F. Brantley Scott

Use of fresh placental membranes for bladder reconstruction.

Several biodegradable and artificial materials have been used in the urinary tract for partial or total replacement of the bladder. Most of the graft materials have resulted in stone formation, collapse, rejection, or extrusion of the graft without adequate reconstruction of a functional bladder. In this paper, we present our assessment of the use of placental membranes as a feasible, economic, and acceptable organic agent for bladder reconstruction. Eight mongrel dogs were subjected to supratrigonal cystectomy, and then a 10 X 10 centimeter patch of human placental membrane was sutured to the remaining trigone in a watertight fashion. The dogs were sacrificed twelve weeks after surgery. Histologic examinations revealed evidence of regeneration of normal-appearing smooth muscle along the path of a retracting placental patch, and thus of reconstitution of a normal-appearing and functioning bladder. On the basis of this study, we believe that placental membranes, because of their low antigenic properties and easy availability, provide an excellent graft material for the urinary tract. Further studies concerning the application of this graft material in various pathological conditions are now in progress.

Ultrastructural analysis of human penile corpus cavernosum Its significance in tumescence and detumescence

The erectile tissue from 15 normal and impotent male patients was studied by electron microscopy to determine if any ultrastructural features could contribute to the basic understanding of the physiology of penile erection and detumescence. It was found that the endothelium lining the cavernous lacunae contained both contractile elements and Weibel-Palade bodies which have a possible role in vasoconstriction. Within the trabeculae of the cavernous body there was an abundance of elastin as well as oxytalan and elaunin fibers around bundles of smooth muscle. With these elements affording an anchorage system for contraction of smooth muscles within the trabeculae, an alternate contraction of smooth muscles and endothelium could account for the erectile and detumescent states.

Treatment of Urinary Incontinence in Children: The Artificial Sphincter Versus Other Methods

Urinary incontinence in children is a distressing problem that often is magnified during puberty, since the children then realize the full significance of the disorder. Although there are numerous methods of treatment described none offers the reliable combination of a normal body image and total urinary continence. We describe our experience with the AS792 artificial urinary sphincter in treating children with urinary incontinence of varying etiologies and compare it with other described methods.

Experience with inflatable penile prosthesis

Prosthesis surgery for management of erectile impotence has become an increasingly important aspect of urology. The inflatable penile prosthesis (IPP) provides the impotent patient with a controllable, natural-appearing and physiologically functional penis. Major modifications in the prosthesis and in the surgical implantation technique have been made since its initial introduction. In this article we present a histologic review of the IPP and our ten-year experience with it.

Psychological Screening of Impotent Men

Rapid advances in methods of treating sexual impotence have produced concomitant demands for more specific diagnosis and determination of prognosis. Herein are presented guide lines for a rapid screening procedure that has diagnostic and prognostic utility. Use of 2 decisional rules for the Minnesota Multiphasic Personality Inventory, an easily administered and scored psychological test, can provide assistance to the urologic surgeon in determining the suitability of a candidate for a corrective operation. Case histories illustrate the value of this test in making treatment recommendations and assessing prognosis.

Use of the AS792 Artificial Sphincter Following Urinary Undiversion

Reconstruction of the urinary tract after diversion has been successful in patients with normal innervation of the lower tracts. However, the possibility of urinary incontinence after such major surgical procedures has dissuaded many surgeons from attempting urinary undiversion in patients in whom the continence status cannot be determined accurately before the operation or who were known to be incontinent before the original diversion. For this reason, the presence of neuropathic bladder dysfunction has been considered a relative contraindication to urinary undiversion unless it can be established preoperatively that the patient will obtain urinary continence. Eight patients are reported who had successful outcome with the use of the AS792 artificial urinary sphincter to control incontinence after urinary undiversion. Because of this successful experience it is now believed that patients with neuropathic bladder dysfunction or anatomically abnormal lower tracts are no longer precluded from urinary undiversion. A variety of methods has been used to reconstruct the urinary tract, including total reconstruction of the bladder and urethra with the sigmoid colon in 1 case. In the latter case the artificial sphincter was placed around the bowel segment to provide continence. The use of the artificial sphincter around a bowel segment offers many possibilities for reconstructive procedures involving bowel in the future.

Treatment of the epispadias-exstrophy complex with the AS792 artificial urinary sphincter.

The AS792 artificial urinary sphincter was implanted in 11 incontinent patients with the epispadias-exstrophy complex. To date 10 patients (91 per cent) are totally continent of urine with normal renal function and intact urinary systems. The recent reports concerning success with bladder neck reconstruction in this syndrome are reviewed. Owing to the relatively poor success of this procedure in achieving total urinary continence it is recommended strongly that insertion of the artificial urinary sphincter be the initial anti-incontinence procedure for these patients. The success rate with the artificial sphincter currently is superior to any form of bladder neck reconstruction in patients with the epispadias-exstrophy complex.

Neurologic bladder dysfunction and uremia. Treatment with simple transurethral sphincterotomy.

Abstract The authors present a case report of the successful treatment of neurologic bladder dysfunction and uremia in a young man, using simple transurethral sphincterotomy.

Bethanechol Chloride and the Traumatic Cord Bladder

The effect of bethanechol chloride was evaluated in 28 men with neurogenic bladder disease secondary to traumatic spinal cord damage. Simultaneous measurements of bladder pressure, electromyography of the pelvic floor and flow rate were obtained to evaluate the effect on voiding. The results of these studies revealed that bethanechol chloride failed to improve voiding dysfunction in these patients in either the supine or sitting position. Functional bladder outlet obstruction was aggravated by bethanechol chloride. It was found that the effect of this drug on the bladder was unpredictable, as evidenced by some patients converting from a definite detrusor contraction to a wave type pattern. Bethanechol chloride failed to induce a detrusor contraction in patients with areflexia or wave pattern bladders.

Experimental evaluation of bladder closure techniques

Two methods of bladder closure have been evaluated in dogs. A conventional two-layer closure including the mucosa and a single layer running horizontal mattress extramucosal closure have been compared. Observations including adequacy of healing, strength of scar, degree of inflammatory reaction, dna degree of bladder adhesions have been made. The extramucosal running horizontal mattress closure appears to approach the ideal bladder closure.