Neuromorphology and neuropharmacology of the human penis: an in vitro study.

The neuromorphology and neuropharmacology of the human penis are only briefly described in literature. The present study was undertaken to define the adrenergic and cholinergic neuromorphology of the human corpus cavernosum (CC) and corpus spongiosum and to evaluate the in vitro response of the CC to pharmacologic stimulation. Human penile tissue was obtained from six transsexual patients undergoing penectomy. For morphologic study, the tissue was processed for (a) hematoxylin and eosin staining; (b) smooth muscle staining; (c) acetylcholinesterase localization; (d) glyoxylic acid histofluorescence; (e) electron microscopy; and (f) electron microscopy after glutaraldehyde dichromate fixation. In addition, strips of CC were placed in in vitro muscle chambers and tension changes recorded isometrically after stimulation with norepinephrine (NE) and acetylcholine. The CC contains abundant smooth muscle, numerous glyoxylic acidfluorescent (catecholaminergic) fibers and varicosities, and a scant distribution of acetylcholinesterase-positive fibers. Fewer of all these elements were present in the corpus spongiosum. No "polsters" were observed in the CC. Although glutaraldehyde-fixed controls exhibited no typical adrenergic vesicles (small, dense core, measuring 400-600 A in diameter), some small, strongly electron-dense vesicles were found in glutaraldehyde dichromate-fixed tissue and were thought to contain NE. A variety of other vesicles were also encountered. The addition of NE to the in vitro muscle chambers caused a dose-related contraction, which was blocked by pretreatment with phentolamine in all CC strips tested. Acetylcholine in high concentration produced minimal contraction in 2 of 24 strips. Our morphologic and pharmacologic data suggest that the sympathetic nervous system may affect erection by acting not only on the penile vasculature but also by direct action on the smooth muscle of the CC itself.

Treatment of urethral condyloma acuminatum with 5-fluorouracil cream.

Total eradication of intraurethral condyloma acuminatum was accomplished in 10 of 11 patients by intraurethral administration of 5 percent 5 fluorouracil cream.

Effect of dantrolene sodium on canine bladder contractility.

Dantrolene sodium (Dantrium) is currently used in the treatment of detrusorstriated sphincter dyssynergia and is thought to act primarily on striated muscle. The effect of this agent on smooth muscle in general is controversial, and its effect on urinary bladder smooth muscle in particular is not known. In an in vitro muscle bath system, dantrolene was found to have no statistically significant inhibitory effect on acetylcholine-induced canine detrusor muscle contractions.

Management of neurogenic bladder dysfunction in the adult.

A review of the management of neurogenic bladder dysfunction in the adult is presented. The various modes of therapy are classified according to their effects on bladder contractility and outlet resistance, providing a logical framework for discussion.

Transient blindness: unusual initial symptom of transurethral prostatic resection reaction.

Transient blindness was seen in 2 patients undergoing transurethral resection (TUR) of the prostate as the initial symptom of a severe TUR reaction. Cerebral edema of the occipital cortex is the most probable mechanism. Both fully recovered their vision when appropriately treated. Patients with visual disturbances during transurethral prostatectomy should be suspected of having a TUR reaction.

Adrenergic innervation and stimulation of canine urethra.

Sympathetic nervous innervation of the canine urethra was studied using catecholamine histofluorescent straining and the in vitro muscle bath. Morphologically, adrenergic nerves were found terminating on the urethral smooth muscle. Pharmacologically, urethral strips responded like muscle strips from the bladder base to adrenergic stimulation. This evidence supports the concept that the sympathetic nervous system supplies and modulates the function of the smooth muscle stimulation of the rich periurethral vasculature nerve supply.

Bladder muscle contractility. Comparative effects and mechanisms of action of atropine, propantheline, flavoxate, and imipramine.

The anticholinergic and antispasmodic activity of atropine, propantheline, imipramine, and flavoxate were judged by each drug's ability to inhibit bethanechol chloride and barium chloride-induced canine detrusor contractions. In this in vitro model, atropine and propantheline are pure anticholinergic agents. Imipramine significantly decreases both bethanechol and barium-induced contractions, while flavoxate only minimally inhibits the response to either stimulant.

Effect of oxybutynin chloride on bladder spasm following transurethral surgery.

A double-blind study of the short-term effects of oxybutynin chloride versus placebo on bladder spasm after transurethral surgery was done in 106 male patients. No significant difference between the placebo and 10 mg. or 20 mg. of the drug was noted.

Effect of muscle length on adrenergic stimulation of canine detrusor.

