The effect of penile squeeze upon bladder instability was examined in 20 males and the results compared with those of anal dilatation. An uninhibited contraction of the bladder was successfully suppressed by squeezing the glans penis in 17 out of 20 patients and by dilating the anal sphincter in 20. It is concluded that this mechanical stimulus, when given to the glans penis of a normal man suffering from bladder instability, suppresses the detrusor contraction during the contracting phase but does not affect bladder tonus during the noncontracting phase.

A clinical analysis was done on 303 patients diagnosed by urodynamic study as having an unstable bladder, which was characterized by uninhibited contraction of the detrusor without any overt neurogenic lesions. An age distribution histogram demonstrated 2 peaks: children less than 10 years old and patients between 60 and 80 years old. Sex was not significant in the children but men predominated in the adults. There were 68 children less than 15 years old with the chief complaints of enuresis (54 per cent), urge incontinence (41 per cent) and fever (25 per cent). The objective findings were vesicoureteral reflux in 29 children, urinary tract infection in 20 and distal urethral stenosis in 8. An unstable bladder type I, the occurrence of uninhibited contractions during the filling phase of cystometry, was found in 53 children (78 per cent). We noted several postures that the children characteristically used to resist unheralded urgency and to prevent urine from leaking. The main therapeutic regimen consisted of anticholinergics with or without antimicrobials. Several children underwent surgical intervention. Once the antireflux operation was performed followup with anticholinergics was of primary importance. The unstable bladders of 63 of the 68 children (93 per cent) have been controlled satisfactorily. The etiology of bladder instability is discussed for both groups of patients.

SummaryThis paper reports a 33-year-old male paraplegic (T6) who fathered a child by artificial insemination following an intrathecal injection of neostigmine. His wife was healthy and pregnancy was achieved after the 10th insemination. She delivered a mature female child weighing 3,100 g in August 1984. To our knowledge this is only the fourth successful case in the world following neostigmine injection.

2 cases of urinary retention were reported which was caused by retroverted gravid uterus and a large fibroid uterus, respectively. A chain cystourethrography and an endoscopic examination were the most informative to disclose the pathogenesis of urinary retention. Urodynamically, bladder compliance was normal without any pathological contraction. Urethral function was characterized by a shortened functional profile length.

An estimation of the weight of the benign prostatic adenoma by quantitative analysis of the urethral pressure profile has been correlated with the surgically removed specimen in 23 patients. It has been found that the length of the continence zone cane be used as an index of prostatic weight. After operation the length of the continence zone fell into the normal range of the age matched controls.