Koichi Takahashi

Non-inflatable penile prosthesis for the management of urinary incontinence and sexual disability of patients with spinal cord injury

During the last 5 years non-inflatable penile prostheses were implanted in 37 patients with spinal cord injury. Operation was done to provide adequate stability of the penis in order to hold an external urinary device, to help erectile impotence and to make self-catheterisation easier. A pair of Shirai-type silicone penile implants were inserted into the corpora cavernosa through a dorsal skin incision at the penile base. In 37 patients 33 had excellent results. Extrusion of the prosthesis occurred in two cases due to infection. Removal of the prosthesis was necessary in a patient who had causalgia in the lower extremities. Posterior migration of the prosthesis was noted in a tetraplegic patient who used to turn on his stomach when he changed clothes. Anterior sphincterotomy which was performed during the surgery in one case and after the surgery in another two cases did not affect the prosthesis. Questionnaire survey revealed that 32 (86%) were satisfied with the procedure which provided better condom fitting and easier intermittent catheterisation whereas only 5 (14%) were dissatisfied. The prosthesis improved sexual function in 15 (41%) patients, 18 (48%) patients were unchanged and four (11%) patients were dissatisfied. Penile prosthesis is an effective manoeuvre for the treatment of urinary incontinence and sexual disability of patients with spinal cord injury provided that the special aspects of the spinal cord injury is taken into consideration.

Urinary tract infection in neurogenic bladder

The most frequent medical complication in patients with neurogenic bladder dysfunction is urinary tract infection (UTI). In the acute phase of neurogenic bladder, aseptic intermittent catheterization should be applied. After this phase, patients are subject to UTIs leading to febrile diseases. In the chronic phase of neurogenic bladders, febrile infections are often accompanied with hypertonic bladder. Some causes or symptoms prior to febrile attack are recognized in many of the cases. Antimicrobial chemotherapy has to be started in time without delay. Newer generation cephalosporins and carbapenems may shorten the febrile period. We report our experience with 229 patients treated between January 1993 and December 1998.

Role of superoxide in pyelonephritis.

The role of superoxide in scar formation following renal infection caused by mannose-sensitive (MS) -piliated strains of bacteria was studied in the experimental pyclonephritis model using female Sprague-Dawley rats. The MS-piliated strain stimulated renal scarring to a significantly greater extent than either the non-piliated or mannose-resistant (MR) -piliated strains. Modification of leukocytes by administering cyclophosphamide to induce neutropenia and colchicine to inhibit leukocyte migration was effective in preventing renal scarring. Treatment with superoxide dismutase during the early stage of infection was also effective in preventing scar formation. Finally, the production of superoxide following stimulation by MS-piliated strain was larger amount than it following stimulation by either non-piliated or MR-piliated strains.These observations suggest that superoxide released from leukocytes plays an important role in the development of renal scarring following infection by MS-piliated strains.