The effect of muscle length on adrenergic stimulation of canine detrusor was studied in an vitro muscle bath. The commonly reported response of muscle relaxation with norepinephrine stimulation was seen in muscle strips at or near the resting length. When the muscle strips were stretched, however, an alpha receptor mediated contraction was noted. Length, rather than norepinephrine dose or tension, was the predominant factor determining whether a given strip would respond in an alpha or beta fashion. Sympathetic stimulation may enhance accommodation (beta effect) during bladder filling at low muscle length and potentiate bladder emptying (alpha effect) at increased muscle length.

Effect of levodopa on urinary bladder.

Levodopa therapy enhanced the ability of the bladder to store urine in two parkinsonian patients. In vitro canine muscle bath studies with the two major metabolites of levodopa, dopamine and norepinephrine, indicate that the effects of the drug on the peripheral sympathetic nervous system may play a major role in the improvement of urinary symptoms observed with levodopa therapy.

Innervation of trigonal area of canine urinary bladder.

Adrenergic and cholinergic histochemical staining techniques and in vitro muscle strip responses to adrenergic and cholinergic stimulation and blockade have failed to demonstrate any neuromorphologic or neuropharmacologic differences between the musculature of the canine trigone and that of the underlying detrusor. There is no evidence to suggest that a functional potential could be attributed to the trigone separate from that of the related bladder base.

Effect of long-term chemical sympathectomy on function of canine urinary tract.

Destruction of the adrenergic terminals in the ureter, bladder, and urethra was produced and maintained in 4 dogs for periods up to twelve months by biweekly intraperitoneal injections of 6-hydroxydopamine. The effects on urine transport, storage, and elimination were studied. The results are discussed in the light of current knowledge regarding the sympathetic innervation of these organs and its function.

Autonomic innervation of the urogenital system: adrenergic and cholinergic elements.

The major organs of the male urogenital (UG) system have been examined in various mammals, including man, using light and electron microscopic (EM) histochemical methods. For the light microscopic study, the urinary bladder, the vas deferens and the penis (corpora cavernosa and corpus spongiosum) were studied in the rat, cat, dog, monkey and man using a glyoxylic acid (GA) method modified for peripheral adrenergic nerve fibers, and a thiocholine method for acetylcholinesterase (AChE). Fine structural analysis was done on the vasa of rat, cat, monkey and man, and on the bladder and penis of cat, dog, monkey and man. Tissue was fixed in glutaraldehyde (GMO) as a control or in glutaraldehyde-dichromate (GDC) for the specific localization of norepinephrine (NE). All organs studied demonstrated numerous adrenergic nerve fibers throughout the muscular layers, in the connective tissue, and in the adventitia of most blood vessels. These fibers had a brilliant fluorescence when visualized with the GA method, and demonstrated many varicosities with small (400-600 A) and/or large (800-1200 A) granular vesicles in both control and GDC-fixed tissue examined with the EM. Evaluation of the vesicles with the analytical electron microscope (AEM) verified that those in the GDC-fixed tissue were chrome-positive, and, therefore, NE-containing. In the vas and penis, acetylcholinesterase(AChE)-positive nerve fibers were encountered less frequently at the light microscopic level than adrenergic fibers, and few typical cholinergic varicosities were seen in these organs with the EM. In the bladder, cholinergic nerves were seen with about the same frequency as adrenergic fibers in both light microscopic and EM preparations. Also observed frequently in each of the viscera were varicosities with large to very large (800-2000 A) granular vesicles of the kind presently hypothesized to be peptidergic or purinergic. Few varicosities of the type considered sensory, with large (800-1200 A) clear vesicles and numerous mitochondria, were observed in this tissue. Evidence from this study suggests that mammalian UG organs are innervated extensively by adrenergic nerves, and, excepting the bladder, have a limited cholinergic innervation; in the bladder, numerous fibers of each type can be found. In addition, another type of nerve fiber, perhaps peptidergic or purinergic, is found in large numbers in each of the organs studied and thus may represent a significant effector of autonomic regulation.

Mixed density lesion of the anterior maxilla.

A case of COC which developed as a mixed lucent-opaque lesion in the anterior maxilla of a young person is discussed from the standpoint of clinical and radiographic differential diagnosis. Current concepts of the pathology of the COC and EOGCT are discussed.

Bladder dysfunction in the elderly.

Bladder dysfunction in the elderly is an enormous public health problem. Laboratory research using animal models has to date not yielded clinically useful new information. Demographic and urodynamic studies in selected elderly patients indicate that neurological disease and bladder outlet obstruction are the primary causes for voiding dysfunction. The effect of aging per se on the urinary bladder is not known. Elderly patients who have bladder dysfunction should be evaluated with a careful history and physical examination combined with a practical urodynamic evaluation rather than simply being labeled as having "bladder dysfunction in the elderly."