Bjarne Kromann-Andersen

The Elasticity and the Tensile Strength of Tunica Albuginea of the Corpora Cavernosa

The aim of this study was to determine the tensile strength and the elasticity of the tunica albuginea (TA), and describe morphological structures in the tissue before and after mechanical deformities. Twenty cadavers of men aged between 33 and 83 were examined. Cavernosometry was performed in all specimens. Afterwards in five cadavers the flow rate was increased until a herniation of the TA appeared. A strength about 1500 mm. Hg was found. Similar results were found in four who had an inflatable prosthesis (AMS 700) inserted, and the intraprosthetic pressure increased until a deformity was noted. Slices of TA (thickness 1.3 to 3.3 mm.) from 11 specimens were tested in a tensiometer. The elasticity coefficient was found to be around 10(8) N/m2, and the tensile strength to be 600 to 750 mm. Hg (10(4) to 10(5) N/m2). The difference between the tensile strength achieved in the tensiometer and during saline infusion is possibly caused by the intracavernous framework. Microscopy showed that TA is mainly composed of collagen fibres which are situated in an undulating arrangement, with a few elastic fibres arranged longitudinally which connect the undulating bundles of collagen fibres. When the tissue is overstretched, the elastic fibres are destroyed and the undulating arrangement disappears.

Failure of Combined Supratrigonal Cystectomy and Mainz Ileocecocystoplasty in Intractable Interstitial Cystitis: is Histology and Mast Cell Count a Reliable Predictor for the Outcome of Surgery?

Eight women with severe intractable interstitial cystitis were treated with supratrigonal cystectomy and Mainz ileocecocystoplasty. The preoperative evaluation consisted of symptom analysis, cystometry, cystoscopy and bladder pathological findings. Seven patients had increased mast cell density. Median followup was 10 months. The symptoms resolved in 2 patients but recurred in 6 shortly after the operation. Voiding could not be established in 4 patients. Self-catheterization was difficult and painful. Ultimately, cystectomy and urinary diversion were performed in 5 patients and is scheduled in 1. The 2 cured patients had a small contracted bladder preoperatively while they were under anesthesia, while all 6 failed cases had a large bladder capacity. Postoperative biopsies from the trigone showed no difference in the amount of fibrosis, the degree of degenerative changes in the muscle and mast cell density between the 2 cured patients and the 6 who failed to improve. The mast cell density and the histological status of the trigone cannot be used as predictors of the outcome of supratrigonal cystectomy. The role of the mast cells in interstitial cystitis is reviewed. Combination of supratrigonal cystectomy and a Mainz augmentation cystoplasty cannot be recommended in patients with intractable interstitial cystitis and a large bladder capacity.

Long-term results of pelvic floor training and surgery for female genuine stress incontinence

Fifty-two women with genuine urinary stress incontinence were randomized to pelvic floor training or surgery. At 4 and 12 months follow-up patients not satisfied with the outcome were offered the alternative treatment. Ten patients (42%) were satisfied following the training program, 20 patients (71%) were satisfied following surgery, while 22 patients underwent both treatment modalities.The patients were re-evaluated 4–8 years later (median 6 years) by history (n=48), pad-weighing test (n=41), and urinary diary (n=37). The beneficial effect of pelvic floor training continues for years. The longterm results were practically the same as after 1 year for all treatments. Patients with significant incontinence may be well-adapted to the situation, and indication for treatment is very much dependent on the hazards involved. Objective measurement of the degree of incontinence is essential when different treatments are compared.

Should we use laparoscopic adrenalectomy for metastases? Scandinavian multicenter study

Laparoscopic adrenalectomy for metastases is considered controversial. Multicenter retrospective study was performed to gain new knowledge in this issue.

Risk factors and prognosis after discharge for patients admitted because of suspected acute myocardial infarction with and without confirmed diagnosis

The prognosis regarding cardiac events--acute myocardial infarction (AMI) or cardiac death after discharge--was evaluated in 257 patients admitted because of suspected AMI due to chest pain, but in whom AMI was not confirmed (non-AMI patients). The findings and patient prognoses were compared with those of 275 patients with confirmed AMI. All patients were younger than 76 years and free of severe chronic diseases, and no cause of chest pain other than possible ischemic heart disease was found. The patients were followed for cardiac events for 11 to 24 months (median 14). The prognoses for the non-AMI patients were significantly better than those for the AMI patients (p = 0.05). The proportion without a cardiac event after 1 year was estimated at 91% and 86%, respectively. In the non-AMI patients, angina pectoris, previous AMI and electrocardiographic changes on admission (intraventricular block and permanent or transient ST-T changes) were significant predictors of cardiac events by univariate and multivariate analysis. In the AMI patients, female gender, heart failure, previous AMI and angina pectoris were significant predictors of cardiac events by univariate analysis. With use of multivariate analysis, female gender, heart failure and angina pectoris were independent predictors of cardiac events. Thus, non-AMI patients admitted with chest pain have a high risk of cardiac events after discharge. The risk is highest when there is evidence of coronary artery disease (electrocardiographic changes on admission and angina pectoris or previous AMI.

