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T C Gerstenberg

Publications and source records attributed to T C Gerstenberg.

At least 19 recordsLinked to original sources
PubMed1996

A consensus on the normal characteristics of corpus cavernosum EMG.

Corpus cavernosum EMG (CC-EMG) has raised much controversy since its introduction. The first workshop on CC-EMG has resulted in acceptance of a standardized technique of recording. Using this technique 110 normal potent volunteers have been examined in different centres. One year later there is an agreement among participants that an analogous recording of CC-EMG during flaccidity in normal subject results in reproducible findings. CC-EMG is characterized by highly reproducible waveforms (potentials) within the individual subject and mostly of comparable shape interindividually. Maximum peak to peak amplitude lies between 75 and > 500 microV and potentials have a mean duration of 12 s.

Adolescent↗
PubMed1992

Intracavernous self-injection with vasoactive intestinal polypeptide and phentolamine in the management of erectile failure.

A total of 52 men, median age 55 years (range 28 to 74 years), with erectile failure was treated with vasoactive intestinal polypeptide and phentolamine. Impotence was classified as psychogenic in 3 patients, psychogenic/arteriogenic in 3, arteriogenic in 25, arteriogenic/neurogenic in 4, neurogenic in 5, venous leakage/psychogenic in 2, venous leakage/neurogenic in 1 and following venous leak surgery in 9. The patients were treated with 30 micrograms vasoactive intestinal polypeptide and 0.5 to 2.0 mg. phentolamine. A total of 1,380 self-injections was given and the number of injections per patient varied from 5 to 245. No patient had priapism, corporeal fibrosis or other serious complications. After sexual stimulation all patients obtained erection sufficient for penetration. Following ejaculation rigidity decreased normally. The median duration of treatment was 6 months (range 1 to 22). Nine patients discontinued treatment. One patient with severe arteriosclerosis experienced decreased effectiveness of the drug and received a penile prosthesis. Five patients elected not to perform self-injection any longer, 1 psychogenic impotent patient was cured, and 1 patient discontinued therapy due to palpitation and sweating. One patient died of a myocardial infarction not associated with this therapy.

Adult↗
PubMed1991

Evoked potentials from the lower urinary tract. II. The spino-cortical neuraxis. A methodological study.

Spinal and cerebral evoked potentials (EPs) on stimulation of the dorsal nerve of the penis, clitoris, bladder wall and posterior urethra were recorded in 20 normal subjects (10 females and 10 males). Responses were obtained by computer averaging of multiple potentials registered over the spinal cord (L1) and cerebral cortex. Responses from the posterior tibial nerve were also recorded. Consistent cortical responses were obtained from the pudendal nerve, bladder wall and posterior urethra, whereas spinal responses were difficult to record. The maximum responses after stimulation of the pudendal nerve, bladder wall and posterior urethra were recorded over the midline of the scalp at CZ-2 cm point. The configuration of the somatosensory evoked potentials of the pudendal nerve had a W-shape with a consistent positive peak P1 (median 42.0 msec, range 39-45 msec), whereas the responses after endovesical and endourethral stimulation mainly were M-shaped with a prominent negative peak N1 (Bladder: mean 104.0 msec, range 75-112 msec and posterior urethra: median 103.0 msec, range 78-114 msec). Conduction times within the central spinal pathways could be calculated by subtracting the latencies of the peripheral spinal potentials from the central cortical potentials.

Adult↗
PubMed1990

Is micturition disorder a pathogenic factor in acute epididymitis? An evaluation of simultaneous bladder pressure and urine flow in men with previous acute epididymitis.

We evaluated 22 men 22 to 70 years old with previous acute epididymitis by pressure-flow study 3 to 12 months after the inflammation had resolved. Nine healthy men 20 to 62 years old were evaluated as controls. The patients had no symptoms from the lower urinary tract except for 2 men with slight prostatism. The maximum intravesical and maximum voiding pressures were elevated significantly in the patients compared to the controls (p less than 0.05). In most patients and in all of the controls the maximum urinary flow rates were within the normal range according to age. Because of the frequency of high voiding pressures in patients with previous acute epididymitis, this condition may be a pathogenic factor by promoting urethrovasal reflux. The high voiding pressures may be transmitted to the proximal urethra or in cases of a narrow and rigid bladder neck they may produce increased turbulence in the urine stream.

Adult↗
PubMed1990

Erection and ejaculation in man. Assessment of the electromyographic activity of the bulbocavernosus and ischiocavernosus muscles.

