Bladder dysfunction is a common occurrence following radical hysterectomy. It is a direct consequence of the intraoperative disruption of the autonomic nerve supply to the bladder. We herein evaluated 158 patients who underwent radical hysterectomy for carcinoma of cervix in the Dept. of Obstet.-Gynecol., Seoul National University Hospital into two separate part. In Part 1,140 patients who received the surgery from Jan. 1980 to Dec 1981 were subjected to this study. The records and the follow-up results were analysed retrospectively. Immediate postoperatively, 44.7% of patients presented bladder dysfunction such as large residual urine over 100 cc and delayed perception of bladder filling sensation. In 6 month follow-up group, 15.8% of patients complained urologic symptoms such as strain. stress incontinence, urgency and sensory loss. In 1 year follow-up group, the same symptoms were persisted in 11.5% of patients. In Part 2, urodynamic test was performed in 10 patients preoperatively and 18 patients postoperatively. No differences were found between two groups except marked increase of bladder volume at the first voiding sensation. Urecholine denervation test of Lapides was done in 18 patients postoperatively and three patients revealed positive test, which means partial parasympathetic detrusor denervation. To decrease the incidence of bladder dysfunction, the use of suprapubic cystostomy, subcutaneous injection of urecholine, intermittent self catheterization are recommended rather than indwelling urethral catheter. Urodynamic test is necessary to define the nature and to manage the patients with bladder dysfunction after radical hysterectomy.
Autonomic Pathways ; Bethanechol Compounds ; Catheterization ; Catheters ; Cervix Uteri ; Cystostomy ; Denervation ; Female ; Follow-Up Studies ; Humans ; Hysterectomy* ; Incidence ; Injections, Subcutaneous ; Retrospective Studies ; Sensation ; Seoul ; Urinary Bladder* ; Urinary Catheters ; Urodynamics

Bladder dysfunction is a common occurrence following radical hysterectomy. It is a direct consequence of the intraoperative disruption of the autonomic nerve supply to the bladder. We herein evaluated 158 patients who underwent radical hysterectomy for carcinoma of cervix in the Dept. of Obstet.-Gynecol., Seoul National University Hospital into two separate part. In Part 1,140 patients who received the surgery from Jan. 1980 to Dec 1981 were subjected to this study. The records and the follow-up results were analysed retrospectively. Immediate postoperatively, 44.7% of patients presented bladder dysfunction such as large residual urine over 100 cc and delayed perception of bladder filling sensation. In 6 month follow-up group, 15.8% of patients complained urologic symptoms such as strain. stress incontinence, urgency and sensory loss. In 1 year follow-up group, the same symptoms were persisted in 11.5% of patients. In Part 2, urodynamic test was performed in 10 patients preoperatively and 18 patients postoperatively. No differences were found between two groups except marked increase of bladder volume at the first voiding sensation. Urecholine denervation test of Lapides was done in 18 patients postoperatively and three patients revealed positive test, which means partial parasympathetic detrusor denervation. To decrease the incidence of bladder dysfunction, the use of suprapubic cystostomy, subcutaneous injection of urecholine, intermittent self catheterization are recommended rather than indwelling urethral catheter. Urodynamic test is necessary to define the nature and to manage the patients with bladder dysfunction after radical hysterectomy.
Autonomic Pathways ; Bethanechol Compounds ; Catheterization ; Catheters ; Cervix Uteri ; Cystostomy ; Denervation ; Female ; Follow-Up Studies ; Humans ; Hysterectomy* ; Incidence ; Injections, Subcutaneous ; Retrospective Studies ; Sensation ; Seoul ; Urinary Bladder* ; Urinary Catheters ; Urodynamics

