bluuebunny/crossref_metadata_2025 huggingface dataset:
Total and static pressure measurements of the male lower urinary tract
Authors: Yalla Subbarao V. , Fraser Lionel
Published: March 2007

Simultaneous total and static urethral pressure measurements were attempted in 22 male subjects who could void around a 10‐French bilumen urethral catheter. The catheter had an end‐hole at its tip and a side‐hole approximately 1 cm away from the end hole (short catheter‐tip segment). Thus, during a single voiding attempt, simultaneous total and static urethral pressures at two different urethral sites (1 cm distance) could be recorded. In addition, suprapubic vesical pressure monitoring was done in all these subjects. The studies also included a comparison of these recordings with those obtained with a 10‐French catheter that had its side‐hole placed 10 cm away from the tip (long catheter‐tip segment). The studies indicated that (1) the total pressure at a particular region of the urethra was usually higher than its static pressure; (2) the pressure sensing catheters produced “plugging effect” of the narrow segments of the outlet; and (3) the static pressure configurations that were obtained with a catheter having a long catheter‐tip segment were markedly different from those obtained through a catheter that had a short catheter‐tip segment.

This presentation also includes observations on static pressure measurements obtained from a crude mechanical model that simulated the geometry of the urinary bladder and its outlet. True lateral pressures of the flowing fluid were obtained via cannulae inserted perpendicularly into the stream, through the wall of the outlet (extraluminal route). A comparison was attempted between the static pressure measurements obtained through the extraluminal route with those obtained through the catheters (10–14 French) that were directly inserted into the lumen of the outlet along its axis (intraluminal route). The studies indicated identical static pressures at the narrowest site (16–18 French) of the outlet recorded through both routes.
Detrusor reflex instability in male infravesical obstruction: Fact or artefact?
Authors: Colstrup H. , Andersen J. T. , Walter S.
Published: March 2007

In a randomized crossover study, 46 males clinically suspected of infravesical outflow obstruction were investigated with two consecutive cystometries, either with the catheter balloon inflated or deflated. The sequence was chosen at random. A statistically significant difference was found in the frequency of cystometrically diagnosed detrusor reflex instability and in the maximum cystometric bladder capacity.
Urethral sensitivity—an integral component of the storage phase of the micturition cycle
Authors: Murray Keith
Published: March 2007

The effect of bladder capacity on the urethral sensitivity threshold in 30 unselected patients is described. A significant reduction in the urethral sensitivity threshold with increasing bladder capacity was demonstrated and the significance of this is discussed. A “normal” pattern of urethral sensitivity changes in patients with no urodynamic abnormality is postulated.
The development of reflex bladder activity following spinal cord injury in cats and a method to control it
Authors: McGuire Edward J. , Morrissey Susan G.
Published: March 2007

Spinal cord transection is associated with the development of detrusor external sphincter dyssynergia in cats. These findings indicate that the cat is a suitable model for the study of lower urinary tract dysfunction after spinal cord injury. Inhibition of reflex detrusor activity was achieved by activation of a sacral inhibitory pathway by electrical stimulation of the sacral roots or anal sphincter in normal and spinal—injured animals, indicating presence of a sacral inhibitory pathway.
Radioligand binding of 3H‐ATP to membranes derived from rabbit urinary bladder: A preliminary report
Authors: Levin Robert M. , Jacoby Richard , Wein Alan J.
Published: March 2007

Utilizing radioligand‐filtration methodology, we have studied the binding characteristics of 3H‐ATP to membrane preparations of rabbit urinary bladder. In order to avoid ATP hydrolysis, the binding assays had to be carried out at 0°C and utilize tissue concentrations between 1 and 3 mg/ml. Under these conditions, 3H‐ATP binding to bladder homogenates was rapid, reaching equilibrium within 1 minute. The binding showed both divalent ion‐specific (75% of total binding) and independent binding. The specific binding was saturable whereas the divalent ion‐independent binding was not saturable at the concentrations studied.
Drug‐induced responses of canine vesical smooth muscle cells in culture
Authors: Thuroff Joachim W. , Bazeed Mahmoud A. , Schmidt Richard A. , Tanagho Emil A.
Published: March 2007

Vesical smooth muscle cells were grown in enzyme‐dispersed cell culture, and contractions of single cells were induced by various exogenous neurotransmitters or analogues. This model may be suitable for studying the physiologic properties of smooth muscle cells in culture and thus cell differentiation and changes under defined conditions of culture. The effects of various drugs on single muscle cells may be compared: The pharmacologic effect on the muscle can thus be judged intrinsically without the interferences inherent in the natural milieu and from pharmacologic effects on the central or peripheral nervous system.
A new video urodynamics: Combined ultrasonotomographic and urodynamic monitoring
Authors: Nishizawa Osamu , Moriya Ltaru , Satoh Sadamoto , Harada Tadashi , Tsuchida Seigi
Published: March 2007

A new video urodynamics to evaluate lower urinary tract function is presented. Video urodynamics was described originally as a combined radiographic and urodynamic monitoring. We describe certain modifications of original method, using the ultrasonotomographic method instead of the radiographic method. The urodynamic data and the simultaneous ultrasonotomography can be displayed through the display controller on the color display monitor. Our technique will be an extremely reliable method for the evaluation of lower urinary tract function.
The urethral pressure profile at rest: An analysis of variance
Authors: Hilton P.
Published: March 2007

Resting urethral pressure protile measurements were carried out by a microtransducer method on 100 women with a variety of urinary symptoms in an attempt to analyse the repeatability and reproducibility of the various protile parameters. The findings were as follows:
The repeatability of parameters was shown to have some dependence on the rate of catheter withdrawal. being optiinal at 15 cm per minute.

