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PubMedDate not supplied

Comparison of the action of the 5-HT2 antagonists amperozide and trazodone on preference for alcohol in rats.

Previous studies in the rat demonstrated that the 5-hydroxytryptamine2 (5-HT2) antagonist amperozide attenuates the volitional intake of both alcohol and cocaine solutions in a free-choice situation. However, another 5-HT2 antagonist, ritanserin, has not been found to reduce alcohol drinking consistently in the rat. In this study, trazodone was compared to amperozide for its effect on the volitional consumption of alcohol because, like amperozide, trazodone is a potent 5-HT2 receptor antagonist but a weak inhibitor of 5-HT reuptake. Male Sprague-Dawley rats were induced to drink alcohol by 10 mg/kg cyanamide injected for 3 days b.i.d. One week later the rats were offered a choice of water and increasing concentrations of alcohol solutions ranging from 3% to 30% v/v in a three-bottle two-choice paradigm. After the concentration of alcohol that produced maximal daily intake was determined for each rat, trazodone or amperozide was injected b.i.d. SC in doses of 1.0 mg/kg or 2.5 mg/kg for three days. Whereas the higher dose of amperozide produced a significant, 55.6% decrease from pretreatment baseline of alcohol intake, trazodone did not alter alcohol preference at either the 1.0- or 2.5-mg/kg dose. These results are discussed in terms of whether the antagonism of 5-HT2 receptors by amperozide is critical to its attenuating effect on preference for alcohol solutions.

Alcohol Drinking↗
PubMedDate not supplied

Opiate and 5-HT2A receptors in alcohol drinking: preference in HAD rats is inhibited by combination treatment with naltrexone and amperozide.

Amperozide, a 5-HT2A receptor antagonist, and naltrexone, an opiate receptor antagonist, have been shown to suppress volitional drinking of alcohol in experimental animals. The present study examined the effects of the concurrent administration of both drugs on the volitional intake of alcohol in the selectively bred, high alcohol drinking (HAD) rat. Individual preferences for alcohol were determined by a standard 10-day test in which alcohol concentrations were increased from 3% to 30%. Following a 4-day predrug test during which water together with a maximally preferred concentration of 7% to 20% was offered to each HAD rat, amperozide and naltrexone were injected SC over a second 4-day period as follows: 1) amperozide at 1600 h and naltrexone at 2200 h; 2) the same drugs but in reversed temporal order; and 3) amperozide and naltrexone administered simultaneously at 1600 and 2200 h. Thereafter, alcohol preference testing continued for a third 4-day period. The alternate delivery of both drugs attenuated significantly the absolute g/kg and proportional intakes of alcohol in the HAD rats, whereas the saline vehicle was without effect. Although the simultaneous administration of naltrexone and amperozide produced an even greater decline in alcohol intake, without side effects on food and water intakes or on body weight, some residual drinking of alcohol persisted. Nevertheless, the results corroborate our previous findings on the suppression of alcohol drinking by antagonists of opiate and 5-HT2A receptors. Because amperozide and naltrexone together reduce the apparent reinforcing property of alcohol, the theory is supported that the addictive liability to alcohol is underpined by multiple receptor subtypes within the mesolimbic and other systems in the brain.

Alcohol Drinking↗
PubMedDate not supplied

The mixed 5-HT 1A/2A receptor drug FG5938 suppresses alcohol drinking while enhancing feeding in P rats.

The neurotransmitter serotonin (5-HT) has long been implicated in the etiology of aberrant consumption of alcohol. Several compounds thought to possess a potential therapeutic value to counteract drinking have high affinities for 5-HT1A and 5-HT2A receptors in the brain. For example, amperozide and FG5865 significantly reduce the volitional intake of alcohol, without altering food intake, both in rats genetically predisposed or chemically induced to drink alcohol. The present study was undertaken in the alcohol-preferring (P) rat to determine whether an amperozide like drug. FG5938 (1-[4-(p-fluorophenyl)butyl]-4-(6-methyl-2-pyridinyl)-piperazine fumarate). exerts an action on the volitional drinking of alcohol as well as on the intakes of food and water. In 11 male P rats, the pattern of preference for different concentrations of alcohol was determined by an 11-day test for water vs. 3 to 30% alcohol solutions. After maximally preferred alcohol concentrations, i.e., 9 to 15% had stabilized for 4 days, saline or FG5938 was injected subcutaneously at 1600 and 2200 h in a dose of 2.5, 5.0, or 10.0 mg/kg over 4 consecutive days. Following treatment, preference testing for the same concentrations of alcohol was continued for 5 additional days. FG5938 caused a significant suppression in alcohol drinking in terms of both absolute g/kg and proportion to total fluid intake. During its administration, FG5938 also enhanced the ingestion of food and water of the P animals significantly, with the largest intake occurring on the initial day, while body weights increased. After FG5938 injections, food and water intakes returned to predrug levels. The saline control vehicle had no significant effect on the intakes of alcohol, food, or water of the P rats. Overall, these results show that FG5938 acts to attenuate alcohol preference while simultaneously increasing the ingestion of food paradoxically. To our knowledge, this is the first known drug to possess this unique property. Finally, these findings support the view that a compound having affinities to both 5-HT1A and 5-HT2A receptors may be useful as a therapeutic agent in the treatment of alcoholism.

