bluuebunny/crossref_metadata_2025 huggingface dataset:
Effect of partial urinary outlet obstruction in the rabbit on the incorporation of adenine into adenine nucleotides in bladder smooth muscle
Authors: Haugaard Niels , McKenna Beth A. W. , Wein Alan J. , Levin Robert M.
Published: March 2007

Bladder outlet obstruction induces marked morphological, functional, and metabolic changes within the urinary bladder. Recent studies indicate that there is a close correlation between the contractile dysfunction induced by partial outlet obstruction and a marked decrease in mitochondrial oxidative activity of the hypertrophied bladder tissue. The current study investigates the effect of partial outlet obstruction on adenine metabolism within the bladder tissue.

After transport into the cell, adenine becomes available as a substrate for adenine phosphoribosyl transferase (APRT), the enzyme that catalyses the non‐mitochondrial conversion of adenine into AMP. Subsequently, AMP is phosphorylated to ADP, the phosphate acceptor in mitochondrial oxidative phosphorylation.

The results of these studies demonstrate that partial outlet obstruction induces a significant increase in 14C‐adenine uptake into the urinary bladder smooth muscle which in turn provides substrate for APRT and results in an increase in 14C‐AMP synthesis. In contrast, the rate of incorporation of adenine into ATP + ADP was similar for both control and obstructed tissue. The activity of APRT was not significantly different in control and obstructed tissue.
Sacral anterior root stimulation: Prerequisites and indications
Authors: Madersbacher H. , Fischer J.
Published: March 2007

An intact sacral reflex arc, or at least an intact second motor‐neuron and a detrusor being able to contract, are the two prerequisites for implanting an anterior sacral root stimulator. Transrectal electrostimulation or direct needle stimulation of the sacral roots may reveal if patients despite absent or only weak detrusor contractions on routine investigation are suitable. Patients with a complete midthoracic paraplegia are the ideal candidates, but tetraplegics also benefit. Patients with incomplete lesions and preserved pain sensations are suitable provided that they can undergo posterior sacral root rhizotomy. Non‐traumatic spinal cord lesions follow the same rules, provided that the type of lesion does not allow recovery and is not progressive. Myelomeningocele patients may be suitable provided that the pathoanatomy of the sacral roots permits the operation (may be possible only in thoracolumbar myelomeningocele). Vesico‐uretero‐renal reflux is no contraindication; it may even be a strong indication, if a low compliance bladder or high detrusor contractions are the main reasons for it. In most patients the procedure should or must be combined with posterior sacral root rhizotomy in order to normalize a low compliance, to abolish spontaneous reflex contractions, and to achieve continence. The benefit of following these rules is reflected in our own series of 30 patients. In all of them the operation has improved considerably the quality of life and no patient so far has regretted the operation.
Adjuvant drug therapy: A review of 30 cases of sacral anterior root stimulator
Authors: Isambert J. L. , Egon G. , Colombel P.
Published: March 2007

Implantation of a sacral anterior root stimulator in spinal cord injured patients must achieve two main goals to maintain a vesicosphincteral balance: complete bladder voiding and correct continence.

During the postoperative period, difficulties may arise or persist with either an incontinence due to an insufficient deafferentation with bladder hyperreflexia or an incomplete voiding because of an insufficient contraction of detrusor and/or too high urethral resistances (vesicosphincteral dyssynergia).

A third of our patients required specific therapies after implantation to promote interstimulation continence and complete bladder voiding.

Regarding continence, adjuvant therapies are effective for bladder hyperreflexia in connection with a too‐partial deafferentation. On the other hand, these therapies have little effect on low bladder compliance.

In regard to bladder voiding, nonsurgical treatments are equally effective. These treatments (parasphincteral infiltrations, alpha‐blockers) must not be permanent, but allow a reharmonizing between expulsive strengths and urethral resistances.

Eighty percent of our patients who required adjuvant therapies have been improved significantly. This confirms the efficiency of adjuvant therapy and speaks for patience.
L N S C3: A Proposed classification system for female urethral diverticula
Authors: Leach Gary E. , Sirls Larry T. , Ganabathi Kumaresan , Zimmern Philippe E.
Published: March 2007

No descriptive criteria for the preoperative classification of female urethral diverticula have been proposed. Consequently, alternative therapies and different treatment series are not easily compared. Since 1982 the authors have evaluated 61 women with urethral diverticula and have identified those preoperative factors critical to an organized surgical approach to urethral diverticula. From this experience, a simple, comprehensive classification system for female urethral diverticula is proposed. The classification system is called L/N/S/C3. Each letter of the system represents a different characteristic of urethral diverticula. L = Location, the site of the diverticulum, i.e., distal, mid, or proximal urethra, with or without extension beneath the bladder neck. N = Number, whether single or multiple diverticula are present. S = Size, expressed in centimeters (cm). C3 = Configuration, Communication, and Continence Configuration (C1) describes whether the diverticulum is single, multiloculated, or saddle shaped. Communication (C2) indicates the site of communication with the urethral lumen, i.e., distal, mid, or proximal urethra. Continence (C3) is the presence of genuine stress urinary incontinence.

