Biomedical subjects

H C Kuo

Publications and source records attributed to H C Kuo.

At least 19 recordsLinked to original sources

PubMed1998

Position of poly(methyl methacrylate) and silicone intraocular lenses after phacoemulsification.

PURPOSE: To compare the positional change of poly(methyl methacrylate) (PMMA) and silicone intraocular lenses (IOLs) in vivo after phacoemulsification. SETTING: Taipei Municipal Yang-Ming Hospital, Taipei, Taiwan. METHODS: A prospective study of 70 cataractous eyes treated by phacoemulsification with IOL implantation was carried out. The eyes were randomized into 2 groups based on IOL type: 1-piece PMMA IOL; 3-piece silicone IOL. The amount of IOL tilt and decentration was measured and anterior chamber depth (ACD) determined by Scheimpflug photography using an anterior eye segment analysis system (EAS-1000, Nidek). All eyes were examined 1 week and 1 to 6 months after surgery. RESULTS: No statistically significantly differences were found in the amount of tilt and decentration between 2 IOL types throughout the study. The ACDs were relatively constant in both groups through the early postoperative periods. CONCLUSION: The stability of PMMA and silicone IOLs were the same after phacoemulsification.

Aged↗

PubMed1998

Chromosomal mosaicism in cleavage-stage human embryos and the accuracy of single-cell genetic analysis.

PURPOSE: Our purpose was to assess the effect of chromosomal mosaicism in cleavage-stage human embryos on the accuracy of single-cell analysis for preimplantation genetic diagnosis. METHODS: Multicolor fluorescence in situ hybridization with X, Y, and 7 or X, Y, 7, and 18 chromosome-specific probes was used to detect aneuploidy in cleavage-stage human embryos. RESULTS: Most nuclei were diploid for the chromosomes tested but there was extensive mosaicism including monosomic, double-monosomic, nullisomic, chaotic, and haploid nuclei. CONCLUSIONS: Identification of sex by analysis of a single cleavage-stage nucleus is accurate but 7% of females are not identified. One or both parental chromosomes 7 were absent in at least 6.5% of the nuclei. With autosomal recessive conditions such as cystic fibrosis, carriers would be misdiagnosed as normal or affected. With autosomal dominant conditions, failure to analyze the affected parents allele (1.6-2.5%) would cause a serious misdiagnosis and analysis of at least two nuclei is necessary to reduce errors.

Chromosome Aberrations↗

PubMed1998

Quality of life after active urological management of chronic spinal cord injury in eastern Taiwan.

OBJECTIVE: Motor cycle accidents are the major cause of head injury and spinal cord injury (SCI) in Taiwan. The incidence of SCI in Hualien county is the highest in the world. In a community hospital in Hualien, active urological management was carried out for SCI patients with voiding dysfunctions and urological complications. This study was conducted to assess the success of active urological management. METHODS: From 1988 to 1996, in the urological department, 251 SCI patients with varying voiding dysfunctions or urological complications were managed with various surgical or nonsurgical procedures according to their underlying pathologies. The satisfaction rate and quality of life index were assessed before and after active urological treatment. RESULTS: There were 118 patients with cervical SCIs, 93 patients with thoracic or lumbar SCIs, and 40 patients with sacral SCIs or infrasacral neuropathy. After initial managements, 174 patients were able to pass urine by themselves, by clean intermittent self-catheterization (CISC) or with an indwelling Foley catheter. The remaining 77 patients suffering from severe dysuria, urinary incontinence, hydronephrosis and frequent urinary tract infections were managed with various surgical procedures. The procedures included external sphincterotomy (n = 30), enterocystoplasty (n = 28), autoaugmentation (n = 6), continent urinary diversion (n = 7), periurethral Teflon injection (n = 3), and transurethral resection of the prostate (n = 3). After treatment, hydronephrosis resolved in 100% of the kidney units; frequent symptomatic urinary tract infection improved in 83.3% after external sphincterotomy and 75% after enterocystoplasty and continent diversion; while urinary incontinence disappeared or improved in 93% after enterocystoplasty and autoaugmentation. The total satisfaction rate was 84.4% after the surgical procedures. The mean quality of life index improved from -1.27 +/- 0.39 to +1.54 +/- 0.38 after management. However, some complications such as mucus secretion (76.5%), abdominal pain (20.6%), loose stool (23.5%) and frequent stone formation (11.8%) still bothered the patients undergoing enterocystoplasty and continent diversion. Repeat sphincterotomy was necessary in 16.7% of patients, and 50% were not satisfied with total incontinence after external sphincterotomy. During the follow-up period, 87% of all patients had > or = 1 yearly episode of urinary tract infection after spinal injury and 11 patients died of urosepsis. CONCLUSIONS: Active urological management to improve quality of life and to treat urological complications in SCI patients is mandatory. After long-term follow-up, SCI patients can be free of indwelling catheters, hydronephrosis usually resolves and urinary tract infections are infrequent.