Alcohol Deterrents↗
PubMed1994

Cortical control of saccade in normal and schizophrenic subjects: a PET study using a task-evoked rCBF paradigm.

In this study, positron emission tomography (PET) was used to evaluate cortical control of saccades. Regional cerebral blood flow (rCBF) patterns demonstrated by 15O water PET during saccadic task performance were tested in 13 normal volunteers and 20 ICD-9 schizo phrenics (10 unmedicated and 10 medicated). The following 3 saccadic tasks, which were controlled for sensory input and oculomotor output, were applied: (1) reflexive saccade = visually guided saccade, (2) volitional saccade = visually guided saccade with distracting stimuli, and (3) memory guided saccade. Schizophrenics lacked the frontal eye field (FEF) activation during every saccadic task. The left dorsolateral prefrontal cortex (DLPFC) was activated during volitional saccade only in normal controls. The rCBF of posterior parietal cortex increased in parallel with that in the DLPFC. These findings suggest functional hypofrontality in schizophrenia and the left DLPFC-PPC's crucial role in saccade against distracting stimuli and its dysfunction in the disease.

Adolescent↗
PubMed2005

Neglect of memory after dopaminergic lesions in monkeys.

Crossed unilateral dopaminergic lesions of the nigrostriatal bundle and unilateral inferotemporal cortex ablations (DA x IT lesions) in marmoset monkeys produced impaired retention of object discriminations first learnt before, or after, the DA lesion but no impairment on new learning of the same type of task. Retention testing of a pre-operatively learned task was given after new learning of a different task so impairment cannot be attributed to improvement with practice or spontaneous recovery. We argue that the DA lesion produces a form of intentional neglect, a defect of volition, which is the mnemonic counterpart of the volitional neglect of directional hypokinesia, which animals with this lesion also exhibit. The DA lesion was unilateral (for welfare reasons) so the information to be retrieved had to be confined to that hemisphere by the use of an IT ablation in the other hemisphere. Unilateral DA lesion compromises the competence of ipsilateral fronto-striatal interactions and our results parallel those found in monkeys with crossed IT x frontal lesions that are impaired on complex tasks requiring effortful implementation of a cognitive strategy but are not impaired on discrimination learning. Parkinsonian patients with sub-total but bilateral DA loss may lack 'top-down' conative mechanisms as well as 'top-down' movement initiation mechanisms. They may fail to initiate retrieval strategies, although they may not exhibit retrograde amnesia under test conditions that provoke retrieval. Failure to self-initiate retrieval of relevant knowledge may contribute to the paucity of cognitive style and loss of executive skills exhibited by some patients with Parkinson's disease.

Analysis of Variance↗
PubMed2005

Inhibitory control of saccadic eye movements and cognitive impairment in Alzheimer's disease.

BACKGROUND: This study examined the relationship of inhibitory control and measures of neuropsychological impairment in patients with early Alzheimer's disease (AD). Four specific questions were addressed: 1) Which error parameters of saccadic inhibition are sensitive to AD? 2) Which inhibitory deficits are related to cognitive measures of impairment? 3) Is the inhibitory impairment in AD dependent on the initiation of a volitional eye movement? 4) How do the effects of saccadic inhibitory control in AD relate to the normal effects of aging? METHODS: Eighteen patients with probable AD and two control groups (seventeen young, and eighteen old participants) completed a battery of neuropsychological tests and four saccadic eye movement paradigms: pro-saccade, NO-GO, GO/NO-GO and anti-saccade. RESULTS: Old controls generated increased inhibition errors in comparison to young controls in the GO/NO-GO paradigm. In comparison to old controls, AD generated normal saccades in the pro-saccade paradigm, but showed a higher proportion of inhibition errors in the NO-GO, GO/NO-GO and anti-paradigms. The frequency of uncorrected errors in the anti-saccade paradigm was positively correlated with cognitive measures of dementia. CONCLUSIONS: AD patients have an impairment of inhibitory control and error-correction that exceeds the effects of normal aging and is related to the severity of dementia. However, the inhibitory impairment is not contingent on the interaction with a volitional saccade.

