bluuebunny/crossref_metadata_2025 huggingface dataset:
Long‐term follow‐up of sphincterotomy in the treatment of autonomic dysreflexia
Authors: Ricottone Anthony R. , Pranikoff Kevin , Steinmetz James R. , Constantino Georgeann
Published: March 2007

Autonomic dysreflexia (AD) is a syndrome affecting a majority of patients with high spinal cord lesions. An association between AD and detrusor‐sphineter dyssynergia (DSD) is often seen. Between 1980 and 1988 we performed 51 transurethral sphincterotomies in 38 patients. Twelve of these patients underwent procedures primarily for the prevention of AD related to bladder distension. This study presents their long‐term follow‐up.

One patient was lost to follow‐up secondary to unrelated death; the remaining 11 patients were followed on average 117.5 months (94–154) after the initial operative procedure. Repeat sphincterotomy was required in 9 of 11 patients (82%) Six (66% ) of these were performed within 24 months. One patient (11%) required delayed sphincterotomy greater than 100 months from the initial procedure. Overall, sphincterotomy was successful in controlling symptoms of AD in 10 of 11 (91%) patients. No major complications were recorded. Sphincterotomy is a sate and effective treatment for AD associated with DSD, however long‐term urologic follow‐up and management are necessary. © 1995 Wiley‐Liss, Inc.
Non‐operative management of the urinary tract in spinal cord injury
Authors: Dmochowski Roger R. , Ganabathi Kumaresan , Leach Gary E.
Published: March 2007

Various options exist for the management of the lower urinary tract in chronic spinal cord injury. These options include chronic indwelling catheterization, urethral sphincterotomy, and intermittent catheterization supplemented with anticholinergic agents.

Sixty‐four spinal cord injured patients, treated with intermittent catheterization and anticholinergic therapy, were evaluated for long‐term efficacy in maintaining upper tract status and preservation or improvement in continence. Complications of therapy were also evaluated. Therapy was based upon initial urodynamic evaluation followed by limited subsequent evaluation of the urinary tract.

Mean follow‐up was 54 months. Only I patient developed hydronephrosis. Fifty‐nine patients either became continent or experienced improved continence on therapy Eight patients required surgical procedures either to increase outlet resistance (2) or to decrease intravesical pressures (6).

The most common complication of therapy was urinary tract infection. Thirty‐nine infections occurred in 23 patients, 16 of which were febrile. Fifteen patients were non‐compliant with treatment recommendations. The only factor related to therapeutic complications which reached statistical significance was non‐compliance with therapy.

The combined use of intermittent catheterization and anticholinergic agents provides an effective means to prevent hydronephrosis and establish continence in chronic spinal injury. © 1995 Wiley‐Liss, Inc.
Fate of the upper urinary tract in multiple sclerosis
Authors: Kasabian Nabet G. , Krause Ira , Brown Wendy E. , Khan Zafar , Nagler Harris M.
Published: March 2007

Urologic problems arc a major source of morbidity for patients with multiple sclerosis (MS). Fifty‐four to 78% of patients experience bladder symptoms which are due to spinal lesions interrupting neural pathways that control micturition. MS patients could have upper or lower motor neuron lesion type bladders. Both obstructive and irritative symptoms may be present. Although lower urinary tract dysfunction has been well described in MS, few studies have investigated the fate of the upper urinary tract.

Thirty‐two patients with MS were referred for urodynamic evaluation. Twenty‐six of the 32 patients had upper urinary tract studies performed. Only I of the 26 patients had evidence of upper urinary tract deterioration It is our impression that upper tract deterioration occurs infrequently in these patients. We discuss clinical clues that may predict deterioration. © 1995 Wiley‐Liss, Inc.
Location and concentration of estrogen, progesterone, and androgen receptors in the bladder and urethra of the rabbit
Authors: Rosenzweig Bruce A. , Bolina Parminder S. , Birch Lynn , Moran Catherine , Marcovici Iacob , Prins Gail S.
Published: March 2007

The objective of this study was to determine location and concentration of estrogen, androgen and progesterone receptors in the bladder and urethra of the rabbit. Two urethral and two bladder specimens were obtained from four 12‐week‐old female New Zealand white rabbits. Rat monoclonal antibody (AN 1–15) to human androgcn receptor and (H222) to human estrogen receptor and mouse monoclonal antibody (PR6) to chicken progesterone receptor were used. Immunocytochemical staining was performed and specimens were evaluated lor presence and location of steroid receptors. Androgen receptors were found in the highest concentrations in urethral and bladder epithelium. Low to low/moderate concentration were found in smooth muscle. Estrogen receptors were found in moderate to moderate/high concentrations in urethral epithelium and bladder and urethral smooth muscle. Progesterone receptors were not found in appreciable concentrations from any location, though the animals were not pretreated with estrogen. The rabbit model suggests a mechanism by which estrogen therapy can be effective in treating postmenopausal lower urinary tract symptoms. Progesterone receptors were not found in appreciable concentrations, suggesting progesterone therapy may not diminish the effectiveness of estrogen therapy by acting on urethral progesterone receptors. The effect of androgcns on the lower urinary tract needs further investigation to determine if androgen therapy can alleviate lower urinary tract symptoms. © 1995 Wiley‐Liss, Inc.
Passive urethral resistance to dilation in healthy women: An experimental simulation of urine ingression in the resting urethra
Authors: Bagi Per , Thind Peter , Nordsten Merete
Published: March 2007

The dynamic urethral pressure response to a simulated urine ingression was studied at the bladder neck, in the high pressure zone, and in the distal urethra in 10 healthy female volunteers. The pressure response was characterised by a steep pressure increase simulataneous with the urethral dilation, followed by a decay during the next seconds until a new equilibrium pressure was reached. The pressure decay could be described by a double exponential function in the form Pt = Pequ + Pαe‐t/τα + Pβct/τβ, where Pt represents the pressure at the time t, Pequ represents the pressure at equilibrium, Pα and Pβ express the decline in pressure, and τα and τβ are time constants. The size of the pressure response proved highly dependent on velocity and size of dilation as well as urethral site of measurement, with the maximum values in the high pressure zone. The time constants, on the other hand, were uninfluenced by these factors.

