David M. Raezer

Autonomic innervation of canine urinary bladder cholinergic and adrenergic contributions and interaction of sympathetic and parasympathetic nervous systems in bladder function

Abstract On the basis of histochemical and pharmacologic studies, the dog urinary bladder is more appropriately divided between its body and base than between its trigone and detrusor muscles. The bladders base has a rich cholinergic innervation while its body has a modest cholinergic innervation. The smooth muscle cells of the bladder are not individually innervated but do have an abundance of membrane acetylcholinesterase. Cholinergic stimulation produces a contraction throughout the bladder. The adrenergic innervation is also regional. The base is richly innervated, and the body has a scant but definite innervation. Adrenergic stimulation by norepinephrine produces a beta inhibition of the body and an alpha contraction of the base. The functional significance of these direct effects of cholinergic and adrenergic stimulation are discussed in light of recent findings that support an interaction between the parasympathetic and sympathetic nervous systems in bladder function.

The Functional Approach to the Management of the Pediatric Neuropathic Bladder: A Clinical Study

A functional approach has been used in the management of the pediatric neuropathic bladder. Herein we report on our experience with incontinent children using pharmacologic manipulation with anticholinergic and sympathomimetic agents. Neuropharmacology and neuroanatomy as they apply to this approach are reviewed.

The Effects of Bethanechol Chloride on Urodynamic Parameters in Normal Women and in Women with Significant Residual Urine Volumes

A 5 mg. subcutaneous dose of bethanechol chloride was given to 12 women with residual urine volumes equal to or greater than 20 per cent of bladder capacity but no evidence of neurologic disease, or anatomic or functional outlet obstruction and to 27 normal women wtih approximately the same mean age. The cystometric and some profilometric parameters did change, indicating that the drug was pharmacologically active. No improvement in voiding function was noted, as judged by residual urine volume and flow rate measurements. These results raise significant questions regarding the contemporary use of this drug, especially in the currently recommended oral dosages.

Management of neurogenic bladder dysfunction in the adult

A review of the management of neurogenic bladder dysfunction in the adult is presented. The various modes of therapy are classified according to their effects on bladder contractility and outlet resistance, providing a logical framework for discussion.

Effect of levodopa on urinary bladder

Levodopa therapy enhanced the ability of the bladder to store urine in two parkinsonian patients. In vitro canine muscle bath studies with the two major metabolites of levodopa, dopamine and norepinephrine, indicate that the effects of the drug on the peripheral sympathetic nervous system may play a major role in the improvement of urinary symptoms observed with levodopa therapy.

Bladder muscle contractility comparative effectsand mechanisms of action of atropine, propantheline, flavoxate, and imipramine

The anticholinergic and antispasmodic activity of atropine, propantheline, imipramine, and flavoxate were judged by each drugs ability to inhibit bethanechol chloride and barium chloride-induced canine detrusor contractions. In this in vitro model, atropine and propantheline are pure anticholinergic agents. Imipramine significantly decreases both bethanechol and barium-induced contractions, while flavoxate only minimally inhibits the response to either stimulant.

Adrenergic and cholinergic stimulation and blockade of the human bladder base.

The response of muscle strips from the human anterior and posterior bladder base to autonomic stimulation and blockade was studied. The human bladder base, like that of the dog, possesses an abundance of cholinergic and alpha-adrenergic receptor sites. Neuropharmacologically, the musculature of the anterior base is similar to that of the posterior base (trigone plus detrusor musculature).

The Reproducibility and Interpretation of Carbon Dioxide Cystonietry

The day-to-day and same-day variability of carbon dioxide cystometry was examined in a population of men. Considerable variability was observed in each parameter monitored. The implications of such variability, and the validity and significance of certain cystometric events are discussed.

The Effect of Oral Bethanechol Chloride on the Cystometrogram of the Normal Male Adult

A double-blind study of the effects of placebo and oral bethanechol chloride (25, 50 and 100 mg.) on the carbon dioxide cystometrogram of the normal male adult was done. Statistical analysis of the data showed no significant dose-response relationship for any of the parameters measured.

Failure of the bethanechol supersensitivity test to predict improved voiding after subcutaneous bethanechol administration.

Subcutaneous administration of 5 mg. bethanechol chloride did not change significantly either flow rates or percentage residual urine in 11 patients with a positive bethanechol supersensitivity test. Therefore, a positive response to this test cannot be used to predict improved voiding function after subcutaneous or oral administration of the drug. Studies that purport to show a long-term rather than a short-term facilitory effect of this agent on voiding must satisfy rigid criteria, which include totally excluding a change in any other factor affecting the lower urinary tract.