Adult↗
PubMed2006

A kinematic analysis of the rapid step test in balance-impaired and unimpaired older women.

Little is known about the kinematic and kinetic determinants that might explain age and balance-impairment alterations in the results of volitional stepping performance tests. Maximal unipedal stance time (UST) was used to distinguish "balance-impaired" old (BI, UST<10s, N=15, mean age=76 years) from unimpaired old (O, UST>30s, N=12, mean age=71 years) before they and healthy young females (Y, UST>30s, N=13, mean age=23 years) performed the rapid step test (RST). The RST evaluates the time required to take volitional front, side, and back steps of at least 80% maximum step length in response to verbal commands. Kinematic and kinetic data were recorded during the RST. The results indicate that the initiation phase of the step was the major source of age- and balance impairment-related delays. The delays in BI were primarily caused by increased postural adjustments prior to step initiation, as measured by center-of-pressure (COP) path length (p<0.003). The Step landing phase showed similar, but non-significant, temporal trends. Step length and peak center-of-mass (COM) deceleration during the Step-Out landing decreased in O by 18% (p=0.0002) and 24% (p=0.001), respectively, and a further 12% (p=0.04) and 18% (p=0.08) in BI. We conclude that the delay in BI step initiation was due to the increase in their postural adjustments prior to step initiation.

Adult↗
PubMed2004

Five-year-old children's difficulty with false belief when the sought entity is a person.

A total of 153 children (excluding those who erred on control questions), mainly 5 and 7 years of age, participated in two experiments that involved tests of false belief. In the task, the sought entity was first at Location 1 and then, unknown to the searching protagonist, it moved to Location 2. In Experiment 1, performance was well below ceiling in 5-year-olds when the sought entity was a person, and this contrasted with a task in which the sought entity was a physical object. Performance was especially inaccurate when the sought person moved of his or her own volition rather than when the sought person was requested to move by a third party. Interestingly, 5-year-olds were more likely to nominate Location 1 when asked where the searching protagonist would look first than when asked what he or she would do next. In Experiment 2, however, 5-year-olds also tended to nominate Location 1 following a question that included the word "first" even in a test of true belief--a patently incorrect response. Altogether, the results suggest that 5-year-old children have considerable difficulty with a test of false belief when the sought entity is a person acting under his or her own volition. This suggests that 5-year-olds' handle on states of belief is surprisingly fragile in this kind of task.

Age Factors↗
PubMed2004

Learned regulation of spatially localized brain activation using real-time fMRI.

It is not currently known whether subjects can learn to voluntarily control activation in localized regions of their own brain using neuroimaging. Here, we show that subjects were able to learn enhanced voluntary control over task-specific activation in a chosen target region, the somatomotor cortex. During an imagined manual action task, subjects were provided with continuous direction regarding their cognitive processes. Subjects received feedback information about their current level of activation in a target region of interest (ROI) derived using real-time functional magnetic resonance imaging (rtfMRI), and they received automatically-adjusted instructions for the level of activation to achieve. Information was provided both as continously upated graphs and using a simple virtual reality interface that provided an image analog of the level of activation. Through training, subjects achieved an enhancement in their control over brain activation that was anatomically specific to the target ROI, the somatomotor cortex. The enhancement took place when rtfMRI-based training was provided, but not in a control group that received similar training without rtfMRI information, showing that the effect was not due to conventional, practice-based neural plasticity alone. Following training, using cognitive processes alone subjects could volitionally induce fMRI activation in the somatomotor cortex that was comparable in magnitude to the activation observed during actual movement. The trained subjects increased fMRI activation without muscle tensing, and were able to continue to control brain activation even when real-time fMRI information was no longer provided. These results show that rtfMRI information can be used to direct cognitive processes, and that subjects are able to learn volitionally regulate activation in an anatomically-targeted brain region, surpassing the task-driven activation present before training.

Arousal↗
PubMed2006

Integration of feeding and spontaneous physical activity: role for orexin.

