Torsten Sundin

The Sympathetic Innervation of the Urinary Bladder and Urethra in the Normal State and After Parasympathetic Denervation at the Spinal Root Level: An Experimental Study in Cats

The innervation of the feline bladder and urethra was studied by a histochemical fluorescence technique and the use of peripheral nerve stimulations in combination with different blocking agents. The studies were performed in the normal state and at various times after parasympathetic denervation, achieved by sectioning of appropriate ventral roots.After parasympathetic denervation the bladder response following hypogastric nerve stimulation was changed from a normal response of initial contraction and subsequent relaxation into a sustained bladder contraction. This altered response, first observed after 6 weeks, was composed of two phases; a weak and brief contraction followed immediately by a strong and long-lasting contraction. The second phase was adrenergic (blocked by an adrenergic aL-blocking agent) and presumably effected via intramural ganglia (blocked by a ganglionic blocking agent).Consistent with this was the histochemical observation of a change in adrenergic innervation. About 6 weeks after ...

The Adrenergic Innervation and Adrenergic Receptor Activity of the Feline Urinary Bladder and Urethra in the Normal State and After Hypogastric and/or Parasympathetic Denervation

After long-term parasymphatetic denervation, detrusor muscle hypertrophy was found regardless of whether the hypogastric nerves had been sectioned simultaneously or not. After hypogastric denervation only, there was no difference in gross appearance from normal bladders. Adrenergic innervation was studied by means of a histochemical fluorescence technique. After hypogastric denervation, there was usually a slight increase in the detrusor innervation, and a clear decrease in the trigone and urethral adrenergic innervation. After parasympathetic denervation, the detrusor showed an increase in adrenergic innervation, while the innervation of the trigone and the urethra was unchanged. After simultaneous parasympathetic and hypogastric denervation, the adrenergic innervation of the detrusor was similar to that of the bladders subjected to parasympathetic denervation only. The adrenergic innervation of the trigone and urethra was similar to that found after hypogastric denervation only. Adrenergic receptor functions were studied by a method in which changes in the isometric tension of muscle strips were recorded following different pharmacological treatments. In the normal state, noradrenalin and phenylephrine caused contraction and isoprenaline relaxation of the trigone-urethra. In the detrusor, noradrenalin caused relaxation of strips contracted by carbacholine. Relaxed detrusor muscle strips were usually not contracted by noradenalin. In 2 out of 8 normal cats, however, a contraction was observed after very large doses of noradrenalin. After hypogastric denervation, the adrenoreceptor functions were consistent with those of the normal state. After parasympathetic denervation, the trigone-urethral receptor functions were unchanged compared with the normal receptor functions. In the detrusor, isoprenaline caused relaxation and noradrenalin and phenylephrine contraction. After simultaneous parasympathetic and hypogastric denervation, the results were consistent with those obtained after parasympathetic denervation only. Thus, the present study showed an increased adrenergic detrusor innervation and alpha-receptor activity after parasympathetic denervation regardless of whether the hypogastric nerves had been sectioned simultaneously or not. Although alpha-receptors might exist in the normal detrusor, beta-receptors dominate strongly. After parasympathetic denervation, there seems to be a change in the relation between alpha- and beta-receptors in favour of alpha-receptors.

Reconstruction of Severed Ventral Roots Innervating the Urinary Bladder: An Experimental Study in Cats

In an experimental study on 12 adult cats, the ventral roots innervating the detrusor muscle of the urinary bladder were transected and anastomosed using the Millipore tubulation technique. In one series one pair of the three sacral ventral roots previously innervating the detrusor were reconnected. In another series one pair of lumbar ventral roots were anastomosed to one pair of sacral ventral roots, thus creating a non-physiological efferent pathway to the denervated bladder. The functional restitution of efferent fibers to the denervated bladder was assessed by the return of the micturition reflex. In all 10 animals where root anastomoses were performed the micturition reflex returned after regeneration periods ranging between 4 and 7 months. In controls, where no anastomoses were performed or where functionally regenerated roots were transected, the micturition reflex was permanently abolished. The results were further evaluated by bioelectrical and histological methods. The mechanisms of restoration...

Reconstruction of Severed Dorsal Roots Innervating the Urinary Bladder An Experimental Study in Cats I. Studies on the normal afferent pathways in the pelvic and pudendal nerves

When using an electrophysiological technique in 5 adult female cats the afferent input of the pelvic and pudendal nerves was found to be represented in one or more of the three dorsal sacral roots, but nut in the lowest lumbar or first coccygeal roots.In another series of 9 cats it was demonstrated that afferent stimulation of the transected pelvic or pudendal nerves resulted in a bladder response similar to that following efferent stimulation of the hypogastric nerves. This bladder reaction was a composite reflex response, the dominating feature of which was a bladder relaxation. The reflexes elicited by afferent stimulation of the pelvic or pudendal nerves were both found to be spinal reflexes with their afferent limbs passing the dorsal sacral roots and their efferent limbs in the hypogastric nerves. The reflex elicited by afferent pelvic nerve stimulation corresponds to Edvardsens storage reflex. Reflex relaxation of the urinary bladder following afferent electrical stimulation of the pudendal nerve ...

Studies on renal damage from percutaneous nephrolitholapaxy.

