bluuebunny/crossref_metadata_2025 huggingface dataset:
Neurourologic correlation in multiple sclerosis
Authors: Hassouna Magdy , Lebel Michel , Elhilali Mostafa
Published: March 2007

Vesicourethral dysfunction is a common finding in patients with multiple sclerosis (MS). In a retrospective study of 70 patients with MS we correlated urologic, neurologic, and urodynamic data. We found that 67% of patients complained of voiding dysfunction: irritative bladder symptoms in 37.2%, obstructive bladder symptoms in 23.2%, and combination of both in 39.5%. Signs of bilateral pyramidal tract dysfunction were found in 58.5% of patients. Urodynamic studies revealed the presence of unstable (hyperreflexic) bladder in 70.2% and hypotonic bladder in 18.2%. There is a high statistical correlation (P = .0001) between the presence of signs of bilateral pyramidal tract dysfunction and bladder unstability. We suggest that in MS patients, a particular emphasis should be placed on pyramidal signs. A urodynamic study is very helpful, particularly in those showing bilateral signs of pyramidal tract dysfunction.
Basic physiological studies of the effects of autonomic drugs on the pacemaker of renal pelvic peristalsis
Authors: Morita Takashi , Suzuki Takashi , Kondo Shun , Saeki Hideaki , Tsuchida Seigi
Published: March 2007

An electromyographic study of the effects of noradrenaline, isoproterenol, and acetylcholine on the calyceopelviureteral system was performed in isolated canine pyeloureteral preparations with continuous infusion of oxygenated Krebs‐Ringer solution into the renal pelvis to provide a condition of constant urine volume. The calyceal pacemaker was slightly stimulated by noradrenaline and acetylcholine and was also quickened in pace by isoproterenol. Noradrenaline caused a marked elevation of renal pelvic pressure and enhancement of propagation of peristalsis generated at the pacemaker region with an increase in frequency of ureteral peristalsis. In contrast, isoproterenol lowered the renal pelvic pressure to an extent of pressure wave disappearance and concomitant blockade of peristaltic movement propagation to the ureter, with consequent suppression of ureteral peristalsis. Acetylcholine slightly reduced the renal pelvic pressure but at the same time exerted a marked effect on the ureter, causing a transient increase in frequency of ureteral peristalsis.
Electrical sphincter stimulation in the treatment of detrusor hyperreflexia of paraplegics
Authors: Vereecken R. L. , Das J. , Grisar P.
Published: March 2007

Strong anal stimulation at the onset of the vesical pressure increase during an uninhibited bladder contraction prevented further bladder pressure increase and urine loss in 11 out of 15 paraplegics; 5 Hz, 10‐Hz and 20—Hz stimuli were equally effective. This effect is probably a spinal reflex. In the acute experiments, stimulation of the peroneal or anterior tibial nerve was without effect on bladder pressure.
The effect of a fine urethral pressure‐measuring catheter on urinary flow in females
Authors: Gleason Donald M. , Bottaccini Manfred R.
Published: March 2007

Urodynamic evaluations of 221 female patients and 21 normal female subjects were performed to study the effects of a small ureteral catheter in the urethra on various voiding parameters. We found that the catheter induced a significant diminution of flow rate, interruption of flow, and stretching and flattening of the flow curves with respect to time. The most marked changes occurred in normal subjects and in patients with stress incontinence. The diminution of flow rate induced by the catheter was not strongly related to disease and varied so greatly within each statistical grouping that it was not possible to separate clearly the effects according to disease. Since the effects of the catheter were most marked on the normal population, catheter‐induced reduction of flow rate could not be used as an index of urinary outflow obstruction.
Intrinsic neuromuscular defects in the neurogenic bladder. II. Long‐term innervation of the unilaterally decentralized feline bladder base by regenerated cholinergic, increased adrenergic, and emergent probable “peptidergic” nerves
Authors: Atta Mohamed A. , Franck Joel I. , Elbadawi Ahmad
Published: March 2007

The ultrastructure of muscular innervation of the feline bladder base was studied eight and ten weeks following its decentralization by unilateral sacral ventral rhizotomy. In all samples, there was widespread regeneration of cholinergic axons that displayed initial transsynaptic degeneration a few weeks after the operation, with re‐formation of cholinergic neuroeffector junctions. This was associated with reactive sprouting of adrenergic axons leading to adrenergic hyperinnervation, as well as the emergence of a population of cholinergic and adrenergic axons containing strikingly abundant polymorphous large dense‐core vesicles that resembled those naturally present in paraganglionic cells, paraneurons, and neurosecretory cells. This increased content of large dense‐core vesicles imparts a probable “peptidergic” character to some regenerating and many reactively sprouting adrenergic axons. Our findings suggest that the long‐term dysfunction of the parasympathetic‐decentralized bladder base is determined by the interplay of reestablished cholinergic, exaggerated adrenergic, and emergent probable “peptidergic” axonal influence and neuroeffector transmission.
Female urinary incontinence: The incidence, identification, and characteristics of detrusor instabiiity
Authors: Webster George D. , Sihelnik Stephen A. , Stone Anthony R.
Published: March 2007

