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PubMed1984

Urinary acidification in the prevention and treatment of feline struvite urolithiasis.

Two groups of 12 cats were fed ad libitum an experimental dry expanded ration high in magnesium (0.37%, dry matter basis) and similar to most commercial dry cat foods in all other nutrients. The diet of one of the groups contained 1.5% ammonium chloride, which was added to the diet before processing. Urethral obstruction developed twice in 7 of the 12 cats fed the ration without ammonium chloride. Of the 5 remaining cats in that group, 2 had calculi in the urinary bladder and urethra at necropsy. In contrast, only 2 of the 12 cats fed the ration containing ammonium chloride had urethral blockage once; neither cat had another blockage. Both cats had been catheterized twice as paired controls before urethral obstruction. One of these 2 cats died from a urinary tract infection apparently introduced through the indwelling catheter, and at necropsy there were 2 small calculi in the urethra. At the end of the study, only 1 other cat fed the ammonium chloride diet had a calculus in the urinary bladder at necropsy; this cat had not had a urethral obstruction throughout the study. After each cat had 2 urethral blockages, its diet was changed. Four cats were fed the ration containing ammonium chloride and 3, a dry, commercial ration. Of the 4 cats fed the diet containing ammonium chloride, none developed another urethral obstruction within 6 months, and at necropsy, no calculi were in the urinary bladder or urethra. Two of the 3 cats fed the commercial ration experienced urethral blockage within 3 months. These 2 cats were then fed the diet containing ammonium chloride.(ABSTRACT TRUNCATED AT 250 WORDS)

Ammonium Chloride↗
PubMed1995

Renal allograft survival in patients with congenital obstruction of the posterior urethra.

In an attempt to clarify the influence of dysfunctional bladders on renal allograft outcome, graft survival was studied retrospectively in patients with congenital posterior urethral obstruction (posterior urethral valves). Using the Australia and New Zealand Dialysis and Transplant Registry (ANZDATA), 25 index patients were compared to all other transplant recipients of the same age range. Three instances of abnormal bladder function leading to graft function deterioration were found, therefore we would recommend investigation of bladder function in all boys with congenital urethral obstruction prior to renal transplant, and as part of the work-up of graft failure, where the cause is otherwise not obvious.

Graft Survival↗
PubMed1976

Management of urethral valve obstruction in male neonates.

Over the past 6 years, 18 neonates with a posterior urethral valve obstruction have been treated. The mortality has been markedly reduced by meticulous investigation, better medical management of renal failure, greater use of catheter drainage and simpler methods of valve ablation and reduction in the use of nephrostomy and ureterostomy. Mortality was 33%, but ther has been no mortality in the last 7 patients.

Congenital Abnormalities↗
PubMed2002

Botulinum toxin urethral sphincter injection resolves urinary retention after pubovaginal sling operation.

The management of prolonged urinary retention following pubovaginal sling surgery typically involves transvaginal urethrolysis for anatomical urethral obstruction. Brubaker recently reported on urethral sphincter abnormalities as a cause of postoperative urinary retention following either Burch suspension or a pubovaginal sling procedure. We report a case of functional urethral obstruction and detrusor acontractility following pubovaginal sling surgery that was successfully treated by botulinum A toxin urethral sphincter injection.

Aged↗
PubMed2003

Urethral pressure profile and hemodynamic effects of phenoxybenzamine and prazosin in non-sedated male beagle dogs.