The pressure response represents an integrated stress response from the surrounding tissues which may reflect the visco‐elastic properties of the structures involved. The findings indicate that striated muscle fibres are of dominating significance for the pressure response, and the varying size of the response along the urethra is in accordance with the localization of the horseshoe‐shaped rhabdosphincter, which quantitatively is the dominating circularly arranged structure around the female urethra.

Functionally, the stress response will oppose any dilation, and increasingly with rising size or velocity of dilation. But even though this reaction seems to represent a forceful mechanism prepared instantaneously to assist in securing continence, it is not energy consuming, and consequently is a very economic additive to the urethral closure mechanism. © 1995 Wiley‐Liss, Inc.
Exercise pad testing in continent exercisers: Reproducibility and correlation with voided volume, pyridium staining, and type of exercise
Authors: Nygaard Ingrid , Zmolek Gwen
Published: March 2007

This study was undertaken to determine normal values for a modified pad test to be used for testing outcomes of studies addressing therapy for exercise incontinence. Fourteen asymptomatic volunteers who were continent by history completed three similar exercise sessions wearing pre‐weighed pads after ingesting phenazopyridine hydrochloride (Pyridium, Parke‐Davis, Sandy. UT). The mean pad weight gain for all exercise sessions combined was 3.19 ± 3.16 g (range 0.1–12.4). The mean area of pyridium staining was 2.66 ± 3.14 mm. Mean volume voided after the exercise sessions was 193 ± 108 cc (range 10–625). The Kendall coefficient of concordance used to test the intertest reliability was 0.96 for pad weight gain, 0.76 for area of stain, and 0.60 for volume voided. All but one of the subjects had at least one spot of pyridium stain on at least one of the three pads. The increase in pad weight attributable to sweat and vaginal moisture is reproducible in a given individual performing the same exercise routine, but due to the large variation between subjccts, we were unable to establish a cut‐off value separating continence from incontinence. Adding pyridium did not improve the specificity o f the test, despite instructing subjects to milk the urethra and blot before applying the pad. © 1995 Wiley‐Liss, Inc.
Short forms to assess life quality and symptom distress for urinary incontinence in women: The incontinence impact questionnaire and the urogenital distress inventory
Authors: Uebersax John S. , Wyman Jean F. , Shumaker Sally A. , McClish Donna K.
Published: March 2007

This article describes short form versions of the Incontinence Impact Questionnaire (IIQ) and the Urogenital Distress Inventory (UDI). These instruments assess life impact and symptom distress, respectively, of urinary incontinence and related conditions for women. All subsets regression analysis was used to find item subsets that best approximated scores of the long form versions. The approach succeeded in reducing the 30‐item IIQ and the 19‐item UDI to 7‐ and 6 item short forms, respectively. The short form versions may be more useful than the long form versions in many clinical and research applications. © 1995 Wiley‐Liss, Inc.
Autonomic dysreflexia in a rat model spinal cord injury and the effect of pharmacologic agents
Authors: Rivas David A. , Chancellor Michael B. , Huang Bin , Salzman Steven K.
Published: March 2007

The object of this study was to develop a spinal cord injury (SCI) rat model for autonomic dysreflexia (AD), assessing the effect of alpha‐adrenergic and calcium channel blockade and to determine the relationship of detrusor‐external sphincter dyssynergia (DKSD) to the development of AD. A laminectomy was performed in male rats at the T4 or TI0 level and a controlled 50 g cm blunt SCI was induced using an impounder. Four weeks after injury, changes in arterial blood pressure and heart rate were monitored while simultaneous cystometry (CMG) and pelvic floor electromography (EMG) were performed in vivo in sham (control) and spinal cord injured rats. The effects of terazosin (0.1 mg/kg). diltiazem (0.5 mg/kg). and oxybutynin chloride (0.1 mg/kg) on hemodynamic changes were assessed independently. Both T4 and TI0 SCI rat displayed evidence of DESD (enhanced pelvic floor EMG activity at cystometric capacity) while control rats did not. Only T4 injured rats exhibited evidence of AD, with mean blood pressure elevations from 82.9 ± 13.6 to 93.9 ± 11.3 mm Hg (P < 0.01) and a mean heart rate decrease from 332.2 ± 56.5 to 311.1 ± 54.5 beats/min (P = 0.02) at cystometric capacity. The intravenous administration of terazosin or diltiazem abolished the AD response during CMC. The administration of oxybutynin exhibited the ability to increase bladder capacity and improve compliance in all 3 groups but did not blunt AD. The rat model of SCI effectively reproduced hemodynamic changes consistent with the AD complex in T4 level SCI but not TI0 level SCI animals, despite incomplete lesions. Blockade with either an alpha‐1 or a calcium channel antagonist effectively ablated the AD response to bladder distention. Anticholinergic agents had no effect on AD DESD frequently accompanies autonomic dysreflexia, although the development of AD is not a prerequisite for DESD. © 1995 Wiley‐Liss, Inc.
Response of guinea pig smooth and striated urethral sphincter to cromakalim, prazosin, nifedipine, nitroprusside, and electrical stimulation
Authors: von Heyden Burkhard , Riemer R. Kirk , Nunes Lora , Brock Gerald B. , Lue Tom F. , Tanagho Emil A.
Published: March 2007

