Nørgaard J. P.
Published: March 2007

This study dealt with urodynamics during sleep where enuresis was provoked by filling cystometries. Data were compared to the ones obtained in the same patients in urodynamics at awake state. Fifty‐six sleep cystometries resulted in 31 enuretic events and 25 arousals. Comparison of pressures revealed that enuresis was taking place during an increase in maximal bladder pressure of 20 cm H2O (P<0.05) and a prolonged contraction time (P<0.05). The configuration of the pressure tracing was otherwise completely similar to the ones obtained in awake state. Furthermore, these were similar to data available in the literature of normal children. It is hence concluded that enuretics are urodynamically normal and that the enuretic event is a coordinated micturition initiated at maximal bladder capacity with some indication of increased urethral resistance.
Maximal electrostimulation of the pelvic floor in female idiopathic detrusor instability and urge incontinence
Authors: Eriksen B. C. , Bergmann S. , Eik‐Nes S. H.
Published: March 2007

A new device for in‐clinic acute maximal electric stimulation of the pelvic floor has been developed to treat motor and sensory dysfunction of the lower urinary tract.

Forty‐eight women suffering from idiopathic detrusor instability and urge urinary incontinence received an average of seven treatments, each lasting for 20 minutes. A mean current intensity of 86 mA using monophasic square pulses with a frequency of 5–10 Hz and a pulse width of 1 msec was delivered simultaneously through a vaginal and an anal plug electrode.

Initially, clinical and urodynamic cures were obtained in about 50% of the patients. In addition, a significant improvement was observed in approximately 33%. At 1‐year follow‐up, a persisting positive therapeutic effect was found in 77% of the study group, and no serious side effects were registered.

The stimulation device used, the “Medicon MS‐103,” which is commercially available, was easy to handle, safe for the patients, and technically reliable. Disposable plugs satisfied hygienic requirements. Low‐frequency, repetitive, short‐term maximal electrostimulation of the pelvic floor is a simple, effective, low‐cost therapeutic method in female idiopathic motor urge incontinence.
Experimental models of reflex contractile activity in the rabbit bladder
Authors: Kitada Shinichiro , Kato Kumiko , Wein Alan J. , Levin Robert M.
Published: March 2007

We were able to produce two highly reproducible experimental models (in the rabbit) that demonstrated a high degree of reflex bladder contractile activity. In one model, a somatovesical reflex was induced by touching or pinching the perineal area. This reflex may be organized through a neurogenic reflex at the spinal level. In another model, rhythmic bladder contractions were produced by distal urethral constriction in the absence of bladder distension. These rhythmic contractions were thought to be due to a supraspinal reflex. In both types of contractile reflexes, intravenous administration of hexamethonium inhibited the reflex contractile activity virtually completely, intravenous atropine inhibited over 90% of the induced contractile activity, thus suggesting that these contractions were mediated reflexly through cholinergic stimulation. These two models of reflex bladder contractions should be useful for the study of hyperreflexic bladders.
Intrinsic neuromuscular defects in the neurogenic bladder: X. Value and limitations of neurohistochemistry
Authors: Elbadawi Ahmad , Atta Mohamed A.
Published: March 2007

Histochemical changes in bladder innervation have been described in various types of clinical and experimental neurogenic voiding dysfunction. Recent studies in the cat have shown that both decentralization and postganglionic “denervation” lead to ultrastructural changes in muscular innervation of the bladder base. The present study was conducted to find out whether these changes can be detected histochemically. Decentralization of the bladder by unilateral sacral ventral rhizotomy, bilateral sacral ventral rhizotomy, or unilateral pelvic neurectomy was performed in 25, and postganglionic “denervation” by unilateral pelvic plexus neurectomy in 9, adult male cats. Specimens of the bladder body and bladder base were collected 2–4 and 8–10 weeks after decentralization, and 2–4 weeks and 10 weeks after “denervation.” The specimens were processed by histochemical methods to demonstrate cholinergic and adrenergic nerves. No recognizable differences from the norm were observed in cholinergic muscular innervation of either the body or base specimens of the decentralized bladder. While adrenergic muscular innervation of both regions was similar to normal in short‐term samples of the same specimens, there was an obvious adrenergic hyperinnervation of both in the long‐term samples. By contrast, there was an obvious, early‐developing, and persistent hypoinnervation by both cholinergic and adrenergic nerves in both the body and base regions after postganglionic “denervation.” It is concluded that histochemistry (1) has no value in detecting either short‐ or long‐term changes in cholinergic muscular innervation of the decentralized bladder and (2) is useful for revealing both short‐ and long‐term cholinergic and adrenergic hypoinnervation of the “denervated,” as well as long‐term adrenergic hyperinnervation of the decentralized vesical muscularis.
In vitro effects of intravesical dimethylsulfoxide
Authors: Freedman Alan I. , Wein Alan J. , Whitmore Kristene , Levin R. M.
Published: March 2007