Profiles recorded by microtransducer showed greater consistency than those recorded by a fluid perfusion method. in terms of the parameters of urethral length.

Whilst the fluid perfusion method has previously been shown to have a significant component of variance duc to time. no such time‐dependent component was found with the microtransducer method.

Urethral pressures measured by microtransducer do appear to have a significant time‐dependence when recorded during the menstrual cycle in women of reproductive age.

These findings suggest that the microtransducer method of urethral pressure measurement has a greater diagnostic reliability than the tluid perfusion method. It also has a greater capacity to assess the effects of drugs. hormones. and surgery on the urethral pressure profile. Care must be takcn. however. in the interpretation of pressure variations noted In women in reproductive age groups.
A computer program for the storage and retrieval of urodynamic data
Authors: Woodside Jeffrey R. , Morris F. Max
Published: March 2007

The computer is idcally suited for storing and retrieving a large volume of medical data. Described herein is a computer program written for the managemenr of data from patients who have had urodynamic evaluation. The program is highly user‐oriented and requires only minimal training of personnel. The required hardware is reliable and relatively inexpensive. Further. the program is flexible and easily modified for use in other subspecialty areas of urology.
Rapid cystometry in males
Authors: Susset Jacques G. , Ghoniem Gamal M. , Regnier Claude H.
Published: March 2007

Rapid injection cystometry is performed by injecting 100 ml of saline into the bladder within three seconds. with continuous pressure recording. The same injection is repeated after the pressure stabilizes. up to bladder capacity which has been determined by a slow CMG performed prior to the test. This test was performed on 70 male patients. Following the rapid rise in intravesical pressure due to the viscoelastic properties of the bladder. three types of detrusor contractions were observed. Type A were single contractions of short amplitude and duration and were always seen in patients with peripheral nerve lesions. Type B were single. coordinated sustained contractions while Type C consisted of polyphasic contractions of variable amplitude and duration. The putential diagnostic usefulness of rapid cystometry is discussed.
Detrusor/sphincter dyssynergia in neurologically normal children
Authors: Griffiths D. J. , Scholtrneijer R. J.
Published: March 2007

For 143 boys and girls without overt neuropathy, the occurrence of urethral overactivity during voiding (detrusorkphincter dyssynergia) has been investigated in three cystometrically recorded micturitions and a free‐flow measurement. The following aspects have been statistically examined for their reproducibility and consistency in reflecting urethral over‐activity: the pressure/flow relationship, the pelvic‐floor EMG, residual urine, and the freeflow curve. Any single aspect, or any single micturition (even the free‐flow measurement), suggests an unrealistically high incidence of “dyssynergia.” By combining them, however, we have developed a concept of consistent urethral overactivity, which is associated with residual urine, appears to be clinically significant, and has an incidence of 19% in our material. Consistent urethral overactivity has a significantly higher incidence (67%) in children with upper‐tract disease on both sides, suggesting a causative role. In girls, there is a spectrum of dysfunction, ranging from a more serious type, reflected in the presence of residual urine and of consistent urethral overactivity, to a relatively trivial type, without residual urine, associated principally with an abnormally high EMG during voiding and with a history of urinary tract infections. In our material, there is no association between urethral overactivity during voiding and detrusor instability during bladder filling, suggesting that these are two unrelated findings and not two aspects of a single syndrome.
Increased motor unit fibre density in the external anal sphincter in genuine stress incontinence: A single‐fibre EMG study
Authors: Anderson R. S.
Published: March 2007

The motor unit tibre density in the external anal sphincter has been measured in 25 female subjects with genuine stress incontinence and in 14 normal female subjects. The mean fibre density in the normal subjects was 1.5 ± 1.5 and in the incontinent patients 1.95 ± 0.32 (p < 0.002). These findings show objective evidence of denervation of the muscle and suggest that genuine stress incontinence often has a neurogenic aetiology.
The effects of acute overdistention of the rabbit urinary bladder
Authors: Levin Robert M. , Staskin David R. , Wein Alan J.
Published: March 2007

The effects of in vivo acute overdistention on both the metabolic state and the in vitro contractile responses of the rabbit urinary bladder were studied. Intracellular adenosine triphosphate (ATP) was used as an indicator of the metabolic states. The responses of isolated strips of bladder body and base to bethanechol, methoxamine, and isoproterenol were used to assess pharmacologic response. The results of acute overdistention for one hour can be summarized as follows: (1) There was no significant decrease in the intracel Mar stores of high‐energy phosphate (ATP). (2) The cholinergic‐induced contractile response of the bladder body was significantly decreased. After one week of recovery, the cholinergic response returned to control levels. (3) There was a moderate shift in the dose‐response of the bladder base to methoxarnine. After one week of recovery, the response to methoxamine returned to control levels.

