ABSTRACT
Striated urethral sphincter function was studied in passive incontinent and continenet male subjects who were deprived of the proximal sphincter mechanism. Functional assessment of striated urethral sphincter include electromyography and electrostimulation. Varying degrees of diminished striated sphincter excitability and reflex activity were observed in passive incontinent male subjects who also had varying degrees of somatomotor neuron lesions. The studies indicate that the participating role of periurethral striated musculature in distal passive continence mechanisms cannot be ignored.
Subject(s)
Urethra/physiopathology , Urinary Incontinence/physiopathology , Aged , Electric Stimulation , Electromyography , Humans , Male , Middle Aged , Pressure , Urethra/physiology , Urinary Bladder/physiopathology , Urinary Incontinence/etiology , UrinationABSTRACT
More than 120 patients with recent spinal cord injuries have been admitted to our hospital during the last 3 years. Intermittent catheterization has been the preliminary step in the urologic management of these patients. The transcutaneous suprapubic cystocath with intermittent aspiration of urine also has been used in 7 cases. A bladder outlet operation after 3 months was indicated 3 times more often in patients with complete than in those with incomplete neurologic lesions. Results and indications are discussed.
Subject(s)
Spinal Cord Injuries/complications , Urinary Bladder, Neurogenic/therapy , Adolescent , Adult , Aged , Bacteriuria/etiology , Female , Humans , Male , Middle Aged , Time Factors , Urinary Bladder/surgery , Urinary Bladder, Neurogenic/etiology , Urinary Bladder, Neurogenic/physiopathology , Urinary Catheterization , Vesico-Ureteral Reflux/surgeryABSTRACT
Anatomical proximal extension of the striated urethral sphincter muscle towards the bladder neck was assessed functionally in normal male subjects and in patients with upper motor neuron lesions. Synchronous cystosphincterometric studies were performed and urethral pressure responses were studied (contraction complexes) at the vesicourethral junction, the supramontane prostatic urethra and the membranous urethra to repeated bulbocavernosus stimuli. All subjects demonstrated positive responses at the membranous urethra. Contraction complexes with amplitudes of less magnitude were elicited at the vesicourethral junction and at the supramontane prostatic urethra in 48 and 71 per cent of the total number of subjects, respectively. The functional significance of the striated muscle component at the bladder neck in patients with detrusor-striated sphincter dyssynergia is described.
Subject(s)
Muscles/physiopathology , Urethra/physiopathology , Urinary Bladder/physiopathology , Adolescent , Adult , Humans , Male , Middle Aged , Motor Neurons , Neuromuscular Diseases/physiopathology , Pressure , Prostate/physiopathologyABSTRACT
Experiences are presented with bilateral (3 and 9 o'clock incisions) and anteromedian (12 o'clock incision) external urethral sphincterotomy in 84 patients with neuropathic vesicourethral dysfunctions. Hemorrhage and loss of reflexogenic erections have been notably absent in 31 patients who underwent anteromedian sphincterotomy. The rationale is discussed for the preference of anteromedian over bilateral sphincterotomy based on postoperative complications. The postoperative, radiologically aided cystosphincterometric and electromyographic studies during micturition indicated the adequacy of the surgical procedures, satisfying the urodynamic criteria, although dyssynergic myolectric activity of the periurethral striated muscle continued to exist.
Subject(s)
Urethra/surgery , Urinary Bladder, Neurogenic/surgery , Electromyography , Erectile Dysfunction/etiology , Evaluation Studies as Topic , Follow-Up Studies , Hemorrhage/etiology , Humans , Male , Methods , Postoperative Complications , Reflex , Urinary Bladder/physiopathology , Urinary Bladder, Neurogenic/diagnostic imaging , Urinary Bladder, Neurogenic/physiopathology , Urination , UrographyABSTRACT
Mechanisms underlying urethral pressure changes at the external sphincter region after administration of neuropharmacologic agents were investigated with cystosphincterometric studies and electromyography of the external urethral sphincter in adult patients with spinal cord injury and control male subjects. Bethanechol chloride, propantheline or phentolamine were administered to 37 spinal cord injury men and 3 normal controls. After cystectomy 3 additional spinal cord injury patients were subjected to bethanechol studies. The results of these studies suggested that the pressure changes in the external sphincter zone were caused predominantly by the concurrent changes produced in the detrusor and/or the smooth muscle components of the proximal urethra and of the external sphincter zone.
Subject(s)
Bethanechol Compounds , Parasympathetic Nervous System/physiology , Phentolamine , Propantheline , Spinal Cord Injuries/physiopathology , Sympathetic Nervous System/physiology , Urethra/innervation , Urinary Bladder, Neurogenic/physiopathology , Urinary Bladder/innervation , Adolescent , Humans , Male , Middle Aged , Muscle, Smooth/innervation , Parasympathetic Nervous System/physiopathology , Pressure , Sympathetic Nervous System/physiopathology , UrinationABSTRACT
Preliminary experiences with a dual pressure transducer catheter (7 F) for the functional vesicourethral evaluation are described. Synchronous cystosphincterometric recording, urethral pressure profile with simultaneous intravesical pressure, and pressure gradient across urethral sphincter were obtained. Comparison of the studies with those conducted with catheter infusion technique revealed that minimal artefacts were encountered with the former although the pressure events displayed by the two methods were grossly similar.