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PubMed1988

Contraction of urinary bladder by central norepinephrine originating in the locus coeruleus.

Studies were performed to elucidate the role of the locus coeruleus, which is rich in norepinephrine-containing cell bodies, in vesical function using alpha-chloralose anesthetized cats. Stimulation of the locus coeruleus caused contraction of the urinary bladder, which was not affected by transection of the bilateral hypogastric nerves, but blocked by intravenous administration of hexamethonium, a ganglion blocking agent. In animals with transected hypogastric nerves, the locus coeruleus-induced contraction was inhibited by intrathecal administration of phentolamine (alpha-blocker) and prazosin (alpha 1-blocker), but not affected by intrathecal sotalol (beta-blocker) or yohimbine (alpha 2-blocker). In animals treated with reserpine, the locus coeruleus-induced contraction was enhanced by intravenous application of L-dopa, a precursor of norepinephrine. These results suggest that norepinephrine derived from the locus coeruleus activated preganglionic neurons in the sacral intermediolateral nuclei via alpha 1-receptors, thereby producing urinary bladder contraction.

Animals↗
PubMed1987

Vasoactive intestinal polypeptide in relation to penile erection in the cat evoked by pelvic and hypogastric nerve stimulation.

The hemodynamics of penile erection were elucidated in the anesthetized cat by studying volumetrically determined erectile responses of the penis and penile blood flow during frequency-graded bilateral stimulation of the pelvic and the hypogastric nerves, selectively or in combination. The study also provided information on possible neurotransmitter mechanisms. The results indicated that the erectile response is mediated by both the pelvic and hypogastric nerves, operating synergistically to evoke a seemingly maximum erection. Optimum erectile responses for either nerve system were obtained at 16 Hz and threshold responses at 0.5 to one Hz. In the presence of atropine, the erectile response to selective stimulation of the pelvic and the hypogastric nerves, respectively, were clearly curtailed, suggesting a cholinergic mechanism to be partly responsible for the diversion of blood from the penile "resistance vessels" to the cavernous bodies, possibly accomplished via the opening of vessels with a shunt-like function. However, the magnitude of the erectile response to combined pelvic and hypogastric nerve stimulation seemed to be surprisingly little affected by muscarinic blockade. Selective stimulations of the pelvic and the hypogastric nerves, respectively, were both found to cause about a five-fold increase in VIP output from the penis, coordinated in time with the local blood flow increase during erection. These data suggest a VIP-ergic neurotransmitter mechanism to be involved in penile erection in the cat, possibly controlling the dilation of the penile arterial "resistance vessels."

Animals↗
PubMed1985

Role of the sympathetic nerve in bladder and urethral sphincter function during the micturition cycle in the dog evaluated by pressure flow EMG study.

The role of the sympathetic nerve on bladder and urethral sphincter function during the whole micturition cycle, including the collecting and emptying phases, was evaluated on 10 decerebrated dogs by pressure flow EMG study. A series of experiments was performed before and after hypogastric nerve transection. In the control condition and after hypogastric nerve transection, reflex micturition with bladder contraction and spasmodic rhythmic sphincter contractions occurred. Urodynamic parameters of the micturition cycle were statistically compared between control and nerve transection experiments. Threshold volume, threshold pressure and opening pressure showed a small but significant change after nerve transection. A decrease in voided volume seems to be secondarily accompanied with a decrease in threshold volume. It seems that adrenergic nerves play a certain role in bladder function during the collecting phase of the micturition cycle.

Animals↗
PubMed1984

Vesicourethral dysfunction following pelvic visceral ablative surgery.

Management of vesicourethral dysfunction after a major extirpative pelvic visceral operation could be complex and difficult owing to the variety of partial and complete functional and anatomical derangements produced by the primary operation. We report our experience with 22 patients who suffered various types of vesicourethral dysfunctions after extirpative pelvic visceral surgery, 5 of whom had preoperative studies. The surgical procedures were abdominoperineal resection in 9 patients, proctocolectomy in 3, anterior resection of the rectum in 2 and radical hysterectomy in 8. All 22 patients underwent urodynamic evaluations. The abnormalities noted on the preoperative urodynamic evaluations in patients about to undergo extirpative pelvic visceral surgery suggest the need for routine preoperative assessment of the lower urinary tract for an accurate understanding of the postoperative changes.

Autonomic Nervous System↗
PubMed1983

The neurophysiological basis of bladder inhibition in response to intravaginal electrical stimulation.

