Urorectodynamic evaluation of healthy volunteers.

Twelve female and 8 male healthy volunteers underwent urorectodynamic evaluation. Mean bladder capacity was 594 ml. and mean maximal vesical pressure 12.5 cm. water (H2O). Maximal bladder pressure correlated significantly with maximal mural tension (r = 0.96) but did not correlate well with bladder capacity (r = 0.20). Mean bladder volume at first desire to void was 32 per cent of mean bladder capacity. The bladder volume at the first desire did not correlate significantly with the capacity. Mean bladder pressure at 100 ml. volume was 2.9 +/- 0.4 cm. H2O (X +/- SEM). After bethanechol injection, the bladder pressure at 100 ml. volume increased by 8.8 +/- 1.2 cm. H2O (X +/- SEM) at twenty minutes. In only 1 subject did bladder pressure rise higher than 15 cm. H2O (5 per cent). Rectal pressure increased from 1.4 +/- 0.3 to 14.1 +/- 2 cm. H2O (X +/- SEM) at sixteen minutes. Electromyogram (EMG) of the external and sphincter did not follow regular pattern with vesical filling or attempt of voiding. The data obtained in these normal subjects may serve as a basis for comparison in the interpretation of data obtained in patients.

Clinical and urodynamic evaluation of urethrocystopexy for stress urinary incontinence: preliminary report.

Thirteen patients presenting with stress urinary incontinence associated with a notion of urgency were evaluated. Each patient underwent a full clinical and paraclinical preoperative evaluation. The urodynamic evaluation included flowmetry, urethral profile, cystometry lying down and standing, and intrarectal pressure measurement. All these patients were operated on (urethrocystopexy), and the evaluation was repeated between one and eight months. The frequency, both diurnal and nocturnal, was reduced in the postoperative period. The urgency decreased from 46 per cent prior to surgery to 7.6 per cent postoperatively. Thirty-eight per cent of patients had urgency incontinence prior to surgery, and none of these patients was incontinent postoperatively. Stress incontinence was corrected in all patients during the period of follow-up. The urodynamic parameters were practically unchanged by the surgery. These parameters included the urethral length, maximum urethral pressure, vesical capacity, and maximum vesical pressure both while lying down and standing. In 4 patients with urgency incontinence preoperatively, the bladder capacity lying down was significantly higher than the bladder capacity standing up whereas the difference was not significant in the patients without urgency incontinence. This difference disappeared postoperatively. No evidence of true uninhibited bladder contractions were noted in any of these patients while lying down or standing.

Urorectodynamics in patients with colonic inertia.

Sixteen female patients with colonic inertia and 12 control women underwent manometric evaluation of their bladder and rectal cavities. After subcutaneous injection of 0.035 mg./Kg. bethanechol, bladder intraluminal pressure increased by over 15 cm. water in 5 patients (31 per cent) and in none of the control group; maximal pressure after injection was 11.5 +/- 1.6 cm. H2O (mean +/- SE) in patients and 8.5 +/- 1 in controls (p less than 0.025). The intraluminal rectal pressure reached 23 +/- 4 cm. H2O in patients and only 11.9 +/- 1.4 in controls (p less than 0.0025). Time taken to reach a peak pressure was faster in patients both in bladder (17.4 +/- 0.7 vs. 19.8 +/- 1.2 minutes; p less than 0.01) and in the rectum 914.6 +/- 0.8 vs. 16.3 +/- 1.2; p less than 0.025). These findings and the clinical presentation suggest an autonomic neuropathic lesion in this group of patients.

Fibroepithelial tumour of the renal pelvis.

From a statistical viewpoint, almost all renal pelvic tumours may be considered to be transitional cell carcinomas. Only six benign pelvic tumours have been reported in the English literature. The author describes one such case. A 40-year-old woman with recurrent cystitis was found on intravenous pyelography to have a mass in the right renal pelvis. Acting on the assumption that the mass was probably a transitional cell carcinoma, the author performed a nephroureterectomy. The fleshy intrapelvic mass turned out to be an extremely rare benign fibroepithelial tumour.

Urethral pressure changes in reflex micturition.

The mechanism and pattern of urethral pressure changes during bladder filling and voiding were investigated in anesthetized female dogs. A series of experiments was performed involving simultaneous recording of intraurethral and intravesical pressures before and after surgical separation of the bladder from the urethra. Similar experiments were done after pharmacologic blockade of the striated muscles, alpha-adrenergic receptors, and autonomic ganglia. The urethral pressure rise during the collection phase and its drop simultaneous with bladder contraction were observed both before and after vesicourethral interruption. Tubocurarine did not block pressure changes recorded in the proximal urethra. Phentolamine did not prevent a urethral pressure drop simultaneous with detrusor contraction. After effective blockade of autonomic ganglia by pentolinium, reflex micturition could not be induced by bladder filling. However subsequent administration of bethanechol chloride induced a bladder pressure rise together with a simultaneous drop of urethral pressure. We conclude that both vesicourethral muscle continuity and autonomic reflexes contribute to the urethral pressure changes during the two phases of bladder activity, passive collection and active expulsion.

Compliance of the bladder: an attempt to establish normal values.

A study of 100 normal cystometries was undertaken to establish compliance values. The results seem to discourage the practical application of this parameter due to the absence of normal distribution and extreme scatter of values.