bluuebunny/crossref_metadata_2025 huggingface dataset:
Comparative study of the motor unit potentials of the external urethral sphincter, anal sphincter, and bulbocavernosus muscle in normal men
Authors: Fanciullacci F. , Kokodoko A. , Garavaglia P. F. , Galli M. , Sandri S. , Zanollo A.
Published: March 2007

Motor unit potentials (MUP) of the perineal muscles and in particular of the external anal sphincter (EA sph.), of the external urethral sphincter (EU sph.) and of the bulbocavernosus muscle (BC) have been seldom analyzed. There is no uniformity of view about amplitude and duration of MUP of these muscles. According to different authors, duration varies from 2 to 10 msec, and amplitude varies from 50 μ V to 3 mV.

In this paper, we studied EMG findings of EU sph., EA sph., and BC in 37 normal men (15 BC, 12 EU sph., and 10 EA sph.). In total we recorded 239 different MUP in BC, 208 in EU sph., and 134 in EA sph. There are no differences among the three groups in amplitude (mean values about 250 μ V). On the contrary, EU sph. showed a significantly shorter duration (3.73 msec) compared to BC (5.58 msec) and EA sph. (5.07 msec). Polyphasic potentials range from 2.3% to 5.9%. Gosling et al (Br J Urol 53:35–41, 1981) has shown that the striated muscle of EU sph. is made of fibers smaller than those of adjacent periurethral muscles. Possibly, motor units are smaller.
Urethral pressure variations in women with neurourological symptoms: II. Relationship to urethral smooth muscle
Authors: Kulseng‐Hanssen S.
Published: March 2007

Simultaneous urethrocystometry and electromyography from the urethral striated muscle during bladder filling was performed on female patients complaining of neurourological symptoms. Their maximum urethral pressure varied between 20 and 84 cm H2O. To study the effect of the urethral smooth muscle on the urethral pressure variations, a bilateral pudendal block was applied successfully in 12 patients. It was found that in 1 patient the urethral pressure variations were caused by the urethral striated muscle only, in 4 patients they were caused mainly by the urethral striated muscle, in 2 other patients they were caused equally by urethral striated and smooth muscle, and finally in 5 patients mainly by urethral smooth muscle. By eliminating the urethral striated muscle activity by pudendal block the maximum urethral pressure was reduced 20 to 84%.
Urethral pressure variations in women with neurourological symptoms: III. Relationship to urethral wall venous plexus
Authors: Kulseng‐Hanssen S. , Stranden A.
Published: March 2007

Twenty‐five women were investigated in order to find out if the urethral submucous venous plexus may influence urethral pressure variations. Urethral and bladder pressure were measured with a microtip transducer catheter. Electromyography (EMG) and integrated EMG from the urethral striated muscle were recorded using a concentric needle electrode. Blood volume in the urethral submucous venous plexus was measured with a urethral photopletysmograph probe. In 9 women without neurourological symptoms, during squeezing there was increased urethral striated muscle activity, increased urethral pressure and decreased blood volume. When they were asked to void the opposite was found.

In 16 patients with marked urethral pressure variations a negative correlation was found between the maximum urethral pressure and the photopletysmograph tracing. In 7 of 8 patients a negative correlation was found also between the integrated EMG tracing and the photopletysmograph tracing, but a positive correlation was found between the maximum urethral pressure and the EMG of the urethral striated muscle. In 1 of the 8 patients no correlation was found between EMG activity and maximum urethral pressure and between EMG activity and the photopletysmograph tracing.

The results demonstrate that the urethral venous plexus becomes emptied secondary to contractions of the urethral striated and/or smooth muscle and filled with blood secondary to relaxation of the same muscles. Hence, the urethral venous plexus does not influence the urethral pressure actively.
Trigone sensitivity testing is a measure of exteroceptive function
Authors: Klein Lester A.
Published: March 2007

The trigone sensitivity test, a complementary test to cystometry, has been proposed as a method for distinguishing certain clinical disorders. Pressure is applied to the trigone region of the bladder by pulling upon a Foley catheter with the balloon inflated and the amount of force needed to induce an urge to void is recorded. Although the trigone sensitivity test has been proposed as a test of exteroceptive function, it is possible that deeper receptors, perhaps proprioceptors, are actually responsible for the awareness of the urge to void during the study. The present investigation compared the trigone sensitivity test with provoked detrusor contraction in 107 patients. The findings indicate that variations in the two responses occur independently of each other. It is concluded that different neural pathways are responsible for the two functions. The hypothesis that exteroceptive and not proprioceptive nerves are being measured during trigone sensitivity testing is supported by these findings.
Urinary incontinence detection in elderly inpatient men
Authors: O'Donnell Pat D. , Sutton Laurie , Beck Cornelia , Finkbeiner Alex E.
Published: March 2007

Urinary incontinence is a serious medical and social problem affecting approximately 40% of elderly inpatients. Evaluating the extent of the illness and response to therapy requires an accurate method for quantitative measurement of urinary incontinence. Quantitative parameters of urinary loss include the frequency and volume of urinary incontinence. A telemetric incontinence detection instrument designed to measure incontinence frequency is described and the instrument is compared with a standard „wet check”︁ incontinence detection technique. The electronic instrument appears to be an accurate method for detection of urine loss and is nonobtrusive to the patients.
Surface spectrofluorometry of the rabbit urinary bladder
Authors: Levin Robert M. , Ruggieri Michael R. , Hypolite Joseph A. , Malkowicz S. Bruce , Wein Alan J.
Published: March 2007

