Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0010200 (cough)
 23,843 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

A total of 67 female patients with pelvic relaxation (cystocele beyond the vaginal orifice) and with no urinary incontinence were clinically and urodynamically evaluated before and after a reconstructive surgical procedure. Of these, 24 patients had a significant decrease in abdominal pressure transmission to the urethra once the cystocele was reduced by vaginal pessary (abdominal pressure transmission ratio to urethra: bladder of less than 1.0). All 24 had a revised Pereyra procedure in addition to the cystocele repair. The other 43 patients had adequate abdominal pressure transmission to the urethra once the cystocele was reduced by vaginal pessary (abdominal pressure transmission ratio to urethra: bladder of greater than or equal to 1.0). These 43 patients underwent cystocele repair only with no surgical repair to the urethra or urethrovesical junction. Evaluation was repeated at 3 to 6 months after the operation. No patient developed urinary incontinence after operation. All 67 patients had urodynamically good abdominal pressure transmission to the urethra while coughing. Women with significant genitourinary prolapse may be continent in spite of a weak urethral sphincter because of kinking of the poorly supported urethra. Urodynamic testing can identify those women at risk of developing postoperative urinary incontinence so that prophylactic measures can be undertaken.
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PMID:Predicting postoperative urinary incontinence development in women undergoing operation for genitourinary prolapse. 336 1

The changes in urethral pressure that occur during a cough, and microtransducer measurements of urethral pressures at rest, suggest that structures extrinsic to the urethra and vesical neck influence sphincteric function. The present study examined the structure of the extrinsic continence mechanism as it relates to these physiologic observations. Serial histologic sections of the pelvic viscera made from eight female cadavers and dissections of 34 cadavers were examined. In the proximal urethra, the anterior vaginal wall is attached to the muscles of the pelvic diaphragm and to the arcus tendineus fasciae pelvis. Contraction of the pelvic diaphragm would pull the vagina against the posterior surface of the urethra, causing an increase in posteriorly measured "pressures." Support of the urethra at rest comes from both its attachment to the arcus tendineus fasciae pelvis and the resting tone of the pelvic diaphragm muscles. Two arches of striated muscle (compressor urethrae and urethrovaginal sphincter) run over the distal urethra in the region of the perineal membrane (ie, urogenital diaphragm). Activity of these muscles could compress the urethra distally, causing the urethral pressure rise that precedes and exceeds the rise in abdominal pressure during a cough and explaining asymmetry of pressure measurements in this area. Recognition of these structural relationships can help us understand urethral pressures during a cough and directional "pressure" variations seen in patients with stress incontinence. They may also contribute to the understanding of surgical failures that occur despite successful urethral suspension.
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PMID:Structural aspects of the extrinsic continence mechanism. 340 47

Cough-pressure spike differences between the urethra and bladder were compared before and after surgery that cured genuine stress incontinence in 267 women. In 97.4% of 151 patients cured by a fascia lata sling procedure, the urethralvesical cough-pressure transmission ratio was greater than 100%, and in no case was it less than 100%. In 46.6% of 116 patients cured by anterior colporrhaphy, the cough-pressure transmission ratio was greater than 100%, and in 20.7% of the 116 patients, the transmission ratio was less than 100%. The 24 women in the latter group were cured by a sufficient increase in resting intraurethral pressure (to augment the maximal intraurethral closure pressure with stress) to maintain continence with increased intra-abdominal pressure. We believe that urethral kinking at the instant of increased intra-abdominal pressure with stress produced the greater than 100% cough-pressure transmission ratio seen in 201 (75.3%) of the 267 patients cured of genuine stress incontinence.
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PMID:Intraurethral-intravesical cough-pressure spike differences in 267 patients surgically cured of genuine stress incontinence of urine. 340 48

To determine the reliability of the Marshall-Marchetti test as a diagnostic and prognostic preoperative screening test for stress urinary incontinence, the changes observed in urethral pressure profiles under resting and stressful situations were recorded and compared following varying degrees of elevation of the urethra and the urethrovesical junction. The characteristic similarity of changes was evident in the functional profile length, urethral closure pressure, and cough pressure profile of the urethra during performance of the Marshall-Marchetti test and intentional urethral occlusion. This study clearly invalidated the Marshall-Marchetti test by objectively demonstrating that the Marshall-Marchetti test restored continence under stress of coughing by occluding the urethra and the urethrovesical junction.
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PMID:Urodynamic appraisal of the Marshall-Marchetti test in women with stress urinary incontinence. 356 27

