Half Of Bladder Research Articles

Bladder Compliance Dynamics of Pelvic Organ Prolapse in Women Undergoing Robotic-Assisted Sacrocolpopexy

Although mean/static compliance of bladder filling can be readily assayed via cystometry, a protocol measuring compliance dynamics at a specific stage of bladder filling has not been established in human patients. For patients with pelvic organ prolapse (POP), the objective benefits of robotic-assisted sacrocolpopexy (RSCP) surgical intervention for restoring bladder functions, primarily urine storage, have yet to be established. Also, bladder compliance is a viscoelastic parameter crucially defines the storage function. Therefore, we aimed to investigate the impact of RSCP on bladder compliance of POP patients using a pressure-volume analysis (PVA), which graphically illustrate bladder compliance. A retrospective pre- and post-operative study. Multiple hospitals in Taiwan. 27 female POP patients (stage ≥ II). RSCP for POP repair. We retrospectively reviewed the pre- and post-operative PVAs for women with POP, who underwent RSCP. The mean compliance of the entire (Cm), the early half (C1/2), and the late half (C2/2) of bladder filling were analyzed as primary outcomes. Changes in intra-vesical volume (ΔVive) and detrusor pressure (ΔPdet) of bladder filling, ΔPdet in the early (ΔPdet1/2) and late (ΔPdet2/2) filling, and post-voiding residual volume (Vres) were analyzed as secondary outcomes. Compared with the pre-operative control, RSCP increased Cm (p=0.010, N=27) and C2/2 (p<0.001, N=27) but negligibly affected C1/2 (p=0.457, N=27). Mechanistically, RSCP decreased ΔPdet (p=0.001, N=27) without significantly affecting ΔVive (p=0.863, N=27). Furthermore, RSCP decreased the ΔPdet2/2 (p<0.001, N=27) but not ΔPdet1/2 (p=0.295, N=27). This is the first report of applying PVA in assaying dynamics of bladder compliance in patients with POP. Our results suggest that RSCP improved bladder storage in women with POP since it increased bladder compliance, particularly in the late filling possibly by restoring the anatomical location and geometric conformation for bladder expansion. This study was registered in ClinicalTrials.gov (https://clinicaltrials.gov/study/NCT05682989); registration number: NCT05682989 submitted on 12/28, 2022.

Adrenergic relaxations in an in situ urinary bladder model evoked by stimulation of sensory pelvic and pudendal nerves in the rat

Urinary bladder dysfunction might be related to disturbances at different levels of the micturition reflex arc. The current study aimed to further develop and evaluate a split bladder model for detecting and analysing relaxatory signalling in the rat urinary bladder. The model allows for discrimination between effects at the efferent and the afferent side of the innervation. In in vivo experiments, the stimulation at a low frequency (1 Hz) of the ipsilateral pelvic nerve tended to evoke relaxation of the split bladder half (contralateral side; −1.0 ± 0.4 mN; n = 5), in contrast to high frequency-evoked contractions. In preparations in which the contralateral pelvic nerve was cut the relaxation occurred at a wider range of frequencies (0.5–2 Hz). In separate experiments, responses to 1 and 2 Hz were studied before and after intravenous injections of propranolol (1 mg/kg IV). The presence of propranolol significantly shifted the relaxations into contractions. Also, electrical stimulation of the ipsilateral pudendal nerve evoked relaxations of similar magnitude as for the pelvic stimulations, which were also affected by propranolol. In control in vitro experiments, substances with β-adrenoceptor agonism, in contrast to a selective α-agonist, evoked relaxations. The current study shows that the split bladder model can be used for in vivo studies of relaxations. In the model, reflex-evoked sympathetic responses caused relaxations at low intensity stimulation. The involvement of β-adrenoceptors is supported by the sensitivity to propranolol and by the in vitro observations.

