S.A. Awad

Sympathetic activity in the proximal urethra in patients with urinary obstruction.

The effect of 10 mg. phentolamine intravenously on the urethral pressure profile was studied in male and female patients with lower urinary tract obstruction. A significant decrease of pressure occurred along the whole length of the urethra in both sexes, including the peak pressure zone in the male patient. This zone has been traditionally attributed to the external sphincter. It was concluded that the sympathetically innervated smooth muscle exerts a certain activity along the whole length of the proximal urethra. The phentolamine test may prove to be a useful adjunct to urethral profile studies in patients with lower urinary tract obstruction.

Carcinoma of the prostate: a critical look at staging.

To stage accurately the extent of the disease comprehensive investigations were done on 75 patients with histologically documented carcinoma of the prostate. Estimation of bone marrow acid phosphatase appears to be the most sensitive test to detect blood-borne metastases. Serum acid phosphatase appears to be of little value in the detection of early blood spread and may have a role only in monitoring the effect of treatment on advanced disease. Bone scanning with technetium compounds has the disadvantage of non-specificity but has far greater sensitivity than a skeletal survey. Bone marrow cytology was not rewarding in the detection of early metastatic disease. Pedal lymphangiography is a highly inaccurate method to detect lymphatic spread of carcinoma of the prostate and pelvic lymphadenectomy, when indicated, remains the only truly adequate method to assess lymph node involvement. There was a 37 per cent incidence of metastatic lymph node pathology in 30 patients undergoing this procedure before either radical prostatectomy or deep x-ray therapy. A close correlation was found between stage and grade of disease and incidence of nodal pathology. There was some correlation between degree of nodal involvement and evidence of blood spread as detected by elevated bone marrow acid phosphatase levels. The significance of this finding remains unclear.

Urethral Pressure Profile in Female Stress Incontinence

The accuracy of the urethral pressure profile as a measure of sphincteric competence was examined in female subjects. Most profile measurements selected proved to be significantly different in patients with stress incontinence from those in controls. However, the measurement that seemed to have the highest potential for diagnostic accuracy was the maximum closure pressure in the continence zone, recorded with the bladder full and the patient standing. The concept of the continence zone and incorporating the effect of standing were believed to be the main reasons for this high accuracy. The second best measurement was the maximum closure pressure with the bladder full and the patient surpine. To lessen the chances of a diagnostic error it was recommended that both of these measurements should be obtained. The physiological implications of these findings and the clinical role of the urethral pressure profile examination in the assessment of female patients with urinary incontinence are discussed.

Sympathetic Dyssynergia in the Region of the External Sphincter: A Possible Source of Lower Urinary Tract Obstruction

Voiding cystourethrography demonstrated urethral constriction at the level of the external urinary sphincter in 10 patients with neurological dysfunctions. Ten mg. phentolamine mesylate intravenously alleviated this constriction, permitting better flow and reducing residual urine in 5 patients with a traumatic spinal injury, 2 with transverse myelitis and 1 who had had a cerebrovascular accident. Oral therapy with phenoxybenzamine hydrochloride, used in 7 of the 8 patients, reduced the post-void residual urine and produced improvement in hydronephrosis when present. These observations are consistent with the presence of a significant sympathetic component to obstruction at the region of the external sphincter in certain neurological disorders.

The Treatment of the Uninhibited Bladder with Dicyclomine

Symptomatic treatment of the uninhibited bladder has presented a challenge because of the lack of an effective, well tolerated smooth muscle relaxant for the bladder that can be used during an extended interval. In a preliminary study oral dicyclomine produced resolution or significant improvement of symptoms in 24 of 27 patients and an increase in bladder capacity by an average of 137 plus or minus 26 ml. (91 plus or minus 22 per cent) after 8 weeks of therapy. Additional controlled trials definitely are warranted.

Urethral Pressure Profile during the Spinal Shock Stage in Man: A Preliminary Report

The functional state of the proximal urethra in the spinal shock stage in man is not fully understood. We studied patients with spinal cord injuries during spinal shock and found that the urethral pressure profile had a normal configuration, the peak profile pressure increased with bladder filling and phentolamine (10 mg. intravenously) reduced the peak pressure, with empty and full bladders.

A Catheter Withdrawing Apparatus for Clinical Urethral Pressure Profile Studies

An apparatus for withdrawing a urethral catheter at a constant speed is described. The motor and the puller assembly are separate components so that the puller assembly can be autoclaved. By matching pulling speed to recorder chart speed a reproducible representation of urethral length can be obtained without using a displacement transducer. The apparatus has been used clinically for measuring urethral pressure profiles.

Gross calcification in bladder tumor

Abstract A case of gross calcification in a vesical hemangioma with concomitant transitional-cellcarcinoma is presented. A review of the literature has failed to reveal a similar case.

Spontaneous urinary extravasation secondary to primary ureteric carcinoma

Abstract Primary carcinoma of the ureter is a rare cause of perirenal urinary extravasation and can present as a diagnostic challenge. A case is presented, and the pathogenesis of urinary extravasation is discussed.

SELECTIVE SACRAL NERVE BLOCKS IN THE MANAGEMENT OF "UNINHIBITED NEUROGENIC BLADDER"

SummaryA case of uninhibited neurogenic bladder is presented and discussed from the viewpoints of diagnosis, physiology of micturition and its derangement in this condition. The role of differential sacral nerve block in treatment is described.RésuméUne meilleure compréhension de la physiologie et en particulier de l’innervation vésicale a rendu possible le traitement de certains cas de “vessie neurogène” consécutif à une hypertonie para-sympathique.Une méthode d’identification de la racine ou des racines sacrées prédominantes dans l’innervation parasympathique vésicale d’un sujet donné est décrite. Cette méthode est basée sur des blocages sélectifs des nerfs sacrés S-2, S-3 et S-4. Une technique de blocage des racines S-2, S-3 et S-4 est également décrite.Les auteurs présentent un cas clinique où des blocages sélectifs des nerfs sacrés ont permis d’établir la prédominence des racines sacrées gauches de S-2 et de S-4.Une section des nerfs érecteurs gauches fut pratiquée par la suite avec amélioration significative du cystogramme et cure de l’incontinence urinaire du malade.