One hundred thirty‐three women with urinary incontinence, including 51 patients who had undergone unsuccessful surgical treatment, were evaluated urodynamically. A high incidence (55%) of bladder instability was noted, and several patterns of instability were recognized. In 52% of the cases, provocation by erect fast fill and other provocative maneuvers were necessary to unmask the abnormal detrusor activity, and it was also noted that the patient's history did not accurately predict instability. A high incidence (33%) of seemingly inapproprate sphincter electrical silence occurred in those with an unstable bladder and appeared to be the precipitating event of the bladder contraction.
Intrinsic neuromuscular defects in the neurogenic bladder. III. Transjunctional, short‐ and long‐term ultrastructural changes in muscle cells of the decentralized feline bladder base following unilateral sacral ventral rhizotomy
Authors: Elbadawi Ahmad , Atta Mohamed A.
Published: March 2007

We have shown previously that vesicourethral decentralization by unilateral sacral ventral rhizotomy in the cat results in sequential degenerative and regenerative ultrastructural changes in intrinsic nerves of the bladder base. The present study in the same model provides evidence that these neural changes are associated with both degenerative and regenerative ultrastructural changes in smooth muscle cells of the feline base, representing the first example of transjunctional postdecentralization change in an effector tissue to be documented in a mammalian autonomically innervated smooth muscle system. The nature of the observed changes in the sarcoplasm, sarcoplasmic organelles, sarcolemma, and cell‐to‐cell relationships will be discusssed, and their physiologic significance as well as implications in the phenomenon of neurogenic muscular supersensitivity will be presented.
Objective assessment of urinary incontinence after successful implantation of the ams artificial urethral sphincter
Authors: Holm‐Bentzen Merete , Klarskov Peter , Opsomer Reinier , Maegaard Else Marie , Hald Tage
Published: March 2007

We selected 34 patients who had been fitted with the AMS artificial sphincter (models 742, 791, 792) in 1978–1982, who claimed to have a satisfactory result and compared their subjective feeling of continence to the objectively measured urine loss by a 1‐hour padweighing test. Furthermore, we related the measured urine loss to the position and size of the cuff and the balloon pressure; 19 patients claimed to be completely dry, ten patients experienced varying degrees of incontinence with physical activity, and five patients did wear some kind of protection, but all patients were satisfied with the operation. The results of the pad‐weighing test showed that 22 patients were completely dry and 12 patients had some measurable urine loss. Patients with an artificial sphincter at the bladder neck had better continence than patients with the sphincter at the bulbous urethra, possibly because of a better transmission of pressure to the cuff from the abdominal cavity. The level of the closure pressure in the balloon in patients with sphincters at the bladder neck was not significantly related to the amount of urine loss. We conclude that patients might be subjectively satisfied with an artificial sphincter operation despite some objectively measured urine loss and that the subjective feeling of continence correlates fairly well with the objective pad‐weighing test. When regarding postimplant continence in isolation the bladder neck position of the prosthesis is superior to the bulbous urethra position.
Prosthetic urinary bladder implantation to facilitate bladder regeneration
Authors: Dørflinger Torben , Frimodt‐Møller Poul C. , England Douglas M. , Madsen Paul O. , Bruskewitz Reginald
Published: March 2007

A temporary artificial bladder was implanted in 15 female dogs undergoing total or subtotal cystectomy. One or two months after implantation, the prosthesis was removed. In three dogs sacrificed 6 months after prosthesis implantation, a new urinary reservoir was identified. Two dogs failed to develop a urinary reservoir, and both ureters anastomosed directly to the top of a dilated urethra. Seven dogs died from complications (infection, urine leakage, etc). Three additional dogs are alive and well 2.5 months after implantation, and in these animals a new urinary reservoir has been demonstrated by cystography. Histologic examination of the new urinary reservoir revealed a thin lining of transitional cell‐like epithelium and an underlying attenuated muscle layer. The ability of the canine species to generate a functioning urinary reservoir after total or subtotal cystectomy may hold promise for eventual clinical application in humans.
Effect of dinitrophenol on bladder metabolism and contraction
Authors: Levin Robert M. , van Arsdalen Keith , Thomas Theresa , Wein Alan J.
Published: March 2007

Urinary bladder function is dependent on the utilization of intracellular metabolic energy. Although preformed ATP is generally regarded to be the major source of metabolic energy for smooth muscle contraction, recent evidence suggests that other sources of metabolic energy may be involved in bladder function. In order to study the relationship between bladder contraction and intracellular ATP, we characterized the effect of 2,4 dinitrophenol (DNP) on rabbit urinary bladder adenine nucleotide metabolsim, intracellular ATP concentration, and isolated bladder strip contraction.

DNP specifically inhibits mitochondrial formation of ATP by “uncoupling” mitochondrial oxidation from the phosphorylation of adenine nucleotides. The results can be summarized as follows: (1) DNP produced a dose‐dependent inhibition of ATP synthesis. (2) DNP (250 μM) produced a similar gradual decrease (with respect to time) in both contractile response to field stimulation and intracellular ATP concentration. (3) DNP (30‐2,000 μM) produced a similar graded dose‐dependent decrease in both contractile response to field stimulation and intracellular concentration of ATP. The effect of DNP on bethanechol stimulation of bladder strip contraction was similar to its effect on field stimulation.

