Biomedical subjects

P Klarskov

Publications and source records attributed to P Klarskov.

At least 37 records · Page 2Linked to original sources

PubMed1988

Flexible fiberoptic versus conventional cystourethroscopy in bladder tumor patients. A prospective study.

In 30 bladder tumor patients flexible fiberoptic and conventional cystourethroscopy was undertaken by two urologists in a random sequence. The findings at conventional cystoscopy, including histologic findings in biopsy and operative specimens, were taken to represent the true pathologic condition. Concordance was found in all but three patients, with solitary superficial grade II bladder tumors less than 2 mm in diameter that were overlooked at flexible cystoscopy. No discordance was observed in the evaluation of grade III or invasive bladder tumors. Flexible fiberoptic cystourethroscopy with urine cytology is recommended 1) as a follow-up investigation under local anesthesia in patients with non invasive bladder tumors and negative random biopsies, and 2) as a diagnostic procedure in poor-risk patients as an alternative to transabdominal ultrasonography.

Aged↗

PubMed1987

Enkephalin inhibits presynaptically the contractility of urinary tract smooth muscle.

The influence of methionine-enkephalin and leucine-enkephalin on human detrusor and on pig detrusor, trigone, bladder neck and urethral smooth muscle was investigated in vitro. The enkephalins inhibited the smooth muscle contractility presynaptically. Methionine-enkephalin was about 40% more potent than leucine-enkephalin. Phentolamine-resistant contractions were less inhibited by the enkephalins than atropine-resistant contractions and contractions that were not blocked. The inhibitory nerve responses of the trigone, bladder neck and urethra were unaffected.

Animals↗

PubMed1987

Pathogenesis of nocturnal urinary incontinence after ileocaecal bladder replacement. Continuous measurement of urethral closure pressure during sleep.

Urethral closure pressure was recorded in four patients during sleep in order to determine the pathogenesis of nocturnal incontinence after radical cystectomy and ileocaecal bladder replacement. The sleep stages were determined by electroencephalography. The resting pressure in the intestinal bladder was low and increased only slightly during filling. The maximum urethral pressure decreased during sleep but the urethral closure pressure remained positive when the intestinal bladder was not contracting. The peristaltic contractions in the intestinal bladder continued during sleep, causing incontinence. The nocturnal incontinence is probably a result of the reduced level of consciousness that makes it impossible to increase the tone of the external urethral sphincter during contractions of the intestinal bladder.

Electroencephalography↗

PubMed1987

Non-cholinergic, non-adrenergic nerve-mediated relaxation of pig and human detrusor muscle in vitro.

Previously unrecognised, nerve-mediated relaxation in pig and human detrusor muscle is described. The relaxation was mediated via non-cholinergic, non-adrenergic and non-prostaglandin transmitter or modulator systems and was present in 12 of 15 detrusor strips from six pigs and in four of 15 detrusor strips from seven patients. A contractile phase preceded relaxation in all strips; in contrast to the contractile phase, relaxation was augmented by an increase in basal tension in a complex way and possibly by the slowest stimulation frequencies.

Adrenergic beta-Antagonists↗

PubMed1987

Vasoactive intestinal polypeptide concentration in human bladder neck smooth muscle and its influence on urodynamic parameters.

Three human studies were performed to evaluate the influence of vasoactive intestinal polypeptide (VIP) on bladder and urethral function. Bladder neck smooth muscle biopsies were obtained from nine men with functional bladder neck obstruction, from 10 men with medium sized benign prostatic hypertrophy and from four patients with a normal infravesical outlet. The biopsies were analysed for VIP by radioimmunoassay and by immunohistochemistry. No differences were found between the groups. Pressure-flow-EMG studies were performed in five men and urethrocystometry was performed in six women at rest, repeated coughing and at squeezing before, during and after VIP 3 micrograms/kg X h intravenously. No systematic changes developed in any of the urodynamic parameters.

Adult↗

PubMed1987

Non-cholinergic, non-adrenergic inhibitory nerve responses of bladder outlet smooth muscle in vitro.

Pig trigone, bladder neck and urethral smooth muscle strips blocked with atropine, phentolamine, propanolol and the prostaglandin synthesis inhibitor ketoprofen were exposed to transmural electric field stimulation in vitro. The strips developed a fast and reproducible relaxation which was sustained during the period of stimulation and ceased slowly after stopping stimulation. The amplitude of the relaxation was proportional to the basal tension. The relaxation was nerve-mediated, since selective nerve blockade with tetrodotoxin abolished the response. Calcium influx inhibition with verapamil did not antagonise the relaxation, while omitting Ca++ from the bath solution caused maximal relaxation. Vasoactive intestinal polypeptide and adenosinetriphosphate evoked submaximal and slowly developing relaxation.