Spontaneous physical activity is activity that is non-volitional, or subconscious, such as fidgeting and shifting in one's seat, and time spent moving (standing and ambulating). Recent evidence indicates that spontaneous physical activity, and the resulting thermogenesis (non-exercise activity thermogenesis) may be regulated by brain systems. A large number of brain areas, with their associated neurotransmitter populations and connectivity, participate in the regulation of feeding behavior by acting as energy sensing and modulating centers. Although less well characterized, it is likely that a multitude of neurotransmitters and brain areas act to mediate spontaneous physical activity. These two behaviors, feeding and spontaneous physical activity, affect energy intake and expenditure and thus are important to body weight. Interestingly, often the two behaviors are affected simultaneously; when feeding is affected, so too is spontaneous physical activity, and both food intake and physical activity (whether spontaneous or volitional) influence activity of brain areas important to both. Several brain areas and neuropeptides are important to feeding and spontaneous physical activity. The lateral hypothalamus is one area that appears important to both behaviors, as stimulation or lesion of this region produces alterations in feeding behavior and spontaneous physical activity. Orexin neurons, with their central location in the lateral hypothalamus, widespread projections and connectivity to other brain areas important to energy homeostasis, are well situated to perform an integrative function. This review focuses on how hypothalamic orexins participate in both feeding and spontaneous physical activity, and provides potential models for the integration of signals important to both.

Animals↗
PubMed2001

Pelvic floor muscle contraction during a cough and decreased vesical neck mobility.

OBJECTIVE: To test the hypothesis that a voluntary pelvic muscle contraction initiated in preparation for a cough, a maneuver we call the Knack, significantly reduces vesical neck displacement. METHODS: A convenience sample of 22 women consisted of 11 young, continent nulliparas (mean age [+/- standard deviation] 24.8 +/- 7.0 years) and 11 older, incontinent paras (mean age [+/-SD] 66.9 +/- 3.9 years). With the use of perineal ultrasound, we quantified vesical neck displacement at rest and during coughs using caliper tracing and a coordinate system. The subjects coughed with and without voluntary pelvic floor muscle contraction. RESULTS: Vesical neck mobility during coughs was significantly decreased when voluntary contraction was used: from a median (range) of 5.4 (20.0) mm without volitional contraction to 2.9 (18.3) mm with volitional contraction (P <.001). The younger women demonstrated a median (range) decrease in excursion from 4.6 (19.5) to 0.0 (17.0) mm (P =.007), and the older incontinent women demonstrated a median (range) decrease from 6.2 (10.0) to 3.5 (15.4) mm (P =.003). At rest, the median vesical neck position in the group of older incontinent women was significantly further dorsocaudal (P =.001) than in the younger women. CONCLUSION: A pelvic floor muscle contraction in preparation for, and throughout, a cough can augment proximal urethra support during stress, thereby reducing the amount of dorsocaudal displacement.

Adult↗
PubMed1996

Site of facilitation of diaphragm EMG to corticospinal stimulation during inspiration.

The electromyographic response of the diaphragm to (a) transcutaneous electrical stimulation (TCES) of the spinal cord at C5 and above, (b) transcranial magnetic stimulation (TMS) over the motor cortex and (c) transcutaneous electrical stimulation of the phrenic nerve in the neck (TPNS), was recorded in six normal subjects at the antero-lateral chest wall. The compound motor evoked potentials (cMEPs) recorded in response to both TMS and TCES were facilitated to a similar extent during volitional inspiration; this facilitation was greater than any change seen in response to TPNS with inspiration. The results show that facilitation of the response in the diaphragm to TMS during volitional inspiration is due to increased excitability at synapses associated with the spinal motoneurone pool, but they do not exclude a component due to increased higher centre excitability. We conclude that it is unsafe to assign a cortical contribution to 'automatic' inspiration on the sole basis of facilitation of the electromyographic response in the diaphragm to TMS.

Adult↗
PubMed1999

A new temporary catheter (ContiCath) for the treatment of temporary, reversible, postoperative urinary retention.

