Epispadias in boys with an intact prepuce

ObjectiveTo present an overview of the clinical presentation and pathological anatomy, and the results of surgical correction of 7 cases of epispadias with intact prepuce; a rare condition that has only occasionally been reported in literature.Patients and methodsA retrospective search was performed in the surgical and diagnoses database between 1991 and 2011. Seven cases of epispadias with intact prepuce were identified. Five presented as a webbed and buried penis, 1 as phimosis and 1 with suspicion for congenital anomaly of the genitalia.ResultsIn 3 of 7 cases, epispadias was suspected or diagnosed at first presentation and could be surgically corrected in the first intervention. In the other 4 cases, epispadias was discovered during surgery, requiring an additional intervention to perform epispadias repair in 3 cases. One boy was diagnosed with glandular, 3 with coronal, 1 with shaft and 2 with penopubic epispadias. Epispadias repair was successful with regard to cosmesis and erectile function. Five patients developed normal continence after surgery, 1 after intensive urotherapy. An under average penile length was the main reported problem during follow-up.ConclusionIn the diagnostic process for a concealed penis, the possibility of epispadias should be considered. If epispadias is suspected or confirmed, epispadias repair can occur in the first intervention, reducing the number of additional interventions. Epispadias with intact prepuce appears to have a better prognosis concerning urinary continence compared to classical epispadias.     

Micturitional Disturbance in Multiple System Atrophy

Abstract: Detailed micturitional histories and urodynamic studies were conducted to investigate the micturitional disturbance in multiple system atrophy (MSA). Eighty-six patients with MSA comprised of 14 with striatonigral degeneration (SND), 42 with olivopontocerebellar atrophy (OPCA) and 30 with Shy-Drager syndrome (SDS). The results were as follows. Micturitional symptoms were noted in over 90% of patients with each type of MSA. Dominant symptoms were irritative ones in SND and OPCA, and a combination of irritative and obstructive ones in SDS. Micturitional symptoms in SDS appeared earlier than those in SND or OPCA. The degree of micturitional disturbance was severer in SDS than in SND or OPCA. Micturitional disturbance tended to become worse as the disease progressed. The responsible sites of lesions of micturitional disturbance seemed to be supra- as well as infranuclear lesions of the pelvic and pudendal nerves in MSA. Infranuclear lesions were more prominent in SDS than in SND or OPCA. Follow-up studies of some of the patients with SDS and OPCA suggested that the responsible sites of pelvic nerve lesions changed from supra- to infranuclear lesions during the course of disease.     

Lower Urinary Tract Dysfunction as Persistent Complication of Radical Hysterectomy

Background This study was performed to evaluate late effects on the lower urinary tract after radical hysterectomy.
Methods We studied 9 women treated with radical hysterectomy for cervical cancer. All patients underwent surgery more than 10 years ago (range, 14 to 36 years). Six patients had urologic complications associated with lower urinary tract dysfunction. The remaining 3 were referred for urinary tract abnormalities detected by radiologic examinations. Lower urinary tract function was evaluated with thorough history taking, laboratory examinations, intravenous urography, and conventional urodynamic studies.
Results Obstructive voiding symptoms and/or urinary incontinence were observed in 7 patients. Uroflowmetry, which was assessable in 7 patients, revealed intermittent flow and a significant amount of residual urine in all patients. Cystometry revealed impaired bladder sensation, detrusor areflexia, straining on voiding, and probable impaired relaxation of the sphincter in all assessable patients. In addition, decreased bladder compliance was observed in 5 patients.
Conclusion All of the examined patients had severe and complicated urinary tract dysfunctions, even at more than 10 years after surgery. Careful follow-up may be mandatory for patients after radical hysterectomy, because compensating factors tend to mask their urologic symptoms.     

Neurogenic bladder in patients with acquired immunodeficiency syndrome

We have performed a urodynamic study on 3 patients with acquired immunodeficiency syndrome (AIDS), presenting with a neurogenic bladder. The first patient had an ascending myelitis of probable herpetic origin, the second patient had a cerebral abscess caused by Toxoplasma gondii, and the third patient had an AIDS dementia complex. The urodynamic study showed an arreflexic detrusor in the first 2 patients, and a hypereflexic detrusor in the third patient. © 1995 Wiley-Liss, Inc.     

良性前列腺增生术后下尿路症状分析及对策

目的 分析良性前列腺增生术后伴下尿路症状的病因及对策。方法 对26例良性前列腺增生术后仍存在下尿路症状临床资料进行分析并行尿动力学检查。结果 26例中膀胱功能障碍16例，单纯下尿路梗阻9例，尿道括约肌损伤1例。结论 良性前列腺增生术后仍存在下尿路症状的主要原因为膀胱逼尿肌功能障碍和梗阻解除不全，尿动力学检查对分析其原因及进一步治疗具有重要的价值。     

Application of capsaicin on urinary bladder

目的：评价辣椒辣素对急性动物模型中膀胱充盈期和由神经刺激而导致的膀胱收缩期的作用。方法：选用11例成年雄性杂种狗，以袖状电极围绕盆神经做电刺激。刺激参数为10V，20Hz，0．2～2ms方波20s周期。本文作者观察用100μmol／L辣椒辣素前后膀胱在溢出点的压力、容量、顺应性及逼尿肌对盆神经电刺激的反应。同时也做了膀胱组织学检查及P物质测定。结果：辣椒辣素注射诱发了3个狗出现多发性自主膀胱收缩。与对照组比较，膀胱溢出压（39．70士3．22cmH20比48．18士6．33cmH2O）和盆神经刺激所引起的最大膀胱压（17．06土1．49cmH2O比17．47士1．31cmH2O）均无统计学差异。辣椒辣素注射明显增加了膀胱溢出点的容量（82．93土3．51ml比122．22土11．32ml）。结论：在急性动物模型中，辣椒素诱发膀胱容量的改变而非影响其收缩力，膀胱感觉神经的功能改变先于P物质耗竭之前。