We evaluated the cystometric and uroflowmetric effects of bethanechol chloride on non-neurogenic, non-decompensated human bladders. Statistically significant changes were measured using cystometric and uroflowmetric parameters. We discuss the indications and methods for therapy with bethanechol chloride.
Renal cell carcinoma with tumor thrombus extension into the inferior vena cava occurs in approximately 5 per cent of the cases. Despite invasion of the inferior vena cava an aggressive surgical approach for these neoplasms is recommended but prevention of a tumor thrombus pulmonary embolus during operation is necessary. Placement of a suprarenal Greenfield filter, with its ease of insertion, excellent late patency rates and minimal morbidity, has made it the procedure of choice today. Preoperative venacavography with radiopaque marking of the tumor thrombus will prevent filter displacement, malpositioning and the awkward use of intraoperative venography, while shortening operative time and minimizing patient risk.
Low dose heparin prophylaxis has proved effective in reducing postoperative thromboembolic complications in a series combining multiple types of surgical procedures. Our series comfirms its safety for transurethral operations. We recommend its use in patients with predisposing factors to thromboembolic complications.
To understand further the urodynamics of female stress urinary incontinence 6 patients with this condition were studied before and after anterior vesicopexy. The evaluation included uroflowmetry, cystometry, urethral pressure profilometry, anatomical urethral length measurement with the subject in the supine and standing positions, demonstration fo stress incontinence and cystourethroscopy. These procedures, except cystometry and cystourethroscopy, were repeated 7 days and 4 to 6 weeks postoperatively in most patients. All patients had short preoperative functional urethral lengths and standing anatomical lengths and all were lengthened after the anterior vesicopexy. The urinary flow rate demonstrated decreased peak and average flow rates 1 week postoperatively but complete recovery 4 to 6 weeks later. We believe that this study reaffirms the importance of urethral length in the pathophysiology of female stress urinary incontinence and, by demonstrating decreased flow rates in the immediate postoperative period, draws attention to the need for careful observation of voiding after catheter removal to avoid bladder decompensation. The marked improvement observed in the 4 to 6-week postoperative period reveals that anterior vesicopexy does not obstruct the urethra since no tissue posterior to the urethra is used. These urodynamic studies have proved to be valuable adjuncts in the evaluation of female stress incontinence.
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