Prazosin (an alpha‐1‐adrenergic blocker) and cromakalim (potassium channel opener), given alone, induced significant fatigue of the urethral sphincter at a concentration of 10−4 M; both drugs combined achieved a significant sphincteric fatigue at a concentration of 10−5 M each. To 10−4 M hexamethonium (ganglionic smooth muscle blocker) and 10−4 M decamethonium (nicotinic blocker of striated muscle) the striated urethral sphincter responded like striated muscle with no detectable function of its smooth muscle component. Therefore, the striated component seems to play a dominant role in sphincteric function. With calcium depletion or in the presence of a calcium channel blocker (10−4 M nifedipine) the urethral sphincter showed a relative enhancement of response to electrical field stimulation when compared with smooth and skeletal muscle, whose responses were both significantly reduced. This phenomenon could not be explained with calcium‐dependent, inhibitory, nitric oxide‐releasing nerves, as the NO‐synthase blocker N‐nitro‐L‐arginine (10−5 M to 5 × 10−4 M) failed to induce the enhancement of sphincter contraction during electrostimulation found with calcium depletion. Still, NO‐releasing nerves might play a role in sphincteric relaxation because sodium nitroprussidc (10−5 M) induced a significant relaxation of the urethral sphincter precontracted with 80 mM potassium. The potential to weaken sphincteric closure with drugs, exemplified by the results obtained in response to prazosin and cromakalim, would represent a therapeutic advance in the patient with neurogenic bladder dysfunction. © 1995 Wiley‐Liss, Inc.
Blood flow rate and total blood flow related to length density and total length of blood vessels in mini‐pig urinary bladder after chronic outflow obstruction and after recovery from obstruction
Authors: Nielsen K. K.
Published: March 2007

Chronic partial bladder outlet obstruction was created in mini‐pigs by implanting a 6–7 mm ring around the proximal urethra. After a median obstruction period of 63 days the ring was removed, and after a median recovery period of 60 days the animals were sacrificed. At each study occasion the blood flow rate (ml per 100 g per min) was measured by washout of locally injected 133Xe in the bladder wall and the washout curves analyzed by the corrected initial slope method. Stereological estimation of length density and total length of blood vessels in the bladder were performed.

The results can be summarized as follows: (1) no differences in the blood flow rate at the time of ring implantation, obstruction, or recovery, (2) no decrease in the blood flow rate in normal bladders after bladder distension, (3) a significant decrease in blood flow rate in obstructed bladders after distension, (4) a 6‐fold increase in total bladder blood flow after obstruction, (5) an unchanged blood flow per length of blood vessels per min during the study, (6) no changes in length densities of blood vessels during the study, and (7) a 7‐fold increase in total length of blood vessels after obstruction and reversion to control level after recovery. The unchanged blood flow per length of vessels implies that capillary proliferation matched the increased bladder mass during the study. © 1995 Wiley‐Liss, Inc.
Imaging of pelvic floor contractions using MRI
Authors: Christensen L. L. , Djurhuus J. C. , Constantinou C. E.
Published: March 2007

Magnetic resonance was used to visualize the effect of voluntary pelvic floor contractions on the abdominal structures with particular emphasis in determining the dynamic relationship between the bladder and surrounding organs. The pelvic floor was imaged in 6 asymptomatic female volunteers using MRI viewed in seven coronal and seven sagittal planes. The relative displacement of the bladder resulting from voluntary pelvic floor contraction was measured and the changes from the relaxed to the contracted stage were identified. Measurements from sagittal images show superior bladder wall movement of 3.8 ± 1.3 mm, posterior of 7.0 ± 2.8 mm, while maximum movement in the gluteal region was 3.5–4.0 mm. The results show that voluntary contractions of the pelvic floor measured and visualized using this technique can be identified and displayed using image processing techniques. Anatomical displacement of the bladder in the superior direction is illustrated, demonstrating that pelvic floor contraction provides increased levator muscle support. There is no significant displacement of the anterior aspect of the bladder, while the posterior wall demonstrates maximum movement. © 1995 Wiley‐Liss, Inc.
Reduced variance of latencies in pudendal evoked potentials after normalization for body height
Authors: Nikiforidis G. , Koutsojannis C. , Giannoulis S. , Barbalias G.
Published: March 2007