Adolescent↗

PubMed1998

Comparative study of therapeutic effect of dibenyline, finasteride, and combination drugs for symptomatic benign prostatic hyperplasia.

OBJECTIVES: A prospective study was conducted in a community hospital in order to evaluate the therapeutic effect of dibenyline, finasteride, and a combination of the two drugs for symptomatic benign prostatic hyperplasia (BPH). METHODS: 190 men suffering from severe prostatism entered this study. They were assessed by IPSS symptom score, digital rectal examination, transrectal sonography of the prostate, uroflowmetry and residual urine. The patients were randomly selected for medical treatment with dibenyline 10 mg b.i.d. (n = 71), finasteride 5 mg q.d. (n = 54), and a combination (n = 65). Clinical assessments were carried out before treatment and 3 and 6 months after starting treatment. Patients who could not complete the treatment and those with prostatic cancer were excluded from the final statistics. The quality of life after 6 months of treatment and side effects were also assessed. RESULTS: A total of 172 patients completed the treatment course and 153 patients completed the periodic clinical assessments. Improvement in IPSS was noted in all 3 groups of patients both at 3 and 6 months. The prostatic volume was found to decrease in the finasteride group and the combination group at 6 months by 24.3 and 10.5%, respectively. Maximal flow rate (Qmax) was significantly improved in the dibenyline and combination groups but not in the finasteride group at 3 months. At 6 months a significant increase in Qmax was noted in all groups with a mean increase of 1.4-1.8 ml/s. The quality of life after treatment was satisfactory in 71.9% of the dibenyline group, 70.4% of the finasteride group and 83.1% of the combination group. Side effects were higher in the dibenyline than the finasteride or combination group. The dropout rate was higher in the dibenyline group (15.5%) than in the finasteride (7.5%) and combination (4.6%) groups. After 6 months of treatment, some of the patients discontinued medication and symptom relapse was noted in 92.6% of the dibenyline group, 57.6% of the finasteride group, and 71% of the combination group. CONCLUSIONS: Medical treatment is effective in treating symptomatic BPH. Combination dibenyline and finasteride provides a weak synergistic clinical effect without additive side effects.

Adrenergic alpha-Antagonists↗

PubMed1998

Transrectal sonographic investigation of urethral and paraurethral structures in women with stress urinary incontinence.

Transrectal sonography of the urethra was used in 14 asymptomatic volunteers, 37 women with frequency-urgency syndrome, 42 patients with mild stress urinary incontinence, and 18 with severe stress urinary incontinence. Transverse scanning over the midurethra was performed and cross-sectional images of the urethral and paraurethral structures were compared among the four groups, with P < 0.05 being considered statistically significant. The total cross-sectional area of the midurethra was significantly smaller in patients with stress urinary incontinence than in those without this disorder (86.7+/-29.9 versus 104+/-35.6 mm2, P = 0.005); this difference resulted from a significantly smaller peripheral striated muscle component in patients with stress urinary incontinence (42.8+/-20.7 versus 58.3+/-27.3 mm2, P = 0.001). The thickness of the urethropelvic ligaments was significantly thinner in patients with stress urinary incontinence than in those without (5.9+/-1.7 versus 8.9+/-2.1 mm, P < 0.001). The distribution of the peripheral striated muscle around the urethra was variable: complete surrounding the urethra was noted in 35.7% of the control women and in 48.6% of frequency-urgency patients, but only in 16.7% of patients with mild stress urinary incontinence and 5.3% of patients with severe disease. Bladder neck incompetence was seen in 42 patients with stress urinary incontinence but in none of the control women. The length of the pubourethral ligaments was similar in the four groups. Our finding showed that stress urinary patients had a smaller striated muscle component in the midurethra and thinner urethropelvic ligaments. These defects in the continence mechanisms might have great implications in the pathophysiology of stress urinary incontinence. Transrectal sonography of the urethra is a valuable investigative tool in assessing urethral and paraurethral conditions in patients with stress urinary incontinence before deciding treatment modality.