OEIS Syndrome: Omphalocele, Exstrophy of the Cloaca, Imperforate Anus, and Spinal Defects

OEIS Syndrome: Omphalocele, Exstrophy of the Cloaca, Imperforate Anus, and Spinal Defects

Cloacal Exstrophy Repair

Cloacal exstrophy is a birth defect in which part of the abdomen is open, and some of the abdominal contents (such as the bladder and intestines) are exposed. It is the most severe birth defect within the exstrophy-epispadias complex and can occur as part of the OEIS complex, which is characterized by omphalocele, exstrophy, imperforate anus, and spinal defects. It is a rare congenital malformation, occurring in 1/200,000-400,000 births, and is diagnosed by prenatal ultrasound. In cloacal exstrophy, there are two exstrophied hemibladders separated by a foreshortened cecum or hindgut, often characterized by a blind end, resulting in an imperforate anus. There is significant diastasis of the pubic symphysis, and the phallus is separated into two halves along with the scrotum. In males, the penis is usually flat and short, with the exposed inner surface of the urethra on top, and split into a right and left half. In females, the clitoris is split and there may be two vaginal openings. This condition is also highly associated with other birth defects, especially spina bifida, which coexists in up to 75% of cases. Multidisciplinary care followed by surgical management should begin immediately following the birth of the patient. Closure of the meningocele and omphalocele, as well as adaptation of the bladder halves, should be started in the neonatal period, followed by a multi-stage approach for bladder, bowel, and genital reconstruction (including a pelvic osteotomy) at a later time. Here, we present a patient who was diagnosed with cloacal exstrophy by prenatal ultrasound. The urinary bladder and intestines were noted to be outside of the body and associated with a closed myelomeningocele. The exstrophied cloaca was repaired and reduced back into the abdominal cavity. Urinary and fecal diversions were created, and a leg casting was placed for pelvic osteotomy.

The effect of exfoliative transurethral resection of bladder tumor with bipolar plasmakinetic system

Objective To evaluate the safety and efficacy of bipolar plasmakinetic system in exfoliative transurethral resection of bladder tumors. Methods Clinical data of 72 patients with non muscle invasive bladder cancer(NMIBC) were retrospectively analyzed.Transurethral bipolar plasmakinetic system was used,30°viewer,F27 outer sheath was pushed off and bladder tumor was cut. When the bladder filling state,pushed off bladder mucosa distance from tumor basal 2cm,then electricity cut the exfoliative bladder tumor. When bladder half filling state electricity cut the base of the bladder muscle layer of bladder tumor. Results This group of 72 cases were successfully completed surgery, surgery time 37~ 93 min, without intraoperative bladder perforation, slight obturator nerve reflex in 5 cases. The keeping intact pathologic specimens was good for pathological staging. Conclusion Exfoliative transurethral resection of bladder tumors with bipolar plasma is a safe, practical and effective way of operation, which can avoid severe obturator reflex occurred in the operation, and greatly reduce the occurrence of bladder perforation,without TURS, surgical removal of the pathological specimens is specification. Key words: Urinary Bladder Neoplasms; Argon Plasma Coagulation; Cystectomy

Complex abdominal wall defects: appearances at prenatal imaging.

Abdominal wall defects are a complex group of anomalies, and many are incorrectly diagnosed. Evaluation of the defect relative to the umbilical cord insertion site is fundamentally important in differentiating among the various malformations. The two most common abdominal wall defects are gastroschisis, in which the defect is on the right side of the normally inserting cord and free-floating bowel loops are present, and omphalocele, in which the cord inserts on a membrane-covered midline defect. Omphalocele may also form a portion of a more complex defect that may remain undiagnosed without thorough evaluation. In cloacal exstrophy, the defect extends inferiorly and the bowel loops extrude between the two bladder halves. In pentalogy of Cantrell, the defect extends superiorly and is typically associated with ectopia cordis. Bladder exstrophy is a lower abdominal defect in which the hallmark finding is absence of a fluid-filled bladder. The cord insertion site is normal to low but does not form part of the defect. Both body stalk anomaly and abdominoschisis due to amniotic bands cause severe malformations, often involving extrusion of solid organs and the bowel. Although these two entities have many overlapping features, body stalk anomaly may be recognized on the basis of absence of a free-floating umbilical cord. With use of an algorithmic approach beginning with discovery of the location of the defect, a more precise diagnosis can be determined that may directly affect pre- and postnatal management decisions.