Prazosin is a readily available alpha-adrenergic antagonist that may be useful in the management of functional urethral obstruction in companion animals. This study used urethral pressure profilometry to evaluate the urethral effects of prazosin and phenoxybenzamine in healthy, non-sedated, male Beagle dogs. Heart rate, indirect systolic, diastolic and mean arterial blood pressures were measured, and saline perfusion urethral pressure profilometry was performed at 0, 10, 20, and 40 min following intravenous administration of prazosin (0.025 mg/kg), phenoxybenzamine (0.2 mg/kg), or placebo. Maximal urethral pressure, maximal urethral closure pressure, post peak nadir, and all blood pressure parameters decreased significantly at nearly all treatment intervals following administration of prazosin compared with placebo. Less consistently significant reductions were observed following phenoxybenzamine administration. Maximal decreases in urethral pressure parameters were observed 20 min following the injection of prazosin; maximal blood pressure decreases were evident by 10 min postinjection. In this non-sedated dog model, urethral pressure profilometry was a sensitive method of detecting urethral effects of alpha antagonists. Repeatable reductions in urethral pressure measurements were observed, with prazosin effecting more consistently significant changes than phenoxybenzamine. Significant decreases in systolic, diastolic, and mean arterial blood pressures were seen with prazosin, but not phenoxybenzamine or placebo. Further study of selective alpha-1 antagonists in dogs is needed to determine appropriate oral dosing protocols that will produce maximal urethral effects with minimal hemodynamic effects, and to demonstrate clinical efficacy in dogs with functional urethral obstruction.

Adrenergic alpha-Antagonists↗
PubMed1997

Naturally occurring xanthine urolithiasis in a domestic shorthair cat.

A five-year-old neutered male domestic shorthair cat was presented after three episodes of urethral obstruction and anuria requiring relief urethral catheterisation. A double contrast cystogram revealed the presence of multiple small cystoliths which were radiolucent on plain radiographs. A perineal urethrostomy and a cystotomy were performed to relieve the urethral obstruction and to remove the cystoliths. Quantitative analysis revealed the cystoliths to be composed of 100 per cent xanthine. Clinical history suggested the xanthinuria to be naturally occurring. Unfortunately, the cat was killed in a road traffic accident two months after the surgical procedure, preventing further long-term assessment.

Animals↗
PubMed1996

Angiotensin II and bladder obstruction in the rat: influence on hypertrophic growth and contractility.

The mechanisms and mediators of hypertrophic growth secondary to infravesical urinary outflow obstruction are unknown. The renin-angiotensin system has been implicated in vascular and cardiac hypertrophy, but the involvement of angiotensin II (ANG II) as a trophic factor in the lower urinary tract has not been investigated. In this study, the ANG II subtype AT1 receptor antagonist losartan (DuP 753) was administered perorally (15 mg.kg-1.day-1) for 28 days to rats subjected to partial urethral obstruction or sham surgery. Partial urethral obstruction caused a 3.5-fold increase in bladder weight and a 3-fold increase in bladder protein content compared with sham rats. However, no difference was observed in bladder weight or bladder protein content between losartan-treated rats and rats receiving no drug. Cystometric evaluation of bladder function revealed significant increases in micturition volume, bladder capacity, bladder compliance, and spontaneous contractile activity in rats subjected to partial urethral obstruction compared with sham rats. However, bladder function in rats treated with losartan was not different from bladder function in rats receiving no drug. In vitro studies of isolated bladder tissue showed a weak contractile response to ANG II (1 microM) that amounted to 4.4 +/- 1.0% of the response to K+ (124 mM). The ANG II-induced contraction was abolished by losartan (10 microM) and indomethacin (10 microM). The contractile response to ANG II (1 microM), K+ (124 mM), and transmural nerve stimulation (2 Hz) was reduced in bladder strips from obstructed rats. In conclusion, no evidence was found for involvement of ANG II in development of bladder hypertrophy. The effect of ANG II on bladder smooth muscle tone was minor but was mediated by stimulation of the AT1 subtype receptor.

Angiotensin II↗
PubMed1994

L-arginine decreases the infiltration of the kidney by macrophages in obstructive nephropathy and puromycin-induced nephrosis.