Neurophysiological measurements of the innervation of the lower urinary tract were performed on 14 female patients presenting with unexplained acute urinary retention. The method consisted of (a) static electromyography (EMG) of the anal and urethral sphincter with the patient relaxed, coughing and gripping, (b) the study of sensory thresholds on the dorsal nerve of the clitoris and in the urethra, (c) the measurement of sacral reflex latencies (SRL) from the dorsal nerve of the clitoris to the anus and urethra and from the urethra to the anus. The results showed that all 14 patients had significant defects in the innervation of their lower urinary tract. These findings suggest that a neurological explanation for acute retention in women should always be sought before making any other diagnosis.
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PMID:Sacral reflex latency in acute retention in female patients. 358 Jul 70

The cause of incontinence in a group of 11 girls (mean age 18 +/- 3 years) who had undergone internal urethrotomy during childhood was assessed. Urodynamic methods were used to characterize the detrusor, and urethral profiles were performed to identify the impact of the operation on the extrinsic and intrinsic mechanisms of urethral closure. The results show that 4 of 11 patients demonstrated detrusor instability associated with a high voiding flow rate. The average resting urethral closure pressure in all patients showed significant reduction in maximum closure pressure (62 +/- 32 cm. water) when compared to normal age-matched controls. Transmission pressures to coughing demonstrated a high percentage of transmission to the distal and mid urethra (180 +/- 20 per cent). It was concluded that the intrinsic mechanism of urethral continence as measured by the resting urethral pressure profile was compromised by the urethrotomy. However, the extrinsic mechanisms as measured by the transmission values was not affected. On the basis of these findings it is argued that internal urethrotomy compromises the closure mechanisms intrinsic to the urethra. Continence in these patients most likely is maintained by the action of extrinsic factors transmitting high closure pressures at the distal third of the urethra. Finally, it is postulated that urethrotomy patients are at increased risk for stress incontinence at an early age.
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PMID:Internal urethrotomy in girls and its impact on the urethral intrinsic and extrinsic continence mechanisms. 377 99

Ratios of the amplitudes of the pressure increments in the urethra and vagina during coughing have been measured with two types of microtransducer catheters in fixed and loose positions. The data obtained from 14 urge incontinent women clearly indicate an artifactual contribution to the cough-induced urethral pressure increment measured by a semirigid microtransducer catheter attached to a withdrawal apparatus. This contribution due to urethral movement over the microtransducer catheter is negative in the proximal urethra and positive distally and accounts for the S-shaped distribution of transmission ratios along the urethra, as has been described for continent women. Transmission ratios exceeding 100 per cent were found over at least a part of the urethra. This excess proved to be present in all four versions of measurement and consequently cannot be considered as artifactual.
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PMID:Cough-induced microtransducer movements in the urethra affecting pressure measurements. 394 22

Urethral profilmetry was performed in seven continent patients with transpubic urethroplasty. The studies were repeated in the supine and upright positions, both at rest and under the stresses of cough, bearing down, and hold maneuvers. The urethral pressure tracing of these patients is characteristically bihumped in shape. The proximal hump with a mean height of 18 cm water at rest corresponds to the prostatic plateau of normal subjects. The distal hump with a mean height of 32 cm water represents the pressure inside that segment of the bulbar urethra which had been brought into the abdomen by the transpubic operation. The average functional urethral length is 4.6 cm and on standing increased to 6.7 cm, mainly due to elongation of the distal hump. Changes in intra-abdominal pressure by cough or bearing down are transmitted along the whole functional urethral length with augmented urethral closure pressure of 57 to 61 cm water in the proximal hump and 44 to 48 cm water in the distal hump. However, contraction of the perineal musculature by hold maneuvers has no effect on the urethra of these patients. We conclude that after transpubic urethroplasty, although the distal urethral mechanism is destroyed and excluded, the new intra-abdominal position of the transposed bulbar urethra provides a new factor that supplements the bladder neck in maintaining urinary continence.
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PMID:Mechanism of continence after transpubic urethroplasty. 394 46

Urethral closure pressures are examined with respect to continence and aging. An attempt is made to interpret the inherent orientation sensitivity of microtip transducer profilometry. The transmission of cough pressures along the length of the urethra is also examined, showing that incontinence is associated with low transmission.
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PMID:Resting and stress urethral pressures as a clinical guide to the mechanism of continence in the female patient. 403 86

A Lyodura sling operation for urinary stress incontinence was performed on 36 patients. The success rate was 89%, when success was defined as absence of objective urine loss at coughing or straining, with full bladder in the upright position and during a Urilos test, at least 6 months after surgery. Full urodynamic assessment, including urethral rest and stress profiles, were performed before, and 6 months after, surgery. Success of the operation depended mainly on enhancement of urethral pressure transmission. Functional length of the urethra and maximal urethral pressure did not influence the success rate. The procedure is especially suitable in patients with some degree of uterine or vaginal prolapse.
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PMID:Urodynamic and clinical assessment of the Lyodura sling operation for urinary stress incontinence. 404 Jul 71


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