Josef Hannappel

Randomized, Double-Blind, Multicenter Trial on Treatment of Frequency, Urgency and Incontinence Related to Detrusor Hyperactivity: Oxybutynin versus Propantheline versus Placebo

Clinical efficacy and adverse effects of oxybutynin and propantheline in the treatment of symptoms related to detrusor hyperactivity were studied in a randomized, controlled, double-blind multicenter trial. Of 169 patients entered into the study 154 were evaluable for statistical analysis. Mean grade of improvement (visual analogue scale) was significantly higher with oxybutynin (58.2%) versus propantheline (44.7%) and placebo (43.4%). Mean bladder volume at first involuntary cystometric contraction was significantly increased with oxybutynin (+57.0 ml.) versus placebo (-9.7 ml.). Mean maximum cystometric bladder capacity was also significantly increased with oxybutynin (+80.1 ml.) versus placebo (+22.5 ml.). Rate of inquired possible adverse effects was significantly higher for oxybutynin (63%) versus propantheline (44%) and placebo (33%). However, only 5 patients dropped out of the study because of adverse effects (oxybutynin 2 and propantheline 3). No serious or lasting adverse effects were encountered with dryness of the mouth being the major complaint. Oxybutynin has statistically significant effects on subjective symptoms and objective urodynamic parameters in patients with detrusor hyperactivity compared to propantheline.

Alloplastic Replacement of the Urinary Bladder

PURPOSE The loss of a functioning bladder is nowadays mostly managed by replacement with gastrointestinal segments. Management of these urinary diversions is difficult and the long-term effects are unknown. We developed a silicone rubber prosthesis for alloplastic replacement of the urinary bladder and tested it in an animal experiment. MATERIAL AND METHODS Two artificial bladders were implanted into subcutaneous pockets on each side of the anterior abdominal wall. Cystectomy was performed and each prosthesis was connected to one kidney. Distally, a Y-shaped tube sutured to the urethral stump joined the two bladder outlets. The whole system was successfully implanted in 5 sheep with a mean follow-up of 11.5 months (5-19 months). RESULTS Adequate capacity, effective and reliable mechanical function and patent anastomoses to the renal pelvis and the urethra could be achieved. Blood chemistry and renal ultrasound were performed at regular intervals demonstrating neither morphological nor functional deterioration of the renal parenchyma. Histopathological examination in the end of the experiment confirmed the excellent clinical results. CONCLUSIONS The positive outcome of these animal experiments suggests this system would be useful for human bladder substitution. Standardized industrial production of the prostheses will be needed prior to implantation in humans.

Pacemaker Process of Ureteral Peristalsis in Multicalyceal Kidneys

The mechanical activity of isolated strips from different areas of the pyeloureteral system was investigated in 10 pigs: calyx, renal pelvis, pyeloureteral junction and ureter. Additionally, electrical activity was measured in some pyeloureteral preparations using the sucrose-gap technique. Regular spontaneous activity with an average frequency of 9.5/min was recorded in calyceal strips, decreasing to 5.4/min in renal pelvis, 5.7/min in pyeloureteral preparations and to 1.2/min in ureteral preparations. The activity of renal pelvis, pyeloureteral and ureteral preparations was less regular, and bursts of fast activity (near 10/min) could be observed in all these preparations. The membrane potential of pyeloureteral strips showed spontaneous generator oscillations of about 10/min. Variations in the pattern of ureteral peristalsis are due to different coupling ratios of membrane potential oscillations to contractions. Adrenaline (10(-5) mol/l) increased the frequency of the oscillations and enhanced their manifestation in the mechanical recordings, whereas tetraethylammonium (5-20 mmol/l) only increased the coupling ratio. The following concept for the generation of ureteral peristalsis in multicalyceal kidneys is developed: several (primary) oscillators exist in the calyces; in the pyeloureteral junction a (secondary) pacemaker exists which has an intrinsic frequency similar to that of the calyceal pacemakers; both processes cooperate in the generation of ureteral peristalsis.