Intravaginal electrical stimulation (IVS) induces a profound bladder inhibition and is successful in the treatment of incontinence due to detrusor instability. In this experimental study in cats, direct recordings of the efferent activity in thin hypogastric and pelvic nerve filaments to the bladder were used to analyze the neuronal mechanisms underlying this bladder inhibition. A longlasting reflex discharge, with a latency of 35 to 50 msec., was evoked in the hypogastric nerve by IVS. The reflex discharge was unaffected by imposed changes in intravesical pressure or by micturition contractions, but the response was very frequency-sensitive with an optimal transmission at about 5 Hz of stimulation. A "spontaneous" efferent activity could be recorded in the pelvic nerve filaments when the bladder pressure was elevated above 5 to 7 cm. H2O. The pelvic activity occurred in 10 to 20-second bursts, each followed by an abortive detrusor contraction. IVS of 5 to 10 Hz completely abolished this efferent pelvic activity by central inhibition. The findings are discussed in relation to the normal neuronal control of the bladder and to the clinical application of IVS.

Action Potentials↗
PubMed1997

The efficacy and complications of laparoscopic presacral neurectomy in pelvic pain.

OBJECTIVE: To evaluate the efficacy and complications of laparoscopic presacral neurectomy in pelvic pain. METHODS: We reviewed records of 655 patients receiving laparoscopic conservative surgery and laparoscopic presacral neurectomy for diagnoses including adenomyosis with dysmenorrhea (n = 55), moderate and severe endometriosis with dysmenorrhea (n = 127), minimal and mild endometriosis with dysmenorrhea (n = 208), primary dysmenorrhea (n = 99), and chronic pelvic pain with or without pathologic disease (n = 166). Pain relief was evaluated at least 12 months postoperatively. RESULTS: Pain relief was evaluated in 527 patients. Significant pain relief (no pain or mild pain requiring no medication) was found in 22 (52%) of 42 women with adenomyosis, in 75 (73%) of 103 with moderate to severe endometriosis with dysmenorrhea, in 123 (75%) of 164 with minimal to mild endometriosis with dysmenorrhea, in 64 (77%) of 83 with primary dysmenorrhea, and in 84 (62%) of 135 with chronic pelvic pain. There were four major complications (0.6%) that required further surgery, including injury of the right internal iliac artery (n = 1) and chylous ascites (n = 3). Three cases (0.5%) had laceration of the middle sacral vein controlled during laparoscopy. In addition, 485 (74%) of the 655 patients complained of constipation after laparoscopic presacral neurectomy, which was relieved easily by medication. CONCLUSION: Presacral neurectomy can be performed safely and efficiently by laparoscopy and is a valuable alternative treatment for pelvic pain.

Adolescent↗
PubMed1998

Long-term outcome of laparoscopic presacral neurectomy for the treatment of central pelvic pain attributed to endometriosis.

OBJECTIVE: To evaluate the long-term pain reduction achieved by laparoscopic presacral neurectomy. METHODS: One hundred seventy-six women with median (range) age 30 (18-45) years underwent presacral neurectomy combined with excision and vaporization of endometriotic lesions and were observed, using structured questionnaires, for up to 72 months postoperatively. The study included a convenience sample of the first 100 questionnaires returned. Forty of the women were studied for 12-23 months, and 60 for 24-72 months. The main outcome measures were reduction of pelvic pain, dysmenorrhea, and dyspareunia after surgery. RESULTS: Pelvic pain, dysmenorrhea, and dyspareunia were reportedly reduced by more than 50% in 74, 61, and 55 patients, respectively, more than 12 months after laparoscopic presacral neurectomy. More than 50% reduction in pelvic pain was reported by 69.8%, 77.3%, 71.4%, and 84.6% of the patients, respectively, with endometriosis stages I-IV, using the revised classification of the American Fertility Society. Comparatively, more than 50% reduction in dysmenorrhea was reported by 52.8% of the patients with stage I endometriosis, 68.2% with stage II, 71.4% with stage III, and 69.2% with stage IV. Reduction of dyspareunia by more than 50% was reported by 54.7% of the patients with stage I endometriosis, 50.0% with stage II, 28.6% with stage III, and 61.5% with stage IV. CONCLUSION: Long-term outcome of laparoscopic presacral neurectomy is satisfactory in the majority of patients. The stage of endometriosis is not related directly to the degree of pain improvement achieved.

Adolescent↗
PubMed1998

Mounting and brief noncontact exposure of males to receptive females facilitate reflexive erection in rats, even after hypogastric nerve section.