It is concluded that overdistention produces an immediate dysfunction in the contractile system of the bladder that is not secondary to a reduction in intracellular ATP and is reversible within one week following overdistention.
Computer analysis of the electromyogram of the external urethral sphincter
Authors: Morita Takashi , Kondo Shun , Tsuchida Seigi
Published: March 2007

The electromyograms of canine external urethral sphincter were recorded and analyzed with a microcomputer (Nihon Koden Co., ATAC 450).

There was no observable change in the electromyographic activity of the external urethral sphincter in response to an α‐blocker (phentolamine) or a β‐blocker (propanolol). However, there was complete abolition of electromyographic activity following the administration of neuromuscular blocking agents (suxamethonium or pancuronium).

The opinions that the α‐adrenerpic system acts predominantly on the external urethral sphincter via the pudendal nerve cannot be supported by the data obtained in this study.
Urodynamics of refluxing ureters in man
Authors: Jørgensen Troels M. , Djurhuus Jens C. , Sørensen Søren S.
Published: March 2007

Peroperative measurements of ureteral pressure, bladder pressure, and ureteral electrornyographic activity were performed during bladder filling in five vesicoureteral reflux patients. A total of seven units were investigated. The investigation supports previous observations that nondilated low‐grade reflux ureters have stable low pressure but react to bladder filling by an increase in the peristaltic activity frequency. Dilated high‐grade reflux ureters also react by an increase in peristaltic rate, but at the same time, the bladder pressure is transmitted to the ureter.
Long‐term urethral catheter drainage and bladder capacity
Authors: Kristiansen Peter , Pompeius Rolf , Wadström Lars B.
Published: March 2007

Bladder capacity has been registered with incremental water cystometry in 399 paticnts with continuous long‐term urethral catheter drainage. The duration of cathcter drainage varied from a few weeks to 15 years. The real bladder capacity was assessed by abolishing bladder overactivity, when present, with an IM injection of 50 mg emepronium bromide. Bladder capacity was reduced with increasing duration of catheter drainage. and the relation was statistically significant (p < 0.001). During the first year of catheter drainage there was a fast reduction of real bladder capacity by 12 mlimonth from 360 ml to 220 ml; during the next 8 years a further reduction by 0.8 rnllrnonth to around 150 ml was registered. The significance of this process in the daily care of the patients was evaluated with a questionnaire to the nursing staff. Bladder overactivity, and to a minor degree. reduction of real bladder capacity caused an increased frequency of urinary leakage beside the catheter but influenced neither the frequency of change of catheter nor the discomfort of the patients.
The mechanics of urine transport in the upper urinary tract: 1. The dynamics of the isolated bolus
Authors: Griffiths Derek J. , Notschaele Cyril
Published: March 2007

On the basis of theoretical and experimental results, a simple mechanical framework is developed in which the propagation of the isolated bolus can be understood. It is shown that the pressure in the bolus is determined primarily by the pressure needed to separate the walls of the collapsed ureter, and that the observed variations in the velocity of the leading edge can be accounted for by nonuniformity of the ureteric cross section.
The mechanics of urine transport in the upper urinary tract: 2. The discharge of the bolus into the bladder and dynamics at high rates of flow
Authors: Griffiths Derek J.
Published: March 2007

On the basis of simple theoretical arguments and experimental results, it is shown that the discharge of the bolus into the bladder is determined by the resistance to flow of the ureterovesical junction (UVJ), which itself depends on the detrusor pressure. If the resistance to flow or the detrusor pressure are too high, or if the ureter is too wide or too weakly contracting, then the UVJ behaves as if obstructive, and bolus flow breaks down. At sufficiently high flow rates the UVJ, even though not obstructive, always governs the flow dynamics, open‐tube flow occurring instead of the isolated bolus flow characteristic of low flow rates. At intermediate rates two other flow regimes can occur: touching or box‐shaped boluses, and leaky bolus flow. In each regime the pelvic pressure varies with mean urine flow rate in a characteristic way.
Pyeloureteral dynamics—Renal pelvis pressure‐flow relationship in pigs
Authors: Mortensen J. , Djurhuus J. C.
Published: March 2007

Intrapelvic pressure in relation to Row was studied in the normal pyeloureter of the pig at progressing flow rates from 0 to 20 ml per minute. The mean pelvic pressure; before perfusion was started, was 6.1 cm H2O, increasing to 19.4 cm H2O at the highest perfusion rate. A significant increment in pressure occurred at a perfusion rate between 2 and 4 ml per minute. Thereafter, the mean pressure rise was linear with a correlation coefficient of 0.987 and an inclination of 0.27 cm H2O per ml.

