Larissa Bresler

Effective methods of pelvic plexus nerve and bladder stimulation in anesthetized animal model.

Urinary retention is a serious urological problem associated with spinal cord injuries (SCIs) and other pelvic disorders. Effective methods of pelvic nerve stimulation were investigated for this problem. Following anesthesia in five dogs, the bladder was surgically exposed. Bladder and anal sphincter pressures were recorded. Testing was first conducted with probe electrodes. Barb electrodes were then implanted with a needle near the pelvic plexus nerves and the bladder wall. We tested different electrode arrangements and stimulating parameters to induce bladder contractions without skeletal muscle stimulation. The pelvic plexus nerves near the bladder were identified, and the barb electrodes were effectively implanted. Stimulation with bipolar and bilateral electrodes induced pressures over 30 cmH(2)O without skeletal muscle activation. Common stimulation parameters were 40 pps, 400 microseconds pulse duration, and 15 to 25 mA stimulating current applied for 3 s. Effective electrode implantation methods were shown. Also identified were electrode arrangements and stimulating parameters that induced strong bladder contractions without skeletal muscle activation. However, voiding studies were not conducted. Further studies with barb electrodes are warranted, and these methods may have applications for bladder stimulation following SCI.

Massive Abdominoscrotal Hydrocele

Abdominoscrotal hydrocele (ASH) is a very rare clinical finding. It is characterized by a large scrotal hydrocele in communication with the abdominal cavity through the inguinal canal. Most reports of ASH have been in the pediatric population. We present the case of a 67-year-old man, with severe liver disease, who was discovered to have massive bilateral ASH secondary to ascites.

Neuroprosthetics for SCI Bladder Management: The Argument for Direct Bladder Stimulation

Implantable neuroprosthetic systems are an important area of practice and research in urinary care for individuals with spinal cord injury (SCI). These devices need to manage three lower urinary tract conditions: urethral sphincter contractions during bladder contractions, an underactive bladder producing poor voiding responses, and neurogenic detrusor overactivity causing urinary incontinence. Two neuroprosthetic approaches have addressed these conditions: sacral anterior root stimulation (SARS) and direct bladder wall stimulation (DBWS). The SARS approach is commercialized for SCI bladder management as the Brindley-Finetech Bladder Control System and is available in Europe. Limitations of this device include invasive surgery and the need for rhizotomy of sacral dorsal (sensory) nerve roots. The DBWS implants produced daily voiding in many SCI individuals, however, clinical use was discontinued primarily because of technical concerns with stimulators and electrodes as well as some cases of poor voiding responses and side effects. These limitations are reviewed as well as efforts to return DBWS to clinical investigations using Permaloc® Systems (Synapse Biomedical Inc., Oberlin OH). This new neuroprosthetic platform includes mapping and intramuscular electrodes as well as multilead cables and new stimulator devices.

Painful Bladder Syndrome: An Unusual Presentation in a Case of Upper Tract Fungus Balls

Urinary tract fungus balls are a rare pathologic entity which may be asymptomatic or have variable presentations. To date, there have been no documented cases of fungus balls presenting as painful bladder syndrome. Painful bladder syndrome is a constellation of symptoms which may include pelvic pain, urgency and frequency not explained by other causes. Here, we present the first case of these two entities concurrently. Our patient had a longstanding history of diabetes, nephrolithiasis and recurrent urinary tract infections. He presented with symptoms of painful bladder syndrome and work-up revealed filling defects within the renal collecting system concerning for malignancy. Subsequent ureteroscopy revealed dense white debris consistent with candida fungus balls. Following clearance of the debris and antifungal therapy, our patient has remained asymptomatic.

Incidentally-Discovered Squamous Cell Carcinoma after Endoscopic Sphincterotomy

The association between the development of bladder cancer and chronic bladder irritation is well established in the literature. Chronic urinary tract irritation can be the result of bacterial infections, foreign bodies, trauma of repeated catheterization, neurogenic bladder, urolithiasis, or chronic bladder outlet obstruction, all which have been implicated in the pathogenesis of non-bilharzial squamous cell carcinoma of the bladder (SCC). With many of the aforementioned factors present in patients with spinal cord injury, several retrospective studies have demonstrated a 16-28 fold increased relative risk of bladder cancer, with SCC accounting for 10 times more cases of bladder cancer compared to the general population. In this report, we present the case of incidentally-discovered SCC of the bladder found within sphincter/prostate chips of a patient with neurogenic bladder due to spinal cord injury n clean intermittent catheterization ho underwent sphincterotomy with negative cystoscopic findings.