Tachykinin- and calcitonin gene-related peptide (CGRP) immunoreactivities were localized by immunohistochemistry in the same nerves of the kidney, renal pelvis and ureter as well as in spinal ganglion cells of both the guinea-pig and man. The tachykinin and CGRP-immunoreactive nerves in the ureter were present within the smooth muscle layers, around blood vessels, close to and within the lining epithelium. The levels of neurokinin A-, substance P- and CGRP-like immunoreactivity per tissue weight, as determined by radioimmunoassay, were about 30-100-fold higher in the guinea-pig than in the human ureter, which was in good agreement with the relative density of immunoreactive nerve fibres, as seen by immunohistochemistry. Capsaicin treatment caused an almost total disappearance of both neurokinin A-, substance P- and CGRP-immunoreactive nerve fibres in the guinea-pig ureter and a 90% depletion of neurokinin A, substance P- and CGRP-like immunoreactivity, further supporting a sensory origin of these nerves. Reversed-phase high performance liquid chromatography of water extracts of the human ureter revealed the presence of neurokinin A- and eledoisin-like material using antiserum K12, which does not cross-react with substance P. Most of the CGRP-like immunoreactivity in human ureter extracts co-eluted with synthetic human CGRP. Capsaicin both caused inhibition of spontaneous motility of the human ureter in vitro and initiated contractions in some preparations. Neurokinin A and neuropeptide K potently initiated phasic contractions of the ureter, while substance P had only minor contractile effects. CGRP inhibited both spontaneous and neurokinin A-induced ureteric contractions. In conclusion, peptides with potent opposite motility effects are present in the same, presumably sensory nerves of the ureter in both the guinea-pig and man. It will be of importance to determine whether local release of neuropeptides can account for ureteric motility changes accompanying sensory nerve activation upon ureteral obstruction, by e.g. renal calculi.

Thirteen patients with advanced multiple sclerosis and urge urinary incontinence were treated with desmopressin--a synthetic analogue of antidiuretic hormone--in a double-blind cross-over study. The micturition frequency decreased significantly (p less than 0.05). Less leakage was considered valuable for daily life. Peroral medication was favourable in these patients with muscular dysfunction. Side-effects were few.

Bladder function and sexual potency were studied before and after surgery for rectal carcinoma. Urinary voiding after postoperative removal of indwelling catheter was impaired in seven of 22 men, leading to prostatic surgery in four. Two years later, eight of 16 men reported disturbed voiding, but no significant changes were found in bladder capacity, residual volume, flow rate, or detrusor pressure. Sexual potency was reduced in five of ten men, in one with retrograde ejaculation; and three did not achieve erection. Objective postoperative bladder disturbance was surprisingly rare. Symptoms of denervation were more commonly attributable to sympathetic rather than parasympathetic lesions, possibly as a result of more energetic dissection in the anteroposterior plane than along the lateral pelvic walls. No patient had total autonomic denervation. Wide indications are advocated for prostatic resection in patients who have prostatic symptoms in association with surgery for rectal carcinoma.

The long-term results of Burch colposuspension for stress urinary incontinence were evaluated in 153 women operated on in 1984-1990. At follow-up 2 months postoperatively, 88% of the women reported continence, 5% were almost continent and the failure rate was 7%. At 24 months the corresponding figures were 86.7 and 7% and 39-102 months (mean 5 years) postoperatively they were 78, 11 and 11%. There were few complications. Follow-up urodynamic investigations showed significant rise of the pressure transmission from bladder to urethra in the cured patients. Reasons for failure are discussed. For patients with low urethral closure pressure, a vaginal sling procedure is preferable to Burch operation. Burch colposuspension is safe and advisable for patients with genuine stress incontinence. Urodynamic evaluation thus should be made preoperatively, but need not to be repeated if the clinical result is good.

In the absence of infection and stone formation hydronephrosis in adults seems to be a fairly benign condition and followup should be directed mainly toward detecting these complications. Recurrent flank pain still seems to be the best indication of the need for surgery.