Alex E. Finkbeiner

Paratesticular Sarcomas: Review of Management

Two patients with paratesticular sarcomas (1 leiomyosarcoma and 1 liposarcoma) are described, making the total number of cases reported 206. A review of the diagnosis and a critical analysis of the therapeutic approaches are presented.

Accuracy of preoperative estimation of resection weight in transurethral prostatectomy.

In a prospective study of 150 consecutive transurethral resections of the prostate gland the preoperative estimate of gland weight was compared to the actual resected weight. The data revealed a wide variation between estimated and actual weight in all size glands.

Uropharmacology: Part VI. Parasympathetic depressants

A discussion of the various parasympathetic depressants is presented. Belladonna alkaloids include atropine, the prototype, and scopolamine. Synthetic drugs include quaternary ammonium compounds with antimuscarinic activity such as methantheline, propantheline, and other drugs such as isopropamide, pipenzolate methylbromide, and diphemanil methylsulfate. A miscellaneous class of drugs such as hemicholinium, valethamate, and oxybutynin chloride also possesses parasympathetic depressant activity. The pharmacologic properties and clinical usage of these drugs are discussed.

Uropharmacology: V. CHoline esters and other parasympathomimetic drugs

Various parasympathomimetic drugs are discussed, including the choline esters, bethanechol, carbachol, methacholine chloride, and furtrethonium. Other cholinomimetic agents include muscarine, muscarone, arecholine, and pilocarpine. Anticholinesterase agents inhibit or inactivate acetylcholinesterase enzyme and thus result in a prolonged stimulation of cholinergic receptors by endogenous ACh. Bethanechol is the most widely used parasympathomimetic drug in the United States. Its action is mainly muscarinic with activity largely confined to the urinary bladder and to a lesser degree the gastrointestinal tract. It can be administered only subcutaneously or orally, and adequate dosage is necessary for a successful response.

Lower urinary tract pharmacology: III. Neuropharmacologic basis for lower urinary tract dynamics.

In vivo studies. Electrical stimulation of the sympathetic and parasympathetic systems is often combined with intravenous administration of autonomic drugs. The effects of receptor stimulation or blockade are recorded as changes in intravesical pressure and flow,lm3 as changes in intraurethral pressure,4 or as variation in the tension of the bladder musculature.5 In situ evaluation with discontinuity of bladder and urethra. In Jonas and Tanagho’s model,6 the bladder and urethra are left in situ but are surgically separated. The blood supply remains intact. This arrangement makes it possible to record separately, simultaneous intravesical and intraurethral pressures while eliminating the factor of direct continuity. In vitro perfusion of bladder outlet region (bladder base, bladder neck, and proximal urethra). 7*10 The specimen is perfused in an organ bath, and the effect of various autonomic drugs are studied as a function of variation in the resistance to flow through the bladder outlet. This technique preserves the anatomic configuration of the outlet region. In vitro studies on isolated strips of bladder and urethra. Muscle segments from the lower urinary tract are studied in a tissue bath.‘l,” The use of isolated muscle segments avoids modification of the response to pharmacologic agents by spinal reflexes and humoral factors. This technique fulfills the requirements for pharmacologic evaluation of receptors as specified by Furchgott. l3 However, extrapolation of results to the intact organ may be difficult. Electron microscopic and histochemical techniques. Delineating the distribution of cholinergic and adrenergic nerves in the bladder and bladder outlet provides a basis for understanding the nature of these fibers and the site and mode of action of drugs acting on them. 14-20 Disagreements concerning the role of sympathetic and parasympathetic nervous system in the regulation of bladder outlet function are largely due to two factors: (1) the response of an in vitro experimental laboratory model does not always reflect the in vivo response, and (2) responses vary with different species of investigational animals. For instance, sympathetic nerve stimulation and epinephrine will bring about contractions of the outlet region in the cat21-23 and man,24 while divergent responses are obtained in the dog and rabbit to the same type of activation.22 This may be caused by species variations in localization and function of adrenergic receptors. 25

Prostatic mycosis: nonsurgical diagnosis and management.

Mycotic prostatitis is usually found incidentally at autopsy or in surgically removed prostates. A seventy-nine-year-old man with mycotic prostatitis presented with prostatism. A non-operative diagnosis was established by needle biopsy of the prostate. Symptoms of prostatism improved with medical management. A review of prostatic mycosis is presented.

Lower urinary tract pharmacology I. Anatomic considerations

With this issue Dr. Bissada, Dr. Finkbeiner, and Dr. Welch introduce a series on uropharmacology, starting with the lower urinary tract. Since an understanding of the anatomy, neurophysiology, and basic pharmacology is necessary, Part I is a description of the functional anatomy of the lower urinary tract and the mechanisms of continence and voiding. Part II is a review of the differences between somatic and autonomic reflexes; the afferent and efferent innervation of lower urinary tract; the organization of pelvic ganglionic cells and the spinal and supraspinal control of lower urinary tract function. Subsequent articles will be on basic pharmacology of lower urinary tract and individual drug classes.

Idiopathic segmental ureteritis

A new case of nonspecific segmental ureteritis is added to the 18 cases previously reported. This case presented similar diagnostic problems to the previously reported cases. Its unique features are the multiplicity of the lesions and their insidious nonsimultaneous development over a number of years.

Uropharmacology: VIII. Sympathomimetic agents

Sympathomimetic drugs stimulate the receptors of the sympathetic nervous system. Although the bladder possesses sympathetic receptors, sympathomimetic drugs, in general, have little effect on bladder function. Their most useful clinical applications on the urinary tract are to increase or decrease bladder resistance.

Unusual inguinal mass secondary to vasitis

Abstract A case is reported of vasitis that presented as an inguinal mass in a forty-six-year-old man. A brief review of the literature is given.