Female↗

PubMed1997

Clinical outcome and quality of life after enterocystoplasty for contracted bladders.

From 1989 to 1995, a total of 21 patients underwent enterocystoplasty in order to increase their bladder capacity and decrease intravesical pressure. Of these, 18 had neuropathic bladders caused by spinal cord injuries and 3 had contracted bladders caused by irradiation cystitis following treatment of cervical cancer. Enterocystoplasty was performed using a 40-cm segment of terminal ileum. The postoperative follow-up periods ranged from 6 to 80 months (mean 36 months). Twelve patients, who had had preoperative hydronephrosis, showed complete resolution after enterocystoplasty. Sixteen patients, suffering from intractable urinary incontinence preoperatively, regained continence after surgery while 2 continued to have mild urgent or stress incontinence. Their mean bladder capacities were 165 +/- 97 ml preoperatively and 760 +/- 289 ml postoperatively. The end-filling pressures were 50 +/- 23 cm H2O preoperatively and 13 +/- 4.7 cm H2O postoperatively. Sixteen patients could urinate smoothly, but 12 of them occasionally needed intermittent catheterization in order to evacuate residual urine. Nineteen patients were satisfied with their surgical result, whereas 1 wished to become completely dry, and 1 could not be catheterized because of poor family support. All but 1 of the patients declared that the quality of life improved after surgery. In conclusion, enterocystoplasty is satisfactory treatment for contracted bladders that result in upper tract deterioration or intractable urinary incontinence. Acceptable continence was achieved in 90% of the patients and the overall satisfaction rate was 95%. Careful patient selection is necessary for achieving a good surgical outcome.

Adult↗

PubMed1997

Inhibitory effect of capsaicin on detrusor contractility: further study in the presence of ganglionic blocker and neurokinin receptor antagonist in the rat urinary bladder.

In order to understand the mechanisms by which capsaicin at high concentrations affects the micturition reflex and detrusor contractility, in vivo and in vitro whole bladder studies were conducted using ganglionic blockers and a neurokinin receptor antagonist. Thirty-eight adult rats were divided into control (normal saline cystometry) and experimental (1,000 microM capsaicin cystometry) groups. Both groups were subdivided to receive pretreatment with intravesical hexamethonium, perivesical hexamethonium, or intravesical spantide ([D-Arg1, D-Trp7,9, Leu11]-substance P). After in vivo cystometry, the bladders were removed and in vitro whole bladder contractility studies using electrical field stimulation as well as bethanechol and KCl stimulations were performed. In the bladders pretreated with perivesical hexamethonium, the amplitudes of contractions and in vitro detrusor contractility under electrical stimulation were decreased. Other bladder preparations showed no significant differences from the controls. However, when 1,000 microM capsaicin was infused into the bladders, both control and experimental bladders showed an initial excitation and a final inhibition with an elevated basal intravesical pressure and retention. Capsaicin at 100 microM did not have this effect. The results of this study conclude that blockage of perivesical ganglia or neurokinin receptors in the submucosa did not influence the depressant effects of 1,000 microM capsaicin on the micturition reflex and detrusor contractility in rats. Nonspecific toxic effects on detrusor muscle or nerves is likely when intravesical high-concentration capsaicin is administered.

Administration, Intravesical↗

PubMed1997

The uroflowmetry in normal men and after prostatectomy.