During the last ten years, 7.384 patients with diabetes mellitus were managed at Seoul National University Hospital. Among them 1,026 patients (13.9%) were diagnosed as diabetic neuropathy and 84 (1.1%) as diabetic neurogenic bladder with severe voiding dysfunction. We analyzed clinical informations. laboratory and radiologic findings. results of urodynamic study and treatment modalities and outcomes. Thirty one patients were eligible, including 13 men and 18 women. The mean duration of diabetes was 9.4 years before severe voiding dysfunctions developed. Significant amount of residual urine was detected in all patients ranging from 300cc to 1,900 cc. Urodynamic study was done in 16 patients, all showed flaccid neurogenic pattern with increased bladder capacity over 500cc. Bacteriuria was found in 24 patients (77.4%), including 8 mixed infections. Hydronephrosis was identified in 7 out of 11 radiologically evaluated patients. Other diabetic chronic complications were found in most of the patients. diabetic retinopathy in 24 (77.4%). nephropathy in 13 (41.9%). and peripheral neumpathy in 24 (77.4%). They were managed successfully with timed voiding and double voiding in 2 patients, and urecholine medication with or without phenoxybenzamine in 6. and intermittent catheterization in l8. Education of the patients and high suspicion and full recognition of medical persons about diabetic neurogenic bladder is necessary for decrement of the development of diabetic neurogenic bladder, for early detection and prevention of severe complication such as renal and bladder impairment.
Bacteriuria ; Bethanechol Compounds ; Catheterization ; Catheters ; Coinfection ; Diabetes Mellitus ; Diabetic Neuropathies ; Diabetic Retinopathy ; Education ; Female ; Humans ; Hydronephrosis ; Male ; Phenoxybenzamine ; Seoul ; Urinary Bladder ; Urinary Bladder, Neurogenic* ; Urodynamics

Cauda equina syndrome is characterized by urinary retention, loss of sexual function, loss of sensation in the perineal region and incontinence of feces. It had been reported by Courville, Kennedy, et al early in 1950. Since then Dripps, Vandam, Philips and others have reviewed many thousands of cases for evalustion of neurologic complications following spinal anesthesia, but there has not been a single case of permanent neurologic sequels reported. This 32 year old male with this postspinal neurologic complication was admitted to this institution on the twelveth post-operative day. His surgery had been carried out under spinal anesthesia for removal of an exostosis of the left knee at a local clinic. According to the history at the local clinic, a lumbar tap was performed at the level between L4-5, then 5% lidocaine in 5% D/W was injected into the subarachnoid space and the surgery was finished untevenfully. He developed pain in his buttocks and coccygeal region 6 hours after the surgery was done, so morphine sulfate was injected into the epidural space. After that, the pain was relieved for a while but he again started having the same pain associated with loss of sensation of the lower extremities, urinary retention, constipation and penile impotence on the 10th post-operative day. He came to this institution for 3 months with the above symptoms on the twelveth post-operative day. A cystoscopy and cystometry was done and showed a neurogenic bladder. He was treated with Urecholine for urinary retention and Dexamethasone for arachnoiditis for 2 months. He also had enemas intermittently for severe constipation and a Foley catheter was inserted. He was trained to void by himself by pressing his lower abdomen. He went home with the same symptoms after the Foley catheter was removed. The possible complications and preventions were listed in tabel l and ll. We will follow the patient.
Abdomen ; Adult ; Anesthesia, Spinal ; Arachnoid ; Arachnoiditis ; Bethanechol Compounds ; Buttocks ; Catheters ; Cauda Equina* ; Constipation ; Cystoscopy ; Dexamethasone ; Enema ; Epidural Space ; Erectile Dysfunction ; Exostoses ; Feces ; Humans ; Knee ; Lidocaine ; Lower Extremity ; Male ; Morphine ; Polyradiculopathy* ; Sacrococcygeal Region ; Sensation ; Subarachnoid Space ; Urinary Bladder, Neurogenic ; Urinary Retention

Urinary retention has been well documented as a complication of spinal anesthesia. This occurs somewhat more frequently than after general anesthesia because the bladder wall, supplied by the parasympathetic system is paralysed by local anesthetics and its fibers from S2 are very susceptihle to analgesic solution. For 5 years since 1974, 127 cases of urinary retention were recorded from 4733 cases of spinal analgesia performed at the Dong San Medical Center. The incidence of urinary retention is 2.7% in our data. In this article, two cases of prolonged urinary retention due to spinal anesthesia are described. Case l A 44 year old female was scheduled for a vaginal hysterectomy because of a prolapse of the uterine cervix. Spinal tapping was performed at L(4~5), and 16 mg of 0.4% Pontocaine was administered. The surgery was uneventful and the patient slept from Nembutal during the whole procedure. Postoperatively the patient developed retention of urine without any abnormality observed by cystoscopy, so that she was treated with urecholine orally and recovered on the 14 th postoperative day. Case ll The patient was a 39 year old female, scheduled for a cholecystectomy. Spinal analgesia was performed and the patient was put to sleep by Nembutal and the surgery was uneventful during the whole procedure. She complained of the difficulty of voiding postoperatively. She was started on urecholine 20 mg tid orally from the 7th postoperative day, then she started voiding on the 10th postoperative day. Since then there have been no problems. The mechanism and the precipitating factors are described.
Analgesia ; Anesthesia, General ; Anesthesia, Spinal* ; Anesthetics, Local ; Bethanechol Compounds ; Cervix Uteri ; Cholecystectomy ; Cystoscopy ; Female ; Humans ; Hysterectomy, Vaginal ; Incidence ; Pentobarbital ; Precipitating Factors ; Prolapse ; Spinal Puncture ; Tetracaine ; Urinary Bladder ; Urinary Retention*