The study shows three phases of urine transport. At flow rates from 0 to 2 ml per minute, transport occurs at low pressure with a low resistance to flow through ureter. Between 2 ml and 4 ml per minute, a significant increase in intrapelvic pressure implicates an alteration of the peristaltic transport mechanism. It is presumed that the pressure increase is due to increased resistance in the ureter, probably caused by an impediment to passive filling. This impediment is probably due to the previous ureteral contraction, limiting the expansion of the fluid bolus. Above 4 ml per minute, transport takes place as a continuous flow through the ureter, which functions as a tube.
The motor nerve supply of the external urethral sphincter muscles: An electrophysiologic study
Authors: Vodusek D. B. , Light J. Keith
Published: March 2007

The term “intrinsic external urethral sphincter” has recently been applied to the striated muscle immediately surrounding the membranous urethra, thus distinguishing and separating it from the periurethral striated muscle which is a component of the pelvic floor. The innervation of the intrinsic external urethral sphincter is still controversial. Six male patients with a sustained spinal cord lesion above D‐4 underwent electrophysiological evaluation of the reflex and direct evoked responses to stimulation of the pudendal nerve branches in the perineal region. Recording of the motor unit potentials was performed using a catheter‐mounted concentric needle introduced into the intrinsic external urethral sphincter transurethrally. The results of this study indicate that the pudendal nerve, i.e., somatic, plays an important role in the innervation of the intrinsic external urethral muscle. It does not, however, exclude the possibility that the autonomic nervous system also innervates this muscle.
The after‐contraction in urodynamic micturition studies
Authors: Webster George D. , Koefoot R. Bruce , Zakrzewski Cary J. , Todd Shelby
Published: March 2007

The detrusor after‐contraction is an involuntary detrusor contraction occurring after the completion of voiding. These contractions were seen in the micturition studies of 20 patients undergoing videourodynamic study to investigate a variety of nonneurogenic urine voiding or storage problems. The contractions occurred in stable bladders on 15 of 20 occasions and only 2 of 20 cases exhibited obstructive urodynamics. Eleven of the 15 patients had hypersensitive bladders. We explore its possible etiology and conclude that it is of neither functional significance nor diagnostic value.
The failure of cystometry as a diagnostic aid in impotence
Authors: Fenemore Janet , Morales Alvaro , Condra Michael , Surridge David H.
Published: March 2007

Recent evidence suggests an increasing recognition of the importance of organic factors in the etiology of impotence. This recognition has spurred the development of indices to reliably differentiate between psychogenic and organic types. This paper reports findings from the evaluation of the cystometric (CMG) assessment in impotence. Forty‐one impotent patients, in whom etiology (organic or psychogenic) had been clearly established using independent criteria, were investigated. The results show that abnormal CMG findings occurred approximately equally in both diagnostic groups, and that CMG values could not be used as a reliable indicator of etiology in impotence.
Animal models for penile erection studies
Authors: Lue Tom F. , Umraiya Matadeen , Takarnura Takao , Schmidt Richard A. , Tanagho Emil A.
Published: March 2007

To study the various aspects of penile erection, we created two animal models: (1) a monkey model, by implanting electrodes around the cavernous nerves, and (2) a dog model, by implanting electrodes around the cavernous and pudendal nerves. The cavernous nerves, which are branches of the pelvic plexus, travel along the posterolateral aspect of the prostate to innervate the erectile tisue of the penis. Electrostimulation of the cavernous nerves in 15 dogs and three monkeys induced prolonged erection. Because the anatomy of the penis in these animals is very close to that in man they offer an excellent model for the study of penile erection.
Functional response of the rabbit urinary bladder to anoxia and ischemia
Authors: Levin Robert M. , Brendler Katharine , Van Arsdalen Keith N. , Wein Alan J.
Published: March 2007

The effects of in‐vitro anoxia and in‐vivo ischemia on bladder function were studied using the in‐vitro whole‐bladder model. In addition to assessing the ability of the bladder to empty, this system provides a quantitative measurement of contractile activity. Anoxia was produced by equilibrating the isolated bladder with nitrogen instead of oxygen and ischemia was produced by clamping the arteries supplying the bladder for a period of one hour. The results of these studies can be summarized as follows: (1) The contractile response of the bladder to bethanechol did not decrease until the oxygen tension fell below 20% of normal; below this value the response decreased rapidly. (2) The ability of the bladder to contract declined gradually, as did the intracellular concentration of adenosine triphosphate. (3) The ability of the bladder to empty was lost immediately upon changing to an anoxic medium, as was the ability of bethanechol to produce a sustained contraction. (4) The bladder was able to fully recover from 60 minutes of in‐vitro anoxia, whereas 60 minutes of in‐vivo ischemia resulted in a permanent reduction in the contractile response to bethanechol.
Effect of extracellular calcium and calcium‐blocking agents on detrusor contractility: An in vitro study
Authors: Finkbeiner Alex E.
Published: March 2007

The effects of varying concentrations of calcium in the bathing solution and the effects of varying doses of the calcium‐blocking agents verapamil, diltiazem, and nifedipine on baseline tension, magnitude, and frequency of spontaneous contractions and on the contractile responses to acetylcholine, bethanechol, and electrical stimulation were tested on guinea pig bladder muscle strips suspended in a muscle bath.

Over a wide range of calcium concentration (10−6 −4.8 × 10−3 M) no significant changes were noted in the aforementioned spontaneous and induced contractile activity. All parameters were, however, significantly depressed in a calcium‐free bathing solution.