OBJECTIVE: This study was designed to determine and compare the uroflow parameters of normal men and patients after prostatectomy in order to investigate the flow rate expression in men without bladder outlet obstruction. MATERIALS AND METHODS: Five hundred and fourteen men aged from 17 to 84 years who subjectively felt that their urination was normal and were objectively demonstrated to be without prostatic hyperplasia were enrolled in the normal group. For comparison, 356 patients after prostatectomy were also included as age-matched treated groups. Both groups were further divided into age-based subgroups. Uroflowmetry and transrectal sonography were performed in all the subjects. The uroflow parameters and prostatic volumes of different patient groups were compared. Regression analysis was used to estimate the correlation between maximal flow rate (Qmax) and age, as well as between Qmax and volume. RESULTS: The results show that voided volume decreased with age in asymptomatic men without prostatic hyperplasia. The decreased voided volume with age resulted in declining Qmax in normal men. In patients after prostatectomy, however, infravesical obstruction affected detrusor contractility more with age and resulted in a declining flow rate expressed in similar voided volumes. In normal men, the mean Qmax was 20.7 +/- 7.3 ml/s in a mean voided volume of 290.7 +/- 123.2 ml. As age increased, smaller bladder capacity resulted in lower flow rate expressions, but the corrected Qmax showed no significant differences. CONCLUSION: Normal elderly men without prostatic hyperplasia can have good urinary flow and good bladder energetics. Asymptomatic men with low flows might have incipient infravesical obstructions. Patients after prostatectomy had impaired detrusor contractility that resulted in a low flow rate expression with age.

Adolescent↗

PubMed1997

CARP, a cardiac ankyrin repeat protein, is downstream in the Nkx2-5 homeobox gene pathway.

To identify the molecular pathways that guide cardiac ventricular chamber specification, maturation and morphogenesis, we have sought to characterize factors that regulate the expression of the ventricular myosin light chain-2 gene, one of the earliest markers of ventricular regionalization during mammalian cardiogenesis. Previously, our laboratory identified a 28 bp HF-la/MEF-2 element in the MLC-2v promoter region, which confers cardiac ventricular chamber-specific gene expression during murine cardiogenesis, and showed that the ubiquitous transcription factor YB-1 binds to the HF-la site in conjunction with a co-factor. In a search for interacting co-factors, a nuclear ankyrin-like repeat protein CARP (cardiac ankyrin repeat protein) was isolated from a rat neonatal heart cDNA library by yeast two-hybrid screening, using YB-1 as the bait. Co-immunoprecipitation and GST-CARP pulldown studies reveal that CARP forms a physical complex with YB-1 in cardiac myocytes and immunostaining shows that endogenous CARP is localized in the cardiac myocyte nucleus. Co-transfection assays indicate that CARP can negatively regulate an HF-1-TK minimal promoter in an HF-1 sequence-dependent manner in cardiac myocytes, and CARP displays a transcriptional inhibitory activity when fused to a GAL4 DNA-binding domain in both cardiac and noncardiac cell context. Northern analysis revealed that carp mRNA is highly enriched in the adult heart, with only trace levels in skeletal muscle. During murine embryogenesis, endogenous carp expression was first clearly detected as early as E8.5 specifically in heart and is regulated temporally and spatially in the myocardium. Nkx2-5, the murine homologue of Drosophila gene tinman was previously shown to be required for heart tube looping morphogenesis and ventricular chamber-specific myosin light chain-2 expression during mammalian heart development. In Nkx2-5(-/-)embryos, carp expression was found to be significantly and selectively reduced as assessed by both whole-mount in situ hybridizations and RNase protection assays, suggesting that carp is downstream of the homeobox gene Nkx2-5 in the cardiac regulatory network. Co-transfection assays using a dominant negative mutant Nkx2-5 construct with CARP promoter-luciferase reporter constructs in cardiac myocytes confirms that Nkx2-5 either directly or indirectly regulates carp at the transcriptional level. Finally, a carp promoter-lacZ transgene, which displays cardiac-specific expression in wild-type and Nkx2-5(+/-) background, was also significantly reduced in Nkx2-5(-/-) embryos, indicating that Nkx2-5 either directly or indirectly regulates carp promoter activity during in vivo cardiogenesis as well as in cultured cardiac myocytes. Thus, CARP is a YB-1 associated factor and represents the first identified cardiac-restricted downstream regulatory gene in the homeobox gene Nkx2-5 pathway and may serve as a negative regulator of HF-1-dependent pathways for ventricular muscle gene expression.

Amino Acid Sequence↗

PubMed1997

Protective effect of tetrandrine on normal human mononuclear cells against ionizing irradiation.

