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Biomedical subjects

A Shafik

Publications and source records attributed to A Shafik.

At least 91 records · Page 5Linked to original sources
PubMed1999

Three new methods for male contraception.

The methods devised for male contraception are meagre. In the current communication, we review 3 recently developed methods applied for male contraception: testicular suspension, polyester-induced azoospermia and prolactin injection. The testicle was suspended in the superficial inguinal pouch close to the scrotal neck using 2 methods: stitch and ball. The azoospermic effect of the polyester sling seems to be due to 1) creation of electrostatic field across the intrascrotal structures, and 2) disordered thermoregulation. Prolactin administration, as a contraceptive method is efficient and safe and has the potential to be developed as a male contraceptive. The effect of the above mentioned 3 methods is reversible. These methods, especially testicular suspension and polyester suspensors, are simple and easily applicable and were well acceptable by the subjects.

Contraception↗
PubMed1999

Pudendal canal: surgical anatomy and clinical implications.

The anatomy of the pudendal canal (PC) was studied in 26 cadavers: 10 stillborn and 16 adults (mean age, 48.2 years). Two approaches were used to expose the PC: gluteal and perineal. The PC was an obliquely lying tube with a mean length of 0.8 cm in the stillborn and 1.6 cm in the adult cadavers. It started at a mean distance of 0.8 cm from the ischial spine in the stillborn and of 1.6 cm in the adult cadavers, and ended at a mean distance of 0.7 cm and 2.6 cm, respectively, from the lower border of the symphysis pubis. The PC wall was formed by the splitting of the obturator fascia and not by the lunate fascia. The PC contained the pudendal nerve and vessels embedded in loose areolar tissue. The three branches of the neurovascular bundle arose inside the canal in all but three cadavers. The wall of the PC consisted of collagen and elastic fibers, whereas that of the obturator fascia consisted of collagen only. The PC seems to be structurally adapted to serve certain functions. The criss-cross textile arrangement of collagen fibers in its wall allows the canal to change its shape in response to changes in pudendal vessels that occur during sexual activity. The elastic recoil may not only help to "pump" the blood up the pudendal vein, but also to prevent PC subluxation. The PC may, furthermore, act as a "pulley" for the neurovascular bundle. The pulley action may be disrupted by disordered pelvic floor muscles or defecation. Knowledge of the precise anatomy of the PC is necessary to carry out PC decompression in the treatment of PC syndrome.

Adult↗
PubMed1998

Electrosigmoidogram in the various pathologic conditions of the sigmoid colon.

The current study investigates the electrosigmoidographic (ESG) patterns in 50 patients with sigmoid colon pathologies and 10 healthy controls. Three electrodes were applied to the skin of the lower abdomen and the reference electrode was placed on the lower limb. Ulcerative colitis patients showed a "tachyarrhythmic" ESG; the PPs had a higher frequency with a lower amplitude and velocity than the normal controls. The sigmoid diverticulitis exhibited a "bradyarrhythmic" pattern; the PP variables were lower than normal. The PPs in sigmoid polyposis were "scarce" and were recorded only occasionally. In sigmoid colon cancer, the electric waves were normal proximal to the tumor and absent opposite and distal to it; a "silent" ESG was recorded in sigmoidectomy patients. Various ESG patterns were recordable in the different pathologic conditions of the sigmoid colon. It is thus suggested that percutaneous ESG can be included as an investigative tool in the diagnosis of sigmoid colon pathologies. The method is simple, easy, non-invasive and non-radiologic.

Adenomatous Polyposis Coli↗
PubMed1998

Choledochosphincter inhibitory reflex: identification of the reflex in dogs and its significance.

BACKGROUND: The sphincter of Oddi (SO) may undergo functional disorders. The mechanism of action of this sphincter is as yet not fully explored; the current study aims at studying some aspects of this mechanism. METHODS: Twelve mongrel dogs (mean weight 15.3 +/- 2. 9 SD kg, 8 male, 4 female) were studied. Under general anesthesia, the abdomen was opened and the gall bladder, common bile duct (CBD), and duodenum were exposed. Through separate punctures in the CBD, a balloon-tipped 2F catheter was introduced into the CBD and a 2F manometric catheter was placed within the SO. The positioning of the catheters was controlled fluoroscopically. The pressure response of the CBD and SO to CBD balloon distension with CO2, without and with separate anesthetization of either the CBD or SO, was recorded. RESULTS: Upon CBD distension by 0.5 ml of CO2, the pressure in the CBD rose (P < 0.001) and in the SO dropped (P < 0.01). The SO pressure drop was momentary and did not change significantly (P > 0. 05) with increase in the volume of CBD distension. The pressure response was blocked on separate anesthetization of the CBD and SO. CONCLUSIONS: The SO opening on CBD distension is suggested to be reflex and not hydromechanical. It seems to be mediated through a reflex which we call "choledochosphincter inhibitory reflex." Derangement of this reflex might result in functional disorders of the SO.