The mainstay of therapy for interstitial cystitis (IC) is intravesical instillation of dimethylsulfoxide (DMSO). Although numerous clinical studies have documented symptomatic improvement in up to 70% of patients, the mechanism of action, and effect on objective parameters of bladder function have not been adequately studied. In this study we have used the in vitro whole bladder model to determine the effect of DMSO on several parameters of bladder function, including in vitro cystometry, pressure generation, and ability to empty in response to both field stimulation and bethanechol. All parameters measured were significantly (P < 0.05) reduced. Bladder capacity was reduced by a mean of 18.71%. Compliance was markedly decreased after instillation of DMSO. The magnitude of pressure generated in response to field stimulation was decreased from a mean of 8.93 cm H2O to a mean of 5.55 cm H2O. In response to bethanechol, the magnitude of pressure generation was decreased from a mean of 9.85 cm H2O to a mean of 7.07 cm H2O after treatment with DMSO. The rate of pressure generation in response to field stimulation was substantially reduced by 46.6%. In response to field stimulation and bethanechol, control bladders emptied 86% and 92%, respectively. After treatment with DMSO, these values were reduced by an average of 33.24% and 14.92%, respectively.

This in vitro study has shown that DMSO has a negative effect on multiple parameters of bladder function, including compliance, capacity, and contractile and functional responses to field stimulation and bethanechol.
Influence of renal failure on urodynamic, cystoscopic and radiologic evaluations of the lower urinary tract: Implications for the pre‐renal transplant evaluation
Authors: Steers William D. , Flechner Stuart M. , Kahan Barry D. , Rudy Delbert C. , Benson George S.
Published: March 2007

A retrospective analysis of 175 consecutive renal transplant patients who underwent extensive urodynamic evaluation and cystoscopy was performed. Urodynamic abnormalities were few, but general trends appeared. Pretransplant patients tended to have small‐capacity bladders (mean 280 cc) and low urine flow rates (mean 7 cc/sec). The flow rates returned to normal after transplantation regardless of preoperative urine volumes. Cystoscopy failed to demonstrate anatomical abnormalities not discovered on preoperative voiding cystourethrography, and no patient was found to have a lower urinary tract malignancy. A history and physical examination, urinalysis, urine culture, and voiding cystourethrogram constitute an adequate urologic screening evaluation for most renal transplant candidates. Although some patients require cystoscopy and urodynamic evaluation, we have abandoned the “routine” use of these studies.
Use of routine videocystourethrography in the evaluation of female lower urinary tract dysfunction
Authors: Barnick C. G. , Cardozo L. D. , Benness C.
Published: March 2007

Controversy remains over which tests are necessary in the routine evaluation of women with lower urinary tract dysfunction. Is cystometry alone sufficient, or is a more detailed investigation such as videocystourethrography justified? Two hundred consecutive new patients attending for urodynamic assessment were reviewed. In fifteen (7.5%) patients the correct diagnosis was made only on videocystourethrography. We therefore suggest that videocystourethrography should continue to be used as the routine investigation of female lower urinary tract dysfunction.
Mechanical properties of the urethra in healthy female volunteers: Static measurements in the resting urethra
Authors: Lose Gunnar
Published: March 2007

A pressure/cross‐sectional area probe was used for measurement of related values of pressure (Pura) and cross‐sectional area (CA) at static circumstances in the resting urethra in 30 healthy females. Measurements were performed at the bladder neck in the high‐pressure zone and distally in the urethra. From the two variables urethral elastance and hysteresis were calculated.

