Mostafa Elhilali

Response of Urethral Smooth Muscles to Pharmacological Agents. II. Noncholinergic, Nonadrenergic Agonists and Antagonists

We studied the effects of a variety of noncholinergic, nonadrenergic agents on the smooth muscles of the cat urethra. Prostaglandin F2 alpha contracted both urethral muscle layers to a similar extent. Prostaglandin E2 contracted the longitudinal and relaxed the circular muscle layers. The effects of the prostaglandins seem to be directly myogenic since cholinergic and adrenergic blockers and tetrodotoxin did not affect them. Bradykinin and substance P contracted both urethral muscle layers. Other tested agonists (neurotensin, vasoactive intestinal peptide, cyclic 3,5 adenosine monophosphate, adenosine diphosphate sodium, cyclic 3,5 guanosine monophosphate sodium, bombesin) had no effect on the cat urethral smooth muscles.

Urethral Stricture After Cardiovascular Surgery, A Retrospective and a Prospective Study

In a review of our cases presenting with urethral stricture we noted a high incidence following cardiovascular surgery. A retrospective study was done, including 87 patients treated for urethral stricture and 304 undergoing open heart surgery during the same period, to search for a possible etiologic factor. A prospective study also was done on 98 patients subjected to cardiovascular surgery. Strictures developed in 17.5 per cent of 63 patients who had a urethral catheter placed for urinary diversion at operation compared to none of 35 who had a suprapubic cystocatheter. We believe that the urethral catheter is at least partly responsible for stricture formation. Associated factors, for example urethral ischemia, may be contributory.

Role of urethral ischemia in the development of urethral strictures after cardiovascular surgery: a preliminary report.

A high incidence of urethral stricture was noted following cardiovascular surgery. In an attempt to elucidate factors predisposing to the occurrence of urethral stricture, we studied the penile blood flow in 7 patients presenting with strictures after cardiovascular surgery. Of these patients 5 had penile-brachial pressure indexes less than 0.5 and 6 had weak or absent erections. Of 14 patients studied prospectively by penile blood flow 2 had a low penile-brachial pressure index and suffered urethral strictures 6 weeks after cardiovascular surgery. This finding suggests that urethral ischemia could be a predisposing factor for the development of urethral strictures after cardiovascular surgery.

Condyloma acuminatum of bladder

A patient with a condyloma acuminatum of the bladder is presented. This is a rare manifestation of the lesion. The salient features which characterize the lesion are described, and the differential diagnosis is discussed.

Urorectodynamic evaluation of healthy volunteers

Twelve female and 8 male healthy volunteers underwent urorectodynamic evaluation. Mean bladder capacity was 594 ml. and mean maximal vesical pressure 12.5 cm. water (H2O). Maximal bladder pressure correlated significantly with maximal mural tension (r = 0.96) but did not correlate well with bladder capacity (r = 0.20). Mean bladder volume at first desire to void was 32 per cent of mean bladder capacity. The bladder volume at the first desire did not correlate significantly with the capacity. Mean bladder pressure at 100 ml. volume was 2.9 +/- 0.4 cm. H2O (X +/- SEM). After bethanechol injection, the bladder pressure at 100 ml. volume increased by 8.8 +/- 1.2 cm. H2O (X +/- SEM) at twenty minutes. In only 1 subject did bladder pressure rise higher than 15 cm. H2O (5 per cent). Rectal pressure increased from 1.4 +/- 0.3 to 14.1 +/- 2 cm. H2O (X +/- SEM) at sixteen minutes. Electromyogram (EMG) of the external and sphincter did not follow regular pattern with vesical filling or attempt of voiding. The data obtained in these normal subjects may serve as a basis for comparison in the interpretation of data obtained in patients.

Urorectodynamics in patients with colonic inertia.

Sixteen female patients with colonic inertia and 12 control women underwent manometric evaluation of their bladder and rectal cavities. After subcutaneous injection of 0.035 mg./Kg. bethanechol, bladder intraluminal pressure increased by over 15 cm. water in 5 patients (31 per cent) and in none of the control group; maximal pressure after injection was 11.5 +/- 1.6 cm. H2O (mean +/- SE) in patients and 8.5 +/- 1 in controls (p less than 0.025). The intraluminal rectal pressure reached 23 +/- 4 cm. H2O in patients and only 11.9 +/- 1.4 in controls (p less than 0.0025). Time taken to reach a peak pressure was faster in patients both in bladder (17.4 +/- 0.7 vs. 19.8 +/- 1.2 minutes; p less than 0.01) and in the rectum 914.6 +/- 0.8 vs. 16.3 +/- 1.2; p less than 0.025). These findings and the clinical presentation suggest an autonomic neuropathic lesion in this group of patients.

The contractile effect of bombesin on the rat isolated urinary bladder

We have investigated and compared the myotropic effects of bombesin (BB) and carbachol (C) in the rat isolated urinary bladder. BB (0.5 x 10(-9) to 0.5 x 10(-5) M) and C (2.7 x 10(-8) to 5.4 x 10(-5) M) were found to produce dose-dependent increases of the basal tone of the rat detrusor muscle. The maximal contraction produced by C was about 4 times greater than that elicited by BB or substance P (SP). However, the threshold concentrations of BB and SP required to stimulate the detrusor muscle were much lower than those of C. The pD2 (-log ED50) values of BB, SP and C were respectively 7.63, 7.05 and 5.8. The tissues exposed to BB relaxed more slowly after washout than those challenged with C or SP. The contractile effects of medium range concentrations of BB were not affected by pretreating the tissues with tetrodotoxin, atropine, antihistaminics, indomethacin, alpha- and beta-adrenergic blockers, methysergide or 8-leucine-angiotensin II. Tissues desensitized with high concentrations of bradykinin maintained their sensitivity to BB. The result suggest that the contractile effect of BB on the rat isolated urinary bladder is likely to be the result of a direct effect on the smooth muscle cells.

Leiomyosarcoma of Prostate

Abstract Leiomyosarcoma of the prostate is a rare tumor with no established protocol of treatmentt in the literature. We report a case with peculiar clinical presentation and androgen receptor content supporting the origin of the tumor. The potential advantage of hormonal manipulation during progression of the disease is suggested.

Visual internal urethrotomy in management or urethral strictures

Visual internal urethrotomy was used in the treatment of urethral strictures in 103 patients. The procedure was performed mostly under local anesthesia. Urethral catheter for forty-eight hours or urethral splinting for two weeks was used as complementary treatment in some cases. We obtained an overall success rate of 95.1 per cent.

Vesicourethral motility following acute spinal cord transection in the cat.

The cause of urinary retention during the phase of spinal shock is still uncertain. In the cat with intact spinal cord, reflex voiding shows a coordination between the longitudinal and circular urethral muscles, the detrusor and the periurethral striated muscles. After transection of the spinal cord in cervical and/or thoracic segments, 26 of 28 cats failed to void. An incoordination between longitudinal, circular, detrusor and periurethral striated muscles was noticed simulating a urethro-urethral and urethrovesical dyssynergia. The 2 cats that voided 6 hours after the cord section showed a return of synergism between longitudinal, circular, detrusor and periurethral striated muscles. The conventional pharmacologic manipulation used during the early period following spinal cord transection, bethanechol chloride and phentolamine, failed to achieve proper bladder emptying because it did not correct the dyssynergic pattern.