The inhibitory effect of DNP on the contractile response to both electrical stimulation and bethanechol appears to be directly related to the progressive decline in the contraction of intercellular adenine nucleotides and the decline of adenine nucleotide synthesis.
Effect of alpha‐adrenergic blockade and anticholinergic agents on the decentralized primate bladder
Authors: McGuire Edward J. , Savastano Joan A.
Published: March 2007

The effect of anticholinergic and alpha‐adrenergic blocking agents on the primate bladder decentralized at the sacral level was studied. Both agents diminish the intravesical pressure response to filling and slightly increase capacity. Each appears to exert an independent effect.
Bladder and upper urinary tract overdistension after silent lnfravesical obstruction
Authors: Bratt Claes‐Göran , Fall Magnus , Blaivas Jerry G.
Published: March 2007

Three young men with a combined poorly contracting upper and lower urinary tract system are presented. Symptoms were few, progression was slow, and the untreated syndrome ended in uremia.
Urinary pH and ureteral dynamics
Authors: Salinas Jesús M.
Published: March 2007

An in vivo study was performed to examine urinary pH influence on ureteral dynamics. At alkaline pH there is a positive inotropic effect, while at acid pH there is a negative inotropic effect. The influence of urinary pH on ureteral dynamics could be due to a direct muscular action.
Rectal electrostimulation of erection in macaca fascicularis primates
Authors: Levin Robert M. , Clayton Russell , Strong George , Brenman Henry , Wein Alan J.
Published: March 2007

Noninvasive transrectal electronic stimulation using a Biosonics MEGS (registered trademark and devices by Biosonics, Inc.; patent pending) unit was employed to produce erection in five Macaca fascicularis primates. Using an electrode‐bearing glove (Biosonics, patent pending) a modulated pulse stimulus of 12 and 15 V was applied to five intra‐rectal loci overlying the prostate. The locus that produced the most positive response was then stimulated at six intensities between 7.5 and 15 V. Erectile response was quantitated with a new device that measures penile rigidity (Biosonics, patent pending). Of the five loci tested (midline central, midline base, midline apex, right and left border), the right border of the prostate produced the most consistent and strongest erectile response. Increasing the stimulus intensity between 7.5 and 15 V demonstrated that a minimum voltage of 10.5 V was necessary for erection. There was a rapid progressive increase in rigidity, which became maximum at 15 V. These results demonstrate that the use of the Biosonics MEGS device and rigidometer provides a reliable method of producing and quantitating erection in primates.
A short‐time‐delay urinary flowmeter
Authors: Ask Per , Engberg Anders , Öberg P. Åke , Spångberg Anders
Published: March 2007

A urinary flowmeter has been designed, using a quickly rotating disc and a balance principle. The flowmeter has a fast and accurate response to changing flows. The time delay of the flowmeter is less than about 0.25 s. The improved accuracy in recording urinary flow using the presented flowmeter should make it possible to extract more information from the detrusor pressure and urinary flow relations, relevant for assessing lower urinary tract function.
A model for both the passive and active properties of urinary bladder tissue related to bladder function
Authors: van Duyl W. A.
Published: March 2007

Herein we propose a new mechanical model for interpretation of volume‐pressure relationships of the bladder in both the collection and in the evacuation phase. Contractile tissue is ascribed plastic properties. The static volume‐pressure relation is related to a plasto/contractile‐elastic tissue component. In contrast to other models, the elastic element in series with the contractile element corresponds to tissue elasticity, which also determines the static volume–pressure relation. Viscoelasticity is more relevant in the evacuation phase than in the collection phase.
Neural control of the urinary bladder: Possible relationship between peptidergic inhibitory mechanisms and detrusor instability
Authors: De Groat William C. , Kawatani Masahito
Published: March 2007

This paper provides a brief review of the organization of the neural mechanisms controlling micturition. The role of neuropeptides in peripheral afferent and efferent pathways and in the central reflex mechanisms is discussed. A major focus of the paper is on the inhibitory functions of spinal and supraspinal enkephalinergic systems in the control of bladder capacity and bladder stability. Pharmacological studies indicate that drug‐induced changes in enkephalinergic mechanisms can elicit marked alterations in bladder function. Similar changes in transmitter mechanisms may occur following neural injury or disease and therefore be involved in the development of neurogenic disorders of the lower urinary tract.
Spontaneous contractions in urinary bladder smooth muscle: Preliminary results
Authors: van Duyl W. A.
Published: March 2007

Spontaneous rhythmic contraction patterns in bladder tissue have been analysed in time and space by using a new experimental technique. These rhythmic contractions appear to be composed of frequency components which are multiples of a basic frequency. Distributions of the activity are also more or less synchronized in space. The physiological significance of the spontaneous activity is related to the potentiality of small regional contractions to become an epicentre for the development of large contractions leading to detrusor instability. The level of spontaneous activity is suggested as a parameter to define the state of the bladder along a bladder‐performance scale with the fully passive and fully activated states as extreme modes of performance.
Stress inconthence and detrusor instability/urge incontinence
Authors: McGuire E. J. , Savastano J. A.
Published: March 2007

