Seigi Tsuchida

Urodynamic studies on hemiplegic patients after cerebrovascular accident.

Thirty-nine hemiplegic patients were evaluated by complete urodynamic study after cerebrovascular accidents. Computerized tomography was performed to identify localization of the brain lesion. The common urinary symptoms were frequency and urgency incontinence (26/39), while 13 patients complained of dysuria or urinary retention. Ten of the 11 patients who had frontal and internal capsular lesions showed hyperactive bladder, and 6 showed uninhibited sphincter relaxation. Nine of the 10 patients who had putaminal lesions showed hyperactive bladder. Normal sphincter activity was demonstrated in 7 of these 10 patients. In the remaining patients with the other types of lesions, no correlation was found between urodynamic dysfunction and type of brain injury.

Microwave surgical treatment of diseases of prostate

A new transurethral probe for microwave radiation of the prostate has been developed. As a preliminary experiment, sliced ham was radiated with microwaves using this probe in order to evaluate the extent of thermal effect. Using mongrel male dogs, microwave coagulation of the prostate was examined. These animal experiments showed marked destruction of the prostate gland. Furthermore, the safety of this method was confirmed on the basis of results from the experiments. Prostatic bladder neck obstruction also has been treated in 6 patients with benign prostatic hypertrophy or carcinoma of the prostate by this technique. There has been no mortality and also no complications. The results of this preliminary clinical trial have been excellent.

Pontine Micturition Center in the Dog

The function and location of the pontine micturition center was studied in ten decerebrate dogs by physiological experiments in which micturition induced by electrical stimulation of the pontine micturition center was compared with reflex micturition in response to bladder filling with physiological saline and by histological studies of the electrolytic lesions made at the stimulated areas. The micturition induced by electrical stimulation of the pontine micturition center showed the same pattern of detrusor contraction, simultaneous urethral relaxation and the elevation of the tail as reflex micturition in response to bladder filling. The peak contraction pressures in both micturitions showed no obvious differences. The electrolytic lesions were histologically identified at the locus coeruleus alpha in six out of 10 dogs, at the locus coeruleus in three and at the peri locus coeruleus alpha in one dog. The coordinated activities of bladder and urethra in the micturition induced by electrical stimulation of locus coeruleus or its subparts suggest that these areas perform an important role in the urine emptying function.

Role of the Pudendal Nerves on the Dynamics of Micturition in the Dog Evaluated by Pressure Flow Emg and Pressure Flow Plot Studies

The role of the pudendal nerves on the dynamics of micturition was studied using 16 decerebrated dogs. The voiding cycles were analyzed by pressure flow EMG and pressure flow plot studies under 3 conditions: control, after unilateral, and after bilateral pudendal nerve transection. In the control condition, highly reproducible reflex micturition with bladder contraction and spasmodic rhythmic sphincter contractions was demonstrated. Two patterns were noted following pudendal nerve transection: reflex micturition and overflow incontinence. Even though reflex micturition could be achieved in 9 out of 16 dogs after bilateral transection, there was decreased bladder emptying as well as absence of spasmodic rhythmic sphincter contractions. Overflow incontinence developed in the remaining 7 dogs (5 dogs after bilateral transection and 2 dogs after unilateral transection). It appears that the pudendal nerves play an important role in emptying the bladder of the dog.

Effect of cerebellectomy on reflex micturition in the decerebrate dog as determined by urodynamic evaluation.

The effect of cerebellectomy on reflex micturition in the decerebrate dog was investigated by cystometric and striated urethral sphincter EMG studies. Before and after cerebellectomy, reflex micturition consisting of bladder contraction and spasmodic contraction of the striated urethral sphincter occurred when a critical degree of filling was reached. Cerebellectomy showed no influence on the striated urethral sphincter EMG activity. However, cerebellectomy produced a significant decrease in threshold volume and threshold pressure during the collecting phase, and also in the contraction pressure and voided volume of the emptying phase. The present study suggests that the cerebellum plays an inhibitory role in the collecting phase and a facilitatory role in the emptying phase during the entire reflex micturition cycle of the decerebrate dog. Further study will have to be done concerning the neurotransmission mechanism that causes these different effects in the collecting and emptying phases.

The changes in the activity of pudendal motoneurons in relation to reflex micturition evoked in decerebrate cats.

