Tohru Takita

Children With Unstable Bladder: Clinical and Urodynamic Observation

A clinical analysis was done on 303 patients diagnosed by urodynamic study as having an unstable bladder, which was characterized by uninhibited contraction of the detrusor without any overt neurogenic lesions. An age distribution histogram demonstrated 2 peaks: children less than 10 years old and patients between 60 and 80 years old. Sex was not significant in the children but men predominated in the adults. There were 68 children less than 15 years old with the chief complaints of enuresis (54 per cent), urge incontinence (41 per cent) and fever (25 per cent). The objective findings were vesicoureteral reflux in 29 children, urinary tract infection in 20 and distal urethral stenosis in 8. An unstable bladder type I, the occurrence of uninhibited contractions during the filling phase of cystometry, was found in 53 children (78 per cent). We noted several postures that the children characteristically used to resist unheralded urgency and to prevent urine from leaking. The main therapeutic regimen consisted of anticholinergics with or without antimicrobials. Several children underwent surgical intervention. Once the antireflux operation was performed followup with anticholinergics was of primary importance. The unstable bladders of 63 of the 68 children (93 per cent) have been controlled satisfactorily. The etiology of bladder instability is discussed for both groups of patients.

A paraplegic fathering a child after an intrathecal injection of neostigmine: case report

This paper reports a 33-year-old male paraplegic (T6) who fathered a child by artificial insemination following an intrathecal injection of neostigmine. His wife was healthy and pregnancy was achieved after the 10th insemination. She delivered a mature female child weighing 3,100 g in August 1984. To our knowledge this is only the fourth successful case in the world following neostigmine injection.

Urinary Retention Caused by Impaction of Enlarged Uterus

2 cases of urinary retention were reported which was caused by retroverted gravid uterus and a large fibroid uterus, respectively. A chain cystourethrography and an endoscopic examination were the most informative to disclose the pathogenesis of urinary retention. Urodynamically, bladder compliance was normal without any pathological contraction. Urethral function was characterized by a shortened functional profile length.

Effect of prostaglandin on urethral resistance and micturition.

SummaryThe effect of four exogenous prostaglandins, PGA1, PG802, PGE2 and PGF2α, upon the lower urinary tract was investigated in female mongrel dogs without neurogenic lesions in vivo. The urethral resistance was studied by means of a urethral pressure profile, and the bladder function by evaluating whether or not the micturition was triggered. The reduction of urethral resistance in terms of the maximum urethral closure pressure was most significant with PGE2 given intraarterially. Micturition was most frequently provoked by the intravenous administration of PG802, a derivative of PGE1. PGE series seemed to be the most potent for the evacuation of urine in female dogs.

Labial Adhesions in a Diabetic Woman

This paper reports a 72-year-old woman with labial adhesions, who complained of difficulty in urination and terminal dribbling. The adhesions were surgically dissected with success. Diabetes mellitus in addition to poor perineal hygiene seem to have made her susceptible to the recurrent vulvitis which led to labial adhesions. This case implies the significance of detecting diabetes mellitus as a contributory factor for labial adhesions.

Holding postures characteristic of unstable bladder.

Holding postures to resist uninhibited detrusor contractions are illustrated and discussed. These postures were observed in children with urodynamically proved unstable bladders. The majority of the holding postures involved compressing the urethral meatus or the perineum in girls, or contracting all of the skeletal muscles or squeezing the glans penis in boys. The holding posture required the child to remain still. Younger children used straightforward holding postures, while older children adopted more sophisticated and less recognizable positions. These clinical observations seem to suggest that a physician should probably suspect an unstable bladder in any child who often demonstrates any of these postures.

Remarkable Responses of Metastatic Renal Cell Cancer in Multiple Organs Treated with Alpha-Interferon

We report a case of renal cell carcinoma with metastases in the lungs, humerus and brain, which we treated with alpha-interferon. After a transperitoneal nephrectomy the patient received a series of intramuscular injections of alpha-interferon every 2 days. Two months after the initial therapy complaints of pain in the humeral bone gradually decreased and the palpable mass in the right brachial region disappeared completely. A computerized tomography scan revealed only the scar of the intracranial metastasis. Most of the pulmonary lesions disappeared 4 months later except for the metastasis at the apex of the left lung.