Anesthesia↗
PubMed1998

A study of the effect of renal pelvic and ureteric distention on the anorectal function with identification of the "reno-anal reflex".

Renal or ureteral diseases are often associated with gastrointestinal symptoms. In this communication, we studied the effect of renal pelvic or ureteric distension on the anorectal function in 12 healthy volunteers. A 3F balloon-tipped catheter was introduced into the renal pelvis. The balloon was filled with saline in increments of 2 ml up to 12 ml and the pressure response of the rectum and anal canal was recorded. Balloon filling was performed twice: rapidly (1 ml/sec) and slowly (1 ml/min). The test was repeated in the ureter with balloon fillings in increments of 0.25 ml up to 1 ml. The electromyographic (EMG) response of the external anal sphincter to distension of the renal pelvis or ureter was evaluated. The pressure response of the rectum, anal canal and external anal sphincter to distension of the anesthetised renal pelvis or ureter was then determined. The test was repeated after external anal sphincter anaesthetisation. Rapid renal pelvic or ureteric distension increased the anal canal pressure (p < 0.05) but did not change the rectal pressure (p > 0.05). With 10 and 12 ml rapid renal pelvis distension and with 0.75 and 1 ml rapid ureteric distension, the EMG activity of the external anal sphincter increased and was accompanied with loin and anal pain. Slow renal pelvic or ureteric distension caused no significant change in the anal or rectal pressures (p > 0.05) or in the EMG activity of the external anal sphincter and no anal pain was perceived. Distension of the anesthetised renal pelvis or ureter effected no changes in anal or rectal pressures (p > 0.05). The anesthetised external anal sphincter as well as the anal or rectal pressure did not respond to renal pelvis or ureteric distension. In conclusion, rapid renal pelvic or ureteric distension stimulates the mechanoreceptors in the renal pelvis or ureteric wall leading to reflex external anal sphincter contraction. This leads to elevation of the anal canal pressure. The findings suggest the possible involvement of a "reno-anal reflex" which is evoked on rapid renal pelvis or ureteric distension. Slow distension does not seem to trigger such a reflex.

Abdomen↗
PubMed1998

Electrocholedochogram: a study of the electromechanical activity of the common bile duct in the dog.

The electromechanical activity of the common bile duct (CBD) was studied in 11 dogs aiming at elucidating the mechanism of bile transport through the CBD as well as at characterizing a normal electrocholedochogram that could act as a standard for the pathologic conditions. After opening the abdomen under anesthesia and exposing the CBD, the electric activity of the CBD was recorded by 2 electrodes sutured to its serosa and the pressure registered by a perfused catheter introduced into the CBD. The effect of CBD distention and myotomy on its EMG activity was tested. Slow waves or pacesetter potentials (PPs) were recorded exhibiting the same frequency, amplitude, and velocity of conduction from the 2 electrodes of each dog on all test days. They were followed by action potentials (APs) which were inconsistent and associated with a rise in the CBD pressure. These variables were higher postcibally than in the fasting state (p < 0.05). They increased on balloon-produced distention of the CBD. The caudad direction of PPs and APs was evident when, following the CBD myotomies, the signals appeared from the segment proximal but not distal to the cut. The study demonstrated that the CBD possesses an electric activity which seems to be responsible for the motile activity of the duct. Furthermore a normal "electrocholedochogram" was characterized which is expected to exhibit changes in pathologic conditions of the CBD. It is proposed that the electrocholedochogram could act as an investigative tool in the diagnosis of CBD disorders, provided it could be performed transcutaneously.

Action Potentials↗
PubMed1998

A new concept of the anatomy of the anal sphincter mechanism and the physiology of defecation: mass contraction of the pelvic floor muscles.