Electromyographic (EMG) recordings were obtained by concentric needle electrodes from the bulbocavernosus (BC) and ischiocavernosus (IC) muscles in 7 human volunteers during excitement to erection and subsequent ejaculation. Simultaneous registration of the time course and volume of each expressed spurt of semen was obtained using an aluminium pan suspended in front of the subject's penis on a force transducer the output of which was charted with the EMG activity. The BC and IC muscles showed no EMG activity during erection and detumescence cycles induced by visual sex stimulation. In 5 of 7 subjects, the first EMG burst of the BC in ejaculations induced by masturbation was not correlated with an expelled spurt of semen as were subsequent bursts. However, only 26 to 60% of the total number of EMG bursts were accompanied by expulsion of a spurt of semen. There thus appears to be a large safety factor in the striated muscle expulsive mechanism. Oral phenoxybenzamine treatment in 2 subjects did not significantly affect either the number of EMG bursts of the BC or the subjective pleasure of the orgasm but did significantly reduce the volume of semen expelled. Semen volume does not appear to be a unique determinant of the pleasure felt or the trigger for ejaculation.

Adult↗
PubMed1989

Standardized evaluation of erectile dysfunction in 95 consecutive patients.

We investigated 95 patients referred for erectile dysfunction by penile blood pressure measurement, the intracavernous papaverine test and Doppler investigation of the penile arteries. Furthermore, penile cutaneous perception threshold, bulbocavernosus reflex latency and somatosensory cortical evoked potentials of the pudendal nerve were measured. In selected cases cavernosometry, cavernosography and corpus cavernosum electromyography were performed. Doppler investigation of the cavernous arteries after papaverine injection was more reliable than penile blood pressure measurement in the diagnosis of arteriogenic erectile dysfunction. Decreased sensibility of the penis may be the sole factor responsible for inability to sustain an erection. Erectile dysfunction may be provoked by impaired function of the pudendal nerve. Penile cutaneous perception threshold measurement and corpus cavernosum electromyography are mandatory in the evaluation of neurogenic etiology. Cavernosometry and cavernosography are reliable methods in the determination of abnormal drainage from the corpus cavernosum.

Adult↗
PubMed1986

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

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

Adult↗
PubMed1986

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

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

Adult↗
PubMed1986

Urodynamic investigation predicts bladder dysfunction at an early stage after abdominoperineal resection of the rectum for cancer.

In a prospective study, 25 consecutive patients (14 men and 11 women) who underwent abdominoperineal resection of the rectum were urodynamically investigated before surgery and 10 days, one month, and three months after the operation. Nine men and three women (48% and 95% confidence limits; range 28% to 69%) developed voiding disturbances 10 days after the operation. One man and one woman developed incomplete lower motor neuron lesion (8% and 95% confidence limits; range 1% to 26%). At follow-up 3 months after surgery, five patients (20% and 95% confidence limits; range 7% to 41%) had still voiding disturbances: two patients with lower motor neuron lesion and three men with bladder outlet obstruction caused by prostatic hypertrophy. The three men underwent transurethral resection of the prostate 6 months after excision of the rectum. It is concluded that the risk of neurogenic bladder and voiding dysfunction is a minor problem. Cystometry performed before removal of the vesical catheter around the tenth postoperative day will diagnose patients with neurogenic bladder dysfunction. If voiding symptoms persist beyond 3 months after the operation, further urodynamic investigations should be undertaken to find patients with bladder dysfunction not due to lesion of the peripheral parasympathetic nerves to the bladder, which could demand surgery.

Abdomen↗
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

Placebo--the drug of choice in female motor urge incontinence?

In a randomised double-blind cross-over trial of 19 females with motor urge incontinence but without bladder suspension defect, the effects of 14 days' treatment with emepronium bromide 200 mg qid, flavoxate chloride 200 mg qid or placebo qid were compared by means of micturition charts, the patients' drug preferences and evaluation of side effects. Placebo was the only drug giving rise to a statistically significant decrease in the frequency of voidings, incontinence and nocturia. Forty-seven per cent of the patients preferred placebo and side effects were less frequent during treatment with this medication. No differences could be demonstrated between the effects of emepronium bromide and flavoxate chloride. Perhaps detrusor instability is not always the main reason for the voiding dysfunction in these patients, in whom the effect of placebo was equal or superior to the effect of "active drugs" and superior to no treatment at all.

Adult↗
PubMed1983

Spastic striated external sphincter syndrome imitating recurrent urinary tract infection in females. Effect of long-term alpha-adrenergic blockade with phenoxybenzamine.

6 women with spastic striated external sphincter syndrome were studied urodynamically and subsequently treated with an alpha-adrenoceptor-blocking agent. Symptoms were abolished, and prolonged, fluctuating flow curves were nearly normalized by phenoxybenzamine, 15 mg daily, in 5 of 6 patients despite the unchanged spasticity of the external striated urethral sphincter.

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↗