Co-localization of tachykinins and calcitonin gene-related peptide in capsaicin-sensitive afferents in relation to motility effects on the human ureter in vitro.

Tachykinin- and calcitonin gene-related peptide (CGRP) immunoreactivities were localized by immunohistochemistry in the same nerves of the kidney, renal pelvis and ureter as well as in spinal ganglion cells of both the guinea-pig and man. The tachykinin and CGRP-immunoreactive nerves in the ureter were present within the smooth muscle layers, around blood vessels, close to and within the lining epithelium. The levels of neurokinin A-, substance P- and CGRP-like immunoreactivity per tissue weight, as determined by radioimmunoassay, were about 30-100-fold higher in the guinea-pig than in the human ureter, which was in good agreement with the relative density of immunoreactive nerve fibres, as seen by immunohistochemistry. Capsaicin treatment caused an almost total disappearance of both neurokinin A-, substance P- and CGRP-immunoreactive nerve fibres in the guinea-pig ureter and a 90% depletion of neurokinin A, substance P- and CGRP-like immunoreactivity, further supporting a sensory origin of these nerves. Reversed-phase high performance liquid chromatography of water extracts of the human ureter revealed the presence of neurokinin A- and eledoisin-like material using antiserum K12, which does not cross-react with substance P. Most of the CGRP-like immunoreactivity in human ureter extracts co-eluted with synthetic human CGRP. Capsaicin both caused inhibition of spontaneous motility of the human ureter in vitro and initiated contractions in some preparations. Neurokinin A and neuropeptide K potently initiated phasic contractions of the ureter, while substance P had only minor contractile effects. CGRP inhibited both spontaneous and neurokinin A-induced ureteric contractions. In conclusion, peptides with potent opposite motility effects are present in the same, presumably sensory nerves of the ureter in both the guinea-pig and man. It will be of importance to determine whether local release of neuropeptides can account for ureteric motility changes accompanying sensory nerve activation upon ureteral obstruction, by e.g. renal calculi.

Electric modification of kidney function. The excretion of radiographic contrast media and adriamycin.

The body consists of systems of conductive pathways for ionic flow of current induced by metabolic or injury potentials among tissues and cells. In vivo electrophoresis in biologically closed electric circuits (BCEC) are coupled to the mechanical transports of blood and lymph. Connections also exist with conductive media such as cerebrospinal fluid, bile, and urine. Artificial induction of current was applied over the kidneys in order to study modification of kidney function. It is thought that studies of this kind will increase our understanding of kidney function from a new angle of view and possibly add new therapeutic possibilities. In anesthetized pigs, one kidney was made anodic (electropositive) and the other cathodic (electronegative). Current was applied between electrodes in each ureter. Intravascularly injected, electronegatively charged aminotrizoate and ioxaglate were excreted mainly by the anodic kidney. Nonionic iohexol was urographically excreted by both kidneys. Excretion of electropositively charged Adriamycin by the cathodic kidney was identified macroscopically and by chemical analysis. Functional effects on the kidneys can be induced electrophoretically without causing injury.

Estrogens and phenylpropanolamine in combination for stress urinary incontinence in postmenopausal women.

Thirty-six postmenopausal women with objectively verified stress incontinence were treated with oral estriol (Triovex, 2 mg x 1) and phenylpropanolamine (Kontexin, 50 mg x 2) alone and in combination. After an initial four-week single-blind period with phenylpropanolamine (PPA), either estriol or estriol and PPA were given randomly in four-week periods, in a crossover design. PPA and estriol in combination as well as PPA alone, raised the intraurethral pressure and significantly reduced the urinary loss by 35 per cent in a standardized physical strain test. In women with an initial low urethral pressure estriol also induced pressure increase. The leakage episodes and the assessed leakage amounts were significantly reduced by both estriol and PPA given separately as single treatment (28%) or when given as combined therapy (40%). Most of the women preferred the combined treatment to either drug alone. Additive but no synergistic effects are indicated.

Urethral stricture complicating transurethral prostatic surgery.

The incidence of urethral stricture was 9 per cent among 336 patients after transurethral prostatic resection for benign hyperplasia. The strictures were mostly in the penile part of the urethra and could be treated with regular dilation, internal urethrotomy or meatal incision. Bacteriuria or indwelling catheter preoperatively did not seem to predispose to stricture formation. When there is an indication of a narrow urethra before TUR, a fine-calibre resectoscope should be used and a preliminary internal urethrotomy is advisable.

[Tough working conditions for urologists]. / Hård arbetsmiljö för urologer.