At doses of 1.0 and 2.0 μg/ml bath each of the calcium‐blocking agents significantly depressed the aforementioned spontaneous and induced smooth muscle contractile activity.
The role of reflexes in modifying the response to bethanechol chloride: A basis for selectivity of action on the bladder
Authors: Downie J. W. , Moochhala S. M. , Bialik G. J.
Published: March 2007

When bethanechol is administered subcutaneously it induces a reflex‐dependent sustained bladder contraction, and causes significant salivation but has little effect on blood pressure or heart rate. This relative selectivity of action is important for the clinical utility of the drug. We tested the hypothesis that the absence of cardiovascular effects is due to reflex compensation by assessing bethanechol's actions after blocking these reflexes. In chloralose‐anesthetized cats the bladder was cannulated for pressure recording. Bethanechol (0.055–0.20 mg/kg SC) caused a sustained bladder contraction with no significant change in heart rate. During hexamethonium infusion (2 mg/min IV) SC bethanechol caused a fall in heart rate with no bladder contraction. Thus, strong cardiac compensatory reflexes normally prevent bethanechol‐induced bradycardia. The time course of bradycardia and bladder contraction in the same bethanechol injection were compared during blockade with the β1‐antagonist metoprolol (0.4 mg/kg IV). The nadir of the bradycardia did not coincide with the sustained bladder contraction. Furthermore, the time to peak bladder effect diminished with SC dose while the time to nadir of bradycardia did not. If the time course of the bradycardia reflects plasma bethanechol concentration, then triggering of the bladder reflex cannot be related directly to this level. The difference in latency may be related to distribution barriers or to response time differences.
The effect of aging on cholinergic receptor binding in the rat urinary bladder
Authors: Hayes Edward E. , McConnell Jo Ann , Benson George S.
Published: March 2007

Binding sites with high affinity and specificity for [3H]quinuclidinyl benzilate (QNB), a cholinergic muscarinic receptor antagonist, were found in homogenates of rat urinary bladder. Atropine and scopolamine inhibited 50% of the specifically bound [3H]QNB (IC50) at a concentration of approximately 2 nM, whereas the agonist oxotremorine had an IC50 of 580 nM. By contrast, the IC50 for the ganglionic nicotinic antagonist mecamylamine was greater than 100,000 nM. These values are similar to those reported for [3H]QNB binding sites in rat brain.

[3H]QNB binding was characterized in rat bladder obtained from animals aged 6, 16, and 26 months. No differences in either the number of binding sites or the affinity constant for the radioligand were noted between these groups, suggesting that there are no agerelated alterations in muscarinic receptor recognition sites in this organ.
Continuous overnight monitoring of bladder activity in vesicoureteral reflux patients: I. Method
Authors: Nielsen J. Bugge , Nøsrgaard J. P. , SøSrensen S. Schwartz , JøSrgensen T. Munch , Djurhuus J. C.
Published: March 2007

A measurement system for monitoring bladder activity during sleep has been established. It includes bladder pressure measurements via suprapubic catheters, measurements of abdominal pressure activity via a rectally placed catheter, measurements of pelvic floor activity via surface electrodes placed perianally, and detections of involuntary voidings during sleep by a specially designed marking and alarm system. The system has been applied to 50 children with vesicoureteral reflux. In 40 patients, monitoring succeeded without discomfort to the patients. Preliminary analysis revealed bladder activity in all patients during sleep, an activity which is undergoing further analysis.
Effect of bilateral sacral decentralization on detrusor contractility and passive properties in dog
Authors: Ghoniern Gamal M. , Regnier Claude H. , Biancani Piero , Johnson Lewis , Susset Jacques G.
Published: March 2007

A series of five dogs underwent complete parasympathetic decentralization through a lumbosacral laminectomy. A full‐thickness biopsy was taken from the anterior wall of the bladder before and 12 weeks after surgery. Both mucosa and adventitia were dissected out and muscle layer was cut into several consecutive longitudinal strips. Each strip was mounted in a muscle chamber and frequencyresponse curves were obtained at different pulse duration. Activelpassive force‐length relationships were then obtained under condi tions of maximal electrical stimulation (100 V, 2 msec, 40 cps), by stretching the strips in successive increments until length of maximal active force development was reached. Curves were normalized per unit cross‐sectional area of muscle. The maximum active stress of the specimens was taken as a measure of bladder contractility, and the rate of exponential increase in passive stress with strain (ratio of deformed to undeformed length) as a measure of detrusor stiffness.

Twelve weeks after detrusor decentralization the following changes were found: (1) The frequency that yielded maximum contraction was 10 cps at 2‐ and 5‐;msec pulse duration as compared to 40 cps in controls at every pulse duration. (2) The maximum active stress was 123.9 ± 13.8 vs 244.7 ± 24.7 gm/cm2 in controls (p<.001). (3) The level of strain corresponding to the maximal active stress was significantly reduced. (4) The stiffness of the bladder wall was markedly increased; the rate of exponential increase was 4.47 ± 0.63 vs 2.19 ± 0.42 in controls (p<.001). (5) Thickness of the bladder wall was significantly increased (7 ± 1 vs 4 ± 1 mm; p<.001). (6) Histology sections of the specimens demonstrated collagen infiltration in all layers as well as smooth muscle hyperplasia.

