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A 59-year-old man with spinal arteriovenous malformation at L-1 level was referred to our clinic for urinary retardation and urinary protraction. Bulbocavernosus reflex (BCR) was performed at empty bladder and at the storage phase during cystometry. BCR was evoked by compressing the glans penis. The evoked reflexes were examined by palpatating the contractile responses of the bulbocavernosus muscle and bipolar surface electrodes on each side of para-perineal raphe. Evoked response of BCR couldn't be detected at empty bladder, but obvious responses of BCR were detected at about 300 ml bladder filled. For further evaluation, a concentric needle electrode was inserted into the periurethral striated muscle to examine the evoked potential of BCR. The responses were unstable at empty bladder, but stable evoked potentials were obtained at storage phase. BCR performed only at empty bladder may cause false negative result.

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BACKGROUND: The prognosis of patients with incidentally detected renal cell carcinoma is better than that of patients with symptomatic renal cell carcinoma. These incidentalomas include those discovered by ultrasonography at health check-up and those found during examinations for unrelated disease. In this study, we investigated the prognosis of the patients of the health check-up group and the unrelated disease group. METHODS: From April 1987 to March 1997, 263 patients with renal cell carcinoma were treated in our department including 166 incidentalomas (63.1%). The occasion of incidental detection was divided into 2 groups; 90 cases as health check-up group and 76 cases as unrelated disease group. RESULTS: The mean age was 52.9 +/- 9.7 years for health check-up group and 65.1 +/- 11.4 years for unrelated disease group (p < 0.01). The mean evaluated tumor size was 3.6 +/- 1.6 cm for health check-up group and 4.4 +/- 2.6 cm for unrelated disease group (p < 0.05). The survival rates were significantly different in the two groups (p < 0.01); the 5- and 10-year survival rate for health check-up group was 91.5% and 55.9%, respectively and for unrelated disease group 79.4% and 66.1%, respectively. CONCLUSION: These results suggested that examination by ultrasonography at health check-up lead to detection of smaller renal cell carcinoma and improve the prognosis further.

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PURPOSE: The change of sacral reflex activity of the striated urethral sphincter in the urine storage phase is investigated using evoked potential reaction of the bulbocavernosus reflex (BCR). METHODS: Eleven normal male subjects and 13 male patients with neurogenic bladder due to suprasacral (C3-C7) spinal cord injury (SCI patients) were investigated. Within the SCI patients, five were complete SCI and 8 were incomplete SCI. BCR was elicited by electrical stimulation of dorsal nerve of the penis, and the evoked potential of the BCR was recorded with a concentric needle electrode from the periurethral striated muscle. BCR was performed both at empty and at filled bladder respectively, and changes of the amplitudes (AMP) were examined. Moreover, the changes of AMP affected by bladder filling were compared between the normal subjects and the SCI patients. RESULTS: In both the normal subjects and the SCI patients, AMP increased at the filled bladder as compared with that of the empty bladder. In addition, the change of AMP was statistically bigger in the SCI patients (a ratio of amplitude at filled bladder/amplitude at empty bladder: 4.73 +/- 3.90) than in the normal subjects (the ratio: 1.32 +/- 0.44). CONCLUSION: Sacral reflex activity was accelerated by bladder filling in both the normal subjects and SCI patients. And the acceleration in the SCI patients was more remarkable than that in the normal subjects. In addition to the conventional evaluation of the integrity of sacral reflex arc by BCR examination, the observation of changes of BCR affected by bladder filling may provide the information for the continuity of sacral segment and supraspinal micturition center.

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This paper is concerned with the development of an artificial urethral valve driven by shape memory alloy actuators, which is attached onto the urethra of a urinary incontinence sufferer for treating the involuntary micturition. Three types of compact cylindrical valves are assembled and their opening and closing functions are examined experimentally. The updated valve is heated and opened by using the transcutaneous energy transformer consisting of a pair of flexible spiral-formed copper wire coils. The experiment using the canine urinary canal verifies that the total system of the valve and the transformer works well as an artificial sphictor muscle and controls the urinary flow through the canal appropriately.