The aim of the present study was to elucidate the direct effects of melatonin on bladder activity and to determine the mechanisms responsible for the detrusor activity of melatonin in the isolated rat bladder. We evaluated the effects of melatonin on the contractions induced by phenylephrine (PE), acetylcholine (ACh), bethanechol (BCh), KCl, and electrical field stimulation (EFS) in 20 detrusor smooth muscle samples from Sprague-Dawley rats. To determine the mechanisms underlying the inhibitory responses to melatonin, melatonin-pretreated muscle strips were exposed to a calcium channel antagonist (verapamil), three potassium channel blockers [tetraethyl ammonium (TEA), 4-aminopyridine (4-AP), and glibenclamide], a direct voltage-dependent calcium channel opener (Bay K 8644), and a specific calcium/calmodulin-dependent kinase II (CaMKII) inhibitor (KN-93). Melatonin pretreatment (10(-8)~10(-6) M) decreased the contractile responses induced by PE (10(-9)~10(-4) M) and Ach (10(-9)~10(-4) M) in a dose-dependent manner. Melatonin (10(-7) M) also blocked contraction induced by high KCl ([KCl]ECF; 35 mM, 70 mM, 105 mM, and 140 mM) and EFS. Melatonin (10(-7) M) potentiated the relaxation response of the strips by verapamil, but other potassium channel blockers did not change melatonin activity. Melatonin pretreatment significantly decreased contractile responses induced by Bay K 8644 (10(-11)~10(-7) M). KN-93 enhanced melatonin-induced relaxation. The present results suggest that melatonin can inhibit bladder smooth muscle contraction through a voltage-dependent, calcium-antagonistic mechanism and through the inhibition of the calmodulin/CaMKII system.
3-Pyridinecarboxylic acid, 1,4-dihydro-2,6-dimethyl-5-nitro-4-(2-(trifluoromethyl)phenyl)-, Methyl ester ; 4-Aminopyridine ; Acetylcholine ; Animals ; Benzylamines ; Bethanechol ; Calcium Channels ; Contracts ; Melatonin ; Muscle, Smooth ; Muscles ; Nocturia ; Phenylephrine ; Phosphotransferases ; Potassium Channel Blockers ; Quaternary Ammonium Compounds ; Rats ; Rats, Sprague-Dawley ; Relaxation ; Sulfonamides ; Urinary Bladder ; Urinary Bladder, Overactive ; Verapamil

OBJECTIVES: This study was designed to evaluate bethanechol's efficacy in urinary difficulty, constipation, dry mouth and blurred vision and to evaluate the bethanechol's effect on psychopathology. METHODS: Thirty-two schizophrenic patients who have been treated with antipsychotics and the total score of anticholinergic side effect of 'Rating scale for side effect (no symptom ; 0, severe ; 3)' is above 5 were assigned to three group(controlled group, bethanechol 30 mg/day group, 60 mg/day group). These patients were entered on 6 weeks open trial. Anticholinergic side effects were assessed by 'Rating scale for side effect' and psychopathology by BPRS at base, 2nd week & 4th week. After 4weeks administration of bethanechol, 30 mg/day group was increase to 60 mg/day and 60 mg/day group was decreased to 30 mg/day for 2 weeks for evaluation of dose difference. And then anticholinergic side effects were reassessed at 6th week. RESULTS: There were significant correlations between blurred vision and age. There were no significant improvement of anticholinergic side effect in placebo group but significant improvement of urinary difficulty and dry mouth in 30 mg/day group and significant improvement of urinary difficulty, constipation and dry mouth in 60 mg/day group at 4th week evaluation. In the case dose up(bethanechol 30 mg/day to 60 mg/day) for 2 weeks, dry mouth was more improved. In the case of dose down (60 mg/day to 30 mg/day), the improvements of urinary difficulty and dry mouth were sustained but constipation was aggravated. There were no BPRS changes by bethanechol administration. CONCLUSION: These findings suggest that more than 30 mg/day of bethanechol made improvements in urinary difficulty, constipation, dry mouth, when the total score of Anticholinergic side effect of 'Rating scale for side effect (no symptom ; 0, severe ; 3)' is above 5, although 60 mg/day of bethanechol was more effective than 30 mg/day. Moreover bethanechol administration does not influence psychopathology.
Antipsychotic Agents* ; Bethanechol* ; Constipation ; Humans ; Mouth ; Psychopathology