The value of the Somatosensory Evoked Potentials (SEP) in the assessment and detection of neurological disorders could be considerably enhanced if the normative standards of (SEP) characteristic parameters were normalized taking into account all other systematic sources of variance. The present study examines the influence of body height on the peak and interpeak latencies of the pudendal somatosensory evoked potentials. We examined the peak latency (L1) of the evoked potential recorded at the L1 vertebra and the onset latency (ONc) of the cortical evoked potentials, after stimulation of the pudendal nerve, as a function of body height in 40 normal male subjects (age 20–40 years). Significant positive correlation was found between both (ONc) latency and ONc‐L1 interpeak latency and body height (H). Assuming that the latter is proportional to the length of the neural pathways, the experimental data were fitted using a theoretical model representing the conduction in the sensory neuraxis as a function of body height. Using the estimated fitting functions, we normalized our data with regard to a typical value of body height. The normalized values of the aforementioned latencies reveal a significantly reduced variance, as compared to the original ones, and consequently their diagnostic importance is significantly increased. Similar procedures applied to the L1 (spinal) latencies and the latencies of the bulbocavernosus reflex (BCR) reveal no correlation with body height and this is discussed on the basis of neuroanatomical considerations. © 1995 Wiley‐Liss, Inc.
Neurogenic bladder in patients with acquired immunodeficiency syndrome
Authors: Menéndez V. , Valls J. , Espuña M. , Pérez A. , Barranco M. A. , Carretero P.
Published: March 2007

We have performed a urodynamic study on 3 patients with acquired immunodeficiency syndrome (AIDS), presenting with a neurogenic bladder. The first patient had an ascending myelitis of probable herpetic origin, the second patient had a cerebral abscess caused by Toxoplasma gondii, and the third patient had an AIDS dementia complex. The urodynamic study showed an arreflexic detrusor in the first 2 patients, and a hypereflexic detrusor in the third patient. © 1995 Wiley‐Liss, Inc.
Use of injectable fat to obstruct the urethra in rabbits
Authors: Canning Douglas A. , Seibold Jöerg , Saito Masahiko , Zderic Stephen A. , Snyder Howard M. , Duckett John W. , Levin Robert M.
Published: March 2007

Bulking agents have been injected to correct urinary incontinence for at least 15 years. The injection seeks to increase bladder outlet resistance by partially obstructing the urethra and thereby reduce urinary leakage in patients with stress urinary incontinence. Although the implant is effective and requires a shorter in‐hospital stay than more traditional procedures, no ideal implant substance has been discovered. To assess the effectiveness of injected fat as a bulking agent, we injected small volumes of perivesical fat into the bladder neck in New Zealand White (NZW) rabbits and tested the effect on the bladder. In eight rabbits, we harvested perivesical fat and partially closed the urethral lumen with an initial injection. A second injection 1 month later completely closed the urethral lumen. We injected six other rabbits with similar volumes of saline as controls. Two weeks after the second injection, we measured micturition frequency, bladder weight, response to electrical field stimulation, and response to bethanecol in each group. Fat implants were present at the injection site in each case 4 weeks after the first injection. Rabbits receiving fat implants had increased micturition frequency, increased bladder weight, and increased response to bethanecol and field stimulation. Previous studies have demonstrated that these changes are characteristic of mild outlet obstruction in rabbits. Injected fat can be made to close the urethra and create bladder outlet obstruction in rabbits. The short‐term success of fat as a bulking agent in this experiment is encouraging and suggests the need for longer term studies. © 1995 Wiley‐Liss, Inc.
Morphological, stereological, and biochemical analysis of the mini‐pig urinary bladder after chronic outflow obstruction and after recovery from obstruction
Authors: Nielsen K. K. , Andersen C. B. , Petersen L. K. , Oxlund H. , Nordling J.
Published: March 2007

Chronic partial bladder outlet obstruction was created in nine mini‐pigs by implanting a 6–7 mm ring around the proximal urethra. After a median obstruction period of 63 days, the ring was removed and after a recovery period of median 60 days the animals were sacrificed. Changes in muscle and connective tissue were assessed by unbiased, modern morphometry and biochemical analysis After obstruction the results were as follows: (1) a 6‐fold increase in bladder weight, (2) a 2.5‐fold increase in smooth muscle cell size, (3) a 3‐fold increase in smooth muscle cell number, (4) unchanged proportions between muscle and connective tissue, (5) unchanged hydroxyproline concentrations, (6) an 8‐fold increase in total collagen content, (7) an increase in the ratio of type I/III collagen, and (8) a 7‐8‐fold increase in total content of type I and III collagen. All changes were markedly, though incompletely, reversed after recovery, except smooth muscle cell number and the ratio of type I/III collagen. © 1995 Wiley‐Liss, Inc.
Long‐term results and complications using augmentation cystoplasty in reconstructive urology
Authors: Flood Hugh D. , Malhotra Sumeeta J. , O'Connell Helen E. , Ritchey Michael J. , Bloom David A. , McGuire Edward J.
Published: March 2007

One hundred and twenty‐two augmentation cystoplasties performed over an 8‐year period were reviewed. Mean age at surgery was 37 years (range 2–82 years). There were 82 female patients. The primary urodynamic diagnosis was reduced compliance in 92 (77%) pattenls and detrusor hyperreflexia/instability in the remainder. The clinical diagnostic groups were: spinal cord injury/disease in 32 (27%), myelodysplasia in 27 (22%), interstitial cystitis in 21 (17%), idiopathic detrusor instability in 13 (11%), radiation cystitis in 8 (7%). Hinman‐Allen syndrome in 5 (4%), and miscellaneous in 11 (9%). A detubularized, ileal augmentation was used in 82 (67%) patients. In 36 (30%) a detubularized ileocecocystoplasty was fashioned and in the remainder detubularized sigmoid was used. In 19 patients augmentation accompanied undiversion. Sixteen patients had a simultaneous fascial sling for urethral incompetence. Mean follow‐up was 37 months (range 6–96 months). There was no postoperative mortality. During follow‐up 4 patients died from unrelated causes, 11 have been lost to follow‐up, and 5 patients await planned transplantation. Bladder capacity was increased from a preoperative mean of 108 ml (range 15–500 ml) to 438 ml (200–1,200 ml) postoperatively. Of the 106 assessable patients, 80 (75%) had an excellent result, 21 (20%) were improved, and 5 (5%) had major ongoing problems.