Adenosine Triphosphate↗

PubMed1987

Influence of prostaglandins and ketoprofen on contractile responses of human and pig detrusor and trigone muscles in vitro.

Detrusor and trigone smooth muscle from pig and man were investigated in vitro. The strips were adjusted to a tension of 1 g. During the first hour detrusor strips relaxed and had to be lengthened repeatedly to maintain tension. The tension of strips from the trigone increased spontaneously during this initial period of recovery and accommodation. Detrusor contractions evoked by transmural electric field stimulation, carbachol, histamine and Ca++ were reduced by ketoprofen (an inhibitor of prostaglandin synthesis), while contractions evoked in trigone strips were augmented by ketoprofen. PGE2 10 nM reversed the effect of prostaglandin synthesis antagonism, augmenting the reduced detrusor response and reducing the augmented trigone response. PGF2 alpha augmented evoked contractions in strips from all regions. Activation of endogenous prostaglandin production can not explain the strip behavior during recovery. After recovery, synthesis of the E-type of prostaglandins seem to dominate over the F-type of prostaglandins, since annulment of the E-type of prostaglandins explains best the alterations of evoked contractions following prostaglandin synthesis antagonism.

Animals↗

PubMed1987

Symptoms and signs predictive of the voiding pattern after acute urinary retention in men.

Over a 9-month period 228 men were admitted for acute urinary retention to six different casualty wards in the Copenhagen area. The patients were followed in the corresponding urological departments for one year. Twenty-seven variables were registered for each patient. The cumulative rate of recurrent retention was 56% after one week and 68% after one year. Factors predictive of preserved voiding ability were a retained volume less than 500 ml, a known event provocative of acute retention, and a maximum flow rate of more than 5 ml/s after the retention. The maximum flow rate measured within the first week after the retention was reliable within the follow-up period if the voided volume was 150 ml or more. The etiology of the acute retention was infravesical obstruction in 90% of the patients, and 85% required subsequent surgical treatment. Predictive of surgical treatment for infravesical obstruction were recurrent urinary retention within one week, a volume of retention of more than 500 ml, the absence of a provocative situation prior to the retention episode and nocturia twice or more.

Acute Disease↗

PubMed1987

Acute urinary retention in women: a prospective study of 18 consecutive cases.

Over a 9 month period 18 women were admitted for acute urinary retention to six different Copenhagen hospitals, serving a population of approximately 700,000 people. Urodynamically 9 patients had underactive detrusor function, 2 had infravesical obstruction and 3 had both underactive detrusor function and infravesical obstruction. In 4 patients bladder and urethral function were not classified. In 10 patients a provocative event preceded the retention episode. Eleven patients developed recurrent retention within 3 months and 7 patients had persistent severe obstructive voiding problems. Best prognosis was found for patients with correctable infravesical obstruction and for patients with minimal symptoms prior to the retention episode.

Acute Disease↗

PubMed1986

Transpubic cystectomy and ileocecal bladder replacement after preoperative radiotherapy for bladder cancer.

Radical cystectomy was modified by leaving the apical prostatic capsule to facilitate anastomosis of the isolated ileocecal segment to the urethra and to preserve erectile potency. The transpubic approach was used to increase the exposure, and to facilitate dissection and anastomosis. A total of 15 patients with stages T1 to T4 bladder tumors underwent the operation: 13 after preoperative radiotherapy with 4,000 rad and 2 had salvage cystectomy after 6,000 rad. One patient died postoperatively. The remaining 14 patients underwent urodynamic evaluation 3 to 6 months postoperatively. The maximum urine flow rates were almost normal and none of the patients had significant residual urine. Daytime urinary continence was satisfactory in 13 patients and 1 was moderately incontinent. All of the patients were incontinent at night, probably owing to peristaltic contractions in the intestinal bladder and relaxation of the pelvic floor muscles. Preoperatively, 8 patients experienced erections and 7 had intercourse. Postoperatively, erectile potency was preserved in 4 patients and 3 had sexual function. No orthopedic disability occurred postoperatively. The median followup was 20 months, with a range of 3 to 30 months. There have been no local recurrences. A year postoperatively 6 of 9 patients had sterile urine. This technique makes it possible to avoid a urinary stoma, to obtain satisfactory voiding and urinary continence in almost all cases, and to preserve sexual function in some patients after cystectomy.

