A. Kondo

A double-blind clinical trial of a ?2-adrenergic agonist in stress incontinence

A multicenter double-blind placebo-controlled trial was performed on aβ2-adrenergic agonist, clenbuterol, in 165 women with stress incontinence. Clenbuterol remarkably improved the stress incontinence, and urodynamically the drug was found to increase the maximal urethral closure pressure. Some side effects were noted, but they were not serious. The results of this trial showed clenbuterol to be a promising drug for the treatment of stress incontinence.

Influence of Aging on the Rat Urinary Bladder Function

We studied in vitro the change in bladder function with aging. The responses of muscle strips made from the rat bladder body to eight neurotransmitters and to four inorganic ions were examined. Six-month-old rats were used as controls and 16- and 24-month-old rats as aged rats. The results of this study are summarized as follows: (1) The contractile responses of the aged rat bladder to norepinephrine, adenosine triphosphate, and serotonin were significantly greater than those of young rat bladder. This may contribute to the development of an unstable bladder in elderly people. (2) In the aged rat bladder magnitude and speed of the response to calcium were significantly weaker which may account for the impaired detrusor contractility frequently observed in elderly persons. (3) There was no significant age-related difference in the response to other agents (acetylcholine, prostaglandin F2 alpha, angiotensin II, vasoactive intestinal polypeptide, KCl, BaCl2, and MgCl2).

The responsiveness of the ICSmale questionnaire to outcome: evidence from the ICS-‘BPH’ study

Objectiveu2002To evaluate the responsiveness of the ICSmale questionnaire to the outcome of treatments for lower urinary tract symptoms (LUTS).

Quantifying Thread Tension is of Clinical Use in Stamey Bladder Neck Suspension: Analysis of Clinical Parameters

Tension on the nylon loops in a Stamey endoscopic bladder neck suspension has been quantified for the first time by using a spring scale. Clinical data were compared between 14 patients with undetermined tension (control group) and 57 with tension of either 400, 600, 700, 800 or 1,000 gm. Experimental study during the operation demonstrated that changes in the posterior urethrovesical angle and distance that the bladder neck was elevated were not proportional to the tension: the lower the thread tension the larger the change in these 2 parameters. Compared to the control group a significant decrease in the period of suprapubic drainage was observed in patients with quantified tension. Operative success was obtained in 86 per cent of the control group and 91 per cent of those in whom tension was quantified. A tension of 400 to 600 gm. seemed to be most appropriate for a successful outcome. We conclude that quantifying the thread tension is useful to prevent either over-tightness of the nylon loops or insufficient suspension of the bladder neck, and that with a spring scale it is easy to instruct a beginner on how tightly to tie the threads.

Effects of ligation of the internal iliac artery on blood flow to the bladder and detrusor function in rat

Ischaemia induced by atherosclerosis is a common cause of disorders in the elderly, including impairment of bladder function. To evaluate experimentally the effects of ischaemia on detrusor function, we performed infusion cystometry and evaluated the morphologic findings in the bladder of the rat.Blood flow to the bladder of the rat was evaluated with a Doppler flowmeter before and after the unilateral or bilateral ligation of the internal iliac arteries. Reevaluation was done at one and two weeks after surgery. Bladder function was studied by infusion cystometry performedin vivo under urethane anaesthesia. Finally, histological examination was performed.Blood flow at mid-dorsal wall of the control bladder was inversely related to intravesical volume. Unilateral or bilateral ligation of the internal iliac arteries decreased blood flow to the bladder, which showed a complete recovery two weeks postoperatively. Infusion cystometry of the ischaemic bladder with bilateral ligation of the internal iliac arteries demonstrated a decrease in voiding pressure, an increase in bladder capacity, and an increase in pressure at which micturition was initiated vs. the control. The bladder with unilateral ligation of the artery showed a decrease in voiding pressure, with no change in the other parameters. Histological examination indicated that the bilateral ischaemia and ischaemic side of unilateral ischaemia led to a degeneration of the mucosa, and severe oedema in submucosal and muscle layers one week postoperatively. Degeneration of smooth muscle was predominant at 2 weeks. Contralateral side of the unilaterally ischaemic bladder showed oedema and congestion of the submucosa and smooth muscle.Ligation of the internal iliac artery decreased blood flow to the bladder significantly, which resulted in smooth muscle degeneration. Consequently,in vivo voiding pressure was impaired in the ischaemic bladder.