Adhering to this format provides the surgeon a systematic means of approaching a urethral diverticulum and thus may minimize postoperative complications. Finally, the authors encourage other surgeons reporting series of urethral diverticula to adopt this system so that standard terminology may allow accurate comparison of surgical results.
Magnetic stimulation of the sacral roots
Authors: Brodak Philip P. , Bidair Mohamed , Joseph Angela , Szollar Susan , Juma Saad
Published: March 2007

Magnetic stimulation using an external surface coil induces an electrodynamic field that penetrates various tissues and stimulates peripheral nerves in a similar fashion to conventional electrical stimulation. An 83 mm magnetic surface coil was used to stimulate 11 spinal cord injury (SCI) patients, during which time detrusor activity and evoked potentials of the striated urinary sphincter motor pathways were evaluated. AH patients had urodynamic studies and conventional sacral evoked potentials prior to magnetic stimulation. The mean bladder capacity was 337 ml (range 109–590), mean leak point pressure was 50 cm H2O (range 10–80), and mean sacral reflex (afferent‐efferent) latency was 37.9 ms (range 25.1–49.3). Eight patients had detrusor‐sphincter dyssynergia. Magnetic stimulation over the sacral spine at different bladder volumes was performed. Detrusor and striated sphincter responses were recorded during stimulation. In all patients the technique was easy and the results were reproducible. The mean sacral motor pathway (efferent) latency was 27.9 ms (range 18.7–39.6). Using maximal stimulation, no detrusor response was recorded at bladder volumes <200 ml. However, a detrusor response was recorded in 7 patients (>10 cm H2O in 2, <10 cm H2O in 5) when the bladder volume was >200 ml. No complications were seen. Sacral evoked potential measurements assess the function and integrity of the sacral arc but it does not distinguish between afferent and efferent pathways. Magnetic stimulation is a safe and effective method to assess the integrity and function of the detrusor and striated sphincter motor (efferent) pathways. When combined with sacral evoked potential studies, the sensory (afferent) pathways can be evaluated indirectly. Independent assessment of the motor (efferent) and sensory (afferent) pathways of the sacral arc has significant implications in the understanding of the pathophysiology of the different types of neuropathic voiding dysfunction. The magnitude of the detrusor contraction induced by magnetic stimulation was too small to allow any conclusions. However, it appears that the detrusor threshold for stimulation increases with increased bladder volumes.
Effect of partial urethral obstruction on force development of the guinea pig bladder
Authors: Van Koeveringe Gommert A. , Mostwin Jacek L. , Mastrigt Ron Van , Van Koeveringe Bram J.
Published: March 2007

We created gradual partial urethral obstruction in 20 guinea pigs using silver jeweler's jump rings. After 4 or 8 weeks obstruction all animals underwent cystometry and were assigned to one of five urodynamic categories: normal, high pressure voiding, unstable, low compliance, or decompensated. After sacrifice, the contractile responses of bladder strips to electrical field stimulation of intramural nerves, direct electrical muscle stimulation, 0.1 mM carbachol, and high K + solution were sampled by computer for phase plot analysis. Following 8 weeks obstruction, the value of the phase plot parameter Fiso, indicative of the number of contractile muscle units, was reduced to 60% of the control response to nerve stimulation (P < 0.05) and to 77% of the control response to carbachol stimulation (P < 0.05). Parameter C, the slope of the phase plot (indicative of unit recruitment during force development), was unchanged for all forms of stimulation. Although in the latter case not statistically significant, obstruction affected responses to nerve and muscle stimulation similarly suggesting that muscle change may possibly be a common denominator of dysfunction. In view of the reduction in Fiso and the increase in bladder weight, instability may represent a more advanced form of dysfunction due to obstruction than high pressure voiding.
Effect of partial outlet obstruction on contractility: Comparison between severe and mild obstruction
Authors: Saito Masahiko , Wein Alan J. , Levin Robert M.
Published: March 2007

Detrusor dysfunction is one of the most common problems in patients with outflow obstruction secondary to benign prostatic hyperplasia. These patients complain of various symptoms, including urinary frequency, urge incontinence, difficulty in voiding, and retention. The severity of the symptoms is dependent on the stage of disease and/or severity of the obstruction. We compared the changes in the rat detrusor function following both mild and severe models of partial outlet obstruction in the rat. Outflow obstructions were created by ligation of the urethra over which a catheter was placed. The size of the catheter determined whether the severity of obstruction was mild or severe (1.70 mm for mild obstruction and 1.09 mm for severe obstruction). Changes in the bladder weight, length‐tension relationships, and the contractile response to field stimulation, pharmacologic agonists, and KCl were studied in bladders isolated from 1 and 2 week obstructed rats.

Bladder weights of all obstructed rats increased significantly. The weight of the severe obstructed rats were significantly greater than rats subjected to mild obstruction. In general, passive length‐tension curves of obstructed rats were shifted to right. The magnitude of the active tension induced by high KCl was higher in the mild obstruction and lower in the severe obstruction. The maximum response to KCl of mild obstruction was generated at greater lengths than for the other groups.

In general, the contractile responses of the mild obstructed bladder body to field stimulation, bethanechol, KCl, and ATP, and of the bladder base to field stimulation, KCl, and methoxamine, were significantly increased when compared to the responses of the control bladder body and base. However in the severe obstructed bladder, the responses to field stimulation, KCl, ATP, and methoxamine were significantly reduced from the responses of the control strips; the response to bethanechol was similar for control and the severe obstructed groups.