Aged↗

PubMed1986

Influence of serotonin on lower urinary tract smooth muscle in vitro.

The influence of serotonin (5-hydroxytryptamine) on human detrusor and on pig detrusor, trigone, bladder neck and urethral smooth muscle was explored in a series of in vitro experiments. Serotonin evoked a dose-dependent and reversible contraction of the detrusor. The reverse response was triggered in trigone, bladder neck and urethral smooth muscle--a dose-dependent and reversible relaxation. The maximum amplitude of this relaxation was 85 +/- 15% of the relaxation produced by electrical nerve stimulation. The effect of serotonin was unaltered by blockade of ganglia, alpha- and beta-adrenergic receptors, cholinergic receptors and prostaglandin synthesis. The serotonin antagonists ketanserin, methysergide and cyproheptadine partly inhibited the effect of serotonin. The antagonism differed in potency on strips of different origin. The antagonists were ineffective or minimally effective in blocking responses to nerve stimulation. The effect of serotonin was probably mediated by specific serotonin receptors different from the serotonin-S2-receptors predominating in vascular smooth muscle. Serotonin is a potential neurotransmitter in lower urinary tract smooth muscle, but its importance in micturition physiology and pathophysiology is unknown.

Animals↗

PubMed1986

Terodiline in the treatment of women with urgency and motor urge incontinence. A clinical and urodynamic double-blind cross-over study.

In a consecutive double-blind cross-over study, 18 females with detrusor instability were treated with an anticholinergic and calcium antagonistic agent terodiline 25 mg bid or placebo for 3 weeks; cross-over took place after a wash-out period of 1 week. The efficacy of the drug was investigated at the end of each treatment period by means of drug preference, micturition charts, pad usage, bladder and urethral mucosal perception threshold and bulbocavernosus reflex latency measurement. Serum levels of terodiline were estimated at the end of each treatment period and all side effects were reported. The preference for the drug was statistically significant (P less than 0.01): 14 patients preferred the drug, one preferred the placebo and three had no preference. A small but statistically significant reduction was found in 24-h micturition frequency (P less than 0.05). Cystometry showed an increase in volume at first sensation, an increase in volume at detrusor contraction and a tendency towards an increase in bladder capacity, whereas detrusor contraction pressure was unchanged. Median serum levels of the drug were 559 ng/ml (range 203-1117). No serious side effects were reported. It was concluded that terodiline should be considered as an alternative drug in the treatment of motor urge incontinence.

Adult↗

PubMed1986

Coecocystoplasty: an evaluation of operative results.

Coecocystoplasty for substituting or augmenting the bladder is a relatively common operation in the United States, but not in Scandinavia. In order to focus the attention on this voiding-preserving operation we evaluated the late postoperative results of 8 patients. Median follow-up was 5 years. Seven of the patients had symptoms from a contracted bladder and 1 patient with epispadias was undiverted from a ureteroileocutaneostomy. There were some early postoperative complications. Two patients had a revision of the coecocystoplasty, 1 patient ended up with a ureteroileocutaneostomy and 1 patient needed a nephrectomy because of a perirenal abscess. The patient with epispadias later had an artificial urinary sphincter because of persisting incontinence. At follow-up time all patients found that they had a better life than prior to operation since the invalidating symptoms from the contracted bladder had disappeared. One patient with residual urine had chronic urinary tract infection. All patients were continent at daytime, 3 patients had nocturnal incontinence. Urodynamic studies showed no infravesical obstruction and bladder capacity between 75 and 380 ml H2O. Three patients had decreased renal function. Based on our limited material we conclude that coecocystoplasty is a reasonable, though not unproblematic, treatment in patients with severe symptoms from a small contracted bladder and a therapeutical alternative in patients with a previously defunctionalised bladder and that this method should always be taken into consideration before a urinary diversion.

Adult↗

PubMed1986

Pelvic floor exercise versus surgery for female urinary stress incontinence.

Fifty consecutive female patients with genuine urinary stress incontinence were randomized either to surgery or to a pelvic floor training program. The operative procedure was chosen according to the type of bladder suspension defect on micturition cystourethrography. The training program was given 5 times in weekly lessons and the patients were guided by trained physiotherapists. Surgery was superior to the pelvic floor training program both subjectively and objectively. However, a significant improvement was found following the training program. Forty-two percent were satisfied with the outcome of the training and did not want operation. We find physiotherapist-guided pelvic floor exercise a realistic alternative to surgery in patients with mild degrees of stress incontinence. Also patients with residual symptoms after surgery are candidates for pelvic floor training.