Cloacal Exstrophy: a complex disease

Cloacal exstrophy is a rare occurrence with an incidence of 1:200,000 to 1:400,000 live births. It represents one of the most challenging reconstructive endeavors faced by pediatric surgeons and urologists. Aside from the genitourinary defects, there are other associated anomalies of the gastrointestinal, musculoskeletal and neurological systems that require a multidisciplinary approach when counseling anxious parents. We present a video of a patient with cloacal exstrophy treated with 21 days of life. Surgery consisted of separation and tubularization of the cecal plate from the exstrophied bladder halves and colostomy construction. The bladder was closed primarily and umbilical scar reconstructed and used for ureteral and cistostomy drainage. A urethral catheter was used to guide bladder neck tubularization. A final epispadic penis was obtained and planned for further repair in a second step. The patient had an initial uneventful postoperative course and immediate outcome was excellent. The bladder healed nicely but patient presented with abdominal distension in the 5th day of postoperative setting requiring parenteral nutrition. The distal colon persisted with lower diameter although non obstructive, but causing difficulty for fecal progression. Continuous colostomy dilatation and irrigation were required. Approximating the bladder halves in the midline at birth and primary bladder closure is a viable option, intestinal transit may be a issue of concern in the early postoperative follow-up.

A novel in situ urinary bladder model for studying afferent and efferent mechanisms in the micturition reflex in the rat

The search for new animal models to investigate both efferent and afferent levels of the micturition reflex, to better understand urinary dysfunctions, is of great importance. Therefore in this study we developed and characterized, by comparisons with a conventional whole bladder model, a novel in situ model. The urinary bladder was carefully prepared and separated, via a midline incision, into two halves all the way to the urethra in pentobarbitone and medetomidine anesthetized male rats. The separated bladder halves (with no direct connection) were immobilized with ligatures to the underlying tissue. The tension could thereafter be recorded at one side, while the other half was occasionally stretched in order to evoke an afferent signal. Also, injections of ATP and methacholine and electric nerve stimulation were employed. Ipsilateral stretch of 30 and 50 mN induced a force-dependent contractile response on the contralateral side. Moreover, electrical stimulation of efferent pelvic nerve fibers, and intravenous injections of methacholine and ATP, evoked dose-dependent contractions, resembling responses observed in the whole bladder model. Here, the threshold frequency at electrical stimulation of the efferent fibers was <2 Hz and the maximum response appeared at 10-20 Hz, while afferent stimulation had a threshold of 5-10 Hz with the maximum response at 40 Hz. In the current study we show that stimulation of afferents at one side of the bladder induces, via impulses from the central nervous system, contractions from the other side. This novel model enables quantitative comparisons of changes occurring within the micturition reflex arc in bladder disorders. Neurourol. Urodynam. 33:550-557, 2014. © 2013 Wiley Periodicals, Inc.

Renal Parenchyma Abnormalities in Infants With Dilating Vesicoureteral Reflux: Relation to Reflux Severity and Pressure at Onset

We used (99m)technetium dimercapto-succinic acid scans in infants to determine the relation between renal deformities and severity of primary dilating reflux. We also used videourodynamics to analyze the association between detrusor pressure at onset of reflux and degree of renal changes. A total of 20 patients (15 males) 0.10 to 1.3 years old (median 0.75) with grade III to V reflux underwent conventional filling videourodynamics. (99m)Technetium dimercapto-succinic acid scans were done 6 months after the last febrile urinary tract infection (median age 0.58 years). Nine males and 1 female had bilateral refluxing ureters, and 10 patients had unilateral reflux (grade III in 10, IV in 11 and V in 9). Among the 30 refluxing ureters renal changes were present in 19 kidneys (63%). Prevalence of renal changes according to reflux grade III, IV and V was 40%, 63% and 89%, respectively (p <0.02). Reflux occurred in 13 patients (21 ureters) with detrusor pressure less than 10 cm water and in 7 (9) at 30 to 70 cm water (median 39.5). Renal changes were significantly more common in low pressure, low volume refluxing ureters (84.6%) compared to ureters refluxing at higher volumes and low pressure (37.5%, p <0.02). At higher pressure reflux renal deformities occurred in 55.5% of refluxing ureters (5 of 9). Five patients had renal function impairment (mean creatinine for age 0.92 mg/dl, range 0.60 to 1.53). High grade reflux and reflux occurring in the first half of bladder filling at low pressure are risk factors for renal changes in this cohort of infants.