In conclusion, the severity of outlet obstruction significantly altered the contractile response of the bladder. Mild obstruction induced a mild increase in bladder mass, which was associated with significant increases to all forms of stimulation. Severe outflow obstruction induced a substantial increase in bladder mass and a significantly greater reduction in the response to field stimulation than the response to bethanechol (which was unchanged).
Interconnections of the upper ventral rami of the human sacral plexus: A reappraisal for dorsal rhizotomy in neurostimulation operations
Authors: Marani Enrico , Fiji Milan E. J. , Kraan Maarten C. , Lycklama à Nijeholt Gus A. B. , Videleer André C.
Published: March 2007

The extension of a dorsal rhizotomy in bladder stimulation patients is partly determined by connections between the ventral rami of the second, third, and fourth sacral spinal nerves. The literature is inconclusive on interconnections of these ventral rami in the human sacral plexus. The sacral plexuses of ten human cadavers were dissected in this gross anatomy study. In nine cases a branch connecting the ventral rami of the second and third sacral spinal nerves was found. Electron microscopy demonstrated the presence of thick myelinated fibers in this branch. In the male plexuses this branch formed the only link between the second sacral spinal segment and the pelvic plexus. The ventral ramus of the second sacral nerve always contributed to the pudendal nerve, whereas involvement of the ventral rami of the first and third sacral nerves differed individually and intersexually.
Effect of terazosin on urine storage and voiding in the aging male with prostatism
Authors: Gleason D. M. , Bottaccini M. R.
Published: March 2007

Patients in a private practice. evaluated for prostatism due to benign prostatic hypertrophy were offered the options of medical treatment with the alpha blocker terazosin, surgical treatment, or continued observation. Nineteen men accepted terazosin treatment and are the subjects of the present series. They were treated over a mean period of 8 months, the longest treatment lasting over 22 months. Dosage was started at 1 mg/d and increased as tolerated to 2.5, and 10 mg/d over the test period. Extensive testing including invasive urodynamics, multiple voiding diaries, and symptoms scores at each dosage level was carried out. We found that flow rales increased moderately from baseline in a dose dependent fashion. At the 10 mg/d dosage some patients achieved flow rates in the low normal range. Patients on treatment documented a decrease in the number of voidings per day, a decrease in nocturia, an increase in bladder capacity and the volume of each voiding. On the other hand, patients frequently did not appreciate changes in their voiding patterns, as reflected in their responses to the symptom questionnaires. We could not demonstrate significant changes in bladder pressures on cystometry either during filling or voiding. Our data suggested that terazosin may well have a direct effect on the fundus of the aging bladder to increase capacity, and, through the well‐known relationship between voided volume and flow rate, increase urinary flow rate. © 1994 Wiley‐Liss, Inc.
Urodynamic parameters in patients with slight and severe genuine stress incontinence: Is the stress profile useful?
Authors: Meyer S. , De Grandi P. , Schmidt N. , Sanzeni W. , Spinosa J. P.
Published: March 2007

This study evaluates the usefulness of the urethral pressure profile (UPP) parameters in assessing the severity of genuine stress incontinence (GSI). Functional length (FL), maximum urethral closure pressure (MUCP), pressure transmission ratio (PTR), residual area at stress (RAS), number of patients with incontinent spikes (IS), and distribution of IS on UPP were determined in supine and standing position for 54 patients (group I) with a 1 ‐hour pad test < 2 g and compared with the values of 63 patients (group 2) with a 1 ‐hour pad test > 2 g. The results were similar: FL (supine: 24 mm ± 6/26 mm ± 7 [P:0.2]; standing: 26 mm ± 8/24 mm ± 11 [P:0.5]); MUCP (supine: 51 cm H2O ± 23/47 cm H2O ± 20 [P:0.3]; standing: 45 cm H2O ± 21/38 cm H2O ± 18 [P:0.1]); and PTR (supine: 83% ± 27/84% ± 31 [P:0.9]; standing: 81% ± 25 and 88% ± 27 [P:0.3]). But the RAS was lower (supine: 502 mm2 ± 497/246 mm2 ± 268 [P < 0.009]; standing: 500 mm2 ± 534/271 mm2 ± 306 [P < 0.05]) in group 2. If the percentage of patients with IS was higher (supine: 57/93% [P < 0.001 ]; standing: 54/84% [P] < 0.011) in group 2, the distribution of IS over the entire FL demonstrated no differences between group 1 and 2. In conclusion, except for the RAS, standard UPP parameters cannot be considered determinant in assessing the severity of GSI. © 1994 Wiley‐Liss, Inc.
Improved method for needle electromyography of the urethral sphincter in women
Authors: Lowe Eithne M. , Fowler Clare J. , Osborne J. L. , Delancey J. O. L.
Published: March 2007

Needle electromyography (EMG) of the urethral sphincter using the periurethral approach is a procedure which most women find painful and their discomfort can restrict the use fulness of the test. A new technique has been devised using a transvaginal approach. The patient lies in the left lateral position and using a Sims speculum the posterior vaginal wall is retracted. The urethral sphincter can be easily seen and palpated, assisting correct electrode placement. This new technique is much less uncomfortable and highly satisfactory EMG recordings are obtained. © 1994 Wiley‐Liss, Inc.
One month maximal electrostimulation for genuine stress incontinence in women
Authors: Schiøotz Hjalmar A.
Published: March 2007

While awaiting surgery for genuine urinary stress incontinence, 51 women with were treated at home for 1 month with vaginal maximal electrostimulation. They were evaluated subjectively, urodynamically, and with two different pad tests. Six patients (12%) were cured and 17 (33%) were much improved, subjectively and objectively. Statistically significant improvement was observed for both pad tests. Successful treatment was significantly more likely in women with milder degrees of incontinence but was unrelated to age or urethral pressure. Patient acceptance was excellent and apart from some vaginal soreness no complications were seen.

