THE presence of both alpha and beta adrenergic receptors has been demonstrated in the caudal third of the pig ureter by means of the technique of Trendelenburg (Deane, 1967) and in all segments of the canine ureter by means of the isometric strip technique (Malin et al., 1968). Activation of the " dominant " alpha receptors by adrenaline and noradrenaline produces a contraction of the smooth muscle. The presence of the " recessive " beta receptors can be revealed by activating the beta receptors directly, or by blocking the alpha receptors and then activating the " unblocked " beta receptors with adrenaline or noradrenaline.It has been suggested that activation of these beta adrenergic receptors during bladder contraction may give rise to vesico-ureteric reflux. This may also account for aperistaltic distal segmental dilatation of the ureter occasionally observed in patients with uretero-vesical obstruction.The aim of this present study was to examine the human ureter to determine if both alpha and beta adrenergic receptors were present.Materials and Method.-Two methods of investigation were employed. The apparatus used by R. F. D. is as described for the Trendelenburg preparation (Trendelenburg, 1917). Specimens of lower third of human ureter were obtained fresh at operation, placed in Krebs solution and transported to the laboratory. Three preparations were obtained. Two were from males and 1 from a female. In each case the bladder was the seat of fairly advanced cancer and subsequent histology of the ureter showed cancerous infiltration.J. M. M. and S . B. used the isometric strip method of investigation (Malin et al., 1968).Specimens from all levels of human ureter were obtained at operation, placed in Locke's solution and transported to the laboratory. Twenty-two normal preparations were obtained from renal transplant donors and 57 experiments were performed.Results.-Trendelenburg's Technique.-The lengths of lower third of the human ureter responded with spontaneous contractions with Trendelenburg's technique. It is presumed that the amplitude of contraction would have been greater if the tissue had not been the seat of neoplastic infiltration. Prolonged experimentation was not possible also because of the cancerous process, the preparation becoming easily fatigued.Only the changes in length are recorded for convenience but the volume change closely followed the changes in length (Fig. 1).Adrenaline hydrochloride at a concentration of 10-5 g./ml. of the salt and L-noradrenaline bitartrate at a concentration of 10-6 g./ml. of the salt both increase the tone and frequency of contraction.Isoprenaline (isoproterenol or D, L-N-Isopropylnoradrenaline), at a concentration of 10-5 g./ml. of the base decreased the amplitude and frequency of contraction.
The incidence of chronic testicular pain following vasectomy has not been previously assessed. We have carried out a survey by postal questionnaire and telephone interview of 172 patients 4 years after vasectomy to assess the incidence of chronic testicular pain. Significant early post-operative complications occurred in 6 patients (3.5%): 2 infection, 3 haematoma and 1 orchitis. Chronic testicular discomfort was present in 56 patients (33%), considered by 26 (15%) to be troublesome but not by the other 30 (17%). Testicular discomfort related to sexual intercourse occurred in 9 cases (5%). Of the 9 patients who had sought further medical help only 2 had had further surgery (1 an epididymectomy and 1 excision of a hydrocele). Only 3 patients regretted having had the vasectomy because of chronic pain. On ultrasound examination, epididymal cysts were a common finding on both asymptomatic and symptomatic patients following vasectomy. Prior to vasectomy, all patients should be counselled with regard to the risk of chronic testicular pain.
Secondary testicular tumours are rare, but metastasis of prostatic carcinoma to the testis is being reported more frequently. While this may not reflect a true increased incidence, more cases are detected by bilateral orchiectomy. Of 916 patients with carcinoma of the prostate diagnosed and treated over a period of 10 years, 124 underwent bilateral orchiectomy. Three patients were found to have testicular metastasis, 1 being bilateral. The route of spread seems to be through the lumen and/or lymphatics of the vas deferens. Although it is a sign of advanced disease, the prognostic significance is undetermined.
Urinary tract involvement by non-Hodgkin's lymphoma is uncommon and whilst extranodal disease may be the first manifestation of NHL in 15% of patients, the primary site of origin of NHL in the urinary tract is very rare. At the time of diagnosis, apparently primary urogenital lymphoma is often widely disseminated, with a correspondingly poor prognosis.
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