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Tachykinin-induced contractility of smooth muscle strips from dog bladders was studied in vitro, and the presence of substance P-like immunoreactivity and neurokinin A and neurokinin B-like immunoreactivity was examined in bladder sections. Nerve fibers with substance P-like immunoreactivity were present in the mucosa, submucosa and smooth muscle. Fibers were also found in nerves, intramural ganglia, and around blood vessels. Neurokinin A-like immunoreactivity had similar distribution, and no neurokinin B-like immunoreactivity was observed. Removal of the mucosa significantly enhanced the sensitivity and the maximum responses to the tachykinins. After removing the mucosa, the sensitivity to these tachykinins increased 0.4 to 0.5log units (p <0.02). The responses to carbachol were not altered by mucosa removal. The leftward shifts of the concentration-response curves for neurokinin A were of similar magnitude after removal of the mucosa, and after pretreatment with phosphoramidon (10 μΜ), an enkephalinase inhibitor, in the presence of mucosa. However, phosphoramidon did not alter the sensitivity of the bladder strips to neurokinin B, and slightly changed the sensitivity to substance P (0.2log units). Additional shifts of the substance P and neurokinin A curves to the left were observed in the presence of phosphoramidon when the mucosa was removed (0.6 and 0.5log units, p <0.005). The order of potency for the tachykinins (neurokinin A > substance P) was not altered by mucosa removal, addition of phosphoramidon, or both. Neurokinin A was degraded by enkephalinase located in the bladder mucosa and addition of phosphoramidon or mucosa removal resulted in an inhibition or loss of enkephalinase activity. It is concluded that the responses to neurokinin A, which acts on NK-2 type of receptors, prevail on the dog bladder.

Different principles for providing stable and durable suspension of the bladder neck and proximal urethral tissue are employed in endoscopic bladder neck suspension for female stress urinary incontinence. Six different anchor materials, some of which are currently used as tissue bolsters (anchors) for endoscopic bladder neck suspension, were implanted in the abdominal wall muscle of 45 rabbits. Tension on the anchors was measured and maintained by springs positioned between pairs of anchors. At two months evaluation, vascular graft and loops of suture retained 40% of the starting tension, while two sizes of screw anchors lost all tension. Silicone pads and kink free silicone tubing rapidly pulled through the tissue in 83% and 100% of the cases, respectively. Local tissue reaction with scar formation, physical characteristics of the anchor material (silicone, stainless steel, dacron or polypropolene) and cross sectional area of the anchor were identified as the important factors for anchor stabilization of tissue which has been repositioned under tension. (J. Urol., 142: 1361–1363, 1989)

The long-term result after transurethral resection of the prostate is not well documented. From 1981 to 1983, 84 consecutive consenting patients completed detailed symptom analysis and urodynamic examination before transurethral resection of the prostate. These studies were repeated 3 and 12 months postoperatively. Of the 84 patients 44 were interviewed at 86 months: 75% reported improvement compared to preoperative symptoms. In addition, 23 patients underwent uroflowmetry at 7 years. For this group the maximum urine flow rate remained virtually unchanged from 1 to 7 years postoperatively: 11.1 ml. per second at 1 year and 12.2 ml. per second at 7 years (9.3 ml. per second preoperatively). When uroflowmetry results from all patients undergoing testing at the various followup intervals are considered, the maximum urine flow rate was 9.5 ml. per second preoperatively, 17.0 ml. per second at 3 months and 19.6 ml. per second at 1 year. Of the 44 patients 7 (16%) underwent repeat transurethral resection of the prostate. (J. Urol., 142: 1251-1253, 1989)

The charts on 241 patients, consecutively undergoing a total of 2043 transurethral resections of bladder tumors and subsequent controls, were reviewed to find the incidence and possible causes of postoperative urethral stricture. The incidence of urethral stricture was 15% in males and 4% in females, but less than one-third were symptomatic. The strictures were found distally in the urethra in 83% of the patients and were treated with optical urethrotomy. Cumulated duration of postoperative catheterization was significantly longer and size of resectoscope used larger in patients with stricture. Repeated transurethral instrumentations may increase the risk of stricture development.

We report 2 cases of unilateral and bilateral excision of pubic bone tumors (chondrosarcoma and giant cell tumor). Postoperative stress incontinence was corrected by implantation of an artificial sphincter (AMS800) following which both patients were continent. The etiology of the incontinence was lack of bladder and urethral support, which was not correctable by bladder neck suspension procedures.