We examined the effect of 1% L-arginine in the drinking water on the infiltration of the kidney by macrophages in rats with puromycin aminonucleoside-induced nephrosis (PAN) and in rats with bilateral ureteral obstruction (BUO) of 24 hours duration. Rats given L-arginine in the drinking water for three days before BUO or PAN was initiated had a greater glomerular filtration rate after release of BUO or induction of PAN than similar rats not given L-arginine (P < 0.0001). Administration of L-arginine decreased the renal infiltration by macrophages in rats with PAN (P < 0.0001) or BUO (P < 0.0001) compared to rats with PAN or BUO given tap water alone. Chemotaxis studies suggested that macrophages were activated during obstruction as evidenced by the greater random migration of peritoneal macrophages obtained from rats with 24-hour urethral obstruction than from sham-operated rats (SOR; P < 0.0001). In vitro, maximal chemotaxis induced by 7% zymosan-activated serum (ZAS) in peritoneal macrophages from SOR was enhanced by low (10(-6) to 10(-5) M) and decreased by high concentrations (10(-3) to 10(-2) M) of L-arginine in the incubation medium. Migration of macrophages from rats with urethral obstruction was increased by 7% ZAS but the increase diminished with high concentrations of L-arginine (10(-3) to 10(-2) M). Random migration of peritoneal macrophages obtained from rats with urethral obstruction given L-arginine prior to obstruction was significantly lower than that of peritoneal macrophages obtained from similar rats given tap water alone prior to obstruction.(ABSTRACT TRUNCATED AT 250 WORDS)

Administration, Oral↗
PubMed2006

The pathophysiology of lower urinary tract symptoms after brachytherapy for prostate cancer.

OBJECTIVES: To determine the spectrum of pathophysiology underlying the lower urinary tract symptoms (LUTS) persisting for > or = 6 months after brachytherapy for localized prostate cancer. PATIENTS AND METHODS: A database of men from two practice settings was searched for men who developed LUTS persisting for > or = 6 months after completing brachytherapy for localized prostate cancer. Patients were evaluated with a structured history and physical examination, International Prostate Symptom Score (IPSS), 24-h voiding diary, noninvasive free-flow uroflowmetry, postvoid residual urine volume (PVR), cystoscopy and a video-urodynamic study. Specific data collected included symptoms, elapsed time since brachytherapy, Gleason score, IPSS, total number of voids/24 h, maximum voided volume, cystoscopic findings, and urodynamics findings (PVR, maximum urinary flow rate, Schaefer obstruction grade, Watts factor, incidence of detrusor overactivity (DO) urethral obstruction and low bladder compliance). These data were compared with those from a previous study of men with LUTS who did not have prostate cancer. RESULTS: The study included 47 men (aged 54-88 years); the median (range) interval between brachytherapy and evaluation was 1.5 (0.5-13) years. Thirty-seven men complained of overactive bladder symptoms (79%), and 31 of incontinence (71%), 21 of obstructive symptoms (44%), and persistent dysuria in 12 (26%). Comparison of urodynamic findings in men with unselected causes of LUTS vs LUTS due to brachytherapy revealed the following comparisons: DO in 252 of 541 (47%) unselected vs 28 of 33 (85%) brachytherapy, (P < 0.001); and urethral obstruction in 374 of 541 (69%) unselected vs 24 of 33 (73%) brachytherapy (P = 0.85). CONCLUSION: The pathophysiology and severity of persistent LUTS in men after brachytherapy differs from that of men with LUTS in the general population. Men after brachytherapy have a much higher incidence of DO, prostatic and urethral strictures and prostatic urethral stones.

Aged↗
PubMed2005

First report of overactive detrusor in association with hypospadias detected by urodynamic screening.

AIMS: The purpose of this study was to determine urodynamic features in hypospadic patients. METHODS: Thirty-seven patients with hypospadias (distal: 31, proximal: 6) underwent preoperative urodynamic study according to International Continence Society (ICS) recommendations. Statistical analysis were done for comparison between urethral obstruction and non-obstruction in patients with detrusor overactivity (DO) plus the relationship of DO with localization of hipospadias. RESULTS: Nearly 45.9% of the patients showed overactive detrusor. Urethral obstruction was found in 60.8% of the patients. The rate of DO was higher in proximal hipospadias, and urethral obstruction than distal type, and non-obstructed patients (P > 0.005). The means overall cystometric capacity, maximum voiding detrusor pressure and maximal urinary flow measured were 132.6 +/- 111.14 ml (range 21-610), 72 +/- 53 cmH2O (range 12-181), and 7.9 +/- 7.1 ml/sec (range 2-30 ml/sec), respectively. CONCLUSIONS: To the best of our knowledge, this is the first study ever to show that overactive detrusor is an accompanying entity in the hypospadic patients.