We have previously demonstrated both anatomically and physiologically that the external anal (EAS) and urethral (EUS) sphincters and the bulbocavernosus muscle (BC) originate from the puborectalis muscle (PR). It is hypothesized that stimulation of any of these muscles would lead to contraction of all the others. Because the levator ani (pubococcygeus) muscle (LA) also has the same innervation as the above-mentioned muscles, it is further suggested that it, too, contracts reflexly upon stimulation of any of those muscles. The purpose of this study was to test this hypothesis. The study comprised 18 healthy volunteers (mean age 36.6 +/- 8.4 years; 10 men, 8 women). The EAS was stimulated and the response of the EUS, PR, LA and BC was determined. Each muscle was thereafter stimulated separately and the response of the other pelvic floor muscles registered. Stimulation of any of the pelvic floor muscles effected an increased EMG activity of the rest of the muscles. The muscle contraction was instantaneous with no latency in all the muscles except the LA EMG activity, which showed a mean latency of 21.3 +/- 6.6 ms. The pelvic floor muscles' response seems to be attributable to muscle stimulation both directly and indirectly through activation of pudendal nerve fibers in the muscles. The study demonstrated that the pelvic floor muscles behave as one muscle: they contract or relax en masse. This 'mass contraction' might explain some of the physiologic phenomena that occur during pelvic organ evacuation. However, besides this mass contraction, a voluntary 'selective' individual muscle activity exists by which each individual muscle acts independently of the others.

Action Potentials↗
PubMed1998

Effect of renal pelvic and ureteral distension on the striated urethral sphincter with recognition of the "reno-vesico-sphincteric reflex".

Renal pelvic and ureteral distension occurs in physiologic (diuresis) and pathologic (calculus) conditions. Its effect on the vesical and posterior urethral pressures as well as on the electromyographic (EMG) activity of the striated urethral sphincter (SUS) was investigated. The renal pelvis of 10 healthy volunteers (7 men, 3 women; mean age 35.8+/-8.6 years) was distended by means of a 4-F balloon-tipped catheter in increments of 2 ml of saline up to 10 ml and the response of the vesical and posterior urethral pressures and SUS EMG activity was recorded. The test was repeated with ureteral distension in increments of 0.25 ml up to 1 ml. The response of the aforementioned parameters was also registered after anesthetization of the renal pelvis, ureter and SUS. Two rates of renal pelvic and ureteral distension were tested: rapid (1 ml/s) and slow (1 ml/min). Renal pelvic distension with large volumes effected an increase of the renal pelvic and urethral pressures (P < 0.05, P < 0.05, respectively), a vesical pressure drop (P < 0.05) and increased EMG activity of the SUS. Ureteral distension caused a rise of ureteral and urethral pressures as well as of SUS EMG activity. With rapid distension, the aforementioned parameters responded at smaller volumes than with slow distension. Renal pelvic, ureteral or SUS anesthetization effected no urethral or SUS EMG response. It is suggested that the reaction of above parameters to distension indicates a mechanism regulating the urine flow so as to protect the renal pelvis and the ureter from being overloaded. The vesical pressure drop with increased SUS EMG activity on renal pelvis distension postulates a reflex relationship that we call the "reno-vesico-sphincteric reflex". The role of this reflex in urine transport requires further study.

Adult↗
PubMed1998

Effect of duodenal distension on the pyloric sphincter and antrum and the gastric corpus: duodenopyloric reflex.

The mechanical effect of balloon distension of the duodenum on the stomach was studied in 10 mongrel dogs with a mean weight of 14.8 +/- 3.2 kg. The response of the pyloric sphincter and antrum as well as of the corpus of the stomach to duodenal distension by a balloon filled with water in increments of 2 ml, up to 6 ml, was determined. The test was repeated after anesthetizing the pyloric sphincter and antrum and the duodenum, each at a separate time. In 5 of 10 dogs the effect of duodenal distension on the vagotomized stomach was studied. Duodenal distension with 2 ml of water produced an increase in the pyloric sphincter pressure (p < 0.05) and a decrease in the antral pressure (p < 0.05); it had no effect on corporeal pressure (p > 0.05). Distension with 4 ml and 6 ml produced the same effect as 2 ml (p > 0.05). The anesthetized pyloric sphincter and antrum did not respond to duodenal distension. Likewise, the pyloric sphincter and antrum showed no response to distension of the anesthetized duodenum or of the duodenum after vagotomy. Pyloric sphincter contraction and antral dilatation upon duodenal distension suggest a reflex relation we call the duodenopyloric reflex. This reflex appears to prevent duodenopyloric reflux. Moreover, the antrum dilates probably to accommodate more gastric contents.