Effect of ischemia and partial outflow obstruction on rat bladder function

We investigated the effects of ischemia induced by ligation of the bilateral internal iliac arteries following partial outlet obstruction on changes in detrusor function in rat. Rats were divided into three groups: sham-operated control rats, rats with partial outlet obstruction, and rats with obstruction + ischemia. Bladder function was studied by the in vitro organ bath technique 7 days after surgery. The weight of the bladder was significantly increased in both the obstruction and obstruction + ischemia groups. The obstruction + ischemia group exhibited a greater increase in weight. The passive length-tension relationship of detrusor muscle strips showed that tissue elasticity was decreased and the active length-tension relationship demonstrated that the peak response was observed at a shorter tissue length in the obstruction + ischemia group compared with the other two groups. There was no difference in the passive and active length-tension relationships between the control group and the obstruction group. The contractile response to various kinds of stimulation (field stimulation, bethanechol, ATP, and KCl) increased in the obstruction group and decreased in the obstruction + ischemia group. These findings suggest that partial outflow obstruction alone increased bladder contractility in response to stimuli. However, ischemia reduced the contractility and elasticity of the bladder wall.

FUNCTIONAL RESTORATION OF RAT BLADDER AFTER SUBTOTAL CYSTECTOMY : IN VIVO CYSTOMETRY AND IN VITRO STUDY OF WHOLE BLADDER

Functional restoration of the rat urinary bladder following subtotal cystectomy was studied via in vivo infusion cystometry and an in vitro whole bladder model. After the bladder had been separated from the prostate, subtotal cystectomy was achieved by ligating the bladder completely at a level just above the insertion of the ureters into the bladder. Bladder function was investigated immediately and 7, 14, and 28 days after surgery. Bladder weight was reduced to 17% that in sham-operated controls immediately after surgery, but recovered to 76% of that in controls 28 days after the operation. In vivo capacity also increased after surgery from 13% that of controls to 59% 28 days later. However, voiding pressure remained low (34% of control) 28 days later. An in vitro whole bladder study showed that the response to field stimulation decreased significantly on day 7, but had recovered considerably by day 28. The maximal response to bethanechol decreased significantly 7 days after surgery, but recovered thereafter. The response to phenylephrine increased significantly immediately after surgery, but gradually returnd to the control level. An in vitro volume-pressure study showed that passive complance of the cystectomized bladder decreased after surgery, but improved with time. The peak of the active pressure increase to field stimulation occurred at a low infusion volume immediately after surgery, but bladder capacity increased gradually until 28 days later, when the maximal active pressure was obtained. Our results suggest that restoration of the bladder following subtotal cystectomy may not derive simply from an expansion of the bladder wall. Functional alteration involving the bladder base was also observed.

Evaluation of Intravesical Alum Irrigation for Massive Bladder Hemorrhage

The efficacy of intravesical alum irrigation was analyzed after application to 9 patients with continuous and severe bladder hemorrhage. Causes of bleeding were radiation cystitis in 4 patients, vesical invasion by cervical cancer in 3, bladder cancer in 1 and cyclophosphamide-induced cystitis in 1. Though alum treatment was initially effective for control of massive bladder hemorrhage in all patients, it eventually failed to suppress a subsequent hemorrhage in 2 patients (78% success rate). No significant side effects directly related to this therapy were observed. In conclusion, alum irrigation is effective for controlling massive bladder hemorrhage for a rather short time. Therefore, additional treatment modalities should also be considered for primary diseases.

A paraplegic fathering a child after an intrathecal injection of neostigmine: case report

This paper reports a 33-year-old male paraplegic (T6) who fathered a child by artificial insemination following an intrathecal injection of neostigmine. His wife was healthy and pregnancy was achieved after the 10th insemination. She delivered a mature female child weighing 3,100 g in August 1984. To our knowledge this is only the fourth successful case in the world following neostigmine injection.

In vitro intravesical instillation of anticholinergic, antispasmodic and calcium blocking agents to decrease bladder contractility.

We investigated the effect of intravesical administration of atropine, oxybutynin, verapamil, diltiazem, and imipramine on pressure responses of the rabbit in vitro whole bladder model. All drugs investigated suppressed the pressure responses to field stimulation and bethanechol in a time-dependent manner (maximum inhibition at 90-120 min). Atropine and oxybutynin suppressed the contractile response to bethanechol to a much greater extent than that to field stimulation. These results suggest that the use of self-intravesical instillation might be a good therapeutic approach for patients with detrusor hyperreflexia, especially those who are already managed by intermittent catheterization.