The Urethral Plug: A New Treatment Modality for Genuine Urinary Stress Incontinence in Women

A new modality, the urethral plug, was used to treat 22 women with genuine urinary stress incontinence. The plug is made of thermoplastic elastomer (Kraton G), and consists of a meatal plate, a soft stalk and 1 or 2 spheres along the stalk. The spheres were located according to the result of the urethral pressure profile. The midpoint of the proximal sphere was placed at the bladder neck and the distal sphere was placed just above the maximum urethral pressure point. At voiding the plug was removed and afterwards a new plug was inserted. The plug with 2 spheres was tested in week 1 (period 1) and the plug with only the distal sphere was tested in week 2 (period 2). A total of 22 patients completed period 1. Eight patients did not complete period 2, mostly due to either unchanged incontinence during period 1 or a repeated loss of the plug with 1 sphere. In periods 1 and 2, 73 and 79% of the patients were subjectively and objectively continent or improved. A total of 14 patients completed both periods. Eight patients preferred the plug with 2 spheres, 1 preferred the other plug and 5 had no preference. The side effects were few. This preliminary study shows that the urethral plug seems to be a promising alternative treatment for female genuine urinary stress incontinence.

Pad weighing tests with 50% or 75% bladder filling: Does it matter?

In order to evaluate the influence of bladder filling at the beginning of a 40 minutes pad test, 71 women completed this study. Thirty‐six patients were randomized to pretest filling of the bladder to 50% of the bladder capacity, and 35 patients to 75% pretest filling. In all patients, a retest was performed approximately fourteen days later. The leakage in the two groups was equal. Median leakage during the first test was 3 g in both groups (p = 0.97). The leakage was numerically larger during the second test, median 6.5 g and median 13 g, respectively (p = 0.69). The test‐retest variation was calculated in both groups. In patients with 50% bladder filling test‐retest variation (mean 2 S.D.) was −28.4%+ 206.8%. In patients with 75% bladder filling mean variation was −58.0% + 203.0%. The difference in test‐retest variation between groups was not statistically significant (p = 0A7). Only the subjective evaluation by the patients revealed a preference in favor of the test with 50% bladder filling. Significantly more patients in the 50% group reported that the results of the first test and the retest corresponded well with the daily urinary leakage (p=0.04). The most striking finding of this study was that, despite filling to either 50%. or 75% of the bladder capacity at the beginning of the test, the fluid load during the test, i.e. the initial volume instilled into the bladder plus the diuresis during the test, was equal in the two groups. The diuresis during the test in patients with 50% bladder filling was median 116 ml at the first test vs. median 64 ml in patients with 75% bladder filling (p = 0.01). These results were highly reproducible during the second test, where the diuresis in the two groups was median 115 ml and 63 ml, respectively (p = 0.01). The theoretical background for this phenomenon is discussed.

Rate of urinary bladder blood flow evaluated by 133Xe washout and radioactive microspheres in pigs.

SummaryUrinary bladder blood flow as measured by the washout of locally injected 133Xe and by the simultaneously performed radioactive microsphere reference-sample method was studied in pigs. The washout curves were analyzed according to the initial slope, the corrected initial slope and the total curve. The corrected-initial-slope flow rates were not statistically significantly different from the microsphere whole-wall flow rates. The variability between the methods shown by the test-retest difference revealed only a minor lack of agreement. The bladder blood flow tended to decrease after the intravesical pressure had been increased to 20 cmH2O, but the difference was not statistically significant. Washout of locally injected 133Xe can be used for the evaluation of urinary bladder blood flow in humans and in longitudinal animal studies. The corrected-initial-slope method is recommended for the analysis of washout curves.

Amyloidosis of the seminal vesicle--a case report and review of the literature.

The finding of amyloid deposits in the seminal vesicles has been known for many years. The deposits are usually localized and asymptomatic. In recent years seminal vesicle amyloidosis has been reported to simulate prostate and bladder cancer invasion on MRI. We therefore feel that knowledge of the entity is important and present herein a typical case confirming the previous findings that amyloidosis of the seminal vesicles is a unique form of amyloidosis, a relatively common incidental finding and one that may be related to prostate cancer.

Urinary bladder blood flow

SummaryThe blood flow of the dog urinary bladder measured by radioactive microsphere technique was compared to the clearance of locally injected 99mTechnetium pertechnate (99mTc) in the bladder wall. In semilogarithmic plots the 99mTc washout curves showed a multiexponential course. From the initial slopes (median 5.7 min) the bladder blood flow was calculated to be only 30–62% of the results obtained from the radioactive microsphere technique (blood flow in the muscular layer 21.7–44.8 ml/ 100 g/min). These lower values imply that the rate of removal of the hydrophilic tracer 99mTc at these flow rates is limited by the capillary diffusion capacity. The multiexponential curves reflect recirculation and excretion of 99mTc by the kidneys with accumulation of 99mTc in the bladder. It is concluded, that clearance studies of locally injected 99mTc in the bladder wall are unable to evaluate bladder blood flow.