During the period of follow‐up, 17 (16%) patients underwent revision of their augmentation. Twenty‐four (21%) patients developed bladder stones and 30% of these did so more than once. Urinary incontinence became manifest in 15 (13%) patients but required surgical treatment in only half of these. Pyelonephritis occurred in 13 (11%) patients. Five patients developed small bowel obstruction following discharge from hospital. There were 7 instances of reservoir rupture in 5 (4%) patients. Augmentation cystoplasty has a pivotal role in the treatment of a broad range of lower and upper urinary tract problems. Careful patient selection and close follow‐up are essential. © 1995 Wiley‐Liss, Inc.
New method to quantify the urodynamic improvement when treating bladder outlet obstruction: The efficacy of transurethral resection in benign prostatic hypertrophy
Authors: Spángberg Anders , Folkestad Bengt , Kristjánsson Baldvin , Ask Per
Published: March 2007

A method to measure the urodynamic improvement when treating urethral obstruction is introduced and applied to patients with benign prostatic hypertrophy. The patients performed pressure‐flow studies before and 3–6 months after TUR‐p. The urethral resistance relation was estimated by curve fitting in the pressure flow plot. The new method quantifies the improvement in urethral resistance as the distance between the urethral resistance relation before and after treatment expressed in pressure units. The distance is measured at the flow rate equal to 75% of the maximum flow rate for the micturition with the lowest maximum flow rate and this distance is called δ‐URA.

The median improvement after TUR‐p was 71 cm H2O (range 2–119). The improvement was strongly correlated to the resistance before treatment and the regression line indicates that the operation normalizes the resistance irrespective of its preoperative value. On the average a lowering of the urethral resistance relation with 8 cm H2O improved the maximum flow rate with 1 ml/s.

The greatest advantage with the new method is that it has a high validity and is almost completely insensitive to changes in contractility. © 1995 Wiley‐Liss, Inc.
Urethral pressure increase on effort originates from within the urethra, and continence from musculovaginal closure
Authors: Petros P. E. Papa , Ulmsten U.
Published: March 2007

The aim of the study was to determine the contribution of intra‐abdominal pressure transmission to urinary continence in the female. Five patients with genuine stress incontinence (GSI) were studied. Pressure transmission was measured in equivalent positions inside and outside the urethra and bladder during the Intravaginal Slingplasty procedure, a surgical operation used for treatment of urinary incontinence, and performed under local anaesthesia. A 6 mm diameter channel was created alongside the urethra. Two separate microtransducer catheters appropriately marked for length were inserted, one inside the urethra, and the other inside the described channel. With the vaginal hammock intact, an average of 10 simultaneous pressure measurements were made intraoperatively in response to coughing and straining in equivalent positions inside the urethra, and directly outside. Significantly higher pressure readings were found inside the urethra (P = 0.0025), indicating that an active component within the urethra may have created this pressure rise.

After opening out two suburethral vaginal flaps, large quantities of urine were lost on coughing in all patients Continence was achieved on tightening the suburethral vagina, indicating that an adequately tight vaginal hammock is a critical element in the continence process. The findings of this study question intraabdominal pressure as a mechanism contributing to continence, but support an alternative mechanism, musculovaginal closure of the urethra. © 1995 Wiley‐Liss, Inc.
Transurethral sphincterotomy in quadriplegic patients: Long‐term‐follow‐up
Authors: Noll Friedhelm , Sauerwein Dieter , Stohrer Manfred
Published: March 2007

Sphincterotomy was the treatment of choice in spinal cord injured patients with reflex bladder activity and detrusor sphincter dyssynergia after World War II. However, nowadays the conversion of a spastic bladder into a low pressure reservoir by medication or operalively has become a more favourable bladder management. Only in quadriplegic patients who are not able to perform sclf‐catheterization, this treatment modality seemed to be an alternative. With twelve o'clock Sphincterotomy, urodynamic parameters of the lower urinary tract can be brought to favourable measures (leak‐point, residuals). However, the reoperation rate for the maintenance of these urodynamic results is high (57%). Laser Sphincterotomy seems to be advantageous in this respect, as it reduces the need for resphincterotomy significantly. Additionally, 14% of the patients needed operations, which made condom fixation possible Upper tract could only be preserved if Sphincterotomy is done early enough. Patients who do not empty completely while in the wheelchair are at risk to develop a hydronephrosis. © 1995 Wiley‐Liss, Inc.
Transrectal ultrasound guided needle electromyography of the urethral sphincter in males
Authors: Hasan S. Tahseen , Hamdy Freddie C. , Schofield Ian S. , Neal David E.
Published: March 2007

Needle electromyography (EMG) of the urethral sphincter in males is commonly performed using a transperineal approach. The technique involves transcutaneous insertion of an EMG needle into the sphincter guided by the investigator's finger placed in the rectum.