OBJECTIVES: To describe the initial experience of a newly designed temporary urethral catheter, ContiCath, as an aid in the management of postoperative or temporary outflow obstruction. In patients with normal detrusor and sphincter function, this catheter allows volitional voiding while maintaining an open prostatic urethra. METHODS: In a pilot study, 64 nonconsecutive patients with postoperative or temporary urinary retention, at eight clinical trial sites, were enrolled for the placement of this temporary catheter. Three patients did not have the catheter placed because of placement failure because of either a large median lobe or a urethral stricture. The remaining 61 patients were divided into three groups: those with non-neuropathic causes of retention and retention for 1 week or less (37 patients), those with non-neuropathic causes of retention and retention for longer than 1 week (19 patients), and those with neuropathic causes of retention and retention for longer than 1 week (5 patients). The ContiCath is placed in the office setting, in the same fashion as a Foley catheter. A blue prolene tether extends from the bulbar urethra to the meatus to assist in the removal of the device. Patients were then reassessed at 3 hours, and at 7, 14, 21, and 28 days, at which point the device was removed. RESULTS: In patients with a neuropathic cause for their retention (5 patients) and those with non-neuropathic causes of retention and retention for longer than 1 week (19 patients), only 3 patients were able to void after the catheter was placed. Of the 37 patients with a non-neuropathic cause and retention 1 week or less, controlled voiding was seen in 33 patients (89%). Controlled voiding was defined as the patient's volitional ability to initiate and stop his urinary stream. There were no complications with catheter placement; however, 8 patients (24.2%) had minor adverse experiences of frequency/urgency (n = 3), incontinence (n = 3), migration of the catheter (n = 1), and pain (n = 1). CONCLUSIONS: ContiCath offers an alternative to an indwelling Foley catheter in men with temporary bladder outlet obstruction and urinary retention.

Aged↗
PubMed2000

A computer analysis of reflex eyelid motion in normal subjects and in facial neuropathy.

OBJECTIVE: To demonstrate how computerized eyelid motion analysis can quantify the human reflex blink. DESIGN: Seventeen normal subjects and 10 patients with unilateral facial nerve paralysis were analyzed. BACKGROUND: Eyelid closure is currently evaluated by systems primarily designed to assess lower/midfacial movements. The methods are subjective, difficult to reproduce, and measure only volitional closure. Reflex closure is responsible for eye hydration, and its evaluation demands dynamic analysis. METHODS: A 60Hz video camera incorporated into a helmet was used to analyze blinking. Reflective markers on the forehead and eyelids allowed for the dynamic measurement of the reflex blink. Eyelid displacement, velocity and acceleration were calculated. The degree of synchrony between bilateral blinks was also determined. RESULTS: This study demonstrates that video motion analysis can describe normal and altered eyelid motions in a quantifiable manner. CONCLUSIONS: To our knowledge, this is the first study to measure dynamic reflex blinks. Eyelid closure may now be evaluated in kinematic terms. This technique could increase understanding of eyelid motion and permit more accurate evaluation of eyelid function. Dynamic eyelid evaluation has immediate applications in the treatment of facial palsy affecting the reflex blink. Relevance No method has been developed that objectively quantifies dynamic eyelid closure. Methods currently in use evaluate only volitional eyelid closure, and are based on direct and indirect observer assessments. These methods are subjective and are incapable of analyzing dynamic eyelid movements, which are critical to maintenance of corneal hydration and comfort. A system that quantifies eyelid kinematics can provide a functional analysis of blink disorders and an objective evaluation of their treatment(s).

Acceleration↗
PubMed2002

The man who executed "imagined" movements: evidence for dissociable components of the body schema.

We examined the nature of representations underlying motor imagery and execution in a patient (CW) with bilateral parietal lesions. When imagining hand movements, CW executed the imagined motor act but was unaware of the movements. These movements were significantly more accurate than volitional movements for the left but not right hand. CW also exhibited preserved motor imagery for the left but not right hand. Consistent with previous accounts, these findings suggest that motor imagery may normally involve the inhibition of movements. CW's unawareness of movements during motor imagery may reflect inattention or misattribution of the unexpected sensory feedback. Furthermore, in line with current models of motor control, motor imagery may depend on the integrity of a "forward model" derived from motor outflow information to generate a prediction of the consequences of a motor command. Such predictions appear to be preserved for imagery of left but not right hand movements in CW. Action may additionally depend on precise updating of effector position derived from the comparison of predicted and actual sensory information. We propose that CW's impaired volitional movements may be attributable to the degradation of such an updating mechanism.

Aged↗
PubMed1999

Spontaneous motor seizures of rats with kainate-induced epilepsy: effect of time of day and activity state.

