Difficult Urination Research Articles

『ヒポクラテス全集』における排尿障害の記述について

Hippocrates was a famous physician of Kos in ancient Greece (c. 460 B.C.). His works were later described in the Hippocratic Collection, in which I studied disorders of urination. I collected mentions of disorders of urination in the Hippocratic Collection (Roeb, Otsuki and Kon editions) to compared description of disorders of urination between the Kos and Knidos Schools. Disorders of urination were mentioned in 67 parts (sentences or sections): difficult urination in 50, retention of urine in 15 and urinary incontinence in two or three (presumably complicated by difficult urination in one). sigmastrangourih (strangourih) and deltadusourih (dusourih) were counted in 20 and 30 parts, respectively. sigmastrangourih was used in 12 (60%), 5 (25%) and 3 (15%) respective descriptions by Kos, Knidos, and unspecified School, while deltadusourih was used in 13 (43%), 17 (57%), and no descriptions; the correlation was not significant, (chi-squared test, p > 0.05). Descriptions of "stoppage of the urine or bladder", "blockage of the urine", "inability to pass urine", and "check" in classic Greek may mean retention of urine, which also is suspected in the case of severe deltadusourih and sigmastrangourih. Retention of urine only appeared in descriptions by the Kos School, except for one of origin not specified between the Kos and Knidos Schools. The terms "deltadusourih" and "sigmastrangourih" are the origins of the English terms "dysuria" and "strangury". Dysuria ("dys + urine + ia") denotes painful or difficult urination, while strangury ("drop + urine") denotes slow and painful discharge of urine. Deltadusourih and sigmastrangourih with severe pain appear in descriptions by the Kos School. However, in classic Greek, these words by no means always meant painful urination, which differed partially from present-day meanings of dysuria and strangury. There were deltadusourih, sigmastrangourih, and retention of urine accompanied by severe, slight or no pain. The former degree of pain may have included urinary tract infection and/or prostatitis, with the latter, including prolape of uterus or bladder. Sigmastrangourih was a chronic disease of a nonfatal natures, unless complications occurred. "Unconsciously passed a copious discharge of urine" may refer to urinary incontinence, which was seen in one description by Kos and two by Knidos. Two types of urinary incontinence were described, copious and drop urine wise urinary incontinence; the former may represent neurogenic bladder caused by brain dysfunctions, while the latter may represent overflow incontinence. Urethral catheterization and diuretics already were mentioned in the Hippocratic Collection. Bleeding and anodyne were used in treatment of deltadusourih and sigmastrangourih. Disorders of urination appeared in four categories, namely difficult urination or dysuria: dropwise urine or strangury; urinary retention : and urinary incontinence. Severe disorders of urination appear frequently in descriptions by the Kos School.

『ヒポクラテス全集』における尿路結石に関する記述について

Hippocrates was a famous physician of Kos in ancient Greece (c. 460 B.C.). His works later were described in the Hippocratic Collection, in which I studied references to urinary stones. I collected mentions of urinary stones from the Hippocratic Collection (Roeb, Otsuki, and Kon editions) to compared descriptions of urinary stones between the Kos and Knidos schools. Urinary stones were mentioned in 24 passages of the collection: 12 (50%) referred to pathogenesis of urinary stones; 6 (25%) to symptoms; 4 (17%) to treatment, and 2 (8%) to other aspects. Symptoms of urinary stones included hematuria, colic, painful urination, difficult urination, and passing a urinary stone. Bladder stones were mentioned in 15 passages (63%), renal stones in 4 (17%), and both bladder and renal stones in 2 (8%). Although no site was mentioned directly in 7 passages (29%), these appeared most likely to refer to bladder stones. Descriptions by Kos, Knidos, and unspecified schools accounted for 15 (63%), 4 (17%), and 5 (21%) of mentions of urinary stones. Descriptions of bladder stones by the Kos school were relatively numerous, while most of the few renal stones were described by the Knidos school. Treatments for urinary stone included medication, presumably to aid in passing the stone or to relieve pain; warm soaks or applications to treat pain; and incision over the kidney, when the affected area showed swelling with elevation. Urinary stones were mentioned in the Hippocratic Collection more frequently by the Kos school. No description of cystolitotomy included. The Oath of Hippocrates proscribed use of the knife to treat urinary stones, however, incision over the kidney (presumably nephrolithotomy) was mentioned in "Internal Affection" by the Knidos school.