In three experiments, reflexive erection in male rats was facilitated by housing the males for 2 min with inaccessible sexually receptive females. In Experiment 1, males were sexually naive or experienced and received two reflexive erection tests, 1 week apart, immediately after the males were exposed to receptive females, to unreceptive females, or to no females (n = 8 per group). In both tests, experienced males exposed to estrous females had the shortest reflexive erection latencies; in Test 1 the differences among groups were of borderline significance (p = 0.057), but in Test 2 the differences among groups were highly reliable (p<0.01). Further analysis indicated that only experienced males exposed to receptive females were significantly different from other groups. In Experiment 2, sexually experienced males (n = 11) received four reflexive erection tests: after being with no female, and 0, 5, or 10 min after exposure to estrous females. As the interval between exposure and test increased, the males had progressively shorter erection latencies (p<0.01) and more intense glans erections (p<0.03). Experiments 1 and 2 may be viewed as demonstrating the psychogenic facilitation of reflexive erections. In Experiment 3, males underwent sham surgery (sham, n = 10) or bilateral transection of the hypogastric nerves (HgNx, n = 10), which are conventionally viewed as mediating psychogenic erection. After males mounted a receptive female for 5 min without intromission or had 2 min of non-contact exposure to receptive females, the males had shorter erection latencies (p<0.001) and more erections (p<0.02). These facilitative effects of pretest stimulation were unaffected by HgN transection. During copulation tests, HgNx males had longer ejaculation latencies (p<0.05) and lower intromission ratios (p<0.05), possible signs of impaired erectile function. However, in Experiment 4, other males were tested twice for reflexive erection and copulation after sham (n = 8) or HgNx (n = 9) surgery, and there were no significant effects of surgery on reflexive erection or copulatory behavior. Collectively, these experiments indicate (a) that brief noncontact exposure of sexually experienced males to estrous females facilitates reflexive erection, (b) that this facilitation increases for at least 10 min after the females are removed, and (c) that the hypogastric nerves do not mediate these facilitative effects. The evidence for a role for the HgN in copulation was inconclusive.

Animals↗
PubMed2002

Modulation of expiratory motor output evoked by chemical activation of pre-Bötzinger complex in vivo.

We have previously demonstrated that chemical stimulation of the pre-Bötzinger complex (pre-BötC) in the anesthetized cat produces either phasic or tonic excitation of phrenic nerve discharge. This region is characterized by a mixture of inspiratory-modulated, expiratory-modulated, and phase-spanning (including pre-inspiratory (pre-I)) neurons; however, its influence on expiratory motor output is unknown. We, therefore, examined the effects of chemical stimulation of the pre-BötC on expiratory motor output recorded from the caudal iliohypogastric (lumbar, L(2)) nerve. We found that unilateral microinjection of DL-homocysteic acid (DLH; 10 mM; 10-20 nl) into 16 sites in the pre-BötC enhanced lumbar nerve discharge, including changes in timing and patterning similar to those previously reported for phrenic motor output. Both increased peak amplitude and frequency of phasic lumbar bursts as well as tonic excitation of lumbar motor activity were observed. In some cases, evoked phasic lumbar nerve activity was synchronized in phase with phrenic nerve discharge. These findings demonstrate that chemical stimulation of the pre-BötC not only excites inspiratory motor activity but also excites expiratory motor output, suggesting a role for the pre-BötC in generation and modulation of inspiratory and expiratory rhythm and pattern.

Animals↗
PubMed1996

Colocalisation of NADPH-diaphorase with neuropeptides in the ureterovesical ganglia of humans.

Neurones in the ureterovesical ganglion complex provide autonomic innervation to the pelvic ureter, the ureterovesical junction and the bladder trigone. We examined the distribution and peptide co-expression pattern of nitric oxide synthase (NOS) in the human ureterovesical ganglia by combining NADPH-diaphorase histochemistry with immunoreactivity for vasoactive intestinal peptide (VIP), neuropeptide Y (NPY), and calcitonin gene-related peptide (CGRP). Less than 20% of nerve cells in the large ganglia of the ureterovesical complex were stained for NOS activity. In elderly individuals, ganglion cells regularly exhibited conspicuous morphological alterations suggestive of degenerative changes. Most of the NOS-positive cell bodies costained for VIP-immunoreactivity. A minority of NOS-expressing cells also reacted for NPY-immunoreactivity. CGRP-immunoreactivity was present in varicose terminal-like nerve fibres which were found to encircle NOS-containing perikarya. Occasionally, NOS-positive somata were surrounded by plexiform axon terminals which immunostained for VIP or NPY. We conclude that the passage of urine across the ureterovesical junction is under relaxatory control of a local nitric oxide/VIP(NPY) pathway which may be modulated by preganglionic efferent and/or primary afferent input.