Sixteen patients (31%) elected not to be operated on. These 16 patients were reevaluated after 1 year and 13 (81%) had maintained their improvement. Three had disimproved but were still better than before treatment; 2 again refused surgery and 1 opted for surgery. Therefore, 15 of 51 (29%) operations were saved after 1 year. This conservative treatment for stress incontinence is safe, simple, inexpensive, and reasonably successful. © 1994 Wiley‐Liss, Inc.
Stimulation of dna synthesis in rabbit bladder wall after partial outlet obstruction and acute overdistension
Authors: Monson F. C. , Wein A. J. , Eika B. , Murphy M. , Levin R. M.
Published: March 2007

Partial outlet obstruction of the rabbit urethrovesical junction (UVJ) has been used to induce pathology in the urinary bladder characteristic of obstructive damage observed in humans. The purpose of the experiments reported here was to compare the 3H‐thymidine (3H‐TdR) labelling of DNA in urinary bladders of male New Zealand White (NZW) rabbits subjected to partial outlet obstruction or overdistension. A total of 18 animals was used. Two normal controls, and 12 partially obstructed animals (at I day [D], 3D, 5D, 7D, 14D, and 2ID) were injected (i.v.) with 3H‐TdR at a dose of 0.5 μ‐Ci/g body weight. An additional 4 were overdistended to volumes 120% of maximum intravesical pressure, immediately emptied via the catheter, and injected with 3H‐TdR 24 hr (ID) later. All animals were sacrificed up to 3.5 hr after injection of the label.

DNA‐associated radioactivity reached a peak at 3D after obstruction and was reduced substantially by 5D, although the level of incorporation remained well above control levels out to 2ID. Levels of 3H‐TdR incorporation ID after overdistension bladders were about half of that found ID following partial obstruction.

The distribution of 3H‐TdR labelled DNA in tissues was demonstrated by radioautography of histologic sections. One day following obstruction, 3H‐Tdr incorporation was localized in the urothelium. Labelling of urothelium subsequent to ID was reduced but remained above control levels until 2ID. Labelled smooth muscle nuclei were observed only in control and 3D bladders, and they were measured at similar frequencies. Labelling of both intrinsic connective tissue (ICT) (mucosal, submucosal, and mural) and extrinsic connective tissue (ECT) (serosal) peaked at 3D after obstruction and declined thereafter but not to control levels. Labelling of ECT was, of course, limited to those bladders in which ECT was present (i.e., 3‐2ID). While the distribution of labelled cells in radioautograms was more variable ID after obstruction than ID after overdistension, the general cellular and biochemical responses to overdistension, as measured by DNA synthesis, are similar to those observed after partial outlet obstruction. Since the first sequela of obstruction is acute distension, these data support the assertion that the initial overdistension of the bladder initiates the cellular response to obstruction. © 1994 Wiley‐Liss, Inc.
Rat: Overview and innervation
Authors: Steers William D.
Published: March 2007

Despite the development of molecular and cellular methods for examining physiological processes, the use of the whole animal model remains essential to advance knowledge regarding the integration and coordination of events associated with urinary tract function. The rat offers an inexpensive and versatile species to investigate bladder and urethral responses to drugs or pathology. Models for many disorders have been developed in rodents including diabetes, multiple sclerosis, spinal cord injury, Parkinson's disease, bladder outlet obstruction, pain, and aging. This review examines methodologies to evaluate lower urinary tract function and manipulations used to create pathological models in rodents. © 1994 Wiley‐Liss, Inc.
Rabbit as a model of urinary bladder function
Authors: Levin Robert M. , Monson Frederick C. , Longhurst Penelope A. , Wein Alan J.
Published: March 2007

Micturition is a complex neuromuscular process. Although control mechanisms have been identified at several levels of the central nervous system and spinal cord, the final pathway in the control of micturition is the autonomic innervation of the urinary bladder and related structures. Following this line of reasoning further, micturition is ultimately dependent on the ability of the urinary bladder to both contract and generate intravesical pressure, and to modify its shape in such a way as to efficiently expel its contents without leaving a high residual volume.