Anesthesia, Local↗
PubMed1998

Effect of renal pelvic distension on the ureteropelvic and ureterovesical junctions and the urinary bladder: the renal pelvivesical reflex.

For investigation of the effect of distension of the renal pelvis on the ureteropelvic (UPJ) and ureterovesical junctions (UVJ) and on the urinary bladder, nephrostomy was performed on 14 anesthetized mongrel dogs. The pressure was measured in the UPJ by a catheter with a side port introduced through the nephrostomy and in the UVJ and urinary bladder by two catheters inserted cystoscopically. Likewise, a balloon mounted on the tip of a catheter was introduced into the renal pelvis. It was filled with saline in increments of 1 ml, and the pressure response of the UPJ, the UVJ, and the urinary bladder was determined. The test was repeated on the anesthetized renal pelvis, UVJ, and bladder. Whereas renal pelvic distension with 1 ml of saline effected no pressure response in the UPJ, UVJ or bladder, distension with 2-4 ml produced a significant pressure drop (P < 0.01, P < 0.01, and P < 0.05. respectively). There was no difference in the pressure drops recorded at distensions with 2, 3, or 4 ml of saline (P > 0.05). Distension of the anesthetized renal pelvis produced no pressure response in the UPJ, UVJ, or bladder. Furthermore, renal pelvic distension did not elicit a pressure response in the anesthetized UPJ or the bladder. In conclusion, the opening of the UVJ synchronously with the UPJ upon renal pelvic distension appears to assist the delivery of urine from the renal pelvis to the urinary bladder and to protect both the renal pelvis and the ureter against dilatation. This process is supported by a vesical pressure drop. The opening of the UPJ together with the UVJ and the vesical relaxation observed on renal pelvic distension seem to be reflex in nature. A "renal pelvivesical reflex" is postulated to regulate the flow of urine from the renal pelvis to the urinary bladder, preventing the occurrence of urine collection in, or backflow into, the renal pelvis or the ureter.

Animals↗
PubMed1998

Response of the renal pelvis and ureter to distension of the contralateral renal pelvis and ureter: identification of the reno-renal pelvic reflex.

For the study of the relationship of the pelviureteric system of one kidney to that of the contralateral one, bilateral cutaneous ureterostomy was performed in 14 dogs. The renal pelvis (RP) and ureter (U) of one side were distended separately with a balloon filled with saline in increments of 1 and 0.25 ml, respectively, and the pressure response of the contralateral RP and U was recorded. The test was repeated after anesthetization of the RP and U. RP distension with 1 ml of saline effected a pressure rise (P < 0.05) in the ipsilateral RP but no pressure response in the ipsilateral U or the contralateral RP or U (P > 0.05). RP distension with 2, 3, and 4 ml of saline induced a significant pressure rise in the ipsi- and contralateral RP but not in the ureters. Ureteric distension produced a pressure elevation (P < 0.05) on the ipsilateral U but had no effect on the contralateral U (P > 0.05) or on either of the renal pelves (P > 0.05). Distension of the anesthetized RP or U effected no pressure response in any of the ipsi- or contralateral RPs or Us. In conclusion, distension of the RP with large volumes led to an increase in pressure in the contralateral RP but not in the U. A reflex relationship is postulated to exist between the two renal pelves and to be mediated through a reflex we call the reno-renal pelvic reflex. It seems that this reflex acts to allow either of the kidneys to share an extra load of the other one by increasing the contractile activity of the RP, thus assumedly assisting the regulation of urine flow.

Animals↗
PubMed1998

Pudendal canal syndrome as a cause of vulvodynia and its treatment by pudendal nerve decompression.