The overall incidence of detrusor instability in 603 women with stress incontinence was 30%. One hundred seventy‐two women had detrusor instability and/or urge incontinence preoperatively. Twenty‐three additional women developed detrusor instability and/or urge incontinence only after operation. By eight weeks after operation 4% of the entire group or 14% of those who had detrusor instability or urge incontinence at any time pre‐or postoperatively still had the difficulty with incontinence. These findings indicate that a small number of women with both stress incontinence and detrusor instabilty and/or urge incontinence will still have symptomatic urinary loss as a result of persistent detrusor abnormalities at eight weeks after operation.
Electrical pelvic floor stimulation for the control of detrusor instability
Authors: Fall Magnus
Published: March 2007

Experimental and clinical investigations have shown that pelvic floor electrical stimulation activates the striated paraurethral musculature and evokes inhibitory segmental reflexes with abolition of bladder hyperactivity. In the early clinical series, the methods were designed for stress incontinence but urge symptoms have later turned out to be the main indication for electrostimulation. The current clinical results of electrostimulation in detrusor instability are good. Electrostimulation seems to be one of the best options for detrusor instability alone or in combination with stress incontinence.
Drug therapy for detrusor hyperactivity: Where are we?
Authors: Wein Alan J.
Published: March 2007

Drug therapy for detrusor hyperactivity can be directed either at decreasing bladder contractility or decreasing sensory input during filling. The agents available to accomplish these purposes are reviewed. Certain questions are raised regarding studies assessing the action of pharrnacologic agents on lower urinary tract storage failure.
The role of denervation in the treatment of detrusor instability
Authors: Torrens Michael J.
Published: March 2007

The bladder can function autonomously after complete denervation [Denny Brown and Robertson, 1933] and the activity of the spastic paraplegic bladder may be improved after extensive anterior rhizotomy [Munro, 1945]. Because of such observations denervation (better termed decentralisation) has been used sporadically over the last 40 years to control bladder overactivity. This denervation may be attempted at many levels:

Intramural, by hyperbaric vesical distension [Dunn et al, 1974].

Intramural, by vesical transection [Essenhigh and Yeates, 1973] or myotomy [Mahony and Laferte, 1972].

Paravesical—transabdominal [Worth and Turner‐Warwick, 1973], transvaginal [Ingelman‐Sundberg, 1959], or transvesical [Mundy and Stephenson, 1984].

Parasacral [Theirmann, 1952].

Transsacral extradural [Meirowsky and Scheibert, 1950; Torrens and Griffith, 1976; Rocks wold et al, 1973].

Lumbosacral intradural [Toczek et al, 1978].

From the analysis of results in a number of relatively small series [Torrens and Hald, 1979], certain general conclusions can be drawn and these are listed below.
Continuous recording of urethral activity in healthy female volunteers
Authors: Søresen S. , Kirkeby H. J. , Stødkilde‐Jørgensen H. , Djurhuus J. C.
Published: March 2007

The pressure variations at the maximal urethral closure pressure (MUCP) were continuously recorded in healthy female volunteers by means of a two‐point microtip transducer catheter for one hour. Before the investigation a normal voiding was assured objectively and bladder instability was excluded.

All women showed pressure variations both at the MUCP and more distally. The pressure variations, from 3 to 66 cm H2O, showed rhythmicity and three frequency ranges could be identified. Slow pressure waves with a frequency of one in eight to 19 minutes were observed. Relatively fast‐pressure waves were observed (one every one to four minutes) and relatively fast‐frequency pressure waves were observed (rate: one to eight per minute).

The pressure variations of the urethra seem to be an aspect of normal urethral physiology possibly contributing to continence and urinary tract infection prevention.
Inter‐ and intra‐departmental variations of the perineal pad weighing test
Authors: Christensen S. J. , Colstrup H. , Hertz J. B. , Lenstrup C. , Frimodt‐Møller C.
Published: March 2007

Twenty women with urinary incontinence performed three pad‐weighing tests each, two of these in the Department of Urology, the third in the Department of Obstetrics and Gynaecology. Comparison of the test results from the two departments showed significantly different median urine losses, ie, 9 g and 24 g (P < .05).

The results of the two tests carried out in the Department of Urology were not significantly different: the median urine losses were 24 g and 21 g (P > .1).

It is concluded that the pad‐weighing test is or limited value for interdepartmental comparison since different investigators may obtain significantly different results.
A new method for correction of urinary stress incontinence in women
Authors: Fianu Stefan , Larsson Bertil , Ölund Anders , Jonasson Aino
Published: March 2007

Twenty‐two patients with urinary stress incontinence confirmed by urodynamic recordings were operated on by using absorbable Dexon sutures combined with a two‐component fibrin sealant, which induced fibrosis, for the fixation of the urethrovesical junction to the retropubic periostium. The postoperative observation period ranged from 12 to 30 months, and so far no relapses or complications have been observed.
Micturitional Reflexes in Chronic Spinalized Cats: The Underactive Detrusor and Detrusor‐Sphincter Dyssynergia
Authors: Galeano César , Jubelin Bruno , Germain Louis , Guenette Lilianne
Published: March 2007

We studied micturitional reflexes in 46 unanesthetized adult male cats spinalized at C5‐C6 17 to 125 days previously and in eight intact central nervous system chloralosed cats that were used as controls. Urethral pressure profiles, cystosphincterograms with the urethrovesical junction opened and closed, and mechanograms of detrusor and circular and longitudinal urethral muscles were performed. The effect of vesical, urethral, pelvic, or pudendal anesthesia and vesical and urethral mechanical stimulation were studied.

