Natural pressure-volume curves and conventional cystometry.

Conventional cystometry using high non-physiological filling rates creates an artificial condition with continuous pressure rise. Controlled Slow Cystometry (CSC), using a defined rate-unit calculated after body weight (hour-diuresis unit, HD), has enabled systematic studies of bladder reaction to natural filling. Physiological filling rate is up to 15 HD. At low physiological filling rate (< 2.4 HD in cats) the pressure-volume curve is flat. Pressure rise is rate-dependent, not volume-dependent and can occur at any time during filling, as the need of the body to excrete urine at high rate is not coordinated with bladder filling. Thus, in an individual cat and human there are numerous variations in natural pressure-volume curves.

Ambulatory urodynamic monitoring of women.

A review of articles concerning ambulatory urodynamic monitoring (AUM) is given AUM, as we practice it, is described. Typical findings in normal continent women, in patients with genuine stress incontinence, unstable detrusor, mixed incontinence, low closure pressure, unstable urethra and during sitting, jumping, and running are given. AUM is indicated and is superior to conventional cystometry in urge incontinent patients and in patients with a supine closure pressure lower than 20 cm H2O. AUM is also indicated in stress incontinent patients not leaking during stress test. AUM may be valuable in drug effect studies and in the study of normal physiology. Abnormalities which are not disclosed with conventional techniques may better be detected by AUM when patients are at their case alone, free from medical observers or are physically or mentally stressed in the situation they usually leak. AUM may, because of the recording of both urethral and bladder pressures, contribute to a more complete understanding of the leak mechanisms.

Frequency volume charts: an indispensable part of lower urinary tract assessment.

Frequency volume charts (FV charts) are widely used by those interested in lower urinary tract function. However, there has been little systematic work on the value and design of FV charts as they have evolved over the years as clinical tools rather than as research instruments. Although FV chart design has developed over the last 20 years, there is no standard and charts vary from simple frequency charts up to urinary diaries which record not only frequency, volume, urge episodes, pad usage and fluid intake, but also the patients' activities in relation to their lower urinary tract symptoms. Studies have shown that charts can be relatively complex and still be acceptable to patients, providing proper instruction is given, either by written advice or at face to face interviews. The correlations between the answers to simple questions concerning frequency and nocturia and the data extracted from FV charts are variably strong: nocturia, pad usage and incontinence episodes correlate well, whereas urinary frequency correlates less closely. A number of conclusions on frequency volume charts can be made. The chart is best kept for 7 days in order to cover both work and leisure periods. The daytime should be separated from the night-time, and this is particularly important in assessing older patients with possible nocturnal polyuria. Addition of voided volume measurement to the frequency chart allows the construction of a simple classification of FV charts. This classification links the characteristics seen on the FV charts with particular lower urinary tract dysfunctions. Whilst this classification gives a guide to the patient's possible diagnosis, the overlap between symptomatic groups and normal controls is large. FV charts have an important role in objectively, recording patients' symptoms, both as a base line and after therapeutic interventions. They are particularly important in everyday clinical use as a vital part of bladder training. In the research field they are important in providing objective evidence of changes in subjective symptoms in a treatment group as opposed to the placebo group. They have been particularly valuable in the evaluation of new drugs for the treatment of detrusor overactivity and benign prostatic obstruction. Most FV charts rely on pen and paper. However in the computer age the possibility of computerising the FV chart is attractive, but as yet not fully evaluated. At present it is advised that a simple frequency volume chart with the additional recording of incontinent episodes, pad usage and overall assessment of fluid intake is used for routine clinical use. In a research setting urinary diaries may add significant additional information, allowing a more complete evaluation of novel therapies.

Congenital and acquired curvature of the penis treated surgically by plication of the tunica albuginea.

OBJECTIVE: To evaluate the effectiveness of plication surgery for patients with congenital and acquired curvature of the penis. PATIENTS AND METHODS: Forty-eight patients with congenital curvature of the penis and 57 with induratio penis plastica were treated by plication of the tunica albuginea. Their average age was 23 and 56 years, respectively. The operation was performed under local anaesthesia, using 2/0 Prolene and a specially designed suture. The average observation time in the two groups was 24 and 20 months, respectively. RESULTS: Nineteen per cent of patients in the first group and 8% in the second group reported normal intercourse pre-operatively. Post-operatively, the numbers increased to 81% and 82%, respectively, and all were able to perform intercourse. Although 18-19% experienced slight discomfort, mostly related to the cut ends of the suture, this minor problem was accepted by all. Five patients needed more than one operation. No impotence was recorded post-operatively and no patient complained of reduced sensibility of the skin. CONCLUSION: Satisfactory results were obtained with the plication technique in the first 105 patients. Since the follow-up study was completed more than 2 years ago, another 70 patients have been treated by the same procedure.