Male Reproductive Health: A village based study of camp attenders in rural India

BackgroundA paucity of information about male reproductive health and a perceived interest in involvement among local men provided the impetus for carrying out a village based male reproductive health camp. The aim was to investigate men's willingness to participate in such camps, and to describe reproductive health problems in men.MethodsStructured interviews were carried out with 120 men attending a reproductive health check-up in a village in rural West Bengal, India. General information, details of family planning methods used and data on reproductive health complaints were collected. Clinical examinations were also carried out. Socio-demographic characteristics were compared for men with and without reproductive health and urinary complaints.ResultsThree quarters of the married men were using contraception, but the majority stated that their wives were responsible for it. The most common reproductive health complaint was urinary problems; 28% had burning on urination, and 22% reported frequent and/or difficult urination. There were few social or demographic differences between men with and without problems. Seventeen percent of the men had clinically diagnosed reproductive health problems, the most common being urethral discharge. None of the men with diagnosed problems were using condoms.ConclusionsThis study highlights the interest of men in their reproductive health, but also highlights the high proportion of men with problems. In addition, a number of men with clinically diagnosed problems had not reported them in the interviews, illustrating either the reticence to report or the lack of knowledge about symptoms of reproductive health problems. Recommendations for future programmes and research in this field are given.

Effects of D-004, a lipid extract from Cuban royal palm fruit, on inhibiting prostatic hypertrophy induced with testosterone or dihydrotestosterone in a rat model: A randomized, controlled study

Background: Benign prostatic hypertrophy is the nonmalignant, uncontrolled growth of prostatic epithelial cells and stroma that, left untreated, may lead to difficult urination and other complications. A common treatment of BPH is lipid extract from saw palmetto fruit, and lipid extract from Cuban Royal palm (a palm of the same family) fruit is being studied for this use. One study found that the latter, D-004, at 100 to 400 mg/kg daily prevented prostatic hypertrophy (PH) induced with testosterone (T) in a rat model. Objectives: This study comprised 2 experiments in a rat model. The first assessed the effects of different doses of D-004 on T-induced PH; the second investigated the effects of D-004 on PH induced with dihydrotestosterone (DHT). Methods: In experiment 1, rats were distributed in 6 groups of 10 rats each. One group received an SC injection of soy oil and oral treatment with Tween 65/water vehicle (negative control). The other 5 groups received an SC injection of T 3 mg/kg daily and oral treatment with vehicle (positive control) or D-004 at 50, 200, 400, or 800 mg/kg daily suspended in vehicle. In experiment 2, rats were distributed in 3 groups of 10 rats each. A negative control group received treatment as in experiment 1. Positive controls received an SC injection of DHT 1.5 mg/kg and vehicle orally. The third group received an SC injection of DHT and oral treatment with D-004 at 800 mg/kg suspended in vehicle. All treatments were given for 14 days. At sacrifice, prostates were removed and weighed. Mean prostatic weights and prostatic/body weight ratios were calculated. Results: In experiment 1, in the groups receiving D-004 at 200, 400, or 800 mg/kg daily, prostatic weight was significantly lower compared with the positive control group ( P < 0.05, P < 0.01, and P < 0.001, respectively); this effect was not seen in the group receiving 50 mg/kg daily. In the groups receiving D-004 at 400 and 800 mg/kg daily, prostatic/body weight ratio was significantly lower compared with positive controls (both, P < 0.05); this effect was not seen in the groups receiving 50 or 200 mg/kg daily. In experiment 2, prostatic weight and prostatic/body weight ratio in the group receiving D-004 were similar to those of positive controls. Body weight was not affected in any of the groups receiving D-004. Conclusions: This study of rats with T- or DHT-induced PH suggests that D-004 at 200 to 800 mg/kg daily administered orally prevents T-induced PH, and that D-004 at 800 mg/kg daily does not prevent DHT-induced PH.