Notwithstanding many established causes of vulvodynia there still remains an idiopathic group with unknown etiology and variable results of treatment. We present 11 women with idiopathic vulvodynia in whom the etiology could be defined and who were successfully treated. Age varied from 28-53 years. The vulvar pain was associated with stress urinary incontinence in 6/11 patients and all had constipation. Perineal and vulvar hypoesthesia occurred in 6, weak anal reflex in 7 and diminished EMG activity of the external anal sphincter in 3, of the external urethral sphincter in 6 and of the levator ani muscle in 11. There was significant increase (P<0.05) of the pudendal nerve terminal motor latency (PNTML) in all. The motor and sensory change as well as the increased PNTML point to pudendal canal syndrome. Pudendal nerve block, as a diagnostic and therapeutic test, effected temporary pain relief. Pudendal nerve decompression was performed. The inferior rectal nerve was exposed through a para-anal incision, and followed to the pudendal nerve in the pudendal canal. Pudendal canal fasciotomy was done to release the pudendal nerve in the ischiorectal fossa. Vulvar pain disappeared in 9/11 women and stress urinary incontinence in 4/6. Anal reflex was normalized in 5/7 women, and vulvar and perineal hypoesthesia in 4/6. The EMG activity of the external urethral sphincter improved in 4/6, of the external anal sphincter in 2/3 and of the levator ani in 9/11 women. The PNTML was normalized in 9/11 women. In conclusion, pudendal nerve decompression effected relief and improvement in the sensory and motor manifestations of the pudendal nerve in 9/11 women. Two women did not improve due probably to an irreversible damage of the pudendal nerve, or to incomplete pudendal nerve decompression.

Adult↗
PubMed1998

A study of the origin of the electric activity of the rectum: is it neurogenic or myogenic?

The rectum possesses electric activity, the origin of which is yet undetermined. The current study investigates the possible source of these waves. Three electrodes were sutured serially to the serosal surface of the rectum in 10 dogs. The rectal pressure was measured by a perfused catheter. Simultaneous recordings of the electric activity and rectal pressure were done before and after bilateral pelvic ganglionectomy and rectal myotomy. Regular slow waves or pacesetter potentials (PPs) followed by inconsistent action potentials (APs) were recorded. They exhibited the same frequency, amplitude and velocity from three electrodes in the individual animal. APs were associated with minor rectal pressure rise. After pelvic ganglionectomy, PPs and APs were recorded but with irregular frequency, amplitude and conduction, a picture of 'rectoarrhythmia'. The rectoarrhythmic waves were registered proximally but not distally to the myotomy. In conclusion, the rectal electric waves persist after bilateral pelvic ganglionectomy but exhibit a 'rectoarrhythmic' pattern. This is suggested to indicate that the waves are not initiated by, but may be under the control of, the extrarectal autonomic innervation. A 'pacemaker' is postulated to exist at the rectosigmoid junction triggering impulses that spread in the rectal wall along the muscle bundles or the myenteric nerve plexus.

Action Potentials↗
PubMed1998

Perirectal graciloplasty: a novel surgical technique for the treatment of the neurogenic rectum and rectal inertia.

A novel technique for evacuation of the denervated rectum was carried out on 11 mongrel dogs (mean weight 15.8 +/- 4.6 kg). The gracilis muscle was mobilized from the thigh, pedicled on its origin from the pubic ramus, and was introduced into the ischiorectal fossa through a para-anal incision. The abdomen was opened and the rectum mobilized and wrapped with the gracilis muscle which was pulled through the ischiorectal fossa into the pelvis. Rectal denervation was induced by bilateral pelvic ganglionectomy; cystostomy was performed owing to the resultant vesical denervation. Two electrodes were sutured to the gracilis muscle and connected to a myostimulator. The effect of electrostimulation of the gracilis muscle on the rectal and rectal neck (anal canal) pressures and on balloon expulsion was determined. Gracilis muscle stimulation with a burst of 30 Hz during 300 msec with a stimulus of 0.5 msec and an intensity just suprathreshold effected a rectal pressure rise (P < 0.001) with no rectal neck pressure change (P > 0.05); balloon expulsion occurred at a mean balloon filling of 14.8 +/- 3.2 mL. Gracilis muscle transposition could be a suitable experimental model for evacuation of the neurogenic rectum. The technique might be considered for the treatment of the neurogenic rectum, or rectal inertia.

Animals↗
PubMed1998

Ureteric profilometry. A study of the ureteric pressure profile in the normal and pathologic ureter.