Proper function of the urinary bladder is dependent on the delivery of a normal supply of blood, oxygen, and nutrients to the tissue. The smooth muscle elements of the bladder utilize metabolic energy in the form of ATP and other high‐energy compounds to support bladder contraction. One of the first metabolic indications of contractile activity would be alterations in the oxidative state (redox) of the tissue, which is reflected by the NADH/ NAD ratio. NADH is a metabolic intermediate synthesized during substrate metabolism and utilized during energy production and utilization. We have studied NADH metabolism in the in vitro bladder strip preparation utilizing a surface spectrofluorometer. This instrument monitors NADH fluorescence in tissue preparations with the use of an optical fiber probe placed on the serosal surface of the strip. The bladder strips displayed rhythmic contractile activity. This was correlated with alterations in NADH fluorescence. There was an excellent correlation (correlation coeficient of 0.986) between the frequency of the spontaneous activity of both contraction and fluorescence. An increase in tension was followed (in seconds) by a decrease in fluorescence. The basal NADH fluorescence was modulated by metabolic inhibitors as would be expected by their metabolic actions: Anoxia and sodium azide (metabolic inhibitors of oxidative phosphorylation) produced a marked increase in the redox state (NADH fluorescence), whereas DNP (a mitochondrial uncoupler) produced a marked decrease. Bethanechol stimulated an increase in tension and a reduction in fluorescence.

The above findings suggest that NADH surface spectrofluorometry reflects NADH metabolism in the detrusor smooth muscle and that fluctuations in such spectra correlate well with functional activity. NADH surface spectrofluorometry displays potential as a noninvasive method of monitoring one aspect of detrusor metabolism.
Muscarinic receptor subtypes in human and rabbit bladder
Authors: Ruggieri Michael R. , Bode Donald C. , Levin Robert M. , Wein Alan J.
Published: March 2007

Subtypes of muscarinic receptors have been proposed by several investigators, based on differences in the potency of muscarinic agonists in various tissues. Development of selective muscarinic agonists and antagonists for the urinary bladder would be extremely useful since side effects of the presently used drugs often limit their clinical usefulness. Direct investigation of muscarinic receptor subtypes by radioligand binding techniques has recently become possible. The muscarinic antagonist pirenzepine distinguishes between a high affinity and low affinity binding site in several tissues. Results of the present investigation indicate that only the low affinity pirenzepine binding site is present in both human and rabbit bladder. Muscarinic receptor linked biochemical responses (increased phosphatidyl inositol turnover and inhibition of adenyl cyclase) were also consistent with the presence of only the low affinity pirenzepine binding receptor subtype in both human and rabbit bladder.
Urinary bladder reformation: Regeneration or dilatation?
Authors: Gasser Thomas C. , Larsen Erik H. , England Douglas M. , Graversen Peder H. , Dørflinger Torben , Madsen Paul O. , Bruskewitz Reginald C.
Published: March 2007

In an earlier study, urinary bladder regeneration was investigated. For that purpose, 15 dogs were subjected to total or subtotal cystectomy, and a silicone rubber prosthesis was nestled in the trigone and covered with polyglycolic acid mesh. After 3–5 months, a newly formed urinary reservoir was found in six dogs. Since transitional cell epithelium and smooth muscle were identified in the wall of the reservoir, it was concluded that bladder regeneration had probably occurred. However, the possibility of distention of the trigone to form the new cavity could not be ruled out.

Therefore, six additional dogs were subjected to subtotal cystectomy, ileal loop, and temporary artificial bladder implantation. The edges of the bladder resection were marked with nonabsorbable sutures. In three fully evaluable dogs a urinary cavity was identified. This was mainly formed by trigonal distention. While the epithelium had regrown over a small area of fibrous tissue found at the dome of the reservoir, no smooth muscle regeneration was found.

It is concluded that the new reservoir was formed by trigonal dilatation rather than by regeneration.
Urethral pressure variations in women with and without neurourological symptoms
Authors: Kulseng‐Hanssen S. , Kristoffersen M.
Published: March 2007

Simultaneous urethrocystometry was performed in 93 females without and 174 patients with neurourological symptoms. Both populations were divided into three age groups. The urethral pressure variation (ΔMUP) was calculated as the difference between the highest and the lowest maximum urethral pressure observed during 1 minute. In all age groups, both the highest and the lowest maximum urethral pressure recorded during bladder filling were significantly higher in the normal females than in the patients. There was, however, no significant difference in the degree of ΔMUP between normal females and patients in the different age groups. Typical urethral pressure variation was also observed during physiological bladder filling. Thus, urethral pressure variation in itself is a physiological phenomenon. With less difference between the lowest maximum urethral pressure and the bladder pressure, the possibility of leaking urine is increased. A urethral pressure decrease may therefore cause leakage in a patient but not in a normal female. More than 50% of the normal females had a urethral pressure variation of more than 20 cm H2O. The previous definitions of urethral pressure variations (unstable urethral pressure, urethral instability), which describe the condition as pathologic when the pressure varies more than 10, 15, or 20 cm H2O, can therefore no longer be considered useful.
Selective sacral cryoneurolysis in the treatment of patients with detrusor instability/hyperreflexia and hypersensitive bladder
Authors: Awad Said A. , Flood Hugh D. , Acker Kelly L. , Clark A. John
Published: March 2007