Botulinum A Toxin Treatment of Urethral Sphincter Pseudodyssynergia in Patients with Cerebrovascular Accidents or Intracranial Lesions

Purpose: Detrusor overactivity and urethral sphincter pseudodyssynergia may develop during recovery from cerebrovascular accidents or intracranial lesions, resulting in difficulty in urination, a large amount of residual urine, and recurrent urinary tract infection. This study evaluated the effectiveness of urethral injection of botulinum A toxin in treating these patients. Methods: Twenty-one patients with chronic cerebrovascular accidents or intracranial lesions and difficult urination were enrolled. Patients participating in the study elected to receive either 100 units of botulinum A toxin (n = 11) or served as medically treated controls (n = 10). The urodynamic parameters and voiding efficiency after treatment were compared between the 2 groups. Results: An excellent result was obtained in 6 patients and an improved result in 4 patients, resulting in an overall success rate of 91% in the study group. Four patients with frank urinary retention before treatment resumed spontaneous voiding. The maximal effects of botulinum A toxin appeared about 2 weeks after treatment. The voiding pressure decreased (57.8 ± 35.2 vs. 33.8 ± 16.9 cm H₂O, p = 0.005) and the maximal flow rate increased (7.2 ± 5.9 vs. 10.3 ± 5.2 ml/s, p = 0.005) significantly. In the control group, 4 patients (40%) had spontaneous voiding 6 months after medical treatment, whereas 6 patients remained unchanged requiring an indwelling Foley catheter (n = 2) or clean intermittent catheterization (n = 4). The symptom score and the quality of life index showed significantly greater improvement in the study group than in the control group. Conclusion: This study demonstrates that urethral injection of botulinum A toxin is effective and without adverse effects in the treatment of patients with urethral sphincter pseudodyssynergia after cerebrovascular accidents or the development of intracranial lesions.

Botulinum A Toxin Urethral Injection for the Treatment of Lower Urinary Tract Dysfunction

This study investigates the effectiveness of botulinum A toxin in the treatment of various types of lower urinary tract dysfunction and determines the predictive factors for a successful outcome. A total of 103 patients with chronic urinary retention (45) or severely difficult urination (58) received urethral injection of botulinum A toxin. The dose was 50 units in 48 patients and 100 units in 55. Clinical effects and urodynamic parameters were compared at baseline and after treatment. The 48 men and 55 women (age range 14 to 86 years) had various types of lower urinary tract dysfunction including detrusor sphincter dyssynergia in 29, dysfunctional voiding in 20, nonrelaxing urethral sphincter in 19, cauda equina lesion in 8, peripheral neuropathy in 14 and idiopathic detrusor underactivity in 13. A total of 40 (39%) patients had an excellent result and 47 (46%) had significant improvement as assessed by the patients. The total success rate was 84.5%. Among these patients mean maximum voiding pressure decreased significantly (62 +/- 40 vs 43 +/- 31 cm H2O, p = 0.000), as did maximal urethral closure pressure (65 +/- 36 vs 48 +/- 31 cm H2O, p = 0.000) and post-void residual (226 +/- 165 vs 89 +/- 112 ml, p = 0.000) at 2 to 4 weeks after treatment. Among 45 patients with urinary retention the indwelling catheters were removed or clean intermittent catheterization was discontinued in 39 (87%). Botulinum A toxin urethral injections at doses of 50 or 100 units were effective in decreasing urethral sphincter resistance in patients with various types of lower urinary tract dysfunction.

Effectiveness of intravesical resiniferatoxin in treating detrusor hyper‐reflexia and external sphincter dyssynergia in patients with chronic spinal cord lesions

To investigate the therapeutic effect of resiniferatoxin in patients with chronic spinal cord lesions, as detrusor hyper-reflexia and external sphincter dyssynergia (DESD) are common phenomenon in such patients. Twenty patients with chronic spinal cord lesions and DESD refractory to anticholinergic treatment were enrolled in a prospective study. They were treated with 30 mL of 10 micro mol/L resiniferatoxin for 30 min. Four types of response were recorded during instillation: type 1, a sustained high-pressure detrusor contraction followed by complete acontractility; type 2, a high-pressure contraction followed by progressively lower contractions; type 3, intermittent high-pressure detrusor contractions throughout the instillation; type 4, intermittent low-pressure detrusor contractions. The changes in clinical symptoms and urodynamics at baseline, during resiniferatoxin instillation and 1 month after treatment were compared. All patients had DESD and 10 had autonomic dysreflexia; 18 had urinary incontinence and 13 had difficult urination. Continence and/or difficult urination improved in 12 patients, including all five with type 1, four with type 2, two with type 3 and only one with a type 4 response. Four patients became dry during the day and eight had less urgency and fewer incontinence episodes, and a significantly increased voided volume. Of the 13 patients who complained of difficult urination, eight had an improvement either by spontaneous voiding (five) or the Crede manoeuvre to voiding (three). The mean (sd) maximum cystometric capacity increased significantly after treatment, from 102.1 (31.5) to 236.6 (88.6) mL (P < 0.001), but the detrusor pressure showed no significant change, at 55.9 (23.2) to 47.5 (28.1) cmH2O. The external urethral sphincter showed intermittent activity during reflexic detrusor contractions at baseline. Resiniferatoxin at 10 micro mol/L has a clinical effect on two-thirds of patients with a spinal cord lesion and detrusor hyper-reflexia, but not on the DESD. The initial response to resiniferatoxin instillation might predict a favourable therapeutic outcome.