The ureteric pressure profile in the normal and pathologic ureter was studied. A 3F ureteric catheter was introduced through the ureteric orifice up to the mid-renal pelvis, and was connected to a pressure transducer. The catheter was pulled down to the urinary bladder and during withdrawal the pressures in the renal pelvis, uretero-pelvic junction (UPJ), ureter, ureterovesical junction (UVJ) and urinary bladder were recorded. The normal ureteric pressure profile started with a peak rise at the UPJ followed by a drop and fluctuations representing the peristaltic waves, and ended with a peak rise at the UVJ. The strictured moderately dilated ureter showed peristaltic waves with irregular rhythm and pressure amplitude, a condition we call "ureteroarryhthmia". The hugely dilated ureter exhibited no waves, i.e. a "silent" profile. The refluxing ureter with normal caliber showed an ureteroarrhythmic pressure profile, while the dilated ureter exhibited either a ureteroarrhythmic or a silent pattern. The study could define a characteristic profilometric pattern for the normal ureter. Two pathologic patterns could be identified: ureteroarrhythmic and silent. Ureteric pressure profilometry is suggested acts as a diagnostic tool in the various pathologic conditions of the ureter.

Adult↗
PubMed1998

Role of the trigone in micturition.

The exact function of the trigone in the act of micturition is not yet known. The current communication discusses its role. The myoelectric activity of the urinary bladder and trigone was studied in nine volunteers (six women, three men; mean age 38.6 +/- 9.9 years) using Beckman suction electrodes. Two electrodes were applied to the bladder and one to the trigone. The EMG and vesical pressure were recorded before and during vesical filling and voiding. Slow waves or pacesetter potentials (PPs) were recorded at rest from the detrusor and trigone. They had regular frequency and were followed randomly by bursts of action potentials (APs). The frequency and amplitude of the trigonal PPs and APs were significantly lower than those of the vesical tissue. The mean PP frequency was 5.8 +/- 1.8 cycle/min (cpm) and amplitude 0.69 +/- 0.1 mV in the bladder and 3.4 +/- 1.2 cpm (P < 0.05) and 0.36 +/- 0.09 mV (P < 0.05), respectively, in the trigone. During vesical filling, neither the vesical pressure nor the vesical and trigonal PPs and APs registered significant differences from the resting stage (P > 0.05). During voiding, the vesical electric activity increased and presented as fast activity spikes or APs of high amplitude (mean 678.6 +/- 88.6 muV). The trigonal electric activity showed no significant change (P > 0.05) in comparison with the pre-evacuation status. These findings suggest that the trigone does not contract during voiding, thus refuting the claim that the trigone is responsible for preventing ureterovesical reflux on voiding.

Action Potentials↗
PubMed1998

Study of the effect of vesical filling and voiding on ureterovesical junctions and internal urethral meatus: the filling and meato-vesico-ureteral reflexes.

BACKGROUND: The effect of vesical filling and voiding on bladder pressure, the ureterovesical junctions (UVJs), and the internal urethral meatus (IUM) was studied. METHODS: A pressure catheter was introduced into each of the UVJs, the IUM, and the urinary bladder of 16 healthy volunteers (9 men, 7 women; mean age, 38.4 years) and their pressure response to vesical filling in increments of 50 mL and during voiding as well as on IUM distension was recorded. The tests were repeated after separately anesthetizing the bladder, UVJs, and IUM. RESULTS: When the bladder was filled to 250 mL, there was a significant increase (P < 0.01) in the pressure of the UVJs, IUM, and bladder, which continued to rise with bladder filling up to 350 mL (P < 0.001). There was no further pressure increase above 350 mL. During voiding, the bladder and UVJs pressures rose (P < 0.0001) while the IUM pressure dropped (P < 0.01). IUM distension caused a significant pressure rise in the bladder and UVJs and a drop of IUM pressure. These pressure responses did not occur upon separate anesthetization of the bladder, UVJs, or IUM. CONCLUSIONS: A reflex relationship appears to exist between vesical filling and an increase in UVJs and IUM pressure which was absent on anesthetizing the presumed 2 arms of the reflex arc, the filling reflex. Another reflex relationship may exist between IUM dilatation and the bladder and UVJs pressure increase, the meato-vesico-ureteral reflex. These 2 reflexes might help further delineate the mechanism of micturition.

Administration, Intravesical↗