Background: Postoperative urinary retention is a commonly encountered problem after anal surgery particularly under spinal anesthesia. Bethanchol chloride, a muscarinic cholinergic receptor agonist was used to determine whether it could prevent this problem. Methods: One hundred six patients with mean age of 37+ 9 who underwent anal surgery under spinal anesthesia from January to August 2007 were included in this nonblinded randomized prospective experimental study. Forty- six patients were given bethanechol chloride 25mg/tab 1 hour post- op then another dose after 4-6 hours. Those with the urge to void but unable to do so within the hour or had hypogastric pain (VAS > 8) were immediately catheterized and the amount drain recorded. Conclusion: Although bethanechol chloride did not completely prevent the development of postoperative urinary retention, it use was associated with reduced need for the catheterization.
Human ; Adult ; BETHANECHOL ; URINARY RETENTION ; ANESTHESIA, SPINAL

VUR is usually diagnosed by standard voiding cystourethrography(VCU). However, we are sometimes puzzled not being able to find VUR on VCU in the group of patients in whom VUR is highly suspected from accompanying obvious clinical, urographic and endoscopic features. For the purpose of detecting this type of VUR or 'subclinical VUR, VCU was performed after subcutaneous injection of bethanechol chloride in 3 patients who were highly suspected of VUR and two were diagnosed as subclinical VUR . Case 1 was diagnosed left VUR(grade II ) and case 2 was diagnosed right VUR(grade II) on VCU after' subcutaneous injection of bethanechol chloride. Both underwent unilateral ureteroneocystostomy and are on follow-up. Bethanechol chloride induced voiding cystourethrography is suggested to be a highly method to detect subclinical vesicoureteral reflux.
Bethanechol* ; Follow-Up Studies ; Humans ; Injections, Subcutaneous ; Vesico-Ureteral Reflux*

PURPOSE: In a previous study increasing the extracellular clacium concentration enhanced the phasic contractile response to low frequency stimulation(2Hz) to a significantly greater degree than the enhancement of high frequency stimulation(16Hz). To investigate the sensitivity of the detrusor contractile responses to field stimulation, bethanechol and ATP in calcium free buffer, the current study was designed. MATERIALS AND METHODS: Each rabbit bladder strip of 5x10mm in size was incubated for 30 minutes in the Tyrode's solution. Individual strips were utilized to generate the response to field stimulation(2, 8 and 32Hz), bethanechol(1.0-250microM) or ATP(0.25-2mM). Upon completion of the first stimulation in Tyrode's solution, each tissue was washed 3 1.tomes at 15 minute intervals with fresh Tyrodes. At 15 minutes following the last wash, the Tyrode's solution was replaced with solution containing no calcium+1.0mM EGTA and incubated for ditional 5, 15 or 30 minutes. At the end of 5, 15 or 30-min period of tulibration a second round of field stimulation or dose-response curves to bethanechol or ATP were generated. The contractile responses were monitored via an FT03 force transducer and recorded on a Grass 7D polygraph and expressed as the g tension per 100mg of tissue. RESULTS: (1) Progressive decrease in both basal tension and spontaneous contractile activity (2) more rapid decrease in the contractile response to 2 and 8Hz field stimulation than to 32Hz stimulation (3) more rapid decrease in the contractile response to lower concentrations of bethanechol and ATP than to high concentrations (4) greater maximal inhibition of the contractile response to low concentrations of bethanechol and ATP than to high concentrations. CONCLUSIONS: These results indicated that detrusor contractility to a sub-maximal stimulation rather than maximal stimulation is more sensitive to extracellular calcium depletion.
Adenosine Triphosphate* ; Bethanechol* ; Calcium* ; Egtazic Acid ; Poaceae ; Transducers ; Urinary Bladder*