Effect of botulinum a toxin in the treatment of voiding dysfunction due to detrusor underactivity

Objectives To investigate the effects of botulinum A toxin in treating patients with voiding dysfunction due to detrusor underactivity. Methods Twenty patients with chronic urinary retention (n = 13) or severe dysuria (n = 7) received 50 U of botulinum A toxin by urethral injection. The clinical effects, obstructive symptom score, quality-of-life index, and urodynamics were compared at baseline and after treatment. Results Of the 4 males and 16 females (age range 14 to 86 years) with voiding dysfunction (cauda equina lesion in 5, dysfunctional voiding in 5, peripheral neuropathy in 6, and detrusor failure of unknown origin in 4), 18 (90%) were treated satisfactorily. Among these patients, the mean quality-of-life score decreased significantly from 5.68 ± 0.67 to 1.16 ± 1.61. The median voiding pressure (56.5 ± 41.2 versus 39.0 ± 38.4 cm H 2O) decreased significantly, as did the maximal urethral closure pressure (65.5 ± 38.1 versus 50 ± 32.1 cm H 2O) and residual urine volume (300 ± 189.1 versus 50 ± 153.6 mL) at 2 weeks after treatment and remained stationary for 3 months. The subjective maximal effect was achieved within 1 to 2 weeks. In 7 patients, the indwelling catheters were removed, and in 4 patients who performed clean intermittent self-catheterization, the frequency decreased or it was discontinued. The other 7 patients with difficult urination had significant improvement in the obstructive symptom score (18 ± 3.3 versus 7 ± 4.5, P = 0.000). Conclusions Botulinum A toxin at a dose of 50 U was effective in reducing urethral sphincter resistance among our patients with detrusor underactivity and difficult urination.

Differences in Physical Discomfort and Childbirth Satisfaction between Primiparous Women with and without having taken Epidural Analgesia

【Purpose: To examine the difference of physical discomfort and childbirth satisfaction between postpartum women with and without having taken Epidural Analgesia. Method: The subjects were divided into one group of 128 primipara taken Epidural Analgesia and the other of the same 70 women who were not taken it. Data were collected by questionnaires of their own physical discomfort and birth satisfaction at postpartum 1 to 2 days in OBGY hospitals, and data were analyzed using SPSS Program. Result: Women having taken epidural analgesia appealed higher physical discomfort than those without it in the lower limbs exercise discomfort, difficult urination, urinary retention, nausea & vomiting, whereas appeared vice versa in breast pain. Among indicators for childbirth satisfaction, women having taken epidural analgesia preferred the same delivery method later again more than those without it. Conclusion: It is confirmed that the method of epidural analgesia is not an absolute way to control labor pain, rather stir physical discomfort after childbirth and does not fully increase the women's childbirth satisfaction. Therefore, it is proposed that nurses should provide the pregnant women the right knowledge and information, thereby enabling them to select the useful method of childbirth to their own course of childbirth and health-recovering after the delivery.】

Differential diagnosis of dysuria in the adult horse

DYSURIA is painful or difficult urination and, generally, is an uncommon presenting sign in the adult horse. Normal horses may grunt on urination and hold the stance adopted for micturition...

