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Biomedical subjects

T Hald

Publications and source records attributed to T Hald.

At least 91 records · Page 5Linked to original sources
PubMed1985

Nonobstructive detrusor myopathy in a group of patients with chronic abacterial cystitis.

Chronic abacterial cystitis is clinically and pathoanatomically an ill-defined condition, presenting with a variety of urologic symptoms and often nonspecific histology. A retrospective histologic analysis of bladder biopsies from 101 patients with chronic abacterial cystitis revealed degenerative changes in the detrusor muscle cells (detrusor myopathy) in 25 of them. The changes were often very severe, and even fatty replacement of muscle tissue was seen. Retrospective analysis of the symptoms, urodynamics and cystoscopic findings in these patients showed that none had haematuria, but five (all women) had had urinary retention requiring catheterization. Significant residual urine was found in nine patients, and the cystometrograms showed a shift to the right. No patient had infravesical obstruction. At cystoscopy less than half of the patients had petechial bleeding after bladder distension. The aetiology and pathogenesis of the degenerative changes are unknown, despite theoretic speculation. The authors conclude that careful histologic examination can identify different clinical types of chronic abacterial cystitis. Such studies may assist future research into the nature of the problem and also the search for more rational therapy.

Adult↗
PubMed1985

Transurethral versus transvesical prostatectomy. Physiological strain.

The present randomized study evaluated the physiological strain in transurethral (TURP) versus transvesical (TVP) prostatectomy in 75 patients with clinically benign, medium-sized prostatic enlargement. In both groups 5 patients had coincidental prostatic carcinoma. During TURP a suprapubic trocar was inserted for irrigation with 1.5% glycine. Antibiotics were given to patients with preoperative urinary tract infection and postoperatively tranexamic acid was administered to all patients. Coexisting diseases which might increase the operative risk were equally present in TURP and TVP patients. No patient died in connection with the operative procedures. Median duration of anaesthesia for TVP was 95 min and for TURP 60 min (p less than 0.001). Almost identical operative blood loss was seen in the two groups. However, more blood transfusion were given to TVP patients. Following discharge, more episodes of bleeding were registered in the TURP group, but no significant difference was observed in number of secondary operations for bleeding. In the TVP group, more patients had pulmonary complications, elevated rectal temperature as well as antibiotic treatment and 34% of these patients developed wound infection. Secondary operations before discharge were also more frequently undertaken in TVP patients. No differences between the two groups were seen pre- or postoperatively with respect to electrolyte, protein, creatinine and haemoglobin values. In the patients with incidental prostatic carcinoma a TURP was the most gentle procedure. With respect to physiological strain a TURP is clearly to be preferred over a TVP for obstructive clinically benign, medium-sized prostatic hyperplasia.

Aged↗
PubMed1984

Vasoactive intestinal polypeptide influence on lower urinary tract smooth muscle from human and pig.

The influence of vasoactive intestinal polypeptide on detrusor, trigone, bladder neck and urethral smooth muscle from human and pig was investigated in vitro. Vasoactive intestinal polypeptide reduced the tension and amplitude of the spontaneous contractions of strips from all regions studied. Human detrusor and pig trigone, bladder neck and urethral strips were more sensitive to vasoactive intestinal polypeptide than pig detrusor. The response was reversible, reproducible and dose-dependent from 10(-9) to 10(-6) mol. per liter. The time to onset of the response was within 1/2 minute and the time to maximal relaxation was 2 to 10 minutes. The response was not affected by selective nerve poisoning with tetrodotoxin, beta-adrenergic blockade with propanolol or prostaglandin synthesis blockade with ketoprofen. Vasoactive intestinal polypeptide did not prevent prostaglandin E2 activity on the musculature. Contractions evoked by transmural electric field stimulation or pharmacologically with carbachol, noradrenaline, substance P and prostaglandin F2 alpha were equally reduced by VIP 10(-7) mol. per liter.

Animals↗
PubMed1984

Urinary incontinence in the female. A long-term study of the effect of anticholinergics on overactive detrusor function.

