S. Vaidyanathan

Enhancement of Detrusor Reflex Activity by Naloxone in Patients With Chronic Neurogenic Bladder Dysfunction. Preliminary Report

An intravenous injection of 0.4 mg. naloxone enhanced detrusor reflex activity in 5 patients with chronic neurogenic bladder dysfunction caused by incomplete suprasacral spinal lesions. The intravesical volume at which detrusor reflex occurred showed a decrease from 498.2 to 346.2 ml. The naloxone-induced effect was short-lived, being absent 1 hour after the injection. In the same dosage naloxone did not induce detrusor reflex in 2 patients with areflexic bladder caused by complete suprasacral spinal lesions.

Beta-Adrenergic Activity in Human Proximal Urethra: A Study with Terbutaline

Beta-adrenergic activity in the proximal urethra was studied in 15 patients with neurogenic bladder dysfunction owing to spinal cord injury or to neurogenic disease. Maximum urethral closure pressure was recorded before and after the administration of terbutaline, a beta-2 agonist. The average decrease in maximum urethral closure pressure after subcutaneous injection of terbutaline was 40.46 per cent and this was significant (p less than 0.001). The clinical implications of this finding are discussed.

Clinical Import of Serotonin Activity in the Bladder and Urethra

It has been observed in animal studies that 5-hydroxytryptamine produces bladder contractions. The role of 5-hydroxytryptamine in human vesicourethral function was studied by administering 75 mg. clomipramine daily for 4 days to 8 patients with neurogenic bladder dysfunction. Clomipramine inhibits the uptake of serotonin into 5-hydroxytryptamine containing presynaptic nerve endings and, thus, makes more neurotransmitter available to the postsynaptic site. The intravesical volume, at which first detrusor reflex activity was observed, showed a decrease from 329.5 to 178.5 ml. after clomipramine therapy. The residual urine also decreased from 111.25 to 30.0 ml. No side effect was observed. Further investigations involving a larger number of patients are indicated to study the possible use of serotonin activity in the bladder for promoting bladder emptying.

Clinical Import of Beta-Adrenergic Activity in the Proximal Urethra

Beta-adrenergic activity of the proximal urethra was studied in 11 patients. Maximum urethral pressure was recorded before, and 20 and 60 minutes after the intravenous administration of 0.5 mg. orciprenaline sulfate. There was a 40 per cent or more decrease in the maximum urethral pressure in 6 of the 11 patients. Beta-adrenoreceptor agonists could prove useful in facilitating vesical emptying by reducing urethral resistance in patients with neurogenic bladder dysfunction.

Study of Intravesical Instillation of 15(S)-15 Methyl Prostaglandin F2-Alpha in Patients with Neurogenic Bladder Dysfunction

AbstractIntravesical 15(3)-15 methyl prostaglandin F2-alpha was instilled in 21 patients with urinary retention or large volumes of residual urine because of neurogenic vesicourethral dysfunction. Administration of this prostaglandin analogue may prove useful in promoting bladder emptying in selected patients with incomplete suprasacral spinal lesions who do not exhibit detrusor-sphincter dyssynergia.

Infusion Pyelography in Anuric Patients

The spectrum for the use of retrograde pyelography in renal failure has been narrowed further by extending the facility of infusion urography to anuric patients. The latter study has helped greatly in sifting apart pre-renal and renal anuria patients from those with obstructive uropathy. In obstructive anuria infusion urography has proved comprehensive in influencing judgment about the exact site and nature of obstruction, in affixing laterality towards the better functioning renal unit and in deciding a suitable definitive operation or planned staged procedures.

Ureteral and Periureteral Fibrosis as Delayed Sequelae to Lower Urinary Tract Injury

AbstractWe describe herein 4 cases of ureteral or periureteral fibrotic involvement following lower urinary tract injury. The degree of ureteral obstruction and the period between injury and detection of these sequelae vary widely. With careful clinical and radiological followup, it is hoped that more attention will be directed toward this entity in the future.

Possible Use of Indoramin in Patients With Chronic Neurogenic Bladder Dysfunction

Indoramin, which has great selectivity for alpha-1-receptors, was administered orally for 10 days to 21 patients with urinary retention or residual urine caused by neurogenic vesicourethral dysfunction. After indoramin therapy 17 patients were able to empty the bladder with residual urine less than 50 ml. There was a significant decrease in the maximum urethral pressure (23.87 plus or minus 4.13 cm. water) and in the functional profile length (0.53 plus or minus 0.19 cm.). A diminution in the sphincter electromyography activity was observed in 3 patients. Two paraplegics who were investigated during spinal shock could not achieve voiding after indoramin therapy. However, involuntary urine leakage associated with a change of posture occurred in 2 patients but subsided after the dosage of indoramin was decreased. No other side effect was observed. It may be desirable to use drugs with selective action upon alpha-1-receptors since blockade of noradrenergic autoreceptors (alpha-2) also by nonspecific alpha-adrenoceptor blocking agents, namely phentolamine, phenoxybenzamine and so forth, causes the overflow of norepinephrine, which would produce symptoms such as tachycardia by stimulating beta-receptors.

Suprapubic Traction Diverticulum of the Bladder

AbstractA case of a full thickness bladder wall diverticulum presenting through a post-prostatectomy scar in the absence oflower urinary tract obstruction is described. The possible pathogenesis of this rare entity is discussed.