First Stage Approximation of the Exstrophic Bladder in Patients With Cloacal Exstrophy—Should This be the Initial Surgical Approach in all Patients?

Cloacal exstrophy is rare and it represents a reconstructive challenge. Options for managing the urinary tract include primary closure or approximation of the bladder halves in the midline with later closure. We present our observations and evolving thoughts concerning optimal treatment in these patients. We retrospectively reviewed the records of patients with cloacal exstrophy seen in the last 5 years. Initial management was examined, including complete primary closure vs a staged approach. We noted midline defects, spinal cord abnormalities or other anatomical reasons that precluded primary closure. Seven patients, including 5 females and 2 males, were identified. An omphalocele noted in all 7 patients was closed in 5 at initial operation. All underwent preservation of the hindgut in the fecal stream. Spinal cord tethering was noted in 7 of 7 cases. Complete primary bladder closure was performed in 3 of the 7 patients, while the size of the bladder plates or a large abdominal wall defect precluded closure in the remainder. Continence was not achieved in the 3 cases closed primarily. All patients achieving urinary continence underwent bladder neck closure and augmentation cystoplasty with a continent catheterizable channel. Patients with cloacal exstrophy have anatomical issues that can prevent complete primary bladder closure or preclude the achievement of urinary continence. The high incidence of tethered cord places these patients at risk for upper tract changes and bladder decompensation during followup. Despite successful primary closure in 3 of 7 patients all have a tiny bladder and require secondary procedures to become continent. Extensive dissection during the first operation can contribute to more difficult dissection with potential increased morbidity during subsequent surgeries. Therefore, the best initial approach for the typical patient may be closure of the abdominal wall and approximation of the exstrophied bladder halves in the midline. Secondary closure with continent diversion and reconstruction of the external genitalia can be performed at ages 18 to 24 months.

Morphology of the Enteric Nervous System in the Hindgut of an Infant with Cloacal Exstrophy

The authors describe the morphology of the enteric nervous system in the hindgut of an infant with cloacal exstrophy. Cloacal exstrophy was diagnosed at 32 weeks' gestation using prenatal ultrasonography. The baby was delivered at 34 weeks' gestation and underwent a separation of the cecum from bladder halves, reapproximation of hemibladders, closure of the omphalocele and pubic symphysis, and a distal colostomy. Intestinal wall specimens were obtained at colostomy from the distal end of the rudimentary hindgut. Serial frozen sections were prepared for histochemical acetylcholinesterase staining. Histological investigations demonstrated a strikingly crowded, immature enteric ganglia and prominent bundles of wandering cholinergic nerves. These findings suggest the unique pathology of the enteric nervous system development in cloacal exstrophy, in which the rudimentary hindgut behaves as a blind alley of the migratory pathway for neural crest-derived cells during embryogenesis. Histological examinations of the hindgut enteric nervous system in cloacal exstrophy may be beneficial for evaluating the postnatal development of the distal colon which might be utilized for a pull-through procedure.

Collateral bladder duplication with exstrophy of one moiety in a female infant

Complete bladder duplication with exstrophy of one moiety is an extremely rare condition. We report an unusual case of complete bladder duplication with exstrophy of one moiety, in which each bladder received one ureter and the internal bladder drained into a urogenital sinus. The patient was treated by combining the two bladder halves and using the bladder neck of the internal bladder, with excellent cosmetic result. This case underscores the importance of ultrasonography and computed tomography to detect the anatomy of the patient with exstrophy in whom the ureteric orifices cannot be clearly identified on both sides of the trigone.

Diagnosis of vesico-intestinal fistulas by contrast medium enhanced 3-D ultrasound