Using selective sacral cryoneurolysis, we treated 28 patients with detrusor instability (DI), hypersensitive bladder (HSB), or detrusor hyperreflexia (DH). A cystometrogram (CMG) was done before and after percutaneous, transsacral infiltration of a sacral nerve root with bupivacaine until a dominant root was identified as judged by a 50% or greater increase in the maximum cystometric capacity (MCC), and/or a 50% or greater decrease in the peak intravesical pressure at the time of the first unstable contraction (P1). The volume at first desire to void (VDV) was also noted. The dominant root was then blocked with a cryoprobe.

In the non‐neurologic group (20), the mean MCC was increased by 61% and the mean P1 decreased by 21%. The VDV was increased significantly. Clinically, 16 out of 17 patients had good or excellent results and one had poor results when followed from 1 to 10 months. The mean duration of effect was 4.8 months. Eleven patients had repeat neurolysis, usually with comparable results. In the neurological patients (8) there was a 165% increase in mean MCC and a 40% fall in P1. In six patients followed up for 1.5–10 months the results were good or excellent in five and poor in one with a mean duration of effect of 3.6 months. Transient sensory side effects were common in the non‐neurological patients, and this combined with the need for repeat treatments may have affected patient compliance.

It is concluded that selective sacral cryoneurolysis has a useful role in the management of the patient with DI/DH or HSB who has failed to respond to pharmacotherapy.
Sacral evoked potentials in normal women and in women with stress incontinence
Authors: Fanciullacci F. , Sandri S. , Politi P. , Garavaglia P. F. , Catanzaro F. , Zanollo A.
Published: March 2007

Recently, using electromyographic techniques, Swash, Snooks, and Henry [1985] and Smith and Warrel [1985] described disorders of perineal floor innervation in patients with foecal incontinence and stress urinary incontinence. Another means to determine the integrity of pelvic floor innervation is the measurement of the bulbo‐cavernosus reflex latency. We performed sacral evoked potentials (SEP) in women, recording the EMG response by surface electrodes at the level of the anal sphincter. With this method, we studied 28 normal women and 31 with stress incontinence. Orienting the electrodes at the anal level always in the same faction (the active electrode on the right side), we obtained, in every case, a constant shape of SEP. This can help in doubtful cases. There was a statistical difference of SEP latencies in the two groups of women (32.9 msec and 38.92 msec, respectively). We concluded that in women with stress incontinence, there is an impairment of the pelvic floor innervation.
Objective assessment of urinary incontinence: An evaluation of three different pad‐weighing tests
Authors: Jakobseny Henrik , Vedel Pernille , Andersen Jens Thorup
Published: March 2007

In 31 women with urinary incontinence the results of three different pad‐weighing tests were evaluated. The three tests were 1) a 48‐hour test performed by the patient at home and at work, 2) a 1‐hour test as recommended by the International Continence Society, and 3) a test including the activities from the 1‐hour test but modified so that the bladder was filled to 75% of the maximum cystometric bladder capacity at the beginning of the test (40‐minute test). The patients found the 48‐hour test and the modified test to be equally representative for their daily leakage, while the 1‐hour test was judged as being less representative than the others. Objectively, the modified test was found to produce a significantly larger urine loss when compared with the conventional tests (median 7 g vs median 3 g, p < 0.003). This may be explained by a significantly larger bladder volume in the modified test during performance of the activity programme. The modified padweighing test is easy to use and interpret owing to its standardized activities. Furthermore, it bypasses the problem of unknown bladder volume at the start of the test.
Effect of ileocystoplasty on contractile response of the bladder, ileum, and cystoplastic ileal segment
Authors: Batra Ashok K. , Wein Alan J. , Ruggieri Michael R. , Gill Harcharan S. , Levin Robert M.
Published: March 2007

Bladder augmentation or substitution with ileal segments is being used to a greater extent in recent years. The goal of the present study is to characterize the physiologic and pharmacologic changes in the ileal segment that occur following ileal cystoplasty. Four weeks following ileocystoplasty in rabbits, the contractile response of sections of normal terminal ileum, bladder body, and the cystoplastic segment of ileum (ileocystoplasty) was studied in isolated muscle baths. Results were as follows: 1) The ileum responded to a maximal dose of bethanechol with an increase in the amplitude and frequency of phasic contractions whereas the bladder displayed a rapid and sustained increase in basal tension. The cystoplastic ileal segment showed a marked increase in basal tension with superimposed phasic contractions. 2) Maximally effective doses of ATP and methoxamine reduced tension in the normal ileal segments but contracted both the bladder and cystoplastic ileal segments. 3) Isoproterenol reduced tension in all three segments. The pharmacological response of the cystoplastic segment of ileum significantly shifted from that of the ileum toward the response of the bladder. This effect is important as a manifestation of the functional plasticity of smooth muscle.
Bladder instability and abnormal micturition pattern in rats with infravesical outflow obstruction
Authors: Malmgren Anna
Published: March 2007

