A survey of ethically challenging issues in urological practice.

PURPOSE: We surveyed ethical attitudes among urological and nonurological practitioners, allowing for thought and discussion regarding ethical issues in a larger audience. MATERIALS AND METHODS: With input from an academic urologist, a senior medical student and a hospital ethics committee member, a survey was created which asked for multiple choice responses to 3 demographic questions (practice type, age, location) and 10 ethically challenging clinical questions. Surveys were distributed online or via mail to 5 groups including academic urologists, urologists in private practice, medical students, hospital risk managers/attorneys and members of a bioethical society. Surveys were analyzed according to demographic variables. RESULTS: Surveys were sent out to 1,447 individuals and 340 responses were received (24%). There were statistically significant differences in the responses to several questions based on practice type, age and practice location. There was a lack of consistency in answer choices with greater than 50% agreeing on a single answer choice for only 4 of 10 questions (40%). CONCLUSIONS: This is the first study to our knowledge which attempts to objectively categorize ethical attitudes in a broad based survey of urologists and nonurologists, and challenges members of our profession to study their own responses to these ethical issues.

Prostaglandin E2mediates spontaneous rhythmic contraction in rabbit detrusor muscle.

INTRODUCTION: The purpose of this investigation was to determine if prostaglandin E2(PGE2) is produced by rabbit detrusor free of urothelium and demonstrate that PGE2 is responsible for the generation of spontaneous rhythmic contraction (SRC). METHODS: A bioassay was performed in which contraction frequency in strips of rabbit detrusor was compared before and after addition of superfusate from incubating sections of rabbit detrusor. Specificity was determined by testing the effects of SC-51089, a PGE2(EP1) antagonist. Effects on development of tension were determined in artery segments after treatment with increasing doses of PGE2, PGF2α, and TXA2, and a section of femoral artery was used as a negative control. Confirmation of PGE2 production was then determined using EIA kits. RESULTS: Increased rhythmic frequency was identified after superfusate from a section of rabbit detrusor free of urothelium was added to strips of detrusor from the same animal. Additional experiments demonstrated that rhythmic frequency generated after treatment with PGE2 was significantly reduced after treatment with SC-51089. In artery smooth muscle, prostaglandin dose response experiments demonstrated that only TXA2 induced contraction at physiologic doses (<10⁻7M). As a negative control, subsequent treatment of a section of femoral artery with detrusor superfusate failed to increase tension, confirming a lack of TXA2 production. EIA confirmed that PGE2 production increased by 4.8-fold in strips of detrusor free of urothelium after 15 minutes of incubation and that this production was blocked by ibuprofen and a COX-1 inhibitor. CONCLUSIONS: Rabbit detrusor produces PGE2 which is the most likely mediator of SRC.