The long-term effect of anticholinergic medication in female patients with overactive detrusor function was studied in a group of 73 patients. The definition of overactive detrusor function is in accordance with the terminology and definition of the International Continence Society. The patients were mailed a questionnaire about the medication, its effect on the continence situation, the side effects, and whether they still used the drugs. The duration of observation was more than 12 months. A satisfactory effect of the treatment was found in 43% while 50% reported no effect or severe side effect. Only 5% stopped the medication because of side effects, 18% because of lack of effect, while 42% had resigned themselves to their voiding disorders. Twenty-nine claimed to be cured or were still using the drug with beneficial effect. Nevertheless the treatment had continued for 6 months in both the group with no effect and in the group with good effect. The anticholinergic medication is of some value because it helps the patient to accept the bladder dysfunction, to alter the micturition habits and to assist in re-establishing inhibition of the micturition reflex.

Adult↗
PubMed1984

Clinical evaluation of transurethral versus transvesical prostatectomy. A randomized study.

The present randomized study gives an evaluation of clinical results 6 months following transurethral (TURP) and transvesical (TVP) prostatectomy in 75 patients with clinical benign medium-sized obstructive prostatic hyperplasia. Following treatment of postoperative urethral stricture, urinary tract infection and residual bladder stones no statistically significant differences could be demonstrated in the effects of TURP and TVP on a calculated total symptom score nor on the individual obstructive and irritative prostatic symptoms. In both groups the obstructive symptoms were best relieved whereas rather high incidences of irritative symptoms were seen at follow-up. The median duration of incontinence following TURP was 10 weeks compared to 6 weeks following TVP but the difference, however, was insignificant. At follow-up also more patients in the TURP group had urinary incontinence although only one patient in this group with benign histology had daily urinary urge incontinence. Stress incontinence was observed in two patients with malignant histology. Persistent detrusor instability was suggested partly responsible for the follow-up irritative symptoms. In both groups and especially in the TVP group a small decrease in frequency of sexual activity was seen 6 months postoperatively. Seventy per cent of TVP patients and 57% of TURP patients reported retrograde ejaculation at follow-up. More urinary tract infections were seen in the TVP group, however, the differences were insignificant. Twenty-five per cent of TVP patients and 17% of TURP patients developed urethral strictures postoperatively and judged from flowmetry most strictures were obstructive.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1984

Reproducibility and reliability of urinary incontinence assessment with a 60 min test.

Urinary incontinence was objectively assessed in 50 patients. The urine loss was measured as weight gain of perineal pads worn during a 60 min standardized activity period. The test was initiated by drinking 500 ml (not milk and soda water). The patients were instructed not to void before and during the test. After the test, the voided volume was collected. The test proved handy, reproducible and reliable compared to the subjective day-time incontinence. Prior to the actual test, 15 patients participated in a pilot study having an initial voiding and a test period of 3 1/2 hours. This longer test period was not found practical and the gain in positive diagnosis was minimal compared to the disadvantages with a higher number of unscheduled voidings.

Adolescent↗
PubMed1984

Urodynamic evaluation of transurethral versus transvesical prostatectomy. A randomized study.

In a randomized study of transurethral prostatectomy (TURP) versus transvesical prostatectomy (TVP) in 75 patients a urodynamic evaluation was undertaken before and 6 months following operation. In the TURP group a resection to the surgical capsule was attempted in each case. Operative specimen weights in the two groups did not differ statistically significantly. 5 patients in each group had unexpected prostatic carcinoma. Rapid fill CO2 cystometry did not show any significant differences in bladder function between TURP and TVP patients 6 months following operation. In both groups a high incidence of detrusor instability was observed at follow-up. However, the incidence as well as the severity of the instability had decreased significantly following the two operative procedures. As judged from flowmetry and pressure flow investigation, relief of infravesical obstruction was almost complete in both groups. However, following treatment of postoperative strictures the patients with benign histology in the TVP group compared to the TURP group had higher maximum flow rate values and lower detrusor pressure values. Confidence limits for the differences between the two groups in detrusor pressure and maximum flow rate at follow-up did, however, hardly suggest clinically significantly differences. At urethral closure pressure profile measurement a statistically significantly shorter profile length was measured in TVP patients. The marginal differences in relief or infravesical obstruction might be due to differences in the amount of apical prostatic adenoma following operation.