Normal rats and rats with infravesical outflow obstruction were investigated with regard to micturition patterns and bladder pressure during the micturition cycle. Normal rats were found to have a micturition pattern characterized by a high micturition frequency and a small micturition volume. The most commonly occurring micturition intervals were between 50 and 75 min. The micturition volumes were between 0.2 and 0.4 ml. The obstructed rats could be divided into two types with regard to their micturition patterns. The majority of the obstructed rats (75%) voided similar volumes as control rats (between 0.2 and 0.4 ml) but the intervals were shorter (between 10 and 20 min). A minority of the obstructed rats (25%) showed a micturition pattern consisting of large volumes (between 1 and 2 ml) and long intervals (> 200 min).

In control rats the bladder pressure was low during the micturition cycle and only minute bladder pressure fluctuations were noted until micturition. The obstructed rats, however, exhibited a marked spontaneous activity during the micturition cycle. The spontaneous activity became more and more pronounced until micturition occurred. Prior to micturition it exceeded 7 cm H2O. The altered micturition pattern and the development of a pronounced bladder instability seen during the micturition cycle reveal clear similarities with findings in man with infravesical outflow obstruction.
Comparison of the in vitro isolated strip methodology with the superfused strip technique
Authors: Levin Robert M. , Ruggieri Michael R. , Barasha Brenda , Kramen David , Wein Alan J.
Published: March 2007

There are several methodologies available for determining the contractile effects of specific agents on isolated smooth muscle. The standard isolated bath technique utilizes strips mounted in a physiological buffer. The agent under study is added to the buffer and the response is recorded on a polygraph. The superfused strip technique utilizes strips in which buffer is pumped over the strip at relatively low flow rates. The agent under investigation is either infused into the stream of buffer bathing the tissue strip or administered directly onto the tissue. We have compared the response of these two methodologies using isolated strips of rabbit urinary bladder body.

Isolated strips of rabbit urinary bladder were mounted in standard isolated baths containing 30 ml Tyrode's solution. The response of these strips to the autonomic agonists bethanechol, ATP, and isoproterenol were determined via cumulative addition at 5‐minute intervals. Similar strips were mounted as above, after equilibration, the Tyrode's was drained, and fresh oxygenated Tyrode's was pumped over the strip at a rate of 4 ml per minute. Flow was stopped and drugs were administered directly onto the tissue in 100‐μl aliquots. After either maximal response or 2 minutes, flow was resumed. Drugs were added at 10‐minute intervals.

The results can be summarized as follows: 1) The superfused bladder strips responded to 100‐fold lower amounts of autonomic agonist than the strips in the isolated bath. 2) The maximum response to ATP (an agent that produces rapid desensitization) was threefold greater in the superfused model than in the bladder bath, and the rate of response of the tissues in the superfused system was significantly greater than in the isolated baths.

In summary, the superfused isolated bladder preparation is an excellent methodology to use in specific investigations.
Detrusor inhibition on selective pudendal nerve stimulation in the perineum
Authors: Vodušek D. B. , Plevnik S. , Vrtačnik P. , Janež J.
Published: March 2007

Selective electrical pudendal nerve stimulation calibrated to achieve a “maximal motor response” as recorded electromyographically in the periurethral sphincter was found to increase the micturition threshold in three neurological patients with detrusor hyperreflexia. Such electrical stimulation (0.2‐ms long pulses at 5 Hz and up to 2.0 mA) could conceivably be also supplied by an implanted “vesicoinhibitory” stimulator, and this report is considered as a pilot study towards formulation of such a therapeutic approach.
Measurement of intrapelvic peristaltic activity in the diagnosis of equivocal upper urinary tract obstruction
Authors: Payne S. R. , Gosling P. T. , Nagendran R. , Wickham J. E. A.
Published: March 2007

Direct measurement of upper urinary tract dynamics during perfusive stress is an accepted method of investigating the dilated upper urinary tract when a clear diagnosis of obstruction cannot be refuted by indirect radiological or renographic means. Transparenchymal renal puncture for intrapelvic pressure transduction has become an accepted technique over the last 15 years, well‐defined “standard” fluid stresses being determined to uncover covert obstructions with strict criteria for the determination of such a state. These antegrade perfusion/pressure tests do not, however, take into account the role of upper tract peristalsis, an important factor for the promotion of renal drainage in multicalyceal animals.

