Hiromitsu Noto

Urodynamic studies on hemiplegic patients after cerebrovascular accident.

Thirty-nine hemiplegic patients were evaluated by complete urodynamic study after cerebrovascular accidents. Computerized tomography was performed to identify localization of the brain lesion. The common urinary symptoms were frequency and urgency incontinence (26/39), while 13 patients complained of dysuria or urinary retention. Ten of the 11 patients who had frontal and internal capsular lesions showed hyperactive bladder, and 6 showed uninhibited sphincter relaxation. Nine of the 10 patients who had putaminal lesions showed hyperactive bladder. Normal sphincter activity was demonstrated in 7 of these 10 patients. In the remaining patients with the other types of lesions, no correlation was found between urodynamic dysfunction and type of brain injury.

Microwave surgical treatment of diseases of prostate

A new transurethral probe for microwave radiation of the prostate has been developed. As a preliminary experiment, sliced ham was radiated with microwaves using this probe in order to evaluate the extent of thermal effect. Using mongrel male dogs, microwave coagulation of the prostate was examined. These animal experiments showed marked destruction of the prostate gland. Furthermore, the safety of this method was confirmed on the basis of results from the experiments. Prostatic bladder neck obstruction also has been treated in 6 patients with benign prostatic hypertrophy or carcinoma of the prostate by this technique. There has been no mortality and also no complications. The results of this preliminary clinical trial have been excellent.

Pontine Micturition Center in the Dog

The function and location of the pontine micturition center was studied in ten decerebrate dogs by physiological experiments in which micturition induced by electrical stimulation of the pontine micturition center was compared with reflex micturition in response to bladder filling with physiological saline and by histological studies of the electrolytic lesions made at the stimulated areas. The micturition induced by electrical stimulation of the pontine micturition center showed the same pattern of detrusor contraction, simultaneous urethral relaxation and the elevation of the tail as reflex micturition in response to bladder filling. The peak contraction pressures in both micturitions showed no obvious differences. The electrolytic lesions were histologically identified at the locus coeruleus alpha in six out of 10 dogs, at the locus coeruleus in three and at the peri locus coeruleus alpha in one dog. The coordinated activities of bladder and urethra in the micturition induced by electrical stimulation of locus coeruleus or its subparts suggest that these areas perform an important role in the urine emptying function.

Effect of KMD-3213, an alpha1A-adrenoceptor antagonist, on the prostatic urethral pressure and blood pressure in male decerebrate dogs.

Background: KMD‐3213 is an α1A‐adrenoceptor‐selective antagonist currently being developed for the treatment of urinary outlet obstruction in patients with benign prostatic hyperplasia. In the present study, the uroselectivity of KMD‐3213 was evaluated and compared with that of prazosin and tamsulosin in a decerebrate dog model.

Effect of cerebellectomy on reflex micturition in the decerebrate dog as determined by urodynamic evaluation.

The effect of cerebellectomy on reflex micturition in the decerebrate dog was investigated by cystometric and striated urethral sphincter EMG studies. Before and after cerebellectomy, reflex micturition consisting of bladder contraction and spasmodic contraction of the striated urethral sphincter occurred when a critical degree of filling was reached. Cerebellectomy showed no influence on the striated urethral sphincter EMG activity. However, cerebellectomy produced a significant decrease in threshold volume and threshold pressure during the collecting phase, and also in the contraction pressure and voided volume of the emptying phase. The present study suggests that the cerebellum plays an inhibitory role in the collecting phase and a facilitatory role in the emptying phase during the entire reflex micturition cycle of the decerebrate dog. Further study will have to be done concerning the neurotransmission mechanism that causes these different effects in the collecting and emptying phases.

Opioid modulation of the micturition reflex at the level of the pontine micturition center.

In precollicular decerebrate cats and dogs the intravenous administration of naloxone reduced urinary bladder capacity. Successive cystometrograms revealed that naloxone in doses of 10-100 micrograms/kg i.v. reduced the volume necessary to evoke micturition by 21-67% (mean 48%) in cats and 15-81% (mean 43%) in dogs, respectively. Microinjection of fentanyl (0.4-10 nM) into the pontine micturition center (PMC) increased the bladder capacity by 4-46% (mean 18%) in cats. Naloxone injected into the same site reversed the effect of fentanyl. Microinjection of naloxone (40-120 nM) into the PMC reduced the bladder capacity by 17-57% (mean 34%) in cats. These data indicate that endogenous opioid peptides may have a role in controlling micturition in both decerebrate cat and dog, and that the enkephalinergic inhibitory mechanisms are important in modulating the micturition reflex at the level of the pontine micturition center.

Pelvic Nerve Innervation of the External Sphincter of Urethra as Suggested by Urodynamic and Horse-radish Peroxidase Studies

In view of the fact that the detrusor vesicae and external urethral sphincter perform closely synergic functions in micturition, experiments were conducted to explore the action of the pelvic efferent neurons on the external urethral sphincter. The pelvic efferent neurons are generally recognized, by urodynamic assessments and histochemical study with the technique of retrograde axonal transport of horse-radish peroxidase, to innervate the vesical detrusor. In 7 of 15 adult dogs studied, the external urethral sphincter continued to show a normal synergic electromyogram pattern with enhanced electrical activity on vesical distention and disappearance of discharges on vesical contraction even after bilateral transection of the pudendal nerves. The electrical discharges ceased in the sphincter only after subsequent bilateral pelvic neurotomy. Horse-radish peroxidase-positive cells were demonstrated in the intermediolateral and intermediomedial nuclei and in the Onuf nucleus of the sacral cord in approximately half the dogs whose pelvic nerve was injected with the plant peroxidase. The results suggest that the pelvic nerve may contain somatic fibers innervating the external urethral sphincter.

Microwave Surgical Treatment of the Prostate: Clinical Application of Microwave Surgery as a Tool for Improved Prostatic Electroresection

Microwave surgery as a tool for improved prostatic electroresection is introduced. Prior to electroresection the prostate was coagulated with 2,450 MHz of microwave which was emitted from the bipolar electrode of a specially designed probe. We conducted a comparative study of 35 patients with bladder neck obstruction. There was a microwave coagulation group treated with subsequent transurethral resection (TUR) and a conventional TUR group. Both groups were analyzed for the amount of blood loss, irrigant absorption and the frequency of complications. Both during and following surgery, the former group had a significant reduction in blood loss and had no complications. We conclude that the combination procedure of microwave coagulation and TUR can minimize the disadvantage of formal TUR and may be of value in the treatment of patients with both prostatic obstruction and of hemorrhagic diathesis as well as in high risk patients.

Transcystoscopic Intracavitary Irradiation for Carcinoma of the Bladder: Technique and Preliminary Clinical Results

A remote controlled transcystoscopic intracavitary after-loading unit is introduced for irradiation therapy of bladder carcinoma. With intense radiation therapy a significant dose can be delivered to the tumor during a short interval. We treated 12 patients with transitional cell carcinoma of the bladder using transcystoscopic intracavitary irradiation. Of the patients 9 initially had a complete response, although within several months 3 subsequently had recurrence in a different part of the bladder. Technical difficulties and severe complications were not encountered. The preliminary results and technique of transcystoscopic intracavitary irradiation are reported.

Effect of carbazochrome sodium sulfonate on refractory chronic prostatitis

To study the effect of carbazochrome sodium sulfonate, an agent that reduces capillary permeability, on refractory chronic prostatitis.