In order to understand the various elements of micturition, a wide variety of both in vivo and in vitro animal models has been developed. In many cases, animal models have been utilized to describe the effect of specific experimental pathologies on the lower urinary tract. The current review of the use of the rabbit in urological research is not meant to be a comprehensive treatise on the topic, but should provide a rational description of the how this species can be utilized to study both normal and pathological function. © 1994 Wiley‐Liss, Inc.
Guinea pig as an animal model for the study of urinary bladder function in the normal and obstructed state
Authors: Mostwin Jacek L. , Karim Omer M. A. , Van Koeveringe Gommert , Seki Narihito
Published: March 2007

The guinea pig has become an excellent model for the study of mechanical and electrical mechanisms regulating bladder function in the normal and obstructed state. Much preliminary work has been done on the in vitro behavior of the detrusor smooth muscle. The tissue has permitted electrophysiological studies by sucrose gap. microelectrode. and patch clamp technique. Excellent urodynamic studies can be performed under anesthesia. A recent model of bladder obstruction has resulted in a source of tissue which is suitable for electrophysiological analysis of the muscle. Low‐cost and simple animal care requirements permit large‐scale studies correlating urodynamic, structural, biochemical, contractile, and electrophysiological changes in response to obstruction. © 1994 Wiley‐Liss, Inc.
Dog as an animal model for neurostimulation
Authors: Hassouna M. , Li J. S. , Elhilali M.
Published: March 2007

The dog provides an important model to study the effect of neural stimulation of different parts of the central and peripheral nervous systems. A multitude of experiments on neurostimulation and neuromodulation to ensure bladder evacuation have been conducted on dogs. The present article reviews the most prominent contributions in the English literature related to neurostimulation using the dog as an experimental model. The various modes of stimulation using dogs as a model and the rationale for their use as well as their shortcomings will be examined. The prominent anatomic features in the neural control of the bladder and the technical aspects involved in neurostimulation of the canine bladder will be reviewed. © 1994 Wiley‐Liss, Inc.
Cat and dog: Higher center of micturition
Authors: Nishizawa Osamu , Sugaya Kimio
Published: March 2007

The nervous control of micturition in the pontine level was studied using cats and dogs as research specimens. Two techniques for this purpose were employed: (1) electrical and chemical stimulations research and (2) nerve tracing research. This investigation suggests that two distinct pontine centers exist, the commonly known pontine micturition center (PMC) which is responsible for urine emptying, and a second, very important pontine center which functions as the urine storage facilitator (PUSFC). The PMC, which triggers bladder contractions and micturition, is located in the nucleus locus coerleus alpha (LCa). The second center (PUSFC) is located in the nucleus locus subcoerleus (LSC). Micturition is controlled by close coordinate operation of both centers in the pontine level. © 1994 Wiley‐Liss, Inc.
Pelvic fascia strength in women with stress urinary incontinence in comparison with those who are continent
Authors: Kondo A. , Narushima M. , Yoshikawa Y. , Hayashi H.
Published: March 2007

Biophysical properties of the anterior vaginal wall as well as the rectus fascia were evaluated in vivo by penetrating the Stamey needle into these tissues of 26 female patients with stress incontinence in comparison with those of 21 continent subjects. The results demonstrated that shear strength of the anterior vaginal wall was lower in incontinent patients than in continent subjects (P < 0.01). Shear strength of the rectus fascia in the patients, which was not supposed to be related to urinary incontinence and should have had the same strength as the control subjects, was also found to be lower than the control (P < 0.01). Shear strength of the vaginal wall was not correlated with age irrespective of their continence status (P > 0.05). Based on our findings it is concluded that some women suffering from stress incontinence may have a hereditary disorder of biophysical properties of the tissues. © 1994 Wiley‐Liss, Inc.
Abnormal sensitivity to intravesical potassium in interstitial cystitis and radiation cystitis
Authors: Parsons C. Lowell , Stein Paul C. , Bidair Mohamed , Lebow Diana
Published: March 2007

The urgency‐frequency syndrome (UFS) (non‐bacterial cystitis, interstitial cystitis) may well represent a heterogenous group with several etiologies. This study was based on the hypothesis that one subset of UFS patients has a leaky (to solutes) epithelium and cations such as potassium could thereby diffuse subepithelially and provoke symptoms. It was also hypothesized that normal impermeable transitional epithelium would not allow cations to diffuse across the cells during the K + provocation test and no symptoms would be experienced. If the epithelium was permeable (“leaky”), diffusion would occur and provoke symptoms. Water or 0.4 M KCl was placed intravesically into normal volunteers and interstitial cystitis (IC) patients. Water did not provoke symptoms in either group but KCl provoked 45% of normals and 70% of IC patients. Differences were significant (P < 0.0001). This test provides a valuable diagnostic tool for UFS and a valuable research tool to separate epithelial permeability problems from other subsets of patients. A third group, consisting of 11 IC patients in remission on heparinoid therapy, was also tested and only 18% were provoked by KCl. Four patients with radiation cystitis were also examined and all four (100%) were provoked by the potassium. © 1994 Wiley‐Liss, Inc.
Correlation of the AUA symptom index with urodynamics in patients with suspected benign prostatic hyperplasia
Authors: Nitti Victor W. , Kim Young , Combs Andrew J.
Published: March 2007

The AUA symptom index is widely used to access patients with suspected benign prostatic hyperplasia (BPH). In order to determine how well symptoms as assessed by this index correlate with urodynamic findings, we evaluated 83 patients referred to our urology clinics with symptoms of BPH. All patients completed the AUA symptom index and then underwent a multichannel urodynamic evaluation. Patients were classified as obstructed, unobstructed, or equivocal according to the Abrams Griffiths nomogram. The AUA symptom index was recorded as the total score and, for purposes of symptom classification, further subdivided into an obstructive score (questions 3, 5, and 6) and an irritative score (questions 1, 2, 4, and 7).

