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Query: UMLS:C0010200 (cough)
 23,843 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

During urethral pressure profile (UPP) studies under gradually increasing stress, the maximum urethral closure pressure decreases. This observation led to a simple urodynamic test which allows the estimation of the maximum stress (intensity of cough) tolerated by the urethra before leakage begins. The determination of this critical pressure forms the basis of the urethral incompetence scale. The urethra of a female patient can be characterized by the amplitude of this maximum stress (in cm H2O) the urethra can handle and still remain continent. The cough intensity scale has been divided into 5 segments, defining 5 degrees of urethral incompetence. The critical pressure, which determines the degree of urethral incompetence is a constant value for a given patient, provided the bladder volume is kept constant and the position of the patient during the examination is unchanged. This method establishes the functional status of the female urethra as far as its sphincteric capabilities are concerned under different stress conditions. It represents the degree of pressure transmission from the abdominal cavity to the proximal urethra during stress. It evaluates objectively the functional results of different surgical or medical therapeutic modalities to cure genuine stress incontinence. It allows a better selection of patients with unstable bladder and genuine stress incontinence who will more likely benefit from a retropubic cystourethropexy.
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PMID:Objective assessment of resistance of female urethra to stress. A scale to establish degree of urethral incompetence. 406 Apr 3

The striated musculature of the dog urethra was studied histochemically. Two main groups of muscle fibers could be identified: 1 with slow twitch oxidative fibers, which are fatigue resistant (type 1), and 1 with fast twitch fibers (type 2). The fast twitch fibers were subdivided into glycolytic (fatiguable) and oxidative glycolytic (fatigue resistant) fibers: the latter constitute 20 per cent of all fast twitch fibers. Type 1 constitutes of 35 per cent of the whole musculature and its proportion tends to decrease toward the distal end of the external urethral sphincter. From these observations we infer that type 1 fibers are likely responsible for continence at rest and that type 2 fibers are recruited in stress conditions, for example, during coughing or sneezing. Additional studies are needed to confirm this conjecture. The clinical implications of these studies for the control of incontinence, urinary retention and dyssynergic urethral sphincter are presented.
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PMID:Histochemical study of urethral striated musculature in the dog. 621 91

The effect of the alpha-adrenergic blocking agent thymoxamine by intravenous administration was studied in 25 patients with spastic paraplegia and uninhibited neurogenic bladder. By cystometry a shift to the right of the first desire to void, the threshold of the first uninhibited contraction and a reduction of the pressures of the uninhibited contractions was found, but the bladder capacity was unchanged. The urethral pressure profile studied in 10 patients showed reduction in most and the peak value in all the patients. EMG from the external urethral sphincter in five patients showed damping of anal reflexes in all cases and in basic activity and cough reflexes when appropriate for studies. The site of action on the bladder is most likely adrenergic receptors in the bladder and the unchanged bladder capacity may be related to a too-short duration of the effect of thymoxamine. The effect on the spastic striated pelvic sphincters may be central, whereas the effect on the smooth muscle may be peripheral. Feedback from the drug relaxed proximal part of the urethra to the bladder might also be of importance.
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PMID:Effect of the alpha-adrenergic blocking agent thymoxamine on the neurogenic bladder and urethra. 644 30

Time separations between cough pulses detected by microtip transducer catheters in bladder, urethra and rectum were studied in 10 healthy female volunteers, 10 genuine stress incontinents, 10 motor urge incontinents and 9 motor urge incontinents after bladder retraining. From the measurements that could be analyzed in the group of volunteers, 25 per cent showed a significant advanced onset of the pressure rise in the urethra and 50 per cent a prolonged duration of the urethral cough pulses. None demonstrated delayed onset or shortened duration compared to the vesical pulses. In the genuine stress incontinent group none of the women had an advanced urethral start whilst the motor urge incontinents had figures somewhere in between, except for a remarkable prolonged duration of the urethral cough pulse in the bladder retrained women. The data obtained can be explained by introducing, besides the passive transmission of abdominal pressure, a 2nd component actively engaged in maintaining continence.
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PMID:Time separation between cough pulses in bladder, rectum and urethra in women. 654 50

To determine the validity of the Bonney test as a prognostic screening test for urinary incontinence, the urethral and urethrovesical functions were studied under resting and stressful conditions. The characteristic similarity of changes was evident in the functional profile length, closure pressure, and cough pressure profile of the urethra during performance of the Bonney test and intentional urethral occlusion. This study clearly invalidated the Bonney test by objectively demonstrating that the Bonney test restored continence under stress of coughing by obstructing the urethra and urethrovesical junction.
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PMID:Urodynamic appraisal of the Bonney test in women with stress urinary incontinence. 668 70