Tetrandrine, an alkaloid isolated from the plant Stephania tetrandra, at low concentration (2 micrograms/ml) was shown to protect normal human mononuclear cells in vitro against damage due to a single high-dose of ionizing irradiation (10 Gy). The cell survival rate increased from 58.3 +/- 2.2% in the irradiated group to 78.0 +/- 2.6% in the tetrandrine-pretreated group, and similarly, the percentage of necrotic cells declined from 20.7 +/- 2.5% to 10.7 +/- 1.9%, respectively. This protective effect of tetrandrine for cell surviving fraction increased in a dose-dependent manner. Tetrandrine was also found to inhibit inflammatory responses induced by irradiation including the release of superoxide (NBT [nitroblue tetrazolium] reduction decreased from 21.3 +/- 2.3% to 10.2 +/- 2.5%) and phagocytic activity (decreased from 80.7 +/- 3.8% to 50.7 +/- 2.3%, the same range level as that of the control group). However, the alkaloid demonstrated no effect on the production of nitric oxide. In terms of cell morphology, only two types were observed-normal or necrotic cells, and there were no characteristics of programmed cell death. These results indicate that tetrandrine possesses radioprotective activity against 10 Gy of ionizing irradiation and could suppress irradiation-induced inflammatory processes.

Alkaloids↗

PubMed1997

Aspirin improves uterine blood flow in the peri-implantation period.

A prospective clinical study at the Infertility Clinic of National Cheng Kung University Hospital investigated the effect of aspirin on infertile women with impaired uterine perfusion. A total of 127 women with unexplained infertility or repeated failure with various assisted-conception techniques were enrolled. Uterine perfusion was assessed by Doppler ultrasound and classified as normal or impaired (pulsatility index < 3.0 or > or = 3.0, respectively). One-third (43/127) of the women were found to have impaired uterine perfusion during their menstrual cycles. Those with impaired uterine blood flow were given aspirin (100 mg/day) starting on day 3 of the next ovulatory cycle. Only 36 women completed both the screening and the aspirin-treated cycles. The pulsatility index was measured in the natural and aspirin-treated cycles in the same group of women and compared using repeated measures analyses of variance. A significant improvement in the uterine blood perfusion (p < 0.05) was detected on the day leutinizing hormone peaked and in the midluteal phase (peri-implantation period) of aspirin-treated cycles. Thus, the use of low-dose aspirin may improve uterine perfusion in women with unexplained infertility and impaired uterine blood flow.

Adult↗

PubMed1997

Comparative study of the effects of capsaicin on the contractility of normal and spinal cord injured human bladders.

In order to investigate the effects of capsaicin on human detrusor contractility in both normal and spinal cord injury (SCI) bladders, a detrusor contractility study was performed in 10 normal and 8 SCI patients using isolated muscle strips. Eight bladder muscle strips were harvested from each patient undergoing surgery. Four strips were treated with capsaicin of 1-1000 microM, and electrical field stimulation and bethanechol were applied to the strips before and after capsaicin administration. The other four strips were pretreated with 40 nmole [D-Arg1, D-Trp7,9,Leu11]-Substance P (spantide) and then were underwent the same procedure. The results showed that capsaicin induced a dose-dependent increase in muscle tension on the human detrusor in both normal and SCI bladders. After treatment with varying concentrations of capsaicin for 10 minutes, low doses of capsaicin partially depressed detrusor contractility under both electrical and bethanechol stimulation while high doses of up to 1000 microM almost totally blocked detrusor contractility. The initial contractile effect of capsaicin was higher in normal bladders but the final depressant effect did not show any difference between normal and SCI bladders. With addition of spantide, the initial contractile effect and the final depressant effect of capsaicin remained the same, indicating that the contractile effects of capsaicin were not mainly through NK receptors but directly on muscle cells. Consecutive application of capsaicin to the same strip could not reproduce the contractile response. After washing free of capsaicin, the detrusor contractility under electrical stimulation and bethanechol was not reversible. A direct neurotoxic or cytotoxic effect could be found after high concentration capsaicin administration. In treating patients suffering from detrusor hyperreflexia using intravesical capsaicin instillation, this effect should be considered to prevent irreversible damage to the urinary bladder.

Analgesics↗

PubMed1997

Capsaicin inhibits detrusor contractility but not the micturition reflex in capsaicin-desensitized rats.

