The surgical treatment of detrusor instabiiity

Mundy, Anthony R.

doi:10.1002/nau.1930040413

Cited by 14 publications

(7 citation statements)

References 30 publications

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“…Hyperreflexia (uninhibited bladder con tractions) has been associated with several forms of bladder dysfunction including be nign prostatic hypertrophy, experimental outlet obstruction and neurogenic bladder [1,2]. In addition, it occurs in the absence of any known dysfunction [3][4][5], Therapies for uninhibited contractions include oral drug therapy [6][7][8], instillation drug therapy [9,10] and chemical or surgical parasympa thetic nerve ablation [11,12], All therapies are directed at decreasing bladder contractile activity.…”

Section: Introductionmentioning

confidence: 99%

Experimental Hyperreflexia: Effect of Intravesical Administration of Various Agents

et al. 1991

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In anesthetized rabbits, we can induce a significant degree of spontaneous activity in the urinary bladder by placing a ligature around the proximal portion of the external urethra. Previous studies characterized the activity as primarily reflex in nature, since intravesical hexamethonium selectively inhibited the hyperreflexia. In this current study we determined the effect of intravesical administration of a variety of compounds to inhibit the induced hyperreflexia. The following agents were tested at concentrations of 1, 10, 100 and 500 μmol/l (intravesically): verapamil, cromakalim, nifedipine, diltiazem, and atropine; lidocaine was tested in 0.05, 0.5 and 5% solutions. The results are summarized as follows: (1) Lidocaine was the most effective agent tested, virtually eliminating both the amplitude and frequency of the spontaneous activity at the lowest concentration (0.5%). (2) Verapamil and nifedipine were somewhat more potent than cromakalim and diltiazem. Atropine sulfate was the least potent, inhibiting both the amplitude and frequency of the hyperreflexia by less than 50% at 500 μmol/l. (3) In all cases, the amplitude of the spontaneous activity was inhibited to a significantly greater degree than the frequency of the spontaneous activity. (4) In general, there was no effect of any of the agents on mean arterial pressure at 1 or 10 μmol/l. At 100 and 500 μmol/l, all agents except for lidocaine and cromakalim decreased arterial pressure. These two agents produced no consistent fall in blood pressure at any concentration. In conclusion, the acute hyperreflexic (rabbit) preparation provides a highly reproducible and consistent model for the study of the effect of drugs on hyperreflexia. The data presented in this report would indicate that the intravesical administration of antispasmodic (and other) agents might provide a useful method of treatment for this condition.

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Section: Introductionmentioning

confidence: 99%

Experimental Hyperreflexia: Effect of Intravesical Administration of Various Agents

et al. 1991

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“…In general, it is believed that hyperreflexia in man is mediated primarily by a reflex con traction of the bladder through spinal or supcrspinal mechanisms, with direct hyperac tivity of the bladder tissue a minor compo nent [1][2][3][4][5]. Thus it is not clear whether the effectiveness of these agents on the sponta neous activity of isolated strips (direct hyper activity of bladder smooth muscle) is a good model for human hyperreflexia.…”

Section: Discussionmentioning

confidence: 99%

“…Uninhibited bladder contractions have been associated with a variety of detrusor dys functions including outlet obstruction, neuro genic bladders or other neurologic and nonneurogenic bladder disorders [1][2][3][4][5]. There is a clear relationship between hyperreflexia and symptoms such as urgency, frequency, noctu ria, and urinary incontinence.…”

mentioning

confidence: 99%

“…(1) Pinacidil is an effective inhibitor of hyperre flexia in the in vivo rabbit model. (2) Pinacidil is a substantially more potent inhibitor of the amplitude of the hyperreflexia than the frequency. (3) Pinacidil was substantially more potent at inhibiting the contractile response to 2-Hz stimulation than to 32-Hz stimulation, but was equally effective at inhibiting field stimulation of the bladder base and body.…”

mentioning

confidence: 99%

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Effect of Pinacidil on Spontaneous and Evoked Contractile Activity