Standard diagnostic tools for vesico-intestinal fistulas are cystoscopy, cystography, colonoscopy, and contrast enema. The aim of our study was to evaluate the efficacy of transrectal 3D-ultrasound with contrast media in these patients. From 5/98 to 12/99 we examined 10 patients with symptoms of a vesico-intestinal fistula (pneumaturia, faecaluria). After placement of a transurethral catheter a transabdominal ultrasound examination (Kretz Combison 530) was performed with the bladder half full to evaluate the bladder wall. Then the bladder was filled with diluted ultrasound contrast media (Levovist 40 mg/ml) to visualize the flow from the bladder towards the fistula. To verify a flow through the bladder wall a colour Doppler sonography of the region of interest was added. To evaluate form and extent of the fistula a transrectal ultrasound with 3D-image assessment was performed. Using this technique it was possible to demonstrate a vesico-intestinal fistula in 9 of 10 patients. In all cases these findings were confirmed by the standard diagnostic procedures. The fistulas were caused by: bladder carcinoma (n = 1), carcinoma of the colon (n = 2), Crohn's disease (n = 3) and diverticulitis of the sigma (n = 3). One patient presented with a neovesico-intestinal fistula in an irradiated local recurrence of bladder carcinoma. In one patient with Crohn's disease whose only symptom was pneumaturia all diagnostic tools failed to provide the diagnosis. For the first time vesico-intestinal fistulas could be demonstrated by ultrasound with 3D-image assessment using contrast media. This technique might be an effective addition to the standard diagnostics of vesico-intestinal fistulas reducing the exposure to radiation.

Antenatally diagnosed cloacal exstrophy variant with intravesical phallus in a twin pregnancy

We report a rare case of covered cloacal exstrophy variant with a hemiphallus trapped within partially closed bladder halves. The persistence of the cloacal membrane until at least 18 weeks’ gestation, confirmed by antenatal ultrasound scanning, is discordant with existing theories of embryogenesis of cloacal exstrophy. The clinical presentation highlights the need for careful assessment, before and during surgery, to obtain a complete understanding of the anatomic defect before gender assignment and appropriate reconstructive efforts. A multispecialty approach and antenatal counseling are important, especially when only one fetus of twins has major birth defects.

A UNIQUE NEW MODEL TO STUDY THE EFFECTS OF URINARY DIVERSION IN THE DEVELOPING RABBIT BLADDER

Purpose Little is known about the developmental effects of high urinary diversion and bladder defunctionalization in infancy. Although clinical experience shows that a poorly functional bladder may result from urinary diversion in infancy, the mechanisms of change and specific bladder wall alterations have not been well characterized. We hypothesized that cyclic filling and emptying are necessary for normal bladder development. To investigate this important question we created a new animal model. Materials and Methods We designed a new method of hemibladder urinary diversion in 3-week-old New Zealand white rabbits. After vertical midline bladder division half of the bladder was formed into a functional reservoir, which remained in continuity with the ipsilateral ureter and urethra. The other bladder half was defunctionalized and isolated from the urine flow by ureteral ligation. Diversion was created for 3, 7, 14 and 28 days. Urodynamic evaluation was done in the functionalized hemibladders and age matched normal rabbit bladders to test the validity of the functionalized hemibladder as an internal control. Functional and defunctionalized hemibladders as well as age matched, nonoperated normal rabbit bladders were weighed, sectioned and stained to demonstrate muscle and connective tissue components. Results In 22 of the 27 healthy rabbits (81%) good quality diverted and functional bladder specimens were obtained after diversion. Defunctionalized hemibladders grew more slowly than functionalized bladders and normal age matched control bladders. Histological staining of the bladder wall demonstrated increased connective tissue between the muscle bundles within the diverted specimens than in functional bladders. Conclusions Our successful model of urinary diversion may be used to study the developmental and histological effects of urinary diversion in the young bladder. Bladder growth and histological appearance are altered when the stimulus of cyclic filling and emptying is removed. Further studies using this model are warranted to define fully bladder changes that result from diversion and investigate the mechanism of the observed changes.

Changes in the Elemental Composition of Bladder Mucus in Stone and Non-Stone forming Patients following Augmentation Cystoplasty

The incidence of bladder stones is increased by 50% following bladder augmentation(l,2). Stones require surgical removal as they are typically too large to pass. A recurrence rate of 19% has been noted(2) necessitating multiple sugical procedures. Etiology of stones in augmented bladders is due to a number of factors including foreign body reactions, metabolic abnormalities, infection and intestinal mucus. In order to determine whether the elemental composition of bladder mucus plays a role in the development of bladder calculi, energy dispersive x-ray spectrometry(EDXS) was done on the mucus from stone and non-stone forming patients. In addition, stones from the same patients were examined and analyzed and the data compared with the composition of the mucus.Eighteen patients participated in this study, 14 of whom had ileo-cystoplasties and 2 ileo-cecal augments. Two were cloacal extrophy patients where the hind gut was incorporated with the bladder halves. To avoid any foreign body reactions, metal staples were not used in any of the bladder augmentation procedures.

