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 23,843 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The key to restoring urinary continence in the female is to raise the internal vesical neck of the bladder to a position behind the symphysis pubis. The operation which accomplishes this with the least morbidity, the most accuracy and the greatest permanency is endoscopic suspension; it is particularly applicable in patients with obesity, multiple operative failures, radiation incontinence, and severe pelvic fractures. Between December 1973 and May 1979, 203 patients underwent 211 operations with a minimum of six months of follow-up study at final review (November 1979). Twenty per cent of the patients were totally incontinent on referral, and 60 per cent lost urine with minimal activity; only 20 per cent of the patients had typical stress urinary incontinence, requiring coughing or sneezing to lose urine. Among the 203 patients, there were 188 previous operations for urinary incontinence, including 74 Marshall-Marchetti retropubic repairs. Forty-seven patients have been followed for over four years, and 156 patients have been followed for six months to four years. While 138 patients had a previous hysterectomy, 65 patients had not; the presence of the uterus did not affect the results. Urinary incontinence is not an indication for hysterectomy. Ninety-one per cent of the 203 patients were cured of their urinary incontinence by endoscopic suspension of the vesical neck. Technical advantages over the retropubic vesical neck suspensions include the use of monofilament heavy nylon (No. 2), a vaginally placed Dacron((R)) buttress to prevent tearing of the pubocervical fascia, less postoperative morbidity, minimal blood loss, functional measurements and anatomic visualization of a restored vesical neck during the operative procedure, easy access to a surgically difficult pelvis, and simultaneous repair of significant rectoceles or substantial cystoceles through the same operative field.
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PMID:Endoscopic suspension of the vesical neck for urinary incontinence in females. Report on 203 consecutive patients. 742 93

In patients with incontinence problems, endovaginal urodynamic ultrasonography is a technique which easily complements manometric examination by permitting a precise study of peri-urethral soft tissue. Use of a linear array probe under standardised conditions gives, at present, the best results. To validate the technique, it is, however, important to understand the artefacts it provokes. Thirty-four patients underwent urethral profilometry at rest and during effort with and without the ultrasonographic probe. In the patients studied, none of the classical urodynamic parameters were modified. However, in cases of narrow vaginas (distance between the arcuate ligament and the ultrasonographic probe less than 12 mm), a small increase in the maximum urethral closure pressure (5 cm H2O) could be observed. The angle between an intra-urethral cotton swab and the horizontal plane was measured at rest and during maximum coughing effort, both with and without the ultrasonographic probe. A significant reduction of the angle was observed at rest and during effort. However, since linear regression is particularly effective in modelling these two artefacts (R2 = 0.8 and 0.7), they can be considered as constants and are not bothersome in clinical practice. Abdominal ultrasound was used in 10 patients during the introduction of the endovaginal ultrasonographic probe to study its impact on the base of the bladder. A clear increase in the posterior urethro-vesical angle was observed, which was shown to be a function of the degree of probe insertion in the vagina. As this artefact was variable and could not be controlled, this angle should no longer be measured using this technique.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Study of the artefacts induced by linear array transvaginal ultrasound scanning in urodynamics. 788 71

Transvaginal sonography can show partial urinary penetration in the urethra in patients with no clinical incontinence. The Fluid Bridge Test-Pressure urodynamically demonstrates the same phenomenon. We compared these two technics in women with stress urinary incontinence (SUI). 49 patients underwent urodynamic testing and transvaginal sonography; 18 had SUI, 20 were asymptomatic postoperatively (Burch procedure) and 11 were normal controls. Urodynamics consisted of filling cystometry with saline (infusion speed: ml 70/min) using transurethral Foley catheter (n degree 14 Fr), and a profilometric-pressure Bard catheter (10 Fr); micturitional cystometry; uroflowmetry; clino- and orthostatic urethral pressure profile (UPP) (extraction speed: cm 0.5-1/sec; infusion speed: cm 1.2/min); sphincteric electromyography (EMG); FBT-P with the Bard catheter only. During extraction patients were requested to cough (stress condition). If the urethra is incompetent pressure is transmitted to the water column connected to the pressure transducer, and a "spike" is observed. A competent urethra shows little pressure variation. Ultrasound (US) equipment consisted in a General Electric (RT 3600) sonograph with an electronic transvaginal probe (7.5 MHz) inserted in a gel-lubricated condom. The probe was positioned in the vaginal vestibule in direct proximity to the urethra. Axial and coronal scannings were performed. Echo-imagings were submitted to "post-processing" on US recording equipment. Fluid penetration in the urethra was evident if iperchogenic "turbulence" was observed on playback of the dynamic sonogram on a videocassette recorder (VCR) connected to the sonograph. The SUI group shows leakage of water under stress without detrusorial activity and dynamic UPP with reduced transmission of abdominal pressure on the urethra.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Ultrasonographic and urodynamic evaluation in stress incontinence]. 812 98