We describe a new method of needle placement into the urethral sphincter in males using transrectal ultrasound (TRUS). With the patient in the left lateral position, the apex of the prostate gland is identified in the longitudinal plane. Using the TRUS biopsy channel, a specially designed long EMG needle is inserted into the sphincter commencing approximately 1.5–2 cm distal to the prostatic apex in an oblique fashion. This method allows precise identification of the site for needle insertion, reducing blind attempts at localization. The transrectal route is much less uncomfortable to patients, potentially improving patient compliance and overall effectiveness of the technique. © 1995 Wiley‐Liss, Inc.
New and simplified vaginal approach for correction of urinary stress incontinence in women
Authors: Falconer Christian , Larsson Bertil
Published: March 2007

Twenty‐lour patients with urodynamically confirmed urinary stress incontinence were operated upon with a new and simplified vaginal approach. This new technique is a simplification of a previously described transahdominal surgical method, in which a two‐component fibrin sealant (TisselR) was used. The sealant resulted in an excess of fibrin, which induced fibrosis. securing the urethrovesical junction in an elevated position to the retropubic periosteum.

In the present study, the sealant was deposited retropubically with a specially designed needle through the anterior vaginal wall. A great advantage with this procedure is that only local anesthesia is used and the patient can leave the outpatient clinic I hour after the operation The minimum duration of the follow‐up period was 18 months The success rate was as high as 6.3%, and no side effects were observed. © 1995 Wiley‐Liss, Inc.
Length density and total length of acetylcholinesterase positive nerves related to cystometry and in vitro studies of muscle strips in mini‐pig urinary bladder after chronic outflow obstruction and recovery from obstruction
Authors: Nielsen Kurt K. , Andersen Claus B. , Kromann‐Andersen Bjarne , Nordling Jørgen
Published: March 2007

Chronic partial bladder outlet obstruction was created in mini‐pigs by implanting a 6–7 mm ring around the proximal urethra. After a median obstruction period of 63 days, the ring was removed and after a median recovery period of 60 days the animals were sacrificed. At each occasion stepwise cystometry, measurement of residual urine, muscle strips studies with electrical and carbachol stimulation, and Stereological estimations of length density and total length of acetylcholinesterase positive nerves were performed. The results can be summarized as follows: (1) unchanged sensitivity of muscle strips to carbachol, but markedly decreased contractility and rate of contraction to carbachol, (2) no evidence of detrusor instability, but severely decompensated bladders in two pigs. (3) a significant increase in residual volume, (4) a pronounced decrease in length density and total length of acetylcholinesterase positive nerves, and (5) at field stimulation strips from some pigs showed increased sensitivity and contractility with high atropine and TTX resistance, while strips from the other pigs revealed decreased sensitivity and markedly decreased contractility to eletrical stimulation. In general, most of the changes were markedly, though incompletely, reversed alter recovery. Light and electron microscopy of muscle strips showed no histological or ultrastructural changes during the experiments or after storing 1 day at 4°C. © 1995 Wiley‐Liss, Inc.
Analyzing finasteride data
Authors: Frankel Sherman
Published: March 2007

Published data on the safety and efficacy of finasteride in the treatment of benign prostatic hyperplasia are studied and compared with published conclusions. The need for publishing correlation studies of both the benefits and side‐effects, to allow for informed physician and patient decisions, is detailed. © 1995 Wiley‐Liss, Inc.
Is detrusor instability in elderly males related to the grade of obstruction?
Authors: Rosier P. F. W. M. , de la Rosette J. J. M. C. H. , Wijkstra H. , Van Kerrebroeck Ph. E. V. , Debruyne F. M. J.
Published: March 2007

Analysis of 185 consecutive patients with BPH revealed concomitant detrusor instability in 20% of the patients. Of all patients 30.9% were not obstructed, 51.8% were moderately obstructed and 17.3% were severely obstructed. Patients with detrusor instability during filling cystometry revealed no differences in average age, prostate volume or symptoms. Mean filling cystometry parameters revealed earlier sense of urge correlating with higher pressures at lower volumes in patients with detrusor instability. Pressure‐flow analysis showed no differences between the patients with and without detrusor instability in bladder outflow obstruction parameters. Further analysis, however, revealed that the prevalence of patients with detrusor instability reaches a “steady state” at a moderate level of obstruction. On clinical epidemiological grounds, the conclusion is made that detrusor instability is developing in the early phase of obstruction. Probably detrusor instability and bladder outflow obstruction are concomitant, due to the aging process in many of these patients. © 1995 Wiley‐Liss, Inc.
Urodynamic and other effects of tolterodine: A novel antimuscarinic drug for the treatment of detrusor overactivity
Authors: Stahl M. M. S. , Ekström B. , Sparf B. , Mattiasson A. , Andersson K.‐E.
Published: March 2007

Tolterodine, a novel compound intended for treatment of urgency and urge incontinence, has been characterized as a potent muscarinic receptor antagonist in pharmacological in vitro and in vivo studies. In cats, tolerodine was shown to reduce bladder pressure at doses significantly lower than those affecting salivation. To predict clinical effectiveness, an open pilot study was performed in healthy male volunteers. Efficacy was measured by cystometry and by spontaneously reported effects after administration of a single oral dose of tolterodine. 6.4 mg, given as a water solution. Tolterodine had distinct inhibitory effects on urinary bladder function, both at 1 and 5 hours post‐dose. At 1 hour, but not at 5 hours post‐dose tolterodine also significantly reduced stimulated salivation. In addition to the objectively demonstrated changes in urodynamic parameters, most volunteers experienced voiding difficulties. No significant changes in blood pressure, heart rate, or near point of accommodation were registered. Tolterodine, in the dosage used, was both objectively and subjectively shown to exert a marked inhibitory effect on micturition in healthy subjects, and the data suggest a more pronounced effect on bladder function than on salivation. © 1995 Wiley‐Liss, Inc.
Irritable bladder syndrome in an animal model: A continuous monitoring study
Authors: Ghoniem Gamal M. , Shaaban Alaa M. , Clarke Margaret R.
Published: March 2007