Growth Factors in Bladder Wound Healing

Introduction Surgical and traumatic injuries to the bladder initiate a complex series of biological processes that result in wound healing. This process involves cellular proliferation, migration and differentiation; removal of damaged tissue; and production of extracellular matrix all of which may be controlled by growth factors. In skin, keratinocyte growth factor (KGF) is induced following incisional injury. We hypothesize that in bladder wound healing KGF and other growth factors are induced to modulate tissue repair. Methods We have created a model of surgical bladder injury in the rodent. At 12, 24 and 48 hrs and 5 and 7 days after injury, the bladder was bisected and total RNA extracted from the anterior or wounded half and posterior or non-wounded half. Histological analysis of the bladder wound was performed with Mason's Trichrome and immunohistochemistry against smooth muscle alpha actin. RNase protection assays were performed to examine the expression of KGF, transforming growth factor (TGF) alpha and TGF beta 2 and 3 as well as the receptors for KGF and epidermal growth factor (EGF). Lastly, the effects of the exogenous administration of KGF on the bladder was tested on neonatal mice by daily injections of 5 micro g KGF per gram body weight for 5 days. Results At 12 hours after injury KGF mRNA expression in the anterior wounded bladder half and posterior non-wounded bladder half was 8 and 6 times higher respectively, compared to unoperated control bladders. A similar response was seen for TGF alpha, where the 12 hour mRNA expression was 4.5 times higher in the anterior wounded bladder half and 3.5 times higher in the posterior non-wounded bladder half compared to unoperated control bladders. The nadir mRNA expression for both KGF and TGF alpha occurred at 7 days after bladder injury and was the same as in unoperated control bladders. EGFR mRNA expression was [approximately] 2 times higher in both the anterior wounded and posterior non-wounded bladder halves compared to the nadir levels which occurred at 24 hours after injury. TGF beta 2 and beta 3 mRNA levels did not significantly change in either the anterior wounded or posterior non-wounded bladder halves. Exogenous KGF stimulation resulted in marked urothelial proliferation when compared to age matched control animals. Conclusion During the early phases of bladder wound healing (12-24 hours post injury), mRNA for KGF and TGF alpha increased, whereas TGF beta 2 and beta 3 and the KGFR and EGFR remain unchanged. Additionally, exogenous KGF has a direct effect on urothelial proliferation. KGF and TGF alpha warrant further study as potential mediators of bladder wound healing.

Classification of human peripheral nerve fibre groups by conduction velocity and nerve fibre diameter is preserved following spinal cord lesion

