A. Ek

Adrenoceptor and Cholinoceptor Mediated Responses of the Isolated Human Urethra

Smooth muscle preparations from various parts of the isolated urethra and the urethrovesical junction were obtained from male and female patients undergoing total cysto-urethrectomy because of bladder malignancy. The preparations were suspended in Krebs solution (37°C) bubbled with carbogen. Isometric tension was recorded. Twenty-nine out of 42 drug-responsive preparations exhibited a spontaneous contractile activity. This was unaffected by tetrodotoxin, atropine, and phenoxybenzamine, suggesting it was of myogenic origin. Noradrenalin contracted preparations from all parts of the urethra, including the urethrovesical junction, in a concentration-related way. No differences in the sensitivity to noradrenalin between different parts of the male or female urethra could be established. The noradrenalin-induced effects were inhibited by phenoxybenzamine, suggesting that they were mediated via α-adrenoceptors. Adrenalin, phenylephrine, ephedrine, and norephedrine had contracting effects that could be blocked b...

The effects of long-term treatment with norephedrine on stress incontinence and urethral closure pressure profile.

Twenty-five women with stress incontinence of urine were given an alpha-adrenoceptor stimulating agent (norephedrine) and a placebo during respective 14-day periods according to a double-blind cross-over schedule. The results were classified as the patients own assessment of therapeutic effect and as change in urethral closure pressure profile measured by a microtransducer catheter. Norephedrine had a significant therapeutic effect on the symptom stress incontinence and produced significant increase in maximum urethral pressure and maximum urethral closure pressure in the lithotomy and the erect position. Reduction of incontinence was associated with increase in maximum urethral closure pressure. The sum therapeutic effect was of moderate degree.

The Effects of Norephedrine and Bethanechol on the Human Urethral Closure Pressure Profile

In twelve women with urinary stress incontinence simultaneous measurements were made of the intravesical and intra-urethral pressures, including the urethral closure pressure profile (UCPP), before and after oral administration of norephedrine or subcutaneous injection of bethanechol. The investigations were carried out at various bladder volumes in the supine position and at bladder volume 300 ml in erect position. Irrespective of bladder volume or body position, norephedrine caused a statistically significant rise in maximum urethral pressure (MUP) and in maximum urethral closure pressure (MUCP). The intravesical pressure was not affected. After intravenous injection of phentolamine, MUP and MUCP fell to levels below the original readings, but here too the intravesical pressure was unaffected. Injection of bethanechol was followed by significant increase in the intravesical pressure, irrespective of bladder volume or body position. There were no consistent changes in the intra-urethral pressure. As a consequence of the rise in intravesical pressure, however, the MUCP fell slightly. The results of the study suggest that orally administered norephedrine causes an increase in the MUCP in women with stress incontinence of urine, an increase that may prove therapeutically useful. Bethanechol, in doses that significantly increased intravesical pressure, did not alter the intra-urethral pressure.

Intravesical Adriamycin Therapy in Carcinoma in Situ of the Urinary Bladder

Intravesical Adriamycin treatment was given to 22 patients with carcinoma in situ of the urinary bladder. The treatment schedule consisted of monthly Adriamycin instillations in a dose related to bladder capacity. Endoscopic inspection with multiple bladder biopsies and cytoanalysis of urine was performed after every third instillation. In two patients there was lasting disappearance of the carcinoma in situ. Another 10 patients possibly had a beneficial effect of the treatment. The remaining 10 patients showed persistent malignancy and in 6 of these, progression of carcinoma in situ during Adriamycin treatment necessitated cystectomy or radiotherapy. The histologic and cytologic findings showed distinct variability in most patients, with atypia or even absence of malignant cells often followed by recurrence. Adriamycin was discontinued in four cases because of severe cystitis, and in one case because of an anaphylactoid reaction following instillation of the drug.

Intracavitary Epodyl® for Multiple, Non-Invasive, Highly Differentiated Bladder Tumours

Multiple, recurrent cancer of the bladder grade I-II (WHO), stage T1 (UICC) was treated with regular intravesical instillation of ethoglucid (Epodyl) in 39 patients. In ten of them cystitis necessitated withdrawal of the treatment. The therapeutic schedule could be followed in 29 cases, with eradication of the tumours in 27. Nine patients who continued the treatment on a prophylactic basis were still recurrence-free after 18-60 (mean 37) months. Myelosuppression did not occur, but cystitis was a serious problem that frequently jeopardized therapy.

Osteitis Pubis After Transrectal Aspiration Biopsy of the Prostate

Two patients developed osteitis pubis after transrectal aspiration biopsy of the prostate. We recommend that prophylactic antibiotics should be given before all such procedures.

Huge Bladder Carcinoma Successfully Treated with Hydrostatic Pressure Technique: A Case Report

A 64-year-old man presented with acute urinary retention and anasarca due to noninvasive multiple papillary transitional cell carcinoma filling the whole bladder cavity and obstructing both ureters. He was treated with hydrostatic pressure distension. A dramatic response occurred, with complete disappearance of the tumour within one month of the treatment.

Intravesical Adriamycin in Patients with Carcinoma in Situ of the Urinary Bladder

Flat carcinoma in situ of the urinary bladder is identified with increasing frequency as a result of the growing use of urine cytology and the increasing practice of endoscopic mucosal biopsy from unstable looking areas of the bladder epithelium[1]. Since the natural history of carcinoma in situ is most variable the choice of treatment may be extremely difficult and is still under trial. Once progress to invasion is proven cystourethrectomy is to be considered as external irradiation has been shown to be inefficient[2]. Less mutilating alternatives to removal of the bladder have been searched for such as intracavitary treatment using different chemotherapeutic agents. This report concerns our experience with intravesical Adriamycin therapy in patients with carcinoma in situ of the bladder with respect to efficacy, tolerance and side effects.