Jørgen Kvist Kristensen

New probe for measurement of related values of cross-sectional area and pressure in a biological tube

A probe for measurement of related values of cross-sectional area (CA) and pressure in a biological tube has been developed to study passive and active closure forces in the female urethra. CA is measured in the range 0·13–1·00 cm2 by the field gradient technique. The system is able to produce an arbitrarily chosen CA in the urethra in about 50 ms. Pressure is measured in the range 0–150 cm H2O (0–14·7 kPa) by a microtransducer. The risetime of the pressure measuring system is 2·5 ms. Pressure needed for inflation and deflation of the balloon ranges from 2 to −5 cm H2O (0·2 to −0·5 kPa). The hysteresis of the balloon is approximately 1 cm H2O (0·1 kPa). The method permits estimation of urethral distensibility (rigidity/compliance), the real (noninstrumented) urethral closure pressure and urethral hysteresis. Furthermore, evaluation of the urethral closure function in terms of isometric contraction, isotonic contraction, muscular work and power can be performed.

A probe for measurements of related values of cross-sectional area and pressure in the resting female urethra

SummaryA probe for measurement of related values of cross sectional area (c.a.) and pressure in the resting female urethra has been developed. C.a. can be measured in the range 0.07 to 0.79 cm2 by means of the field gradient principle. Pressure is measured in the range 0 to 150 cm H2O. Pressure needed for inflation and deflation of the balloon ranges from +4 to-5 cm H2O with a hysteresis of 3 to 4 cm H2O. The probe is able to follow changes of the c.a. up to 0.7 cm2/sec. The method makes possible estimation of urethral stiffness/rigidity during distension of the balloon, estimation of the capability of contraction of the closure apparatus in terms of isometric and isotonic contraction, muscular work and power. Furthermore, hysteresis during inflation and deflation of the balloon can be described.

Pregnancy after assisted ejaculation procedures in men with spinal cord injury

OBJECTIVEnTo present the results of fertility treatment in 28 men with spinal cord injury (SCI) and their partners.nnnDESIGNnRetrospective analysis.nnnSETTINGnUniversity hospital outpatient clinic and home.nnnPATIENTSnTwenty-eight anejaculatory men with SCI and their partners seeking treatment for infertility.nnnINTERVENTIONnPenile vibratory stimulation and electroejaculation as semen retrieval methods. Assisted reproductive techniques used: vaginal self-insemination at home, intrauterine insemination, in vitro fertilization with or without intracytoplasmic sperm injection.nnnMAIN OUTCOME MEASURESnEjaculation rate; sperm count and motility; pregnancy rates.nnnRESULTSnAll of the men were able to ejaculate either by penile vibratory stimulation (79%) or electroejaculation (21%). Median total sperm count was 65 million (range, 0.1 to 480) with a median motility of 13% (range, 1% to 60%). Overall, 9 of 28 couples (32%) achieved 10 pregnancies (4 self-insemination, 3 intrauterine insemination, 1 in vitro fertilization, and 2 intracytoplasmic sperm injection).nnnCONCLUSIONSnAn ejaculation rate of 100% was achieved using penile vibratory stimulation as a first treatment option with electroejaculation as a second option. Motivated couples with adequate semen quality may be offered penile vibratory stimulation combined with self-insemination at home. Together with intrauterine insemination or fertilization techniques used in vitro, the pregnancy rate per treatment cycle for SCI couples may approach that of natural procreation in healthy and fertile couples.

Ureteroscopy: Results and Complications

The results and complications of 100 consecutive ureteroscopy studies are reported. Introduction through the orifice or the intramural ureter failed in 11 per cent of the patients and in 14 per cent the ureteroscope could not be advanced up to the level of the lesion. Ureteroscopy was successful in 75 per cent of the patients and stone extraction was successful in 69 per cent. Complications occurred in 9 patients: 4 had an uncomplicated urinary tract infection, 4 had a ureteral perforation and 1 presented with ureteral stenosis at the site of the extracted stone a few weeks later. At followup 1 to 3 months after ureteroscopy clinical examination, excretory urography and/or renography revealed no further late sequelae.