Our results suggest that spinalization produces two major types of neurourologic disorders: (1) weakness of detrusor contractor reflexes (vesicovesical and urethrovesical contraction reflexes) and (2) exaggeration of urethral contractor reflexes (urethrourethral contraction reflex, guarding reflex). Secondarily the weakness of detrusor contractions diminishes the efficiency of the urethral reflex relaxation needed for voiding (vesicourethral relaxation reflex).

Because of these abnormalities, two main syndromes appear: (1) underactive detrusor function and (2) detrusor sphincter dyssynergia. Isolated peripheral manipulations of the bladder or urethra do not improve micturition: (1) increase in detrusor contraction strength induces detrusor sphincter dyssynergia, and (2) relaxation of the external sphincter facilitates voiding, but urinary retention persists.

It is proposed that spinalization produces a central micturitional dysreflexia responsible for the peripheral dysfunction, and treatment must be oriented toward the central dysreflexia rather than the peripheral dysfunction.
Intrinsic neuromuscular defects in the neurogenic bladder: V. Autonomic re‐innervation of the male feline rhabdosphincter following somatic denervation by bilateral sacral ventral rhizotomy
Authors: Elbadawi Ahmad , Atta Mohamed A.
Published: March 2007

We have shown previously that myofibers of the male feline rhabdosphincter are innervated by somatomotor end‐plates as well as nonspecialized surface junctions by autonomic cholinergic and adrenergic axons. Shortly after sacral ventral rhizotomy, the somatomotor cholinergic axons innervating the plates disappear, but the autonomic cholinergic and adrenergic surface junctions are preserved. In the present study, the eventual pattern of innervation of the somatically denervated rhabdosphincter is described. Four to ten weeks after denervation there was (1) progressively marked sprouting of nonmyelinated cholinergic and adrenergic axons, with an increasingly prominent probable copeptidergic component of both axon types; (2) preservation and possibly increase in the number of autonomic surface junctions; and (3) re‐innervation of the initially nerveless end‐plates by autonomic cholinergic and/or adrenergic axons, occasionally with cholinergic/adrenergic axoaxonal synapses. Based on these and our previous observations, it is concluded that any neural control that the denervated rhabdosphincter may eventually have is purely autonomic, and may in part be achieved via its original end‐plates. The significance of our findings with respect to the physiology and pharmacology of the rhabdosphincter (incontrast to other striated muscle) and its possible role in lower‐motor neurogenic voiding dysfunction are analyzed.
Effectiveness of propantheline bromide in the treatment of geriatric patients with detrusor instability
Authors: Zorzitto M. L. , Jewett M. A. S. , Fernie G. R. , Holliday P. J. , Bartlett S.
Published: March 2007

A placebo controlled, single‐blind drug trial was designed to assess the efficacy of propantheline bromide (PB) in the treatment of urinary incontinence in geriatric institutionalized subjects with an uninhibited neurogenic bladder. Patients were randomly assigned to start PB 15 mg per os (PO) four times a day (QID), or placebo. Drug therapy was continued for 4 days after which a 3‐day wash‐out period was allowed before crossing over. Incontinence was recorded using an electronic monitor. If incontinence continued, the protocol was repeated at a 30‐mg QID dose. Thirty‐four patients completed the 15‐mg protocol; no significant difference in continence was found between PB and placebo at this dose. Twenty‐four patients completed the 30‐mg dose, and a 17% improvement in continence was observed. This marginal clinical benefit was outweighed by the number of significant side effects. In conclusion, propantheline bromide was not a found to be a clinically useful agent for the managment of incontinence in this group of institutionalized, elderly patients.
Pathogenetic factors in vesicoureteral reflux
Authors: Jørgensen Troels Munch
Published: March 2007

The pathogenesis of vesicoureteral reflux and reflux nephropathy is multifactorial, but certain known interconnections between different factors have been established. There exists an age‐dependent anatomy and function of the ureterovesical junction, and this is of absolute importance for the presence of vesicoureteral reflux. Also, bladder urethral dysfunction with formation of high bladder pressures, urinary tract infections, and ureteric peristaltic properties seem to be of major importance for the development and maintenance of reflux. Vesicoureteral reflux combined with normal bladder‐urethral function induces no change in the dynamic function of the upper urinary tract. In cases of bladder‐urethral dysfunction that lead to high‐pressure reflux, dilatation of the upper urinary tract is produced with irreversible damage of the peristaltic rhythm, frequency, and propagation. Such changes are aggravated by simultaneous infection. Reflux nephropathy most often occurs in cases of pyelorenal backflow with infected urine but can be aggravated by bladder‐urethral dysfunction producing high pelvic pressures. Bacteria ascend from the bladder to the kidney, and maximal bladder pressures and the peristaltic conditions in the ureter have an impact on this. The maximal bladder pressure and the compiled pressure load transmitted without hindrance from the bladder to the kidney are presumably mandatory for the formation of nephropathy in cases of sterile reflux.
Beta‐adrenergic stimulation of cyclic AMP production in the rabbit urinary bladder
Authors: Levin Robert M. , Ruggieri Michael R. , Hypolite Joseph , Wein Alan J.
Published: March 2007