Fifteen patients with equivocal upper urinary tract obstruction had their upper urinary tract dynamics determined prospectively by a modification of the standard Whitaker test, results of these studies being compared with measurements of pelvic peristalsis and baseline intrarenal pressure made by using an intrapelvic microtransducer‐tipped catheter interfaced to a computerised recording system. This system enabled the measurement of pelvic dynamics in various postures without the necessity for transducer rezeroing. Six patients showed abnormalities of pelvic peristaltic activity indicative of the obstructed upper tract, only three of whom had unequivocally obstructed Whitaker tests. All obstructed patients had accentuation of their peristaltic abnormalities in the sitting position, underlining the importance of performing direct dynamic measurements in a physiological position. We have found that measurement of pelvic peristaltic activity as well as baseline intrapelvic pressure during perfusion is important for the delineation of the equivocally obstructed kidney, suggesting that the antegrade perfusion/pressure test should be modified to allow more physiological study of renal outflow dynamics.
Unstable urethral pressure: Toward a more relevant definition
Authors: Hilton Paul
Published: March 2007

There is confusion in the literature over the use of the terms unstable urethra and unstable urethral pressure, which are often held inappropriately to be synonymous. The importance of the former condition, as a cause of incontinence, is beyond doubt, although it appears to be an uncommon condition; the finding of unstable urethral pressure is reported much more frequently, although its clinical significance remains in debate. An analysis of urethral pressure recordings in a group of 131 women with urodynamically proven genuine stress incontinence, and 14 urodynamically normal women entirely free from urinary symptoms has been carried out in an attempt to define the differences between the two and thus to establish a more clinically relevant definition for the phenomenon of “unstable urethral pressure.”

The variation in urethral pressure was calculated first in absolute terms, as the variation in cm H2O above and below the mean maximum urethral closure pressure (MUCP), and second in relative terms, as a percentage of the mean MUCP itself; these two parameters are described as “delta‐MUCP (absolute)” and “delta‐MUCP (relative),” respectively.

The mean delta‐MUCP (absolute) values were 9.5 and 13.4 cm H2O for the symptomatic and control groups, respectively (not significant); the mean delta‐MUCP (relative) values were 27.0% and 17.1% of the MUCP (p < 0.001). Examination of various potential points of discrimination for the diagnosis of “unstable urethral pressure” showed a delta‐MUCP (relative) of 30% to be the best discriminator, allowing the identification of a subgroup of stress incontinent women whose urethral pressure variation was likely to be of relevance in the determination of symptoms.
Voiding dysfunction associated with cervical spondylotic myelopathy
Authors: Katz P. Gary , Alberico Anthony M. , Zampieri Thomas A. , Fox Lorick
Published: March 2007

Patients with cervical spondylotic myelopathy who were neurosurgical candidates were prospectively evaluated for voiding abnormalities. The patients had relatively advanced neurologic disease because of delays in presentation and in diagnosis. The 22 consecutive patients included 20 males and 2 females with average age of 57 years. Sixteen patients had voiding symptoms with 12 noting a change in voiding pattern following the onset of their neurologic symptoms. Detrusor hyperreflexia was present in 16 (73%) of the patients and external sphincter dyssynergia in 8 (36%) of the patients. Neurologically mediated voiding dysfunction was common in patients with myelopathy secondary to cervical spondylosis.
Electrical membrane events underlying contraction of guinea pig bladder muscle
Authors: Mostwin Jacek L.
Published: March 2007

The relationship of electrical to mechanical activity of guinea pig bladder muscle has been studied in vitro by intracellular microelectrode and sucrose gap techniques. A discrete relationship between individual electrical action potentials and muscle contractions of small amplitude can be seen in muscle which is spontaneously active or stimulated by muscarinic activation or electrical current. An increase in the frequency of action potentials is associated with an increase in the frequency of small‐amplitude contractions and the generation of muscle tension. The frequency of action potential firing is sensitive to changes in the resting membrane potential of the muscle. The findings suggest that an increase in the frequency of action potential firing may be a major mechanism in the development of muscular tension in the wall of the bladder.
Experimental studies with total and static urethral pressures in canine urethra and their clinical significance
Authors: Yalla Subbarao V. , Cravalho Ernest , Resnick Neil M. , Chiang Rossanna
Published: March 2007

Canine experiments were conducted in order to determine potential sources of error in measurement of total and static urethral pressures during urodynamic studies. Transmural urethral cannulas were inserted at various urethral sites, downstream and upstream of an elastic constriction, and attempts were made to study 1) the effect of increasing rates of urethral perfusion, 2) the differences in static and total urethral pressures at a urethral site, and 3) the differences between the static pressures recorded through the transmural cannulas and the intraurethral catheter. More than 300 pressure measurements were made in 14 dogs (both male and female). The results suggested that 1) static pressure increases with increasing rates of infusion, 2) when constrictions are applied in the midurethra, the increase of pressure is greater in the proximal (upstream) than the distal (downstream) urethral segments, 3) the total urethral pressures were (4 to 10%) higher than the static pressures, and 4) although statistically not significant, the static pressures recorded through the urethral catheter were lower than those recorded through the extraluminal transmural cannula.
Micturition‐facilitating mechanism in benign prostatic hypertrophy: A theory
Authors: Cucchi A.
Published: March 2007

Forty males aged 46–82 years (mean, 65 years) with bladder outflow obstruction due to benign prostatic hypertrophy were chosen among a group referred for prostatism. They were assessed by means of symptom analysis, rectal examination, intravenous urography and/or cystoscopy, and urodynamic testing (medium‐fill water cystometry and pressure flow study). Only those patients were considered who had compensated bladders with no severe trabeculation. A significant correlation was found in this series between urethral resistance and opening time (r = −.41, p < .01), the best fit being a negative exponential relationship (the higher the degree of obstruction, the lesser the time needed to reach the threshold pressure at which flow begins). This was supposed to describe a real micturition‐facilitating mechanism, which might be explained by abnormal activation of a nerve pathway relaying through the spinal cord between the proximal urethra and detrusor muscle. Such a mechanism would be valid for those proximally obstructed bladders with mild to moderate detrusor collagenosis.
Effects of nifedipine and Bay K8644 on normal and hypertrophied rat detrusor
Authors: Malmgren A. , Andersson K.‐E. , Andersson P.‐O. , Fovaeus M. , Sjögren C.
Published: March 2007