In summary, the effects of parasympathetic decentralization of the bladder wall are collagen infiltration, increased thickness, increased stiffness, and decreased contractility.
Urodynamic evaluation of the bilharzial urinary bladder
Authors: Abdel‐Hakim Amr , Shoukry Lsmail , Fam Aziz , Safwat Mohamed , Elhilali Mostafa M.
Published: March 2007

Urodynamic evaluations of 63 male bilharzial patients and 25 normal males were included in the present work. According to the uroflowmetric parameters, patients were classified into two groups: those with normal voiding (38 patients) and those with impaired voiding (25 patients). Fluid cystometry followed by a micturition study were conducted in all patients with impaired voiding, 14 patients with normal micturition, and for two of the control group. The urodynamic data were computed and analyzed. Nineteen patients with bilharzial calcification of the urinary bladder underwent the same urodynamic evaluation. No urodynamic differences were found between the control group, the patients with normal voiding, and the patients with bilharzial bladder calcification. Patients with impaired voiding showed a significantly lower peak flow and longer micturition time; the voiding pressures and the abdominal contribution (%) were also significantly higher. Three factors were associated with impairment of micturition in our patients: (1) bladder outlet obstruction, (2) hypoactive detrusor, and () high‐grade vesicoureteral reflux.
Intrinsic neuromuscular defects in the neurogenic bladder. 1. Short‐term ultrastructural changes in muscular innervation of the decentralized feline bladder base following unilateral sacral ventral rhizotomy
Authors: Elbadawi Ahmad , Atta Mohamed A. , Franck Joel L.
Published: March 2007

The morphology of cholinergic and adrenergic muscular nerves of the feline bladder base was studied ultrastructurally 2, 3, and 4 weeks following its decentralization by unilateral sacral ventral rhizotomy. In all samples, there was widespread transsynaptic degeneration of cholinergic axon terminals and varicosities, with loss of neuroeffector junctions. This was associated with preservation of most adrenergic axons, and — especially in the 4‐week samples—with concurrent early regeneration or sprouting in many cholinergic and adrenergic axons. The findings are discussed in relation to neural ultrastructure in other known models of axonal degeneration, and to the pathogenesis of neurogenic dysfunction of the parasympathetic‐decentralized bladder. The concurrent degenerative and early regenerative axonal changes herein observed in such a bladder (1) suggest that the degeneration of cholinergic axons occurring shortly after rhizotomy is reversible, and probably is compensated for by developing adrenergic hyperinnervation; (2) support the existence of mutual peripheral cholinergic/adrenergic neurotrophism in the vesical muscularis; and (3) provide a probable structural basis for the altered motor and autonomic drug responses of the parasympathetic‐decentralized bladder.
Comparative effects of five tricyclic compounds on the rabbit urinary bladder
Authors: Levin Robert M. , Wein Alan J.
Published: March 2007

The tricyclic antidepressant irniprarnine is widely utilized in treating a number of the disorders of micturition. Its effect on urinary tract smooth muscle is believed to occur through several mechanisms including direct antimuscarinic activity, direct smooth muscle relaxation, and indirectly by the inhibition of noradrenaline uptake into adrenergic neurons. The present study compared the potency of five tricyclic compounds on the contractile response of the rabbit urinary bladder to bethanechol. In addition, the direct antimuscarinic potency of these agents on radioligand binding to muscarinic receptors isolated from rabbit urinary bladder was determined.

Of the five agents tested (imipramine, desrnethylirnipramine, amitriptyline, nortripty‐line, and doxapine), doxapine was found to be significantly more potent than the other agents with respect to both antimuscarinic and musculotropic relaxant activity.
Effect of lsoproterenol and EGTA on the volume‐pressure relationship of the in vitro whole bladder preparation
Authors: Levin Robert M. , Goldman Michele , Wein Alan J.
Published: March 2007

In a previous study comparing the pharmacological response of smooth muscle strips isolated from rabbit urinary bladder with the response of the whole bladder preparation, we observed that although isoproterenol stimulated a marked decrease in isometric tension in the muscle strips, isoproterenol only slightly decreased intravesical pressure (whole bladder preparation).

We have recently modified our whole bladder system so that we can now quantitatively
determine the effect of drugs on bladder volume at constant pressure as well as on
intravesical pressure at constant volume. Using this system we have reinvestigated the
effect of isoproterenol and have demonstrated that although isoproterenol has only a slight
effect on intravesical pressure, this minor effect on pressure resulted in a marked increase
in whole bladder volume, and a corresponding increase in cystometric compliance.
Effect of metoclopramide on ejaculatory threshold in a group of premature ejaculators
Authors: Wabrek Alan J.
Published: March 2007

The exact etiology of premature ejaculation is not known. Recent data using rats has demonstrated that dopamine agonists can lower ejaculatory thresholds while pretreatment with substituted benzamides will block that effect. Metoclopramide, the only drug in the group available in the United States, and a placebo were given to 12 premature ejaculators in a double‐blind crossover fashion. Couples had intercourse on Wednesdays and Saturdays for four weeks. Ejaculatory latencies were recorded separately by husbands and wives on a 1–5 scale. There was no statistical difference in perception of ejaculatory latency between metoclopramide‐ and placebo‐treated coiti although the P values for the wives' perception was.067. An added observation was that approximately 80% of premature ejaculators had palmar hyperhidrosis. It is conjectured that early ejaculation and palmar hidrosis are manifestations of sympathetically mediated “overreactivity”.
The effectiveness of bethanechol chloride in lower motor neuron lesions: The importance of mode of administration
Authors: Awad Said A. , McGinnis Rosemary H. , Downie John W.
Published: March 2007