Although adenyl cyclase stimulation has been associated with beta‐receptor activation in the heart and some smooth muscle systems, it has been shown not to correlate with beta receptor activation in several other smooth muscle preparations. The present study investigates the relationship between cyclic AMP formation and beta‐adrenergic stimulation in the rabbit urinary bladder. The intracellular concentration of cyclic AMP was determined in fresh rabbit bladder and isolated strips incubated under a variety of conditions. The results can be summarized as follows: (1) there was no difference between the cyclic AMP concentration in the bladder base and the bladder body, (2) incubation with theophylline significantly increased the concentration of cyclic AMP in all bladder strips, (3) isoproterenol significantly increased cyclic AMP in the bladder dome but not in the base, and (4) propranolol specifically inhibited the cyclic AMP increase produced by isoproterenol.

Incubation with methoxamine, bethanechol, ATP, or diltiazem had no effect on the cyclic AMP concentration. The difference in the response to isoproterenol between bladder base and body correlates very well with both the distribution of beta receptors and the contractile response of these sections to isoproterenol. These studies demonstrate that the bladder body contains an isoproterenol‐sensitive adenyl cyclase system.
Stream flow rate and velocity at the end of micturition
Authors: Gleason Donald M. , Bottaccini Manfred R. , Seitzinger Marilyn
Published: March 2007

The most significant changes in voiding patterns in male subjects with prostatism occur toward the end of the stream rather than at the beginning or at peak flow. The flow curve shape that is heavily weighted toward endstream events flattens and can be expressed mathematically as the ratio of peak flow to time of voiding. The flow rate at the end of voiding deteriorates more in the obstructed patient than in the normal, so that terminal flow is a better discriminator of pathology than peak flow. The terminal velocity is also sensitive to minor changes in outflow resistance. Values of terminal flow rate in the obstructed male were scattered below 8 ml/s. Terminal velocity in obstructed males was usually less than 85 cm/s with an overlap zone between 85 and 100 cm/s. The studies were done on a total of 35 subjects, 12 normal men and 23 patients.
Urethral resistance—a misleading term
Authors: Schäfer Werner
Published: March 2007

The hydrodynamic concepts of micturition dynamics ignore the detrusor as an integral part of the energy balance of voiding and postulate that the key for grading and judging voiding function is the intraurethral fluid energy loss alone. Such concepts are summarized in the term “urethral resistance” one of the most frequently misused terms in urodynamics.
Office vs. urodynamic flows: Is there a difference?
Authors: Reid R. E. , Maliver L. , Laor E. , Tolia B. M. , Freed S. Z.
Published: March 2007

In order to evaluate the possible effect environment might have upon a patient's flow pattern, a study was conducted of 50 patients (23 males and 27 females), who first voided in the privacy of an office and for whom a repeat flow measurement was later obtained in the urodynamic setting. An analysis of covariance was used to compare maximum flow rates in both areas. Male patients voided with a significantly lower maximum flow rate in the urodynamic laboratory. A calculated correction factor was derived for men (1.62), which would bring the maximum flow in the urodynamic laboratory up to the flow measurements in the office. It appears that environment does play a significant role upon the voiding parameters of men under testing situations.
Spinal nerve root surgery for urinary bladder reinnervation
Authors: Vorstman Bert , Schlossberg Steven , Kass Leonard , Devine Charles J. , Horton Charles E.
Published: March 2007

This paper focuses briefly on the concept of urinary bladder reinnervation. Unilaterally decentralized bladders were reinnervated using a new experimental technique, mixed nerve root crossover surgery via a nerve graft. Electrophysiologic and cystometric data indicated axonal regeneration and bladder reinnervation after a mixed suprasacral nerve root (L7) to mixed sacral root (S1) anastomosis. Similar data were obtained from anastomosis with an interposition nerve graft. The crossover nerve root anastomosis also provided for redirection of axons. By employing a similar technique to bypass a damaged segment of spinal cord, urinary bladder reinnervation and restoration of central bladder control may be achievable in select spinal cord injury or spina bifida patients.
The effect of hexamethonium on the distension‐induced contractile activity of the rat bladder: Evidence for the existence of a spinal ‘short‐loop’ vesicovestioal reflex in rats
Authors: Maggi Carlo Alberto , Santicioli Paolo , Meli Alberto
Published: March 2007