Adult↗
PubMed2003

Estrogen receptors in the spinal cord, sensory ganglia, and pelvic autonomic ganglia.

Until relatively recently, most studies of the effects of estradiol in the nervous system focused on hypothalamic, limbic, and other brain centers involved in reproductive hormone output, feedback, and behaviors. Almost no studies addressed estradiol effects at the spinal cord or peripheral nervous system level. Prior to the mid-1960s-1970s, few studies examined neural components of reproductive endocrine organs (e.g., ovary or testis) or the genital organs (e.g., uterus or penis) because available data supported endocrine regulation of these structures. Over the last two decades interest in and studies on the innervation of the genital organs have burgeoned. Because of the responsiveness of genital organs to sex steroid hormones, these neural studies seeded interest in whether or not autonomic and sensory neurons that innervate these organs, along with their attendant spinal cord circuits, also are responsive to sex hormones. From the mid-1980s there has been a steady growth of interest in, and studies of the neuroanatomy, neurochemistry, neural connectivity, and neural functional aspects in reproductive organs and the response of these parameters to sex steroids. Thus, with the growth of probes and techniques, has come studies of anatomy, neurochemistry, and circuitry of sex hormone-responsive neurons and circuits in the spinal cord and peripheral nervous system. This review focuses on estrogen receptors in sensory, autonomic, and spinal cord neurons in locales that are associated with innervation of female reproductive organs.

Animals↗
PubMed2000

Recent advances in the management of the neurogenic bladder.

Proper evaluation of the neurogenic bladder remains the cornerstone for accurate management of the neurologically impaired patient. Due to the inherent progressive nature of many neurologic disorders causing bladder dysfunction and lack of targeted medical therapy, much work has been done and needs to be done to advance the management of this often-difficult patient population. This article reviews the latest advances in managing the neurogenic bladder. For ease of review, the neurogenic bladder can be divided into 2 basic categories: first, bladders that fail to empty successfully and, second, those that fail to store urine adequately. Therapy should be based on these categories because poor therapeutic results are seen when a standard treatment is prescribed for the wrong bladder condition. Given the success of other specialties (physical medicine and rehabilitation, orthopedics, and neurology) at improving and prolonging the lives of the neurologically impaired patient, the urologist has an increasing responsibility to evaluate and treat the neurogenic bladder effectively over a life span that is approaching that of the normal population.

Anastomosis, Surgical↗
PubMed2003

Benign retroperitoneal schwannoma: a case series and review of the literature.

OBJECTIVES: To present our experience with four retroperitoneal schwannomas treated by surgical excision and review the current literature. Retroperitoneal schwannomas are rare, benign tumors and infrequently present to the urologist. METHODS: From 1997 through 2002, the charts of 164 patients with a diagnosis of benign retroperitoneal soft tissue mass were reviewed. Of those, four had a pathologic diagnosis of retroperitoneal schwannoma. RESULTS: Three of the 4 patients were women, with a median age of 54 years (range 46 to 80). The average tumor size was 13.7 cm (range 8.8 to 20). All patients underwent magnetic resonance imaging, computed tomography, or ultrasonography, and 3 of the 4 patients underwent a computed tomography-guided fine needle aspiration biopsy (all were either inaccurate or inconclusive). All patients underwent complete tumor excision with free margins of resection and tolerated surgery without any complications. None of the patients have had any evidence of recurrence at a mean follow-up of 26 months (range 10 to 48). CONCLUSIONS: Retroperitoneal schwannomas are difficult to diagnose preoperatively. Computed tomography-guided fine needle aspiration biopsy does not appear to provide an accurate preoperative diagnosis. The surgical approach should focus on complete excision of the mass. Patients undergoing complete surgical resection tend to do well without evidence of early recurrence.

Aged↗
PubMed1999

History of the neurobiology of the pelvis.

The contemporary clinical management of a variety of pelvic disorders has benefited greatly from both basic science research discoveries and clinical observations in pelvic neurobiology. The foundation of this scientific discipline emanates from historical advances in the neuroanatomy and neurochemistry of the pelvic region. These advances, many of which were controversial when introduced, have served to shape currently accepted views regarding the neuroregulatory basis of pelvic functions. This report highlights the major contributions in the history of pelvic neurobiology, providing both an overview of the evolution of scientific thought in this discipline and insight into the role of this discipline in the development and practice of medicine and surgery related to the pelvic region.

Animals↗