Rises in intra-abdominal pressure are common and are accompanied by reflex contraction of the external sphincter. Voluntary contraction of the sphincter is an uncommon event but is routinely used as a measure of sphincter strength. Cough pressure and squeeze pressure were compared in 75 patients using a 4 channel perfused catheter (3 anal and 1 rectal side-hole). Maximum anal cough pressure was higher than squeeze pressure (mean 158 vs 133 cm H2O, P = 0.0015). Intra-individual variance was less using cough pressure (mean 20% vs 29%, P = 0.005). There was significant overall correlation between cough pressure and squeeze pressure (P < 0.001) although in some cases there were wide differences, suggesting that use of both cough and squeeze pressure in manometry will assess sphincter strength more reliably. Measurement of the recto-anal pressure gradient during coughing correlated significantly better with degree of incontinence than cough or squeeze pressure (P = 0.005). The presence of a positive gradient was 100% specific for incontinence but the sensitivity was only 43% suggesting that factors other than simple mechanical sphincter weakness are involved in incontinence. Measurement of cough pressure has both clinical and research importance and should be added to standard manometric protocols.
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PMID:The cough response of the anal sphincter. 816 97

To estimate the probabilities of complications and follow-up treatment, a sample of Medicare patients who underwent radical prostatectomy (1988 through 1990) was surveyed by mail, telephone, and personal interview. Respondents reported their current status with respect to continence and sexual function as well as post-surgical treatments they had had to treat residual or recurrent cancer or surgical complications. Over 30 percent reported currently wearing pads or clamps to deal with wetness; over 40 percent said they drip urine when they cough or when their bladders are full; 23 percent reported daily wetting of more than a few drops. About 60 percent of patients reported having no full or partial erections since their surgery, and only 11 percent had any erections sufficient for intercourse during the month prior to the survey. Six percent had surgery after the radical prostatectomy to treat incontinence; 15 percent had treatments or used devices to help with sexual function; 20 percent report having had post-surgical treatment for urethral strictures. In addition 16 percent, 22 percent, and 28 percent reported follow-up treatment for cancer (radiation or androgen deprivation therapy) at two, three, and four years after radical prostatectomy. These estimates of complication and follow-up treatment rates are generally higher, and almost certainly more representative for older men, than estimates previously published. Patients and physicians may want to weight heavily the complications and need for follow-up treatments when considering radical prostatectomy for prostate cancer.
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PMID:Patient-reported complications and follow-up treatment after radical prostatectomy. The National Medicare Experience: 1988-1990 (updated June 1993). 825 94

Involuntary urinary leakage due to a rise in abdominal pressure caused by stress (cough, laugh, change in position, walking, running or carrying heavy weight) is a clinical entity often experienced by women. Management can be based on physical therapy techniques, drugs or surgery but indications and results to be expected are still very largely debated. Cure of an underlying condition such as obesity, or chronic bronchitis may be sufficient in some cases and others may benefit from "preventive" physical therapy to reinforce the perineum after difficult pregnancy and delivery. Alpha-stimulating drugs have also been proposed to increase sphincter tone. Surgery gives the best results. Several procedures have been proposed, usually based on classical retropubic colposuspension and aponevrosis loops. Success rate is approximately 80 to 90% although the lack of a sufficient understanding of the underlying mechanism involved, makes it impossible to predict outcome. Results in women with recurrent incontinence are less satisfactory.
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PMID:[Treatment of stress urinary incontinence in women]. 854 51