Irritable bladder syndrome (IBS) was induced in four female African green monkeys (Cercopithecus aethiops) by the use of intravesical instillation of acetone. The animals were housed in a modified metabolic cage for continuous micturition monitoring, and two uroflowmeters connected to a remote PC monitored the frequency, voided volumes, and peak flows. Before and after, urea absorption studies and urodynamics were obtained for each animal. Urea absorption increased significantly after acetone instillation and returned to baseline after 4 weeks (26 to 66 to 32%). Intravesical acetone instillation produced marked effects on bladder physiology in the first week. Bladder compliance dropped from a baseline of 10.47 to 0.58 ml/cm H2O. The voiding pattern changed from a normal pattern with a mean voided volume of 17.58 ml into marked increase in frequency and dribbling pattern with few voids (mean = 5.03 ml). Systematic behavioral observations were carried out for 4 hours per day utilizing an observation program on a laptop computer. Activity patterns, attention, sterotypic behaviors, and self‐directed activities were recorded for each monkey. The animals demonstrated decreased frequency of activity and increased frequency in self‐directed activities (groom, scratch), behaviors consistent with an animal experiencing pain or discomfort. The findings suggested that IBS induction in monkeys is feasible and produces a clinical picture similar to interstitial cystitis in humans. It offers a suitable animal model to enhance the understanding of voiding dysfunction with its neural pathways and to test the different therapeutic modalities to control IBS. © 1995 Wiley‐Liss, Inc.
A critical assessment of methods of measuring metabolite concentrations by NMR spectroscopy
Authors: Tofts Paul S. , Wray Susan
Published: March 2007

Many NMR studies are made by scientists and clinicians in order to measure metabolite levels. There is a growing need to obtain absolute quantification of these metabolites. We have therefore reviewed the methods that are available and those which are being developed, for studies in vivo and on isolated tissues. We describe the following methods and assess their advantages and limitations: (1) Conventional spectroscopy and area ratios, (2) Tissue extracts, (3) External capillary, (4) Internal endogenous marker, (5) Internal exogenous marker, (6) External marker in bath, (7) Reference to internal 1H water concentration, (8) Gradient‐localized spectroscopy and (9) Fourier series analysis localization. The relevant biological and technical aspects associated with quantification of metabolite concentrations are also discussed. This includes NMR visibility, origin of the NMR signals, definitions of concentration, influence of the RF coil, data collection and data analysis.
Alterations in relative phosphocreatine concentrations in preclinical mouse muscular dystrophy revealed by in vivo nmr
Authors: Heerschap A. , Bergman A. H. , Van Vaals J. J. , Wirtz P. , Th. Loermans H. M. , Veerkamp J. H.
Published: March 2007

Using in vivo 31P NMR spectroscopy, the early postnatal development of lower hindleg muscles of normal and dystrophic mice was investigated. Ratios of phosphocreatine and inorganic phosphate, and of phosphocreatine and ATP increased exponentially during normal postnatal growth and differentiation. In dystrophic skeletal muscles, however, the ratios were already considerably lower during the early postnatal period, before histopathological features were observed. The ratios remained lower, relative to normal muscles, at least into the young adult stage. A deficiency in the sequestering of creatine or a defect in the phosphocreatine shuttle is proposed to explain the pathological features observed in this disorder.
Phosphate metabolites in rat skin
Authors: Stubbs Marion , Vanstapel Florent , Rodrigues Loreta M. , Griffiths John R.
Published: March 2007

A model for studying the 31P NMR spectrum of rat skin without contribution from other tissue signals has been developed by creating a skin pedicle. 31P NMR spectra were obtained with a solenoidal coil, which was separated from the flank of the rat by a Faraday shield. Phosphomonoesters, inorganic phosphate (Pi) (1.63 ± 0.12 m̈mol per g wet wt), phosphodiesters, phosphocreatine (PCr) (1.4 ± 0.12 m̈mol per g wet wt) and ATP (1.35 ± 0.22 m̈mol per g wet wt) were observed, superimposed on broader signals, probably due to phospholipids. Extracts of freeze‐clamped pedicles contained concentrations of phosphorus metabolites similar to those seen by NMR. The exception was Pi which was twofold higher in the extract. The presence of the broader phospholipid contribution suggests that the signals did not arise solely from the panniculus carnosus muscle of rat skin, although this muscle was evident on histological examination of the pedicles. In extracts of normal rat skin levels of creatine, ATP, ADP and Pi were similar to those of pedicles, whereas PCr was about twofold higher. Signals from rat skin are likely to contribute to spectra of subcutaneous organs and tumours. Two kinds of rat hepatoma that contained no PCr frequently gave PCr signals from the overlying skin, whereas in three other subcutaneous tumours the contribution from skin was negligible.
Four‐dimensional phosphorus‐31 chemical shift imaging of carcinoid metastases in the liver
Authors: Jane Cox I. , Sargentoni Janet , Calam John , Bryant David J. , Iles Richard A.
Published: March 2007