Sequential Events in Prostatic Obstruction

The urinary tract is designed to collect and transport the continuously produced urine volume. Storage and voiding are controlled voluntarily. This complex system has to fulfill various important functions: protection against ascending infection, prevention of crystallization and stone formation, and limitation of maximal pressure, which might disturb glomerular and tubular function. The pelvis, ureter, bladder, and urethra form an interesting physiological system. The calyx, pelvis, and proximal ureter collect the urine from the various papillae and collectively act as an intermediate storage space. When a certain amount of distension of the pyeloureteral junction is reached, an excitation wave from the calyces is conducted down the ureter by rhythmic peristalsis that does not completely empty the pelvis.

Effects of Beta-Adrenergic Stimulating and Blocking Agents on the Dynamics of the Human Bladder Outlet

The alpha-adrenergic innervation of the functional urethra is a well-known fact, while beta-adrenergic influence is rather unknown until now. We studied the influence of beta-stimulating and beta-blocking agents on the human urethra by the urethral pressure profile (UPP). A decrease of the UPP under orciprenaline sulfate and an increase under propranolol could be mentioned.

Uroflow measurements: their information yield in a long-term investigation of pre- and postoperative measurements.

This investigation shows that the reproducibility of uroflow measurements is limited. For their evaluation, anamnesis and the measured results have to be taken into account equally. We found correspondence of both parameters in about 50% only. One single measurement cannot provide precise information, as psychogenic, social, and other factors influence the measurement. In our study 3 subjects had their micturitions registered over a period of 2 months. We found an increase of the maximum flow with increasing bladder volume. The maximum bladder volume was reached in only four micturitions. Normal values range at about 25% of the maximum bladder volume. Analyzing the micturitions in regard to the time of day, we found maximum flow rates in the morning hours. Under clinical conditions the altered surroundings lead to a measured result which is psychogenically influenced and can only be balanced after repeated measurements. The curves of all 3 patients were equal and inconspicuous. In cases of infravesical obstruction, surgical success could be documented by comparing the pre- and postoperative uroflows. In all cases of neurogenic bladder disorders and unclear findings, uroflow measurements are, however, not sufficient, and diagnosis is accomplished by a complete urodynamic examination. In spite of certain restrictions, uroflowmetry yields a high level of information, besides being a simple, at any time reproducible, and noninvasive procedure. Due to its low costs, it should be the primary step in diagnostics in the clinic as well as for practitioners.

Entwicklung und Erprobung einer künstlichen Blase mit Sphinkter

Die Harnblase kann durch angeborene oder erworbene Erkrankungen funktionsunfahig sein. Die heutigen Methoden der Rekonstruktion der harnableitenden Wege sind nicht selten mit Komplikationen behaftet und stellen fur den Patienten in nicht unerheblicher Weise psychosomatische und soziale Belastungen dar (Lutzeyer 1956/57). Die Indikation zur Implantation einet kunstlichen Blase erscheint daher bei jeder Zystektomie angezeigt, zumal der Urin bei dieser Methode per vias naturales ausgeschieden werden kann.

Detrusor Contractility and Its Relationship to Different Degrees of Tension

Bladder function and its modulation have been the topic of much experimental work ever since Budge (1958) described the bladder innervation for the first time. Special contributions have been achieved by the use of neurohistochemical and pharmacological methods.

Myogenic Excitation Conduction After Microsurgical Anastomosis of the Ureter

Ureteral peristalsis originates in the proximal part of the urinary collecting system by way of spontaneous depolarization of smooth muscle cells (Bozler 1942; Golenhofen and Hannappel 1973).

Urodynamische Untersuchungen bei rezidivierender Zystitis der Frau

Bei der Atiologie der rezidivierenden Zystitis kann zwischen immunologisch bakteriologischen Faktoren einerseits und mechanisch urodynamischen Faktoren andererseits unterschieden werden. Haufig bestehen Wechselwirkungen zwischen diesen beiden Mechanismen, so das es fur den Untersucher schwierig ist zu entscheiden, was Ursache und was Folge der pathologischen Veranderungen ist.