CNS Adverse Effects of Opioids in Cancer Patients

Most of the adverse effects of Opioid analgesics are related to effects on the CNS. This article reviews the causes and treatment of the most frequent CNS adverse effects of Opioid analgesics prescribed for the relief of cancer-related pain. Such effects can occur during short term treatment of opioid-naive patients (e.g. sedation, nausea, vomiting, respiratory depression, mood changes, difficult micturition) and during long term treatment of patients in chronic pain (e.g. delirium, hyperalgesia, generalised myoclonus, tonic-clonic seizures), and can be classified according to their clinical relevance. The symptoms can be associated with high concentrations of Opioids and their metabolites in CSF, but can also be caused by pharmacological interactions between Opioids and other drugs commonly used in clinical practice. Moreover, they may be related to the accumulation of active metabolites in patients with renal impairment. Opioid rotation, hydration of the patient and suspension of drugs that can interfere with the pharmacokinetics of Opioids are suggested approaches to treatment. Psychostimulants can be used to treat opioid-induced sedation. Naloxone can be used to reverse severe respiratory depression caused by high doses of Opioids. Haloperidol and midazolam are useful for the treatment of opioid-induced hyperactive delirium.

Hyper-dopaminemia may Produce an Increased Outlet Resistance of the Prostatic Urethra: A Case Report of Malignant Pheochromocytoma

We report on a 43-year-old man with difficult urination attributed to malignant pheochromocytoma with hyper-dopaminemia. A decrease and increase in the plasma dopamine values during the clinical course clearly coincided with improvement and deterioration, respectively, in urination difficulty. The prostatic peak pressure decreased by 37 percent when the plasma dopamine value was minimal. Detrusor function was normal throughout. Endocrinological and urodynamic studies suggested that hyper-dopaminemia produced an increased outlet resistance of the prostatic urethra without altering detrusor function. Thus, peripheral dopaminergic systems may influence voiding mechanisms, especially those involving the proximal urethra.

Local control of prostate cancer by intraarterial infusion chemotherapy facilitated by the use of angiotensin II.

Intraarterial infusion chemotherapy with angiotensin II was carried out in 8 prostate cancer patients whose ages ranged from 61 to 77 years. They had stage C or D tumor progression and complained of difficult urination, bone pain or lymphedema caused by intrapelvic tumor infiltration. Endocrine therapy had been done before the infusion therapy but the clinical status showed little change with a persistence of local symptoms. Cis-platinum and doxorubicin were infused with an indwelling catheter into both internal iliac arteries. After the completion of 1-5 courses, 6 of 8 patients responded remarkably in local symptoms. It is thought that intraarterial infusion chemotherapy can be used safely and effectively in elderly patients.

Spinal Coning after Lumbar Puncture in Prostate Cancer with Asymptomatic Vertebral Metastasis: A Case Report

A 60-year-old man was admitted to our hospital for complete urinary retention. Prostate cancer was diagnosed and anti-cancer chemotherapy was administered. Regression of prostatic enlargement was appreciated and difficult urination improved. At 6 months after the initial treatment vertebral metastasis of T10-11 was noted on a bone scintigram but there were no symptoms induced by bone metastasis. Orchiectomy was performed with the patient under lumbar anesthesia. Complete paralysis of both lower extremities occurred postoperatively. Computerized tomography and myelographic findings demonstrated complete subarachnoid block with an extramedullary spinal cord tumor. It was concluded that traction on the spinal cord producing neurological deterioration (spinal coning) occurred after removal of the cerebrospinal fluid by lumbar puncture.

Earlier Therapies for Urinary Stones

To the Editor.— The recent article on lithotripsy by the Health and Public Policy Committee of the American College of Physicians1describes the 20th century approach to the fragmentation of stones in the urinary tract. Descriptions of urinary calculi and remedies for their treatment are already found in the Talmud, which was compiled in the second century of the common era. In Yebamoth, folio 64b, the Talmud states that Rabbi Acha ben Jacob once suffered from painful or difficult urination that Jastrow2interprets to have been due to a uratic stone. Elsewhere (Baba Metzia, folio 85a) the Talmud describes the 13-year suffering of Rabbi Judah the Prince from bladder calculi. His screams of pain were so loud they could be heard at the seashore. These pains are portrayed as follows: when the horse steward of Rabbi Judah gave fodder to the horses, their neighs could be heard for

Prostatic Urethral Polyp Causing Lower Urinary Tract Obstruction: Report of a Case

Polyps of the male urethra are relatively uncommon lesions. They usually arise from the prostatic urethra mostly verumontanum or Just lateral to the verumontanum. Posterior urethral polyp often presents with hematuria, hemospermia and sometimes lower urinary tract obstruction. We recently experienced a pedunculated prostatic urethral polyp in a 63-year-old man who complained of gross total hematuria and difficult micturition for several years. On rectal examination the prostate was slightly enlarged with normal consistency. Excretory urogram showed a round filling defect in the right side of the bladder neck measuring about in size. Cystourethroscopy revealed trabeculation of the vesical wall, mild bilateral prostatic hypertrophy and a round cystic mass with a long stalk arising from the prostatic floor 1 cm. Proximal to the verumontanum which caused ball-valve obstruction in the bladder neck. This pedunculated polypoid mass was then resected at its base with resectoscope and was removed transurethrally using Lowsley's grasping forceps. The specimen was proved as fibrous polyp histologically.