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PURPOSE: Among spinocerebellar degeneration, syndromes categorized as multiple system atrophy (MSA) are commonly associated with neurogenic bladder, and urinary disturbances change with the disease progression. Accordingly, the changes in the urodynamic findings during the progression of the disease have been studied in the case of Olivopontocerebellar atrophy (OPCA) and OPCA type of MSA. METHODS: Urodynamic study (UDS) was performed more than twice in eight patients (5 males, 3 females, age 48-76, mean 55.0). The interval range between the first examination and follow up examination was 9-93 months (mean 42.4). UDS included cystogram, intravenous pyelography, residual urine volume, cystometry, urethral pressure profilometry, and external sphincter electromyography. RESULTS: The bladder was deformed in almost all patients with the progression of the disease, but the upper urinary tract was properly preserved. Residual urine volume tended to increase, and residual urine rate worsened significantly. The stable detrusor activity seemed to become overactive accompanied by detorusor hyperreflexia, and finally seemed to be acontractile. The normal sphincter activity seemed to become overactive accompanied by detrusor-sphincter dyssynergia, and finally complete relaxation could't be observed. CONCLUSION: These results suggest that urinary disturbance deteriorates together with other neuropathies as the disease progresses in OPCA. These patients should be continuously observed along with proper urinary management depending on the disease progression.

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PURPOSE: The aim of this study was to investigate the sacral reflex activity at the striated urethral sphincter relaxation by evoking the potential of the bulbocavernosus reflex (BCR). METHODS: 17 normal male subjects were investigated. BCR was elicited by electrical stimulation of dorsal nerve of the penis, and the evoked potential of the BCR (BCR-EP) was recorded by a concentric needle electrode at the periurethral striated muscle. In normal subjects BCR was performed at rest and during voluntary voiding. In 8 of the normal subjects electrical stimulation was increased gradually during voluntary voiding, and changes of BCR-EP were studied. 3 male patients with neurogenic bladder suffering from urinary incontinence caused by involuntary sphincter relaxation (IVSR) were also investigated. In these patients with neurogenic bladder, BCR was performed at rest and during voluntary voiding as well as during involuntary voiding. RESULTS: In the normal subjects stable BCR-EP was elicited at rest and disappeared during voluntary voiding. But a gradually increased larger stimulation clearly demonstrated BCR-EP during voluntary voiding. In 3 patients with neurogenic bladder, stable ECR-EP was elicited at rest. During involuntary voiding caused by IVSR obvious BCR-EP was also elicited, but its amplitude was slightly less than the amplitude of BCR-EP at rest. During voluntary voiding in 2 of the 3 patients BCR-EP was recognized but the amplitude was much less, and in the third patient BCR-EP could not be recognized. CONCLUSION: BCR-EP was suppressed during voluntary voiding in normal subjects, but insufficiently suppressed in the patients with neurogenic bladder. In these patients BCR-EP during voluntary voiding was suppressed more distinctly than BCR-EP during involuntary voiding due to IVSR. In urodynamic study, the detrusor contraction and the sphincter relaxation were common phenomenon in both voluntary voiding and involuntary voiding, but the difference in the degree of the BCR suppression depended on whether micturition was voluntary or involuntary. It was suggested that the measurement of BCR-EP could distinguish involuntary voiding caused by pathological urethral sphincter relaxation from voluntary voiding.