A technique for video urethrocystography in women is described and evaluated from the results of examinations on 76 subjects. The patients were examined seated in the lateral position and investigations were carried out at rest, and during straining and coughing, micturition and holding-back maneuvers. Special attention was paid to the overall morphology and the position of the bladder base, the bladder neck and the urethra. Apart from the contour of the symphysis, which in some patients was difficult to identify, the various structures were easily displayed. Also the dynamics of the function of the bladder base, the bladder neck and the urethra were visualized. Almost all patients were able to carry out all parts of the examination including micturition without difficulty. TLD dosimeters in the vagina and uterus showed a low radiation dose to the ovaries.
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PMID:Dynamic urethrocystography in women. 668 61

Simultaneous urethrocystometry by means of a dual microtransducer catheter was performed according to a precise, standardized technique serially at 8, 16, 28, and 36 weeks of pregnancy and at 8 weeks post partum in 43 healthy nulliparous women. The urethral pressure profile at rest and the effect of stress (cough) on the urethral pressure profile during pregnancy and after delivery were measured. At each recording session, blood was obtained for determination of 17 beta-estradiol (E2), progesterone (P), and 17-alpha-hydroxyprogesterone (17-OH-PO). The continence parameters functional urethral length and urethral closure pressure, as well as the urethral closure pressure response to stress, did not change systematically during the course of pregnancy. Engagement of the presenting part at 36 weeks did not influence the urethral pressure profile measurements. Alterations in hormone levels during pregnancy were not correlated with the changes in urethral pressure profile measurements. Both urethral pressure and length parameters in all women who underwent vaginal delivery were notably decreased 8 weeks post partum when compared with early pregnancy values and with values obtained in a group of healthy nulliparous women in the follicular phase of the cycle. The decrease in length parameters was not observed in the six women in whom delivery was by cesarean section. The postpartum changes were not significantly correlated with the duration of the second stage of labor or with the presence or absence of an episiotomy. Also, no relationship with infant birth weight was found. Values of the urethral pressure profile parameters below the median value and defective transmission of pressure over the urethra were observed in almost all women who experienced stress incontinence during pregnancy and/or after delivery. These observations suggest that an inherent weakness of the urethral sphincter mechanism plays a key role in the pathogenesis of stress incontinence.
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PMID:The urethral pressure profile in pregnancy and after delivery in healthy nulliparous women. 689 Mar 13

The transmission of intra-abdominal pressures to the urethra of the healthy female is examined with respect to cough, Valsalva and holding stimuli. A new method of recording urethral pressures using a four-channel, perfused gap catheter specifically constructed for this investigation is used. The results show that the increase of urethral pressure to stimuli is magnified at the distal urethra to a significant degree. This magnification is significantly higher than that expected by direct intra-abdominal transmission. Anatomically, the focus of urethral magnification of pressures is located 2-3 mm distal to the external urethral sphincter. The data provided from this study indicate that the mechanism of action of urethral closure to stress is active and does not directly correspond to the transmission properties of the lower urinary tract to stresses. Evidence supporting this mechanism is drawn also from the differential behavior of the proximal and distal regions of the urethra to the initiation and cessation of voiding.
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PMID:Urodynamic analysis of urethral, vesical and perivesical pressure distribution in the healthy female. 718 69

The value of the patient's history, the nappy-test (urilos meter) and urethro-cystometry with microtip-transducers was analized in 125 "stressincontinent" women. We consider the results of the nappy-test together with urine loss during coughing in the erect position as an objective evidence of incontinence. On this basis, two groups of patients were formed which allowed that statistical comparison of the different urethro-cystotonometric parameters. The urethral closure pressure under stress (urethral stress profile) is still the best criterium for the diagnosis of an urethral insufficiency. We studied especially the urethral closure pressure at rest and the pressure transmission from the bladder to the urethra. Although we could prove that both these parameters were statistically more often altered in cases of "proven" incontinence (urine loss when erect and positive nappy-test) than in cases without "proven" incontinence (no urine loss when erect and negative nappy-test), the lower limits of normal could not be determined because of the broad range of confidence. The diagnostic and therapeutic consequences are discussed.
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PMID:[The importance of the sphincterometric parameters using microtip-transducers and of the urilos-nappy-test for the investigation of female urinary incontinence (author's transl)]. 718 67

A new test for detecting urethral incompetence during coughing has been used in the investigation of women with urinary incontinence. The test detects fluid descending into the urethra and the results is positive a "fluid-bridge" is established between the bladder and a test point in the urethra. For the purpose of this study the test point selected was 0.5 cm from the urethrovesical junction. Sixty-seven incontinent patients and 23 women with normal urinary control were studied. Thirty-nine of the 67 incontinent women had a positive fluid-bridge test compared with only one of the women in the control group. The difference between the test results in the 2 group was highly significant (P < 0.001). In the incontinent patients a diagnosis was made after cystometry had been performed and after the urethral closure pressure profile had been measured. In 46 (69%) of these 67 patients there was agreement between the the diagnosis made following these urodynamic investigations and the one made from the new test. The advantages and shortcomings of the new method are compared with those of other stress tests in current use.
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PMID:Detection of urethral incompetence in women using the fluid-bridge test. 719 43


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