Saline distension of the bladder in urethane‐anaesthetized rats elicited three types of phasic contractions: (a) a low amplitude (<4 mmHg) asynchronous contractile activity which is hexamethonium‐resistant; (b) an intermediate amplitude (8–16 mmHg) rhythmic contractile activity that was still present in spinal (C2‐C3) rats and was eliminated by hexamethonium; and (c) a high amplitude (>20 mmHg) rhythmic contractile activity that was eliminated by spinal cord transection or hexamethonium. All types of hexamethonium‐sensitive rhythmic contractile activity having an amplitude higher than 4–6 mmHg were prevented by destruction of the lumbosacral spinal cord. It is concluded that in adult rats two distinct types of vesicovesical reflex activity organized at spinal and supraspinal level, respectively, could be elicited by distension at a physiological‐like filling rate.
Subtrigonal phenol injection: Lack of effect in the treatment of detrusor hyperactivity
Authors: Nordling J. , Steven K. , Meyhoff H. H. , Hald Tage
Published: March 2007

Subtrigonal phenol injections were administered to 16 patients with detrusor hyperreflexia resistant to conventional treatment. Two patients experienced a temporary improvement lasting 2 months; in eight patients there was no effect; four developed urinary retention, which was treated by intermittent catheterization in three and by an indwelling catheter in one; symptoms deteriorated in one, and one patient developed a vesico‐vaginal fistula requiring urinary diversion after a second injection treatment. Subtrigonal phenol injection appears to be an ineffective treatment of severe detrusor hyperreflexia in this group of patients.
Continuous urethral pressure measurement in women with unstable detrusor
Authors: Sørensen S. , Nørgaard J. P. , Djurhuus J. C.
Published: March 2007

To study the role of the urethra in bladder instability, we performed continuous urethrocystometry in 16 patients with verified unstable detrusor and found two qualitatively different pressure oscillations in the urethra: (1) continuous rhythmic pressure waves, characterized by frequency and pressure amplitude and (2) sudden and consistent urethral pressure drops of 35 cm H2O occurring on average at mean time intervals of 3.5 seconds prior to the onset of the detrusor contraction. Simultaneous pelvic floor electromyographic (EMG) registration showed that the urethral pressure drop occurred either during decreased, unchanged, or increased pelvic floor activity. Restoration of the urethral pressure to its previous level was also unrelated to the pelvic floor EMG activity. Increased EMG activity at the onset of urethral pressure drops was not sufficient to suppress the urethral pressure drop, but could abolish the detrusor contraction.

These findings suggest that the unstable detrusor is of a complex pathophysiological origin and involves both storage and micturition as well as detrusor and urethral function.
Urethral instability: Diagnosis based on variations of the maximum urethral pressure in normal climacteric women
Authors: Versi Eboo , Cardozo Linda
Published: March 2007

The existence of urethral instability as a pathological entity is debated, and this discussion is hampered by the lack of rational guidelines for its diagnosis. The literature is not uniform, as different authors have chosen arbitrary values of urethral pressure fluctuations for characterizing the condition. To attempt to clarify the situation, 85 healthy climacteric women have been examined. They had normal flow rates and were found to be normal on videocystourethrography. Their urethral pressure profile traces (microtransducer technique) were examined for fluctuations in the maximum urethral pressure (MUP). Given that the MUP decreases with age and that in this data set fluctuation in the MUP (Δ MUP) is dependent upon the MUP, the ratio of Δ MUP divided by MUP has been examined. Statistical analysis of the derived distribution suggests that fluctuations of MUP that are greater than one‐third of the resting MUP fall outside the 99% confidence limit and so should be regarded as abnormal. If, when this occurs, the patient is regarded as having urethral instability, then the incidence of urethral instability in our normal climacteric women is 14 ± 4%. We suggest that this method of analysis should be employed to arrive at a rational statistical threshold for the diagnosis of urethral instability. Only then will it be possible to explore the clinical implications of this condition.
Significance of electromyographic changes in the external urinary sphincter
Authors: Davis L. , Khan Z.
Published: March 2007

The diagnostic role of electromyography of external urinary sphincter is well established in neurologically compromised patients. A brief historical review and methodology is described. For those who are not familiar with this modality, the character and clinical significance of abnormal potentials has been described. The coordination of bladder and sphincter mechanism and its abnormality is explained. Our experience with various neurological disorders is listed. It includes myelodysplasia, transverse myelitis, multiple sclerosis, herpes zoster, Parkinson disease, and some cerebral disorders. Any apparent statistical difference is due to the highly selected nature of the cases.
Do “Conscious” and “Reflex” micturition have a separate sensory input? Implications for clinical urodynamics
Authors: Maggi Carlo Alberto , Meli Alberto
Published: March 2007

Anatomical, neurophysiological, pharmacological, and clinical observations indicate the existence of multiple sensory pathways relaying information from the lower urinary tract to the central nervous system. The sensory input that activates “voluntary” (in humans) or “conscious” (in animals) micturition may be, at least in part, separate from that which activates “reflex” micturition. Recent observations obtained with capsaicin, a sensory neuron blocking agent, indicate that multiple sensory pathways may activate micturition and that these systems operate at a different threshold, eg, certain sensory systems are particularly sensitive to variations in filling rate. These advances in the physiopharmacology of the afferent branch of micturition suggest that the use of very different filling rates from one laboratory to another may be a major cause of heterogenicity of results in clinical urodynamics. Moreover, a complete and meaningful evaluation of the sensory function regulating micturition should include evaluation of the bladder response to both “low” (physiological) and “high” (provocative) filling rates.
Biochemical characterization of the rabbit urinary bladder base and body
Authors: Levin Robert M. , Haugaard Niels , Ruggieri Michael R. , Wein Alan J.
Published: March 2007