(1) Single nerve fibre action potentials (APs) of lower sacral nerve roots were recorded extracellularly with two pairs of wire electrodes during an operation in which an anterior root stimulator for bladder control was implanted in 9 humans with a spinal cord lesion and dyssynergia of the urinary bladder. Roots that were not saved and that were used to record from were later used for morphometry. (2) Nerve fibre groups were identified by conduction velocity distribution histograms of single afferent and efferent fibres and partly by nerve fibre diameter distribution histograms, and correlation analysis was performed. Group conduction velocity values were obtained additionally from compound action potentials (CAPs) evoked by electrical stimulation of nerve roots and the urinary bladder. (3) The group conduction velocities and group nerve fibre diameters had the following pair-values at 35.5°C: Spindle afferents: SP1 (65 m/s/13.1 μm), SP2 (51/12.1); touch afferents: T1 (47/11.1), T2 (39/10.1), T3 (27/9.1), T4 (19/8.1); urinary bladder afferents: S1 ( 41 m/s/−), ST (35/−); α-motoneurons: α 13 (−/14.4), α 12 (65m/s/13.1 μm), α 11 (60?/12.1)(FF), α 2 (51/10.3)(FR), α 3 (41/8.2)(S); γ-motoneurons: γ β (27/7.1), γ 1 (21/6.6), γ 21 (16/5.8), γ 22 (14/5.1); preganglionic parasympathetic motoneurons: (10 m/s/3.7 μm). (4) The values of group conduction velocity and group nerve fibre diameter measured in the paraplegics were very similar to those obtained earlier from brain-dead humans and patients with no spinal cord lesions. Also, the number and the density of myelinated fibres were preserved in the roots. Thus, the classification and identification of nerve fibre groups remained preserved following spinal cord lesion. A direct comparison can thus be made of natural impulse patterns of afferent and efferent nerve fibres between paraplegics (pathologic) and brain-dead humans (supraspinal destroyed CNS, in many respects physiologic). (5) When changing the root temperature from 32°C to 35.5°C, the group conduction velocities changed in the following way in one case: SP2: 40 m/s (32°C) to 50 m/s (35.5°C), S1:31.3 to 40, ST: 25 to 33.8, M: 12.5 to 13.8; α 2: 40 to 50, α 3: 33 to 40. The group conduction velocities showed different temperature dependence apart from SP2 fibres and α 2-motoneurons. (6) Upon retrograde bladder filling the urinary bladder stretch (S1) and tension receptor afferent (ST) activity levels were undulating and increased. As compared to activity levels detected in a brain-dead human, S1 (designates afferents, not cord segment) and ST afferents fired, even when the bladder was empty, with an activity level similar to that observed in a brain-dead human with the bladder half filled. Two reasons are brought forward for a too small storage volume of the urinary bladder in paraplegics: too high afferent activity of the bladder due to changed receptor field signal transduction mechanisms and too low compliance.

DOES VESIOCURETERAL REFLUX (VUR) CORRELATE WITH INTRAVESICAL PRESSURE (IVP)?

With this purpose 14 patients with known VUR were studied with urodynamic methodology and simultaneous radiology. Evaluating IVP simultaneously with time of appearance of VUR: 1) while bladder filling (in the first or second half), 2) with the presence of uninhibited contractions (UC), 3) during voiding, 4) in the postmicturition (PM). It also was quoated if the VUR was intermitent or permanent. None of the patients evaluated had neurogenic bladder or urinary tract obstruction. All had urinary tract infection being this the reason for the urodynamic study. All the patients were females between 2 and 15 years of age. 14 patients, 28 renal units, VUR was detected in 19 units: 6 in the first half of bladder filling, 7 in the second half, 0 during UC, 1 while voiding, and 5 in the PM. 7 were permanent and 12 intermitent. Of the 12 intermitent: 6 while filling, 1 during micturition, and 5 in the PM. Of the 7 permanent: 5 in the first half of bladder filling and 2 in the second half. From the data presented it is clear that VUR does not correlate with high bladder pressure during micturition or UC, showing that VUR can appear at any moment of the vesical cycle. VUR is a radiologic sign of the incompetence of the vesicoureteral junction, and this incompetence may be is more related to the migration of the wall of the detrusor muscle of the bladder during compliance or micturition. From an hydraulic point of view, areteral filling during VUR should depend on 3 interdependent factors: 1) the competence of the vesicoureteral junction, 2) the ureteral compliance, 3) ureteral peristaltic activity. With this criteria if appears inconvenient to clasify VUR according to the ureteral filling because this is nothing more than the radiologic evidence of the interrelation of these 3 factors unknown by this methodology.

Aldosterone response in the turtle bladder is associated with an increase in ATP.

Urinary bladders from freshwater turtles, mounted as sacs, were stripped of their serosa and submucosa. This did not alter conductance. They were maintained in open circuit except for brief observation of short-circuit current (SCC) every 15 min. Potential difference (PD) averaged 68 +/- 14 mV and SCC 485 +/- 100 microA. Acetazolamide 10(-3) M increased SCC by 46 +/- 27 microA. Aldosterone 10(-7) M following acetazolamide resulted in a rise in SCC that began at about 75 min and reached a plateau between 3 and 5 h. SCC rose 127 +/- 15% compared with control bladder halves. ATP measured in perchloric acid extracts 5 h after addition of aldosterone increased by 33% (P less than 0.01) and (ATP)/(ADP) X (Pi) by 81% (P less than 0.01). These results support the view that the stimulatory effects of aldosterone on active sodium transport involve an increase in ATP and (ATP)/(ADP) X (Pi).