Four‐dimensional chemical shift imaging was used to map spatial variations in phosphorus metabolites in a patient with carcinoid metastases in the liver. The results were compared to those from an age and sex matched volunteer, with no known previous history of liver disease. In the patient local abnormalities were observed. These included elevated phosphomonoester and decreased phosphodiester concentrations relative to adenosine triphosphate. The regions of abnormality corresponded to regions containing metastases identified with x‐ray computed tomography and magnetic resonance imaging.
Passive electrical isolation of double coil probes for localized spectroscopy and imaging
Authors: Styles Peter
Published: March 2007

A circuit is described for the electrical isolation of double coil probes where separate transmitter and receiver coils are both tuned to the same frequency and are coupled by mutual inductance. There are only passive components in the probe, and so no additional control signals are required for switching between transmit and receive conditions. An analysis of the operation of the circuit is included together with details of component selection and setting‐up procedures, thus facilitating the implementation of the design for a variety of applications in both imaging and spectroscopy.
A 31p nuclear magnetic resonance study in vivo of metabolic abnormalities in rats with acute liver failure
Authors: Bates T. E. , Williams S. R. , Busza A. L. , Gadian D. G. , Proctor E.
Published: March 2007

31P NMR spectroscopy was used in conjunction with conventional biochemical techniques to study metabolic abnormalities in normal rats, in rats with CCl4‐induced acute liver failure and in rats with paracetamol‐induced acute liver failure. Studies were carried out before and after a metabolic challenge in the form of a fructose infusion. Prior to fructose infusion the ATP levels in the groups with acute liver failure were significantly lower than in control rats, despite their having a similar ATP/Pi ratio. Following a fructose infusion in control animals, the changes in phosphomonoesters, ATP and inorganic phosphate were consistent with previously reported findings. However, in both test groups the percentage changes in phosphomonoesters and ATP were significantly smaller. Intracellular pH declined in control animals, but did not change significantly in the animals with acute liver failure. Fructose clearance from the blood in control animals was not significantly different from that in animals with CCl4‐induced acute liver failure. Metabolic changes measured using a horizontal magnet were very similar to those obtained with a vertical magnet.
Effects of repeated ischemia on cerebral blood flow and brain energy metabolism
Authors: Laptook Abbot R. , Hassan Abdullah , Peterson Janet , Corbett Ron J. T. , Nunnally Ray L.
Published: March 2007

To determine if cerebral blood flow (CBF) and cerebral metabolic alterations during partial ischemia are affected by a prior interval of ischemia, 13 neonatal piglets were studied during two successive protocols (termed A and B), each consisting of an interval before, during and after partial ischemia induced by hypotension. Piglets were studied with either microspheres (n = 6) to measure CBF and calculate cerebral uptake of O2 and glucose or 31P nuclear magnetic resonance spectroscopy (n = 6) to measure intracellular pH (pHi) and cerebral phosphorylated metabolites. One piglet was used to determine time effects. Control values of all variables were similar during protocol A and B. In each protocol hypotension was associated with similar reductions in CBF and cerebral O2 uptake but cerebral glucose uptake differed (0.10 ± 0.05 vs 0.05 ± 0.02 mmol · min−1 · 100 g−1 during hypotension of A and B, respectively, p < 0.05). During hypotension of protocol A and B similar changes in phosphorylated metabolites and pHi occurred and were characterized by a reduction in pHi, phosphocreatine and adenosine triphosphate and an increase in inorganic phosphate. Changes in phosphate metabolites and pHi were reversible within 25 min following hypotension in both protocols. Thus, changes in CBF, cerebral O2 uptake, pHi and cerebral energy metabolism are similar during repeated episodes of partial ischemia. However, differences in cerebral glucose uptake in protocol A and B raise the possibility that the balance between energy production and utilization is altered, or alternative substrates are metabolized or enzymatic activity in the glycolytic pathway is changed.
The relationship between serum water proton t1 and protein content in the p388 leukemic mouse and the effect of chemotherapy by CIS‐diamminedichloroplatinum(ii)
Authors: Raeymaekers H. H. , Callens F. , Eisendrath H. , Atassi G. , Fossoul C. , Vandewalle J. , Gielen M. , Willem R.
Published: March 2007

Proton NMR longitudinal relaxation times (T1; 10.7 MHz; 37°C) were measured in the kidneys and blood serum of mice inoculated with P388 leukemia, and/or treated with the chemotherapeutic drug cis‐diammine‐dichloroplatinum(II) (cis‐Pt). In parallel, serum total protein content, urea and creatinine levels were determined and protein fractions were separated electrophoretically.

Serum T1 was found to be 1518 ± 73 ms (1 SD) in control mice, 1670 ± 69 ms in leukemic mice, and 1380 ± 71 ms in the healthy and the leukemic cis‐Pt treated mice. The T1 increase in leukemic serum and T1 decrease in the serum of cis‐Pt injected mice are attributed to decreased and increased protein contents respectively. A detailed analysis in terms of electrophoretic fractions of serum proteins reveals that the serum relaxation rate 1/T1 is a multilinear function of the mass concentrations of the main serum protein fractions, explaining all serum T1 effects. This makes T1 a non‐specific blood parameter.

The kidney T1 was found to be 311 ± 12 ms in normal mice and 334 ± 20 ms in leukemic mice. A dramatic T1 increase is observed when the mice are injected with cis‐Pt; the values are 400 ± 38 ms and 407 ± 39 ms for healthy and leukemic mice, respectively. This effect is related to the nephrotoxicity of the drug, as evidenced by serum urea and creatinine levels and protein content being higher than normal.