Urethral stricture.

Urethral stricture in the tropics may be a serious public health problem; the majority of cases are caused by the gonococcus. The pathology is varied, and many advanced cases with complications are seen. Most strictures are seen in the posterior urethra, where fibrosis and narrowing may extend from a short length of under 5 mm to well over 10 cm. A wide variety of complications occurs. Diagnosis is easy when the patient presents in acute retention or with a history of difficult micturition, but more difficult when stricture is the underlying cause of perianal abscess, gangrene of the scrotum caused by extravasation, uremia or hypertension, hernia or rectal prolapse, urinary infection, or elephantiasis of scrotum with multiple fistulae. A careful history is helpful, paricularly if previous gonorrhea is involved. Physical examination varies according to mode of presentation and complications; a rectal examination and neurological examination should be included. Definitive investigation to prove the presence of a stricture includes urethrography and urethroscopy, if facilities are available. Indirect methods of diagnosis include tests for hemoglobin, blood urea, plain X-ray of the whole urinary tract, urinalysis, and others. It is preferable to leave instrumentation until last in diagnostic cases, to avoid infection, but a diagnostic bougie may be passed under strict aseptic conditions prior to treatment. The mainstay of treatment is regular bouginage for life, which is best done in a bougie clinic held at regular intervals. Equipment for bouginage, in order of desirability, includes soft plastic bougies, straight metal bougies, or curved metal bougies in larger sizes, a large stainless steel instrument tray, a basin for sterile water, and lubricant. Care should be taken during bouginage not to pass bougies into acutely inflamed strictures, and not to overstretch the urethra. Plastic bougies are preferable, until a stable situation has been reached. Surgery is indicated for a persistently impassable stricutre, for 1 requiring difficult bouginage at frequent intervals with many failures, for an established false passage, and for complications, especially bladder neck stenosis. Instructions for intravenous pyelograms and for urethrography from below and above, and diagrams of urethrograms indicating various pathological states and a diagnostic schema for urethral stricture are included.

Urinary Tract Infections and Difficult Urination in Girls: Long-Term Followup

Urinary Tract Infections and Difficult Urination in Girls: Long-Term Followup

Infections of the Urinary Tract

NFECTIONS of the urinary tract occur alone or in combination with other disease processes in all age groups of both sexes. Consequently, they come to the attention of the physician in general practice as well as the specialist in every field of medicine. The urologist usually sees those patients who have not responded to the usual therapeutic measures. The failure of these patients to respond to treatment is due, largely, to incomplete diagnosis and the consequent inadequate treatment. In turn, the patients' complaints of frequent, difficult, or painful urination may not tell the entire story. All are common complaints, but while they call attention to a disturbed emptying mechanism of the bladder, they do not reflect the abnormality which is usually present in the upper urinary tract. Therefore, unless a thorough investigation is carried out, the concurrent abnormalities in the bladder and elsewhere in the urinary tract are often overlooked; the treatment they require is not instituted; and symptoms recur.

URINARY OBSTRUCTION DUE TO TRIPELENNAMINE HYDROCHLORIDE

Various side reactions from the use of tripelennamine hydrochloride (pyribenzamine® hydrochloride) have been observed. 1 Drowsiness, dizziness, gastric disturbances and headache have been the responses most commonly evoked. Less frequent in occurrence have been urinary burning and urinary frequency. In none of these reports has there actually been a description of a case involving urinary difficulty. I recently saw a patient whose reaction to tripelennamine involved the urinary tract and was so unusual that it appears worth recording. REPORT OF CASE On Feb. 25, 1949 a white man aged 54 complained of difficult urination of three days' duration. He had been examined periodically, and there was no reason to anticipate the occurrence of the predicament. Urination was of an obstructive character but was completely painless. Only a dribbling stream was possible. When the urethra was compressed against straining, thereby increasing the bladder pressure, the stream became full for about