The therapeutic effectiveness of bethanechol has been the subject of controversy. This study documents its effectiveness in initiating micturition and lowering postvoid residual urine when given subcutaneously to seven patients with lower motor neuron lesions. By contrast, the effect was not as consistent when bethanecol was given orally. Disturbing side effects seem to occur with repeated subcutaneous administration. The development of methods by which serum levels could be accurately measured is recommended.
Possible errors in uroflowmetry
Authors: Lief Matthew , Khan Zafar , Leiter Elliot , Melman Arnold
Published: March 2007

The possibility of alteration of uroflow rates by rapid bladder filling was evaluted in 61 consecutive patients referred for urodynamic evaluation. Nine of the 28 patients who were able to void did in fact demonstrate a significant reduction in uroflow rates after the bladder had been rapidly filled. Thus, the manner of obtaining the uroflow should be taken into account when making a clinical decision based on that test.
Anti‐incontinence surgery in females with detrusor instability
Authors: Lockhart Jorge L. , Vorstman Bert , Politano Victor A.
Published: March 2007

Fifty‐eight females with clinical stress or stress and urge incontinence were evaluated urodynamically and treated surgically. Forty‐six females (group A) presented with a stable detrusor or low‐pressure instability (below 25 cm of water), and 12 (group B) had high‐pressure instability (above 25 cm of water). Overall surgical results were worse in group B. Analyzing the urodynamic and surgical results, detrusor pressure recording may have surgical predictive value.
Bethanechol chloride in urology—A discussion of issues
Authors: Downie John W.
Published: March 2007

The widespread and long‐standing use of bethanechol chloride in urology attests as much to the lack of a suitable alternative as it does to the drug's perceived efficacy. The bases for both positive and negative conclusions about bethanechol's usefulness are critically examined and areas of controversy and uncertainty highlighted. An attempt is made to rationalize bethanechol's effects in the light of recent investigations into its mechanism of action but clearly more information is required for a full understanding of the drug's action and its' appropriate place in urologic practice.
Urethral sensitivity to α‐adrenoceptor stimulation and blockade in patients with parasympathetically decentralized lower urinary tract and in healthy volunteers
Authors: Mattiasson Anders , Andersson Karl‐Erik , Sjöugren Christer
Published: March 2007

The urethral pressure responses to i.v. infusion of increasing doses of noradrenaline (NA) and to i.v. injection of a single dose of phentolamine were compared in male and female patients with parasympathetically decentralized lower urinary tract and in normal volunteers of both sexes. Maximum urethral pressure (MUP) was significantly lower in the patients than in the volunteers. NA caused a dose‐dependent increase in MUP in all subjects; the absolute increase was greater in the patients. However, even at the highest rates of NA infusion, the MUP of the patients did not reach the resting pressure of the normal volunteers', and the dose‐response relations for the NA effect did not differ between patients and normal subjects. Phentolamine reduced the urethral pressure significantly less in male volunteers than in the other subjects. It is concluded that patients with parasympathetically decentralized lower urinary tract have no urethral smooth muscle supersensitivity to NA, and that it cannot be excluded that the pelvic, parasympathetic innervation contributes to the regulation of pressure in both the male and female urethra.
Preoperative screening for latent stress incontinence in women with cystocele
Authors: Fianu Stefan , Kjaeldgaard Anders , Larsson Bertil
Published: March 2007

A preoperative urodynamic investigation with and without a vaginal pessary ring including simultaneous urethrocystometry and urethral pressure profiles in supine and standing position during coughing was evaluated in 41 continent women with cystocele. Following the application of the vaginal pessary ring, loss of urine was demonstrated in six patients, in whom a negative urethral closure pressure was found only when the pessary ring was inserted, suggesting that latent stress incontinence might become manifest after surgical repair of the cystocele. These patients were all continent during the follow‐up period of 12–18 months after Manchester repair combined with urethrocystopexy. The remaining 35 patients with normal urodynamic registrations with and without an inserted pessary ring had no signs of urinary incontinence during the follow‐up period after the Manchester repair. Thus, the present urodynamic screening was found to be valuable for preoperative selection of an adequate surgical method in order to avoid postoperatively manifest stress incontinence after anterior colporaphy.
Urethral sphincter EMG activity registered with surface electrodes in the vagina
Authors: Colstrup H. , Jørgensen L. , Lose G. , Kristensen J. K. , Andersen J. T. , Blaivas Jerry G.
Published: March 2007

Transvaginal registration of urethral sphincter EMG with surface electodes at the anterior vaginal wall has been compared to simultaneous registrations of urethral ring electrode EMG and anal surface electrode EMG in 12 patients. We found that the transvaginal EMG was almost identical to the intraurethral EMG during different pelvic floor muscle activities but differed considerably from the perianal EMG. The clinical applicability was investigated during medium‐fill water cystometry followed by pressure‐flow studies, and in 21 out of 25 patients, a satisfactory EMG was registered.
Ultrastructure of vesicourethral innervation: IV. Evidence for somatomotor plus autonomic innervation of the male feline rhabdosphincter
Authors: Elbadawi Ahmad , Atta Mohamed A.
Published: March 2007