Intravesical capsaicin at high concentration (1 mmol/L) inhibits the micturition reflex and detrusor contractility. To investigate the mechanism, we compared rats that had been desensitized by capsaicin at birth with control rats. In vivo cystometrography was performed with normal saline (n = 5) or 1 mmol/L capsaicin (n = 5), then an isolated whole bladder contractility study with electrical field stimulation, bethanechol, and KCl was carried out. In the bladders with normal saline cystometrography and after isolated bladder study, 0.5 mL of 1 mmol/L capsaicin was instilled into the bladders and another set of stimulations by electrodes, bethanechol, and KCl was given. The bladders of capsaicin-desensitized rats showed the presence of detrusor reflexes but diminished amplitudes of detrusor contractions. There was no urinary retention or increased intravesical pressure in these desensitized bladders after capsaicin cystometrography. The detrusor contractility in the isolated whole bladder study showed no significant difference between the control and experimental bladders. After 1 mmol/L capsaicin cystometrography the bladders had little contractility compared with bladders after saline cystometrography. The bladders of the desensitized rats increased in weight compared to the controls. Intravesical administration of 1 mmol/L capsaicin induced an initial excitatory effect on the micturition reflex and final urinary retention in control rats. After capsaicin treatment at birth, these effects no longer existed but the depressant effect of capsaicin on detrusor contractility persisted. We conclude that a high concentration of intravesical capsaicin acutely inhibits the micturition reflex and detrusor contractility. Neonatal desensitization by capsaicin can depress the detrusor contractility in rats but the micturition reflex is not affected.

Animals↗

PubMed1997

Reversibility of the inhibitory effect of intravesical capsaicin on the micturition reflex in rats.

The reversibility of the inhibitory effect of capsaicin on the micturition reflex was investigated in adult rats. The experimental group (n = 38) were given 0.5 mL of 1 mmol/L intravesical capsaicin. After 30 minutes the bladder was evacuated, then the rats were allowed to recover for various times from 0 to 24 hours before cystometrography. Control rats (n = 6) were injected with saline. Immediately after capsaicin treatment, the bladders showed detrusor hyperactivity and high intravesical pressure during cystometrography. All capsaicin-treated bladders showed final urinary retention and hematuria developed in 32 of 38. At 6 hours after intravesical instillation of capsaicin, detrusor hyperactivity was reduced and the micturition reflex gradually reappeared. By 12 hours, micturition reflexes were noted in seven of eight bladders with a volume threshold equal to that of the control group. At 24 hours, the volume threshold for the micturition reflex was significantly greater in the capsaicin-treated group than in the control group. The amplitude of detrusor contractions at 6, 12, and 24 hours showed no significant difference from that in the controls. In vitro whole bladder contractility in response to electrical field stimulation, bethanechol, and KCl also showed no significant difference between the control and the experimental groups. The bladder weight increased as the recovery period increased, indicating the presence of neurogenic inflammation. From this study we conclude that capsaicin-induced micturition reflex inhibition in rats is reversible at 12 hours and the volume threshold for eliciting the micturition reflex continues to increase up to 24 hours after capsaicin treatment. These results may provide insight into the clinical application of capsaicin in the treatment of various voiding disorders in humans.

Animals↗

PubMed1996

Effects of capsaicin on detrusor contractility of rats: an in vivo and isolated whole bladder study.

Capsaicin has been proven to deplete neuropeptides in sensory afferent nerve terminals, causing initial excitatory and final inhibitory effects on the urinary bladder in rats and humans. In order to investigate the effect of capsaicin on detrusor contractility, an in vivo and in vitro whole bladder study was undertaken in 32 adult rats with an intact neuraxis. With intravesical application of capsaicin solution, an increased inhibitory effect of detrusor contractility was observed while the concentration of capsaicin increased. At the concentration of 1,000 microM, all rat bladders showed urinary retention in vivo. While the bladders were mounted in the baths for in vitro study, detrusor contractility was significantly affected in bladders pretreated with 1,000 microM capsaicin. Substance P-induced detrusor contraction was not affected by the presence of high concentrations of capsaicin. The presence of exogenous substance P did not improve detrusor contractility in capsaicin-pretreated bladders. The results of this study reveal that capsaicin-sensitive primary afferents have an important role in modulating reflex micturition and detrusor contractility. Depletion of neuropeptides by topical capsaicin administration at high concentrations can inhibit detrusor contractility and results in urinary retention in rats with intact neuraxis.

Administration, Intravesical↗

PubMed1996

Transrectal sonography of the female urethra in incontinence and frequency-urgency syndrome.