Reflex micturition was evoked in both non-immobilized (n = 5) and immobilized (n = 5) decerebrate cats by filling the bladder with physiological saline. Intracellular recordings were made from pudendal motoneurons (PU-MNs; n = 14) throughout the periods of before, during and after reflex micturition. The changes in the activity of PU-MNs were correlated with those in the intravesical pressure. Our results support the proposition that coordination of the sphincters and the detrusors is established by a gating mechanism, which is activated by the supraspinal source such as the pontine micturition center.

Opioid modulation of the micturition reflex at the level of the pontine micturition center.

In precollicular decerebrate cats and dogs the intravenous administration of naloxone reduced urinary bladder capacity. Successive cystometrograms revealed that naloxone in doses of 10-100 micrograms/kg i.v. reduced the volume necessary to evoke micturition by 21-67% (mean 48%) in cats and 15-81% (mean 43%) in dogs, respectively. Microinjection of fentanyl (0.4-10 nM) into the pontine micturition center (PMC) increased the bladder capacity by 4-46% (mean 18%) in cats. Naloxone injected into the same site reversed the effect of fentanyl. Microinjection of naloxone (40-120 nM) into the PMC reduced the bladder capacity by 17-57% (mean 34%) in cats. These data indicate that endogenous opioid peptides may have a role in controlling micturition in both decerebrate cat and dog, and that the enkephalinergic inhibitory mechanisms are important in modulating the micturition reflex at the level of the pontine micturition center.

Pelvic Nerve Innervation of the External Sphincter of Urethra as Suggested by Urodynamic and Horse-radish Peroxidase Studies

In view of the fact that the detrusor vesicae and external urethral sphincter perform closely synergic functions in micturition, experiments were conducted to explore the action of the pelvic efferent neurons on the external urethral sphincter. The pelvic efferent neurons are generally recognized, by urodynamic assessments and histochemical study with the technique of retrograde axonal transport of horse-radish peroxidase, to innervate the vesical detrusor. In 7 of 15 adult dogs studied, the external urethral sphincter continued to show a normal synergic electromyogram pattern with enhanced electrical activity on vesical distention and disappearance of discharges on vesical contraction even after bilateral transection of the pudendal nerves. The electrical discharges ceased in the sphincter only after subsequent bilateral pelvic neurotomy. Horse-radish peroxidase-positive cells were demonstrated in the intermediolateral and intermediomedial nuclei and in the Onuf nucleus of the sacral cord in approximately half the dogs whose pelvic nerve was injected with the plant peroxidase. The results suggest that the pelvic nerve may contain somatic fibers innervating the external urethral sphincter.

Pacemaker Activity of the Pelvicalyceal Border Recorded by an Intracellular Glass Microelectrode

Applying intracellular glass microelectrodes to the smooth muscle obtained from the guinea pig pelvicalyceal border, we have succeeded in recording periodic spontaneous action potentials, the so-called slow waves, which are characteristic of a pacemaker. This experiment proved that the pacemaker exists at the pelvicalyceal border. The slow waves originate from the pelvicalyceal border, close to the papilla renalis; they show a biphasic pattern and have the characteristics of a spontaneously excitable cell. The resting potential is 42.3 +/- 1.1 mV, the spontaneous depolarizing potential is 12.1 +/- 0.7 mV, and the depolarizing period is 12/min. The rate of rise of the potential is 22.9 +/- 2.1 mV/s in the first slow depolarization phase, and 50.9 +/- 9.5 mV/s in the following rapid depolarization phase. The rate of decline of the potential is 47.3 +/- 5.4 mV/s in the repolarization phase.

Role of the Sympathetic Nerve in Bladder and Urethral Sphincter Function During the Micturition Cycle in the Dog Evaluated by Pressure Flow EMG Study

The role of the sympathetic nerve on bladder and urethral sphincter function during the whole micturition cycle, including the collecting and emptying phases, was evaluated on 10 decerebrated dogs by pressure flow EMG study. A series of experiments was performed before and after hypogastric nerve transection. In the control condition and after hypogastric nerve transection, reflex micturition with bladder contraction and spasmodic rhythmic sphincter contractions occurred. Urodynamic parameters of the micturition cycle were statistically compared between control and nerve transection experiments. Threshold volume, threshold pressure and opening pressure showed a small but significant change after nerve transection. A decrease in voided volume seems to be secondarily accompanied with a decrease in threshold volume. It seems that adrenergic nerves play a certain role in bladder function during the collecting phase of the micturition cycle.