Fast-track open transperitoneal nephrectomy

Objective: Hospital stay after open transperitoneal nephrectomy is usually 5-10 days, the limiting factors being pain, ileus, stress-induced organ dysfunction and fatigue. Recent studies have shown that aggressive multimodal rehabilitation may improve recovery and shorten hospitalization after other abdominal procedures. We therefore studied the effect of a multimodal rehabilitation regimen in patients undergoing open transperitoneal nephrectomy. Material and Methods: A total of 25 consecutive patients scheduled for elective transperitoneal nephrectomy were studied after the introduction of a multimodal rehabilitation regimen (continuous epidural analgesia, enforced mobilization and oral nutrition and revision of the transurethral catheterization and drain regimen) and compared with 50 consecutive patients treated before the introduction of this regimen. Results: The multimodal rehabilitation regimen decreased hospital stay from 8 to 4 days (pu2005<u20050.001) with mobilization for ≈6u2005h on the first postoperative day and 8u2005h on the second and third days. Use of a drain was shorter with the multimodal regimen (1u2005vs 4 days; pu2005<u20050.001), as was transurethral catheterization (1u2005vs 5 days; pu2005<u20050.001). Medical 30-day morbidity was low (6-8%) in both groups. Conclusion: Our results suggest that a multimodal rehabilitation regimen with optimized pain relief, enforced mobilization, early oral nutrition and short-term transurethral catheterization and drain placement may reduce hospital stay after open transperitoneal nephrectomy.

Fracture of the penis with urethral rupture.

We report a case of fracture of the penis. Emergency operation revealed total rupture of the urethra. The ruptures of the tunica albuginea as well as the urethra were sutured, and convalescence was uneventful. A slight urethral stricture without practical significance was demonstrated during followup. In cases of fracture of the penis with suspected urethral damage we advise urethrography followed by emergency operation.

A New Method for the Investigation of the Closure Function of the Resting Female Urethra

The field-gradient principle has been used in the development of a probe for the recording of related values of cross-sectional area and pressure in the resting female urethra. The probe is used in a manner that allows pressure to be increased in steps of 10 cm. water, distending the urethra up to a cross-sectional area of 0.79 cm.2. Recordings are performed at 0.5 cm. steps throughout the urethra. The obtained parameters make possible a description of the closure function in terms of urethral rigidity, closure pressure of the noninstrumented urethra, capability of isometric and isotonic contraction, muscular function and power of the closure mechanism.

Ureteroscopic Management of Transitional Cell Tumors

Eighty-nine ureteroscopies, comprising 102 renal units, were performed on 31 patients for diagnosis, treatment or follow-up of transitional cell tumors of the upper urinary tract. The indications were hematuria or filling defect (29 endoscopies), treatment of tumor (19) and follow-up (41), i.e. 33, 21 and 48 renal units. Ureteroscopy (including 2 peroperative) was satisfactorily completed in 93 units. Tumor was suspected or diagnosed in 57 units, but later disproved in 11. Two tumors were overlooked at endoscopy. Surgery was performed in 21 cases (bilateral in 3), with indications based on ureteroscopic findings in 58%. Electroresection, laser photocoagulation or fulguration was done on ten units (average treatment sessions 2.6). Inadequate ureteroscopic treatment led to surgery in two of these units, but in seven open surgery was avoided (follow-up 6-47, mean 25 months). One old patient had no further treatment. Follow-up ureteroscopy was planned for 48 units and completed in 42. Complications occurred after 11 of 89 endoscopies. Ureteroscopic management of upper-tract urothelial tumors can be satisfactory, with long freedom from recurrence.

Pressure-to-Cross-Sectional Area Relationships in the Proximal Urethra of Men with Bladder Outlet Obstruction

PURPOSEnRelated values of pressure and cross-sectional area in the proximal urethra were measured in patients with bladder outlet obstruction. Urethral opening pressure and elastance (the inverse of compliance) were estimated.nnnMATERIALS AND METHODSnWe studied 15 men with standard urodynamic examinations. The pressure-to-cross-sectional area relationship in the prostatic urethra was determined using a special probe.nnnRESULTSnElastance varied significantly along the studied portion of the urethra, with higher values found in the sphincter area. The estimated urethral opening pressure appeared high compared to that in unobstructed cases and without variation along the prostatic urethra.nnnCONCLUSIONSnThe most important effect of prostatic obstruction appears to be the increased urethral opening pressure.

A Case of Vesicouterine Fistula After Cesarean Section with Delivery Through the Bladder

We report a case of a vesicouterine fistula subsequent to delivery at cesarean section through the bladder. A first attempt to close the fistula failed but a second operation adhering to the general principles of fistula repair was successful.