Transrectal sonography of the bladder and urethra was performed to investigate urethral conditions in 296 women (191 with stress urinary incontinence, 78 with frequency-urgency syndrome, and 27 who were asymptomatic). Patients with stress urinary incontinence showed larger pubovesical angle during both resting and straining states than those with either frequency-urgency syndrome or those who were asymptomatic. Pubovesical length did not vary among the three groups of women. Five types of stress urinary incontinence were classified according to the four findings of transrectal sonography: hypermobility of the bladder neck, bladder neck incompetence, urethral sphincteric incompetence, and the presence of a cystocele. Of the patients with frequency-urgency syndrome, 55.1% showed bladder neck incompetence, whereas only 29.6% of the asymptomatic women did. Of the patients with frequency-urgency syndrome, nine had urethral sphincteric incompetence and one had a cystocele. none of the asymptomatic women had any of these disorders. However, the presence of bladder neck incompetence did not correlate well with the presence of clinical symptoms. Transrectal sonography could not differentiate symptoms caused by the bladder from those caused by the urethra. Although a large overlapping of pubovesical angle size was noted among the groups of women, the angle was largest in those with stress urinary incontinence, second largest in those with frequency-urgency syndrome, and smallest in those who were asymptomatic. These findings held true during both resting and straining. Bladder neck incompetence was often associated with a weak extrinsic continence mechanism, as was demonstrated by pubovesical angle changes in both frequency-urgency syndrome patients and asymptomatic women. Urethral sphincteric incompetence was not present in asymptomatic women but could be found in 12.8% of those with frequency-urgency syndrome.

Adult↗

PubMed1996

Recovery of bladder function after relief of mild outlet obstructions of different durations in rabbits.

In order to understand the influence of obstruction duration on the recovery of obstructed bladders, a functional study of 36 obstructed rabbit bladders after relief of outlet obstruction was done. Bladder outlets were obstructed by placing a 5-mm inner diameter polyethylene cuff around the urethra. Obstructions were kept in place for varying periods: 1 day, 3 days, 1 week, 2 weeks, 4 weeks, 6 weeks and 8 weeks. The obstructions were then released and functional studies were performed after a recovery period of 2 weeks (experimental groups). Using results of another study of obstructed bladders as a basis, the bladder weight of the experimental groups decreased from an initial increase after obstruction, but stabilized at a 2.5-fold increase 8 weeks after release compared with the control bladders. In vitro whole bladder responses to electrical and carbachol stimulations were also studied. Significant functional recovery was noted in the experimental bladders of less than 4 weeks' obstruction, whereas in those of 6 weeks' and 8 weeks' obstruction, no definite functional improvement was noted after relief of outlet obstruction. The expulsion ability was not significantly better in the experimental bladders than in the obstructed bladders. A slight decrease in expulsion ability was noted in the experimental bladders as the obstructive duration increased but the difference was not statistically significant. An obstructive duration of up to 8 weeks did not have a significant influence on the functional recovery of the rabbit bladders. Applying these results to the management of humans with benign prostatic hyperplasia, surgical intervention seems indicated only in those patients with symptomatic outlet obstruction. Stable, mild obstruction can probably be treated conservatively.

Animals↗

PubMed1995

Interference with uterine blood flow by clomiphene citrate in women with unexplained infertility.

OBJECTIVE: To investigate the effect of clomiphene citrate on the uterine blood flow in women with unexplained infertility. METHODS: Twenty-one women who had normal uterine blood flow (pulsatility index [PI] less than 3 from the LH peak to the middle luteal phase of a natural ovulatory cycle) were enrolled in this study. Patients were given clomiphene citrate (100 mg/day) from days 5-9 of the next ovulatory cycle. The PI values measured in the natural and clomiphene citrate-treated cycles were compared using repeated measures analysis of variance. Their correlations with the estradiol (E2) and progesterone concentrations in the treatment cycle were calculated using the Pearson correlation coefficient. RESULT: In the natural cycles of those with normal uterine blood flow, the highest impedance of uterine blood flow was detected at the late follicular phase, then blood flow increased during the luteal phase. In the clomiphene citrate-treated cycles, a statistically significant decrease in uterine blood flow also occurred during the early luteal phase (P < .05). No significant correlation of E2 or progesterone serum concentrations with PI values of the uterine artery could be found in either natural or clomiphene citrate-treated cycles. CONCLUSION: The use of clomiphene citrate decreases the uterine blood flow during the early luteal phase, a periimplantation stage.

Adult↗