The mean urethral elastance (i.e., dPura/dCA) was found to be of the order of 1 cm H2O/mm2 all along the urethra. No correlation could be established between the elastance and age or parity. The mean hysteresis was of the order of 20–25 cm H2O along the urethra. Urethral hysteresis appeared to be a time‐dependent phenomenon.
Effect of urethral catheterisation on urethral sphincter emg and pressure profile
Authors: Lose Gunnar , Jørgensen Lisbeth
Published: March 2007

The impact on urethral sphincter EMG and pressure profile of the introduction of a catheter per urethram was assessed in 48 women with various voiding dysfunctions. Urethral EMG activity was recorded with vaginal surface electrodes placed behind the midurethra. A 5F urethral profile catheter was used in 13 patients (group I), an 8F in 23 patients (group II), and a 10F in 12 patients (group III).

In all three groups a statistically significantly increased EMG activity was observed following the introduction of the catheter. This increased activity ceased after a median time of 3–5 minutes. The increased EMG activity did not affect the maximum urethral closure pressure and functional profile length. No correlation could be established between changes in EMG activity and changes in urethral closure pressure. It is concluded that the increased sphincter EMG activity provoked by catheterisation does not affect the urethral pressure profile significantly.
Urethral pressure measurement: A comparison of profiles obtained by conventional and fibre‐optic microtransducers
Authors: Hilton P. , Mayne C. J.
Published: March 2007

Resting urethral pressure profile measurements and continuous urethrocystometry traces were carried out in a group of 24 patients by using both conventional microtransducer catheter and fibre‐optic microtransducer techniques in an effort to assess the repeatability of the various profile parameters and to investigate rotational variations in the recordings.

The microtransducer technique resulted in profiles with significantly higher values for total profile length (TPL), functional profile length (FPL), length to peak pressure (LtPP), and maximum urethral pressure (MUP), with significantly lower variation in urethral pressure than the fibre‐optic technique. These findings applied in all transducer orientations, even though the microtransducer method showed a greater degree of rotational variation.

When a standard catheter orientation was employed (with the transducer facing laterally in the urethra) the microtransducer technique showed significantly greater consistency of profile parameters when an analysis of variance technique was used.
Effect of oxybutynin on reflex micturition in the decerebrate dog as determined by urodynamic evaluation
Authors: Nishizawa Osamu , Sugaya Kimio , Kohama Takeo , Satoh Keietsu , Harada Tadashi , Tsuchida Seigi
Published: March 2007

The effect of oxybutynin on reflex micturition in the decerebrate dog was investigated by cystometric and striated urethral sphincter EMG studies. Reflex micturition consisting of bladder contraction and relaxation of the striated urethral sphincter occurred when a critical degree of filling was reached in the absence and presence of cumulative doses of 30, 100, and 300 μg/kg of oxybutynin. Oxybutynin at doses of 30, 100, and 300 μg/kg produced a significant increase in threshold volume during the collecting phase in a dose‐dependent manner. In the urodynamic parameters of the emptying phase considered to be influenced greatly by cholinergic activity there was a small but significant decrease in the maximum bladder pressure only at a dose of 300 μg/kg. The present study supports urodynamically clinical usefulness of oxybutynin for the relief of symptoms associated with detrusor instability and hyperreflexia.
Acute animal studies on electrically induced collision block of pudendal nerve motor activity
Authors: Sweeney J. D. , Mortimer J. T. , Bodner D. R.
Published: March 2007