Bladder strip preparations from normal female Sprague‐Dawley rats as well as from rats with bladder outflow obstruction were mounted in organ baths, and isometric tension responses to electrical stimulation were recorded. Preparations of normal rat detrusor exhibited a minute spontaneous contractile activity. Addition of the calcium channel “agonist” Bay K8644 increased the basal tension and markedly enhanced spontaneous activity. In the presence of the drug the sensitivity to electrical field stimulation was enhanced; maximum amplitude increased, and the frequency producing 50% of maximum tension decreased. The calcium antagonist nifedipine had the opposite effects. In the presence of tetrodotoxin (TTX), the electrically induced responses were markedly depressed. Addition of Bay K8644 only partly restored these responses.

Detrusor strips from rats with infravesical outflow obstruction exhibited marked spontaneous activity. They were less sensitive to electrical field stimulation than strips from normal bladder. Bay K8644 increased basal tension and spontaneous activity and also the maximum response to electrical stimulation. Nifedipine abolished spontaneous activity, induced a rightward shift of the frequency‐response curve, and decreased the maximum amplitude. Electrically induced responses were significantly more resistant to TTX than in normal detrusor, and in the presence of TTX addition of Bay K8644 increased electrically induced response to control level.

Provided that TTX completely blocks nervous transmission and that Bay K8644 and nifedipine both have a preference for voltage‐operated calcium channels, these data suggest that hypertrophied bladder muscle has a nonspecific smooth muscle hypersensitivity to depolarizing stimuli. Possibly such changes can be linked to detrusor instability associated with outflow obstruction in man.
New diagnostic criteria in obstruction of the pyeloureteral junction
Authors: Kinn Anne‐Charlotte , Ohlson Lars , Coolsaet Bo , Constantinou Christos E.
Published: March 2007

The peristalsis of the upper urinary tract was studied with kinetic urography in 34 patients in whom conventional urography indicated obstruction of the pyeloureteral junction (PUJ). The fluoroscopic image at urography was recorded and manually transferred to plastic film for later analysis. In 18 patients the following features were found to deviate from normal peristalsis and were considered to be due to obstruction: (1) ectopic starts of retrograde contractions from the pyeloureteral junction, (2) absence of the injection of urine across the PUJ, (3) inhibition of impulse conduction across the PUJ, (4) absence of the postcontraction injection. In the remaining 16 patients the peristalsis was normal. Manometry of the renal pelvis during perfusion was performed in 24 and diuresis renography in 32 of the patients. The findings at kinetic urography were in accordance with manometry in 83%; and with diuresis renography in 71%; In a clinical follow‐up of nonoperated patients as well as patients who had undergone pyeloplasty, kinetic urography proved to be a correct predictive method in 94% of the patients, manometry in 88%, and diuresis renography in 72%, respectively. Kinetic urography thus proved to be a valuable technique for selecting patients likely to benefit from pyeloplasty.
The distal urethral electrical conductance test: Standardisation of method and clinical reliability
Authors: Mayne C. J. , Hilton P.
Published: March 2007

Urethral electrical conductance was recorded throughout standard exercise test in a group of 40 women with known urinary incontinence. Analysis of the results has shown it to be of little diagnostic value (sensitivity = 33%). It is, however, a sensitive means of detecting leakage (sensitivity = 97%), and a comparison of the total change in conductance during the exercise test with weighed perineal pads shows this parameter to be a reasonable index of the severity of leakage.
Uroflowmetric observations in pregnancy
Authors: Hong Peter L. , Leong Mary , Seltzer Vicki
Published: March 2007

Uroflowmetric studies were performed on 752 antepartum patients at various stages of pregnancy and 153 patients 6 weeks postpartum. The mean voided volume in the antepartum group (203.4 ml) was significantly lower (P < .001) than that of the postpartum group (261.1 ml). In the antepartum group, the data suggests a significant decrease in voided volume in the third trimester. The uroflowmetric parameters (FT, Q‐max, T‐Q‐max) studied were observed to be directly related to voided volumes. This is an observation known in the nonpregnant female. Presenting stations of zero and above do not appear to influence the uroflowmetric parameters. Subjective increases in frequency of urination during pregnancy are correlated with objective decreases in the volumes voided, and the converse is also found to be true. The contributory roles of the mechanical and endocrinological factors on micturition in pregnancy are discussed. It appears that the predominant factor may be mechanical.
Predictive value of detrusor instability index in surgery for female urinary incontinence
Authors: Lose Gunnar , Jørgensen Lisbeth , Johnsen Anni
Published: March 2007

Pre‐ and postoperative data were reviewed in 33 female patients with urinary incontinence associated with demonstrated detrusor instability who underwent conventional anti‐incontinence surgery (anterior colporrhaphy or colposuspension).

