1 In order to characterize P2-purinoceptor(s) in human urinary bladder the contractile effects of ATP and its slowly-hydrolyzable analogues m,-methylene ATP (m,P-MeATP) and P,y-methylene ATP (P,yMeATP) were investigated on human detrusor strips taken from patients undergoing cystectomy for bladder carcinoma.2 Serial concentration-response curves (SCRC) for ATP, a,-MeATP and ,Iy-MeATP were constructed with an interval of 25 min between two successive doses to avoid tachyphylaxis. ATP (10 gM-10 mM) induced a phasic contraction, which was very rapid in onset. The dose-response curve to ATP appeared not to be monophasic: at the lower concentrations (10-300pM) the curve was shallow, whilst at high concentrations (1-10 mM) the curve was steeper. The magnitude of the response obtained at the highest concentration tested (10 mM) was only 21.1 ± 2.8% (mean ± s.e.mean; n = 4) of the KCI (100 mM)-induced contraction.3 a,4-MeATP (O.3 IM-1 mM) and ,y-MeATP (10 M-1 mM) elicited a phasic contraction with a time course similar to that exhibited by ATP. The magnitude of the response obtained at the highest concentration tested (1 mM) was 70.3 ± 6.3% for a,P-MeATP (n = 10) and 27.9 ± 4.5% for ,7y-MeATP (n = 8) of KCl (100 mM)-induced contraction. The rank order of potency was MP-MeATP>P,7y-MeATP>ATP. A plateau of response could not be achieved by any of these agonists. 4 The P2-purinoceptor antagonist, suramin (10-300 tM), dose-dependently antagonized only the lower part of ax,-MeATP dose-response curve. Data were analysed in terms of dose-ratio estimated at two levels of response (10% and 35% of KC1 100 mM-induced contraction). At 10% of KCl response the Schild plot slope was 0.98 and the estimated pKB was 5.85, whereas using the dose-ratio at the 35% level of the KCl response, the Schild plot was not linear suggesting an interaction of X,1-MeATP with a heterogeneous receptor population.5 The putative P2-purinoceptor antagonist, Coomassie Brilliant Blue G (CB-G) at 0.3 and 1 llM (n = 5), shifted to the left the a,P-MeATP SCRC. The response at the highest concentration of agonist was potentiated, being equal to 78.8 ± 11.7% of the KCl (100 mM) response (n = 5). CB-G at 0.3 LM also shifted to the left the ,Iy-MeATP SCRC and significantly potentiated the response at 1 mM up to 46.3 ± 5.6% of KCl 100 mM response (n = 4).6 Pretreatment with terodotoxin (TTX) at 1 lM shifted to the left the a,P-MeATP SCRC but the response to the highest concentration of the agonist was not potentiated, being 73.6 ± 9.9% of the KCl (100 mM) response (n = 5). TTX (1I M) shifted to the left the P,7-MeATP SCRC and significantly potentiated the response at 1 mM (61.6 ± 3.1% of KCl response; n = 4). 7 The NO synthase inhibitor NW-nitro-L-arginine methyl ester (L-NAME) at 100 gM did not modify the SCRC to either tp or P,y-MeATP. 8 We conclude that in human detrusor muscle there is a heterogeneity of purinoceptors. The complex antagonism exhibited by suramin suggests the presence not only of Ph-purinoceptors but also of another contractile P2-purinoceptor s...

Objective: The efficacy and safety of using α₁-adrenergic blockers for treating primary bladder neck obstruction in young and middle-aged men was assessed as the first therapeutic step, before surgery, in a symptomatic non-neurogenic selected group of patients. Materials and Methods: From January 1995 to December 2001, primary bladder neck obstruction was diagnosed in 41 men whose average age was 43 years. All of them were evaluated by a complete clinical history, American Urological Association (AUA) symptom score index, physical examination, uroflowmetry, transabdominal ultrasound prostatic volume determination, ultrasound post-void residual determination, videourodynamics including pressure-flow analysis and upper urinary tract screening with renal ultrasound or an excretory urogram. A full daily dose of α₁-adrenergic blockers (alfuzosin or tamsulosin) was administered for at least 6 months. Successful treatment was defined as improved symptoms, voiding diary, maximum flow rate and pressure-flow parameters. Patients who did not gain improvement of symptoms with pharmacological treatment were offered surgery. Results: Overall, pharmacological treatment was successful in 29/41 patients (70.7%) whereas bladder neck endoscopic incision was mandatory in 12/41 (29.3%). Conclusions: α₁-Blockers were effective and safe for treating young and middle-aged men with symptomatic bladder neck obstruction.

Purpose To assess long-term renal function and micturition pattern of males submitted to transurethral resection of the prostate (TURP) for moderate-to-severe lower urinary tract symptoms (LUTS) after renal transplantation (RT). To investigate the role of clinical and urodynamic (UD) parameters for bladder outlet obstruction (BOO) diagnosis in these patients. Methods Retrospective data analysis of ≥ 50 years old patients who underwent RT between 01/2005 and 12/2016. Patients with moderate-to-severe LUTS after RT who underwent a urologic evaluation and a UD study were included. TURP was performed in case of BOO diagnosis. Kidney function and micturition patterns were evaluated before, 3, 12, 24, 36, and 48 months after TURP. Predictors of BOO were assessed at univariable and multivariable logistic regression models. Statistical analysis was performed with STATA16. Results 233 male patients ≥ 50 years underwent RT. 71/233 (30%) patients developed voiding LUTS. 52/71 (73%) patients with moderate-to-severe LUTS underwent UD. TURP was performed in 36/52 (69%) patients, with BOO diagnosis. Median (interquartile range) follow-up was 108 (75–136) months. Maximum flow at flowmetry (Qmax), International Prostate Symptom Score and post-voided residual volume improved significantly after surgery. Serum creatinine decreased and glomerular filtration rate improved significantly at follow-up, especially when TURP was performed ≤ 6 months from RT. At the multivariable model, bladder capacity ≥ 300 mL (OR = 1.74, CI 95% 1.03–3.15, p = 0.043) and detrusor pressure at Qmax (OR = 2.05, CI 95% 1.48–3.02, p = 0.035) were the independent predictors of BOO. Conclusion RT patients with moderate-to-severe LUTS at risk for BOO and graft failure are better identified by UD than clinical parameters. Bladder capacity and voiding pressure are key for the early diagnosis of BOO.

Maintaining sufficient motility of the vagina is another advantage of 'Cupid and Psyche', avoiding as it does any negative effects on patients' later sexual activity, granting more natural motility of both uterus and vagina but resolving the prolapse.Further prospective studies comparing the long-term functional outcomes of the various HSP techniques are needed to confirm these findings.

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