In this paper we describe acute experiments in five adult male dogs on testing of a pudendal nerve cuff electrode implant for collision block of motor signals to the periurethral sphincter. The average quasi‐trapezoidal stimulus parameters at an “operating point” where antidromic unidirectionally propagating action potentials (needed to produce a motor collision block) were most effectively produced were regulated current level of 14.2 mA (S.D. 2.3 mA), pulse width of 500 μsec (S.D. 71 μsec), and a 90% to 10% exponential fall‐time (following the rectangular stimulus phase) of 840 μsec (S.D. 147 μsec). With these parameters for single monophasic stimuli, an average pressure reduction at the distal urethra of 89% (S.D. 6%) could be elicited in comparison to the maximal single stimulus pressure response. In two tests of collision block with stimulus trains a substantial decrease in distal urethral pressure could be elicited using either monophasic or the electrochemically preferable balanced‐charge biphasic (BCB) waveforms (e.g., pressure reductions of 76% and 89% with 30 Hz BCB collision block).
Comparison of palmitic acid and glucose metabolism in the rabbit urinary bladder
Authors: Hypolite Joseph A. , Haugaard Niels , Wein Alan J. , Ruggieri Michael R. , Levin Robert M.
Published: March 2007

This study was designed to investigate the relative importance of carbohydrate and fatty acids as substrates for energy production in the urinary bladder and to obtain information about the kinetics involved in the oxidation of glucose and a representative fatty acid by rabbit bladder incubated in vitro.

Isolated strips of rabbit bladder body were incubated in the presence of various concentrations of 14C‐glucose or 14C‐palmitate for different periods of time up to 90 minutes. The rate of 14CO2 generation was measured. In addition, the effect of bethanechol on both glucose and palmitic acid metabolism was determined.

The results can be summarized as follows: (1) The oxidation of glucose showed a distinct lag period with time lasting for about 30 minutes. From 30 to 90 minutes the rate of 14C2‐palmitate was linear over the entire 90‐minute period of incubation. (2) Experiments in which the concentration of glucose was varied showed saturation kinetics. From a Lineweaver‐Burk plot a Vmax of 0.645 umol/g/hr was obtained with a km of 2.30 mM. (3) Preincubation of tissues without substrate caused a significant increase in the rate of glucose oxidation. (4) The rate of oxidation of 14C‐palmitate increased with concentration of the fatty acid. (5) A Lineweaver‐Burk plot showed a Vmax of 30.0 nmol/g/hr and a km of 2.50 mM. Addition of unlabeled glucose to tissues oxidizing 14C‐palmitate had no effect on 14CO2 production. Similarly, the addition of non‐radioactive palmitate to tissues incubated with 14C‐glucose did not decrease glucose oxidation. When both radioactive substrates were present the rates of oxidation were additive. (6) Although bethanechol stimulated glucose oxidation, the drug had no significant effect on palmitate metabolism.
Effect of castration on penile erection in the dog
Authors: Creed Kate E.
Published: March 2007

The reduction in sexual activity in hypogonadal men is at least partially due to a decrease in sexual interest, but it may also involve peripheral mechanisms. In the present experiments, the effects of castration on penile erection in dogs was investigated. The pressure within the corpus cavernosum was measured in intact anaesthetized dogs and in dogs castrated 2 weeks or more than 6 months previously. It was found that there was no significant difference between intact and castrated dogs in the magnitude or time course of increase in corpus cavernosal pressure induced by pelvic nerve stimulation or in the inhibitory effects of simultaneous stimulation of the sympathetic chain. Furthermore, the mean ED50 value for contraction to phenylephrine of isolated strips of erectile tissue from the corpus cavernosum was not significantly different between groups. This suggests that the mechanism of penile erection is not affected by reducing the levels of testosterone.
Pressure measurement techniques in urodynamic investigations
Authors: Ask Per , Hök Bertil
Published: March 2007

It is apparent that the use of accurate pressure measurement techniques is essential for the outcome of urodynamic investigations. The aim of this paper is to estimate the demands on urodynamic pressure measurements and to review the properties of various techniques used. For the infused catheter technique, the dynamic properties are very much dependent on the complicance of the infusion system. With optimal infusion, the bandwidth and the pressure rise rate seem to be sufficient for most applications. Intraluminal microtransducers have a high bandwidth, but a certain fiber optic transducer cannot accurately measure mechanical pressure in the collapsed urethra. The principal differences in measuring hydrostatic pressure between the infused catheter technique and microtransducers should be observed. Flexion artefacts are a problem when measuring urethral pressure profiles. Newly developed transducers may offer a solution to this problem.
Residual urine volume following involuntary voiding in elderly inpatient men
Authors: O'Donnell Pat D. , Walls Robert C.
Published: March 2007

