Paul Gonick

Cholinergic and adrenergic neuroreceptors in urinary tract of female dogs. Evaluation of function with pharmacodynamics.

Our preliminary pharmacodynamic studies on the lower urinary tract of adult female dogs indicate that cholinergic and adrenergic (alpha and beta) neuroreceptors in the urethra appear to coordinate the detrusor and urethral function during micturition. Urethral resistance measured as urethral pressure was easily altered with various pharmacologic agents. However, only bethanechol elicited detrusor response measured as intravesical pressure. The possible clinical usefulness of various drugs is outlined. Our results indicate the therapeutic value of ephedrine sulfate and propranolol in stress urinary incontinence; phenoxybenzamine in neurogenic vesical dysfunction and functional outlet obstruction; phenoxybenzamine plus bethanechol in atonic neurogenic bladder; and imipramine in enuresis.

Effects of phenoxybenzamine hydrochloride on canine lower urinary tract Clinical implications

The results of our study show that phenoxybenzamine hydrochloride, a potent long-acting alpha-adrenergic blocker, has clearly demonstrable effects on urethral function. In a dose of 0.5 mg. per kilogram of body weight it caused a significant lowering of the resting urethral pressure, a decrease in the arterial pressure, and no change in the intravesical pressure. Higher doses caused similar but more pronounced and prolonged effects. The combined use of phenoxybenzamine and bethanechol increased the intravesical pressure and decreased the urethral pressure. It appears that the predominant mechanism of urethral resistance is alpha-adrenergic activity in smooth muscle. A review of the medical literature, our experimental studies, and limited clinical application lead uo to conclude that phenoxybenzamine could be useful in treating neurogenic vesical dysfunction of various types, urethral syndrome, urgency incontinence, functional outlet obstruction with or without vesicoureteral reflux, drug-related obstructive urinary symptoms, partial prostatic obstruction, and ureteral colic. The combination of phenoxybenzamine and bethanechol could be used in managing patients with atony of the bladder of neuropathic or myopathic origin.

Home monitoring of penile tumescence for erectile dysfunction Initial experience

A technique using nocturnal penile tumescence monitoring has been developed to gather objective data on an outpatient basis. Patients have readily accepted the procedure and have easily learned to operate the monitor. Data from this group of controls and subjects are consistent with previously published reports by others. Suggestions are made from possible further refinements in technique.

Imipramine hydrochloride: pharmacodynamic effects on lower urinary tract of female dogs.

Our study of the pharmacodynamics of imipramine hydrochloride of the female canine lower urinary tract indicates the primary mode of action to be the stimulation of alpha adrenergic neuroreceptors in the bladder neck and urethra. This stimulation results in increased resting urethral pressure, adequate sphincter closure, possibly an increase in the bladder capacity and efficient urinary control. Imipramine had no anticholinergic effect on the bladder and the urethra. It also appears unlikely that in enuretic patients imipramine acts by central augmentation of the adrenergic system. No change was noticed in the intravesical or arterial pressures.

SARCOIDOSIS OF TESTIS AND EPIDIDYMIS

Abstract A case of sarcoidosis involving the testes and epididymis is reported. The disease was bilateral, and evolved one year after discontinuation of corticoid therapy and was not accompanied by signs of systemic sarcoidosis.

Post-biopsy intrarenal arteriovenous fistula.

We present 5 cases of intrarenal arteriovenous fistulas after renal biopsy. Of these cases 3 followed percutaneous needle biopsy and 2 occurred after open renal biopsy. A nephrectomy was necessary in 1 patient to control the severe hypertension secondary to a hydronephrotic kidney and 1 patient required a partial nephrectomy to control marked hematuria.

Carcinoma of prostate in men aged fifty and under: therapeutic options

We made a retrospective study of 20 men, aged fifty or under, with adenocarcinoma of the prostate to evaluate presenting symptoms, stage, grade, and therapeutic results. Sixty-five percent were found to have extracapsular spread of disease (Stage C or D). The therapy used was one or a combination of three types: radical prostatectomy, radiation therapy, and hormonal manipulation. Five of 6 patients with Stage B disease and 3 of 6 patients with Stage C disease were treated with radiation therapy. The other Stages B and C patients underwent radical prostatectomy. In all 5 of Stage B patients receiving radiation, therapy failed; the mean time to tumor recurrence was 3.2 years. Two of 3 patients with Stage C disease died of metastatic disease within three years of receiving radiation. The 4 patients (Stages B and C) who underwent radical prostatectomy are free of disease. There was a statistically higher failure rate among the radiation therapy patients with Stages B and C disease than among the surgical patients (X2 = 8.4, p less than 0.1).

Accelerated hypertension due to intramural dissection of accessory renal artery

Abstract A case of sudden, accelerated hypertension due to a spontaneous, idiopathic isolated dissecting aneurysm of an accessory right renal artery is reported. Diagnostic studies including selective angiography, split renal function tests, and plasma renal vein renin levels showed the dissected vessel to be the cause of hypertension.

Open renal biopsy technique Results in 202 patients

Two hundred five cases of open renal biopsy using a muscle-splitting technique have been performed over the past seven years. Eighty-seven per cent were done under local anesthesia. Tissue for routine histology, immunofluorescence staining and electromicroscopy were obtained in all cases. Morbidity was low, and there were no deaths attributed to the procedure.

Extensive renal involvement by renal cell carcinoma.

Experience with the management of 3 cases of bilateral adenocarcinoma and 1 case of unilateral carcinoma in the solitary kidney is presented. Two patients died of metastases six and thirteen months postoperatively, while one is alive with metastases at fourteen months and another is alive without metastases at four months. The literature is reviewed, and the various treatments are discussed.