Generally, the surgical result was poor. Only 27% (95% confidence limits 13–46%) were subjectively and objectively cured. In patients with a detrusor instability index ≤0.4 cure rate was significantly better compared to patients with an index > 0.4.

In conclusion, simple cystometric data, in particular the detrusor instability index, seem to provide valuable predictive information regarding the outcome of conventional surgery in females with urinary incontinence associated with detrusor instability.
Lower urinary tract smooth muscle inhibitory nerve responses
Authors: Klarskov Peter
Published: March 2007

Detrusor and trigone from man and detrusor, trigone, bladder neck, and urethral smooth muscle from pig were investigated in a series of experiments in vitro. A noncholinergic, nonadrenergic inhibitory nerve response was demonstrated. In the outlet smooth muscle, the onset of the relaxation was fast and sustained during stimulation. The amplitude of the relaxation was proportional to the basal tension and maximal with stimulation frequencies of 5‐10 Hz. In pig detusor, the relaxation was preceded by a contractile phase. Spontaneous or induced contractility and high tension favoured the relaxation in a nonlinear way. In human detrusor the relaxation was difficult to generate and the results were equivocal. No tested transmitter candidate mimicked exactly the relaxation evoked by electric nerve stimulation. Acetylcholine, noradrenaline, enkephalins, substance P, histamine, and prostaglandins were excluded. Vasoactive intestinal polypeptide induced relaxation in both detrusor and outlet muscles. Serotonin and ATP induced contraction in the detrusor and relaxation in pig outlet muscle. However, the relaxationevoked pharmacologcally developed slowly and the amplitudes were submaximal. The relaxation evoked by ATP was probably caused by adenosine after degradation of ATP. No other known and tested transmitter candidate evokes relaxation in lower urinary tract smooth muscle.

Bladder neck smooth muscle biopsies from men with bladder neck dyssynergia, median‐sized benign prostatic hypertrophy, and normal infravesical outlet were analysed for vasoactive intestinal polypeptide by radioimmunoassay and by immunohistochemistry. No diferences were found between the groups. Pressure‐flow‐EMG studies were performed in men and urethrocystometry was performed in women before, during, and after vasoactive intestinal polypeptide 3 μg/kg × h intravenously. No systematic changes developed in any of the urodynamic parameters.
A comparison of the cough and standing urethral pressure profile in the diagnosis of stress incontinence
Authors: Cadogan Mark , Awad Said , Field Christopher , Acker Kelly , Middleton Susan
Published: March 2007

Controversy over the accuracy of the urethral pressure profile (UPP) and its role in the diagnosis of stress urinary incontinence (SUI) is unresolved. Different UPP methods and techniques have been introduced. In this study, we examined 78 female patients with mixed symptoms of stress and urge incontinence. Each had a history, physical examination, cystoscopy, and urodynamic assessment, which consisted of a cystometrogram (CMG), UPP (supine and standing), and “cough profile” by the Brown and Wickham (BW) method and also UPP (supine) and “cough profile” with the microtip transducer (MTT). The final diagnosis in 38 patients was SUI (group I) and in 40 patients, no SUI (group II). The maximum urethral closure pressure (MUCP) supine and standing was significantly lower in group I, but there was no significant difference between the two groups in the transmission index (TI) of the “cough profile.” MUCP standing showed the least overlap between the two groups, and with a cutoff point at 40 cm H2O, the overall diagnostic accuracy was 69%, with 39% sensitivity and 98% specificity. By combining MUCP supine and standing and using cutoff points at 40 cm H2O and 35 cm H2O, respectively, the overall diagnostic accuracy was 72%, with 47% sensitivity and 95% specificity. We believe that the UPP is a useful ancillary tool in the assessment of complicated cases of urinary incontinence in the female.
Cystometry: H2O or CO2 as filling medium? A literature survey of the influence of the filling medium on the qualitative and the quantitative cystometric parameters
Authors: Jørgensen Lisbeth , Lose Gunnar , Andersen Jens Thorup
Published: March 2007

A literature survey is presented on the influence of the filling medium on qualitative and quantitative cystometric parameters. Only ten relevant reports comparing H2O and CO2 cystometry were found. From the reports the following parameters were extracted: size and description of study population, randomisation of sequence of the cystometries (H2O/CO2), patient position, filling rates, catheters used, and qualitative and quantitative cystometric parameters.

The conclusions that can be drawn from the ten studies analysed are that the qualitative classification is independent of the used filling medium (CO2 or H2O). However, the quantitative parameters (first sensation and maximal cystometric capacity) decrease statistically significantly when CO2 is used as the infusion medium. However, we found it difficult to compare the studies, since investigative modalities known to influence the obtained cystometric data differed significantly from study to study.
New proposal for the determination of the nerve conduction velocity of the dorsal nerve of the penis
Authors: Fanciullacci F. , Garavaglia P. F. , Colpi G. M. , Beretta G. , Sandri S. , Zanollo A.
Published: March 2007