Levin

Hayes²,

Yang³

et al. 1992

Pharmacology

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Uninhibited bladder contractions have been associated with a variety of bladder dysfunctions including outlet obstruction, neurogenic bladder, incontinence, and other neurologic and nonneurogenic bladder disorders. One class of compounds that is gaining popularity and support for the treatment of hyperreflexia is potassium channel openers, such as pinacidil and cromakalim. In general, these agents act by hyperpolarizing the smooth muscle membrane, resulting in an increase in membrane stability which in turn would be expected to inhibit spontaneous and evoked contraction. It is the purpose of this study to compare the potency and selectivity of pinacidil at inhibiting both hyperreflexia in vivo, and several forms of in vitro contractile stimulation in the rabbit. The following is a summary of the results. (1) Pinacidil is an effective inhibitor of hyperreflexia in the in vivo rabbit model. (2) Pinacidil is a substantially more potent inhibitor of the amplitude of the hyperreflexia than the frequency. Pinacidil was substantially more potent at inhibiting the contractile response to 2-Hz stimulation than to 32-Hz stimulation, but was equally effective at inhibiting field stimulation of the bladder base and body. Pinacidil was significantly more potent at inhibiting the peak response to field stimulation than the rate of tension generation. (5) Pinacidil was equally potent and effective at inhibiting the phasic and tonic components of the response to field stimulation. (6) Pinacidil was a more potent inhibitor of methoxamine stimulation of the bladder base than bethanechol stimulation of the bladder body. (7) Pinacidil was a noncompetitive or mixed inhibitor of both methoxamine and bethanechol stimulation, whereas it was a competitive inhibitor of KCl stimulation. In general, intravesical pinacidil may be useful in the treatment of hyperreflexia.

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“…including outlet obstruction, neu rogenic bladders or other neurologic and nonneurogenic bladder disorders [1][2][3][4][5]. A clear relationship exists between hyperreflexia and symptoms such as urgency, frequency, noctu ria and urinary incontinence.…”

Section: Discussionmentioning

confidence: 99%

The Effect of Terodiline on Hyperreflexia (in vivo) and the in vitro Response of Isolated Strips of Rabbit Bladder to Field Stimulation, Bethanechol and KCI

Levin

Scheiner²,

Yang³

et al. 1993

Pharmacology

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Hyperreflexia, a condition characterized by contractions of the urinary bladder, is not mediated by a micturition reflex. The contractions can be of neurogenic origin through spinal or supraspinal reflexes or of myogenic origin, independent of neuronal mediation. There is a clear relationship between hyperreflexia and symptoms such as urgency, frequency, nocturia and urinary incontinence. Therapies to reduce the presence of uninhibited bladder contractions include oral drug therapy, instillation drug therapy and parasympathetic nerve ablation. The current study characterizes the ability of terodiline to inhibit an experimental form of hyperreflexia and compares the efficacy and potency of terodiline and other agents on hyperreflexia and evoked contractions. The results can be summarized as follows: (1) terodiline inhibits the amplitude of the hyperreflexia at lower concentrations than it inhibits the frequency of hyperreflexia; (2) terodiline had no statistically significant effect on mean blood pressure at any concentration utilized; (3) terodiline had approximately the same potency for inhibition of 2 and 32 Hz stimulation for both the bladder body and base; (4) terodiline inhibited the maximum contractile response to bethanechol and also shifted the curve to the right, demonstrating that terodiline is a mixed inhibitor, and (5) terodiline was a noncompetitive inhibitor of KCI.

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The surgical treatment of detrusor instabiiity

Cited by 14 publications

References 30 publications

Experimental Hyperreflexia: Effect of Intravesical Administration of Various Agents

Experimental Hyperreflexia: Effect of Intravesical Administration of Various Agents

Effect of Pinacidil on Spontaneous and Evoked Contractile Activity

The Effect of Terodiline on Hyperreflexia (in vivo) and the in vitro Response of Isolated Strips of Rabbit Bladder to Field Stimulation, Bethanechol and KCI

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