Urethral function after cystectomy: a canine in vivo experiment.
To study the function of the pelvic floor and the isolated urethra after removal of the bladder, 5 male and 5 female mongrel dogs were used in an acute in vivo experiment. Urethral pressure changes secondary to unilateral stimulation of the pelvic and pudendal nerves were recorded. After baseline data of the intact system were documented, the following procedures were carried out: separation of the urethra from the bladder neck (prostate), nerve-sparing cystectomy (cystoprostatectomy), and cold-knife incision through the entire length of the proximal urethra. Pressure recordings were repeated after each step of surgery. Pudendal nerve stimulation resulted in rapid and large pressure rises in the distal urethra (reaction typical of striated muscle). This response remained unchanged after all three surgical steps. Pelvic nerve stimulation provoked pressure rises within the urethra of a pattern typical of smooth muscle. The findings persisted after separation of the urethra from the bladder neck (prostate) and after cystectomy, but were not observed after urethrotomy. Contractions secondary to pudendal nerve stimulation were inhibited by curare, which did not affect the reaction to pelvic nerve stimulation. Our experiments demonstrate that in the dog the continuity of bladder and urethra is not required for the function of urethral closure mechanisms. The contractile potency of the urethral smooth muscles remains intact after nerve-sparing cystectomy. We believe that problems with the baseline continence of surrogate bladders should mainly be ascribed to a lack of surgical caution in preserving the autonomic nerves of cystectomy.(ABSTRACT TRUNCATED AT 250 WORDS)
Hübner
W A
WA
Department of Urology, University of California School of Medicine, San Francisco 94143-0738.
Trigo-Rocha
F
F
Plas
E G
EG
Tanagho
E A
EA
D000818:Animals; D015653:Cystectomy / Q000009:adverse effects*; D004285:Dogs; D004558:Electric Stimulation; D005260:Female; D008297:Male; D009130:Muscle, Smooth / Q000502:physiology; D009424:Nervous System Physiological Phenomena; D011312:Pressure; D014521:Urethra / Q000502:physiology*; D001743:Urinary Bladder / Q000294:innervation; D014550:Urinary Incontinence, Stress / Q000209:etiology