The Journal of urology
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The Journal of urology · Oct 1993
Intraurethral capsaicin produces reflex activation of the striated urethral sphincter in urethane-anesthetized male rats.
The effect of intraurethral application of capsaicin on the urethral motility of urethane anesthetized rats has been investigated. The urinary bladder and the urethra were surgically disconnected, and both organs were cannulated to record variations in intraluminal pressure (cystourethrogram). Urinary bladder reflex contractions in response to intravesical infusion of saline were paralleled by activation of the external striated urethral sphincter, resulting in intraluminal pressure high frequency oscillations (IPHFO) which were recorded at the urethral level. ⋯ Electrical field stimulation (EFS, 0.1 Hz, 30 microseconds, 20 to 30 v) of the rat isolated external urethral sphincter (EUS), elicited d-tubocurarine and tetrodotoxin-sensitive twitch contractions, the amplitude of which was unaffected by capsaicin (1 microM.). Altogether these results suggest a physiological interaction between capsaicin-sensitive primary afferents innervating the urethra and the somatic efferent innervation to the urethral rabdosphincter. Present findings suggest the existence of a chemonociceptive urethro-urethral neural loop which, via pudendal nerves, leads to a supraspinally-mediated activation of the external urethral sphincter.
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The Journal of urology · Sep 1993
Comparative StudyChest staging in testis cancer patients: imaging modality selection based upon risk assessment as determined by abdominal computerized tomography scan results.
We compared chest computerized tomography (CT) to chest x-ray as chest staging modalities in testis cancer patients on the basis of abdominal CT findings. We identified 92 patients who presented with negative staging abdominal CT scans and 52 with abnormal abdominal CT scans. Of these patients 42 and 32, respectively, underwent a chest x-ray and chest CT concurrently as part of the initial staging evaluation. ⋯ The use of chest CT as a staging modality in abdominal CT negative patients failed to increase diagnostic sensitivity relative to chest x-ray alone. However, in 32 patients with abnormal abdominal CT scans the use of chest x-ray alone would have missed intrathoracic metastatic disease in 4. These data suggest that chest x-ray may be the preferred initial chest staging study for testis cancer patients with negative abdominal CT, while chest CT is mandated in patients with abnormal abdominal CT.
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The Journal of urology · Aug 1993
Extracorporeal membrane oxygenation: an adjunct in the management of the neonate with severe respiratory distress and congenital urinary tract anomalies.
Severe respiratory distress is the major cause of perinatal mortality associated with congenital urinary tract anomalies or severe obstructive uropathy, and is often accompanied by oligohydramnios. In the past the prognosis in these high risk cases was extremely poor. ⋯ A review of the National Neonatal Extracorporeal Membrane Oxygenation Registry for neonates with urological indications for extracorporeal membrane oxygenation revealed 10 interventions with 9 survivors, for a survival rate of 90%. Extracorporeal membrane oxygenation may provide cardiopulmonary support during a period of immature circulation, allowing pulmonary parenchymal and vascular maturation as well as preventing iatrogenic barotrauma.
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The Journal of urology · Jul 1993
Comparative StudyManagement of low velocity gunshot wounds to the anterior urethra: the role of primary repair versus urinary diversion alone.
The management of partial transection of the anterior urethra following penetrating penile injuries is controversial. Optional therapeutic techniques range from a primary sutured reapproximation to urinary diversion alone. We recently managed 17 low velocity gunshot wounds to the external genitalia in which the missile traversed the penile corpus cavernosum, and was associated with less than 40% transection of the corpus spongiosum and anterior urethra. ⋯ Urethral strictures developed in 7 patients (78%) managed by a suprapubic tube and urethral stenting during an average followup of 20 months (range 18 to 24). In contrast, 1 patient (12%) managed by a sutured urethral approximation had a urethral stricture during an average followup of 20 months (range 18 to 30, p < 0.01). Our data support a significantly better prognosis for partial transection of the anterior urethra secondary to low velocity gunshot wounds if managed by aggressive wound débridement, corporeal repair, placement of a suprapubic catheter and primary repair of the urethra.
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The Journal of urology · May 1993
Clean intermittent catheterization in spinal cord injury patients: a followup study.
A followup study on nonhospitalized spinal cord injury patients using clean intermittent catheterization was conducted to evaluate long-term clean intermittent catheterization for any genitourinary complications, and to institute and evaluate prompt management. A total of 50 patients (36 paraplegics and 14 quadriplegics) was followed for 3 months to 6.5 years (average followup 22 months). All patients had a baseline urodynamic study and renal scan before they were discharged from the hospital. ⋯ Of 7 patients who were catheterized by others 4 elected to discontinue long-term clean intermittent catheterization after an average of 13 months. Overall, 33 patients (66%) discontinued clean intermittent catheterization and 17 are still being followed on a long-term basis. Clean intermittent catheterization is a successful long-term option to drain bladders in spinal cord injury patients who can perform catheterization independently.