No abstract

Thirty-two male patients with mechanical or functional bladder outlet obstruction were treated by bilateral endoscopic bladder neck incision. In three cases a repeat incision was necessary. Subjective cure or improvement was obtained in 81%. Objective evaluation, including uroflowmetry and residual urine measurements, showed a similar improvement. Bladder neck incision takes only a few minutes, is simple and less traumatic than transurethral resection. The aetiology of impaired micturition and the value of urodynamic assessment are discussed and some attention devoted to the problem of post-operative retrograde ejaculation.

No abstract

A clinical study of intravesical prostaglandin E2 (PGE2) and F2 alpha (PGF2 alpha) in the treatment of 13 female patients with difficulties in emptying their bladder is reported. Urodynamic investigations were performed before and after instillation of the drug. Although 3 patients had some reduction in residual urine volume, the remainder showed no obvious change and no patient experienced subjective improvement. In 6 patients, biopsies of the vesical mucosa were taken before and after instillation in order to measure the uptake of prostaglandin by the mucosa, but no conclusions could be drawn from these measurements. Although prostaglandins are known to have contractile effects on the detrusor muscle, the results of this study suggest that intravesical PGE2 and PGF2 alpha have no therapeutic value in the treatment of voiding dysfunction and residual urine.

Anterior bladder neck incision was carried out in 32 female patients suffering from difficult, mostly incomplete, bladder emptying. All patients underwent a full urodynamic investigation with voiding cystourethrography and endoscopy. Detrusor failure was observed in 20 patients; in the remainder, a mechanical iatrogenic bladder neck obstruction was held responsible for inefficient voiding. Twenty-eight patients (56%) benefited in some degree from the procedure. Six were submitted to a repeat incision and two of them developed severe stress incontinence later on. As the results are far from promising, intermittent self-catheterisation may be proposed in some cases as an alternative to bladder neck incision for fear of incontinence. The urodynamic findings and the results of bladder neck incision, which are very different in the two sexes, are analysed. The poorer results in the female are presumably due to the decompensated state of the bladder, mostly responsible for incomplete bladder evacuation.

No abstract

42 patients with ‘unstable bladder’ were treated with flavoxate hydrochloride. A previous treatment with parasympathicolytic drugs (propantheline bromide and/or emepronium bromide) was unsuccessful. The instability of the detrusor was proven by a urodynamical investigation. Flavoxate hydrochloride is a papaverine-like smooth muscle relaxant. The results and the complications of the treatment are discussed.

We treated 63 patients with urinary symptoms associated with uninhibited detrusor contractions on cystometry by prolonged bladder distension. All patients had received drug therapy previously without success. Fourteen patients whose symptoms relapsed after a previous distension or who failed to obtain any improvement have had repeat distension. Postoperative cystometry was done in 36 cases. Only in 7 patients (19 per cent) did the unstable pattern convert to stable bladder function. The results of symptomatic assessment were dependent upon the moment of followup, since many patients had relapses. After a 3-month followup 17 per cent of the patients were cured and 19 per cent noticed some symptomatic improvement. A subjective evaluation after 1 year revealed 11 per cent cured and 21 per cent improved. The results after a second distension were even less than after prior distension. Complications included a ruptured bladder in 6 female subjects (8 per cent), 2 patients were temporarily unable to void spontaneously, while 1 patient still had atony of the bladder after 6 months of followup. Bladder distension appears to be of limited or doubtful value in the treatment of the patient with an unstable bladder. Moreover, when the high incidence of complications is considered we do not recommend this therapy to be pursued further.