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The aim of this study is to localize the primary sensory cortex of urogenital organs in the human brain. Using a newly developed MRI-linked magnetoencephalography system, we measured somatosensory evoked magnetic fields (SEFs) for unilateral stimuli on the dorsal penile nerve (DPN), posterior tibial nerve (PTN) and median nerve (MN). In five healthy male subjects, SEFs were clearly observed. Peak latency of the first cortical components were 63.8 +/- 9.2 ms for DPN, 39.8 +/- 3.0 ms for PTN and 20.7 +/- 0.7 ms for MN stimuli. Peak amplitude of the first cortical components were 63.1 +/- 10.8 fT for DPN, 160.2 +/- 50.1 fT for PTN and 335.2 +/- 70.3 fT for MN stimuli. Isofield map for the peak latencies indicated a single dipolar pattern for DPN as well as for PTN and MN stimuli. Using a single current dipole model, all SEF sources were localized on the contralateral central sulcus to the stimuli, indicating the primary sensory cortex. The DPN sources were localized on the interhemispheric surfaces, corresponding to previous speculations by direct cerebral stimulation. This non-invasive SEF technique promises further brain functional mapping for the urogenital organs.

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Gelsolin is a calcium-activated actin-binding protein with six subdomains. The N-terminal (G1) domain is essential for actin-filament-severing activity while other domains within G2-3 position the protein on the filament side allowing G1 to sever. In order to generate reagents capable of competitively inhibiting endogenous gelsolin and, potentially, other actin filament regulatory protein, we expressed several truncates of gelsolin in Escherichia coli, and analyzed how they affected the in vitro activity of two different actin-binding proteins, gelsolin and cofilin. A Ca2+-sensitive truncate containing G2-6 inhibited the F-actin-depolymerizing activities of both gelsolin and cofilin, while a G2-3 truncate was less effective. Using two independent assays, our results support the idea that gelsolin truncates inhibit actin filament severing and do not markedly affect actin subunit dissociation kinetics. Cosedimentation assays in the presence of calcium demonstrate that the G2-6 truncate binds to F-actin more strongly than the G2-3 truncate consistent with a protection mechanism by conformational change of F-actin and/or competitive binding to actin filaments which depends upon the presence of actin filament binding domains.

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UNLABELLED: PURPOSE AND MATERIALS: Out of 84 patients with meningomyelocele repaired at birth, 14 (15. 7%) children (6 boys and 8 girls, average 8.8 year-old) who underwent cord untethering for tethered cord syndrome of delayed onset (Delayed TCS) were urologically evaluated. RESULTS: Eleven (78.5%) children were detected orthopedically by deterioration of lower extermities function and only 3 (21.5%) were detected urologically. Preoperative urodynamic study, however, revealed in 5 children aggravation of urinary tract dysfunction, including accelerated uninhibited contraction in 4, impaired bladder compliance in 3, decreased bladder capacity in 2 and recurrence of VUR in 1. Although there were no particular urinary symptom for detection of Delayed TCS, acceleration of uninhibited contraction seemed to be one of the most important findings. After untethering, deterioration or normalization of urological dysfunction was not seen. Six of 14 children had favorable clinical results, such as improvement of uninhibited contraction, increasing of bladder compliance and capacity, prolongation of dry time and disappearance of VUR. In 3 children Delayed TCS were detected by postoperative improvement of urinary tract function. Consequently, of 14 children who were evaluated preoperatively and postoperatively 8 (52. 7%) had urological impairment compatible with Delayed TCS. CONCLUSIONS: It is not easy to detect the urological deteriorations associated with Delayed TCS behind initial neuro-urological deficits. Careful and regular follow-up examinations are required to early detection of Delayed TCS. The fact that urinary tract dysfunction improved in some cases after untethering encourages aggressive surgical untehtering of Delayed TCS.