Adolescent↗
PubMed1984

[Prune belly syndrome, a secondary urethral functional obstruction due to prostatic hypoplasia].

The authors describe their experience of "prune belly syndrome" about 7 personal cases. The major signs are abdominal muscle aplasia or hypoplasia, cryptorchidix, and severe urinary tract malformations. The first evenment of the malformation sequence is a prostatic hypoplasia with functional obstruction of the urethra. Abdominal muscle aplasia is a secondary point of variable aetiology.

Cryptorchidism↗
PubMed1996

Immunity to nerve growth factor prevents afferent plasticity following urinary bladder hypertrophy.

PURPOSE: The goal of this investigation was to examine the effect of immunity to nerve growth factor (NGF) on alterations in sensory nerves from the urinary bladder in the dorsal root ganglia (DRG) and their projections to the L6/S1 spinal cord following urethral obstruction in the rat. MATERIALS AND METHODS: Female Wistar rats were immunized to murine 2.5S NGF, then obstructed by partial urethral ligation for 6 weeks. Retrograde axonal tracing with FluoroGold and WGA-HRP was used to measure areas of bladder DRG cells and afferent projections in the sacral spinal cord. Multiunit activity on bladder nerves allowed recording of micturition reflexes. Immunohistochemical staining for growth associated protein (GAP)-43 in the sacral parasympathetic nucleus (SPN) was used to assess potential growth or activity of axons in the spinal cord. Voiding frequencies were then measured in awake obstructed and NGF immune-obstructed rats. RESULTS: Immunity to NGF prevented obstruction-induced hypertrophy of DRG neurons, reduced retrograde axonal labeling of sacral afferent projections, eliminated enhancement of a spinal micturition reflex and abolished the increased GAP-43 expression in the SPN. Immunity to NGF prevented the urinary frequency that accompanies obstruction. CONCLUSIONS: Our results demonstrate that obstruction of the bladder elicits structural and functional plasticity in afferents as a result of ongoing neurotrophic interactions. Neurotrophic interactions offer a potential mechanism whereby symptoms and bladder hyperactivity develop with obstruction associated with benign prostatic hyperplasia.

Animals↗
PubMed1983

[Clinical effect of new alpha-adrenergic blocker on micturition disturbance of neurogenic bladder and lower urinary tract obstruction].

E-643, a newly developed alpha 1-adrenergic blocker with a postsynaptic action, was tried on 17 subjects, 10 patients with neurogenic bladder and 7 patients with lower urethral obstruction. The results of treatment were excellent in 5, good in 7, and poor in 5 of them, the rate of effectiveness therefore being 70.6%. The inhibitory effect of E-643 on the contractility of the detrusor was no stronger than that of other alpha-blockers. The rate of effectiveness for neurogenic bladders was as high as 80% whereas that for lower urethral obstruction was much lower: 57%. Concerning benign prostatic hyperplasia (B.P.H.) alone, this agent was markedly beneficial. In the case of B.P.H the urethra pressure in the prostatic urethra tends to drop and urination is facilitated even without a change in maximum urethral closure pressure, which reduces the amount of residual urine, this sequence of events taking place on condition that the contractility of the detrusor is adequate. According to urodynamic criteria, the underlying causes of the so-called bladder neck contracture can be classified into organic and functional obstruction, but it is mistaken to use this term for functional disturbance of the bladder neck. It seems worthwhile to determine the clinical effect of alpha-blockers on functional urethral obstruction. E-643 produced few if any appreciable signs or symptoms of side effects either subjectively or objectively.

Adrenergic alpha-Antagonists↗
PubMed1980

The neuropathic urethra.

The hypothesis is advanced that the functional urethral obstruction found in neuropathic states is due, in part at least, to urethral supersensitivity following sympathetic decentralisation. A simple postural test for this condition is described. By its use it has been shown that urethral denervation occurs not only in disorders of the central nervous system but with peripheral damage such as may result from rectal excision and hysterectomy. In some cases with functional urethral obstruction, attributable to suersensitivity of the urethra, no neurological abnormality has been found. These may be examples of localised visceral neuropathy.

