We prospectively studied the effect of terazosin on bladder compliance in 12 spinal cord injured patients. All study patients had demonstrated previously poor compliance despite clean intermittent catheterization and maximum anticholinergic therapy. Patients were started on 5 mg. terazosin nightly for 4 weeks. They were evaluated with a history, physical examination, symptom score, and synchronous cystoscopy and cystometry before, during and after terazosin therapy. Detrusor compliance improved in all patients during the treatment phase. The change in bladder pressure and the safe bladder volume were statistically and clinically significant. Patients also reported fewer episodes of incontinence and dysreflexia. The improvement in compliance and continence suggests that in the spinal cord injured patient terazosin may have an effect on alpha receptors in the detrusor muscle or central effects and that improved compliance is not due to decreased outlet resistance.

A newly revised operation for controlling spasticity in cerebral palsy patients, selective dorsal rhizotomy (SDR), has the potential to affect bladder function. The goal of this multidisciplinary study is to investigate the potential change in bladder function by characterizing and comparing pre- and post-operative symptoms and bladder function, both qualitatively and quantitatively, in 34 pediatric patients over the age of three with spastic cerebral palsy as the indication for selective dorsal rhizotomy. Video urodynamics were performed in a subset of patients. Almost all patients with quadriplegia were incontinent (8/9) and none were significantly helped with bladder control. Almost half (5/11) of patients with diplegia who failed prior bladder control training were able to gain continence post-operatively. No patient experienced permanent damage to the function of their bladder. In conclusion, selective dorsal rhizotomy using the revised technique of Peacock [Peacock et al. (1987): Pediatr Neurosci 13:61-66.] appears to be safe for spastic cerebral palsy patients' bladder function. It can help decrease symptoms and improve bladder capacity and control in almost half of those symptomatic cerebral palsy patients with diplegia.

Percutaneous resection and intracavitary instillation of bacillus Calmette-Guerin (BCG) is currently being used in treatment protocols in select patients in whom the standard nephroureterectomy for upper tract transitional cell carcinoma is undesirable. However, the complications of BCG in these patients are not well defined. Among 16 patients treated in this manner 4 (25%) had asymptomatic granulomatous involvement of the renal pelvis discovered during regular followup nephroscopy and biopsy: 2 had recurrent carcinoma at discovery, whereas the other 2 remain free of disease. The significance and therapeutic consequences of BCG granulomatosis are unknown. Continued followup is necessary to identify any complications of BCG therapy.

Of 23 patients being treated with the Urolume Wallstent for bladder outlet obstruction, 4--3 with anterior urethral strictures and 1 with benign prostatic hyperplasia--required two to four stents. When placing multiple stents, there should be enough overlap to prevent the opening of a gap as the stents expand and shorten over the ensuing weeks. Use of more than 1 stent is indicated when the stricture or the prostatic urethra is longer than 3 cm or when stricture recurs beyond the end of a previously placed stent.