Effect of partial bladder outlet obstruction on the histological structure of adult male rat urinary bladder and the role of L-arginine supplementation

Bladder outlet obstruction [BOO] is one of the most common urological problems in elderly men. l-Arginine, a precursor of nitric oxide synthesis, is thought to play an important role in the lower urinary tract function. The aim of this study was to verify the effect of partial BOO on the structure of the urinary bladder in adult male albino rats and to test the possible protective role of l-arginine. Twenty-seven adult male albino rats were divided into three groups: rats in group I served as controls. Rats in group II were subjected to partial BOO. In group III, the obstructed rats were injected intraperitoneally with L-arginine [at a dose of 150 mg/kg body weight/day] for 6 weeks. Specimens were processed for H and E and Mallory trichrome stains, desmin immunoreaction, and electron microscopic study. Morphometric results were statistically analyzed. Examination of the urinary bladder of obstructed rats showed an observable reduction in the urothelium thickness with focal sloughing of the mucosa as well as cytoplasmic vacuolation of some cells. Cellular infiltration and dilated congested blood vessels of the lamina propria were also encountered. Most smooth muscle cells were distorted with wide separation of muscle bundles and significant increase in the optical density of desmin expression. An increase in collagen fiber deposition was detected in the lamina propria. Ultrastructurally, the superficial urothelial cells showed electron-lucent vacuoles and large electron-dense granules, whereas the myocytes had irregular sarcolemmae. L-Arginine was able to prevent most of the observed alterations. L-Arginine showed a potential protective role against the altered urinary bladder structure induced by partial outlet obstruction. Further physiological studies on the detrusor muscle under the effect of l-arginine are recommended

Bladder exstrophy: treatment and results

67 patients [49 males and 18 females] presented with bladder extrophy with ages ranging from 30 days 28 years and have been followed for up to 12 years. The surgical procedures were multiple and included primary or secondary closure [with or without iliac osteotomy], ileocystoplasty, tightening of bladder neck, creation of a urinary pouch to replace the bladder, ureterosigmoid anastamosis, and repair of epispadius. Closure was eventually achieved in all the cases who attended for the completion of their treatment, and with the repair of epispadius, continence was not achieved although bladder augmentation helped in keeping the patients dry for longer hours especially on supine position. Although the treatment of bladder extrophy should start immediately after birth, yet older patients should not be denied the long painstaking procedures to let them lead an almost a normal life

Clinical significance of residual urine in patients with prostatism Is it still the same?

40 patients with symptom complex of prostatism were investigated using routine urological work up, and urodynamic assessment, to evaluate the clinical significance of residual urine and its relation to detrusor function. No significant relation could be detected between residual urine and presence of obstruction, while a significant negative correlation with detrusor power was demonstrated. Residual urine may indicate impaired detrusor irrespective of presence or absence of outflow obstruction

Estenosis benigna de la vía biliar, secundaria a yatrogenia: tratamiento quirúrgico con sonda trans-hepática, experiencia en el Centro Médico Nacional Siglo XXI / Handling of beningn strictures of the biliary tract with transhepatic tubes

Objetivo: informar la experiencia en el tratamiento de las estenosis benignas de las vías biliares con el empleo de sonda transhepática y anatomosis entre la mucosa intestinal y el endotelio biliar, sin sutura. Diseño: Estudio retrospectivo, longitudinal, observacional, sin grupo control. Sede: Servicio de Gastro-Cirugía del Hospital de Especialidades del Centro Médico Nacional Siglo XXI del IMSS en el D.F. Pacientes: Se estudiaron 33 enfermos, 23 mujeres y 10 varones con edad promedio de 44.6 años, veinte de ellos operados en una ocasión, nueve en 2 y 3 en cuatro. La causa de la lesión yatrógena de la vía biliar fue: colecistectomía en el 67 por ciento (22 pacientes); en 15 enfermos la lesión no se detectó en forma inmediata, en 5 sí. Trece pacientes fueron sometidos a una segunda o tercera operación. Resultados: El sitio de la estenosis se localizó en los conductos hepáticos en 12 sujetos (36 por ciento), en el sitio de la primera anastomosis en 11 (33 por ciento) no se pudo determinar en 9 (27 por ciento). Los procedimientos quirúrgicos para resolver la yatrogenia fueron los siguientes: dilatación de la anastomosis en 4 enfermos, exploración de la vía biliar en 2, hepático-yeyuno-anastomosis en Y de Roux en 3, hepático-yeyuno-anastomosis en Y-Roux con ferulación con sonda transhepática en 13, colocación de sondas transhepáticas en 6 y colocación de guías de nylon en 3. Los pacientes fueron observados por un lapso de 4 semanas en el post-operatorio con un 86.3 por ciento de buenos resultados.