The mean age of the 83 patients was 67 (45–84). The mean total AUA symptom score was 16.6 (6–34), mean obstructive score was 6.1 (0–15), and the mean irritative score 10.4 (3–20). Pressure flow analysis using the Abrams‐Griffiths nomogram classified 28 patients (34%) as obstructed, 17 (20%) as unobstructed, and 38 (46%) as equivocal. Using the analysis of variance procedure (ANOVA) there was no statistically significant difference in the mean total (P = 0.446), obstructive (P = 0.979), or irritative (P = 0.136) scores. Detrusor instability was present in 45 patients (54%). While total and obstructive scores were not significantly different in patients with detrusor instability vs. those with stable bladders, irritative scores were higher in patients with instability (P = 0.028) using the T‐test procedure. Using ANOVA, the difference in post void residual (PVR) between the groups was not quite statistically significant (P = 0.057).

The AUA symptom score does not appear to correlate with urodynamic obstruction. However, higher irritative symptom scores are associated with detrusor instability. It is likely that in many men with “BPH,” symptoms are not caused by outlet obstruction and may be related to changes in the aging bladder. © 1994 Wiley‐Liss, Inc.
Basis of severity grade in detrusor hyperreflexia
Authors: Bonney William W.
Published: March 2007

For both treatment and research it is useful to classify detrusor hyperreflexia/instability according to degree of severity, because it relates to symptomatic impact. However, there has been no systematic evaluation of criteria for severity assignment. This report compares patient classification by urodynamic data according to 3 methods: arbitrary criteria, a severity index, and an empirical cluster analysis. Within the primary urodynamic data there were no natural groupings as a basis for division into discrete patient groups. By all three methods, however, severity level did relate to symptoms. © 1994 Wiley‐Liss, Inc.
Functional obstruction of the female urethra: Relevance to refractory bed wetting and recurrent urinary tract infection
Authors: Kondo Atsuo , Kapoor Rakesh , Ohmura Masaharu , Saito Masahiko
Published: March 2007

A 20‐year‐old woman and 3 girls were referred to our urodynamic unit because of refractory bed wetting, recurrent urinary tract infection, and/or weak stream. All patients required extremely high detrusor pressure to evacuate urine, a mean of 116 cm of water. Urethral configuration was either a ballooning or a spinning‐top shape. Organic stenosis of the urethra was not detected by bougie a boule. Urodynamically, functional obstruction at the distal urethra was found to be an etiology of these symptoms. When the urethra was dilated with the Otis urethrotome, all patients were greatly benefitted both symptomatically and urodynamically without an adverse effect of urinary incontinence. We stress clinical importance of pressure flow study and fluoroscopic monitoring of the bladder and urethra when one encounters female patients with long histories of above symptoms. © 1994 Wiley‐Liss, Inc.
Detrusor‐myoplasty, innervated rectus muscle transposition study, and functional effect on the spinal cord injury rat model
Authors: Chancellor Michael B. , Rivas David A. , Acosta Rafael , Erhard Michael J. , Moore John , Salzman Steven K.
Published: March 2007

The purpose of this investigation was to determine the feasibility of striated muscular augmentation of the urinary bladder (detrusor‐myoplasty, DMP). Initial studies, transposition, and bladder wrap using several distinct muscle groups was attempted in laboratory rats, goats, and fresh human cadavers. The rectus abdominus muscle was found to be best suited to completely encompass the bladder with an intact neural and vascular supply. The technique was then applied in a rat model of spinal cord injury (SCI).

Modified Tarlov ratings were employed to assess neurologic function 30 days after SCI. The median final neurological score of SCI rats with and without DMP was 4 and 5, respectively. Sham‐operated SCI (control) rats, with and without DMP, both had normal final Tarlov scores of 12 (P < 0.05). Muscle blood flow values for the flap and the contralateral undissected rectus muscles were not significantly different (97 ± 34 and 105 ± 40 ml/100 g tissue/min, respectively, P = 0.47). Postoperatively, no bowel or abdominal wall functional deficits were apparent. The rotated muscular flap remained innervated and vascularized.

Analysis of 24 hr micturition patterns demonstrated no differences in oral fluid intake/24hr. voided volume/24hr, and ratio of number of micturitions during the night vs. day among the four groups: (1) control (neither SCI nor DMP), (2) DMP only, (3) SCI only, and (4) SCI with DMP. Spinal cord injured rats with and without detrusor‐myoplasty demonstrated a significant decrease in the number of micturitions/24hr, an increased volume per micturition, and greater largest and smallest micturition volumes (P < 0.05) when compared to controls. The micturition patterns among SCI rats with and without DMP were similar, as were non‐SCI animals with and without DMP.