Aged↗
PubMed1984

Long term results of superselective sacral nerve resection for motor urge incontinence.

Eight female patients suffering from severe urge incontinence not manageable by conservative treatment were subjected to superselective sacral nerve resection in the period 1974-1977. The aim of the resection was a complete parasympathetic decentralization of the bladder. The resection was carried out according to the results of pre-operative sacral nerve blockade and per-operative electrical nerve stimulation. Post-operatively all cystometrograms were shifted to the right and four patients had bladder areflexia. At six months follow-up, three patients were continent, four were improved and one patient had an indwelling catheter for persistent retention. However, incontinence and detrusor instability returned in all the patients within one year. After seven to eight years follow-up one patient had died, two patients had had a urinary diversion operation and three had an indwelling urethral catheter. Only two patients were permanently improved. The surgical procedure was complicated by wound necrosis in one patient, by persistent dysesthesia in two and hypesthesia in three.

Adult↗
PubMed1983

Non-cholinergic, non-adrenergic nerve mediated relaxation of trigone, bladder neck and urethral smooth muscle in vitro.

Human trigone and porcine urethral, bladder neck and trigone smooth muscle were exposed to transmural electric field stimulation in vitro. The responses were composed of different combinations of a relaxation phase and a contraction phase. A few strips exhibited contractions only and a few strips relaxation only. The individual strip retained the behavior throughout the experiment. No systematic difference in the responses was found in strips from the different regions. The configuration of the response was slightly shifted in favor of contraction by beta-adrenergic blockade with propanolol and prostaglandin synthesis inhibition with Ketoprofen. After alpha-adrenergic blockade with phentolamine and cholinergic blockade with atropine, the reverse effect was seen with augmentation of the relaxation and reduction of the contraction. The relaxation phase was completely abolished by nerve poisoning with tetrodotoxin, but was still observed with all other antagonists present, and was therefore nerve-mediated through non-cholinergic, non-adrenergic and non-prostaglandin transmitter or modulator systems.

Animals↗
PubMed1983

Prostaglandin type E activity dominates in urinary tract smooth muscle in vitro.

Changes in isometric tension and spontaneous contractions in human and porcine lower urinary tract smooth muscle strips caused by PGE2, PGF2a and the prostaglandin biosynthesis inhibitor ketoprofen were investigated in vitro. Ketoprofen reduced the prostaglandin biosynthesis significantly and caused reversible and dose dependent decreases of tension and spontaneous contractions in detrusor strips, while tension increase was induced in strips from the urethra, bladder neck and trigone. PGE2 reestablished the tension and the spontaneous activity in the detrusor strips and counteracted the tension increase in strips from the urethra, bladder neck and trigone. PGF2a increased the tension in all strips. The threshold concentration for prostaglandin effect in strips pretreated with ketoprofen was 10(-10) - 10(-9) mol./l., a concentration which might be considered physiologically relevant. Prostaglandin synthesis inhibition thus caused responses opposite to those of PGE2 in every single strip. These results strongly suggest the PGE-type of activity to be more important than the PGF-type of activity in lower urinary tract smooth muscle in vitro.

Animals↗
PubMed1983

Permeability and ultrastructure of human bladder epithelium.

Leakage of tight junctions as observed with electron microscopy and demonstration of solute transport across bladder epithelium was investigated in 13 patients with different bladder diseases: urinary retention and infection, bladder tumours and interstitial cystitis. The latter group showed consistent leakage of solutes through the urothelium. Electron microscopy revealed leaky tight junctions. This finding might be helpful in establishing the histological criteria and explain the pathogenesis of interstitial cystitis.