Transvaginal sonography has become an invaluable technique for examining the uterus, adnexa, and other nongynecologic structures in the pelvis because it provides better spatial resolution than transabdominal sonography [1]. Transvaginal sonography is a technique that complements manometric urodynamic examination by permitting a precise study of periurethral soft tissue. However, the principal disadvantage of transvaginal sonography is the distortion it provokes in vesicourethral anatomy [2]. Furthermore, transvaginal sonography cannot be used in small girls, virgins, and women with narrow vaginas, nor can it be used in assessing incontinence and other voiding dysfunctions because of direct effects on the physiology of the urinary tract caused by the probe itself [3]. Translabial sonography, which we have routinely used since 1990 [4], is an excellent alternative means of examination for these patients and for disorders of the lower urogenital tract. We have used translabial sonography in different types of incontinence. To learn more about the physiology of micturition, using translabial sonography, we let patients micturate not only in a recumbent position but also standing while straining and coughing. The latter position simulates a provocative cystometry. In this paper, we describe the translabial sonographic technique and some of the disorders we have encountered.
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PMID:Translabial sonography in evaluating the lower female urogenital tract. 863 42

We discontinued temporarily an infusion of propofol for surgical reasons in 20 patients undergoing incontinence surgery. The patients, who had not received neuromuscular blockers, were allowed to regain consciousness to a level enabling them to cough on command, open their eyes, and identify and verbally confirm a randomly assigned digit shown on paper. Thereafter, 5-14 min after discontinuation of the propofol infusion, anaesthesia was reinstituted. Memory of the request to cough, a standard conversation and the digit shown was tested 1 h after anaesthesia and on the following day. Only 35% of patients were able to recall one or more of the stimuli presented during wakefulness or were even able to recall having been "awake", and there were very few differences in memory on the day after surgery compared with 1 h after anaesthesia. In comparison with corresponding stimuli given before anaesthesia, memory of material learned during wakefulness was significantly impaired (P < 0.0001). Thus patients temporarily capable of cognitive action during propofol anaesthesia may have no subsequent explicit recall of intraoperative events.
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PMID:Recall during intermittent propofol anaesthesia. 1646 36

This is a report on the fundamentals of perineal ultrasound examination for female incontinence. The measurement method described here enabled us to determine the position of the bladder neck, the size of the retrovesical angle beta and the occurrence of funnelling. In four different investigations, each involving at least 30 patients, we investigated the influence of examination position, bladder filling volume and pressure of the ultrasound probe against the perineum on these measurements and analyzed the difference between coughing and the Valsalva maneuver. The results showed that when the patient is standing, the bladder neck is lower than when the patient is supine. We also observed that excessive pressure on the ultrasound probe displaces the bladder neck cranially and can squeeze the urethra. Increasing the bladder filling volume does not affect the measurement values, but funnelling can be seen better with higher bladder volumes. The best overall image quality was obtained at 300 ml. A comparison between coughing and the Valsalva maneuver showed that during coughing, the bladder neck descends less and remains closer to the symphysis than with the Valsalva maneuver.
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PMID:Perineal ultrasound: determination of reliable examination procedures. 877

Twenty four patient with neurogenic bladder undergoing vesical enlargement were pre-operatively evaluated to determine the need to perform also an anti-incontinence technique. None of them had such a technique performed, so as to control whether our prediction was correct. Each patient had one or more video-urodynamic studies performed to evaluate adjustment and the likely vesical hyperreflexia, critical incontinence pressure, and the presence of leaks with cough and cervicourethral morphology at different filling times. Critical incontinence pressure and presence of contrast leaks with cough, the latter demanded with moderate intravesical pressures, have been the parameters which better predicted the likely incontinence, with reliability over 90%. With regard to myelodysplastic bladders, the study shows the relevance of the detrusor as a cause of incontinence and sustains the practice of implementing only the cervical cuff without the remaining components when the artificial sphincter is chosen as the anti-incontinence technique, when the likely cause, whether sphincter or detrusor, is unclear at the time of considering vesical enlargement.
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PMID:[Prediction of continence in patients with neurogenic bladder who will be treated with bladder augmentation]. 901 57


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