Functionally, the urinary bladder can be divided into two sections: the bladder body and bladder base. Pharmacologically, the bladder body responds to a greater extent than the bladder base to cholinergic agonists (contraction), beta‐adrenergic agonists (relaxation), and purinergic agonists (contraction), whereas the bladder base responds to a greater extent than the bladder body to alpha‐adrenergic agonists (contraction). The autonomic receptor density parallels the pharmacological response; that is, the bladder body contains higher densities of muscarinic cholinergic and beta‐adrenergic receptors than the bladder base, whereas the base contains a higher density of alpha‐adrenergic receptors. The purpose of this present study was to compare a variety of biochemical factors between the rabbit urinary bladder base and body.

Sections of rabbit bladder body and base were rapidly dissected and frozen in liquid nitrogen. Tissue concentrations of DNA, RNA, hydroxyproline, lipids, glycogen, cyclic AMP, CP, ATP, ADP, and AMP were determined. The results demonstrated that the bladder base contained a 34% greater concentration of DNA, whereas the bladder body contained a 127% greater concentration of RNA. The bladder base contained 39.6% and 36% greater concentrations of hydroxyproline and glycogen, respectively. The concentration of lipids, cyclic AMP, and adenine nucleotides was equal in the two areas. The observed differences between bladder body and base may be related to the significantly greater work (energy utilized to actively expel urine) performed by the bladder body.
Urethral pressure variations in women with neurourological symptoms: I. Relationship to urethral and pelvic floor striated muscle
Authors: Kulseng‐Hanssen S. , Stien R. , Fønstelien E.
Published: March 2007

Simultaneous urethrocystometry and electromyography (EMG) of the urethral and pelvic floor striated muscle were performed in 42 gynecological patients with neurourological symptoms. Their maximum urethral pressure varied between 20 and 124 cm H2O. A correlation analysis was performed between the maximum urethral pressure and the integrated EMG of the urethral striated muscle and the pelvic floor striated muscle. The analyses were performed on results obtained in 1‐min periods during bladder filling before first desire to void was reported, when first desire to void was reported, and when a strong desire to void was reported.

In 21 patients no correlation was found between the urethral and pelvic floor striated muscle activity and the maximum urethral pressure at any stage of bladder filling. In the other 21 patients a correlation was found in at least 1 of the 3 stages. At all stages of bladder filling a correlation was found significantly more often between the maximum urethral pressure and the striated urethral muscle EMG than between the maximum urethral pressure and the striated pelvic floor muscle EMG. Thus, activity of the urethral striated muscle cannot be reliably studied in an EMG recording from the pelvic floor striated muscle. In the same patient, periods with a correlation could be succeeded by periods without a correlation. Thus, the urethral pressure variations may in the same patient sometimes be caused mainly by the urethral striated muscle and sometimes mainly by the urethral smooth muscle.
Coexistence of prostate cancer and dysfunctional bladder neck obstruction
Authors: McCulloch Allen W. , Woodside Jeffrey R. , Lackner L. Henry , Key Charles R.
Published: March 2007

The etiology of dysfunctional bladder neck obstruction remains elusive. Obstruction has been attributed to muscular hypertrophy, fibrosis, scarring, and neurologic dysfunction of the bladder neck opening mechanism. We describe two patients with urodynamic findings of dysfunctional bladder neck obstruction who proved to have stage A1 prostate adenocarcinoma on transurethral prostate biopsies obtained at the time of surgery. We recommend that the transurethral surgical treatment of men over the age of 40 years with dysfunctional bladder neck obstruction include a biopsy for histological examination.
Effects of atropine on bladder capacity and instability in rats with bladder hypertrophy
Authors: Malmgren A. , Sjögren C. , Andersson K.‐E. , Andersson P. O.
Published: March 2007

Cystometries were performed in conscious normal rats and in rats with infravesical outflow obstruction in the absence and presence of atropine. The effects were evaluated with regard to bladder capacity, bladder compliance, threshold pressure, micturition volume, residual volume, micturition pressure, and spontaneous contractile activity. In control rats following the administration of atropine, bladder capacity increased in six of seven experiments, but this effect was not statistically significant. No other cystometrical variable was changed in control rats by muscarinic receptor blockade. Bladder capacity in obstructed rats was clearly larger than in control rats (mean 4.4 ± 1.1 and 0.20 ± 0.02 ml, respectively). In obstructed rats atropine significantly increased bladder capacity from 4.4 ± 1.1 to 7.9 ± 1.2 ml. Further, the obstructed rats were characterized by an increase in threshold pressure and residual volume, and a decrease in micturition volume after atropine administration. Micturition pressure in obstructed rats was higher than in control rats (131 ± 29 and 33 ± 6 cm H2O, respectively). In obstructed rats, administration of atropine decreased micturition pressure, indicating a cholinergic component participating in bladder contraction. A clear‐cut bladder instability was observed in all obstructed rats, and part of the contractions remained after atropine, suggesting a myogenic or a noncholinergic nervous origin.