Adult↗

PubMed1986

Catheter-associated bacteriuria. A controlled trial with the Bardex Urinary Drainage System.

In a randomized trial, the Bardex Urinary Drainage System was tested against a routine system consisting of a silicone-coated 16F Latex Foley catheter and exchangeable 1 500 ml collecting bags. The Bardex system consists of an all-silicone balloon catheter preconnected and sealed to the drainage tube with tape. The tube is united with a 2,000 ml collecting bag via a vented drip chamber. It has an extremely hydrophilic coating (BN-74) resembling the natural glycosaminoglycans lining the urothelium. This coating is intended to minimize urethral irritation and bacterial migration and also to cause slow release of water-soluble antiseptics applied to the surface. In the present study, isobetadine 10% was applied prior to the insertion and reapplied daily after pulling gently on the catheter. Forty female patients aged 31 to 85 years completed the study. In the Bardex group of patients, bacteriuria developed in none by the third day of catheterization and in 5% by the fourth day. In the Foley group, the bacteriuria rate was significantly higher, with 35% on the third day (p less than 0.01) and 45% on the fourth day (p less than 0.02). No difference between the two drainage systems was found concerning incontinence beside the catheter, urethral pain or burning, meatal reddishness or urethral discharge. No conclusion regarding the advantages or disadvantages of the BN-74 coating and the isobetadine application can be drawn from the present study.

Adolescent↗

PubMed1986

Bladder training and terodiline in females with idiopathic urge incontinence and stable detrusor function.

Twenty consecutive female patients with urge incontinence and stable detrusor function on provocative rapid fill CO2-cystometry were treated as out-patients with a bladder training programme and with terodiline/placebo in a double-blind cross-over design. Frequency and incontinence episodes decreased significantly, while first sensation and cystometric bladder capacity increased. Both objectively and subjectively terodiline was significantly better than placebo with 50% (95% confidence limits 18-82) more patients improved on terodiline than on placebo. Thirty percent of the patients (95% confidence limits 12-54) relapsed after withdrawal of terodiline. At 3 months follow-up the remaining 70% were satisfied with the outcome of the training programme. Side effects were mild and reversible. Serum creatinine and alkaline phosphatase increased slightly on terodiline and the diastolic blood pressure was probably also increased by terodiline. In conclusion, female patients with idiopathic urge incontinence and stable detrusor function did respond to treatment as do female patients with urge incontinence and proven instability.

Adult↗

PubMed1986

Gastrectomy for recurrent ulcer after vagotomy: five- to nineteen-year follow-up.

Sixty patients with recurrent ulcers after vagotomy were treated by partial gastrectomy without revagotomy. One patient died after surgery. Seven others died of unrelated causes and one patient was lost to follow-up before 5 years, without rerecurrence having been diagnosed. Of the remaining 51 patients, one underwent reoperation for rerecurrent ulcer and four for postgastrectomy symptoms before 5 years of follow-up. Forty-six others were followed for between 5 and 19 years, in addition to the one postoperative death. Major postoperative complications occurred in four other patients. Recurrent ulceration developed in four of 51 patients. The patients were classified according to a modified Visick system with regard to recurrent ulceration and postgastrectomy symptoms: Visick I, 16 patients; Visick II, 14 patients; Visick III, 11 patients; and Visick IV, 11 patients. Gastrectomy after vagotomy can be achieved with a low mortality and recurrent ulcer rate but with a high incidence of postgastrectomy symptoms.

Adult↗

PubMed1984

A novel non-adrenergic, non-cholinergic nerve-mediated relaxation of the pig bladder neck: an examination of possible neurotransmitter candidates.

Electrical field stimulation of the isolated pig bladder neck preparation initiated rapid non-adrenergic, non-cholinergic nerve-mediated relaxations. A wide range of substances were examined as possible candidates for the neurotransmitter involved. Of these, only 5-hydroxytryptamine, vasoactive intestinal polypeptide, adenosine and adenosine 5'-triphosphate produced relaxations. Noradrenaline, acetylcholine, substance P, bradykinin and angiotensin II caused contraction, while neurotensin, somatostatin, bombesin and gamma-amino butyric acid were without effect. The nerve response was not blocked by methysergide, ketanserin, chymotrypsin, apamin or 8-phenyltheophylline, although methysergide antagonised the responses to 5-hydroxytryptamine, chymotrypsin blocked the responses to VIP, and 8-phenyltheophylline antagonised the responses to adenosine and ATP.

Adenosine↗