Female↗
PubMed1983

[Obstructive posterior urethral valves. A series of 82 cases].

The authors report their experience gained from a series of 82 cases of severe posterior urethral valves with distension of the upper urinary tract. From analysis of their own series and from a study of the literature, they propose a therapeutic approach to these severe forms. Vesico-ureteral reflux was present in 45% of cases. Once the patency of the bladder neck and urethra was restored, 41% of these cases of reflux disappeared spontaneously and 25% persisted but were well tolerated. Only 13 ureters (29.5%) had to be re-implanted. The cases of ureteral distension without reflux had a similar favourable course after removal of the obstruction of the lower urinary tract. 57% of the dilated ureters resolved or were greatly improved and 11% persisted but were well tolerated. Simple treatment of the valves meant that ureterovesical re-implantation was avoided in 68% of cases. The overall results of uretero-vesical re-implantation were mediocre: out of 32 re-implanted ureters, there were only 15 successes (46.9%), 13 cases (40.6%) were unchanged and there were 4 failures (12.5%). The authors recommend the simple treatment of the posterior valves and suggest careful consideration of the indications for ureterovesical re-implantations in children with abnormal bladder and ureters proximal to the posterior urethral valves.

Adolescent↗
PubMed2003

[Non-coordinated micturition syndrome mimicking posterior urethral valves in a male neonate].

UNLABELLED: High-grade of vesicoureteral reflux (VUR) has been reported in association with prenatal diagnosis of abnormal bladder function in a male neonate with postpatally no anatomical urethral obstruction and bladder dysfunction. This study was designed to describe clinical presentation of this entity in male neonates, the urodynamic pattern, prognosis in terms of renal function and therapeutic management since birth, in our experience with four cases. MATERIALS AND METHODS: We reviewed the records of 4 male neonates diagnosed at birth of bilateral high-grade VUR (grade > or = 4) with prenatally diagnosed hydronephrosis; thus 8 refluxing renal units (RRU) were studied. All cases had renal failure at birth. In all cases dimercaptosuccinic acid (DMSA) renography was performed. All RRU had reflux nephropathy; 5 RRU had moderate impairment of renal function (20-40%). In 3 RUU was demonstrated by a severe decrease in renal function (10-20% in 2 RUU, and less than 10% in 1 RUU). Micturating cystouretrography (MCUG) excluded the presence of posterior urethral valves; however, in all cases a tightened bladder neck ("bladder neck impression") was present. Endoscopy was performed in one baby excluding posterior urethral valves. Follow up ranged from 2 to 5 years (mean 3.5). RESULTS: In all 4 cases underwent transient urinary diversion during their first month of life. Urodynamic study revealed a high-risk bladder with low compliance, a reduced functional bladder capacity and a high residual urine volume in all cases. All the patients was placed on antibiotic prophylaxis and oral oxybutinin chloride. Three patients underwent bilateral Cohen ureteral reimplantation. The other boy underwent left nephrectomy, right Politano ureteral reimplantation and ureterocystoplasty. In the 7 RRU postoperative MCUG revealed cessation of reflux. Currently therapy includes antibiotic prophylaxis in 4, oral oxybutinin in 4 and intermittent catheterisation in 2 patients. 3 patients have normal renal function. The other boy underwent re-diversion because of renal failure. CONCLUSIONS: Fetal severe bilateral reflux nephropathy is a clinical entity almost exclusively in male neonate mimicking hyper-pressure syndrome due to urethral obstruction, in terms of evolution (to chronification and renal failure) and treatment (that requires primordial management of bladder dysfunction). Absence of anatomical urethral obstruction and urodynamic pattern suggest functional obstruction of bladder neck-periurethral sphincter complex in fetal life as a cause for this syndrome. For this reason we consider it as a clinical presentation of fetal non-coordinated voiding in male or "posterior urethral valves like syndrome".

Diagnosis, Differential↗