Kainate treatment in rats can result in a chronic behavioral state that is similar to human temporal lobe epilepsy. We tested the hypothesis that, like some humans with epilepsy, rat with kainate-induced epilepsy have more spontaneous motor seizures during inactivity (i.e. little to no volitional movement, including apparent sleep) than during activity (i.e. apparent volitional movement, as in walking, grooming, eating, etc.). Rats were given intraperitoneal (i.p.) injections of kainate (5 mg/kg) every hour so that class III/IV/V seizures were elicited for > or = 3 h. Seizure behavior was video-monitored (24 h for 5-6 days, n = 32 rats at 3 months and n = 23 rats at 4 months after treatment) to examine the occurrence of seizures as a function of light versus dark (12-12-h light-dark cycle) and inactivity versus activity. Significantly more spontaneous motor seizures occurred during inactive versus active states (82% vs. 18%, P = 0.0001). Although more seizures occurred during the light period than the dark, the difference was not significant (62% vs. 38%, P > 0. 1). These data suggest that the frequency of spontaneous motor seizures in the rat with kainate-induced epilepsy depends primarily on activity state rather than time of day (i.e. time during the light-dark cycle). The effect of inactivity on the occurrence of seizures in the rat with kainate-induced epilepsy appears similar to some forms of human epilepsy.

Animals↗
PubMed2000

Reflex facilitation during the stretch-shortening cycle.

Maximal torque during the concentric phase of a movement has been shown to be enhanced by prior eccentric muscle actions, a movement strategy referred to as the stretch-shortening cycle. Although the mechanical basis for this enhancement is well established, the neural component is not. We hypothesized that brief high-frequency bursts of spindle afferent discharge during the eccentric phase of the stretch-shortening cycle could be one mechanism for facilitating the volitional drive. To test this hypothesis, three sets of experiments were done. In the first (N=15), we demonstrated that both the peak and mean EMG of the soleus (S) and lateral gastrocnemius (LG) muscles were considerably greater during a reciprocal hopping (RHOP) task than for maximum isometric contractions (MIVCs). In the second experiment, we tested whether the dynamic nature of the RHOP or the eccentric phase of the RHOP contributed to the EMG potentiation. Peak and mean EMG produced with a concentric hop (CHOP), in which the lengthening phase of the hop was eliminated, were compared with that produced with the RHOP and MIVCs conditions (N=7). The RHOP produced greater peak EMG than either the CHOP or the MIVCs while the mean EMG for both hopping conditions was considerably more than the MIVCs. In the final experiment, we attempted to mimic the brief high-frequency burst of spindle afferent activity during the lengthening phase of the stretch-shortening cycle in the absence of muscle length changes. High-frequency (100 Hz) afferent stimulation (HFS) was delivered during MIVCs. At rest, the HFS produced negligible EMG activity but when superimposed over MIVCs produced a marked potentiation of the S EMG over values obtained during MIVCs alone. Evidence that HFS synchronizes the EMG associated with volitional activation is also provided. We conclude that a substantial but brief facilitation and possible synchronization of the neural drive is provided by the spindle afferents during the eccentric phase of the stretch-shortening cycle.

Adolescent↗
PubMed2006

Surgery Insight: advantages and pitfalls of surgical techniques for the correction of bladder exstrophy.

Staged reconstruction repair of bladder exstrophy results in hydronephrosis or renal scarring in 15-25% of patients. A cosmetically acceptable and functional phallus can be achieved in 85% of patients, 20-30% of whom will require more than one operation for penile reconstruction. Episodes of penile glans loss or corporal loss are rarely reported with this technique. Widely disparate results relating to complete urinary continence and volitional voiding have been published, with urinary continence reported to occur in 7-85% of patients. The need for bladder augmentation to obtain urinary continence also varies, with reports that somewhere between 10% and 90% of patients require an augmentation procedure to gain urinary continence. Complete primary repair of bladder exstrophy using the penile disassembly technique results in hydronephrosis or renal scarring in 0-30% of patients, and hypospadias, as a consequence of this repair, will occur in 30-70% of patients. Loss of the glans and corpora appear more frequently with penile disassembly than in staged reconstruction of bladder exstrophy, however, the exact incidence of this complication is unknown. Reported complete urinary continence and volitional voiding rates are also varied following penile disassembly, ranging from 25-65%. A modified bladder-neck reconstruction to gain urinary continence is reportedly required in 15-90% of patients, with 5-10% requiring both bladder augmentation and bladder-neck reconstruction. Experience with complete primary repair of bladder exstrophy, using the penile disassembly approach, seems promising but is not a panacea. To outline the risks and benefits regarding the various surgical techniques for bladder exstrophy, we would recommend the establishment of a national registry for patients with this disorder.

Bladder Exstrophy↗