This is the first report of the principle and technique of detrusor‐myoplasty. Dissection of rats, goats, and human cadavers revealed that a vascularized and innervated rectus muscle flap can be rotated into the pelvis and wrapped around the bladder without tension. Significant loss of bladder capacity did not occur with skeletal muscle adaptation. Detrusor‐myoplasty may be applicable for patients with an areflexic detrusor and non‐intact sacral motor roots who are not candidates for sacral anterior root neurostimulation. © 1994 Wiley‐Liss, Inc.
Ultrasound diagnosis of bladder outlet obstruction in rabbits
Authors: Schoor Richard A. , Canning Douglas A. , Bella Richard D. , Broderick Gregory A. , Snyder Howard M. , Duckett John W. , Krasnapolski Lev , Wein Alan J. , Levin Robert M.
Published: March 2007

One of the primary characteristics of partial outlet obstruction secondary to BPH is an increase in bladder mass commonly referred to as bladder hypertrophy. This condition has been simulated in rabbits by the partial ligation of the catheterized urethra. Ultrasonography has been utilized in both adult and pediatric urology to visualize the bladder and diagnose specific bladder disorders. The aim of the present study is to determine if ultrasonography can visualize bladder wall hypertrophy induced by obstruction. Partial outlet obstructions were created in NZW rabbits using standard methodologies, and then 5 to 7 days later, sonography was performed. The films were read by both the principal investigator and blinded investigators instructed to determine bladder wall thickness and from this predict the bladder weight.

Then results were correlated with cystometrograms (CMGs) and whole bladder weights. Both the principal investigator and the blinded investigators were consistently able to distinguish obstructed from control bladders based solely on sonographic depictions of relative bladder wall thickness. In addition, the investigators were able to distinguish between low (control), medium, and high bladder weights based on sonography.

The accuracy of predicting the bladder weights increased when cystosonograms were correlated with CMC studies. Thus, the degree of bladder hypertrophy can be accurately estimated by the combination of cmg and ultrasonography. © 1994 Wiley‐Liss, Inc.
Contractility of the guinea pig bladder measured in situ and in vitro
Authors: Groen J. , Van Mastrigt R. , Bosch R.
Published: March 2007

To study the relative importance of neurogenic factors in detrusor contractility and to relate a total bladder in vitro contractility model to a previously described bladder wall strip model, active intravesical pressure values were compared in situ and in vitro in eight male guinea pigs. In situ, the active pressure was measured in spontaneous isometric and nonisometric micturition contractions. In vitro, the active pressure was measured in isometric contractions of the same bladders, developed in response to optimal electrical stimulation. The volume dependence of the active pressure generated by the bladder was measured in vitro in order to relate bladder capacity to the volume where the generated force is maximal and to determine the optimal volume at which to study detrusor contractility. The results indicated that in normal micturition the detrusor muscle was not fully stimulated: active pressure in isometric contractions in vivo was about 60% of the pressure values attained in vitro at the same bladder volume. Most micturitions occurred at a volume where the active pressure generated in vitro was about 80% of the maximal pressure. The active pressure‐bladder volume relationship complied with the sliding filament‐cross bridge theory. In whole bladder preparations active stress was about twice as high as in strips. © 1994 Wiley‐Liss, Inc.
Elastic wall properties and collagen content in the ureter: An experimental study in pigs
Authors: Knudsen L. , Gregersen H. , Eika B. , Frøkiær J.
Published: March 2007

We used an impedance planimetric method to look at elastic wall properties of ureter in ten anaesthetized pigs. A balloon was stepwise inflated and deflated in the ureteropelvine junction in the mid‐ureter and in the intramural part of the ureter at the ureterovesical junction with pressures up to 70 cmH2O, while the pressure and balloon cross‐sectional area (Bcsa) were measured simultaneously. The elastic wall parameters were calculated from these measurements. At sacrifice, tissue samples were collected for analysis of collagen content of the ureteral wall.

A non‐linear clockwise relation (hysteresis loops) between Bcsa and balloon pressure was demonstrated. At maximal inflation of the balloon, the Bcsa, wall tension, and compliance were 35.28 ± 3.52. 38.44 ± 3.23, and 61.36 ± 8.09 mm2, 230.71 ± 12.82. 242.38 ± 10.49. and 302.17 ± 20.03 cmH2O × m, and 0.167 ± 0.047, 0.124 ± 0.002, and 0.182 ± 0.040 mm2 × cmH2O 1 in the intramural part of the ureter, middle part, and ureteropelvine junction, respectively. The collagen content was 0.3249 ± 0.0077, 0.3301 ± 0.0066. and 0.3457 ± 0.0060 mg × mg 1 dry defatted weight in the intramural part, in the middle, and in the ureteropelvine junction, respectively. The collagen content of the ureteropelvine junction was significantly higher than that of the middle of ureter (P < 0.02) and than that of the intramural part (P < 0.05). No significant correlations were found between the elastic parameters at maximal inflation of the balloon and the collagen content (P > 0.10)

In conclusion the elastic wall properties were significantly different in the three ureteral segments and the collagen content of the ureteropelvine junction differed from that of the two distal locations. However, no relationship between the wall properties and the collagen content was found. © 1994 Wiley‐Liss, Inc.
Comparative studies on intracellular calcium and nadh fluorescence of the rabbit corpus cavernosum
Authors: Levin Robert M. , Hypolite Joseph , Broderick Gregory A.
Published: March 2007

Erectile function (erection and detumescence) involves the complex interaction of direct neuronal stimulation of corporal smooth muscle, neurohumoral release of specific endothelial contractile and relaxant factors, and secondary modulation by a variety of putative neuropeptides and vasoactive modulators. Using surface spectrofluorometry, we have correlated spontaneous contractile activity and the contractile response to field and pharmacological agents with intracellular calcium and NADH metabolism.