Urinary incontinence is a debilitating condition for elderly inpatients. The etiology is not well understood and has not been investigated extensively. Incontinence volume per episode has been shown to vary within patients and does not appear to be associated with cystometric bladder capacity. The objective of this study was to determine the relationship of residual urine volume following involuntary voiding to the incontinence volume and the total bladder volume in elderly inpatient men. Sixteen patients had catheterized residual urine volume measurements done following involuntary voiding on each of four days. Significant variability was found in the residual urine volume, the incontinence volume, and the total bladder volume within patients having urinary incontinence. The variability observed in volume parameters suggests that factors other than intravesical volume may have a significant role in the etiology of involuntary voiding in elderly patients.
Control and coordination of bladder and urethral function in the brainstem of the cat
Authors: Griffiths Derek , Holstege Gert , Dalm Eddie , Wall Hans De
Published: March 2007

Stimulation and lesion experiments in the pontine tegmentum of 34 cats, with urodynamic measurements both pre‐ and peroperatively and during up to 4 months of follow‐up, have confirmed the existence of two different brainstem regions concerned with lower urinary tract function. In the dorsolateral pontine tegmentum, a compact, dorsomediolaterally located M region, corresponding to Barrington's micturition centre, reacts specifically to electrical stimulation, causing prompt relaxation of the anal and urethral striated sphincters followed after about 2 s by detrusor contraction, as in normal micturition. Bilateral lesions in this M region lead to a 2–9 week period of urinary retention, during which detrusor activity is depressed and the bladder capacity increases. Stimulation in a larger, more diffuse, more laterally located L region elicits sphincter activity: contraction of the striated urethral sphincter together with an increase in the anal‐sphincter EMG, or relaxation of the striated urethral sphincter together with either a decrease or an increase in the anal‐sphincter EMG. Provided lethal respiratory complications can be avoided, bilateral lesions in this L region lead after a few days to a state, lasting up to 2 months, in which there is urinary incontinence accompanied by a decrease in the bladder capacity and detrusor overactivity. Neither type of lesion leads to true detrusor‐urethra dyssynergia. However, because the amplitude of anal‐sphincter EMG sometimes increases when the striated urethral sphincter relaxes, observations of the anal‐sphincter EMG can misleadingly suggest dyssynergia. Brainstem mapping of the results of stimulation suggests a motor pathway running from the M to the L region and another descending caudally from the L region. The observations suggest that the M region forms a true micturition centre, facilitating the detrusor voiding contraction and also (via the presumptive connection with the L region) ensuring synergic sphincter relaxation. The L region appears not only to relay this voiding sphincter relaxation, but to be responsible for control of the pelvic floor and its sphincters in general, and for helping to maintain urinary continence.
Urodynamic findings in the lower urinary tract: II. Latent stress incontinence in women scheduled for hysterectomy?
Authors: Van Venrooij Ger E. P. M. , Vervest Harry A. M. , Boon Tom A.
Published: March 2007

Urodynamic findings in 48 patients scheduled for hysterectomy and without any component of motor urge or stress incontinence were compared to those of asymptomatic women and females with objective stress incontinence. The results revealed no significant difference between the prehysterectomy group and the continent control group in terms of percentage of patients voiding by abdominal strain, detrusor contractility, urethral resistance. maximal urethral closure pressure, and relative urethral leakage pressure.

Only a marginal but not significant difference in detrusor contractility and urethral resistance was found. Those parameters were lower than those of the continent control group but higher than those of the stress‐incontinent group. Thus, with the urodynamic findings of the prehysterectomy group not differing significantly from the normal control group, it is recommended that preoperative urodynamic evaluation be reserved for women in whom, apart from the hysterectomy, surgery is planned for bladder neck repositioning. If there are no findings on routine history and physical exam of the patient about to undergo hysterectomy suggestive of urodynamic pathology, further assessment is not very fruitful.