Bladder dysfunction in patients with benign prostatic hyperplasia: relevance of cystometry as prognostic indicator of the outcome after prostatectomy.

BACKGROUND: We correlated cystometric findings to the clinical features of benign prostatic hyperplasia (BPH) and compared them in terms of outcome after prostatectomy. METHODS: Cystometric findings obtained from 78 patients who underwent prostatectomy were correlated with clinical features in BPH patients. In 41 consecutive patients of this group, prospective periodical cystometry was also performed. RESULTS: Low bladder compliance correlated significantly with an increase in age and prostate volume, detrusor instability and impaired contractility. Low compliance also correlated with irritative symptoms, decreased maximum flow rate, increased post-void residual urine and an increase in the American Urological Association symptom score. Postoperative persistent incontinence was associated with low bladder compliance and detrusor instability. In a prospective study, bladder dysfunction was not completely restored in 53% of patients examined at a mean interval of 7.7 months after prostatectomy. CONCLUSIONS: Among the cystometric parameters investigated, low compliance was the most relevant to the clinical features of BPH and had some predictive value for the outcome after prostatectomy. In about half of the BPH patients with bladder dysfunction preoperatively, this condition was irreversible for a significant period of time after prostatectomy, in spite of surgical relief of the infravesical obstruction.

[Morphological changes in major pelvic ganglion neurons and histological structure of bladder using rat model of partial urethral ligation].

Ninety six rats were divided into 4 groups (normal control group (N = 4), ligation group (N = 20), ligation-removed group (N = 36), and sham surgery group (N = 36)). The neuronal size of the 4-week ligated rats returned to normal 6 weeks after removal of the ligation. Rats ligated for 7, 11 and 20 weeks also exhibited a significant increase in the mean area but they could not make a complete recovery after removal of ligation for 6 weeks. Only the rats in the 1- and 4-week ligation groups could recover their neuronal size. Area densities of smooth muscle: connective tissue (ADsc ratio) was calculated using Elastica van Gieson staining sections of bladder strips. When ligation was removed, the ratio dropped and became nearly equal to the value of the sham surgery group. Only the 7-week group showed a lower ADsc ratio than the sham surgery group after the ligation was removed. These findings suggest that the reversibility of neuronal hypertrophy might become irreversible when the period of partial urethral ligation persisted beyond 7 weeks. Irreversible hypertrophy of major pelvic ganglion (MPG) neurons might be greatly related with the irreversibly enlarged fibrous bladder which could not show the same ADsc ratio as was seen in the sham surgery groups.

[Morphological change and reversibility of major pelvic ganglion neurons using rat model of partial urethral ligation].

We made partial urethral ligation in female Wistar rats to evaluate the morphological change and the reversibility of the major pelvic ganglion (MPG) neurons before and after partial urethral ligation. Thirty rats were divided into 4 groups; normal control group (N = 3), ligation group (N = 9), release of ligation group (N = 9), and sham-operated group (N = 9). WGA-HRP (horseradish peroxidase with lectin wheat germ agglutinin) was injected into the right side of the bladder 4 days before the MPG neurons were removed. MPG was examined by the axonal tracer method. Rats with partial urethral ligation for 1 week exhibited a significant increase in the size (419.1 +/- 146.0 microns2) of the mean area of MPG neurons as compared to the normal controls (318.0 +/- 118.6 microns2), but they showed a steady decrease in size (304.2 +/- 118.6 microns2) similar to that in the sham-operated group (310.2 +/- 116.3 microns2) 3 weeks after the removal of the ligation. The rats with partial urethral ligation for 7 weeks and 11 weeks also exhibited a significant increase in the mean area (7w; 484.1 +/- 192.6 microns2, 11w; 549.4 +/- 181.3 microns2), but they did not show complete recovery (7w; 383.3 +/- 159.6 microns2, 11w; 549.6 +/- 279.5 microns2) as compared to the sham-operated group (7w; 324.4 +/- 124.9 microns2, 11w; 345.9 +/- 121.7 microns2) after removal of ligation. Only the 1-week ligation group showed recovery in neuronal size. These findings imply that the neuronal hypertrophy might become irreversible when the period of partial urethral ligation persisted beyond 7 weeks.

Pharmacological characterization of alpha 1-adrenoceptor subtypes in the human prostate: functional and binding studies.

OBJECTIVE: To characterize the alpha 1-adrenoceptor subtypes of the human benignly enlarged prostate using functional and binding studies. MATERIALS AND METHODS: Strips of prostatic tissue taken from nine patients with benign prostatic hypertrophy who were undergoing open prostatectomy were used in the study. RESULTS: The strips isolated from five prostates produced a large contraction in response to noradrenaline and phenylephrine but not to clonidine. The contractile response induced by noradrenaline was competitively antagonized by representative alpha 1-adrenoceptor antagonists (prazosin, WB4101, 5-methylurapidil and HV723), the dissociation constants (pKB) being < 8.5. Pre-treatment with chloroethylclonidine was without effect on the contractile response to noradrenaline. In saturation experiments with five prostates, [3H]-prazosin bound to the prostate membranes with two distinct affinities (pKD = 9.95 +/- 0.07 and 8.71 +/- 0.04, Bmax = 151 +/- 8 and 138 +/- 3 fmol/mg protein, respectively). Unlabelled prazosin and WB4101 biphasically displaced the binding of 200 pM [3H]-prazosin; the resulting high and low pKI values for each of the antagonists were consistent with the two pKD values obtained for [3H]-prazosin in the saturation experiments. 5-Methylurapidil and HV723 displaced the [3H]-prazosin binding monophasically with an affinity (pKI) close to 8.5. CONCLUSIONS: These results suggest the presence of at least two distinct alpha 1-adrenoceptor subtypes (presumably an alpha 1C subtype with a high affinity for prazosin and WB4101, and a putative alpha 1L subtype with a low affinity for the antagonists) in the human prostate, in which the latter subtype may be predominantly involved in the contractile response to noradrenaline.

