T. J. Christmas

Abnormal electromyographic activity of the urethral sphincter, voiding dysfunction, and polycystic ovaries: a new syndrome?

A potential association between abnormal electromyographic activity--that is, decelerating bursts and complex repetitive discharges--of the urethral sphincter and difficulty in voiding was examined in 57 women with urinary retention. Abnormal electromyographic activity was found in 33. Ultrasonography of the ovaries in 22 of the 33 women showed that 14 had polycystic ovaries. Of the other eight women, two had had oophorectomies, one had shrunken ovaries and ovarian failure, and one had previously undergone oophorectomy and the other ovary could not be seen; in one neither ovary could be seen, and three had ovaries of normal appearance, although two of these women were taking the contraceptive pill. Thirteen of the group had endocrine symptoms and signs characteristic of the polycystic ovary syndrome. Videocystometrography in 17 of the women who were examined by ultrasonography showed low flow rates and high residual volumes of urine after micturition in 12 women who could void, the other five having chronic urinary retention. A speculative hypothesis for the observed association of impaired voiding, abnormal electromyographic activity of the urinary sphincter, and polycystic ovaries is advanced, based on the relative progesterone deficiency that characterises the polycystic ovary syndrome. Progesterone stabilises membranes, and its depletion might permit ephaptic transmission of impulses between muscle fibres in the muscle of the urethral sphincter, giving rise to the abnormal electromyographic activity. This may impair relaxation of the sphincter, resulting in low flow rates of urine, incomplete emptying of the bladder, and, finally, urinary retention.

ROLE OF SUBCUTANEOUS APOMORPHINE IN PARKINSONIAN VOIDING DYSFUNCTION

Ten patients with Parkinsons disease and urinary symptoms underwent urodynamic assessments before and after subcutaneous administration of the dopamine receptor agonist apomorphine. Voiding efficiency improved after apomorphine injection, with an increase in mean and maximum flow rates in nine patients and reduction in post-micturition residual volume in six. Although the effect on detrusor behaviour was variable, subcutaneous apomorphine may be of use in both the assessment and treatment of voiding dysfunction in patients with Parkinsons disease.

Nerve fibre proliferation in interstitial cystitis

The aetiology of pain in interstitial cystitis is not understood, although it has been reported to be due to release of mediators from mast cell granules. Cystolysis and intravesical instillation of dimethyl sulphoxide have been shown to relieve pain in this condition. We have studied the nerve population within the bladder wall using immunohistochemical stains for protein gene product 9.5. A group of 18 cases of chronic interstitial cystitis and 12 controls; neuropathic bladder (n=1), chronic bacterial cystitis (n=3), systemic lupus erythematosus cystitis (n=2) and normals (n=6), were investigated. There were significantly more nerve fibres within the sub-urothelial and detrusor muscle layers in chronic interstitial cystitis than there were in normals. Patients with chronic cystitis of other aetiology did not have a significant increase in nerve fibre density within the bladder wall suggesting a specific association between nerve fibre proliferation and interstitial cystitis. Cystolysis is shown to deplete selectively the submucosal nerve plexuses without altering the nerve density within detrusor muscle. This finding explains the desensitisation of the bladder without impairment of detrusor function after this procedure.

The black thyroid: an unusual finding during neck exploration.

Black thyroid discolouration has been reported in post-mortem examinations on patients who have previously taken minocycline. The discovery of this phenomenon during neck exploration and a review of the possible mechanism of black thyroid discolouration are discussed in this paper.

Renal angiomyolipoma: a comparison of 5 cases diagnosed by CT scan.

Introduction Renal angiomyolipomas are uncommon benign tumours accounting for only 0.3% of renal neoplasms1. The clinical presentation of these tumours varies widely with the. patients falling into two distinct groups. Approximaely 50% of cases occur in patients with tuberous sclerosis whereas 50% have no known association. The pathological characteristics of the tumour vary in each group and are described in this paper. In the past the management of these lesions was determined primarily by acute haemorrhage or an inability to distinguish them from renal carcinoma. In recent years abdominal computed tomography (CT) has provided an accurate means ofpreoperative diagnosis and whereas previously nephrectomy was the hallmark oftherapy, most urologists now advocate a more conservative management protocol. We report a series of 5 cases with renal angiomyolipoma and discuss the importance of CT in the diagnosis of the condition along with current management concepts.