The male feline rhabdosphincter was studied ultrastructurally to define the patterns of innervation of its fibers. Two types of neural junctions were observed: classical neuromuscular junctions with motor end‐plates (of both the en plaque and en grappe types), and surface junctions without any specialization of the related muscle fibers. The former represent somatomotor cholinergic, and the latter most likely autonomic cholinergic, adrenergic, and probable co‐peptidergic neuromuscular junctions. These findings confirm the theory of triple innervation of the male feline rhabdosphincter, which was introduced originally on a histochemical basis.
Sympathetic inhibition of reflex activation of bladder motility during filling at a physiological‐like rate in urethane anaesthetized rats
Authors: Maggi Carlo Alberto , Santicioli Paolo , Meli Alberto , Downie John W.
Published: March 2007

The mean volume of saline (infused at a physiological‐like rate) required to elicit neurogenic rhythmic contractions of the detrusor muscle (micturition threshold) in urethane anaesthetized rats was reduced by reserpine pretreatment, as well as by chemical (6‐hydroxydopamine) or surgical sympathectomy (bilateral section of the hypogastric nerves). Propranolol pretreatment had no significant effect on micturition threshold but increased the intraluminal pressure at which the rhythmic contractions occurred. In spinal rats (T12L1) a flat pressure volume curve was obtained with only a minor phasic contractile activity. Propranolol administration or bilateral section of the hypogastric nerves significantly increased the intraluminal pressure response to saline filling in spinal rats. Topical tetrodotoxin increased the intraluminal pressure response to saline filling in control spinal rats but not following propranolol administration or bilateral section of the hypogastric nerves. These findings provide evidence for a sympathetic inhibition of the reflex activation of the detrusor muscle in response to a physiological‐like filling of the urinary bladder.
The routine assessment of detrusor contraction strength
Authors: Griffith D. J. , van Mastrigt R.
Published: March 2007

A method is described for the semiquantitative assessment of the strength of the detrusor contraction during any voiding for which the detrusor pressure, flow rate, and residual urine are measured. A computer is used to produce plots of detrusor pressure vs detrusor shortening velocity throughout voiding. The adequacy of the contraction can be followed through micturition until the bladder is nearly empty. In some cases the isovolumetric detrusor pressure and the maximum potential velocity of shortening of the detrusor can be estimated. The ranges of values found are comparable with those deduced from the stop test, although there are slight discrepancies. The median values of these two parameters form the basis of the routine method that can be used for any detrusor contraction.
Simultaneous urethrocystometry and hyperactive bladders: A manometric differential diagnosis
Authors: Penders L. , De Leval J.
Published: March 2007

The authors reviewed simultaneous urethrocystometry (SUCM) in 96 patients with hyperactive bladders subclassified into four groups (pure detrusor instability, mixed instability, suprasacral spinal lesion, and CNS lesion) and compared the incidence of various urethral parameters. The absence of urethral relaxation before or during the augmentation of the detrusor pressure is the most specific sign of suprasacral spinal lesions. It constitutes what we call passive or tonic dyssynergia. When, at the beginning of SUCM, the maximal closure pressure is > 30 cm H2O, or when a sphincteric contraction is associated with, either before (“kick”) or during (active or clonic dyssynergia) the detrusor contraction, this urethral nonrelaxation is pathognomic of such a spinal lesion. A “kick” is also specific of hyperreflexia but is less constant. On the contrary, in this series and with this technique, an active dyssynergia has no etiological significance; it only reflects the degree of the vesico‐urethral imbalance. This study further supports the importance of the brain stem in controlling and coordinating the vesicosphincteric unit.
Neurogenic bladder dysfunction in sacral agenesis and dysgenesis
Authors: Jakobsen Henrik , Holm‐Bentzen Merete , Hald Tage
Published: March 2007

In seven adult patients suffering from congenital caudal spinal malformations including total agenesis, dysgenesis, and dysraphism of the sacral bones, the neurological and the neurogenic bladder disorders are described. Based upon clinical, radiological, and urodynamic investigations, previous observations were confirmed of the wide spectrum of micturition disorders in this type of patient. In three females and four males (median age 30 years, range 19–51 years) a wide spectrum of neurogenic bladder disorders ranging from complete suprasacral to complete infrasacral lesions was found. In one patient, no evidence of sensory‐motor bladder nerve deficiency was found. The finding of neurologic damage not corresponding to the levels of bone lesions and the high proportion of patients suffering from concurrent genitourinary developmental defects should emphasize the need for thorough and frequent investigations including urodynamics and monitoring of renal function.
Bladder and urethral pressures during bladder filling in patients with multiple sclerosis and urge incontinence
Authors: Kinn Anne‐Charlotte , Nergårdh Arne , Sidén ÅKe
Published: March 2007

Twenty patients with multiple sclerosis and distressing urge incontinence underwent continuous measuring of bladder and urethral pressures during bladder filling. Hyperreflexia with high‐pressure peaks resulted in more excessive leakage than detrusor instability with frequent recurring pressure rises of low amplitude and short duration. Atropine reduced leakage by decrease of amplitude as well as frequency of the detrusor contractions. In some patients atropine also normalized urethral instability. Thus it seems probable that both hyperreflexia and instability in patients with multiple sclerosis are mediated by cholinergic neurones in the bladder wall.