A questionnaire sent by the Swedish Association of Urology to all active Swedish urologists (n = 249) was returned by 89%. Questions concerned actual urological work, emergency duties, education, development facilities and research access, but also job satisfaction, psychological fatigue and emotional stress, as well as each urologist's plans for the future. Answers indicate that Swedish urologists carry a heavy work load and experience considerable demands from patients, relatives and colleagues. Physical and psychological exhaustion are common, and many hope to find work outside hospitals or abroad. The tightening of health-care purses presumably augments the work load, but local factors are also involved. For the future, more and improved educational programs are planned, together with greater participation on the part of junior doctors in organizational and structural processes. Compared to other physicians, urologists show greater reserves of psychic energy, but also signs of increasing intellectual exhaustion.

Vesicoureteral reflux in adults studied by computerized radionuclide cystography.

Direct radionuclide cystography in a computerized method as described by Willi and Treves was used in adults with recurrent pyelitis but without evidence of obstruction. Reflux was observed in 15 out of 38 patients. In patients with neurogenic bladder dysfunction or megaureters, reflux began early during the bladder filling and attained higher volumes than in those with uncomplicated pyelitis, who had minor reflux appearing mainly during voiding. Bladder capacity and detrusor compliance were lower in patients with reflux than in those without reflux. The low radiation exposure in radionuclide cystography permits observation of the urodynamic course of urinary reflux and correlation to the intravesical volume and pressure. The method is sensitive, and minor refluxed volumes can be detected. Radionuclide cystography can therefore be recommended for checking of surgical results and for follow-up of patients with neurogenic bladder dysfunction.

Percutaneous nephrolithotomy--the birth of a new technique.

Extraction of renal calculi via a percutaneous track was for the first time practised at the Karolinska Hospital in 1973. After very strict indications in the beginning because of fear of uncontrollable bleeding, the method was found to be safe and the technique was spread all over the world. Now being to a large extent replaced by extracorporeal shock wave lithotripsy (ESWL), percutaneous nephrolithotomy (PNL) has still many applications e.g. alone in obstructed kidneys or together with ESWL in staghorn calculi.

Urethral sensitivity in incontinent women.

OBJECTIVES: The aim of this study was to ascertain whether frequent voiding and urge incontinence are associated with supersensitivity to electrical stimulation in the posterior urethra. METHODS: Current perception thresholds (CPT) were tested at four stimulus frequencies (1, 3, 20, and 100 Hz; duration 0.5 ms) using a square-wave constant current electrical stimulator connected to ring electrodes on a urethral catheter. The strength of the current at the first tingling sensation was regarded as the CPT. CPT analysis and cystometry were performed on 61 women (ages 28-89 years). RESULTS: CPTs were significantly higher at lower than at elevated stimulus frequencies, and they were also generally higher in old than in younger patients. Seven women repeated the CPT test after two months, and the thresholds were unchanged. There were no significant differences in sensitivity between patient groups with stress incontinence, urge, or mixed symptoms. Moreover, CPT was not significantly related to bladder volume at first sensation of filling. CONCLUSION: Measuring CPT is an easy and reproducible method of testing urethral sensibility, but our results do not support the suspicion that urethral hypersensitivity is involved in increased voiding frequency and urge incontinence.

Stop-flow measurement of detrusor contractility in bladder outflow obstruction.

Detrusor contractility was evaluated by measuring the increase in isometric pressure during a stop test in 25 men with benign prostatic hyperplasia. Before transurethral prostatic resection (TUR), a low pressure increase (delta P det iso) was associated with a large volume of residual urine. After TUR both the speed and the amplitude of isometric detrusor contractions during the stop test increased. A pre-operative low detrusor pressure increase was correlated with a great improvement in flow rate after TUR. The value of the stop-flow test was limited, however, since improvement in other urodynamic parameters could not be predicted.

Tension-free vaginal tape evaluated using patient self-reports and urodynamic testing--a two-year follow-up.

OBJECTIVE: Urinary incontinence entails both reduced quality of life for many women and considerable public expense. Compared with other methods aimed at alleviating incontinence, tension-free vaginal tape (TVT) is minimally invasive, can be performed under local anaesthesia and results in less morbidity and shorter hospitalization. The present study was carried out to evaluate early and late complications and as a 2-year follow-up after surgery. MATERIAL AND METHODS: In 1996-98, 75 women underwent TVT sling plasty; mean time for surgery was 39 min and for hospitalization 24 h. The procedure caused bladder perforation in 3 women, but this was detected by cystoscopy and immediately corrected. Postoperative retention occurred in 9 patients but was transient. RESULTS: After surgery 80% were cured, 9% showed improvement and 11% were failures. Two women exhibited vaginal erosion, and one of these had previously undergone radiation therapy. One sling caused obstruction and had to be cut. Improvements included less impact on social and physical activities and mental status and significant reduction of voiding frequency, leakage episodes and pad use. CONCLUSIONS: The TVT technique seems to provide results comparable with those obtained with Burch colposuspension, but it entails less risk of obstruction than previous slings techniques because it causes no compression of the urethra. TVT is effective in women with genuine stress incontinence due to urethral hypermobility and in elderly women with sphincter incompetence, although the outcome is better in the former.