[Genitourinary endometriosis: report of 2 cases and clinical aspects of patients in Japan].

One hundred and fifty two cases of genito-urinary tract endometriosis reported in Japan including our 2 cases were reviewed. The incidence and mean patients' age were respectively 0.7% and 22 years old for kidneys, 37.5% and 38.8 years old for ureter and 61.8% and 36.2 years old for bladder. Clinical symptoms in ureteral endometriosis were similar to those in upper urinary tract obstruction and in vesical endometriosis, lower urinary tract symptoms such as pain on urination, irritative bladder symptoms and macrohematuria were frequently observed. Vesical lesions tend to be located on the posterior wall in the retrotrigone or trigone, and ureteral lesions tend to be located in the bilateral lower segments. The incidence of extrinsic type of ureteral endometriosis was 6 times higher than that reported as intrinsic type, and mixed type was reported in only 3.5%. Recent first choice for mild endometriosis is hormonal therapy with Danazole or LH-RH analogue. Surgical treatment is recommended in severe cases or patients in whom hormonal therapy is not effective.

[Ultrasonographic assessment of intravesical urine volume].

The assessment of intravesical urine volume is very important in the management of the patients with lower urinary tract obstruction or incontinence. As the non-invasive method for measuring residual urine volume, accuracy and usefulness of ultrasonographic measurement was evaluated in a total of 116 occasions in comparison with the conventional catheter technique. The values of the maximum transverse (W), cranio-caudal (H) and antero-posterior distance (D) of the inflated bladder were obtained by trans-abdominal scanning. These parameters were used for the ellipsoid formula (pi/6 x W x H x D). The ultrasonographic measurement of urine volume showed a high coefficiency against the conventional catheterized volume (r = 0.9543). Although a mean standard error was 56.3% of the actual volume, the amount of residual urine at the target of 50 ml and 100 ml could be accurately assessed by ultrasound with an accuracy of 90.5%. The method was also valid in follow-up study to monitor the changes of residual urine volume. The ultrasonographic assessment of intravesical urine volume is, thus, a non-invasive, useful tool in the management of the patients with voiding disturbance.

[A case of hamartoma of the retroperitoneal space].

A case of hamartoma of the retroperitoneal space in a 59-year-old woman is reported. Excretory urography, computed tomography and adrenal angiography revealed a tumor with multiple calcification in the left retroperitoneal space. The tumor measuring 6.5 by 3.5 cm, and weighing 30 gm, was removed operatively. Removed specimen consisted of many cysts of various sizes containing mucous fluid and multiple small stones. Microscopically, the tumor was composed of a tubular structure lined by ciliated, epithelium-like tissue of the respiratory system or that of Fallopian tube. These tubules were occasionally dilated cystically. No atypical cells were found. The postoperative course was uneventful.

[Report of a case of a renal arteriovenous malformation presenting an unusual computed tomographic finding].

A fifty-three-year-old woman was admitted for gross hematuria and left lumbago. She was diagnosed as having left renal arteriovenous malformation (AVM) by renal angiography, but contrast enhanced CT of her left kidney demonstrated a low density area of renal parenchyma adjacent to AVM. Because a renal tumor could not be denied completely, we performed translumbar nephrectomy. No renal tumor was found in the removed kidney, and she was diagnosed as having cirsoid type AVM of the left kidney. The low density area in contrast enhanced CT was suspected to be indicating the ischemic renal parenchyma due to the steal phenomenon of renal AVM. This is the first report of a renal AVM with ischemic renal parenchyma demonstrated by CT.

[Two cases of emphysematous pyelonephritis--considerations on the choice of treatment].

Emphysematous pyelonephritis is a severe infection characterized by the presence of gas within the renal parenchyma and perirenal tissues. Two cases of this disease are presented. They were the 16th and 17th case reported in Japan. Case 1 was a 63-year-old woman with diabetes mellitus and liver cirrhosis. She was hospitalized for abdominal pain and anuria. Renal X-rays showed a gas shadow in and around the left kidney, but no evidence of upper urinary tract obstruction. Although hemodialysis was done, she died of heart failure. Case 2 was a 54-year-old man with diabetes mellitus was admitted with the complaint of fever and left abdominal pain. Renal X-rays showed a gas shadow in and around the left kidney but no evidence of upper urinary tract obstruction. He was treated with intensive antibiotic therapy, control of blood sugar, intravenous drips and percutaneous drainage. Clinical features improved, but deteriorated after 40 days of therapy. The gas shadow remained unchanged on CT scanning, and aortography showed the occlusion of the left renal artery. Nephrectomy was done after 50 days. Seventeen cases of emphysematous pyelonephritis in the literature including our cases are reviewed, especially the choice of the treatment is discussed.

[Torsion of the undescended testicle: a case report].

A 15-year-old boy was consulted to our hospital with the complaint of swelling of the left inguinal region with tenderness. Under the diagnosis of torsion of the undescended testicle, left orchidopexy was done with the finding of left testicle which had 360 degree counterclockwise intravaginal rotation. This was thought to be the 54th case of the disease in Japan. We have made some discussion on incidence, complication, diagnosis and therapy.