The results demonstrate that the corpus cavernosal tissue has very unusual properties. Spontaneous contractile activity is correlated with a phasic increase in intracellular calcium. However, spontaneous contractile activity is most often correlated with a bi‐phasic effect on the ratio of NADH/NAD. At the start of the spontaneous contraction, there is a sharp phasic increase in NADH/NAD; peak contractile force occurs simultaneous with a phasic decrease in this ratio showing that at peak force generation, there is a decrease in the level of intracellular energy. Phenylephrine stimulation results in an increase in intracellular calcium in proportion to the increase in tension; however, phenylephrine stimulation at low concentrations results in a net increase in the NADH/NAD ratio whereas high concentrations of phenylephrine result in a net decrease in the NADH/NAD ratio. In general, field stimulation results in a decrease in tension at low frequencies, a biphasic response at midfrequencies, and a contraction at high frequencies. These contractile responses are directly related to alterations in the intracellular concentration of calcium. That is, a decrease in tension is preceded by a decrease in intracellular calcium while an increase in tension is preceded by an increase in intracellular free calcium. Field stimulation results in a rapid and phasic alteration in the NADH/NAD ratio; however, the NADH/NAD response can be either an increase, decrease, or biphasic response. There does not appear to be a consistent relationship between the contractile/relaxant response to field stimulation and altered NADH/NAD ratio. Finally, ATP, bethanechol, and nitroprusside induce a decrease in the basal tension of the corpus cavernosal strips which corresponds with a decrease in the NADH/NAD ratio. However, whereas nitroprusside relaxation is correlated with a decreased intracellular calcium level, both ATP and bethanechol stimulate an increase in intracellular free calcium.

These studies indicate that the response of the corpus cavernosal tissue to both field stimulation and pharmacological agents is complex and may involve both direct and indirect actions of a variety of cellular mediators on the corporal smooth muscle. © 1994 Wiley‐Liss, Inc.
Enterocystoplasty in the neuropathic bladder
Authors: Singh Gurpreet , Thomas David G.
Published: March 2007

Patients with neuropathic bladders who have intractable hyperreflexia often require cystoplasty and in patients adequately motivated and counselled, continence rates in excess of 90% can be achieved.

Seventy‐eight patients with neurological disease have undergone enterocystoplasty and are presented. Twenty‐two patients had acquired cord lesions of which 17 were traumatic. Of the 56 patients with congenital myelodysplasia. 49 were meningomyelocele, 5 had sacral agenesis, and 2 lipoina of cauda equina. The mean age was 26 (range 13–61) years with 48 male and 30 females. Pre‐operative video urodynamics showed sphincter weakness in 54 patients, all patients had intermediate type bladders; hyperreflexia in 52, reduced compliance in 17. and in 7 a combination of both. Forty‐seven patients had ileal, 20 had sigrnoid, and I I had ileocaecal cystoplasty. Fifty‐two patients had an artificial urinary sphincter inserted, 9 had a colposuspension. and I had both tor concurrent sphincter weakness incontinence.

Acceptable continence has been achieved in 73 (93.6%) patients, 65 claiming complete continence with no pads or incontinence episodes and the 8 others needing pharmacotherapy or pads. Two of our 5 failures have been converted to an ileal loop, 2 are awaiting further surgery, and 1 is wet despite normal urodynamics. Our threshold for initiating intermittent catheterisation is low and 63 (81%) of our patients catheterise. Complications in these patients are few and the only one of note is persistent bowel problems in 30% of our patients.

Cystoplasty is recommended as safe and reliable in the treatment of neurogenic detrusor over activity with a continence rate of 93% being achieved. All our patients need to demonstrate competence in performing intermittent self‐catheterisation before surgery is offered. © 1995 Wiley‐Liss, Inc.
External urethral sphincterotomy: Long‐term follow‐up
Authors: Yang Claire C. , Mayo Michael E.
Published: March 2007

We retrospectively reviewed the charts of 37 male spinal cord injury patients who underwent sphincterotomy from 1986–1993 to evaluate the long‐term results of this procedure.

Patients were selected for the operation based on urodynamic criteria and all had some detrusor activity or were able to void by Valsalva's maneuver. There were 26 cervical injuries and 11 thoracic injuries. The operation was judged a failure if the following were present postoperatively: the presence of large post void residual volumes associated with urinary tract infections, autonomic dysreflexia symptoms associated with bladder overdistension or high voiding pressures, and/or progressive upper tract deterioration due to persistent vesicoureteral reflux or poor bladder emptying.

Eighteen' operations were failures and 19 operations were successful. Causes for sphincterotomy failure included recurrent detrusor sphincter dyssynergy (6), detrusor hypocontractility (6), bladder neck contracture (3), stricture at the external sphincter (1), incomplete sphincterotomy (1), and unknown etiology (1). The reoperation rate was 32%. The mean follow‐up time was 49 months for the failure group (range 2–81) and 26 months (range 2–54) for the successes. The longer mean follow‐up period in the former group suggests that the number of failures increased with time. There was no predictor of failure among any of the following parameters: age at operation, level of injury, previous bladder neck/sphincter operations, preoperative maximum detrusor contraction pressures, or rise time to maximum pressure.

In conclusion: (1) the external urethral sphincterotomy, even in appropriately selected patients, can have a high failure rate over time, and (2) we could not identify any variables to predict an unsuccessful operation using our present selection criteria. © 1995 Wiley‐Liss, Inc.