S. Perlberg

Adrenergic response of bladder muscle in prostatic obstruction: Its relation to detrusor instability

In vitro isometric studies of bladder dome muscle taken at operation from 47 patients with benign prostatic obstruction, revealed an alpha-adrenergic response instead of the normal beta response in 23 per cent. The relationship between this finding and the presence of irritative symptoms and an unstable detrusor is examined. This finding may explain the beneficial effect of alpha-blockers on these symptoms in many patients with prostatic obstruction.

Phenoxybenzamine for benign prostatic obstruction review of 200 cases

Two hundred patients treated with phenoxybenzamine for benign prostatic obstruction were reviewed. In 171 of these patients the treatment was given to relieve symptoms in patients not requiring operation, or in patients in whom operation was postponed. Eighty per cent of these patients derived benefit from the treatment, most commonly for the obstructive symptoms (78.7 per cent) but almost as often for nocturia (76 per cent). The treatment was also found to be useful in aiding catheter removal after an attack of acute retention, and in preventing recurrent attacks of acute retention. Side effects occurred in 30 per cent of patients, but necessitated cessation of treatment in only 10 per cent. They consisted of other alpha-blocking effects, and caused after stopping or reducing treatment.

The effect of epidural morphine on ureteral colic and spasm of the bladder.

Twenty-one patients suffering from severe pain associated with ureteric stones and spasm of the bladder which did not respond to repeated systemic injections of pethidine and papaverine received continuous epidural morphine. The morphine, 3-4 mg per dose, was injected into the lumbar-epidural space, and 15-20 min later all patients were pain free for at least 24 h. Administration of morphine was continued for periods ranging from 2 days to 2 weeks according to need. Eleven of the patients with ureterolithiasis passed the stone spontaneously. Epidural morphine analgesia is indicated for persistent ureteral colic and for spasm of the bladder when conventional treatment fails or systemic drugs are contraindicated. It abolishes pain and spasm for prolonged periods of time and does not interfere with the spontaneous elimination of stone.

Evaluation of the relative inhibitory potential of fractionated urinary macromolecules

SummaryUltrafiltration membranes of 10,000 d, 1,000 d and 500 d were used to remove urinary macromolecules from the urine of normal subjects and from the urine of stone forming patients. The filtrated urines were examined for their residual inhibitory potential for calcium-oxalate precipitation, by the discrimination method of Sarig et al. (D.I. test). The results of testing the filtrate were complementary to the information gained by analyses of retentates obtained in successive ultrafiltration. The method has an inherent advantage because the manipulation of solids retained on membranes may inadvertantly modify their inhibitory potential. At least two distinct groups of inhibitors were found in 20 normal urines. The first group has MW above 10,000 d while the second group of inhibitors has MW in the range of 500–1,000 d. The mean of the D.I. values increased dramatically from the normal range (<0.6) to the stone former range (>1.1) (p<0.001) after the 500 d filtration. Some of the normal urines, even after the 500 d filtration, still had a degree of inhibitory potential. This inhibitory potential may be related to the inorganic compounds which were found in the urines. The inhibitory activity of macromolecules with MW above 10,000 d and below 500 δ was negligible in 7 stone formers (SF) urines. The relative contribution of 500–1,000 d macromolecules is the highest both in SF and normal urines. Conclusions: 1) inhibitors in human urine are of wide range in MW; 2) stone formers and normals differ in the level of inhibitor activity at all MW ranges; especially in above 10,000 d and below inhibitors.

The inhibitory effect of polymeric carboxylic amino-acids and urine on calcium oxalate crystallization

Abstract A new method has been established to follow the inhibitory effect of some polymeric-dicarboxylic-amino-acids and other poly-anionic derivatives. The technique is based on using calcium specific electrode to measure continuously free calcium ion activity in solution to assess the formation of calcium oxalate precipitate. The retardation effect of Poly-L-glutamic and aspartic acids has been established in 5–100 ppm range and compared to other monomeric and polymeric compounds with inactivated functional groups. The retardation effect is in agreement with previous reports on inhibition effect on crystal growth rate of seed crystals, with the same retardants. The inhibitory effect was also determined with normal urine and compared to pathological urine.

May enzyme activity in urine play a role in kidney stone formation

SummaryIt has been found that calcium oxalate stone formers have low UGOT and UGPT activity compared to healthy individuals. The urine of 23 stone formers and 19 controls has been tested for combined UGOT and UGPT activity. The effect of L-aspartic acid, alanine and L-glutamic acid on calcium oxalate precipitation has been tested. Only L-glutamic acid exerted a significant retardation effect at physiological concentrations. As GPT and GOT convert alanine and aspartic acid respectively into glutamic acid, a possible mechanism of retardation of kidney stone formation involving enzyme steps via glutamic acid creation in situ is suggested.

Retardation of calcium oxalate precipitation by glutamic-oxalacetic-transaminase activity

SummaryIt has been found that calcium oxalate stone formers have low UGOT activity compared to healthy individuals (controls). Urine from stone formers with no GOT activity and no effect on calcium oxalate precipitation was incubated with GOT for various periods. Subsequently calcium oxalate precipitation was decreased and found to be considerably retarded i.e., the pathological urine after the incubation acted in a way similar to that of normal urine. The yield of Glutamic-Oxalacetic Transaminase (GOT) activity is gultamic acid. It was shown that glutamic acid has a significant retardation effect on the precipitation of calcium oxalate stone formation. Therefore it may be suggested that GOT activity involved in glutamic acid creation in situ, has a role in kidney stone formation.

Use of Risk Factors in Medical Management to Reduce Recurrence of Calcium-Oxalate Kidney Stones

Treatment with phosphates, thiazides, and allopurinol was undertaken in 54 calcium-oxalate stone formers. The patients were followed-up for 5.3 to 7.6 years (mean, 6.4 years). Five patients who had a single stone occurrence discontinued their participation, whereas 38 recurrent-stone formers were included in the follow-up.

Assessment of the Risk Factor Index in Stone Formers

About 2,500 patients underwent lithotripsy treatment (ESWL) in the Urology Department of Hadassah Hospital. A random group of 243 was subjected to evaluation of risk factors using the Discriminant Index (DI) method which measures the over-all inhibitory potential of the patients’ urine to calcium-oxalate crystallization.

The Connection between Amino Acids, Urinary Enzymes and Stone Formation

About 30 enzymes have been identified in urine, none of whose activities is correlated with calcium oxalate (CaOx) kidney stone disease1. Recently, however, we reported2 a significant difference in the activities of the urinary transaminase enzymes (GOT and GPT) between stone formers (SF) and normals. The average activity values of GOT and GPT in normal urines were found to be higher than those of SF by a factor of 3. GOT and GPT convert aspartic acid and alanine to glutamic acid. In vitro and in vivo studies3,4 showed that glutamic acid is a potent inhibitor for CaOx precipitation. In this study the role of GOT and GPT activity in CaOx stone formation were studied along with evaluation of the effect of drug treatment on it.