Adult↗
PubMed1983

Histamine content and mast cell count of detrusor muscle in patients with interstitial cystitis and other types of chronic cystitis.

The quantitative mast cell count in the detrusor muscle, the histamine content and the degree of collagen staining material in the bladder wall have been evaluated in order to elucidate their value in distinguishing between patients with interstitial cystitis and other types of chronic cystitis. The number of mast cells in the detrusor muscle was statistically significantly increased in patients with interstitial cystitis compared with the control group (P less than 0.0001). With a proposed level of greater than 20 mast cells/sq mm of muscle tissue the diagnostic specificity was 88% and the diagnostic sensitivity 95%. The histamine content in the bladder wall was significantly increased in patients with interstitial cystitis (P less than 0.05) but not useful as a diagnostic test. The amount of collagen staining material was significantly increased in the intra- and inter-fascicular muscle tissue of the bladder in patients with interstitial cystitis (P less than 0.0005, P less than 0.001) and might be used as a support for the histological diagnosis, even in patients with uncontracted bladders.

Adult↗
PubMed1983

Incontinence surgery in female motor urge incontinence.

Conventional incontinence surgery was performed in 41 consecutive female patients despite the finding of motor urge incontinence. The patients were reinvestigated 6 months to more than 2 years after operation. Twenty-eight of the patients also had the symptom stress incontinence. Seventeen patients had coexisting symptomatic genital prolapse and were operated on without prior pharmacological treatment. The remaining 24 patients were all resistant to parasympatholytic treatment. The choice of operative procedure was based on vaginal examination as well as bladder suspension defect as demonstrated on voiding-colpo-cysto-urethrography. Subjective cure and improvement rate was 73%. At follow-up, 30% of the patients had normal detrusor reflex control, and a significant improvement in urge incontinence as well as frequency of micturition and nocturia was observed. Probably the primary treatment in females with motor urge incontinence should be pharmacological. However, in patients with symptomatic genital prolapse as well as in patients with ineffective medical treatment, conventional incontinence surgery seems to be well indicated in the absence of neurological disease-providing the patient has an associated bladder suspension defect.

Adult↗
PubMed1983

Voiding inability after transurethral resection of a bladder diverticulum.

Following transurethral resection of the opening of a large bladder diverticulum a 62-year-old man was in complete urinary retention. The reason was the considerable vent created by altering the hydrodynamics. The complication was resolved only after conventional vesical diverticulectomy. A warning is issued against the use of transurethral treatment of large bladder diverticula.

Diverticulum↗
PubMed1982

High flow infravesical obstruction in men: symptomatology, urodynamics and the results of surgery.

High flow infravesical obstruction in male patients with severe prostatism is defined by a maximum flow rate of more than 15 ml. per second and a vesical pressure exceeding 100 cm. water at maximum flow rate. During a 9-month period urodynamic screening of 225 patients referred to our hospital with prostatism revealed high flow infravesical obstruction in 16 (7 per cent). Transurethral surgery of the prostate or bladder neck was performed in 11 of the patients, with good results observed in symptomatology as well as in maximum flow rate. A urodynamic screening program is suggested to establish the diagnosis so that these patients can benefit from surgical treatment.

Adult↗
PubMed1982

Mast cells in interstitial cystitis.

Specific clinical criteria have been used to diagnose interstitial cystitis in 32 patients. The distribution of mast cells in biopsies of the bladder wall from these patients has been compared with that of similar cells in control specimens. A highly significant increase (P less than 0.001) in the number of mast cells within the detrusor muscle bundles has been demonstrated in 27 of these patients. This mast cell infiltration is widespread throughout the detrusor muscle and is not confined to the ulcerative lesions seen cystoscopically. Histological estimation of mast cells is of value, therefore, in establishing the diagnosis of interstitial cystitis, and may be particularly helpful in equivocal cases. The relationship between mast cell infiltration of the detrusor muscle bundles and the aetiology of the disease remains to be determined.

Cell Count↗