The dorsal nerve of the penis reportedly affects sexual function. The method previously used to measure the nerve conduction velocity (NCV) of the dorsal nerve of the penis divided the distance between the stimulating and recording electrodes by the latency to the negative peak of the action potential. According to Bradley, the NCV in normal men was 33 m/sec ± 3.8. Measurement of the NCV by this method revealed that the velocity decreased when the distance between the stimulating and recording electrodes was shortened. Furthermore, these different measurements were linearly related. As a result, NCV values were calculated by means of a regression equation (see text for more specific details). In normal subjects, it resulted in faster values than those reported previously. The mean value was 46.4 m/sec.
Hydrodynamic aspects of pyelocalyceal peristalsis
Authors: Ohlson Lars
Published: March 2007

This study was undertaken to determine the nature of pressure changes in manometric studies of renal pelvis and calyces. In previous studies in pigs it has been assumed that pressure increases occur in the contracting segments of the renal pelvis and calyces, but our observations suggested that these increases were actually due to distension of noncontracted segments. Pressures were recorded with two catheters introduced percutaneously into the pyelocalyceal system with simultaneous video recording of the fluoroscopic image. There was no pressure rise in the calyces or the renal pelvis when these segments contracted; however, pressure rose when the noncontracted calyces were distended by a remote contraction ring. These findings confirmed the observations at kinetic urography. They agreed with the hydrodynamic experience that the pressure in a ring‐shaped contracted segment is lower than upstream and downstream of that segment. It was concluded that if the porcine pyelocalyceal system is a valid model of the human, the pressure increases, assumed to be contractions, were actually caused by the injection and distension of the noncontracted segments.
The influence of filling rates and sympathectomy on bladder compliance in the chloralose‐anaesthetised cat
Authors: Flood Hugh D. , Downie John W. , Awad Said A.
Published: March 2007

The effect of total sympathectomy (hypogastric nerve and sympathetic chain section) on the relationship between bladder compliance and filling rate has never been studied over the full range of physiological filling rates. In a series of chloralose‐anaesthetised cats, we examined the effect of total sympathectomy on bladder stiffness (the inverse of compliance) at filling rates from 1 to 50 hourly diuresis (HD) units. In control animals the slopes of regression lines fitted from 5 to 30 (n = 7) or 5 to 50 (n = 3) HD units were equal to or approached 0 (mean slope = .002 ± .0008 SE). After sympathectomy there was a statistically significant increase in stiffness at filling rates from 5 to 30 HD units (P < .005), and, although there was a trend for increased stiffness at higher filling rates, the increase in the slopes of the regression lines did not reach statistical significance (.05 < P < .1). The volume threshold for micturition at a filling rate of 5 HD units was significantly lowered after sympathectomy (P ≤ .0005). We conclude that the sympathetic nervous system makes a significant contribution to the control of bladder stiffness (and therefore compliance) within the range of physiological filling rates and that this effect may be more important at higher rates of filling. The sympathetic nervous system also has a role in determining the volume threshold for micturition at physiological filling rates.
Rapid filling cystometry for predicting poor symptomatic results after transurethral prostatic surgery
Authors: Nielsen Knud T. , Graversen Peder H. , Madsen Paul O. , Bruskewitz Reginald C.
Published: March 2007

Twenty‐seven patients with symptomatic bladder outlet obstruction secondary to benign prostatic hyperplasia (BPH) were evaluated preoperatively by standard urodynamic investigation and by rapid filling cystometry (RFC). Rapid filling cystometry was performed by injecting a maximum of 120 ml saline into the empty bladder through a catheter at a constant flow rate over 4 seconds. Twenty‐three patients were reexamined 3 months after transurethral prostatic surgery. Three patients had not improved symptomatically. None of these three had uninhibited detrusor contractions (UDC) by RFC, but medium filling cystometry revealed UDC in 2 of the patients, both pre‐ and postoperatively. Rapid filling cystometry, as used in this study, correlated poorly with medium filling cystometry and failed to identify the patients that will not benefit from prostatic surgery due to persistent postoperative UDC.
The burch colposuspension for urinary incontinence in patients with stable and unstable detrusor function
Authors: Jørgensen Lisbeth , Lose Gunnar , Mortensen Svend O. , Pedersen Lars Mølsted , Kristensen Jørgen Kviss
Published: March 2007

Eighty patients with urinary incontinence, 61 with stable and 19 with unstable detrusor function, were evaluated preoperatively and postoperatively after Burch colposuspension. The cure rate in the stable group was found to be 75% vs. 26% in the unstable group. This difference was highly significant (P < 0.0005). In the unstable group, the major cause of failure was persistent instability. The great controversy in the literature as to the prognostic significance of preoperatively demonstrated detrusor instability when treating urinary incontinence by conventional antiincontinence surgery is suggested to be due to: (1) differences in the cystometric techniques, hence the populations classified with detrusor instability; and (2) difficulties in identification of instability secondary to bladder neck incompetence. The cystometric technique described in this study is considered sufficiently physiologic to allow a reliable identification of true instability, thereby selecting patients who will not benefit from surgery. It is emphasized that there is a need for a thorough standardization of the cystometric technique for classifying true instability and as a basis for comparative studies.
Short pad test: Standardisation of method and comparison with 1‐hour test
Authors: Mayne C. J. , Hilton P.
Published: March 2007

Three different exercise pad tests were performed on 33 patients with known urinary incontinence. It was found that prolonging the test or carrying it out at a specified bladder volume increased the detection of leakage. There was, however, no direct correlation between the three different methods.