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We investigated the incidence of associated bladder tumor and prognosis in 101 cases with a pathological diagnosis of transitional cell carcinoma, selected from those with renal pelvic and ureteral tumor whom we had encountered over the 18 years between April 1976 and March 1993. Among these 101 cases, the incidence of associated bladder tumor was noted in 42 (41.6%), 23 (22.8%) with coexistence and 19 (18.8%) with subsequence. As for the primary site of renal pelvis and ureter, the coexistence was 15.4% and subsequence 20.5% in renal pelvis, and the coexistence was 24.6% and subsequence 19.3% in ureter, and the coexistence was 60.0% and subsequence 0.0% in both renal pelvis and ureter. The incidence of coexistent bladder tumor was high in both renal pelvis and ureter, but no significant difference was noted. As for the stage, the incidence of coexistence was high in T1, while subsequence was high in T2, but no significant difference was noted. As for the grade, the incidence of coexistence was high in G2, but no significant difference was noted. The 5 year survival rate was 58.2% in those without, 54.2% with coexistence, and 82.5% with subsequent bladder tumor, with a significant difference (p < 0.05) between the last two groups. The interval of subsequent bladder tumor ranged from 4 to 164 months (mean 27.7 months), with the incidence within 2 years being approximately 70.0%. It was found that the renal pelvic and ureteral tumors are frequently associated bladder tumor while associated bladder tumor dose not appear to have an ill effect on the prognosis. Therefore it is necessary that patients with renal pelvic and ureteral tumor be observed closely for 5 years, especially for the initial 2 years.

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We reported three cases of neurogenic bladder due to neuro-Beçhet disease. Case 1 (24-year-old male) and case 3 (54-year-old male) had complaint of urinary frequency and urinary incontinence. Case 2 (35-year-old male) had a complaint of urinary retention. Uro-dynamic study were performed repeatedly in each case. Two cases showed overative detrusor activity in storage phase and normal or hypo detrusor activity in voiding phase. One case (case 2) showed normal detrusor activity in storage phase and acontractile in voiding phase. All cases showed detrusor-sphincter dyssynergia (DSD). All cases were managed with clean intermittent catheterization. Six months later case 2 complained of urge incontinence. Repeated uro-dynamic study revealed that bladder function changed from normal detrusor to overactive detrusor in storage phase. These findings suggest that neurogenic bladder due to neuro-Beçhet disease is characterized uro-dynamical by overactive detrusor in storage phase and DSD in voiding phase.

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The effect of oral administration of Streptococcus faecalis BIO-4R, an antibiotic-resistant lactic acid bacterium, on the intestinal flora of weanling piglets and cows reared on antibiotic-containing diet was investigated. Fourteen days after administration of the bacteria, the intestinal flora of the piglets was examined. Animals of the administered group had stabilized lactic flora such as bifidobacteria, streptococci, and lactobacilli, whereas most animals of control group had reduced lactic flora. On the other hand, abundant yeasts were detected from the cecum, colon, and feces of the control animals, but the levels were significantly lower in the animals given strain BIO-4R. The density of Salmonella in the intestine appeared to be reduced after the administration of strain BIO-4R. The number of BIO-4R cells was shown to be 10 times lower in the duodenum and jejunum than in the ileum, suggesting that strain BIO-4R might have grown transiently in the ileum. The similar trend toward stabilization of the lactic flora was also observed in cows after administration of BIO-4R. In addition, an antagonistic effect of the strain against yeasts and Salmonella was suggested. These findings indicate that the oral administration of strain BIO-4R is one of the useful methods whereby the potentially deleterious effect of antibiotics on the intestinal flora of farm animals may be minimized.

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The growth-inhibitory effects of Bacillus natto and Streptococcus faecalis on Canida albicans were investigated. When inoculated into the filtrate of a long-term culture of B. natto strain BN (BN), a stock culture of C. albicans RIMD 0301020 lost its viability completely, whereas C. albicans RIMD 0301011, a fresh isolate from a clinical source, did not. In continuous flow (CF) culture the growth of both strains of C. albicans was suppressed by mixed cultivation with BN. On the other hand, in classical batch culture BN did not suppress the growth of C. albicans. S. faecalis BIO-4R, a multi-drug resistant strain, was also antagonistic to C. albicans RIMD 0301011 but symbiotic with BN in CF culture. These findings suggest that BN in concert with S. faecalis BIO-4R may inhibit the growth of C. albicans in the intestinal tract.

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