[Normalization of bladder emptying in patients on clean intermittent catheterization]. / Normalisering av blaeretømmingen hos pasienter på ren intermitterende kateterisering.

CIC is an established treatment for various functional disturbances of the lower urinary tract (UT). Termination of CIC due to successful restoration of normal or near-normal spontaneous bladder emptying has been reported in individual cases but there have been no reports of it in larger series. In the present study, data for 1,702 patients on CIC were obtained with the help of an organised system of registration and follow-up of these patients, developed by Astra Tech AS, Norway. CIC could be terminated because of the restoration of satisfactory spontaneous bladder emptying in 13.2 per cent of the series as whole (n = 1702). The rate of improved bladder emptying was significantly higher among patients with lower UT lesions and bladder dysfunction of unknown aetiology than among patients with upper UT lesions and miscellaneous diagnoses (18.4 vs. 8.8 per cent, p < 0.001). The improvement almost always occurred during the first year, and was more common among women than among men (17.2 vs. 9.5 per cent). There was no difference in the frequency of catheterisation episodes between the group able to end treatment owing to normalisation of spontaneous bladder emptying and the group still on CIC. A possible explanation of why CIC results in satisfactory spontaneous bladder emptying is that the treatment reduces over-distension of the bladder wall.

A bladder cancer multi-institutional experience with total cystectomy for muscle-invasive bladder cancer.

BACKGROUND: The role of total cystectomy was to be assessed in the curative treatment of muscle-invasive bladder cancer. METHODS: Two hundred and fifty-three patients with T2-T4a transitional cell carcinoma of the urinary bladder were referred to precystectomy radiation therapy (46 Gy, 66 patients; 20 Gy, 187 patients). These patients represented approximately 20% of all patients developing muscle-invasive bladder cancer in Southern Norway from 1980-1990. The clinical T categorization was generally based on palpability and extent of the palpable bladder tumor assessed by the referring urologist. Twenty-six patients (10%) did not have total cystectomy, most often due to peroperatively demonstrated locoregional inoperability. Two or three cycles of cisplatin-based combination chemotherapy were given to 68 patients. RESULTS: For the 227 patients who underwent cystectomy, the cancer-specific 5-year survival rate was 58% (T2 [104 patients], 63%; greater than or equal to T3 [123 patients], 54%) (P = 0.022). The comparable figure for patients with histologically proven regional lymph node metastases was 22%. The 97 stage-reduced cases (less than or equal to pT1) survived significantly longer than the 130 patients without stage reduction (74% versus 46%) (P < 0.0001). Neoadjuvant chemotherapy was correlated with a more favorable survival in patients with greater than or equal to T3 tumors but did not seem to influence survival of patients with T2 bladder cancer. CONCLUSIONS: In a multicenter setting, prognostically relevant T categorization of operable muscle-infiltrating bladder cancer can be based on the palpability of the primary tumor. Approximately 50% of favorably selected patients with operable T2-T4 bladder cancer survived for at least 5 years independent of whether the operation was done at a large uro-oncologic unit or a smaller urologic section. In this retrospective review, chemotherapy seemed to improve the survival in patients with deeply infiltrating (greater than or equal to T3) bladder cancer but appeared to represent an overtreatment in patients with T2 tumors.

[Primary vesicoureteral reflux with renal failure in adults]. / Primaer vesikoureteral refluks med nyresvikt hos voksne.

The present article describes the case of two men, 18 and 30 years respectively, in whom renal insufficiency was discovered incidently. In the two cases renography showed 46 and 30% of expected function given two healthy kidneys. They had neither experienced clinical symptoms of urinary tract disorder, been operated upon, nor endoscopically examined. Micturition was normal without any sign of vesicourethral dysfunction. Micturition cystography revealed severe vesicoureteral reflux in both patients. They were treated by bilateral ureterovesical reimplantation. The cases presented here show that primary vesicoureteral reflux complicated by impaired renal function can be revealed in adults who have had no symptoms of urinary tract disorder. In these cases the probable cause of renal damage is the mechanical effect of reflux ("water-hammer effect") alone.

Continence mechanism in the female.

Continence is partly automatically and partly consciously regulated. It is automatically regulated until the desire to void is felt. From then on, micturition reflex elicitation is consciously inhibited. When that is no longer possible, the sequence of urethral relaxation and detrusor contraction automatically takes place. Continence may thereafter be consciously maintained through squeezing with striated muscles and then by external mechanical compression of the urethra.

Isolated cavernous bodies.

Corpus cavernosography in a patient with erectile dysfunction revealed absence of communication between the 2 cavernous bodies. No similar case was found in a review of 100 consecutive cavernosograms or in the literature. The abnormality may be a source of error in pressure recordings or in intravenous injection of pharmaceutical agents.