To study in detail the effects of percutaneous nephrolitholapaxy on renal function, a consecutive series of 11 patients were investigated preoperatively by excretory urography, gamma camera renography for determination of individual renal function and computerized tomography of the kidneys. Postoperatively, gamma camera examination, computerized tomography, antegrade nephrostography, renal angiography and excretory urography were performed. With 2 exceptions, percutaneous nephrostomy, dilation of the tract and stone removal were done in 1 stage with the patient under continuous epidural anesthesia. Nephrostomy tract dilation was done with an Olbert type balloon catheter or Alken metallic dilators. Thickening of Gerotas fascia was demonstrated by computerized tomography in most cases, and small to moderate perirenal hematomas were found in several. At gamma camera examination decrease of renal function was noted regularly on postoperative day 1 and returned to near initial levels 2 weeks postoperatively in most cases. Angiography in 10 patients showed discrete parenchymal scarring in some and a peripheral arteriovenous fistula in 1. We conclude that percutaneous renal stone surgery usually is tolerated well by the kidney.

Reconstruction of Severed Dorsal Roots Innervating the Urinary Bladder: An Experimental Study in Cats II. Regeneration studies

In an experimental study on 12 adult female cats, the dorsal sacral roots mediating the afferent inflow of the pelvic and pudendal nerves were transected. In 4 animals, the S1 dorsal roots transected immediately distally to their ganglia were anastomosed with tubulation technique to the peripheral part of the transected S2 radicular nerves. In 5 animsals anastomoses were performed between the L7 dorsal roots and the S1 radicular nerves, thus creating a non-physiological afferent pathway to the urinary bladder. In 3 control animals all sacral dorsal roots were transected but no anastomoses were performed. The functional restitution of afferent fibers was assessed by the return of the micturition reflex and storage reflexes. The micturition reflex returned in the cystometrograms of 5 of 9 animlals with reconstructed dorsal roots after regeneration periods ranging between 8 and 11 months. The storage reflexes were present in approximately half of the animals with root anastomoses tested in final experiments ...

Cardiovascular complications of estrogen therapy for nondisseminated prostatic carcinoma. A preliminary report from a randomized multicenter study.

In a prospective multicenter study, 244 men with highly or moderately differentiated prostatic cancer in stage I, II or III (VACURG) were consecutively randomized to three groups of treatment: Group A (77 patients) received polyestradiol phosphate (Estradurin, Leo) 80 mg i.m. every fourth week + ethinyl estradiol (Etivex, Leo) 150 micrograms daily, group B (72 patients) estramustine phosphate (Estracyt, Leo) 280 mg twice daily, and group C (76 patients) no therapy. Only men without current or previous other malignancy and without cardiovascular disease were admitted to the study. After 4 1/2 years 125 of the 244 patients had left the study, 9 because of cancer progression (stage IV, VACURG). The most serious complications were cardiovascular, including ischemic heart disease, cardiac decompensation, cerebral ischemia and venous thromboembolism, which occurred in 24 patients from group A and 9 from group B as compared to only one patient in group C. The subgroup superficial or deep venous thrombosis comprised 11 group A and 2 group B patients. Estrogens (E + e) offered as palliative treatment to patients with non-generalized prostatic carcinoma is burdened with a high incidence of serious cardiovascular complications.

Open Technique for Ureteric Implantation in Ileal Conduits

An open technique for ureteric implantation into the ileal loop is described. After a mean follow-up time of 2V3 years, the results of this technique were compared to those of different conventional methods. With the open technique, no ureteric dilatation was observed in the IVP films of 55 renal units. In one patient, a slight dilatation was observed on one side. In another three patients with cutaneous stomal complications, a significant ureteric dilatation was observed bilaterally. In these patients, an intestino-ureteric reflux was demonstrated roentgenologically. With the conventional techniques for uretero-intestinal anastomosis, no post-operative ureteric dilatation was noted in 19 renal units, two kidneys showed no contrast excretion, and 17 ureters became dilated post-operatively. The investigation indicates that the open method for ureteric implantation prevents secondary stricturation. A possible ureteric reflux does not cause ureteric dilatation as long as the outflow from the ileal loop is unobstructed.

The valved S-shaped rectosigmoid pouch for continent urinary diversion

Continent urinary diversion to the valved S-shaped rectosigmoid pouch was performed in 9 female and 6 male patients 12 to 65 years old (mean age 51 years). The pouch was constructed by detubularization and S-shaped reconfiguration of 30 cm. of the intact rectum and sigmoid colon. The ureters were reimplanted into the pouch using antireflux techniques. Reflux of urine from the pouch to the proximal colon was prevented by fashioning an intussusception valve. The construction was protected by a transverse colostomy for 6 to 8 weeks. With a followup of 3 to 24 months (mean 11 months), all patients are continent during the day and also at night with evacuation intervals of 3 to 6 hours. There have been no cases of symptomatic urinary tract infection. Only 1 patient had mild hyperchloremic acidosis. No patient complained of abdominal distention or constipation. Contrast study via the anus (radiography of the pouch) showed that the intussusception valve was competent in all but 1 patient in whom reflux to the proximal colon was noted due to sliding of the nipple valve, which was revised successfully. Urodynamic studies (cystometry of the pouch) showed a capacity of 400 to 900 ml. (mean 600) with an intraluminal pressure of 22 cm. water (range 10 to 34) at maximal filling. The valved S-shaped rectosigmoid pouch is a faster and simpler surgical procedure compared with the modified rectal bladder (valved rectum augmented with ileum). It also results in a smooth postoperative course, since an intestinal anastomosis proximal to the colostomy is avoided.

Ureteral injury secondary to laparoscopic CO2 laser

A case of a 32‐year‐old nulligravida who underwent a carbon dioxide laser‐laparoscopy for endometriosis is reported. Ureteral injury was complicated by a postoperative ‘urinoma’. Injury occurred despite utilizing the hydrodissection technique destined to create a bed of water beneath the peritoneum to prevent laser beam penetration to adjacent normal tissue. This case illustrates that the hydrodissection technique may be less effective in the presence of severe endometriotic adhesions and fibrosis.